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Home My WebLink AboutMidwest Concrete, Inc.9835 Cottingham Rd. Peosta, IA 52068-7001 Ph: (563) 845-0947 Fax: (563) 583-1007 office@midwest-concrete.net Bid Documents Sealed Bid for Complete Construction Bid Bond FY 2021 Commercial St., Katoski Dr., and Hawkeye Rd. RT Turn Lane Reconstruction Program Contract No: 1024 City of Waterloo i.E.. March 4,2021 @1:00p«- CLERKS O —F P— MAR s^t y ..I ; t—&R q 20 1 P H 12: 56:45 M idwest Concrete Inc. 9835 Cottingham Rd. Peosta, IA 52068-7001 Ph: (563) 845-0947 Fax: (563) 583-1007 oifice@midwest-concrete.net Bid Documents Sealed Bid for Complete Construction Sealed Proposal • FY 2021 Commercial St., Katoski Dr., and Hawkeye Rd. RT Turn Lane Reconstruction Program Contract No: 1024 City of Waterloo March 4, 2021 @ 1:00 p.m. s. Y OF AIRTERI n { i ] p ar � i' a �i � ERKS i w FORM OF BID OR PROPOSAL FY 2021 COMMERCIAL ST., KATOSKI DR., AND HAWKEYIJ RD. RT TURN LANE RECONSTRUC ION PROGRAM CONTRACT NO. 1024 Honorable Mayor and City Council Waterloo, Iowa Gentlemen: 1. GITi Y OF WATERLOO, IOWA The undersigned, being a Corporation existing under the laws of the State of t v V\( .. a Partnership consisting of the following partners: , having familiarized (himself) (themselves) (itself) with the existing conditions on the project area affecting the cost of the work, and with all the contract documents listed in the Table of Contents and Addenda (if any), as prepared by the City Engineer of the City of Waterloo now on file in the office of the City Clerk, City Hall, Waterloo, Iowa, hereby proposes to furnish all supervision, technical personnel, labor, materials, machinery, tools, appurtenances, equipment, and services, including utility and transportation services required to construct and complete this FY 2021 COMMERCIAL ST., KATOSKI DR., AND HAWKEYE RD. RT TURN LANE RECONSTRUCTION PROGRAM, Contract No. 1024, all in accordance with the above -listed documents and for the unit prices for work in place for the following items and quantities: FY 2021 COMMERCIAL ST., KATOSKI DR., AND HAWKEYE RD. RT TURN LANE RECONSTRUCTION PROGRAM CONTRACT NO. 1024 BID ITEM 1 2 3 4 5 SUDAS SPECIFICATION * SEE S UPPLEMENTAL S P = SPCL PROV 2010-108-D * 2010-108-E-0 * 2010-108-G * 2010-108-H * 2010-108-1 * IDOT 2121 7 8 9 10 4020-108-A-1 * 4020-108-A-1 * 4020-108-A-1 * 4020-108-D-0 * DIVISION I - STREET RECONSTRUCTION DESCRIPTION DIVISION 2 - EARTHWORK TOPSOIL, 4 INCHES, ON OR OFF SITE EXCAVATION, CLASS 10 S UBGRADE PREPARATION S UBGRADE TREATMENT, WOVEN GEOTEXTILE S UBBASE, MODIFIED GRANULAR SHOULDER, TYPE B SUBTOTAL EARTHWORK DIVISION 4 - SEWERS AND DRAINS - STORM STORM SEWER, TRENCHED, RCP 2000D, 15 INCH STORM SEWER, TRENCHED, RCP 2000D, 12 INCH STORM SEWER,FLARED END SECTION, RCP, 2000D, 15 INCH REMOVAL OF STORM SEWER, RCP, LESS THAN OR EQUAL TO 36 INCH UNIT SY CY SY SY CY TON EST QTY 5,516.0 15,086.0 1,500.0 6,500.30 2,621.00 UNIT BID PRICE $ TOTAL BID PRICE $ �ght List LF LF EACH LF 110.0 $ gib IV 150.0 3.0 211.0 $ 311r0 $ J $ qQIRt17.`( $ itei vitio tip (C3Oict MID SUDAS SPECIFICATION * SEE DIVISION I STREET RECONSTRUCTION o BID SUPPLEMENTAL (CONTINUED) UNIT BID TOTAL BID ITEM SP SPCL PROV DESCRIPTION UNIT EST QTY PRICE PRICE DIVISION 4 SEWERS AND DRAINS STORM e o (CONTINUED) 11 4040-108-A-0 i ( SUBDRAIN, TYPE SP, 6 INCH LF 1,735.0 $ -I 5 $ j t ,O; 12 4040-108-A-0 '; .iM)Si 74 SUBDRAIN, TYPE SP, 4 INCH LF 9,834.0 $ $ SUBDRAIN OUTLETS AND CONNECTIONS, s_ 13 4040-108-D-0 2) 3C1, 2 6Z ) CMP, 6 INCH EACH 68.0 $ e $ DIVISION 6 o STRUCTURES FOR STORM SEWERS 14 6010-108-A-0 * MANHOLE, SW-401, 48" EACH 1.0 $ ;LQ' $ ;2 o 9 3 •}- -$ 15 6010-108-A-0 MANHOLE, SW-406, SHALLOW RECTANGULAR EACH 2.0 $ 36) /v, p $ 1-2zts 03 16 6010-108-B-0 h (Wrist INTAKE, SW-501, SINGLE GRATE EACH 6.0 $ 23 $ i INTAKE, SW-507, SINGLE OPEN THROAT, CURB 17 6010-108-B-0 Z44 9132, 39 INTAKE, SMALL BOX EACH 2.0 $ (IC C $ INTAKE, SW-509, DOUBLE OPEN THROAT, 18 6010-108-B-0 ligtadS MU', CURB INTAKE, SMALL BOX EACH 1.0 $ $ CONNECTION TO EXISTING INTAKE, DRAIN 19 6010-108-H-0 4r>C 1(33 TILE EACH 2.0 $ $ 20 6010-108-B-0 at, REMOVE MANHOLE OR INTAKE, STORM EACH 12.0 $ $ yeq.vz INTAKE SW-545, REMOVE AND REPLACE 21 SP #6 f % Li 4it4, W SPECIAL SHAPING AND TOP EACH 1.0 $ it $ i INTAKE, SW-545, SINGLE OPEN THROAT WITH 22 6010-108-B-0 EXTENDED OPENING EACH 1.0 $f ma $ Wi-'t .S INTAKE, SW-501, REMOVE AND REPLACE 23 6010-108-E * SaliSler BOXOUT EACH 2.0 $ 25115-r $ MINOR ADJUSTMENT, MANHOLE W/ SW-601 24 6010-108-E * TYPE A CASTING & CITY OF WATERLOO EACH 2.0 �- c:' 0289. t COVER $ MINOR ADJUSTMENT, MANHOLE W/ SW-602 * 25 6010-108-E TYPE E CASTING & CITY OF WATERLOO EACH 2.0 ��) Sv COVER $ r. $ Z.6 FURNISH AND INSTALL SW-603 TYPE R 26 SP #3 !T40'st CASTING EACH 2.0 $etiCisti$ SUBTOTAL STORM SEWER $ DIVISION 5 - WATER MAINS AND APPURTENANCES CONVERT WATER VALVE MANHOLE TO 27 SP # 4 1 c9ZIA 1o5-0xlt[ ROADBOX EACH 1.0 $ $ 28 SP # 2 WATER SERVICE KILL EACH 25.0 $ /0 £O&S $ tie (41, SUBTOTAL WATER APPURTENANCES $ DIVISION 7 e STREETS AND RELATED WORK PCC PAVEMENT 29 7010-108-A-0 try-- PAVEMENT, PCC, 8 INCH, C-4 W/ CLASS 3 AGG SY 12,761.0 $ $ ontos1' 30 7010-108-A-0 3 PAVEMENT, PCC, 9 INCH, C-4 W/ CLASS 3 AGG SY 5,432.0 $ 4 $ Igt 74910 PAVEMENT, PCC, 10 INCH, C-4 W/ CLASS 3 31 7010-108-A-0 AGG SY 920.0 $ ii0 $ cave CONCRETE MEDIAN, 6 INCH, C-4 W/ CLASS 3 32 7010-108-G AGG SY 286.5 $ $ 13YeS;(e) 33 7010-108-1-0 act, PCC PAVEMENT SAMPLES AND TESTING LS 1.0 $ $ 34 7010-3.04 COLD WEATHER CONCRETE PROTECTION SY 2,000.0 $ $ * 35 7010-3.02, J LINSEED OIL TREATMENT SY 7,000.0 $ $ 000 SUDAS SPECIFICATION *SEE DIVISION I STREET RECONSTRUCTION - BID SUPPLEMENTAL (CONTINUED) UNIT BID TOTAL BID ITEM SP o SPCL PROV DESCRIPTION UNIT EST QTY PRICE PRICE SIDEWALKS, SHARED USE PATHS AND DRIVEWAYS -1(2I 36 7030-108-A-0 REMOVAL OF SIDEWALK SY 459.6 $ i t: • `- $ 3y 7e 37 7030-108-A-0 REMOVAL OF DRIVEWAY SY 235.7 $ &(5 $ k( i ic 480.2 $ We $a)s- 21 38 7030-108-E-0 SIDEWALK, PCC C-4, 6 INCH, C-4 SY 330 , 39 7030-108-G-0 DETECTABLE WARNING SURFACE SF 70.0 $ ta $ Ket , IVA ) 202.3 $ kat $ 40 7030-108-H-1 DRIVEWAY, PAVED, PCC, 6 INCH, C-4 SY YalAtyr‘ Lies< cLi 41 7030-108-H-1 PCC, 8 INCH, C-4 SY 38.8 $ 57 $ DRIVEWAY, PAVED, , PAVEMENT REHABILITATION * SY 20,700.0 $ C• I-3 $ 04616, 42 7040-108-H-0 PAVEMENT REMOVAL, CONCRETE SUBTOTAL STREETS AND RELATED WORK $ DIVISION 8 PAVEMENT MARKINGS AND e TRAFFIC CONTROL PAVEMENT MARKINGS PAINTED PAVEMENT MARKINGS, 43 8020-108-B-0/SP#10 .�� STA 206.61 $ $ Wti}-- SOLVENT/WATERBOURNE Litt $ 44 8020-108-H-0/SP#10 PRECUT SYMBOLS AND LEGENDS EACH 21.0 $ 71 ,054q, tt` ,Styc 45 8020-108-K-0 PAINTED PAVEMENT MARKINGS, REMOVED STA 12.0 $ 1 ZL', 7:5- $ ►tare,F'S TEMPORARY TRAFFIC CONTROL 46 8030-108-A-0 TEMPORARY TRAFFIC CONTROL LS 1.0 $ `ig ete $ t9 ) AND TRAFFIC CONTROL $ SUBTOTAL PAVEMENT MARKINGS DIVISION 9 - SITE WORK AND LANDSCAPING SEEDING SEEDING, FERTILIZING HYDRAULIC SEEDING, 47 9010-108-B-0 SY 140.0 $to l- $ clocen) AND MULCHING 48 9010-108-E-0 * WARRANTY SY 100.0 $ 't'%9 $ (10- EROSION AND SEDIMENT CONTROL */ 9040-108-T-1 INLET PROTECTION DEVICE, INTERMEDIATE 49 2 � ,�~ qb $ coe $a SP#13 AND DROP IN EACH 11.0 $ 7 7 50 9040-108-T-2 23 */SP#13 $ Zia% INLET PROTECTION DEVICE, MAINTENANCE EACH 11.0 $ $ SUBTOTAL SITE WORK AND LANDSCAPING DIVISION 11 e MISCELLANEOUS CONSTRUCTION SURVEY 51 11010-108-A CONSTRUCTION SURVEY (DIVISIONS I AND II) LS 1.00 $ 140 $ igocc 0 LS 1.00 $ $ C 52 11,050-108-A-0 CONCRETE WASHOUT cQ00 EACH 4.0 $ S!C $ 515 53 PLAN SHEET 2.09 REMOVE AND REINSTALL TREE GRATES SUBTOTAL MISCELLANEOUS $ TO AL DIVISION I $ /fiv381 35 gGC SUDAS SPECIFICATION * SEE UNIT BID TOTAL BID BID SUPPLEMENTAL DIVISION II COMMERCIAL STREETSCAPE — ITEM SP o SPCL PROV DESCRIPTION UNIT EST QTY PRICE PRICE GRUBBING SUDAS 2010-108-A-0 CLEARING AND 1 UN 7.8 $ nZ, $> SUDAS 2010-108-D-0 OFFSITE TOPSOIL �!' 2 CY 28.0 $ $ SUDAS SPECIFICATION *SEE DIVISION II COMMERCIAL STREET SCAPE - BID SUPPLEMENTAL (CONTINUED) UNIT BID TOTAL BIC ITEM SP = SPCL PROV UNIT EST PRICE PRICE DESCRIPTION QTY SUDAS 2010-108-E-0 EXCAVATION, CLASS 10, WASTE cisttzto Q 3 CY 300.0 $ $ 1/ .i SUUA:• JU I U U8 1-Li SUBBASE, I`MIODIFIEU4 I 4 6qaq C1' 199.3ncg $ SUDAS 7030-108-A-0 REMOVAL OF PAVEMENT 604 g 5 SY 37.9 $ na3 $16 SUDAS 7030-108-A-0 REMOVAL OF SIDEWALK fir Co I 5-(6.1 I 6 SY 1,003.3 $ / $ SUDAS 7030-108-A-0 REMOVAL OF DRIVEWAY ZUi 7 SY 157.9 $ $ e_ SUDAS 7030-108-E-0 SIDEWALK, PCC, 6 IN.34,' t 8SY 857.6 $ t $ j cTS , 2 SUDAS 7030-108-E-0 SIDEWALK9, FCC, 8 IN. 7(e ` 21 /z 72:SI SY 16.7 $ $ SUDAS 7030-108-E-0 SIDEVVALK, COLORED PCC, 6 IN. t M 10 SY 742.2 $ a rgd $ SUDAS 7030-108-G-0 DETECTABLE WARNINGS, CAST IRON 11 SF - $ $ SUDAS 7030-108-H-0 PAVED DRIVEWAY, PCC, 6 IN. (tit Vi Sas- 12 SY 40.8 $ $ 20 (}1 SUDAS 7030-108-H-0 PAVED DRIVEWAY, PCC, 8 IN. 13 SY 1 `19.2 $ s $ ? $ 3t7 (24 PLAN POROUS PAVE 14 SF 850.0 $ 049 $ in' SUDAS 7040-108-A-0 FULL DEPTH PATCH chic 15 SY 37.9 $O $ SUDAS 8020-108-B-0 PAINTED PAVEMENT MARKINGS 30;4‘if 16 STA 5.0 $ l- $ SUDAS 8020-108-B-0 PAVEMENT MARKINGS REMOVED 17 STA 1.5 $ Ai 5t' $ 14c5 IA -DOT 2523- "L4j LIGHTING POLES, TYPE 1, STREET LIGHT n WitY0 18 0000100 EACH 10.0 $ Y-O'6t $ IA -DOT 2523- LIGHTING POLES, TYPE 2, PED LIGHTa Milo 19 0000100 EACH 20.0 $Btsie , $ PLAN REMOVAL OF LIGHT POLE FOOTINGS 20 EACH 12.0 $ 4(8 civ $ cta IA -DOT 2523- ELECTRICAL CIRCUITS 5151 21 0000200 LF 2,083.0 $/JXO$ 15 IA -DOT 2523- HANDHOLES AND JUNCTION BOXES Lice° 22 0000310 EACH 4.0 $ j (5D $ PLAN ELECTRICAL MODIFICATIONS co 23 LS 1.0 bcri- It $ I $ PLANTS WITH WARRANTY, TYPE 1, SKYLINE SUDAS 9030-108-B-0 71141/4 24 HONEYLOCUST EACH 4.0 $Cp �Y>�f $ PLANTS WITH WARRANTY, TYPE 2, SKYLINE SUDAS 9030-108-B-0 2$23I% HONEYLOCUST Of 25 EACH 4.0 $ $ PLANTS WITH WARRANTY, TYPE 3, SKYLINE SUDAS 9030-108-B-0 `6 7.-this7-31° 26 HONEYLOCUST EACH 4.0 4 PLANTS WITH WARRANTY, TYPE 1, COMMON SUDAS 9030 108-B-0 Stinieg 27 HACKBERRY EACH 12.0 $ 7tAtO $ 0 PLANTS WITH WARRANTY, TYPE 3, AUTUMN SUDAS 9030-'i 08-B-Q )Otht( ob 28 BLAZE MAPLE EACH 5.0 $ $ PLAN REMOVE AND REINSTALL TREE GRATE 29 EACH - 3C-17 PLAN INSTALL NEW TREE GRATE 1I CO30 C EACH 4.0 $ • $ 1 PLAN REMOVE AND REINSTALL BIKE RACKS 31 LS `1.0 $ 1000 $ )0CD ff.”7 q6:4"// 4, TOTAL. DIVISION II (I, r 1 ei) Contract No. 1023 Addendum No. 1 Division 11 Quantity Correction Form of Enid Page 4 of 6 TO 11 AL IMMON 11 Cu7 HIMS11 r 2/ 3/4 3Z3, 2. It is understood that the quantities set forth are approximate only and subject to variation and that the unit bid price for the work done shall govern in the actual payment to Contractor. 3. In submitting this bid, the bidder understands that the right is reserved by the City of Waterloo, Iowa, to reject any or all bids. If written notice of the acceptance of this bid is mailed, telegraphed, or delivered to the undersigned within thirty (30) days after the opening thereof, or at any time thereafter before this bid is withdrawn, the undersigned agrees to execute and deliver an agreement in the prescribed form and furnish the required bond and certificate of the insurance within ten (10) days after the agreement is presented to him for signature, and start work within ten (10) days after "Notice to Proceed" is issued. 4. Security in the sum of )intheformof 13 r7,t- t3oric - the INSTRUCTIONS TO BIDDERS. Dollars ($ , is submitted herewith in accordance with 5. Attached hereto is a Non -Collusion Affidavit of Prime Contractor. 6. Attached hereto is a Bidder Status Form. 7. The bidder is prepared to submit a financial and experience statement upon request. 8. The Prime Contractor and Subcontractor(s), which have performed an aggregate of $10,000.00 in work for the City in the current calendar year, are prepared to submit an AAP or Update and an EOC, within ten (10) days of notification that the bid submitted is lowest and acceptable. 9. The bidder has received the following Addendum or Addenda: Addendum No. 1 Date <% I L 10. The bidder shall list the MBE/WBE subcontractor(s), amount of subcontracts and bid items on the City of Waterloo Minority and/or Women Business Pre -bid Contact Information Form submitted with this Form of Bid or Proposal. The apparent low Bidder shall submit a list of all other Subcontractor(s) to be used on this Project to the City of Waterloo by 5:00 p.m. the business day following the day Bids on this Project are due along with the Non -Collusion Affidavits of All Subcontractor(s). The Contractor shall submit information on subcontractors on "SUBCONTRACTOR REQUEST AND APPROVAL" Form to be provided by City prior to approval of contract. The subcontractors listed on this proposal and/or submitted to the Contract Compliance Officer cannot be changed except for the following reasons: 1) The City of Waterloo does not approve the subcontractors. 2) The subcontractors submit in writing that they cannot fulfill their subcontracts. 11. The bidder has filled in all blanks on this proposal. Those blanks not applicable are marked "none" or "NA". 12. The bidder has attached all applicable forms. 13. The Owner reserves the right to select alternates, delete line items, and/or to reduce quantities prior to the award of a contract due to budgetary limitations. ;1‘, iti r; , 2 t c rt -1-e ir pi( -/ t , (Name of Bidder) (Date) BY: Ar Title j' f"-( ( Official Address: (Including Zip Code): ea -Win ha ty, b(AS (--a( A snee.) (p I.R.s.No. -ate/-7a---7(77 END SECTION NONCOLLUSION AFFIDAVIT OF PRIME BIDDER State of � 0 1/v °v County of DIA-- n_01 i/l,c'i' ) i )ss rATA-Alu 0,0 6c__-, -itst 1. He is (Owners Partner, Officer, Representative, or Agent) , of , the Bidder that has submitted the attached Bid; being first duly sworn, deposes and says that: VIA rictile 71-1 2. He is fully -informed respecting the preparation and contents of the attached Bid and of all pertinent circumstances respecting such Bid; 3. Such Bid is genuine and is not a collusive or sham Bid: 4. Neither the said Bidder nor any of its officers, partners, owners, agents, representatives, employees, or parties in interest, including this affiant, has in any way colluded, conspired, connived or agreed, directly or indirectly, with any other Bidder, firm or person to submit a collusive or sham Bid in connection with the Contract for which the attached Bid has been submitted or to refrain from bidding in connection with such Contract, or has in any manner, directly or indirectly, sought by agreement or collusion or communication or conference with any other Bidder, firm or person to fix the price or prices in the attached Bid or of any other Bidder, or, to fix any overhead, profit or cost element of the bid price or the bid price of any other Bidder, or to secure through any collusion, conspiracy, connivance, or unlawful agreement any advantage against the City of Waterloo, Iowa, or any person interested in the Proposed Contract; and 5. The price or prices quoted in the attached Bid are fair and proper and are not tainted by any collusion, conspiracy, connivance or unlawful agreement on the part of the Bidder or any of its agents, representatives, owners, employees, or parties in interest, including this affiant. (Signed) 1/;1511 nate 6,7* Title Subscribed and sworn to before me this 47 4-f1 day of /11/LI't17 , 20.EI N (., fAA.4};:o Title My commission expires a 41*,P' a0 AMANDA M. WESSELS a "' r Notarial Seal = State of Iowa ' '' CommissionNumber 712724 . "towr► My bn.Ei_ s 9 -at. -Ye^ Bidder Status Form To be completed by all bidders Part A Please answer "Yes" or 'No" for each of the following: Yes QNo Yes ONo sYes QNo Yes QNo Yes QNo My company is authorized to transact business in Iowa. (To help you determine if your company is authorized, please review the worksheet on the next page). My company has an office to transact business in Iowa. My company's office in Iowa is suitable for more than receiving mail, telephone calls, and e-mail. My company has been conducting business in Iowa for at least 3 years prior to the first request for bids on this project. My company is not a subsidiary of another business entity or my company is a subsidiary of another business entity that would qualify as a resident bidder in Iowa. If you answered "Yes' for each question above, your company qualifies as a resident bidder. Please complete Parts B and D of this form. If you answered "No" to one or more questions above, your company is a nonresident bidder. Please complete Parts C and D of this form. To be completed by resident bidders Part B My company has maintained offices in Iowa during the past 3 years at the following addresses: Dates: / 15 / i 1 to /( A A V (Lid- Address: ¶ g..35 Collin c,/7 ifd • City, State, Zip' Pe os fA , 1 A 5 Ulo &) Dates: / / to / / Address: City, State, Zip• Dates: / / to / / Address: You may attach additional sheet(s) if needed. City, State, Zip4 To be completed by non-resident bidders Part C 1. Name of home state or foreign country reported to the Iowa Secretary of State: 2. Does your company's home state or foreign country offer preferences to resident bidders, resident labor Q Yes Q No force preferences or any other type of preference to bidders or laborers? 3. If you answered "Yes' to question 2, identify each preference offered by your company's home state or foreign country and the appropriate legal citation. You may attach additional sheet(s) if needed. To be completed by all bidders Part D I certify that the statements made on this document are true and complete to the best of my knowledge and I know that my failure to provide accurate and truthful information may be a reason to reject my bid. Firm Name. idl w1 /i f !Write- /G'IC Signature: azim ister14 ALA/Lbi, Date: Tha r‘41 f t)U.3 % You must submit the completed form to the governmental body requesting bids per 875 Iowa Administrative Code Chapter 156. This form has been approved by the Iowa Labor Commissioner. 309-6001 (09 15) Worksheet: Authorization to Transact Business This worksheet may be used to help complete Part A of the Resident Bidder Status form. If at least one of the following describes your business, you are authorized to transact business in Iowa. Yes QNo Q Yes QNo Q Yes QNo Q Yes o My business is currently registered as a contractor with the Iowa Division of Labor. My business is a sole proprietorship and I am an Iowa resident for Iowa income tax purposes. My business is a general partnership or joint venture. More than 50 percent of the general partners or joint venture parties are residents of Iowa for Iowa income tax purposes. My business is an active corporation with the Iowa Secretary of State and has paid all fees required by the Secretary of State, has filed its most recent biennial report and has not filed articles of dissolution. My business is a corporation whose articles of incorporation are filed in a state other than Iowa, the corporation has received a certificate of authority from the Iowa secretary of state has filed its most recent biennial report with the secretary of state, and has neither received a certificate of withdrawal from the secretary of state nor had its authority revoked. My business is a limited liability partnership which has filed a statement of qualification in this state and the statement has not been canceled. My business is a limited liability partnership which has filed a statement of qualification in a state other than Iowa, has filed a statement of foreign qualification in Iowa and a statement of cancellation has not been filed. My business is a limited partnership or limited liability limited partnership which has filed a certificate of limited partnership in this state, and has not filed a statement of termination. My business is a limited partnership or a limited liability limited partnership whose certificate of limited partnership is filed in a state other than Iowa, the limited partnership or limited liability limited partnership has received notification from the Iowa secretary of state that the application for certificate of authority has been approved and no notice of cancellation has been filed by the limited partnership or the limited liability limited partnership. My business is a limited liability company whose certificate of organization is filed in Iowa and has not filed a statement of termination. My business is a limited liability company whose certificate of organization is filed in a state other than Iowa, has received a certificate of authority to transact business in Iowa and the certificate has not been revoked or canceled 309-6001 (09-15) MBE/WEP BUSINESS ENTERPRISE PREriBID CONTACT INFORMATION FORM P rime Contractor Name: P roject: FT'\f )03 / eOIflVflLI„if = > > f e o ' Letting Date: - '� ��ffl,s�i 1� tr�w1�-�� t. ,� Ir,?I N O MBE/WBE SUBCONTRACTORS: If you are NOT using any MBE/WBE subcontractors to complete this project, sign below. Attach a brief explanation as to why subcontracting was not feasible with this project. If any MBE/WBE subcontractors will be used, please use the bottom portion of this form. idyvt, 51 11,0�f �v(5 1 //,// r:. Contractor Signature: �.- Title: Pr( s i ci c -f Date: /t 1 ( SUBCONTRACTORS APPLICABLE: You are required, in order for your bid to be considered responsive, to provide the information on this form showing ALL of your MBE/WBE subcontractor contacts made for your bid submission. This information is subject to verification. Any questions may be directed to Contract Compliance Office 319-291-4429. You are required, in order for your bid to be considered responsive, to provide the information on this Form showing your MBE/WBE Business Enterprise contacts made prior to your bid submission. This information is subject to verifications and confirmation. If you are unable to identify MBE/WBE firms to perform portions of the work, please contact Rudy Jones, Contract Compliance Officer, for assistance at (319) 291-4429. In the event it is determined that the MBE/WBE Business Enterprise goals are not met, then before awarding the contract the City of Waterloo will make a determination as to whether or not the apparent successful low bidder made good faith efforts to meet the goals. TABLE OF INFORMATION SHOWING BIDDER'S PREnBID MBF/WBE BUSINESS ENTERPRISE CONTACTS Quotes Received Quotation used in bid Dates Dollar Amount Proposed to MBE/WBE Dates Subcontractors Contacted Yes/No Contacted Yes/No be Subcontracted go fre ce; ti Ida 7764 14 ea+, do, 'Q LIP � J r 5jor 3�(.,� tjs Is lU� OcekSee f �,(� 5v. /3/Li 3// Vailif LOtha kofr (5 wsio i a r 1 (Form CCO-4) Rev. 06-20-02 1 KNOW ALL MEN BY THESE PRESENTS, that we, as Principal, and bound unto the West Bend Mutual Insurance Company BUD BOND Midwest Concrete, Inc. , as Surety, are held and firmly CITY OF WATERLOO Iowa, hereinafter called "OWNER." In the penal sum Five Percent of Amount Bid Dollars ($, 5% ) lawful money of the United States, for the payment of which sum will and truly be made, we bind ourselves, our heirs, executors, administrators, and successors, jointly and severally, firmly by these presents. The condition of this obligation is such that whereas the Principal has submitted the accompanying bid dated the 4t11 day of March , 20 21 , for FY 2021 Commercial St., Katoski Dr., and Hawkeye Rd. Rt Turn Lane Reconstruction Program • NOW, THEREFORE, (a) If said Bid shall be rejected, or in the alternate, (b) If said Bid shall be accepted and the Principal shall execute and deliver a contract in the form specified and shall furnish a bond for his faithful performance of said contract, and for the payment of all persons performing labor or furnishing materials in connection therewith, and shall in all other respects perform the agreement created by the acceptance of said Bid, Then this obligation shall be void, otherwise the same shall remain in force and effect; it being expressly understood and agreed that the liability of the Surety for any and all claims hereunder shall, in no event, exceed the penal amount of this obligation as herein stated. By virtue of statutory authority, the full amount of this bid bond shall be forfeited to the Owner in liquidation of damages sustained in the event that the Principal fails to execute the contract and provide the bond as provided in the specifications or by law. The Surety, for value received, hereby stipulates and agrees that the obligations of said Surety and its bond shall be in no way impaired or affected by any extension of the time within which the Owner may accept such Bid or execute such contract; and said Surety does hereby waive notice of any such extension. IN WITNESS WHEREOF, the Principal and the Surety, have hereunto set their hands and seals, and such of them as are corporations, have caused their corporate seals to be hereto affixed and these presents to be signed by their proper officers this 4th day of March , A.D. 20 21 . Witness W evin Ehrlich, Producer BID BOND Midwest Concrete, Inc. Principal By 4-00 West Bend Mutual Insurance ColipanyASeal) By Nicole Hermsen Attorney -in -fact Ryan Coates, Owner (Title) Attorn %n-Fact ,' it1, fir , , ► �1 , (Seal) �''•a, Page 1 of 1 !) J i. i Jht )))J)}l)1)Ili)\ . --- ---- i T A MUTUAL INSURANCE COMPANY THE SILVER LINING Bond No. 2457471 POWER OF ATTORNEY Know all men by these Presents, That West Bend Mutual Insurance Company, a corporation having its principal office in the City of West Bend, Wisconsin does make, constitute and appoint Nicole Hermsen lawful Attorney(s)-in-fact, to make, execute, seal and deliver for and on its behalf as surety and as its act and deed any and all bonds, undertakings and contracts of suretyship, provided that no bond or undertaking or contract of suretyship executed under this authority shall exceed in amount the sum of. Ten Million Dollars ($10,000,000) This Power of Attorney is granted and is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of Directors of West Bend Mutual Insurance Company at a meeting duly called and held on the 21st day of December, 1999. Appointment ofAttorney-In-Fact. The president or any vice president, or any other officer of West Bend Mutual Insurance Company may appoint by written certificate Attorneys -In -Fact to act on behalf of the company in the execution of and attesting of bonds and undertakings and other written obligatory instruments of like nature. The signature of any officer authorized hereby and the corporate seal may be affixed by facsimile to any such power of attorney or to any certificate relating therefore and any such power of attorney or certificate bearing such facsimile signatures or facsimile seal shall be valid and binding upon the company, and any such power so executed and certified by facsimile signatures and facsimile seal shall be valid and binding upon the company in the future with respect to any bond or undertaking or other writing obligatory in nature to which it is attached. Any such appointment may be revoked, for cause, or without cause, by any said officer at any time. In witness whereof, the West Bend Mutual Insurance Company has caused these presents to be signed by its president undersigned and its corporate seal to be hereto duly attested by its secretary this 22nd day of September, 2017. Attest � � e Christopher C. Z Secretary any at l I gart ^`rJ. coRPORAT SEAL J;$l a. Kevin A. Steiner Chief Executive Officer/President State of Wisconsin County of Washington On the 22nd day of September, 2017, before me personally came Kevin A. Steiner, to me known being by duly sworn, did depose and say that he resides in the County of Washington State of Wisconsin; that he is the President of West Bend Mutual Insurance Company, the corporation described in and which executed the above instrument; that he knows the seal of the said corporation; that the seal affixed to said instrument is such corporate seal; that is was so affixed by order of the board of directors of said corporation and that he signed his name thereto by like order. Juli Anedum Senior orporate Attorney Notary Public, Washington Co., WI My Commission is Permanent The undersigned, duly elected to the office stated below, now the incumbent in West Bend Mutual Insurance Company, a Wisconsin corporation authorized to make this certificate Do Hereby Certify that the foregoing attached Power of Attorney remains in full force effect and has not been revoked and that the Resolution of the Board of Directors, set forth in the Power of Attorney is now in force. Signed and sealed at West Bend, Wisconsin this 4th day of lYgrch 2021 coRPORsire t SEAL . Heather Dunn •`3ry°?!.`' ' ice President - Chief Financial Officer No ice: Any questions conceming this Power of P t. rney may Se directed to the Bond Manager at NSI, a division of West Bend Mutual Insurance Company. 1900 S. 18th Ave. West Bend, WI 53095 I ph (262) 334''ZOI7,0 ; 1 800-236-5004 I fax (262) 338-5058 I www.thesilverlining.com