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Peterson Contractors, Inc.
katUriak ia%N\RAC\MS Vtt. BOX A REINBECK, IOWA 50669-0155 (Zs 10 %PCS1RL CosivlVaCJALI )1kikerOCK1 1 te4 4RD4 Cagin�T el • F CITY 0.F WATERLOO CITY t PK'S OFFICE MAR�o � rd � iC .s C 4 2021 PHI :41:58 Zan\ 116111 �NCRACI�RS �� BOX A REINBECK, IOWA 60669-0165 '��'•a • tr- •h u ,eye -a—r%a _fl0 th< Arm MAR 4 2021 NW 19:4 9 -1 Kitles4 1%Si E �uD wre N504 tozii CatH of Wkreue-co C FORM OF BID OR PROPOSAL FY 2021 COMMERCIAL ST., KATOSKI DR., AND HAWKEYE RD. RT TURN LANE RECONSTRUCTION PROGRAM CONTRACT NO. 1024 CITY OF WATERLOO, IOWA Honorable Mayor and City Council Waterloo, Iowa Gentlemen: The undersigned, being a Corporation existing under the laws of the State of awarev.1lA a Partnership consisting of the following partners: 1—erriaSat4 l . x_tre.. QanRs —J—n1C. , 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 ITEM BID SPECIFICATION SUPPLEMENTAL SUDAS * SEE DIVISION I — STREET RECONSTRUCTION : UNIT BID ` 'i TOTAL BID SP = SPCL PROV DESCRIPTION UNIT EST QTY PRICE PRICE DIVISION 2 - EARTHWORK 1 2010-108-D * TOPSOIL, 4 INCHES, ON OR OFF SITE SY 2,015.0 $t7-c$tS jit let" 2 2010-108-E-0 * EXCAVATION, CLASS 10 CY 5,516.0 $S $ y Met- * 3 2010-108-G SUBGRADE PREPARATION SY 15,086.0 $ Q, $ 7S 6, t * 4 2010-108-H SUBGRADE TREATMENT, WOVEN GEOTEXTILE SY 1,500.0 $ 3; $ 1/57:0i , 5 2010-108-1 * SUBBASE, MODIFIED CY 6,500.30 $. 3 (2s $ 2063g4•, 6 IDOT 2121 GRANULAR SHOULDER, TYPE B TON 2,621.00 621120r 010r SUBTOTAL EARTHWORK $ 330IClittos DIVISION 4 - SEWERS AND DRAINS - STORM STORM SEWER, TRENCHED, RCP 2000D, 7 4020-108 A 1 INCH 15 LF 110.0 ,_ $ 10 • $ "Van —' STORM.SEWER, TRENCHED, RCP 2000D, 12 -- 8 4020-108-A-1 INCH LF 150.0 $ (c3 '�/� $ /Q,twA STORM SEWER,FLARED END SECTION, RCP, 9 4020-108-A-1 * 2000D, 15INCH EACH 3.0 - $ 3706• $ ///!�` REMOVAL OF STORM SEWER, RCP, LESS 10 4020 108-D-0 THAN OR EQUAL TO 36 INCH LF 211.0 $ ,. (p. $ 'Z ao i SPECIFICATION SUDAS BID SUPPLEMENTAL * SEE DIVISION I - STREET (CONTINUED) RECONSTRUCTION UNIT BID TOTAL BID ITEM SP = SPCL PROV DESCRIPTION UNIT EST QTY PRICE PRICE DIVISION (CONTINUED) 4 SEWERS AND DRAINS - STORM 11 4040 108-A-0 SUBDRAIN, TYPE SP, 6 INCH LF 1,735.0 $ g. $ / si 816 • 12 4040-108-A-0 SUBDRAIN, TYPE SP, 4 INCH LF 9,834.0 $ Co 7s $ !! 137q, 13 4040 108 D 0 SUBDRAIN OUTLETS AND CONNECTIONS, - CMP, 6 INCH EACH 68.0 $ 1 L#O i $ /OJ)c i DIVISION SEWERS 6 - STRUCTURES FOR STORM * 14 6010-108-A-0 MANHOLE, SW-401, 48" EACH 1.0 $ 37567 $ 3750 15 6010-108-A-0 MANHOLE, SW-406, SHALLOW RECTANGULAR EACH 2.0 $ tides0O• . $ grCbt 16 6010-108-8-0 INTAKE, SW-501 SINGLE GRATE EACH 6.0 $ yOOO[ $ ziiao INTAKE, SW-507 SINGLE OPEN THROAT, CURB 17 6010-108-B-0 INTAKE, SMALL BOX EACH 2 0 $ 000' o $ 49tiCOr INTAKE, SW-509 DOUBLE OPEN THROAT, - 18 6010-108-B-0 CURB INTAKE, SMALL BOX EACH 1.0 $ (pZOO• $ (PZ00 CONNECTION TO EXISTING INTAKE, DRAIN 19 6010 108 H 0 TILE EACH 2.0 $ SOO' $ /V /x� - `�' ` 20 6010-108-B-0 REMOVE MANHOLE OR INTAKE, STORM EACH 12 0 $ 1S0; $ SyOo• 21 SP #6 INTAKE SPECIAL SW-545, SHAPING REMOVE AND TOP AND REPLACE EACH 1.0 $ 35-O6a $ 5SVZ s 22 6010-108-B-0 INTAKE, EXTENDED SW-545 OPENING SINGLE OPEN THROAT WITH EACH 1.0 $ g4tcn,r $ 81-00rr INTAKE, SW-501 REMOVE AND REPLACE 23 6010 108-E * n GO60! BOXOUT EACH 2.0 $ $ ,34001 MINOR ADJUSTMENT, MANHOLE W/ SW-601 24 6010-108-E * TYPE A CASTING & CITY OF WATERLOO EACH 2.0 -- COVER $ /GOO' $ 2,j(JO 0 MINOR ADJUSTMENT, MANHOLE W/ SW-602 25 6010-108-E * TYPE E CASTING & CITY OF WATERLOO EACH 2.0 --- COVER $ 75-°r $ / r 26 SP #3 FURNISH AND INSTALL SW-603 TYPE R - - CASTING /700' EACH 2.0 $ not $ SUBTOTAL STORM SEWER DIVISION APPURTENANCES 5 - WATER MAINS AND CONVERT WATER VALVE MANHOLE TO .� 27 SP # 4 ROADBOX EACH 1.0 $ 001 $ !Zlf{� 28 SP # 2 WATER SERVICE KILL EACH 25.0 $ Or $ r ,. 4751.0. � SUBTOTAL WATER APPURTENANCES $ /6 DIVISION 7 STREETS AND RELATED WORK PCC PAVEMENT � 29 7010-108-A-0 PAVEMENT, PCC, 8 INCH, C 4 W/ CLASS 3 AGG SY 12,761.0 $ !I/�.el $ 528,( 30 7010-108-A-0 PAVEMENT, PCC, 9 INCH, C-4 W/ CLASS 3 AGG SY 5,432.0 $ t{s8'S , $ ex9q j,057.' PAVEMENT, PCC, 10 INCH, C 4 W/ CLASS 3 31 7010 108 A-0 AGG SY 920.0 $ S%, $ 54 (1004 CONCRETE MEDIAN, 6 INCH, C 4 W/ CLASS 3 in' 32 7010-108-G AGG SY 286.5 $ 07. $ /9/ 1//4 33 7010-108-1-0 PCC PAVEMENT SAMPLES AND TESTING LS 1.0 $ n( J r $ ?COOr 34 7010-3.04 COLD WEATHER CONCRETE PROTECTION SY 2,000.0 $ $ 5-,-'� /0,000r� 35 7010-3 02, * J LINSEED OIL TREATMENT SY 7,000.0 $ /, $ / O�- rs)?_ SPECIFICATION SUDAS * SEE DIVISION I - STREET RECONSTRUCTION BID SUPPLEMENTAL (CONTINUED) UNIT BID TOTAL BID ITEM SP = SPCL PROV DESCRIPTION UNIT EST QTY PRICE PRICE SIDEWALKS, DRIVEWAYS SHARED USE PATHS AND 36 7030-108-A-0 REMOVAL OF SIDEWALK SY 459.6 $ (o -- $ Ain. 2.19 37 7030-108-A-0 ; REMOVAL OF DRIVEWAY SY 235.7 $ (p $ 249,t78.'ll 38 7030-108-E-0 SIDEWALK, PCC C-4, 6 INCH, C 4 SY 480 2 $ 1.42,25 $ zc•ts0 39 7030-108-G-0 DETECTABLE WARNING SURFACE SF 70.0 $ 38.-- $ IZi39e. 8 zs 40 7030-108-H-1 DRIVEWAY PAVED, PCC, 6 INCH, C 4 SY 202 3 $ 41 $ arzz 41 7030-108-H-1 DRIVEWAY, PAVED, PCC, 8 INCH, C 4 SY 38.8 $ G 5' $ PAVEMENT REHABILITATION 42 7040-108-H-0 * PAVEMENT REMOVAL, CONCRETE SY 20,700.0 $ 46&? $ /Of 39S y� STREETS AND RELATED WORK $ Ii OW/SUBTOTAL O, 002 DIVISION TRAFFIC 8 CONTROL - PAVEMENT MARKINGS AND PAVEMENT MARKINGS PAINTED PAVEMENT MARKINGS, 43 8020-108 B-0/SP#10 SC SOLVENT/WATERBOURNE STA 206.61 $ 3S,� $ 7Z3). - 44 8020-108-H-0/SP#10 PRECUT SYMBOLS AND LEGENDS EACH 21.0 $ 00 $ ?S7O 45 8020-108-K-0 PAINTED PAVEMENT MARKINGS, REMOVED STA 12.0 $ qOr $ /0/0r TEMPORARY TRAFFIC CONTROL _ 46 8030-108-A 0 TEMPORARY TRAFFIC CONTROL LS 1.0 $ 3slx $ 3S100, SUBTOTAL PAVEMENT MARKINGS AND TRAFFIC CONTROL $ S3, /8/. 3S DIVISION 9 - SITE WORK AND LANDSCAPING SEEDING HYDR47 SEEDING, SEEDING, FERTILIZING 9010-108-B-0 * AND MAULIC ULCHING SY 140.0 $ 12, $ %(0$04 48 9010-108-E-0 * WARRANTY SY 100.0 $ I Z [ $ /ZOO i EROSION AND SEDIMENT CONTROL 9040 108-T-1 */ INLET PROTECTION DEVICE, INTERMEDIATE 49 SP#13 AND DROP IN EACH 11.0 $ no , $ SZ$O ` 50 9040-108-T-2 "sr */SP#13 INLET PROTECTION DEVICE, MAINTENANCE EACH 11.0 $ ZS64 $ SUBTOTAL SITE WORK AND LANDSCAPING $ /3/ 88G, - DIVISION 11 - MISCELLANEOUS CONSTRUCTION SURVEY _ 51 11010-108-A CONSTRUCTION SURVEY (DIVISIONS I AND II) LS 1.00 $ Z4O0P $ 200500-; 52 11,050-108-A-0 CONCRETE WASHOUT LS 1.00 $ 3ano $ .?jp6C7.! 53 PLAN SHEET 2 09 REMOVE AND REINSTALL TREE GRATES EACH 4.0 $ 9ZS[ $ 2•9OOr SUBTOTAL MISCELLANEOUS $ 2- -1100 61 TOTAL DIVISION I $ t) (0(pZ) q Gm SPEC SUDAS FICATION *SEE BID SUPPLEMENTAL DIVISION 11- COMMERCIAL STREETSCAPE UNIT BID TOTAL BID ITEM SP = SPCL PROV DESCRIPTION UNIT EST QTY PRICE PRICE SUDAS 2010-108-A-0 CLEARING AND GRUBBING 1 UN 7.8 $ cad $ CQZr 2 SUDAS 2010-108-D-0 OFFSITE TOPSOIL CY 28.0 $ � � �� $%%6 9 SUDAS SPECIFICATION * SEE DIVISION II COMMERCIAL S T REE T SCAPE — BID SUPPLEMENTAL (CONTINUED) UNIT BID TOTAL BIL' ITEM SP = SPCL PROV DESCRIPTION UNIT EST QTY PRICE PRICE SUDAS 2010-108-E-0 EXCAVATION, ,, CLASS 10, WASTE o Cl' 300.0 $ Vi T $ 24001- SUDAS 2010-108-1-0 SUBBASE, MODIFIED 4 CY 199.3 $ 50 a $ encelp� SUDAS 7030-108-A-0 REMOVAL - CO tic OF PAVEMENT r 5 SY37.9 $ $ ��° $ Cit i, SUDAS 7030-108-A-0 REMOVAL OF SIDEWALK ® ®r 6 SY 1,003.3 $°� $ SUDAS 7030-108-A-0 REMOVAL OF DRIVEWAY 7 SY 157.9 $ 6 6 $ 991, SUDAS 7030-108-E-0 SIDEWALK, PCC, 6 IN. 8 SY 857.6 WTht= 43-021n35gr SUDAS 7030-108-E-0 SIDEWALK, PCC, 8 IN. © - o $ I3Citiitie v , SUDAS 7030-108-E-0 SIDEWALK, COLORED PCC, 6 IN. 10 SY 742 2 .1 4J� SUDAS 7030-108-G-0 DETECTABLE WARNINGS, CAST IRON 11 `r- SF - $ $ SUDAS 7030-108-H-0 PAVED DRIVEWAY, PCC, 6 IN. z '" 12 SY ict 40.8 $ti i._. $ SUDAS 7030-108-H-0 PAVED DRIVEWAY, PCC, 8 IN. 13 SY 119 2 $ Ce.C: $ 77q8.1� o PLAN POROUS PAVE SO°E 14 SF 850.0 $ 0 4 $ •TI SUDAS 7040-108-A-0 FULL DEPTH PATCH 15 SY 37.9 $ $ 3110 SUDAS 8020-108-B-0 PAINTED PAVEMENT MARKINGS 16 STA 5.0 $ 3ci $ ) %c v SUDAS 8020-108-B-0 PAVEMENT MARKINGS REMOVED 17 STA 1.5 $ 90• $ iiSe4 IA -DOT 2523- ocie LIGHTING POLES. TYPE 1, STREET LIGHT 18 0000100 EACH 05,00 I0-0 $i $ IA 2523- -DOT LIGHTING POLES d TYPE 2, PED LIGHT 19 0000100 EACH 20.0 05(000° $ pdcor $ PLAN REMOVAL OF LIGHT POLE FOOTINGS r 20 45o EACH 12.0 $ $ IA -DOT 2523- ELECTRICAL CIRCUITS 21 0000200 LF 2,083.0 $ /1' $ tZ t9 1 3 ° IA -DOT 2523- HANDHOLES AND JUNCTION BOXES 22 0000310 EACH 4.0 $ /100. $ q%o' PLAN ELECTRICAL MODIFICATIONS 23 LS 1.0 $ / ! i $ /tad PLANTS WITH WARRANTY, TYPE 1, SKYLINE SUDAS 9030-108-B-0 o 0 24 HONEYLOCUST EACH 4.0 $ /4130' $ 5710' PLANTS WITH WARRANTY, TYPE 2, SKYLINE a SUDAS 9030-108-B-0 25 HONEYLOCUST EACH 4.0 $ /Zt30i $ tri Z4 PLANTS WITH WARRANTY, TYPE 3, SKYLINE G- SUDAS 9030-108-B-0 26 HONEYLOCUST EACH 4.0 $ 6761 $ zt r PLANTS WITH WARRANTY, TYPE 1, COMMON SUDAS 9030.108-B-0 r, P, 27 HACKBERRY NO EACH 12.0 $ k $ rig PLANTS WITH WARRANTY, TYPE 3, AUTUMN SUDAS 9030-108-B-0 6- 28 BLAZE MAPLE EACH 5.0 $ elcer $ 325�' PLAN REMOVE AND REINSTALL TREE GRATE 29 0 EACH - $ $ PLAN INSTALL NEW TREE GRATE 30 307Si EACH 4.0 $ $JZ,3ciOb PLAN REMOVE AND REINSTALL BIKE RACKS 31 LS 1.0 $ 2,► $ 1 2® TOTAL DIVISION II $ 3C-gi 5,. a � Contract No. 1 023 Addendum No. 1 Division -- 11 Quantity Correction Form of Bid Page 4 of 6 TOTAL DIVISION DIVIS 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 SalaDollars($6 /o or gno 7, 7r9'L ) in the form of -2, en ®gin , is submitted herewith in accordance with the INSTRUCTIONS TO BIDDERS. Attached hereto is a Non -Collusion Affidavit of Prime Contractor. Attached hereto is a Bidder Status Form. 7 The bidder is prepared to submit a financial and experience statement upon request. 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. 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. torrzs cml (Nam- of B' BY: der) .rnt1/4t Official Address: (Including Zip Code): 2/2c/2( (Elate) Title C7litlern Yii g‘/Ansecr, 7? I.R.S. No. qZ-Ot7L/6P5 END SECTION NON -COLLUSION AFFIDAVIT OF PRIME BIDDER State of LAM County of K. Ink4,6142. M Pnr 1. He is )ss (Owner, Partner, Office , being first duly sworn, deposes and says that: or Agent) , of , the Bidder that has submittecfthe attached Bid; Cr:es 1 �--mortettrieS He is fully -informed respecting the preparation and contents of the attached Bid and of all pertinent circumstances respecting such Bid; 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 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) Title Subscribed and sworn to before me this 3&3 Titl Pit day of `����. 20a1 . / ) o-farcrj My commission expires t+a. AMYL CLARK Commission Number 798999 My Commission Expires ow August 30. 2022 P rime Contractor Name: P roject: MBE/WBE BUSINESS ENTERPRISE PRE -BID C • NTACT INFORMATION FORM Letting Date: 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 use •, ple- . use the botto portion of this form. Contractor Si' ature: Title° Date: S UBCONTRACTORS 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 PRE -BID MBE/WBE BUSINESS ENTERPRISE CONTACTS Quotes Received Quotation used in bid Subcontractors MBE/WBE Contacted Dates Yes/No Contacted Dates Yes/No Dollar Amount be Subcontracted Proposed to 3/1 3/3 C.0 qes 'ifS 1�. •C tz-P 0 scpQ,A; 3i tls 3r3 ter t ties '4e5 (cvyrc 4a 3 i U 6 l tarr /G%tTr1 GE N O77 i ice COI, 0 ', cn, rxc e( n 4d� % ayet 3f eafteK &Ad I &L do frig ces ie91 N . (Form CCO-4) Rev. 06-20-02 Bidder Status Form To be completed by all bidders Please answer "Yes" or' No" for each of the following: ■ "Yes C No 2/Yes ❑ No 'Yes ❑ No ✓[`"Yes ❑ No No 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. Part A 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: / ZZ— /(t/�5to 046 Address: IO etc.- --'o t Sir City, State, Zip ' 1,n% c S k`1 `:�(069 Dates: / / to / / Address: City, State, Zip' Dates. / / to / / Address' You may attach additional sheet(s) if needed. City, State, Zip. 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 bidders who are residents? ■ Yes ❑ No 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. Date: I / -02of ` ( r 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 02-14 Worksheets 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 ❑ No ❑ Yes ErNo ❑ Yes Cam' No 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. [✓"Yes ❑ No 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. El Yes [✓�No ❑ Yes [moo 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. ❑ Yes [-No 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. Yes Qco 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. ❑ Yes th-lo ❑ Yes ❑'No ❑ Yes QNo 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 02-14 BID BOND KNOW ALL MEN BY THESE PRESENTS, that we, Peterson Contractors, Inc. as Principal, and Travelers Casualty and Surety Company of America as Surety are held and firmly bound unto the CITY OF WATERLOO , Iowa, hereinafter called "OWNER." In the penal sum ---Five Percent of the Bid Submitted --- Dollars ($---50/C--- ) 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 4th day of March • 2021 , for FY 2021 Commercial St., Katoski Dr., and Hawkeye Rd. Rt Turn Lane Reconstruction Program, City of Waterloo, IA; Contract No. 1024 . 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 tnat 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 18th day of February _ ,, A.D. 2021 se Witness Witness l�) Peterson Contractors, Inc. lice ncipalI &Pd Travelers Casualty a, d Surety Company of Pktn9r cp president rety .a.vatalived //ems' *�ney-in-fact Anne Crowner (Seal) (Title) TRAVkU, Th, vc l h-is Casua lIty and Soh -Jot y Company of Arnehica T r>'avaO r s C su l y and Succ r\ Company St Peafill give and Pidah-lhica, JI nskur U11Ce coo 6-ni pC' nay POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company, and St. Paul Fire and Marine Insurance Company are corporations duly organized under the laws of the State of Connecticut (herein collectively called the "Companies"), and that the Companies do hereby make, constitute and appoint Anne Crowner of Waukee Iowa , their true and lawful Attorney -in -Fact to sign, execute, seal and acknowledge any and all bonds, recognizances, conditional undertakings and other writings obligatory in the nature thereof on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. IN WITNESS WHEREOF, the Companies have caused this instrument to be signed, and their corporate seals to be hereto affixed, this 17th day of January, 2019. ,4 #:Ji/l,ii" try M1}a .d.""trr9 fad L.4 ibybi.:414. capis q 11/4 -‘14"..f.refft Airli Waft State of Connecticut By: City of Hartford ss. On this the 17th day of January, 2019, before me personally appeared Robert L. Raney, who acknowledged himself to be the Senior Vice President of Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company and St. Paul Fire and Marine Insurance Company, and that he, as such, being authorized so to do, executed the foregoing instrument for the purposes therein contained by signing on behalf of said Companies by himself as a duly authorized officer. IN WITNESS WHEREOF, I hereunto set my hand and official seal. My Commission expires the 30th day of June, 2021 111 •�" �pl {� _ro1 °1. sitsat ad,: Att.' rt—,� t' t h, IIT,LLI tY • • • 114 a• • �. Anna P. Nowik, Notary Public fJ J Senior Vice President This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company, and St. Paul Fire and Marine Insurance Company, which resolutions are now in full force and effect, reading as follows: RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President, any Vice President, any S econd Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary may appoint Attorneys -in -Fact and Agents to act for and on behalf of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with the Company's name and seal with the Company's seal bonds, recognizances, contracts of indemnity, and other writings obligatory in the nature of a bond, recognizance, or conditional undertaking, and any of said officers or the Board of Directors at any time may remove any such appointee and revoke the power given him or her; and it is FURTHER RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice P resident may delegate all or any part of the foregoing authority to one or more officers or employees of this Company, provided that each such delegation is in writing and a copy thereof is filed in the office of the Secretary; and it is FURTHER RESOLVED that any bond, recognizance, contract of indemnity, or writing obligatory in the nature of a bond, recognizance, or conditional undertaking shall be valid and binding upon the Company when (a) signed by the President, any Vice Chairman, any Executive Vice President, any S enior Vice President or any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary; or (b) duly executed (under seal, if required) by one or more Attorneys -in -Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority; and it is FURTHER RESOLVED, that the signature of each of the following officers: President, any Executive Vice President, any Senior Vice President, any Vice President, any Assistant Vice President, any Secretary, any Assistant Secretary, and the seal of the Company may be affixed by facsimile to any Power of Attorney or to any certificate relating thereto appointing Resident Vice Presidents, Resident Assistant Secretaries or Attorneys -in -Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof, and any such Power of Attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding on the Company in the future with respect to any bond or understanding to which it is attached. I, Kevin E. Hughes, the undersigned, Assistant Secretary of Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company, and St. Paul Fire and Marine Insurance Company, do hereby certify that the above and foregoing is a true and correct copy of the Power of Attorney executed by said Companies, which remains in full force and effect. Dated this 18th day of February Kevin E Hughes, Assistant Secretary To verify the authenticity of this Power of Attorney, please call us at 1 a8©©o42—3880, Please refer to the above -named Attorney -in -Fact and the details of the bond to which this Power of Attorney is attached.