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HomeMy WebLinkAboutBenton's Sand & GravelBENTON'S SAND & GRAVEL 905 CENTER STREET CEDAR FALLS IA 50613 BENTON'S SAND & GRAVEL 905 CENTER STREET CEDAR FALLS IA 50613 CITY LWATERLOO x CLERK'S h ?�IIYULERv 'S OFFICE LitiN 8 9021 111:57:OR CITY OF WATERLOO 715 MULBERRY STREET WATERLOO IOWA BID FOR: FY 2021 WESTDALE BIOSWALE CONTRACT 997 { r"'n MtlL �11t� 0 i Y tass tl inII c wist �1 TI ten Isat au4 SCIrf H rti rM' /r �4 y� 0 rn CITY OF WATERLOO 715 MULBERRY STREET WATERLOO IOWA BID SECURITY FOR: FY 2021 WESTDALE BIOSWALE CONTRACT 997 FORM OF BID OR PROPOSAL F.Y. 2021 WESTDALE BIOSWALE CONTRACT NO. 997 CITY OF WATERLOO, IOWA Honorable Mayor and City Council Waterloo, Iowa Gentlemen: 1. The undersigned, being a Corporation existing under the laws of the State of Iowa 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 F.Y. 2021 WESTDALE BIOSWALE, Contract No. 997, all in accordance with the above -listed documents and for the unit prices for work in place for the following items and quantities: BID ITEM F.Y. 2021 WESTDALE BIOSWALE CONTRACT NO. 997 UNIT,' EST.;QTY.' UNIT BID PRICE • TOTAL .BID.PRICE 1 2 3 4 CLEARING & GRUBBING (VEGETATION) CLEARING & GRUBBING (WILLOWS) CLEARING & GRUBBING (TREES) TREE REMOVAL ACRES ACRES ACRES EACH 0.61 0.37 0.66 1.0 $ 7500.00 $15000.00 $25000.00 $ 2500.00 $ 4575.00 $ 5550.00 $ 16500.00 $ 2500.00 5 6 SNOW FENCE PROTECTION 36' DIA. STORM APRON - REMOVE & REINSTALL LIN FT EACH 760.0 1.0 $ 7.00 $1000.00 $ 5320.00 $ 1000.00 7 8 9 36" DIA. STORM APRON - NEW 24' DIA. STORM APRON - REMOVE & REINSTALL 24" DIA. STORM APRON - NEW EACH EACH EACH 1.0 1.0 $2500.00 $1000.00 $ 2500.00 $ 2500.00 $ 1000.00 $ 2500.00 FORM OF BID CONTRACT NO. 997 Page 1 of 4 12" DIA. STORM APRON - REMOVE & 10 REINSTALL 11 12" DIA. STORM APRON - NEW 12 24" DIA. RCP- REMOVE & REINSTALL 13 12" DIA. RCP - REMOVE & DISPOSE CHAIN LINK FENCE - REMOVE & 14 REPLACE 15 GRADING - WASTE REMOVAL 16 GRADING - NEW CHANNEL 17 GRADING - FILL AREAS 18 TOPSOIL - STOCKPILE & RESPREAD 19 36" DIA. STORM SEWER PIPE 20 24" DIA. STORM SEWER PIPE STORM SEWER MANHOLE - 60" DIA. 21 (SW-401) SANITARY SEWER MANHOLE 22 ADJUSTMENT PER PLAN SHEET 4 23 RETAINING WALLS 24 TURF REINFORCEMENT MAT (TRM) 25 CONCRETE FLOOR (FOREBAY) 26 ENGINEERED SOIL 27 CHOKER AGGREGATE 28 STONE AGGREGATE 29 6" DIA. PERFORATED SUBDRAIN 30 6" DIA. SOLID SUBDRAIN 6" DIA. SOLID SUBDRAIN RISERS W/ 31 CAP 32 ENGINEERING FABRIC 33 GRANULAR SUBBASE 34 RIP RAP STONE EACH EACH LIN FT LIN FT LIN FT CU YDS CU YDS CU YDS CU YDS LIN FT LIN FT EACH EACH LIN FT SQ YDS SQ FT CU YDS TONS TONS LIN FT LIN FT EACH SQ FT TONS TONS 1.0 1.0 20.0 10.0 125.0 4000.0 720.0 880.0 4000.0 92.0 45.0 2.0 2.0 165 110.0 $ 750.00 $ 1200.00 $ 75.00 $ 50.00 $ 24.00 $ 20.00 $ 20.00 $15.00 $10.00 $125.00 $100.00 $ 4100.00 $1000.00 $212.00 $ 20.00 610.0 $ 7.50 113.3 $ 100.00 8.0 81.0 755.0 $ 50.00 $ 50.00 $ 15.00 50.0 $ 15.00 5.0 450.0 164.2 $ 500.00 $ 1.50 $ 50.00 20.0 $ 90.00 $ 750.00 $ 1200.00 $ 1500.00 $ 500.00 $ 3000.00 $ 80000.00 $ 14400.00 $ 13200.00 $ 40000.00 $ 11500.00 $ 4500.00 $ 8200.00 $ 2000.00 $ 34980.00 $ 2200.00 $ 4575.00 $ 11330.00 $ 400.00 $ 4050.00 $ 11325.00 $ 750.00 $ 2500.00 $ 675.00 $ 8210.00 $ 1800.00 FORM OF BID CONTRACT NO. 997 Page 2 of 4 35 EROSION CONTROL MAT SO YDS 850.0 $ 5.00 $ 4250.00 36 CHANNEL EROSION PROTECTION LIN FT 426.0 $ 7.00 $ 2982.00 37 38 CHANNEL EROSION PROTECTION MAINTENANCE TEMPORARY SEEDING EACH ACRES 4.0 1.8 $ 150.00 $ 1500.00 $ 600.00 $ 2700.00 39 APRON FOOTING EACH 4.0 $ 750.00 $ 3000.00 40 INTAKE PROTECTION EACH 2.0 $ 175.00 $ 350.00 41 INTAKE PROTECTION MAINTENANCE EACH 4.0 $ 75.00 $ 300.00 TOTAL BID $ 319,172.00 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 Security in the sum of 5% of Bid Amount Dollars ($ Five Percent ) in the form of Bid Bond is submitted herewith in accordance with the INSTRUCTIONS TO BIDDERS. 5. 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. 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. FORM OF BID CONTRACT NO. 997 Page 3 of 4 9. The bidder has received the following Addendum or Addenda; Addendum No, 1 Date 5-28-21 10. The bidder shall list the V1BE/W13= subcontractor(s), amount of subcontracts and bid items on the City of Waterloo Vinority 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 Su bcontractor(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. BY: Benton's Sand & Gravel, Inc. (Name of Bidder) June 3, 2021 (Date) Title Vice -President fficial Address: (Including Zip Code): 905 Center Street Cedar Falls IA 50613 I.R.S. No. 42-1273294 FORM OF BID CONTRACT NO. 997 Page 4 of 4 INFORMATION NEEDED FOR IOWA CONSTRUCTION SALES TAX EXEMPTION CERTIFICATE CONTRACTOR NAME: Benton's Sand & Gravel, Inc. ADDRESS: 905 Center Street, Cedar Falls, IA 50613 (Check One) PRIME x FEDERAL ID#: 42-1273294 P ROJECT NAME: F.Y. 2021 Westdale Bioswale P ROJECT CONTRACT NO.: 997 SUBCONTRACTOR DESCRIPTION OF WORK: ❑ Brickwork ❑ Carpentry ❑ Concrete Drywall -Plaster -Insulation Electrical ® Excavation/Grading ❑ Flooring Heavy Construction Heating -Ventilating -Air Cond ■ ■ ■ Landscaping P ainting ❑ Paving P lumbing Roofing -Siding -Sheet Metal ❑ Windows ❑ Wrecking -Demolition ❑ Other (Please specify) ■ NON -COLLUSION AFFIDAVIT OF PRIME BIDDER State of Iowa County of Black Hawk James D Snodgrass that: )ss , being first duly sworn, deposes and says 1. He is Officer (Owner, Partner, Officer. Representative. or Agent_ , Benton's Sand & Gravel Inc , the Bidder that has submitted the attached Bid; 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) Vice-Presid- t Subscribed and sworn to before me this 1 , 2 0 -2.< My commission expires /3 `off (9 Title day of 6/' • Title Ti110 �v, �,4 TEUESA M CHIAPPONE o $ t Commission Number 821205 Z ig° `I)► '� My Commission Expires * *Aim /ovv� November 13, 2022 EQUAL OPPORTUNITY CLAUSE (As provided in Executive Order No. 11246) All contractors, subcontractors, vendors and suppliers of goods and services doing business with the City and value of said business equals or exceeds ten thousand dollars ($10,000.00) annually agree as follows: 1. The contractors, subcontractor, vendor and supplier of goods and services will not discriminate against any employee or applicant for employment because of race, color, creed, sex, national origin economic status, age mental or physical handicap, political opinions or affiliations. The contractor, subcontractor, vendor and supplier will develop an Affirmative Action program to ensure that applicants are employed and that employees are treated during employment without regard to their race, creed, color, sex, national origin, religion, economic status, age, mental or physical disability, political opinions or affiliations. Such actions shall include but not be limited to the following: a. Employment b. Upgrading c. Demotion or Transfer d. Recruitment and Advertising e. Layoff or Termination f. Rates of Pay or Other Forms of Compensation g. Selection for Training Including Apprenticeship 2. The contractor, subcontractor, vendor and supplier of goods and services will, in all solicitations or advertisements for employees, state that all qualified applicants will receive consideration for employment without regard to race, creed, color, sex, national origin, religion, economic status age, mental or physical disabilities, political opinion or affiliations. The contractor, subcontractor, vendor and supplier or his/her collective bargaining representative will send to each labor union or representative of workers which he/she has a collective bargaining agreement or other contract or understanding, a notice advising said labor union or workers' representative of the contractor's commitment under this section. The contractor subcontractor, vendor and supplier of goods and services will comply with all published rules, regulations, directives, and order of the City of Waterloo Affirmative Action Program Contract Compliance Provisions. 5. The contractor, subcontractor, vendor and supplier of goods and services will furnish and file compliance reports within such time and upon such forms as provided by the Affirmative Action Officer. Said forms will elicit EQUAL OPPORTUNITY CLAUSE PAGE 1 OF 2 PAGES information as to the policies, procedures, patterns, and practices of each subcontractor as well as the contractor himself/herself and said contractor, subcontractor, vendor and supplier will permit access to his/her employment books, records and accounts to the City's Affirmative Action Officer, for the purpose of investigation to ascertain compliance with this contract and with rules and regulations of the City's Affirmative Action Program Contract Compliance Provisions relative to Resolution No. 24664. 6 In the event of the contractor's non-compliance with the non-discrimination clauses of this contract or with any of such rules, regulations and orders, this contract may be canceled, terminated or suspended in whole or in part and the contractor may be declared ineligible for further contracts in accordance with procedures authorized by the City Council. 7. The contractor, subcontractor, vendor and supplier of goods and services will include, or incorporate by reference, the provisions of the non- discrimination clause in every contract, subcontract or purchase order unless exempted by the rules, regulations or orders of the City's Affirmative Action Program, and will provide in every subcontract, or purchase order that said provisions will be binding upon each contractor, subcontractor, or supplier. 8. We, the undersigned, recognize that we are morally and legally committed to non-discrimination in employment. Any person who applies for employment with our company will not be discriminated against because of race, creed, color, sex, national origin, economic status, age, mental or physical disabilities. (Signed b (Appropriate Offici Vice President Title) June 3, 2021 (Date) EQUAL OPPORTUNITY CLAUSE PAGE 2 OF 2 PAGES TITLE VI CIVIL RIGHTS During the performance of this contract, the contractor (for itself), its assignees, and successors in interest (hereinafter referred to as the "contractor") agrees as follows: 1. Compliance with Regulations: The contractor shall comply with the Regulations relative to non-discrimination in Federally assisted programs of the DOT Title 49, Code of Federal Regulations Part 21, as they may be amended from time to time, (hereinafter referred to as the Regulations), which are herein incorporated by reference and made a part of this contract. 2. Nondiscrimination: The contractor, with regard to the work performed by it during the contract, shall not discriminate on the grounds of race color, n ational origin, sex, age, or disability in the selection and retention of subcontractors, including procurement of materials and leases of e quipment. The contractor shall not participate either directly or indirectly in the discrimination prohibited by section 21 5 of the Regulations, including employment practices when the contract covers a program set forth in Appendix B of the Regulations. 3. Solicitations for Subcontracts, Including Procurement of Materials and Equipment: In all solicitations either by competitive bidding or negotiation made by the contractor for work to be performed under a subcontract, including procurement of materials or leases of equipment, each potential subcontractor or supplier shall be notified by the contractor of the contractor's obligations under this contract and the Regulations relative to n on discrimination on the grounds of race, color, national origin, sex, age, o r disability. 4. Information and Reports: The contractor shall provide all information and reports required by the Regulations or directives issued pursuant there to, and shall allow access to its books, records, accounts, other sources of information, and its facilities as may be determined by the Contracting Authority, the Iowa DOT, or FHWA to be pertinent to ascertain compliance with such Regulations, orders and instructions. Where any information required of a contractor is in the exclusive possession of another who fails or refuses to furnish this information the contractor shall so certify to the Contracting Authority the Iowa DOT, or the FHWA as appropriate, and shall set forth what efforts it has made to obtain the information. 5. Sanctions for Noncompliance• In the event of the contractor's noncompliance with the nondiscrimination provisions of this contract, the Contracting Authority, the Iowa DOT, or the FHWA shall impose such contract sanctions as they may determine to be appropriate, including, but not limited to: a. Withholding of payments to the contractor under the contract until the contractor complies, and/or b. Cancellation, termination, or suspension of the contract, in whole or in part. 6. Incorporation of Provisions: The contractor shall include the provisions of paragraphs (1) through (6) in every subcontract, including procurement of materials and leases of equipment, unless exempt by the Regulations, or directives issued pursuant thereto. The contractor shall take such action with respect to any subcontract or procurement as the Contracting Authority, the Iowa DOT, or the FHWA may direct as a means of enforcing such provisions including sanctions for non-compliance: Provided, however, that, in the event of a contractor becomes involved in, or it threatened with, litigation with a subcontractor or supplier as a result of such direction, the contractor may request the Contracting Authority or the Iowa DOT to enter into such litigation to protect the interests of the Contracting Authority or the Iowa DOT; and, in addition, the contractor may request the United States to enter into such litigation to protect the interest of the United States. Bidder Status Form To be completed by all bidders Please answer "Yes" or "No" for each of the following: x x M Part A Yes ri 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) Yes No My company has an office to transact business in Iowa. Yes No My company's office in Iowa is suitable for more than receiving mail, telephone calls, and e-mail. Yes No My company has been conducting business in Iowa for at least 3 years prior to the first request for bids on this project. Yes No 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: 04 / 01 / 1986 to 06 / 03 / 2021 Address: 905 Center Street City, State, Zip: Cedar Falls IA 50613 Dates: /_ / to / / Address: _ ._ City, State, Zip: Dates: / / to / / Address: You may attach additional sheets) if needed. City, State, Zip: To be completed by nonnresident bidders 1. Name of home state or foreign country reported to the Iowa Secretary of State: Part C 2. Does your company's home state or foreign country offer preferences to resident bidders, resident labor 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. To be completed by all bidders Yes fl No You may attach additional sheet(s) if needed. 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: Benton's Sand & Gravel Signature: Date' June 3, 2021 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) SRF Required Front -End Specifications FOR NONPOINT SOURCE & SPONSORED PROJECTS PLEASE NOTE: Attachment 5 is a new program requirement and is effective for all SRF projects bid after January 2021 Attachment 1: Certification of Non -Segregated Facilities Form (to be completed and signed by Prime Contractor and submitted with the bid) Attachment 2: Statement in Advertisement for Bids on Debarment and Suspension/Certification Regarding Debarment and Suspension Form (to be completed and signed by Prime Contractor and submitted with the bid) STATE REVOLVING FUND Attachment 3: Other Federal Requirements Language A. Standard Equal Employment Opportunity Specifications B. Preservation of Open Competition and Government Neutrality C. Historical and Archeological Finds D. Prohibitions on Procurement from Violating Facilities Attachment 4: Right of Entry and Records Retention Attachment 5: February 2021 Prohibition on Certain Telecommunications and Video Surveillance Services or Equipment (to be completed and signed by Prime Contractor and submitted with the bid) INVESTING IN IOWA'S WATER www ioviasrf.com Attachment 1 SAW Required Fr©nt41;nd Specifications ('his form must be completed and signed by Prime Contractor and submitted with the bid.) U.S. Environmental Protection Agency Certification of Non=Segregated Facilities (Applicable to contracts, subcontracts, and agreements with applicants who are themselves performing Federally assisted construction contracts, exceeding $10,000 which are not exempt from the provisions of the Equal Opportunity clause.) By the submission of this bid, the bidder, offeror, applicant, or subcontractor certifies that he does not maintain or provide for his employees any segregated facilities at any of his establishments, and that he does not permit his employees to perform their services at any location, under his control, where segregated facilities are maintained. He certifies further that he will not maintain or provide for his employees any segregated facilities at any of his establishments, and that he will not permit his employees to perform their services at any location, under his control, where segregated facilities are maintained. The bidder, offeror, applicant, or subcontractor agrees that a breach of this certification is a violation of the Equal Opportunity clause in this contract. As used in this certification, the term "segregated facilities" means any waiting rooms, work areas, restrooms and washrooms, restaurants and other eating areas, time clocks, locker rooms and other storage or dressing areas, parking Tots, drinking fountains, recreation or entertainment areas, transportation, and housing facilities provided for employees which are segregated by explicit directive or are in fact segregated on the basis of race, creed, color, or national original, because of habit, local custom, or otherwise. He further agrees that (except where he has obtained identical certifications from proposed subcontractors for specific time periods) he will obtain identical certifications from proposed subcontractors prior to the award of subcontracts exceeding $10,000 which are not exempt from the provisions of the Equal Opportunity clause; that he will retain such certifications in his files; and that he will forward the following notice to such proposed subcontractors (except where the proposed subcontractors have submitted identical certifications for specific time periods): NOTICE TO PROSPECTIVE SUBCONTRACTORS OF REQUIREMENT FOR CFRTIFICATIONS OF NON-SEGREGATFD FACILITIES A Certification of Non -segregated Facilities, as required by the May 9, 1967, order (33 F.R. 7808, May 28, 1968) on Elimination of Segregated Facilities, by the Secretary of Labor, must be submitted prior to the award of a subcontract exceeding $10,000 which is not exempt from the provisions of the Equal Opportunity clause. The certification may be submitted either for each subcontract or for all subcontracts during a period (i.e., quarterly, semiannually, or annually). et, ,?) or Si • f .. ture J e mes D. Snodgrass, Vice -President June 3, 2021 Date Name and Title of Signer (Please Type) NOTE The penalty for making false statements in offers is prescribed in 18 U.S.C. 1001. EPA-7 5720-4 2 February 2021 Attachment 2 SRFRequired t°rontaEnd Specifications (This form must be completed and signed by the Prime Contractor and submitted with the bid.) Debarments and Suspensions Any bidder or equipment supplier whose firm or affiliate is listed in on the U.S General Services Administration Excluded Parties List will be prohibited from the bidding process. The excluded parties records search engine is located at the System for Award Management (SAM) website: https://www.sam.cjov/SAI\rl/. Pursuant to 2 CFR Part 180, as supplemented by 2 CFR 1532, any entity submitting a bid while the SAM website lists that entity as having an active exclusion will be determined by the DNR to be a non -responsive bidder and will not be able to receive SRF funding. United States Environmental Protection Agency Washington, DC 20460 Certification Regarding Debarment, Suspension, and Other Responsibility Matters The prospective participant certifies to the best of its knowledge and belief that it and the principals: (a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency; (b) Have not within a three year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State, or local) transaction or contract under a public transaction: violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; (c) Are not presently indicted or otherwise criminally or civilly charged by a government entity (Federal, State, or local) with commission of any of the offenses enumerated in paragraph (1) (b) of this certification; and (d) Have not within a three-year period preceding this application/proposal had one or more public transactions (Federal, State, or local) terminated for cause or default. understand that a false statement on this certification may be grounds for rejection of this proposal or termination of the award. In addition, under 18 U SC Sec. 10 01, a false statement may result in a fine of up to $10,000 or imprisonment for up to 5 years, or both. James D. Snodgrass, Vice -President Typed Name & Title of Authorized Representative June 3, 2021 Signa ure of Authorized Repres ntative Date am unable to certify to the above statements. My explanation is attached. February 2021 Attachment 5 SRF Required FrontnEnd Specifications (This form must be completed and signed by Prime Contractor and submitted with the bid) PROFIIF3ITION ON CERTAIN TELECOMMUNICATIONS AND VIDEO SURVEILLANCE SERVICES OR E S UIPMENT This term and condition implements 2 CFR 200.216 and is effective for obligations and expenditures of EPA financial assistance funding on or after 8/13/2020. EPA recipients and subrecipients, including borrowers under EPA funded revolving loan fund programs, are prohibited from obligating or expending loan or grant funds to: (a) Procure or obtain, extend or renew a contract to procure or obtain; (b) Enter into a contract (or extend or renew a contract) to procure; or (c) Obtain the equipment, services, or systems that use `covered telecommunications equipment or services" identified in the regulation as a substantial or essential component of any system, or as critical technology as part of any system. Certain equipment, systems, or services, including equipment, systems, or services produced or provided by entities subject to the prohibition are recorded in the System for Award Management exclusion list, website: https://www.sam.Qov/SAM/, (1) As described in Public Law 115-232, section 889, covered telecommunications equipment or services includes: (i) Telecommunications equipment produced by Huawei Technologies Company or ZTE Corporation (or any subsidiary or affiliate of such entities). (ii) For the purpose of public safety, security of government facilities, physical security surveillance of critical infrastructure, and other national security purposes, video surveillance and telecommunications equipment produced by Hytera Communications Corporation, Hangzhou Hikvision Digital Technology Company, or Dahua Technology Company (or any subsidiary or affiliate of such entities). (iii) Telecommunications or video surveillance services provided by such entities or using such equipment. (iv) Telecommunications or video surveillance equipment or services produced or provided by an entity that the Secretary of Defense, :n consultation with the Director of the National Intelligence or the Director of the Federal Bureau of Investigation, reasonably believes to be an entity owned or controlled by, or otherwise connected to, the government of a covered foreign country. (2) Consistent with 2 CFR 200.471, costs Incurred for telecommunications and video surveillance services or equipment such as phones, internet, video surveillance, and cloud servers are allowable except for the following circumstances: (i) Obligating or expending EPA funds for covered telecommunications and video surveillance services or equipment or services to procure (enter into, renew or extend contracts) or obtain the equipment, services, or systems as described in 2 CFR 200.216. I understand the above prohibitions and certify that the project will be in compliance with all the requirements. James D. Snodgrass, Vice -President Typed Name & Title of Authorized Representative t h) /1 June 3 2021 j . Signq'f re of Authorized Representative Date February 2021 June 3, 2021 Ft 0 -J a) (a 0 m '12®� r Ill la' �0 z N LLI O . CO 0 'L W Z O 7 r Pan Z al0 III® U 2 Ili z- v J e 0 0) m Prime Contractor Name: June 3, 2021 Q) 0 Vice -President V) O tit0) C Q 0 _0 L 0 o O UO 0-Q O -0 r. CD co C O Q.(8 E o O .- O co F H O O o E 0 C oa �-. 5 La-) :LED: a3 P 0-p�f' c op r r t CO) D N _w L. U c)') r O- C C7 p U ca o Q RYo >- '" C o •ILI 0 co rs <WU cot J i CL C:-LL1 c < 2U � s5 T 'OI � o q�) 0 O C Z _ 0 0 °) m 3 � 0 t 2 o O L_ (/) 0 en w U_ v m O- O U C O ° o _C C L 0 E C 0 t0 O Qom) O C rn > O CC C:.,._,� o_ i-' co U t Ccu L C > O co O O_O o n Q. u O (!) O CO C a C O•EO a flF. o a) c 0o C E O_a o O u) r .r3 4-71 al W o 0' L 0 G al it T3at: cr t. al CDQ� 0 E 832 N 22 42 Z7 2 O V e (o 2 O co U a) C L rn 2 O u) O C a cn cn U) >— W ` (o 0 FL O W 0 0 012 Z W Z UEI 033 LL LLJ Z CO LL OW W m J2 co 1- •WA Quotes Recthed 0 (9) 7 24 cA 0 O O (>1 CO N 10 z a col 6 cri co 8 cit `.#D Z N CO N 10 Z Z a) >- r N N 1 10 r N N 1 10 mprovements Daniels Home 0 (6 0 Q U U 0 r N CO N 10 0 e U U 0 0 0 N 0 (Form CCO-4) Rev BID BOND KNOW ALL MEN BY THESE PRESENTS, that we, Benton's Sand & Gravel Inc as Principal, and Employers Mutual Casualty Company as Surety are held and firmly bound unto the 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 3rd day of _ June 20 21 for FY 2021 Westdale Bioswale Contract No. 997 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 3rd day of June , A.D. 20 21 (Seal) Witness By Principal Benton's Sank& Gravel Inc (Title) Employers Mutual Casualty Company (Seal) Surety By rney-in-fact Nancy D. Baltutat P.O. Box 712 • Des Moines, Iowa 50306-0712 INSURANCE POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY -IN -FACT KNOW ALL MEN BY THESE PRESENTS, that: 1. Employers Mutual Casualty Company, an Iowa Corporation 2. EMCASCO Insurance Company, an lowa Corporation 3. Union Insurance Company of Providence, an Iowa Corporation 4. Illinois EMCASCO Insurance Company, an Iowa Corporation 5. Dakota Fire Insurance Company, a North Dakota Corporation 6. EMC Property & Casualty Company, an Iowa Corporation hereinafter referred to severally as "Company" and collectively as "Companies", each does, by these presents, make, constitute and appoint: Nancy D. Baltutat its true and lawful attorney -in -fact, with full power and authority conferred to sign, seal, and execute the Bid Bond In an amount not exceeding Ten Million Dollars $10,000,000.00 and to bind each Company thereby as fully and to the same extent as if such instruments were signed by the duly authorized officers of each such Company, and all of the acts of said attorney pursuant to the authority hereby given are hereby ratified and confirmed. AUTHORITY FOR POWER OF ATTORNEY This Power -of -Attorney is made and executed pursuant to and by the authority of the following resolution of the Boards of Directors of each of the Companies at the first regularly scheduled meeting of each company duly called and held in 1999: RESOLVED: The President and Chief Executive Officer, any Vice President the Treasurer and the Secretary of Employers Mutual Casualty Company shall have power and authority to (1) appoint attorneys -in -fact and authorize them to execute on behalf of each Company and attach the seal of the Company thereto, bonds and undertakings, recognizances, contracts of indemnity and other writings obligatory in the nature thereof; and (2) to remove any such attorney -in -fact at any time and revoke the power and authority given to him or her. Attorneys -in -fact shall have power and authority subject to the terms and limitations of the power -of -attorney issued to them, to execute and deliver on behalf of the Company, and to attach the seal of the Company thereto, bonds and undertakings, recognizances, contracts of indemnity and other writings obligatory in the nature thereof, and any such instrument executed by any such attorney -in -fact shall be fully and in all respects binding upon the Company Certification as to he validity of any power -of -attorney authorized herein made by an officer of Employers Mutual Casualty Company shall be fully and in all respects binding upon this Company. The facsimile or mechanically reproduced signature of such officer, whether made heretofore or hereafter, wherever appearing upon a certified copy of any power -of -attorney of the Company, shall be valid and binding upon the Company with the same force and effect as though manually affixed. IN WITNESS THEREOF, the Companies have caused these presents to be signed for each by their officers as shown, and the Corporate seals to b hereto affixed this 1st day of July , 2018 . Seals y • . < lt‘n m • 5 SEAL • iown tttttttt UyOdi 0s` oR.1 I04, SEAL =•<- • • •t.t t, IOWA,Mtt ,: tttttttttttttt c�CA O APA ;7 , RP0 0 4 •1% • -,: cj) 1863 cu:\1953 =<- IOWA �; ttttttttttt • O: • p SEAL °Y •+t '' 4cikt gill DM" ,, tttttttttttttt �o �P'p eo !ts9• •• •• : C f4. . f • 0 KATHY LOVERIDGE Commission t&imbs 786769 kly on Expires October10,2022 a Bruce G Kelley, CEO, Cha" an of Companies 2, 3, 4, 5 & 6' President of Companies 1, 2 & 6; Treasurer of Companies 1, 2, 3, 4 & 6 Todd Strother Senior Vice President On this 1st day of July 2018 before me a Notary Public in and for the State of Iowa, personally appeared Bruce G. Kelley and Todd Strother, who, being by me duly sworn, did say that they are, and are known to me to be the CEO Chairman, President and Treasurer and/or Senior Vice President, respectively of each of the Companies above that the seals affixed to this instrument are the seals of said corporations; that said instrument was signed and sealed on behalf of each of the Companies by authority of their respective Boards of Directors; and that the said Bruce G Kelley and Todd Strother, as such officers, acknowledged the execution of said instrument to be their voluntary act and deed, and the voluntary act and deed of each of the Companies. My Commission Expires October 10, 2022. MA/_! 4 Notary Publin and for the State of/lowa CERTIFICATE I, James D. Clough, Vice President of the Companies, do hereby certify that the foregoing resolution of the Boards of Directors by each of the Companies, and this Power of Attorney issued pursuant thereto on 1st day of July , 2018 , are true and correct and are still in full force and effect. In Testimony Whereof I have subscribed my name and affixed the facsimile seal of each Company this 3rd day of June 7854 (9-19) B005536 A1419 912 A 000000-00 i 2021 Vice President "For verification of the authenticity of the Power of Attorney you may call (515) 345-2689."