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FORM OF BID OR GPRoPOSAP ,
C 11P FI(())E MV G\U rE AND CARRIAGE ovr, Wi ORIM l AT ER kfii �l� C_WILAV\IT
CONTRACT MO. 1010
ary OF WATERLOO, 00WA
Honorable Mayor and City Council
Waterloo, Iowa
Gentlemen:
1. The undersigned, being a Corporation existing under the laws of the State of
/ 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. 021
U f TO H 1-Wir,HUH AND eV':ARM GH C=IAILL- MIME STORIMPJAITfl DMPRVEB E\ !1 S9 C o 61ti;;[' -1tt;
rik n 10 ii o, all in accordance with the abovodisted documents and for the unit prices for work in
place for the following items and quantities:
FY
P
a
ON'WEN
tlE
&
C
F,
HILL
DROVE
Scfl
Oh-
nirdbiJA`INC'
2021
J1,RRDAG
IIMPROVEilliENITS
CONTRACT
Ni
``%
p 1010
BID
SUDAS
TOTAL
UNIT
BID
TOTAL
BID
SPECIFICATION
DESCRIPTION
UNIT
QTY
PRICE
PRICE
ITE[fl
1
CLEARING
AND
i0
2010-1.08B
GRUBBING
ACRE
2
$ 53 0069
$ &"?‘`
2
ON
-SITE
TOPSOIL,
STRIP,
SALVAGE,
--
2010-1.08D
AND
SPREAD
CY
2800
$ 6
$ f4 10
3
OFF
-SITE
TOPSOIL,
FURNISH
AND
...
2010-1.08D
SPREAD
CY
330
$ 9 6
$ 4510
4
`
2010-1.08E
CLASS
10
EXCAVATION,
HAULED
CY
6300
$ ;,
$
75 A°(
5
2010-1.08E
EMBANKMENT
CONSTRUCTION
CY
455
$
$
) )fl
6
EXISTING
STORM
SEWER,
REMOVAL
OF
4020-1.08D
RCP,
12
IN
LF
30
$
$ ,7sO
7
REMOVAL
OF
EXISTING
STORM
SEWER,
4020-1.08D
RCP,
15
IN
LF
11
$
$ r
BID
UNIT
SUDAS
TOTAL
BID
TOTAL
BID
SPECIFICATION
DESCRIPTION
UNIT
QTY
PRICE
PRICE
ITEM
8
HIGH
DENSITY
POLYETHYLENE
PIPE
.
,.)
r Y
4020-2.01
F
(HDPE),
AASHTO
M
294,
8
IN
LF
174
$ .
$ 7)5o?
9
HIGH
DENSITY
POLYETHYLENE
PIPE
, ,
M)35-3-
4020-2.01
F
(HDPE),
AASHTO
M
294,
15
IN
LF
353
$
$
FORM OF BID
of 4
CONTRACT NO. 1010
Page 1
PIPE
--
HIGH
DENSITY
POLYETHYLENE
.-
24
IN
LF
120
$ `
.�
$ �v
10
4020-2.01
F
(HDPE),
AASHTO
M
294,
))/6°
„we
/00
PIPE
APRON
15"
EACH
1/60
11
4030-2.02
CONCRETE
I
20°
>
12
4030-2.02
CONCRETE
PIPE
APRON
24"
EACH
2
$
Jel
$
o�
PERFORATED
SUBDRAIN,
CORRUGATED
PE,
AASHTO
M
252,
TYPE
13
4040-2.02D
CP,
4-
IN.
LF
30
'
$ A$
430
MANHOLE,
STORM
SEWER,
SW-401,
48
14
6010-2.01
IN
EACH
2
$ C/C c`
$ /,,oC0
MANHOLE,
STORM
SEWER,
SW-401,
60
15
6010-2.01
IN
EACH
1
$10
A,t
$ /0)o&8
INTAKE
STRUCUTRE,
60
IN
x
60
IN
AREA
.,.,
16
6010-2.01
SW-513
EACH
1
$ > vL„
$ 400
STRUCUTRE,
72
IN
x
72
IN
AREA
INTAKE
,
17
6010-2.01
SW-513
EACH
2
$ ;Lt"
$
4414;
18
8030-1.08A
TRAFFIC
CONTROL
LS
1
$ 7j '.4
$ 5 J `P
SEEDING,
TYPE
1
(PERMANENT
LAWN
�/
19
9010-2
02A
MIXTURE)
ACRE
3
$ `4"
$ 04200
LF
1235
$ a
$ I17e
20
9040-1.08N
SILT
FENCE
-))
ra
21
9040-1.08N
SILT
FENCE
REMOVAL
LF
1235
$ /
$ 6
:235
STABILIZED
CONSTRUCTION
22
9040-1.080
ENTRANCE,
EC-303
TONS
150
$ -
$ 1/ boa
MATS
TURF
REINFORCEMENT
(TRM),
3236
23
9040-1.08R
TYPE
II
SQ
62
$ ` 3
$
set,.
TEMPORARY
ROLLED
EROSION
f .; 5J
-6°2
24
9040-2.052C
CONTROL
PRODUCT
(RECP),
TYPE
2.0
SY
7650
$
$ T
"
,
25
9040-2.09D
RIP
RAP
(TYPE.
EROSION
STONE)
TONS
70
$ PO
$
` a
26
9040-3.02
SWPPP
MANAGEMENT
LS
1
$
,t1'0
$ &coo
27
11010-1.08A
CONSTRUCTION
SURVEY
LS
1
$ i j�l5V
$ 5,9•SO .`
28
11020-1.08A
MOBILIZATION
LS
1
$ `f0C1,
$ /4000
6
2Vocc
29
SEE
DRAWINGS
*
CONSTRUCTION
FENCING
LF
4000
$
$
INLINE
DRAIN
BASIN
W/18
IN
GRATE
•'
Vice
30
SEE
DRAWINGS
*
INTAKE
(NYLOPLAST
OR
EQUAL)
EACH
3
$ <Vet
$
24
IN
INLINE
DRAIN
BASIN
W/
SOLID
TOP
..-
/5-D
1
$ n-
$
31
SEE
DRAWINGS*
(NYLOPLAST
OR
EQUAL)
EACH
CONNECTION
OF
DOWNSPOUT
TILE
TO
-'
Q.)
*
14
$. Z 0311
32
SEE
DRAWINGS
NEW
STORM
LINE/STRUCTURES
EACH
$115-
FIELD
DRAIN
TILE
LINE
CONNECTION(S)
%
1!
t/
33
SEE
DRAWING
S *
TO
NORTH
INTAKE
STRUCTURE
LS
1
$
$ r
i
*See
sheet
G04
of
the
design
drawings
for
estimate
reference
notes
covering
these
bid
items.
Sijuj
T*TALEIID
$
__ a,
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 payrnent 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
FORM OF BID CONTRACT NO. 1010 Page 2
of 4
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 --�0 of
Dollars ($
in the form of fl e , is submitted herewith in accordance with the
INSTRUCTIONS IONS TO BIDDERS.
5. Attached hereto is a NonoCollusion Affidavit of Prime Contractor.
6. Attached hereto is a Bidder status Form.
7. The bidder is prepared to subrnit 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.
Date4>/rec2•/
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 PreObid 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 NonCollusion Affidavits of All
Subcontractor(s).
The Contractor shall submit information on subcontractors on "SUBCONTRACTOR RFQUEST
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 fortes.
FORM OF BID
of 4
CONTRACT NO. 1010 Page 3
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.
c
CoV/ rkfG�ir\_. 1)12_
Name of Bidder)
Official Address: (Including Zip Code):
P t3cA (69
1
Title
lJ rti V l
(Date)
cAlcc,,, le j-54 srowq
I.R.S. No. (I -7 - �� 1 688'9,
FORM OF BID CONTRACT NO. 1010 Page 4
of 4
NON COLLUSION AFFID�- VIT OF PRIME BIDDER
State of jr-
County of.1j/'u='g_ K-
Ovvik
)ss
, being first duly sworn, deposes and says that:
Partner officer Representative or Agent) , of L cnl e_
1. Hers Owner , ,� �
('t +t, the Bidder thatias su mitted the attached Bid;
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
S. 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.
Subscribed and sworn to before me this
My commission expires
(Signed)
Title
cdvfie&
Title
C (70,93
1 ct,seict
day of , 20a
An%)
•
LINDA K SENN
COMMISSION NO, 803307
MY COMMISSION EXPIRES
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, rnental or physical disabilities, political opinion or affiliations.
3. 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.
4. 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 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.
S. 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)
(Appropriate Official)
23-14,4-eJ- r raj
(Date)
(Title)
Ethloloir St tus Forrm
To be completed by aOl bidders
PI ase answer "Yes" or "No" for each of the following:
d
Yes 0 No My company is authorized to transact business in lowa.
(To help you determine if your company is authorized, please review the worksheet on the next page).
es KJ 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 l`�1No My company has been conducting business in Iowa for at least 3 years prior to the first request for
bids on this project.
Yes 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 eompOoted by resident b6 alders
Part B
My company has maintained offices in Iowa during the past 3 years at the following addresses:
Dates / / to / / Address: Roe )301 V5-1
p , •
City, State, Zip: C1" iN( i 1ie J �� ��'�%
Dates: / / to / / Address:
City, State, Zip:
Dates: / / to / / Address:
You may attach additional sheet(s) if needed. City, State, Zip:
To be corripfeted by non re&&dent 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
_ 0Yes 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 afl bidders
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: to Cow�/'�`C�'
Signature:
/ — Date: ge
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)
Vk!out'khee'c t= t rdl o r o a Lli; o ni to Transact LEkullness
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.
0 Yes
0Yes 0No
0 Yes
O
Yes
Yes
0 Yes 0-do
0Yes 0No
0 Yes
0 Yes
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)
MBERIVBE, BUSINESS Pru rG-= P US
I-VaEID CONTACT 8NFO bkfd`K ION {FOR Mfd
Prime Contractor Name: Cciin_)-hurt (CAA
Project: A)e a- (cot et liti 11 „--for/ -f-e-, - five) Letting Date:
1
NO IVIBE/WBE SUBCONTRACTORS: If you are NOT using any MBIfVVBE 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.
Contractor Signature:
Title: -4-`` r
Date: &-P — e-9" I
SUBCONTRACTORS APPLOC/\ _ALE: 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/WBF= 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. or INFORMATION 3u-IOWfvING BIDDER P I E0BID
MBF/W -, E BUSINESS FNIEFIPRISE CONTACTS
Quotes
Received
Quotation
used
in
bid
M
B
E/WB
E
Dates
Dates
Dollar
Amount
Proposed
to
Contacted
Yes/No
Contacted
Yes/No
be Subcontracted
Subcontractors
1
9 397 75.-
T.)
44-
)h
,at
0
-9--;
yes
,
(Form CCO-4) Rev. 06-20-02
CONTRACTOR'S OR SUBCONTRACTOR'S AFFIRMATIVE ACTION PROGRAM
Check box that applies to party completing program:
(
(
General Contractor
Subcontractor
I. Section A to be completed by GENERAL CONTRACTORS only:
A.
Name of v Com anLcA t cavisa_k_c_1114,-
p
Address of Company IUD. 36/ y,5�% Zip 500
Telephone Number (r(f ) o`-'/U ' -77E 7
Federal ID Number (if no Federal ID Number, Owner/President's Social Security Number)
Name of Equal Employment Officer s ��c Loc4 Lt
Name of Project °�tivt
Project Contract Number /01�
Estimated Construction Work Dates / -�
Start Finish
Section B to be completed by SUBCONTRACTORS only:
B.
Name of General or Prime Contractor
Name of Subcontractor
Subcontractor's Address Zip
Subcontractor's Telephone Number
Revised February 2003
'17-Th2ftligot
Subcontractor's Federal ID Number (if no Federal ID Number Owner/President's Social Security Number)
Name of Equal Employment Officer
AFFIRMATIVE ACTION PROGRAM Page 1 of 8
A. Remainder of program to be completed by party completing program, either Prime or Subcontractor.
1. The Owners and/or Principals of your company:
Name
S-}eye, IDS e-
Ethnic
Address Position Sex Origin
Poi 30( 9.51
c lu tcaifejP-
-
est6 15
2. Other Areas of Interest:
I iv
If your company has branches or subsidiaries, or if your company is a branch or subsidiary of a parent
organization, give the following information:
Name
Type of
Address Affiliation Degree
ll. EMPLOYER'S POLICY (Please read carefully.)
A. We, the undersigned, recognize that we are morally and legally committed to nondiscrimination in
employment. Any person who applies for employment with our company will not be discriminated against
because of race, color, creed, sex, national origin, economic status, age, mental or physical handicap.
B. The employment policies and practices of the undersigned are to recruit and hire employees without
discrimination, and to treat them equally with respect to compensation and opportunities for advancement,
including training, upgrading, promotion, and transfer. However, we realize the inequities associated with
employment training, upgrading, contracting and subcontracting for minorities and women and we will direct
our efforts to correcting any deficiencies to the maximum extent possible. The same will be required of our
SUBCONTRACTORS and suppliers.
C. We submit this prograrn to assure compliance with Executive Order 11246, as amended, and other
subsequent orders that may pertain to equal employment opportunity and merit employment policies, fully
realizing that our qualification and/or merit system should be evaluated and revised, if necessary.
D. We agree to put forth the maximum effort to achieve full employment and utilization of capabilities and
productivity of all our citizens without regard to race, creed, color, sex, national origin, economic status, age,
and mental or physical handicap.
E. viESL C.k vy-rc.ci L will give training
(Name of Company)
and employment opportunities to local residents of Waterloo, Iowa, to the greatest extent feasible.
AFFIRMATIVE ACTION PROGRAM Page 2 of 8
III. AFFIRMATIVE ACTION
A. L ocet5c et tAtcx--i'✓�
(Name of Company)
recognizes that the effective application of a policy of
merit employment involves more than just a policy statement, and te/e4e
(Name of Company)
will, therefore, re-evaluate our Affirmative Action Program to ensure that equal employment opportunities
are available on the basis of individual merit, and to actively encourage minorities, women and local residents
to seek employment with our company on this basis.
B. L of e_ ro ws-htiL ki-.
(Name of Company)
our Affirmative Action Program:
C.
will undertake the following six (6) steps to improve
1. Minority Recruitment and Employment;
2. Local Recruitment and Employment;
3. Disabled Veteran and Vietnam Era Veteran Recruitment and Employment;
4. Handicapped Recruitment and Employment;
5. Female Recruitment and Employment; and
6. Training, Upgrading and Promotional Opportunities.
Ckatel-t----
will take whatever steps are necessary to
(Name of Company)
ensure that our total work force has adequate minority, female, and local representation. We will utilize the
following methods in our recruitment attempts:
1. Local advertising media (newspapers, radio, TV);
2. Community organizations (churches, clubs, schools);
3. Public and private institutions in the area (UNI, Hawkeye Community College);
4. Job Service of Iowa; and
5. Other.
D. iva-c -c ic will seek qualified minority, female, and local group applicants
(Name of Company)
for all job categories and will make asserted efforts to increase minority, female and group representation in
occupations at the higher levels or skill and responsibility.
E. All sources of employment used shall be aware that we are an Equal Employment Opportunity Employer.
Labor organizations representing our employees will be notified of our Equal Employment Opportunity Policy
and Affirmative Action Program.
F.
G.
Training, upgrading, promotion and transfer activities at all levels will be monitored to ensure that full
consideration has been given to qualified minority, female, and local group employees.
C vie-J4 _ will encourage other companies, with whom we are
(Name of Company)
associated and/or do business, to do the same and we will assist them in their efforts.
AFFIRMATIVE ACTION PROGRAM
Page 3 of 8
H. lack t has taken the following Affirmative Action to ensure that
(Name of Company)
minority, female, local contractors and/or suppliers were provided opportunities to negotiate and/or bid on
this project: (if none, write "NONE")
1.
2.
Eon (
e
As a result of the above efforts, we have involved minority, female, and local contractors and/or suppliers in
the following areas of subcontracting: (if none, write "NONE")
1 secct
2.
Eice.5 / tM C C , vt.C'f v
J. i-uce- Cr td`-L ; will require approved Affirmative Action Programs from
(Name of Company)
all nonexempt contractors who propose to work on this project and will take whatever steps are necessary
to ensure that non -minority contractors have adequate representation of minority, female and local persons
in their total work force.
K. In further accordance with rules and guidelines issued pursuant to Executive Order 11246 as amended, we
establish the goals for our company, based on parity percentages supplied by the City, and we realize these
goals will be reviewed on an annual basis.
L. Zo‘ CCIA4frich•%- will records of s ecific actions relative to
keep p
(Name of Company)
recruitment, employment, training, upgrading and promotion and will provide the City of Waterloo with any
information relative to same, including activities of our SUBCONTRACTORS and suppliers as necessary or
when requested.
M. Parity figures for companies located in Waterloo are as follows:
Minority Parity = .08 (8%)
N. Gdp) /et/ 54 tG
(Name of Company)
Affirmative Action Employment Goals:
The definition of Affirmative Action Goals is as follows: "Goals may not be rigid and inflexible quotas which
must be met, but must be targets, reasonably attainable by means of applying every good faith effort to make
all aspects of the entire Affirmative Action Program work."
For the year 201, please submit percentage targets for employing minorities and women. If you already
have reached your target for hiring minorities and women, please submit that percentage.
*Goals for Minorities:
Goals for Women:
AFFIRMATIVE ACTION PROGRAM Page 4 of 8
We hereby certify that we are in compliance with all City and Federal Affirmative Action Regulations and agree to accept all
liability for failure to comply.
Respectfully submitted,
By:
Company Executive
Date
By: s-Ae. /o4 e,
Equal Employment
Opportunity Officer
Date
City of Waterloo Affirmative Action Officer
Approved
Disapproved Reason:
By:
Date:
AFFIRMATIVE ACTION PROGRAM Page 6 of 8
BID BOND
KNOW ALL MEN BY THESE PRESENTS, that we, Lodge Construction, Inc.
as Principal, and North American Specialty Insurance Company
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 ($---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
2021 , for F.Y. 2021 Upton Avenue and Carriage Hill Drive Stormwater
Improvements, Contract No. 1010, Waterloo, Iowa
NOW, THEREFORE,
(a) If said Bid shall be rejected, or in the altemate,
•
(b) If said Bid shall be accepted and the Principal shall execute and deliver a contract in the form specified
and shall fumish 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 27th day of May , A.D.: 2021
•
iWess/
itness Stacie Christensen
Lodge Construction, Inc. (Seal)
Principa
By
/ e-----5A/nock-C
(Title)
North Arp an Specialty In � rance Comparleal)
i
urety
By
Attorney -ins
Dione R. Young
SWISS RE CORPORATE SOLUTIONS
NORTH AMERICAN SPECIALTY INSURANCE COMPANY
WASHINGTON INTERNATIONAL INSURANCE COMPANY
WESTPORT INSURANCE CORPORATION GENERAL POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS, THAT North American Specialty Insurance Company, a corporation duly organized and existing under
laws of the State of New Hampshire, and having its principal office in the City of Kansas City, Missouri and Washington International Insurance
Company a corporation organized and existing under the laws of the State of New Hampshire and having its principal office in the City of Kansas
City, Missouri, and Westport Insurance Corporation, organized under the laws of the State of Missouri, and having its principal office in the City of
Kansas City, Missouri does hereby make, constitute and appoint:
JAY D. FREIERMUTH, CRAIG E. HANSEN, BRIAN M. DEIMERLY, SHIRLEY S. BAR I'hNHAGEN, CINDY BENNETT, ANNE CROWNER
TIM McCULLOH, STACY VENN, DIONE R. YOUNG, WENDY A LEWIS, and STACIE CHRIS IENSEN JOINTLY OR SEVERALLY
Its true and lawful Attorney(s)-in-Fact, to make, execute, seal and deliver, for and on its behalf and as its act and deed, bonds or other writings
obligatory in the nature of a bond on behalf of each of said Companies, as surety, on contracts of suretyship as are or may be required or permitted by
law, regulation, contract or otherwise provided that no bond or undertaking or contract or suretyship executed under this authority shall exceed the
amount of: ONE HUNDRED TWENTY FIVE MILLION ($125,000,000.00) DOLLARS
This Power of Attorney is granted and is signed by facsimile under and by the authority of the following Resolutions adopted by the Boards of
Directors of North American Specialty Insurance Company and Washington International Insurance Company at meetings duly called and held
on March 24 2000 and Westport Insurance Corporation by written consent of its Executive Committee dated July 18, 2011.
"RESOLVED, that any two of the President, any Senior Vice President, any Vice President, any Assistant Vice President,
the Secretary or any Assistant Secretary be, and each or any of them hereby is authorized to execute a Power of Attorney qualifying the attorney named
in the given Power of Attorney to execute on behalf of the Company bonds, undertakings and all contracts of surety, and that each or any of them
hereby is authorized to attest to the execution of any such Power of Attorney and to attach therein the seal of the Company; and it is
FURTHER RESOLVED, that the signature of such officers and the seal of the Company may be affixed to any such Power of Attorney or to any
certificate relating thereto by facsimile, and any such Power of Attorney or certificate bearing such facsimile signatures or facsimile seal shall be
binding upon the Company when so affixed and in the future with regard to any bond, undertaking or contract of surety to which it is attached. '
toutintswoi
GIA97Y/A,_
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Na_'�LSEAL fi=
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aAUitallttlthyyH
l.e(oec,
4o¢ovikeBy
aSEAL `t..
Steven P. Anderson, Senior Vice President of Washington International Insurance Company
& Senior Vice President of North American Specialty Insurance Company
& Senior Vice President of Westport Insurance Corporation
By l!n• i
Mike A. Ito, Senior Vice President of Washington International Insurance Company
& Senior Vice Pres'dent of North American Specialty Insurance Company
& Senior Vice President of Westport Insurance Corporation
IN WITNESS WHEREOF, North American Specialty Insurance Company, Washington International Insurance Company and Westport
Insurance Corporation have caused their official seals to be hereunto affixed, and these presents to be signed by their authorized officers this
this 3RD day of DECEMBER , 20 20
State of Illinois
County of Cook ss:
On this 3RD day of DECEMBER 20 20, before me, a Notary Public personally appeared Steven P. Anderson , Senior Vice President of
North American Specialty Insurance Company
Washington International Insurance Company
Westport Insurance Corporation
Washington International Insurance Company and Senior Vice President of North American Specialty Insurance Company and Senior Vice President of
Westport Insurance Corporation and Michael A. Ito Senior Vice President of Washington International Insurance Company and Senior Vice President
of North American Specialty Insurance Company and Senior Vice President of Westport Insurance Corporation, personally known to me, who
being by me duly sworn, acknowledged that they signed the above Power of Attorney as officers of and acknowledged said instrument to be the
voluntary act and deed of their respective companies. _ 4
OFFICIAL SEAL
N. KENNY
Notary public - State of IDi irk
My Commission Expho
12/042021
M. Kenny, Notary Public
I, Jeffrey Goldberg , the duly elected Vice President and Assistant Secretary of North American Specialty Insurance Company, Washington
International Insurance Company and Westport Insurance Corporation do hereby certify that the above and foregoing is a true and correct copy of a
Power of Attorney given by said North American Specialty Insurance Company, Washington International Insurance Company and Westport Insurance
Corporation which is still in full force and effect.
IN WITNESS WHEREOF, I have set my hand and affixed the seals of the Companies this 27thday of May , 2021
Jeffrey Goldberg, Vice President & Assistant Secretary of Washington International Insurance Company &
North American Specialty Insurance Company & Vice President & Assistant Secretary of Westport Insurance Corporation