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FORM OF BID OR PROPOSAL
FY 2023 SERGEANT ROAD TRAIL BRIDGES NO. 2 AND NO. 3 REPLACEMENT
CONTRACT NO. 1070
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
a Partnership consisting of the following partners:
having
familiarize'(himself) (themselves) (itself) with the existing conditions on the project area
affecting the cost-ofthe 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 2023 SERGEANT ROAD TRAIL BRIDGES
NO. 2 AND 3 REPLACEMENT, Contract No. 1070, all in accordance with the above-.
listed documents and for the unit prices for work in place for the following items and
quantities:
FY
2023
SERGEANT
ROAD
TRAIL
BRIDGES
NO.
2 AND
3
REPLACEMENT
CONTRACT
NO.
1070
ITEM
BID
SPECIFICATION
SUPPLEMENTAL
SP
=
SUDAS
SPCL
*SEE
PROV
DIVISION
DESCRIPTION
1
—
BRIDGE
NO.
2
UNIT
EST
QTY
UNIT
PRICE
BID
TOTAL
PRICE
BID
DIVISION
2
1
2010-108-C*
CLEARING
REMOVAL
&
GRUBBING,
STUMP
LS
1.0
$ .3)09c,
$ 2 J000
2
2010-108-D
TOPSOIL,
SPREAD
STRIP,
STOCKPILE,
SY
775.0
$7
�`"
$ -;-
y(25
' ,
3
2010-108-J
SUBBASE,
MODIFIED,
6
INCH
SY
193.5
$ 10-,
$ :R3312.
$ :
)3o I/
4
2010-108-E
EXCAVATION,
CLASS
10
CY
312.0
$ 1 7 ''
5
2010-108-E
EXCAVATION,
CLASS
10,
WASTE
CY
43.0
$ a
-"
$ 5
0 75 -
IDOT
SPECIFICATIONS
6
2121.04
GRANULAR
INCH$
SHOULDER,
TRAIL,
6
SY
55.3
$ 1 51)
7
4109
-GRAD
13a
GRANULAR
CULVERT
INCHES
THICK
BASE,
MATERIAL
MACADAM,
FOR
BOX
24
CY
112.5
$ q
`
u
$
l�)
S
o
v
FORM OF BID
CONTRACT NO. 1070
Page 1 of 5
ITEM
BID
SPECIFICATION
SUPPLEMENTAL
SP
=
SUDAS
SPCL
* SEE
PROV
DIVISION
(CONTINUED)
DESCRIPTION
1
-
BRIDGE
NO.
2
UNIT
EST
QTY
UNIT
PRICE
BID
TOTAL
PRICE
BID
IDOT
(CONTINUED)
SPECIFICATIONS
8
4109
-
GRAD
3
GRANULAR
BLANKET,
CLEAN,
12
BOX
INCHES
MATERIAL
CULVERT,
THICK
FOR
1
INCH
CY
56.3
['
$ J
_�
$ 3� '}�
JO
9
2415.04
PRECAST
CULVERT,
X6FT.
CONCRETE
IDOT
CLASS
BOX
1,
12
FT.
LF
30.0
$1210°
$w3/"`"�
i
10
2415.04
PRECAST
CULVERT
SECTION,
CONCRETE
STRAIGHT
12
FT
X
6
FT.
END
BOX
EACH
1.0
$ 17100
46400R
$
$
$
13000
1")�
011
61
2415.04
PRECAST
SECTION,
FT.
X
6
FT.
FLARED
45
DEGREE
END
ANGLE,
12
EACH
1.0
DIVISION
4
12
4040-108-A
SUBDRAIN,
TYPE
SP,
4
INCH
LF
192.0
$
?AO'
$ r 7 -
13
4040-108-D
SUBDRAIN
OUTLET,
CMP,
4
INCH
EACH
8.0
$
?� ��Q
$ �a� -
DIVISION
7
14
7030-108-A
TRAIL
REMOVAL
SY
138.2RE
$
$ ��)
�Jl%
15
7030-108-E
NCCHREATION
TRAIL,
PCC,
6"
SY
138.2
$ /
$ Iv
)3(06-
DIVISION
8
16
8030-108-A
TEMPORARY
TRAFFIC
CONTROL
LS
1.0
$ 5, ,/ (,
$3,
jSV —
DIVISION
9
17
9010-108-B
HYDRAULIC
FERTILIZING
2
SEEDING,
&
MULCHING
-
TYPE
SY
775.0
$c?
---
$))
�5 0
18
9040-108-E
ROLLED
PRODUCT,
EROSION
RECP
-
TYPE
CONTROL
2.0
SY
775.0
$
$ /
S'�-�J
19
9040-108-J
RIPRAP,
CLASS
E,
EROSION
12
INCH
STONE,
DEPTH
TON
160.0
/, j !
$ `7 I
/
$ v)�l�'
/�
--
.-
20
9040-108-F
WATTLES,
(INSTALLATION,
REMOVAL)
8
INCH
MAINTENANCE,
LF
249.0
$ IoR
/5-
$ -5-
21
9040-108-N
SILT
MAINTENANCE,
FENCE
(INSTALLATION,
REMOVAL)
LF
390.0
$ s'
$ I)
93-0
22
9040-108-0
CONSTRUCTION
(INSTALLATION,
REMOVAL)
MAINTENANCE,
ENTRANCE
LS
1.0
,--
?JCOO
$
i
3
$ J
500
DIVISION
10
23
10,010-108-A
BRIDGE
REMOVAL
LS
1.0
$ 5000'
$ 5300e ---
DIVISION
11
24
11,020-108-A
MOBILIZATION
LS
1.0
$ 4000 -'
$ 7A00 -
a
TOTAL
DIVISION
1
BRIDGE
NO.
2 $ 17
-
)9
FORM OF BID
CONTRACT NO. 1070
Page 2 of 5
ITEM
BID
SPECIFICATION
SUPPLEMENTAL
SP
=
SUDAS
SPCL
*
SEE
PROV
DIVISION
DESCRIPTION
2
-
BRIDGE
NO.
3
UNIT
EST
QTY
UNIT
PRICE
BID
TOTAL
PRICE
BID
•
DIVISION
2
1
2010-108-C*
CLEARING
REMOVAL
&
GRUBBING,
STUMP
LS
1.0$
3,0°
$ )(2o0
2
2010-108-D
TOPSOIL,
SPREAD
STRIP,
STOCKPILE,
SY
1,510.0
$
7
$ 0)5-7o
3
2010-108-J
SUBBASE,
MODIFIED,
6
INCH
SY
234.0
$ /oL
—
$-f)It8-
$ $)5OC' ✓
$ (, 750
4
2010-108-E
EXCAVATION,
CLASS
10
CY
500.0
$ /
7
5
2010-108-E
EXCAVATION,
BORROW
CLASS
10,
CY
70.0
$ cA
S
IDOT
SPECIFICATIONS
6
2121.04
INCH GRANULAR
SHOULDER,
TRAIL,
6
SY
67.0
$
13
$ 87l
DIVISION
4
7
4020-108-A-1
CULVERT,
INCH
CONCRETE
PIPE,
48
EACH
138.0
$ 320
$ �aj7
'J VV
8
4020-108-A-1
APRON,
CONCRETE,
48
INCH
EACH
6.0
$ s,cCo
$ c��000
$ 3OJ000
$ j,)C30v
9
4020-108-A-1
FOOTING
APRON,
RCP,
FOR
48
CONCRETE
INCH
PIPE
EACH
6.0
DIVISION
7
10
7030-108-A
TRAIL
REMOVAL
SY
167.0
$ /b —
$ a,
w"7,z.-`
11
7030-108-E
RECREATION
INCH
TRAIL,
PCC,
6"
SY
167.0
C'
$ 7'
$ igjCe2S
DIVISION
8
12
8030-108-A
TEMPORARY
TRAFFIC
CONTROL
LS
1.0
$ 3} /sz> -
$ ?Jac) -
DIVISION
9
13
9010-108-B
HYDRAULIC
FERTILIZING
2
SEEDING,
&
MULCHING
-
TYPE
SY
1,510.0
$ /
sz
.-
o?jc--E
14
9040-108-E
ROLLED
PRODUCT,
EROSION
RECP
-
CONTROL
TYPE
2.0
SY
1,510.0
%
$ /
$ ,�)
C 65-
15
9040-108-J
RIPRAP,
CLASS
E,
EROSION
12
INCH
STONE,
DEPTH
TON
120.0
$ L/i
l// 9c20
$ r)
}
16
9040-108-F
WATTLES,
(INSTALLATION,
REMOVAL)
8
INCH
MAINTENANCE,
LF
300.0
$
J
$ / �
4091
17
9040-108-N
SILT
MAINTENANCE,
FENCE
(INSTALLATION,
REMOVAL)
LF
403.0
'�$
hoz--
3 ,iCao
$
_.
18
9040-108-0
CONSTRUCTION
(INSTALLATION,
REMOVAL)
MAINTENANCE,
ENTRANCE
LS
1.0
, 0U
$ )
DIVISION
10
19
10,010-108-A
BRIDGE
REMOVAL
LS
1.0
$ 6104'4'
$ S jceo —
DIVISION
11
20
11,020-108-A
MOBILIZATION
LS
1.0
—
$ 7J 000—
$
7)Oio
OU
TOTAL
DIVISION
2
BRIDGE
NO.
3
$ /62,org
—
TOTAL
DIVISION
1
BRIDGE
NO.
2 +
DIVISION
2
BRIDGE
NO.
3
—
—
9.,i
s
341)3tL7
$
FORM OF BID
CONTRACT NO. 1070
Page 3 of 5
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. Securityin the sum of Dollars $
the)ino �3 ,
form of ' C���is submitted herewith in
accordance with the INSTRUCTIONS TO BIDDERS.
5. Attached hereto is a Non -Collusion Affidavit of Prime Contractor.
6. Attached hereto is a Resident Bidder Certification ( / ` ), or Non -Resident Bidder
Certification ( ). (Mark one.)
7 The bidder is prepared to submit a financial and experience statement upon request.
8. The Prime Contractor and Subcontractor(s), which have performed an aggregate of
$10,000.00 in work for the City in the current calendar year, are prepared to submit an
AAP or Update and an EOC, within ten (10) days of notification that the bid submitted is
lowest and acceptable.
9. The bidder has received the following Addendum or Addenda:
Addendum No. Date
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:
FORM OF BID
CONTRACT NO. 1070 Page 4 of 5
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.
tods , CO-:kUJ-reit-\
(Name of Bidder) (Date)
BY: - Title ( 5 �`) Nam- ,i
-
Official Address: (Including Zip Code):
70.
80)(
C /or16viHz 179 SOCi//
I.R.S. No. 10-- Pg72--
FORM OF BID
CONTRACT NO. 1070 Page 5 of 5
NON -COLLUSION AFFIDAVIT OF PRIME BIDDER
State of fi
County of Bit-ei }C A4'/1-t4 VIAL
t)
)ss
, being first duly sworn, deposes and says that:
1 He is (Owner, Partner, Officpr;'�ep esentafive, or Agent) , of ��� = C"04266�
the Bidder thk_has-submitted-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
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.
Subscribed and sworn to before me this
(Signed)
t
Title
day of
Title
My commission expires 4i1/t /St1 9- 23
•
c1/41ec LINDt''' -•
:: IM
1 "Ot1rmlsst.
n 44
Worksheet: Authorization to Transact Business
This worksheet may be used to help complete Part A of the Resident Bidder Status form. If at least one of the following
describes your business, you are authorized to transact business in Iowa.
Yes
es
O Yes
O Yes
O Yes Q,Slo
O Yes
O YesO
O Yes
O Yes
O Yes
"o
My business is currently registered as a contractor with the Iowa Division of Labor.
My business is a sole proprietorship and I am an Iowa resident for Iowa income tax purposes.
My business is a general partnership or joint venture. More than 50 percent of the general
partners or joint venture parties are residents of Iowa for Iowa income tax purposes.
My business is an active corporation with the Iowa Secretary of State and has paid all fees
required by the Secretary of State, has filed its most recent biennial report, and has not filed
articles of dissolution.
My business is a corporation whose articles of incorporation are filed in a state other than Iowa,
the corporation has received a certificate of authority from the Iowa secretary of state, has filed
its most recent biennial report with the secretary of state, and has neither received a certificate of
withdrawal from the secretary of state nor had its authority revoked.
My business is a limited liability partnership which has filed a statement of qualification in this
state and the statement has not been canceled.
My business is a limited liability partnership which has filed a statement of qualification in a
state other than Iowa, has filed a statement of foreign qualification in Iowa and a statement of
cancellation has not been filed.
My business is a limited partnership or limited liability limited partnership which has filed a
certificate of limited partnership in this state, and has not filed a statement of termination.
My business is a limited partnership or a limited liability limited partnership whose certificate of
limited partnership is filed in a state other than Iowa, the limited partnership or limited liability
limited partnership has received notification from the Iowa secretary of state that the application
for certificate of authority has been approved and no notice of cancellation has been filed by the
limited partnership or the limited liability limited partnership.
My business is a limited liability company whose certificate of organization is filed in Iowa and has
not filed a statement of termination.
My business is a limited liability company whose certificate of organization is filed in a state other
than Iowa, has received a certificate of authority to transact business in Iowa and the certificate
has not been revoked or canceled.
309-6001 (09-15)
Bidder Status Form
To be completed by all bidders
PartA
Please answer "Yes" or "No" for each of the following:
My company is authorized to transact business in Iowa.
(To help you determine if your company is authorized, please review the worksheet on the next page).
My company has an office to transact business in Iowa.
My company's office in Iowa is suitable for more than receiving mail, telephone calls, and e-mail.
My company has been conducting business in Iowa for at least 3 years prior to the first request for
bids on this project.
My company is not a subsidiary of another business entity or my company is a subsidiary of another
business entity that would qualify as a resident bidder in Iowa.
If you answered "Yes" for each question above, your company qualifies as a resident bidder. Please
complete Parts B and D of this form.
If you answered "No" to one or more questions above, your company is a nonresident bidder. Please
complete Parts C and D of this form.
To be completed by resident bidders Part B
My company has maintained offices in Iowa during the past 3 years at the following addresses:
Dates:
Dates: /
Dates: /
/ / Address: �_U 90 tin
City, State, Zip:
/ to / / Address:
City, State, Zip:
/ to / / Address:
You may attach additional sheet(s) if needed.
J
City, State, Zip:
s
To be completed by non-resident bidders Part C
1. Name of home state or foreign country reported to the Iowa Secretary of State:
2. Does your company's home state or foreign country offer preferences to resident bidders, resident labor
force preferences or any other type of preference to bidders or laborers? O Yes O 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.
Firm Name: 1 Die C (� Yciv1
Signature:
Date: �'-02
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)
MBE/WBE BUSINESS ENTERPRISE
PRE -BID CONTACT INFORMATION FORM
Prime Contractor Name: L-d Co 4100-110 0-1C=
Project: FY eg0�3 5c13- dirt- Rek- Tr'r� I RI ic15e
Letting Date: C
NO MBE/WBE SUBCONTRACTORS: If you are NOT using any MBE/WBE subcontractors to complete this project,
sign below. Attach a brief explanation as to why subcontracting was not feasible with this project. If any MBE/WBE
subcontractors will be used, please use the bottom portion of this form.
Contractor Si natu e:
Title:
Date: 7-ai -�a-
OPE
SUBCONTRACTORS APPLICABLE: You are required, in order for your bid to be considered responsive, to provide
the information on this form showing ALL of your MBE/WBE subcontractor contacts made for your bid submission.
This information is subject to verification. Any questions may be directed to Contract Compliance Office 319-291-
4429.
You are required, in order for your bid to be considered responsive, to provide the information on this Form showing
your MBE/WBE Business Enterprise contacts made prior to your bid submission. This information is subject to
verifications and confirmation.
If you are unable to identify MBE/WBE firms to perform portions of the work, please contact Rudy Jones, Contract
Compliance Officer, for assistance at (319) 291-4429.
In the event it is determined that the MBE/WBE Business Enterprise goals are not met, then before awarding the
contract the City of Waterloo will make a determination as to whether or not the apparent successful low bidder made
good faith efforts to meet the goals.
TABLE OF INFORMATION SHOWING BIDDER'S 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
/ `�g-a9�C/S
/ o
r-r
I �� /vU�1so
(Form CCO-4) Rev. 06-20-02
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.
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.
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)
ii Appropriate Official)
f
'-a —(��—
(Date)
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, national origin, sex, age, or
disability in the selection and retention of subcontractors, including procurement of
materials and leases of equipment. 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 non-
discrimination on the grounds of race, color, national origin, sex, age, or 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,
TITLE VI CIVIL RIGHTS Page 1 of 2
Revised February 2003
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.
N ame of Company to6e,
Address of Company Pa i3 O $'15 % 5 U b
1c,
Telephone Number ( 3 )'% ) 092 � 2
Federal ID Number (if no Federal ID Number, Owner/President's Social Security Number)
t/ '7 -.any & fl Q
N ame of Equal Employment Officer
,5-4eAs tf, J,
N ame of Project r-v)0023 S e <5Q 4 > Rest r CtL rj 1
Project Contract Number /G' U
�s „9 0
Estimated Construction Work Dates 7-1-5---olg /
Start Finish
Section B to be completed by SUBCONTRACTORS only:
B.
N ame of General or Prime Contractor
N ame of Subcontractor
Subcontractor's Address Zip
Subcontractor's Telephone Number ( )
Subcontractor's Federal ID Number (if no Federal ID Number Owner/President's Social Security Number)
N ame 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
4isef
Ethnic
Address Position Sex Origin
p.o B o/ ys,
/14
-19 540
2. Other Areas of Interest:
If your company has branches or subsidiaries, or if your company is a branch or subsidiary of a
parent organization, give the following information:
Type of
Name Address Affiliation Degree
II. 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 program 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 i ,
and productivity of all •r�F;j•„ },;i_
status, age, and • - • •= Or
E.
(Name
and emplo
genut
'CONSTRUCTION ► JNC!,.
P.O. Box 459 ! CLARKSV1LIY, to 50619
um effort to achieve full employment and utilization of capabilities
s without regard to race, creed, color, sex, national origin, economic
al handicap.
AFFIRMATIVE ACTION PROGRAM
will give training
!dents of Waterloo, Iowa, to the greatest extent feasible.
Page 2 of 8
III. AFFIRMATIVE AC
A.
B.
C.
D.
will, therefore, re-eval
opportunities are avail
women and local
(Na
our Affirm
1.
2.
3.
4.
5.
6.
recognizes that the effective application of a policy of
meritRatilSintchrtasgrDOSO61'an just a policy statement, and
(Name of Company)
Affirmative Action Program to ensure that equal employment
e basis of individual merit, and to actively encourage minorities,
employment with our company on this basis.
will undertake the following six (6) steps to improve
P.�. Box 459 I CIR(SWILLF,, IA 50619
Minority Recruitment and Employment;
Local Recruitment and Employment;
Disabled Veteran and Vietnam Era Veteran Recruitment and Employment;
Handicapped Recru
Female Recruitmen
Training, Upgradin
(Name
ensure that ou
utilize the foll
1.
2.
3.
4.
5.
(Na
for
represi teti»iSmg %g
Communit
Public an
Job Servi
Other
. E Box 459 1 CL NNINaLti, EA 1O619 v t
nd Employment;
ployment; and
otional Opportunities.
will take whatever steps are necessary to
minority, female, and local representation. We will
attempts:
Local advertising media (newspapers, radio, TV);
rg izations (churches, clubs, schools);
'nstitutions in the area (UNI, Hawkeye Community College);
and
will seek qualified minority, female, and local group applicants
e asserted efforts to increase minority, female and group
gher 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 an. Affirmative Action Program.
5�!I+Q
F Training,u upgrading, ::;�' and transfer activities at all levels will be monitored to ensure that full
• pg 9� p'•
;=_ y1
consideration has b: Ac('.=Io qualified minority, female, and local group employees.
4
G.
(Name
associa
Pa
A Box 459 I CIARKSVILLE, IA 50519,r
AFFIRMATIVE ACTION PROGRAM
will encourage other companies, with whom we are
same and we will assist them in their efforts.
Page 3 of 8
H
1.
•`=`C;ONIST!'itiJ('i, IeiNi
, to S0b19
has taken the following Affirmative Action to ensure that
and/or suppliers were provided opportunities to negotiate and/or
ONE")
2. pticzvie
I. 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")
seeot- rviv lck
J.
1.
2.
celdr-7, Cc v5�- c will require approved Affirmative Action Programs from
(Name of ompany)
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 accorda rules and guidelines issued pursuant to Executive Order 11246 as
amended, we esta •��_ �,`? oafs for our company, based on parity percentages supplied by the City,
and we re reviewed on an annual basis.
,,
L. �` L � will keep records of specific actions relative to
(Nam::
recruit
with any! a .t `6
as necessary or w
ding and promotion and will provide the City of Waterloo
cria' MiM4 ncluding activities of our SUBCONTRACTORS and suppliers
ested.
M. Parity figures for located in Waterloo are as follows:
N.
Minority
tt4,'►<inrh i inter kl .:.i for.
P.O. Box 4,91 ARKSVU,I.F, IA S0619
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: -?
*Your affirmative action goals should be between 1% and 10% or more for minorities and 1% and
5% or more 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: , 54-eve
Company Executive
Date
By: :56--re /015 a
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 Swiss Re Corporate Solutions America Insurance Corporation
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 21 st day of July
2022 , for FY 2023 Sergeant Road Trail Bridges No. 2 and 3 Replacement,
•
Waterloo, Iowa; Contract No. 1070
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 fumish a bond for his faithful performance of said contract, and for the payment of all persons
performing labor or furnishing matenais 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 13th day of July , A D. 2022
Lodge Construction, Inc. (Seal)
Principal
By
t s-1:14i 4c (
(Title)
Swills"e C r$ rate Solu ions America Insurees9 ornoration
Witn ss ; ra Huston
S
-fact Anne Crowner
SWISS RE CORPORATE SOLUTIONS
SWISS RE CORPORATE SOLUTIONS AMERICA INSURANCE CORPORATION F/KIA NORTH AMERICAN SPECIALTY INSURANCE COMPANY ("SRCSAIC")
SWISS RE CORPORATE SOLUTIONS PREMIER INSURANCE CORPORATION F/KJA WASHINGTON INTERNATIONAL INSURANCE COMPANY ("SRCSPIC")
WESTPORT INSURANCE CORPORATION ("WIC")
GENERAL POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS, THAT SRCSAIC, a corporation duly organized and existing under laws of the State of Missouri, and
having its principal office in the City of Kansas City, Missouri, and SRCSPIC, a corporation organized and existing under the laws of the State of
Missouri and having its principal office in the City of Kansas City, Missouri, and WIC, organized under the laws of the State of Missouri, and having its
principal office in the City of Kansas City, Missouri, each does hereby make, constitute and appoint:
JAY D. FREIERMUTH, CRAIG E. HANSEN, BRIAN M. DEIMERLY, CINDY BENNETT, ANNE CROWNER, TIM McCULLOH, STACY VENN,
DIONE R. YOUNG, STACIE CHRISTENSEN, SETH ROOKER, JENNIFER MARINO AND JOSEPH TIERNAN
JOINTLY or SEVERALLY
Its true and lawful Attorneys) -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 both SRCSAIC and SRCSPIC at meetings duly called and held on the 18th of November 2021 and WIC by written consent of its
Executive Committee dated July 18, 2011.
"RESOLVED, that any two of the President, any Managing Director, any Senior Vice President, any 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 Corporation 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 Corporation; and it is
FURTHER RESOLVED, that the signature of such officers and the seal of the Corporation 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 Corporation when so affixed and in the future with regard to any bond, undertaking or contract of surety to which it is attached."
otosttlIllittlf
e salt Top,
i
0/0
,it%;
f.
5SEAL�tt
• Ds
1973 ,,
0
tttttttttttttttttttt
Sot.urio
::
'I 0
0• •2:
's d'.• : •.y\, By
',��'c., 4.. 4,1 S SS� tt, a-.4 Gerald Jagrowski, Vice President ofSRCSAIC & Vice President of SRCSPIC
(751:Nrads._.„..p
can
By
Erik Janssens, Senior Vice President of SRCSAIC & Senior Vice President
of SRCSPIC & Senior Vice President of WIC
SEALzip
& Vice President of WIC
IN WITNESS WHEREOF, SRCSAIC, SRCSPIC, and WIC have caused their official seals to be hereunto affixed, and these presents to be signed by their
authorized officers
this 29TH day of APRIL , 20 22
State of Illinois
County of Cook
Swiss Re Corporate Solutions America Insurance Corporation
Swiss Re Corporate Solutions Premier Insurance Corporation
Westport Insurance Corporation
On this 29TH day of APRIL , 20 22 , before me, a Notary Public personally appeared Erik Janssens , Senior Vice President of SRCSAIC
and Senior Vice President of SRCSPIC and Senior Vice President of WIC and Gerald Jagrowski , Vice President of SRCSAIC and Vice President of
SPCSPIC and Vice President of WIC, personally known to me, who being by me duly swom, 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. esa /
VA$1.11N A. PATEL
QFFICIAL SEAL
Nowt r.61c. S11!• 01 L041
MyCOMA1111N%1argot
May 9. IOi)
Yasmin A. Patel, Notary
I, Jeffrey Goldberg, the duly elected Senior Vice President and Assistant Secretary of SRCSAIC and SRCSPIC and WIC, do hereby certify that the above and
foregoing is a true and correct copy of a Power of Attorney given by said SRCSAIC and SRCSPIC and WIC, which is still in full force and effect.
IN WITNESS WHEREOF, I have set my hand and affixed the seals of the Companies this 13th day of July , 2022,
Ati
e sae --
Jeffrey Goldberg, Senior Vice President &
Assistant Secretary of SRCSAIC and
SRCSPIC and WIC