HomeMy WebLinkAboutWoodruff ConstructionFORM OF BID OR PROPOSAL
FY 2023 SANITARY SEWER GATEWELL REPAIRS PHASE II
CONTRACT NO. 1071
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 I owa
a Partnership consisting of the following partners: John Mallen
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 AECOM 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 the FY 2023 SANITARY SEWER GATEWELL
REPAIRS PHASE II, CONTRACT NO 1071, 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 SANITARY GATEWELL REPAIRS PHASE II
CONTRACT NO. 1071
Item
No.Description
Unit
Est.
Qty.
Unit
Price
Bid
Total
Price
Bid
BASE
BID
e
1
Mobilization
and
General
Items
LS
1
$ 4,1131
tj3
$ 10
13
2
Gatewell
3C-2
-
Replacement
LS
1
$1151%1'I13.it
$
$ iA1S54,,i-j2
$
r
/02)
312")L(:71
i5o,
62
$11375)913411
$
$
$
$
$
$ \/•
64-115%)-12-
102115042
15112.111
53123t4
Hiiily1
1t3g1
1
vy1
'.11
,
•z
03
3
Gatewell
3C-2
-
Lining
LS
1
4
Gatewell
3D-1
--
Replacement
LS
1
5
Gatewell
3E-0
- Installation
of
New
LS
1
6
Gatewells
Abandonment
3E-1,
3E-2,
3E-4,
3E-5
and
3E-6
-
LS
1
$
$
$
151it11,
113L1.71.2z1,'3
qii1i-lii
,
gt
03
7
Gatewell
5C-1
-
Replacement
LS
1
8
Gatewell
5D-1
-
Replacement
LS
1
9
Gatewell
5D-1
-
Lining
LS
1
$ 5161000/IS-
$ 111153,
$ 1-lire75,1
IL
$
$
$
t05/g,7.2
171
%oc0,
`11s,3(
#5
10
48"
Manhole
EA
6
11
60"
Manhole
EA
1
12
8"
Ductile
Iron
Pipe
LF
215
$ 10035
$
13
12"
Ductile
Iron
Pipe
LF
1144
$
lv$,/,h3
$ il
ic1
c;3 01.
TOTAL
BASE
BID
$
$cj
%fiiii)3,
a
FORM OF BID CONTRACT NO. 1071
AECOM #60549334
FB-1 of 3
FY 2023 SANITARY SEWER GATEWELL
REPAIRS PHASE II
Item
No.
Description
[Unit
Est.
Qty.
Unit
Price
Bid
Total
Price
Bid
BID
ALTERNATE
NO.
1
1-1
Replacement
of
Gatewell
8669
LS
1
$ 231
$ 23)000
po
TOTAL
BID
ALTERNATE
NO.
1
$4Z3i
GOO .00
$ 25)000000
BID
ALTERNATE
NO.
2
2-1
Replacement
of
Gatewell
21768
LS
1
$?., 'grj,
co
$ 26,q1c0.00
TOTAL
BID
ALTERNATE
NO.
2
$ X,140De 00
$ 2(Q, gW,,do
2. It is understood that the quantities set forth are approximate only and subject to variation and that the
unit bid price for the work done shall govern in the actual payment to Contractor.
3. In submitting this bid, the bidder understands that the right is reserved by the City of Waterloo, Iowa,
to reject any or all bids. If written notice of the acceptance of this bid is mailed, telegraphed, or
delivered to the undersigned within thirty (30) days after the opening thereof, or at any time thereafter
before this bid is withdrawn, the undersigned agrees to execute and deliver an agreement in the
prescribed form and furnish the required bond and certificate of the insurance within ten (10) days
after the agreement is presented to him for signature, and start work within ten (10) days after
"Notice to Proceed" is issued.
4. Security in the sum of two �u.tid-YO ri vteJ-y--o he �o tsa-tid Style Cu� A°''i Dollars
($ '19 /, lon,. 2-1 ) in the form of Ski, 'go Ind , 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 Bidder Status Form indicating Resident Bidder Certification ( X ), 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
The bidder has received the following Addendum or Addenda:
Addendum No. i Date 111l ' 2-7-
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. 1071
AECOM #60549334
FB-2 of 3
FY 2023 SANITARY SEWER GATEWELL
REPAIRS PHASE II
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:
Woodruff Construction, Inc. 11/3/2022
(Nanr of Bidder
(Date)
Title NE Region President
O ai I Address: (Including Zip Code):
Corporate office: 1890 Kountry Lane
Fort Dodge, IA 50501
I.R.S. No.
76-0721180
FORM OF BID CONTRACT NO. 1071
AECOM #60549334
FB-3 of 3
FY 2023 SANITARY SEWER GATEWELL
REPAIRS PHASE II
Revised February 2003
CONTRACTOR'S OR SUBCONTRACTOR'S AFFIRMATIVE ACTION PROGRAM
Check box that applies to party completing program:
( X ) General Contractor
( ) Subcontractor
I. Section A to be completed by GENERAL CONTRACTORS only:
A.
Name of Company Woodruff Construction, Inc.
1717 Falls Avenue
Address of Company Waterloo, IA Zip 50701
Telephone Number ( 319 ) 233-3349
Federal ID Number (if no Federal ID Number, Owner/President's Social Security Number)
76-0721180
Name of Project FY 2023 Sanitary Sewer Gatewell Repairs, Phase II
Project Contract Number City Contract 1071 I AECOM Project # 6054 9334
Estimated Construction Work Dates � I (t') bikAr . D1 �4
Start inish
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 f )
Subcontractor's Federal ID Number (if no Federal ID Number Owner/President's Social Security
Number)
Name of Equal Employment Officer
C. Remainder of program to be completed by party completing program, either Prime or
Subcontractor
1 The Owners and/or Principals of your company:
1
Ethnic
Name Address Position Sex Origin
Don Woodruff Fort Dodge, IA Owner
San Orr Ames, IA HR Manager
Jason Rechkemmer. Ames, IA COO
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
Woodruff Construction Locations: Waterloo, IA
Ames, IA
Fort Dodge, IA
II. EMPLOYER'S POLICY (Please read carefully.)
Waterloo, IA
Spencer, IA
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.
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.
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.
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.
Woodruff Construction will give training
(Name of Company)
and employment opportunities to local residents of Waterloo, Iowa, to the greatest extent
feasible.
III. AFFIRMATIVE ACTION
A. Woodruff Construction recognizes that the
(Name of Company)
effective application of a policy of merit employment involves more than just a policy
statement, and Woodruff Construction
(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.
Woodruff Construction will undertake the
(Name of Company)
following six (6) steps to improve our Affirmative Action Program:
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.
Woodruff Construction will take
(Name of Company)
whatever steps are necessary to 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.
Woodruff Construction will seek qualified minority,
(Name of Company)
female, and local group applicants 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. 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.
G. Woodruff Construction will encourage other
(Name of Company)
companies with whom we are associated and/or do business, to do the same and we will
assist them in their efforts.
H. Woodruff Construction has taken the following
(Name of Company)
Affirmative Action to ensure that minority, female, local contractors and/or suppliers were
provided opportunities to negotiate and/or bid on this protect: (if none, write "NONE")
Emailed Bid Invites to subcontractors
1. that fall under the DBE, MBE, WBE umbrella.
Emailed Specs, Drawings, Addenda and other related documentation
2, to subcontractors that fall under the DBE, MBE, WBE umbrella.
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")
1. —1\-efiivit-i) 1\eivii-tH (&01k fam
2.
J. Woodruff Construction will require approved
(Name of Company)
Affirmative Action Programs from 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. Woodruff Construction will keep records of
(Name of Company)
specific actions relative to 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. Woodruff Construction
(Name of Company)
Employment Goals:
Affirmative Action
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 2022, 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:
%
Ok
*Your affirmative action goals should be between 1 % and 10% or more for minorities and
1% and 5% or more for women.
Please be advised that the goals or targets are purely your estimation of how many
women and minorities your company can reasonably expect to hire in 2022 Note, that
none of the goals are rigid or inflexible. They are targets that your company calculates as
reasonably attainable. This will help the City in its monitoring procedures as required by
City of Waterloo Resolution No. 1984-142(4).
CONTRACTOR'S TOTAL WORK FORCE
(WATERLOO)
NAME AND ADDRESS
JOB CATEGORY
RACE
SEX
HOURLY
WAGE
SEE ATTACHED
INDICATE:
DISABLED VETERAN: DV
VIETNAM ERA VETERAN: VV
HANDICAPPED: H
Sex
Race
City
State
ZIP
Code
Position
M
H
WEBSTER
CITY
IA
50595
Craft
Worker
M
H
NEVADA
IA
50201
Craft
Worker
F
W
IA
52340
Administrative
TIFFIN
M
H
IOWA CITY
IA
52240
Craft
Worker
F
W
AMES
IA
50014
Administrative
F
W
NEVADA
IA
50201
Administrative
F
W
COWRIE
IA
50543
Administrative
F
W
FORT
DODGE
IA
50501
Administrative
F
W
DES
MOINES
IA
50309
Administrative
F
W
IOWA CITY
IA
52240
Manager
M
H
AMES
IA
50010
Craft
Worker
M
H
MT
PLEASANT
IA
52641
Craft
Worker
F
W
NORTH
LIBERTY
IA
52317
Manager
M
H
IOWA CITY
IA
52240
Craft
Worker
M
H
MARSHALLTOWN
IA
50158
Craft
Worker
M
H
AMES
IA
50010
Craft
Worker
M
H
BOONE
IA
50036
Craft
Worker
M
H
ELLSWORTH
IA
50075
Craft
Worker
F
W
WATERLOO
IA
50701
Administrative
F
W
AMES
IA
50014
Manager
M
B
FORT DODGE
IA
50501
Laborer
M
H
AMES
IA
50010
Craft
Worker
M
H
BOONE
IA
50036
Craft
Worker
M
H
MARSHALLTOWN
IA
50158
Craft
Worker
M
H
NEVADA
IA
50201
Craft
Worker
M
H
AMES
IA
50010
Craft
Worker
M
H
DES
MOINES
IA
50313
Craft
Worker
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 submi ted,
cjmpany Execut ve v Jbhn Mallen
NE Region President
By:
Sana.d2�n,t,
Sara Orr
Equal Employment HR Director
Opportunity Officer
11/3/2022
Date
City of Waterloo Affirmative Action Officer
Approved
Disapproved Reason:
By:
Date:
6
DESCRIPTION OF JOB CATEGORIES
1. Officials/Manager: Occupations in which employees set broad policies, exercise overall
responsibility for execution of all policies, or direct individual departments or special phases of the
agencys operations or provide specialized consultation on a regional, district or area basis.
Includes: department heads, bureau chiefs, division chiefs, directors, deputy directors, controllers,
examiners, wardens, superintendents, unit supervisors, sheriffs, police and fire chiefs and
inspectors and kindred workers.
2. Professionals: Occupations which require specialized and theoretical knowledge which is
usually required through college training or thorough work experience and other training which
provides comparable knowledge. Includes: personnel and labor relations workers, social workers,
doctors, psychologists, registered nurses, economists, dietitians, lawyers, system analysts,
accountants, engineers, employment and vocational rehabilitation counselors, teachers or
instructors, police and fire captains and lieutenants and kindred workers.
Technicians: Occupations which require a combination of basic scientific or technical knowledge
and manual skill which can be obtained through specialized post -secondary school education and
through equivalent on-the-job training. Includes: computer programmers and operations,
draftsmen, surveyors, licensed practical nurses, photographs, radio operators, technical
illustrators, police and fire sergeants and kindred workers.
Office/Clerical: Workers are responsible for internal and external communication, recording and
retrieval of data and/or information and other paper work required in an office. Includes:
bookkeepers, messengers, office machine operators, clerk -typists, stenographers, court
transcribers, hearing reporters, statistical clerks, dispatchers, license distributors, payroll clerks
and kindred workers.
Skilled Craft Workers: Workers perform jobs which require special manual skill and a thorough
and comprehensive knowledge of the processes involved in the work which is acquired through
on the -job training programs. Includes: Mechanics and repairman, electricians, heavy equipment
operators, stationary engineers, skilled machine occupations, carpenters, compositors and
typesetters and kindred workers.
6. Sales Workers: Occupations engaging wholly and primarily in direct selling. Includes:
advertising agents and salesman, insurance agents and brokers, real estate agents and brokers,
stock and bond salesmen, demonstrators, salesmen and sales clerks, grocery clerks and cashier
checkers, and kindred workers.
Operatives (semi -skilled}: Workers who operate machine or processing equipment or perform
other factory -type duties of intermediate skill level which can be mastered in a few weeks and
require only limited training. Includes: apprentices (auto mechanics), plumbers, building trades,
metal working trades, bricklayers, carpenters, electricians, machinists, mechanics, printing trades,
etc., operatives, attendants (auto service and parking), plasterers, chauffeurs, deliverymen and
furnacemen, heaters (metal), laundry and dry cleaning operatives, milliners, mine operatives and
laborers, motormen, oilers and greasers, (except auto painters), (except construction and
maintenance), photographic process workers, stationary fireman, truck and tractor drivers,
weavers, (textile) welders and flame cutters and kindred workers.
Laborers (unskilled): Workers in manual occupations which generally require no special
training. Perform elementary duties that may be learned in few days and require the application
of little or no independent judgment. Includes: garage laborers, car washers and greasers,
gardeners (except farm) and groundskeepers, longshoremen, and stevedores, lumbermen,
craftsmen and woodchoppers, laborers performing lifting, digging, mixing, loading and pulling
operations and kindred workers.
9. Apprentices: Persons employed in a program including work training and related instruction to
learn a trade or craft which is traditionally an apprenticeship, regardless of whether the program is
registered with a Federal or State agency.
10. Trainees (on-the-lobl: Production. Persons in formal training for craftsmen when not trained
under apprentice programs --operative laborer, and service occupations.
White Collar. Persons engaged in formal training for clerical, managerial, professional, technical,
sales, office and clerical occupations.
SRF Required Front -End Specifications
PLEASE NOTE: Attachment 10 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)
SRF
STATE
REVOLVING FUND
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)
Attachment 3: Disadvantaged Business Enterprise Certification Form (to be
completed and signed by Prime Contractor and submitted with the bid)
Attachment 4: DBE Program Subcontractor Performance Form (to be completed and
signed by Prime and DBE Subcontractor for each subcontract and
submitted with the bid)
Attachment 5:
Attachment 6:
Attachment 7:
Attachment 8:
Attachment 9:
Attachment 10:
DBE Program Subcontractor Utilization Form (to be completed and
signed by Prime Contractor and submitted with the bid)
DBE Program Subcontractor Participation Form (for voluntary use of
DBEs)
Other Federal Requirements Language
A. Standard Equal Employment Opportunity Specifications
B. Federal Labor Standards Provisions (including Davis -Bacon
prevailing wage rates**)
C. Preservation of Open Competition and Government Neutrality
D. Historical and Archeological Finds
E. Prohibitions on Procurement from Violating Facilities
Right of Entry and Records Retention
Use of American Iron and Steel
Prohibition on Certain Telecommunications and Video Surveillance
Services or Equipment
(to be completed and signed by Prime Contractor and submitted with
the bid)
**The Davis Bacon wage determination received from the Iowa Finance Authority must also
be included in the front-end specifications.
January 2021
SRF-1
INVESTING IN IOWA'S WATER
www.iowasrf.com
Attachment 1
SRF Required Front -End Specifications
(This 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
CERTIFICATIONS OF NON -SEGREGATED 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).
SOfure
`/
John Mallen, NE Region President
Name and Title of Signer (Please Type)
11/3/2022
Date
NOTE: The penalty for making false statements in offers is prescribed in 18 U.S.C. 1001.
EPA-7 5720-4.2
SRF-2 January 2021
Attachment 2
SRF Required Front -End 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.gov/SAM/. 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.
I 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.
John Mallen, NE Region President
Typed Name- & Title of A oried Representative
11/3/2022
Signature of Autlirized epresentative Date
I am unable to certify to the above statements. My explanation is attached.
SRF-3
January 2021
Attachment 3
SRF Required Front -End Specifications
(This form must be completed and signed by Prime Contractor and submitted with the bid)
Disadvantaged Business Enterprise (DBE) Solicitation
It is EPA's policy that recipients of EPA financial assistance through the State Revolving Fund
programs award a "fair share" of subagreements to small, minority and women -owned
businesses, collectively know as Disadvantaged Business Enterprises (DBEs). Iowa's Fair
Share goals are:
Minority
Enterprise
-Owned
(MBE)
Business
Goal
Women
Enterprise
-Owned
(WBE)
Business
Goal
Construction
1.7%
2.2%
Supplies
0.6%
5.6%
Services
2.5%
11.3%
Goods/Equipment
2.5%
10.4%
Average
1.8%
7.4%
Only work performed by certified DBEs can be counted toward the goals. In Iowa, DBEs must
be certified through the Iowa Department of Transportation (IDOT). Information on certification
requirements and a list of certified DBEs is on the IDOT website at
https://secure.iowadot.gov/DBE/Home/Index/.
Prime contractors' DBE requirements for SRF projects include:
• Taking affirmative steps for DBE participation
• Documenting the efforts and the proposed utilization of certified DBEs
PROJECT INFORMATION
SRF
Applicant:
Bidder:
Woodruff
Construction,
Inc.
Address:
1717
Falls
Avenue,
Waterloo,
IA 50701
Contact
Person:
John
Mallen,
NE
Region
President
Signature:
Phone
Number:319-233-3349
A
E-Mail
Address:JohnM@woodruff
.build
Check
if
Prime
Contractor
is:
❑
Minority
-Owned
❑
Women
-Owned
SRF-4 January 2021
GOOD FAITH EFFORTS CHECKLIST
Please complete the checklist to determine if you have complied with the requirement to make
good faith efforts to ensure that certified DBEs have the opportunity to compete for
procurements funded by EPA financial assistance funds. Bidders/offerors must make good faith
efforts prior to submission of bids/proposals.
1. Did you ensure that DBEs are made aware of contracting opportunities to the fullest extent
practicable through outreach and recruitment activities? x Yes ❑ No
2. Did you make information on forthcoming opportunities available to DBEs and arrange time
frames for contracts and establish delivery schedules, where the requirements permit, in a way
that encourages and facilitates participation by DBEs in the competitive process? This includes,
whenever possible, posting solicitation for bids or proposals for a minimum of 30 calendar days
before the bid or proposal closing date. ❑ Yes X No
3. Did you consider in the contracting process whether firms competing for large contracts
could subcontract with DBEs? This will include dividing total requirements, when economically
feasible, into smaller tasks or quantities to permit maximum participation by DBEs in the
Yes x No
competitive process.
4. Did you encourage contracting with a consortium of DBEs when a contract is too large for
one of these firms to handle individually? ❑ Yes x No
5. Did you use the services of the Small Business Administration and the Minority Business
Development Agency of the Department of Commerce to identify potential subcontractors?
f l Yes x No
6. List the potential DBE subcontractors that were contacted. Only list those that are certified
through the Iowa Department of Transportation.
Name
How
(e.g.
call,
Contacted
letter,
fax,
e-mail)
phone
Response
not
interested,
(e.g.
not
did
not
competitive)
respond,
DC
Corporation
Email
-w&
ION-
92 c1
DeLong
Construction
Email
—OA
\\\Or /k
d1/4
OEL
Construction
Email
k Op
ViJ
\;
Tara
Erosion
Control
Email
'Q
\ t
'- Shck
0-4161
`ftetc 3 (Sem%
GmLi
V\e
NAor
R--tNtAa1/4
PROPOSED UTILIZATION OF DBE SUBCONTRACTORS
Please include Attachments 4 and 5 to document the proposed utilization of certified DBE
subcontractors.
SRF-5 January 2021
CONTRACT ADMINISTRATION PROVISIONS
Several contract provisions are required to prevent unfair practices that adversely affect DBEs.
These include:
1. Prime Contractor must pay its Subcontractor for satisfactory performance no more than 30
days from the Prime Contractor's receipt of payment from the SRF loan recipient.
2. Prime Contractor must notify the SRF loan recipient in writing prior to termination of a DBE
subcontractor for convenience.
3. Prime Contractor must employ the six Good Faith Efforts to solicit a replacement
subcontractor if a DBE subcontractor fails to complete work under a subcontract for any
reason.
SRF-6 January 2021
59\4 16t-4
a;r4et el.td,
Attachment 4
SRF Required Front -End Specifications
(This form must be completed and signed by Prime and DBE Subcontractor for each subcontract and submitted with the bid)
Disadvantaged Business Enterprise Program
DBE Subcontractor Performance Form
This form is intended to capture the DBE' subcontractor's2 description of work to be performed and the price of the work
submitted to the prime contractor. An EPA Financial Assistance Agreement recipient must require its prime contractor to
have its DBE subcontractors complete this form and include all completed forms in the prime contractor's bid or proposal
package.
Subcontractor
eon
S
Name
Sb kkkWS
LIB
Project
rat
U
Name
23
Say;
tc,
Alen-
Ga
dQ-
Ra.f
uc
P'
Bid/Proposal
No.
Assistance
(if
known)
Agreement
ID
No.
Point
of
Contact
Address
Telephone
No.
Email
Address
Prime
Woodruff
Contractor
Construction,
Name
Inc.
Issuing/Funding
Entity
Contract
Number
Item
Description
Construction,
of
Work
Submitted
Services,
to
Equipment
the
Prime
Contractor
or
Supplies
Involving
Price
the
of
Prime
Work
Submitted
Contractor
to
+.C4Q,
tic:
V cmK104,
DBE
Certified
by
DOT
SBA
Meets/exceeds
YES
EPA
certification
NO
standards?
Unknown
Other:
'A DBE is a Disadvantaged, Minority, or Woman Business Enterprise that has been certified by an entity from which EPA accepts
certification as described in 40 CFR 33.204-33.205 or certified by EPA. EPA accepts certifications from entities that meet or exceed
EPA certification standards as described in 40 CFR 33.202.
2Subcontractor is defined as a company, firm, joint venture, or individual who enters into an agreement with a contractor to provide
services pursuant to an EPA award of financial assistance.
IASRF6100-3 DBE Subcontractor Performance Form — Page 1
SRF-7 January 2021
Disadvantaged Business Enterprise Program
DBE Subcontractor Performance Form
I certify under penalty of perjury that the forgoing statements are true and correct. Signing this form does not signify a
commitment to utilize the subcontractors above. I am aware of that in the event of a replacement of a subcontractor, I will
adhere to the replacement requirements set forth in 40 CFR Part 33 Section 33.302 (c).
Prime
,,tractor
Signature
Print
Name
John
Malien
Tit
a
Date
NE
Region
President
11/3/2022
Subcontractor
Signature
Name
Print
Akavik
Title
Date
IASRF6100-3 DBE Subcontractor Performance Form — Page 2
SRF-8 January 2021
Attachment 4
SRF Required Front -End Specifications
(This form must be completed and signed by Prime and DBE Subcontractor for each subcontract and submitted with the bid)
Disadvantaged Business Enterprise Program
DBE Subcontractor Performance Form
This form is intended to capture the DBE' subcontractors2 description of work to be performed and the price of the work
submitted to the prime contractor. An EPA Financial Assistance Agreement recipient must require its prime contractor to
have its DBE subcontractors complete this form and include all completed forms in the prime contractors bid or proposal
package.
Subcontractor Name
Conco Spray Solutions, LLC
Project
FY2023
Name
Sanitary Gatewell Repairs Phase II
Bid/Proposal No.
Contract No. 1071
Assistance Agreement ID No.
(if known)
Point of Contact
Jennifer Hoop
Address PO Box
36726, Indianapolis, IN 46236
Telephone No.
317-428.6543
Email Address
jhoop@concospray.com
Prime Contractor Name
Issuing/Funding Entity
SRF
Contract Item
Number
Description of Work Submitted to he Prime Contractor Involving
Construction, Services, Equipment or Su lies PP
Price of Work Submitted to
the Prime
3
9
Gatewefl 3C-2 Lining
Gatewell 5D-1 Lining
Contractor
$3515o0.00
$37,500.00
DBE Certified by
X Other: WBENC
X DOT SBA
Meets/exceeds EPA certification standards?
X YES NO
Unknown
'A DBE is a Disadvantaged, Minority, or Woman Business Enterprise That has been certified by an entity from which EPA accepts
certification as described in 40 CFR 33,204-33.205 or certified by EPA. EPA accepts certifications from entities that meet or exceed
EPA certification standards as described in 40 CFR 33.202.
'Subcontractor is defined as a company, firm, joint venture, or individual who enters into an agreement with a contractor to provide
services pursuant to an EPA award of financial assistance.
IASRF6100.3 DBE Subcontractor Performance Form — Page 1
SRF-7 January 2021
Disadvantaged Business Enterprise Program
DBE Subcontractor Performance Form
certify under penalty of perjury that the forgoing statements are true and correct. Signing this form does not signify a
commitment to utilize the subcontractors above. I am aware of that in the event of a replacement of a subcontractor, I will
adhere to the replacement requirements set forth in 40 CFR Part 33 Section 33.302 (c).
Prime Contractor Signature
Print
Name
% -
Se\nv\ 1\t \
eir)
,l
Title
Date
N
&-zr
Reosso.,r)
Fycse+—
e
I l 3 j 72
Subcontractor
Signature
Print
Name
Jennifer
Hoop
Gr._
16z6)
Title
Date
President
11/2/2022
IASRF6100-3 DBE Subcontractor Performance Form — Page 2
SRF-8 January 2021
C01"lC0 SPRFIJ'
5 n L u r i n n 5
Date: 11/2/2022
To: Prime Contractors
Owner: City of Waterloo, Iowa
Re: FY2023 Sanitary Sewer Gatewall Repairs, PH 2
Jennifer Hoop
PO BOX 36726
Indianapolis, IN 46236
Office Phone 317-428-6543
www.concospray.com
Email: jhoop@concospray.com
Proposal
Certified
WBENC
Women's Business Enterprise
Item
No.
Item
Unit
Est
Qty
Unit
Price
Amount
3
Gatewell
3C-2
Lining
LS
1.00
$ 35,500.00
$ 35,500.00
9
Gatewell
5D-1
Lining
LS
1.00
$ 37,500.00
$ 37,500.00
Total
$ 73,000.00
Scope: New concrete has to cure 28 days before coating
We will first hydroblast/ brush blast new structures, apply fastset mortar to round all angles, sealing joints,
voids & bugholes. Concrete will be rinsed of latents & dried with industrial indirect fire heaters. Lining
thickness will be a corrosion barrier 100 mils thick. Application of the Polyurea Lining will need to take
place when concrete is 50 degrees & rising, or a winter conditions containment would need to be added.
Each Gatewell Structure will take approximately 2-3 days to line.
Exclusions:
Terms:
Leak Elimination would be charged at a time & material basis
Scaffolding
Work on Holidays/Sundays
Winter/Weather Provisions or Containment
Permits
Performance or Payment Bonds
Sales Tax
Traffic Control Plans (only basic cones & signs included)
Payment Net in Thirty (30) days
Proposal Pricing is held for 30 days
Eii SPRAYROQ
i
••
®° STRUCTURAL PROTECTIVE LINING SYSTEMS
Conco Spray Solutions is a Certified WBE & DOT DBE
NI Er
NMI r
WOMEN'S BUSINESS ENTERPRISE
JOa1 FORCES. SUCCEED. TOGETHER.
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Attachment 5
SRF Required Front -End Specifications
(This form must be completed and signed by Prime Contractor and submitted with the bid if utilizing DBE subcontractors)
Disadvantaged Business Enterprise Program
DBE Subcontractor Utilization Form
This form is intended to capture the prime contractor's actual and/or intended use of identified certified DBE1
subcontractors2 and the estimated dollar amount of each subcontract. An EPA Financial Assistance Agreement Recipient
must require its prime contractors to complete this form and include it in the bid or proposal package. Prime contractors
should also maintain a copy of this form on file.
Prime
Woodruff
Contractor
Construction,
Name
Inc.
Project
Name
FY
Gatewell
2023
Sanitary
Repairs,
Sewer
Phase
II
Bid/Proposal
No.
Assistance
(if
known)
Agreement
ID
No.
Point
Nate
of
Contact
Goetsch
Address
1717
Falls
Avenue,
Waterloo,
IA 50701
Telephone
319-233-3349
No.
Email
NateG@woodruff.build
Address
Issuing/Funding
Entity
I have
identified
potential
DBE
certified
subcontractors
/
V YES
NO
If
yes,
please
complete
the
table
below.
If
no,
please
explain:
Name/Company
Subcontractor
Name
Company
Address/Phone/Email
Estimated
Amount
Dollar
Currently
Certified?
DBE
cs',01ta
5iituk
Po
,ox
3
Col
lAta
it)
OW
\tleS
Continue on back if needed
1A DBE is a Disadvantaged, Minority, or Woman Business Enterprise that has been certified by an entity from which EPA accepts
certification as described in 40 CFR 33.204-33.205 or certified by EPA. EPA accepts certifications from entities that meet or exceed
EPA certification standards as described in 40 CFR 33.202.
2Subcontractor is defined as a company, firm, joint venture, or individual who enters into an agreement with a contractor to provide
services pursuant to an EPA award of financial assistance.
IASRF6100-4 DBE Subcontractor Utilization Form — Page 1
SRF-9 January 2021
Disadvantaged Business Enterprise Program
DBE Subcontractor Utilization Form
certify under penalty of perjury that the forgoing statements are true and correct. Signing this form does not signify a
commitment to utilize the subcontractors above. I am aware of that in the event of a replacement of a subcontractor, I will
adhere to the replacement requirements set forth in 40 CFR Part 33 Section 33.302 (c).
Prime
Contractor
Signature
Print
Name
/4 -- -
John
Mallen
Title
Date
NE
Region
President
11/3/2022
IASRF6100-4 DBE Subcontractor Utilization Form — Page 2
SRF-10 January 2021
Attachment 6
SRF Required Front -End Specifications
(This form is for the voluntary use of DBE Subcontractors)
Disadvantaged Business Enterprise Program
DBE Subcontractor Participation Form
An EPA Financial Assistance Agreement Recipient must require its prime contractors to provide this form to its DBE
subcontractors. The use of this form by DBE subcontractors is voluntary and is not required for bidding. This form
gives a DBE1 subcontractor2 the opportunity to describe work received and/or report any concerns regarding the EPA -
funded project (e.g. in areas such as termination by prime contractor, late payments, etc.). The DBE subcontractor can,
as an option, complete and submit this form to the EPA DBE Coordinator at any time during the project period of
performance.
Subcontractor Name
Project
Name
Bid/Proposal No.
Assistance Agreement ID No.
(if known)
Point of Contact
Address
Telephone No.
Email Address
Prime Contractor Name
Issuing/Funding Entity
Contract Item
Number
Description of Work Received from the Prime Contractor Involving
Construction, Services, Equipment or Supplies
Amount Received by
Prime Contractor
1A DBE is a Disadvantaged, Minority, or Woman Business Enterprise that has been certified by an entity from which EPA accepts
certification as described in 40 CFR 33.204 33.205 or certified by EPA. EPA accepts certifications from entities that meet or exceed
EPA certification standards as described in 40 CFR 33.202.
2Subcontractor is defined as a company, firm, joint venture, or individual who enters into an agreement with a contractor to provide
services pursuant to an EPA award of financial assistance.
IASRF6100-2 DBE Subcontractor Participation Form — Page 1
SRF-11 January 2021
Disadvantaged Business Enterprise Program
DBE Subcontractor Participation Form
Please use the space below to report any concerns regarding the above EPA -funded project:
Subcontractor Signature
Print Name
Title
Date
Return to: Regional Coordinator, Small Business Utilization, U.S. Environmental Protection Agency, Region 7, 11201
Renner Blvd., Lenexa, KS 66219
IASRF6100-2 DBE Subcontractor Participation Form — Page 2
SRF-12 January 2021
Attachment 7
SRF Required Front -End Specifications
Other Federal Requirements Language
A. Standard Federal Equal Employment Opportunity Construction Contract
Specifications (Executive Order 11246)
1. As used in these specifications:
a. "Covered area" means the geographical area described in the solicitation from which
this contract resulted;
b. "Director" means Director, Office of Federal Contract Compliance Programs, United
States Department of Labor, or any person to whom the Director delegates authority;
c. "Employer identification number" means the Federal Social Security number used
on the Employer's Quarterly Federal Tax Return, U.S. Treasury Department Form 941.
d. "Minority" includes:
(i) Black (all persons having origin in any of the Black African racial groups not of
Hispanic origin);
(ii) Hispanic (all persons of Mexican, Puerto Rican, Cuban, Central or South
American or other Spanish Culture or origin, regardless of race);
(iii) Asian and Pacific Islander (all persons having origins in any of the original
peoples of the Far East, Southeast Asia, the Indian Sub -continent, or the Pacific
Islands); and
(iv) American Indian or Alaskan Native (all persons having origins in any of the
original peoples of North America and maintaining identifiable tribal affiliations
through membership and participation or community identification).
2. Whenever the Contractor, or any Subcontractor at any tier subcontracts a portion of the
work involving any construction trade, it shall physically include in each subcontract in excess of
$10,000 the provisions of these specifications and the Notice which contains the applicable
goals for minority and female participation and which is set forth in the solicitations from which
this contract resulted.
3. If the Contractor is participating (pursuant to 41 CFR 6-4.5) in a Hometown Plan
approved by the U.S. Department of Labor in the covered area either individually or through an
association, its affirmative action obligations on all work in the Plan area (including goals and
timetables) shall be in accordance with that Plan for those trades which have unions
participating in the Plan. Contractors must be able to demonstrate their participation in and
compliance with the provisions of any such Hometown Plan. Each Contractor or Subcontractor
participating in an approved Plan is individually required to comply with its obligations under the
EEO clause, and to make a good faith effort to achieve each goal under the Plan in each trade
in which it has employees. The overall good faith performance by other Contractors or
Subcontractors toward a goal in an approved Plan does not excuse any covered Contractor's or
Subcontractor's failure to take good faith efforts to achieve the Plan goals and timetables.
4. The Contractor shall implement the specific affirmative action standards provided in
paragraphs 7a through p of these specifications. The goals set forth in the solicitation from
which this contract resulted are expressed as percentages of the total hours of employment and
training of minority and female utilization the Contractor should reasonably be able to achieve in
each construction trade in which it has employee in the covered area. Covered construction
contractors performing construction work in geographical areas where they do not have a
SRF-13 January 2021
Federal or federally assisted construction contract shall apply the minority and female goals
established for the geographical area where the work in being performed. Goals are published
periodically in the Federal Register in notice form, and such notices may be obtained from any
Office of Federal Contract Compliance Programs office or from Federal procurement contracting
officers. The Contractor is expected to make substantially uniform progress in meeting its goals
in each craft during the period specified.
5. Neither the provisions of any collective bargaining agreement, nor the failure by a union
with whom the Contractor has a collective bargaining agreement, to refer either minorities or
women shall excuse the Contractor's obligations under these specifications, Executive Order
11246, or the regulations promulgated pursuant thereto.
6. In order for the nonworking training hours of apprentices and trainees to be counted in
meeting the goals, such apprentices and trainees must be employed by the Contractor during
the training period, and the Contractor must have made a commitment to employ the
apprentices and trainees at the completion of their training, subject to the availability of
employment opportunities. Trainees must be trained pursuant to training programs approved by
the U.S. Department of Labor.
7. The Contractor shall take specific affirmative actions to ensure equal employment
opportunity. The evaluation of the Contractor's compliance with these specifications shall be
based upon its effort to achieve maximum results from its actions. The Contractor shall
document these efforts fully, and shall implement affirmative action steps at least as extensive
as the following:
a. Ensure and maintain a working environment free of harassment, intimidation, and
coercion at all sites, and in all facilities at which the Contractor employees are assigned
to work. The Contractor, where possible will assign two or more women to each
construction project. The Contractor shall specifically ensure that all foremen,
superintendents and other on -site supervisory personnel are aware of and carry out the
Contractor's obligation to maintain such a working environment, with specific attention to
minority or female individuals working at such sites or in such facilities.
b. Establish and maintain a current list of minority and female recruitment sources,
provide written notification to minority and female recruitment sources and to community
organizations when the Contractor or its unions have employment opportunities
available and maintain a record of the organizations' responses.
c. Maintain a current file of the names, addresses and telephone numbers of each
minority and female off -the -street applicant and minority or female referral from a union,
a recruitment source or community organization and of what action was taken with
respect to each such individual. If such individual was sent to the union hiring hall for
referral and was not referred back to the Contractor by the union or, if referred, not
employed by the Contractor, this shall be documented in the file with the reason
therefore, along with whatever additional actions the Contractor may have taken.
d. Provide immediate written notification to the Director when the union or unions with
which the Contractor has a collective bargaining agreement has not referred to the
Contractor a minority person or woman sent by the Contractor, or when the Contractor
has other information that the union referral process has impeded the Contractor's effort,
to meet its obligations.
e. Develop on-the-job training opportunities and/or participate in training programs for
the area which expressly include minorities and women, including upgrading programs
and apprenticeship and trainee programs relevant to the Contractor's employment
needs, especially those programs funded or approved by the Department of Labor. The
SRF-14 January 2021
Contractor shall provide notice of these programs to the source complied under 7b
above.
f. Disseminate the Contractor's EEO policy by providing notice of the policy to unions
and training programs and requesting their cooperation in assisting the Contractor in
meeting its EEO obligations; by including it in any policy manual and collective
bargaining agreement; by publicizing it in the company newspaper, annual report, etc.;
by specific review of the policy with all management personnel and with all minority and
female employees at least once a year; and by posting the company EEO policy on
bulletin boards accessible to all employees at each location where construction work is
performed.
g. Review, at least annually, the company's EEO policy and affirmative action obligations
u nder these specifications with all employees having any responsibility for hiring,
assignment, layoff, termination or other employment decisions including specific review
of these items with onsite supervisory personnel such as Superintendents, General
Foremen, etc., prior to the initiation of construction work at any job site. A written record
shall be made and maintained identifying the time and place of these meetings, persons
attending, subject matter discussed, and disposition of the subject matter.
h. Disseminate the Contractor's EEO policy externally by including it in any advertising in
the news media, specifically including minority and female news media, and providing
written notification to and discussing the Contractor's EEO policy with other Contractors
and Subcontractors with whom the Contractor does or anticipates doing business.
i. Direct its recruitment efforts, both oral and written, to minority, female and community
organizations, to schools with minority and female students and to minority and female
recruitment and training organizations serving the Contractor's recruitment area and
employment needs. Not later than one month prior to the date for the acceptance of
applications for apprenticeship or other training by any recruitment source, the
Contractor shall send written notification to organizations such as the above, describing
the openings, screening procedures, and test to be used in the selection process.
1. Encourage present minority and female employees to recruit other minority persons
and women and, where reasonable, provide after school, summer and vacation
employment to minority and female youth both on the site and in other areas of a
Contractor's workforce.
k. Validate all tests and other selection requirements where there is an obligation to do
so under 41 CFR Part 60-3.
1. Conduct, at least annually, an inventory and evaluation at least of all minority and
female personnel for promotional opportunities and encourage these employees to seek
or to prepare for, through appropriate training, etc., such opportunities.
m. Ensure that seniority practices, job classifications work assignments and other
personnel practices, do not have a discriminatory effect by continually monitoring all
personnel and employment related activities to ensure that the EEO policy and the
Contractor's obligations under these specifications are being carried out.
n . Ensure that all facilities and company activities are nonsegregated except that
separate or single -user toilet and necessary changing facilities shall be provided to
assure privacy between the sexes.
o. Document and maintain a record of all solicitations of offers for subcontracts from
minority and female construction contractors and suppliers, including circulation of
solicitations to minority and female contractor associations and other business
associations.
p. Conduct a review, at least annually, of all supervisors' adherence to and performance
u nder the Contractor's EEO policies and affirmative action obligations.
SRF-15 January 2021
8. Contractors are encouraged to participate in voluntary associations which assist in
fulfilling one or more of their affirmative action obligations (7a through p). The efforts of a
contractor association, joint contractor -union, contractor -community, or other similar group of
which the contractor is a member and participant, may be asserted as fulfilling any one or more
of its obligations under 7a through p of these Specifications provided that the contractor actively
participates in the group, makes every effort to assure that the group has a positive impact on
the employment of minorities and women in the industry, ensures that the concrete benefits of
the program are reflected in the Contractor's minority and female workforce participation, makes
a good faith effort to meet its individual goals and timetables, and can provide access to
documentation which demonstrates the effectiveness of actions taken on behalf of the
Contractor. The obligation to comply, however, is the Contractor's and failure of such a group to
fulfill an obligation shall not be a defense for the Contractor's noncompliance.
9. A single goal for minorities and a separate single goal for women have been established.
The Contractor, however, is required to provide equal employment opportunity and to take
affirmative action for all minority groups, both male and female, and all women, both minority
and non -minority. Consequently, the Contractor may be in violation of the Executive Order if a
particular group is employed in a substantially disparate manner (for example, even though the
Contractor has achieved its goals for women generally, the Contractor may be in violation of the
Executive Order if a specific minority group of women is underutilized).
10. The Contractor shall not use the goals and timetable or affirmative action standards to
discriminate against any person because of race, color, religion, sex, or national origin.
11. The Contractor shall not enter into any Subcontract with any person or firm debarred
from Government contracts pursuant to Executive Order 11246.
12. The Contractor shall carry out such sanctions and penalties for violation of these
specifications and of the Equal Opportunity Clause, including suspension, termination and
cancellation of existing subcontracts as may be imposed or ordered pursuant to Executive
Order 11246, as amended, and its implementing regulations, by the Office of Federal Contract
Compliance Programs. Any Contractor who fails to carry out such sanctions and penalties shall
be in violation of these specifications and Executive Order 11246, as amended.
13. The Contractor, in fulfilling its obligations under these specifications, shall implement
specific affirmative action steps at least as extensive as those standards prescribed in
paragraph 7 of these specifications so as to achieve maximum results from its efforts to ensure
equal employment opportunity. If the Contractor fails to comply with the requirements of the
Executive Order, the implementing regulations, or these specifications, the Director shall
proceed in accordance with 41 CFR 60-4.8.
14. The Contractor shall designate a responsible official to monitor all employment related
activity to ensure that the company EEO policy is being carried out, to submit reports relating to
the provisions hereof as may be required by the Government and to keep records. Records
shall at least include for each employee the name, address, telephone numbers, construction
trade, union affiliation if any, employee identification number when assigned, social security
number, race, sex, status (e.g., mechanic, apprentice, trainee, helper, or laborer), dates of
changes in status, hours worked per week in the indicated trade, rate of pay, and locations at
which the work was performed. Records shall be maintained in an easily understandable and
retrievable form; however, to the degree that existing records satisfy this requirement,
contractors shall not be required to maintain separate records.
SRF-16 January 2021
15. Nothing herein provided shall be construed as a limitation upon the application of other
laws which establish different standards of compliance or upon the application of requirements
for the hiring of local or other area residents (e.g., those under the Public Works Employment
Act of 1977 and the Community Development Block Grant Program).
Federal Register, Vol. 43, No. 68 - Friday, April 7, 1978 (Corrected May 5, 1978).
Effective Date: May 8, 1978
Federal Register, Vol. 45, No. 194. Paragraph 4, revised October 3, 1980
Effective Date: September 30, 1980
APPENDICES A and B-80
Notice of Requirement for Affirmative Action to Ensure Equal Employment Opportunity
(Executive Order 11246)
1. The Offerors or Bidder's attention is called to the "Equal Opportunity Clause" and the
"Standard Federal Equal Employment Specifications" set forth herein.
The goals and timetables for minority and female participation, expressed in percentage
terms for the Contractor's aggregate workforce in each trade on all construction work in
the covered area, are as follows:
(See Appendix B-80 and Appendix A Below)
These goals are applicable to all the Contractor's construction work (whether or not it is Federal
or federally assisted) performed in the covered area. If the contractor performs construction
work in a geographical area located outside of the covered area, it shall apply the goals
established for such geographical area where the work is actually performed. With regard to this
second area, the contractor also is subject to the goals for both its federally involved and non -
federally involved construction.
The Contractor's compliance with the Executive Order and in the regulations in 41 CFR Part
60-4 shall be based on its implementation of the Equal Opportunity Clause, specific affirmative
action obligations required by the specifications set forth in 41 CFR 60-4.3(a), and its efforts to
meet the goals. The hours of minority and female employment and training must be
substantially uniform throughout the length of the contract, and in each trade, and the contractor
shall make a good faith effort to employ minorities and women evenly on each of its projects.
The transfer of minority or female employees or trainees from Contractor to Contractor or from
project to project for the sole purpose of meeting the Contractor's goals shall be a violation of
the contract, the Executive Order and the regulations in 41 CFR Part 60-4. Compliance with
the goals will be measured against the total work hours performed.
3. The Contractor shall provide written notification to the Director of the Office of Federal
Contract Compliance Programs within 10 working days of award of any construction
subcontract in excess of $10,000 at any tier for construction work under the contract
resulting from this solicitation. The notification shall list the name, address and telephone
number of the subcontractor, employer Identification number of the subcontractor,
estimated dollar amount of the subcontract, and the geographical area in which the
subcontract is to be performed.
SRF-17 January 2021
4. As used in this Notice, and in the contract resulting from this solicitation, the "covered
area" is (State of Iowa).
APPENDIX A
The following goals and timetables for female utilization shall be included in all Federal and
federally assisted construction contracts and subcontracts in excess of $10,000. The goals are
applicable to the contractor's aggregate on -site construction workforce whether or not part of
that workforce is performing work on a Federal or federally assisted construction contract or
subcontract.
Area covered: Goals for Women apply nationwide.
Timetable Goals (percent)
From Apr. 1, 1978 until March 31, 1979 3.1
From Apr. 1, 1979 until March 31, 1980 5.0
From Apr. 1, 1980 until March 31, 1981 6.9
Published, Federal Register May 5, 1978
APPENDIX B-80
Until further notice, the following goals for minority utilization in each construction craft and trade
shall be included in all Federal or federally assisted construction contracts and subcontracts in
excess of $10,000 to be performed in the respective geographical areas. The goals are
applicable to each nonexempt contractor's total onsite construction workforce, regardless of
whether or not part of that workforce is performing work in a Federal, federally assisted or
nonfederally related project, contract or subcontract. Construction contractors which are
participating in an approved Hometown Plan (see 41 CFR 60-4.5) are required to comply with
the goals of the Hometown Plan with regard to construction work they perform in the area
covered by the Hometown Plan. With regard to all their other covered construction work, such
contractors are required to comply with the applicable SMSA of EA goal contained in this
appendix B-80.
SRF-18 January 2021
Economic Areas
State: Iowa Goal %
096 Dubuque IA:
S MSA Counties:
2200 Dubuque, IA 0.6
IA Dubuque
Non-SMSA
Counties 0.5
IA Allamakee, IA Clayton, IA Delaware, IA, Jackson IA, Winneshiek
099 Davenport Rock Island Moline, IA -IL:
S MSA Counties:
1960 Davenport Rock Island Moline, IA -IL
IL Henry, IL Rock Island Moline, IA Scott
4.6
Non-SMA
Counties 3.4
IL Carroll, IL Hancock, IL Henderson, IL ,Mercer, IL Whiteside, IA Clinton, IA Des
Moines, IA Henry, IA Lee, IA Louisa, IA, Muscatine, MO Clark
100 Cedar Rapids, IA:
S MSA Counties:
1360 Cedar Rapids, IA 1.7
IA Linn
Non-SMSA Counties 1.5
IA Benton, IA Cedar, IA Iowa, IA Johnson, IA, Jones, IA, Washington
101 Waterloo, IA:
SMSA Counties:
8920 Waterloo -Cedar Falls, IA 4.7
IA Black Hawk
Non-SMSA Counties 2.0
IA Bremer, IA Buchanan, IA Butler, IA Cerro Gordo, IA Chickasaw, IA Fayette, IA Floyd,
IA Franklin, IA Grundy, IA Hancock, IA Hardin, IA Howard, IA Mitchell, IA Winnebago, IA
Worth
102 Fort Dodge, IA:
Non-SMSA Counties 0.4
IA Buena Vista, IA Calhoun, IA Carroll, IA Clay, IA Dickinson, IA Emmet, IA Greene, IA
Hamilton, IA Humboldt, IA Kossuth, IA Palo Alto, IA Pocahontas, IA Sac, IA Webster, IA
Wright
103 Sioux City, IA:
SMSA Counties:
7720 Sioux City, IA -NE 1.9
IA Woodbury, NE Dakota
SRF-19 January 2021
Non-SMSA Counties 1.2
IA Cherokee, IA Crawford, IA Ida, IA Monona, IA O'Brien, IA Plymouth, IA Sioux, NE
Antelope, NE Cedar, NE Cuming, NE Dixon, NE Knox, NE Madison, NE Pierce, NE
Stanton, NE Thurston, NE Wayne, SD Bon Homme, SD Clay, SD Union, SD Yankton
104 Des Moines, IA:
SMSA Counties:
2120 Des Moines, IA 4.5
IA Polk, IA Warren
Non SMSA Counties: 2.4
IA Adair, IA Appanoose, IA Boone, IA Clarke, IA Dallas, IA Davis, IA Decatur, IA Guthrie,
IA Jasper, IA Jefferson, IA Keokuk, IA Lucas, IA Madison, IA Mahaska, IA Marion, IA
Marshall, IA Monroe, IA Poweshiek, IA Ringgold, IA Story, IA Tama, IA Union, IA Van
Buren, IA Wapello, IA Wayne
143 Omaha, NE:
SMSA Counties:
5920 Omaha, NE -IA
IA Pottawattamie, NE Douglas, NE Sarpy
7.6
Non-SMSA Counties 5.3
IA Adams, IA Audubon, IA Cass, IA Fremont, IA Harrison, IA Mills, IA Montgomery, IA
Page, IA Shelby, IA Taylor, NE Burt, NE Cass, NE Colfax, NE Dodge, NE Platte, NE
Saunders, NE Washington
Published, Federal Register October 3, 1980
B. Federal Labor Standards Provisions (including Davis -Bacon prevailing wage rates)
Applicability
The Project or Program to which the construction work covered by this contract pertains is being
assisted by the United States of America and the following Federal Labor Standards Provisions
are included in this Contract pursuant to the provisions applicable to such Federal assistance.
(1) Minimum wages. (i) All laborers and mechanics employed or working upon the site of the
work will be paid unconditionally and not less often than once a week, and without subsequent
deduction or rebate on any account (except such payroll deductions as are permitted by
regulations issued by the Secretary of Labor under the Copeland Act (29 CFR part 3)), the full
amount of wages and bona fide fringe benefits (or cash equivalents thereof) due at time of
payment computed at rates not less than those contained in the wage determination of the
Secretary of Labor which is attached hereto and made a part hereof, regardless of any
contractual relationship which may be alleged to exist between the contractor and such laborers
and mechanics. Contributions made or costs reasonably anticipated for bona fide fringe benefits
under section 1(b)(2) of the Davis -Bacon Act on behalf of laborers or mechanics are considered
wages paid to such laborers or mechanics, subject to the provisions of paragraph (a)(1)(iv) of
this section; also, regular contributions made or costs incurred for more than a weekly period
(but not less often than quarterly) under plans, funds, or programs which cover the particular
weekly period, are deemed to be constructively made or incurred during such weekly period.
Such laborers and mechanics shall be paid the appropriate wage rate and fringe benefits on the
wage determination for the classification of work actually performed, without regard to skill,
SRF-20 January 2021
except as provided in Sec. 5.5(a)(4). Laborers or mechanics performing work in more than one
classification may be compensated at the rate specified for each classification for the time
actually worked therein: Provided that, the employer's payroll records accurately set forth the
time spent in each classification in which work is performed. The wage determination (including
any additional classification and wage rates conformed under paragraph (a)(1)(ii) of this section)
and the Davis -Bacon poster (WH-1321) shall be posted at all times by the contractor and its
subcontractors at the site of the work in a prominent and accessible place where it can be easily
seen by the workers.
(ii)(A) The contracting officer shall require that any class of laborers or mechanics, including
helpers, which is not listed in the wage determination and which is to be employed under the
contract shall be classified in conformance with the wage determination. The contracting officer
shall approve an additional classification and wage rate and fringe benefits therefore only when
the following criteria have been met:
(1) The work to be performed by the classification requested is not performed by a
classification in the wage determination; and
(2) The classification is utilized in the area by the construction industry; and
(3) The proposed wage rate, including any bona fide fringe benefits, bears a reasonable
relationship to the wage rates contained in the wage determination.
(B) If the contractor and the laborers and mechanics to be employed in the classification (if
known), or their representatives, and the contracting officer agree on the classification and wage
rate (including the amount designated for fringe benefits where appropriate), a report of the
action taken shall be sent by the contracting officer to the Administrator of the Wage and Hour
Division, Employment Standards Administration, U.S. Department of Labor, Washington, DC
20210. The Administrator, or an authorized representative, will approve, modify, or disapprove
every additional classification action within 30 days of receipt and so advise the contracting
officer or will notify the contracting officer within the 30-day period that additional time is
necessary.
(C) In the event the contractor, the laborers or mechanics to be employed in the classification
or their representatives, and the contracting officer do not agree on the proposed classification
and wage rate (including the amount designated for fringe benefits, where appropriate), the
contracting officer shall refer the questions, including the views of all interested parties and the
recommendation of the contracting officer, to the Administrator for determination. The
Administrator, or an authorized representative, will issue a determination within 30 days of
receipt and so advise the contracting officer or will notify the contracting officer within the 30-day
period that additional time is necessary.
(D) The wage rate (including fringe benefits where appropriate) determined pursuant to
paragraphs (a)(1)(ii) (B) or (C) of this section, shall be paid to all workers performing work in the
classification under this contract from the first day on which work is performed in the
classification.
(iii) Whenever the minimum wage rate prescribed in the contract for a class of laborers or
mechanics includes a fringe benefit which is not expressed as an hourly rate, the contractor
shall either pay the benefit as stated in the wage determination or shall pay another bona fide
fringe benefit or an hourly cash equivalent thereof.
(iv) If the contractor does not make payments to a trustee or other third person, the contractor
may consider as part of the wages of any laborer or mechanic the amount of any costs
reasonably anticipated in providing bona fide fringe benefits under a plan or program, Provided,
That the Secretary of Labor has found, upon the written request of the contractor, that the
applicable standards of the Davis -Bacon Act have been met. The Secretary of Labor may
require the contractor to set aside in a separate account assets for the meeting of obligations
under the plan or program.
SRF-21 January 2021
(2) Withholding. The EPA shall upon its own action or upon written request of an authorized
representative of the Department of Labor withhold or cause to be withheld from the contractor
under this contract or any other Federal contract with the same prime contractor, or any other
federally -assisted contract subject to Davis -Bacon prevailing wage requirements, which is held
by the same prime contractor, so much of the accrued payments or advances as may be
considered necessary to pay laborers and mechanics, including apprentices, trainees, and
helpers, employed by the contractor or any subcontractor the full amount of wages required by
the contract In the event of failure to pay any laborer or mechanic, including any apprentice,
trainee, or helper, employed or working on the site of the work, all or part of the wages required
by the contract, the EPA may, after written notice to the contractor, sponsor, applicant, or
owner, take such action as may be necessary to cause the suspension of any further payment,
advance, or guarantee of funds until such violations have ceased.
(3) Payrolls and basic records. (i) Payrolls and basic records relating thereto shall be
maintained by the contractor during the course of the work and preserved for a period of three
years thereafter for all laborers and mechanics working at the site of the work. Such records
shall contain the name, address, and social security number of each such worker, his or her
correct classification, hourly rates of wages paid (including rates of contributions or costs
anticipated for bona fide fringe benefits or cash equivalents thereof of the types described in
section 1(b)(2)(B) of the Davis -Bacon Act), daily and weekly number of hours worked
deductions made and actual wages paid. Whenever the Secretary of Labor has found under 29
CFR 5.5(a)(1)(iv) that the wages of any laborer or mechanic include the amount of any costs
reasonably anticipated in providing benefits under a plan or program described in section
1(b)(2)(B) of the Davis -Bacon Act, the contractor shall maintain records which show that the
commitment to provide such benefits is enforceable, that the plan or program is financially
responsible, and that the plan or program has been communicated in writing to the laborers or
mechanics affected, and records which show the costs anticipated or the actual cost incurred in
providing such benefits. Contractors employing apprentices or trainees under approved
programs shall maintain written evidence of the registration of apprenticeship programs and
certification of trainee programs, the registration of the apprentices and trainees, and the ratios
and wage rates prescribed in the applicable programs.
(ii)(A) The contractor shall submit weekly for each week in which any contract work is
performed a copy of all payrolls to the (write in name of appropriate federal agency) if the
agency is a party to the contract, but if the agency is not such a party the contractor will submit
the payrolls to the applicant, sponsor, or owner, as the case may be, for transmission to the
(write in name of agency). The payrolls submitted shall set out accurately and completely all of
the information required to be maintained under 29 CFR 5.5(a)(3)(i), except that full social
security numbers and home addresses shall not be included on weekly transmittals. Instead the
payrolls shall only need to include an individually identifying number for each employee (e.g.,
the last four digits of the employee's social security number). The required weekly payroll
information may be submitted in any form desired Optional Form WH-347 is available for this
purpose from the Wage and Hour Division Web site at
http://www.dol.gov/whd/programs/dbra/forms.htm or its successor site. The prime contractor is
responsible for the submission of copies of payrolls by all subcontractors. Contractors and
subcontractors shall maintain the full social security number and current address of each
covered worker, and shall provide them upon request to the (write in name of appropriate
federal agency) if the agency is a party to the contract, but if the agency is not such a party, the
contractor will submit them to the applicant, sponsor, or owner, as the case may be, for
transmission to the (write in name of agency) the contractor, or the Wage and Hour Division of
the Department of Labor for purposes of an investigation or audit of compliance with prevailing
wage requirements. It is not a violation of this section for a prime contractor to require a
subcontractor to provide addresses and social security numbers to the prime contractor for its
SRF-22 January 2021
own records, without weekly submission to the sponsoring government agency (or the applicant,
sponsor, or owner).
(B) Each payroll submitted shall be accompanied by a "Statement of Compliance," signed by
the contractor or subcontractor or his or her agent who pays or supervises the payment of the
persons employed under the contract and shall certify the following:
(1) That the payroll for the payroll period contains the information required to be provided
under Sec. 5.5 (a)(3)(ii) of Regulations, 29 CFR part 5, the appropriate information is being
maintained under Sec. 5.5 (a)(3)(i) of Regulations, 29 CFR part 5, and that such information is
correct and complete;
(2) That each laborer or mechanic (including each helper, apprentice, and trainee) employed
on the contract during the payroll period has been paid the full weekly wages earned, without
rebate, either directly or indirectly, and that no deductions have been made either directly or
indirectly from the full wages earned, other than permissible deductions as set forth in
Regulations, 29 CFR part 3;
(3) That each laborer or mechanic has been paid not less than the applicable wage rates and
fringe benefits or cash equivalents for the classification of work performed, as specified in the
applicable wage determination incorporated into the contract.
(C) The weekly submission of a properly executed certification set forth on the reverse side of
Optional Form WH-347 shall satisfy the requirement for submission of the "Statement of
Compliance" required by paragraph (a)(3)(ii)(B) of this section.
(D) The falsification of any of the above certifications may subject the contractor or
subcontractor to civil or criminal prosecution under section 1001 of title 18 and section 231 of
title 31 of the United States Code.
(iii) The contractor or subcontractor shall make the records required under paragraph (a)(3)(i)
of this section available for inspection, copying, or transcription by authorized representatives of
the EPA or the Department of Labor, and shall permit such representatives to interview
employees during working hours on the job. If the contractor or subcontractor fails to submit the
required records or to make them available, the Federal agency may, after written notice to the
contractor, sponsor, applicant, or owner, take such action as may be necessary to cause the
suspension of any further payment, advance, or guarantee of funds. Furthermore, failure to
submit the required records upon request or to make such records available may be grounds for
debarment action pursuant to 29 CFR 5.12.
(4) Apprentices and trainees--(i) Apprentices. Apprentices will be permitted to work at less
than the predetermined rate for the work they performed when they are employed pursuant to
and individually registered in a bona fide apprenticeship program registered with the U.S.
Department of Labor, Employment and Training Administration, Office of
Apprenticeship Training, Employer and Labor Services, or with a State Apprenticeship Agency
recognized by the Office, or if a person is employed in his or her first 90 days of probationary
employment as an apprentice in such an apprenticeship program, who is not individually
registered in the program, but who has been certified by the Office of Apprenticeship Training,
Employer and Labor Services or a State Apprenticeship Agency (where appropriate) to be
eligible for probationary employment as an apprentice. The allowable ratio of apprentices to
journeymen on the job site in any craft classification shall not be greater than the ratio permitted
to the contractor as to the entire work force under the registered program. Any worker listed on
a payroll at an apprentice wage rate, who is not registered or otherwise employed as stated
above, shall be paid not less than the applicable wage rate on the wage determination for the
classification of work actually performed. In addition, any apprentice performing work on the job
site in excess of the ratio permitted under the registered program shall be paid not less than the
applicable wage rate on the wage determination for the work actually performed. Where a
contractor is performing construction on a project in a locality other than that in which its
program is registered, the ratios and wage rates (expressed in percentages of the journeyman's
SRF-23 January 2021
hourly rate) specified in the contractor's or subcontractors registered program shall be observed.
Every apprentice must be paid at not less than the rate specified in the registered program for
the apprentice's level of progress, expressed as a percentage of the journeymen hourly rate
specified in the applicable wage determination. Apprentices shall be paid fringe benefits in
accordance with the provisions of the apprenticeship program. If the apprenticeship program
does not specify fringe benefits, apprentices must be paid the full amount of fringe benefits
listed on the wage determination for the applicable classification. If the Administrator determines
that a different practice prevails for the applicable apprentice classification, fringes shall be paid
in accordance with that determination. In the event the Office of Apprenticeship Training,
Employer and Labor Services, or a State Apprenticeship Agency recognized by the Office,
withdraws approval of an apprenticeship program, the contractor will no longer be permitted to
utilize apprentices at less than the applicable predetermined rate for the work performed until an
acceptable program is approved.
(ii) Trainees. Except as provided in 29 CFR 5.16, trainees will not be permitted to work at less
than the predetermined rate for the work performed unless they are employed pursuant to and
individually registered in a program which has received prior approval, evidenced by formal
certification by the U.S. Department of Labor, Employment and Training Administration. The
ratio of trainees to journeymen on the job site shall not be greater than permitted under the plan
approved by the Employment and Training Administration. Every trainee must be paid at not
less than the rate specified in the approved program for the trainee's level of progress,
expressed as a percentage of the journeyman hourly rate specified in the applicable wage
determination. Trainees shall be paid fringe benefits in accordance with the provisions of the
trainee program. If the trainee program does not mention fringe benefits, trainees shall be paid
the full amount of fringe benefits listed on the wage determination unless the Administrator of
the Wage and Hour Division determines that there is an apprenticeship program associated with
the corresponding journeyman wage rate on the wage determination which provides for less
than full fringe benefits for apprentices. Any employee listed on the payroll at a trainee rate who
is not registered and participating in a training plan approved by the Employment and Training
Administration shall be paid not less than the applicable wage rate on the wage determination
for the classification of work actually performed. In addition, any trainee performing work on the
job site in excess of the ratio permitted under the registered program shall be paid not less than
the applicable wage rate on the wage determination for the work actually performed. In the
event the Employment and Training Administration withdraws approval of a training program,
the contractor will no longer be permitted to utilize trainees at less than the applicable
predetermined rate for the work performed until an acceptable program is approved.
(iii) Equal employment opportunity. The utilization of apprentices, trainees and journeymen
under this part shall be in conformity with the equal employment opportunity requirements of
Executive Order 11246, as amended, and 29 CFR part 30.
(5) Compliance with Copeland Act requirements. The contractor shall comply with the
requirements of 29 CFR part 3, which are incorporated by reference in this contract.
(6) Subcontracts. The contractor or subcontractor shall insert in any subcontracts the clauses
contained in 29 CFR 5.5(a)(1) through (10) and such other clauses as the (write in the name of
the Federal agency) may by appropriate instructions require, and also a clause requiring the
subcontractors to include these clauses in any lower tier subcontracts. The prime contractor
shall be responsible for the compliance by any subcontractor or lower tier subcontractor with all
the contract clauses in 29 CFR 5.5.
(7) Contract termination: debarment. A breach of the contract clauses in 29 CFR 5.5 may be
grounds for termination of the contract, and for debarment as a contractor and a subcontractor
as provided in 29 CFR 5.12.
SRF-24 January 2021
(8) Compliance with Davis -Bacon and Related Act requirements. All rulings and
interpretations of the Davis -Bacon and Related Acts contained in 29 CFR parts 1, 3, and 5 are
herein incorporated by reference in this contract.
(9) Disputes concerning labor standards. Disputes arising out of the labor standards
provisions of this contract shall not be subject to the general disputes clause of this contract.
Such disputes shall be resolved in accordance with the procedures of the Department of Labor
set forth in 29 CFR parts 5, 6, and 7. Disputes within the meaning of this clause include disputes
between the contractor (and any of its subcontractors) and the contracting agency, the U.S.
Department of Labor, or the employees or their representatives.
(10) Certification of eligibility. (i) By entering into this contract, the contractor certifies that
neither it (nor he or she) nor any person or firm who has an interest in the contractor's firm is a
person or firm ineligible to be awarded Government contracts by virtue of section 3(a) of the
Davis -Bacon Act or 29 CFR 5.12(a)(1).
(ii) No part of this contract shall be subcontracted to any person or firm ineligible for award of
a Government contract by virtue of section 3(a) of the Davis -Bacon Act or 29 CFR 5.12(a)(1).
(iii) The penalty for making false statements is prescribed in the
U.S. Criminal Code, 18 U.S.C. 1001.
(b) Contract Work Hours and Safety Standards Act. The Agency Head shall cause or require
the contracting officer to insert the following clauses set forth in paragraphs (b)(1), (2), (3), and
(4) of this section in full in any contract in an amount in excess of $100,000 and subject to the
overtime provisions of the Contract Work Hours and Safety Standards Act. These clauses shall
be inserted in addition to the clauses required by Sec. 5.5(a) or 4.6 of part 4 of this title. As used
in this paragraph, the terms laborers and mechanics include watchmen and guards.
(1) Overtime requirements. No contractor or subcontractor contracting for any part of the
contract work which may require or involve the employment of laborers or mechanics shall
require or permit any such laborer or mechanic in any workweek in which he or she is employed
on such work to work in excess of forty hours in such workweek unless such laborer or
mechanic receives compensation at a rate not less than one and one-half times the basic rate of
pay for all hours worked in excess of forty hours in such workweek.
(2) Violation; liability for unpaid wages; liquidated damages. In the event of any violation of
the clause set forth in paragraph (b)(1) of this section the contractor and any subcontractor
responsible therefor shall be liable for the unpaid wages. In addition, such contractor and
subcontractor shall be liable to the United States (in the case of work done under contract for
the District of Columbia or a territory, to such District or to such territory), for liquidated
damages. Such liquidated damages shall be computed with respect to each individual laborer or
mechanic, including watchmen and guards, employed in violation of the clause set forth in
paragraph (b)(1) of this section, in the sum of $10 for each calendar day on which such
individual was required or permitted to work in excess of the standard workweek of forty hours
without payment of the overtime wages required by the clause set forth in paragraph (b)(1) of
this section.
(3) Withholding for unpaid wages and liquidated damages. The loan recipient shall upon its
own action or upon written request of an authorized representative of the Department of Labor
withhold or cause to be withheld, from any moneys payable on account of work performed by
the contractor or subcontractor under any such contract or any other Federal contract with the
same prime contractor, or any other federally -assisted contract subject to the Contract Work
Hours and Safety Standards Act, which is held by the same prime contractor, such sums as
may be determined to be necessary to satisfy any liabilities of such contractor or subcontractor
for unpaid wages and liquidated damages as provided in
the clause set forth in paragraph (b)(2) of this section.
(4) Subcontracts. The contractor or subcontractor shall insert in any subcontracts the clauses
set forth in paragraph (b)(1) through (4) of this section and also a clause requiring the
SRF-25 January 2021
subcontractors to include these clauses in any lower tier subcontracts. The prime contractor
shall be responsible for compliance by any subcontractor or lower tier subcontractor with the
clauses set forth in paragraphs (b)(1) through (4) of this section.
(c) In addition to the clauses contained in paragraph (b), in any contract subject only to the
Contract Work Hours and Safety Standards Act and not to any of the other statutes cited in Sec.
5.1, the Agency Head shall cause or require the contracting officer to insert a clause requiring
that the contractor or subcontractor shall maintain payrolls and basic payroll records during the
course of the work and shall preserve them for a period of three years from the completion of
the contract for all laborers and mechanics, including guards and watchmen, working on the
contract. Such records shall contain the name and address of each such employee, social
security number, correct classifications, hourly rates of wages paid, daily and weekly number of
hours worked, deductions made, and actual wages paid. Further, the Agency Head shall cause
or require the contracting officer to insert in any such contract a clause providing that the
records to be maintained under this paragraph shall be made available by the contractor or
subcontractor for inspection, copying, or transcription by authorized representatives of the EPA
and the Department of Labor, and the contractor or subcontractor will permit such
representatives to interview employees during working hours on the job.
Preservation of Open Competition and Government Neutrality Towards
Government Contractors' Labor Relations on Federal and Federally Funded
Construction Projects (Executive Order 13202, as amended by Executive Order
13208)
Executive Order 13202, signed February 17, 2001 and amended April 4, 2001, requires all
executive agencies that issue grants to ensure Government neutrality toward contractors' labor
relations. This applies to recipients of SRF assistance. The Executive Order prohibits
discrimination against contractors and their employees in construction contracts based upon
labor affiliation or lack thereof.
SRF assistance recipients and any construction managers acting on their behalf must ensure
that bidding specifications, project agreements, and other controlling documents do not require,
prohibit, or otherwise discriminate, with respect to labor affiliation or lack thereof.
D. Historical and Archeological Finds
If, during the course of construction, evidence of deposits of historical or archeological interest is
found, the contractor shall cease operations affecting the find. The owner shall then notify the
State Revolving Fund Environmental Review Specialist, who shall in turn notify the State
Historic Preservation Office. The SRF shall consult with the SHPO and other interested parties
to determine the proper course of action regarding the discovery. No further disturbance of the
deposits shall ensue until the SRF Environmental Review Specialist determines that the project
activities in that area may proceed. Compensation to the contractor, if any, for lost time or
changes in construction to avoid the find, shall be determined in accordance with changed
conditions or change order provisions of the specifications.
Authority for this derives from the National Historic Preservation Act (16 U.S.C. §§ 470 et seq.)
and 36 CFR Part 800. If human remains are discovered then state law also applies IC 263B.
SRF-26 January 2021
E. Prohibitions on Procurement from Violating Facilities (Section 306, Clean Air Act;
Section 508, Clean Water Act; Executive Order 11738)
Both the Clean Water Act and the Clean Air Act prohibit federal agencies from extending
assistance by way of loans or contracts to persons who have been convicted of violations of
either law. Executive Order 11738 was issued to coordinate enforcement by the U.S.
Environmental Protection Agency, which shall designate facilities which have given rise to a
conviction for an offense under the criminal provisions of the Clean Air Act and the Clean Water
Act.
The Executive Order also prohibits agencies from extending assistance to facilities that are not
in compliance with either Act.
SRF assistance recipients may not procure goods, services, or materials from suppliers listed
by the EPA as violators.
The Excluded Parties Listing search engine is located at the System for Award Management
(SAM) website: https://www.sam.gov/SAM/.
Attachment 8
SRF Required Front -End Specifications
Right of Entry and Records Retention
The recipient shall provide access at all times for the Department of Natural Resources, the
Iowa Finance Authority, the state auditor and the U.S. EPA Office of the Inspector General to
all project records and documents for inspection and audit purposes for a period of three years
after the date of last loan payment. The same access to the project site(s) shall be provided for
inspection purposes.
567 Iowa Administrative Code paragraph 92.8(2).e. State inspections. Personnel of the department
shall have the right to examine all construction aspects of the project, including materials and
equipment delivered and stored on site for use on the project.
SRF-27 January 2021
Attachment 9
SRF Required Front -End Specifications
"American Iron and Steel" Requirements
H.R. 3547, the "Consolidated Appropriations Act, 2014," enacted January 17, 2014 by the U.S.
Congress, includes "American Iron and Steel" provisions that require Clean Water and Drinking
Water State Revolving Fund assistance recipients of these funds to use iron and steel produced
in the United States.
H.R. 3547 includes the following language in Division G, Title IV, under the heading, "Use of
American Iron and Steel":
Sec. 436. (a)(1) None of the funds made available by a State water pollution control
revolving fund as authorized by title VI of the Federal Water Pollution Control Act (33 U.S.C.
1381 et seq.) or made available by a drinking water treatment revolving loan fund as
authorized by section 1452 of the Safe Drinking Water Act (42 U.S.C. 300j-12) shall be
used for a project for the construction, alteration, maintenance, or repair of a public water
system or treatment works unless all of the iron and steel products used in the project are
produced in the United States.
(2) In this section, the term "iron and steel products" means the following products made
primarily of iron and steel: Tined or unlined pipes and fittings, manhole covers and other
municipal castings, hydrants, tanks, flanges, pipe clamps and restraints, valves, structural
steel, reinforced precast concrete, and construction materials.
(b) Subsection (a) shall not apply in any case or category of cases in which the
Administrator of the Environmental Protection Agency (in this section referred to as the
"Administrator") find that
(1) Applying subsection (a) would be inconsistent with the public interest;
(2) Iron and steel products are not produced in the United States in sufficient and
reasonably available quantities and of a satisfactory quantity; or
(3) Inclusion of iron and steel products produced in the United States will increase the
cost of the overall project by more than 25 percent.
(c) If the Administrator receives a request for a waiver under this section, the Administrator
shall make available to the public on an informal basis a copy of the request and
information available to the Administrator concerning the request, and shall allow for
informal public input on the request for at least 15 days prior to making a finding based on
the request. The Administrator shall make the request and accompanying information
available by electronic means, including on the official public Internet Web site of the
Environmental Protection Agency.
The final guidance and any published waivers are found at: https://www.epa.gov/cwsrf/state-
revolving-fund-american-iron-and-steel-ais-requirement. In particular the contractor should pay
attention to the guidance for documentation of compliance. There is also a waiver for incidental
items; in order to qualify for this waiver the total materials and costs for the project must be
tracked and incidental items identified.
SRF-28 January 2021
Sample "American Iron and Steel" Contract Language
In order to fulfill the requirements, the assistance recipient must in good faith design the project
and solicit bids for construction with U.S.-made iron and steel. The following information will be
included in any contracts resulting from this request for bids:
Contractor
Agreement
in the
Contractor
Fund
known
project
iron
and
and
acknowledges
the
are being
and/or
as
to
steel
hereby
to
State of Iowa
fimded
Drinking
"American
be produced
products
represents
and
(the
with
Water
Iron
in
provided
and
for the benefit
"State")
monies
State
and Steel;"
the United
by
warrants
made
Revolving
the
of
that
available
that
States
Contactor
to and
it
requires
the
understands
Fund
("American
for
City
pursuant
the
of
by the
and
all
benefit
The
("Purchaser")
this
Revolving
commonly
used
including
of
such
the
Clean
the
Iron
to
of
the
goods
law
iron
and
this
and
Water
contains
and
Steel
Agreement.
Purchaser
services
State
steel
Requirement")
provisions
products
and
the
under
The
State
that
(a)
the
Contractor
has reviewed
and
understands
the
American
Iron and
Steel
been
Requitement,
(b)
all
of
the
iton and
steel
products
used
in
the
project
will
be and/or
have
produced
in
the
United
States
in a manner
that complies
with
the
American
Iron and
Steel
or
Requirement
unless
a waiver of
the
requirement
is approved,
and
(c)
the Contractor
will
provide
any
further
verified
information,
certification
or assurance of
compliance
with
this
paragraph,
information
necessary
to support
a waiver of
the
American
Iron and
Steel
limitation
(nor
Requirement,
with
as damages
fees)
or any
privity
and
any
shall
this
incurred
as may
against the
by
owed
the
Contractor
or
be requested
by the
Purchaser
or
the
State.
Agreement, any
Purchaser or State
without limitation
failure (including
whole or in part,
has no
of its project,
and neither this
this paragraph
the State.
failure to comply
to recover
attorney's
without
from the State
direct contractual
the Purchaser
paragraph
force or effect)
Notwithstanding arty
paragraph by the Contractor
Contractor any loss,
the Purchaser or State
impairment or loss
to the State by the Purchaser).
State, as a lender to
agree that the State
provision of this Agreement
waived without the
other
expense,
resulting
of funding,
the
is a
provision
shall permit
or cost
from
whether
While
Purchaser for
third -party
necessary
written consent
beneficiary
of
(including
this
the
such
Contractor
funding
give
of
any
the
the
in
to
any
damages
with
the
other
be amended
prior
Sample Certifications
As indicated in the contract language, it will be the responsibility of the Contractor to obtain
certifications that the products and materials used in the project are U.S.-made. EPA
recommends the use of a step certification process for documenting compliance with AIS
requirements, similar to one used by the Federal Highway Administration. Step certification
creates a paper trail which documents the location of the manufacturing process involved with
the production of steel and iron materials. Each handler (supplier, fabricator, manufacturer,
processor, coater, etc.) of the iron and steel products certifies that their step in the process was
domestically performed.
The following information is provided as a sample letter of step certification for AIS compliance.
Documentation must be provided on company letterhead. In this example, there may be
multiple letters from different manufacturers if one manufacturer did not perform all of the steps.
SRF-29 January 2021
Date
Company Name
Company Address
City, State Zip
Subject: American Iron and Steel Step Certification for Project (XXXXXXXXXX)
I, (company representative), certify that the (melting, bending, coating, galvanizing, cutting, etc.)
process for (manufacturing or fabricating) the following products and/or materials shipped or
provided for the subject project is in full compliance with the American Iron and Steel
requirement as mandated in EPA's State Revolving Fund Programs.
Item, Products and/or Materials:
I. Xxxx
2. Xxxx
3. Xxxx
Such process took place at the following location:
If any of the above compliance statements change while providing material to this project we
will immediately notify the prime contractor and the engineer.
Signed by company representative
Alternatively, the final manufacturer that delivers the iron or steel product to the worksite,
vendor, or contractor, may provide a certification asserting that all manufacturing processes
occurred in the U.S. and providing detailed information on the steps involved.
The following is a template for this type of final certification.
SRF-30 January 2021
SRF Template American Iron and Steel Certification Letter
STATE
April 30,
RE: Job
Infrastructure
SRF Project
I certify
and/or materials
locations:
IRON &
STEEL
INC.
2015
Name_ \\raterprojectcille,
Project
Number. CS1920999
that the processes for
provided for the
STEEL,
Drive
OH
INC.
12345
On Manufacturer's
Letterhead
Iowa — 2015 State
C---______
01
manufacturing or fabricating
subject project took
Revolving
MATERIAL
----
the
at
Fund
IRON &
1959 Steel
Ironsille,
CERTIFICATION
Water
References
the
SRF Project
place
following products
the following U S.
Quantity
Description
Manufacturing Processes
Location Where
Processes Occurred
3 count
A13123456 4" Gate Valve
Melting, poured, machined
Ironville, OH
60 count
XY654321 Reinforced Concrete
Manhole
Melted rolled fabricated
Steel City, Lk
60 count
XZ123456 Manhole Cover
Melted cast finished
Stainless, MS
1200 linear feet
AB654321 4" Ductile Iran Water
Pipe
Melted, rolled, fnnished
Pipet n, CA
I further certify drat
American Iron and .teel
Protection Agen 's State
compliance stements
immediately notify the
O` Ilet
and/or
while
prime
materials
as mandated
Fund
are
in
programs.
material
consulting
On behalf
in full compliance
the U S
If any of
to this
engineer;
of IRON
7
Product
Environmental
above
STEEL,
Page
Quality
with the
we will
Speclfiesthe
Manufacturing
Processes
Locations
Where
Performed
the
Were
U.S.
They
and
products
requirements
Revolving
change
supplier,
the
project
&
providing
contractor,
or project
INC.,
Specifies
Products
Quantities
the
and
Sada
Jane Smith
Manager
Signature
Manufacturer's
Representative
of
SRF-31
January 2021
Covered and Non -Covered Items
The EPA issued a waiver for De Minimis incidental components of eligible water and
wastewater infrastructure projects. Funds used for such De Minimis incidental components
cumulatively may comprise no more than a total of 5% of the total cost of the materials used in
and incorporated into a project. The cost of an individual incidental item may not exceed 1% of
the total cost of the materials used in and incorporated into a project.
De Minimis incidental items include miscellaneous, generally low-cost components that are
essential for, but incidental to, the construction and are incorporated into the physical structure
of the project. For many of these incidental components, the country of manufacture and the
availability of alternatives are not readily or reasonably identifiable prior to procurement in the
normal course of business. For others, the country of manufacture may be known but the
miscellaneous character in conjunction with the low cost, individually and (in total) as typically
procured in bulk, mark them as properly incidental.
Examples of incidental components could include small washers, screws, fasteners (Le., nuts
and bolts), miscellaneous wire, corner bead, ancillary tube, etc. Examples of items that are
clearly not incidental include significant process fittings (i.e., tees, elbows, flanges, and
brackets), distribution system fittings and valves, force main valves, pipes, treatment and
storage tanks, large structural supports, etc.
In consultation with their contractors, assistance recipients should determine the items to be
covered by this waiver and must retain relevant documentation (i.e. invoices) as to those items.
Assistance recipients must summarize in reports to the State of Iowa the types and/or
categories of items to which this waiver is applied, the total cost of incidental components for
each type or category, and the calculations by which they determined the total cost of materials
used in and incorporated into the project.
The successful bidder will fill out the materials spreadsheet (shown below) and submit it to the
assistance recipient to indicate iron and steel items proposed to be procured for the project.
American Iron and Steel Materials Spreadsheet — to be Submitted by Successful Bidder
Iowa Department of Natural Resources - January 2O21
Based on EPA Memorandum (4/15/2014): De Minimis Waiver of Section 436 of P.L.113-76, Consolidated Appropriation Acts (CAA), 2O14
Project:
Bidder:
Date:
'Covered Product Categories Include: Lined or unlined pipes or fittings; manhole covers; municipal castings; pipe clamps and restraints; valves; structural sleet
hydrants, tanks; flanges; reinforced precast concrete; construction materials.
'Incidental items are miscellaneous, generally low-cost items, often procured in bulk, such as washers, screw , fasteners, small amounts of wire, et .
Covered Products
Category'
Description of Covered
Products
Documentation
Will be Obtained
Item is
Incidental and
will be
claimed under
De Minimis
Waiver"
Bid Amount
Covered
Products
Bid Amount
Incidentals
1
Choose a, lens.
u
2
Choost intc .
IJ
IJ
3
Choose an'terr
IJ
tJ
4
Choose till item.
U
1 I
SRF-32
January 2021
At the end of construction, the contractor will submit a final list showing covered items being
claimed as incidental components under the De Minimis Waiver. Assistance recipients will
complete a De Minimis Waiver Incidental Components List for the entire project to demonstrate
compliance with the De Minimis Waiver cost requirements outlined above.
~I
American Iron and Steel - De Minimus Waiver Incidental
Iowa Department of Natural Resources —January 2021
Based on EPA Memorandum (4/15/2014): De Minimus Waiver
This form Is to be used by the State Revolving Fund (SRF)
Incorporated Into an SRF project that meet the requirements
submit their final Incidental components list to the SRF applicant.
Components List
of Section 436 of P.L. 113-76, Consolidated Appropriation Acts (CAA), 2014
applicant to identify all non -domestic iron and steel Incidental components permanently
of the public interest De Minimis Waiver. This form can also be used by Individual contractors to
SRF Applicant:
SRF Project if:
Submitted By:
Date:
Individual Contractor De Minimis List
❑
Final De Minimis List for SRF Project
U
Total Materials Cost:
Total amount claimed as De
Minimis Incidental
Components:
i
Percent:
(must be S% or less of total materials cost)
Contractor Name
Covered Products
Description of Covered
Products
(list each item type separately)
Date
Purchased
Individual
Item/Unit
Cost
Quantity
Claimed as
Incidental
Dollar
Incidental
Components
Amount
Example
JB Construction
Construction materials
Steel Doors
1-21-2020
$500
5
$2500
1
j Choose an Remaly
l
1
2
Choose an item.
j
o
r4.....�., .., ..., ...,
j
These documents are available on-line at http://www.iowasrf.com/about srf/use-of-american-
iron-and-steel/.
SRF-33 January 2021
Attachment 10
SRF Required Front -End Specifications
(This form must be completed and signed by Prime Contractor and submitted with the bid)
PROHIBITION ON CERTAIN TELECOMMUNICATIONS AND VIDEO SURVEILLANCE
SERVICES OR EQUIPMENT
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, in 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.
understand the above prohibitions and certify that the project will be in compliance with all the
requirements.
John Mallen, NE Region President
Typed Nam es& Title of Authorized R9presentative
Signynf' r-%f/Authorized Representative
11/3/2022
Date
SRF-34
January 2021
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Form CCO-4A Rev. 07-08-02
CONTRACT NO. 1071
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Bidder Status Form
To be completed by all bidders Part A
Please answer "Yes" or "No" for each of the following:
X
X
X
X
X
Yes U 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: 08 / 01 / 1990 to Present / / Address'
1890 Kountry Lane
City, State, Zip: Fort Dodge, IA 50501
Dates: 05 / 25 /1996 to Present / / Address' 1920 Philadelphia Street, Suite 102
City, State, Zip. Ames, IA 50010
Dates: 02 / 08 /2016 to Present/ / Address. 501 Greenfield Drive
You may attach additional sheet(s) if needed. City, State, Zip• Tiffin, IA 52340
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?
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.
Yes l I No
You may attach additional sheet(s) if needed.
To be completed by all bidders Part D
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: Woodruff opstructionInc.
Signature:
9
John Mallen, NE Region President
Date:
11/3/2022
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)
Additional Sheet for Bidder Status Form
(continued)
My company has maintained offices in Iowa during the pass 3 years at the following addresses:
Dates: 7 / 17 / 2017 to Present / / Address' 1717 Falls Avenue
City, State, Zip: ..Waterloo, IA 50701
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 ❑ No My business is currently registered as a contractor with the Iowa Division of Labor.
❑ Yes ❑ No My business is a sole proprietorship and I am an Iowa resident for Iowa income tax purposes.
❑ Yes ❑ No My business is a general partnership or Joint venture. More than 50 percent of the general
partners or Joint venture parties are residents of Iowa for Iowa income tax purposes.
Yes U No My business is an active corporation with the Iowa Secretary of State and has paid all fees
required by the Secretary of State, has filed its most recent biennial report, and has not filed
articles of dissolution.
Yes ■ No 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.
Yes ❑ No My business is a limited liability partnership which has filed a statement of qualification in this
state and the statement has not been canceled.
Yes ■ No My business is a limited liability partnership which has filed a statement of qualification in a
state other than Iowa, has filed a statement of foreign qualification in Iowa and a statement of
cancellation has not been filed.
Yes ❑ No My business is a limited partnership or limited liability limited partnership which has filed a
certificate of limited partnership in this state, and has not filed a statement of termination.
Yes ■ No 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.
Yes U No My business is a limited liability company whose certificate of organization is filed in Iowa and has
not filed a statement of termination.
Yes U No 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)
INFORMATION NEEDED
FOR
IOWA CONSTRUCTION SALES TAX EXEMPTION CERTIFICATE
CONTRACTOR NAME:
Woodruff Construction, Inc.
ADDRESS: 1890 Kountry Lane
Fort Dodge, IA 50501
(Check One) PRIME X
FEDERALID#: 76-0721180
SUBCONTRACTOR
PROJECT NAME: FY 2023 Sanitary Sewer Gatewell Repairs, Phase II
PROJECT CONTRACT NO.: 1071
DESCRIPTION OF WORK:
Brickwork
Li Carpentry
A Concrete
_1 Drywall -Plaster -Insulation
A Electrical
A Excavation/Grading
A Flooring
A Heavy Construction
A Heating -Ventilating -Air Cond.
SALES TAX EXEMPTION
AECOM #60549334
C Landscaping
E Painting
❑ Paving
L Plumbing
LI Roofing -Siding -Sheet Metal
Li Windows
LI Wrecking -Demolition
I Other (Please specify)
NiGeneral Contractor
CONTRACT NO. 1071
STE-1 of 1
FY 2023 SEWER SANITARY GATEWELL
REPAIRS PHASE II
NON -COLLUSION AFFIDAVIT OF PRIME BIDDER
State of IOWA )
)ss
County of BLACK HAWK )
John Mallen , being first duly sworn, deposes and says that:
1 He is (Owner, Partner, Officer Representative, or Agent) , of Woodruff Construction, Inc
, the Bidder tha • - _ ubmitted 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 injntt est, including this affiant.
(Signed)
NE Region President
Title
Subscribed and sworn to before me this 3rd day of November , 2022
dum, Motwtin;S4Yraivt frissishiettr
My commission expires October 22, 2025
NON -COLLUSION AFFIDAVIT CONTRACT NO. 1071
AECOM 460549334
Title
NCA-1 of 2
FY 2023 SANITARY SEWER GATEWELL
REPAIRS PHASE II
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.
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.
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,
EQUAL OPPORTUNITY CLAUSE CONTRACT NO. 1071
AECOM 460549334
EOC-1 of 2
FY 2023 SANITARY SEWER GATEWELL
REPAIRS PHASE II
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)
(Ap• •• priate Official)
NE Region President
(Title)
11/3/2022
(Date)
EQUAL OPPORTUNITY CLAUSE CONTRACT NO. 1071 EOC-2 of 2
AECOM #60549334 FY 2023 SANITARY SEWER GATEWELL
REPAIRS PHASE II