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PROPOSAL FORM
FOR
HANGARS 1 & 2 ROOF REPAIRS
FAA AIP 3-19-0094-048 (CARES MNT)
AT THE
WATERLOO REGIONAL AIRPORT
WATERLOO, IOWA
Waterloo Regional Airport
2790 Livingston Lane
Waterloo, IA 50703
Gentlemen:
1. The undersigned, being a Corporation existing under the laws of the State of Iowa , a Partnership consisting of the
following partners:Al/a , having familiarized (himself) (themselves) (itself)
with the existing conditions on the project area affecting the cost of the work, and with all the contract documents listed in
the Table of Contents and Addenda (if any), as prepared by the City Engineer of the City of Waterloo now on file in the
office of the City Clerk, City Hall, Waterloo, Iowa, hereby proposes to furnish all supervision, technical personnel, labor,
materials, machinery, tools, appurtenances, equipment, and services, including utility and transportation services required
to construct and complete this Hangars 1 & 2 Roof Repairs -- FAA AIP 3-19-0094-048 (CARES MNT), all in
accordance with the above -listed documents and for the unit prices for work in place for the following items and
quantities:
2. The extent of the work involved is as follows.
The FAA 3-19-0094-048 (CARES MNT) Hangars 1 & 2 Roof Repairs project which consists of the removal of
apptoximately 360 square feet of skylights (combined for both hangars) and replacing them metal decking and
insulation.
3. The undersigned, in compliance with your Invitation for Bids dated earilaM , hereby proposes to do the
work called for in said Contract and Specifications and shown on said Plans and Addendum Nos.
41__1,12/12/27) and to furnish all materials, tools, labor and all appliances and appurtenances necessary for the
said work at the fo lowing rates and pi ices:
FAA AIP 3-19-0094-048 (CARES MNT) P-1 Hangars 1 & 2 Roof Repairs
Proposal Form Waterloo Regional Airport - 60675091
ITEMIZED PROPOSAL
WATERLOO REGIONAL AIRPORT
WATERLOO, IOWA
PROJECT: • HANGARS I & 2 ROOF REPAIRS
FAA AIP PROJECT NO. 3-19-0094-048 (CARES MNT)
ITEM
NO.
DESCRIPTION
UNIT
ESTIMATED
QUANTITY
UNIT
PRICE
BID
TOTAL
PRICE
BID
BASE
BID
1
SKYLIGH"I'
REMOVAL
SF
360
$ 8.00
$
$
2,880.00
18, 720.00
2
ROOF
DECK
REPAIR
SF
960
$
19.50
3
ROOF
COATING
SF
960
$ 9.85
$ 9,456.00
$ 2,928.00
4
INSULATION
SF
960
$ 3.05
TOTAL
BID
$ 33, 948.00
4. The Airport reserves the right to award the contract based on the Total Bid.
5. The undersigned understands that the above quantities of work to be done are approximate only and are intended
principally to serve as a guide in evaluating the bids. All quantities are subject to increase or decrease and are to be
performed at the unit prices stipulated herein.
6. It is understood that the schedule of minimum wage rates, as established by the Secretary of Labor and included in
the Specifications, are to govern on this project, and the undersigned certifies that he has examined this schedule of
wage rates and that the prices bid are based on such established wage rates.
7. The bidder shall make good faith efforts, as defined in Appendix A of 49 CFR Part 26, Regulations of the Office of
the Secretary of Transportation, to subcontract zero (0%) percent of the dollar value of the prime contt act to small
business concerns owned and controlled by socially and economically disadvantaged individuals (DBE). Individuals
who are rebuttably presumed to be socially and economically disadvantaged include women, Blacks, Hispanics,
Native Americans, Asian -Pacific Americans, and Asian -Indian Americans. The apparent successful competitor will
be required to submit information concerning the DBE's that will participate in the contract. The information will
include the name and address of each DBE, a description of the work to be performed by each named firm, and the
dollar value of the contract. If the bidder fails to achieve the contract goal stated herein, it will be required to provide
documentation demonstrating that it made good faith efforts in attempting to do so. In the event that the apparent
successful competitor for this solicitation qualified as a DBE, the contract goal shall be deemed to have been met. A
bid that fails to meet these requirements will be considered nonresponsive.
8. The undersigned certifies that he does not maintain or piovide 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. The undersigned 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 undersigned agrees that a breach of this certification is a violation of the equal opportunity clause in this contract.
As used in this certification, the ter m "segregated facilities" means any waiting rooms, work areas, restrooms and
washrooms, restaui ants and other eating areas, timeclocks, locker rooms and other storage or dressing areas, parking
lots, 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, color, religion, or
national origin, because of habit, local custom, or any other reason. The undersigned 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 awaid of subcontracts exceeding $10,000 which are not
exempt from the provisions of the equal opportunity clause, and that he will retain such certifications in his files.
9. The undersigned agrees, upon written notice of the acceptance of this bid, within ninety (90) days after the opening of
the bids, that he will execute the Contract in accordance with the bid as accepted and give Contract (Performance and
Payment) bond on attached forms within fifteen (15) days after the prescribed forms are presented for signature.
FAA AIP 3-19-0094-048 (CARES MNT) P-2 Hangars 1 & 2 Roof Repairs
Proposal Form Waterloo Regional Airport - 60675091
10. The undersigned understands, award of contract is contingent upon receipt of project funding from the Federal
Aviation Administration. If funding is not received, bid bonds will be returned to all bidders and the project will be
postponed.
11. The undersigned further agrees that if awarded the Contract, he will commence the work within ten (10) calendar
days after the receipt of a "Notice to Proceed" and that he will substantially complete all work according to the terms
of the entire contract within forty-five (45) calendar days from the date established in the Notice to Proceed. An
extension of time may be allowed when extra or additional work is ordered by the Engineer.
12. The undersigned agrees that within 30 days after award of this contract, the Contractor/Subcontractor shall file a
compliance report (Standard Foim 100) if s/he has not submitted a complete compliance report within 12 months
proceeding the date of maid. This report is required if the Contractor/Subcontractor meets all of the following
conditions:
a. Contractors/Subcontractors are not exempt based on 41 CFR 60-1,5.
b. Has 50 or more employees.
c. Is a prime contractor or first tier subcontractor.
d. There is a contract, subcontract, or purchase order amounting to $50,000 or more.
13. To satisfy Clear Air and Water Pollution Control Requirements on all Construction Contracts and Subcontracts
exceeding $100,000.00 Contractors and Subcontractors agree:
a. That any facility to be used in the performance of the Contract or to benefit from the Contract is not listed on the
Environmental Protection Agency (EPA) List of Violating Facilities.
b. To comply with all the requirements of Section 306 of the Clean Air Act (42 USC 1857(h)), and Section 508 of
the Clean Water Act (33 USC 1368), Executive Order 11738, and Environmental Protection Regulations (40
CFR Part (15)).
c. That as a condition for award of a Contract he shall notify the awarding official of the receipt of any
communication from EPA indicating that a facility to be utilized for performance ofor benefit from the Contract
is under consideration to be listed on the EPA List of Violating Facilities.
d. To include or cause to be included in any Contract or Subcontract which exceeds $100,000.00 the
aforementioned criteria and requirements.
14. The contractor, by submission of this offer and/or execution of a contract, certifies that it:
a. is not owned or controlled by one or more citizens or nationals of a foreign country included in the list of
countries that discriminate against U.S. firms published by the Office of the United States trade Representative
(USTR).
b. has not knowingly entered into any contract or subcontract for this project with a contractor that is a citizen or
national of a foreign country on said list or is owned or controlled directly or indirectly by one or more citizens
or nationals of a foreign country on said list.
c. has not procw ed any product nor subcontracted for the supply of any product for use on the project that is
produced in a foreign country on said list.
Unless the restrictions of this clause are waived by the Secretary of Transportation in accordance with 49 CFR 30.17,
no contract shall be awarded to a contractor or subcontractor who is unable to certify to the above. If the contractor
knowingly procures or subcontracts for the supply of any product or service of a foreign country on the said list for
use on the project, the Federal Aviation Administration may direct, through the sponsor, cancellation of the contract
at no cost to the Government.
FAA AIP 3-19-0094-048 (CARES MNT)
P-3 Hangars 1 & 2 Roof Repairs
Proposal Form waterloo Regional Airport - 60675091
Further, the contractor agrees that, if awarded a contract resulting from this solicitation, it will incorporate this
provision for certification without modification in each contract and in all lower tier subcontracts. The contractor
may rely upon the certification of a prospective subcontractor unless it has knowledge that the certification is
erroneous.
The contractor shall provide immediate written notice to the sponsor if the contractor learns that its certification or
that of a subcontractor was erroneous when submitted or has become el roneous by reason of changed circumstances.
The subcontractor agrees to provide immediate written notice to the contractor, if at any time it learns that its
certification was erroneous by reason of changed circumstances.
This certification is a material representation of fact upon which reliance was placed when making the award. If it is
later determined that the contractor or subcontractor knowingly rendered an erroneous certification, the Federal
Aviation Administration may direct, through the sponsor, cancellation of the contract or subcontract for default at no
cost to the Government.
Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to
render, in good faith, the certification required by this provision. The knowledge and information of a contractor is
not required to exceed that which is normally possessed by a prudent person in the ordinary course of business
dealings.
This certification concerns a matter within the jurisdiction of an agency of the United States of America and the
making of a false, fictitious, or fraudulent certification may render the maker subject to prosecution under Title 18,
United States Code, Section 1001.
15. The bidder/offeror certifies, by submission of this proposal or acceptance of this contract, that neither it nor its
principals are presently debar red, suspended, proposed for debarment, declared ineligible, or voluntar ily excluded
from participation in this transaction by any Federal department or agency. It further agrees by submitting this
proposal that it will include this clause without modification in all lower tier transactions, solicitations, proposals,
contracts, and subcontracts. Where the bidder/offer/contractor of any lower tier participant is unable to certify this
statement, it shall attach an explanation to this solicitation/proposal.
16. As evidence of good faith in submitting this Proposal, the undersigned encloses bid security in the amount of five (5)
percent of the bid which, in case he refuses or fails to accept an award and to enter into a Contract and file the
required bonds within the prescribed time, shall be forfeited to the Waterloo Regional Airport as liquidated damages.
17. By entering into this contract, the contractor certifies that neither it (not 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).
18. No part of this contract shall be subcontracted to any pet son 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).
19. The undersigned hereby declares that the only parties interested in this Proposal are named herein, that this Proposal
is made without collusion with any other person, firm, or corporation, that no member of the Council, Waterloo
Regional Airport or agent of the City of Waterloo, Iowa, is directly or indirectly financially interested in this bid.
20. In submitting this bid, it is understood that the right to reject any and all bids has been reserved and that this bid may
not be withdrawn for a period of ninety (90) days from the opening thereof.
21. Contractor certifies that all employees employed by Contractor or any subcontractor working on behalf of the
Contractor are in compliance with the Immigration Reform Control Act of 1986 (IRCA) and indemnifies the Owner
and holds harmless Ownei for any violations of IRCA as a result of the Contractor's employees or his subcontractor's
employees working on behalf of the Contractor on the Owner's project.
22. The undersigned certifies, to the best of his or her knowledge and belief, that:
FAA AIP 3-19-0094-048 (CARES (ANI') P-4 Hangars 1 & 2 Roof Repairs
Proposal Form waterloo Regional Airport - 60675091
a. No Federal appropriated funds shall be paid, by or on behalf of the Contractor, to any person for influencing or
attempting to influence an officer or employee of any agency, a Member ofCongress, an officer or employee of
Congress, or an employee of a member of Congress in Congress in connection with the making of any Federal
grant and the amendment or modification of any Federal grant.
b. If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing
or attempting to influence an officer or employee of any agency, a member of Congress, an officer or employee
ofCongress, or an employee of a Member of Congt ess in connection with this Federal grant, the Contractoi shall
complete and submit Standard Form-LLL, "Disclosure of Lobby Activities", in acco►dance with its instructions.
c. The Undersigned shall require that the language of this certification be included in the award documents for all
subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative
agreements) and that all subrecipients shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction was made
of entered into. Submission of this certification is a p►erequ►site for making o► entering into this transaction imposed
by Section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil
penalty of not less than $10,000 and not more than $200,000 for each such failure.
23. BUY AMERICAN CERTIFICATE (Title 49 U.S.C. Chapter 501)
As a condition of bid responsiveness, the bidder must how it intend to comply with the Buy American preferences
established under Title 49 U.S.C. Section 50101. Bidder must complete the attached Buy American certification. If
the bidder requests a permissible waiver to the Buy America requirements, the Bidder identified as with the
successful bid must submit a formal waiver request and component cost calculation within the prescribed time
identified on the Buy America certification.
24. Drug Free Workplace, Act of 1988.
a. By submission of this offer, the offeror, if other than an individual, who is making an offer that equals or exceeds
$25,000, certifies and agrees that with respect to all employees of the offeror to be employed under a contract
resulting from this solicitation, it will --no later than 30 calendar days after contract award (unless a longer period
is agreed to in writing, for contracts of 30 calendar days or more performance duration;) or as soon as possible
for contracts of less than 30 calendar days performance duration, but in any case, by a date prior to when
performance is expected to be completed--
(1) Publish a statement notifying such employees that the unlawful manufacturer, distribution, dispensing,
possession, or use of a controlled substance is prohibited in the Contractor's workplace and specifying the
actions that will be taken against employees for violations of such prohibition.
(2) Establish an on -going drug -free awareness program to inform such employees about --
(a) The dangers of drug abuse in the workplace.
(b) The Contractor's policy of maintaining a drug -free workplace.
(c) Any available drug counseling, rehabilitation, and employee assistance programs; and
(d) The penalties that may be imposed upon employees for drug abuse violations occurring in the
workplace.
(3) Provide all employees engaged in performance of the contract with a copy of the statement required by
subparagraph a. (1) of this provision.
FAA AIP 3-19-0094-048 (CARES MNT)
P-5 Hangars 1 & 2 Roof Repairs
Proposal Form Waterloo Regional Airport - 60675091
(4) Notify such employees in writing in the statement required by subparagraph a.( 1) of this provision that, as
a condition of continued employment on the contract resulting from this solicitation, the employee will --
(a) Abide by the terms of the statement; and
(b) Notify the employer in writing of the employee's conviction under a criminal drug statute for a
violation occurring in the workplace no later than 5 calendar days after such conviction.
(5) Notify the Contracting Officer in writing within 10 calendar days after receiving notice under subdivision
a. (4) (b) of this provision, from an employee or otherwise receiving actual notice of such conviction. The
notice shall include the position title of the employee; and
(6) Within 30 calendar days after receiving notice under subdivision a.(4)(b) of this provision of a conviction,
take one of the following actions with respect to any employee who is convicted of a drug abuse violation
occurring in the workplace.
(a) Take appropriate personnel action against such employee, up to and including termination; or
(b) Require such employee to satisfactorily participate in a drug abuse assistance or rehabilitation
program approved for such purposes by a Federal, State, or local health, law enforcement, or other
appropriate agency.
Make a good faith effort to maintain a drug -free workplace through implementation of subparagraphs a. (1)
through a. (6) of this provision.
b. By submission of its offer, the offeror, if an individual who is making an offer of any dollar value, certifies and
agrees that other offeror will not engage in the unlawful manufacture, distribution, dispensing, possession, or use
of a controlled substance in the performance of the contract resulting from this solicitation.
(7)
c. Failure of the offeror to provide the certification required by paragraphs a. or b. of this provision, renders the
offeror unqualified and ineligible for award. [See FAR. 9.104-1(g) and 19.602-1 a.(2)(a)].
d. In addition to other remedies available to the Government, the certification in paragraphs a. or b. of this
provision concerns a matter within the jurisdiction of an agency of the United States and the making of a false,
fictitious, or fraudulent certification may render the maker subject to prosecution under title 18, United States
Code, Section 1001.
25. Attachment to This Bid. The following documents are attached to and made a part of this Bid:
a. Bid Guaranty in the form of Bid Bond
b. Non -Collusion Affidavit of Prime Bidder.
c. Statement of Intent — Non -Discrimination and Equal Opportunity Statement.
d. Buy American Certification Statement.
e. Bidder's Information Sheet.
f. Synopsis of Experience Record. (IDOT Certification may be substituted.)
g. Completed DBE forms "Utilization Statement" and "Letter of Intent."
•
FAA AIP 3-19-0094-048 (CARES MNT)
P-6 Hangars 1 & 2 Roof Repairs
Proposal Form Waterloo Regional Airport - 60675091
26. The Bidder shall indicate whether the bid is submitted by a/an:
❑ Individual, Sole Proprietorship
❑ Partner ship
M Corporation
❑ Joint -venture: all parties must join -in and execute all documents
❑ Other
Respectfully submitted,
By
Bidder
Signature
Rick Stensland, President
Title
201 Main Street, PO Box 418
Address
Janesville, IA 50647
(Include Zip Code)
319/987/2911
Telephone No.
FAA AIP 3-19-0094-048 (CARES !ANT)
P-7 Iiangars 1 & 2 Roof Repairs
Proposal Form Waterloo Regional Airport - 60675091
Document A310 TM - 2010
Conforms with The American Institute of Architects AiA Document 310
Bid Bond
CONTRACTOR: SURETY:
(Name, e, legal status and addi•cs.%) Name, legal status and principal place Villainess)
Modern Builders, Inc.
201 Main Street, P.O. Box 418
Janesville, IA 50647
OWNER:
(Name, legal stains and address)
Waterloo Regional Airport
2790 Livingston Lane
Waterloo, IA 50703
Western Surety Company
151 N Franklin St.
Chicago, IL 60606
This document has important
legal consequences. Consultation
with an attorney is encouraged
with respect to its completion or
modification.
Any singular reference to
Contractor, Surety, Owner or
other party shall be considered
plural where applicable.
BOND AMOUNT: $ Five Percent (5%) of the Total Amount Bid
PROJECT:
(\ainc. location or address, and Pro/ect number, Wang
Hangars 1 & 2 Roof Repairs at the Waterloo Regional Airport - Waterloo, Iowa - FAA AIP 3-19-0094-048 (CARES MNT)
The Contractor and Surety are bound to the Owner in the amount sot forth above. for the payment of which the Contractor and Surety bind
themselves• their heirs, executors, administrators, successors and assigns, jointly and severally, as provided herein. The conditions of this
Bond aro such that if the Owner accepts the bid of the Contractor within the time specified in the bid documents, or within such time period
as may be agreed to by the Owner and Contractor, and the Contractor either (1) enters into a contract with the Owner in accordance with
the terms of such bid, and gives such bond or bonds as may be specified in the bidding or Contract Documents, with a surety admitted in
the jurisdiction of the Project and otherwise acceptable to the Owner, for the faithful performance of such Contract and for the prompt
payment of labor and material funiished in the prosecution thereof; or (2) pays to the Owner the difference, not to exceed the amount of
this Bond, between the amount specified in said bid and such larger amount for which the Ostler may in good faith contract with another
party to perform the work covered by said bid, then this oibligation shall be null and void, otherwise to remain in bill tierce and effect. The
Surety hereby waives any notice °fan agreement between the Owner and Contractor to extend the lime in which the Owner niay accept the
hid. Waiver of notice by the Surety shall not apply to uny extension exceeding sixty (60) days in the aggregates beyond the time Ibr
acceptance of bids specified in the hid documents, and the Owner and Contractor shall obtain the Surety's consent lbr an extension beyond
sixty (60) days.
If this Bond is issued in connection with a subcontractor's bid to a Contractor, the terns Contractor in this Bond shall be deemed to be
Subcontractor and the term Owner shall be deemed to be Contractor.
When this Bond has been tarnished to comply with a statutory or other legal requirement in the location afire Project, any provision in
this Bond conflicting with said statutory or legal requirement shall be deemed deleted herclrom and provisions conforming to such
statutory or other legal requirement shall be deemed incorporated herein. When so furnished, the intent is that this Bond than be construed
as a statutory bond and not as a common law bond.
Signed and sealed this 13th day of December
(1Vitncss)
2022
Modern Builders, Inc.
(Principal)
ety Company
Mae) Dione R. Young, A� ey-' -Ft
(Seal)
(Seal)
Western Surety Company
POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY -IN -FACT
Know All Alen By These Presents, That WESTERN SURETY COMPANY, a South Dakota corporation, is a duly organized and existing corporation
having its principal office in the City of Sioux Falls, and State of South Dakota, and that it does by virtue of the signature and seal herein affixed hereby
make, constitute and appoint
Dione R Young, Craig E Hansen, Jay D Freiermuth, Stacy Venn, Cindy Bennett, Anne
Crowner, Brian M Deimerly, Stacie Christensen, T Mc Culloh, Individually
of Waukee, IA, its true and lawful Attomey(s)-in-Fact with full power and authority hereby conferred to sign, seal and execute for and on its behalf bonds,
undertakings and other obligatory instruments of similar nature
- In Unlimited Amounts -
and to bind it thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of the corporation and all the acts of said
Attorney, pursuant to the authority hereby given, are hereby ratified and confirmed.
This Power of Attorney is made and executed pursuant to and by authority of the By -Law printed on the reverse hereof, duly adopted, as indicated, by
the shareholders of the corporation.
In witness Whereof, WESTERN SURETY COMPANY has caused these presents to be signed by its Vice President and its corporate seal to be
hereto affixed on this 22nd day of June, 2021.
State of South Dakota
County of Minnehaha
}
SS
WESTERN SURETY COMPANY
Paul T. Bnuflat, Vice President
On this 22nd day of June, 2021, before me personally came Paul T. Bruflat, to me known, who, being by me duly sworn, did depose and say: that he
resides in the City of Sioux Falls, State of South Dakota; that he is the Vice President of WESTERN SURETY COMPANY described in and which executed
the above instrument; that he knows the seal of said corporation; that the seal affixed to the said instrument is such corporate seal; that it was so affixed
pursuant to authority given by the Board of Directors of said corporation and that he signed his name thereto pursuant to like authority, and acknowledges
same to be the act and deed of said corporation.
My commission expires
March 2, 2026
• •
M. BENT _
NOTARY PUBLIC +
i E SOUTH DAKOTA i
• •
CERTIFICATE
/22.
M. Bent, Notary Public
I. L. Nelson, Assistant Secretary of WESTERN SURETY COMPANY do hereby certify that the Power of Attorney hereinabove set forth is still in
force, and further certify that the By -Law of the corporation printed on the reverse hereof is still in force. In testimony whereof I have hereunto subscribed
my name and affixed the seal of the said corporation this 13th day of December . 2022
WESTERN SURETY COMPANY
2414—Lrrtl/
L. Nelson, Assistant Secretary
Fomr F4280-7-2012
Go to www.cnasurety.com > Owner / Obligee. Services > Validate Bond Coverage, if you want to verify bond authenticity.
Authorizing By -Law
ADOPTED BY THE SHAREHOLDERS OF WESTERN SURETY COMPANY
This Power of Attorney is made and executed pursuant to and by authority of the following By -Law duly adopted by the shareholders
of the Company.
Section 7. All bonds, policies, undertakings, Powers of Attorney, or other obligations of the corporation shall be executed in the
corporate name of the Company by the President, Secretary, and Assistant Secretary, Treasurer, or any Vice President, or by such other
officers as the Board of Directors may authorize. The President, any Vice President, Secretary, any Assistant Secretary, or the Treasurer
may appoint Attorneys in Fact or agents who shall have authority to issue bonds, policies, or undertakings in the name of the Company.
The corporate seal is not necessary for the validity of any bonds, policies, undertakings, Powers of Attorney or other obligations of the
corporation. The signature of any such officer and the corporate seal may be printed by facsimile.
NON -COLLUSION AFFIDAVIT OF PRIME BIDDER
State of Iowa )
)ss
County of Bremer )
Rick Stensland , being first duly sworn, deposes and says that:
(1) He is
fewnet;-Paritiera, Officer, -R€pEesetItat+wrer A )- of
Modern Builders, Inc. , the Bidder that has submitted the attached Bid:
(2) He is fully informed respecting the preparation and contents of the attached bid and of all pertinent
circumstances respecting such bid.
(3) Such bid is genuine and is not a collusive or sham bid.
(4) Neither the said Bidder nor any of its officers, partners, owners, agents, representatives, employees or parties in
interest, including this affiant, has in any way colluded, conspired, connived or agreed, directly or indirectly, with any other
Bidder, firm or person to submit a collusive or sham bid in connection with the Contract for which the attached bid has been
submitted or to refrain from bidding in connection with such Contract, or has in any manner, directly o1 indirectly, sought
by agreement or collusion or communication or confer ence 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 o1 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, 01 any person interested in the proposed Contract; and
(5) The price or prices quoted in the attached bid are fair and proper and are not tainted by any collusion, conspiracy,
connivance, or unlawful agreement on the part of the Bidder or any of its agents, representatives, owners, employees, or
parties in interest, including this affiant.
(Signed)127,
Title Rick Stensland, President
Subscribed and sworn to before me
this /�%! '' • day of
My Commission Expires , 20 .
44 w • .14
Notarial Seal - IOWA ►
IOWA Commission No. 156798
My Commission Expires July 06, 20
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FAA AIP 3-19-0094-048 (CARES MNT) P-8
Proposal Form
I-langars 1 & 2 Roof Repairs
Waterloo Regional Airport - 60675091
STATEMENT OF INTENT
NONDISCRIMINATION
AND
EQUAL OPPORTUNITY STATEMENT
The Contractor does hereby certify to the Waterloo Regional Airport, that no person shall, in any way, be favored or
discriminated against because of his race, political or religious opinions and affiliations, national origins, sex, age, sexual
orientation, gender identity, disability, color, creed, marital status, employee union or association membership or office
herein.
If selected as the successful bidder, this contractor hereby agrees to file either a nondiscrimination and equal opportunity
statement and/or an Affirmative Action Program.
Improvements to the Waterloo Regional Airport consisting of
HANGARS 1 & 2 ROOF REPAIRS
FAA AIP 3-19-0094-048 (CARES MNT)
Modern Builders, Inc.
COMPANY
Rick Stensland
EXECUTIVE OFFICER
Rick Stensland
AFFIRMATIVE ACTION OFFICER
ADDRESS OF THE AFFIRMATIVE ACTION OFFICER
201 Main Street, PO Box 418
Janesville, IA 50647
PHONE NUMBER 319/987/2911
FAA AIP 3-19-0094-048 (CARES MNT) P-9 Hangars I & 2 Roof Repairs
Proposal Form Waterloo Regional Airport - 60675091
UTILIZATION STATEMENT
Disadvantage Business Enterprise
The undersigned bidder/offeror has satisfied the requirements of the bid specification in the following manner. (Please
mark the approp late box)
The bidder/offeror is committed to a minimum of 0% DBE utilization on this contract.
CI The bidder/offeror, while unable to meet the DBE goal of %, hereby commits
to a minimum of % DBE utilization on this contract and also submits
documentation, as an attachment demonstrating good faith efforts (GFE).
The undersigned hereby further assures that the information included herein is true and correct, and that the DBE firm(s) listed herein have agreed to
perform a commercially useful function in the work items noted for each firm. The undersigned further understands that no changes to this statement
may be made without prior approval from the Civil Right Staff of the Federal Aviation Administration.
Modern Builders, Inc.
Bidder's/Offeror's Firm Name
Signature
/z //.5"A oZ z.
Date
DBE UTILIZATION SUMMARY
Contract Amount
DBE Amount Contract Percentage
DBE Prime Contractor $ x 1.00 = $
DBE Subcontractor $ x 1.00 = $
DBE Supplier $ x 0.60 = $
DBE Manufacturer $ x 1.00 = $
Total Amount DBE $
DBE Goal $
%
Note: If the total proposed DBE participation is less than the established DBE goal, Bidder must provide written documentation of the good
faith efforts as required by 49 CFR Part 26.
FAA AIP 3-19-0094-048 (CARES !ANT)
Proposal Form
P-10 I langars I & 2 Roof Repairs
Waterloo Regional Airport - 60675091
LETTER OF' INTENT
Disadvantage Business Enterprise
(This page shall be submitted for each DBE firm)
NONE CONTACTED
Bidder/Offer Name:
Address:
City: _ State: Zip:
DBE Firm:
DBE Contact Person:
DBE Firm:
Address:
City: State: Zip:
Name: Phone: ( )
DBE Certifying Agency: Expiration Date:
Each DBE Firm shall submit evidence (such as a photocopy) of their certification status.
Classification:
Prime Contractor
Manufacturer
Subcontractor
Supplier
Joint Venture
to
Work
be
performed
DBE
item(s)
by
Description
of
Work
Item
Quantity
Total
The bidder/offeror is committed to utilizing the above -named DBE firm for the work described above. The estimated
participation is as follows:
DBE contract amount: $ Percent of total contract:
AFFIRMATION:
The above -named DBE firm affirms that it will perform the portion of the contract for the estimated dollar value as stated
above.
By:
(Signature)
(Title)
Note: In the event the bidder/offeror does not receive award of the prime contract, any and all representations in this
Letter of Intent and Affirmation shall be null and void.
FAA AIP 3-19-0094-048 (CARES MNI')
P-11 I langars 1 & 2 Roof Repairs
Proposal Form Waterloo Regional Airport - 60675091
BUY AMERICAN CERTIFICATION FORM FOR TOTAL FACILITY
(Building projects such as Terminal, SRE, ARFF, eta)
As a matter of bid responsiveness, the Bidder or Offeror must complete, sign, date, and submit this
certification statement with their proposal. The Bidder or Offeror must indicate how they intend to comply
with 49 USC § 50101 by selecting one of the following certification statements These statements are
mutually exclusive. Bidder must select one or the other (i.e. not both) by inserting a checkmark (✓) or the
letter "X".
■
The Bidder or Offeror hereby certifies that it will comply with 49 USC. 50101 by:
a) Only installing steel and manufactured products produced in the United States, or;
b) Installing manufactured products for which the FAA has issued a waiver as indicated by
inclusion on the current FAA Nationwide Buy American Waivers Issued listing, or;
c) Installing products listed as an Excepted Article, Material or Supply in Federal Acquisition
Regulation Subpart 25.108.
By selecting this certification statement, the Bidder or Offeror agrees:
1. To provide to the Owner evidence that documents the source and origin of the steel and
manufactured product.
2. To faithfully comply with providing US domestic products.
3. To refrain from seeking a waiver request after establishment of the contract, unless extenuating
circumstances emerge that the FAA determines justified.
The Bidder or Offeror hereby certifies it cannot comply with the 100% Buy American Preferences of
49 USC § 50101(a) but may qualify for either a Type III or Type IV waiver under 49 USC § 50101(b). By
selecting this certification statement, the apparent Bidder or Offeror with the apparent low bid agrees:
To the submit to the Owner within 15 calendar days of the bid opening, a formal waiver request
and required documentation that support the type of waiver being requested.
2. That failure to submit the required documentation within the specified timeframe is cause for a non-
responsive determination may results in rejection of the proposal.
3. To faithfully comply with providing US domestic products at or above the approved US domestic
content percentage as approved by the FAA.
4. To furnish US domestic product for any waiver request that the FAA rejects.
5. To refrain from seeking a waiver request after establishment of the contract, unless extenuating
circumstances emerge that the FAA determines justified.
1.
Required Documentation
Type III Waiver — The cost of components and subcomponents produced in the United States is more that
60% of the cost of all components and subcomponents of the "facility". The required documentation for a
Type III waiver is:
a) Listing of all manufactured products that are not comprised of 100% US domestic content (Excludes
products listed on the FAA Nationwide Buy American Waivers Issued listing and products excluded
by Federal Acquisition Regulation Subpart 25.108; products of unknown origin must be considered
as non -domestic products in their entirety).
b) Cost of non -domestic components and subcomponents, excluding labor costs associated with final
assembly and installation at project location.
FA/\ AIP 3-19-0094-048 (CARES MNT) P-12 I langars 1 & 2 Roof Repairs
Proposal Form Waterloo Regional Airport - 60675091
c) Percentage of non -domestic component and subcomponent cost as compared to total "facility"
component and subcomponent costs, excluding labor costs associated with final assembly and
installation at project location.
Type IV Waiver — Total cost of project using US domestic source product exceeds the total project cost
using non -domestic product by 25%. The required documentation for a Type IV of waiver is:
a) Detailed cost information for total project using US domestic product.
b) Detailed cost information for total project using non -domestic product.
False Statements: Per 49 USC § 47126, this certification concerns a matter within the jurisdiction of the
Federal Aviation Administration and the making of a false, fictitious or fraudulent certification may render the
maker subject to prosecution under Title 18, United States Code.
Date
/ f49IOW /3A era `/t, iv
Company Name
Signature ,
e4Lc/a14
Title
FAA AIP 3-19-0094-048 (CARES MNT)
P-13 I langars 1 & 2 Roof Repairs
Proposal Form Waterloo Regional Airport - 60675091
Buy America Waiver Request
Title 49 U.S.C. Section 50101 (b)
For Airfield Development Projects funded under the
Airport Improvement Program
(Revised 4/19/2010)
Instructions for Permissible Waivers
Section 50101(b)(1) Waiver
The bidder may not request a waiver based upon the best interests of the public. The FAA Office of Airports publishes such waivers at:
http://www.faa.gov/airports/aip/procurement/federal_contract_provisions/media/buy_american_waiver.xls
Section 50101(b)(2) Waiver:
The bidder may not request a waiver based upon insufficient supply of U.S. manufactured. The FAA Office of Airports publishes such
waivers at:
http://www.faa.gov/airports/aip/procurement/federal_contract_provisions/media/buy_american waiver.xls
Section 50101(b)(3) Waiver:
The bidder may request a waiver if 60% or more of the components are produced in the United States and final assembly
occurs to the U.S. Bidder is hereby advised that the Owner's approval with the bidder's waiver request is contingent upon
FAA approval.
1. "Equipment" in Section 50101 shall mean the following:
a) Individual type "L" items (Airfield Lighting Equipment) as listed in FAA Advisory Circular 150/5345-53.
b) individual bid items as established within FAA Advisory Circular 150/5370-10. The bid item application may not be applied
for the type "L" items listed in AC 150/5345-53.
c) A waiver request may only address one specific equipment item. Submit separate requests for each equipment item for which
a waiver.
d) items listed under the Nationwide Waiver do not require further review. Please refer to the following webpage:
http://www.faa.gov/airports/aip/procurement/federal_contract_provisions/media/buy_american_waiver.xls
2. The bidder must base the U.S. percentage upon the value that results from completing a component cost calculation table similar to
the attached format. Bidder shall avoid mere pro forma efforts to establish the waiver request percentage. The Bidder must submit
the component cost calculation table as an attachment to the waiver request.
3. Components/subcomponents are the material and products composing the "equipment".
4. The final assembly of the AIP-funded "equipment" must be within the USA (Section 50101(b)(3)(B)). Final assembly is the
substantial transformation of the components and subcomponents into the end product.
5. All steel used in the "Equipment" must be produced in the United States.
6. The Buy American requirements apply to all tier contractors and subcontractors. All contractors/subcontractors arc required to
provide appropriate documentation that indicates origin of manufacturer and percentage of domestic made product.
7. The bidder is hereby advised there is no implied or expressed guarantee that a requested waiver will be issued by the Federal
Aviation Administration (FAA). Less than 60% USA component/subcomponent proposed for this facility CANNOT be waived.
Products made with foreign steel are not eligible for a waiver.
8. North America Free Trade Act (NAFTA): Free Trade Agreements such as NAFTA do not apply to the AiP. Products and material
made in Canada or Mexico must be considered as foreign made products.
9. Preparation of a Component Cost Calculation Table is not necessary for equipment listed on the FAA national listing:
http://www.faa.gov/airports/aip/procurement/federal_contract_provisions/media/buy_american_waiver.xls.
Bidder however shall submit a listing of any equipment it proposes to install on the project that is included on the National Buy
American conformance list.
Instructions for Section 50101(b)(4) Waiver:
1. The bidder tnay request a waiver if application of Buy Atnerica preferences results in a 25% cost increase in the
overall project. This waiver is rarely applicable. Consult the Owner before making this request.
FAA AIP 3-19-0094-048 (CARES MNT)
Proposal Form
P-14 Hangars 1 & 2 Roof Repairs
Waterloo Regional Airport - 60675091
COMPONENT COST CALCULATION TABLE (Type 3 Waiver
• In lieu of completing this table, bidder nzav prepare a spreadsheet that addresses the same information and calculations as presented herein
• Preparation of a Component Cost Calculation Table is not necessary for equipment listed on the FAA national listing:
help://►►'w►v.faa.gov/aiportsfaipiprocuremeni/federal coniraccprovisions/media/buv american ►cai►'er.xls.
• The component breakout shall be along major components of the equipment. Submit separate calculation for each different equipment type
calculations of different types of equipment.
• For Airfield development projects, equipment is defined as the " L " items (Airfield Lighting Equipment) as listed in FAA Advisory Circular
established within FAA Advisory Circular 150/5370-10. The individual bid item method mm' not be applied to the " L " type ileums.
• An authorised person shall attest under signature and date that the submitted information is accurate and complete.
Equipment Type: None
Buy America Waiver Request
Title 49 U.S.C. Section 50101 (b)(3)
For Airfield Development Projects funded under the
Airport Improvement Program
i
s. Do not con.
150/5345-53 c
Metal
Component/Subcomponents
Roof
System
Name
of
Manufacturer
Country
of
Origin
Cost
Components/Subcomponents
of
Foreign
Manufactured
American
Building
Co.
USA
$4 516.00
Roof
Coating
Uniflex
Roof
USA
$2, 500.00
Sum of US Manufactured Component/Subcomponent Cos
Sum of all Equipment Components and Subcomponen
Percentage of Equipment Components Manufactured in the United Stat
Place of Final Assemb
Certification Signature
Bidder hereby requests a waiver to Buy America preferences based upon Section 50101(b)(3) for the equipment identified above. The bidd
of the cost of components and subcomponents comprising the equipment are produced in the United States and that final assembly occurs
1 hereby certify the above information is accurate and complete.
,O26 LeHt-3 Bud ?dee`s ;UV c jzA / ette.
13idlder's Firm Name Date
n:desde,
Signature
FAA A1P 3-19-0094-048 (CARES MNT) P-15
Proposal Form
Buy America Conformance Listing
Title 49 U.S.C. Section 50101 (b)
For Airfield Development Projects funded under the
Airport Improvement Program
• Preparalion ofa Component Cost Calculation "fable is not necessary for equipment listed on the FAA national listing:
hap://wwwfaa.gov/ai►porls/nip/procurement/federal contract provisions/ media/buy _american u'aiver.xls
• Bidder shall submit a listing of equipment it proposes to install on the project that is included on the current National Buy
American conformance list.
Equipment Type
Name of Manufacturer
4�J,DY1e.
Product Number
Certification Signature:
Bidder hereby certifies that the above listed equipment, which we propose for installation on the subject
project, are on the current National Buy America Conformance list as established at:
http://www.faa.gov/airports/aip/procurement/federal contract provisions/media/buy american waiver.xls
I hereby certify the above information is accurate and complete.
`flod ,aa '/c� ;t! 214c
Bidder's Firm Name
Signature
2./K51/4OZE
Date
FAA AIP 3-19-0094-048 (CARES [ANT)
P-I6
I langar 1 & 2 Roof Repairs
Proposal Form Waterloo Regional Airport - 60675091
Bidder Status Form
You may attach additional sheet(s) if needed.
To be completed by all bidders Part A
Please answer "Yes" or "No" for each of the following:
El/Yes
t/I Yes
[AYes
[t�Yes
Yes
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).
No My company has an office to transact business in Iowa.
No My company's office in Iowa is suitable for more than receiving mail, telephone calls, and e-mail.
No My company has been conducting business in Iowa for at least 3 years prior to the first request for
bids on this project.
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: / / / 1 I /(/7 to f
/ &0 / J2' / Y Address.
zuiny
City, State, Zip. i 't 42id4 d4 UD4 0
Dates: / AO /lDa to --�i' 7 Address. ,M / l i-w ,2,
City, State, Zip. AVI / ;c a 5o6V7
Dates: / / to / / Address'
City, State, Zip.
To be completed by non-resident bidders
Part C
1. Name of home state or foreign country reported to the Iowa Secretary of State:
2. Does your company's home state or foreign country offer preferences to 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 1 know that my
failure to provide accurate and truthful information may be a reason to reject my bid.
� LI�
Firm Name: f frd t 4u .(AA�P �4� !1Le'- .
Signature:
Date: M 4.4e/a
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)
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 1J 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 1;1410 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.
VYes ❑ 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 [E'No
Yes (!No
Yes i 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.
My business is a limited liability partnership which has filed a statement of qualification in this
state and the statement has not been canceled.
My business is a limited liability partnership which has filed a statement of qualification in a
state other than Iowa, has filed a statement of foreign qualification in Iowa and a statement of
cancellation has not been filed.
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
Yes Fle" o
Yes [ T4io
My business is a limited partnership or a limited liability limited partnership whose certificate of
limited partnership is filed in a state other than Iowa, the limited partnership or limited liability
limited partnership has received notification from the Iowa secretary of state that the application
for certificate of authority has been approved and no notice of cancellation has been filed by the
limited partnership or the limited liability limited partnership.
My business is a limited liability company whose certificate of organization is filed in Iowa and has
not filed a statement of termination.
My business is a limited liability company whose certificate of organization is filed in a state other
than Iowa, has received a certificate of authority to transact business in Iowa and the certificate
has not been revoked or canceled.
309-6001 (09-15)
BSF-2