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Home My WebLink AboutGee Asphalt Systems, Inc.�ZD /1/6404sco ASPHALT /SYSTEMS, INC. 4715 6th St. SW Cedar Rapids, Iowa 52404 800-747-8567 1 (319) 366-8567 www.geeasphalt.com To: L . 4 y O* '1 0taCe /O o , C . G 1 t,r JC Qod 1ec K -Pggc•+len t l?cy at 2 (/ yr w+►y 3C7 -YY: n.a► r 4 "S 3- erne( E. WC14(11oo RC*010 A,,etcr F.A4t3 ?'q-attic. oft 360A.3 I fib, b e11',w gd-' C . 41 (,lry IL C:4y of wasidoo 111s /14yI bury 54-Ko} Vvct rloc, ;.A 5%o703 ti • PROPOSAL FORM FOR PAVEMENT REHABILITATION (RUNWAY 12/30, TAXIWAY A EAST, TAXIWAY E) FAA AIP 3-19-0094-056 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.' a wa' , , a Partnership consisting of the following partners: , having familiarized (himself) (themselves) (itself) with the existing conditions on the project area affecting the cost of the work, and with all the contract documents listed in the Table of Contents and Addenda (if any), as prepared by the City Engineer of the City of Waterloo now on file in the office of the City Clerk, City Hall, Waterloo, Iowa, hereby proposes to furnish all supervision, technical personnel, labor, materials, machinery, tools, appurtenances, equipment, and services, including utility and transportation services required to construct and complete this PAVEMENT REHABILITATION (RUNWAY 12/30, TAXIWAY A EAST, TAXIWAY E) -- FAA AIP 3-19-0094-056, 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 work to be performed in this project shall include the following described improvements at the Waterloo Regional Anport, Waterloo, Iowa: • P-608 Asphalt Surface Treatment for Runway 12-30 outside of the Runway 18-36 Runway Safety Area • P-608 Asphalt Surface Treatment for Taxiway A from concrete limits near Taxiway B to Runway 12-30 and Taxiway E • Crack Sealing on Runway 12-30, Taxiway A and Taxiway E • Asphalt Joint Repair on Runway 12-30 • Pavement Marking Removals and Replacement for Runway 12-30, Taxiway A and Taxiway E 3. The undersigned, in compliance with your Invitation for Bids dated 360/23 , hereby proposes to do the work called for in said Contract and Specifications and shown on said Plans and Addendum Nos. and to furnish all materials, tools, labor and all appliances and appurtenances necessary for the said work at the following rates and prices: FAA AIP 3-19-0094-056 P-1 Waterloo Regional Airport AECOM Project 1/60695145 Pavement Rehab. (Rwy 12/30, Txy A East, Txy E) Revised Per Addendum No. 1 — 3/27/2023 ITEMIZED PROPOSAL WATERLOO REGIONAL AIRPORT WATERLOO, IOWA PROJECT: • PAVEMENT REHABILITATION (RUNWAY 12/30, TAXIWAY A EAST, TAXIWAY E) FAA AIP PROJECT NO. 3-19-0094-056 ITEM NO. SPEC. NO. DESCRIPTION UNIT ESTIMATED QUANTITY UNIT PRICE BID TOTAL PRICE BID 1 GP 105 MOBILIZATION DEMOBILIZATION AND LS 1 $ �1 / s, Ii s $ y t1 ( Its- 2 P-101 JOINT AND CRACK REPAIR LF 61,000 $ /' $ (-4 0 To 3 P-101 SPALLED PAVEMENT AND REPAIR FAILED ASPIIALT SF 1,500 $ 7 S' 13 $ Zv Os P-101 COLD MILLING SF 1,500 $ if y �� $ 1 / 2 b 0 5 P-608 ASPHALT SURFACE TREATMENT SY 156,500 $ I 4/ $ 1 7 OCR 6 P-620 PAVEMENT MARKING REMOVAL _ .� SF 91,000 $ Q, stol / $ y0/ 9fo - 7 P-620 AIRFIELD REFLECTIVE MARKING -WATERBORNE) (YELLOW- SF 5,000 $ 0,53 $ Zd S0 ,. 8 P-620 AIRFIELD REFLECTIVE MARKING -WATERBORNE) (WHITE- _ SF 129,000 $ 0. Si _ 1L $ V�' 3 70 � 9 P-620 AIRFIELD REFLECTIVE MARKING -WATERBORNE) (BLACK -NON- SF 4,900 $ (%' 2 S3 $ �- il7 10 P-620 REFLECTIVE GRADATION MEDIA A) (TYPE I, LB 7,750 $ 1,121 f $ Or %1 TOTAL BID AMOUNT $Sg),7ogS= 4. It is the Airport's intention to evaluate bids; and the Airport reserves the right to award or reject based on available funding. 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 ate 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 ofLabor 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 seven and one-third (7.33%) percent of the dollar value of the prime contract 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 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. 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 FAA AIP 3-19-0094-056 P-2 Waterloo Regional Airport AECOM Project n60695145 Pavement Rehab. (Rwy 12/30, Txy A East, Txy E) 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 term "segregated facilities" means any waiting rooms, work areas, restrooms and washrooms, restaurants and other eating areas, timeclocks, locker rooms and other storage or dressing areas, parking lots, drinking fountains, recreation of 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 under signed 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, 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 (Perfoi mance and Payment) bond on attached forms within fifteen (15) days after the prescribed forms are presented for signature. 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) calendaf 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 Form 100) if s/he has not submitted a complete compliance report within 12 months proceeding the date of award. 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 of of 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: FAA AIP 3-19-0094-056 P-3 Waterloo Regional Airport AECOM Project I/60695145 Pavement Rehab. (Rwy 12/30, 'I'xy A East, 'I'xy E) 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 procured 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. 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 of that of a subcontractor was erroneous when submitted or has become erroneous 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 is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily 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 or any lower tier participant is unable to certify this statement, it shall attach an explanation to this solicitation/proposal. 16. As an 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 refiises 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 (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). FAA AIP 3-19-0094-056 P-4 Waterloo Regional Airport AECOM Project J/60695145 Pavement Rehab. (Rwy 12/30, Txy A East, Txy E) 18. 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). 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 pet son, 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 Owner 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 protect. 22. The undersigned certifies, to the best of his or her knowledge and belief, that: 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 of Congress, 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 of Congress, or an employee of a Member of Congress in connection with this Federal grant, the Contractor shall complete and submit Standard Form-LLL, "Disclosure of Lobby Activities", in accordance 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, subgtants, 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 or entered into Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352, Title 31, U.S. Code. Any person who fails to file the requited 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 Work Place, 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 -- FAA AIP 3-19-0094-056 P-5 Waterloo Regional Airport AECOM Project it60695145 Pavement Rehab. (Rwy 12/30, Txy A East, Txy E) (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 work place; (b) The Contractor's policy of maintaining a drug -free work place; (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 work place; Provide all employees engaged in performance of the contract with a copy of the statement required by subparagraph a.(1) of this provision; 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; 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 dt ug abuse violation occuning in the work place; (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. (7) 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. 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 19.602-1a.(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 b. Non -Collusion Affidavit of Prime Bidder. c. Statement of Intent — Non -Discrimination and Equal Opportunity Statement. FAA AIP 3-19-0094-056 P-6 Waterloo Regional Airport AECOM Project it60695145 Pavement Rehab. (Rwy 12/30, 'I'xy A East, Txy E) 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." 26. The Bidder shall indicate whether the bid is submitted by a/an: ❑ Individual, Sole Proprietorship ❑/ Pat tnership Q Corporation ❑ Joint -venture: all parties must Join -in and execute all documents ❑ Other Respectfully submitted, By Bidder / aeca- ,4 h&.// 5 1.-<401/ ( Signature 042/47 Title Address «7/5 R s/ See). ZeZr 444 eti- 62 YW (Include Zip Code) (? /9- 34 -9SY `7 Telephone No. FAA AIP 3-19-0094-056 P-7 Waterloo Regional Airport AECOM Project /160695145 Pavement Rehab. (Rwy 12/30, Txy A East, Txy E) BID BOND KNOW ALL MEN BY THESE PRESENTS, that we Gee Asphalt Systems, Inc. as Principal, and United Fire & Casualty Company as Surety are held and firmly bound unto the Waterloo Regional Airport, 2790 Livingston Lane, Waterloo, Iowa, hereinafter call "Owner", in the penal sum of Five Percent (5%) of the Total Amount Bid Dollars ($ 5% ) lawful money of the United States, for the payment of which sum will and truly be made, we bind ourselves, our heirs, executors, administrators, and successors, jointly and severally, firmly by these presents. The condition of this obligation is such that whereas the Principal has submitted the accompanying bid, dated March 30 120 23 for PAVEMENT REHABILITATION (RUNWAY 12/30, TAXIWAY A EAST, TAXIWAY E) at the Waterloo Regional Airport, Waterloo, Iowa, FAA AIP 3-19-0094-056. NOW, THEREFORE, (A) If said Bid shall be rejected, or in the alternate, (B) If said bid shall be accepted and the Principal shall execute and deliver a Contract in the form specified and shall furnish a bond for his faithful performance of said Contract, and for the payment of all persons performing labor or furnishing materials in connection therewith, and shall in all other respects perform the agreement created by the acceptance of said bid. then this obligation shall be void, otherwise the same shall remain in force and effect; it being expressly understood and agreed that the liability of the Surety for any and all claims hereunder shall, in no event, exceed the penal amount of this obligation as herein stated. By virtue of statutory authority, the full amount of this bid bond shall be forfeited to the Owner in liquidation of damages sustained in the event that the Principal fails to execute the Contract and provide the bond as provided in the Specifications or by law. The Surety, for value received, hereby stipulates and agrees that the obligations of said Surety and its bond shall be in no way impaired or affected by any extension of the time within which the Owner may accept such bid or execute such Contract; and said Surety does hereby waive notice of any such extension. IN WITNESS WHEREOF, the Principal and the Surety, have hereunto set their hands and seals, and such of them as are corporations, have caused their corporate seals to be hereto affixed and these presents to be signed by their proper officers this 27thday of March , A.D., 20 23. Gee A Principe By (Title) Surety tems, Inc cifitfri( cE0 & Casualty Company act) Anne Crowner (Seal) FAA AIP 3-19-0094-056 AECOM Project #60695145 P-8 Waterloo Regional Airport Pavement Rehab. (Rwy 12/30, Txy A East, Txy E) fl u INSURANCE UNITED FIRE & CASUALTY COMPANY, CEDAR RAPIDS, IA UNITED FIRE & INDEMNITY COMPANY, WEBSTER, TX FINANCIAL PACIFIC INSURANCE COMPANY, LOS ANGELES, CA CERTIFIED COPY OF POWER OF ATTORNEY (original on file at Borne Office of Company — See Certification) Inquiries: Surety Department 118 Second Ave SE Cedar Rapids, IA 52401 KNOW ALL PERSONS BY THESE PRESENTS, That United Fire & Casualty Company, a corporation duly organized and existing under the laws of the State of Iowa; United Fire & Indemnity Company, a corporation duly organized and existing under the laws of the State of Texas; and Financial Pacific Insurance Company, a corporation duly organized and existing under the laws of the State of California (herein collectively called the Companies), and having their corporate headquarters in Cedar Rapids, State of Iowa, does make, constitute and appoint CRAIG E. HANSEN, JAY D. FREIERMUTH, BRIAN M. DEIMERLY, CINDY BENNETT, ANNE CROWNER, TIM MCCULLOH, STACY VENN, DIONE R. YOUNG, MICHELLE GRUIS, KATHLEEN BREWER, SETH D. ROOKER, SARA HUSTON, SHELBY GREINER, GINGER HOKE, JOHN CORD, JOE TIERNAN, JENNIFER MARINO, BEN WILLIAMS, KATE ZANDERS, EACH INDIVIDUALLY their true and lawful Attorney(s)-in-Fact with power and authority hereby conferred to sign, seal and execute in its behalf all lawful bonds, undertakings and other obligatory instruments of similar nature provided that no single obligation shall exceed $100, 000, 000. 00 and to bind the Companies thereby as fully and to the same extent as if such instrtunents were signed by the duly authorized officers of the Companies and all of the acts of said Attorney, pursuant to the authority hereby given and hereby ratified and confirmed. The Authority hereby granted is continuous and shall remain in full force and effect until revoked by United Fire & Casualty Company, United Fire & Indemnity Company, and Financial Pacific Insuiance Company. This Power of Attorney is made and executed pursuant to and by authority of the following bylaw duly adopted by the Boards of Directors of United Fire & Casualty Company, United Fire & Indemnity Company, and Financial Pacific Insurance Company. "Article VI — Surety Bonds and Undertakings" Section 2, Appointment of Attorney -in -Fact. "The President or any Vice President, or any other officer of the Companies may, from time to time, appoint by written certificates attorneys -in -fact to act in behalf of the Companies in the execution of policies of insurance, bonds, undertakings and other obligatory instruments of like nature. The signature of any officer authorized hereby, and the Corporate seal, may be affixed by facsimile to any power of attorney or special power of attorney or certification of either authorized hereby; such signature and seal, when so used, being adopted by the Companies as the original signature of such officer and the original seal of the Companies, to be valid and binding upon the Companies with the same force and effect as though manually affixed. Such attorneys -in -fact, subject to the limitations set of forth in their respective certificates of authority shall have frill power to bind the Companies by their signature and execution of any such instruments and to attach the seal the Companies thereto. The President or any Vice President, the Board of Directors or any other officer of the Companies may at any time revoke all power and authority previously given to any attomey-in-fact. IN WITNESS WHEREOF, the COMPANIES have each caused these presents to be signed by its vice president and its corporate seal to be hereto affixed this t` SQ .0011111141, n%% 'sr ijLY2Z C,p_ fr:'''/� �4IFOA? �: ''�%Iflll 11i411 ``` '�'�((llIM 111411%'»"```` `o11t `y I S,, , 7 •G04:POq'% C+� 18th day of March, 2022 UNITED FIRE & CASUALTY COMPANY UNITED FIRE & INDEMNITY COMPANY FINANCIAL PACIFIC INSURANCE COMPANY By: State of Iowa, County of Linn, ss: " Vice President On 18th day of March, 2022, before me personally came Dennis J. Richmann to me known, who being by me duly swore, did depose and say; that he resides in Cedar Rapids, State of Iowa; that he is a Vice President of United Fire & Casualty Company, a Vice President of United Fire & Indemnity Company, and a Vice President of Financial Pacific Insurance Company the corporations described m and which executed the above instrument; that he knows the seal of said corporations; 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 corporations and that he signed his name thereto pursuant to like authority, and acknowledges same to be the act and deed of said corporations. Judith A. Jones Iowa Notarial Seal Commission number 173041 My Commission Expires 4/23/2024 Notary Public My commission expires: 4/23/2024 I, Mary A. Bertsch, Assistant Secretary of United Fire & Casualty Company and Assistant Secretary of United Fire & Indemnity Company, and Assistant Secretary of Financial Pacific Insurance Company, do hereby certify that I have compared the foregoing copy of the Power of Attorney and affidavit, and the copy of the Section of the bylaws and resolutions of said Corporations as set forth in said Power of Attorney, with the ORIGINALS ON FILE IN THE HOME OFFICE OF SAID CORPORATIONS, and that the same are correct transcripts thereof, and of the whole of the said originals, and that the said Power of Attorney has not been revoked and is now in full force and effect. In testimony whereof I have hereunto subscribed my name and affixed the corporate seal of the said Corporations this 27th day of March 2023. /ii E 111 Ill\ By: (-1 7 /t,,�it-1 A Assistant Secretary, UF&C & OF&I & FPIC BP0A0049 1217 NON -COLLUSION AFFIDAVIT OF PRIME BIDDER State of ova_ )ss County of L/Ni ) c?..n9 sk , being first duly sworn, deposes and says that: (1) He is (Owner, P artner, Officer epresentative . r Agent) of ,4,5/0ha // �jstC�-,.S e - , 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 or indirectly, sought by agreement or collusion or communication or conference with any other Bidder, firm or person to fix the price or prices in the attached bid or of any other Bidder, or, to fix any overhead, profit or cost element of the bid price or the bid price of any other Bidder, or to secure through any collusion, conspiracy, connivance, or unlawful agreement any advantage against the City of Waterloo, Iowa, or any person interested in the proposed Contract; and (5) The price or prices quoted in the attached bid are fair and proper and are not tainted by any collusion, conspiracy, connivance or unlawful agreement on the part of the Bidder or any of its agents, representatives, owners, employees, or parties in interest, including this affiant. Subscribed and sworn to before me this SO day of 62� , 20/ My Commission Expires raw- "taar DENISE FITZPATRICK Commission Number 764410 My Coi mis on Expires 0?/a5. (S Title FAA AIP 3-19-0094-056 P-9 Waterloo Regional Airport AECOM Project 1160695145 Pavement Rehab. (Rwy 12/30, Txy A East, Txy E) NON -COLLUSION AFFIDAVIT OF SUBCONTRACTOR (To Be Submitted After Bid But Prim to Award) State of ) )ss County of ) , being first duly sworn, deposes and says that: (1) He is (Owner, Partner, Officer, Representative, or Agent) of , 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 or indit ectly, sought by agreement or collusion or communication or conference with any other Bidder, firm or person to fix the price or prices in the attached bid or of any other Bidder, or, to fix any overhead, profit or cost element of the bid price or the bid price of any other Bidder, or to secure through any collusion, conspiracy, connivance, or unlawful agreement any advantage against the City of Waterloo, Iowa, or any person interested in the proposed Contract; and (5) The price or prices quoted in the attached bid are fair and proper and are not tainted by any collusion, conspiracy, connivance or unlawful agreement on the part of the Bidder or any of its agents, representatives, owners, employees, or parties in interest, including this affiant. (Signed) Title Subscribed and sworn to before me this day of , 20. Title My Commission Expires , 20. FAA AIP 3-19-0094-056 P-10 Waterloo Regional Airport AECOM Project 1160695145 Pavement Rehab. (Rwy 12/30, Txy A East, Txy E) 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 Pavement Rehabilitation (Runway 12/30, Taxiway A East, Taxiway E) FAA AIP Project No. 3-19-0094-056 COMPANY EXECUTIVE OFFICER a _ktscit-/.-r IRMATIVE ACTION OFFICER ADDRESS OF THE AFFIRMATIVE ACTION OFFICER 2Po roll S v PHONE NUMBER 7" i J J t- 8 g FAA AIP 3-19-0094-056 P-11 Waterloo Regional Airport AECOM Project 1160695145 Pavement Rehab. (Rwy 12/30, Txy A East, Txy E) BIDDER'S INFORMATION SHEET A. BIDDER'S CAPACITY: (Check One) 1. Individual ❑ 2. Co -Partnership 0 3. Corporation B. (IF ITEM 2 IS CHECKED, COMPLETE THE FOLLOWING) State of Names and Addresses of Partners 1. 2. 3. 4. 5. C. (IF ITEM 3 IS CHECKED, COMPLETE THE FOLLOWING) State of Incorporation "'Gap _ Names and Addresses of Officers: President 471 A 4tet//' Secretary S /W& Zau>g/'( Treasurer Al a 4,,j.#' FAA AIP 3-19-0094-056 P-12 Waterloo Regional Airport AECOM Project 1160695145 Pavement Rehab. (Rwy 12/30, Txy A East, Txy E) Name of Bidder Business Address SYNOPSIS OF EXPERIENCE RECORD (This synopsis must accompany Proposal Form.) 97/6 4143/ 59.0 a%) /P,o540/ chi savoy Individual ( ) Partnership ( ) Corporation (Check One.) Construction successfully completed within past five years similar in size, scope, and difficulty of construction to the work bid upon. Name of Name of Owner Project ea 1)4 4/ 2 _doe Lou, 3 lidhe-Aary Ithvybdirri 4 keet/ patch/et_ 5 // /LSd JM ir �A v/eQ4/ T � Number of Contract Days Allowed for Above Projects 1 s'190y� 2 ,'c" Day S 3 4 3 0 5 /50 Li , 5 (By) (TITLE) -77asel Loi Projectcaton of Al P7.0 Amount of Contract 1301S4o-co yde G4 3 M-60 aktteae, 4t"JdC77°?e0 &earl- /72en e° 2;lec4 .01 19g . co Actual Number of Days to Complete above Project DaNy._5 / 9 i�.y Date 2 -629-,aCblei FAA AIP 3-19-0094-056 P-13 AECOM Project #60695145 Waterloo Regional Airport Pavement Rehab. (Rwy 12/30, Txy A East, Txy E) UTILIZATION STATEMENT Disadvantage Business Enterprise The undersigned bidder/offeror has satisfied the requirements of the bid specification in the following manner. (Please ,nark the appropriate box) ❑ The bidder/offeror is committed to a minimum of 8.4% DBE utilization on this contract. The bidder/offeror, while unable to meet the DBE goal of 0 %, hereby commits to a minimum of b % DBE utilization on this contract and also submits documentation, as an attachment demonstrating good faith efforts (GIVE). 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. 1,.lc ,4j(44 1)" (yq fr rn / InL Bidder's/Offeror's Firm Name ignaturc 3/2Dt/�3 Date DBE UTILIZATION SUMMARY Contract Amount Percentage DBE Amount Contract 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 Icss than the established DBE goal, Bidder must provide written documentation of the good faith efforts as required by 49 CFR Part 26. 4 we h Q v e I) a E b ; ds , Lein rev if lv w( ow arr c ,iel FAM tw sec - 4 kcy b � Sclr e,/ FAA AIP 3-19-0094-056 P-14 Waterloo Regional Airport AECOM Project i160695145 Pavement Rehab. (Rwy 12/30, Txy A East, Txy E) Waterloo, Reginal Airport Waterloo, IA DBE Good Faith Effort 3-27-23 thru 3-30-23 Company YTT Design solutions, Ilc Bonnies Barricades Jackson Contracting Midwest Contrators Paco Construction Pro Paving Rockett Trucking Advanced Traffic Phone 319-429-7625 515-306-8877 515-306-4487 319-266-2528 515-240-0625 319-470-6077 563-933-2035 319-396-5269 Notes 3/27 Called for survey, they are not interested and will not bid 3/27 They are bidding and will email bid 3/29,Called, I had not received, they are emailing still 3/30. Called, ran out of time to put bid together 3/27 Said they are intersted, we emialed drawings 3/29 had not seen anything, called back, no answer 3/30 They emialed bid. We did not use. It is an add of $31,414 to use them. 3/27 not bidding 3/27 left vm 3/29 no answer 3/27 no anwer or option to leave vm 3/27 said he would look but very doubtful emailed drawings 3/27 will look at traffic and paint removal 3/29 only sendign trffic, have not seen yet 3/29 Emailed two options: Did not use either To rent and for Gee to install it is an add of $29,000 For Advance to set up and take down would be an add of $44,800 LETTER OF INTENT Disadvantage Business Enterprise (This page shall be submitted for each DBE firm) Bidder/Offer Name: DBE Firm: DBE Contact Person: Address: frbt City: State: Zip: 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 Work to be item(s) performed by Description of Work Item Quantity Total DBE 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: OA 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: (Title) (Signature) Note: In the event the bidder/offci or does not receive award of the prime contract, any and all representations in this Letter of Intent and Affi►mation shall be null and void. FAA AIP 3-19-0094-056 P-15 Waterloo Regional Airport AECOIvi Project ti606951/15 Pavement Rehab. (Rwy 12/30, 'I'xy A East, Txy l;) BUY AMERICAN CERTIFICATION FORM FOR MANUFACTURED PRODUCTS (Non -building projects such as airfield/roadway construction, equipment acquisition, etc.) As a matter of bid responsiveness, the Bidder or Offerer must complete, sign, date, and submit this certification statement with their proposal. The Bidder or Offerer must indicate how they intend to comply with 49 USC § 50101 by selecting one on the following certification statements. These statements are mutually exclusive. Bidder must select one or the other (not both) by inserting a checkmark (✓) or the letter "X". iThe Bidder or Offerer 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 Offerer 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 product. 3. To furnish US domestic product for any waiver request that the FAA rejects. 4. To refrain from seeking a waiver request after establishment of the contract, unless extenuating circumstances emerge that the FAA determines justified. ❑ The Bidder or Offerer hereby certifies it cannot comply with the 100% Buy American Preferences of 49 USC§ 50101(a) but may qualify for either a Type 3 or Type 4 waiver under 49 USC§ 50101(b). By selecting this certification statement, the apparent Bidder or Offerer with the apparent low bid agrees: 1. 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 result 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 refrain from seeking a waiver request after establishment of the contract, unless extenuating circumstances emerge that the FAA determines justified. Required Documentation Type 3 Waiver - The cost of the item components and subcomponents produced in the United States is more that 60(3/0 of the cost of all components and subcomponents of the "item". The required documentation for a type 3 waiver is: a) Listing of all product components and subcomponents 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; FAA AIP 3-19-0094-056 P-16 Waterloo Regional Airport AECOM Project 1160695145 Pavement Rehab. (Rwy 12/30, Txy A East, Txy E) products of unknown origin must be considered as non -domestic products in their entirety). Cost of non -domestic components and subcomponents, excluding labor costs associated with final assembly at place of manufacture. b) Percentage of non -domestic component and subcomponent cost as compared to total "item" component and subcomponent costs, excluding labor costs associated with final assembly at place of manufacture. Type 4 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 4 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. 3--o7y�03 Date gee- 1 AA / Signa Company Name Title _1_,.At Ite-n/-iric--- FAA AIP 3-19-0094-056 P-17 Waterloo Regional Airport AECOM Project 1160695145 Pavement Rehab. (Rwy 12/30, Txy A East, Txy E) Buy America Waiver Request Title 49 U.S.0 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_provisionshnedia/buy_american_waivcr.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 in 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 are 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_provisionshnedia/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 may request a waiver if application of Buy America preferences results in a 25% cost increase in the overall project. This waiver is rately applicable. Consult the Owner before making this request. FAA AIP 3-19-0094-056 AECOM Project //60695145 P-18 Waterloo Regional Airport Pavement Rehab. (Rwy 12/30, Txy A East, Txy E) ..1 w 0 LI- 0 1 NOT SUBJECT TO DISCLOSURE UNDER EXEMPTION # 4 OF THE FREEDOM OF INFORMATION ACT Buy American Product Content Percentage Worksheet r .51 S'l/$kv2/cc e &ec 4,512hat%.'oT LL r Telephone: 3'f� FAA Eligible Item: Address of Final Assembly Location: E co z �C E a) a) rn N rd.) CD O S 8 N •c 0 CA C z Lri CD a. rn U u. t) cu 0 ad tri axi C c O Q E k3 N .N N 0) J cti 0 0 J 0 O a C w O } J m J Other 1,Other j Price/Unit Cost/Each of Measure : US Origin CostfEach b O p US Origin Price/Unit of Measure \ dv e Price/Unit of Measure 4 ,_s ^'1 ainseew 3o uut1 Cs vi ----A 'S Quantity Per Unit n,\ cz J Level Part Item Description (0, 1, 2) Number iv , 1 � c 054#,.c4 hn o- FAA Form 5100-136 (6/20) SUPERSEDES PREVIOUS EDITION 0 O O 0 0 t3 FAA AIP 3-19-0094-056 AECOM Project #60695145 0 z 0 2 0 L z lL 0 0 0 w w f� tL w 2 I u_ _1 0 air I- 4t Z z w0 Dr - •a aX Uw w 0 z w D 0 sal to A 0 N F-� 0 w co H 0 z Other PricerUnit Other CosthEach of Measure US Origin Cost/Each US Origin Price/Unit of Measure Level Part 1 Quantity Unit of Price/Unit (0, 1, 2) Number Item Description Per Unit Measure i of Measure • z 0 p 0 w 0) 0 0 w 0 w 0) cc w 0 co chi r- 0 O 0 Qw w 0 FAA AIP 3-19-0094-056 AECOM Project #60695145 - CONFIDENTIAL NFORMATION ACT NOT SUBJECT TO DISCLOSURE UNDER EXEMPTION # 4 OF THE FREEDOM OF Date: 09I1 6I2020 Total material cost $ 1,523,900.00 0 a U.S. Content Non-U.S. Content 95.00 % Airport Sponsor Sample Airport Authority Airport Worksite: Sample Municipal Airport Worksite LOCID: SMP Project Description: Reconstruct Runway 1 0 r =• Q .wi z icj 4- « o Q to ir- 0 0 0 O EA I 00'000409$ $8,000.0o 0 Q tiA 0 00 ( } O EH O. ci O N to 0 O to 'CN 13.� oUO o 0 U 06 ( O O O r 69 O O o to (f) 00'000'oszn O O .— ire O O 0 o N r ) 00O b3p V) O O 0�o Ict N (f} Pavement items Pavement Item Component Pavement Item Subcomponent Painting and Marking Component J Painting and Marking Component Electrical and Lighting Electrical and Lighting Subcomponent Electrical and Lighting Subcomponent SUBTOTAL r N r r r N N N (0 V' U) (0 N. W 0) N ID 4A cn 0 a 2 J O o CI CI 0 ui In U.S. Content: Non-U.S. Content: 0 a) d FAA Form 5100-143 (8120) W >, 74 4-. aW to o O Y. O i2, O `4 en 3 (24 TIE cs U U U > c3 a FAA AIP 3-19-0094-056 AECOM Project #60695145 M 0 0 M (D te 0 O - CONFIDENTIAL - NOT SUBJECT TO DISCLOSURE UNDER EXEMPTION # 4 OF THE FREEDOM OF INFORMATION ACT 4•4 W a) i whe a) d a eal C3 CO .O Qu. Y. Qi 0 Airport Sponsor. Total material cost: Airport Worksite: 0 U.S. Content Worksite LOCO: Non-U.S. Content ward 2 0 4-4 .J 1- 3 L O �(0 4-1 d t) 2 CI CI 4-1 Q) 0 .o•0 a d -1 V) D N 0 to • Z c, ,ea .. o co .-5 0 O 0 c led n 1_6 o H U to. S N II 1-6 ( SSS J 1 ro N i ca O) ti O J e- c = J CV M 'it in CD ti co Q) o • a s a 0 d FAA AIP 3-19-0094-056 N N C 4; 0 .-tz Z p4 0 cr. N i. f!, 0 0 SUBTOTAL I l G N O .2) ro v O c, o • -- 0 c in m a M S Fs` — N al ea o O al'- L G _.I N c1) V. I 15 CD N 18 a) 20 r t- r A"' IT'- r U.S. Content: 0 Non-U.S. Content: ai m 0 c Title: 4 c cotr j FAA Form 5100-143 (8/20) oft FAA AIP 3-19-0094-056 AECOM Project #60695145 Buy America Conformance Listing Title 49 U.S.0 Section 50101 (b) For Airfield Development Projects funded under the Airport Improvement Program • Preparation of a Component Cost Calculation Table is not necessary for equipment listed on the FAA national listing: http://www.Jira.gov/airports/aip/procurement/federal conlracY_provisions/media/buts angelica!) waiver.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. 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://vww.faa.gov/airports/aip/procurement/federal contract provisions/media/buy arnerican waiver.xls I hereby certify the above information is accurate and complete. /s;tit /- Sy Sdr ntS Bidder's Firth Nam e Date Signature FAA AIP 3-19-0094-056 P-24 Waterloo Regional Airport AECOM Project 1/60695145 Pavement Rehab (Rwy 12/30, Txy A East, Txy E)