HomeMy WebLinkAboutMidwest Concrete, Inc.9835 Midwest Ln.
Peosta, IA 52068-7001
Ph: (563) 845-0947
Fax: (563) 583-1007
officeQmidwest-concrete.net
Bid Documents
Sealed Bid for Complete Construction
Bid Bond
FY 2024 Sidewalk Infill, Sidewalk Ramp & Trail Repair Program — Zone 3
Contract No. 1079
City of Waterloo
June 22, 2023 @ 1:00 p.m.
9835 Midwest Ln.
Peosta, IA 52068.7001
Ph: (583) 845-0947
Fax: (563) 583-1007
ot0ceem idwest-concrete.net
Bid Documents
Sealed Bid for Complete Construction
Sealed Proposal
FY 2024 Sidewalk InfiII, Sidewalk Ramp & Trail Repair Program — Zone 3
Contract No. 1079
City of Waterloo
June 22, 2023 @ 1:00 p.m.
BID BOND
KNOW ALL MEN BY THESE PRESENTS, that we, Midwest Concrete Inc
as Principal, and West Bend Mutual Insurance Company , as Surety, are held and firmly
bound unto the CITY OF WATERLOO , Iowa, hereinafter called "OWNER." In the penal sum
Five Percent of 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 the 22nd day of
June , 20 23 ,for FY 2024 Sidewalk Infill, Sidewalk Ramp & Trail Repair Program - Zone 3,
Contract No. 1079
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 22nd day of June , A.D. 20 23 .
Witness
Midwest Concrete Inc (Seal)
Principal
By
Ryan
West Bend Mutual Insurance Company (Seal)
Surety
By Kim Hess
Attorney -in -fact
(Title) Owner
BID BOND
Page 1 of 1
A MUTUAL INSURANCE COMPANY"
THE SILVER LINING '
Bond No. 2548278
POWER OF ATTORNEY
Know all men by these Presents, That West Bend Mutual Insurance Company, a corporation having its principal office in the City of West Bend,
Wisconsin does make, constitute and appoint:
Kim Hess
lawful Attorneys) -in -fact, to make, execute, seal and deliver for and on its behalf as surety and as its act and deed any and all bonds, undertakings
and contracts of suretyship, provided that no bond or undertaking or contract of suretyship executed under this authority shall exceed in amount the
sum of:
Twenty Million Dollars ($20,000,000)
This Power of Attorney is granted and is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board
of Directors of West Bend Mutual Insurance Company at a meeting duly called and held on the 21sl day of December, 1999,
Appointment of Attorney -in -Fact. The president or any vice president, or any other officer of West Bend Mutual insurance Company may appoint
by written certificate Attorneys-br-Fact to act on behalf of the company in the execution of and attesting of bonds and undertakings and other
written obligatory instruments of like nature. The signature of any officer authorized hereby and the corporate seal may be affixed by facsirnile
to any such power of attorney or to any certificate relating therefore and any such power of attorney or certificate bearing such facsimile
signatures or facsimile seal shall be valid and binding upon the company, and any such power so executed and certified by facsimile signatures
and facsimile seal shall be valid and binding upon the company in the future with respect to any bond or undertaking or other writing obligatory
in nature to which it is attached. Any such appointment may be revoked, for cause, or without cause, by any said officer at any time.
In witness whereof, the West Bend Mutual Insurance Company has caused these presents to be signed by its president undersigned and its
corporate seal to be hereto duly attested by its secretary this 17th day of August, 2021,
Attest
tAvtis±rn x e. 94µfThril
Christopher C. It gatt
Secretary
State of Wisconsin
County of Washington
On the 17th day of August, 2021, before me personally came Kevin A. Steiner, to me known being by duly sworn, did depose and say that he resides
in the County of Washington, State of Wisconsin; that he is the President of West Bend Mutual Insurance Company, the corporation described in and
which executed the above instrument; that he knows the seal of the said corporation; that the seal affixed to said instrument is such corporate seal;
that is was so affixed by order of the board of directors of said corporation and that he signed his name thereto by like order,
ifirpRPoMArs
r ,:
di SEAL
IN a
Kevin A. Steiner
Chief Executive Officer/President
Matt lew E. Carlton
Senior Corporate Attorney
Notary Public, Washington Co., WI
My Commission is Permanent
The undersigned, duly elected to the office stated below, now the incumbent in West Bend Mutual Insurance Company, a Wisconsin corporation
authorized to make this certificate, Do Hereby Certify that the foregoing attached Power of Attorney remains in full force effect and has not been
revoked and that the Resolution of the Board of Directors, set forth in the Power of Attorney is now in force.
Signed and sealed at West Bend, Wisconsin this 22nd day of
June
2023
AvVi-I/i
t SEALI / Heather Dunn
. • Vice President— Chief Financial Officer
i orixonArF,,
Notice: Any questions concerning this Power of Attorney may be directed to the Bond Manager at West Bend Mutual Insurance Company,
1900 South 181h Avenue I West Bend, WI 53095 1 Phone: (608).410-3410 I Fax: (877) 674-2663 I www.thesilverlining.com
FORM OF BID OR PROPOSAL
FY 2024 SIDEWALK INFILL, SIDEWALK RAMP & TRAIL
REPAIR PROGRAM — ZONE 3
CONTRACT NO. 1079
CITY OF WATERLOO, IOWA
Honorable Mayor and City Council
Waterloo, Iowa
Gentlemen:
1. The undersigned, being a Corporation existing under the laws of the State of
IOWA a Partnership consisting of the following partners:
having
familianzed (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 FY 2024 SIDEWALK INFILL, SIDEWALK RAMP
& TRAIL REPAIR PROGRAM — ZONE 3, Contract No. 1079 all in accordance with the
above -listed documents and for the unit prices for work in place for the following items and
quantities:
FY 2024 SIDEWALK
REPAIR
CONTRACT
INFILL,
PROGRAM
SIDEWALK
NO.
— ZONE
1079
RAMP &
3
TRAIL
ITEM
BID
SPECIFICATION
SUPPLEMENTAL
SP
SUDAS
*SEE
= SPCL
PROV
'
DESCRIPTION
UNIT
EST
QTY
TOTAL
PRICE
BID
UNIT
PRICE
BID
DIVISION 1-EDISON ADDITION SIDEWALK INFILL
1
7030-108-E-0
SIDEWALK,
PCC,4"
SF
3,321.5
$ 6.39
$ 21,224.39
2
2010-108-E-0
EXCAVATION,
CLASS
10
SF
3,321.5
$ 6.27
$ 20,825.81
3
9010-108-C-0
HYDROSEEDING
SF
1,993.0
$ 1.94
$ 3866.42
4
8030
108-A-0
TRAFFIC
CONTROL
LS
1.0
$ 7960.00
$ 7960.00
5
SP
#1
EROSION
& SEDIMENT
CONTROL
LS
1.0
$ 790.00
$ 790.00
TOTAL
BID
-DIVISION
1 $
'' 54,666.61
FORM OF BID
CONTRACT NO. 1079
Page 1 of 5
ITEM
BID
SUDAS
SPECIFICATION
SUPPLEMENTAL
SP = SPCL
SEE
PROV
`.'DESCRIPTION
UNIT
EST
QTY
"
UNIT
PRICE
BID
TOTAL
PRICE
BID
DIVISION 2 - RAMP
REPAIRS
1
7030-108-A-0
REMOVE
SIDEWALK
SF
3,170.0
$
2.71
$
8590.7
2
7030-108-E-0
SIDEWALK,
PCC, 4"
SF
1,870.9
$
6.43
$
12,029.89
3
7030-108-E-0
SIDEWALK,
PCC, 6"
SF
1,179.2
$
10.25
$
12,086.80
4
7030-108-G-0
DETECTABLE
SURFACE
WARNING
SF
216.0
$
51.12
$
11,041.92
5
7030-108-B-0
SAW CUT,
1/2" CURB OPENING
LF
157.8
$
48.45
$
7645.41
6
7040-108-1-0
REMOVE
CURB
& GUTTER
LF
57.3
$ 16.98
$ 972.95
7
7010-108-E-0
CURB
& GUTTER,
24", 8.5"
LF
7.8
$ 30.27
$ 236.11
8
7010-108-E-0
CURB
& GUTTER, 24", 10.5"
LF
41.1
$ 27.74
$ 1140.11
9
7010-108-E-0
CURB
& GUTTER,
24",
12.5"
LF
16.2
$ 30.90
$ 500.59
10
7040-108-H-0
REMOVE
PAVEMENT
SF
110.2
$ 8.10
$ 892.62
11
7040-108-A-0
PAVEMENT,
PCC, 8.5"
SF
43.4
$ 27.76
$ 1204.78
12
SP #2
PATCH,
HMA,
2"
SF
66.8
$ 15.45
$ 1032.06
13
2010-108-E-0
EXCAVATION,
CLASS
10
SF
2,261.2
$ 6.53
$ 14,765.64
14
9010-108-C-0
HYDROSEEDING
SF
2,295.0
$ 1.95
$ 4475.25
15
SP
#3
WATER VALVE
ADJUST
EA
4.0
$ 137.72
$ 550.88
16
SP #1
EROSION
& SEDIMENT
CONTROL
LS
1.0
$ 790.00
$ 790.00
17
8030-108-A-0
TRAFFIC
CONTROL
LS
1.0
$ 7960.00
$ 7960.00
TOTAL
BID
- DIV SION 2 $
85,915.70
DIVISION 3 - COUNTY RAMP REPAIRS
1
7030-108-A-0
REMOVE
SIDEWALK
SF
265.5
$ 2.81
$ 746.06
2
7030-108-E-0
SIDEWALK,
PCC, 4"
SF
115.6
$ 7.50
$ 867.00
3
7030-108-E-0
SIDEWALK,
PCC, 6"
SF
149.8
$ 7.98
$ 1195.40
4
7030-108-G-0
DETECTABLE
SURFACE
WARNING
SF
32.0
$ 52.55
$ 1681.60
5
7030-108-B-0
SAW CUT,
1/2" CURB
OPENING
LF
13.1
$ 48.86
$ 640.07
6
7040-108-H-0
REMOVE
PAVEMENT
SF
44.4
$ 5.41
$ 240.20
7
7040-108-A-0
PAVEMENT,
PCC 9.5"
SF
44.4
16.63
$
738.37
$
8
2010-108-E-0
EXCAVATION,
CLASS
10
SF
195.7
$ 6.52
$ 1275.96
9
9010-108-C-0
HYDROSEEDING
SF
195.7
$ 1.97
$ 383.53
10
SP
#1
EROSION
& SEDIMENT
CONTROL
LS
1.0
$ 790.00
$ 790.00
11
8030-108-A-0
TRAFFIC
CONTROL
LS
1.0
$ 7960.00
$ 7960.00
TOTAL
BID
-DIVISION 3 $
16,520.19
FORM OF BID
CONTRACT NO. 1079
Page 2 of 5
ITEM
BID
SPECIFICATION
SUPPLEMENTAL
SP
'. SODAS
*SEE
= SPCL
PROV
DESCRIPTION
UNIT
EST
QTY
UNIT
PRICE
BID
TOTAL
PRICE
BID
DIVISION
4 -TRAIL
REPAIRS
1
7030-108-A-0
REMOVE
SIDEWALK
SF
2,342.8
$ 2.98
$ 6981.54
2
7030-108-E-0
TRAIL,
PCC 6"
SF
2,342.8
$ 10.06
$ 23,568.57
3
8030-108-A-0
TRAFFIC
CONTROL
LS
1.0
$ 7960.00
$ 7960.00
TOTAL BID
-
DIVISION
4
$
38,510.11
DIVISION 1 - ALTERNATE -
AVENUE
INFILL
FLETCHER
SIDEWALK
1
7030-108-A-0
REMOVESIDEWALK/DRIVEWAY
SF
513.3
$ 1.97
$ 1011,20
2
7030-108-E-0
SIDEWALK,
PCC, 4"
SF
939.0
$ 8.54
$ 8019.06
3
7030-108-E-0
SIDEWALK,
PCC, 6"
SF
199.8
$ 6.00
$ 1198.80
4
7030-108-E-0
DRIVEWAY,PCC,5"
SF
183.4
$ 6.28
$
1151.75
5
7030-108-G-0
DETECTABLE
SURFACE
WARNING
SF
38.0
$ 50.52
$ 1919.76
6
7030-108-6-0
SAW CUT, 1/2' CURB OPENING
LF
29.6
$ 48.34
$ 1430.86
7
7040-108-H-0
REMOVE
PAVEMENT
SF
16.0
$ 27.51
$
440.16
8
SP
#4
FULL
DEPTH
PATCH,
PCC , 9"
SF
16.0
$ 200.00
$ 3200.00
9
2010-108-E-0
EXCAVATION,
CLASS 10
SF
1384.9
$ 6.50
$ 9001.85
10
9010-108-C-0
HYDROSEEDING
SF
1200.3
$ 1.99
$ 2388.60
11
SP
#5
SUBDRAIN
EXTENSION
LS
1.0
$ 780.60
$ 780.60
12
8030-108-A-0
TRAFFIC
CONTROL
LS
1.0
$
4120.00
$
4120.00
13
SP
#1
EROSION
& SEDIMENT
CONTROL
LS
1.0
$ 790.00
$ 790.00
TOTAL
BID
- DIVISION
1 - ALTERNATE
$
35,452.64
TOTAL
DIVISIONS
1, 2,' 3 & 4
$ 195,912.64
-,
BID
TOTAL
BID
DIVISION
1 - ALTERNATE
$ 231,065.26
It is understood that the quantities set forth are approximate only and subject to variation
and that the unit bid price for the work done shall govern in the actual payment to
Contractor.
3. In submitting this bid, the bidder understands that the right is reserved by the City of
Waterloo, Iowa to reject any or all bids. If written notice of the acceptance of this bid is
mailed, telegraphed, or delivered to the undersigned within thirty (30) days after the
opening thereof, or at any time thereafter before this bid is withdrawn, the undersigned
agrees to execute and deliver an agreement in the prescribed form and furnish the
required bond and certificate of the insurance within ten (10) days after the agreement is
presented to him for signature, and start work within ten (10) days after "Notice to
Proceed" is issued.
FORM OF BID
CONTRACT NO. 1079 Page 3 of 5
4. Security in the sum of five percent of amount bid Dollars ($
5 % ) in the form of a bid bond
accordance with the INSTRUCTIONS TO BIDDERS.
5. Attached hereto is a Non -Collusion Affidavit of Prime Contractor.
is submitted herewith in
6. Attached hereto is a Resident Bidder Certification ( X ), or Non -Resident Bidder
Certification ( ). (Mark one.)
7. The bidder is prepared to submit a financial and experience statement upon request.
8. The Prime Contractor and Subcontractor(s), which have performed an aggregate of
$10,000.00 in work for the City in the current calendar year, are prepared to submit an
AAP or Update and an EOC, within ten (10) days of notification that the bid submitted is
lowest and acceptable.
The bidder has received the following Addendum or Addenda:
Addendum No. Date
10. The bidder shall list the MBENVBE subcontractor(s), amount of subcontracts and bid items
on the City of Waterloo Minority and/or Women Business Pre -bid Contact Information
Form submitted with this Form of Bid or Proposal. The apparent low Bidder shall submit a
list of all other Subcontractor(s) to be used on this Project to the City of Waterloo by 5:00
p.m. the business day following the day Bids on this Project are due along with the Non -
Collusion Affidavits of All Subcontractor(s).
The Contractor shall submit information on subcontractors on "SUBCONTRACTOR
REQUEST AND APPROVAL" Form to be provided by City prior to approval of contract.
The subcontractors listed on this proposal and/or submitted to the Contract Compliance
Officer cannot be changed except for the following reasons:
1) The City of Waterloo does not approve the subcontractors.
2) The subcontractors submit in writing that they cannot fulfill their subcontracts.
11. The bidder has filled in all blanks on this proposal. Those blanks not applicable are
marked "none" or "NA".
12. The bidder has attached all applicable forms.
13. The Owner reserves the right to select alternates, delete line items, and/or to reduce
quantities prior to the award of a contract due to budgetary limitations.
FORM OF BID
CONTRACT NO. 1079 Page 4 of 5
Midwest Concrete Inc.
6-22-23
BY:
(Name of Bidder) (Date)
Title President
Official Address: (Including Zip Code):
9835 Midwest Lane
Peosta, IA 52068
I.R.S. No. 35-2472747
FORM OF BID
CONTRACT NO. 1079 Page 5 of 5
State of
NON -COLLUSION AFFIDAVIT OF PRIME BIDDER
owL
County of t / 1/�! V U F� )
OWN Qb(Ak15
)ss
being first duly sworn, deposes and says that:
1. He is Owner Partner, Officer, Representative, or Agent) of i\Ac AV(ASi" 161/10,1 l4 kid
, 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
My commission expires CY ol W -S
(Signed)
Title
ark day of WAL' 2023
((),244.(--do
4 AMANDA M. WESSELS
ir Notarial Seal State of lowa
• ,
Commission Numb@ a t 1S4
sown My CMmissIon Expires
EQUAL OPPORTUNITY CLAUSE
(As provided in Executive Order No 11246)
All contractors, subcontractors, vendors and suppliers of goods and services doing business with the City and value of said
business equals or exceeds ten thousand dollars ($10,000.00) annually agree as follows:
1. The contractors, subcontractor, vendor and supplier of goods and services will not
discriminate against any employee or applicant for employment because of race, color, creed, sex, national origin,
economic status, age, mental or physical handicap, political opinions or affiliations. The contractor, subcontractor, vendor
and supplier will develop an Affirmative Action program to ensure that applicants are employed and that employees are
treated during employment without regard to their race, creed, color, sex, national origin, religion, economic status, age,
mental or physical disability, political opinions or affiliations. Such actions shall include but not be limited to the following:
a. Employment
b. Upgrading
c. Demotion or Transfer
d. Recruitment and Advertising
e. Layoff or Termination
f. Rates of Pay or Other Forms of Compensation
g. Selection for Training Including Apprenticeship
2. The contractor, subcontractor, vendor and supplier of goods and services will, in all solicitations or advertisements for
employees, state that all qualified applicants will receive consideration for employment without regard to race, creed,
color, sex, national origin, religion, economic status, age, mental or physical disabilities, political opinion or affiliations.
3. The contractor, subcontractor, vendor and supplier or his/her collective bargaining representative will send to each
labor union or representative of workers which he/she has a collective bargaining agreement or other contract or
understanding, a notice advising said labor union or workers' representative of the contractor's commitment under this
section.
4. The contractor, subcontractor, vendor and supplier of goods and services will comply with all published rules,
regulations, directives, and order of the City of Waterloo Affirmative Action Program Contract Compliance Provisions.
5. The contractor, subcontractor, vendor and supplier of goods and services will furnish and file compliance reports within
such time and upon such forms as provided by the Affirmative Action Officer. Said forms will elicit information as to
the policies, procedures, patterns, and practices of each subcontractor as well as the contractor himself/herself and
said contractor, subcontractor, vendor and supplier will permit access to his/her employment books, records and
accounts to the City's Affirmative Action Officer, for the purpose of investigation to ascertain compliance with this
contract and with rules and regulations of the City's Affirmative Action Program —Contract Compliance Provisions
relative to Resolution No. 24664.
In the event of the contractor's non-compliance with the non-discrimination clauses of this contract or with any of such
rules, regulations and orders, this contract may be canceled, terminated or suspended in whole or in part and the
contractor may be declared ineligible for further contracts in accordance with procedures authorized by the City Council.
The contractor, subcontractor, vendor and supplier of goods and services will include, or incorporate by
reference, the provisions of the non-discrimination clause in every contract, subcontract or purchase order
unless exempted by the rules, regulations or orders of the City's Affirmative Action Program, and will provide
in every subcontract, or purchase order that said provisions will be binding upon each contractor,
subcontractor, or supplier.
8. We, the undersigned, recognize that we are morally and legally committed to non-discrimination in employment. Any
person who applies for employment with our company will not be discriminated against because of race, creed, color,
sex, national origin, economic status, age, mental or physical disabilities.
(Signed)
(Appropriate Official)
0 W \AI ( 3
(Title) (Date)
•
Bidder Status Form
To be completed by all bidders
Part A
Please answer"Yes
Yes ONO
Yes 0 No
® Yes ®No
pYes ®No
�iYes ONo
" or "No" for each of the following:
My company is authorized to transact business in Iowa.
(To help you determine if your company is authorized, please review the worksheet on the next page).
My company has an office to transact business in Iowa.
My company's office in Iowa is suitable for more than receiving mail, telephone calls, and e-mail.
My company has been conducting business in Iowa for at least 3 years prior to the first request for
bids on this project.
My company is not a subsidiary of another business entity or my company is a subsidiary of another
business entity that would qualify as a resident bidder in Iowa.
If you answered "Yes' for each question above, your company qualifies as a resident bidder. Please
complete Parts 8 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:
5
/ 15 / 17 to current Address 9835 Midwest Lane
City, State Zip.Peosta, IA 52068
Dates: / / to / /
Dates: / / to
You may attach additional sheet(s) if needed.
Address*
City, State Zip
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? 0 Yes Q No
3. If you answered "Yes" to question 2, identify each preference offered by your company's home state or foreign country
and the appropriate legal citation.
You may attach additional sheet(s) if needed.
To be completed by all bidders Part D
I certify that the statements made on this document are true and complete to the best of my knowledge and I know that my
failure to provide accurate and truthful information may be a reason to reject my bid.
Firm Name: Midwest Concrete Inc.
Signature:
Date: 6/22/2023
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 QNo My business is currently registered as a contractor with the Iowa Division of Labor.
Q Yes No My business is a sole proprietorship and I am an Iowa resident for Iowa income tax purposes.
Q Yes 0 No My business is a general partnership or joint venture. More than 50 percent of the general
partners or joint venture parties are residents of Iowa for Iowa income tax purposes.
Q Yes
Q Yes
Q Yes
Q Yes
Q Yes
Q Yes
Q Yes
My business is an active corporation with the Iowa Secretary of State and has paid all fees
required by the Secretary of State, has filed its most recent biennial report, and has not filed
articles of dissolution.
My business is a corporation whose articles of incorporation are filed in a state other than Iowa,
the corporation has received a certificate of authority from the Iowa secretary of state, has filed
its most recent biennial report with the secretary of state, and has neither received a certificate of
withdrawal from the secretary of state nor had its authority revoked.
My business is a limited liability partnership which has filed a statement of qualification in this
state and the statement has not been canceled.
My business is a limited liability partnership which has filed a statement of qualification in a
state other than Iowa has filed a statement of foreign qualification in Iowa and a statement of
cancellation has not been filed.
My business is a limited partnership or limited liability limited partnership which has filed a
certificate of limited partnership in this state, and has not filed a statement of termination.
My business is a limited partnership or a limited liability limited partnership whose certificate of
limited partnership is filed in a state other than Iowa, the limited partnership or limited liability
limited partnership has received notification from the Iowa secretary of state that the application
for certificate of authority has been approved and no notice of cancellation has been filed by the
limited partnership or the limited liability limited partnership.
My business is a limited liability company whose certificate of organization is filed in Iowa and has
not filed a statement of termination.
My business is a limited liability company whose certificate of organization is filed in a state other
than Iowa has received a certificate of authority to transact business in Iowa and the certificate
has not been revoked or canceled.
309-6001 (09-15)
MBE/WBE BUSINESS ENTERPRISE
PRE -BID CONTACT INFORMATION FORM
Prime Contractor Name: MAkNI 'f court"
it
Project: F�10Is� i Otw k \y
lvlu •
Letting Date: '1.1-'0V*j
NO MBE/WBE SUBCONTRACTORS: if you are NOT using any MBE/VVBE subcontractors to complete this project,
sign below. Attach a brief explanation as to why subcontracting was not feasible with this project. If any MBE/WBE
subcontractors will be used, please use the bottom portion of this form.
Contractor Signpture: /�
Title: Vow �
Date: \J'1,1--A-12
SUBCONTRACTORS APPLICABLE: You are required, in order for your bid to be considered responsive, to provide
the information on this form showing ALL of your MBE/WBE subcontractor contacts made for your bid submission.
This information is subject to verification. Any questions may be directed to Contract Compliance Office 319-291-
4429.
You are required, in order for your bid to be considered responsive, to provide the information on this Form showing
your MBE/WBE Business Enterprise contacts made prior to your bid submission. This information is subject to
verifications and confirmation.
If you are unable to identify MBENVBE firms to perform portions of the work, please contact Rudy Jones, Contract
Compliance Officer, for assistance at (319) 291-4429.
In the event it is determined that the MBE/WBE Business Enterprise goals are not met, then before awarding the
contract the City of Waterloo will make a determination as to whether or not the apparent successful low bidder made
good faith efforts to meet the goals.
TABLE OF INFORMATION SHOWING BIDDER'S PRE -BID
MBE/WBE BUSINESS ENTERPRISE CONTACTS
Quotes Received Quotation used in
bid
Subcontractors
MBE/WBE
Dates
Contacted
Yes/No
Dates
Contacted
YeslNo
Dollar
Amount Proposed to
be Subcontracted
sco*
Tito('
NvrsrM)
4/zo/23
41p
AP)
(Form CCO-4) Rev. 06-20-02