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Home My WebLink AboutBrock Even Construction, LLC1 (064 C_ b13%atserl , Li_ Fir QD-3, 3'idetszAK - . CAI , 3‘Cewa\K Penec4 --17601/4 Reea‘r`rram - ie,e3 CcaVra . Ab. Abaci BID BOND Nationwide Mutual Insurance Company 1100 Locust St., Dept 2006 Des Moines, IA 50391-2006 (866) 387-0457 CONTRACTOR: SURETY: Brock Even Construction LLC Nationwide Mutual Insurance Company 13012 Fox Road 1100 Locust Street, Department 2006 Jesup, IA 50648 Des Moines, IA 50391 OWNER: City of Waterloo 715 Mulberry St Waterloo, IA 50703 BOND AMOUNT: 5% of amount bid PROJECT: FY 2024 Sidewalk In611, Sidewalk Ramp & Trail Repair Program - Zone 3 The Contractor and Surety are bound to the Owner in the amount set 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 are 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 (I) 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 furnished 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 Owner may in good faith contract with another party to perform the work covered by said bid, then this obligation shall be null and void, otherwise to remain in full force and effect. The Surety hereby waives any notice of an agreement between the Owner and Contractor to extend the time in which the Owner may accept the bid. Waiver of notice by the Surety shall not apply to any extension exceeding sixty (60) days in aggregate beyond the time for acceptance of bids specified in the bid documents, and the Owner and Contractor shall obtain the Surety's consent for an extension beyond sixty (60) days. If this Bond is issued in connection with a subcontractor's bid to a Contractor, the term Contractor in this Bond shall be deemed to be a Subcontractor and the term Owner shall be deemed to be Contractor. When this Bond has been furnished to comply with a statutory or other legal requirement in the location of the Project, any provision in this Bond conflicting with said statutory or legal requirement shall be deemed deleted herefrom and provisions conforming to such statutory or other legal requirement shall be deemed incorporated herein. When so furnished, the intent is that this bond shall be construed as a statutory bond and not as a common law bond. Signed and sealed this 19th day of June 2023 Brock Even Construction LLC (Witness) thrtu (Win ess) (Principal (Seal). (Title) Nationwide Mutual Insurance Company (Surety) ;A��°LLJY (Title) Elirabetl Moore M Attorney -in -Fact This document conforms to American Institute of Architects Document A310, 2010 edition Power of Attorney KNOW ALL MEN BY THESE PRESENTS THAT: Nationwide Mutual Insurance Company, an Ohio corporation hereinafter referred to severally as the "Company" and collectively as "the Companies" does hereby make, constitute and appoint: Elizabeth Moore each in their individual capacity, its true and lawful attorney -In -fact, with full power and authority to sign, seal, and execute on its behalf any and all bonds and undertakings, and other obligatory Instruments of similar nature, in penalties not exceeding the sum of Five Hundred Thousand and 00/100 Dollars ($5001000) and to bind the Company thereby, as fully and to the same extent as if such instruments were signed by the duly authorized officers of the Company; and all acts of said Attorney pursuant to the authority given are hereby ratified and confirmed. This power of attorney is made and executed pursuant to and by authority of the following resolution duly adopted by the board of directors of the Company: "RESOLVED, that the president, or any vice president be, and each hereby is, authorized and empowered to appoint attorneys -in -fact of the Company, and to authorize them to execute and deliver on behalf of the Company any and all bonds, forms, applications, memorandums, undertakings, recognizances, transfers, contracts of indemnity, policies, contracts guaranteeing the fidelity of persons holding positions of public or private trust, and other writings obligatory in nature that the business of the Company may require; and to modify or revoke, with or without cause, any such appointment or authority; provided, however, that the authority granted hereby shall in no way limit the authority of other duly authorized agents to sign and countersign any of said documents on behalf of the Company." "RESOLVED FURTHER, that such attorneys -in -fact shall have full power and authority to execute and deliver any and all such documents and to bind the Company subject to the terms and limitations of the power of attorney issued to them, and to affix the seal of the Company thereto; provided, however, that said seal shall not be necessary for the validity of any such documents." This power of attorney is signed and sealed under and by the following bylaws duly adopted by the board of directors of the Company. Execution of Instruments. Any vice president, any assistant secretary or any assistant treasurer shall have the power and authority to sign or attest all approved documents, instruments, contracts, or other papers in connection with the operation of the business of the company in addition to the chairman of the board, the chief executive officer, president, treasurer or secretary; provided, however, the signature of any of them may be printed, engraved, or stamped on any approved document, contract, instrument, or other papers of the Company. IN WITNESS WHEREOF, the Company has caused this instrument to be sealed and duly attested by the signature of Its officer the 20th day of August, 2021. Antonio C. Albanese, Vice President of Nationwide Mutual Insurance Company ACKNOWLEDGMENT STATE OF NEW YORK COUNTY OF NEW YORK: ss On this 201h day of August, 2021, before me came the above -named officer for the Company aforesaid, to me personally known to be the officer described in and who executed the preceding instrument, and he acknowledged the execution of the same, and being by me duly swom, deposes and says, that he is the officer of the Company aforesaid, that the seal affixed hereto is the corporate seal of said Company, and the said corporate seal and his signature were duly affixed and subscribed to said Instrument by the authority and direction of said Company. Stephanie Rubino McArthur Notary Public, State of New York No.02MC6270117 Qualified in New York County Commission Expires October 19.2024 Notary Pubru My CanallsSion Ex pire, Ocrober 19, 2024 CERTIFICATE I, Laura B. Guy, Assistant Secretary of the Company, do hereby certify that the foregoing is a full, true and correct copy of the original power of attomey issued by the Company; that the resolution included therein is a true and correct transcript from the minutes of the meetings of the boards of directors and the same has not been revoked or amended in any manner; that said Antonio C. Albanese was on the date of the execution of the foregoing power of attorney the duly elected officer of the Company, and the corporate seal and his signature as officer were duly affixed and subscribed to the said instrument by the authority of said board of directors; and the foregoing power of attorney is still in full force and effect. IN WITNESS WHEREOF, 1 have hereunto subscribed my name as Assistant Secretary, and affixed the corporate seal of said Company this 19th day of June 2023 . cue-ta e Csv * Assistant Secretary BDJ 1(08-21)00 FORM OF BID OR PROPOSAL 1=�V 2024 SIDEWALK INFILL, SIDEWALK RAIVIP & TRAIL REPAIR PROGRAM — ZONE 3 CONTRACT NO. 1079 CI`i`Y 014 WATERLOO, IOWA Honorable Mayor and City Council Waterloo, Iowa Gentlemen: 1. The undersigned, being a Corporation existing under the laws of the State of Ta Partnership consisting of the following partners: 1 xtek Coen CCI-� toU\co , 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 FY 2024 8IDEWALIt INFILL, SIDEWALK RAMP & TRAIL REPAIR PROGRAM o ZONE 3, Contraot 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 INFILL, SIDEWALK RAMP & TRAIL REPAIR PROGRAM ZONE 3 CONTRACT NO. 1079 ITEM BID SPECIFICATION SUPPLEMENTAL SP = SUDAS SPCL * SEE PROV DESCRIPTION UNIT EST QTY UNIT PRICE BID TOTAL PRICE BID DIVISION 1 ., EDISON ADDITION SIDEWALK INFILL 1 7030-108-E-0 SIDEWALK, PCC, 4" SF 3,321.5 $ tap $, , ,clik,(60 2 2010-108-E-0 EXCAVATION, CLASS 10 SF 3,321.5 $ a ,fO $ 111 y q y1, ;15 3 9010-108-C-0 HYDROSEEDING SF 1,993.0 $ ,,a0 $ ")3(11, tgC 4 8030-108-A-0 TRAFFIC CONTROL LS 1.0 $ 1 CCO $ 1. ,CO _.CO $ $ 3CD MO ,e 4W 5 SP #1 EROSION & SEDIMENT CONTROL LS 1.0 TOTAL BID - DIVISION 1 $ L4 , 55`? )5 FORM OF BID CONTRACT NO. 1079 Page 1 of 5 ITEM BID SPECIFICATION SUPPLEMENTAL SP = SUDAS SPCL * SEE PROV DESCRIPTION UNIT EST QTY UNIT PRICY DID TOT/11, PRICL HID DIVISION 2 - RAIUMP REPAIRS 1 7030-108-A-0 REMOVE SIDEWALK SF 3,170.0 $ 3,tce $ 1\ ,LA \a„CC SF 1,870.9 4 % 2 7030-108-E-0 SIDEWALK, PCC, 4" $ $1 )'416.` 3 7030-108-E-0 SIDEWALK, PCC, 6" SF 1,179.2 $ ?s V3 $q)g05 43 4 7030-108-G-0 DETECTABLE SURFACE WARNING SF 216.0 $ $5 Ck) $ Z,? ,01) 5 7030-108-B-0 SAW CUT, 1/2" CURB OPENING LF 157.8 $ 85_CL) $1,I-113 Cn 6 7040-108-1-0 REMOVE CURB & GUTTER LF 57.3 $ I 5.63 $$Jl - 14tAso 7 7010-108-E-0 CURB & GUTTER, 24", 8.5" LF 7.8 $ (gO_C $ 8 7010-108-E-0 CURB & GUTTER, 24", 10.5" LF 41.1 $ ViN_t $ v7b1, )55 9 7010-108-E-0 CURB & GUTTER, 24", 12.5" LF 16.2 $ `iy.C(W $ 1a15.,W 1-k.CO 4-i-Ib 10 7040-108-H-0 REMOVE PAVEMENT SF 110.2 $ $ 11 7040-108-A-0 PAVEMENT, PCC, 8.5" SF 43.4 $ 9, 5L $ kV; 12 SP #2 PATCH, HMA, 2" _ SF 66.8 $ 1 �-i . ' $ tb ,bpi 13 2010-108-E-0 EXCAVATION, CLASS 10 SF 2,261.2 $ 1.50 $ io, I-1 `AO 14 9010-108-C-0 HYDROSEEDING SF 2,295.0 $ Lola $ ;;-151-.(' 15 SP #3 WATER VALVE ADJUST EA 4.0 $ 150.0 $ (900 iC° 16 SP #1 EROSION & SEDIMENT CONTROL LS 1.0 $ SEt.°' $ 2it.C° 17 8030-108-A-0 TRAFFIC CONTROL LS 1.0 $ 1W6.0\ $ 1?O\W TOTAL BID - DIVISIOI'1 2 $ *i 4O5 Sb DIVISION 3 COUNTY RAMP RLPAIRS - 1 7030-108-A-0 REMOVE SIDEWALK SF 265.5 $ tr)). kD $ ci 5`J . W 2 7030-108-E-0 SIDEWALK, PCC, 4" SF 115.6 $ '1 30 $ 34D _3- 3 7030-108-E-0 SIDEWALK, PCC, 6" SF 149.8 $ `� .4 $ lam 36 v 4 7030-108-G-0 DETECTABLE SURFACE WARNING SF 32.0 $ 45.C° SaTiDOPC ` 5 7030-108-B-0 SAW CUT, 1/2" CURB OPENING LF 13.1 $ $5 CD $ 1113.5 6 7040-108-H-0 REMOVE PAVEMENT SF 44.4 $Lot $ FTtbc 7 7040-108-A-0 PAVEMENT, PCC, 9.5" SF 44.4 9 $ Oa\ .$) $ 4 8 2010-108-E-0 1 EXCAVATION, CLASS 10 SF 195.7 $ L0- $ aM,(05 9 9010-108-C-0 HYDROSEEDING SF 195.7 $ 1 • ,, $ ni 1k.tSA 10 SP 01 EROSION & SEDIMENT CONTROL LS 1.0 $ L \(j,C) $ LICO“Ob 11 8030-108-A-0 TRAFFIC CONTROL LS 1.0 $ Cie0 aCi) $ ico.1th TOTAL GRID 4 DIVISION 3 $ (Thcp-A ,I 8a FORM OF BID CONTRACT NO. 1079 Page 2 of 5 ITEM BID SPECIFICATION SUPPLEMENTAL SP = SUDAS * SPCL SEE 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 $ 3.(DO $ .6?" 2 7030-108-E-0 TRAIL, PCC, 6" SF 2,342.8 $ `.4b $ \cth-t-A $ \ c(t 53 .i" 3 8030-108-A-0 TRAFFIC CONTROL LS 1.0 $ 1 C LQ .CO TOTAL BID - DIVISION 4 $ YL0 ,\\a• DIVISION 1 - ALTERNATE - FLETCHER AVENUE SIDEWALK INFILL 1 7030-108-A-0 REMOVE SIDEWALK/DRIVEWAY SF 513.3 $ 3, I00 $ 64-1 ,M 2 7030-108-E-0 SIDEWALK, PCC, 4" SF 939.0 $ 'Ti lab $ jp I(dl,%v 3 7030-108-E-0 SIDEWALK, PCC, 6" SF 199.8 $ %,yp $ I V . 6D 4 7030-108-E-0 DRIVEWAY,PCC,5" SF 183.4 $ . cp $ v uj:i .ap 5 7030-108-G-0 DETECTABLE SURFACE WARNING SF 38.0 $ 5 ,ob $ 3a30-CO 6 7030-108-B-0 SAW CUT, 1/2" CURB OPENING LF 29.6 $ )5,0C:10 $ 351lg,CU 7 7040-108-H-0 REMOVE PAVEMENT SF 16.0 $ �] .CO $ W S° 8 SP #4 FULL DEPTH PATCH, PCC , 9" SF 16.0 $ Via, CO $ $ LyiNi tga,CO , Q5 9 2010-108-E-0 EXCAVATION, CLASS 10 SF 1384.9 $ y , J 10 9010-108-C-0 HYDROSEEDING SF 1200.3 $ A ,dib $ )1-0b43U, $ \ t3N , CJ 11 SP #5 SUBDRAIN EXTENSION LS 1.0 $ t'(,CO 12 8030-108-A-0 TRAFFIC CONTROL LS 1.0 $ rSID.CO $ ?;CO-(1) $ '1%O0SCL3 $ ?--ncO 13 SP #1 EROSION & SEDIMENT CONTROL LS 1.0 TOTAL BID b DIVISION 1 - ALTERNATE $ a-1 , tr,o\ t t l TOTAL BID DIVISIONS 1, 2, 3 A 4 $ I lb, (0A) ,L1L\ fl li b I TOTAL BID DIVISION 1 t ALTERNATE $ ,(a 4 2 It is understood that the quantities set forth are approximate only and subject to variation and that the unit bid price for the work done shall govern in the actual payment to Contractor. 3 In submitting this bid, the bidder understands that the right is reserved by the City of Waterloo, Iowa to reject any or all bids. If written notice of the acceptance of this bid is mailed, telegraphed, or delivered to the undersigned within thirty (30) days after the opening thereof, or at any time thereafter before this bid is withdrawn, the undersigned agrees to execute and deliver an agreement in the prescribed form and furnish the required bond and certificate of the insurance within ten (10) days after the agreement is presented to him for signature, and start work within ten (10) days after "Notice to Proceed" is issued. FORM OF BID CONTRACT NO. 1079 Page 3 of 5 4. Security in the sum of 5 . Dollars ($ dit915.13 ) in the form of V). \,n V , is submitted herewith in accordance with the INSTRUCTIONS TO BIDDERS. 5. Attached hereto is a Non -Collusion Affidavit of Prime Contractor. 6. Attached hereto is a Resident Bidder Certification ( ), or Non -Resident Bidder Certification ( ). (Mark one.) 7 The bidder is prepared to submit a financial and experience statement upon request. 8. The Prime Contractor and Subcontractor(s), which have performed an aggregate of $10,000.00 in work for the City in the current calendar year, are prepared to submit an AAP or Update and an EOC, within ten (10) days of notification that the bid submitted is lowest and acceptable. 9. The bidder has received the following Addendum or Addenda: Addendum No. Date 10. The bidder shall list the MBE/WBE subcontractor(s), amount of subcontracts and bid items on the City of Waterloo Minority and/or Women Business Pre -bid Contact Information Form submitted with this Form of Bid or Proposal. The apparent low Bidder shall submit a list of all other Subcontractor(s) to be used on this Project to the City of Waterloo by 5:00 p.m. the business day following the day Bids on this Project are due along with the Non - Collusion Affidavits of All Subcontractor(s). The Contractor shall submit information on subcontractors on "SUBCONTRACTOR REQUEST AND APPROVAL' Form to be provided by City prior to approval of contract. The subcontractors listed on this proposal and/or submitted to the Contract Compliance Officer cannot be changed except for the following reasons: 1) The City of Waterloo does not approve the subcontractors. 2) The subcontractors submit in writing that they cannot fulfill their subcontracts. 11. The bidder has filled in all blanks on this proposal. Those blanks not applicable are marked "none" or "NA". 12. The bidder has attached all applicable forms. 13. The Owner reserves the right to select alternates, delete line items, and/or to reduce quantities prior to the award of a contract due to budgetary limitations. FORM OF BID CONTRACT NO. 1079 Page 4 of 5 rue44 Len C b ntitrue-h nn LLB tr)7i/33 (Name of Bidder) (Date) BY: 1 rock 4 n arc) Title (Xcner Official Address: (Including Zip Code): I oOl D k:x I.R.S. No. Lib-- \_5(nN0r)r3)$ FORM OF BID CONTRACT NO. 1079 Page 5 of 5 FY 2024 SIDEWALK INFILL, SIDEWALK RAMP & TRAIL REPAIR PROGRAM o ZONE 3 CONTRACT NO. 1079 CONTRACT DOCUMENTS TABLE OF CONTENTS 1. NOTICE OF PUBLIC HEARING 2. NOTICE TO BIDDERS 3. INSTRUCTIONS TO BIDDERS 4. FORM OF BID OR PROPOSAL 5. SALES TAX EXEMPTION INFORMATION FORM 6. FORM OF BID BOND 7 NON -COLLUSION AFFIDAVITS (Prime) 8. EQUAL OPPORTUNITY CLAUSE 9. TITLE VI CIVIL RIGHTS 10. BIDDER STATUS FORM 11. AFFIRMATIVE ACTION PROGRAM 12. POTENTIAL ITEMS OF WORK FOR MBE/WBE PARTICIPATION A. SUBCONTRACTOR'S BID REQUEST FORM, B. LETTER FORM FOR SUBCONTRACTOR QUOTES (CCO-3) C. MBE/WBE SCOPE LETTER, (CCO-4) D. MBE AND/OR WBE PREBID CONTACT INFORMATION FORM (CCO-4A) E. MBP/WBE LETTER OF INTENT TO BID (CCO-5) 13. WATERLOO/CEDAR FALLS MINORITY AND WOMEN BUSINESSES ENTERPRISE CONSTRUCTION AND MAINTENANCE CONTRACTOR'S GUIDE 14. STATEMENT OF BIDDER'S QUALIFICATIONS 15. GENERAL SPECIAL PROVISIONS 16. SPECIAL PROVISIONS 17. GENERAL SPECIFICATIONS FOR CONSTRUCTION 18. SUPPLEMENTAL GENERAL SPECIFICATIONS FOR CONSTRUCTIONS 19. FORM OF CONTRACT 20. FORM OF PERFORMANCE BOND 21. FORM OF PAYMENT BOND Highlighted items must be included with bid. 7 ti»1201ill:: ,ii I!,C;III,:jIC;/MicHkil Inn Ari,ei!li 10 1: 11W�\II ,IIC II II\1I I; :III ,Il ,y SII DO4W\I1,IIC ' II'I;/\II I1, CON [k II'I��/�Cc"I►' Ih\'I,1J11079 CITY OF (1)tid WATERLOO Engineering WILLIAM W. CASTLE, P.E. Uconne Number 19715 My Ucanae Ronowal Mato is tlecombor 31, 2023, Pages or shoots covered by this anal : 1 hereby certify that this engineering document was prepared by me or under my direct personal supervision and that I am a duly Iicensd Professional Engineer under the laws the State of Iowa, 6/#05 • 1 MBE/1NBE BUSINESS ENTERPRISE PRE -BID CONTACT INFORMATION FORM Prime Contractor Name: -:6Len ec on , LLr Project: i``( ,Q3aLl S\dELcz_Alk Toctit1,a'‘Cketh.1\11\ Ra , Tc�'�l Letting Date: (e/,9n?I&3 Reov- col 7.cne 3 - rani ray± kb`t NO MBE/WBE SUBCONTRACTORS: If you are NOT using any MBE/WBE subcontractors to complete this project, sign below. Attach a brief explanation as to why subcontracting was not feasible with this project. If any MBE/WBE subcontractors will be used, please use the bottom portion of this form. Contractor Signature: Title: (; Cr)e c Date: SUBCONTRACTORS APPLICABLE: You are required, in order for your bid to be considered responsive, to provide the information on this form showing ALL of your MBE/WBE subcontractor contacts made for your bid submission. This information is subject to verification. Any questions may be directed to Contract Compliance Office 319-291- 4429. You are required, in order for your bid to be considered responsive, to provide the information on this Form showing your MBE/WBE Business Enterprise contacts made prior to your bid submission. This information is subject to verifications and confirmation. If you are unable to identify MBE/WBE firms to perform portions of the work, please contact Rudy Jones, Contract Compliance Officer, for assistance at (319) 291-4429. Rudy e c3@ L314}-erteo 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 IRE -BID MBE/WBE BUSINESS ENTERPRISE CONTACTS Quotes Received Quotation used in bid Subcontractors MBERNDE Contacted Dates Yes/No Contacted Dates Yes/No Dollar be Amount Subcontracted Proposed to (Form CCO-4) Rev. 06-20-02 MBE/WBE BUSINESS ENTERPRISE PRE -BID CONTACT INFORMATION FORM INSTRUCTIONS Prime Contractor Responsibilities: Prime Contractors bidding on City of Waterloo contract work are required to ensure that MBE/WBE businesses are provided the opportunity to participate in the performance of contracts and subcontracts. Prime contractors are required to assist MBE/WBE businesses in overcoming barriers to participation, and must make good faith efforts to secure bids from, and award subcontracts to, MBE/WBE businesses. For all contract bids of $50,000 or more, the following is required to demonstrate good faith efforts in accordance with this policy: 1. "MBE/WBE BUSINESS ENTERPRISE PRE -BID CONTACT INFORMATION FORM" submitted with the prime contractor bid, properly completed and signed on Form CCO-4 (Rev. 06-20-02). Please note that this document must include all subcontractor contacts, bids received, and awarded - not just those related to disadvantaged business enterprise vendors. 2. A minimum of three (3) MBE/WBE business contacts must be made and documented, if there are at least three (3) MBE/VVBE businesses offering services in the areas to be subcontracted (see City of Waterloo MBE/WBE Certified List). If less than three (3) are offering the services to be subcontracted, then a contact is required for any that are listed as providing that service. If you have submitted a MBE/WBE contact not on the City's MBE/WBE list, attach a copy of the certification from another government agency. 3. Contacts to each MBE/WBE businesses are required to be a minimum of seven (7) working days prior to the date the prime contractor submits the bid to the City of Waterloo. 4. The following documentation must accompany the "MBE/WBE BUSINESS ENTERPRISE PRE -BID CONTACT INFORMATION FORM" for each MBE/WBE business contacted: a. A copy of the bid received from the MBE/VVBE, OR b. If no bid was received, a copy of correspondence received from the MBE/WBE with a "no bid" response, OR c. If no response was received, a copy of the solicitation sent to the MBE/WBE with proof of mailing attached. 5. if any MBE/WBE business submitting bids are not selected for subcontract award, documentation must accompany the "MBE/WBE BUSINESS ENTERPRISE PRE -BID CONTACT INFORMATION FORM" on why the MBE/WBE was not selected. These reasons could include: a. Not low bid. Copies of the competing bids may be required for verification. b. MBE/WBE did not bid, withdrew bid or was non -responsive. c. Documentation of other business -related reason for not selecting the MBE/WBE business for a subcontract. d. Prime contractor self performs work. e. Any other reason relied on by the Prime Contractor. The Contract Compliance Officer will determine the weight to be given to each item listed above (supported by appropriate documentation) based on overall program goals. Subcontractors Responsibilities: 1. Each MBE/WBE firm planning to submit quotes on construction projects with goals, shall submit a Letter of Intent to Bid (Form CCO-5) to the City Contract Compliance Officer seven (7) working days prior to bid opening, listing specific items which the MBE/WBE firm is interested in bidding. If the City Contract Compliance Officer does not receive sufficient scope letters seven (7) working days prior to bid opening, goals on subject project will be reduced accordingly. Agreements between the bidder/proposer and an MBE/WBE in which the MBE/WBE promises not to provide subcontracting quotations to other bidders/proposers are prohibited. Form CCO-4A Rev. 07-08-02 iliddor° Status Form To be completed by all bidders Part A Please answer "Yes" or "No" for each of the following: Qyes QNo Yes ONo Yes No GSYes ONo Yes ONO My company is authorized to transact business in Iowa. (To help you determine if your company is authorized, please review the worksheet on the next page). My company has an office to transact business in Iowa. My company's office in Iowa is suitable for more than receiving mail, telephone calls, and e-mail. My company has been conducting business in Iowa for at least 3 years prior to the first request for bids on this project. My company is not a subsidiary of another business entity or my company is a subsidiary of another business entity that would qualify as a resident bidder in Iowa. If you answered "Yes" for each question above, your company qualifies as a resident bidder. Please complete Parts B and D of this form. If you answered "No" to one or more questions above, your company is a nonresident bidder. Please complete Paris C and D of this form. To be completed by resident bidders Part 3 My company has maintained offices in Iowa during the past 3 years at the following addresses: Dates: / / to / / )04Address: 1 ,-e)i 8 -0>(- IRC� City, State, Zip: c\c3ctp. TU L AC'L t / to / / Address: City, State, Zip: Dates: / / to / / Address. You may attach additional sheet(s) if needed. City, State, Zip. Dates: / To be completed by nonresident bidders Par`: 'L 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 0 force preferences or any other type of preference to bidders or laborers? Yes 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: __DC(C`k Zv i l C c )S4( ESL` i rC Lim'_ Signature: Date: Wftw'33 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) that, in the event of a contractor becomes involved in, or it threatened with, litigation with a subcontractor or supplier as a result of such direction, the contractor may request the Contracting Authority or the Iowa DOT to enter into such litigation to protect the interests of the Contracting Authority or the Iowa DOT; and, in addition, the contractor may request the United States to enter into such litigation to protect the interest of the United States. TITLE VI CIVIL RIGHTS Page 2 of 2 NON -COLLUSION AFFIDAVIT OF SUBCONTRACTOR State of ) County of ) , being first duly sworn, deposes and says that: ) ss: 1. He is (Owner, Partner, Officer, Representative or Agent) of hereinafter referred to as the "Subcontractor;" He is fully informed respecting the preparation and contents of the subcontractor's proposal submitted by the subcontractor to contract pertaining to the _ project in • (City or County and State) 3. Such subcontractor's proposalis genuine and is not a collusive or sham proposal; Neither the subcontractor 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 proposal in connection with such contract or to refrain from submitting a proposal in connection with such contract, or has in any manner, directly or indirectly, sought by unlawful agreement or connivance with any other bidder, firm or person to fix the price or prices in said subcontractor's proposal, or to fix any overhead, profit or cost element of the price of prices in said subcontractor's proposal, or to secure through collusion, conspiracy, connivance or unlawful agreement any advantage against the City of Waterloo, Iowa, or any person interested in the proposed contract; and The price or prices quoted in the subcontractor's proposal are fair and proper and are not tainted by any collusion, conspiracy, connivance or unlawful agreement on the par(, of the,hidder or,any of its agents, representatives, owners, employees, or parties in interest, including this affiantt. (Signed) Title Subscribed and sworn to before me this day of 20 Title My commission expires . NON -COLLUSION AFFIDAVIT OF PRIME BIDDER State of 1 (Nk ` County of .} eACk i-\oce\C wick F\s •e n )ss , being first duly sworn, deposes and says that: 1. He is (Owner, Partner, Officer, Representative, or Agent) , of 13vrek CIxnl rues lic:01 LLC , 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. £ZOZ `17, d s saildx3 uocssIwwoJ I(w L I.99ZR Thgwns uol98lwwo) !'J UMol - leas 1WIJ*low c 39Y1S32M3dS 2133N3dS f"riztrivr-iwri; a-cg,►its-*ttn— Subscribed and sworn to before me this (Signed) Title My commission expires SUVA 1 \ \ �4L 3 day of J (Asi\Ci , 20 5. BID BOND KNOW ALL MEN BY THESE PRESENTS, that we as Principal, and as Surety, are held and firmly bound unto the CITY OF WATERLOO Iowa, hereinafter called "OWNER." In the penal sum Dollars ($ ) 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 day of 20 ,for 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 day of A D 20 . (Seal) Principal By (Title) (Seal) Witness Surety By Witness Attorney -in -fact BID BOND Page 1 of 1 INFORMATION NEEDED FOR IOWA CONSTRUCTION SALES TAX EXEMPTION CERTIFICATE CONTRACTOR NAME' LJr�<-� �� C•s'� ADDRESS: 1.70i z 771 (Check One): PRIME C FEDERAL ID#: SUBCONTRACTOR PROJECT NAME: / 2 oz v PROJECT CONTRACT NO.: DESCRIPTION OF WORK: Li Brickwork ❑ Carpentry ❑ Concrete all -Plaster -Insulation /o 7s ❑ Electrical Li Excavation/Grading ❑ Flooring ❑ Heavy Construction ❑ Heating -Ventilating -Air Cond ❑ Landscaping ❑ Painting ❑ Paving Li Plumbing ❑ Roofing -Siding -Sheet Metal ❑ Windows ❑ Wrecking -Demolition • Other (Please specify)