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HomeMy WebLinkAboutWRH, Inc.WRH, INC 1648 T Ave South Amana, IA 52334 BID SECURITY FINAL CLARIFIER NO. 3 REHABILITATION CITY OF WATERLOO CITY CLERK CITY HALL 715 MULBERRY STREET WATERLOO, IA 50703 I WRH, INC 1648 T Ave South Amana, IA 52334 BID PROPOSAL FINAL CLARIFIER NO. 3 REHABILITATION CITY OF WATERLOO CITY CLERK CITY HALL 715 MULBERRY STREET WATERLOO, IA 50703 FORM OF BID OR PROPOSAL F.Y. 2023 WASTEWATER TREATMENT PLANT FINAL CLARIFIER NO. 3 REHABILITATION CITY OF WATERLOO, IOWA CITY CONTRACT NO. 1067 Honorable Mayor and City Council Waterloo, Iowa 1. The undersigned, being a Corporation existing under the laws of the State of WRH, Inc. , 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 F.Y. 2023 Wastewater Treatment Plant Final Clarifier No. 3 Rehabilitation, City Contract No. 1067, all in accordance with the above -listed documents and for the Lump Sum Base Bid cost: LUMP SUM BASE BID: t'3H r n u *f D/i D Four) r 7 Ti.P T &vs0,4 0 (Words) (Numbers) Dollars $ gq i oo'o. See Section 01 29 00—Contract Considerations for discussion of Cash Allowances to include in the Bid. FORM OF BID Section BF-1 4463.016/City Contract No. 1067 2. Cash Allowances The following Cash Allowances shall be included in the Lump Sum Base Bid. The Cash Allowances for non -Lump Sum items shall be equal to the product of the quantity included in the Lump Sum Base Bid and the Unit Price. The Cash Allowances will be adjusted in the event that estimated quantities to be included in the Lump Sum Base Bid are different from final measured quantities. A single Unit Price shall be bid for each item. Failure to include one or more of the following Unit Price items may result in rejection of the entire Bid as nonconforming. For items with a quantity of 1, the Cash Allowance shall be adjusted based on actual final costs. CASH ALLOWANCES Number Item Description included Estimated Lump Quantity Base in Sum Bid the Unit Bid Unit Price Lump Total Included Bid Sum Bid in Price Base the 1. Concrete Surface (Section Repairs 03 Surface 01 30) Repair —Top of Slab 10 CF $ b 700 Jeo$ J-' 9. UO 2. Concrete Slab (Section Removal 03 Surface 01 and 30) Repair Replacement —Concrete Base 20 CY $ 1 , .t, Lcb e $ 2 2 00 40 v 3. Crack (Section Repairs 03 —Chemical 64 00) Grout Injection 100 LS $ =' $ 1 o •- U u 4. Final Repair (Section Clarifier —Support 46 43 Equipment 22) Truss Repairs Inspection and 1 LS $5,000.00 $5,000.00 5. Final Repair (Section Clarifier —Unidentified 46 43 Equipment 22) Repairs Inspection and 1 LS $50,000.00 $50,000.00 FORM OF BID Section BF-2 4463.016/City Contract No. 1067 4. In submitting this bid, the Bidder understands that the right is reserved by the City of Waterloo, Iowa, to reject any or all bids. If written notice of the acceptance of this bid is mailed, telegraphed, or delivered to the undersigned within thirty (30) days after the opening thereof, or at any time thereafter before this bid is withdrawn, the undersigned agrees to execute and deliver an agreement in the prescribed form and furnish the required bond and certificate of the insurance within ten (10) days after the agreement is presented to him for signature, and start work within ten (10) days after "Notice to Proceed" is issued. 5. Security in the sum of 5% Bid Bond Dollars ($ ) in the form of Bid Bond is submitted herewith in accordance with the INSTRUCTIONS TO BIDDERS. 6. Attached hereto is a Non -Collusion Affidavit of Prime Contractor. 7 Attached hereto is a Resident Bidder Certification ( X ), or Non -Resident Bidder Certification ( ). (Mark one.) 8. The Bidder is prepared to submit a financial and experience statement upon request. 9. 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. 10. The Bidder has received the following Addendum or Addenda: Addendum No. Date 11. 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. 12. The Bidder has filled in all blanks on this proposal. Those blanks not applicable are marked "none" or "NA." 13. The Bidder has attached and completed all applicable forms, including the entire Iowa SRF Required Front -End Specifications. 14. CITY 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 Section BF-3 4463.016/City Contract No. 1067 WRH, Inc. 7/6/2023 BY: (Name of Bidder) (Date) Title Vice President Official Address: (Including Zip Code): 1648 T Ave South Amana, IA 52334 I.R.S. No. 42-1012899 END OF SECTION FORM OF BID Section BF-4 4463.016/City Contract No. 1067 INFORMATION NEEDED FOR IOWA CONSTRUCTION SALES TAX EXEMPTION CERTIFICATE CONTRACTOR NAME: ADDRESS: WRH, Inc. 1648 T Ave South Arnana, IA 52334 (Check One) PRIME FEDERAL ID#: X 42-1012899 SUBCONTRACTOR P ROJECT NAME: Final Clarifier No. 3 Rehabilitation P ROJECT CONTRACT NO.: DESCRIPTION OF WORK: 1067 ❑ Brickwork ❑ Carpentry ❑ Concrete ❑ Drywall -Plaster -Insulation ❑ Electrical ❑ Excavation/Grading ❑ Flooring [Heavy Construction ❑ Heating -Ventilating -Air Cond SALES TAX EXEMPTION ❑ Landscaping Painting Paving Plumbing ❑ Roofing -Siding -Sheet Metal ❑ Windows Wrecking -Demolition ❑ Other (Please specify) ■ ■ ■ ■ ■ Section STE-1 4463.016/City Contract No. 1067 NON -COLLUSION AFFIDAVIT OF PRIME BIDDER State of Iowa ) )ss County of Linn ) Bruce Marsh , being first duly sworn, deposes and says that: 1. He is Vice President , of WRH, Inc. , the Bidder that has submitted the attached Bid; 2. He is fully informed respecting the preparation and contents of the attached Bid and of all pertinent circumstances respecting such Bid; 3. Such Bid is genuine and is not a collusive or sham Bid; 4. Neither the said Bidder nor any of its officers, partners, owners, agents, representatives, employees, or parties in interest, including this affiant, has in any way colluded, conspired, connived or agreed, directly or indirectly, with any other Bidder, firm or person to submit a collusive or sham Bid in connection with the Contract for which the attached Bid has been submitted or to refrain from bidding in connection with such Contract, or has in any manner directly 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. (Signed) Vice Presidenrt Subscribed and sworn to before me this iAly ,2023. Title ES4.MC day of Title My commission expires C/z ?/Z Y JORDAN THOMAS RICHEY Notarial Seat - Iowa Commission Number 832702 My Commission Expires Jun 28, 2024 • NON -COLLUSION AFFIDAVIT Section NCA-1 4463.016/City Contract No. 1067 NON -COLLUSION AFFIDAVIT OF SUBCONTRACTOR State of ) ) ss: County of ) , being first duly sworn, deposes and says that: 1. He is (Owner, Partner, Officer, Representative, or Agent) of hereinafter referred to as the "Subcontractor;" 2. 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 proposal is genuine and is not a collusive or sham proposal; 4. 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 5. 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 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 END OF SECTION NON -COLLUSION AFFIDAVIT Section NCA-2 4463.016/City Contract No. 1067 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. 6. 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. EQUAL OPPORTUNITY CLAUSE Section EOC-1 4463.016/City Contract No. 1067 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) Vice President (Title) 7/6/2023 (Date) END OF SECTION EQUAL OPPORTUNITY CLAUSE Section EOC-2 4463.016/City Contract No. 1067 TITLE VI CIVIL RIGHTS During the performance of this contract, the contractor (for itself), its assignees, and successors in interest (hereinafter referred to as the "contractor") agrees as follows: 1. Compliance with Regulations: The contractor shall comply with the Regulations relative to non-discrimination in Federally assisted programs of the DOT Title 49, Code of Federal Regulations, Part 21, as they may be amended from time to time, (hereinafter referred to as the Regulations), which are herein incorporated by reference and made a part of this contract. 2. Nondiscrimination: The contractor, with regard to the work performed by it during the contract, shall not discriminate on the grounds of race, color, national origin, sex, age, or disability in the selection and retention of subcontractors, including procurement of materials and leases of equipment. The contractor shall not participate either directly or indirectly in the discrimination prohibited by section 21.5 of the Regulations, including employment practices when the contract covers a program set forth in Appendix B of the Regulations. 3. Solicitations for Subcontracts, Including Procurement of Materials and Equipment: In all solicitations either by competitive bidding or negotiation made by the contractor for work to be performed under a subcontract, including procurement of materials or leases of equipment, each potential subcontractor or supplier shall be notified by the contractor of the contractor's obligations under this contract and the Regulations relative to non-discrimination on the grounds of race, color, national origin, sex, age, or disability. 4. Information and Reports: The contractor shall provide all information and reports required by the Regulations or directives issued pursuant there to, and shall allow access to its books, records, accounts, other sources of information, and its facilities as may be determined by the Contracting Authority, the Iowa DOT, or FHWA to be pertinent to ascertain compliance with such Regulations, orders and instructions. Where any information required of a contractor is in the exclusive possession of another who fails or refuses to furnish this information the contractor shall so certify to the Contracting Authority, the Iowa DOT, or the FHWA as appropriate, and shall set forth what efforts it has made to obtain the information. 5. Sanctions for Noncompliance: In the event of the contractor's noncompliance with the nondiscrimination provisions of this contract, the Contracting Authority, the Iowa DOT, or the FHWA shall impose such contract sanctions as they may determine to be appropriate, including, but not limited to: a. Withholding of payments to the contractor under the contract until the contractor complies, and/or b. Cancellation, termination, or suspension of the contract, in whole or in part. 6. Incorporation of Provisions: The contractor shall include the provisions of paragraphs (1) through (6) in every subcontract, including procurement of materials and leases of equipment, unless exempt by the Regulations, or directives issued pursuant thereto. The contractor shall take such action with respect to any subcontract or procurement as the Contracting Authority, the Iowa DOT, or the FHWA may direct as a means of enforcing such provisions including sanctions for non-compliance: Provided, however, 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 Section CR-1 4463.016/City Contract No. 1067 Bidder Status Form To be completed by all bidders Part A Please answer "Yes" or "No" for each of the following: Ki 11 GI V 0 Yes (_J No My company is authorized to transact business in Iowa. (To help you determine if your company is authorized, please review the worksheet on the next page). Yes ❑ No My company has an office to transact business in Iowa. Yes ❑ No My company's office in Iowa is suitable for more than receiving mail, telephone calls, and e-mail. Yes ❑ No My company has been conducting business in Iowa for at least 3 years prior to the first request for bids on this project. Yes ❑ No My company is not a subsidiary of another business entity or my company is a subsidiary of another business entity that would qualify as a resident bidder in Iowa. If you answered "Yes" for each question above, your company qualifies as a resident bidder. Please complete Parts B and D of this form. If you answered "No" to one or more questions above, your company is a nonresident bidder. Please complete Parts C and D of this form. To be completed by resident bidders Part B My company has maintained offices in Iowa during the past 3 years at the following addresses: Dates: _Li k /2°-' to -7 / G / 20�1 Address: 1648 T Ave City, State, Zip: South Amana IA 52334 Dates: / / to / / Address: City, State, Zip: Dates: / / to / / Address: You may attach additional sheet(s) if needed. 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? ,_, Yes U 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 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:Bruce Marsh Signature: /1& Date. 7/6/23 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 RB-1 4463.016/City Contract No. 1067 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. U X Yes ❑ No My business is currently registered as a contractor with the Iowa Division of Labor. Yes K No My business is a sole proprietorship and I am an Iowa resident for Iowa income tax purposes. Yes j No My business is a general partnership or joint venture. More than 50 percent of the general partners or joint venture parties are residents of Iowa for Iowa income tax purposes. Yes ❑ No My business is an active corporation with the Iowa Secretary of State and has paid all fees required by the Secretary of State, has filed its most recent biennial report, and has not filed articles of dissolution. Yes 11 My business is a corporation whose articles of incorporation are filed in a state other than Iowa, the corporation has received a certificate of authority from the Iowa secretary of state, has filed its most recent biennial report with the secretary of state, and has neither received a certificate of withdrawal from the secretary of state nor had its authority revoked. Yes IN No My business is a limited liability partnership which has filed a statement of qualification in this state and the statement has not been canceled. Yes i!1 No My business is a limited liability partnership which has filed a statement of qualification in a state other than Iowa, has filed a statement of foreign qualification in Iowa and a statement of cancellation has not been filed. Yes ri No My business is a limited partnership or limited liability limited partnership which has filed a certificate of limited partnership in this state, and has not filed a statement of termination. Yes 11 No My business is a limited partnership or a limited liability limited partnership whose certificate of limited partnership is filed in a state other than Iowa, the limited partnership or limited liability limited partnership has received notification from the Iowa secretary of state that the application for certificate of authority has been approved and no notice of cancellation has been filed by the limited partnership or the limited liability limited partnership. Yes ri No My business is a limited liability company whose certificate of organization is filed in Iowa and has not filed a statement of termination. Yes E No My business is a limited liability company whose certificate of organization is filed in a state other than Iowa, has received a certificate of authority to transact business in Iowa and the certificate has not been revoked or canceled. RB-2 4463.016/City Contract No. 1067 ag ce W O WZ O to F-- LLI ZQ • o u- Lu mZ U W H Z 5O 0 a. Z 0 Z Prime Contracto a) N c aoa) Z 0_ R3 .0 0 ate o fl E •-'O O c D 0 O 0 et O Q a) O) o 'fir Cfn L a) on - O c c0 C LL O'( .=_a a) ,Q W Wm c 1112) W W m mww mm 002 '5-0o • +r U) U co Cr RI 0 - cO o o U U '1 N Em-L -EtO @ O • c �Et uio 0 CO "C O+L.. 0 C ov- ICS 2 o 0 O U U 0) O'a 0 0 11 2 U (2 Uo� O ® E c +-C,. a) O • 'O v- D 0 °� ccr EA0 � ,E�n fl = c 0 E' -c -o o c= C (04O c 0 o) .O 73 1 0 U (0 4c 0 a_ 0 a. 73 C (an -O a) }' E O Q) � A 3 a) (ti 0 0 a ;a 73 a N .-- O W U 2" C U 0 o a) uj E U a. 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O C= O `t o E0 3LN-c> ..a 4-73' Q) 0_ O L (I) acn)•- U 0�4- cn0•Qo O L c0 CUo coon) U ° U -O o (6 (a c Egym . - (0 .«c 0 -- ao�omm)oo W o WWomo't-c.� mCv)Z_pa.Q o G L G a (0 .Q U 'O a) � �� o �w U a) tow _c C 0 0 C O •� c E 0 a] Q O a 0 13 a) 0 0 Q E business for a subcontract. RS 73 a) SW }' }' U (6), U +' -0 O C [3:B Q.o U (!)-(Y).13 U�•-�cn ow-5o Eai`�a Lc'> O O o 0 Li_ C cn 'O U) O0 4-4 w E 0) O O . L Oj C 4- CW•- u) C0-E o W O m .- Q a)� aW rn a)0L (a�'LW E lE>+Dw-o� c O•c U u) i -c O vi ( 3 c O O N. W 0 cm Section M-5 z 0 D Z 0 0 N • O 00 OOP Z O 0 H O `e 00 O U m th E 11ti 4463.016/City Contract No. 1067 w0 VJ 0 U 1— Z co 0 cn L1.. w Z Z 1— rfai Ln b er Ca CO 2 LL a. CO 0 0) c U c Prime Contractor Name: (0 0 Vice President Contractor Signature: 0 -O O 0 c Q) L O -0 O O w c 0) O 0 O (0 Q) L O CT c • Q .c a) O 33 j (0 O L o sc Q) O > a) o • o U c Q) o Q O 0) a) 0 47-1(0 O • (7) E c O O c_ a) u) O '— O L 0) : >, - _0 O 0 D fl O � c 0 L a] O a) 0--0 ) CO L 0 CO U >-- 0 U `- J o ca U a. ct 0 U ce z 0 m 0 0 U c Q 0 0 U (0 c 0 a) cn } c0 Q (I) L 0 a) c 4C" CO c w to a (0 (1 O COLLI a) CO 0 m 0 0 E 0 O >' c a-, U c uC• ) O C uO Li_ O co ..c (0 U) O C 0 0 0 J 0 op -O (0 c u) O • c O Uo Q) a) L a 2 O 0 Q -4-1 O a) _c >= o • W co c O c O O • c co O LW'" (3 / Oa E • _L 0 0 ..c a) O O E O -(7) 4_-7- _ E ca w Oj,-0m L O a) O 0 O O ) a. 0.) 0 -O -0c0 COCY a) a) _4 (0 CO : 0 0 > 0 o ,- c0 (0 E O L 0) a) U c 0 U a) O c � co Q) Q) a) L E tic) 0 a) 4-4 (DC .c (1 O O C E) Z) a3 c0 E 0 L 1D Q 0) c no M W CO a) (0 C Q) 4-0 4J c 0) a) c 4-- 0) 0 U 0 4J c a] !0 0 (0 4-0 c L 0 _c O 0) c0 0 (0 c a) 112) NNDI] u) . 0 ix Z. u© m • E2 Z O I- I Z O W L• _ rio LL 0 W 'Z O u D_1 E] Quotes Received Quotation used in bid lar Amount be Subcont 0 Dates Contacted Dates Contacted Yes/No 0 O 0 7 7 1 N vD 6/26/23 6/26/23 MBE/WIBE Subcontractors Culpepper Electric DC Corporation Carter Electric 0 z 0 0 z D CONTACT m 3- 0 z U 4c 0 r M CD SRF Required Front -End Specifications PLEASE NOTE: Attachment 10 is a new program requirement and is effective for all SRF projects bid after January 2021. Attachment 1: Attachment 2: Certification of Non -Segregated Facilities Form (to be completed and signed by Prime Contractor and submitted with the bid) SRF STATE REVOLVING FUND Statement in Advertisement for Bids on Debarment and Suspension/Certification Regarding Debarment and Suspension Form (to be completed and signed by Prime Contractor and submitted with the hid) Attachment 3: Disadvantaged Business Enterprise Certification Form (to he completed and signed by Pnme Contractor and submitted with the hid) Attachment 4: DBE Program Subcontractor Performance Form (to be completed and signed by Prime and DBE Subcontractor for each subcontract and submitted with the bid) Attachment 5: Attachment 6: Attachment 7: Attachment 8: Attachment 9: Attachment 10: DBE Program Subcontractor Utilization Form (to be completed and signed by Prime Contractor and submitted with the bid) DBE Program Subcontractor Participation Form (for voluntary use of DBEs) Other Federal Requirements Language A. Standard Equal Employment Opportunity Specifications B. Federal Labor Standards Provisions (including Davis -Bacon prevailing wage rates**) C. Preservation of Open Competition and Government Neutrality D. Historical and Archeological Finds E. Prohibitions on Procurement from Violating Facilities Right of Entry and Records Retention Use of American Iron and Steel Prohibition on Certain Telecommunications and Video Surveillance Services or Equipment (to be completed and signed by Prime Contractor and submitted with the bid) **The Davis Bacon wage determination received from the Iowa Finance Authority must also be included in the front-end specifications. Section SRF-1 4463.016/City Contract No. 1067 INVESTING IN IOWA'S WATER www.iowasrf.conm Attachment 1 SRF Required Front -End Specifications (This form must be completed and signed by Prime Contractor and submitted with the bid) U.S. Environmental Protection Agency Certification of Non -Segregated Facilities (Applicable to contracts, subcontracts, and agreements with applicants who are themselves performing federally assisted construction contracts, exceeding $10,000 which are not exempt from the provisions of the Equal Opportunity clause.) By the submission of this bid, the bidder, offeror, applicant, or subcontractor certifies that he does not maintain or provide for his employees any segregated facilities at any of his establishments, and that he does not permit his employees to perform their services at any location, under his control, where segregated facilities are maintained. He certifies further that he will not maintain or provide for his employees any segregated facilities at any of his establishments, and that he will not permit his employees to perform their services at any location, under his control, where segregated facilities are maintained. The bidder, offeror, applicant, or subcontractor agrees that a breach of this certification is a violation of the Equal Opportunity clause in this contract. As used in this certification, the term "segregated facilities" means any waiting rooms, work areas, restrooms and washrooms, restaurants and other eating areas, time clocks, locker rooms and other storage or dressing areas, parking Tots, drinking fountains, recreation or entertainment areas, transportation, and housing facilities provided for employees which are segregated by explicit directive or are in fact segregated on the basis of race, creed, color or national original, because of habit, local custom, or otherwise. He further agrees that (except where he has obtained identical certifications from proposed subcontractors for specific time periods) he will obtain identical certifications from proposed subcontractors prior to the award of subcontracts exceeding $10,000 which are not exempt from the provisions of the Equal Opportunity clause; that he will retain such certifications in his files; and that he will forward the following notice to such proposed subcontractors (except where the proposed subcontractors have submitted identical certifications for specific time periods): NOTICE TO PROSPECTIVE SUBCONTRACTORS OF REQUIREMENT FOR CERTIFICATIONS OF NON -SEGREGATED FACILITIES A Certification of Non -segregated Facilities, as required by the May 9, 1967, order (33 F.R. 7808, May 28, 1968) on Elimination of Segregated Facilities, by the Secretary of Labor, must be submitted prior to the award of a subcontract exceeding $10,000 which is not exempt from the provisions of the Equal Opportunity clause. The certification may be submitted either for each subcontract or for all subcontracts during a period (i.e., quarterly, semiannually, or annually). Signature frivvh 7/6/23 Date Bruce Marsh Vice President Name and Title of Signer (Please Type) NOTE: The penalty for making false statements in offers is prescribed in 18 U.S.C. 1001. EPA-7 5720-4.2 Section SRF-2 4463.016/City Contract No. 1067 Attachment 2 SRF Required Front -End Specifications (This form must be completed and signed by the Prime Contractor and submitted with the bid) Debarments and Suspensions Any bidder or equipment supplier whose firm or affiliate is listed in on the U.S. General Services Administration Excluded Parties List will be prohibited from the bidding process. The excluded parties records search engine is located at the System for Award Management (SAM) website: https://www.sam.qov/SAM/. Pursuant to 2 CFR Part 180, as supplemented by 2 CFR 1532, any entity submitting a bid while the SAM website lists that entity as having an active exclusion will be determined by the DNR to be a non -responsive bidder and will not be able to receive SRF funding. United States Environmental Protection Agency Washington, DC 20460 Certification Regarding Debarment, Suspension, and Other Responsibility Matters The prospective participant certifies to the best of its knowledge and belief that it and the principals: (a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency; (b) Have not within a three year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State, or local) transaction or contract under a public transaction: violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; (c) Are not presently indicted or otherwise criminally or civilly charged by a government entity (Federal, State, or local) with commission of any of the offenses enumerated in paragraph (1) (b) of this certification; and (d) Have not within a three-year period preceding this application/proposal had one or more public transactions (Federal, State, or local) terminated for cause or default. I understand that a false statement on this certification may be grounds for rejection of this proposal or termination of the award. In addition, under 18 U SC Sec. 10 01, a false statement may result in a fine of up to $10,000 or imprisonment for up to 5 years, or both. Bruce Marsh Vice President Typed Name 3Title of Authorized Representative Signature of Authorized Representative 7/6/23 Date I am unable to certify to the above statements. My explanation is attached. Section SRF-3 4463.016/City Contract No. 1067 Attachment 3 SRF Required Front -End Specifications (This form must be completed and signed by Prime Contractor and submitted with the bid) Disadvantaged Business Enterprise (DBE) Solicitation It is EPA's policy that recipients of EPA financial assistance through the State Revolving Fund programs award a "fair share" of subagreements to small, minority and women -owned businesses, collectively know as Disadvantaged Business Enterprises (DBEs). Iowa's Fair Share goals are: Minority Enterprise -Owned (MBE) Business Goal Women Enterprise -Owned (WBE) Business Goal Construction 1.7% 2.2% Supplies 0.6% 5.6% Services 2.5% 11.3% Goods/Equipment 2.5% 10.4% Average 1.8% 7.4% Only work performed by certified DBEs can be counted toward the goals. In Iowa, DBEs must be certified through the Iowa Department of Transportation (IDOT). Information on certification requirements and a list of certified DBEs is on the IDOT website at https://secure.iowadot.qov/DBE/Home/Index/. Prime contractors' DBE requirements for SRF projects include: • Taking affirmative steps for DBE participation • Documenting the efforts and the proposed utilization of certified DBEs PROJECT INFORMATION SRF Applicant: Bidder: WRH, Inc. Address: 1648 T Ave South Amana IA 5234 Contact Person: Bruc Marsh Signature: Phone Number: 319-622-3816 ...AAN E-Mail Address: bmarsh@wendlerinc.com Check if Prime Contractor is: ❑ Minority -Owned ❑ Women -Owned Section SRF-4 4463.016/City Contract No. 1067 GOOD FAITH EFFORTS CHECKLIST Please complete the checklist to determine if you have complied with the requirement to make good faith efforts to ensure that certified DBEs have the opportunity to compete for procurements funded by EPA financial assistance funds. Bidders/offerors must make good faith efforts prior to submission of bids/proposals. 1. Did you ensure that DBEs are made aware of contracting opportunities to the fullest extent practicable through outreach and recruitment activities? ❑ Yes ❑ No 2. Did you make information on forthcoming opportunities available to DBEs and arrange time frames for contracts and establish delivery schedules, where the requirements permit, in a way that encourages and facilitates participation by DBEs in the competitive process? This includes, whenever possible, posting solicitation for bids or proposals for a minimum of 30 calendar days before the bid or proposal closing date. ❑ Yes ❑ No 3. Did you consider in the contracting process whether firms competing for large contracts could subcontract with DBEs? This will include dividing total requirements, when economically feasible, into smaller tasks or quantities to permit maximum participation by DBEs in the competitive process. ❑ Yes ❑ No 4. Did you encourage contracting with a consortium of DBEs when a contract is too large for one of these firms to handle individually? ❑ Yes ❑ No 5. Did you use the services of the Small Business Administration and the Minority Business Development Agency of the Department of Commerce to identify potential subcontractors? I-1 Yes II No 6. List the potential DBE subcontractors that were contacted. Only list those that are certified through the Iowa Department of Transportation. Name How (e.g. call, Contacted letter, fax, e-mail) phone Response not interested, (e.g. not did not competitive) respond, Carter Electric email no bid Culpepper Electric email no bid DC Corp email no bid PROPOSED UTILIZATION OF DBE SUBCONTRACTORS Please include Attachments 4 and 5 to document the proposed utilization of certified DBE subcontractors. Section SRF-5 4463.016/City Contract No. 1067 CONTRACT ADMINISTRATION PROVISIONS Several contract provisions are required to prevent unfair practices that adversely affect DBEs. These include: 1. Prime Contractor must pay its Subcontractor for satisfactory performance no more than 30 days from the Prime Contractor's receipt of payment from the SRF loan recipient. 2. Prime Contractor must notify the SRF loan recipient in writing prior to termination of a DBE subcontractor for convenience. 3. Prime Contractor must employ the six Good Faith Efforts to solicit a replacement subcontractor if a DBE subcontractor fails to complete work under a subcontract for any reason. Section SRF-6 4463.016/City Contract No. 1067 Attachment 4 SRF Required Front -End Specifications (This form must be completed and signed by Prime and DBE Subcontractor for each subcontract and submitted with the bid) Disadvantaged Business Enterprise Program DBE Subcontractor Performance Form This form is intended to capture the DBE1 subcontractor's2 description of work to be performed and the price of the work submitted to the prime contractor. An EPA Financial Assistance Agreement recipient must require its prime contractor to have its DBE subcontractors complete this form and include all completed forms in the prime contractor's bid or proposal package. Subcontractor Name Project Name Bid/Proposal No. Assistance (if known) Agreement ID No. Point of Contact Address Telephone No. Email Address Prime Contractor Name Issuing/Funding Entity Contract Number Item Description Construction, of Work Submitted Services, to the Equipment Prime Contractor or Supplies Involving Price the of Prime Work Submitted Contractor to DBE Certified by DOT SBA Meets/exceeds EPA certification standards? Other: YES NO Unknown 1A DBE is a Disadvantaged, Minority, or Woman Business Enterprise that has been certified by an entity from which EPA accepts certification as described in 40 CFR 33.204-33.205 or certified by EPA. EPA accepts certifications from entities that meet or exceed EPA certification standards as described in 40 CFR 33.202. 2Subcontractor is defined as a company, firm, joint venture, or individual who enters into an agreement with a contractor to provide services pursuant to an EPA award of financial assistance. IASRF6100-3 DBE Subcontractor Performance Form — Page 1 Section SRF-7 4463.016/City Contract No. 1067 Disadvantaged Business Enterprise Program DBE Subcontractor Performance Form I certify under penalty of perjury that the forgoing statements are true and correct. Signing this form does not signify a commitment to utilize the subcontractors above. I am aware of that in the event of a replacement of a subcontractor, I will adhere to the replacement requirements set forth in 40 CFR Part 33 Section 33.302 (c). Prime Contractor Signature Print Name 4y . 7 / - Bruce Marsh Date Title Vice President 7/6/23 Subcontractor Signature Print Name Title Date IASRF6100-3 DBE Subcontractor Performance Form — Page 2 Section SRF-8 4463.016/City Contract No. 1067 Attachment 5 SRF Required Front -End Specifications (This form must be completed and signed by Prime Contractor and submitted with the bid if utilizing DBE subcontractors) Disadvantaged Business Enterprise Program DBE Subcontractor Utilization Form This form is intended to capture the prime contractor's actual and/or intended use of identified certified DBE1 subcontractors2 and the estimated dollar amount of each subcontract. An EPA Financial Assistance Agreement Recipient must require its prime contractors to complete this form and include it in the bid or proposal package. Prime contractors should also maintain a copy of this form on file. Prime Contractor WRH, Inc Name Project Clarifier Name No. 3 Bid/Proposal No. Assistance (if known) Agreement ID No. Point of Contact Address 1648 T Ave South Amana, IA 52334 Telephone No. 319-622-3816 Email Address bmarsh@wendlerinc.com Issuing/Funding Entity I have identified potential DBE certified subcontractors YES X NO If yes, please complete the table below. If no, please explain: Name/Company Subcontractor Name Company Address/Phone/Email Estimated Amount Dollar Currently Certified? DBE Continue on back if needed 'A DBE is a Disadvantaged, Minority, or Woman Business Enterprise that has been certified by an entity from which EPA accepts certification as described in 40 CFR 33.204-33.205 or certified by EPA. EPA accepts certifications from entities that meet or exceed EPA certification standards as described in 40 CFR 33.202. 2Subcontractor is defined as a company, firm, joint venture, or individual who enters into an agreement with a contractor to provide services pursuant to an EPA award of financial assistance. IASRF6100-4 DBE Subcontractor Utilization Form — Page 1 Section SRF-9 4463.016/City Contract No. 1067 Disadvantaged Business Enterprise Program DBE Subcontractor Utilization Form I certify under penalty of perjury that the forgoing statements are true and correct. Signing this form does not signify a commitment to utilize the subcontractors above. I am aware of that in the event of a replacement of a subcontractor, I will adhere to the replacement requirements set forth in 40 CFR Part 33 Section 33.302 (c). Prime Contractor Signature Print Name g.t/Vk Bruce Marsh Title Date Vice President 7/6/23 IASRF6100-4 DBE Subcontractor Utilization Form — Page 2 Section SRF-10 4463.016/City Contract No. 1067 Attachment 6 SRF Required Front -End Specifications (This form is for the voluntary use of DBE Subcontractors) Disadvantaged Business Enterprise Program DBE Subcontractor Participation Form An EPA Financial Assistance Agreement Recipient must require its prime contractors to provide this form to its DBE subcontractors. The use of this form by DBE subcontractors is voluntary and is not required for bidding. This form gives a DBE1 subcontractor2 the opportunity to describe work received and/or report any concerns regarding the EPA - funded project (e.g. in areas such as termination by prime contractor, late payments, etc.). The DBE subcontractor can, as an option, complete and submit this form to the EPA DBE Coordinator at any time during the project period of performance. Subcontractor Name Project Name Bid/Proposal No. Assistance (if known) Agreement ID No. Point of Contact Address No. Address Telephone Email Prime Contractor Name Issuing/Funding Entity Contract Number Item Description of Construction, Work from the Prime or Contractor Supplies Involving Amount Prime by Received Services, Received Contractor Equipment 1A DBE is a Disadvantaged, Minority, or Woman Business Enterprise that has been certified by an entity from which EPA accepts certification as described in 40 CFR 33.204-33.205 or certified by EPA. EPA accepts certifications from entities that meet or exceed EPA certification standards as described in 40 CFR 33.202. 2Subcontractor is defined as a company, firm, joint venture, or individual who enters into an agreement with a contractor to provide services pursuant to an EPA award of financial assistance. IASRF6100-2 DBE Subcontractor Participation Form — Page 1 Section SRF-11 4463.016/City Contract No. 1067 Disadvantaged Business Enterprise Program DBE Subcontractor Participation Form Please use the space below to report any concerns regarding the above EPA -funded project: Subcontractor Signature Print Name Date Title Return to: Regional Coordinator, Small Business Utilization, U.S. Environmental Protection Agency, Region 7, 11201 Renner Blvd., Lenexa, KS 66219 IASRF6100-2 DBE Subcontractor Participation Form — Page 2 Section SRF-12 4463.016/City Contract No. 1067 Attachment 10 SRF Required Front -End Specifications (This form must be completed and signed by Prime Contractor and submitted with the bid) PROHIBITION ON CERTAIN TELECOMMUNICATIONS AND VIDEO SURVEILLANCE SERVICES OR EQUIPMENT This term and condition implements 2 CFR 200.216 and is effective for obligations and expenditures of EPA financial assistance funding on or after 8/13/2020. EPA recipients and subrecipients, including borrowers under EPA funded revolving loan fund programs, are prohibited from obligating or expending loan or grant funds to: (a) Procure or obtain, extend or renew a contract to procure or obtain; (b) Enter into a contract (or extend or renew a contract) to procure; or (c) Obtain the equipment, services, or systems that use "covered telecommunications equipment or services" identified in the regulation as a substantial or essential component of any system, or as critical technology as part of any system. Certain equipment, systems, or services, including equipment, systems, or services produced or provided by entities subject to the prohibition are recorded in the System for Award Management exclusion list, website: https://www.sam.qov/SAM/. (1) As described in Public Law 115-232, section 889, covered telecommunications equipment or services includes: (i) Telecommunications equipment produced by Huawei Technologies Company or ZTE Corporation (or any subsidiary or affiliate of such entities). (ii) For the purpose of public safety, security of government facilities, physical security surveillance of critical infrastructure, and other national security purposes, video surveillance and telecommunications equipment produced by Hytera Communications Corporation, Hangzhou Hikvision Digital Technology Company, or Dahua Technology Company (or any subsidiary or affiliate of such entities). (iii) Telecommunications or video surveillance services provided by such entities or using such equipment. (iv) Telecommunications or video surveillance equipment or services produced or provided by an entity that the Secretary of Defense, in consultation with the Director of the National Intelligence or the Director of the Federal Bureau of Investigation, reasonably believes to be an entity owned or controlled by, or otherwise connected to, the government of a covered foreign country. (2) Consistent with 2 CFR 200.471, costs incurred for telecommunications and video surveillance services or equipment such as phones, internet, video surveillance, and cloud servers are allowable except for the following circumstances: (i) Obligating or expending EPA funds for covered telecommunications and video surveillance services or equipment or services to procure (enter into, renew or extend contracts) or obtain the equipment, services, or systems as described in 2 CFR 200.216. understand the above prohibitions and certify that the project will be in compliance with all the requirements. Bruce Marsh Vice President Typed Name & Title of Authorized Representative Signature of Authorized Representative Section SRF-34 4463.016/City Contract No. 1067 7/6/23 Date BID BOND KNOW ALL MEN BY THESE PRESENTS, that we, WRH, Inc. as Principal, and Merchants Bonding Company (Mutual) as Surety are held and firmly bound unto the CITY OF WATERLOO , Iowa, hereinafter called "OWNER." In the penal sum Five Percent (5%) of the Total Amount Bid Dollars ($ 50A ) 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 6th day of July 2023 , for F.Y. 2023 Wastewater Treatment Plant Final Clarifier No. 3 Rehabilitation, Contract No. 1067, Waterloo, Iowa 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 26th day of June , A.D. 20 23 . Witness WRH, Inc. (Seal) Principal By Rvc.£ Pmas `^ (Title) lit [C Par»4 p,4 Merchants Bonding Company (Mutual) (Seal) Surety (1))W By Attorney -in -fact Cindy Bennett BID BOND Section BB-1 4463.016/City Contract No. 1067 STATE OF IOWA '•. 1~`f COUNTY OF DALLAS ss. On this 24th day of J anuary 2023 , before me appeared Larry Taylor, to me personally known, who being by me duly sworn did say that he is President of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC.; and that the seals affixed to the foregoing instrument are the Corporate Seals of the Companies; and that the said instrument was signed and sealed in behalf of the Companies by authority of their respective Boards of Directors. M ERCHANTS�+� BONDING COMPANY, POWER OF ATTORNEY Know All Persons By These Presents, that MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC., both being corporations of the State of Iowa, d/b/a Merchants National Indemnity Company (in California only) (herein collectively called the "Companies") do hereby make, constitute and appoint, individually, Anne Crowner, Ben Williams; Brian M Deimerty; Cameron M Burt; Cindy Bennett Craig E Hansen; D Gregory Stitts; Dione R Young; Donald E Appleby; Douglas Muth; Ginger Hoke; Grace Rasmussen; Greg Krier; J ames A Holter; J ay D Freiermuth; J ennifer Marino; J essica J can Rini; J essie Allen; J oe Tiernan; J ohn Cord; Kate Zanders; Mark R DeWitt; Mark Sweigart; Michelle R Gruis; Sara Huston; Sarah C Brown; Seth D Rooker; Stacy Venn; Tim McCulloh; Todd Bengford; W R Withrow their true and lawful Attorney(s)-in-Fact, to sign its name as surety(ies) and to execute, seal and acknowledge any and all bonds, undertakings, contracts and other written instruments in the nature thereof, on behalf of the Companies in theft business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. This Power -of -Attorney is granted and is signed and sealed by facsimile under and by authority of the following By -Laws adopted by the Board of Directors of Merchants Bonding Company (Mutual) on April 23, 2011 and amended August 14, 2015 and adopted by the Board of Directors of Merchants National Bonding, Inc., on October 16, 2015. "The President, Secretary, Treasurer, or any Assistant Treasurer or any Assistant Secretary or any Vice President shall have power and authority to appoint Attorneys -in -Fact, and to authorize them to execute on behalf of the Company, and attach the seal of the Company thereto, bonds and undertakings, recognizances, contracts of indemnity and other writings obligatory in the nature thereof." "The signature of any authorized officer and the seal of the Company may be affixed by facsimile or electronic transmission to any Power of Attorney or Certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligations of the Company, and such signature and seal when so used shall have the same force and effect as though manually fixed." In connection with obligations in favor of the Florida Department of Transportation only, it is agreed that the power and aut hority hereby given to the Attorney -in -Fact includes any and all consents for the release of retained percentages and/or final estimates on engineering and construction contracts required by the State of Florida Department of Transportation. It is fully understood that consenting to the State of Florida Department of Transportation making payment of the final estimate to the Contractor and/or its assignee, shall not relieve this surety company of any of its obligations under its bond. In connection with obligations in favor of the Kentucky Department of Highways only, it is agreed that the power and authority hereby given to the Attorney -in -Fact cannot be modified or revoked unless prior written personal notice of such intent has been given to the Commissioner - Department of Highways of the Commonwealth of Kentucky at least thirty (30) days prior to the modification or revocation. In Witness Whereof, the Companies have caused this instrument to be signed and sealed this 24th day of J anuary , 2023 ,•ARP00*• ••� . • Viz:? -o- vim 'a• NMI :z- z 2003 ;;,4) - 0 • • ••�GR C• p,.•.O,,9• OP 099, •�� • • • z• 3• • y• 1933 ••• )i ••• • b • MERCHANTS BONDING COMPANY (MUTUAL) MERCHANTS NATIONAL BONDING, INC. d/b/a MERCHANTS NATIONAL INDEMNITY COMPANY By Kim Lee Crmrnisson Number 702737 My GmmissKon Expres April 14, 2024 Notary Public (Expiration of notary's commission does not invalidate this instrument) I, William Warner, Jr., Secretary of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC., do hereby certify that the above and foregoing is a true and correct copy of the POWER -OF -ATTORNEY executed by said Companies, which is still in full force and effect and has not been amended or revoked. In Witness Whereof, I have hereunto set my hand and affixed the seal of the Companies ••••••. •• • �\N6 CO• • ,.. •• S.. �P09••oq• 4'; c, "9A •• ..Z. • • r2-'? -0- C ^• ',,*00.**r♦♦ 444* •110 Nq� ••• • ♦ • : y;G0RPOft4 . o ; Z.? -0- o:o v•: 2003 7,0 :�., ♦ •♦#•••.••....... , 4••♦ Ar • z• : 3• y, 1933 • •c • '��• • • •••• • o•• )'i.. ••• on this 26th day of June , 2023 . Secretary POA 0018 (10/22)