HomeMy WebLinkAboutLodge Construction, Inc. �j
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BID BOND
KNOW ALL MEN BY THESE PRESENTS , that we , Lodge Construction, Inc.
as Principal , and Swiss Re Corporate Solutions America Insurance Corporation as Surety, are held and firmly
bound unto the CITY OF WATERLOO Iowa , hereinafter called "OWNER. " In the penal sum
Five Percent of the Total Amount Bid Dollars ($ 5% ) lawful money of
the United States , for the payment of which sum will and truly be made , we bind ourselves , our heirs, executors ,
administrators, and successors , jointly and severally, firmly by these presents. The condition of this obligation is
such that whereas the Principal has submitted the accompanying bid dated the 27th day of
July , 20 23 , for F.Y. 2024 W Airline Hwy Railroad Crossing Repair, Contract No. 1090, 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 18th day of July , A. D . 20 23
N �
Lodge Construction, Inc. (Seal)
Principal
By �s,�r�.�:a� ✓
(Title)
011111111ISwissRe
Oran
Solutions America Insurance Corporation . "%�,ONSAMERy/Vo ,
v, ,��� ` �yo�GOPP•Q RgTq�2s
1 n s Sy/ret goo F. � '
B L ;
By
Witness Sara 1-lukoK Attorney- n-fact1973 ' ate;'
Amy HL nh itness to Surety a\446 , o°
BID BOND S/MS rr*r �004 1
SWISS RG CORPORATE SOLUTIONS
SWISS RE CORPORATE SOLUTIONS AMERICA INSURANCE CORPORATION ("SRCSAIC")
SWISS RE CORPORATE SOLUTIONS PREMIER INSURANCE CORPOkKI'ION ("SRCSPIC')
WEST PORI' INSURANCE CORPORATION ("WIC")
GENERAL POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS, THAT SRCSAIC, a corporation duly organized and existing under laws of the Stale of Missouri, and
having its principal office in the City of Kansas City, Missouri, and SRCSPIC, a corporation organized and existing under the laws of the State of
Missouri and having its principal office in the City of Kansas City, Missouri, and WIC, organized under the laws of the State of Missouri, and having its
principal office in the City of Kansas City, Missouri, each (foes hereby make, constitute and appoint:
JAY D. FREIERMUTH, CRAIG E. HANSEN, BRIAN M. DEIMERLY, CINDY BENNETT, ANNE CROWNER, TIM McCULLOH, STACY VENN,
DIONE R. YOUNG, STACIE CHRISTENSEN, SETH ROOKER, JENNIFER MARINO, JOSEPH TIERNAN, KATE ZANDERS, and SARA HUSTON
JOINTLY OR SEVERALLY
Its true and lawful Attorney(s)-in-Fact, to make, execute, seal and deliver, for and oil its behalf and as its act and deed, bonds or other writings
obligatory in the nature of a bond on behalf of each of said Companies, as surety, on contracts of suretyship as are or may be required or permitted by
law, regulation, contract or otherwise, provided that no bond or undertaking or contract or suretyship executed tinder this authority shall exceed the
amount of:
ONE HUNDRED TWENTY FIVE MILLION ($ 125,000,000.00) DOLLARS
This Power of Attorney is granted and is signed by facsimile under and by the authority of the following Resolutions adopted by the Boards of
Directors of both SRCSAIC and SRCSPIC at meetings duly called and held on the 18th of November 2021 and WIC by written consent of its
Executive Committee dated July 18, 2011 .
"RESOLVED, that any two of the President, any Managing Director, any Senior Vice President, any Vice President, the Secretary or any Assistant
Secretary be, and each or any of them hereby is, authorized to execute a Power of Attorney qualifying the attorney named iu the given Power of
Attorney to execute on behalf of the Corporation bonds, undertakings and all contracts of surety, and that each or any of them hereby is authorized to
attest to the execution of any such Power of Attorney and to attach therein the seal of the Corporation; and it is
FURTHER RESOLVED, that the signature of such officers and the seal of the Corporation may be affixed to any such Power of Attorney or to
any certificate relating thereto by facsimile, and any such Power of Attorney or certificate bearing such facsimile signatures or facsimile seal shall be
binding upon the Corporation when so affixed and in the future with reeard to anv bond, undertaking or contract of surety to which it is attached."
....Jt\OnSItootsoi, q�. •S\ONS Pato ZF t.o
.'y°:oAPORAr Esol,c °�y6 so?o R,q•. ,psg , ,\ �- PP��tp
to c, 11'•x+ 4` •.,• : ° 1F; .\6 • Bycot �¢1 Lkjjj
WS L A Erlk Jansiens, fSRC Vire President r tet Pr SA1C of WICr Vitt Pr¢[idenl
O•. Jig . AS E A ofSRCSOPICRSenpior Vice President of WIC
t s ,d> 7973 \ . °s� s., oba, 1 .1A yngw M 464 Ft r
'•,, ,PS .lSSOU .• da .' ''.to V 40'IssOJP: „ B rr (l644000
'..�4150414q, 1N0�1"` "•.'r�TIS • NOex Y i
„ „ * . Gerald Jagrosyski, Vice President of SR"AIC & Vire President ofSHcSPIc I
& Vice President of WIC
IN WITNESS WHEREOF, SRCSAIC, SRCSPIC, and WIC have caused their official seals to be hereunto affixed, and these presents to be signed by their
authorized officers
this 17TH day of JANUARY 20 23
Swiss Re Corporate Solutions America Insurance Corporation
State of Illinois Swiss Re Corporate Solutions Premier Insurance Corporation
County of Cook ElWestport Insurance Corporation
On this 17TH day of JANUARY 20 23 , before me, a Notary Public personally appeared Erik Janssens , Senior Vice Presidcn( of SRCSAIC
and Senior Vice President of SRCSPIC and Senior Vice President of WIC and Gerald Jaerowski , Vice President of SRCSAIC and Vice President of
SPCSPIC and Vice President of WIC, personally known to nue, who being by me duly sworn, acknowledged that they signed the above Power of Attorney
as officers of and acknowledged said instrument to be the voluntary act and deed of their respective companies.
J14RI"NA AMNIWO
YM)Kt ), WAVE gFU OR
�- � tL'I�rbi�trMwGO
1, Jeffrey Goldberg, the duly elected Senior Vice President and Assistant Secretary of SRCSAIC and SRCSPIC and WIC, do hereby certify that the above and
foregoing is a Ince and correct copy of a Power of Attorney given by said SRCSAIC and SRCSPIC mrd WIC, which is still in fill force and effect.
IN WITNESS WHEREOF, I have set my hand and affixed the seals of the Companies this— g}Ltday of July 2023 .
Jeffrey Goldberg, Senior Vice President &
Assistant Secretary of SRCSAIC and
SRCSPIC and WIC
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FORM OF BID OR PROPOSAL
F.Y. 2024 W AIRLINE HWY RAILROAD CROSSING REPAIR
CONTRACT NO. 1090
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 ;fA ,
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. 2024 W AIRLINE HWY
RAILROAD CROSSING REPAIR, Contract No. 1090, all in accordance with the above-listed documents and for the
unit prices for work in place for the following items and quantities:
F .Y. 2024 W AIRLINE HWY RAILROAD CROSSING REPAIR
CONTRACT NO. 1090
BID EST. UNITBID TOTALBID
ITEM IDOT ITEM NO, ITEM DESCRIPTION UNIT QTY PRICE PRICE
1 2102-2710090 EXCAVATION, CLASS 10 - WASTE CY 40.0 $ $ / P0
2 2510-6745850 REMOVAL OF PAVEMENT SY 230. 3 $ $ 3qA<s
3 2515-6745600 REMOVAL OF PAVED DRIVEWAY SY 63.0 $ aS' — $
4 2502-8215806 SUBDRAIN TILE, 6- INCH LF 95. 0 $ $ a d �0
5 2502-8221305 SUBDRAIN OUTLET, DR-305 EA 2.0 $ 300 $ 6610
6 2115-0100010 MODIFIEDSUBBASE CY 80.0 $ 70 $ 5; GoU
7 2121-7425020 GRANULAR SHOULDERS, TYPE TON 10.0 $ 35- $ 35-0
8 2315-8275055 SURFACING, DRIVEWAY TON 27. 1 $ 406 " $ 5-1 o20
9 2122-5190010 PAVED SHOULDER, PCC, 10- INCH SY 22.7 $ S0 $ Z YK
_
10 2517-4225210 RAILROAD APPROACH SECTION, PCC SY 62. 5 $ �W0 '_ $ /a SU0 "
11 2301- 1033100 STANDARD/SLIP- FORM PCC PAVEMENT, CLASS SY 167.7 _
C, CLASS 3 DURABILITY, 10-INCH $ D $
12 2529-2242304 CDJOINTASSEMBLY EA 4. 0 $ g00 $ 0 000 '
13 2529-8201000 JOINTASSEMBLY, EF EA 2.0 $ / aSU " $ Dig
14 2527-9263109 PAINTMARKINGS, SOLVENT OR WATER-BOURNE STA 5. 14 $ A5-0 $ ic2 Y-L
15 2528-8445110 TRAFFIC CONTROL LS 1.0 $ 00G ' $ 000
16 2528-2518000 SAFETY CLOSURE EA 3. 0 $ JOU '- $ aleirl '
17 25334980005 MOBILIZATION LS 110 $ $' 06i0 ` $ 5' 006
TOTAL BID
FORM OF BID CONTRACT NO, 1090 Page 1 of 3
Z 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 .
4 . Security in the sum of s Ya Dollars ($_
) in the form of [{epwuA ' 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 Bidder Status Form.
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, 1090 Page 2 of 3
(Name of Bidder) (Date)
BY: - Title /z
O ial Address: (Including Zip Code):
Cl� � I's� i lR F � s o � 1c
I . R.S. No. ! I?�(✓v ���
FORM OF BID CONTRACT NO, 1090 Page 3 of 3
i
NON-COLLUSION AFFIDAVIT OF PRIME BIDDER
State of �� )
County of l� /mac t )ss ft��*- )
ILI. SL tt vv being first duly sworn , deposes and says that:
1 . He is (Owner, Partner. Off ic r, Reoresenta ' 2, or Agent) of
, the Bidder tha a& 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 ;
34 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)
s � j 4c, —
Title
Subscribed and sworn to before me this 77 day of (:LZe 2Q,23
title
My commission expires Z /, Z .542
oeiei LINDA KSENN
o rn COMMISSION NO. 803307
w ' My COMMISSION EXPIRES
*IOWA*
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 forfurther contracts in accordance with procedures authorized by the City Council,
7. 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)
, (A��p``propriate Official)
� TiS k vee 4oZ2 �3
(Title) (Date)
i
Bidder Status Form
To be completed by all bidders Part A
aPie a answer "Yes" or "No" for each of the following :
9xes
b1s 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).
es ONo My company has an office to transact business in Iowa.
ONo My company's office in Iowa is suitable for more than receiving mail , telephone calls, and e-mail,
s ONo My company has been conducting business in Iowa for at least 3 years prior to the first request for
JX
bids on this project.
Yes ONo My company is not a subsidiary of another business entity or my company is a subsidiary of another
er
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 foffices in Iowa during the past 3 years at the following addresses:
Dates: /� /� to 3 Address: L�O� yetx y$ {
City, State, Zip:
Dates: / / to / ( Address:
City, State, Zip:
Dates: / / to / / Address:
You may attach additional sheet(s) if needed. City, State, Zip:
To be completed by noneresident 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 Yes o No
force preferences or any other type of preference to bidders or laborers?
3 . If you answered "Yes" to question 2 , identify each preference offered by your company's home state or foreign country
and the appropriate legal citation.
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 :
Signature : - � - - Date: 7x97 ,93
�u_muf at 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)
I
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
describ s your business, you are authorized to transact business in Iowa.
Yes so
My business Is currently registered as a contractor with the Iowa Division of Labor.
V s ONo My business is a sole proprietorship and I am an Iowa resident for Iowa income tax purposes.
OYes � ' "" 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.
WyesoNo 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 to 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 .
O Yes 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 No My business is a limited liability partnership which has filed a statement of qualification in a
o
state other than Iowa, has filed a statement of foreign qualification in Iowa and a statement of
cancellation has not been filed .
Yes My business is a limited partnership or limited liability limited partnership which has filed a
JJJJJJWNo
certificate of limited partnership in this state, and has not filed a statement of termination.
Yes 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.
OYes No My business is a limited liability company whose certificate of organization is filed in Iowa and has
not filed a statement of termination.
oYes (/ ) No My business is a limited liability company whose certificate of organization is filed in a state other
l` 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)
0
MBE/WBE BUSINESS ENTERPRISE
I nn PRE-BID CONTACT INFORMATION FORM
Prime Contractor Name: Loc�l;L
Project: 10Wo Letting Date:
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, pleause the bottom portion of this form.
Contractor Signature:
Title: , &,
Date : -7
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) 2914429.
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
MBE/WBE Dates Dates Dollar Amount Proposed to
Subcontractors Contacted Yes/No Contacted Yes/No be Subcontracted
7 ,a �,
as Y � a� 3 � 93s-
(Form CCO-4) Rev. 06-20-02
i
Revised February 2003
CONTRACTOR'S OR SUBCONTRACTOR'S AFFIRMATIVE ACTION PROGRAM
Check box t aYapplies to party completing program :
( ) General Contractor
( ) Subcontractor
I . Section A to be completed by GENERAL CONTRACTORS only:
A, //
Name of Company l �Se, Ce S- e oec> 0 "
Address of Company /Uc� �61� y `� Zip �a �J
Telephone Number el �6
Federal ID Number (ifno Federal ID Number, Owner/President's Social Security Number)
N �
Name of of Equal Employment Officer S Fe ✓e Loc •-k�
Name of Project Gay � �y tl r y� Y
Project Contract Number �G
Estimated Construction Work Dates
Start Finish
Section B to be completed by SUBCONTRACTORS only:
Be
Name of General or Prime Contractor
Name of Subcontractor
Subcontractor's Address Zip
Subcontractor's Telephone Number (
Subcontractor's Federal ID Number (if no Federal ID Number Owner/President's Social Security Number)
Name of Equal Employment Officer
AFFIRMATIVE ACTION PROGRAM Page 1 of 8
A. Remainder of program to be completed by party completing program , either Prime or Subcontractor.
1 . The Owners and/or Principals of your company:
Ethnic
Name Address Position Sex Ori in
2. Other Areas of Interest:
If your company has branches or subsidiaries, or if your company is a branch or subsidiary of a
parent organization, give the following information:
Type of
Name Address Affiliation Degree
II , EMPLOYER'S POLICY (Please read carefully. )
A. We , the undersigned , recognize that we are morally and legally committed to nondiscrimination in
employment. Any person who applies for employment with our company will not be discriminated
against because of race , color, creed , sex, national origin , economic status, age, mental or physical
handicap.
B . The employment policies and practices of the undersigned are to recruit and hire employees without
discrimination , and to treat them equally with respect to compensation and opportunities for
advancement, including training , upgrading , promotion, and transfer. However, we realize the
inequities associated with employment training , upgrading, contracting and subcontracting for
minorities and women and we will direct our efforts to correcting any deficiencies to the maximum
extent possible. The same will be required of our SUBCONTRACTORS and suppliers.
C . We submit this program to assure compliance with Executive Order 11246, as amended , and other
subsequent orders that may pertain to equal employment opportunity and merit employment policies,
fully realizing that our qualification and/or merit system should be evaluated and revised , if
necessary.
D. We agree to put forth the maximum effort to achieve full employment and utilization of capabilities
and productivity of all our citizens without regard to race, creed, color, sex, national origin , economic
status, agg, and mental or physical handicap.
E . &Vjrl .o✓ will give training
(Name o Company)
and employment opportunities to local residents of Waterloo, Iowa , to the greatest extent feasible.
AFFIRMATIVE ACTION PROGRAM Page 2 of 8
i
III . AFFIRMATIVE ACTION
A. L recognizes that the effective application of a policy of
(Name of Company) // �
merit employment involves more than just a policy statement, and U 1ez9r
(Name'6f Company)
will , therefore, re-evaluate our Affirmative Action Program to ensure that equal employment
opportunities are available on the basis of individual merit, and to actively encourage minorities,
women and local residents to seek employment with our company on this basis.
B . C v,4 , - will undertake the following six (6) steps to improve
(Name of ompany)
our Affirmative Action Program :
1 . Minority Recruitment and Employment;
2, Local Recruitment and Employment;
3, Disabled Veteran and Vietnam Era Veteran Recruitment and Employment;
4 , Handicapped Recruitment and Employment;
5 , Female Recruitment and Employment; and
6 . Training , Upgrading and Promotional Opportunities.
C . Le-4 G will take whatever steps are necessary to
(Name of C mpany)
ensure that our total work force has adequate minority, female, and local representation . We will
utilize the following methods in our recruitment attempts:
1 . Local advertising media (newspapers, radio, TV);
2 . Community organizations (churches, clubs , schools);
3 . Public and private institutions in the area ( UNI , Hawkeye Community College);
4 , Job Service of Iowa; and
5 . Other.
D . &el </4e% will seek qualified minority, female, and local group applicants
( Name of Company)
for all job categories and will make asserted efforts to increase minority, female and group
representation in occupations at the higher levels or skill and responsibility.
E. All sources of employment used shall be aware that we are an Equal Employment Opportunity
Employer. Labor organizations representing our employees will be notified of our Equal Employment
Opportunity Policy and Affirmative Action Program ,
F. Training, upgrading , promotion and transfer activities at all levels will be monitored to ensure that full
consideration has been given to qualified minority, female, and local group employees .
G . Ly 4LbGie will encourage other companies, with whom we are
(Name of Compa y)
associated and/or do business, to do the same and we will assist them in their efforts.
AFFIRMATIVE ACTION PROGRAM Page 3 of 8
i
H . GGd5e� has taken the following Affirmative Action to ensure that
(Name of Company)
minority, female, local contractors and/or suppliers were provided opportunities to negotiate and/or
bid on this project: (if none , write , NONE")
2 .
I . As a result of the above efforts, we have Involved minority, female, and local contractors and/or
suppliers in the following areas of subcontracting : (if none, write "NONE")
2 . (//y SIC m4"
J . i( will require approved Affirmative Action Programs from
(Name of mpany)
all nonexempt contractors who propose to work on this project and will take whatever steps are
necessary to ensure that non-minority contractors have adequate representation of minority, female
and local persons in their total work force.
K. In further accordance with rules and guidelines issued pursuant to Executive Order 11246 as
amended , we establish the goals for our company, based on parity percentages supplied by the City,
and we realize these goals will be reviewed on an annual basis.
L. (ti ' L, >s will keep records of specific actions relative to
(Name of Company)
recruitment, employment, training , upgrading and promotion and will provide the City of Waterloo
with any information relative to same, including activities of our SUBCONTRACTORS and suppliers
as necessary or when requested .
M. Parity figures for companies located in Waterloo are as follows:
Minority Parity = .08 (8%)
N . Zy04 &�
(Name of ompany)
Affirmative Action Employment Goals :
The definition of Affirmative Action Goals is as follows: "Goals may not be rigid and inflexible quotas
which must be met, but must be targets, reasonably attainable by means of applying every good
faith effort to make all aspects of the entire Affirmative Action Program work. "
For the year 201 _, please submit percentage targets for employing minorities and women . If you
already have reached your targetforhiring minorities and women, please submit that percentage.
*Goals for Minorities: %
Goals for Women : %
*Your affirmative action goals should be between 1 % and 10% or more for minorities and 1 % and
5% or more for women.
AFFIRMATIVE ACTION PROGRAM Page 4 of 8
We hereby certify that we are in compliance with all City and Federal Affirmative Action Regulations and agree to
accept all liability for failure to comply.
Respectfully submitted ,
By: Ague Go�s �
Company Executive
7 a7� -3
Date
By: SJeJ-e, �✓
Equal Employment
Opportunity Officer
Date
City of Waterloo Affirmative Action Officer
Approved
Disapproved Reason :
By:
Date :
AFFIRMATIVE ACTION PROGRAM Page 6 of 8