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Boomerang Corp.
Boomerang Corp 13225 Circle Dr. Suite A P.O. Box 227 Anamosa, lows 52205 Bid Security For: FY 2024 Titus Lift Station and Force Main, Contract No. 975 To: City of Waterloo, City Clerk 715 Mullberry Street Waterloo, Iowa 50703 Letting: December 14, 2023 1:00 PM Boomerang Corp 13225 Circle Dr. Suite A P.O. Box 227 Anamosa, Iowa 52205 Bid Proposal For: FY 2024 Titus Lift Station and Force Main, Contract No. 975 To: City of Waterloo, City Clerk 715 Mullberry Street Waterloo, Iowa 50703 Letting: December 14, 2023 1:00 PM FORM OF BID OR PROPOSAL ADDENDUM NO. 2—12/07/2023 FY 2024 TITUS LIFT STATION AND FORCE MAIN CONTRACT NO. 975 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 —TC')L2 )0\ a Partnership consisting of the following partners. jP\ 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 AECOM 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 the TITUS LIFT STATION AND FORCE MAIN, CONTRACT NO. 975, 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 TITUS LIFT STATION AND FORCE MAIN CONTRACT NO. 975 Item No. Measurement SUDAS Payment — & Description Unit Estimated Quantities Unit Price Bid Total Price Bid BASE BID 1 11020-A MOBILIZATION LS 1.0 $ r%-1Qo .00 a 2 8030-A TRAFFIC CONTROL LS 1.0 $JbCt) 4:O$ %boc( 0.000( 3 2010-C CLEARING AND GRUBBING LS 1.0 $2C)C4D.O 4 3010-B EXISTING VALVE VAULT PUMP REMOVAL BUILDING, PUMP VAULT AND LS 1.0 $ 1/2) 66 A $%000. 5 3010-B IMPORT FILL FOR LIFT STATION SITE CY 250.0 $ b, 00 $5600,4 6 3010-B IMPORT FILL FOR TRENCH REMOVALS CY 1,500.0 $9 Oo $30600( iiit 7 2010-D-3 IMPORT TOPSOIL CY 2,420.0 $z ea 8 AS PER PLANS LIFT STATION WET WELL AND VALVE VAULT LS 1.0 $l3ANte & )366 9 AS PER PLANS ELECTRICAL EQUIPMENT BUILDING LS 1.0 $ 0,666 A 3606 10 AS PER PLANS SITE ELECTRICAL LS 1.0 $ 11DQ\ 0 tL'o,Qo$,9oaoD to $116000 11 AS PER PLANS METERING MANHOLE LS 1.0 12 4010-G AIR STATION RELEASE MANHOLE AT TITUS LIFT EA 1.0sawo.01 $,ej 8 $ tg6obo 000 13 4010-G AIR RELEASE MANHOLE EA 5.0 14 6010-A 48" MANHOLE EA 2.0 $/ y),ty) sJooLxa $L 060 &, er a C 6 ( 15 AS PER PLANS STAND-BY GENERATOR - TITUS LS 1.0 16 ITEM INTENTIONALLY OMITTED - 17 3010-B UNCLASSIFIED RAPPABLE ROCK) MATERIAL (REMOVAL OF CY 500.0 $ you $ ,�iQ} 18 3010-B ROCK EXCAVATION CY 500.0 $ 70.6 $c Oa( 19 3010-C FOUNDATION ROCK TON 150.0 $96.00 *wen, < FORM OF BID - Addendum No. 2 AECOM #60590223 CONTRACT NO. 975 FB-1 of 3 FY 2024 TITUS LIFT STATION AND FORCE MAIN 4QO.Op .DO >• 00 ov )Q ,00 ob ,Ob 0160 .a0 a0 �.00 06 co �cS(J• Gd 06 CO )(J 20 3010-F TRENCH COMPACTION TESTING LS 1.0 $J'/OCO t $ ; gob° 21 4010-L ABANDON AND PLUG 12" SANITARY SEWER LF 290.0 $ 26. 0c $ 15".tih. 1 22 4060 SANITARY SEWER FORCE MAIN TESTING LS 1.0 3'6000 60 $/6600 23 4060 CLEANING, INSPECTION AND TESTING OF SANITARY SEWER GRAVITY MAINS LS 1.0 $ ��(?CY�_1. $ 10000 24 4010 A 1 18" SANITARY SEWER GRAVITY MAIN - OPEN CUT LF 232.8 $:200 co $: /4c /s, V 25 4010 A-2 12" SANITARY SEWER FORCE MAIN DIRECTIONAL DRILLING LF 7,340.8 $%CU.c.�L) $I'7�i�]2' 26 --- ITEM INTENTIONALLY OMITTED --- --- --- 27 4010-A-1 12" SANITARY SEWER FORCE MAIN - OPEN CUT LF 653.6 $c_ .0c $594 7 1 28 4010 A 1 8" SANITARY SEWER GRAVITY MAIN, DUCTILE IRON - OPEN CUT LF 55.0 $ ; J 25.b0 $ l(o;,Z„i- $3549 � 7 29 5010 4-INCH STEEL CASING PIPE WITH 2-INCH PVC COMMUNICATION CONDUIT LF 322.7 $ //0 .Oa 30 5010 B 2 24" STEEL CASING WITH 12" SANITARY SEWER FORCE MAIN LF 392.9 $ i O 'tl $ 3)(0% V./al IO ti 31 5010-C-2 FORCE MAIN FITTINGS LBS 3,875.0 $ f) ; ?o 32 6010 G 1 CONNECTION TO EXISTING SANITARY MANHOLE EA 2.0 $ Sig c.l) $ 7,..;nf1C'? 33 5010-E-1 WATER SERVICE, TRENCHED, COPPER, 1- INCH, INTEGRAL RESTRAINED JOINTS LF 95.0 $ 419•. Cb5,..) $ c 34 7010-A 6" PCC PAVEMENT SY 715.6 $ .1.c 0 $6 (i•t 35 7030 GRAVEL SURFACING SY 125.1 $;20 Joe $(9.5o 36 7030 CRUSHED STONE - CLASS "A" SY 715.6 $1DNO0 $ 715t,. 37 9010-B SEEDING, FERTILIZING AND MULCHING FOR HYDRAULIC SEEDING - TYPE 1 SEED MIX AC 1.9 $ 4/660. cd 7(oi)o 38 9010-B SEEDING, FERTILIZING AND MULCHING FOR HYDRAULIC SEEDING - TYPE 2 SEED MIX AC 1.9 St -re - c.1d.00$1012 $ $ . •on`J6 $ $ , , ( 39 9010-B SEEDING, FERTILIZING AND MULCHING FOR AC 1.1 HYDRAULIC SEEDING - TYPE 4 SEED MIX /ld.()() $. - 6,t,0 $),5e) 40 9010-B SEEDING, FERTILIZING AND MULCHING FOR HYDRAULIC SEEDING - TYPE 5 SEED MIX AC 1.1 a- 1:25o 41 9040-N-1 SILT FENCE LF 2,900.0 42 9040 SWPPP REQUIREMENTS LS 1.0 $ 2760,''w)$7200 43 9060-A 6' CHAIN -LINK FENCE LF 360.3 $NA/ $ 13&,00 44 9060-B 16' CHAIN -LINK GATE EA 2.0 $13/.3b.O0 $aLoOO 45 AS PER PLANS FORCE MAIN WARNING SIGN EA 5.0 $ ' -OC $ atjob PROJECT TOTAL $ $ 4W7 3 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 - Addendum No. 2 CONTRACT NO. 975 AECOM #60590223 FB-2 of 3 FY 2024 TITUS LIFT STATION AND FORCE MAIN 06 0 00 eo oe l OD (n0 J0 06 a -00 -OLD 00 00 60 �0 • 0 6 00 o© xD 06 aa tia 00 c)d J [.a� 4. Security in the sum of 7o O C °r att\ �i Dollars ($ ) in the form of �ji cl 0 , 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 indicating 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 MBENVBE subcontractor(s), amount of subcontracts and bid items on the City of Waterloo Minority and/or Women Business Pre -bid Contact Information Form submitted with this Form of Bid or Proposal. The apparent low Bidder shall submit a list of all other Subcontractor(s) to be used on this Project to the City of Waterloo by 5:00 p.m. the business day following the day Bids on this Project are due along with the Non -Collusion Affidavits of All Subcontractor(s). The Contractor shall submit information on subcontractors on "SUBCONTRACTOR REQUEST AND APPROVAL" Form to be provided by City prior to approval of contract. The subcontractors listed on this proposal and/or submitted to the Contract Compliance Officer cannot be changed except for the following reasons: 1) The City of Waterloo does not approve the subcontractors. 2) The subcontractors submit in writing that they cannot fulfill their subcontracts. 11. The bidder has filled in all blanks on this proposal. Those blanks not applicable are marked "none" or "NA". 12. The bidder has attached all applicable forms. 13. The Owner reserves the right to select alternates, delete line items, and/or to reduce quantities prior to the award of a contract due to budgetary limitations. BY: 1&._ 5(ne,an Clr»r (Name dt idder) /2 4LQ1jQ3 (Date) Title 1 Official Ad • ress: (Including Zip Code): ia-Q-a5 Qirc/eupk Po X7 if-\(\c-ifncx_ma , TLCtQ 5D3G5 I.R.S.No ya 15al1l9 FORM OF BID — Addendum No. 2 CONTRACT NO. 975 AECOM #60590223 FB-3 of 3 FY 2024 TITUS LIFT STATION AND FORCE MAIN 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 lots, 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). 4 J»qt?32 3 Signature Date frier) TYQ n --kket_a5 Ctec-Thr en Printed Name Title NOTE: The penalty for making false statements in offers is prescribed in 18 U.S.C. 1001. EPA-7 5720-4.2 January 2021 INVESTING IN IOWA'S WATER www.iowasrf.com DNR Form 542-0621 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://sam.gov. 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. 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. Signature of Auth'arfzed Representative Date \ Ocka2) Printed Name Title I am unable to certify to the above statements. My explanation is attached. January 2021 INVESTING IN IOWA'S WATER www.iowasrf.com DNR Form 542-0621 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 known as Disadvantaged Business Enterprises (DBEs). Iowa's Fair Share goals are: Minority -Owned Enterprise (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.gov/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 SRF Applicant: PROJECT INFORMATION Address: I� ?5 Cdkz City: r Contact Person: 7-er--); Phone Number:319 "`t/CQ Email: Bidder: n eVY)Or atid a Yr Q; 1 State: Zip: eon -kirk Q honmoro Cor p, CzDn-j Check if Prime Contractor is: Minority -Owned ❑ Women -Owned After the Good ith Efforts Checklist was completed, was a DBE chosen by the primary contractor to be utilized for this Project? ❑ Yes ❑ No Signature: 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/offerers 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 January 2021 INVESTING IN IOWA'S WATER www.iowasrf.com DNR Form 542-0621 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 minim m of 30 calendar days before the bid or proposal closing date. es 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. laYes ❑ 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? �es 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? `Yes I I No 6. List the potential DBE subcontractors that were contacted. Only list those that are certified through the Iowa Department of Transportation. Name How phone Contacted call, fax, (e.g. e-mail) letter, Response interested, (e.g. did not not competitive) respond, not tckuanotd Tcdc (oy4m 1 k?r M'al— re d lChef £\tX\2TiCCun CC3h4r%fICflSfpJ/t Qrrmn 1 did net r e s .Q ,t`Y,atz; ( Ninpri e( grr)s\ Ur hi-r O j di\ci not' royme 0 r,oj l dief rc'J non poia \019\ f (VI e‘c\ r;00des N 30-{ aboau ,, M dic,442_ keicazJane-Neu 1 din Ion- itSty rL4 cspedct I + Pc* P_n-Theij I Mot rb re 46—of eA `mil' PROPOSED yT�I�L�IZA IO OF DBE SUBCONTRiWW4 a04p Please include Attachment's 4 and 5 to documer�t'ttSe}5rdpbsed utilization of cerilired DBEs 4ontractors. 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. January 2021 INVESTING IN IOWA'S WATER www.iowasrf.com DNR Form 542-0621 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.) * If no DBE was chosen by the Prime Contractor to be utilized for this project, then this form is not required to be submitted. Disadvantaged Business Enterprise Program DBE Subcontractor Performance Form This form is intended to capture the DBE' subcontractor's' 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: TrE'g Pu (Se ( , r Project Name: F )/ Zo t Bid/Proposal No.: L f) ((fUS lift 43fttfOk Clt\ d, ro(Ce ct,rr Point of Contact: 3ca4{ lTec{ j- Assistance Agreement ID No. (if known): Address: Zit lc( Calf- B•re ( kvt Telephone No.: 3 (T— 3SZ - O 4 t( 8 Email: Prime Contractor Name: Pxc-naran3 Corp Issuing/Funding: Entity: Waver (y f -E- 4 5-04 fl Scab 4-t ecf 4- (d9 Mai / . c ca Contract Number Item Description Construction, of Work Submitted Services, to the Equipment Prime Contractor or Supplies Involving Price to the of Prime Work Submitted Contractor 7) / ?GSeed 'Seedti t , 1, Type Ty pe ( Z 66 0a, w n ,00 3ci Stec( my , type q 2 e-to , 110 Z i SO co 5eecf (ny , Tpp,e 5 q I S( l I r‘c iv < (oo`lo . co WZ S t P P 2 5-7s0, G u4) DBE Certified by Nt DOT SBA ❑ Other: Meets/exceeds EPA certification standards? L_1 Yes ❑ No I x1 Unknown '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. 'Subcontractor 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. IA SRF6100-3 January 2021 • INVESTING IN IOWA'S WATER www.iowasrf.com DNR Form 542.0621 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 Title Date Subcontrac or Signature 3c64 Tgetr Print Name I di /1 5 Title Date IA SRF6100-3 January 2021 INVESTING IN IOWA'S WATER www.iowasrtcorn ONR Form 542-0621 I J�Q \cQ dQn f Title 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 Contract • SiPrint Name ID-111-2003 Date Subcontractor Signature Print Name Title Date IA SRF6100-3 January 2021 INVESTING IN IOWA'S WATER www.iowasrf.com DNR Form 542-0621 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.) If no DBE was chosen by the Prime Contractor to be utilized for this project, then this form is not required to be submitted. 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 DBE' subcontractors' 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 Name: Project Name: FY ) i i ce, LL ; )Itez ttInn are1 P)r(W a A n Bid/Proposal No.: Assistance Agreement ID No. (if known): Point of Contact: Address: 1W Telephone No.: 3f-4/p. r t-f `/ 35 Issuing/Funding Entity: 1 Email: C6r Cxtm `e ( m have identified potential DBE certified subcontractors �,�"Yes ❑ No If yes, complete the table below. If no, explain: Subcontractor Company Name Name/ Company Address/Phone/Email Dollar Estimated Amount Currently Certified? DBE M ed + NJui D531 '- l q cks remW 1 I 3�l0.00 Yes No .0 LQ..v l 506 7 Oa y ►---lr�.e�a, H 319 Oy g 5C0hf. ed1'02,ni?, - ! cam, Yes No ❑ No 121<es No �} Yes ❑ No '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. 'Subcontractor 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. IA SRF6100-4 INVESTING IN IOWA'S WATER www.iowasrf.com DNR Form 542-0621 January 2021 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). \en kaacn Prime Contra gnature Print Name aThien\ den f Title Date IA SRF6100-4 January 2021 INVESTING IN IOWA'S WATER www.iowasrf.com DNR Form 542-0621 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://sam.gov. (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. I understand the above prohibitions and certify that the project will be in compliance with all the requirements. 1a-15-�oa3 Signature Date ---bac7-Th r€3) c14 Printed Name Title January 2021 INVESTING IN IOWA'S WATER www.iowasrf.com DNR Form 542-0621 INFORMATION NEEDED FOR IOWA CONSTRUCTION SALES TAX EXEMPTION CERTIFICATE CONTRACTOR NAME: jni')')QprQin Qcrp ADDRESS: J32) r(',IQThHUe '2J 4 Arcxmoo 17uefl 39s0.05 (Check One) PRIME FEDERAL ID#: `�Y��' i5D- I I 9 SUBCONTRACTOR PROJECT NAME: F'Y oa4'Tc ktg satIon and F&ct (flaln PROJECT CONTRACT NO.: 9/5 DESCRIPTION OF WORK: • Brickwork • Carpentry ▪ Concrete ▪ Drywall -Plaster -Insulation J Electrical k E)wavation/Grading J Flooring • Heavy Construction .J Heating -Ventilating -Air Cond. SALES TAX EXEMPTION AECOM #60590223 E Landscaping E Painting L Paving E Plumbing E Roofing -Siding -Sheet Metal E Windows E Wrecking -Demolition E Other (Please specify) E CONTRACT NO. 975 STE-1 of 1 FY 2024 TITUS LIFT STATION AND FORCE MAIN INFORMATION NEEDED FOR IOWA CONSTRUCTION SALES TAX EXEMPTION CERTIFICATE CONTRACTOR NAME: ADDRESS: Pc CQC1C5-1 re( ilS) ----ictoa 56613 FEDERAL ID#: (Check One) PRIME ija- P--)5308 PROJECT NAME: PROJECT CONTRACT NO.: ] � r� DESCRIPTION OF WORK: ❑ Brickwork O Carpentry Concrete Drywall -Plaster -Insulation ❑ Electrical ❑ Excavation/Grading Li Flooring ❑ Heavy Construction 0 Heating -Ventilating -Air Cond. II 1 SALES TAX EXEMPTION AECOM #60590223 ❑ CONTRACT NO. 975 SUBCONTRACTOR V 7- Licl et_ ;nn Grae ithin Landscaping 11 Painting C Paving ❑ Plumbing Roofing -Siding -Sheet Metal i Windows ❑ Wrecking -Demolition ther (Please ecif ) Tra (t'! > • r / STE-1 of 1 FY 2024 TITUS LIFT STATION AND FORCE MAIN INFORMATION NEEDED FOR IOWA CONSTRUCTION SALES TAX EXEMPTION CERTIFICATE CONTRACTOR NAME: I eain n )) CQ S ADDRESS: el (� %E1Le4-k 5---ro Q 1- TO (Check One) PRIME FEDERAL ID#: `� ` I (' rpc)", PROJECT NAME: PROJECT CONTRACT NO.: DESCRIPTION OF WORK: ❑ Brickwork ❑ Carpentry ❑ Concrete ❑ Drywall -Plaster -Insulation ❑ Electrical ❑ Excavation/Grading ❑ Flooring (� Heavy Construction Heating -Ventilating -Air Cond. SALES TAX EXEMPTION AECOM #60590223 SUBCONTRACTOR ipe/ ❑ Landscaping n Painting ❑ Paving Plumbing C Roofing -Siding -Sheet Metal ❑ Windows Wrecking -Demolition Li Other (Please specify) I1 vie CONTRACT NO. 975 Te;9 STE-1 of 1 FY 2024 TITUS LIFT STATION AND FORCE MAIN INFORMATION NEEDED FOR IOWA CONSTRUCTION SALES TAX EXEMPTION CERTIFICATE CONTRACTOR NAME: � \-ed T K)Lasorti ADDRESS: Lkjt9 QTyrg,y)er Ape Wave( /k./ :rhun 5(X/7 (Check One) PRIME FEDERAL IDtt: LID L PROJECT NAME: fl'2O2LtTkr) LtLPROJECT CONTRACT NO.: -I � L DESCRIPTION OF WORK: ❑ Brickwork ❑ Carpentry 9 Concrete ❑ Drywall -Plaster -Insulation ❑ Electrical Excavation/Grading ❑ Flooring ❑ Heavy Construction ❑ Heating -Ventilating -Air Cond. SALES TAX EXEMPTION AECOM #60590223 SUBCONTRACTOR Landscaping Painting Paving ❑ Plumbing ❑ Roofing -Biding -Sheet Metal ❑ Windows - Wrecking -Demolition ❑ Other (Please specify) CONTRACT NO. 975 STE-1 of 1 FY 2024 TITUS LIFT STATION AND FORCE MAIN INFORMATION NEEDED FOR IOWA CONSTRUCTION SALES TAX EXEMPTION CERTIFICATE CONTRACTOR NAME: ADDRESS: -WO OrcJctkrr l2oacf �. Yci{E _ I aa" (Check One) PRIME FEDERAL ID#: Z qo- )L)(985 SUBCONTRACTOR PROJECT NAME: �.220Z4"1 I I Bbti/JYn anyi v-S-cke Obi>) PROJECT CONTRACT NO.: 915 DESCRIPTION OF WORK: 1 Brickwork Carpentry Li Concrete %J Drywall -Plaster -Insulation 1 Electrical u Excavation/Grading Flooring L Heavy Construction i. 1 Heating -Ventilating -Air Cond. SALES TAX EXEMPTION AECOM #60590223 ❑ Landscaping D Painting ❑ Paving ❑ Plumbing ❑ Roofing -Siding -Sheet Metal ❑ Windows ❑ Wrecking -Demolition ❑ Other (Please specify) ❑ CONTRACT NO. 975 STE-1 of 1 FY 2024 TITUS LIFT STATION AND FORCE MAIN INFORMATION NEEDED FOR IOWA CONSTRUCTION SALES TAX EXEMPTION CERTIFICATE CONTRACTOR NAME: , 121 mQ `en C ADDRESS: PC (3cx Li Li aarto-r Pope' , _Trot n (Check One) PRIME FEDERAL ID#: 49 -4 ig-741,25 SUBCONTRACTOR PROJECT NAME: RYC31 T; ks L 1 i 3h4tn ors' FTrce ./ThtV) PROJECT CONTRACT NO.: 9-75 DESCRIPTION OF WORK: ❑ Brickwork ❑ Carpentry Li Concrete ❑ Drywall -Plaster -Insulation • Electrical ❑ Excavation/Grading Li Flooring ❑ Heavy Construction ❑ Heating -Ventilating -Air Cond. SALES TAX EXEMPTION AECOM #60590223 ❑ Landscaping ❑ Painting ❑ Paving ❑ Plumbing ❑ Roofing -Siding -Sheet Metal O Windows ❑ Wrecking -Demolition O Other (Please specify) Q•( &nee CONTRACT NO. 975 STE-1 of 1 FY 2024 TITUS LIFT STATION AND FORCE MAIN INFORMATION NEEDED FOR IOWA CONSTRUCTION SALES TAX EXEMPTION CERTIFICATE CONTRACTOR NAME: COIUMn ADDRESS: (Check One) PRIME FEDERAL ID#: SUBCONTRACTOR 1,/ PROJECT NAME: PROJECT CONTRACT NO.: DESCRIPTION OF WORK: fl Brickwork Carpentry U Concrete ❑ Drywall -Plaster -Insulation 12/Electrical ❑ Excavation/Grading LI Flooring O Heavy Construction U Heating -Ventilating -Air Cond. SALES TAX EXEMPTION AECOM #60590223 ❑ Landscaping ❑ Painting ❑ Paving Plumbing 0 Roofing -Siding -Sheet Metal • Windows ❑ Wrecking -Demolition O Other (Please specify) CONTRACT NO. 975 STE-1 of 1 FY 2024 TITUS LIFT STATION AND FORCE MAIN INFORMATION NEEDED FOR IOWA CONSTRUCTION SALES TAX EXEMPTION CERTIFICATE CONTRACTOR NAME: ADDRESS: 1--er K ra Us (Check One) PRIME SUBCONTRACTOR FEDERAL ID#: q I a%315583�P PROJECT NAME: PYZCZLF11 A-utS L1\ -(1 Sb1 tin 4- gT,r9 (YbJ n PROJECT CONTRACT NO.: 9/ S DESCRIPTION OF WORK: Brickwork ❑ Carpentry U Concrete Li Drywall -Plaster -Insulation ❑ Electrical ❑ Excavation/Grading ❑ Flooring O Heavy Construction La Heating -Ventilating -Air Cond. ❑ Landscaping ❑ Painting ❑ Paving ❑ Plumbing ❑ Roofing -Siding -Sheet Metal ❑ Windows ❑ Wrecking -Demolition ❑ Other (Please specify) n SALES TAX EXEMPTION CONTRACT NO. 975 AECOM #60590223 STE-1 of 1 FY 2024 TITUS LIFT STATION AND FORCE MAIN INFORMATION NEEDED FOR IOWA CONSTRUCTION SALES TAX EXEMPTION CERTIFICATE CONTRACTOR NAME: ADDRESS: 40 n AA v`GSGy1rN (Check One) PRIME FEDERAL ID#: Ca. " Q SS Co,05 SUBCONTRACTOR V PROJECT NAME: 01)7()Z14 I ! L S PROJECT CONTRACT NO.: qi5 Pon 4---k-\xce /Min DESCRIPTION OF WORK: Brickwork ❑ Carpentry D Concrete ❑ Drywall -Plaster -Insulation D Electrical D Excavation/Grading D Flooring ❑ Heavy Construction ❑ Heating -Ventilating -Air Cond. SALES TAX EXEMPTION AECOM #60590223 ❑ Landscaping G Painting [i Paving D Plumbing D Roofing -Siding -Sheet Metal D Windows ❑ Wrecking -Demolition D Other (Please specify) ❑ CONTRACT NO. 975 STE-1 of 1 FY 2024 TITUS LIFT STATION AND FORCE MAIN INFORMATION NEEDED FOR IOWA CONSTRUCTION SALES TAX EXEMPTION CERTIFICATE CONTRACTOR NAME: DA (3wcti ADDRESS: (Check One) PRIME FEDERAL ID#: SUBCONTRACTOR PROJECT NAME: P1"Zcz'4 1 / Fi.le-5 Lit PROJECT CONTRACT NO.: Q �S DESCRIPTION OF WORK: -ict-h'tYl ri)rce, ❑ Brickwork O Carpentry Li Concrete ❑ Drywall -Plaster -Insulation O Electrical ❑ Excavation/Grading O Flooring O Heavy Construction ❑ Heating -Ventilating -Air Cond. SALES TAX EXEMPTION AECOM #60590223 Landscaping -• Painting Li Paving Plumbing • Roofing -Siding -Sheet Metal Li Windows Li Wrecking -Demolition ii Other (Please specify) CONTRACT NO. 975 STE-1 of 1 FY 2024 TITUS LIFT STATION AND FORCE MAIN State of L 3Lt2Q County of �On-e.3 1 NON -COLLUSION AFFIDAVIT OF PRIME BIDDER Vlocte3 )ss , being first duly sworn, deposes and says that: He is (Owner, Partne Officer Representative, or Anent) , orPrA nar n are , the Bidder tha 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) V&1 Subscribed and sworn to before me this PI Title day �iQCQntQr , 20a3 cida(kait AJ 0 VLii Title My commission expires 1 r a (� JENNA HAAG Commission Number 768229 My Commission Expires NON -COLLUSION AFFIDAVIT CONTRACT NO. 975 AECOM #60590223 NCA-1 of 2 FY 2024 TITUS LIFT STATION AND FORCE MAIN 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. 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, EQUAL OPPORTUNITY CLAUSE CONTRACT NO. 975 EOC-1 of 2 AECOM #60590223 FY 2024 TITUS LIFT STATION AND FORCE MAIN 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) (A3ropriate Official) a-61 N-) a WC>12/- (Title) )2* w 3 (Date) EQUAL OPPORTUNITY CLAUSE CONTRACT NO. 975 EOC-2 of 2 AECOM #60590223 FY 2024 TITUS LIFT STATION AND FORCE MAIN Bidder Status Form To be completed by all bidders Part A Please answer "Yes" or "No" for each of the following: [(Yes ❑ 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). 6Yes ❑ 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 followingrenaddresses:. Dates: / Q L ) _ . tent / Address:130,c95 2i� re I� it Fie_ 4 City, State, Zip. AnGrn6a TTbcq20 5.9a0- 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? 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. Yes l I No 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: Cr Date: ait �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. 309-6001 (09-15) Worksheet: Authorization to Transact Business This worksheet may be used to help complete Part A of the Resident Bidder Status form. If at least one of the following describes your business, you are authorized to transact business in Iowa. ❑Yes ❑ No ❑ Yes ❑ No I�Yes No My business is currently registered as a contractor with the Iowa Division of Labor. My business is a sole proprietorship and I am an Iowa resident for Iowa income tax purposes. 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 ❑ No 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 ❑ 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 state other than Iowa, has filed a statement of foreign qualification in Iowa and a statement of cancellation has not been filed. Yes ❑ 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 ❑ 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 ❑ 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 ❑ 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. 309-6001 (09-15) BSF-2 Revised February 2003 CONTRACTOR'S OR SUBCONTRACTOR'S AFFIRMATIVE ACTION PROGRAM Check box that applies to party completing program: ) General Contractor Subcontractor ( ( Section A to be completed by GENERAL CONTRACTORS only: A. Name of CompanryiDOOM \ Qt 52Q5 it l2 iviz Address of Company Knninnetrn Zip 5Q2cf Telephone Number (2(9 ) 1-1 - Liq;35 Federal ID Number Of no F deral ID Number, Owner/President's Social Security Number) Name of Project ryrWM J 1' ktcS Liff • b Q f L� te.- Tin Project Contract Number915 Estimated Construction Work Dates / Start Finish Section B to be completed by SUBCONTRACTORS only: B. 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 C. Remainder of program to be completed by party completing program, either Prime or Subcontractor 1. The Owners and/or Principals of your company: 1 Name Address SOQ Ct-fla NW 04 Position Ethnic Sex Origin 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 NA 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, age, and mental or physical handicap. (Nabof Co pany) and employment opportunities to local residents of Waterloo, Iowa, to the greatest extent feasible. E. will give training III. AFFIRMATIVE ACTION A. iEtXDfflQrarflCrecognizes that the (Name of Company) 2 effective applicati of a policy of merit inployment involves more than just a policy statement, and jCf)r�r) n L c)C� (Name of Company) P Y) 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. CCM will undertake the (Named Compa y) following six (6) steps to improve 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 Training, Upgrading and Promotional Opportunities. nY1..Q.t''QZ,f� COY 0 will take (Na�f Compa'iy) whatever steps are necessary to 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. ICCfl1QfOnQwill seek qualified minority, (Nana of Com ny) female, and local group applicants 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. AOmeteariQOpwill encourage other (Name d$ Com an P Y) companies with whom we are associated and/or do business, to do the same and we will assist them in their efforts. H. I tinPereen at p has taken the following (Name oftompany) Affirmative Action to ensure that minority, female, local contractors and/or suppliers were provided opportunities to negotiate and/or bid on this project: (if none, write "NONE") • 1. 1 rY,1c LCJ14rU 2. trcfrxj crCaP i n 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") 1. ckc 3 t P � J. QXQc.0CoO� will require approved (Name of Company) Affirmative Action Programs from 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. �c_flF )araawill keep records of (Nam of Compa ) specific actions relative to 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. Affirmative Action (Name ofj ompany) 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 20ka please submit percentage targets for employing minorities and women. If you already have reached your target for hiring minorities and women, please submit that percentage. *Goals for Minorities: Goals for Women: 0/0 Ohl 1 *Your affirmative action goals should be between 1 % and 10% or more for minorities and 1 % and 5% or more for women. Please be advised that the goals or targets are purely your estimation of how many women and minorities your company can reasonably expect to hire in 201_. Note, that none of the goals are rigid or inflexible. They are targets that your company calculates as reasonably attainable. This will help the City in its monitoring procedures as required by City of Waterloo Resolution No. 1984-142(4). Mcx i. ov wAcckWit\ ORUNA fectivko �•� INDICATE: CONTRACTOR'S TOTAL WORK FORCE (WATERLOO) DISABLED VETERAN: DV VIETNAM ERA VETERAN: VV HANDICAPPED: H 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: 1(9 -1 --c9003 Date By: re/14/ Equal Employment Opportunity Officer IgitA-Joo3 Date City of Waterloo Affirmative Action Officer Approved Disapproved Reason: By: Date: Corporate Officers Bryce Ricklefs — President — Male - White 3397 Stone City Road, Central City, Iowa 52214 Sarah Ricklefs — Vice President/Secretary/Treasurer — Female - White 3397 Stone City Road, Central City, Iowa 52214 Brent Ricklefs — Vice President — Male - White 3313 Stone City Road, Central City, Iowa 52214 Jeni Haas — Vice President — Female - White 1137 Settlers Court, Marion, Iowa 52302 Jenna Haag — Secretary — Female - White 801 Southhaven Drive, Monticello, Iowa 52310 ANAMOSA HIAWATHA p 319.462.4435 p 319.462.4435 a 13225 Circle Dr Suite A l Anarnosa, IA 52205 a 1204 Dina Court I Hiawatha, IA 52233 3 boomerang BOOMERANGCORP.COM mco co Om Itm thD CO-n 0 N W D O 9L6 'ON 1OVHINOO 00 m D z Form CCO-4A Rev. 07-08-02 a D C� C� fA -� -0 cr O O-r• D33m o co -i m=h o Ca Qa o n cc) o 5 (.0 (D a 0 cr ca -° �, (D (D co v D D Z O W 00 o OOm O CD(T) c.0 Cpo Zm (D (D 0 0 rn N 0 0 (D C ( n ✓ 0 -1 -, m -' cD CO (D a - o o� CO O- -I m a • Z CY c o 0-0 = o v o Qnm (D (n rt : °' ° o�v �' o o O-0° �m � 0• � 2, 1:3-1 O n cn o O 3 � � (D a Fps c O ° (p cD (n y 0 ° o c a o o � cQ N cD ® � (Do 0- 0 • O (n co = O O C o m O v g (DD `< 3 7 O CO (D 5e w .c. � �- c 3 0 0 � �� :Q • ° 5• cD n D o v a it; 0" Q 0° rt CD o O (o O 0 ,..,. ° 3 rt C- cD cD ° 0 �'�o'<o ?FQO �g �D3r(n co (D o 0 (D (n o t.G (D 0 • o o m (�D (D- co) c 1 o• 0 co _O c o �^ (�D 0 ca N c 0 me _o o o C OJO 0 5• C4 v)' -O O (n R' rn O CO c * * (fl (OD n' l0D (D O 051 v o o w 0 D n• D— E a) o (0 al al � (o 7 cD -�;� (D a 0 = n (D 0 CD L) OCI0 m- ��cn (D m ?Q.o. -1 o 3 = 03 �o m ° v CO CT (n a a' 0 3 a a c c 71 (D 0003 a- _ aoih 3. 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C O a0 3 c O (n h-1 co73 0_ mhQ- M w (D my � ,, ° o coCo ., 3 mmp° m(D -, o mT 0 o �� h 05.m ✓ a)0 O (D o o 0 't- (n O c rt co 0 v(D5. fl) Cr. -O (D o ac. o-5'0 cc) (n 3 rt o 5 3 o Q O O rt 0 0 o° 0 (D v 5cn0 ®O 0co (D w (<D F) ccnn R 12 02„' a0 05O W < can' c°v O 0o n coQ- �m aO ov 0 CO o- cD 0-• 0) CM v 0 o �, cD re, C7 a' o (�D a rn00 a� h�o o (D C O 0 co (D w C in o7. r rt 0.)a O (n (D o O o.-I- rt 0 O O D'O'cD 5-a co co a) CDCDO D. �• Q 5 o �(n cDa �3-. -0OCD cD� Qc� Q o ho o0 CD' 35' a a cp ,-,• o rt (D In C' 0 5 0 0 (D mco eg 0m cn ' o z (� O y..y) -'m )4,20 m 0 N a H D- z C 0 m O Li Z7 • 0) m D z zz • Q., (13 ut) 0 g 0 Quotes ,,r) , cr(c) v , Th( i:, e\g & 9- ) _c_. _ i\-- Di D 8 nct o F)- g a h iii 5 o rn () &_ c----.. 9'' 0 4..%, ..i,., (?L) des tacted cij ON/SOA 0 Quotation used in bid ites tacted m 0 uoogns aq ;unowy Jell Proposed to tracted dO 318d1 m 0 0 0 0 -13 63 v m 0) m v co v a 0 0 v 0 v rt O 0 (D co ✓ m -oc O 0 0 5. Cp u) 0� 0 w 0 �(C) 0 - 0 3 n Qo (0 co o O 0 0- 4 O 0 0 o v 3 0_ o 5. co0 co (D CC2 0 0 n ✓ r+ ( 3) 5- (D O (�D O .3 0 0 3 0 0 0rt r 0 0 0 0 v 0 rt 0 a 0 0 0 0 0) 0 N O 0.3 _s - COCD N D CO cp cp P • w N 0 co • Q. W W 0- 0 c CT 3 VS' 0 v 1 0 c 0 0 O 0 v r 0 0 a 0 v o• 0-. O 0 0 0 a.. 1 Q c0 0 cn 0 m rt 5• 0 1 v o. 0 u�' 5' (0 O c m CO W 5• 0) (D 1 0 (D 0_ v r 0 (D 0 X Z O v g rn 03 u> N CO ON_m 3 1 C �W O cZ cr7,1 o 0 0 O rt C0 C --', O 0 ten) O 0 z � •• W co 0v o co 0m CO c 0 0 0 v 0 0 0 0 -o 0 rt 0 a O Q w (D st 0) (D 0 0- 0 rt rt 3 oa CO CO a- 0 0 0 0 0 Cll Prime Contractor Name: 73 613 v 0 n m 0 O m 0 70 00 rn C 0) cn 73 m ,,,o, so boomerang Carter Electric 725 Adams Street Waterloo, Iowa 50703 RE Contract No: 975 Dear Derrick Carter: Boomerang Corp is presently soliciting for the following work in connection with the above referenced project. Items 9 & 10 Boomerang Corp is an Equal Opportunity Employer, and all qualified bidders will not be discriminated against due to race, religion, color, sex or origin. If interested in bidding your proposal must be turned in to this office by 12/13/23 @ 5:O0pm. Send quote to bids@boomerangcorp.com Sincerely, Dawn King Boomerang Corp ANAMOSA HIAWATHA p 319.462.4435 p 319.462.4435 a 13225 Circle Dr Suite A 1 Anamosa, IA 52205 a 1204 Dina Court I Hiawatha, IA 52233 BOOMERANGCORP.COM boomerang Daniels Home Improvement 339 Albany Street Waterloo, Iowa 50703 RE Contract No: 975 Dear Sammy Daniels: Boomerang Corp is presently soliciting for the following work in connection with the above referenced project. Items: Boomerang Corp is an Equal Opportunity Employer, and all qualified bidders will not be discriminated against due to race, religion, color, sex or origin. If interested in bidding your proposal must be turned in to this office by 12/13/23 @ 5:O0pm. Send quote to bids@boomerangcorp.com Sincerely, Dawn King Boomerang Corp ANAMOSA HIAWATHA p 319.462.4435 p 319.462.4435 a 13225 Circle Dr Suite A 1 Anarnosa, IA 52205 a 1204 Dina Court 1 Hiawatha, IA 52233 BOOMERANGCORP.COM boomerang D.C. Corporation 426 Beech Street Waterloo, Iowa 50703 RE Contract No: 975 Dear Terry Philips: Boomerang Corp is presently soliciting for the following work in connection with the above referenced project. Items: Boomerang Corp is an Equal Opportunity Employer, and all qualified bidders will not be discriminated against due to race, religion, color, sex or origin. If interested in bidding your proposal must be turned in to this office by 12/13/23 @ 5:00pm. Send quote to bids@boomerangcorp.com Sincerely, Dawn King Boomerang Corp ANAMOSA HIAWATHA p 319.462.4435 p 319.462.4435 a 13225 Circle Dr Suite A I Anamosa, IA 52205 a 1204 Dina Court I Hiawatha, IA 52233 BOOMERANGCORP.COM boomerang Quick Construction 217 Bates Street Waterloo, Iowa 50703 RE Contract No: 975 Dear Leroy Harrington: Boomerang Corp is presently soliciting for the following work in connection with the above referenced project. Items: Boomerang Corp is an Equal Opportunity Employer, and all qualified bidders will not be discriminated against due to race, religion, color, sex or origin. If interested in bidding your proposal must be turned in to this office by 12/13/23 @ 5:OOpm. Send quote to bids@boomerangcorp.com Sincerely, Dawn King Boomerang Corp ANAMOSA HIAWATHA p 319.462.4435 p 319.462.4435 a 13225 Circle Dr Suite A I Anamosa, IA 52205 a 1204 Dina Court I Hiawatha, IA 52233 BOOMERANGCORP.COM boomerang E. Castro Roofing 702 Riehl Street Waterloo, Iowa 50701 RE Contract No: 975 Dear Emillio Casstro: Boomerang Corp is presently soliciting for the following work in connection with the above referenced project. Items: Boomerang Corp is an Equal Opportunity Employer, and all qualified bidders will not be discriminated against due to race, religion, color, sex or origin. If interested in bidding your proposal must be turned in to this office by 12/13/23 @ 5:00pm. Send quote to bids@boomerangeorp.com Sincerely, Dawn King Boomerang Corp ANAMOSA HIAWATHA p 319.462.4435 p 319.462.4435 a 13225 Circle Dr Suite A I Anarnosa, IA 52205 a 1204 Dina Court I Hiawatha, IA 52233 BOOMERANGCORP.COM boomerang Jason's Indoor and Outdoor 700 Bishop Avenue Waterloo, Iowa 50707 RE Contract No: 975 Dear Jason Butt: Boomerang Corp is presently soliciting for the following work in connection with the above referenced project. Items: Boomerang Corp is an Equal Opportunity Employer, and all qualified bidders will not be discriminated against due to race, religion, color, sex or origin. If interested in bidding your proposal must be turned in to this office by 12/13/23 @ 5:00pm. Send quote to bids@boomerangcorp.com Sincerely, Dawn King Boomerang Corp • ANAMOSA HIAWATHA p 319.462.4435 p 319.462.4435 a 13225 Circle Dr Suite A I Anarnosa, IA 52205 a 1204 Dina Court I Hiawatha, IA 52233 BOOMERANGCORP.COM BID BOND KNOW ALL MEN BY THESE PRESENTS, that we, Boomerang Corp. as Principal, and United Fire & Casualty Company 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 14th day of December , 20 23 , for FY 2024 Titus Lift Station and Force Main, Contract No. 975, 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 pres- ents to be signed by their proper officers this 4th day of December , A.D. 2023. ss Anne Crowner BID BOND AECOM 1160590223 Boomerang Corp. (Seal) Principal By (Title) United Fire & Casualty Company (Seal) Surety elreSr clPn f- By Cindy Bennett Attorney -in -fact CONTRACT NO. 975 BB-1 of 1 FY 2024 TITUS LIFT STATION AND FORCE MAIN tifig INSURANCE UNITED FIRE & CASUALTY COMPANY, CEDAR RAPIDS, IA UNITED FIRE & INDEMNITY COMPANY,'WEBSTER, TX FINANCIAL PACIFIC INSURANCE COMPANY, LOS ANGELES, CA CERTIFIED COPY OF POWER OF ATTORNEY (original on file at Home Office of Company — See Certification) Inquiries: Surety Department 118 Second Ave SE Cedar Rapids, IA 52401 KNOW ALL PERSONS BY THESE PRESENT'S, That United Fire & Casualty Company, a corporation duly organized and existing under the laws of the State of Iowa; United Fire & Indemnity Company, a corporation duly organized and existing under the laws of the State of Texas; and Financial Pacific Insurance Company, a corporation duly organized and existing under the laws of the State of California (herein collectively called the Companies), and having their corporate headquarters in Cedar Rapids, State of Iowa, does make, constitute and appoint CRAIG E. HANSEN, JAY D. FREIERMUTH, BRIAN M. DEIMERLY, CINDY BENNETT, ANNE CROWNER, TIM MCCULLOH, STACY VENN, DIONE R. YOUNG, MICHELLE GRUIS, KATHLEEN BREWER, SETH D. ROOKER, SARA HUSTON, SHELBY GREINER, GINGER HOKE, JOHN CORD, JOE TIERNAN, JENNIFER MARINO, BEN WILLIAMS, KATE ZANDERS, EACH INDIVIDUALLY their true and lawful Attorney(s)-inn-Fact with power and authority hereby conferred to sign, seal and execute in its behalf all lawful bonds, undertakings and other obligatory instruments of similar nature provided that no single obligation shall exceed $100, 000, 000. 00 and to bind the Companies thereby as fitlly and to the same extent as if such instruments were signed by the duly authorized officers of the Companies and all of the acts of said Attorney, pursuant to the authority hereby given and hereby ratified and confirmed. The Authority hereby granted is continuous and shall remain in full force and effect until revoked by United Fire & Casualty Company, United Fire & Indemnity Company, and Financial Pacific Insurance Company. This Power of Attorney is made and executed pursuant to and by authority of the following bylaw duly adopted by the Boards of Directors of United Fire & Casualty Company, United Fire & Indemnity Company, and Financial Pacific Insurance Company. "Article VI — Surety Bonds and Undertakings" Section 2, Appointment of Attorney -in -Fact. "The President or any Vice President, or any other officer of the Companies may, from time to time, appoint by written certificates attorneys -in -fact to act in behalf of the Companies in the execution of policies of insurance, bonds, undertakings and other obligatory instruments of like nature. The signature of any officer authorized hereby, and the Corporate seal, may be affixed by facsimile to any power of attorney or special power of attorney or certification of either authorized hereby; such signature and seal, when so used, being adopted by the Companies as the original signature of such officer and the original seal of the Companies, to be valid and binding upon the Companies with the same force and effect as though manually affixed. Such attorneys -in -fact, subject to the limitations set of forth in their respective certificates of authority shall have full power to bind the Companies by their signature and execution of any such instruments and to attach the seal the Companies thereto. The President or any Vice President, the Board of Directors or any other officer of the Companies may at any time revoke all power and authority previously given to any attomey-in-fact. s r), IN WITNESS WHEREOF, the COMPANIES have each caused these presents to be signed by its vice president and its corporate seal to be hereto affixed this \ll !/ P" h/i - cs tt- /fir/ JrtHltNp\`\� r.Q-'3\) 2. �o b$ 18th day of March, 2022 UNITED FIRE & CASUALTY COMPANY UNITED FIRE & INDEMNITY COMPANY FINANCIAL PACIFIC INSURANCE COMPANY By: State of Iowa, County of Linn, ss: On 18th day of March, 2022, before me personally came Dennis J. Richmann to me known, who being by me duly sworn, did depose and say; that he resides in Cedar Rapids, State of Iowa; that he is a Vice President of United Fire & Casualty Company, a Vice President of United Fire & Indemnity Company, and a Vice President of Financial Pacific Insurance Company the corporations described m and which executed the above instrument; that he knows the seal of said corporations; that the seal affixed to the said instrument is such corporate seal; that it was so affixed pursuant to authority given by the Board of Directors of said corporations and that he signed his name thereto pursuant to like authority, and acknowledges same to be the act and deed of said corporations. Judith A. Jones Iowa Notarial Seal Commission number 173041 My Commission Expires 4/23/2024 Vice President 1t Notary Public My commission expires: 4/23/2024 I, Mary A. Bertsch, Assistant Secretary of United Fire & Casualty Company and Assistant Secretary of United Fire & Indenmity Company, and Assistant Secretary of Financial Pacific Insurance Company, do hereby certify that I have compared the foregoing copy of the Power of Attorney and affidavit, and the copy of the Section of the bylaws and resolutions of said Corporations as set forth in said Power of Attorney, with the ORIGINALS ON FILE IN THE HOME OFFICE OF SAID CORPORATIONS, and that the same are correct transcripts thereof, and of the whole of the said originals, and that the said Power of Attorney has not been revoked and is now in full force and effect. In testimony whereof I have hereunto subscribed my name and affixed the corporate seal of the said Corporations day of December 2023. this 4th A Assistant Secretary, UF&C & OF&I & FPIC BPOA0049 1217