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Home My WebLink AboutLodge Construction, Inc.P.O. BOX 459 J CLARitSV , IA 50%19 C\4-/ CLe(K \Nr-vf_e( )00 R�; F/ 2oay fr(ijsie/ five RecctJ P.O. Box 439 J CLARKsvILLE,1A 50619 C:1—/ (\t‘ckC e\N e,1,4e(100) RF/ OJAY K;) FORM OF BID OR PROPOSAL F.Y. 2024 KINGSLEY AVENUE RECONSTRUCTION PROJECT CONTRACT NO. 1100 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 -G i_w 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 KINGSLEY AVENUE RECONSTRUCTION PROJECT, Contract No. 1100, 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 KINGSLEY AVENUE RECONSTRUCTION PROJECT CONTRACT NO.1100 ITEM BID SPECIFICATION SUPPLEMENTAL SUDAS * SEE DESCRIPTION UNIT KINGSLEY AVE QTY UNIT BID PRICE TOTAL BID PRICE DIVISION 2 - EARTHWORK 1 2010-108-D-1* TOPSOIL, 4 INCHES, ON SITE SY 1,798.0 — $ i -- $ 3� s'po 2 2010-108-D-3* TOPSOIL, 4 INCHES, OFF SITE SY 2,197.0 $ 7 — $ /53371 3 2010-108-E * EXCAVATION, CLASS 10 CY 2,115.0 $ 1r $ g)re( ' 4 SEE EST. REF. EXCAVATION, CLASS 10, WASTE CY 2,115.0 - $ /3 -- $ (2 7 xis- 5 2010 108-F * EXCAVATION, GRADE CLASS 10, BELOW CY 698.0 $ /�� // �_ $ (4) lie 6 2010 108-I * SUBGRADE GEOTEXTILE TREATMENT, OR GEOGRID WOVEN SY 4,175.0 F $ 3 $ Jai --- 5 s 7 2010-108-J SUBBASE, MODIFIED, 12 INCH SY 4,175.0 $ /1-" $ 75j`3a ._ SUBTOTAL EARTHWORK = $ DIVISION DRAINS - 4 STORM - SEWERS AND 8 4020-108-A STORM 2000D, SEWER, 12 INCH TRENCHED, RCP LF 89.5 $ 6° _ $ SJ>%a - 9 4020-108-D REMOVAL LESS THAN OF OR STORM EQUAL SEWER, TO 36 INCH RCP, LF 31.6 -� $ 1�-- $ 101 10 4020-108-D REMOVAL SUBDRAIN,4INCH OF STORM SEWER, LF 2,154.0 $ D2 $ g)30a9 11 4040-108-A SUBDRAIN, TYPE SP, 6 INCH LF 2,459.0 " $ R ? /3/ .' $ 0/ 12 4040 108-D SUBDRAIN 6INCH OUTLET TO STRUCTURE, EACH45.0 $ /g9 ` ._ $ ?) �° FORM OF BID CONRACT NO. 1100 Page 1 of 4 13 4040 108E * STORM SP, 4 INCH SEWER SERVICE STUB, TYPE LF 120.0 $ ,5 0 $ -�- J SUBTOTAL SEWERS AND DRAINS - STORM = $ DIVISION AND APPURTANCES 5 - WATER MAINS 14 SEE EST. REF. CONVERT WATER MANHOLE TO 4-.0 .�=-- ,�T $ EACH $ 15 SEE EST. REF. WATER SERVICE KILL EACH 2.0 $ i1 0 .-- $ Qj ra SUBTOTAL WATER MAINS AND APPURTANCES = $ DIVISION FOR SEWERS SANITARY 6 - STRUCTURES AND STORM 16 6010-108-A MANHOLE, SW-401, 48" EACH 1.0 $ 14CUU - $ 4/j34 - 17 6010-108-B INTAKE, SW-501, SINGLE GRATE EACH 2.0 $ 4) ppo - $ /29 O00 - 18 6010-108-B INTAKE, SW-505, DOUBLE GRATE EACH 2.0 $ 8.� D do— $ /(,oar 19 6010-108-E SANITARY MINOR, SW-301 MANHOLE ADJUSTMENT, EACH 4.0 _ $ 66V 0 /� $%&06 20 6010 108E STORM MINOR, MANHOLE SW-402$ ADJUSTMENT, EACH 30 6.0D0 $ J 2c2c 21 6010-108-E INTAKE 501 ADJUSTMENT, MINOR, SW- EACH 10.0 $ (3: e1C) $ .32 ea o 22 6010-108-E 05AKE ADJUSTMENT, MINOR, SW- EACH 4.05 $)-5=61, $ /S D pis 23 6010-108-E INTAKE 507 ADJUSTMENT, MINOR, SW- EACH 2.0 $ 3J `po `- $ 7.; o �'' 24 6010 108 F SW-402 MANHOLE ADJUSTMENT, MAJOR, EACH 1.0 , $ 6J3 D() -" $ 3J-C`in 25 6010-108-G * CONNECTION MANHOLE OR TO INTAKE, EXISTING SUBDRAIN EACH 37.0 >> $ /d d .._ $ S.5 (2t 26 6010-108-G * CONNECTION 54" STORM TO EXISTING PIPE, EACH 2.0 $ 4 Lf o C r $ Z &d SUBTOTAL STRUCTURES FOR SANITARY AND STORM SEWERS = $ DIVISION RELATED WORK 7 - STEETS AND PAVEMENT, C-4,CL3AGG PCC, 7 INCH, C-SUD OR $ ,5l1 / $ 1Tej 4a _- 27 SY 3,667.0 7010-108-A * 28 IA 9999008 -DOT 2599- * ('POUNDS' MACRO FIBERS ITEM) FOR SYNTHETIC PCC, 5 LBS / CY LB 3,620.0 $ 7 $ 02 s ..„ 3 9d 29 7010 108 I * PCC TESTING PAVEMENT SAMPLES AND LS 1.0 G _- $ fe o $ t'/o 30 11,050-108-A CONCRETE WASHOUT LS 1.0 $ fin-0 - $ -v6' - SIDEWALKS, SHARED USE PATHS AND DRIVEWAYS 31 7030-108-A-1 REMOVAL OF SIDEWALK SY 268.5 $ 9 ' $ % l/6 - - 32 7030-108-A-3 REMOVAL OF DRIVEWAY SY 290.3 $ '9' --- $ c)b/d- $ 7 7S 33 El- 33 7030-108-E SIDEWALK, PCC, 4 INCH, C-4 SY 120.1 $ 6 6 - 344 7030-108-E SIDEWALK, PCC, 6 INCH, C-4 SY 161.1 $ //d 's $ 1717) ' 35 7030-108-G DETECTABLE WARNINGS SF 240.0 $ 147 $ it jaw 3� / 36 7030-108-H-1 4 DRIVEWAY, PAVED, PCC, 5 INCH, C- SY 290.3 "--(�J $ �� $ 37 7030-108-H-3 DRIVEWAY, GRANULAR TON 2.9 $ PO' $ 69 FORM OF BID CONRACT NO. 1100 Page 2 of 4 PAVEMENT REHABILITATION 38 7040-108-H * PAVEMENT REMOVAL, CONCRETE SY 3,667.0 $ - $ c29j 33,6 -- SUBTOTAL STREETS AND RELATED WORK = $ DIVISION MARKINGS CONTROL 8 AND - PAVEMENT TRAFFIC 39 8030-108-A TEMPORARY TRAFFIC CONTROL LS 1.0 $ Dv Goo -- $ aidOr - SUBTOTAL PAVEMENT MARKINGS AND TRAFFIC CONTROL = $ DIVISION LANDSCAPING 9 - SITE WORK AND SEEDING 40 9010-108-B * HYDRAULIC FERTILIZING 1 SEEDING, AND MULCHING SEEDING, - TYPE SY 2,197.0 $ a -.-- $ 9/3,1/ 41 9010-108-E * WARRANTY SY 550.0 $ / fvc> - $ a EROSION CONTROL AND SEDIMENT 42 9040-108-Q-2 EROSION HYDROMULCHING CONTROL MULCHING, SY 2,197.0 $ 9` $ ')9r 43 9040-108-T-1 * INLET INSTALLATION PROTECTION DEVICE, EACH 20.0 $ 3J nn `' $ %- ° 44 9040-108-T-2 * INLET MAINTENANCE$ PROTECTION DEVICE, EACH 20.0 •- $ S -eh" 25- SUBTOTAL SITE WORK AND LANDSCAPING = $ DIVISION MISCELLANEOUS 11 - 45 11010-108-A CONSTRUCTION SURVEY LS 1.0 $ 6,6teep,-- $ 61l>el, 'y 46 11020-108-A MOBILIZATION LS 1.0 $ 33: twe - $ 3 Cleo " SUBTOTAL MISCELLANEOUS = $ TOTAL BID $ (� � I/6 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. 4. Security in the sum of � Dollars ($ in the form of )3- (AO— , is submitted herewith in accordance with the INSTRUCTIONS TO BIDDERS. 5. Attached hereto is a Non -Collusion Affidavit of Prime Contractor. FORM OF BID CONRACT NO. 1100 Page 3 of 4 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 $10,000.00 in work for the City in the current calendar year are prepared to submit an AAP or Update and an EOC, within ten (10) days of notification that the bid submitted is lowest and acceptable. 9. The bidder has received the following Addendum or Addenda: Addendum No. / Date -- 9-17 ' V 10. The bidder shall list the MBE/WBE subcontractor(s), amount of subcontracts and bid items on the City of Waterloo Minority and/or Women Business Pre -bid Contact Information Form submitted with this Form of Bid or Proposal. The apparent low Bidder shall submit a list of all other Subcontractor(s) to be used on this Project to the City of Waterloo by 5:00 p.m. the business day following the day Bids on this Project are due along with the Non -Collusion Affidavits of All Subcontractor(s). The Contractor shall submit information on subcontractors on "SUBCONTRACTOR REQUEST AND APPROVAL" Form to be provided by City prior to approval of contract. The subcontractors listed on this proposal and/or submitted to the Contract Compliance Officer cannot be changed except for the following reasons: 1) The City of Waterloo does not approve the subcontractors. 2) The subcontractors submit in writing that they cannot fulfill their subcontracts. 11. The bidder has filled in all blanks on this proposal. Those blanks not applicable are marked "none" or "NA". 12. The bidder has attached all applicable forms. 13. The Owner reserves the right to select alternates, delete line items, and/or to reduce quantities prior to the award of a contract due to budgetary limitations. L. 0 d5 e .s -vj4 1 ov< (Name of Bidder) (Date) BY: N\ oVIA-t csie. vti Title 9�/,�-_c )C ( Official Address: (Including Zip Code): p . 0 . 8 0 I.R.S. No. fle (2$Vo lgo-- FORM OF BID CONRACT NO. 1100 Page 4 of 4 NON -COLLUSION AFFIDAVIT OF PRIME BIDDER State of ) County of BleAtK 1--cwK ) )ss 41-01Avk sew, , being first duly sworn, deposes and says that: 1 He is (Owner, Partner, Office , epresenta I Agent) , of L oc{se- Ct-tni..)-rueh c-cri , the Bidder that mltted t e 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) Title Subscribed and sworn to before me this _ 7Th day of Alt "�e(j My commission expires /1/j &etc\ 4, a *l o w 1AZ ull 111(�P 11IsIlIIIIi1 tp LINDA K SENN COMMISSION NO. 803307 MY COMMISSION EXPIRES Title £cc, as9-0 20g. Prime Contractor Name: Project: //OO MBE/WBE BUSINESS ENTERPRISE PRE -BID CONTACT INFORMATION FORM Lo 4t L:c,03.04-sCU04- 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, please,se the bottgm portion of this form. Contractor Signature: Title: ri`Yin-L--\-k�1 Date: 3.-7 -a- `t SUBCONTRACTORS APPLICABLE: You are required, in order for your bid to be considered responsive, to provide the information on this form showing ALL of your MBE/WBE subcontractor contacts made for your bid submission. This information is subject to verification. Any questions may be directed to Contract Compliance Office 319-291- 4429. You are required, in order for your bid to be considered responsive, to provide the information on this Form showing your MBE/WBE Business Enterprise contacts made prior to your bid submission. This information is subject to verifications and confirmation. If you are unable to identify MBE/WBE firms to perform portions of the work, please contact Rudy Jones, Contract Compliance Officer, for assistance at (319) 291-4429. In the event it is determined that the MBE/WBE Business Enterprise goals are not met, then before awarding the contract the City of Waterloo will make a determination as to whether or not the apparent successful low bidder made good faith efforts to meet the goals. TABLE OF INFORMATION SHOWING BIDDER'S PRE -BID MBE/WBE BUSINESS ENTERPRISE CONTACTS Quotes Received Quotation used in bid Subcontractors MBE/WBE Contacted Dates Yes/No Contacted Dates Yes/No Dollar Amount be Subcontracted Proposed to u .57 D-A9.-021( tY 3--(;-(Y /004-- /et*. Bic& .ca ('V tLL 5 ieji i� /ye- 2 -Pci4V y .3-6-ay y II) 7° ° te Reyes L1c. i1.S f Yac+ t t1 a 'a dY Y 3 ?K/5755G)0 D (Form CCO-4) Rev. 06-20-02 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, 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) ropriate Official) n'l I' Intok r (Title) (Date) Revised February 2003 CONTRACTOR'S OR SUBCONTRACTOR'S AFFIRMATIVE ACTION PROGRAM Check ox that applies to party completing program: ( ) General Contractor ( ) Subcontractor I. Section A to be completed by GENERAL CONTRACTORS only: A. N ame of Company o 60 CC v, s--W Y_-c 4 Address of Company p o , t3 07 V-C-9 Zip S 0 Telephone Number (& «1 ) Federal ID Number (if no Federal ID Number, Owner/President's Social Security Number) d/7 - UV /'''- N ame of Equal Employment Officer 54e0e le - N ame of Project 40( Pei c (-1 Project Contract Number %/0 0 Estimated Construction Work Dates &V / 9-4 r Start Finish Section B to be completed by SUBCONTRACTORS only: B. N ame of General or Prime Contractor N ame 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) N ame 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 Origin 54ese 14e R,oGv VX'1 Gwti�l (f v( tw1/lekr# 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 and productivity status, age, a E. and a mployrr bnt o maximum effort to achieve full employment and utilization of capabilities citizens without regard to race, creed, color, sex, national origin, economic r physical handicap. will give training AFFIRMATIVE ACTION PROGRAM al residents of Waterloo, Iowa, to the greatest extent feasible. Page2of8 III. AFFIRMA A. B. 1. 2. 3. 4. 5. 6. recognizes that the effective ap PD. Box 459�C�involves ��i�� than just a statement and merit employ en t policy .> � >� 3 Rtt�� , , a will, therefore, re xalu to our Affirmative Action Program tq �� ns �= rrlt; t opportunities are on the basis of individual merit, and tb'- 8tivdfy bfib Wrcard 'r r�;.rtItes, women and local - to seek employment with our company on this basis. t r�4 i ve %., our A ►r atJv • Qu. - `'ti _! k� Frl h� � Yj S• � ASter JMinbtit''ROcruitfnqutra..Rd,, ' ,° p}byment; Local Recruitment and Employment; Disabled Vetera Handicapped R Female Recruit Training, Up will undertake the following six (6) steps to improve ietnam Era Veteran Recruitment and Employment; nt and Employment; Employment; and Promotional Opportunities. will take whatever steps are necessary to uate minority, female, and local representation. We will ecrtttrt'. ent attempts: 50619 1. Local advertising media (newspapers, radio, TV); 2. Community organizations (churches, clubs, schools); 3. Public an.». ivs n institutions in the area (UNI, Hawkeye Community College); 4. Job Serviand 5. Other. D. ai '1'Y "% ; J, , I will seek qualified minority, female, and local group applicants (Na a dtijpl for aRclob. A ..9x4 yap .f if , ke asserted efforts to increase minority, female and group repreiii"ttortt}'eij3 igher levels or skill and responsibility. Box \ •f 1 CIA` IC.SVn1y , xA Se's:t9 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 consideration has b G. will encourage other companies, with whom we are (Namercf• Company) e ro -t otion and transfer activities at all levels will be monitored to ensure that full Tto qualified minority, female, and local group employees. 1 associated and/or do business, to dd` he same and we will assist them in their efforts. 1'- RO. Box 459 I CLMucrvaLE, IA 50619 AFFIRMATIVE ACTION PROGRAM Page 3 of 8 H. 1 P.O. Box 439 I CIARKSVILIr, IA 50619 has taken the following Affirmative Action to ensure that s and/or suppliers were provided opportunities to negotiate and/or "NONE") See (.4ice 5r1 ..5 t`+'"� 2. &y.e-C 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") 1. 2. dvt% K. tip• l tes ' ' V . amended,we es 9 s and we realize L. recr wit as necessary o M. Parity figures for c N. Minority Parit (Na f)� Ali Affirma i?d1Attiziij Enpgyfrfca. c 644(0 1 c ovc «e4c_ will require approved Affirmative Action Programs from o propose to work on this project and will take whatever steps are minority contractors have adequate representation of minority, female work force. 1tn+s Ltules and guidelines issued pursuant to Executive Order 11246 as goals for our company, based on parity percentages supplied by the City, s will be reviewed on an annual basis. will keep records of specific actions relative to upgrading and promotion and will provide the City of Waterloo including activities of our SUBCONTRACTORS and suppliers located in Waterloo are as follows: 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 20gt , 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: *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: 54-eje toclj Company Executive 7294 By: Date 5R-e.)ee ,(:) Equal Employment Opportunity Officer Date City of Waterloo Affirmative Action Officer Approved Disapproved Reason: By: Date: AFFIRMATIVE ACTION PROGRAM Page 6 of 8 Bidder Status Form To be completed by all bidders Part A Ple see answer "Yes" or "No" for each of the following: YsONo Yes O No es ONo �'jes YNo es ONo My company is authorized to transact business in Iowa. (To help you determine if your company is authorized, please review the worksheet on the next page). My company has an office to transact business in Iowa. My company's office in Iowa is suitable for more than receiving mail, telephone calls, and e-mail. My company has been conducting business in Iowa for at least 3 years prior to the first request for bids on this project. My company is not a subsidiary of another business entity or my company is a subsidiary of another business entity that would qualify as a resident bidder in Iowa. If you answered "Yes" for each question above, your company qualifies as a resident bidder. Please complete Parts B and D of this form. If you answered "No" to one or more questions above, your company is a nonresident bidder. Please complete Parts C and D of this form. To be completed by resident bidders Part B My company has maintained offices in Iowa during the past 3 years at the following addresses: Dates: / / / / %.3� to / 7 / °2 V Address: Pe) 13 67 VS City, State, Zip. C%cI Cc\i; lft 't _5-/6/ 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? O Yes O No 3. If you answered "Yes" to question 2, identify each preference offered by your company's home state or foreign country and the appropriate legal citation. You may attach additional sheet(s) if needed. To be completed by all bidders Part D I certify that the statements made on this document are true and complete to the best of my knowledge and I know that my failure to provide accurate and truthful information may be a reason to reject my bid. Firm Name: Signature: LC 6 Co v 4Xtie/1- Date: - 7 ` eP- 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 es O Yes es ONo O Yes Q Yes Q Yes Q Yes a Yes O Yes Q Yes 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. My business is an active corporation with the Iowa Secretary of State and has paid all fees required by the Secretary of State, has filed its most recent biennial report, and has not filed articles of dissolution. My business is a corporation whose articles of incorporation are filed in a state other than Iowa, the corporation has received a certificate of authority from the Iowa secretary of state, has filed its most recent biennial report with the secretary of state, and has neither received a certificate of withdrawal from the secretary of state nor had its authority revoked. My business is a limited liability partnership which has filed a statement of qualification in this state and the statement has not been canceled. My business is a limited liability partnership which has filed a statement of qualification in a state other than Iowa, has filed a statement of foreign qualification in Iowa and a statement of cancellation has not been filed. My business is a limited partnership or limited liability limited partnership which has filed a certificate of limited partnership in this state, and has not filed a statement of termination. My business is a limited partnership or a limited liability limited partnership whose certificate of limited partnership is filed in a state other than Iowa, the limited partnership or limited liability limited partnership has received notification from the Iowa secretary of state that the application for certificate of authority has been approved and no notice of cancellation has been filed by the limited partnership or the limited liability limited partnership. My business is a limited liability company whose certificate of organization is filed in Iowa and has not filed a statement of termination. My business is a limited liability company whose certificate of organization is filed in a state other than Iowa, has received a certificate of authority to transact business in Iowa and the certificate has not been revoked or canceled. 309-6001 (09-15) 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 7th day of March 2024 , for FY 2024 Kingsley Avenue Reconstruction Project in the City of Waterloo, Iowa; Contract No. 1100 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 fumishing matenals in connection therewith, and shall in all other respects perform the agreement created by the acceptance of said Bid, Then this obligation shall be void, otherwise the same shall remain in force and effect; it being expressly understood and agreed that the liability of the Surety for any and all claims hereunder shall, in no event, exceed the penal amount of this obligation as herein stated. By virtue of statutory authority, the full amount of this bid bond shall be forfeited to the Owner in liquidation of damages sustained in the event that the Principal fails to execute the contract and provide the bond as provided in the specifications or by law. The Surety, for value received, hereby stipulates and agrees that the obligations of said Surety and its bond shall be in no way impaired or affected by any extension of the time within which the Owner may accept such Bid or execute such contract; and said Surety does hereby waive notice of any such extension. IN WITNESS WHEREOF, the Principal and the Surety, have hereunto set their hands and seals, and such of them as are corporations, have caused their corporate seals to be hereto affixed and these presents to be signed by their proper officers this 22nd day of February , A D. 2024 Witness Lodge Construction, Inc. Principal B (Seal) Swiss Re .rporate Sol tions America Insuran Sajporation / 1 Attorney-in-f.. By Suret Sara Huston (Title) SWISS RE CORPORATE SOLUTIONS SWISS RE CORPORATE SOLUTIONS AMERICA INSURANCE CORPORATION ("SRCSAIC") SWISS RE CORPORATE SOLUTIONS PREMIER INSURANCE CORPORATION ("SRCSPIC") WESTPOR'f 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 State 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 does hereby make, constitute and appoint: JAY D. FREIERMUTH, CRAIG E. IIANSEN, BRiAN M. DEIMERLY, CINDY BENNETT, ANNE CROWNER, TIM McCULLOH, DIONE R. YOUNG, SETH ROOKER, JENNIFER MARINO, JOSEPH TIERNAN, KATE ZANDERS, SARA HUSTON, JOHN CORD LUKAS SCHRODER and JAMIE GIFFORD JOINTLY OR SEVERALLY Its true and lawful Attorneys) -in -Fact, to make, execute, seal and deliver, for and on 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 under 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 in 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 noon the C'arporatien when so affixed and in the future with regard to any bond, undertaking or contract of surety to which it is attached." ,,,l„r:ll,lra,r .,,,,flIuui,,r, . ``‘;:S a01ER lllll e �\`� . ,.... �cll • -`_. t• iFtt:E �A °0, 1973 , : • a '.4S�,ii •SS JVEi e ‘ f•;(\14 N4: "\::).:. .PS. llllllllllllllllllllllllllllll e� • •• •• n: `+r By Erik Janssens, Senior Vice President of SRCSAIC & Senior Vice President of SRCSPIC & Senior Vice President of WIC 1-11 By Gerald Jagrowski, Vice President of SRCSAIC & Vice President of SRCSPIC & 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 2nd day of State of Illinois County of Cook li •• .` d••••Sib • SSW./cam•• ATS llllllll * ‘00, ttttttttttttttttt FEBRUARY 20 24 SS Swiss Re Corporate Solutions America Insurance Corporation Swiss Re Corporate Solutions Premier Insurance Corporation Westport Insurance Corporation On this 2nd day of FEBRUARY , 20 24 , before me, a Notary Public personally appeared Erik Janssens , Senior Vice President of SRCSAIC and Senior Vice President of SRCSPIC and Senior Vice President of WIC and Gerald Jagrowski , Vice President of SRCSAIC and Vice President of SPCSPIC and Vice President of WIC, personally known to me, 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. 1 OFFICIAL SEAL CHRISTWA MANISC0 NOTARY PUBLIC, t3TATE QF UMW. , , Ntt a r iV E+tpkt;i rm eft 28»ie2i Notay I, 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 true and correct copy of a Power of Attorney given by said SRCSAIC and SRCSPIC and \VIC, which is still in full force and effect. IN WITNESS WIIEREOF, I have set my hand and affixed the seals of the Companies this 22ndday of February , 20 24 . Jeffrey Goldberg, Senior Vice President & Assistant Secretary of SRCSAIC and SRCSPIC and WIC