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FORM OF BID OR PROPOSAL
F.Y. 2024 W 11TH STREET RAILROAD CROSSING REPAIR
CONTRACT NO. 1107
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 - ow4-
a Partnership consisting of the following partners: jvWee/z ca4ArretC, Lc-?.
, having familiarized (himself) (themselves)
(itself) with the existing conditions on the project area affecting the cost of the work, and with all the contract
documents listed in the Table of Contents and Addenda (if any), as prepared by the City Engineer of the City
of Waterloo now on file in the office of the City Clerk, City Hall, Waterloo, Iowa, hereby proposes to furnish all
supervision, technical personnel, labor, materials, machinery, tools, appurtenances, equipment, and services,
including utility and transportation services required to construct and complete this F.Y. 2024 W 11TH STREET
RAILROAD CROSSING REPAIR, Contract No. 1107, all in accordance with the above -listed documents and
for the unit prices for work in place for the following items and quantities:
F.Y. 2024
W11TH
STREET
CONTRACT
RAILROAD
NO.
1107
CROSSING
REPAIR
ITEM
BID
IDOT
ITEM
/
SUDAS
NO.
ITEM
DESCRIPTION
UNIT
EST.
QTY.
UNIT
PRICE
BID
TOTAL
PRICE
BID
1
2102.2710090
EXCAVATION,
CLASS
10
-
WASTE
CY
10
$ ?4 oo
$ nit0. oD
2
2105-8425005
TOPSOIL,
FURNISH
AND
SPREAD
CY
2
$ 5'ra.cro
$ aSG.00
3
2115.0100010
MODIFIED
SUBBASE
CY
15
$ 9 S 50
$ I , 28 a, CC)
4
2301.4875008
MEDIAN,
P.C.
CONCRETE,
8
IN.
SY
73.2
$ /03•cm
$ 1539. GO
5
2435-0600020
MANHOLE
ADJUSTMENT,
MINOR
EA
1.0
$, av
$ 900 Iry
6
2435-0252100
LINEAR
TRENCH
DRAIN,
SW-521
LF
121.0
vA9 co
7
2502.8212206
SUBDRAIN,
PLASTIC
PIPE,
STANDARD,
6
IN.
DIA.
PERFORATED
LF
125.0
$ /a.cJv
$ 1,coo. ert)
8
4040-1.08.C.1
SUBDRAIN
CLEANOUT,
TYPE
A-1
EA
2.0
$ yso • Q
$ yoo
9
2510.6745850
REMOVAL
OF
PAVEMENT
SY
333.9
$ ar,,5'v
$ &I t
IL' .95
10
2517.4225210
RAILROAD
APPROACH
SECTION,
PCC
SY
260.6
$ la?•'So
$ 35,,a1,•So
11
2511-0300000
REMOVAL
OF
RECREATIONAL
TRAIL
SY
46.6
$ aa,00
$ /,vas, a0
12
2511-6745900
REMOVAL
OF
SIDEWALK
SY
16.0
$ 10 uy
$ 9bo
W
13
2511-7526006
SIDEWALK,
P.C.
CONCRETE,
6
IN.
SY
22.4
$ ?LOP
$ 11/117,
ao
14
2511-7526106
SIDEWALK,
IN.
REINFORCED
P.C. CONCRETE,
6
SY
42.6
$
ra5'.00
$ 6;ga .oa
15
2511-7528101
DETECTABLE
WARNINGS
SF
44.0
$ 301•00
$ 1,716. o0
16
2527.9263109
PAINT
BOURNE
MARKINGS,
SOLVENT
OR
WATER-
STA
13.49
$ °11•15
$
/ia 37,7
17
2601-2636044
SEEDING
AND
FERTILIZING
(URBAN)
ACRE
0.01
$ CM 5.00.rJv
$ q/s.Oa
18
2528.8445110
TRAFFIC
CONTROL
LS
1.0
$ y,c00.01.2
$ y, Soo. OD
19
2528-2518000
SAFETY
CLOSURE
EA
9.0
$ 00.a>
$ 720.ua
20
2533-4980005
MOBILIZATION
LS
1.0
$ 5, 00 v. ao
$ 5, vov, ut)
TOTAL
BID
$ 9`l1(�GC�.
46
FORM OF BID
CONTRACT NO. 1107
Page 1 of 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.
4. Security in the sum of FVE t ecE�,T or /Imbue gr9 Dollars ($ r 570 em-
) in the form of $D AND , is submitted herewith in accordance with
the INSTRUCTIONS TO BIDDERS.
5. Attached hereto is a Non Collusion Affidavit of Prime Contractor.
6. Attached hereto is a Bidder Status Form.
7 The bidder is prepared to submit a financial and experience statement upon request.
8. The Prime Contractor and Subcontractor(s), which have performed an aggregate of $10,000.00 in work
for the City in the current calendar year, are prepared to submit an AAP or Update and an EOC, within
ten (10) days of notification that the bid submitted is lowest and acceptable.
9. The bidder has received the following Addendum or Addenda:
Addendum No.
Date 431r
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.
FORM OF BID
CONTRACT NO. 1107 Page 2 of 3
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.
&o1#6€ CA/Z;e-fre•ri426; /LC•
(Name of Bidder)
BY:
Official Address: (Including Zip Code):
54/ zy
(Date)
Title PM, r - _
P.O. 8^0x 31 Q 606 E. fsr sr.
GgaUit2y eteAilief a. £6439
I.R.S. No. 2 7 - 3o 7 2-'46..3
FORM OF BID
CONTRACT NO. 1107 Page 3 of 3
Bidder Status Form
To be completed by all bidders Part A
Please answer "Yes" or "No" for each of the following:
o
Yes
Yes
Yes
0No
ONo
No
Yes ONo
My company is authorized to transact business in Iowa.
(To help you determine if your company is authorized, please review the worksheet on the next page).
My company has an office to transact business in Iowa.
My company's office in Iowa is suitable for more than receiving mail, telephone calls, and e-mail.
My company has been conducting business in Iowa for at least 3 years prior to the first request for
bids on this project.
My company is not a subsidiary of another business entity or my company is a subsidiary of another
business entity that would qualify as a resident bidder in Iowa.
If you answered "Yes" for each question above, your company qualifies as a resident bidder. Please
complete Parts B and D of this form.
If you answered "No" to one or more questions above, your company is a nonresident bidder. Please
complete 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: D I /
Dates:
Dates:
01 / 2bl° to OS / oZ / 202s, Address: Po. Bsx310 bob E. isr sr.
City, State, Zip.
/ / to / / Address.
City, State, Zip:
/ / to / / Address:
You may attach additional sheet(s) if needed.
GA"MQy
(buret, Dit.
City, State, Zip:
To be completed by non-resident bidders Part C
1. Name of home state or foreign country reported to the Iowa Secretary of State:
2. Does your company's home state or foreign country offer preferences to resident bidders, resident labor
force preferences or any other type of preference to bidders or laborers?
Yes 0No
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: &fr1t76C £2 7 ivv Lie .
i
Signature:
Date: `///Z45/G2/
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 cNo
0 Yes
Q Yes
xYYes QNo
QYes 0No
Q Yes
Q Yes
O Yes CONo
O Yes 0No
0 Yes() No
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)
NON -COLLUSION AFFIDAVIT OF PRIME BIDDER
State of a- )
County of C3(kkMNAes. Co-psoLiAres
)
)ss
, being first duly sworn, deposes and says that:
1. He is (Owner, Partner,�fficer epresentative, or Agent) , of ue ( CO
the Bidcatraiat has submitted the attached Bid;
2. He is fully -informed respecting the preparation and contents' of the attached Bid and of all pertinent
circumstances respecting such Bid;
3. Such Bid is genuine and is not a collusive or sham Bid:
4. Neither the said Bidder nor any of its officers, partners, owners, agents, representatives, employees, or
parties in interest, including this affiant, has in any way colluded, conspired, connived or agreed, directly or
indirectly, with any other Bidder, firm or person to submit a collusive or sham Bid in connection with the
Contract for which the attached Bid has been submitted or to refrain from bidding in connection with such
Contract, or has in any manner, directly or indirectly, sought by agreement or collusion or communication or
conference with any other Bidder, firm or person to fix the price or prices in the attached Bid or of any other
Bidder, or, to fix any overhead, profit or cost element of the bid price or the bid price of any other Bidder, or
to secure through any collusion, conspiracy, connivance, or unlawful agreement any advantage against the
City of Waterloo, Iowa, or any person interested in the Proposed Contract; and
5. The price or prices quoted in the attached Bid are fair and proper and are not tainted by any collusion,
conspiracy, connivance or unlawful agreement on the part of the Bidder or any of its agents, representatives,
owners, employees, or parties in interest, including this affia
(Signed)
Title
Subscribed and sworn to before me this a \ day of N\a, 202.
VN•YA,✓ k
Title
My commission expires -'^2LYLS'
KIMBERLY D LYNCH
Th s COMMISSION NUMBER EXPIRES
MY COMMISSION
MBE/WBE BUSINESS ENTERPRISE
PRE -BID CONTACT INFORMATION FORM
Prime Contractor Name: $os c aa- Con tse-rnwc, s-es. €.
Project: fY ,vim( II tt Sr. e.4u** Gloss Au6 (t60n-rs- Letting Date: thAdi
Agftiv7
NO MBE/WBE SUBCONTRACTORS: If you are NOT using any MBE/WBE subcontractors to complete this project,
sign below. Attach a brief explanation as to why subcontracting was not feasible with this project. If any MBE/WBE
subcontractors will be used, please use the bottom portion of this form.
Contractor Signature:
Title:
Date:
SUBCONTRACTORS APPLICABLE: You are required, in order for your bid to be considered responsive, to provide
the information on this form showing ALL of your MBE/WBE subcontractor contacts made for your bid submission.
This information is subject to verification. Any questions may be directed to Contract Compliance Office 319-291-
4429.
You are required, in order for your bid to be considered responsive, to provide the information on this Form showing
your MBE/WBE Business Enterprise contacts made prior to your bid submission. This information is subject to
verifications and confirmation.
If you are unable to identify MBE/WBE firms to perform portions of the work, please contact Rudy Jones, Contract
Compliance Officer, for assistance at (319) 291-4429.
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
YeslNo
Contacted
Dates
Yes/No
Dollar
Amount
be Subcontracted
Proposed
to
Sit SC&mac
Hjatl?
1
Y44
5/1611
Y'is
# a, .0),
(Form CCO-4) Rev. 06-20-02
BID BOND
KNOW ALL MEN BY THESE PRESENTS, that we, Boulder Contracting, LLC
as Principal, and Westfield Insurance Company
bound unto the
, as Surety, are held and firmly
CITY OF WATERLOO , Iowa, hereinafter called "OWNER." In the penal sum
Five percent of 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 2nd day of
May , 2024 , for F.Y. 2024 W. 11 th Street Railroad Crossing Repair, Contract No. 1107
•
NOW, THEREFORE,
(a) If said Bid shall be rejected, or in the alternate,
(b) If said Bid shall be accepted and the Principal shall execute and deliver a contract in the form specified and
shall furnish a bond for his faithful performance of said contract, and for the payment of all persons performing
labor or furnishing materials in connection therewith, and shall in all other respects perform the agreement
created by the acceptance of said Bid,
Then this obligation shall be void, otherwise the same shall remain in force and effect; it being expressly
understood and agreed that the liability of the Surety for any and all claims hereunder shall, in no event, exceed
the penal amount of this obligation as herein stated.
By virtue of statutory authority, the full amount of this bid bond shall be forfeited to the Owner in liquidation of
damages sustained in the event that the Principal fails to execute the contract and provide the bond as provided
in the specifications or by law.
The Surety, for value received, hereby stipulates and agrees that the obligations of said Surety and its bond shall
be in no way impaired or affected by any extension of the time within which the Owner may accept such Bid or
execute such contract; and said Surety does hereby waive notice of any such extension.
IN WITNESS WHEREOF, the Principal and the Surety, have hereunto set their hands and seals, and such of
them as are corporations, have caused their corporate seals to be hereto affixed and these presents to be signed
by their proper officers this 2nd day of May , A.D. 2024 .
Boulder Contracting, LLC (Seal)
Principal
Witness
Witness
A_ a
/v, r
BID BOND
By
Westfield Insurance Company (Seal)
Surety
By
Joseph I. S mit Attorney -in -fact
(Title)
Page 1 of 1
THIS POWER OF ATTORNEY SUPERCEDES ANY PREVIOUS POWER BEARING THIS SAME
POWER # AND ISSUED PRIOR TO 06/20/22, FOR ANY PERSON OR PERSONS NAMED BELOW.
General
Power
of Attorney
CERTIFIED COPY
POWER NO. 1429172 00
Westfield Insurance Co.
Westfield National Insurance Co.
Ohio Farmers Insurance Co.
Westfield Center, Ohio
Know All Men by These Presents, That WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO
FARMERS INSURANCE COMPANY, corporations, hereinafter referred to individually as a "Company" and collectively as "Companies," duly
organized and existing under the laws of the State of Ohio, and having its principal office in Westfield Center, Medina County, Ohio, do by these
presents make, constitute and appoint
JOSEPH I. SCHMIT, JEFFREY R. BAKER, GREG T. LAMAIR, E. A. VONHARZ, BRANDON HORBACH, JOINTLY OR SEVERALLY
of WEST DES MOINES and State of IA its true and lawful Attorney(s)-in-Fact, with full power and authority hereby conferred in its name,
place and stead, to execute, acknowledge and deliver any and all bonds, recognizances, undertakings, or other instruments or contracts of
suretyship in any penal limit. - -
LIMITATION: THIS POWER OF ATTORNEY CANNOT BE USED TO EXECUTE NOTE GUARANTEE, MORTGAGE DEFICIENCY, MORTGAGE
GUARANTEE, OR BANK DEPOSITORY BONDS.
and to bind any of the Companies thereby as fully and to the same extent as if such bonds were signed by the President, sealed with the corporate
seal of the applicable Company and duly attested by its Secretary, hereby ratifying and confirming all that the said Attorneys) -in -Fact may do in
the premises. Said appointment is made under and by authority of the following resolution adopted by the Board of Directors of each of the
WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY:
"Be It Resolved, that the President, any Senior Executive, any Secretary or any Fidelity & Surety Operations Executive or other Executive shall
be and is hereby vested with full power and authority to appoint any one or more suitable persons as Attorney(s)-in-Fact to represent and act for
and on behalf of the Company subject to the following provisions:
The Attorney -in -Fact. may be given full power and authority for and in the name of and on behalf of the Company, to execute, acknowledge and
deliver, any and all bonds, recognizances, contracts, agreements of indemnity and other conditional or obligatory undertakings and any and all
notices and documents canceling or terminating the Company's liability thereunder, and any such instruments so executed by any such
Attorney -in -Fact shall be as binding upon the Company as if signed by the President and sealed and attested by the Corporate Secretary."
"Be it Further Resolved, that the signature of any such designated person and the seal of the Company heretofore or hereafter affixed to any
power of attorney or any certificate relating thereto by facsimile, and any power of attorney or certificate bearing facsimile signatures or facsimile
seal shall be valid and binding upon the Company with respect to any bond or undertaking to which itis attached." (Each adopted at a meeting
held on February 8, 2000).
In Witness Whereof, WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE
COMPANY have caused these presents to be signed by their National Surety Leader and Senior Executive and their corporate seals to be hereto
affixed this 20th day of JUNE A.D., 2022 .
an.11l lUp fill
Corporate .• "1t U FI4�Clli
'.
Seals ''�.
Affixed iiby
SEAL41
It' ,4 tfl.1ltIt"
State of Ohio
County of Medina ss.:
'•1NSU1"''' WESTFIELD INSURANCE COMPANY
••'i ••••'••• d�, so WESTFIELD NATIONAL INSURANCE COMPANY
e E' - OHIO FARMERS INSURANCE COMPANY
urn! OI RTERED ; a
1848
%, , ••• 0 •••tttttttttttttttttt
Its let%
B
umper, NationaT"Surety Leader and
Senior Executive
On this 20th day of JUNE A.D., 2022 , before me personally came Gary W. Stumper to me known, who, being by me duly sworn,
did depose and say, that he resides in Medina, OH; that he is National Surety Leader and Senior Executive of WESTFIELD INSURANCE
COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY, the companies described in and which
executed the above instrument; that he knows the seals of said Companies; that the seals affixed to said instrument are such corporate seals; that
they were so affixed by order of the Boards of Directors of said Companies; and that he signed his name thereto by like order.
Notarial
Seal
Affixed
State of Ohio
County of Medina ss.:
` "`,lµd111 ll/,y,, I
ttttt
si N
,� . ��. ottttttttttttttttttttttt
aziega
David A. Kotnik, Attorney at Law, Notary Public
My Commission Does Not Expire (Sec. 147.03 Ohio Revised Code)
I, Frank A. Carrino, Secretary of WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS
INSURANCE COMPANY, do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney, executed by said
Companies, which is still in full force and effect; and furthermore, the resolutions of the Boards of Directors, set out in the Power of Attorney are
in full force and effect.
In Witness Whereof, I have hereunto set my hand and affixed the seals of said Companies at Westfield Center, Ohio, this 2nd day of
May A.D., 2024
N ,',..aullllll,..,,
9NA( .•
1.w SEAL ;" N n
SEAL il
:m:
. .
,Nsul�''
szt,..itoRiaroll
Is: 1848•t
•o ..• e
,
, s�
tt,q,,, Ih 1 lu N,.••••
Frank A. Carrino, Secretary
Secretary
BPOAC2 (combined) (03-22)