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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
a Partnership consisting of the following partners:
, having familiarized (himself) (themselves)
(itself) with the existing conditions on the project area affecting the cost of the work, and with all the contract
documents listed in the Table of Contents and Addenda (if any), as prepared by the City Engineer of the City
of Waterloo now on file in the office of the City Clerk, City Hall, Waterloo, Iowa, hereby proposes to furnish all
supervision, technical personnel, labor, materials, machinery, tools, appurtenances, equipment, and services,
including utility and transportation services required to construct and complete this F.Y. 2024 W 11" 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
$ //0
$ / /oa -
2
2105-8425005
TOPSOIL,
FURNISH
AND
SPREAD
CY
2
$ '3.309
S640--
3
2115.0100010
MODIFIED
SUBBASE
CY
15
$ 4N
$7\5-
4
2301.4875008
MEDIAN,
P.C.
CONCRETE,
8
IN.
SY
73.2
$ /fr/6
$ Q
5
2435.0600020
MANHOLE
ADJUSTMENT,
MINOR
EA
1.0�c`,
►
$?�Udf�
6
2435-0252100
LINEAR
TRENCH
DRAIN,
SW-521
LF
121.0
?? --
z-
7
2502.8212206
SUBDRAIN,
PLASTIC
PIPE,
STANDARD,
6
IN.
DIA.
PERFORATED
LF
125.0
$ t'
$ 2,
J,25
8
4040-1.08.C.1
SUBDRAIN
CLEANOUT,
TYPE
A-1
EA
2.0
$ / "de/p-
-
$ 00a 4
9
2510.6745850
REMOVAL
OF
PAVEMENT
SY
333.9
•--,
$ /3
$ C, 76 /S.
10
2517-4225210
RAILROAD
APPROACH
SECTION,
PCC
SY
260.6
$
dC -}
$ ‘Sr -G
/(20
-
11
2511.0300000
REMOVAL
OF
RECREATIONAL
TRAIL
SY
46.6
$
/ ----
$_
\C-
12
2511-6745900
REMOVAL
OF
SIDEWALK
SY
16.0
$ / 3
$ t 0
r>
--
13
2511.7526006
SIDEWALK,
P.C.
CONCRETE,
6
IN.
SY
22.4
$ co
$ %t:26
.a
14
2511-7526106
SIDEWALK,
REINFORCED
P.C. CONCRETE,
6
42.6
�-
IN.
SY
$ U,<^
$ J 6,
15
2511-7528101
DETECTABLE
WARNINGS
SF
44.0
16
2527-9263109
PAINT
BOURNE
MARKINGS,
SOLVENT
OR
WATER-
STA
13.49
$ `n ) -
$ ji 3 `/1
17
2601-2636044
SEEDING
AND
FERTILIZING
(URBAN)
ACRE
0.01
0 000
-
18
2528-8445110
TRAFFIC
CONTROL
LS
1.0
e
19
2528.2518000
SAFETY
CLOSURE
EA
9.0
$ g
s- -
-
$ 76'5-
20
2533.4980005
MOBILIZATION
LS
1.0
;.ate, —
TOTAL
BID
$ J3)
Pa
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.
� b
4. Securityin the sum of `5 Dollars ($
) in the form of Ro hot , is submitted herewith in accordance with
the INSTRUCTIONS TO BIDDERS.
5. Attached hereto is a Non•Collusion Affidavit of Prime Contractor.
6. Attached hereto is a Bidder Status Form.
7 The bidder is prepared to submit a financial and experience statement upon request.
8. The Prime Contractor and Subcontractor(s), which have performed an aggregate of $10,000.00 in work
for the City in the current calendar year, are prepared to submit an AAP or Update and an EOC, within
ten (10) days of notification that the bid submitted is lowest and acceptable.
9. The bidder has received the following Addendum or Addenda:
Addendum No. Date
10. The bidder shall list the MBE/WBE subcontractor(s), amount of subcontracts and bid items on the City
of Waterloo Minority and/or Women Business Pre -bid Contact Information Form submitted with this
Form of Bid or Proposal. The apparent low Bidder shall submit a list of all other Subcontractor(s) to
be used on this Project to the City of Waterloo by 5:00 p.m. the business day following the day Bids on
this Project are due along with the Non -Collusion Affidavits of All Subcontractor(s).
The Contractor shall submit information on subcontractors on "SUBCONTRACTOR REQUEST AND
APPROVAL" Form to be provided by City prior to approval of contract.
The subcontractors listed on this proposal and/or submitted to the Contract Compliance Officer cannot
be changed except for the following reasons:
1) The City of Waterloo does not approve the subcontractors.
2) The subcontractors submit in writing that they cannot fulfill their subcontracts.
11. The bidder has filled in all blanks on this proposal. Those blanks not applicable are marked "none" or
"NA".
12. The bidder has attached all applicable forms.
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.
Lod , c vi JC. ju Vl
(Name of Bidder)
(Date)
BY: / Title fS 7J, `neac
Qif+ 'al Address: (Including Zip Code):
Pa- BOA girl
G i�,� �v� Ile � 4 5 o61
Q.R.S. No. y.7 - a8yG88a
FORM OF BID
CONTRACT NO. 1107 Page 3 of 3
NON -COLLUSION AFFIDAVIT OF PRIME BIDDER
State of "C^-
County of gi,cf< Mc-� )
)ss
, being first duly sworn, deposes and says that:
1 He is (Owner, Partner Officer ' e•resentat' _, or Agent) , of IP ('sir�
, the Bidder that has submitted the attached Bid;
2. He is fully -informed respecting the preparation and contents of the attached Bid and of all pertinent
circumstances respecting such Bid;
3. Such Bid is genuine and is not a collusive or sham Bid:
4. Neither the said Bidder nor any of its officers, partners, owners, agents, representatives, employees, or
parties in interest, including this affiant, has in any way colluded, conspired connived or agreed, directly or
indirectly, with any other Bidder, firm or person to submit a collusive or sham Bid in connection with the
Contract for which the attached Bid has been submitted or to refrain from bidding in connection with such
Contract, or has in any manner, directly or indirectly, sought by agreement or collusion or communication or
conference with any other Bidder, firm or person to fix the price or prices in the attached Bid or of any other
Bidder, or, to fix any overhead, profit or cost element of the bid price or the bid price of any other Bidder, or
to secure through any collusion, conspiracy, connivance, or unlawful agreement any advantage against the
City of Waterloo, Iowa, or any person interested in the Proposed Contract; and
5. The price or prices quoted in the attached Bid are fair and proper and are not tainted by any collusion,
conspiracy, connivance or unlawful agreement on the part of the Bidder or any of its agents, representatives,
owners, employees, or parties in interest, including this affiant.
(Signedj,
Subscribed and sworn to before me this ,elinet day of
+4/
e
My commission expires /6 '94'
fir
dn./ _te7A
as
LINDA K SENN
COMMISSION NO. 803307
MY COMMISSION EXPIRES
Bidder Status Form
To be completed by all bidders
Part A
Please answer "Yes" or "No" for each of the following:
Yes
des
eYes
Yes
ONo
ONo
ONo
fNo
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 Paris 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: ( /
Dates:
Dates:
1 / /s'to s- /0 /a?
Address: P Oflo$ '/S9
City, State, Zip:
/ / to / / Address:
City, State, Zip:
to / / Address:
You may attach additional sheet(s) if needed.
c c u; //c)
So 6/
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 0 Yes 0 No
force preferences or any other type of preference to bidders or laborers?
3. If you answered "Yes" to question 2, identify each preference offered by your company's home state or foreign country
and the appropriate legal citation.
You may attach additional sheet(s) if needed.
To be completed by all bidders
Part D
I certify that the statements made on this document are true and complete to the best of my knowledge and I know that my
failure to provide accurate and truthful information may be a reason to reject my bid.
Firm Name: eeg L' Co 14.5.-fr-C-/14''1
Signature:
Date: a V
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.
s 1No
QX6'0NO
CesQNN
(110‘s 0 No
Q Yes
Q Yes
Q Yes
Q Yes
oYes(
vi
0
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)
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 dis. •'lities.
(Signed)
,(Appropriate Official)
`em s-�f fr c J
(Title)
(Date)
MBE/WBE BUSINESS ENTERPRISE
PRE -BID CONTACT INFORMATION FORM
Prime Contractor Name: L o(4 . ('OviS-i'ftsc► ot7) i c�-
Project: / j o
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 use the bottom portion of this form.
Contractor Signature:
Title: t:S )< c
Date: -02_ `f
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
,S�tV
fC
��vi��►�i
V,P7-t)
V
Sc e
ti
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11)7X) d
(Form CCO-4) Rev. 06-20-02
Revised February 2003
CONTRACTOR'S OR SUBCONTRACTOR'S AFFIRMATIVE ACTION PROGRAM
Check box that applies to party completing program:
(
(
General Contractor
Subcontractor
I. Section A to be completed by GENERAL CONTRACTORS only:
A.
Name of Company Lo4
CGvi.5 mkc
Address of Company P 0. Go)C. VS-9 G41 rtp/' 9
Telephone Number (9 10* ." / 7
Federal ID Number (if no Federal ID Number, Owner/President's Social Security Number)
1/7
y
Name of Equal Employment Officer
Name of Project %/
Project Contract Number
Estimated Construction Work Dates e
/ ca-
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
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:
Name
5 )eoc
Address Position
1).ti.. Po/ 0-1
t/�� f�
Ethnic
Sex Origin
/4/)
57 /°7
2. Other Areas of Interest:
If your company has branches or subsidiaries, or if your company is a branch or subsidiary of a
parent organization, give the following information:
Type of
Name Address Affiliation Degree
II. EMPLOYER'S POLICY (Please read carefully.)
A. We, the undersigned, recognize that we are morally and legally committed to nondiscrimination in
employment. Any person who applies for employment with our company will not be discriminated
against because of race, color, creed, sex, national origin, economic status, age, mental or physical
handicap.
B. The employment policies and practices of the undersigned are to recruit and hire employees without
discrimination, and to treat them equally with respect to compensation and opportunities for
advancement, including training, upgrading, promotion, and transfer. However, we realize the
inequities associated with employment training, upgrading, contracting and subcontracting for
minorities and women and we will direct our efforts to correcting any deficiencies to the maximum
extent possible. The same will be required of our SUBCONTRACTORS and suppliers.
C We submit this program to assure compliance with Executive Order 11246, as amended, and other
subsequent orders that may pertain to equal employment opportunity and merit employment policies,
fully realizing that our qualification and/or merit system should be evaluated and revised, if
necessary.
D. We agree to put forth t
and productivity of all o
status, age, and mental
E.
(Name o
and employ
a 'ma3(
d
:i'
d =, ;,
..4...�.v.� _
t : f ? . 'If!+\ �%.. .1..
j.ai°.•.,. _�
gle t
1;110
i<!t c . 10
P.O. Box 459 1 CutyozwofI IA 50t0. J
mum effort to achieve full employment and utilization of capabilities
without regard to race, creed, color, sex, national origin, economic
%al handicap.
will give training
ents of Waterloo, Iowa, to the greatest extent feasible.
AFFIRMATIVE ACTION PROGRAM
Page 2 of 8
III. AFFIRM
A.
B.
C.
D.
r)f. tK
�. �'iT tis��
P.O. Box 459 I Ck1ucs\9l..vv. IA 5P1,11.
merit employment involves more than just a policy statement, and
recognizes that the effectiv
will, therefore, re
opportunities are
women and local r
our Aff
1.
2.
3.
4.
5.
6.
• e.' `fit
I . �Z 3.r� ,��•i
• lure e our Affirmative Action Program to ensure �raA��. �otpySen
ijirett . A. on the basis of individual merit, and to actively encourage minoriti�es,4 �
o seek employment with our company on this basis.
b .•
Ara,:
Ai
);.
fin ilt eMitrnw_nbani .15ioyment;
Local Recruitment and Employment;
Disabled Veteran and Vietnam Era Veteran Recruitment and Employment;
will undertake the following six (6) steps to improve
Handicapped R
Female Recruit
Training, Upgr
(Na
ensure tha
ent and Employment;
Employment; and
Promotional Opportunities.
will take whatever steps are necessary to
p;, uate minority, female, and local representation. We will
utilize then, F.Atft� r '4)1 ent attempts:
P.O. Box 459 1 Ct Afixsiq i.l:, JA 5O �.19
Loca ,ydv•r.fising media (newspapers, radio, TV);
tt?,v,;:prganizations (churches, clubs, schools);
Publ "f- �VV,%%�vate institutions in the area (UNI, Hawkeye Community College);
Jo •.'. .'_1;;•_if Iowa; and
•
.`,,. ,fe- jy ti Az_ 1
jzul
will seek qualified minority, female, and local group applicants
r ,_.t,��i !A, „,. ,fflh 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, upgradi
consideration ha
G.
(Na T /
asso?' 1 orJ v••e_l�.L�_. t
q, �
� 4.���
%.a Y i t.✓'. -AIL V' IWS:P :L.\ - 1.
Pt; . Box 459 1 CLARXSV%L.LF, X 50619
,.�
AFFIRMATIVE ACTION PROGRAM
otion and transfer activities at all levels will be monitored to ensure that full
ven to qualified minority, female, and local group employees.
will encourage other companies, with whom we are
o the same and we will assist them in their efforts.
Page 3of8
H
J.
• e--• ; * :•:,Y:.• has taken the following Affirmative Action to ensure that
•
�3I
3 . , :�_
•
6Y and/or suppliers were provided opportunities to negotiate and/or
bl e3ti Io.. tsk •''+` ? s{ ONE' �)
�Na
P.O. Box 4159 CG ossviu1 , 111. 50619
1.
2. p kt �e e c- / 1
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.
will require approved Affirmative Action Programs from
propose to work on this project and will take whatever steps are
inority contractors have adequate representation of minority, female
agid'"fZeghlatii `ellitittieirdtot6i work force.
K. In further accor
amended, we
and w,e
L.
M. Parity figures for
recto `�-{flt
with a ' Frf6Pr oYil latiksa.l ;SWpn
as necessary or when requested.
5
Jl tdei
ith rules and guidelines issued pursuant to Executive Order 11246 as
e goals for our company, based on parity percentages supplied by the City,
ill 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:
rr,
..-- SOO •
(Ks IVO-MP
Affirmat g' Wbfgri ElAi`fEDj7t1/2 rift Gb :
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 20, 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: _ c
*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: 1lC�•<
Company Executive
9- 9 Y
By:
Date
$-( 60c /6-/6/5 c_
Equal Employment
Opportunity Officer
Date
City of Waterloo Affirmative Action Officer
Approved
Disapproved Reason:
By
Date:
AFFIRMATIVE ACTION PROGRAM Page 6 of 8
BID BOND
KNOW ALL MEN BY THESE PRESENTS, that we, Lodge Construction, Inc.
as Principal, and Swiss Re Corporate Solutions America Insurance Corporation
bound unto the
, as Surety, are held and firmly
CITY OF WATERLOO , Iowa, hereinafter called "OWNER." In the penal sum
Five Percent of the Total Amount Bid Dollars ($ 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 end day of
May , 20 24 , for
FY 2024 W 11th Street Railroad Crossing Repair in the City of Waterloo, Iowa; 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 25th day of April , A.D. 20 24 ,
Lodge Construction, Inc. (Seal)
Principal D )/
By
Swiss Re Corporate Solutions America Ins nce
Corporation/
Witness Surety
By
Kate Zanders
BID BOND
Attorney-in-factSara Huston
•(Title)
Page 1 of 1
SWISS RE CORPORATE SOLUTIONS
SWISS RE CORPORATE SOLUTIONS AMERICA INSURANCE CORPORATION ("SRCSAIC")
SWISS RE CORPORATE SOLUTIONS PREMIER INSURANCE CORPORATION ("SRCSPIC")
WES'I'POR I' 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, h'lissouri, each does hereby make, constitute and appoint:
JAY D. FREIERMUTII, CRAIG E. HANSEN, BRIAN M. DEIMERLY, CINDY BENNETT, ANNE CROWNER, TiM McCULLOH, DIONE R. YOUNG,
SETT I ROOKER, JENNIFER MARINO, JOSEPH TIERNAN, KATE ZANDERS, SARA HUSTON, JOHN CORD
LUKAS SCHRODER and JAMIE GIFFORD JOINTLY OR SEVERALLY
Its true and lawful Attorney(s)-in-Fact, to make, execute, seal and deliver, for and on its behalf and as its act and deed, bonds of 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 (8125,000,000.00) 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 \VIC 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 upon the Corporation when so affixed and in the future with regard to any bond, undertaking or contract of surety to which it is attached."
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By
Erik Janssens, Senior Vice President of SRCSAIC & Senior Vice President
of SRCSPIC & Senior Vice President of WIC
:.'i^. , .r
Gerald Jagrowski, Vice President of SRCSAIC & Vice President of SRCSPIC
& Vice President of WIC
IN \VITNESS WHEREOF, SRCSAIC, SRCSPIC, and \VIC have caused their official seals to be hereunto affixed, and these presents to be signed by their
authorized officers
this 2nd day of
FEBRUARY 20 24
State of Illinois
County of Cook
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 \VIC and Gerald Jagrowski , Vice President of SRCSAIC and Vice President of
SPCSPIC and Vice President of \VIC, 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.
Olontat.2.
rummy
I, Jeffrey Goldberg, the duly elected Senior Vice President and Assistant Secretary of SRCSAIC and SRCSPIC and \VIC, 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 WIC, which is still in full force and effect.
IN WITNESS WI IEREOF, I have set my hand and affixed the seals of the Companies this 25thday of April , 20 24 .
Jeffrey Goldberg, Senior Vice President &
Assistant Secretary of SRCSAIC and
SRCSPIC and WIC