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Home My WebLink AboutLodge Construction, Inc.P.O. Box 459 CL :nviaE, IA 50AII Cit4/ e\mck_vet )0 F7 ry 0209-C 54v4-e. P.O. BOX 459 I CLARKSVILLE, IA 50619 1 C 4y ot \\)°kike )00 RE: cy was 54,.�e S+ FORM OF BID OR PROPOSAL FY 2025 STATE STREET SANITARY SEWER REPLACEMENT AND STORM SEWER DISCONNECTS CONTRACT NO. 1110 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 FY 2025 STATE STREET SANITARY SEWER REPLACEMENT AND STORM SEWER DISCONNECTS, Contract No. 1110, all in accordance with the above -listed documents and for the unit prices for work in place for the following items and quantities: FY 2025 STATE STREET SANITARY SEWER REPLACEMENT AND STORM SEWER DISCONNECTS - CONTRACT NO. 1110 DIVISION I - STATE STREET SANITARY SEWER REPLACEMENT BID ITEM SUDAS SPECIFICATION * SEE SUPPLEMENTAL DESCRIPTION UNIT DIV 1- EST QTY UNIT BID PRICE TOTAL BID PRICE DIVISION 2 - EARTHWORK 1 2010-108-D-1* TOPSOIL, 4 INCHES, ON SITE SY 1720.0 2 2010-108-E * EXCAVATION, CLASS 10 CY 736.0 3 SEE EST. REF. EXCAVATION, CLASS 10, WASTE CY 732.0 4 2010-108-J SUBBASE, MODIFIED, 10 INCH DEPTH SY 0.0 5 2010-108-J SUBBASE, 1 INCH ROADSTONE, 7 INCH DEPTH SY 2366.0 DIVISION 4 - SEWERS AND DRAINS - SANITARY 6 4010-108-A SANITARY SEWER, TRENCHED, TRUSS, 12 INCH LF 516.1 7 4010-108-A SANITARY SEWER, TRENCHED, TRUSS, 10 INCH LF 312.2 8 4010-108-E SANITARY SEWER SERVICE STUB, SDR 23.5, 6 INCH LF 386.0 9 SEE EST. REF. SANITARY SEWER SERVICE, UNDERGROUND INVESTIGATION EACH 2.0 DIVISION 4 - SEWERS AND DRAINS - STORM 10 4020-108-A STORM SEWER, TRENCHED, RCP 2000D, 15 INCH LF - 11 4020-108-A STORM SEWER, TRENCHED, RCP 2000D, 12 INCH LF - 12 4020 108 D REMOVAL OF STORM SEWER, RCP, LESS THAN OR EQUAL TO 36 INCH LF - 13 4020-108-G STORM SEWER ABANDONMENT, FILL AND PLUG, 10 INCH PIPE LF - 14 4040-108-D SUBDRAIN OUTLET TO STRUCTURE, 6 INCH EACH - $ �'> $ /opsz90 $ , $ (9, 9 V,/ $ !�' $ 13f7� $ $ $ JO' $ 03, 66 $ P8 $ t/sue //l $ �vZ $ (2S 6QO ze- $ .36 ,>2 6 $ /00 d $ °v" FORM OF BID CONTRACT NO. 1110 Page 1 of 5 DIVISION 5 - WATER MAINS AND APPURTANCES 15 SEE EST. REF. CONVERT WATER MANHOLE TO ROADBOX EACH _ 16 SEE EST. REF. WATER SERVICE, LOWER AND INSULATE EACH 5.0 DIVISION 6 - STRUCTURES FOR SANITARY AND STORM SEWERS 17 6010-108-A MANHOLE, SW-301, 48" EACH 2.0 18 6010-108-A MANHOLE, SW-401, 48" EACH - 19 6010-108-B INTAKE, SW-501, SINGLE GRATE EACH - 20 6010-108-B EACH - INTAKE, SW-512, 24", TYPE4B CASTING 21 6010-108-G * CONNECTION TO EXISTING MANHOLE OR INTAKE, STORM EACH 22 6010-108-H REMOVE MANHOLE OR INTAKE EACH 2.0 DIVISION 7 - STREETS AND RELATED WORK SIDEWALKS, SHARED USE PATHS AND DRIVEWAYS 23 7010-108-E * CURB & GUTTER, 24-INCH WIDE, 7-INCH DEPTH, PCC, C-4 LF - 24 7030-108-A-1 REMOVAL OF SIDEWALK SY 108.4 25 7030-108-A-3 REMOVAL OF DRIVEWAY SY 17.8 26 7030-108-E SIDEWALK, PCC, 4 INCH, C-4 SY 22.2 27 7030-108-E SIDEWALK, PCC, 6 INCH, C-4 SY 83.0 28 7030-108-G DETECTABLE WARNINGS SF 120.0 29 7030-108-H-1 DRIVEWAY, PAVED, PCC, 5 INCH, C-4 SY 17.8 30 7030-108-H-1 ALLEY, PAVED, PCC, 6 INCH, C-4 SY 46.5 31 7030-108-H-3 DRIVEWAY, GRANULAR, 4 INCH TON 79.5 PAVEMENT REHABILITATION 32 7040-108-H * PAVEMENT REMOVAL, SEAL COAT SY 2368.0 DIVISION 8 - PAVEMENT MARKINGS AND TRAFFIC CONTROL 33 8030-108-A TEMPORARY TRAFFIC CONTROL LS 0.75 DIVISION 9 - SITE WORK AND LANDSCAPING 'SEEDING 34 9010 108 B * HYDRAULIC SEEDING, SEEDING, FERTILIZING AND SY 1720.0 MULCHING - TYPE 1 35 9010-108-E * SY 430.0 WARRANTY EROSION AND SEDIMENT CONTROL $ /So 36 9040-108-Q-2 EROSION CONTROL MULCHING, HYDROMULCHING SY 1720.0 37 9040-108-T-1 * INLET PROTECTION DEVICE, INSTALLATION EACH 6.0 38 9040-108-T-2 * INLET PROTECTION DEVICE, MAINTENANCE EACH 6.0 DIVISION 11 - MISCELLANEOUS 39 11010-108-A CONSTRUCTION SURVEY LS 0.75 40 11020-108-A LS 0.75 MOBILIZATION 7 $ $ 87 $ $37- a- $ $ /O»)x7o $ J $ $ 11gQ2) r/C $ 7,c2a1 $ 7iibo $ and 1 ea° $ 4000 3 S/700 $ 5 3O — $ 6 9s-- $ 1J720.� $ ?CO $ c2QJsvo TOTAL BID DIVISION I c233 - 60 FORM OF BID CONTRACT NO. 1110 Page 2 of 5 DIVISION II - BUTLER AVENUE AND DEARBORN AVENUE STORM SEWER DISCONNECTS ITEM BID SUDAS * SEE SUPPLEMENTAL SPECIFICATION DESCRIPTION UNIT DIV QTY 2 - EST UNIT BID PRICE TOTAL BID PRICE DIVISION 2 - EARTHWORK 1 2010-108-D-1* TOPSOIL, 4 INCHES, ON SITE SY 1053.0 2 2010-108-E * EXCAVATION, CLASS 10 CY _ 3 SEE EST. REF. EXCAVATION, CLASS 10, WASTE CY - 4 2010-108-J SUBBASE, MODIFIED, 10 INCH DEPTH SY 637.0 5 2010-108-J SUBBASE, 1 INCH ROADSTONE, 7 INCH DEPTH SY - DIVISION 4 - SEWERS AND DRAINS - SANITARY 6 4010-108-A SANITARY SEWER, TRENCHED, TRUSS, 12 INCH LF - 7 4010-108-A SANITARY SEWER, TRENCHED, TRUSS, 10 INCH LF - 8 4010-108-E SANITARY SEWER SERVICE STUB, SDR 23.5, 6 INCH LF - 9 SEE EST. REF. SANITARY SEWER SERVICE, UNDERGROUND INVESTIGATION EACH DIVISION 4 - SEWERS AND DRAINS - STORM 10 4020-108-A STORM SEWER, TRENCHED, RCP 2000D, 15 INCH LF 899.5 11 4020-108-A STORM SEWER, TRENCHED, RCP 2000D, 12 INCH LF 695.9 12 4020 108 D REMOVAL OF STORM SEWER, RCP, LESS THAN OR EQUAL TO 36 INCH LF 194.2 13 4020-108-G STORM SEWER ABANDONMENT, FILL AND PLUG, 10 INCH PIPE LF 84.0 14 4040-108-D EACH 8.0 SUBDRAIN OUTLET TO STRUCTURE, 6INCH DIVISION 5 - WATER MAINS AND APPURTANCES 15 SEE EST. REF. CONVERT WATER MANHOLE TO ROADBOX EACH 1.0 16 SEE EST. REF. WATER SERVICE, LOWER AND INSULATE EACH 9.0 DIVISION 6 - STRUCTURES FOR SANITARY AND STORM SEWERS 17 6010-108-A MANHOLE, SW-301, 48" EACH - 18 6010-108-A MANHOLE, SW-401, 48" EACH 2.0 19 6010-108-B INTAKE, SW-501, SINGLE GRATE EACH 9.0 20 6010-108-B EACH 3.0 INTAKE, SW-512, 24", TYPE 4B CASTING 21 6010-108-G * EACH 4.0 CONNECTION TO EXISTING MANHOLE OR INTAKE, STORM 22 6010-108-H REMOVE MANHOLE OR INTAKE EACH 12.0 DIVISION 7 - STREETS AND RELATED WORK SIDEWALKS, SHARED USE PATHS AND DRIVEWAYS 23 7010-108-E * LF 258.0 CURB & GUTTER, 24-INCH WIDE, 7-INCH DEPTH, PCC, C-4 24 7030-108-A-1 REMOVAL OF SIDEWALK SY 7.4 25 7030-108-A-3 REMOVAL OF DRIVEWAY SY - 26 7030-108-E SIDEWALK, PCC, 4 INCH, C-4 SY - 27 7030-108-E SIDEWALK, PCC, 6 INCH, C-4 SY 7.4 28 7030-108-G DETECTABLE WARNINGS SF 10.0 $ 17 $ 11 $ /as- $ �j j /d - $ 1O)i'a9 $ `a) 77/ $ 3 `/ ° `I I $ 90° ` $ 70° $ ts_°V $ 3t5V 4°'' $ ?o $ 61c° $ 400 $ 3a $ )7y0 $ 70.3 $ 75o FORM OF BID CONTRACT NO. 1110 Page3of5 29 7030-108-H-1 DRIVEWAY, PAVED, PCC, 5 INCH, C-4 SY - 30 7030-108-H-1 ALLEY, PAVED, PCC, 6 INCH, C-4 SY 23.7 31 7030-108-H-3 DRIVEWAY, GRANULAR, 4INCH TON 35.7 PAVEMENT REHABILITATION 32 7040-108-H * PAVEMENT REMOVAL, SEAL COAT SY 637.0 DIVISION 8 - PAVEMENT MARKINGS AND TRAFFIC CONTROL 33 8030-108-A TEMPORARY TRAFFIC CONTROL LS 0.25 DIVISION 9 - SITE WORK AND LANDSCAPING SEEDING 34 9010 108 B * HYDRAULIC SEEDING, SEEDING, FERTILIZING AND SY 1053.0 MULCHING - TYPE 1 35 9010-108-E * WARRANTY SY 264.0 EROSION AND SEDIMENT CONTROL 36 9040-108-Q-2 EROSION CONTROL MULCHING, HYDROMULCHING SY 1053.0 i 37 9040-108-T-1 * EACH 15.0 INLET PROTECTION DEVICE, INSTALLATION 38 9040-108-T-2 * INLET PROTECTION DEVICE, MAINTENANCE EACH 15.0 DIVISION 11 - MISCELLANEOUS 39 11010-108-A LS 0.25 CONSTRUCTION SURVEY 40 11020-108-A MOBILIZATION LS 0.25 $ $ 15. $ (2 _ $ 977 <P` $ r $ )Cjf% $ boot" $ 1 $ 6377 $ 1 s-41 � $ 3 Vk $ Iso $ a)aco $ s $ 751) $ (2.5a00 J.500 TOTAL BID DIVISION II 66 TOTAL BID = DIVISION I + DIVISION II $ tos atle 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 6/0 ) in the form of the INSTRUCTIONS TO BIDDERS. Dollars ($ , is submitted herewith in accordance with 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. FORM OF BID CONTRACT NO. 1110 Page 4 of 5 9. The bidder has received the following Addendum or Addenda: Addendum No. Date 10. The bidder shall list the MBE/WBE subcontractor(s), amount of subcontracts and bid items on the City of Waterloo Minority and/or Women Business Pre -bid Contact Information Form submitted with this Form of Bid or Proposal. The apparent low Bidder shall submit a list of all other Subcontractor(s) to be used on this Project to the City of Waterloo by 5:00 p.m. the business day following the day Bids on this Project are due along with the Non -Collusion Affidavits of All Subcontractor(s). The Contractor shall submit information on subcontractors on "SUBCONTRACTOR REQUEST AND APPROVAL" Form to be provided by City prior to approval of contract. The subcontractors listed on this proposal and/or submitted to the Contract Compliance Officer cannot be changed except for the following reasons: 1) The City of Waterloo does not approve the subcontractors. 2) The subcontractors submit in writing that they cannot fulfill their subcontracts. 11. The bidder has filled in all blanks on this proposal. Those blanks not applicable are marked "none" or "NA" 12. The bidder has attached all applicable forms. 13. The Owner reserves the right to select alternates, delete line items, and/or to reduce quantities prior to the award of a contract due to budgetary limitations. LO 4C Cod (Name of Bidder) BY: Avv) <S-e, w� r vc--ke Official Address: (Including Zip Code): ffOe By / vs ga-ged (Date) Title k>14111AC < < CI \<5-.1ille )��r So�Ol�1 I.R.S. No. ti 7 - a $y 105109- FORM OF BID CONTRACT NO. 1110 Page 5 of 5 NON -COLLUSION AFFIDAVIT OF PRIME BIDDER State of K County of ,�� ICc. K�._� __ ) )ss , being first duly sworn, deposes and says that: 1 He is (Owner, Partner, Officer, Representative;Sr Agent) , of / .f t (co 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 afflant, 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 S a 'v-t o—rlf Subscribed and sworn to before me this azd. day of , 20,g Title My commission expires Y4A.,1/6" �Da� • 0W • ♦••a.• o LINDA K SENN COMMISSION NO. 003307 e�• MY COMMISSION EXPIRES c /5,aaa? 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 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) opriate Official) 5 tvi-c.,Jcf (Title) 6. --Y g- ---c& (Date) Bidder Status Form To be completed by all bidders Part A Pleas/answer "Yes" or "No" for each of the following: Q No No • Ye ONO Q'?yYQNo Yes O No My company is authorized to transact business in Iowa. (To help you determine if your company is authorized, please review the worksheet on the next page). 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: 1 / i to / l a Address: p,o, poi< t is Dates: Dates: Dates: You may attach additional sheet(s) if needed. City, State, Zip: 61 "r U d l c /1- / / to / / Address: J City, State, Zip: / / to / / Address: City, State, Zip: .s64»9 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 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: You C06.54 0L,c k t '1 Date: p d� ust 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. o Yes Q Yes Q Yes Q Yes o Yes QYes 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) MBE/WBE BUSINESS ENTERPRISE PRE -BID CONTACT INFORMATION FORM Prime Contractor Name: � do (5 -krte 54- 5Cc'/ S t= `e" I Project: J j 0 Letting Date: -3t) 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, ply e use the bottom portion of this form. Contractor Signature: - Title: Date: g y 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 R eyes c 024,5,-i--suefit,i1 84 ii -aii Y y _i_-(91 ky 9e6 6 � 8.-mcn y 8 ai-ay X u :3 SO 0 8.-8.-091 7 3.-ai4v 7 r- Y.) V IT -- -ri cit÷ k)(6, 7 (Form CCO-4) Rev. 06-20-02 Revised February 2003 CONTRACTOR'S OR SUBCONTRACTOR'S AFFIRMATIVE ACTION PROGRAM Check bgxlhat applies to party completing program: ( ( General Contractor Subcontractor I. Section A to be completed by GENERAL CONTRACTORS only: A. Name of Company 1-064 6 Cczi Address of Company Pgoi ci(AKe3\471 ip 5 off' Telephone Number (- t ) ca9C1 (, Federal ID Number (if no Federal ID Number, Owner/President's Social Security Number) '1i-Aewn— Name of Equal Employment Officer 6.4-e\le )v tO N ame of Project i7 anc- 54-44e s " A'7 set-L-e) Project Contract Number Estimated Construction Work Dates bo /143.-c,i( 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) Name of Equal Employment Officer AFFIRMATIVE ACTION PROGRAM Page 1 of 8 A. Remainder of program to be completed by party completing program, either Prime or Subcontractor. 1. The Owners and/or Principals of your company: Ethnic Name Address Position Sex Origin :54cue (c,.dj-c Ra, got e/s-5 yki 1/(5 -14-) LG� r C 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 o; .L •': Iification and/or merit system should be evaluated and revised, if necessary. D We agree to and prod status, a m effort to achieve full employment and utilization of capabilities t regard to race, creed, color, sex, national origin, economic •�� i� �._ �..� !cap. will give training (Na :.r •'a Y) and employment opportunities to local residents of Waterloo, Iowa, to the greatest extent feasible. AFFIRMATIVE ACTION PROGRAM A Page2of8 III. AFFIRMATIV A. B C. D. NC. (Nbi d AR9S u ,%i recognizes that the effective appl merit employment involves more than just a policy statement, and will, therefore, re opportunities are women and local our Affirmat 1. 2. 3. 4. 5. 6. our Affirmative Action Program t on the basis of individual merit, an to seek employment with our company on this ba is. 415. At :4 t`: 459 1 CLApKSVI1.• ' Minority Recruitment and Employment; Local Recruitment and Employment; will undertake the following six (6) steps to improve Disabled Vet- an and Vietnam Era Veteran Recruitment and Employment; Handicapped : •.. ; 'tment and Employment; Female Recr i';► `; end Employment; and Training, U. si•k;lnd Promotional Opportunities. I! .y (I'ila ensure tk utilize 1. 2. 3. 4. 5. (Na for Communit Public an Job Servi Other • lit •,. -• • • :r will take whatever steps are necessary to #adequate minority, female, and local representation. rre';Uttment attempts: LARK5VILI.E, IA 5061 `i Local advertising media (newspapers, radio, TV); izations (churches, clubs, schools); ;nstitutions in the area (UNI, Hawkeye Community College); and re p resigAtiltit 45ThfaitmilSgAkt We will will seek qualified minority, female, and local group applicants e asserted efforts to increase minority, female and group gher levels or skill and responsibility. E. All sources of employment used shall be aware that we are an Equal Employment Opportunity Employer. Labor orga•' atio s representing our employees will be notified of our Equal Employment Opportunity Policy ani % if ative Action Program. e H F Training, upgrading considera G. (Name associa ufa •.• •• • and transfer activities at all levels will be monitored to ensure that full Iified minority, female, and local group employees. will encourage other companies, with whom we are uiness, to do the same and we will assist them in their efforts. AFFIRMATIVE ACTION PROGRAM Page3of8 H. (Na mino bid on i mojsotf ()faggor$ 1. 2. erkR 1L() Oat, lit C.- � cv 1 has taken the following Affirmative Action to ensure that /or suppliers were provided opportunities to negotiate and/or E") 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. (Na all n nexem_ nec ssar� a nc:,, 0:100 J%.o. Box K. In further a L. amended,, .K% Fll 9M311 _�� g, upgrading and promotion and will provide the City of Waterloo with any information re a we {o same, including activities of our SUBCONTRACTORS and suppliers as necessary or wht re ested. etiP. k C C. Vi tr.(' ( C c• V1 co 1-1+° 1115 will require approved Affirmative Action Programs from ;pose to work on this project and will take whatever steps are ity contractors have adequate representation of minority, female force. 4E, IA 50619 y with rules and guidelines issued pursuant to Executive Order 11246 as h the goals for our company, based on parity percentages supplied by the City, be reviewed on an annual basis. will keep records of specific actions relative to M. Parity figures for c N. located in Waterloo are as follows: P.0, BOX 459t.A - i IAA Affirmative Action �E�mp`loyi ten 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'i , 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: 0 L Goals for Women: 0 0/0 *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: Company Executive Date By: 54e'.ak kids .t Equal Employment Opportunity Officer g - co 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 , 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 22nd day of August 20 24 for FY 2025 State Street Sanitary Sewer Replacement and Storm Sewer Disconnects in the City of Waterloo, Iowa; Contract No. 1110 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 19th day of August , A.D. 20 24 0 Witnes Wt Anne Crowner BID BOND Swiss cf • rporate Solutions America Insurance Corpor ion �.� (Seal) By 7 Attorney-in-fauston Lodge Construction, Inc. Principal By (Title) 10° (Seal) Page 1 of 1 SWISS RE CORPORATE SOLUTIONS SWISS RE CORPORATE SOLUTIONS AMERICA INSURANCE CORPORATION ("SRCSAIC") SWISS RE CORPORATE SOLUTIONS PREMIER INSURANCE CORPORATION ("SRCSPIC") 1VES'I'PORT INSURANCE CORPORATION ("WIC") GENERAL POWER OF ATTORNEY KNOW ALL MEN BY '1'FIESE 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. HANSEN, BRIAN M. DEIMERLY, CINDY BENNETT, ANNE CROWNER, TIM McCULLOI1, DIONE R. YOUNG, SETH ROOKER, JENNIFER MARINO, JOSEPH TIERNAN, KATE ZANDERS, SARA HUSTON, JOIIN 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 or other writings obligatory in the nature of a bond on behalf of each of said Companies, as surety, on contracts of suretyship as arc 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 relatfn2 thereto by facsimile, and any such Power of Attorney or certificate bearing such facsimile signatures or facsimile seal shall be bind;na anon the Corporation when so affixed and in the future with card to any bond, undertaking or contract of surety to which it is attached." \\,.nflI111a %%%I \\`` ens kw. ''P. `vt\%%%%%6, k�Cq',,� •. ' PO •• 4�Y'. bp“? Rq• : v. J =tt.• =`;� 197,3 .a S ..\,� 0NS PRE,, \,\\\, • �,,. ••••,� ,,,A, SEAL •n- ;o•• •o '1c ts: � / ,nunutcsaa r,\ sip`,• _ By Erik Janssens, Senior Vice President of SRCSAIC & Senior Vice President of SRCSPIC & Senior Vice President of WIC By Gerald Jagrowski, Vice President of SRCSAIC& Vice President of SRCSPIC & Vice President of WIC IN WITNESS 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 WIC 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. OFFICIAL SEAR. CHRIS11NA MANlscO NOTARY Ptleuc eTAtt QF 14100 . Mft ealis ll JS1 Expire, Mardi 28, 2Q2I GD Nimuy 1, 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 WIIEREOF, I have set my hand and affixed the seals of the Companies this 19thday of August , 20 24 . Jeffrey Goldberg, Senior Vice President & Assistant Secretaty of SRCSAIC and SRCSPIC and WIC