HomeMy WebLinkAboutJ.B. HollandD
frcr
co
z
0
2
JFI
OLLAND
JB HOLLAND CONSTRUCTION, INC.
2191 US Hwy 52
Decorah, IA 52101
BID ENCLOSED
F.Y. W.A R.P. 4th Addition
Contract No 1114
11 /21 /24, 1:00 PN
City Clerk, City of Waterloo
715 Mulberry St, Waterloo, IA
r
CLIN
liat'{
C'9 �
i ppyn
c15
1
rn
O
BID BOND
KNOW ALL MEN BY THESE PRESENTS, that we, J. B. Holland Construction, Inc.
as Principal, and United Fire & Casualty Company
bound unto the
, as Surety, are held and firmly
CITY OF WATERLOO , Iowa, hereinafter called "OWNER." In the penal sum
Five Percent of the Bid Amount
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 21 st day of
November , 20 24 , for F.Y. 2025 W.A.R.P. 4th Addition, Contract No. 1114
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 21 st day of November , A.D. 20 24 .
ac‘AklivokwuNkt
Witness
Adi
Witness
J. B. Holland Construction, Inc.
United Fire & Casualty Company (Seal)
Surety
By z „AN
Erik Partridge, Attorney -in -fact
(Seal)
BID BOND Page 1 of 1
INSURANCE
UNITED FIRE & CASUALTY COMPANY, CEDAR RAPIDS, IA
UNITED FIRE & INDEMNITY COMPANY, WEBSTER, TX
FINANCIAL PACIFIC INSURANCE COMPANY, LOS ANGELES, CA
CERTIFIED COPY OF POWER OF ATTORNEY
(original on file at Home Office of Company — See Certification)
KNOW ALL PERSONS BY THESE PRESENTS, That United Fire & Casualty Company, a corporation duly organized and existing under the laws
of the State of Iowa; United Fire & indemnity Company, a corporation duly organized and existing under the laws of the State of Texas; and
Financial Pacific Insurance Company, a corporation duly organized and existing under the laws of the State of California (herein collectively called
the Companies), and having their corporate headquarters in Cedar Rapids, State of Iowa, does make, constitute and appoint
MATT FAY, ABIGAIL R. MOHR, MAT DEGROOTE, SANDY VANOSTEN, LAURA PEIFFER, DENISE ALLEX, ERIK
PARTRIDGE, EACH INDIVIDUALLY
Inquiries: Surety Deparhnent
118 Second Ave SE
Cedar Rapids, IA 52401
their true and lawful Attorneys) -in -Fact with power and authority hereby conferred to sign, seal and execute in its behalf all lawful bonds,
undertakings and other obligatory instruments of similar nature provided that no single obligation shall exceed $100 , 000 , 000. 00
and to bind the Companies thereby as fully and to the same extent as if such instruments were signed by the duly authorized officers of the Companies
and all of the acts of said Attorney, pursuant to the authority hereby given and hereby ratified and confirmed.
The Authority hereby granted is continuous and shall remain in full force and effect until revoked by United Fire & Casualty Company, United Fire &
Indemnity Company, and Financial Pacific Insurance Company.
This Power of Attorney is made and executed pursuant to and by authority of the following bylaw duly adopted by the Boards of Directors of United
Fire & Casualty Company, United Fire & Indennity Company, and Financial Pacific Insurance Company.
"Article VI — Surety Bonds and Undertakings"
Section 2, Appointment of Attorney -in -Pact. "The President or any Vice President, or any other officer of the Companies may, from time to time, appoint by written
certificates attomeys-in-fact to act in behalf of the Companies in the execution of policies of insurance, bonds, undertakings and other obligatory instnnnents of like nature.
The signature of any officer authorized hereby, and the Corporate seal, may be affixed by facsimile to any power of attorney or special power of attorney or certification of
either authorized hereby; such signature and seal, when so used, being adopted by the Companies as the original signature of such officer and the original seal of the
Companies, to be valid and binding upon the Companies with the same force and effect as though manually affixed. Such attorneys -in -fact, subject to the limitations set of
forth in their respective certificates of authority shall have fiill power to bind the Companies by their signature and execution of any such instnnnents and to attach the seal
the Companies thereto. The President or any Vice President, the Board of Directors or any other officer of the Companies may at any time revoke all power and authority
previously given to any attorney -in -fact.
ekt
/i"It R IIIIllt "`
State of Iowa, County of Lunn, ss:
On 30th day of March, 2021, before me personally came Kyanna M. Saylor
to me known, who being by me duly sworn, did depose and say; that she resides in Cedai Rapids, State of Iowa; that she is a Vice President of United
Fire & Casualty Company, a Vice President of United Fire & Indennty Company, and a Vice President of Financial Pacific Insurance Company the
corporations described in and which executed the above instrument; that she knows the seal of said corporations; that the seal affixed to the said
instrument is such corporate seal; that it was so affixed pursuant to authority given by the Board of Directors of said corporations and that she signed her
name thereto pursuant to like authority, and acknowledges same to be the act and deed of said corporations.
IN WITNESS WHEREOF, the COMPANIES have each caused these presents to be signed by its
vice president and its corporate seal to be hereto affixed this 30t h day of March, 2021
UNITED FIRE & CASUALTY COMPANY
UNITED FIRE & INDEMNITY COMPANY
FINANCIAL PACIFIC INSURANCE COMPANY
BY: rug—,
Patti Waddell
Iowa Notarial Seal
Commission number 713274
My Commission Expires 10/26/2025
Vice President
Notary Public
My commission expires: 10/26/2025
I, Mary A. Bertsch, Assistant Secretary of United Fire & Casualty Company and Assistant Secretary of United Fire & Indenuity Company, and Assistant
Secretary of Financial Pacific Insurance Company, do hereby certify that I have compared the foregoing copy of the Power of Attorney and affidavit, and
the copy of the Section of the bylaws and resolutions of said Corporations as set forth in said Power of Attorney, with the ORIGINALS ON FILE IN THE
HOME OFFICE OF SAID CORPORATIONS, and that the same are correct transcripts thereof, and of the whole of the said originals, and that the said
Power of Attorney has not been revoked and is now in full force and effect.
In testimony whereof I have hereunto subscribed my name and affixed the corporate seal of the said Corporations
this 21 st day of November , 20 24 .
"01:0F11���f/��i
So
rig
-.-
3y
1p
"Infriliit
By:
Assistant Secretary,
UF&C & OF&I & FPIC
BPOA0049 1217
Honorable Mayor and City Council
Waterloo, Iowa
Gentlemen:
FORM OF BID OR PROPOSAL
F.Y. 2025 W.A.R.P. 4TH ADDITION
CONTRACT NO. 1114
CITY OF WATERLOO, IOWA
•
1. The undersigned, being a Corporation existing under the laws of the State of Iowa
a Partnership consisting of the following partners: JB Holland Construction, Inc.
William F. Holland, President , 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. 2025 W.A.R.P. 4TH ADDITION, Contract No. 1114, 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. 2025
WA
RP.
4TH
ADDITION
nail
NO
REFERENCE
UNIT
DIMSION
1
WATER
DIVISION
QUANITIIES
MAIN
2
UNITPRICE
DIVISION
AMOUNT
1
DIMSION2
AMOUNT
1
DESCRIPTION
QUAKES
BASE
BID
DIMSION
2
-
EARTHWORK
ell
kg(i).
b0
_
1
2010-108-B
CLEARING
AND
GRUBBING
AC
9.7
G
i0
2
2010-108-
D-1
TOPSOIL,
ON
-SITE
STRIP,
STOCKPILE,
SPREAD,
CY
80,330.3
1G
I
qOS•�O
jL•1
3
2010-108-E
DCAVATION,
CLASS
10
CY
237,577.7
2 .15
U5
s;g
4
2010-108-E
EXCAVATION,
CLASS
10,
BORROW
CY
22,208.8
ic,Goci.cii
.46
5
2010-108-G
SUBGRADEP
D
ARAIION
SY
12,388.2
t
, 2D
LOT
u44
6
2010-108-I
SUBBASE,
6"
MODIFIED
SY
12,388.2
1-10
1)1CJ359,I
.
l
7
2010-108-I
SUBBASE,
4"
MODIFIED
SY
800.0
6,20
y I
tO•
OO
8
2010-108-I
SUBBASE,
8"
MACADAMSIONE
SY
800.0
-
I .G
,
,CI
U0
. Del
9
2010-108-E
SUBGRADEOVERDEAVATION
CY
350.0
S•
0
1120
4bb
10
2010-108-I
GRANULARSTABIUZATION
TN
685.0
It
00
kCJ
`ig
.0
•
DIVISION
4
-
SEWERS
AND
DRAINS
11
4010-108-
A-1
LF
4,108.4
,
6 A
2,11-bW
.16
SANITARYSLI
TREI\CI
IED,
RC
D
TRUSS,
GRAVfIYMAIN,
12
12
4010-108-
A-1
SANITARYSE�VEitSER\ICE,
I
D
TCHED,
P\C
SDR23.5,
6"
LF
910.0
1O
CA)
u1.\\
b°
13
4020-108-��R
STORM
CP,
SEWER,
TRENCHED,
GASKEIID
LFSEWER,
245.0
, ^
CO6
CD%o2'eg3
V(a
14
4020-108-
A
l
STORM
RCP,
18"
SEWER,
TRENCHED,
GAS1u
ED
LF
776.0
�Q�
•.
%
\ y04
��..
.W((��
15
4020-108-
A-1
LF
1,120.0
S
kQ
• b
0
�
0 (;1
1Q
n
3 ^ W
.1/4,,
STORMSE\
RCP,
24"
D TRENCHED,
GAS
I
DI
16
4040-108-A
SUBDRAIN,HDPE,
TYPE
SP,
6"
IF
6,449.4
I�,'
�03
t ' :_
a
‘i „
17
4040-108-C
SUBDRAIN
CIEANOUT,
1\PEA:1
EA
2.0
'
% Cjil
,00
121
OO
•
W
FORM OF BID
CONRACT NO. 1114
Page 1 of 5
18
404D0
i 08
SUBDRAIN,
OUII
TIO
STRUCTURE
EA
40.0CP3
*00
egA00.
Co
19
SUBDRAIN
CLEANOLTI
n
• VAL
EA
2.0
30,
0O
I
D
•
CO
20
4030-108-B
PIPE
APRON,
RCP,
15"
EA
2.0
1030.o
2oo0•
Do
21
4030-108-C
FOOTINGS
APRONS,
15"
FOR
CONCRETE
PIPE
EA
2.0
IV)
10.00
``
21.0
•
22
4030-108-D
PIPE
APRON
GUARDS,
15"
EA
2.0
gV
•bV
rig°
•00
23
4030-108-B
PIPEAPRON,
RCP,
24"
EA
2.0
12.'o0
.00
12.0.
U
24
4030-108-C
EA
2.0
'b
20
•
k%
3k04
b.
b0
FOOTINGS
APRONS,
24"
FOR
CONCRE
PIPE
25
4030-108-D
PIPE
APRON
GUARDS,
24"
EA
2.0
1 .1Q
•
66
2y20.
66
DIVISIONS
APPURTENANCES
-
WATER
MAINS
AND
26
5010-108-
A-1
WATER
MAIN,
MUNCHED,LF
3,242.4
(�
b
b
•
cpbiiiii2\00t2.t3
POLYWRAPP
1,
DIP,
8"
27
5010-108-
C-1
EA
1.0
2GO•
06
r\
2Q0
FIITLNG,MIIDCKING
It•+,8"X8"X8"
28
5010-108-
C-1
EA
11.0
�r
2Js
10
•
W
:_,-P
22416
.O
0
E1111NG,
MI
LOCKING
th
,
8"
X8"
X6"
29
5010-108-
C-1
EA
1.0
l
i
U306.
.
°I
N
CO
III
11h\G,
,VIJ
REDUCER,
8"
X6"
.
30
5010-108-
C-1
FITII�,TG,
11.25°MIBD
D,8"
EA
6.0
IMO
•
f�
VPs
31
5020-108-A
VALVE,
MI
GATE,
8"
EA
13.0
'%'t
•
tOi
-IV
11COO
. Ixi
32
5020-108-C
FIRE
HYDRANTASS
EMBLY
EA
11.0
1%
0
bO
1;S0•
OD
33
5020-108-C
DEAD
END
FIRE
HYDRANTASSENBLY
EA
1.0
CIS
•
W
1 gg•
a)
SANITARYAND
DIVISION
6
-
STRUCTURES
STORM
SEWERS
FOR
34
6010-108-A
MANHOLE,
SW-301,
48"
EA
17.0
U(,Q
b().
`ll�
112.2.00
•
bb
35
6010-108-B
INTAKE,
SW-507
EA
15.0
10M
.
U
1t0eo.
Qb
36
6010-108-B
INTAIC,
SW-509
EA
4.0
CILI
DO'
G1
3l
tQoO
•
00
DIVISION
7-
SIR
WORK
n
1
AND
R
D
ne
37
7010-108-A
PAVEMENT;
11
PCC,
C
4
�V/CLASS
3
AGG,
SY
10,986.8
S2)
•
GO
i-1eitii$,10
38
7040-108-H
PAN
is
REMOVAL
SY
10.3
V%
•
lco.40
DIMSON
8
-
TRAFFIC
CONTROL
39
8030-108-A
IRAFFIC
CONTROL
LS
1.0
I tt'
O
•
nV
„Q
to
•
DIVISON
LANDSCAPING
9
-
SIIE
WORKAND
40
9010
108
A
PC
96.0
1110.00
In
520.
�y�
%
CO
n
ONALS}�
1)ING,
FERTILIZING,
AND
MULCHING
-
TYPE
1
41
9040-108-
Q-1
TEMPORARYEROSIONCONTROL
MULCHING
AC
50.0
'?fl
..bo
IALQ
W
• oO
42
9040-108-A
AC
G.3
S10,00
r
`O$
• W
TGMPORARYSET•1)ING
AND
MULCHING
-
TYPES
43
9040-108-N
SILTFENCE,
INSTALLATION
LF
20,125.0
}r`)
SO
,%1 •
SO
44
9040-108-N
SILTFENCE,
MAINII
NANCE
LF
20,125.0
0.01
_01.26)
45
9040-108-N
SILT
•
D
TCE,
REMOVAL
IF
20,125.0
0.01
2.
01.2.5
46
9040-108-0
CONSTRUCTION
(INSTALLATION,
ENTRANCE
MAI
IENANCE,
AND
LS
1.0
"i 1
�
I 'j lo*o�
LI'�1,,°.
47
9040-108=T
INLEI'PROTECTION
DEVICE
EA
31.0
1,1
` •M
1
ALLALTON,,
•
ID
•NCE,
AND
,%
48
9040-108-J
EROSION
STONE,
1'
DEPTH
TN
58.0
10
.0 b
29J\ot
•Ov
49
9040-108-N
SILT
n
TCEDIICI-1
CHECK
EA
21.0
ci b
• SO
19
00
• c20
50
9010-108-E
SDOIINGWARRANIY
LS
1.0
W.
tl
�b2o.o6
FORM OF BID
CONRACT NO. 1114
Page 2 of 5
DIVISION
11
-
MSC
D
NEOUS
51
11,010-
108-A
CONSTRUCTION
SURVEY
LS
1.0
u;
bb
.60
Vises
.06
52
11,020-
108-A
MOBILZATION
LS
1.0
//��
"I�Q ^ 1
W
1 1Q1
Ob
TOTAL
BASE
BID
DIVISION
1
2`
3 in
O
t'1.5L0
TOTAL
BASE
BID
DIVISION
2
1120
CIS&20
'?
TOTALRASE
DIVISION
2
BID
DIVISION
1 +
k %i °W)`1.1
w
AL
IERNATEA
DIVISSION
2
-
EARTHWORK
53
2010-108-G
SUBGRADEP
a
ARATION
SY
4,291.3
0 •Zb
�G>etS•
2LP
54
2010-108-I
SUBBASE,
6"
MODIFIED
$30 43. 01
SY
4,291.3
'
b
DIVISION
-
SEWERS
AND
DRAINS
55
4020-108-
A-1
IF
93.0
U1
•
GI()
tarn
• ib
STORMSE\VER,
TRENCHED,
GAS
14
aII
RCP,
15"
56
4020-108-
A-1
STORMSEWER,
RCP,
18"
TRENCH
DI,
GASKEIFD
LF
348.0
Vet.
C&•
�„,
1 l4
I
cqa.
CO
57
4020-108-
A-1
STORMSE\VER,
RCP,
24"
TRENCHED,
GASKEIED
IF
284.0
►
•G
25i-{l
,
58
4030-108-B
PIPE
APRON,
RCP,
24"
EA
1.0
`Z\i•
bb
\2••uo
.
c0
59
4030-108-C
FOOTINGS
APRONS,
24"
FORCONCREIEPIPE
EA
1.0
\
1
.00
1
b2b.O0
60
4030-108-D
PIPE
APRON
GUARDS,
24"
EA
1.0
rTh12bk)
.
00
1200
.
I h
N
61
4040-108-A
SUBDRAJN,
HDPE
TYPE
SP,
6"
IF
2,147.8
%�%
�,
k.
.iallial
62
404I0}-i
08-
SUBDRAIN,
OUILETTO
STRUCTURE
EA
12.0
i
, ��
"l
•
� CjC,f�
O
DV •�
O
DIMS
ION
APPURTENANCES
5
-
WATER
MAINS
AND
63
5010-108-
A-1
WAFER
POLYWR\PPED,
MAN,
TRENCHED,
DIP,
8"
IF
1,023.8
V
O�
v
. M�
0l 01% •
o
03
64
5010-108-
C-1
EA3.0
��
`f`
��
�Mn.
HMG,
MIDOCKING
11+,
8"X8"X6"
65
5020-108-A
VALVE,
MI
GATE,
8"
EA
3.0
315b
• b�
(if
23sitto
15v0
.
•t6
/��
op
66
5020-108-C
FIRE
HYDRANTASS
a
i:LY
EA
3.0
eli0b
•
U
v
67
R
HYDRANI'ASSI?MBLY
a
•
VALOF
DEAD
END
FIRE
1.0
t`
EA
,alb
•
--float)
DIVISION
6
-
STRUC
D.
FOR
SANITARYAND
STORM
SEVERS
68
6010-108-B
INTAKE
SW
507
EA
6.0
10
by
•
0
2060
^n
.00
DIVISION
7-
S
1
a
4
AND
RELATED
WORK
69
7010-108-A
PA
D
ID
;
PCC,
C
4 W/CLASS
3 AGG,
SY
3,800.8
�2
��2
v-�
3•(',�\
w
J
•O
70
7040-108-II
PAVEMENTRGVIOVAL
SY
10.3
kii
VV
.
�ti),
DIMSON
8
-
TRAFFIC
CONTROL
71
8030-108-A
TRAFFIC
CONTROL
LS
1.0
Iu
ID
•O)
1oto
•ts
DIMSON
LANDSCAPING
9
-
SITE
\\ ;ORKAND
72
9040-108-J
EROSION
STONE,
1'
DEPTH
'IN
22.0
•
b
%
. 04
DIMSION
11
-
MSC
a
SOUS
73
11,010-
108-A
CONSTRUCTION
SURVEY
LS
1.0
�10
•
t,
Vb
LW
O
M
. W
74
11,020-
108-A
MOBILIZATION
LS
1.0
% kbb . 40
I ib/(��•
00
TOTAL
ALTERNATE
A
DIMSION
1
" 15
12 1 11S
•W
TOTALALTERNATE
A
DIVISION
2
FORM OF BID
CONRACT NO. 1114
Page 3 of 5
TOTALALTERNATEADIVISION I +
DIVISION 2
TOTALDIVISION I - BASEBID +
ALTERNATEA
TOTAL DIVIS ION 2 - BASEBID +
ALIERNATEA
TOTALDIVISION 1 AND DIVISION 2
BASEBID +ALIDI • I
3 013,6 920.-1%
yuv52g3.-is
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 5% of Total Bid Dollars ($
) in the form of Bid Bond , 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. 1
Date 11/15/24
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.
FORM OF BID
CONRACT NO. 1114 Page 4 of 5
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.
JB Holland Construction, Inc. 11/21/24
(Name of -Bidder)
(Date)
BY Y i�/��� `i, 'title President
William F Holl : nd
Official Address: (Including Zip Code):
2191 US Hwy 52
Decorah, IA 52101
I.R.S. No. 42-1237122
FORM OF BID
CONRACT NO. 1114 Page 5 of 5
INFORMATION NEEDED
FOR
IOWA CONSTRUCTION SALES TAX EXEMPTION CERTIFICATE
CONTRACTOR NAME' JB Holland Construction, Inc.
ADDRESS:
2191 US Hwy 52, Decorah, IA 52101
(Check One): PRIME X
FEDERAL ID#:
PROJECT NAME.
42-1237122
SUBCONTRACTOR
F.Y. 2025 W.A.R.P. 4TH ADDITION
PROJECT CONTRACT NO.: CONTRACT NO. 1114
DESCRIPTION OF WORK:
❑ Brickwork
❑ Carpentry
[ l Concrete
Drywall -Plaster -Insulation
Electrical
X] Excavation/Grading
Flooring
❑ Heavy Construction
❑ Heating -Ventilating -Air Cond
❑ Landscaping
n Painting
l Paving
[ Plumbing
H Roofing -Siding -Sheet Metal
H Windows
rl Wrecking -Demolition
[ ] Other (Please specify)
State of
NON -COLLUSION AFFIDAVIT OF PRIME BIDDER
Iowa
)ss
County of Winneshiek
William F Holland , being first duly sworn, deposes and says that:
1 He is (Owner, Partner, Officer, Representative, or Agent) , of JB Holland Construction, Inc.
1 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.
(Sign
William F Holl
•
President
Title
Subscribed and sworn to before me this 21 st day of November 1 2024,
4 QY(CEZ
Title Diane Marie Krentz, Notary
My commission expires April 5, 2027
on s DIANE MARIE KRENTZ
* j
2 T. Commission Number 173755
' My Commission Expires
ow� April 5, 20
Bidder Status Form
To be completed by all bidders
Part A
Please answer "Yes" or "No" for each of the following:
AO Yes O No
X® Yes 0 No
X® Yes No
X® Yes 0N0
Yes ®No
X
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: 4 / 18 / 24 to 11 / 21 / 24 Address: 2191 US Hwy 52
City, State, Zip:
Decorah, IA 52101
Dates: 10 / 1 / 92 to 4 / 17 / 24 Address: 2092 Hwy 9 W
City, State, Zip:
Decorah, IA 52101
Dates:
/ / to / / Address:
You may attach additional sheet(s) if needed. City, State, Zip:
To be completed by non-resident bidders Part C
1. Name of home state or foreign country reported to the Iowa Secretary of State:
2. Does your company's home state or foreign country offer preferences to resident bidders, resident labor 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
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: JB Holland Cpnstruction, Inc.
Signature:
William F Holla d
Date: 11/21/24
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 JNo
0 YeflS No
0 YeCNo
X0Yes 0No
0 YesQ No
(")Yes)eNo
O Yes No
0 YesV No
O Yes
O Ye 'c_c)‘No
My business is currently registered as a contractor with the Iowa Division of Labor.
My business is a sole proprietorship and I am an Iowa resident for Iowa income tax purposes.
My business is a general partnership or joint venture. More than 50 percent of the general
partners or joint venture parties are residents of Iowa for Iowa income tax purposes.
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)
Prime Contractor Name:
MBE/WBE BUSINESS ENTERPRISE
PRE -BID CONTACT INFORMATION FORM
JB Holland Construction, Inc.
Project: F.Y. 2025 W.A.R.P. 4TH ADDITION
Letting Date: 11/21/24
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 e the botto portion of this form.
Contractor Signatur
Title:
Date:
President
11/21/24
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
BoNCes
2-�r'Cc&cks
1
I i (
N®
Akokca
tecCM
Ili/ 1
A)o
i
�1-k
1
_'�� ��'uc1C�{�
`� ii
9
IJ'`
Teck*
iestr\
,�
I
\
L/11
7e..
Q
11
`�-
I
y•es
P0V-
�(v .1-4;v
(Form CCO-4) Rev. 06-20-02