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FORM OF BID OR PROPOSAL
F.Y. 2027 SIDEWALK ASSESSMENT PROGRAM — ZONE 5B
CONTRACT NO. 1156
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 Iowa
a Partnership consisting of the following partners: Noah Koch
, having familiarized ''riiy ms ;(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. 2027 SIDEWALK ASSESSMENT PROGRAM ZONE 5B, Contract No. 1156, all in accordance
with the above -listed documents and for the unit prices for work in place for the following items and
quantities:
FY
2027
SIDEWALK
REPAIR
ASSESSMENT
PROGRAM
— ZONE
5B,
CONTRACT
NO.
1156
ITEM
BID
DESCRIPTION
UNIT
EST.
QTY.
UNIT
PRICE
BID
TOTAL
BID
PRICE
1
4"
PCC
R/R
Sidewalk
SF
6,507.0
$ 18
. 21
$118,
492
. 47
2
5"
PCC
R/R
Sidewalk
SF
1,269.6
$ 27 . 66
$ 35, 117
.
14
3
6"
PCC
R/R
Sidewalk
SF
771.2
$ 33.43
$ 2 5 , 7
81
. 2 2
4
Water
Valve
Adjust
EACH
9.00
$ 265.00
$ 2,385.00
5
Sawcut
LF
8.00
$
60.00
$ 480.00
30.6$
36.05
$ 1,103.13
6
Joint
Seal
LF
TOTAL
BID
$
183,358.96
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.
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is withdrawn, the undersigned agrees to execute and deliver an agreement in the prescribed form and
FORM OF BID
CONRACT NO. 1156
Page 1 of 3
4. Security in the sum of
183,358.96 ) in the form of 5% Bid Bond , is submitted herewith in accordance with
the INSTRUCTIONS TO BIDDERS.
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.
One Hundred Eighty -Three Thousand Three Hundred
Fifty -Eight Dollars and Ninety-Six.Cents
5. Attached hereto is a Non Collusion Affidavit of Prime Contractor.
6. Attached hereto is a Bidder Status Form.
Dollars ($
7 The bidder is prepared to submit a financial and experience statement upon request.
B. 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.
n/a
Date
n/a
10. 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
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.
FORM OF BID
CONRACT NO. 1156 Page 2 of 3
N.B. Koch General Contractors, Inc. 09.03.2026
(Name of Bidder) (Date)
BY: "r
-- Noah Koch
Official Address: (Including Zip Code):
1571 W 7th. St.
Title President
Cedar Falls, IA 50613
I.R.S. No. 99-0547321
FORM OF BID
CONRACT NO. 1156 Page3of3
NON -COLLUSION AFFIDAVIT OF PRIME BIDDER
State of Iowa
)
)ss
County of Black Hawk
Noah Koch
, being first duly sworn, deposes and says that:
1 He is (Owner, Partner, Officer, Representative, or Agent) , of N.B. Koch General
Contractors, Inc., 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.
(Signed)
President
Title
Subscribed and sworn to before me this 3rd day of September , 2026.
Colin Pratt, Notary Public
Title
My commission expires 0 5. 2 8. 2 0 2 8
COLIN PRA1i
Commission Number 864997
MY COMMISSION EXPIRES
MAY 28, 2028
EQUAL OPPORTUNITY CLAUSE
(As provided in Executive Order No. 11246)
All contractors, subcontractors, vendors and suppliers of goods and services doing business with the City and value of said
business equals or exceeds ten thousand dollars ($10,000 00) annually agree as follows:
1. The contractors, subcontractor, vendor and supplier of goods and services will not
discriminate against any employee or applicant for employment because of race, color, creed, sex, national origin,
economic status, age, mental or physical handicap, political opinions or affiliations. The contractor, subcontractor, vendor
and supplier will develop an Affirmative Action program to ensure that applicants are employed and that employees are
treated during employment without regard to their race, creed, color, sex, national origin, religion, economic status, age,
mental or physical disability, political opinions or affiliations. Such actions shall include but not be limited to the following:
a. Employment
b. Upgrading
c. Demotion or Transfer
d. Recruitment and Advertising
e. Layoff or Termination
f Rates of Pay or Other Forms of Compensation
g. Selection for Training Including Apprenticeship
2 The contractor, subcontractor, vendor and supplier of goods and services will, in all solicitations or advertisements for
employees, state that all qualified applicants will receive consideration for employment without regard to race, creed,
color, sex, national origin, religion, economic status, age, mental or physical disabilities, political opinion or affiliations.
3. The contractor, subcontractor, vendor and supplier or his/her collective bargaining representative will send to each
labor union or representative of workers which he/she has a collective bargaining agreement or other contract or
understanding, a notice advising said labor union or workers' representative of the contractor's commitment under this
section.
4. The contractor, subcontractor, vendor and supplier of goods and services will comply with all published rules,
regulations, directives, and order of the City of Waterloo Affirmative Action Program Contract Compliance Provisions.
5. The contractor, subcontractor, vendor and supplier of goods and services will furnish and file compliance reports within
such time and upon such forms as provided by the Affirmative Action Officer. Said forms will elicit information as to
the policies, procedures, patterns, and practices of each subcontractor as well as the contractor himself/herself and
said contractor, subcontractor, vendor and supplier will permit access to his/her employment books, records and
accounts to the City's Affirmative Action Officer, for the purpose of investigation to ascertain compliance with this
contract and with rules and regulations of the City's Affirmative Action Program Contract Compliance Provisions
relative to Resolution No. 24664.
6. In the event of the contractor's non-compliance with the non-discrimination clauses of this contract or with any of such
rules, regulations and orders, this contract may be canceled, terminated or suspended in whole or in part and the
contractor may be declared ineligible for further contracts in accordance with procedures authorized by the City Council.
7 The contractor, subcontractor, vendor and supplier of goods and services will include, or incorporate by
reference, the provisions of the non-discrimination clause in every contract, subcontract or purchase order
unless exempted by the rules, regulations or orders of the City's Affirmative Action Program, and will provide
in every subcontract, or purchase order that said provisions will be binding upon each contractor,
subcontractor, or supplier.
8. We, the undersigned, recognize that we are morally and legally committed to non-discrimination in employment. Any
person who applies for employment with our company will not be discriminated against because of race, creed, color,
sex, national origin, economic status, age, mental or physical disabilities.
(Signed)
(Appropriate Official)
President
(Title)
09.03.2026
(Date)
Bidder Status Form
To be completed by all bidders Part A
Please answer "Yes" or "No" for each of the following:
Yes No
ce Yes ONo
42) Yes QNo
g Yes cNo
QYes ONo
My company is authorized to transact business in Iowa.
(To help you determine if your company is authorized, please review the worksheet on the next page).
My company has an office to transact business in Iowa.
My company's office in Iowa is suitable for more than receiving mail, telephone calls, and e-mail.
My company has been conducting business in Iowa for at least 3 years prior to the first request for
bids on this project.
My company is not a subsidiary of another business entity or my company is a subsidiary of another
business entity that would qualify as a resident bidder in Iowa.
If you answered "Yes" for each question above, your company qualifies as a resident bidder. Please
complete Parts B and D of this form.
If you answered "No" to one or more questions above, your company is a nonresident bidder. Please
complete Parts C and D of this form.
To be completed by resident bidders Part B
My company has maintained offices in Iowa during the past 3 years at the following addresses:
Dates:
12
1 / 2024 to 09 / 03 / 2026 Address: 2909 Airport Blvd
City, State, Zip: Waterloo, IA 50703
Dates: 12 / 1 / 2023 to 09 / 03 / 2026 Address. 1571 W 7th St
City, State, Zip. Cedar Falls, IA 50613
Dates: / / to / / Address:
City, State, Zip: '
You may attach additional sheet(s) if needed.
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 Q 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: N.B. Koch General Contractors, Inc.
Signature:
Date:
09.03.2026
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
Yes O JNo
(DYesC)No
O Yes ONo
Q Yes QNo
O Yes
O YesflNo
Q YesQNo
EII Yes
O Yes O No
O Yes OONo
My business is currently registered as a contractor with the Iowa Division of Labor.
My business is a sole proprietorship and I am an Iowa resident for Iowa income tax purposes.
My business is a general partnership or joint venture. More than 50 percent of the general
partners or joint venture parties are residents of Iowa for Iowa income tax purposes.
My business is an active corporation with the Iowa Secretary of State and has paid all fees
required by the Secretary of State, has filed its most recent biennial report, and has not filed
articles of dissolution.
My business is a corporation whose articles of incorporation are filed in a state other than Iowa,
the corporation has received a certificate of authority from the Iowa secretary of state, has filed
its most recent biennial report with the secretary of state, and has neither received a certificate of
withdrawal from the secretary of state nor had its authority revoked.
My business is a limited liability partnership which has filed a statement of qualification in this
state and the statement has not been canceled.
My business is a limited liability partnership which has filed a statement of qualification in a
state other than Iowa, has filed a statement of foreign qualification in Iowa and a statement of
cancellation has not been filed.
My business is a limited partnership or limited liability limited partnership which has filed a
certificate of limited partnership in this state, and has not filed a statement of termination.
My business is a limited partnership or a limited liability limited partnership whose certificate of
limited partnership is filed in a state other than Iowa, the limited partnership or limited liability
limited partnership has received notification from the Iowa secretary of state that the application
for certificate of authority has been approved and no notice of cancellation has been filed by the
limited partnership or the limited liability limited partnership.
My business is a limited liability company whose certificate of organization is filed in Iowa and has
not filed a statement of termination.
My business is a limited liability company whose certificate of organization is filed in a state other
than Iowa, has received a certificate of authority to transact business in Iowa and the certificate
has not been revoked or canceled.
309-6001 (09-15)
BID BOND
KNOW ALL MEN BY THESE PRESENTS, that we, N.B. Koch General Contractors, Inc.
as Principal, and Westfield Insurance Company , as Surety, are held and firmly
bound unto the CITY OF WATERLOO , Iowa, hereinafter called "OWNER." In the penal sum
Dollars ($ 5% ) lawful money of
Five percent of amount bid
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 3rd day of
September , 20 26 , for F.Y. 2027 Sidewalk Repair Assessment Program - Zone 5B
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 3rd day of September , A.D. 20 26 .
N.B. Koch General Contractors, Inc. (Seal)
Principal ,
Witness
&'ii e&s
Witness
By
/2
Westfield Insurance Company (Seal)
Surety
By
Courtney Meyer Attorney -in -fact
(Title)
BID BOND
Page 1 of 1
THIS POWER OF ATTORNEY SUPERCEDES ANY PREVIOUS POWER BEARING THIS SAME
POWER # AND ISSUED PRIOR TO 10/21/25, FOR ANY PERSON OR PERSONS NAMED BELOW.
General
Power
of Attorney
CERTIFIED COPY
POWER NO. 1429172 00
Westfield Insurance Co.
Westfield National Insurance Co.
Ohio Farmers Insurance Co.
Westfield Center, Ohio
Know All Men by These Presents, That WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO
FARMERS INSURANCE COMPANY, corporations, hereinafter referred to individually as a "Company" and collectively as "Companies," duly
organized and existing under the laws of the State of Ohio, and having its principal office in Westfield Center, Medina County, Ohio, do by these
presents make, constitute and appoint
JOSEPH I. SCHMIT, JEFFREY R. BAKER, GREG T. LAMAIR, E A. VONHARZ, BRANDON HORBACH, JULIANA BARTLETT,
COURTNEY MEYER, JOINTLY OR SEVERALLY
of WEST DES MOINES and State of IA its true and lawful Attorney(s)-in Fact, with full power and authority hereby conferred in its name,
place and stead, to execute, acknowledge and deliver any and all bonds, recognizances, undertakings, consents of surety, or other instruments
or contracts of suretyship in any penal limit, and to bind any of the Companies thereby as fully and to the same extent as if such bonds were
signed by the President, sealed with the corporate seal of the applicable Company and duly attested by its Secretary, hereby ratifying and
confirming all that the said Attorney(s)-in-Fact may do in the premises. Said appointment is made under and by authority of the following
resolution adopted by the Board of Directors of each of the WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY
and OHIO FARMERS INSURANCE COMPANY:
"Be It Resolved, that the President, any Senior Executive, any Secretary or any Fidelity & Surety Operations Executive or other Executive shall
be and is hereby vested with full power and authority to appoint any one or more suitable persons as Attorney(s)-in-Fact to represent and act for
and on behalf of the Company subject to the following provisions:
The Attorney in -Fact may be given full power and authority for and in the name of and on behalf of the Company, to execute, acknowledge and
deliver, any and all bonds, recognizances, contracts, agreements of indemnity and other conditional or obligatory undertakings and any and all
notices and documents canceling or terminating the Company's liability thereunder, and any such instruments so executed by any such
Attorney -in -Fact shall be as binding upon the Company as if signed by the President and sealed and attested by the Corporate Secretary."
"Be it Further Resolved, that the signature of any such designated person and the seal of the Company heretofore or hereafter affixed to any
power of attorney or any certificate relating thereto by facsimile, and any power of attorney or certificate bearing facsimile signatures or facsimile
seal shall be valid and binding upon the Company with respect to any bond or undertaking to which it is attached." (Each adopted at a meeting
held on February 8, 2000)
In Witness VNhereof, WESTFIELD INSURANCE COMPANY, WESTFIELD NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE
COMPANY have caused these presents to be signed by their Vice President, Surety and their corporate seals to be hereto affixed this 21st day
of OCTOBER A.D., 2025 .
Corporate 001•"41ra,,
Seals *.sc�Veg%I1 Rd1�C ,
Affixed ,O,''•t� ��
' nee
N
d SEAL it)
''duo ••r,
State of Ohio `''!ia'• ++n'"°
County of Medina ss.:
.o•
0
WESTFIELD INSURANCE COMPANY
WESTFIELD NATIONAL INSURANCE COMPANY
OHIO FARMERS INSURANCE COMPANY
rl
i
(1041 v
By:
Gary W. tumper, Vice President, Surety
4
.....a.a-.. ._ rem- -:
On this 21st day of OCTOBER A.D., 2025 , before me personally came Gary W. Stumper to me known, who, being by me duly sworn,
did depose and say, that he resides in Medina, OH; that he is Vice President, Surety of WESTFIELD INSURANCE COMPANY, WESTFIELD
NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY, the companies described in and which executed the above
instrument, that he knows the seals of said Companies; that the seals affixed to said instrument are such corporate seals; that they were so affixed
by order of the Boards of Directors of said Companies; and that he signed his name thereto by like order.
Notarial
Seal
Affixed
State of Ohio
County of Medina ss.:
%ton",au,lfbqu
Ick‘A
•
0,rIg��..
avid A. Kotnik, A{trneat`Law, Notary Public
My Commission Does Not Expire (Sec. 147.03 Ohio Revised Code)
i, Kathleen Golovan, Chief Administrative Officer & Corporate Secretary of WESTFIELD INSURANCE COMPANY, WESTFIELD
NATIONAL INSURANCE COMPANY and OHIO FARMERS INSURANCE COMPANY, do hereby certify that the above and foregoing is a true and
correct copy of a Power of Attorney, executed by said Companies, which is still in full force and effect; and furthermore, the resolutions of the
Boards of Directors, set out in the Power of Attorney are in full force and effect.
In Witness Wherg,o I Wave hereunto set my hand and affixed the seals of said Companies at Westfield Center, Ohio, this 3rd day of
September A.D., 2u2b .
it 4.4 tit Mont
(114. SEAL);
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Kathleen Golovan, Chef Administrative Officer &
Corporate Secretary
BPOAC2 (combined) (07-25)