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FORM OF BID OR PROPOSAL
F.Y. 2027 STORM SEWER DISCONNECTS — 400 BLK KERN STREET
CONTRACT NO. 1167
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 aareot.,30
a Partnership consisting of the following partners: `fie-k-crsor,
, 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. 2027 STORM SEWER DISCONNECTS — 400 BLK KERN STREET, Contract No. 1167, 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
STORM
SEWER
DISCONNECTS
- 400
BLK
KERN
STREET,
CONTRACT
NO.1167
ITEM
BID
SPECIFICATION
SUPPLEMENTAL
SUDAS
*
SEE
DESCRIPTION
UNIT
TOTAL
EST
QTY
UNIT
PRICE
BID
TOTAL
BID
PRICE
1
2010-108-D-1
TOPSOIL,
4
INCHES,
ON
SITE
SY
215.00
$ //
$ 2, 36S
2
2010-108-G
SUBBASE,
MODIFIED,
6
INCH
SY
30.00
$ 3
0
$ ;, NO
3
4020-108-A
STORM
15-INCH
SEWER,
TRENCHED,
RCP
2000D,
LF
23.7
$ 20c,
$ 9, 74/0
4
4020-108-A
STORM
12-INCH
SEWER,
TRENCHED,
RCP
2000D,
LF
252.40
$ /SD
$ %f5, 92a
5
4020
108-D
REMOVAL
THAN
OR
EQUAL
OF
STORM
TO
15-INCH
SEWER,
RCP,
LESS
LF
61.0
$ ca jj
$ it 88b
6
5010-108-E-1
WATER
INCH
SERVICE
STUB,
COPPER,
3/4-
LF
13.5
$ 5755
5�
$ ?,7762.
7
6010-108,
G
CONNECTION
TO
EXISTING
MANHOLE
EACH
2.0
$ 2,66-0
$ S, 300
8
6010-108-B
INTAKE,
SW-502
EACH
2.0
$ Q,`j
So
$ 1 Q
igoo
g
6010-108-B
INTAKE,
SW-507
EACH
1.0
$ /0,aoo
$ to,
bop
10
6010-108-B
INTAKE,
SW-512,
GRATE
TYPE
4A
EACH
1.0
$ 4-1,
75-6
$ 91754
11
6010-108-H
REMOVE
INTAKE,
STORM
EACH
4.0
$ t,650
$ 6, 606
12
7010-1.08-E
CURB
INCH
&
DEPTH,
GUTTER,
PCC,
24-INCH
C-4
WIDE,
13-
LF
33.4
$ L0
$ ! r 9/0
a.
8�
13
7010-108-A;
3.02
PAVEMENT,
PCC,
9.5
INCH
SY
60.0
$ 2
I
$ 9 r i 60
FORM OF BID
CONRACT NO. 1167
Page 1 of 3
14
7020-108-B
PAVEMENT,
HMA,
3.5-INCH
SY
36.2
$ y6, bD
$ Ms M, 1g--
15
7020-108-B
PAVEMENT,
HMA,
2-INCH
SY
123.1
$ 30. ` 5-
`i'
$ 3,1'n.
16
7030-108-A-1
SIDEWALK
REMOVAL
SY
21.1
$ go
$ 8 yL/
17
7030-108-A-3
DRIVEWAY
REMOVAL
SY
27.0
$ 90
$ /,p gD
18
7030-108-E
SIDEWALK,
PCC,
6-INCH,
C-4
SY
7.8
$ 69/
$ 999,
19
7030-108-E
SIDEWALK,
PCC,
4-INCH,
C-4
SY
13.4
$ 5-6.
-
/D
$ 757.
20
7030-108-G
DETECTABLE
WARNINGS
SF
20.0
$ L, 3 00
$ 6 S
21
7030-108-H
ALLEY,
PCC,
6-INCH,
C-4
SY
27.0
$ 6'
$ 1, 7 2-8
22
7030-108-H-1
DRIVEWAY,
GRANULAR,
6"
TONS
15.8
$ 6o
$ 9 8
23
7040-108-H
PAVEMENT
REMOVAL
SY
96.2
$ 30
$ a, g 86
24
7040-108-1
CURB
&
GUTTER
REMOVAL
LF
33.0
$ 35
$ I r 1S5-
25
8030-1.08,
A
TEMPORARY
TRAFFIC
CONTROL
LS
1.0
$ 9, 00o
$ 91000
26
9010-108-B
HYDRAULIC
MULCHING
MECHANICALLY
SEEDING,
-
TYPE
BONDED
1
SEED
FERTILIZING
,
FIBER
MATRIX
AND
SY
215.0
So
$ j 3, sa
$ ;,
qoa,
27
9040-108-Q-2
EROSION
HYDROMULCHING
CONTROL
MULCHING,
SY
30.0
3v
$ I• `.
��y//
$ •D• a
28
11020-108-A
MOBILIZATION
LS
1.0
$ 10,cto
$ ' o, o00
TOTAL
BID
$
15Q,30--i.9?
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 Lkz P'"'` "a" Dollars ($
) in the form of E►'s- ?Dna. , is submitted herewith in accordance with
the INSTRUCTIONS TO BIDDERS.
5. Attached hereto is a Non Collusion Affidavit of Prime Contractor.
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 `I/2F/2";&
FORM OF BID
CONRACT NO. 1167 Page 2 of 3
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
"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.
PeAtesert". Cvviof'S arc -
iile/a0--A6
(Name of Bidder)
BY: c6ra)c-iar, Ro+½kaJi
Official Address: (Including Zip Code):
PI Dack .av0 Ss+ /Po god
qALL TA . "066q
(Date)
Title Prnjtc /vAKa -r'/cs
I.R.S. No. L12 _ Oq 21(o 5ii
FORM OF BID
CONRACT NO. 1167 Page 3 of 3
NON -COLLUSION AFFIDAVIT OF PRIME BIDDER
State of ,1_40w c, )
)ss
County of ,(vr.c4y
, being first duly sworn, deposes and says that:
1 He is (Owner, Partner, Officer, Representative, or Agent) , of Ptheso,n Covn. -c-Iors i-e-
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)
Title
Subscribed and sworn to before me this 7 day of k.� , 2074 .
ibccetpA�--
Title
My commission expires /0,qdt>
•
�� clot JAMES WEI DA
x , . Commission Number 851681
•
My Commission Expires
October 26, 2026
Bidder Status Form
To be completed by all bidders
Part A
Please answer "Yes" or "No" for each of the following:
erY-es QNo
0' Yes CNo
@"Yes QNo
�"Yes ONo
�"Yes ONo
My company is authorized to transact business in Iowa.
(To help you determine if your company is authorized, please review the worksheet on the next page).
My company has an office to transact business in Iowa.
My company's office in Iowa is suitable for more than receiving mail, telephone calls, and e-mail.
My company has been conducting business in Iowa for at least 3 years prior to the first request for
bids on this project.
My company is not a subsidiary of another business entity or my company is a subsidiary of another
business entity that would qualify as a resident bidder in Iowa.
If you answered "Yes" for each question above, your company qualifies as a resident bidder. Please
complete Parts B and D of this form.
If you answered "No" to one or more questions above, your company is a nonresident bidder. Please
complete Parts C and D of this form.
To be completed by resident bidders Part B
My company has maintained offices in Iowa during the past 3 years at the following addresses:
Dates:
Dates:
Dates:
la_
You may attach additional sheet(s) if needed.
/
aa- / NI'S
to c 0 / (' C I -e n4- Address• lb 9 •Blaakl nc- s/-
City, State, Zip. Re { n L L k , z'A ge)gig
/ / to / / Address.
City, State, Zip.
/ / to / / Address.
City, State, Zip:
To be completed by non-resident bidders Part C
1. Name of home state or foreign country reported to the Iowa Secretary of State:
2. Does your company's home state or foreign country offer preferences to resident bidders, resident labor
force preferences or any other type of preference to bidders or laborers? Q 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 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: -erSov\ Cv\A-ray -DNS J J(
Signature:
Date: /6l6 / 20.6
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.
3Yes ONo
O Yes aN o
O Yes (3Ri0
ales Q No
Q Yes �No
Q ves(37No
QYes0No
O Yes eiNo
O Yes
O Yes(13\10
Q Yes (3'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)
BID BOND
KNOW ALL MEN BY THESE PRESENTS, that we, Peterson Contractors, Inc.
as Principal, and Travelers Casualty and Surety Company of America , 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 8th day of
October , 20 26 , for F.Y. 2027 Storm Sewer Disconnects - 400 Blk Kern Street, Contract No. 1167, Waterloo, IA
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 29th day of September , A.D. 20 26
Peterson Contractors, Inc.
(Seal)
Pri cipal
BY dkr
J�
president
Travelers Casualty and Surety Company of America
(Seal)
Witness
Witness Zachary Fuller
S
y
e crownerAttorney-in-fact
(Title)
BID BOND Page 1 of 1
TRAVELERS J
Travelers Casualty and Surety Company of America
Travelers Casualty and Surety Company
St. Paul Fire and Marine Insurance Company
POWER OF ATTORNEY
Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company, and St. Paul Fire and Marine Insurance Company are
corporations duly organized under the laws of the State of Connecticut (herein collectively called the "Companies"), and the Companies do hereby make,
constitute and appoint Anne Crowner of WAUKEE , Iowa , their
true and lawful Attorney(s)-in-Fact to sign, execute, seal and acknowledge any and all bonds, recognizances, conditional undertakings and other writings
obligatory in the nature thereof on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of
contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law.
IN WITNESS WHEREOF, the Companies have caused this instrument to be signed, and their corporate seals to be hereto affixed, this 13th day of May,
2026.
State of Connecticut
By:
City of Hartford ss.
Bryce Grissom, Senior Vice President
•
On this the 13th day of May, 2026, before me personally appeared Bryce Grissom, who acknowledged himself to be the Senior Vice President, Surety,
Bond & Specialty Insurance, of each of the Companies, and that he, as such, being authorized so to do, executed the foregoing instrument for the purposes
therein contained by signing on behalf of said Companies by himself as a duly authorized officer.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
My Commission expires the 31st day of March, 2031
ante, EAin/ta.ct
Marie E. Sorensen, Notary Public
This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of each of the Companies,
which resolutions are now in full force and effect, reading as follows:
RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President, any Vice President, any
Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary may appoint Attorneys -in -Fact and
Agents to act for and on behalf of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign
with the Company's name and seal with the Company's seal bonds, recognizances, contracts of indemnity, and other writings obligatory in the nature of
a bond, recognizance, or conditional undertaking, and any of said officers or the Board of Directors at any time may remove any such appointee and
revoke the power given him or her; and it is
FURTHER RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice
President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company, provided that each such delegation
is in writing and a copy thereof is filed in the office of the Secretary; and it is
FURTHER RESOLVED, that any bond, recognizance, contract of indemnity, or writing obligatory in the nature of a bond, recognizance, or conditional
undertaking shall be valid and binding upon the Company when (a) signed by the President, any Vice Chairman, any Executive Vice President, any
Senior Vice President or any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any
Assistant Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary; or (b) duly executed (under seal, if
required) by one or more Attorneys -in -Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or by one
or more Company officers pursuant to a written delegation of authority; and it is
FURTHER RESOLVED, that the signature of each of the following officers: President, any Executive Vice President, any Senior Vice President, any
Vice President, any Assistant Vice President, any Secretary, any Assistant Secretary, and the seal of the Company may be affixed by facsimile to any
Power of Attorney or to any certificate relating thereto appointing Resident Vice Presidents, Resident Assistant Secretaries or Attorneys -in -Fact for
purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof, and any such Power of Attorney or
certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified
by such facsimile signature and facsimile seal shall be valid and binding on the Company in the future with respect to any bond or understanding to
which it is attached:
I, Kevin E. Hughes, the undersigned, Assistant Secretary of each of the Companies, do hereby certify that the above and foregoing is a true and correct
copy of the Power of Attorney executed by said Companies, which remains in full force and effect.
Dated tills 29th day of September
•
2026
!.e.
Kevin E. Hughes, Secretary
To verify the authenticity of this Power of Attorney, please call us at 1-800-421-3880.
Please refer to the above -named Attorney(s)-in-Fact and the details of the bond to which this Power of Attorney is attached.