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JFK Road and NW Arterial Right-Turn-Lane Improvements Project Award
Copyrighted May 7, 2018 City of Dubuque Action Items # 1. ITEM TITLE: JFK Road and NW Arterial Right-Turn-Lane Improvements Project Award SUMMARY: City Manager recommending award of the construction contract for the JFK Road and NW Arterial Right-Turn-Lane Improvements Project to the low bidder Midwest Concrete, Inc., subject to lowa DOT approval of the award. RESOLUTION Awarding the Public Improvement Contract for the Northwest Arterial - JFK Intersection Right-Turn- Lane Improvements lowa DOT Project No. STP-A-2100 (688)--86-31 SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Adopt Resolution(s) ATTACHMENTS: Description Type NW Arterial and JFK Intersection Right Turn Lane City Manager Memo Improvements-NNM Memo Staff Memo Staff Memo Resolution Resolutions THE CITY OF Dubuque � AIFA�erlwGh UB E '�� III► Masterpiece on the Mississippi Z°°'�w'2 7A13 2017 TO: The Honorable Mayor and City Council Members FROM: Michael C. Van Milligen, City Manager SUBJECT: Northwest Arterial-JFK Intersection Right Turn Lane Improvements CIP No. 3002675, lowa DOT Project No. STP-A-2100 (688)-86-31 DATE: May 1 , 2018 Sealed bids were received for the Northwest Arterial-JFK Intersection Right Turn Lane Improvements Project by the lowa Department of Transportation. City Engineer Gus Psihoyos recommends award of the construction contract to the low bidder, Midwest Concrete, Inc., in the amount of$128,857.45, which is 7.9°k under the estimate of probable cost, subject to lowa DOT approval of the award. The City received a $114,285.96 grant from the lowa Department of Transportation for this project. I concur with the recommendation and respectfully request Mayor and City Council approval. �� �� ��� Mic ael C. Van Milligen �� � MCVM:jh Attachment cc: Crenna Brumwell, City Attorney Teri Goodmann, Assistant City Manager Cori Burbach, Assistant City Manager Gus Psihoyos, City Engineer THE CITY OF Dubuque � �-�s� UB E �� �., I � Masterpiece on the Mississippi z°°''Z°t2 20t3•2017 TO: Michael C. Van Milligen, City Manager f� '.� � � FROM: Gus Psihoyos, City Engineer -� , ;'`°, _ , DATE: April 30, 2018 SUBJECT: Northwest Arterial - JFK Intersection Right Turn Lane Improvements CIP No. 3002675, lowa DOT Project No. STP-A-2100 (688)-86-31 INTRODUCTION The purpose of this memorandum is to provide the City Council with information related to award of a construction contract for the Northwest Arterial - JFK Intersection Right Turn Lane Improvements Project. BACKGROUND The northerly approach driving lane of the JFK Road and Northwest Arterial intersection has one left turn lane and one shared thru and right turn lane. The thru and right turn movement go straight or south and is a very heavy traffic movement. Unfortunately, it only takes one southbound (straight thru) vehicle queued at the light to block all free right turn movements. Once blocked, this shared lane can rapidly back up with vehicles stacking to over 400 feet from the intersectian. The City of Dubuque applied for and was awarded an lowa Clean Air Attainment Program (ICAAP) grant from the lowa DOT in the amount of $198,202 to assist with the construction of a right turn lane on the north leg of JFK Road with traffic signal adjustments at NW Arterial and JFK Road intersection. EXISTING CONDITIONS Although traffic signal timings at the NW Arterial - JFK intersection are reviewed and updated throughout the year, the existing shared through - right turn lane does not efficiently handle right turning traffic movements. ITS improvements have been implemented at this intersection over the last 10 years to provide the most efficiency from the existing geometrics. This approach has come to the point where no additional efficiencies can be achieved without adding traffic lane improvements. PROPOSED TURN LANE IMPROVEMENT Based on the current operational and capacity challenges the City is experiencing at the JFK Road and NW Arterial intersection, the proposed turn lane improvement includes adding an exclusive 250-foot right turn lane along the existing northerly approach on JFK Road. The new right turn lane would allow for a dedicated straight thru lane as well as maintaining the existing dedicated left turn lane. The proposed turn lane improvement will improve the capacity and efficiency of this intersection. BID RESULTS Sealed bids were received on the project by the lowa Department of Transportation on April 17, 2018 in Ames. Midwest Concrete, Inc., of Peosta, IA submitted the low bid in the amount of $128,857.45. This amount is 7.9% under the estimate of probable cost. A summary of the bid proposals received is as follows: Contractor Name Total Bid � Midwest Concrete, Inc. $128,857.45 Eastern lowa Excavating & Concrete, LLC $138,371.88 Horsfield Construction, Inc. $161,919.00 Tschiggfrie Excavating, Co. $162,257.81 Lodge Construction, Inc. $199,641 .25 RECOMMENDATION I recommend that the contract for the for the Northwest Arterial - JFK Intersection Right Turn Lane Improvements Project be awarded to Midwest Concrete, Inc., of Peosta, IA, in the amount of$128,857.45 subject to lowa DOT approval of award. BUDGET IMPACT The estimate of probable cost for the recommended turn lane improvements are summarized in the following table: Description Estimate Award Construction — JFK New Right Turn Lane $ 140,000.00 $128,857.45 Contingency (10%) 14,000.00 14,000.00 Engineering Design and Administration (15%) 23,100.00 23,100.00 Total Construction Cost Estimate $ 177,100.00 $165,957.45 The proposed project funding is summarized as follows: CIP No. Fund Description Fund Amount 3002675 ICAAP Grant (80% construction) $ 114,285.96 3002675 NW Arterial Road Right Turn Lane Improvements 51,671.49 Total Project Funding $ 165,957.45 The grant funding agreement between the lowa DOT and the City provides for the utilization of ICAAP Grant Funds for eligible construction costs for the construction of a new right turn lane. The portion of the eligible construction costs reimbursed by ICAAP funds shall be limited to a maximum of 80% of eligible participating costs. All other costs, such as preliminary engineering (PE), Final Engineering (FE), and construction engineering (CE) will be funded solely with City funding. ACTION TO BE TAKEN The City Council is requested to award the contract for the Northwest Arterial - JFK Intersection Right Turn Lane Improvements Project to Midwest Concrete, Inc. through adoption of the enclosed resolution. cc: Jenny Larson, Budget Director Jon Dienst, Civil Engineer Greg Doeden, Civil Engineer Kent Ellis, lowa DOT RESOLUTION NO. 139-18 AWARDING PUBLIC IMPROVEMENT CONTRACT FOR THE NORTHWEST ARTERIAL - JFK INTERSECTION RIGHT TURN LANE IMPROVEMENTS IOWA DOT PROJECT NO. STP -A-2100 (688)--86-31 Whereas, said sealed proposals were opened and read by the Iowa Department of Transportation on the 17th day of April 2018 and it has been determined that Midwest Concrete, Inc., of Peosta, IA, with a bid in the amount of $128,857.45 is the lowest responsive, responsible bidder for the Project. NOW THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF DUBUQUE, IOWA: That a Public Improvement Contract for the Project is hereby awarded to Midwest Concrete, Inc., subject to the concurrence by Iowa Department of Transportation (Iowa DOT), and the City Manager is hereby directed to execute a Public Improvement Contract on behalf of the City of Dubuque for the Project. Passed, adopted and approved this 7th day of May 2018. Attest: Kelytirf S. Eirnstahl, GMC, City Clerk Roy D. Buol, Mayor Thompson, Mary From: Thompson, Mary Sent: Tuesday, May 22, 2018 3:06 PM To: 'Jon Dienst Cc: Dunn, Mark Subject: FW: Contract documents for STA -A-2100(689)--86-31 and STP -A-2100(688)--86-31 Jon, We received your contract documents for bid orders 102 and 101 from the April 17, 2018 letting in the mail today. We are signing the contract for bid order 102, however, bid order 101 you did not submit the original bond to me. The bond that was sent in, is incomplete and photo copied. There is no signature from the contractor or the bonding company's attorney on the bond and there is no seal on the bond, however your city did sign it. I cannot accept a photo copy or an incomplete bond. I did try to call you and I left a message, but haven't heard back from anyone in the engineering department to see if you perhaps have the completed, original bond there, so I am putting everything back in the mail to you, unsigned. Please send all of the contract documents back into me with a completed, original bond, signed by the city once you have it and we will process the contract. Thank you. Mary E. Thompson Engineering Office Asst. II Iowa Department of Transportation Office of Contracts 800 Lincoln Way Ames, Iowa 50010 Phone: 515-239-1415 Fax: 515-239-1325 Email: Mary.Thompson@iowadot.us "The best and most beautiful things cannot be seen or heard, they must be felt by the heart" Helen Keller From: Jon Dienst[mailto:Jdienst@citvofdubuque.org] Sent: Friday, May 18, 2018 3:35 PM To: Ryan, Stacy <Stacv.Rvan@iowadot.us> Subject: Contract documents for STA -A-2100(689)--86-31 and STP -A-2100(688)--86-31 Stacy, We are mailing the executed copies of contracts and bonds from the city and contractor back to the IDOT for the above two projects. Please let me know as soon as the (689) project is approved. We want to get them moving as soon as possible. I have not spoken to the contractor yet and I won't until you give me the green light. Thanks. Jon Dienst, P.E. Civil Engineer II 1 City of Dubuque 563-589-4270 jdienst@cityofdubuque.org Imagine Dubuque! Have you shared your ideas to make Dubuque a more viable, livable, and equitable community? To learn more and share your ideas visit http://imaginedubuque.com or download the project app today! 2 Form 161418 (12-18) Bond Number 2381695 CONT CIWADOT CTOR'S PERFORMANCE BOND contract LD.:31-2100-688 Dubuque County: 1418 IN WITNESS WHEREOF, we have hereunto set our hands and seals this day o ay By: Principal Title Andrew Hendricks Attorney-in-fact TRICOR Insurance Address: Tide By: Surety Address: Title For contracts where iCowity Board ot Supervisors l.th. Contracting Authority: This bond approved by the Board of Supervisors of thls day of Signature County, Tine Fc r contracts where neither the DOT nor a County Board of Supervisors is the Contraciing Authority: This bond approved by the City of Dubuque this 18th of May 2018 Signature (Contracting Authoitty) City Manager Title DISCLOSURE STATEMENT FOR CONTRACTOR'S PERFORMANCE BONDS The infomiatIon requested will be used by the Iowa Department of Transportation to determine If e oontrectedvendor is bonded Si accord with the requirements established by the contract/18 authority This secures the IDOT andter to State clime the dont to recover Irian the tontractrxhandor If material arbibot entered Into the wore Wormed is net in accord rah the contract, epeclicelicna or clans. Persons outside the Depostasnt may occasion* request this Information Faure to provide all required rformation MI mak In denial Mate evosM el the contract Pape 2 012 EW ST BEND A MUTUAL INSURANCE COMPANY THE SILVER LINING' Bond No. 2381695 POWER OF ATTORNEY Know all men by these Presents, That West Bend Mutual Insurance Company, a corporation having its principal office in the City of West Bend, Wisconsin does make, constitute and appoint; Andrew Hendricks lawful Attorneys) -in -fact, to make, execute, sea! and deliver for and on its behalf as surety and as its act and deed any and all bonds, undertakings and contracts of suretyship, provided that no bond or undertaking or contract of suretyship executed under this authority shall exceed in amount the sum of: Seven Million Five Hundred Thousand Dollars ($7,500,000) This Power of Attorney is granted and is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of Directors of West Bend Mutual Insurance Company at a meeting duly called and held on the 21st day of December, 1999. Appointment of Attorney -In -Fact The president or any vice president, ar any other officer of West Bend Mutual Insurance Company may appoint by written certificate Attorneys -In -Fact to act on behalf of the company in the execution of and attesting of bonds and undertakings and other written obligatory instruments of like nature. The signature of any officer authorized hereby and the corporate seal may be affixed by facsimile to any such power of attorney or to any certificate relating therefore and any such power of attorney or certificate bearing such facsimile signatures or facsimile seal shall be valid and binding upon the company, and any such power so executed and certified by facsimile signatures and facsimile seal shall be valid and binding upon the company in the future with respect to any bond or undertaking or other writing obligatory in nature to which it is attached. Any such appointment may be revoked, for cause, or without cause, by any said officer at any time. In witness whereof, the West Bend Mutual Insurance Company has caused these presents to be signed by its president undersigned and its corporate seal to be hereto duly attested by its secretary this 22nd day of September, 2017. Attest Christopher C. Zwygart Secretary State of Wisconsin County of Washington On the 22nd day of September, 2017, before me personally came Kevin A. Steiner, to me known being by duly sworn, did depose and say that he resides in the County of Washington, State of Wisconsin; that he is the President of West Bend Mutual Insurance Company, the corporation described in and which executed the above instrument; that he knows the seal of the said corporation; that the seal affixed to said instrument is such corporate seal; that is was so affixed by order of the board of directors of said corporation and that he signed his name thereto by like order, j Kevin A. Steiner Chief Executive Officer/President Juli A nedum Senior orporate Attorney Notary Public, Washington Co., WI My Commission is Permanent The undersigned, duly elected to the office stated below, now the incumbent in West Bend Mutual Insurance Company, a Wisconsin corporation authorized to make this certificate, Do Hereby Certify that the foregoing attached Power of Attorney remains in full force effect and has not been revoked and that the Resolution of the Board of Directors, set forth in the Power of Attorney is now in force. Signed and sealed at West Bend, Wisconsin this 7th day of May CMS\. SF Notice: My questions concerning this Power of Attorney maybe directed to the Bond Manager at NSI, a division of West Bend Mutual Insurance Company. 1900 S. 18t Ave. West Bend, WI 53095 1 ph (262) 334-6430 1 1-800-236-5004 1 fax (262) 338-5058 1 wvv..thcsil-•erlining.com 1 2018 Heather Dunn Vice President— Chief Financial Officer Pam taut (12-1e) Bond Number2381695 OWADOTI BUSINESS9750 CONT CTOR'S PERFORMANCE BOND Contract I.D.: 31-2100-688 County: Dubuque KNOW ALL PERSONS BY THESE PRESENTS: That we, Midwest Concrete, Inc of 9835 Cottingham Road Peosta Iowa 52068 (hereinafter calmed the P ' ' ) and West Bend Mutual Insurance Company of PO Box 620976 Middleton Wisconsin 53562 (hereinafter called the Surety) are held and firmly bound unto the Iowa Department of Transportation (Iowa DOT, County, or City name, etc.) (hereinafter called the Conhecting Authority) Iowa, in the sum of One hundred twenty-eight thousand eight hundred fifty-seven and 451100 128,857.45 dollars ), lawful money of the United States, to the payment of which sum, well and tray to be made, we bind ourselves, our executors, administrators, successors, and assigns jointly and severally by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH, THAT whereas the above bounden Principal did enter into a written contract with the Contracting Authority to perform NW Arterial & JFK Right Tum Lane Project PCC Pavement - Grade & Replace Copy of which contract, together with all of its teens, covenants, condl1ona, and stipulations, da incorporated herein and made a part hereof as fully and completely as If said contract were recited et length; and whereas, the prattles! and sureties on this bond hereby agree to pay all parsons, firms, ar corporations having contracts directly with the parapet or with subcontractors, ell Just claims due them for labor perfomxd or materials furnished, In the performance of the contact on account of which this bond is given, when the sono are not satisfied out of the portion of the contract price which the public corporation is required to retain until completion of the public improvements, but the principal and auretisa sial not be Gable to said persons, firms, or miporations unless the claims of said claimants against said portion of the contract price shall have been established es provided by law. Now, If the principal shell in all respects fulfill his said contract according to the terms and tenor thereof, and shoe aatialy all claims and demands incurred for the same, and shall fully indemnify and save hamllaes the Contracting Authority from all costa and damages which It may suffer by reason of failure to do so and shall fully reimburse and repay the Contracting Authority all outlays and expense which lt may incur in making good any such default, then the oblgation Is to be void and of no efface otherwise to remain in fill force and effect Every surety on this bond shah be deemed and held, any contract 10 the contrary notwithstanding, to consent without notice: 1. To any extension of time to the contractor In which to perform the contract. 2, That the bond shall remain in full force and effect unit the contract is completed within the specified contact paned, within an extension thereof, or wahine period of limo after the contract period has elapsed and the Iiqutdeted damage is being charged against the contractor. 3, To any change In the plana, apeccicatfona, or contract, when such change does not Involve an increase of more than 20 percent of the total contract price, and shag then be released only as to such excess Increase. 4. That no provision of this bond or of any other contract shall be veld which Iimila to less then five years from the completion of the contract the right to sue on lits bond for defects in work quality or material not discovered or (mown to the Contracting Authority elle time such work is accepted. This bond is to be considered a performance bond and secures the Contracting Authority the right to recover from the contractor on account of materiel or labor entered into the work or wait performed not in accordance with the contract, specifications, or plans, The contractor does not by this obligation guarantee to maintain the wart for five years. Page 1 of 2 June 4, 2018 F J m SMARTER 1 SIMPLER I CUSTOMER DRIVEN.. DOT www.iowadot.gov Office of Contracts I Project Delivery Bureau 800 Lincoln Way I Ames, Iowa 50010 Phone: 515-239-1414 I Email: dot.contracts@iowadot.us Dear Contractor: We are enclosing one fully signed copy of the contract(s) for the attached project(s). We have attached the FHWA-1273 to each federally funded contract. 23 CFR Part 633.102(e) requires that you physically attach a copy of the FHWA-1273 to each subcontract on federally funded subcontracts. Sincerely, -44 Mark J. Dunn, P.E. Contracts Engineer MJD/met Enc. cc: City with attachment CONTRACT Letting Date: Apr 17, 2018 10:00 A.M. Contract ID: 31-2100-688 Cali Order No.: 101 County: DUBUQUE Project Engineer: CITY OF DUBUQUE, PUBLIC WORKS DIRECTOR Cost Center: 849300 Object Code: 890 DBE Commitment: $0.00 Contract Work Type: PCC PAVEMENT - GRADE & REPLACE This agreement made and entered by and between the Contracting Authority, CITY OF DUBUQUE and Contractor, MIDWEST CONCRETE, INC. Vendor ID: MI296 City: PEOSTA State: IA It is agreed that the notice and instructions to bidders, the proposal filed by the Contractor, the specifications, the plan, if any, for project(s) listed herein, together with Contractor's performance bond, are made a part hereof and together with this instrument constitute the contract. This contract contains all of the terms and conditions agreed upon by the parties hereto. Contractor, for and in considerations of $ 128,857.45 payable as set forth in the specifications constituting a part of this contract, agrees to construct various items of work and/or provide various materials or supplies in accordance with the plans and specifications therefore, and in the locations designated in the Notice to Bidders. Contractor certifies by signature on this contract, under pain of penalties for false certification, that the Contractor has complied with Iowa Code Section 452A.17(8) as amended, if applicable, and Iowa Code Section 91C.5 (Public Registration Number), if applicable. In consideration of the foregoing, Contracting authority hereby agrees to pay the Contractor promptly and according to the requirements of the specifications the amounts set fourth, subject to the conditions as set forth in the specifications. It is further understood and agreed that the above work shall also be commenced or completed in accordance with Page 1B of this Contract and assigned Proposal Notes. To accomplish the purpose herein expressed, the Contracting authority and Contractor have signed this and one other identical instrument. For Federal -Aid Contracts the Contractor certifies that each subcontract is evidenced in writing and that it contains all pertinent provisions and requirements of the contract. By, Contractor (if joint venture) Iowa DOT Concurrence For Local Agcy Cntracts Concurrence Date May 7, 2018 Contract Award Date JUN 042018 Cil ADOT SMA11UR I SIMNLEP 1 CUSTOMER DRIVEN Contract Project(s) 04/20/2018 13:43:20 AASHTOWare Project v3.01.164.01 Page 1 of 4 Contract ID: 31-2100-688 CaII Order No.: 101 Letting Date: Apr 17, 2018 10:00 A.M. Project Number: STP -A-2100(688)--86-31 County: DUBUQUE Project Work Type: PCC PAVEMENT - GRADE & REPLACE Accounting ID: 35174 Location: Right Turn Lane on North leg of JFK rd with traffic signal adjustment at NW Arterial and JFK rd intersection Route: JFK ROAD Federal Aid - Predetermined Wages are in Effect 0101MADOT SMAUFERI SIMPLER I CUSIOiMEUURIVEN Contract Time 04/20/2018 13:43:20 AASHTOWare Project v3.01.164.01 Page 2 of 4 Contract ID: 31-2100-688 Cali Order No.: 101 Letting Date: Apr 17, 2018 10:00 A.M. 00 Late Start Date 09/04/2018 20 WORK DAYS (*) - Indicates Cost Pius Time Site. See Schedule of Items for Cost Per Unit $1,000.00 Cat)1 OWADOT $MRRTERI SIMPLER CUSTOM OMEN Notes 04/20/2018 13:43:20 AASHTOWare Project v3.01.164.01 Page 3 of 4 Contracts ID: 31-2100-688 CaII Order No.: 101 Letting Date: Apr 17, 2018 10:00 A.M. Notes : *** Work Restrictions *** Work shall be performed between the hours of 7:00 am to 4:00 pm. Outside these hours, traffic control needs to be adjusted to not have any existing lanes closed. �"":,IOWADOT SMARTER I SIMPLER I CUSTOMER DRIVEN Contract Addenda 04/20/2018 13:43:20 AASHTOWare Project v3.01.164.01 Page 4 of 4 Contract ID: 31-2100-688 Call Order No.: 101 Letting Date: Apr 17, 2018 10:00 A.M. No Addenda for this Contract. CIOWADOT SMARTER 1 SIMPLER 1 CN;IOMER DRIVEN Contract Specifications List 04/20/2018 13:43:20 AASHTOWare Project v3.01.164.01 Page 1 of 2 Contract ID: 31-2100-688 CaII Order No.: 101 Letting Date: April 17, 2018 10:00 A.M. : 001 005.1113 * STANDARD SPECIFICATIONS -- SERIES 2015"** The Iowa Department"of Transportation STANDARD SPECIFICATIONS FOR HIGHWAY AND BRIDGE CONSTRUCTION, SERIES 2015, plus applicable General Supplemental Specifications, Developmental Specifications, Supplemental Specifications AND Special Provisions shall apply to construction work on this contract. *** ELECTRONIC DOCUMENT STORAGE *** Section 1113 shall apply to this contract. REVISIONS TO STANDARD ROAD PLANS TABULATION TC -61 TC -418 TC -421 TC -422 with the following, TC -61 TC -418 TC -421 TC -422 replace the following Standard Road Plans: 04-17-18 04-17-18 04-17-18 04-17-18 respectively: 04-21-15 10-15-13 10-21-14 10-15-13 500.01 *** WINTER WORK *** The free time allowed between November 15 and April 1 will not be permitted on this project. The Contractor shall work during the winter on all working days as defined in Article 1101.03 'Working Day'. 660.26 *** SPECIALTY ITEM ** The item 'TRAFFIC SIGNALIZATION' and/or 'TRAFFIC considered a specialty item for this project. SIGNAL INSTALLATION' is When performed by subcontract, the cost of the specialty item/s so performed by subcontract may be deducted from the total cost before computing the amount of work required to be performed by the Prime Contractor with his/her own organization. Refer to Article 1108.01 of the Standard Specifications. CIOWADOTaRricusroN 04/20/2018 13:43:20 AASHTOWare Project v3.01.164.01 Contract Specifications List Page 2 of 2 Contract ID: 31-2100-688 CaII Order No.: 101 Letting Date: April '17, 2018 10:00 A.M. FHWA-1273.05 FHWA-1273: REQUIRED CONTRACT PROVISIONS FEDERAL -AID CONSTRUCTION CONTRACTS GS -15006 IA18-1.0 GENERAL SUPPLEMENTAL SPECIFICATIONS FOR HIGHWAY AND BRIDGE CONSTRUCTION PREDETERMINED WAGE RATE - GENERAL DECISION NUMBER IA180001 FOR HEAVY AND HIGHWAY CONSTRUCTION -- STATEWIDE (EXCEPT SCOTT COUNTY) Note: The Contractor shall review the contract documents and is responsible for identifying which zone(s), as defined in the Predetermined Wage Rate specification, apply to the work on the contract. 'Additional Requirement's*' The Prime Contractor shall submit certified payrolls for itself and each approved Subcontractor weekly to the Project Engineer. The Contractor may use the Iowa D.O.T. Certified Payroll form or other approved form. The Contractor shall list the craft for each employee covered by the Predetermined Wage Rates. The Prime Contractor shall sign each of the Subcontractor's payrolls to acknowledge the submittal of the Certified Payroll. &IOWA DOTARiAII CUSTOMER Contract Schedule 04/20/2018 13:43:20 AASHTOWare Project v3.01.164.01 Page 1 of 4 Contract ID: 31-2100-688 Awarded Vendor: M1296 SECTION 0001 Alt Set ID: Roadway Items Alt Mbr ID: MIDWEST CONCRETE, INC. $128,857.45 wavo 0010 2102-2713070 EXCAVATION, CLASS 13, ROADWAY AND BORROW 0030 0040 2105-8425005 TOPSOIL, FURNISH AND SPREAD A 420.000 CY 20.00 2115-0100000 MODIFIED SUBBASE 2121-7425020 GRANULAR SHOULDERS, TYPE B 40.00 0050 2301-1033090 STANDARD OR SLIP FORM PORTLAND CEMENT CONCRETE PAVEMENT, CLASS C, CLASS 3 DURABILITY, 9 IN. 0060 2435-0140148 MANHOLE, STORM SEWER, SW -401, 48 IN. TON 635.000 SY 20.00 55.00 8,400.00 1,500.00' 3,200.00 500.00 34, 925.00 5,400.00 3,850.00 5,400.00 4,250.00 ,850.00 4,653.75 0070 2435-0140160 MANHOLE, STORM SEWER, SW -401, 60 IN. 0080 2435-0250100 INTAKE, SW -501 0090 2435-0250500 INTAKE, SW -505 0100 2435-0600020 MANHOLE ADJUSTMENT, MAJOR 2,700.00 0110 2502-8212206 SUBDRAIN, PERFORATED PLASTIC PIPE, 6 IN. DIA. 1.000 EACH 3,850.00 2.000 EACH 2,700.00 1.000 EACH 1.000 EACH 1850.00 4,250.00 365.000 LF 12.75 CIOWA DOT SMARTER !SIMPLER I CUSTOMER DRIVEN Contract Schedule 04/20/2018 13:43:20 AASHTOWare Project v3.01.164.01 Page 2 of 4 Contract ID:' 31-2100-688 Awarded Vendor: M1296 SECTION 0001 Alt Set ID: Roadway Items Alt Mbr ID: MIDWEST CONCRETE, INC. $128,857.45 'VA 4,101 2503-0114215 STORM SEWER GRAVITY MAIN, TRENCHED, REINFORCED CONCRETE PIPE (RCP), 2000D (CLASS III), 15 IN. 0130 2503-0114218 STORM SEWER GRAVITY MAIN, TRENCHED, REINFORCED CONCRETE PIPE (RCP), 2000D (CLASS III), 18 IN. 0140 2503-0114221 STORM SEWER GRAVITY MAIN, TRENCHED, REINFORCED CONCRETE PIPE (RCP), 2000D (CLASS III), 21 IN. 24.100 LF 82.00 1,976.20 0150 2503-0114230 STORM SEWER GRAVITY MAIN, TRENCHED, REINFORCED CONCRETE PIPE (RCP), 2000D (CLASS III), 30 IN. 0160 2503-0200036 REMOVE STORM SEWER PIPE LESS THAN OR EQUAL TO 36 IN. 6.500 LF 105.00 26.600 LF 110.00 682.50 2,926.00 13.800 LF 140.00 1,932.00 0170 2510-6745850 REMOVAL OF PAVEMENT 0180 2510-6750600 REMOVAL OF ACCESSES 0190 2511-0300000 REMOVAL OF RECREATIONAL TRAIL 0200 176.000 2511-7526006 SIDEWALK. P.C. CONCRETE, 6 IN. SY 12.00 3.000 EACH 750.00 32.000 SY 24.000 SY 15.00 60.00 2,112.00 2,250.00, 480.00 1,440.00 QIOWADOTSMI CUSTOMER µ Contract Schedule 04/20/2018 13:43:20 AASHTOWare Project v3.01.164.01 Page 3 of 4 Contract ID: 31-2100-688 Awarded Vendor: M1296 SECTION 0001 Alt Set ID: Roadway Items Alt Mbr ID: MIDWEST CONCRETE, INC. $128,857.45 0210 2511-7528101 DETECTABLE WARNINGS 0220 2524-6765010 REMOVE AND REINSTALL SIGN AS 'J PER PLAN 0230 2527-9263109 20.000 0250 0260 2527-9263190 SYMBOLS AND LEGENDS REMOVED PAINTED PAVEMENT MARKING, WATERBORNE OR SOLVENT -BASED 2527-9263137 PAINTED SYMBOLS AND LEGENDS, WATERBORNE OR SOLVENT -BASED 2527-9263180 PAVEMENT MARKINGS REMOVED 0270 0280 0290 2528-8445110 TRAFFIC CONTROL 2528-8445113 FLAGGERS 2533-4980005 MOBILIZATION 0300 2599-9999005 ('EACH' ITEM) RMV SALV & REINSTALL PED POLE AND BASE SF 45.00 1.000 EACH 150.00 10.650 STA 100.00 9.000 EACH 100.00 4.600 STA 3.000 EACH 100.00 100.00 LUMP SUM 10.000 900.00 150.00 1,065.00 900.00 460.00 300.00 5,000.00 EACH 462.00 LUMP SUM 0310 2599-9999020 ('TONS' ITEM) 3 INCH BREAKER RUN 0320 2601-2634100 MULCHING 1.000 EACH 5,000.00 550.000 TON 0.100 ACRE 5,000.00 16.50 4,620.00, 10,000.00 5,000.00 9,075.00 500.00 COIOWADOT,CUSTOMER SMARTER I SIMPLER Contract Schedule 04/20/2018 13:43:20 AASHTOWare Project v3.01.164.01 Page 4 of 4 Contract ID: 31-2100-688 Awarded Vendor: MI296 SECTION 0001 Alt Set ID: Roadway Items Alt Mbr ID: MIDWEST CONCRETE, INC. $128,857.45 0330 0340 2602-0000312 PERIMETER AND SLOPE SEDIMENT CONTROL DEVICE, 12 IN. DIA. 2601-2636044 SEEDING AND FERTILIZING (URBAN) 0350 2602-0000350 REMOVAL OF PERIMETER AND SLOPE SEDIMENT CONTROL DEVICE 0.100 ACRE 7,500.00 220.000 LF 5.00 220.000 LF 2.00 Total Bid: 750.00 ,100.00 440.00 $128,857.45 REQUIRED CONTRACT PROVISIONS FEDERAL -AID CONSTRUCTION CONTRACTS I. General II. Nondiscrimination III. Nonsegregated Facilities IV. Davis -Bacon and Related Act Provisions V. Contract Work Hours and Safety Standards Act Provisions VL Subletting or Assigning the Contract VII. Safety: Accident Prevention VIII. False Statements Concerning Highway Projects IX. Implementation of Clean Air Act and Federal Water Pollution Control Act X. Compliance with Governmentwide Suspension and Debarment Requirements XI. Certification Regarding Use of Contract Funds for Lobbying ATTACHMENTS A. Employment and Materials Preference for Appalachian Development Highway System or Appalachian Local Access Road Contracts (included in Appalachian contracts only) I. GENERAL 1. Form FHWA-1273 must be physically incorporated in each construction contract funded under Title 23 (excluding emergency contracts solely intended for debris removal). The contractor (or subcontractor) must insert this form in each subcontract and further require its inclusion in all lower tier subcontracts (excluding purchase orders, rental agreements and other agreements for supplies or services). The applicable requirements of Form FHWA-1273 are incorporated by reference for work done under any purchase order, rental agreement or agreement for other services. The prime contractor shall be responsible for compliance by any subcontractor, lower -tier subcontractor or service provider. Form FHWA-1273 must be included in all Federal -aid design - build contracts, in all subcontracts and in lower tier subcontracts (excluding subcontracts for design services, purchase orders, rental agreements and other agreements for supplies or services). The design -builder shall be responsible for compliance by any subcontractor, lower -tier subcontractor or service provider. Contracting agencies may reference Form FHWA-1273 in bid proposal or request for proposal documents, however, the Form FHWA-1273 must be physically incorporated (not referenced) in all contracts, subcontracts and lower -tier subcontracts (excluding purchase orders, rental agreements and other agreements for supplies or services related to a construction contract). 2. Subject to the applicability criteria noted in the following sections, these contract provisions shall apply to all work performed on the contract by the contractor's own organization and with the assistance of workers under the contractor's immediate superintendence and to all work performed on the contract by piecework, station work, or by subcontract. 1 FHWA-1273 -- Revised May 1, 2012 3. A breach of any of the stipulations contained in these Required Contract Provisions may be sufficient grounds for withholding of progress payments, withholding of final payment, termination of the contract, suspension / debarment or any other action determined to be appropriate by the contracting agency and FHWA. 4. Selection of Labor: During the performance of this contract, the contractor shall not use convict labor for any purpose within the limits of a construction project on a Federal -aid highway unless it is labor performed by convicts who are on parole, supervised release, or probation. The term Federal -aid highway does not include roadways functionally classified as local roads or rural minor collectors. II. NONDISCRIMINATION The provisions of this section related to 23 CFR Part 230 are applicable to all Federal -aid construction contracts and to all related construction subcontracts of $10,000 or more. The provisions of 23 CFR Part 230 are not applicable to material supply, engineering, or architectural service contracts. In addition, the contractor and all subcontractors must comply with the following policies: Executive Order 11246, 41 CFR 60, 29 CFR 1625-1627, Title 23 USC Section 140, the Rehabilitation Act of 1973, as amended (29 USC 794), Title VI of the Civil Rights Act of 1964, as amended, and related regulations including 49 CFR Parts 21, 26 and 27; and 23 CFR Parts 200, 230, and 633. The contractor and all subcontractors must comply with: the requirements of the Equal Opportunity Clause in 41 CFR 60- 1.4(b) and, for all construction contracts exceeding $10,000, the Standard Federal Equal Employment Opportunity Construction Contract Specifications in 41 CFR 60-4.3. Note: The U.S. Department of Labor has exclusive authority to determine compliance with Executive Order 11246 and the policies of the Secretary of Labor including 41 CFR 60, and 29 CFR 1625-1627. The contracting agency and the FHWA have the authority and the responsibility to ensure compliance with Title 23 USC Section 140, the Rehabilitation Act of 1973, as amended (29 USC 794), and Title VI of the Civil Rights Act of 1964, as amended, and related regulations including 49 CFR Parts 21, 26 and 27; and 23 CFR Parts 200, 230, and 633. The following provision is adopted from 23 CFR 230, Appendix A, with appropriate revisions to conform to the U.S. Department of Labor (US DOL) and FHWA requirements. 1. Equal Employment Opportunity: Equal employment opportunity (EEO) requirements not to discriminate and to take affirmative action to assure equal opportunity as set forth under laws, executive orders, rules, regulations (28 CFR 35, 29 CFR 1630, 29 CFR 1625-1627, 41 CFR 60 and 49 CFR 27) and orders of the Secretary of Labor as modified by the provisions prescribed herein, and imposed pursuant to 23 U.S.C. 140 shall constitute the EEO and specific affirmative action standards for the contractor's project activities under this contract. The provisions of the Americans with Disabilities Act of 1990 (42 U.S.C. 12101 et seq.) set forth under 28 CFR 35 and 29 CFR 1630 are incorporated by reference in this contract. In the execution of this contract, the contractor agrees to comply with the following minimum specific requireinent activities of EEO: a. The contractor will work with the contracting agency and the Federal Government to ensure that it has made every good faith effort to provide equal opportunity with respect to all of its terms and conditions of employment and in their review of activities under the contract. b. The contractor will accept as its operating policy the following statement: "It is the policy of this Company to assure that applicants are employed, and that employees are treated during employment, without regard to their race, religion, sex, color, national origin, age or disability. Such action shall include: employment, upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship, pre -apprenticeship, and/or on-the- job training." 2. EEO Officer: The contractor will designate and make known to the contracting officers an EEO Officer who will have the responsibility for and must be capable of effectively administering and promoting an active EEO program and who must be assigned adequate authority and responsibility to do so. 3. Dissemination of Policy: All members of the contractor's staff who are authorized to hire, supervise, promote, and discharge employees, or who recommend such action, or who are substantially involved in such action, will be made fully cognizant of, and will implement, the contractor's EEO policy and contractual responsibilities to provide EEO in each grade and classification of employment. To ensure that the above agreement wit be met, the following actions will be taken as a minimum: a. Periodic meetings of supervisory and personnel office employees will be conducted before the start of work and then not less often than once every six months, at which time the contractor's EEO policy and its implementation will be reviewed and explained. The meetings will be conducted by the EEO Officer. b. All new supervisory or personnel office employees will be given a thorough indoctrination by the EEO Officer, covering all major aspects of the contractor's EEO obligations within thirty days following their reporting for duty with the contractor. c. All personnel who are engaged in direct recruitment for the project will be instructed by the EEO Officer in the contractor's procedures for locating and hiring minorities and women. d. Notices and posters setting forth the contractor's EEO policy will be placed in areas readily accessible to employees, applicants for employment and potential employees. e. The contractor's EEO policy and the procedures to implement such policy will be brought to the attention of employees by means of meetings, employee handbooks, or other appropriate means. 2 4. Recruitment: When advertising for employees, the contractor will include in all advertisements for employees the notation: "An Equal Opportunity Employer." All such advertisements will be placed in publications having a large circulation among minorities and women in the area from which the project work force would normally be derived. a. The contractor will, unless precluded by a valid bargaining agreement, conduct systematic and direct recruitment through public and private employee referral sources likely to yield qualified minorities and women. To meet this requirement, the contractor will identify sources of potential minority group employees, and establish with such identified sources procedures whereby minority and women applicants may be referred to the contractor for employment consideration. b. In the event the contractor has a valid bargaining agreement providing for exclusive hiring hall referrals, the contractor is expected to observe the provisions of that agreement to the extent that the system meets the contractor's compliance with EEO contract provisions. Where implementation of such an agreement has the effect of discriminating against minorities or women, or obligates the contractor to do the same, such implementation violates Federal nondiscrimination provisions. c. The contractor will encourage its present employees to refer minorities and women as applicants for employment. Information and procedures with regard to referring such applicants will be discussed with employees. 5. Personnel Actions: Wages, working conditions, and employee benefits shall be established and administered, and personnel actions of every type, including hiring, upgrading, promotion, transfer, demotion, layoff, and termination, shall be taken without regard to race, color, religion, sex, national origin, age or disability. The following procedures shall be followed: a. The contractor will conduct periodic inspections of project sites to insure that working conditions and employee facilities do not indicate discriminatory treatment of project site personnel. b. The contractor will periodically evaluate the spread of wages paid within each classification to determine any evidence of discriminatory wage practices. c. The contractor will periodically review selected personnel actions in depth to determine whether there is evidence of discrimination. Where evidence is found, the contractor will promptly take corrective action. If the review indicates that the discrimination may extend beyond the actions reviewed, such corrective action shall include all affected persons. d. The contractor will promptly investigate all complaints of alleged discrimination made to the contractor in connection with its obligations under this contract, will attempt to resolve such complaints, and will take appropriate corrective action within a reasonable time. If the investigation indicates that the discrimination may affect persons other than the complainant, such corrective action shall include such other persons. Upon completion of each investigation, the contractor will inform every complainant of all of their avenues of appeal. 6. Training and Promotion: a. The contractor will assist in locating, qualifying, and increasing the skills of minorities and women who are applicants for employment or current employees. Such efforts should be aimed at developing fuel journey level status employees in the type of trade or job classification involved. b. Consistent with the contractor's work force requirements and as permissible under Federal and State regulations, the contractor shall make full use of training programs, i.e., apprenticeship, and on-the-job training programs for the geographical area of contract performance. In the event a special provision for training is provided under this contract, this subparagraph will be superseded as indicated in the special provision. The contracting agency may reserve training positions for persons who receive welfare assistance in accordance with 23 U.S.C. 140(a). c. The contractor will advise employees and applicants for employment of available training programs and entrance requirements for each. d. The contractor will periodically review the training and promotion potential of employees who are minorities and women and will encourage eligible employees to apply for such training and promotion. 7. Unions: If the contractor relies in whole or in part upon unions as a source of employees, the contractor will use good faith efforts to obtain the cooperation of such unions to increase opportunities for minorities and women. Actions by the contractor, either directly or through a contractor's association acting as agent, will include the procedures set forth below: a. The contractor will use good faith efforts to develop, in cooperation with the unions, joint training programs aimed toward qualifying more minorities and women for membership in the unions and increasing the skills of minorities and women so that they may qualify for higher paying employment. b. The contractor will use good faith efforts to incorporate an EEO clause into each union agreement to the end that such union will be contractually bound to refer applicants without regard to their race, color, religion, sex, national origin, age or disability. c. The contractor is to obtain information as to the referral practices and policies of the labor union except that to the extent such information is within the exclusive possession of the labor union and such labor union refuses to furnish such information to the contractor, the contractor shall so certify to the contracting agency and shall set forth what efforts have been made to obtain such information. d. In the event the union is unable to provide the contractor with a reasonable flow of referrals within the time limit set forth in the collective bargaining agreement, the contractor will, through independent recruitment efforts, fill the employment vacancies without regard to race, color, religion, sex, national origin, age or disability; making full efforts to obtain qualified and/or qualifiable minorities and women. The failure of a union to provide sufficient referrals (even though it is obligated to provide exclusive referrals under the terms of a collective bargaining agreement) does not relieve the contractor from the requirements of this paragraph. In the event the union referral practice prevents the contractor from meeting the obligations pursuant to Executive Order 11246, as amended, and these special provisions, such contractor shall immediately notify the contracting agency. 8. Reasonable Accommodation for Applicants Employees with Disabilities: The contractor must be familiar 3 with the requirements for and comply with the Americans with Disabilities Act and all rules and regulations established there under. Employers must provide reasonable accommodation in all employment activities unless to do so would cause an undue hardship. 9. Selection of Subcontractors, Procurement of Materials and Leasing of Equipment: The contractor shall not discriminate on the grounds of race, color, religion, sex, national origin, age or disability in the selection and retention of subcontractors, including procurement of materials and leases of equipment. The contractor shall take all necessary and reasonable steps to ensure nondiscrimination in the administration of this contract. a. The contractor shall notify all potential subcontractors and suppliers and lessors of their EEO obligations under this contract. b. The contractor will use good faith efforts to ensure subcontractor compliance with their EEO obligations. 10. Assurance Required by 49 CFR 26.13(b): a. The requirements of 49 CFR Part 26 and the State DOT's U.S. DOT -approved DBE program are incorporated by reference. b. The contractor or subcontractor shall not discriminate on the basis of race, color, national origin, or sex in the performance of this contract. The contractor shall carry out applicable requirements of 49 CFR Part 26 in the award and administration of DOT -assisted contracts. Failure by the contractor to carry out these requirements is a material breach of this contract, which may result in the termination of this contract or such other remedy as the contracting agency deems appropriate. 11. Records and Reports: The contractor shall keep such records as necessary to document compliance with the EEO requirements. Such records shall be retained for a period of three years following the date of the final payment to the contractor for all contract work and shall be available at reasonable times and places for inspection by authorized representatives of the contracting agency and the FHWA. a. The records kept by the contractor shall document the following: (1) The number and work hours of minority and non - minority group members and women employed in each work classification on the project; (2) The progress and efforts being made in cooperation with unions, when applicable, to increase employment opportunities for minorities and women; and (3) The progress and efforts being made in locating, hiring, training, qualifying, and upgrading minorities and women; b. The contractors and subcontractors will submit an annual report to the contracting agency each July for the duration of the project, indicating the number of minority, women, and non -minority group employees currently engaged in each work classification required by the contract work. This information is to be reported on Form FHWA-1391. The staffing data should represent the project work force on board in all or any part of the last payroll period preceding the end of July. If on-the-job training is being required by special provision, the contractor will be required to collect and report training data. The employment data should reflect the work force on board during all or any part of the last payroll period preceding the end of July. III. NONSEGREGATED FACILITIES This provision is applicable to all Federal -aid construction contracts and to all related construction subcontracts of $10,000 or more. The contractor must ensure that facilities provided for employees are provided in such a manner that segregation on the basis of race, color, religion, sex, or national origin cannot result. The contractor may neither require such segregated use by written or oral policies nor tolerate such use by employee custom. The contractors obligation extends further to ensure that its employees are not assigned to perform their services at any location, under the contractor's control, where the facilities are segregated. The term "facilities" includes waiting rooms, work areas, restaurants and other eating areas, time clocks, restrooms, washrooms, locker rooms, and other storage or dressing areas, parking lots, drinking fountains, recreation or entertainment areas, transportation, and housing provided for employees. The contractor shall provide separate or single -user restrooms and necessary dressing or sleeping areas to assure privacy between sexes. IV. DAVIS-BACON AND RELATED ACT PROVISIONS This section is applicable to all Federal -aid construction projects exceeding $2,000 and to all related subcontracts and lower -tier subcontracts (regardless of subcontract size). The requirements apply to all projects located within the right-of- way of a roadway that is functionally classified as Federal -aid highway. This excludes roadways functionally classified as local roads or rural minor collectors, which are exempt. Contracting agencies may elect to apply these requirements to other projects. The following provisions are from the U.S. Department of Labor regulations in 29 CFR 5.5 "Contract provisions and related matters" with minor revisions to conform to the FHWA- 1273 format and FHWA program requirements. 1. Minimum wages a. All laborers and mechanics employed or working upon the site of the work, will be paid unconditionally and not less often than once a week, and without subsequent deduction or rebate on any account (except such payroll deductions as are permitted by regulations issued by the Secretary of Labor under the Copeland Act (29 CFR part 3)), the full amount of wages and bona fide fringe benefits (or cash equivalents thereof) due at time of payment computed at rates not less than those contained in the wage determination of the Secretary of Labor which is attached hereto and made a part hereof, regardless of any contractual relationship which may be alleged to exist between the contractor and such laborers and mechanics. Contributions made or costs reasonably anticipated for bona fide fringe benefits under section 1(b)(2) of the Davis -Bacon Act on behalf of laborers or mechanics are considered wages paid to such laborers or mechanics, subject to the provisions 4 of paragraph 1.d. of this section; also, regular contributions made or costs incurred for more than a weekly period (but not less often than quarterly) under plans, funds, or programs which cover the particular weekly period, are deemed to be constructively made or incurred during such weekly period. Such laborers and mechanics shall be paid the appropriate wage rate and fringe benefits on the wage determination for the classification of work actually performed, without regard to skill, except as provided in 29 CFR 5.5(a)(4). Laborers or mechanics performing work in more than one classification may be compensated at the rate specified for each classification for the time actually worked therein: Provided, That the employer's payroll records accurately set forth the time spent in each classification in which work is performed. The wage determination (including any additional classification and wage rates conformed under paragraph 1.b. of this section) and the Davis -Bacon poster (WH -1321) shall be posted at all times by the contractor and its subcontractors at the site of the work in a prominent and accessible place where it can be easily seen by the workers. b.(1) The contracting officer shall require that any class of laborers or mechanics, including helpers, which is not listed in the wage determination and which is to be employed under the contract shall be classified in conformance with the wage determination. The contracting officer shall approve an additional classification and wage rate and fringe benefits therefore only when the following criteria have been met: (i) The work to be performed by the classification requested is not performed by a classification in the wage determination; and (ii) The classification is utilized in the area by the construction industry; and (iii) The proposed wage rate, including any bona fide fringe benefits, bears a reasonable relationship to the wage rates contained in the wage determination. (2) If the contractor and the laborers and mechanics to be employed in the classification (if known), or their representatives, and the contracting officer agree on the classification and wage rate (including the amount designated for fringe benefits where appropriate), a report of the action taken shall be sent by the contracting officer to the Administrator of the Wage and Hour Division, Employment Standards Administration, U.S. Department of Labor, Washington, DC 20210. The Administrator, or an authorized representative, will approve, modify, or disapprove every additional classification action within 30 days of receipt and so advise the contracting officer or will notify the contracting officer within the 30 -day period that additional time is necessary. (3) In the event the contractor, the laborers or mechanics to be employed in the classification or their representatives, and the contracting officer do not agree on the proposed classification and wage rate (including the amount designated for fringe benefits, where appropriate), the contracting officer shall refer the questions, including the views of all interested parties and the recommendation of the contracting officer, to the Wage and Hour Administrator for determination. The Wage and Hour Administrator, or an authorized representative, will issue a determination within 30 days of receipt and so advise the contracting officer or will notify the contracting officer within the 30 -day period that additional time is necessary. (4) The wage rate (including fringe benefits where appropriate) determined pursuant to paragraphs 1.b.(2) or 1.b.(3) of this section, shall be paid to all workers performing work in the classification under this contract from the first day on which work is performed in the classification. c. Whenever the minimum wage rate prescribed in the contract for a class of laborers or mechanics includes a fringe benefit which is not expressed as an hourly rate, the contractor shall either pay the benefit as stated in the wage determination or shall pay another bona fide fringe benefit or an hourly cash equivalent thereof. d. If the contractor does not make payments to a trustee or other third person, the contractor may consider as part of the wages of any laborer or mechanic the amount of any costs reasonably anticipated in providing bona fide fringe benefits under a plan or program, Provided, That the Secretary of Labor has found, upon the written request of the contractor, that the applicable standards of the Davis -Bacon Act have been met. The Secretary of Labor may require the contractor to set aside in a separate account assets for the meeting of obligations under the plan or program. 2. Withholding The contracting agency shall upon its own action or upon written request of an authorized representative of the Department of Labor, withhold or cause to be withheld from the contractor under this contract, or any other Federal contract with the same prime contractor, or any other federally - assisted contract subject to Davis -Bacon prevailing wage requirements, which is held by the same prime contractor, so much of the accrued payments or advances as may be considered necessary to pay laborers and mechanics, including apprentices, trainees, and helpers, employed by the contractor or any subcontractor the full amount of wages required by the contract. In the event of failure to pay any laborer or mechanic, including any apprentice, trainee, or helper, employed or working on the site of the work, all or part of the wages required by the contract, the contracting agency may, after written notice to the contractor, take such action as may be necessary to cause the suspension of any further payment, advance, or guarantee of funds until such violations have ceased. 3. Payrolls and basic records a. Payrolls and basic records relating thereto shall be maintained by the contractor during the course of the work and preserved for a period of three years thereafter for all laborers and mechanics working at the site of the work. Such records shall contain the name, address, and social security number of each such worker, his or her correct classification, hourly rates of wages paid (including rates of contributions or costs anticipated for bona fide fringe benefits or cash equivalents thereof of the types described in section 1(b)(2)(B) of the Davis -Bacon Act), daily and weekly number of hours worked, deductions made and actual wages paid. Whenever the Secretary of Labor has found under 29 CFR 5.5(a)(1)(iv) that the wages of any laborer or mechanic include the amount of any costs reasonably anticipated in providing benefits under a plan or program described in section 1(b)(2)(B) of the Davis - 5 Bacon Act, the contractor shall maintain records which show that the commitment to provide such benefits is enforceable, that the plan or program is financially responsible, and that the plan or program has been communicated in writing to the laborers or mechanics affected, and records which show the costs anticipated or the actual cost incurred in providing such benefits. Contractors employing apprentices or trainees under approved programs shall maintain written evidence of the registration of apprenticeship programs and certification of trainee programs, the registration of the apprentices and trainees, and the ratios and wage rates prescribed in the applicable programs. b.(1) The contractor shall submit weekly for each week in which any contract work is performed a copy of all payrolls to the contracting agency. The payrolls submitted shall set out accurately and completely all of the information required to be maintained under 29 CFR 5.5(a)(3)(i), except that full social security numbers and home addresses shall not be included on weekly transmittals. Instead the payrolls shall only need to include an individually identifying number for each employee e.g. , the last four digits of the employee's social security number). The required weekly payroll information may be submitted in any form desired. Optional Form WH -347 is available for this purpose from the Wage and Hour Division Web site at http://www.dol.gov/esa/whd/forms/wh347instr.htm or its successor site. The prime contractor is responsible for the submission of copies of payrolls by all subcontractors. Contractors and subcontractors shall maintain the full social security number and current address of each covered worker, and shall provide them upon request to the contracting agency for transmission to the State DOT, the FHWA or the Wage and Hour Division of the Department of Labor for purposes of an investigation or audit of compliance with prevailing wage requirements. It is not a violation of this section for a prime contractor to require a subcontractor to provide addresses and social security numbers to the prime contractor for its own records, without weekly submission to the contracting agency.. (2) Each payroll submitted shall be accompanied by a "Statement of Compliance," signed by the contractor or subcontractor or his or her agent who pays or supervises the payment of the persons employed under the contract and shall certify the following: (i) That the payroll for the payroll period contains the information required to be provided under §5.5 (a)(3)(ii) of Regulations, 29 CFR part 5, the appropriate information is being maintained under §5.5 (a)(3)(i) of Regulations, 29 CFR part 5, and that such information is correct and complete; (ii) That each laborer or mechanic (including each helper, apprentice, and trainee) employed on the contract during the payroll period has been paid the full weekly wages earned, without rebate, either directly or indirectly, and that no deductions have been made either directly or indirectly from the full wages earned, other than permissible deductions as set forth in Regulations, 29 CFR part 3; (iii) That each laborer or mechanic has been paid not less than the applicable wage rates and fringe benefits or cash equivalents for the classification of work performed, as specified in the applicable wage determination incorporated into the contract. (3) The weekly submission of a properly executed certification set forth on the reverse side of Optional Form WH -347 shall satisfy the requirement for submission of the "Statement of Compliance" required by paragraph 3.b.(2) of this section. (4) The falsification of any of the above certifications may subject the contractor or subcontractor to civil or criminal prosecution under section 1001 of title 18 and section 231 of title 31 of the United States Code. c. The contractor or subcontractor shall make the records required under paragraph 3.a. of this section available for inspection, copying, or transcription by authorized representatives of the contracting agency, the State DOT, the FHWA, or the Department of Labor, and shall permit such representatives to interview employees during working hours on the job. If the contractor or subcontractor fails to submit the required records or to make them available, the FHWA may, after written notice to the contractor, the contracting agency or the State DOT, take such action as may be necessary to cause the suspension of any further payment, advance, or guarantee of funds. Furthermore, failure to submit the required records upon request or to make such records available may be grounds for debarment action pursuant to 29 CFR 5.12. 4. Apprentices and trainees a. Apprentices (programs of the USDOL). Apprentices will be permitted to work at less than the predetermined rate for the work they performed when they are employed pursuant to and individually registered in a bona fide apprenticeship program registered with the U.S. Department of Labor, Employment and Training Administration, Office of Apprenticeship Training, Employer and Labor Services, or with a State Apprenticeship Agency recognized by the Office, or if a person is employed in his or her first 90 clays of probationary employment as an apprentice in such an apprenticeship program, who is not individually registered in the program, but who has been certified by the Office of Apprenticeship Training, Employer and Labor Services or a State Apprenticeship Agency (where appropriate) to be eligible for probationary employment as an apprentice. The allowable ratio of apprentices to journeymen on the job site in any craft classification shall not be greater than the ratio permitted to the contractor as to the entire work force under the registered program. Any worker listed on a payroll at an apprentice wage rate, who is not registered or otherwise employed as stated above, shall be paid not less than the applicable wage rate on the wage determination for the classification of work actually performed. In addition, any apprentice performing work on the job site in excess of the ratio permitted under the registered program shall be paid not less than the applicable wage rate on the wage determination for the work actually performed. Where a contractor is performing construction on a project in a locality other than that in which its program is registered, the ratios and wage rates (expressed in percentages of the journeyman's hourly rate) specified in the contractor's or subcontractor's registered program shall be observed. Every apprentice must be paid at not less than the rate specified in the registered program for the apprentice's level of progress, expressed as a percentage of the journeymen hourly 6 rate specified in the applicable wage determination. Apprentices shall be paid fringe benefits in accordance with the provisions of the apprenticeship program. If the apprenticeship program does not specify fringe benefits, apprentices must be paid the full amount of fringe benefits listed on the wage determination for the applicable classification. If the Administrator determines that a different practice prevails for the applicable apprentice classification, fringes shall be paid in accordance with that determination. In the event the Office of Apprenticeship Training, Employer and Labor Services, or a State Apprenticeship Agency recognized by the Office, withdraws approval of an apprenticeship program, the contractor will no longer be permitted to utilize apprentices at less than the applicable predetermined rate for the work performed until an acceptable program is approved. b. Trainees (programs of the USDOL). Except as provided in 29 CFR 5.16, trainees will not be permitted to work at less than the predetermined rate for the work performed unless they are employed pursuant to and individually registered in a program which has received prior approval, evidenced by formal certification by the U.S. Department of Labor, Employment and Training Administration. The ratio of trainees to journeymen on the job site shall not be greater than permitted under the plan approved by the Employment and Training Administration. Every trainee must be paid at not less than the rate specified in the approved program for the trainee's level of progress, expressed as a percentage of the journeyman hourly rate specified in the applicable wage determination. Trainees shall be paid fringe benefits in accordance with the provisions of the trainee program. If the trainee program does not mention fringe benefits, trainees shall be paid the full amount of fringe benefits listed on the wage determination unless the Administrator of the Wage and Hour Division determines that there is an apprenticeship program associated with the corresponding journeyman wage rate on the wage determination which provides for less than full fringe benefits for apprentices. Any employee listed on the payroll at a trainee rate who is not registered and participating in a training plan approved by the Employment and Training Administration shall be paid not less than the applicable wage rate on the wage determination for the classification of work actually performed. In addition, any trainee performing work on the job site in excess of the ratio permitted under the registered program shall be paid not less than the applicable wage rate on the wage determination for the work actually performed. In the event the Employment and Training Administration withdraws approval of a training program, the contractor will no longer be permitted to utilize trainees at less than the applicable predetermined rate for the work performed until an acceptable program is approved. c. Equal employment opportunity. The utilization of apprentices, trainees and journeymen under this part shall be in conformity with the equal employment opportunity requirements of Executive Order 11246, as amended, and 29 CFR part 30. d. Apprentices and Trainees (programs of the U.S. DOT). Apprentices and trainees working under apprenticeship and skill training programs which have been certified by the Secretary of Transportation as promoting EEO in connection with Federal -aid highway construction programs are not subject to the requirements of paragraph 4 of this Section IV. The straight time hourly wage rates for apprentices and trainees under such programs will be established by the particular programs. The ratio of apprentices and trainees to journeymen shall not be greater than permitted by the terms of the particular program. 5. Compliance with Copeland Act requirements. The contractor shall comply with the requirements of 29 CFR part 3, which are incorporated by reference in this contract. 6. Subcontracts. The contractor or subcontractor shall insert Form FHWA-1273 in any subcontracts and also require the subcontractors to include Form FHWA-1273 in any lower tier subcontracts. The prime contractor shall be responsible for the compliance by any subcontractor or lower tier subcontractor with all the contract clauses in 29 CFR 5.5. 7. Contract termination: debarment. A breach of the contract clauses in 29 CFR 5.5 may be grounds for termination of the contract, and for debarment as a contractor and a subcontractor as provided in 29 CFR 5.12. 8. Compliance with Davis -Bacon and Related Act requirements. All rulings and interpretations of the Davis - Bacon and Related Acts contained in 29 CFR parts 1, 3, and 5 are herein incorporated by reference in this contract. 9. Disputes concerning labor standards. Disputes arising out of the labor standards provisions of this contract shall not be subject to the general disputes clause of this contract. Such disputes shall be resolved in accordance with the procedures of the Department of Labor set forth in 29 CFR parts 5, 6, and 7. Disputes within the meaning of this clause include disputes between the contractor (or any of its subcontractors) and the contracting agency, the U.S. Department of Labor, or the employees or their representatives. 10. Certification of eligibility. a. By entering into this contract, the contractor certifies that neither it (nor he or she) nor any person or firm who has an interest in the contractor's firm is a person or firm ineligible to be awarded Government contracts by virtue of section 3(a) of the Davis -Bacon Act or 29 CFR 5.12(a)(1). b. No part of this contract shall be subcontracted to any person or firm ineligible for award of a Government contract by virtue of section 3(a) of the Davis -Bacon Act or 29 CFR 5.12(a)(1). c. The penalty for making false statements is prescribed in the U.S. Criminal Code, 18 U.S.C. 1001. 7 V. CONTRACT WORK HOURS AND SAFETY STANDARDS ACT The following clauses apply to any Federal -aid construction contract in an amount in excess of $100,000 and subject to the overtime provisions of the Contract Work Hours and Safety Standards Act. These clauses shall be inserted in addition to the clauses required by 29 CFR 5.5(a) or 29 CFR 4.6. As used in this paragraph, the terms laborers and mechanics include watchmen and guards. 1. Overtime requirements. No contractor or subcontractor contracting for any part of the contract work which may require or involve the employment of laborers or mechanics shall require or permit any such laborer or mechanic in any workweek in which he or she is employed on such work to work in excess of forty hours in such workweek unless such laborer or mechanic receives compensation at a rate not less than one and one-half times the basic rate of pay for all hours worked in excess of forty hours in such workweek. 2. Violation; liability for unpaid wages; liquidated damages. In the event of any violation of the clause set forth in paragraph (1.) of this section, the contractor and any subcontractor responsible therefor shall be liable for the unpaid wages. In addition, such contractor and subcontractor shall be liable to the United States (in the case of work done under contract for the District of Columbia or a territory, to such District or to such territory), for liquidated damages. Such liquidated damages shall be computed with respect to each individual laborer or mechanic, including watchmen and guards, employed in violation of the clause set forth in paragraph (1.) of this section, in the sum of $10 for each calendar day on which such individual was required or permitted to work in excess of the standard workweek of forty hours without payment of the overtime wages required by the clause set forth in paragraph (1.) of this section. 3. Withholding for unpaid wages and liquidated damages. The FHWA or the contacting agency shall upon its own action or upon written request of an authorized representative of the Department of Labor withhold or cause to be withheld, from any moneys payable on account of work performed by the contractor or subcontractor under any such contract or any other Federal contract with the same prime contractor, or any other federally -assisted contract subject to the Contract Work Hours and Safety Standards Act, which is held by the same prime contractor, such sums as may be determined to be necessary to satisfy any liabilities of such contractor or subcontractor for unpaid wages and liquidated damages as provided in the clause set forth in paragraph (2.) of this section. 4. Subcontracts. The contractor or subcontractor shall insert in any subcontracts the clauses set forth in paragraph (1.) through (4.) of this section and also a clause requiring the subcontractors to include these clauses in any lower tier subcontracts. The prime contractor shall be responsible for compliance by any subcontractor or lower tier subcontractor with the clauses set forth in paragraphs (1.) through (4.) of this section. VI. SUBLETTING OR ASSIGNING THE CONTRACT This provision is applicable to all Federal -aid construction contracts on the National Highway System. 1. The contractor shall perform with its own organization contract work amounting to not less than 30 percent (or a greater percentage if specified elsewhere in the contract) of the total original contract price, excluding any specialty items designated by the contracting agency. Specialty items may be performed by subcontract and the amount of any such specialty items performed may be deducted from the total original contract price before computing the amount of work required to be performed by the contractor's own organization (23 CFR 635.116). a. The term "perform work with its own organization" refers to workers employed or leased by the prime contractor, and equipment owned or rented by the prime contractor, with or without operators. Such term does not include employees or equipment of a subcontractor or lower tier subcontractor, agents of the prime contractor, or any other assignees. The term may include payments for the costs of hiring leased employees from an employee leasing firm meeting all relevant Federal and State regulatory requirements. Leased employees may only be included in this term if the prime contractor meets all of the following conditions: (1) the prime contractor maintains control over the supervision of the day-to-day activities of the leased employees; (2) the prime contractor remains responsible for the quality of the work of the leased employees; (3) the prime contractor retains all power to accept or exclude individual employees from work on the project; and (4) the prime contractor remains ultimately responsible for the payment of predetermined minimum wages, the submission of payrolls, statements of compliance and all other Federal regulatory requirements. b. "Specialty Items" shall be construed to be limited to work that requires highly specialized knowledge, abilities, or equipment not ordinarily available in the type of contracting organizations qualified and expected to bid or propose on the contract as a whole and in general are to be limited to minor components of the overall contract. 2. The contract amount upon which the requirements set forth in paragraph (1) of Section VI is computed includes the cost of material and manufactured products which are to be purchased or produced by the contractor under the contract provisions. 3. The contractor shall furnish (a) a competent superintendent or supervisor who is employed by the firm, has full authority to direct performance of the work in accordance with the contract requirements, and is in charge of all construction operations (regardless of who performs the work) and (b) such other of its own organizational resources (supervision, management, and engineering services) as the contracting officer determines is necessary to assure the performance of the contract. 4. No portion of the contract shall be sublet, assigned or otherwise disposed of except with the written consent of the contracting officer, or authorized representative, and such consent when given shall not be construed to relieve the contractor of any responsibility for the fulfillment of the contract. Written consent will be given only after the contracting agency has assured that each subcontract is 8 evidenced in writing and that it contains all pertinent provisions and requirements of the prime contract. 5. The 30% self -performance requirement of paragraph (1) is not applicable to design -build contracts; however, contracting agencies may establish their own self -performance requirements. VII. SAFETY: ACCIDENT PREVENTION T his provision is applicable to all Federal -aid construction contracts and to all related subcontracts. 1. In the performance of this contract the contractor shall comply with all applicable Federal, State, and local laws governing safety, health, and sanitation (23 CFR 635). The contractor shall provide all safeguards, safety devices and protective equipment and take any other needed actions as it determines, or as the contracting officer may determine, to be reasonably necessary to protect the life and health of employees on the job and the safety of the public and to protect property in connection with the performance of the work covered by the contract. 2. It is a condition of this contract, and shall be made a condition of each subcontract, which the contractor enters into pursuant to this contract, that the contractor and any subcontractor shall not permit any employee, in performance of the contract, to work in surroundings or under conditions which are unsanitary, hazardous or dangerous to his/her health or safety, as determined under construction safety and health standards (29 CFR 1926) promulgated by the Secretary of Labor, in accordance with Section 107 of the Contract Work Hours and Safety Standards Act (40 U.S.C. 3704). 3. Pursuant to 29 CFR 1926.3, it is a condition of this contract that the Secretary of Labor or authorized representative thereof, shall have right of entry to any site of contract performance to inspect or investigate the matter of compliance with the construction safety and health standards and to carry out the duties of the Secretary under Section 107 of the Contract Work Hours and Safety Standards Act (40 U.S.C.3704). VIII. FALSE STATEMENTS CONCERNING HIGHWAY PROJECTS T his p r o v i s i o n is applicable to all Federal -aid construction contracts and to all related subcontracts. In order to assure high quality and durable construction in conformity with approved plans and specifications and a high degree of reliability on statements and representations made by engineers, contractors, suppliers, and workers on Federal - aid highway projects, it is essential that all persons concerned with the project perform their functions as carefully, thoroughly, and honestly as possible. Willful falsification, distortion, or misrepresentation with respect to any facts related to the project is a violation of Federal law. To prevent any misunderstanding regarding the seriousness of these and similar acts, Form FHWA-1022 shall be posted on each Federal -aid highway project (23 CFR 635) in one or more places where it is readily available to all persons concerned with the project: 18 U.S.C. 1020 reads as follows: "Whoever, being an officer, agent, or employee of the United States, or of any State or Territory, or whoever, whether a person, association, firm, or corporation, knowingly makes any false statement, false representation, or false report as to the character, quality, quantity, or cost of the material used or to be used, or the quantity or quality of the work performed or to be performed, or the cost thereof in connection with the submission of plans, maps, specifications, contracts, or costs of construction on any highway or related project submitted for approval to the Secretary of Transportation; or Whoever knowingly makes any false statement, false representation, false report or false claim with respect to the character, quality, quantity, or cost of any work performed or to be performed, or materials furnished or to be furnished, in connection with the construction of any highway or related project approved by the Secretary of Transportation; or Whoever knowingly makes any false statement or false representation as to material fact in any statement, certificate, or report submitted pursuant to provisions of the Federal -aid Roads Act approved July 1, 1916, (39 Stat. 355), as amended and supplemented; Shall be fined under this title or imprisoned not more than 5 years or both." IX. IMPLEMENTATION OF CLEAN AIR ACT AND FEDERAL WATER POLLUTION CONTROL ACT This provision is applicable to all Federal -aid construction contracts and to all related subcontracts. By submission of this bid/proposal or the execution of this contract, or subcontract, as appropriate, the bidder, proposer, Federal -aid construction contractor, or subcontractor, as appropriate, will be deemed to have stipulated as follows: 1. That any person who is or will be utilized in the performance of this contract is not prohibited from receiving an award due to a violation of Section 508 of the Clean Water Act or Section 306 of the Clean Air Act. 2. That the contractor agrees to include or cause to be included the requirements of paragraph (1) of this Section X in every subcontract, and further agrees to take such action as the contracting agency may direct as a means of enforcing such requirements. X. CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION This provision is applicable to all Federal -aid construction contracts, design -build contracts, subcontracts, lower -tier subcontracts, purchase orders, lease agreements, consultant contracts or any other covered transaction requiring FHWA approval or that is estimated to cost $25,000 or more — as defined in 2 CFR Parts 180 and 1200. 1. Instructions for Certification — First Tier Participants: a. By signing and submitting this proposal, the prospective first tier participant is providing the certification set out below. b. The inability of a person to provide the certification set out below will not necessarily result in denial of participation in this 9 covered transaction. The prospective first tier participant shall submit an explanation of why it cannot provide the certification set out below. The certification or explanation will be considered in connection with the department or agency's determination whether to enter into this transaction. However, failure of the prospective first tier participant to furnish a certification or an explanation shall disqualify such a person from participation in this transaction. c. The certification in this clause is a material representation of fact upon which reliance was placed when the contracting agency determined to enter into this transaction. If it is later determined that the prospective participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the contracting agency may terminate this transaction for cause of default. d. The prospective first tier participant shall provide immediate written notice to the contracting agency to whom this proposal is submitted if any time the prospective first tier participant learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. e. The terms "covered transaction," "debarred," "suspended," "ineligible," "participant," "person," "principal," and "voluntarily excluded," as used in this clause, are defined in 2 CFR Parts 180 and 1200. "First Tier Covered Transactions" refers to any covered transaction between a grantee or subgrantee of Federal funds and a participant (such as the prime or general contract). "Lower Tier Covered Transactions" refers to any covered transaction under a First Tier Covered Transaction (such as subcontracts). "First Tier Participant" refers to the participant who has entered into a covered transaction with a grantee or subgrantee of Federal funds (such as the prime or general contractor). "Lower Tier Participant" refers any participant who has entered into a covered transaction with a First Tier Participant or other Lower Tier Participants (such as subcontractors and suppliers). f. The prospective first tier participant agrees by submitting this proposal that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the department or agency entering into this transaction. g. The prospective first tier participant further agrees by submitting this proposal that it will include the clause titled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion -Lower Tier Covered Transactions," provided by the department or contracting agency, entering into this covered transaction, without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions exceeding the $25,000 threshold. h. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous. A participant is responsible for ensuring that its principals are not suspended, debarred, or otherwise ineligible to participate in covered transactions. To verify the eligibility of its principals, as.well as the eligibility of any lower tier prospective participants, each participant may, but is not required to, check the Excluded Parties List System website (https://www.epls.gov/), which is compiled by the General Services Administration. i. Nothing contained in the foregoing shall be construed to require the establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of the prospective participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings. j. Except for transactions authorized under paragraph (f) of these instructions, if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government, the department or agency may terminate this transaction for cause or default. ie 2. Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion — First Tier Participants: a. The prospective first tier participant certifies to the best of its knowledge and belief, that it and its principals: (1) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participating in covered transactions by any Federal department or agency; (2) Have not within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; (3) Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State or local) with commission of any of the offenses enumerated in paragraph (a)(2) of this certification; and (4) Have not within a three-year period preceding this application/proposal had one or more public transactions (Federal, State or local) terminated for cause or default. b. Where the prospective participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal. 2. Instructions for Certification - Lower Tier Participants: (Applicable to all subcontracts, purchase orders and other lower tier transactions requiring prior FHWA approval or estimated to cost $25,000 or more - 2 CFR Parts 180 and 1200) a. By signing and submitting this proposal, the prospective lower tier is providing the certification set out below. b. The certification in this clause is a material representation of fact upon which reliance was placed when this transaction was entered into. If it is later determined that the prospective lower tier participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the department, or agency with which 10 this transaction originated may pursue available remedies, including suspension and/or debarment. c. The prospective lower tier participant shall provide immediate written notice to the person to which this proposal is submitted if at any time the prospective lower tier participant learns that its certification was erroneous by reason of changed circumstances. d. The terms "covered transaction," "debarred," "suspended," "ineligible," "participant," "person," "principal," and "voluntarily excluded," as used in this clause, are defined in 2 CFR Parts 180 and 1200. You may contact the person to which this proposal is submitted for assistance in obtaining a copy of those regulations. "First Tier Covered Transactions" refers to any covered transaction between a grantee or subgrantee of Federal funds and a participant (such as the prime or general contract). "Lower Tier Covered Transactions" refers to any covered transaction under a First Tier Covered Transaction (such as subcontracts). "First Tier Participant" refers to the participant who has entered into a covered transaction with a grantee or subgrantee of Federal funds (such as the prime or general contractor). "Lower Tier Participant" refers any participant who has entered into a covered transaction with a First Tier Participant or other Lower Tier Participants (such as subcontractors and suppliers). e. The prospective lower tier participant agrees by submitting this proposal that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the department or agency with which this transaction originated. f. The prospective lower tier participant further agrees by submitting this proposal that it will include this clause titled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion -Lower Tier Covered Transaction," without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions exceeding the $25,000 threshold. g. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous. A participant is responsible for ensuring that its principals are not suspended, debarred, or otherwise ineligible to participate in covered transactions. To verify the eligibility of its principals, as well as the eligibility of any lower tier prospective participants, each participant may, but is not required to, check the Excluded Parties List System website (https://www.epls.00v/), which is compiled by the General Services Administration. h. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings. i. Except for transactions authorized under paragraph e of these instructions, if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government, the department or agency with which this transaction originated may pursue available remedies, including suspension and/or debarment. Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion --Lower Tier Participants: 1. The prospective lower tier participant certifies, by submission of this proposal, that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participating in covered transactions by any Federal department or agency. 2. Where the prospective lower tier participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal. XI. CERTIFICATION REGARDING USE OF CONTRACT FUNDS FOR LOBBYING This provision is applicable to all Federal -aid construction contracts and to all related subcontracts which exceed $100,000 (49 CFR 20). 1. The prospective participant certifies, by signing and submitting this bid or proposal, to the best of his or her knowledge and belief, that: a. No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any Federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. b. If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any Federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form -LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. 2. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by 31 U.S.C. 1352. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. 3. The prospective participant also agrees by submitting its bid or proposal that the participant shall require that the language of this certification be included in all lower tier subcontracts, which exceed $100,000 and that all such recipients shall certify and disclose accordingly. 11 DOT SMARTER I SIMPLER 1 CUSTOMER DRIVEN TO: COUNTIES CITIES COUNTY CONSERVATION BOARDS www.iowadot.gov Office of Contracts I Project Delivery Bureau 800 Lincoln Way I Ames, Iowa 50010 Phone: 515-239-1414 I Email: dot.contracts@iowadot.us SUBJECT: INSTRUCTIONS FOR ISSUING SALES AND USE TAX EXEMPTION CERTIFICATES Iowa Code allows designated exempt entities to issues Sales and Use Tax Exemption Certificates. These certificates, when issued to contractors and sub -contractors, allow the purchase of qualifying items to be made exempt from Iowa sales tax, applicable local option sales tax, and school infrastructure local option sales tax. Enclosed are the Sales and Use Exemption Certificates for contract(s) awarded through the Iowa DOT letting. IMPORTANT: Please sign each of the Sales and Use Tax Exemption Certificates and send them to the prime contractor. Call the Office of Contracts at 515-239-1414 if you have any questions. Sincerely, Mark J. Dunn, P.E. Contracts Engineer MJD/met Enclosure(s) toIowa Department of Transportation Iowa Department of Revenue F005 (650071) 08-06 www.state.ia. us/tax DESIGNATED EXEMPT ENTITY IOWA CONSTRUCTION SALES TAX EXEMPTION CERTIFICATE AND AUTHORIZATION LETTER This document may be completed by a designated exempt entity and given to their contractor and/or subcontractor. Seller: Keep this certificate in your files. Contractor/Exempt Entity: Keep a copy of this certificate for your records. Do not send this to the Department of Revenue. Designated Exempt Entity CITY OF DUBUQUE, PUBLIC WORKS DIREC Address 1 50 WEST 13TH ST Address 2 City DUBUQUE State IA Zip Code 52001-4864 Construction Project Name 18/04/17\101 Construction Project Number (if used) 31-2100-688 Description of contract/subcontract (please print/type clearly) DUBUQUE STP -A-2100 (688) --86-31 PCC PAVEMENT - GRADE & REPLACE General Contractor or Subcontractor Name MIDWEST CONCRETE, INC. Address 1 9835 COTTINGHAM ROAD Address 2 City PEOSTA State IA Zip Code 52068-7001 The named contractor/subcontractor may purchase building materials used in the contract, exempt from sales tax. This exemption does NOT apply to materials, equipment and supplies consumed by the contractor or subcontractor that are not incorporated into the real property being constructed. Designated Exempt Entity Authorized Agent Date 31-013 (8/18/03) AUTHORIZATION LETTER FROM IOWA DEPARTMENT OF TRANSPORTATION CONTRACTOR/SUBCONTRACTORS: A copy of this document must be presented to your supplier(s) prior to purchasing your building materials. Pursuant to Iowa Code Section: 423.3 (80), you are authorized to purchase building materials tax free for the contract specified above. The exemption certificate (or a copy of the certificate) may be provided to the suppliers of your building materials and will authorize them to sell you the materials exempt from Iowa sales tax and any applicable local option sales tax. Complete information on qualifying materials and supplies can be found at www.state.ia.us/tax, the Iowa Department of Revenue (IDR) Web site. It is your responsibility to have records identifying the materials purchased and verifying they were used on this construction project. Any materials purchased tax—free and not used on this construction project are subject to sales and applicable local option tax. Should this occur, the tax must be paid directly by you to IDR in the same calendar quarter the contract is completed. Email the department at idr@iowa.gov if you have questions on this requirement. Contractors should be aware that use of the certificate to claim exemption from tax for items not used on this project or that do not qualify for exemption could result in civil or criminal penalties. SUBCONTRACTOR AUTHORIZATION AND EEO POSTER NOTICE County: DUBUQUE Contract ID: 31-2100-688 Date of Letting: 18/04/17 Wage Decision: IA18-1.0 To: Employees and Applicants Equal Employment Opportunity (EEO) and Affirmative Action (AA) requirements apply to this contract. It is the policy of the contractors working on this contract to ensure that applicants are employed, and that employees are treated during employment, without regard to their race, religion, sex, color, national origin, age, or disability. Such action shall include: employment, upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship, pre -apprenticeship, and/or on-the-job training. You should contact the Iowa Department of Transportation, Office of Employee Services, Civil Rights Section at 515-239-1921 to register your complaint if you feel that you are being discriminated against because of your race, religion, sex, color, national origin, age, or disability. Contractors authorized to work on this contract are listed below. Individuals seeking employment may contact them about employment opportunities and information about each company's training program. Contractor MIDWEST CONCRETE, INC. F002 (650196) 09-13 City State Telephone PEOSTA IA (563)845-0947 MIDWCON-03 AHENDRICKS A R'o CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 05/14/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER TRICOR, Inc. - Dubuque 600 Star Brewery Dr., Suite 110 Dubuque, IA 52001 CONTACT NAME: PHONE (A/c, No, Ext): (563) 556-5441 FAX No):(608) 723-6440 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Sheboygan Falls/LeMars/Donegal Ins Co. 15148 INSURED Midwest Concrete Inc 9835 Cottingham Rd Peosta, IA 52068 INSURER B : CPR9030194 INSURER C : 04/15/2019 INSURER D : $ 1,000,000 INSURER E : INSURER F : X COVERAGES CERTIFICATE NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLIC ES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTRINSD TYPE OF INSURANCE ADDL SUBR W VD POLICY NUMBER POLICY EFF 4MM/DD/YYYY) POLICY EXP (MM/DD/YYYY)_ LIMITS A X COMMERCIAL GENERAL LIABILITY X X CPR9030194 04/15/2018 04/15/2019 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO (Eoccurrence) $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GE X 'L AGGREGATE POLICY OTHER: X LIMIT APPLIES JECT X PER: LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS-COMP/OPAGG $ 2,000,000 $ A AUTOMOBILE X LIABILITY ANY AUTO OWNED AUTOS ONLY AUTOS ONLY SCHEDULED AUTOS NON-OWNEDUUOYY CLR9030194 04/15/2018 04/15/2019 COMBINED SINGLE LIMIT (Ea accident) 1,000,000 $ BODILY INJURY (Per person) $ $ $ • BODILY INJURY (Per accident) (Peri accidentDAMAGE $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE CXR9030194 04/15/2018 04/15/2019 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 DED X RETENT ON $ 0 $ A AND EMPLOYERS' LIABILITY ATION ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below YNN N / A X WCA9030194 04/15/2018 04/15/2019 X STATUTE OTH- ER E.L. EACH ACCIDENT 500,000 $ E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT 500,000 $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Project: NW Arterial & JKF Right Turn Lane Project; STP -A-2100(688)--86-31 City of Dubuque including all its elected and appointed officials, all its employees and volunteers, all its boards, commmissions and/or authorities and their board members, employees and volunteers are additional insured on a primary, non-contributory basis including ongoing and completed operations. Governmental Immunities applies in favor of City of Dubuque. Waiver of subrogation on the Work Comp and general liability policies in favor of the City of Dubuque. Notice of cancel is ammended to 30 days. CERTIFICATE HOLDER CANCELLATION City of Dubuque 50 W 13th Street Dubuque, IA 52001 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: CPR 9030194 COMMERCIAL GENERAL LIABIUTY CGD 90 36 05 15 THIS ENDORSEMENT CHANGES THE POUCY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS - AUTOMATIC STATUS WHEN REQUIRED IN WRITTEN CONSTRUCTION CONTRACT OR AGREEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LABILITY COVERAGE PART A. SECTION II - WHO IS AN INSURED is amended to include as an insured any person or organization whom you are required under a written contract or agreement to provide insurance such as is afforded under this policy, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by your work" performed at the site or location designated in the written contract or agreement. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. The insurance afforded to such additional Insured will not be broader than: a. The coverage you have agreed to provide in the written contract or agreement; or b. The coverage provided by this endorsement. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: 1. This does not apply to "bodily injury" or "property damage" occurring: a. Prior to the date the written contract or agreement was executed and in effect; b. After your contract or agreement with such additional insured ends; or c. After the requirement in the written contract or agreement to add such person or organization as an additional insured on your policy ends. 2. "Bodily injury" or "property damage" arising out of an architect's, engineer's, or surveyor's rendering of or failure to render any professional services for you, for such person or organization, or for others, including: a. The preparing, approving, or failure to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders, designs, drawings or specifications;* and b. Supervisory, inspection, or engineering services. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage" involved the rendering of or the failure to render any professional services. 3. Any "bodily injury" or "property damage" for which valid and collectible insurance is available under an Owners and Contractors Protective Liability policy that you have purchased. C. With respect to the Insurance provided by this endorsement, the following is added to SECTION III - UMITS OF INSURANCE: 8. The most we will pay under the insurance provided by this endorsement is: a. The applicable limit of insurance to which you have agreed in the written contract or agreement to provide; or b. The applicable Limit of Insurance shown in the Declarations, whichever is less. D. With respect to the Insurance provided by this endorsement, Paragraph 4. Other Insurance as found under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS is replaced by the following: 4. Other Insurance This insurance is excess over any other valid and collectible insurance, whether primary, excess, contingent or on any other basis, unless you have agreed in a written contract or agreement for this insurance to apply either on a: (1) Primary and non-contributory; or (2) Contributory basis. CGD 90 36 05 15 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Donegal Insurance Group Page 1 of 2 When this insurance is excess, we will have no duty under Coverage A to defend the insured against any "suit" if any other insurer has a duty to defend the insured against that "suir. If no other insurer defends, we will undertake to do so, but we will be entitled to the insured's rights against all those other insurers. When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, If any, that exceeds the sum of: (1) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and (2) The total of all deductible and self-insured amounts under all that other insurance. We will share the remaining loss, if any, with any other insurance that is not described in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part. CGD 90 36 05 15 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 2 Donegal Insurance Group F. The insurance afforded to any additional insured is excess over any other valid and collectible insurance, whether primary, excess, contingent or on any other basis, unless you have agreed in a written contract or agreement for this insurance to apply on either a: 1. Primary and non-contributory basis; or 2. Contributory basis. IX. MEDICAL EXPENSE INCREASED LIMIT The following provision applies only if a Limit of Insurance is shown in the Declarations for Medical Expense. If no Limit of Insurance is shown in the Declarations for Medical Expense, or if Medical Expense is shown as excluded, the following provision does not apply. Subject to the Each Occurrence Limit Shown in the Declarations, the Limit of Insurance shown in the Schedule above for Medical Expense Increased Limit is the most we will pay under Coverage C for all medical expenses because of "bodily injury" sustained by any one person. The Limit of Insurance for Medical Expense Increased Umit shown in the Schedule above is in addition to any Limit of Insurance shown in the Declarations for Medical Expense. X. AMENDMENT OF GENERAL AGGREGATE UMIT OF INSURANCE - PER PROJECT AND PER LOCATION A. Wth respect to COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY and COVERAGE C. MEDICAL PAYMENTS only, the following provision is added to SECTION III - LIMITS OF INSURANCE: The General Aggregate as described in paragraph 2. under SECTION III - LIMITS OF INSURANCE applies separately to each of your projects away from premises owned by or rented to you and separately to each of your "locations" owned by or rented to you. However: 1. This Amendment of General Aggregate Limit of Insurance - Per Project and Per Location provision does not apply if a single "occurrence" under Coverage A, or a single accident under Coverage C, can be attributed to multiple projects or "locations". The General Aggregate Limit of Insurance shown in the Declarations will apply to the sum of all damages under Coverage A arising out of such "occurrence" and all medical expenses under Coverage C arising out of such accident; CGD 09 06 07 16 2. This Amendment of General Aggregate Limit of Insurance - Per Project and Per Location does not apply to damages under Coverage B. The General Aggregate Limit of Insurance shown in the Declarations continues to apply to the sum of all damages under Coverage B, regardless of the number of projects or "locations"; 3. if Included with a Stop Loss Limitation is indicated in the Schedule above under Limit(s) of Insurance, the most we will pay under this Amendment of General Aggregate Limit of Insurance - Per Project and Per Location for the sum of all damages under Coverage A (except for damag because of "bodily injury" or "property damage" included in the "products -completed operations hazard") and for all medical expenses under Coverage C, occurring during any one period of twelve (12) consecutive months (or portion thereof) beginning with the effective date of the policy to which this endorsement is attached, is three (3) times the General Aggregate Limit of Insurance shown in the Declarations. This applies regardless of the number of: a. Projects away from premises owned by or rented to you; b. "Locations" owned by or rented to you; c. insureds; d. Claims made or "suits" brought; or e. Persons or organizations making claims or bringing "suits". B. With respect to the insurance provided by this endorsement, the following Definition is added to SECTION V DEFINMONS: "Locations" means premises involving the same or connecting lots, or premises whose connection is interrupted only by a street, roadway, waterway or right-of-way of a railroad. XI. KNOWLEDGE OF AN OCCURRENCE, OFFENSE, CLAIM OR SUIT Subparagraphs a. and b. under paragraph 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit as found in SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS are deleted and replaced by the following: Includes copyrighted material of Insurance Services Office, Inc., with its permission, Donegal Insurance Group Page 6 of 7 a. You must see to it that we are notified as soon as practicable of an "occurrence or an offense which may result in a claim. To the extent possible, notice should include: (1) How, when and where the "occurrence" or offense took place; (2) The names and addresses of any injured persons and witnesses; and (3) The nature and location of any injury or damage arising out of the "occurrence" or offense. This Condition only applies when the "occurrence", offense, claim or ''suit" is known to you (if you are an individual), to a partner (if you are a partnership), a manager (if you are a limited liability company), or an officer or insurance manager of a corporation (1 you are a corporation). Knowledge of an "occurrence", offense, claim or "suit" by an agent, servant or "employee" of an insured (other than a partner, manager, officer, or insurance manager) does not imply knowledge by the insured unless the insured has received notice from the agent, servant or "employee". b. If a claim is made or "suit" is brought against any insured, you must: (1) Immediately record the specifics of the claim or "suit" and the date received; and (2) Notify us as soon as practicable. You must see to it that we receive written notice of the claim or "suit" as soon as practicable. Failure by an agent, servant or "employee" of an insured (other than a partner, manager, officer, or insurance manager) to notify us of an "occurrence", offense, claim or "suit" will not jeopardize your coverage. XII. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY The following is added to the paragraph 8. Transfer Of Rights Of Recovery Against Others To Us as found in SECTION IV - COMMERCIAL LIABILITY CONDITIONS: We waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of "your work" included in the "products -completed operations hazard" or your ongoing operations, subject to the following: a. You are required under a written contract to waive your rights to recover from that person or organization; and CGD 09 06 07 16 b. The written contract was executed and in effect before any injury or damage that would give rise to a claim under this Commercial General Liability Coverage Part. This waiver does not apply to any person who is an engineer or architect, or to any organization with respect to an engineer or architect employed by such organization, unless agreed to in writing by us. XIII.UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS The following Condition is added to SECTION IV - COMMERCIAL GENERAL LIABILITY CONDMONS: 10. Unintentional Failure To Disclose Hazards Any unintentional error or omission in the description of, or failure to completely describe, any premises or operations intended to be covered by this Coverage Part will not invalidate or affect coverage for those premises or operations. Such unintentional error or omission must be reported to us as soon as practicable after its discovery. This Condition does not affect our right to collect any additional premium associated with such unintentional error or omission or our right to cancel or non -renew this policy. XIV, MOBILE EQUIPMENT REDEFINED Subparagraph f.(1) under the definition of "mobile equipment" as found in SECTION V - DEFINITIONS is deleted and replaced by the following: (1) Equipment with a gross vehicle weight of 1000 pounds or more and designed primarily for: (a) Snow removal; (b) Road maintenance, but not construction or resurfacing; or (c) Street cleaning. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Donegal Insurance Group Page 7 of 7 POLICY NUMBER: CPR 9030194 COMMERCIAL GENERAL LIABILJTY CGD 20 33 05 15 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. SECTION II - WHO IS AN INSURED is amended to include as an insured any person or organization whom you are required under a written contract or agreement to provide insurance such as is afforded under this policy, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations at the site or location designated in the written contract or agreement. However, 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. The insurance afforded to such additional insured will not be broader than: a. The coverage you have agreed to provide in the written contract or agreement; or b. The coverage provided by this endorsement. B. Wfith respect to the insurance afforded to these additional insureds, the following additional exclusions apply: 1. This does not apply to "Bodily injury" or "property damage" occurring: a. Prior to the date the written contract or agreement was executed and in effect; b. After all work on the project (other than service, maintenance or repairs) to be performed at the site or location of the covered operations has been completed; or c. After that portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CGD 20 33 05 15 2. "Property damage" to: a. Property owned, occupied or used by; b. Property rented to, in the care, custody, or control of, or over which physical control is being exercised for any purpose by; or c. "Your work" for, such person or organization. 3. "Bodily injury* or "property damage" arising out of an architect's, engineer's, or surveyor's rendering of or failure to render any professional services for you, for such person or organization, or for others, including: a. The preparing, approving, or failure to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders, designs, drawings or specifications; and b. Supervisory, inspection, or engineering services. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, If the "occurrence" which caused the "bodily injury" or "property damage" involved the rendering of or the failure to render any professional services. 4. Any "bodily injury" or "property damage" for which valid and collectible insurance is available under an Owners and Contractors Protective Liability policy that you have purchased. C. With respect to the Insurance provided by this endorsement, the following is added to SECTION III - LIMITS OF INSURANCE: 8. The most we will pay under the insurance provided by this endorsement is: a. The applicable limit of insurance to which you have agreed in the written contract or agreement to provide; or Includes copyrighted material of Insurance Services Office, Inc., with its permission. Donegal Insurance Group Page 1 of 2 b. The applicable Limit of Insurance shown in the Declarations, whichever is less. D. With respect to the Insurance provided by this endorsement, Paragraph 4. Other Insurance as found under SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS is replaced by the following: 4. Other Insurance This insurance is excess over any other valid and collectible insurance, whether primary, excess, contingent or on any other basis, unless you have agreed in a written contract or agreement for this insurance to apply on either a: (1) Primary and non-contributory basis; or (2) Contributory basis. When this insurance is excess, we will have no duty under Coverage A to defend the insured against any "suit" if any other insurer has a duty to defend the insured against that "suit". If no other insurer defends, we will undertake to do so, but we will be entitled to the insured's rights against all those other insurers. When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of: (1) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and (2) The total of all deductible and self-insured amounts under all that other insurance. We will share the remaining loss, if any, with any other insurance that is not described in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part. CGD 20 33 0515 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Donegal Insurance Group Page 2 of 2 POLICY NUMBER: INTERLINE ILD 90 30 05 14 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. GOVERNMENT ENTITY AS ADDITIONAL INSURED - IOWA This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART BUSINESSOWNERS LIABILITY COVERAGE PART SCHEDULE Mailing Address Municipality: Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Cancellation and Material Changes Provision The following is added to the Cancellation Provisions included in the policy: In the event of cancellation for non-payment of premium, the insurer agrees to advise the municipality at the address shown in the schedule by written notice ten days prior to the effective date of cancellation. If the policy is, for any other reason, cancelled, not renewed, or there is a reduction in Insurance coverage and/or limits the insurer agrees to advise the municipality at the address shown in the schedule by written notice thirty days prior to the effective date of cancellation, non -renewal or change in coverage. B. Additional Insured Provision The municipality shown in the Schedule, including all its elected and appointed officials, all its employees and volunteer workers, all its boards, commissions and/or authorities and their boards, members, employees, and volunteer workers, are included as additional insureds but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf: in the performance of your ongoing operations for the municipality shown in the schedule. This coverage shall be primary to the additional insureds, and not contributing with any other insurance or similar protection available to the additional insureds, whether other available coverage is primary, contributing or excess. ILD 90 30 05 14 C. Governmental Immunities Provision 1. Nonwaiver of Governmental Immunity. The insurance carrier expressly agrees and states that the purchase of this policy and the including of the municipality shown in the Schedule as an Additional Insured does not waive any of the defenses of governmental immunity available to them under Code of Iowa Section 670.4 as it now exists and as it may be amended from time to time. 2. Claims Coverage. The insurance carrier further agrees that this policy of insurance shall cover only those claims not subject to the defense of governmental immunity under the Code of Iowa Section 670.4 as it now exists and may be amended from time to time. 3. Assertion of Governmental Immunity. The municipality shown in the Schedule shall be responsible for asserting any defense of governmental immunity, and may do so at any time and shall do so upon the timely written request of the insurance carrier. Nothing contained in this endorsement shall prevent the carrier from asserting the defense of governmental immunity on behalf of the municipality shown in the Schedule. Includes copyrighted material of ISO, Inc., with its permission. Donegal Insurance Group Page 1 of 2 4. Non -Denial of Coverage. The insurance carrier shall not deny coverage under this policy and the insurance carrier shall not deny any of the rights and benefits accruing to the municipality shown in the Schedule under this policy for reasons of governmental immunity unless and until a court of competent jurisdiction has ruled in favor of the defense(s) of governmental immunity asserted by the municipality. 5. No Other Change In Policy. The insurance carrier and the municipality shown in the schedule agree that the above preservation of governmental immunities shall not otherwise change or alter the coverage available under the policy. ILD 90 30 05 14 Includes copyrighted material of ISO, Inc., with its permission. Donegal Insurance Group Page 2 of 2 a. You must see to it that we are notified as soon as practicable of an "occurrence" or an offense which may result in a claim. To the extent possible, notice should include: (1) How, when and where the "occurrence" or offense took place; (2) The names and addresses of any injured persons and witnesses; and (3) The nature and location of any injury or damage arising out of the "occurrence" or offense. This Condition only applies when the "occurrence", offense, claim or "suit" is known to you (if you are an individual), to a partner (If you are a partnership), a manager (if you are a limited liability company), or an officer or insurance manager of a corporation (if you are a corporation). Knowledge of an "occurrence", offense, claim or '"suit" by an agent, servant or "employee" of an insured (other than a partner, manager, officer, or insurance manager) does not imply knowledge by the insured unless the insured has received notice from the agent, servant or "employee". b. If a claim is made or "suit" is brought against any insured, you must: (1) Immediately record the specifics of the claim or "suit" and the date received; and (2) Notify us as soon as practicable. You must see to it that we receive written notice of the claim or "suit" as soon as practicable. Failure by an agent, servant or "employee" of an insured (other than a partner, manager, officer, or insurance manager) to notify us of an "occurrence", offense, claim or "suit" will not jeopardize your coverage, XII. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY The following is added to the paragraph 8. Transfer Of Rights Of Recovery Against Others To Us as found in SECTION IV - COMMERCIAL LIABILITY CONDITIONS: We waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of "your work" included in the "products -completed operations hazard" or your ongoing operations, subject to the following: a. You are required under a written contract to waive your rights to recover from that person or organization; and CGD 09 06 0716 Inclu s pyrtght b. The written contract was executed and in effect before any injury or damage that would give rise to a claim under this Commercial General Liability Coverage Part. This waiver does not apply to any person who is an engineer or architect, or to any organization with respect to an engineer or architect employed by such organization, unless agreed to in writing by us. XIII. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS The following Condition is added to SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS: 10. Unintentional Failure To Disclose Hazards Any unintentional error or omission in the description of, or failure to completely describe, any premises or operations intended to be covered by this Coverage Part will not invalidate or affect coverage for those premises or operations. Such unintentional error or omission must be reported to us as soon as practicable after its discovery. This Condition does not affect our right to collect any additional premium associated with such unintentional error or omission or our right to cancel or non -renew this policy. XIV. MOBILE EQUIPMENT REDEFINED Subparagraph f.(1) under the definition of "mobile equipment" as found in SECTION V - DEFINITIONS is deleted and replaced by the following: (1) Equipment with a gross vehicle weight of 1000 pounds or more and designed primarily for: (a) Snow removal; (b) Road maintenance, but not constructton or resurfacing; or (c) Street cleaning. d material of Insurance Servic Donegal Insurance )trice, Inc., with Its permission. Page 7 of 7 oup WORKERS COMPNSKflON AND EMPLOYERS A ure. INSURANCE POLICY WC 00 03 13 (Ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule Any persori with whom or organization for which you have agreed in writing to waive your rights to recover. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 04/15/18 Policy No. WCA 9030194 Insured Midwest Concrete Inc Endorsement No. Premium Insurance Company ATLANTIC STATES INSURANCECOMPANY Countersigned By WC 00 03 13 (Ed. 4-84) CopyrIght, 1883 National Council an Campensation Insurance. April 24, 2018 DOT �� SMARTER 1 SIMPLER 1 CUSTOMER DRIVEN To: Local Agency Contracting Authority www.iowodot.gov OOffice of Contracts I Project Delivery Bureau 800 Lincoln Way I Ames, Iowa 50010 Phone: 515-239-1414 1 Email: dot.contracts@iowadot.us Subject: Contracts for Award Determination (See listing enclosed) The Iowa DOT has accepted bids on behalf of your agency. We have determined the contractor who provided the lowest responsive bid. It is your responsibility to analyze the bids and make a final determination to award the contract or reject all bids. We have enclosed a copy of the bid tabulations for your review of the bids. Also enclosed are two (2) original copies of the contract. Please take one of the two following actions: REJECT ALL BIDS OPTION Do not have discussions with the contractor prior to rejecting all bids. 1. Take formal Board/Council action to reject all bids. 2. Send written notification to the contractor of your intent to not award a contract. 3. Send written notification with justification to the Office of Contracts, Iowa DOT, of your action to reject all bids within 30 days. 4. Destroy bid tabs. This information is confidential for projects that are not awarded. AWARD OF CONTRACT OPTION Do not discuss or have discussions with the contractor prior to receiving notice from the DOT that the DOT has concurred in the award of the contract. 1. Take formal Board/Council action to award the contract. 2. Send 2 originals of the contract to the contractor and ask for two signed originals to be returned to the contracting authority for signature.. Do not remove any pages from this contract. 3. Obtain Bond Form 181419 (12-16) from the contractor. The Local Agency must sign the bond where indicated. 4. Obtain a "certificate of insurance" from the contractor listing the contractor as insured and the contracting authority as an additional insured party. 5. Please forward two originals of the contract, one original performance bond, and one certificate of insurance to: Mary Thompson Office of Contracts, Iowa DOT 800 Lincoln Way, Ames, IA 50010 These contract documents should be returned to the Office of Contracts within 30 days, regardless of when the work is proposed to start. 6. The Office of Contracts will furnish your City Clerk/County Engineer and the contractor a fully executed and signed original of the contract. 7. The Office of Contracts will authorize all subcontracts and send the City Clerk/County Engineer the paper tax exemption certificates for signature. 8. The contracting authorities are reminded that federal regulations may apply to this contract. The contracting authorities shall ensure compliance with all applicable civil rights, and Davis -Bacon requirements. The Office of Contracts, Iowa DOT, will furnish the contractor with applicable posters. Please contact the Iowa Department of Transportation Administrating Office regarding the pre -construction meeting and construction administration and inspection requirements. Note: No preconstruction conferences shall be held and no work shall commence on this project untilthe contractor has been furnished a fully executed and signed contract. 0 Sincerely, Mark J. Dunn, P.E. Contracts Engineer MJD/met Enc. CD • ELIST90 - Part A Iowa Department of Transportation -- Office of Contracts p. 21 Local Awarded Contracts in the 17APR2018 Letting Contracting Authority: CITY OF DUBUQUE Bid Order: 101 Bid Order: 102 Awarded to: MIDWEST CONCRETE, INC. 9835 COTTINGHAM ROAD PEOSTA, IA 52068-7001 Phone: (563)845-0947 FAX: (563)583-1007 Awarded to: EASTERN IOWA EXCAVATING & CONCRETE, LLC 121 NIXON ST. SE' P.O. BOX 189 CASCADE, IA 52033-0189 Phone: (563)852-5120 FAX: (563)852-6020