The URL can be used to link to this page

Contract/Bond_Tschiggfrie Excavating_Kerper Blvd . Sanitary Sewer ReconstructionCopyrighted December 17, 2018 City of Dubuque Consent Items # 23. ITEM TITLE: Improvement Contracts / Performance, Payment and Maintenance Bonds SUMMARY: Temperley Excavating, Inc. for the 30th and Leibe Street Sanitary Sewer Reconstruction Project; Tschiggfrie Excavating Co. for the Kerper Blvd. Sanitary Sewer Reconstruction Project SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Approve ATTACHMENTS: Description Type Temperley Excavating, Inc. Contract/Bond Supporting Documentation Tschiggfrie Excavating Co. Contract/Bond Supporting Documentation SECTION 00500 PUBLIC IMPROVEMENT CONTRACT SECTION 00500 Kerper Blvd. Sanitary Sewer Reconstruction THIS IMPROVEMENT CONTRACT (the Contract), made in triplicate, dated for references purposes the 20th day of November 2018 between the City of Dubuque, Iowa, by its City Manager, through authority conferred upon the City Manager by its City Council (City), and Tschiqqfrie Excavating Company (Contractor). For and in consideration of the mutual covenants herein contained, the parties hereto agree as follows: CONTRACTOR AGREES: 1. To furnish all material and equipment and to perform all labor necessary for the Kerper Blvd. Sanitary Sewer Reconstruction (Project). 2. CONTRACT DOCUMENTS A. The Contract Documents consist of the following: 1. Project Title Page (Section 00100). 2. Project Directory Page (Section 00101). 3. SRF Required Front -End Specifications (Section 00400) 4. This Public Improvement Contract (Section 00500). 5. Performance, Payment, and Maintenance Bond (Section 00600). 6. Out -of -State Contractor Bond (Section 00610). 7. Other Bonds: a. (Bond Name) (pages _ to , inclusive). b. (Bond Name) (pages _ to _ , inclusive). c. (Bond Name) (pages _ to _ , inclusive). 8. The Iowa Statewide Urban Design and Specifications (SUDAS) 2018 Edition. 9. CITY OF DUBUQUE Supplemental Specifications 2017 Edition. 10.Other Standard, Supplementary, and Technical Specifications as listed on the Title Page of the Contract Document Manual. 11. Special Provisions included in the project Contract Document Manual. 12. Drawings —Sheet No. A.01 through No. MSA.08 (31 pages) or drawings consisting of sheets bearing the following general title: Kerper Blvd. Sanitary Sewer Reconstruction 13.Addenda (numbers 1 to 1 , inclusive). 14. Insurance Provisions and Requirements (Section 00700). 15. Sales Tax Exemption Certificate (Section 00750). 16. Site Condition Information (Section 00775). SECTION 00500 17. Construction Schedule and Agreed Cost of Delay (Section 00800). 18. Erosion Control Certificate (Section 00900). 19. Consent Decree (Section 01000). 20. Other Project Information and Permits (Section 01100). 21. Exhibits to this Contract (enumerated as follows): a. Contractor's Bid (pages 1 to 20 , inclusive). b. Bidder Status Form (Section 00460). c. Contractor Background Information Form (Section 00471) d. The following documentation that must be submitted by Contractor prior to Notice of Award. ii. e. None. 22.The following which may be delivered or issued on or after the Effective Date of the Agreement: a. Notice to Proceed (Section 00850). b. Project Certification Page (Section 00102). c. Change Orders (Not attached to this agreement). There are no other Contract Documents. The Contract Documents may only be amended, modified, or supplemented as provided in General Conditions. 3. All materials used by the Contractor in the Project must be of the quality required by the Contract Documents and must be installed in accordance with the Contract Documents. 4. The Contractor must remove any materials rejected by the City as defective or improper, or any of said work condemned as unsuitable or defective, and the same must be replaced or redone to the satisfaction of the City at the sole cost and expense of the Contractor. 5. Five percent (5%) of the Contract price will be retained by the City for a period of thirty (30) days after final completion and acceptance of the Project by the City Council to pay any claim by any party that may be filed for labor and materials done and furnished in connection with the performance of this Contract and for a longer period if such claims are not adjusted within that thirty (30) day period, as provided in Iowa Code Chapter 573 or Iowa Code Chapter 26. The City will also retain additional sums to protect itself against any claim that has been filed against it for damages to persons or property arising through the prosecution of the work and such sums will be held by the City until such claims have been settled, adjudicated or otherwise disposed of. 6. The Contractor has read and understands the Contract Documents herein referred to and agrees not to plead misunderstanding or deception related to estimates of quantity, character, location or other conditions for the Project. 7. In addition to any warranty provided for in the specifications, the Contractor must also fix any other defect in any part of the Project, even if the Project has been accepted and fully paid SECTION 00500 for by the City. The Contractor's maintenance bond will be security for a period of two years after the issuance of the Certificate of Substantial Completion. 8. The Contractor must fully complete the Project under this Contract on or before the date indicated in the Construction Schedule and Agreed Cost of Delay Section of the Contract Documents. 9. INDEMNIFICATION FROM THIRD PARTY CLAIMS. To the fullest extent permitted by law,. Contractor shall defend, indemnify and hold harmless City, its officers and employees, from and against all claims, damages, losses and expenses claimed by third parties, but not including any claims, damages, losses or expenses of the parties to this Contract, including but not limited to attorneys' fees, arising out of or resulting from performance of this Contract, provided that such claim, damages, loss or expense is attributable to bodily injury, sickness, disease or death, or injury to or destruction of property, including loss of use resulting there from, but only to the extent caused in whole or in part by negligent acts or omissions of Contractor, or anyone directly or indirectly employed by Contractor or anyone for whose acts Contractor may be liable, regardless of whether or not such claim, damage, loss or expense is caused in part by a party indemnified hereunder. 10. The Contractor hereby represents and guarantees that it has not, nor has any other person for or in its behalf, directly or indirectly, entered into any arrangement or Contract with any other Bidder, or with any public officer, whereby it has paid or is to pay any other Bidder or public officer any sum of money or anything of value whatever in order to obtain this Contract; and it has not, nor has another person for or in its behalf directly or indirectly, entered into any Contractor arrangement with any other person, firm, corporation or association which tends to or does lessen or destroy free competition in the award of this Contract and agrees that in case it hereafter be established that such representations or guarantees, or any of them are false, it will forfeit and pay not less than ten percent (10%) of the Contract price but in no event less than $2,000.00 (Two Thousand Dollars) to the City. 11. The surety on the Bond furnished for this Contract must, in addition to all other provisions, be obligated to the extent provided for by Iowa Code 573.6 relating to this Contract, which provisions apply to said Bond. 12. The Contractor agrees, and its Bond is surety therefore, that after the Certificate of Substantial Completion has been issued by the City, it will keep and maintain the Project in good repair for a period of two (2) years. 13. The Project must be constructed in strict accordance with the requirements of the laws of the State of Iowa, and the United States, and ordinances of the City of Dubuque, and in accordance with the Contract Documents. A. All applicable standards, orders, or regulations issued pursuant to the Clean Air Act of 1970 (42 U. S. C. 1958 (H) et. seq.) and the Federal Water Pollution Act (33 U. S. C. 1368 et. seq.) as amended, Executive Order 11738, and Environmental Protection Agency regulations (40 CFR, Part 15). Contractor must comply with Section 103 and 107 of the Contract Work Hours and Safety Standards Act (40 USC 327-330) and Department of Labor Regulations (29 CFR, Part 5). B. The City and the Contractor agree to comply with all provisions of the Davis -Bacon Federal Prevailing Wage Act and related labor requirements and regulations and the Federal Wage Determination for this Project. SECTION 00500 C. Equipment or products authorized to be purchased with federal funding awarded for this Contract must be American-made to the maximum extent feasible, in accordance with Public Law 103-121, Sections 606(a) and (b). D. The City of Dubuque in accordance with Title VI of the Civil Rights Act of 1964, 78 Stat. 252, 42 U.S.C. 2000d -2000d-4 and Title 49, Code of Federal Regulations, Department of Transportation, Subtitle A, Office of the Secretary, Part 21, Nondiscrimination in Federally assisted programs of the Department of Transportation issued pursuant to such Act, hereby notifies all bidders that it will affirmatively insure that in any contract entered into pursuant to this advertisement, minority business enterprises will be afforded full opportunity to submit bids in response to this invitation and will not be discriminated against on the grounds of race, color, national origin, sex, age, or disability in consideration for an award. CONSENT DECREE RELATING TO THE PROJECT 14. THIS CONTRACTOR IS PERFORMING WORK FOR THE CITY OF DUBUQUE RELATED TO THE WATER & RESOURCE RECOVERY CENTER OR THE SANITARY SEWER COLLECTION SYSTEM. THEREFORE, THE CONSENT DECREE AND THIS SECTION ARE APPLICABLE. q.psihoyos CIT4 CONTRACTOR THIS CONTRACTOR IS NOT PERFORMING WORK FOR THE CITY OF DUBUQUE RELATED TO THE WATER & RESOURCE RECOVERY CENTER OR THE SANITARY SEWER COLLECTION SYSTEM. THEREFORE THE CONSENT DECREE AND THIS SECTION ARE NOT APPLICABLE. The City has entered into a Consent Decree in the case of The United States of America, and the State of Iowa v. The City of Dubuque, Iowa, Civil Action Number Case 2:11-cv-01011-EMJ, Civil Action Number 2008V00041, DOJ Case Number 90-5-1-1-09339, United States District Court for the Northern District of Iowa. The provisions of the Consent Decree apply to and are binding upon the City and its officers, directors, employees, agents, servants, successors, assigns, and all persons, firms and corporations under contract with the City to perform the obligations of the Consent Decree. The City is required to provide a copy of the Consent Decree to any contractor or consultant retained to perform work required by the Consent Decree. A copy of the Consent Decree is included in the Contract Documents and can be viewed at http://www.cityofdubuque.orq/DocumentCenter/Home/View/3173. A hard copy is available upon request at the City's Engineering Department Office. The City must condition any contract to perform work required under the Consent Decree upon performance of the work in conformity with the provisions of the Consent Decree. The Consent Decree also provides that until five (5) years after the termination of the Consent Decree, the City must retain, and must instruct its contractors and agents to preserve, all non -identical copies of all documents, reports, data, records, or other information (including documents, records, or other SECTION 00500 information in electronic form) in its or its contractors' or agents' possession or control, or that come into its or its contractors' or agents' possession or control, and that relate in any manner to the City's performance of its obligations under this Consent Decree, including any underlying research and analytical data. This information -retention period, upon request by the United States or the State, the City must provide copies of any documents, reports, analytical data, or other information required to be maintained under the Consent Decree. At the conclusion of the information -retention period, the City must notify the United States and the State at least ninety (90) Days prior to the destruction of any documents, records, or other information subject to such requirements and, upon request by the United States or the State, the City must deliver any such documents, records, or other information to the EPA or IDNR. CERTIFICATION BY CONTRACTOR The undersigned, on behalf of the Contractor, with full authority to act on behalf of the Contractor, certifies to the City of Dubuque as follows: 1. I have received a copy of the Consent Decree in the case of The United States of America, and the State of Iowa v. The City of Dubuque, Iowa, Civil Action Number Case 2:11-cv-01011-EMJ, Civil Action Number 2008V00041, DOJ Case Number 90- 5-1-1-09339, United States District Court for the Northern District of Iowa. 2. All work performed will be in conformity with the provisions of the Consent Decree. 3. All documents reports, data, records, or other information (including documents, records, or other information in electronic form) that relate in any manner to the performance of obligations under the Consent Decree, including any underlying research and analytical data, will be retained as required by the Consent Decree. 4. The Contractor agrees to defend, indemnify, and hold harmless the City, its officers, agents, or employees from and against any claims, including penalties, costs and fees as provided in the Consent Decree, relating to or arising out of the Contractor's failure to comply with the Consent Decree. CONTRACTOR: �.✓c gfrie Excavating Company /Cont ` for By: Sign ure Randy Steffen Printed Name General Superintendent Title 11/26/18 Date SECTION 00500 THE CITY AGREES: 15. Upon the completion of the Contract, and the acceptance of the Project by the City Council, and subject to the requirements of law, the City agrees to pay the Contractor as full compensation for the complete performance of this Contract, the amount determined for the total work completed at the price(s) stated in the Contractor's Bid Proposal and less any Agreed Cost of Delay provided for in the Contract Documents. CONTRACT AMOUNT $ 2,279,444.90 CITY OF DUBUQUE, IOWA: City Manager' ffice By: Department Signature Michael C. Van Milligen Printed Name City Engineer Title Date CONTRACTOR: T. higgfrie Excavating Company By: SigAature Randy Steffen Printed Name General Superintendent Title • 1/26/18 Date ___= END OF SECTION 00500 =___ Bond No. 0565724 SECTION 00600 PERFORMANCE, PAYMENT AND MAINTENANCE BOND SECTION 00600 KNOW ALL BY THESE PRESENTS: That we, Tschiggfrie Excavating Company, as Principal (hereinafter the "Contractor" or "Principal") and International Fidelity Insurance Company, as Surety are held and firmly bound unto the City of Dubuque, Iowa, as Obligee (hereinafter referred to as "Owner"), and to all persons who may be injured by any breach of any of the conditions of this Bond in the penal sum of Two million, two hundred seventy-nine thousand, four hundred forty-four dollars and ninety cents ($2,279,444.90), lawful money of the United States, for the payment of which sum, well and truly to be made, we bind ourselves, our heirs, legal representatives and assigns, jointly or severally, firmly by these presents. The conditions of the above obligations are such that whereas said Contractor entered into a contract with the Owner, bearing date the 20th day of November 2018, (hereinafter the "Contract") wherein said Contractor undertakes and agrees to construct the following project in accordance with the Contract Documents, and to faithfully perform all the terms and requirements of said Contract within the time therein specified, in a good and workmanlike manner, and in accordance with the Contract Documents. The Contract Documents for Kerper Blvd. Sanitary Sewer Reconstruction Project, Project detail the following described improvements: Kerper Blvd. Sanitary Sewer Reconstruction CIP # 7102663 The Kerper Blvd. sanitary sewer reconstruction project begins at the intersection of Sycamore St. and E. 16th St. A new 24" PVC gravity sanitary sewer will be extended along the south side of E. 16th St., to the U.S. highway 151/61 overpass.. Dual 10" PVC force mains will be constructed adjacent to the U.S. Highway 151/61 Right -of -Way., from E. 16th St. to Kerper Blvd. A 4.1 mg/d lift station and appurtenances will be constructed adjacent to the Kerper Blvd. Right -of -Way and U.S. Highway 151/61 Right -of -Way. A new 18" PVC gravity sanitary sewer will be constructed from the lift station to the intersection of Fengler St. and Kerper Blvd. The gravity main will be constructed in the southbound lanes of Kerper Blvd. A portion of the existing 10" DIP sanitary sewer on Kerper Ct. will be redirected south, to the new lift station. Portions of the existing 18" DIP sanitary sewer and manholes will be abandoned in place. The project consists of approximately; 520 LF of 24" PVC and 1,677 LF of 18" PVC gravity sewer, 1.715 LF of dual 10" PVC force mains, 12 manholes, (1) Lift stations, 1,390 Sy of PCC pavement, 3,800 Sy ACC pavement, staged construction and traffic control, and dewatering. It is expressly understood and agreed by the Contractor and Surety in this Bond that the following provisions are a part of this Bond and are binding upon said Contractor and Surety, to -wit: 1. PERFORMANCE: The Contractor shall well and faithfully observe, perform, fulfill, and abide by each and every covenant, condition, and part of said Contract and Contract Documents, by reference made a part hereof, for the project, and shall indemnify and save harmless the SECTION 00600 Owner from all outlay and expense incurred by the Owner by reason of the Contractor's default of failure to perform as required. The Contractor shall also be responsible for the default or failure to perform as required under the Contract and Contract Documents by all its subcontractors, suppliers, agents, or employees furnishing materials or providing labor in the performance of the Contract. 2. PAYMENT: The Contractor and the Surety on this Bond hereby agreed to pay all just claims submitted by persons, firms, subcontractors, and corporations furnishing materials for or performing labor in the performance of the Contract on account of which this Bond is given, including but not limited to claims for all amounts due for labor, materials, lubricants, oil, gasoline, repairs on machinery, equipment, and tools, consumed or used by the Contractor or any subcontractor, wherein the same are not satisfied out of the portion of the contract price the Owner is required to retain until completion of the improvement, but the Contractor and Surety shall not be liable to said persons, firms, or corporations unless the claims of said claimants against said portion of the contract price shall have been established as provided by law. The Contractor and Surety hereby bind themselves to the obligations and conditions set forth in Chapter 573 of the Iowa Code, which by this reference is made a part hereof as though fully set out herein. 3. MAINTENANCE: The Contractor and the Surety on this Bond hereby agree, at their own expense: A. To remedy any and all defects that may develop in or result from work to be performed under the Contract Documents within the period of two (2) year(s) from the date of acceptance of the work under the Contract, by reason of defects in workmanship, equipment installed, or materials used in construction of said work; B. To keep all work in continuous good repair; and C. To pay the Owner's reasonable costs of monitoring and inspection to assure that any defects are remedied, and to repay the Owner all outlay and expense incurred as a result of Contractor's and Surety's failure to remedy any defect as required by this section. Contractor's and Surety's Contract herein made extends to defects in workmanship or materials not discovered or known to the Owner at the time such work was accepted. 4. GENERAL: Every Surety on this Bond shall be deemed and held bound, any contract to the contrary notwithstanding, to the following provisions: A. To consent without notice to any extension of time authorized in approved change orders to the Contractor in which to perform the Contract; B. To consent without notice to any change in the Contract or Contract Documents, authorized in approved change orders which thereby increases the total contract price and the penal sum of this Bond, provided that all such changes do not, in the aggregate, involve an increase of more than twenty percent (20%) of the total contract price, and that this Bond shall then be released as to such excess increase; SECTION 00600 C. To consent without notice that this Bond shall remain in full force and effect until the Contract is completed, whether completed within the specified contract period, within an extension thereof, or within a period of time after the contract period has elapsed and the liquidated damage penalty is being charged against the Contractor. The Contractor and every Surety on the Bond shall be deemed and held bound, any contract to the contrary notwithstanding, to the following provisions: D. That no provision of this Bond or of any other contract shall be valid that limits to less than five (5) years after the acceptance of the work under the Contract the right to sue on this Bond. E. That as used herein, the phrase "all outlay and expense" is not to be limited in any way, but shall include the actual and reasonable costs and expenses incurred by the Owner including interest, benefits, and overhead where applicable. Accordingly, "all outlay and expense" would include but not be limited to all contract or employee expense, all equipment usage or rental, materials, testing, outside experts, attorney's fees (including overhead expenses of the Owner's staff attorneys), and all costs and expenses of litigation as they are incurred by the Owner. It is intended the Contractor and Surety will defend and indemnify the Owner on all claims made against the Owner on account of Contractor's failure to perform as required in the Contract and Contract Documents, that all agreements and promises set forth in the Contract and Contract Documents, in approved change orders, and in this Bond will be fulfilled, and that the Owner will be fully indemnified so that it will be put into the position it would have been in had the Contract been performed in the first instance as required. In the event the Owner incurs any "outlay and expense" in defending itself against any claim as to which the Contractor or Surety should have provided the defense, or in the enforcement of the promises given by the Contractor in the Contract, Contract Documents, or approved change orders, or in the enforcement of the promises given by the Contractor and Surety in this Bond, the Contractor and Surety agree that they will make the Owner whole for all such outlay and expense, provided that the Surety's obligation under this Bond shall not exceed one hundred twenty-five percent (125%) of the penal sum of this Bond. In the event that any actions or proceedings are initiated regarding this Bond, the parties agree that the venue thereof shall be Dubuque County, State of Iowa. If legal action is required by the Owner to enforce the provisions of this Bond or to collect the monetary obligation incurring to the benefit of the Owner, the Contractor and the Surety agree, jointly, and severally, to pay the Owner all outlay and expense incurred therefor by the Owner. All rights, powers, and remedies of the Owner hereunder shall be cumulative and not alternative and shall be in addition to all rights, powers, and remedies given to the Owner, by law. The Owner may proceed against surety for any amount guaranteed hereunder whether action is brought against the Contractor or whether Contractor is joined in any such action(s) or not. NOW THEREFORE, the condition of this obligation is such that if said Principal shall faithfully perform all the promises of the Principal, as set forth and provided in the Contract, in the Contract Documents, and in this Bond, then this obligation shall be null and void, otherwise it shall remain in full force and effect. SECTION 00600 When a work, term, or phrase is used in this Bond, it shall be interpreted or construed first as defined in this Bond, the Contract, or the Contract Documents; second, if not defined in the Bond, Contract, or Contract Documents, it shall be interpreted or construed as defined in applicable provisions of the Iowa Code; third, if not defined in the Iowa Code, it shall be interpreted or construed according to its generally accepted meaning in the construction industry; and fourth, if it has no generally accepted meaning in the construction industry, it shall be interpreted or construed according to its common or customary usage. Failure to specify or particularize shall not exclude terms or provisions not mentioned and shall not limit liability hereunder. The Contract and Contract Documents are hereby made a part of this Bond. Project No. 7102663 Witness our hands, in triplicate, this 21st day of November SURETY COUNTERSIGNED BY: not required Signature of Agent Printed Name of Agent Company Address City, State, Zip Code Company Telephone Number PRINCIPAL: Twschiggfrie Excavating Co. Contractor Sig r ture Printed Name Tic 4.'5 S 4:e_ Title NOTE: f 4c./7 , 2018. FORM APP BY: Representailve for Owner SURETY: Intern al Fidelity Insur. c Company Suret By Signature Attorney -in -Fact:+. is & + wa Resident Agent Dione R. Young, Attorney -in -Fact Printed Name of Attorney -in -Fact Officer Holmes, Murphy and Associates, LLC Company Name P. 0. Box 9207 Company Address Des Moines, IA 50306-9207 City, State, Zip Code (515) 223-6800 Company Telephone Number 1. All signatures on this performance, payment, and maintenance Bond must be original signatures in ink; copies, facsimile, or electronic signatures will not be accepted. 2. This Bond must be sealed with the Surety's raised, embossing seal. 3. The name and signature of the Surety's Attorney-in-Fact/Officer entered on this Bond must be exactly as listed on the Certificate or Power of Attorney accompanying this Bond. ___= END OF SECTION 00600 =___ POWER OF ATTORNEY INTERNATIONAL FIDELITY INSURANCE COMPANY ALLEGHENY CASUALTY COMPANY One Newark Center, 20th Floor, Newark, New Jersey 07102-5207 PHONE: (973) 624-7200 Bond # 0565724 KNOW ALL MEN BY THESE PRESENTS: That INTERNATIONAL FIDELITY INSURANCE COMPANY, a corporation organized and existing under the laws of the State of New Jersey, and ALLEGHENY CASUALTY COMPANY a corporation organized and existing under the laws of the State of New Jersey, having their principal office in the City of Newark, New Jersey, do hereby constitute and appoint STACY VENN, SETH D. ROOKER, SYDNEY BURNETT, CRAIG E. HANSEN, GINGER HOKE, DIONE R. YOUNG, JAY D. FREIERMUTH, ANNE CROWNER, BRIAN M. DEIMERLY, SHIRLEY S. BARTENHAGEN, TIM MCCULLOH, CINDY BENNETT Waukee, IA their true and lawful attorney(s)-in-fact to execute, seal and deliver for and on its behalf as surety, any and all bonds and undertakings, contracts of indemnity and other writings obligatory in the nature thereof, which are or may be allowed, required or permitted by law, statute, rule, regulation, contract or otherwise, and the execution of such instrument(s) in pursuance of these presents, shall be as binding upon the said INTERNATIONAL FIDELITY INSURANCE COMPANY and ALLEGHENY CASUALTY COMPANY, as fully and amply, to all intents and purposes, as if the same had been duly executed and acknowledged by their regularly elected officers at their principal offices. This Power of Attorney is executed, and may be revoked, pursuant to and by authority of the By -Laws of INTERNATIONAL FIDELITY INSURANCE COMPANY and ALLEGHENY CASUALTY COMPANY and is granted under and by authority of the following resolution adopted by the Board of Directors of INTERNATIONAL FIDELITY INSURANCE COMPANY at a meeting duly held on the 20th day of July, 2010 and by the Board of Directors of ALLEGHENY CASUALTY COMPANY at a meeting duly held on the 10th day of July, 2015 "RESOLVED, that (1) the Chief Executive Officer, President, Executive Vice President, Vice President, or Secretary of the Corporation shall have the power to appoint, and to revoke the appointments of, Attorneys -in -Fact or agents with power and authority as defined or limited in their respective powers of attorney, and to execute on behalf of the Corporation and affix the Corporation's seal thereto, bonds, undertakings, recognizances, contracts of indemnity and other written obligations in the nature thereof or related thereto; and (2) any such Officers of the Corporation may appoint and revoke the appointments of joint -control custodians, agents for acceptance of process, and Attorneys -in -fact with authority to execute waivers and consents on behalf of the Corporation; and (3) the signature of any such Officer of the Corporation and the Corporation's seal may be affixed by facsimile to any power of attorney or certification given for the execution of any bond, undertaking, recognizance, contract of indemnity or other written obligation in the nature thereof or related thereto, such signature and seals when so used whether heretofore or hereafter, being hereby adopted by the Corporation as the original signature of such officer and the original seal of the Corporation, to be valid and binding upon the Corporation with the same force and effect as though manually affixed." IN WITNESS WHEREOF, INTERNATIONAL FIDELITY INSURANCE COMPANY and ALLEGHENY CASUALTY COMPANY have each executed and attested these presents on this 31st day of December, 2017 STATE OF NEW JERSEY County of Essex George R. James Executive Vice President (International Fidelity Insurance Company) and Vice President (Allegheny Casualty Company) On this 31st day of December, 2017 , before me came the individual who executed the preceding instrument, to me personally known, and, being by me duly sworn, said he is the therein described and authorized officer of INTERNATIONAL FIDELITY INSURANCE COMPANY and of ALLEGHENY CASUALTY COMPANY; that the seals affixed to said instrument are the Corporate Seals of said Companies; that the said Corporate Seals and his signature were duly affixed by order of the Boards of Directors of said Companies. ttt ,uqt etrip ,, , {' ,ori so,y Lc' :o + NOTARY s 7.:4a PUBLIC Co ", OFNEWt.•', 'line, tos I, the undersigned officer of INTERNATIONAL FIDELITY INSURANCE COMPANY and ALLEGHENY CASUALTY COMPANY do hereby certify that I have compared the foregoing copy of the Power of Attorney and affidavit, and the copy of the Sections of the By -Laws of said Companies as set forth in said Power of Attorney, with the originals on file in the home of said companies, and that the same are correct transcripts thereof, and of the whole of the said originals, and that the said Power of Attorney has not been revoked and is now in full force and effect. IN TESTIMONY WHEREOF, I have hereunto set my hand on this day, November 21, 2018 IN TESTIMONY WHEREOF, I have hereunto set my hand affixed my Official Seal, at the City of Newark, New Jersey the day and year first above written. CERTIFICATION Cathy Cruz a Notary Public of New Jersey My Commission Expires April 16, 2019 A00639 VER1 7/2017 e_POA keyk:ot. 11~ Maria H. Branco, Assistant Secretary AC'OR®® ��. CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 11/26/2018 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 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 1-800-300-0325 Holmes Murphy & Assoc - CR 201 First Street SE, Suite 700 Cedar Rapids, IA 52401 CONTACT Michelle Gruis NAME: PHONE FAX (A/c, No. Ext): 319-896-7715 (A/c, No): 866-231-7822 E-MAIL MGruis@holmesmur h com ADDRESS: P Y• INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:BITCO National Insurance Co 20109 INSURED Tschiggfrie Excavating Co 425 Julien Dubuque Dr Dubuque, IA 52003-7997 INSURERB:BITCO General Insurance Co 20095 INSURER CWESTCHESTER SURPLUS LINES INS CO 10172 INSURER D: $ 1,000,000 INSURER E : $ 300,000 INSURERF: COVERAGES CERTIFICATE NUMBER: 54612650 REVISION 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 POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSD SUER WVD POLICY NUMBER POLICY EFF (MM/DDIYYYYL POLICY EXP (MMIDD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY: CLP3673413 10/01/18 10/01/19 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 300,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 10,000 PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GE 'L AGGREGATE POLICY OTHER: X LIMIT APPLIES PRO- JECT X PER: LOC PRODUCTS -COMP/OP AGG $ 2,000,000 $ B AUTOMOBILE ^ X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NON -OWNED AUTOS CAP3673414 10/01/19 10/01/19 jEa COMBaccidINEDent)SINGLELIMIT $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ B X UMBRELLALIAB EXCESS LIAB X OCCUR CLAIMS -MADE CUP2815586 10/01/18 10/01/19 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 $ DED X RETENTION $ 0 B .WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N N / A WC3673412 10/01/18 10/01/19 X ST ATUTE EORH E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT $ 500,000 C Pollution Liability G70916484001 10/01/18 10/01/19 Each Occurrence 5,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if mo e space is required) The City of Dubuque, including all its elected and appointed officials, all its employees and volunteers, all its boards, commissions and/or authorities and their board members, emplouees and volunteers are additional insureds on general liability on a primary and non-contributory basis as required by written contract with the insured, per policy terms and conditions. The General Liability and Workers Compensation includes a waiver of subrogation in favor of the additional insureds as required by written contract with the insured, per policy terms and conditions. Project: #7102663 Kerper Blvd Sanitary Sewer Reconstruction CERTIFICATE HOLDER CANCELLATION City of Dubuque Public Works Dept 925 Kerper Court Dubuque, IA 52001 USA 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 (2014/01) sgreinercr 54612650 © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. TRANSPORTATION CONTRACTORS EXTENDED LIABILITY COVERAGE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM It is agreed that the provisions listed below apply only upon the entry of an of such provision. A. B. C. D. E. F. G. H. I . J. K. L. M. X X X X X X X X X X X X X Partnership and Joint Venture Extension N. Contractors Automatic Additional Insured 0. Coverage — Ongoing Operations Automatic Waiver of Subrogation Extended Notice of Cancellation, Nonrenewal Unintentional Failure to Disclose Hazards Broadened Mobile Equipment P. Q. Personal and Advertising Injury - Contractual Coverage Nonemployment Discrimination Liquor Liability Broadened Conditions Automatic Additional Insureds — Equipment Leases Suits Against Dredges and Barges Insured Contract Extension - Railroad Property and Construction Contracts R S T. U. V. W X. X X X X X X X X X X X X in the box next to the caption Construction Project General Aggregate Limits Fellow Employee Coverage Property Damage Liability - Elevators Property Damage to the Named Insured's Work Care, Custody or Control Electronic Data Liability Coverage Consolidated Insurance Program Residual Liability Coverage Automatic Additional Insureds — Managers or Lessors of Premises Automatic Additional Insureds — State or Governmental Agency or Political Subdivisions — Permits or Authorizations Contractors Automatic Additional Insured Coverage — Completed Operations Additional Insured — Engineers, Architects or Surveyors A. PARTNERSHIP AND JOINT VENTURE EXTENSION The following provision is added to SECTION II - WHO IS AN INSURED: The last full paragraph which reads as follows: No person or organization is an insured with respect to the conduct of any current or past partnership, joint venture or limited liability company that is not shown as a Named Insured in the Declarations. is deleted and replaced with the following: GL -3086 (09/11) -1- With respect to the conduct of any past or present joint venture or partnership not shown as a Named Insured in the Declarations and of which you are or were a partner or member, you are an insured, but only with respect to liability arising out of "your work" on behalf of any partnership or joint venture not shown as a Named Insured in the Declarations, provided no other similar liability insurance is available to you for "your work" in connection with your interest in such partnership or joint venture. B. CONTRACTORS AUTOMATIC ADDITIONAL INSURED COVERAGE — ONGOING OPERATIONS SECTION II — WHO IS AN INSURED is amended to include as an additional insured any person or organization who is required by written contract to be an additional insured on your policy, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" 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 additional insured(s) at the project(s) designated in the written contract. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. 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. This insurance is excess of all other insurance available to the additional insured, whether primary, excess, contingent or on any other basis, unless the written contract requires this insurance to be primary. In that event, this insurance will be primary relative to insurance policy(s) which designate the additional insured as a Named Insured in the Declarations and we will not require contribution from such insurance if the written contract also requires that this insurance be non-contributory. But with respect to all other insurance under which the additional insured qualifies as an insured or additional insured, this insurance will be excess. C. AUTOMATIC WAIVER OF SUBROGATION Item 8. of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, is deleted and replaced with the following: 8. Transfer of Rights of Recovery Against Others to Us and Automatic Waiver of Subrogation. a. If the insured has rights to recover all or part of any payment we have made under this Coverage Form, those rights are transferred to us. The insured must do nothing after loss to impair those rights. At our request, the insured will bring "suit" or transfer those rights to us and help us enforce them. b. If required by a written contract executed prior to loss, 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" for that person or organization. GL -3086 (09/11) -2- D. EXTENDED NOTICE OF CANCELLATION, NONRENEWAL Item A.2.b. of the COMMON POLICY CONDITIONS, is deleted and replaced with the following: A.2.b. 60 days before the effective date of the cancellation if we cancel for any other reason. Item 9. of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, is deleted and replaced with the following: 9. WHEN WE DO NOT RENEW a. If we choose to nonrenew this policy, we will mail or deliver to the first Named Insured shown in the Declarations written notice of the nonrenewal not less than 60 days before the expiration date. b. If we do not give notice of our intent to nonrenew as prescribed in a. above, it is agreed that you may extend the period of this policy for a maximum additional sixty (60) days from its scheduled expiration date. Where not otherwise prohibited by law, the existing terms, conditions and rates will remain in effect during that extension period. It is further agreed that so long as it is not otherwise prohibited by law, this one time sixty day extension is the sole remedy and liquidated damages available to the insured as a result of our failure to give the notice as prescribed in 9. a. above. E. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS Although we relied on your representations as to existing and past hazards, if unintentionally you should fail to disclose all such hazards at the inception date of your policy, we will not deny coverage under this Coverage Form because of such failure. F. BROADENED MOBILE EQUIPMENT Item 12.b. of SECTION V - DEFINITIONS, is deleted and replaced with the following: 12.b. Vehicles maintained for use solely on or next to premises, sites or locations you own, rent or occupy. G. PERSONAL AND ADVERTISING INJURY - CONTRACTUAL COVERAGE Exclusion 2.e. of SECTION I, COVERAGE B is deleted. H. NONEMPLOYMENT DISCRIMINATION Unless "personal and advertising injury" is excluded from this policy: Item 14. of SECTION V - DEFINITIONS, is amended to include: "Personal and advertising injury" also means embarrassment or humiliation, mental or emotional distress, physical illness, physical impairment, loss of earning capacity or monetary loss, which is caused by "discrimination." SECTION V - DEFINITIONS, is amended to include: "Discrimination" means the unlawful treatment of individuals based on race, color, ethnic origin, age, gender or religion. GL -3086 (09/11) -3- Item 2. Exclusions of SECTION I, COVERAGE B, is amended to include: "Personal and advertising injury" arising out of "discrimination" directly or indirectly related to the past employment, employment or prospective employment of any person or class of persons by any insured; "Personal and advertising injury" arising out of "discrimination" by or at your, your agents or your "employees" direction or with your, your agents or your "employees" knowledge or consent; "Personal and advertising injury" arising out of "discrimination" directly or indirectly related to the sale, rental, lease or sub -lease or prospective sale, rental, lease or sub -lease of any dwelling, permanent lodging or premises by or at the direction of any insured. Fines, penalties, specific performance or injunctions levied or imposed by a governmental entity, or governmental code, law, or statute because of "discrimination." I. LIQUOR LIABILITY Exclusion 2.c. of SECTION I, COVERAGE A, is deleted. J. BROADENED CONDITIONS Items 2.a. and 2.b. of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, are deleted and replaced with the following: 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit: a. You must see to it that we are notified of an "occurrence" or an offense which may result in a claim as soon as practicable after the "occurrence" has been reported to you, one of your officers or an "employee" designated to give notice to us. 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. b. If a claim is made or "suit" is brought against any insured, you must: (1) Record the specifics of the claim or "suit" and the date received as soon as you, one of your officers, or an "employee" designated to record such information is notified of it; and (2) Notify us in writing as soon as practicable after you, one of your officers, your legal department or an "employee" you designate to give us such notice learns of the claims or "suit." Item 2.e. is added to SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS: 2.e. If you report an "occurrence" to your workers compensation insurer which develops into a liability claim for which coverage is provided by the Coverage Form, failure to report such "occurrence" to us at the time of "occurrence" shall not be deemed in violation of paragraphs 2.a., 2.b., and 2.c. However, you shall give written notice of this "occurrence" to us as soon as you are made aware of the fact that this "occurrence" may be a liability claim rather than a workers compensation claim. GL -3086 (09/11) -4- K. AUTOMATIC ADDITIONAL INSUREDS - EQUIPMENT LEASES SECTION II - WHO IS AN INSURED is amended to include any person or organization with whom you agree in a written equipment lease or rental agreement to name as an additional insured with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, at least in part, by your maintenance, operation, or use by you of the equipment leased to you by such person or organization, subject to the following additional exclusions. The insurance provided to the additional insured does not apply to: 1. "Bodily injury" or "property damage" occurring after you cease leasing the equipment. 2. "Bodily injury" or "property damage" arising out of the sole negligence of the additional insured. 3. "Property damage" to: a. Property owned, used or occupied by or rented to the additional insured; or b. Property in the care, custody or control of the additional insured or over which the additional insured is for any purpose exercising physical control. This insurance is excess of all other insurance available to the additional insured, whether primary, excess, contingent or on any other basis, unless the written contract requires this insurance to be primary. In that event, this insurance will be primary relative to insurance policy(s) which designate the additional insured as a Named Insured in the Declarations and we will not require contribution from such insurance if the written contract also requires that this insurance be non-contributory. But with respect to all other insurance under which the additional insured qualifies as an insured or additional insured, this insurance will be excess. L. SUITS AGAINST DREDGES AND BARGES We agree that any "suit" in rem against any dredge or barge owned, operated by or for you, and used in your operations, shall in all respects be treated in the same manner as though the "suit" were against you. This coverage is excess over and above any specific insurance on any dredge or barge owned, operated by or for you, and used in your operations. M. INSURED CONTRACT EXTENSION - RAILROAD PROPERTY AND CONSTRUCTION CONTRACTS Item 9. of SECTION V - DEFINITIONS, is deleted and replaced with the following. 9. "Insured Contract" means: a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire to premises while rented to you or temporarily occupied by you with permission of the owner is not an "insured contract"; b. A sidetrack agreement; c. Any easement or license agreement; d. An obligation, as required by ordinance, to indemnify a municipality, except in connection with work for a municipality; e. An elevator maintenance agreement; GL -3086 (09/11) -5- f. That part of any other contract or agreement pertaining to your business (including an indemnification of a municipality in connection with work performed for a municipality) under which you assume the tort liability of another party to pay for "bodily injury" or "property damage" to a third person or organization. Tort liability means a liability that would be imposed by law in the absence of any contract or agreement. Paragraph f. does not include that part of any contract or agreement: (1) That indemnifies an architect, engineer or surveyor for injury or damage arising out of: (a) Preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (b) Giving directions or instructions, or failing to give them, if that is the primary cause of the injury or damage; or (2) Under which the insured, if an architect, engineer or surveyor, assumes liability for an injury or damage arising out of the insured's rendering or failure to render professional services, including those listed in (1) above and supervisory, inspection, architectural or engineering activities. N. CONSTRUCTION PROJECT GENERAL AGGREGATE LIMITS This modifies SECTION HI - LIMITS OF INSURANCE. A. For all sums which can be attributed only to ongoing operations at a single construction project for which the insured becomes legally obligated to pay as damages caused by an "occurrence" under SECTION I - COVERAGE A, and for all medical expenses caused by accidents under SECTION I - COVERAGE C: 1. A separate Construction Project General Aggregate Limit applies to each construction project, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2. The Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under COVERAGE A, except damages because of "bodily injury" or "property damage" included in the "products -completed operations hazard," and for medical expenses under COVERAGE C regardless of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits." 3. Any payments made under COVERAGE A for damages or under COVERAGE C for medical expenses shall reduce the Construction Project General Aggregate Limit for that construction project Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Construction Project General Aggregate Limit for any other construction project. 4. The limits shown in the Declarations for Each Occurrence, Fire Damage and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Construction Project General Aggregate Limit. GL -3086 (09/11) -6- B. For all sums which cannot be attributed only to ongoing operations at a single construction project for which the insured becomes legally obligated to pay as damages caused by an "occurrence" under SECTION I - COVERAGE A, and for all medical expenses caused by accidents under SECTION I - COVERAGE C: 1. Any payments made under COVERAGE A for damages or under COVERAGE C for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products -Completed Operations Aggregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Construction Project General Aggregate Limit. C. Payments for damages because of "bodily injury" or "property damage" included in the "products -completed operations hazard" will reduce the Products -Completed Operations Aggregate Limit, and not reduce the General Aggregate Limit nor the Construction Project General Aggregate Limit. D. If a construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project. E. The provisions of SECTION III - LIMITS OF INSURANCE not otherwise modified by this endorsement shall continue to be applicable. O. FELLOW EMPLOYEE COVERAGE Exclusion 2.e. Employers Liability of SECTION 1, COVERAGE A, is deleted and replaced with the following 2.e. "Bodily injury" to (1) An "employee" of the insured arising out of and in the course of: (a) Employment by the insured; or (b) Performing duties related to the conduct of the insured's business; or (2) The spouse, child, parent, brother or sister of that "employee" as a consequence of paragraph (1) above. This exclusion applies: (1) Whether the insured may be liable as an employer or in any other capacity; and (2) To any obligation to share damages with or repay someone else who must pay damages because of the injury. This exclusion does not apply to: (1) Liability assumed by the insured under an "insured contract"; or (2) Liability arising from any action or omission of a co -"employee" while that co -"employee" is either in the course of his or her employment or performing duties related to the conduct of your business. GL -3086 (09/11) -7- Item 2.a. (1)(a) of SECTION II - WHO IS AN INSURED, is deleted and replaced with the following: 2.a. (1)(a) To you, to your partners or members (if you are a partnership or joint venture) or to your members (if you are a limited liability company), or to your "volunteer workers" while performing duties related to the conduct of your business. P. PROPERTY DAMAGE LIABILITY - ELEVATORS "Property damage" liability is changed as follows: 1. Exclusions 2.j.(3) and 2.j.(4) of SECTION I, COVERAGE A, do not apply to the use of elevators. 2. The insurance afforded by reason of this provision is excess over any valid and collectible property insurance (including any deductible portion thereof) available to the insured whether primary, excess, contingent or on any other basis, and the OTHER INSURANCE condition is changed accordingly. Q. PROPERTY DAMAGE TO THE NAMED INSURED'S WORK Exclusion I of SECTION I, COVERAGE A. is deleted and replaced with the following: I. Damage to Your Work "Property damage" to "your work" arising out of it or any part of it and included in the "products completed operation hazard." This exclusion applies only to that portion of any loss in excess of $50,000 per occurrence if the damaged work and the work out of which the damage arises was performed by you. This exclusion does not apply if the damaged work or the work out of which the damage arises was performed on your behalf by a subcontractor. R. CARE, CUSTODY OR CONTROL Exclusion 2.j.4 of SECTION I, COVERAGE A. is deleted and replaced with the following: 2.j.4 Personal property in the care, custody or control of the insured. However, for personal property in the care, custody or control of you or your "employees," this exclusion applies only to that portion of any loss in excess of $25,000 per occurrence, subject to the following terms and conditions; (a) The most that we will pay under this provision as an annual aggregate is $100,000, regardless of the number of occurrences. (b) This provision does not apply to "employee" owned property or any property that is missing where there is not physical evidence to show what happened to the property. (c) The aggregate limit for this coverage provision is part of the General Aggregate Limit and SECTION III - LIMITS OF INSURANCE is changed accordingly. (d) In the event of damage to or destruction of property covered by this exception, you shall, if requested by us, replace the property or furnish the labor and materials necessary for repairs thereto, at actual cost to you, exclusive of prospective profit or overhead charges of any nature. GL -3086 (09/11) -8- (e) $2,500 shall be deducted from the total amount of all sums you became obligated to pay as damages on account of damage to or destruction of all property of each person or organization, including the loss of use of that property, as a result of each "occurrence." Our limit of liability under the endorsement as being applicable to each "occurrence" shall be reduced by the amount of the deductible indicated above; however, our aggregate limit of liability under this provision shall not be reduced by the amount of such deductible. The conditions of the policy, including those with respect to duties in the event of "occurrence," claims or "suit" apply irrespective of the application of the deductible amount. We may pay any part or all of the deductible amount to effect settlement of any claim or "suit" and, upon notification of the action taken, you shall promptly reimburse us for such part of the deductible amount as has been paid by us. S. ELECTRONIC DATA LIABILITY COVERAGE 1. Exclusion 2.p. Electronic Data of SECTION I, COVERAGE A, is deleted and replaced with the following: 2.p. Damages arising out of the loss of, loss of use of, damage to, corruption of, inability to access, or inability to manipulate "electronic data" that does not result from physical injury to tangible property. 2. The following definition is added to SECTION V — DEFINITIONS: "Electronic data" means information, facts or programs stored as or on, created or used on, or transmitted to or from computer software (including systems and applications software), hard or floppy disks, CD-ROMS, tapes, drives, cells, data processing devices or any other media which are used with electronically controlled equipment. 3. For the purposes of this coverage, the definition of "property damage" in SECTION V — DEFINITIONS is replaced by the following: "Property damage" means: a. Physical injury to tangible property, including all resulting loss of use of that property. All such loss of use shall be deemed to occur at the time of the physical injury that caused it; b. Loss of use of tangible property that is not physically injured. All such loss of use shall be deemed to occur at the time of the "occurrence" that caused it; or c. Loss of, loss of use of, damage to, corruption of, inability to access, or inability to properly manipulate "electronic data", resulting from physical injury to tangible property. All such loss of "electronic data" shall be deemed to occur at the time of the "occurrence" that caused it. For the purposes of this insurance, "electronic data" is not tangible property. T. CONSOLIDATED INSURANCE PROGRAM RESIDUAL LIABILITY COVERAGE With respect to "bodily injury", "property damage", or 'personal and advertising injury" arising out of your ongoing operations; or operations included within the "products -completed operations hazard", the policy to which this coverage is attached shall apply as excess insurance over coverage available to "you" under a Consolidated Insurance Program (such as an Owner Controlled Insurance Program or Contractors Controlled Insurance Program). Coverage afforded by this endorsement does not apply to any Consolidated Insurance Program involving a "residential project" or any deductible or insured retention, specified in the Consolidated Insurance Program. GL -3086 (09/11) -9- The following is added to Section V — Definitions "Residential project" means any project where 30% or more of the total square foot area of the structures on the project is used or is intended to be used for human residency. This includes but is not limited to single or multifamily housing, apartments, condominiums, townhouses, co-operatives or planned unit developments and appurtenant structures (including pools, hot tubs, detached garages, guest houses or any similar structures). A "residential project" does not include military owned housing, college/university owned housing or dormitories, long term care facilities, hotels, motels, hospitals or prisons. All other terms, provisions, exclusions and limitations of this policy apply. U. AUTOMATIC ADDITIONAL INSUREDS - MANAGERS OR LESSORS OR PREMISES SECTION II — WHO IS AN INSURED is amended to include: Any person or organization with whom you agree in a written contract or written agreement to name as an additional insured but only with respect to liability arising out of the ownership, maintenance or use of that part of the premises, designated in the written contract or written agreement, that is leased to you and subject to the following additional exclusions: This insurance does not apply to: 1. Any "occurrence" which takes place after you cease to be a tenant in that premises. 2. Structural alterations, new construction or demolition operations performed by or on behalf of the additional insured listed in the written contract or written agreement. This insurance is excess of all other insurance available to the additional insured, whether primary, excess, contingent or on any other basis, unless the written contract requires this insurance to be primary. In that event, this insurance will be primary relative to insurance policy(s) which designate the additional insured as a Named Insured in the Declarations and we will not require contribution from such insurance if the written contract also requires that this insurance be non-contributory. But with respect to all other insurance under which the additional insured qualifies as an insured or additional insured, this insurance will be excess. V. AUTOMATIC ADDITIONAL INSUREDS — STATE OR GOVERNMENTAL AGENCY OR POLITICAL SUBDIVISIONS — PERMITS OR AUTHORIZATIONS SECTION II — WHO IS AN INSURED is amended to include any state or governmental agency or subdivision or political subdivision with whom you are required by written contract, ordinance, law or building code to name as an additional insured subject to the following provisions: This insurance applies only with respect to operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization. This insurance does not apply to: 1. "Bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed for the federal government, state or municipality; or 2. "Bodily injury" or "property damage" included within the "products -completed operations hazard". This insurance is excess of all other insurance available to the additional insured, whether primary, excess, contingent or on any other basis, unless the written contract requires this insurance to be primary. In that event, this insurance will be primary relative to insurance policy(s) which designate the additional insured as a Named Insured in the Declarations and we will not require contribution GL -3086 (09/11) -10- from such insurance if the written contract also requires that this insurance be non-contributory. But with respect to all other insurance under which the additional insured qualifies as an insured or additional insured, this insurance will be excess. W. CONTRACTORS AUTOMATIC ADDITIONAL INSURED COVERAGE — COMPLETED OPERATIONS SECTION II — WHO IS AN INSURED is amended to include as an additional insured any person or organization who is required by written contract to be an additional insured on your policy for completed operations, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the project designated in the contract, performed for that additional insured and included in the "products -completed operations hazard". This insurance is excess of all other insurance available to the additional insured, whether primary, excess, contingent or on any other basis, unless the written contract requires this insurance to be primary. In that event, this insurance will be primary relative to insurance policy(s) which designate the additional insured as a Named Insured in the Declarations and we will not require contribution from such insurance if the written contract also requires that this insurance be non-contributory. But with respect to all other insurance under which the additional insured qualifies as an insured or additional insured, this insurance will be excess. X. ADDITIONAL INSURED — ENGINEERS, ARCHITECTS OR SURVEYORS SECTION II — WHO IS AN INSURED is amended to include as an additional insured any architect, engineer or surveyor who is required by written contract to be an additional insured on your policy, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" 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 performed by you or on your behalf. This includes such architect, engineer or surveyor, who may not be engaged by you, but is contractually required to be added as an additional insured to your policy. With respect to the insurance afforded to these additional insureds, the following additional exclusion applies: This insurance does not apply to "bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of or the failure to render any professional services, including: 1. The preparing, approving, or failing to prepare or approve maps, drawings, opinions, reports, surveys, change orders, designs or specifications; or 2. Supervisory, inspection or engineering services. This insurance is excess of all other insurance available to the additional insured, whether primary, excess, contingent or on any other basis, unless the written contract requires this insurance to be primary. In that event, this insurance will be primary relative to insurance policy(s) which designate the additional insured as a Named Insured in the Declarations and we will not require contribution from such insurance if the written contract also requires that this insurance be non-contributory. But with respect to all other insurance under which the additional insured qualifies as an insured or additional insured, this insurance will be excess. GL -3086 (09/11) -11- WORKERS COMPENSATION AND EMPLOYERS UABILF! Y INSURANCE POLICY WC 00 0313 (Ed. 4-84_L 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 PERSON OR ORGANIZATION FOR WHOM YOU ARE PERFORMING OPERATIONS IF YOU AND SUCH PERSON OR ORGANIZATION HAVE AGREED TO A WAIVER OF SUBROGATION IN A WRIIIEN CONTRACT OR AGREEMENT SIGNED BY YOU AND ALL OTHER PARTIES TO THAT WRIIIEN CONTRACT OR AGREEMENT PRIOR TO ANY LOSS FOR WHICH A WAIVER IS REQUIRED. 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 Policy Nb. Endorsement Nb. Insured Premium Insurance Company Countersigned by WC 00 0313 (Ed. 4-84) Copyright 1983 National Council on Corrpensation Insurance Policy# CLP 3 673 413 MANUSCRIPT ENDORSEIVCNf MAN.#1-GOV.IMM.-CIY OF DUBUQUE, IOWA MAN #1- GOV. IMMUNITIES -CITY OF DUBUQUE, IOWA THE FOLLOWING CHANGES HAVE BEEN MADE TO YOUR POLICY. PLEASE READ CAREFULLY. CITY OF DUBUQUE 50 W. 13TH STREET DUBUQUE, IA 52001 1. NONWAIVER OF GOVERNMENT IMMUNITY: THE INSURANCE CARRIER EXPRESSLY AGREES AND STATE THAT THE PURCHASE OF THIS POLICY AND THE INCLUDING OF THE CITY OF DUBUQUE, IOWA AS AN ADDITIONAL INSURED DOES NOT WAIVE ANY OF THE DEFENSES OF GOVERNMENTAL IMMUNITY AVAILABLE TO THE CITY OF DUBUQUE, IOWA 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 CODE OF IOWA SECTION 670.4 AS IT NOW EXISTS AND AS IT MAY BE AMENDED FROM TIME TO TIME. 3. ASSERTION OF GOVERNMENTAL IMMUNITY. THE CITY OF DUBUQUE, IOWA 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 CITY OF DUBUQUE, IOWA. 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 CITY OF DUBUQUE, IOWA 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 CITY OF DUBUQUE, IOWA 5. NO OTHER CHANGE IN POLICY. THE INSURANCE CARRIER AND THE CITY OF DUBUQUE, IOWA AGREE THAT THE ABOVE PRESERVATION OF GOVERNMENTAL IMMUNITIES SHALL NOT OTHERWISE CHANGE OR ALTER THE COVERAGE AVAILABLE UNDER THE POLICY. MAN -00 (01/02) SECTON 00750 SALES AND USE TAX EXEMPTION CERTIFICATE SECTON 00750 The City of Dubuque, as a designated exempt entity awarding construction contracts, will issue special exemption certificates to contractors and subcontractors, allowing them to purchase, or withdraw from inventory, materials for the Contract free from sales tax pursuant to Iowa Code Sections: 422.42 (15) & (16), and 422.47 (5). The special exemption certificate will also allow a manufacturer of building materials to consume materials in the performance of a construction contract without owing tax on the fabricated cost of those materials. 1. These tax exemption certificates and authorization letters are applicable only for the work under the contract. The Contractor and each subcontractor shall comply with said Iowa Code Sales Tax requirements, shall keep records identifying thematerials and supplies purchased and verify that they were used on the contract, and shall pay tax on any materials purchased tax-free and not used on the contract. 2. Upon award of Contract the City will register the Contract, Contractor, and each subcontractor with the Iowa Department of Revenue and Finance; and distribute tax exemption certificates and authorization letters to the Contractor and each subcontractor. SECTON 00750 PROJECT INFORMATION REQUIREMENTS FOR STATE OF IOWA SALES TAX EXEMPTION CERTIFICATES FOR CONTRACTORS & SUBCONTRACTORS Submitting Department: Engineering Department Department Contact: Todd Irwin Project CIP Number(s): 7102663 Please complete this form in its entirety and submit along with the executed Contract, Bonds and Certificate of Insurance. Upon receipt, the City Finance Department will work with the Iowa Department of Revenue to issue Sales Tax Exemption Certificates to the approved contractor(s) to allow for the purchase or inventory withdrawal of materials for the specified Project free from State of Iowa Sales Tax. Sales tax exemption certificates are not provided to material suppliers. The Contractor and subcontractors can provide copies of the sales tax exemption certificates issued by the City to individual material suppliers. Project Name: Kerper Blvd. Sanitary Sewer Reconstruction Project Description: The project consists of approximately; 520 LF of 24" PVC and 1,677 LF of 18" PVC gravity sewer, 1.715 LF of dual 10" PVC force mains, 12 manholes, (1) Lift stations, 1,390 Sy of PCC pavement, 3,800 Sy ACC pavement, staged construction and traffic control, and .dewatering. Start Date (Bid Opening Date): November 8, 2018 Completion Date: July 1,'`2019 1. General Prime Contractor: Tschiggfrie Excavating Contact Name: Randy Steffen Complete Address: (Include PO Box and Street Information) 425 Julien Dubuque Drive City, State, Zip Code Dubuque, IA 52003 Telephone Number: 563-557-7450 ext. 123 Federal I.D. Number: (or Include Social Security Number) Work Type to be Completed: Sanitary Sewer Reconstruction SECTON 00750 2. Subcontractor: Biechler Electric Complete Address: (Include PO Box and Street Information) P.O. Box 1568 City, State, Zip Code Dubuque, IA 52004-1568 Telephone Number: 563-583-5366 Federal I.D. Number: (or Include Social Security Number) Work Type to be Completed: Electrical 3. Subcontractor: Contract Dewatering Services, Inc. (CDS) Complete Address: (Include PO Box and Street Information) P.O. Box 1 5820 W. Riverside Drive City, State, Zip Code Saranac, MI 48881-0001 Telephone Number: 616-642-9415 Federal I.D. Number: (or Include Social Security Number) Work Type to be Completed: Dewatering 4. Subcontractor: Jim Schroeder Construction, Inc. Complete Address: (Include PO Box and Street Information) 500 South Second Street City, State, Zip Code Bellevue, IA 52031-1326 Telephone Number: 563-872-5591 Federal I.D. Number: (or Include Social Security Number) Work Type to be Completed: Lift Station 5. Subcontractor: Nauman Nursery Complete Address: (Include PO Box and Street Information) 4101 Pennsylvania Avenue City, State, Zip Code Dubuque, IA 52002 Telephone Number: 563-588-2276 Federal I.D. Number: (or Include Social Security Number) Work Type to be Completed: Seeding, Fertilizing, Mulching, Plants SECTON 00750 6. Subcontractor: River City Paving Complete Address: (Include PO Box and Street Information) P.O. Box 1430 City, State, Zip Code Dubuque, IA 52004-1430 Telephone Number: 608-568-3433 Federal I.D. Number: (or Include Social Security Number) Work Type to be Completed: HMA Paving 7. Subcontractor: SELCO Complete Address: (Include PO Box and Street Information) 210 Second Street P.O. Box 137 City, State, Zip Code East Dubuque, IL 61025 Telephone Number: 815-554-6594 Federal I.D. Number: (or Include Social Security Number) Work Type to be Completed: Traffic Control 8. Subcontractor: Thurn Seeding Complete Address: (Include PO Box and Street Information) 16978 Asbury Road City, State, Zip Code Dubuque, IA 52002 Telephone Number: 563-584-0546 Federal I.D. Number: (or Include Social Security Number) Work Type to be Completed: Seeding, Filter Sock 9. Subcontractor: WHKS & Co. Complete Address: (include PO Box and Street Information) 1701 Route 35 North City, State, Zip Code East Dubuque, IL 61025 Telephone Number: 815-747-8833 Federal I.D. Number: (or Include Social Security Number) Work Type to be Completed: Staking SECTON 00750 10. Subcontractor: Complete Address: (Include PO Box and Street Information) City, State, Zip Code Telephone Number: Federal I.D. Number: (or Include Social Security Number) Work Type to be Completed: 11. Subcontractor: Complete Address: (Include PO Box and Street Information) City, State, Zip Code Telephone Number: Federal ID. Number: (or Include Social Security Number) Work Type to be Completed: 12. Subcontractor: Complete Address: (Include PO Box and Street Information) City, State, Zip Code Telephone Number: Federal I.D. Number: (or Include Social Security Number) Work Type to be Completed: ___= END OF SECTION 00750 =___ SECTION 00775 SITE CONDITION INFORMATION SECTION 00775 250.1 SUBSURFACE CONDITIONS In the preparation of the Contract Documents, the Engineer relied upon the following report(s) and drawing(s) of explorations and tests of subsurface conditions at the Site: 1) Geotechnical Engineering Report prepared by: HRGreen Title: 16th and Kerper Area Subsurface Investigation Date: January 15, 2018 Pages: 1 -169 The technical data in the above report(s), upon which the Contractor may rely, consists of boring logs, test results, and boring locations all as of the date made. Engineer accepts no responsibility for accuracy of the soil data or water level information. Soil information, included with these Contract Documents, was not obtained for the purposes of designing excavations and trenches. Soil information was used by Engineer for design purposes only. Contractor shall assure itself by personal examination as to subsurface conditions and shall provide its own investigations and make its own assumptions to comply with OSHA and any other applicable laws and regulations regarding excavation and trenching requirements. 250.2 PHYSICAL CONDITIONS In the preparation of the Contract Documents, Engineer relied upon the following drawing(s) of physical conditions in or relating to existing surface and subsurface structures (except underground facilities) which are at or contiguous to the Site: 1) Drawings prepared by Title: Date: Pages: 1 - 2) Sanborn Fire Insurance Map: NONE OF THE CONTENT OF SUCH DRAWINGS INCLUDE TECHNICAL DATA ON WHICH THE CONTRACTOR MAY RELY. SECTION 00775 250.3 HAZARDOUS ENVIRONMENTAL CONDITIONS In the preparation of the Contract Documents, ENGINEER relied upon the following reports(s) known to the owner of hazardous environmental conditions at the Site: 1) Phase I Environmental Site Assessment Study prepared by Title: Date: 2) Phase II Environmental Site Assessment Study prepared by: HRGreen Title: 16th and Kerper Area Subsurface Investigation Date: Jan. 15, 2018 3) Soil and Groundwater Management Plan prepared by Title: Date: The technical data in the above report(s), upon which the Contractor may rely, consists of test results all as of the date made. Contractor must not remove, disturb or remediate any Hazardous Environmental Conditions encountered, uncovered or revealed at the Project Area, unless such removal or remediation is expressly identified in the Contract Documents to be within the scope of work. ___= END OF SECTION 00775 ==== SECTION 00800 CONSTRUCTION SCHEDULE AND AGREED COSTS OF DELAY SECTION 00800 800.1 SCHEDULE: CALENDAR DAY SCHEDULE: Work required by the Contract Documents shall commence within ten (10) calendar days after Notice to Proceed has been issued and shall be Substantially Complete by June 1, 2019 and Finally Complete by July 1, 2019. MILESTONE DATES: In addition to the required Substantial and Final Completion Dates, there are milestones by which certain items of work must be completed. See General Requirements for milestone requirements. Milestone 1 5-1-2019 In general the following contract completion Milestone shall be followed. a. Milestone 1 Completion: All gravity sewers, force main, lift station start up, concrete pavements. are completed and operational and City by-pass pumping has ceased. 800.2 AGREED COSTS OF DELAY: Time is of the essence of the Contract. As delay in the diligent prosecution of the work may inconvenience the public, obstruct traffic, interfere with business, and/or increase costs to the City such as engineering, administration, and inspection, it is important that the work be prosecuted vigorously to final completion. An extension of the contract period may be granted by the City for any of the following reasons: 1. Additional work resulting from a modification of the Contract Documents by approved change order. 2. Delays caused by the City. 3. Other reasons beyond the control of the Contractor, which in the City's opinion, would justify such. Should the Contractor, or in case of default the Surety, fail to complete the work within the specified Milestone(s), Substantial and Final Completion Dates, a deduction at the daily rate for agreed costs of delay will be made for each and every calendar day or working day, whichever is specified, such that the work remains uncompleted. The Contractor or the Contractor's Surety shall be responsible for all costs incidental to the completion of the work, and shall be required to pay the City the following daily costs: SECTION 00800 A. For each calendar day that any work remains uncompleted beyond the Substantial Completion date the contractor will be assessed and shall pay, $1,300 per calendar day, not as a penalty but as predetermined and Agreed Cost of Delay until Substantial Completion requirements are met. B. For each calendar day that any work remains uncompleted beyond the Final Completion date the contractor will be assessed and shall pay, $500 per calendar day, not as a penalty but as predetermined and Agreed Cost of Delay until Final Completion requirements are met. C. For each calendar day that any work remains uncompleted beyond the Milestone date(s) the contractor will be assessed and shall pay, $1,000 per calendar day, not as a penalty but as predetermined and Agreed Cost of Delay until the Milestone requirements are met. Extensions to the milestone date will not be granted for any reason. D. For each calendar day that the work identified for milestone 1 is completed before the Milestone date(s), the contractor will receive a bonus of $1,000 per calendar day to a maximum of $100,000. Extensions to the milestone date will not be granted for any reason. Permitting the Contractor to continue and finish the Work, or any part of it, after the expiration of the Substantial and Final Completion dates or Milestone Dates or extension thereof shall in no way operate as a waiver on the part of the City of any of its rights or remedies under the contract, including its right to Agreed Cost of Delay pursuant to this provision. Furthermore, the assessment of Agreed Cost of Delay shall not constitute a waiver of the City's right to collect any additional damages which the City may sustain by failure of the Contractor to carry out the terms of the Contract. The Agreed Cost of Delay rates specified in the Contract Documents is hereby agreed upon as the true and actual damages due the City for loss to the City and to the public due to obstruction of traffic, interference with business, and/or increased costs to the City such as engineering, administration, construction, and inspection after the expiration of the contract times, or extension thereof. Such Agreed Cost of Delay will be separately invoiced to the Contractor, and final payment will be withheld from the Contractor until payment has been made of this invoice for the agreed cost of delay. The Contractor and its surety shall be liable for any agreed cost of delay in excess of the amount due the Contractor. ___= END OF SECTION 00800 ==== UNIT PRICE BID PROPOSAL FORM SECTION 00400 PROJECT: Kerper Blvd. Sanitary Sewer Reconstruction BID TO: Office of Engineering Department City Hall Dubuque, Iowa 52001 BID FROM: Tschiggfrie Exc. Co. (Company) 425 Julien Dubuque Drive (Street Address) Dubuque, IA 52003 (City, State, Zip) (563) 557-7450 (Telephone) 400.1 General The undersigned Bidder agrees, if the Bid is accepted, to enter into a Contract with the City, in the form included in the Contract Documents, to perform and furnish the Work as specified or indicated in the Contract Documents for the Total Bid Amount and within the Bid time indicated in the Contract Documents and in accordance with other terms and conditions of the Contract Documents. 400.2 Recitals In submitting this Bid, Bidder represents, as more fully set forth in the Public Improvement Contract, that: a. This Bid will remain subject to acceptance for Sixty (60) calendar days after the day of Bid opening; b. The City has the right to reject this Bid and to waive any informalities in the Bidding; c. Bidder accepts the provisions to the Instructions to Bidders regarding dispositions of Bid Security; d. Bidder will sign and submit the Public Improvement Contract with the Bond and other documents required by the Contract Documents within ten (10) calendar days after the date of City's Notice of Award; SECTION 00400 The Bidder hereby certifies that the Bidder is the only person or persons interested in this proposal as principals; that an examination has been made of the plans, specifications, contract form, including the special provision contained herein, and the work site, and the Bidder understands that the quantities of work shown herein are approximate only and are subject to increase or decrease. The measured unit quantity of any item stated in the plans, specification, or on the bid proposal form, are approximate only and the final payment must be made by the work covered in the contract (Public Improvement Contract - Section 500). The Contractor further understands that all quantities of work, whether increased or decreased, are to be performed at the Unit Prices as stipulated herein; the Bidder proposes to furnish all necessary machinery, equipment, tools, labor and other means of construction, and to furnish all materials specified in the manner and time prescribed and to do the work at the prices herein set out. 400.3 Bidder's Acknowledgment In submitting this Bid this Bidder acknowledges and represents that: 1) Bidder has examined copies of all the Contract Documents; 2) Bidder has visited the Project Area and become familiar with the general, local, and site conditions; 3) Bidder is familiar with Federal, State, and local laws, ordinances and regulations that govern the work specified by the Contract Documents; 4) Bidder has correlated the information known to the Bidder, observations obtained from the examination of the site, reports and drawings identified in the Contract Documents and additional investigations, explorations, tests, studies and data within the Contract Documents; 5) This Bid is genuine and not made in the interest of or on behalf of an undisclosed person, firm or corporation; Bidder has not directly or indirectly induced or solicited another Bidder to submit a false or sham Bid; Bidder has not solicited or induced a person, firm or corporation to refrain from Bidding; and Bidder has not sought by collusion to obtain for itself an advantage over another Bidder or over City; 6) Local and State sales and use taxes are not included in the Bid Amount. 7) Bidder has examined and understands that the following reports listed in Section 00775 are part of the Contract Documents have been considered and are included in the Bid Amount. Report Title: 16th and Kerper Area Subsurface Investigation, Dated; January 15 Report Title 11iL 6iL,-,L crks 1' r t. (2 Dated 11 1 31 17 I %1`1)73 LINE NO. Masterpiece on the Mississippi REFERENCE NUMBER BIDDER NAME: Project Name: City of Dubuque, Iowa Bid Proposal Schedule Tschiggfrie Exc. Co. Kerper Blvd. Sanitary Sewer Reconstruction 2018 BID ITEM DESCRIPTION Division 2010 - Earthwork, Subgrade, and Subbase 1 2010-108-C-0 Clearing and Grubbing C 2 2010-108-D-3 Topsoil, Off-site 3 2010-108-1-0 Subbase, Special Backfill - Gradation 30 Division 3010 - Trench Excavation and Backfill 4 3010-108-D-0 Trench Foundation - 3" Breaker 5 3010-108-D-0 Bedding Material, 1" Commercial Clean Stone 6 3010-108-1D-0 Replacement of Unsuitable Backfill Material Gradation 30 7 3010-108-E-0 Special Pipe Embedment or Encasement 8 2010-108-L-0 Compaction Testing 9 3010-108-1-2 Trenching, 26 Inch Depth 10 3010-108-J-3 Trenching, 48 Inch Depth 11 Spec Prov Dewatering - E. 16th St. 12 Spec Prov Dewatering - E. 16th St. Redirect to Sanitary Sewer 13 Spec Prov Dewatering - Kerper Blvd. 14 Spec Prov Dewatering - Lift Station Division 4010 - Sanitary Sewers r�Hry QUANTIT v UNIT 1.00 LS Addendum No.: One DATE: 11/8/2018 BID UNIT PRICE $1,200.00 100.00 CY $14.10 TOTAL PRICE $1,200.00 $1,410.00 1885.00 TON $16.10 $30,348.50 Sub Total $32,958.50 1500.00 TON $16.10 $24,150.00 2300.00 TON $22.60 $51,980.00 5000.00 TON $12.00 $60,000.00 20.00 LF $157.00 $3,140.00 1.00 LS $3,600.00 $3,600.00 80.00 LF $3.85 $308.00 180.00 LF $4.45 $801.00 1.00 LS $62,000.00 $62,000.00 1.00 LS $10,000.00 $10,000.00 1.00 LS $101,000.00 $101,000.00 1.00 LS $104,000.00 $104,000.00 Sub Total $420,979.00 15 4010-108-A-1 Sanitary Sewer Gravity Main, Trenched, 10" PVC (SDR -26) 211.33 LF $42.80 $9,044.92 16 4010-108-A-1 Sanitary Sewer Gravity Main, Trenched, 15" PVC (SDR -26) 45.32 LF $72.40 $3,281.17 17 4010-108-A-1 Sanitary Sewer Gravity Main, Trenched, 18" PVC (PS -115) 1520.08 LF $102.00 $155,048.16 18 4010-108-A-1 Sanitary Sewer Gravity Main, Trenched, 18" PVC (C900 DR -18) 117.67 LF $89.40 $10,519.70 19 4010-108-A-2 Sanitary Sewer Gravity Main, Trenched, 24" PVC (PS -115) 518.88 LF $100.00 $51,888.00 20 4010-108-C-1 Sanitary Sewer Force Main, Trenched, 10" PVC (C900 DR -25) 3430.00 LF $29.80 $102,214.00 21 5010-108-C-1 Joint Restraint - Joint Harness 20.00 EA $1,300.00 $26,000.00 22 5010-108-C-1 Joint Restraint - Retainer Gland 32.00 EA $405.00 $12,960.00 23 4010-108-E-1 Sanitary Sewer Service Pipe, Trenched 200.00 LF $38.50 $7,700.00 24 4010-108-H-0 Removal of Sanitary Sewer, 10" 10.00 LF $262.00 $2,620.00 25 4010-108-H-0 Removal of Sanitary Sewer, 18" 15.00 LF $262.00 $3,930.00 26 4010-108-L-0 Sanitary Sewer Abandonment 185.00 CY $153.00 $28,305.00 27 4010-108-M-0 Fitting, PVC Wye 7.00 EA $1,100.00 $7,700.00 Division 4020 - Storm Sewers 28 4020-108-A-1 Storm Sewer Gravity Main, Trenched, 36" RCP 29 4020-108-A-0 Concrete Collar Connection - Type PC -2 Division 5010 - Pipe and Fittings Sub Total $421,210.95 20.00 LF $83.20 $1,664.00 2.00 EA $392.00 $784.00 Sub Total $2,448.00 30 5010-108-A-1 Water Main, Trenched, DIP, 6" 80.00 LF $54.40 $4,352.00 31 Live Tap, 24 x 6 1.00 LS $6,800.00 $6,800.00 32 5010-108-C-1 Fittings, Mega lug, 6" 2.00 EA $149.00 $298.00 Division 5020 - Valves, Fire Hydrants, and Appurtenances 33 5020-108-C-0 Fire Hydrant Division 6010 - Structures for Sanitary and Storm Sewers 34 6010-108-A-0 Manhole Type, PC, 48" SW -301 35 6010-108-A-0 Manhole Type, PC, 60" SW -301 (Cone) 36 6010-108-A-0 Manhole Type, PC, 72" SW -301 (Flat Top) 37 6010-108-H-0 Remove Manhole Sub Total $11,450.00 1.00 EA $3,900.00 $3,900.00 Sub Total $3,900.00 14.83 VF $420.00 $6,228.60 188.30 VF $545.00 $102,623.50 14.89 VF $1,100.00 $16,379.00 12.00 EA $913.00 $10,956.00 Sub Total $136,187.10 LINE NO. REFERENCE NUMBER BID ITEM DESCRIPTION Division 7010 - Portland Cement Concrete Pavement 38 7010-108-A-0 Pavement, PCC, 8" (Thickness) 39 7010-108-A-0 Pavement, PCC, 9" (Thickness) 40 7010-108-E-0 Curb and Gutter, 30" (Width), 8" (Thickness) Division 7020 - Hot Mix Asphalt Pavement 41 7020-108-B-0 Pavement or Overlay, HMA, 8" (Thickness) Division 7030 - Sidewalks, Shared Use Paths, and Driveways 42 7030-108-A-0 Removal of Sidewalk 43 7030-108-A-0 Removal of Shared Use Path 44 7030-108-C-0 Shared Use Path, HMA, 4" (Thickness) 45 7030-108-E-0 Sidewalk, PCC, 4" (Thickness) 46 7030-108-H-1 Driveway, Paved, PCC, 8" (Thickness) Division 7040 - Pavement Rehabilitation 47 7040-108-H-0 Removal - Pavement 48 7040-108-1-0 Removal - Curb and Gutter Division 8010 - Traffic Signals & Lighting YLHrr QUANTIT v UNIT 482.00 SY 617.00 SY 270.00 LF 3655.00 SY BID UNIT PRICE $49.40 $54.60 TOTAL PRICE $23,810.80 $33,688.20 $23.50 $6,345.00 Sub Total $63,844.00 $35.90 $131,214.50 Sub Total $131,214.50 12.00 SY $11.90 $142.80 73.00 SY $11.90 $868.70 73.00 SY $36.20 $2,642.60 12.00 SY $41.40 $496.80 22.50 SY $49.40 $1,111.50 Sub Total $5,262.40 4495.00 SY $6.95 $31,240.25 176.00 LF $5.00 $880.00 Sub Total $32,120.25 49 8010-108-A.1 Handhole, PC, Rectangular 1.00 EA $1,900.00 $1,900.00 50 8010-108-A.2 Handhole, Composite, Small 4.00 EA $516.00 $2,064.00 51 8010-108-13-1 Conduit, PVC, 2" 600.00 LF $3.55 $2,130.00 52 8010-108-6-1 Conduit, PVC, 4" 50.00 LF $28.70 . $1,435.00 53 8010-108-D.5 Electrical Service Control Pedestal Precast Concrete Base 1.00 EA $2,100.00 $2,100.00 54 8010-108-J-0 Electrical Service Control Pedestal with Battery Backup 1.00 EA $18,500.00 $18,500.00 55 8010-108-C-0 Wiring and Cable - Fiber Optics, 144 Single Mode, Micro Fiber, 6.4MM 3825.00 LF $3.20 $12,240.00 56 Wiring and Cable - Fiber Optics, 12 LC Single Mode, Micro Fiber, Pre -Term. 1.00 EA $665.00 $665.00 57 8010-108-B-3 Conduit, Microduct, HDPE, 3 - 10/8mm 2625.00 LF $3.95 $10,368.75 58 Wiring and Cable - Fiber Optics, Splice Capsule, Tyco, Type B 1.00 EA $2,100.00 $2,100.00 59 Wiring and Cable - Fiber Optics, Fusion Splice 36.00 Strands $179.00 $6,444.00 60 Ethernet Switch 1.00 EA $3,700.00 $3,700.00 61 8010-108-F.2 Fiber Optic Vault - Composite 1.00 EA $2,200.00 $2,200.00 62 8010-108-N.2 Removal - Relocate Existing Light Pole and Precast Concrete Base 1.00 EA $1,100.00 $1,100.00 63 8010-108-D.1 Street Light Precast Concrete Base, 2' Dia. x 7' 1.00 EA $1,100.00 $1,100.00 64 8010-108-M-0 Street Light, Galvanized, 30' 1.00 EA $774.00 $774.00 IDOT Division 2528 - Traffic Control 65 IDOT 2528.04-A Traffic Control Stage I Construction 66 IDOT 2528.04-A Traffic Control Stage III Construction 67 IDOT 2528.04-A Traffic Control Stage IV Construction Division 9010 - Seeding 68 9010-108-A-0 Conventional - Seeding, Fertilizing, and Mulching, Type 1 Division 9030 - Plant Materia! and Planting Sub Total $68,820.75 1.00 LS $6,200.00 $6,200.00 1.00 LS $28,400.00 $28,400.00 1.00 LS $25,200.00 $25,200.00 Sub Total $59,800.00 5.00 AC $3,400.00 $17,000.00 Sub Total $17,000.00 69 9030-108-0-0 Plants 1.00 LS $4,600.00 $4,600.00 70 Landscape Edging, 6", Steel 225.00 LF $8.75 $1,968.75 71 Landscape Mulch, 6", Drk. Brown 26.00 CY $67.10 $1,744.60 Division 9040 - Erosion and Sediment Control 72 9040-108-A-1 SWPPPPreparation 73 9040-108-A-2 SWPPP Management 74 9040-108-D-1 Filter Socks, 12" 75 9040-108-D-2 Filter Socks, Removal Division 9060 - Chain Link Fence 76 9060-108-A-0 Chain Link Fence, PVC Coated, Black, 8' 77 9060-108-B-0 Gates, Dbl Leaf, PVC Coated, Black, 8' Sub Total $8,313.35 1.00 LS $1,700.00 $1,700.00 1.00 LS $1,700.00 $1,700.00 500.00 LF $5.15 $2,575.00 500.00 LF $0.01 $5.00 Sub Total $5,980.00 217.00 LF $52.30 $11,349.10 1.00 EA $284.00 $284.00 Sub Total $11,633.10 LINE NO. REFERENCE NUMBER BID ITEM DESCRIPTION Division 11 - Miscellaneous 78 11010-108-A-0 Construction Survey 79 11020-108-A-0 Mobilization 80 11050-108-A-0 Concrete Washout 81 82 83 Non -SODAS - Miscellaneous Lift Station Generator and Controls Transformer Pad 400.5 Base Bid Amount I -LAN QUANTIT Y UNIT 1.00 LS BID UNIT PRICE $12,900.00 TOTAL PRICE $12,900.00 1.00 LS $167,500.00 $167,500.00 1.00 LS $423.00 $423.00 Sub Total $180,823.00 1.00 LS $615,000.00 $615,000.00 1.00 LS $47,900.00 $47,900.00 1.00 EA $2,600.00 $2,600.00 Sub Total $665,500.00 Bid Amount $2,279,444.90 Two million, two hundred seventy nine thousand, four hundred forty four dollars and ninety cents (Use Words) SECTION 00400 400.4 Unit Prices and Bid Amount Inser 400.6 SRF Forms Attachment 1: SRF Required Front -End Specifications Certification of Non -Segregated Facilities Form (to be completed and signed by Prime Contractor and submitted with the bid) SECTION 00400 SRF Attachment 2: Statement in Advertisement for Bids on Debarment and STATE Suspension/Certification Regarding Debarment and REVOLVING FUND Suspension Form (to be completed and signed by Prime Contractor and submitted with the bid) Attachment 3: Attachment 4: Attachment 5: Attachment 6: Attachment 7: Disadvantaged Business Enterprise Certification Form (to be completed and signed by Prime Contractor and submitted with the bid) DBE Program Subcontractor Performance Form (to be completed and signed by Prime and DBE Subcontractor for each subcontract and submitted with the bid) DBE Program Subcontractor Utilization Form (to be completed and signed by Prime Contractor and submitted with the bid) DBE Program Subcontractor Participation Form (for voluntary use of DBEs) Other Federal Requirements Language A. Standard Equal Employment Opportunity Specifications B. Federal Labor Standards Provisions (including Davis -Bacon prevailing wage rates) C. Preservation of Open Competition and Government Neutrality D. Historical and Archeological Finds E. Prohibitions on Procurement from Violating Facilities Attachment 8: Right of Entry and Records Retention Attachment 9: Use of American Iron and Steel Please note: The Davis Bacon wage determination received from the Iowa Finance Authority must also be included in the front-end specifications. SECTION 00400 Attachment 1 SRF Required Front -End Specifications (This form must be completed and signed by Prime Contractor and submitted with the bid.) U.S. Environmental Protection Agency Certification of Non -Segregated Facilities (Applicable to contracts, subcontracts, and agreements with applicants who are themselves performing Federally assisted construction contracts, exceeding $10,000 which are not exempt from the provisions of the Equal Opportunity clause.) By the submission of this bid, the bidder, offeror, applicant, or subcontractor certifies that he does not maintain or provide for his employees any segregated facilities at any of his establishments, and that he does not permit his employees to perform their services at any location, under his control, where segregated facilities are maintained. He certifies further that he will not maintain or provide for his employees any segregated facilities at any of his establishments, and that he will not permit his employees to perform their services at any location, under his control, where segregated facilities are maintained. The bidder, offeror, applicant, or subcontractor agrees that a breach of this certification is a violation of the Equal Opportunity clause in this contract. As used in this certification, the term "segregated facilities" means any waiting rooms, work areas, restrooms and washrooms, restaurants and other eating areas, time clocks, locker rooms and other storage or dressing areas, parking lots, drinking fountains, recreation or entertainment areas, transportation, and housing facilities provided for employees which are segregated by explicit directive or are in fact segregated on the basis of race, creed, color, or national original, because of habit, local custom, or otherwise. He further agrees that (except where he has obtained identical certifications from proposed subcontractors for specific time periods) he will obtain identical certifications from proposed subcontractors prior to the award of subcontracts exceeding $10,000 which are not exempt from the provisions of the Equal Opportunity clause; that he will retain such certifications in his files; and that he will forward the following notice to such proposed subcontractors (except where the proposed subcontractors have submitted identical certifications for specific time periods): NOTICE TO PROSPECTIVE SUBCONTRACTORS OF REQUIREMENT FOR CERTIFICATIONS OF NON -SEGREGATED FACILITIES A Certification of Non -segregated Facilities, as required by the May 9, 1967, order (33 F.R. 7808, May 28, 1968) on Elimination of Segregated Facilities, by the Secretary of Labor, must be submitted prior to the award of a subcontract exceeding $10,000 which is not exempt from the rovisions of the Equal Opportunity clause. The certification may be submitted either for e�aubcontract or for all subcontracts during a period (i.e., quarterly, semiannually, or a thuaIII Signature Date Randy Steffen Superintendent Name and Title of Signer (Please Type) NOTE: The penalty for making false statements in offers is prescribed in 18 U.S.C. 1001. PA -7 5720-4.2 SECTION 00400 Attachment 2 SRF Required Front -End Specifications (This form must be completed and signed by the Prime Contractor and submitted with the bid.) Debarments and Suspensions Any bidder or equipment supplier whose firm or affiliate is listed in on the U.S. General Services Administration Excluded Parties List System web site at http://www.epls.gov/ will be prohibited from the bidding process. Anyone submitting a bid who is listed on this web site will be determined to be a non-responsive bidder in accordance with 40 CFR Part 31. United States Environmental Protection Agency Washington, DC 20460 Certification Regarding Debarment, Suspension, and Other Responsibility Matters The prospective participant certifies to the best of its knowledge and belief that it and the principals: (a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency; (b) 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; (c) Are not presently indicted for otherwise criminally or civilly charged by a government entity (Federal, State, or local) with commission of any of the offenses enumerated in paragraph (1) (b) of this certification; and (d) Have not within a three-year period preceding this application/proposal had one or more public transaction s (Federal, State, or local) terminated or cause or default. I understand that a false statement on this certification may be ground for rejection of this proposal or termination of the award. In addition, under 18 U SC Sec. 10 01, a false statement ma y result in a fine of up to $10,000 or imprisonment for up to 5 years, or both. Randy Steffen Superintendent Typed Name & Title of Authorized Representative ct,k, Sig ature of Ai4thorized Representative ❑ I am unable to certify to the above statements. My explanation is attached. EPA Form 5700-49 (11-88) SECTION 00400 Attachment 3 SRF Required Front -End Specifications (This form must be completed and signed by Prime Contractor and submitted with the bid.) Disadvantaged Business Enterprise (DBE) Solicitation It is EPA's policy that recipients of EPA financial assistance through the State Revolving Fund programs award a "fair share" of sub agreements to small, minority and women -owned businesses, collectively known as Disadvantaged Business Enterprises (DBEs). Iowa's Fair Share goals are: Only work performed by certified DBEs can be counted toward the goals. In Iowa, DBEs must be certified through the Iowa Department of Transportation (IDOT). Information on certification requirements and a list of certified DBEs is on the IDOT website at http://www.iowadot.gov/contracts/contracts eeoaa.htm. Prime contractors' DBE requirements for SRF projects include: • Taking affirmative steps for DBE participation • Documenting the efforts and the proposed utilization of certified DBEs SRF Applicant: Minority -Owned Business Enterprise (MBE) Goal Women -Owned Business Enterprise (WBE) Goal Construction 1.7% 2.2% Supplies 0.6% 5.6% Services 2.5% 11.3% Goods/Equipment 2.5% 10.4% Average 1.8% 7.4% Only work performed by certified DBEs can be counted toward the goals. In Iowa, DBEs must be certified through the Iowa Department of Transportation (IDOT). Information on certification requirements and a list of certified DBEs is on the IDOT website at http://www.iowadot.gov/contracts/contracts eeoaa.htm. Prime contractors' DBE requirements for SRF projects include: • Taking affirmative steps for DBE participation • Documenting the efforts and the proposed utilization of certified DBEs SRF Applicant: City of Dubuque Bidder: Tschiggfrie Exc. Co. Address: 42 Julien Dubuque Dr., Dubuque, IA 52003 Contact Person:,,. Rdy St ffen Signature: _ ` Phone Number: 563) 557-7450 E -Mail Address: rsteffen@tschiggfrie.net Check if Prime Contractor is: ❑ Minority -Owned ❑ Women -Owned SECTION 00400 GOOD FAITH EFFORTS CHECKLIST Please complete the checklist to determine if you have complied with the requirement to make good faith efforts to ensure that certified DBEs have the opportunity to compete for procurements funded by EPA financial assistance funds. Bidders/offerors must make good faith efforts prior to submission of bids/proposals. 1. Did you ensure that DBEs are made aware of contracting opportunities to the fullest extent practicable through outreach and recruitment activities? ® Yes ❑ No 2. Did you make information on forthcoming opportunities available to DBEs and arrange time frames for contracts and establish delivery schedules, where the requirements permit, in a way that encourages and facilitates participation by DBEs in the competitive process? This includes, whenever possible, posting solicitation for bids or proposals for a minimum of 30 calendar days before the bid or proposal closing date. EI Yes ❑ No 3. Did you consider in the contracting process whether firms competing for large contracts could subcontract with DBEs? This will include dividing total requirements, when economically feasible, into smaller tasks or quantities to permit maximum participation by DBEs in the competitive process. ® Yes ❑ No 4. Did you encourage contracting with a consortium of DBEs when a contract is too large for one of these firms to handle individually? Yes ❑ No 5. Did you use the services of the Small Business Administration and the Minority Business Development Agency of the Department of Commerce to identify potential subcontractors? ® Yes ❑ No 6. List the potential DBE subcontractors that were contacted. Only list those that are certified through the Iowa Department of Transportation. Name How Contacted (e.g. letter, phone call, fax, e-mail) Response (e.g. did not respond, not interested, not competitive) Advanced Traffic Control e-mail did not respond Anne Duffield Construction, Inc. e-mail did not respond Curtis Contracting Corp. e-mail did not respond Hard Rock Sawing & Drilling e-mail did not respond Heritage Landscape Design, Inc. e-mail did not respond Tiedt Nursery e-mail did not respond PROPOSED UTILIZATION OF DBE SUBCONTRACTORS Please include Attachments 4 and 5 to document the proposed utilization of certified DBE subcontractors. SECTION 00400 CONTRACT ADMINISTRATION PROVISIONS Several contract provisions are required to prevent unfair practices that adversely affect DBEs. These include: 1. Prime Contractor must pay its Subcontractor for satisfactory performance no more than 30 days from the Prime Contractor's receipt of payment from the SRF loan recipient. 2. Prime Contractor must notify the SRF loan recipient in writing prior to termination of a DBE subcontractor for convenience. 3. Prime Contractor must employ the six Good Faith Efforts to solicit a replacement subcontractor if a DBE subcontractor fails to complete work under a subcontract for any reason. SECTION 00400 Attachment 4 SRF Required Front -End Specifications (This form must be completed and signed by Prime and DBE Subcontractor for each subcontract and submitted with the bid.) OMB Control No: 2090-0030 Approved 8/13/2013 Approval Expires 8/31/2015 United States Environmental Protection Agency Disadvantaged Business Enterprise Program DBE Subcontractor Performance Form This form is intended to capture the DBE1 subcontractor's2 description of work to be performed and the price of the work submitted to the prime contractor. An EPA Financial Assistance Agreement recipient must require its prime contractor to have its DBE subcontractors complete this form and include all completed forms in the prime contractor's bid or proposal package. Subcontractor Name Project Name Kerper Blvd Sanitary Sewer Reconstruction Bid/Proposal No. Assistance Agreement ID No. (if known) Point of Contact Address - 425 Julien Dubuque Dr., Dubuque, IA 52003 Telephone No. (563) 557-7450 Email Address rsteffen@tschiggfrie.net Prime Contractor Name Tschiggfrie Exc. Co. Issuing/Funding Entity Contract Item Number Description of Work Submitted to the Prime Contractor Involving Construction, Services, Equipment or Supplies Price of Work Submitted to the Prime Contractor DBE Certified by DOT SBA Meets/exceeds EPA certification standards? YES NO Unknown Other: 1A DBE is a Disadvantaged, Minority, or Woman Business Enterprise that has been certified by an entity from which EPA accepts certification as described in 40 CFR 33.204-33.205 or certified by EPA. EPA accepts certifications from entities that meet or exceed EPA certification standards as described in 40 CFR 33.202. 2Subcontractor is defined as a company, firm, joint venture, or individual who enters into an agreement with a contractor SECTION 00400 to provide services pursuant to an EPA award of financial assistance. EPA Form 6100-3 (DBE Subcontractor Performance Form) — Page 1 OMB Control No: 2090-0030 Approved 8/13/2013 Approval Expires 8/31/2015 United States Environmental Protection Agency Disadvantaged Business Enterprise Program DBE Subcontractor Performance Form I certify under penalty of perjury that the forgoing statements are true and correct. Signing this form does not signify a commitment to utilize the subcontractors above. I am aware of that in the event of a replacement of a subcontractor, I will adhere to the replacement requirements set forth in 40 CFR Part 33 Section 33.302 (c). Prime Contractor Signature Print Name et, Randy Steffen Title Date Superintendent Os / i 61 Subcontractor Signature Print Name Title Date The public reporting and recordkeeping burden for this collection of information is estimated to average three (3) hours per response. Send comments on the Agency's need for this information, the accuracy of the provided burden estimates, and any suggested methods for minimizing respondent burden, including through the use of automated collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed form to this address. EPA Form 6100-3 (DBE Subcontractor Performance Form) — Page 2 SECTION 00400 Attachment 5 SRF Required Front -End Specifications (This form must be completed and signed by Prime Contractor and submitted with the bid if utilizing DBE subcontractors.) OMB Control No: 2090-0030 Approved 8/13/2013 Approval Expires 8/31/2015 United States Environmental Protection Agency Disadvantaged Business Enterprise Program DBE Subcontractor Utilization Form This form is intended to capture the prime contractor's actual and/or intended use of identified certified DBE1 subcontractors2 and the estimated dollar amount of each subcontract. An EPA Financial Assistance Agreement Recipient must require its prime contractors to complete this form and include it in the bid or proposal package. Prime contractors should also maintain a copy of this form on file. Prime Contractor Name Tschiggfrie Exc. Co. Project Name Kerper Blvd Sanitary Sewer Reconstruction Bid/Proposal No. Assistance Agreement ID No. (if known) Point of Contact Address 425 Julien Dubuque Dr., Dubuque, IA 52003 Telephone No. (563) 557-7450 Email Address rsteffen@tschiggfrie.net Issuing/Funding Entity I have identified potential DBE certified subcontractors If yes, please complete the table below. If no, please explain: YES ,' NO Subcontractor Name/Company Name Company Address/Phone/Email Estimated Dollar Amount Currently DBE Certified ontinue on back if needed 1A DBE is a Disadvantaged, Minority, or Woman Business Enterprise that has been certified by an entity from which EPA accepts certification as described in 40 CFR 33.204-33.205 or certified by EPA. EPA accepts certifications from entities that meet or exceed EPA certification standards as described in 40 CFR 33.202. 2Subcontractor is defined as a company, firm, joint venture, or individual who enters into an agreement with a contractor to provide SECTION 00400 services pursuant to an EPA award of financial assistance. EPA Form 6100-4 (DBE Subcontractor Utilization Form) — Page 1 OMB Control No: 2090-0030 Approved 8/13/2013 Approval Expires 8/31/2015 United States Environmental Protection Agency Disadvantaged Business Enterprise Program DBE Subcontractor Utilization Form I certify under penalty of perjury that the forgoing statements are true and correct. Signing this form does not signify a commitment to utilize the subcontractors above. I am aware of that in the event of a replacement of a subcontractor, I will adhere to the replacement requirements set forth in 40 CFR Part 33 Section 33.302 (c). Prime Contractor Signature Print Name , ELy Randy Steffen Title Date Superintendent ` J5 /)& It/5 The public reporting and recordkeeping burden for this collection of information is estimated to average three (3) hours per response. Send comments on the Agency's need for this information, the accuracy of the provided burden estimates, and any suggested methods for minimizing respondent burden, including through the use of automated collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed form to this address. EPA Form 6100-4 (DBE Subcontractor Utilization Form) — Page 2 SECTION 00400 400.7 Timeliness Bidder agrees that the work shall be Substantially Complete and made ready for final payment in accordance with Contract Documents no later than the date(s) indicated in Section 00800 — Construction Schedule and Agreed Cost of Delay. 400.8 Additional Documents To Be Submitted With Bid The following additional documents are included and made a condition of this Bid: A. Bid Bond (Section 00450)—or other approved Bid Security. Accompanying this Bid in a separate sealed envelope is a Bid Bond, cashier's check, or certified check in the penal sum of ten percent (10%) of the submitted Bid. It is understood that the Bid security will be retained in the event a contract is not executed by the Contractor if award is made to the undersigned. If a Bid Bond is submitted it must be executed by the Bidder and acceptable corporate surety. If a Cashier's check or certified check is submitted it must be made payable to the City Treasurer, City of Dubuque, drawn on a bank in Iowa or a bank chartered under the laws of the United States. B. Bidder Status Form (Section 00460) 400.9 Document Submittal Re• uirements b A • arent Low Bidder The apparent low bidder must submit the Contractor Background Information Form (Section 00470 to the Jurisdiction Representative within 72 hours after the bid opening. Failure to submit the Contractor Background Information Form by the required deadline may be considered justification for the City to determine the Bidder as not responsible. 400.10 Contract Execution The Bidder further agrees to execute a formal contract and Bond, within ten (10) calendar days after the date of the City's Notice of Award. The Bidder aiso agrees it will commence work on or before ten (10) calendar days after the date of City's Notice to Proceed, and it will complete the work within the specified contract period or pay the Agreed Cost of Delay stipulated in the Contract Documents. 400.11 Questions and Interpretations Failure by the Bidder to request clarification of the Contract Documents during the bidding process does not waive the responsibility for comprehension of the documents and performance of the work in accordance with the Contract Documents. Signing of the Bid Proposal Form constitutes the Contractor's certification as implicitly denoting thorough comprehension of intent of the Contract Documents. 400.12 Addenda The Bidder acknowledges receipt of the following addenda: Addendum # 1 Dated: 10/31/2018 Dated: Dated: Dated: 400.13 Signatures Contractor: Tschiggfrie Exc. Co. Contractor Name 425 Julien Dubuque Drive Street (Business Location) Street (Business Location) Dubuque City Iowa 52003 Staff Zip Signature Superintendent Title Dated: A //6 - Dated: i1t1' SECTION 00400 The Bidder's State of does ( )/ does not ( ) utilize a percentage preference for in-state Bidders. The amount of preference is percent. ___= END OF SECTION 00400 === SECTION 00450 BID BOND SECTION 00450 We Tschiggfrie Excavating Co. as Principal (Contractor), and International Fidelity Insurance Company , as Surety, are held and firmly bound unto the City of Dubuque, Iowa (City), in the sum of $10% (Ten Percent of Bid Amount) (Indicate the bond value, in dollars, which is 10% of the Bid amount), (use numbers) for the payment of which sum well and truly to be made, we bind ourselves, our heirs, executors, administrators, and successors, jointly and severally, firmly by these presents. The condition of this obligation is such that whereas the Principal has submitted the accompanying Bid, dated 8th day of November 2018 for Kerper Blvd Sanitary Sewer Reconstruction (Project). NOW, THEREFORE, if the Principal shall not withdraw said Bid within the period specified therein during the opening of same, or if no period specified, within thirty (30) days after said opening, and must within the period specified therefore, if no period be specified, within ten (10) days after date of City's Notice of Award, enter into a the Public Improvement Contract with the City, in accordance with the Bid as accepted, and give Bond with good and sufficient surety or sureties, as may be required for the faithful performance and proper fulfillment of such Contract, then the above obligation shall be void and of, no effect, otherwise to remain in full force. The full amount of this Bid Bond will be forfeited to the City as an Agreed Cost of Delay in the event that the Principal fails to execute the contract and provide the Bond as provided in the Contract Documents or by law. IN WITNESS WHEREOF, the above parties have executed this instrument under their several seals this 30th day of October , 2018 the name and corporate seal of each corporate party being hereto affixed and duly signed by its undersigned representative pursuant to authority of its governing body. By: PRINCIPAL: SURETY: Tschiggfrie Excavating Co. Contractor Name By: SO ature �' Signature e- +2 c -re_ c� International Fidelity Insur-•'ice Company Sur ame Title II Date Date Dione R. Young, Attorney -in -Fact Title October 30, 2018 ___= END OF SECTION 00450 =___ POWER OF ATTORNEY Bond # Bid Bond INTERNATIONAL FIDELITY INSURANCE COMPANY ALLEGHENY CASUALTY COMPANY One Newark Center, 20th Floor, Newark, New Jersey 07102-5207 PHONE: (973) 624-7200 KNOW ALL MEN BY THESE PRESENTS: That INTERNATIONAL FIDELITY INSURANCE COMPANY, a corporation organized and existing under the laws of the State of New Jersey, and ALLEGHENY CASUALTY COMPANY a corporation organized and existing under the laws of the State of New Jersey, having their principal office in the City of Newark, New Jersey, do hereby constitute and appoint STACY VENN, SETH D. ROOKER, SYDNEY BURNETT, CRAIG E. HANSEN, GINGER HOKE, DIONE R. YOUNG, JAY D. FREIERMUTH, ANNE CROWNER, BRIAN M. DEIMERLY, SHIRLEY S. BARTENHAGEN, TIM MCCULLOH, CINDY BENNETT Waukee, IA their true and lawful attorney(s)-in-fact to execute, seal and deliver for and on its behalf as surety, any and all bonds and undertakings, contracts of indemnity and other writings obligatory in the nature thereof, which are or may be allowed, required or permitted by law, statute, rule, regulation, contract or otherwise, and the execution of such instrument(s) in pursuance of these presents, shall be as binding upon the said INTERNATIONAL FIDELITY INSURANCE COMPANY and ALLEGHENY CASUALTY COMPANY, as fully and amply, to all intents and purposes, as if the same had been duly executed and acknowledged by their regularly elected officers at their principal offices. This Power of Attorney is executed, and may be revoked, pursuant to and by authority of the By -Laws of INTERNATIONAL FIDELITY INSURANCE COMPANY and ALLEGHENY CASUALTY COMPANY and is granted under and by authority of the following resolution adopted by the Board of Directors of INTERNATIONAL FIDELITY INSURANCE COMPANY at a meeting duly held on the 20th day of July, 2010 and by the Board of Directors of ALLEGHENY CASUALTY COMPANY at a meeting duly held on the 10th day of July, 2015 "RESOLVED, that (1) the Chief Executive Officer, President, Executive Vice President, Vice President, or Secretary of the Corporation shall have the power to appoint, and to revoke the appointments of, Attorneys -in -Fact or agents with power and authority as defined or limited in their respective powers of attorney, and to execute on behalf of the Corporation and affix the Corporation's seal thereto, bonds, undertakings, recognizances, contracts of indemnity and other written obligations in the nature thereof or related thereto; and (2) any such Officers of the Corporation may appoint and revoke the appointments of joint -control custodians, agents for acceptance of process, and Attorneys -in -fact with authority to execute waivers and consents on behalf of the Corporation; and (3) the signature of any such Officer of the Corporation and the Corporation's seal may be affixed by facsimile to any power of attorney or certification given for the execution of any bond, undertaking, recognizance, contract of indemnity or other written obligation in the nature thereof or related thereto, such signature and seals when so used whether heretofore or hereafter, being hereby adopted by the Corporation as the original signature of such officer and the original seal of the Corporation, to be valid and binding upon the Corporation with the same force and effect as though manually affixed." IN WITNESS WHEREOF, INTERNATIONAL FIDELITY INSURANCE COMPANY and ALLEGHENY CASUALTY COMPANY have each executed and attested these presents on this 31st day of December, 2017 STATE OF NEW JERSEY County of Essex George R. James Executive Vice President (International Fidelity Insurance Company) and Vice President (Allegheny Casualty Company) On this 31st day of December, 2017 , before me came the individual who executed the preceding instrument, to me personally known, and, being by me duly sworn, said he is the therein described and authorized officer of INTERNATIONAL FIDELITY INSURANCE COMPANY and of ALLEGHENY CASUALTY COMPANY; that the seals affixed to said instrument are the Corporate Seals of said Companies; that the said Corporate Seals and his signature were duly affixed by order of the Boards of Directors of said Companies. . G ��• 0 NOTARY 13\ S PUBLIC. 0.: ,4 416 2°'` •.. k40 ��,.',''��•. pg NEW IN TESTIMONY WHEREOF, I have hereunto set my hand affixed my Official Seal, at the City of Newark, New Jersey the day and year first above written. CERTIFICATION Cathy Cruz a Notary Public of New Jersey My Commission Expires April 16, 2019 I, the undersigned officer of INTERNATIONAL FIDELITY INSURANCE COMPANY and ALLEGHENY CASUALTY COMPANY do hereby certify that I have compared the foregoing copy of the Power of Attorney and affidavit, and the copy of the Sections of the By -Laws of said Companies as set forth in said Power of Attorney, with the originals on file in the home of said companies, and that the same are correct transcripts thereof, and of the whole of the said originals, and that the said Power of Attorney has not been revoked and is now in full force and effect. IN TESTIMONY WHEREOF, I have hereunto set my hand on this day, October 30, 2018 A00639 Me.A.140-iee Maria H. Branco. Assistant Secretary SECTION 00471 Page 1 of 12 SECTION 00471 CONTRACTOR BACKGROUND INFORMATION FOR SMALL CONTRACTS (Between $25,000 and $3,000,000) All questions must be answered clearly and comprehensively. If necessary, questions may be answered on separate attached sheets. The Bidder may submit any additional information that it deems necessary. 1. SUBMITTED BY: Official Name of Firm: Address: Tschiggfrie Exc. Co. 425 Julien Dubuque Drive Dubuque, IA 52003 2. CONTRACTOR'S CONTACT INFORMATION: Contact Person: Title: Phone: Email: 3. TYPE OF ORGANIZATION: Randy Steffen Superintendent (563) 557-7450 rsteffen@tschiggfrie.net n SOLE PROPRIETORSHIP Name of Owner: Doing Business As: Date of Organization: PARTNERSHIP Date of Organization: Type of Partnership: Name of General Partner(s): SECTION 00471 Page 2 of 12 CORPORATION State of Organization: Date of Organization: Executive Officers: - President: - Vice President(s): Iowa 3/31/1987 Ed Tschiggfrie Rod Tschiggfrie - Treasurer: - Secretary: LIMITED LIABILITY COMPANY State of Organization: Date of Organization: Members: JOINT VENTURE State of Organization: Date of Organization: Form of Organization: Vicki Tschiggfrie Joan Tschiggfrie Joint Venture Managing Partner - Name: - Address: Joint Venture Managing Partner - Name: - Address: Joint Venture Managing Partner - Name: - Address: n Other State of Organization: Name of Organization: Form of Organization: Date of Organization: Principal - Name: - Title: - Address: SECTION 00471 Page 3 of 12 A. How many years has your organization been in business as a contractor? 55 years. B. How many years have you been engaged in the contracting business under your present firm or trade name? 55 years. C. Under what other or former names does or has your organization operated? None 4. CERTIFICATIONS: Disadvantage Business Enterprise: Minority Business Enterprise: Woman Owned Enterprise: Small Business Enterprise: Other: CERTIFIED BY: None None None None None SECTION 00471 Page 4 of 12 5. BONDING INFORMATION: Bonding Company: Address: Bonding Agent: Address: Contact Name: Phone: International Fidelity Insurance Company One Newark Center, 20th Floor Newark, NJ 07102-5207 Holmes Murphy 2727 Grand Prairie Parkway Waukee, IA 50263 Brian Deimerly (515) 223-6906 Aggregate Bonding Capacity: $ 25 million Available Bonding Capacity as of date of this submittal: $ 24 million 6. CONSTRUCTION EXPERIENCE: A. Current Experience: List on Schedule A all uncompleted projects currently under contract. B. Previous Experience: List on Schedule B at least three (3) projects completed within the last three (3) years that had a similar scope of work. In the past eight (8) years has the firm listed in Section 1 ever failed to complete a construction contract awarded to it? If YES, add an Attachment that provides details of the circumstances and include Project Owner's contact information. U NO ❑YES Do you have direct related project experience? If no direct related project experience, add an Attachment that explain how you intend to complete the contract fI NO RYES Have you ever been found not to be a responsible Bidder under Iowa Code Chapter 26? If YES, add an Attachment that provides details of the circumstances and include Project Owner's contact information. IXI NO YES SECTION 00471 Page 5 of 12 In the past eight (8) years has any Corporate Officer, Partner, Joint Venture participant or Proprietor ever failed to complete a construction contract awarded to them in their name or when acting as a principal of another entity? If YES, add an Attachment that provides details of the circumstances and include Project Owner's contact information. IXI NO YES Are there any judgments, claims, disputes or litigation pending or outstanding with an individual value greater than $200,000 involving the firm listed in Section 1 or any of its officers (or any of its partners if a partnership or any of the individual entities if a joint venture)? If YES, add an Attachment that provides details of the circumstances and include Project Owner's contact information. X NO YES Have you ever been declared in default under a performance Bond in the last five (5) years? If YES, add an Attachment that provides details of the circumstances and include the name and contact person of the owner(s) of the project and the contact person at the surety/Bonding company. X NO I f YES Are you currently being investigated for or have previously violated in the last five years any of the following state or federal laws: Iowa Minimum Wage Act, Iowa Non- English Speaking Employees Act, Iowa Child Labor Act, Iowa Labor Commissioner's Right to Inspect Premises, Iowa Compensation Insurance Act, Employment Security Act, Iowa Competition Act, Iowa Income, Corporate and Sales Tax Code, Iowa Employee Registration Requirements, Iowa Hazardous Chemical Risks Act, Iowa Wage Payment Collection Act, Federal Income and Corporate Tax Code, The National Labor Relations Act, The Drug -Free Workplace Act, the Employee Retirement Insurance Security Act, Title VI of the Civil Rights Act of 1964, The Fair Labor Standards Act: If YES, add an Attachment that provides details of the circumstances and explain. X NO YES SECTION 00471 Page 6 of 12 7. SAFETY PROGRAM: Name of Contractor's Safety Officer: Randy Steffen Name of Contractor's Safety Officer assigned to the project: Randy Steffen Include the following as attachments: A. Provide as an Attachment Contractor's OSHA No. 300- Log & Summary of Occupational Injuries & Illnesses for the past 2 years. Contractor must submit the same information for all proposed Subcontractors performing Work having a value in excess of 10 percent of the total bid amount, within 72 hours after the bid opening. NONE -- B. Provide as an Attachment Contractor's list of all OSHA Citations & Notifications of Penalty (monetary or other) received within the last 2 years (indicate disposition as applicable) - IF NONE SO STATE. Contractor must submit the same information for all proposed Subcontractors performing Work having a value in excess of 10 percent of the total bid amount, within 72 hours after the bid opening. NONE -- C. Provide as an Attachment Contractor's list of all safety citations or violations under any state all received within the last 2 years (indicate disposition as applicable) - IF NONE SO STATE. Contractor must submit the same information for all proposed Subcontractors performing Work having a value in excess of 10 percent of the total bid amount, within 72 hours after the bid opening. D. Provide the following for the firm listed in Section 3 (attach additional sheets as necessary) the following (Contractor must submit the same information for all proposed Subcontractors performing Work having a value in excess of 10 percent of the total bid amount, within 72 hours after the bid opening): Workers' compensation Experience Modification Rate (EMR) for the last 2 years: YEAR 2018 YEAR 2017 EMR 1.40 EMR 1,18 Total Recordable Frequency Rate (TRFR) for the last 2 years: YEAR 2017 TRFR 3 YEAR 2016 TRFR 3 Total number of man-hours worked for the last 2 Years: YEAR 2017 TOTAL NUMBER OF MAN-HOURS 155,853 YEAR 2016 TOTAL NUMBER OF MAN-HOURS 158,365 SECTION 00471 Page 7 of 12 8. EQUIPMENT: Within 72 hours after the bid opening, provide a statement that explains the contractual relationship between the firm listed in Section 3 and the owners of major pieces of equipment that will be utilized on this project. MAJOR EQUIPMENT: List on Schedule C all pieces of major equipment available for use on this Project. I HEREBY CERTIFY THAT THE INFORMATION SUBMITTED HEREWITH, INCLUDING ANY ATTACHMENTS, IS TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF AND THAT THE CITY OF DUBUQUE MAY RELY ON THE INFORMATION PROVIDED. NAME OF ORGANIZATION: 4 SIGNATURE: NAME: TITLE: DATED: NOTARY ATTEST: SUBSCRIBED AND SWORN TO BEFORE ME THIS Irr DAY OF/ ee,.'er, 20 /8 NOTARY PUBLIC - STATE OF ----Lc),—) MY COMMISSION EXPIRES:— - 19 REQUIRED ATTACHMENTS: Randy Steffen Superintendent ‘1 he 1. Schedule A (Current Experience). 2. Schedule B (Previous Experience). 3. Evidence of authority for individuals listed in Section 3 to bind organization to a Contract. 4. Resumes of officers and key individuals (including Safety Officer) of firm named in Section 1. 5. Additional items as needed to complete background information request. SECTION 00471 Page 8 of 12 SCHEDULE A PROJECTS CURRENTLY UNDER CONTRACT Project Name: LEA 5T __SEE ATTA c/-iE.fl Project Information Project Type: Contract Start Date: Contract End Date: Percent Complete: Project Name: Contract Amount: Project Information Project T •e: Contract Start Date: Contract End Date: Percent Complete: Project Name: Contract Amount: Project Information Project Type: Contract Start Date: Contract End Date: Percent Complete: Project Name: Contract Amount: Project Information Project Type: Contract Start Date: Contract End Date: Percent Complete: Project Name: Contract Amount: Project Information Project Type: Contract Start Date: Contract End Date: Percent Complete: Project Name: Contract Amount: Project Information Project Type: Contract Start Date: Contract End Date: Percent Complete: Contract Amount: SECTION 00471 Page.9 of 12 SCHEDULE A PROJECTS CURRENTLY UNDER CONTRACT Project Name: pL E-A S E SEE / i 1,4 0-( F 0 Project Information Project Type: Contract Start Date: Contract End Date: Percent Complete: Contract Amount: Project Name: Project Information Project Type: Contract Start Date: Contract End Date: Percent Complete: Project Name: Contract Amount: Project Information Project Type: Contract Start Date: Contract End Date: Percent Complete: Project Name: Contract Amount: Project Information Project Type: Contract Start Date: Contract End Date: Percent Complete: Project Name: Contract Amount: Project Information Project Type: Contract Start Date: Contract End Date: Percent Complete: Project Name: Contract Amount: Project Information Project Type: Contract Start Date: Contract End Date: Percent Complete: Contract Amount: Tschiggfrie Excavating Backlog Schedule A -Current Experience Job* 775 779 781 787 788 791 795 796 810 814 815 816 817 821 822 825 Job Description LL Pelling-Linn Co Hwy 100 Jim Schroeder Co-IDOT Dubuque Peterson Con.-IDOT-Dubuque Co IDOT-Johnson/Linn Pipe Culvert Mathy Cons-IDOT Fayette Co. Top Grade -Manchester Street Steger-IDOT-SW Arterial Box Independence -2nd St NE PCC Moyna-Linn Co Slipline Pipe Fayette -Sanitary Sewer Repairs Independence -17th St Int. Imp. Sherrill -Drain Tile Lagoon IDOT-Fayette Co PCC Trail Taylor Construction- Dyersvill City of Manchester - South Tam City of Dyersville - Beltline Contract $ 3,726,506 $ 174,093 $ 1,304,706 $ 2,328,512 $ 201,178 $ 303,639 $ 625,929 $ 247,273 $ 25,560 $ 252,817 $ 189,705 $ 26,834 $ 258,672 $ 63,937 $ 14,832 $ 30,480 Rev To Date $ 3,417,275 $ 285 $ 706,087 $ 2,127, 711 $ 147,247 148,571 484,145 70,156 2,623 Backlog $ 309,231 $ 173,808 $ 598,619 $ 200,800 $ 53,931 $ 155,068 $ 141,784 $ 177,117 $ 25,560 $ 250,194 $ 189,705 $ 26,834 $ 258,672 $ 63,937 $ 14,832 $ 30,480 $ 9,774,672 $ 7,104,100 $ 2,670,571 SECTION 00471 Page 10 of 12 PREVIOUS EXPERIENCE (In SCHEDULE B ude ALL Similar Projects Project Name: PL EI S E 5F- r A e-AcE F 0 Project Information Project Type: Contract Start Date: Contract End Date: Percent Complete: Project Name: Contract Amount: Project Information Project Type: Contract Start Date: Contract End Date: Percent Complete: Project Name: Contract Amount: Project Information Project Type: Contract Start Date: Contract End Date: Percent Complete: Project Name: Contract Amount: Project Information Project Type: Contract Start Date: Contract End Date: Percent Complete: Project Name: Contract Amount: Project Information Project Type: Contract Start Date: Contract End Date: Percent Complete: Project Name: Contract Amount: Project Information Project Type: Contract Start Date: Contract End Date: Percent Complete: Contract Amount: SECTION 00471 Page 11 of 12 SCHEDULE B PREVIOUS EXPERIENCE. Include ALL Similar Proj Project Name: YLEA5E SEE /1 d!,AcHrp Project Information Project Type: Contract Start Date: Contract End Date: Percent Complete: Project Name: Contract Amount: Project Information Project Type: Contract Start Date: Contract End Date: Percent Complete: Project Name: Contract Amount: Project Information Project Type: Contract Start Date: Contract End Date: Percent Complete: Project Name: Contract Amount: Project Information Project Type: Contract Start Date: Contract End Date: Percent Complete: Project Name: Contract Amount: Project Information Project Type: Contract Start Date: Contract End Date: Percent Complete: Project Name: Contract Amount: Project Information Project Type: Contract Start Date: Contract End Date: Percent Complete: Contract Amount: Schedule B - Record of Past Experience Page 1 of 2 RECORD OF PAST EXPERIENCE 7. List below construction projects performed by the Company's own forces for the past three or more years, including Federal, State, County, City and private work. List total dollar amounts and work category dollar amounts for each project. In addition, cubic yards (CY) should also be shown for excavation square yards (sy) for PCC Pavement and tons for ACC Pavement. Attach additional sheets if necessary. 1 Dubuque - Bee Branch - Grading & Utilities 2017 $ 207 $ 207 2 Independence - PH II - Curb & Sidewalk Replacement 2017 $ 670 3 Dubuque - Jule Training Center 2017 $ 1,352 $ 391 4 Iowa DOT - Dubuque Co - Hwy 52 Bridge Approach & 2017 $ 509 $ 69 2185'= $ 273 Deck Overlay 5 Dubuque - Graf Solar Farm Project 2017 $ 880 $ 455 305 3,241'F' $ 100 389 10;66 $ 106 6 Iowa DOT - Dubuque Co - Clay Hill Road - Patching & Subgrade 2017 $ 215 $ 140 19 37 34 Other Description $ 2 $ 2 $ 4 $ 257 Removals, Storm Sewer $ 35 $ 4 $ 424 $ 133 $ 57 $ 74 $ 2 $ 273 Water Main, Sanitary Sewer, Storm Sewer, Subdrain, Removals Removals, Pavement Scarification, Storm Sewer Removals, Surveying, Water Main, Storm Sewer, Electrical $ 38 Mobilization 7 Iowa DOT - Jackson Co - Hwy 64 - Sabula to Preston 2017 $ 346 $ 41 $ 1881= $ 138 2005 r $ 10 $ 43 $ 3 $ 111 Storm Sewer, Removals 8 McGregor- Ash St- Pavement Reconstruction 2017 $ 170 $ 44 s 1 r260w $ 46 '. $ 56 r 609 $ 2 $ 3 $ 19 Storm Sewer, Removals 9 Cedar Rapids - Alliant Energy - Oak Hill Substation 2017 $ 656 $ 198 25 6680 $ 80 486, $ 18 217.. $ 24 $ 6 $ 1 $ 329 10 Clayton Co - Courthouse Parking Lot 2017 $ 169 $ 21 ) )55+ $ 69 11 Manchester- Norby's Farm & Fleet- Parking Lot 2017 $ 297 T $ 297 12 Davenport- Phoenix Corp -1-74 Hauling 2017 $ 300 $ 5,771 $ 1,566 $ 1,597 29Q1`2r $ 336 Storm Sewer, Subdrain, Retaining Wall, Removals $ 3 $ 76 Guardrail, Fence, Removals $ 300 Hauling $ 47 $ $ 43 $ 121 $ 84 $ 17 $ 1,960 Total In Excavation PCC ACC Pavt RCB Erosion Land - Name, Address, and (1000"s) Paving Paving Repair Bridge Culvert Control scaping Signing Other Phone Number of Reference Year ($) ($) QTy (CN) ($) :> 1} tYN°; (8) _ Q� Xt ON ($) ($) ($) ($) (8) (8) (8) 1 Dubuque - Bee Branch - Grading & Utilities 2017 $ 207 $ 207 2 Independence - PH II - Curb & Sidewalk Replacement 2017 $ 670 3 Dubuque - Jule Training Center 2017 $ 1,352 $ 391 4 Iowa DOT - Dubuque Co - Hwy 52 Bridge Approach & 2017 $ 509 $ 69 2185'= $ 273 Deck Overlay 5 Dubuque - Graf Solar Farm Project 2017 $ 880 $ 455 305 3,241'F' $ 100 389 10;66 $ 106 6 Iowa DOT - Dubuque Co - Clay Hill Road - Patching & Subgrade 2017 $ 215 $ 140 19 37 34 Other Description $ 2 $ 2 $ 4 $ 257 Removals, Storm Sewer $ 35 $ 4 $ 424 $ 133 $ 57 $ 74 $ 2 $ 273 Water Main, Sanitary Sewer, Storm Sewer, Subdrain, Removals Removals, Pavement Scarification, Storm Sewer Removals, Surveying, Water Main, Storm Sewer, Electrical $ 38 Mobilization 7 Iowa DOT - Jackson Co - Hwy 64 - Sabula to Preston 2017 $ 346 $ 41 $ 1881= $ 138 2005 r $ 10 $ 43 $ 3 $ 111 Storm Sewer, Removals 8 McGregor- Ash St- Pavement Reconstruction 2017 $ 170 $ 44 s 1 r260w $ 46 '. $ 56 r 609 $ 2 $ 3 $ 19 Storm Sewer, Removals 9 Cedar Rapids - Alliant Energy - Oak Hill Substation 2017 $ 656 $ 198 25 6680 $ 80 486, $ 18 217.. $ 24 $ 6 $ 1 $ 329 10 Clayton Co - Courthouse Parking Lot 2017 $ 169 $ 21 ) )55+ $ 69 11 Manchester- Norby's Farm & Fleet- Parking Lot 2017 $ 297 T $ 297 12 Davenport- Phoenix Corp -1-74 Hauling 2017 $ 300 $ 5,771 $ 1,566 $ 1,597 29Q1`2r $ 336 Storm Sewer, Subdrain, Retaining Wall, Removals $ 3 $ 76 Guardrail, Fence, Removals $ 300 Hauling $ 47 $ $ 43 $ 121 $ 84 $ 17 $ 1,960 Schedule B - Records of Past Experience Page 2 of 2 RECORD OF PAST EXPERIENCE 7. List below construction projects performed by the Company's own forces for the past three or more years, including Federal, State, County, City and private work. List total dollar amounts and work category dollar amounts for each project. In addition, cubic yards (CY) should also be shown for excavation square yards (sy) for PCC Pavement and tons for ACC Pavement Attach additional sheets 0 necessary. 1 Dubuque - Bee Branch - Grading & Utilities 2 Dubuque Regional Airport - Grading & Utilities 2016 $ 959 $ 245 3 IDOT - Dubuque Co - US 52 Structures 2016 $ 190 $ 79 4 IDOT - Clinton Co - RCB Culvert Rplcmnt - Main Ave 2016 $ 2,205 $ 151 $ 6b0° $ 231 3,320 ' $ 60 5 Marengo - Sanitary Sewer Rehab 2016 $ 372 $ 38 6 IDOT - Linn Co - Hauling 2016 $ 701 7 La Porte City - PCC Pavement- Bishop Ave Recon 2016 $ 694 $ 114 2,900,; $ 303 8 IDOT - Urbana - PCC Pavement- Union Ave 2016 $ 487 $ 18 2 255';' $ 256 9 IDOT - Dubuque - 2016 Bridge Repairs 2016 $ 335 $ 54 $ 30 10 IDOT - Garnavillo - PCC Pavement - Van Buren St 2016 $ 550 $ 47 1,100';' $ 313 11 IDOT-Benton Co - Hwy 150 - Subdrain 2016 $ 119 $ 19 12 Independence - Street Improvements 2016 $ 1,124 $ 90 4 000 $ 405 13 Alliant Energy - Oak Hill Substation - Sitework 2016 $ 287 $ 62 418Oa $ 16 2016 $ 6,619 $ 2,614 124 25 27 3 Other Description $ 68 $ 16 $ 3,921 Water Main, Sanitary Sewer, Storm Sewer $ 191 $ 5 $ 518 Storm Sewer, Subdrain $ 111 Storm Sewer $ 983 $ 15 $ 4 $ 19 $ 742 Removals, Storni Sewer, Sanitary Sewer $ 22 $ 188 Sanitary Sewer $ 701 Trucking $ 92 $ 7 $ 9 $ 10 $ 134 Storm Sewer, Subdrain $ 3 $ 10 $ 15 $ 185 Storm Sewer, Subdrain, Electrical $ 108 $ 1 $ 2 $ 40 $ 73 Water Main, Sanitary Sewer, Storm Sewer, Pavement Markings $ 7 $ 22 $ 14 $ 147 Removals, Storm Sewer, Subdrain $ 100 Subdrain $ 14 $ 13 $ 12 $ 590 Removals, Storm Sewer, Subdrain $ 12 $ 57 $ 2 $ 135 Removals, Staking, Structures $ 14,642 $ 3,493 212010: $ 1,592 45- $ 239 $ 108 $ 1,075 $ 318 $ 133 $ 139 $ 7,545 Total In Excavation PCC ACC Pavt. RCB Erosion Land - Name, Address, and (1000"s) Paving Paving Repair Bridge Culvert Control soaping Signing Other Phone Number of Reference Year ($) ($) QTY (CY,),: (5) QTY (S62 (5) Z1.3N:(TQt (5) (5) ($) (5) (5) (5) ($) 1 Dubuque - Bee Branch - Grading & Utilities 2 Dubuque Regional Airport - Grading & Utilities 2016 $ 959 $ 245 3 IDOT - Dubuque Co - US 52 Structures 2016 $ 190 $ 79 4 IDOT - Clinton Co - RCB Culvert Rplcmnt - Main Ave 2016 $ 2,205 $ 151 $ 6b0° $ 231 3,320 ' $ 60 5 Marengo - Sanitary Sewer Rehab 2016 $ 372 $ 38 6 IDOT - Linn Co - Hauling 2016 $ 701 7 La Porte City - PCC Pavement- Bishop Ave Recon 2016 $ 694 $ 114 2,900,; $ 303 8 IDOT - Urbana - PCC Pavement- Union Ave 2016 $ 487 $ 18 2 255';' $ 256 9 IDOT - Dubuque - 2016 Bridge Repairs 2016 $ 335 $ 54 $ 30 10 IDOT - Garnavillo - PCC Pavement - Van Buren St 2016 $ 550 $ 47 1,100';' $ 313 11 IDOT-Benton Co - Hwy 150 - Subdrain 2016 $ 119 $ 19 12 Independence - Street Improvements 2016 $ 1,124 $ 90 4 000 $ 405 13 Alliant Energy - Oak Hill Substation - Sitework 2016 $ 287 $ 62 418Oa $ 16 2016 $ 6,619 $ 2,614 124 25 27 3 Other Description $ 68 $ 16 $ 3,921 Water Main, Sanitary Sewer, Storm Sewer $ 191 $ 5 $ 518 Storm Sewer, Subdrain $ 111 Storm Sewer $ 983 $ 15 $ 4 $ 19 $ 742 Removals, Storni Sewer, Sanitary Sewer $ 22 $ 188 Sanitary Sewer $ 701 Trucking $ 92 $ 7 $ 9 $ 10 $ 134 Storm Sewer, Subdrain $ 3 $ 10 $ 15 $ 185 Storm Sewer, Subdrain, Electrical $ 108 $ 1 $ 2 $ 40 $ 73 Water Main, Sanitary Sewer, Storm Sewer, Pavement Markings $ 7 $ 22 $ 14 $ 147 Removals, Storm Sewer, Subdrain $ 100 Subdrain $ 14 $ 13 $ 12 $ 590 Removals, Storm Sewer, Subdrain $ 12 $ 57 $ 2 $ 135 Removals, Staking, Structures $ 14,642 $ 3,493 212010: $ 1,592 45- $ 239 $ 108 $ 1,075 $ 318 $ 133 $ 139 $ 7,545 SECTION 00471 SCHEDULE C - pL.0/9 Str F 4 4 cHr O Page 12 of 12 LIST OF MAJOR EQUIPMENT TO BE UTILIZED ON THIS PROJECT ITEM MODEL YEAR CONDITION RUN HOURS OWNER ___= END OF SECTION 00471 ==== SCEHDULE C - Equipment Available to be utilized Backhoe CAT D4 Dozer CAT D5 Dozer with GPS CAT D6 Dozer with GPS Mini Excavator Excavator, 50 Ton Excavator, 35 Ton Excavator, 15 Ton Excavator, 30 Ton Loader - Track Motor Grader Electric Pumps Drop Hammer Generator Office Trailer Roller - Steel Drum Skid Loader - Rubber Tire Skid Loader - Track Dump Trucks Lowboy OSHA's Form 300A (Rev. 01/2004) Summary of Work -Related Injuries and Illnesses Note: You can type input into this form and save it. Because the forms in this recordkeeping package are "fillable/writable" PDF documents, you can type into the input form fields and then save your inputs using the free Adobe PDF Reader. v�.�.wsc.aaa.n....ors;. ,��s,.v,.0 saw...ryntewzxu:�cu�.:;�,.wnv�.-u,aua..cu:-..,esm:i:aas..�acwv.u:u=v�.nuxvc.v�.;ursuw.,�us�r:.:v.�r - ..�"uuuu�rsivwsanvdwars.;.uv..artuamtiwvu.rvu�sr� All establishments covered by Part 1904 must complete this Summary page, even if no work-related injuries or illnesses occurred during the year. Remember to review the Log to verify that the entries are complete and accurate before completing this summary. Using the Log, count the individual entries you made for each category. Then write the totals below, making sure you've added the entries from every page of the Log. If you had no cases, write "0." Employees, former employees, and their representatives have the right to review the OSHA Form 300 in its entirety. They also have limited access to the OSHA Form 301 or its equivalent. See 29 CFR Part 1904.35, in OSHA's recordkeeping rule, for further details on the access provisions for these forms. Number of Cases Total number of deaths 0 Total number of cases with days away from work 2 (G) (H) Total number of cases with job transfer or restriction (1) Total number of other recordable cases 0 (I) Number of Days Total number of days away from work 119 (K) Total number of days of job transfer or restriction 83 (L) Injury and Illness Types Total number of ... (M) (1) Injuries (2) Skin disorders 3 0 (3) Respiratory conditions 0 (4) Poisonings 0 (5) Hearing loss 0 (6) All other illnesses 0 Post this Summary page from February 1 to April 30 of the year following the year covered by the form. Public reporting burden for this collection of information is estimated to averaee 50 minutes per response, including time to review time instructions, search and gather the data needed. and complete and review the collection of information. Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number. If you have any comments about these estimates or any other aspects of this data collection, contact: US Department of Labor, OSHA Office of Statistical Analysis, Room N-3644, 200 Constitution Avenue, NW, Washington, DC 20210. Do not send the completed forms to this office. Year 20 17 U.S. Department of Labor Occupational Safety and Health Administration Ponn approved OMB no. 1_18-0176 Establishment information Your establishment name Tschiggfrie Excavating Co Street 425 Julien Dubuque Drive City Dubuque State IA Zip 52003 Industry description (e.g., Manufacture of motor truck hailers) General Contractor - Excavating Standard Industrial Classification (SIC), if known (e.g., 3715) 1915 OR North American Industrial Classification (NA1CS), if known (e.g., 336212) Employment information (/fyou don't have these figures, see the Worksheet on the next page to estimate) Annual average number of employees 69 Total hours worked by all employees last year 155853 Sign here Knowingly falsifying this document may result in a fine. I certify that I have examined this document and that to the best of my Knowledge )a-entrigs are true, accurate, and cpmpleet. Company executive Phone 5.63 _ Ssi _ 7y50 0 c-cjtE rrcQa�f Title Date / Ce / 1t' ave Input OSHA's Form 300 (Rev. 01/2004) L_og of Work -Related Injuries and Illnesses Note: You can type input into this form and save it. Because the forms in this recordkeeping package are "fillable/writable" PDF documents, you can type into the input form fields and then save your inputs using the free Adobe PDF Reader. In addition, the forms are programmed to auto -calculate as appropriate. Attention: This form contains information relating to employee health and must be used in a manner that protects the confidentiality of employees to the extent possible while the information is being used for occupational safety and health purposes. You must record information about every work-related death and about every work-related injury or illness that involves loss of consciousness, restricted work activity orjob transfer, days away from work, or medical treatment beyond first aid. You must also record significant work-related injuries and illnesses that are diagnosed by a physician or licensed health care professional. You must also record work-related injuries and illnesses that meet any of the specific recording criteria listed in 29 CFR Part 1904.8 through 1904.12. Feel free to use two lines for a single case if you need to. You must complete an Injury and Illness Incident Report (OSHA Form 301) or equivalent form for each injury or illness recorded on this form. If you're not sure whether a case is recordable, call your local OSHA office for help. Idef'Itify the person Reset,' ;;Reset+ SiReset Reset.: Reset. Reset: Reset'. Reset ' Reset: (A) Case no. (B) Employee's name (C) Job title (e.g., Welder) Describe the case (D) (E) (F) Date of injury Where the event occurred Describe injury or illness, parts of body or onset of (e.g., Loading dock north end) affected, and object/substance that illness directly injured or made person ill (e.g.. (e.g., 2/10) Second degree burns on right forearm from acetylene torch) 1 Frank Thomas SR Truck Driver 6 / 20 month / day month / day On Hwy to Jobsite Back, Neck, Groin 2 Ryan Naab Foreman 8 / 22 Trailer Park month / day month / day 3 Dave Schumacher Laborer 10 / 17 month / a�— month / day month / day month / day rrstt /tlay month / day Job site Public reporting burden far this collection of information is estimated to average 14 minuses per response, including time to review the instructions, search and gather the data needed, and complete and review the collection of information. Persons are not required to respond to the collection of information unless n displays a currently valid OMB control number. If you have any comments about these estimates or any other aspects of this data collection. cotacP US Department of Labor, OSHA Office of Statistical Analysis, Room N-31+14, 200 Constitution Avenue, NW, Washington, DC 20210. Do not send the completed forms to this office. Year 20 17 U.S. Department of Labor Occupational Safety and Health Administration Form approved OMB no. 1213-0176 Establishment name Tschiggfrie Excavating Co. c;ty Dubuque Classify the case SELECT ONLY ONE box for each case based on the most serious outcome for that case: eriiamed at VOrk e y y JotisOtbd'; Death'.,'fronf work or restritrl ction ; able a • (G) State IA Enter the number of days the injured or Select. the injury column or ill worker was: choose onetype. ofillness. . ' drhdir -:–:edt'SfaaSti.aktt � ;aJr1 Away rowom (K)k 44 days In�urea tuna - Moving I railer Stepped on Broken Fence Post C)' On job transfer or restriction (L) (1) (2) (3) (4) (5) (6) days,:{' )0 days days days 83 days days _daysfi)'i .l �! L 75 days _days 1 !f^ i0 0 0. rc; _days C _days days 0 0. 0 c lf� ' 0'. days _days 0'0 0 ); 0, days i 0. 0l 0 0 —days 0'0'000 0 83 3 0 0 0 0 0 days ave;ln Page totals ® 0 o'''rm kq s .I? 2 1 days _days 0 119 Page 1 of 1 c cg (1) (2) (3) (4) (5) (6) OW Form 300A (Rev. 01/2004) Summary of .:ork-Related injuries -and illnesses All establishments covered by Part 1904 must complete this Summary page, even if no work-related injuries or illnesses occurred during the year. Remember to review the Log to verify that the entries are complete and accurate before completing this summary. Using the Log, count the individual entries you made for each category. Then write the totals below, making sure you've added the entries from every page of the Log. Ifyou had no cases, write '0.' Employees, former employees, and their representatives have the right to review the OSHA Form 300 in its entirety. They also have limited access to the OSHA Form 301 or its equivalent. See 29 CFR Part 7904.35, in OSHA's recordkeeping rule, for further details on the access provisions for these forms. 4Nunabetofcases Total number of Total number of deaths 0 (G) cases with days away from work Total number of days away from work /53— (K) 53 (H) Total number of cases with job transfer or restriction D (1) Total number. of days`of j ob transfer or restriction 1'9 (L) Total 'number of other recordable cases (J) Injury and lllness.9yrpes `, Total number of (M) (1) Injuries (2) Skin disorders (3) Respiratory conditions 2' 0 D (4) Poisonings (5) Iearing loss (6) All other illnesses D D 0 Post this Summary page from February f to April 30 of the year following the year covered by the form. Public reporting burden for this collection of information is estimated to overage 20 minutes per response, including -time to review the instructions, search and gather the data needed, and complete and review the collection of informetion..Persons arc not required to respond to the collection of information unless it displays a currently valid OMB control number. If you have any comments about these estimates or any other aspects of this data collection, contact: US Department of Labor, OSHA Office of Statistical Analysis, Room N-2044, 200 Constitution Avenue, NW, Washington, DC 30210_ Do not send the completed forms to this office. 20 t G. r... U.S. Department of Lab Occupational Safety and Health Admrnistral farm approved Ohili no. 12111-1 Establishment information Your establishment name Street City 11.• Stare ZIP Industry description (e.g., Mant fsture of motor truck trailers) \J Standard Industrial Classification (SIC), if known, (e.g., 3715) ft i OR North American Industrial Classification (NAICS), if -known (e.g., 336212) Employment information (IJyou don't have rhesefi tires, see the Worksheet on the batt; of this page to estimate.) Annual average number of employees Total hours worked by all employers last year 7� /ss 3 Sign here Knowingly falsifying this document may result in a fine. I certify thatI have ermined this document and that to rhe best of my knowledge the entries arc true, accurate, and complete. Company `' (3) ,J S57-7 '70.�� 1/ i- y/iii/ 7 D,,, OSl ,A's -r)rm 300 (Rev 01/2004) Log of Work -Related Injuries and Illnesses You must record information about every work-related death and about every work-related injury or illness that involves loss of consciousness r days away from work, or medical treatment beyond first aid You must also record significant w restricted work activity licensed transfer, care rolessio also record work-related injuries and illnesses that meet any of the specific recording crfteria Ested illnesses that are diagnosed by a physician or health use two tubes P nal You must 9 work-related Attention: This form contains information relating to employee health and must be used in a manner that protects the confidentiality of employees to the extent possible while the information is being used for occupational safety and health purposes. Injunes and 1I n, es for a single case if.you need to. You must complete an Injury and Illness Incident Report (OSHA Form 301) or equivalent form n 29 CFR Part ea19ch injury or4.3 1904.12. Feel free to ibne s recorded on this (orm. If you're not sure whethera case is recordable, call your local OSHA office for help. (A) (9) Case L• mployee's name no. 2 Deserbe he;case (C) . (D) Job title Date of injury (e.g., Wielder) or onset of illness (E) Where the event occurred Loading dock north end) lF h9r2f (21,-W br.,c Le. =1T mernh/csy // month/day /heliean:f._ cl /,:z or.„.r- 5tiDp rh month/day morntt/oay V u c --e- mornh/day month/day-art/enTn/P., cP�r / month/day / month/day / 0OndVtlay month/Cay / month/day / month/day / month/day Public reporting burden for this collection of -information is estimated to average 14 minutes per response, including time to review tu,uun,ons, search and gather -the data needed, and complete and review the collection ofinformation- Persons are not required to respond to the collection or information unless it displays a currently valid 0M13 control r. 11 -you have any commen about these estimates ar any other aspceu ofd6s data collection, conmm US Deportment orLabor, OSHA 05HA Once a I -Statistical Analysis. Room N-3044, 200 Constitution Avenue, N1V, Washington, 00 20010. Do not send dm completed forms 10 EMS office. ( Describe i jury or illness, parts of body affected, and object/substance that directly injured or made person 01 (e.g., Second degree burns 071 right forearm from acetylene torch) Classify the case CHECK ONLY ONE box for each case based on the most serious outcome for that case: 20 U.S. Department of Lab Occupational Safety and Health ddministrat Form approved oath no. I 218-0 Establishment name / S . I ,S e r!, L F,�(GG ✓•=-t City \ /.. u ti? t1F Slate -Lc:, t..J r� Enfetthe number of days the injured or Check the Injury" columc III worker was, choose one type of illness • Remained at Work bays away Joh transfer. Other recard- Death from work or restriction able cases Ze{t vss to / �� o. bs Ip c ne s L o e (G) • (H) f f c Ij«Ki L I) 5s r -s+ � ��tti�ed f`- /0 a.n...t�t, -S 5.'n.� •�r•�c..i+..re (1) (J) 3 ❑ ❑ ❑ ❑ 0 0 5 11.z,ofre a) a, %lr-7 co,.. 7e U 'L -h ❑ 0 C� ese{e r% 5ls�`j``iJrSfee�,..7lf�n[z❑ 0 ❑ P� •) STr_.L e c) J .5 c_CK //i, Ie. ❑ !� 5"I`rG"I-G�.nt S o`t-� e5 rlrtn ,' ait CI CI O ID LI 0 l r s s4.1-1; Wt�sz�rn) : s he 1.e c) Goo=re_-i-e Page totals> 0 0 ❑ 0 ❑ 0 0 0 0 cD Away On job from transfer. ar. work restriction (K)(L) (1) (2) /t� `'I d s �i� d.y.s X 0 (M) l� d.!yt _ days / G days ? city, -5- days days days days dans daps days- days days days days _ days days days days l�S Be sure to transfer these totals to (he Summary page (Form 30C/AJ before you post it. p� Z r5 S da,a Page _- of_ (3) (4) (5) 0 ❑ ❑ ❑ X ❑ ❑ 0 0 0 0 0 0 0 ❑ ❑0 0 0 ❑ O p (1) (2) (3) (4) (5) (1 1.. OSHA's Form 300A (Rev. 01/2004) Summary of Work -Related Injuries and Illnesses Note: You can type input into this form and save it. Because the forms in this recordkeeping package are "fillable/writable' PDF documents, you can type into the input form fields and then save your inputs using the free Adobe PDF Reader. ',.rr,` w.....a l•+.�s ,d ,L..L;i;µy .ki nnj.n_Y:W 4d! ,rr..'A :kxar .w.-+Im�;Y .�.vwr.rHLk, r vv+1.-5'.r:A„ Y+. !!r?.,/u we r.{rr.5 rl{µ.-.r .w:�ryaA rrrl3vS: ?�+:'r4o �r. 'r1.4[1�4 r-..ro-.uvniaRti-rtWZli..vw�W,�"�:+i0i0: t�.a L9.;?Xnwn'1rWnrr...., ;::tilt: All establishments covered by Part 1904 must complete this Summary page, even if no work-related injuries or illnesses occurred during the year. Remember to review the Log to verify that the entries are complete and accurate before completing this summary. Using the Log, count the individual entries you made for each category. Then write the totals below, making sure you've added the entries from every page of the Log. If you had no cases, write "0." Employees, former employees, and their representatives have the right to review the OSHA Form 300 in its entirety. They also have limited access to the OSHA Form 301 or its equivalent. See 29 CFR Part 1904.35, in OSHA's recordkeeping rule, for further details on the access provisions for these forms. Number'uf Cases Total number of deaths (G) Total number of cases with days away from work ' Number, of Days Total number of days away from work (K) (H) Total number of cases with job transfer or restriction 0) Total number of days of job transfer or restriction (L) ut-7 Injuryand Illness Types Total number of.. . (M) (1) Injuries (2) Skin disorders (3) Respiratory conditions 3 0 (4) Poisonings Total number of other recordable cases 3 (J) (5) Hearing loss 0 (6) All other illnesses (.) Post this Summary page from February 1 to April 30 of the year following the year covered by the form. Public reporting burden for this collection of information is estimated to average 50 minutes per response, including time to review the instructions, search and gather the data needed. and complete and review the collection of information. Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number. If you have any comments about these estimates or any otter aspects of Ibis data collection, contact: US Department of Labor, OSHA Office of Statistical Analysis, Room N-36,14,200 Constitution Avenue, NW, Washington, DC 20210. Do not send the completed forms to this office. Year 20/5 U.S. Department of Labor Occupational Safety and Health Administration Porro approved OMB no. 1210-0176 Establishment information Your establishment name mak t r, 5c`.I� •CQ 7", (",„ Street 9,2S I t e/ Ib6h5 21 Pfr o it City b�✓� State Zip 3 c)c33 Industry description (e.g., Manufacture ofnmtor truck bailers) Standard Industrial Classification (SIC), if known (e.g., 3715) OR l co -6" North American Industrial Classification (NAICS), if known (e.g., 336212) Employment information (/fyou don't have these figures, see the Worksheet an the next page 10 estimate) Annual average number of employees Total hours worked by all employees last year Sign here Knowingly falsifying this document may result in a fine. I certify that I have examined this document and that to the best of my -nowleldge tly entries are true, accurate, and comp! Company executive Phone 3 -7 - %c%•D 6,7 1(2,58), Title Date a3. /+3-1 l 75 Save Input OSHA's Form 300 (Rev. 01/2004) Log of Work -Related Injuries and Illnesses Note: You can type input into this form and save it. Because the forms in this recordkeeping package are "fillable/writable" PDF documents, you can type into the input form fields and then save your inputs using the free Adobe PDF Reader. In addition, the forms are programmed to auto -calculate as appropriate. Attention: This form contains information relating to employee health and must be used in a manner that protects the confidentiality of employees to the extent possible while the information is being used for occupational safety and health purposes. muWrF,�. 'n4«aw aw4. V n,o,+..M.'. p'.. v.>L .<4 :VY7iY.1 u�+uVr a.;N"N.k: WawK4vkN0. }k.+nYk. 1✓,-MXwq SN,m45u: arwxaKtlNi�w.]Wn+fwf—KµuvN4ll trpN::TtlIUTu9dk FqX <n +'vXRiN➢1z YUE.cgb'IkhTy 4 vlFr1.rW.V.Nu�BS+: Mx➢,6,tiW:':(ti tkAh_1a .fF S},Xu"qs� Ir`vt X2ak::..W.a�a';. You must record information about every work-related death and about every work-related injury or illness that involves loss of consciousness, restricted work activity or job transfer, days away from work, or medical treatment beyond first aid. You must also record significant work-related injuries and illnesses that are diagnosed by a physician or licensed health care professional. You must also record work-related injuries and illnesses that meet any of the specific recording criteria listed in 29 CFR Part 1904.8 through 1904.12. Feel free to use two lines for a single case if you need to. You must complete an Injury and Illness Incident Report (OSHA Form 301) or equivalent form for each injury or illness recorded on this form. If you're not sure whether a case is recordable, call your local OSHA office for help. Identify the person 'Reset Reset Reset:. " Resetl F Re'sef l (A) Case no. (B) Employee's name (C) Desc (D) ibe the case (E) (F) Job title Date of injury Where the event occurred Describe injury or illness, parts of body (e.g., Welder) or onset of (e.g., Loading dock north end) affected, and object/substance that illness directly injured or made person ill (e.g., (e.g., 2//0) Second degree burns on right forearm from acetylene torch) C1> (e.ccvl �JrJ tm h t\ oa 2 month /day— {ahha i �4�v JSr �2 f (a) S th Reset Reset': Reset Reset; Reset, -FrL1T Wise r+v'i month/day i 2 I .�.'7 nth / day j r000nth/day— LA.-1133.1o,2_ ay 4 L'S / / t month / day- month / day month / day month / day— month ay month/day month / day — .ZP,tar, t.aleix kkt.ic L nhc.k — Chew.. i�-vr, U.S.titit Department of Labor Occupational Safety and Health Administration Form approved 0145 no. 1210-0170 Establishment name /sh i J _ F.-.)-(ca..0 Y' r‘,5 `=r0, -Tri City -D;JryyUeState 0,,_)(._ Classify the case SELECT ONLY ONE box for each case based on the most serious outcome for that case: Death (G) Enter the number of days the injured or Select the "Injury". column or in worker was: choose one type of illness: rs t,,, a mu.,,uttusu, N.wnna„rusauackfttiROAKNItAlnnuv' +ve54 Mlrtt.a.r,e?,t,it , t h .titaiitY, s,., At l .a tt .1Zemained a--IBtork (M) • Days away Job transfer 'Other record. from work or restriction able cases (H) (I) (J) C Co 2,;4_P` C Public reporting burden for this collection of inromtation is estimated to average 14 minutes ler response, including time to review the instnictions. search and gather the data needed. and complete and review die collection of i; tonnation. Persons are not required to respond to the collection of inlonnation unless it displays a currently valid OMB control number. If you have any continents about these estimates or any other aspects of'this data collection contact: US Department of Labor. OSHA Office of Statistical Analysis. Room N-3644. 200 Constitution Avenue, NW, Washington, DC 20210. Dn not send the completed forms to tins office. Page totals ora Page; Q Q Away from work On job transfer or restriction (K) (L) 1 i"1 days t1 days Dl days _days days days days Z5 days days days days _days days days days _days days _days loq 80 (1) (2) (3) (4) (5) (6) c c (- c- c ( c 'c c c C 'c c �c C r �l t ` Y` J/�c rc^ 1 c t r c c' C (- C (` c t c c c c c c c c 3 o (7 a o z) (1) (2) (3) (4) (5) (6) November 9, 2018 To whom it may concern, TSCHIGGFRIE EXCAVATING 425 JULIEN DUBUQUE DRIVE PHONE 563 557-7450 - FAX 563 557-7585 DUBUQUE, IOWA 52003 Our General Superintendents Randy Steffen, Erin Rogers, and Mike Schroeder have the authority to sign for and bind our organization to an agreement. Thank you Rod Tschiggfrie Corporate Secretary Tschiggfrie Excavating SECTION 00460 Bidder Status Form SECTION 00460 To be completed by all Bidders Part A Please answer "Yes" or "No" for each of the following: l Yes 0 No My company is authorized to transact business in Iowa. (To help you determine if your company is authorized, please review the worksheet on the next page). ]Yes 0 N My company has an office to transact business in Iowa. 1IYes ❑No My company's office in Iowa is suitable for more than receiving mail, telephone calls, and e-mail. IYes 0 N My company has been conducting business in Iowa for at least 3 years prior to the first request for Bids on this project. tlYes 0 No My company is not a subsidiary of another business entity or my company is a subsidiary of another business entity that would qualify as a resident Bidder in Iowa. If you answered "Yes" for each question above, your company qualifies as a resident Bidder. Please complete Parts B and D of this form. If you answered "No" to one or more questions above, your company is a non-resident Bidder. Please complete Parts C and D of this form. To be completed by all resident Bidders Part B My company has maintained offices in Iowa during the past 3 years at the following addresses: Dates: 01/01/1977 to present Address: 425 Julien Dubuque Drive (mm/dd/yyyy) Dates: (mm/ddlyyyy) Dates: to to City, State, Zip: Address: City, State, Zip: Address: (mm/dd/yyyy) You may attach additional sheet(s) if needed. City, State, Zip: Dubuque, IA 52003 To be com feted b all non- resident Bidders Name of your home state or foreign country reported to the Iowa Secretary of State. Part C Does your company's home state or foreign country offer preferences to Bidders who are residents? ❑ Yes 0 No If you answered "Yes" to question 2, identify each preference offered by your company's home state or foreign country and the appropriate legal citation. You may attach additional sheet(s) if needed. To be completed by all Bidders Part D certify that the statements made on this document are true and complete to the best of my knowledge and I know that my failure ter rde ccurate and truthful information may be a reason to reject my Bid. Firm Name r' schi frie Excavating Signature: Date: 11/8/18 You must s mit the complete form to the government body requesting Bids per 875 Iowa Administrative Code Chapter 156 This Form has been approved by the Labor Comrnissioner 309-6001 02-14 Worksheet: Authorization to Transact Business This worksheet may be used to help complete Part A of the Resident Bidder Status form. If at least one of the following describes your business, you are authorized to transact business in Iowa. Ll Yes ❑ No My business is currently registered as a contractor with the Iowa Division of Labor. ❑ Yes 0 No My business is a sole proprietorship and I am an Iowa resident for Iowa income tax purposes. O Yes 0 No My business is a general partnership or joint venture. More than 50 percent of the general partners or joint venture parties are residents of Iowa for Iowa income tax purposes. ❑ Yes ❑ No My business is an active corporation with the Iowa Secretary of State and has paid all fees required by the Secretary of State, has filed its most recent biennial report, and has not filed articles of dissolution. O Yes ❑ No My business is a corporation whose articles of incorporation are filed in a state other than Iowa, the corporation has received a certificate of authority from the Iowa secretary of state, has filed its most recent biennial report with the secretary of state, and has neither received a certificate of withdrawal from the secretary of state nor had its authority revoked. ❑ Yes 0 No My business is a limited liability partnership which has filed a statement of qualification in this state and the statement has not been canceled. ❑ Yes 0 No My business is a limited liability partnership which has filed a statement of qualification in a state other than Iowa, has filed a statement of foreign qualification in Iowa and a statement of cancellation has not been filed. ❑ Yes 0 No My business is a limited partnership or limited liability limited partnership which has filed a certificate of limited partnership in this state, and has not filed a statement of termination. O Yes ❑ No My business is a limited partnership or a limited liability limited partnership whose certificate of limited partnership is filed in a state other than Iowa, the limited partnership or limited liability limited partnership has received notification from the Iowa secretary of state that the application for certificate of authority has been approved and no notice of cancellation has been filed by the limited partnership or the limited liability limited partnership. O Yes 0 No My business is a limited liability company whose certificate of organization is filed in Iowa and has not filed a statement of termination. ❑ Yes 0 No My business is a limited liability company whose certificate of organization is filed in a state other than Iowa, has received a certificate of authority to transact business in Iowa and the certificate has not been revoked or canceled. ___= END OF SECTION 00460 =___