Traffic Safety Improvement Agreement Copyright 2014
City of Dubuque Consent Items # 8.
ITEM TITLE: Traffic Safety Improvement Agreement
SUMMARY: City Manager recommending authorization for the Mayor to execute an
agreement with the Iowa Department of Transportation for Traffic Safety
Improvement Program Funding in the City of Dubuque for the Grandview
Avenue at Loras Boulevard and Grandview Avenue at University Avenue
Intersection Improvements.
RESOLUTION Approving the Iowa Department of Transportation
Agreement for Traffic Safety Improvement Program Funding for the City of
Dubuque Grandview Avenue at Loras Boulevard and Grandview Avenue
at University Avenue Intersection Improvements
SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Adopt Resolution(s)
ATTACHMENTS:
Description Type
❑ Traffic Safety Improvement Agreement-MVM Memo City Manager Memo
❑ Staff Memo Staff Memo
❑ Resolution Resolutions
❑ IDOT Agreement Supporting Documentation
THE CITY OF Dubuque
UBE I
erica .i
Masterpiece on the Mississippi 2007-2012-2013
TO: The Honorable Mayor and City Council Members
FROM: Michael C. Van Milligen, City Manager
SUBJECT: Agreement for Traffic Safety Improvement Program Funding for the
Grandview Avenue at Loras Boulevard and Grandview Avenue at
University Avenue Intersection Improvements
Project No. CS-TSF-2100(680)--85-31
Iowa DOT Agreement No. 2015-TS-020
DATE: January 28, 2015
City Engineer Gus Psihoyos recommends City Council authorization for the Mayor to
execute an agreement with the Iowa Department of Transportation for Traffic Safety
Improvement Program Funding in the City of Dubuque for the Grandview Avenue at
Loras Boulevard and Grandview Avenue at University Avenue Intersection
Improvements.
The total cost for these improvements is $478,750. The Traffic Safety Improvements
grant will fully fund this project construction with no additional City match funds required.
I concur with the recommendation and respectfully request Mayor and City Council
approval.
Mic ael C. Van Milligen
MCVM:jh
Attachment
cc: Barry Lindahl, City Attorney
Cindy Steinhauser, Assistant City Manager
Teri Goodmann, Assistant City Manager
Gus Psihoyos, City Engineer
THE CITY OF Dubuque
DUB E A'-A�ca cy
Masterpiece on the Mississippi 2007.2012.2013
TO: Michael C. Van Milligen, City Manager
FROM: Gus Psihoyos, City Engineer CD
DATE: January 26, 2015
RE: Agreement for Traffic Safety Improvement Program Funding for the
Grandview Avenue at Loras Boulevard and Grandview Avenue at
University Avenue Intersection Improvements
Project No. CS-TSF-2100(680)-85-31
Iowa DOT Agreement No. 2015-TS-020
INTRODUCTION
The enclosed resolution authorizes the Mayor to execute an agreement with the Iowa
Department of Transportation (Iowa DOT) for Traffic Safety Improvement Program
Funding in the City of Dubuque for the Grandview Avenue at Loras Boulevard and
Grandview Avenue at University Avenue Intersection Improvements.
BACKGROUND
The location is along Grandview Avenue between Loras and University. Currently
University is a four way stop and has delays during peak movements. Loras is currently
signalized, but the signals are in deteriorated condition. The existing conduits are
impassable and vehicle detection has not worked for many years turning the signal
essentially into a "pretimed" signal. There are also no left turn signals for Grandview
Avenue traveling North or South. These two intersections are adjacent to Allison-
Henderson Memorial Park which sees heavier pedestrian movements and the existing
signals do not have pedestrian signal heads.
This agreement will signalize the intersection of University and Grandview, and to
reconstruct the signal at Loras and Grandview. Both signals will have dedicated left
turn movements along with pedestrian signals. These two signals will be tied together
with fiber optics so that progression for the north/south movement can be obtained. The
fiber will also go into the Traffic Operations Center at City Hall for remote monitoring
and adjustments.
These proposed improvements were recommended by the East/West Corridor Study
that was formally adopted by the City Council at the February 20, 2012 City Council
meeting. The total cost for these improvements is $478,750.00. The Traffic Safety
Improvements grant will fully fund this project construction with no additional City match
funds required.
RECOMMENDATION
I recommend that the City Council authorize the Mayor to execute an agreement with
the Iowa DOT for Traffic Safety Improvement Program Funding for the Grandview at
Loras and Grandview at University Intersection Improvements.
ACTION TO BE TAKEN
The City Council is requested to authorize the Mayor to execute an agreement with the
Iowa Department of Transportation for Traffic Safety Improvement Program Funding for
the Grandview at Loras and Grandview at University Intersection Improvements.
cc: Don Vogt, Director of Public Works
Bob Schiesl, Assistant City Engineer
John Klosterman, Street & Sewer Maintenance Supervisor
David Ness, Civil Engineer
Duane Richter, Traffic Engineer
2
RESOLUTION NO. 28-15
RESOLUTION APPROVING THE IOWA DEPARTMENT OF TRANSPORTATION
AGREEMENT FOR TRAFFIC SAFETY IMPROVEMENT PROGRAM FUNDING FOR
THE CITY OF DUBUQUE GRANDVIEW AVENUE AT LORAS BOULEVARD AND
GRANDVIEW AVENUE AT UNIVERSITY AVENUE INTERSECTION
IMPROVEMENTS
Whereas, the increasing growth of traffic volumes, along with operational and
safety concerns, at Grandview Avenue at Loras Boulevard and Grandview Avenue at
University Avenue Intersection in the City of Dubuque could be improved by intersection
and traffic signal improvements; and
Whereas, the City of Dubuque has determined that improvements to this
intersection, as recommended in the East-West Corridor Connectivity Study of the
Grandview Avenue at Loras Boulevard and Grandview Avenue at University Avenue as
provided by HDR Engineering and Dubuque Metropolitan Area Transportation Study
(DMATS) Long -Range Transportation Plans, will improve traffic flow; and
Whereas, the total cost for these improvements is $478,750.00. The Traffic
Safety Improvement Funding Program will fully fund this project with no additional City
match funds required.
NOW THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY
OF DUBUQUE, IOWA, THAT:
Section 1. That said Traffic Safety Improvement Program Funding in the City of
Dubuque for the Grandview Avenue at Loras Boulevard and Grandview Avenue at
University Avenue Intersection Improvements is hereby approved.
Section 2. That the Mayor be authorized and directed to execute two copies of
said Agreement for Traffic Safety Improvement Program Funding in the City of Dubuque
for the Grandview Avenue at Loras Boulevard and Grandview Avenue at University
Avenue Intersection Improvements.
Attest:
Passed, approved and adopted this 2nd day of February, ;'015.
Ke r(S. Firnstahl, CMC -city Clerk
Roy D. uol, Mayor
January2012
IOWA DEPARTMENT OF TRANSPORTATION
AGREEMENT FOR TRAFFIC SAFETY IMPROVEMENT PROGRAM FUNDING
(Site-Specific Improvement)
County Dubuque Count
Recipient City of Dubuque
Project No. CS-TSF-2100(680)--85-31
Iowa DOT
Agreement No. 2015-TS-020
This agreement is entered into by and between the Iowa Department of Transportation, hereinafter
designated the "DOT", and the City of Dubuque, Iowa, hereinafter designated the"Recipient". The
Recipient submitted an application to the DOT for funding through the Traffic Safety Improvement
Program under Iowa Code Section 312.2(l 1), and the application was approved by Transportation
Commission Order No. H-2014-36 on, December 10, 2013.
Pursuant to the terms of this agreement, and applicable statutes and administrative rules, the DOT
agrees to provide funding to the Recipient to aid in the development of a certain traffic safety
improvement project.
In consideration of the foregoing and the mutual promises contained in this agreement,the parties agree
as follows:
1. Project Information
a. The Recipient shall be the lead local governmental agency for carrying out the provisions of this
agreement.
b. All notices required under this agreement shall be made in writing to the DOT's and/or the Recipient's
contact person. The DOT's contact person shall be the District 6 Local Systems Engineer in Cedar
Rapids, Iowa. The Recipient's contact person shall be City of Dubuque, City Engineer.
c. The Recipient shall be responsible for the development and completion of the following described
Traffic Safety improvement project located in Dubuque:
Add left-turn lanes on north and south approaches at the intersection of Grandview Avenue and
Loras Boulevard; reconstruct traffic signals at the intersection of Grandview Avenue and Loras
Boulevard; and add left-turn lanes on all approaches at the intersection of Grandview Avenue and
University Avenue; and construct,traffic signals at the intersection of Grandview Avenue and
University Avenue.
See Exhibit A-1 for the location of the project and Exhibit A-2 for the estimated project cost.
2. Project Costs
a. Eligible project costs for the project described in Section 1 of this agreement which are incurred after
the effective date of Commission Approval shall be paid from Traffic Safety Funds and other funds as
listed below, subject to the execution of a signed agreement:
Traffic Safety Funds: $478,750
b. The portion of the total project costs paid by Traffic Safety Funds shall not exceed the amount stated
above or the actual cost of the Traffic Safety Improvement Program eligible items, whichever is the
smaller amount.
2015-TS-020_Dubuque 1
January 2012
c. The project shall be let to contract within 2 years of the date this agreement is approved by the
Department. If not, the Recipient may be in default, for which the Department may revoke funding
commitments. This agreement may be extended for a period of 6 months upon receipt of a written
request from the Recipient at least 30 days prior to the 2 year deadline.
d. Project activities or costs eligible for TSIP funds include only the following: (a) road modernization,
upgrading or reconstruction; (b) bridge and culvert modernization, replacement or removal; (c) road
intersection and interchange improvement including channelization, traffic control devices or lighting;
(d) right-of-way required for a traffic safety project; (e) drainage and erosion measures which are an
integral part of the project; (f) traffic control devices required by the project; (g) guardrail; (h)tree
removal; and (i) other construction activities directly related to or required by the safety project.
e. Project activities or costs ineligible for TSIP funds include, but are not limited to, the following: (a) any
and all costs incurred prior to commission approval of funding; (b) routine maintenance of a road,
street, bridge, culvert or traffic control device; (c) safety-related activities associated with projects
initiated for purposes other than traffic safety; (d) contract administration costs; (e) design and
construction engineering and inspection; (f) utility construction, reconstruction, or adjustment except
as an integral part of a project; (g) sidewalks, bicycle paths or railroad-highway crossings, except as
an integral part of the project; and (h) expenditures for items not related to the roadway.
f. If Federal highway funds, Farm-to-Market funds, or other Federal funds are used in combination with
Traffic Safety Funds, the Recipient shall also follow all administrative and contracting procedures
which would normally be used when such funds are used on a non-Traffic Safety Improvement
Program project. The Recipient shall comply with all requirements for the use of said funds.
3. Right of Way and Permits
a. In the event that right-of-way is required for the project, said right-of-way shall be acquired in
accordance with 761 Iowa Administrative Code Chapter 111, Real Property Acquisition and
Relocation Assistance. The Recipient shall submit preliminary right-of-way plans to the DOT's Office
of Right of Way for review and approval prior to the commencement of any acquisition. Additionally, if
said right-of-way is for an improvement to the Primary Road System, it shall be acquired in the name
of the State of Iowa.
b. The Recipient shall be responsible for obtaining any permits, such as the Right to Occupy and/or
Perform Work Within the Right-of-Way, Permit of Access , Utility Accommodation, Right to Install and
Maintain Traffic Control Devices, and/or other construction permits required for the project prior to the
start of construction. Neither the approval of the Traffic Safety application for funding nor the signing
of this agreement shall be construed as approval of any required permit from the DOT.
c. The Recipient shall certify to the DOT's contact person that all known environmental permits have
been received and that all environmental regulations have been complied with before Traffic Safety
Funds are reimbursed or credited.
4. Project Design
The Recipient shall develop all project improvements using good engineering judgment. The
Recipient shall use "A Policy on Geometric Design of Highways and Streets", (latest edition), by the
American Association of State Highway and Transportation Officials and/or the "The Manual on
Uniform Traffic Control Devices for Streets and Highways" (MUTCD), as adopted pursuant to 761
Iowa Administrative Code, Chapter 130.
a. For projects which include the installation or modification of traffic signal systems, the following shall
apply:
2015-1'S-020_Dubuque 2
January2012
i. There will be a minimum of one mast-arm mounted signal head with back plate for each incoming
through or left-turn lane. In addition there will be one signal head, side of pole mounted, on the far
right side pole. All vehicle signal lenses shall be 12-inch. The positioning of signal faces and the
signal indications for left-turn movements shall be in accordance with current adopted MUTCD.
ii. Combination signal/lighting pole shall be used to minimize the number of fixed objects.
iii. Interconnection and coordinated traffic signal timing plans shall be developed for the traffic
signals if there are two or more other signal installations within 1/2 mile of the subject access to
provide for progressive traffic flow. Said plans shall be reviewed and approved the DOT Office of
Traffic & Safety.
iv. Pedestrian activated signals shall be provided for all pedestrian movements and timed in
accordance with the MUTCD.
v. The concrete pad for the controller shall extend no more than 4 inches above the ground line.
vi. Where the distance from the stop bar to the signal indication is in excess of 180 feet, there shall
also be a near side signal head.
vii. Dilemma zone protection shall be provided if the 85th percentile speed is at/over 35 mph.
5. Bid Letting
a. If the project must be let for bids, then project plans, specifications and engineer's cost estimate for
site specific improvements and/or traffic control devices shall be prepared and certified by a
professional engineer licensed to practice in the State of Iowa. The Recipient shall submit the plans,
specifications and other contract documents to the DOT for review. This submittal may be in divisions
and in the order of preference as determined by the Recipient. However, the plans, specifications and
other contract documents for each division must be submitted at least ten weeks (traffic control
devices) or fourteen weeks (site specific project) prior to the project letting of each division. The DOT
shall review said submittal(s) recognizing the Recipient's development schedule and shall, after
satisfactory review, authorize in writing the Recipient to proceed with implementation of the project.
The work on this project shall be in accordance with the survey, plans, and specifications on file. Any
substantial modification of these plans and specifications must be approved by the DOT prior to the
modification being put into effect.
b. If the Recipient lets the project, as described herein, the Recipient shall include in their Notice to
Bidders that Sales Tax Exemption Certificates will be issued, as provided for by Iowa Code section
423.3, subsection 80. The Recipient shall be responsible for obtaining the sales tax exemption
certificates through the Iowa Department of Revenue and Finance. The Recipient shall issue these
certificates to the successful bidder and any subcontractors to enable them to purchase qualifying
materials for the project free of sales tax.
c. If the Recipient lets the project, then the Recipient shall use positive efforts to solicit bids from and to
utilize Targeted Small Business (TSB) enterprises as contractors and ensure that the contractors
make positive efforts to utilize these enterprises as subcontractors, suppliers or participants in the
work covered by this agreement. Efforts shall be made and documented in accordance with Exhibit B
which is attached hereto and by this reference incorporated into this agreement.
d. For portions of the project let to bid, the Recipient shall advertise for bidders, make a good faith effort
to get at least three (3) bidders, hold a public letting and award contracts for the project work. DOT
concurrence in the award must be obtained prior to the award. The Recipient shall provide the DOT
file copies of project letting documents within five (5) days after letting.
6. Construction and Maintenance
2015-TS-020_Dubuque 3
January 2012
a. The Recipient shall conduct the project development and implementation in compliance with
applicable laws, ordinances and administrative rules.
b. The Recipient shall be responsible for the daily inspection of the project, and the compilation of a
daily log of materials, equipment and labor on the project.
c. The Recipient shall maintain records, documents, and other evidence in support of work performed
under the terms of this contract. All accounting practices applied and all records maintained will be in
accordance with generally accepted accounting principles and procedures. Documentation shall be
made available for inspection and audit by authorized representatives of the DOT or its designee at
all reasonable times during the period of the contract and for three (3) years after the date of final
payment. Reimbursement shall be based on eligible actual and indirect costs associated with
performance of contract service work. The Recipient shall provide copies of said records and
documents to the DOT upon request.
d. The Recipient shall require its contractors to permit the DOT authorized representative to inspect all
work materials, records, and any other data with regard to agreement related costs, revenues and
operating sources.
e. Upon project completion and prior to final reimbursement for the project, the Recipient shall furnish
three sets of "as-built" plans for any portion of the project which is on or intersects any primary road
or primary road extension to the DOT's contact person for future maintenance and road design
purposes.
f. If this project requires the installation of or modification to a traffic control signal system, the Recipient
shall be responsible for all future ownership, maintenance, operation and energy costs of said
installation or modification.
g. The Recipient hereby certifies that,for a period of ten (10) years following completion of project and
receipt of final payment from the DOT, there shall be no modifications in the geometric features,the
construction features, or the access management features (including driveway design and location) of
the project, nor shall there be any fixed objects or obstructions placed in any clear zone established in
conjunction with this project without the prior written approval of the Office of Traffic and Safety.
Failure to comply shall be considered a default under the terms of this agreement.
7. Payments and Reimbursements
a. The Recipient may submit to the DOT periodic itemized claims for reimbursement for eligible project
activities. Reimbursement claims shall include certification by a professional engineer licensed to
practice in the State of Iowa that all eligible project activities for which reimbursement is requested
have been completed in substantial compliance with the terms of this agreement.
b. The Department will reimburse the Recipient for properly documented and certified claims for eligible
project costs. The Department may withhold up to 5%of the construction costs or 5%of the total
TSIP funds available for the project, whichever is less. Reimbursement will be made either by State
warrant or by crediting other accounts from which payment was initially made. If, upon final audit or
review, the Department determines the Recipient has been overpaid, the Recipient shall reimburse
the overpaid amount to the Department. After the final audit or review is complete and after the
Recipient has provided all required paperwork, the Department will release the funds withheld.
c. Upon completion of the project described in this agreement, a professional engineer licensed to
practice in the State of Iowa shall certify in writing to the DOT that the project activities were
completed in substantial compliance with the terms of this agreement. Final reimbursement of Traffic
Safety Funds shall be made only after the DOT accepts the project as complete.
2015-TS-020--Dubuque 4
January 2012
d. If the Recipient fails to perform any obligation under this agreement, the DOT shall have the right,
after first giving thirty(30) days written notice to Recipient by certified mail return receipt requested, to
declare this agreement in default. The Recipient shall have thirty(30) days from date of mailing of
notice to cure the default. If the Recipient cures the default, the Recipient shall notify DOT no later
than five (5) days after cure or before the end of said thirty(30) day period to cure default. Within ten
(10) working days of receipt of Recipient's notice of cure,the DOT shall issue either a notice of
acceptance of cure or notice of continued default.
e. In the event a default is not cured the DOT may revoke funding commitments and/or seek repayment
of Traffic Safety Funds granted by this agreement through charges against the Recipient's road use
tax funds.
8. General Provisions
a. This agreement shall be considered to be in default if the DOT determines that the Recipient's
application for funding contained inaccuracies, omissions, errors or misrepresentations.
b. The Recipient agrees to indemnify, defend and hold the DOT harmless from any action or liability
arising out of the design, construction, maintenance, placement of traffic control devices, or
inspection of this project. This agreement to indemnify, defend and hold harmless applies to all
aspects of the DOT's application review and approval process, plan and construction reviews, and
funding participation.
c. In accordance with Iowa Code Chapter 216, the Recipient shall not discriminate against any person
on the basis of race, color, creed, age, sex, sexual orientation, gender identity, national origin,
religion, pregnancy, or disability.
d. The Recipient shall comply with the requirements of Title II of the Americans with Disabilities Act of
1990 (ADA), Section 504 of the Rehabilitation Act of 1973 (Section 504), and the associated Federal
regulations that implement these laws.
e. If any part of this agreement is found to be void and unenforceable then the remaining provisions of
this agreement shall remain in effect.
f. This agreement is not assignable without the prior written consent of the DOT.
g. It is the intent of both parties that no third party beneficiaries be created by this agreement.
h. In case of dispute concerning the terms of this agreement, the parties shall submit the matter to
arbitration pursuant to Iowa Code Chapter 679A. Either party has the right to submit the matter to
arbitration after ten (10) days notice to the other party of their intent to seek arbitration. The written
notice must include a precise statement of the disputed question. DOT and the Recipient agree to be
bound by the decision of the appointed arbitrator. Neither party may seek any remedy with the state
or federal courts absent exhaustion of the provisions of this paragraph for arbitration.
i. This agreement shall be executed and delivered in two or more copies, each of which so executed
and delivered shall be deemed to be an original and shall constitute but one and the same
instrument.
j. This agreement, including referenced exhibits, constitutes the entire agreement between the DOT
and the Recipient concerning this project. Representations made before the signing of this agreement
are not binding, and neither party has relied upon conflicting representations in entering into this
agreement. Any change or alteration to the terms of this agreement must be made in the form of an
addendum to this agreement. Said addendum shall become effective only upon written approval of
the DOT and Recipient.
2015-TS-020_.Dubuque 5
January 2012
IN WITNESS WHEREOF, each of the parties hereto has executed Agreement No. 2015 -TS -020 as of the
date shown opposite its signature below.
City of Dub tiue, Iowa:
By: 'f �'' ``'f Date February 2 , 20 15 .
Title: Mavc,r
I, Kevin S . F i r n s t a h l , certify that I am the Clerk of the City, and that
Roy D. Rii o 1 , who signed said Agreement for and on behalf of the City was duly
authorized to execute the same by virtue of a formal Resolution duly passed and adopted by the
City, on the 2nd day of Februar , 20 15
Signed Date February 2 , 20 15
City Clerk of ubuque, Iowa
Iowa Department of Transportation:
By: Date , 20
Steve J. Gent.
Director,
Office of Traffic and Safety
2015-TS-020_Dubuque 6
EXHIBIT A-1
[Project Location]
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2015-TS-020—Dubuque 7
EXHIBIT A-2
[Estimated Project Cost]
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WR W-40 LS 4 ,000.00 $4,1041.00 88'Duo.03
W-OA&A A"601,W01,nNIMAY $12.00 $-400.05 $1,240.00
M-kWaIN, 4 b $D,!JOSIAROS" i"a n.ul VA'MOOD
Wk'.'EY'TJ.,,4E p tOuu $1,61rkJQ-d't s1'aw.00 59-QDJ
4 10 C INAL I N,'-WtXWE,4 N, Sr 'mk 535,00 E44..'%l1:
EXHIBIT B
UTILIZATION OF TARGETED SMALL BUSINESS(TSB) ENTERPRISES
ON NON-FEDERAL AID PROJECTS
(THIRD-PARTY STATE-ASSISTED PROJECTS)
In accordance with Iowa Code Section 196.7 and 541 Iowa Administrative Code (IAC) Chapter 4, it is the
policy of the Iowa Department of Transportation (Iowa DOT) that Targeted Small Business (TSB)
enterprises shall have the maximum practicable opportunity to participate in the performance of contracts
financed in whole or part with State funds.
Under this policy the Recipient shall be responsible to make a positive effort to solicit bids or proposals
from TSB firms and to utilize TSB firms as contractors or consultants. The Recipient shall also ensure
that the contractors or consultants make positive efforts to utilize TSB firms as subcontractors,
subconsultants, suppliers, or participants in the work covered by this agreement.
The Recipient's"positive efforts"shall include, but not be limited to:
1. Obtaining the names of qualified TSB firms from the Iowa Department of Inspections and Appeals
(515-281-7102) or from its website at: http://dia.iowa.gov/page7.htmi.
2. Notifying qualified TSB firms of proposed projects involving State funding. Notification should be
made in sufficient time to allow the TSB firms to participate effectively in the bidding or request for
proposal (RFP) process.
3. Soliciting bids or proposals from qualified TSB firms on each project, and identifying for TSB firms
the availability of subcontract work.
4. Considering establishment of a percentage goal for TSB participation in each contract that is a
part of this project and for which State funds will be used. Contract goals may vary depending on
the type of project, the subcontracting opportunities available, the type of service or supplies
needed for the project, and the availability of qualified TSB firms in the area.
5. For construction contracts:
a) Including in the bid proposals a contract provision titled "TSB Affirmative Action
Responsibilities on Non-Federal Aid Projects (Third-Party State-Assisted Projects)"or a
similar document developed by the Recipient. This contract provision is available on-line at:
http://www.dot.state.ia.us/local_systems/publications/tsb_contract_provision.pdf
b) Ensuring that the awarded contractor has and shall follow the contract provisions.
6. For consultant contracts:
a) Identifying the TSB goal in the Request for Proposal (RFP), if one has been set.
b) Ensuring that the selected consultant made a positive effort to meet the established TSB
goal, if any. This should include obtaining documentation from the consultant that includes a
list of TSB firms contacted; a list of TSB firms that responded with a subcontract proposal;
and, if the consultant does not propose to use a TSB firm that submitted a subcontract
proposal, an explanation why such a TSB firm will not be used.
2015-TS-020_Dubuque 9
The Recipient shall provide the Iowa DOT the following documentation:
1. Copies of correspondence and replies, and written notes of personal and/or telephone contacts
with any TSB firms. Such documentation can be used to demonstrate the Recipient's positive
efforts and it should be placed in the general project file.
2. Bidding proposals or RFPs noting established TSB goals, if any.
3. The attached "Checklist and Certification." This form shall be filled out upon completion of each
project and forwarded to: Iowa Department of Transportation, EEO Administrator, Office of
Contracts, 800 Lincoln Way, Ames, IA 50010.
2015-TS-020—Dubuque 10
CHECKLIST AND CERTIFICATION
For the Utilization of Targeted Small Businesses(TSB)
On Non-Federal-aid Projects(Third-Party State-Assisted Projects)
Recipient: Project Number:
County: Agreement Number:
1. Were the names of qualified TSB firms obtained from the Iowa Department of Inspections and Appeals?
[]YES ❑ NO
If no, explain
2. Were qualified TSB firms notified of project? ❑YES F1 NO
If yes, by ❑ letter, ❑telephone, ❑ personal contact, or ❑other(specify)
If no, explain
3. Were bids or proposals solicited from qualified TSB firms? ❑YES ❑ NO
If no, explain
4. Was a goal or percentage established for TSB participation? 0 YES ❑ NO
If yes, what was the goal or percentage?
If no, explain why not:
5. Did the prime contractor or consultant use positive efforts to utilize TSB firms on subcontracts? ❑ YES ❑ NO
If no, what action was taken by Recipient?
Is documentation in files? ❑ YES ❑ NO
6. What was the dollar amount reimbursed to the Recipient
from the Iowa Department of Transportation? $
What was the final project cost? $
What was the dollar amount performed by TSB firms? $
Name(s) and address(es) of the TSB firm(s)
(Use additional sheets if necessary)
Was the goal or percentage achieved? 11 YES ❑ NO
If no, explain
As the duly authorized representative of the Recipient, I hereby certify that the Recipient used positive efforts to utilize
TSB firms as participants in the State-assisted contracts associated with this project.
Title
Signature Date
2015-TS-020_._Dubuque 11