Traffic Signal Mastarm Retroifit Proejct Agreement_Central_5th_7th StreetsMasterpiece on the Mississippi
Dubuque
All- Ametica City
111111
2007
TO: The Honorable Mayor and City Council Members
FROM: Michael C. Van Milligen, City Manager
SUBJECT: Traffic Signal Mastarm Retrofit Project, Central Avenue at 5th and 7th
Street - Traffic Safety Funding Agreement
Agreement No. 2011 -TS -029
(Iowa DOT Project No. CS -TSF- 2100-- 85 -31)
(CIP 1011133, 3001133, 250 -1615 and 1021609)
DATE: April 27, 2010
City Engineer Gus Psihoyos recommends City Council approval for the Mayor to
execute the Iowa Department of Transportation Traffic Safety Funding Agreement for a
Traffic Signal Mastarm Retrofit Project, Central Avenue at 5 and 7 Street. This
agreement will provide $36,500 in State Traffic Safety Funds for this now complete
project.
concur with the recommendation and respectfully request Mayor and City Council
approval.
MCVM:jh
Attachment
cc: Barry Lindahl, City Attorney
Cindy Steinhauser, Assistant City Manager
Gus Psihoyos, City Engineer
aelC.V
Mic Van Milligen
Masterpiece on the Mississippi
TO: Michael C. Van Milligen, City Manager
FROM: Gus Psihoyos, City Engineer
DATE: April 26, 2010
SUBJECT: Traffic Signal Mastarm Retrofit Project, Central Avenue at 5 and 7th
Street – Traffic Safety Funding Agreement
Agreement No. 2011 -TS -029
(Iowa DOT Project No. CS -TSF- 2100- 85 -31)
(CIP 1011133, 3001133, 250 -1615 and 1021609)
INTRODUCTION
BACKGROUND
Dubuque
All-Amesica cfty
11111 F
2007
The enclosed resolution authorizes the Mayor to execute the Iowa Department of
Transportation (Iowa DOT) Traffic Safety Funding Agreement (2011-TS-029) for a
Traffic Signal Mastarm Retrofit Project, Central Avenue at 5 and r Street.
This mastarm retrofit project initiated construction last summer during FY 2009 -2010.
Before construction started, city officials spoke with personnel from the Iowa DOT office
of traffic safety concerning the project and the possibility of partially funding some of the
equipment using Traffic Safety Funds. The Iowa DOT concurred and have worked up a
funding agreement to aid in the (post) purchase of some of the equipment needed to
construct this project.
DISCUSSION
Agreement No. 2011 -TS -029 is for The Traffic Signal Mastarm Retrofit Project that
provides for the standardization of mastarm- mounted signals along the Central Avenue
corridor. This project replaced the pedestal style traffic signals with mastarm mounted
signals along Central Avenue at 5 Street and 7 Street. This agreement between the
Iowa DOT and the City of Dubuque (City) provides for the utilization of State Traffic
Safety Funds (TSF) funding in the amount of $36,500. The remaining portion of the
project was covered using local funds.
RECOMMENDATION
recommend that the City Council adopt the enclosed resolution and authorize the
Mayor to sign the state funding agreement for the Traffic Safety Fund Program Project
(Agreement No. 2011 -TS -029 for the Traffic Signal Mastarm Retrofit Project, Central
Avenue at 5 and 7 Street.
ACTION TO BE TAKEN
I respectfully request that the City Council adopt the attached resolution and authorize
the Mayor to sign the Iowa Department of Transportation State Funding Agreement
(Agreement No. 2011 -TS -029) for the Traffic Signal Mastarm Retrofit Project, Central
Avenue at 5 and 7 Street.
cc: Jenny Larson, Budget Director
Don Vogt, Public Works Director
John Klostermann, Street Maintenance Supervisor
Bob Green, Water Department Manager
Robert Schiesl, Assistant City Engineer
Jon Dienst, Civil Engineer II
Greg Doeden, Civil Engineer II
Deron Muehring, Civil Engineer II
RESOLUTION NO. 128 -10
RESOLUTION APPROVING THE IOWA DEPARTMENT OF TRANSPORTATION
STATE AID FUNDING AGREEMENT (AGREEMENT NO. 2011 -TS -029) FOR THE
TRAFFIC SIGNAL MASTARM RETROFIT PROJECT, CENTRAL AVENUE AT 5
AND 7 STREET.
Whereas, the Iowa Department of Transportation (Iowa DOT) has authorized the use of
Iowa DOT (TSF) funds for the Traffic Signal Mastarm Retrofit Project, Central Avenue at
5 and 7 Street.
Whereas, the Traffic Signal Mastarm Retrofit Project, Central Avenue at 5 and 7
Street will provide for provides for the standardization of mastarm- mounted signals
along the Central Avenue corridor.
Whereas, the Iowa DOT TSF funds will be eligible to complete said
improvements to the signals on Central Avenue at 5 and 7 Streets, within Dubuque
County, Iowa.
NOW THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY
OF DUBUQUE, IOWA:
Section 1. That said Iowa DOT Traffic Safety Funding Agreement (Agreement
2011 -TS -029) between the City of Dubuque and the Iowa Department of Transportation
be approved for a Traffic Signal Mastarm Retrofit Project, Central Avenue at 5 and 7
Street.
Section 2. That the Mayor be authorized and directed to execute two copies of
Iowa DOT Traffic Safety Funding Agreement (Agreement No. 2011 -TS -029) for the
Traffic Signal Mastarm Retrofit Project, Central Avenue at 5 and 7 Street in Dubuque.
Attest:
Passed, approved and adopted this 3rd
eanne F. Schneider, CMC, City Clerk
day of • May , 2010.
L.0
Roy D. Buol, Mayor
fcM Iowa Department of Transportation
District 6 Office 319 -364 -0235
430 Sixteenth Avenue SW FAX: 319 -364 -9614
P.O. Box 3150, Cedar Rapids, IA 52406-3150 kentellis @dot.iowa.gov
March 17, 2010
Gus Psihoyos, P. E.
City of Dubuque - Engineering
50 West 13 Street
Dubuque, Iowa 52001 -4864
Ref: CS- TSF- 2100(656) —85 -31
Dubuque County
City of Dubuque
Agreement No. 2011 -TS -029
SUBJECT: Agreement 2011 -TS -029 FINAL (Traffic Signal Upgrade at Central Avenue and
5 Street and 7 Street Intersections in Dubuque)
Dear Mr. Psihoyos::
I have enclosed two (2) copies of an agreement between the City of Dubuque and the Iowa
Department of Transportation for the referenced project. The project involves upgrade traffic
signals from pedestal-only to mast -arm mounted signal heads at the Intersection of Central
Avenue and 5 Street and 7;th Street in Dubuque..
Please secure the necessary approvals and signatures of the appropriate city officials and return
both signed copies of the agreement to this office for further processing. After I receive the signed
copies of the agreement, I will sign the agreement, and the fully executed agreement will be
returned to your office.
Please contact me if you have any questions concerning this agreement.
KLE /sjb
Enclosure (2)
Sincerely,
Kent L. Ellis, P.E.
Local Systems Engineer
District 6
SCANNED
, ,1.1ci w 1 1 i; U
IOWA DEPARTMENT OF TRANSPORTATION
AGREEMENT FOR TRAFFIC SAFETY IMPROVEMENT FUNDING
(Traffic Control Device)
RECIPIENT: Dubuque, Iowa
COUNTY: Dubuque
PROJECT NO.: CS -TSF- 2100(656)- -85 -31
AGREEMENT NO.: 2011 -TS -029
This is an agreement between Dubuque, Iowa (hereinafter referred to as Recipient) and the Iowa
Department of Transportation (hereinafter referred to as the DOT). The Recipient submitted an
application to the DOT for special funding that was approved for this use by Transportation
Commission Order No. H- 2002 -66, on December 11, 2001.
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. The Recipient shall be the lead local governmental agency for carrying out the provisions of
this agreement.
2. 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 the City Engineer.
3. The Recipient shall be responsible for the development and completion of the following
described Traffic Safety Improvement project located in the city of Dubuque, Iowa at the
intersections of Central Avenue and 5 Street, and Central Avenue and 7 Street:
Upgrade traffic signals from pedestal -only to mast -arm mounted signal
heads. See Exhibit A for the estimated project cost.
2
4. Eligible project costs for the project described in paragraph 3 of this agreement which are
incurred after the effective date of Commission Approval shall be paid from Traffic Safety
Improvement funds and other funds as listed below, subject to the execution of a signed
agreement:
Traffic Safety Improvement Funds: $36,500 (Equipment /Material costs only)
5. The portion of the total project costs paid by Traffic Safety Improvement funds shall not
exceed the amount stated above ($36,500) or the actual cost of the Traffic Safety
Improvement eligible items, whichever is the smaller amount.
6. 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.
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.
7. The Recipient shall initiate project activities in a timely manner. The proposed project
completion date is December 31, 2011. If construction of the project has not been
completed by this date, this agreement shall be considered to be in default. The Recipient
may request the approval of the DOT to revise the completion date. The request must be
in writing and be submitted thirty (30) days prior to the completion date as shown above.
8. A clear zone shall be established as a part of this project. The clear zone to the face of all
fixed objects shall be 10 feet from the back of curb. Within the corner radii /returns, all
fixed objects, including signal poles /controller, shall be relocated to meet the clear zone
established above. The DOT Office of Traffic and Safety may approve exceptions on a
case -by -case basis.
For projects which include the installation or modification of traffic signal systems, the
following shall apply:
A. There will be a minimum of one mast -arm mounted signal head with back plate for
each incoming through or left -turn lane. To comply with the 2009 MUTCD, the signal
head over the left -turn lanes shall not display a green ball. For permissive left -turn
phasing, a flashing yellow arrow must be used or the signal head for the left -turn lane
must be on the lane line or over the thru lane. In addition there will be one signal
head, side of pole mounted, on the far right side pole.
3
B. Combination signal /lighting pole shall be used to minimize the number of fixed
objects.
C. 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 by the DOT Office of Traffic and Safety.
D. Pedestrian activated signals shall be provided for all pedestrian movements and timed
in accordance with the current MUTCD.
E. The concrete pad for the controller shall extend no more than 4 inches above the
ground line.
F. 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.
G. Dilemma zone protection shall be provided if the 85 percentile speed is at / over 35
mph.
All pedestrian accommodations within the project shall meet current ADA requirements.
The 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.
9. 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.
10. 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
4
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.
11. The Recipient shall conduct the project development and implementation in compliance with
applicable laws, ordinances and administrative rules. 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.
Additionally, for projects where Federal highway funds, Farm -to- Market funds, or other
Federal funds are used to match Traffic Safety Improvement 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 project. The Recipient shall
comply with all requirements for the use of said funds.
12. 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 Improvement funds are reimbursed or credited.
13. Project activities or costs eligible for Traffic Safety Improvement funding include only those
items set out in Exhibit B which is attached hereto and by this reference incorporated into
this agreement.
14. Activities or costs ineligible for Traffic Safety Improvement funding include but are not
limited to those items set out in Exhibit C which is attached hereto and by this reference
incorporated into this agreement.
15. 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 Engineering and Safety. Failure to comply
shall be considered a default under the terms of this agreement.
16. 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.
17. 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
5
reimbursement is requested have been completed in substantial compliance with the terms of
this agreement.
18. The Department shall reimburse the Recipient for properly documented and certified claims
for eligible project activity costs, less a withholding of 5% of the Federal and / or State share
of construction costs, either by state warrant or by crediting other accounts from which
payment may have been initially made. If upon final audit, 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 Federal or State funds withheld.
19. 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 plans and specifications set out in this
agreement. Final reimbursement of Traffic Safety Improvement funds shall be made only
after the DOT accepts the project as complete.
20. 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.
21. 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.
22. In the event a default is not cured the DOT may revoke funding commitments and/or seek
repayment of Traffic Safety Improvement funds granted by this agreement through charges
against the Recipient's road use tax funds.
23. 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.
24. 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.
6
25. 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.
26. 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
D which is attached hereto and by this reference incorporated into this agreement.
27. If any part of this agreement is found to be void and unenforceable then the remaining
provisions of this agreement shall remain in effect.
28. This agreement is not assignable without the prior written consent of the DOT.
29. It is the intent of both parties that no third party beneficiaries be created by this agreement.
30. 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.
31. 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.
32. This agreement as set forth in paragraphs 1 through 32 herein, 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.
IN WITNESS WHEREOF, each of the parties hereto has executed Agreement No. 2011 -TS -029 as
of the date shown opposite its signature below.
City of Dubu R ue, Iowa:
By:
Title:
1 Jeanne . F. Schneider , certify that I am the Clerk of the City, and that
Roy D. B u 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 3rd day of May , 2010 .
Signed
a or
City C4 k of Dubuque, Iowa
Iowa Department of Transportation:
By: Date , 20
Steve Gent
Director,
Office of Traffic and Safety
7
Date
Date May 3
May 3 , 20 10' .
,2010 .
Central Avenue, City of Dubuque
material only
Traffic Signalization Lump Sum Item
5th Street
& Central
7th Street
& Central
Totals
unit
price
total
price
Units
Qty
Qty
Qty
D3 -1 Street NameSigns
EA
2
2
4
50
200
R10 -3e (modified)
EA
0
50
0
R6 -1 Rt
EA
1
1
2
50
100
R6 -1 Lt
EA
1
1
2
50
100
R3 -1
EA
1
1
2
50
100
R3 -2
EA
1
1
2
50
100
Traffic Signal Head, pole mount, furnish and install
EA
6
6
12
600
7200
Traffic Signal Head, mast arm mount, furnish and
install
EA
2
2
4
570
2280
Countdown Pedestrian Signal Head, pole mount,
furnish and install
EA
8
8
16
450
7200
16' Traffic Pole, furnish and install
EA
3
3
6
600
3600
16' Traffic Pole Foundation - 2' dia x 5'
EA
3
3
6
350
2100
Mast arm Foundation - 36" dia x 9' - 4"
EA
1
1
2
500
1000
30' Traffic Pole w/32' mast arm , furnish and install
EA
0
1
1
6225
6225
30' Traffic Pole w/37' mast arm , furnish and install
EA
1
0
1
6885
6885
Luminaire for installation on mast arm
EA
1
1
2
325
650
PTZ Camera
EA
1
1
3500
72 port fiber distribution center (FDC)
EA
1
1
2
400
800
6 MM fiber panel with MM SC Sleeves
EA
4
4
8
35
280
6 SM fiber panel with SM ST Sleeves
EA
8
8
16
32
512
12 fiber fain -out (assuming 12 fibers per tube)
EA
6
6
12
17.5
210
SC MM hot -melt connector
EA
24
24
48
6.5
312
ST SM hot -melt connector
EA
48
48
96
9
864
RTS 4port DB9 Serial Server 99445 -9
EA
1
1
2
470
940
Garrettcom Switche 6K32TRC
EA
1
1
2
1650
3300
Garrettcom 6KP4 -FXSC
EA
1
1
2
780
1560
Garrettcom GBPM -20TX
EA
1
1
2
500
1000
Garrettcom GBIC- LXSC10
EA
2
2
4
600
2400
SC -SC multimode jumpers
EA
2
2
4
20
80
LC -ST singlemode jumpers
EA
2
2
4
20
80
ST -ST Singlemode jumpers
EA
2
2
4
20
80
Battery Backup
EA
1
1
2
8250
16500
Traffic Signal Controller
EA
1
1
2
12000
24000
Total
$90,658
8
EXHIBIT A
Maximum TSIP funding = $36,500
9
EXHIBIT B
(Traffic Control Devices)
Project activities or costs eligible for Traffic Safety Improvement funds include only the following:
a. The cost of materials purchased for initial installation of traffic control devices or replacement
of obsolete traffic control devices to comply with the applicable warrants in the Manual on
Uniform Traffic Control Devices (MUTCD) adopted in 761 Iowa Administrative Code
130.1(321), shall be eligible for funding.
10
EXHIBIT C
(Traffic Control Devices)
Activities and costs ineligible for Traffic Safety Improvement funds include but are not limited to:
a. Any and all costs incurred prior to Transportation Commission approval of funding.
b. Maintenance or energy costs for traffic control devices or lighting.
c. Installation costs.
In accordance with Iowa Code Section 19B.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 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-
7357) or from its website at: http : / /www.iowai.net/iowa /dia /tsb
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
projects sub - contractible items, 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 /Iocal_systems /publications /tsb_contract_provision.pdf
b) Ensuring that the awarded contractor has and shall follow the contract provisions.
6. For consultant contracts:
EXHIBIT D
UTILIZATION OF
TARGETED SMALL BUSINESS (TSB) ENTERPRISES ON
NON - FEDERAL AID PROJECTS
(THIRD -PARTY STATE - ASSISTED PROJECTS)
a) Identifying the TSB goal in the 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.
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.
Title
Signature
12
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 ❑ N
If no, explain
2. Were qualified TSB firms notified of project? ❑ YES ❑ 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? ❑ 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? ❑ 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.
Date