Signed Contract_2020-2022 Snow Removal Contracts (Skyline, Tri-State, Arensdorf) Copyrighted
October 5, 2020
City of Dubuque Consent Items # 13.
City Council Meeting
ITEM TITLE: Signed Contract(s)
SUM MARY: 2020-2022 Snow removal and ice control contracts to Skyline
Construction, TriState Paving Services, and Dan Arensdorf Construction,
I nc.
SUGGESTED Suggested Disposition: Receive and File
DISPOSITION:
ATTACHMENTS:
Description Type
Skyline Construction Contract Supporting Documentation
Tri-State Paving Services Contract Supporting Documentation
Dan Arensdorf Construction Contract Supporting Documentation
THE C1TY OF
City of Dubuque
DU� E Transportation Services Department
MasterF�iece on the Mississippi 949 Kerper Blvd �
Dubuque, lA 52001 I
(563) 589-4198 '
This Service Contract (the Contract), is made and entered into by and between the
City of Dubuque, lowa (City), by its City Manager, through authority conferred upon the
City Manager by its City Council and Skyline Construction (Contractor) of Dubuque, lowa.
Project Name: Snow Removal at City Properties II
Service Locations and Service Type(s):
10�'' & Elm Lot Sidewalks, 11"' & Elm Lot Sidewalks, 12�h & Elm Lot Sidewalks, 18�h &
Elm Lot Sidewalks, 5'h & Bluff Lot Sidewalks, 11�h & Bluff Lot Sidewalk, 9�h & Bluff
Sidewalk, 12th & Bluff Sidewalks, 3�d & Main Lot Sidewalks, 3�d & Locust Lot Sidewalks,
4th & Central Lot Sidewalks, 5'h & Bell Lot Sidewalks, 5�h & Main Lot Sidewalks, 5�'' St
Ramp Sidewalks, Central Ave Ramp Sidewalks, Five Flags Ramp Sidewalks, Intermodal
Sidewalks, lowa St Ramp Sidewalks, Locust St Ramp Sidewalks, Washington St Row
Houses Sidewalks, 11 th & Elm Lot, 12�h & Elm Lot, 18th & Elm Lot, 5�h & Main Lot, 9�h &
Elm Lot, 12�h & Central Lot, Port of Dubuque Lots, Washington St Row House Lot.
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 forthe Project
as detailed in the Bid Document for snow removal including plowing, shoveling,
hauling and related services. Snowfall amounts are measured at the Jule Operations
and Training Center.
i
The work described above shall be completed at the following location(s): �
10t'' & Elm Lot Sidewalks, 11th & Elm Lot Sidewalks, 12th & Elm Lot Sidewalks, '
18t'' & Elm Lot Sidewalks, 5"' & Bluff Lot Sidewalks, 17�" & Bluff Lot Sidewalk, I
9'n & Bluff Sidewalk, 12'h & Bluff Sidewalks, 3�d & Main Lot Sidewalks, 3'd & I
Locust Lot Sidewalks, 4th & Central Lot Sidewalks, 5th & Bell Lot Sidewalks, 5�'' 'I
& Main Lot Sidewalks, 5"' St Ramp Sidewalks, Central Ave Ramp Sidewalks, Five '
Flags Ramp Sidewalks, Intermodal Sidewalks, lowa St Ramp Sidewalks, Locust ��,
St Ramp Sidewalks, Washington St Row Houses Sidewalks, 11th & Elm Lot, 12�'' I
& Elm Lot, 18th & Elm Lot, 5�h & Main Lot, 9"' & Elm Lot, 12�h & Central Lot, Port I
of Dubuque Lots, Washington St Row House Lot. I
1 I�
The Project shall be completed in strict accordance with the terms as described in this
Contract; in strict accordance with the requirements of the laws of the State of lowa
and ordinances of the City of Dubuque, and in accordance with the Invitation for Bid
(IFB) Documents which provisions and documents are each and all hereby referred
to and made a part of this Contract just as much as if the detailed statements thereof
were repeated herein.
2. Contract Documents shall mean and include the following: This Contract; The
Request for Bid dated August 24, 2020; all documents and specifications in the IFB �
for this Project; and the Bid Proposal Form, all of which are incorporated by reference
into this Contract.
3. All materials used by the Contractor on this Project shall be of the quality required by
the Contract Documents and shall be put in place in accordance with the Contract I
Documents.
4. Contractor shall complete all work as outlined in the Scope of Services and any work
condemned as unsuitable or defective shall be replaced or done anew to the
satisfaction of the TSOS at the cost and expense of Contractor. �
5. Contractor has read and understands the Contract Documents and has examined and
understands the project description described in the IFB Scope of Services and
summarized in Section 1 of this Contract and any conditions herein referred to and
agrees not to plead misunderstanding or deception because of estimates of quantity,
character, location or other conditions surrounding the same.
6. The initial term of the Contract shall commence on the date the City executes the I
Contract and shall end upon two years of Contract execution. Contractor may renew '
this Contract by delivering written notice of renewal to City not less than 90 days prior
to the termination of the initial term.
City may terminate the Contract at any time for any reason with or without cause. In
that event, all finished or unfinished Work, reports, materials(s) prepared or furnished
by Contractor under the Contract shall, at the option of City, become its property. If I
the Contract is terminated by City as provided herein, Contractor shall be paid for all
Work which has been authorized, provided, and approved up to the effective date of
termination. City will not be subject to any termination fees from Contractor.
7. 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 therefrom, but only to the extent caused in
2
whole or in par� by negligen# acts or omissions of Contractor, or anyone directly or
indirect�y employed by Contractor ar anyone for whose acts Contractflr may be liable,
regardless of whether ar not such claim, damage, loss or expense is caused in part
by a party indemnified hereunder.
8. Unless otherwise specified in the Contract Documents, prior ta the commencement of
any work on fhis Project and at all times during the performance af this Con�ract,
Contractor shaif provide evidence of insurance which meets the requirements of the .
City's Insurance Schedule M attached to �t�is Contract.
9. Confractor agrees that no work und�r this Gontract shall commence on tne Praject
until the City has issued a wriften "Notice ta Proceed° ta Contractor. Any work started
by Contractor or prior the issuance of the Notice to Proceed shall be cansidered
unauthorized and done at the sole risk to Contractor.
10.The City o# Dubuque in accordance with Title VI of the Civif Righfs Ac# af �964, 78
Stat. 252, 42 U.S.C. 2000d-2000d-4 ar�d Title 49, Code of Federal Regulations,
De�artment of Transportation, Subtitle A, Office of the Secretary, Part 21 ,
Nondiscrimination in Federally assisted programs of the Department af Transportation
issued pursuant to such Act, Y�ereby notifies all bidders that it will affirmati�eiy insure
that in any contract entered into pursuant ta this adverkisement, minority business
enterprises will be afforded full opportunity to submit bids in response to this invitatian
and will not be discriminated aga�nst on the grounds af race, calor, national origin,
sex, age, or disability in considerafion far an award.
CITY AGREES:
Upon the submission of monthly invoices listing only the exact service perfa�-med in the
specified month, including the dates and times that service was performed; using the
provided invaice templa�e; and upon review and autY�ar�zation by the Transpo�tation
Services Operations Supervisor; payment will be authorized based on the amounts listed
in the Bid Proposal Form and snawfall amounts recorded at The Jule Operations and
Training C�nter (JOTC).
CITY OF DUBUQUE, IOWA SKYLINE CONSTRUCTlON,
CONTRACTOR
�,c,� �'�"�/���'��
By: By:
Michael C. Van Mifligen Mar J. Arthafer
City Manager President
Dated: 10/1/2020 Dated: �� �i J ��
3
CONTRACTOR ACKNOW��DGEMENT
OF ATTACHED FTA CL�K�JS �
By: /.
Mark . Arthofer
President
Dated: �� �e �2 0
4
ATTACHMENT D — Sales and Use Tax Exemption Certificate
SALES AND USE TAX EXEMPTION CERTIFICATE
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 lowa 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. Contractor and each subcontractor shall comply with said
lowa Code Sales Tax requirements, shall keep records identifying the materials 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 lowa Department of Revenue and Finance; and distribute tax
exemption certificates and authorization letters to Contractor and each subcontractor.
PROJECT INFORMATION REQUIREMENTS FOR
STATE OF IOWA SALES TAX EXEMPTION CERTIFICATES
FOR CONTRACTORS & SUBCONTRACTORS
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 lowa 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 lowa Sales Tax.
Sales tax exemption certificates are not provided to material suppliers.
Contractor and subcontractors can provide copies of the sales tax exemption certificates issued by
the City to individual material suppliers.
Project Name: Snow and Ice Removal at Cit Pro ertie i
Project Description: _
Start Date (Bid Opening Date : 9/11/2020 I
Final Completion Date: I
Contact Name:
Complete Address: 165 Westside Court I
(Indude PO Box and Street Information)
City, State, Zip Code Dubu ue lowa 52003
Telephone Number: 563-556-1655
Federal I.D. Number: 42-1512376
(or Include Social Security Number) i
wo�k rype to be compieted: Snow removal services I
Page 30 of 39 � � � � I
� � M
Attachment E-Bidder Status From
Bidder Status Form �I
To be completed byall8idders PartA I
Pleas answer"Yes"or"No"for each of the following:
� No My company is authorized to transact business in lowa.
(To help you determine if your company is authorized,please review the worksheet on the next page).
es No My company has an office to transact business in lowa.
Yes� No My company's office in lowa is suitable for more than receiving mail,telephone calis, and e-mail.
es No My company has been conducting business in lowa for at least 3 years prior to the first request for Bids on �
Ihis project.
Yes 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 lowa.
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 nomresident Bidder. Please
complete Parts C and D of this form.
To be completed byallresident Bidders PariB
My company has maintained offices in lowa during the past 3 years at the following addresses:
Dates: 4/1/2009 to Present add�ess: 165 Westside Court
(mm/dd/yyyy) c�cy, State, z�P: Dubuque lowa 52003
Dates: to Address:
(mm/dd/yyyyJ City, State, Zip:
Dates: to Address:
(mm/dd/yyyy) City, State, Zip:
You ma attach additional sheet s if needed.
To be completed by a!I non-�esident Bidders Part C
Name of your home state or foreign country reported to the lowa Secretary of State.
Does your company's home state or foreign country offer preferences to Bidders who are residents? Yes I
No I
If you answered "Yes" to question 2, identify each preference offered by your company's home state or foreign I
country and the appropnate legal citation.
You may attach additional sheet(s) if needed. I
To be completed by a!I Bidders Part D
I certify that the statements made on this document are true and complete to the best of my knowledge and I I
know that my failure to provide accurate and truthful information may be a reason to reject my Bid.
Firm Name: Skylln2 C nstr ct'on I
Signature: Date: 9�10/2020 II
You mus[submit the co lete fo to the government body requesting Bids per 8751owa Administrative Code Chap[er 156 �'
This Form has been approved by the Labor Commissioner 309-6001 02-14
>
�-� �,.� ;
Page 32 of 39 � y�
� " "
Certification and Restrictions on Lobbying
i, Mark J Arthofer hereby certify on behalf of Skyline Constructiontnat:
No federal appropriated funds have been paid or will be paid, by or on behalf of the
undersigned, to any person for influencing or attempting to influence an officer or employee
of any agency, a Member of Congress, and officer or employee of Congress, or an
employee of a Member of Congress in connection with the awarding of any federal contract,
the making of any federal grant, the making of any federal loan, the entering into of any '
cooperative agreement, and the extension, continuation, renewal, amendment, or I
modification of any federal contract, grant, loan, or cooperative agreement. If any funds _
other than federal appropriated funds have been paid or will be paid to any person �
influencing or attempting to influence an officer or employee of any agency, a Member of
Congress, and officer or employee of Congress, or an employee of a Member of Congress
in connection with the federal contract, grant, loan, or cooperative agreement, the
undersigned shall complete and submit Standard Form - LLL, "Disclosure Form to Report
Lobbying," in accordance with its instructions. The undersigned shall require that the
language of this certification be included in the award documents for all sub-awards at all
tiers (including sub-contracts, subgrants and contracts under grants, loans, and cooperative
agreements) and that all sub-recipients shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when
this transaction was made or entered into. Submission of this certification is a prerequisite
formaking or entering into this transaction imposed by 31 U.S.C. § 1352 (as amended by
the Lobbying Disclosure Act of1995). Any person who fails to file the required certification
shall be subject to a civil penalty of not/ess than $10,000 and not more than $100,000 for
each such failure. The undersigned certifies or affirms the truthfulness and accuracy of the
contents of the statements submitted on or with this certification and understands that the
provisions of 31 U.S.C. Section 3801, et seq., are applicable thereto.
Name of Bidder/Company Name Skyline Construction
Type or print name Mark J Arthofer
Signature of authorized representative: Date: 9/� �j2�2�
Signature of notary and SEAL �tOf�+ �
�° �
a � F cr� � u � .E�
'�' �n�j a�lon w� m a :i 35'I
� �� �#�G�t�mles ris�, � c_/f/ mZl
I
� �
Page 39 of 39 a� � '
; 9�
V
Government Wide Debarment, Suspension, Ineligibility and Voluntary Exclusion
The Contractor shall comply and facilitate compliance with U.S. DOT regulations,
"Nonprocurement Suspension and Debarment," 2 C.F.R. part 1200, which adopts and
supplements the U.S. Office of Management and Budget (U.S. OMB) "Guidelines to
Agencies on Government Wide Debarment and Suspension (Nonprocurement)," 2 C.F.R.
part 180. These provisions apply to each contract at any tier of$25,000 or more, and to
each contract at any tier for a federally required audit (irrespective of the contract amount),
and to each contract at any tier that must be approved by an FTA official irrespective of the
contract amount. As such, the Contractor shall verify that its principals, affiliates, and
subcontractors are eligible to participate in this federally funded contract and are not r
presently declared by any Federal department or agency to be: �
a) Debarred from participation in any federally assisted Award;
b) Suspended from participation in any federally assisted Award;
c) Proposed for debarment from participation in any federally assisted Award;
d) Declared ineligible to participate in any federally assisted Award;
e) Voluntarily excluded from participation in any federally assisted Award; or
f) Disqualified from participation in ay federally assisted Award.
By signing and submitting its bid or proposal, the bidder or proposer certifies as follows:
The certification in this clause is a material representation of fact relied upon by the
AGENCY. If it is later determined by the AGENCY that the bidder or proposer knowingly
rendered an erroneous certification, in addition to remedies available to the AGENCY, the
Federal Government may pursue available remedies, including but not limited to
suspension and/or debarment. The bidder or proposer agrees to comply with the
requirements of 2 C.F.R. part 180, subpart C, as supplemented by 2 C.F.R. part 1200, while
this offer is valid and throughout the period of any contract that may arise from this offer. I
The bidder or proposer further agrees to include a provision requiring such compliance in its
lower tier covered transactions.
contra�tor: Sk line Construction
Signature of Authorized Official Date: g�20
Name and Title of Contractor's Authorized Off'cial: Mark J Arthof2l' Pr@Sldent
�F
r
Page 40 of 39 � ��'
�
,ac Ro o� CERTIFICATE OF LIABILITY INSURANCE °°�E,"'M�°°,TTYT,
osizaizozo
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELYAMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE�OES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER�S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certifica[e holder is an ADDITIONAL INSURED,the policy(ies)mus[have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED,subject to the terms and conditions of[he policy,certain policies may require an endorsement. A s[a[emen[on
[his cer[itica[e does not confer rights to the certificate holder in lieu of such endorsement(s).
PRO�OCER CONTACT SU¢MIIIEf
NAME:
EnglishlnsuranceAgency,lnc. q�C�H Ex�: (563)557-74A0 p�c,Ho: (563)583-9142
O'Connor 8 English Insurance pooaess smiller@english-insurance.com
1545ASSOCI3�25OL,$llll¢103 INSORER(S�AFFORDINGCOVERAGE NAICp
Dubuque �A 52002 iNsuRERp: WeslBendMutuallnsuranceCompany 15350 —
iNsuReo iNsuREa e�.
Skyline Storage&Trucking,Inc., Arthofer Pwper�ies,LLC WsuRea C:
Skyline Sweeping,Inq dba:Skyline Construction iHsurtert o�.
�65 Westside Ct. irvsuaea e�.
Dubuque IA 52003 iHsuaeaF:
COVERAGES CERTIFICATE NUMBER: 2�-Z� REVISION NUMBER:
THI515 TO CERTIFV THATTHE POLIGES OF MSl1RANCE LISTED BELOW HAVE BEEN ISSUED TOTHE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATE�. NOTWITHSTANDINGANVREQUIREMENT,TERMORCON�ITIONOFANYCONTRACTOROTHEROOCUMENTWITHRESPECTTOWHICHTHIS
CERTIFICATE MAV BE ISSUED OR MAV PERTAIN,THE INSURANCE AFFORDED BV THE POLIGES DESCRIBED HEREIN IS SUBJECT TOALLTHE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLIGES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR 7ypE OF INSURANCE POLICY EFF POLICV EXP LIMITS
LTR INS� WVD POLICYNUMBER MMIDDIYYYY MMID�IYYYY
X COMMERCIALGENERALLIABILITY EACHOCCURRENCE g 1,000,000
OAMAGE TO REMED 300,000
CLAIMS-MH�E x OCCUR PREMISES Eaoccurrence 5
ro1EDEXP(Anyone0erson� � 5,000
A V A218756 01/01I2020 01/01/2021 pERsoNn�anoviNduav 5 �.000,000
GEMLAGGREGATELIMITAPPLIESPER' GENERALAGGREGATE 5 2,000,000
POLICV � PR� ❑LOC PRODUCTS-COMPIOPAGG S Z�OOO,OOO
JECT
OTHER: 5
AUTOMOBILELIABILITY COMBINEOSINGLELIMIT g 1,000,000
Ea accidenl
x ANVAUTO BODILYINJURY(PerOersan� $
A OWNED SCHEOULEO A218758 O1/OV2O2O OlI0U2021 BODILVINJURY�PeracGtlenq 5
AuiO50NLv Auios
HIRED NON-OWNEO PROPERTYDAMHGE 5
AUTOSONLY AUTOSONLV Peraccitlent
5
X UMBRELLALIAB X OCCUR EACHOCCURRENCE 5 5,000,000
A EXCESSUAa CLAIMS-MADE A218756 Oi/Ol/2020 01/01/2021 qGGREGATE g 5,000,000
DED X RETENTION$ � $
WORKERSCOMPENSATION X PER OTH-
ANDEMPl.0YER5'LIABILRY STATUTE ER
Y I N 1,000,000
A NNYPROPRIETORIPARTNEILEXECUTIVE � NIA A21S765 O1/O1/2020 O1/O1/2021 EL EACHACCIDENT 5
OFFlCEF/MEMBER EXC W DED?
(Mantla�oryinNH� ELDISEASE-EAEMPLOYEE g ��000,000
ifves descrbeuntler 1,000,000 '�
DESCFIPTIONOFOPERATIONSbelow ELDISEASE-POLICYLIMIT 5
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACOR��01,Atltlitlonal Remarks SCM1edule,may be attachetl If more space is�equi�etl�
The City of Dubuque,induding all its elected and appointed officials,all its employees and volunteers,all its boards,commissions and/or authorities and
Iheir board mem6ers,employees and volun�eers are an addn'I insured on gen liab policies including ongoing 8 completed operations coverage equivilant�o
ISO CG2010 0704&CG2037 0704. Gen Lia6 policy is primary&non-contributing. Form CG2503 0397"Designated Projects"General Liab aggregate limit
shall be included. Governmen�al Immunities endorsement is included. Waiver of subroga�ion on workers compensalion and General Liability.
CERTIFICATE HOLDER CANCELLATION
SHOUID ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE E%PIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
Cily of Dubuque ACCORDANCE WRH THE POLICV PROVISIONS.
50 W.13[h 5�.
AIITHORIZED REPRESENTATNE
Dubuque IA 5200� ����
OO 1989-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
THE CITY OF
DT7 City of Dubuque
V B E Transportation Services Department
Mnsterpiece orr t/te MississipF�i 949 Kel'pel' Blvd
Dubuque, lA 52001
(563) 589-4198
This Service Contract (the Contract), is made and entered into by and between the
City of Dubuque, lowa (City), by its City Manager, through authority conferred upon the
City Manager by its City Council and Tri-State Paving Services (Contractor) of Dubuque,
lowa.
Project Name: Snow Removal at City Properties
Service Locations and Service Type(s): 10�h and Elm Street Parking Lot
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 forthe Project
as detailed in the Bid Document for snow removal including plowing, shoveling,
hauling and related services. Snowfall amounts are measured at the Jule Operations
and Training Center.
The work described above shall be completed at the following location(s):
10th and Elm Street Parking Lot
The Project shall be completed in strict accordance with the terms as described in this
Contract; in strict accordance with the requirements of the laws of the State of lowa
and ordinances of the City of Dubuque, and in accordance with the Invitation for Bid
(IFB) Documents which provisions and documents are each and all hereby referred
to and made a part of this Contract just as much as if the detailed statements thereof
were repeated herein.
2. Contract Documents shall mean and include the following: This Contract; The
Request for Bid dated August 24, 2020; all documents and specifications in the IFB
for this Project; and the Bid Proposal Form, all of which are incorporated by reference
into this Contract. �
3. All materials used by the Contractor on this Project shall be of the quality required by
the Contract Documents and shall be put in place in accordance with the Contract I
Documents.
1
4. Contractor shall complete all work as outlined in the Scope of Services and any work
condemned as unsuitable or defective shall be replaced or done anew to the
satisfaction of the TSOS at the cost and expense of Contractor.
5. Contractor has read and understands the Contract Documents and has examined and
understands the project description described in the IFB Scope of Services and
summarized in Section 1 of this Contract and any conditions herein referred to and �
agrees not to plead misunderstanding or deception because of estimates of quantity,
character, location or other conditions surrounding the same. �
6. The initial term of the Contract shall commence on the date the City executes the
Contract and shall end upon two years of Contract execution. Contractor may renew
this Contract by delivering written notice of renewal to City not less than 90 days prior
to the termination of the initial term.
City may terminate the Contract at any time for any reason with or without cause. In
that event, all finished or unfinished Work, reports, materials(s) prepared or furnished
by Contractor under the Contract shall, at the option of City, become its property. If
the Contract is terminated by City as provided herein, Contractor shall be paid for all
Work which has been authorized, provided, and approved up to the effective date of
termination. City will not be subject to any termination fees from Contractor.
7. 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 therefrom, 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.
8. Unless otherwise specified in the Contract Documents, prior to the commencement of
any work on this Project and at all times during the performance of this Contract,
Contractor shall provide evidence of insurance which meets the requirements of the
City's Insurance Schedule M attached to this Contract.
9. Contractor agrees that no work under this Contract shall commence on the Project
until the City has issued a written "Notice to Proceed" to Contractor. Any work started
by Contractor or prior the issuance of the Notice to Proceed shall be considered
unauthorized and done at the sole risk to Contractor.
2
10.The City of Dubuque in accordar�ce with Title VI of the Civil Rights Act of �964, 78
Stat. 252, 42 U.S.C. 200Dd-2000d-4 and Ti#fe 49, Code of Federal Regulafions,
Department af Transporka�ion, Subtitle A, Office of the Secretary, Part 21 ,
Nondiscrimination in Federally assisted programs of the Departmenf of Transportation
issued pursuant to such Act, hereby nofifies all bidders that it w�ll affirmatively insur�
that in any contrac# entered into pursuant to this advertisement, minority business
enterprises wilf be affarded full opporkunity to submit bids in response to this invitatior�
and will not be discriminated against on the grounds af race, color, national origin,
sex, age, or disa�ility in consideratian for an award.
CITY AGREES:
Upon the sUbmissian of monthfy invoices listing only the exact service performed ir� the
specified manth, inciuding the dates and times thaf service was performe�; using the
pravided invoice template; and upon review and autharization by the Transportation
Services Operations Superv'rsor; payment will be authorized based on the amounts listed
in #h� Bid Proposal Form an� snowfall amounts recorded at The Jule �perations and
Training Center (JOTC).
CITY OF DUBUQUE, IOWA TRI-STATE PAVING SERVECES,
C4NTRACTQR
. ��� ��",����
By, gy;
Michael C. Van Milligen eff hn
City Manager President
10/1/2020 � ,
Dated: Dated: �� � �'�,r�
C4NTRACTOR ACKNOWLEDGEMENT
OF ATTACHED FTA CLAUSES
B .
p �
President
Dated: � ��'
3
ATTACHMENT D - Sales and Use Tax Exemption Certificate
SALES AND USE TAX EXEMPTION CERTIFICATE
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 lowa 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
perfonnance of a construction contr2ci 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. Contractor and each subcontractor shall comply with said
lowa Code Sales Tax requirements, shall keep records identifying the materials 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 contracL
2. Upon award of Contract the City will register the Contract, Contractor, and each
subcontractor with the lowa Department of Revenue and Finance; and distribute tax
exemption certificates and authorization letters to Contractor and each subcontractor.
PROJECT INFORMATION REQUIREMENTS FOR
STATE OF IOWA SALES TAX EXEMPTION CERTIFICATES
FOR CONTRACTORS & SUBCONTRACTORS
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 lowa Department of Revenue to issue Sales Tax Exernption Certificates to the
approved contractor(s) to allow for the purchase or inventory withdrawal of materials for the
specified Project free from State of lowa Sales Tax.
Sales tax exemption certificates are not provided to material suppliers.
Contractor and subcontractors can provide copies of the sales tax exemplion certificates issued by
the City to individual material suppliers.
Project Name: o�,, �D,,.� �
Project Description:
Start Date (Bid Opening Date): o
Final Completion Date: 4 i
Contact Name: —`)�}�—' --���,�,� _
Complete Address: �O,j �.�u- �oss o,,
(Include PO�ox and Slreet Informalion)
City, State, Zip Code t,e y�
Telephone Number: Q _
Federal I.D. Number: aQ -s��(�AO�
jnr Indude Social Security IJumber)
Work Type to be Completed: P�0�.1 y, s�+ I�
Page 30 of 39
Attachment E-Bidder Status From
Bidder Status Form
To be compleled by a118idders Part A
Pie�answer"Yes"or"No"for each oi the[ollowing
No My company is authorizeA b Iransad business in lowa.
(To help you determine il your company is airthorized,please review the worksheef on!he next page)-
� Nr� My comp�ny has an office to Iransacl business m lowa.
e: No My company's oNice In lowa is suilable for more than receiving mail, telephone c2115, and e-mail.
e. No My company has be�n conAucliny business in lowa for at Ieas1 3 years prior�o Ihe (irsl request lor Bids on
this projecl.
'��. No My company is not a subsidiary of another business en�ity or my company is a subsidiary of
another business entily that would quali(y as a resident Bidder in lowa.
If you answercd "Yes" lor each ques�Ion aUove, your rompnny yualifies as a resideni Bitltler. Please
com��le�e Parls B and D o�lhis form.
If you answered "Nd to one or moro �uestions �bove. your mmpdny is �i non-residenl Bidd�r. Piease
complete Parts C and D of this(orm.
To be completed by all�esident Bidders Part F3
My company has ma/�intained offices in low�a du�ring ihe pas� 3 years at the followiii addresses� /�
Dates. � � "1 p fo � o / 1 ► �'� Addr�ss- ���S/ �,y.1` �.�,�„f_ �d� _
jntm/dd/YYYY) Y� City. St2te. Zip' 1�J�w_��.—�--{�0�---
Dates- to Address�
(mm/dci/YYYY1 Ciry. State. Zip�. _
Dates. to Address�.
(mm/dd/YYYY) City. State. Zip:
You ma altach adddional shoef sJ il needed �
To be completed by aN non-resident Bidders Part C
Name of your home state or foreign counlry reported to lhe lowa Secretary of State.
Does your company's home state or toreign counlry offer preferences to Bidders who are residents'? Yes
No
If you answered "Yes" to question 2, idenlify each preference offered by your r.ompanys home state or foreiyn
country and the appropriate leyal citaUon.
Ynu may attar.h additional sheet(s) if needed. �
To be completed by all Bidders Part D
1 certify that lhca statements made on this document are true and complele lo the besl of my knowiedge and I
know that m fY allureto prov� e ar,urate lruthful Information may be a reason to reject my Bid.
Firrn Name� ' ... . .
Date �
Siyna�ure _ L_�Q.� ..._._...
Vnu must su6mit lh� omp ele forin to lh overmnent body requestlng Bids per 9751owa Adminlstretive Code CI apter 156
This Form has Heen approvod by the La6or Commissioner :i���'h0�� 0?'�4
Page 32 of 39
Certification and Restrictions on Lobbying
� � ,�_ hereby certify on behalf of �S i � that:
No federal a ropriated Funds have been paid or will be paid, by or on behalf the
undersigned, to any person for influencing or attempting to influence an officer or employee
of any agency, a Member of Congress, antl officer or employee of Congress, or an
employee of a Member of Congress in connection with the awarding of any federal contract,
the making of any federal grant, the making of any federal loan, lhe eniering into of any —
cooperative agreement, and the extension, continuation, renewal, amendment, or
modification of any federal contract, grant, loan, or cooperative agreement. If any funds
other than federal appropriated funds have been paid or will be paid to any person
influencing or attempting to influence �n officer or employee of any agency, a Member of
Congress, and officer or employee of Congress, or an employee of a Member of Congress
in connection with the federal contract, grant, loan, or cooperative agreement, the
undersigned shall complete and submit Standard Form - LLL, "Disclosure Forin to Report
Lobbying," in accordance with its instructions. The undersigned shall require that the
language of this certification be included in the award documents for all sub-awards at all
tiers (including sub-contracts, subgrants and contracts under grants, loans, and cooperative
agreements) and that all sub-recipients shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when
this transaction was made or entered into. Submission of this certificafion is a prerequisite
for making or entering into this transaction imposed by 31 U.S.C. § 1352 (as arnended by
the Lobbying Disclosure Act of1995). Any person who fails to file the required certificativn
shall be subject to a civil penalty of not/ess than $10,000 and not more than $100,000 for
each such failure. The undersigned certifies or affrrms the truthfulness and accuracy of the
contenfs of the statements submitted on or with this certification and understands that the
provisions of 31 U.S.G Section 3£30i, et seq., are applir,aUle thereto.
Name of Bidder/Co�y Name )r-; S� � �
�
Type or print name r T �
Signature of authorized represent tive: Date: o /I / � ,
Signat � '
__ __..._ _---- _..
BRANDY RAKESTRAW
��,�µT CommissionNumber771274
g�-� M�Commission Expires
I�LV\11 p f�A��_�I
Page 39 of 39
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GENERAL COMPANY INFORMATION FORM
Company Name _ I` 1 � � - \ Q
CompanyAddress 3�S �;QG�,q�' r�-o�; ��o�,�_�In,l�,,,c,�a�O3
General Descriptipn of the Company:
�.�t� .��..� � � ..
__��r�-�—f_.
Type of Organization (franchise, corporation, partnership, etc.) � �,�.T p
Number of years in business: �p�
References
List three (3) customers who are current or have been served by your coinpany within the last
three (3) years with projects of similar scopes. (Name of firm, address, contact person,
phone number)
Reference #1 - Name: p 1�„
Address: �,�
Contact Person & Phone: 1 �� 3
Date & Description of Job: � �,� � ` �
Contract Value: ,� M� �po
/
Reference #2 - Name:
Address: � b �� �� �.(. ab0
Contact Person & Phone: � �'„� _ C�a
Date & Description of Job: ��ey,� �
Contract Value: r' � ,�„dpp
Reference #3 - Name: o ' G� �
Address:
�
Contact Person & Phone: � b �•
Date & Description of Job: _ A� �n�„� � 5� �
Contract Value: � � � o�
_. Personnel
Name and title of person
overseeing the City account: �F'��-�y� � �
Office Phone: _ p g�
Mobile: 3
Email: S C�r.,,,
ames, tities and years o experi n�(�j o persons expected to service the City account:
� — �S i rn��' � ------
�r6,w,rw, ._—�p
Page 23 of 39
Safety R�cord
Has your company received an OSHA violation in the past five (5) I � Yes � No
years? u \
If yes, please attach copies of the citations and an explanation of how they have been
resolved.
Page 24 of 39
-�"1 HAMEPAR-01 NHERMSEN
A`ORO GERTIFICATE OF LIABILITY INSURANCE °A�E,�"M,°°""r�,
70/1/2020
,, THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
'�� CERTIFICATE DOES NOT APFIRMATIVELY OR NEGATIVELY AMENO, EXTEND OR ALTER THE COVERAGE APFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE OOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER�S),AUTHORIZED
REPRESENTATIVE OR PRODUCER.AND THE CERTIFICATE HOLDER.
IMPORTANT: i( the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions m be endorsetl.
iIf SU6ROGATION IS WAIVEq subject [o [he terms and conditions of the policy,certain policies may require an entlorseinen[. A statement on
this certifiw[e does not confer righ[s to the certifiwte holder in lieu of such endorsement(s).
aeoouceR coNEncr Nicole Hermsen
TRICOR,Inc.-Dubuque PHONE Fax
600 Star Brewery Drive 1arc,r�o,e,��:(563) 231-2264 1428 �nic.Nop.
Suite 110 aoo"aEss:nhermsen@tricorinsurance.com
Dubuque,IA 52001 —
INSURER 5 AFFORDING COVERAGE NAIC k
wsuaeRn:United Fire 8 Casualt Co 13021
INSURED INSURER B:
Sulam Corporetion dba Tri-State Paving Services iNsuaee c:
305 Cedar Cross Road
INSURER D:
Dubuque,lA 52003
INSURER E'.
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFV THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEO TOTHE WSURED NAMEDABOVE FOR THE POLICV PERIOD
INDICATED. NOTNITHSTANDMG ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENTIMTH RESPECTTO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAV PERTAIN. THE INSURANCE AFFORDED BY THE POLIGES DESCRIBED HEREINISSUeJECTTOA�LTHETERMS,
EXCWSIONS AN�CONDITIONS OF SUCH POLIGES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
�LTR TYPEOFINSURNNCE N50 WV� POLICYEFF POLICYEXP LIMITS
POLICYNUMBER MMIDOIYVYY MMI�OIVYVY
� A X COMMERCIALGENERAL�IABILITV cnCFJC.;JFRENCE 5 ��QOO,OOO
a4i�st�`Aoe �X eccu� X 60505170 6/9/2020 6/9f2021 pq�°�,isEs�eaoccorrence� 5 '�00,000
X Contractors liabilit 5,000
MEDEt�An one ersom S
PeasONa�s.�ovin„u�v 5 1,000,000
GER'L�C-3FEGA'EIJA41T4PPLIESPFH G`cNEft4L436REG,�TE 5 3,���,�00
�e�icr P4O- 3,000,000
❑ .�cr ❑�cc Przooucrs-cor��arevas� s
u.��,,E,�. CONTRACTORS � 500,000
A auroMoei�e unaiury "oro�eiN.=_osiNc�e unaiT � 1,000,000
'Ea accula�Y
X qNv suro 60505170 6/9/2020 819f2027 �o�I�v I�udoav Par erson� s
04'umIEC SCH[CULE�
AUiOECMLv AUTCS EOCILYINJUFY PerecctlenC 5
NIRED NON-0�,1ME� PROPERTY pHAnaGE
AL�=050M1�Y AVTOSP'Jll ��eraccitleM�
S I
A UMBRELIn Llne X JccLa 5,000,000
EAGH OGCU4ftENCE
X EXCESS LINB cLoiMs-ntaee 60505170 6!9/2020 61912021 �ccae-,�1=
oec X aEreMrior�s 0 Ac�pregata � 5,000,000
A WORKERS COMPENSATION PER JTH-
ANDEMPLOVERSLIp61LITY STnTUTE eF
�Nr�ancaieTeR-PaaTNek;exs:�nve �� fi0505170 679/2020 6/9/2027 F 1,000,000
jM� ricEaaa-=_n�e a ex�woeco ruin .�.eacn acao=_irr s I
annarory in NH� 1,000,000
Ifves.descr�beuntlsr EL.�ISEASE-EhEMCLOYES 5
nEScaia-io�voFOPew�ricas�.m��� E�.oise�5e-oou^ruMi1 s 1,000,000
I (
pESLRIPTIONOFOPEftATION5ILOCATIONSIVEHiCLES (ACOR0101,AtltlltionalRemarks5chetlule.maybeattacM1etlif�norespaceisrepuiretl�
City of Dubuque. including all its elected and appointed officials,all its employees and volun[eers.all its boards.commissions and/or authorities and their
board members,employees and volunteeis are addifional insureA on the general liability policy on a primary,noncontributory basis and including ongoing
and completed operetions.A waiver of subrogation is applieA in favor of the City of Dubuque, including all its electeA and appointeA officials,all its
'employees antl voltmteers.all its boards,commissions and/a'authorities and their board mem6ers,employees and volunteers on the workers compensation
policy.Governmental immunities endorsemen[included.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE A80VE DESCRIBED POIICIES BE CANCELLED BEFORE
City of Dubuque THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERE� IN
ACCORDANCE WITH iHE POLICY PROVISIONS.
50 W 13th SI
� Dubuque.lA 52001
I AIITHOftIZED REPRESENTNTIVE
I �-���.
ACORD 25(2016103) c01988-2015 ACORD CORPORATION. All rights reserved.
The ACORO name and logo are registered marks o(ACORD
TH6 CTTY OF
D� 7 City of Dubuque
V B E Transportation Services Department
Masterpiece ora the Mississippi 949 Kerper Blvd
Dubuque, IA 52001
(563) 589-4198
This Service Contract (the Contract), is made and entered into by and between the
City of Dubuque, lowa (City), by its City Manager, through authority conferred upon the �
City Manager by its City Council and Dan Arensdorf Construction Inc (Contractor) of I
Dubuque, lowa.
Project Name: Snow Removal at City Properties I
Service Locations and Service Type(s):
Five Flags Parking Ramp, Intermodal Parking Ramp, Central Ave Parking Ramp, Locust I
St Parking Ramp, lowa St Parking Ramp, Port of Dubuque Parking Ramp, 5"' St Parking
Ramp, 4th & Central Lot, 5th & Bell Lot, 9�h & Bluff Lot, 11'" & Bluff Lot, 12�h & Bluff Lot, 5�n
& Bluff Lot, Historic Federal Building Lot, Ice Harbor Lot, 3'd & Locust Lot, 3�d & Main Lot
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 Project i
as detailed in the Bid Document for snow removal including plowing, shoveling, ',
hauling and related services. Snowfall amounts are measured at the Jule Operations �i
and Training Center.
I
The work described above shall be completed at the following location(s):
Five Flags Parking Ramp, Intermodal Parking Ramp, Central Ave Parking Ramp,
Locust St Parking Ramp, lowa St Parking Ramp, Port of Dubuque Parking Ramp,
5th St Parking Ramp, 4th & Central Lot, 5"' & Bell Lot, 9th & Bluff Lot, 11t" & Bluff
Lot, 12�h & Bluff Lot, 5"' & Bluff Lot, Historic Federal Building Lot, Ice Harbor Lot,
3�d & Locust Lot, 3�d & Main Lot
The Project shall be completed in strict accordance with the terms as described in this
Contract; in strict accordance with the requirements of the laws of the State of lowa
and ordinances of the City of Dubuque, and in accordance with the Invitation for Bid
(IFB) Documents which provisions and documents are each and all hereby referred
to and made a part of this Contract just as much as if the detailed statements thereof
were repeated herein.
2. Contract Documents shall mean and include the following: This Contract; The
Request for Bid dated August 24, 2020; all documents and specifications in the IFB I
1 �I
for this Project; and the Bid Proposal Form, all of which are incorporated by reference
into this Contract.
3. All materials used by the Contractor on this Project shall be of the quality required by
the Contract Documents and shall be put in place in accordance with the Contract
Documents.
4. Contractor shall complete all work as outlined in the Scope of Services and any work
condemned as unsuitable or defective shall be replaced or done anew to the
satisfaction of the TSOS at the cost and expense of Contractor.
5. Contractor has read and understands the Contract Documents and has examined and
understands the project description described in the IFB Scope of Services and
summarized in Section 1 of this Contract and any conditions herein referred to and
agrees not to plead misunderstanding or deception because of estimates of quantity,
character, location or other conditions surrounding the same.
6. The initial term of the Contract shall commence on the date the City executes the
Contract and shall end upon two years of Contract execution. Contractor may renew
this Contract by delivering written notice of renewal to City not less than 90 days prior
to the termination of the initial term.
City may terminate the Contract at any time for any reason with or without cause. In
that event, all finished or unfinished Work, reports, materials(s) prepared or furnished
by Contractor under the Contract shall, at the option of City, become its property. If
the Contract is terminated by City as provided herein, Contractor shall be paid for all
Work which has been authorized, provided, and approved up to the effective date of
termination. City will not be subject to any termination fees from Contractor.
7. 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 therefrom, 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.
8. Unless otherwise specified in the Contract Documents, prior to the commencement of
any work on this Project and at all times during the performance of this Contract,
Contractor shall provide evidence of insurance which meets the requirements of the
City's Insurance Schedule M attached to this Contract.
2 �
9. Contractor agrees that na work under this Contract shail commence an the Project
until the City has issued a written "Notice to Proceed" to Contractor. Any wark sta�ted
by Contractor or priar the issuance of the Notice to Proceed shafl be considered
unauthorized and done at the sole risk to Contractor.
10.The City of Dubuque in accordance with Title VI of the Civil Rights Act of 19�4, 78
Stat. 252, 42 U.S.C. 200Qd-200Dd-4 and Title 49, Code of Federal Reguiations,
Department of Transportatior�, Subtitle A, Office of the Secretary, Part 21,
Nondiscrimination in Federally assisted programs af the Department of T�ansportation
issued pursuant to suct� 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 afFarded fiull opportunity to submit bids in respanse ta this invitation
and wilf not be cEiscriminated against on the graunds of race, calor, national origin,
sex, age, or disability in consideration far an award.
CITY AGREES:
Upon the submission of monthfy invoices listing only the exact service perfo�med in the
specified month, including the dates and times that service was performed; usir�g the
provided invoice template; and upon review and autharization by the Transporta#ion
Services Operations Supervisor; payment will �e authorized based on the amounts listed
in the Bid Proposal Form and snowfall amounts recorde� at The Jule Operations and
Trainir�g Center (JOTC).
CITY OF DUBUQUE, IOWA DAN ARENSDORF CONSTRUCTION,
CONTRACTQR
��� ����� �
By: By: ���
Michael C. Van Millig�n Dan ArensdorF
City Manager President
10/1/2020 `
Dated: Dated: �� - � ` ��
CONTRACTQR ACKNOWLEDGEMENT
�F ATTACHED FTA CLAUSES
.� �BY� ` �-CJ
Dan Arensdorf
President
Dated: �� �- � r� ���
3
Certification and Restrictions on Lobbying
� +ruc.� �on�Snc.
I,� '�ffiJ�SlL���trereby certify on behalf of`�c�n /�r�ps�o��f' � �� that:
No federal appropriate funds have been paid or will be paid, by or on behalf of the
undersigned, to any person for influencing or attempting to influence an officer or employee
of any agency, a Member of Congress, and officer or employee of Congress, or an
employee of a Member of Congress in connection with the awarding of any federal contract,
the making of any federal grant, the making of any federal loan, the entering into of any
cooperative agreement, and the extension, continuation, renewal, amendment, or
modification of any federal contract, grant, loan, or cooperative agreement. If any funds
other than federal appropriated funds have been paid or will be paid to any person
influencing or attempting to influence an officer or employee of any agency, a Member of
Congress, and officer or employee of Congress, or an employee of a Member of Congress
in connection with the federal contract, grant, loan, or cooperative agreement, the
undersigned shall complete and submit Standard Form - LLL, "Disclosure Form to Report
Lobbying," in accordance with its instructions. The undersigned shall require that the
language of this certification be included in the award documents for all sub-awards at all
tiers (including sub-contracts, subgrants and contracts under grants, loans, and cooperative
agreements) and that all sub-recipients shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when
this transaction was made or entered into. Submission of this certification is a prerequisite
for making or entering into this transaction imposed by 31 U.S.C. § 1352 (as amended by
the Lobbying Disclosure Act of1995). Any person who fails to file the required certification
shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for
each such failure. The undersigned certifies or affirms the truthfu/ness and accuracy of the
contents of the statements submitted on or with this certification and understands that the
provisions of 31 U.S.C. Section 3801, et seq., are applicable thereto.
�, � ��,� �nc
Name of Bidder/Company Name .1�c1 r� �� r�n s ��t'rt� L �n s tr� c,'� �
Type or print name �17�y i e� � �rr� S c%�'�
Signature of authorized representative: + Date: C� / .i
Signature of notary and SEAL
*a< <s RUSSELL K. S7ECKLEIN
z�� CommJss`cn Number 014078 -
!,1y Co rnisslpn Expires
♦ �OVIa ��
Page 39 of 39 I
Government Wide Debarment, Suspension, Ineligibility and Voluntary Exclusion
The Contractor shall comply and facilitate compliance with U.S. DOT regulations,
"Nonprocurement Suspension and Debarment," 2 C.F.R. part 1200, which adopts and
supplements the U.S. Office of Management and Budget (U.S. OMB) "Guidelines to
Agencies on Government Wide Debarment and Suspension (Nonprocurement)," 2 C.F.R.
part 180. These provisions apply to each contract at any tier of $25,000 or more, and to
each contract at any tier for a federally required audit (irrespective of the contract amount), I
and to each contract at any tier that must be approved by an FTA official irrespective of the
contract amount. As such, the Contractor shall verify that its principals, affiliates, and
subcontractors are eligible to participate in this federally funded contract and are not
presently declared by any Federal department or agency to be:
a) Debarred from participation in any federally assisted Award;
b) Suspended from participation in any federally assisted Award;
c) Proposed for debarment from participation in any federally assisted Award;
d) Declared ineligible to participate in any federally assisted Award;
e) Voluntarily excluded from participation in any federally assisted Award; or
f) Disqualified from participation in ay federally assisted Award.
By signing and submitting its bid or proposal, the bidder or proposer certifies as follows:
The certification in this clause is a material representation of fact relied upon by the
AGENCY. If it is later determined by the AGENCY that the bidder or proposer knowingly
rendered an erroneous certification, in addition to remedies available to the AGENCY, the
Federal Government may pursue available remedies, including but not limited to
suspension and/or debarment. The bidder or proposer agrees to comply with the
requirements of 2 C.F.R. part 180, subpart C, as supplemented by 2 C.F.R. part 1200, while
this offer is valid and throughout the period of any contract that may arise from this offer.
The bidder or proposer further agrees to include a provision requiring such compliance in its
lower tier covered transactions.
�, „
<<.
Contractor: � y `
Signature of Authorized Official t � Date: ,�/�/��
Name and Title of Contractor's Authorized Official: ��j ��iti.,`f
Page 40 of 39
I
ATTACHMENT D — Sales and Use Tax Exemption Certificate
SALES AND USE TAX EXEMPTION CERTIFICATE
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 lowa 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.
i
1. These tax exemption certificates and authorization letters are applicable only for the '
work under the contract. Contractor and each subcontractor shall comply with said
lowa Code Sales Tax requirements, shall keep records identifying the materials 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 lowa Department of Revenue and Finance; and distribute tax
exemption certificates and authorization letters to Contractor and each subcontractor.
PROJECT INFORMATION REQUIREMENTS FOR
STATE OF IOWA�ALES TAX EXEMPTION CERTIFICATES
FOR CONTRACTORS & SUBCONTRACTORS
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 lowa 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 lowa Sales Tax.
Sales tax exemption certificates are not provided to material suppliers.
Contractor and subcontractors can provide copies of the sales tax exemption certificates issued by
the City to individual material suppliers.
Project Name: ��cw ar�c� �c�, (��,v�,;�ct u} C . �- '
Project Description: �'ro . �-� rs
Start Date (Bid Opening Date): -1(J -�(�:�C
Final Completion Date: _ � - �{;� ,. „ , }E
Contact Name: �n .p n �� tl
CompleteAddress: 87�� 5��,,;c. I�I�.tl Ln,
(Include PO Box and Street Information) D�.�{.�.�,.-� ��"^ a �'� �jc�
City, State, Zip Code „� Z S'a�; ,,
Telephone Number: S(v3 �- 5�1�— �S/L2
�
Federal I.D. Number: a �: -aey� q� �5
(or Include Social Security Number) ���
Work Type to be Completed: p
� h o W Q v� C� ,�C-C �P m cv�� �
Page 30 of 39 c ��er,n, , -f- #� �3�G�(�;�5 ��
S4 ��r5 + Lx
Attachment E-Bidder Status From
Bidder Status Form i
To be completed by all Bidders Part A
Please answer"Yes"or"No"foreach ofthefollowing:
Yes No My company is authorized to transact business in lowa.
(To help you determine if your company is authorized,please review the worksheet on the next page).
Yes No My company has an office to transact business in lowa.
Y No My company's office in lowa is suitable for more than receiving mail, telephone calls, and e-mail.
Yes No My company has been conducting business in lowa for at least 3 years prior to the first request for Bids on
this project. —
Yes 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 lowa.
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 Biddec Please
complete Parts C and D of this form.
To be completed by all resident Bidders Part 8
My company has maintained offices in lowa during the past 3 years at the following addresses:
Dates: �=� �� �9g to �Y-�S�ri�t Address: � 7� � S'c �n�c . N �• �� �-�1 ,
(mm/dd/yyyy) City, State, Zip: �u��� .� � -�C�O�
Dates: to Address:
(mm/dd/yyyy) City, State, Zip:
Dates: to Address:
(mm/dd/yyyy) City, State, Zip:
You may attach additional sheet(s) if needed.
To be completed by all non-resident Bidders Part C
Name of your home state or foreign country reported to the lowa Secretary of State.
Does your company's home state or foreign country offer preferences to Bidders who are residents? Yes
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. I
To be completed by all Bidders Part D
I certify that the statements made on this document are true and complete to the best of my knowledge and I
know that my failure to provide accurate and truthful informatio may be a reason to reject my Bid.
FirmName: ��tr� ��'�t'YlSC( (, �'� ��T�S �Yi� C_��'On �YIL�
Signature: �,;,�;,��' � �J-7�7����� Date: � % —c��S '�.�
. .
You must submit the complete form to tb' government body requesting Bids per 8751owa Administrative Code Chapter'156
This Form has been approved by the Labor Commissioner 309-6001 02-14
Page 32 of 39
.i� DANAREN-01 KHESS
Aco�ro° CERTIFICATE OF LIABILITY INSURANCE °A�E`MM'°°"Y"",
�' 9/25/2020
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 BYTHEPOLICIES
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 [he certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be entlorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A stateme�t on
this certificate tloes no[confer rights[o the certificate holtler in lieu of such endorsemen[�s).
PROOUCER CONTNCT
NAME:
TRICOR, Inc.-Dubuque PHONE cnx
600 Star Brewery Drive inro,No,e.q:(563)556-5441 �ac,No�:(608)723-6440
Suite 110 ADDRE55:
Dubuque,lA52001 INSURERSAFFORDINGCOVERAGE NAICp I
INSURER A:{�CUI 14184
INSUREO INSURER B:
Dan Arensdort Construction Inc i�vsueea c:
8785 Scenic Hill Drive INSORER D: I
Dubuque, lA 52003
INSURER E:
INSURER F: �
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OP INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTMTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECTTO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE WSURANCE AFFORDED BY THE POLICIES DESCRBED HEREW ISSUBJECTTOALLTHETERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
��7R NPE OF MSURANCE NS�S�D I POLICY NUMBER POLICY EFF POLICV EXP
MMIO�fIVYY MMIDDIWYV LIMIT$
A X COMMERqALGENERALLIABILITV EACHOCCURRENCE S ��OOO�OOO
CLAIMS-MA�E �OCCUR iX120$1 $�$0/2020 3/30I2021 DAMAGETOREMEO 25000p
PREMISES Eaoccurrence 5
MeDexP An one ereon 5 �0,000
PERSONALSADVINJl1RV S �,OOO,OOO
GEMLAGGREGATELIMITAPPLIESPER: GENERALAGGREGATE 5 3,OOQOOO
POLICV� jEC�T ���� PRODUCTS-COMPIOPAGG 5 3,000�000
OTHER: g
A AUTOMOBILELIFBILITY COMBWE�SINGLELIMIT �,00�,0�0 I
Ea accitlent 5
X qNvnuio X12051 3/30/2020 3130/2021 eooi�viNduRv Per erson 5
OWNED SCHEDULED
AUTOSONLY AUTOS I BO�ILYINJURV Peraccitlen! 5
HIRED NON-ONMED PROPERTV DAMAGE
AUiOSONLV AUiOSONLl Peraccitlent i5
5
A X UMBRELLALIPB X OCCUR ENCHOCCURRENCE 5 2�000�000
EXCESSLINB CLAIMS�MADE X�205� 3/30/2�2� 313012021 qGGREGATE 5 z'�Q�,���
�ED X RETENTION$
5
A WORKERSCOMPENSATION )( PER OTH-
AN�EMPLOYERS'L�IBILITY STATUTE ER
nnrPaoPRieroaianarn�eaiexecurive Y�N X12051 3/30/2020 3I30/2021 500,000
OFFlCERIMEMBEREXCWDED? �Y NIA EL.EACHACCIDENT 5
(MantlaroryinNH) EL.OISEASE-ENEMPLOYEES SOO,OOO
f yes describe untler 500,000
DESCRIPTIONOFOPERATIONSbelow EL.�ISEASE-POLICVLIMIT 5
I
OESCRIPTION OF OPERATIONS I LOCATION51 VEHICLES �ACORD 101,Atltlitional Remarks Schedule,may be attachetl if more space is requiretl�
The Ciry of Dubuque,including all its elec[etl and appointed officials,all its employees and volunteers,all its boards,commissions and/or authorities and
[heir board members,employees and volunteers are additional insured on[he general liability policy on a primary and non-contributory basis for on-going
antl completed opere[ions,as required by wri[ten contrect.Waiver of subrogation in favor of the City of Dubuque applies on the work comp antl general
liability policies.Governmental Immuni[ies endorsemen[applies.Fellow Employee coverage included on generel liability.General aggrega[e per
location/projec[apples on the general liability.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANV OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Cit 01DUb11 UC THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Y 4 ACCORDANCE WITH THE POLICV PROVISIONS.
50 W 13th St
Dubuque,lA 52001
AIITM��ORIZED REpPRESENTATIVE
NIX( y'"'
ACORD 25(2016/03) OO '1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
I