HomeMy WebLinkAboutRESOLUTION NO. 2013-52 RESOLUTION NO.2013-52
A RESOLUTION APPROVING AND MAKING AWARD OF CONTRACT. FOR THE
PHASE 1 —EAST CEMETERY ROAD RECONSTRUCTION,DRAINAGE,.STORM
SEWER, WATER MAIN,AND SANITARY SEWER IMPROVEMENTS PROJECT
WHEREAS, the City Council of the City of Fairfax, Iowa., did receive bids on Thursday,
July 18, 2013, at 10:00 AM for the Phase 1 — East Cemetery Road Reconstruction, Drainage,
Storm Sewer, Water Main, and Sanitary Sewer Improvements Project; and
WHEREAS, the City Council of the City of Fairfax, Iowa, did approve the plans,
specifications, form of contract, and estimated cost for the Phase 1 — East Cemetery Road
Reconstruction, Drainage, Storm Sewer, Water Main, and Sanitary Sewer Improvements Project
on July 23, 2013.
NOW, THEREFORE, RE IT RESOLVED, by the City Council of the City of Fairfax,
that the quote from Ricklefs Excavating, Ltd. in the amount of$1,411,555.00 for the Phase 1 —
East Cemetery Road Reconstruction, Drainage, Storm Sewer, 'Nater Main, and Sanitary Sewer
Improvements Project, be and is hereby accepted, as the lowest responsible quote received, and a
contract is hereby awarded; and
BE IT FURTHER RESOLVED, that the contractor is hereby instructed to promptly
execute the construction contract and return the same to the Mayor along with all the supporting
documents required therein, including surety bond covering work to be performed and proof of
,satisfactory insurance coverage; and
BE IT FURrTIER RESOLVED, that the Mayor, with the assistance of the City
Engineer is thereafter directed to examine the contract for proper execution and all supporting
documents, including surety bond and proof of insurance coverage to determine satisfactory
compliance with contract specifications. If all documents are in order, the Mayor shall approve
the same in writing and place written approval on file in the office of the City Clerk/Treasurer;
and
BE IT FURTHER RESOLVED, that the Mayor and City Clerk/Treasurer are hereby
authorized and directed to execute the contract for and on behalf of the City and upon execution
the contract shall be in full force and effect; and
BE IT FURTHER RESOLVED, by the City Council of the City of Fairfax, Iowa, that
the Mayor and City Clerk/Treasurer are hereby authorized and directed to execute said
Resolution.
AYES: Beer, Frieden, and Otto
NAYS: None
ABSENT: Magers and Wainwright
Passed and approved this 23Td day of July, 2013.
JasonRabe, Mayor � A
ATTEST:
Cyntl is Stimson, City Clerk/Treasurer
a
PHASE I EAST CEMETERY ROAD RECONSTRUCTION, DRAINAGE,
STORM SEWER,WATER MAIN, AND SANITARY SEWER IMPROVEMENTS
CITY OF FAIRFAX
BIDS READ ON JULY 18, 10:00 AM
Bidder Bid Bond? AAllendums cknowledged? Bid Amount
elf �T5,
$
$
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00300 /
BUD i
PHASE �
EAST CEMETERY ROAD RECONSTRUCTION, DRAINAGE,' |
WATER MAIN, AND SANITARY SEWER IMPROVEMENTS
THIS BID IS SUBMITTED TO: City ofFairfax
525 Vanderbilt Street
Fairfax, Iowa 52228
1.01 The undersigned Bidder proposes and agrees, if this Bid is accepted, to enter into an Agreement
with OWNER in the form Included in the Bidding Documents to perform all Work as specified or
indicated in the Bidding Documents for the prices and within the times indicated in this Bid and in
accordance with the other terms and conditions ofthe Bidding Documents.
2.01 Bidder accepts all of the &ennu and conditions of the Notice of Hearing and Lett|ng, including
without limitation those dealing with the disposition ofBid nwourity. The Bid will remain subject tn
acceptance for 30 days after the Bid qponinq, or for such longer period of time that Bidder may
agree to in writing upon request of OWNER. Bidder will sign and deliver the required number of
counterparts of the Agreement with the Bondu, insurance mertifiva1ea, and other documents
required bythe Bidding Requirements within 15days after the 0WNER'o Notice ofAwaod
. �
3.01 In submitting this B|d. Bidder represents, as set forth inthe Agreement,that: �
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A. Bidder has examined and carefully studied the Bidding Documents,the other related data �
identified In the Bidding Documents, and the following Addenda, receipt nfall which is
hereby acknowledged.
Addendum No., Addendum Date
1 July 12. 2O13
B. Bidder has visited and examined the Site and become familiar with and is satisfied as to
the general, local and Site conditions that may affect cost, progress, and performance of
the Work.
O. Bidder is familiar with and is satisfied as to all federal, state and local Laws and
Regulations that may affect cost, progress and performance ofthe Work.
D. Bidder has rmmsbu|k/ studied all: (1) reports of explorations and tests of subsurface
conditions at or contiguous to the Site and all Drawings of phyn|oe| conditions in or
m|o1|ng to existing :surface or subsurface structures at orcontiguous 10 the Site (except
Underground Fucditioa) which have been identified Imthe Supplementary Conditions as
provided in paragraph 4.02 of the General Conditions, and (2) reports and Drawings of a
Hazardous Environmental Conditiun, if any, which has been identified in the
Supplementary Conditions as provided in paragraph 4.06 of the General Conditions.
E. Bidder has obtained and carefully studied (or assumes responsibility for having done so)
all additional or supplementary examinations, |nvemt1ga0on*, explorations, tests, studies
and data concerning conditions (surface, subsurface and Underground Fen||h|gu) at or
AddendumNo. 1 00300'1 7/12/13
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contiguous to the Site which may affect cost, progress, urperformance of the Work or
which relate to any aspect of the means, methods, teohniquoa, sequences, and
procedures of construction to be employed by Bidder, 'including applying the specific
means, methods, teohniqueo, sequences, and procedures of construction oxpmaa|y
required bythe Bidding Documents tube employed by Bidder, and safety precautions
and programs incident thereto.
F. Bidder dnon not consider that any further examinations, invetigat|ona, explorations,
teata, atudieu, or data are necessary for the determination of this Bid for performance of �
the Work at the price(s) Bid and within the times and in accordance with the other terms
and conditions ofthe Bidding Documents.
G. Bidder is aware of the general nature of work to be performed by OWNER and others at �
the Site that relates tnthe Work amindicated |nthe Bidding Documents, �
H. Bidder has correlated the information known to Bidder, information and observations
obtained from visits to the Site, reports and Drawings identified in the Bidding
Duoumontu, and all additional examinations, investigations, explorations, tests, studies, �
and data with the Bidding Documents.
i Bidder has given ENGINEER written notice of all oonficts, nmora, ambiguitieu, or
discrepancies that Bidder has discovered in the Bidding Douumento, and the written
resolution thereof byENGINEER |eacceptable toBidder.
J. The Bidding Documents are generally sufficient 0a indicate and convey understanding of
allterms and conditions for the performance of the Work for which this Bid is submitted.
K. Bidder has received and |afamiliar with:
(i) Cedar Rapids Metropolitan Area 8tamdenj Specifications for Public
Improvements, latest edition.
(ii) Cedar Rapids Metropolitan Area Standard Details for Public Improvements, latest /
edition.
4.01 Bidder further represents that this Bid in genuine and not made in the interest of or on behalf of
any undisclosed individual orentity and is not submitted |mconformity with any Agreement or
rules of any group, u:oocim%inn, organization or corporation; Bidder has not directly or indirectly
induced or solicited any other Bidder to submit ofa|ae or sham Bid; Bidder has not eo||obod or
induced any individual mrentity to refrain from bidding; and Bidder has not muught by collusion to
obtain for itself any advantage over any other Bidder orover OWNER.
5.01 Bidder m8rnny that the Work will be completed and ready for final payment in accordance with
paragraph 14.07.13 nfthe General Conditions on or before the dates or within the number of
Calendar nrWorking Days indicated inthe Agreement.
5.02 Bidder accepts the provisions of the Agreement as to liquidated damages in the event of failure to
complete the Work within the times specified above, which shall be stated in the Agreement.
8.01 Include the following documents in the envelope with this Bid:
A. Attachment |—Equal Opportun|ty/Non'Diondm|no1ionPolicy
B. Attachment ||—Non-Collusion Affidavit
C. Attachment X|—LcenoedPlumber orPipe Layer Certification
6.02 The following documents are submitted |ma separate envelope and made a condition ufthis Bid:
Addendum No. 1 00300'2 7/12/13
A. Required Bid security in the form set forth in the Bidding Documents.
7.01 The terms used in this IBid with initial capital letters have the meanings indicated in the
Instructions to Bidders,the General Conditions, and the Supplementary Conditions.
8.01 Bidder will complete the Work in accordance with the Contract Documents for the prices as
shown on the attached schedule of Bid prices.
Unit Prices have been computed in accordance with paragraph 11.01.A of the General
Conditions.
Bidder acknowledges that estimated quantities are not guaranteed, and are solely for the purpose
of comparison of Bids, and final payment for all Unit Price Bid items will be based on actual
quantities provided, determined as provided in the Contract Documents.
8.02 Abbreviations
The following abbreviations may be used in this Bid:
AGC Asphaltic Cement Concrete LBS - Pounds
CIP Complete in Place LF - Linear Foot
COMP Complete LS - Lump Sum
CF Cubic Foot LT - Left
CY Cubic Yard MAT - Material
DI Ductile Iron MH - Manhole
DIA Diameter PCC - Portland Cement Concrete
EA Each RCB - Reinforced Concrete Box
ELEC Electrical RCP - Reinforced Concrete Pipe
EST Estimate(d) RT - Right
EXCL Excluding SF - Square Foot
FIXT Fixture STA - Station
FT Feet SY - Square Yard
GAL Gallon TN Ton
HERCP Horizontal Elliptical RCP VLF - Vertlical Linear Foot
HRS Hours W/ With
IN Inch WIO Without
INCL Including
Addendum No. 1 00300-3 7112/13
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SUBMITTED on .. t. � T. ot;�
Iowa Department of Lab=or(Registration NO./CONTRACTOR License No. j��
If Bidder is:
An Individual
Name (typed or printed):
By; _ . (SEAL)
(individual's signature)
Doing lousiness as:
Business address:
Phone No.: FAX No.:
A Partnership
Partnership Name:, ) (SEAL)
By;
(Signature of general partner — attach evidence of authority to
sign)
Name (typed or printed):
Business address;
Phone No.: FAX No.:
A Corporation
Corporation Name: "$ a "t . S - �: "t. t-.est.. " (SEAL)
State of Incorporation; ^"
Type p�qral Busiruess } fes "onal, Service, Limited Liability): ( "y
a
By: e M _
a ff'. (Signature attach evidence of authority to sign)
Name (typed or printed):
Title: N
(CORPORATE SEAL)
Attest
(Signature of Corporate Secretary)
Business address
Phone No.: ,Wl °9eLA `A�-l3"� �..•w FAX No.: 3trt..
Date of Incorporation:
Addendum No. 1 00300-4 7/12/13
A Joint Venture
Joint Venturer Name: (SEAL)
By:
(Signature of joint venture partner--attach evidence of authority
to sign)
Name (typed or printed):
Title:
Business address
Phone No.: FAX No.:
Joint Venturer Name: (SEAL)
By:
(Signature —attach evidence of authority to sign)
Name (typed or printed):
Title:
Business address:
Phone No.: FAX No.:
Phone and FAX Number, and Address for receipt of official communications:
(Each joint ventureir must sign. The manner of signing for each individual, partnership,
and corporation that is a party to the joint venture should be in the manner indicated
above.)
Addendum No. 1 00300-5 7/12/13
UNIT PRICE BID
PHASE I EAST CEMETERY ROAD RECONSTRUCTION, DRAINAGE,STORM SEWER,WATER MAIN, AND SANITARY
SEWER PROJECT
IN THE CITY OF FAIRFAX, LINN COUNTY, IOWA
The following prices per item shall be for furnishing and installing the various items of material and Work as specified and shown
on the Drawings. Bidder agrees to perform all Work as shown on the Drawings and described in the Specifications for the
following listed prices. Bidder acknowledges that unit prices have been computed in accordance with paragraph 11.01 of the
General Conditions. Bidder acknowledges that quantities are not guaranteed and final payment will be based on actual quantities,
unless otherwise stated in the contract documents, and classifications are to be made by ENGINEER as provided in paragraph
11.01 of the General Conditions.
NOTE, A price must be entered for each item in the Bid, even if the estimated quantity is zero, Unbalanced or unreasonable unit
prices may cause rejection of the Bid. All numbers shall be in ink,
Legal Name of Bidder:
Address of Bidder: fvKa%ncs(�,.
ITEM NO ITEM ITEM DESCRIPTION UNIT ESTIMATED UNIT PRICE EXTENDED COST
CODE QUANTITIES (Bid Numbers)
1 01100-01 Mobilization ILS 1
$
2 01200-01 Traffic Control LS I $ Q,
3 01200-70 Temporary Orange Construction Fencing LF 700
4 01300-01 Temporary Erosion and Sediment Control LS Ic:x)-
5 01300-10 Silt Fence LF 750
6 01300-21 Rock Ditch Check EA. 12
7 01400-01 Clearing and Grubbing LS I
8 01400-10 Removal and Disposal of Existing PCC Driveway Sy 67
Located at 52 E Cemetery Road (,; 0 $ c) (:)c"
Removal and Disposal of Existing Asphalt
9 01400-10 Pavement(East Cemetery Road and Casey's SY 178
General Store Driveways) $
10 01400-10 Removal and Disposal of Existing Sea]Coat(E SY 1,940
Cemetery Road)
11 01400-41 Removal and Disposal of Existing 18"Dia.HDPE LF 53
Storm Sewer Pipe(Includes F.E.S.)
12 01400-41 Removal and Disposal of Existing 36"Dia.RCP LF 50
Storm Sewer Pipe(Includes F.E.S.)
13 01400-42 Remove and Dispose of 6'1131a.Valve Pit Manhole LS I
(Deliver Valves to Fairfax Maintenance Shop)
Removal and Disposal of 6"Dia PVC Sanitary
14 01400-43 Force Main LF 105 0 c)
. I I
15 02000-.01 Unclassified Excavation and Embankment I LS 1
Addendum No. 1 30OA-1 7-12-13
16 02000-02 Strip and Respread Topsoil LS 1
X201 Osl) $.......................
17 02200-01 Trench Excavation Through Rock(Contingency) CY 50 s $ A,,
18 02200-10 Trench Stabilization(Contingency) CY 440 c) co $ 0
19 02200-20 Granular Backfill (Contingency) CY 3,000 (D $ Obo 00%
20 02250-01 Boring and Jacking 20"Dia.Steel Casing Pipe LF 70
with Installation of 12"Dia.Water Main x-
21 02300-01 8" Dia. PVC Truss Sanitary Sewer Gravity Main LF 1,,884
$
24"Dia,RCP Sanitary Sewer Gravity Main
22 02300-01 (Includes QonShelld Admixture and Water Tight I-F 1,690
Joints)
$
23 02300-10 Sanitary Sewer Services(4"&6"Dia. PVC) EA. "16
(A,) $ 1 q ,L)
24 02300-20 Sanitary Sewer Manholes 1(4'inside dia.) EA. 31
vo(I C) $
26 02300-20 Sanitary Sewer Manhol'ies(5"inside dia.) EA. 1 .3 $
6"Dia. PVC 0900 Sanitary Sewer Force Main
Including, Polyethylene Wrap:,Tracer Wire,all
26 02300-30 LF 100
Fittings in Place,and other necessary work(See
Special Provisions for Detalis) $
27 02300-50 Connection to Existing Sanitary Sewer Manhole EA. 1
$ 9 Oc", (-')o
28 02400-01 12"Dia. HDPE Storm Sewer Pipe(Solid Dual LF 1,,140
Wall,Smooth Interior) ("X"') $ 0
29 02400-01 15"Dia.ROP Storm Sewer LF 30 $ 1, 91-10100
18"Dia. HDPE Storm Sewer Pipe(Solid Dual
30 02400-01 LF 90
Wall,Smooth Interior) $ 3 ,u
31 02400-01 36"Dia.RCP Storm Sewer LF 975 15 0' $ 9 3, -k
32 02400-30 12"Dia.HDPE F.E.S(including Apron Guard) EA, I
100 Cc,) $ 9 Dci
33 02400-30 15"Dia,RCP F.E.S(including Apron Guard) EA. 1
CSO' C"'O $ j D< C,01
34 02400-45 5'x 17'ID RCP Storm Sewer Junction Box EA. 1
$
35 02400-45 5'x 10'ID RCP Storm Sewer Outfall Structure EA. 1
c"C" $ i s(..,C"ac"L�
36 02400-46 Back Flow Provoriter Valve for 15"Dia. Pipe EA. I
,4 $
37 02400-5024"DIa.Standpipe Intake EA. 51
$
Connect Ex.Driantile to Proposed Storm Sewer
38 02400-60 EA. I
(Contingency) $ o
39 02500-01 8"Dia PVC Water Main(C-!900) LF 11260 $
40 02500-01 12"Dia PVC Water Main(C-90(7)(Except from LF 1,090
Sta 3+50 to Sta 16+00 on East Cemetery Road) CSC $ C
12"Dia PVC Water Main(C-900)(From Sta 3+50
41 02500-01 to Sta 16+00 on East Cemetery Road) LIF 1,250 3'll 00 $
42 02500-20 Furnish and Install 8"Dia.Gate Valve and Box EA. 3 $
43 02500-20 Furnish and Install 12" Dia.Gate Valve and Box EA. 6 ? 00 $ P 0 i"44 c—
Blow-off Assembly for 12"°Dia.Water Main EA. 1
3 $
45 02500-31 IBlow-oft Assembly for 8" Dia.Water Main EA. 1 $
UCX.
Addendum oto. 1 30OA-2 7-12-13
46 02500-50 Furnish and install Fire Hydrant and Assembly EA. 10 E, $ { c:'
47 Furnish and Install Air Release Assemblies For 6"
02500-52 Dia Force Main EA. 1
48 02500-55 Automatic Flushing Device(Contingency) EA. 2 t
49 02500-60 Disinfection and Hydrostatic Testing LS 1
50 02600 01 IDOT Class E Revetment(1Y8"deep)on 6" SY 2'.40
Macadam and Engineerings Fabric $ (.,1 D tui
Adjustment of Existing Sanutary Sewer Wet Well
(Remove existing top and replace with standard
51 02600 20 sanitary casting and cone section,fillet bottorn, LS 1
clean and deliver existing pumps to Fairfax
maintenance shop, removal and disposal of all
unnecessary existing items) ' :L:f
52 02600-30 6"Dia. HDPE Agricultural Drain Tile LF 500
(Contingency) .> $ ; ;C
53 02600-50 Cast-in-Place Concrete for Concrete Pipe CY 40
Encasement ; ';(; $ �, 00, CXD
6"Asphalt Cement Concrete Driveway(Includes
54 02750-20 6"granular Subbase) SY 200 ,✓ $ ( >
55 02800-40 8"Gravel -Class A Road Stone SY 2,500 $ i ti t , `
6"Temporary Rock Access Drives(Install and
56 02800-40 TON 100
Remove) 3 ,OD $ f 3CC,a..')C)
57 02900-12 Hydroseeding with Liquid Mulch Binder LS 1 (µ (n,. ' $ r
J ,. (,.t, d.,,C"'
58 02900-40 Wood Excelsior Mat SY 10„0006
M t "rva
Pre-packaged Pump Station,Genset, Pumps,
59 15000-01 Hoist/Jlb Crane,and Accessories(see LS 1
specifications for complete hist) $ 103,585.00 $ 103,585.00
Pre-packaged Pump Station Installation(pump
installation,pipe installation,accessory
installation, holstljib crane and foundation
60 15000-02 installation,genset concrete pad and genet LS 1
installation,wetwell and deck installation,valve pit
and piping installation,access hatches,grading,
power and gas hook-ups,necessary dowatering,
transformer pad,and any other necessary work)
6i 02300-0212”Dia.Sanitary Sewer Removal and LF 20
Replacement(Contingency)
TOTAL BID
COMPUTEDTOTAL BID , . (ITEMS 1 THROUGH 61)
Co o q "
(W ards) (Numbers)
Addendum No. 1 30OA-3 7-12-13
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ATTACHMENT
EQUAL EMPLOYMENT OPPO#TO0|T9/NON-DISCR|K0|NATIGN POLICY STATEMENT
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1. This is toaffirm that (hereinafter referred toauthe CONTRACTOR)
(CONTRACTOR'S NAME)
haoopdicyofNon'Disohnnhnmd�onandpnovid|ngEqmdOppnMunitytoaUemp|oy*euandopp|ivants
for employment|naccordance with all applicable Equal Employment OppnnuniLy6Affirmat|weAotion
laws, directives and regulations of:Federal, State and Local governing bodies or agencies thereof,
and specifically Iowa Statutes.
2. The CONTRACTOR, will riot discriminate against any employee or applicant for employment because
of nsue, creed, color, nex, n»Uigion, nei|nna| udA|n, ago, nmohte[ status, status with regard to public
mopin1mnoe' sexual orientation, handicap, or status as adiaab|od veteran or ovetenan of the Vietnam
era, except where age and sex are essential bona fide occupational requirements, or where handicap
|oabona fide occupational disqualification.
3. The CONTRACTOR will take Affirmative Action 1nensure that all employment practices anafone of
such discrimination. Such empVoymortpractices include, but are not limited to, the following: hiring, '
upgrading,demotion, transfer, recruitment orrecruitment advertising,selection, layoff disciplinary i
action,termination, rates of pay or other forms of compensation and selection for training, including !
apprenticeship.The CONTRACTOR,further assures that managers and employees comply with both
the spirit and intent of federal, state, and local legislation,government regulation, and executive
orders |nproviding affirmative action aowell aoequal opportunity,
4. The CONTRACTOR will use its best efforts to afford minority and female business enterprises with
the maximum practicable opportunity to participate in the performance of subcontracts for
construction projects that this employer engages in.
5. The CONTRACTOR will commit the necessary time and resources,both financial and human to
achieve the goals ofEqual EmpVmymontOpportunity and Affirmative Action.
0. The CONTRACTOR fully supports incorporation of nondiscrimination and Affirmative action rules and �
regulations into contracts.
7. The CONTRACTOR, or his ooUmct|wg bargaining representative, will mend to each labor union orrepresentative i
/
of workers with which he has a collective bargaining mQneomerd or other Contract or .
understanding, a notice advising the said labor union or workers' representatives of the �
CONTRACTORS'nommNnents under this selection.
8. The CONTRACTOR will evaluate the performances of its management and supervisory personnel on
the basis of their involvement in achieving the Affirmative Action objectives as well as other
established criteria. Any employee of this organization, or subcontractor to this employer, or to who
does not comply with the Equal Employment Opportunity policles and procedures as set forth in this
Statement and Plan will hesubject tndisciplinary action. Any subcontractor nu1opmp|yinQvvidh
applicable Equal Employment Opportunity/Affirmative Action laws,directives and regulations of the .
Federal, State, and Local governing bodies or agencies thereof, specifically Iowa statutes, will be
subject toappropriate legal sanctions.
O0410-1
Attachment 1
I
0. The CONTRACTOR has appointed the following individual to manage the Equal Employment
Opportunity activities and reporting the effectiveness of this Affirmative Action program, as required
by f=ederal, State, and Local agencies. An official for the CONTRACTOR will receive and review
reports of the progress of the program. If any employee or applicant for employment believes he/she
has been discriminated agai'n'st,please contact the following:
Company Name
Contact Individual
Address y
City, State, Zip Code
Phone Number
10. The CONTRACTOR,will include, or incorporate by reference,the provisions of this Equal
Employment Opportunity/Nondiscrimination policy in every Contract,subcontract or purchase order
unless exempt by the rules, regulations or orders of the OWNER"s Affirmative Action Program and
will provide in every subcontract, or purchase order that said provision will be binding upon each
Subcontractor and Supplier of(goods.
Signature of appropriate official bate
Title
Representing
00410-2
Attachment I -2
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ATTACHMENT 11 �
NON-COLLUSION AFFIDAVIT
CITY 0FFA|RFAX, IOWA
Each CONTRACTOR submitting a Bid on this Project shall complete the Non-Collusion Affidavit and
submit itwith the proposal.
STATE OFIOWA)
COUNTY OF
/ represennnQupo
oath pose and state that neither ( ' (my/our) employment has e4loyedy person �
\nsolicit orprocure this Contract nor will (|/wo) nor they make any payment or agreement for payment nf
any compensation |nconnection with the procurement ofthis Contract.
| further depose and state that there is no Contract, Agreement or arrangement, either mal or written,
express nrimplied, contemplating any division nfcompensation for services rendered under this Contract,
or participation therein, directly or indirectly, by any other person,firm or corporation, except if shown by
the Contract another CONTRACTOR jointly serving with (me/us) in thesame capacity.
| further depose and state that neither (|/we) nor anyone in (my/our) employment has either directly or
indirectly entered into any Agreement, participated in any mo||ua|mn or otherwise taken any action in
restraint offree competitive bidding in connection with this Contract.
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Subscribed and sworn before me this _�_`� day of
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ANNA HEASTy
COMMission Number 76M
L 29
MY COMmission Expires
O041O-3
Attachm eni U 1
ATTACHMENT XI
LICENSED PLUMBER OR PIPE LAYER CERTIFICATION
1 The CONTRACTOR certifies that a plumber or pipe layer, licensed by the Metro
Plumbing Licensing Board will perform all work covered under Section 02300 - Sanitary
Sewers and Section 02500-Water Mains of the Cedar Rapids Metropolitan Area
Standard Specifications for Public Improvements.
,Y) C
Name of Company Officer Sig ture
Title Date
Company
00410-4
Attachment X1 - 1
BID BOND FORM
00430
BID BOND
BIDDER(Name and Address):
12536 Buffalo Road
A amo a IA 5220
SURETY(Name and Address):
United Fire & Casualt
118 Second Avenue SE
Cedar Rapids IA 52407__
OWNER (Name and Address),
525 Vanderbilt Street
Fairfax, IA 5222$
BID
BID DUE DATE: July 18 2013
PROJECT (Brief Description Including Location):
City of Fairfax Phase 1 East Cemetery Road Reconstruction, Drainage, Storm
Sewer Water Main and Sanita Sewer Improvements
BOND
BOND NUMBER: N/A
DATE (Not later than Bid due date): July 1$ 2013
PENAL SUM: Five Percent of Amount Bid-------------------- **5%
(Words) (Figures)
IN WITNESS WHEREOF, Surety and Bidder, intending to be legally bound hereby, subject to the terms
printed on the reverse side hereof, do each cause this Bid Bond to be duly executed on its behalf by its
authorized officer, agent, or representative.
BIDDER SURETY
Ricklefs Excavating, LTD (Seal) United Hre & Casualty (Seal)
Bidder'a1�ie and torpor Surety's ane and Corporate Seal
IBy: By:
Signature and Title Susan A Holt, Attorney-in-fact
Attest: Atte
Signature and Title Signature and Title Account Manager
Note: (1) Above addresses are to be used for giving required notice.
(2) Any singular reference to Bidder, Surety, OWNER or other party shall be considered
plural where applicable.
00430-1
April 1, 2000
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BID BOND FORM �
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1. Bidder and Swreiy, jointly and severally, bind thmmsmlves. their heirs, executors, administrators, !
successors and assigns tmpay\oOWNER upon default ufBidder the penal sum set forth onthe '
face nfthis Bond. i
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2. Default of Bidder shall occur upon the failure of Bidder to deliver within the time required by the |
Bidding Documents (or any extension thereof agreed to in writing by OWNER) the executed /
Agreement required by the Bidding Documents and any performance and payment Bonds
required bythe Bidding Documents. !
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3. This obligation shall banull and void if: /
3.1. OWNER accepts Bidder's Bid and Bidder delivers within the time required by the Bidding '
Documents (o[ any extension thereof egnood to in writ�ing by OWNER) the executed
Agreement required by the Bidding Oncomem{$ and any performance and payment Bonds
required bythe Bidding Documents, or
3.2. All Bids are rejected by OWNER, or |
|
3.3. OWNER fmUn to issue a Notice of Award to Bidder within the time specified in the Bidding
i
Documents (on any extension thereof agreed to in writing by Bidder and, if applicable, !
consented 1obySurety when required byparagraph 5henaof). |
4. Payment under this Bond will be due and payable upon default by Bidder and within 30 Calendar �
Days after receipt by Bidder and Surety of written notice of default from OVVNER, which notice !
will begiven with nmanonaKdo promptness, identifying this Bond and the Project and including a
statement ofthe amountdwe'
5. Surety waives notice of and any and all defenses based on or arising out of any time extension to
issue Notice of Award agreed to in writing by OWNER and Bidder, provided that the total time for
issuing Notice of Award including extensions shall not in the aggregate exceed 120 days from Bid
due date without Surety's written consent.
6. Nosuit oraction shall becommenced under this Bond prior bm3QCalendar Days after the notice �
of default required in paragraph 4 above is nam*k/od by Bidder and Surety and in no oonn later
than one year after Bid due date.
7. Any suit or action under this Bond uhnU be commenced only in a court of competent jurisdiction
located inthe state ofIowa.
8. Notices required hereunder shall be in writing and sent to Bidder and Surety at their respective
addresses shown onthe face of this Bond. Such notices may be oand by personal delivery, �
commercial courier or by United States Registered or Certified K8aU, return receipt requested,
postage pre-paid, and shall hedeemed to be effective upon receipt by the party concerned.
9. Surety shall cause to be attached to this Bond m current and effective Power or Attorney
evidencing the authority of the officer, agent or representative who executed this Bond on behalf
of Surety to execute, seal arid deliver such Bond and bind the Surety thereby.
10. This Bond is intended to conform to all applicable otatutmry requirements. Any applicable
requirement ofany applicable statute that has been omitted from this Bond shall bedeemed tobe
included herein aoifset forth a$ length. |fany provision n/this Bond conflicts with any applicable
statute, then the provision of said statute shall govern and the remainder of this Bond that is not
inconflict therewith shall continue infull force and effect.
11. The term "Bid" as used herein includes a Bid, offer or proposal as applicable.
OO43O'2
April 1. 2UUO
W00081®8
UNITED FiRE & CASUALTY COMPANY Bond 4 '.
Home Wice - Ce°Ar T'V kK lmvra City of Falrtax I
( errilie cl
Copy a of lower of Attorney Ofr gee �
fC'irWraM on file ;'al Flume;C)ffic:e of Company —Seer Cenificaitkanl 525 Vand�rrbtltStne�t'
Fairfax, IA 52226
KNOW ALI. MEN BY THESE PRESENTS,Thai Ilan: UNITED FIDE & CASUALTY COMPANY, a corporation duly orgmiized and
eXistiral„ urxler the 10X s of the. Slate of lowa,, and 111ving its principal office. in Cedar Rala€c % State of Iowa, does make, crrnsik
h He and appoint.
TIMOTHY J.GASSMANN,OR SUSAN A.HOLT,OR KEVIN S.MEASE,OR CASSANDRA J.REINKE,OR JAMES A.TRUNNELL,ALL INDIVIDUALLY
of PO SOX,3100,CEDAR RAPIDS, IA 52406
€is true aracl leamdul Altorneyts)Arr-Acl vAh IXAver and authority hereby coniErresl to'si+rn, seal and exescutea in it'. hehalf gall la-r l-
ful brands, anade�rlakint�si anus other obligatory €rastrem melds of Arra€lar nature as follows:&ID0,000.00 �
land to hind UNI-fTD I II I~; & USUALTY COMPANY thereby ias fully Garret to thy s an-le eae ent, as it suds, irlsinlrivnu "uv signed
by tl•re:duly ,aullwOzed tafficers of UNITED FIRE & C5SUALEY,COk41'ANY and all die acts of sa€d Attr3riel pumlam to than
LauthuiAy hereby Liven are hereb,y.ratifie.d.and confirmed.
The.A.tttllurity hereby granted 5hLill ext?ire November 6th,2013 sinless sooner revokml.
This power(A'Anonwy is made and execr_rted pursuant in and by ,authorily of the following. By-Llw duly adapted by the_
Botaml of 0huctors of the Comiaany on April 18, 1911
Artir_IeV ';Urr%2 Ur3nds ancJ Uma prlakings"
Srr`Wm I Appoint miv oY Nn]nA)y v A L"Th &rat,u,any-her of{ircr rri tfllr;e on1mny; way. hmn rims-to Singe,nkal7om tart
wwrtramea c�riiilcaie.;,rhirn,)<�.-3n-fatl In apt in lieh�II nr Nay C:gnapany iaa!h= C�axa:reinn or�Iicrm�rai inswar.urac a',titanrla;rimriea-takin�s aril<�Iher rarzba;;t,hary In�e�rroa-
nionks raf likt�iGarure The signature of any officer Aikahaira n d hrre i;y,and the whoraHf°se.ti, be offixed baa ra&T11ile-11)any I owi-r nl oln rncmy ur Per atl
Imura;er A,7lt MM or Wll{fly-16011 Of Vil}ter,wthnnvera hLIUag';such si nalua'€s:anrl>e�a 1,"I")so eiSctl.be ia�r;aa.Initilc�eJ by the Coeipany as the rarigiii at r�ir,�•
trrua-rat sue h rriiirnr un I thcr earrt�isro�l s��l z*t to
(rrnal'a„ aM11 In in?E,1 •nrrl hinrl 1 ulmn he cmmsta,any a�•iT the We owe and ulmu as th xqh nt,amilly
gnami tincts Mh7rncav!n-(ael Q610 k e tinW akms Q kWh h rhr N rustat:- Ira,e trey dhe me%sal aaurlsoAy shall hd"40 Iro1i•ttr Ira PxiYd the C..currolataq by
llr;ar 5iz ulture and nmr;usm W my W haaemnalm MW IYJAYtar:h we swI ars Mu C'Wara,alW tr e melra."tlatr 1)r'any lee f'resickril, tho 1 ow(l e,i
Diirrloors tw zany ugh(:r(46co art iParr,C::enatratrr aaaarp gar;arW tinge rRwraW A lna+velrmd who,Q>wiaro Ny paiaG n rte lar'sy attnvi,raa^.illt',!.
IN VVITrNIESS WHEREOF, the UNITH) FIRE&CASUALTY COMPANY has casrtied these,
*www0 1$M11 Z�fr�'i esently ofJWe si d hyrits vies Fnesident
2013 and its corporme seal Ina be lure aM CCI dos
8thJuly
�, ruratrcaae aT�
UNI'.TI:I FIi E &CASUALTY COMPANY
�r< - E3}r
1 e Pre?siclenl
Stade of owl Cmarl r to Linn, at
OWN 8tlta d47 �.� Of Y Jur 12013 Defense nae pc,i`s Tally c<ara e Dermis Riehmann to me known, who boing by me
duly swona, did dell oa o salad s ty: thit he resides in Cedar' Rapids, States of lowx that he is My Pmskhu of the UNM FLRE?
& CASUi L"EY C:O&ILIANY, iha,�e.e°rrl:ytsrat.lon described in �'ln l Wh1Ch eveRcerte.,'d Me alaaat;Qrt.lrateantl that he the se�ra9 of
saki corpearatton; that the teal kalfiNed N) the said inSVLln Ql1( is Suc;1"1 C.Car-porate scal; that it%',as 5rn aith7e.'d f7llrSl9slial I0 aert14e.7r1t)a
gNe.TMn by the Board of Dheac;tors caf said copcaradon znd lhaat he s€meet his.n.an-le tla(retc> to like at d)6rity, i id
aac•:knowiedges same to be the iac;t and deed of Saki Corporation.
air
May A.JensenAnt tel',
AMIowv i Nolarial SB erecommisslon numtser 713273 N4: -y Publi
My Commission Expires 10126013 My Commission reS 0c tol]t r 2G,2013
CER11F1CATiON
I, David A. Lange, Secy clary of LJl\11 L[) FIRL& CASUALTY (,C)MI'Al4Y, do hereby cort'i#y that I have compared ared the foregoing
copy of the Power of Anumey and afficlavil, and Ke c q y of the::Section of the by-laws of said Corinparly Las sort forth in Saaid
Power of Attorney, y-vith the ORIGINALS (114 FILE iN TIV HOME C)FFK: OI"SAID COMPANY, and that the sannc are Correct
hanse:Hps thereof, and caf the whole of the%ki CrrilyinM% ,ane tl•aent the said Privver ofAttorney has not been rt.vcsk(,,d tsnd k now
ill t'a'll (eai�e.0 311r,l OffeCl. '
In;te?stirliony whel'eoc I have htara;rttnn)subscribed my rionae and aaffiNe d they corporato se'll of thy'tiaid cL'7rd"4l':aany
tin€s 16th clay Of July ,2013 M11�t.Y'el4tr' � ,'�M
�? Sr„\L O�
131'UAN& 1020U7 +�Jrrirr3kei»>+`,l,`
�
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�
00300
BID
PHASE I
EAST CEMETERY ROAD RECONSTRUCTION, DRAINAGE, STORM SEWER,
WATER MAIN, AND SANITARY SEWER IMPROVEMENTS
THIS BID USSUBMITTED TO: City 0fFairfax
525 Vanderbilt Street
Fairfax, IDVV8 52228
1.01 The undersigned Bidder proposes and agrees, if this Bid is accepted,to enter into an Agreement �
with QVVN2R in the torm included in the Bidding Documents toperform all Work mospecified or �
indicated in the Bidding Documents for the prices and within the times indicated in this Bid and in |
accordance with the other terms and conditions qfthe Bidding Documents. �
2.01 Bidder accepts all ofthe terms and conditions of the Notice of Hearing and Letting, including
without limitation those dealing with the disposition of Bid security. The Bid will remain subject to
acceptance for 30 days after the Bid oponing, or for such longer period of time that Bidder may
agree to in writing upon request of OWNER. Bidder will sign and deliver the required number of
counterparts of the Agreement with the Bonds, insurance certificates, and other documents
required bythe Bidding Requirements within 15 days after the OWNER'n Notice of Award,
101 In submitting this Bid, Bidder represents, aoset forth inthe Agreement,that:
A. Bidder has examined and carefully studied the Bidding Documents, the other related data
identified in the Bidding Documents, and the following Addenda, receipt of all which is
hereby acknowledged.
1
July 12. 2013 �
B, Bidder has visited and examined the Site and become familiar with and is satisfied as to
the general, local and Site conditions that may affect cost, pmgreaa, and performance of |
the Work, !
C. Bidder is familiar with and is satisfied as to all federal, state and local Laws and
Regulations that may affect cost, progress and performance nfthe Work.
D. Bidder has carefully studied all: (1) reports of explorations and tests of subsurface |
conditions otorcontiguous to the Site and all Drawings of physical conditions in or �
relating to existing surface or subsurface structures at orcontiguous to the Site (except '
Underground Facilities) which have been identified in the Supplementary Conditions as
provided in paragraph 4.02 of the General Conditions, and (2) reports and Drawings of a
Hazardous Environmental Condition, if any, which has been identified in the
Supplementary Conditions auprovided |nparagraph 4.06 ofthe General Conditions,
E Bidder has obtained and carefully studied (or assumes responsibility for having done so) �
all additional orsupp(ementaryexaminations, investigations, explorations, tests, studies �
and data concerning conditions (surface, subsurface and Underground Fmm||h|me) at or �
AddondumNo. 1 00300'1 7/12/13
�
'
�
�
contiguous to the Site which may affect cost, progress, mperformance of the Work or
which relate to any aspect of the means, methods, techniquea, aequenoee, and
procedures of construction to be employed by Bidder, including applying the specific
means, methods, techniques, ooquenoeu, and procedures of construction expressly
required by the Bidding Documents to be employed by Bidder, and safety precautions
and programs incident thereto.
F. Bidder does not consider that any further examinationa, investigations, explorations,
tests, studien, or data are necessary for the determination of this Bid for performance of �
�
the Work at the the times and Inaccordance with the other terms �
and conditions ofthe Bidding Documents.
G. Bidder is aware of the general nature of work to be performed by OWNER and others at "
the Site that relates tothe Work aeindicated |nthe Bidding Documents,
H. Bidder has correlated the information known to Bkdder, information and observations
obtained from Visits to the Site, reports and Drawings identified in the Bidding
Documents, and all additional examinations, investigations, explorations, tests, otud|aa'
and data with the Bidding Documents.
|. Bidder has given ENGINEER written notice of all conf|iutu, errors, ambiguitieu, or
discrepancies that Bidder has discovered in the Bidding Documents, and the written
naao|u1|on thereof by ENGINEER is acceptable to Bidder.
J� The Bidding Documents are generally sufficient to indicate and convey understanding of
all terms and conciftions for the performance of the Work for which this Bid is submitted.
K. Bidder has received and |ofamiliar with:
(i) Cedar Rapids Metropolitan Area Standard Specifications for Public
Improvements, latest edition,
(ii) Cedar Rapids Metropolitan Area Standard Details for Public Improvements, |e1ea1
edition.
4.01 Bidder further represents that this Bid is genuine and not made in the interest of or on behalf of
any undisclosed individual orentity and is not submitted in conformity with any Agreement ur
rules of any gmup, association, organization or corporation; Bidder has not directly or indirectly
induced or solicited any other Bidder to submit afalse ur sham Bid; Bidder has not ao||oked or
induced any individual orentity to refrain from bidding; and Bidder has not sought by collusion to
obtain for itself any advantage over any other Bidder orover OWNER,
5.01 Bidder agrees that the Work will be completed and ready for f:|ma| payment in accordance with
paragraph 14.07.8 of the General Conditions on or before the dates or within the number of
Calendar nrWorking Days indicated inthe Agreement, �
5.02 Bidder accepts the provisions ufthe Agreement autuliquidated damages inthe event offailure to �
complete the Work within the times specified above, which shall be stated in the Agreement.
6.01 Include the following documents inthe envelope with this Bid:
A. Attachment |—Eq�ua)Opportunity/Non'Diuohm|nu1ionPolicy
B. Attachment ||—Non-Collusion Affidavit
C. Attachment X|—Licensed Plumber orPipe Layer Certification �
6,02 The following documents are submitted in a separate envelope and made a condition of this Bid:
Addendum No 1 00380-2 7/12h3 �
�
�
A. Required Bid security in the form set forth in the Bidding Documents.
7.01 The terms used in this, Bid with initial capital letters have the meanings indicated in the
Instructions to Bidders,the General Conditions, and the Supplementary Conditions.
8.01 Bidder will complete the Work in accordance with the Contract Documents for the prices as
shown on the attached schedule of Bid prices,
Unit Prices have been computed in accordance with paragraph 11.01.A of the General
Conditions.
Bidder acknowledges that estimated quantities are not guaranteed, and are solely for the purpose
of comparison of Bids, and final payment for all Unit Price Bid items will be based on actual
quantities provided, determined as provided In the Contract Documents.
8.02 Abbreviations
The following abbreviations may be used in this Bid:
ACC - Asphaltic Cement Concrete LBS. Pounds
CIP - Complete in Place LF Linear Foot
COMP Complete LS Lump Sum
CF Cubic Foot LT Left
CY Cubic Yard MAT Material
D1 Ductile Iron MH Manhole
DIA Diameter PCC Portland Cement Concrete
EA Each RCB Reinforced Concrete Box
ELEC Electrical RCP Reinforced Concrete Pipe
EST Estimate(d) RT Right
EXCL Excluding SF - Square Foot
FIXT Fixture STA - Station
FT Feet SY Square Yard
GAL Gallon TN Ton
HERCP Horizontal Elliptical RCP VLF Vertical Linear Foot
HRS Hours W/ With
IN Inch W/O Without
INCL Including
Addendum No. 1 00300-3 7/12/13
SUBMITTED on '�� � u [
r
Iowa Department of Labor Registration No./CONTRACTOR License No. 4:
If Bidder is:
An Individual
Name (typed or printed):
By: (SEAL)
(Individual's signature)
Doing business as:
Business address:
Phone No.: FAX No.:
A Partnership
Partnership Name: (SEAL)
By
(Signature of general partner – attach evidence of authority to
sign)
Name (typed or printed):
Business address:
Phone No.: FAX No.:
A Corporation
Corporation Name: (SEAL)
State of Incorporation: �
Type (General Business, Professional, Service,,Limited'(Liability): 6i" # 6u&k'1 ss
-
By: .�
(Signature 4 attach evidence of authority to sign)
Name (typed or printed): cp itg
Title:
(CORPORATE SEAL)
Attest
(Signature of Corporate Secretary)
Business address: w6 6o Y'-,jc
Cej—
Phone No.: . . ' 6 (-If FAX NIo.: 13 HY ��� r"-111
Date of Incorporation: t
Addendum No. 1 00300-4 7/12/13
A Joint Venture
Joint Venturer Name: (SEAL)
By:
(Signature of joint venture partner— attach evidence of authority
to sign)
Name (typed or printed):
Title:
Business address:
Phone No.: FAX No.:
Joint Venturer Name: (SEAL)
By:
(Signature —attach evidence of authority to sign)
Name (typed or phnted):
Title:
Business address:
Phone No.: FAX No.:
Phone and FAX Number, and Address for receipt of official communications:
(Each joint venturer must sign. The manner of signing for each individual, partnership,
and corporation that is a party to the joint venture should be in the manner indicated
above.)
Addendum No. 1 00300-5 7112113
i.
UNIT PRICE BID
PHASE I EAST CEMETERY ROAD RECONSTRUCTION, DRAINAGE, STORM SEWER, WATER MAIN, AND SANITARY
SEWER PROJECT
IN THE CITY OF FAIRFAX, LINN COUNTY,IOWA
The following prices per item shall be for furnishing and installing the various items of material and Work as specified and shown
on the Drawings. Bidder agrees to perform all Work as shown on the Drawings and described in the Specifications for the
following listed prices. Bidder acknowledges that unit prices have been computed in accordance with paragraph 11.01 of this
General Conditions. Bidder acknowledges that quantities are not guaranteed and final payment will be based on actual quantities,
unless otherwise stated in the contract documents, and classifications are to be made by ENGINEER as provided in paragraph
11,01 of the General Conditions.
NOTE: A price must be entered for each item in the Bid, even if the estimated quantfty Is zero. Unbalanced or unreasonable unit
prices may cause rejection of the Bid. All numbers shall be in Ink.
Legal Name of Bidder:
Address of Bidder: (eAe. X:C-d 1C. &I-t U
ITEM NO. ITEM ITEM DESCRIPTION UNIT ESTIMATED UNIT PRICE EXTENDED COST
CODE QUANTITIES (Bid Numbers)
1 01100-01 Mobilization LS 1 $ I s er 6
2 01200-01 Traffic Control LS 1 $ i 6 6,
3 01200-70 Temporary Orange Construct&Fencing LF 700 u $ -?
4 01300-01 Temporary Erosion and Secl'lnrient Control LS 1 I MI5 $ -Ycx�
5 01300-10 Silt Fence LF 750 $
6 01300-21 Rock Ditch Check EA. 12 $
7 01400-01 Clearing and Grubbing LS I $
8 01400-10 Removal and Disposal of Existing PCC Driveway Sy 67
Located at 52 E Cemetery Road $
Removal and Disposal of Existing Asphalt
9 01400-10 Pavement(East Cemetery Road and Casey's SY 178
General Store Driveways) $ 13
10 01400-10 Removal and Disposal of Existing Seal Coat(E SY 1,1940
Cemetery Road) $ 3 -7-
11 01400-41 Removal and Disposal of:Existing 18"Dia. HDPE LF 53
Storm Sewer Pipe(Includes F.E.S.) S- $ S C,
12 01400-41 Removal and Disposal of:Existing 36"Dia. RCP LF so
Storm Sewer Pipe(Includes F.E.S.) 3— $ 6.
13 01400-42 Remove and Dispose of 61DIa.Valve Pit Manhole LS 1
(Deliver Valves to Fairfax Maintenance Shop) am. $
14 01400-43 Removal and Disposal of 6"Dia PVC Sanitary LF 105
Force Main
15 02000-01 Unclassified Excavation and Embankment LS I
Addendum No. 1 30OA-1 7-12-13
16 02000-02 Strip and Respread Topsoil LS I
17 02200-01 Trench Excavation Through Rock(Contingency) CY 50 'C u
18 02200-10 Trench Stabilization(Confingency) CY
440
A-) $
19 02200-20 Granular Backfill (Contingency) CY 3,00015 c' $
Baring and Jacking 20"Dia.Steel Casing Pipe
20 02250-01 with Installation of 12" Dia.,Water Main LF -70
21 02300-01 8"Dia.PVC Truss Sanitary Sewer Gravity Main LF 1,884
24"Dia. RCP Sanatary Sewer Gravity Main
22 02300-01 (Includes ConSheild Admixture and Water Tight LF 1,690
Joints t <�c' $0,'Yj
23 02300-10 Sanitary Sewer Services(4"&6" Dia. PVC) EA, 16
24 02300-20 Sanitary Sewer Manholes,(4'inside dia.) EA. 11
25 02300-20 Sanitary Sewer Manholes(5"inside dia.) EA. 1
6"Dia. PVC C900 Sanitary Sewer Force Main
Including, Polyethylene Wrap,Tracer Wire, all
26 02300-30 Fittings in Place,and other necessary work(See LF 100
Fay.ccs
Special Provisions for Details)
27 02300-50 Connection to Existing Sanitary Sewer Manhole EA. I II
28 02400-01 12"Dia. HDPE Storm Sewer Pipe (Solid Dual LF 1,1140
Wall,Smooth Interior 0 a 4
29 02400-01 15"Dia.RCP Storm Sewer LF 30
30 02400-01 18"Dia. HDPE Storm Sewer Pipe(Solid Dual LF 90
Wall,Smooth Interior)
31 02400-01 36"Dia. RCP Storm Sewer LF 975
32 02400-30 12"Die. HDPE F.E.S(Incluftg Apron Guard) EX I G4.3. 3
33 02400-30 15"Dia. ROP F,E.S(including Apron Guard) EA. 1 a
34 02400-45 5'x 171D RCP Storm Sewer Junction Box EA. 1 'ee, 6
35 02400-45 5'x 10'ID RCP Storm Sewer Outfall Structure EA. I j {lga.A
36 02400-46 Back Flow Preventer Valve for 15" Dia. Pipe EX I
37 02400-50 24"Dia.Standpipe Intake EA. 5
38 02400-60 Connect Ex.Driantile to Proposed Storm Sewer EA. 1'
(Contingency) 0'n'
39 02500-01 8"Dia PVC Water Main(C-900) LF 1,2160 $ J i LA 2 -va.
40 02500-01 12"Dia PVC Water Main(C-!900)(Except from LF 1,090
Sta 3+50 to Sta 16+00 on East Cemetery Road) $ NY6
41 02500-01 12"Dia PVC Water Main (C-900)(From Sta 3+50 LF 1,250
to Sta 16+00 on East Cemetery Road) $ 36 )L 5 e-
42 02500-20 Furnish and Install 8"Dia.Gate Valve and Box EA. 3
43 02500-20 Furnish and Install 12" Dia.Gate Valve and Box EA, 6
44 02500-31 Blow-off Assembly for 12"Dia.Water Main EA. I
45 02500-31 1Blow-off Assembly for 8"Dora.Water Main EA. 7<
Addendum No. 1 300A-2 7-12-13
46 02500-50 Furnish and Install Fire Hydrant and Assembly EA. 10
47 Furnish and Install Air Release Assemblies For 6"
02500-52 Dia Force Main EA. 1 p3.3 c, >
48 02500-65 Automatic Pushing Device(Contingency) EA. 2
49 02500-60 Disinfection and Hydrostatic Testing LS I
I DOT Class E Revetment(18"deep)on 6"
50 02600-01 SY 240
Macadam and Engineering Fabric
Adjustment of Existing Sanitary Sewer Wet Well
(Remove existing top and replace with standard
51 02600-20 san4ary casting and cone section,fillet bottom, LS I
clean and deliver existing pumps to Fairfax
maintenance shop, removal and disposal of all
unnecessary existing items)
$
6" Dia. HDPE Agricultural Drain Tile
52 02600-30 (Contingency) LF 5100 $ 'Y
Cast-in-Place Concrete for Concrete Pipe
53 02600-50 CY 40
Encasement JI I $ 1
54 02750-20 6"Asphalt Cement Concrete Driveway(Includes SY 200
6"granular Subbase) $ l
55 02800-40 8"Gravel -Class A Road Stone SY 2,500 $ 14
56 02800-40 6"Temporary Rock Access Drives(Install and TON 100
Remove) $ t),
57 02900-12 Hydroseeding with Lquid Mulch Btnder LS 1 $
58 02900-40 Wood Excelsior Mat SY 10,000 i, $ 0
Pre-packaged Pump Station,Genset, Pumps,
59 15000-01 Hoist/Jib Crane,and Accessories(see LS 1
specifications for complete list) $ 103,585.00 $ 103,1585.00
Pre-packaged Pump Station installation(pump
installation,pipe installation,accessory
installation, hoist/jib crane and foundation
60 15000-02 installation,genset concrete pad and genset LS 1
installation,wetwell and deck tnstallatiofl,valve pit
and piping installation,access hatches,grading,
power and gas hook-ups,necessary dewatering,
transformer pad, and any other necessary work)
12"Dia.Sanitary Sewer Removal and
61 1 02300-02 lReplacernent(Contingency) LF 20
TOTAL.BID
COMPUTED TOTAL BID (ITEMS 1 THROUGH 61)
Ale Alflef>�-, t, e4-1 441?A,-cA Isi,
(Words) (Numbers)
Addendum No. 1 300A-3 7-12-13
ATTACHMENT I
EQUAL EMPLOYMENT OPPORTUNITY/NON-DISCRIMINATION POLICY STATEMENT
1 This is to affirm that ",(hereinafter referred to as the CONTRACTOR)
(CONTRACTOR'S NAME)
has a policy of Non-Discrimination and providing Equal Opportunity to all employees and applicants
for employment in accordance with all applicable Equal Employment Opportunity/Affirmative Action
laws, directives and regulations of:Federal, State and Local governing bodies or agencies thereof,
and specifically Iowa Statutes.
2. The CONTRACTOR, will not discriminate against any employee or applicant for employment because
of race, creed, color, sex, religion,, national origin, age, marital status, status with regard to public
assistance, sexual orientation, handicap, or status as a disabled veteran or a veteran of the Vietnam
era, except where age and sex are essential bona fide occupational requirements, or where handicap
is a bona fide occupational disqualification.
3, The CONTRACTOR will take Affirmative Action to ensure that all employment practices are free of
such discrimination. Such employment practices include, but are not limited to, the following: hiring,
upgrading, demotion, transfer, recruitment or recruitment advertising, selection, layoff disciplinary
action, termination, rates of pay or other forms of compensation and selection for training, including
apprenticeship. The CONTRACTOR,further assures that managers and employees comply with both
the spirit and intent of federal, state, and local legislation, government regulation, and executive
orders in providing affirmative action as well as equal opportunity,
4. The CONTRACTOR will use its best efforts to afford minority and female business enterprises with
the maximum practicable opportunity to participate in the performance of subcontracts for
construction projects that this employer engages in.
5. The CONTRACTOR will commit the necessary time and resources, both financial and human to
achieve the goals of Equal Employment Opportunity and Affirmative Action.
& The CONTRACTOR fully supports incorporation of nondiscrimination and Affirmative action rules and
regulations into contracts.
7. The CONTRACTOR, or his collective bargaining representative, will send to each labor union or
representative of workers with which he has a collective bargaining agreement or other Contract or
understanding, a notice advising the said labor union or workers' representatives of the
CONTRACTORS' commitments under this selection.
8. The CONTRACTOR will evaluate the performances of its management and supervisory personnel on
the basis of their involvement in achieving the Affirmative Action objectives as well as other
established criteria. Any employee of this organization, or subcontractor to this employer, or to who
does not comply with the Equal Employment Opportunity policies and procedures as set forth in this
Statement and Plan will be subject to disciplinary action. Any subcontractor not.complying with
applicable Equal Employment Opportunity/Affirmative Action laws, directives and regulations of the
Federal, State, and Local governing bodies or agencies thereof, specifically Iowa statutes, will be
subject to appropriate legal sanctions.
00410-1
Attachment I - 1
i
9. The CONTRACTOR has appointed the following individual to manage the Equal Employment
Opportunity activities and reporting the effectiveness of this Affirmative Action program, as required
by Federal, State, and Local agencies. An official for the CONTRACTOR will receive and review
reports of the progress of the program. If any employee or applicant for employment believes he/she
has been discriminated against, please contact the following:
Company Name
Contact Individual
Address
City, State, Zip Code
Phone Number
10. The CONTRACTOR, will include„ or incorporate by reference,the provisions of this Equal
Employment Opportunity/Nondiscrimination policy in every Contract,subcontract or purchase order
unless exempt by the rules, regulations or orders of the OWNER's Affirmative Action Program and
will provide in every subcontract, or purchase order that said provision will be binding upon each
Subcontractor and Supplier of Goods.
f
Signature of appropriate official Date
Title
Representing
00410-2
Attachment I - 2
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ATTACHMENT 11
NON-COLLUSION AFFIDAVIT
CITY OFFA|RFAX. IOWA
Each CONTRACTOR submitting a Bid on this Project shall complete the Non-Collusion Affidavit and
submit |twith the proposal.
STATE DFIOWA) �
COUNTY OFL|NN ) �
�~ �
---------------
representing upon
oath depose and state that neither (1/we) nor anyone in (my/our) employment has employed any person
to solicit or procure this Contract nor will (]/we) nor they make any payment or agreement for payment of
any compensation in connection with the procurement of this Contract,
further
express or implied, contemplating any division of compensation for services rendered under this Contract,
or participation therein, directly or indirectly, by any other person, firm or corporation, except if shown by
the Contract another CONTRACTOR jointly serving with (me/us) in the same capacity.
| further depose and state that neither (1/we) nor anyone in ( employment has either directly or
indirectly entered into any Agreement, participated in any collusion or otherwise taken any action in
restraint uffree competitive bidding in connection with this Contract, �
�
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Sub�h�d �d�mm ��nemaMh� ��^,_ day of 'J / �
rL
Commission Number 751573
'Low__ march S, 2014
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00410-3
Attachment U - 1
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}
00500
AGREEMENT
PHASEI
EAST CEMETERY ROAD RECONSTRUCTION, DRAINAGE, STORM SEWER, WATER MAIN, AND
SANITARY SEWER IMPROVEMENTS
THE CITY OF FAIRFAX, LINN COUNTY, IOWA
THIS AGREEMENT is by and between City of Fairfax, Iowa (hereinafter called OWNER) and Ricklefs
Excavating, Ltd. (hereinafter called CONTRACTOR).
OWNER and CONTRACTOR, in consideration of the mutual covenants hereinafter set forth, agree as
follows:
ARTICLE 1 -THE PROJECT
1.01 The Project for which the Work under the Contract Documents may be the whole or only a part is
generally referred to as follows:
Phase I East Cemetery Road Reconstruction, Drainage, Storm Sewer, Water Main, And Sanitary
Sewer Improvements.
ARTICLE 2-WORK
2.01 CONTRACTOR shall complete all Work as specified or indicated in the Contract Documents.
The Work is generally described as follows:
The project generally consists of the installation of approximately 3,660 L.F. of water main, the
installation of approximately 3,556 L.F. of sanitary sewer (1,866 L.F. of 8" PVC truss and 1,690
L.F. of 24" RCP), sanitary sewer lift station (12' dia. concrete wet well), installation of
approximately 1,130 L.F. drainage swale, and approximately 2,250 L.F. of storm sewer (size
ranges from 12" dia. to 36" dia.), and all other work necessary to complete the project.
ARTICLE 3- ENGINEER
3.01 The Project will be administered by Hall and Hall Engineers, Inc. who is hereinafter called
ENGINEER and who is to act as OWNER's representative, assume all duties and responsibilities,
and have the rights and authority assigned to ENGINEER in the Contract Documents in
connection with the completion of the Work in accordance with the Contract Documents.
ARTICLE 4-CONTRACT TIMES
4.01 Time of the Essence
A. All time limits for Milestones, if any, and completion and readiness for final payment as
stated in the Contract Documents are of the essence of the Contract.
B. The early start date is as soon as all contract documents are signed and in place.
The late start date is August 14, 2013.
4.02 Working Days for Completion and Final Payment
A. The Work will be completed and ready for final payment in accordance with paragraph
14.07 of the General Conditions within 80 Working Days (as defined in General
Conditions)after the date when the Contract Times commence to run.
00500-1
4.03 Dates for Milestones
A. In addition to final completion times, there are Milestones by which certain WORK ITEMS
must be completed. See General Conditions for Milestone requirements:
Milestone 1: Installation and seeding complete for the drainage swale.
9/13/13
Milestone 2: All water main and sanitary sewer for the project installed, tested,
12/18/13 and operational (including lift station). Installation of 15" RCP and
36"twin RCP storm sewers with structures and outlet protection.
Milestone 3: All work completed and entire project seeded.
5/16/13
4.04 Liquidated Damages
A. CONTRACTOR and OWNER recognize that time is of the essence of this Agreement
and that OWNER will suffer financial loss if the Work is not completed within the times
specified in paragraph 4.02 above, plus any extensions thereof allowed in accordance
with Article 12 of the General Conditions. The parties also recognize the delays, expense,
and difficulties involved in proving in a legal or arbitration proceeding the actual loss
suffered by OWNER if the Work is not completed on time. Accordingly, instead of
requiring any such proof, OWNER and CONTRACTOR agree that as liquidated damages
for delay(but not as a penalty), CONTRACTOR shall pay OWNER$500 for each day that
expires after the time specified in paragraph 4.02 until the Work is complete and ready for
final payment.
ARTICLE 5-CONTRACT PRICE
5.01 OWNER shall pay CONTRACTOR for completion of the Work in accordance with the Contract
Documents an amount in current funds equal to the sum of the amounts determined pursuant to
paragraphs below:
A. For all Unit Price Work, an amount equal to the sum of the established unit price for each
separately identified item of Unit Price Work times the estimated quantity of that item as
indicated in Exhibit 500-A.
B. For all accepted Supplemental Unit Price Work, each item identified separately as
indicated in Exhibit 00500-B.
ARTICLE 6- PAYMENT PROCEDURES
6.01 Submittal and Processing of Payments
A. CONTRACTOR shall submit monthly pay quantities by the 4th Wednesday of the same
month and sign-off on OWNER generated pay application and, if applicable, change order
documents within 7 calendar days of 4th Wednesday of the month in accordance with
Article 14 of the General Conditions. Applications for Payment will be processed by
ENGINEER as provided in the General Conditions.
00500-2
6.02 Progress Payments;Retainage
A. OWNER shall make progress payments on account of Work completed on the basis of
ENGINEERS generated quantities on or within 21 calendar days of OWNER stated due
date for all appropriate documents (or within 30 calendar days of receipt if documents are
received subsequent to OWNER stated due date) during performance of the Work as
provided in paragraphs 6.02.A.1 and 6.02.A.2 below. All such payments will be measured
by the schedule of values established in paragraph 2.07.A of the General Conditions (and
in the case of Unit Price Work based on the number of units completed) or, in the event
there is no schedule of values, as provided in the General Requirements:
1. Prior to Project Completion, progress payments will be made in an amount equal
to the percentage indicated below but, in each case, less the aggregate of
payments previously made and less such amounts as ENGINEER may determine
or OWNER may withhold, in accordance with paragraph 14.02 of the General
Conditions:
a. 95 % of Work completed (with the balance being retainage). If the Work
has been 95% completed as determined by ENGINEER, and if the
character and progress of the Work have been satisfactory to OWNER
and ENGINEER, OWNER, on recommendation of ENGINEER, may
determine that as long as the character and progress of the Work remain
satisfactory to them, there will be no retainage on account of Work
subsequently completed, in which case the remaining progress payments
prior to Final Completion will be in an amount equal to 100% of the Work
completed less the aggregate of payments previously made; and
b. 100 % of cost of materials and equipment not incorporated in the Work
(with the balance being retainage).
2. OWNER shall pay retainage to CONTRACTOR in accordance with paragraph
14.02.B.5 of the General Conditions.
6.03 Final Payment
A. Upon final completion and acceptance of the Work in accordance with paragraph 14.07 of
the General Conditions, OWNER shall pay the remainder of the Contract Price as
recommended by ENGINEER as provided in said paragraph 14.07.
ARTICLE 7—NOT USED
ARTICLE 8-CONTRACTOR'S REPRESENTATIONS
8.01 In order to induce OWNER to enter into this Agreement CONTRACTOR makes the following
representations:
A. CONTRACTOR has examined and carefully studied the Contract Documents and the
other related data identified in the Bidding Documents.
B. CONTRACTOR has visited the Site and become familiar with and is satisfied as to the
general, local, and Site conditions that may affect cost, progress, and performance of the
Work.
C. CONTRACTOR is familiar with and is satisfied as to all federal, state, and local Laws and
Regulations that may affect cost, progress, and performance of the Work.
00500-3
D. CONTRACTOR has carefully studied all: (1) reports of explorations and tests of
subsurface conditions at or contiguous to the Site, if any, and all Drawings of physical
conditions in or relating to existing surface or subsurface structures at or contiguous to
the Site, if any, (except Underground Facilities) which have been identified in the
Supplementary Conditions as provided in paragraph 4.02 of the General Conditions and
(2) reports and Drawings of a Hazardous Environmental Condition, if any, at the Site
which has been identified in the Supplementary Conditions as provided in paragraph 4.06
of the General Conditions. CONTRACTOR acknowledges that such reports and
Drawings are not Contract Documents and may not be complete for CONTRACTOR's
purposes. CONTRACTOR acknowledges that OWNER and ENGINEER do not assume
responsibility for the accuracy or completeness of information and data shown or
indicated in the Contract Documents with respect to Underground Facilities at or
contiguous to the Site.
E. CONTRACTOR has obtained and carefully studied (or assumes responsibility for having
done so) all such supplementary examinations, investigations, explorations, tests, studies
and data concerning conditions (surface, subsurface and Underground Facilities) at or
contiguous to the Site or otherwise which may affect the cost, progress, performance or
furnishing of the Work as CONTRACTOR considers necessary for the performance or
furnishing of the Work or which relate to any aspect of the means, methods, techniques,
sequences and procedures of construction to be employed by CONTRACTOR and safety
precautions and programs incident thereto.
F. CONTRACTOR does not consider that any further examinations, investigations,
explorations, tests, studies, or data are necessary for the performance of the Work at the
Contract Price, within the Contract Times, and in accordance with the other terms and
conditions of the Contract Documents.
G. CONTRACTOR is aware of the general nature of Work to be performed by OWNER and
others at the Site that relates to the Work as indicated in the Contract Documents.
H. CONTRACTOR has correlated the information known to CONTRACTOR, information and
observations obtained from visits to the Site, reports and Drawings identified in the
Contract Documents, and all additional examinations, investigations, explorations, tests,
studies, and data with the Contract Documents.
I. CONTRACTOR has given ENGINEER written notice of all conflicts, errors, ambiguities,
or discrepancies that CONTRACTOR has discovered in the Contract Documents, and the
written resolution thereof by ENGINEER is acceptable to CONTRACTOR.
J. The Contract Documents are generally sufficient to indicate and convey understanding of
all terms and conditions for performance and furnishing of the Work.
K. CONTRACTOR is competent and has sufficient equipment, personnel and financial
resources to perform Work in accordance with the Contract Documents.
00500-4
ARTICLE 9-CONTRACT DOCUMENTS
9.01 Contents
A. The Contract Documents consist of the following items (either bound herein or separately)
as marked with an "X".
Included Not Included
1. This Agreement
® ❑ a. Pages 1 to 8 inclusive;
® ❑ b. Exhibit 500-A, Unit Price Work(pages 1 to 2, inclusive);
❑ ® c. Exhibit 500-13, Supplemental Unit Price Work (pages 1 to [ ],
inclusive);
❑ ® 2. Notice of Hearing and Letting.
® ❑ 3. Performance Bond (pages 1 to 4 inclusive);
® ❑ 4. Payment Bond (pages 1 to 3 inclusive);
5. Other Bonds (pages [ ] to [ ], inclusive), (name of bond);
❑ ® a. [ ] (pages [ ] to [ ], inclusive);
❑ ® b. [ ] (pages [ ] to [ ], inclusive);
❑ ® c. [ ] (pages [ ] to [ ], inclusive);
6. Bid Form Attachments
® ❑ a. Attachment I—Equal Employment Opportunity/Non-
Discrimination Policy Statement
® ❑ b. Attachment II —Non-Collusion Affidavit
❑ ® c. Attachment III—Disadvantaged Business Enterprise (DBE)
Certification for Non-Rolling Stock Materials or Services
❑ ® d. Attachment IV—Disadvantaged Business Enterprise(DBE) List
❑ ® e. Attachment V—Debarment and Suspension Certification
❑ ® f. Attachment VI—Certification of Primary Participant Regarding
Debarment, Suspension, and Other Responsibility Matters
❑ ® g. Attachment VII—Part 661 —Buy America Requirements—
Surface Transportation Assistance Act of 1982, As Amended
❑ ® h. Attachment VIII—Certification of Restrictions on Lobbying
❑ ® i. Attachment IX—Certification of Non-segregated Facilities
® ❑ j. Attachment XI - Licensed Plumber or Pipe Layer Certification
® ❑ 7. Cedar Rapids Metropolitan Area Standard Documents;
a. Cedar Rapids Metropolitan Area Standard Specifications for
Public Improvements, Version April 2003 with approved
updates.
b. Cedar Rapids Metropolitan Area Standard Details for Public
Improvements, Version April 2003 with approved updates.
® ❑ 8. Supplementary Conditions, Section 00800, (pages 1 to 7, inclusive);
® ❑ 9. Special Provisions and Specifications as listed in the table of
contents of the Project Manual;
® ❑ 10. Drawings consisting of a cover sheet and sheets numbered A.01
through W.07, inclusive, with each sheet bearing the following
general title: Phase I East Cemetery Road Reconstruction,
Drainage, Storm Sewer, Water Main, and Sanitary Sewer
Improvements
❑ ❑ 11. Addenda (numbers [ ] to [ ], inclusive);
12. Exhibits to this Agreement.(enumerated as follows):
00500-5
❑ ® a. Notice to Proceed (pages [ ] to [ ], inclusive);
❑ ❑ b. CONTRACTOR's Bid Exhibit 00300A(pages 1 to 3, inclusive);
❑ ❑ c. Documentation submitted by CONTRACTOR prior to Notice of
Award (pages [ ] to [ ], inclusive);
® ❑ d. Insurance Certificates;
13. The following which may be delivered or issued on or after the
Effective Date of the Agreement and are not attached hereto:
❑ ® a. Written Amendments;
® ❑ b. Work Change Directives;
® ❑ c. Change Order(s).
B. The documents listed in paragraph 9.01.A are incorporated by reference (except as
expressly noted otherwise above).
C. There are no Contract Documents other than those listed above in this Article 9. Any
attachments within an appendix not listed in Article 9, are not part of the Contract
Documents. The CONTRACTOR has limited reliance on these appendices, in
accordance with the General Conditions.
D. The Contract Documents may only be amended, modified, or supplemented as provided
in paragraph 3.04 of the General Conditions.
ARTICLE 10 - MISCELLANEOUS
10.01 Terms
A. Terms used in this Agreement will have the meanings indicated in the General
Conditions.
10.02 Assignment of Contract
A. No assignment by a party hereto of any rights under or interests in the Contract will be
binding on another party hereto without the written consent of the party sought to be
bound; and, specifically but without limitation, moneys that may become due and moneys
that are due may not be assigned without such consent (except to the extent that the
effect of this restriction may be limited by law), and unless specifically stated to the
contrary in any written consent to an assignment, no assignment will release or discharge
the assignor from any duty or responsibility under the Contract Documents.
10.03 Successors and Assigns
A. OWNER and CONTRACTOR each binds itself, its partners, successors, assigns, and
legal representatives to the other party hereto, its partners, successors, assigns, and
legal representatives in respect to all covenants, agreements, and obligations contained
in the Contract Documents.
10.04 Severability
A. Any provision or part of the Contract Documents held to be void or unenforceable under
any Law or Regulation shall be deemed stricken, and all remaining provisions shall
continue to be valid and binding upon OWNER and CONTRACTOR, who agree that the
Contract Documents shall be reformed to replace such stricken provision or part thereof
with a valid and enforceable provision that comes as close as possible to expressing the
intention of the stricken provision.
00500-6
IN WITNESS WHEREOF, OWNER and CONTRACTOR have signed this Agreement in duplicate. One
counterpart each has been delivered to OWNER and CONTRACTOR. All portions of the Contract
Documents have been signed or identified by OWNER and CONTRACTOR or on their behalf.
This Agreement will be effective on the date the Award is approved by the City Council as acting on behalf
of the OWNER.
OWNER: City of Fairfax, Iowa CONTRACTOR: Ricklefs Yxcavafing,Ltd.
By: By: 4 114,11-It
ryce Ricklefs, President
(Title) (Title)
Date: Date: PWUsf U, 0013
&./0 _�C'c
[CORPORATE SEAL] [CORPORATE SEAL]
Attest Attest
Address for giving notices: Address for giving notices:
City of Fairfax, Iowa Ricklefs Excavating, Ltd.
City Clerk 12536 Buffalo Road
525 Vanderbilt Street Anamosa, IA 52205
Fairfax, Iowa 52228 License No. C096519
License No.
(If OWNER is a corporation, attach evidence of (Where applicable)
authority to sign. If OWNER is a public body,
attach evidence of authority to sign and resolution Agent for service of process:
or other documents authorizing execution of
OWNER-CONTRACTOR Agreement.)
Designated Representative: Designated Representative:
Name: Mike Dufoe, P.E. Name: Bryce Ricklefs
Title: Project Manager Title: President
Address: Hall and Hall Engineers Address: Ricklefs Excavating, Ltd.
1860 Boyson Road 12536 Buffalo Road
Hiawatha, Iowa 52233 Anamosa, IA 52205
Phone: 319 362-9548 Phone: 319-462-4435
Facsimile: 319 362-7595 Facsimile: 319-462-2599
00500-7
INSTRUCTIONS FOR EXECUTING CONTRACT
If the Agreement is to be signed by the Secretary of the corporation, the certificate below should be
executed by some other officer of the corporation, under the corporate seal. In lieu of the foregoing
certificate, there may be attached to the Agreement copies of so much of the records of the
corporation which will show the official character and authority of the officers signing, duly
certified by the secretary or assistant secretary under the corporate seal to be true copies.
The full name and business address of CONTRACTOR should be inserted and the Agreement should be
signed with CONTRACTOR's official signature. Please have the name of the signing party printed under
all signatures of the Agreement.
If CONTRACTOR is operating as a partnership, each partner should sign the Agreement. If the
Agreement is not signed by each partner, there should be attached to the Agreement a duly authenticated
power of attorney evidencing the signer's (signers') authority to sign such Agreement for and in behalf of
the partnership.
If CONTRACTOR is an individual, the trade name (if CONTRACTOR is operating under a trade name)
should be indicated in the Agreement and the Agreement should be signed by such individual. If signed
by other than CONTRACTOR, there should be attached to the Agreement a duly authenticated power of
attorney evidencing the signer's authority to execute such Agreement for and in behalf of CONTRACTOR.
If CONTRACTOR is a corporation, the following certificate should be executed:
I, Sarah Ricklefs, certify that I am the Secretary of the corporation named as CONTRACTOR herein
above; that Bryce Ricklefs who signed the foregoing Agreement on behalf of CONTRACTOR was then
President of said corporation; that said Agreement was duly signed for and in behalf of said Corporation
by authority of its governing body, and is within the scope of its corporate powers.
yv0 See, I
(Corporate Seal)
END OF SECTION 00500
00500-8
00610 Bond #54194540
PERFORMANCE BOND
CONTRACTOR (Name and Address): SURETY (Name and Address of Principal Place of
Ricklefs Excavating, LTD Business):
12536 Buffalo Road United Fire &Casualty
Anamosa, IA 118 Second Avenue SE
52205 Cedar Rapids, IA
52407
OWNER (Name and Address):
City of Fairfax, Iowa
525 Vanderbilt Street
Fairfax, IA
52228
CONTRACT
Date: July 26, 2013
Amount: **$1,411,555.00**
Description (Name and Location): Phase I East Cemetery Road Reconstruction, Drainage, Storm
Sewer, Water Main and Sanitary Sewer Improvements in the City of Fairfax, Linn County, Iowa
BOND
Date (Not earlier than Contract Date): July 26, 2013
Amount: **$1,411,555.00**
Modifications to this Bond Form: None
Surety and CONTRACTOR, intending to be legally bound hereby, subject to the terms included in this
Section 00610, do each cause this Performance Bond to be duly executed on its behalf by its authorized
officer, agent, or representative.
CONTRACTOR AS PRINCIPAL (Corp Seal) SURETY (Corp Seal)
Company: Ricklefs Excavating, LTD Company: Unit d Fire & Can1ty
Signature:
Signature: _ a
usan A Holt, Attorney-in-fact
Name and Title: �I,, I j<-KAC'.k V-rP.. Name and Title:
(Attach Power of Attorney)
(Space is provided below for signatures of additional parties, if required.)
CONTRACTOR AS PRINCIPAL SURETY
Company: (Corp. Seal) Company: (Corp. Seal)
Signature: Signature:
Name and Title: Name and Title:
--------------------------------------------- FOR USE BY OWNER ONLY---------------------------------------------
REVIEWED BY OWNER
Signature Date
Name and Title
00610-1
April 1,2000
1. The CONTRACTOR and the Surety,jointly and severally, bind themselves,their heirs. Executors,
administrators, successors and assigns to the OWNER for the performance of the Contract,
which is incorporated herein by reference.
2. If the CONTRACTOR performs the Contract, the Surety and the CONTRACTOR have no
obligation under this Bond, except to participate in conferences as provided in paragraph 3.1.
3. If there is no OWNER Default,the Surety's obligation under this Bond shall arise after:
3.1. The OWNER has notified the CONTRACTOR and the Surety at the addresses described
in paragraph 10 below, that the OWNER is considering declaring a CONTRACTOR
Default and has requested and attempted to arrange a conference with the
CONTRACTOR and the Surety to be held not later than fifteen days after receipt of such
notice to discuss methods of performing the Contract. If the OWNER, the
CONTRACTOR and the Surety agree, the CONTRACTOR shall be allowed a reasonable
time to perform the Contract, but such an Agreement shall not waive the OWNER's right,
if any, subsequently to declare a CONTRACTOR Default; and
3.2. The OWNER has declared a CONTRACTOR Default and formally terminated the
CONTRACTOR's right to complete the Contract. Such CONTRACTOR Default shall not
be declared earlier than twenty days after the CONTRACTOR and the Surety have
received notice as provided in paragraph 3.1; and
3.3. The OWNER has agreed to pay the Balance of the Contract Price to:
3.3.1. The Surety in accordance with the terms of the Contract;
3.3.2 Another CONTRACTOR selected pursuant to paragraph 4.3 to perform the
Contract.
4. When the OWNER has satisfied the conditions of paragraph 3, the Surety shall promptly and at
the Surety's expense take one of the following actions:
4.1. Arrange for the CONTRACTOR, with consent of the OWNER, to perform and complete
the Contract; or
4.2. Undertake to perform and complete the Contract itself, through its agents or through
independent contractors; or
4.3. Obtain bids or negotiated proposals from qualified CONTRACTORS acceptable to the
OWNER for a Contract for performance and completion of the Contract, arrange for a
Contract to be prepared for execution by the OWNER and the CONTRACTOR selected
with the OWNER's concurrence, to be secured with performance and payment Bonds
executed by a qualified surety equivalent to the Bonds issued on the Contract, and pay to
the OWNER the amount of damages as described in paragraph 6 in excess of the
Balance of the Contract Price incurred by the OWNER resulting from the CONTRACTOR
Default; or
4.4. Waive its right to perform and complete, arrange for completion, or obtain a new
CONTRACTOR and with reasonable promptness under the circumstances;
4.4.1 After investigation, determine the amount for which it may be liable to the
OWNER and, as soon as practicable after the amount is determined, tender
payment therefor to the OWNER; or
4.4.2 Deny liability in whole or in part and notify the OWNER citing reasons therefor.
5. If the Surety does not proceed as provided in paragraph 4 with reasonable promptness, the
Surety shall be deemed to be in default on this Bond fifteen days after receipt of an additional
00610-2
April 1, 2000
written notice from the OWNER to the Surety demanding that the Surety perform its obligations
under this Bond, and the OWNER shall be entitled to enforce any remedy available to the
OWNER. If the Surety proceeds as provided in paragraph 4.4, and the OWNER refuses the
payment tendered or the Surety has denied pliability, in whole or in part,without further notice the
OWNER shall be entitled to enforce any remedy available to the OWNER.
6. After the OWNER has terminated the CONTRACTOR's right to complete the Contract, and if the
Surety elects to act under paragraph 4.1. 4.2. or 4.3 above, then the responsibilities of the Surety
to the OWNER shall not be greater than those of the CONTRACTOR under the Contract, and the
responsibilities of the OWNER to THE Surety shall not be greater than those of the OWNER
under the Contract. To a limit of the amount of this Bond, but subject to commitment by the
OWNER of the Balance of the Contract Price to mitigation of costs and damages on the Contract,
the Surety is obligated without duplication for:
6.1. The responsibilities of the CONTRACTOR for correction of defective Work and
completion of the Contract;
6.2. Additional legal, design professional and delay costs resulting from the CONTRACTOR's
Default, and resulting from the actions or failure to act of the Surety under paragraph 4;
and
6.3. Liquidated damages, or if no liquidated damages are specified in the Contract, actual
damages caused by delayed performance or nonperformance of the CONTRACTOR.
7. The Surety shall not be liable to the OWNER or others for obligations of the CONTRACTOR that
are unrelated to the Contract, and the Balance of the Contract Price shall not be reduced or set
off on account of any such unrelated obligations. No right of action shall accrue on this Bond to
any person or entity other than the OWNER or its heirs, executors, administrators, or successors.
8. The Surety hereby waives notice of any change, including changes of time, to the Contract or to
related subcontracts, purchase orders and other obligations.
9. Any proceedings legal or equitable, under this Bond may be instituted in any court of competent
jurisdiction in the state of Iowa and shall be instituted within two years after CONTRACTOR
Default or within two years after the CONTRACTOR ceased working or within two years after the
Surety refuses or fails to perform its obligations under this Bond, whichever occurs first. if the
provisions of this paragraph are void or prohibited by law, the minimum period of limitation
available to sureties as a defense in the jurisdiction of the suit shall be applicable.
10. Notice to the Surety, the OWNER or the CONTRACTOR shall be mailed or delivered to the
address shown on the signature page.
11. When this Bond has been furnished to comply with a statutory or other legal requirement in the
location where the Contract was to be performed, any provision in this Bond conflicting with said
statutory or legal requirement shall be deemed deleted here from and provisions conforming to
such statutory or other legal requirement shall be deemed incorporated herein. The intent is that
this Bond shall be construed as a statutory bond and not as a common law bond.
12. Definitions.
12.1 Balance of the Contract Price: The total amount payable by the OWNER to the
CONTRACTOR UNDER THE Contract after all proper adjustments have been made,
including allowance to the CONTRACTOR of any amounts received or to be received by
the OWNER in settlement of insurance or other Claims for damages to which the
CONTRACTOR is entitled, reduced by all valid and proper payments made to or on
behalf of the CONTRACTOR under the Contract.
12.2. Contract: The Agreement between the OWNER and the CONTRACTOR identified on the
signature page, including all Contract Documents and changes thereto.
00610-3
April 1, 2000
12.3. CONTRACTOR Default: Failure of the CONTRACTOR, which has neither been
remedied nor waived, to perform or otherwise to comply with the terms of the Contract.
12.4. OWNER Default: Failure of the OWNER, which has neither been remedied nor waived,
to pay the CONTRACTOR as required by the Contract or to perform and complete or
comply with the other terms thereof.
00610-4
April 1, 2000
Bond #54194540
00620
PAYMENT BOND
Any singular reference to CONTRACTOR, Surety, OWNER or other party shall be considered plural
where applicable.
CONTRACTOR (Name and Address): SURETY (Name and Address of Principal Place of
Business):
Ricklefs Excavating, LTD United Fire&Casualty
12536 Buffalo Road 118 Second Avenue SE
Anamosa, IA Cedar Rapids, IA
52205 52407
OWNER (Name and Address):
City of Fairfax, Iowa
525 Vanderbilt Street
Fairfax, IA
52228
CONTRACT
Date: July 26, 2013
Amount: **$1,411,555.00**
Description (Name and Location): Phase I East Cemetery Road Reconstruction, Drainage, Storm
Sewer, Water Main and Sanitary Sewer Improvements in the City of Fairfax, Linn County, Iowa
BOND
Date (Not earlier than Contract Date): July 26, 2013
Amount:: **$1,411,555.00**
Modifications to this Bond Form: None
Surety and CONTRACTOR, intending to be legally bound hereby, subject to the terms included in this
Section 00620, do each cause this Payment Bond to be duly executed on its behalf by its authorized
officer, agent, or representative.
CONTRACTOR AS PRINCIPAL SURETY
company: Ricklefs Excavating, LTD company: JtE
d Fire & Ca alty n /�
Signature: 7� i��/v�� - Signature:
usan A Holt, Attorney-in-fact
Name and Title: 'S>cr-La�� ��!<:f� , VP• Name and Title:
(Attach Power of Attorney)
(Space is provided below for signatures of additional parties, if required.)
CONTRACTOR AS PRINCIPAL SURETY
Company: (Corp. Seal) Company: (Corp. Seal)
Signature: Signature:
Name and Title: Name and Title:
-------------------------------------------- FOR USE BY OWNER ONLY-------------- ------------------------------
REVIEWED BY OWNER
Signature Date
Name and Title
00620-1
April 1, 2000
1. The CONTRACTOR and the Surety,jointly and severally, bind themselves,their heirs, executors,
administrators, successors and assigns to the OWNER to pay for labor, materials and equipment
furnished for use in the performance of the Contract,which is incorporated herein by reference.
2. With respect to the OWNER,this obligation shall be null and void if the CONTRACTOR:
2.1. Promptly makes payment, directly or indirectly, for all sums due Claimants, and
2.2. Defends, indemnifies and holds harmless the OWNER from all claims, demands, Liens or
suits by any person or entity who furnished labor, materials or equipment for use in the
performance of the Contract, provided the OWNER has promptly notified the
CONTRACTOR and the Surety (at the addresses described in paragraph 12) of any claims,
demands, Liens or suits and tendered defense of such claims, demands, Liens or suits to
the CONTRACTOR and the Surety, and provided there is no OWNER Default.
3. With respect to Claimants, this obligation shall be null and void if the CONTRACTOR promptly
makes payment,directly or indirectly,for all sums due.
4. The Surety shall have no obligation to Claimants under this Bond until.-
4.1.
ntil:4.1. Claimants who are employed by or have a direct Contract with the CONTRACTOR have
given notice to the Surety (at the addresses described in paragraph 12) and sent a copy,
or notice thereof,to the OWNER, stating that a Claim is being made under this Bond and,
with substantial accuracy,the amount of the Claim.
4.2. Claimants who do not have a direct Contract with the CONTRACTOR:
1. Have furnished written notice to the CONTRACTOR and sent a copy, or notice
thereof, to the OWNER, within 90 days after having last performed labor or last
furnished materials or equipment included in the Claim stating, with substantial
accuracy, the amount of the Claim and the name of the party to whom the
materials were furnished or supplied or for whom the labor was done or
performed; and
2. Have either received a rejection in whole or in part from the CONTRACTOR, or
not received within 30 days of furnishing the above notice any communication
from the CONTRACTOR by which the CONTRACTOR had indicated the Claim
will be paid directly or indirectly; and
3. Not having been paid within the above 30 days, have sent a written notice to the
Surety and sent a copy, or notice thereof, to the OWNER, stating that a Claim is
being made under this Bond and enclosing a copy of the previous written notice
furnished to the CONTRACTOR.
5. If a notice required by paragraph 4 is given by the OWNER to the CONTRACTOR or to the
Surety,that is sufficient compliance.
6. When the Claimant has satisfied the conditions of paragraph 4, the Surety shall promptly and at
the Surety's expense take the following actions:
6.1. Send an answer to the Claimant,with a copy to the OWNER, within 45 days after receipt
of the Claim, stating the amounts that are undisputed and the basis for challenging any
amounts that are disputed.
6.2. Pay or arrange for payment of any undisputed amounts.
7. The Surety's total obligation shall not exceed the amount of this Bond, and the amount of this
Bond shall be credited for any payments made in good faith by the Surety.
00620-2
April 1, 2000
8. Amounts owed by the OWNER to the CONTRACTOR under the Contract shall be used for the
performance of the Contract and to satisfy claims, if any, under any Performance Bond. By the
CONTRACTOR furnishing and the OWNER accepting this Bond, they agree that all funds earned
by the CONTRACTOR in the performance of the Contract are dedicated to satisfy obligations of
the CONTRACTOR and the Surety under this Bond, subject to the OWNER's priority to use the
funds for the completion of the Work.
9. The Surety shall not be liable to the OWNER. Claimants or others for obligations of the
CONTRACTOR that are unrelated to the Contract . The OWNER shall not be liable for payment
of any costs or expenses of any Claimant under this Bond, and shall have under this Bond no
obligations to make payments to, give notices on behalf of, or otherwise have obligations to
Claimants under this Bond.
10. The Surety hereby waives notice of any change, including changes of time, to the Contract or to
related Subcontracts, purchase orders and other obligations.
11. No suit or action shall be commenced by a Claimant under this Bond other than in a court of
competent jurisdiction in the location in which the Work or part of the Work is located or after the
expiration of one year from the date (1) on which the Claimant gave the notice required by
paragraph 4.1 or paragraph 4.2.3, or (2) on which the last labor or service was performed by
anyone or the last materials or equipment were furnished by anyone under the Construction
Contract, whichever of (1) or (2) first occurs. If the provisions of this paragraph are void or
prohibited by law, the minimum period of limitation available to sureties as a defense in the
jurisdiction of the suit shall be applicable.
12. Notice to the Surety, the OWNER or the CONTRACTOR shall be mailed or delivered to the
addresses shown on the signature page. Actual receipt of notice by Surety, the OWNER or the
CONTRACTOR, however accomplished, shall be sufficient compliance as of the date received at
the address shown on the signature page.
13. When this Bond has been furnished to comply with a statutory or other legal requirement in the
location where the Contract was to be performed, any provision in this Bond conflicting with said
statutory or legal requirement shall be deemed deleted herefrom and provisions conforming to
such statutory or other legal requirement shall be deemed incorporated herein. The intent is, that
this Bond shall be construed as a statutory Bond and not as a common law bond.
14. Upon request of any person or entity appearing to be a potential beneficiary of this Bond, the
CONTRACTOR shall promptly furnish a copy of this Bond or shall permit a copy to be made.
15. DEFINITIONS
15.1. Claimant: An individual or entity having a direct Contract with the CONTRACTOR or with
a Subcontractor of the CONTRACTOR to furnish labor, materials or equipment for use in
the performance of the Contract. The intent of this Bond shall be to include without
limitation in the terms 'labor, materials or equipment'that part of water, gas, power, light,
heat, oil, gasoline, telephone service or rental equipment used in the Contract,
architectural and engineering services required for performance of the Work of the
CONTRACTOR and the CONTRACTOR's Subcontractors, and all other items for which a
mechanic's lien may be asserted in the jurisdiction where the labor, materials or
equipment were furnished.
15.2. Contract: The Agreement between the OWNER and the CONTRACTOR identified on
the signature page, including all Contract Documents and changes thereto.
15.3. OWNER Default: Failure of the OWNER, which has neither been remedied nor waived,to
pay the CONTRACTOR as required by the Contract or to perform and complete or
comply with the other terms thereof.
00620-3
April 1, 2000
UNITED FIRE&CASUALTY COMPANY
HOME OFFICE-CEDAR RAPIDS,IOWA
CERTIFIED COPY OF POWER OF ATTORNEY
(Original on file at Home Office of Company See Certification)
KNOW ALL MEN BY THESE PRESENTS, That the UNITED FIRE & CASUALTY COMPANY, a corporation duly organized and
existing under the laws of the State of Iowa, and having its principal office in Cedar Rapids,State of Iowa,does make, constitute and
appoint TIMOTHY J. GASSMANN, OR SUSAN A. HOLT, OR KEVIN S. MEASE, OR CASSANDRA J. REINKE, OR `JAMES
A. TRUNNELL, ALL INDIVIDUALLY of CEDAR RAPIDS IA
its true and lawful attorney-in-Fact with power and authority hereby conferred to sign, seal and execute in its behalf all lawful bonds,
undertakings and other obligatory instruments of similar nature as follows: : All bonds;not to'exceed $20,000,000.00
and to bind UNITED FIRE&'CASUALTY COMPANY thereby as fully and to the same extent as if such instruments were signed by the
duly authorized officers of UNITED FIRE &'CASUALTY COMPANY and all the acts of said Attorney,pursuant to the authority hereby
given are hereby ratified and confirmed.
The Authority hereby granted shall expire 4th day of April , 2015 unless sooner revoked.
This power of Attorney is made and executed pursuant to and by authority of the following By-Law duly adopted by Board of
Directors of the Company on May 16,2012.
"Article VI -Surety Bonds and Undertakings"
Section 2, Appointment of Attorney-in-Fact. "The President or any Vice President, or any other officer of the Company may,
from time to time, appointby written certificates attorneys-in-fact to act in behalf of the Company in the execution of policies of,
insurance, bonds, undertakings and other obligatory instruments of like nature. The signature of any officer authorized hereby,
and the Corporate seal, may be affixed by facsimile to any power of attorney or special power of attorney or certification of
either authorized hereby; such signature and seal, when so used, being adopted by the Company as the original signature of
such officer and the original seal of the Company,to be valid and binding upon the Company with the same force and effect as
though manually affixed. Such attorneys-in fact, subject to the limitations set forth in their respective certificates of authority
shall have full power to bind the Company by their signature and execution of any such instruments and to attach the seal of
the Company thereto. The President or any Vice President,the Board of Directors or any other,officer of the Company may at
any time revoke all power and authority previously given to any attorney-in-fact.
IN WITNESS WHEREOF, the UNITED FIRE&CASUALTY COMPANY has caused these presents to be signed by
its vice president and its corporate seal to be hereto affixed this 4th day of Apri 1 , 2013
9R Co i'OR+TE � U�NITED FIRE&CASUALTY COMPANY
• K�
By
Vice President..
State of Iowa, County of Linn,ss
On 4th day of April , 2013, before me personalty came Dennis J. Richmann
to me known, who being by me duly sworn, did depose and say; that he resides in Cedar Rapids, State of Iowa; that he is a Vice
President of the UNITED FIRE &CASUALTY COMPANY, the corporation described in and which executed the above instrument;that
he knows the seal of said corporation;that the seal affixed to the said instrument;is such corporate seal; that it was so affixed pursuant
to authority given by the Board of Directors of said corporation'and that he signed his name ther to pursuant to like authority, and
acknowledges same to be the act and deed of said corporation.
Oat Judith A.Davis A
o Iowa Notarial Seal
Commission number 173041 Notary Public
owe My Commission Expires 04/23/2015 My commission expires: 04-23-2015
I, the undersigned officer of the UNITED FIRE&'CASUALTY COMPANY,do hereby certify that I have compared the foregoing copy of
the Power of Attorney and affidavit, and the copy of the Section of the by-laws of said Company as set forth in said Power of Attorney,
with the ORIGINALS ON FILE IN THE HOMEOFFICE OF SAID COMPANY, and that the same are correct transcripts thereof, and of
the whole of the said originals, and that the said Power of Attorney has not been revoked and is now in full force and effect.
In testimony whereof I have hereunto subscribed my name and affixed the corporate seal of the said Company
this 26th day of July 2013
O
�(u
CORPORATE
a SEAL _ Secretary,
y'd o`gyp
8POA0014 0113
--•� RICKL4 OP ID:CT
A�'QRQ" DATE(MMIDDIYYYY)
�,.. CERTIFICATE OF LIABILITY INSURANCE 08/06/13
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER 319-365-8611 'N-;AM E:
Millhiser Smith Agency, Inc. PHONE FAX
3100 Oakland Road NE 319-365-691 (AIC,No Ext): AIC No):
PO Box 3100 EMAIL
ADDRESS:
Cedar Rapids, IA 52406-3100
Michael L.Fittro INSURER(S)AFFORDING COVERAGE NAIC#
INSURERA:Cincinnati Insurance Company 10677
INSURED Ricklefs Excavating, Ltd INSURER B:Cincinnati Insurance Company 10677
12536 Buffalo Rd
INSURERC:
Anamosa, IA 52205
INSURER D:
INSURER E:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
ADDLISUBR INSR TYPE OF INSURANCE POLICY NUMBER POLIMIDCY EFFYYYt POLICY EXP LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00
A X COMMERCIAL GENERAL LIABILITY X X EPP0184672 03/15/13 03/15/14 DAMAGE TO RENTED
PREMISES Ea occurrence $ 500,00
CLAIMS-MADE FX_1 OCCUR MED EXP(Any one person) $ 10,00
PERSONAL&ADV INJURY $ 1,000,00
GENERAL AGGREGATE $ 2,000,00
GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMP/OP AGG $ 2,000,00
POLICY X PRO LOC $
AUTOMOBILE LIABILITY CO Ea accident $ _1,000,00
A X ANY ALTO X X EPA0194672 03/15/13 03/15/14 BODILY INJURY(Per person) $
ALL OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS AUTOS
NON-OWNED PROPERTY a $DAMAGE
HIREDAUTOS AUTOS
X UMBRELLA LIAB IX OCCUR EACH OCCURRENCE $ 1,000,00
A EXCESS LIAB CLAIMS-MADE EPP0184672 03/15/13 03/15/14 AGGREGATE $ 1,000,00
DED I X I RETENTION O
WORKERS COMPENSATION X I WC STATU- OTH-
AND EMPLOYERS'LIABILITY TORY LIMITS ER
B ANY PROPRIETORIPARTNERIEXECUTIVE Y� X WC1926495 03/15/13 03115/14 E.L.EACH ACCIDENT $ 1,000,00
OFFICERIMEMBER EXCLUDED? N I A
(Mandatory m NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00
A Installation EPP0184672 03/15/13 03/15/14 Instaliat 50,00
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required)
roject: Phase 1 East Cemetery Road Reconstruction, Drainage Storm Sewer,
Water Main, and Sanitary Sewer Improvements, Fairfax, Iowa
Umbrella is following form
FAIRF-4
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Fairfax ACCORDANCE WITH THE POLICY PROVISIONS.
525 Vanderbilt Street
AUTHORIZED REPRESENTATIVE
PO Box 337
Fairfax, IA 52228 Michael L. Fittro
O 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CONTRACTORS' COMMERCIAL GENERAL LIABILITY
BROADENED ENDORSEMENT
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
A. Endorsement-Table of Contents:
Coverage: Begins on Page:
1. Employee Benefit Liability Coverage ..................................................................................................2
2. Unintentional Failure to Disclose Hazards..........................................................................................7
3. Damage to Premises Rented to You...................................................................................................8
4. Supplementary Payments...................................................................................................................9
5. Medical Payments................................................................................................................................9
6. Voluntary Property Damage (Coverage a.)and Care, Custody or Control
Liability Coverage (Coverage b.).........................................................................................................9
7. 180 Day Coverage for Newly Formed or Acquired Organizations..................................................10
8. Waiver of Subrogation .......................................................................................................................10
9. Automatic Additional Insured -Specified Relationships: ................................................................10
• Managers or Lessors of Premises;
• Lessor of Leased Equipment;
• Vendors;
• State or Political Subdivisions-Permits Relating to Premises;
• State or Political Subdivisions- Permits;and
• Contractors'Operations
10. Broadened Contractual Liability-Work Within 50'of Railroad Property......................................... 14
11. Property Damage to Borrowed Equipment....................................................................................... 14
12. Employees as Insureds -Specified Health Care Services: ............................................................ 14
• Nurses;
• Emergency Medical Technicians;and
• Paramedics
13. Broadened Notice of Occurrence...................................................................................................... 14
B. Limits of Insurance:
The Commercial General Liability Limits of Insurance apply to the insurance provided by this endorse-
ment,except as provided below:
1. Employee Benefit Liability Coverage
Each Employee Limit: $ 1,000,000
Aggregate Limit: $ 3,000,000
Deductible: $ 1,000
3. Damage to Premises Rented to You
The lesser of:
a. The Each Occurrence Limit shown in the Declarations;or
b. $500,000 unless otherwise stated $
4. Supplementary Payments
a. Bail bonds: $ 1,000
b. Loss of earnings: $ 350
5. Medical Payments
Medical Expense Limit: $ 10,000
Includes copyrighted material of Insurance
GA 233 02 07 Services Office, Inc.,with its permission. Page 1 of 15
6. Voluntary Property Damage (Coverage a.)and Care, Custody or Control Liability Coverage
(Coverage b.)
Limits of Insurance (Each Occurrence)
Coverage a.$1,000
Coverage b.$5,000 unless otherwise stated $
Deductibles(Each Occurrence)
Coverage a.$250
Coverage b.$250 unless otherwise stated $
COVERAGE PREMIUM BASIS RATE ADVANCE PREMIUM
(a) Area (For Limits in Excess of (For Limits in Excess of
(b) Payroll $5,000) $5,000)
(c) Gross Sales
(d) Units
e Other
b. Care, Custody $
or Control
TOTAL ANNUAL PREMIUM T$
11. Property Damage to Borrowed Equipment
Each Occurrence Limit: $ 10,000
Deductible: $ 250
C. Coverages: have used up the ap-
plicable
p-
tlimit in
t. Employee Benefit LiabilityCoverage ane in the payment of
a. The following is added to SECTION I judgments or settle-
- COVERAGES: Employee Benefit ments.
Liability Coverage. No other obligation or liabil-
(1) Insuring Agreement ity to pay sums or perform
acts or services is covered
(a) We will pay those sums that unless explicitly provided for
the insured becomes legally under Supplementary Pay-
obligated to pay as dam- ments.
ages caused by any act, er-
ror or omission of the in-
(b) This insurance applies to
sured, or of any other per- damages only if the act, er-
son for whose acts the in- ror or omission, is negli-
gently committed in the
sured is legally liable, to "administration" of your
which this insurance ap- "employee benefit pro-
plies. We will have the right gram";and
and duty to defend the in-
sured against any "suit" 1) Occurs during the pol-
seeking those damages. icy period;or
However, we will have no
duty to defend against any 2) Occurred prior to the
"suit" seeking damages to effective date of this
which this insurance does endorsement provided:
not apply. We may, at our
discretion, investigate any a) You did not have
report of an act, error or knowledge of a
omission and settle any claim or "suit" on
claim or "suit" that may re- or before the ef-
sult. But: fective date of this
endorsement.
1) The amount we will pay
for damages is limited You will be
as described in SEC- deemed to have
TION III - LIMITS OF knowledge of a
INSURANCE; and claim or "suit"
when any
2) Our right and duty to "authorized repre-
defend ends when we sentative";
Includes copyrighted material of Insurance
GA 233 02 07 Services Office, Inc.,with its permission. Page 2 of 15
i) Reports all, or formance of investment
any part, of the vehicles;or
act, error or
omission to us 3) Advice given to any
or any other person with respect to
insurer; that person's decision
to participate or not to
ii) Receives a participate in any plan
written or ver- included in the "em-
bal demand or ployee benefit pro-
claim for dam- gram".
ages because
of the act, er- (f) Workers' Compensation
ror or omis- and Similar Laws
sion;and Any claim arising out of
b) There is no other your failure to comply with
applicable insur- the mandatory provisions of
ance. any workers'compensation,
unemployment compensa-
(2) Exclusions tion insurance, social secu-
rity or disability benefits law
This insurance does not apply or any similar law.
to:
(a) Bodily Injury, Property (g) ERISA
Damage or Personal and Damages for which any in-
Advertising Injury sured is liable because of
"Bodil injury", "property liability imposed on a fiduci-
Y J rY p p y ary by the Employee Re-
damage" or "personal and tirement Income Security
advertising injury". Act of 1974, as now or
(b) Dishonest, Fraudulent, hereafter amended, or by
Criminal or Malicious Act any similar federal, state or
local laws.
Damages arising out of any
intentional, dishonest, (h) Available Benefits
fraudulent, criminal or mali- Any claim for benefits to the
cious act, error or omission, extent that such benefits
committed by any insured, are available, with reason-
including the willful or reck- able effort and cooperation
less violation of any statute, of the insured, from the ap-
(c) Failure to Perform a Con- plicable funds accrued or
tract other collectible insurance.
Damages arising out of fail- (i) Taxes, Fines or Penalties
ure of performance of con- Taxes, fines or penalties,
tract by any insurer. including those imposed
(d) Insufficiency of Funds under the Internal Revenue
Code or any similar state or
Damages arising out of an local law.
insufficiency of funds to
meet any obligations under (j) Employment-Related
any plan included in the Practices
employee benefit pro- Any liability arising out of
gram". any:
(e) Inadequacy of Perform- (1) Refusal to employ;
ance of Investment / Ad-
vice Given With Respect (2) Termination of em-
to Participation ployment;
Any claim based upon: (3) Coercion, demotion,
1 Failure of an invest- evaluation, reassign-
) Y ment, discipline, defa-
ment to perform; mation, harassment,
2) Errors in providing in- humiliation, discrimina-
formation on past per- tion or other employ-
Includes copyrighted material of Insurance
GA 233 02 07 Services Office, Inc.,with its permission. Page 3 of 15
ment-related practices, (e) A trust, you are an insured.
acts or omissions;or Your trustees are also in-
sureds, but only with re-
(4) Consequential liability spect to their duties as
as a result of(1), (2) or trustees.
(3)above.
(2) Each of the following is also an
This exclusion applies insured:
whether the insured may be
held liable as an employer (a) Each of your "employees"
or in any other capacity and who is or was authorized to
to any obligation to share administer your "employee
damages with or repay benefit program".
someone else who must
pay damages because of (b) Any persons, organizations
the injury. or "employees" having
proper temporary authori-
(3) Supplementary Payments zation to administer your
SECTION I - COVERAGES, "employee benefit program"
SUPPLEMENTARY PAY- if you die, but only until your
MENTS - COVERAGES A AND legal representative is ap-
B also apply to this Coverage. pointed.
b. Who is an Insured (c) Your legal representative if
you die, but only with re-
As respects Employee Benefit Liabil- spect to duties as such.
ity Coverage, SECTION II - WHO IS That representative will
AN INSURED is deleted in its en- have all your rights and du-
tirety and replaced by the following: ties under this Coverage
Part.
(1) If you are designated in the
Declarations as: (3) Any organization you newly ac-
quire or form, other than a part-
(a) An individual, you and your nership, joint venture or limited
spouse are insureds, but liability company, and over
only with respect to the which you maintain ownership
conduct of a business of or majority interest, will qualify
which you are the sole as a Named Insured if no other
owner. similar insurance applies to that
organization. However, cover-
(b) A partnership or joint ven- age under this provision:
ture, you are an insured.
Your members, your part- (a) Is afforded only until the
ners, and their spouses are 180th day after you acquire
also insureds but only with or form the organization or
respect to the conduct of the end of the policy period,
your business. whichever is earlier;and
(c) A limited liability company, (b) Does not apply to any act,
you are an insured. Your error or omission that was
members are also insureds, committed before you ac-
but only with respect to the quired or formed the or-
conduct of your business. ganization.
Your managers are in- c. Limits of Insurance
sureds, but only with re-
spect to their duties as your As respects Employee Benefit Liabil-
managers. ity Coverage, SECTION III - LIMITS
(d) An organization other than OF INSURANCE is deleted in its en-
a partnership, joint venture tirety and replaced by the following:
or limited liability company, (1) The Limits of Insurance shown
you are an insured. Your in Section B. Limits of Insur-
"executive officers" and di- ance, 1. Employee Benefit Li-
rectors are insureds, but ability Coverage and the rules
only with respect to their below fix the most we will pay
duties as your officers or di- regardless of the number of:
rectors. Your stockholders
are also insureds, but only (a) Insureds;
with respect to their liability
as stockholders.
Includes copyrighted material of Insurance
GA 233 02 07 Services Office, Inc.,with its permission. Page 4 of 15
(b) Claims made or "suits" (b) The deductible amount
brought; stated in the Declarations
c Persons or organizations applies to all damages
( ) g sustained by any one "em-
making claims or bringing ployee", including such
..Suits"; "employee's" dependents
(d) Acts,errors or omissions;or and beneficiaries, because
of all acts, errors or omis-
(e) Benefits included in your sions to which this insur-
"employee benefit pro- ance applies.
gram". (c) The terms of this insurance,
(2) The Aggregate Limit shown in including those with respect
Section B. Limits of Insurance, to:
1. Employee Benefit Liability 1) Our right and duty to
Coverage of this endorsement
is the most we will pay for all defend the insured
damages because of acts, er- against any "suits'
rors or omissions negligently seeking those dam-
committed in the "administra-
tion" of your "employee benefit 2) Your duties, and the
program"• duties of any other in-
(3) Subject to the limit described in volved insured, in the
(2) above, the Each Employee event of an act, error or
Limit shown in Section B. Limits
omission, or claim,
of Insurance, 1. Employee apply irrespective of the
Benefit Liability Coverage of application of the deductible
this endorsement is the most we amount.
will pay for all damages sus-
tained by any one "employee", (d) We may pay any part or all
including damages sustained by of the deductible amount to
such "employee's" dependents effect settlement of any
and beneficiaries,as a result of: claim or "suit" and, upon
notification of the action
(a) An act, error or omission;or taken, you shall promptly
(b) A series of related acts, er- reimburse us for such part
rors or omissions, regard- of the deductible amount as
less of the amount of time we have paid.
that lapses between such d. Additional Conditions
acts, errors or omissions,
As respects Employee Benefit Li-
negligently committed in the ability Coverage, SECTION IV -
administration" of your 'em- COMMERCIAL GENERAL LIABIL-
ployee benefit program". ITY CONDITIONS is amended as
However, the amount paid un- follows:
der this endorsement shall not (1) Item 2. Duties in the Event of
exceed, and will be subject to Occurrence, Offense, Claim or
the limits and restrictions that Suit is deleted in its entirety and
apply to the payment of benefits replaced by the following:
in any plan included in the em-
ployee benefit program". 2. Duties in the Event of an Act, Error or
(4) Deductible Amount Omission, or Claim or Suit
a. You must see to it that we are noti-
(a) Our obligation to pay dam- fied as soon as practicable of an act,
ages on behalf of the in- error or omission which may result in
sured applies only to the a claim. To the extent possible, no-
amount of damages in ex- tice should include:
cess of the deductible
amount stated in the Decla- (1) What the act, error or omission
rations as applicable to was and when it occurred; and
Each Employee. The limits
of insurance shall not be (2) The names and addresses of
reduced by the amount of anyone who may suffer dam-
this deductible. ages as a result of the act, error
or omission.
Includes copyrighted material of Insurance
GA 233 02 07 Services Office, Inc.,with its permission. Page 5 of 15
b. If a claim is made or"suit" is brought b. Method of Sharing
against any insured,you must:
If all of the other insur-
(1) Immediately record the specifics ance permits contribu-
of the claim or "suit" and the tion by equal shares,
date received; and we will follow this
method also. Under
(2) Notify us as soon as practicable. this approach each in-
You must see to it that we receive surer contributes equal
written notice of the claim or suit as
amounts until it has
soon as practicable. paid its applicable limit
of insurance or none of
c. You and any other involved insured the loss remains,
must: whichever comes first.
(1) Immediately send us copies of If any of the other in-
any demands, notices, sum- surance does not per-
monses or legal papers re- mit contribution by
ceived in connection with the equal shares, we will
claim or"suit"; contribute by limits.
Under this method,
(2) Authorize us to obtain records each insurer's share is
and other information; based on the ratio of its
(3) Cooperate with us in the investi- applicable limit of in-
gation or settlement of the claim surance to the total ap-
or defense against the "suit"; plicable limits of insur-
and
ance of all insurers.
(4) Assist us, upon our request, in c. No Coverage
the enforcement of any right This insurance shall not
against any person or organiza- cover any loss for
tion which may be liable to the which the insured is
insured because of an act, error entitled to recovery un-
or omission to which this insur- der any other insur-
ance may also apply. ance in force previous
d. No insured will, except at that in- to the effective date of
sured's own cost, voluntarily make a
this Coverage Part.
payment, assume any obligation, or e. Additional Definitions
incur any expense without our con-
sent. As respects Employee Benefit Li-
ability Coverage, SECTION V -
(2) Item 5. Other Insurance is de- DEFINITIONS is amended as fol-
leted in its entirety and replaced lows:
by the following:
(1) The following definitions are
5. Other Insurance added:
If other valid and collectible 1. "Administration"means:
insurance is available to the
insured for a loss we cover a. Providing information to
under this Coverage Part, "employees", including
our obligations are limited their dependents and
as follows: beneficiaries, with re-
spect to eligibility for or
a. Primary Insurance scope of "employee
This insurance is pri- benefit programs";
mary except when c. b. Interpreting the "em-
below applies. If this ployee benefit pro-
insurance is primary, grams";
our obligations are not
affected unless any of c. Handling records in
the other insurance is connection with the
also primary. Then, we "employee benefit pro-
will share with all that grams"; or
other insurance by the
method described in b. d. Effecting, continuing or
terminating any "em-
below. ployee's" participation
Includes copyrighted material of Insurance
GA 233 02 07 Services Office, Inc.,with its permission. Page 6 of 15
in any benefit included benefits, workers' com-
in the "employee bene- pensation and disability
fit program". benefits;and
However, "administration" d. Vacation plans, includ-
does not include: ing buy and sell pro-
grams; leave of ab-
a. Handling payroll sence programs, in-
ductions; or cluding military, mater-
b. The failure to effect or nity, family, and civil
maintain any insurance leave; tuition assis-
or adequate limits of tance plans; transpor-
coverage of insurance, tation and health club
including but not limited subsidies.
to unemployment in- (2) The following definitions are
surance, social security deleted in their entirety and re-
benefits, workers' com- placed by the following:
pensation and disability
benefits. 21. "Suit" means a civil pro-
ceeding in which money
2. "Cafeteria
p damages because of an
plan authorized by applica- act error or omission to
ble law to allow "employ- which this insurance applies
ees" to elect to pay for cer- are alleged. "Suit"includes:
tain benefits with pre-tax
dollars. a. An arbitration pro-
ceeding in which such
3. "Employee benefit pro-
damages are claimed
grams" means a program and to which the in-
providing some or all of the sured must submit or
following benefits to "em- does submit with our
ployees", whether provided consent;
through a "cafeteria plan" or
otherwise: b. Any other alternative
a. Grouplife insurance; dispute resolution pro-
ceeding in which such
group accident or damages are claimed
health insurance; den- and to which the In-
tal, vision and hearing sured submits with our
plans; and flexible consent; or
spending accounts;
provided that no one c. An appeal of a civil
other than an "em- proceeding.
ployee" may subscribe
to such benefits and 8. "Employee" means a per-
such benefits are made son actively employed, for-
generally available to merly employed, on leave
those "employees"who of absence or disabled, or
satisfy the plan's eligi- retired. "Employee" in-
bility requirements; cludes a "leased worker".
Employee does not in-
b. Profit sharing plans, clude a"temporary worker".
employee savings
plans, employee stock 2. Unintentional Failure to Disclose Haz-
ownership plans, pen- ards
sion plans and stock SECTION IV- COMMERCIAL GENERAL
subscription plans, LIABILITY CONDITIONS, 7. Represen-
provided that no one tations is hereby amended by the addi-
other than an "em- tion of the following:
ployee may subscribe
to such benefits and Based on our dependence upon your
such benefits are made representations as to existing hazards, if
generally available to unintentionally you should fail to disclose
all "employees" who all such hazards at the inception date of
are eligible under the your policy, we will not reject coverage
plan for such benefits; under this Coverage Part based solely on
c. Unemployment insur-
such failure.
ance, social security
Includes copyrighted material of Insurance
GA 233 02 07 Services Office, Inc.,with its permission. Page 7 of 15
3. Damage to Premises Rented to You e) Settling, cracking,
of Paragraph shrinking or ex-
a. The last Subparagraph
9 p pansion; or
2. SECTION I - COVERAGES,
COVERAGE A. - BODILY INJURY f) Nesting or infesta-
AND PROPERTY DAMAGE, 2. LI- tion, or discharge
ABILITY Exclusions is hereby de- or release of
leted and replaced by the following: waste products or
Exclusions c,through do not I secretions, , o-
9 q� apply sects, birds, ro-
to damage by fire, explosion, light- dents or other
ning, smoke or soot to premises animals.
while rented to you or temporarily
occupied by you with permission of (b) Loss caused directly or indi-
the owner. rectly by any of the follow-
b. The insurance provided under SEC- ing:
TION I - COVERAGES, COVERAGE 1) Earthquake, volcanic
A. BODILY INJURY AND PROP- eruption, landslide or
ERTY DAMAGE LIABILITY applies any other earth move-
to "property damage" arising out of ment;
water damage to premises that are
both rented to and occupied by you. 2) Water that backs up or
overflows from a
(1) As respects Water Damage Le- sewer,drain or sump;
gal Liability, as provided in
Paragraph 3.b.above: 3) Water under the
ground surface press-
The exclusions under SECTION ing on, or flowing or
I - COVERAGES, COVERAGE seeping through:
A. BODILY INJURY AND
PROPERTY DAMAGE LIABIL- a) Foundations,
ITY, 2. Exclusions, other than I. walls, floors or
War and the Nuclear Energy paved surfaces;
Liability Exclusion, are deleted b) Basements,
and the following are added: whether paved or
This insurance does not apply not;or
to: c) Doors, windows or
(a) 'Property damage": other openings.
1) Assumed in any con- (c) Loss caused by or resulting
tract;or from water that leaks or
flows from plumbing, heat-
2) Loss caused by or re- ing, air conditioning, or fire
sulting from any of the protection systems caused
following: by or resulting from freez-
a) Wear and tear; ing, unless:
b Rust, corrosion, 1) You did your best to
maintain heat in the
fungus, decay, building or structure;or
deterioration, hid-
den or latent de- 2) You drained the
fect or any quality equipment and shut off
in property that the water supply if the
causes it to dam- heat was not main-
age or destroy it- tained.
self;
(d) Loss to or damage to:
C) Smog;
1) Plumbing, heating, air
d) Mechanical conditioning, fire pro-
breakdown in- tection systems, or
cluding rupture or other equipment or ap-
bursting caused pliances; or
by centrifugal
force; 2) The interior of any
building or structure, or
to personal property in
the building or structure
Includes copyrighted material of Insurance
GA 233 02 07 Services Office, Inc.,with its permission. Page 8 of 15
caused by or resulting 5. Medical Payments
from rain, snow, sleet
or ice, whether driven The Medical Expense Limit of Any One
by wind or not. Person as stated in the Declarations is
amended to the limit shown in Section B.
c. Limit of Insurance Limits of Insurance, 5. Medical Pay-
The Damage to Premises Rented to ments of this endorsement.
You Limit as shown in the Declara- 6. Voluntary Property Damage and Care,
tions is amended as follows: Custody or Control Liability Coverage
(2) Paragraph 6. of SECTION III - a. Voluntary Property Damage Cov-
LIMITS OF INSURANCE is erage
hereby deleted and replaced by
the following: We will pay for"property damage" to
property of others arising out of op-
6. Subject to 5. above, the erations incidental to the insured's
Damage to Premises business when:
Rented to You Limit is the
most we will pay under (1) Damage is caused by the in-
COVERAGE A. BODILY sured; or
INJURY AND PROPERTY (2) Damage occurs while in the in-
DAMAGE LIABILITY, for sured's possession.
damages because of
"property damage" to With your consent, we will make
premises while rented to these payments regardless of fault.
you or temporarily occupied
by you with permission of b. Care, Custody or Control Liability
the owner, arising out of Coverage
any one "occurrence" to SECTION I - COVERAGES, COV-
which this insurance ap- ERAGE A. BODILY INJURY AND
plies. PROPERTY DAMAGE LIABILITY, 2.
(3) The amount we will pay is lim- Exclusions,j. Damage to Property,
ited as described in Section B. Subparagraphs (3), (4) and (5) do
Limits of Insurance, 3. Dam- not apply to "property damage" to
age to Premises Rented to the property of others described
You of this endorsement. therein.
4. Supplementary Payments With respect to the insurance provided by
this section of the endorsement, the fol-
Under SECTION I - COVERAGE, SUP- lowing additional provisions apply:
PLEMENTARY PAYMENTS - COVER-
AGES A AND B: a. The Limits of Insurance shown in the
Declarations are replaced by the lim-
a. Paragraph 2. is replaced by the fol- its designated in Section B.Limits of
lowing: Insurance, 6. Voluntary Property
U to the limit shown in Section B. Damage and Care, Custody or
Up
Limits of Insurance, 4.a. Bail Bonds Control Liability Coverage of this
endorsement with respect to cover-
bonds of this endorsement for cost of bail age provided by this end
bonds required because of accidents These limits are inclusive o and not
or traffic law violations arising out of in addition to the limits being re-
the use of any vehicle to which the placed. The Limits of Insurance
Bodily Injury Liability Coverage ap- shown in Section B. Limits of Insur-
ance, 6. Voluntary Property Dam-
these bonds. age and Care, Custody or Control
b. Paragraph 4. is replaced by the fol- Liability Coverage of this endorse-
lowing: ment fix the most we will pay in any
one "occurrence" regardless of the
All reasonable expenses incurred by number of:
the insured at our request to assist
us in the investigation or defense of (1) Insureds;
the claim or "suit", including actual (2) Claims made or "suits" brought;
loss of earnings up to the limit shown or
in Section B. Limits of Insurance,
4.b. Loss of Earnings of this en- (3) Persons or organizations mak-
dorsement per day because of time ing claims or bringing"suits".
off from work.
Includes copyrighted material of Insurance
GA 233 02 07 Services Office,Inc.,with its permission. Page 9 of 15
b. Deductible Clause 9. Automatic Additional Insured - Speci-
(1) Our obligation to pay damages fied Relationships
on your behalf applies only to a. The following is hereby added to
the amount of damages for each SECTION II-WHO IS AN INSURED:
"occurrence" which are in ex- 1 An person or organization de-
cess of the deductible amount ( ) scribd in Paragraphgniz 9.ade
stated in Section B. Limits of
Insurance, 6. Voluntary Prop- below (hereinafter referred to as
erty Damage and Care, Cus- additional insured) whom you
tody or Control Liability Cov- are required to add as an addi-
erage of this endorsement. The tional insured under this Cover-
limits of insurance will not be re- age Part by reason of:
duced by the application of such (a) A written contract or
deductible amount. agreement; or
(2) Condition 2.Duties in the Event (b) An oral agreement or con-
of Occurrence, Offense, Claim tract where a certificate of
or Suit, applies to each claim or insurance showing that per-
"suit"irrespective of the amount. son or organization as an
(3) We may pay any part or all of additional insured has been
the deductible amount to effect issued,
settlement of any claim or "suit" is an insured, provided:
and, upon notification of the ac-
tion taken, you shall promptly (a) The written or oral contract
reimburse us for such part of the or agreement is:
deductible amount as has been
paid by us. 1) Currently in effect or
becomes effective
7. 180 Day Coverage for Newly Formed or during the policy pe-
Acquired Organizations riod;and
SECTION II - WHO IS AN INSURED is 2) Executed prior to an
amended as follows: "occurrence" or offense
Subparagraph a. of Paragraph 4. is to which this insurance
hereby deleted and replaced by the fol- would apply;and
lowing: (b) They are not specifically
a. Insurance under this provision is af- named as an additional in-
forded only until the 180th day after sured under any other pro-
you acquire or form the organization vision of, or endorsement
or the end of the policy period, added to, this Coverage
whichever is earlier;
Part.
8. Waiver of Subrogation (2) Only the following persons or
g organizations are additional in-
SECTION IV- COMMERCIAL GENERAL sureds under this endorsement,
LIABILITY CONDITIONS, 9. Transfer of and insurance coverage pro-
Rights of Recovery Against Others to vided to such additional in-
Us is hereby amended by the addition of sureds is limited as provided
the following: herein:
We waive any right of recovery we may (a) The manager or lessor of a
have because of payments we make for premises leased to you with
injury or damage arising out of your on- whom you have agreed per
going operations or "your work" done un- Paragraph 9.a.(1) above to
der a written contract requiring such provide insurance, but only
waiver with that person or organization with respect to liability aris-
and included in the "products-completed ing out of the ownership,
operations hazard". However, our rights maintenance or use of that
may only be waived prior to the "occur- part of a premises leased to
rence" giving rise to the injury or damage you, subject to the following
for which we make payment under this additional exclusions:
Coverage Part. The insured must do This insurance does not
nothing after a loss to impair our rights. apply to:
At our request,the insured will bring suit
or transfer those rights to us and help us 1) Any "occurrence"
enforce those rights. which takes place after
Includes copyrighted material of Insurance
GA 233 02 07 Services Office, Inc.,with its permission. Page 10 of 15
you cease to be a ten- c) Any physical or
ant in that premises. chemical change
in the product
2) Structural alterations, made intentionally
new construction or by the vendor;
demolition operations
performed by or on be- d) Repackaging, un-
half of such additional less unpacked
insured. solely for the pur-
pose of inspection,
(b) Any person or organization demonstration,
from which you lease testing, or the
equipment with whom you substitution of
have agreed per Paragraph parts under in-
9.a.(1) above to provide in- structions from the
surance. Such person(s)or manufacturer, and
organization(s)are insureds then repackaged
solely with respect to their in the original
liability arising out of the container;
maintenance, operation or
use by you of equipment e) Any failure to
leased to you by such per- make such in-
son(s) or organizations(s). spections, adjust-
However, this insurance ments, tests or
does not apply to any "oc- servicing as the
currence"which takes place vendor has
after the equipment lease agreed to make or
expires. normally under-
takes to make in
(c) Any P g the usual course
(referred to below as ven- of business, in
dor) with whom you have connection with
agreed per Paragraph the distribution or
9.a.(1) above to provide in- sale of the prod-
surance, but only with re- ucts;
spect to "bodily injury" or
"property damage" arising f) Demonstration, in-
out of"your products"which stallation, servic-
are distributed or sold in the ing or repair op-
regular course of the ven- erations, except
dor's business, subject to such operations
the following additional ex- performed at the
clusions: vendor's premises
in connection with
1) The insurance afforded the sale of the
the vendor does not product;
apply to:
"Bodily injury" or g) Products which,
a
Y J rY' after distribution or
"property damage" sale by you, have
for which the ven- been labeled or
dor is obligated to relabeled or used
pay damages by as a container,
reason of the as- part or ingredient
sumption of liabil- of any other thing
ity in a contract or or substance by or
agreement. This for the vendor.
exclusion does not
apply to liability for 2) This insurance does
damages that the not apply to any in-
vendor would sured person or or-
have in the ab- ganization:
sence of the con-
tract or agree- a) From whom you
ment; have acquired
such products, or
b) Any express war- any ingredient,
ranty unauthorized part or container,
by you; entering into, ac-
Includes copyrighted material of Insurance
GA 233 02 07 Services Office, Inc.,with its permission. Page 11 of 15
companying or 2) This insurance does
containing such not apply to "bodily in-
products; or jury", "property dam-
age"b When liabilityin- or "personal and
advertising injury' aris-
cluded within the ing out of operations
products- performed for the state
completed opera- or political subdivision.
tions hazard" has
been excluded (f) Any person or organization
under this Cover- with which you have agreed
age Part with re- per Paragraph 9.a.(1)
spect to such above to provide insurance,
products. but only with respect to li-
d An state or political subdi- ability arising out of "your
( ) Y p work" performed for that
vision with which you have additional insured by you or
agreed per Paragraph on your behalf. A person or
9.a.(1) above to provide in- organization's status as an
surance, subject to the fol- insured under this provision
lowing additional provision: of this endorsement contin-
This insurance applies only ues for only the period of
with respect to the following time required by the written
hazards for which the state contract or agreement, but
or political subdivision has in no event beyond the ex-
issued a permit in connec- piration date of this Cover-
tion with premises you own, age Part. If there is no
rent or control and to which written contract or agree-
this insurance applies: ment, or if no period of time
is required by the written
1) The existence, mainte- contract or agreement, a
nance, repair, con- person or organization's
struction, erection, or status as an insured under
removal of advertising this endorsement ends
signs, awnings, cano- when your operations for
pies, cellar entrances, that insured are completed.
coal holes, driveways, (3) Any insurance provided to an
manholes, marquees, additional insured designated
hoist away openings,
sidewalk vaults, street under Paragraph 9.a.(2):
banners, or decora- (a) Subparagraphs (e) and (f)
tions and similar expo- does not apply to "bodily
sures; or injury"or"property damage"
2) The construction, erec- included within the "prod-
tion, or removal of ele- ucts-completed operations
vators;or hazard";
3) The ownership, main- (b) Subparagraphs (a), (b), (d),
(e)and (f) does not apply to
elevators covered
or use any "bodily injury", "property
elevatby damage" or "personal and
this insurance. advertising injury" arising
(e) Any state or political subdi- out of the sole negligence
vision with which you have or willful misconduct of the
agreed per Paragraph additional insured or their
9.a.(1) above to provide in- agents, "employees" or any
surance, subject to the fol- other representative of the
lowing provisions: additional insured;or
1) This insurance applies (c) Subparagraph (f) does not
only with respect to op- apply to "bodily injury",
erations performed by "property damage" or "per-
you or on your behalf sonal and advertising injury"
for which the state or arising out of:
political subdivision has 1) Defects in design fur-
issued a permit,
Wished by or on behalf
Includes copyrighted material of Insurance
GA 233 02 07 Services Office, Inc.,with its permission. Page 12 of 15
of the additional in- spects any other insurance
sured;or policy issued to the addi-
tional insured, and such
2) The rendering of, or other insurance policy shall
failure to render, any be excess and / or noncon-
professional architec- tributing, whichever applies,
tural, engineering or with this insurance.
surveying services, in-
cluding: (b) Any insurance provided by
this endorsement shall be
a) The preparing, primary to other insurance
approving or fail- available to the additional
ing to prepare or insured except:
approve maps,
shop drawings, 1) As otherwise provided
opinions, reports, in SECTION IV
surveys, field or- COMMERCIAL GEN-
ders, change or- ERAL LIABILITY
ders or drawings CONDITIONS, 5.Other
and specifications; Insurance, b. Excess
and Insurance;or
b) Supervisory, in- 2) For any other valid and
spection, archi- collectible insurance
tectural or engi- available to the addi-
neering activities. tional insured as an
3 "Your work"for which a additional insured by
attachment of an en-
consolidated (wrap-up) dorsement to another
insurance program has insurance policy that is
been provided by the written on an excess
primecontractor-project basis. In such case,
manager or owner of the coverage provided
the construction project under this endorse-
in which you are in- ment shall also be ex-
volved, cess.
b. Only with regard to insurance pro- (2) Condition 11. Conformance to
vided to an additional insured desig- Specific Written Contract or
nated under Paragraph 9.a.(2) Sub- Agreement is hereby added:
paragraph (f) above, SECTION III -
LIMITS OF INSURANCE is amended 11. Conformance to Specific
to include: Written Contract or
The limits applicable to the additional Agreement
insured are those specified in the With respect to additional
written contract or agreement or in insureds described in Para-
the Declarations of this Coverage graph 9.a.(2)(f)above only:
Part,whichever are less. If no limits
are specified in the written contract If a written contract or
or agreement, or if there is no written agreement between you
contract or agreement, the limits ap- and the additional insured
plicable to the additional insured are specifies that coverage for
those specified in the Declarations of the additional insured:
this Coverage Part. The limits of in- a. Be provided by the In-
surance are inclusive of and not in surance Services Of-
addition to the limits of insurance fice additional insured
shown in the Declarations. form number CG 20 10
c. SECTION IV - COMMERCIAL GEN- or CG 20 37 (where
ERAL LIABILITY CONDITIONS is edition specified);or
hereby amended as follows: b. Include coverage for
(1) Condition 5. Other Insurance is completed operations;
amended to include: or
(a) Where required by a written c. Include coverage for
contract or agreement, this "your work";
insurance is primary and / and where the limits or cov-
or noncontributory as re- erage provided to the addi-
Includes copyrighted material of Insurance
GA 233 02 07 Services Office, Inc.,with its permission. Page 13 of 15
tional insured is more re- 11, of this endorsement fix the
strictive than was specifi- most we will pay in any one "oc-
cally required in that written currence" regardless of the
contract or agreement, the number of:
terms of Paragraphs
9.a.(3)(a), 9.a.(3)(b) or 9.b. (a) Insureds;
above, or any combination (b) Claims made or "suits"
thereof, shall be interpreted brought;or
as providing the limits or
coverage required by the (c) Persons or organizations
terms of the written contract making claims or bring
or agreement, but only to "suits".
the extent that such limits or
coverage is included within (2) Deductible Clause
the terms of the Coverage (a) Our obligation to pay dam-
Part to which this endorse- ages on your behalf applies
ment is attached. If, how- only to the amount of dam-
ever, the written contract or ages for each "occurrence"
agreement specifies the In- which are in excess of the
surance Services Office Deductible amount stated in
additional insured form Section B. Limits of Insur-
number CG 20 10 but does ance, 11. of this endorse-
not specify which edition, or ment. The limits of insur-
specifies an edition that ance will not be reduced by
does not exist, Paragraphs the application of such De-
9.a.(3)(a) and 9.a.(3)(b) of ductible amount.
this endorsement shall not
apply and Paragraph 9.b, of (b) Condition 2. Duties in the
this endorsement shall ap- Event of Occurrence, Of-
ply. fense, Claim or Suit, ap-
10. Broadened Contractual Liability-Work plies to each claim or "suit"
Within 50'of Railroad Property irrespective of the amount.
It is hereby agreed that Paragraph f.(1) of (c) We may pay any part or all
Definition 12. "Insured contract" (SEC- of the deductible amount to
TION V-DEFINITIONS)is deleted. effect settlement of any
claim or suit' and, upon
11. Property Damage to Borrowed Equip- notification of the action
ment taken, you shall promptly
reimburse us for such part
a. The following is hereby added to Ex- of the deductible amount as
clusion j. Damage to Property of has been paid by us.
Paragraph 2., Exclusions of SEC-
TION 1 - COVERAGES, COVERAGE 12. Employees as Insureds - Specified
A. BODILY INJURY AND PROP- Health Care Services
ERTY DAMAGE LIABILITY: It is hereby agreed that Paragraph
Paragraphs (3) and (4) of this exclu- 2.a.(1)(d) of SECTION 11 - WHO IS AN
sion do not apply to tools or equip- INSURED, does not apply to your "em-
ment loaned to you, provided they ployees" who provide professional health
are not being used to perform opera- care services on your behalf as duly li-
tions at the time of loss. censed:
b. With respect to the insurance pro- a. Nurses;
vided by this section of the en- b. Emergency Medical Technicians;or
dorsement, the following additional
provisions apply: c. Paramedics,
(1) The Limits of insurance shown in the jurisdiction where an "occurrence"
in the Declarations are replaced or offense to which this insurance applies
by the limits designated in Sec- takes place.
tion B. Limits of Insurance, 11.
of this endorsement with respect 13. Broadened Notice of Occurrence
to coverage provided by this
endorsement. These limits are Paragraph a. of Condition 2. Duties in
inclusive of and not in addition to the Event of Occurrence, Offense,
the limits being replaced. The Claim or Suit (SECTION IV- COMMER-
Limits of Insurance shown in CIAL GENERAL LIABILITY CONDI-
Section B. Limits of Insurance,
Includes copyrighted material of Insurance
GA 233 02 07 Services Office, Inc.,with its permission. Page 14 of 15
TIONS) is hereby deleted and replaced (2) The names and addresses of
by the following: any injured persons and wit-
a. You must see to it that we are noti- nesses; and
fied as soon as practicable of an (3) The nature and location of any
"occurrence" or an offense which injury or damage arising out of
may result in a claim. To the extent the'occurrence"or offense.
possible, notice should include:
This requirement applies only when
(1) How, when and where the "oc- the"occurrence" or offense is known
currence" or offense took place; to an "authorized representative".
Includes copyrighted material of Insurance
GA 233 02 07 Services Office, Inc.,with its permission. Page 15 of 15
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13
(Ed. 4-84)
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce
our right against the person or organization named in the Schedule. (This agreement applies only to the extent that
you perform work under a written contract that requires you to obtain this agreement from us.)
This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.
Schedule
BLANKET WAIVER OF SUBROGATION
If you are required by a written contract or agreeement, which is executed before a loss, to waive your rights of recc
from others, we agree to waive our rights of recovery
This waiver of rights applies to any person or organization for whom the named insured has agreed by written cont)
to furnish this waiver, but shall not be construed to be a waiver with respect to any other operations in which
insured has no contractual interest.
This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.
(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)
Endorsement Effective Policy No. Endorsement No.
Insured Premium
Insurance Company Countersigned by._.__
WC 00 03 13
(Ed.4-84)
0 1983 National Council on Compensation Insurance.
08/12/2013 09:31:26 AM RICKLEFS EXCAVATING,LTD Page 1 of 1
Subcontractor STE List
Vendor Name Address 1 Address 2 City State Zip Code Federal ID
Bee Line Products Corporation P.O. Box 285 Cedar Rapids IA 52406 42-1029022
Kelley Dewatering&Const Co. 5175 Clay Ave SW Wyoming MI 49548 38-3213018
L.L. Pelling Co. Inc. 1425 W. Penn Street PO Box 230 North Liberty IA 52317-0230 42-0791811
Ricklefs Excavating, Ltd. 12536 Buffalo Road Anamosa IA 52205 42-1521119