Targeted Small Business Form (1).pdf
PDF 58 KB Posted
- Attached to
- A1 PHASE 2 – CENTRAL ROOF REPAIRS
- Solicitation number
- C622A1601
- Issued by
- Polk County, Iowa
About this file
This is a Targeted Small Business Form supplement submitted by bidders to the Iowa Department of Public Defense for the A1 Phase 2 – Central Roof Repairs project at Camp Dodge in Johnston, Iowa. The project, identified as Contract No. C622A1601 and Project No. 19084320, involves central roof repairs as part of a larger Phase 2 exterior wall recladding initiative at the Iowa National Guard Joint Forces Headquarters building. Bids were due September 15, 2026 at 1:00 p.m. CDT, with bids opened on August 22, 2026 at 12:00 a.m. CDT. The solicitation structure includes a base bid and one alternate bid item, both submitted as lump-sum amounts. Bidders must submit technical drawings, specifications, a form of bid, and the completed targeted small business form through the IMPACS system.
The form requires bidders to identify whether they are certified Iowa Targeted Small Businesses and to document all Targeted Small Business Enterprise contacts made prior to bid submission, including company names, phone numbers, contact dates, quotes received, and proposed amounts. Bidders must reference the construction-related Iowa Targeted Small Business Directory as certified by the Department of Economic Development, State of Iowa, and comply with all affirmative action and equal opportunity provisions of State and Federal laws. The Owner seeks to provide opportunities for Targeted Small Businesses in accordance with Chapter 73 of the Code of Iowa. Payment follows Iowa Code 8A.514, allowing the State of Iowa sixty days to process and pay invoices. Philip Payton, issuing officer, can be contacted at 515-975-6211 or philip.payton@dpd.iowa.gov for solicitation questions.
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Text version
A1 PHASE 2 – CENTRAL ROOF REPAIRS SUPPLEMENT D:
CAMP DODGE, JOHNSTON, IOWA TARGETED SMALL BUSINESS FORM
Revised Nov. 1, 2021 00 43 16 - 1
DOCUMENT 00 43 16
SUPPLEMENT D: TARGETED SMALL BUSINESS FORM
(To be submitted with Form of Bid)
I. PROJECT TITLE:
A1 PHASE 2 – CENTRAL ROOF REPAIRS
PROJECT LOCATION:
CAMP DODGE, JOHNSTON, IOWA
PROJECT NO.: 19084320
CONTRACT NO.: C622A1601
Bidder’s Company Name Area Code/Telephone
Address City State Zip Code
Bidder is _____ is not _____ a certified Iowa Targeted Small Business.
INSTRUCTIONS: Bidder shall provide the information requested below showing any Targeted Small Business Enterprise contacts made prior to bid submission for the project listed. Bidder shall use the construction-related Iowa Targeted Small Business Directory as certified by the Department of Economic Development, State of Iowa. Bidders shall comply with all affirmative action/equal opportunity provisions of State and Federal laws. The Owner seeks to provide opportunities for Targeted Small Businesses in accordance with the provisions of Chapter 73 of the Code of Iowa. Information is subject to verification and confirmation.
TSB Company Name and Phone #
Date Contacted
Quote Rec’d (Y/N)
$ Amount Proposed (if quote used in bid)
(Use second sheet if needed)
Date Signature of Bidder (same person signing the Form of Bid)
END OF DOCUMENT 00 43 16
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