Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Opening of Bids - Ironwood Dr Sidewalk Edison Road to SR 23 Project No 117-033A - Edward & Jones Concrete
CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK:_ CHECKLIST FOR BIDDERS`" Project Name Ironwood Drive Sidewalk Edison Road to S.R. 23 Project No. 117-033A For Bids Due December 12, 2017 From time to time the South Bend Board of Public Works finds it necessary to reject a bid because it does not comply with statutory requirements. In preparing your bid, please use the following checklist in order to make sure that your bid is done in the proper manner. Proper bid security included. The bidder has the option of providing either a Certified Check � or Bid Bond. Bid prepared on the City of South Bend Contractor's Bid for Public Work Form, completely executed. Contractor's Non -Collusion and Non -Debarment Affidavit, Certification Regarding Investments with Iran, Employment Eligibility Verification, Non -Discrimination Commitment, and Certification of use of United States Steel Products or Foundry Products. Proof of MBEIWBE Participation Goal Form [MWBE-1.0]. If minimum participation goal is not �( met, also provide Evidence of Good Faith Efforts Form [MWBE-2,0] and MBEIWBE Contacted Form [MW8E-2.1]. IAcknowledge Receipt of _2_ Addendum(s) included with the bid. XAll required additional information is included with the bid. Proposal statements and other affidavits all signed by the proper party with name either printed or typed underneath signature. AThis checklist submitted with the Bid. This checklist is provided for bidder's use in assuring compliance with required documentation; however, it does not include all specifications requirements and does not relieve the bidder of the need to read and comply with the specifications. Bidder: ,JW r.V`c a0zn Date: By Authorized Signature: Print Name & Title. C' hc�v' lf.s v0,t - J © V M0144 J,"r Version 10/17/2016 Contractor's Bid for Public Works - 1 CITY OF SOUTH BEND INDIANA CONTRACTOR'S BID FOR PUBLIC WORK Project Name ironwood Drive Sidewalk Edison Road to S.R. 23 Project No. 117-033A For Bids Due December 12, 2017 PART (Must be completed for all bids. Please type or print) Date: Q-\ k - 56C\-� Bidder (Firm): Address: Q,a , f' 7Ck City/State/Zip: �YN&tFs —i(A Telephone Number: (30 Agent of Bidder (if Applicable): Pursuant to notices given, the undersigned offers to furnish labor and/or material necessary to complete the public works project of: the City of South Bend, Indiana, in accordance with plans and specifications prepared by: Abonmarche Consultants, Inc. and dated ! V `7 ._ for the sum of (enter the Total Bid as shown on the Proposal) -lb-c-r : � �d�- 1 ' � ,4 i c c rcv,ru S` Scu tr (� ? __ ) (Enter sum of Total Base Bid plus Alternates shown on P oposal) (Numerical) The undersigned further agrees to furnish a bond or certified check with this bid for an amount specified in the notice of the letting. If alternative bids apply, the undersigned submits a proposal for each in accordance with the notice_ Any addendums attached will be specifically referenced at the applicable page. If additional units of material included in the contract are needed, the cost of units must be the same as that shown in the original contract if accepted by the City of South Bend. If the bid is to be awarded on a unit basis, the itemization of the units shall be shown on a separate attachment. By (Signature) (Printed Name of Person Signing) The above bid is accepted this Subject to the following conditions: BOARD OF PUBLIC WORKS A. Gilot, President Elizabeth A. Maradik, Member James A, Mueller, Member ACCEPTANCE day of PART II Suzanna M. Fritzberg, Member Therese J. Dorau, Member Attest: Linda M. Martin, Clerk Version 10/17/2016 Contractor's Bid for Public Works - 2 20 (For projects of $100,000 or more — IC 36-1-12-4) These statements to be submitted under oath by each bidder with and as part of his bid. Attach additional pages for each section as needed. SECTION 1 EXPERIENCE QUESTIONNAIRE 1. Attach information regarding projects your organization has completed for the period of one (1) year prior to the date of the current bid. 2. Attach a listing of public works projects currently in process of construction by your organization. 3. Attach information regarding any failure to complete any work awarded to you and the location thereof. 4. Attach references from private firms for which you have performed work. SECTION II PLAN AND EQUIPMENT QUESTIONNAIRE Attach an explanation of your plan or layout for performing proposed work. (Examples could include a narrative of when you could begin work, complete the protect, number of workers, etc. and any other information which you believe would enable the City of South Bend to consider your bid.) 2. Attach a listing of the names and addresses of all subcontractors (i.e. persons or firms outside your own firm who have performed part of the work) that you have used on public works projects during the past five (5) years along with a brief description of the work done by each subcontractor. If you intend to sublet any portion of the work, attach the name and address of each subcontractor, equipment to be used by the subcontractor, and whether you will require a bond. However, if you are unable to currently provide a listing, please understand a listing must be provided prior to contract approval. Until the completion of the proposed project, you are under a continuing obligation to immediately notify the City of South Bend in the event that you subsequently determine that you will use a subcontractor on the proposed project. 4. Attach a listing of equipment you have available to use for the proposed project. 5. Have you entered into contracts or received offers for all materials which substantiate the prices used in preparing your proposal? If not, attach an explanation for the rationale used which would corroborate the prices listed. SECTION III CONTRACTOR'S FINANCIAL STATEMENT Attachment of bidder's financial statement is mandatory. Any bid submitted without said financial statement as required by statute shall thereby be rendered invalid. The financial statement provided hereunder to the City of South Bend awarding the contract must be specific enough in detail so that said City of South Bend can make a proper determination of the bidder's capability for completing the project if awarded. Version 10117/2016 Contractor's Bid for Public Works - 3 When the prospective Contractor is unable to certify to ar. r of the statements below, it shall attach an explanation to this Affidavit. CONTRACTOR'S NON -COLLUSION AND NON -DEBARMENT AFFIDAVIT, CERTIFICATION REGARDING INVESTMENT WITH IRAN, EMPLOYMENT ELIGIBILITY VERIFICATION, NON- DISCRIMINATION COMMITMENT AND CERTIFICATION OF USE OF UNITED STATES STEEL PRODUCTS OR FOUNDRY PRODUCTS (Must be completed limn all quotes and bids. Please ty pe or print) STATE OF Indiana ) ) SS: St. Joseph COUNTY ) The undersigned Contractor, being duly sworn upon his/her/its oath, affirms under the penalties of perjury that: 1. Contractor has not, nor has any other member, representative, or agent of the Firm, company. corporation or partnership represented by him, entered into any combination, collusion or agreement a ith any person relative to the price to be hid by anyone at such letting nor to prevent any person from bidding nor to induce anyone to retrain from bidding, and that this bid is made without reference to any other hid and without any agreement, understanding or combination with any other person in reference to such bidding. Contractor further says that no person or persons, firms, or corporation has, have or will receive directly or indirectly, any rebate, fee, gift, commission or thing of ralue on account of such sale. and 2. Contractor certifies by submission of this proposal that neither contractor nor any of its principals are presently debarred, suspended, proposed lbr debarmeni. declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency; and 3. Contractor has not, nor has any successor to, nor an affiliate of, Contractor, engaged in investment activities in Iran. a. For purposes ofthis Certification, "Iran" means the government of Iran and any agency or instrumentality of Iran, or as otherwise defined at Ind. Code § 5-22-16.5-5, as amended from time -to -time. b. As provided by Ind. Code § 5-22-16.5-8, as amended from time -to -time, a Contractor is engaged in investment activities in Iran if either: i. Contractor, its successor or its affiliate, provides goods or services of twenty million dollars ($20,000,000) or more in value in the energy sector of Iran: or ii. Contractor, its successor or its affiliate, is a financial institution that extends twenty million dollars ($20,000,000) or more in credit to another person for forty-five (45) days or more, if that person will (i) use the credit to provides goods and services in the energy sector in Iran, and (6) at the time the financial institution extends credit, is a person identified on list published by the Indiana Department of Administration. Version 10/17/2016 Contractor's Bid for Public Works - 4 4. Contractor does not knowingly employ or contract %%ith an unauthorized alien. nor retain any employee or contract with a person that the Contractor stabscquentfy learns is an unauthorized alien. Contractor agrees that he/she/it shall enroll in and verify the work eligibility status of all of Contractor's newly hired employees through tale E-Vcritj Program as defined by I.C. 22-5-1.7-3. Contractor's documentation oaf enrollment and participation in the E-Veril_N Program is included and attached as part of this bidlquotc; and S. Conu-actor shall require his/her/its subcontractors performing work under this public contract to certify that the subcontractors do not knowingly employ or contract with an unauthorized alien, nor retain any employ cc or contract with a person that the subcontractor subsequently learns is an unauthorized alien, and that the subcontractor has enrolled in and is participating in the E-Veri ly Program. The Contractor agrees to maintain this certification throughout the term ofthe contract with the City of South Bend. and understands that the City maN terminate the contract Ibr defituft if the C'ontructor fails to cure a breach ofthis provision no later than thirty (30) days after being notified by the City. 6. Persons_ pat•tnerships, corporations, associations, or joint venturers awarded a contract by the Cit} of South Bend through its agencies, boards, or commissions shall not discriminate against any employee or applicant firr employment in the performance ofa City contract with respect to hire. tenure. terms, conditions, or privileges of employment, or any matter directly or indirectly related to employment because of race, sex, religion, color. national origin, ancestry, age, gender expression, gender identity. sexual orientation or disability that does not affect that person's ability to perlorm the work. In awarding contracts for the purchase of work, labor, services. supplies. equipment. materials, or any combination of the foregoing including, but not limited to, public works contracts awarded under public bidding laws or other contracts in which public bids are not required by hm, the City, its agencies, boards. or commissions may consider the Contractor's good faith efforts to obtain participation by those Contractors certified b\- the State of Indiana as a Minority Business C'MBE") or as a Women's Business Enterprise ('`WISE") as a lactor in determining the lowest, responsible. responsive bidder. In no event shall persons or entities seeking the award ofa City contract be required to award a subcontract to an MBE/WBE: however, it may not unlawfully discriminate against said WISE./MBE. A finding of a discriminatory practice by the City's MBE/WBE Utilization Board shall prohibit that person or entity from being awarded a City contract for a period of one (1) year from the date of such determination, and such determination may also be grounds for terminating the contact for which the discriminatory practice or noncompliance pertains. 7. The undersigned contractor agrees that the following nondiscrimination commitment shall be made a part of any contract which it may hencel'orth enter into with the City of Soutlt Rend, Indiana or any of its agencies. boards ON. commissions. Contractor agrees not to discriminate against or intimidate any employee or applicant for employment in the performance of this contract with privileges of employment, or, any matter directly or indirectly related to employment. because of race, religion. Color. sex, gender expression, gender identity, sexual orientation, handicap, national origin or ancestry. Breach of this provision may be regarded as material breach of contract. 1, the undersigned bidder or agent as contractor on a public works project, understand my statutory obligations to the use of steel products or foundry' products made in the United States (I.C. 5-16-8-1),1 hereby certil; that I and all subcontractors employed by me liar• this project will use steel products or foundry products made in the United States on this project if awarded. I understand I have an afiirmative duty to notify the City in my bid that my proposal does not include the use of steel products or foundry products made in the United States. I understand it is my sole obligation and responsibility to provide a justification to the City. subject to review and approval, why the cost oft Inited States made steel or foundry products is unreasonable. Prior to award and upon submission of bid N%hich does not use steel products or foundry products made in the United States, the City, through its director of public works, shall make a determination if the price of United States made steel or foundry is unreasonable. I understand that violations hereunder Version 10f17/2016 Contractor's Bid for Public Works - 5 may result in Jivteiture of contractual payments. I hereby affirm under the penalties of perjury that the facts and information contained in the foregoing bid for public works are true and correct. Dated this —LL day of be— 20 1-7 NANCY R BROWN Notary Public- Seal State of Indiana My Commission Expires May 23, 2021 Contractor/Bidder (Firm) , Signature of Contractor/[3idder or Its Agent Printed Name and Title Subscribed and sworn to before me this day of 20 My Commission Expires Notary Public County of Residence Version 1011712016 Contractor's Bid for Public Works - 6 Project Name Project No. For Bids Due F-u—GAAF-Tril Addendum No. 2 ................ JM BID/PROPOSAL CITY OF SOUTH BEND Ironwood Drive Sidewalk Edison Road to S.R. 23 117-033A December 12, 2017 Item No. Description Quantity Unit Unit Price Total Amount 1 Mobilization/Demobilization 1 LS 30, cv,) ao,ow 2 Construction Engineering 1 LS 3 Maintenance of Traffic 1 LS wi, rim 4 Flashing Arrow Sign, 45 Days d A5 I 5 Construction Sign, Type "A" 16 EA 174) 7,20) 6 Curb, Remove 560 LFT 7 Concrete Sidewalk/Approach, Remove 250 SYD 8 Tree, Remove, 48" 1 EA 9 10 Sign, Sheet, Relocate Common Excavation 5 300 EA CYS 2'-?L S-q) 11 Compacted Aggregate, No. 53 150 TON 1 11-S7 17M 12 HMA for A proaches 150 Sys qjrrj 13 Sidewalk, Concrete, 4" 850 SYS 66 14 Curb Ramp, Concrete 35 SYS 9'7.S-- 9, 6,25 15 Concrete Curb and Gutter, 6", Type B 300 LFT 16j2,W 16 Concrete Approach, 8" 450 SYS 17 High -Early Concrete Additive 350 SYS 16 3,5-03 18 Sodding 550 SYS ! 1-4 11/1-6 19 Fire Hydra t Assembly, Relocate 1 EA 20 Casting, Adjust to Grade 4 EA 37�5— 21 22 Line, Epoxy, Solid, White, 6" Transverse Marking, Thermoplastic, White, 24" 115 25 LFT LFT Iq r3o CII-20 — 76-0 TOTAL BASE BID 61 Bidder (Firm): Address: X. v City/State/Zip: Telephone Number: A-- I By xcna. (Signature) (Printbd Name of Person Signing) Version 10/1712016 Contractor's Bid for Public Works - 7 m 11� W d LL) N EL OLLJ0: mto tzu0 _ V) cc Z z N 0 U. DLU Om0 E- W W U D W �:m 0 z a C: O z i z o_ O �a m H � a. aw mm O LL {LJ co m d C m _O ar O O m n c CL CA L �L Y tr E V Hl w W u d � c O VI a� o E u � � O 0. •r a C N •- m � a+ � 0 H A O � 0 01 L Q. > w� m f+ C a 3 N N p� CL O Yl CL 0 N CD 0 N O � C IA O E_m y 0 y0O w C 7 E la O O CL,?.- 0 H CL CS LO rl- C4 m C+•) Cl C9 QI � y O :2 3 CO C � n E E m z +, 0 ao U ti 0 1-+ M M r W r CL co rn m N m O m F- O U Q1 c w ar o � 0 a 0 0 EQ Q W lO ❑ m 2 cL 0 m -Drn y o m � � N m c kJJ O T O � o � �" ov O c L U L U Z w Q Q R = d o F-^ L m m C 0 U � � � O 0. w W In Iv m a m v Q N E Z G _T W CITY OF SOUTH BEND _ �"`T" A14`J MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY %`,, y :7•�,5 DEVELOPMENT PROGRAM FORM MWBE-2.0 EVIDENCE OF GOOD FAITH EFFORTS This completed form should be included as part of the Bids documents related to City of South Bend Public Works Projects requiring Good Faith Efforts to obtain MBEIWBE participation, It is the bidder's sole responsibility to verify whether any listed minority or woman business meets the qualifications of a Minority or Women's owned business as defined by the Indiana Department of Administration ("IDOA"). Project Number: 117-033A Date r4/&OT Project Name: Ironwood Drive Sidewalk Edison Road to S.R. 23 Bidder: Edward & Jones Concrete, INC Contact Person: Charles Merriweather Telephone 317-284-1117 : 12/1 Address: PO BOX 502811 City: Indianapolis State IN Zip Email: To determine whether a bidder has demonstrated good faith efforts to reach the MBE/WBE utilization goals set forth in the City of South Bend Public Works Project Specifications; the City and its agencies, boards, or commissions, REQUIRE ALL of the following Good Faith Efforts as listed in the table below* EVIDENCE OF GOOD FAITH EFFORTS MBE/WBE LIST(S): The bidder reviewed the City of South Bend's Minority and Women Business Enterprise Diversity Development Program, which uses the 100A approved list of Minority and Women Owned Business as found on their website (http://www.in.gov/idoa). ACTION (ADVERTISE/CONTACT): In order for your bid to be deemed responsive, the City of South Bend requires that all perspective bidders complete no less than 2 of the following: i, Attend all pre -bid meetings scheduled by the City to inform MBE/WBEs of contracting and subcontracting opportunities. 2. Advertise in general circulation and/or trade association publications concerning subcontracting opportunities, and allow MBE/WBEs reasonable time to respond. 3. Perform any and all necessary steps to provide written notice in a manner reasonably calculated to inform MBE/WBEs of subcontracting opportunities and allowed sufficient time for them to participate effectively. 4. Utilize pre-existing services of available community organizations, small and/or disadvantaged business assistance offices and other organizations that provided assistance in the recruitment and placement of MBE/WBE firms. **Bid er must circle or otherwise notate which of the two (2) required actions were performed. GOO FAITH NEGOTIATIONS: The bidder negotiated in good faith with interested MBENUBEs, incluc ing providing such MBEIWBE's with adequate information about the plans, specifications and other requii ements of the subcontract and did not reject MBE/WBEs as unqualified without sound business reaso is based on a thorough investigation of their capabilities. SMALL CONTRACT(S): The bidder selected specific portions of the work to be performed by MBEA1VBEs in order to increase the likelihood of meeting the MBEANBE goals (including breaking down contracts into smaller units to facilitate MBEIWBE participation) CONTRACT RECORDS: The bidder has maintained the following records for each MBE/WBE that has bid ot the subcontracting opportunity: 1. Na ne, address, and telephone number; 2. A c escription of information provided by the bidder or subcontractor; and 3. A i tatement of whether an agreement was reached, and if not, why not, including any reasons for concl iding that the MBE/WBE was unqualified to perform the job. *Proper demonstration of Good Faith' Effort requires your initials next to all of the above boxes. Any omissions shall be considered grounds for rejection of the bid by the Board of Public Works. The City of South Bend reserves the right to request additional information. Version 10/17/2016 Contractor's Bid for Public Works - 9 CITY -OF SOUTH BEND _tyossTr�o - MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY DEVELOPMENT PROGRAM FORM MWBE-2.1 MBEIWBE CONTACTED This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects requiring contacted MSEIWBE to obtain Good Faith Efforts. It is the bidder's sole responsibility to verify whether any listed minority or woman business meets the qualifications of a Minority or Women's owned business. Project Number: 117-033A Project Name: Bidder: �j By: 0 - ` (Signature) PAGE—J^OF MBE/WBE Participation Goal 470 Ironwood Drive Sidewalk Edison Road to S.R. 23 ✓ A + J r, C o v%c, v L- ., C- MBEIWBE Fim1 Yr 1 C U 1-, {- Owner or Contact at MBEIWBE Firm (Date) Telephone: 2L32- && /) 0 Fax: I Email: •TvC, t ri ` TYPE OF WORK SOLICITED FOR THIS PROJECT: RESULTS OF CONTACT WITH THE MBEIWBE FIRM: N)O+ �n v�,[ '. /I r. +c C, f 1n ;) / or MBEIWBI Firm " ] Qve vti L OA Owner or Contact at MBE/WBE Firm y ec c Telephone: 5 " - '- �d Fax: Email: TYPE OF WORK SOLICITED FOR THIS PROJECT: J ✓J r - RESULTS OF CONTACT WITH THE MBEIWBE FIRM: U110 vm 6e-f- 404 i ve lilt[ atj 11 tt Version 10/17/2016 Contractor's Bid for Public Works - 10 CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY DEVELOPMENT PROGRAM FORM MWBE-2.1 ' ?� MBEIWBE CONTACTED This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects requiring contacted MBE/WBE to obtain Good Faith Efforts. It is the bidder's sole responsibility to verify whether any listed minority or woman business meets the qualifications of a Minority or Women's owned business. �^ Project Number: Project Name: Bidder_ By: PAGE _OF r 117-033A MBENVSE Participation Goal l Ironwood Drive Sidewalk Edison Road to S.R. 23 MBEMIBE Firm G k r441 ✓1 Owner or Contact at MBEIWBE Firm Telephone: 74- y777"Fax. — Email_ TYPE OF WORK SOLICITED FOR THIS PROJECT: f �` (Date) RESULTS OF CONTACT WITH THE MBENVBE FIRM: ct G cc JUlpr MBEIWBE Firm Owner or Contact at MBENVBE Firm Telephone:7j �'�, Fax: Email: TYPE OF WORK SOLICITED FOR THIS PROJECT: r, RESULTS OF CONTACT WITH THE MBEIWBE FIRM: Version 10/17/2016 Contractor's Bid for Public Works - 10 CITY -OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY „ x DEVELOPMENT PROGRAM FORM MWBE-2.I MBEMBE CONTACTED «G� This completed form should be supplied with Bids that pertain to City of South Bend Pudic Works Projects requiring contacted MBEIWBE to obtain Good Faith Efforts. it is the bidder's sole responsibility to verify whether any listed minority or woman business meets the qualifications of a Minority or Women's owned business. Project Number: PAGE �OF^ 117-033A MBEIWBE Participation Goal Project Name: ironwood Drive Sidewalk Edison Road to S.R. 23 AM By: MBEMIBE Firm 15YAQ ram_ 1 — V)A c v'1 4 c )Gkt Owner or Contact at MBEIWBE Firm Telephone: 7 Fax: Email: l G N r, L �� r f 'om TYKE OF WORK SOLICITED FOR THIS PROJECT: MSEIWBE Firm Owner or Contact at MBE&BE Firm Telephone: Fax: TYPE OF WORK SOLICITED FOR THIS PROJECT: RESULTS OF CONTACT WITH THE MSEANBE FIRM: Email: Version 1011712016 Contractor's Bid for Public Works - 10 PEA(T 1316 COUN'ry-Cri), BULDING 227 W, JEFFr: RSON BotiLEVARD SOUI 11 BEND, INDIANA 46601-1830 PHONF ' 574/ 235-9251 AX U571t/ 235-9171 Tffl) 574/ 235-5567 CITYCIF SOUTHBIEND BOARD OF PUBLIC WORKS Date: December 7, 2017 To: All Planholders From Linda M. Martin, Clerk, Board of Public Works Subject Addendum Number: I Project Name: Ironwood Road Sidewalk, Edison Road to S.R. 23 Project Number: 117-033A ACKNOWLEDGEMENT OF RECEIPT OF ADDENDUM Date Received: I I This addendum is being forwarded to, you for the above referenced project. Please sign below and acknowledge receipt of this Addendum by faxing this sheet to the Board of Public Works at (574) 235-9171 within 48 hours of receipt. A copy MUST also be included with your bid package upon submittal. Notes: The attached documents are hereby added to the Specifications and Contract Documents and become a part of herein. Company: Authorized Signature: Date: C,kV' C 6> 1;I'1Cr�'O�arr�r�€-CII4'I�RrILDING � � r ��� /����' 11m) I, 574/235-9"�5'@ 727 W. JE�FFCII SON BOU�,I.�f,�RD � � , , FAX 574/ 2:J'S �JV71 SOUI'IIBEND, INDIAvn46601-1830 1'DD 5741235-5567 CFFY OF S01D'I"1'1 I1HNI I)is"T� 1�I9'I I"1�nVNi�w, MAYOR BOARD OF PUBLIC WORKS Date: December 8, 2017 To: All Planholders From Linda M. Martin, Clerk, Board of Public Forks Subject Addendum Number: 2 Project Name: Ironwood Road Sidewalk, Edison Road to S.R. 23 Project Number. 117-033A 1 �► Date Received: I , - , I This addendum is being forwarded to you for the above referenced project. Please sign below and acknowledge receipt of this Addendum by faxing this sheet to the Board of Public Works at (574) 235-9171 within 48 hours of receipt. A copy MUST also be included with your bid package upon submittal. Notes: The attached documents are hereby added to the Specifications and Contract Documents and become a part of herein. Company: i t)0 ii" C, - S -.6A Authorized Signature:._v Date: Version 4/2/201.5 '"k MERCHANTS BONDING COMPANYTm MERCHANTS BONDING COMPANY(Ml)TUAL) • MERCHANTS NATIONAL BONDING, INC. 2100 FLEUR DRIVE ' DES Mf-)(NES, IOWA 50321-1158 • (800) 678-8171 ' (515) 243-3854 FAX CONTRACTOR: (Name, legal status and address) Edward & Jones Concrete, Inc. 8537 Bash Street, Suite 1 Indianapolis, IN 46250-1566 OWNER: (Name, legal status and address) City of South Bend, Indiana Board of Public Works 227 W Jefferson St., Ste 1200 N South Bend, IN 46601-1830 BOND AMOUNT: *** Ten Percent (10%) of the Accompanying Bid *** Bond Number: Bid Bond SURETY: (Name, legal status and principal place of Inesiness) Merchants National Bonding, Inc. A Corporation 2100 Fleur Drive, Des Moines, IA 50321-1158 This document has important legal consequences. Consultation with an attorney is encouraged with respect to its completion or modification. PROJECT: Any singular reference to (Name, location or address, and Project number, if any) Contractor, Surety, Owner or Ironwood Drive Sidewalk Edison Road to S.R. 23, 117-033A, South Bend, IN other party shall be considered plural where applicable. The Contractor and Surety are bound to the Owner in the amount set forth above, for the payment of which the Contractor and Surety bind themselves, their heirs, executors, administrators, successors and assigns, jointly and severally, as provided herein. The conditions of this Bond are such that if the Owner accepts the bid of the Contractor within the time specified in the bid documents, or within such time period as may be agreed to by the Owner and Contractor, and the Contractor either (1) enters into a contract with the Owner in accordance with the terms of such bid, and gives such bond or bonds as may be specified in the bidding or Contract Documents, with a surety admitted in the jurisdiction of the Project and otherwise acceptable to the Owner, for the faithful performance of such Contract and for the prompt payment of labor and material furnished in the prosecution thereof, or (2) pays to the Owner the difference, not to exceed the amount of this Bond, between the amount specified in said bid and such larger amount for which the Owner may in good faith contract with another party to perform the work covered by said bid, then this obligation shall be null and void, otherwise to remain in full force and effect. The Surety hereby waives any notice of an agreement between the Owner and Contractor to extend the time in which the Owner may accept the bid, Waiver of notice by the Surety shall not apply to any extension exceeding sixty (60) days in the aggregate beyond the time for acceptance of bids specified in the bid documents, and the Owner and Contractor shall obtain the Surety's consent for an extension beyond sixty (60) days. If this Bond is issued in connection with a subcontractor's bid to a Contractor, the term Contractor in this Bond shall be deemed to be Subcontractor and the term Owner shall be deemed to be Contractor. When this Bond has been furnished to comply with a statutory or other legal requirement in the location of the Project, 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. When so furnished, the intent is that this Bond shall be construed as a statutory bond and not as a common law bond. Signed and sealed this 12th day of December I 20W Edward & Jones Concrete, Inc. (Principal) (Se a1) (Witness) (Title) s Merchants N tional Bonding, Inc. •-� ~ (Surety) )f,tners) % All ? (Title) Tiffa . Williams, Attorney -in -Fact CON 0657 (6j12) Printed in cooperation with American Institute of Architects (_MA). The language in this doctment conforms exactly to the language used in AIA Document A3I0-Bid Bond-2010 edition. MERCHANTS BONDING COMPANY,,, POWER OF ATTORNEY Know All Persons By These Presents, that MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC., both being corporations of the State of Iowa (herein collectively called the "Companies") do hereby make, constitute and appoint, individually, Carolyn J Waggoner; David A Linthicum; Michael K Corcoran; Stella M Milli; Tiffany Williams; Vickie L Wolcott their true and lawful Attorneys) -in -Fact, to sign its name as surety(ies) and to execute, seal and acknowledge any and all bonds, undertakings, contracts and other written instruments in the nature thereof, on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. This Power -of -Attorney is granted and is signed and sealed by facsimile under and by authority of the following By -Laws adopted by the Board of directors of Merchants Bonding Company (Mutual) on April 23, 2011 and amended August 14, 2015 and adopted by the Board of Directors of Merchants National Bonding, Inc., on October 16, 2015. "The President, Secretary, Treasurer, or any Assistant Treasurer or any Assistant Secretary or any Vice President shall have power and authority to appoint Attorneys -in -Fact, and to authorize them to execute on behalf of the Company, and attach the seal of the Company thereto, bonds and undertakings, recognizances, contracts of indemnity and other writings obligatory in the nature thereof." "The signature of any authorized officer and the seal of the Company may be affixed by facsimile or electronic transmission to any Power of Attorney or Certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligations of the Company, and such signature and seal when so used shall have the same force and effect as though manually fixed." In connection with obligations in favor of the Florida Department of Transportation only, it is agreed that the power and aut hority hereby given to the Attorney -in -Fact includes any and all consents for the release of retained percentages and/or final estimates on engineering and construction contracts required by the State of Florida Department of Transportation. It is fully understood that consenting to the State of Florida Department of Transportation making payment of the final estimate to the Contractor and/or its assignee, shall not relieve this surety company of any of its obligations under its bond. In connection with obligations in favor of the Kentucky Department of Highways only, it is agreed that the power and authority hereby given to the Attorney -in -Fact cannot be modified or revoked unless prior written personal notice of such intent has been given to the Commissioner - Department of Highways of the Commonwealth of Kentucky at least thirty (30) days prior to the modification or revocation. In Witness Whereof, the Companies have caused this instrument to be signed and sealed this 6th day of April 2017 .aaaarrrr . rry..., ••... .•• . • \NG Cp ••. •,.••Pt10Nq� '��• �0 40 q� • y . �o�� RPCq'O9': 46 d 4�;.y�, MERCHANTS BONDING COMPANY (MUTUAL) INC. r •. • MERCHANTS NATIONAL BONDING, 2flfl3 : y 1933 �•' c; By774 •��6�W �r L,a••• �'�fi/ ' �?O' President STATE OF IOWA ••rrr.rraa•.a•a• ••• •,• • r• COUNTY OF DALLAS ss. On this this 6th day of April 2017 , before me appeared Larry Taylor, to me personally known, who being by me duly sworn did say that he is President of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC.; and that the seals affixed to the foregoing instrument are the Corporate Seals of the Companies; and that the said instrument was signed and sealed in behalf of the Companies by authority of their respective Boards of directors. IAf s ALICIA K, GRAM p Commission Number 787430 My Commission I xpires April 1, 2020 r Notary Public (Expiration of notary's commission does not invalidate this instrument) I, William Warner, Jr., Secretary of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC., do hereby certify that the above and foregoing is a true and correct copy of the POWER -OF -ATTORNEY executed by said Companies, which is still in full force and effect and has not been amended or revoked. In Witness Whereof, I have hereunto set my hand and affixed the seal of the Companies on this 12th day of December 2017 . x 2003 Q 1933 c • Secretary '�'n: ,� may: ad. A , POA 0018 (3117) `•rar•r,..riN•a, •• • • • • ACCEPTANCE The above bid is accepted this day of , subject to the following conditions: Contracting Authority Members; PART II (For projects of $150, 000 or more —1C 36-1-12-4) Governmental Unit: City of South Send Bidder (Firm) Edward & Jones Concrete Inc Date (month, day, year): 1211112017 These statements to be submitted under oath by each bidder with and as a part of his bid. Attach additional pages for each section as needed. SECTION I EXPERIENCE QUESTIONNAIRE 1. What public works projects has your organization completed for the period of one (1) year prior to the date of the current bid? Contract Amount Class of Work Completion Date Name and Address of Owner 440,960.00 concrete flat work 10/6/17 Milestone Contractors 6954Belmont lndianapoiir.IN46242 382,924,39 concrete flat work 10/31/17 Grady Brothers 915 s Somerset Indpls IN 46241 417,142.61 concrete flat work 9/29/17 16105 River Rd, Noblesville, IN 46062 2. What public works projects are now in process of construction by your organization? Expected Contract Amount Class of Work Completion Name and Address of Owner Date None 3. Have you ever failed to complete any work awarded to you? NO 4. List references from private firms for which you have performed work. If so, where and why? Eagle valley -�L' _3/ -- -/ Diamond Construction q- Continential builders systems Grady Brothers - 'Tom 6"ro i, Milestone Contractors SECTION II PLAN AND EQUIPMENT QUESTIONNAIRE 1. Explain your plan or layout for performing proposed work. (Examples could include a narrative of when you could begin work, complete the project, number of workers, etc. and any other information which you believe would enable the governmental unit to consider your bid.) Our firm can start the project within 5 days of receiving the notice to proceed. We will has 6 man crew dedicated to this project to make the completion date. We will have all staking and and layout done by our own sub engineering firm. Our company has 10 years experience in government concrete work. We own our equipment and self perform all of our work. Please list the names and addresses of all subcontractors (i.e. persons or firms outside your own firm who have performed part of the work) that you have used on public works projects during the past five (5) years along with a brief description of the work done by each subcontractor. NIA 3. If you intend to sublet any portion of the work, state the name and address of each subcontractor, equipment to be used by the subcontractor, and whether you will require a bond. However, if you are unable to currently provide a listing, please understand a fisting must be provided prior to contract approval. Until the completion of the proposed project, you are under a continuing obligation to immediately notify the governmental unit in the event that you subsequently determine that you will use a subcontractor on the proposed project. NIA 4. What equipment do you have available to use for the proposed project? Any equipment to be used by subcontractors may also be required to be listed by the governmental unit. (2) Backhoes (1) T770 Skid Steer (3) Service Trucks (2010) (1) Gomaco Curb Machine (3) Tandems Trucks Have you entered into contracts or received offers for all materials which substantiate the prices used in preparing your proposal? If not, please explain the rationale used which would corroborate the prices listed. Yes SECTION III CONTRACTOR'S FINANCIAL STATEMENT Attachment of bidder's financial statement is mandatory. Any bid submitted without said financial statement as required by statute shall thereby be rendered invalid. The financial statement provided hereunder to the governing body awarding the contract must be specific enough in detail so that said governing body can make a proper determination of the bidder's capability for completing the project if awarded. SECTION IV CONTRACTOR'S NON — COLLUSION AFFIDAVIT The undersigned bidder or agent, being duly sworn on oath, says that he has not, nor has any other member, representative, or agent of the firm, company, corporation or partnership represented by him, entered into any combination, collusion or agreement with any person relative to the price to be bid by anyone at such letting nor to prevent any person from bidding nor to include anyone to refrain from bidding, and that this bid is made without reference to any other bid and without any agreement, understanding or combination with any other person in reference to such bidding. He further says that no person or persons, firms, or corporation has, have or will receive directly or indirectly, any rebate, fee, gift, commission or thing of value on account of such sale. SECTION V OATH AND AFFIRMATION I HEREBY AFFIRM UNDER THE PENALTIES FOR PERJURY THAT THE FACTS AND INFORMATION CONTAINED IN THE FOREGOING BID FOR PUBLIC WORKS ARE TRUE AND CORRECT. Dated at Monday this 11 th day of December 2017 Edward & Jones Concrete Inc. (Name of Organization) By. Project Manager (Title of Person Signing) ACKNOWLEDGEMENT STATE OF Indiana ss COUNTY OF Marion ) Before me, a Notary Public, personally appeared the above -named NANCY R BROWN Notary Public= Seal =� State of fndiaria . . My Cornmissron Explres May 23, 2021 ' Charles Merriweather and swore that the statements contained in the foregoing document are true and correct. Subscribed and sworn to before me this 11th day of December 2017 Notary Pudtic My Commission Expires: May 20, 2021 County of Residence: Marion Company ID Number: 847959 THE E-VERIFY Mmlp, FOR EMPLOYERS ARTICLE I PURPOSE AND AUTHORITY The parties to this agreement are the Department of Homeland Security (DHS) and the Edward & Jones Concrete Inc (Employer). The purpose of this agreement is to set forth terms and conditions which the Employer will follow while participating in E-Veriifi/ 71 E-Verify is a program that electronically confirms an employee's eligibility to work in the United States after completion of Form 1-9, Employment Eligibility Verification (Form 1-9). This Memorandum of Understanding (MOU) explains certain features of the E-Verify program and describes specific responsibilities of the Employer, the Social Security Administration (SSA), and DHS. Authority for the E-Verify program is found in Title IV, Subtitle A, of the, Illegal Immigration Reform and Immigrant Responsibility Act of 1996 (IIRIRA), Pub. L. 104-208, 110 Stat. 3009, as amended (8 U.S.C. § 132,4a note). The Federal Acquisition Regulation (FAR) Subpart 22.18, "Employment Eligibility Verification" and Executive Order 12989, as amended, provide authority for Federal contractors and subcontractors (Federal contractor) to use E-Verify to verify the employment eligibility of certain employees working on Federal contracts. N,*9 Z-01 MRTFIIIIU�R 1. The Employer agrees to display the following notices supplied by DHS in a prominent place that is clearly visible to prospective employees and all employees who are to be verified through the system: a. Notice of E-Verify Participation b, Notice of Right to Work 2. The Employer agrees to provide to the SSA and DHS the names, titles, addresses, and telephone numbers of the Employer representatives to be contacted about E-Verify. The Employer also agrees to keep such information current by providing updated information to SSA and DHS whenever the representatives' contact information changes. 3. The Employer agrees to grant E-Verify access only to current employees who need E-Verify access. Employers must promptly terminate an employee's E-Verify access if the employer is separated from the company or no longer needs access to E-Verify. Page 1 of 17 E-Verify MOU for Employers I Revision Date 06101113 Company ID Number: 84795,9 4. The Employer agrees to become familiar with and comply with the most recent version of the E-Verify User Manual. 5. The Employer agrees that any Employer Representative who will create E-Verify cases will complete the E-Verify Tutorial before that individual creates any cases. a. The Employer agrees that all Employer representatives will take the refresher tutorials when prompted by E-Verify in order to continue using E-Verify. Failure to complete a refresher tutorial will prevent the Employer Representative from continued use of E-Verify. 6. The Employer agrees to comply with current Form 1-9 procedures, with two exceptions: a. If an employee presents a "List B" identity document, the Employer agrees to only accept "List B" documents that contain a photo. (List B documents identified in 8 C.F.R. § 274a,2(b)(1)(B)) can be presented during the Form 1-9 process to establish identity.) If an employee objects to the photo requirement for religious reasons, the Employer should contact E-Verify at 888-464-4218. b, If an employee presents a DHS Form 1-551 (Permanent Resident Card), Form 1-766 (Employment Authorization Document), or U.S. Passport or Passport Card to complete Form 1-9, the Employer agrees to make a photocopy of the document and to retain the photocopy with the employee's Form 1-9. The Employer will use the photocopy to, verify the photo and to assist DHS with its review of photo mismatches that employees contest. DHS may in the future designate other documents that activate the photo screening tool, Note: Subject only to the exceptions noted previously in this paragraph, employees still retain the right to present any List A, or List B and List C, document(s) to complete the Form 1-9. 7. The Employer agrees to record the case verification number on the employee's Form 1-9 or to print the screen containing the case verification number and attach it to the employee's Form 1-9. 8. The Employer agrees that, although it participates in, E-Verify, the Employer has a responsibility to complete, retain, and make available for inspection Forms 1-9 that relate to its employees, or from other requirements of applicable regulations or laws, including the obligation to comply with the antidiscrimination requirements of section 274B of the INA with respect to Form 1-9 procedures. a. The following modified requirements are the only exceptions to an Employer's obligation to not employ unauthorized workers and comply with the, anti -discrimination provision of the INA: (1) List B identity documents must have photos, as described in paragraph 6 above; (2) When an Employer confirms the identity and employment eligibility of newly hired employee using E-Verify procedures, the Employer establishes a rebuttable presumption that it has not violated section 274A(a)(1)(A) of the Immigration and Nationality Act (INA) with respect to the hiring of that employee; (3) If the Employer receives a final nonconfirmation for an employee, but continues to employ that person, the Employer must notify DHS and the Employer is subject to a civil money penalty between $550 and $1, 100 for each failure to notify DHS of continued employment following a final nonconfirmation; (4) If the Employer continues to employ an employee after receiving a final nonconfirmation, then the Employer is subject to a rebuttable presumption that it has knowingly Page 2 of 17 E-Verify MOU for Employers J Revision Date O6/01/13 E.-Verollf z, 7'r Company ID Number: 847959 employed an unauthorized alien in violation of section 274A(a)(1)(A); and (5) no E-Verify participant is civilly or criminally liable under any law for any action taken in good faith based on information provided through the E-Verify. b. DHS reserves the right to conduct Form 1-9 compliance inspections, as well as any other enforcement or compliance activity autlhorizedl by law, including site visits, to ensure proper use of E-Verify. 9. The Employer is strictly prohibited from creating an E-Verify case before the employee has been hired, meaning that a firm offer of employment was extended and accepted and Form 1-9 was completed, The Employer agrees to create an E-Verify case for new employees within three Employer business days after each employee has been hired (after both Sections 1 and 2 of Form 1-9 have been completed), and to complete as many steps of the E-Verify process as are necessary according to the E-Verify User Manual, If E-Verify is temporarily unavailable, the three-day time period will be extended until it is again operational in order to accommodate the Employers attempting, in good faith, to make inquiries during the period of unavailability. 10. The Employer agrees not to use E-Verify for pre -employment screening of job applicants, in support of any unlawfuil employment practice, or for any other use that this MOU or the E-Verify User Manual does not authorize. 11. The Employer must use E-Verify for all new employees. The Employer will not verify selectively and will not verify employees hired before the effective date of this IMOU. Employers who are Federal contractors may qualify for exceptions to this requirement as described in Article 11.6 of this MOU. 12. The Employer agrees to follow appropriate procedures (see Article III below) regarding tentative nonconfirmations. The Employer must promptly notify employees in private of the finding and provide them with the notice and letter containing information specific to the employee's E-Verify case. The Employer agrees to provide both the English and the translated notice and letter for employees with limited English proficiency to employees. The Employer agrees to provide written referral instructions to employees and instruct affected employees to bring the English copy of the letter to the SSA. The Employer must allow employees to contest the finding, and not take adverse action against employees if they choose to contest the finding, while their case is still pending. Further, when employees contest a tentative nonconfirmation based upon a photo mismatch, the Employer must take additional steps (see Article I I L B. below) to contact DHS with information necessary to resolve the challenge. 13. The Employer agrees not to take any adverse action against an employee based upon the employee's perceived employment eligibility status while SSA or DHS is processing the verification request unless the Employer obtains knowledge (as defined in 8 C.F.R. § 274a.1(1)) that the employee is not work authorized. The Employer understands that an initial inability of the SSA or DHS automated verification system to verify work authorization, a tentative nonconfirmation, a case in continuance (indicating the need for additional time for the government to resolve a case), or the finding of a photo mismatch, does not establish, and should not be interpreted as, evidence that the employee is not work authorized. In any of such cases, the employee must be provided a full and fair opportunity to contest the finding, and if he or she does so, the employee may not be terminated or suffer any adverse employment consequences based upon the employee's perceived employment eligibility status Page 3 of 17 E-Verify MOU for Employers I Revision Date 06101/13 r=-Veriff Y Company 11D Number: 847959 (including denying, reducing, or extending work hours, delaying or preventing training, requiring an employee to work in poorer conditions, withholding pay, refusing to assign the employee to a Federal contract or other assignment, or otherwise assuming that he or she is unauthorized to work) until and unless secondary verification by SSA or DHS has been completed and, a final nonconfirmation has been issued. If the employee does not choose to contest a tentative nonconfirmation or a photo mismatch or if a secondary verification is completed and a final nonconfirmation is issued, then the Employer can find the employee is not work authorized and terminate the employee's employment. Employers or employees with questions about a final nonconfirmation may call E-Verify at, 1-888-464- 4218 (customer service) or 1-888-897-7781 (worker hotline). 114. The Employer agrees to comply with Title V11 of the Civil Rights Act of 1964 and section 274B of the lNA as applicable by not discriminating unlawfully against any individual in hiring, firing, employment eligibility verification, or recruitment or referral practices because of his or her national origin or citizenship status, or by committing discriminatory documentary practices. The Employer understands that such illegal practices can include selective verification or use of E-Verify except as provided in part D below, or discharging or refusing to hire employees because they appear or sound "foreign" or have received tentative nonconfirmations. The Employer further understands that any violation, of the immigration -related unfair employment practices provisions in section 274B of the INA could subject the Employer to civil penalties, back pay awards, and other sanctions, and violations of Title V11 could subject the Employer to back pay awards, compensatory and punitive damages. Violations of either section 274B of the INA or Title V1 I may also lead to the termination of its participation in E-Verify. If the Employer has any questions relating to the anti -discrimination provision, it should contact OSC at 1-800-255-8155 or 1-800-237-2515 (TDD). 15. The Employer agrees that it will use the information it receives from E-Verify only to confirm the employment eligibility of employees as authorized by this MOU. The Employer agrees that it will safeguard this information, and means of access to it (such as PINS and passwords), to ensure that it is not used for any other purpose and as necessary to protect its confidentiality, including ensuring that it is not disseminated to any person other than employees of the Employer who are authorized to perform the Employer's responsibilities under this MOU, except for such dissemination as may be authorized in advance by SSA or DHS for legitimate purposes. 16. The Employer agrees to notify DHS immediately in the event of a breach of personal information. Breaches are defined as loss of control or unauthorized access to E-Verify personal data. All suspected or confirmed breaches should be reported by calling 1-888-464-4218 or via email at E-Verify@dhs.go . Please use "Privacy Incident— Password" in the, subject line of your email when sending a breach report to E-Verify. 17. The Employer acknowledges that the information it receives from SSA is governed by the Privacy Act (5 U.S.C. § 552a(i)(1) and (3)) and the Social Security Act (42 U.S.C. 1306(a)). Any person who obtains this information under false pretenses or uses it for any purpose other than as provided for in this MOU! may be subject to criminal penalties. 18. The Employer agrees to cooperate with DHS and SSA in their compliance monitoring and evaluation of E-Verify, which includes permitting DHS, SSA, their contractors and other agents, upon Page 4 of 17 E-Verify MOU for Employers, I Revssponl Date 06101/13 Company ID Number: 847959 reasonable notice, to review Forms 1-9 and other employment records and to interview it and its employees regarding the Employer's use of E-Verify, and to respond in a prompt and accurate manner to DHS requests for information relating to their participation in E-Verify. 19. The Employer shall not make any false or unauthorized claims or references about its participation in E-Verify on its website, in advertising materials, or other media. The Employer shall not describe its services as federally -approved, federally -certified, or federally -recognized, or use language with a similar intent on its website or other materials provided to the public. Entering into this MOU does not mean that E-Verify endorses or authorizes your E-Verify services and any claim to that effect is false. 20. The Employer shall not state in its website or other public documents that any language used therein has been provided or approved by DHS, USCIS or the Verification Division, without first obtaining the prior written consent of DHS. 21. The Employer agrees that E-Verify trademarks and logos may be used only under license by DHS/USCIS (see M-795 (Web)) and, other than pursuant to the specific terms of such license, may not be used in any manner that might imply that the Employer's services, products, websites, or publications are sponsored by, endorsed by, licensed by, or affiliated with DHS, USCIS, or E-Verify. 22. The Employer understands that if it uses E-Verify procedures for any purpose other than as authorized by this MOU, the Employer may be subject to appropriate legal action and termination of its participation in E-Verify according to this MOU. 1. If the Employer is a Federal contractor with the FAR E-Verify clause subject to the employment verification terms in Subpart 22.18 of the FAR, it will become familiar with and comply with the most current version of the E-Verify User Manual for Federal Contractors as well as the E-Verify Supplemental Guide for Federal Contractors. 2. In addition to the responsibilities of every employer outlined in this MOU, the Employer understands that if it is a Federal contractor subject to the employment verification terms in Subpart 22.1'8 of the FAR it must verify the employment eligibility of any "employee assigned to the contract" (as defined in FAR 22.1801). Once an employee has been verified through E-Verify by the Employer, the Employer may not create, a second case for the employee through E-Verify. a. An Employer that is not enrolled in E-Verify as a Federal contractor at the time of a contract award must enroll as a Federal contractor in the E-Verify program:, within 30 calendar days of contract award and, within,90 days of enrollment, begin, to verify employment eligibility of new hires using E-Verify. The Employer must verify those employees who are working in the United States, whether or not they are assigned to the contract. Once the Employer begins verifying new hires, such verification of new hires must be initiated within three business days after the hire date. Once enrolled in E-Verify as a Federal contractor, the Employer must begin verification of employees assigned to, the contract within 90 calendar days after the date of enrollment or within 30 days of an employee's assignment to the contract, whichever date is later. Page 5 of 17 E-Verify MOU for Empioyers I Revision Date 06101/13 Company ID Number: 847959 b. Employers enrolled in E-Verify as a Federal contractor for 90 days or more at the time of a contract award must use E-Verify to begin verification of employment eligibility for new hires of the Employer who are working in the United States, whether or not assigned to the contract, within three business days after the date of hire. If the Employer is enrolled in E-Verify as a Federal contractor for 90 calendar days or less at the time of contract award, the Employer must, within 90 days of enrollment, begin to use E-Verify to initiate verification of new hires of the contractor who are working in the United States, whether or not assigned to the contract. Such verification of new hires must be initiated within three business days after the date of hire. An Employer enrolled as a Federal contractor in E-Verify must begin verification of each employee assigned to the contract within 90 calendar days after date of contract award or within, 30 days after assignment to the contract, whichever is later, c. Federal contractors that are institutions of higher education (as defined at 20 U.S.C. 1001 (a)), state or local governments, governments of Federally recognized Indian tribes, or sureties performing under a takeover agreement entered into with a Federal agency under a performance bond may choose to only verify new and existing employees assigned to the Federal contract. Such Federal contractors may, however, elect to verify all new hires, and/or all, existing employees hired after November 6, 1986. Employers in this category must begin verification of employees assigned to the contract within 90 calendar days after the date of enrollment or within 30 days of an employee's assignment to the contract, whichever date is later. d. Upon enrollment, Employers who are Federal contractors may elect to verify employment eligibility of all existing employees working in the United States who, were hired after November 6, 1986, instead of verifying only those employees assigned to a covered Federal contract. After enrollment, Employers must elect to verify existing staff following DHS procedures, and begin E-Verify verification of all existing employees within 180 days after the election. e. The Employer may use a previously completed Form 1-9 as the basis for creating an E-Verify case for an employee assigned to a contract as long as: i. That Form 1-9 is complete (iincludiing the SSN) and complies with Article II.A.6, ii, The employee's work authorization has not expired, and iii. The Employer has reviewed the Form 1-9 information either in person or in communications with the employee to ensure that the employee's Section 1, Form 1-9 attestation has not changed (including, but not limited to, a lawful permanent resident alien having become a naturalized U.S. citizen), f. The Employer shall complete anew Form 1-9 consistent with Article II.A.6 or update the previous Form 1-9 to provide the necessary information if: L The Employer cannot determine that Form 1-9 complies with Article II.A.6, H. The employee's basis for work authorization as attested in Section 1 has expired or changed, or iii. The Form 1-9 contains no SSN or is otherwise incomplete. Note: If Section I of Form 1-9 is otherwise valid and up-to-date and the form otherwise complies with Page 6 of 17 E-Verify MOU for Employers I Revision Date 06/01/13 460 r -Verm,f Nno,/ Company ID Number: 847959 Article II.C.5, but reflects documentation (such as a U.S. passport or Form 1-551) that expired after completing Form 1-9, the Employer shall not require the production of additional documentation, or use the photo screening tool described in Article II.A.5, subject to any additional or superseding instructions that may be provided on this subject in the E-Verify User Manual. g. The Employer agrees not to require a second verification using E-Verify of any assigned employee who has previously been verified as a newly hired employee under this MOU or to authorize verification of any existing employee by any Employer that is not a Federal contractor based on this Article. 3. The Employer understands that if it is a Federal contractor, its compliance with this MOU is a performance requirement under the terms of the Federal contract or subcontract, and the Employer consents, to the release of information relating to compliance with its verification responsibilities under this MOU to contracting officers or other officials authorized to review the Employer's compliance, with Federal contracting requirements. 1. SSA agrees to allow DHIS to compare data provided by the Employer against SSA's database. SSA sends DHS confirmation that the data sent either matches or does not match the information in SSA's database. 2. SSA agrees to safeguard the information the Employer provides through E-Verify procedures. SSA also agrees to limit access to such information, as is appropriate, by law, to individuals responsible for the verification of Social Security numbers or responsible for evaluation of E-Verify or such other persons or entities who may be authorized by SSA as governed by the Privacy Act (5 U.S.C. § 552a), the Social Security Act (42 U.S.C. 1306(a)), and SSA regulations (20 CFR Part 401). 3. SSA agrees to provide case results from its database within three Federal Government work days of the initial inquiry. E-Verify provides the information to the Employer. 4, SSA agrees to update SSA records as necessary if the employee who contests the SSA tentative nonconfirmation visits an SSA field office and provides the required evidence. If the employee visits an SSA field office within the eight Federal Government work days from the date of referral to SSA, SSA agrees to update SSA records, if appropriate, within the eight -day period unless SSA determines that more than eight days may be necessary. In such cases, SSA will provide additional instructions to the employee. If the employee does not visit SSA in the time allowed, E-Verify may provide a final nonconfirmation to the employer. Note: If an Employer experiences technical problems, or has a policy question, the employer should contact E-Verify at 1-8,88-464-4218. 1. DHS agrees to provide the Employer with selected data from DHS databases to enable the Employer to conduct, to the extent authorized by this MOU: a. Automated verification checks on alien employees by electronic means, and Page 7 of 17 E-Verify MOU for Empdyers I Revision Date 06101113 Company ID Number: 847959 b. Photo verification checks (when available) on employees. 2. DHS agrees to assist the Employer with operational problems associated with the Employer's participation in E-Verify. DHS agrees to provide the Employer names, titles, addresses, and telephone numbers of DHS representatives to be contacted during the E-Verify process. 3. DHS agrees to provide to the Employer with access to E-Verify training materials as well as an E-Verify User Manual that contain instructions on E-Verify policies, procedures, and requirements for both SSA and DHS, including restrictions on the use of E-Verify. 4, DHS agrees to train Employers on all important changes made to E-Verify through the use of mandatory refresher tutorials and updates to the E-Verify User Manual. Even without changes to E-Verify, DHS reserves the right to require employers to take mandatory refresher tutorials. 5. DHS agrees to provide to the Employer a notice, which indicates the Employer's participation in E-Verify. DHS also agrees to provide to the Employer anti -discrimination notices issued by the Office of Special Counsel for Immigration -Related Unfair Employment Practices (CSC), Civil Rights Division, U.S. Department of Justice. G. DHS agrees to issue each of the Employer's E-Verify users a unique user identification number and password that permits them to log in to E-Verify. 7. DHS agrees to safeguard the information the Employer provides, and to limit access to such information to individuals responsible for the verification process, for evaluation of E-Verify, or to such other persons or entities as may be authorized by applicable law. Information will be used only to verify the accuracy of Social Security numbers and employment eligibility, to enforce the INA and Federal criminal laws, and to administer Federal contracting requirements. 8. DHS agrees to provide a means of automated verification that provides (in conjunction with SSA verification procedures) confirmation or tentative nonconfirmation of employees' employment eligibility within three Federal Government work days of the initial inquiry. 9. DHS agrees to provide a means of secondary verification (including updating DHS records) for employees who contest DHS tentative nonconfirmations and photo mismatch tentative nonconfirmations. This provides final confirmation or nonconfirmation of the employees' employment eligibility within 10 Federal Government work days of the date of referral to DHS, unless DHS determines that more than 10 days may be necessary. In such cases, DHS will provide additional verification instructions. F, T;7Vff*JX4M V;?_XW*1 still] kyj I A. REFERRAL TO SSA 1. If the Employer receives a tentative nonconfirmation issued by SSA, the Employer must print the notice as directed by E-Verify. The Employer must promptly notify employees in private of the finding and provide them with the notice and letter containing information specific to the employee's E-Verify Page 8 of 17 E-Verify MOU for Employers l Revision Date 06/01/13 Company ID Number: 847959 case. The Employer also agrees to provide both the English and the translated notice and letter for employees with limited English proficiency to employees. The Employer agrees to, provide written referral instructions to employees and instruct affected employees to bring the English copy of the letter to the SSA. The Employer must allow employees to contest the finding, and not take adverse action against employees if they choose to contest the finding, while their case is still pending. 2. The Employer agrees to obtain the employee's response about whether he, or she will contest the tentative nonconfirmation as soon as possible after the Employer receives the tentative nonconfirmation. Only the employee may determine whether he or she will contest the tentative nonconfirmation. 3. After a tentative nonconfirmation, the Employer will refer employees to SSA field offices only as directed by E-Verify. The Employer must record the case verification number, review the employee information submitted to E-Verify to identify any errors, and find out whether the employee contests the tentative nonconfirmation. The Employer will transmit the Social Security number, or any other corrected employee information that SSA requests, to SSA for verification again if this review indicates a need to do so. 4. The Employer will instruct the employee, to visit an SSA office within eight Federal Government work days. SSA will electronically transmit the result of the referral to the Employer within 10 Federal Government work days of the referral unless it determines that more than 10 days is necessary. 5. While waiting for case results, the Employer agrees to check the E-Verify system regularly for case updates. S. The Employer agrees not to ask the employee to obtain a printout from the Social Security Administration number database (the Numident) or other written verification of the SSN from the SSA. B. REFERRAL TO DHS 1. If the Employer receives a tentative nonconfirmation issued by DHS, the Employer must promptly notify employees in private of the finding and provide them with the notice and letter containing information specific to the employee's E-Verify case. The Employer also agrees to provide both the English and the translated notice and letter for employees with limited English proficiency to employees. The Employer must allow employees to contest the finding, and not take adverse action against employees if they choose to contest the finding, while their case is still pending. 2. The Employer agrees to obtain the employee's response about whether he or she will contest the tentative nonconfirmation as soon as possible, after the Employer receives the tentative nonconfirmation. Only the employee may determine whether he or she will contest the tentative nonconfirmation. 3. The Employer agrees to refer individuals to DHS only when the employee chooses to contest a, tentative nonconfirmation. 4. If the employee contests a tentative nonconfirmation issued by DHS, the Employer will instruct the Page 9 of 17 E-Verify MOU for Employers Ii Revision Date 06/01113 Company ID Number: 847959 employee to contact DHS through its toll -free hotline (as found on the referral letter) within eight Federal Government work days. 5. If the Employer finds a photo mismatch, the Employer must provide the photo mismatch tentative nonconfirmation notice and follow the instructions outlined in paragraph I of this section for tentative nonconfirmations, generally. 6. The Employer agrees that if an employee contests a tentative nonconfirmation based upon a photo mismatch, the Employer will send a copy of the employee's Form 1-551, Form 1-766, U.S. Passport, or passport card to DHS for review by: a. Scanning and uploading the document, or b. Sending a photocopy of the document by express mail (furnished and paid for by the employer). 7. The Employer understands that if it cannot determine whether there is a photo match/mismatch, the Employer must forward the employee's documentation to DHS as described in the preceding paragraph. The Employer agrees to resolve the case as specified by the DHS representative who will determine the photo match or mismatch. 8. DHS will electronically transmit the result of the referral to the Employer within 10 Federal Government work days of the referral unless it determines that more than 10 days is necessary. 9. While waiting for case results, the Employer agrees to check the E-Verify system regularly for case updates. F-M _tN C* VA 1. SSA and DHS will not charge the Employer for verification services performed under this MOU. The Employer is responsible for providing 'equipment needed to make inquiries. To access E-Verify, an Employer will need a personal computer with Internet access. F-MURRAM F-111 III M ki 1. This MOU is effective upon the signature of all parties and shall continue in effect for as long as the SSA and DHS operates the E-Verify program unless modified in writing by the mutual consent of all parties. 2. Any and all E-Verify system enhancements by DHS or SSA, including but not limited to E-Verify checking against additional data sources and instituting new verification policies or procedures, willi be covered under this MOU and will not cause the need for a supplemental MOU that outlines these changes. Page 10 of 17 E-Verify MOU, for ErnpCoyers I Revision Date 06/01113 E-Vien Company ID Number: 847959 B. TERMINATION 1. The Employer may terminate this MOU and its participation in E-Verify at any time upon 30 days prior written notice to the other parties. 2. Notwithstanding Article V, Ipart A of this MOU, DHS may terminate this MOU, and thereby the Employer's participation in E-Verify, with or without notice at any time if deemed necessary because of the requirements of law or policy, or upon a determination by SSA or DHS that there has been a breach of system integrity or security by the Employer, or a failure on the part of the Employer to comply with established E-Verify procedures and/or legal requirements. The Employer understands that if it is, a Federal contractor, termination of this MOU by any party for any reason may negatively affect the performance of its contractual responsibilities. Similarly, the Employer understands that if it is in a state where E-Verify is mandatory, termination of this by any party MOU may negatively affect the Employer's business. 3. An Employer that is, a Federal contractor may terminate this MOU when the Federal contract that requires its participation in E-Verify is terminated or completed. In such cases, the Federal contractor must provide written notice to DHS. If an Employer that is a Federal contractor fails to provide such notice, then that Employer will remain an E-Verify participant, will remain bound by the terms of this MOU that apply to non -Federal contractor participants, and will be required to use the E-Verify procedures to verify the employment eligibility of all newly hired employees. 4. The Employer agrees that E-Verify is not liable for any losses, financial or otherwise, if the Employer is terminated from E-Verify. A. Some or all SSA and DHS responsibilities under this MOU may be performed by contractor(s), and SSA and DHS may adjust verification responsibilities between each other as necessary. By separate agreement with DHS, SSA has agreed to perform its responsibilities as described in this MOU. B. Nothing in this MOU is intended, or should be construed, to create any right or benefit, substantive or procedural, enforceable at law by any third party against the United States, its agencies, officers, or employees, or against the Employer, its agents, officers, or employees. C. The Employer may not assign, directly or indirectly, whether by operation of law, change of control or merger, all or any part of its rights or obligations under this MOU without the prior written consent of DHS, which consent shall not be unreasonably withheld or delayed. Any attempt to sublicense, assign, or transfer any of the rights, duties, or obligations herein is void. D. Each party shall be solely responsible for defending any claim or action against it arising out of or related to E-Verify or this MOU, whether civil or criminal, and for any liability wherefrom, including (but not limited to) any dispute between the Employer and any other person or entity regarding the applicability of Section 403(d) of IIRIRA to any action taken or allegedly taken by the Employer. E. The Employer understands that its participation in E-Verify is not confidential information and may be disclosed as authorized or required by law and DHS or SSA policy, including but not limited to, Page 11 of 17 E-Verify MOU for Employers I Revision Date 06101113 Company 10 Number: 847959 0 71.-. r w Employer Edward & Jones Concrete Inc Name (Please Type or Print) Title Nancy Brown Signature Date Electronically Signed 01/27/2015 Department of Homeland Security — Verification Division Name (Please Type or Print) Title USCIS Verification Division Signature Date Electronically Signed 01/2712015 Page 13 of 17 E-Verify MOU for Employers I Revision Date 06/01/13 Company ID Number: 847959 Information Required for the E-Verify Program Information relating to your Company: Edward & Jones Concrete Inc Company Name 8553 Bash Street Suite 205 Indianapolis, IN 46250 Company Facility Address P.O. Box 502811 Indianapolis, IN 46250 Company Alternate Address County or Parish MARION Employer Identification Number 352308925 North American Industry Classification Systems Code 238 Parent Company Number of Employees 1 to Number of Sites Verified for I Page 14 of 17 E-Verify MOU for Employers I Revision Date 06/01/13 Company ID Number: 847959 Are you verifying for more than 1 site? If yes, please provide the numberof sites verified for in each State: INDIANA 1 site(s) Page 15 of 17 E-Verify MOU for Employers I Revision IDate OU01 113 E,-Veriwowaf Y" Company I'D Number: 847959 Information, relating to the Program Administrator(s) for your Company on policy questions or operational problems: Name Charles E Merriweather Phone Number (317) 223 - 8185 Fax Number (317) 284 -1117 Email Address charles@ejconcrete.com Name Uayton R Merdweather Phone Number (317) 286 - 8166 Fax Number (317) 284 - 1117 Email) Address clayton@ejconcrete.com Name Nancy R Brown Phone Number (317) 284 - 1117 Fax Number (317) 284 - 1117 Email Address nbrown@ejconcrete.com Page 16 of 17 E�-Verify MOU'far Employers I Revision Date 016101/13 Company ID Number: 847959 OMM= Page 17 of 17 E-Verify MOU for Employers I Revision, Date 06101 Ili 3 Company ID Number: 847959 Congressional oversight, E-Verify publicity and media inquiries, determinations of compliance with Federal contractual requirements, and responses to inquiries under the Freedom of Information Act (FOIA). F. The individuals whose signatures appear below represent that they are authorized to enter into this MOU on behalf of the Employer and DHS respectively. The Employer understands that any inaccurate statement, representation, data or other information provided to DHS may subject the Employer, its subcontractors, its employees, or its representatives to: (1) prosecution for false statements pursuant to 18 U.S.C. 1:001 and/or; (2) immediate termination of its MOU and/or; (3) possible debarment or suspension, G. The foregoing constitutes the full agreement on this subject between DHS and the Employer. To be accepted as an E-Verify participant, you should only sign the Employer's Section of the signature page. If you have any questions, contact E-Verify at 1-888464-4218. Page 12 of 17 E-Verify MOU for Employers I Revision Date 06/01113 Edward & Jones Concrete Inc. P.O. Box 502811 Indianapolis, IN 46250 Project Manager. Charles Merriweather EEO POLICY AND STATEMENT January 1, 2016 317-223-8185 or 317-284-1117 317-288-8109 Fax i,nfC ee oncrele.com .11.111 1C It is the policy of Edward & Jones Concrete Inc. not to discriminate against any employee or any applicant for employment because of age, race, religion, color, handicap, sex, physical condition, developmental disability, sexual orientation or national origin. This policy shall include, but not be limited to, the following: recruitment and employment, promotion, demotion, transfer, compensation, selection for training including apprenticeship, layoff and termination. Except with respect to sexual orientation, this company further agrees to take affirmative action to ensure equal employment opportunities, Nancy Brown Office Manager has been appointed Equal Employment Opportunity Officer and is responsible for planning and implementing our affirmative action program as well as for its day-to-day monitoring of affirmative action related decisions and activities. All personnel who are responsible for hiring and promoting employees and for the development and implementation of programs or activities are charged to support this program. They shall provide leadership in implementing affirmative action goals and initiatives. Edward & Jones Concrete Inc. seeks to ensure, compliance with the Civil Rights Acts of 1964, as amended, the Federal Highway Act of 1968, the Executive Order 11246, and 11375, the Indiana Civil Rights Act, and other Federal and State Law and Regulations pertaining to Equality of Opportunity and Affirmative Action Policies, Edward & Jones Concrete Inc. is committed to leadership within the community, and to put forth - maximum efforts to achieve full employment and utilization of capabilities and productivity of all qualified: individuals without regard to race, religion, color, national origin, age, or disability. E & J Concrete Inc. further recognizes that the effective application of a policy of Equal Employment Opportunity involves more than just a policy statement, and is committed to the promotion of Affirmation Action. Printed Name Signature Date Title I P.O,. Box 502811 Indianapolis, |N4625Q Project Manager: Charles Merriweather Tel Office: 317`284'1117 Fax: 317-288'8109 Edward &Jones Concrete, Inc. prohibits the unlawful use, possession, consumption, manufacture or distribution (for sale ornot) onits premises, facilities orjob sbes,lmdud|mg Company vehicles and private vehicles parked on Company premises orjob sites of any of the following: alcoholic beverages, intoxicants and narcotics, illegal or unauthorized drugs (including marijuana), "look -alike" (simulated) drugs and related drug paraphernalia. Employees who fail to conform to these rules will be subject to removal from the facility mrjob site and appropriate disciplinary action will be taken up to and including termination of employment, This policy applies to all employees. Company employees must not report for duty under the influence 0fany drug, alcoholic beverage, intoxicant, narcotic or other substance (including legally prescribed medication) which will in any way adversely affect their working ability, alertness, coordination, response orthe safety ofothers onthe job. Employees working at or visiting any job site include, but not limited to, laborers, operators, teamsters, foremen, mechanics, new hires, replacements or subs, supervisory personnel and office personnel are subject tmalcohol and drug testing for: pne+amp|oymentrandom, probable cause, pre -job site entry, poat'acddent/|mcident return to duty and follow-up testing. Random drug testing will be held quarterly and shall come under the control and supervision of a physician with confidentially and protected in accordance with state law and the "American Medical Association's Code of Ethical Conduct for Physicians Providing Occupational Medical Services or the Medical Review Off icer Manual, as developed by the National Institute on Drug Abuse (NIDA). All substance abuse testing shall be conducted in accordance with the Department of Health and Human Services (DHH1S)"Mandatory Guidelines for the Federal Workplace Drug Testing Pro8ranms,.asset forth inthe Federal Register. Only DHHS-approYmdlaboratories, asset forth bythe Federal: Register, will perform uihnedrug testing. An employee must submit a photo ID & supply proof of his social security number at the time of testing. All drug test results will beentered into the Metro Indianapolis Coalition for Construction Safety Inc. (MICCS) database. Employees, who test negative, will be issued mMICCS card to verify that he or she has had a current valid drug test, to gain entry onto a MIC�S owner's premise, or for any other such reason. &4|CCS0 cards will be [ouuad by Midwest Toxicology. The back of the card states that you have met the K4VCCS requirements and that this was aN|DA5'pane|test. A r, cu { Edward & Jones Concrete Inc. Employees, who test positive, will be required to seek the services of a Substance Abuse Professional (SAP) for an evaluation before returning to work and may be required to enroll in one of the following: an Assistance Program; Education and/or Training Program; or a Rehabilitation Program. No employee will be allowed to take another MICCS drug test for at least 14 days from the day of the first positive test. Documentation of the SAP's recommendations and treatment must be furnished to Midwest Toxicology by Grady Brothers, Inc. before any re -testing can be performed or the issuing of any MICCS card. Employees holding any Commercial Drivers License (CDL) as a job requirement, who test positive, will be immediately removed from performing any safety sensitive function until they have been evaluated by a Substance Abuse Professional (SAP) and released by said professional. Any employee required to seek the services of a Substance Abuse Professional (SAP) for evaluation, to receive counseling and/or rehabilitation and refuses to accept or follow prescribed treatment will be in violation of this policy. Employee's refusal will be considered as insubordination and therefore, will be terminated. The cost of all evaluations, return to duty and follow-up drug tests will be at the sole expense of the employee. All employees will be terminated immediately if any of their return to duty or follow-up tests come back positive. All follow-up testing requirements will be issued by a Substance Abuse Professional (SAP) and/or regulated by the Department of Transportation (DOT), after completing their evaluation, counseling or rehabilitation. Follow-up testing will be conducted randomly, over a period of no less than twelve (12) months, from the date of first positive test. Mandatory random follow-up testing for any employee, holding a Commercial Drivers License (CDL), will cover a period of no less than twelve (12) months from the date of first positive test as required by the Department of Transportation (DOT) agency regulations. Any employee who refuses to cooperate with testing procedures, or who adulterates or switches a urine specimen is in breach of the rules of this policy, and will be treated in the same manner as a positive test result. Any person possessing/using a counterfeit drug card will be dealt with in the same manner as a person with a positive test result. A diluted specimen result will require a re -test. A second diluted result, without a medical reason, will result in the same consequences as a positive test result. W t� Edward & ,hones Concrete Inc. An employee testing "positive" shall have the right to have the secured portion of the urine sample independently re -tested by a DHHS certified laboratory of his/her choice at his/her own expense. If the independent re -test is "negative," the worker shall be allowed to resume work immediately and be reimbursed for the costs of such independent test. No adverse action or discipline shall be taken against any worker or applicant for employment on the basis of any "unconfirmed positive" result of the drug test. Confirmation of positive results shall be conducted using the GCMS method as recognized by the U.S. Department of Health and Human Services. The employee will provide a urine specimen for the drug test. A "hand held" breathalyzer unit, similar to those used by law enforcement officers for field sobriety tests, will be used for alcohol testing. A "positive" drug test result shall mean test levels exceed both the screening test and the confirmatory test that are recognized by the "U.S. Mandatory Guidelines for Federal Workplace Drug Testing" programs, or a diluted test which is an unacceptable specimen. A "positive" alcohol test result shall mean blood alcohol levels exceed limits specified within this policy, and parallel to the Department of Transportation and the Commercial Drivers License guideline requirements. A positive test will first be reported to the employee, and secondly to the employer, by the Medical Review Officer (MRO). If an MRO is unable to contact an employee within a reasonable amount of time, the employer will be the only one contacted. Donor's Right to Challenge the Positive Test Result: After being notified of a positive test result, the donor has 72 hours in which to request that the MRO arrange for the split portion of the specimen be sent to a different SAMHSA (NIDA) certified laboratory for testing, providing the donor with a second opinion. Payment for retest ($140) is the responsibility of the donor. If the test result in the secondary laboratory is not consistent with the first lab's result, a cancelled test will be issued and the positive result retracted. NIDA DRUG SCREEN Drugs of abuse tested in a routine NIDA 5-Panel Screen Type Preliminary Cut -Off Levels (ng/ml) Confirmation Levels Amphetamines 1000 S00 Cocaine 300 150 Opiates 2000 2000 THC-Cannabinoids 50 15 Ethanol (Alcohol) .04% w/vol. (enzyme assay) .04% w/vol. (GC/FD) New drugs, preliminary cut off and confirmation levels may be modified periodically in order to parallel the Department of Transportation and the Commercial Drivers License guideline requirements. Employees who test positive twice (2) times, while employed at Grady Brothers, Inc., will be terminated. DEFINITIONS Accredited Laboratory (SAMHSA): A federally certified organization approved by the Department of Health and Human Services (DHHS) for testing of prohibited items and substances. Accident/incident: Any event caused by and employee, either directly or indirectly, that results in treatment by a health care provider, or that resulted in damage to property. This would also include any serious near -miss incidents. Adulteration: Tampering with a test sample by the substitution or addition of other ingredients to mask the presence of alcohol and/or other use of drugs illegally. Controlled Substances: Includes all illegal drugs listed in this policy and per the Department of Transportation (DOT) limits, (including controlled substances, look alike drugs and designer drugs), prescription drugs used by one for whom they were not prescribed, overuse of prescription drugs prescribed for the user, drug paraphernalia and alcoholic beverages in the personal possession of our being used by an employee on the premises or while assigned to work off premises. Confirmation Test: A test performed by a SAMS HA-ce rtifie d laboratory, on the same sample used for the screen test which involves more complex methodology, is more precise, and is therefore more expensive, for the purposes of confirming or refuting screen test results. Counterfeit Drug Card: A drug card is considered counterfeit if it is modified in any manner without authorization from MICCS, or if it was not issued by a MICCS representative to the person using it to verify that he has a current valid drug test, to gain entry on a MICCS owner's premises, or for any other such reason. Diluted Test: Diluted specimens are usually caused by over hydration - meaning a person has either intentionally or unintentionally consumed a large enough volume of fluid to put the body into a temporary state of over hydration, resulting in an unacceptable specimen and an invalid test (2 dilutes a positive test result). `a�onct Edward & Jones Concrete Inc, Documentation: A card bearing the name of MICCS, issued by a third party, and has been entered into the MICCS database. Medical Review Officer (MRO): A licensed physician responsible for receiving laboratory results generated by a substance abuse testing program, who has knowledge of substance abuse disorders, and who has received appropriate medical training to interpret and evaluate an individual's medical history, and any other relevant biomedical information, as certified by either the American Medical Association (AMA) or the American College of Occupational and Environmental Medicine (ACOEM). Negative Test: A negative test is obtained if: (1) the screen test indicated the absence of legal or illegal substance in excess of the screen limit, or (2) the screen test indicates the presence of legal or illegal substance in excess of the screen limit but the confirming test indicates the absence of legal or illegal substance in excess of the confirmation limits. Positive Test -Alcohol: A positive alcohol test result is obtained if the breathalyzer test, or its equivalent test, indicates presence of alcohol that meets or exceeds both the screen and confirmation limits of the DOT and the Commercial Drivers License (CDQ guideline requirements listed in this policy. Positive Test — 5 Panel Screen: A positive test result is obtained if the substance abuse test result indicates the presence of illegal substance that meets or exceeds both the screen and confirmation limits listed in this policy, as verified by a Medical Review Officer (MRO), and the MRO has determined that the test results do not stem from use of prescription medicines, over the counter medicines, food, or any cause other than the use of illegal substances. This would also include the illegal use of prescription drugs. (Example would be exceeding the dose of a prescription or over the counter drug and/or using prescription drugs without a prescription.) Pre-employment/Pre-Job Site Entry: Screening of prospective employees to ascertain whether an applicant is capable of safely performing his/her duties and of meeting the pre -requisites for employment contained herein. Probable Cause: Probable cause shall be defined as those circumstances, based on objective evidence about the worker's conduct in the workplace that would cause a reasonable person to believe that the worker is demonstrating signs of impairment due to alcohol or other drugs. In most cases, the objective evidence giving rise to probable cause will be observed by at least two individuals, ideally two supervisors, but the parties recognize that in certain circumstances the observance may be made by only one individual. Examples of objective evidence include when a worker shows signs of impairment such as difficulty in maintaining balance, slurred speech, or erratic or atypical behavior. Such observation must be reduced to writing, and the supervisor shall provide the employee with a documented copy. Random Testing: An unannounced, unscheduled drug and/or alcohol test, pursuant to an objective method for random selection of employees to be tested. The selection must be truly random without discrimination or arbitrary selection. Upon notification the employee must immediately report to the testing facility. x w t+l Edward & Jones Concrete Inc. Substance Abuse Professional (SAP): A licensed physician (Medical Doctor or Doctor of Osteopathy), a licensed or certified psychologist, a licensed or certified social worker, or licensed or certified employee assistance professional. Additionally alcohol and drug abuse counselors certified by the National Association of Alcoholism and Drug Abuse Counselors (NAASAC) Certification Commission, a national organization that imposes qualification standards for treatment of alcohol -related disorders. All must have the knowledge of and clinical experience in the diagnosis and treatment of substance abuse - related disorders. All employees have the responsibility for the following: A. Report to work fit for duty, including being in the appropriate mental and physical condition necessary to perform their work in a safe, competent manner, free of the influence of drugs and alcohol. Report to the Safety Director, any medications he/she may be taking, that may impair his/her job performance and his/her safety or the safety of others. C. Consent to and participate in owner/employer required testing and consent to the release of the drug screen results to the employer, and to the MICCS database or for specific purposes as permitted by law.