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Opening of Bids - VPA Maintenence Storage Building Project No 118-046R - The Robert Henry Corporation
Date: T 0 1 A A 009090MO: 111191."401:11 1111111102Y Him Project Name Project No. For Bids Due VPA Maintenance Storage Building 118-046R August 28, 2018 PART I (Must be completed for all'bids. Please type or print) I IX-1. Bidder (Firm): -Me_ I�Abea IlnnU CD 6 M i mou'ress: City/State/Zip: &Lgh hod Telephone Number: Agent of Bidder (if Applicable): tQ [A 4W 1 -7 Pursuant to notices given, the unaersigned offers to furnish labor and/or material necessary to complete the public works project of: the City of South Bend, Indiana, in I/. I A I - a - I plans and 'specifications prepared by: and dated n, C�?Qls for the sum of (enter the Total Bid as shown on the Proposal) I —Y (Enter sum of"total Ra a Bid plus Alternates shown, on Proposal) /J'R1,k7v. '(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 n shown in the original contract if accepted by the City of 'I 4 basis, the itemization of the units shall be show.n.,onliull M ACCEPTANCE The above bid is accepted this day of Subject to the following conditions: BOARD OF PUBLIC WORKS Gary A. Gilot, President Elizabeth A. Maradik, Member James A. Mueller, Member 1, the cost of units must be the same as that Bend. If the bid is to be awarded on a unit attachment. (Printed! Nary(6-bf Person Signing) Suzanna M. Fritzberg, Member Therese J. Dorau, Member Attest: Linda M. Martin, Clerk Version 10/17/2017 Contractor's Bid for Public Works - 2 401 BID/PROPOSAL (Revised Aug 22,2018) CITY OF SOUTH SEND Project Name, VPA Maintenance Storage Building Project No, For Bids Due BASE BID 118-046R August 28, 2018 Item No, Description Quantity Unit Unit Price Total Amount Building Addition: pre-engineered metal 1 building addition delivered to site, erection, roof panels, wall panels, 1 LS 51 insulation (superstructure) 2, Sectional OH Doors, operators, service 1 LS 25 ( doors 3 Excavation, Concrete foundation and 1 LS f2 (0 concrete floor slab (substructure) 4 Site work: Excavation, drywells, crushed 1 LS stone 5 Electrical' Power and Lighting 1 LS Zq 5 e4 17 5,, 57 ALTERNATE#1 BASE BID TOTAL zqf d/X( 0-'- Item Description Quantity Unit Unit Price Total Amount Unit price for from one to three concrete 441Z1 1 aprons, as shown on C1.1 (alternates ea LS 2 la, 1b, 1c). All, to be 19'x 6'x 6". ALTERNATE #1 EACH il z 1. 00 ALTERNATE #2 Item Description Quantity Unit Unit Prig: Total Amount 1 20' x 8' Ihigh gate with chain and pad lock. LS -Z(,, q5, e:P— 42(,,95, ALTERNATE #2 TOTAI-of ALTERNATE #3 Item Description Quantity Unit Unit Price Total Amount 470 LF x 6'high chain link fencing with 11 one 16'x 6' high double gate on west 470, LF side, at curb cut near Sample Street. . ( ALTERNATE #3 TOTAL Bidder (Firm): —A6-, &cA, [:�noA OrwCovaltm Address: City/State/Zip: (Printed (Name of Person Signiing) 08-22-2018 Contractor's Bid for Public Works - 1 Bidder {Firm)� Address: City/State/Zip (Printed Name of -Person Sigining) Version 10/17/2017 Contractor's Bid for Public Works - 8 When the prospective Contractor is unable to certify to any 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 for all quotes and bids. Please type or print) STATE OF .t-Iti�SOtfj(, ) C ) SS: c3 nS h 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 with any person relative to the price to be bid by anyone at such letting nor to prevent any person from bidding nor to induce 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. 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 value 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 for debarment, 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 of this 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 (ii) at the time the financial institution extends credit, is a person identified on list published by the Indiana Department of Administration. Version 10/17/2017 Contractor's Bid for Public Works - 4 4. Contractor does not knowingly employ or contract with an unauthorized alien, nor retain any employee or contract with a person that the Contractor subsequently 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 the E-Verify Program as defined by I.C. 22-5-1.7-3. Contractor's documentation of enrollment and participation in the E-Verify Program is included and attached as part of this bid/quote; and 5. Contractor 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 employee 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-Verify Program. The Contractor agrees to maintain this certification throughout the term of the contract with the City of South Bend, and understands that the City may terminate the contract for default if the Contractor fails to cure a breach of this provision no later than thirty (30) days after being notified by the City. 6. Persons, partnerships, corporations, associations, or joint venturers awarded a contract by the City of South Bend through its agencies, boards, or commissions shall not discriminate against any employee or applicant for employment in the performance of a 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 perform 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 law, the City, its agencies, boards, or commissions may consider the Contractor's good faith efforts to obtain participation by those Contractors certified by the State of Indiana as a Minority Business ("MBE") or as a Women's Business Enterprise ("WBE") as a factor in determining the lowest, responsible, responsive bidder. In no event shall persons or entities seeking the award of a City contract be required to award a subcontract to an MBE/WBE; however, it may not unlawfully discriminate against said WBE/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 henceforth enter into with the City of South Bend, Indiana or any of its agencies, boards or 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 certify that I and all subcontractors employed by me for this project will use steel products or foundry products made in the United States on this project if awarded. I understand I have an affirmative 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 of United States made steel or foundry products is unreasonable. Prior to award and upon submission of bid which 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 10117/20W Contractor's Bid for Public Works - 5 may result in forfeiture 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. 'I 81h 20 Iq Dated this 0) day of Tkw, nrlkeA � Contr#aqAidder (Firm) S94ture of tontracYl3idder or Its Agent Print6d Name and Title Subscribed and sworn to before me this Ag'rh day of 20J-R- My Commission Expires Notary Public PATRICINI aunty of Residence " Public SEAL. Jewhow", no of Indiana 5, 2024 Version 10/17/2017 Contractor's Bid for Pubfic Works - 6 Fidelity & Deposit Company of Maryland Conforms with The American Institute of Architects AIA Document 310 Bid Bond CONTRACTOR: SURETY: (Name, legal status and address) (Name, legal status andprincipal place of business) The Robert Henry Corporation Fidelity and Deposit Company of Maryland PO Box 1407 1299 Zurich Way South Bend, IN 46624-1407 Schaumburg, 111- 60196-5870 This document has important legall consequences. Mailing Address for Notices Consultation with an attorney is OWNER: encouraged with respect to its (Name, legal status and address) completion or modification. City of South Bend Any singular reference to 227 W Jefferson St., Ste 1200 N Contractor, Surety, Owner or South Bend, IN 46601-1830 other party shall be considered plural where applicable. BOND AMOUNT: *** Five Percent (5%) of the Accompanying Bid *** PROJECT: (Name, location or address, and Project number, if any), VIDA Maintenance Storage Building 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 hevefrorn and provisions conforming to such statutory or other legal requirement shall be deemed incorporated herein. When so ftnuished, the intent is that this Bond shall be construed as a statutory bond and not as a common law bond. Signed and sealed this 28th day of August 1 2018 k, (Witness) The Robert He (Seal) and Deposit Company of (Surety) (Title)'' --%Ay T. lvk9ms, Attorney -in -Fact LM9-10054 08110 EXTRACT FROM BY-LAWS OF THE COMPANIES "Article V, Section 8, Attorney s-in-Fact. The Chief Executive Officer, the President, or any Executive Vice President or Vice President may, by written instrument under the attested corporate seal, appoint attomeys-in-fact with authority to execute bonds, policies, recognizances, stipulations, undertakings, or other like instruments on behalf of the Company, and may authorize any officer or any such attorney -in -fact to affix the corporate seal thereto; and may with or without cause modify of revoke any such appointment or authority at any time." CERTIFICATE 1, the undersigned, Vice President of the ZURICH AMERICAN INSURANCE COMPANY, the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, do hereby certify that the foregoing Power of Attorney is still in full force and effect on the date of this certificate; and I do further certify that Article V, Section 8, of the By -Laws of the Companies is still in force. This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of the ZURICH AMERICAN INSURANCE COMPANY at a meeting duly called and held on the 15th day of December 1998. RESOLVED: "'that the signature of the President or a Vice President and the attesting signature of a Secretary or an Assistant Secretary and the Seal of the Company may be affixed by facsimile on any Power of Attorney... Any such Power or any certificate thereof bearing such facsimile signature and seal shall be valid and binding on the Company." This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at a meeting duly called and held on the 5th day of May, 1994, and the following resolution of the Board of Directors of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at a meeting duly called and held on the 10th day of May, 1990. RESOLVED: "That the facsimile or mechanically reproduced seal of the company and facsimile or mechanically reproduced signature of any Vice -President, Secretary, or Assistant Secretary of the Company, whether made heretofore or hereafter, wherever appearing upon a certified copy of any power of attorney issued by the Company, shall be valid and binding upon the Company with the same force and effect as though manually affixed. IN TESTIMONY WHEREOF, I have hereunto subscribed my name and affixed the corporate seals of the said Companies, this 28th day of August 2018 t�'q oEroa,. �r w ZZ UAL I � t� Thomas O. McClellan, Vice .President ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND POWER OF ATTORIN`EY KNOW ALL MEN BY THESE PRESENTS: That the ZURICI I AMERICAN INSURANCE COMPANY, a corporation of the State of New York, the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, a corporation of the State of Maryland, and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND a corporation of the State of Maryland (herein collectively called the "Companies"), by Michael P. Bond, Vice President, in pursuance of authority granted by Article V, Section 8, of the By -Laws of said Companies, which are set forth on the reverse side hereof and are hereby certified to be in full force and effect on the date hereof, do hereby nominate, constitute, and appoint Vickie L. WOLCOTT, Stella M. MILLI, David A. LINTFHCUM, Carolyn J. WAGGONF'.R, Tiffany'r. WILLIAMS and Michael K. CORCORAN, all of Indianapolis, IN, EACH its true and lawful agent and Attorney -in -Fact, to make, execute, seal and deliver, for, and on its behalf as surety, and as its act and deed: any and all bonds and undertakings, and the execution of such bonds or undertakings in pursuance of these presents, shall be as binding upon said Companies, as fully and amply, to all intents and purposes, as if they had been duly executed and acknowledged by the regularly elected officers of the ZURICH AMERICAN INSURANCE COMPANY at its office in New York, New York., the regularly elected officers of the COLONIAL. AMERICAN CASUALTY AND SURETY COMPANY at its office in Owings Mills, Maryland., and the regularly elected officers of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at its office in Owings Mills, Maryland., in their own proper persons. The said Vice President does hereby certify that the extract set forth on the reverse side hereof is a true copy of Article V, Section 8, of the By -Laws of said Companies, and is now in force. IN WITNESS WHEREOF, the said Vice -President has hereunto subscribed his/her names and affixed the Corporate Seals of the said ZURICH AMERICAN INSURANCE COMPANY, COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and FIDELITY AND DEPOSIT COMPANY OF MARYLAND, this 12th day of January, A.D. 2016. ATTEST-. ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FH)ELITY AND DEPOSITCOMPANY OF MARYLAND arc P n /L By: 11ichael P. Bona Vice Pr•esidenl By: Eric D. Barnes Secretary State of Maryland County of Baltimore On this 12th day of January, A.D. 2016, before the subscriber, a Notary Public of the State of Maryland, duly commissioned and qualified, Michael P. Bond, Vice President and Eric D. Barnes, Secretary of the Companies, to me personally known to be the individuals and officers described in and who executed the preceding instrument, and acknowledged the execution of same, and being by nip duly sworn, deposeth and saith, that he/she is the said officer of the Company aforesaid, and that the seals affixed to the preceding instrument are the Corporate Seals of said Companies, and that the said Corporate Seals and the signature as such officer were duly affixed and subscribed to the said instrument by the authority and direction of the said Corporations. fN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my Official Seal the day and year first above written. Constance A. Dunn, Notary Public My Commission Expires, July 9, 2019 3 16 '01 N I Y CH Y W ILDING ZQ 227 W. Jiu'ii rtsm BoN TINARID 1 A X SOI YJ 0 BIND, NKANA 46601-193�O s' i865 CITY OF SOUTH ffiD PETE BUTTIGIEG, MAYOR 110A1 OFP(JBLI(''WORIKIS 1574/235-925 � 574/ 235-9171 574,1235-5567 4 Date: To: From Subject Project Name: Project No.: Date Received: August 21, 2018 All Planholders Linda M. Martin, Clerk, Board of Public Works Addendum Number: 1 VPA New Maintenance Storage Building (Re -bid) ' VPA Project No 1062-2018 / Public Works Project No 118-046R 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. Compa Author Date: 13 16 Cowqiy-Ci i N, BUILDING 227 W. JITHASON Bouj,j:IVARD �()tj�1113l^NI),Irwl)IAr� A46601830 Date: To: From Subject Project Name: Project No.: PHOM5 74)12 235-9251 FAX 574/ 23 �5 -9 71 TDD 574/ 235 5567 CH'Y OF Sou,Fii BEN D PE"I'E Bu,rr,i(JIEG, MAYOR BOARD OU'PUBLIC WORKS August 22, 2018 All Planholders Linda M, Martin, Clerk, Board of Public Works Addendum Number: 2 VPA New Maintenance Storage Building (Re -bid) VPA Project No 1062-2018 / Public Works Project No 118-046R IN - 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 pail of herein. Comp Author Date: Z A;l CHECKLIST FOR BIDDERS MZMCEMLA� M 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 MBEtWBE 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 MBE/WBE Contacted L/ Form [MWBE-2.1]. A41-1 City of South Bend, Indiana Contractor's Bid for Public Work Responsible Bidder Checklist. Z Acknowledge Receipt of _41— Addendum(s) included with the bid. Al All required additional linformation is included with the bid. L/ Proposal statements and other affidavits all signed by the proper party with name either printed or typed underneath signature, Z This 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. Signature: Version 10/17/2017 Contractor's Bid for Public Wod(s, - 1 PART II (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/her/its bid. Attach additional pages for each section as needed. SECTION I 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 1. 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 project, 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. 3. 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 10/17/2017 Contractor's Bid for Public Works - 3 Part 11— Section I — Experience Questionnaire 1. St. Joseph County Public Library Project Completed 2009 — Contract Amount - $4,050,604. South Bend Transportation and Maintenance Facility Project Completed October 2010 — Contract Amount - $20,170,000. Ft. Wayne/South Bend Catholic Diocese — Marian High School Project Completed August 2011 - Contract Amount $557,000 Penn/Harris/Madison School Corporation Project Completed August 2011 - Contract Amount $3,320,000 Gurley Leep Addition and Remodel Project Completed December 2011 — Contract Amount $1,073,441 Elkhart County Library Projected Completed March 2012 - Contract Amount - $420,000 St. Joseph High School Project Completed June 2012 - Contract Amount - $2,000,000 Potawatomi Conservatory Project Completed June 2012 - $1,180,000 Granger Community Medicine Project Completed January 2013 - $904,000 Whole Foods Project Completed March 2013 — $435,000 Roseland Animal Hospital — Project Completed May 2013 - $780,000 St. Joseph County Library Digital Lab Job Completed June 2014 - $188,000 St. Jude Catholic Church Renovation Project Completed August 2013 - $3,524,000 Gurley Leep Audi Project Completed September 2014 - $1,018,000 Saint Joseph Regional Medical Center — ER Addition Plymouth - $4,900,000 Completed July 2015 Church of Jesus Christ of Latter Day Saints — Addition — $1,465,000 Completed July 2015 Cassopolis Hight School — Interior Finishes - $312,444 Completed Summer 2016 Penn High School Football Stadium - $1,093,000 Completed Summer 2017 Gurley Leep Honda Store - $5,722,000 Completed Fall 2017 2. Current Projects in Progress: Trinity Health PACE Project - $2,500,000 Leighton Hall Addition — University of Notre Dame - $439,994 Dowagiac Federal Credit Union - $120,684 Northwest Family Medicine - $225,260 Siemens Mishawaka - $278,149 St. Joe Regional Medical Center — Pavilion II - $383,806 University Park Family Medicine - $392,506 3. Have you ever failed to complete work awarded to you? NO 4. References from Private Firms: • Father Michael Heintz — St Matthew's Cathedral — 574-289-5539 • Mr. Mike Stahly — South Bend Public Transportation — 574-532-6852 • Mr. Don Napoli — St. Joseph County Public Library — 574-282-4646 Part II — Section II — Plan and Equipment Questionnaire 1. A detailed quantity survey has been made from the contract plans and specifications. Sufficient manpower is available to begin work 10 days to 2 weeks after Notice of Award. We anticipate completion per plans and specifications. 2. A list of subcontractors will be provided within 24 hours of Notice of Award. 3. A lit of subcontractors will be provided within 24 hours of Notice of Award. It is not anticipated that a bond will be required from subcontractors. 4. All required equipment will be provided for this project. 5. Yes. CITY OF SOUTH BEND 0 � �1" rig ej MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY DEVELOPMENT PROGRAM t"{ FORM MWBE-1.61 MBEIWBE PARTICIPATION This completed form should be supplied with Bids that Pertain to City of South Bend Public Works Projects Involving MBEIMBE 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. Project Number: 11"46R Project Name: VPA Maintenance Storage Building Bidder: � t)0C%� Total Bid Amount: �2/,,fg�,9- , G 2 MBEMBE Goal: Page / off Noma 8 Address of MBEA"lBE Primary Contact Person (NamelTelephone) Scope of Work to be Performed (Attach scope/schedule If you need additional space) Collar Amount of MBEMd'BE Component Percentage of Total BidNPro sal n ,r, il/; 1y 'hSlrrf Iv"AOS J�:4,i Y, plaG 6G� 3 9'�i7v�rr9 n ,%rd � � a S>p Submitted by: Print me.,.-1— a Version 10117/2017 Contractor's Bid for Public Works - 9 CITY OF SOUTH BEND, YO MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY 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 Bond Public Works Projects requiring Good Faith Efforts to obtain MBE[WBE 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: Project Name: Bidder: Contact Person: Address: City: Email: 1 18-046R VIPA Maintenance Storage Building Telephone: 514 - 2,�a -,a 69 m-na— zip: State: 1_n To determine whether a bidder has demonstrated good faith efforW 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 MBEIWBE LIST(S): The bidder reviewed the City of South Bend's Minority and Women Business Enterprise Diversity Development Program, which uses the IDOA approved list of Minority and Women Owned Business as found on their wabsite (hftp://www.in.gov/idoa). ACTION (ADVERTISEICONTACT): 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: Attend all pre -bid meetings scheduled by the City to inform MBENVBEs of contracting and subcontracting opportunities. 2. Advertise in general circulation and/or trade association publications concerning subcontracting opportunities, and allow MBEA1VBEs reasonable time to respond. 3. Perform any and all necessary steps to provide written notice in a manner reasonably calculated to inform MBEANBEs 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 MBEANBE firms. "Bidder must circle or otherwise notate which of the two (2) required actions were performed. GOOD FAITH NEGOTIATIONS: The bidder negotiated in good faith with interested MBENVBEs, including providing such MBE/VVBE's with adequate information about the plans, specifications and other requirements of the subcontract and did not reject MBE/WBEs as unqualified without sound business reasons based on a thorough investigation of their capabilities. SMALL CONTRACT(S): The bidder selected specific portions of the work to be performed by MBE1WBEs in order to increase the likelihood of meeting the MBENVBE goals (including breaking down contracts into smaller units to facilitate MBENVBE participation) CONTRACT RECORDS: The bidder has maintained the following records for each MBEMBt that has bid on the subcontracting opportunity: 1. Name, address, and telephone number; Z A description of information provided by the bidder or subcontractor; and 1 A statement of whether an agreement was reached, and if not, why not, including any reasons for concluding that the MBEANBE was unqualified to perform the job. Proper demonstration of Good Faith Effort requires your Initiais next to au OT tne anove Poxes. 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 10/17/2017 Contractor's Bid for Public Works - 10 CITY OF SOUTH BEND , MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY DEVELOPMENT IPROGRAIMII FORM MWBE-2.1 MBENVBE CONTACTED This completed forrn should be supplied with Bids that pertain to City of South Bond , Public Works Projects requiring contacted MBEfWBE 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. PAGE OF' Project Number: 118-046R MBE,NVBE Participation Goal Project Name: VPA Maintenance Storage Building Bidder: on")n"n-N In (Title) MBEMBE Firm 9 ; A,,—, 44, , d � " -/ t, � � 4 Owner or Contact at MBENVBE Firm Fax: 3-7�,,,gg _,fygr Email: Telephone: Y-g�a- 1777 TYPE OF WORK SOLICITED FOR THIS PROJECT: 19 I-* 9�4 RESULTS OF CONTACT WITH THE MBEMBE FIRM: 22 reAe_;ye-,d MBEIWBE Firm S,,:4 ge 7 �°,Ca�'aW4 _� r Owner or Contact at MBEANBE Firm TeIephone:S7-,,e,?,'7-JX7�7 Fax: g1,7, "9, o�w Email: I TYPE OF WORK SOLICITED FOR THIS PROJECT: RESULTS OF CONTACT WITH THE MBENVBE FIRM: Version 10/17/2017 Contractor's Bid for Public Works - 11 CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK RESPONSIBLE BIDDER CHECKLIST Project Name: VPA Maintenance Storage Building Proiect No.: 118-046R For Bids Clue: Contractor Name: The City seeks to enhance its ability to identify responsive and responsible bidders on all City public works projects by institution of comprehensive submission requirements in compliance with State law. Quality workmanship, efficient operation, safety, and timely completion of projects requires that all bidders meet certain minimum requirements to be responsive and responsible bidders. Ili'.Il���I�Is'iP��lI11���1I�iTilJlilli �wl?i'11li�l'��P1i:.=]l� INSTRUCTIONS: If you are a pre -qualified bidder, complete Section I only. If you are not a pre -qualified bidder, complete Section 11 only. Section II acts as an application for pre -qualification. Submission of Section 11 will allow the bidder to be considered for pre -qualification for bids with the City of South Bend Department of Public Works. Pre - qualified bidders will then be exempt from a portion of the submission requirements outlined in Section 6- 63 of The Responsible Bidding Ordinance No. 10594-18 (hereinafter, "Responsible Bidding Ordinance") for a period of twelve (12) months. Thereafter, contractors who are pre -qualified must submit a complete application for continuation of "pre - qualified" standing, on a form provided by the City ("Responsible Bidder Checklist (1) Pre -Qualified Bidders") by December 31st for the upcoming calendar year, or within twelve (12) months of obtaining pre - qualified standing. If the status of any item changes within the twelve (12) months, it is the responsibility of the contractor to notify the City. Failure by any pre -qualified contractor to submit its complete application for continuation of "pre -qualified" standing within the time prescribed above shall result in automatic removal of the designation, effective January 1 of the following year, or immediately following the twelve (12) months of pre -qualified standing. However, the "removed" contractor or subcontractor shall still be permitted to bid on City public works projects, though the contractor must submit all required documents under 6-63 until "pre -qualified" status is re-established. Please Note: The City reserves the right to request supplemental information from the bidder, additional verification of any information provided by the bidder, and may also conduct random inquiries of the bidder's current and previous customers regardless of pre -qualified standing. It is the sole responsibility of the potential bidder to comply with all submission requirements applicable to the bidder in Section 6-63 of the Responsible Bidding Ordinance no later than the date of the public bid opening. 06-18-2018 Contractor's Bid for Public Works - 12 POST BID SUBMISSIONS - Post -bid submissions must be submitted in accordance with Section 6-64 of the Responsible Bidding Ordinance. The post -bid submission requirements are as follows: 1. All bidders shall collect, maintain, and provide upon request, a current written list that discloses the name, address, licensing status, and type of work for any subcontractor from whom the bidder has accepted a bid and/or intends to hire on any part of the public work project, including individuals performing work as independent contractors. 2. Each subcontractor, whose portion of the project is estimated to be at least one -hundred fifty thousand dollars ($150,000.00), shall be required to adhere to the requirements of Section I of the Responsible Bidder Ordinance as though it were bidding directly to the City, except that the subcontractor shall submit the required information (including the name, address, and type of work) to the successful bidder prior to the commencement of work. 3. Failure of a subcontractor to submit the required information shall not disqualify the successful bidder from performing work on the project and shall not constitute a contractual default and/or breach by the successful bidder. However, the City may withhold all payment otherwise due for work performed by a subcontractor, until the subcontractor submits the required information and the City approves such information. 4. The disclosure of a subcontractor list ("Disclosed Subcontractor(s)") to the City by a bidder shall not create any rights in the Disclosed Subcontractor(s). Thus, a bidder may substitute another subcontractor for a Disclosed Subcontractor by giving the City, upon request, written notice of the name, address, licensing status, and type of work of the substitute subcontractor. 5. The successful bidder and all subcontractors on a public works project are required to submit certified payroll utilizing the federal form known as WH-347 or a similar form on a bi-weekly basis, submitted within 10 days after the end of each bi-weekly payroll period. Certified payrolls shall identify the job title and craft for each employee. Please Note: Submissions deemed inadequate, incomplete, or untimely by the City may result in the automatic disqualification of the bid. The City, after review of complete and timely submissions, shall, in its sole discretion, after taking into account all information in the submission requirements, determine whether a bidder is responsive and responsible, and provide a Pre -Qualification Verification Letter. The City specifically reserves the right to utilize all information provided in the contractor's submission and any information obtained by the City through its own independent verification of the information provided by the contractor. 06-18-2018 Contractor's Bid for Public Works - 13 PRE -QUALIFIED BIDDER CHECKLIST Q/A (a) Acknowledgements ✓✓✓✓ (i) By checking this box, I hereby acknowledge that I am a pre -qualified bidder with the City of South Bend and that I have met the pre -qualification requirements within the last twelve (12) months. A copy of my Pre -Qualification verification letter is attached. By checking this box, I hereby acknowledge that the City reserves the right to request supplemental information, additional verification of any information provided by me, and may also conduct random inquiries of my current and prior customers. (b) Attachments {i) _ Indiana Secretary of State's on-line records (ie. Business verification) dated within sixty (60) days of the submission of said document showing that business is in existence, current with the Indiana Secretary of State's Business Entity Report, and eligible for a certificate of good standing. (Not applicable to individuals, sole proprietors or partnerships). (ii) Statement on staffing capabilities, including labor sources. This statement indicates and ensures I have sufficient employees on staff to complete the work. It outlines how I intend to meet the staffing needs of the work. (iii) _ Evidence that I am utilizing a surety company which is on the United States Department of Treasury's Listing of Approved Sureties as required in the bid specifications or contract. (iv) List of projects of similar size and scope of work performed in all areas, including the State of Indiana, within the last three (3) years. 06-18-2018 Contractor's Bid for Public Works -14 III. PRE -QUALIFICATION CHECKLIST (FOR BIDDERS THAT ARE NOT PRE -QUALIFIED) (a) Acknowled9 ments (i) ✓ By checking this box, I hereby acknowledge that I am not a pre - qualified bidder with the City of South Bend. (ii) ✓ By checking this box, I hereby acknowledge that the City reserves the right to request supplemental information, additional verification of any information provided, and may also conduct random inquiries of my current and prior customers. The City reserved the right to utilize all information provided in this submission and all information obtained in inquiries or requests to determine if a bidder is responsive and responsible. Additionally, I acknowledge that all information provided to the City shall be regarded as public records. (iii) ✓ By checking this box, I hereby acknowledge that copies of all Applicable apprenticeship certificates or standards for training programs applicable to the work performed on the project may be requested at any time and shall be furnished upon request. (iv) ✓ By checking this box, l hereby acknowledge and ensure that 1 and all sub -contractors, from whom I have accepted a bid and/or intend to hire to perform work on the public work project, are properly licensed. Furthermore, I acknowledge my understanding that it is my responsibility to ensure that all sub- contractors have the necessary licenses to undertake the work called for in this bid. If a sub -contractor loses their license at any point, it is the responsibility of that sub -contractor to notify the City. (b) Attachments (i) ✓ Indiana Secretary of State's on-line records (ie. Business verification) dated within sixty (60) days of the submission of said document showing that business is in existence, current with the Indiana Secretary of State's Business Entity Report, and eligible for a certificate of good standing. (Not applicable to individuals, sole proprietors or partnerships). (ii) List identifying all former business names. (iii) _7� Any determinations by a court or governmental agency any violations of federal state, or local laws including, but not limited to, violations of contracting or antitrust laws, tax or licensing laws, environmental laws, Occupational Safety and Health Act (OSHA), or federal Davis -Bacon and related Acts, within the preceding five (5) years. (iv) Statement about staffing capabilities, including labor sources. This statement indicates and ensures I have sufficient employees on staff to complete the work I ✓ am bidding on OR outlines how I intend to meet the staffing needs of the work. (v) Statement that individuals who will perform work on the public work project on my behalf will be properly classified as an employee or as an independent contractor under all applicable state and federal laws and local ordinances. (vi) Evidence of participation in apprenticeship and training programs, applicable to the work to be performed on the project, which are approved by and registered with the United States Department of Labor's Office of Apprenticeship, / or its successor organization. (vii) ✓ Copy of a written plan for employee drug testing that covers all of my employees who will perform work on the public work project and meets or exceeds the requirements set forth in IC 4-13-18-5 or IC 4-13-18-6. (viii) '� Evidence that I am utilizing a surety company which is on the Bureau of Fiscal Service "Department of Treasury's listing of Approved Sureties" as required in the bid specifications or contract, (ix) Written statement of any federal, state or local tax liens or tax delinquencies owed to any federal, state or local taxing body in the preceding three years. (x) List of projects of similar size and scope of work performed in all 06-18-2018 Contractor's Bid for Public Works -15 areas, including the State of Indiana, wiftri three (3) years prior to the date on which the bid is due. 1.1 MIMIMAA MOROM Nrohm �- Unowi, (Print Name (Here) -ILLP, keA, 16u4 (Name of Company) j 40q Is. -FWr-)C-r"S (Address of Company) (City) a:o L�fjLp 1-7 (State) Qq I (Telephone Number) 06-18-2018 Contractor's Bid for Public Works - 16 fj e o �& �t 14len II. PRE -QUALIFICATION CHECKLIST (FOR BIDDERS THAT ARE NOT PRE -QUALIFIED) (a) Acknowled ments (i} By checking this box, I hereby acknowledge that I am not a pre - qualified bidder with the City of South Bend. (ii) ✓ By checking this box, I hereby acknowledge that the City reserves the right to request supplemental information, additional verification of any information provided, and may also conduct random inquiries of my current and prior customers. The City reserved the right to utilize all information provided in this submission and all information obtained in inquiries or requests to determine if a bidder is responsive and responsible. Additionally, I acknowledge that all information provided to the City shall be regarded as public records. (iii) ✓ By checking this box, I hereby acknowledge that copies of all Applicable apprenticeship certificates or standards for training programs applicable to the work performed on the project may be requested at any time / and shall be furnished upon request. (iv) ✓ By checking this box, I hereby acknowledge and ensure that I and all sub -contractors, from whom I have accepted a bid and/or intend to hire to perform work on the public work project, are properly licensed. Furthermore, I acknowledge my understanding that it is my responsibility to ensure that all sub- contractors have the necessary licenses to undertake the work called for in this bid. If a sub -contractor loses their license at any point, it is the responsibility of that sub -contractor to notify the City. (b) Attachments Indiana Secretary of State's on-line records (ie. Business verification) dated within sixty (60) days of the submission of said document showing that business is in existence, current with the Indiana Secretary of State's Business Entity Report, and eligible for a certificate of good standing. (Not applicable to individuals, sole proprietors or partnerships). (ii) 7' List identifying all former business names. {iii} Any determinations by a court or governmental agency any violations of federal state, or local laws including, but not limited to, violations of contracting or antitrust laws, tax or licensing laws, environmental laws, Occupational Safety and Health Act (OSHA), or federal Davis -Bacon and related ✓ Acts, within the preceding five (5) years. (iv) Statement about staffing capabilities, including labor sources. This statement indicates and ensures I have sufficient employees on staff to complete the work I ✓ am bidding on OR outlines how I intend to meet the staffing needs of the work. {v} Statement that individuals who will perform work on the public work project on my behalf will be properly classified as an employee or as an independent contractor under all applicable state and federal laws and local ✓ ordinances. (vi) Evidence of participation in apprenticeship and training programs, applicable to the work to be performed on the project, which are approved by and registered with the United States Department of Labor's Office of Apprenticeship, or its successor organization. (vii) Copy of a written plan for employee drug testing that covers all of my employees who will perform work on the public work project and meets or exceeds the requirements set forth in IC 4-13-18-5 or IC 4-13-18-6. (viii) Evidence that I am utilizing a surety company which is on the Bureau of Fiscal Service "Department of Treasury's Listing of Approved Sureties" as required in the bid specifications or contract. (ix) Written statement of any federal, state or local tax liens or tax delinquencies owed to any federal, state or local taxing body in the preceding three years. (x) List of projects of similar size and scope of work performed in all 06-18-2018 Contractor's Bid for Public Works - 15 Business Name: THE ROBERT HENRY CORPORATION Entity Type: Domestic For -Profit Corporation Creation Date: 08/01/1974 Principal Office Address: USA Frances Street, South Bend, IN, 46624, Jurisdiction of Formation: Indiana BUSINESS INFORMATION CONNIE LAWSON INDIANA SECRETARY OF STATE 08/21/2018 02:25 PM Business ID: 197408-008 Business Status: Active Inactive Date: Expiration Date: Perpetual Business Entity Report Due 08/31/2018 Date: Years Due: 2018/2019 Title Name Address President STEPHEN R HENRY 15524 HEARTHSTONE DRIVE, MISHAWAKA, 1N, 46545, USA Type: Individual Name: STEPHEN HENRY Address: 404 S FRANCES ST, SOUTH BEND, IN, 46617 - 0000, USA A General and Utility Contractors 'To Whom It May Concern: Per the Pre -Qualification Checklist (b) (ii) — The Robert Henry Corporation operated under the business name Henry -Williams, Inc. prior to 1980. �01L.&JUMN 404 South Frances Street - RO, Box 1407 -South Bend, Indiana 46624 www,roberthenrycorp.com - Tel. 574-232-2091 - IFax 574-232�-3979 General and Utility Contractors To Whom It May Concern: Per the Pre -Qualification Checklist (b) (ii) — The Robert Henry Corporation has not operated under another business name. Stephen R. Henry President 404 South Frances Street - P.O. Box 1407 -South Bend, InOana 46624 www,roberthenrycorp.com - Tel. 574-232-2091 - Fax 574-232-3979 General and Utility Contractors To Whom It May Concern: Per the Pre -Qualification Checklist (b) (iii) — The Robert Henry Corporation has had no determinations by a court or governmental agency of any violations of federal, state or local laws including, but not limited to, violations of contracting or antitrust laws, tax or licensing laws, environmental laws, Occupational Safety and Health Act (OSHA), or federal Davis -Bacon and related Acts, within the preceding,fi.ye (5) years. Stephen R. Henry President 404 South Frances Street - P.O. Box 1407 •South Bend, Indiana 46,624 www.robertli,enrycorp.com - Tel. 574-232-2091 - Fax 574-232-3979 III` Mi j� J! 11-1 Eli' 11i rk i, MA 11111,111 091"'N 11, JOAN I' , �Z11� 20 k m General and Utility Contractors To whom i it may concern: The Robert Henry Corporation has the staffing capabilities including the labor reources necessary to complete the project on time. We will be utilizing workforce form the local union hall or from our existing workforce. Stephen R. Henry President 404 South Frances Street ® RO, Box 1407 -South Bend, Indiana 46624 www,roberthenrycorp.com - Tel. 574-232-2091 - Fax 574-232-3979 is General and Utility Contractors To whom it may concern: The individuals that ore performing work on behalf of The Robert Henry Corporation are properly classified as employees or an independent contractor as under the applicable state and federal laws and local ordinances. Stephen Stephen R. Henry 7 President 404 South Frances Street - P.0, Box 1407 -South Bend, Indiana 46624 www.roberthenrycorp.com - Tel. 574-232-2091 - Fax 574-232-3979 TO ILVA Plasterers' & Cement Masons' Apprentice Coordinator of Local Union #692 Phone 317-508-1609 FAX 317-972-4907 Emd hansen@plcrnlocal692.org o E00-M TO WHOM IT MAY CONCERN, AUGUST 23, 2018 THIS LETTER IS TO CERTIFY THAT ROBERT HENRY CORP. HAS BEEN A SIGNATORY UNION CONTRACTOR WITH THE PLASTERERS' AND CEMENT MASONS' JOINT APPRENTICESHIP TRAINING PROGRAM OF LOCAL 692, FOR AT LEAST THE LAST FIVE YEARS, AND IS IN GOOD STANDING. THEY HAVE A SIGNED CONTRACT WITH LOCAL 692 AND IS ELIGIBLE TO USE UNION PLASTERERS' APPRENTICES AND UNION CEMENT MASONS' APPRENTICES. THROUGH THIS CONTRACT AND OTHERS, THE FINANCIAL OBLIGATIONS OF TRAINING AND SAFETY ISSUES ARE MET. ALL OF THE APPRENTICES ARE REGISTERED WITH THE UNITED STATES DEPARTMENT OF LABOR, BUREAU OF APPRENTICESHIP AND TRAINING. SINCERELY, PAT HANSEN APPRENTICESHIP COORDINATOR FOR LOCAL 692 220 N. Fulton St. Indianapolis, IN 46202 U.S. Department of Labor 46 East Ohio St. - Room 511 Indianapolis, IN 46204 OFFICE OF APPRENTICESHIP Employment and Training Administration Date: - r �7 Mr. Pat Hansen, Coordinator Plasterers & Cement Masons Local 4692 JATC (mailing)220 N. Fulton Street, Indianapolis, IN 46202 (school) 9200 Louisiana Street— Merrillville, IN 46410 Re: EEO Compliance Review (and Quality Assessment) Dear Mr. Hansen: Phone: 3171226-7001 Fax: 317/226-7016 Our recent EEO Compliance Review (and Quality Assessment) of your registered apprenticeship program, Plasterers & Cement Masons Local #692 JATC was conducted on April 11, 2017 and October 5, 2016. This review covered the time period 08/15/2015 (date of your last review) through 10/04/ 2016. We are writing to inform you that our office found no apparent violations of the requirements governing registered apprenticeship programs as set forth in regulations at 29 CFR Part 29, "Labor Standards for the Registration of Apprenticeship Programs," and Part 30, "Equal Employment Opportunity in Apprenticeship and Training." Based on our review, it appears that your apprenticeship program is making good faith efforts to comply with the requirements of 29 CFR Parts 29 and 30. We note, however, that despite these efforts, there exists underutilization of women and minorities in your apprenticeship program and skilled workforce, including journeyworkers. Please be aware that Plasterers & Cement Masons Local #692 JATC remains under an obligation, pursuant to the regulations at 29 CFR Part 30 to continue with its good faith efforts to increase participation of women in its Registered Apprenticeship program. We sincerely appreciate the cooperation and courtesies extended by you and your office to the Department of Labor while we conducted the compliance review. If you have any questions or concerns, please do not hesitate to call. I can be reached at (317) 226- 7003. enc r ly, l John Delgado ; State Director cc: Kathleen Sokolowski, ATR �OT GDAOHddV lzl •� tit 1}.� t, W cn z ¢ U W LL �s a 07 4f d � a e� d D 11 d INDLANA LABORERS` TRAINING TRUST FUND DavidA. Frye Secretary -Treasurer Jerry J. Bolk Chris L. Guerrero Ricky Henson, Jr. Ramon Mendoza, Jr. Robert S Wright P.O. Box 758 -)Bedford, Indiana 47421 (812) 279-9751 August 23, 2018 To Whom It May Concern: Sean Coakley, Director Jolla P. Brown Chairman Kelly Abel Brad Dreibelbis Michael Ferrara Stan Meyer Jim Wiseman FAN, (912) 279-5545 This letter is to confirm that "Robert Henry Corp." is a signatory contractor in good standing with the Indiana Laborers' Training Trust Fund. The above mentioned company is a participant in the Joint Apprenticeship and Training Committee through this Union and has been an active participant in good standing for each of the past five plus consecutive years, and is currently eligible to use our apprentices on a project. Further, our organization's program is approved by the U.S. Veterans Administration to participate in the GI educational benefits program. A copy of our approval letters are attached along with the collective bargaining agreement stating the ratios of Journey workers to Apprentices; which is one (1) Apprentice for every five (5) Journey workers and thereafter may not employ more that (1) Apprentice for every (3) Journey workers. Sincerely, Sean Coakley, Director SC:dc www.indianalaborerstraining.org C 0 tn co cV O 1 N O C1 u d o24 e o O 0 Q 0 Q Q C7 Q 0 0 0 O y R � O N t LO (Y) LD N Q I T 0) ti M F7 e r t1 tT ti O LO v m U7 N N T d r.! M M N ch NO M N r N � in TT--- r- w- CO a �+ r T C\! 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O C �l cl ©l "I C'l r1 a1 �1 oI "I Ql Q! aI U) A prop� O o O LO O N LA O T- 0YT. M O O co y0. Q M i w av r d 0 N co I LO m Ln rn O �* A O Q CV CAE m 0 W N O o c � O fA y M r ca N e! r N ��'„ Op O o0 r tQl a 0 a N W t, Ln f0 h b � d .r . e- coC9 et r O N � a Nco h C] Lp� � d d � O T O m O G I`- In N N � LO r N l+9 - �- 0 O LO to z Z4 (i% V l ifs 0 0 LO 4DO T r 0 l— FP w N co 1p &0 w c" N CD „ r„ T O a .=i 3J N N CO A (E 0 O Q STATE OF INDIANA DEPARTMENT OF VETERANS AFFAIRS STATE APPROVING AGENCY 402 WEST WASHINGTON STREET Room W-469 INDIANAPOLIS, INDIANA 46204-2736 Ootober 25, 2016 Certifying Official, Michael R. Pence, Governor James M, drown, Director The Indiana State Approving Agency would like to inform you that the Department of Veterans Affairs St, Louis .Regional Ogee has .relocated. For enrollment ce rtifxcations sent by ta* address to the Education Division as follows; Department of Veterans Affairs 9700 Page Avenue Suite 101— Education, St. Louis, MO 63132-I502 Fax number for certifications; To Submit OJTIA)PP documents- 314-253-4140 Feel free to contaot the kdiana State Approving Agency with any questions. Tara Eggen Program Coordinator State Approving Agency Tudiena Department of Veterans Affairs 402 west W ashin&n Street RM W469 Indianapolis IN 46204 317-234-6062 Teggenl@dva.imgov tu STATE OF INDIANA DEPARTMENT OF VETERANS AFFAIRS STATE APPROVING AGENCY 302 WEST WASHINGTON STREET Room E-120 INDIANAPOLIS, INDIANA 46204-2738 Renae Sullivan Indiana Laborers Training Trust Fund -- Apprent. PO Box 758 Bedford, IN 47421-0758 Dear Ms. Sullivan: Michael R. Pence, Governor James M. gown, Director January 27, 2015 I recently conducted a compliance survey at your institution. I appreciated the professionalism, courtesy and assistance you and your staff extended to me, your Program Director with the Indiana State Approving Agency. This letter will discuss the purpose of a compliance survey, what I review during a survey and my findings, What Is The Purpose Of A S>ulry A compliance survey is periodically conducted for the following two reasons: (1) To ensure that Department of Veterans Affairs (DVA) payments to veterans and eligible dependents enrolled in the training programs are based upon proper and correct enrollment information furnished by the school (2) Assist school officials and students in understanding the requirements of the law in order to prevent deficiencies or violations that could develop because of misunderstandings or misinterpretations of the law. What Do I Review During A Surve ? The information and data reviewed during the survey includes, but is not limited to, curriculum requirements, prior credit evaluations, written agreements between the student and the facility, copies of the application and enrollment certifications, and copies of the progress reports. The wage scales and work processes are also reviewed. Advertising materials are reviewed to ensure no erroneous, misleading, or deceptive information is conveyed to the students. What Did We IFin.d In Our Survey? One discrepancy, or reporting error, was found in the records reviewed for this survey. The discrepancy is as follows: There were zero discrepancies found in the records reviewed during the compliance survey. If You Need A.ssistauce This concludes the preliminary findings of our Compliance Survey. If you need any assistance or have questions regarding this survey, please contact me directly, by email, at khlood�ood E[z�dvaan..g�ov. If you cannot email me, you can leave a voice mail message at (317)232-391 b, The education and training opportunities that your apprenticeship continues to provide veterans and their dependents are appreciated. . Sinc4ely, Kimberly Bloodgd�d Program Director State Approving Agency Phone: (317) 232-3910, Toll -Free (800) 400.4620 • Fax: (317) 232 7721 WebsRe Address: ww3n.govlve#eran B; Ulf 111-4 AM Illromoting the Safety Well-BeingAnd of EmployeesWorkplace r ,W11111 1 i 111111W . • BRICKLAYERS • CARPENTERS • IBE • IRONWORKERS RS le LABORERS • MILLWRIGHTS • OPERATING ENGINEERS • PAINTERS • PIPEFITTERS • PLUMBERS • ROOFERS • SHEE METAL WORKERS • TEAMSTERS • TECHICA.L, ENGINEERS • PLASTERERS AND CEMENT MASONS • GLAZIERS This Policy has beeti appi- aved by the Northwest Indiana Business Roundtable IUIIIIUUI�uiis�����°'�°'° ml Ali�ll Building & Construction resource Center, Inc. 6050 Southport Road, Suite B Portage, Indiana 46368 Telephone: (219) 764-9500 Toll Free: (877) 988-5400 Fax: (219) 764-9505 Website: www.bcrcnet.com Robert Anadell Executive Director Your Employee Assistance Program (EAP) PERSPECTIVES (800) 456-6327 Policy Revision January 1, 2013 1MW ........................ Introduction 1 The Policy 2 Definitions 4 Drug Testing 9 Drug Group 11 Alcohol Testing 12 Payment for Testing 12 Initial Testing (Pre -Employment) 13 Random Testing 13 Probable Cause Testing 14 Past-Accident/Incident Testing 15 "Emergency" Work Assignment 16 Card System 17 Status Confirmation 18 Insufficient Specimen 18 Diluted Specimen 19 Adulterated, Substituted, and/or Out -of -Temperature Range Specimen 19 Consequences for a Positive Test 19 Return -to -Duty Testing 21 Follow-up Testing 21 Disputed Positive Results 22 Appeals and Protections 23 Letters of Notice for Random Testing Attachment A — General Trades 24 Attachment B — Non -Bargaining 25 Attachment C — Pipe Fitters Local 597 26 Attachment D — Pipefitters Local 137 & Springfield Slit. Metal Workers Local 218 27 Attachment E — Failure to Report 28 Attachments I & 11 29 BCRC Authorization for Consent to Drug and Alcohol Analysis and Authorization 30 For Release of Results BCRC Applicant/Cardholder Drug Test Information and Instruction Sheet 31 BUILDING AND CONSTRUCTION RESOURCE CENTER, INC. INTRODUCTION The labor and management representatives of The Building and Construction Industry for Northwest Indiana have formed an alliance to address the problems caused by drug and alcohol abuse. Management and labor have created the Building and Construction Resource Center (hereafter "BCRC") an independent not -for -profit corporation which offers a wide range of services to its employees in the unionized construction industry, which include employers, labor union organizations, construction industry and related workers. It is BCRC's goal to assist employers to establish and maintain workplaces that are free of the destructive effects caused when employees use drugs and/or abuse alcohol. BCRC's activities are not intended to interfere with normal practices of the unions or management. BCRC recognizes its responsibility to communicate with and educate its employees relative to this policy, as well as the harmful effects of drugs and alcohol in our society and in the workplace. BCRC also recognizes the need to provide a program of assistance to those persons for whom drugs or alcohol may be causing problems. Finally, while not wishing to violate the rights or invade the privacy of any employee, BCRC's drug testing program will seek to identify those employees who are unable or unwilling to conform to BCRC's program. This program has been established in accordance with federal guidelines for specimen collection, laboratory analysis and review, and standards of integrity and confidentiality. THE POLICY Persons who use illegal drugs or abuse alcohol or other controlled substances, on or off their jobs, are likely to be less productive, to be less reliable, to be more frequently absent, and to have other work related problems that can cause increased cost, delays, accidents, and injuries. These employees can also damage the health, safety and well-being of other workers on the job. The unionized construction industry can control and reduce this problem through recognition of the problem, development of a comprehensive policy and program of education and information, promotion of an assistance program, and implementation of fair and respectful drug testing that conforms to federal guidelines for specimen collection and analysis. All of this is to be done with the utmost confidentiality and respect for the individual. In order to enhance substance abuse awareness among all employees, educational seminars and training programs will be offered. The educational seminars will be directed toward education about the seriousness of the nationwide problem of drug and alcohol abuse, and how the use of drugs and alcohol negatively impacts safety, productivity, and the competitive ability of the American workforce. Supervisors will be trained to identify employees in potentially difficult situations, and to recognize signs of impairment, as well as the supervisors' responsibility to document, intervene and follow up with the troubled individual. These sessions will be offered as ongoing training programs. BCRC encourages all employees troubled by their own, a family member's drug, or alcohol abuse to seek professional care and treatment. Early recognition and treatment of alcohol and drug abuse provides the greatest opportunity for successful recovery. BCRC provides an Employee Assistance Program (EAP) for all employees and their families who need professional guidance in assessing their substance abuse or alcohol -related problem and choosing an appropriate course of treatment. Current employees will be referred to an EAP representative as a result of a positive drug test or alcohol or upon an individual's own request. In either case, the content of the discussion with the EAP will be protected and confidential, to the extent allowed by law. A participant's use of the EAP is confidential and information will not be released to BCRC or any of its subscribing organizations or participants without written release from the participant in accordance with the law. Employees who use the EAP as a consequence of a positive drug or alcohol test will be subject to the conditions established in the drug -testing portion of this policy. The EAP staff has knowledge of the level and types of benefits available to BCRC employees, Employees can access the services of the EAP through a hotline that is staffed. twenty-four (24) hours a day, seven (7) days a week, throughout the entire year. Employees calling the EAP hotline are put in touch with a counselor who will conduct a professional assessment and who may meet with them to further assess the nature of the problem in order to provide a referral to the best and most appropriate level of care. The EAP is staffed by certified and credentialed human services professionals who are sensitive to the needs of the individual. Individuals who take the initiative to contact the EAP for assistance do so with the assurance that their cat Is will be treated respectfully and confidentially. The direct services provided by the EAP are sponsored by BCRC. In compliance with Public Law 100-690 (The Drug -Free Workplace Act), which applies only to employers who have federal grants or federal contracts of more than $100,000, an employee who is convicted of a workplace drug or alcohol violation and who is employed by a BCRC affiliated employer must report this information to his/her immediate supervisor no later than five (5) days after such conviction. The supervisor must report this information immediately to the employer's Program Administrator. • AdiAternted .4gpeeimen means a specimen that contains a substance that is not expected to be present in human urine, or contains a substance expected to be present but is at a concentration so high that it is not consistent with human urine. Air blank means, in evidential breath testing devices (EBTs) using gas chromatography technology, a reading of the device's internal standard. In all other EBTs, a reading of ambient air containing no alcohol. • Alcohol means the intoxicating agent in beverage alcohol, ethyl alcohol, or other low molecular weight alcohols including methyl and isopropyl alcohol. • Alcohol concentration (or content) means the alcohol in a volume of breath expressed in terms of grams of alcohol per 210 liters of breath as indicated by an evidential breath test under this policy (BrAC). • Alcohol confirmation test means a subsequent test using an EBT, following a screening test with a result of 0.04 or greater, which provides quantitative data about the alcohol concentration. • Alcohol Ncreening De 'ce LAND), means a breath device, other than an EBT, that is approved by the National Highway Traffic Safety Administration (NHTSA) and placed on a conforming products list (CPL) for such devices. • Alcohol §&Legning test means an analytic procedure to determine whether an employee may have a prohibited concentration of alcohol in a breath specimen. • Alcohol testing site means a place selected by the employer where employees present themselves for the purpose of providing breath for an alcohol test. • Alcohol use means the drinking or swallowing of any beverage, liquid mixture or preparation (including any medication), containing alcohol. • AftuuLmeans a fractional part of a specimen used for testing. It is taken as a sample representing the whole specimen. • AU12lican means a person, independent contractor, or employer, or person working for an independent contractor, or employer who applies to become an employee of a BCRC contractor/ employer participant, and includes a person who has received a job offer made contingent on the person passing a drug test. • Association means Building and Construction Resource Center, which is the association formed by labor and management representatives of the building and construction industry for Northwest Indiana, for the purpose of addressing problems of drugs and alcohol in the workplace. • Blind specimen or blind performance test specimen means a specimen submitted to a laboratory for quality control testing purposes, with a fictitious identifier, so that the laboratory cannot distinguish it from an employee specimen. • Breath Alcohol Technician (BAT) is a person who instructs and assists employees in the alcohol testing process and operates an Evidential Breath Testing device (EBT). • Canceled Je§ means a drug or alcohol test that has a problem identified that cannot be or has not been corrected. A canceled test is neither a positive nor a negative test. An employer is not permitted to take adverse job action based on a canceled test. • Card Manager is the individual designated by each employer who has the authority to access data information that will confirm the status of employees through the call -in system, through the BCRC scanner by swiping employees' identification cards, or by electronic e-mail. • Chain of custody means the procedure used to document the handling of the specimen from the time the employee.gives the specimen to the collector until the specimen is destroyed. • Collection container means a container into which the employee urinates to provide the specimen for a drug test. • Collection site means a place designated by BCRC where individuals present themselves for the purpose of providing a specimen to be analyzed for the presence of controlled substances, or for purposes of providing breath sample to be analyzed for alcohol concentration. • Collector means a person who instructs and assists employees at a collection site, who receives and makes an initial inspection of the specimen provided by those employees, and who initiates and completes necessary forms. • ComUany means an employer who is a member of Building and Construction Resource Center. • Confirmation (or confirmatory) drug test means a second (2) analytical procedure performed on a urine specimen to identify and quantify the presence of a specific drug or drug metabolite. • Confirmation (or confirmatory) validii _test means a second test performed on a urine specimen to further support a validity test result. • Confirmed drue_fe-at means a confirmation test result received by an MRO from a laboratory. • Confirmatory_tes a) For alcohol testing, a confirmatory test is a second test following a screening test with a result of 0.02 or greater, conducted 15-30 minutes later, that provides quantitative data of alcohol concentration. This test is conducted on an EBT. b) For controlled substances testing, a confirmatory test is a second analytical procedure to identify the presence of a specific drug or metabolite. This confirmatory test is independent of the initial test and uses a different technique and chemical principle from that of the screening test in order to ensure reliability and accuracy. (Gas chromatography/mass spectrometry_(GC/MS) is the only authorized confirmation method for cocaine, marijuana, opiates amphetamines and phencyclidine) • Contractor garticipanLmeans an employer who is a contributing member of Building and Construction Resource Center • Controlled Substance means marijuana (THC), cocaine, opiates, phencyclidine (PCP), amphetamines (including methamphetamines), barbiturates, benzodiazepine, propoxyphene, methadone, b-acetymorphine and ecstasy. • DHHS means the Department of Health and Human Services or any designee of the Secretary, Department of Health and Human Services. • DHHS-annroved laboratory means a laboratory that is certified by the U.S. Department of Health and Human Services. Drug tests under this program will be performed by a DHHS—certified laboratory. + DesiLwated Emulover Representative (DERI means the Human Resource Manager, Card Manager, Program Administrator or similar designee of each employer who shall receive necessary communications related to this program. • Dilute specimen means a specimen with creatinine and specific gravity values that are lower than expected for human urine. • DOT means U.S. Department of Transportation. Many of DOT's standards and procedures related to drug and alcohol testing are mirrored in BCRC's drug and alcohol policy. •D_r= mean the substances for which tests are required under this policy and include marijuana (THC), cocaine, amphetamines (including methamphetamines), phencyclidine (PCP), opiates, barbiturates, benzodiazepine, propoxyphene, methadone and ecstasy. + Drug test means a test conducted for controlled substances. • Employee means an employee of a company, or of a contractor/employer participant who is a member of Building and Construction Resource Center. • Emllooyee Assistance Program (EAP) Counselor means a masters -level professional with an education in psychology, social work, counseling, etc. with knowledge of and clinical experience in diagnosis and treatment of alcohol and controlled substance related disorders. The EAP will assess and make recommendations concerning education, treatment, follow-up testing and aftercare. • Employer means a company, or a contractor/employer participant, who is a member of Building and Construction Resource Center. • Evidential Breath Testinu Device (EBT) means a device approved by NHTSA for the evidential testing of breath at .04 alcohol concentrations, placed on NHTSA's Conforming Products List (CPL) for "Evidential Breath Measurement Devices" and identified on the CPL as conforming with the model specifications available from NHTSA's Traffic Safety Program. • First Occurrence Clause means if an employee does not report for a random test, and it is the first time the employee has failed to report, the Third Party Administrator (TPA) may allow the employee to take the test without reporting to the EAP for further review. Employees may utilize this clause only one time. • Follow-up Testing may be required, based on an EAP evaluation for a non -negative or positive test result as described in this policy. Follow-up testing will be administered by the TPA. • Initial test (for drugs) means an immunoassay screen to eliminate negative urine specimens from further consideration. • Initial validity test paeans the first test used to determine if a specimen is adulterated, diluted, or substituted. • Invalid druLy test means the result of a drug test for a urine specimen that contains an unidentified adulterant or an unidentified interfering substance, has abnormal physical characteristics, or has an endogenous substance at an abnormal concentration that prevents the laboratory from completing or obtaining a valid drug test result. • Laboratory means a U.S. laboratory certified by DHHS under the National Laboratory Certification Program as meeting the minimum standards of Subpart C of the DHHS Mandatory Guidelines for Federal Workplace Drug Testing Programs. • Licensed medical practitioner means a person who is licensed, certified, and/or registered, in accordance with applicable Federal, State, local, or foreign laws and regulations, to prescribe controlled substances and other drugs. • Medical Review Officer -- LT R=) means a licensed physician responsible for receiving laboratory results generated by BCRC's drug testing program who has knowledge of substance abuse disorders and who has appropriate medical training to interpret and evaluate an individual's confirmed positive test result together with his/her medical history and any other relevant biomedical information. • Non -negative (Positive) test result means a sample has been found to contain substances above the test levels established in this policy that would provide a negative test result, or was an invalid test. • Positive Test (alcohol) occurs when an employee's confirmatory test result reads 0.04% BrAC or higher. • Positive Test (drugs) occurs when an employee's confirmatory test or retest result is at or above cutoff levels specified by DHHS and has been verified by the MRO to be a positive test. • Post-Accident/incident Testing means an employer may require a drug and/or alcohol test when an accident/incident occurs. • Probable Cause Testing may be required when a supervisor observes and documents unusual behavior. • Protyram Administrator means the individual who has administrative responsibilities for overseeing the drug and alcohol -testing program for an employer. The Program Administrator may serve as an employer's DER. • ProgerU means all employer -owned and/or -leased property, including but not limited to owned and/or leased buildings and other real estate, parking lots and vehicles located on parking lots, and employer -owned and/or -leased vehicles, lockers, tools, equipment and desks. • Random selection means a scientifically valid method for selection of employees to be tested that result in an equal probability that any employee from a group of employees subject to the selection mechanism will be selected, and does not give an employer discretion to waive the selection of any employee under the mechanism. ➢ Fails(ed) to appear for any test (except a pre -employment test) within a reasonable time, as determined by the policy, after being directed to do so by the policy; ➢ Fails(ed) to remain at the testing site until the testing process is complete; (a walk -out) ➢ Fails(ed) to provide a urine specimen for any drug test required by this policy; ➢ In the case of a directly observed or monitored collection in a drug test, fails to permit the observation or monitoring of the employee's provision of a specimen; ➢ Fails(ed) to provide a sufficient amount of urine when directed, and it has been determined, through a required medical evaluation, that there was no acceptable medical explanation for the failure; ➢ Fails(ed) or declines to take a second test the employer or collector has directed the employee to take; ➢ Fails(ed) to undergo a medical examination or evaluation, as directed by the MRO as part of the verification process, or as directed by the policy. In the case of a pre -employment drug test, the employee is deemed to have refused to test on this basis only if the pre -employment test is conducted following a contingent offer of employment; ➢ Fails(ed) to cooperate with any part of the testing process (e.g., refuse to empty pockets when so directed by the collector, behaves in a confrontational way that disrupts the collection process, provides incorrect or inaccurate infonnation to the collection site or on necessary forms, or fails to complete all documents); ➢ Provides a second (2) specimen that is dilute. • Return to Duty test is required once an EAP evaluation has been completed and the counselor has set a date for the test, because of a non -negative (positive) test or refusal to submit as described in this policy. • ScreeninL, test for initial test) means: ■ In drug testing, a test to eliminate "negative" urine specimens from further analysis or to identify a specimen that requires additional testing for the presence of drugs. ■ In alcohol testing, an analytical procedure to determine whether an employee may have a prohibited concentration of alcohol in a breath specimen. ' Screening Test Technician_ (S_T_ f 1 means a person who instructs and assists employees in the alcohol testing process and operates an Alcohol Screening Device (ASD). • SbiContainer means a container that is used for transporting and protecting urine specimen bottles and associated documents from the collection site to the laboratory, •52ecimen means a sample of urine, used for analysis and/or diagnosis. For the purpose of this policy; specimen is defined as urine. " Specimen bottle, means the bottle that, after being sealed and labeled according to the procedures in this policy, is used to hold the urine specimen during transportation to the laboratory. • Snlit specimen means a part of the urine specimen that is sent to a first laboratory and retained unopened, and which is transported to a second laboratory in the event that the employee requests that it be tested following a verified positive test of the primary specimen or a verified adulterated or substituted test result. • Substituted specimen means a specimen with creatinine and specific gravity values that are so diminished that they are not consistent with human urine. • Testing levels means levels at or above when a specimen is determined to be positive, and below when a specimen is determined to be negative. • Third Party Administrator (TPA) means an entity that provides or coordinates one or more chug and/or alcohol testing services to employers. A TPA typically provides or coordinates the provision of a number of such services and performs administrative tasks concerning the operation of drug and alcohol testing programs for employers. This term includes, but is not limited to, groups of employers who join together to administer, as a single entity, the drug and alcohol testing programs of its members (e,g., having a combined random testing pool). • Verified test means a drug test result or validity testing result from a DHHS-certified laboratory that has undergone review and final determination by the MRO. DRUG TESTING BCRC will provide an identification card to each participant which will reflect the results of the Drug & Alcohol Screen Test from the laboratory and as confirmed by the Medical Review Officer (MRO). To implement an appropriate and acceptable program, BCRC has adopted six (6) safeguards that reflect the standards established by the U.S. Department of Health and Human Services (DHHS) Substance Abuse and Mental Health Services Administration (SAMHSA) for testing mandated by the U.S. Department of Transportation. Those safeguards are as follows: The integrity of collected urine specimens will be ensured by utilization of one collection procedure at all sites. Samples will be collected in accordance with federal standards that provide for a continuous chain of custody and which recognize privacy concerns regarding the individuals being tested. 2. Testing will be conducted only by accredited labs that have obtained and retained DHHS certification. 3. All specimens that are positive in an initial screen must then be confirmed by gas chromatography/mass spectrometry (GC/MS). GC/M confirmation is the state-of-the-art drug testing technology, providing a fingerprint of the detected drug. 4. A Medical Review Officer (MRO) will review all drug test non -negatives (positives) prior to verification of positive test results. The MRO is a physician with specialty training and expertise in substance abuse and drug testing. The MRO will review confirmed positive test results to ensure proper procedure, protocol, and reporting. The MRO will interview the individual who has a confirmed positive test result by telephone to investigate whether a legal prescription has caused the specimen to test positive. If the individual has no legal prescription, the MRO will take appropriate steps to report a verified positive to the BCRC Program Administrator, who will then invalidate the employee's certification card. All persons who have tested positive must have their return to work cleared by the EAP. 5. All non -negative (positive) specimens will be retained frozen in a locked facility at the testing laboratory for one (1) year. The retained specimens will be available should the results of that test be disputed or should arbitration or litigation arise out of the actions taken because of the test results. 6. On a periodic basis, BCRC will submit blind pre -tested urine samples with appropriate documentation to the drug -testing laboratory as a means of assuring itself of laboratory proficiency. The drug -testing program will test for the following drugs at these levels: Ana Xte Initial Screening __ ____ Cop f r,matorytest Amphetamines 500 ng/mL 250 ng/mL Cocaine 150 ng/mL 100 ng/mL Marijuana 50 ng/mL 15 ng/mL Opiates (Codeine/Morphine)2000 ng/mL 2000 ng/mL 6-Acetylmorphine (Heroine) 10 ng/mL 10 ng/mL Phencyclidine 25 ng/mL 25 ng/mL Barbiturates 300 ng/mL 200 ng/mL Benzodiazepines 300 ng/rnL 200 ng/mL Methadone 300 ng/mL 200 ng/mL Propoxyphene 300 ng/mL 200 ng/mL MDA-Analogues (Ecstasy) 500 ng/mL 250 ng/mL ".I 114 Col.-.1��� l . Alcohol tests (screening and confirmatory) will be performed on a device that appears on the National Highway Traffic Safety Administration's (NHTSA) Conforming Products List (CPL) and that meets the DOT'S testing requirements. 2. When a specific time for an employee's test has been scheduled, and the employee does not appear at the collection site at the scheduled time, the Breath Alcohol Technician (BAT) will contact the Designated Employer Representative (DER), who may determine that the employee has refused to be tested. 3. For alcohol testing (screening and confirmatory), a breath sample will be collected and analyzed by a Breath Alcohol Technician (BAT) using an Evidential Breath Testing device (EBT). For the screening test, a breath sample may be collected by the Screening Test Technician (STT), using an Alcohol Screening Device (ASD). 4. If the result of the screening test indicates an alcohol concentration of 0.02 or greater, a Breath Alcohol Technician (BAT) will perform a confirmatory test, no less than fifteen (15) and no more than thirty (30) minutes after the completion of the screening test. 5. If the confirmatory test is positive (0.04 and above, BrAC), the Breath Alcohol Technician (BAT) shall immediately notify the BCRC/Employers DER. b. Results of additional tests arranged by an employee, or requested by a medical practitioner, will not be considered, This includes testing of blood samples, hair samples, DNA, or any other testing methods or protocols. Costs related to drug and alcohol testing will be borne by the program except for re -testing of disputed test results by an employee. The issue of payment for the employee's time will be categorized as follows: 1. For new or current union members or employees seeking an initial test, the test is a condition of employment, and employees in the BCRC Program will not be paid for their time in providing a specimen for the initial test. 2. All current employees who are to test for any of the following: Late Random, Probable Cause, Post -Accident, Diluted Re -Test, Return -to -Duty, or Follow-up Testing or Retest due to a flawed or rejected test, will not be paid for their time in providing a specimen for the test. 3. Employees will be paid a stipend by the program for the time necessary to secure subsequent random testing required by the program. (See attachments A thru D) It is understood that such testing will occur on the employee's time. Test to be taken with seven (7) days of notice. 4. D.O.T., Non -Bargaining and Pipe Fitter's Local 597 employees are exempt from the stipend reimbursement. INITIAL TESTING (PRE -EMPLOYMENT) Prospective employees and current employees of BCRC affiliated employers and unions will be subject to the BCRC program. All persons who are eligible and who intend to obtain a BCRC card will be instructed to report to an approved BCRC collection site and to provide a urine specimen for initial (pre -employment) testing and a clear status before starting work for any participating employer. The individual will be directed by BCRC or by their employer, to report to a BCRC approved collection site location. These selected collection sites will have collection kits, chain -of - custody forms, and all other necessary supplies. RANDOM TESTING After the individual's completion of the initial drug test (with a negative result), he/she will be placed in the Random Pool after which he/she will be notified via U.S. mail to report to an approved collection site for a random drug test. The individuals chosen for a random chug test will be selected anonymously, fiom a computerized selection program. Fifty percent (50%) of the currently active BCRC individual cardholders will be selected annually for random testing. Then, on a monthly basis, one -twelfth (1/12) of the selected employees will be notified to submit to a random test in order to update their BCRC identification cards and status. A copy of the form letters notifying individuals of their selection for this random test appears as an attachment A, B, C & D at the back of this booklet. Employees will be required to report to an approved collection site within seven (7) days from the date of the Notice for Random Testing letter in order to maintain their BCRC identification card and status. No employee will be required to submit to a random test more than twice (2) in a twelve (12) month period. All employees will be selected for a random at least once (1) every two (2) years. If an employee does not provide a sample at an approved collection site within seven (7) days of having been notified of a random selection, his/her status in the BCRC Substance Abuse Program will be deemed "Not Available." Employees who fail to report for a random test in the required time should contact the Third Party Administrator (TPA). If an employee does not report for a random test, and it is the first (1) time the employee has failed to report, the TPA may allow the employee to take the test without reporting to the EAP for further review. Employees may choose to take a "First Occurrence Clause" at this time. Employees may utilize this clause only one (1) time. However, once this "First Occurrence Clause" has been utilized, an employee who fails to report for a random test at any time in the future will be required to contact to the EAP for evaluation and to receive instructions on the required procedure(s) for removing the "Not Available" status from his/her card. PROBABLE LAL5E JESTING An employee may be subject to drug and alcohol testing for Probable Cause based on observed and documented unusual behavior. Circumstances sufficient to lead a reasonable person to suspect that an employee is under the influence of, or is in possession of a controlled substance shall be determined by an immediate supervisor and should be confirmed by one other supervisor whenever possible. The immediate supervisor shall document, in writing, the incident and the probable cause basis for such testing. The documentation shall specifically detail the behavior and conduct of the employee, the location, date, time, of observation, conversations, witnesses, (if any), and should be signed by the supervisor who witnessed the incident. Such employees may request that a union representative be available or present prior to any action taken by an employer, if any, at any stage of the policy and its administration. A rapid or express test is authorized for this test at the discretion of the employer or union representative. There is no stipend for these tests. An employer may require an employee to submit to a post -accident drug and alcohol test after the involvement in, or cause of an accident/incident, that causes injury to the employee or another party. The employer may also require an employee to submit to a post -accident drug and alcohol test when the employee is involved in, or causes an accident, which results in damage or destruction to property. Post -accident drug and alcohol testing must be completed within two (2) hours of the recorded accident/incident if BCRC testing facility is located on the job site or within four (4) hours of the recorded accident/incident if an employee is required to go off the job site to a BCRC testing facility. Any employee suspected of unnecessarily delaying the test process will be considered to have refused to submit to testing. In instances of post-accident/incident or probable cause testing for drugs and alcohol, the employee will be transported to the testing facility by the employer. At the option of the employer, the employee may be suspended pending the test result. In the event a negative test result is reported, the employee shall be compensated for all lost time at the appropriate rate within the collective bargaining agreement, straight or premium pay. When an employee is injured in a qualifying accident, priority must be given to the employee's medical treatment before any consideration is given to collecting a specimen for testing. Such employees may request that a union representative be available or present prior to any action taken by an employer, if any, at any stage of the policy and its administration. If an employee is aggrieved by any action taken under this Drug and Alcohol Policy and his/her complaint cannot be resolved, the complaint may, if the employee or Union requests, be referred as grievance under the grievance and arbitration provisions of the employee's collective bargaining agreement. In the event the matter is referred to arbitration, the arbitrator shall be bound substantively by the provision of this Drug and Alcohol Policy. A rapid or express test is authorized for this test at the discretion of the employer or union representative. There is no stipend for these tests, fii ul►� 1l�eCy`itL� t7 lam,9101_R O.1 _ To accommodate owners with emergency work, craft personnel who have not previously held a BCRC identification card or taken an initial drug test, the following provisions will apply when starting for emergency work assignments. 1. Upon arrival at a job location for sign-up, the employer representative (Card Manager) shall request the employee to present his/her BCRC identification card. An individual that does not have a BCRC card at the time of hire will be requested to secure a card and submit to an initial drug test within one (1) day, in order to comply with the BCRC Policy. 2. An employee without a BCRC identification card may work one (1) day. On the second (2) day, a Chain of Custody form (as proof of having submitted to a drug test) or a BCRC card must be presented. 3. An employee who has provided a specimen for testing must bring to the job site his/her copy of the Chain of Custody form, given to him/her by the collection site, as proof that he/she has submitted to an initial test. 4. If the work assignments are consecutive, the employee will be allowed to work for up to a maximum of four (4) days in order for the employee to receive his BCRC identification card and have the employer Card Manager swipe the card for status verification. 5. If the member's work assignment is terminated by his/her employer before the member's status is verified within the allowable four (4) days for verification, and the individual is rehired, the member will have to provide the same employer a BCRC identification card at the second (2) rehiring sign up, and a clear status. Except in the event that the rehire is less then four (4) days from the initial hire date, the Individual, Local and Non -Local, BCRC card holder shall accept and understand that should his/her drug test results be reported as positive, he/she will be subject to disciplinary action up to and including termination without obligation for further compensation by the BCRC affiliated employer. Such termination shall also be subject to the individual's rights under his/her collective bargaining agreement. CARD SYSTEM Employees will be required to give their BCRC Card ID Number to a Card Manager in order for the Card Manager to access the e-mail status confirmation system. Categories are: 1. Not on File (NOF) 2. Not Available (NIA) 3. Clear (CL) STATUS CONFIRMATION Participating employers may verify the status of all BCRC employees, who are working, by having their card status verified on their job site in order to determine if the employee is available or not available under the BCRC program. The employer may use the Phone-in System or Electronic e- mail for verification. When an employee's status is Not Available (NIA), he/she will be advised to contact the BCRC office to resolve the N/A status. The individual may be required to follow the consequences for a non -negative (positive) test within the BCRC Policy. The employer may verify the employee's card after four (4) days to reconfirm the status and if the employee's status is still N/A, the employer may terminate the employee. An employee who receives a status of NIA a second (2nd) time will be referred to the Employee Assistance Program for assessment, and will be required to follow the recommendations of the EAP Counselor before being considered for further assignments. The status of Clear (CL) will be restored only with written approval of the EAP. This procedure will protect the employee's confidentiality and allow the employer to audit the status of his/her employees, which may be required by the owner to be submitted monthly. INSUFFICIENT SPECIMEN A person who provides an insufficient specimen of urine or breath when required to do so shall be referred to an appropriate medical professional for evaluation at the participant's expense. If the medical evaluation fails to reveal an acceptable medical explanation for the inability to provide a specimen, the donor shall be considered to have refused to test and shall be subject to the rules as outlined in this policy. If a legitimate medical reason is revealed, no action shall be taken. DILUTED SPECIMEN An employee providing a diluted specimen will be given the opportunity to return to a collection site within forty-eight (48) hours to provide a second (2nd) specimen, on his/her own time. Employees should refi•ain fiom excessive consumption of fluids prior to the retest. No adverse action shall be taken against any employee based on a first (1) diluted specimen. A second (2nd) diluted specimen, without a valid medical reason, will be treated as a refusal to submit to testing. ADULTERATED. SUBSTITUTED. AND/OR OXIT-OF-TEMPERAIJIBE RANGF SPECIMEN When a urine specimen is reported as adulterated, or substituted, or when the temperature range is below 90 degrees or above 100 degrees F., the employee will be considered to have not cooperated with the testing process, and the test will be considered a refusal to be tested. If the temperature is out of range, the employee will be offered the opportunity to take an additional observed test prior to leaving the site. A refusal to test will be considered non-compliance and the employee will be made "N/A" and referred to the EAP. In addition, the employee who has refused to be tested, or who uses or possesses a counterfeit drug card, shall be subject to employer discipline up to and including discharge, subject to the unions' collective bargaining agreements. 1. An employee who tests non -negative (positive) for drugs and/or alcohol shall be contacted directly by the Medical Review Officer (MRO). If the MRO verifies the results of the non -negative (positive) test, the MRO will notify the individual that he or she is ineligible for work and he/she will be directed to contact the TPA. The BCRC will refer the member to the program's Employee Assistance Program (EAP) for consultation and review. If the MRO contacts the individual and finds that there is a reason for the non -negative (positive) test (an authorized prescriptive medication) the MRO will downgrade the result to a negative, and the individual's card will be marked CL„ 2. In the case of a confirmed non -negative (positive) drug or alcohol test, the Third Party Administrator (TPA) will be notified that the employee's status should be marked "NIA". The "NIA" status will be effective at the moment that a confirmed non -negative (positive) test is received. 3. Before returning to work, an employee must (1) complete an evaluation with the program's Employee Assistance Program provided by the BCRC EAP Provider, (2) follow a treatment plan prescribed by the program's EAP, (3) obtain written documentation from the program's EAP verifying return to duty date, and (4) obtain a negative result on a return -to -duty test. 4. A "NIA" status will not be the sole basis for termination of employment. An employee must contact the BCRC office to resolve an "NIA" status. Only employees who are in non-compliance with this program may be discharged. For the purposes of this provision, "non-compliance" shall mean one or more of the following: • Failure to report to the program's Employee Assistance Program as directed, • Failure to follow and/or complete a EAP-prescribed treatment program, • Failure to take a return -to -duty or follow-up test, • Failure to report for a random test request within seven (7) days, • Failure to submit to a drug or alcohol test when requested to do so by the EAP S. An individual testing positive for a third (3) time in a twelve (12) month period shall not be permitted to take a Return -to -Duty test for one (1) year and his/her BCRC Substance Abuse Card shall be invalidated for the same time period. The individual must also complete an EAP-prescribed treatment program before returning to work. For the purposes of this policy, a negative test must occur before any future non - negative (positive) tests will be counted as additional strikes. 6. An employee whose test results are verified non -negative (positive) by the MRO will be referred to the EAP by the BCRC (TPA). The employee is expected to attend all appointments with the EAP counselor and to follow the EAP counselor's instructions. RETURN -TO -DUTY TESTING The return -to -duty test is required for an employee to be re -instated into the program following a positive test. The participant must have a negative drug test before resuming performance of his/her job duties. This test may not be taken until the counselor has set a date for the test. Follow-up testing for drugs and/or alcohol is a requirement in order for a returning employee to stay in compliance with the BCRC Program. Testing shall be determined by the Employee Assistance Counselor, and will be implemented and monitored by the TPA (BCRC) when the employee returns to work. Follow-up tests must be taken immediately when the TPA contacts the member or the member will be considered non -compliant, made "N/A", and returned to the EAP for further evaluation. IM30"Mve-la V Vmm :. __ la...... An employee who disputes non -negative (positive) results shall have the right to have his/her initial sample independently re -tested by a Department of Health and Human Services (DHHS) certified laboratory of his/her choice, at his/her own expense, within ten (10) working days of when he/she was notified of the test results. A portion of the initial sample shall be forwarded under a chain -of - custody directly by BCRC's testing laboratory to the DHHS laboratory selected by the individual. Review of the drug test result must be performed by a qualified MRO who has been approved by BCRC. If the second lab report shows the presence of a controlled substance, the test result will be considered non -negative (positive). If the second lab report test indicates no presence of a controlled substance, then both tests will be considered negative. The following section only applies when the employee tests due to Post -Accident or Probable Cause: If the test is negative, the affiliated employer will reimburse the individual for compensation lost at the appropriate rate within the collective bargaining agreement, straight or premium pay, during the period of his/her disciplinary suspension or termination and will reimburse the individual for the cost of the re -test. An individual, whose test results are verified non -negative (positive) by the MRO, will be referred to the EAP by the TPA (BCRC). The individual is expected to attend all appointments with the EAP counselor and to follow the counselor's recommendations and requirements. A non -negative (positive) alcohol test conducted on a breath sample cannot be re -tested. All problem situations shall be resolved in accordance with current guidelines and standards established by the U,S. DHHS or Department of Transportation. APPEALS AND PROTECTIONS/, -UST CA115L Employees who are subject to this policy continue to have access to the usual protections provided as a part of their union membership and/or as members of bargaining units covered by collective bargaining agreements. Such individuals may request that a union representative be available or present prior to any action taken by an employer, if any, at any stage of the policy and its administration. if an individual is aggrieved by any action taken under this Drug and Alcohol Policy and his/her complaint cannot be resolved, the complaint may, if the individual or Union requests, be referred as a grievance under the grievance and arbitration provisions of the individual's collective bargaining agreement. In the event the matter is referred to arbitration, the arbitrator shall be bound substantively by the provisions of this Drug and Alcohol Policy. Attachment A -- General Trades BCRC LETTER HEAD Letter of Notice for Random Testine Dear Your name has been randomly selected by BCRC's computer generated selection program to take a random drug test in order to maintain your "Cleat" BCRC identification card status. Our computer program selects the names of one -twelfth (1/12) of 50% of all BCRC cardholders for update each month. No one will be tested in this system more than twice in a twelve month period. You will be required to report to an approved collection site within seven (7) days from the date of this "Notice for Random Testing" letter to stay in compliance with the BCRC policy. In order to avoid any potential interruption in the status of your card, you must be tested no later than midnight the (day) of (Month), 20_. This random test is to be taken on your own time at any of the approved collection sites identified on the enclosed collection site list. You will be mailed a $40,00 stipend for the time necessary to secure random testing as long as your test is taken within seven (7) days of this notice. If you do not take your random test within seven (7) days of this notice, your BCRC card status will be deetned "Not Available". Failure to report for a random test in the required time it will be necessary for you to contact the BCRC office to receive instructions on the required procedure(s) for removing the "Not Available" status fiotn your card. Remember it is your responsibility to keep the BCRC informed of any change in your address or telephone number. The BCRC has contracted with Perspectives as a fully independent, professional Employee Assistance Program (EAP) for you and your family. Perspectives' 24 hour, 7 day a week hotline number is (800) 456-6327. Please contact the BCRC office @ 219-764-9500 or toll free @ 877-988-5400 if you have any questions. Thank you for your cooperation. Sincerely, Robert Anadell Executive Director Attachment B — Nan -Bargaining BCRC LETTER HEAD Letter of Notice for Random - Dear Your name has been randomly selected by BCRC's computer generated selection program to take a random drug test in order to maintain your "Clear" status on your BCRC identification card. Our computer program selects the names of one -twelfth (1112) of 50% of all BCRC cardholders for random updating each month. No one will be tested in this system more than twice in a twelve month period. You will be required to report to an approved collection site within seven (7) days from the date of this "Notice for Random Testing" letter to stay in compliance with the BCRC policy. In order to avoid any potential interruption in the status of your card, you must be tested no later than midnight the (day) of (Month), 20_. If you do not take your random test within seven (7) days of this notice, your BCRC card status will be deemed "Not Available". Failure to report for a random test in the required time will make it necessary for you to contact the BCRC office to receive instructions on the required procedure(s) for removing the "Not Available" status from your card. Remember it is your responsibility to keep the BCRC informed of any change in your address or telephone number. The BCRC has contracted with Perspectives as a fully independent, professional Employee Assistance Program (EAP) for you and your family. Perspectives' 24 hour, 7 day a week hotline number is (800) 456-6327. Please contact the BCRC office @ 219-764-9500 or toll free @ 877-988-5400 if you have any questions. Thank you for your cooperation. Sincerely, Robert Anadell Executive Director Attachment C — Pipe Fitters — Local #597 BCRC LETTER HEAD Letter of Notice for Random Testing Dear Your name has been randomly selected by BCRC's computer generated selection program to take a random drug test in order to maintain your "Clear" status on your BCRC identification card. Our computer program selects the names of one -twelfth (1/12) of 50% of all BCRC cardholders for random updating each month. No one will be tested in this system more than twice in a twelve month period. You will be required to report to an approved collection site within seven (7) days from the date of this "Notice for Random Testing" letter to stay in compliance with the BCRC policy. In order to avoid any potential interruption in the status of your card, you must be tested no later than midnight the (day) of (Month), 20_. Tests may be taken on your Employer /Contractor's time at the collection facility selected from the enclosed list. If you do not take your random test within seven (7) days of this notice, your BCRC card status will be deemed "Not Available". Failure to report for a random test in the required time will make it necessary for you to contact the BCRC office to receive instructions on the required procedure(s) for removing the "Not Available" status from your card. Remember it is your responsibility to keep the BCRC informed of any change in your address or telephone number. The BCRC has contracted with Perspectives as a fully independent, professional Employee Assistance Program (EAP) for you and your family. Perspectives' 24 hour, 7 day a week hotline number is (800) 456-6327. Please contact the BCRC office @ 219-764-9500 or toll free @ 877-988-5400 if you have any questions. Thank you for your cooperation. Sincerely, Robert Anadell Executive Director Attachment D — Pipefitters Local 137 & Springfield Sheet Metal Workers Local 218 BCRC LETTER HEAD Letter of Notice for Random Testing Dear Your name has been randomly selected by BCRC's computer generated selection program to take a random drug test in order to maintain your "Clear" BCRC identification card status. Our computer program selects the names of one -twelfth (1/12) of 50% of all BCRC cardholders for update each month. No one will be tested in this system more than twice in a twelve month period. You will be required to report to an approved collection site within seven (7) days from the date of this "Notice for Random Testing" letter to stay in compliance with the BCRC policy. In order to avoid any potential interruption in the status of your card, you must be tested no later than midnight the (day) of (Month), 20. This random test is to be taken on your own time at any of the approved collection sites identified on the enclosed collection site list. You will be mailed an $80.00 stipend for the time necessary to secure random testing as long as your test is taken within seven (7) days of this notice, If you do not take your random test within seven (7) days of this notice, your BCRC card status will be deemed "Not Available". Failure to report for a random test in the required time it will be necessary for you to contact the BCRC office to receive instructions on the required procedure(s) for removing the "Not Available" status fiom your card. Remember it is your responsibility to keep the BCRC informed of any change in your address or telephone number. The BCRC has contracted with Perspectives as a fully independent, professional Employee Assistance Program (EAP) for you and your family. Perspectives' 24 hour, 7 day a week hotline number is (800) 456-6327. Please contact the BCRC office @ 219-764-9500 or toll five @ 877-988-5400 if you have any questions. Thank you for your cooperation. Sincerely, Robert Anadell Executive Director Attachment E — Failure to Report BCRC LETTERHEAD Dear Your Name was selected on f2go by the BCRC computerized selection process for a BCRC random drag test. You failed to report for the test by the cutoff date of Mate) and your status has been recorded as "Not Available". You must call the BCRC's office for _"autliorizadon" before you can take, y,21ir randomtest. Please call (219) 764- 9500 or toll fi•ee @ (877) 988-5400 to reschedule your randoan. Your "Not Available" status cannot be changed without contacting the BCRC office to resolve this matter. Sincerely, Robert Anadel l Executive Director AUTHORIZATION FOR CONSENT TO DRUG AND ALCOHOL.a ANALYSIS D AUTHORIZATION FOR RELEASE RESULTS I, the undersigned, , do hereby authorize the testing of my body fluids for employment reasons and understand and agree that the results of any such testing will be turned over to the Building and Constructions Resource Center, Inc. and, further that the testing procedures will be limited to tests for prohibited and illegal drugs and controlled substances. I understand that the results of these tests may be used for employment and disciplinary reasons and hereby authorize the release of such information from the laboratory and MRO. I further certify that the urine specimen collected from me is mine and not adulterated or altered in any manner. I have been advised that matters affecting me relative to the interpretation or application of the Drug Policy and subject exclusively to the grievance and arbitration procedure under my collective bargaining agreement (if applicable). Witness Date Time Notary Public Commission Expires Official Seal Signature of Applicant/Employee Employee's Social Security Number Employee's Telephone Number Employee's Address City State & Zip Code (Must be notarized if NO ID) ATTACHMENTII „ BCRC APP.LICANTICARDHOLDER DRUG TEST INFORMATION D INSTRUCTION SHEET BCRC is exercising extreme care to ensure that strict quality control measures are followed in the collection, handling, and analysis of you specimen. You play an important role in this process and should be certain that you have provided an unadulterated specimen to the laboratory. Remember, you are certifying that the specimen which you provide is yours and is unadulterated. Any adulteration or switching of specimen is a breach of BCRC's rules and, if you are employed, may subject you to discipline up to and including termination by your employer. For your own protection and peace of mind, we ask that you: • Provide a picture identification to the collection site/technician at time of arrival; • Be escorted to a collection room and asked to provide an unadulterated specimen in the collection bottle provided. The bottle should be filled to 45 ml; • Return the specimen bottle to the medical technician and witness, initial and date the integrity seals placed on your specimen; • Verify the proper spelling of your name as recorded on the log sheet; • Verify that your social security number has been properly recorded; • Verify that the social security number placed on your specimen bottle is the same as that recorded on the log sheet and the Chain of Custody form. I HAVE READ THE ABOVE AND HAVE HAD AN OPPORTUNITY TO ASK QUESTIONS REGARDING THIS PROCEDURE. BCRC Applicant/Cardholder Signature Date 8f22/2018 Surety Bonds - Certified Companies 229-3420. UNDERWRITING LIMITATION bl: $3,445,000. SURETY LICENSES CN: AL, AK, AZ, AR, CA, CO, CT, DE, DO, FL, GA, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, INM, NY, NO, OH, OK, OR, PA, RI, SO, SDI, TN, TX, UT, VT, VA, WA, WI, WY. INCORPORATED IN: Ohio. Executive Risk Indemnity Inc, (NAIL #35181) BUSINESS ADDRESS: 202E Hall's Mill Road, Whitehouse Station, NJ 08889. PHONE: (215) 640-5259. UNDERWRITING LIMITATION b/: $156,166,000. SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, DE, DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MID, MA, M1, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, No, NO, OH, OK, OR, PA, RI, SC, SO, TN, TX, UT, VT, VA, WA, WV, WI, WY INCORPORATED IN: Delaware. Explorer Insurance Company (NAIL #40029) BUSINESS ADDRESS: P.O. BOX 509039, SAN DIEGO, CA 92150. PHONE: (858) 350-2400 x-2550. UNDERWRITING LIMITATION lak $14,355,000. SURETY LICENSES cjl: AZ, CA, CO, CT, DE, HI, ID, IL, IN, IA, MD, MA, MI, MS, MT, NV, NJ, NM, OR, PA, TN, TX, UT, VT, VA, WA, WV. INCORPORATED IN: California. -L-- Back To -top Fair American Insurance and Reinsurance Company (NAIL #36157) BUSINESS ADDRESS: One Liberty Plaza, 165 Broadway, New York, NY 10006, PHONE: (212) 365-2200. UNDERWRITING LIMITATION b/: $19,390,000. SURETY LICENSES c,M AL., AK, AZ, AR, CA, CO, CT, DE, DO, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MID, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NO, NO, OH, OK, OR, PA, RI„ SC, SD, TN, TX, UT, VT, VA, VI, WA, WV, WI, WY. INCORPORATED IN: New York. Farmers Alliance Mutual Insurance Company (NAIL #19194) BUSINESS ADDRESS: P.O. Box 1401, McPherson, KS 67460. PHONE: (620) 241-2200. UNDERWRITING LIMITATION bl: $17,571,000. SURETY LICENSES c,f/: CO, ID, IA, KS, MN, MO, MT, NE, NM, ND, OK, SO. INCORPORATED IN: Kansas, Farmington Casualty Company (NAIC #41483) BUSINESS ADDRESS: ONE LOWER SQUARE, HARTFORD, CT 06183. PHONE: (860) 277-0111. UNDERWRITING LIMITATION b/: $27,447,000. SURETY LICENSES 01: AL, AK, AZ, AR, CA, CO, CT, DE, DO, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, IMO, MT, NE, NV, NH, NJ, NM, NY, NC, ND, OH, OK, OR, PA, RI, SO, SO, TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: Connecticut. Farmland Mutual Insurance Company (NAIL #13838) BUSINESS ADDRESS: ONE WEST NATIONWIDE BLVD., 1-04-701, COLUMBUS, OH 43215 - 2220. PHONE: (515) 508-3300. UNDERWRITING LIMITATION bl: $16,365,000. SURETY LICENSES cJ/: AL, AZ, AR, CA, CO, DE, DO, FL, GA, ID, IL, IN, IA, KS, KY, MID, MI, MN, MS, MO, MT, NE, NV, NC, NO, OH, OK, OR, PA, SO, SO, TN, TX, UT, VA, WA, WV, WI, WY. INCORPORATED IN: Iowa, FCCI Insurance Company (NAIL #10178) BUSINESS ADDRESS: 6300 University Parkway, Sarasota, FL 34240 - 8424. PHONE: (800) 226-3224 x-2726. UNDERWRITING LIMITATION bl: $54,754,000. SURETY LICENSES Ok AL, AZ, AR, CO, DO, FL, GA, 11L, IN, IA, KS, KY, LA, MD, MI, MS, MO, NE, NO, OH, OK, PA, SC, TN, TX, VA. INCORPORATED IN: Florida. Federal Insurance Company (NAIL #20281) BUSINESS ADDRESS: 202B Hall's Mill Road, Whitehouse Station, NJ 08889. PHONE: (908) 903-2000. UNDERWRITING LIMITATION b/: $393,705,000. SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT, DE, DC, FL, GA, GU, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MP, MT, NE, NV, NH, NJ, NM, NY, NO, NO, OH, OK, OR, PA, PR, RI, SO, SO, TN, TX, UT, VT, VA, VI�, WA, WV, WI, WY. INCORPORATED IN:: Indiana. FEDERATED MUTUAL INSURANCE COMPANY (NAIL #13935) BUSINESS ADDRESS: 121 EAST PARK SQUARE, OWATONNA, MN 55060, PHONE: (507) 455-5200. UNDERWRITING LIMITATION b/: $336,551,000. SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT, DE, DO, FL, GA, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NO, NO, OH, OK, OR, PA, RI, SC, SO, TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: Minnesota. Fidelity and Deposit Company of Maryland (NAlC #39306) BUSINESS ADDRESS: 1299 ZURICH WAY, 5TH FLOOR, SCHAUMBURG, IL 60196 - 1056. PHONE: (847) 605-6000. UNDERWRITING LIMITATION b/: $14,785,000. SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT, DE, DC, FL, CA, GU, HI, ID, IL, IN, IA, KS, KY, LA, ME, MID, MA, MI, MN, NIS, MO, MP, MT, NE, NV, NH, NJ, NM, NY, NO, NO, 01-1, OK, OR, PA, PR, RI, SC, SO, TN, TX, UT, VT, VA, VI, WA, WV, WI, WY. INCORPORATED IN: Maryland. FIDELITY AND GUARANTY INSURANCE COMPANY (NAIL #35386) BUSINESS ADDRESS: One Tower Square, Hartford, CT 06183. PHONE: (860) 277-0111. UNDERWRITING LIMITATION b/: $1,775,000. SURETY LICENSES c,fl: AL, AK, AZ, AR, CA, CO, CT, DE, DC, FL, GA, IT, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NO, NO, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY, INCORPORATED IN: Iowa. Fidelity and Guaranty Insurance Underwriters, Inc. (NAIL #25879) BUSINESS ADDRESS: One Tower Square, Hartford, CT 06183. PHONE: (860) 277-0111. UNDERWRITING LIMITATION b/: $8,899,000. SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT, DE, DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NO, NO, OH, OK, OR, PA, RI, SO, SO, TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: Wisconsin. https://www.fiscaLtreasury.govtfsreports/ref/suretyBnd/c570—a-z.htm#f 8/23 General and Utility Contractors To Whom It May Concern: Per the Pre -Qualification Checklist (b) (ix) — The Robert Henry Corporation has no federal, state or local tax liens or tax delinquencies owed to any federal, state or local taxing body in preceding three (3) years. , , Stephefi R. Henry President 404 South Frances Street - P.O. Box 1407 -South Bend, Indiana 46624 www. ro berth e nrycorp,com - Tel. 574-232-2091 - Fax 574-232-3979 0 Part lI — Section I — Experience Questionnaire St. Joseph County Public Library Project Completed 2009 — Contract Amount - $4,050,604. South Bend Transportation and Maintenance Facility Project Completed October 2010 — Contract Amount - $20,170,000. Ft. Wayne/South Bend Catholic Diocese — Marian High School Project Completed August 2011 - Contract Amount $557,000 Penn/HarrislMadison School Corporation Project Completed August 2011 - Contract Amount $3,320,000 Gurley Leep Addition and Remodel Project Completed December 2011 — Contract Amount $1,073,441 Elkhart County Library Projected Completed March 2012 - Contract Amount - $420,000 St. Joseph High School Project Completed June 2012 - Contract Amount - $2,000,000 Potawatomi Conservatory Project Completed June 2012 - $1,180,000 Granger Community Medicine Project Completed January 2013 - $904,000 Whole Foods Project Completed March 2013 — $435,000 Roseland Animal Hospital --- Project Completed May 2013 - $780,000 St. Joseph County Library Digital Lab Job Completed June 2014 - $188,000 St. Jude Catholic Church Renovation Project Completed August 2013 - $3,524,000 Gurley Leep Audi Project Completed September 2014 - $1,018,000 Saint Joseph Regional Medical Center — ER Addition Plymouth - $4,900,000 Completed July 2015 Church of Jesus Christ of Latter Day Saints — Addition — $1,465,000 Completed July 2015 Cassopolis Hight School — Interior Finishes - $312,444 Completed Summer 2016 Penn High School Football Stadium - $1,093,000 Completed Summer 2017 Gurley Leep Honda Store - $5,722,000 Completed Fall 2017 2. Current Projects in Progress: Trinity Health PACE Project - $2,500,000 Leighton Hall Addition — University of Notre Dame - $439,994 Dowagiac Federal Credit Union - $120,684 Northwest Family Medicine - $225,260 Siemens Mishawaka - $278,149 St. Joe Regional Medical Center — Pavilion II - $383,806 University Park Family Medicine - $392,506 3. Have you ever failed to complete work awarded to you? NO 4. References from Private Firms: • Father Michael Heintz — St Matthew's Cathedral — 574-289-5539 • Mr. Mike Stahly — South Bend Public Transportation — 574-532-6852 • Mr. Don Napoli — St. Joseph County Public Library — 574-282-4646 Part II — Section II — Plan and Equipment Questionnaire 1. A detailed quantity survey has been made from the contract plans and specifications. Sufficient manpower is available to begin work 10 days to 2 weeks after Notice of Award. We anticipate completion per plans and specifications. 2. A list of subcontractors will be provided within 24 hours of Notice of Award. 3. A lit of subcontractors will be provided within 24 hours of Notice of Award. It is not anticipated that a bond will be required from subcontractors. 4. All required equipment will be provided for this project. 5. Yes.