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HomeMy WebLinkAboutOpening of Bids - WWTP Electrical Improvements Proj No 117-132 - J. Ranck Electric Inc' 00 ga r M CITY OF SOUTH BEND INDIANA CONTRACTOR'S BID FOR PUBLIC WORK Project Name City of South Bend Wastewater Treatment Plant Electrical Improvements . _ ....... ... Project No. 117-132 For Bids Due November 13, 2018 PART (Must be completed for all bids. Please type or print) Date: Nov. 26, 2018 Bidder (Firm): J. Ranck Electric Inc. Address: 1993 Gover Parkwav City/State/Zip: Mt. Pleasant, MI 48858 Telephone Number: ( 989 ) 775-7393 Agent of Bidder (if Applicable): N/A Pursuant to notices given, the undersigned offers to furnish labor and/or material necessary to complete the public works project of: Wastewater Treatment Plant Electrical Improvements, Project No. 117-132 the City of South Bend, Indiana, in accordance with plans and specifications prepared by: Black & Veatch Corporation and dated October 17 2018 for the sum of (enter the Total Bid as shown on the Proposal) y� (Enter sum of Total Base Bid plus Alternates sho= 0nposa Prol) p , � - (Nur-herical) �.J cry The undersigned further agrees to furnish a bond or certified check with this bid for an amount specified in the notice of the letting. If alternative bids apply, the undersigned submits a proposal for each in accordance with the notice. Any addendums attached will be specifically referenced at the applicable page. If additional units of material included in the contract are needed, the cost of units must be the same as that shown in the original contract if accepted b t e City of South Bend. If the bid is to be awarded on a unit basis, the itemization of the units shall be s n o"—separate att ol�"' .. By The above bid is accepted this Subject to the following conditions: BOARD OF PUBLIC WORKS Gary A. Gilot, President Elizabeth A. Maradik, Member James A. Mueller, Member #n Levert (Printed Name of Person Signing) ACCEPTANCE day of Suzanna M. Fritzberg, Member Therese J. Dorau, Member Attest: Linda M. Martin, Clerk Version 7/20/2018 Contractor's Bid for Public Work - 2 c BID/PROPOSALaty mws CITY OF SOUTH BEND Project Name: City of South Bend Wastewater Treatment Plant Electrical Improvements; Project Number: 117-132.'r � For Bids Due: November 13, 2018 wr�rws Contractor Name: BASE BID Item Description No. Quantity Unit Unit Price Total Amount Electrical and SCADA Communication 1 Improvements, including all labor and 1 SumLump ! 7 0) 7 ®" 770 materials to complete the Work j i BASE BID TOTAL , D ALTERNATES Item Description Quantity No. Unit Unit Price Total Amount I Gallery 4 Shed and Containment Box 2 Demolition 1 Lump Sum'22 DewaterinRiverside Drive g Well Removal — East of 3 7 / �j c( 1 I a Each �a 11 "1 Concrete Containment 4 1 Lum v 31,Zs, 1 25, Demolition _ Sum ALTERNATES TOTAL " The City of South Bend will award the subject project based on a review of all Base Bids or Base Bids plus Alternate(s) to the lowest, responsive, responsible bidder. The City of South Bend reserves the right to award the Base Bid or the Base Bid plus any combinations of Alternate(s) with respect to available funding for the project. Bidder (Firm): J. Ranck Electric, Inca Address: 1993 Gover Parkway City/State/Zip: Mt. Pleasant, MI 48858 Telephone Nufb r: /(" '9 ) 775-7393 � (Signature) JIII Levert (Printed Name of Person Signing) Version 7/20/2018 Contractor's Bid for Public Work - 7 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 MICHIGAN ) ISABELLA ) SS: ,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. 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: 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 7/20/2018 Contractor's Bid for Public Work - 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. I, 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). I 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 7/20/2018 Contractor's Bid for Public Work - 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. Dated this 26th day of NOV 920 18 J. Ran lectric, Inc. ptract i,/lax lder (Firm) of Contractor/Bidder or 1 `'Jinn Levert Estimator Printed Name and Title Subscribed and sworn to before me this 26th day of November , 20 '1 t My Commission Expires December3,,2019 Not Public Janice AaRose County of Residence Clare, MI Version 7/20/2018 Contractor's Bid for Public Work - 6 Tttri, CINCINNATI INSURANCE COMPANY CINCINNATI,0111tw KNOW ALL MEN BY THESE PRESENTS, thatwe J. Ranck Electric, Inc. as Principal„ hereinafter called the Principal, and THE CINCINNATI INSURANCE COMPANY, a corporation duly organized, under the laws of the State of Ohio„ as Surety, hereinafter called the Surety, are held and firmly bound unto City of South Bend as Obligee, hereinafter called the Obligee, in the sum of Five Percent of Bid Dollars ($ 5% of Bid ), for the payment of which sum well and truly to be made, the said Principal and the said Surety, bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. WHEREAS, the Principal has submitted a bid for South Bend Wastewater Treatment Electrical Improvements NOW, THEREFORE, if the Obligee shall accept the bid of the Principal and the Principal shall enter into a Contract with the Obligee in accordance with the terms of such bid, and give such bond or bonds as may be specified in the bidding or Contract Documents with good and sufficient surety for the faithful performance of such Contract and for the prompt payment of labor and material furnished in the prosecution thereof, or in the event of the failure of the Principal to enter such Contract and give such bond or bonds, if the Principal shall pay to the Obligee the difference not to exceed the penalty hereof between the amount specified in said bid and such larger amount for which the Obligee 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. Signed and sealed this 14th day of November, 2018. (Wr ess) Amanda Schulte (Witness) J. Ranck Electric, Inc. (Principal) (Seal) ,J lie "V. Smith t a rt�e Management ', Director C INC INNATI INSURANCE COMPANY (Surety) (Seal) as Sue Gillett ttum y-in Fact Printed in cooperation with the American Institute of Architects (AIA), by The Cincinnati Insurance Company whc, vouches that the language in this document conforms exactly to the language used in AIA Document A310, February 1970 ED. S- 000-AI (4k)9) t'ttT 11C Fairfield, Ohio POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That THE CINCINNATI INSURANCE COMPANY, a corporation organized under the laws of the State of Ohio, and having its principal office in the City of Fairfield, Ohio, does hereby constitute and appoint Paul Wiese; Lenny J. Wilkins; Sue Gillett; Mark Wiess H and/or Amanda Schulte of Bay City, Michigan its true and lawful Attomey(s)-in-Fact to sign, execute, seal and deliver on its behalf as Surety, and as its act and deed, any and all bonds, policies, undertakings, or other like instruments, as follows: Any such obligations in the United States, up to Twenty Five Million and Noll00 Dollars ($25,000,000.00). This appointment is made under and by authority of the following resolution passed by the Board of Directors of said Company at a meeting held in the principal office of the Company, a quorum being present and voting, on the 61 day of December, 1958, which resolution is still in effect: "RESOLVED, that the President or any Vice President be hereby authorized, and empowered to appoint Attomeys-in- Fact of the Company to execute any and all bonds, policies, undertakings, or other like instruments on behalf of the Corporation, and may authorize any officer or any such Attomey-in-Fact to affix the corporate seal; and may with or without cause modify or revoke any such appointment or authority. Any such writings so executed by such Attorneys -in - Fact shall be binding upon the Company as if they had been duly executed and acknowledged by the regularly elected officers of the Company." ']'his Power of"Attorney is signedand scaled by facsimile under and by the authority of the following Resolution adopted by the Board of I)irectors of the Company at a Meeting daily cared and hell on the 711 day of December, 1973. "RESOLVED, that the signature of the President or a Vice President and the seal of the Company may be affixed by facsimile on any power of attorney granted, and the signature of the Secretary or Assistant Secretary and the seal of the Company may be affixed by facsimile to any certificate of any such power and any such power of certificate bearing such facsimile signature and seal shall be valid and binding on the Company. Any such power so executed and sealed and certified by certificate so executed and sealed shall, with respect to any bond or undertaking to which it is attached, continue to be valid and binding on the Company." IN WITNESS WHEREOF, THE CINCINNATI INSURANCE COMPANY has caused these presents to be sealed with its corporate seal, duly attested by its Vice President this 81 day of March, 2017. q7g,0QRKRJkTE THE CINCINNATI INSURANCE COMPANY _...............................................................................................�.�........................ Vine President STATE OF OHIO ) ss: COUNTY OF BUTLER ) On this 81 day of March, 2017, before me came the above -named Vice President of THE CINCINNATI INSURANCE COMPANY, to me personally known to be the officer described herein, and acknowledged that the seal affixed to the preceding instrument is the corporate seal of said Company and the corporate seal and the signature of the officer were duly affixed and subscribed to said instrument by the authority and directimi of said corporation. 0 , q b MARK J. H LLER, Attorney at Law r " NOTARY PUBLIC - STATE OF OHIO r „fir My commission has no expiration date. Section 147.03 O.R.C_ I, the undersigned Secretary or Assistant Secretary of THE CINCINNATI INSURANCE COMPANY, hereby certify that the above is a true and correct copy of the Original Power of Attorney issued by said Company, and do hereby further certify that the said Power of Attorney is still in full force and effect. GIVEN under my hand and seal of said Company at Fairfield, Ohio. this 14th day of November, 2018 Am Itkt•" �aa�arr SEAL. �irra . BN-1005 (3/17) _.�.,� .-_.. ...... ... . Secretary .► .* ► ► ► 1,1 filly-111114N Z, 01 NO, Date: November 5,, 2018 PITONE 574/235-9251 FAx 574/ 235-9171 T'DD 574/ 235-5567 To: All Planholders From Linda M. Martin, Clerk, Board of Public Works Subject Addendum Number: 1 ........... .......... _ Project Name: Wastewater Treatment Plant Electrical Improvements Project Number: 117-132 ACKNOWLEDGEMENT OF RECEIPT OF ADDENDUM Date Received: 11 /5/2018 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. THIS ADDENDUM MAY AFFECT YOUR BID. Notes: The attached documents are hereby added to the Specifications and Contract Documents and become a part of herein. Company: J. Ranck ft tric lrlc Authorized Signature: - "' Jim Levert Date: 11/26/2018 Version 4/2/2015 1316 COUNTY -CITY BUILDING 227 W. JEFFERSON BOULEVARD PHONE 574/235-9251 FAx 574/ 235-9171 T D 574/ 235-5567 CITY OF • l ' BOARD OF PUBLICWORKS Date: November 16, 2018 To: All Planholders From Linda M. Martin, Clerk, Board of Public Works Subject Addendum Number: 2 Project Name: Wastewater Treatment Plant Electrical Improvements Project Number: 117-132 ACKNOWLEDGEMENT OF RECEIPT OF ADDENDUM Date Received: 11/16/2018 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. THIS ADDENDUM MAY AFFECT YOUR BID. Notes: The attached documents are hereby added to the Specifications and Contract Documents and become a part of herein. Comps Author Date: Version 4/2/2015 Uf CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK,��`°_ ' CHECKLIST FOR BIDDERS Project Name City of South Bend Wastewater Treatment Plant Electrical Improvements Project No. 117-132 For Bids Due November 13, 2018 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 X or Bid Bond. Bid prepared on the City of South Bend Contractor's Bid for Public Work Form, completely X executed. Contractor's Non -Collusion and Non -Debarment Affidavit, Certification Regarding Investments with Iran, Employment Eligibility Verification, Non -Discrimination Commitment, and X.. Certification of use of United States Steel Products or Foundry Products. Proof of MBE/WBE 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 Form [MWBE-2.1]. X Acknowledge Receipt of 2 Addendum(s) included with the bid. X All required additional information is included with the bid. Proposal statements and other affidavits all signed by the proper party with name either X printed or typed underneath signature. X 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. Bidder: J. By Authorized Signature: Print Name & 1 Version 7/20/2018 Ranck Electric Inc. Date: November 26, 2018 Contractor's Bid for Public Work - 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 7/20/2018 Contractor's Bid for Public Work - 3 U) w w G w cn a' ag w mw0 a' a OZZ Nyw 0m0 v2> Ow z a 0 z I z 0 aoa w0 00 � �a �w � 00 O� a w Cm C c w O mE Q-''O E ` m O w •� m cc wg 0o m tmo c_ c >o > m c 0 - a= tr d ' o0 IL Y +) � d O d E N � O mm L E '3 o ` U) o o� V c c � 'a7 w � U1 � L !Q l0 L � a+ � � L m L L 3 m > a° C 7 �+ U! d L L 'U) O 0a O N L U) E d O O N UJ 4) U) � � C a �_ U) E.0M N C 0 a) E m Z U a) O a` N M ti 0 c 0 E Q m 0 F- .L U a) W Y U C m w b V V J t N E a) E m z c ,u Y O U _O m 0 U C 0 U 00 cra: r a� CITY OF SOUTH BEND %� MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY DEVELOPMENT PROGRAM��t FORM MWBE-2.0` EVIDENCE OF GOOD FAITH EFFORTS This completed form should be included as part of the Bids documents related to City of South Bend Public Works Projects requiring Good Faith Efforts to obtain MBEIWBE participation. It is the bidder's sole responsibility to verify whether any listed minority or woman business meets the qualifications of a Minority or Women's owned business as defined by the Indiana Department of Administration ("IDOA"). Project Number: 117-132 Date: 11/27/18 Project Name: _City of South Bend Wastewater Treatment Plant Electrical Improvements Bidder: J. Ranck Electric Inc. Contact Person„ a�.im LPyo. ..,- ............._ Telephone: � 989 �21-1129 Address: 1993 Gover Parkwa City: Mt. Pleasant State; �j D� zips 48858 Email: .levert ranck.com To determine whether a bidder has demonstrated good faith efforts to reach the MBE/WBE utilization goals set forth in the City of South Bend Public Works Project Specifications, the City and its agencies, boards, or commissions, REQUIRE ALL of the following Good Faith Efforts as listed in the table below*: EVIDENCE OF GOOD FAITH EFFORTS MBE/WBE LIST(S): The bidder reviewed the City of South Bend's Minority and Women Business Enterprise Diversity Development Program, which uses the IDOA approved list of Minority and Women Owned Business as found on their website (hftp://www.in.gov/idoa). ACTION (ADVERTISE/CONTACT): In order for your bid to be deemed responsive, the City of South BT,.d requires that all perspective bidders complete no less than 2 of the following: Attend all pre -bid meetings scheduled by the City to inform MBE/WBEs of contracting and subcontracting opportunities. 2. Advertise in general circulation and/or trade association publications concerning subcontracting opportunities, and allow MBE/WBEs reasonable time to respond. Perform any and all necessary steps to provide written notice in a manner reasonably calculated to inform MBE/WBEs of subcontracting opportunities and allowed sufficient time for them to participate effectively. Utilize pre-existing services of available community organizations, small and/or disadvantaged business assistance offices and other organizations that provided assistance in the recruitment and placement of MBE/WBE firms. **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 MBE/WBEs, including providing such MBE/WBE'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 MBE/WBEs in order to increase the likelihood of meeting the MBE/WBE goals (including breaking down contracts into smaller units to facilitate MBE/WBE participation) CONTRACT RECORDS: The bidder has maintained the following records for each MBE/WBE that has bid on the subcontracting opportunity: 1. Name, address, and telephone number; 2. A description of information provided by the bidder or subcontractor; and 3. A statement of whether an agreement was reached, and if not, why not, including any reasons for concluding that the MBE/WBE was unqualified to perform the job. *Proper demonstration of Good Faith Effort requires your initials next to all of the above boxes. Any omissions shall be considered grounds for rejection of the bid by the Board of Public Works. The City of South Bend reserves the right to request additional information. Version 7/20/2018 Contractor's Bid for Public Work - 9 IJ 11I CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY DEVELOPMENT PROGRAM FORM MWBE-2.1' MBE/WBE CONTACTED '� " This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects requiring contacted MBE/WBE to obtain Good Faith Efforts. It is the bidder's sole responsibility to verify whether any listed minority or woman business meets the qualifications of a Minority or Women's owned business. Project Number: Project Na e: Bidder By: PAGE 1 OF 8 117-132 MBE/WBE Participation Goal City ofwSouth Bend Wastewater Treatment Plant Electrical Improvements J. Ranck E Estimator (Title) 11/26/18 (Date) MBE/WE Firm Atlas Excavatin m 4740 Swisher Road West Lafa ette N 47906 Owner or Contact at MBE/WBE Firm Telephone: 765 4294BDD Fax: Email: TYPE OF WORK SOLICITED FOR THIS PROJECT: RESULTS OF CONTACT WITH THE MBE/WBE FIRM: MBE/WBE Firm Busch Landsca in LLC 5703 US-421 Os god„SIN 47037 .. Owner or Contact at MBE/WBE Firm Melodie Busch Telephone: 812 852-5800 Fax: Email: TYPE OF WORK SOLICITED FOR THIS PROJECT: Erosion Control RESULTS OF CONTACT WITH THE MBE/WBE FIRM: ........W . called on 11/5/1 phone could not connect" i t v 'I le" Version 7/20/2018 Contractor's Bid for Public Work - 10 CITY OF SOUTH BEND ON, MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY DEVELOPMENT PROGRAM rrMk FORM MWBE-2.1 MBE/WBE CONTACTED This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects requiring contacted MBE/WBE to obtain Good Faith Efforts. It is the bidder's sole responsibility to verify whether any listed minority or woman business meets the qualifications of a Minority or Women's owned business. Project Number: 117-132 PAGE 2 OF 8 MBE/WBE Participation Goal Project Nam Cityof South Bend Wastewater Treatment Plant Electrical Improvements Bidder: J. Ranck Electric Inr, By: Estimator (Title) 11/26/18 (Date) Firm Caretaker Landscaping & Lawny, LLC 4285 N 525 W La Porte IN 46350 Owner or Contact at MBEM/BE Firm Kathleen Kellv Telephone: 219 878-3218 Fax: Email: cystomoraervice0caretak dan ca ina.com TYPE OF WORK SOLICITED FOR THIS PROJECT: Emig .... RESULTS OF CONTACT WITH THE MBEM/BE FIRM: o since that d@y With no r95pQn5 - -• MBEMIBE Firm Cazares Concrete LLC 6358 N 100 W Alexandria IN 46011 Owner or Contact at MBEM/BE Firm Francisco Cazares._______ ....._ Telephone: 765 649-7159 Fax . Email: f.cazares..._ caz.c..o....nllc.com w TYPE OF WORK SOLICITED FOR THIS PROJECT: Concrete RESULTS OF CONTACT WITH THE MBEM/BE FIRM: read recei is bask. Version 7/20/2018 Contractor's Bid for Public Work - 10 CITY OF SOUTH BEND w"00 h MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY; DEVELOPMENT PROGRAM FORM MWBE-2.1 r MBE/WBE CONTACTED " This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects requiring contacted MBE/WBE to obtain Good Faith Efforts. It is the bidder's sole responsibility to verify whether any listed minority or woman business meets the qualifications of a Minority or Women's owned business. Project Number: Proje Oa Bidder," By _..._ i nature) 117-132 PAGE 3 OF 8 MBE/WBE Participation Goal City of South Bend Wastewater Treatment Plant Electrical Improvements._ c, Inc. - Estimator (title) MBEANSE.,firm CLS Industries 3960 IN-60 Salem IN 47167 Owner or Contact at MBE/WBE Firm ardy Short Telephone: 12 3-4492 Fax: TYPE OF WORK SOLICITED FOR THIS PROJECT: --- E.S sJDn_=t La _ RESULTS OF CONTACT WITH THE MBE/WBE FIRM: Email: 11 /26/18 (Date) MBENVBE Firm Cornerstone Construction Group, LLC 1456 Aetna Street, Gary, IN 46403 � Owner or Contact at MBE/WBE Firm Nakia Lunn Telephone: (219) 979-5004 Fax: Email' TYPE OF WORK SOLICITED FOR THIS PROJECT: _. Concrete RESULTS OF CONTACT WITH THE MBE/WBE FIRM: We called n 1 /31118 and 11/5/18. First cell ng. n w r. second callsaid "line no loner in use" Version 7/20/2018 Contractor's Bid for Public Work - 10 CITY OF SOUTH BEND 0VTh�"� MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY DEVELOPMENT PROGRAM'' FORM MWBE-2.1 MBENVBE CONTACTED This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects requiring contacted MBE/WBE to obtain Good Faith Efforts. It is the bidder's sole responsibility to verify whether any listed minority or woman business meets the qualifications of a Minority or Women's owned business. PAGE 4 OF 8 Project Number: 117-132 MBE/WBE Participation Goal Project N in N Cityof South Bend Wastewater Treatment Plant Electrical Improvements Bidder,, J. Ranck Electric By: Estimator (Title) 11 /26/18 (Date) MBENVB, F)rm I otlich Trucking Excavating 830 Ironwood E Drive Brownsburg, IN 46112 Owner or Contact at MBE/WBE Firm Annie Dotlicb Telephone: 317 852-2692 Fax: Email: TYPE OF WORK SOLICITED FOR THIS PROJECT: RESULTS OF CONTACT WITH THE MBE/WBE FIRM: f . . I z ra 111541r. Romimillis .. •. MBE/wBE Firm Fox Contractors Corporation 5430 W Far on Road' Fort Wayne, IN 46809 Owner or Contact at MBEM/BE Firm Dallas D ay Telephone: 260 747-7461 Fax: Email; TYPE OF WORK SOLICITED FOR THIS PROJECT: Excavating, grading RESULTS OF CONTACT WITH THE MBE/WBE FIRM: ll n 1 Q/31/18 no_r. -we ft rn.ossaae. Version 7/20/2018 Contractor's Bid for Public Work - 10 `yry4s4i�,��- CITY OF SOUTH BEND, MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY DEVELOPMENT PROGRAM µ FORM MWBE-2.1`` M MBEIWBE CONTACTED This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects requiring contacted MBE/WBE to obtain Good Faith Efforts. It is the bidder's sole responsibility to verify whether any listed minority or woman business meets the qualifications of a Minority or Women's owned business. PAGE 5 OF 8 Project Number: Project Na Bidder: By: 117-132 Ci!r of So�ctric, J. Ranck MBE/WBE Participation Goal Treatment Plant Electrical Im Estimator (Title) 11 /26/w18 (Date) MBENVBE FirnY H & H Construction Service 1111 S Franklin Road Indiana olis IN 46239 Owner or Contact at MBENVBE Firm Telephone: -J75- 114 Fax: Email: TYPE OF WORK SOLICITED FOR THIS PROJECT: RESULTS OF CONTACT WITH THE MBENVBE FIRM: MBENVBE Firm HASCO. Inc. 5349 E Whitestowvn I arkwav, Lebanon. IN 46052 Owner or Contact at MBENVBE Firm Carla Merrill Telephone: 317 769-7283 Fax: Email: TYPE OF WORK SOLICITED FOR THIS PROJECT: Asphalt, and Gradin RESULTS OF CONTACT WITH THE MBENVBE FIRM: no answer Version 7/20/2018 Contractor's Bid for Public Work - 10 CITY OF SOUTH BEND ;e MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY DEVELOPMENT PROGRAM ,; M9 P FORM MWBE-2.1 MBEIWBE CONTACTED IgO This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects requiring contacted MBE/WBE to obtain Good Faith Efforts. It is the bidder's sole responsibility to verify whether any listed minority or woman business meets the qualifications of a Minority or Women's owned business. PAGE 6 OF 8 Project Number: Project Name: Bidder: By: _ C_ 117-132 MBE/WBE Participation Goal City of South Bend Wastewater Treatment Plant Electrical Imor J. Ranck E Estimator (Title) 11 /26/18 (Date) _Indiana Reclamation & Excavatin 7720 Records Street Indianapolis, IN 4622 Owner or Contact at MBE/WBE Firm Telephone: 317 800-1836 Fax: TYPE OF WORK SOLICITED FOR THIS PROJECT: RESULTS OF CONTACT WITH THE MBE/WBE FIRM: Email: tkivett inrecex.com _w-e-cale w + 8 nd 41 /19/ B Ckaoy illmtquQt ,._h st.%d.. .d. o .e .-o him.,.he,— won't be available to do anything until next spring see attached emails . MBE/WBE Firm J.,,,R. Kell C_ mo an , Inc, 3450 Concord Road Lafayette, IN 47909 Owner or Contact at MBE/WBE Firm _Elizabeth Spencer Telephone: (765) 772-3991 Fax: Email:. TYPE OF WORK SOLICITED FOR THIS PROJECT: IV*1010&KOI S101ar_T441ILT 119:NI:I:8►LTil 7:fty,i -*191:1Bit We called on 10/31 /18. They will not quote, they do not travel that far. Version 7/20/2018 Contractor's Bid for Public Work - 10 CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY ­ DEVELOPMENT PROGRAM t FORM MWBE-2.1 MBEIWBE CONTACTED ","65 This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects requiring contacted MBE/WBE to obtain Good Faith Efforts. It is the bidder's sole responsibility to verify whether any listed minority or woman business meets the qualifications of a Minority or Women's owned business. Project Number: Project Nam Biidd'er, By: PAGE 7 OF 8 117-132 _ ......mmm m._. . .._.._.....- MBE/WBE Participation Goal of South Bend Wa tewnrater Treatment Plant Electrical Improvements J. Ranck Electri c. Estimator (Title) 11 /26/18 (Date) MBE/WBE­Firm pKS Construction 450 S Ritter Avenue Suite A Indianapolis IN 46219 Owner or Contact at MBE/WBE Firm Telephone: 317 354-1070 Fax: TYPE OF WORK SOLICITED FOR THIS PROJECT: C RESULTS OF CONTACT WITH THE MBE/WBE FIRM: Email: - - �� 1 .4• �- ��- - �- t so MBE/WBE Firm Price Construction 10645 Deme Drive Suite B Indianapolis IN 46236 Owner or Contact at MBENVBE Firm Nakia Price Telephone: Fax: Email;. (317 728-201 TYPE OF WORK SOLICITED FOR THIS PROJECT: Concrete _,,,,, RESULTS OF CONTACT WITH THE MBE/WBE FIRM: We called n_10 18 they will not►otew.wnr r tcl. they do not travel that far. Version 7/20/2018 Contractor's Bid for Public Work - 10 CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY;' r DEVELOPMENT PROGRAM FORM MWBE-2.1 . MBEfWBE CONTACTED 1"65 " This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects requiring contacted MBE/WBE to obtain Good Faith Efforts. It is the bidder's sole responsibility to verify whether any listed minority or woman business meets the qualifications of a Minority or Women's owned business. Project Numbe Project Nam Bidder: By: PAGE 8 OF 8 117-132 MBE/WBE Participation Goal City' of South Bend Wastewater Treatment Plant Electrical Imor Ranck Ele Estimator (Title) 11 /26/18 (Date) MBE/WBE Fft/ Ritschard Bros Inc. 1204 W Sample Street South Bend IN 46619 Owner or Contact at MBE/WBE Firm Telephone: 574 288-4777 Fax: Email: rit1204 datacruz.com TYPE OF WORK SOLICITED FOR THIS PROJECT: RESULTS OF CONTACT WITH THE MBE/WBE FIRM,. -• • • : r • i •• - •d- - - e-, drawin • - _ +w w - r - n MBE/WBE Firm S & S Keller 4239 N Meridian Road Huntin ton IN 46785 Owner or Contact at MBE/WBE Firm an Keller Sir, Telephone: 317 728-3201 Fax: Email: stansr@sskeller.com TYPE OF WORK SOLICITED FOR THIS PROJECT: Concrete RESULTS OF CONTACT WITH THE MBE/WBE FIRM We palled n 11/61.. , . 1 1 �11 1�4.L I Co n email address. Afte n_ in tiM_dr�ng..!LLQ _him, he told me due to work load he will not rouide a gq;te see attached emails . Version 7/20/2018 Contractor's Bid for Public Work - 10 A in, Ja den From: Agin, Jayden Sent: Monday, November 05, 2018 10:16 AM To: 'customerservice@caretakerlandscaping.com' Cc: Madlem, Cody; Levert, Jim Subject: South Bend WWTP — Quote Request - Erosion Control Attachments: 117-132 WWTP Electrical Improvements - Drawings 9.pdf, 117-132 WWTP Electrical Improvements - Drawings 10.pdf Please review the drawings in the above attachments, a full set of the drawings is in the link below. South Bend WWTP Documents Thank you, Jayden JAYIII IE!N AGIN IE;;S"'IrIIII IA"'T"IIIII G ASSIS"'I1FAIII'4 T"' 800-792-3822 Ext. 2,114.�.... " 1 �. SAFETY. QUALITY. INTEGRITY. FAMILY. EVERY DECISION. EVERY DAY. ,Agin, Ja den From: Agin, Jayden Sent: Wednesday, November 21, 2018 10:13 AM To: customerservice@caretakerlandscaping.com Subject: South Bend - Quote Request Hello, I am wondering if you are still interested in providing a quote for the erosion control work at the South Bend WWTP project? If you have any questions feel free to contact me at (989) 334-3168 or by email. Thank you, JAYIIE,N AGIN ESTHIVIA"'rING ASSIS"'T"AN'T J. Ran k Electric, Eris, 9nc, gjn r�kx2m 800 ...7 w'r` i2114� ... c'1� ,w�x�� 'd.�£ SAFETY. QUALITY. INTEGRITY. FAMILY, EVERY DECISION. EVERY DAY. A in, JaXden From: Agin, Jayden Sent: Monday, November 26, 2018 11:18 AM To: customerservice@caretakeriandscaping.com' Subject: South Bend - Quote Request Good morning, I just wanted to verify that you would still be able to provide a quote today for the South Bend WWTP project. Please let me know. Thank you, JAYDEN AGIN ESTIMATING ASSISTANT J, Ranck Electric, Inc, I iagiriftrainck.corn 7 SAFETY. QUALITY. INTEGRITY. FAMILY, EVERY DECISION. EVERY DAY. Agin, Ja den From: Agin, Jayden Sent: Friday, November 09, 2018 3:15 PM To: 'f.cazares@cazconllc.com' Cc: Levert, Jim; Madlem, Cody Subject: South Bend - Quote Request Tracking: Recipient Read 'f.cazares@cazconl Ic.com' Levert, Jim Read: 11/9/2018 3:22 PM Madlem, Cody Hello, I was wondering if you would be interested in quoting some concrete work at the South Bend Waste Water Treatment Plant. The work would consist of the following: concrete curbs, gutters, sidewalks, and generator pads. Feel free to contact me if you have any questions or if you are interested in quoting, I can send you the drawings. Quotes would have to be sent to me by Nov. 26, 2018. The concrete work will happen next year. Thank you, JAYDEN i ASSISTANTESTIMATING SAFETY. QUALITY, INTEGRITY. FAMILY, EVERY DECISION. EVERY DAY. st IxRANCK N yip r ELECTRIC, INC. 11 A 2in, Ja den From: F. Cazares <f.cazares@cazconllc.com> Sent: Monday, November 12, 2018 8:55 AM To: Agin, Jayden Subject: Read: South Bend - Quote Request Attachments: Read: South Bend - Quote Request This is an EXTERNAL E-MAIL. Stop and think before clicking a link or opening an attachment. Agin, Ja den From: Agin, Jayden Sent: Tuesday, November 13, 2018 10:52 AM To: 'f.cazares@cazconllc.com' Subject: South Bend WWTP - Quote Request Hello, I was wondering if you have had a chance to look at the South Bend Wastewater Treatment Plant project? If so, are you interested in providing a quote? Thank you, JAYDEN AGIN ESTIMATING ASSISTANT E ja in 7ajranck.corn SAFETY. QUALITY. INTEGRITY. FAMILY. EVERY DECISION. EVERY DAY. A in, Ja den From: F. Cazares <f.cazares@cazconllc.com> Sent: Wednesday, November 14, 2018 8:48 AM To: Agin, Jayden Subject: Read: South Bend WWTP - Quote Request Attachments: Read: South Bend WWTP - Quote Request This is an EXTERNAL E-MAIL. Stop and think before clicking a link or opening an attachment. Addendum two has been released for this project, it can be viewed / downloaded through the link below. Let me know if you have any questions. JAYDEN AGIN ESTIMATING ASSIS IFAN T" J, Bectrt, �nc, � jgJnLa)' �ranck.gom SAFETY. QUALITY. INTEGRITY. FAMILY. EVERY DECISION. EVERY DAY. A 2in, Ja den From: F. Cazares <f.cazares@cazconllc.com> Sent: Monday, November 19, 2018 10:07 AM To: Agin, Jayden Subject: Read: South Bend - WWTP - Addendum Two Attachments: Read: South Bend - WWTP - Addendum Two This is an EXTERNAL E-MAIL. Stop and think before clicking a link or opening an attachment. Agin, Ja den From: Agin, Jayden Sent: Monday, November 26, 2018 11:18 AM To: f.cazares@cazconllc.com Subject: South Bend - Quote Request Good morning, I just wanted to verify that you would still be able to provide a quote today for the South Bend WWTP project. Please let me know. Thank you, JAYIDIIi;;;N AGAIN ES1"IIIIIIi A;TIIIING ASSylllm;,�"'IIFAIN"'f'rry y y� j y ryry , ? R;;;d�4�rl'°+. ,B�:ctrjc; � Il tl ✓, $ 1�A�W A . Iw�C".N4' 40.rF�p� a,.Frn 80(')-, 2 38 /2 Ext.Ext. 2114 SAFETY. QUALITY. INTEGRITY. FAMILY, EVERY DECISION. EVERY DAY. i Agin, Jayden From: F. Cazares <f.cazares@cazconllc.com> Sent: Monday, November 26, 2018 1:47 PM To: Agin, Jayden Subject: RE: South Bend - Quote Request This is an EXTERNAL E-MAIL. Stop and think before clicking a link or opening an attachment. I am sorry but we are not biting this project From: Agin, Jayden <jagin@jranck.com> Sent: Monday, November 26, 2018 11:18 AM To: f.cazares@cazconllc.com Subject: South Bend - Quote Request Good morning, I just wanted to verify that you would still be able to provide a quote today for the South Bend WWTP project. Please let me know. Thank you, JAYDI 1I.I"!N AGAIN ES If"IIMA°"IFIIII G ASSIS°°III°°AN°"IC° Remck, EIectric, Inc dr, k �r;j,c k .g o, new ..... SAFETY. QUALITY. INTEGRITY. FAMILY. EVERY DECISION. EVERY DAY. Agin, Ja den From: Agin, Jayden Sent: Friday, November 09, 2018 9:43 AM To: 'tkivett@inrecex.com' Cc: Levert, Jim; Madlem, Cody Subject: South Bend - Quote Request - Sewer Line Tony, In the link below are the drawings. If you are interested there is also some duct bank that we would need excavated and then backfilled. If you would like to take a look at that you are more than welcome to quote anything in your scope of work. We would need a quote back from you by Nov. 26, 2018. Please let me know if you are able to provide a quote. Thank you, JAYDE14 AGIIN Es "'rIIIMA"'III'"ING ASSIS"'T'A T 00- 93822 Ext, 2 1 wmvjiinck, c r, a III SAFETY. QUALITY. INTEGRITY. FAMILY. EVERY DECISION. EVERY DAY. Agin, Ja den From: Agin, Jayden Sent: Tuesday, November 13, 2018 8:37 AM To: 'tkivett@ i nrecex.com' Subject: South Bend WWTP - Quote Request Hello, I was just wondering if you are still interested in providing a quote for the South Bend WWTP project? If so, what all would you be quoting on? If you have any questions feel free to call me at (989) 334-3168 or by email. Thank you, IES1°'IIIWA°I""IuNG ASSiis rAN„I„ 800n. a 92122 ,.,,,Fit 2114 i 4yi (V fi w c0" )irn SAFETY. QUALITY. INTEGRITY. FAMILY, EVERY DECISION. EVERY DAY. ELECTRIC,Me $000 ]PANICK Agin, Ja den From: Tony Kivett <tkivett@inrecex.com> Sent: Tuesday, November 13, 2018 11:27 AM To: Agin, Jayden Subject: Read: South Bend WWTP - Quote Request Attachments: Read: South Bend WWTP - Quote Request This is an EXTERNAL E-MAIL. Stop and think before clicking a link,or opening an attachment. A in, Ja den From: Agin, Jayden Sent: Wednesday, November 07, 2018 11:30 AM To: ritl204@datacruz.com' Cc: Levert, Jim; Madlem, Cody Subject: South Bend WWTP — Quote Request - Storm Sewer/Erosion Control Hello, Please review the drawings in the link below, if you have any questions feel free to call me at (989) 334-3168 or by email. Thank you, JAYDEN AGIN ESTIMATING S I T T SAFETY. QUALITY. INTEGRITY. FAMILY. EVERY DECISION. EVERY DAY. Agin, Ja den From: Agin, Jayden Sent: Friday, November 09, 2018 8:36 AM To: ritl204@datacruz.com' Subject: South Bend WWTP Hello, I sent you those drawings for the South Bend Waste Water Treatment Plant a couple days ago and I was just wondering if you were planning on quoting some of the work? If you are interested please let me know what you are going to quote on. Feel free to quote anything in your scope of work. Thank you, JAYIEN AGIN ESTIMATING ASSISTANT J. Rank Bec trio, Inc. I jagi nrp nc , rn SAFETY. QUALITY. INTEGRITY. FAMILY, EVERY DECISION. EVERY DAY. ! in, Ja den From: Agin, Jayden Sent: Tuesday, November 13, 2018 8:29 AM To: Irit1204@datacruz.com' Subject: South Bend WWTP Hello, I was just wondering if you are still interested in providing a quote for the South Bend Project? If so, what all would you be quoting on? If you have any questions feel free to call me at (989) 334-3168 or by email. Thank you, JAYDEN AGIN ESTIMATING ASSISTANT E iaaiin a)jranck.c r SAFETY. QUALITY. INTEGRITY. FAMILY, EVERY DECISION, EVERY DAY. 44000 uANcK „-u wELECTRIC, INC. Addendum two has been released for this project, it can be viewed / downloaded through the link below. Let me know if you have any questions. --------- --is11 - JAY1)1:::."N AGIlq ESTIMA T"IHING ASSISTA14T J, Ranck Elec;tdc, Inc., I kaJLn@,1Lqnck.q �_q.M SOU-792-3822 Ext, 2114 jy� qv SAFETY. QUALITY. INTEGRITY. FAMILY. EVERY DECISION. EVERY DAY. Agin, Ja den From: rit1204@datacruz.com Sent: Monday, November 19, 2018 9:23 AM To: Agin, Jayden Subject: Return Receipt (read): South Bend - WWTP - Addendum Two Attachments: Return Receipt (read): South Bend - WWTP - Addendum Two This is an EXTERNAL E-MAIL. Stop and think before clicking a link or opening an attachment. Agin, Ja den From: Agin, Jayden Sent: Monday, November 19, 2018 9:29 AM To: 'rit1204@datacruz.com' Subject: South Bend - WWTP - Quote Request Good Morning, I am wondering if you are still interested in providing a quote for some of the work at the South Bend WWTP project? If so, what work would you provide a quote for? Feel free to quote any thing in your scope of work. If you have any questions you can contact me at (989) 334-3168 or by email. Thank you, JA '9I,; IEN AG'IN ES°°Ilillll6 'IA°"1I IING ASSISTAI!gT J, I: Orrick i:':'�i .�t � a:. �r _ i g i Qranck.00r SAFETY. QUALITY. INTEGRITY. FAMILY, EVERY DECISION, EVERY DAY. w o.a]. RANCK ELECTRIC INC, A in, Ja den From: rit1204@datacruz.com Sent: Monday, November 19, 2018 9:43 AM To: Agin, Jayden Subject: Return Receipt (read): South Bend - WWTP - Quote Request Attachments: Return Receipt (read): South Bend - WWTP - Quote Request This is an EXTERNAL E-MAIL. Stop and think before clicking a link or opening an attachment. Agin, Jayden From: Agin, Jayden Sent: Monday, November 26, 2018 11:19 AM To: ritl 204@datacruz.com' Subject: South Bend - Quote Request Good morning, I just wanted to verify that you would still be able to provide a quote today for the South Bend WWTP project. Please let me know. Thank you, JAYIf)EN AGIHIN 11:..:..:S IFIHIMATING ASSIST'Allq-r ,J, 1r,,c, � j2_qLi2@j��qf.�kcorn 800-792-3822 Ext 2114 1 1, �")' n (,;J,, (co III SAFETY. QUALITY. INTEGRITY. FAMILY, EVERY DECISION. EVERY DAY. JRANCK 0000 ELECTRIC, INC. A in, Jayden From: Stan Keller Sr. <stansr@sskeller.com> Sent: Wednesday, November 14, 2018 12:04 PM To: Agin, Jayden Subject: RE: South Bend WWTP Attachments: Stan Keller Sr.vcf This is an EXTERNAL E-MAIL. Stop and think before clicking a link or opening an attachment. Jayden, Thanks for the invite Due to the work load I will not be providing a quote, Stan Keller Sr S&S Keller Construction,Inc. Vice President (260) 200-1111 V ork 260-417-6501 Mobile stansr@sskeller.com 4239 N Meridian Rd Huntington, Indiana 46750 From: Agin, Jayden [mailto:jagin@jranck.com] Sent: Tuesday, November 13, 2018 8:33 AM To: stansr@sskeller.com Subject: South Bend WWTP Sta n, I was wondering if you are still interested in providing a quote on the South Bend WWTP project? If you have any questions feel free to call me at (989) 334-3168 or by email. Thank you, JAYDEN I ESTIMATING I T jEk lii,@iCanck.com V4/JAA', IProdf�kl a �9G6 SAFETY. QUALITY. INTEGRITY. FAMILY, EVERY DECISION. EVERY DAY. 1 r�. �� ��„ ,�� Agin, Jayden From: Agin, Jayden Sent: Monday, November 05, 2018 12:42 PM To: 'stansr@sskeller.com' Cc: Levert, Jim; Madlem, Cody Subject: South Bend WWTP — Quote Request - Concrete Tracking: Recipient Read 'stansr@sskel Ier.com' Levert, Jim Read: 11/5/2018 1:10 PM Madlem, Cody Stan, Please review the drawings in the link below, I would need a quote by November 12, 2018 and wouldn't need concrete until next march. South Bend WWTP Documents Thank you, Jayden JAYDEN AGIN ESTIMATING ASSISTANT n.@'ra�k.corrt SAFETY. QUALITY. INTEGRITY. FAMILY. EVERY DECISION. EVERY DAY. �. RIANCK ELECTRIC, INC. J. Ranck Electric, Inc. Public Works Projects Subcontractor Listing 2013-2017 5 STAR DIRECTIONAL DRILLING A TO Z LAWN CARE SERVICE PO BOX 194 7939 CHILSON RD KINGSLEY, MI 49649 PICKNEY, MI 48169 A-1 ASPHALT INC A-1 UNDERGROUND INSTALLATION 4634 DIVISION AVE 233 MIDLAND ROAD WAYLAND, MI 49348 BAY CITY, MI 48706 ACE-SAGINAW PAVING CO. ACH PEST & TERMITE MANAGEMENT 2981 CARROLLTON ROAD 6001 WILDCAT DRIVE SAGINAW, MI 48604 TEMPLE, TX 76502 ADVANCED COMMUNICATIONS INC. ADVANCED REHABILITATION TECH 5711 RESEARCH DRIVE 01116 COUNTY ROAD 17 CANTON, MI 48188 BRYAN, OH 43506 AFFORDABLE SPRINKLER SYSTEMS AGGREGATE INDUSTRIES PO BOX 680189 4950 LOVELAND RD PRATTVILLE, AL 36068 GRASS LAKE, MI 49240 AGGRESSIVE SYSTEMS ALERT ELECTRONICS 24269 INDOPLEX CIRCLE 712 DELTA AVENUE FARMINGTON HILLS, MI 483352525 GLADSTONE, MI 49837 ALLIED CAPITAL PARTNERS, L.P. AMENT DESIGN P.O. BOX 676649 4703 15TH STREET A DALLAS, TX 75267-6649 MOLINE, IL 61265 AMERICAN ENERGY SERVICES, INC. AMERISCAPES LANDSCAPE SUPPLY 69210 SKINNER DRIVE PO BOX 295 204 NORTH MAIN STREET RICHMOND, MI 48062-0295 YALE, MI 48097 ANDY J EGAN COMPANY INC APAC TEXAS INC WHEELER COAT 2001 WALDORF NW 6904 WEST HIGHWAY 190 GRAND RAPIDS, MI 49544 BELTON, TX 76513 ARBOR EAST LOCATING ASBESTOS ABATEMENT INC. 7223 WESTBROOK RD 2420 N GRAND RIVER FENWICK, MI 48834 LANSING, MI 48906 J. Ranck Electric, Inc. Public Works Projects Subcontractor Listing 2013-2017 ASCOM NORTH 6100 U.S. 31 NORTH ASPHALT SPECIALIST LLC P.O. BOX 126 504 LIBERTY HILL DRIVE EVERGREEN, AL 36401 ACME, MI 49610 ASTRUM TECHNOLOGIES BACKER LANDSCAPING INC 1010 WEST HAMLIN RD 15251 E 12 MILE ROAD ROCHESTER HILLS, MI 48309 ROOSEVILLE, MI 48066 BADGER DAYLIGHTING CORP 75 REMITTANCE DR BAR-B PLUMBING CO INC STE 3185 15103 W HWY 190 CHICAGO, IL 60675-3185 COPPERAS COVE, TX 76522 BAT ELECTRIC INC BELL ROOFING COMPANY 20400 MARTINEZ LANE 1916 ENTERPRISE ST REDDING, CA 96002 MARQUETTE, MI 49855 BELL WIRE COMMUNICATION BILACIC TRUCKING 6684 JONES RD 2136 E HURON RD NORTH BRANCH, MI 48461 AUGRES, MI 48703 BILL'S CUSTOM FAB INC BLEDSOE RIGGERT GUERRETTAZ 1836 GOVER PKWY 1351 WEST TAPOP RD MT PLEASANT, MI 48858 BLOOMINGTON, IN 47403 BOSK CORPORATION BOSS ENGINEERING PO BOX 461 3121 E GRAND RIVER ESCANABA, MI 49829 HOWELL, MI 48843 BOWEN PAVING, INC BRADY SAND & GRAVEL, INC. 1001 CESAR E. CHAVEZ AVE 2978 RUSSELL RD PONTIAC, MI 48340 TECUMSEH, MI 49286 BRIDGEWAY POWER BRICK PAVER CONSTRUCTION 863 SOUTH AIRPORT ROAD PO BOX 339 TRAVERSE CITY, MI 49686 HILLSDALE, MI 49242 ELECTRIC P.O. BOX 1090 BROADCAST ENGINEER SERVICES P.O. BOX 7041 GRAND RIVER ROAD 2803 ROLFE RDMASON, MI 48854 BRIGHTON, MI 48114-9347 2 J. Ranck Electric, Inc. Public Works Projects Subcontractor Listing 2013-2017 BUD DESIGN & ENGINEERING SERVI C & D HUGHES INC 10775 SOUTH SAGINAW ST SUITE B 3097 LANSING RD CHARLOTTE, MI 48813 GRAND BLANC, MI 48439 C & J BUSH C.A.S.S. SHEETMETAL 14405 MARSHALL 5641 CONNER WARREN, MI 48089 DETROIT, MI 48213 CANIFF ELECTRIC SUPPLY CO INC CARDNO ATC PO BOX 12490 46555 HUMBOLDT DRIVE HAMTRAMCK, MI 48212 SUITE 100NOVI, MI 48377 CARL ALLBEE EXCAVATING CARLO CONSTRUCTION INC 4758 BEAVERTON ROAD 850 FEATHERSTONE ST BEAVERTON, MI 48612 PONTIAC, MI 48342 CAROLINA SOLAR SERVICES E MAIN ST CB ASPHALT MAINTENANCE 807 STE MA 8625 OAKVILLE WALTZ BELLEVILLE, MI 48111 DURHAM, NC 27701 CCE INC CRANES & HOISTS CDC ELECTRIC, INC. 10741 TUBE DR P.O. BOX 99 HURST, TX 76053 CHEBOYGEN, MI 49721 CENTER LINE ELECTRIC INC CENTRAL ASPHALT INC 26554 LAWRENCE P.O. BOX 389 CENTER LINE, MI 48015 MT. PLEASANT, MI 48804-0389 CENTURY CEMENT COMPANY CHAMPAGNE & MARX EXCAVATING 12600 SIBLEY RD 1445 LIBERTY RD RIVERVIEW, MI 48193 SAGINAW, MI 48604 CHAPMAN FENCE CIRCLE INCORPORATED 2988 CLARIDGE CT. 1204 ENGINEERS RD MACON, GA 31204 BELLE CHASE, LA 70037 CITEL INC CIVIL ENGINEERING CONSULTANTS 11381 INTERCHANGE CIRCLE PO BOX 130 MIRAMAR, FL 33025 AUBURN, MI 48611 3 J. Ranck Electric, Inc. Public Works Projects Subcontractor Listing 2013-2017 CLEANING CONTRACTORS INC CLERY FENCE COMPANY 25600 BREST RD 1430 JOHNSON STREET TAYLOR, MI 48180 DANSVILLE, MI 48819 CLOSNER CONSTRUCTION COMMERCE CONTROLS INC 2050 ENTERPRISE STREET 41069 VINCENTI CT MARQUETTE, MI 49855 NOVI, MI 48375 COMMUNICATION INFRASTRUCTURE CONCRETE CUTTING &BREAKING RESOURCES, INC 4500 AIRWEST SE 8438 BEACON LANE NORTHVILLE, MI 48167 GRAND RAPIDS, MI 49512 CONCRETE CUTTING SPECIALIST CONEX INC 10333 HERCULES RD. G-4376 BEECHER RD FREELAND, MI 48623 FLINT, MI 48532 CONSTRUCTION VIDEO MEDIA INC CONSUMERS ENERGY PO BOX 90 111 EAST NEWBERRY ONE ENERGY PLAZA ROM EO, MI 48065-0090 JACKSON, MI 49201-9938 CONTRACTORS FENCE & GATE SERVI CONTROL NET LLC 14900 TELEGRAPH PO BOX 2092 REDFORD, MI 48239 KALAMAZOO, MI 49003 COUNTRY CLUB TURF, INC. CROSS ENTERPRISES INC 4137 W. MICHIGAN AVENUE 4321OAKWOOD JACKSON, MI 49202 MELVINDALE, MI 48122 CUMMINS BRIDGEWAY LLC #774494 CUSTOM STEEL FABRICATORS LLC 4494 SOLUTIONS CENTER 3925 LINDEN AVE SE CHICAGO, IL 60677-4004 WYOMING, MI 49548 D&R CONCRETE INC DASCAN INDUSTRIAL CONTROLS 14144 PERCY DR 2200 STEPHENSON HWY MECOSTA, MI 49332 TROY, MI 48083 DAVISON LAND SURVEYING, INC DB FIBER COMMUNICATION CO 1063 S. STATE ROAD, STE 9 3566 CASTLE RD DAVISON, MI 48423-1900 NORTH BRANCH, MI 48461 4 J. Ranck Electric, Inc. Public Works Projects Subcontractor Listing 2013-2017 DB FIBER COMMUNICATION CO DC BYERS COMPANY 3566 CASTLE RD 16429 UPTON ROAD NORTH BRANCH, MI 48461 SUITE #3 EAST LANSING, MI 48823-9428 DEALERS ELECTRICAL SUPPLY CO., DESIGN -BUILD LANDSCAPE SERVICE P.O. BOX 2676 23403 WOODWARD AVE WACO, TX 76702 BIG RAPIDS, MI 49307 DEWITT FENCE COMPANY DHE PLUMBING AND MECHANICAL 3236 W STJOSEPH 500140TH AVENUE LANSING, MI 48917 HUDSONVILLE, MI 49426 DIAMOND CUT CONCRETE CUTTERS DL KESLER CONSTRUCTION INC 327 N FERNDALE AVE PO BOX 408 ELMHURST, IL 60126 BATH, MI 48808 DLF INC DNR TREE SERVICE II INC PO BOX 8 10580 LAUREL ST ROMEO, MI 48065 LIVONIA, MI 48150 DOAN COMPANIES DEPT 129301 DOTLICH CRANE 1111 POLCO STREET P.O. BOX 67000 I DETROIT, MI 48267-1293 NDIANAPOLIS, IN 46222 DRAKER CORPORATION DRIESENGA & ASSOCIATES INC 431 PINE ST 12330 JAMES ST SUITE 114 H-80 BURLINGTON, VT 05401 HOLLAND, MI 49424 DYKEMA EXCAVATORS EARTHWORM 1730 3 MILE RD NE 2814 S. OLD KAWKAWLIN RD GRAND RAPIDS, MI 49505 KAWKAWLIN, MI 48631 EASTLUND CONCRETE INC ECKER MECHANICAL 3929 E HOLT RD P.O. BOX 190099 PO BOX 368 3149 E MAPLE AVE. HOLT, MI 48842 BURTON, MI 48519 ECS MIDWEST LLC - CHICAGO ENGINEERING CONSULTING SRV ELECTRICAL RELIABILITY SERVICE 216 W JACKSON BLVD, STE1050 24865 NETWORK PLACE CHICAGO, IL 60606 5 CHICAGO, IL 60673-1248 J. Rand Electric, Inc. Public Works Projects Subcontractor Listing 2013-2017 ELITE UTILITY CONTRACTORS EMAN NURSERY & GARDEN CARE PO BOX 148 1628 S FORT HOOD STREET MERRILL, MI 48637 KILLEEN, TX 76542 EO INTEGRATED SYSTEMS ERIX CRANE AND RIGGING 12700 31 MILE RD 9741 TITAN PARK CIRCLE WASHINGTON, MI 48095-1418 LITTLETON, CO 80125 FENSTERMACHER ASPHALT PAVING FESSLER & BOWMAN INC 18573 NORTHLAND DRIVE 4099 EAGLE'S NEST CT BIG RAPIDS, MI 49307 FLUSHING, MI 48433 FISK ELECTRIC FLOTATION DOCKING SYSTEMS P.O. BOX 4417 PO BOX 178 HOUSTON, TX 77210-4417 CEDARVILLE, MI 49719 FMG CONCRETE CUTTING INC FUEL TANK DISPOSAL, INC. 3515 S. OLD US 23 5335 FILMORE RD BRIGHTON, MI 48116 HART, MI 49420 FULL BORE DIRECTIONAL BORING FUTURE FENCE 6105 BIRCH DR 23450 REGENCY PARK DR FLINT, MI 48507 WARREN, MI 48089 G & J SITE SOLUTIONS INC G2 CONSULTING GROUP LLC 51811 INDUSTRIAL DR 1866 WOODSLEE STREET CALUMET, MI 49913 TROY, MI 48083 GARNER LANDSCAPING GCC TECHNOLOGIES 615 THREE BRIDGES RD 207 E. KIPP RD ROANOKE RAPIDS, NC 27870 MASON, MI 48854 GENESEE TECHNOLOGIES GENPOWER PRODUCTS INC 14305 FENTON RD 29905 ANTHONY DR FENTON, MI 48430 WIXOM, MI 48393 GIBBONS EXCAVATING GIVE-EM A BRAKE SAFETY PO BOX 848 2610 SANFORD AVE POINTE AUX PINS, MI 49775 GRANDVILLE, MI 49418 6 J. Ranck Electric, Inc. Public Works Projects Subcontractor Listing 2013-2017 GIVE-EM A BRAKE SAFETY GLAZING SOLUTIONS INC 2610 SANFORD AVENUE 402 N MAIN ST GRANDVILLE, MI 49418 MORRICE, MI 48857 GM & SONS INC GOYETTE MECHANICAL 678 WHITMORE LAKE RD 3482 GOREY AVE.P.O. BOX 33 WHITMORE LAKE, MI 48189 FLINT, MI 48501 GRAPIDS IRRIGATION GRAYBAR 1170 PLAINFIELD AVE NE 12431 COLLECTIONS CTR DR GRAND RAPIDS, MI 49503 CHICAGO, IL 60693-2431 GREEN PLUS LANDSCAPING GROUND PENETRATING RADAR SYS 38 STATE ST PO BOX 932 MIDDLEVILLE, MI 49333 TOLEDO, OH 43697 GROUND PENETRATING RADAR TECH HARDROCK HHD, INC 1230 NORTH MAPLE ROAD 2383 EAST SOUTH STREET ANN ARBOR, MI 48103 JACKSON, MI 49201 HAZARDOUS WASTE EXPERTS 2693 RESEARCH PARK DR HCM&J, INC. SUTIE 201 231 MEMORIAL DRIVE FITCHBURG, WI 53711 GATESVILLE, TX 76528-1028 HESCO HICKEY ELECTRICAL CONTRACTORS 28838 VAN DYKE AVE 15048 SOUTH CICERO AVE WARREN, MI 48093 OAK FOREST, IL 60452 HORROCKS NURSERY FARMS INC HOYT, BRUMM & LINK, INC 3355 DILDINE RD 1400 EAST NINE MILE RD IONIA, MI 48846 FERNDALE, MI 482202040 HUBBELL ROTH & CLARK INC IMPERIAL CRANE SERVICE INC 555 HULET DRIVE 7500 W IMPERIAL DR BLOOMFIELD, MI 48302 BRDIGEVIEW, IL 60455 INDUSTRIAL PROCESS PIPING INC INNOVATIVE EXTERIORS INC 347 PARK ST 2110 CAROLINA ST TROY, MI 48083 MIDLAND, MI 48642 7 J. Ranck Electric, Inc. Public Works Projects Subcontractor Listing 2013-2017 INTEGRAL ELECTRONIC SYSTEMS INTERLOCK DESIGN 540 E SURREY RD 5830 COMSTOCK PARK DR NW FARWELL, MI 48622 PO BOX 453 COMSTOCK PARK, MI 49321 INTERNATIONAL CONTROLS IQ LIFE SAFETY SYSTEMS INC 35056 CORDELIA 2220 SCOTT LAKE RD CLINTON TOWNSHIP, MI 48035 WATERFORD, MI 48328 ISABELLA CORPORATION AM CONSTRUCTION 2201 COMMERCE ST PO BOX 175 MT PLEASANT, MI 48858 NEW HUDSON, MI 48165-0175 JOHNSON & WOOD LLC JUSTIN LAMBDEN INC 1745 N. OUTER DR. 2905 CREASEY DR SAGINAW, MI 48601 TEMPLE, TX 76501 K&H CONCRETE CUTTING OF LANSIN KATERBERG VERHAGE 3503 W. ST. JOSEPH 3717 MICHIGAN NE LANSING, MI 48917 GRAND RAPIDS, MI 48525 KELCRIS CORPORATION KENMARK INC P.O. BOX 362 PO BOX 2 WILLIAMSTON, MI 48895 BUCKLEY, MI 49620 KENNEDY INDUSTRIES KENT COMPANIES INC P.O. BOX 180 130 - 60TH STREET SW NEW HUDSON, MI 48615 GRAND RAPIDS, MI 49548 KIPS ASPHALT MAINTENANCE KIRBY STEEL INC 6098 E 6 MILE RD 4072 FLINT ASPHALT DRIVE WHITE CLOUD, MI 49349 BURTON, MI 48529 KOEHLER ELECTRIC KNEPCO EQUIPMENT & SERVICES 2716 W CENTRAL PARK AVE 7555 W. 1050S DAVENPORT, IA 52804 MILROY, IN 46156 KTK DRAFTING AND DESIGN SERVIC KARL KWAST L & S HAYES 2579 KIESEL RD 17782 18 MILE ROAD MIDLAND, MI 48642 LEROY, MI 49655 8 J. Ranck Electric, Inc. Public Works Projects Subcontractor Listing 2013-2017 LAKE PAINTING LANAVILLE FOUNDATIONS INC PO BOX 2105 2040 INDUSTRIAL DR MIDLAND, MI 48641-2105 HOWELL, MI 48843 LARAMIE LAWRENCE MORNINGSTAR ENTERPRIS 48400 WEST RD 15181 172ND AVE WIXOM, MI 48393 BIG RAPIDS, MI 49307-9525 LEADBETTER ELECTRIC COMPANY LECOM UTILITY CONTRACTORS PO BOX 187 29377 HOOVER ROAD MARQUETTE, MI 49855 ATTN: BILL CATALFIO WARREN, MI 48093 LEDOUX'S CONTROL SYSTEMS INC LEE WOOD CONTRACTING INC 2860 NEEDHAM DRIVE 930 WAGNER RD BATON ROUGE, LA 70814 ESSEXVILLE, MI 48732 LEWIS BROTHERS PO BOX 517 LIGHTNING PROTECTION CORP 510 WEBSTER ST 5750 THORNWOOD DR COLEMAN, MI 48618 GOLETA, CA 93117 LOFTIN EQUIPMENT CO LOIS KAY CONTRACTING 4728 COTTON BELT DRIVE 3046 CARROLLTON RD SAN ANTONIO, TX 78219 SAGINAW, MI 48604 LUIGI FERDINANDI & SONS CEMENT M A P MECHANICAL CONTRACTORS 16481 COMMON RD 2600 N WEST RIVER RD ROSEVILLE, MI 48066 SANFORD, MI 48657 MACATAWA RADIANT INC MACOMB MECHANICAL INC 10702 CHICAGO DR 625019 MILE RD ZEELAND, MI 49464 STERLING HEIGHTS, MI 48314 MARSHALL CONCRETE INC MARTIN CONTROL SERVICES 6099 CHARLEVOIX RD 23905 FREEWAY PARK DRIVE CHARLEVOIX, MI 49720 FARMINGTON HILLS, MI 48335 MCKINLEY MASONRY & CONCRETE MCNALLY & NIMERGOOD INC 13653 S MASON DR PO BOX 368 5825 DIXIE HIGHWAY GRANT, MI 49327 9 SAGINAW, MI 48601 J. Ranck Electric, Inc. Public Works Projects Subcontractor Listing 2013-2017 MCNAUGHTON-MCKAY ELECTRIC CO MICHIGAN CAT DEPT 14801 DEPT 77576 PO BOX 67000 PO BOX 77000 DETROIT, MI 48267-0148 DETROIT, MI 48277-0576 MICHIGAN LIGHTNING PROTECTION MICHIGAN PAVING & MATERIALS CO 24010'BRIEN ST. SW PO BOX 600 GRAND RAPIDS, MI 49544 THORNVILLE, OH 43076 MID MICHIGAN CONCRETE CUTTING MIDLAND FENCE 12221 STATE RD 6000 NORTH SAGINAW RD RIVES JUNCTION, MI 49277 MIDLAND, MI 48642 MIDWAY RENTALS MIDWEST ASPHALT MAINTENANCE 43 INDUSTRIAL PARK RD 10365 NORTHLAND DR NE NEGAUNEE, MI 49866 ROCKFORD, MI 49341-9730 MITCHELL & ASSOCIATES INC MKC GROUP INC 102 NORTH COLLEGE ST 103 DEENS LANE KILLEEN, TX 76541-6106 BAY CITY, MI 48706 MONUMENT ENGINEERING INC MOORE & BRUGGINK INC 20318 WINDEMERE DR 2020 MONROE AVE NW MACOMB TWP, MI 48044 GRAND RAPIDS, MI 49505 MORNING STAR PUBLISHING CO MURRAY PAINTING COMPANY 21ST CENTURY MEDIA MICHIGAN 6078 RACKETY RD PO BOX 94559 CLEVELAND, OH 44101-4745 FREELAND, MI 48623 MUSCO LIGHTING LLC NATIONAL COATINGS INC PO BOX 808 3520 RENNIE SCHOOL ROAD 100 1ST AVE WEST TRAVERSE CITY, MI 49685 OSKALOOSA, IA 52577-0808 NATIONAL TIME & SIGNAL NC UNDERGROUND 28045 OAKLAND OAKS CT 22175 GRATIOT WIXOM, MI 48393 MERRILL, MI 48637 NEDERVELD CONSTRUCTION NEWKIRK ELECTRIC INC 217 GRANDVILLE AVE SW 1875 ROBERTS ST SUITE 302 MUSKEGON, MI 49442 GRAND RAPIDS, MI 49503 10 1. Ranck Electric, Inc. Public Works Projects Subcontractor Listing 2013-2017 NOMAD CONSTRUCTION NORTHERN ANALYTICAL SERVICE 4089 S NICOLET 2139113 MILE ROAD SAULT STE. MARIE, MI 49783 LEROY, MI 49655 NORTHERN BOILER NORTHERN ELECTRICAL TESTING 2025 LATIMER DR 1991 WOODSLEE STREET MUSKEGON, MI 49442 TROY, MI 48083-2236 NORTHERN FIRE & SAFETY NOVA CONSULTANTS INC 1798 NORTHERN STAR DR 21580 NOVI RD TRAVERSE CITY, MI 49686 STE 300 NOVI, MI 48375 NOVA CONSULTANTS, INC OASIS WATER SYSTEMS 21580 NOVI RD H2OASIS LAWN SPRINKLING & SUITE 300 5950 14 MILE RAODS NOVI, MI 48375 ROCKFORD, MI 49341 OBERSTAR INC OWEN TREE SERVICE 1900 INDUSTRIAL PARKWAY 225 N LAKE GEORGE RD MARQUETTE, MI 49855 ATTICA, MI 48412-9743 PAC ENGINEERING PADGETT INC 4406 JACKMAN RD 901 E 4TH ST IDA, MI 48140 NEW ALBANY, IN 47150 PANTER MASTER CONTROLS INC PARADIGN 2000 INC G-7430 N DORT HWY 672 WOODBRIDGE PO BOX 342 SUITE 200 MT. MORRIS, MI 48458 DETROIT, MI 48226 PARK ELECTRIC LLC PATRIOT PUMPS 19197 SHERWOOD 2210 SCOTT LAKE RD DETROIT, MI 48234 WATERFORD, MI 48328 PAT'S GRADALL SERVICE 820 S. JEFFERSON AVENUE PAUL J TOTI 131 MAIN ST PO BOX 1603 MIDLAND, MI 48641 GATESVILLE, NC 27938 PERCEPTIVE CONTROLS PERFITT EXCAVATING, INC. 951 INDUSTRIAL PARKWAY 1957 SEVEN GABLE RD PLAINWELL, MI 49080 �� DANSVILLE, MI 48819 J. Ranck Electric, Inc. Public Works Projects Subcontractor Listing 2013-2017 PHOENIX CRANE RENTAL PK CONTRACTING INC 4207 MIKE PADGETT HIGHWAY 1965 BARRETT AUGUSTA, GA 30906 TROY, MI 48084 POCO INC POWER PLUS ENGINEERING INC 4850 S SHELDON RD 47119 CARTIER COURT CANTON, MI 48188-2743 WIXOM, MI 48393 POWERTECH SERVICES INC POWERTECH SYSTEMS 4095 S DYE ROAD 5015 N. DICKENSON RD SWARTZ CREEK, MI 48473 COLEMAN, MI 48618 PROFESSIONAL SERVICE IND PROLINE CONCRETE CONSTRUCTION PO BOX 74008418 4185 PROLINE CT - SUITE A CHICAGO, IL 60674-8418 DORR, MI 49323 PRO -TECH CABLING SYSTEMS INC QUALITY ENVIROMENTAL SRV 1805 E MAPLE RD PO BOX 558 CLARE, MI 48617 GLADWIN, MI 48624 RAYCAP 806 W CLEARWATER LP REMINGTON CONSTRUCTION CO STE C 26542 RED ARROW HIGHWAY POST FALLS, ID 83854-9480 MATTAWAN, MI 49071 RIETH-RILEY CONST CO INC ROESE CONTRACTING CO INC 4150 S CREYTS RD 2674 S. HURON RD LANSING, MI 48917 PO BOX 158KAWKAWLIN, MI 48631 ROWE PROFESSIONAL SERVICES CO 540 S SAG INAW ST ROWE PROFESSIONAL SRV CO STE 200 127 S MAIN ST FLINT, MI 48502 MT PLEASANT, MI 48858 ROY NESS CONTRACTING & SALES RS CONTRACTING 1801 N. LINCOLN 9276 MARINE CITY HWY ESCANABA, MI 49829 CASCO, MI 48064 RW CONCRETE SAWING INC S & S DIRECTIONAL BORING PO BOX 119 01 116 COUNTY ROAD 17 DORR, MI 49323 12 BRYAN, OH 43506-8849 J. Ranck Electric, Inc. Public Works Projects Subcontractor Listing 2013-2017 S.S.C. ASPHALT COMPANY SAFETY SYSTEMS INC.. P.O. BOX 475 29701 SIX MILE RD WASHINGTON TWP, MI 48094 SUITE 140A LIVONIA, MI 48152 SCAFFOLDING INC SEAWAY PAINTING LLC 135 E MCNICHOLS 31801 SCHOOLCRAFT DETROIT, MI 48203 LIVONIA, MI 48150-1808 SECURITY CORPORATION SENTRILLION 22325 ROETHEL DRIVE 1881 CAMPUS COMMONS DR NOVI, MI 48375 SUITE 403 RESTON, VA 20191 SESTRA COMMUNICATIONS CORP SEVEN BROTHERS PAINTING 3585 CASTLE RD 50805 RIZZO DRIVE NORTH BRANCH, MI 48461 SHELBYTOWNSHIP, MI 48315 SHAW SYSTEMS & IRRIGATION SHAW WINKLER INC 22100 TELEGRAPH RD. 4910 DAWN AVENUE SOUTHFIELD, MI 48033 EAST LANSING, MI 48823 SIEMENS C/O CITIBANK (BLDG TECH) SIEMENS FIRE SAFETY PO BOX 2134 7850 COLLECTIONS CENTER CAROL STREAM, IL 60132-2134 CHICAGO, IL 60693 SIEMENS INDUSTRY INC SIMPLEX GRINNELL C/O CITIBANK (BLDG TECH) 24755 HALSTED ROAD PO BOX 2134 ATTN: JEFF FRASER CAROL STREAM, IL 60132-2134 FARMINGTON HILLS, MI 48335 SLEEPING BEAR LIGHTNING SLUSARSKI EXCAVATING &PAVING PROTECTION LLC 1 204 SPRUCE LANE 19 GREENLY ST MAPLE CITY, MI 49664 ADRIAN, MI 49221 SMITH PAVING SMITH TREE & LANDSCAPING INC 4090 US 41 WEST 6270 WEST GRAND RIVER MARQUETTE, MI 49855 LANSING, MI 48906 SNYDER & STALEY ENGINEERING PL SOILS AND STRUCTURES 3085 BAY RD STE 6 2682 GARFIELD RD N SUITE 23 SAGINAW, MI 48603 13 TRAVERSE CITY, MI 49686 J. Ranck Electric, Inc. Public Works Projects Subcontractor Listing 2013-2017 SOLECTRIA 360 MERRIMACK ST SOUND ENGINEERING BLDG 9 FLOOR 2 12933 FARMINGTON RD. LIVONIA, MI 48150 LAWRENCE, MA 01843 SOUNDCOM SPARTAN BARRICADING INC 24600 N INDUSTRIAL DR 1560 CEDAR ST FARMINGTON, MI 48335 HOLT, MI 48842 SPICER GROUP INC 230 S WASHINGTON AVE SPORS CO., INC. P.O. BOX 1689 3031 IROQU015 STR. DETROIT, MI 48214 SAGINAW, MI 48605-1689 STREETSCAPE LLC STUB'S TRUCKING 4645 W WALTON BLVD 202 ARMORY DRIVE WATERFORD, MI 48329 SAULT STE. MARIE, MI 49783 STURGEON ELECTRIC SUPER CONSTRUCTION LLC 2825 E. GINTER ROAD 201 MORTON TUSCON, AZ 85706 BAY CITY, MI 48706 SUPERIOR LAWN CARE & LANDSCAPING SUPERIOR SCAPE INC P.O. BOX 87 51989 SCHOENHERR ISHPEMING, MI 49849 SHELBYTWP, MI 48315 SUPREME SWEEPING SERVICES SURVEYING SOLUTIONS INC 23860 SHERWOOD 4471 M-61 CENTER LINE, MI 48015 STANDISH, MI 48658 TACH SERVICES INC TAILOR MADE WINDOWS & DOORS IN 13317 OAKALLA RD 24460 GRATIOT KILLEEN, TX 76549 EASTPOINTE, MI 48021 TEAM ELMER'S PO BOX 6150 TELEDYNE ISCO, INC 3600 RENNIE SCHOOL RD P.O. BOX 223135 TRAVERSE CITY, MI 49696-6150 PITTSBURGH, PA 15251-2135 TELEGRA TELE FREEWAY TERRACON CONSULTANTS INC SUITE 1385 135 AMBASSADOR DR DALLAS, TX 74234 14 NAPAERVILLE, IL 60540 J. Ranck Electric, Inc. Public Works Projects Subcontractor Listing 2013-2017 TH EIFERT LLC THE DATACOM GROUP 3302 W STJOSEPH 3979 HOTL RD LANSING, MI 48917 HOLT, MI 48842 THE JAMAR COMPANY THE UNDERGROUND DETECTIVE 4701 MIKE COLALILLO DR 9192 COLERAIN AVE DULUTH, MN 55807 CINCINNATI, OH 45251 THOMPSON LIGHTNING PROTECTION TKMS ASPHALT SPECIALISTS INC 901 SIBLEY HIGHWAY 1780 E HIGHWOOD ST. PAUL, MN 55118-1792 PONTIAC, MI 48340 TMEIC CORPORATION 1325 ELECTRIC RD TODD C HAMILTON SUITE LE 128 FORREST CREEK CIRCLE WEATHERFORD, TX 76088 ROANOKE, VA 24018 TRAFFIC CONTROL CORP TRANSPAK 10435 ARGONNE WOODS DR 810 W. HOWARD LANE WOODRIDGE, IL 60517 AUSTIN, TX 78753 TRC ENVIRONMENTAL CORPORATION TRC LOCKBOX TTG UTILITIES LP PO BOX 536282 PO BOX 299 PITTSBURGH, PA 15253-5904 GATESVILLE, TX 76528 TWS CONTRACTING INC GLASS &METAL CONTRACTORS UNDERGROUND SOLUTIONS OF NC 1110 S CARNEY DRIVE 2002 ALTARA LANE ST CLAIR, MI 48079 MATTHEWS, NC 28104 UNION LIGHTNING PROTECTION UP ELECTRIC/WITTOCK SUPPLY 7975 INDUSTRIAL DR P.O. BOX 5289 FOREST PARK, IL 60130 SAGINAW, MI 48603-0289 UTILITIES INSTRUMENTATION SERV W SOULE & CO 2290 BISHOP CIRCLE EAST 7125 S SPRINKLE RD DEXTER, MI 48130 PORTAGE, MI 49002 WALDORF & SON'S , INC WATERTAP G-9118 N. DORT HWY 56720 MCKENZIE LANE MT. MORRIS, MI 48458 SOUTH LYON, MI 48178 15 J. Ranck Electric, Inc. Public Works Projects Subcontractor Listing 2013-2017 WB UNDERGROUND LLC PO BOX 1249 WERNER PLUMBING & HEATING, INC 6053 PROSPECT RD. PO BOX 310CHEBOYGAN, MI 49721 INDIAN RIVER, MI 49749 WESCO DISTRIBUTION WESCO RECEIVABLES CORP WEST MI RECYCLED AGGREGATES PO BOX 633718 PO BOX 907 CINCINNATI, OH 45263-3718 GRANDVILLE, MI 49468-0907 WHITE ELECTRICAL CONSTRUCTION WILTEC TECHNOLOGIES 5504 CATERPILLAR DRIVE 5840 INTERFACE DRIVE APEX, NC 27539 SUITE 300 ANN ARBOR, MI 48103 WINDEMULLER WJ ONEIL COMPANY 1176 ELECTRIC AVE 35457 INDUSTRIAL ROAD WAYLAND, MI 49348 LIVONIA, MI 48150 WO GRUBB CRANE RENTAL WOLVERINE POWER SYSTEMS 5120 JEFFERSON DAVIS HIGHWAY 3229 80TH AVE RICHMOND, VA 23234 ZEELAND, MI 49464 XTREME POWERLINE CONSTRUCTION 1925 LAPEER AVE YPS FACILITY SERVICES LP SUITE 300 PO BOX 9009 PORT HURON, MI 48060 AUSTIN, TX 78766 YUKON CONSTRUCTION 3868 MAYER ROAD CASCO, MI 48064 16 w LL w 0 o a F a Z 2 2 z z0 a K rG V 0 3 p Z = S x Y opc n w 7 a Z — u z .:gin. in u u ¢ a. 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Ranck Electric, Inc. has never failed to complete awarded work, or ever defaulted on a contract. There are no judgments, claims, arbitration proceedings or suits pending or outstanding against J. Ranck Electric, Inc. or its officers. No officer or principal of J. Ranck Electric, Inc. has ever been an officer or principal of another organization when it failed to complete a construction contract. References Enbridge Energy Superior, W1 Attn: Brian Hammond Phone: (218) 522-4786 Brian.hammond@enbridge.com Granger Construction Lansing, MI Attn: Greg Brand Phone: (734) 904-1169 gbrand@grangerconstruction.com DTE Energy Detorit, MI Attn: Paul Lisecid Phone: (313) 949-3047 lisecldp@dteenergy.com PA, H Ranck Electric's goal is to maintain a diverse pool of resources for employees and operators to pull from depending on the unique aspects of the job at hand. To say we are a "turnkey" contractor is an understatement. JRE handles the majority of work in-house and our fully staffed fleet eliminates the need to involve subcontractors. Because of the diverse knowledge of our operators, our fleet capabilities far exceed just putting holes in the ground and running conduit. Crews are prepared to assist in new construction projects, repairs, maintenance and exploratory excavation, Our group of stationed mechanics and mobile mechanics ensure ourfleet is prepared and in top shape whenever and wherever needed. Our routine annual maintenance program and mobile maintenance services ensures that our fleet is compliant with all state and federal regulations. Trencher/Plows/Boring (5) Arrow Boards (20) Backhoes(8) Bulldozers (2) Forklifts (14) Tractors (6) Excavators (33) Generators (7) Gator & ORV (5) Scissor Lifts (11) Skidders (7) Trailers (112) Cement Products (1) Compressors (8) Hydroseeders (1) Compactors (3) Water Pump Products (1) Pay Loaders (2) Post/Pile Drivers (5) Cars and Trucks Light Duty cars/trucks (72) DOT Trucks/One Ton (38) Bucket Trucks (25) Digger Trucks (11) Dump and Vac Trucks (13) Stinger/Knuckle Booms (3) Stake Trucks (3) Mechanic Trucks (2) Van/Box Trucks (6) TMA Trucks (6) Semi Trucks (3) Pricing: J. Ranck Electric, Inc. has received quotations for all materials to substantiate our price(s) as quoted herein. CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK RESPONSIBLE BIDDER CHECKLIST Project Name City of South Bend Wastewater Treatment Plant Electrical Improvements Project No. 117-132 For Bids Due November 13, 2018 Contractor Name: J, Ranck Electric Inc. 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. THIS FORM MUST BE SUBMITTED WITH YOUR BID. INSTRUCTIONS: If you are a pre -qualified bidder, complete Section I only. If you are not a pre -qualified bidder, complete Section II only. Section II acts as an application for pre -qualification. Submission of Section II 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 315' 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. Version 7/20/2018 Notice to Bidders 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. Certified payrolls shall be submitted electronically. 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. Version 7/20/2018 Notice to Bidders PRE -QUALIFIED BIDDER CHECKLIST (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. (ii) _ 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. Version 7/20/2018 Notice to Bidders II. PRE -QUALIFICATION CHECKLIST (FOR BIDDERS THAT ARE NOT PRE -QUALIFIED) (a) Acknowledgements: (i) X By checking this box, I hereby acknowledge that I am not a pre -qualified bidder with the City of South Bend. (ii) X 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) X 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 anytime and shall be furnished upon request. (iv) X 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: (i) X 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) N/A List identifying all former business names. (iii) NLA 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) (iv) X years. 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) X 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) X 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) X 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) X 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) X 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. (i) X List of projects of similar size and scope of work performed in all areas, including the State of Indiana, within three (3) years prior to the date on which the bid is due. Version 7/20/2018 Notice to Bidders (Print Name Here) J. Ranck Electric Inc. (Name of Company) 1993 Gover Parkway (Address of Company) Mt. Pleasant (City) MI (State) (989) 775-7393 (Telephone Number) Version 7/20/2018 Notice to Bidders Business Name: J. RANCK ELECTRIC, INC. Entity Type: Foreign For -Profit Corporation Creation Date: 04/27/2010 Principal Office Address: 1993 GOVER PKWY, MOUNT PLEASANT, MI, 48858, USA Jurisdiction of Formation: Michigan BUSINESS INFORMATION CONNIE LAWSON INDIANA SECRETARY OF STATE 11/15/2018 10:16 AM Business ID: 2010042700666 Business Status: Active Inactive Date: Expiration Date: Perpetual Business Entity Report Due 04/30/2020 Date: Original Formation Date: 07/23/1986 Years Due Title Name Address President ADAM RANCK 1993 GOVER PARKWAY, MT PLEASANT, MI, 48858, USA Vice President ANGELA WOOD 1993 COVER PARKWAY, MT PLEASANT, MI, 48858, USA Treasurer MATTHEW WARREN 1993 GOVER PARKWAY, MT PLEASANT, MI, 48858, USA Secretary ANGELA WOOD 1993 GOVER PARKWAY, Mt Pleasant, MI, 48858, USA Type: Business Commercial Registered Agent Name: CORPORATION SERVICE COMPANY Address: 135 North Pennsylvania Street, Suite 1610, Indianapolis, IN, 46204, USA Violations and Staffing Capabilities: There are no federal, state, or local tax liens or tax delinquencies owed to any federal, state or local taxing body in the preceding three years. No officer or principal of JRE has ever been an officer or principal of another organization when it failed to complete a construction contract. J. Ranck Electric, Inc. (JRE) has sufficient employees and sources for employees to complete the work and will staff the project as follows: Project management will be handled through our Michigan office(s). Field supervision will be secured through our Michigan labor force. All other labor will be staffed through the local union halls as jurisdictionally required. Individuals who will perform work on the public work project on my behalf will be properly classified as an employee. JRE is a member of NECA and an active participant in the IBEW JATC program. Sample reports attached. INDIANA DEPARTMENT OF TRANSPORTATION ECONOMIC OPPORTUNITY DIVISION 100 North Senate Avenue Room N750 Indianapolis, Indiana 46204-2216 Telephone: (317) 233-2412 Fax: (317) 233-0891 i11141�1%raITvITly oda e 1lAn:4Bold?7 ,Irol:o OJT TRAINEE INTRODUCTION FORM 1. Contractor Name: 2. Address: 3. Name of Trainee: 4. Trainee Address and Telephone Number: 5. Date of Birth (MM/DD/YYYY): 6. SSN (Last 4 digits): 7. Employee Status (Check One): ❑ New Hire ❑ Rehire 8. Racial/Ethnic Identification (Check One or More): 9. Gender: ❑ American Indian or Alaska Native ❑ Asian ❑ Black or African American ❑ Male ❑ Female ❑ Hispanic or Latino ❑ Native Hawaiian or Pacific Islander ❑ White 10. Hire/Rehire Date: 11. Previous Training Hours (Enter "N/A" if Not Applicable): 12. Does Trainee Have Any Experience Performing Work Stipulated Under the Approved Program? ❑ Yes ❑ No If yes, briefly summarize 13. Trade Classification of Trainee: 14. Type of Training Program: ❑ Carpenter ❑ Cement Mason ❑ Electrician ❑ Equipment Operator ❑ Iron Worker ❑ Laborer ❑ USDOL Approved ❑ FHWA Approved Mechanic ❑ Millwright ❑ Painter ❑ Pipefitter/Plumber ❑ Truck Driver 15. Total Training Hours of Program: 16. How Was Trainee Referred? ❑ Union ❑ Minority/Women Organization ❑ Employment Agency ❑ Other 17. Has Trainee Received Copy of Training Program? 18. Union Affiliation (Enter "N/A" if Not Applicable): ❑ Yes ❑ No Union Trade Name: 19. PREPARED BY: Contractor's Representative Name, Title, and Signature 20.. Date Signature: Printed Name and Title: .I III N ,A cy T - 2L Approved Denied Reason for denial: 22. INDOT Representative Name and Signature: 23. Date Signature: Printed Name: INDIANA DEPARTMENT OF TRANSPORTATION ECONOMIC OPPORTUNITY DIVISION 100 North Senate Avenue Room N750 Indianapolis, Indiana 46204-2216 Telephone: (317) 233-2412 Fax: (317) 233-0891 4tBlhMNm LmAQt�22�3,lqrn MONTHLY OJT TRAINEE HOURS REPORT (Due no later than 2011 of the following month) 1. Contractor Name; 1 2. Trainee Name: 3. Sex: E] Male [] Female Date 4. Racial/Ethnic Identification (Check One or More): n American Indian or Alaska Native DAsian OBlack or African American El Hispanic or Latino El Native Hawaiian or Pacific Islander E]White Project # INDOT Hours Non-INDOT Hours Total Hours This Reporting Period: Total Combined Training Hours This Period, Total Combined Training Hours For Current Year: PREPARED BY: Signature and Title of Contractor's Representative Date: INDIANA DEPARTMENT OF TRANSPORTATION ECONOMIC OPPORTUNITY DIVISION 100 North Senate Avenue Room N750 Indianapolis, Indiana 46204-2216 Telephone: (317) 233-2412 Fax: (317) 233-0891 11 4 d _ 1? mwal� oy/i dot/275W1 ton MONTHLY PROJECT REPORT Month Reporting: Contractor Name: INDOT Contracts: Non-INDOT Contracts: PREPARED BY: Signature and Title of Contractor's Representative Date: INDIANA DEPARTMENT OF TRANSPORTATION ECONOMIC OPPORTUNITY DIVISION 100 North Senate Avenue Room N750 Indianapolis, Indiana 46204-2216 Telephone: (317) 233-2412 Fax: (317) 233-0891 Troll nlrovdilrodotr2'753jitm QUARTERLY OJT TRAINEE REPORT 1. ContractorNamet Name of Trainee: 2, Sex 3, Racial/Ethnic Identification (Check One or More): El Male Female El American Indian or Alaska Native Asian El Black or African American [I Hispanic or Latino Native Hawaiian or Pacific Islander White Performance Ratings: (1, 2, 3 = Poor Performance) (4, 5, 6, 7 = Average Performance) (8, 9, 10 = Excellent Performance) 4. Attendance: L 2. 3, 4, 5. 6 7, 8. 9. 10, 5. Attitude toward co-workers & employer: 1. 2 3, 4. 5. 6. 7. 8. 9, 10, 6. Job Knowledge: 1. 2. 3, 4. 5. 6 7, 8. 9. 10. 7. Use of time: 1. 2. 3. 4, 5, 6. 7, 8, 9, 10. S. Handling of tools, equipment& material: 1. 2, 3, 4 5, 6. 7. 8, 9. 10. 9. Observance of safety rules: 1. 2. 3. 4, 5, 6, 7, 8, 9, 10, 10. Professional Appearance/Preparedness 1. 2. 3. 4. 5, 6. 7. 8. 9, 10, 11. Overall Ability: L 2. 3, 4. 5. 6. 7. 8. 9 10, 12. Comments: 13. PREPARED BY: Signature and Title of Contractor's Representative 14. Date: INDIANA DEPARTMENT OF TRANSPORTATION ECONOMIC OPPORTUNITY DIVISION 100 North Senate Avenue Room N750 Indianapolis, Indiana 46204-2216 Telephone: (317) 233-2412 Fax: (317) 233-0891 111 t1l., 1/w -w y - i 11.&ov —/in d (1—(/ -21Z5. 1-11L, v OJT TRAINEE TERMINATION/COMPLETION FORM 1. Contractor Name: 1. Name of Trainee: 2. Date of Birth: 3, SSN (Last 4 digits): C Sex: - El Male El Female 5 Racial/Elboic Identification (Check One or More): 7. ferminationiCompletion Date: ❑ American Indian or Alaska Native ElAsian El Black or African American Hispanic or Latino [I Native Hawaiian or Pacific Islander El White Trade Classification of Trainee (e.g., Electrician): Type of Training Program: Ej USDOL Approved [I FHWA proved 10. Total Training Hours of Program: ill. Total Training Hours Completed: 12. Termination/Completion 13. Reason for Termination: E]Fired E]Quit [] Laid Off [I Completed Program 1 14, PREPARED BY: Signature andTille of Contractor's Representative 15. Date: U.S. DEPARTMENT OF TRANSPORTATION PIPELINE & HAZARDOUS MATERIALS SAFETY ADMINISTRATION (PHMSA) PREPARED IN ACCORDANCE WITH THE REQUIREMENTS OF: 49 CFR PART 199 49 CFR PART 40 J. RANCK ELECTRIC, INC. 1993 GOVER PARKWAY MT. PLEASANT, MI 48858-8137 (989)775-7393 ORIGINAL DATE OF IMPLEMENTATION: Jul 1, 1994 NEW EFFECTIVE DATE: Jan 4, 2011 PLAN REVISION DATE: january 4. 2Q1"I' ONA77ONAL COMPL/ANCE MANAGEMENT SERWC4 INC. (NCMS) REws/ON DATEIN000EOBYNCMS ONLY J. RANCK ELECTRIC, INC, Table of Contents I. INTRODUCTION 4 1. Development of "Combined" Plan 4 2. Approach 4 3. Background 5 H. GENERAL 5 1. Scope 5 2. Applicability 6 3. Compliance 6 4.' "DOT" vs. "PHMSA" 6 5. DOT Procedures 6 6. Stand -down Waiver 6 7. " Preemption of State and Local Laws 6 8. Definitions 7 III. POLICY AND RESPONSIBILITIES 12 1. Company Policy 12 2. Responsibilities of Key Personnel 12 3. Responsibility of Covered Employees 13 4. Use of Service Agents 13 5. Critical Service Agent Positions 13 6. "NON -DOT" Testing Program 14 IV. DOT PROGRAM REQUIREMENTS 14 1. Employees Subject to Testing 14 2. Acknowledgement/Receipt Form 14 3. History -check Requirement 14 4. Employee Notification of Tests 15 5. DOT Drug Violations 15 6. DOT Alcohol Violations and Prohibited Conduct 16 7. Violation Consequences and Company Actions 16 V. ANTI -DRUG PROGRAM 17 1. DOT -Required Drug Tests 17 2. Drug Tests That Require Direct Observation Procedures 19 3. Specimen Collection Procedures 20 4. PHMSA Inspection Protocol for Specimen Collection Sites 21 5. Drug Testing Laboratory 22 6. Laboratory Retention Periods and Reports 24 7. Laboratory Quality Control 24 S. MRO Review of Drug Test Results 24 9. Split Specimen Testing 25 10. Medical Marijuana 26 J. RANCK ELECTRIC, INC. PHMSA DRUG/ALCOHOL PLAN NATIONAL COMPI IANCF- MANAGFMENTSFRVICF, INC, (NCRAS) 2b10 VI. ALCOHOL MISUSE PREVENTION PROGRAM 26 1. DOT -Required Alcohol Tests 26 2. Alcohol Test 27 3. PHMSA Inspection Protocol for Alcohol Testing Sites 28 VII. PROGRAM ELEMENTS COMMON TO DRUG AND ALCOHOL 31 1. Substance Abuse Professional 31 2. Employee Assistance Program 32 3. Supervisor Training 32 4. Contractor Monitoring 32 5. Recordkeeping 33 6. Management Information system 34 VIII. APPENDIX A ACKNOWLEDGEMENT/RECEIPT FORM 35 IX. APPENDIX B DESIGNATED PERSONNEL & SERVICE AGENTS 36 X. APPENDIX C COVERED POSITIONS 37 XI. APPENDIX D COMPANY DISCIPLINARY ACTIONS AND ADDITIONAL PROCEDURES 38 XII. APPENDIX E PHMSA INSPECTION PLAN CROSS-REFERENCE ENDNOTES 40 J. RANCK ELECTRIC, INC. PHMSA DRUWALCOHOL PLAN NATIONAL COMPLIANCE MANAGEMENT SERVICE, INC. (NCMS) - 2010 3 a 1. Development of "Combined" Plan The Pipeline and Hazardous Materials Safety Administration (PHMSA) is the agency within the Department of Transportation (DOT) that regulates operators in the natural gas and hazardous liquid pipeline industry. PHMSA's Drug and Alcohol Testing Regulation, 49 CFR Part 1991, requires each operator to develop, maintain, and follow an Anti -Drug Plan and an Alcohol Misuse Prevention Plan. Historically, companies have produced these plans as two separate documents. This "combined" Anti -Drug and Alcohol Misuse Prevention Plan," merges both PHMSA-required plans into a single document. Authorization for a combined plan was granted by PHMSA's Office of Pipeline Safety stating. "PHMSA will allow the combining of the two plans into one written plan, as long as all requirements of each regulation are met." The "requirements of each regulation" means the requirements of Part 199 and the requirements of DOT's "Procedures for Transportation Workplace Drug and Alcohol Testing," 49 CFR Part 402, The Anti -Drug and Alcohol Misuse Prevention Plan, henceforth referred to as the "Plan," meets all the requirements of Part 199 and Part 40. 2. Approach The Plan will use the generic word " Company" in reference to the operator or contractor, as applicable, for which it is written. PHMSA's requirement for plan development and implementation applies equally to each operator and contractor that performs safety -sensitive operations, maintenance, or emergency -response functions on a pipeline or LNG facility within the natural gas and hazardous liquid pipeline industry. The Plan will describe how the Company will comply with government requirements. The Plan will identify "Company -additional" requirements — those that go beyond the minimum requirements of DOT. n I , i Therefore, consider anything that is not underscored a requirement of DOT or a process put In place by the Company to meet a DOT requirement. Appendix D outlines the Company disciplinary actions and additional procedures. The Plan is written in "plain language" and follows the requirements of each rule. However, the Plan does not repeat the language of either Part 40 or Part 199. Doing so would require the Company to produce a new plan every time DOT or PHMSA issued a change to their respective rule. The goal of DOT is to know that the Company understands the requirements of the rules and how the Company will go about achieving compliance. The Plan makes use of existing DOT language in places where summaries are used to explain a more detailed process e.g., specimen collection and alcohol test procedures are extracted from DOT's "Employee Guide" ). ' Title 49 Code of Federal Regulations (CFR), Part 199, "Drug and Alcohol Testing Requirements," Pipeline and Hazardous Materials Safety Administration, Department of Transportation, 53 FR 47096, Nov. 21, 1988 as amended. 2 Title 49, Code of Federal Regulations (CFR), Part 40, "Procedures for Transportation Workplace Drug and Alcohol Testing Programs," Office of the Secretary, Department of Transportation, 65 FR 79462, Dec. 19, 2000 as amended. 3 "What Employees Need To Know About DOT Drug & Alcohol Testing," ODAPC, DOT, October, 2010. J. RANCK ELECTRIC, INC. PHMSA DRUG/ALCOHOL PLAN NATIONAL COMPLIANCE MANAGEMENT SERVICE, INC. (NCMS) - 2010 w: s r- w ♦ w w zwwe 3. Background Safety. The DOT requires transportation employers to develop and implement drug and alcohol testing programs in the interest of public safety. Safety is the highest priority for DOT. One of the means by which the DOT helps ensure safety is by subjecting those workers responsible for transportation '.safety to drug and alcohol testing. Workers tested under the DOT program have direct Impact on the safety of the traveling public or the safety of those potentially affected by the transportation of hazardous products, such as natural gas, liquefied natural gas (LNG) and hazardous liquids. Test Procedures. The overall responsibility for management and coordination of the DOT program resides within the Office of the Secretary of Transportation's (OST), Office of Drug and Alcohol Policy and Compliance (ODAPC). ODAPC Issues Part40. Whether the transportation employee Is a pipeline worker, truck driver, or airline pilot, their drug and alcohol tests are conducted using the same Part 40 procedures,. This consistency benefits all employees affected by DOT regulations in that each agency's regulations must adhere to DOT's testing procedures. Better known simply as "Part 40," this rule has become the standard for workplace testing in the United States. Compliance Enforcement. Regulation and enforcement within the different transportation industries is the responsibility of the DOT agency that has authority over the particular industry, The regulatory authority requiring drug and alcohol testing of safety-sensitive employees in aviation, trucking, railroads, and mass transit industries is the Omnibus Transportation Employee Testing Act of 19911 (OTETA), The OTETA did not specifically address the pipeline industry. PHMSA has regulatory authority over the pipeline industry and conveyed', their authority, for drug and alcohol testing„ through the issuance of their regulation -- Part 199. Part 199 spells out who is subject to testing, when and In what situations, Operators, and In turn, their associated contractors, implement the regulations. 11. GE1a1ERAL I. Scope Operators of pipeline facilities subject to 49 CFR Parts 1926, 193 7r, or 195 9 are required to test covered employees for the presence of prohibited drugs and alcohol. Contractors doing similar work on the behalf of their operators are subject to the same requirements. Part 199 requires of each operator the assurance that any contractor performing any DOT safety -sensitive work for that operator, under Parts 192, 193, or 195, is in full compliance with the provisions of the DOT's drug and alcohol program, as applicable. 4 "Substance Abuse Program: Comprii•'he ive Audit and Inspection Protocol Form, Combined Anti -Drug and Alcohol. Misuse Progmms, Form No.: 3.1.11, January 29, 2010" Pipeline and Hazardous Materials Safety Administration, Office of Pipeline Safety- 5 Public Law 102-143, October 28, 1991, Title V -- Omnibus Transportation Employee Testing, 105 Stat. 952-965; 49 U.S.C. 45104(2). 6 Part 192 — Transportation of Natural and Other Gas by Pipeline: Minimum Federal Safety Standards 7 Part 193 — Liquefied Natural Gas Facilities: Federal Safety Standards 8 Part 195 — Transportation of Hazardous Liquids by Pipeline J. RANCK ELECTRIC, INC. PHMSA DRUGIALCOHOL PLAN 1. NATIONAL COMPLIANCE MANAGEMENT SERVICE. INC (NCVSI -- 2010 2. Applicability Part 199, and the provisions of the Plan, applies to operators and contractors only with respect to their employees located within the territory of the United States, including those employees located within the limits of the "Outer Continental Shelf." Part 199 and the provisions of the Plan do not apply to covered functions performed on master meter systems or pipeline systems that transport only petroleum gas or petroleum gas/air mixtures. 3. Compliance' 2 Plan Development . The Plan meets the requirement of Part 199, paragraphs §199,101 and §199.202, respectively, to develop a written anti -drug plan and a written alcohol misuse prevention plan. The Plan describes the methods and procedures for compliance with the drug and alcohol program requirements of the DOT, including the employee assistance program. The Plan covers the operational, day-to-day requirements that are found in Part 199, and the procedural, testing requirements that are found in Part 40. The Plan provides appendices for the name and address of each laboratory that analyzes specimens for the Company, the Company's Medical Review Officer, and Substance Abuse Professionals. The Plan communicates to employees, Company officials, and DOT officials the path that the Company will follow in order to comply with the requirements for a successful DOT drug and alcohol program. Plan Availability. The Plan will be posted in a common place, selected by the Company, for employee review and feedback. A copy of the Plan will be made available to all covered employees. Any covered employee desiring a copy of Part 40 and/or Part 199 must contact the Designated Employer Representative (see Appendix $). The Plan provides a basic description of the rules and testing requirements, and shows how the Company implements and follows them. The Plan is not meant as a substitute for the detail provided in either rule. If there is any difference in instruction or interpretation between the Plan and the rules, the rules prevail. The Plan will be updated at any time its language, or the intent of its language, differs from that of either Part 40 or Part 199. Employees are encouraged to obtain and read Part 40 and Part 199 on their own. 4. "DOT" vs. "PHMSA" All DOT workplace testing procedures will follow Part 40 requirements. All DOT procedural responsibilities for pipeline operators and contractors will follow Part 199. In the Plan, the term "DOT" will be used for references to general requirements (e.g., testing procedures) placed on all transportation employers, including operators and contractors. The use of the term "PHMSA" will be to distinguish specific, unique administration requirements versus general, DOT requirements (e.g., random alcohol testing is not authorized by PHMSA). 5. DOT Procedures The Company will assure that the procedures of Part 40 are followed for drug and alcohol testing conducted under the requirements and authority of Part 199; a violation of Part 40 is a violation of Part 199. If the Company employs a Consortium/Third-Party Administrator (C/TPA) to assist in program development, implementation, and management, the C/TPA will, likewise, follow all the requirements of Part 40 and Part 199. It is the Company's goal to establish and maintain compliance with the DOT drug and alcohol program. 6. Stand -down Waiver 3 DOT "stand -down" is not in effect for this Company. The Company does not hold a stand -down waiver under Part 40, and has not applied for one. Should this status change, the Company will notify all covered employees and Company officials, in accordance with Part 40 requirements. 7. Preemption of State and Local Laws Part 40 and Part 199 are Federal laws. Federal law preempts any state or local law, rule, regulation, or order to the extent that: (a) compliance with both the state or local requirement and Part 40 or 199 J. RANCK ELECTRIC, INC. PHMSA DRUG/ALCOHOL PLAN NA i"IONAL COMW(.IANCE MANAGeMENT SERVICE, INC. (NCMS) - 2010 is not possible; or, (b) compliance with the state or local requirement is an obstacle to the accomplishment and execution of any requirement of Part 40 or 199, or, (c) the state or local requirement is a pipeline safety standard applicable to interstate pipeline facilities. This provision does not preempt provisions of state criminal taw that impose .sanctions for reckless conduct; leading to actual loss of life, injury, or damage to property,, whether the provisions apply specifically to transportation employees or employers or to the general ,public. 8. Definitions Definitions from Parts 40, 191, 195, and 199 have been combined in alphabetical order and are provided in a single listing. For purposes of the Plan the following definitions apply: Acgtdant - An incident reportable under Part 191 involving gas pipeline facilities or LNG facilities or an accident reportable under Part 195 involving hazardous liquid pipeline facilities. a) (§191.3) — An accident on a gas pipeline or LNG facility is defined as an "incident," as follows: (1) An event that involves a release of gas from a pipeline, or of liquefied natural gas, liquefied petroleum gas, refrigerant gas, or gas from an LNG facility, and that results in one or more of the following consequences: (a) A death, or personal injury necessitating inpatient hospitalization; or (b) Estimated property damage of $50,000 or more (5,000 or more for intrastate operators/contractors in Oklahoma and New Mexico), including loss to the operator and others, or both, but excluding cost of gas lost; (c) Unintentional estimated gas loss of three million cubic feet or more; (2) An event that results in an emergency shutdown of an LNG facility. Activation of an emergency shutdown system for reasons other than an actual emergency does not constitute an incident. (3) An event that is significant, in the judgment of the operator, even though it did not meet the criteria of paragraphs (1) or (2). b) (§195.50) —An accident report is required for each failure in a pipeline system in which there is a release of the hazardous liquid or carbon dioxide transported resulting in any of the following: (1) Explosion or fire not intentionally set by the operator. (2) Release of 5 gallons (19 liters) or more of hazardous liquid or carbon dioxide, except that no report is required for a release of less than 5 barrels (0.8 cubic meters) resulting, from a pipeline maintenance activity if this release is: (a) Not otherwise reportable under this section; (b) Not one described in §195.52(a)(4); (c) Confined to Company property or pipeline right-of-way; and (d) Cleaned up promptly; (3) Death of any person. (4) Personal injury necessitating hospitalization; (5) Estimated property damage, including cost of clean-up and recovery„ value of lost product, and damage to the property of the operator or others, or both, exceeding $50n000, Ar minlafr - The Administrator of the Pipeline and Hazardous Materials Safety Administration (PHMSA) or any person to whom authority in the matter concerned has been delegated by the Secretary of Transportation. Ad_utlgrated s cirnen - A specimen that has been altered, as evidenced by test results showing either a substance that is not a normal constituent for that type of specimen or showing an abnormal concentration of an endogenous substance. A� �atll t - Persons are affiliates of one another if, directly or indirectly, one controls or has the power to control the other or a third party controls or has the power to control both. Indicators of control include, but are not limited to: interlocking management or ownership; shared interest among family members; shared facilities or equipment; or common use of employees. Following the, issuance of a Public Interest Exclusion (PIE), an organization having the same or similar management, ownership, or principal employees as the service agent concerning who public interest exclusion is in effect is J. RANCK ELECTRIC, INC. PHMSA DRUGIALCOHOL PLAN NATIONAL COMM IANr E MANAGEMENT SERVICE, INC, (NCKAS) -2010 regarded as an affiliate. This definition is used in connection with the public interest exclusion procedures of Part 40, Subpart R. Aires - 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. Alc� - The intoxicating agent in beverage alcohol, ethyl alcohol or other low molecular weight alcohols, including methyl or isopropyl alcohol. lgghol concentratIon - The alcohol in a volume of breath expressed in terms of grams of alcohol per 210 liters of breath as indicated by a breath test under this part. At' foot conflrmatt n tgst - A subsequent test using an EBT, following a screening test with a result of 0.02 or greater, that provides quantitative data about the alcohol concentration. Al o_hol nl d vl' - A breath or saliva device, other than an EBT, that is approved by the National Highway Traffic Safety Administration (NHTSA) and placed on a conforming products list (CPI.) for such devices. At t s r ntn toot - An analytic procedure to determine whether an employee may have a prohibited concentration of alcohol in a breath or saliva specimen. Al hot tongj#Ang site - A place selected by the employer where employees present themselves for the purpose of providing breath or saliva for an alcohol test. At arse - The drinking or swallowing of any beverage, liquid mixture or preparation (including any medication), containing alcohol. A Lq&o - A fractional part of a specimen used for testing. It is taken as a sample representing the whole specimen. Blind sample or Mind performance test specimen . A specimen submitted to a laboratory for quality control erg ing purposes, with a tictitious identifier, so that the laboratory cannot distinguish it from an employee specimen. Breath Alc2hol Techniol n BA - A person who instructs and assists employees in the alcohol testing process and operates an evidential breath testing device. Cancelled test - A drug or alcohol test that has a problem identified that cannot be or has not been corrected, or which Part 40 otherwise requires to be cancelled. A cancelled test is neither a positive nor a negative test. Chaln-c&Sustody (or Custody and Control Form (CCF)) - The procedure used to document the handling of the urine specimen from the time the employee gives the specimen to the collector until the specimen is destroyed. This procedure uses the Federal Drug Testing Custody and Control Form (CCF). Il c t n C2,nklner - A container into which the employee urinates to provide the specimen for a drug test. Coltectlon Slte - A place selected by the employer where employees present themselves for the purpose of providing a urine specimen for a drug test. Co ieptor - 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 the CCF. C2nflrmgtojy drug test- A second analytical procedure performed on a different aliquot of the original specimen to identify and quant6 the presence of a specific drug or drug metabolite. C nflrm tlo conftrmato v lidi tes - A second test performed on a different aliquot of the original urine specimen to further support a validity test result. C nf1 d grug t - A confirmation test result received by an MRO from a laboratory. J. RANCK ELECTRIC, INC. PHMSA DRUG/ALCOHOL PLAN NAT IONAL COMPLIANCE MANAGEMENT SERVICE, INC, (NCMS) -- 2010 QqnIgEllumabird-Party A mliaistr C P - A service agent that provides or coordinates the provision of a variety of drug and alcohol testing services to employers. C/TPA,s typically perform administrative tasks concerning the operation of the employers drug and alcohol testing programs. This term includes, but is not limited to, ,groups of employers who join together to administer, as a single entity, the DOT drugand alcohol testing programs of its members. CfTPAs are not "employers" for purposes of Part 40. Contln irr ca t n - Training for medical review officers (MROs) and substance abuse professionals (SAPS) w;o have completed qualification training and are performing MRO or SAP functions, designed to keep MROs and SAPs current on changes and developments In the DOT drug and alcohol testing program. 92MO—r0d fUnctln Jgr afe -ser_s v f ctlo - An operations, maintenance, or emergency - response function regulated by 49 CFR Part 199, 19 , or 195 that is performed on a pipeline or on an LNG facility. DOT Procedureglor Part Oil -The Procedures for Transportation Workplace Drug and Alcohol Testing Program published by the Office of the Secretary' of Transportation in 49 CFR Part 40. Designated em Io er re re en ttve IDER -An employee authorized by the employer to take immediate action(s) to remove employees from safety -sensitive duties, or cause employees to be removed from these covered duties, and to make required decisions in the testing and evaluation processes. The DER also receives test results and other communications for the employer, consistent with the requirements of Part 40. Service agents cannot act as DERs. Chute s eclm - A urine specimen with creatinine and specific gravity values that are lower than expected for human urine. 171kT jhq D rtme t DQT ggeLicy - These terms encompass all DOT agencies, including, but not limited to, the Federal Aviation Administration (FAA)„ the Federal Railroad' Administration (FRA), the Federal Motor Carrier Safety Administration (FMC SA), the Federal Transit. Administration (FTA), the National Highway Traffic Safety Administration (NHTSA), the Pipeline and (Hazardous Materials Safety Administration (PHMSA), and the Office of the Secretary (OST). These terms include any designee of a DOT agency. Drugs - The drugs for which tests are required under Part 40 and DOT agency regulations are marijuana, cocaine, amphetamines, phencyclidine (PCP), and opiates. Em tr► ee covered em o ee - Any person who is designated in a DOT agency regulation as subject to drug testing and/or alcohol testing. The term includes individuals currently performing safety -sensitive functions designated in DOT agency regulations and applicants for employment subject to pre -employment testing. For purposes of drug testing under Part 40, the term employee has the some meaning as the term "donor" as found on CCF and related guidance materials produced by the Department of Health and Human Services. For the purposes of regulation under Part 199, the term employee means a person who performs a covered function, including persons employed by operators, contractors engaged/ by operators, and persons employed by such contractors. This includes full-time, part-time and temporary employees. It also includes any applicant for a covered function. Errrrrtgver - A person or entity employing one or more employees (including an individual who is self- employed) subject to DOT agency regulations requiring compliance with Part 40. The term includes an employer's officers, representatives, and management personnel. Service agents are not employers for the purposes of Part 40. Enror!qoEMgJIon, Training - Training provided to BATs, collectors, and screening test technicians (STTs) following an error that resulted in the cancellation of a drug or alcohol test. Error correction training must be provided in person or by a means that provides real-time observation and interaction between the instructor and trainee. Eyfogn1lal ftggh Toll1_ng Device _81 - A device approved by NHTSA for the evidential testing of breath at the .02 and .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. J. RANCK ELECTRIC, INC. PHMSA DRUG/ALCOHOL PLAN ':e NATIONAL COMPLIANCE MANAGEMENT SERVICE, INC. (NCMS) —2010 HHS a artrnent of Hogith and Human Servi s - The Department of Health and Human Services or any designee of the Secretary, Department of Health and Human Services. Initial rui test(also known s a "Screening #1VSJgs'J - The test used to differentiate a negative specimen from one that requires further testing for drugs or drug metabolites. ni l i speggimen v lidl test - The first test used to determine if a urine specimen is adulterated, diluted, substituted, or invalid. fall -The result reported by an HHS-certified laboratory in accordance with the criteria established by HHS Mandatory Guidelines when a positive, negative, adulterated, or substituted result cannot be established for a specific drug or specimen validity test. brates -Any U.S. laboratory certified by HHS under the National Laboratory Certification Program as meeting the minimum standards of Subpart C of the HHS Mandatory Guidelines for Federal Workplace Drug Testing Programs; or, in the case of foreign laboratories, a laboratory approved for participation by DOT under this part. Llmft gf Deloglion l] - The lowest concentration at which a measurand can be identified, but (for quantitative assays) the concentration cannot be accurately calculated. LIMft of g11MntI_WloLi- For quantitative assays, the lowest concentration at which the identity and concentration of the measurand can be accurately established. MShccal Review Officer J MPIR4) - A person who is a licensed physician and who is responsible for receiving and reviewing laboratory results generated by an employer's drug testing program and evaluating medical explanations for certain drug test results. Nertative result -The result reported by an HHS-certified laboratory to an MRO when a specimen contains no drug or the concentration of the drug is less than the cutoff concentration for the drug or drug class and the specimen is a valid specimen. Non-1]2gative 129&IM,20,7A urine specimen that is reported as adulterated, substituted, positive (for drug(s) or drug metabolite(s)), and/or invalid. - The office in the Office of the Secretary, DOT, that is responsible for coordinating drug and alcohol testing program matters within the Department and providing information conceming the implementation of Part 40. .Opgr -A person who owns or operates pipeline facilities subject to 49 CFR Part 192, 193, or 195. fix Izinci adulterant - A substance that acts alone or in combination with other substances to oxidize drugs or drug metabolites to prevent the detection of the drug or drug metabolites, or affects the reagents in either the initial or confirmatory drug test. Performs a gw%4 f n - Actually performing, ready to perform, or immediately available to perform a covered function. Pipeline - All parts of those physical facilities through which gas, hazardous liquids or carbon dioxide moves in transportation, including, but limited to, pipe, valves, and other appurtenance attached to pipe, compressor units, metering stations, regulator stations, delivery stations, holders, pumping units, breakout tanks and fabricated assemblies. PiRgline fcility - New and existing pipelines, rights -of -way, and any equipment, facility, or building used in the transportation of gas or in the treatment of gas, or transportation of hazardous liquids or carbon dioxide during the course of transportation. Positive to for random dru tlestin -The number of verified positive results for random drug tests conducted under Part 199, plus the number of refusals of random drug tests required by Pert 199, divided by the total number of random drug tests conducted plus the number of refusals of random tests under Part 199. J. RANCK ELECTRIC, INC. PHMSA DRUG/ALCOHOL PLAN NATIONAL COMPI LANCE MANAGEMENT SERVICE, INC (NCMS) ^ 2010 10 ft-SINve result - The result reported by an HHS-certified laboratory when a specimen contains a drug or drug metabolite equal to or greater than the cutoff concentrations. Primary peci mre,en - In drug testing, the urine specimen bottle that is opened and tested by a first laboratory to determine whether the employee has a drug or drug metabolite In his or her system, and for the purpose of validity testing. The primary specimen is distinguished from the split specimen, defined In this section. f!EghlMled - Any of the following substances specified in Schedule I or Schedule 11 of the Controlled Substances Act (1 U.S.C. 812): marijuana, cocaine, opiates, amphetamines, and phencyclidine (PCP). al talon Tral In - The training required in order for a collector, BAT, MRO, SAP, or STT to be qualified to perform their functions in the DOT drag and alcohol testing program. Qualification training may be provided by any appropriate means (e.g., classroom instruction, Internet application, CD- ROM, 'video), fjg_qonflrmglj - The result reported for a split specimen when the second laboratory is able to corroborate the original result reported for the primary specimen. RVjIglo fgr 1glUng- The result reported by an HHS-certified laboratory when no tests are performed for a specimen because of a fatal flaw or a correctable flaw that is not corrected. efresher Tralplag - The training required periodically for qualified collectors, BATs, and STTs to review basic requirements and provide instruction concerning changes in technology (e.g., new testing methods that may be authorized) and amendments, interpretations, guidance, and issues concerning Part 40 and DOT agency drug and alcohol testing regulations (e.g., Part 199). Refresher training can be provided by any appropriate means (e.g., classroom instruction, Internet application, CD-ROM, video). eftasal Lo u mit refusp, or refuse to take - Behavior consistent with Part 40 concerning refusal to take a drug test or refusal to take an alcohol test. pereening4f ;g k - See Initial drug test definition above. § r enl Test T' chnl lan TT - A person who instructs and assists employees in the alcohol testing process and operates an ASD. ISecrltaly - The Secretary of Transportation or the Secretary's designee. %grylg2 eg- Any person or entity, other than an employee of the employer, who provides services specified under Part 40 to employers and/or employees in connection with DOT drug and alcohol testing requirements. This includes, but is not limited to, collectors, BATs and STTs, laboratories, MROs, substance abuse professionals, and C/TPAs. To act as service agents, persons and organizations must meet the qualifications set forth in applicable sections of Part 40. Service agents are not employers for purposes of Parts 199 and 40. Sfrltarlrrgntalrrer - A container that is used for transporting and protecting urine specimen bottles and associated documents from the collection site to the laboratory. Sgeclmen bottle - The bottle that, after being sealed and labeled according to the procedures in Part 40, is used to hold the urine specimen during transportation to the laboratory. _Sg,ll) p3e0 - In drug testing, 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. SPIR $12021men pail( ctlon - A collection in which the urine collected is divided into two separate specimen bottles, the primary specimen (Bottle A) and the split specimen (Bottle B). J. RANCK ELECTRIC, INC. PHMSA DRUG/ALCOHOL PLAN NATIONAL COMPLIANCE, MANAGEMENT SERVICE, INC. (NCNB) - 2010 State agengyr , - An agency of any of the several states, the District of Columbia, and the Commonwealth of Puerto Rico that participates under the pipeline safety laws (49 U.S.C. 60101 et seq.) nd-lgn - The practice of temporarily removing an employee from the performance of safety - sensitive functions based only on a report from a laboratory to the MRO of a confirmed positive test for a drug or drug metabolite, an adulterated test, or a substituted test, before the MRO has completed verification of the test result. SublMace Abuse Profbs,slonal SAP - A person who evaluates employees who have violated a DOT drug and alcohol regulation and makes recommendations concerning education, treatment, follow-up testing, and aftercare. Substltu ed s clm n -A specimen with creatinine and specific gravity values that are so diminished or so divergent that they are not consistent with normal human urine. r ed test. - A drug test result or validity testing result from an HHS-certified laboratory that has undergone review and final determination by the MRO. M 61 1. Company Policy Policy Statement. Lhe to these high standards. The DOT Compliance . The Company is aware that it is ultimately responsible for meeting the requirements of Parts 40 and 199. The DOT authorizes transportation employers to use a service agent(s) to perform tasks necessary to comply with the Plan. The Company understands that, under the DOT regulations, it is responsible for the actions of its service agents. The Company is responsible for developing and implementing a successful and comprehensive DOT workplace drug and alcohol program. Components of the Company's program include clear policies, provisions for education and training, drug and alcohol testing, and when needed, referral for evaluation, education, and treatment. The Company shall ensure that all covered employees are aware of the provisions and coverage of the Plan. 2. Responsibilities of Key Personnel The Company will convey to responsible individuals — the Designated Employer Representative(s) and affected supervisors - that, to the best of their ability, the privacy and confidentiality of any covered employee subject to the Plan must be maintained at all times. Designated Employer Representative (DER) . Appendix B contains the name, address, and phone number of the DER(s). The DER is: a. the key employee for the Company's drug and alcohol program functions, and has the knowledge and authority to make decisions about the testing process and answer questions about it. b. not a service agent. C. one or more employees of the Company assigned to ensure adequate coverage on all shifts and at all locations. d. responsible for the preparation of the Plan, as well as providing oversight and evaluation on the Plan. e. responsible to review all adverse personnel action or discipline applied under the Plan for consistency and conformance to human resources policies and procedures. f. responsible for scheduling random, retum-to-duty and follow-up testing, as applicable, and is authorized to receive and m6intain, in a secure file system, all drug and alcohol testing results. J. RANCK ELECTRIC, INC. PHSA DRUG/ALCOHOL PLAN NATIONAL COMPLIANCE. MANAGEMENT SERVICE, INC, (NCMS) -2010 12 9- responsible for providing answers to employee questions regarding the testing program, and Information on the resources available for drug and alcohol counseling. h. responsible for overseeing the employee assistance program (EAP). Supervisor. A Company Individual(s) responsible for observing the performance and behavior of employees that is suggestive enough to lead to reasonable suspicion/cause drug and/or alcohol testing. Supervisors who will determine whether an employee must be drug tested and/or alcohol tested based on reasonable suspicion/cause will be trained in the "signs and symptoms" of each substance. The supervisor is required to document a reasonable suspicion/cause event. The supervisor may also be responsible for requests as the second supervisor for substantiation and concurrence for reasonable suspicion/cause drug test, if applicable. 3. Responsibility of Covered Employees" Compliance. Each covered employee must comply with the requirements of the Plan, and the DOT drug and alcohol rules it pertains to, in order to remain eligible to work in a DOT safety -sensitive position. Each covered employee has the responsibility to read, be knowledgeable of, and comply with, the requirements of the Plan, and Parts 40 and 199. Committing a DOT violation will result in the employee's immediate removal from the covered function, and remain so until successfully completing the DOT retum-to-duty conditions of Part 40, The Plan describes circumstances for being tested, violations, prohibited conduct, and their subsequent consequences. The Plan describes what is available to each covered employee as services (e.g., EAP) in such cases where the employee has a potential problem with drugs or alcohol prior to a drug or alcohol test. It is a condition of 4. Use of Service Agents 6 Compliance. The Company will contract with service agents to accomplish many of the requirements of Parts 40 and 199. Appendix B (Designated Personnel and Service Agents) provides the names and addresses of service agents that are under contract. Contracts will contain a provision that the service agent will comply with Parts 40 and 199 in the services provided. The work of any service agent providing services to the Company will be open to inspection by the Company. The service, agent must allow access to property and records by the operator, the Administrator, and if the operator is subject to the Jurisdiction of a state agency, a representative of the state agency for the purpose of monitoring the operator"s compliance with the requirements of Part 199. No service agent will serve as DER for this Company. Public Interest Exclusion. The Company will not use a service agent against whom a Public Interest Exclusion (PIE), has been Issued. The Company will stop using the services of a service agent no later than 90 days after the DOT has published the decision in the Federal Register or posted it on its wets site that a PIE has been issued. The Company may apply to the ODAPC Director for an extension of 30 days if it Is demonstrated that a substitute service agent cannot be found within 90 days. Consortium/Third Party Administrator. The Company may employ the service of a Consortium/Third Party Administrator (C/TPA) to assist the DER with overall program management and consultation on any program issue. While the C/TPA will not serve as the DER, the C/TPA may support the DER by explaining the regulations and offering guidance on program -compliance issues. 5. Critical Service Agent Positions' a Compliance. The Company recognizes the significance of critical service agent positions within the DOT drug and alcohol program. The Company understands the importance of each service agent meeting their initial qualifications, as applicable, and then maintaining compliance throughout the conduct of their program functions, all in accordance with Part 40 and Part 199 requirements. The Company will ensure that the following critical positions meet DOT rule requirements: a) Medical Review Officer (MRO) (§40.121 and §199. 1 09(b)); J. RANCK ELECTRIC, INC. PHMSA DRUG/ALCOHOL PLAN NA ?ZONAL COMPL IANCE MANAGEMENT SERVICE, INC (NCh9S) - 2010 13 b) Substance Abuse Professional (SAP) (§40.281); c) Urine Specimen Collector (§40.33); d) Screening test Technician (§40.213); and, e) Breath Alcohol Technician (§40.213) 6. "Non -DOT" Testing Program"' Compliance. The Company may implement an additional drug and/or alcohol testing program, referred to as a "non -DOT program." Any additional testing program would be completely independent of the DOT testing program. Such a testing program would be developed under the Company's own authority and kept separate from the DOT program. All DOT testing would be accomplished first; the Company's non -DOT program would commence afterwards. The non -DOT program would use different forms and not use the Federal Custody and Control Form or the DOT Alcohol Testing Form. The non-D .T pLagram could test different o le for different drums, and "" Ir 1w 1. Employees Subject to Testing"" Compliance. Any employee who would perform an operations, maintenance, or emergency - response function, regulated by Part 192, 193, or 195, on a pipeline or LNG facility, is subject to mandatory DOT drug and alcohol testing under this program. Such Individuals are subject to DOT testing because their job functions have been determined by PHMSA to be a covered, or safety - sensitive, transportation function. Appendix C (Covered Positions) provides specific employee titles, for this Company, of those subject to testing under this program. However, it is the work that an individual performs, not the title of their job, which determines whether their work is covered and therefore subject to drug and alcohol testing. Operator or Contractor . Covered employees may be employed by the operator, be a contractor engaged by the operator, or be employed by such a contractor; this includes full-time, part-time and temporary employees and includes any applicant for a covered function. 2. AcknowledgementfReceipt Form The "Acknowledgement/Receipt Form," (Appendix A), applies to all drug and/or alcohol tests, or related foregoing or subsequent DOT procedures, while the employee is in a covered function with the Company. The signed form will be maintained by the Company. For any test, the expectations placed on the employee by the Company are to "follow all instructions" in order to accomplish the test. 3. History -check Requirement 1314, Compliance. Prior to the first time that the Company uses an employee to perform safety -sensitive duties (i.e., a new hire or an employee transferring into a safety -sensitive position) the Company will require a "history check" of the employee. The history check will look back into the employee's past two years of DOT employment for DOT violations. History checks are conducted only after obtaining the employee's written authorization to do so. Any employee refusing to provide written consent will not be permitted to perform safety -sensitive functions. The Company will not allow the covered employee to perform their functions after 30 days from the date on which the employee first performed safety -sensitive functions, unless the Company has obtained or made and documented a good faith effort to obtain alcohol and drug testing information from previous DOT -regulated employers. Information request. The Company will request the following information about the employee. a) Alcohol tests with a result of 0.04 or higher alcohol concentration; b) Verified positive drug tests; c) Refusals to be tested (including verified adulterated or substituted drug test results); d) Other violations of DOT agency drug and alcohol testing regulations; and J. RANCK ELECTRIC, INC. PHUISA DRUG/ALCOHOL PLAN ' NA'1IGNAL COMPLIANCE MANAGEMENT SERVICE;, INC. (NCNB) - 2010 14 e) With respect to any employee who violated a DOT drug and alcohol regulation, documentation of the employee's successful completion of DOT return -to -duty and follow-up testing requirements. The Company will make at least one attempt by telephone, e-mail or fax, and maintain documentation associated with the attempt to obtain history -check information (e.g., date and time of the attempt, person contacted). If the Com ani finds evidence of ast DOT violations those violations may be u as ihie sale r n for not Kirin th IndividaN or for termination. Violation Consequences. The Company will not use any employee in a DOT safety -sensitive position that has had a past DOT violation and has not complied with DOT eligibility standards for returning to safety sensitive work. The Company will also ask the employee if they had any pre- employment test that was positive for which the previous employer did not hire them„ The employee's answer to this question will be maintained as part of the employee's history -check information. 4. Employee Notification of Tests Employees will be notified directly when a test must be conducted, While the circumstances for a test will differ by Its reason -for -test, the Company will endeavor to conduct all tests with only a limited number of Company personnel having knowledge of the reason for the test,. AM testing' will be unannounced until the last possible moment. The timing will vary in conjunction with the reason -for -test. For example, a pre -employment test will be announced during the job application, a random test Is announced within the test period„ but Just prior to the test, to maintain the element of surprise„ and, announcements of post -accident or reasonable suspicion tests are controlled by the circumstances that come to light around the time of the event (e.g., accident). All alcohol test will be conducted just prior to, during, or just after the performance of safety -sensitive duties. Drug tests may be conducted anytime the employee is at work. The DER and Company supervisors will be responsible for notifications and to help maintain the element of confidentiality.. When an employee is noted for a test, the employee must proceed to the collection site Immediately. Immediately means that after notification, all the employee's actions must lead to an Immediate specimen collection (or test). Thy PMPAny consider `travel time to the collection site lus Q minutes" as the maximum acceptable interval of tme between notification and testlgn , In test situations such as post -accident and reasonable suspicion/cause, where the employee's job performance is called into possible question, supervisors will use their dlscretlon and training to minimize further confrontation. A reasonable attempt will be made by the supervisor to Isolate and inform the employee of the decision to test„ the steps that must be taken to accomplish the test, and the consequences of refusing the test. If possible, for post -accident and reasonable suspicion tests, the Company will have the DER or a supervisor accompany the employee to the collection site. 5. DOT Drug Violations Drug Violations . The following provides a listing of DOT drug violations prohibited of covered employees,. a) A verified positive drug test result; b) A refusal to be tested, determined by: (1) Having a verified adulterated or substituted drug test result; (2) Failing to appear for any drug test (except a pre -employment test) within a reasonable time, as determined by the Company, after being directed to do so by the Company; (3) Failing to remain at the drug testing site until the testing process is complete; (4) Failing to provide a urine specimen for any drug test; (5) Failing to allow a directly observed or monitored collection in a drug test that requires such a collection procedure; J. RANCK ELECTRIC, INC. PHMSA DRUG/ALCOHOL PLAN N!AIIONAL COMPLJANCE MANAGEMENT SERVICE, (NC.. (NCMS) - 2010 15 (6) Failing to provide a sufficient amount of urine for a drug test when directed, and it has been determined, through a required medical evaluation, that there was no adequate medical explanation for the failure; (7) Failing or declining to take an additional drug test the Company or collector has directed the employee to take; (8) Failing to undergo a medical examination or evaluation, as directed by the MRO as part of the verification process, or as directed by the DER; or, (9) Failing to cooperate with any part of the testing process (e.g., refuse to empty pockets or failure to wash hands when so directed by the collector, behave in a confrontational way that disrupts the collection process, tampering with a specimen). (10) For an observed collection, fail to follow the observer's instructions to raise clothing above the waist, lower clothing and underpants, and to turn around to permit the observer to determine if there is any type of prosthetic or other device that could be used to interfere with the collection process. (11) Possess or wear a prosthetic or other device that could interfere with the collection process. (12) Admit to the collector or MRO that a specimen has been adulterated or substituted. 6. DOT Alcohol Violations and Prohibited Conduct14 78 Alcohol Violations. The following provides a listing of DOT alcohol violations prohibited of covered employees: a) A test result of 0.04 or higher alcohol concentration; b) A refusal to be tested, determined by: (1) Failing to appear for any alcohol test (except a pre -employment test) within a reasonable time, as determined by the Company, after being directed to do so by the Company; (2) Failing to remain at the alcohol testing site until the testing process is complete; (3) Failing to provide an adequate amount of saliva or breath for an alcohol test; (4) Failing to provide a sufficient amount of breath for an alcohol test when directed, and it has been determined, through a required medical evaluation, that there was no adequate medical explanation for the failure; (5) Failing to undergo a medical examination or evaluation, as directed by the DER; (6) Failing to sign the certification statement on the Alcohol Testing Form; or, (7) Failing to cooperate with any part of the testing process. c) On -duty use of alcohol while performing covered functions. d) Pre -duty use of alcohol within four (4) hours prior to performing covered functions, or if the employee is called to duty to respond to an emergency, within the time period after the employee has been notified to report for duty. e) Use of alcohol within eight (8) hours following an accident in which the performance of covered functions has not been discounted by the Company as a contributing factor to the accident, unless the employee has already been given a post -accident alcohol test. Alcohol Prohibited Conduct. The following is prohibited conduct of DOT covered employees: a) A test result of 0.02 or greater alcohol concentration, but less than 0.04. 7. Violation Consequences and Company Actions1e 7 After DOT Rule Violations. The Company will not allow any covered employee who has a DOT drug or alcohol violation to perform safety -sensitive duties for the Company. Immediately upon learning of the violation, the DER shall assure the removal of the employee from all safety -sensitive duties. That employee will be ineligible to work in any DOT safety -sensitive function for the Company until the employee has successfully completed the DOT return -to -duty process. The Company will refer the J. RANCK ELECTRIC, INC. PHMSA DRUG/ALCOHOL PLAN NATIONAL COMPLIANCE MANAGEMENT SERVICE, INC. ;NCMS) --2010 16 employee to a Substance Abuse Professional (SAP) as soon as practicable after the verified violation report. After DOT Alcohol Prohibited Conduct. The Company will not allow any covered employee to perform, or continue to perform, any function covered by Part "lgg when the employee is found to have an alcohol cenoentration of 0.02, or higher, but less than 0,04, The Company may continue testing the employee until the alcohol concentration Is less than 0.02, or the Company may not use the, employee in a safety -sensitive function until the, start of the employee's next regularly scheduled shift, which must be not less than eight hours following the test that Indicated "prohibited conduct." DOT -Required Drug Tests Compliance. The Company will ensure that each employee who performs a DOT --covered function will be drug tested for the following reasons when called for by Part "lgg: All drug tests will be conducted following the procedures of Part 40. Pre-EEMg1gy rent.r8 A pre -employment drug test will be conducted before an individual is hired or contracted into a covered position and when an individual is transferred or promoted from a non - covered to a covered position. This includes when an individual switches back and forth from a covered position to a non -covered position and back again. This also aoolles to emoloveas returnin viuminfivajiubuiaba utarip sure mrnmmammoom se)ect�on rocess,. A negative DOT urine drug test result is required prior to performing covered functions. DOT does not allow the use of a "quick test" (e.g., a urine test that produces an immediate test result) or any other methodology other than urine. Pre -employment tests are normally unobserved by the collector. However, provisions will be available at the collection site for a directly observed collection to take place should circumstances require such action. Pos -A l t T tin The Company will conduct both a drug test and an alcohol test after an accident, or Incident on each employee whose performance either contributed to the accident or cannot be completely discounted as a contributing factor to the accident. The decision whether to test or not to test any employee shall be based on the Company's determination, using the best available information immediately following the accident, that the covered employee's performance could or could not have contributed to the accident. The Company will explain to each employee to be tested there is reason to believe their performance either contributed to the accident or cannot be completely discounted as a contributing factor to the accident. The Company will document the decisions that support the determination to conduct a post -accident test. Refer to the Post Accident or Reasonable Cause/Suspiclon Supervisor Written Record. A post -accident drug test shall be conducted on each employee as soon as possible but no later than 2 hours after the accident. The Company must take all reasonable steps to obtain a urine specimen from an employee after an accident, but any injury shouldbe treated first. Nothing In this section shall be construed to require the delay of necessary medical attention for injured people following an accident, to prohibit a covered) employee from leaving, the scene of an accident for the period necessary to obtain assistance in responding to the accident, or to obtain necessary emergency medical care. The affected employee will not be allowed to proceed alone to or from the collection site. An employee who is subject to post -accident testing who fails to remain readily available for such testing, including notifying the Company or Company's representative of their location if they leave the scene of the accident prior to submission to such test„ may be deemed by the Company to have refused to submit to testing. Post accident tests are normally unobserved by the collector. However, provisions will be available at the collection site for a directly observed collection to take place should circumstances require such action. Depending on the circumstances of the accident and if feasible the em to ee will not be allowed to perform covered functions gending the resuilts of thedrug test. %andom Drug Testing,. r that meets or exceeds the current minimum mannuall percentagnduct a e random randomr of lender 2223 The Company testing ate. The year 'wnu J. RANCK ELECTRIC, INC. PHMSA DRUWALCOHOL PLAN NATIONAL COMPL IANCE MANAGEMENT SERVICE, INC. (NICMS) - 2010 17 minimum rate for random drug testing, set by the PHMSA regulation, is 25 percent of the Company's covered employees. If the industry random drug testing positive rate is above 1 percent, PHMSA will raise the annual percentage rate for random drug testing to 50 percent of the Company's covered employees. The Company may use the services of the C/TPA to manage all aspects of the Company's random testing program. If the Company conducts random testing through a CJTPA, the number of employees to be tested may be calculated for each individual Company or may be based on the total number of covered employees covered by the C1TPA who are subject to random testing (e.g., consortium random testing pool). All covered employees will be immediately placed in the random pool after obtaining a negative result on their pre -employment test. Covered employees will remain in the random selection pool at all times, regardless of whether or not they have been previously selected for testing. The selection of employees shall be made by using a computer -based, scientifically valid method (e.g., random number generator or equivalent random selection method) that is matched with an employee's social security number or employee ID number. The DER will assure the pool contains employee social security numbers or employee identification numbers that are current, complete, and correct. Employees will have an equal chance of being selected for testing. Random testing will occur on a quarterly basis. Prior to selection, the DER shall ensure that the random testing pool has been updated to include all current covered employees in the Company's workforce. The number of tests to be conducted will be based on the number of covered employees at the beginning of each quarter's test cycle. The DER, or C/TPA, shall use the random selection procedures to compile a list of covered employees selected for testing in each testing cycle. The number of employees selected shall be sufficient to assure that the minimum number of required tests can be achieved. The list of employees selected will be retained by the DER in a secure location until the time of testing when the list will then be provided to the appropriate division manager, department head, or supervisor who will, in turn, notify the employee(s) to report for testing. Random testing is unannounced, with employees being notified that they have been selected for testing after they have reported for duty on the day of collection. Specimen collection will be conducted on different days of the week throughout each test cycle to prevent employees from matching their drug use patterns to the schedule for collection. Random tests are normally unobserved by the collector. However, provisions will be available at the collection site for a directly observed collection to take place should circumstances require such action. Once notified by the appropriate Company official, employees will be instructed to report immediately to the collection site. Rgasonp§lo §gspicign C T!e tin 24 The Company will conduct reasonable suspicion testing, also known as reasonable cause testing, based on the Company's observation of "signs and symptoms" of specific, contemporaneous, articulable observations concerning the appearance, behavior, speech, or body odors of the employee. At least two Company supervisors, one of whom is trained in detection of the possible signs and symptoms of drug use, shall substantiate and concur in the decision to test an employee. The concurrence between the two supervisors may be by telephone. If the Company has 50 or fewer employees subject to testing under PHMSA regulations, only one supervisor, trained in detecting possible drug use signs and symptoms, is needed to make the decision to test. The supervisor making the determination to test shall document, in writing, the behavioral signs and symptoms that support the determination to conduct a reasonable suspicion/cause test. This documentation of the employee's conduct shall be prepared and signed within 24 hours of the observed behavior or before the results of the tests are released, whichever is earlier. Refer to the Post Accident or Reasonable Cause/Suspicion Supervisor Written Record. The potentially affected employee should not be allowed to proceed alone to or from the collection site. In addition to the safety concerns for the employee, accompanying the employee also assures that there is no opportunity in route to the collection site for the employee to compromise the test through any method of tampering that could affect the outcome of the test result. Reasonable suspicion/cause tests are normally unobserved by the collector. However, provisions will be available at the collection site for a directly observed collection to take place should circumstances require such action. J. RANCK ELECTRIC, INC. PHMSA DRUGALCOHOL PLAN NA110NAt COMPLIANCE MANAGEMENT SERVICE, INC (NGMS) - 2M 18 R -Iu T .2s The Company will conduct a return -to -duty test prior to an employee returning to safety -sensitive duty following a DOT violation. When an employee has a DOT violation the employee cannot work again in any DOT safety -sensitive function until successfully completing the Substance Abuse Professional (SAP) return -to -duty requirements, Only after the SAP has reported to the Company that the employee Is eligible to return to safety -sensitive duties is the Company authorized to return the employee to a covered function. How r whether or not to do so is a gusiness decision of the Company, not the DOT. When the Company makes the decision to return the employee to safety -sensitive duty, the Company will initiate the order for the retum-to-duty test. All retum-to-duty tests will be conducted using direct -observation collection procedures. A retum-to-duty test, as a minimum, will be for the substance associated with the violation. A return - to -duty test may, however, be lbr both drugs and alcohol, The decision belongs solely to the SAP from information gained during the SAP-evaluation/treatment processes. The results of a return -to - duty drug test must be negative in order "to count" and allow the employee to return to work. A cancelled test must be recollected; a positive test or refusal -to -test will be considered as a new, separate violation. When the employee "passes" his retum-to-duty test, their name is immediately placed into the Company's random testing pool. 26 after anemployee returns to safe psensitive work, following a negative result es of tests that occur F liow-u Testing, The Company will conduct follow-up testing, as a series "~ g g on the return -to -duty,.. drug and/or alcohol tests. Follow-up testing, as a minimum, will be for the substance associated with the violation. In addltion, follow-up testing may be for both drugs and alcohol, as directed by the SAP's written follow-up testing plan. Follow-up testing is the Company's responsibility to conduct. Follow -rap testing will run concurrently with random testing. All follow-up tests will be conducted using direct -observation collection procedures. The number and frequency of the follow-up tests will be determined by the SAP, but shall consist of at least six tests in the first 12 months following the covered employee's return to duty. The follow-up plan will give both the number of tests and their frequency; the Company will select the actual day and time of the test and the tests are unannounced. Follow-up testing shall not exceed 60 months from the date of the covered employee's return to duty. The SAP may terminate the requirement for follow-up testing at any time after the first six tests have been administered, if the SAP determines that such testing is no longer necessary. 2. Drug Tests That Require Direct Observation Procedures Compliance. The Company will conduct all retum-to-duty and follow-up drug tests using the direct observation collection procedures specified by Part 40. Pre -employment, post -accident, reasonable suspicionloause and random drug tests are norm -ally conducted by giving the employee the privilege of privacy when providing the urine specimen. However, should it become required that these collections be conducted under direct observation procedures, the Company will convey instructions to the collector to ensure that this is done. Direct observation procedures will also be used for collections when a specimen is provided and the temperature is out of range, when the specimen appears to have been tampered with or when a previous specimen has been reported as invalid, adulterated, substituted or negative -dilute with a creatinine concentration greater than or equal to 2 mg/dL but less than or equal to 5 mg/dL, as defined in Part 40. J. RANCK ELECTRIC, INC. PHMSA DRUGIALCOHOL PLAN NATIONAL COMPLIANCE MANAGEMENT SERVICE, INC, (NCMS) - 2010 19 3. Specimen Collection Procedures Compliance. The Company will follow the requirements of Part 40 for its DOT collections. A full description of DOT collection requirements that collectors will follow can be found in Part 40, Subpart C ("Urine Collection Personnel"), Subpart D ("Collection Sites, Forms, Equipment and Supplies Used in a DOT Urine Collection"), and Subpart E ("Urine Specimen Collections"). Collection Site Personnel . 2930 The Company will ensure that collection sites, utilized by its employees, are aware of their responsibilities with regard to the DOT specimen collection process. These responsibilities are to collect urine specimens using Part 40 procedures, ship the specimens to a Department of Health and Human Services (HHS) certified laboratory for analysis, and distribute copies of the Federal Drug Testing Custody and Control Form (CCF) to the laboratory, Medical Review Officer, employer or employer's C/TPA, and employee in a confidential manner. All attempts are made to use collectors who have been trained in accordance with Part 40. The Company, or the Company's C/TPA, will ask the collection sites conducting DOT collections to attest to the fact that they comply with DOT standards of practice. The direct supervisor of a covered employee shall not serve as a collector in conducting any required drug test unless it is otherwise impracticable. Collection Site, Forms, and Specimen. The Company will provide the employee with the specific location of the collection site where the drug test will take place. In most cases, the Company will provide the employee with a drug testing kit, which includes the CCF, to present to the collector. The only specimen that will be collected for any DOT collection is urine; the only form that will be used is the Federal CCF. The employee must report for drug testing in no less than 2 hours, not including driving time to the testing site. Collections. The Company will inform every employee that they are required to carry and present a current valid photo ID, such as a driver's license, passport, or employer -issued picture ID to the collection site. The employee will be advised that the collector will ask them to empty their pockets, remove any unnecessary garments (the employee may retain their wallet), and wash and dry their hands prior to the collection. The employee will be instructed to follow the collector's instructions throughout the collection process. Normally, the employee will be afforded privacy to provide a urine specimen. Exceptions to the rule generally surround issues of attempted adulteration or substitution of a specimen or any situation where questions of specimen validity arise, like an unusual specimen temperature. After the employee has provided the specimen (a minimum of 45 mL) of their urine into a collection container, the collector will check the temperature and color of the urine. All DOT collections are "split specimen collections." The collector will pour the urine into two separate bottles (bottle "A" as the primary specimen and bottle "B" as split specimen), seal them with tamper -evident tape, and then ask the employee to initial the seals after they have been placed on the bottles. (Remember: Neither the employee nor the collector should let the specimen out of their sight until it has been poured into two separate bottles and sealed.) Next, the employee will write their name, date of birth, and daytime and evening phone numbers on the MRO Copy (Copy 2) of the CCF. This is so the MRO can contact the employee directly if any questions arise about their test. Lastly, the collector will complete the necessary documentation on Copy 1 of the CCF and package the CCF and the two specimen bottles in the plastic bag and seal the bag for shipment to the laboratory. Copies of the CCF will be distributed: Copy 2 to the MRO and Copy 4 to the employer or the employer's C/TPA; the collector keeps Copy 3; and, the employee gets Copy 5. The employee may list any prescription and over-the-counter medications they may be taking on the back of their copy of the CCF (this may serve as a reminder for the employee in the event the MRO calls to discuss their test results). Possible collection Issues. If the employee is unable to provide 45 mL of urine on the first attempt, the time will be noted, and they will be required to remain in the testing area under the supervision of the collection site personnel, their supervisor, or a representative from their Company (e.g., supervisor accompanying the employee). Leaving the testing area without authorization may be considered a refusal to test. The employee will be urged to drink up to 40 oz. of fluid, distributed reasonably over a period of up to three hours, and asked to provide a new specimen (into a new collection container). If the DER is contacted, the DER should instruct the employee to remain at the collection site to complete the collection process. If the employee does not provide a sufficient J. RANCK ELECTRIC, INC. PHMSA DRUG/ALCOHOL PLAN NATIONAL COMPLIANCE MANAGEMENT SERVICE, INC (NCMS) - 2010 20 specimen within three hours, the DER, in consultation with the MRO, will direct the employee to obtain a medical evaluation within five days to determine if there is an acceptable medical reason for not being able to provide a specimen. If it is determined that there Is no acceptable physiological or pre=existing psychological reason for not providing a urine specimen, it will be considered a refusal to test.. Directly observed collections . If a direct observation collection is required of the employee, the Company will ensure that the DOTrequirements (i.e., direct observation by same -sax collector, observation of body-to-bodle urination, and use of full turn -around observation) procedures are followed. 4. PHMSA Inspection Protocol for Specimen Collection Sites Compliance. PHMSA"s Substance Abuse Program: Comprehensive Audit and Inspection Protocol Form, Combined Anti -Drug and Alcohol Misuse Prevention Programs, Form No.: 3.1.11, dated January 29, 2010, provides a separate inspection protocol for Specimen Collection Sites, The Company provides this protocol to correspond with the detail found in the PHMSA Inspection Form. As previously stated, the Company will ensure that all DOT drug tests comply with Dart 40 requirements. Collection Personinell. The Company will ensure that only qualified collectors are used to conduct. Company DOT tests. An immediate supervisor of an employee may be used In cases where there are no qualified collectors available, and where their use is the only way to get the test conducted. Collectors will maintain documentation to verify they meet training requirements and will make that documentation available to the Company on request.31 If an error occurs causing a test to be canceled and the error is directly attributed to the collector, the collector will undergo error - correction training within 30 days of the date of notification of the error that led to the need for training. 32 Collection Sites, (Forms and Supplies . The Company will use designated collection sites that meet DOT requirements. 33 If the collection site uses a facility normally used for other purposes, the collector will ensure that it meets DOT standards before continuing the Collection. 34 Access to collection materials and specimens will be restricted, and the facility will be secured against access during the procedure to ensure privacy to the employee and prevent distraction of the collector. Limited -access signs will be posted as necessary. The collector will maintain personal control over each specimen and CCF throughout the collection process and will prevent unauthorized personnel from entering any part of the site in which urine specimens are collected or stored. 35 The current CCF and a collection kit, that meets the requirements of Appendix A to Part 40, will be used for DOT collections.3637 Specimen Collections. Collectors will explain the basic collection procedure to the employee, including showing the employee the instructions on the back of the CCF. 3e In most all collections, the Company will provide the employee with a kit and CCF to carry to the collection site. In other collections, collectors will provide the employee with an individually wrapped or sealed collection container from the collection kit materlalO Precautions will be taken to ensure that unadulterated specimens are obtained and correctly identified. Specimen integrity will be maintained by: bluing agents being added in the toilet tank and all water sources secured; positive photo identification of the employee for collection; notification of the DER if employee fails to arrive at the assigned time; having the employee remove any unnecessary outer garments (purses or briefcases will remain with outer garments); having employees wash and dry their hands; and, to the greatest extent possible, the collector will keep an employee"'s collection container within view of both the collector and the employee between the time the employee has urinated and the specimen is sealed. Any unusual 40 behavior will be noted on the, CCF. Following the collection, the specimen will be checked for sufficient volume (i.e., 45 mQ, acceptable temperature, range ('i.e., between 90-100 degrees F), and shows no signs of tampering (e.g.,, color, odor).41 Having problematic Issues with specimen volume„ the collector will follow DOT"'s '"shy bladder" procedures42; problems with temperature or tampering will result In the collector conducting a second collection under direct observation (,see Section V.2, "Drug Tests That Require Direct Observation Procedures"), 43 Direct observation procedures will be used for all collections where the reason -for -test is either retm-to-duty or follow-up. Direct observation procedures will also be used for collections when a specimen is provided and the temperature Is out of range, when the specimen J. RANCK ELECTRIC, INC. PHMSA DRUG/ALCOHOL PLAN! NATIONAL COMPLIANCE MANAGEMENT SCRVICF, INC. (NCM&), - 2010 21 appears to have been tampered with or when a previous specimen has been reported as invalid, adulterated, substituted or negative -dilute with a creatinine concentration greater than or equal to 2 mg/dL but less than or equal to 5 mg/dL, as defined in Part 40. If the collector does a monitored collection, same gender monitors will be used if the monitors are non -medical personnel.44 All collections are completed by the specimens being sealed and labeled, the CCF being properly executed', and the specimens and the CCF being sealed in a plastic bag for shipment to the laboratory.45 S. Drug Testing Laboratory Compliance. The Company will employ a laboratory that will follow the requirements of Part 40 for the Company's DOT drug tests. A full explanation of DOT drug testing requirements that the laboratory will follow is found in Part 40, Subpart F ("Drug Testing Laboratories"). Laboratory46 47 The Company shall ensure that all DOT testing is conducted only by a laboratory that is certified by the Department of Health and Human Services (HHS) under the National Laboratory Certification Program (NLCP). Doing so ensures that the Company complies with the requirements of Part 40 and with all applicable requirements of HHS in testing DOT specimens, whether or not those requirements are explicitly stated in the Plan. The laboratory used by this Company is specified in Appendix B. The laboratory will report the certified results to the MRO and only to the MRO, at the address provided on the Federal CCF. Results will not be reported directly to the Company or to or through another service agent, such as the C/TPA. Specimen. Urine is the only specimen that is authorized for DOT drug testing. The Company will not use any other specimen (e.g., hair or saliva) for a DOT -required drug test. A "quick test" (e.g., a urine test that produces an immediate test result) is also prohibited by DOT. Drug Testing .48 The laboratory will ensure that, on each DOT test, each specimen is tested for marijuana, cocaine, amphetamines, opiates, and phencyclidine (PCP ). (See Table 1, pg 23) The testing is a "two step" process: all presumptive positive results on the initial test must be confirmed by a confirmation test. The initial and the confirmation tests use different chemical principles, and separate portions of the original specimen, for testing. DOT specimens will not be tested for any other drugs. DOT specimens will not be subjected to DNA testing. Validity Testing. The laboratory will ensure that, on each DOT test, each specimen is also subjected to "validity testing." The purpose of validity testing is to determine if the employee tampered with their specimen during the collection process. Validity testing measures the creatinine concentration and specific gravity to detect a diluted or substituted specimen; pH is measured as one criterion established to detect an adulterated specimen. Validity testing also incorporates HHS criteria (used by DOT) in testing for specific adulterants such as nitrites, chromates, surfactants, and other active chemical compounds. Laboratory specimen handling and reporting. When the laboratory receives a DOT specimen they will unpack and enter it into the testing process. Part of that process is to examine the condition of the specimen bottles and accompanying CCF. The laboratory will look closely for any specific reason to stop the testing process (i.e., "fatal flaws"). If the laboratory determines a fatal flaw exists, the specimen is rejected for testing. if a fatal flaw does not exist, the specimen will be tested. DOT specimens are limited to four fatal flaws. They are: a) Specimen ID numbers on the CCF and the bottles do not match. b) Not enough urine and the bottles cannot be re -designated., c) Signs of tampering and the bottles cannot be re -designated. d) Collector's printed name and signature are missing. The laboratory will open only the primary specimen (Bottle "A") to conduct the two tests (initial and confirmatory). If the specimen tests negative In either test and does not have any specimen validity issues, the result will be reported to the MRO as a negative. Only if the specimen test results are positive, adulterated, substituted, and/or invalid under both tests will the specimen be reported to the MRO as a positive, adulterated, substituted, and/or invalid, respectively. These results are also referred to as "non -negative" results. J. RANCK ELECTRIC, INC. PHMSA DRUGIALCOHOL PLAN NATIONAL COMPLIANCE MANAGEMENT SERVICE, INC. �NCMS) - 2010 22 Required DOT Drug Tests & Cutoffs TYPE OF DRUG INITIAL TEST CONFIRMATORY TEST CONFIRMATORY TEST Initial Test Analyte Cutoff Concentration Analyte Cutoff Concentration Marijuana metabolites 50 ng/mL THCA9 15 ng/mL Cocaine metabolites 150 ng/mL Benzoylecgonine 100 ng/mL Opiate metabolites: Codeine/Morphine 2000 ng/mL Codeine 2000 ng/mL Morphine 2000 ng/mL 6-acetylmorphine (6-AM) 10 ng/mL 6-acetylmorphine (6-AM) 10 ng/mL Phencyclidine (PCP) 25 ng/mL Phencyclidine 25 ng/mL Amphetamines: AMP/MAMP 500 ng/mL Amphetamine 250 ng/mL Methamphetamine 250 ng/mL'a MDMA 500 ng/mL MDMA10 250 ng/mL MDA" 250 ng/ml MDEA12 250 ng/mL Table 1 9 Delta-9-tetrahydrocatmabinol-9-caTboxylic acid 19 Methylcucdioay ethatnpheta ni -e (MDMA). 11 Methylenedioxyamphetamine (MDA. 12 Methylenedioxyethylamph ` e (MDEA). 13 Specimen must also contain amphetatnine at a concentration of greater than or equal to 100 ng/mL. J. RANCK ELECTRIC, INC. PHMSA DRUG/ALCOHOL PLAN :. NATIONAL COMPI IANCF MANAGEMENT SERVICE., INC. (NCMS) r 2010 23 6. Laboratory Retention Periods and Reports Specimen retention ae Specimens that are confirmed by the laboratory to be positive, adulterated, substituted, or invalid will be retained by the laboratory in properly secured, long-term, frozen storage for at least 365 days. Within this 365 day period, the MRO, the employee, the Company, PHMSA or other state agencies with jurisdiction, may request in writing that the specimens be retained for an additional period. If the laboratory does not receive the request to retain the specimen within the 365- day period, the specimen will be discarded. Record retention .60 All laboratory records pertaining to any test for this Company on its covered employees will be retained for two years. The employer -specific data that is created by the laboratory for the laboratory statistical summary will be retained for two years. Semi-annual reports 51 The laboratory will prepare and send to the Company the aggregate employer -specific summary on a semi-annual basis. The format for this report is found in Part 40, Appendix B. 7. Laboratory Quality Control Inspections. The laboratory shall permit inspections by the Company, the PHMSA Administrator, or if the Company is subject to the jurisdiction of a state agency, a representative of the state agency. Additigpgfly,if the Comi2any uses il PZEA, Jbgt,gITE6may uct ri i s ction of the laboratory on the behalf of the odm argyles Lhatare clients of the /TPA. Quality control .62 If the Company, or any C/TPA employed by the Company, has 2000 or more covered employees, the Company, or C/TPA, will submit quality control specimens to any laboratory where they have more than 100 specimens tested each year. The rate of quality control specimens is 1 % with a cap at 50 per quarter. At any time that the Company, or any C/TPA employed by the Company, reaches the 2000-employee threshold, quality control specimen will be submitted following the specifications of Part 40. Quality control specimens, known as `blind" specimens, submitted to the laboratory, will appear to be real, employee specimens. The MRO will be informed of each test result and expected outcome. Reporting discrepancies. The MRO will inform the Company or its C/TPA of any discrepancy in the expected result of any blind specimen. The MRO and C/TPA will resolve any discrepancies in the expected outcomes with this testing. If the unexpected outcome is positive, adulterated, or substituted where the expected outcome was to be negative, the MRO will report this result directly to DOT/ODAPC, in accordance with Part 40. 8. MRO Review of Drug Test Results Compliance .-r'3 The Company will have, on staff or contract for the services of, an MRO who is a licensed physician with knowledge of drug abuse and is qualified under Part 40. The MRO will follow the requirements of Part 40 in carrying out the functions of the "independent and impartial gatekeeper of the drug testing process." A full description of DOT MRO requirements can be found in Part 40, Subpart G ("Medical Review Officers and the Verification Process"), and Subpart H (Split Specimen Testing). Dutles 54 All confirmed drug test results for the Company are received by the MRO directly from the laboratory. The MRO is responsible for the review of both negative and non -negative test results, review of the CCFs associated with each test, and to conduct quality control reviews of the MRO staff. The MRO will review and interpret confirmed positive, adulterated, substituted, and invalid test results. In carrying out this responsibility, the MRO shall examine alternate medical explanations for any positive, adulterated, substituted, or invalid test result. This action would include conducting a medical interview with the employee and review of the employee's medical history, or review of any other relevant biomedical factors, such as the results of a physical examination following an opiate positive. The MRO shall review medical records made available by the tested employee when the source of the confirmed result could have been from legally prescribed medication. The MRO shall J. RANCK ELECTRIC, INC. PHMSA DRI IG/ALCOHOL PLAN : NA710NAI_ COMPLIANCE MANAGEMENT SERVICE, INC.'140108)-2D10 24 not, however, consider the results of urine or other specimens that are not obtained or processed in accordance with DOT regulations. Results.'' The MRO will use staff under his direct supervision to handle administrative processes for negative test results including receiving the iresult from the laboratory, reviewing the paperwork for accuracy, and reporting of the result to the DER. The MRO staff may make the initial contact with employees having confirmed positive, adulterated, substituted, and invalid test results, for the purposes of setting up an interview for the MRO. The MRO will personally conduct the interview with the employee to determine whether there is a legitimate medical explanation for these results. This interview will be conducted, in most cases, before the Company is notified. If the result is confirmed positive by the laboratory, and a legitimate medical explanation is established, the MRO will report the result to the DER as negative. If not, the MRO will report the result to the DER as positive. If the confirmed result is adulterated or substituted, and a legitimate medical' explanatlon is established, the MRO will report the result to the DER as cancelled and notify ODAPC, in accordance with Part 40 procedures. If not, the MRO will report the result to the DER as a refusal to test. If the result is invalid, and an acceptable reason is established, the MRO will report the result to the DER as cancelled and the process will stop, unless a negative test result Is needed (e,g., pre -employment, return -to -duty and follow-up). If an acceptable reason Is not established, the MRO will report the result to the DER as cancelled and order an immediate recollection under direct observation. Reports.s' All drug test results will be reported to the Company 'DER in a confidential and timely manner. Before reporting any results, the MRO will have received a copy of the CCF showing where the employee has signed the form. The time period from collecting the specimen to re -porting the verified test result is generally shorter for negatives than for non -negatives. Non -negatives will not be reported to the DER until all Information required for the employee interview is received and approved by the MRO. The Company may use a. CITPA as Its intermediary in receiving drug test results. If so, those reports will be handled in accordance with Part 40 requirements. If the MRO does not use Copy 2 of the CCF for reporting results, the MRO will maintain a copy of the signed or stamped report in addition to the signed or stamped and dated Copy 2. If the MRO uses an electronic data file to report negatives, the MRO will maintain a retrievable copy of that report in a format suitable for inspection and auditing by a DOT representative. 9. Split Specimen Testing Split Specimen. SB When the MRO has verified a result as positive, adulterated, or substituted, the MRO will notify the employee of their right to have the split specimen tested. The employee must notify the MRO within 72 hours of the result being verified in order to have this testing conducted. If the employee requests that the split specimen be tested within the 72-hour period, the MRO will ensure that the split specimen Is tested, Testing of the split specimen is only conducted at the request of the employee, and then only after using the MRO as the requesting agent for the employee. The Company is responsible for making sure that the MRO, first laboratory, and second laboratory perform the functions noted in Part 40 in a timely manner, once the employee has made a timely request for a test of the split specimen (e.g., by establishing appropriate accounts with laboratories for testing split specimens). The Company must not condition compliance with these requirements on the employee's direct payment to the MRO or laboratory or the employees agreement for reimbursement of the costs of testing. For example, if the Company's asks the employee to pay for some or all of the cost of testing the split specimen, and the employee is unwilling or unable to do so, the Company must ensure that the test takes place to a timely manner, which means that the Company will pay for the split testing. The Company may seek payment or reimbursement of all or part of the cost of the split specimen from the employee. Part 40 takes no position on who ultimately pays the cost of the test, so long as the Company ensures that the testing is conducted as required and the results released appropriately. Laboratory." The testing of the ,split specimen will be conducted at another HHS-certified laboratory, different from, the original laboratory. The Company will select the second laboratory. The split specimen will be tested for the same substance or condition that was found in the primary J. RANCK ELECTRIC, INC. PHMSA DRUG/ALCOHOL PLAN NATIONAL COMPL IANCE MANAGEMENT SERVICE, INC. (,NCMS) - 2M 25 specimen. The MRO will report back to the DER and the employee whether the split reconfirms the primary. If the test of the split does not reconfirm the primary, both tests will be cancelled as if they never occurred. 10. Medical Marijuana The DOT and the Co an i does nct accommodate the use of medical mari"uana by DOT -covered emglo -ees. _. Vt. ALCQHOL MISUSE PREVENTION PROGRAM 1. DOT -Required Alcohol Tests Compliance. The Company will ensure that each employee who performs a DOT -covered function will be alcohol tested for the following reasons when called for by Part 199. All alcohol tests will be conducted following the procedures of Part 40. Pre -Employment 60 PHMSA does not mandate a pre -employment alcohol test for covered employees in the pipeline industry. PHMSA does give operators and contractors who wish to conduct a pre -employment alcohol test the authority to do so. If the Company decides to conduct pre- employment alcohol testing, all applicants will be advised of the test prior to the test occurring, and all tests will be conducted before the first performance of covered functions by every covered employee (whether a new employee or someone who has transferred to a position involving the performance of covered functions). The Company will treat all covered employees the same for the purpose of pre- employment alcohol testing; the Company will not test some covered employees and not others. The Company will conduct the pre -employment tests after making a contingent offer of employment or transfer, subject to the employee passing the pre -employment alcohol test. A result of less than 0.02 alcohol concentration is required prior to performing covered functions. Post -Accident Testing 81 The Company will conduct both a drug test and an alcohol test, after an accident, or incident, on each employee whose performance either contributed to the accident or cannot be completely discounted as a contributing factor to the accident. The decision whether to test or not to test any employee shall be based on the Company's determination, using the best available information immediately following the accident, that the covered employee's performance could or could not have contributed to the accident. The Company will explain to each employee to be tested there is reason to believe their performance contributed to the accident or cannot be completely discounted as a contributing factor to the accident. The Company will document the decisions that support the determination to conduct a post -accident test. Refer to the Post Accident or Reasonable CauseJSuspi i n Supervisor Written Record. A post -accident alcohol test shall be conducted on each employee as soon as possible but no later than 8 hours after the accident. If the test is not completed within 2 hours the Company will prepare and maintain a written statement documenting the reason the test was not conducted. If the testis not completed within 8 hours the Company shall cease attempts to do so. The Company will take all reasonable steps to obtain a breath test from an employee after an accident, but any injury should be treated first. Nothing in this section shall be construed to require the delay of necessary medical attention for injured people following an accident, to prohibit a covered employee from leaving the scene of an accident for the period necessary to obtain assistance in responding to the accident, or to obtain necessary emergency medical care. The affected employee will not be allowed to proceed alone to the testing site. A covered employee who is subject to post -accident testing who fails to remain readily available for such testing, including notifying the Company or Company's representative of their location if they leave the scene of the accident prior to submission to such test, may be deemed by the Company to have refused to submit to testing. Random Testing. PHMSA does not authorize random alcohol testing of covered employees within the natural gas and hazardous liquids pipeline industry. The Company will not conduct DOT random alcohol testing of their PHMSA-regulated employees. J. RANCK ELECTRIC, INC. PHMSA DRUM/ALCOHOL PLAN _ NATIONAL COMPLIANCE MANAGEMENT SERVICE, INC. (NCMS) 2010 26 Reasonable Suspiclon/Cause Testing . 3" The Company will conduct reasonable suspicion testing, also known as reasonable cause testing, based on the Company"s observation of "signs and symptoms' of specific, contemporaneous„ articulable observations concerning the appearance, behavior„ speech, or body odors of the employee. A supervisor trained in detection of the possible signs and symptoms of alcohol use shall make the, decision to test an employee. The decision to test will only be made on an employee during, just before, or just after his performance of DOT functions. The supervisor making the determination to test shall document, in writing, the behavioral signs and symptoms that support the determination to conduct a reasonable suspicion/cause test. This documentation of the employee's conduct should be prepared and signed within 24 hours of the observed behavior or before the results of the tests are released, whichever is earlier. Refer to the PostAccident or Reasonable CauselSu picion Supervisor Wif ten Record. The potentially affected employee should not be allowed to proceed alone to or from the test site, If the reasonable suspicion test is not administered within 2 hours following the determination, the Company will prepare and maintain on file a record stating the reasons the test was not promptly administered. If a test is not administered within 8 hours, the Company will cease attempts to administer an alcohol test and record the reasons for not testing. Return -to -Duty Testing 8r' The Company will conduct a return -to -duty test prior to an employee returning to safety -sensitive duty following a DOT violation. When an employee has a DOT violation the employee cannot work again in any DOT safety -sensitive function until successfully completing the SAFE/return-to-duty requirements. Only alter the SAP has reported to the Company that the employee is eligible to return to safety -sensitive duties is the Company authorized to return the employee to a covered function. l-lowever, whether or OgI to do so is a business decision of the Comggny,,not the DOT. When the Company makes the decision to return the employee to safety - sensitive duty, the Company will initiate the order for the return -to -duty test. A return -to -duty test, as a minimum, will be for the substance associated with the violation. A return - to -duty test may, however, be for both drugs and alcohol. The decision belongs solely to the SAP from information gained during the SAP-evaluation/treatment processes. The results of a return -to - duty alcohol test must be less than 0.02 in order "to count" and allow the employee to return to work. A cancelled test does not meet this criterion and requires a retest; a result greater than 0.02 but less than 0.04 must be retested until the result is less than 0.02; a result of 0.04 or greater is a new, separate violation. Follow-up Testing." s' The Company will conduct follow-up testing, as a series of tests that occur after an employee returns to safety -sensitive work, following a negative result on the return -to -duty drug and/or alcohol tests. Follow-up testing, as a minimum, will be for the substance associated with the violation. In addition, follow-up testing may be for both drugs and alcohol, as directed by the SAP's written follow-up testing plan. Follow-up testing is the Company's responsibility to conduct. The number and frequency of the follow-up tests will be determined by the SAP, but shall consist of at least six tests in the first 12 months following the covered employee's return to duty. The follow-up plan will give both the number of tests and their frequency; the Company will select the actual day and time of the test and the tests are unannounced. Follow-up testing shall not exceed 60 months from the date of the covered employee's return to duty. The SAP may terminate the requirement for follow-up testing at any time after the first six tests have been administered, if the SAP determines that such testing is no longer necessary. 2. Alcohol Test Compliance. The Company will follow Part 40 procedures for alcohol testing. A full description of DOT alcohol testing requirements can be found in Part 40, Subpart J ("Alcohol Testing Personnel"); J. RANCK ELECTRIC, INC. PHMSA DRUG/ALCOHOL PLAN NAl rONAL COMPLIANCE MANAGEMENT sERvICF, INC. �Ncrv!s> - 2010 27 Subpart K ("Testing Sites, Forms, Equipment and Supplies Used in Alcohol Testing"); Subpart L ("Alcohol ,Screening Tests"); Subpart M ("Alcohol Confirmation Tests"); and,. Subpart N ("Problems in Alcohol Testing"). These procedures apply to all DOT alcohol tests regardless of the reason for the test. Personnel and Testing Devices.eB � The Company will only use qualified 'Screening Test Technicians (STT) or Breath Alcohol Technicians (BAT) for DOT alcohol tests. These technicians will only conduct the test using DOT -approved devices. Devices are approved by the National Highway Traffic Safe+ Administration NHTSA , an agency of DOT, and placed on the Conforming Products ( ) g cy List (CPL),' The devices used by the Company will be maintained according to the particular manufacturer's specifications In the Quality Assurance Plan (c1AP). External calibration checks will be performed at the intervals specified in the manufacturer's instructions for any EBT used for DOT - required alcohol confirmation testing. Testing Site, Forms, and Specimen. The Company will provide the employee with the specific location where the test will take place. Tests will be conducted in an area to prevent unauthorized people from hearing or seeing the employee's test result. The Company will remind the employee that failure to sign the DOT Alcohol Testing Form (ATF) at the instruction of the testing technician will be viewed as a refusal to test. The alcohol screening test may be conducted with breath or saliva, as applicable for the device used by the testing technician. Only breath will be used for the confirmation test, which is conducted by a BAT using an EBT. Test. The Company will inform the employee that they are required to carry and present a current valid picture ID, such as a driver's license, passport, or employer -issued picture ID to the testing site. The testing technician will perform a screening test and show the employee the test result. If the screening test result is an alcohol concentration of less than 0.02, no further testing is authorized, and there is no DOT action to be taken. The technician will document the result on the ATF, provide the employee a copy and also provide the Company and/or the Company's C/TPA a copy. If the screening test result is 0.02 or greater, the employee will be required to take a confirmation test, which can only be administered by a BAT using an EBT. The BAT will wait at least 15-minutes, but not more than 30 minutes, before conducting the confirmation test. During that time, the employee will not be allowed to eat, drink, smoke, belch, put anything in their mouth or leave the testing area. Leaving the testing area without authorization may be considered a refusal to test. The BAT will perform an "air blank" (which must read 0.00) on the EBT device to ensure that there is no residual alcohol in the EBT or in the air around it. The confirmation test result is the final result of the test, and the will be shown to the employee and on the printout from the EBT. If the result is less than 0.02, no action is taken under Part 199. Any result of 0.02 or greater will be immediately reported to the Company. 3. PHMSA Inspection Protocol for Alcohol Testing Sites Compliance. PHMSA's Substance Abuse Program: Comprehensive Audit and Inspection Protocol Form, Combined Anti -Drug and Alcohol Misuse Prevention Programs, Form No.: 3.1.11, dated January 29, 2010, provides a separate inspection protocol for Alcohol Testing Sites. The Company provides this protocol to correspond with the detail found in the PHMSA Inspection Form. As previously stated, the Company will ensure that all DOT alcohol tests comply with Part 40 requirements. Alcohol Testing Personnel. The Company will ensure that only qualified STTs and BATs are used to conduct Company DOT tests. STTs and BATs are responsible to maintain their own verification documentation and will make. it available to the Company on request. 70 A supervisor of an employee may not be used to conduct a reasonable suspicionicause test if that supervisor was the one who made the determination to test.71 14 National. Highway Traffic Safety Administration, Confoarxnins.. Products List for Evidential Breath Measurement Devices, March 11, 2010, and addendurns. J. RANCK ELECTRIC, INC. PHMSA DRUGIALCOHOL PLAN "A r10NAL COMPI IANCE MANAGEMENT SERVICE, INC. (NCMS) -2010 28 Alcohol Testing Sites, Forms and Supplies. The testing site will ensure visual and aural privacy to the employee being tested' to prevent unauthorized persons from seeing or hearing test results. The site will have the needed personnel, materials, equipment, and facilities to provide for the collection and, analysis of breath and/or saliva samples, and a suitable clean surface for writing. The site will be able to prevent unauthorized personnel from entering the testing site, and ensure no unauthorized employee has access to an unsecured EBT, and that when an EBT or ASD is not being used for testing, it is stored In a secure place. Tests will be conducted on only one employee at a time.72 Only EBTs and ASDs listed on the Nl-ITSA CPL will be used for DOT alcohol testing, and only an EBT must be used for conducting the confirmation tests.'$ The QAP and associated manufacturers Instructions will be followed for all EBTs and! ASC]s used by the Company74 It is the responsibility of the testing sites used by the Company to carry out this responsibility for the Company.75 Alcohol Screening Tests. Only the DOT -approved ATF will be used for all Company alcohol tests.7e The employee will provide a positive identification through the use of photo ID or by employer representative prior to the test. 77 The BAT or STT shall explain the testinA process to the employee, including showing the employee the instructions on the back of the ATF. If the employee has a designated testing time and does not appear, the BAT or STT will notify the DER. Testing will begin without undue delay. An alcohol test will be given prior to a drug test and medical attention, if it is required, will not be delayed in order to conduct a test. The testing technician will explain the testing procedure to the employee, including showing the employee the instructions on the back of the ATF. The ATF will be completed and the employee will be asked to sign the ATF. Failure to sign is a refusal to test. The BAT or STT will select, or allow the employee to select, an individually wrapped or sealed mouthpiece from the testing materials and insert it into the device in accordance with the manufacturers instructions. The employee will be instructed to blow steadily and forcefully into the mouthpiece for at least six seconds or until the device indicates that an adequate amount of breath has been obtained. The employee will be shown the displayed test result. The device will print a label with, or the technician will write, the result and pertinent information on the ATF.79 Alcohol Screening with an ASD Be It is not the intent of the Company to use an ASD for an alcohol test. However, it Is possible that, when necessary, one may have to be used to conduct the test. In those cases the STT or BAT will follow the manufacturer's instructions, and only use a device that has been under their control. The ASD may be either a saliva device or a breath tube. The expiration date will be shown to the employee. A device will not be used after its expiration date. The device will be opened in the presence of the employee, and the employee will be offered the opportunity to use the device, according to instructions. In any case where the technician uses the device, the device will be inserted into the employee's mouth and gather saliva, with the technician wearing single -use examination gloves while doing so and change them following each test. Assurance will be made that the device has properly activated and that the correct amount of time will be allowed to elapse before reading the result. If problems occur (e.g., the device does not activate, it is dropped on the floor), it will be discarded and a new test will be conducted using a new device. The STT or BAT will note on the ATF the reason for the new test. If efforts to ,get the ASD to work properly fail, the technician will direct the employee to take a new test immediately, using an EBT for the screening test. Devices, swabs, gloves or other materials used in the prior saliva or breath tube testing will not be used in subsequent tests. Alcohol Screening Results .B1 A result with an alcohol concentration of less than 0.02 will be recorded on the ATF; the result will be transmitted to the DER, with the test concluded without consequence. A result with an alcohol concentration of 0.02 or higher requires the employee to take a confirmation test. If the same BAT who conducted the alcohol screening test will also conduct the confirmation test, the test will begin immediately. If a different BAT will conduct the confirmation test, the technician conducting the screening test will direct the employee to the site where the test will take place. The technician will also advise the employee not to eat, drink, put anything (e.g., cigarette, chewing gum) into the employee's mouth, or belch, during the 15-minute waiting period until the test occurs. The employee will be observed by the technician or an employer representative on the way to the confirmation testing site. The employee will be directed not to attempt to drive a motor vehicle to the confirmation testing site. J. RANCK ELECTRIC, INC. PHMSA DRUG/ALCOHOL PLAN NATIONAL COMPLIANCE NANAGEWNT SERVICE, INC. (NC1hS) - 7_U1Q 29 Alcohol Confirmation Test.8283All alcohol confirmation tests will be conducted by BATS using EBTs. The BAT will ensure that the time since the screening test has been at least 15 minutes, and the employee has been advised not to eat, drink, put anything (e.g., cigarette, chewing gum) into the employee's mouth, or belch. The BAT will conduct an air blank on the EBT in the presence of the employee. The reading must be 0.00 for the test to proceed. if the reading is greater than 0.00, another air blank must be conducted; the EBT must not be used (taken out of service) if the second reading is greater than 0.00. The EBT cannot be used for testing until it is found to be within tolerance limits on an external check of calibration. A new sealed mouthpiece will be opened, in view of the employee, and used for the test. The employee will be instructed to blow steadily and forcefully into the mouthpiece for at least six seconds or until the device indicates that an adequate amount of breath has been obtained. The results will be shown to the employee and printed for application to the ATF. Alcohol Confirmation Results . If the alcohol confirmation test result is lower than 0.02, nothing further is required of the employee. If the alcohol confirmation test result is 0.02 or higher, the BAT will immediately transmit the result directly to the DER in a confidential manner. Problems In Alcohol Testing.""' The Plan addresses the situations in which an employee has refused to take an alcohol test. See Section IVA, "DOT Alcohol Violations and Prohibited Conduct." In situations where an employee is unable to provide sufficient saliva to complete a screening test, the Company will ensure that the employee takes a breath test immediately. In situations where an employee is unable to provide sufficient breath to complete a test, the employee will be sent for an evaluation, by a licensed physician who is acceptable to the Company. The physician will have expertise in the medical issues raised by the employee's failure to provide a breath specimen, as well as be apprised of the consequences of the appropriate DOT agency regulation for refusing to take the required alcohol test. The physician will provide the Company with a signed statement of their conclusions. If it is the reasonable medical judgment of the physician, that a medical condition has, or with a high degree of probability could have, precluded the employee from providing a sufficient amount of breath, the test will be canceled by the Company. If there is not an adequate basis for determining that a medical condition has, or with a high degree of probability could have, precluded the employee from providing a sufficient amount of breath, this constitutes a refusal to test. Canceling an Alcohol Test B7 The Company will ensure that an alcohol test is canceled if a fatal flaw occurs. Fatal flaws are: 1) in the case of a screening test conducted on a saliva ASD or a breath tube ASD, the STT or BAT reads the result either sooner than or later than the time allotted by the manufacturer; the saliva ASD does not activate; the device is used for a test after its expiration date; or, in the case of a screening or confirmation test conducted on an EBT, the sequential test number or alcohol concentration displayed on the EBT is not the same as the sequential test number or alcohol concentration on the printed result; 2) in the case of a confirmation test the BAT conducts the confirmation test before the end of the minimum 15-minute waiting period; the BAT does not conduct an air blank before the confirmation test; there is not a 0.00 result on the air blank conducted before the confirmation test; the EBT does not print the result; or, the next external calibration check of the EBT produces a result that differs by more than the tolerance stated in the QAP from the known value of the test standard. In this case, every result of 0.02 or above obtained on the EBT since the last valid external calibration check is canceled. The Company will ensure that an alcohol test is canceled if a correctable flaw occurs and is not corrected. Correctable flaws are: the BAT or STT does not sign the ATF; the BAT or STT fails to note on the "Remarks" line of the ATF that the employee has not signed the ATF after the result is obtained; and, the BAT or STT uses a non -DOT form for the test. Correcting Alcohol Problems." The Company will ensure that BATS and STTs will try to successfully complete each alcohol test for an employee. If they become aware of a problem that will cause the test to be canceled, they will try to correct the problem promptly, if practicable. Repeating the test is an acceptable part of this process. If repeating the testing process is necessary, a new test (new ATF, new device) must begin as soon as possible. If repeating the testing process is necessary, the technician is not limited in the number of attempts to complete the test, provided that the employee is making a good faith effort to comply with the testing process. If another testing device is not available for the new test at the testing site, the technician will immediately notify the DER and J. RANCK ELECTRIC, INC. PHMSA DRUG/ALCOHOL PLAN NATIONAL COMPLIANCE. MANAGEMENT SERVICE, INC- .NCMS) - 2010 30 advise the DER that the test could not be completed. The DER will make all reasonable efforts to ensure that the test is conducted at another testing site as soon as possible. If the Company or its service agent administering the testing process becomes aware of a correctable flaw that has not been corrected, all practicable action will be taken to correct the problem so that the test is not cancelled. If the problem resulted from the omission of required information, the person responsible for providing the information must supply in writing the missing information and a signed statement that it is true and accurate. If the problem is the use of a non -DOT form, the technician must, as the person responsible for the use of the incorrect form, certify in writing that the Incorrect form contains all the Information needed for a valid DOT alcohol test. The technician must also provide a signed statement that the incorrect form was used Inadvertently or as the only means of conducting a test, in circumstances beyond the technician's control, and the steps the technician leas taken to prevent future use of non -DOT forms for DOT tests. The technician must supply this information on the same business day on which the collector was notified of the problem, transmitting it by fax, e-mail or courier. If the technician cannot correct the problem, the technician must cancel the test. 1. Substance Abuse Professional Compliance. The Company will fditow the requirements of Part 40 for Its Substance Abuse Professional (SAP) obligations. A full description of the SAP requirements Is in Part 40, Subpart O ("Substance Abuse Professionals and the Return -to -Duty Process ).. Quaiiflcati+ons.99 The Company will refer employees only to SAP's who have the credentials, basic knowledge, and qualification training, including fulfilling obligations for continuing education courses, for DOT violations. The SAP will not be an advocate for the Company or the employee. The SAP's function is to protect the public interest in safety by professionally evaluating the employee and recommending appropriate education/treatment, follow-up tests, and aftercare. SAP Referral.90 The Company will provide to each employee who violates a DOT drug and alcohol regulation a listing of SAP's readily available to the employee and acceptable to the Company. The list will include SAP names, addresses, and telephone numbers. There will not be a charge to the employee for compiling or providing this list. The Company may use its C/TPA or other service agent to provide this information. Any covered employee who has violated DOT drug and alcohol regulations cannot again perform any DOT safety -sensitive duties for this Company until and unless the employee successfully completes the SAP evaluation, referral, and education/treatment process. Payment. The Company is not required to pay for a SAP evaluation or any subsequent recommended education or treatment for an employee who has violated a DOT drug and alcohol regulation. Company,! Regspy�ryonsibilit�yy, . The Company ipsp only safety -sensitive DOT to ensurethatIftheemployee is prided an opportunity to return to a DOT safety-sel f itiMe duty.. following a violation, that the Company ensure that the employee receives an evaluation by a. SAP meeting the requirements of Part 40 and that the employee successfully complies with the SAP's evaluation recommendations before returning to the safety -sensitive job. Even if a SAP believes that the employee is ready to return to safety -sensitive work, the Company is under no obligation to return the employee to work. Under the DOT regulations, hiring and reinstatement decisions are left to the employer. The DOT leaves all payment issues for SAP evaluations and services to the Company and the employee to resolve. SAP Process . The SAP will make a face-to-face clinical assessment and evaluation to determine what assistance is needed by the employee to resolve problems associated with alcohol and/or drug use. The SAP will refer the employee to an appropriate education and/or treatment program. At the completion of the education and/or treatment, the SAP will conduct a face-to-face follow-up evaluation to determine If the employee actively participated in the education and/or treatment program and demonstrated successful compliance with the initial assessment and evaluation recommendations. Reports will be provided to the Company on both the initial requirements and the outcome of the follow-up evaluation. The report will be specific and will Include all of the Part 40 requirements of a written SAP report, The SAP will provide the DER with a written follow-up drug and/or alcohol testing plan for the employee and, if deemed necessary, will also provide the J. RANCK ELECTRIC, INC. PHMSA DRUG/ALCOHOL PLAN NATIONAL COMPLIANCE MANAGEMENT SERVICE, INC. INCMS) - 2010 31 employee and the Company with recommendations for continuing education and/or treatment. 2. Employee Assistance Program''' The Company will provide an Employee Assistance Program (EAP) for its employees and supervisors. The EAP may be established "in house," as part of internal personnel service or may be contracted to an entity that provides EAP services at other locations. The function of the EAP will be to provide employees with informational material on the awareness and danger of drug and alcohol use. General EAP-information material, such as the availability of brochures or videos, and community service "hotline" telephone numbers will be displayed in common areas and distributed to employees. Employees will be encouraged to call the hotline if needed. Additionally, this Plan will be displayed and made available to all employees. The Plan contains the employer's policy regarding the use of prohibited drugs and alcohol misuse. The areas and places in which the above material will be displayed include employee bulletin boards, break rooms, locker rooms, or other areas designated by the Company. 3. Supervisor Training ""9s Each supervisor who will determine whether an employee must be drug tested and/or alcohol tested based on reasonable suspicion/cause will be trained in the "signs and symptoms" of each substance. Each supervisor will receive one 60-minute period of training on the specific, contemporaneous physical, behavioral, and performance indicators of probable drug use and one 60-minute period of training on the specific, contemporaneous physical, behavioral, and performance indicators of probable alcohol use. The two 60-minute training periods may run concurrently. 4. Contractor Monitoring ss 07 Compliance. Operators are responsible for ensuring that contractors and contractor employees working for, and/or on the properties of, the operator are in compliance with the requirements of Part 40 and 199. With respect to those covered employees who are contractors or employed by a contractor, an operator may provide by contract that all requirements of Part 40 and 199 will carried out by the contractor. To assure that the contractor is in full compliance, the contractor will allow access to property and records by the operator, the operator designee, the Administrator, any DOT agency with regulatory authority over the operator or covered employee, and, if the operator is subject to the jurisdiction of a state agency, a representative of the state agency for the purposes of monitoring the operator's compliance with the requirements of Part 40 and 199. The operator will ensure that all contractors are qualified prior to commencing, as well as during the performance of, covered functions for the operator. Qualifying Potential Contractor. Qualifications of the potential contractor as it pertains to drug and alcohol testing policies and procedures are assured by requesting the potential contractor to submit a copy of its Plan for review and compliance with PHMSA regulations. After review of the Plan is completed, written correspondence to the contractor will advise whether or not it is acceptable or in need of further additions, deletions, revisions or clarifying language. The review of the contractor Plan shall be completed utilizing the criteria established by PHMSA. Monitoring Contractor's Compliance . The contractor may be required to provide information on their employees who will perform covered functions for the operator. This information will include, as a minimum, the name, type of test and test date of the employees who will perform any work or functions covered by Part 199 under that contract. A list of each contractor's covered employees may be distributed to appropriate Company field management. All contractors will be required to submit drug and alcohol testing statistical information on a periodic basis, which may be based on the duration of the contract. Typically, this requirement will be on a semi-annual basis. The Company may require a more frequent schedule for submission of drug and alcohol testing data should they determine a need for such statistics. The Company shall maintain a complete file on each contractor's statistical drug and alcohol testing reports. The Company shall make these reports available when requested by a PHMSA agency -designated representative, or representatives of J. RANCK ELECTRIC, INC. PHMSA DRUG/ALCOHOL PLAN NATIONAL COMPI,IANCF MANAGEMENT SERVICE, INC. INCMS; --2010 32 those state agencies under which jurisdiction the Company operates. The operator will also submit contractor Management Information System (MIS) reports to PHMSA by March 15�h each year. The contractor will cooperate with the operator, or the operator's designee, if additional information is requested to further verify compliance of the regulations. S. Recordkeeping9 "100 Compliance. The Company will ensure that all records required by the DOT are maintained. The Company is not required to keep records related to a program requirement that does not apply to Part 40 or 199. The Company or its C/TPA will maintain the records in a locked file system and will be accessed only on a strict "need to know" basis. The Company or its C/TPA will not release an employee's drug and alcohol records to third parties without the employee's specific written consent. A"third party" is any person or organization to whom Parts 40 or 199 do not explicitly authorize or require the transmission of information in the course of the drug and alcohol testing process. "Specific written consent" means a statement signed by the employee that he or she agrees to the release of a particular piece of information to a particular, explicitly identified, person or organization at a particular time. The Company or its C/TPA will release the employee's information without consent to DOT, PHMSA, or other government agency having regulatory authority over the Company or employee without consent. The Company or its C/TPA will release the employee's information without consent as a part of an accident investigation by the National Transportation Safety Board. The Company or its C/TPA will release the employee's information without consent in. certain legal proceedings. These proceedings include a lawsuit, grievance, administrative proceeding (e.g., an unemployment compensation hearing brought by or on behalf of an employee resulting from a positive drug or alcohol test or refusal to test), a criminal or civil action resulting from an employee's performance of safety -sensitive duties, in which a court of competent jurisdiction determines that the drug or alcohol test information sought is relevant to the case and issues an order directing the Company to produce the information. In such a proceeding the information will be released to the decision maker in the proceeding with a binding stipulation that the decision maker to whom it is released will make it available only to parties to the proceeding. After releasing the information, the Company or its C/TPA will notify the employee. If the Company uses a C/TPA to maintain the records, the Company will ensure that the C/TPA can produce these records at the Company's principal place of business in the time required by the DOT agency for an inspection. The records will be provided within two business days after receipt of the request. Most records will be stored electronically, where permitted by Part 40 and 199, The Company will ensure that the records are easily accessible, legible„ and formatted and stored in an organized manner. If electronic records do not meet these criteria for the DOT inspector, the Company will convert them to printed documentation in a rapid and readily auditable manner, at the request of DOT agency personnel. Records and Retention Periods. The Company or its C/TPA will maintain the following records for the noted time periods, as a minimum: a) Records kept for five years: (1) Records of alcohol test results indicating an alcohol concentration of 0.02 or greater, (2) Records of the inspection, maintenance, and calibration of EBTs; (3) Records of verified positive drug test results; (4) Documentation of refusals to take required alcohol and/or drug tests (including substituted or adulterated drug test results); (5) SAP reports; (6) Follow-up tests and schedules for follow-up tests; and, (7) Statistical data related to the Company's testing program, entitled "Management Information System," will be available to a representative of DOT, PHMSA, or a state agency having regulatory authority over the Company upon request. J. RANCK ELECTRIC, INC. PHMSA DRUG/ALCOHOL PLAN NATIONAL COMPI IANCE MANAGEMENT SERVICE, INC. (NCMS) - 2010 33 b) Records kept for three years: (1) Records of information obtained from previous employers under Part 40 concerning drug and alcohol test results of employees; (2) Records that demonstrate the drug -testing collection process; and, (3) Records related to "signs and symptoms" alcohol and drug training for supervisors. c) Records kept for two years: (1) Records related to the alcohol collection process (i.e., calibration documentation for evidential breath testing devices, documentation of breath alcohol technician training, documents generated in connection with decisions to administer reasonable suspicion alcohol tests, documents generated in connection with decisions on post -accident tests, and documents verifying existence of a medical explanation of the inability of a covered employee to provide adequate breath for testing); and, d) Records kept for one year: (1) Negative drug test results. (2) Alcohol results less than 0.02. Employee Request for Records . All employees have the right to request and obtain copies of any records pertaining to the employee's use of alcohol and/or drugs, including records of the employee's DOT -mandated drug and/or alcohol tests, and copies of SAP reports. Requests for records must be made in writing to the DER. A laboratory must provide, within 10 business days of receiving a written request from an employee, and made through the MRO, the records relating to the results of the employee's drug test (i.e., laboratory report and data package). Service agents providing records may charge no more than the cost of preparation and reproduction for copies of these records. SAPs must redact follow-up testing information from the report before providing it to the employee. 6. Management Information System 101 102103 Compliance. The Company will prepare and maintain the DOT Management Information System (MIS) report for its drug and alcohol testing program. This report will be submitted to PHMSA In accordance with annual submission requirements. If the Company uses a C/TPA then the CITPA may prepare and maintain the MIS, reporting the MIS as the Company requires. The DER will certify each report submitted by a C/TPA for accuracy and completeness. Contractor Reporting for MIS. If the Company is an operator, it will verify and identify all contractors who performed covered functions, as defined under Part 199, for this Company in a given calendar year. If required, by either mandated annual or PHMSA written request, the Company will submit an MIS report for each of these contractors on or before Marcia 160'. J. RANCK ELECTRIC, INC. PHMSA DRUG/ALCOHOL PLAN NATIONAL COMPLIANCE MANAGEMENT SERVICFjNC. (NCMS) 2010 34 I acknowledge, by signing this form, that my full compliance with, the Anti -Drug and Alcohol Misuse Prevention Plan (the "Plan") and DOT drug and alcohol regulation requirements is a condition of my initial and continued employment with the Company, I understand and agree that I may be discharged or otherwise disciplined for any drug and/air alcohol violation, committed by me, as cited in the Plan and/or in the DOT drug and alcohol regulatory requirements. I also acknowledge, by signing this form, that a copy of the Plan has been made available to me and that I have read and understand the requirements of the Company and DOT drug and alcohol program. I have also been provided with informational material on the dangers and problems of drug abuse and alcohol misuse. Signed, this the day of , 20 Employee Name (Please Print) Employee Signature Company Representative Name (Please Print) Company Representative Signature J. RANCK ELECTRIC, INC. PHMSA DRUG/ALCOHOL PLAN NATIONAL COMPLIANCE MANAGEMENT SERVICE, INC. (NCPAS) ^ 2010 35 CONSORTIUM/THIRD PARTY ADMINISTRATOR (C/TPA) Name: Pipeline Testing Consortium, Inc. Address: 9 Compound Drive, Hutchinson, Kansas 67502 Phone Number: (800) 294-8758 DESIGNATED EMPLOYER REPRESENTATIVE (DER)/ALCOHOL $ DRUG PROGRAM MANAGER Name: Paul Johnson / Angie Wood / Matt Warren Address: 1993 Gover Parkway, Mt. Pleasant, MI 48858-8137 Phone Number: (989) 775-7393 MEDICAL REVIEW OFFICER (MRO) Name: David Paine, M.D. - American Medical Review Officers, LLC Address: 7 Compound Drive, Hutchinson, Kansas 67502 Phone Number. (866) 359-0414 SUBSTANCE ABUSE $ MENTAL HEALTH ADMINISTRATION (SAMHSA/HHS) LABORATORY Name: Clinical Reference Laboratory Address: 8433 Quivira Road, Lenexa, Kansas 66215 Phone Number: (800) 445-6917 COLLECTION SITE(s) - DRUG AND BREATH ALCOHOL Name: Pipeline Testing Consortium, Inc.-www.pipelinetesting.com for a current list of collection sites. Address: 9 Compound Drive, Hutchinson, KS 67502 Phone Number: (800) 294-8758 LIST OF APPROVED EVIDENTIAL BREATH TESTING DEVICES (EBTS) UTILIZED: EBT Manufacture Name and EBT Model Name: Draeger Breathlyzer 7410; Intoximeters Alcohol Sensor IV; Intoxilyzer 200D SUBSTANCE ABUSE PROFESSIONAL (SAP) Name: Pipeline Testing Consortium, Inc. Address: 9 Compound Drive, Hutchinson, Kansas 67502 Phone Number: (800) 294-8758 EMPLOYEE ASSISTANCE PROGRAM (EAP) Name: Pipeline Testing Consortium, Inc. Address: 9 Compound Drive, Hutchinson, Kansas 67502 Phone Number: (800) 294-8758 J. RANCK ELECTRIC, INC. PHMSA DRUG/ALCOHOL PLAN NATIONALC,OMPL.IANCE MANAGEMENT SERVICE, INC. (NCMS)--2010 36 EMPLOYEE/SUPERVISOR POSITIONS SUBJECT TO ALCOHOL & DRUG TESTING (JOB CLASSIFICATIONS/TITLES) SUPERVISOR POSITIONS THAT HAVE RECEIVED ALCOHOL AND DRUG TRAINING (60 MINUTES DRUG, 60 MINUTES ALCOHOL) FOREMAN JOURNEYMAN APPRENTICE FENCEINSTALLERS J. RANCK ELECTRIC, INC. Supervisor Check applicable box. ❑ ❑X a ❑ ❑X ❑ x❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ L91 Em lovee Su en rvisor Check applicable box. ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ PHMSA DRUG/ALCOHOL PLAN NATIONAL COMPLIANCE' MANAGEMCNT SERVICE, INC. (NCM5)- 20Y0 37 Under the Antl-Drug and Alcohol Misuse Prevention Plan, the Company is committed to a drug and alcohol free workplace. 'Violations to this Plan Include: «, . as w I« , 11 �z * 1169WNmm01O. w « . . .: , s and alcohol, b) An employee or applicant who tests positive for dru s, has an alcohol concentration of 0.04 or higher, or refuses to take any drug or alcohol test as directed by go Company. c) The prohibited use of alcohol with a test result of 0.02 or greater, but less than 0.04. Employees violating this Plan will be subject to discipline actions up to and including termination. Disciplinary action may include, but is not limited to: removed from working in a covered position„ suspension, loss of pay, and termination of employment. Reservation of Ri hts. The Comeppan)r reserves the right to Interpret., modify, or revise this policy statement in whole or in part w thout notice, I Eothin in this policy statement Is to be construed as an employment contract nor does this alter an eMoyee's employment at -will status. The employyee remains free to resin his/her employment at any time r any or no reason, without notice. Similarly, 4he Company reserves the right to terminate any employee's employment„ for any or no reason, without notice. Compliance with All Laws. This policy statement will be amended from time to time to comply with changes in Federaland State laws. The Company reserves the right to revise or amend this policy with or without notice at any time. J. RANCK ELECTRIC, INC. PHMSA DRUG/ALCOHOL PLAN NAT!6NAL COMPLIANCE MANAGEMENT SERVICE. INC, (14CMS) •-2010 38 Uffl.... 1 A.01 a. Verify that the operator maintains and follows a written Anti -Drug Plan that conforms to Part 199 and Part 40 and that the plan contains the following 1§199,101): 1) Methods and procedures for compliance with all the requirements of Part 199, Including the employee assistance program; 2) The name and address of each laboratory that analyzes the specimens collected for drug testing; 3) The name and address of the operators Medical Review Officer; and Substance Abuse Professional; and Procedures for notifying employees of the coverage and provisions of the plan. 2 H.01.e. Verify that the operator maintains and follows a written Alcohol Misuse Plan that conforms to Part 199 and Part 40 and that the plan contains methods and procedures for compliance with required testing, recordkeeping, reporting, education and training elements 1§199.202). 3 A.02.a. Verify that "stand -down' is prohibited before the MRO has completed the drug test verification process or that an approved waiver Is granted per the requirements of [§40.21] and [§199.7]. 4 H.02,e. Verify that the educational materials made available to covered employees includes detailed discussion of at least the following 1§199.239(b)]: t)The identity of the person designated by the operator to answer covered employee questions about the materials; 2) The categories of employees who are subject to the provisions of this subpart; 3) Sufficient information about the covered fiunot ons performed by those employees to make clear what period of the worts day the covered employee is required to be In compliance with this subpart; 4)Rpecific Information concerning covered employee conduct that Is prohibited by this subpart; 5) The circumstances under which a covered employee will be tested for alcohol under this subpart„ 6,) The procedures that will be used to test for the presence of alcohol„ protect the covered employee and the integrity of the breath testing process, safeguard the validity of the test results, and ensure that those results are attributed to the correct employee; 7) The requirement that a covered employee submit to alcohol tests administered In accordance with this subpart; 8) An explanation of what constitutes a refusal to submit to an alcohol test and the attendant consequences; 9) The consequences for covered employees found to have violated the prohibitions under this subpart, Including the requirement that the employee be removed Immedlately from covered functions, and the procedures under §199.243-, 10) The consequences for covered employees found to have an alcohol concentration of 0.02 or greater but less than 0.04 and 11) Information concerning the effects of alcohol misuse on an Individual"s health, work, and personal life; signs and symptoms of an aloohol problem (the employee"s or a coworkars); and Including Intervening evaluating and resolving problems associated with the misuse of alcohol Including Intervening when an alcohol problem is suspected, confrontation, referral to any available E P, and/or referral to management. 513.01.11 Verify that a service agent is not used to fulfill the function of a DER [§40.15(d)]. 8 N.01 A. Verify that an employer who is using a service agent concerning whom a PIP is Issued stops using the service of the service agent no Pater than 90 days attar the Department has published the decision In the Fed -eras Register or posted It on its web site. The employer may apply to the ODAPC Director for an extension of 30 days If It Is demonstrated that a substitute service agent cannot be found within 90 days [§40.409(b)]. 7 8:01,a. Verify that critical poaltions most the applicable qualifications of Part 40 and 199; 1) Medical Review Officer (MRO), 040.121 and §199.109(b)); 2) Substance Abuse Professionals (SAP), (§.40.81) 3); 3) Urine Specimen Collectors (§40.33). 81.01 a, Verify that Alcohol Misuse Prevention Program positions meet the applicable qualification requirements of Part 40 and Part 199 as foli+rrwa: I )Screening Test Technician (§40.213); 2) Breath Alcohol Technician (§40.213'); and, 3) Substance Abuse Professional (SAP) (§40.281). 9 A.01.d. Verify that DOT tests are completely separate from non -DOT tests in all respects [§40.13] 10 Hi.01.d. Verify that the Alcohol Misuse Prevention Program ensures that the DOT tests are completely separate from non -DOT tersts In all respects [§40,13]. 11 A.01,b. Verify that the Plan identifies covered employees (as defined In §199.3), required to be tested for drugs, are Identified [§1'99.1). 12 H.01.b. Verify that the Alcohol Misuse Prevention Program Identifies the covered employees (as defined in §199.3) that are required to be tested for the presence of alcohol [§199.11. 13 CAI.a. Verify drug tasting information [§40.25(b)) is requested from previous DOT -regulated employers for any employee seeking to begirt covered functions for the first time (i.e., a new hire or an employee transfer)1§40.25(a)]. Covered employee must not perform their functions after 30 days from the date on which the employee first performed satety-sensttive functions, unless a good faith effort to obtain the information has been made and documented. 14 "f.01.a. Verify that alcohol testing Information (§40.25(b)) is requested from previous DOT -regulated employers for any employee seeking to begin covered functions for the first time (i.e., a now hire or an employee transfer) [§40.25(a)]. In addition, verify that a covered employee must not perform their functions after 30 days'from the date on which the employee first performed safety - sensitive functions, unless you have obtained or made and documented a good faith effort to obtain alcohol testing information from previous DOT -regulated employers. 15 H.02.s. Verify that the Alcohol Misuse Plan ensures that a covered employee is not permitted to perform covered functions if the employee has engagad In violations of §§199.215 through 199.223 (see below) or an alcohol misuse rule of another DOT agency [§199.233). 1) Having an alcohol concentration of 0.04 or ,greater 1§40.23(c), §40.285 and §199,2151; 2) Using alcohol while performing covered functions 1§199.217, Oni 13) using alcohol within 4 hours prior to performing covered functions, or, If am employee Is called to duty to respond to an emergency, within the time period after the employee has been notified to report for duty 1§199.219, Pre -dirty use); 4') A covered employee, who has actual knowledge of an accident In which his or her performari of J. RANCK ELECTRIC, INC. PHMSA DRUG/ALCOHOL PLAN NAT ZONAL COMPLIANCE' MANAGEMENT SERViCF_, INC (i. - 2010 40 covered functions has not been discounted by the operator as a c ontri'txsd'ng factor to the accident, Is prohibited from using alcohol for 8 hours following the accident unless he or she has been given a ,Post -accident test under §199.225(a), or the operator has detenrlined that the employee"s performance could .not .have conblbuted to the accident [§1 9.221„ Use following an accident];, and, 5) Upon refusal of a covered employee to submit to a post -accident alcohol test required under §199„225(a), a reasonable suspicion alcohol test required under §199.225(b), or a follow-up alcohol test required under §199.225(d) LW.285 and §199.223. Refusal to submit to a required alcohol test]. 16 H.02& Verify that the Alcohol Misuse Prevention Program assures that a covered employee is prohibited from performing or continuing to perform covered functions when found to have an alcohol concentration of 0.02 or greater but less than 0.04, until: The employee"s alcohol concentration measures less than 0.02 in ac ardence with a last administered under §199.225(o); or The start of the amployae°s next regularly scheduled duty period, but not less than 8 hours following administration of the test [§40.23(c) and §199.237(o)]. 17 A.02.1b. Verify that a covered employee that violates DOT drug regulations is removed from performing safety -sensitive functions [§40.23 and §199.7). A vadflad positive DOT drug test result or a refusal to test (including by adulterating or substituting a urine specimen) constitutes a violation of DOT drug regulations 1§40,285(b) and §199.103(a)]. If a covered employee violates a DOT drug regulation„ a listing of SAPS that are readily available is provided to the employee [§40„287]. 18 C.01.b. Verify no new personnel (new hire, contracted, or transferred employees) are used to perform covered functions unless that person receives a negative drug test and or is covered by the Plan that conforms to Part 199 [§199.105(a)]. Procedures are In place for direct observation when required under §§40.67(a), (b) and (4). 19 C.02A. Verily poet-acaldent drug testing is performed, as soon as possible but no later than 32 hours after an accident (§ 195.5a) or incident (§ 191.3), for each employee whose patfomlance either contributed to the accident or cannot be completely discounted' as a contributing! factor to the accident [§199.105(b)]'.. In addition, procedures are In place for direct observation when required under %40,67(a), (b) and (d). 20 C.03,a. Verify the minimum annual percentage rate used for random drug testing of covered employees complies with §199.105(c)(1) through (4). 21 C.03.b. Verify the selection of employees for random drug testing is based on a scientifically valid method, such as a random number table or a computer -based random number generator matched with employee identification data It 99.105(c)(5)]. 22 C.03.c. Verify a sufficient number of covered employees will be selected for random testing during each calendar year to equal an annual rate not lass then the required minimum annual percentage rate (see Protocol C.03.a.) [199.105(c)(6)]. The total number of covered employees eligible for random testing throughout the year will be calculated by adding the total number of covered employees eligible for testing during each random testing period for the year and dividing that total by the number of random testing periods 1199.119(c)]. 23 C.03.41. Verify random drug tests are unannounced and that the dates for administering the tests are spread reasonably throughout the calendar year [199.105(c)(7)]. 24 C.04,a. Verify decisions to test are reasonable and artloulable, and based on specific contemporaneous physical, behavioral or performance indicators of probable drug use. At least two supervisors, one of whom is trained in detection of the symptoms of drug use, substantiate and Concur in the decision to test an employee who is reasonably suspected of drug use [§199.105(d)]. 25 C.05,s. Verify a covered employee that violates DOT drug regulations does not return to duty for a covered function until the employee: 1) Completes a SAP evaluation, referral, and education/treatment process [§40.285(a), §40.289(b), and §199.105(e)]; 2) After completion of the SAP process above, successfully completes a return -to -duty drug test [§40.305(a) and §199.105(e)]; and 3) All return -to -duty testing will be performed under direct observaton 1§40.67({b)). 26 C.06.a. Verify SAP will establish a written follow-up testing plan for a covered employee that violates DOT drug regulations and seeks to return to the performance of a covered function [§40.307(a)]. All follow-up testing will be performed under direct observation ]§40.67(b)]. 27 C.06.b. Verify follow-up testing Is performed on an unannounced basis, at a frequency establlshed by the SAP, for a period of not more than 60 months. At least six tests must be conducted within the first 12 months following the covered employee's return to duty. [§40.307, §40.309, and §199.105(f)]. 28 C.07.s. Verify procedures are in place for direct observation when required under §§40.67(a), (b) and (d). 29 B.01.a. Urine Specimen Collector (§40.33) meet the applicable qualification requirements of Part 40 and Part 199. 30 0.01.a. Does the operator ensure that, unless no other collector Is available, an immediate supervisor of an employee does not serve as a collection site person [§40.31(c)]? 31 0.01.b. Do collectors meet the training requirements of §40.33 and is documentation available showing that currently all requirements are met [§40.33(g)]? 32 0.01.c. Does the operator provide error correction training as required by §40.33(f) and does the braining occur within 30 days of the date of notification of the error that led to the need for training? 33 0.02.a. Has the employer designated a collection site that meets the requirements of §40.41. 34 0.02.b. If the collection site uses a facility normally used for other purposes, are procedures in place to ensure before the collection that: (1) access to collection materials and specimens is effectively restricted; and (2) the facility is secured against access J. RANCK ELECTRIC, INC. PHMSA DRUG/ALCOHOL PLAN N.ATIONA!, COMI-1IANCE MANAGEMENT SERVICE, INC, (NCMS) - 2010 41 during the prooadure to ensure privacy to the employee and prevent distraction of the collector? Also, are limited -access signs posted [§40.43(c)]? 35 0.02.c. Are procedures in place to assure the collector maintains personal control over each specimen and CCF throughout the collection process and to prevent unauthorized personnel from entering any part of the site in which urine specimens are collected or stored [§40.43(dx5) and §40.43(e)]? 36 0.02.d. Is the current Federal Drug Testing Custody and Control Form (CCF) or equivalent being used [§40.45]? 37 0.02.e. Is a collection kit used that meets the requirements of Appendix A to Part 40 [§40.49]? 38 0.03.a. Do collection site personnel explain the basic collection procedure to the employee, including showing the employee the instructions on the back of the CCF [§40.61(e)]? 39 0.03.b. Do collection site personnel provide the donor with an Individually wrapped or sealed collection container from the collection kit materials [§40.63(c)]9 40 0.t13«c... Are precautions taken to ensure that unaduttarsted specimens are obtained and correctly identified that most the following requirements: 1) sluing agents in toilet tank and all water sources secure [§40.43(b)(11) and (2)); 2) individual positively Identified (photo ID, etc.) [§40.61(c)]; 3) Proper authority contacted if individual fails to arrive at the assigned time [§40.61(a)]; 4) The donor shall remove any unnecessary outer garments. Pumas or briefcases shall remain with outer garments [§40.61(f)]; 5) Donor shall wash and dry his/her hands [§40.83(b)); 6) To the greatest extent possible, the collector must keep an employee's collection container within view of both himself/herself and the employee between the time the employee has urinated and the specimen is sealed [§40.43(d)(2)]; and, 7) Any unusual behavior noted on the CCF [§40.63(e)] 41 0.03.d. Are procedures being followed at the collection site after the specimen has been provided In compliance with the requirements of §40.65 42 0.03.e. Have provisions been made If the donor is unable to provide at least 45 milliliters of urine [§40.65(a)]? 43 0.031. Are procedures in place for immediately collecting urine specimens under direct observation for the situations identified In §40.67(c). As of August 31, 2009, verify that all collections for return -to -duty and follow-up testing were performed under DER directed direct observation [§40.67(b)] 44 0.03.9. Are same gender collection personnel used if a collection is monitored under direct observation by non -medical personnel [§40.89(g)] 45 0.03.h. Is the CCF properly executed by authorized collection site personnel upon receipt and transfer of a urine specimen [§40.73(a)] 46 D.01.a. Verify drug testing laboratory used for all testing required by Part 40 and Part 199 Is certified by the Department of Health and Human Services (HHS) [§40.81(a) and §199.107(a)]. 47 0.01.c. Verify laboratory results are reported directly, and only, to the MRO at his or her place of business. Results must not be reported to or through the DER or a service agent (e.g., CfTPA) [§40.97(b)]. 48 D.01 b. Verify drug testing laboratory only tests for the following five drugs or classes of drugs in a DOT drug test. (The laboratories must not test "DOT specimens" for any other drugs): (a) Marijuana metabolites; (b) Cocaine metabolites; (c) Amphetamines; (d) Opiate metabolites; and (a) Phencyclidine (PCP)1§40.3, §40.85 and §199.3]. 49 0.01.d. Verify laboratory testing the primary specimen will retain a specimen that was reported with positive, adulterated, substituted, or invalid results for a minimum of one year. The specimen must be kept in secure, long-term, frozen storage in accordance with HHS requirements [§40.99 and §199.111(a)]. 50 D.03.a. Verify laboratory retains all records pertaining to each employee urine specimen for a minimum of two years and also keeps for two years employer -specific data required In §40.111 [§40.1091. 51 D.03.b. Verify laboratory transmits an aggregate statistical summary to the Company per Part 40, Appendix B, on a semi-annual basis. 52 D.02A. If the Company or CITPA, used by the Company, has an aggregate of 2000 or more DOT -covered employees, blind specimens are submitted to the laboratories used. If the Company or C/TPA has an aggregate of fewer than 2000 DOT -covered employees, DOT does not require them to provide blind specimens [W.103(a)]. 53 E.01.a. Verify that an MRO is designated or appointed by the Anti -Drug Plan [§199,109(a)]. 54 E.01.b. Verify that the MRO provides quality assurance reviews of the drug testing process, including ensuring the review of the Custody and Control Form (CCF) on all specimen collections [§40.123(b)]. 55 E.01.c. Verify that the MRO performs the review functions required by §40.127 for negative drug test results received from a laboratory, prior to verifying the result and releasing it to the Designated Employer Representative (DER). 56 E.01.d. Verify that the MRO performs the review functions required by §40.129 for confirmed positive, adulterated, substituted, or Invalid drug test results received from a laboratory, prior to verifying the result and releasing It to the DER. In addition, the MRO must determine whether there is a legitimate medical explanation for confirmed positive, adulterated, substituted, and Invalid drug test results from the laboratory [§40.123(c)]. J. RANCK ELECTRIC, INC. PHMSA DRUGIALCOHOL PLAN _ 20'10 NATIONAL COMPLIANCE MANAGEMENT SERVICE, INC. (NCKIS) 42 57 F.02.a. Verify that the MRO reports all drug test results to the oPersllorMO-163(a) and §199.109(d)) in accordance with the requirements In §40.163,, §40.166 and §40.167. These requirements Include; Reporting all drug test results to the DER, except In the circumstances provided for in §40.345, when a CrrPA may act as an Intermediary [§40,1 65(a)); reporting the results In a confidenitarl manner[§40,167(a)] and reporting the results within the required time constraints [§40.107(b) and (Q. 68 E-01 ,6. Verify that when the MRO has vedfle(J a drug test as Positive for a ftl; or drug metabolite. or as a refusal to test because of adulteration or substitution, and the MRO must notify the employee of his or her right to have the split specimen tested. The MRO must also notify the employee of the procedures for requesting a lost of the split specimen, and Inform the employee that he or she has 72 hours from the time of this notification to him or her to request a too of the spill specimen [§40,163]. 59 E,01.f. If additional testing Is requested by the employee, verity that the split specimen W tested. The split testing laboratory must be certified by HHS. (Note: Correction maids to Inspection language,) 1§190.11 1(b) and (c)). So J.01.b. If the operator chooses to conduct pre-emptoyment alcohol testing, verify That the operator, 1) Conducts a Pre- employment alcohol test before the first performance of covered functions by every covered employee (whether a now employee or someone who has transferred to a position Involving fibs performance of covered functions) 1§1 99209(tiXII)I; 2) Treats all covered employees the some for the purpose of preemployment alcohol tasting (I,C, You must not test some covered employees and not others) [,§199.209(b)(2)j;and, 3) Conducts the pre -employment tests after rnehing, a contingent offer of employment or transfer, sut4act to the employee passing the pre -employment alcohol test [§1 99,209(b)(3)). 61 J-02-IL Verify that post -accident alcohol testing is performed* 1) As soon as practicable following an accident (§195.50) or Incident (§191.3) for each surviving covered employee If Chet employee's performance of a covered function either contributed to the accident or cannot be completely discounted as a contributing factor to the accident 1§1 99.225(a)(11)1- and, 2) Within two hours following the accident (§195,50) or incident (§191 .3). othervAse, the operator shalt prepare and maintain on file a record stating the reasons the test was not promptly administered. If a post -accident test Is not administered within eight hours following the accident, the operator shall cease attempts to administer an alcohol test and shall state In The record the reasons for not administering the test [§199226(aX2)], 62 J.03.a. Verify that decisions to test are based on, specific, contemporaneous, arliculable observatims concerning the appearance, behavior, speech, of body odors of the employee. The required observations shall be made by a supervisor who is trained in detecting the symptoms of alcohol misuse 1§199,225(b)(2)], 63 J. 03.b. Verify that a covered employee Is dInscled by the operator to undergo reasonable suspiclen lasting for alcohol only while the employee is performing covered functions; just before the employee Is to perform covered functions, or just after the employee has ceased performing covered functions. 1§1 99.225(b)(3)1. 64 J.03.c.'Verify that if a reasonable suspicion tat is required and is not administered within 2 hours following the determination under § 199225(b)(2), the operator shall prepare and maintain on file a record stating ft reasons the test was not promptly administered, If a test Is not administered within 8 hours, the operator shalt cease attempts to administer an alcohol tee and shall state In the record the reasons for not administering the test [§199.225(b)(4)(1)]. 65 J.04m. Verify that a covered employee that engages In conduct prohibited by §§199,215 through 199.223 does not return to duty for a covered function until the employee. 1) Completes a SAP, evaluation, referral, and educalkinttrealment process 1§40.2"a), §40289(b), §199.235, and § 1 99. 243(b)); and, 2) After completion of the SAP process above, undergoes a return -to -duly alcohol test with a result indicating an alcohol concentration of lass then 0.02 j§40,305(a), § I 991.225(c), and § 199, 243(c)]. 66 J.05.s. Verify that the SAP establishes a written follow-up testing plan for a covered employee that engages in conduct prohibited by §§199.216 through 199223 and seeks to return to the performance of covered function [§40.307(a)]. 67 J,05-b. Verify that follow-up tasting is performed on an unannounced basis, at a frequency established by the SAP, for a period of not more than 60 months. At least six tests must be conducted within the Arst 12 months fbilcyring the covered amployee!s return to duty 1§40.307, §40„ 309, § 199 225(d) and § 1 K 243(c)(2)(II)], So K.04 .s, Verify that any Evidential Brealh Testing Device (EBT) or Alcohol Soreeni ng Device (ASO) used for DOT required alcohol lesting is approved by the National Highway Traffic Safety Administration (NHTSA) and placed on a Conforming Products List (CPQ [§40.229 and §40.231] eg K-01.b. Verify that external calibration checks are performed at the intervals specified In the manufacturer's instructions for any EBT used for DOT required alcohol confirmation testing [§40.231 and §40.2331, 70 P.M.& Does the operators plan specify training for BATS and STTs that is in compliance with §40.213 and does the documentation certify that all requirements are met [§40.213(g)] J. RANCK ELECTRIC, INC. PHMSA DRUGWCOHOL PLAN :-- NATIONAL COMPLIANCIF MANAGEMENT SERVICE, INC, (NGMS) - 2010 43 71 P.01,1b, Doe's the plan specify that a supervisor shall not serve as the BAT or STT if that supervisor makes the reasonable cause determination 1§40.211(c)and §199.2251b)(2)). 72 P.02.a Does the alcohol testing site comply with the applicable physical and security requirements of 640.221 and §40223? 73 P.02.b. Does the plan specify that only EBTs and ASD9 listed on the NHTSA CPL will be used for DOT alcohol testing [§40.229]? Also, does the plan specify that an EBT must be used for conducting the confirmation tests [§40.231(a)]? 74 P.02.c. Does the operator follow the Quality Assurance Plan (QAP) for the EBT that is used [§40.233(c)(1)]? If this service Is contracted out does the operator ensure that the QAP is being followed [§40.233(c)]? 75 P.02.d. Does the plan specify that the operator or Its agents shall comply with the QAP and manufacturer's Instructions and does the operator follow the OAP for the ASD that Is used (§40.235 and §40.235(c)]? 76 P.03.a. Does the plan prescribe that only the DOT -approved Alcohol Testing Form (ATF) shall be utilized [§40.225(a)]? 77 P.03.b. Does the plan specify that the employee shall provide a positive identification through use of photo ID or by employer representative [§40.241 (o)]? 78 P.03.a Does the plan indicate that the BAT or STT shall explain the testing process to the employee [§40.241(e)]? 79 P.03.d. Does the plan contain specific instructions for conducting alcohol screening tests in compliance with §40.241 and §40.243 requirements? 80 P.03.9. Does the plan contain specific instructions for conducting alcohol screening tests using a saliva ASD In compliance with §40.245 requirements? 81 P.031 Does the plan specfy actions that are taken after receipt of alcohol screening test results that are in compliance with §40.247? 82 P.04.a. Does the plan provide guidance for the actions a new BAT must complete to conduct a confirmation test in compliance with §40.251(b)? 83 P.04.b. Does the plan specify procedures to be followed In conducting a confimration test that are in compliance with §40.253 and §40.255? 84 P.05.a. Does the plan address the situations for which the employee is considered to have refused to take an alcohol test [§40.261(a)(1) to (7)]? 85 P.05.b. Does the plan specify procedures oonceming an employee's Inability to provide an adequate amount of saliva for testing and instructions for requiring the employee to attempt again to provide adequate amount of saliva for testing [§40.263]? 86 P.OS.c. Does the plan specify procedures concerning an employee's inability to provide an adequate amount of breath for testing In compliance with §40.285? 87 P.05.d. Does the plan specify under what conditions that an alcohol test shall be cancelled [§40.267 and §40.269]? 88 P.05.9. Does the plan specify procedures concerning the potential inability to complete an alcohol test and trying to successfully complete the test [§40.271]? 89 8.01.a. Substance Abuse Professionals (SAP) meet the applicable qualification requirements of Part 40 (§40.81) and Part 199. 90 H.02.b. Verify, that the Alcohol Misuse Prevention Program assures that each covered employee who has engaged in conduct prohibited by §§199.215 through 199.223 shall be advised of the resources available to the covered employee in evaluating and resolving problems associated with the misuse of alcohol. This Includes the names, addresses, and telephone numbers of substance abuse professionals and counseling and treatment programs [§40.286(b) and §199.243(a)] 91 G.01.b. Verify that education under the EAP includes at least the following elements: display and distribution of informational material; display and distribution of a community service hot-line telephone number for employee assistance; and display and distribution of the employers policy regarding the use of prohibited drugs [§199.113(b)]. 92 H.02.d. Verify that the Alcohol Misuse Prevention Program assures for providing educational materials that explain alcohol misuse requirements and the operator's policies and procedures with respect to meeting those requirements [§199.239(a)]. The operator shall ensure that a copy of these materials is distributed to each covered employee prior to start of alcohol testing under this subpart, and to each person subsequently hired for or transferred to a covered position [§199.239(a)(1)]. Each operator shall provide written notice to representatives of employee organizations of the availability of this information [§199.239(a)(2)]. J. RANCK ELECTRIC, INC. PHMSA DRUG/ALCOHOL PLAN NATIONAL COMPLIANCE. MANAGEMENT SERVICE, INC_ (NCN115) - 2WO 44 93 G.01.s. Verify that an EAP Is provided for its employees and supervisory personnel who will determine whether an employes must be drug tested teased on reasonable cause. Each EAP must include education and training on drug use (see Prot000ls G.01.b. and G.01.c.) [§199. 1 13(a)]. 94 G.01.o, Verify that training under the EAP for supervisory penaonnol who will determine whether an employee must be drug tested based on reasonable cause must Include one 60-minute period of training on Iha specific, contemporaneous physical, behavioral, and performance indicators of probable drug use [§199.113(c)]. 96 L01.b. Verify that supervisors designated to determine whether reasonable suspicion axis% to require a covered employee to undergo alcohol testing under §199.225(b) receive at least 60 minutes of training on the physical„ behavioral, speech,, and performance Indicators of probable stoohol misuse, [§199.241]> 96 A.01.c. If an employer contracts drug testing, education and training, [§199,116]. there is a process In place and implemented to ensure compliance with Part 199 and Part 40. The contractor must allow access to property and records by the operator, the Administrator, and if the operator is subject to the jurisdiction of a state agency, a representative of the state agency for the purpose of monitoring the operator's compliance [§199.115(b)]. 97 H.01.c. If an employer contracts alcohol testing, education and training [§199.245], there is a process in place and implemented to ensure compliance with Part 199 and Part 40. The contractor must allow access to property and records by the operator, the Administrator, any DOT agency with regulatory authority over the operator or covered employee, and, if the operator is subject to the jurisdiction of a state agency, a representative of the state agency for the purposes of monitoring the operator's compliance with the requirements of Part 199 and Part 40 [§199.245(c)]. 98 1..01.a. Verify that the following records are retained as required by Part 40 and Part 199 and that the records are maintained in a secure location with controlled access [§40.333(c) and §199.227(a)]. 5 years: Records of alcohol test results indicating an alcohol concentration of 0.02 or greater [§40.333(a)(1) and §199.227(b)(1)]; Documentation of refusals to take required alcohol tests 1§40.333(a)(1) and §199.227(b)(f)]; SAP reports [§40.333(a)(1) and §199.227(b)(1)]; All follow-up tests and schedules for follow-up tests [§40.333(a)(1)]; MIS annual report data [§199.227(b)(1)]; and, Calibration Documentation [§199.227(b)(1)]. 3 years: Intonation obtained from previous employers under §40.25 concerning alcohol test results of employees [§40.333(a)(2)]. 2 years: Records of the inspection, maintenance, and calibration of EBTs [§40.333(aX3)]. 90 M.02.a. Verify that upon written request from an employee, records of drug and alcohol use, testing results, and rehabilitation are provided to the employee [§199.117(b) and §199.231(b)]. 100 F.01.s. Verify that records are retained as required by Part 40 and Part 199 and that the records are maintained in a location with controlled access [§40.333(c)] 101 U.01jL Verify If this operator has more than 50 covered employees and submits an annual MIS report in accordance with the form and instruction requirements of §40.26 and Appendix H to Part 40, not later than March 15 of each year for the prior calendar year (January 1 through December 31) [§40.26, §199.119(a) and §199.229(a)). Beginning with the March 15, 2010 MIS submission date, also verify if this operator identifies all contractors who performed covered functions, as defined under § 199.3, for this operator in a given calendar year; and, If required by either mandated annual or PHMSA written request, is or has submitted an MIS report for each of these contractors? 102 M.01.b. Verify If this operator has 50 or lass covered employees and has either a compilation of data or statistical information regarding drug and alcohol testing which, upon written request, could have been used to submit a MIS report in accordance with the form and instruction requirements of §40.26 and Appendix H to Part 40, not later than March 15 of each year for the prior calendar year (January 1 through December 31) [§40.26, §199.119(s) and §199.229(a)]. Beginning with the March 15, 2010 MIS submission date, verify that this operator Identifies all contractors who performed covered functions, as defined under § 199.3, for this operator and received a compilation of data or statistical Information from these contractors which, upon written request, could be used for submitting an MIS report for each of these contractors. 103 M.01.c. If a service agent (e.g., ConsortiumIThird Party Administrator) prepares the MIS report on behalf of an operator, verify that each report is certified by the operator's anti -drug manager/alcohol misuse prevention manager or designated representative for accuracy and completeness [§199.119(f) and §199.229(d)]. J. RANCK ELECTRIC, INC. PHMSA DRUGIALCOHOL PLAN NATIONAL COMPLIANCE MANAGEMENT SERVICE, INC. (NC'tJ!5) -- 2010 45 G NCINNA ri Charles A. Heider, AFSB Senior R4onzil Director Surety Vidd I 'F I I I 1.1 Ir 1 , ' I I i f I , 'i fill , , " ; t I r I ( , , , ( , ) [ -"� f � I- I ;, II', w f � ( i' : j ! r l I ) ( I i1 ' 1 j ) r i f IYj III t 11: I11 �y irj f l, rJ I `) 'i r f i, j 1 f, W I I f I I i " f I � � ;f (1 1, , 11 f 1 11 lwjioiij' UMHIJHI�' it has been the privilege of The Cincinnati Insurance Company to provide surety bonds 011, behalf of J, Ranck Electric, Inc. since 2006, In our opinion, J, Rarick FI-Jectric, Inc. remains properly financed, well equipped and capably managed. At the present time, The Cincinnati Insurance Company provides a million single projectl$70 million aggregate surety Pigratri to J. Ranck Electric, Inc. ol" which over $30 111illion I) is available, As always,'I'lle Cillcilinati 11'stRIM"ce ('01 , ' pt 11 I y reserstes the right to perf'(.'n-in, normal underwriting at the time of any bond request, inClUding, without fin-litatiori, prior review and apl)MV31 Of MCVallt contract documents, bond fornis, and pr(tiject financing, We assume i10 liability to you or your affiliates if ror any reas(,)n we do not execute such bonds. The Cincinnati Insurance Company is listed on the US, Treasury Department's Listing of Approved Sureties (Department Circular 570) and is rated A+ (Superior) by AM Best Company. Should you have any questions regarding the above, feel free to call me at 616-884-0092. Very'f'ruly Yours, Charles A. Heider, AFSB Senior Regional Director -Surety Wfflflm,' Ad(J i! 1-,, 92 N1, i n 1, c "',J F -0-1') 6 1A C',,,KJqU,3r t (�' rs' 'f/ j f ^ 1:' �r I I I 'W 8 U, k uA�) Q 3 C ", � 1 „ , 'Z' k, ,"w'0 F, Y'C al 8 0 8 0= C r. 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