HomeMy WebLinkAboutOpen Market Contract - Cornerstone Stewards Inc - WWTP Raw Sewage Pump No 2 Rehabilitation1316 COUNTY —CITY BUILDING
227 W. JEFFERSON BOULEVARD
SO[ ITH BEND. INDIANA 46601-1 830
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CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR
BOARD OF PUBLIC WORKS
December 20, 2018
Daniel Mason
Cornerstone Stewards, Inc.
5720 Huguenard Road
Fort Wayne, IN 46818
RE: Open Market Contract
Dear Mr. Mason:
PHONE 574/235-9251
FAx 574/235-9171
The Board of Public Works, at its meeting held on December 20, 2018, approved the above
referenced contract for the Wastewater Treatment Plant Raw Sewage Pump No. 2 Rehabilitation in
the amount of $370,000.
Please forward the following documents in one submittal by January 3 2019 to my attention for
Board of Public Works approval:
1) One (1) original of the Public Works Contract (enclosed)
2) Labor & Material Payment Bond
3) Performance Bond (125% of Bid Amount)
4) Certificate of Insurance naming the City of South Bend as an additional insured
5) Item #4 for all subcontractors you use
If you have any further questions regarding this matter, please call this office at (574) 235-9251..
Sincerely,
Linda M. Martin, Clerk
Enclosure
GARY A. GILOT SUZANNA M. FRITZBERG ELIZABETH A. MARADIK JAMES A. MUELLER THERESE J. DORAU
INTER -OFFICE MEMORANDUM
DEPARTMENT OF PUBLIC WORKS
DIVISION OF ENVIRONMENTAL SERVICES
TO: Members of the Board of Public Works
Eric Horvath, Director of Public Works
Clara McDaniels, Assistant City Attorney Public Works
Linda M. Martin, Clerk
FROM: Al Greek, Director of Utilities
Jacob M. Klosinski, P.E., Assistant City Engineer
SUBJECT: Wastewater Treatment Plant Raw Sewage Pump No. 2 - Rehabilitation
Award Recommendation
DATE: December 12, 2018
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On December 12„ 2018, the Division of Utilities received solicited open market bids from three
contractors. The Division of Utilities and Division of Engineering reviewed the documents and finds
the information correct and complete for all contractors.
The responsive quotes(s) ranked as follows based on price:
.._.............._��.................................. _......................._.....��._.....�..�.�.�.................66
Bidder Bid Price
... _� Total
1. Cornerstone Stewards, Inc. (Fort Wayne, Indiana) $370,000.00
.................................................. ... .m-m ...-
2. HRP Construction, Inc. South Bend, Indiana ._._ _ $432,00 ( ) 0.00
3. Thieneman C _...�......
construction, Inc (Westfield, Indiana) $450,000.00
The Division of Utilities and Division of Engineering recommend the award of the contract for
Wastewater Treatment Plant Raw Sewage Pump No. 2 Rehabilitation to the lowest,
responsive, responsible bidder, Cornerstone Stewards Inc. Fort Wayne, Indiana) at the total
quotation price of 370 000.00 lump sum.
The Division of Utilities will fund the project with funds from the 2018 Sewage Works Capital,
Wastewater Treatment and Disposal E ui ment Capital Account 642-0630-415-43-66 .
For questions regarding the above recommendation or the subject project, contact Al Greek
(Ext. 4210) at the Division of Utilities or Jacob M. Klosinski (Ext. 9496) at the Division of
Engineering.
BOARD OF PUBLIC WORKS
CITY OF SOUTH BEND INDIANA.
PUBLIC WORKS CONTRACT
THIS AGREEMENT, made and entered into this 20th day of December, 2018, by and between,
Cornerstone Stewards, Inc., 5720 Huguenard Road, Fort Wayne, IN 46818, HEREINAFTER
called the "Contractor", and the Board of Public Works herein called the "Board".
WITNESSETH: That the Contractor covenants and agrees to make the following improvement,
as fully set out in the Notice to Bidders, Standard Specification, Special Provisions, Plans, and Bid
Proposal, all of which are set forth as a part of this Contract, for:
PROJECT NO.: 118-020
DESCRIPTION; WWTP RAW SEWAGE PUMP NO. 2 REHABILITATION
COMPLETION SEE SPECIFICATIONS
DATE:
AMOUNT: $370,000
FUNDING: SEWAGE WORKS CAPITAL/WASTEWATER/TREATMENT
AND DISPOSAL EQUIPMENT
The Contractor further agrees to notify the Engineer when this improvement is completed. This
notification shall be in the form of a Completion Affidavit, signed by the Contractor. Upon final
acceptance of the improvement by the Engineer, the Contractors final estimate will be presented
to the Board for final Payment with one (1) copy of the Completion Affidavit and one (1) copy of
a Waiver of Lien.
BOARD OF PUBLICW
Suzanna
Ther6se J. DoOdu. M"ember
El.i beth. A Mara�dilc, Member
._. Member
711
�.`: .�_a.._......
test, Linda M. 4artin,
Clerk
CORNERSTONE STEWARDS, INC.
Signature
CERTIFICATION (To be completed if Contractor is a Corporation)
I, . ................................... , certify that I am Secretary of the Corporation named as
Contractor herein; that who signed this Agreement on behalf of the Contractor
was then�m — of said Corporation; that said agreement was duly signed for and in
behalf of said Corporation by authority of its governing body, and is within the scope of its
corporate powers.
Secretary Corporate Seal
-
CITY OF SOUTH BEND, INDIANA ( "`
CONTRACTOR'S BID FOR PUBLIC WORK 1865
Project Name Wastewater Treatment Plant Raw Sewage Pump No. 2 Rehabilitation
Project No. 118-020
For Bids Due December 12, 2018
PART
(Must be completed for all bids. Please type or print)
Date: 1; „ tA Bidder (Firm): �,.. c E? � c
Address: „ � t �".6 4� R tie OO"A
City/State/Zip: � = l w^t r -' ( Telephone Number: i3 7—70
Agent of Bidder (if Applicable;): !fir°
Pursuant to notices given, the undersigned offers to furnish labor and/or material necessary to complete the
public works project of:
_ Nm; , 2h
the City ofSouth Bend, Indiana, in accordance with plans and specifications prepared by:
zv,YY
and dated F _r 2-C) for the sum of (enter the Total Bid as shown on the Proposal)
(Enter sum of Total Base Bid 6hown on Proposal) (Numerical)
The undersigned further agrees to furnish a bond or certified check with this bid for an amount specified in
the notice of the letting. If alternative bids apply, the undersigned submits a proposal for each in accordance
with the notice. Any addendums attached will be specifically referenced at the applicable page.
If additional units of material included in the contract are needed, the cost of units must be the same as that
shown in the original contract if accepted by the Ci�yof South Bend. If the bid is to be awarded on a unit
basis, the itemization of the units shall be showLKa e,parat ,a achment
BYE''.,
(Signature)
(Printed Name of Person Signing)
ACCEPTANCE
The above bid is accepted this -�U
Subject to the following conditions:
ZR�i OF PUBLIC W I
l t,
Gary A. Gi o , President
zab h A. Mar' ,, ber
,la e�all Member
L-p, vr,.ti ®.dud(;
day of 20 ly
-Su z nna M. _ zb ei g, Mem er
Therese J. Dorau. Me er
..
4Atst: Linda M. Martin, Clerk '
Version 7/20/2018 Contractor's Bid for Public Works - 2
BID/PROPOSAL
CITY OF SOUTH BEND
Project Name: Wastewater Treatment Plant Raw Sewage Pump No. 2 Rehabilitation
Project Number: 118-020
For Bids Due: December 12, 2018
Contractor Name:
BASE BID
Item
No.
Description
Quantity Unit
Unit Price
Total Amount
1
General Construction
1 LS
BASE BID TOTAL -7C,, 066)I—D,
The City of South Bend will award the subject project based on a review of all Base Bids to the lowest,
responsive, responsible bidder. The City of South Bend reserves the right to reject or disqualify any or all
bidders that do not submit a complete bid package
Bidder (Firm): y-v1-R-nP-- S ,s, c
Address: c°w''� .....r
City/State/Zip:
w 4
7 Telephone Number. / ( - �3
r,J c g
B
' v-t 6,� Y.Se (Signature)
1-00-n « 1 91. McLsOV\, -P\f\es
(Printed Name of Person Signing)
v C r A(-e
V-,
Version 7/20/2018 Contractor's Bid for Public Works - 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
SS:
Nee_ -, COUNTY )
The undersigned Contractor, being duly sworn upon his/her/its oath, affirms under the penalties of perjury
that:
1. Contractor has not, nor has any other member, representative, or agent of the firm, company,
corporation or partnership represented by him, entered into any combination, collusion or agreement with
any person relative to the price to be bid by anyone at such letting nor to prevent any person from bidding
nor to induce anyone to refrain from bidding, and that this bid is made without reference to any other bid and
without any agreement, understanding or combination with any other person in reference to such bidding.
Contractor further says that no person or persons, firms, or corporation has, have or will receive directly or
indirectly, any rebate, fee, gift, commission or thing of value on account of such sale; and
2. Contractor certifies by submission of this proposal that neither contractor nor any of its principals
are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from
participation in this transaction by any Federal department or agency; and
3. Contractor has not, nor has any successor to, nor an affiliate of, Contractor, engaged in
investment activities in Iran.
a. For purposes of this Certification, "Iran" means the government of Iran and any agency
or instrumentality of Iran, or as otherwise defined at Ind. Code § 5-22-16.5-5, as
amended from time -to -time.
b. As provided by Ind. Code § 5-22-16.5-8, as amended from time -to -time, a Contractor
is engaged in investment activities in Iran if either:
i. Contractor, its successor or its affiliate, provides goods or services of twenty
million dollars ($20,000,000) or more in value in the energy sector of Iran;
or
ii. Contractor, its successor or its affiliate, is a financial institution that extends
twenty million dollars ($20,000,000) or more in credit to another person for
forty-five (45) days or more, if that person will (i) use the credit to provides
goods and services in the energy sector in Iran; and (ii) at the time the
financial institution extends credit, is a person identified on list published by
the Indiana Department of Administration.
Version 7/20/2018 Contractor's Bid for Public Works - 4
4. Contractor does not knowingly employ or contract with an unauthorized alien, nor retain any
employee or contract with a person that the Contractor subsequently learns is an unauthorized alien.
Contractor agrees that he/she/it shall enroll in and verify the work eligibility status of all of Contractor's
newly hired employees through the E-Verify Program as defined by I.C. 22-5-1.7-3. Contractor's
documentation of enrollment and participation in the E-Verify Program is included and attached as part of
this bid/quote; and
5. Contractor shall require his/her/its subcontractors performing work under this public contract to
certify that the subcontractors do not knowingly employ or contract with an unauthorized alien, nor retain
any employee or contract with a person that the subcontractor subsequently learns is an unauthorized alien,
and that the subcontractor has enrolled in and is participating in the E-Verify Program. The Contractor agrees
to maintain this certification throughout the term of the contract with the City of South Bend, and understands
that the City may terminate the contract for default if the Contractor fails to cure a breach of this provision
no later than thirty (30) days after being notified by the City.
6. Persons, partnerships, corporations, associations, or joint venturers awarded a contract by the City
of South Bend through its agencies, boards, or commissions shall not discriminate against any employee or
applicant for employment in the performance of a City contract with respect to hire, tenure, terms, conditions,
or privileges of employment, or any matter directly or indirectly related to employment because of race, sex,
religion, color, national origin, ancestry, age, gender expression, gender identity, sexual orientation or
disability that does not affect that person's ability to perform the work.
In awarding contracts for the purchase of work, labor, services, supplies, equipment, materials, or any
combination of the foregoing including, but not limited to, public works contracts awarded under public
bidding laws or other contracts in which public bids are not required by law, the City, its agencies, boards,
or commissions may consider the Contractor's good faith efforts to obtain participation by those Contractors
certified by the State of Indiana as a Minority Business ("MBE") or as a Women's Business Enterprise
("WBE") as a factor in determining the lowest, responsible, responsive bidder.
In no event shall persons or entities seeking the award of a City contract be required to award a subcontract
to an MBE/WBE; however, it may not unlawfully discriminate against said WBE/MBE. A finding of a
discriminatory practice by the City's MBE/WBE Utilization Board shall prohibit that person or entity from
being awarded a City contract for a period of one (1) year from the date of such determination, and such
determination may also be grounds for terminating the contact for which the discriminatory practice or
noncompliance pertains.
7. The undersigned contractor agrees that the following nondiscrimination commitment shall be made
a part of any contract which it may henceforth enter into with the City of South Bend, Indiana or any of its
agencies, boards or commissions.
Contractor agrees not to discriminate against or intimidate any employee or applicant for employment in the
performance of this contract with privileges of employment, or any matter directly or indirectly related to
employment, because of race, religion, color, sex, gender expression, gender identity, sexual orientation,
handicap, national origin or ancestry. Breach of this provision may be regarded as material breach of
contract.
1, the undersigned bidder or agent as contractor on a public works project, understand my statutory
obligations to the use of steel products or foundry products made in the United States (I.C. 5-16-8-1). 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 Works - 5
may result in forfeiture of contractual payments.
Um
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 day of',
4eA"1C
ContN'actor/Bidder .�rm r
+ wwWWW
Signature of Contractor/Bidder or Its Agent
Printed Name and Title
Subscribed and sworn to before me this V d al'
My Commission Expires v V,� , yl "...
Notary ubl is Ap" f ova e
County of Residence
Version 7/20/2018 Contractor's Bid for Public Works - 6
FJCID C
UIGP' EE4� to.., CW,-iS(.I
.0UL 't", i C-l"
PENAL SUM FORM
Any singular reference to Bidder, Surety, Owner or other party shall be considered plural where applicable.
BIDDER (Name and Address)..
Cornerstone Stewards, Inc.
5720 Huguenard Road
Fort Wayne, IN 46818
SURETY (Name, and Address of Principal Place of Business): Western Surety Company: South Dakota Corporation
151 N. Franklin Street, 17th Floor
Chicago, IL 60606
OWNER (Name and Address):
City of South Bend, Indiana
Department of Public Works
County -City Building Room 1316
227 West Jefferson Street
South Bend, IN 46601
BID
Bid Due Date: 12/ 12/2018
Description:
WWTP Raw Sewage Pump No. 2 Rehabilitation (31 l3 Riverside Drive, South Bend, Indiana 46628)
BOND
Bond Number:
natP. December 12, 2018
Penal sum Five Percent of Accompan in Bid $ (5%)
(Words) (Figures)
Surety and Bidder, intending to be legally bound hereby, subject to the terms set forth below, do each cause
this Bid Bond to be duly executed by an authorized officer, agent, or representative,
BIDDER SURETY
Cornerstone Stewards, Inc, (Seal) Western Surety Company (Seal)
Bidder's Name apl, Corporate Seal Surety's Name and Corporate Seal
1 � 4 ) a u
By:
Signature Signature (Attach Power of Attorney)
MCL5 0 Laura L. Divemrm
Print Name Print Name
Attorney -in -Fact
Title Tit(e
Attesta I�M Attest:
"
Signature Signatur da Karst
Title �� , Title
a t- �C.1.e.�tit..�. ��.... � � CSA
Note; Addresses are to be used for giving any rLyquired notice. Provide execution by any additional parties, such
as joint venturers, if necessary,
EJCDC® C-430, Bid Bond (Penal Sum Form). Published 2013,
Prepared by the Engineers Joint Contract Documents Committee,
Page 00 43 13-1 of 2
L.rC D
PENAL SUM FORM
1. Bidder and Surety, jointly and severally, bind themselves, their heirs, executors, administrators, successors, and
assigns to pay to Owner upon default of Bidder the penal sum set forth on the face of this Bond. Payment of the penal
sum is the extent of Bidder's and Surety's liability, Recovery of such penal sum under the terms of this Bond shall be
Owner's sole and exclusive remedy upon default of Bidder.
2. Default of Bidder shall occur upon the failure of Bidder to deliver within the time required by the Bidding
Documents (or any extension thereof agreed to in writing by Owner) the executed Agreement required by the Bidding
Documents and any performance and payment bonds required by the Bidding Documents.
3. This obligation shall be null and void if;
3.1 Owner accepts Bidder's Bid and Bidder delivers within the time required by the Bidding Documents (or any
extension thereof agreed to in writing by Owner) the executed Agreement required by the Bidding
Documents and any performance and payment bonds required by the Bidding Documents, or
3.2 All Bids are rejected by Owner, or
3.3 Owner fails to issue a Notice of Award to Bidder within the time specified in the Bidding Documents (or any
extension thereof agreed to in writing by Bidder and, if applicable, consented to by Surety when required by
Paragraph 5 hereof).
4. Payment under this Bond will be due and payable upon default of Bidder and within 30 calendar days after receipt
by Bidder and Surety of written notice of default from Owner, which notice will be given with reasonable promptness,
identifying this Bond and the Project and including a statement of the amount due.
5. Surety waives notice of any and all defenses based on or arising out of any time extension to issue Notice of Award
agreed to in writing by Owner and Bidder, provided that the total time for issuing Notice of Award including extensions
shall not In the aggregate exceed 120 days from the Bid due date without Surety's written consent.
6. No suit or action shall be commenced under this Bond prior to 30 calendar days after the notice of default required
in Paragraph 4 above is received by Bidder and Surety and in no case later than one year after the Bid due date.
7. Any suit or action underthis Bond shall be commenced only in a court of competent jurisdiction located in the state
in which the Project is located.
8. Notices required hereunder shall be in writing and sent to Bidder and Surety at their respective addresses shown
on the face of this Bond. Such notices may be sent by personal delivery, commercial courier, or by United States
Registered or Certified Mail, return receipt requested, postage pre -paid, and shall be deemed to be effective upon
receipt by the party concerned.
9. Surety shall cause to be attached to this Bond a current and effective Power of Attorney evidencing the authority
of the officer, agent, or representative who executed this Bond on behalf of Surety to execute, seal, and deliver such
Bond and bind the Surety thereby.
10. This Bond is intended to conform to all applicable statutory requirements. Any applicable requirement of any
applicable statute that has been omitted from this Bond shall be deemed to be included herein as if set forth at length.
If any provision of this Bond conflicts with any applicable statute, then the provision of said statute shall govern and
the remainder of this Bond that is not In conflict therewith shall continue in full force and effect.
11. The term "Bid" as used herein includes a Bid, offer, or proposal as applicable.
EJCDC® C-430, Bid Bond (Penal Sum Form). Published 2013.
Prepared by the Engineers Joint Contract Documents Committee,
Page 00 43 13-2 of 2
Western Surety Company
Know All Men By These Presents, That WESTERN SURETY COMPANY, a South Dakota corporation, is a duly organized and existing corporation
having its principal office in the City of Sioux Falls, and State of South Dakota, and that it does by virtue of the signature and seal herein affixed hereby
make, constitute and appoint
Thomas J Mc Govern, Harold E Everett, Elaine K Miller, J Kevin Hughes, Thomas J Van
Dyck, Jada M Karst, Melinda S Jagger, Tracie M Mc Bride, Connie J Messer, Laura L Diver,
Individually
of Fort Wayne, IN, its true and lawful Attorneys) -in -Fact with full power and authority hereby conferred to sign, seal and execute for and on its behalf
bonds, undertakings and other obligatory instruments of similar nature
- In Unlimited Amounts -
and to bind it thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of the corporation and all the acts of said
Attorney, pursuant to the authority hereby given, are hereby ratified and confirmed.
This Power of Attorney is made and executed pursuant to and by authority of the By -Law printed on the reverse hereof, duly adopted, as indicated, by
the shareholders of the corporation.
In Witness Whereof, WESTERN SURETY COMPANY has caused these presents to be signed by its Vice President and its corporate seal to be
hereto affixed on this 9th day of August, 2018.
NNXMM WESTERN SURETY COMPANY
t Y
x
4at.w. ' d T. Br.flat, Vice President
State of South Dakota I
s:.y
County of Minnehaha
On this 9th day of August, 2018, before me personalty came Paul T. Bruflat, to me known, who, being by me duly sworn, did depose and say: that he
resides in the City of Sioux Falls, State of South Dakota; that he is the Vice President of WESTERN SURETY COMPANY described in and which executed
the above instrument; that he knows the seal of said corporation; that the seal affixed to the said instrument is such corporate seat; that it was so affixed
pursuant to authority given by the Board of Directors of said corporation and that he signed his name thereto pursuant to like authority, and acknowledges
same to be the act and deed of said corporation.
My commission expires J. MOHR
........ ... ........ ........,_. NV7FVCdiM1"riU'W,C9� •-��II �I
June 23, 2021 SOUIIIIIAXr 7A SFAL
.......................... __............ J. Mohr, Notary Public
CERTIFICATE
I, L. Nelson, Assistant Secretary of WESTERN SURETY COMPANY do hereby certify that the Power of Attorney hereinabove set forth is still in
force, and further certify that the By -Law of the corporation printed on the reverse hereof is still in force. In testimony whereof I have hereunto subscribed
my prune and affixed the seal of the said corporation this ]_ __ day of r __,
Yr. WESTERN SURETY COMPANY
A
L. Nel�^ton, Assistant Secretary
Form F4280-7-2012
Go to wrwwwwrw cnasurety oln > Owner / Obligee Services > Validate Bond Coverage, if you want to verify bond authenticity.
CITY OF SOUTH BEND, INDIANA
CONTRACTOR'S BID FOR PUBLIC WORK
CHECKLIST FOR BIDDERS
Project Name Wastewater Treatment Plant Raw Sewage Pump No. 2 Rehabilitation
Project No. 118-020
For Bids Due December 12, 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
x Form [MWBE-2.1].
A Acknowledge Receipt of D 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
(� 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: � r.° .,, gym °�� "s 1v�c Date: Cq cy�
By Authorized Repr(
Signature:
Print Name & Title: \�, . c� t
Version 7/20/2018 Contractor's Bid for Public Works - 1
PART II (5e-e--
(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 (,Stv-
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 (Sp-p- a+1-ac, d)
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 Works - 3
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Section II Plan and Equipment Questionnaire:
1.) Purchase orders and shop drawings will begin upon award. Work will commence
upon approval and delivery of materials.
2.) Painting Subcontractors
Howard Painting, 1740 Spruce Street, Defiance, OH 43512
Odle, Inc., 2560 Kilgore Avenue, Muncie, IN 47307
Advance Painting & Sandblasting, Inc. 312 North 8th Street, Decatur, IN
46733
HVAC Subcontractors -
Precision Mechanical Contractors, 5720 Industrial Road, Fort Wayne, IN 46825
Electrical Subcontractors -
LA Electric, 902 Incentive Drive, Fort Wayne, IN 46825
Design Build Electrical Contracting, LLC, 7702 B Bluffton Road, Fort
Wayne, IN 46809
Bender Electric, Inc., 19636 Allegheny Street, Cassopolis, MI 49031
Service Electric, Inc. 4015 Meyer Road, Fort Wayne, IN 46806
Dirtwork/Excavation Subcontractors -
Land Construction, 11808 St. Road 205 E, LaOtto, IN 46763
Ironclad Excavating, 576 Geiger Drive Ste C, Roanoke, IN 46783
Concrete & Rebar
Weigand Construction, 7808 Honeywell Drive, Fort Wayne, IN 46825
3.) Belzona Painting Subcontractor No -bonds required.
4.) , Material Handler
5.) Yes
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CITY OF SOUTH BEND�r"��;
MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY�`
DEVELOPMENT PROGRAM ;,,
FORM MWBE-2.0 F,
EVIDENCE OF GOOD FAITH EFFORTS _ 4
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 MBE/WBE participation. It is the bidder's sole
responsibility to verify whether any listed minority or woman business meets the qualifications of a Minority
or Women's owned business as defined by the Indiana Department of Administration ("IDOA").
Project Number: 118-020
Date ;1 e.,iV v)(( i Z018
Project Name: Wastewater Treatment Plant Raw Sewage Pump No. 2 Rehabilitation
...
Bidder: `� Yak ..........
Contact Person: 00.-V t�e* Z _ j a 'Telephone: -(o O
Address: CS-1 to
City: r- W 1 State: �j . (A Zip:
Email: n °':,� VV\61 L) 'r
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 (http://www.in.gov/idoa).
ACTION (ADVERTISE/CONTACT): In order for your bid to be deemed responsive, the City of South
Bend requires that all perspective bidders complete no less than 2 of the following:
1. Attend all pre -bid meetings scheduled by the City to inform MBE/WBEs of contracting and
subcontracting opportunities.
2. Advertise in general circulation and/or trade association publications concerning subcontracting
opportunities, and allow MBE/WBEs reasonable time to respond.
3. Perform any and all necessary steps to provide written notice in a manner reasonably calculated
to inform MBE/WBEs of subcontracting opportunities and allowed sufficient time for them to
participate effectively.
4. Utilize pre-existing services of available community organizations, small and/or disadvantaged
business assistance offices and other organizations that provided assistance in the recruitment
and placement of MBEM/BE 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.
WIA
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 Works - 9
CITY OF SOUTH BEND '' "lei
MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITYi,
DEVELOPMENT PROGRAM;
FORM MWBE-2.1
MBEIWBE CONTACTED `
This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects
requiring contacted MBEIWBE to obtain Good Faith Efforts. It is the bidder's sole responsibility to verify
whether any listed minority or woman business meets the qualifications of a Minority or Women's owned
business.
Project Number:
118-020
PAGE I OF
MBEMIBE Participation Goal
Project Name: Wastewater Treatment Plant Raw Sewage Pump No. 2 Rehabilitation
Bidder:5, Au`
By:
(Signature)..t„c AiP� Sa %-� (Title) (Date)
MBE/WBE Firm hJ/ A
Owner or Contact at MBE/WBE Firm
Telephone:
Fax:
TYPE OF WORK SOLICITED FOR THIS PROJECT:
RESULTS OF CONTACT WITH THE MBE/WBE FIRM:
MBE/WBE Firm N /
Owner or Contact at MBE/WBE Firm
Telephone:
Fax:
TYPE OF WORK SOLICITED FOR THIS PROJECT:
RESULTS OF CONTACT WITH THE MBEMBE FIRM:
Email:
Email:
Version 7/20/2018 Contractor's Bid for Public Works - 10
IN
WRITTEN CONSENT TO RESOLUTIONS
OF THE BOARD OF DIRECTORS OF
CORNERSTONE STEWARDS, INC.
The undersigned, constituting the members of the Board of Directors of Cornerstone Stewards,
Inc., an Indiana corporation (hereinafter sometimes referred to as "Corporation"), pursuant to the
provisions of the Indiana Business Corporation Law and pursuant to the provisions of the Articles of
Incorporation and By -Laws of said Corporation, hereby consent(s) to and adopt(s) the following action
to be taken by the Corporation in lieu of an annual meeting of the
Board of Directors:
RESOLVED, that the following person or persons is/are hereby elected to the offices
of the Corporation set forth opposite their names, each to hold office until the next
annual meeting of the Board of Directors of the Corporation and until their
successors are duly elected and qualified.
Name
Daniel R. Mason
April M. Beber
Michael A. Hensley
Melissa R. Frisby
Cheryl L. Mason
Office
President
Vice -President
Vice -President
Secretary/Treasurer
Assistant Secretary/Treasurer
RESOLVED FURTHER, that all acts and things done by the officers and Directors
for and on behalf of this Corporation as shown by the files and records of this
Corporation since their election be, and the same hereby are, ratified, approved, and
confirmed in all respects.
Dated this 7th day of February, 2018
Daniel R asol"b
CERTIFICATE OF QUALIFICATION
to provide
CONSTRUCTION SERVICES
for
PUBLIC WORKS PROJECTS
to the
STATE OF INDIANA
This Certification Board, having duly considered application for qualification in terms of apparent experience and financial
resources; and under the applicable Indiana Code 4-13.6-4 and adopted rules of this Board hereby issues a
Certificate of Qualification to provide COIAStruction services to the State of Indiana for Public Works Projects to:
CORNERSTONE STEWARDS INC
5720 HUGUENARD RD
FORT WAYNE IN 46818
Phone 260-497-8701
Fax 260-497-8702
Company Official
DANIEL MASON
for the twenty-seven month period stated herein, unless revoked by this Board for cause,
and in the classifications of services stated below. This certificate supercedes any previous certificate.
1629.05 Sewage & Water Treatment Plant Construction
CERTIFICATION DATE 5/24/2018 EXPIRATION DATE 8/24/2020
THIS CERTIFICATE ISSUED BY THE S rA'T6 OF INDIANA, PIA.3LIC WORKS DIVISION CERTIFICATION BOARD,
402 WEST WAS➢-NNG r ON STREET, ROOM W467„ INI''AANAPOLIS, INDIANA 46204,
ALSO A $ ASTHE t1FAC IAL NOTICE OF EXPIRATION.
Tracy L. Cross, Ex et'ive, Secretary
Certification Board
dAPW PQ2 State Form 3983R Rev 07/06 �'Ill-tiAIK" �
1/r R —
State of Indiana
Office of the Secretary of State
CERTIFICATE OF EXISTENCE
To Whom These Presents Come, Greeting:
I, CONNIE LAWSON, Secretary of State of Indiana, do hereby certify that I am, by virtue of the laws of
the State of Indiana, the custodian of the corporate records and the proper official to execute this
certificate.
i further c:eirtlify that records of lhis'�,offuce disclose that
x"
'If N STONV
duly filed the requisite documents to commence business activities under the lags of the State of
Indiana on December 16, 2008, and was in existence or authorized to transact business in the State of
Indiana on December 10, 2018.
I further cer'tifiy this Dornestic For -Profit Corporation has filed its most recent report required by
Indiana law with,the Secretary of State, or is not yet'required to file'such report, and that no notice of
withdrawal, dissolution, or expiration has been"filed or taken lace. All fees, taxes, interest, and
penalties owed to Indiana by the domestic or foreign entity and collected by the Secretary of State
have been paid,
In WitnessWhereof, I have caused to be affixed my
signature and the seal of the State of Indiana, at the City
of Indianapolis, December 10, 2018
CONNIE LAWSON
SECRETARY OF STATE
2008121700212 / 2018814026
All certificates should be validated here: https://bsd.sos.in.gov/ValidateCertificate
Expires on December 31, 2018.
mason
engineering
& construction
cornerstone
stewards, inc
5720 Huguenard Road PH: (260) 497-8701
Fort Wayne, IN 46818 FX: (260) 497-8702
Equipment Installation and Repair
Install Owner Purchased Equipment
Bar Screens, Mechanical and Manual
Comminutors / Grinders
Grit Equipment
Pumps & Piping
Settling Equipment
Aeration Diffusers & Piping
Blowers
Chemical Feed Equipment
Ultraviolet Equipment
Sludge Pumps
Sludge Mixing
Digester Covers
Digester Gas Equipment
Belt Press
Conveyors
Concrete
New Structures
Repair of Deteriorated and Cracked Concrete
Chemical Grout Leak Repair
Mike Hensley: (260) 409-4842
Mike Harrigan: (260) 249-5615
Brad Johnson: (260) 450-8352
Dennis Norris: (260) 704-1482
Dan Mason: (260) 341-4764
Piping, Valves & Gates
Valve Replacement
Sluice & Slide Gates
Exposed and Buried Piping
Metals
Grating
Handrails
Structural
Lift Stations
Pump Replacements
Bypass Pumping
New Lift Station Installation
Design/ Build Solutions
New Installation
Rehab & Repair
Specialty Vacuum Services
Pocket Excavating
Confined Space Material Removal
CITY OF SOUTH BEND, INDIANA
CONTRACTOR'S IBID FOR PUBLIC WORK
RESPONSIBLE BIDDER CHECKLIST
Project Name Wastewater Treatment Plant Raw Sewage Pump No. 2 Rehabilitation
Project No. 118-020
For Bids Due December 12, 2018
Contractor Name:
The City seeks to enhance its ability to identify responsive and responsible bidders on all City public works
projects by institution of comprehensive submission requirements in compliance with State law. Quality
workmanship, efficient operation, safety, and timely completion of projects requires that all bidders meet
certain minimum requirements to be responsive and responsible bidders.
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 31 s' 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 General Conditions - 6
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 General Conditions - 7
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).
Statement on staffing capabilifies, 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.
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 General Conditions - 8
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) By checking this box, I hereby acknowledge that copies of all Applicable
apprenticeship certificates or standards for training programs applicable to the
work performed on the project may be requested at any time and shall be furnished
upon request.
(iv) By checking this box, I hereby acknowledge and ensure that I and all sub-
contractors, from whom I have accepted a bid and/or intend to hire to perform work
on the public work project, are properly licensed. Furthermore, I acknowledge my
understanding that it is my responsibility to ensure that all sub -contractors have
the necessary licenses to undertake the work called for in this bid. If a sub-
contractor loses their license at any point, it is the responsibility of that sub-
contractor to notify the City.
(b) Attachments:
(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).
List identifying all former business names.
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
X
am bidding on OR outlines how I intend to meet the staffing needs of the work.
(v)
Statement that individuals who will perform work on the public work project on my
behalf will be properly classified as an employee or as an independent contractor
under all applicable state and federal laws and local ordinances.
(vi) 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
x
organization.
(vii)
Copy of a written plan for employee drug testing that covers all of my employees
who will perform work on the public work project and meets or exceeds the
requirements set forth in IC 4-13-18-5 or IC 4-13-18-6.
(viii)
Evidence that I am utilizing a surety company which is on the Bureau of Fiscal
Service "Department of Treasury's Listing of Approved Sureties" as required in the
bid specifications or contract.
Version 7/20/2018 General Conditions - 9
(ix) Written statement of any federal, state or local tax liens or tax delinquencies owed
to any federal, state or local taxing body in the preceding three years.
(i) 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.
Date:
(Sign Here) Doly1 t' e—k R . � � n 1CLSlo yl
(Print Name Here)
Coy Y1eJS-tov�,e S--PWafzAS, 1✓ C.
(Name of Company)
(Address of Compa y)
;.,� ..
(City)
v . ALOW
(State)
(Iico 4:11_ S-10 1
(Telephone Number)
Version 7/20/2018 General Conditions - 10
2
mason
engineering
& construction
December 12, 2018
Attn: Jacob Klosinski
City of South Bend, Indiana
Division of Utilities
3113 Riverside Drive
South Bend, Indiana 46601
Re: Pre -Qualification Attachments
cornerstone
stewards, inc
II.b.i.) Indiana Secretary of State business verification: see attached certificates for both Mason
Engineering and Construction Inc. and Cornerstone Stewards Inc.
II.b.ii.) List identifying all former business names: Cornerstone Stewards and Mason Engineering and
Construction Inc. are sister companies or variable interest entities (VIE) that coordinate business together.
Mason Engineering and Construction was established in 2003 and Cornerstone Stewards Inc was
established in 2008.
II.b.iii.) Violations: Neither company have any violations.
II.b.iv.) Cornerstone Stewards Inc employs the management team and service crew workers (total
employees = 10) Mason Engineering and Construction Inc has 6 full time field workers and draws from
the Laborer and Carpenter unions for additional manpower as needed.
II.b.v.) Labor Classification: Individuals who will be performing work on this project will be Cornerstone
Stewards Inc employees and supplemented with Mason Engineering employees if required.
II.b.vi.) Mason Engineering and Construction participates in the union apprentice programs for Laborers
and Carpenters. (copy attached) Cornerstone Stewards Inc's apprenticeship program is not registered by
the US department of labor.
II.b.vii.) Cornerstone Stewards Inc drug policy is attached. Mason Engineering utilizes the union drug
policy attached.
�._ ... ............... ....... ._ ............_............. _....... __..m....
5720 Huguenard Rd, Fort Wayne, IN 46818 e-mail: dmasongmasonec.com
Phone: (260) 497-8701 Fax: (260) 497-8702
ire
mason
engineering
& construction
II.b.viii.) Evidence of surety company qualification is attached.
II.b.ix.) Neither company has any tax liens or tax delinquencies.
II.b.x.) See attached list of projects.
Sincerely,
Daniel R. Mason, P.E.
President
Mason Engineering and Construction, Inc.
Cornerstone Stewards, Inc.
5720 Huguenard Rd, Fort Wayne, IN 46818
Phone: (260) 497-8701
cornerstone
stewards, inc
e-mail: ason( asonec®co .
Fax: (260) 497-8702
w
State of Indiana
Office of the Secretary of State
CERTIFICATE OF EXISTENCE
To Whom These Presents Come, Greeting:
I, CONNIE LAWSON, Secretary of State of Indiana, do hereby certify that I am, by virtue of the laws of
the State of Indiana, the custodian of the corporate records and the proper official to execute this
certificate.
I further certify that records ofthAs+office disclose that
CORNERSTONE WWAIDS, INC.
duly filed the requisite documents to commence business activities under the laws of the State of
Indiana on December 16, 200, and was in existence or authorized to transact business in the State of
Indiana on December 10, 20J.B.
I further certifiy this Domestic For Profit Corporation has filed its most recent report required by
Indiana law with the Secretary of State, or is not y (required to file'such report, and that no notice of
withdrawal, dissolution, or expiration has been"fiied or taken,plae'e. All fees, taxes, interest, and
penalties owed to Indiana by the domestic or foreign entity and collected by the Secretary of State
have been paid.
In Witness Whereof, I have caused to be affixed my
signature and the seal of the State of Indiana, at the City
of Indianapolis, December 10, 2018
CONNIE LAWSON
SECRETARY OF STATE
2008121700212 / 2018814026
All certificates should be validated here: https://bsd.sos.in.gov/ValidateCertificate
Expires on December 31, 2018.
CERTIFICATE OF QUALIFICATION
to provide
CONSTRUCTION SERVICES
for
PUBLIC WORKS PROJECTS
to the
STATE OF INDIANA
This Certification Board, having duly considered application for qualification in terms of apparent experience and financial
resources; and under the applicable Indiana Code 4-13.6-4 and adopted rules of this Board, hereby issues a
Certificate of Qualification to provide construction services to the State of Indiana for Public Works Projects to:
CORNERSTONE STEWARDS INC
5720 HUGUENARD RD
FORT WAYNE IN 46818
Phone 260-497-8701
Fax 260-497-8702
Company Official
DANIEL MASON
for the twenty-seven month period stated herein, unless revoked by this Board for cause,
and in the classifications of services stated below, This certificate supercedes any previous certificate.
1629.05 Sewage & Water Treatment Plant Construction
CERTIFICATION DATE 5/24/2018 EXPIRATION DATE 8/24/2020
THIS CERTIFICATE ISSUE i`1 BY'11IF STKn OF INDI AMA PUBLIC 'WORKS DIVISION CERTIFICATION BOARD,
402 WEST WASHiNGTON ,STR lI"l', ROOM W467, INDIANAPOLIS, INDIANA 46204,
ALSO ACTS AS I I II O FICIAL NOTICE OF EXPIRATION.
,':fit
Tracy L. Cross, Ex 4 dt�ive � ---
Secretary
Certification Board
DAPW PQ2 State Form 3983R Rev 07/06
12/10/2018
ff,
(http://www.INBiz.IN.gov)
Business Search
Business Search Result
INBiz: Your one -stop source for your business.
Registered
Business ID
Business Name
Name
Entity Type
Principal
Agent Status
Type
Office Address
Name
2008121700212
5720
(/PublicBusinessSearch/BusinessInformation?
CORNERSTONE
LEGAL
Domestic
HUGUENARD
DANIEL R.
businessId=686492&businessType=Domestic%20For-
STEWARDS,
NAME
For -Profit
ROAD, FORT
Active
MASON
Profit%20Corporation&isSeries= False)
INC.
Corporation
WAYNE, IN,
46818, USA
Page 1 of 1, records 1 to 1 of 1
Return to Search
https://bsd.sos.in.gov/publicbusinesssearch 1/1
PENDING APPROVAL
CONNIE LAWSON
INDIANA SECRETARY OF STATE
12/10/2018 02:47 PM
BUSINESS ID 2008121700212
BUSINESS TYPE Domestic For -Profit Corporation
BUSINESS NAME CORNERSTONE STEWARDS, INC.
ENTITY CREATION DATE 12/16/2008
JURISDICTION OF FORMATION Indiana
PRINCIPAL OFFICE ADDRESS 5720 HUGUENARD ROAD, FORT WAYNE, IN, 46818, USA
YEARS 2018/2019
EFFECTIVE DATE 12/10/2018
EFFECTIVE TIME 2:47 PM
REGISTERED AGENT TYPE Individual
NAME DANIEL R. MASON
ADDRESS 5720 Huguenard Road, Fort Wayne, IN, 46818, USA
SERVICE OF PROCESS EMAIL dmason@masonec.com
I acknowledge that the Service of Process email provided above is the email address at which electronic service of process may be accepted and
is publicly viewable.
PENDING APPROVAL
CONNIE LAWSON
INDIANA SECRETARY OF STATE
12/10/2018 02:47 PM
TITLE Director
NAME April M. Beber
ADDRESS 5720 Huguenard Road, Fort Wayne, IN, 46818, USA
TITLE
Director
NAME
Daniel R. Mason
ADDRESS
5720 Huguenard Road, FORT WAYNE, IN, 46818, USA
TITLE
Treasurer
NAME
Melissa R. Frisby
ADDRESS
5720 Huguenard Road, Fort Wayne, IN, 46818, USA
TITLE
Assistant Secretary/Treasurer
NAME
Cheryl L. Mason
ADDRESS
5720 Huguenard Road, Fort Wayne, IN, 46818, USA
TITLE
President
NAME
Daniel R. Mason
ADDRESS
5720 Huguenard Road, Fort Wayne, IN, 46818, USA
TITLE
Secretary
NAME
Melissa R. Frisby
ADDRESS
5720 Huguenard Road, Fort Wayne, IN, 46818, USA
TITLE
Director
NAME
Melissa R. Frisby
ADDRESS
5720 Huguenard Road, Fort Wayne, W, 46818, USA
TITLE
Director
NAME
Cheryl L. Mason
ADDRESS
5720 Huguenard Road, Fort Wayne, IN, 46818, USA
TITLE
Vice President
NAME
April M. Beber
ADDRESS
5720 Huguenard Road, Fort Wayne, IN, 46818, USA
PENDING APPROVAL
CONNIE LAWSON
INDIANA SECRETARY OF STATE
12/10/2018 02:47 PM
TITLE Vice President
NAME Michael A. Hensley
ADDRESS 5720 Huguenard Road, Fort Wayne, IN, 46818, USA
THE SIGNATOR(S) REPRESENTS THAT THE REGISTERED AGENT NAMED IN THE APPLICATION HAS CONSENTED TO THE
APPOINTMENT OF REGISTERED AGENT.
IN WITNESS WHEREOF, THE UNDERSIGNED HEREBY VERIFIES, SUBJECT TO THE PENALTIES OF PERJURY, THAT THE
STATEMENTS CONTAINED HEREIN ARE TRUE, THIS DAY December 10, 2018.
SIGNATURE Daniel R. Mason
TITLE Registered Agent
State of Indiana
Office of the Secretary of State
CERTIFICATE OF EXISTENCE
To Whom These Presents Come, Greeting:
I, CONNIE LAWSON, Secretary of State of Indiana, do hereby certify that I am, by virtue of the laws of
the State of Indiana, the custodian of the corporate records and the proper official to execute this
certificate.
I further certify that records of this office disclose that
MASON ENGINEERING AND CONSTRUCTION, INC.
duly filed the requisite documents to commence: business activities under the laws of the State of
Indiana on December 10, 2003, and was in existence or authorized to transact business in the State of
Indiana on December 10, 2018.
1 further certifiy this Domestic For -Profit Corporation has filed its most recent report required by
Indiana law with the Secretary of State, or is not yet required to file such report, and that no notice of
withdrawal, dissolution, or expiration has been filed or taken place. All fees, taxes, interest, and
penalties owed to Indiana by the domestic or foreign entity and collected by the Secretary of State
have been paid.
si�
At� In Witness Whereof, I have caused to be affixed my
signature and the seal of the State of Indiana, at the City
of Indianapolis, December 10, 2018
CONNIE LAWSON
SECRETARY OF STATE
2003121000327/2018814104
All certificates should be validated here: https://bsd.sos.in.gov/ValidateCertificate
Expires on January 09, 2019.
CERTIFICATE OF QUALIFICATION
to provide
CONSTRUCTION SERVICES
for
PUBLIC WORKS PROJECTS
to the
STATE OF INDIANA
This Certification Board, having duly considered application for qualification in terms of apparent experience and financial
resources, artd under the applicable Indiana. Code 4-13.6.4 and adopted rules of this Board, hereby issues a
Certificate ofQualification to provide construction servicts to the State of Indiana for Public Works Projects to:
MASON ENGINEERING AND CONSTRUCTION INC
5720 HUGUENARD RD
FORT WAYNE IN 46818
Phone 260-497-8701
Fax 260-497-8702
Company Official
DANIEL MASON
for the twenty-seven month period stated herein, unless revoked by this Board for cause,
and in the classifications of services stated below. This certificate supercedes any previous certificate.
1629.05 Sewage & Water Treatment Plant Construction
CERTIFICATION DATE 3/15/2017
EXPIRATION DATE 6/15/2019
THIS CERTIFICATE ISSUED BY THE STATE OF INDIANA, PUBLIC WORKS DIVISION CERTIFICATION BOARD,
402 WEST WASHINGTON STREET, ROOM W467, INDIANAPOLIS, INDIANA 46204,
ALSO ACTS AS THE OFFICIAL NOTICE OF EXPIRATION.
Tracy L. Cross, Exeout ve Secretary
Certification Board
DAPW P02 State Form 3963R Rev 07106
12/10/2018
y (http://www.INBiz.IN.gov)
Business Search
Business Search Result
INBiz: Your one -stop source for your business.
Principal
Registered
Business ID
Business Name
Name
Entity Type
Office
Agent Status
Type
------------
Address
Name
2003121000327
MASON
5720
ENGINEERING
Domestic
HUGUENARD
(/PublicBusinessSearch/BusinessInformation?
LEGAL
DanielR
businessId=503338&businessType=Domestic%20For-
AND
NAME
For -Profit
ROAD, FORT
Mason Active
CONSTRUCTION,
Corporation
WAYNE, IN,
Prof it%20Corporation8cisSeries=False)
INC.
46818, USA
Page 1 of 1, records 1 to 1 of 1
Return to Search
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Entity Type: Domestic For -Profit Corporation
Creation Date: 12/10/2003
Principal Office Address: 5720 HUGUENARD ROAD, FORT
WAYNE, IN, 46818, USA
Jurisdiction of Formation: Indiana
Title
Secretary
Vice President
President
Other
Treasurer
Director
Director
Director
Name
Business Status: Active
Inactive Date:
Expiration Date: Perpetual
Business Entity Report Due 12/31/2019
Date:
Years Due:
Name
Address
April M. Beber
5720 Huguenard Road, Fort Wayne, IN, 46818, USA
DENNIS J NORRIS
5720 HUGUENARD ROAD, FORT WAYNE, IN, 46818, USA
Daniel Mason
5720 Huguenard Road, FORT WAYNE, IN, 46818, USA
Cheryl L. Mason
5720 Huguenard Roadz, Fort Wayne, IN, 46818, USA
Melissa R Frisby
5720 Huguenard Road, Fort Wayne, IN, 46818, USA
Dennis J Norris
8750 E 300 N, Howe, IN, 46746, USA
Daniel R Mason
226 W Wallace Street, Fort Wayne, IN, 46802, USA
Gregory MacDonald
2801 Martin Luther Drive, Fort Wayne, IN, 46825, USA
Title Address
M. RANDALL SPENCER Incorporator 1400 ONE SUMMIT SQUARE, FORT WAYNE, IN, 46802, USA
Type: Individual
Name: Daniel R Mason
Address: 226 W Wallace Street, Fort Wayne, IN, 46802, USA
ARTICLE IX
TRAINING TRUST FUND
Section 1. On work covered by this Agreement all Employers, Party to this
Agreement, agree to pay into the Indiana Laborers Training Trust Fund an amount set
forth on the wage schedule which is attached hereto and made a part hereof for each hour
worked by Employees covered by this Agreement. Payments shall be made on the dates,
in the manner, form and in accordance with the rules and regulations as adopted by the
Trustees of the herein mentioned Trust Fund. The Employer may submit funds
electronically.
Section 2. The Employer agrees to be bound by the Agreement and Declaration of
Trust establishing the Indiana Laborers Training Trust Fund.
Section 3. The Training Trust Fund shall be administered in accordance with all
provisions of applicable law.
ARTICLE X
DEFINED CONTRIBUTION TRUST FUND
Section 1. On work covered by this Agreement, the Employer agrees to pay into the
Indiana Laborers Defined Contribution Trust Fund the amount in cents per hour as shown
in Article XXX. Payment shall be made on the dates, in the manner, form and in
accordance with the rules and regulations as adopted by the Trustees of the herein
mentioned Defined Contribution Trust Fund. The Employer may submit funds
electronically.
Section 2. The Employer agrees to be bound by the Agreement and Declaration of
Trust entered into and dated May 1, 2014, establishing the Indiana Laborers Defined
Contribution Trust Fund and Participating Employers and by any amendments to said
Trust Agreement.
Section 3. The Indiana Laborers Defined Contribution Trust Fund shall be
administered in accordance with all provisions of applicable law, and will be domiciled in
Indiana.
ARTICLE XI
POLITICAL ACTION COMMITTEE CHECK -OFF
Section 1. Each Employer signatory to this Agreement agrees to deduct from the pay
of Employees covered by this Agreement a voluntary contribution, in the amount
designated by the Union, to the Indiana Laborers District Council Political Action
Committee (ILDCPAC), or other political action committee as determined by Union,
G7
at all times said Employer is required to have one, the Union shall have the right to strike
and/or picket, after notice, and use all other legal and/or economic means to cause the
Employer to comply with this Article.
ARTICLE XXXIII
NO STRIKE CLAUSE
During the term of this Agreement, there shall be no lockouts by the Employer and no
strikes, picketing, work stoppages, slow downs or other disruptive activity for any reason
by the Union or by any Employee. Failure of the Union or Employees to cross any picket
line at the Employer's project site is a violation of this Article.
The Union shall not sanction, aid or abet, encourage or continue any work stoppage,
strike, picketing or other disruptive activity which violates this Article and shall
undertake all reasonable means to prevent or to terminate any such activity. No
Employee shall engage in activity which violates this Article. Any Employee who
participates in or encourages any activity which violates this Article shall be subject to
disciplinary action, subject to the grievance procedure.
The Union and its principal officers will immediately instruct, order and use its best
efforts to cause its members to cease any violation of this Article.
If the Union initiates, participates in, or supports a work stoppage, strike, picketing or
other disruptive activity in violation of this Article, the Employer may pursue all legal
and administrative remedies and any damages available thereto related to the Union's
violation of this Article.
This Article does not apply with regards to collection of delinquent fringe benefits.
ARTICLE XXXIV
APPRENTICES
Section 1. New Applicants for employment with a signatory contractor who have
fewer than 4,000 hours of experience as a Construction Craft Laborer (or alternatively,
cannot demonstrate equivalent skills by achieving a satisfactory score in a placement
examination administered by the Joint Apprenticeship and Training Committee (JATC),
shall, whenever practical, enter and be allowed to enter the Apprenticeship program on a
non-discriminatory basis in accordance with the terms of the Apprenticeship Program.
Any person entering, but failing to maintain and complete his or her apprenticeship, shall
not be employed by the Employer as a Journeyworker under this Agreement. The failure
of any Apprentice to maintain his or her apprenticeship status shall obligate the Employer
to discharge such person upon notice from the Union.
29
Section 2. The Apprenticeship and Training Standards approved by the Federal
Bureau of Apprenticeship and Training or State Apprenticeship Committee are hereby
incorporated herein by reference and made a part of this Agreement.
Section 3. The Apprentice wage rates:
Hours of Credit Wage Rate
Section 4. The requirements for entry into the Apprenticeship program shall be
controlled by the JATC, which shall employ appropriate testing and screening
procedures. An Apprentice advances from one hours -of credit and wage -rate category to
another only upon determination of satisfactory performance by the JATC, pursuant to
requirements specified in the Apprenticeship Program which shall have the authority to
grant accelerated credit where warranted by the performance of an individual Apprentice.
Section 5. Except as provided in Section 9, the Employer shall participate in the
Apprenticeship Program by considering Apprentices for employment upon referral by the
Union. The Employer shall have the sole right to reject, at any time, any Apprentice
referred to it, or working for it. The Employer is not obligated to accept more than one
(1) Apprentice for every five (5) Journeyworkers commencing with the sixth Laborer
needed by the Employer. This ratio shall be measured on a company wide basis, and
does not require an Employer to have a sixth Laborer, if only five are needed, as
determined by the Employer.
Section 6. The Employer may not employ an Apprentice until at least one (1)
Journeyworker is employed and thereafter may not employ more than one (1) Apprentice
for every additional three (3) Joumeyworkers.
Section 7. An Apprentice should, whenever practical, be rotated by the Employer
through different types of work so as to become trained in a variety of operations and
work skills. Where the Employer is unable to provide an Apprentice with experience in
the full range of craft skills, the JATC may request the Local Union to reassign the
Apprentice to other employment in order to provide that experience. For so long as the
Employer is able to provide the necessary range of employment experience, the
Employer may choose to retain the Apprentice from job to job. Upon request the
Employer will inform the JATC and Local Union of an Apprentice's job reassignments
on a project.
Section 8. An Apprentice shall not be penalized for taking off from work to attend
offsite training (though time off for training is unpaid).
30
Section 9. Notwithstanding the provisions of Section 5, the Employer may call the
Union for an individual by name, provided he or she is not then employed by another
Employer. If available, the Union shall refer that individual.
Section 10. The Union agrees to hold harmless and to indemnify any Employer in any
claim arising out of the Union's referral rules/practices or the Union's or JATC's
administration of the Apprenticeship Program.
ARTICLE XXXV
SUBSTANCE ABUSE TESTING
Section 1. Recognizing that project owners, government regulations, and other
external pressures often necessitate substance abuse testing, the Parties mutually agree to
implement the substance abuse program("SAT Program") and perform substance abuse
testing in accordance with the SAT Program attached hereto as Exhibit A.
Section 2. Each Employer party to this collective bargaining agreement agrees to pay
the SAT Program $.03/hour (3 cents per hour) for each hour worked by each Employee
working under this Agreement. The contributions to the SAT Program will be deposited
each month, or at such other regular intervals as may be determined by the ICI-LRD
("Association") to the depository designated by the Association. and such contributions
shall be reported on such forms as may be designated by the Association.
Section 3. Each Employer party to this collective bargaining agreement agrees that a
representative designated by the Association shall be permitted, upon request, to audit the
payroll records of the Employer to determine compliance with this Article. In the event a
lawsuit is commenced to collect any delinquencies, and a delinquency is determined due
then the Employer agrees to be responsible for, and to pay, all expenses and costs of
collecting such delinquency including attorney's fees incurred by the Association in
pursuit and collection of such delinquency.
Section 4. It is expressly agreed and understood that no Employee, Employer, or
Union has any vested or proprietary interest in or right to any monies constituting a part
of such Substance Abuse Testing Program.
Section 5. The costs of the tests associated with this program will be paid from the
contributions identified in Section 2 in accordance with the terms of the SAT Program.
EXHIBIT A
SUBSTANCE ABUSE TESTING PROGRAM
I. POLICY STATEMENT. All signatory Employers to this Agreement and the
Union have a commitment to protect people and property, and to provide a safe
31
8
representing the party of the second part, and the foreman, representing the party of the first part, such
difference of opinion or dispute shall be referred to and considered by a representative of the individual
contractor and the Indiana/Kentucky/Ohio Regional Council of Carpenters. if this procedure fails of a
satisfactory and prompt adjustment of the difference of opinion or dispute it shall be immediately referred
to a Board consisting of two (2) members, one to be appointed by the "Employer" and one by the
"Council". If within forty-eight (48) houl s after such difference or dispute is referred to the Board, as so
constituted, and tile), are unable to reach a, decision, the Board shall appoint a third (3rd) member within a
reasonable time not to exceed twenty-four (24) hours after such difference of opinion or dispute is
submitted, the Board, as so constituted, shall request the Director of the Federal Mediation and
Conciliation Service to appoint an impartial third (3`d) member. A decision of the Board shall be binding
on both parties. Nothing herein contained shall prevent an employee from presenting his individual
grievance, as provided for and guaranteed by the Labor Management Relations Act of 1947.
b) it is agreed that the Indiana/Kentucky/Ohio Regional Council of Carpenters will not authorize nor
recognize a work stoppage which arises out of a dispute between other unions or other unions and a third
party.
ARTICLE XIH
JURISDICTIONAL DISPUTES — OTHER WORK STOPPAGE
Should a jurisdictional dispute arise between the second party and any other union or unions on any work of the
first party, such dispute shall be promptly settled by the unions affected. In the event no such settlement can be
reached, the contractor who has the responsibility for the performance and installation of such disputed work shall
make a specific assignment of the work.
It is agreed that there shall be no stoppage of work on the job while the jurisdictional dispute is pending or being
settled, provided no Employer will assign employees to perform work contrary to decisions or agreements of
record, or established trade practice. It is further agreed that all jurisdictional disputes shall be referred to the
respective International Presidents of the Unions involved for a decision and the parties of this Agreement shall
abide by such decisions.
ARTICLE XIV
SUBCONTRACTORS
Any contractor who sublets any of his work on any project he has in the territory covered by this Agreement shall
sublet same subject to the terms of this Agreement.
ARTICLE XV
APPRENTICES
Section 1. Both parties signatory hereto agree to abide by the approved certified standards and rule of the
Indiana/Kentucky/Ohio Regional Council of Carpenters Joint Apprenticeship and Training Fund. One (1)
apprentice for three (3) journeymen shall be the established ratio unless mutually agreed by both panties. In the
event apprentices are not available in the jurisdiction of the local Joint Apprenticeship Committees, both parties
agree to cooperate and expend every effort to comply with interpretations of statutory law.
Section 2. A Joint Apprenticeship and Training Committee consisting of Employer representatives and
employee representatives shall be selected by the parties to this and other Agreements to formulate standards of
Apprenticeship in conformance with the standards of the United Brotherhood of Carpenters and Joiners of
16
America as approved by the Bureau of Apprenticeship and Training, United States Department of Labor. The
Apprenticeship Program shall be administered by the Joint Apprenticeship and Training Fund. Any questions
concerning the training of apprentices shall be brought before the Joint Apprenticeship and Training Committee
and the decision of the Committee shall be final and binding. The JATF shall have full power to act on all
matters, financial and otherwise, relative to the Apprenticeship Program, and shall by its rules or decisions make
all determinations relative thereto, which determinations shall be final acid binding upon all parties or persons
affected.
Section 3. Carpenter and Millwright Apprentices of the Joint Apprenticeship Training Program shall be
subject to the following wage and benefit rates:
EFFECTIVE APRIL 1, 2016:
180 day Probationary Period: 55% of the Journeyman rate, $0 Annuity, $0 Pension
I" Year: 55% of the Journeyman rate, 55% of Annuity, 50% of Pension
2°d Ye:er° 65% of the Journeyman rate, 65% of Annuity, 50% of Pension
3`d Ye,r: 75% of the Journeyman rate, 75% of Annuity, 50% of Pension
4°i Year: 85% of the Journeyman rate, 85% of Annuity, 50% of Pension
All other contributions remain the same as journeyman.
Section 4. It is the intent of the parties to this Agreement that al I Apprentices indentured to the
Indiana/Kentucky/Ohio Regional Council of Carpenters Joint Apprenticeship Training Fund shall attend day
classes as part of their apprenticeship training. The Joint Apprenticeship and Training Fund may pay each
Apprentice while attending school.
ARTICLE XVI
SAVING CLAUSE
Any provision contained herein that is contrary to or in violation of the Labor Management Relations Act of 1947,
or of any Federal or State law now in force or hereafter enacted, shall be void and of no force or effect, and this
contract shall be construed as if said void provision herein were not a part thereof, it being intended, however, that
the other provisions of [his contract shall not be affected thereby. It is further agreed that should compliance with
any Federal or State law, or amendment thereof, or any order, decision, or regulation issued thereunder, now or
hereafter in force and effect, prohibit the carrying out of any of the provisions of this Agreement, then to the extent
of such deviation or prohibition, this Agreement shall be deemed to have been automatically amended, effective
on the effective date of such law, order, decision or regulation. Such amendment to this contract shal I remain in
effect only so long as said law, amendment, order, decision or regulation continues in force, or until the expiration
of this Agreement, whichever shall first occur.
ARTICLE XVII
EQUAL EMPLOYMENT OPPORTUNITY
SECTION 1.
The Employer will not discriminate in hiring of employees and will conform to laws with respect to hiring. it is
understood that the Employer shall have the right to reject any employee referred for hire.
17
DRUG FREE WORKPLACE POLICY
PURPOSE:
Cornerstone Stewards, Inc. is committed to providing a safe and productive work environment. We expect our
employees to report to work each day fit to perform their jobs. In order to meet these objectives, as well as our
obligations under applicable federal and state laws, we must take a firm and positive stand against substance
abuse. This policy is intended to ensure a drug -free work environment for the benefit of our employees and
customers. This policy supplements our Substance Abuse Policy and is necessary due to our government
contracts.
POLICY STATEMENT:
The unlawful manufacturing, distribution, dispensation, possession, or use of a controlled substance while on
Cornerstone Stewards, Inc. premises or in the performance of services for Cornerstone Stewards, Inc. is strictly
prohibited.
As a condition of continuing employment with Cornerstone Stewards, Inc. each employee must:
1.) Abide by the terms of this policy; and
2.) Notify Cornerstone Stewards, Inc. of any criminal drug state conviction for a violation
occurring in Cornerstone Stewards, Inc.'s workplace no later than five days after such
conviction.
Any violation of this policy will result in discipline, up to and including discharge depending on the
individual case and severity of the infraction involved.
Drug -Free Awareness Program
To assist in ensuring compliance with Cornerstone Stewards, Inc. Drug -Free Workplace Policy, we
have established a Drug -Free Awareness Program to inform our employees about:
1.) The dangers of drug abuse in the workplace.
2.) Cornerstone Stewards, Inc.'s policy of maintaining a drug -free workplace.
3.) Employee assistance programs that may be offered for drug counseling and rehabilitation
through major medical policies currently carried by the individual employee. (Programs will
differ depending on your carrier.)
4.) The penalties that may be imposed upon employees for drug abuse violations.
Participation in our Drug -Free Awareness Program by all employees is mandatory.
DRUG TESTING:
In accordance with IC 4-13-18, Cornerstone Stewards, Inc. requires random drug testing of all employees. A
minimum of one (1) employee will be randomly tested each month and each employee will be tested at least
once a year. A drug test will be required in the event of a workplace accident.
Drug 'Leg
Cornerstone Stewards, Inc. requires a minimum of a five (5) drug panel containing the tests for the
following illegal substances:
(A) Amphetamines
(B) Cocaine
(C) Opiates (2000 ng/ml)
(D) PCP
(E) THC.
Results of Failed Test
If an employee fails a drug test, they are subject to the following minimum consequences:
1.) First positive test, thirty (30) day suspension without pay and participation in a treatment/rehab
program.
2.) Second positive test, ninety (90) day suspension without pay and participation in a
treatment/rehab program.
3.) Third positive test, termination effective immediately.
During suspension, there will be no pay and collected PTO does not apply. Employees will not be
eligible to collect unemployment.
Cornerstone Stewards, Inc. will advise employees on the participation in a program of treatment or
rehabilitation at the time of suspension. Proof of completion of the program is required to return to
work. The company reserves the right to terminate employment as a consequence of a confirmed failed
drug test at any time.
If an employee would like to contest a false positive, they may do so immediately following the results.
Retesting is available on a case -by -case basis.
RESERVACTION OF RIGHTS
Cornerstone Stewards, Inc. reserves the right to interpret, modify, or expand upon this policy in whole or part,
with or without notice. Nothing in this policy alters an employee's at -will status.
ACKNOWLEDGEMENT AND CONSENT
I hereby acknowledge having received a copy of Cornerstone Stewards, Inc. Drug -Free Workplace Policy. I
agree, without reservation, to abide by the policy.
Date Employee Signature
Employee's Name (Printed)
DRUG FREE WORKPLACE 11O ,1(`Y
PURPOSE:
Mason Engineering and Construction, Inc. is committed to providing a safe and productive work environment.
We expect our employees to report to work each day fit to perform their jobs. In order to meet these objectives,
as well as our obligations under applicable federal and state laws„ we, must take a. firm and positive stand against
substanc;c abuse, This policy is intended to ensure a drug, -free work environment for (lrc benefit of our employees.
and customers. This policy supplements our Substance Abuse l'olicy and is necessary due to our goverriment
contracts.
POLICY STATEMENT:
The unlawful manufacturing, distribution, dispensation, possession, or use of a controlled substance while on
Mason Engineering and Construction, Inc. premises or in the performance of services for Mason Engineering
and Construction, Inc. is strictly prohibited.
As a condition of continuing employment with Mason Engineering and Construction, Inc. each employee must:
1.) Abide by the terms of this policy; and
2.) Notify Mason Engineering and Construction, Inc, of any criminal drug state conviction for a
violation occurring in Mason Engineering and Construction, Inc.'s workplace no later than five
days after such conviction.
Any violation of this policy will result in discipline, up to and including discharge depending on the
individual case and severity of the infraction involved.
Drug -Free Awareness Program
To assist in ensuring compliance with Mason Engineering and Construction, Inc. Drug -Free Workplace
Policy, we have established a Drug -Free Awareness Program to inform our employees about:
1.) The dangers of drug abuse in the workplace.
2.) Mason Engineering and Construction Inc.'s policy of maintaining a drug -free workplace.
3.) Employee assistance programs that may be offered for drug counseling and rehabilitation
through major medical policies currently carried by the individual employee. (Programs will
differ depending on your carrier.)
4.) The penalties that may be imposed upon employees for drug abuse violations.
Participation in our Drug -Free Awareness Program by all employees is mandatory.
RESERVACTION OF RIGHTS
Mason Engineering and Construction, Inc. reserves the right to interpret, modify, or expand upon this policy in
whole or part, with or without notice. Nothing in this polity alters an employee's at -will status.
ACKNOWLEDGEMENT AND CONSENT
I hereby acknowledge having received a copy of Mason Engineering and Construction's Inc. Drug -Free
Workplace Policy. I agree, without reservation, to abide by the policy.
Date Employee Signature
Employee's Name (Printed)
^Tesh
AGREEMENT
HY AND BETWEEN
IiNDIANA CONSTRUCTORS, INC, — LABOR RELATIONS DIVISION (ICI.LRD)
and
LABORCRS, INTERNATIONAL
UNION OF NORTH AMERICA
STATE OP INDIANA DISTRICT COUNCIL
FOR AND ON BE, IIALF OP ITS AFFILIATED LOCAL UNIONS
V120, V204, 0213,11274, #561, 1;615, P741, I1795, VI 112
APIM, I, 2017
1\1ARC1131, 2022
SecUorr 9, Nohvilhst�rrarlrn
l Pf(Wislons Or Union Isar an individual by rrrrmrre„epa ���idcd he or shprosrrr5�l le n
Ole
Employer
l Oy call the
�nrployer• [f available Ilrc Union sil tll refer (,In,it►(lividnal. employedby another
Scgelion p TI►e Unron a ,, to hold pram►less and to indemnify any lymPloy, in any
claiurr arising out of the Union's rnferral ra!►IQS/prnclices or the Union's or JATC's
atlrr►inislration of tlrc Appr•errlicesh ip Iarogramrr.
ARTICLE- XXX V
S UNSTANCE, ABUSE TESTING
�Secpinru p, flceo�c�mtiring tlral prr�o�ccl o►vracrs
overnnl Iares�srum one" nrcemusatc sultshu e rr curse I slhr�u tlrctl'c r esrq rrrrrrrlunplawmn olirer
imnplenrerrl tllC -ulasgarr c rrtrt► c p►roErrtnr x,�SA , T"ro r , „ , y gee to
lcstlrrg prr aecorcl�rrrcre aitlm llae SAT Pmgnm ntlaclrc I Irerr o nscl�x�lrilailr�A�trlasla MCC abuse
Seclle&rr ;�, p na lr f"rnpltrycr� pmrrly to tluls collcutivc� larsr Barr►rru � �n
Ole SAT parograr►r S.I/iiocmr cents lac^r horr►' for encar hear eroraci by oaclm p�:nr,laa t
g yrc,crrrent ahrecs to prry�
r�or�°irrr� rrr►cler flume Ay„reemrrc.rrC. i"Ire co►rlr�ihuliorrs tra Ilre SAT l'ro�rnr'rr ��si�lN be ticlr�ssilr:cl
Caclr nronllr, car nt sualr olha:r r lWu A a srl„s as prrrc+ I y.,
(`°Amcr�rlrcarr'") 10 llr� dclrository desigrunlcrl y tar tlelcmowd try the p%I LRI:y
slrnll be repealed can srrch fom�arr. ns nmyP to cpesigmr terl by tile rAssocjfticra r'rclw eorrdrulaatlrtiaars
Section 3, UK lklayc^.r prar lya 10 Ibis e015000 laagalrrmrr,� rr�recratcurt nf�r�ecs t@rnt n
rcprresellitrlive � cic signaled lay life Association shall lac law rrrrrgtw.cic lrpor► reel►Net tea nn I the
payroll records ofllue hrnpaloycr• lu cicicrrnrrre comtrfalimrr►e.c sw�ltlm Ilrls. Arkicle, lm► ll►e twrent o
hrcvstril is con►rrrcr►c,ccl to collect trury� rlcjltwdna.ncicrs, amrrl n clelimdrpc►tm�rcy--� is cl<alcrrrrirrecN clrre,
Ilren llrc p tc►paBoyc r np,res lrr lac r claramrs'ihle fora nrrcn to a m
collecling swell delrrrcprcncy� irrclrrtNirtg� nllormre cs l.y' rrll expenses artrl costs of
pwrmr° rit rmncl c'crllcclrorr of"srrclr alr l'imrclrrcrosc y y fcc�s incurred try^ Ilre Associnliour imr
l+cclinrr PI, 11 r aw, pror�c�A nc Ni noel W%sluud that no Ear rin �o ,.
1p s�d has any v"wd or° l,arcaprieN inlel'csl in or right to nny ninnies consliUrling
ofsrrclt Srr6slancc Atrnsc, `pc,�log NMI, I y' l Grnpl g 11 or
tr p:rrl
Section 5, 11w Costs of the Icsls nssocialzd with Ihis idprogn► will be Iraid firrom the
cnnlrih►rlions e.rrlified in Section ? in accordance with the Ica rirnis of the SAT I'roytrrornr.
SU1lS'I'ANC'I; AHUSl's'I'IiSTIr\'CI PROCIIAA,\I
1'UI.IC:1' S'1;4'I'l;illl;r\''p', All sunnlory l nrl,lnyers lu Ihis Af;r�en►cul and the
Unionhn�'e n conunilr►ierrl to prulec1 p,;ople tnrd Irroperty, noel Icr prmicic n cafe
31
vcrrbiitg eurviromnant. The• puipwic OI. the follotviiag prolrant is to eslablislt tool
Ilraullarils a drug free, alcohol frcc, stare, healthy work, catviroil mcnt for all of its
r"Il pleryccs Conrcd by this AgretIt ol.
It. AScadclit - Any eveol resulling in i� Ul ry to n person or
I"attlrloycc conlributecl as a direct or in(irecl cause, propcity to which an
b. A-r- diced L nbcrrmLgy - A h oralory certified by the Substance Abuse and
enhil I catch aSrrr�lccs Administration (SAMI-13A) for testing of Prohibilive
Ileiwms � Stlbsl buss es.
cn 1)tetoCirja - To degrade a lest Sample by substitulion or adafition of other
hij,vedlews in nileffortto
adultorIltecalcel Qe;l shall be cmast; the Irresence of unnulhoriZed drugs, An
coils n lrosilivc lest,
d. I i Lld rd S�tror,Ip9S — Urine s�a"lmples which the laboralory reports as, ttiiaeceptable
Stith regrards to menstwed levels of cre'1611ine or spcoific gravity will be
considered diluted snntlales, The l:airployce shall be . s' required to Provide another
urine sample for lesling,
e° I iroaplc'?YL0 — All individuals who are coverorcl by this .Agra^ducat, pu•ovictcal Thal
ntdividutals referred for cutpiloymew Iry the Union under llae hiring ptt)visiolts of
the Afroollient are consitl,�r-ocj "Applicirnts" taattil they al.e Iuiu�ed and bail to fork
by thc^ 1?atrployer,
f °' pa�rlleIti')I"" Apfwu�nvctl I°cal Itt.saailaes Ir Inlrt,rtilory test coitdttcdad by a
�SAd� HSA c,eu Cil'icd laboratory for- lltc crf oiicz or more of the NO, d1ligs ¢gar
Classes of tIr°arl;,i Ilkscrihcal alrrcici tltc tlelirailioar ref "parohibiled iletaas nttrl�t�rr
sultsumces'k luld liw'd in Secalion IV, I,lr of llae IC1 SAT Program.
g° l.itcrdr.lai — A evonl which leas all cide
the nRribules of all nanl, except lhot no
It ttGBIa�trs cnus.d to person or properly
la. I Isua� liewi� u� flflic at' (u'rdli ),� Mlle iu KO is a Piece V1d }51a �sic�itasr w °her
karotvlcclgc crl sulrsl�rrtrc altause adps,c�irlos iialcrltica atad than nppr�odr 1r 0e rnodic•rrl lydai�titr�, tar
atrarl ra iltr la lrarsilir r VHt 1.diaitcc alrara+� lest t ^sash lai ,, iitrlivitltiial" rrrrrBrt.trl Ittslcaiy toutel agi�t)x Whet" r lmilit lrrarlwaMwcCie-artl ruilirorsat�rtirirtllrOle
l�ltc
ttlleC) p Ilio itsalatltla�iil r��slrorr�il+lc� flit rr,C6611g Ialactr'Wtlwwiy t�rsatlls.
i. rd �wrtrl,rlrla Intl "ccltliNt _ors urine sautple Iltal the ,'Medicnl I�cviety 01'lico�
(lallw) tleleititisues ns rtcol rtaa,ucliup; the Ie
roquuer�ttcnls fur n �'nlicl sl, Aflcr
a�owildf alioll with Ille d �iitdreln)`r �, a r4lc,l tnny he t-oaired,
1?
j• PyQrttu%! - All unst,11clion job sites s
futu lvhi lu tlMc 1:i�nplaaye^r has responsibility.
d"Iur"s iMbcluudcs all job ara;as, oftMce;, facMpuua;^�, IaMutl, bbuildibulxs, lnMclures, and all
erautslMunty vegticics used in the Iyerforrutanwe Ofwvered work
kcanse shall he defined ns observable abnormal or
cru"utlbt babs"ior such As not'iceable imbalance, incoherence, and disorientation.
1. I"rt?.pa�9 1 �tb �s rurb buM 5tt@ys ukbc s- I'toluMlaitetl substallm h1clude illcI,uMI drutgs
(MMtcludixl controlled stubstnMtcrsw Zook alike drbuys And rlesid�ue�u° tlu•tMysj�
Itrescril tiotb dusu@t, tuscrl y one Mr tvhrabtt they %arc nabl preseriM[ alfittl
hraraltltrrnnlia in tlMc I>ecsoutnl posse,
sion of or hrlMtg tM�sccl by on I:'.nblboy"tbbt Ilue
1brcMtblsm Also prohlbhed Mw alcoluolir; bcvrrrb�es b6nl coursIMIR,i Eby nuM
I ullplgcc, Olt the premises,
"t IL.111(Iomu I Asa - An I'll ambomiced lost pursbMarbl to an objective Mmethod for
seleetoabMu COW of suoh tc,IT 100 be pald for by the Indiana Coubslrubctors Inc.
,Stubstancc Abtuse'TcstiMtg I'rt rants (ICI SAT ProflM°ants).
Mb• Itchat blltntuotu pt t an�IMb An F?Mub Aqu Wand caNdeb,dW counseling service,
dwslpm! to help Hury)Ioyees resolve problcltMs that invohb c nlcohol or drug nbuse,
slaty d by Whed nntl e MedSIWAIcd huutu;bn seM• kcs prrrofcssionl'b9a.
o Ite uMr kfut u�ue�Mt • Itcf�rs to the rquiremonts that a person %vho tested positive for
IMrcltiWteel itenM°, Wdr substance^.s tinder the ICI SAT Program must satisfy
I'bcluaMc IMbw Is chgiblc to fCI(H-n Io work,
p ItM tc t, A sceond seputuatc test blcwwcssiuMbtcd by an Mtw^rated or howalrbnally
Mod sauultle or n test emsitlere,ul not sttilnitle for tewliIIII, A Melest tlbubt is
considered as nu nclulkm kd or a du"lured s,uuu 10 (evhuth r shhued inknturbuM,gy or
bMutibM6eMutioMMally , sir uMs a test nw suitable fetr Na atiuutl slMMtll Ibe C MusWcwd n posiuive
le4t frbsls ofrwtcsli� 1 MuteesAwled by nn a bnintentionb'blly diluted RtI(Vor bu tcjt
eoMbsidore'd not sui(hi'c fo testinty wilt be plid Im by the WISM' I" o
t oos or Mw*ta oh ,� nuu WNW n intentirbnnlly° dihPd snMutplew tt M Ibc Iu�t tl bfo�r
by the indhiduusl,
ulxwt�nt°e r biNg l'Mr7Ie Mrbuu�ll._ l) - A SAII Ms Mr kcewwd lblMysiri�uub rru° to
IlueMlsetl twM Ibs)clbolctlk; Social st°abrl G enMldoyca ubswistdutca�
I�bMeafewwMcwMulut, b+M atldiclicbM tomMst,lor (e~erlifteal I>y tluc fltifmnl. Assiscu;Mt'Ic,ib aMf
Ale obOlisrub MUMd I HII ACbusww CoMMOMsa,, f'tru'tifM¢^a"nticrut ftebuMMumtissiMtubj st°itlb
hMbMbwvle*ctl,e* of bnMal cllMuical aawlbe�u°ie,uMbrew h, the diuMylomk anal hvmnucm tbfrllst"xrtleus
Mc utuug ter rdoohol owl alrnl obtliv,
;I,"ssI a Is defiMMrd as me uollweHabn of an individnutl's ud" shceinMerm tend the
"4IMM:+011 sM US flty.t ombsls of Ihnl speeinbeuu, in trucWnnce btsh nwd ,l
stabMbelortts. F'or Alcohol, a IN is dewfined ns the colleati land analywis of on
htaivS Iwtl'z bmillM sp ehllM ,n MMM n,-C idnnce- bvilk rcdornl suubudards; mnat,u 0en a
11
SPOCillICII (111111Y7,Cd by 11 11ranIllillyZer
Products List, listed an the US Dors Colifornling
11L CONFIDENTIALITY,
All partios 10 this program sljotjl(I encourage any I'miployce will" A SU11,31nnee
'""Pt assistance In dealing Nvit), tile:
take IrOblem. All pal,ties wilt
"'a 1)cccs��Ijy �",IiDns to assure the problem k 11111n(Ited in a collfidClitial
Manner.
b, R lest is required,
11le SPOc"lle" s ill be Identified by it code number
%villi 11 Cllnln of C'StOdY 1`01-111 to Insure co rl(lc tiplity of t,
Employee, The Employee 111Ist witness this procedure.c. n n le
Resells will be reported 10 the Employer mid 1110 Union by the hilto.
V. RULES — DISCIPLINARY ACT101''S —CRIEVANCg, 1'R0Cf,.1)JJ1JLS
A.VURS' — All El"PlOYM ?"list report to work in a pllysiclil coia(filion that will
onable, flicill to perform their jobs In n safe nod OfFicielit 111,11mer. niployccs liot:
A. Use, Psgcsi, clisPollse or receive prohibited subsiallces on or a, the job
site, or durh1f; working hours,
c"
b. Report 10 %vol.k. %v'(11 above the measurable 1111101.1111 of the following
prohibited sub.ginlices in theirsysteill,
DRUG Olt METABOLITE INITIALTES1,
DETECTED CONTIRMATIOIN
(G C/Ims)
Amplictillijille, S00 11'(01111
(includes hie (lialliplimil 11 ilia) 250 jj'Q/jjjl
Cnilliabinold 50 lighill
(Marliumin, I-lasilisil) 15 lig/1111
Cocaine 150 no/1111
11
0111,11c: N101-1111illo, codoille. 2.000 qq/1111 100 lighill
6-AcclyliliorpIlinc 10 lig/lill .000 lighill
I'llulicyclidille- (1101) 25 jig/oll
MDMA 500 ilghill 23 jig/jill
l"llumol (Alcohol) .04% wl%,ol
.041,140 w/%,of
(enzyme assay) (GICII-D)
If
New dings roay lie rydded os they' are delenttined to be illegal or considered to be
prohibited flcros aly(yorsubatances by mutual agreement.
2, Tt1-rr1� ll.L — Wherr time firoployor has probable Cause to believe wtn l'lrr slo
yce antler the influence of n prollibile(] sarfyslruycep for reason of safety, the l�yyyl lioyr�r�
may be suspended trrrlil test restllts nre nvailable, If tso test results are r'ecloyce
after three (3) workiry�tl rlryysll'ye J„nrlyloyec, if available sly^rll Ire relurtccrl to cive ,
with back pay subject to the lrwst re,scrll s.
f f the test results prove negativa, the Employee shall be relurncd to work tivilh back pay
In nll olher cases;
a. Applicants testing positive for drug u,c will not be hired.
b. ftrnplC)Yacs who refuse to cd00perale with lo,sling procedures will be subject to
ill *Im:dinle lerrnblaliort, If my individual does prat pt°()vide a ssyilable slrceirnen
ss^tlhln IWO hours (2 hours), it wlfl lye cotisidt red a. reftts.,il And lrcalcd rr rt posilive
l+.sl resttlI n1ldl the individual will lye strfsjecl 10 inurl xIj,,1Ie lcrdnitreatiotr.
C. C:rnployees found to be in the possession of prohibited items an(Vur will be tesubstances
nninnted.
d. Ernployaos found sclling ordislribuling prohibited ilents nncUor substances will be
Icrntinaled,
c, Lmploy" es Who lost ahove the nteasurecl antounl of prohibited items mid/orsubst;rnys as provicicd fhr in W, Lb while on duly, or while operating n codnly,yyy
vohir.k sV ill be subject. to lenninswlion,
f. Firsl Posilivc'I'csl Result: The llri)Visions belOw npply to all lampinycc tasted purswwl to Ihis policy find tJKJ receives n lyosilive lost rcsull. wlio is
I) (;`twdtsNllcncc for First Positive 'Post Resull: The Grttployee is str iecl to
irrtstlediale lel7ninntion, ulron police to the Isny.)loycr by Iha Ml,()of (lie
lost rC.luh.
?) 1(cins�alenicnl: f?ortplt, e i,a rtt�l clipilt111 Iir�rlstsrk torrtid ftc hdys l,tkt°ry, rtt Itgws
overt c,spcnsc, n ,,1 ltarr�Uq Lis I)ot", rrfatYdtry^ d lr� t, stt rtry rtlrlrrctserf �firyic
oral the results t f' llyi, t��,t fl.We lraa!ry nttal,l^rQtf by n wSA'M11SA a�ctlili �r,l
laboratory and the, last Vstdls lnttsl ltAV hecry tcs�it;ss�4�cl try fin is11M alld
vol-lificd ns b infg rye alive, r0 llta p'nslriltitc(I ilvpyts uyyrtlrt rstrl+sdrtryc�s Itslcri
in 11'.I.h, find IhV l(k ,SA"r' t°utef„drddtt„ q lrtlia�t@t rtdtrl Itiryyl00YVI, have y`ct��cit�erN
the ccrlificd negnlivc lest resells,
�) Sporadic'j'e.+ling of Reinslntcd Bntpl())yes; A reinslnled linyrloyce, who
has previously tested positive-, is sul"10M to unscheduled sporadic testing
3j
for one Year front the dale or mosm,,, cusi or such ka,
paid for by the ICI SATProgi-nni. �tiill be
SMWW IWIT 701 wK The provisions belch, apply to an Employee tvljo
111151 Prcv;011sly tested PbsWvc, and leas IMSUI, , Q,qQl,
Iawursunnl to such
SPOInIlicicailig orrI (Qflingtwuk�f this policy:
QW(Two 1br Second Positive Test Result: I'lle En,j)l()ycc is StIbjec, to
illInlediale l0rininntion, ,poll notice to 1110 Employer by the Mfto, of the
P041NO lot remlit.
2) ReInswow NOW is not cligiblo J'w- work 1111611 he has,
expense, been evaln,11c(I by n1l III his owil
ficcMlited SAP, succcss rill, ly c()jj 111, CtLd runt
SAP recon line Ilded r0iA)HHMW,
releasing Me FISM W rMml W wwk mul Find Me SAP hu vuHW, a NQ.
and Employer have Ow IM SAT ProUnq U&I,
test, R copy of the received the restdi'l Dra 113 pallal 1"Is t6i- 11l Proved
letter %`fitllen bye the SAT' nmi R COPY of [fir, rellabliyall program SlICCOS010 CoIllp1dion letter, jjjkCIJ n, all Approvc(l cjjjjjc
nwQzW by n SAW-ISA c4iificd lnborw,ijory jjq(l 1114 lost results InUst have
been reviewed by all MR0 And certified as hoing negative rt)j, (Ito,
prohibiled 11cills allifl/or sltbsUvccs listed in IV, ll.b.
3) Sporndic Testing Of Reinstated A
ltrus InOW111150 Wed pwww, is Q 10
j Sporadic jes(ill,
for 0110 ycllt. 1) 01111 the dale of re ills III tal 11c,11t. c"ast Of silch lvstlut will be
paid rOl' by the ICI SAT Program.
Thild and Addiiion,11 p0AW, 1, 1 1,110 Pf0visions below apply to all
who 1"'s NOW litre or mom limes Iusto ,,
random
.'st i l Ig, Sporadic k%i ling or n ny to her h3lingunder this policy:
1) Consequence For Tfilra jjjjw(j Addjjj(nr�jj Test
13-11q)JO)ye is
'humodiAtc, WIlldn"Ifi011 Upoll notice to
the
F."Inployo. by 140 HRO, ff the, lloiOve IN Ivsull and he will 1101 be. ME tsar wWvmMwjq q Q
Ali) monllus fromPON% lest. dale dole
I, IM, chviltla rot %VOrk W1611 he" hors, at
Iris snts°rr
OXPOOSO-, Iwo evalwo®rcl 11), nII, ACCINdiled SAV,
SAP rmamnnuba
MW dws A P Nu wd yu to q
1MI INklyer We lu6ma 0,ls 8ATproomn; Ow tj,Wn
lem, Inkro, Al fill Ill *'S I %A l I - I I JS D CY I " NIPMved
Uw"Wd by a SAKINA vellifica
110"My MW Ole Wsl HIM
Cerlificd As ll�'hlg 1w.gative firer the, �w y an, hqj�o alld
it) jj
IR
3) `Iffraaa(Prc 'i'a5firaX A ruinslated Iwrarpalarycc> wlfo hays pfra�vioaa„>I
Ifosifivc (hIce 3 y loste(i
j or carers liarres, is s(rbjccl to unschccI ded sporadic tcsli6v
1rrr tyro j� years froarr tlae rlatc (ufrcin lnrlcrf��fent, C�osl' of such ILslifap' vilN
be paid for • by llre TCl SA 11'aroftanlrr,
3. pa°pscarpal%�rllarlu�s l
bed
lhrl perforrrrance of,pol� (It 1Ics, cilheratrgrcrrt rNft a nraluan( lorlpk sbrlros s rrraaslication 1pNlrrrary impafir
inform their supreavisaaa (rf' sfrc'h pre�scriplaon rlrarg rase• for the saf'bt
frre(giaalcly
Enrployccs, the hafrrpaloyer will consfrNl rrillr the arrprlrfycrt to ricicrrrty If ar
reassignment of (lallics is rfcccssar il rap all,
Employee will be roNeve(I of(Ira6N a altil rcleaase(Nfasalfprfor claal of Possible, l'Ircw
physician, at which tiftfc Ilse 1 rrrlfloycaa shall lfc arslnlc(i faa Ids f(,rrfrcr.
employment slnlus if avnrl: for arri'rlrsh hr." is (Iaanlifierl is rcin able aft l the Ids f a mj,,,I1
Nr�rt taarre.
II' the Employcc i' Nested aaa(l life lest is posiaiv(., arrcl Ill Flrlploy(,o has
previously informed the Employer of the use of prrescriplinar drag �s life Ir;rrf ale
rrrrt
may be suspended for two wee ,l nrul is subjecl to manscNac(Iulcd Sporadic teslirrf;
for six months. p ycc'
`I tW(MVI�IW, ,.P - All nspecis of this progf•afarr shall be subject to the '
prao~edUI'a spcllc(I out in the Collective Ilnrfparirrirrg Agreement,
blleVance
DRUf'pi'Al,t'°fllloI 1"1 Tt•pd° cermThe pr,aalics to This pram,
oncl n d Forafst4ffr(c,, lire I,IrfpaloYea• Will find lhsat iI is nccessarf} for testing to l,`
conclucle(I forparolrfbited iterrrS alydfor Substanccs paursuanl to the Isar rvr or arakll �stilldal undar
q ores,
it. A pre-cmploynrcnl daaa�,t rfrf(q nlccrh(al tY�sl rfrray lao 111
ato all' Ap�prlicrfrrls
u grout n N;rpu 110 SAiwolf' l(lwfnlipicarlroar card" The Applicarral will bo pinced u¢r tlar�,
payr(aIl caul Iatal to rv(frk- peaf(lilIg re cipl Of the rlrfr
emprloynrcnt shall be p cob�flionar} tar Ilfe. s rrsP� fe aararl ralcrfifrrl tasd.
individual shall be (•ufftiaagefrf qwf SrCC� !Ssrtd jr.rssslge o `Rp � rdrwa�ti �rr�rc(ul cap owlast. � aaarrl aalcaalrol
b. All Gnrplaye�.s Sllilll be SllhjeCl to lirrl(IOIIr l8itln�,
c°. A Ic'til aiaart Ira fatiiaan�ar�l=r<�fi ira lir(� (iPaarl Cirefe is I°outalr,l4rla, c�affra•r tar i+��Nia'r"a"
Iirrfifltar, ra'prgnfah(l log work, carr N [h tNr�r� urfVafefafc of to I��aralail�il�c;(N it(°rdr firarlr(rr..
lllaat
asala,faana°aTM (fr i car gray lryaeaf uffflor tha, iIIC1laa�rfcc- (af rr parrairflfifc(I ilAffaf lraw(Iraff,
sallrsfaafc.r while rare dlaa j(w1a or fh�� t>Irfpalo (, lr�rs rollrlad tgaas (grarp�
iltarrrip; life Nfrsace�s (aI r'!«tarlrlualrgrap; Irr'falralale r.rrars�u I•waa k<,�,ti�arl;« tgac• IrrrpAl(f�^,�a, Nrru
llfaw Vr1;IaI taa Ic^klaae:,p iais rare•site , (O: card lay tae, paaa ra�,(fl,if aaw ailaulaN(wd tar "�„rubfI"
et, i°c.,fin� nrny he required if fill I3rnploycc is inv(�la cd in a rvpr� pflncr
a�"r°iclenllincicl.arl or injure.
37
m lim Vem may nlso be tested on a Voldmtary basis.
1• Sporadic testing as blooded Ruin IU Way be required as I�rrrl ofa frrlbsww wuia pry
counseling or rchataulilrrlirra l rr srubsqurrdee RIMS,-*, for tip to a Iwo (2) ycrrr pe��riod,
fsaela Alrlal�icdrtrl or E1,11lrloycc to he lcxled ww^ill Iro rcrltuirerl to sigur j eotrs rdl :wrrrl
clraltr rwf ouwlody form, assadring Iwrolaed' (lcct�trrrcurtcrliorr and �srcw;wdraey, if rrn
AI:wlrlicarrl or .lirwrlr8oy�e rcfudscs to sil;ut tw llre f
Oneoursrrrt form atdllrorizinl; lire 1«wst,
Ongoing colplcrynterrl' by °ill be oils irrr6l
The Employee shall if the lost results lye I)"'(' for the lime lost for the follrawwiag tests to be conductocl only
arc (WPAlive, Random, Post Accident,11Widenl, and Probnble Cause
"1"Ire Lnrlrloycr grill Pcrrurit the Iadtrl1loycc wwlro is retlwrircwl Icr hrle a r6rwug text 1�o rwbttwidu a
'"Plll xnmpi%h and lbe 1""'drsl7lr�wyce rr9ay rerltdest tips Ialworelod' to lwlirel lire �" i,
rrdd awurerlilu;cl Iaboralor or his clroosirr wl Iris orwlw cxlrrrr. e,Wa�d the edrli Ir plo 1r3
y t,m
Icsl rc^salt of the No sanulrlo rntrsl he released to laic Iwrtwlwloyrr wwithidr cro td�daxitrrun�rr of live
1"Ire.
{ ws^orf irrg drtys. if me slwlit xarrrlrlc test re�sudl is trcgatiwe, lido Iirwrlrl�yee rdaay [rc�
r'a.lrrrrpeti I<a wworI oil lire sadrrc fob ells Previdirrg wwor fod wwlricau lde ix cldraliiir�cl is aslill
awrwil'ablt. Any f:ddrploy^eo wwho swacec"wsfrrliy challr*'" flue are�:ruupr11 rr�f a Irarsiliwe test
rrmstdlt slrn1l I,rc reiurut�rdrxrcl Ibc lrrs ecr5l for B1rc sceond Imlh a said any lhrrebu I`ru" wwrorlti
up ton rnaxin Um of MT C�� Wart Clay, If the sgrl"dI srurrrlrlc lesCS� pso iliw�e, llre,dr tlrr"�
Employee shall be subject to irnmeabatc lcrnrlamion,
Ond1, raid arleAW Iesly ww"ill be cordrldreteci by an necreditcd lab�ralor , , ofcltlrer blood or uriudw tests, cyr both, as required. 131ood le;ls (for clruls and rrle:olrol)
), and my earwm,
w+"ill 60 ultldxcd RXPo�:at acciHO h w°•c�sligalirnr only if n t�ur�irra or brenlhalyrer last cd�rdinol
be ndmasumcl,
V1, IDENTIPIC:A'f10,\' CAlt),
An ICI SAT idenlificaliotr r;rrrr'l wwipl ire issr�wael lrw cwr,r,;lp Ircr'srrud wwluww t��'°sir gweIl,wtiwetm e
a WN hiwlrlid lost, The card' wwi11 rrithe ApPlicmdY n,dm; Irhr°M and a wupiT ,w K i
SAT database identiCrr rdtHm dtnmb.r 11c° U SAT card will hey w^aldrl tdrrl'ul lluam
f mPlurnr tests to o li aj Ilse l�,mi,loy o sbq emrm tlrwwir� v9d ICI SAT enrcN
whliwrc� pj liutr�y me on n job, I'milme twu ln`oclname lire: ICI SAT c�trM on d�amrWal luyP
the 1 trul�alwryer or Ihedr tus,aul krt`uy cmiso It lr
Ire srus
1;`ddrlrlruy^e�*o tt'r lr�,rrclecl nrtlil lire
crud is hreacnlcd iv uddldq it ps w�crifdr.cl Iu)^ lire lexlhdg Nle*ney flout the �rnlwlawyoe^
last lest ws�n, nehculivc. Ilclal,rea*writ, rdfu qcw+;l rr� chrkA�,ayMewtl 11�'I SAT shirr➢I Ir. al
the Employee's e, pe nsc,
b, New hires, wwith an 1C"I a."r I' icPdmnlrlaaeurliewrd w°ard°wta ll" urrp Ap,lrlur�°rrdrl Ir�wx rr w°rrli¢d
lindploycc ICI SAT csr %q l e'v Will Irse ANH 11W cud Iuwr' lrPtnta�r��.trl�wy�urr� pew dprw
hrasPrctiw'e I:nrlrinyer wwrluern Ilreey pre'So'It Ilredprstwlwe,, I"e�d�, e'ndlrl«wynrwaudt" lme
I:nrployci shall haws lhe� tilplrl Crw frrdllrer w°rdlicldle ll�uw' IC'l Sad"l`oar6 la
the ngeucy rc,;lmiisible l ru° drrwurr°idol llic I?urrlrlary: ,r"' ICI LSAT m(I rw I+de.wddllyr
y wruruRa atirdg
wnlid. fhe Alrplicanl swill C+ Irhrwrl ewrr lh< lr�ryrrwli rddrrI Iwwdk ter ww°eau Iru"rttlidrl
t�
rcccipl of (lie resell tar tlua�s trualuiry� 1?awl�loyruwertt slurull Iae Iarsalwrwtirwrwar
continued enwploytneutt of owe individual shall be cawntingent up n the vawli¢o ,I•
Ole Smploycc's ICI SAT card being verllW& 'flue ITuNlayer srhall have wc days
to validate the ICI ,SAT card. Il"AD U SAT cud is iuwvr Nd tlwc loyhycc ,.ill
have no right enwployunu:rwt anwl rnny be tarrnwinntetl,
how hires, wvithowrt Ml .1C'I ,SA`l` card, If the ApplI nt clots not hWve a valid ICI
SA T card, cnuploynwcrut slwall be probationary and curutirutrc:cl eruwlwlrryrnent conlingent wtlwon successftul l)Mjssngc ofthe dntfl and nlcc,�)wrwl tesl„ shall be
When tested Ibr any reason, the 11mployee ww°ill stuurertcl r the KA SAT' card to the
sco
tcslingt agethnt. If the lost is negative, Me I:nululurAVI wrrW IC�"l RAT cud Swill be
returneed. e Lamployee• If the test is positift, the ICI SAT' c ixi wvill not be
VI1, PEIIABILITAT70N AND EtiN1PL0)'F,I; ASSISTANCE PROGRA11l
laaawplcayccs rare encoi raged to ,seek; help for n drag or° alCohoN larsableruu l�rcfcse it
detcrioratas into a discwplanna'y aauatt�*u If an l rwwlwloyce �rol"rntr�wtily urrwtufurs saubefol-e it
that he "my have a snbstanwce abrusc Iwroblenw„ oyer twa,ay assist iuu lr�wcatruwg n
suNtable SAP and rchabthtnttoar lrerogrM r�w for Q2000,I Y 'l;;rwwla�irwya�r., �, 11 infcaurw tlwc
l;rwwployae thaUaiedicnl banelits InuuyIse rwvpail�lwle wrrwdeu Ilue llenitlu a0 °a�"elfatre "ro�flr;uuuw.
l^or [3NOW information, within Indsm, cnNN 1- 00-9624150, 1
If trealnaent necessitates Bowe mqy from Work, the Ilrwwployer MAY providwt fot• the
Employee an unpaid leave Ul' Alasence for lwturposas of gasnlicilmdon iuw wwrp nftrt,o(I wulrorwow
treatment program. An Ernplo)IN ww°luo s;auecessfully c°owwwlwlcCe�s n aellabi9il�wltaf" l'rrol,Polr
may be rcii Owl d to his founuer° cu1116)^wneaul stratus, if w ofk, fswr° wvholw he is clnuwl�if d is
available al (pal lima Gmlalloye s rournd ug to work nner suce",,a lly^ complet'in g
rehabilitation program wjH be stub Q to clrwr, flue
one year. A positive lest wvilN tlweut resirlt ill c6 sc,pl,lJ'JryuJ r iorwura ^ 1rr�lwru o'w�wlyawwalliuwV Pwicid i'gyf
This pmgrma.
VIII, COST — IN, p, previvanuuly noted Nluc costs cal' tests associated with the
praal;r�anw ww�ill be pMd for by the 1s�tnploWr the WAS t'�i t of 1 re wawlwililnlion led
coua;:ailtalaon Willi rw SAP will be Iho, respousibilily Of Ow l'"uwploy0e, I �ranw and
IX SUBSTANCE lJUS1; TESTING I'RO(;ItAL1
I raa�h l:anlw}el^cr swgaetis to lrawy taw Llwc Narrliauu�a C:orpclaar<atr�u°,, luuc�. Sub t,uuuc.�wr skbusc
"1'a,tiwwrt l'rwofkuw Q" l(a �SA1 man cants I�wr cull lemur wol'kewal iwy w�ar.h
l uwalalwsyce ww°awajiilug uuurlca"this A�;u°cw��mcrul. I ash I emwlrl Ver "'luau pnrlia°ilaat sire the
If"N �Sry"I` 1"u rrgarwrrr ij staa rwl,ly crww,u+sue°nl„�wrl tww crnutuitwwutc. I�w the luwrlimet t°uraw,Cawa TO
Nrarlrulua� Aulr�rwn<°u��ruuanl I°turucNIC:Irtl",
).
b� The contdwo�ojj, 1" 1110 ICf SAT Progr'lm slITIll be deposited each month,
filtervC11S ps nlily
W dulurillinedi Or ;J�
(J.'sigmiled by ilia by the, ICI-I.A.D to 1110 depository
f01,11111 Ps oWly bo (fcsl(:i nrid Stich ConWIMlions slmfl be reported on sqrjj
ito I Irj te(j by the IC I .1'rk 1)a
'1"110 ActiMiCs shall be dejell,
1114"Pilcills pravic1ccl for herein)"led by tile Mid sliall be finamed from the
SAT poliay� fly CXCOLItjoil , jllt� 1�ljjploycr rxflrcs�sly rat'rics "d I'doWs the 1c1
of This Agreallient, the I,',,I
taken by th UN-111") Nvidlin flic scope ONts mallority, ployer raNfirs All fictions
This Silbstancc Abmic "roiling Program has been ratified, signed And sealed As of
by the K11.1,ki) And Loc , Al Unions of Laborers' International Union of North
Slate of fildiana Di�slrid Council. Aincrica,
SUBSTANCL AlAPM 'yf�S,I,INC3
-OR CONSENI—ro ])HUG AND AJLCOHOL ANALYST
AUTHORIZATION r PROGRAM
AND s
AUTHORIZATION FOR RELEASE Or RESULTS
1, the undersigned
do hereby malloriz .a tile testing of Iny
e Tcstllts or All And or breath f
And understand And ogroe Ilial III y Such testing �vj or employllient 1'ensolls
r;lnPI0ye,' And the Union, furlher that the testing 11 be turned ovel. 10 the
prohibited and 19 procedures will be limited to tests for
11109111 (111I.Cs AM] controlled substances And Alcohol.
disciplinary understand
(11'11 Ilia 1.0"lls or illcs'� test.) way be used for employment find
lary roasolls and helcby nWhMiZO Ilse rele,,lSe or StIC11
Inborntories it) the designated 1zjlq)joyCj, nII(I Uniones, information from the
I further certify 111,11 any urine, specilljoll collecled froll, Ile
WILIllel-Ilt0d or Altered in nily In., nne,., "lille And not
is
I IIAVe A(16.1,ed (1110 1111401's IIrIC�qjjjg
'111pliCIllion of tile J)Ir(fp' J'()JjC3�' llo.0 S , fie I'allllivo to tileinlerprcLltiuu or
UbjM CxC'j1lLiiV0Iy 10 the �I'i
procedure. udder my C'oljlvtk'c Hargninfrg QvIlIC0. and ni-biti.
, Agrecillent,
. ...... ...
Siplalme
MI
LL7TI.It UI Ulti'pl;1t,STAINI)I1INC:
LETTER I"" U%II)I I'S°I`A II IINCi h"f�11 THE A(IEU'C:iwII NT by and behweco ICI-LRU
alai A Local U1`1611 of Laborers" Illlcrlltlpolraui Up1w Q rAdh America Sm or Indiana
District Cornlcil eclnc"llt 00 faubstnnee Als a "fall, Program.
In regard to the KSubslance Abuse TestingOull Prc�g„�rnen, 1l is understd�o�d behveon the parties
osi under ibis prol„rllm, the follotvillll guideNs will be follolw(,rl when n person tests
I'ltaa, it it�e:
I tt's1 I�oslIL t� —v" (
Results A immediate tenninalion.
hnr ReinslntemcnL
Provide tl Ilegnlivc "SmI°annel US DOT" lest resull ns inlclpreled by an MRO.
Sporadic testing for one, (0 YOU following whulntenlenl.
Results in in)nlecliale (ermination.
For Relnstntelllcnl:
• Be cvnlunled by nn SAP,
• t','onlPlele I'm ASAP eacmmeledc(I r,,I,�buRitaliolt Iuaogrnllr.
Scetll'ss a°riltele ra le xis, froele Me Mu return tcs'rAwm-jl�,
I"Irlw�icl„ a luertruti c^ �r Intact US Do'" test lcsttlt ns itelerlmwd 11, idle NII C),
• Slaclradw Wing for calls (I) year roll�mvilq" lcinstiacntellt.
I Prlr t INeraCl A Ic� i�brlorrL,M r altll�dti 'I, St
Itesulls in inlrnediate (ernlineliorl; not eligible for rcinslatcnlcnl for 51\ (G) I110111h3,
Par Rcinsfill erllcat:
• he Cvnlllnlcd by an SA 1',
• Canlplete all SAP4montlnended rellnbililalion I,ro�ranl.
• Secure written release. Crom the SAP In return to twork.
• Provide n negative "> p:nlel US Wr IcA resull ns interpreted h)' nn h4ko.
• Sllornclic (es(ing far Iwo (?) yenrs bllotvius reinsmlenlenl.
FARTHER it is umlers(nnd Ihnl 1-1111Y ensts nssocinlecl whh Ills SAP, Mao, Rchnbilila(iarl
Pr(1.1'n111, nrld leitllig le(ILI'l0 l (o he rclllstaled, are Ille lilill, ln)'cc's fCSIIUIISIbllllj'.
ME
AGREEMENT
INDIA.NA. CONSTI�UCTpRS
LABOR RELATIONS DIVISION � INC.
� rsroN (r.Cr..LRD)
IIATD
INDIANA/r(ENTU CjCy�orll:o M,
COUNCIL or CARPENTERS
Aril ENTL+ RS
FOR
APRIL, :15 201 - I IARC.r1 31. 2019
Ls:•l%C?l.L'Q-\Cl C_r�a ��c to-ICer tS )U `J5 Art c.q-
AADCL1, XIX
SUBSTANCE A I I liSl„'1'1:S'I'If1 C
SECTION 1,
Itecra tos6rei, Ili,(P iraoJecl twbencrs a�,c(plletlent rcii(Ilnliool, and olhcr cxlaa(•(lsl laressnres lnc�ll necessilnle subslnncc
nb(rsc la slua� , the lelrrlics atunalnnily n rcC Ife Impir"nwcael the 51rlasloee(c a Ahtus(; I eslinl; I"rieiyaw (SAT 1Into s s wild
periderctl (eizslnna ( nlel(sc 4c,lia(ig iw do Cow`tl'Rue e+ dl the SAY I�arnmm wdlor�lrc(1 hcd'10, n" raillihil B.
SECUON 2,
wr h irreJslllr vil Ie,lrl}^ Mit lieis Colh„cIf wo hlni haeieal(e1; AhrCcnrcnd ngycca ku I dy ilpc aCA"I" I"row"
ieCr Iwotra) Jol cccclr Iw(edn° alorked by cwch Clo') c yec ew oaS ireJl (rddilua INdio AlC ., praarll 4i,11
larisi r, ale ww°i0l be eleiaosiRc(I a�nclr oedanpNia, lar n4 toCh didcr rc 1;arl r ilukcrvnPs ns trear}^ NSc "Itewrfllludcak by Cl(c 0 IIK'(S
ws.adbt°Idk, I'duc ccrrske$laldkincws Ian tI9C SAL
C oarttdrtlewls, Inc,. IAbor Relations Diwiiiaaee (%CI•P l(l,}} ko Ileo tN(aao•sidcar � <Iczi�d
Ifrc .,,� i,nhor )t(rlarliafles Idwisioae (ICl•L11 O weeal s(acl( caelddhlhokioroslsl(aeik l c raporlcd rnid l aeolluCf�aanudns elaur.Mkrrdeaaerc,
(I sigapndCsl hp� plec ir(eii"�r(n �otptdr4fclaerr lust, N„waEaiar l(aiculkcrrres C�livisivafp Gt'L1.N"rkd
lec
I nah Eleeiwio er Ia of di° I ilfis (twlYcclie, IJori;(1ui61(i; A rCcrlur(dd Ji� (c� hro(Nuunae C;(vuuskmrrfOw "Northlorlfouws I7iaisiort (ICi•LI(17) slueNI W iacr•unitted, (,rle�r�ar acairecsd, to n(ritlq P,ikiw,
� ca Ilw,ek n u'tiwlaru:scaydwllsrc (tln."sl,lldrnk�"dN lu}� Iluc
pa llecti Iccornls tal Its P nsimt(I r (rr tict, ruruduec o;,aultlaliatcwcu With 00; Au draae, P(1 ¢qpc cwcrel o poer°sad�q Is caeuee111 ow Iaro
co to ore} rlcliflaciacallcs ItIl cc n alcaire(pwf racl„ i:�� r9clu�rullldlc l ther, IIeC(y lIre l;msrl�Ioys"u nl,u°ccs Io he r�espnaesilalas flu,
Rod Iss le"uir, eeli c;�Jw" nssCs naeu�i cafsls tafcopVszwticc� sieclr ilelCila cca+ulrr , Ceracmairpa�laera„ Irrc. I,trlr"af^ Pia,l,'ticoage� I'Ji4�iaiois �'Cti.".i„i.IdC7j iaa lracr cpi�deo(ark cerllccNoiocce�e7f noa kfsd��klcetpacccec� COuat hetli�ueca
SEC;°1`IC,1N 41
II is a psuessl} ngrecrl and undcls4er�('l Ihnl nn cniplo}'cc, Glnployor, or Union 11,1 l(uey �cslccl or propriclor)' inlcresl
!it or ri ,hl to July (prrrueies cona(lull1i; n Ifwrl ofsuch Sulaslwncc Ahusc'I'csling I"'ees rmn,
SECTION S.
Proiv
cuss oflhe Icsls Jissocinled I('ilh
nceonlaIhl; leru� wfw ++ill he pald hrUlll Ille C(11111Ih(IliJilli I(ICllllllcfl III SCCII(In hI
ccnce Will) Irrnu ol'Ihe SAT um.
EMT 11
SIIIIS'k'ANC:I;AI1lISl:'1'I;S'I'lN(- I'ItOC12Af11
I°(llatl"l M+a I r1"I"I„;fldl N1," AIU sli,nrliery i:ynlal(aJefm lore this r'bAgr�� llje-nl and the Union have o
f°(rnconilfnu rdd its l"d°olra I p��ralrh mo irrauieNK mid rn IrrrevuiJ+. o swdB eeorUnn .
a"f4h�� Itrlia"ursnaid Irrol,rnnd Il M r slui4"llrir nail nu,uhari(hr n tlrnl Irec„ wlcohol I'rc�c snfr,�hunl(I )I(r� orl l'"'se
a°draahflf�ufaland Cue( nil0 6 canplor ea s ctwercrl Iola Ihis Al„rraa"rr irpe9�
pEFh\'I'I'IOf\s,
4.,i'+ idcn! Any C e rnI resoidog In injurJ' to it person or prop; rl}' In w1liel( Jill cnyfluyee conlrilfulcd ws
14 (li9Cel ("1' I11(III•del C(Illid,
�i44aa"� ` IJ"l?a° 11 Fe' A lu1lor8600' cerlili0d hl-the Sul"sk,(nce AI(u•ce nn(I Alenlnl I Icnllh 5crvic�s
Aalfltlr(lulu°ldCunw (,�Ai«„IIItiA) lirr Icslioc; oF1'r�rhkbilic'e licu(s "C Suhslnwccs.
19
c, 6clatli+ MLM --To dcgrudu it lesl 54111pIC by stlb%IIIIIIir5U1 nr nddI110Ii or olller IIIgrodiellij Bn nII crl'iirl
tir0sl; tlir pira sclsee of unnulhorltcd drugs. An nclullerIlle^d Iesl shall be considered n positive twist,
cl. Owt I cg,l rsup � — IJritic snewptles tw°hiels the f itborarlor), reports as unncccpinblc ta�ilh rcgnrtls to
Shalthe rec
Iltcrlsttresl levels of"crcatinlisc orspecilic gravlly wvlll Ile raalasidcred ctlhlled snmpies. 9•hc clnployce
itthed Ica provide nnarthwr gsrlPsc" saltllaBe� far Nc�srua
e (.JM1W2Y.Q.. _ Alp hidpvirlalisls ts•ItI' are cowertl by llils Agrcclwlesal, prawwided ilim Individuals rercn•ed
ror curl loyincltl by the U11101i IIWer Ills hprlltg irravislons ad IIIc� hgree1rwelrl me ConsideredAplwhcattgs ' illigil they arc,
and Inn to Work by the Elllidoyer,
f. l Ire .4 L O7m" �"gprllr IqI i� eacrihc,s n lnbrwrnlary I pli0rngar� for IBIe IwI t;cocc Drone Icsl caswrpwtrlcd Ra,y n wa �ip I4 w ccrpificd
! "r°n�rrarslrk. ar wwlotc orlltc flue drtld� ar chwsscs archuis clrschlbc�al tt1l€I'cr the
cicrblrlcwn rwr "iirohlbil�:d pletsls all¢ldwir swlhslances"" nll(l I(sted In 5celiari IV, ") Of the K•N 4A`r
g. Intl Ier — An weal %%"dell has I'll the nllribulcs or oil neeidcnl, e,ec person or properly, apt Ihnl no loran teas caused to
h, ", ctN t na. tail .at .f! .CYAA.i �i' -- "I•Ile h4m) Is It kprcttscP�B irPly pc�irort wt�pear Iltts I to,a Vcrpr,�e cetr
subma v alwllse riisorsl'rs nnsl IIIC altlirwslwsintr; lncll'icral Irnlualurg 10 fikI"rprcl olutp eyalulwte paslliv�c
salts„Inrlec� nlrrrsc t ¢ cesaull; lofcPho:r 4tells IIIc lwadlvialrlal"s nacdiccap Iristrury r1ild atluy' other posiInipt
WrInlecl coil Ntwrlirprow wtiowrr "I be MR0 is dtc hldivld'ao„wl mspons�Ihle ror rcca Itfplwg lniwarI'prwr) rawsalpus.
I"Asrt a1 Ow i rwr I r�cmlcpt3 A urine snnl t. Ihnl the Medical Review Ofliccr (M11O) dclennines ns not
Iwaew I117;y tllrti w:clar6rusrrclpds for n v;did test. Ancreonsullation %vilh the employee,11 rclesl Inny be
p e'w�Isrlr�al,
J @"rgllaB All cmislructiolrf up) silts For which the Employer has responsihilily. 'I•hls lochulos all Jab
rarco+Q orlices rulcl'lilics, land, IiuBldings, slnlclures All ll nil Company vehicles used In the perforluancc
cwP`ctiserexl rvolh.
VmNtiwlk v 1m0 — Pr0bable elitist shall be clalincd AS 0bscn•able 111)n0rtiial or errnlic Itahnt'I0r Buell I's
tiawlicubda' hotihtdnlice, Incoherence nod clisoricnlnlion•
I• L`'6101W ignrrM nnrlrrgt, Sttprsttyll+ ; - Prolrllilteel Sn5hMlnwccs ilt, hJmf w luc,llnl dli°tlgs (ptdrlal:Biniy
wotttlttlNctiol srtll�wi�1ac^0;4, law,il, Ilhkt* dltigl andd[:srf„rM'dnigs), l+rc"scrlls ol; tl'rugs tssc'cp 1iy° alr�" B"arr tvhoru
Ipucya warwrc Intl lwre crib:°tl IBrrI, Iwau°Irlrltcrlialltl III plle� pcssawnnl poscssittts cwl"cs p1oBr1 tt�e:ul l,y, wtuw
s^rutlilrrwt�s. Ott tlut lwitiiwwrhrw Ah,:w ImacwhiprlPeellltr" Irlcolaoll� hcve�rrau�we�s h�„ltag crwrl,tnoiwrc9 Ii)� arr claaplo}•cc
011 the III'volkes,
m I�mfj,Bswtal `ll to — An Im IW IIR' cd test pursunnl to nn nhlcclit•c 11101Ia(I 101. "Ieclion, Cusl ol'such
Pc�liltti talpl Bwc Iriid Inr 6y the InJinu;r C,unslrticlurs, Inc. Subslnllcc Abow 'Icsllug I'rnc;rnnl (ICI S,q'l'
l'ruw4;ro9cetlW)�
n tw^Io upe+IttlutBe,Ii l�Pgw��rlhl�t —Au I;nlplu} cr.illilirovcd cuntidenli;11 c01111301ing servluc, du;lt;ncel I"w hell,
empl ogwyt , Ie,wrlwi Ibis "bills Iluu lnrolve ulcuh0l ardrug nluise, shlfled by ccrlllied laid crcdenlinlud
hntrum scrwice��s p Ol'ar .al0nals.
20
at i,rrNcamMa g— lief�rs to the requirepticatps Ilan1 n person Who IosNcd ltnsilive for prolaibiled INclps
fil1(lFasa' (ala laalaccs 1111(ter the ICI SAT yr rl;rnnl na(Isl snllsr)' bcrore Ile Is eligible In rcllu•p to Welk
Ia- Il-01 --A sccollzl salaGarprlc" less necc=slN}mlcd I�}° Ilea ndllllwroNeal car MI)NcuaNlel}aatllyrgill(Ncd slualtple rar n Iausl,
enarslalcrca! aaral swllNfihlc rna IcstMma A relc9l 111fi1 is craara,lrlered as
(awlacllIrr dmlualataC laagvalli()lIdl� or ulalllle(tpillluall��� Oil a% best tatal sllihtblo rk rcul � I�sllm}� alllaul��al �Ilalaplc
colaslcicrod n l srjllve lesh cl)sll rarrelc Ilalll nccessNla%qc(1 by apra lanlallolrtiola ll dilalNc(1 nm)dPrmr (t Icsd
ca)[tslala��a'c(I IInN slallmalaltw rror Lcsl,,I 1 slrnll lac
)Icllaltarllccicar111Nc111ionnll,yd1low(Isajiaplcwill,,laeNOrorWayslhelbldivldtaalL al Ca) Nsaarrale:slbll,
�� lua
c1. a u.I t aLi c r I�lase tlrftss;gI,,I f$ 1'; a w
1a�}°clam lSlsN sasclll t or1 cr a:n)plope nlsis r lec�icellml
la�awlf ssloarap Isar ichil of I con,iselo( k^ Nli"rfra116
Nitl1olllil Assna 1 tlloaa orAlcnlrnbsll) naa(I I)IIa Abuse (2(saalrs'clors 1.�crt11aa1mllatll C'nlnaulssiaaga
Caa)ra A"(1,;a Garland elln6cnl c�ap�.a r rmlcc ll'1 the cl'iay,rlabsas nncl III"c &BealN asf dm ° Ylhc
rind drlal, alaW$01 tarde�r rclallcp g tr'llh
to filecahol
I'a OT is dsis01` la1 Ilea' COWechnel arltrfat)a IIIaIIr^l(Ialnl's larlaac sl>ecMlllcn INllall Ills*, sarlrsccgaaeaat „lanlrel l�d:
DOT, In)olicM ( id l nl jysh O%earx ht nccnr'(lfiaaec %t^1t1: fetla rnN sN«ntala,ols, 1'°fir a%lcrslaarl, n lard �Is cicl)laU ns
Ilse'% Ofi t) It naucl llcilly^sla nraara 1rmcll140.11 s brr.n(Im slreeharocn In Pecortl,tlac tt„IINa raalrrnl sla(rtlbarrl�;,
a,ant�l od)cn n sl'mcciam4tal fira,al)r� (l la)^ fi laa allaill IWIM Illy tite US 1)(ri'1""s f aayar(yrfeder l maln'la� tl,�l;
III. C'ON�IUF:N7'JALITI'.
ll, All pall kimrs In l is pl'(11 111 11c problem,
,ll a fin)' enydo)'ec t% ilh al subshulcc abuse problem to nccepl
nssistraaacc in denllrr t1llh llt laraablcna, A11 panics will Inke the neccss;u)� nclirnas to assure Ilse
probla mam l hanrllcal Imr n conrWenlinl nannncr„
b, When fi lost 18 to(Illll'ctl, the sllr cinleu will he 1(lell"Ilel b)' n code number associated tsilh n chain or
Cusaody fnrrn to Insure conll(lclllinlil)' orthe engalnycc, °I'hc cnaplopcc (null tviancss Ihis pr(Icedure, r, Itesuhs trill be rcporled In the VIIII)ln)'cr find the lhaion by the A41t0,
Iltllal•:S-1)ISC'll'LllItY AC T'O,\'S_ 6'1111.1'ANU lilt (I(:I;I)t11t1.5
N, IUMJ, -S — A II cnaplgrces Wald I'l I In n'ork Ill phy'slcnl eun(lidou thnl %s III l n;(blr th:ul lu lmerrurul
Ih,1a jobs in n s;lrc and cflicicnI naaouacr, Gngslo)'ces shall nnl:
n• Use pu.asest, dislaell$e ur rcrrirc prnhlbitccl s(Ibslunces nu rn al Ilr, joh site, or cluriu� %%firkin)
hnurs.
I). Itcpnrl Ica truck %till, nllotro the mcnsln'lal'Ic nmoulal ol'Ihc I'ollou ink pl,)hibited suhsltalacc; in Iheir
S%'$ICIII•
I)Itll6,OIt n1G"I'AlI0I,ll'li
INrvIdI,'I'1;5'I" cC)V'I'lltN1A'I'l0lIN'I'l.:
Anylhel1111111e (C�(.YAIs)
(includes Nlclllnnaphrlalnalll,,) tQ(} aiglnil
2>O fig/ml
21
cruulabinold
(Marijuana, I Inslilsh) 54 ng/Inl
IS nglml
cocaine
A 50 Na�lIg11
OPIAN: Morpltblc (,"e,gsls irrc p0 nl.ltu�l
ti AeIlyllrrraN�pslghrr 'rCOO119fptg9
1 Irlrgq l 2,h0d1 nf�d qql
Phencyclirh,1w (I'C"f',) I I) Igthid
(Al25 nllrrtl
I:tlu ncrl e.o4ol 25 of"arlill
AM IV/Vol
(01?yYnre tr°rsny°) 0'I / t°1 qua l
llyrM A Nc/vf'))
500 ne/rttl
NOW dru's nIn , 250 ng/ntl
b I 111 nddcd ns Ihcy are dcicrmined lu Uc Illeg l nr considered 10 tic prahibilcd Ilems nn /or
subslnnccs lays frroulunl ngrcenlcnL
2.' (d"ahug — Witelw itic I Nru �I<N °erg p
tj
lieve
rr pr0lribifarl slr9r511nc1 e IaarlFen"ulI ors lnl`�C�alflNcic ccI,lpIuIYVO�II, Y beep tislaclr csivaoNfllelcsBtlpcsalptlfsglculyca of
n �rgilrrble. II"no Icsf rw .;gllgs are eeceitcd nNr Nllre�e (y) tsaar� !ug Army"s ftlse Crrrlrlcryee, If rrvrgllgr�dalc„ steal
lrrr re�trrrned It, work. rviib b°te°l:� as aqr
1 y srrJw to fllc Icsq re,ullx, I
irlile lesl 1'e51I115 l91'p1'e ncg;llis'e, the
Coses: culployce shall be I'elurned to SVQI'I: tYh11 bncl; p+Iy, In all 0
(ISCS
lllcr
n, Alysliconls Iesling pnsilivc fat° (Irtlg, 113e tp1111101 be llll'e'd,
b. l°rYrlklevoc,s who fel"arse 10 c+3ol3crnlc 1t 1118 Nesgi(1 f 1 feNrarlunliONr 1d"I1ru iur¢Iiviolgrnl (lots nol pryer ir!e at suilablc spccinrl'rN lapglailq Nst'o (2) hours, It tt'ill be
y I lWedures a 111 be sullycaal to 1111111cdlnit: cOtasNrlcle°el N1Ia faasal arrtl lrclafed ns n pOslfiwe lawsf resell and 111 i1-'ll 1 idq 11 will be subject to
hglnrcall,rge tcrrtal11ru11ora„
C. limpinyees lilund to he In the lerminnlcd, possessl0n nl'prohlbileil hats nndlor substances tt•ill be
d. I;nylluyccs found sellinf; nr elish•ihulblg pro!Nlbhed ilcnls and/nrsulrslnnccs tt•ill be lernlilnlccl•
1. B:InNlrler} rye; uhn Icsl nbwhi the u1ItIly,'`Il unlnunl 0l'pn}h!bllcd Ironis and/0r subslunccs us
lrralt Irlesl I'nr 1n 11!• I,b, tt'hllc unduly, nr at•h!Ic 0peralille n c0ulhnnt' vehlcic,'111 I he sub 3
qe1 alrlrroa�d lr,n.
In
First I'nsiltt'c'I'rsl kcsull: hc prns'Isituts below Igapl}' to nn rulpint'ee tt hu is fcslcel purswlnl u1
this policy and W110 reeelt'os n pnc!lit'c lest resell,
I) Cunscqucucr All, l'irsl I'os!1ia'c'I'r'sl Ilesull: The enylhti}r6 i� sagCa�ecl la Inunedialc
Irrmhlul!o16 ullnu notice In the I:ngllnycr by the hlllfi, ul°111e p(rac!'llt'c Icsl resell.
?) IlalrrslnNeus I I tl1a o r y,Ilrlc flat ttarrl traltl tie lairs I Aleu At Irls ear $ cw 1r�Ntse a1
llaaea lsluslelr+
l I'rrrla+l IJ )eD l npprd oar Sul trsl nq tup nlrOra«4t°w�el cluddc, rind Ille tl� �squluI Irl" Ihls b sl h�1t� be»ed1
rINUNIw r'all,a°nn w�A'III�A e^e'rllfiul Iralrua'NN1gar
h•t°arr hlllty undeaalqiP'ia sl lNs tie 10.0
MIT naliwrellt,e fr�h flora lllmd prululaige�'tl hBrrgernd9eNlgrN sulr#latogea.B llsNe,!
10. 0. I I d L,'Ia" the+kl
22
In resuhs.
IV,livc ye I nIcsl ncl the ICI 5A'f program,
aicgAUttion And Gugtlnyer have received lice ce,iiiiecl
3) Sporapllc Test atf Itehreslaled I:nt Ie 'ccs;
tesicai pnsipivc, Is sppC,�ccl to unschcdarleal s arrrrd cticsli nr1 eaitlwlatyec� yv1a+,� has previously
renosinperprcttl. Cost olsptch Testing tvlll helOld for b foroneS y�caar front the dAle of
Y the If:N 4�11"I" 1 roCrant.
6 ScconslPosiliveTcsI Ilcsptll; The
p tla<1'Iaosltivc, roy
and Icsis Ipaasilivat tills j.opMd till ccp0l'sAlunl to si ch rltrudo t Ic Iilloyce lht has previously
crerrtaay ollper lesling llrrtlerllIIs poliicy,
6 sporndle Icslinf;
I) Consequence for Seeatrrid I'osilive Test Resull; "I"lpc c
by Irnploycc Is subJecl to inu,,edi;tic
Ienninallon, upnn ttoplce to the I:uyaln}'cr h;" IIIIC'y, of the positive Icsl result.
Itcaapspariw tnerrt I rt�tltloyc is itoq agiblc for wwork trnlal Ipe hap,, Al lalw awt at cslrcnsc, la ree,
ea^ntoaAl d byl1 Accratllpcd rltfc,sarccessftollYcottaplelerl all SAII-rcenpparprenrlaat rclartbgtlhaatiurr
lrerogaaaret aratal llac SAP Ia„ts pr'rltiarr A Icplcr r lenstat re
S 7 l°ro "r ilue l rsorp lu return in y"Oft, Itrtci the ICtlt
I„ Apaa, Clruloat Aota1 liaatlalrcsy"cr liawva^ resolved Iho respalts ofri ", I'nor;q tIS
npal�trot csl paal, n copy ss1 dre Ic'glcr tvrllpcar b mlae S I natcl n co a
IrrngrAaot sparcessl'oal caranplelloap letter, IAA, Ill taut Alalreroveal clt 'Ic,ann�ol cal CliAkre�l err
rerllPiIle htlaornpor�", naprl Iltc pest restiNrs ptpart9larvm bWl rcvhctvvd by not #�lRo maul eAaepg6tle
CacItt,t1 ro,agtative (asriha Ill, ul1lbliod Items Aitdlaor subsinnces hsleal lta Iq,l la" Y hells a
r1 to„s
3) Sporadic "I'csllptg nl"Ittin,laled lw"ore tin ecs;
rcinshtpdarer nl, ^,�tclelIspeiuslylesled posiPlve, I,s sopltjeclto Iunschedulcl slo
cwt s"such csllut+nac arelesllay91 for oneycar fro,,, the (1nlc ofpA1d for b), lllc lC"I SAT ly(iga°nin,
h, 13ts j gnat y,c 11ilh)nnl I'o)I'c limes
es P ll-S ; 'I'Iw provisgons boluty apply to nn cmpley'cc, tyha
h^sis g tsit o, Ihrep ur mare limes pursonnl to such random teslina., sporadic all
01c 1D Tc,fill)nIlo
h spirt6 lirtalcr ptlalz policy:
I) Consa"queen e^ Etta I'hgrd and r`rd&floppw1 I'n:titlrea� 't'csl a' Ic�ratplot Itcsaulps; c crat1Irelatycc^ is stal r l to
Inpunc�cliAlIlion upetpa itatllce Ira the liaatlrlNrl c, Irey" Ilse a f RO ilte It¢tsil,vc 1 sl resuh
narat iv svIIIapop Nrec eligible Tarrra,irls,gatgcrencnt Ecru ri pciiat�atl awl" s;,w eft) Iapor1cI ,13kit Ics rruthe
Iaasslllt"c° It'
sr,
') ltulit path noP upl: l.rnlregarey'ce Is,,aat cligible for yvo� .p, Iaotlll he pat., Ill 111s awwre^orcyltcnsc"� Irc�"ore
a"Alaa,tical l'I Aaa hacru"cl IA tyre�a " l'� sou �ccsslttll
aural IN Seal" NIA mt SAI )".wcaauolptteruled r4l,atlwliligaoloaatre
lrrngaAatt ittc ar ar I+„tta r p aleras'Iot SAT I'r°ol�onnt, 1110 0111olp And IAIIIIIOYOI Itna","+ tecr;irepeul Itp r(sit 1lts rtllaartaq � tt'rt�p
Altproved IVA, taokcap rut trero nitltr•nveal clinic npw�gyrvu» re . raortl Ilan lC�p
aaaraM planw l p taa,gNis ipato;P h.utdc Gaacat ret"Terre"aP Grw°Aau N nal
Ihfft%poA qe,C tlid tawpq a�cjaaa Iaasq�"wltirew�gyrre
phcpreani'aghllcul NtMattworrptldatuanrabslnuppa'cs Iuslcpl tut Mrr.t.Iu.
3) ponlic Icslaap; Jk Iaohtslnpeacntln>etu s%rerc tnts. thfilutN Itc,slillve Ihrec t
unsc°Nac"doled sl^urtuhe lcsllnl; laver Ireaau >
o arastatlancnl t"o,at atl tiuch rtsGhtg tyllt Grc ,alit for b the It I 1 l' ) or
)y°eaua, I'ar�wnt the d;uc of
I
"l� a�Y'lr�regy lJrlr T lmopalrluwyaa, ia,lnlg n luax�ia"r1'bctl InadIc^atlaotp aalrelcli aat;ty" Ioprp„oqr the 1tc"rt"4aorppnrpran art"
)uwlrrhulres ciptacraaoawoPuaitrrppta+duollrapcprawpp.r,ruparsllrtpltlAlcly'Nnl"c+rap�Nhc'la°scahccs^isata`awfsarasgr
toes sarllalioor rGa°repy trsc". I"rar iltc c pfa^pI° ()Fall c^rtplrla`ty ari «s Ilur lrt deterndltac� h"rt .^'d'assll,ppap�ctrt apt ,r�ltrtrttiplayY cretarltdlies Illocesslly II'n th yllt tIte enqluyee
,1101
,r utt h as^Ian a arC nl"rlan,ca pustrli pr"IeAzecl rrc d7p fasp°ctaupnt' kry° tlpa tar �a rc8tahtptt irel+,h�sl )w i,reAbt Iltott il,trp�� 1a��
23
cntploycc shall be reiaslaled to his former employnte,I status If hark for tehich he is qunlilicd is
available nl Ihnl lintc,
If Ilte csnpaluyee is Icsfed And tfte los! Is poshlvc, nts(l Illo cntptloyec has not previously Informed
,',a f.ntpl to (tflhe tusc nfpo scripllon drugs, Ihc csllpl(Yee otay be suspended for I%vo %vccks and
is strlrjeel lr� tntsol'scdslleu) xpuors(die leslhtg for sl,e ut(anllrs,
'I (Lft " !)eO — All aspects of Iltis program shall be subject to the grievamcc procc(IUI'e spelle(I 011l lu Illc
I oUuctis+e fJnrgalning Agrerntcnl,
��• I)IIp,JGMp,�;(�I���r" �'^f;`�� pf, I'rtu: r1l�lies In (hiS pro�rnnl ngrec lltnl un(Iereel'InilI Circultlslances the
Employer avpfl flstsd Iltnf Nl Is It;cessnt for lesllng to be conducled for prohibhed hems nudlrn'subslunees
pmsts,sns In Nltc far)10Wil191ifouillI1vs,
n, A pre •cstlpwlop•ment drug mid 0Whop lesl III a), be arhtlflVl tc`rad to 0 f I npplicanls srllhouul tt v'aIIt1 pp�I
I" Idrvtllflcalpoo enrd "l"die nppldennf w0l In pinccd on the pnyrolp rand pill to Ivnrk pett¢lin ,
of tho mcl loll llcohnl ido , turlt crn)riny^Itte,tl sNN Ile probalpoltary hn the sense Ilim eDII1111tteal
crtrprlraytstcurol of"Ihc Indivlrlttnl s�lr,tllhe c�ortllosh,asl Irprkip successful ttas+• '^brecaiht
test, l .,ago or the rfrugo oesd Alcohol
b. All cnihlnpecs shnli besobjecl larnndnnt Idling,
c. A lost dut;ty" Ire n¢duspstdslcreal pat 1'1tr cvcttl Ifl rat Is praimble cattse Ira belicu Ihnl Ilia csrtpuh,13,ec Itns
rk°lrorle(l Ir)'sr(rIt. mn(Ner fie lnllau(.rtce Oro prnblfritetfplon onaflor satbslrtus�ce, ass ls� nrbns been under the
Inll(tcncc (rfat pararlyplrptr(f hcas nna° or salrslnrlre ts•ptlle'Itl Idtejod, or Iho crsuployce bns sbee'cd Ibis
(drill, ptrograusu l)ttrbsp, Me pua)cresr ofctlaprplslsdrpg„ proltnblc cruse for Ieslpws k,
rdl;hllsr rr^aptuu. I Ispsotrosiila slewartrildut ptepresetoq pl°na"autdn,bl(M
g Iltc ettsp>froy r has Ihc
d. Testing gamy be required Iraq employee Is Involve(1 In a work pinco nccidoo(Andlent or injury,
a Iiniployces may also he Jested on n vofuntni)• basis,
I: +Ianosr(1ia lcslln(" Css ptrcwvlale(I faar to IV12 ttstty bo te(pIINd as pro,tul (tf It fiapdotw°�trltto caatssssclp�ttp, (�,v
uelstrobtlitotlioil fats stsbsl"'ncc nbu"w' fat,Ipiw Ids mt datie p
tested tt°pq1 lac rr(purlrr"aI I('r s1gn n comeul and cjj;spus Irf r usI«t¢d � f'ortr, stsstu "
YOU l+erlod Each upplicanl or cutspl(rser^ tat lac ttu(I hiv, ncyk if to uaplelpcntti ao csttpl,asce trrftttes Itl sign n cnnseatl f(0rsls 111 horl,(btlg Cdre I051,
osrla�rfit�l c^nlprlos'mr�n1 by° dso pstttployrr st•lfl! pao Iersttlu,tlr(I, y rlut�pto•rop'cr dfuctromcnl�sllott
The employee ah;tll be p;tld for Ilse lime lust for Ihc follow I'
Idls In be cnnductr(I, only If the Icsl results me
leg;dive; rnn(luri, post•nccldenl, Inci(Icnl, nn(I prnbalrla era,
I Itr f smprhtl eu to ill prcrmh Ihat enspj(tx O WhO Is' ra'upilolrod to lai,e tl1 (Ittiab
(aufadnt°,�c ta�y ra,ituw sI Ilue I�sl'tttorslsars^ to s,std I c „spits sntutptfc"' tar out awctedila(I 1�slt(+f) "Spy ofhl's ch(�oshst�
Iry+'I dar (tpaq;ulm n sprfis s;ttttptdr"" nturU Ilre
utatls c prcts f a( (Iart) Work Its 11r "r, Tb,� leel rr'satls (af 9ftr� "*spttlit suuoplr nttu,tl laa+ refwatsc<I tar Idre I ngtdoyr+r toptlpeht ru
pu,swinttatt art lisa (•s) wa(trkdstg (drtt s, II,tluc "spritI sttloptde'" Real r,atsdl I,t suopistllt^;, Clse entptf(rt) t rotas° lue tw�ltprltthill(r
(rrisk errs Ilta� sdssptej,tlr ellr� prptrsdl(fittg tv(rsk Iltr Which III: Istilts„ypiUcd Is slilf ttt�(slbrlale, rkars etnpfry�ec wtpt(r
sue(cs«fulls rlrtlleutlps� Iluc sttcuuna s rrfrtpMsrellitae, lc,I ra"strfl sft�tll ltra rr�Irul"ur' e(f ftra lslscn.cp lieu Ifue sccuwrs(d lb^slp�t(�
st�rnd ads) Il'uaa laasa I1'tiuu eI t k pm I(t ss rss (�wlttsatrst tr9"gtac (gip ar°ailsk dns°s, ifIpuc ""sprlpl s•vatpalat"°toasts aospeco w
t°dtiptgtat'u°,."spr,tdp Ira Sulro�,e,^tl to Iuttptw(xalt,tle lr+rwurltp,tiintl.
d Ihrutlhc
Urt,p)tuul nlranluarl baling Will hr (aandueled by nn uecrcdiled htburnlory, and may caulsl (tfc^Ilhc,• bhtwa(:I nr urine
tliads nr both, Ist te,lttis'r"(l• Ulon(I Ir sls (I. Or drugs and nlc�ihnl) twill be utilized li,r pns�•ncrlsl ran Inrestdsgallnn only
ilia tsupue or Iat +rRhaly m, lest cnnrttri be utlutlnislcre(L
24
VI. II)I:N'I'IRiC'A7'IUN CA ItD,
nr• CMAA at ICI SAT Idenlifrcndlon cdolrJ trill Ile Is,laed to cncla pacrsaisi rrlaaa IawRs iscp riipwc pri n wnllcl list, "floc
The ww'lGl ccrrsllshi Ilac npipsld'c�oit'I aMna ; pahodo IMI � ooiltpwaw' l'C I SA"I' rinln9 orsc pdcriliGicnlla�di luldtisirer,
The ICI �SA I sral' if"v I w�nilaC ihetil Nino craipiloY'ce tests IMIllra'. 'I"Tsai cowapaloycc shall carry llsch� WON
IC.I Irtyo cnrd ww Iaaare °vcr Ill y me �Ir n �rspr. !'�iplare lla rraa ttc�c gplc ! I ,'ri"I' cnrsV rwap rcapauc l Try lllc
I riaprlrrycr or llaclr Apoll Ildny colIX lite mlipwpoyee to lie snspscnalctl snslpl t11 cnrd Is parescoled or IlaillI It
dw wcrillccl Isy Ilic GcsllIM npYcaiU 01 the ewolpluyoc's past tell rs°ss neg,111s°c. ftcitl'Iwu ctrmcuaB alndoss19col W1 rSAT cnrd➢ shall➢ In Ill file crisp inyco s cxfedlsc. or Is przsl' or
4i. l`Icnw Iolres Will$ MA ICI SAS" Ia t"ollcaBp t card,, Ifnod opiprliconal pares n wnlial cuepilarycn ICI tiA"i° eraral
Iliey ww'Ill piresedsl lite cnrd for Photo copry°hag N am paroslieclive IidswpslaiY^cr ea°lecri Ilacy Yarescrid"
Iht asasclwas fart clilpsloyines 1, The Empnlo•yersitnll Idcwc Ggsc rl lil ICr fiarlhtrr wseliiO,alc the IC.G SAT 'd. cdsr I
fry conlscling Glenn cddcy tcsp aresllile fatrlaiswauladp, Ilse cnipilo o! t IC.I;S�r t cI lspsrescailly vwspltlw
Tlpc wtfptlicndiG ww'lii Ire psinecd 011Ilia Impoll MA p ul to wworC pss asdiawd recclpil of lGaai rwwsleld of Ilea.'
liirpiolrp rrapilaiyr+leis➢ slit�ll I prrcgr gBaroyry nddcp conlpnancad emprloyencitl crow Idildiwland"sI spin➢➢ he
ncondldiyycdrl wdptoos Glaenikllty ofGlac cdelpiloY^cc"s let SA"l'cadrel Ircldsg vcrllacJ. "G'Iec preeµloy r sleasgl
o ri lit 10 army to rtnlpclstc Ilse ll, Sul ocnru8 If Iloc NC:1 SAT cliril ps Ilsvnllal„ Igsc ciieprioY°cc ww°llI 'ldowc"
ra�o rigltl to coeePlriuccl crnpilcryisicdld naicl rtr' y lrc Iernisloindrc c1,
e. llcsi° Irlres u'illiColl nn Wl SAT cnrd; If the npplicrpnd aloes nol huw'e it convalpd ICI SA I' cnrd,
empiloyurenl Sin,
i n,II be parobdullorsnr)' Anal continual a:naptloyneenl shall Ix conlingcnl upon successful
p assnge of the drugaal nnlcolloI lest.
rl wI Kali Ic;RcJ' for any reason,'Ile employed will surrender the ICI SATcard Io the telling
de.+d Is etcp;cldlVc, the employee's vnlld ICI SAT cud trill he sent In the cm In cc,
Ins°sidrwc, Ilan ICI SAT cnrd will not Ix rclurned• n��nl If the
Y Vale Icsl is
VII. It MIAIIII I I A"f'ION AND EMPLOY109 ASSIS'fAOWp'.; p'pGC)dpIGAM. Iaaropiinyw««eta altc t*raa autaris�crl dai
sa a I in¢�lpi Gor rd dr°wnp ria" rslcatldasl pro(sicril irafair * lr dclawtiCanradc�s Radar os rdlsr;Iprllan,du I oycec° re nui rasprloYrtit
t nh MIJI.11Y nollfcs saopicr°w°Islazle lPdasd lac lai,ey° have n saalrslnnce lalrsese paruliledds, Ilse l:rseprlaiyc"r rlaray re sise lyd
latcretias g Sultrelnla� SAS' n1r,l rwthashllllndlcn parog un for Ilia
cIrclpiprerrl .p'Ilc IzrtspalCrY"ar wa"TIN lawfcirdu
catepdp0'ee dual 000cclicnl bcncfrds HMy he nwnfNW, Iarwa, dhc Idcsllli nl e 1""clfleraw l'rurp;rnrgw. I"asl° le uaCr�l
Ir fan, ddrrwd icias rd Il '1' -1 l 7.79I.1 •.%),
1p`laa^nCuia,"ass ofnncof;;lduida s plots Dart°np° l�attas tt'roe�, GVtii^ p.asipalaaY^cr Isrtey paottt°Irlµ" f,ta'tlo� t"ruapahpS" °�" ouro truapaTllal
ietiiwc ln�a.raea asrpiwalpbai,c�c nfptliaGleipa,adldorl Iaa trip nY;a'a,'cal wdpiaYn dra"aw" traw "rdirli. A In emptb e,r
i+ho "➢race slaellY caslriprtlr W n ichnirlHWIlm, wooiloae may he rehlsdntc(I to Ilk fnirnner cnapilaaY�dsrcrtd
I d�
sdnitd�, ifwt'arrk for it°bleb lee Is aptttlddlej is nsn0h6la nl dla�il Ilmc, I?ui rp,uroY'e��s reGaol ialua
p ,
str" c Addly coo prlcVHng Hw rrrlt;thllilrallaiol por'argrnars Cadll ire satlayecq IrttorinaraA l ,da ww lgldr uI parlanr uardkc Ilia ds
a a acid rol"Corr. Y c"„wr. A I
paaraltiw c a"•ct ww M linen I°csanll hl a lisiapolid,,ir)' nedlcndr sty psra�a°aa�isaslw rruadl+ n, Ial
Wk lnliip,r��itdt
%'III. COST, faccpl (I.¢ pret'iowl)' nnled, the CNN ol'Ihe ksts nssocinlcd ttilh the prugriuu trill be I,,tid I'ur ht
the limployct'• The cost crl"rt rehabilil,dlaut I,rugru"1 nod curlsullntion tt•pllt nn SAT' tt ill he the
respmtslbilily ol'Ihc clnpnloY'cc,
d i', SIIIIS'I'ANCE AII()SI;'I'ESTI\"C I'ItOGIIABI
l,aa"hl:rinprintw d°kI p1,1Va'Inllwlricliun.1Catdraudnetet�s,luc tiubamd a� �prrne'I'o tlasp,I'rarga�rinu(ICI
r'1) Ihrn a ccriq„r MAN! fear rnch hotar u'ur kesi Iiy^ cawch enip,lrr"t "c' twuehlnaGc trader IlllJ Ap;r cc'ngdenal,
I of h I:mpoll iw'hct p.nrllripiarles ht the ICI 5,�T I'dauY„risen I> �Iawtngl)' casmtipns°aif:e;l to a'aiardribtidtr to Ilia
Ianslinna t:rrdasdr"anctoi:c htdada�laY' Adv,ldd enicitl I^taarCG (pC';pAP}.
25
b, "I lum.� tutalu IlruuClrsa� ln It�a* ICI �� C" I'rol,raceur shnll he lmaualle�rl each pauosaCko, atir At rcgutAr lit tcrvuuds As
uuaa Ise alu &A�ruurlasual lad Ilmc IC:I � 'I. i'aru raudu, Co llro akluos'Ilor} alcs,Il,wuAkcd' lad Chc ICI 5h"I" C ao
Mid suueh connributlauuus strAll Ire r cPOTIod DO such P�ruuds Au +urA Nr ale t ; , �
l as ograns, brnm
�" I W�sl+�al Maly Ibc ICI SAT
c. "I"IM acClwiluca'shAll he dlrCcrub�laucal Ire Clue ICA WJ' I'ro pujuu wuoap sluAll Ise luo��rsca uI Pruran Clrc faAl'uurcuaCs
I b a�V lalc�l Isar IuureIn, IIuc I:nu 'Io cr expresl ruglhes auuut uurEs I qs Iluc IG',P 5h'f altc . II, r w .
r Ctsls olhod°uuocwll, the I;uurolslu 'cv ruuNulics 011 Ae^llu�n, lakcn Iwo° the IM «aA I C'ru) fu,A) w`IINurl, C6 s�clsalac
aaf tl� ausulhourilp�m
rccment. s ner Awe 1'esling 1'rognun has
hgrbeciti rNlCiecl, sighed And sealed As of Che eflccllve dale of ilris
uuenl.
SUhS'i`A NCEAd91J�d" lIs 'I`lyd I'A iRAMALd'l"ll()l$1y,A°Ifl()Nroll
dC11iNW£'l'AI DAI.(!ONOLA PAE.,"hSIS ANDAU I'l l(MUZA'l R)"N d'I}la ltlwd EMl'.n fll" I I: IIpM"d'S
I, the trrrdcrsip;,tretl.._.. �_
Icsling li n % body fluids nnver ilia ► for enrploypuretld rcasorrs rwnd titnla rslttllrl rtmd al;r � Iliad llta trstI Is of nn
alolterlrytutttlirt ire Iltc
such Icsling �� ill be Inrned over to the l� o11plr7ycr aral the f�ullrnt, frprllrcr Plral the leslntdIrrnocrdatt°,cs �nidp be limited
In Icsls for prohlbllcd and Illegal drugs and cclwdrolui l suCasdartees oturl c Ihat1N
I undcrsl that Ise rrsUhs of Iitrsc Icslsatilhorize ilia relensc ofsuclr Inforinalofnmy be Used for ctnploytpctrl and diselplimrp• tenons and hcrebyreprescnnlivcs, ront thelaboraorles In the designated Gmpl('ver.and Unlon
I furlher cerlifY Ihnl any urine spechnen collected from Ilia Is mine mid net ndulleraled or nllered lit ally IltaltIler.
have been advised lhal mailers n%Iing Ilia r0ladlvc to Ilia^ 11ttarsubjeclexcluslvclytothe giavanar aid nrbllradoat proeclmU anpcd"iol o,,npplicaUrl rf the Drugruy i i Cnratit6 [ olica' are
Agrecmcnl,
SignaluronrProspcctivcAprpriierastp�ltraps!'ray �
I .cc
fhUr
27
LT-,'TI'Elt Of UI`1p1:ItS'1°Ah'1)INC
l`(1 1`FR 01 ONI)ERra fANDINfi POR 'I'l if ACIM I'MENT by And bclmell t»dinna Constructors, lnc,
lt'clarlNodds 1)rvosv ClCl I.1tI)p rpgorllhc Indinna/I(c�itlawc )Vollio Ilcglonnl Council ofCnrpenlcrs conccrnin
+triralarwcao Alrawwi; 7"cslud I'rawf,w,oII, Labor
5 the
In raard to the SubslAncc Abusc'I`csling Program, PI Is underslaaod bclwccn the panics Ihnl undo This ro
the followin.0 gt1i(,elinas ►rill be foUusrcd 110 I)crsoil tests positive: P brnuw,
),,"iris l I"rwslir cl°rsl
Resells In Inuncdinlc teranlnnlion
For Ilelnslnlcmrnl;
e Provide n I'dcl rrjilvc "5•Ponel US b0'I-" test rest,,, os interpreted by Ali A9R0.
5pornclic for liod,d for one Mycar foho,rins rcinslalcmedq,
i�n+mtt P' LI4i s "ILCAI
Resells In Immodintc Icnnhimion°
her 11CIFISlnlarnen1;
' il:o cr'aoha"aled 11 rsn ,S'AP,
C"cl��rolsla�lr: nn AI'•rcaronura�enrEcrN rojilb,*IjIltlicarI p,ga ge��ru�.
" �ccory avrli,Caw rOlarrasc ftcalwa INCSAlr to Witrn to Provide Ia dd�Pwadvic'",d°1"raroel US I)t)"1°"+le.�
SG resirlp na Irs6crlucicd by III, AIRO.
pont'Mc Ica@in I+aa milel
).t ye ft,lloaain,b" rcidoslalclncul.
fir all j,IIrI L1llklonnl I,! .1 lir°c'IL°�G
Itcsuhs in luuncdinlc lennlnAllon; not cliglb,e for reinstalcmeil, for six (6) umnlhs.
I'UI• Re III sill lc4lell l;
Uc crnluclted by An SAP.
f c,rorlbladlr nroAI'•rcrasaolun,rltlP�«�I rclarr!'pud'ilnlinn pr°cl:rr�roc
r°�unc wl°IGlcle Icicnse 1'rOW the SAP to "I'astlrou�n to �v^¢a,I,
Provide" itId�'l;atia"at S l'"drwcl [. S 1)01 ", lca,g result ray Iradcd Slw,rcicd by an kIRO,
' oa.adic luksdang AwrI,wo(,?);4°"" tu,GRa�wwiapw rrin,lu�laraVy,"url.
I'lll fired ik PI is urlcicrsluod Ih;il fill), costs nssncinlccl orllb the SAP' N11t0 RchnbllPlnlh,r, I'rugrlmi nn
required IA be rcinshrled. Are the cm ,lu 'ec's
I ) resl,onsibilil)', � clles,ing
28
DEPARTMENT OF THE TREASURY
BUREAU OF THE FISCAL SERVICE
WASHINGTON, DC 20227
Mr. Dino E. Robusto, President
Western Surety Company
151 N. Franklin St.
Chicago, IL 60606
Dear Mr. Robusto;
Your Company's Certificate of Authority to qualify as an acceptable surety and/or reinsurer on Federal
bonds is hereby renewed and will remain in effect until June 30, 2019, unless revoked prior to that date.
On the basis of our review of the Company's Annual Financial Statement as of the close of the last
calendar year, the following underwriting limitation has been established, effective July 1, 2018, under
the renewed Certificate:
POLICYHOLDERS' SURPLUS at December 31, 2017......... ..,.........$1,527,220,637
DEDUCTIONS (See Attached) .................................................. $7,642,527
ADJUSTED POLICYHOLDERS' SURPLUS... .... ..... —.31,519,5783 10
UNDERWRITING LIMITATION................................................$151,958,000
We are following the practice of making no deductions from policyholders' surplus reported where the
amount of adjustment (e.g., for unauthorized reinsurance, inadequate loss reserves, etc.) would have a
nominal effect on the surplus and where it has been determined that the Company is solvent per
Treasury's guidelines. This practice facilitates the review work and should not be interpreted as changing
or nullifying applicable Treasury requirements.
The list of approved sureties (Circular 570) is available on our website at
�rv.lAsc,�11a1iaslir.�owflsi°e,'tsiret"s�ircl°1�i1d,�u►t h�i��c.ite�1. Please disseminate this informationto
your associates, agents, reinsurers and even Government agencies whenever possible.
If you wish to comment on the underwriting limitation established, please contact Pratibha Goel at
(202) 874-7102, immediately.
Enclosure
Sincerely,
Digitally signed by Melvin H.
Melvin H. Saunders sanders
Date: 2018.07.10 09:10:42-04'00'
Melvin Saunders
Manager
Surety Bond Branch
SURETY BOND SECTIO ROADN -- 6515 BELCREST -- RM. 345
HYATTSVILLE, MD 20782 — FAX: (202) 874-9978
INTERNET ADDRESS %vew av�Blc��.igek� �� per�gpat�u Ir" gunirlo��9NaA°� r ��croua.hb�v��
ENCLOSURE
Western Surety Company
DEDUCTIONS
Common Stocks U]
T-Listed Sub: SURETY BONDING COMPANY OF AMERICA ....... $7 64�7
Total Deduction.......................................................................................... $7,642,527
u The common stock of insurance subsidiaries certified by the Treasury, if held by other certified companies, will
be considered a non -admitted asset when determining the parent company's Treasury underwriting limitation. This
valuation method is effective for certifications dated after December 31, 1988, and will be applied to new subsidiary
relationships created by reorganization or by changes in the organization structure of the group due to new
acquisitions or combinations. (See Instruction III of Treasury's Annual Letter dated December 31, 2017.)
List of Projects of Similar Size and Scope of Work Performed Within 3 Years over $100,000
Owner: Town of Eaton, Indiana
Contact Person and Phone No: Travis Hunt — 765 396.3941
Project: Eaton, Indiana WWTP Division A Original Contract Amount $2,071,000
Job Status: Open Engineer: Commonwealth Engineers
Contractor: Cornerstone Stewards
Owner: Metropolitan School District of Wabash County
Contact Person and Phone No: Steve Hojly — i260 568-0447
Project: Southwood Schools WWTP Imp Original Contract Amount $977,945.00
Job Status: Open Engineer: United Consulting
Contractor: Cornerstone Stewards
Owner: Turkey Creek Regional Sewer District
Contact Person and Phone No: Tim Woodward — 574 529-0098
Project: Turkey Creek WWTP Headworks Imp Contract 5 Original Contract Amount $1,203,000
Job Status: Open Engineer: Jones & Henry Engineers
Contractor: Cornerstone Stewards
Owner: City of Wabash, Indiana
Contact Person and Phone No: Bob Grater - (260) 563-2941
Project: Wabash LS#12 Original Contract Amount $128,777
Job Status: Open Engineer: United Consulting
Contractor: Cornerstone Stewards
Owner: City of Fort Wayne, Indiana
Contact Person and Phone No: Pat Dooley - 260 427-2686
Project: Golfview LS Imp Original Contract Amount $226,777
Job Status: Open Engineer: None
Contractor: Cornerstone Stewards
Owner: Town of Milford, Indiana
Contact Person and Phone No: Mark Brubaker - 574 658-4519
Project: Milford WWTP Imp Original Contract Amount $606,000
Job Status: Open Engineer: Wessler Engineering
Contractor: Mason Engineering and Construction
Owner: City of Elkhart, Indiana
Contact Person and Phone No: Dan Pasternak 574 23-2572
Project: Elkhart Grant St PS Original Contract Amount $127,559.00
Job Status: Completed 2018 Engineer: None
Contractor: Cornerstone Stewards
Owner: Town of Albany, Indiana
Contact Person and Phone No: Jerry Scott— 765 '789-6112
Project: Albany WWTP Imp Original Contract Amount $3,040,000
Job Status: Open Engineer: Commonwealth Engineers
Contractor: Mason Engineering and Construction
Owner: City of Fort Wayne, Indiana
Contact Person and Phone No: Chris Ravenscroft— 260 427.2694
Project: Sweetwater Pump Station Original Contract Amount $1,561,000
Job Status: Closed 2018 Engineer: None
Contractor: Mason Engineering and Construction
Owner: Town of Roann, Indiana
Contact Person and Phone No: Jarnes Peil — C765) 83'3.2100
Project: Roann WTP Div A Disinfection Facilities Original Contract Amount $153,900
Job Status: Closed 2017 Engineer: Ladd Engineering
Contractor: Mason Engineering and Construction
Owner: City of Fort Wayne, Indiana
Contact Person and Phone No: Chris Rayenscroft - 2,60 427-2694
Project: Wet Weather Pond 1 & 2 Gates Original Contract Amount $220,000
Job Status: Closed 2017 Engineer: None
Contractor: Mason Engineering and Construction
Owner: City of Coldwater, Michigan
Contact Person and Phone No: Ken De - 517 279 9531
Project: Coldwater MI WWTP Original Contract Amount $2,104,800
Job Status: Closed 2017 Engineer: Fishbeck, Thompson, Carr, & Huber
Contractor: Mason Engineering and Construction
Owner: City of Elkhart, Indiana
Contact Person and Phone No: Dan Pasternak--( 74) 293-2572
Project: Elkhart PS Original Contract Amount $109,659
Job Status: Completed 2017 Engineer: None
Contractor: Mason Engineering and Construction
Owner: Aqua Indiana
Contact Person and Phone No: Michelle Buffenbar er- 26 625-4700
Project: Main Aboite WWTP Non Potable Original Contract Amount $247,500
Job Status: Completed 2017 Engineer: None
Contractor: Mason Engineering and Construction
Owner: Aqua Indiana
Contact Person and Phone No: fames Shields- :31.7 577-1390
Project: Main Aboite WWTP Non Potable Original Contract Amount $183,100
Job Status: Completed 2017 Engineer: Greeley & Hansen
Contractor: Mason Engineering and Construction
Owner: Turkey Creek Regional Sewer District
Contact Person and Phone No: Tim Woodward'- 574 529w0098
Project: Turkey Creek Contract 3 WWTP Original Contract Amount $1,775,000
Job Status: Completed 2016 Engineer: Jones & Henry Engineers
Contractor: Mason Engineering and Construction, Inc.
Owner: City of Goshen, Indiana
Contact Person and Phone No: DustinSal)or - )574) 534-2201
Project:WWTP Headworks Gate Replacement Original Contract Amount $285,196.50
Job Status: Completed 2015/2016 Engineer: Donohue & Associates
Contractor: Mason Engineering and Construction, Inc.
Owner: Aqua Indiana
Contact Person and Phone No: James Shields -)317) 577-1390
Project: Midwest Expansion Facility Expansion Original Contract Amount $4,651,000
Job Status: Completed 2016 Engineer: Aecom
Contractor: Mason Engineering and Construction
Owner: City of Fort Wayne, Indiana
Contact Person and Phone No: Jeana Evlston - 1260) 427-2708
Project: Flocculation Phase III Original Contract Amount $445,808
Job Status: Closed 2015 Engineer: None
Contractor: Mason Engineering and Construction
Owner: City of Elkhart, Indiana
Contact Person and Phone No: Dan Pasternak 574 293-2572
Project: Elkhart CSO 6 & 7 Original Contract Amount $1,215,000
Job Status: Completed 2014/2015 Engineer: DLZ Indiana LLC
Contractor: Mason Engineering and Construction
Owner: Meijer
Contact Person and Phone No: 'Scott La ton - 9,37 667-9601.
Project: Meijer Dairy Pretreatment Original Contract Amount $1,651,800
Job Status: Closed 2014/2015 Engineer: None
Contractor: Mason Engineering and Construction
Owner: Town of Albany, Indiana
Contact Person and Phone No:
Project: Albany Bar Screen Installation
Job Status: Closed 2014
Contractor: Mason Engineering and Construction
Owner: City of South Bend, Indiana
Contact Person and Phone No:
Project: Pump#3 Upgrade
Job Status: Closed 2010
Contractor: Mason Engineering and Construction
Jerry Scott— 765789-611.2
Original Contract Amount $137,329.00
Engineer: None
Jacob KI )sinski _ 74 23S 949fi,
Original Contract Amount $283,000
Engineer: Malcolm Pirnie
BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
Date December 12, 2018
Name Jacob M. Klosinski
Department Utilities Wastewater
BPW Date December 20, 2018 Phone Extension JE.,,35-9496
1111111111111111111111111
Required Prior to Submittal to Board . . . . . ... . ..............
. ................................
Legal Attorney Name Clara McDaniels, Assistant City Attorn�y
Controller Controller review is required for all Contracts $5,000.00 or more and
greater than one year in length per the City Purchasing Policy
Purchasing
mm Check the.
Agreement
Professional Services
F] Bid Opening
] Quote Opening
[:] Change Order No.
[-1 Ease/Encroach.
F-1 Other:
A] Greek, Director of Utilities
............... .. . ..... .
propriate Item Type= _qe gy Lre�d for All Submissions
. ... ......... _.. I. —
El Contract Proposal
El Resolution
�I Bid Award F-1 Req. to Advertise
E] Quote Award
Ej C/O & PCA No. El PCA
Traffic Control
Required Information
Company or Vendor Name Cornerstone Stewards, Inc. (Fort Wayne, Indiana
New Vendor Z Yes F No El If Yes, Approved by Purchasing
MBEANBE Contractor F1 MBE F WBE
MBE/WBE Contractor Requested D No F Yes Name of Company
Project Name WWTP Raw Sewage Pump, No. 2 Rehabilitation
.....................
Project Number 118-020
Addendum
0 Title Sheet
2018 Sewage Works Capital, Wastewater, Treatment and Disposal
Funding Source Equipment
Account No. 642-0630-415-43-66
... — . ...... __ . . ...... ___ ... ...
Amount ........... 370,000.00
Terms of Contract Lump Sum
........... . ........
Purpose/Description The Division of Utilities recommeds the Board of Public Works
award the bid for the subject project to the most responsive,
responsible bidder, Cornerstone Stewards, Inc. (Fort Wayne,
Indiana).
F-1 Required Contractor's Certification Form Attached (Non -
Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc)
Required For Change Orders Only
............
Amount of increase
❑ Decrease
Previous Amount ........ .
Current Percent of Change: %
New Amount $
Total Percent of Change: %
Dispersal After Approval
Copy Original
z F-1 Al Greek, Director of Utilities
z F-1 Jacob M. Klosinski, Assistant City Engineer
z F-1 Susan Zeeb, Director of Wastewater Financial Services