HomeMy WebLinkAboutOpening of Bids - Liberty Tower Exterior Renovations Project No 118-086R - Slatile Roofing and Sheet Metal Co IncCITY OF SOUTH BEND, INDIANA
CONTRACTOR'S BID FOR PUBLIC WORK
Project Name Liberty Tower Exterior Renovations
Project No. 118-086R
For Bids Due January 22, 2019
Date:
Address:
City/State/Zip
PART I
(Must be completed for all bids.
1 /21 /2019 Bidder (Firm):
1703 South Ironwood Dr
Please type or print)
Slatile Roofing and Sheet Metal Co., INC.
South Bend/I N/46613 Telephone Number: A 574 ) 233-7485
Agent of Bidder (if Applicable):
Pursuant to notices given, the undersigned offers to furnish labor and/or material necessary to complete the
public works project of:
Liberty Tower Exterior Renovations
the City of South Bend, Indiana, in accordance with plans and specifications prepared by:
Kil Architecture / Planning
and dated 1 /4/2019 for the sum of (enter the Total Bid as shown on the Proposal)
Division A: Upper Level Roof Work
Two hundred seventy four thousand two hundred eighteen dollars and zero cents. ($ 274,218.00 )
(Enter sum of Total Base Bidplus Alternates shown on Proposal) (Numerical)
Division B: Exterior Concrete Masonry Repair
N/A
(Enter sum of Total Base Bid plus Alternates shown on Proposal)
Division C: 501 Floor Parking Garage Ceiling Insulation and EFIS Finish
N/A
(Enter sum of Total Base Bid plus Alternates shown on Proposal)
Division D: Sidewalk and Curb Replacement Work on Washington Street
N/A
(Enter sum of Total Base Bid plus Alternates shown on Proposal)
$ N/A
(Numerical)
�.�N/A )
(Numerical)
$ N/A
(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 addendurs 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
Version 7/20/2018 Contractors Bid for Public Works - 2
shown in the original contract if accepted by the City of South Bend. If the bid is to be awa d on a unit
basis, the itemization of the units shall be s n o eparatt tta fi) nent .... c,...
By
(Priniert Name of Person Signing) ..
ACCEPTANCE
The above bid is accepted this day of
Subject to the following conditions:
BOARD OF PUBLIC WORKS
Gary A. Gilot, President
Elizabeth A. Maradik, Member
Suzanna M. Fritzberg, Member
Therese J, Dorau, Member
20
James A. Mueller, Member Attest: Linda M. Martin, Clerk
PART II
(For projects of $100,000 or more — IC 36-1-12-4)
These statements to be submitted under oath by each bidder with and as part of his/her/its bid.
Attach additional pages for each section as needed.
SECTION I EXPERIENCE QUESTIONNAIRE
1. Attach information regarding projects your organization has completed for the period of one
(1) year prior to the date of the current bid.
2. Attach a listing of public works projects currently in process of construction by your
organization.
3. Attach information regarding any failure to complete any work awarded to you and the
location thereof.
4. Attach references from private firms for which you have performed work.
SECTION II PLAN AND EQUIPMENT QUESTIONNAIRE
1. Attach an explanation of your plan or layout for performing proposed work. (Examples could
include a narrative of when you could begin work, complete the project, number of workers,
etc, and any other information which you believe would enable the City of South Bend to
consider your bid.)
2. Attach a listing of the names and addresses of all subcontractors (i.e. persons or firms outside
your own firm who have performed part of the work) that you have used on public works
projects during the past five (5) years along with a brief description of the work done by each
subcontractor.
3. If you intend to sublet any portion of the work, attach the name and address of each
subcontractor, equipment to be used by the subcontractor, and whether you will require a
Version 7/20/2018 Contractor's Bid for Public Works - 3
bond. However, if you are unable to currently provide a listing, please understand a listing
must be provided prior to contract approval. Until the completion of the proposed project, you
are under a continuing obligation to immediately notify the City of South Bend in the event that
you subsequently determine that you will use a subcontractor on the proposed project.
4. Attach a listing of equipment you have available to use for the proposed project.
5. Have you entered into contracts or received offers for all materials which substantiate the
prices used in preparing your proposal? If not, attach an explanation for the rationale used
which would corroborate the prices listed.
SECTION III CONTRACTOR'S FINANCIAL STATEMENT
Attachment of bidder's financial statement is mandatory. Any bid submitted without said
financial statement as required by statute shall thereby be rendered invalid. The financial
statement provided hereunder to the City of South Bend awarding the contract must be specific
enough in detail so that said City of South Bend can make a proper determination of the bidder's
capability for completing the project if awarded.
Version 7/20/2018 Contractor's Bid for Public Works - 4
BID/PROPOSAL
CITY OF SOUTH BEND
Project Name: Liberty Tower Exterior Renovations
Project Number: 118-086R
_ M
For Bids Due: January 22, 2019 ,YFs
Contractor Name: Slatile Roofing and Sheet Metal Co., INC.
BASE
BID:. DIVISION A: UPPER LEVEL ROOF WORK
Item®
No
Description Quantity
Unit
T11 otal Amount
1
New Membrane Roof — 20 Year TPO 1
Lump
$264, 218.00
..
Sum
2
Contingency Allowance for Unforseen
Conditions 1
Each
$5,000
3
Contingency Allowance for North
1
Each
Pro erty —L.-
$5,000
DIVISION A: BASE BID TOTAL $274,218.00
BASE BID: DIVISION B: EXTERIOR CONCRETE MASONRY REPAIR AND COATING
Item
No.
Description
Quantity Unit
Total Amount
1
Exterior Concrete Masonry Repair and
1 Lump
N/A
Coatin
Sum
2
Tuck -pointing
400 SF
N/A
3
Soft Joint Backer Rod and Sealant
1500 LFT
NA-
4
Cut Control Joints
350 LFT
N/A
5
Contingency Allowance for Unforseen
�..
_u
Conditions
1 EACH
$5,000
6
Contingency Allowance for North
Pro e
1 EACH
$5,000
DIVISION B: BASE BID TOTAL
N/A
BASE
BID: DIVISION C: MAIN FLOOR STOREFRONT AND VESTIBULE ENTRANCE
Item
.......
No.
Description
Quantity Unit
Total Amount
1
Main floor storefront and vestibule
Lump
entrance
1
Sum
N/A
2
Contingency Allowance for Unforseen
Conditions
1 EACH
$5,000
DIVISION C: BASE BID TOTAL
N/A
BASE BID: DIVISION D: SIDEWALK AND CURB REPLACEMENT WORK ON WASHINGTON ST
Item
No. Description Quantity Unit Total Amount
1 Pavement, Remove 424 SYS N/A
_
2 Curb, Concrete, Remove 155 LFT I
N/A
Version 7/20/2018 Contractors Bid for Public Works - 8
BIDIPROPOSAL
CITY OF SOUTH BEND �� p
Project Name: Liberty Tower Exterior Renovations
Project Number: 118-086R
For Bids Due: January 22, 2019
Contractor Name: Slatile Roofing and Sheet Metal Co., INC.
BASE
BID1 : DIVISION D: SIDEWALK AND CURB
REPLACEMENT
WORK
ON WASHINGTON
ST
3
Surface Milling, Asphalt, 1 '/ IN
117
SYS
N/A
4
Temporary Inlet Protection
3
EACH
N/A
5
.
Tree, Remove
�........
3
�.
EACH
N/A
6
Sidewalk, Concrete
294
SYS
N/A
7
Light Pole Foundation
2
EA
N/A
8
Ornamental Light
2
EA
N/A
9
Handhole
1
EA
N/A
10
NO. 4 Wire
155
LFT
N/A
11
NO.6 Wire
155
LFT
N/A
12
Conduit, PVC, 21N, Schedule 80
150
LFT
N/A
13
Construction Engineering
1
LS
N/A
14
Mobilization/Demobilization
1
LS
N/A
15
Maintaining Traffic (MOT)
1
LS
N/A
16
Concrete Overlay
26
SYS
N/A
17
Repair of spalled/delaminated concrete
15
SF
N/A
on bottom of Main St. Entrance slab
18
HMA Base, Type B
9
TON
N/A
19
_.....
HMA Surface, Type B
11
TON
N/A
21
PCCP For Approach, 6"
.........
92
SYS
N/A
22
Curb and Gutter, Concrete
191
LFT
N/A
23
Line, Thermoplastic, Solid, White, 4in _
200
LFT
N/A
24
Line, Thermoplastic, Solid, Yellow, 4in
34
LFT
N/A
25
Turn Arrow, Thermoplastic, White
1
EACH
N/A
26
Light Standard, Type A
2
EACH
N/A
27
Tree Grate
3
EACH
N/A
28
Ornamental Tree, 2" Caliper
3
EACH
N/A
29 Additional Common Excavation, 10 CYS N/A
Undistributed ......
........
30 Utility Allowance 1 EACH $5,000
31 Allowance for Sidewalk Conditions 1 EACH $5,000
DIVISION D: BASE BID TOTAL N/A
Version 7/20/2018 Contractors Bid for Public Works - 9
BID/PROPOSAL
CITY OF SOUTH BEND
Project Name: Liberty Tower Exterior Renovations
Project Number: 118-086R
For Bids Due: January 22, 2019
Contractor Name: Slatile Roofing and Sheet Metal Co., INC.
Bidder (Firm): Slatile Roofing and Sheet Metal Co., INC.
Address: 1703 South Ironwood Dr _....
City/State/Zip: South Bend/IN/46613 Telephone Number: 57( 4 233-7485
r.
By rwo;";
-
�,-�resident
Gerald Lon erot
(Printed Name of Person Signing)
Version 7/20/2018 Contractor's Bid for Public Works -10
When the prospective Contractor is unable to certify to any of the statements below, it shall allach an e_%planation 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 IN )
SS:
St. Jose h� COUNTY )
The undersigned Contractor, being duly sworn upon his/her/its oath, affirms under the penalties of perjury
that:
1. Contractor has not, nor has any other member, representative, or agent of the firm, company,
corporation or partnership represented by him, entered into any combination, collusion or agreement with
any person relative to the price to be bid by anyone at such letting nor to prevent any person from bidding
nor to induce anyone to refrain from bidding, and that this bid is made without reference to any other bid and
without any agreement, understanding or combination with any other person in reference to such bidding.
Contractor further says that no person or persons, firms, or corporation has, have or will receive directly or
indirectly, any rebate, fee, gift, commission or thing of value on account of such sale; and
2. Contractor certifies by submission of this proposal that neither contractor nor any of its principals
are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from
participation in this transaction by any Federal department or agency; and
3. Contractor has not, nor has any successor to, nor an affiliate of, Contractor, engaged in
investment activities in Iran.
a. For purposes of this Certification, "Iran" means the government of Iran and any agency
or instrumentality of Iran, or as otherwise defined at Ind. Code § 5-22-16.5-5, as
amended from time -to -time.
b. As provided by Ind. Code § 5-22-16.5-8, as amended from time -to -time, a Contractor
is engaged in investment activities in Iran if either:
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 - 5
4. Contractor does not knowingly employ or contract with an unauthorized alien, nor retain any
employee or contract with a person that the Contractor subsequently learns is an unauthorized alien.
Contractor agrees that he/she/it shall enroll in and verify the work eligibility status of all of Contractor's
newly hired employees through the E-Verify Program as defined by I.C. 22-5-1.7-3. Contractor's
documentation of enrollment and participation in the E-Verify Program is included and attached as part of
this bid/quote; and
5. Contractor shall require his/her/its subcontractors performing work under this public contract to
certify that the subcontractors do not knowingly employ or contract with an unauthorized alien, nor retain
any employee or contract with a person that the subcontractor subsequently learns is an unauthorized alien,
and that the subcontractor has enrolled in and is participating in the E-Verify Program. The Contractor agrees
to maintain this certification throughout the term of the contract with the City of South Bend, and understands
that the City may terminate the contract for default if the Contractor fails to cure a breach of this provision
no later than thirty (30) days after being notified by the City.
6. Persons, partnerships, corporations, associations, or joint venturers awarded a contract by the City
of South Bend through its agencies, boards, or commissions shall not discriminate against any employee or
applicant for employment in the performance of a City contract with respect to hire, tenure, terms, conditions,
or privileges of employment, or any matter directly or indirectly related to employment because of race, sex,
religion, color, national origin, ancestry, age, gender expression, gender identity, sexual orientation or
disability that does not affect that person's ability to perform the work.
In awarding contracts for the purchase of work, labor, services, supplies, equipment, materials, or any
combination of the foregoing including, but not limited to, public works contracts awarded under public
bidding laws or other contracts in which public bids are not required by law, the City, its agencies, boards,
or commissions may consider the Contractor's good faith efforts to obtain participation by those Contractors
certified by the State of Indiana as a Minority Business ("MBE") or as a Women's Business Enterprise
("WBE") as a factor in determining the lowest, responsible, responsive bidder.
In no event shall persons or entities seeking the award of a City contract be required to award a subcontract
to an MBE/WBE; however, it may not unlawfully discriminate against said WBE/MBE. A finding of a
discriminatory practice by the City's MBE/WBE Utilization Board shall prohibit that person or entity from
being awarded a City contract for a period of one (1) year from the date of such determination, and such
determination may also be grounds for terminating the contact for which the discriminatory practice or
noncompliance pertains.
7. The undersigned contractor agrees that the following nondiscrimination commitment shall be made
a part of any contract which it may henceforth enter into with the City of South Bend, Indiana or any of its
agencies, boards or commissions.
Contractor agrees not to discriminate against or intimidate any employee or applicant for employment in the
performance of this contract with privileges of employment, or any matter directly or indirectly related to
employment, because of race, religion, color, sex, gender expression, gender identity, sexual orientation,
handicap, national origin or ancestry. Breach of this provision may be regarded as material breach of
contract.
I, the undersigned bidder or agent as contractor on a public works project, understand my statutory
obligations to the use of steel products or foundry products made in the United States (I.C. 5-16-8-1). I hereby
certify that I and all subcontractors employed by me for this project will use steel products or foundry
products made in the United States on this project if awarded. l 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 Contractors Bid for Public Works - 6
may result in forfeiture of contractual payments.
I hereby affirm under the penalties of perjury that the facts and information contained in the foregoing bid
for public works are true and correct.
Dated this 21 st day of January, 2019
Subscribed and sworn to before me this 21 st
My Commission Expires CQ
County of Residence
Teresa Lynn Redick
LNolavy Public aeal 81ateor Indlane
N IKh,art County
Conrmniaanon #/ 7074 4y Cornm issmorn Expres 1 t4M2025
Version 7/20/2018 Contractors Bid for Public Works - 7
� �wlliiiil�
Slatile RoofinrJ g. t ra tO1 o., INC..
Contractor/Bid
Signature of Gont cto r Its ht
A
Gerald Longfs '?resident
Printed Namearr�'lim
0)0v
day of January 21
.. ct:k
Notary Public
�f fill
ow.
1316 COUNTY -CITY BUILDING F PHONE 574/ 235-9251
227 W. JEFFERSON BOULEVARD f J FAX 574/ 235-9171
SOUTH BEND, INDIANA 46601-1830 TDD 574/ 235-5567
w �
1865
CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR
BOARD OF PUBLIC WORKS
Date: Janus 18, 2019
To: All Bidders
From Linda M. Martin, Clerk, Board of Public Works
Subject Addendum Number: 1
Project Name: Liberty Tower Exterior Renovations
Project
Number: 118-086R
ACKNOWLEDGEMENT OF RECEIPT OF ADDENDUM
Date Received: i A �- / I 1
This addendum is being forwarded to you for the above referenced project.
Please sign below and acknowledge receipt of this Addendum
by faxing this sheet to the Board of Public Works at (574) 235-9171.
A copy M S°T' also be included with your bid package upon
submittal.
THIS ADDENDUM MAY AFFECT YOUR BID.
Note:
The attached documents are hereby added to the Specifications and Contract
Documents and become a part of herein.
Company:
S atile Roofing and Sleet , etal Co., INC.
Authorized Signature:
Date: 1/1.8/219
BID OR PROPOSAL BOND
KNOW ALL MEN BY THESE PRESENTS, That we,
Slatile Roofing and Sheet Metal, Inc.
of 1703 S. Ironwood Dr. #A South Bend, IN 46613
(hereinafter called the Principal) as Principal, and PHILADELPHIA INDEMNITY INSURANCE COMPANY, with its
principal office at One Bala Plaza, Suite 100 in the City of Bala Cynwyd, Pennsylvania (hereinafter called the Surety), as Surety,
are held and firmly bound unto
City of South Bend, Indiana Dept. of Public Works
of 227 West Jefferson Blvd. Room 1316 South Bend, IN 46601
(hereinafter called the Obligee) in the penal sum of
Five Percent of the Total Amount Bid
........
Dollars$ ° 5/o ___ .,.......,, _.e lawful money oft_
he United States, for the payment of which sum well and truly to be made,
we bind ourselves, our heirs, executors, administrators, successors, and assigns.
THE CONDITION OF THIS OBLIGATION IS SUCH, that whereas, the Principal has submitted the
accompanying bid dated January 22, 2019 for
Liberty Tower Exterior Renovations, Project No. 118-086R
NOW, THEREFORE, if the Obligee shall make any award according to the terms of said bid and the Principal shall enter
into a contract with said Obligee in accordance with the terms of said bid and give bond for the faithful performance thereof
within the time specified; or if no time is specified within thirty days after the date of said award; or if the Principal shall, in
the case of failure so to do, indemnify the Obligee against any loss the Obligee may suffer directly arising by reason of such
failure, not exceeding the penalty of this bond, then this obligation shall be null and void: otherwise to remain in full force
and virtue.
Signed, sealed and dated: January 18, 2019
Slatile Roofing and Sheet Metal, Inc.
(Principal)
.� .
By: �
PHILADELPHIA INDEMNITY INSURANCE COMPANY
By'�,,
.....,
ttor
David K. Mahler ltey-'n I etc°
S-137-Rev„
1191
PHILADELPHIA INDEMNITY INSURANCE COMPANY
One Bala Plaza, Suite 100
Bala Cynwyd, PA 19004-0950
Power of Attorney
KNOW ALL PERSONS BY THESE PRESENTS: That PHILADELPHIA INDEMNITY INSURANCE COMPANY (the Company), a corporation organized and
existing under the laws of the Commonwealth of Pennsylvania, does hereby constitute and appoint David F. Drum[ or David K. Mahler or Horace A. Nabers III of
Druml Group, Inc., its true and lawful Attorney -in -fact with full authority to execute on its behalf bonds, undertakings, recognizances and other contracts of indemnity
and writings obligatory in the nature thereof, issued in the course of its business and to bind the Company thereby, in an amount not to exceed 150,000ztR00
This Power of Attomey is granted and is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of Directors of
PHILADELPHIA INDEMNITY INSURANCE COMPANY on the 14'h of November, 2016,
RESOLVED: That the Board of Directors hereby authorizes the President or any Vice President of the
Company: (1) Appoint Attorney(s) in Fact and authorize the Attorney(s) in Fact to
execute on behalf of the Company bonds and undertakings, contracts of indemnity and
other writings obligatory in the nature thereof and to attach the seal of the Company
thereto; and (2) to remove, at any time, any such Attorney -in -Fact and revoke the
authority given. And, be it
FURTHER
RESOLVED: That the signatures of such officers and the seal of the Company may be affixed to any
such Power of Attomey or certificate relating thereto by facsimile, and any such Power of
Attorney so executed and certified by facsimile signatures and facsimile seal shall be
valid and binding upon the Company in the future with respect to any bond or
undertaking to which it is attached.
IN TESTIMONY WHEREOF, PHILADELPHIA INDEMNITY INSURANCE COMPANY HAS CAUSED THIS INSTRUMENT TO BE SIGNED AND ITS
CORPORATE SEALTO BE AFFIXED BY ITS AUTHORIZED OFFICE THIS 27TH DAY OF OCTOBER, 2017.
(Seal)
Robert D, O'Leary Jr., President & CEO
Philadelphia Indemnity Insurance Company
On this 27'h day of October, 2017, before me came the individual who executed the preceding instrument, to me personally known, and being by me duly sworn said
that he is the therein described and authorized officer of the PHILADELPHIA INDEMNITY INSURANCE COMPANY; that the seal affixed to said instrument is
the Corporate seal of said Company; that the said Corporate Seal and his signature were duly affixed.
" M ra�7vntswesaW
Notary Public:
tureeeM w f a �rvw,�,am�daw'�"�++M�
rt1w tl:.e»mr p �w �- D�dt �ewf uG rifA�k1
residing at:
(Notary Seal)
My commission expires:
Bala..C,XnH Yaa..pA...._..
Se tember 25 2021
I, Edward Sayago, Corporate Secretary of PHILADELPHIA INDEMNITY INSURANCE COMPANY, do hereby certify that the foregoing resolution of the Board of
Directors and this Power of Attorney issued pursuant thereto on this 27'h day of October, 2017 are true and correct and are still in full force and effect, I do further
certify that Robert D, O'Leary Jr„ who executed the Power of Attorney as President, was on the date of execution of the attached Power of Attorney the duly elected
President of PHILADELPHIA INDEMNITY INSURANCE COMPANY,
..�
In Testimony Whereof I have subscribed my name and affixed the facsimile seal ofeach Company this/
3 day of' 20
Edward Sayago, Corporate Secretary
PHILADELPHIA INDEMNITY INSURANCE COMPANY
rrrrrr
CITY OF SOUTH BEND, INDIANA
CONTRACTOR'S BID FOR PUBLIC WORK
CHECKLIST FOR BIDDERS
Project Name Liberty Tower Exterior Renovations
Project No. 118-08611
For Bids Due January 22, 2019
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
V or Bid Bond.
/ Bid prepared on the City of South Bend Contractor's Bid for Public Work Form, completely
executed.
Contractor's Non -Collusion and Non -Debarment Affidavit, Certification Regarding Investments
with Iran, Employment Eligibility Verification, Non -Discrimination Commitment, and
Certification of use of United States Steel Products or Foundry Products.
Proof of MBEM/BE Participation Goal Form [MWBE-1.0]. If minimum participation goal is not
met, also provide Evidence of Good Faith Efforts Form [MWBE-2.0] and MBE/WBE Contacted
Form [MWBE-2.1].
Acknowledge Receipt of 1 Addendum(s) included with the bid.
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.
T 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: Slatile Roofing and Sheet Metal Co., INC. Date: 1/21/2019
By Authorized Repre ntative: r'" '"
Signature:
r
Print Name & Title: Gerald Longerot -W resident
Version 7/20/2018 Contractors Bid for Public Works -1
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CITY OF SOUTH BEND ,"`" r°8�
MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY
DEVELOPMENT PROGRAM
FORM MWBE-2.0 „
EVIDENCE OF GOOD FAITH EFFORTS
This completedform should be Included as part of the Bids documents related to City of South Bend Public.
Works Projects requiring good Faith Efforts to obtain MBENVBE participation. It Is the bidders sole
responsibility to verify whether ainy 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"y).
Project Number: 118-086R Date: 1 /21 /2019
Project Name: Liberty Tower Exterior Renovations
Bidder: Slatile Roofing and Sheet Metal Co., INC.
Contact Person: Ken Hoy Jr. Telephone: 5742337485
Address: 1703 South Ironwood Dr
City: South Bend state: IN Zip: 46613
Email: kenh@slatileroofing.com
To determine whether a bidder has demonstrated good faith efforts to reach the MBENVBE 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':
tDENCE OF GOOD FAITH EFFORTS
_.. -......_--
MBENUBE 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://Wwwv.in.goy/idoa)
ACTION ADVERTISEICONTACT . In order for our bid to b ( ) y e 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 MBENUBEs of contracting and
subcontracting opportunities.
2. Advertise in general circulation and/or trade association publications concerning subcontracting
opportunities, and allow MBE1WBEs 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 MBENVBE firms.
"*Bidder must circle or otherwise notate which of the two (2) required actions were performed.
OOD FAITH NEGOTIATIONS: The bidder negotiated in good faith with interested MBE/WBEs,
including providing such MBE/WBE's with adequate information about the plans, specifications and other
requirements of the subcontract and did not reject MBE/WBEs as unqualified without sound business
reasons based on a thorough investigation of their capabilities.
/ SMALL CONTRACT(S): The bidder selected specific portions of the work to be performed by
v MBE/WBEs in order to increase the likelihood of meeting the MBENNBE goals (including breaking down
contracts into smaller units to facilitate MBENVBE participation)
CONTRACT RECORDS: The bidder has maintained the following records for each MBENVBE 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 MBENVBE was unqualified to perform the job.
"Proper demonstration of Good Faith Efffortr rejection of the bid b the to all of the above boxes. Any
omissions shall be considered grounds j y and 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 - 12
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY a
DEVELOPMENT PROGRAM
FORM MWBE-2.1
MBEIWBE CONTACTED " M
This completed form should be
ied
Bids that
o City of
whether ang listed minority contacted IW of womto an basin d Faith Efforts.
theme! It t s the bidders sole respoend nsibility bility�t c Works Projects
qualifications of a Minority or Women s owned
business.
PAGE OF
Project Number: 118-086R MBE/WBE Participation Goal
Project Name: Libe Tower Exterior Renovations
Bidder: Slatile Roofinq and Sheet Metal Co., INC.
By: President 1/21/2018
(Signature) (Title) (Date)
MBE/WBE Firm 6pq[los Wetter LLC
Owner or Contact at MBEM/BE Firm Kristi Sn der
Telephone: 7654636774 Fax: Email:.,_
i ��. a aht30.COm
TYPE OF WORK SOLICITED FOR THIS PROJECT:
Waste Removal
RESULTS OF CONTACT WITH THE MBE/WBE FIRM:
ReCelyed pricing_„
MBE/WBE Firm
Owner or Contact at MBE/WBE Firm
Telephone: Fax: Email:
TYPE OF WORK SOLICITED FOR THIS PROJECT:
RESULTS OF CONTACT WITH THE MBE/WBE FIRM:
Version 7/20/2018 Contractor's Bid for Public Works -13
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE § 1189
A notary public or other officer completing this certificate verities only the identity of the individual who signed the
document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.
State of California }
County of San Mateo }
On before me, _. Soy Try Wong,, Notary Public
Date Here Insert Name and Title of the Officer
personally appeared David K. Mahler
Name(s) of Signer(s)
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are
subscribed to the within instrument and acknowledged to me that he/she/they executed the same in
his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s),
or the entity upon behalf of which the person(s) acted, executed the instrument.
SOY TRY WONG
NotaryPublic— California
* San Mateo County
Commission # 2225478
My Comm, Expires Dec 15. 2021
Place Notary Seal Above
I certify under PENALTY OF PERJURY under the laws
of the State of California that the foregoing paragraph
is true and correct.
WITNESS my hand and official seal.
Signature.„ .
oSignatXoNotary Public .. .w._..
OPTIONAL
Though this section is optional, completing this information can deter alteration of the document or
fraudulent reattachment of this form to an unintended document.
Description of Attached Document
Title or Type of Document:
Number of Pages: Signer(s)
Document Date:
Other Than Named Above:
Capacity(ies) Claimed by Signer(s)
Signer's Name: .�.
❑ Corporate Officer — Title(s):
❑ Partner — ❑ Limited El General
❑ Individual ❑ Attorney in Fact
* Trustee ❑ Guardian or Conservator
❑ Other
Signer Is Representing ...__.._. _._
Signer's Name:
Corporate Officer — Title(s):
❑ Partner — ❑ Limited ❑ General
❑ Individual ❑ Attorney in Fact
❑ Trustee ❑ Guardian or Conservator
FA Other:
Signer Is Representing:
02014 National Notary Association • www.NationalNotary.org - 1-800-US NOTARY (1-800-876-6827) Item #5907
CITY OF SOUTH BEND, INDIANA
CONTRACTOR'S BID FOR; PUBLIC WORK
RESPONSIBLE BIDDER CHECKLIST
Project Name Liberty Tower Exterior Renovations
Project No. 118-086R
For Bids Due January 22, 2019
Contractor Name: Slatile Roofing and Sheet Metal Co. INC.
The City seeks to enhance its ability to identify responsive and responsible bidders on all City public works
projects by institution of comprehensive submission requirements in compliance with State law. Quality
workmanship, efficient operation, safety, and timely completion of projects requires that all bidders meet
certain minimum requirements to be responsive and responsible bidders.
THIS FORM MUST BE SUBMITTED WITH YOUR BID.
INSTRUCTIONS:
If you are a pre -qualified bidder, complete Section I only.
If you are not a pre -qualified bidder, complete Section II only.
Section II acts as an application for pre -qualification. Submission of Section II will allow the bidder to be
considered for pre -qualification for bids with the City of South Bend Department of Public Works. Pre -
qualified bidders will then be exempt from a portion of the submission requirements outlined in Section 6-
63 of The Responsible Bidding Ordinance No. 10594-18 (hereinafter, "Responsible Bidding Ordinance")
for a period of twelve (12) months.
Thereafter, contractors who are pre -qualified must submit a complete application for continuation of "pre -
qualified" standing, on a form provided by the City ("Responsible Bidder Checklist (1) Pre -Qualified
Bidders") by December 3181 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 -QUALIFICATION CHECKLIST (FOR BIDDERS THAT ARE NOT PRE -QUALIFIED)
(a) Acknowledgements:
(I)
By checking this box, I hereby acknowledge that I am not a pre -qualified bidder
with the City of South Bend.
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
(iii) V_
information provided to the City shall be regarded as public records.
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
V_
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) V`
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)
years.
Statement about staffing capabilities, including labor sources. This statement
indicates and ensures I have sufficient employees on staffto complete the work I
(v)
am bidding on OR outlines how I intend to meet the staffing needs of the wort.
'Statement that individuals
who wilt perform work on the public worn project on my
behalf will be property classified as an employee or as an independent contractor
under all applicable state and federal taws and local ordinances.
(vi)
Evidence of participation in apprenticeship and training programs, applicable to the
work to he performed on the project, which are approved by and registered with
the United States Department of Labor's Office of Apprenticeship, or its successor
(vii)
organization.
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.
Gerald Longerot -
(Print Name Here)
Slatile Roofing and Sheet Metal Co., INC.
(Name of Company)
1703 South Ironwood Dr
(Address of Company)
South Bend
(City)
IN
(State)
5742337485
(Telephone Number)
Version 7/20/2018 General Conditions -10
1 /18/2019
j (http://www.INBiz.IN.gov)
INBiz: Your one -stop source for your business.
Business Search
Business Search Result
Business ID
194439-082
(/PublicBusinessSearch/BusinessInformation?
busi nessId=136313&businessType= Domestic%20For-
Prof it%20Corporation&isSeries= False)
Page 1 of 1, records 1 to 1 of 1
Return to Search
Registered
Business
Name
Principal Office
Entity Type
Agent Status
Name
Type
Address
Name
1703 S
SLATILE
Domestic
IRONWOOD
ROOFING
LEGAL
GERALD E
For -Profit
DR, SOUTH
Active
AND SHEET
NAME
LONGEROT
Corporation
BEND, IN,
METAL INC
46613, USA
https://bsd.sos.in.gov/publicbusinesssearch 1/1
INDIAN�A
b.. i *.
DEPARTMENT OF LABOR
September 7, 2018
Slatile Roofing and Sheet Metal Company, Inc.
Attention: Joshua Longerot
1703 South Ironwood Drive
South Bend, Indiana 46613
ERIC J. HOLCOMB, GOVERNOR
Rick J. Ruble, Commissioner
402 West Washington Street, Room W195
Indianapolis, Indiana 46204-2751
Phone: (317) 232-2655
Fax: (317) 233-3790
Re: Inspection Number 318098555 Safety Order and Notification of Penalty
issued on August 6, 2018, to Slatile Roofing and Sheet Metal Company, Inc.
Dear Mr. Longerot:
We are in receipt of the petition for review concerning the above which results from
an inspection conducted May 23 to June 22, 2018. Please be advised that we hereby
affirm the Safety Order and Notification of Penalty and grant your petition for review.
Accordingly, we will certify this dispute to the Board of Safety Review.
Sincerely,
Timothy aley
Deputy C missioner abor
indiana O 'HA
TEM/jts
Certified Mail # 7016 3010 0001 0290 1616
An Equal Opportunity Employer
TTNoice: 1 (800) 743-3333
WmJa omal
sae
"DOL
µif ,,„ P INDIAIN .
* DEPARTMENT OF LABOR
September 13, 2018
Sent via U.S Mail, First Class
Mr. Joshua Longerot
Slatile Roofing and Sheet Metal Company, Inc.
1703 South Ironwood Drive
South Bend, IN 46613
ERIC HOLCOMB, GOVERNOR
Rick J. Ruble, Commissioner
402 West Washington Street, Room W195
Indianapolis, Indiana 46204-2751
Phone: (317) 232-2655
Fax: (317) 233-3790
Re: Commissioner of Labor v. Slatile Roofing and Sheet Metal Company, Inc.
IOSHA BSR Docket No.18-024
Dear Mr. Longerot:
Please find enclosed a file -stamped copy of my Appearance and Complainant's Witness
and Exhibit Lists, along with a copy of Complainant's First Interrogatories and Requests for
Production of Documents in the above referenced matter. Your responses to the interrogatories
and requests for production of documents must be received by my office within thirty (30) days
of the date of service.
Please contact me if you have any questions or would like to further discuss this matter.
Enclosures
Sincerely,
J. Anthony Hardman
General Counsel
Indiana Department of Labor
An Equal Opportunity Employer
TTNoice: 1 (800) 743-3333
wwminjogy1clol
THE EMPLOYER IS SATISFIED WITH THE AMENDMENTS STATED ABOVE AND
ACCORDINGLY WAIVES ITS RIGHT TO FILE A NOTICE OF CONTEST OF THE
SAFETY ORDER(S) AND NOTIFICATIONS) OF PENALTY AS AMENDED AND
AGREES TO WITHDRAW ANY PREVIOUSLY FILED NOTICES OF CONTEST IN THIS
MATTER -
Upon full execution of this Settlement Agreement the Employer will post this Agreement for
three (3) working days or until abatement is completed, whichever period is longer.
The Safety Order(s) and Notification(s) of Penalty are, and shall be, herein a final and
enforceable Order of the Board of Safety Review.
Unless other►vise specified herein, the total AGREED PENALTYis due and payable ivithi►:
fifteen (I5) working days from the Employer's execution of this Agreement. The Employer
further agrees that. if Employer fails to make timely payments or fails to pay the full. total
agreed penalty as stated herein, the full. amount of the penalty initially assessed against file
Employer in the Safety Order(s) and Notfcation(s) of Penalty which are file subject of this
Agreement, minus any payments already made, is due and payable immediately to the Indiana
Department of Labor. The Commissioner may use every legal remedy available to collect such
unpaid amount, interest shall begin to accrue on said unpaid amount at the rate of 12% apr
compounded daily, and the Commissioner may collect legal fees from the Employer for any
collection action that may be necessary.
Please make your check or money order payable to `Indiana DOL170SHA," indicate
IOSMA's Inspection Number (indicated above) on your remittance, and send payments to the
following address:
L,/' Indiana Department of Labor
402 West Washington: Street —Room W195
Indianapolis, Indiana 46204
Except for this agreement, and matters arising out of this agreement and any other subsequent
IOSHA proceedings between the parties, none of the foregoing agreements, statements, findings,
and actions taken by Employer shall be deemed an admission by Employer of the allegations
contained within the Safety Order(s) and Notification(s) of Penalty. The agreements, statements,
findings and actions taken herein are made in order to compromise and settle this matter
economically and amicably, and they shall not be used for any other purpose, except as herein
stated.
Roofino and SheofWetal Co no COMAOSS,XOARR OF LABOR
Un
Title: Title:
Date:
SETTLEMENT AGREEMENT
The Commissioner of Labor (hereinafter referred to as "Commissioner") and Slatile Roofing
and Sheet Metal Co Inc (hereinafter referred to as "Employer') hereby agree as follows:
The Commissioner amends the Safety Order(s) and Notification(s) of Penalty, IOSHA Inspection
No. 318098555 issued to the Employer on August 30, 2018, in the following manner.
SAFETY ORDER 01:
Item 1: Upheld; penalty reduced to $ 2.4250.00.
SAFETY ORDER 02:
Item 1: DELETE; penalty reduced to $ 0.00.
Item 2: Upheld; penalty reduced to $ 1,350.00, abatement has been modified until September
30, 2018.
In exchange, The Employer agrees:
1. Refresher training for all employees) who have a safety responsible in a limited scope
Construction Fall Protection and Scaffold safety course, within thirty (30) days of
signed Settlement Agreement, Also provide Competent Person training for supervisors.
2. The Employer shall provide an agenda and the class sign in sheet to IDOL upon
completion of the course.
3. Agreed Plan o PA IVT. Employer may take up to a total. of [121 consecutive
months to pay the total agreed. penalty. Employer shall make one payment of at least
[$ 300.001 each consecutive month until the total agreed penalty of [$ 3,600.001 is paid
in full.; t1�e zz st � ei dzze ivltlz Etrz to er' executiozr o this A reezuezzt
Subsequent payments slzall be dzze b the 20rr' da r of each consecutive month until said
peelz is° atd in ull:
Employer understands that a request must be made in writing to IOSHA for a Petition for
Modification of Abatement prior to the above abatement date if abatement cannot be met by the
respective dates and an extension is required.
above specified amendments all other provisions of Safety Order Number
318098555 ar retained intact.
The TOTAL AGREED PENAL is $ 3,600.00
4, Y I .Z Vyw,4,4
U
r ( % C
' -CLOSING ' ONFERENCE'UWORKSHEET
1926 STANDARDS, CONSTRUCTION., SAFETY.& HEALTH.
State Form 47278 (R14-09)
l
1. Safety & Health Provisions.
2. Environmental Controls
3. PPE & Life Safety Equipment
4. Fire Protection
5. Signs, Signals & Barricades
6. Material Handling
7. Tools, Hand & Power
8. Welding & Cutting
....................
1. Type of inspection I Location
[r
9. Electrical
1o. Scaffolding
11. Fall Protection
12. Cranes, Derricks & Hoists
13. Motor Vehicles & Mechanical Equipment
14. Excavations
15. Concrete & Masonry
16. Steel -Erection
17.
Underground Construction
18.
Demolition
19.
Blasting & Explosives
20.
Power Transmission
21.
Rollover Protection
22.
Stairways & Ladders
23.
Toxic / Hazardous Substances
24.
General Duty
Hazard A (x4--------_-_-
Comments 6 ]
2. Type of Inspactioru Location �- /lip
Hazard - JNb
Hazard - - `� - (a Atau
Comments
Hazard------------------------------------------------ - -- -. - -_- __-_. _ -
Comments
5.
Hazard - - - - -
Comments
Hazard - - - _,------- - - - - - -------------------------------------------------
-
Comments
The aforementioned hazards were noted by the IOSHA Compliance Officer during the onsite inspection of your worksite. The compliance officers recommendations
regarding the above referenced hazards are subject to review by the IOSHA supervisory personnel. You may receive Safety Orders and Notification of
Penalties related to this (OSHA inspection.
_ .... wi pate (month, day. Year)
by
_T_1 ..., . . .
ntcTRtRi ITION- hlte - Employer copy, Canary - Employee Represe tative, Pink -Office
Indiana Department of Labor
Indiana Occupational Safety and Health Administration -
402 West Washington St - Room W195 =,
Indianapolis, IN 46204 axe
Phone: (317)232-1979 FAX: (317)233-3790
Safety Order and Notification of Penalty
To:
Slatile Roofing and Sheet Metal Co Inc
1703 S Ironwood Dr
South Bend, IN 46613
Inspection Site:
2015 Western Ave
South Bend, IN 46619
Inspection Number: 318098555
CSHO ID: L9647
Optional Report No.: 08318
Inspection Date(s): 5/23/2018 - 6/22/2018
Issuance Date: 8/6/2018
The violation(s) described in this Safety Order and
Notification of Penalty is (are) alleged to have occurred
on or about the day(s) the inspection was made unless
otherwise indicated within the description given below.
An inspection of your place of employment has revealed conditions which we believe do not comply with
the provisions of the Indiana Occupational Safety and Health Act (Indiana Code Chapter 22-8-1.1) or the
standards or rules adopted thereunder. Accordingly, enclosed please find safety order(s) and
notification(s) of penalty describing such violation(s) with references to applicable standards, rules, or
provisions of the statute and stating the amount of any penalty(ies).
Informal Conference - Please be advised that it may be possible to informally settle any
potential dispute without initiating the more elaborate proceedings brought on by a petition for
review. Prior to filing a petition for review, you may request an informal conference concerning
any of the results of the inspection (safety orders, penalties, abatement dates, etc.) by contacting
the Indiana Department of Labor/IOSHA, preferably by telephone, in a prompt manner. Please be
advised that a request for an informal conference cannot extend the fifteen working day period for
filing a petition for review. Informal conferences frequently resolve an possible disputes, and
therefore you are urged to take advantage of this opportqnitj. Because of the limited time period
and in order to facilitate scheduling, anv requests for an informal eonference should be made
jgompLly non your receipt of the safety order) and notifications of anal .
Right to Contest - You are hereby also notified that you are entitled to seek administrative review of
the safety order(s), penalty(ies), or both by filing a written petition for review at the above address
postmarked within fifteen working days of your receipt of the safety order(s) and notification(s) of
penalty. ("Working days" means Mondays through Fridays, but does not include Saturdays, Sundays,
legal holidays under a state statute or days on which the Indiana Department of Labor's offices are closed
during regular business hours). If you do not file such a petition for review (contest), the safety order(s)
Safety Order and Notification of Penalty Pagel of 8 OSHA-2 (Rev 1/14)
and penalty(ies) shall be deemed final orders of the Board of Safety Review and not subject to review by
any court or agency. The issuance of a safety order does not constitute a finding that a violation has
occurred unless no petition for review is filed, or if a petition for review (contest) is filed, it must contain a
statement of its basis and should reference the above inspection number. Upon receipt of your petition for
review, we will affirm, amend or dismiss the safety order(s) and notification(s) of penalty. If we affirm,
your petition for review will be granted (unless it was not timely) and the dispute will be certified by the
Board of Safety Review for further proceedings. The Board of Safety Review is an independent agency
appointed by the governor with authority to conduct hearings and to issue decisions concerning disputed
safety order(s) and notification(s) of penalty. If we amend the safety order(s) or notification(s) of penalty,
your petition for review shall be deemed moot. However, you will then be given an opportunity to file a
petition for review concerning the amended safety order(s) and notification(s) of penalty.
Please be advised that an employee or representative of employees may file a petition for review to contest
the reasonableness of the time stated in the safety order(s) for the abatement of any violation.
Posting - Upon receipt of any safety order(s) you are required to post such safety order(s), or a copy
thereof, unedited, at or near each place an alleged violation referred to in the safety order(s) occurred.
However, if your operations are such that it is not practicable to post the safety order(s) at or near each
place of alleged violation, such safety order(s) shall be posted, unedited, in a prominent place where it will
be readily observable by all affected employees. For example, if you are engaged in activities which are
physically dispersed, the safety order(s) may be posted at the location from which the employees operate
to carry out their activities. You must take steps to ensure that the safety order is not altered, defaced, or
covered by other material. Posting shall be until the violation is abated, or for three working days,
whichever is longer. CopQ d F- ` AJ pe>67 -p � Com PAW
13&,1 i" 1 --�-,+ - Ai O pe, r- ra J k et ° 11 sr- 0- 0 ~ , " V -T14 >..# t
Penalties - Penalties are due within fifteen (1) working days of receipt of this notification unless
contested. Abatement does not constitute payment of penalties.
Abatement - The conditions cited in the safety order(s) must be corrected (abated) on or before the
date shown for each item on the safety order(s) and notification(s) of penalty unless:
(1) You file a petition for review concerning the violation, in which case the full abatement period
shall commence from the issuance of a final decision by the Board of Safety Review or the courts which
requires compliance with the safety order; or
(2) The abatement period is extended by the granting of a petition for modification of abatement
date.
PMAs - The petition for modification of abatement date is a manner in which you may seek additional
time to correct (abate) a violation without having to file a petition for review concerning the safety order,
or. after the expiration of the time period to file such a petition for review when it becomes apparent that
you need extra time to abate the violation. A petition for modification of abatement date shall be in
writing and shall include the following information:
(1) All steps you have taken, and the dates of such actions, in an effort to achieve compliance during
the prescribed abatement period.
Safety Order and Notification of Penalty Page 2 of 8 OSHA-2 (Rev 1/14)
(2) The specific additional abatement time necessary in order to achieve compliance.
(3) The reasons such additional time is necessary, including the unavailability of professional or
technical personnel or of materials and equipment, or because necessary construction or alteration of
facilities cannot be completed by the original abatement date.
(4) All available interim steps being . taken
p g en to safeguard employees against the cited hazard during the
abatement period.
(5) A certification that a copy of the petition has been posted, and if appropriate, served on the
authorized representative of affected employees, and a certification of the date upon which such posting
and service was made.
A petition for modification of abatement date shall be filed with the Indiana Department of Labor/IOSHA
no later than the close of the next working day following the date on which abatement was originally
required. A later -filed petition shall be accompanied by the employer's statement of exceptional
circumstances explaining the delay. A copy of such petition shall be posted in a conspicuous place where
all affected employees will have notice thereof or near such location where the violation occurred. The
petition shall remain posted until the time period for the filing of a petition for review of the
Commissioner's granting or denying the petition expires. Where affected employees are represented by an
authorized representative, said representative shall be served a copy of such petition.
Notification of Corrective Action - Correction of the alleged violations which have an abatement
period of thirty (30) days or less should be reported in writing to us promptly upon correction. A "Letter
of Abatement" form and an "Abatement Photographs" worksheet are enclosed for your assistance in
providing adequate documentation of abatement. Reports of corrections should show specific corrective
action on each alleged violation and the date of such action. On alleged violations with abatement periods
of more than thirty (30) days, a written progress report should be submitted, detailing what has been done,
what remains to be done, and the time needed to fully abate each such violation. When the alleged
violation is fully abated, we should be so advised. Timely correction of an alleged violation does not affect
the initial proposed penalty..
Followup Inspections - Please be advised that a followup inspection may be made for the purpose of
ascertaining that you have posted the safety order(s) and corrected the alleged violations. Failure to
correct an alleged violation may result in additional penalties for each day that the violation has not been
corrected.
Employer Discrimination Unlawful - The law prohibits discrimination by an employer against an
employee for filing a complaint or for exercising any rights under this Act. An employee who believes that
he/she has been discriminated against may file a complaint no later than 30 days after the discrimination
occurred with the Indiana Department of Labor/IOSHA at the address shown above.
Notice to Employees - The law gives an employee or his/her representative the opportunity to object
to any abatement date set for a violation if he/she believes the date to be unreasonable. The contest must
be mailed to the Indiana Department of Labor/IOSHA at the address shown above within fifteen (15)
Safety Order and Notification of Penalty Page 3 of 8 OSHA-2 (Rev 1/14)
working days (excluding weekends and State holidays) or receipt by. the employer of this safety order and
penalty.
If you wish additional information, you may direct such requests to us at the address or telephone number
stated above.
Safety Order and Notification of Penalty Page 4 of 8 OSHA-2 (Rev 1/14)
Indiana Department of Labor
NOTICE TO EMPLOYEES OF INFORMAL CONFERENCE
An informal conference has been scheduled with IOSHA to discuss the safety order(s) issued on 8/6/2018.
The conference will be held at the IOSHA office located at 402 West Washington Street, Room W195,
Indianapolis, IN 46204 on at . Employees and/or representatives of
employees have a right to attend an informal conference.
Safety Order and Notification of Penalty Page 5 of 8 OSHA-2 (Rev 1/14)
Indiana Department of Labor
Occupational Safety and Health Administration
Inspection Number: 318098555
Inspection Date(s): 5/23/2018 - 6/22/2018
Issuance Date: 8/6/2018
CSHO ID: L9647
Optional Report No.: 08318
Company Name: Slatile Roofing and Sheet Metal Co Inc
Inspection Site: 2015 Western Ave, South Bend, IN 46619
Saftty Order OI Item 001 Type of Violation: Serious
29 CFR 1926.5 01 (b)(9)(i): Each employee performing overhand bricklaying and related work 6 feet or
more above lower levels was not protected from falling by guardrail systems, safety net systems,
personal fall arrest Is ste or working in a controlled access zone: � � � � � ( �-, + e t p, & Ut PM n1
Roof, south side, 2015 Western Ave, South bend IN 46619, on May 23, 2018, during constmetion 0
activities, two employees performing overhand brick laying 59 feet above lower level, were not protected
from falls.
Date By Which Violation Must Be Abated: Corrected During Inspection
Proposed Penalty: $3,000.00
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Safety Order and Notification of Penalty Page 6 of 8 OSHA-�<Rev 1/14)
Indiana Department of Labor
Occupational Safety and Health Administration
Inspection Number: 318098555
Inspection Date(s): 5/23/2018 - 6/22/2018
Issuance Date: 8/6/2018
CSHO ID: L9647
Optional Report No.: 08318
Company Name: Slatile Roofing and Sheet Metal Co Inc
Inspection Site: 2015 Western Ave, South Bend, IN 46619
Safe Order 02 Item. 001. Type of Violation: Repeat
• . 1 • • • and health programr • not providefor frequent and
regular inspections of the jobsite and equipment by a competent person:
..
• rrr
Roof -south side-2015 Western Ave, South Bend IN 46619-On May 23, 2018, during construction
activities, frequent and regular inspections were not made by the employer's designated competent
person, who was on site where employees were exposed to a hazard such as falls
Date By Which Violation Must Be Abated: 8/30/201.8
Proposed Penalty: $2,400.00
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Safety Order and Notification of Penalty Page 7 of 8 OSHA-2 (Rev 1/14)
Indiana Department of Labor
Occupational Safety and Health Administration
Safe Order and Notification of Penal
Inspection Number: 318098555
Inspection Date(s): 5/23/2018 - 6/22/2018
Issuance Date: 8/6/2018
CSHO ID: L9647
Optional Report No.: 08318
Company Name: Slatile Roofing and Sheet Metal Co Inc
Inspection Site: 2015 Western Ave, South Bend, IN 46619
SgeA Order 02 Item 002 Type of Violation: Repeat
29 CFR 1926.503(b)(1): The employer did not prepare a written certification record containing the name
or other idenity of the employee trained, the dates of the training, and the signature of the person who
conducted the training.
E olo t U10 kC o keB100A -Gk�W M t'Y�1
SAP-A�
(A�Cet Sr
'Joy site,-2015 Western Ave, South. Bend IN 46619- on oe ' ou May 23, 2018, during construction m
activities, the employer did not prepare such record/certification.
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0 12 3, .�� �t fZ , CL C'-'Vt S;'�x e--a
Date By Which Violation Must Be Abated:
Proposed Penalty:
8/30/ 1.8
1, 0 00
Je W. der
IIJ cor o Construction Safety
Safety Order and Notification of Penalty Page 8 of 8
OSHA-2 (Rev 1/14)
'7
Indiana Department of :labor
Indiana Occupational Safety and Health Administration
402 West Washington St - Room W195
Indianapolis, IN 46204
Phone: (317)232-1979 FAX: (317)233-3790
INVOICE/DEBT COLLECTION NOTICE
Company Name: Slatile Roofing and Sheet Metal Co Inc
Inspection Site: 2015 Western Ave, South Bend, IN 46619
Issuance Date: 8/6/2018
Summary of Penalties for Inspection Number: 318098555
Safety Order 1, Serious
= $3,000.00
Safety Order 2, Repeat
= $4,200.00
TOTAL PENALTIES
= $7,200.00
Penalties are due within fifteen (15) working days of receipt of this notification unless contested. Make
your check or money order payable to: "Indiana DOL/IOSHA'. Please indicate IOSHA's Inspection
Number (indicated above) on the remittance.
IOSHA does not agree to any restrictions or conditions or endorsements put on any check or money
order for less than full amount due, and will cash the check or money order as if these restrictions,
conditions, or endorsements do not exist.
Corrective action, taken by you for each alleged violation should be submitted to this office on or about
the abatement dates indicated on the Safety Order and Notification of Penalty.
/11
A wo sheet een provided to assist in providing the required abatement information. A completed
copy f`Ps w r sheet sltuld be posted at the worksite with the safety order(s).
Jerry W. Lander
Direc r of Cory
Safety
p, a ,ems zoia
Date
Safety Order and Notification of Penalty Page 1 (Rev 9/13)
Phone 5741233••74$5
0?�r f� Fax 574/233-753'1
�'�, info@ slatileroofing_corn
www.slatileroofing.com
IT
ROOFING AND SHEET ME1'AL CO, INC,
1703 South Ironwood . South Bend. IN 46613
Indiana Department of Labor
402 W. Washington St.
Indianapolis, IN 46204
RE inspection No. 318098555
We are requesting an informal phone conference. Please contact Jerry Longerot at:
Office: 574-233-7485
Cell: 574-440-2923
Joshua Longerot
Project Manager/Service Department Manager
Slatile Roofing and Sheet Metal Co., Inc.
Phone: (574) 233-7485 ext. 3310
Mobile: (574) 440-5927
josh ual @slatileroofin .corn
PHOTO MOUNTING WORK SHEET
State Form 48593 (R / 8-02)
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(OSHA complaint or inspection number
Date of photo (month, day, year)
Classified material
Safety order number
Time of Photo
Name of photographer .
Item
Re. V i
Photo ID number
❑ am Trade secret material:
❑ nm
Instance number
Location (photograph and photographer)
-----------------------------------------------------------------------------------------------------------
Description of hazard /Abatement
CSHO number. I Report number.
PHOTO MOUNTING WORK SHEET
State Form 48593 (R / 8-02)
Indi
occupationa�!nna Department of Labor
fdt and Health Administration
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(Fasten photograph
here
(OSHA complaint or inspection number
Photo ID number
Date of photo (month, day, year)
Time of Photo
❑ am
Trade secret material:
❑ nm
Classified material
Name of photographer
Safety order number Item
Instance number
Location (photograph and photographer)
------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------
Description of hazard /Abatement
------------------------------------------------------------------------------------------------------------
4 ,
CSHO number.
Report number.
THE EMPLOYER IS SATISFIED WITH THE AMENDMENTS STATED ABOVE AND
ACCORDINGLY WAIVES ITS RIGHT TO FILE A NOTICE OF CONTEST OF THE
SAFETY ORDER(S) AND NOTIFICATIONS) OF PENALTY AS AMENDED AND
AGREES TO WITHDRAW ANY PREVIOUSLY FILED NOTICES OF CONTEST IN THIS
MATTER -
Upon full execution of this Settlement Agreement the Employer will post this Agreement for
three (3) worldng days or until abatement is completed, whichever period is longer.
The Safety Order(s) and Notification(s) of Penalty are, and shall be, herein a final and
enforceable Order of the Board of Safety Review.
Unless otherwise specified herein, the total AGREED PENAL T Ty is due and payable within
fifteen (IS) working clays from. the Employer's execution of this Agreement. The Employer
further agrees that if Employer fails to make timely payments or fails to pay the full. total
agreed penalty as stated herein, the full amount of the penalty initially assessed against tine
Employer in th a ,Safcop Order(s) and Notfcation(s) of Penalty which are the subject of this
Agreement, Yninus any payments already made, is due anal payable immediately to the Indiana
Department of Labor. The Commissioner may use every legal remedy available to collect such
unpaid amount, interest shall begin to accrue on said unpaid amount at the rate of 12 % apr
compounded daily, and the Commissioner may collect legal fees from the Employer for any
collection action that may be necessary.
Please make your check or money order payable to "Indiana DOL/I0SHA,11 indicate
IOSIYA's Inspection Number (indicated above) on your remittance, and send payments to the
following addres.p:
ndiana Department of Labor
402 TYest Washington Street —Room WI95
1'ndianapolis, Indiana 46204
Except for this a;,►reement, and matters arising out of this agreement and any other subsequent
IOSHA proceedin gs between the parties, none of the foregoing agreements, statements, findings,
and actions taken by Employer shall be deemed an admission by Employer of the allegations
contained within t lie Safety Order(s) and Notification(s) of Penalty. The agreements, statements,
findings and actions taken herein are made in order to compromise and settle this matter
economically and ;imicably, and they shall not be used for any other purpose, except as herein
stated.
Slatile Roofing and Sheet Metal Co Inc COMMISSIONER OF'LABOR
BY'.. �.m.. By
Title: Title:
Date: Date:
October 3, 2018
iv --Key Personnel
• Gerald Longerot-President; 50 years experience
• Ann Longerot-Sec/Treas.; 34 years experience
• Ken Hoy Jr.-Superintendant; 28 years experience
• Wendell Simmons -Project Manager -Roofing; 25 years experience
• Josh Longerot-Masonry Project Manager; 10 years experience
• Jim Polk -Materials Manager; 22 years experience
• Michael Albert -Assistant Project Manager; 2 year experience
• Ryan Gramza-Manager of Sheet Metal Shop; 22 years experience
• Dan Lewis —Manager of Service; 5 years
• Teresa Redick —Office Manger 2 years, Previous Owner of a Business 30 years
• Lou Ann Ward —Controller 13 years; Previous Experience 20 years.
• Robert Davis—Superintendant of Jobs and Workers, 30Years roofer
Field Employees
• Roofers: 29 Full Time Roofers with 84% Journeymen Roofers, All are trained thru JATC
• Sheet Metal : 5 Full Time Sheet Metal Employees, 3 Journeymen
• Masonry: 4 Fulltime all Journeymen Masons.
• Warehouse and Drivers: We have one full time warehouse employee that is a Journeyman
roofer for 22 years, 2 truck drivers that are CDL Class A drivers and one mechanic.
v--No outside services or contract labor will be used on this job.
"t,
IN
1111MI'villilli "llk,
NORTHWEST INDIANA
INDEX PAGE
Introduction
I
The Policy
I
Definitions
3
Drug Testing
8
Drug Group
9
Alcohol Testing
10
Payment for Testing
10
Initial Testing (Pre -employment)
10
Random Testing
11
Probable Cause Testing
11
Post-Accident/Incident Testing
12
"Emergency" Work Assignment
12
Card System
13
Status Confirmation
13
Insufficient Specimen
14
Diluted Specimen
14
Adulterated, Substituted, &/or Out -of -Temperature Range
14
Consequences for a Positive Test
15
Return -to -Duty Testing
15
Follow-up Testing
16
Disputed Positive Results
16
Appeals & Protections
16
BUILDING AND CONSTRUCTION RESOURCE CENTER, INC.
INTRODUCTION
The labor and management representative of The Building and Construction Industry for
Northwest Indiana have formed an alliance to address the problems caused by drug and
alcohol abuse. Management and labor have created the Building and Construction
Resource Center (hereafter `BCRC") an independent not -for -profit corporation which
offers a wide range of services to its employees in the unionized construction industry,
which include employers, labor union organizations, construction industry and related
workers. It is BCRC's goal to assist employers to establish and maintain workplaces that
are free of destructive effects causes when employees use drugs and/or abuse alcohol.
BCRC's activities are not intended to interfere with normal practices of the unions or
management. BCRC recognizes its responsibility to communicate with and educate its
employees relative to this policy, as well as the harmful effects of drugs and alcohol in
our society and in the workplace. BCRC also recognizes the need to provide a program
of assistance to those persons for whom drugs or alcohol may be causing problems.
Finally, while not wishing to violate the rights or invade the privacy of any employee,
BCRC's drug testing program will seek to identify those employees who are unable or
unwilling to conform to BCRC's program. This program has been established in
accordance with federal guidelines for specimen collection, laboratory analysis and
review, and standards of integrity and confidentiality.
THE POLICY
Person who use illegal drugs or abuse alcohol or other controlled substances, on or off
their jobs, are likely to be less productive, to be less reliable, to be more frequently absent
and to have other work related problems that can cause increased cost, delays, accidents
and injuries. These employees can also damage the health, safety and well-being of other
workers on the job. The unionized construction industry can control and reduce this
problem through recognition of the problem, development of a comprehensive policy and
program of education and information, promotion of an assistance program, and
implementation of fair and respectful drug testing that conforms to federal guidelines for
specimen collection and analysis. All of this is to be done with the utmost confidentiality
and respect for the individual.
In order to enhance substance abuse awareness among all employees, educational
seminars and training programs will be offered. The educational seminars will be
directed toward education about the seriousness of the nationwide problem of drug and
alcohol abuse, and how the use of drugs and alcohol negatively impacts safety,
productivity, and the competitive ability of the American workforce.
Supervisors will be trained to identify employees in potentially difficult situations, and to
recognize signs of impairment, as well as the supervisors' responsibility to document,
intervene and follow up with the troubled individual. These sessions will be offered as
ongoing training programs
BCRC encourages all employees troubled by their own, a family member's drug, or
alcohol abuse to seek professional care and treatment. Early recognition and treatment of
alcohol and drug abuse provides the greatest opportunity for successful recovery. BCRC
provides an Employee Assistance Program (EAP) for all employees and their families
who need professional guidance in assessing their substance abuse or alcohol -related
problem and choosing an appropriate course of treatment. Current employees will be
referred to an EAP representative as a result of a positive drug test or alcohol or upon an
individual's own request. In either case, the content of the discussion with the EAP will
be protected and confidential, to the extent allowed by law. Employees who use the EAP
as a consequence of a positive drug or alcohol test will be subject to the conditions
established in the drug -testing portion of this policy.
The EAP staff has knowledge of the level and types of benefits available to BCRS
employees. Employees can access the services of the EAP through a hotline that is
staffed twenty-four (24) hours a day, seven (7) days a week, throughout the entire year.
Employees calling the EAP hotline are put in touch with a counselor who will conduct a
professional assessment and who may meet with them to further assess the nature of the
problem in order to provide a referral to the best and most appropriate level of care. The
EAP is staffed by certified and credentialed human service professionals who are
sensitive to the needs of the individual. Individuals who take the initiative to contact the
EAP for assistance do so with the assurance that their calls will be treated respectfully
and confidentially. The direct services provided by the EAP are sponsored by BCRC.
In compliance with Public Law 100-690 (the Drug -Free Workplace Act), which applies
only to employers who have federal grants or federal contracts of more than $100,000, an
employee who is convicted of a workplace drug or alcohol violation and who is
employed by a BCRC affiliated employer must report this information to his/her
immediate supervisor no later than five (5) days after such conviction. The supervisor
must report this information immediately to the employer/s Program Administrator.
DEFnLITIONS
0 Adulterated specimen means a specimen that contains a substance that is not
expected to be present in human urine, or contains a substance expected to be present
but is at a concentration so high that it is not consistent with human urine.
# Air blank means, in evidential breath testing devices (EBTs) using gas
chromatography tecluiology, a reading of the device's internal standard. In all other
EBTs, a reading of ambient air containing no alcohol.
0 Alcohol means the intoxicating agent in beverage alcohol, ethyl alcohol, or other low
molecular weight alcohol including methyl and isopropyl alcohol.
o Alcohol concentration for content means the alcohol in a volume of breath
expressed in terms of grams of alcohol per 2 10 liters of breath as indicated by an
evidential breath test under this policy (BrA Q.
o Alcohol confirmation test means a subsequent test using an EBT, following a
screening test with a result of 0.04 or greater, which provides quantitative data about
the alcohol concentration.
0 Alcohol. Screening Device LASD) means a breath device, other than an EBT, that is
approved by the National Highway Traffic Safety Administration (NHTSA) and
placed on a conforming products list (CPL) for such devices.
0 Alcohol screening test means an analytic procedure to determine whether an
employee may have a prohibited concentration of alcohol in a breath specimen.
o Alcohol testing site m
' eans a place selected by the employer where employees present
themselves for the purpose of providing breath for an alcohol test.
o Alcohol use means the drinking or swallowing of any beverage, liquid mixture or
preparation (including any medication), containing alcohol.
a Applicant means a person, independent contractor, or employer who applies to
become an employee of a BCRC contractor/employer participant, and includes a
person who has received a job offer made contingent on the person passing a drug
test.
• 6ssociation means Building and Construction Resource Center, which is the
association formed by labor and management representatives of the building and
construction industry for Northwest Indiana, for the purpose of addressing problems
of drugs and alcohol in the workplace.
• Blinds ecimen or blind performance test specimen means a specimen submitted
to a laboratory for quality control testing purposes, with a fictitious identifier, so that
the laboratory cannot distinguish it from an employee specimen.
• Breath Alcoliolrechnician, (BAT) is a person who instructs and assists employees
in the alcohol testing process and operates, an Evidential Breath Testing device
(EBT).
• Canceled test means a drug or alcohol test that has a problem identified that cannot
be or has not been corrected. A canceled test is neither a positive nor a negative test.
An employer is not permitted to take adverse job action based on a canceled test.
• Card manager is the individual designated by each employer who has the authority
to access data information that will confirm the status of employees through the call-
in system, through the BCRC scanner by swiping employees' identification cars, or
by electron e-mail.
• Chain of custody means the procedure used to document the handling of the
specimen from the time the employee gives the specimen to the collector until the
specimen is destroyed.
• Collection container means a container into which the employee urinates to provide
the specimen for a drug test.
• Collection site means a place designated by BCRC where individuals present
themselves for the purpose of providing a specimen to be analyzed for the presence of
controlled substances, or for purposes of providing breath sample to be analyzed for
alcohol concentration.
• Collector means a person who instructs and assists employees at a collection site,
who receives and makes an initial inspection of the specimen, provide by those
employees, and who initiates and completes necessary forms.
• Company means an employer who is a member of Building and Construction
Resource Center.
• Confirmation or confirmato drug test means a second (2) analytical procedure
performed on a urine specimen to identify and quantify the presence of a specific
drug or drug metabolite.
• Confirmation for confirmatoryl validity test means a second test performed on a
urine specimen to further support a validity test result.
• Confirmed drue test means a confirmation test result received by a MRO from a
laboratory.
• Confirmatory test
a) For alcohol testing, a confirmatory test is a second test following a screening test
with a result of 0.02 or greater, conducted 15-30 minutes later, that provides
quantitative data of alcohol concentration. This test is conducted on an EBT.
b) For controlled substances testing, a confirmatory test is a second analytical
procedure to identify the presence of a specific drug or metabolite. This
confirmatory test is independent of the initial test and uses a different technique
and chemical principle from that of the screening test in order to ensure reliability
and accuracy.
• Contractor Participant means an employer who is a contributing member of
Building and Construction Resource Center.
• Controlled Substance means marijuana (THC), cocaine, opiates, phencyclidine
(PCP), amphetamines (including methamphetamines), barbiturates, benzodiazepine,
propoxyphene, methadone and ecstasy.
• DHHS means the Department of Health and Human Services or any designee of the
Secretary, Department of Health and Human Services.
• DH:IIS-a roved laboratory means a laboratory that is certified by the U.S.
Department of Health and Human Services. Drug test under this program will be
performed by a DHHS-certified laboratory.
• Desi nated Ern to er Representative fDERImeans the Human Resource Manager,
Card Manager, Program Administrator or similar designee of each employer who
shall receive necessary communications related to this program.
• Diloite s pecinien means a specimen with creatinine and specific gravity values that
are lower than expected for human urine.
• DOT weans U.D. Department of Transportation. Many of DOT's standards and
procedures related to drug and alcohol testing are mirrored in BCRC's drug and
alcohol policy.
• Drugs mean the substances for which tests are required under this policy and include
marijuana (THC), cocaine, amphetamines (including methamphetamines),
phensyclidine (PCP), opiates, barbiturates, benzodiazepine, propoxyphene,
methadone and ecstasy.
• D.Tug test means a test conducted for controlled substances.
• l �np,oyee means an employee of a company, or of a contractor/employer participant
who is a member of Building and Construction Resource Center.
• Employee Assistance Program (EAP) Counselor means a rnasters-level
professional with an education in psychology, social work, counseling, etc. with
knowledge of and clinical experience in diagnosis and treatment of alcohol and
controlled recommendations concerning education, treatment, follow-up testing and
aftercare.
• ;E�ver means a company, or a contractor/employer participant, who is a member
of Building and Construction Resource Center.
• Evidential Breath Testing Device LEB'l means a device approved by Nlm TSA for
the evidential testing of breath at ,04 alcohol concentrations, placed. on NHTSA's
Conforming Products List (CPL) for "Evidential Breath Measurement Devices" and
identified on the CPL as conforming with the model specifications available from
NHTSA's Traffic Safety Program.
• First Occurrence Clause means if an employee does not report for a random test,
and it is the first time the employee has failed to report, the Third Party Administrator
(TPA) may allow the employee to take the test without reporting to the EAP for
further review. Employees may utilize this clause only one time.
• Initial test for dru s means an immunoassay screen to eliminate negative urine
specimens from further consideration.
• Initial validitv test means the result of a drug test for a urine specimen that contains
an unidentified adulterant or an unidentified interfering substance, has abnormal
physical characteristics, or has an endogenous substance at an abnormal concentration
that prevents the laboratory from completing or obtaining a valid drug test result.
• Lab raton means an U.S. laboratory certified by DHHS under the National
Laboratory Certification Program as meeting the minimum standards of Subpart C of
the DHHS Mandatory Guidelines for Federal Workplace Drug Testing Programs.
• Licensed medical practitioner means a person who is licensed, certified, and/or
registered, in accordance with applicable Federal, State, local or foreign laws and
regulations, to prescribe controlled substances and other drugs.
• Medical Review Officer means a licensed physician responsible for receiving
laboratory results generated by BCRC's drug testing program who has knowledge of
substance abuse disorders and who has appropriate medical training to interpret and
evaluate an individual's confirmed positive test result together with his/her medical
history and any other relevant biomedical information.
• Positive "Vest alcohol occurs when an employee's confirmatory test result reads
0.04% BrAC or higher.
• Positive test(drug) occurs when an employee's confirmatory test or retest is at or
above cutoff levels specified by DHHS and has been verified by the MRO to be a
positive test.
• Program Administrator means the individual who has administrative
responsibilities for overseeing the drug and alcohol -testing program for an employer.
The Program Administrator may serve as an employer's DER.
• Proms' means all employer -owner and/or —leased property, including but not
limited to owned and/or leased buildings and other real estate, parking lots and
vehicles, lockers, tools, equipment and desks.
• Random selection means a scientifically valid method for selection of employees to
be tested that result in an equal probability that any employee from a group of
employees subject to the selection mechanism will be selected and does not give an
employer discretion to waive the selection of any employee under the mechanism.
Thus, an employee may not be selected more than twice (2) during the year.
• Refuse to submit to an alcohol or controlled substances teso means that an
employee:
• Fails(ed) to appear for any test (except a pre -employment test) within a reasonable
time, as determined by the policy, after being directed to do so by the policy;
• Fails(ed) to remain at the testing site until the testing process is complete;
• Fails(ed) to provide a urine specimen for any drug test required by this policy;
• In the case of a directly observed or monitored collection in a drug test, fails to
permit the observation or monitoring of the employee's provision of a specimen;
• Fails(ed) to provide a sufficient amount of urine when directed, and it has been
determined, through a required medical evaluation, that there was no acceptable
medical explanation for the failure;
• Fails(ed) or declines to take a second test the employer or collector has directed
the employee to take;
• Fails(ed) to undergo a medical examination or evaluation, as directed by the MRO
as part of the verification process, or as directed by the policy. In the case of a
pre -employment drug test, the employee is deemed to have refused to test on this
basis only if the pre -employment test is conducted following a contingent offer of
employment;
• Fails(ed) to cooperate with any part of the testing process (e.g., refuse to empty
pockets when so directed by the collector, behaves in a confrontational way that
disrupts the collection process, provides incorrect or inaccurate information to the
collection site or on necessary forms, or fails to complete all documents);
• Provides a second (2) specimen that is diluted.
• creenin tent or, initial test means:
• In drug testing, a test to eliminate "negative" urine specimens from further
analysis or to identify a specimen that requires additional testing for the presence
of drugs.
•
In alcohol testing, an analytical procedure to determine whether an employee may
have a prohibited concentration of alcohol in a breath specimen.
2 Screeni m Test Technician
KUfflffl9jS9j±n!!!9---Mr—fJmeans a person who instructs and assists
employees in the alcohol testing process I and operates an Alcohol Screening Device
(ASD),
• S LhiMinu Container means a container that is used for transporting and protecting
urine specimen bottles and associated documents from the collection site to the
laboratory.
•&9cunen means a sample of urine, used for analysis and/or diagnosis. For the
purpose of this policy; specimen is defined as urine.
• �ecimerr hot means the bottle that, after being sealed and labeled according to the
procedures in this policy, is used to hold the urine specimen during transportation to
the laboratory.
• aRlit WIEimgILmeans a part of the urine specimen that is sent to a first laboratory
and retained unopened, and which is transported to a second laboratory in the event
that the employee requests that it be tested following a verified test of the primary
specimen or a. verified adulterated or substituted test result.
• Substituted
smeinien ' means a specimen with creatinine and specific gravity values
that are so diminished that they are not consistent with human urine.
• LTe—sting levels means levels at or above when a specimen is determined to be
positive, and below when a specimen is determined to be negative.
• Third Party AdIministi-ator (TPA) means an entity that provides or coordinates one
or more drug and/or alcohol testing the provision of a number of such services to
employers. A TPA typically provides or coordinates the provision of a number of
such services and performs administrative tasks concerning the operation of drug and
alcohol testing programs for employers. This term includes, but is not limited to,
groups of employers who join together to administer, as a single entity, the drug and
alcohol testing programs of its members (e.g., having a combined random testing
pool),
• Verified test means a drug test result or validity testing result from a DHHS-certified
laboratory that has undergone review and final determination by the MRO.
BCRC will provide an identification card to each participant which will reflect the results
of the Drug & Alcohol Screen Test from the laboratory and as confirmed by the Medical
Review Officer (MRO). To implement an appropriate and acceptable standards
established by the U.S. Department of Health and Human Services (DHHS) Substance
Abuse and Metal Health Services Administration (SAMHSA) for testing mandated by the
U.S. Department ofTransportation, Those safeguards are as follows:
1. The integrity of collected urine specimens will be ensured by utilization of
one collection procedure at all sites. Samples will be collected in accordance
with federal standards that provide for a continuous chain of custody and
which recognize privacy concerns regarding the individuals being tested.
2. Testing will be conducted only by accredited labs that have obtained and
retained DHHS certification.
3. All specimens that are positive in an initial screen must then be confirmed by
gas chromatography/mass spectrometry (GC/MS). GUAS confirmation is
the state-of-the-art drug testing technology, providing a fingerprint of the
detected drug.
4. A Medical Review Officer (MRO) will review all drug test positives prior to
verification of positive test results. The MRO is a physician with specialty
training and expertise in substance abuse and drug testing. The MRO will
review confirmed positive test results to ensure proper procedure, protocol,
and reporting. The MRO will interview the individual who has a confirmed
positive test result by telephone to investigate whether a legal prescription has
caused the specimen to test positive. If the individual has no legal
prescription, the MRO will take appropriate steps to report a verified positive
to the BCRC Program Administrator, who will then invalidate the employee's
certification card. All persons who have tested positive must have their return
to work cleared by the EAP.
5. All positive specimens will be retained frozen in a locked facility at the testing
laboratory for one (1) year. The retained specimens will be available should
the results of that test be disputed or should arbitration or litigation arise out of
the actions taken because of the test results.
6. On a periodic basis, BCRC will submit blind pre -tested urine samples with
appropriate documentation to the drug -testing laboratory as a means of
assuring itself of laboratory proficiency.
Drug Group
The drug -testing program will test for the following drugs at these levels:
Initial
Confirmatory
An l e
Screenin
Test
Amphetamines
1000 ng/Ml
500 ng/Ml
Cocaine
300 ng/Ml
150 ng/Ml
Marijuana
50 ng/Ml
15 ng/Ml
Opiates
2000 ng.Ml
2000 ng/Ml
Phencyclidine
25 ng/Ml
25 ng/Ml
Barbiturates
300 ng/Ml
200 ng/Ml
Benzodiazepines
300 ng/Ml
Methadone
300 ng/Ml
Propoxyphene
300 ng/Ml
MDA-Analogues (Ecstasy)
250 na/Ml
200 ng/Ml
200 ng/Ml
200 ng/Ml
200 ng/Ml
Alcohol Testin
1. Alcohol tests (screening and confirmatory) will be performed on a device that appears
on the National Highway Traffic Safety Administration's (NHTSA) Conforming
Products List (CPL) and that meets the DOT'S testing requirements.
2. When a specific time for an employee's test has been scheduled, and the employee
does not appear at the collection site at the scheduled time, the Breath Alcohol
Technician (BAT) will contact the Designated Employer Representative (DER), who
may determine that the employee has ref4sed to be tested.
3. For alcohol testing (screening and confirmatory), a breath sample will be collected
and analyzed by a Breath Alcohol Technician (BAT) using an Evidential Breath
Testing device (EBT). For the screening test, a breath sample may be collected by
the Screening Test Technician (S`l T), using an Alcohol Screening Device (ASD).
4. If the result of the screening test indicates an alcohol concentration of 0.02 or greater,
a Breath Alcohol Technician (BAT) will perform a confirmatory test, no less than
fifteen (15) and no more than thirty (30) minutes after the completion of the screening
test.
5. If the confirmatory test is positive (0.04 and above, BrAC), the Breath Alcohol
Technician (BAT) shall immediately notify the BCRC/Employers DER.
6. Results of additional tests arranged by an employee, or requested by a medical
practitioner, will not be considered. This includes testing of blood samples, hair
samples, DNA, or any other testing methods or protocols.
PAYMENT FOR TESTING
Costs related to drug and alcohol testing will be borne by the program except for re-
testing of disputed test results by an employee. The issue of payment for the employee's
time will be categorized as follows:
l . For new or current union members or employees seeking an initial test, the test is a
condition of employment, and employees in the BCRC Program will not be paid for
their time tin providing a specimen for the initial test.
2. All current employees who are to test for any of the following: Late Random,
Probable Cause, Post -Accident, Diluted Re -Test, Return -to -Duty, or Follow-up
Testing or Retest due to a flowed or rejected test, will not be paid for their time in
providing a specimen for the test.
3. Employees will be paid a (forty -dollar) $40. Stipend by the program for the time
necessary to secure subsequent random testing required by the program. It is
understood that such testing will occur on the employee's time. Test to be taken with
seven (7) days of notice.
4. Non -Bargaining and Pipe fitter's; trade code 14 are exempt from the stipend
reimbursement.
INITIAL TESTING (PREE-EMPLOYME SIT
Prospective employees and current employees of BCRC affiliated employers will be
subject to the BCRC program. All persons who are eligible and who intend to obtain a
IN
BCRC card will be instructed to report to an approved BCRC collection site and to
provide a urine specimen for initial (pre -employment) testing and a clear status before
starting work for any participating employer. The individual will be directed by BCRC
or by their employer, to report to a BCRC approved collection site location. These
selected collection sites will have collection kits, chain -of -custody forms, and all other
necessary supplies.
RANDOM TESTING
After the individual's completion of the initial drug test (with a negative result), he/she
will be placed in the Random Pool after which he/she will be notified via U.S. mail to
report to an approved collection site for a random drug test. The individuals chosen for a
random drug test will be selected anonymously, from a computerized selection program.
Fifty percent (50%) of the currently active BCRC individual cardholders will be selected
annually for random testing. Then, on a monthly basis, one -twelfth (1/12) of the selected
employees will be notified to submit to a random test in order to update their BCRC
identification cards and status. A copy of the form letters notifying individuals of their
selection for this random test appears as an attachment A, B & C at the back of this
booklet.
Employees will be required to report to an approved collection site within seven (7) days
from the date of the Notice for Random Testing letter in order to maintain their BCRC
identification card and status. No employee will be required to submit to a random test
more than twice (2) in a twelve- (12) month period. All employees will be selected for a
random at least one (1) every two (2) years.
If an employee does not provide a sample at an approved collection site within seven (7)
days of having been notified of a random selection, his/her status in the BCRC Substance
Abuse Program will be deemed "Not Available." Employees who fail to report for a
random test in the required time should contact the Third Party Administrator (TPA). If
an employee does not report for a random test, and it is the first (1) time the employee
has failed to report, the TPA may allow the employee to take the test without reporting to
the EAP for further review. Employees may choose to take a "First Occurrence Clause"
at this time. Employees may utilize this clause only one (1) time. However, once this
"First Occurrence Clause" has been utilized, an employee who fails to report for a
random test at any time in the future will be required to contact to the EAP for evaluation
and to receive instructions on the required procedure(s) for removing the "Note
Available" status from his/her card.
PROBABLE CAUSE TESTING
An employee may be subject to drug and alcohol testing for Probable Cause based on
observed and documented unusual behavior. Circumstances sufficient to lead a
reasonable person to suspect that an employee is under the influence of, or is in
possession of a controlled substance shall be determined by an immediate supervisor and
should be confirmed by one other supervisor whenever possible. The immediate
supervisor shall document, in writing, the incident and the probable Cause basis for such
testing. The documentation shall specifically detail the behavior and conduct of the
employee, the location, date, time, of observation:, conversations, witnesses, (if any), and
should be signed by the supervisor who witnessed the incident. Such employees may
request that a union representative be available or present prior to any action taken by an
employer, if any, at any stage of the policy and its administration.
POST- ACCIDENTANCIDENT TESTING
An employer may require an employee to submit to a post -accident drug and alcohol test
after the involvement in, or cause of an accident/incident, that causes injury to the
employee or another party. The employer may also require an employee to submit to a
post -accident drug and alcohol test when the employee is involved in, or causes an
accident, which results in damage or destruction to property. Post -accident drug and
alcohol testing must be completed within two (2) hours of the recorded accident/incident
if a BCRC testing facility is located on the job site or within four, (4) hours of the
recorded accident/incident if an employee is required to go off the job site to a BCRC
testing facility. Any employee suspected of unnecessarily delaying the test process will
be considered to have refused to submit to testing.
In stances of post-accident/incident or probable cause testing for drugs and alcohol, the
employee will be transported to the testing facility by the employer. At the option of the
employer, the employee may be suspended pending the test result. In the event a
negative test result is reported, the employee shall be compensated for all lost time at the
appropriate rate within the collective bargaining agreement, straight or premium pay.
When an employee may request that a union representative be available or present prior
to any action taken by an employer, if any, at any stage of the policy and its
administration. If an employee is aggrieved by any action taken under this Drug and
Alcohol Policy and his/her complaint cannot be resolved, the complaint may, if the
employee or Union requests, be referred as grievance under the grievance and arbitration
provision of the employee's collective bargaining agreement. In the event the matter is
referred to arbitration, the arbitrator shall be bound substantively by the provision of this
Drug & Alcohol Policy.
"EMERGENCY11 WORK ASSIGNME NTS
To accommodate owners with emergency work, craft personnel who have not previously
held a BCRC identification card or taken an initial drug test the following provisions will
apply when starting for emergency work assignments.
Upon arrival at a job location for sing -up, the employer representative (Card
Manager) shall request the employee to present his/her BCRC identification card.
An individual that does not have a BCRC card at the time of hire will be requested
to secure a card and submit to an initial drug test within one (1) day, in order to
comply with the BCRC Policy.
12
2. An employee without a BCRC identification card may work one (1) day. On the
second (2) day, a Chain of Custody from (as proof of having submitted to a drug
test) or a BCRC card must be presented.
3. An employee who has provided a specimen for testing must bring to the job site
his/her copy of the Chain of Custody form, given to him/her by the collection site,
as proof that he/she has submitted to an initial test.
4. If the work assignments are consecutive, the employee will be allowed to work for
up to a maximum of four (4) days in order for the employee to receive his BCRC
identification card and have the employer Card Manager swipe the card for status
verification,
5. If the member's work assignment is terminated by his/her employer before the
member's status is verified within the allowable four (4) days for verification, and
the individual is rehired, the member will have to provide the same employer a
BCRC identification card at the second (2) hiring sign up, and a clear status.
Except in the event that the rehire is less than four (4) days from the initial hire
date, the Individual, Local and Non -Local, BCRC card holder shall accept and
understzind that should his/her drug test results be repoiled as positive, he/she will
be subject to disciplinary action up to and including termination without obligation
for further compensation by the BCRC affiliated employer. Such termination shall
also be subject to the individuals' right under his/her collective bargaining
agreement.
Employees will be required to give their BCRC Card ID Number to a Card Manager in
order for the Card Manager to access the e-mail status confirmation system.
Categories are:
1. Not On File (NOF)
2. Not Available (N/A)
3. Clear (CL)
The card manager will also have access to safety training information, which has been
downloaded through the Construction Advancement Foundation (CAT) and accessible
through the BCRC scanner or email system only with the permission of each
participating Local Union.
k's IF.11 I
...... ---- -
Participating employers may verify the status of all BCRC employees, who are working,
by having their card status verified on their job site in order to determine if the employee
is available or not available under the BCRC program. The employer may use the Phone-
in system, scanner, or electronic e-mail for verification.
13
When an employee's status is Not Available (N/A) he/she will be advised to contact the
BCRC office to resolve the N/A status. The individual may be required to follow the
consequences for a positive test within the BCRC Policy.
The employer may verify the employee's card after four (4) days to reconfirm the status
and if the employee's status is still N/A, the employer may terminate the employee.
An employee who receives a status of N/A a second (2) time will be referred to the
Employee Assistance Program for assessment, and will be required to follow the
recommendations of the EAP Counselor before being considered for further assignments.
The status of Clear (CL) will be restored only with written approval of the EAP.
The procedure will protect the employee's confidentiality and allow the employer to audit
the status of his/her employees, which may be required by the owner to be submitted
monthly.
A person who provides an insufficient specimen of urine or breath when required to do so
shall be referred to an appropriate medical professional, as designated by the BCRC for
evaluation at the participant's expense. If the medical evaluation fails to reveal an
acceptable medical explanation for the inability to provide a specimen, the donor shall be
considered to have refused to test and discipline shall be imposed according to this
policy. If a legitimate medical reason is revealed no action shall be taken and the
employee shall be reimbursed by BCRC for the medical evaluation expense.
DILUTED SPECIMEN
An employee providing a diluted specimen will be given the opportunity to return to a
collection site within forty-eight (48) hours to provide a second (2) specimen, on his/her
own time. Employees should refrain from excessive consumption of fluids prior to the
retest. No adverse action or discipline shall be taken against any employee rased on a
first (1)-diluted specimen. A second (2)-diluted specimen, without a valid medical
reason, will be treated as a refusal to submit to testing.
ADULTERATED SUBSTITUTED AND/OR 0 UT -OF, -TEMPERATURE RANGE
SPECIMEN
When a urine specimeri is reported as adulterated, or substituted, or when the temperature
range is below 90 degrees or above 100 degrees F., the employee will be considered to
have not cooperated with the testing process, and the test will be considered a refusal to
be tested.
In addition, the employee who has refused to be tested, or who uses or possesses a
counterfeit drug card, shall be subject to employer discipline up to and including
discharge, subject to the representation language.
14
An employee who tests positive for drugs and /or alcohol shall be contacted directly
by the Medical review Officer (MRO). If the MRO verifies the results of the positive
test, the MRO will notify the individual that he or she is ineligible for work and
he/she will be directed to contact the program's Employee Assistance Program (EAP)
for consultation and review. If the MRO contacts the individual and fins that there is
a reason for the positive test (an authorized prescriptive medication) the MRO will
downgrade the result to a negative, and the individual's card will be marked "CU.
In the case of a confirmed positive drug or alcohol test, the Third Party Administrator
(TPA) will be notified that the employee's status should be marked "N/A". The
"N/A" status will be effective at the moment that a confirmed positive test is
received.
Before returning to work, an employee must (1) complete an evaluation with the
program's Employee Assistance Program provided by the BCRC EAP Provider, (2)
follow a treatment plan prescribed by the program's EAP, (3) obtain written
documentation from the program's EAP verifying .fitness for duty, and (4) obtain a
negative result on a return -to -duty test.
A confirmed positive test or a "N/A" status will not be the sole basis for termination
of employment. Only employees who are in non-compliance with this program may
be discharged. For the purposes of this provision, "non-compliance" shall mean one
or more of the following:
• Failure to report to the program's Employee Assistance Program as directed,
• Failure to follow and/or complete a EAP-prescribed treatment program,
• Failure to take a return -to. -duty or follow-up test.
• Failure to report for a random test request within seven (7) days,
• Failure to submit to a drug or alcohol test when requested to do so by the EAP
An individual testing positive for a third (3) time in a twelve (12) month period shall
not be permitted to take a Return -to -Duty test for one (1) year and his/her BCRC
Substance Abuse Card shall be invalidated for the same time period. The individual
must also complete an EAP-prescribed treatment program before returning to work.
For the purposes of this policy, a negative test must occur before any future positive
tests will be counted as additional strikes.
An employee whose test results are verified positive will be referred to the EAP by
the MRO. The employee is expected to attend all appointments with the EAP
counselor and to follow the EAP counselor's instructions.
RETURN —T0.DUTY TESTING
The return -to -duty test is required for an employee to be reinstated into the program
following a positive test. The participant must have a negative drug test before resuming
performance of his/her job duties.
Follow-up testing for drugs and alcohol is a requirement in order for a returning
employee to stay in compliance with the BCRC Program. Testing shall be determined by
the Employee Assistance Counselor, and will be implemented when the employee returns
to work.
DISPUTED POSITIVE RESULTS
An employee who disputes positive results shall have the right to have his/her initial
sample independently re -tested by a Department of Health and Human Services (DHHS)
certified laboratory of his/her choice, at his/her own expense, within ten (10) working
days of when he/she was notified of the test results. A portion of the initial sample shall
be forwarded under a chain -of- custody directly by BCRC's testing laboratory to the
laboratory performed by a qualified MRO who has been approved by BCRC. If the
second lab report shows the presence of a controlled substance, the test result will be
considered positive. If the second lab report test indicates no presence of a controlled
substance, then both tests will be considered negative.
The following section only applies when the employee tests due to Post -Accident or
Probable Cause: If the test is negative, the affiliated employer will reimburse the
individual for compensation lost at the appropriate rate within the collective bargaining
agreement, straight or premium pay, during the period of his/her disciplinary suspension
or -termination and will reimburse the individual for the cost of the re -test.
An individual whose test results are verified positive will be referred to the EAP by the
MRO. The individual is expected to attend all appointments with the EAP counselor and
to follow the counselor's recommendations and requirements.
All problem situations shall be resolved in accordance with current guidelines and
standards established by the U.S. DHHS or Department of Transportation.
APPEALS AND PROTECTIONS
Employees who are subject to this policy continue to have access to the usual protections
provided as a part of their union membership and/or as members of bargaining units
covered by collective bargaining agreements. Such individuals may request that a union
representative be available or present prior to any action taken by an employer, if any, at
any stage of the policy and its administration. If an individual is aggrieved by any action
taken under this Drug an Alcohol Policy and his/her complaint cannot be resolved, the
complaint may, if the individual or Union requests, be referred as a grievance under the
grievance and arbitration provisions of the individual's collective bargaining agreement.
In the event the matter is referred to arbitration, the arbitrator shall be bound
substantively by the provisions of this Drug and Alcohol Policy.
16
(On BCRC Letterhead)
LETTER OF NOTICE FOR RANDOM TESTING
Dear
Your name has been randomly selected by BCRC's computer generated selection
program to take a random drug test in order to maintain your "Clear" BCRC
identification card status. Our computer program selects the names of one -twelfth (1/12)
of 50% of all BCRC cardholders for update each month. No one will be tested in this
system more than twice in a twelve-month period.
You will be required to report to an approved collection site within seven (7) days from
the date of this "Notice for Random Testing" letter to stay in compliance with the BCRC
policy. In order to avoid any potential interruption in the status of your card, you must be
tested no later than midnight the (day) of (month), 2007. This random test is to be taken
on your own time at any of the approved collection sites identified on the enclosed
collection site list. You will be mailed a $40.00 stipend for the time necessary to secure
random testing as long as your test is taken within seven (7) days of this notice.
If you do not take your random test within seven (7) days of this notice, your BCRC card
status will be deemed "Not Available". Failure to report for a random test in the required
time it will be necessary for you to contact the BCRC office to receive instructions on the
required procedure(s) for removing the "Not Available" status from your card.
Remember it is your responsibility to keep the BCRC informed of any change in your
address or telephone number.
The BCRC has contracted with Perspectives as a fully independent, professional
Employee Assistance Program (EAP) for you and your family. Perspectives' 24 hour,
day a week hotline number is (800) 456-6327.
Please contact the BCRC office @ 219-764-9500 or toll free @877-988-5400 if you have
any questions. Thank you for your cooperation.
Sincerely,
James Bohlen
Executive Director
17
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° Certified Companies
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-,5upplemental Changes to Circular 570
Download the complete listing of Certified Companiest(140KB)
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ACCREDITED SURETY AND CASUALTY COMPANY, INC. U«AIC
BUSINESS ADDRESS: PO Box 140855, Orlando, FL 32814. PHONE: (407) 629-2131. UNDERWRITING
LIMITATION uc*5,4«o.ouo.SURETY LICENSES c,f/:AL, AK, AZ, AR, CA, CO, CT, DE, DC, FL, GA, HI, ID, IL,
IN, IA, KS, KY, LA, ME, MD, MA, M|.MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC, ND, OH, OK, OR, PA, R].
SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: Florida.
.
ACE American Insurance Company
BUSINESS ADDRESS: 43OWa|�t So�o PO.Box 1�OOO.Philadelphia, RA191u*.PHONE:
UNDERWRITING LIMITATION b/: $478,637,000SURETY LICENSES c,f/:AL, AK, AZ, AR, CA, CO, CT, DE,
oa«xom«*«
DC, FL, GA, H|.ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, M|.MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC,
ND, OH, OK, OR, PA, PR, R1.SC, SD, TN, TX, LIT, VT, VA, WA, WV, WI, WY. INCORPORATED IN:
Getting Started
Pennsylvania.
Certified Companies
ACE Property and Casualty Insurance Conpony(NAIC #20699)
BUSINESS ADDRESS: 43OWALNUT STREET, P0.Box 1OOO.Philadelphia, RA181OO.PHONE: (21o)O4O'
1000.UNDERVvR|T|NGL|M|7AT|0Nb/: $u8O.u48.00O.SURETY LICENSES o.OtAL, AK, AZ, AR, CA, CO, CT,
Aum/ueunomavmm
DE, DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, M|.MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY
NC, ND, OH, OK, OR, PA, PR, R|.SC, SD, TN, TX, LIT, VT, VA, WA, WV, WI, WY. INCORPORATED IN:
Sureties Listing
Pennsylvania.
ponno
ACSTARINSURANCE COMPANY p«AIC #22950
__________________
BUSINESS ADDRESS: 3OSOUTH ROAD, FARMINGTON, CTO0032.PHONE: (OOO)415'84OO.
m»o^/ou^nuumuman«»
UNDERWRITING LIMITATION � Nb/�$2.3O0.oOO�GURETYL|�EN8E80.: AL'AK AZ, AR`CA'CO,CTCO DE'Do'
FL. GA. H|. |D. |L. IN, |A. K8. �LA. ME, MD. MA. m|. MN. MG. MO. �w. N' NH, J. N. NY, NC, ND,KY,MT,
OH, OK, OR, PA, PR, RI, SC, SD.TN, TX, UTVTVA, YVA.VV�VV|.VVYINCORPORATED IN: U|inoio.
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Aegis Security
Contacts
BUSINESS ADDRESS: eo. Box x1no.Harrisburg, Pw171ou.PHONE: pn7>0*7'8O71.UNDERWRITING
LIMITATION b/:$5.374.O0O.SURETY LICENSES o.f/:AL, AK, AZ, AR, CA, CO, CT, DE, DC, FL, GA, H|.ID, IL,
IN, IA, KS, KY, LA, ME, MID, MA, M|, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC, ND, OH, OK, OR, PA, R|.
SC, SD, TN, TX, UT, VT, VA, WA, WV, VN.WY. INCORPORATED IN: Pennsylvania.
PARTNERRE INSURANCE COMPANY OF NEW YORK (NAIC #10006)
BUSINESS ADDRESS: 200 First Stamford Place, Suite 400, Stamford, CT 06902. PHONE: (203) 485-4200.
UNDERWRITING LIMITATION b/: $01,932,000. SURETY LICENSES c,f/: AL, AZ, CA, CO, DE, DC, ID, IL, IN,
IA, KS, KY, MD, MI, MN, MS, MT NE, NJ, NM, NY, ND, OH, OK, OR, PA, RI, SC, SD, TX, UT, VT, VA, WA, WV
WI. INCORPORATED IN: New York.
Pekin Insurance Company (NAIC #24228)
BUSINESS ADDRESS: 2505 COURT STREET, PEKIN, IL 61558 - 0001. PHONE: (309) 346-1161.
UNDERWRITING LIMITATION b/: $13,231,000. SURETY LICENSES c,f/: AZ, IL, IN, IA, MI, OH, WI.
INCORPORATED IN: Illinois.
Pennsylvania Manufacturers Indemnity Company (NAIC #41424)
BUSINESS ADDRESS: P.O. Box 3031, Blue Bell, PA 19422 - 0754. PHONE: (610) 397-5000.
UNDERWRITING LIMITATION b/: $8,662,000. SURETY LICENSES c,f/: AL, AK, AZ, AR, CO, CT, DE, DC, ID,
IN, KS, KY, LA, ME, MD, Ml, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC, OH, PA, RI, SC, SD, TN, UT VT, VA,
WA. INCORPORATED IN: Pennsylvania.
Pennsylvania Manufacturers' Association Insurance Company (NAIC #12262)
BUSINESS ADDRESS: P.O. Box 3031, Blue Bell, PA 19422 - 0754. PHONE: (610) 397-5000.
UNDERWRITING LIMITATION b/: $34,384,000. SURETY LICENSES c,f/: AL, AK, AR, CO, CT, DE, DC, FL,
GA, HI, ID, IL, IA, KS, KY, LA, ME, MD, MA, MI, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC, OH, OK, PA, RI,
SC, SD, TN, TX, UT, VT, WA, WV. INCORPORATED IN: Pennsylvania.
Pennsylvania National Mutual Casualty Insurance Company (NAIC #14990)
BUSINESS ADDRESS: P. O. Box 2361, Harrisburg, PA 17105 - 2361. PHONE: (717) 234-4941.
UNDERWRITING LIMITATION b/: $64,019,000. SURETY LICENSES c,f/: AL, AS, AZ, AR, CO, CT DE, DC,
FL, GA, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NJ, NM, NY, NC, OH, OK, OR, PA,
RI, SC, SD, TN, TX, UT VT VA, WA, WV, WI. INCORPORATED IN: Pennsylvania.
PHILADELPHIA INDEMNITY INSURANCE COMPANY (NAIC #18058)
BUSINESS ADDRESS: One Bala Plaza East, Suite 100, Bala Cynwyd, PA 19004 - 1403. PHONE: (610) 206-
7836. UNDERWRITING LIMITATION b/: $231,637,000. SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT,
DE, DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY,
NC, ND, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VT VA, WA, WV, WI, WY INCORPORATED IN:
Pennsylvania.
PLATTE RfV'ER INSURANCE COMPANY (NIAIC #18619)
BUSINESS ADDRESS: P.O. Box 5900, Madison, WI 53705 - 0900. PHONE: (608) 829-4200. UNDERWRITING
LIMITATION b/: $4,827,000. SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT, DE, DC, FL, GA, HI, ID, IL,
IN, IA, KS, KY, LA, ME, MD, MA, Ml, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC, ND, OH, OK, OR, PA, RI,
SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: Nebraska.
Plaza Insurance Company (NAIC #30945)
BUSINESS ADDRESS: 518 East Broad Street, Columbus, OH 43215. PHONE: (614) 464-5000.
UNDERWRITING LIMITATION b/: $2,769,000. SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT, DE, DC
FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT NE, NV, NH, NJ, NM, NY, NC, ND,
OH, OK, OR, PA, RI, SC, SD, TN, TX, UT VT VA, WA, WV, WI, WY. INCORPORATED IN: Iowa.
ProCentury Insurance Company (NAIC #21903)
BUSINESS ADDRESS: 550 Polaris Parkway, Westerville, OH 43082. PHONE: (614) 895-2000.
UNDERWRITING LIMITATION b/: $5,833,000. SURETY LICENSES c,f/: AK, AZ, AR, CA, DE, DC, GA, IL, IN,
IA, KS, LA, MD, MA, MI, MN, MS, MO, MT, NE, NV, NJ, NM, NY, ND, OK, OR, PA, SC, SD, TX, UT WV, WI,
WY INCORPORATED IN: Michigan.
Progressive Casualty Insurance Company (NAIC #24260)
BUSINESS ADDRESS: RO, BOX, 89490, CLEVELAND, OH 44101 - 6490. PHONE: (440) 461-Fnnn
UNDERWRITING LIMITATION b/': $212,481„000. SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, Translate
DC, FL, GA, HI„ 113, IL, IN, IA, KS, KY, LA, ME„ MID, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC,
ND, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN: Ohio.
Progressive Northwestern Insurance Company (NAIC #42919)
BUSINESS ADDRESS: P.O. BOX 89490, CLEVELAND, OH 44101 - 6490. PHONE: (440) 461-5000.
UNDERWRITING LIMITATION b/: $52,118,000. SURETY LICENSES c,f/: AK, AZ, CA, CO, CT, DE, DC, GA,
HI, ID, IN, IA, KS, KY, LA, ME, MD, MN, MS, MO, MT, NE, NV, NJ, NM, NY, NC, ND, OH, OK, OR, RI, SC, SD,
TN, TX, UT, VA, WA, WV, WI. INCORPORATED IN: Ohio.
Protective Insurance Company (NAIC #12416)
BUSINESS ADDRESS: 111 Congressional Blvd., Suite 500, Carmel, IN 46032. PHONE: (317) 636-9800 x-
7433. UNDERWRITING LIMITATION b/: $28,733,000. SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT,
DE, DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY,
NC, ND, OH, OK, OR, PA, PR, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY. INCORPORATED IN:
Indiana.
Protective Property & Casualty Insurance Company (NAIC #35769)
BUSINESS ADDRESS: 14755 North Outer Forty Rd., Suite 400, St. Louis, MO 63017. PHONE: (636) 536-
5600. UNDERWRITING LIMITATION b/: $16,992,000. SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT,
MIRINASM
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09/11/2018
To Whom it may concern:
Slatile Roofing, Sheet Metal and Masonry is a contractor in good standing,
signatory to the South Bend Roofers Joint Apprenticeship and Training
Committee's (J.A.T.C.) Registered Apprenticeship Program #IN020780008.
Department of Labor
2420 Viridian Drive -Suite G
South Bend, IN 46628
Office of apprenticeship.
C.O. Kathleen Sokolowski
574-236-8295
Derek Carrington
Roofers Local 23
Apprenticeship Coordinator
22990 Ardmore Trail
South Bend, IN 46628
574-968-5500
C"ww C,T
Sheet Metal Workers Local 20
Apprenticeship &Training Trust
2828 East45th Street, Suite A
Indianapolis, Indiana46205
(317) 541-0050.1-800-835-4531
www.smw20training.com
October 3, 2018
To Whom It May Concern,
� , ,«I
am -al
I am the State Apprenticeship Coordinator for the Sheet Metal Workers' Local #20
Apprenticeship and Training Trust. I am writing this letter on behalf of Slatile Roofing
and Sheet Metal in South Bend; Indiana. They are one of our contractors and have been
in good standing and have been actively participating for well over three consecutive
years; therefore, they are eligible to hire Apprentices through our program. Apprentices
hired by this company are registered with the Bureau of Apprenticeship and Training as
"Sheet Metal" Apprentices.
Additionally, the Sheet Metal Workers' Local # 20 Apprenticeship and Training Trust
has been active for well over three years, in fact dating back to March 5, 1946.
Thank you for your consideration in this matter. If you have any questions, please call
me at your convenience.
Sincerely,
1.01
Jason Benson
State Apprentice Coordinator
Sheet Metal Contractors -Sheet Metal Workers Local 20
Evansville • Ft. Wayne •Gary -Indianapolis •Lafayette •South Bend -Terre Haute
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