HomeMy WebLinkAboutOpening of Bids - Water Works North Station Well No 1 Replacement Project No 117-031R - Peerless Midwest IncCITY OF SOUTH BEND, INDIANA
CONTRACTOR'S BID FOR PUBLIC WORK
Project Name North Station - Well No. 1 Replacement
..w ._.................._..............................
Project No. 117-031 R
For Bids Due February 12, 2019
PART I
(Must be completed for all bids. Please type or print)
Date: February I Ith, 2019 Bidder (Firm): Peerless Midwest Inc.
Address: 55860 Russell Industrial Parkwa
City/State/Zip: Mishawaka, IN 46545 Telephone Number: (574 ) 254-9050
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:
N olth Station - Well No. 1 Re l ig;,nletJi_Pr ect Number 1177--0�31
the City of South Bend, Indiana, in accordance with plans and specifications prepared by:
Arcadis U.S.
and dated January 2019 for the sum of (enter the Total Bid as shown on the Proposal)
five hundred thirty-two thousand seven hundred and six -three $ 532,763
(Enter sum of Total Base Bid shown on Proposal) (Numerical)
The undersigned further agrees to furnish a bond or certified check with this bid for an amount specified in
the notice of the letting. If alternative bids apply, the undersigned submits a proposal for each in accordance
with the notice. Any addendums attached will be specifically referenced at the applicable page.
If additional units of material included in the contract are needed, the cost of units must be the same as that
shown in the original contract if accepted by the City of South Bend. If the bid is to be awarded on a unit
basis, the itemization of the units shall be shown on a separate attachment.
By
.......................
(Signature)
Frank Williams
(Printed 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
Laura O'Sullivan, Member
Suzanna M. Fritzberg, Member
Therese J. Dorau, Member
Attest: Linda M. Martin, Clerk
Version 7/20/2018 Contractor's Bid for Public Works - 2
20
BID/PROPOSAL
CITY OF SOUTH BEND
Project Name: North Station - Well No. 1 Replacement
Project Number: 117-031 R
For Bids Due: February 12, 2019
Contractor Name:
Peerless Midwest, Inc.
BASE BID
Item IDescription Quantity Unit Unit Price Total Amount
No. _
1 General Construction 1 LS 532,763 532,763
BASE BID TOTAL 532,763
The City of South Bend will award the subject project based on a review of all Base Bids to the lowest,
responsive, responsible bidder. The City of South Bend reserves the right to reject or disqualify any or all
bidders that do not submit a complete bid package
Firm): _,,.,,,Peerless eerless Midwest, Inc.
Bidder ..._..__ ...............................
Address: 55860 Russell Industrial Parkway
City/State/Zip: Mishawaka, IN 46545 Telephone Number: (574 ) 254-9050
BYm............... ���
(Signature)
Frank Williams
(Printed Name of Person Signing)
Version 7/20/2018 Contractor's Bid for Public Works - 7
When the prospective Contractor is unable to certify to any of the statements below, it shall attach an explanation to this Affidavit.
CONTRACTOR'S NON -COLLUSION AND NON -DEBARMENT AFFIDAVIT, CERTIFICATION
REGARDING INVESTMENT WITH IRAN, EMPLOYMENT ELIGIBILITY VERIFICATION, NON-
DISCRIMINATION COMMITMENT AND CERTIFICATION OF USE OF UNITED STATES STEEL
PRODUCTS OR FOUNDRY PRODUCTS
(Must be completed for all quotes and bids. Please type or print)
STATE OF Indiana )
) SS:
St. Joseph COUNTY )
The undersigned Contractor, being duly sworn upon his/her/its oath, affirms under the penalties of perjury
that:
1. Contractor has not, nor has any other member, representative, or agent of the firm, company,
corporation or partnership represented by him, entered into any combination, collusion or agreement with
any person relative to the price to be bid by anyone at such letting nor to prevent any person from bidding
nor to induce anyone to refrain from bidding, and that this bid is made without reference to any other bid and
without any agreement, understanding or combination with any other person in reference to such bidding.
Contractor further says that no person or persons, firms, or corporation has, have or will receive directly or
indirectly, any rebate, fee, gift, commission or thing of value on account of such sale; and
2. Contractor certifies by submission of this proposal that neither contractor nor any of its principals
are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from
participation in this transaction by any Federal department or agency; and
3. Contractor has not, nor has any successor to, nor an affiliate of, Contractor, engaged in
investment activities in Iran.
a. For purposes of this Certification, "Iran" means the government of Iran and any agency
or instrumentality of Iran, or as otherwise defined at Ind. Code § 5-22-16.5-5, as
amended from time -to -time.
b. As provided by Ind. Code § 5-22-16.5-8, as amended from time -to -time, a Contractor
is engaged in investment activities in Iran if either:
i. Contractor, its successor or its affiliate, provides goods or services of twenty
million dollars ($20,000,000) or more in value in the energy sector of Iran;
or
Contractor, its successor or its affiliate, is a financial institution that extends
twenty million dollars ($20,000,000) or more in credit to another person for
forty-five (45) days or more, if that person will (i) use the credit to provides
goods and services in the energy sector in Iran; and (ii) at the time the
financial institution extends credit, is a person identified on list published by
the Indiana Department of Administration.
Version 7/20/2018 Contractor's Bid for Public Works - 4
4. Contractor does not knowingly employ or contract with an unauthorized alien, nor retain any
employee or contract with a person that the Contractor subsequently learns is an unauthorized alien.
Contractor agrees that he/she/it shall enroll in and verify the work eligibility status of all of Contractor's
newly hired employees through the E-Verify Program as defined by I.C. 22-5-1.7-3. Contractor's
documentation of enrollment and participation in the E-Verify Program is included and attached as part of
this bid/quote; and
5. Contractor shall require his/her/its subcontractors performing work under this public contract to
certify that the subcontractors do not knowingly employ or contract with an unauthorized alien, nor retain
any employee or contract with a person that the subcontractor subsequently learns is an unauthorized alien,
and that the subcontractor has enrolled in and is participating in the E-Verify Program. The Contractor agrees
to maintain this certification throughout the term of the contract with the City of South Bend, and understands
that the City may terminate the contract for default if the Contractor fails to cure a breach of this provision
no later than thirty (30) days after being notified by the City.
6. Persons, partnerships, corporations, associations, or joint venturers awarded a contract by the City
of South Bend through its agencies, boards, or commissions shall not discriminate against any employee or
applicant for employment in the performance of a City contract with respect to hire, tenure, terms, conditions,
or privileges of employment, or any matter directly or indirectly related to employment because of race, sex,
religion, color, national origin, ancestry, age, gender expression, gender identity, sexual orientation or
disability that does not affect that person's ability to perform the work.
In awarding contracts for the purchase of work, labor, services, supplies, equipment, materials, or any
combination of the foregoing including, but not limited to, public works contracts awarded under public
bidding laws or other contracts in which public bids are not required by law, the City, its agencies, boards,
or commissions may consider the Contractor's good faith efforts to obtain participation by those Contractors
certified by the State of Indiana as a Minority Business ("MBE") or as a Women's Business Enterprise
("WBE") as a factor in determining the lowest, responsible, responsive bidder.
In no event shall persons or entities seeking the award of a City contract be required to award a subcontract
to an MBE/WBE; however, it may not unlawfully discriminate against said WBE/MBE. A finding of a
discriminatory practice by the City's MBE/WBE Utilization Board shall prohibit that person or entity from
being awarded a City contract for a period of one (1) year from the date of such determination, and such
determination may also be grounds for terminating the contact for which the discriminatory practice or
noncompliance pertains.
7. The undersigned contractor agrees that the following nondiscrimination commitment shall be made
a part of any contract which it may henceforth enter into with the City of South Bend, Indiana or any of its
agencies, boards or commissions.
Contractor agrees not to discriminate against or intimidate any employee or applicant for employment in the
performance of this contract with privileges of employment, or any matter directly or indirectly related to
employment, because of race, religion, color, sex, gender expression, gender identity, sexual orientation,
handicap, national origin or ancestry. Breach of this provision may be regarded as material breach of
contract.
I, the undersigned bidder or agent as contractor on a public works project, understand my statutory
obligations to the use of steel products or foundry products made in the United States (I.C. 5-16-8-1). I hereby
certify that I and all subcontractors employed by me for this project will use steel products or foundry
products made in the United States on this project if awarded. I understand I have an affirmative duty to
notify the City in my bid that my proposal does not include the use of steel products or foundry products
made in the United States. I understand it is my sole obligation and responsibility to provide a justification
to the City, subject to review and approval, why the cost of United States made steel or foundry products is
unreasonable. Prior to award and upon submission of bid which does not use steel products or foundry
products made in the United States, the City, through its director of public works, shall make a determination
if the price of United States made steel or foundry is unreasonable. I understand that violations hereunder
Version 7/20/2018 Contractor's Bid for Public Works - 5
may result in forfeiture of contractual payments.
I hereby affirm under the penalties of perjury that the facts and information contained in the foregoing bid
for public works are true and correct.
Dated this 1Ith day ofFebrua2019
Peerless Midwest,
actor/Bidder ( irin,
Sig]"�Tatlu"
of COW)alnis,
l'or/ idler or Its Agent
l./General Manager
Printed Name and Title
Subscribed and sworn to before me this 11th day of February .20 19
My Commission Expires
OM
E Notary Ibiic
CATHY S. LANCtary Public. state of Indiana
CrfC"I�@�llrceI' y Cor�'nMission Expwres _.._����...� .. ..._.... ....June 06, 2023
Version 7/20/2018 Contractor's Bid for Public Works - 6
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BID BOND
PENAL SUM FORM
Any singular reference to Bidder, Surety, Owner or other party shall be considered plural where applicable.
BIDDER (Name and Address):
Peerless -Midwest, Inc.
55860 Russell Industrial Parkway, Mishawaka, IN 46545
SURETY (Name, and Address of Principal Place of Business):
Travelers Casualty and Surety Company of America
One Tower Square, Hartford, CT 06183
OWNER (Name and Address):
City of South Bend, Indiana
Department of Public Works, County -City Building Room 1316
227 West Jefferson Street, South Bend, IN 46601
BID
Bid Due Date: February 12, 2019
Description (Project Name— Include Location):
Well No. 1 Replacement - North Station (830 North Michigan Street, South Bend, Indiana 46601)
BOND
Bond Number: Bid Bond
Date: February 12, 2019
Penal SUM Five Percent of Amount Bid $ 5%
(Words) (Figures)
Surety and Bidder, intending to be legally bound hereby, subject to the terms set forth below, do each cause
this Bid Bond to be duly executed by an authorized officer, agent, or representative.
BIDDER SURETY
Peerless -Midwest, Inc. (Seal) Travelers Caslually and Surety CornRapyof'An
Bidder's Name and Corporate Seal Surety's Name and Corporate Seal
1____) I/' /
By: cap, �.6Z By:
Sign ure
Print Name
G of ,0_iG A t— o w .✓.o 2 !' 1_r__
Title
1-11
Attest: 6��Attest:
Sig ature 61
Title Wnels
Signature (Attach Power of
J. Karl Sherrill, Jr.
Print Name
Attorney -in -Fact
Title
-_ - �L Aa�
Signature Anne Baker
Title Witness to Surety
Note: Addresses are to be used for giving any required notice.
Provide execution by any additional parties, such as joint venturers, if necessary.
EJCDC' C-430, Bid Bond (Penal Sum Form). Published 2013.
Prepared by the Engineers Joint Contract Documents Committee.
Page 1 of 2
HARTFO ) i
COIN. .�
PENAL SUM FORM
1. Bidder and Surety, jointly and severally, bind themselves, their heirs, executors, administrators, successors, and
assigns to pay to Owner upon default of Bidder the penal sum set forth on the face of this Bond. Payment of the
penal sum is the extent of Bidder's and Surety's liability. Recovery of such penal sum under the terms of this Bond
shall be Owner's sole and exclusive remedy upon default of Bidder.
2. Default of Bidder shall occur upon the failure of Bidder to deliver within the time required by the Bidding
Documents (or any extension thereof agreed to In writing by Owner) the executed Agreement required by the Bidding
Documents and any performance and payment bonds required by the Bidding Documents.
3. This obligation shall be null and void if:
3.1 Owner accepts Bidder's Bid and Bidder delivers within the time required by the Bidding Documents (or any
extension thereof agreed to in writing by Owner) the executed Agreement required by the Bidding
Documents and any performance and payment bonds required by the Bidding Documents, or
3.2 All Bids are rejected by Owner, or
3.3 Owner fails to issue a Notice of Award to Bidder within the time specified in the Bidding Documents (or any
extension thereof agreed to in writing by Bidder and, if applicable, consented to by Surety when required
by Paragraph 5 hereof).
4. Payment under this Bond will be due and payable upon default of Bidder and within 30 calendar days after
receipt by Bidder and Surety of written notice of default from Owner, which notice will be given with reasonable
promptness, identifying this Bond and the Project and including a statement of the amount due.
5. Surety waives notice of any and all defenses based on or arising out of any time extension to issue Notice of
Award agreed to in writing by Owner and Bidder, provided that the total time for issuing Notice of Award including
extensions shall not in the aggregate exceed 120 days from the Bid due date without Surety's written consent.
6. No suit or action shall be commenced under this Bond prior to 30 calendar days after the notice of default
required in Paragraph 4 above is received by Bidder and Surety and in no case later than one year after the Bid due
date.
7. Any suit or action under this Bond shall be commenced only in a court of competent jurisdiction located in the
state in which the Project Is located.
8. Notices required hereunder shall be in writing and sent to Bidder and Surety at their respective addresses shown
on the face of this Bond. Such notices may be sent by personal delivery, commercial courier, or by United States
Registered or Certified Mail, return receipt requested, postage pre -paid, and shall be deemed to be effective upon
receipt by the party concerned.
9. Surety shall cause to be attached to this Bond a current and effective Power of Attorney evidencing the authority
of the officer, agent, or representative who executed this Bond on behalf of Surety to execute, seal, and deliver such
Bond and bind the Surety thereby.
10. This Bond is intended to conform to all applicable statutory requirements. Any applicable requirement of any
applicable statute that has been omitted from this Bond shall be deemed to be included herein as if set forth at
length. If any provision of this Bond conflicts with any applicable statute, then the provision of said statute shall
govern and the remainder of this Bond that is not in conflict therewith shall continue in full force and effect.
11. The term "Bid" as used herein includes a Bid, offer, or proposal as applicable.
EJCDCa C-030, Bid Bond (Penal Sum Form). Published 2013.
Prepared by the Engineers Joint Contract Documents Committee.
Page 2 of 2
19JAY1:111 W-111%si
POWER OF ATTORNEY
Farmington Casualty Company
Fidelity and Guaranty Insurance Company
Fidelity and Guaranty Insurance Underwriters, Inc.
St. Paul Fire and Marine Insurance Company
St. Paul Guardian Insurance Company
Surety Bond No. Bid Bond
OR
St. Paul Mercury Insurance Company
Travelers Casualty and Surety Company
Travelers Casualty and Surety Company of America
United States Fidelity and Guaranty Company
Principal: Peerless -Midwest, Inc.
Project Description: Well No. 1 Replacement Project No. 17-031R Obligee: City of South Bend, Indiana
KNOW ALL MEN BY THESE PRESENTS: That Farmington Casualty Company, St. Paul Fire and Marine Insurance Company, St. Paul Guardian
Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America,
and United States Fidelity and Guaranty Company, are corporations duly organized under the laws of the State of Connecticut, that Fidelity and
Guaranty Insurance Company is a corporation duly organized under the laws of the State of Iowa, and that Fidelity and Guaranty Insurance
Underwriters, Inc. Is a corporation duly organized under the laws of the State of Wisconsin herein collectively called the "Companies"), and that the
Companies do hereby make, constitute and appoint J. Karl Sherrill, Jr. of the City of reensbarro , State of NIC , their true and lawful
Attorney -in -Fact, to sign, execute, seal and acknowledge the surety bond(s) referenced above.
IN WITNESS WHEREOF, the Companies have caused this Instrument to be signed and their corporate seals to be hereto affixed, this 24th day of
June, 2016.
Farmington Casualty Company
Fidelity and Guaranty Insurance Company
Fidelity and Guaranty Insurance Underwriters, Inc.
St. Paul Fire and Marine Insurance Company
St. Paul Guardian Insurance Company
St. Paul Mercury Insurance Company
Travelers Casualty and Surety Company
Travelers Casualty and Surety Company of America
United States Fidelity and Guaranty Company
(90ee)(000ee
,,K�•w,+,ATM�+�a� c ass
State of Connecticut
City of Hartford ss.
Robert L. Raney, Senior Vice President
On this the 24th day of June , 2016, before me personally appeared Robert L. Raney, who acknowledged himself to be the Senior Vice
President of Farmington Casualty Company, Fidelity and Guaranty Insurance Company, Fidelity and Guaranty Insurance Underwriters, Inc., St. Paul Fire
and Marine Insurance Company, St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company,
Travelers Casualty and Surety Company of America, and United States Fidelity and Guaranty Company, and that he, as such, being authorized so to do,
executed the foregoing Instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized offlcer.
In Witness Whereof, I hereunto set my hand and official seal.
My Commission expires the 30th day of June, 2021.
�o,It�
� � Marie C. Tetreault, Notary Public
This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of Farmington
Casualty Company, Fidelity and Guaranty Insurance Company, Fidelity and Guaranty Insurance Underwriters, Inc., St. Paul Fire and Marine Insurance
Company, St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casualty and
Surety Company of America, and United States Fidelity and Guaranty Company, which resolutions are now in full force and effect, reading as
follows:
RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President, any Vice President,
any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary may appoint
Attorneys -in -Fact and Agents to act for and on behalf of the Company and may give such appointee such authority as his or her certificate of
authority may prescribe to sign with the Company's name and seal with the Company's seal bonds, recognizances, contracts of indemnity, and
other writings obligatory in the nature of a bond, recognizance, or conditional undertaking, and any of said officers or the Board of Directors at
any time may remove any such appointee and revoke the power given him or her; and it is
FURTHER RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any
Vice President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company, provided that
each such delegation is in writing and a copy thereof is filed in the office of the Secretary; and it Is
FURTHER RESOLVED, that any bond, recognizance, contract of indemnity, or writing obligatory in the nature of a bond, recognizance, or
conditional undertaking shall be valid and binding upon the Company when (a) signed by the President, any Vice Chairman, any Executive Vice
President, any Senior Vice President or any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate
Secretary or any Assistant Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary; or (b) duly
executed (under seal, if required) by one or more Attorneys -in -Fact and Agents pursuant to the power prescribed In his or her certificate or
their certificates of authority or by one or more Company officers pursuant to a written delegation of authority; and it is
FURTHER RESOLVED, that the signature of each of the following officers: President, any Executive Vice President, any Senior Vice President,
any Vice President, any Assistant Vice President, any Secretary, any Assistant Secretary, and the seal of the Company may be affixed by
facsimile to any Power of Attorney or to any certificate relating thereto appointing Resident Vice Presidents, Resident Assistant Secretaries or
Attorneys -in -Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof, and
any such Power of Attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and
any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding on the Company In the
future with respect to any bond or understanding to which it is attached.
I, Kevin E. Hughes, the undersigned, Assistant Secretary, of Farmington Casualty Company, Fidelity and Guaranty Insurance Company, Fidelity and
Guaranty Insurance Underwriters, Inc., St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, St. Paul Mercury Insurance
Company, Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America, and United States Fidelity and Guaranty
Company, do hereby certify that the above and foregoing is a true and correct copy of the Power of Attorney executed by said Companies,
which is in full force and effect and has not been revoked.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this 12th day of February ,
2019
Kevin E. Hughes, Assistant Secretary
(Doem(00800
ro verify the authenticity of this Power of Attorney, cal/ 1-800-421-3880 or contact us at www.travel rsbvnd com. Please refer to
the Attornerrn-Fact number, the above -named individuals and the detalls of the bond to which the power is attached.
1316 COUNTY —CITY BUILDING ^" "� PHONE 574/ 235-9251
227 W. JEFFERSON BOULEVARD ,� FAx 574/ 235-9171
SOUTH BEND, INDIANA46601-1830 ilk I cy d" TDD 574/235-5567
uiw a
CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR
BOARD OF PUBLIC WORKS
ACKNOWLEDGEMENT OF RECEIPT OF ADDENDUM
Date Received: /_ d 9 - / 9
This addendum is being forwarded to you for the above referenced project.
.,_. Please sign below and acknowledge receipt of this Addendum by
faxing this sheet to the Board of Public Works at (574) 235-9171
within 48 hours of receipt. A copy M UST, also be included with your
bid package upon submittal.
THIS ADDENDUM MAY AFFECT YOUR BID.
Notes:
The attached documents are hereby added to the Specifications and Contract
Documents and become a part of herein.
Company: M ,4. _ s J-
Authorized Signature:
Date: / - ? 9 - /
ANN&
PEERLESS-MIDWEST, INC. "When it Comes to
55860 Russell Industrial Pkwy.
Water Supply Contracting
Mishawaka, Indiana 46545
Phone: (574) 254-9050 & Hydrogeologic Services...
Fax: (574) 254-9650
wwwpeerlessmidwestcom We're PEERLESS!
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1316 COUNTY -CITY BUILDINGt y PHONE 574/ 235-9251
227 W. TEFFERSON BOULEVARD 8( FAX 574/ 235-9171
SOUTH BEND, INDIANA 46601-1830 "E"" TDD 574/ 235-5567
CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR
BOARD OF PUBLIC WORKS
North Station Well No. 1 Replacement
117-031R
Addendum No. 1
Date: January 29, 2019
To: All Planholders
From: Rebecca Plantz, Project Engineer
The following information is to be changed/added to the contract documents:
The scheduled prebid meeting on January 30, 2019 at 11:00 am is rescheduled to February 4,
2019 at 3:00 pm due to the City of South Bend being closed from noon on Tuesday, January 29,
2019 through noon on Thursday, January 31, 2019 because of severe weather.
Attachments:
-This addendum consists of a total 2 pages inclusive of "Acknowledgement of Receipt of
Addendum" sheet-
Communication Result Report ( Jan.29, 2019 12:14PM )
2)
Date/Time: Jan.29. 2019 12:13PM
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1316 COUNTY -CITY BUILDING
227 W.JEFFERSON BOULEVARD
SOUTH BEND, INDIANA 46601-1830
Date:
To:
From
Subject
Project Name
Project No.:
PHONE 574/235-9251
FAx 574/ 235-9171
TDD 574/ 235-5567
CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR
BOARD OF PUBLIC WORKS
February 8, 2019
All Planholders
l ebecca P1a1itz, En�ineer I
Addendum Number: 2
North Station Well No. 1 Replacement
117-031R
ACKNOWLEDGEMENT OF RECEIPT OF ADDENDUM
Date Received:
This addendum is being forwarded to you for the above referenced project.
Please sign below and acknowledge receipt of this Addendum by
faxing this sheet to the Board of Public Works at (574) 235-9171
within 48 hours of receipt. A copy MUST also be included with your
bid package upon submittal.
THIS ADDENDUM MAY AFFECT YOUR BID.
Notes: lie,
G n 'L
The attached documents are hereby added to the Specifications and Contract
Documents and become a part of herein.
Company: pw- e ,/ c s s M 1 d w SITS �I L a c ..
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Authorized Signature:
Date: 00 L� alb / q
PEERLESS-MIDWEST, INC.
"Mien it Comes to
55860 Russell Industrial Pkwy.
Mishawaka, Indiana 46545
Water Supply Contracting
(574) 254-9050
& flydrogeologic Services...
VPhone:
Fax: (574) 254-9650
wwwpeerlessmidwestcom
We're PEERLESS!
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THANK YOU
P, I
Communication Result Report ( Feb. B. 2019 4:32PM
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Date/Time: Feb. 8. 2019 4:31PM
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CITY OF SOUTH BEND, INDIANA
CONTRACTOR'S BID FOR PUBLIC WORK,,=
CHECKLIST FOR BIDDERS
Project Name North Station - Well No. 1 Replacement
Project No. 117-031 R
For Bids Due February 12, 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
X or Bid Bond.
Bid prepared on the City of South Bend Contractor's Bid for Public Work Form, completely
X executed.
Contractor's Non -Collusion and Non -Debarment Affidavit, Certification Regarding Investments
with Iran, Employment Eligibility Verification, Non -Discrimination Commitment, and
X Certification of use of United States Steel Products or Foundry Products.
Proof of MBE/WBE Participation Goal Form [MWBE-1.0]. If minimum participation goal is not
met, also provide Evidence of Good Faith Efforts Form [MWBE-2.0] and MBE/WBE Contacted
X Form [MWBE-2.1].
_X_ Acknowledge Receipt of 2 Addendum(s) included with the bid.
X All required additional information is included with the bid.
Proposal statements and other affidavits all signed by the proper party with name either
X printed or typed underneath signature.
X This checklist submitted with the Bid.
This checklist is provided for bidder's use in assuring compliance with required
documentation; however, it does not include all specifications requirements and does not
relieve the bidder of the need to read and comply with the specifications.
Bidder: Peerless Midwest, Inc. Date: February 11th, 2019
By Authorized Representative:
Signature: X11L_ �F _
Print Name & Title: Frank Williams, Project Mana er
Version 7/20/2018 Contractor's Bid for Public Works - 1
PART II
(For projects of $100,000 or more — IC 36-1-12-4)
These statements to be submitted under oath by each bidder with and as part of his/her/its bid.
Attach additional pages for each section as needed.
SECTION I EXPERIENCE QUESTIONNAIRE
1. Attach information regarding projects your organization has completed for the period of one
(1) year prior to the date of the current bid.
2. Attach a listing of public works projects currently in process of construction by your
organization.
3. Attach information regarding any failure to complete any work awarded to you and the
location thereof.
4. Attach references from private firms for which you have performed work.
SECTION II PLAN AND EQUIPMENT QUESTIONNAIRE
Attach an explanation of your plan or layout for performing proposed work. (Examples could
include a narrative of when you could begin work, complete the project, number of workers,
etc. and any other information which you believe would enable the City of South Bend to
consider your bid.)
2. Attach a listing of the names and addresses of all subcontractors (i.e. persons or firms outside
your own firm who have performed part of the work) that you have used on public works
projects during the past five (5) years along with a brief description of the work done by each
subcontractor.
3. If you intend to sublet any portion of the work, attach the name and address of each
subcontractor, equipment to be used by the subcontractor, and whether you will require a
bond. However, if you are unable to currently provide a listing, please understand a listing
must be provided prior to contract approval. Until the completion of the proposed project, you
are under a continuing obligation to immediately notify the City of South Bend in the event that
you subsequently determine that you will use a subcontractor on the proposed project.
4. Attach a listing of equipment you have available to use for the proposed project.
5. Have you entered into contracts or received offers for all materials which substantiate the
prices used in preparing your proposal? If not, attach an explanation for the rationale used
which would corroborate the prices listed.
SECTION III CONTRACTOR'S FINANCIAL STATEMENT
Attachment of bidder's financial statement is mandatory. Any bid submitted without said
financial statement as required by statute shall thereby be rendered invalid. The financial
statement provided hereunder to the City of South Bend awarding the contract must be specific
enough in detail so that said City of South Bend can make a proper determination of the bidder's
capability for completing the project if awarded.
Version 7/20/201 B Contractor's Bid for Public Works - 3
PART II
Section I Experience Questionnaire
1. Sample of Projects Peerless Midwest Has Completed In The Past Year
• Citizens Energy Group Well # Harbour 12 — CEG, Indianapolis, IN — New 16" Production Well
• Citizens Energy Group Well # Harbour 13 — CEG, Indianapolis, IN — New 16" Production Well
• Michigan State University Well #32A, Michigan State University, East Lansing, MI — New 16"
Production Well
• NIPSCO Wheatfield Well #76, NIPSCO, Wheatfield, IN — New 12" Production Well
• Indiana American Kokomo Well #22, Indiana American Kokomo, Kokomo, IN — New 12"
Production Well
• Indiana American Kokomo Well #G-3, Indiana American Kokomo, Kokomo, IN — New 12"
Production Well
• Berrien Springs Well #8, Berrien Springs Water Department, Berrien Springs, MI — New 12"
Production Well
• Quincy Well #4, Quincy Water Department, Quincy, MI — New 12" Production Well
• Michigan Milk Producers Association Well #3 — MMPA, Constantine, MI — New 12" Production
Well
2. Sample of Public Works Project Peerless Midwest is Currently Completing
• Monticello Well #5 — Monticello Water Department — Monticello, IN — New 16" Well
• Citizens Energy Group Well # Riverside E — CEG, Indianapolis, IN — New Production Well
• Citizens Energy Group Test Drilling — CEG, Indianapolis, IN —Test Drilling for New Production
Well Location
3. Peerless Midwest, Inc. has not failed to complete any work awarded.
4. Private Firms that Peerless Midwest Inc., has performed work for. Specific contact names and
numbers available upon request.
• Memorial Hospital of South Bend, IN
• Kropp Fire Protection, South Bend, IN
• Ancon Construction, Goshen, IN
SECTION II PLAN AND EQUIPMENT QUESTIONNAIRE
1. In general, Peerless Midwest Inc., and the selected subcontractors are able to begin this work as soon
as the notice to proceed has been issued. A general outline of the project's schedule is below, is
conservative, and showing the project meeting Milestone No. 1 and as complete five (5) days before the
substantial completion requirement.
• Procurement of well construction materials following completion of pre -project
paperwork with the City. Site preparation for well construction. Four weeks.
Mobilization of drilling equipment and personnel for construction of well, construction
of well. One week.
Mobilization of well development crew, variable step testing, 48 hour testing,
processing of data and submittal: Three weeks.
55860 Russell Industrial Pkwy., Mishawaka, IN 46545
574.254.9050 phone 574.254.9650 fax www.peerlessmidwest.com
MILESTONE No. 1— Well Test Data Submittal Complete
• Mobilization of excavator for construction of cast in place concrete structure. One week.
• Mobilization of concrete contractor for construction of cast in place concrete structure.
Five weeks.
• Completion of watermain construction, electrical line construction, demolition of
existing well structure and well abandonments. Five weeks.
• Pump and piping installation and connection to watermain. Three weeks.
• Fence and accessory installation. One week.
• Final site restoration. One week.
• Punch list. One Week.
2. Subcontractors we have used in last five (5) years
• Bender Electric —19636 Allegheny Street / P.O. Box 143 Cassopolis, MI 49031. General
electrical contracting in well pump houses, factories, and water treatment facilities
• HRP Construction — 5777 Cleveland Road South Bend, IN 46628. Excavation for
installation of pitless adapters on large diameter wells. Backfill of excavations.
• ELF Excavating — 20140 Jane Street South Bend, IN 46637. Excavation for watermain
construction, underground storage tank construction, well pump house foundations,
backfill of excavations.
• Motor City Electric Company — 9440 Grinnell Detroit, MI 48213. General electrical
contracting at well pump installation.
• Badger Daylighting — 5597 Old Porter Road Portage, IN 46368 — Hydroexcavation and
utility daylighting services
• Blood Hound, LLC — 750 Patricks Place Brownsburg, IN 46112 — Underground utility
locating and ground penetrating radar
3. Subcontractors we plan to use for this project
• HRP Construction — 5777 Cleveland Road South Bend, IN 46628. HRP will be utilizing
dewatering equipment as well as various excavating equipment and dump trucks. No
bond will be required.
• Larson -Danielson Construction — 302 Tyler Street La Porte, IN 46360. L-D will be using
concrete forms and concrete trucks. No bond will be required.
• Bender Electric, Inc. —19636 Allegheny Street / P.O. Box 143 Cassopolis, MI 49031.
Bender Electric will be using service trucks and general hand tools.
• Stans Painting and Decorating, Inc. —1821 Clover Road, Suite 1 Mishawaka, IN 46545.
Stans will be using service trucks and general hand tools.
• Milestone Fence LLC —13399 McKinley Highway Mishawaka, IN 46545. Milestone Fence
will be using service trucks and general hand tools.
• Acorn Landscaping — 3680 W. Sample Street South Bend, IN 46619. Acorn will be using
service trucks and trailers, various tractor and seeding equipment.
4. Listing of equipment Peerless Midwest has for this project..
• V1555 Versa -Drill well drilling machine
• V2000 Versa -Drill well drilling machine
• Nine (9) Smeal Pump Hoists
• Ten (10) RO Crane Pump Hoists
• Twenty -Seven (27) Foreman Service Trucks
Peerless Midwest has received offers for all materials which substantiate the prices used in preparing
this proposal.
SECTION III CONTRACTOR'S FINANCIAL STATEMENT
1. Enclosed
Frank Williams
Project Manager
Peerless Midwest, Inc.
Craig T. Wanke
Account Executive Officer
Bond & Specially fnsurance
11440 Carmel Commons Blvd
Charlotte, NC 28225
Phone: 704-544-3647
Fax: 1-806-216-5977
B-mail: cwanke(Mtravelers.com
January 7, 2019
City of South Bend
830 North Michigan Street
South Bend, IN 46601
Re: Peerless -Midwest, Inc. (Subsidiary ofSUEZ Water Advanced Solutions, LLC)
Project — North Well Field: Weil #1 A
To Whorn It May Concern:
We understand that Peerless -Midwest, Inc. is being considered for the captioned project, Please be advised
that Travelers Casualty and Surety Company of America/Travelers Casualty and Surety Company
(hereinafter referred to as "Travelers") handles all of the bonding requirements for Peerless -Midwest, Inc,
(a wholly -owned subsidiary of SIJEZ Water Advanced Solutions, LLC) , We have confidence in the
financial and operations strength of the firm, and are a strong supporter of their total work program.
Peerless -Midwest, Inc. and SUEZ Water Advanced Solutions, LLC have a surety program with Travelers
for single projects up to $ 5,000,000 and supporting backlogs approaching $ 40,000,000, We are pleased
that Peerless -Midwest, Inc. is pursuing the above referenced project and we recommend them to you as one
of the outstanding contractors in the country.
Peerless -Midwest, Inc. has the ability to provide Performance and Payment Bonds for this project should
they be selected. Naturally, as is customary within the surety industry, the issuance of any bid or final
bonds is always contingent upon a satisfactory underwriting review at the time a request for bonds is made.
This review may include, but not be limited to, acceptable terms, conditions, documents, bond forms and
confirmation of an acceptable financing source and payment provisions. It should be understood that any
arrangement for surety bonds is a matter strictly between Peerless -Midwest, hic. and Travelers. We
assume no liability to third parties or to you by issuance of this letter.
Travelers Casualty and Surety Company of America/Travelers Surety and Casualty Company are licensed
to do business in the State of North Carolina. Travelers Casualty and Surety Company of America is listed
in the Department of Treasury's Listing of Approved Sureties (Department Circular 570) and holds an A++
(Superior) rating by A.M. Best with a Financial Size Category XV by A.M. Best.
Please do not hesitate to contact me if there are any questions or if I may be of further assistance.
Sincerely,
s y
t raig; "1 '"Wankcw, Attorney -In -Fact
Travelers Casualty and Surety Company of America
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CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY
DEVELOPMENT PROGRAM" `
FORM MWBE-2.0"
EVIDENCE OF GOOD FAITH EFFORTS . r'
This completed form should be included as part of the Bids documents related to City of South Bend Public
Works Projects requiring Good Faith Efforts to obtain MBEIWBE participation. It is the bidder's sole
responsibility to verify whether any listed minority or woman business meets the qualifications of a Minority
or Women's owned business as defined by the Indiana Department of Administration ("IDOA").
Project Number:
Project Name:
Bidder:
Contact Person
117-031 R
Date: February I Ith, 2019
North Station - Well No. 1 Replacement
Peerless Midwest, Inc.
Frank Williams Telephone: 574-254-9050
Address: 55860 Russell Industrial Parkwa
y Indiana Zip: 46545
City: Mishawaka a State:
Email: frank.williams@peerlessmidwest.com
To determine whether a bidder has demonstrated good faith efforts to reach the MBE/WBE utilization goals set
forth in the City of South Bend Public Works Project Specifications, the City and its agencies, boards, or
commissions, REQUIRE ALL of the following Good Faith Efforts as listed in the table below*:
EVIDENCE OF GOOD FAITH EFFORTS
MBE/WBE LIST(S): The bidder reviewed the City of South Bend's Minority and Women Business
Enterprise Diversity Development Program, which uses the IDOA approved list of Minority and Women
Owned Business as found on their website (http://www.in.gov/idoa).
ACTION (ADVERTISE/CONTACT): In order for your bid to be deemed responsive, the City of South
Bend requires that all perspective bidders complete no less than 2 of the following:
Attend all pre -bid meetings scheduled by the City to inform MBENVBEs of contracting and
subcontracting opportunities.
Advertise in general circulation and/or trade association publications concerning subcontracting
opportunities, and allow MBE/WBEs reasonable time to respond.
�3 Perform any and all necessary steps to provide written notice in a manner reasonably calculated
to inform MBENVBEs 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.
GOOD FAITH NEGOTIATIONS: The bidder negotiated in good faith with interested MBE/WBEs,
including providing such MBENVBE's with adequate information about the plans, specifications and other
requirements of the subcontract and did not reject MBENVBEs 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
MBENVBEs in order to increase the likelihood of meeting the MBENVBE goals (including breaking down
contracts into smaller units to facilitate MBENVBE participation)
CONTRACT RECORDS: The bidder has maintained the following records for each MBE/WBE that has
bid on the subcontracting opportunity:
1. Name, address, and telephone number;
2. A description of information provided by the bidder or subcontractor; and
3. A statement of whether an agreement was reached, and if not, why not, including any reasons for
concluding that the MBENVBE was unqualified to perform the job.
*Proper demonstration of Good Faith Effort requires your initials next to all of the above boxes. Any
omissions shall be considered grounds for rejection of the bid by the Board of Public Works. The City of
South Bend reserves the right to request additional information.
Version 7/20/2018 Contractor's Bid for Public Works - 9
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY
DEVELOPMENT PROGRAM
FORM MWBE-2.1 f `f
MBEIWBE CONTACTED
This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects
requiring contacted MBEIWBE to obtain Good Faith Efforts. It is the bidder's sole responsibility to verify
whether any listed minority or woman business meets the qualifications of a Minority or Women's owned
business.
PAGE I OF 2
Project Number: 117-031Rm mmmmm mmm_�mmmmm �IT_mmmmmmmmmmmmmmmmmm MBE/WBE Participation Goal Good Faith
Project Name: North Station -Well No. 1 Replacement
Bidder: �7 Peerless Midwest, Inc.
By:Project Manager February 11, 2019
(Signature) (Title) (Date)
MBENVBE Firm 3D Company, Inc.
Owner or Contact at MBENVBE Firm Deanna Case
Telephone: 765-288-3326 Fax:
TYPE OF WORK SOLICITED FOR THIS PROJECT:
Cast in place concrete structure
RESULTS OF CONTACT WITH THE MBE/WBE FIRM;;
No
Email: dcase@3dcompanyinc.com
MBENVBE Firm An Honest Hand LLC
Owner or Contact at MBE/WBE Firm Miguel Covarubias
Telephone: 219-201-7210 Fax Email: anhonesthand@outlook.com
TYPE OF WORK SOLICITED FOR THIS PROJECT:
Cast in place concrete structure
RESULTS OF CONTACT WITH THE MBE/WBE FIRM:
No response
Version 7/20/2018 Contractor's Bid for Public Works - 10
CITY OF SOUTH BEND"""'"
MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY
DEVELOPMENT PROGRAM
NY,nMW Y.<.
FORM MWBE-2.1
MBEIWBE CONTACTED
This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects
requiring contacted MBE/WBE to obtain Good Faith Efforts. It is the bidder's sole responsibility to verify
whether any listed minority or woman business meets the qualifications of a Minority or Women's owned
business.
PAGE 2 OF 2
Project Number: 117-031R
MBE/WBE Participation Goal Good Faith
Project Name: North Station - Well No. 1 Re lacement
Bidder: Peerless Midwest, Inc.
By: - t idu44 - Project Manager Februar 11 2019
(Signature) (Title) (Date)
MBE/WBE Firm Cazares Concrete LLC
Owner or Contact at MBE/WBE Firm Francisco Cazares
Telephone: 765-649-7159 Fax: Email: francisco@cazaresconcretellc.com
TYPE OF WORK SOLICITED FOR THIS PROJECT:
Cast in glace concrete structure
RESULTS OF CONTACT WITH THE MBE/WBE FIRM:
No response
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 7/20/201 S Contractor's Bid for Public Works - 10
Williams, Frank
From: Williams, Frank
Sent: Wednesday, February 06, 2019 8:37 AM
To: 'dcase@3dcompanyinc.com'
Subject: Cast In Place Concrete Structure - South Bend, IN
Ms. Case,
I wanted to reach out to see if 3D was in the business of cast in place concrete structures for municipal projects? We
have a structure in an 'T' shape approximately 15' tall, 10' long, and 7' tall on the lower part of the 'T'.
Please let me know and I can send more information on this.
Regards,
Frank Williams
Peerless Midwest, Inc.
574-254-9050
Williams, Frank
From: Williams, Frank
Sent: Wednesday, February 06, 2019 8:41 AM
To: Ianhonesthand@outlook.com'
Subject: Cast In Place Concrete Structure - South Bend, IN
Mr. Covarubias,
I wanted to reach out to see if An Honest Hand LLC was in the business of cast in place concrete structures for municipal
projects? We have a structure in an "L" shape approximately 15' tall, 10' long, and 7' tall on the lower part of the "L".
Please let me know and I can send more information on this.
Regards,
Frank Williams
Peerless Midwest, Inc.
574-254-9050
Williams, Frank
From: Williams, Frank
Sent: Wednesday, February 06, 2019 8:43 AM
To:'francisco@cazaresconcretellc.com'
Subject: Cast In Place Concrete - South Bend, IN
Mr. Cazares,
I wanted to reach out to see if Cazares Concrete LLC was in the business of cast in place concrete structures for
municipal projects? We have a structure in an 'T' shape approximately 15' tall, 10' long, and 7' tall on the lower part of
the 'T'.
Please let me know and I can send more information on this.
Regards,
Frank Williams
Peerless Midwest, Inc.
574-254-9050
IG2S�o�S4, 4-o Su, 44,
Williams, Frank
From: Williams, Frank
Sent: Monday, February 11, 2019 3:48 PM
To: Jacqueline Sessa
Subject: RE: Document Request
Jacqueline,
The documents are too large to send via email, but can be viewed electronically at the following website:
https- order e—arc.com argQOCj weII Project Marin asp?pub-160-1-178,1
Regards,
Frank Williams
From: Jacqueline Sessa <JacquelineSessa@deltek.com>
Sent: Monday, February 11, 2019 3:34 PM
To: Williams, Frank <frank.williams@peerlessmidwest.com>
Subject: Document Request
Hello,
I recently came across this project:
North Station Well #1 Replacement
I am hoping you can email me a copy of any specifications and/or documents associated with this project. If they can't
be emailed, please let me know. Please do not send them if a fee is required.
Thank you,
Jacqueline Sessa
Peerless Midwest Inc. IN.- an EEO Employer- is seeking proposals from qualified MBE/WBE/DBE businesses for the City
of South Bend- IN; North Station Well #1 replacement- Project No. 117-031R. This project bids on Tuesday- February
12- 2019- at 9:30 a.m. All proposals must be received prior to noon on February 11- 2019 and must be per the contract
documents. Anyone interested in bidding on any part of this project should contact Frank Williams by phone at 574-254-
9050 or by fax at 574-254-9650. Project documents are available for review at our office with prior arrangements at
55860 Russell Ind. Pkwy.- Mishawaka- IN 46545 or e-mail Frank at ��'�g����mlc N11�t�nm�aT���I��w���N�� ���kp�nr�w�c a�� � �s�r��„ Hspaxlp 1x 2:8
Associate Research Analyst, Seattle
T: 206.373.9150
509 Olive Way, tAte 400, Seattle, VVA 98,101
Deftek.c9irn I L Rpan (
BID:37456976
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parfies at Oeltek other than those narne�d iin the rnessage header, and may not necessarily constitute an officW representatron of
..... . .... ...
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ptqqqipti DeItO,,,cqip w4l,') any questions or concerns,
CITY OF SOUTH BEND, INDIANA
CONTRACTOR'S BID FOR PUBLIC WORK
RESPONSIBLE BIDDER CHECKLIST
Project Name North Station - Well No. 1 Replacement
Project No. 117-031 R
For Bids Due February 12, 2019
Contractor Name:
The City seeks to enhance its ability to identify responsive and responsible bidders on all City public works
projects by institution of comprehensive submission requirements in compliance with State law. Quality
workmanship, efficient operation, safety, and timely completion of projects requires that all bidders meet
certain minimum requirements to be responsive and responsible bidders.
THIS FORM MUST BE SUBMITTED WITH YOUR BID.
INSTRUCTIONS:
If you are a pre -qualified bidder, complete Section I only.
If you are not a pre -qualified bidder, complete Section II only.
Section II acts as an application for pre -qualification. Submission of Section II will allow the bidder to be
considered for pre -qualification for bids with the City of South Bend Department of Public Works. Pre -
qualified bidders will then be exempt from a portion of the submission requirements outlined in Section 6-
63 of The Responsible Bidding Ordinance No. 10594-18 (hereinafter, "Responsible Bidding Ordinance")
for a period of twelve (12) months.
Thereafter, contractors who are pre -qualified must submit a complete application for continuation of "pre -
qualified" standing, on a form provided by the City ("Responsible Bidder Checklist (1) Pre -Qualified
Bidders") by December 315' for the upcoming calendar year, or within twelve (12) months of obtaining pre -
qualified standing. If the status of any item changes within the twelve (12) months, it is the responsibility of
the contractor to notify the City. Failure by any pre -qualified contractor to submit its complete application
for continuation of "pre -qualified" standing within the time prescribed above shall result in automatic removal
of the designation, effective January 1 of the following year, or immediately following the twelve (12) months
of pre -qualified standing.
However, the "removed" contractor or subcontractor shall still be permitted to bid on City public works
projects, though the contractor must submit all required documents under 6-63 until "pre -qualified" status
is re-established.
Please Note: The City reserves the right to request supplemental information from the bidder,
additional verification of any information provided by the bidder, and may also conduct random
inquiries of the bidder's current and previous customers regardless of pre -qualified standing.
It is the sole responsibility of the potential bidder to comply with all submission requirements applicable to
the bidder in Section 6-63 of the Responsible Bidding Ordinance no later than the date of the public bid
opening.
Version 7/20/2018 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.
PRE -QUALIFIED BIDDER CHECKLIST
(a) Acknowledgements:
(i) _ By checking this box, I hereby acknowledge that I am a pre -qualified bidder with
the City of South Bend and that I have met the pre -qualification requirements within
the last twelve (12) months. A copy of my Pre -Qualification verification letter
is attached.
(ii) _ By checking this box, I hereby acknowledge that the City reserves the right to
request supplemental information, additional verification of any information
provided by me, and may also conduct random inquiries of my current and prior
customers.
(b) Attachments:
(i) _ Indiana Secretary of State's on-line records (ie. Business verification) dated within
sixty (60) days of the submission of said document showing that business is in
existence, current with the Indiana Secretary of State's Business Entity Report,
and eligible for a certificate of good standing. (Not applicable to individuals, sole
proprietors or partnerships).
Statement on staffing capabilities, including labor sources. This statement
indicates and ensures I have sufficient employees on staff to complete the work. It
outlines how I intend to meet the staffing needs of the work.
Evidence that I am utilizing a surety company which is on the United States
Department of Treasury's Listing of Approved Sureties as required in the bid
specifications or contract.
(iv) List of projects of similar size and scope of work performed in all areas, including
the State of Indiana, within the last three (3) years.
II. PRE -QUALIFICATION CHECKLIST (FOR BIDDERS THAT ARE NOT PRE -QUALIFIED)
(a) Acknowledgements:
(i) _X_ By checking this box, I hereby acknowledge that I am not a pre -qualified bidder
with the City of South Bend.
(ii) X By checking this box, I hereby acknowledge that the City reserves the right to
request supplemental information, additional verification of any information
provided, and may also conduct random inquiries of my current and prior
customers. The City reserved the right to utilize all information provided in this
submission and all information obtained in inquiries or requests to determine if a
bidder is responsive and responsible. Additionally, I acknowledge that all
information provided to the City shall be regarded as public records.
(iii) g By checking this box, I hereby acknowledge that copies of all Applicable
apprenticeship certificates or standards for training programs applicable to the
work performed on the project may be requested at any time and shall be furnished
upon request.
(iv) _X_ By checking this box, I hereby acknowledge and ensure that I and all sub-
contractors, from whom I have accepted a bid and/or intend to hire to perform work
on the public work project, are properly licensed. Furthermore, I acknowledge my
understanding that it is my responsibility to ensure that all sub -contractors have
the necessary licenses to undertake the work called for in this bid. If a sub-
contractor loses their license at any point, it is the responsibility of that sub-
contractor to notify the City.
(b) Attachments:
(i)
Indiana Secretary of State's on-line records (ie. Business verification) dated within
sixty (60) days of the submission of said document showing that business is in
existence, current with the Indiana Secretary of State's Business Entity Report,
and eligible for a certificate of good standing. (Not applicable to individuals, sole
proprietors or partnerships).
(ii)
List identifying all former business names.
(iii) X
Any determinations by a court or governmental agency any violations of federal
state, or local laws including, but not limited to, violations of contracting or antitrust
laws, tax or licensing laws, environmental laws, Occupational Safety and Health
Act (OSHA), or federal Davis -Bacon and related Acts, within the preceding five (5)
years.
(iv) g
Statement about staffing capabilities, including labor sources. This statement
indicates and ensures I have sufficient employees on staff to complete the work I
am bidding on OR outlines how I intend to meet the staffing needs of the work.
(v) g
Statement that individuals who will perform work on the public work project on my
behalf will be properly classified as an employee or as an independent contractor
under all applicable state and federal laws and local ordinances.
(vi) __Y
Evidence of participation in apprenticeship and training programs, applicable to the
work to be performed on the project, which are approved by and registered with
the United States Department of Labor's Office of Apprenticeship, or its successor
organization.
(vii) X
Copy of a written plan for employee drug testing that covers all of my employees
who will perform work on the public work project and meets or exceeds the
requirements set forth in IC 4-13-18-5 or IC 4-13-18-6.
(viii) _X_
Evidence that I am utilizing a surety company which is on the Bureau of Fiscal
Service "Department of Treasury's Listing of Approved Sureties" as required in the
bid specifications or contract.
(ix) 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.
0) X List of projects of similar size and scope of work performed in all areas, including
the State of Indiana, within three (3) years prior to the date on which the bid is due.
Date: February 11th, 2019
(Sign Here)
Frank Williams
(Print Name Here)
(Name of Company)
S
(Address of Company)
Mishawaka
(City)
(State)
574-254-9050
(Telephone Number)
II. PRE-QUALIFICAITON CHECKLIST (FOR BIDDERS THAT ARE NOT PRE -QUALIFIED)
(b) Attachements:
(i) Referenced enclosed
(ii) Peerless Midwest, Inc. has no former business names. This section does not apply
(iii) Peerless Midwest, Inc. has had no determinations by a court or governmental
agency of any violations of federal, state, or local laws including, but not limited
to, violations of contracting or antitrust laws, tax or licensing laws,
environmental laws, Occupational Safety and Health Act, or federal Davis -Bacon
and related Acts, within the preceding five (5) years
(iv) Peerless Midwest, Inc. has 102 employees, including 57 field personnel and 45
office staff. Our field personnel includes four licensed drillers in the state of
Indiana, and twenty-four licensed pump installers in the state of Indiana.
(v) Peerless Midwest, Inc. will ensure that individuals who will perform work on the
public work project on my behalf will be properly classified as an employee or as
an independent contractor under all applicable state and federal laws and local
ordinances.
(vi) Reference enclosed
(vii) Reference enclosed
(viii) Reference enclosed
(ix) Peerless Midwest, Inc. has no federal, state or local tax liens or tax delinquencies
owed to any federal, state or local taxing boxy in the preceding three years.
(x) Peerless Midwest, Inc. has completed many projects of similar size and scope, some
for the City of South Bend itself. In the last three years, we would offer these
project for consideration:
1. Charleston Corporation — Bremen, IN — New Fire Protection Well - 2017: 26" x 16"
Gravel Walled Well to 162' b.g.s., produced 1,500 GPM, 1,000 GPM rated
capacity vertical turbine pump, pump house, and underground watermain.
2. City of Nappanee, IN — Nappanee, IN — New Production Wells #4 & #5 - 2016: Two
(2) 26" x 16" Gravel Walled Wells to 155' and 163' b.g.s. with 1,500 GPM rated
capacity vertical turbine pumps.
3. Memorial Hospital South Bend — South Bend, IN — 2015 & 2016: Three (3) 30" x 20"
Gravel Walled Wells to approximately 143', 130', and 115' b.g.s. with 3,000
GPM rated capacity submersible pumps with pitless adapters.
4. Citizens Energy Group — Indianapolis, IN — Production Wells Harbour #12 & #13 —
2018: 24" x 16" Gravel Walled Wells to 115' and 121' b.g.s., proposed design of
pumps is 700 GPM, pumps are still in submittal phase.
55860 Russell Industrial Pkwy., Mishawaka, IN 46545
574.254.9050 phone 574.254.9650 fax www.peerlessmidwest.com
Business Name: PEERLESS MIDWEST, INC.
Entity Type: Domestic For -Profit Corporation
Creation Date: 03/20/1972
Principal Office Address: 55860 Russell Industrial Pkwy.,
MISHAWAKA, IN, 46545, USA
Jurisdiction of Formation: Indiana
BUSINESS INFORMATION
CONNIE LAWSON
INDIANA SECRETARY OF STATE
01/07/2019 08:35 AM
Business ID: 197203-402
Business Status: Active
Inactive Date:
Expiration Date: Perpetual
Business Entity Report Due 03/31/2020
Date:
Years Due:
Title Name Address
CEO Dominique Demessence 535 Courtney Hodges Boulevard, Perry, GA, 31069, USA
DIRECTOR Dominique Demessence 535 Courtney Hodges Boulevard, Perry, GA, 31069, USA
CFO/TREASURER/DIRECTOR Fernando Almirall 535 COURTNEY HODGES BOULEVARD, Perry, GA, 31069, USA
Corporate Secretary J. Shane Albritton 535 COURTNEY HODGES BOULEVARD, Perry, GA, 31069, USA
SR. VP of Operations Jonathan Cato 55860 Russell Industrial Pkwy, Mishawaka, IN, 46545, USA
Type: Business Commercial Registered Agent
Name: CORPORATION SERVICE COMPANY
Address: 135 North Pennsylvania Street, Suite 1610, Indianapolis, IN, 46204, USA
Boilerplate Individual Non Joint Guideline Standards
DEVELOPED BY
PEER ESS-MIDWEST, INC.
55860 RUSSELL INDUSTRIAL PARKWAY
MISHAWAKA, INDIANA 46545
FOR THE OCCUPATION OF
O*NET-SOC CODE: 47-6021.00
RAPIDS CODE: 0629
APPROVED BY
OFFICE OF APPRENTICESHIP
U.S. DEPARTMENT OF LABOR
:Iqac aLq#J ilk gig
Foreword.........................„,.........., ........
Definitions....................................................w......................„..,,,.,.,.,.....,...,......,,..........,.„,.
SECTION I
Program Administration ................... .„._.......... .„...........„........... .,......
SECTION II
Equal Opportunity Pledge ..................... ,......... .„........ .............. ...,,..„,,,
SECTION III
Affirmative Action Plan ..........................„.„ .....................
SECTION IV
„.,............„.,
Qualifications for Apprenticeship.„...,.....„,,.........„„.„„........„.„..., ...
SECTION V
Selection of Apprentices.„
SECTION VI
.....„„,„....... ........ . ....................
Apprenticeship Agreement ......, ......... ,„..,.,.....„... ...... W ..... ... .....
SECTION VII
Ratio of Apprentices to Journeyworkers ........................
SECTION Vill
Term of Apprenticeship...........................................„,.,.,...,,„............
SECTION IX
Probationary Period ............................ ..„,............. ,........
SECTION X
Hours of Work ................. .„„._ ...........„.,.,„,,.,.
SECTION XI
Apprentice Wage Progression ..................... .... .„.. ....
SECTION XII
Credit for Previous Experience ........................................„„,......
SECTION XIII
Work Experience
SECTION XIV
............. .........„.......„.„,„,„., .,.......„........
Related Instruction ....... .............. ..„.......... ..,„.....,.....,.....,...,.„.
SECTION XV
...,,.....
Safety and Health Training .................... ............... ,.,,,,.......................
SECTION XVI
Supervision of Apprentices ..................... ......„,..„........ ..,.............
SECTION XVII
Records and Examinations ... ___ u............. ...T
SECTION XXIII
„„..,..
Maintenance of Records..........................................
SECTION XIX
.„
Certificate of Completion of Apprenticeship ......... ..„.. ....
SECTION XX
Notice to Registration Agency ............. __.................. ....,...,,.,,,.„„„„,.,..
SECTION XXI
Cancellation and Deregistration ..,,„,„„......... ............
SECTION XXII
Amendments and Modifications .....a.„.......
SECTION XXIII
Adjusting Differences/Complaint Procedure ..................................„„.,
SECTION XXIV
Transfer of an Apprentice and Training Obligation ..................„......,..
SECTION XXV
Responsibilities of the Apprentice ....................................
SECTION XXVI
Technical Assistance .............................. .......
SECTION XXVII
Signature Page Adopting Apprenticeship Standards..,.....„,„............„.
Appendix Al —Wage Structure
Appendix A2 — Work Process Schedule
Appendix A3 — Related Instruction Outline and Provider information
Appendix B - Apprenticeship Agreement
Appendix C - Template Affirmative Action Plan*
Appendix D - Qualifications and Selection Procedures*
* attached if required
FOREWORD
These PEERLESS-MIDWEST, INC. Apprenticeship Standards have as their objective, the training of
Well Drillers (Well Drill Operators) skilled in all phases of the industry. The Sponsor recognizes that in
order to accomplish this, there must be well -developed on-the-job learning combined with related
instruction.
This recognition has resulted in the development of these Standards of Apprenticeship. They were
developed in accordance with the basic standards recommended by the U.S. Department of Labor,
Office of Apprenticeship, as a basis from which the Sponsor can work to establish an apprenticeship
training program that meets the particular needs of the area.
DEFINITIONS
APPRENTICE: Any individual employed by the employer meeting the qualifications described in the
Standards of Apprenticeship who has signed an Apprenticeship Agreement with PEERLESS-
MIDWEST, INC. for training and related instruction under these Standards, and who is registered with
the Registration Agency.
APPRENTICE ELECTRONIC REGISTRATIONAER : Is an electronic tool that allows for
instantaneous transmission of apprentice data for more efficient registration of apprentices and
provides Program Sponsors with a faster turnaround on their submissions and access to their
apprenticeship program data.
APPRENTICESHIP AGREEMENT: The written agreement between the apprentice and the
Sponsor setting forth the responsibilities and obligations of all parties to the Apprenticeship
Agreement with respect to the Apprentice's employment and training under these Standards. Each
Apprenticeship Agreement must be registered with the Registration Agency.
APPRENTICESHIP COMMITTEE COMMITTEE Apprenticeship Committee (Committee) means
those persons designated by the sponsor to act as an agent for the sponsor in the administration of
the program. A committee may be either joint or non -joint as follows:
(1) A joint committee is composed of an equal number of representatives of the employer(s) and
of the employees represented by a bona fide collective bargaining agent(s).
(2) A non -joint committee which may also be known as a unilateral or group non- joint (may
include workers) committee has employer representatives but does not have a bone fide
collective bargaining agent as a participant.
CERTIFICATE OF COMPLETION OF APPRENTICESHIP: The Certificate of Completion of
Apprenticeship issued by the Registration Agency to those registered apprentices certified and
documented as successfully completing the apprentice training requirements outlined 'in these
Standards of Apprenticeship.
JOURNEYWORKER: A worker who has attained a level of skill, abilities and competencies
recognized within an industry as having mastered the skills and competencies required for the
occupation. Use of the term may also refer to a mentor, technician, specialist or other skilled worker
who has documented sufficient skills and knowledge of an occupation, either through formal
apprenticeship or through practical on-the-job experience and formal training.
O*NET-SOC CODE: The Occupational Information Network (O*NET) codes and titles are based on
the new Standard Occupational Classification (SOC) system mandated by the federal Office of
Management and Budget for use in collecting statistical information on occupations. The O*NET
classification uses an 8-digit O*NET-SOC code. Use of the SOC classification as a basis for the
O*NET codes ensures that O*NET information can be readily linked to labor market information such
as occupational employment and wage data at the national, State, and local levels.
ON'THE-JOBLEARNING OJL : Tasks learned on-the-job in which the apprentice must become
proficient before a completion certificate is awarded. The learning must be through structured,
supervised work experience.
PROGRAM SPONSOR: The Sponsor in whose name the Standards of Apprenticeship will be
registered, and which will have the full responsibility for administration and operation ' of the
apprenticeship program.
PROVISIONAL REGISTRATION: Means the 1-year initial provisional approval of newly registered
programs that meet the required standards for program registration, after which program approval
may be made permanent, continued as provisional, or rescinded following a review by the
Registration Agency, as provided for in the criteria describe in §29.3 (g) and (h).
REGISTERED APPRENTICESHIP PARTNERS INFORMATION, DATA SYSTEM (RAPIDS): The
Federal system which provides for the automated collection, retention, updating, retrieval and
summarization of information related to apprentices and apprenticeship programs.
REGISTRATION AGENCY: Means the U.S. Department of Labor, Office of Apprenticeship or a
recognized State Apprenticeship Agency that has responsibility for registering apprenticeship
programs and apprentices; providing technical assistance; conducting reviews for compliance with
Title 29, CFR parts 29 and 30 and quality assurance assessments.
RELATED INSTRUCTION: An organized and systematic form of instruction designed to provide the
apprentice with the knowledge of the theoretical and technical subjects related to the apprentice's
occupation. Such instruction may be given in a classroom, through occupational or industrial
courses, or by correspondence courses of equivalent value, electronic media, or other forms of self -
study approved by the Registration Agency.
STANDARDS OF APPRENTICESHIP: This entire document including all appendices and
attachments hereto, and any future modifications or additions approved by the Registration Agency.
SUPERVISOR OF APPRENTICES : An individual designated by the program sponsor to supervise
or have charge and direction of an apprentice.
TIME -BASED OCCUPATION: The time -based approach measures skill acquisition through the
individual apprentice's completion of at least 2,000 hours of on-the-job learning as described in a
work process schedule.
TRANSFER,: A shift of apprenticeship agreement from one program to another or from one employer
within a program to another employer within that same program, where there is agreement between
the apprentice and the affected apprenticeship committee or program sponsor.
Program Sponsors, at their discretion, may establish an Apprenticeship Training Committee (ATC) to
carry out the responsibilities and duties required of a Program Sponsor as described in these
Standards of Apprenticeship. If an ATC is established by the Program Sponsor, a list of the
membership and the areas of expertise they represent must be provided to the Registration Agency.
While the Office of Apprenticeship recommends that Program Sponsors utilize the services of an
ATC. PEERLESS-MIDWEST, INC. elects to administer the program without the services of an ATC.
Structure of the Apprenticeship and Training Committee ATC if a licable:
A. Members of the ATC will be, selected by the groups they represent.
B. Membership will be composed of representatives appointed by the Sponsor. A minimum
of two members must be journeyworkers in one of the trades covered under this
program.
C. Technical Assistance — such as that from the U.S. Department of Labor, Office of
Apprenticeship, State Apprenticeship Agencies, and vocational schools — may be
requested to advise the ATC.
A. The ATC will elect a Chairperson and a Secretary, and will determine the time and
place of regular meetings which will take place every (N/A) month(s).
B. The Chairperson and Secretary will have the power to vote on all questions affecting
apprenticeship.
C. The Chairperson and Secretary should rotate among members of the ATC.
A. Cooperate in the selection of apprentices as outlined in this program.
B. Ensure that apprentices are under written Apprenticeship Agreements and register the
local apprenticeship standards and agreements with the appropriate Registration
Agency.
C. Review and recommend apprenticeship activities in accordance with this program.
D. Establish the minimum standards of education and experience required of apprentices.
E. Regularly review records and progress of each apprentice in training and recommend
improvement or modification in training schedules, schooling and other training
activities. If applicable, written minutes of the meeting will be kept.
F. Determine the quality and quantity of experience on the job which apprentices should
have and to make every effort toward their obtaining it.
G. Hear and resolve all complaints of violation of Apprenticeship Agreements.
H. Arrange tests or evaluations for determining the apprentice's progress in manipulative
skills and technical knowledge.
Maintain a record of all apprentices, showing their education, experience, and progress
in learning the occupation.
J. Determine the physical fitness of qualified applicants to perform the work of the
occupation that may require a medical examination prior to their employment as
apprentices.
K. Advise apprentices on the need for accident prevention and provide instruction with
respect to safety in the workplace.
L. Certify that apprentices have successfully completed their apprenticeship program.
M. Notify the appropriate Registration Agency of all new apprentices to be registered, credit
granted, suspensions for any reason, reinstatements, extensions, completions and
cancellations with explanation of causes and notice of completions of Apprenticeship
Agreements.
N. Supervise all the provisions of the local standards and be responsible, in general, for
the successful operation of the standards by performing the duties here listed by
cooperating with public and private agencies which can be of assistance by obtaining
publicity to develop public support of apprenticeship and by keeping in constant touch
with all parties concerned; apprentices, employers and journeyworkers.
O. Provide apprentices with a copy of the written rules and policies and the apprentice will
sign an acknowledgment receipt of same. This procedure will be followed whenever
revisions or modifications are made to the rules and policies.
SECTION II — EQUAL OPPORTUNITY PLEDGE — Title 29 CFR 29.5(b)(21) and 30.3(b)
The recruitment, selection, employment, and training of apprentices during their apprenticeship, shall
be without discrimination because of race, color, religion, national origin, sex (including pregnancy
and gender identity), sexual orientation, genetic information, or because they are an individual with a
disability or a person 40 years old or older. The sponsor will provide equal opportunity in
apprenticeship and operate the apprenticeship program as required under title 29 of the Code of
Federal Regulations, part 30.
SECTION III — AFFIRMATIVE ACTION PLAN — Title 29 CFR 29.5(b)(21) and 30.4
If the Sponsor employs five or more apprentices, the Sponsor will adopt an Affirmative Action Plan
and Selection Procedures as required under Title 29, CFR part 30. It will be attached as Appendix C.
SECTION IV- QUALIFICATIONS FOR APPRENTICESHIP — Title 29 CFR 29.5(b)(10)
Applicants will meet the following minimum qualifications:
A. Age
Apprentices must not be less than 18 years of age.
B. Education
A high school diploma or GED equivalency is required. Applicant must provide an official
transcript(s) for high school and post high school education and training. All GED records
must be submitted if applicable.
Applicants must submit a DD-214 to verify military training and/or experience if they are a
veteran and wish to receive consideration for such training/experience.
LOAMMOMM
Applicants will be physically capable of performing the essential functions of the apprenticeship
program, with or without a reasonable accommodation, and without posing a direct threat to
the health and safety of the individual or others.
SECTION V — SELECTION OF APPRENTICES — Title 29 CFR 30.5
Selection into the apprenticeship program will be in accordance with the selection procedures made a
part of these Standards (Appendix D).
SECTION VI — APPRENTICESHIP AGREEMENT — Title 29 CFR 29.3(d) and (e) and 29.5(b)(11)
After an applicant for apprenticeship has been selected, but before employment as an apprentice or
enrollment in related instruction, the apprentice will be covered by a written Apprenticeship
Agreement (Appendix B) signed by the Sponsor and the apprentice and approved by and registered
with the Registration Agency. Such agreement will contain a statement making the terms and
conditions of these standards a part of the agreement as though expressly written therein. A copy of
each Apprenticeship Agreement will be furnished to the apprentice, the Sponsor, the Registration
Agency, and the employer. An additional copy will be provided to the Veteran's State Approving
Agency for those veteran apprentices desiring access to any benefits to which they are entitled.
Prior to signing the Apprenticeship Agreement, each selected applicant will be given an opportunity to
read and review these Standards, the Sponsor's written rules and policies and the Apprenticeship
Agreement.
The Registration Agency will be advised within forty-five (45) days of the execution of each
Apprenticeship Agreement and will be given all the information required for registering the apprentice.
SECTION VII — RATIO OF APPRENTICES TO JOURNEYVORKERS — Title 29 CFR 29.5(b)(7)
The numeric ratio of apprentices to journeyworkers_ will be consistent with proper supervision,
training, safety, and continuity of employment throughout the apprenticeship. The ratio of apprentices
to journeyworkers will not exceed one apprentice to one journeyworker. This ratio language is
specific and clearly described as to its application on the job site, workforce, department or plant.
SECTION VIII — TERM OF APPRENTICESHIP — Title 29 CFR 29.5(b)(2)
The term of the occupation will be three years of RTI with an OJL attainment of 6000 hours
supplemented by the required hours of related instruction as stated on the Work Process Schedule
and Related Instruction Outline (Appendices A2 and A3). Full credit will be given for the probationary
period.
SECTION I — PROBATIONARY" PERIOD — Title 29 CFR 29.5(b)(8), (b)(20)
All applicants selected for apprenticeship will serve a probationary period of 2000 hours or one-year,
whichever is shorter.
During the probationary period either the apprentice or the Sponsor may terminate the Apprenticeship
Agreement, without stated cause, by notifying the other party in writing. The records for each
probationary apprentice will be reviewed prior to the end of the probationary period. Records may
consist of periodic reports regarding progression made in both the OJL and related instruction, and
any disciplinary action taken during the probationary period.
Any probationary apprentice evaluated as satisfactory after a review of the probationary period will be
given full credit for the probationary period and continue in the program.
After the probationary period the Apprenticeship Agreement may be canceled at the request of the
apprentice, or may be suspended or canceled by the Sponsor for reasonable cause after documented
due notice to the apprentice and a reasonable opportunity for corrective action. In such cases, the
Sponsor will provide written notice to the apprentice and to the Registration Agency of the final action
taken.
Apprentices will generally work the same hours as journeyworkers, except that no apprentice will be
allowed to work overtime if it interferes with attendance in related instruction classes.
Apprentices who do not complete the required hours of OJL during a given segment will have the
term of that segment extended until the required number of hours of training are accrued.
SECTION XI — APPRENTICE WAGE PROGRESSION — Title 29 CFR 29.5(b)(5)
Apprentices will be paid a progressively increasing schedule of wages during their apprenticeship
based on the acquisition of increased skill and competence on-the-job and in related instruction.
Before an apprentice is advanced to the next segment of training or to journeyworker status, the
Sponsor will evaluate all progress to determine whether advancement has been earned by
satisfactory performance in their OJL and in related instruction courses. In determining whether
satisfactory progress has been made, the Sponsor will be guided by the work experience and related
instruction records and reports.
The progressive wage schedule will be an increasing percentage of the journeyworker wage rate.
The wage progression that will be applied and the applicable journeyworker rate are shown on the
attached Wage Structure Page, Appendix Al. In no case will the starting wages of apprentices be
less than that required by any minimum wage law which may be applicable.
SECTION XII — CREDIT FOR PREVIOUS EXPERIENCE — Title 29 CFR 29.5(b)(12) and 30.4(c)(8)
The Sponsor may grant credit towards the term of apprenticeship to new apprentices who
demonstrate previous acquisition of skills or knowledge equivalent to that which would be received
under these Standards.
Apprentice applicants seeking credit for previous experience gained outside the supervision of the
Sponsor must submit the request at the time of application and furnish such records and affidavits as
may ber required to substantiate the claim. Applicants requesting such credit who are selected into
the ' apprenticeship program will start at the beginning wage rate. The request for credit ,will be
evaluated and a determination made by the Sponsor during the probationary period when actual on-
the-job and related instruction performance can be examined. Prior to completion 'of the
probationary period, the amount of credit to be awarded will be determined after review of the
apprentice's previous work and training/education record and evaluation of the apprentice's
performance and demonstrated skill and knowledge during the probationary period.
An apprentice granted credit will be advanced to the wage rate designated for the period to which
such credit accrues. The Registration Agency will be advised of any credit granted and the wage rate,
to which the apprentice is advanced.
The granting of advanced standing will be uniformly applied to all apprentices.
SECTION XIII — li'IIORK EXPERIENCE — Title 29 CFR 29.5(b)(3) and 30.8
During the apprenticeship the apprentice will receive such OJL and related instruction in all phases of
the occupation necessary to develop the skill and proficiency of a skilled journeyworker. The OJL will
be under the direction and guidance of the supervisor of the apprentice(s).
SECTION XIV — RELATED INSTRUCTION — Title 29 CFR 29.5(b)(4)
During each segment of training each apprentice is required to participate in coursework related to
the job as outlined in Appendix A3. The apprenticeship will include no less than 144 hours of related
instruction for the Well Drilling Operator trade for each year of the apprenticeship. Apprentices agree
to take such courses as the Sponsor deems advisable. The Sponsor will secure the instructional aids
and equipment it deems necessary to provide quality instruction. In cities, towns or areas having no
vocational school or other schools that can furnish related instruction; the apprentice may be required
to take an alternate form of instruction that meets the approval of the Sponsor and the Registration
Agency.
Apprentices "will not" be paid for hours spent attending related instruction classes.
If applicable, the Sponsor will inform each apprentice of the availability of college credit
Any apprentice who is absent from related instruction classes, unless officially excused, will
satisfactorily complete all course work missed before being advanced to the next period of training.
In cases of failure of an apprentice to fulfill the obligations regarding related instruction (or OJL)
without due cause, the Sponsor will take appropriate disciplinary action and may terminate the
Apprenticeship Agreement after due notice to the apprentice and opportunity for corrective action.
To the extent possible, related instruction will be closely correlated with the practical experience and
training received on-the-job. The Sponsor will monitor and document the apprentice's progress in
related instruction classes.
The Sponsor will select a related training provider which secures competent instructors whose
knowledge, experience, and ability to teach will be carefully examined and monitored. When
possible, the related training provider may require the instructors to attend Indiana-PHCC-
recommended training.
SECTION XV -- SAFETY AND HEALTH TRAINING — Title 29 CFR 29.5(b)(9)
All apprentices will receive instruction in safe and healthful work practices both on-the-job and in
related instruction that are in compliance with the Occupational Safety and Health Standards
promulgated by the Secretary of Labor under 29 U.S.C. 651 et seq., as amended, dated December
29, 1970, and subsequent amendments to that law, or State Standards that have been found to be at
least as effective as the Federal Standards
Apprentices will be taught that accident prevention is very largely a matter of education, vigilance,
and cooperation and that they should strive at all times to conduct themselves in their work to ensure
their own safety and that of their fellow workers.
SECTION X"VI . SUPERVISION OF APPRENTICES — Title 29 CFR 29.5(b)(14)
The Sponsor will be responsible for the training of the apprentice on the job. Apprentices will be
under the general supervision of the Sponsor and under the direct supervision of the journeyworker to
whom they are assigned. The supervisor of apprentice(s) designated by the employer will be
responsible for the apprentice's work assignments, and will ensure the apprentice is working under
the supervision of a skilled journeyworker, evaluation of work performance, and completion and
submittal of progress reports to the Sponsor.
No apprentice will be allowed to work without direct journeyworker supervision.
SECTION XII — RECORDS AND EXAMINATIONS — Title 29 CFR 29.5(b)(6)
Each apprentice may be responsible for maintaining a record of his/her work experience/training on-
the-job and in related instruction and for having this record verified by his/her supervisor at the end of
each week. The apprentice will authorize an effective release of their completed related instruction
records from the local school authorities to the Sponsor. The record cards and all data, written
records of progress evaluations, corrective and final actions pertaining to the apprenticeship,; will be
maintained by and will be the property of the Sponsor. This record will be included in each
apprentice's record file maintained by the Sponsor.
Before each period of advancement, or at any other time when conditions warrant, the Sponsor will
evaluate the apprentice's record to determine whether he/she has made satisfactory progress. If an
apprentice's related instruction or on-the-job progress is found to be unsatisfactory, the Sponsor may
determine whether the apprentice will continue in a probationary status, or require the apprentice to
repeat a process or series of processes before advancing to the next wage classification. In such
cases, the Sponsor will initiate a performance improvement plan with the apprentice.
Should it be found that the apprentice does not have the ability or desire to continue the training to
become a journeyworker, the Sponsor will, after the apprentice has been given adequate assistance
and opportunity for corrective action, terminate the Apprenticeship Agreement.
SECTION XVIII — MAINTENANCE OF RECORDS — Title 29 CFR 29.5(b)(23)
The Sponsor will maintain for a period of five (5) years from the date of last action, all records relating
to apprentice applications (whether selected or not), the employment and training of apprentices, and
any other information relevant to the operation of the program. This includes, but is not limited to,
records on the recruitment, application and selection of apprentices, and records on the apprentice's
job assignments, promotions, demotions, layoffs, terminations, rate of pay, or other forms of
compensation, hours of work and training, evaluations, and other relevant data. The records will
permit identification of minority and female (minority and non -minority) participants. These records
will be made available on request to the Registration Agency.
SECTION XIX. — CERTIFICATE OF COMPLETION OF APPRENTICESHIP — Title 29 CFR
29.5(b)(15)
Upon satisfactory completion of the requirements of the apprenticeship program as established in
these Standards, the Sponsor will so certify in writing to the Registration Agency and request that a
Certificate of Completion of Apprenticeship be awarded to the completing apprentice(s). Such
requests will be accompanied by the appropriate documentation for both the OJL and the ,related
instruction as may be required by the Registration Agency.
SECTION XX — NOTICE TO REGISTRATION AGENCY — Title 29 CFR 29.3(2)(d) and (e) and
29.5(b)(19)
The Registration Agency will be notified within forty-five (45) days of all new apprentices to be
registered, credit granted, suspensions for any reason, reinstatements, extensions, modifications,
completions, cancellations, and terminations of Apprenticeship Agreements and causes.
SECTION XXI — CANCELLATION AND DEREGISTRATION — Title 29 CFR 29.5(b)(18)
These Standards will, upon adoption by the Sponsor be submitted to the Registration Agency for
approval. Such approval will be acquired before implementation of the program.
PEERLESS-MIDWEST, INC. reserves the right to discontinue at any time the apprenticeship
program set forth herein. The Registration Agency will be notified promptly in writing of any decision
to cancel the program.
Deregistration of these Standards may be initiated by the Registration Agency for failure of the
Sponsor to abide by the provisions herein. Such deregistration will be in accordance with the
Registration Agency's regulations and procedures.
Within fifteen (15) days of cancellation of the apprenticeship program (whether voluntary or
involuntary), the Sponsor will notify each apprentice of the cancellation and the effect of same. This
notification will conform to the requirements of Title 29, CFR part 29.7.
SECTION XXII — AMENDMENTS OR MODIFICATIONS — Title 29 CFR 29.5(b)(18)
These Standards may be amended or modified at any time by the Sponsor provided that no
amendment or modification adopted will alter any Apprenticeship Agreement in force at the time
without the consent of all parties. Such amendment or modification will be submitted to the
Registration Agency for approval and registration prior to being placed in effect. A copy of each
amendment or modification adopted will be furnished to each apprentice to whom the amendment or
modification applies.
SECTION XXIII — ADJUSTING DIFFERENCES/COMPLAINT PROCEDURE — Title 29 CFR
29.5(b)(22) and 30(11)
The Sponsor will have full authority to supervise the enforcement of these Standards. Its decision will
be final and binding on the employer, the sponsor, and the apprentice, unless otherwise noted below.
If an applicant or an apprentice believes an issue exists that adversely affects his/her participation in
the apprenticeship program or violates the provisions of the Apprenticeship Agreement or Standards,
relief may be sought through one or more of the following avenues, based on the nature of the issue:
Title 29 CFR 29.7 k
The Sponsor will hear and resolve all complaints of violations concerning the Apprenticeship
Agreement and the registered Apprenticeship Standards, for which written notification is received
within fifteen (15) days of violations. The Sponsor will make such rulings as it deems necessary in
each individual case and within thirty (30) days of receiving the written notification. Either party to
the Apprenticeship Agreement may consult with the Registration Agency for an interpretation of
any provision of these Standards over which differences occur. The names and addresses of the
appropriate authorities to receive, process and make disposition of complaints are:
Robin Kealy - PEERLESS-MIDWEST, INC.
55860 RUSSELL INDUSTRIAL PARKWAY, MISHAWAKA, INDIANA 46545
robin. keal eerlessmidwest.com 574-254-9050
or
Office of Apprenticeship- U.S. DOL, 2420 Viridian Drive — Suite G,
South Bend, IN 46628-7900.
Any apprentice or applicant for apprenticeship who believes that he/she has been discriminated
against on the basis of race, color, religion, national origin, or sex, with regard to apprenticeship or
that the equal opportunity standards with respect to his/her selection have not been followed in the
operation of an apprenticeship program, may personally or through an authorized representative,
file a complaint with the Registration Agency or, at the apprentice or applicant's election, with the
private review body established by the Program Sponsor (if applicable).
The complaint will be in writing and will be signed by the complainant. It must include the name,
address, and telephone number of the person allegedly discriminated against, the Program
Sponsor involved, and a brief description of the circumstances of the failure to apply equal
opportunity standards.
The complaint must be filed not later than one hundred eighty (180) days from the date of the
alleged discrimination or specified failure to follow the equal opportunity standards, and in the
case of complaints filed directly with the review body designated by the Program Sponsor to
review such complaints, any referral of such complaint by the complainant to the Registration
Agency must occur within the time limitation stated above or thirty (30) days from the final decision
of such review body, whichever is later. The time may be extended by the Registration Agency for
good cause shown.
Complaints of discrimination in the apprenticeship program may be filed and processed under
Title 29, CFR part 30, and the procedures as set forth above. The Sponsor will provide written
notice of its complaint procedure to all applicants for apprenticeship and all apprentices.
SECTION XXIV — TRANSFER OF AN APPRENTICE AND TRAINING OBLIGATION - Title 29 CFR
29.5(13)
The transfer of an apprentice between apprenticeship programs and within an apprenticeship
program must be based on agreement between the apprentice and the affected apprenticeship
committee or program sponsors, and must comply with the following requirements:
i. The transferring apprentice must be provided a transcript of related instruction and
on-the-job learning by the committee or program sponsor:
ii. Transfer must be to the same occupation; and
iii. A new apprenticeship agreement must be executed when the transfer . occurs
between the program sponsors.
SECTION XXV — RESPONSIBILITIES OF THE APPRENTICE
Apprentices, having read these Standards formulated by the Sponsor and signed) an Apprenticeship
Agreement with the Sponsor agree to all the terms and conditions contained therein and agree to
abide by the Sponsor"s rules and policies, including any amendments, serve such time, perform such
manual training, and study such subjects as the Sponsor may deem necessary to become a skilled
Well Driller (Well Drill Operator).
In signing the Apprenticeship Agreement, apprentices assume the following responsibilities and
obligations under the apprenticeship program:
A. Perform diligently and faithfully the work of the occupation and other pertinent duties assigned
by the Sponsor and the employer in accordance with the provisions of these Standards.
B. Respect the property of the employer and abide by the working rules and regulations of the
employer.
C. Attend and satisfactorily complete the required hours in the OJL and in related instruction in
subjects related to the occupation as provided under these Standards.
a
D. Maintain and make available such records of work experience and training received on-the-job
and in related instruction as may be required by the Sponsor.
E. Develop and practice safe working habits and work in such a manner as to assure his/her
personal safety and that of other fellow workers.
F• Work for the employer to whom the apprentice is assigned for the completion of apprenticeship,
unless reassigned to another employer or the Apprenticeship Agreement is terminated by the
Sponsor.
SECTION XXVI -- TECHNICAL ASSISTANCE
Technical Assistance such as that from the U.S. Department of Labor, Office of Apprenticeship, State
Apprenticeship Agencies, and vocational schools —may be requested to advise the Sponsor.,
The Sponsor is encouraged to invite representatives from industry, education, business, private
and/or public agencies to provide consultation and advice for the successful operation of their training
program.
SECTION XXVII — OFFICIAL ADOPTION OF APPRENTICESHIP STANDARDS:
OFFICIALLY ADOPTED BY
PEERLESS-MIDWEST, INC.
Name of Sponsor
SIGNED TITLE O eratlons Mana er
PRINTED NAME Cathv S. Lance
Registered as incorporating the basic standards of
Office of Apprenticeship
United States Department of Labor
State Director
Office of Apprenticeship
United States Department of Labor
Date of Registration
Registration Number
APPENDIX Al
OT
rf
YEAR
1ST
2nd
WAGE SCALE: 2000 hour Increments
OCCUPATION: WELL DRILL OPERATOR (0629)
TERM OF APPRENTICESHIP: 3 YEARS RTI/ 6000 OJL HRS.
TIME PERIOD
1st 2000 Hours
2nd 2000 Hours
Rate or er Hour
17.66 /1000 21.97 /1000
02MMMIMMM1
3rd 3rd 2000 Hours 23,01/1000 29.72 /1000
Journeyworker Rate (Completion): 29.72 / HOUR
WORK EXPERIENCE
DURING THE TERM OF APPRENTICESHIP, THE APPRENTICE SHALL BE GIVEN SUCH
INSTRUCTION AND EXPERIENCE TO DEVELOP THE SKILLS AND KNOWLEDGE NECESSARY
FOR COMPLETE MASTERY OF THE TRADE. THE TRAINING OF ALL APPRENTICES SHALL
INCLUDE THE FOLLOWING WORK UNITS, BUT NOT NECESSARILY IN THE SEQUENCE LISTED.
THE TIME REQUIRED IN THE DIFFERENT UNITS OF THE TRADE MAY NEED TO BE ADJUSTED
FOR CERTAIN INDIVIDUAL APPRENTICES, BUT RETENTION OF THE APRENTICE ON A
PARTICULAR OPERATION BEYOND THE ESTABLISHED TIME SHOULD NOT OCCUR UNLESS
THERE IS A DEFINATE NEED FOR FURTHER TRAINING AT THAT STEP.
Fair Labor Standards Act: Employers should ascertain if any of their activities are covered in this act.
Employees in covered activities, including apprentices, must be paid time and one-half for all hours
worked over forty (40) hours per week.
Davis Bacon Act. On work sites covered by prevailing wage law, required Journeyworker rate and
corresponding apprentice wages for that project may exceed those stated in this document.
APPENDIX A2
OCCUPATION AND WORK PROCESS SCHEDULE
WELL DRILL OPERATOR
O*NET/SOC CODE: 47-5021.02 RAPIDS CODE: 0629
DESCRIPTION: Sets up and operates portable drilling rig (machine and related equipment) to drill wells:
Extends stabilizing jackscrews to support and level drill rig. Moves levers to control power -driven winch that
raises and extends telescoping derrick. Bolts trusses to derrick and machine frame. Assembles drilling tools,
using handtools or power tools. Moves levers and pedals to raise and lower drill tools and well casing into well
bore. Moves levers and pedals and turns handwheels to control action of machine that drills or punches well
bore and lowers casing into well. Pours water into well or pumps water or slush into well to cool drill bit and
remove drillings. Listens to sounds of drilling machine and feels cable or brake to determine changes in rock
formations being penetrated or variations in drilling process. Moves levers to adjust stroke and impact of cable
tool drilling machine or changes drill bits of rotary drilling machine according to nature of strata encountered.
Replaces drill bit with tool to collect samples of earth or rock being penetrated. Inspects core samples to
determine nature of strata encountered or takes samples to laboratory for analysis. Records drilling progress
and geological data. Splices worn or broken cable. Fabricates well casings and builds up worn drill bits, using
oxyacetylene cutting and welding equipment. Retrieves lost equipment from boreholes, using fishing
(specialized retrieval) tools and equipment. May repair drill bits, using forging furnace, hammer, and anvil.
May operate well -drilling rig to restore irrigation, industrial and domestic water wells to active production.
ON-THE-JOB TRAILING:
WORK PROCESS APPROXIMATE HOURS
A.
Safety and learn various pipe sizes and types
200
B.
Cutting and threading pipe
300
C.
Rig lubrication
300
D.
Maintenance of drilling tools
200
E.
Care and use of acetylene torch -burning
300
F.
Set up well drilling equipment
1100
G.
Start and align well casing
200
H.
Drive well casing
500
I.
Rigging
150
J.
Gas welding
150
K.
Electric welding
100
L.
Select and set well strainer according to sand
200
M.
Take proper samples and recognize formation
200
N.
Operate machine hydraulic jacks for removing well casing
300
O.
Pump and develop well after drilling
750
P.
Take samples for chemical and bacterial tests
300
Q.
Repair old wells (remove old casings, install new casings, sealing
750
TOTAL HOURS 6000
APPENDIX A3
INN
1. Number of hours per year 144 MIN. (Should be 144 contact
hours or 9 credit hours per year minimum; 432 minimum total contact hours
2. Method COMBINATION (Primarilv Classroom
(classroom; shop; e-learning; combination)
3. Specify Provider(s):
4. List proposed courses to be taken by apprentice(s):
Course Title Provider Approximate Duration in Contact Hours
Year ONE
Mud School
USF OSHA 10
CIC Crane Training
USF OSHA 30
PMI 3 Day Training
Year TWO
ARC Flash Training
Rigging & Signaling
HAZWOPER
Basic Geology
Drilling Safety
Ground Water Basics
Aquifer Storage Recovery
Well Abandonment
Well Development
PMI 3 Day Training
Year THREE
Well Rehabilitation
Well Rehabilitation
Drilling Methods
PMI 3 Day Training
PUMPS
Welding
Baroid, Halliburton
40 hours
USFOSHA.com
10 hours
Crane Institute Certification
40 hours
USFOSHA.com
30 hours
Peerless -Midwest, Inc.
24 hours
NFPA 70 E Trainer
12 hours
PMI Certified Trainer
8 hours
USFOSHA.com
40 hours
International School Of Well Drilling
10 hours
ISWD ON-LINE SCHOOL
10 hours
ISWD ON-LINE SCHOOL
10 hours
ISWD ON-LINE SCHOOL
10 hours
ISWD ON-LINE SCHOOL
10 hours
ISWD ON-LINE SCHOOL
10 hours
Peerless -Midwest, Inc.
24 hours
ISWD ON-LINE SCHOOL
10 hours
ISWD ON-LINE SCHOOL
10 hours
ISWD ON-LINE SCHOOL
24 hours
Peerless -Midwest, Inc.
24 hours
Peerless -Midwest, Inc.
40 hours
Peerless -Midwest, Inc.
60 hours
APPENDIX B
U.S. Department of Labor
Program Registration and Employment and Training Administration
Apprenticeship Agreement g
_ffiCe_ta At)jarenti.ceshin
APPRENTICE REGISTRATION -SECTION III OMB No. 1205-022 Ex ires:01/31/2012
Warning: This agreement does not constitute a certification under Title 29,The program sponsor and apprentice agree to the terms of the Apprenticeship
CFR, Part 5 for the employment of the apprentice on Federally financed or Standards incorporated as part of this Agreement. The sponsor will not discriminate
assisted construction projects. Current certifications must be obtained in the selection and training of the apprentice in accordance with the Equal
from the Office of Apprenticeship (OA) or the recognized State Opportunity Standards in Title 29 CFR Part 30.3, and Executive Order 11246. This
Apprenticeship Agency shown below. (Item 22) agreement may be terminated by either of the parties„ citing cause(s), with notification
to the registration aaencv. in comollance with Title 29. CFR. Part 29.6
PART A TO BE COMPLETED BY APPRENTICE, NOTE TO SPONSOR: PART A SHOULD ONLY BE FILLED O
1. Name (Last, First, Middle) and Address *Social Security Number Answer Both A and B (Voluntary)
- _ I (Definitions on reverse)
(No., Street, City, State, Zip Code, Telephone Number)
4. a. Ethnic Group (Mark one)
❑ Hispanic or Latino
❑ Not Hispanic or Latino
b. Race (Mark one or more)
❑ American Indian or Alaska native
❑ Asian
--•- ❑ Black or African American
2. Date of Birth (Mo., Day, Yr.) 3. Sex (Mark one) ❑ Native Hawaiian or other
❑ Male ❑ Pacific Islander
Female ElWhite
7. Career Linkage or Direct Entry (Mark one) (Instructions on reverse) ❑ None ❑ Incumbent Worker
❑ Dislocated Worker ❑ Trade Adjustment Assistance ❑ Job Corps
❑ YouthBuild ❑ HUD/STEP-UP ❑ Direct Entry:
8. Signature of Apprentice
5. Veteran Status (Mark one)
❑ Non -Veteran
❑ Veteran
6. Education Level (Mark one)
❑ 8th grade or less
❑ 9th to 12th grade
❑ GED
❑ High School Graduate or
Greater
❑ Post Secondary or Technical
Training
❑ Adult ❑ Youth
❑ School -to -Registered Apprenticeship
Date 19. Signature of Parent/Guardian (if minor) Date
PART B: SPONSOR:
10. Sponsor Program No. 11a. Trade/Occupation (The work processes listed in the standards are part of
this agreement).
Sponsor Name and Address (No. Street, City, County, State, Zip Code 01110
Nere M1feSt; MfM 11 b. Occupation Code 12. Term 13. Probationary Period
5t'�6�bi�ust�eN�� Mrwd�ilstrfal P;irkwuri
(Hrs., Mos., Yrs.) (Hrs., Mos., Yrs.)
is I raka 1N 4 4 kb Wn'AL"2 3 yrs
14. Credit for Previous 15. Term Remaining 16. Date Apprenticeship
Experience (Hrs., Mos., Yrs.) (Hrs., Mos., Yrs.) Begins
17a. Related Instruction 17b. Apprentice Wages for Related Instruction 17c. Related Training Instruction Source
(Number of Hours Per Year) X - Will Not Be Paid Peerless -Midwest, Various Teachers and Online Education
144
18. Wages: (Instructions on reverse)
8a. Pre -Apprenticeship Hourly Wage $
Check Box Period 1 2
18d. Term
X Hrs., ❑ Mos., or ❑yrs. 1000 1000
18e. Wage Rate
(Mark one) % ❑ or $ X 17.66 21.97
19. Signature of Sponsor's Representative(s)
20. Signature of Sponsor's Representative(s)
Apprentice's Entry Hourly Wage 18b.$ Journeyworker's Hourly Wage18c. $
3 4 5 6
1000 1 1000 1 1000 1 1000
23.98 25.93
Date Signed
Date Signed
28.01 1 29.72
7 8 9 10
21. Name and Address of Sponsor Designee to Receive Complaints
(If applicable)
PART Ca TO BE COMPLETED BY REGISTRATION AGENCY ,!" k'
22. Registration Agency and Address 23. Signature (Registration Agency) 24, Date Registered
U.S. DOL - Office of Apprenticeship
2420 Viridian Drive - Suite G
South Bend, IN 46628-7900
25. Apprentice Identification Number (Definition on reverse):
Boilerplate Individual Non Joint Guideline Standards
Item 4.a. Definitions:
Hispanic o,Latino. Aperson ofCuban, Mexican, Puerto Rican, South or Central �mh�Gpa��ou�ummohg�
ega��ouofmnm Tho0onn.^Opao�ho�g�.^oonhe�edinodd�onto1H�men�mr-Latino."
Item uem��oo�n�ono: --
American Indian or Alaska NativeA person having origins Inany of the original peoples of North and South America (including
Central America), tribalor Asian.A having origins in the original � fthe
` F^'|.
--�—Southeast Asia,urthe Indian subcontinent including,
for example, China, India, Japan, the Philippine Islands, Thailand, and Vietnam.
Black ~^ African: ~".°,"~=". " person having origins manymrtnmomoxnoo/o/groups of Terms such oo^MoiUan^vr''Ne8m''
��kem�g�a��m���m mr���nAme��w." '
Native Hawaiian o,Other Pacific Islander, Aperson having origins inany ufthe original peoples ofHawaii�uomGemvonr
other Peoi�cIslands. ' ' '
VVhdo. A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
Item 7.motrmctimms:
Indicate any career linkage
'Incumbent Worker" if the Individual before becoming, an apprentice was currently employed full-time by the sponsor or enfifies
participating In the apprenticeship program (Military), Career linkage kicludes, participation, in programs that provided employment,
training and other services to adults, youth and dislocated workers. Funds for these activities are provided by the U.S, Department
of LaborlEmployment and Training Administration (U.S. DOUETA) to states and local communities,
Adult. Also includes Individuals participating in Native American Programs, and/or Migrant and Seasonal Farmworker Programs.
Youth, Includes Youth ages 16-21 years, and other concentrated Youth programs in designated areas.
Dislocated Worker. Includes an individual that has been terminated or laid off and is unlikely to return to the industry or
occupation. It also includes a displaced homemaker who has been providing unpaid services to family members in the home, is
no longer supported, and is unemployed or underemployed,
Trade Adjustment Assistance, Includes trade -affected workers who have become unemployed as a result of increased imports or
shifts in
production out mthe United
Job Corps. Youth ages 16-24 years usually receiving services in a residential setting.
School -to -Registered Apprenticeship. Program designed to allow high school youth ages 16 - 17 to enter a Registered
Apprenticeship program and continue after graduation with full' credit given for the high school portion,
YouthBuild, Program transferred from the U.S. Department of Housing and Urban Development (HUD) to U,S. DOUETA in
September 2006,, It assists youth ages 16-24 to obtain education and skill training and advance toward post -secondary education
and career pathways in construction and other high growth, high demand occupations while building affordable housing In their
HU'DISTEF-UPDeveloped i
provides the actual' apprenticeship experience and the framework for moving into high -skill Registered Apprenticeship,
Direct Entry, A graduate from an accredited technical training school, Job Corps training program, Youth Build Program, of a
participant in a military apprenticeship program, any of which training Is specifically related to tile occupation and incorporated in
the Registered Apprenticeship staticlards, Also� fill In the narne of the program,
Item 18. Wage Instructions:
18a. Pre -Apprentice hourly wage, sponsor enters the Individual's hourly wage in the quarter prior to becoming an apprentice.
18b. Journeyworker's wage, sponsor enters wage per hour.
18c. Apprentice's entry hourly wage, (hourly dollar amount paid), sponsor enters this apprentice's entry hourly wage.
18d. Term, sponsor enters in each box the apprentice schedule of pay for each advancement period,
18e. Percent or dollar amount, sponsor marks one,
Note, 18bIf the employer is signatory to a colleclive bargaining agreement, the journeyworker's wage rate In the applicable
collective bargaining agreement is identified, Apprenticeship program sponsors not covered' by a collective bargaining agreement
must identify a minimum journeyworker's
10e. mfthis agreement. hourly- ill be the basis — the progressive wage schedule Identified in item
I8dThe employer agrees to pay the hourly wage rate identified inthis section to the apprentice each period ofthe
apprenticeship based on the successful completion or the on-the-job learning and the mYeWmd instructions outlined in the
Apprenticeship Standards. The period may beexpressed |nhours, months, mryears,
1 8e. The wage aama are m«pmxmmmd either as m percent or in do||om and cents of the joumayworkor'o wage
depending mothe industry,
oiNar late Individual Non Joint Guideline Standards
provisions of the Privacy Act apply to any unlawful disclosure of your social security number, which is prohibited
The collection and maintenance of the data on PTA-671, Apprentice Registration — Section H Form, Is authorized under the National Apprenticeship Act, 29 UN &C. 50, an
29 Part 29.1 The data is used for apprenticeship program statistical purposes and is maintained, pursuant to the Privacy Act of 1974 (5 U,S.C. 552aJ, In a system of r
entitted, DOUETA-4, Apprenticeship tnfonnation Management System (AIMS)„ which is now known as (RAPIDS) at the office of Apprentioeship, U,S. Department of Labor
may be disclosed to a State Apprenticeship Council to determine an assessment of skill needs and program information, and in connection with federal lghgation or when rf
by law.
Persons are not required to respond to this collection of information unless It displays a currently valid t MIB control number, Public reporting burden for this collet
Information Is estlmaled to average five minutes per response, Including the time for reviewing instructions, searching existing data sources, gathering and maintaining t'f
needed, and completing and reviewing the collection of Information The obligation to respond is required to obtain or retain benefits under 29 USC So. 'Send corn
regarding this burden estimate or any other aspect of this collection of information, Including suggestions for reducing this burden,to the U.S. Department of Labor, o
Apprenticeship„ 200 Constitution Avenue, N.W., Room N-5311, Washington„ D.C.. 20,210(Paperwork Reduction Project 1205.022 ),
=1 ;
Substance Abuse Policy For
Peerless -Midwest, Inc.
55860 Russell Industrial Parkway
Mishawaka, IN 46545
A. Forward
Among Peerless -Midwest Inc. most vital concerns are the safety, health, and well
being of its employees and all people who come into contact with its workforce,
property, and/or its products, and services. It is our goal to provide a healthy,
satisfying work environment that promotes personal opportunities for growth.
Furthermore, our employees have the right to work with persons free from the effects
of alcohol and/or drugs.
Peerless -Midwest Inc. does not intend to intrude into the private lives of its employees
and recognizes the employee's off -the -job as well as on -the -job -involvement with
illegal drugs can have a negative impact on the workplace, fellow employees and
customers. Employees are expected to report for work with no illegal drugs in their
bodies and free of all adverse effects of alcohol misuse. Peerless -Midwest Inc.
encourages employees to seek professional assistance any time for personal
problems, including alcohol or drug dependency that adversely affects their ability to
perform their assigned duties.
Supervisors are dedicated to the fair and equitable application of this policy. They are
required to apply all aspects of this policy and to use it in an unbiased and impartial
manner.
B. Purpose
The purpose of this policy is to comply with Department of Transportation Regulations
(DOT) 49 CFR Part 40, Procedures for Transportation Workplace Drug Testing
Programs, 49 CFR Part 382, controlled Substances and Alcohol Use and Testing -
Federal Motor Carrier Safety Administration, and 49 CFR Part 29, Drug -Free
Workplace Act of 1988. This policy incorporates these regulations for safety sensitive
employees.
C. Applicability
This policy applies to all employees that are required to have a Commercial Driver's
License (CDL), or are considered by DOT to be in a safety -sensitive position, full or
part-time, contract employees and contractors when they are on Peerless -Midwest
Inc. property or when performing any safety -sensitive function for Peerless -Midwest
Inc.
E
Performing a safety -sensitive function means from the time an employee is ready to
work, begins work, and is relieved from all responsibility for performing work. Safety
sensitive functions may include, however, are not limited to the following items:
i. All time on Peerless -Midwest Inc. property, or shipper property, terminal,
facility, or other property, or on any public property, waiting to be dispatched,
unless the driver has been relieved from duty by Peerless -Midwest Inc.
ii. All time inspecting equipment as required by 49 CFR Part 392 (392.7 & 392.8)
or otherwise inspecting, servicing, or conditioning any Commercial Motor
Vehicle (CMV) at any time.
iii. All time spent at the driving controls of a CMV.
iv. All time, other than driving time, in or upon any CMV except time spent resting
in a sleeper berth (the berth must conform to the requirements of 49 CFR Part
393.7).
v. All time loading or unloading, attending a CMV being loaded or unloaded,
remaining in readiness to operate the CMV or in giving or receiving receipts for
shipments loaded or unloaded.
vi. All time repairing, obtaining assistance, or remaining in the attendance of a
disabled CMV.
D. Legal Drugs
For a drug to be legally prescribed the employee must have a prescription or other
written approval in his/her name from a licensed physician for the use of the drug in
the course of medical treatment. The prescription or written document must also
contain the name of the substance, the quantity/amount to be taken, and the period of
authorized use. Any abuse or misuse of legal drugs while performing a safety -
sensitive function is prohibited by Peerless -Midwest Inc.
The appropriate use of legally prescribed drugs and non-prescription medications is
not prohibited by Peerless -Midwest Inc. However, the use of any substance which
carries a warning label that indicates that motor skills, mental functioning, or judgment
may be affected; the employee must report this to supervisory personnel immediately.
An employee must obtain a written release from the attending physician releasing the
employee from performing safety -sensitive duties any time the employee is using a
performance altering prescription.
E. Prohibited Substances
Any substance or illegal drug identified in the Controlled Substance Act (21 U.S.C.
812) is prohibited at all times. This includes, but is not limited to marijuana (THC),
amphetamines, opiates, phencyclidine (PCP), and cocaine, as well as any drug not
approved for medical use by the U.S. Drug Enforcement Administration or the U.S.
Food and Drug Administration. Illegal use includes, but not limited to, any illegal drug
3
use, misuse of legally prescribed drugs, and the use of illegally obtained prescription
drugs.
The consumption of beverages containing alcohol or substances in which alcohol is
present (including any medication, mouthwash, food, candy) or any other substance
in which alcohol is present while performing safety -sensitive functions for Peerless -
Midwest Inc. is prohibited.
F. Prohibited Conduct
Engaging in unlawful manufacture, distribution, dispensing, possession, or use of
prohibited substances is prohibited by any safety -sensitive employee of Peerless -
Midwest Inc. Employees who violate this provision will be terminated.
All employees of Peerless -Midwest Inc. are required to notify their supervisor within
five (5) days of any criminal drug statute conviction. Failure to comply with this
provision shall result in termination.
G. Compliance with Testing Requirements
All employees in safety -sensitive positions will be subject to urine drug testing and
breath alcohol testing. A refusal to test is considered a positive test result and will
lead to immediate removal from duty, referral to a Substance Abuse Professional
(SAP), and termination of employment. The following items constitute a refusal to
test:
i. Failure to appear or remain at the test site.
ii. Failure to provide urine specimen when required.
iii, Failure to permit direct observation or monitored collection.
iv. Declines to take a second test when directed.
. Failure to provide sufficient urine or breath without a valid medical explanation.
vi. Failure to undergo a medical evaluation.
vii. Failure to cooperate with the testing process.
viii. Attempt to dilute, substitute, or tamper with a specimen.
ix. Failure to sign the Custody Control Form or Breath Alcohol Form.
H. Testing Procedures
Federal regulations required analytical urine drug testing and breath alcohol testing to
be conducted when circumstances warrant or as outlined in the regulations.
Peerless -Midwest Inc. affirms the need to protect individual dignity privacy and
confidentiality throughout the testing process. If at any time the integrity of the testing
procedures or the validity o the tests results are compromised, the test will be
cancelled.
4
Dru Tests
The drugs that will be tested for include marijuana (THC), cocaine, opiates,
amphetamines, and phencyclidine (PCP), Urine specimens will be conducted using
the split specimen sample method as described in 49 CFR Pat 40. Each specimen
will be accompanied by a DOT Chain of Custody and Control Form (CCF) and
identified using a unique identification number that attributes the specimen to the
correct individual.
The specimen will be sent to a laboratory where a validity test will be performed to
ensure that it is non -adulterated human urine. Then an initial drug screen test will be
conducted on the primary specimen. For the primary specimen that is no negative, a
confirmatory Gas Chromatography/Mass Spectrometry (GC/MS) test will be
performed. The primary test will be considered positive if the amounts present are
above the minimum thresholds established in 49 CFR Part 40.
All test results from the laboratory will be, reported to a Medical Review Officer (MRO).
The MRO is a licensed physician with detailed knowledge of substance abuse
disorders and drug testing. The MRO will be knowledgeable in the DOT regulations
and MRO guidelines, DOT operating administration regulations and any changes to
any of these. The MRO must obtain the appropriate qualification training as
mandated in 49 CFR Part 40.
The MRO will review all test results to ensure the scientific validity of the test and to
determine whether there is a legitimated medical explanation for a confirmed positive
test result. The MRO will contact the employee, notify him/her of the positive
laboratory result, and provide the employee with an opportunity to explain the
confirmed test result. The MRO will subsequently review the employee's medical
history/records to determine whether there is a legitimate medical explanation for the
positive test result. If no legitimate medical explanation is found, he test will be
verified positive and reported to the Peerless -Midwest Inc. Designated Employee
Representative (DER). If a legitimate medical explanation is found, the MRO will
report the test result as negative.
The split specimen sample will be stored at the initial laboratory until the analysis of
the primary specimen is complete. If the primary specimen is negative, the split
sample will be discarded. However, if the primary specimen is positive, the split
sample specimen will be retained by the initial laboratory for testing if so requested by
the employee through the MRO within 72 hours of being notified. The split sample
specimen, if requested to be tested, will be sent to an alternate certified laboratory for
testing, at the expense of the employee or applicant.
1. The Collector must complete mandated qualification training as defined in 49
CFR Part 40 to be able to perform collections.
5
2. The Collector must obtain photo identification from the employee or be
identified by a Peerless -Midwest Inc. representative prior to administering the
test.
3. The Collector will ask the employee to display the contents of their pockets
prior to the test being taken.
4. The Collector will ask the employee to wash their hands only with water.
5. The Collector and employee will check the identification numbers of the seals
with the number on the CCF.
6. The Collector will ask the employee to sign the CCF signifying the correctness
of the data for test reporting.
7. The Collector will unwrap and wrap the specimen containers in the presence of
the employee. .
8. After the specimen is collected, the Collector will inspect the specimen for
sufficient volume, temperature and signs of tampering.
9. The specimen sample containers are placed in a shipping container, sealed
with tamper proof seals in the presence of the employee. The employee will be
asked to initial the seals on the specimen sample containers.
10.The Laboratory will check the seals on the specimen bottles upon receipt to
ensure they are not broken, if they are broken, the laboratory will report the test
as cancelled.
11.The laboratory will report the results to the MRO by electronic communication.
Direct Observation Collection is Mandatont in the Following Circumstances
1. The Laboratory reports an invalid test and the MRO reports there isn't a
medical reason for it.
2. The test results are reported as positive, adulterated, or substituted cancelled
with no split specimen sample available.
3. The Collector observed signs that indicate an attempt was made to tamper with
the specimen.
4. The Collector notes that the temperature of the specimen is not within range.
Note: The Collector is NOT required to take the employee's body temperature.
The DER from Peerless -Midwest Inc. will be notified of the out of temperature
specimen after the direct observation test is completed.
In addition, Peerless -Midwest Inc. has the option of requesting direct observation testing
for return -to -duty and/or follow-up testing. The Observer must be the same gender as
the employee. The observer may be someone other than the collector to ensure the
same gender; however, this individual may not handle the specimen.
1FrPVM- 79- 4
If the employee cannot provide a specimen at the initial attempt, the employee will be
urged to drink up to 40 oz. of water. The amount of water is to be spaced out over a
three hour period. The employee is not required to drink the water by 49 CFR Part 40
regulations.
If the employee does not provide a specimen, or refuses to provide a specimen, the test
will be marked as a "Refusal to Test" and considered a positive test result. The
employee will be sent to a physician with expertise in the field, within five (5) days for an
evaluation as to why the individual was not to provide a specimen. If there is a valid
medical reason, the test result will be changed to "Cancelled".
Breath Alcohol Test
All tests for breath alcohol will be conducted'using a National Highway Traffic Safety
Administration (NHTSA) approved Evidential Breath Testing (EBT) device. The device
must be operated by a certified trained Breath Alcohol Technician (BAT). The certified
training must meet the qualification as defined in 49 CFR Part 40.
A blank air test will be administered prior to the initial test and the confirmation test. This
indicates the EBT chamber is clear.
An initial breath test will be given, if the results are less than a concentration of 0.02, the
test result is negative. No additional test will be required. If the initial test result is a
concentration of 0.02 or higher, a second confirmation test will be conducted. A waiting
period of at least 15 minutes but no longer than 30 minutes after completion of the initial
test must be completed before the confirmation test is done. If the results of the
confirmation test are between 0.020-0.039; the employee must be removed from the
safety sensitive position for at least 24 hours. If the result is 0.040 or higher the
employee is considered under the influence of alcohol and the employee must be
removed from service, referred to a Substance Abuse Professional (SAP). Any result on
the confirmation test of 0.020 or higher is considered a screening test. Each test will
have its own unique sequential number. A printout will also include the time the test was
taken, and EBT identification number. The test will be performed in a private, confidential
manner as required by 49 CFR Part 40.
MUM,
. M M. OR
1. The BAT will request photo identification from the employee or be identified by a
Peerless -Midwest Inc. representative prior to administering the test.
2. The Employee will select an individually sealed mouthpiece and it will be opened
by the BAT while in the presence of the employee for the initial test.
3. Calibration checks will be frequently performed to insure the EBT is working
efficiently. The employee may ask to see the last calibration.
4. The Employee will select an individually sealed mouthpiece and it will be opened
by the BAT while in the presence of the employee for the confirmation test
I. Positive Test Results
Any employee of Peerless -Midwest Inc. that has a confirmed positive drug or alcohol test
be terminated from his/her safety -sensitive position, informed of the educational and
rehabilitation programs available, and referred to a Substance Abuse Professional (SAP)
for assessment.
J. Compliance with the Treatment Program Requirements
Employees are encouraged to make use of the available resources for treatment of
alcohol misuse and/or illegal drug use problems. Under certain circumstances,
employees may be required to undergo treatment for substance abuse or alcohol misuse..
Any employee of Peerless -Midwest Inc. who refuses or fails to comply with a SAP's
requirements for treatment, after care or return -to -duty shall be subject to termination.
The cost of treatment will be paid by the employee or their insurance provider.
K. Types of Testing
Pre -Employment Testing
Any individual that seeks employment with or transfers into a DOT safety -sensitive
Position will be required to take and pass a urine drug test. The receipt of a negative
urine drug test is required. If the results of the urine drug test are negative -diluted, the
result will be considered negative. If the test was cancelled, Peerless -Midwest, Inc.
requires the applicant to take and pass a second urine drug test.
Anytime an employee of Peerless -Midwest, Inc. is off work for 30 consecutive days or
more, the employee will be required to take and pass another pre -employment urine drug
test.
Reasonable Cause Testing
Reasonable Cause referral testing will be made on the basis of documented objective
facts and circumstances, which are consistent with the short-term effects of substance
abuse.
At least one supervisor that has been trained in Reasonable Cause detection is needed
to make a Reasonable Cause referral for testing. The training must include ways to
determine the signs and symptoms of drug and alcohol use. The supervisor must
conclude that the employee is impaired in his/her work performance. Documentation as
to the physical appearance, behavioral and performance indicators, speck and body
odors of the employee must be completed prior to the test result being received.
Examples of Reasonable Cause include, but are not limited to, the following:
Physical signs and symptoms consistent with prohibited substance use or alcohol
misuse.
Evidence of the manufacture, distribution, dispensing, possession, or use of controlled
substances, drugs, alcohol, or other prohibited substances.
E✓
Occurrence of a serious or potentially serious accident that may have been caused by
prohibited substance abuse or alcohol misuse.
Physical contact (meaning fights), assaults, and flagrant disregard or violations of
established safety, security, or other operating procedures.
Post Accident Testing
All employees of Peerless -Midwest Inc. are required to undergo urine drug testing and
breath alcohol testing if they are involved in an accident with a vehicle owned or leased
by Peerless -Midwest Inc. If on or all of the following conditions are met:
i. The accident resulted in a fatality.
ii. The employee of Peerless -Midwest Inc. was issued a citation and a vehicle was
towed from the scene of the accident.
iii. The employee of Peerless -Midwest Inc. was issued a citation and an individual in
the accident received bodily injury requiring immediate medial treatment away
from the scene of the accident.
The surviving employee that operated the vehicle or any other employee whose
performance cannot be completely discounted as contributing to the accident must be
tested.
Following the accident, the employee(s) must be tested as soon as possible, but not to
exceed eight (8) hours for alcohol testing and thirty-two (32) hours for urine drug testing.
Any employee of Peerless -Midwest Inc. involved in an accident must refrain from alcohol
use for eight (8) hours following the accident or until he/she has completed an alcohol
test or released from duty. Any employee of Peerless -Midwest Inc. who voluntarily
leaves the scene of an accident prior to submission to drug and alcohol testing will be
considered to have refused the test and the employee will be terminated.
An alcohol test should be administered within two (2) hours of the accident. If this has
not been done, Peerless -Midwest Inc. will document the reason the test was not
completed within tow (2) hours of the accident and will continue to attempt to obtain a test
and document their attempts within the eight (8) hour period. At the end of the eight (8)
hours, Peerless -Midwest Inc. will cease the attempt to administer the test and document
why the test was not completed.
The employee must remain readily available for testing, until they are released from the
scene of the accident. If the employee is required to leave the scene under the authority
of medical or police personnel, they must notify Peerless -Midwest Inc. as to their
whereabouts.
If Peerless -Midwest Inc. is unable to perform a urine drug test and a breath alcohol test,
(i.e., employee is unconscious, employee is detained by a police agency), Peerless -
Midwest Inc. may use drug and alcohol post -accident test results administered by the
E
State and/or Local law enforcement officials if they were completed. Peerless -Midwest
Inc. will obtain the results in conformance with State and Local law.
Post Accident Testing for Non -DOT Circumstances
Peerless -Midwest Inc. requires an employee to submit to drug and alcohol tests following
a motor vehicle accident or property damage accident involving injury to any individual
involved in the accident requiring immediate medical treatment away from the scene,
serious damage to any motor vehicle or equipment involved in the accident, a fatality
from the accident, or a physical injury that requires immediate medical attention away
from the work site. Tests will not be required if the supervisor in charge determines, using
the best information available at the time of the decision, that the employee's
performance can be completely discounted as a contributing factor to the accident.
Random Drug and Alcohol Testing
All employees of Peerless -Midwest inc. that work in safety -sensitive positions will be
subject to random unannounced testing. The selection of these employees for random
testing of drug and alcohol will be made using a scientifically valid method the ensures
each covered employee will have an equal chance of being selected each time selections
are made. The random test will spread throughout the year. Tests can be conducted at
any time during an employee's shift. Employees are required to proceed immediately to
the collection site upon notification of their random selection. There is no discretion on
the part of management in the selection and notification of employees who are to be
tested.
The percentages of the number of safety -sensitive employees in the random program are
established by 49 CFR Part 40 on an annual basis. Currently the rates are 50% for drug
testing and 10% for alcohol testing.
Return -to -Duty Testing
Employees of Peerless -Midwest Inc., under certain circumstances, that previously tested
positive on a drug and/or alcohol test must be evaluated and released by a Substance
Abuse Professional (SAP) before returning to work. A SAP is a licensed physician,
certified psychologist, social worker, employee assistance professional, or addiction
counselor. The SAP must also have clinical experience in the diagnosis and treatment of
drug and alcohol related diseases. The SAP must have completed the required
qualification training and completed the continuing education trainings as detailed in 49
CFR Part 40. Before the return -to -duty test, the SAP must assess the employee and
determine if the required treatment has been completed.
Follow -Up Testing
10
Under certain circumstances employees of Peerless -Midwest Inc. will be required to
undergo frequent unannounced random urine and/or breath testing following their return -
to -duty test. Follow-up testing on an employee will be performed for a period of one (1)
to five (5) years with a minimum number of six tests performed the first year. The
employee will remain in the random testing program. A qualified SAP will determine the
frequency and duration of the follow-up tests, beyond the minimum number.
L. Confidential Result Record Keeping
The results of all drug and alcohol testing results will be maintained in a secure
confidential manner by the employer, laboratory, collection site, MRO, SAP, and the
Consortium/Third Party Administrator (CTPA). Information can only be released in the
following circumstances and with the employee being notified in writing of the release.
i. To a third party only as directed by specific written instructions of the employee.
ii. To the decision -maker in a lawsuit, grievance, or other proceeding initiated by or
on behalf of the employed tested.
iii. To a subsequent employer upon receipt of a written request from the employee as
required by 49 CFR Part 40 of the DOT regulations.
iv. To the National Transportation Safety board during an accident investigation.
V. To the DOT or and DOT agency with regulatory authority over the employer or any
of its employees, or to a State agency with oversight.
vi. To the employee upon written request.
M. Employee/Supervisor Training
All employees of Peerless -Midwest Inc. in a safety -sensitive position will undergo a
minimum of 60 minutes of training on the signs and symptoms of drug use including the
effects and consequences of drug use on personal health, safety, and the work
environment. The training must include manifestations and behavioral cues that may
indicate prohibited drug use. In addition, all employees will also receive a minimum of 60
minutes of training on the signs and symptoms of alcohol misuse including the
consequences on personal health, safety, and work environment.
N. Employee Contract for Policy Violations
Under certain circumstances, employees of Peerless -Midwest Inc. who re-enter the
workforce must agree to a re-entry contract. The contract may include, but is not limited
to, the following items:
i„ A release to return to work statement from the SAP.
ii. A negative test result for drugs and/or alcohol.
iii. An agreement to unannounced frequent follow-up testing for a period of one (1) to
five (5) years with at least six (6) tests performed the first year.
iv. A statement of expected work -related behaviors of the employee.
11
V. An agreement to follow specified after care requirements with the understanding
that a violation of the re-entry contract is grounds for termination.
O. System Contacts
Employer:
Name: Peerless Midwest Inc.
Address: 55860 Russell Industrial Parkway
City, State, Zip: Mishawaka, IN 46546
Phone: (574) 254-9050
Fax: (574) 254-9650
Designated Employee Representatives:
Name: Cathy Lance
Title: Operations Manager
Telephone: (574) 252-4138
Email: cathy.lance(@r)eeriessmidwest.com
Name: Robin Kealy
Title: Compliance Manager
Telephone: (574) 252-4136
Email: rolin.keal eerlessmidwest.colm.
Name: Jon Dock
Title: Field Superintendent
Telephone: (574) 254-9050
Email: jon,dockQ eerlessmidwest,com
This policy was adopted by Peerless -Midwest Inc. on 2019,
Signature Title
12
RECEIPT FOR DRUG AND ALCOHOL POLICY
I hereby certify that I have received the companies Drug and Alcohol Policy and that I
have read and understand all the information contained therein. I further agree to
abide by the provisions that are set forth in the manual.
Date- Signature:
13
rtoii Ib . ,;r
January 7, 2019
City of South .Bend
830 North Michigan Street
South Bend, IN 46601
Craig T. Wanke
Account Executive Officer
Bond & Specialty insurance
11440 Carmel Commons Blvd
Charlotte, NC 28226
Phone: 704-544-3647
Fax:1-866-216-5977
E-mail: cWanke@travelers,com
Re,: Peerless -Midwest, Inc. (Subsidiary of SUEZ Water Advanced Solutions, LLC)
Project — North Well Field: Well # I A
To Whom It May Concern:
We understand that Peerless -Midwest, Inc. is being considered for the captioned project. Please be advised
that Travelers Casualty, and Surety Company of America/Travelers Casualty and Surety Company
(hereinafter referred to as "17ravelers") handles all of the bonding requirements for Peerless -Midwest, Inc.,
(a wholly -owned subsidiary of SUEZ Water Advanced Solutions, .LLC) . We have confidence in the
financial and operations strength of the firm, and are a strong supporter of their total work program.
Peerless -Midwest, Inc. and SUEZ Water Advanced Solutions, LLC have a surety program with Travelers
for single projects up to $ 5,000,000 and supporting backlogs approaching $ 40,000,000. We are pleased
that Peerless -Midwest, Inc. is pursuing the above referenced project and we recommend them to you as one
of the outstanding contractors in the country.
Peerless -Midwest, Inc. has the ability to provide Performance and Payment Bands for this project should
they be selected. Naturally, as is customary within the surety industry, the issuance of any bid or final
bonds is always contingent upon a satisfactory underwriting review at the time a request for bonds is made.
This review may include, but not be limited to, acceptable terms, conditions, documents, bond forms and
confirmation of an acceptable financing source and payment provisions. It should be understood that any
arrangement for surety bonds is a matter strictly between Pecrless-Midwest, Inc. and Travelers. We
assume no liability to third parties or to you by issuance of this letter.
Travelers Casualty and Surety Company of America/Travelers Surety and Casualty Company are licensed
to do business in the State of North Carolina. Travelers Casualty and Surety Company of America is listed
in the Department of Treasury's .Listing of Approved Sureties (Department Circular 570) and holds an A+F
(Superior) rating by A.M..Best with a Financial Size Category XV by A.M. Best.
Please do not hesitate to contact me if there are any questions or if I may be of further assistance.
Sincerely,
1
Craig'I""Wanke, Attorney -In -Fact
Travelers Casualty and Surety Company of America