HomeMy WebLinkAboutOpening of Bids - Century Center Parking Lot Entry Gate Improvements Proj No 118-035A - Walsh & Kellyul
CITY OF SOUTH BEND, INDIANA ,o
CONTRACTOR'S BID FOR PUBLIC WORK
Project Name Century Center Parking Lot Entry Gateway Improvements
Project No. 118-035A
For Bids Due September 24, 2019
PART
(Must be completed for all bids. Please type or print)
Date: 9/24/19 Bidder (Firm): Walsh & Kglly Inc.___
Address: 24358 SR 23
City/State/Zip: South Bend IN 48814 Telephone Number: �574 ,) _288-4811
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:
Centu Center Parking Lot Ent Gateway Improvements
the City of South Bend, Indiana, in accordance with plans and specifications prepared by:
and dated September 5, 2019 for the sum of (enter the Total Bid as shown on the Proposal)
Two hundred foq four thousand four hundred twenty dollars and zero cents $ 244,420.00
(Enter sum of Total Base Bid plus Alternates 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 need
shown in the original contract if accepted by the City of 1
basis, the Itemdz ticn,of the units shall be shown on a p a
By
Custiln
9
r
ACCEPTANCE
The above bid''i's accepted this' day of
Subject to°tie foll6 wih, conditions:...... ......... ......... ........
�F
BOARD OF PUBLIC WORKS
Gary A. Gilot, President
Elizabeth A. Maradik, Member
Laura L. O'Sullivan, Member
cost of units must be the same as that
Jf Oe bid is to be awarded on a unit
(Signature)
Name of
Genevieve E. Miller, Member
Therese J. Dorau, Member
Attest: Linda M. Martin, Clerk
Version 4/2/2019 Contractor's Bid for Public Works - 2
20
PART II
(For projects of $100,000 or more — IC 36-1-12-4)
These statements to be submitted under oath by each bidder with and as part of his/her/its bid.
Attach additional pages for each section as needed.
SECTION I EXPERIENCE QUESTIONNAIRE
1. Attach information regarding projects your organization has completed for the period of one
(1) year prior to the date of the current bid.
2. Attach a listing of public works projects currently in process of construction by your
organization.
3. Attach information regarding any failure to complete any work awarded to you and the
location thereof.
4. Attach references from private firms for which you have performed work.
SECTION II PLAN AND EQUIPMENT QUESTIONNAIRE
1. Attach an explanation of your plan or layout for performing proposed work. (Examples could
include a narrative of when you could begin work, complete the project, number of workers,
etc. and any other information which you believe would enable the City of South Bend to
consider your bid.)
2. Attach a listing of the names and addresses of all subcontractors (i.e. persons or firms outside
your own firm who have performed part of the work) that you have used on public works
projects during the past five (5) years along with a brief description of the work done by each
subcontractor.
3. If you intend to sublet any portion of the work, attach the name and address of each
subcontractor, equipment to be used by the subcontractor, and whether you will require a
bond. However, if you are unable to currently provide a listing, please understand a listing
must be provided prior to contract approval. Until the completion of the proposed project, you
are under a continuing obligation to immediately notify the City of South Bend in the event that
you subsequently determine that you will use a subcontractor on the proposed project.
4. Attach a listing of equipment you have available to use for the proposed project.
5. Have you entered into contracts or received offers for all materials which substantiate the
prices used in preparing your proposal? If not, attach an explanation for the rationale used
which would corroborate the prices listed.
SECTION III CONTRACTOR'S FINANCIAL STATEMENT
Attachment of bidder's financial statement is mandatory. Any bid submitted without said
financial statement as required by statute shall thereby be rendered invalid. The financial
statement provided hereunder to the City of South Bend awarding the contract must be specific
enough in detail so that said City of South Bend can make a proper determination of the bidder's
capability for completing the project if awarded.
Version 4/2/2019 Contractor's Bid for Public Works - 3
BID/PROPOSAL
CITY OF SOUTH BEND
t t
1065
PROJECT NAME: CENTURY CENTER PARKING LOT ENTRY GATEWAY IMPROVEMENTS
PROJECT NO. 118-035A
BIDS DUE: September 24, 2019 @ 9:30am local time
BASE QUOTE
Item
Description
Quantity
Unit
Unit Price
Total Amount
1
Construction Engineering
1
LS
3,730.00
$3,730.00
2
Mobilization & Demobilization
1
LS
25,400.00
$25,400.00
3
Excavation, Common
222
CYS
151.00
$33,522.00
4
Pavement, Remove
12
SYS
84.00
$1,008.00
5
Curb, Concrete, Remove
150
LIFT
20.00
$3,000.00
6
Attendant Booth, Remove
1
LS
7,800.00
$7,800.00
7
Protective Bollard, Remove
5
EA
840.00
$4,200.00
8
Sign, Relocate
1
EA
1,800.00
$1,800.00
9
Temporary Inlet Protection
3
EA
115.00
$345.00
10
Compacted Aggregate, No. 53
110
TON
70.00
$7,700.00
11
Curb, Concrete
420
LIFT
68.00
$28,560.00
12
Concrete, Reinforced, 6 IN
468
SYS
111.00
$51,948.00
13
Single Swing Barrier Gate
4
LS
3,450.00
$13,800.00
14
Misc. Electrical
1
LS
5,101.00
$5,101.00
15
Electrical Handhole
5
EA
1,000.00
$5,000.00
16
Wire, No. 4
130
LIFT
7.00
$910.00
17
Conduit, PVC, Schedule 80, 2 IN
108
LIFT
12.00
$1,296.00
18
Conduit, PVC, Schedule 80, 3 IN
26
LIFT
18.00
$468.00
19
Conduit, PVC, Schedule 80, 4 IN
42
LIFT
19.00
$798.00
20
Line, Thermoplastic, Crosswalk, Solid,
102
LIFT
4.00
$408.00
White 6IN
21
Line, Thermoplastic, Solid, White, 6 IN
46
LIFT
4.00
$184.00
22
Line, Epoxy, Solid, White, 6 IN
96
LIFT
6.00
$576.00
23
Parking Lot attendant Booth
1
EA
22,000.00
$22,000.00
24 Protective Bollards 4 EA 3,000.00
$12,000.00
25 Hardwood Mulch, 3 IN Depth 14 CYS 154.00
$2,156.00
26 Irrigation Allowance 1 ALLOW 400.00
$400.00
27 Irrigation Sleeve, PVC, 4 IN 45 LIFT 42.00
$1,890.00
BASE BID TOTAL.
$236,000.00
ALTERNATE A — TRAFFIC SIGNAL HEAD REPLACEMENT
Item No.
Description
Quantity
Unit
Unit Price
Total Amount
1
Traffic Signal Head Replacement
1
LS
3,600.00
$3,600.00
ALTERNATE A'TOTAL
$3,600.00
ALTERNATE B — INTERSECTION SIGNAL MANHOLE CASTING, ADJUST TO GRADE
Item No. Description
Quantity I Unit I Unit Price Total Amount
1 1Grade
Bidder(Firm):
Address:
City/State/Zip
Telephone Number:
Fax Number:
LS 4,820.00 $4,820.00
ALTERNATE B TOTAL $4,820.00
Walsh & Kelly, Inc..
24358 SR 23
South Bend,IN 46614
574-288-4811
Dustin P. Hilary, VP of South Bend Area
(Printed Name of Person Signing)
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 § 5-22-16.5-9, as amended from time -to -time, a Contractor
is engaged in investment activities in Iran if either:
i. Contractor, its successor or its affiliate, provides goods or services of twenty
million dollars ($20,000,000) or more in value in the energy sector of Iran;
or
ii. Contractor, its successor or its affiliate, is a financial institution that extends
twenty million dollars ($20,000,000) or more in credit to another person for
forty-five (45) days or more, if that person will (i) use the credit to provides
goods and services in the energy sector in Iran; and (ii) at the time the
financial institution extends credit, is a person identified on list published by
the Indiana Department of Administration.
Version 4/2/2019 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 4/2/2019 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 IT,___u24th day of Sept. .20 19
t�
& Kelly, Inc,
of Iw"ktractor/Biddcr or Its Agent
t�stin Hilary,_ VP of Southm Bend Area
Printed Name and Title
Subscribed and sworn to before me this 24th day of Se ternbe_r. , 2019
99
I'
My Commission Expires 6/5/22 IJ ...N -,
Notary Ptrmic Alisna 6rueger
County of Residence St.µ Joseph
ALISHA KHUEjinijiino
Notary Public, State of
St, Joseph countMy
Commission ExJune
Oran 202
Version 4/2/2019 Contractor's Bid for Public Works - 6
.. .I µ J a S Surety O + 908.903.3485
202B Halls Mill Road, PO Box 1650 F + 908.903.3656
Whitehouse Station, NJ 08889-1650
Federal Insurance Company
AIA Document A31OTM - 2010 Bid Bond
Any singular reference to Contractor, Surety, Owner or other party shall be considered plural where applicable.
CONTRACTOR
0
ame le al status and address),
alst belly, Inc.
24358 State Road 23
South Bend, IN 46614
OWNER
(Na/me, legal status and address):
City of South Bend, Indiana
County -City Building Room 1316
227 West Jefferson Blvd.
South Bend, Indiana, 46601
BOND AMOUNT
SURETY
(Name, legal status and principal place of business):
Federal Insurance Company
202B Halls Mill Rd., PO Box 1650
Whitehouse Station, NJ 08889-1650
In the amount of not less than five percent (5%) of the base bid plus any alternates.
PROJECT
(Name, location or address, and Project number, if any)
Century Center Parking Lot Entry Gateway Improvements
Project No. 118-035A
The Contractor and Surety are bound to the Owner in the amount set forth above, for the payment of which the
Contractor and Surety bind themselves, their heirs, executors, administrators, successors and assigns, jointly and
severally, as provided herein. The conditions of this Bond are such that if the Owner accepts the bid of the Contractor
within the time specified in the bid documents, or within such time period as may be agreed to by the Owner and
Contractor, and the Contractor either (1) enters into a contract with the Owner in accordance with the tenons of such
bid, and gives such bond or bonds as may be specified in the bidding or Contract Documents, with a surety admitted
in the jurisdiction of the Project and otherwise acceptable to the Owner, for the faithful performance of such Contract
and for the prompt payment of labor and material furnished in the prosecution thereof, or (2) pays to the Owner the
difference, not to exceed the amount of this Bond, between the amount specified in said bid and such larger amount
for which the Owner may in good faith contract with another party to perform the work covered by said bid, then this
obligation shall be null and void, otherwise to remain in full force and effect. The Surety hereby waives any notice of
an agreement between the Owner and Contractor to extend the time in which the Owner may accept the bid. Waiver
of notice by the Surety shall not apply to any extension exceeding sixty (60) days in the aggregate beyond the time for
acceptance of bids specified in the bid documents, and the Owner and Contractor shall obtain the Surety's consent for
an extension beyond sixty (60) days.
If this Bond is issued in connection with a subcontractor's bid to a Contractor, the term Contractor in this Bond shall
be deemed to be Subcontractor and the term Owner shall be deemed to be Contractor.
Printed in cooperation with the American Institute of Architects aW by Chubb. The language in this document conforms to the language used in
AI9INocumentA310 -2010.
Form 1502-05MFED (Rev. 3/M
When this Bond has been furnishedto complywith a statutory or other legal requirement in the location ofthe Project,
any provision in this Bond conflicting with said statutory or legal requirement shall be deemed deleted here
from and provisions conforming to such statutory or other legal requirement shall be deemed incorporated herein.
When so furnished, the intent is that this Bond shall be construed as a statutory bond and not as a common law
bond.
Signed and sealed this 24th
(Wilnes) Alisha 1(ruege
'x
(Witness) ryn R. Postma
day of September, 2019.
Walsh & Kel
(PI, aclp
�af Swth lid. Armor
(Title)
rporatOOD
Federal Insurance Company
By:
(Attorney -in -Fact) Lisa M. Becker
Printed in cooperation with the American Institute of Architects (ALA) by Chubb. The language in this document conforms to the language used in
AM DocumentA310 TK- 2010.
Form 15-02-0575-FED (Rea 3/I7) 2
CHUBB'
Power of Attorney
Federal Insurance Company I Vigilant Insurance Company I Pacific Indemnity Company
Know AB by These Presents, That FEDERAL INSURANCE COMPANY, an Indiana corporation, VIGILANT INSURANCE COMPANY, a New York corporation, and PACIFIC
INDEMNITY COMPANY, a Wisconsin corporation, do each hereby constitute and appoint Lisa M. Becker, Tia A. Boice, Terry R. Hurst, Brian T. Morton,
David M. Oliger, Kathryn R. Postma, Tina N. Senefeld and Eric M. Wahlstrom of Indianapolis, Indiana --------------------------------------------------------------
each as their true and lawful Attorney -in -Fact to execute under such designation In their names and to affix their corporate seals to and deliver for and on their behalf as surety
thereon or otherwise, bonds and undertakings and other writings obligatory in the nature thereof (other than bail bonds) given or executed in the course of business, and any
instruments amending or altering the same, and consents to the modification or alteration of any instrument referred to in said bonds or obligations.
In Witness Whereof, said FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY have each executed and attested these
presents and affixed their corporate seals on this 61h day of March, 2019.
Itivm \I Chli)nis. As islantkrrctary
STATE OF NEW JERSEY
County of Hunterdon
A-' W v,l
d-t-�
Slcph01 NI Il:mCy. 1'iCC IY V(1011
On this 60, day of March, 2019, before me, a Notary Public of New Jersey, personally came Dawn M. Chloros, to me known to be Assistant Secretary of FEDERAL INSURANCE
COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY, the companies which executed the foregoing Power of Attorney, and the said Dawn M.
Chloros, being by me duly sworn, did depose and say that she is Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC
INDEMNITY COMPANY and knows the corporate seals thereof, that the seals affixed to the foregoing Power of Attorney are such corporate seals and were thereto affixed by
authority of said Companies; and that she signed said Power of Attorney as Assistant Secretary of said Companies by like authority; and that she is acquainted with Stephen M.
Haney, and knows him to be Vice President of said Companies; and that the signature of Stephen M. Haney, subscribed to said Power of Attorney is in the genuine handwriting of
Stephen M. Haney, and was thereto subscribed by authority of said Companies and in deponent's presence.
Notarial Seal ROSE CURTIS
emm NOTARY PUBLIC OF NEW Jf &'Y
*4 50072400
OM 2L 2022
"kA.,n) I°tulgpi,
CERTIFICATION
Resolutions adopted by the Boards of Directors of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY on August 30, 2016:
"RESOLVED, that the following authorizations relate to the execution, for and on behalf of the Company, of bonds, undertakings, recognizances, contracts and other written commitments ofthe Company
entered into In the ordinary course of business (each a "Written Commitment"):
(1) Each of the Chairman, the President and the Vice Presidents of the Company is hereby authorized to execute any Written Commitment for and on behalf of the Company, under the
seal of the Company or otherwise.
(2) Each duly appointed attomey-in-fact of the Company is hereby authorized to execute any Written Commitment for and on behalf of the Company, under the seal of the Company or
otherwise, to the extent that such action Is authorized by the grant of powers provided for In such person's written appointment as such attorney -in -fact.
(3) Each of the Chairman, the President and the Vice Presidents of the Company is hereby authorized, for and on behalfof the Company, to appoint in writing any person the attorney -
In -fact of the Company with full power and authority to execute, for and on behalfof the Company, under the seal ofthe Company or otherwise, such Written Commitments ofthe
Company as may be specified In such written appointment, which specification may be by general type or class of Written Commitments or by specification of one or more particular
Written Commitments.
(4) Each of the Chairman, the President and the Vice Presidents of the Company is hereby authorized, for and on behalfof the Company, to delegate in writing to any other officer ofthe
Company the authority to execute, for and on behalf of the Company, under the Company's seal or otherwise, such Written Commitments ofthe Company as are specified In such
written delegation, which specification may be by general type or class of Written Commitments or by specification of one or more particular Written Commitments.
(5) The signature of any officer or other person executing any Written Commitment or appointment or delegation pursuant to this Resolution, and the seal ofthe Company, may be affixed by
facsimile on such Written Commitment or written appointment or delegation.
FURTHER RESOLVED, that the foregoing Resolution shall not be deemed to be an exclusive statement ofthe powers and authority of officers, employees and other persons to act for and on behalfof
the Company, and such Resolution shall not limit or otherwise affectthe exercise ofany such power or authority otherwise valldlygranted or vested"
I, Dawn M. hloro�. Assistant Secretary of FEDERAL INSURANCE COMPANY, VIGILANT INSURANCE COMPANY, and PACIFIC INDEMNITY COMPANY (the "Companies") do hereby
certify that
.
(f) the ft)t'( ohtfy;'ResohakI s adopted by the Board of Directors ofthe Companies are true, correct and in full force and effect,
klre r���t ' paver tit attorney is stile, correct and in full force and effect
Gl ejl (1t)(Jer 1rly habd an�J seals ofsaid C.f mpanles at Whitehouse Station, AQ, this 24t1i day of September, 2019.
"^Maw,n� i',i " lkivn \l l.hh a -I x: asu4ant S�rr'tgai}°
,
YOU WISH TO VERIFY THE AUTHENTICITY OF THIS BOND OR NOTIFY US OF ANY OTHER MATTER, PLEASE CONTACT US AT:
I'dephone(808)9 3493 F x(908)9wTf56 emtsll. surx , Iub'h.com
FED- VIG-N (rev.. 08-18)
CITY OF SOUTH BEND, INDIANA
CONTRACTOR'S BID FOR PUBLIC WORK
CHECKLIST FOR BIDDERS
Project Name Century Center Parking Lot Entry Gateway Improvements
Project No. 118-035A
.............._. ............
For Bids Due September 24, 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 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: Walsh & Kelly, Inc.
By Authorized Representative
Signature:
Print Name & Title: lodstin Hilda , VP of South Bend Area
Version 4/2/2019 Contractor's Bid for Public Works - 1
Date: 9/24/19
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CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITYF;
DEVELOPMENT PROGRAM f'
FORM MWBE-2.0
EVIDENCE OF GOOD FAITH EFFORTS db
This completed form should be included as part of the Bids documents related to City of South Bend Public
Works Projects requiring Good Faith Efforts to obtain MBE/WBE participation. It is the bidder's sole
responsibility to verify whether any listed minority or woman business meets the qualifications of a Minority
or Women's owned business as defined by the Indiana Department of Administration ("IDOA").
Project Number: 118-035A Date: 9/24/19
Project Name: Centu Center Parking Lot Entry Gateway Improvements
Bidder: Walsh & KellV, Inc.
Contact Person: Edward Pil oW _ Telephone: 574-288--481 1
Address: 24358 SR 23
City: South Rend State: Indiana zip: 46614
Email:
_._.M..............................
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
commis ions„ 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
�17
enquires that all perspective bidders complete no less than 2 of the following:
Attend all pre -bid meetings scheduled by the City to inform MBE/WBEs of contracting and
subcontracting opportunities.
2. Advertise in general circulation and/or trade association publications concerning subcontracting
opportunities, and allow MBE/WBEs reasonable time to respond.
Perform any and all necessary steps to provide written notice in a manner reasonably calculated
to inform MBE/WBEs of subcontracting opportunities and allowed sufficient time for them to
participate effectively.
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 MBE/WBE firms.
**Bidder must circle or otherwise notate which of the two (2) required actions were performed.
............ ............................................__ -
GOOD FAITH NEGOTIATIONS: The bidder negotiated in good faith with interested MBE/WBEs,
including providing such MBE/WBE's with adequate information about the plans, specifications and other
requirements of the subcontract and did not reject MBE/WBEs as unqualified without sound business
reasons based on a thorough investigation of their capabilities.
SMALL CONTRACT(S): The bidder selected specific portions of the work to be performed by
LX MBE/WBEs in order to increase the likelihood of meeting the MBE/WBE goals (including breaking down
contracts into smaller units to facilitate MBE/WBE participation)
CONTRACT RECORDS: The bidder has maintained the following records for each MBE/WBE that has
id on the subcontracting opportunity:
1. Name, address, and telephone number;
2. A description of information provided by the bidder or subcontractor; and
3. A statement of whether an agreement was reached, and if not, why not, including any reasons for
concluding that the MBE/WBE was unqualified to perform the job.
*Proper demonstration of Good Faith Effort requires your initials next to all of the above boxes. Any
omissions shall be considered grounds for rejection of the bid by the Board of Public Works. The City of
South Bend reserves the right to request additional information.
Version 4/2/2019 Contractor's Bid for Public Works - 10
k"k4! WN r
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY
DEVELOPMENT PROGRAM"
FORM MWBE-2.1'
µ
MBE/WBE CONTACTED
This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects
requiring contacted MBE/WBE to obtain Good Faith Efforts. It is the bidder's sole responsibility to verify
whether any listed minority or woman business meets the qualifications of a Minority or Women's owned
business.
Project Number: 11
Project Name,
Bidder: VV
By:
Center p!kin Lot
Kelly, Inc.
re) Dustin Hilary
PAGE, 1 OF
MBE/WBE Participation Goal
a'teway Improvements
VP of South Bend Area 9/24/19
(Title)
'BE Firm State Barricading, Inc.
or Contact at MBE/WBE Firm James Michalski
(uate)
Telephone: 574-287-2078 Fax: 574-287-1744 Email: STATE BAIR R I CADE 1-_DJ&om
TYPE OF WORK SOLICITED FOR THIS PROJECT:
Control Devices
RESULTS OF CONTACT WITH THE MBE/WBE FIRM:
We will use State Barricading, Inc. if we are awarded the project.
MBE/WBE Firm
Owner or Contact at MBE/WBE Firm
Telephone:
Fax:
TYPE OF WORK SOLICITED FOR THIS PROJECT:
RESULTS OF CONTACT WITH THE MBE/WBE FIRM:
Email:
Version 4/2/2019 Contractor's Bid for Public Works - 11
WRITTEN CONSENT TO RESOLUTIONS
of the
BOARD OF DIRECTORS
of
WALSH & KELLY, INC.
The undersigned, being all of the Directors of WALSH & KELLY, INC., an Indiana Corporation,
hereby consent to the following actions to be taken by the Corporation without a meeting of the Board of
Directors under the applicable provisions of the Indiana Business Corporation Law, as amended:
RESOLVED that the following be, and hereby are, elected officers of the Corporation, to
hold the office until the next regular meeting of the Board of Directors and until their
successors are duly elected and have qualified:
Kevin J. Kelly, President and Chief Executive Officer
Jeffrey L. Swan, Executive Vice President
John P. Vercruysse, Executive Vice President
Jamie L. Tancos, Controller
John M. Peisker, Vice President of Asphalt Operations
David J. Misirly, Vice President
Albert E.VanDenBergh, Vice President
Gregory A. Hoffman, Vice President
John C. Wall, Vice President
J. Michael Schaum, Secretary and Treasurer, CFO
David L. Franz, Vice President of Finance
Dustin P. Hilary, Vice President
Lynn J. Bauer, Vice President
Mark E. Krachenfels, Vice President
RESOLVED FURTHER that the actions of the Officers of the Corporation taken since the
last meeting of the Board of Directors be, and the same hereby are, fully ratified and
approved.
RESOLVED FURTHER that the following be, and they hereby are, authorized to execute
all contracts or similar documents on behalf of the Corporation:
Kevin J. Kelly, President and Chief Executive Officer
Jeffrey L. Swan, Executive Vice President
Jamie L. Tancos, Controller
John M. Peisker, Vice President of Asphalt Operations
David J. Misirly, Vice President
Gregory A. Hoffman, Vice President
Dustin P. Hilary, Vice President
Lynn J. Bauer, Vice President
John C. Wall, Vice President
J. Michael Schaum, Secretary and Treasurer, CFO
Mark E. Krachenfels, Vice President
RESOLVED FURTHER that this consent shall be in lieu of an annual meeting of the Board
of Directors of the Corporation and shall be filed in the minute book of the Corporation in
place of any such annual minutes.
<<SIGNATURES ON THE NEXT PAGE>>
EXECUTED this 281h day of March, 2019,.
.. _ • �.:m, �._-gym ��m..
�
d x rt 1 , VanDenBergh
Kevin J. Kelly
c r_--�
James ( N a l se11 sI11 Cc11 1 1 11
�r P. Vercruysse
EXECUTED this 28`" day of March, 2019,
Fred Fehsenfeld, Jr.
James C. Fehsenfeld
Albert E. VanDenBergh John P. Vercruysse
CERTIFICATE OF QUALIFICATION
to provide
CONSTRUCTION SERVICES
for
PUBLIC WORKS PROJECTS
to the
STATE OF INDIANA
This Certification Board, having duly considered application for qualification in terms of apparent experience and financial
resources; and under the applicable Indiana Code 4-13.6-4 and adopted rules of this Board, hereby issues a
Certificate of Qualification to provide construction services to the State of Indiana for Public Works Projects to:
WALSH & KELLY INC
1700 E MAIN ST
GRIFFITH IN 46319
Phone 219-924-5900
Fax 219-924-8768
Company Official
I
KEVIN KELLY
for the twenty-seven month period stated herein, unless revoked by this Board for cause,
and in the classifications of services stated below. This certificate supercedes any previous certificate.
1611.01 Concrete Construction of Roads & Curbing
1611.02 Asphalt Construction of Roads and Parking Lots
CERTIFICATION DATE 3/1412018 EXPIRATION DATE 6/14/2020
THIS CERTIFICATE ISSUED BY THE STATE OF INDIANA, PUBLIC WORKS DIVISION CERTIFICATION BOARD,
402 WEST WASHINGTON STREET, ROOM W467, INDIANAPOLIS, INDIANA 46204,
ALSO ACTS AS THE OFFICIAL NOTICE OF EXPIRATION.
Tracy L. Cross, Exec utive''S�-retary
Certification Board
DAPW PQ2 State Form 3983R Rev. 07/06
State of Indiana
Office of the Secretary of State
CERTIFICATE OF EXISTENCE
To Whom These Presents Come, Greeting:
I, CONNIE LAWSON, Secretary of State of Indiana, do hereby certify that I am, by virtue of the laws of
the State of Indiana, the custodian of the corporate records and the proper official to execute this
certificate.
I further certify that records of this office disclose that
WALSH & KELLY INC
duly filed the requisite documents to commence business activities under the laws of the State of
Indiana on March 29, 1966, and was in existence or authorized to transact business in the State of
Indiana on September 05, 2019.
I further certify this Domestic For -Profit Corporation has filed its most recent report required by
Indiana law with the Secretary of State, or is not yet required to file such report, and that no notice of
withdrawal, dissolution, or expiration has been filed or taken place. All fees, taxes, interest, and
penalties owed to Indiana by the domestic or foreign entity and collected by the Secretary of State
have been paid.
In Witness Whereof, I have caused to be affixed my
signature and the seal of the State of Indiana, at the City
of Indianapolis, September 05, 2019
�II
CONNIE LAWSON
SECRETARY OF STATE
194484-057 / 20191089739
All certificates should be validated here: https://bsd.sos.in.gov/ValidateCertificate
Expires on October 05, 2019.
GRIFFITH SOUTH BEND
1700 East Main Street 24358 SR 23
04 Griffith, Indiana 46319 www.walshkelly.com South Bend, Indiana 46614
Phone (219) 924-5900 Phone (574) 288-4811
inc. Fax (219) 924-8768 Fax (574) 289-7174
EQUAL EMPLOYMENT OPPORTUNITY POLICY
It is the policy of this Company to assure that the applicants and those that are subsequently employed are
treated without discrimination without regard to: their race, religion, sex, gender identity, sexual orientation,
color, national origin, age, association with the Vietnam era or any other war, disability, genetic information,
citizenship status, military status, veteran status, ancestry, or any other status protected under applicable
laws. Such action shall include: employment, upgrading, demotion, or transfer; recruitment or recruitment
advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training,
including apprenticeship, pre -apprenticeship, and/or on the job training.
A. The Contractor will work with the State Highway Agency (SHA) and the Federal Government in carrying
out EEO obligations and in their review of his/her activities under the contract.
H. Director of Human Resources; Randall L. Walls, shall be designated as Walsh & Kelly, Inc.'s Equal
Employment Officer. He will be responsible for all activities associated with the implementation of all
policies affecting equal employment opportunity.
III. Walsh & Kelly, Inc. assures nondiscriminatory recruitment by taking appropriate steps such as:
A. Placing employment advertisements in newspapers which serve the largest number of minority and
female groups in the recruiting area.
B. Recruiting through schools and vocational colleges having substantial proportions of minority and
female students.
C. Maintaining systematic contacts with minority (MBE), female (WBE), disabled (DBE), Veteran
(VBE) and human relations organizations leader's referral of qualified minority applicants.
D. Encourage present employees to refer minority and female applicants.
E. Make it known to all recruitment sources that qualified minority and female members are being
sought whenever there is hiring.
IV. This policy is intended to comply with the Civil Rights Act of 1964, as amended, the Federal Highway Act
of 1968, the Executive Order 11246 and 11375, the Rehabilitation Act of 1973, asamended, the Disabled
Veterans and Vietnam Era Veterans Readjustment Act of 1974, as amended, the Indiana Civil Right Act,
and other Federal and State Laws and Regulations pertaining to Equality of Opportunity and Affirmative
Action Policies.
V. Forms for filing any complaints are available in the Griffith office located at 1700 E. Main Street,
Griffith, IN 46319 or the South Bend office located at 24358 S.R. 23, South Bend, IN 46614. In addition,
employees can call (574) 288-4811, Ext. 211 to report any workplace concerns under this policy.
WALSH & KELLY, INC.
John C. Wall
Vice President/EEO Officer
Revised: August 1, 2019
INDIANAPOUS, IN Apd] 25, 2019
WALSH & KEL.LY INC
GRIPFML IN
cw :r� r:, r' w•: ! :w ► ,w w r ♦ i:w: � w n,w ;�w�
i JM #u IY tl A YI, M # `M 9N wr..� . "■. :-4
•«w w w« ws v' ♦w «. sw +w � r • - »w ♦:^awe � :w ww
ry rw �: r w w re w• " w w
r M : wr � �""'^e. w fw w fw: w � � a N w NMw w~c f ara . � : w ^ ►; a w•. -
w .. %� •. ';:' M 'w � i :. w w, ', w M rF 1 w ".�.lei'. # • ', « w iM #' :. ;,
Valid May 1, 2019 Thru April 30, 2020
AGGREGATE....................................................................................................................................... $UI�TLIl1eLlT®
A(B) CONCRETE PAVEMENT. LMTED......................................................................................................... $25.000.000
B(A) ASPHALT PAVEMENT: W/1NDOT CERTIFIED HMA...........................................................................SUNI]NIITED
C(B) LIGHT GRADING.......................................................................................................................................SUNLAUTfiD
E(E) SMALL STRUCTURES AND DRAINAGE ITEMS
$25.000,000
SM SURFACE MASONRY AND MISC CONCRETE...................................................................................... $50.000,000
E(0) TRAFFIC CONTROL. PAVEMENT MARKINGS...................................................................................... S25,000,000
E(H) DEEP SEWER AND/OR EXCAVATION.................................................................................................... $25,000,000
E(Q) CONCRETE PAVEMENT REPAIRS .......................................................................................................... $25.000,000
EM ASPHALT PAVEMENT MILLING ....................................... _..................................................................... $50,000,000
Ar.� J.
PREQUALIFICATION ENGINEER
Stets F 20508 (113 / 5-06)
PREQUALI "ICATION WORKSBEET
PRINTED:
42?12019
PQA APPROVED:
4/92019
ACCT = # 35-1120685 ALT ACCT: # 0449 NEW? SUPP?
NAME: WALSH & KELLY INC
APPROVED BY:
DATE:
42220I9
December 31, 2018
CURRENT FIXED
EQUIPMENT
ASSETS REPORTED
........... .............................
$42,594,782.00 $9,745,339.00
.. ... _...,_...
$28,570,400.00
VALID:
5/12019
LIABU TTIES REPORTED
($16,642,474.00) ($16,987,249.00)
EXPIRES:
4/302020
NET ASSETS REPORTED
$25,952,308.00 ($7,241,91I.00)
$28,570,400.00
D L DATE:
.
----_- :_-:-_
D SON:
09 OMIT NO DETAIL OR QUANTITY
($3,570,326.00) $0.00
$0.00
11 OMIT NO DETAIL
($167,486.00) $0.00
$0.00
15 CASH SURRENDER VALUE
$1,253,591.00 ($1,253,591.00)
$0.00
16OMIT INTANGIBLES
$0.00 ($1,152,280.00)
$0.00
22 DUE AFTER 24 MONTHS
$0.00 $13,690,291.00
$0.00
NET FIXED ASSETS
$0
NEET FI3MD ASSETS EQUIPMENT
$0
COMPONENT
:.
RATING
= _... _...
CURRENT
_.....m_. .
$234,680,870.00
NET ACCEPTABLE ASSETS
$23,468,087 $4,042,509
$28,570,400
FIXED
$8,085,018.00
RATING FACTORS
_.m::.._ ...,:::.,. ...::».:..W..:w.. .....:..:
X i 0 X 2
....::::: ._.._.,_.
X 8
EQUTMENT
$'2,29,563,200,00
RATING COMPONENTS
$234,680,870 $8,085,018
$228,563,200
... . . ........ ......... .........
.............
MA3dMUM BALANCE
$471.329,089.00
X 1.5
$228.563,200
MAXIMUM EQUIPMENT
$352 021,305
S0
STATELIENT TYPE:
AUDITED
8-00
EXPER REDUCTION
0yo
$228,563,200
_,, .. , .._ . _......... _..
$0
AGGREGATE
UNLIMITED
+
$4,042,509
._..
Sm...
A...
�)
$25 ,000,000'.
$463,244,070
$4,042,509
B(A)
UNLIMITED
C(B)
UNLIMITED
MA7GMUM FIXED
$1' S 811 018 ADJ. FIXED
$8,095 018
. ...
E(E)
$25,000,000
BALANCE SHEET ANALYSIS
^ N Y'CURRENT
E(F)
$50,000,000
CURRENT ASSETS:
$42,594,782 RATIO:
2.559
E(G)
$25,000,000
INVENTORY .,,_._.. w.._.._-
$3,570,326 QUICK RA ....... .........
RATIO:
..,._..,
2.345
E(H)
$25,000,000
..... _..,. ,,.".... ..u.W.. ..........
CURRENT LIABILITIES:
.........
$16,642,474 WORKING CAPITAL
-------
$25,952,308
E(Q)
$25,000,000
�. .,._ _�...
LONG TERM LIABILITIES:
... W ..... ,
$16,987,249 DEBTINET WORTH:
0,711
_ .. .
E )
$50.000,000
NET WORTH:
$47,280,797
TOTAL LIABILITIES:
$33,629,723
NOTES
CITY OF SOUTH BEND, INDIANA
CONTRACTOR'S BID FOR PUBLIC WORK
RESPONSIBLE BIDDER CHECKLIST
Project Name Century Center Parking Lot Entry Gateway Improvements
Project No. 118-035A
For Bids Due September 24, 2019
Contractor Name: Walsh & Kelly. Inc.
The City seeks to enhance its ability to identify responsive and responsible bidders on all City public works
projects by institution of comprehensive submission requirements in compliance with State law. Quality
workmanship, efficient operation, safety, and timely completion of projects requires that all bidders meet
certain minimum requirements to be responsive and responsible bidders.
THIS FORM MUST BE SUBMITTED WITH YOUR BID.
INSTRUCTIONS:
If you are a pre -qualified bidder, complete Section I only.
If you are not a pre -qualified bidder, complete Section II only.
Section II acts as an application for pre -qualification. Submission of Section II will allow the bidder to be
considered for pre -qualification for bids with the City of South Bend Department of Public Works. Pre -
qualified bidders will then be exempt from a portion of the submission requirements outlined in Section 6-
63 of The Responsible Bidding Ordinance No. 10594-18 (hereinafter, "Responsible Bidding Ordinance")
for a period of twelve (12) months.
Thereafter, contractors who are pre -qualified must submit a complete application for continuation of "pre -
qualified" standing, on a form provided by the City ("Responsible Bidder Checklist (1) Pre -Qualified
Bidders") by December 31 s' for the upcoming calendar year, or within twelve (12) months of obtaining pre -
qualified standing. If the status of any item changes within the twelve (12) months, it is the responsibility of
the contractor to notify the City. Failure by any pre -qualified contractor to submit its complete application
for continuation of "pre -qualified" standing within the time prescribed above shall result in automatic removal
of the designation, effective January 1 of the following year, or immediately following the twelve (12) months
of pre -qualified standing.
However, the "removed" contractor or subcontractor shall still be permitted to bid on City public works
projects, though the contractor must submit all required documents under 6-63 until "pre -qualified" status
is re-established.
Please Note: The City reserves the right to request supplemental information from the bidder,
additional verification of any information provided by the bidder, and may also conduct random
inquiries of the bidder's current and previous customers regardless of pre -qualified standing.
It is the sole responsibility of the potential bidder to comply with all submission requirements applicable to
the bidder in Section 6-63 of the Responsible Bidding Ordinance no later than the date of the public bid
opening.
Version 5/16/2019 General Conditions - 6
POST BID SUBMISSIONS:
Post -bid submissions must be submitted in accordance with Section 6-64 of the Responsible Bidding
Ordinance. The post -bid submission requirements are as follows:
1. All bidders shall collect, maintain, and provide upon request, a current written list that discloses the
name, address, licensing status, and type of work for any subcontractor from whom the bidder has
accepted a bid and/or intends to hire on any part of the public work project, including individuals
performing work as independent contractors.
2. Each subcontractor, whose portion of the project is estimated to be at least one -hundred fifty
thousand dollars ($150,000.00), shall be required to adhere to the requirements of Section I of the
Responsible Bidder Ordinance as though it were bidding directly to the City, except that the
subcontractor shall submit the required information (including the name, address, and type of work)
to the successful bidder prior to the commencement of work.
3. Failure of a subcontractor to submit the required information shall not disqualify the successful
bidder from performing work on the project and shall not constitute a contractual default and/or
breach by the successful bidder. However, the City may withhold all payment otherwise due for
work performed by a subcontractor, until the subcontractor submits the required information and
the City approves such information.
4. The disclosure of a subcontractor list ("Disclosed Subcontractor(s)") to the City by a bidder shall
not create any rights in the Disclosed Subcontractor(s). Thus, a bidder may substitute another
subcontractor for a Disclosed Subcontractor by giving the City, upon request, written notice of the
name, address, licensing status, and type of work of the substitute subcontractor.
5. The successful bidder and all subcontractors on a public works project are required to submit
certified payroll utilizing the federal form known as WH-347 or a similar form on a bi-weekly basis,
submitted within 10 days after the end of each bi-weekly payroll period. Certified payrolls shall
identify the job title and craft for each employee. Certified payrolls shall be submitted
electronically.
Please Note: Submissions deemed inadequate, incomplete, or untimely by the City may result in
the automatic disqualification of the bid.
The City, after review of complete and timely submissions, shall, in its sole discretion, after taking into
account all information in the submission requirements, determine whether a bidder is responsive and
responsible, and provide a Pre -Qualification Verification Letter. The City specifically reserves the right to
utilize all information provided in the contractor's submission and any information obtained by the City
through its own independent verification of the information provided by the contractor.
Version 5/16/2019 General Conditions - 7
PRE -QUALIFIED BIDDER CHECKLIST
(a) Acknowledgements:
(i) _ By checking this box, I hereby acknowledge that I am a pre -qualified bidder with
the City of South Bend and that I have met the pre -qualification requirements within
the last twelve (12) months. A copy of my Pre -Qualification verification letter
is attached.
_ 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.
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.
(iv) For every project, submit 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.
Version 5/16/2019 General Conditions - 8
II. PRE -QUALIFICATION CHECKLIST (FOR BIDDERS THAT ARE NOT PRE -QUALIFIED)
(a) Acknowledgements:
(i) X By checking this box, I hereby acknowledge that I am not a pre -qualified bidder
with the City of South Bend.
(ii) X By checking this box, I hereby acknowledge that the City reserves the right to
request supplemental information, additional verification of any information
provided, and may also conduct random inquiries of my current and prior
customers. The City reserved the right to utilize all information provided in this
submission and all information obtained in inquiries or requests to determine if a
bidder is responsive and responsible. Additionally, I acknowledge that all
information provided to the City shall be regarded as public records.
(iii) X By checking this box, I hereby acknowledge that copies of all Applicable
apprenticeship certificates or standards for training programs applicable to the
work performed on the project may be requested at 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) X
Indiana Secretary of State's on-line records (ie. Business verification) dated within
sixty (60) days of the submission of said document showing that business is in
existence, current with the Indiana Secretary of State's Business Entity Report,
and eligible for a certificate of good standing. (Not applicable to individuals, sole
proprietors or partnerships).
(ii) N/A
List identifying all former business names.
(iii) N/A
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) X
Statement about staffing capabilities, including labor sources. This statement
indicates and ensures I have sufficient employees on staff to complete the work I
am bidding on OR outlines how I intend to meet the staffing needs of the work.
(v) X
Statement that individuals who will perform work on the public work project on my
behalf will be properly classified as an employee or as an independent contractor
under all applicable state and federal laws and local ordinances.
(vi) X
For every project, submit 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.
Version 5/16/2019 General Conditions - 9
(ix) X Written statement of any federal, state or local tax liens or tax delinquencies owed
to any federal, state or local taxing body in the preceding three years.
(i) X List of projects of similar size and scope of work performed in all areas, including
the State of Indiana, within three (3) years prior to the date on which the bid is due.
\/D of Qni ifh De -A Ares
7nnt Name here)
Walsh & Kelly, Inc.
(Name of Company)
24358 SR 23r ,
(Address of Company)
South Bend
(City)
Indiana
(State)
574-288-4811
(Telephone Number)
Version 5/16/2019 General Conditions -10
Responsible bidding Practices and Submission
Requirements for ;pre -Approval
(b) Attachments
(i) Attached
(ii) Not Applicable
(iii) Not Applicable
(iv) Staffing Capabilities: Walsh & Kelly, Inc. is signatory with the following unions
which supply our workforce — Laborers International Union, Teamsters, Operating
Engineers and Cement Masons.
(v) All individuals who will perform worn on the public works project on behalf of
Walsh & Kelly, Inc. will be properly classified under applicable state and federal
laws and local ordinances.
(vi) Attached
(vii) Attached
(viii) Attached
(ix) Not Applicable — no tax delinquencies
(i) See Forms �)Aatid 96a
By: Dated: September 24 2019
i 1wa:l.y, VP of South Bend Area
State of Indiana
Office of the Secretary of State
CERTIFICATE OF EXISTENCE
To Whom These Presents Come, Greeting.
I, CONNIE LAWSON, Secretary of State of Indiana, do hereby certify that I am, by virtue of the laws of
the State of Indiana, the custodian of the corporate records and the proper official to execute this
certificate.
I further certify that records of this office disclose that
WALSH & KELLY INC
duly filed the requisite documents to commence business activities under the laws of the State of
Indiana on March 29, 1966, and was in existence or authorized to transact business in the State of
Indiana on September 05, 2019.
I further certify this Domestic For -Profit Corporation has filed its most recent report required by
Indiana law with the Secretary of State, or is not yet required to file such report, and that no notice of
withdrawal, dissolution, or expiration has been filed or taken place. All fees, taxes, interest, and
penalties owed to Indiana by the domestic or foreign entity and collected by the Secretary of State
have been paid.
In Witness Whereof, I have caused to be affixed my
signature and the seal of the State of Indiana, at the City
of Indianapolis, September 05, 2019
CONNIE LAWSON
SECRETARY OF STATE
194484-057 / 20191089739
All certificates should be validated here: https://bsd.sos.in.gov/ValidateCertificate
Expires on October 05, 2019.
06/03/2016 tea III Oa BAY 12119Fa131a Weal al
AGREHMENI'
BY AND BETWEEN
FOUR COUNTY HIGHWAY CONTRACTORS GROUP
and
LABORERS' INTERNATIONAL
UNION OF NORTH AMERICA
STATE OF I NDIANA DISTRICT COUNCIL
FOR AND ON BEHALF OF ITS AFFILIATED LOCAL UNIONS
#41 & 081
APRIL 1, 2017
thru
MARCH 31, 2022
Section 7^ An Apprernfto ahoUld, whenevor tface(cag,H, be rWBW by the h� pdoyer lvouglr
44Eeasoa ly s orwork no as to pw:me ow,o04 in a vvivIy lrrUPvxaguans eu i %vorWk �ski8da Wiscrrr 01a Empaloyrx ,iw Unable In provide an Apfurnhife Ada experienceIn the full flago of o mll'sk'Hhs, the JATC Pauly roquesl 4hc local Union to Malaita, tho Appaemice to olhar etoploy mean in otilar
for pquvWe ring eaperieaoe. For an gong , rig 1120 nploy^cr is able ta, Wde lIR fla r'aagcot
ona*Yeloat. r�aperiaaaea; Ora l3mployca WAY chorwo to rmido rite Appremico fanmlob go job. Upon
request the. fignplayer will rnfonm. Dee JAI'(.' amp ,LOW Union of an Apprentices jUb
rresslppuneaa4arrer a prrta,t.
'.Moo g. AO Apprcmh%re shall nor hap VIeditad for taking off from workto atlend affiite reining
(d3eaegh time off fur hninlog i3 am id).
5mction 9. Norm hetsocling'the provigimxm Or pion S. the Employer' "my tall IN Union form Lndtvidural by 1111100, provided he Or she Ira not then arraplwmyad by anathog' iinrupdoyar, lrAvollalgle,
the Unlnn shall ra4esthat ind'rvid at
50etfon 10, 710 Ilion agrees Ut hold haroess anal to ingionn7(y' any Employer pt1 any egaGm Arising out ofthe Unaer's mitrratl Vultra'A tRIA'k,"s admdninnu4hra ofrinc
Apprenficetbip,Pro .
ARTICLE XXXV
BCRC / DRUG TESTING
5ortlan 1.. Thar Union recOgnines the right Of tlac Employer to establish a drug testing policy for
Etnpfayoas.
SeeAhr 2. 10 oil 0lnwtlurgp wh m so F�ploycs to arspojngd to"to a o ging Mpdm In on trognafirytnbe,dsssaaeerafUloa"hatawona'proloct,testingmayheTV nirnd,inNuocdanee,;aipb
a1roe. ar 41Ya,t oro$program, or, Mile, ownav's rognlrementa for autuccaarvl comratttsa We more
stri',nitera, in BOCOMI alM wida tlac owner'imgolceme ms No sniv a tp6ayraicvra Uctpoo shall be
Oaten al',priaaA.O.'at'ndacr aolady becmaea ha"aho rafewal a. job owgganaaoa thathm a anfore,cs testing.
requirement,.
Seefloa 3. BCRC
(A) The Asuciabon,. the Union„ various other E'mphow Aaaociahona, wad %so out other
tadona ago Anentbera Of 09 Balding and Cog atnatllen Roanatnec Center, hwc
(hereinA1001 'ACC"), a rat"VoWit ccrpor"1104 fti %" AUMO N to provtalr seim, Ira
4proeolast9nu.taoa indaaany. brrluding, but oar Iiawiod to,educocfmu and Oriernl scmi000
ronocroing Aleobot, drug, and other sull tare, Abuse Which parp mea arc me" rally
thrtrd In the Ank1'caof hrcatparmtim and ByLAWO of old RCR(:'.
(B) F :h 'Fartploycr r dale Arrtemcol "' pay m BVRC den' arnooen 41 quecifYed kn
AMie1r XXXI of tlda Agcttannai'. pre bear wnrlood by each of ha'llknptuyras emvcrcal
bylhhAgrrcrnwan.,Eacayp;mptleycwisohpigpandtywmA.kryAwelhrarvnardp�rnut3ggda,ao
Of WhEdW car not atnh FMPlfty'cr Is a Member of Be, jt ;'. gaol On
ARTICLE XXXIV
APPRENTICES
Sosllnn I. New Applicants for employmoo4 wM a signatory cortrovest Ago have fewer than
4,000 doors o6 eapaa%C1roa ors a Csrru2rmuua3cm Ca^all L'ths"' (or alPml'urr7+ Yy', a lop d argadnktt
og dradong a1 ills k y aoidev&ng a aagiisfactxy raoga t1 A plaoampm aw aaptaagan sdrnlnlitaae4 by
t1aA fount Appitaralaeafr}'p and Iirafning Curraml4ass (fA'IC".), sharp, wtthaa0vsr ptrnrai0al, rmsr and
frosdlavwu+,74�axmterIteeApapranho hl'ppa pauat anatn«rNsvrr'impr�µrtybasisin� vokh
gin Iornts of lu' Appronl)ecelrip lenup an �Aaty purrs 04oring„ big fWlft m Maintain and
CbAt9p '1f.0A ht0 4MT lkar a'f2pgeryil" A`pw a7WI1 AYIYE hC:glphN}'&I by' t12n'Iyg4pi0.',jplr0` am . a fo%Ymn
nrNaroft
ines^AntsAagrc�mnwnA:'EdgerkilnprmoftugyApyaeNlicstooa ilia .Idsorherapp ati tlp'stptus'
a1 All obllga4othe Faaapinyeg 0 dS aRolt pstseo � raniktia boys the Union,
Section '2 The Appr"arlic 11 .and T=Wq Sgan both, apprand by the Fadcral lhotaU of
Appreaaticeshipaged 1'mioics of Strata Appmm3ceshlpOuouguiateoan: hereby 'p. l heaeln
by rereroneo And made a part of this Agrocco nt,
Section 3. TheApprentice wage rates:
Ho1ns of CredH Wage Rate
�I 1" Wind 0-1000 hours 75% ofjoutoeyworker rate
AA 2Jpelind I001-2000hoars 85%of;joom ywork"rote
3Paidd 2001-3000horra 90%ofjourney"Tiorerete
Opertod 3001-40DO hours 95% oflpurneyworiter rate
Section 4. The r U tents for entry into the Apponndimittip p rogglan s1ua1l be DOMIMUOd by the
JATC, whirhaball cmpl'oy approprcial8 taigangand spmcciog pros gshom,, An Appratuico adsBracoe
from ow htnna-of wit and wggt-gtts cage y t9 anol,Iasr Only 'Upon, detemYimnlon of
54dFln-44V peffotnsanese by tlto fAT"C, purger at Id regnheaaaant speciftad in the Apponsiceship
Fromm which shol have the asabority to ,grant ACOMIeTOW Owdit where wacrmfBdby the
performance of an lndividual Apporniae,
Secion S. Except a2 provided inSecdon 9, t vt EIRPIO)w $hall pastfcipatlo in. Eito Appromiccablp
lkoggstn by constricting Apmerttioes for amploymem Upon MrQTW by lba Union. "ft Employes
shad how the 1010 dot toMitcl,A any time, any Appnamlm reigned tun It, or working for it
'1lnn Employer is teatobligwwadto a'eccpt numv lluta am
(1) Aptunnoica for ovaa^y fin (5) fomUoytwogltsra o g With the ahUh labone" naDIod'by
the E111POY a. 'k'hia moo shall be rooaagood on a Wanig any wide haslay and does not aoVing rat
Ilgoployca'ra barn A siulla Laborer, if only tiro an at Aa 4oloutined by Oamliniployar.
Section & The OrWoyes may not employ on Appaeaatim ttatil At ➢ ing no (1) 3'ommoywaltkrr is
cmployodand 0aereafaargraynot oaspdoyTOM t'hmOnes (1)ApApromice, for ty ayadd'Stiorualone
i3) Iotuao'. Wrions.
q7i
�gg AGREEMENT
IR BYANDBETWER Y
INDIANA CONSTRUCTORS, INC. —LABOR RELATIONS DIVISION (ICI-LRD)
and
LOCAL UNIONS
#120, #204, #213, #274, #561, #645, #741, #795, #1112
OF
LABORERS' IN'rE,RNATTONAL
UNION OF NORTH AMERICA
STATE OF I NDIANA DLBTRICr COUNCIL
If APRIL 1, 2017
711m
MARCH 31, 2022
P
79'
Socalift 4. Sherd an 800001me NI err rdi'" 140 pto,rlda Sit aruiukeca surduy ia`4 whas
Saabis dannadedby due UWM,, at ahoWd M Employer fail to kwp a bond in clbak as all
Mates cold Employer is required to 'its" ant, the Uadoo %hall have nw right to atrika
=&or plekee, oft nood=, nod Hasa nl1 Other bosh c WXW eosoannlo umca 10 ceew tha
Eepleyee to comply with this Arsido,
ARTICLE JODUII
NO STRWE CLAUSE
DVIWg the ream of thig Aammaget, dmv eeh➢ ba so teals by the Emplayao aid as
bgoat, ;dgkods& nark topp&M
l Paillrm of do Unlas is to any
by Rho the E pl y eny mjo osie L, a viala4lomnf this Arklo.
That as the Eoaplayer°s Pmjeot "
71M Unum *41 not used^ oil or chat. Aga of oxonnc cry" vrode
sRrikaw Pi+de+�aS, er triad aliamPtaro aotivlty wbladrw➢olates' data Aadalt omJ whsYl
� n9l aecsamwbad � la arts � any �GFvtty. Nm Ertm)r7oyoa
u� phylg gR lA orazivluy wpndolti ro5cr9atco tluic A rtiohn A:ay P�npSograa who paaxlaipat� in or
ao� one maaivity wbladt wiolatao lbia Attlnlo abal'l'bo mdsjox'lo afisriPlhaary aatrrn„
snbjoollotha;
7%s Usloo, and its Prird,Psl ofeams vafll isms dlocdy hwee ci, order sod use its boat
MAU to =u se'ipe to ixmsa sey wialshanr o'f the Ardcko
If the VOW nmisbas, PlAci ra+ K of toppoom t walk vsvpuc, sue, PlAdws of
odd dWMWvc cadAW in em s too of This Ard6la, Ow EmPloyar may Patent all Ind
mod t reme" mod any svaibabla thmmo related to tbo 1lnWo
violation of this Ardd&
This Article does nor apply with KVA& to co1lwtmo ofdolfixtua at fringe bwadW,
ARTICLE X7UGV
APPRENTICES
Emden 1< Now Apptimmis for -kilt o who bows
'W, Ow 4,OW tom of OPQKW— As a C sied- Cho ' (re'abarnativotlyo
asemt d umo agtdvayms akft➢a by aaldowiog a o$timfielary" saris in a'plaaanmla
by tbt idiot P and Training Co®elttaa O'ATO,
"I wthenavm potatkol, corm and be Aualemd to rate tin Apprmug=WP MP- of s
n boil In mac with rba term$ of the Am p Pmv—
Any pmmmm mnimit$ but fading m msuomin and compWo No or its aprprao400WA nhall
act be o itloymdi by the firnplaym is a Jomsmywmkm undar this Agroetsmn• The fall'uM
ofany Apprmddoa to n We or ber appaanll0nwp noon shallabligeo dw ingpla'ymrr
to dimcbmge oasis Pmaan aPcm neita fmm'dn'thsao
32
I4'
p;
Employer •. if avmlablq the Union d aS refef thatladhsldaol.
�I ISaction,
IC The Unks dpaw or hold homeless and to Waraftify any Esaploym to my
am of me union's a hauad ruledipwows or lido Union"s or JATC's
CIsm ables
migninAAbifien ofdx AppreadomblP
ARTICLE XXXV
SUBSTANCE ABUSE TESTING
yy
SudanL RcoophdAgiladyrr trot, , l VoOdmeso ande'✓hor
cs'ternal poseemmo oft wa,sabesooaaboso dwputt- mnaadlyosnmeto
aboso
p
cad substatm
tsft Noma wnb SAT pm�AT as
In o
1 to ■
Station J. 'Each seapicyce poesy to this cosamtivo sepses Pay
the SAT" Worm S.03ftor (3'Matta Per boo fbr each boar worked by each EmPloyoo
ui
t " AVOMML no oomribmians to the SAT Amara WRI be dOP014104
cult -smuts, or at rasa* other revatur wervall as may be dotenalmod by One ".LR1y
to the depoeihny dasBp ad by the Aoaealelam. And v Ah moons
�y
■
i-At%m idion)
a" be edoolod on suvb fixac, 0 mey be deAVY00 by the A-CMn.
3. E&db amployd, poly to this Milactivo bmipsiniag agreaMelif swam that a
va dash by th m Amotodati0a shall be pcmsftttl, rrsyumt, to BUM ibe
psay$oE raoords of tmo 10 aoatyrllmtoa writs rids Anlrla. In fb� aweal a
Jswstit ie oanoaammaad to os�oe eery datlltmiuemaisa, and t dalimpmsanay is
11xaa �' � Ws � s�Um➢o fm, to Pay+ aI �s � eosa�
ao➢letting seals dalioapsamay ioalunsVing atoamcy"a fees iruaaarod Ray twat Astoedotirm his
Pu>maut osdmsBaodanofmmohddlnquanay.
�n 4, It is aproady agrood, and. %nalast000fl tot no Erpx(lmFonEmployer. or Was
bar any or 0XV401oy itmed in. err alsht to my manira *mub'otileg' m. Part of such
� AdiwaTmsiltgPmtrgmm.
�I
Stedso 5, The Main of dw tests 04taciNiOd will this proSrmn WIN be Paid Liam $0
Proven.
ldAidif{ed in Section 2 in 49tardwo withthe items ofdmSAT
A
EXHIBIT
SUBSTANCE, ABUSE TESTING PROGRAM
L POLICY STATEMENT. All ilgnasmmy Employers to rims AsreWMA nod tmo!
Union. haveit owronotmena to Ported Pacple sniff praporty, and to pieMdo a tuft
area. ThePurposeof the falowigg prom- is w cobla'tish snl
n a drug free, alWW fate, safe, healthy work C'Mrrtome t for aI of its d
Imajdayeto tovemd by thim AFv=WtI�
34
Scanlon I. T7se APprmniotohiP reed Tramiel Standards %Tmvad by Our Federal Buroao
ufAPprankloehlP Wd Training or State Apprectice0dF Com'mittoo are herby
incorporeal havirn by refacm W nsada s.Pao ofthds Agramacta
Section 3. The A'ppeatice wage rates:
HomsofCredit Wage Rate
laae,lad 0-1000home 75%ofjoumywwkmrate
2"Ipanod 1001.2000 home SS%ofJourmywedrer rate
1WPerio.d 2MI-3000boms 909Aofjm orate
4tparlod 3001-4000be= 95%ofj'oMtmcyandaarInto
SaeA:rose+4."�mrpgralrrusdafiterareryi'ru�1]weA : ip ehepNRwa�eomrtsolldh
pay 111e JATCe which slsaiN ootPloy apProPdsee tamttts stmJ An
APParratce advmtmrmsr' from enn lmmmwof'aredld cod wagO^',taev aaRagtrym as enatlmar an➢lr
spare daamrmtlnaSan of sagsllmaa'y pmftamaneo by too JATC, pvamaaatl tt togwr+snmots
mpn�tiYaJ ni dha Apt6p '�'am 'w etaa1,i hove � nuhcrity as arson
stew lexaced eraddt vita w h y tba paalorxasnm of sn lndivldmd APPtmnioo.
Stwoo 5, Esaapk as pmvklod In 'Section 9„ toe Employer shot Firtiapda in tub
Appradlowhip.ProppcmbyoxulataiogAppromo fi "lloyrnmwtoPmewreRxe➢bythe
Urgkah, The Employe, shall have mha Iota right to Meet, a any U soy Apprentice
tcfeaod tar lt, or' for it, T7?+e EmPloym la nett oblltad to aeoapot torso loads one
(1) Appmateo,fbr MWY live (5) J with the oho lam'
nodal by the. Vmployvr" "ibis radio shall be rnaaeoumd our o mftPlny wide bowac, L
dote not mgah a aEtmpl'oyce to have a sixth t abor+m, if only 'five are nova d» am
ddermitord by'dw P.a tployar.
Sasaslon d. 'rho EMpInymr may nap atuploy ao Appcantka =61 at least am (1)
pommyworka is employed and lhamSem may am employ ands than one (1) Appremiev
for every aMtinnoldaft (3)J ors.
SWAIM a. AnApptantdrmabould, vbcnoa prarrteal, be related byahoEl"lloer'flumoh
diffonom typca af' wa k ao as to became baited in a vadety of opaudem, and work skills,,
Whmo the Employer is uaabha to Provide to Appamttiaa'with oapmianao in ft fall aaty
of eafh alsills,'UK JATC may topear the Laral Uo%a to'masaign the Appmattat to other
aeploymem to order toprovide that estpmieune. For so lions as do Employer Is ON* to
prowdo to aacecerry top of Kuployrawaml empe ioue, the Employar may dosses to
-coin 0ta Approadou awn job, to job. Upoosquat the Employer Val. Wbria the JATC'
mod Load Union of an A,pdmmtat'sjob rraWli Batas on a paMimt«
Section d An Appremiaam shall not be Pam bW 'liar htkinS off 'tbam work to *nod
aflilte hu ming (thousb tlmm off far bah tng de, oopmld).
Section 9. Nalwiduonding the pravisiom of Section So rho Employe may aeil. its..
Union for me imlivldoal by tutu provided he or $be it not Than employed iy anodmm
33
COLLECTIVE BARGAINING AGREEMENT
IWMDSCnVM
INTERNA71ONAL UNION OF OPERATING ENGINE MS
LOCAL ISO, AFL-CIO
AND
FOUR COUNTY HIGHWAY CONTRACTORS GROUP
MAY 1, 2017
moucill
APRIL 30, 2022
Poymemsstommponfedbymom'hfyre"rtaanforresptnvUedfor saw aveiwaude,Voodoo &vbW
MUM office at6150lobotR"Co" .Megat60ns.Setlaterthentheteoth(IOth')d'everItim(Apilowager
muadk6rrmn gr ootkReportforreeare ava0ebleatheaboveeddten llmwovorlfpaymoc5brrotln
bythetwoutleth(2 )dsysithemoDtitsballbe whoklaroda.viohntianefh6 Alrnoraantand shabsumble
for contributions dull liquidated damaps, hamreak and say other cost o(coateC'ber...
AddWoW Infarmadon and limpkaynor code numbers ass be obtained In the Vacation Savings OlBce at
6150Joliet A , Countrysidt,al'linois606M
'..,, ARTICLE )a
SBCITON I -APPROnUMPAND SILW. DWXWMURT VUND
A arrd SW �Fund has been created and Is lemurs aethe Operating
EngmtimorWellSOAppmvenwodpFund, .
MAY 1, 2017, rhs'gmpkw„Wer SW Pat, one da0ar and ftes f Pants ($ 35) par hour for moth
hour %Vu are received by the MMVIQYM Wm*d'bythis AIgro mewintothowd1rrnaatld AppoommudipF d,
Watt" Mny2,2OI%the EaoployawShelf paya"dollarantiddrlydveants(S13S)povhonrfat,tark
eWI hour wagoa...an received by Moomployan covered by" AWoomeml.We the Fund
I� Alff&*ftMAY L20I%the RM'Phyw°MUM M(IRA) Per boanAWmolh.how wMesare received bythe
®ployeascrvarpdbydu Agrowme ttwotheoforavaldAppsenticeshipPunt
M�w'1,x�X',p„Ibt rpm;m"aprYy(D)per YSrtnar arbour wagesare retelvad bythe
aroployoeaexraerodbythis Alfteamerat too the x6ormaaldAp pFu"
EtPood" Noy J. 2021, the Employer sballlwy (f0O) parhour for each hour wain are received by the
emplvyooscovmadbythis AFftwent here the afnroaddApprenticeship fund.
It Is understood end agreed than the 9nopleyor shall ba boned by the tam end provisions of the
Agmeosentand Owlemel000f Trust often Appronfladckp Amd,and ..4 t btrumajW
madethat as though the same were IW W Incorporated herein,«
The Employartafteragreas tnbebanndbythe terms ofthe Appm mtektbbodby
the JointApproudtnahlp.TkalnamE ooltboNorthern WlaulswadNorthern huhmemApperoand
%kflI UVW090MArm Progracago, approved,bytheUnited StameDdiratnwartoftober;DumapadAy�lat sip
TrWndng,
no Approodorship Fund kasbeen establisheduedaballbemiralakw.areddo. cavdah..thelabor
MaomgwmwatRelydom' Act of 1547„ as grounded aid ■U Wharapp0coblo Federal ad State Lawn
Paymtats Wed bF Monthly reports an forms pmvldad by Serum am due in the heel ofOm'at
6150 )ages Road, CmrntrYelde, IL 6052Sgo War than the IOah day Of the fallowing moth fa the pacuding
MAVWX taponform are OVAII elealtiaaboveAddreea,Nawever,ItpsymeatlSwetitbycan20thdayofthe
mould,RsnrJlbeoanaldnrnAaetlrdaatnnofrbaagros,eerie: ,
Contrabu Ionsta the aforesaldApprentlashlp Fund shall not constitute orbedeemed wageedue tothe
employee.
91
F—LCr41n-Wieme.&—G—p
FEM Z
ngen
Fd,.m 2al0t7
P
re "aaSe orM toa7twnYRAoA aaarltW Uwe apµa Split 5l1(:1
m ataanaawaSarr s1430 Simon Mef1.75 MSL75 IMI{7.
yalyoa s10E0 Siam
SL40 t1An
SL75 SL75
SLSS 5135
yyl5p i325 $350
acaC seas tone
Cp m,y "Ae m0.45
W $0.12 $0.12
W440FaR. iWuntil
atptJfa,a �U40 5"lM76. � TS #"SIM
$372lar,rWr Sa9.SS nszs
tfaaal 0920
%a tNaaeiSrd.Ymr Sim means
2aaDnst7sN Ymr Smeans
UM $we
7aanaNtf4laYar 916Z SIM
aadtfaaaraavar stRaS� t9sns
W# n%r to Mq 1e, the total padmge small be allocated baaysso WRgsr and Otago beeeda ee
drtwealned by the Unim
CmMbutlomtotbe Weifa%Penvbn and Apprtntlttak)p,Pdngegol7tEtFrmdc�R➢m10 walfee
to the employee
Atthe -and of6.g0Oarr 040tmWiftfbouos,the Apprartice Aallbecome al,0umvteymanEflpxerand
dmUbepaid p tothswoo salaand ofeasdRrsdoaaaSee forth Inthis Alpsount.
In no event stela ore rite of pay for appro UM exceedinit that cam pmvadog for the dwMAMon of
machine 60 op'preatia MW be operating aacQVtaloed do Artide %U ofthimAgIromaat.
Alppro'nslas shelf are paid tnt was$ Mtn ws f n'th0n the ter introduction SEp issued to the
Emplayes'end the la at the time *0ApprefMceIsdlapocchaltothsEmp%My
Tfwlu 5fipanaEOedlatothoatsRYadtha camftopparditprwwminpatodor
step number, be obig be paid purruant to the rates setforth,, in"Averment
In edditlootathe above provisions formes ofpsy, the Reopltyemshall pry fdogebenegtcoiefhrelooeas
prmddedforcoothbAgroantarlL
ART IM RU
MMCZMgffMMD WAGE MTV FOR LUM PORT®6 UMTRAMFrI1lEgRDItIIM
numanammm SM111 Inn, Ill/l! all— Stla1
RnYh&Welie $14% S1500 601ILTS WRSL75 end 3710
Peaaba 51050 Men
AV OL40
Y maaS'amiryy 5100 $Lee
F00d $135 S13S
aim un am
aft" SL40 "AS
uo $on moan
19 Fat Ceaer9HW.MCaWIW—M.W
FD16L2
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hi mry xe, 2D17
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NoP4rgraataa@tAgrdaarUetmsypadomboth pnpurdcatrdnoo4orplabo unhwork, fardanofthose
venploy rsxsBvecoanpwivaaaJe11tiesockamannaea'hmha5diaCdcwdatndorormtivalorpryr pnffrdopsbaneRa..
aRnDlbutlomthapredseDtasherofhourawhicharsVintporformbeghorgetu9agunitwork Absigesgam
weed tlwtreheoanomp]OYVOwho 19wrepleyedbyao n/AmploW, parformsboth.barilumnogueriaW
non -bargaining uag workaudwho:
A. IsaSbarthoblos;.olfrcor'and/ordfsacto'rofthe roapovsa5mpjRmaployam or
1L Isa15%orgreater 'owntroran.4f.Corthe twinhntlCtkartao,or
C. Is a relative (fathsr; mother, son, domighter, brothot sister, husband, wife, In-law) of ■
Shareholder, *Mar so'rpormionjImployor, the barpinall parties have
aVvW that any shareholder/rshtive reporting under this dean mast report one hundred
skts"ve('115)hours per roan* 'tH 1"(12)rnombsayour, tl voad'ahewous nof'•werk
they per arm 0r tht Mmut of 00RtpF.nSAUM they malve to any indlysdwf monde.
Contributions art dig by the I" day of 4be Pmadb* month for wwch the ' ois
reporting, The Employer may abet to report on del holes afaetual boost worlrsd;. par m oo
providw; boom roporcted are to cum of one hundred tiatrty,ove (IM hour. rash Moo&
Nwrrsraported to exam ofem hundred tblrtpfnve (135) hours wrtrtpoamd'on theegarou faA
rolefaraunktoncerepartduo bytto t0th day of thefA4weriftmesa,
no Eanpbaya^ shad be required' to make cortu tartloos on behalf of'meh emplayses for at low a
mmlmum.*font hundred thhty4vt(135) hours permonth or, attheampWyoa°teltDDorL o tuallourm Worked
doamnaahitgreaaerlhunout bundrorlth "ve,(155}
Coeparait d &-tar% shaaholden and their children will be asmtopt feom rhos prnvingn were O ty
operate equipment doing b rga moll unit work duties an emergoDcy such as Am. go" or tosn Wv or
property.
"Me sale RAlhly« of the Rmp'ioyar to the N'pprowtcoahlp Pund Shall be the payment of howly
contributions argot forth In.t'hIAArtide provldod,however,thatnoddugbortlushen.bo umrprenrefto regain
*4 E'mpkayerfmm its okltgadnns undertheApprontXasbfp Standards as get forth above mall Small be habits for
tontrdbuttoirm; do*, 114WAstod damomimerest, and any other too of'cofleadoo.
MMON 2 - WAC85 AND pRDIM RENEFITE FOR AFPREMCES IN ALL COUNT=
Thef odwdulastmforahtbermeofpayanidcontrmutiomfor WngebeneAmforappreudeaan
the period or sup number emilc ted on the Introduction7d'lp,:
FMON FORMSfANDSMMYSARAFP'
Dwahaw.11—
peeke
S4�SlaI
tt7o
n'taaa4 off"L75 "MYS "MAD
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$1
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$330
a=
taw
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sin
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32
Paw CelmtyNiSh.7Caauw wa Qeup
FINAL2
D
puree re 20, 2017
g Ora Fa® 1433e $42.90040 I aaSS� "#$M
Ctaaaf«
$m4Sa � Bill,
0�75 /N�31
.r;ypa�uMal aSnr)
.4+FdWMrtrwrc*tF*rwwnwlJl
cart nwaar• .
Y won
sup rareFare
eammhwherd Na-odnk,47-Aa*dk-b47"wc,arah moam'gar
Z ,,7a,'S.*on una'Kmfewn'.40wMR augur
Ream
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�rawwananAae taata'aomwar
eamanr.saasaW lyawAroa�ptfkwq
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ageramdnra;,2,r mJLwra W
raaaeaierep
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cum mum modems PrapJud)
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CMM MMo4edmavaran (Ala
errata Cemen sad
ecrwaae
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samrrrCrbud seer wdma .36 uwYd mand�a.mwe
onalav fob fADr llatlir1�r %lvrb W
Nandraad aedda. .1 ngeleme edudheAaAOatbwY
emedm®dYadatreta k etwe
t.AC aaa POR011ar7rue[Yard
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34
Four Camp IdelvvnyConn rn en Group
FINAL 2
➢hpn
M-02a,2017
COLLECTIVE BARGAINING AGREEMENT
FOR
ROAD, BRIDGES AND AIRPORTS
BETWEEN
OPERATIVE PLASTERERS
AND CEMENT MASONS
LOCAL #692
Areas #165, #406, & #438
and
ROAD, BRIDGES, AND AIRPORT
CONTRACTORS
June 1,2018
through
May 31, 2023
—........ . � _w T—im H ,7-13 ..... _....._. CAP _ . grgi ...,
Ara 165 - Tim Hudson 219-713-0905 Wudaon Icmlatca1692 0
Area 406 Matt Rhoades 219-771-0766 opcmia4256@rahao.com
Area 438 • Tom Graham 219-36}5089 opemia438QaoLcom
Local 692 - Areas 165, 406, & 438
ROAD, BRIDGES, AND AIRPORT
Pages 22, 23, and 24
8.7 Appmaireship.
(Ir) The Employers arwemn to make the caadubodiun rate for the Apprlemiearlhip Funds
s1.11 IV 410 amount sal, forth in 8rourl'iou 8.1 above, for e,aeb hour Worked by an hmployvg ,,
(lu) It Ix dgHad ljdel tita.nshall ko calaMlihed ut J040 Ap%twmulcahrtr "rm4 ing Conu11111ey.
aumaprivod url ma aalauak nioursl„era mrl" l?M
, gntoyee aura' 63'mtlnvm wary;n�elyola4vreo l"holy C ommiaam sl uell
be aura in calmplbmrm whIl all alpPhcatufe IMS, end ilw Aplmrenll0,aaNV Mnbug Prang-nxbnll ba
uwllohni'aulmeccl 1n wkvw 4lury Twill'$ Ilanploviu"Uau;u M 11M bialaurnal I.-0Iwm kelmionm ewt as igrmwavd,
mod Alpo in wootshnagg wrah the vHo" of dlun InAl AgZeeunam' 'awdalsh nadnblklud IN,
Appmranieriah)p trmiodog, lLg,rWM.
(c) Appmotkv 1v110 luau ewmty Two (2) toornoymnau, igsamrr nmty Ibo one aiplwentice
ufilized Win aysllable, Do loins Appoamaarmhlp A "Tneiming R"I,�aearuoltdco wimn t r0em41 and
indenhtre a mlulydow otill"lrarnq appamn Pb^tie lug uaurl llzc dmorlmauCx upolt Ilan ptov.lur.
lst Period: Oto 900 Hrs- 60Y of Journeyman Rote
2nd Pmiod: 801 to 1600 No - 70% of Journeymma Rate
31d Period: 1601 to 2400 No - 75% oflomina,ynuaor 1l;mta
40r Period: 2401 to 3200 No - 80-A of 1'au.le,ymen hart.
Slh Period: 3201 to 4WD Hrs - 85%of,fontavlr�youni fdtnao
6th Period: 4001 to 5600 No - 95% of Journeyman Rate
6.0 Contributlons to BCRC
(►) VsHm n EamPloyrws ua 11ca phut Awcomxm aaltl dbe Uratse any mrnobrol of Oal.by'l.g
seed ConMxukddom R"Ldta IV COOT, IMr G Ill Mil "), a nos pmfh' <oePoradnn Shod wsa, lomell ur
Provide peawlko in, dhc msmnrawdaoe hnlonry, Including, but xnn dladdod dog,. edumalhunl nod rafasml
meawrlr„mx AvSrIIA14, almhol dnuem,will loct malralrlmre Abuse, vlhach Innivaes ore MOO,, Pxl(y
40low l in the Anlwlea nll'lurw+a>rPapd's16t+nand fly-1.aµ v o%'sudd I+df„M!,
(h) Each Colptauyer utalwt lime Agm.eptiwnd rehnii pay to nt Rl" in awwordnficz "ill)
8'W6 na Y.1)Mnl'bodowa Rw oaeh tw or weodked Iq cach of ilm bntployma Said gmynnmn:shaflj be
111a4e Inusulhly Mrt dlu mmmlru and'a m1rh tlmca dP we e,dkblioh d by ft BeRC, Fach Phiploye.1
r m ohii8adced to rinke awl. cmolitwimmrva, irovaar 1vu nif wh i-IN'r or nat ameh lhnpkly" IS a mcaal err
ofkid RC„-
W Papaamaw mrlmmi W be made to MAW AM I%, dwoned to be g vmAd I,D, Pym
pov isiosul of ahil A88avmenan.i luexdaining to the oollotoon ofndbe, ltgvmwnts rcquMxaml to b, anedo
by ➢ranPhryrm.
89 E'mplw)mw Harrill Nalca. 1ht FmpluJcc br"fit MI' m ffkl iunh in gmrflom 8.1(e) nborvy
fax each liar wworkcal fto Iitabtu A'a@ldfuO, Va Worl, 5adaga, Apprtraret-Aiip, Lhln r1'm:k-tAy'fi
OCR('% mw1 CAI` xball be emnlalned ink, name ulmm;k eurde Idsyuble loIlse Indlamm ,Slaw Courulc.il of
P7mmten"s lA t°nrucetx `h+lawxwts bl&W aed. P"nn601t Fwfui any mn1lmd 19) P.C'.l lloa. „4p440,
OPCMIA LOCAL 692 a A: A) _ 11a % off y 1 gT
w
tits Agreement Expiration Date May 31, 2023
yW RATES E
7FF
{E
p �C
��^TIVE ON DATE SHOWN
,t& PAUl/��;±PER
aHOUR WORKED
14AZE&U"XaNAMwh,�r,ImMN" m ..ddrr�p A,MU b7dA ,p si
Journeyman Cement Masons ROAD Rate
$35.09
Foreman ($3 above Journeyman)
$36.09
Health & Welfare Fund
$8.93
Pension Fund
$9.07
Apprenticeship Fund
$0.70
Industry Fund
$0.16
B-CA C,
$0,10
TOTAL Package Cement Mason (RD)
W 04
Savings Fund (DEDUCT)
$375
Market Recovery (DEDUCT)
$0,25
Work Dues (DEDUCT)
$2.97
International Dues (DEDUCT)
$0..54
there will be a One Dollar and Filly Cent ($1.50) increase. Seventy Cents ($070)
to Benefits, Ten Cents ($0.10) to Apprenticeship Fund, and Seventy Cents ($0.70) to be disbursed as
voted by the membership.
there will be a One Dollar and Fifty Cent ($1,..50) increase. Seventy Cents ($0.70)
to Benefits, Ten Cents ($0.10) to Apprenticeship Fund, and Seventy Cents ($0.70) to be disbursed as
voted by the membership.
'(I)gfryry')gdp tdato2�� there will be a One Dollar and Fifty Cent ($1..50) increase. Ten Cents ($0.10) to
Apprenticeship Fund, and One Dollar and Forty Cents ($1.40) to be disbursed as voted by the
membership„
[here will be a One Dollar and Fitly Cent ($1.50) increase to be disbursed as
voted by the membership.
Ihq (¢Tl{kq'_IYFJ _(YTJ,(11: Combt,. Health & Weller., Apprenticeship, hdusoy, BCRC, and Dues monies In ONE CHECK
Payable to ISO PBCM HAW FUND and ..it vdth repodhrg forms W Hea11hSCOPE ® PO Box 50M6, Indianapolis. Indlana
46260 All PENSION Hours & Abney Should be made payable to Cement Masons 155 Pension Hammond & Vwlnity for all
haae Worked In Area 165 For all Cement Masons and mad to Sloned C MiOer Co @ 2111 W Unceln Hwy, MenillWlle,
Irdian®46410.
TERRITORIAL JURISDICTION: The territory of area covered by this Agreement shall include "Lake
County except by the Northeastern Section lying north of Crown Point and east of Griffith, and all of
Nevilon County" and shall be referred to as "Hammond, Indiana and Vicinity^..
Tian Hudson -Business Agent
thudson@picmloeai69E.org
I.mml 692 - Area 166
9209lnuisiam Street M—finilla, lndiaaa 48410
(219) 7134905 Phone
plemloca1692.org
OPCMIA LOCAL 692 MWIMT
Agreement Expiration Date May 31, 2023
RATES RIFFECTAT ON DATE SHOWN& PAM PERHOUR WORKED
I-wo-TUROVOKMAY-all 21uf
OPCMU LOCAL 692 &AAY-ORC
Agreement Expiration Date May 31, 2023
k 0l 001� RATES EFFECTIVE ON DATE SHOWN & PAID PER HOUR WORKED
Journeyman Cement Masons ROAD Rate
$32.19
Journeymen Cement Masons ROAD Rate
$33, -
Forman ($3 above Journeymen)
$35.19
Forman ($3 above Journeyman)
$36,90
Health & Welfare Fund
$950
Health & Welfare Fund
$9-GB
Pension Fund
$11,09
Pension Fund
Appremacermlis Fund
$9.51
$070
Apprenticeship Fund
$0.70
Industry Fund
WAS
Industry Fund
$016
RC R C
$oAO
B,C R C,
$0,10
TOTAL Package Cement Mason (RD)
$54.04
TOTAL Package Cement Mason (RD)
$53.73
Savings Fund (DEDUCT)
$425
Savings Fund (DEDUCT)
$4, DO
Market Recovery (DEDUCT)
$0.25
Market Recovery (DEDUCT)
$0,25
Work Dues (DEDUCT)
$2.97
Work Dues (DEDUCT)
$ZD6
International Does (DEDUCT)
K54
International Dues (DEDUCT)
$0.54
liners will be a One Dollar and Fifty Cent ($1,60) Increase Seventy Cants
($0.70) to Benefits, Ten Come ($0.10) toAppmffWcoablp Fund, and So" Cards ($0-70) to be
dlsb' reed devoted by the membership
T,#wAp"#SSJ_ZWA them will be a One Dollar and Fifty Cent ($1,50) increase, seventyr Cents
($0.70) to Benefits, Ten Cents ($0-10) to Apprenticeship Fund, and Seventy Cents ($0,70) to be
didbum.d a. -led by the membership..
=J there will be a One Dollar and Fifty Cant ($160) increase, Too Cents ($0,10)
to Apprenticeship Fund, and One Dollar and Forty Cards ($1 AD) to be disbursed as voted by the
membership.
EffitgfimjaftLL�= them will be a One Dollar and Fifty Cent ($1,50) Increase to I. distrumed as
voted by the membership.
W,H1IJMflFPQRTA1QC-16L- ALL MOMS$ in OW, G"MdltlCKd egNllJWs 00
14C 1WCXI HAW FUNn and 000 Wow oq-tre, ha.. M WMaoCXPE St,*%U Q PO sox 50"i xinw, kwNona
Qla
TERRITORIAL JURISDICTION: Boundaries of Arse 406 shall be bounded on the North by Lake
Michigan. The boundary to the East shall be Routs No. 49 including the city Unift of Chesterton and
Valparaiso Indiana. Prooeedling Southward on Route No, 49 to the Jasper. Benton, and VVIAB
County lines, including the city hmft of Whealfield, Rensselaer and Remington, Indiana To the want
the boundary shall be the Newton and Porter County I-Irm Including the city limits of DeMotle and
Hebron, but not the rAy faults of Kouts. Indiana, Northward on Lake Comfy Line to and including She
city limits of Merrillville, Indiana. 'but not" the city limits of Crown P.H. Indiana, Northward to Room
30 and than Westward to Cline Ave to Route 30 and than Westward to Cline Avenue bra nor the
city lindis of Grill Indiana Northward on Cline Avenue (ecurtside) to Lake Michigan
AfaLt Rhoades - Business Ag..l
up-1.4256ft.h—co-
Taal 1 , Area IN
S—t M-11. -46410
(219) 771-0789 Ph—
pleod-1692.-K
June 1, 21319 - May 31, 2022
ARTICLES OF AGREEMENT
for
GENERAL CONSTRUCTION
OF
HEAVY& HIGHWAY
PROJECTS
Lake and Porter Counds% Indiana
Calumet City, Illinois
TEAMSTERS
LOCAL No. 142
An Affiliate of Ithe
Intematorad Brotherhood of Teamsters
gfffidi"--,&VAJ,2W them Wig be a ()no Doflar and Fifty Cent (111,50) increase. SOVONyConts ($0.70)
to Benefits, Ton Cents (40,10) to Apprentloorship Fund. and Seventy Cents (SS70)-to toe disbursed as
voted by the membership.
r;fthaAfgA_L2= there will be a One Dollar and Fifty Cent ($1.50) increase, Seventy Cents ($0.70)
to Benefits, Ten Cents ($010) to Apprenticeship Fund. and Seventy Cents ($0.70) to be disbursed as
voted by the membership.
0A*S.d0LL2AU there Will be a One Dollar and Fifty Cent ($1.50) Increase. Ten Cents ($0.10) to
Apprenticeship Fund, and One Dollar and Forty Cents ($1.40) to be disbursed as voted by the
membership
k929XLdVW-L= there Will be a One Dollar and Filly Cent ($1.50) increase to be dishursed as
voted by the membership.
Ell, 4TItfVf Rgpoj.[Y%Combine ALL MONIES (I-I&WIPENSIAPRINTRICRIGIDUES) in ONE CHECK Pay" to ISC P&CM
HEW FUND and mail withmp.,14 1.— 1. H-MSCOPE Bseddits Q PO Box 5M0, Indianapolis, Indiana 40260,
TERRITORIAL JURISDICTION: The jurisdiction of Local Union 9692 - Area 9438 in the State of Indiana
is LaPorte and Starke Counties, the Northam two-thirds of Pulaski County; the Eastern portion of Porter
County, including Kouts in the South; and the Northeastern portion of Jasper County, West to, but not
including the city of Wheatfield
Tom Graham -Business Agent
opemia428@aol.com
f,160'k-Asv.438
1536 W61e, Avenue I.P."., Indiana 46360
(210) 86"089 Ph.oa
pllc-1ose1692 are
(a) When the senrloss of an amplatrw are no longer required. Its met receive at of his wages due within
thfisen (15) minutes of his quilting tons or by mail postmarked Within twenty4sur (24) haunt of Ng
normal quilting Iftne. If not paid within "Id twenty-four (24) hours, the Employer shall pay a penalty of
two (2) hours pay to such employee at the employee's straight time Me of pay for each twenty-four
(24) period at delay after ft Inift twenty4our (24) hours. it Is undemboad M said twerdy4bur how
(24) periods shall not Include Saturdays, S~, or hoklays
(0 Emallo"os knoriol the job 0 than accord, excepi d Injury, shall be pold only for One grad tudbadd
worlaki, 0 an employee valwAnAly spars or fasgre his job for my reason, he shot be ped an IN
regular payday.
(g) The Employer shall pay $100 in liquidated damages to ernplayese who have been Issued e bad
Check by ft. employe.
(h) AN Personal Protective Equoneat (PPE) slid be furnished by the Employer. This shall lnokxl., but
not be Imiled to, hwdhft, ad* glum, sarely harnesses. N" too~ (Balety be and
no.talanad), raspinslon, food ehbMs, FRC, Tyak suits, rubber boots, aid, as deemed necessary by
OSHA, ANSI, Employer or the Owner.
ARTICLE 5
LOARNGAMUNLCAUNG
Truck Drham shall help load and unload their trucks and persons adw dudes assigned to them
that will W violabe the recognized Jurisdiction of my other Union, provided, Ishapmr. no Drkw wh] be
requiretl to handle merchandise alone that will endanger he personal Haab or Steely. Dhmm will be
attested the opportunity to Inspect as loads for asisty considerations. The &nPI%W may not take
recourse agent a driver who refunes a load for vaild salary vicialkins.
ARTICLE 9
TRAINING AND APPRENTICESHIP FUND
S*ahl I' Ellactive June 1, 2016 the parties tD this Agnael sufforhm the ens Local
No. 142 Training Tom Fund to become the Teamsters Local No, 142 Trokling and Appmntbnhlp Trust
Fund. The partim agree to reopen M Agmimnat for On nab pwposa of a0maillnet the Wpasshicasurip
prograin a may be requited by action of the Board of Trusters of the Training and Apprentice Fund.
Section 2. On work covered by this Agresseed . the Employer egressto pay Into the Townews
Local No. 142 TmInkV andAppmoSsaship Fund the fallowing amounts per hour. Payment " be made
anthe In the mama, form and in accordance with the ndw and reguletora se adopted by the
Trustees tithe herein mentioned Tralning and Apprenticeship Fund,
PERIOD EMPLOYER CONTRIBUTION
SM119 - rV31120 $0.60
SMr A .5131121 TOD
VM121-6131122 TOD
Section & The EnWWw agrees to be bound by the Agreement and Declaration of Trust entered
Wo setabsifft We Toonnams batch Locat No, 142 Tminhq and Apprenticeship Fund and Parfictisift
L 'raplayers end by my mWARMIUW X 40 Trust AQMNMML
Sess"on 4. The Tamotersi Local Union No. 142 Training and Apprandcashap Fund shah be
administered in accordance with all provisions of soplosbia low.
employer and Mall natty atempoyase or the employer who ere working under this Agreement that the
employer has ralkd W"Me "And bond.
ARTICLE 11
HOURLY WAGE RATES AND JOB CLASSIFICATIONS
A. HOURLY WAGE RATES AND JOB CLASSIFICATION FOR ALL COVERED WORN
BaetaaA 1. Effactirro Juna 1, 2019, and cuoOulr�p c WAlore and eflecithrough Mey 31, 2020
the following HoQrfy Raaoa of Ray Mall pmwHi. Ar tta Jpb tJawd6ralam IM94below::
Sbalght Tirw TIme and Double Thee Fringe
Hourly Role One -Hat Reis Benefits
Group 1 - 2 or 3 Axis Trucks
$32.29
$48,44
W'so
$21183
Graff 2 -4 Me Trucks
$32.49
$48,74
504.98
$28.83
Group 3 - 5 Me Tmcke
S32 69
$0,04
$05,30
$28.83
Group 4-6 Aide Trudrs
MOD
SM34
$85.70
$28.83
Group 5 - The rote for this Ifneup ere Group
4 men plus $0,35 per ede for each ads over sin (6). At
BbaAah-Tmkkee era an addunai $936 owes fide pay.
Group 8akdkackkd Dumps
$34.54
$51.81
S89.08
528.,83
Section 2 Effodfm June 1, 2020 and coontinwing In lull fame. and *Mac 'taagh May 31. 2021, the
following Handy Rom,, of Pay shall pre-fi inter a*e Job Cime tcadon toted below:
Them will be a total increment of $1.551n 2020-2021 to be spit As determined by the Unon..
ShalghlThw Ttneand Double Time Fringe
Hourly Rob One Hall Rate Benefits
Group 1 2 or 3 Axle Trrrcire
Group 4Aide Tnadu
Group 3 5 Axle Trucks
Gnbup4 Bide Trucks
Group 5 The role for this group and Group 4 roles plus SD.35 par ode for me h ode over sin (8). All
Stitch —Trailers era an additional $0.35 o-r axis pay,.
Group 6 Articulated Dumps
Section A Effective June 1, 2021 end continuing In full force and ailed thnxgh May 31. 2022 the
following Hourly Rake of Pay shall pmvd:
There will be a total Increase of $1.651n 2021.2022, to be a* As determined by the Union..
Bastion 4. Hourly Wage rates for the following equipment shot be based upon the number of odes
Bulk Tank Trucks Fuel Trucks Service Trucks
Dry Batch Truck. Gro a Trucks Scissor Tnxta
Buse Telaswpe Trucks
Dump or Conveyor Water Trudrs
Tmdte All Tnrcim aver 6 Ades
for apprentices doing covered work,
3-(b) The minimum hour and minimum time requirements for each period am In addition to all minimum
bw and min rntan too ortfAmmerm, for "but pariDds. The applicable pvtoriago for
pw" 4 & rind 4 stoma ah*9 om apply um6 Me Appronfido hta owntrioNdl M of I'k* rnirfturri
hock sow n"Irmuun II*w' req Immms (or as paawow end as cow rw,Blha rem Col tee
Approntiosamp, T*opranh are' teaaious YkbeWdY ,$hall cooled tar Appmnodbe
Doardsratew and pro oppeopfunim S*shws* Ropm*onta0vo responsible aw tw placement #Ad'.
wage Me of Apprentice to confirm the applosbk wage mla pmeertage for each Apprentice,.
4. Ratio. The mbdrmem number of Apprentice for such Joumeyworker shall be a ratio of 1:5 for
each Empopiror and 1:3 a0 eon ob Amy EmpMywor aroMning 0 loaf free l5) , ' ,aa
may dWoma To *rnproy ore (1) appmntaa, k a.. To stick tit* Nayrft a0 a
cum' ornpicyod by an Empoyu, Appm660e as9 tm 0400 by Sou I bilon with on Employdr
waan sine E'mpkryor makes Iha now.. awalkbMr roqueat nor nwnpa mr,
5, Wade.. The Emp'k" after be notmonalBle err Ito iveltap p1 soon, Ap,pr"Om on Ito (rtb. The
eWfoiner, that IMto mosortabitt Mope to aei%D vankeeand wok to on Appramleo In a marrtwr
SwF atkwm mid AWmlka to raatIre oo4 woo, ImImtg micumnutma under fiha Apamnskamilis
8, COOMDMMAUW, 6 ohee be the mApaAWN of am Coordin0or and Are approprimat
S*atwa* RoPreankt*a m*ponsob fortha and wraps rake of ApP*aesCak k rorrar
En�lan�DduwW stela ttmat mkt seams; ease -fir, they ahaul taAa
raerutala steps tea awoldd lo'Nho oparralama oo OO BmpMgarardWkOapwaApprwwrltCa..
w-p!r an E"rAphpyer k aw E;ampticuywr W reotn tw AWpr*rtadp 6nr1 pod Emphhna Act wrwk
a+aatrnbk par Sou ApPmrakw tine wtT seder teat ApprwaSCa tp resat, kJa an4aafiab pna&mavg
raimmama uneler ThuwJrppsWllkrahq ptbpwrprha.
ARTICLE 12
BHIFT WORK
Emplorw smigaod I* ft 2nd W Afternoon stale on a two o" opommut, that be win an.
addt2wal SBy, cuts ItOM par bour. Ernptayree to th* 2rd or a8kmpum sM5'.. an a three' saki
sNait be, ptld an adichamalkwtpwtpflinapints (SIZ)ter sonar and employs" aeatgmad Wthe 3rd
ice *IgM afaae *hat be paid an adont'oneet Sty cards (SO 50) per how. YA81wra weak to Oabg carried. an
Constantly by land or am ohah, each ohm 0*1 be showed twenty (M minoba floc Iwinch with pay,
tWaAwm the Employer ray, a Ilk own apilm Oka schedule ornpDoymat om'to 2nd *Not ar IM atilt e.
foDinow 4:30 P.M, W MOO Btdnight with % hour far lunch thckrded; 12:00 Midnight to 720 A.M. with %
pear for lunch tncuded.
Emoutman sit achaduied shot' be timarkaad a tronkruna d atpNt (0) haunt we* ore pay aI their eaa(m
Bank hourly MK aaugpt sae*n Inckrastl weather atmps work at w hO ore the PoaNOma of AaoCte 7,
section 3 shall apply.
ARTICLE 13
HEALTH AND WELFARE BENEFITS
The Eogky r spat pay the following amounts per hates' Nt own ampl ym, covered by gw
pravkbat of Stein Agrsarowotfor all hours worked Into CENRRA,, STATES SCSJTHEAST AND
SOUTHWEST AREAS HEALTH AND WELFARE FUND (CENTRAL. STATES WELFARE FUND), an
Imnrca6k bust momentum atoned by on Atimearaial, and DWansiera of Trust (Trual
pumwM W ■ CDltadhw Bugrtlnag Agmtmwm between carmim Empkyrto and the Unon Tea, chat
Soctbn It AN ampoyoea ohm 00 pold woody and no more than arre W4*4 wages that be
wtAtwkp, EmPIDya`* PAY Check to be seedy der h'tn h0l etc than 4,wdag the on d"V,, od pay day,
"At wet be meta In U S ra,motry, chuck, or If amp'lpmo selects direct drrposk. An emprrysa
5610dog dlroot deposit wS lea lunftlod a'rncaad edplr" of Na
Borden 12,.. The Etoplotnir 00 ask. on own ^s rdwok *Brea the unoura of m t'gmga
hatow and the anxounl of aaamme hoes, rotes of pay ae was a% ea deduotom from the dhode, and Ind
boo",ing amd oadPag debit or the pay period, The Employer shat deduct, taa0ed. and m"A W she
Toamslem Union L004t No 142 An" Fund any pm4ax ompppye aaallotaadi by An
oitgkb omployea of On Emp�ayse, p IrMad tiaee; the ampkyaes auttroduallon musk do made in votingan
a Payroll deduction outhodration,teem.
$04040 13. An om0" who was inymoo an the folo and he sank home, W to a holonk a %tie
must obtain m eftM a temisuk shall rev" pay as the applicable howdy, too sir Dee paAknot of No raptor
t9Mel an the deny. An ornplorme wtw hot miumed W his ropuau duties artu * a ccrrgpasaabta
rnwry who is MOuked by tine Employorl doh Ira micalm Adilbrun modoat imahnard daring He
mptarty meted vwdung hour" morpm he morviow hourly rase o4 pay' for ft houm W tmm.nwo*„
The Employer k to pay for all mndom DOT required drug Leah and brie spent for the purposes of the
let.
Section 14, OaaMig Cold woothu, Toomdam shot alert their -Notes. IMaim a,defmders and ate
condtiiorees on wehlokpa, t 4* octully"d, thal be kept. In good working order.
BaoUon 16.. The Group, or E,naplayer, rwil employes ogpmea to rady Sre Union Reprnaentatim
when uslrlp "aw Wo of 0*4 molt'tot foready used by Nos Car'IPae9 n' kNo Negatle" Odtm INA, of Am
&APICY"
o r to the aqulptones Host day at ui�a. tea wmBa "a for aa;na Tas ag, Arta
Section 18. Apprentice.
1. Genwmlr.. "Tow Perlis* 1* IN* A MWNrAhave hed an apprw4kw*hlr pmVvm that is
administered by tw Toovittaim LOCat Union No. 142 T'mtabg and ApPmmpossate Una Fund
therairafter 'Apprankaship, Pa1(Fun.1, This Article apple in each who Is stowed
heoAnd onmBadathe ter Progaan(Nowintrtar'"AppmmoA .
2. PropWkgye taalOd, EaFdh FyppAenhan three be wired to serve a peep ay Forbid d rA t IIme
ahaa 601J mum of ontaefattb MaaNEng ocat a ported senor tease than sac aomraCttfvamantaa, 'Tale
tab aT Pay for' an ApPmmaw 'hu tints ppC4wtklnsyy Period aha1l' be Aity PKCAM ("It) of mo
apparabw raos sot lode k ARTtCUE' 11 d1 tNts ( ' �.ya'pnwyapraar' RHaa"7..
3, 'Wkit , Tho wogao of an Approafte shall be a pereenhge of the Journeyworker Reiss, which
parpampgo snag be.:
Minimum
On-ThsJob
Hours to
Complete WfAnum Tine Required Appousbas
During Period 1 Boo -.. Bloc (0) wnsewtire months 50%
During Period 2 Additional 000 Additional sin (6) consecutive months 66%
During Period 3 Additional 600 Additional a& (8) conseoullve months 80%
During Period 4 Additional ON Addtio al eon (0) coneeeulim months 90%
3-(a) The applicable pu-mkge oar the approrlko' wage rode mhommoa'd to SOMW 3 ebu" sheet be
"paid W ft TaemabrGroup III mtecoMatmd in OK*n 11'W daeermke to -treat waja reas
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1/10/2019 2:42 PM FROM: MOEITS TO: -12199248760 P, 3
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INTERNATIONAL UNION OF OPrRATING ENGINEERS
JA
January 10, 2019
Walsh & Kelly
170D E Main St,
Griffith, IN 46319
dy
Rc: Pronfol'Compliance with 30 ILCS 500/30-22(6)
our File No. MI-00321
Dear Si,o,Madam:
At Ou mquawofWPI51l&KtDY fim, I
30 ILCSWIW1 2�.(6) ofibc Illinois
Pinvore"venlCmda, I gal
(Nos, [LO12020003 and IL008780173).
Asa signatory contractor with the Intemational Union of Operating Engineers, Local
150, AFLCIO, Walsh & Kelly Inc, is required by Collective Bargaining Agrecirrent to
participate in it applicable apprenticeship and training program approved by and
mgIiaercd with the United States Department of Labor's Bureau of Apprenticeship and
Training- The attached cerfificilms am evidence of compliance with the U.S. Department
ofLabVs.pp-6..hip.q.i—eat,;,
Thank you far your ca.p.ration in this matter Ify-have-YA-Stions.rcamearns.
rj
please do nor hesitste to contact me.
Very truly yours,
IUOE. Local ISO, AFI-CIO
District I disp.t'l—fli..
C..Ii.eL-ni.k
tt�
Enclosures: Certificates
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INDIANALABORERS'TRADVING TRUSTFUND
DuWdA Frye
Sendaryy— Jory J. Ba
Gr6 L G.—
M* Heawt Jr.
Rmme M A Jr.
R.b S Wrlgid
PJ7. B-758-Burford, Indira. 47421
(812)M9751
January 14, 2019
I.A. F. Bmwe
R'Wr6'40
Brad A1W Wbfa
Mlch.dFersora
St_Meyer
Jhn Warms
FAX: (812) 27MUS
To Whom It May Concern:
This letter Is to coa8rm that "Walsh & Kelly, Inc. " is a sip story contractor in good standing
with the ImUfma Laborers' Tmining Trust Amd.
The above meattoarsi company is a participant in the Joint Apptomdoeship and Delmar,
rAmntittee tbrogh Wx Union and has boen an active Wiriparit in gorsd 4tasaflr4 for toll of the
past live plus ocnwoutive years, ad is enrmady cliy,ibtlo to oaa ana approodaea an, a project,
Further, our orpnizatlon s program is approved by the U.S. Veterans Administration to
pmtlogpdw in the 01 eduoattond beco8ts program, A Dopyof man approvnt letters are attached
idoog wtlh tho oolloctive be osininS agreement stating, dw m603 of Journey wadtom to
Apprent% , which is ova (1) Apprsmtiue for every Ave ($) Jautuncy wotkors oral thereafter may
nctemploy more that fit Approot'ico.for every (J) Jouanmy vmrkoM
Sinomcly� n
SagoCunkicy„ I� ;/
Director
SC:de
rvww.Indtaralaborpru ar)aWng.org
TATE OF INDIA A
U AR't7i UT Of V8T6RAt4S AF'PAtRB M000 K p4p^.aa„ spama W ..
STATE 0pRW91'tV.il A4Y4M" ...".... ... ._.
t riMfl'sT R*MMW-'P1AU 8'7itt^E''
pupWAPOdJ DIAM 4BZ4878n R'
Ootob& 25, 2016
GattifyEng.Official:
The'ledbeac State ARaovlbg Agency would like to )nlbrm you flat 1ha Dapsrtmaant of Vetem=
Affides St Louis RsOculd Office has ralacded.
Per mmllmezd metM44aw sent by mail, adck.,assto the l3ducation Division as follows:
DopotmantofVoWmaAffain
9700 Page Avenva
Suite 101—x4fla son
St Louie, MO 63132.1502
Faxnamberforo 'fflcedurd:
To Submit OJTIA" dooummuts: 514-2534140
Fed free t000dacttheIndian State Appmving,'Aganorwith any gtto4 M.
Tara
Program cooadiem"
State Approving Aguuwy
todimDcpatmemvi'V s,Affidto
402 Wee. Wadat SWAS'UcatRM W469
Jediat gd1ia IN 46204 u
317 -ZA-L061t.
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I
7NDIANA LABORERS'TRAINNG TRUST FUND
D.UA. Frye
M. P. Drown
Surelary-—
Chahnron
JwryJ. Boa
AM&
XeUyAbel
Clwh L CroOa (a
BradDMk1b1,
Rloby Hen M A
Ramon Ah dose, Jr.
ilvt WIV)
Mcbael Ferrma
$Banc qpw
Roberts. Wrlgk
Jba W&ranon
P.O. Box 758 -Bedford, Inddaa 47421 Sean Coabfcy. Doeeem
FAX: (812) 21MUS
(812)279-9751
Jammuy 14, 2019
To Whom It May Concern:
This letter is to confirm that "Walsh & Kelly, Inc. " is a sig ory contractor In goodstanding
with the Indiana Laborers' `I'mine"og Trust Fund.
The above mentluniad company is a participant in the Joint Apprenticeship and Training
CAxam um through this Union and has been an active participsat in good Mending for each of the
past five plus consecutive years, and is currently eligible to use our gppmuti'cr4 on aproject
Further, our organination's pmgrma is approved by the U.S.. Veterans Adroinistradw to
partMpaw in the OI educational benefits program. A copy of our approval letters ere attached
along with the collective barge atng agrcesnund atsting the ratios of Journey workers to
Apprentices; which is one (1) Apprentice for every five (5) Journey wcakor i and thereafter may
not employ more that (1) Apprentice for every (3) Journey watkers.
Sinuatel POA/
9c4te. Coaktoy,
Director
SC:dc
www.indkmalaboyerstraining.org
STATE QF I�MNIA�i r
OIiPARTUMT OF VETERANS APPArRB N1W4np R„&+axwx,+2aro4rew
STATE APPROVING AGENCY
402 WEST WASHINOTON STREET
Roam Woes
INDIANAPOIJS� INDIANA 4OM-27Ba
October 25, 2016
certifylne Official,
The ladi w Stele Approving Apoey would like to inform youthat the Dopaatmant ofYoftew
Affxb St Louis RegionaL Office has relocated.
For enrollment cextifioatEoti'ro scat by mail, address to the Eduoadoo Division as fonowd:
Depatnoow of Vatmmae. Affalm
9700Page As^ =
Suite lol—Efteation
St Lams, MO 63132-1502
Fast tanml4u for cextl0oallroaw:.
To Submit OYVAPP documents: 314-2534140
Fed free to content the Tudiana State Apimviq Agency with MY qZatlenle
TOMEggan
Progrmn Conalkwfor
State Approving Agency
Tndiane Dqnutatal of Vsbm m Alf bs,
402 West WAshinSaou SttnetRM W469
1:ndbumpollP IN 46204
317 234-6062
Teggesl@dvaia.gov
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- �- �- �- �- �- I- �- I- I- �- �- 1161
March 1, 2019
SUBSTANCE ABUSE PROGRAM
1. taLUMMILUM
Walsh & Kelly, Inc recognizes the importance of assuring proper administrative and
operational decisions and actions in the asphalt paving industry..Werecognize the need
to even those individuals who might endanger themselves through the abuse of'alcohol or
controlled substances (drugs) In order to mitigate the risks, which result from, being
under the influence of alcohol or drugs, the management of Walsh &Kefly, Inc will
enforce unnurni testing for determination ru'ability to work and disciplinary action as
described in the Following policy documentation
Furthermore, Walsh & Kelly, Inc does not allow, condone the consumption, or use of
illegal controlled substances (drugs) during working hours or on company property Any
possession, consurnintion, or sale of controlled subsiances, on company property or
worksins of Walsh & Kelly, Inc is forbidden alld-tsillLigs Rdqqfpgdtjg , ,, , ,ALL 0, I'J'It'll J Jbdy sfy
The consumption of alcohol is likewise prohibited, with the cyception of social events
sanctioned by senior management ofWalsh & Kelly, Inc where and when manufacturing
work is not taking place Any consumption of alcohol on company property, is strictly
forbidden and mill result in ferntination
Management or Walsh & Kelly, Inc.also reserves the right to search all company
property, including, but not limited to, employee desks and lockers, cramptury cars, tool
boxes, etc to prevent violations of this policy or for any other legitimate reasons Entry
onto company property orjob sites consulates consent to and recognition or the right of
Walsh & Kelly, Inc company managementio search the person, vehicle, and other
ponanaiproperty orindividualswhile oncompany's propertN, Such searches may be
initialed by Walsh & Kelly, Inc management offhom prior announcement and will be
conducted at such times and locations as deemed appropriate, Persons who refuse 10
cooperate with a search will not be showed to remain on company property and will be
subject to termination.
In order to consistently meet the standards of the Walsh and Kelly Substance Abuse
Program and the requirements of the Indiana Department of Transportation (DOT)
requirements, Walsh and Kelly, Inc "ill use the Building & Combustion Resource
Center, Inc, (BCRC) and the Indiana Construction Amornsfion's (ICA) Substance Abu u
Programs found in Appendixes 1. 2, and 3 of this document
Ea. PERSONS SUBJECT TO THE SUBSTANCE ABUSE PROGRAM
The Walsh & Kelly, Inc Substance Abuse Program applies to all Walsh & Kelly, Inc
employees, including employees under collective bargaining agreements
III. 01111IR I'VOING RIF101 1113FAIll'"N'M
bgl _jipff- As pad of Walsh & Kelly, Inc, accident investigation program,
employees who require medical question as the result of any injury or illness occurring
Pursuant to the federal Drug -Free Workplace Act of 1989, employees are required to
nobly the company of any conviction for crintinal drug violations that may affect their
ability to work legalb,. Abiding by these regulations and Walsh & Kelly, Inc Substance
Abuse Program is a condition of continued employment Violation of this program wilt
subject the employee to termination
while on duty, will receive a drug and alcohol screen as soon as medically reasonable and
possible during the first visit to the clinic for medical treatment The facility manager,
corporate management, or the corporate safety manager may, as a result of an accident, a
near -miss accident, or unsafe incident, require involved employees lobe tested Such
tests shall be conducted in accordance with Inc Reasonable Came procedures as
described in If above
Pursuant to the US DOT regulations, any CDL driver involved in an accident resulting
In a fatality, bodily injury, one or more vehicles which most be towed, or a moving traffic
violation resulting front the accident, must be alcohol and drug tested within two (2)
hours All deviations from these requirements must be reported to the Walsh & Kelly,
Griffith office at 1-2 19-924-5900 within uvenly four (24) hours
agLA.t_p Lj:�, . qtg,_, In some cases, creammor conaracla require that the Company
perform drug screens on company employees prior to gaining access to the customer's
work site The company will perform such pre -access drug screens on all employees who
will be working at the customer's site as appropriate
IV. CHANGE.Qfl NIODIFICADOM
Walsh & Kelly, Inc reserves the right to change the provisions of this policy, including
the uniform testing procedure and disciplinary action at any future time
V, SUBSTANCE ABUSE PROGRAM COORDINATORS
The coordinator for Walsh & Kelly, Ins,' Substance Abuse ft.gounthull be Heritage
Group Safety (iGS) LOS shall review the program periodically and same as the
recipient of the last results from the Medical Review Officer (MRO) for testing done in
accordance with the DOT regulations or from the clinic for non -DOT testing
The Medical Revice, Officer is the medical director or designate of the company -
designated program conducting the substance abuse testing The MRO receives results
from the NIDA - certified testing laboratory and/or Breath Alcohol Technician on
substance abuse test results, delearmines, the basis for "positives", and communicates the
recalls to the compani
Va. EMPLOYEE INFORMATION AND TRAINING
Emplo) ee information and training sessions shall be conducted periodicall) This
hushing will firmirk, information on program benefits, testing procedures and
requirements, as well as answer any questions or concerns employees may have about the
program Training for supervisory personnel in recognition of the signs of alcohol and/or
substance abuse and reasonable suspicion shall he provided Powndialnew employees
shall be informed of the program and procedures prior to the pre -employment testing
Any questions must be directed to the coordinator prior to the mind testing of the
potential employee
Via. CONVICTIONS FOR DRUG VIOLATIONS
SUBSTANCE ABUSE PROGRAM
APPENDIX I
PARTICIPATING UNION CRAFTS
is BRICKLAYERS
• CARPENTERS
BUILDING &CONSTRUCTION
. IBEW
RESOURCE CENTER, INC.
• IRONWORKERS
• LABORERS
• MILLWRIGHTS
DRUG & ALCOHOL
• OPERATING ENGINEERS
• PAINTERS
POLICY
• PIPEFITTERS
NORTHWEST INDIANA
• PLUMBERS
• ROOFERS
• SHEETMETAL WORKERS
• TEAMSTERS
Promoting the Safety
• TECHNICAL ENGINEERS
and
• PLASTERERS AND CEMENT MASONS
Well -Being of Employees in the Workplace
. GLAZIERS
This Policy has been approved by the
Nonhxest Indiana Business Roundtable
6
INDEX
PAGE
n,I
Introduction
115
The Policy
116
Derudtions
118
Drug Testing
I.
Drug Group
124
Building & Construction Resource Center, Inc.
Alcohol Testing
Payment for Testing
124
125
Initial Testing (Pre -Employment)
125
6050 Southport Road, Suite B
Random Testing
126
Probable Cause Testing
127
Portage, Indiana 46368
Post-Accident/Incident Testing
127
"Emergency" Work Assignment
128
Telephone: (219) 764-9500
Card system
130
status Cont rnation
130
Toll Free: (877) 988-5400
Insufficient specimen
131
Diluted pcimen
131
Fax: (219) 764-9505
Adulterated, Substituted, andior Outrof-Temperature Range Specioneu
131
Consequences for a Positive Test
132
Website: BCRCNet.com
Return -to -Duty Testing
133
20Follow-up Testing
133
Robert Anadell
21Disputed Positive Results
134
Execulipe Director
Appeals and Protections
135
Letters of Notice for Random Testing
Your Employee Assistance Program (EAP):
AMuchnueul A — General Trades 136
PERSPECTIVES (800) 456-6327
Attachment B—Non-Bargaining 137
Policy Revision January 1, 2013
Attachment C — Pipe Fitters 138
BCRC Authorization for Consent to Drug and Alcohol Analysis and 139
Authorization For Release of Results
BCRCAppllcmd/Cardholder Drug Test lnforumllou andlnstruction Sheet 140
7 9
BUILDING AND CONSTRUCTION
RESOURCE CENTER, INC.
INTRODUCTION
The labor and management representatives ofThe Building and Construction Induviry for
Northwest Indiana have formed an alliance to address the problem caused In, drug and alcohol
abuse Management and labor have created the Building and Corannuction Resource Center
(hereafter "13CR12") an independent not -far -profit corporation which often aivide range of services
to its employees in The unionized construction industry, which include employers, labor union
organimlioms,,a)nsiTuctionindus[R'and related workem It is BCRC's goal to assist employers to
establish and maintain workplaces that are free of the destructive effects owed when employees
we drugs and/or abuse alcohol BCRC's activities are not intended to interfere with normal
practices ofthe unions ormanagement 13CRCrecognizes its responsibility tocommunicate with
and educate its employees relative to this policy, as, well as the harmful effects of drugs and alcohol
inour society and inflineworkplace BCRC also recognizes the need to provide a program of
assistance to those persons for who drugs or alcohol may he causing problem Finally, while not
wishing loviolthe the rights or invade the privacy crony employee, BCRC's drug testing program
will seek to identify those employees who are unable or unwilling to conform to BCRC's program
'Ibis program has been established in accordance with federal guidelines for specirmsn collection,
laboratory analysis and review, and standards of integrity and confidentiality
their substance abuse or alcohol -relater) problem and choosing an appropriate course of Irealrinent
Current employees will be referred to an CAP representative as a result of positive drug last or
alcohol ur upon an individual's own request. in either case, the content orde discussion with The
EAPoill bersholecled and confidential, to the extent allowed by lini,. A participant's use of the
PAP is confidential and information will not be released lo BCRC or any or its subscribing
organizations or participants without written release from the participant in accordance with the low.
Employees who use the EAP as a consequence of a positive drug or alcoholtest will be subject to
the conditions established in the drug -testing portion of this policy
The EAP inalfhas knowledge of the level and types of benefits available to BCRC employees
Employees can access the seivices of the EAP through a hotline That is staffed twenty-four (24)
hours a day, seven (7) days aweek, throughout the entire year. Employees calling the EAP hotline
are put in touch vvilh a counselor who will conduct aprofessiored assessment and who may meet
with them to further assess are nature drone problem in order to provide a referral to the beat and
most appropriate level of care The EAP is staffed by certified and wedermaled human services
professionals who are sensitive to the needs of the individual Individuals who take the initiative to
contact the EAP lisrassiquince do so with the assurance that their calls will be treated respectfully
and confidentially, 'The ifinen services provided by the EAP are sponsored by BCRC
In compliance with Public Law 100-00 Cibe Drug -Free Workplace Act), which applies only to
employers who have federal grants or federal contracts of more than $100,000, an employee who is
convicted ofa workplace drug or alcohol violation and wito is employed by, a BCRC affiliated
employer ol report this information to hisilaw immediate supervisor no later than five (5) days
after such conviction The supervisor must report has information immediately to the employer's
Program Administrator
= SQL LCY—
Persons who use illegal drugs or abuse alcohol or other controlled substances. on or offtheir jobs,
are likely to be less productive, to be less reliable, to be more frequently absent, and to have other
work related problem that can cause increased wel, delays, accidents, and injuries These
employees can also damage the health, satiety and well-being charter workers on ovejob flie
unionized construction industry can control and reduce this problem through recognition ofthe
problem, development of'a comprehensive policy and program or education and information,
promotion of an assistance program, and implementation of fair and respectful drug testing into
conforms to federal guidelines for specimen collection and trusksis All ofthicialobedone with
the tarnoin confidentiality and respect To, The individual
In order to enhance substance above awareness among all employees, educational seminars and
Training programs w ill be offered The educational seminars will be directed toward education
about the seriousness of the nationwide problem of drug and alcohol abuse, and no%%, the use of
drugs and alcohol negirliveli, impacts safety, productivity, and the competitive ability of the
American wroliforce
Supervisors will be trained to identify employees in potentially difficult situations, and to recognise
signs of impairment. as —11 as lh—pei vism' responsibility to d-urniml, urs—atic and follow up
with the troubled individual These sessions will be offered as ongoing training programs
BCRC encourages all employees troubled by their own, a Family inember's drug, or alcohol abuse
to seek professional care and treatment Early recognition and treatment ofalwhol and drug chase
provides the greatest opportunity for succiresfid recovery. BCRC provides an Employee Assistance
Program (EAP) for all employees and their families who need professional guidance in assessing
to
DEFINITIONS
•Adulterated %piscliurn means a specimen that contains a substance that is not
expected to be present in human wine, or contains a substance expected to be present
but is at a concentration so high that it is not consistent with human urine
it blonh means, in evidential breath testing devices (EBTs) wing go
chromatography technology, a reading of the device's internal standard, in all
other EBTs, a reading of ambient air containing no alcohol
• Meager means the intoxicating agent in beverage alcohol, ethyl alcohol, or other low
molecular weight alwhols including methyl and isopropyl alcohol
rocans the alcohol in a volume of breath
expressed in term of grams of alcohol per 210 [item of breath as indicated by an
evidential breath test under this policy (BrAQ
leld means a subsequent test using an EBT, following a
screening test with a result art) 04 or greater, which provides quantitative data about
the alcohol concentration
Alcohm$ §ragihrig M*v I0) means a breath device, other than an EB'F, that is
approi ed by the National Highway Traffic Safely Administration (NNTSA) and
placed on a communing products list (CPL) for such devices
• ;ANeaaklfi,M.,raaMatalaaale»l rnewsmianalytic procedure lodetermine whether a.
employee may have a prohibited concentration of alcohol in a breath specimen
• AIgt llml Iea&ialL*Jte means a place selected by the employer ofiens employees present
themselves for the purpose of providing breath for an alcohol test
Alcolial kne means the drinking or swallowing of any beverage, liquid mixture or
preparation (including any medication), containing alcohol
• _Agoligm means a person, independent contractor, or employer, or person working
for an independent contractor, or employer who applies to become an employee or a
BCRC contractor/ employer participant, and includes a portion who has received a job
offer made contingent on the person passing a drug test
• AU91tWitti macro Building and Construction Resource Center, which is the
association formed by labor and management representatives of the building and
construction industry for Northwest Indiana, for the purpose of addressing problems
ordmils and alcohol in the workplace
• phriq mriv,ill bM, up Illiod N" meihjytt means a specimen submitted
to a laborthory for quality control testing purposes, with a fictitious identifier, so that
the fidooralory, carrier distinguish it from an onglovoc specimen
• Utimik Akilrol MA is a person who instructs and assists employees
in the alcohol testing process and operates an Evidential Breath Testing device (EBT)
12
j,'utifterlpi ("I moms a drug or alcohol test That has a problem identified that cannot
boor has not been corrected. A canceled rent isneither a positive nor a negative test
An employer is net permi [led to lake adverse job action based on a canceled test
• VOL4 NJ matum is I he individual designated by each employer who has the authority to
access data information that will confirm the cantos of employees through the call -in
system, through it. BCRC scanner by swiping employee,' identification cards, may
electronic e-mail
QkLilvl of truglIth means the procedure used to document the handling of the
specimen from the time the amplovee, Shoo the specimen to the collector until the
specimen is destroyed
00hcifloy cnrsln8earw^ means a amnime, into which the employee oracles to provide
the specimen for a drug test
(*Q11gKdPn41A means a place designated by BCRC where individuals present
themselves for the purpose of providing a specimen to be analyzed for the presence of
controlled substances, or for purposes of providing breath sample to be analyzed for
alcohol concentration
• Collector means a person one inshours and insists employees at a collection site,
who receives and makes an initial inspection of the specimen provided by those
employees, and who initiates and completes necessary forms
• C :,uniganj means an employer who is a member cif Building and Construction
Resource Center
means a second (2) aludiffical procedure
performed on a urine specimen to idenli ry and strand (v the presence of a specific drug
,it duip metabolite
tonfirtnatifilrit 5 -1fidini ilvirl items a second lost performed on a
urine specimen to further support a v alidily test result
• ("on"ram,11 rliluo Jv%l means a confirmation text result received by an MRO from a
laboratory.
• (`ottlfinnriolitry hct�
a) For alcohol testing, a confirmatory lest is a second test fallowing a screening test
with a result orO 02 or greater, conducted 15-30 minutes later, that prov ides
quatan tali i c data oralcohol concentration 'Phis testis conducted onmEBT
b) For controlled substances; testing, a confirmatory rest is a second analytical
procedure toidentify the pr��ericeofaspecific drug ormetabolite. This
confirmatory test is independent of the initial test and mesa different rechnique,
and chemical principle from that of the screening beat in older to ensure reliability
and accuracy
CgnLi�AEIELkgEiiliEEILmeansanemployer i%hoisacontributing member of
Building and Construction Resource Center
Cinatolkil $nbrattic y means marijuana (THQ, cocaine, opiates, phencyclidine
(PCP), amphetamines (including melhampheiammes), barbiturates. bearrodiatz.opme,
13
means the result of drug test for a units specimen that contains an
unidentified adulterant or an unidentified interfering substance, has abnormal physical
characteristics, or has an ead.gemns, substance at an abnormal concentration that
prevents the laboratory from completing or obtaining a valid drug lost result
laboratory certified by DFIFIS under the National
Laboratory Certification Program m meeting the musimunistandards of'Subpart C of
the DFITIS Mandator), Guidelines for Federal Workplace Dug Testing Programs
JUramfril flacitlkill iin-mclillortri means a person who is licensed, certified, and/or
registered, in accordance with applicable Federal, State, local, or foreign laws and
regulations, to prescribe controlled substances and other drugs,
Alelfliml Reyjacs OlYlvv means a licensed physician responsible for receiving
laboratory results generated by BCRC's drug citing program who has knowledge or
substance abuse disorders and who has appropriate medical training to interpret and
evaluate an individual's auctioned positive test result together with his/her medical
hislori, and any other relevant biomedical information
p"ox,NlNyr Wont (&,1,)JlOJ re -re when an employee's confirmatory test result reads
0 04% DrAC or higher
• taxidNaMJAe rulitfacours when it employee's confirmatory test or retest result is
.__ employee's
at or above cutoff levels specified by DHHS and has been verified by the MRO to be
a positive lest
• Proyra"i Adinklaillroor means the individual who has administrative
responsibilities for overseeing the dug and alcohol -testing program for an employer.
Tire Program Achninistirsharamys—c as an ounpi.yer's DER
• Pero err means all employer-tavrted and/or -leased property, including but not
limited to owned and/or leased buildings and other real estate, parking lots and
vehicles located on parking lots, and employer -owned and/or -leased vehicles,
lockers, tools, equipment and desks
• R4iii4wha it4,kcilitha means a scientifically valid mallaid for selection of employees to
be tested that result in an equal probability that any employee from a group of
employees subject to the selection mechanism will be selected, and does not give an
employer the discretion to waive the selection army employee under the mechanism
Thus, an employee may not be selected more than ovics, (2) during a year,
nil VOTWO i
-o- Failided) to appear for any test (except a pre -employment test) within a
reasonable time, as determined by the policy, after being directed to do
so by the policy;
a Fails(ed) to remain at the testing site until the testing process is
complete;
Fafts(ed) to provide a urine specimen for any drug test required by this
15
purposyphene, methadone and ecstasy.
DIJUHS means the Department of Health and Human Services or any designee of the
Secretary, Department off anum and Human Services
labbrisinor. r means a laboratory that is certified by the It S
Department of Health and Human Senaceii Drug tests under this program will be
performed by, affl-HIRS--certified laboratory.
(ISqeaullern Ern plitiven (DER means the Human Resource Manage,,
Card Manager, Program Administrator or similar designee preach employer who,
shall receive necessart, communications related to has program
means a specimen with creatinme and specific gravity values that
are lower than expected for human unite
ROT means U.S Department of Transportation Many ol'DOrPs standards and
procedures related to drug and alcohol testing are mirrored in BCRC'a duag and
alcohol policy.
• DmIs mean the substances for which tests are required under this policy and include
marijuana CHIC), cocaine, amphetamines (including melfairopmairmines).
phencyclidine (PCP), opiates, barbiturates, beraossfiazaturae, propoxyrdiene.
methadone and ecinasy
ftj= Iirrf means a rest conducted for controlled substances
fmo tar as means an employee ofit company, or of a corartefor/employer participant
_X_
who is a member of Building and Construction Resource Center,
Ina. glo)n nocans ri
pwrinmiraid ivitit an edurtalurn w work, counseling, etc with
knowledge of and clinical experience in diagnosis and treatment of alcohol and
controlled substance related disorders..The BAP trill assess and make
recommendations concerning education, treatment, yellow -up testing and aftercare
1•. trrr mean, a conneirt), or . cmhcactortenrploy or parliciparia, vho is a member
al'Building and Construction Resource Center.
Evitlolfigi Oectifli tfliirvJ,coil. 1') mems a device approved by NfTISA for
the evidential testing of breath at 04 alcohol concentrations, placed on NHTSA's
Conforming Products List (CPQ for "Ei iderund Breath Measurement Do% ices" and
identified on the CPI. as conforming with the model specifications available from
191ITSA'sTraffic Sidery, Program
• 1'InJ_QrcIarrtgLt4Jg= means if an employee does not report fora random test, and
it is the first time the employee has failed to report, the Third Party Administrator (TPA)
may allow the employee to take the last without reporting to the GAP for further review..
Employees may utilize this clause only one time
• h1ftJO_LW- (For dugs) means an immunoassay screen to eliminate negative urine
specimens from further consideration
jlljfil!�� means the First lost used to determine if a specimen is adulterated,
diluted, or substituted
14
Policy;
In the case of a directly observed or monitored collection in a drug
lest, rails to permit the obsci-valtort or monitoring of the employee's
provision of a specimen;
Fairs(id) to provide a sufficient annown of urine when directed, and it
no been determined, through a inquired medical evaluation, that there
was no acceptable medical explanation for the failure;
> Filtrat(ed) or declines to lake a second test the employer or collector has
directed the employee to take;
> Failin(ed) to undergo a medical examination or evaluation, as directed
by the MRO as part of the verification process, or as directed by lire
policy..In the case are pre -employment drug lest, the employee is
employment hen is conducted following a cisihing4rat offer of
employment:
Failt(ed) to cooperate milh any part of the testing process (a g, refuse
to empty pockets when so directed by the collector, behaves in a
confiromalional way that chiampas the collection process, provides
incorrect or inaccurate information to the collection site or on
necessary ficurne, or frails to complete all documents);
Provides asecond (2)specimen that isdilute
In dmg testing, a hen to eliminate "negative" urine specimens from
further analysis or to identify a specimen that requires additional
testing for the presence of drugs
In alcohol testing, an analytical procedure to determine whether an
employee may have a prohibited concentration of alcohol in a
breath specimen
• itanrvudim I'm 617) mean, a person who instructs and assists
employees in the alcohol testing process and operates an Alcohol Screening
Device (ASD)
L"Jilitillm Cvn 1A means a container that is used for transporting and
protecting urine specimen battles and associated documents from the
collection site to the liftoratory.
® $Wchp means a sample of urine, used to, analysis and/or diagnosis For the
16
purpose of this policy: specimen is defined as urine
• ��Vjxliupja tmtlle, means the battle that, after being sealed and labeled
according to the procedures in this policy, is used to hold the urine specimen
during transportation to the laboratory.
• kgjjLWjfjfflM mews a pan or the urine specimen that is sent to a first
laboratory and retained unopened, and which is transported In a second
laboratory in the event that the employee requests that if be tested following a
verified positive test or the primary specimen or a verified adulterated or
substituted test result
jobijittielt means a specimen with crealinine and specific gravity values
that are so diminished that they we not consistent with human urine
mews levels at or above when a specimen is determined to be positive,
and below when a specimen is defenioned to be negative
• JWLd.N9rri ^ ,hdrrr6raq�xtn^ &or^. Th�f4 means an entity that provides or coordinates one
or more drug andlor alcohol testing services to employers A TPA typically provides
or coordinates the provision of number of'such services and performs administrative
lasks concerning the operation of drug and alcohol testing programs for employers
This Berm includes, but is not limited to, groups of emplovers, whojoin together to
administer, as a single entity, the drop and alcohol testing programs orils members
(a g , having a combined random testing pool)
• ALifivil leg mews a drug test result or validity testing result from a ®FINS -certified
laboratory That has undergone rovieu, and final determination by The MRO
BCRC, will provide an identification cud to each participant which will reflect the results of the
Lung & Alcohol Semen Test from 1he laboratory and as confirmed by the Medical Review Officer
(MRO) '['a implement an appropriate and acceptable program, BCRC has adopted six (6)
safeguards that reflect the standards established by the U S. Department of Health and Human
Services (DHHS) Substance Abuse and Mental Health Services Administration (SAMHSA) for
toning mandated by the It S Department in'Transpornilion Those safeguards are as follows:
I The fiflegrih, of collected urine specimens will be ensured by tailisafien of
one collex;tion procedure al alb sites. Samples will becollected in
accordance with federal standards that provide fora continuous chain of
custody and which recognize privacy concerns regarding the individuals
being tested.
2 Testing will be conducted only by accrediled Jobs that have obtained and
retained CITIES certification
3.. All specimens that are positive in an initial screen most then be confirmed
by gas chromatography/max; spectrometry (GC.(MS) GC/M confirmation
is the state-of-the-art drug testing feermology, providing a fingerprint of the
detected drug
4 If the result of the screening test indicates an alcohol concentration off) 02 or greater, a
Breath Alcohol Technician (BAT) will perform, a confirmatory fact, no less than fifteen
(15) and no more than thirty (30) minutes after be completion of the screening test
5 If the confirmalory test is positive (0.04 and above, BrAQ, the Breath Alcohol
Technician (BAT) shall immediately notify the BCRC(Employers DER
6 Results of additional tests arranged by an employee, or requested by a medical
practitioner, will not be considered This includes testing of blood samples, hair samples,
DNA, or any other testing methods or protocol,
Costs related to drug and alcohol testing will be home by the program except for re -testing of
disputed lest results by an employee The issue of payment for the employee's time will be
calegovived as follows:
I For new or current union members or employees seeking an initial test, the test is a
condition ofemployrnert, and employees in the BCRC Program will not be paid for
their time in providing a specimen for the initial test
2 All current employees who are to test for an), offite following: Late Random,
Probable Cause, Post-Accidem, Diluted Re -Test, Return -to -Duty, or Follow-up
Testing or Retest due to a flawed or rejected test, will not be paid for their time in
providing a specimen for the test
3 Employees will be paid a (forty -dollar) $40 stipend by the program for the time
necessary to secure subsequent random testing required by the program his
understand that such testing will occur on the employee's time Tc%itobataken
with seven (7)days ofnotice.
4 Non -Bargaining and Pipe Fitter's; rule code 14 are exempt from the stipend
reimbursement
A Medical Review Officer (MRO) will review at drug lost positives prior
to verification of positive lest results The MRO isaphysician with
specialty training and experliseinsubstance abuse and dmgtmling The
MRO will review, confirmed positive Uel resulls, to minim proper
procedure, protocol, and reporting..The MRO will interview the individual
who has a confirmed positive test result by telephone to investigate
whether a legal prescription has caused the specimen to lost positive. lifthe
Individual has no legal prescription, the MRO will lake appropriate steps to
report a verified positive to the BCRC Program Administrator, who will
ben invalidate the employee's certification card All persons who have
tested positive annual have their return to work cleared by the RAP
All positive specimens will be retained frown in a locked Facility at the
lesfirig laboratory for one (1) year.'rhe retained specimens will be
available should the results of that last be disputed or should arbitration or
litigation arise out of the actions taken because of the Ion results
On a periodic basis, BCRC will submit blind pre -tested urine samples with
appropriate documentation to the drug -testing laboratory as a mews of
assuring itself of laboratory proficiency
The drug -testing program %%ill lest for the following drugs in those levels
Amphetamines
1000 ins'nil,
500 ng/mL
Cocaine
300 rigind,
150 ng/mL
Marijuana
50 ng/ml.
15 ng/mL
Drones
2000 ng/mL
2000 ng/mL
Phencyclidine
25 aglim.
25 ng/mL
Barbiturates
300 ng/mL
200 ng/mL
Ben-diraepirres
300 agora,
200 ng/mL
Methadone
300 ngtmL
200 ng/mL
Propov) phone
30U ng/mL
2UU ng/.L
MDA-ANALOGIJES
(Ealasy) 250 ng/mL
200 ng/ml,
Alcohol lests, (screening and confirmatory) will be performed on a device that appears on
the National Highway Traffic Safety Adminisr,nion's (N I I'l SA) Contouring Products
List (CPL) and that imsts the DOT's testing roclufivmi,rfls.
When a specific time far an employee's test has been scheduled, and the employee does
not appear at the collection site at the scheduled time, the Breath Alcohol Technician
(BAT) will contact the Designated Employer Representative (DER), who may determine
that the employee has refused to be tested
For alcohol testing (screening and confirmatory), a breath quathe will be collected and
analyzed by a Breath Alcohol Technician (BAT) using an Evidential Breath Testing
device(EBI) For the screening test, a breath swings maybe collected by the Screening
Tesi'lectsucim (STI), using an Alcohol Screening Device (ASD)
INITIAL TESTING, (PRE -EMPLOYMENT)
Prospective employees and current employees of BCRC affiliated employers will be subject 10 the
BCRC program All persons who are eligible and who intend to obtain a BCRC card will be
instructed to report to an approved BCRC collection rile and to provide aunne specimen for initial
(pre -employment) testing and a clear status before starting work for any participating employer. The
individual will be directed by BCRC or by, their employer, to report to a BCRC approved collection
site location These selected collection sites mill have collection kits, chairr-ofeusiody forms, and
all other nociscrin, supplies
RANDOM TESTING
After the individual's completion of the initial drug test (whit a negative result), he/she will be
pieced in be Random Pool after which he/she will be notified via U S. mail to report to an approved
collection site for a random drug test The individuals chosen for a random drug lest will be selected
anonymously, from acompharrized selection program Fifty percent (50o/,)orthe currently active
BCRC individual cardholders will be selected annually for random testing Then, on a monthly
basis, one -twelfth (1(12) of the selected employees will be notified to submit to a random last in
order to update their BCRC identification cards and mouis A copy, of be form letters notifying
individuals or their selection for this random test appears as an attachment A, B & C at the back of
this booklet
Employees %%ill be required to report to an approved collection site whim seven (7) dins from the
date of the Notice for Random Testing letter in order to maintain their BCRC identification card and
status No employee will be required to submit to a random test more than twice (2) in a twelve (12)
monfliperical All employees will be selected for a random at least once (1) even, two (2)ycacs
It an employee (fare not provide a sample at an approved collection site within iewerk (7) days of
having been notified of a random selection, his/her status in the BCRC Substance Abuse Program
will be deemed "Not Available" Employees who fail to report for a random task in the required
time should contact the Third Perry Administrator (TPA) If an employee does net report for a
random test, and it is the Run (1) time the employee has filled to report, the TPA may allow the
employee to take the test without reporting to the EAP for further review. Employees may choose to
take a"First O"umnocClause" althis lime Employees may in liar this clause only one (1) time.
However, once this "First 0—mores Clause" has been utilized, an employee who fails to report for
a random test at any time in the future will be required to contact to the EAP For evaluation and to
receive instructions on the required procedure(s) RH removing the "Net Available" status from
his/her card
PROBABLE CAUSE TESTING
An employee may be subject to drug and alcohol testing for Probable Cause based on observed and
documented unusual behavior Circumstances sufficient, to lead a reasonable person to suspect that
an employee is under the influence of, or is in possession of a controlled substance shut] or,
determined by an immediate supervisor and should be confirmed by one other supervisor whenever
possible The immediate supervisor shall document, in writing, [he incident and the probable cause
busis for such testing The documentation shall specifically detail the behavior and conduct of the
employee, the location, date, time, of observation, conversations, witnesses, (if Amy), and should be
signed by the supervisor who witnessed the incident Such employe:, may request that . union
rop—entafivc be available or present prior to any action taken by an mployar, if any, at any
.stage of flo policy and Its administration
"I
"EMERGENCY" WORK ASSIGNMENTS
To accommodate owners with emergency work, craft personnel who have not previously held a
BCRC identification card or taken an initial drug test, the following provisions will apply when
sterling for emergency work assignments
I Upon ameal at ajob lowlier for sign-up, the employer representative
(Cud Manager) shall request the employee to present his/her BCRC idernfleation card
An individual that does not have a BCRC cud at the time of hire will be requested to
secure a card and submit to an initial drug mil within one (1) day, in order to comply
with the BCRC Policy
2 An employee without aBCRC identification cud may, work one (1) day. Orithe second
(2) day, a Chain of Custody form (as proof of having submitted to a drug lost) or a
BCRC card must be presented
3 An employee who liar, provided a specimen for testing must bring to thejob site his/her
copy of the Chain of Custody forth, given to himher by the collection site, as proof that
he/she has subinutiod to an initial test
4 If the work assignments are consecutive, the employee will be allowed to work for up to
a maximum of poor (4) days in order for the employee to receive his BCRC
identification cud and have the employer Cud Manager swips, the card for same
verification
5 If the members work assugs art is ub-nimased by his/her employer before the member',
status is verified within the allowable few (4) days for verification, and the individual is
rehireci, the member will have to provide the same employer a BCRC ithemificalion cud
at the second (2) rehiring sign up, and a clear %team Except in the event that the rehire is
less then four (4) days from the initial hire dale, the Individual, Crical and Non -Local,
23
POST, -ACCIDENT'/ INCIDENT TESTAN
An employer may require an employee to submit to a post -accident drug and alcohol last agar the
involvement in, or came of an =cideriVincidept, that comes injury to the employee or another
party The employer may also require an employee to submit to a post -accident drig and alcohol
test when the employee is involved in, or comes rat accident, which results in damage or
destruction toproperty Post accident drup, and alcohol testing most be completed within two (2)
hours of the recorded accident/incident ire BCRC testing facility is located on thejob site or
within fbu (4) hours of the recorded accidenthroident if an employee is required to go off the job
site to a BCRC testing facility. Any employee suspected ofunnecessaffly delaying the test proem
will be considered to have refused to submit to testing
In instances, offiren-accidem/inciderit or probable come testing to, drugs and alcohol, the emplovee°
will be transported to the testing facility by the employer. At the option of the employer, the
employee maybe suspender! pending the test result in the event anegalive test result is reported,
the employee shall be compensated for all lost time at the appropriate rake within the collective
bargaining agreement, straight or premium pay.
When an employee is injured in a qualifying accident, priority must be given to fire employee's
medical treatment before any consideration is given to collecting a specimen for testing
Such employees may request that a union representative be available or present prior to any nation
taken by an employer, if any, at any stage of the policy, said its administration Haromplovesis
aggrieved by any action taken under this Drug and Alcohol Policy and his/her complaint cannot be
resolved, the complaint may, if the employee or Union requests, be referred as grievance under the
grievance and arbitration provisions of the employee's collective bargaining agreement, In the
event the matter is referred to arbitration, the arbitrator shall be bound substantively by the
provision of this Drug and Alcohol Policy
W
BCRC cud holder shall accept and understand that should his/her drug test results be
reported as positive, he/she will be subject to disciplinary nation up to and including
lamination without obligation for Rather compensation by the BCRC affiliated
employer. Such annimakra ,;hall also be subject to flin imirvalmd's rights under his/her
collective bargaining agreement
CARD SYSTEM
Employees will be required to give their BCRC Card ID Number to a Cud Manager in order for
the Cud Manager to access the e-mail items confirmation system
Categories are:
I Not On File (NOF)
2, No[Available(N(A)
3 Clear (CL)
The Cud Marriager will also have access to safety training infick-mali on, which has been downloaded
through the Construction Advancement Foundation (CAT) and accessible through the BCRC
scanner or email system only with the permission of each participating LAxed Union
STATUS CONFIRMATHOL4
Participating employers may vanity the status of all BCRC employees, who are working, by having
their card slams verified on flaii-joh, site in order Ed determine if the employee is available or not
available trader the BCRC program The employer may use the Phone-in System, Scanner or
Elecrromc e-mail for verification
When an employee's status is Not Available (N/A), he/she will be advised to contact the BCRC
office to resolve the N/A strips The individual may be required to fiflow, the consequences for a
positive test wiflurk the BCRC Policy
RM
The employer ritay verity, the employee's card after four (4) days to reconfirm the states and if the
empkry.c's inums is still N/A, the employermayterminate the employee
An employee who receives a states of N/A a second (2) time will be inferred to the Employee
Assistance Program for osamnuen, and will be required to follow the recommendations of the
HAP Counselor before being considered for further assignments The status ol'Clear (CL)will be
restored only with written approval of the EAP
This procedure will protest the employee's confidentiality and show the employer to audit the
status of his/her employees, which may be required by the owner to be submitted nionariv
A person who provides an insufficient specimen of urine or breath when required to do so shall be
repaired to an appropriate medical professional, as designated by the BCRC for evaluation at the
participant's expense. If the medical evaluation fails to reveal an acceptable medical explanation
for the inability to provide a specimen, the donor shall be considered to have refused to last and
discipline shall be imposed according to this policy tr a legitimate medical reason is repealed, no
action shall be taken and the employee shall be reimbursed by BCRC for the medical evaluation
expense
DILUTED SPECIMEN
An employee providing a diluted specimen will be given the opportunity to return to a collection
site within fortil-eight (49) hours to provide a amend (2) spoeirove, on his/her own time
Employees should refrain front excessive consumption of fluids prior to the ereat No adverse
action or discipline shall be taken against my employee based on a first (1) diluted specimen A
second (2) diluted specimen, without a valid medical reason, will be treated a, a refusal to submit to
testing
M
4 A confirmed positive or a "N/A" stains will not be the sale basis for termination of
employment Only employees %%tie are in non-compliance widir this program may be
discharged, For the purposes ofilds provision, "non-cornpliance" shall mean one or
more of the following:
Failure to report to the program's Employee Assistance Frogman as directed,
Radius to follow and/or complete a EAP-prescribed treatment Fragrant,
Failure to take a return -to -duly or hallow -up test,
Failure to report for a random Irm request within seven (7) days,
Failure to sularnh to a drug or alcohol fear when requested to do so by the EAP
5 An individual testing positive for a third (3) time in a twelve (12) month period shall
not be pennitled to take a Return -to -Duty test for one (1) year and his/her BCRC
Substance Abuse Cud shall be invalidated for the same time period..The individual
most also complete an EAP-prescribed treatment program before returning to work
For the purposes of this policy, a negative test meant occur before any future positive
tests vail be wanted as additional strikes
6 An employee whose test resells are verified posifi% e will be referred to [he HAP by the
MRO The employee is expected to attend all appointments with the EAP counselor and
to follow the HAP counselors instructions
The return-lo-duty test is required for an employee to be re -instated into the program following a
positive test The participant mot have a negative drag test before reaching performance of his/her
job duties
FOLWW-UP TESUNG
SPECIMEN
When a urine specimen is referent as adulterated, or substituted, or who. the temperature range is
below 90 degrees or above 100 degrees F, the employee will be considered to have not cooperated
with the testing proms, and the rest will be considered a refusal to be tested
In addition, the employee who has refused to be [cited, or who um; or possesses a counterfeit drug
card, shall be subject to employer diseftairic up to and including discharge, subject to the
representation language
I An emplovee who tests positive for drugs and/or almhol shall be contacted directly by
the Medical Review Officer (MRO) ll'theMRO verifies the res.iLgorthe positive IV31,
the MRO will notify the individual that he or she is ineligible for work and he/she will
be directed to contact the prsueni'a Employee Assistance Program (HAP) tic,
consultation and roview, If the MRO corhavis the indi, local and find, that there is a
reason for the positive test (an authorized prescriptive medication) the MRO sill
downgrade the result to a negative, and the individual's card will be marked "Cf.",
2 In the case of a confirinecd positive drug or alcohol last, the Third party Admirtislonor
(T'PA) svfll be nati[ied that the emphryee's status should be marked `°N!A The"N/K'
status will be efriective at the moment that a coramouxi positive test is received
3 Before rearming in work, an employee mot (1) complete an evaluation with the
program's Employee Assistance Program provided by the BCRC EAP Provider, (2)
follow a treatment plan proscribed by the program's HAP, (3) obtain written
documentation from the program's HAP verifying fanns far duty, and (4) obtain a
negative result ou a 'mum-10-duh, lest
26
Follow-up feeling fordrugs and alcohol is a requirement in order for a returning employee to stay in
compliance with the BCRC Program Testing shall be determined by the Employes Assistance
Counselor, and will be implemented when the employee returns to work
DISPUTED POSITIVE RESULTS
An employee who disputes positive results mall have the right to have his/her initial sample
independently re -tested by a Department of Health and Human Services (DHHS) certified
laboratory of his/her choice, at his/her own expense, within ten (10) working days of when he/she
rows no(itied of the Lost results. A portion of the initial sample shall be forwarded trader a chain-of-
cianody directly by BCRC's testing laboratory to the laboratory selected by the individual Review
of am drug test result must be performed by a qualified MRO who has been approved by BCRC If
the second lab report shows the presence ofacontrolled substance, the test result whit be considered
positive. If the second lab report test indicates no presence of a controlled smanturce, then both tests
will be considered negative
The following section only applies when the employee tests due to Post -Accident or Probable
Cave: If the test is negative, the affiliated employer will reimburse the individual for compensation
lost at the appropriate rate within me collective bargaining agreement, straight orpocrinurn pay,
during the period of his/her disciplinary suspension or Intimation and will reimburse the individual
for the cost of the re-Iml
An individual whose last results are verified positive will be referred to the HAP by the MRO,. The
individual is eomersed to attend all appointmems with the LAP counselor and to follow the
counselor's recommendations and requirements
A positive alcohol testing conducted on a breath sample cannot be re -tested.
27 28
All problem bluenose shall be resolved in accordance with current guidelines and standards
established by the U.S. DIIHS or Department of Transportation
Employees who are subject to this policy continue to have access to the usual protectionist provided
as a part of their urban membership and/or as members of bargaining units covered by collective
bargaining agracmerils Such individuals may request that a union representative be available or
present poor to any action taken by an employer, if any, ill any stage of the policy and its
administration Iran individual is aggrieved by my action taken under this Drug. and Alcohol
Policy and his/he, colmakara cannot be resolved, the complaint may, if the individual or Union
requests, be referred as a grievance under the grievance and arbitration provisions of the individual's
collective bargaining agreemem [it the event the matter is referred to arbitration, the arbitrator shall
be bound substantively by the provisions orlhis Drug and Alcohol Policy
In
BCRC LETTER HEAD
LtOgr_ of Notice for itsvidom 'rest na
RM
Your aware has been randomly selected by BCRC's computer generated selection program to take a
random drug test in order to maintain your "Clear" status on you, BCRC identification card. Our
computer program selects the names of one -twelfth (1/12) of 50% of all BCRC cardholders for
random updating each nawph No one will be tested in this system more than twice in a twelve
month period
You will be required to report to an approved collection she within seven (7) days from the dale
or this "Notice for Random 'retiLing" letter to stay in compliance %vilh the BCRC policy In order
to avoid any potential interruption in the status of your card, you most be tested no later than
midnight the (do,,) of (Month), 201
If you do hot lake your random last within seven (7) dins of this notice, your BCRC candrudus will
be deemed "Not A,.q;qoc'% Failure to report far . clad.m test in the required time will make it
necessary for you to contact The BCRC office to receive instructions on the required procedure(s)
for removing the "Net Available".daws flowyour cud
Remember it is your responsibility to keep the BORE informed of any change in your address or
telephone nurnber.
The BCRC has contracted wilb Perspectives as a fully independent, professional Employee
Assistance Program (EAP) for you and you, family, Perspectives" 24 hot., 7 day a week hotline
number is (800) 456-02 7
Please contact the BCRC office (y) 219-764-9500 or loll free @) 977 -998-5400 if you have any
questions Thaskyouloryour cooperation
M=
Attachment A
BCRC LETTER HEAD
Letter co' Notice for Ran&m Tesfin
W"
Your name has own randomly selected by BCRC's computer generated selection program to lake a
random d Our ompuu,r
program selects the names of one -twelfth (1/12) of 50% of all BCRC cardholders for update each
month Noone will betested wthis system more than twice in auveho month period
You will be required to report to an approved collection site within seven (7) days from the date
of this "Nofiri, hot Ilwarid.ra Testing' letter to stay in ccrnrpliance with the BCRC policy I. older
to avoid any potential interruption in the status of your cud, you must be tested no hear thict
midnight the (day) of (Month), 201 This random lest is to be taken on your own time at an)
of the approved collection sites identified on the enclosed collection site list You will be mailed
a $40 00 stipend for the time necessary to secure random testing as long M your test is taken
within seven (7) days of this notice
If you do not take ),our random lest within seven (7) days of this notice, your BCRC card status will
be deemed "Net Available", Failure to report fora random test in tire required time it will be
necessary far you to contact the BCRC office, to receive instructions on the required procedurebs)
Poi removing ire "Nola Available" status fi.-you, card.
Remember it it,, your responsibility to keep the BCRC informed or any change in your address or
telephone number
The BCRC has conimeled with Perspectives as a fully independent, professional Employee
Assistance Pictiparn (EAP) for you and your Family, Perspectives' 24 tuntir, 7 day . week h.tliric
,lumber is (800) 456-6327
Please comacl lite BCRC office dy) 219 764 9500 or loll free (a,) 877-988-5400 it you have one
questions 1hankyouforyourcooperalion
Robert Anadell
Executive Director
0
Attachment C
BCRC LETTER HEAD
Later of Notice for Random Testing
Dear
Your name has been randomly selected by BCRC's computer generated selection program 10 take a
rund.in drug test !it order to maimain your "Clear" srafts an yaw BCRC identification card Our
computer program selects the names of one -twelfth (1112) of 50% of all BCRC cardholders for
random updating each month No one will be Issued in This system more than twice in a twelve
month period
You will be required to report to an approved colleebonsito within seven (7) days from the doe
of this "Notice for Random Testing" letter ro stay in compliance with the BCRC policy. In order
mavold any potential interruption in the status of your card, you must be tested no later than
midnight the (day) nF(h4unth), 2.(pl ,Tests may be taken an your Employer (CantracCar's tune
at the collection facility selected from the enclosed list
If you do not take your raddiorn last within seven (7) days of this notice, your BOR.C. cud status will
be di,emccl "Not Avsibsbk", Frilun, ro ,,pan fts a random reel in lite required time will make it
rie"s.sary for you to contact the BCRC office to receive instructions on The required procedure(s)
lbremoving ific "Not A,aihible"sirflus Bver, you, card,
Remember it is your responsibility to keep the BCRC informed of any change in you, address or
telephone number,
The BCRC has contracted with Perspectives as a fully independent, professional Employee
Assistance program (E.AP) for you and your Isedly. Perspectives' 24 hour, 7 day a week hotline
number is (800) 45(,6327
Please contact the BCRC office @ 219-764-9500 or toll free @P, 877-988 .5-400 if you have any
questions Thankyouporyourcooperation
9MM
Robert Arsordell
Executive Director
IN
Mimmm
fIVILDING ANI)QINM'RUCJ'Jf)N L1LS.0k4b(T.(XNr1'FI1, INC.`.
61,11' Ar O� " �C'TQ R ��; 17:cal 1
JMY . - _Jk)N
ANALV5'1S A_NQ AJ1J'JJ!QRIZAJ'JQN FORRELEASLOF RESUI
1, one undersigned, ....... . , 11 do hereby authorize the testing of my body fluids
for employment reasons and understand and agree that the results of'arry, such feeling will be turned
over to the Building and Constructions Resource Center, Inc..and, further that the training procedures
will be limited to tests for prohibited and illegal drugs and controlled substances
I understand that the results of these tests may be used for employment and disciplinary reasons and
hereby authorise the release of such information from the laboratory and MRO
I further county that the came specimen collecked from me is mine and no adulterated or altered in
any mariner. I have been advised that matters appealing me relative to the interpretation or
application of one Drug policy and subject exclusively to the grievance and arbitration procedure
under my collective bargaining agreement (if applicable).
Attachment F
Signature ofAliplicano/Employee
Dire " --' . ... .. . .......... .... . Ranploye's Social I Security Number
Time Employee's Telephone rminbe,
FmpJ.y,=',, Addncs
Suack iqs Co'do............
...............
M
Drug and Alcohol Policy
in complianceivof,rh
49 ( 'hl? Part 40, and
49 CPR Par? 382 (FMCSA)
for
DOT -Covered Contractor Participants
BCRC Baud Approved August 18,2004
BUILDING and CONSTRUCTION RESOURCE CENTER
(BCRC)
Drug and Alcohol Policy
in compliance with
49 CFR Part 40, and
49 CFR Part 382 (FMCSA)
for
DOT -Covered Contractor Participants
BCRC Baud Approved August 18,2004
L PURPOSE
Building and Construction R ....... " Card. ("BCRC", "the Assochalon") has established
this alcohol and controlled substances testing program for contractor participants who
have employees that are drivers of Commercial Motor Vehicles (CMVs) and nloo require
Commercial Drivers Licenses (CDLs), to meet requirements of the U.S. Department of
Transportation(DOT) The overall goods of this testing program are to ensure a safe and
drug -Free transportation environment, to reduce the potential for accidents and casualties
related to accidents involving Company -owned /-leased vehicles, and to cooperate with
the U.S. Department of Transportation and the transportation industry in efforts to
eliminate the unsure of alcohol and the illegal use ofcontrolled substances by our
drivers
With these objectives in mind, BCRC has established the following policy and
procedures for DOT -covered employees of its contractor participants Full compliance
with this policy is a condition of employment wild; each individual contractor.
11. SCOPE
BCRC's Drug and Alcohol Policy for DOT- Covered Employees, outlined below, applies
to all full-time, part-time, and temporary employees who are "covered drivers" as dell-cl
inSection VIIA) This policy also covers independent drivers %%,he may be specifically
named in a contract to provide service In addition, this policy covers all job applicants
35
INFORMATION AND INSTRUCTION SHEET
BCRC is exercising extreme cue to ensure that sami, quality control measures are followed in
the collection, mapping, and analysis of you specimen You pho, an important role in [his
process and should be contain [hat you have provided an unadulterated specimen to the
laboratory Remember, you are certifying that the specimen mhichyou provide is ycim; and is
unadulterated. Any adulteration or switching of specimen is a breach ofBCRC's rules and, if
you are employed, may subject you to discipline up to and including termination by you
employer
Forvour own protection and Mee of mind, we ask that you:
Provide a picture idemi fication to his colleefionsitic/lechnician at time of moral;
Be escorted to a collection room and asked to provide an unadulterated specimen no
the collection bottle provided The bottle should be filled to 60ml;
Return the specimen bodie to the medical technician and witness, initial and dale the
integrity cards placed on your specimen;
men:
Verify the proper spelling of) our time as recorded on the log sheet;
Verily that 3 our social scrum) number has been properlYuscorded:
Verip, that the social security number placed on your specimen bottle is the same Is
that recorded on the log sheet and the Chain of Custody room
I HAVE READ THE ABOVE AND HAVE HAD AN OPPORTUNITY TO ASK
QUESTIONS REGARDING THIS PROCEDURE.
BCRC Applicant/Cardholder Signinurit I Law
34
for positions that require Commercial Drivers Licenses (CDL) for the operating of
Commercial Minor Vehicles as described in Section VI [A)
In those circumstances that are not addressed by DOTregalwairis or in this policy, DOT -
covered employees contain subject to onfles, and testing as defined in BCRC'v Drug and
Alcohol Policy for all employees
In addition, a driver will be required to submit to a non -DOT test for reasonable suspicion
in those circumstances when the driver is suspected of drug or alcohol use, or has
violated a work infle as stated elsewhere in this policy, or is involved in or may have
contributed to the cawing of m accident, or causes injury to hanuberself or to another
person, when the circumstances related to that incident do not main the requirements of
DOT test
11L REFERENCES
Title 49 CFR §382, in al, fto�-
Title 49 CFR §40, AWBJqjigI ],,u�.Wjog
pawala
Title 41 U.S.C. §§ 403, 701 at Sea ,
Note: If there are conflicts between federal regulations and this policy, aldribuledin part
to revisions to the law or changes in interpretations, and when those changes have not
been updated or accurately repeated in this policy, the Federal law shall prevail
IV. POLICY / RULES OF CONDUCT
A driver who violates the FMCSA prohibitions of this policy (Section VII Bk, including a
refusal no he tested, mod be immediately removed from all FMCSA rarely-sensilive
functions, including driving, in accordance with 49 CFR Part 382 501, FMCSA rates and
ieguhifi... Law, each employer's independent authority, the drive, will be subject to
disciplinary action up to and including termination ofemploymenI
An employer also reserves the fight to take action against an employee, where
appropriate, for violation brother general employer policies, procedures anchor rules that
may be defined in nuns that are separate from this policy for DOT -covered employees
A A covered driver may not engage in any of the conducts) prohibited in Section
VI[B]
B Under independent authority, BCRC prohibits the possession of alcohol, or the
sale, purchase, manufacture, possession or transfer of an illegal drug, or being
under the influence of alcohol or of an illegal drug, during all work time,
including meals and breaks, or at my time while on Company property, at a
Company',, job site, shippeh/vactdver site, track stop, rest itica, on Company
business, or in a Company -owned Meased vehicle An employee who possesses
alcohol, or who uses alcohol while on duly, will be terminated from employment
C Under independent authority, BCRC prohibits the use of any over-the-counter
medication by an employee during working time or any time while on Company
36
property, at ajob site, on Company business, or in a Company -owned (-leased
vehicle if such we ran), detrimentally affect or impair the safely of coworkers,
customers ., members of the public, ., an employee's job performance, or the
safe or efficient operation of the Company, or its property
D A driver who uses prescribed medicalion(s) will not be permitted or required to
operate a Commercial Motor Vehicle until and unless the employer is provided
with appropriate authorization from the employee's prescribing licensed medical
professional.
E Cases of suspected trafficking, possession or use of illegal rebalances or drug
paraphemald on Company property, in or on Company vehicles, and/or at job
sites, will be referred to Is%%, enforcement authorities, under each employer's
independent authority
F. BCRC encourages participants who wish to voluntarily seek assistance for
questions or problems related to drugs and alcohol to so do by contacting the
A".siatim's Employee Assistance Po.gorim DOT -covered drivers who seek
assislance, underthe provisions of the Self-rchanification Policy will have to be
removed from safety -sensitive function during the time of assessment and
rehabilitation, but their admission of use will not be considered a DOT violation
In accordance with the policy, drivers %%,he return to work after rehabilitation will
be required to Lake a DOT return -to -duly last, and will be subject to non -DOT
follow-up testing
G. If a driver is called to duty during the driver's typical "off -duty" time, the driver
may report to work only If he/she has not consumed alcohol or any time during
the previous four (4) hours When a driver has used alcohol during four (4) hours
prior to his/her providing safely -smsith c duiv, he/she will be expected to
acknowledge such use at the lime fie/she is called rritiarsolpossibleforthe
supervisor to delay the requested start fare so as to accommodate DOT's pre -duty
requirement, the employee
vee mill not report to work lifarm on -call employee
acknowledges the use or alcohol, he/she will be permitted to determine a start
time that will comply with the 4-hour prohibition, Under each employer's
independent authority, no discipline will be labor against an employee who
acknowledges his/her use of alcohol during the four (4) news prior to being called
to duly, unless such conduct has the effect of making that employee repeatedly
unim ailable for duct
IT BCRC considers a conviction for criminal drug actin it) to be i or) serious An
employee who no a workplace -related drug conviction must report that
conviction to his/her supervisor within fire (5) days of receiving it An employee
who fails to report such a conviction will, upon discovery ofthe conviction, be
subject to immediate termination from employment
I Each employer reserves the right to test a DOT -covered employee For alcohol or
controlled substance use under the Company's independent authority when DOT
regulations do not apply. These circumstances would include suspected
impairment, violation of an employer's drug and alcohol rules, or of'other nules,
participants) who are required to hold a Commercial Driver's License (CDL) and
who operate a commercial motor vehicle (CMV), when that vehicle:
® has a gross % miclo or combination weight rating of 26,001 or more pounds:
® is designed to transport 16 or more persons including a driver; or
o is a vehicle ofany size that transports liv-andous materials and requires
procuring under the krwa,dous Materials Transportation Act
B FMCSA PRO/nor (ions:
A driver shall not:
Report far duty or remain on duty requiring the perfornamice of safely -
sensitive functions while having an alcohol concentration off 04 or greater
Use alcohol, including medications that contain alcohol, while performing
safety -sensitive fianctions
perform safety-scrialive functions within hear (4) hours after using alcohol,
including the use of medications that contain alcohol
Use alcohol for eight (8) hours following an accident, or until the driver has
undergone a post -accident alcohol test, whichever occurs first
Refuse to submit to a pre -employment, post -accident, random, reasonable
suspicion, or follow-up alcohol or drug task
Report lot duty or remain on duly requiring the peiltirriturce orsafety-
sensitive functions when he/she uses any controlled substances, except when
the use is pursuant to the instructions of licensed medical practitioner oche
has advised the driver that the substance does not adversely affect the driver's
ability to operate a commercial motor vehicle safely.
Report for duty, remain on duty, or perform safety -sensitive functions it'
he/she tests positive for conlrefled substances
If a driver engages in any of the conduct(s) prohibited in (B) above, the driver is not
qualified, under FMCSA regulations, to drive a commercial motor vehicle (including
operating any interstate commercial motor vehicle with GVWR of 10,001 pounds or
more) lie/she raw[ be immediately removed from all safety -sensitive functions
including driving, and is subject to Section Vill,
A driest who engages in prohibited conduct a second time will be immediately
terminated from employment
Under FMCSA regulations, a driver vdbo is found to have an alcohol concentration of
0,02 or greater, but less than 0 04, may nor operate or continue to operate a commercial
motor vehicle or provide other safety -sensitive fixiclime for a twenty -Pour (24) hour
period, Under each employer's independent authority, that driver will he on unpaid leave
to, any It.— not worked
In this regard, under independent authority, a driver who provides an *chat test result
greater than 0,02 but below 0.04 on a amend incident will be subject to disciplinary
that are slated in this policy, and causing or being involved in an accident or
injury ofself oranother employee. In those owes, testing levels would be
identical to DOT levels, but the test would be conducted as a non-DO1 test
If a DOT -covered employee tests positive for drugs under an employco's
independent authority, that employee will be considered to be in violation of
DOT's prohibited use of controlled substances, He/she will be immediately
,viffirloovn from ssfictV_,emilive function, and will be subject to consequences a,
defined in this Drug and Alcohol Policy for DOT' Employees.
If a DOT -covered employee tests positive for alcohol under an anspime,'s
Independent authority, that employee will be considered to be in violation of
BCRC's policy regarding alcohol in the workplace Fichilewill bsubject t.
consequences as defined in BCRC's policy for employees who are tested under
non -DOT circumstances
V. AUTHORIZED USE OF CONTROLLED SUBSTANCES
Ira driver undergoes prescribed medical treatment with a drug or controlled substance,
the driver is required to report this treatment to his/her employer, who will take steps to
investigate whether the driver's job assignment should be temporarily changed during the
period or treatment, or whether other accommodations may be appropriate
BCRC requires a driver to make such notification as soon as possible, and prior to
perforating a safety-sessifive function, and to provide written documentation from the
prescribing licensed method practitioner that the medicalion() will not affect the driver's
ability to perform safety -sensitive functions safety, including operating a commercial
motor vehicle Each employer reserves the fight to obtain an independent medical
opinion regarding the potential effects of prescription or at er-the-counter drug on a
rinver's ability, to perform safety -sensitise functions or other aspects orhis(herjob
Further, each employer reserves the right to place any
v driver taking medications) on a
fro of absence pending a decisionas to whether the chn, c, may continue to perform
his/her regularjob duties while taking the modicationly)
Each employer mar, as it determines necessary, and when possible. temporarily reassign
a. employee 10 functions for the durolion ofhis/heruse of such
draf(s) However, due to the saletv-scraiiii, a nature of many jobs in the construction
industry, no employee can be guaranteed that these accommodations can always be made
V1. TESTING FOR CONTLIOLLED SUBSTANCES AND AI,COMOI,
Employers who are members ofBCRC will conduct controlled substance and alcohol
testing of their dfiver/applictrairs and their driver/employees (including memories and
management drivers) in compliance with regulations established by the U.S Department
ofTramportaluer (DOT), 49 CFR §§ 40 and 382
A COVERED DRIVERS
In accord with U.S, Department ofTransperialion FMCSA Regulations, drivers
.subject to drug and alcohol telling are those employees (of contractor
action up to and including termination of employment For disrupting normal business
noun,
C DLFIN111ONS
Acgiatil$ means an occurrence involving a commercial motor vehicle
operating on a public road in which:
a There is the loss of human life; or
b The driver receives a citation under Slate or local lam, for a moving
traffic violation arising from the accident; add
(1) Any involved vehicle sustains disabling damage as defined
in this policy; and/or
(2) Anyone receives bodily injury that requires immediate
medical treatment away from the accident scene
A(hutf ktr!Mloft means actual knowledge by an employer that a driver
has used alcohol or controlled substances based on the employer's direct
observation of the employee, infientration provided by the driver's
preview employer(s), a traffic edition for driving a CMV while rather the
influence or alcohol or controlled substances, or air employee's admission
or alcohol or controlled substance use, except as provided by our Self -
Identification Policy (Section X) Because our non-1301 testing is
conducted under the same qlficl collection and laboratory standards as our
DOT lasts, we his,, consider a positive drug 1.1 result to be actual
knowledge that an employee is using a controlled substance without
authorization
means a specimen that contains a substance that is
net expected to be present in humeri done, or contains a substance
expected to be present but is at a concentration so high that it is not
consistent with human urine
Akoho mews the intoxicating agent in beverage alcohol, ethyl alcohol,
or olhea low molecular weight alcohols including methyl and isopropyl
alcohol,
MOW tot ittaivitu" means the alcohol mavolume of
breath expressed in terms of grams or alcohol per 210 there, of breath as
indicated by an evidential breath test (BrAQ
Aftbffiql UC"l1Jilg Qevpee iAfiTil means a breath or saliva device, other
than an EBT, that is approved by the National Highway Traffic Sinfiny
Administration (KHTSA) and placed on a conforming fayd.rta list (CPQ
for such devices
4 means an madylic procedure to determine whether
an employee may have a prohibited concentration of alcohol in a breath or
saliva specimen,
• Alkolholl oir means the drinking or swallowing of any beverage, liquid
mixture or preparation (including any medication), containing alcohol
Allilltrall$ mears a person, independent contractor, or person working for
an independent contractor, who applies to become a driver/employee at's
BCRC contractor participant, and includes a person rare has received a
job offer made contingent on the person passing a drug test
AlIldlififidl moms Building and Construction Resource Center, which is
the association formed by labor and management representatives of The
Building and Construction Washy For Northwest Indiana, for the purpose
of addressing problem of drugs and alcohol in the workplace
• IlIntoth Alyftl 'WhvWfln fRAT) is an individual who is certified as
trained to operate an Evidential Brown Testing device (EBT) and who is
proficient in breath -testing procedures
• Cigifto trul mews a drug or arsenal test that has a problem identified
that cannot be or no not been retracted, or which is otherwise required,
by Part 40, to be canceled A awarded test is neither a positive nor a
negative lest An employer is not remained to lake adverse job action
based on a canceled test
• Clittfitfull means an employer ofro is a member or Building and
Construction Resource Center
• J�is , nterms a place designated by BCRC where individuals
present themselves for the purpose of providing a specimen of their urine
to be analyzed for the presence of controlled substances, or ror purposes of
pro, fling iisaliva a, breath sample to be analyzed to, alcohol
concentration
f' means all employer -owned and/or -leased property.
including but not limited to Owned writer [eased buildings and other real
estate parking lots and vehicles located on parking lith and chiplo, a, -
owned and/or -leased vehicles, backers, and desks
a For alcohol testing, a confirmatory task is a second Iasi following a
screening lost with a result of0 02 or greater, conducted 15-30
minutes later, that pan ides quarnitalke data of alcohol
concentration This testis conducted an an BET
Is For controlled substances testing, a confirmatory last is a second
analytical procedure to identify the presence of specific drug or
metabolite This confirmatory test is independent orthe initial test
and uses a different technique and chemical principle from that of
[he screening test in order to ensure reliability and accuracy.
• Eflojlg �hin means an reality, including a group or association or
employers or commuters that provides services related to alcohol or
Litt O= means an employee of a company, or of a contractor parficiparal
who is a member of Building and Construction Resource Center.
• Ent RL oyerniemsacompan),,oramniraclorparticipmhc) participant,
._
contributing member of Building and Construction Resource Center, and
who owns or Imes a commercial motor vehicle that is subject to DOTS
rules, and who assigns persons to operate such a vehicle In this policy,
employer includes a company's agents, offlurs and representatives
• FIVICSA means Federal Motor Carrier Safety Administration, an
Operating Administration of the Department ol"Iyansportaron
$OlOildhif, (Fer drugs) means an immunoassay screen to eliminate
"negative" urine specimens from runner consideration
Ifffilla (for post -accident testing) excludes (i) an occurrence involving
only boarding or alighting from a stationary motor vehicle; or (it) an
occurrence involving only the loading or unloading of cargo; or (in) an
occurrence in the comes of the operation of a passenger car or a
multipurpose passenger vehicle by an employee, unless the motor vehicle
is transporting passengers for hire or harearckna, materials of a type and
quantity that require the motor vehicle to be placarded
•D means a licensed physician responsible for
receiving laboratory results generated by BCRC"s drug issuing program
who has knowledge of substance abuse disorders and who no appropriate
medical training to interpret and evaluate an Irian idual's confirmed
positive fast result together with his/her medical history and any other
relevant biomedical immurralion
are.. when . drive,', a-fina,wa-y last result
reads 0 04% BrAC or higher.
• E2kftLyL:LuLJd2JW occurs when a driver's confirmatory test or retest
result is at or above cutoff levels specified by DFIVIS in DOT rules and
regulations, and has been verified by the MRO to be a positive test
Wouillital Wtgfirlui means aschinfifically valid method for selection of
driven to belesurd that results in an equal probability that any driver from
a group of drivers subject to the selection mechanism %sit] be selected, and
does not give an employer discretion to waive the selection of any
employee under the mechanism no, a driver might be selected more
than once during a year.
AVLLo1ivAJL1LPNjfI1S1lLn mews a belief that a driver has violated alcohol or
controlled substances prolubalions, based on specific, contemporaneous,
documentable observalions concerning the appearance, behavior, speech,
or body odors of that driver. In the case of controlled substances, ilia
observations may include indicators orchronic and withdrawal offiam, of
controlled substances
controlled substances testing as required by the DOT rules and regulations
and that acts on behalf of the employer..For purposes of this policy,
BCRC serves as the consortium for contractor participants ",he are
members of Building and Construction Resource Center.
• CoKplinlidistr Pail lchifigit means an employer who is a contributing
member ol'Building and Construction Resource Center
• g`ialllouslkil sigbiq'i"teirs means marijuana (TEC), cocaine, opiates,
phencyclidine (PCP) and amphetamines (including mersamphinamines
• PER Wesivnitird P"dilyVer welow an employee
authorized by each employer to take immediate action(s) to remove
employees from safely -sensitive duties and to make required decisions in
thelestingandevatuationprocesses The DER also receives lest results,
SAP reports, and offer communications on behalf of his/her employer.
(An employer may designate more than one DER)
• D13118-atiormord labaralorli'mearsalmoralory Paris certified water
the US Department of Ilea] In and I [man Services Mandatory Guidelines
for federal workplace drug testing programs Drugtevisfat-DOT-covered
dd%erswN,illbeperformed byaDHHS-cerliFiedlaboratory.
• [I spetillinen means a specimen with crealinine and specific gravity
values that are lower than expected for human urine
moms damage that precludes departure of a motor
vehicle From the same of the accident in its usual manner in daylight after
simple repairs
dnchesions
Damage to motor vehicles that could have been driven, but would
have been further damaged Won driven
uniing,
i Damage that can be remedied temporarily in the scene of we
accident without special tools or puts
ii Tire disablement without other damage even it no spare lire is
available
is Headlight or taillight damage
i, Damage In In,n signals hom or n indshreld wipers that make them
inoperative
Driver means any person who operates acommencial motor vehicle This
includes, but is not limited to: Full time, regularly employed drivers;
casual, intermittent or occasional drivers; leaved drivers and independent,
owner -operator contractors who are either directly employed by or order
lease to an employer, or who operate a commercial motor vehicle at the
direction of or with the consent of an employer
• (�mews a Iasi conducted for controlled substances, including
marijuana, cocaine, amphetamines, opiates, and phencyclidine
J�Jfitiail to mppils Iqu lllfaifjad iolLthhsJ1(,�pl includes failure to appear
_
for any test, failure to provide a breath or saliva specimen for a required
last, Failure to remain at the testing site until the testing process is
complete, failure to provide a sufficient breath specimen without a
medical explanation, failure to undergo a medical esaamnation following
mobility to provide a sufficient breath specimen, refusal losigir Step 2 of
the Alcohol Testing Form, and failure to cooperate with the bearing
process
Kvfiml W submil to # rrulfligVg_lJ13itJtU includes failure to appear for
any test within a reasonable time, failure to remain at the collection site
will the testing proem is complete, refusal to provide a urine specimen
for a required drug test, Failure to rental a already observed or monitored
collection %%ban required, failure to provide a sufficient Mount ermine
without a medical explanation, failure to take a second Iasi when required
by a wheeler or by his/tier employer, failure to undergo a medical
examination following inability to provide a sufficient urine sample, and
failure to cooperate with the collection/testing proms (including redoing
to empty pockets at the collection site)
Under each employer's independent authority, an employee/driver who
refuses to submit to required alcohol and drug testing %vid be terminated
from employment
Safety <lltflllflyg Na%&lp means all time from the time a driver begins to
work or is required in be in readiness to work Mil the time he/she is
relieved from work and all responsibility for performing work Surely-
swenfivefuractions shall include: a) All time at an employer or shipper
plant, terminal, Facility, or other property, or on any public property,
wailing to be dispatched, Mess the driver has been relieved from duty by
the employer; b) All time inspecting equipment as required by §§ 392.7
and 392.8 or otherwise inspecting, servicing, or conditioning any
commercial motor vehicle at any time; c) All time spent at the driving
controls of a commercial molar vehicle in operation; d) All time, other
than driving time, in or upon any commercial motor vehicle except time
spent resting in a sleeper berth (a berth cementing to the requirements of
§393 76); edf Ad time loading or unloading a vehicle, supervising, or
assisting in the loading or unloading, attending a vehicle being loaded or
unloaded, remaining in readiness to operate the vehicle, or in giving or
receiving receipts for shipments loaded or unloaded; and f) All time
repairing, obtaining assistance, or remaining in attendance upon a disabled
vehicle Adriver is considered to beperformingamfiny-seraffive
functions during any period in which he/she is actually perfornong, read),
to perform, or Immediately available to perform safety -sensitive fractions
§�ii � (for alcohol) means an malyfical procedure to determine
efieffier a driver may have a prohibited crincenummal of alcohol in a saliva
or breath specimen
S51vitil bill Rd I 'WhOdIAHMOD nissurn a rusaon "ho Jmlrvcls and
rmirmiamplovocs in flao ate choE ceaurf, process and operate., an ASD
(Ali orquil 'kneening Otivicef
5i I ��A ever". r Ai �S' I means a licensed physician
(Medical Doctor or Doctor of Osteopathy), or a licensed or certified
psychologist, social worker, employee assistance professional, or
addiction cowsador(cerfified by the National Association or Alcoholism
and Drug Abuse Counselors Certification Commission INAADACJ or by
the International Certification Reciprocity ComorturmAlcohol & Other
Drug Abuse [!CRC]), or by the National Board of Certified Counselors,
Inc, and Affiliates/ Master Addictions Counselor (NBCC), with
knowledge of and clinical experience in the diagnosis and treatment of
alcohol and controlled substances -related disorders A SAP evaluates
employees who have violated a DOT drug and alcohol regulation and
makes recommendations concerning education, treatment, follow-up
testing, and aftercare,
spinnFrigo means a specimen with creminine and specific
gravity values that are so diminished that they are not consistent with
human mine
U8WXJVS.11 means levels established by the U S DIHIS, at which a
specimen or sample is determined to be either negative or positive,
according to 49 CFR §40, JtqSv�jqVjbql UM ON non 'mL ild C Ob M
D Tizsra RrQuau_,o
Asprovided inUS Department ol'Transportation rules and regulations,it dther
who must possess a COL shall be subject to pre-employninampre-placement
testing (drug only), and random, reasonable suspicion, post -accident, iraum-to-
duty mid follow-up testing for alcohol and controlled substances
4M=1U . .... . .....
Every applicant for a driving position who receives ajob offer front a
BCRC contractor pathiciparn, must submit to a mine drug aw Thojob
offer is comingern on the applicant's providing a negative rest result
Each applicant will be asked whether he/she has tested positive, or refused
to test, on any DOT pre -employ meat drug or alcohol rest for a DOT
employer during the previous two years Anapplicant who has previously
tested positive, or refused to be [acted, will not be considered for
employment mill or undo he/she successfully completes D01's return to
duty process (See Section VIII,
DOT does not require a driverhipplicarm to submit to apro-craployment
drug lest if all the following provisions are m& to an employer's
satisfaction
received a SAP's report of compliance, including a follow-up testing
requirement
If the applicant is a current employee who is being transferred to a
position or assignment that requires the driver to possess a COL, a
negative pre-employmeni drug last result must be received before the
employee acauntes, the new position or assignment Ifthe test resift is
posilive, the offer of promotion or transfer will he immediately withdrawn,
and the employee will be subject to rates that the cantilever may have
established in a separate drug and alcohol policy for non -DOT employees
When an employer was, but does not employ a driver to operate a
Commercial Motor Vehicle more than once ayear, the driver will be
required to provide authorization for the employer to obtain verification at
least once ever), six (6) months that the driver is participating in a
qualified drug and alcohol testing program, that there have been no
refusals to be tested for alcohol or controlled substances, the dates the
driver was lot tested for alcohol and/or controlled substances, the results
army tests within the previous six (6) months and any other violation of
prohibited conduct as defined mVI(B) above Iftmemployer isunable m
satisfactorily obtain this inkirmalion, the driver will be recruited to auburn:
to a pro-emptoyment drug fast with a negative test result prior to being
reunited or requested to provide safety -sensitive functions for that
employer
2 tuhiltiftaLlaqu
As soon a, possible following an accident involving commercial motor
vehicle on a public highway, (See Section V[[C], Jbfipqlplfr&l, the
surviving DOT drivers) involved in the accident must be tested for
alcohol and drugs
a. A past -accident alcohol Iasi, when required, mot be adriamiucred
as soon six possible, but within eight (8) hours following the
accident
If testing is required but is not conducted within two (2) news, the
reasons the leg was not conducted must be documented If'testing
is required but is not We to be conducted within the next six (6)
home, Increase., the test was not conducted must again be
documented. After eight (8) boom, there will be no more arempis
to omliwo mi rikolfA litit
le A post -accident drug test, when required, must be administered as
soon as possible, but ividurt thirty-two (32) hours following the
moment If testing is required but is notable to be conducted
within thirty-two (32) news, the reasons the test was not conducted
muslinsdocumented. After thirty-two (32) hours, there will be no
more attempts to conduct u drug test
a. The employer can verify that the driver has participated in a valid
drag testing program (that meets the requirements of D(Yrrules
and regulations) wilhin the preceding thirty (30) days; and
b while participating in that program, the driver/applicant was either
tested within Inc pot six (6) months or was enrolled in a readcan
selection program for the previous twelve (12) months; and
C no prior employer of whom the employer has knowledge has
record that the driver violated any pan of the DOT rates and
regulations regarding controlled substances use within the kral six
(6) months
If the applicant is a new hire, the testing must be completed, and a
negative lost result must be received, before the driver will be permitted to
provide safety -sensitive function If the pre -employment test result is
positive, the job offer will be immediately withdrawn, and the applicant
will be provided with names ol'qualified SAPS. The applicarrcannot lic
reconsidered unless and until he/she completes a SAP assessment and
recommended assistance (Section Vill, Ne
Conduct)
g_
An applicant who has previously
v refused to be tested or %%he provided a
positive test result on a DOT pre-employmeril test for controlled
substances for any other employer will be expected to report those last
results at the Orric of milifirruirm, Under each employer's indrainsid-1
authority, failure to do so will constitute gasification of application
information, and when discovered, will result in removal from
consideration for employment, or, if already hired, immediate termination
of employment. An employer who wishes to reconsider the individual for
amplo3 mom w ill make such consideration only after the indn idual has
completed a SAP assessirml, compiled with the SAP's recommendations;
and provided a notatilive result on a Reftan-to-Duly, test
If an applicant has previously complied with . SAP's no-ramendiaicow as
the result of a violation Larder' a pravnmv employer, theapplicant's pre-
employment ymern in[ will be considered to also be a Relum-to-Duty rest
When significant time has lapsed since the SAP's report of compliance, an
ampirour may require in additional, second follow-up evaluation to he
conducted by a SAP, designated by
v, the employer, to verify that the
applicant is currently free of drag we, prior to being considered for hire
The cost of this SAP evaluation will he paid by the employer who requests
it
An applicant is required to sign a form authorizing the hiring employer to
obtain from all previous employers (in the previous three (3]years) a
report of all DGri'violadions, including positive last results and refusals to
forested The hiring employer will also request copies or Substance
Abuse Professional (SAP) reports related to each of these violations A.
applicant with a violation cannot [is hired mill the hiring employer has
A driver who is subleel to post -accident testing shall remain resettle
available for such testing tribe driver is not available for any reason,
except for leaving the accident scene for the period necessary to obtain
assistance in responding to the accident or to obtain necessary emergency
medical care, an employer will consider the driver to have refused to
submit to testing
Under independent authority, a driver who has submitted to a post -
accident rest will be permitted to return to safety -sensitive functions only
at the direction of a supervisor.
Even if highway enforcemool or other officials conduct a drug or alcohol
test imlowing an accident, drivers are still subject to DOT testing under
these employer rules In the event that federal, state, or local officials
conduct breath or blood tests for the we of alcohol and/or urine tests for
the use of controlled sulasatereser following an accident, and a DOT Lost is
required but is not able to be conducted, the tests conducted by law,
enforcement may meet the requirement of this section, provided those
tests conform to applicable federal, stale, or local requirements Each
employer will request test results and other pertinent documentation from
such agencies or law enforcement almocan it", and a driver is required to
sign a release allowing his/her employer to obtain such information
Under each employer's independent authority, refusal to sign such a
relative will be grounds for termination of employment
In the event that a driver is so seriously injured that the driver cannot
provide a sample of urine or breath at the time of the accident, each
employer requires that the driver provide necessary authorization for
his/her employer to obtain hospital records or other documents that would
indicate whether controlled substances or alcohol were present (and the
resulting levels) in the driver's body at the time ofthe accident Unfici
each employer's independent authority, refusal to sam, such a release will
be grounds for termination ofemploymeni
3, flaumai&Au
A percentage or drivers will he subject to random alcohol and drug heating
each year. 'Die percentage of drivers to be posted! will be as determined
annually by FMCSA and published in me &A,"r UkIljoLr in January (At
the effective date or this policy, the minimum annual peicernages are ten
I101 percent of the average number ofdriver positions for alcohol totaling,
and fifty 1501 percent of the average number of driver positions for drug
testing) Selections ofdrivers us be tested shall be done by anientifically
valid method ficaprovides half each driver will have equal chance of
being selected each time the selections no made While tidriver is
subject to testing, the driver's name is never removed front the pool,
Thus, a driver ought be selected more than once during ayear
4
st Random nad% %vill be unannounced; the dates for random tests will
be spread throughout the year.
b A driver who is selected for random testing will be required to
report to the collection site immediately upon notification ]fine
driver engages in conduct had does not lead to a collection as soon
as possible after notification, such counsel grill be considered as a
refusal to submit to ii test The driver will be in a duly status (paid)
from the time he/she leaves to go to the collection site until the
time he/she returns from the collection she
c A random test for alcohol shall be scheduled to occur onlyjust
prior to, during, orjust after performing a safety -sensitive function,
or at any time that the driver is in readiness to provide safely -
sensitive Function
d A random test for controlled substances can be scheduled at any
time the driver is on duty, and is net related to when the driver is
performing safety -sensitive function
0 An employee who has been selected for random testing must be
tested in dial testing period FMCSA regulations do not permit a
replacement to be named fire selected employee is unavailable
for testing
f BCRC will administer its own random selection through a
scientifically valid means, and will maintain all necessary records
as required in 49 CFR §382, Subpart D, Recordkeeping
BCRC shall require an employee to submit to drug and/or alcohol testing
for reasonable suspicion %viien a supervisor has reason to believe that an
employee has engaged in Prohibited Conduct (See Section VI (B),
based on ab,,mslicn ofine craid.yee', appearance,
behavior, speech, and/or body odor, Such employee conduct must be
witnessed and documented to asupervistur who has been trained in
compliance with FMCSArotes and regulations. Should asupervisor
determine that an employee might have violated a prohibition orthess
the employee must submit 1.1.1mg De.cumeminvon's
required for both drug and alcohol reasonable suspicion Documentation
her a drug test must be signed and submitted to the DER within 24 hours,
and for an alcohol tusk, prior to the conducting or the alcohol test
An employee who is represented by a bargaining wit and %%,no is
requested by a supervisor to submit to reasonable suspicion testing may
request to have a union representative present, provided fire employee,
signs a consem for the supervisor to nobly the union representative or the
request for testing When the suspicion involves drugs only, the employer
will allow a maximum ofone-half hour to, the union representative 1a
as rive and accompany the employee through the collection process When
prohibiledcanduel ASubstance Abuse Profiesional (SAP) may,
however, order testing for both alcohol and commiled substances
Each employer reserves the right to withhold a Final decision regarding
reinstatement are driver until after a negative result of's Relum-ho-Duly
lest no been received
A positive Return-uh-Dray text result is not considered L. be .n employ.',
second positive lest, and is therefore not came for termination An
employee may schedule additional Return-lo-Duly tests, until such lime as
a negative result is obtained
Under independent authority, an employer me), require dial are cost of
Return -to -Duty tests will be home by the driver,
6 Edb
A driver, who remms to do[), alter complying with the recommendation of
a Substance Abuse Professional and after providing a negative result on a
Retum-to-Duty test, is subject to unannounced follow-up alcohol handler
controlled substances testing as directed by the Substance Above
Professional..Follow-up testing may be scheduled fare period crop to
sixty (60) months, and must include no Fewer thus six (6) tests to be
conducted in the first twelve (12) months after the employee's rerum-to-
duty dale Follow-up alcohol testing shall be conducted onlyjust prior to,
during, orjust after the driver's perfirman" of safety-sensi live functions,
or when the driver is in readiness to perform safen'-sensitive Function
Under independent ambustity, each employer may require that the cost of
all follow-up tests will be borne by the driver.
When an employer, under independent authority, has ferpormled a driver
From employment, the responsibility for any remaining follow-up tests
recommended by a SAP must be assumed by The driver's gaining
employer, provided the driver is offered employment as a DOT' -covered
employee with a new employer
If newly -hired driver is subject to follow-up testing due to a previous
violation while working for a previous employer, dial driver will, order
independent authority, be responsible for the cost of any remaining
follow-up tests at required by the Substance Abuse Professional, and such
costs, if not paid by cash or personal check, will be deducted from the
ifti,shr's next paycheck
E GDCRAL Tusitmo INFORMAriON (STANDARDS AND INI EORITY OF I HF-MmUNG
PROCESS)
I All tests shall be conducted as specified in 49 CFR §40
2 An applickull or driver has the right to request and receive from his/her
employer a copy of the lest result report on any drug or alcohol rest for which
he/she provided a urine or breath sample For alcohol test resmis, the request,
inwriting, should be addressed to the employer's DER For drug tusks, the
the suspicion involves alcohol only, or alcohol and drugs, the union
representative may be nolified, but because DOT requires alcohol testing
to occur in a timely trowel, the half-hour time allowance will not apply.
If the union representative is not immediate]), available, he/she may have
to arrange independent transportation to the collection site, as regulations
do not allow for delay of the collection process
Observation and testing for reasonable suspicion for controlled substances
use can occur at any time the employee is on duty, and is not related to
when he/she performs safety-sensifivo Functions A trained supervisor's
determinatimt will he based rot observafrcm of an employee's appemrancr.,
behavior, speech and/or body odor, and on chronic and withdrawal effects
ofdrug uire An employee who is suspected of controlled substances use
must be immediately withdrawn from safety -sensitive fivisclums and is
required to undergo drug testing
Observation and testing for reasonable suspicion for alcohol use on occur
onlyjust prior to, during, orjust after the employee's performance of
safety -sensitive Function, or at any time that the employee is in readiness
to provide safety -sensitive function A [rained supervisor's determination
of suspected alcohol use will be based on observation ofan employee's
appearance, behavior, speech and/or bsxh, odor An employee who is
suspected of alcohol misuse must be immediately niflidruiva from safety -
sensitive functions and cannot return unless an alcohol test has been
conducted with an alcohol concentration that measures less than 0 02, or
(if no test is conducted) nveray-four (24) hours have elapsed since the
reasonable suspicion determination occurred
An alcohol lot for reasonable suspicion should be administered %% ithin the
firial two (2) hours, or within the next six (6) hours, but no more than eight
(8) home after the initial observation occurred
if alcohol testing is not conducted within two (2) hours, the reasons the
test wasnoi ,,chicb,cl must be documented Ir.1-hol wsling their is not
conducted within the next mr, (6) hours, the reasons the lest was not
conducted must again be documented After eight (8) hours, there will be
no more attempts to conduct an alcohol Fear If no alcohol test is
conducted at all, the driver cannot perform safety -sensitive functions until
liverin-four (24) hours have elapsed following the original determination
of reasonable suspicion of alcohol use If this emplo3 es must return to
safety -sensitive functions before 24 hours have passed, lie/she may do so
only after taking mother alcohol lest and receiving a lest result beloo,
002
fWkjr".p94kfitXJWW
Under DOT regulations, berate a driver can be considered for
reinstatement after having engaged in prohibited conduct (Section V1, [B],
the driver must provide a negative Relturn-to-Duly drug
reaper alcohol test, depending on the subsuarce(s) involved in the
request can be either verbal or in writing, and addressed to the MRO
3 Collection and testing procedures will be such as to protect the driver and the
integrity of due testing process, safeguard the validity of the lost results, mid
ensue that lest results we olubakilid to the correct driver.
4 When an employee is required to obtain a medical examination by a medical
specialist (related to the employee's inability to provide a sufficient breath or
urine specimen), under each employer's independent authority, the umpkiyu
will be required to fen, the costs associated with that examination
r. Ai.civnor.TESTING AND THE REx)RTfN() OF TEST RF.SLJLJ S
I Alcohol tests (screening and confirwahiry) will be performed on a device that
appears on the National Highway Traffic Safety Adminusl ration's (NI UFSA)
Conforming Product,, List (CPL) and that meets the DOI", testing
requirements
2 When a specific Fine for an employee's lest has been scheduled, and [lie
employee does not appear at the collection site at the scheduled time, the BA,r
will —fact the employer's DER, who may determine that the employee has
refused to be lashed
3 For alcohol toting (screening and a breath sample will be
collected and analyzed by a Breath Alcohol Technician (BAT) using an
Evidential Breath Testing device (EBT) For the screening lest, asafiva
sample may be collected by a Screening Test Technician, using an Alcohol
Screening Device
4 If the result of the screening lest indicates an alcohol concentration orO 02 or
greater, a Breath Alcohol Technician (BAT) will perform a confirmatory ro[,
no less than fifteen (15) and no more than thin), (30) minutes after the
completion afire screening test
5 If the cerrifinumbily, lost is positive (0.04 and above BrAQ, the Breath Alcohol
Technician (BAT) shall immediately notify the employer's DER,
6.. Random, reasonable suspicion and follow-up alcohol testing must be
conduchidjust before, during, orjust after a driver performs safely -sensitive
function, or at any time the driver is in readiness to perform safety -sensitive
functions
T. Results of additional tests arranged by an employee, or requested by a medical
practitioner, will not beconsidered. This includes testing of blood samples,
hair samples, DNA, or any other testing methods or protocols
O. CoN,rROLI.F.'DSLJBSIANCi,.sTFsiiN(i,iiiE.MROPROCI,.SSAM)REPORErNC.OF'['ESI
RESULTS
I All controlled substances testing specimens shall be analyzed by a laboratory
that is approved by the
U. S. Department of Health and Human Services (DRIHS), and that observes
applicable chain -of -custody procedures
2 When aspecific lime Par an employee's lest has been scheduled, and the
employee does not appear at the collection site in the scheduled lime, the
collection silo personnel will contact an employer's DER, who may deterraire,
dick the employee has refused to he tested
At the collection site, the employee will be required to empty his/her pockets
and display the items in them A refusal to empty all packets as directed by
the collector will be a refusal to he tested
3.. If a mine specimen temperature is outside the acceptable range (90 — 100
degrees F ), the collector must immediately require a new collection, "der
direct observation An employee who refuses to provide a second specimen,
or who refuses to parrim a direct observation collection, will be determined to
have refused to be tested
4 Thu DHFIS-approved testing laboratory shall forward the results of every drug
test to a B(CRC-designated Medical Review Officer (MRO) for review
5 If a lest reach is negative, the result will be reported by the MRO to the
employer',, DER
6 If a lest result is non -negative, the MRO shall contact the driver, and will give
the drive, an oppoi-huni) in discuss the leg nsimils prior tomaking a fine
decision to verify a lest result The MRO shall inform the driver rd'his/her
right to request a retest of the same specimen at a different DIHIS-approved
laboratory, Such request raw[ be made by the driver within seventy-two (72)
hours of the alriver having been informed of a verified positive test result,
unless the driver presents information to the MRO documenting that serious
illness, injury, inability to comsel, dhe MRO, lack of actual knowledge of the
verified positive rest, or other circumstances una, oidabb, pre, ended the
employee from contacting the MRO within 72 hours Ifthe lvIROconcludes
that there is alegifirrede explanation for the employee', failure to contact the
MRO within 72 hours, the MRO shall direct that the reanalysis of the
specimen be performed
7 An employer, under independent authority, will require that the cost aft, risheu
shall be home by the drive,, and will be deducted Pisan the driver's subsequent
paycheck
9 If. rider making 3 riumimns in a 24-hour period the MRO is not able to contact
a driver, the MRO shall report to the employer's DER that all , casonable
efflarks have been made to contact the driver, without success The DER shall
than. as; soon &a practicable, ask the driver to contact the MRO within the next
72 hours, and shall apprise the MRO that the driver has been so notified
9 The MRO may verity atesl as positive without communicating with the driver
if
a The driver expressly declines the opportunity to discuss the test
result; or
1, The employs,'., DER has successfully made and documented
an identified person as directed by the specific, written consent of the driver authorizing
the release of the information..
'drill. Lqly �rrNLLS()Lp
When a DER receive, act!" at's driver', verified positive drug or alcohol Lest result, m
pre verified refusal to be tested, orrifany olherviololion of FMCSA rules, (See Section
Vhff, the driver will be immediately removed from all FMCSA
safety -sensitive battalions (see definition), including driving, and will not be permitted or
required u, return to performing safety -sensitive functions until or unless the employee
successfully completes the romm-lo-dia), process that is required by FMCSA under this
regulation. This includes a supervisor or manager having actual knowledge (see
definition) that a driver has used alcohol on duly. or a controlled substance on dinv,
without authorization
'I he employer's DER will provide the driver with the phone number of BCRC'%
Employee Assistance Program, who will in turn direct The driver to qualified SAPS,
Under independent authority, each employer will accept cremations conducted only by
EAP-.commended SAPS. Additionally, DOT regulations donot permit memployee to
obtain asecond SAP's evaluation Iran employee does obtain a second SAP's opinion,
DOT'regulations do not permit an employer to acknowledge that second opinion
ffan applicant intends to reapply to an employer., or to mother transportation incident),
employer, ha/she must first successfully complete a SAP assessment and
recommendation
A drive, whe refuses to submit to testing will midst each employer'., independent
authority, be terminated from employment, and will be provided with times, addresses
and phone number of qualified SAPS and ofarrailable treatment resources
DOT rules mid regulations do not permit an employer to consider a driver for retain to
sal'a - v-sersitive functions until the driver has been evaluated by, a qualified SAP, and has
complied with the SAP's recommendation(s) For rehabilitation and/or education
If and when possible, an employer may reassign a driver to non -safety -sensitive functions
while he/she is following the SAP's recommended prognon of.ashefirwo and/or
education However, due to the safety -sensitive nature ofmost offlinjobs; in this
inificary, no employer on guarantee that these accommodations can or will be made
For employers with more than 50 enuiloy—s, a driver who is following a SAP's
recommendation of treatment may seems benefits under Farm]), and Medical Leave Act
(FILMA), provided he/she is eligible for such benefits.. Under separate authority,
employers imp, pennif a driverwho has been removed from safety -sensitive functions
under these regulations to request to receive earned time off anchor vacation lime benefits
during the assessment mope, makurnart phase
Up.. receiving . SAP's report rofecreplierve with i-seruncestichifions, each employer will
arrange for the driver to take a Relum-lo-Duly test In order for the employee to return to
safely -sensitive functions, this Relum-to-Duly lost must have a negative lost result
Under independent authority, each employer will require that any costs incurred in regard
to services Provided by a SAP, or of treatment cantor education recommended by the
contact with the driver and instructed the driver to contact the
MRO and more than 72 boom have passed since the time the
employee was successfully contacted by the DER; or
c Neither the MRO nor the DER, after making all reasonable effarls,
has been able to contact the employee within 10 days of the date
on which the MRO receives the confirmed positive task result from
the laboratory
to If a ie%k is verified positive under the circumstances specified in #10 above,
the driver may, within 60 days, present to the MRO infitrinalion clocumenfing
that serious illness, injury or other eircurnesairces, unavoidably prevented the
driver from being contacted by the MRO m his/her employer's DER, or from
contacting the MRO, as applicable, within the times provided The MRO, on
the basis of such information, may reopen the veri ficali on, allowing the driver
10 present information concerning a legitimate explanation for the comforted
positive test. If' fie MRO concludes that there isalegitimate expimalion,the
MRO will declare the lost to be negative
I I When a required drug task (pre -employment, return -to -duty, or follow-up) is
canceled, the employee will be required to ineurnalimeh, take mother test. with
minimum advance, notice
12 Resells of additional leaks that are arranged by an employee, or requested by a
medical practitioner, will not be considered. This includes testing of blood
samples, hair samples, DNA, or any other testing methods or Protocols
13 When a drug fork is reported &a positive dilute (or negative dilute), the lest
result will be considered to be positive (or negative), respectively
14 H; in the MRO's opinion, the employee provides information that medically
disqualifies the employee from providing salm) -sensitke functions, or that
ecusas, the MRO 1. have concern about the employee's ability to s.Jely
perform his/be, safety -sensitive duties, the MRO is required to give that
information In an employer's DER After ve,ir, ing the lestresults- the MRO
.shall report the tom results in a confidential rearms, 1. The employer's DER
15 Verified lost results will be reported by a. MRO as either positive, realuak a,
invalid, refused, or canceled
VAL TEST RECORDS
Records perfaining to the alcohol and commiled substances testing program shall be
maintained in secured and looked confidential filar, in the office oFeach employer's DER.
Access to these records shall be limited to each employer's management oRicicla on a
rused-co-know, basis
Records and report data shall be maintained as specified in U.S. DOT's rules and
regulations
Except as required by law or extu essly authorized or required by FMCSA's rules and
regulations, driver testing irmarmedion maintained under the *shot and controlled
substances testing program rift be released only to the driver (on written request), or to
SAP, which are nor covered by a driver's insurance plan or by BCRC's Employee
Assistance Program, will be the responsibility of the driven
VVIuni . SAP .,quires c ch or to participate in a program of after", v, it,. driver's
compliance with that requirement will he monitored by the EAR or the SAP Under
independent authority, any costs related to this monitoring will be the responsibility of
the driver 'llieaftercare requirement wilt beincluded inaRetum-lo-D.tyAgreement,
which must be signed by the driver. Failure to sign such agreement, or failure to adhere
to the to= of a silmed agreement, will result in termination of employment
NX. EDUCATION AND TRAINING
Any employee ,,he has questions or concerns regarding this policy may seek clarification
and ffird— details from his/her employs,'., DER,
1, —NIP I PUMA
BCRC provides a comprehensive Employee Assistance Program (EAP) for employees of
of cordraclor participants in the association Our EAP is accessible by a loll -free phone
number. Employees are encouraged to access the PAP for comodannin and assistance
regarding non -work -related problems that are or could potentially affect their ability to
perform theirjobs satisfactorily or safe]),, including problems with alcohol auseere or the
use of controlled substances.
Educational materials, including a copy of this policy, and information concerning the
effects of alcohol and controlled substances use an an individual's health, work and
personal life, signs and symptoms of an alcohol or controlled submarines problem (the
employee's or a uoworkri's) and available methods for intervening when an alcohol or
controlled substances problem is suspected, will be provided to each employee
Additional materials may be requested and arawers, to questions about the materials may
be obtained by ecociaing his/her employer'. DER.
Attendance at training programs will be mandator), for supervisors and other employees
involved in administering the drugla1c.hol lesifirg program
Supervisors who are designated to determine cbeffier or not reasonable suspicion exists
and who then order a DOT FMCSA-covered employee to undergo testing under FMCSA
rules and regulations, will receive at least 60 minutes of training on recognizing alcohol
misuse, and at leak 60 minutes of training on recognizing controlled substances use
training shall cover the physical, behavioral, speech, and performance indicators of
probable alcohol noisome and use ofoontrolled substances
All supervisors who participate in training will be given a certificate of completion of
such training The original cerfificare will be kept in Company records, and a copy will
be provided to each supervisor for his/her own records, when requested
DRUG-FREF, WORKPLACE EDUCATION
BCRC employers are committed to a Drug -Free Awareness program for all employees
Each employer wfil use that program in an ongoing educational effort to prevent and
eliminate drug said alcohol abuse that may affect the workplace The Drug -Free
Awareness program will inform employees said their families about the dangers of
slash,,] and drug abuse I. the workplace, of the employer's alcohol said drug policy, the
availability of treatment for employees who voluntarily seek such assistance (including
the Employee Assistance Program}, and the consequences imposed by the employer on
emitcyces, who violate the alcohol and drug policy,
SELF -IDENTIFICATION PROGRAM AND POLICY
BCRC encourages drivers who recognize that they may have a problem with drugs and/or
alcohol to seek assishanco, for resolving, that problem before they have a DOT violation
due to a positive lost result or because they engaged in other DOT prohibited conduct
A driver who admits to a drug and/or alcohol problem will not have a DOT violation
lie/she will be given an opportunity to obtain a chemical use assessment from BCRC's
Employee Assistance Program (EAP) Prior to die assessment, however, each employer
will require the driver to sign a release orimmminfion that will enable that employer's
DER to receive the results ofthe assessment, and to receive subsequent reports refined to
the assessment, and the driver's successful completion of all recommendations for
assistance
The following conditions rimat, apply to the driver's self -admission:
• 'The driver's admission correct be made during his/her on -duty time limust occur prior
In the driver's reporting for duly on any particular day,
• Thu driver's admission cannot be made in an attempt to avoid a required DOT ding rest,
• Under 49 CFR Part 392 121, DOT' requires the employer to remove the driver from
safety -sensitive functions, including driving
• When the employer is satisfied that the driver has complied with the EAP's
recommendations for assistance, the employer will return the driver to safety -sensitive
functions, provided Ifian:
c Prior to returning to qafely-sensifive functions, the driver will be required
to provide a negative DOT drug and/or alcohol test result, and
a After being returned to safety -sensitive function, the driver will be subject
to follow-up a.-DOT'testing. as pormissibla, by BCRC', policy For non-
DO`rdmg and alcohol testing
A driver who self-idernifies, under this policy, and who then rails to comply with the
EAP's recommendations will be considered to have engaged in conduct prohibited in, the
DOT in 49 CFR Put 382, Subpart B, and will not be permitted to relum to safety -
sensitive function until helibre, has successfially complied with the SAP return -to -duty
proms
Each BCRC employer will adhere to the following terms, in accordance with 49 CFR
Part 382 12 1:
ACKNOWLEDGEMENT AND AGREEMENT FORM
FOR
CONTRACTOR PARTICIPANTS WHO ARE CONTRIBUTING MEMBERS
OF
BUILDING AND CONSTRUCTION RESOURCE CENTER (BCRC)
Contractor Participant:
'Phis acknowledges the receipt ofDCRC', Drug and Alcohol Policy m compliance with -
El 49 CFR Pan 382 (FMCSA)
El 49 CFR Pan 199 (RSPA)
In addition, I understand that as an employer who is subject to federal requirements, laws and
regulations related to misuse of alcohol and use of controlled substances, I sanresponsible for all
requirements of c:nmplfance with those rotes.. Runderstand that mycompany issubject loD(YI'-
levied sanctions and fines for non -compliant services Asanemployer, lagree to:
a Provide a copy of this policy to all current employcesm,ho are subject lo these miss
• Require each employee to sip an Acknowledgement ofReceipal of this policy; an
employee who refuses to sign will be removed from safety -sensitive functions
Give each applicant an opportunity to review Ike policy at the time of application for
employment, and will sign a fiamn acknowledging that he/she has seen the policy,
Arrauge for each manager/supervisor to receive training as reignited by die regulations of
the transportation mode that apply to the employees he/she supervises, and to maintain
documentation of the training in the managenisupervism's file
• Maintain all files and records as specified in the regulations, including a file that
identifies all managers and administrators who have responsibilities related to this
program, and the nature of those responsibilities
Maintain a current list craft employees who are subject to testing under these regulations,
and immediately inform BCRC of newly -hired and terminated employees within two (2)
days of the date of occurrence
* Promote the Employee Assistance Program (EAP) as a reliable and confidential resource
for employees who recognize that they may have personal problem related to drug
and/or alcohol use
* Seek assistance, clarification and guidance from EdCRC when questions and problems
arise related to the ishrunigralion of this program
* immediately notify BCRC of non-compliance problems and issues (krav%vii or potential)
when they are discovered
No advemejob action will be taken against a driver who admits to drug and/or
alcohol use mile, the terms above
A driver who self -identifies under this program will be given reasonable time to
obtain the required assessment and assistance Under independent authority,
DCRC requires the assessment proem., to be initiated within three (3) days of the
ddviu's disclosure
• A driver who complies with all requirements, and who complies satisfactorily
with the EAP's recommendations for assistance, will be permitted to return to
safety -sensitive functions.
• A driver who cooperates and successfully complies with this program will not be
considered to have hod a DOT violation of prohibited conduct under 49 CFR Part
382, Subpart B
1`11INDRUGAND A LCOHM POLICYISNOTANEXIFLOMENY CONMCY;
ORAN 01"FiEfit OFANEALPLOVAIEN] CONTAUCT.
..... .. . .. . J . .. ... ... ....
... .. ...... .. . .. r P.n . . ....
- - ----- - - ----------------
ACKNOWLEDGEMENT OF RECEIPT
OF
DOT DRUG AND ALCOHOL POLICY AND TESTING PROGRAM
FOR
WALSH & KELLY, INC.
..... . .......
I acknowledge that K have received a cop), of the DOT Drug and Alcohol Policy for WALSH so
KELLY, INC,
I understand that it is in), responsibility to read the policy in its entirety
I understand that as an employee of WALSH & KELLY, INC, I araniquinal to abide by the
rules and regulations established by [his policy, and that I am subjml to consequences if K violate
the poliry.
I understand that the policy may change to comply v,ilh federal and state laws, and that I may
obtain a current copy offlo, policy at any time, dining busyness hours fi orn my employer's
designated employe, representative (DER)
I understand that if have any questions about this policy, or if need assistance or resources
related to alcohol andlor drug -related issues or problems, I may take those questions and
rin"IMS to my employer's DER,
Idameof Emplopee (print ',u u aiginers
Social Security No Date
51—g.awrc of Supervisor or Dkr.R— - — — --------- ----------
faseructions: D01'requires all DOT -covered employees to sign this acknowledgernmi form
The original of this fierin will bu retained in Inc v ployec',, file in compliance with DOT
regulations
An employee who refuses to sign this acknowledgement form is disqualified from providing
safety -sensitive function for WALSH & KELLY, INC
SUBSTANCE ABUSE POLICY
APPENDIX 3
[, lAPPLICANTS FOR DOT -COVERED POS T16Ni
I'l�!��Y.i lINFORMATION FOR...
OR, ".!.m...... ... ...........................
I
Federal law requires applicaras to indicate whether they have previously rid`tei,cl 10 be tested or
received a pastl.ive test result on any prcempkayancnt test far anp other 116"[' employer Please
provide this information below, II is a federal offense to falat£y pail inforznation.
I Gave NOT tested positive an a preempinyment drug test for any oprcr D<}T employer
in I.he past trvo years, nor have 1 refused to Tic tested. (irr.,please sign below, and
ramplcle the remuinder of this form.}
D Yes, l tested positive (or I refused to be tested) on a pre employnnau drug test r—nod-
DOT npl.y.r in the p..,l two y, n,', (ifs., lar...,nitc helaw, otrd do not va.nran)
Sigrirt—rAppli,anl Done
finch applicant f.r a DO"I'covered position at Emplcyer, alter being nol.ified IiYat he(she aitl be
alpercd ajoh. must be drug tested., in arcordancr, a ipr Federal eeynalalions 49CFRPurl 392 If the
test result is positive, or if the apptie.1 refuses to 'inarat I.. pre -employment test diaJob hTcr
vnil be o,othbawrs
We inuel have a negative test result in our ilk before we can request or allow in employee to
provide safety -sensitive fineelm for us
The .,.,it of the in hid s';ox.u.@ test and the -ol.ocni,) met will be paid by (Cornpany
Every applicant who pro, ides a positive lest result a ill have an oppeounny W speak with a
Medical Review Off— ab-nan, .—L use.fti—criplici. and r—in—unk,a drugs that
inighl -phar, the p.sni'e test ne.11
An applicant whose test result is positire maw. a ithio ir2 boors, neq,1 at In.,11- -n
"isv.sv The re lost will be e.adbieled .. the %ann. sample ., was provided Far ffie apilml lea,
and inusl be conducted by a different testing labecapin, that raccle [lie 'eq,oresionle of
—nitration DOT',, lesnalt —jai—ents
I he,, not tested poslike (a, refused to be anaid) on a DOT pro —pk,yr.rat drug teat, at any
ture in the inc,ms two yearn
Mysignature hot.,, —, that I have read this inamnial.., that I have had in. appralarilyb.
roviow. copy of(c..p..), N—) drug and alcohol analog policy, and thin if .m aff—d a
proW.., I cce-.1 to bring Icsted for drugs a, a -rdih- ofaraployrnew
Signature or Applicant Date
Agreement
is
BY AND BETWEEN
INDIANA CONSTRUCTORS, INC
LABOR RELATION DIVISION
And
LOCAL UNIONS
OF
LABORERS'INTERNATIONAL
UNION OF NORTH AMERICA
STATE OF INDIANA
DISTRICT COUNCIL
MARCH 1, 2012
Through
MARCH 31,2017
61 64
SUBSTANCE ABUSE TESTING PROGRAM
1. RI)II,lf7lb a.AT ENJEN 1,
All signatory Employers to this Agreement and the Union have a commitment to protect
people and property, and to provide a safe working environment The purpose of the
following program is to establish and maintain a drug free, alcohol free, safe, health),
work environment for all of its employees covered by this Agreement
mlm��
A Accident - Any event resulling in injury to a person or property to which an
employee contributed as a direct or indirect cause
U. Accredited Laboratory - A laboratory certified by the Substance Abuse and Mental
Health Services Administration (SAMI]SA) roarlesting of Prohibitive Items &
Substances
C. Adullecafican- To degrade a test sample by substitution or addition of other
ingredients in an effort to rawk the Presence of unauthorised drugs An adulterated
log shall be considered a positive lost
D Diluted Sample -Urine samples which the laboratory reports as unacceptable with
regards to measured levels of onsafinine or specific gravity will be considered diluted
samples The employee shall be required to provide mother urine sample for testing
E Employees All individuals who are covered by this Agreement, provided that
individuals referred for employment by
y the Union under the hiring provisions of the
Agreement are considered "Affilkarms" until they are hired and put to week by the
Emplo.% or
F '5-panel US DOT` Approved Test- - Describes a laboratory test winducLed by a
SAMHSA certified laboradiry for the presence of one or more of the five drugs or
classes ofdrugs described raider the definition of"prohmited items and/or
.,xibsurives" and listed in Section IV.I b of the ICI SAT Program,
G Incident An event which has all the attributes oran accident, except that no ham
was, caused to person or property,
11 "Medical Review Office, (MRO)" -The MRO is . licensed physician colon has
knowledge of substance abuse disorders and the appropriate medical training to
interpret and evaluate positive substance abuse rest reendis together with the
imlMduaf.s medical history and any after relevant biomedical information
MRO is the individual responsible for receiving laboratory requils
RE
individual', b—thyporimen in accordance with firden.] sunicharly; most open .
specimen analyzed by a breathalyzer listed on the US DOT', Conforming Products
List
111. CONFIDENTIALITY
A All parties to this program should encourage any employee with asubsiance abuse
problem to accept assistance in dealing with the problem All Forbes will take The
necessary actions to assure the problem is handled in a confidential manner.
If When a lest is required, the specimen will be identified by a code number associated
with a Chain of Custody Form to insure confidenficnity of the employee The
employee must witness this procedure
C Results will be reported to the Employer and the Union by the MRO
IV. RULES -DISCIPLINARY ACTIONS -GRIEVANCE PROCEDURES
A RULES -All employees must report to work in a physical condition that will enable
them to perform theirjobs in a safe and efficient mariner, Employees shall not:
1.. Use, possess, dispense or receive prohibited substances on or at the job site, or
during working boom
2 Report to work wide above tiro measurable amount of the following prohibited
sunslances in their system
DRUG OR METABOLITE
INITIAL TEST
CONFIRMATION TEST
DETECTED
(GCYMS)
Amphetamine
1,000 again
500 nismil
(includes Metharriphotarnme)
Cannalainoid
50 Rem]
15 ng/ml
(Marijuana, Hashish)
Cocaine
300 nrymb
150 ng/rib
Opiate: Morphine, Codeine
2,000 ng/nd
2,000 ng/rrJ
Phencyclidine (PCP)
25 ngmd
25 ng/nd
Ethanol (Alcohol)
04%w1vol
04% ",/vol
(enzyme assay)
(GC/FD)
I Nor Suitable for Testing A urine sample that the Medical Review Officer (MRO)
determines as not meeting the requirements for a valid lest After consuitalion blih
the employee, a relent may be required
I Premises- All conspormonjob site; for which the Employer has responsibility This
includes all job areas, offices, facilities, land, buildings, structures, and all company
vehicles used in the performance of covered work
K Probable Cause - Probable cause shall be defined as observable unnamed or erratic
behavior such as noticeable imbalance, incoherence, and disorientation
L. Prohibited hems and/or Substances - Prohibited substances include illegal drugs
(including controlled substances, look alike drugs and designer drugs), prescription
drugs used by one for whom they were not prescribed, drug paraphernalia in the
personal possession oforbeing used by an employee on the promises Also
prohibited are alcoholic beverages being consumed by an employee on the premises
M Random'fesr - An unannounced test pursuant to an objective method for selection
Cost of such testing will be paid for by, the Indiana Constructors, Inc Substance
Abuse Testing Program (ICI SAT Program)
N Rehabilitation Program -- An Employer approved confidential counseling son ice,
designed to help employees resolve problems that involve alcohol or drug abuse,
staffed by certified and credenthhed human services professionals
O. Reinstatement - Refers to the requirements that a person alto tested positive for
prohibited items and/or substances under die ICI SAT Program must salivIS before he
is eligible to return to work
P Retest- A second separate test necessitated by an adulterated or hilenlionalh diluted
sample or a test considered not suitable for testing A noW that is considered as an
adulterated or a diluted sample (another diluted imentionall) or unindailionalK), or
as a test not suitable for testing shall be considered a positive lost costs or retesting
necessitated by an unintentionally diluted and/or a rest considered nor suitable for
testing will be paid For by IhcICf SAT Program Costs of
s oreteefiarr retesting an
imenfionalb, diluted sample,,Ill be paid for by the individual
Q. Substance Abuse Professional (SAP) - A SAP is a licensed ph) sham or a licensed or
certified psychologist, social worker, employee assistance professional, or addiction
counselor (certified by the National Association of Alcoholism and Drug Abuse
Counselors Certification Commission) with knowledge of and clinical experience in
the diagnosis and treatment ordisordersr relating to alcohol and drug abuse
R. Test- Is defined as the collection ofan individual's urine specimen and the
subsequent 5-panel US DOT' analysis of that specimen, in accordance with federal
standards For alcohol, a test is defined as the collection and analysis arm
Im
New, drugs maybe added as they are determined lobe illegal or considered to be prohi In led
items and/or substances by mutual agreement
B DISCIPLINE -When fire Employer has probable cause to believe an employee is
under Inc influence of prohibited substance, for reason of safety, die employee may
be suspended will I test results we available ifinotell results are received after have
(3) working days, the employee, if available, shall berefurned to work with back pay
subject lothe lest restrini
If the lost results prove negative, the employee shall be returned to work with back
pay. In all other cases:
I Applicants ruling positive For drug are will nor be hired
2 Employees who refuse to cooperate with testing procedures will be subject to
immediate termination. Iran individual does not provide a suitable specimen
within two hours (2 boom), it will be considered a refusal and treated as a positive
lest result and the individual will be subject to immediate termination
3 Employees found to be in the possession offarohibiled items and/or substances
will be terminated
4 Employees found selling or distributing prohibited items and/or substances will be
terminated Employees who test above me measured amount offarohibiled items
and/or subehavisq as provided for in IV,I,b while on duty, or while operating a
company vehicle, will be subject to termination
5 First Posithe'lestResuft: 'Fire provisions below apply to an employee %%,no is
tested pursuant to this policy and who receives aposilive iscl result.
Consequence for First PosifiveTesl Recall: The employee is subject to
immediate rumination, upon notice to die Employer by the MRO, of the
positive lest result
b Reinstatement: Employee is not eligible for work until he no taken, at his
own expense, . "5-panel US DOT approved test, at .n approved embe and
the results of this lest have been analyzed by a SAMHSA certified laboratory
and the lest results must have been reviewed by an MRO and certified as
being negative for the prohibited hems and/or substances listed in IV I b said
the ICI SAT Program, Union and Employer have received the certified
negative fear results
c Sporadic Testing ofRoinithiled Employees: A reinsialed employee, who has
previously tested positive, is subject to unscheduled sporadic testing for one
year from the date of reinstatement Cost of'such testing dill be paid for In,
the ICI SAT Program.
6 Second Positive Teaul Resull: The provisions below apply to an employee who
has previously tested positive, and tests positive a second lime pursuant to such
random testing, sporadic Rating or any other testing under this policyz
a Consequence for Second Positive Test Resell: The employee is subject to
immediate lerminalion, upon notice to the Employer by the MRO, of the
positive lost result
b Reinstatement Employee is not eligible for work until he has, at his own
67 68
expense, been evaluated by an accredited SAP, successfully completed an
SAP recommended rehabilitation program and the SAP has written a letter
releasing the person to return to work and the ICI SA'[' Program, Union and
Employer have received Inc results of "5-panel US DOT' approved test, a
copy of the letter written by the SAP and a copy of the rehabilitation program
successful completion letter, taken at an approved clinic, analyzed by a
SAMFISA certified laboratory and the test results must have been reviewed by
an MRO and certified as being negative for the prohibited items and/or
substances listed in IV I b
c Sporadic *leslingorReinstated Employees: A reinstated employee, who has
previously tested positive, is subject to unscheduled sporadic testing for one
year from the data ofchislaternerit Cost of such testing will be paid for by
the ICI SAT Program
7 Third and Additional Positive Test Results: The provisions below apply to an
employee, who tests positive three or more times pursuant to such random testing,
sporadic testing or any other testing under this policy:
a Consequence rer'llawd and Additional Positive Teal Results '['he employee is
subject to immediate termination upon notice to Inc Employer by the MRO, or
the positive test result and he will that be eligible for reinstatement for a period
of six (6) months From date of the positive last
b Reinstatement Employee is not eligible far work until he has, at his own
expense, been evaluated b) an accredited SAP, successfully completed a SAP
recommended rehabilitation program and the SAP has written a letter
releasing the person to return to work and the ICI SAT Program the Union
and Employer have received the results of. "5-panel US DOT" approved test,
taken at an approved clinic, analyzed by a SAMFISA certified laboratory and
the last results must have been reviewed by an MRO and certified as being
negative for the prohibited items and/or substances listed in IV I Is
c Sporadic 'testing: A reinstated employee, who has pre, ionzy tested p.mi, e
three (3) or more times, is subject to unscheduled sporadic testing for two (2)
years from the date of reinstatement Cost orsuch testing will be paid for b)
the ICI SAT Program
C E — Employees using a proved bed medication which may
impair the perfamaturce or job duties. either menial or motor runclions must
immediately hire" their supervisor of such prescription drug use Forthe safety of
all employees, the Employer will consult with the employee to determine ira
reassignment ofduties isnecessary. If reassignment is not possible, the employee
will be relieved of duties until released &a fit for duty by the prescribing physician, at
which time the employee shall be reinstated to his former employment status if work
for which he is qualified is available at that time
]fine employee is tested and the last is positive, and the employee has not previously
informed the Employer of the use of prescription drugs, the employee may be
inhV2 The lost result of the split sample mot be released to the Employer within a
maximum of five (5) working days Irthe split sample test result isnegative, the
employee may be returned to work on the same job site providing work for which he
isqualified isstill available. Any employee who survexaddlh, challenges the
accuracy of a positive test result shall be reimbursed for his war for the second testing
and any time loss from work up to a maximum of five (5) work days Ifthe split
sample tests positive, than the employee shall be subject to immediate termination
Drug, and alcohol testing will he conducted by an accredited laboratory, and may
consist of either blood or urine tests, or both, in required..Blood tests (for drugs
and alcohol) will be utilized for post -accident investigation only if's urine or
breathalyzer real cannot be administered
VI. IDENTIFICATION CARD
A An ICI SA'[' identification card will be issued to each person who tests negative to a
valid test. The card will contain the Applicant's name, photo and a unique ICI SAT
database identification number. The ICI SAT cud will be valid until the employee
tests positive The employee shall cur), their valid P21 SAT cud whenever they are
on ajob Failure to produce The ICI SAT card on request In, the Employer or their
agent may cause the employee to be suspended until the card is presented or until it is
verified by the testing agency that the employee's last non was negative Replacement
of lost or damaged ICI SAT' card shall be at the employee's expense
B New hires, with an ICI SA'[' identification card If a. Applicant has a valid employee
ICT SAT card they will present the cud for photocopying to the prospective
Employer when they present themselves for employment The Employer shall have
the Light to further sulichne the ICI SAT cud by contacting the agency responsible for
insuring the ernployve'c ICI SAT cud is presently valid The Applicant will be placed
on the payroll and put to work pending receipt of the reach of the inquiry..
Employment shall be probationary and continued employment of the individual shall
be contingent upon the validity of the employee's ICI SAT card being verifiad,1hy
Employer shall have three days to validate the ICI SAT cud IFthe ICI SAT card is
invalid the employee will have no right to continued employment mid may be
terminated
C Mew hires, without anICI SAT card If the Applicant does not have a valid ICI SAT
card, employment shall be probationary and continued employment shall be
contingent upon successful passage of the drug and alcohol lost
D. When heated for any reason, the employee will surrender the ICI SAT cud to the
testing agent Ilthe testis negative, the employee's valid ICI SAT cud %hill be sent 10
the employee IF the test is positive, the ICI SAT card will not be returned
VIL REHABILITATION AND EMPLOYEE ASSISTANCE PROGRAM.
suspended for two weeks and is subject to unscheduled sporadic testing for six
months
D. QJ),'YANC.,L All intheins ofthis program shall beadjecl to the grievance
procedure spelled out in the Collective Bargaining Agreement
V. DRUG/ALCOHOL TESTING
The parties to this program agree that harder certain circumstances the Employer will had
that it is necessary for testing to be conducted for prohibited items wallor substances
pursuant to the following procedures
A A pre-employmenal cheig and alcohol last may be administered to all Applicants
without a valid ICI SAT identification card The Applicant will be placed on the
payroll and put to work pending receipt of the drug and alcohol test. Such
employment shall be probationary in the sense that continued employment of the
individual shall be contingent upon successful passage of the drug and alcohol last
B All employees shall be subject to random testing
C A Lost may be administered in the chant there is probable cause to believe that the
employee has reported to work under the influence pro prohibited item and/or
substance, or is or has been under the influence pre prohibited item and/or substance
whin, on flar,job; or the employee has violated this drug program During the process
of establishing probable came for testing, the employee no the right to request his
on -site slaward to be present, if available
D 'testing may be required iron employee is involved in a work place accident/incident
or injury
E Emplovete; may also be tested on a voluntary basis
F. Sporadic lesling as provided For in IV 2 may be required as part of's Follow-up to
counseling or rehabilitation for substance abuse, for up in a two (2)-year period Each
Applicant or employee to be tested will be required in sign a consent and chain of
cusno(ri form..assuring proper documerflabon and accuracy.
v Iran Applicant or
employee refuses to sign a consent form authorizing the lost, ongoing employment by
the Employer will be terminated
The employee shall be paid for the time lost for the following tests to be conducted,
only if the fact results are negative, Random, Post Accident, Incident, and Probable
Cause
The Employer will permit the employee who is required to take a drug test to obtain a
"split sample," and the employee may request the laboratory to send the "split
sample" to an thcocclied laboratory of his choosing, nt his own expense, a,, described
Employees we encouraged to seek help for a drug or alcohol problem before it
deteriorates into a disciplinary matter. Iran employee voluntarily notifies supervision that
he may have a substance above problem, the Employer may assist in locating a suitable
SAP and rehabilitation program for iremmeril The Employer will inform the employee
that medical benefits may be available under the Flea] in and Welfare Program For
benefit information, within Indiana, call 1-800-962-3158,
If Fragment necessitates time away from work, the Employer may provide For the
employee an unpaid leave of absence for purposes of participation in an agreed upon
treatment program An employee who successfully completes a rehabilitation program
may be reinstated to his former employment slates, if work for which he is qualified is
available at that time Employees returning to work after successfully completing the
rehabilitation program will be subject to drug tests without prior notice for a period of
one year A positive hear will then result in discipliner), action as previously outlined in
this program
Vill. COST
Except as previously noted the costs or the tests associated with the program will be paid
for by the Employer, The cost pre rehabilitation program and consultation with a SAP
will be the responsibility of the employee
IX. SVQSJ �AK,t AM61JES.AING PROGRAM,
A Each employer agrees to pay to the Indiana Consinaclors, Inc Substance Abuse
Testing Program ('FCI SAT") three ($0,03) cents for each how worked by each
employee working under this Agreement Each Employer who participates in the
ICI SAT Program is strongly encouraged to contribute to the Indiana Constructors
Industry Advancement Fund flCiAF)
B The cembi bution to the ICI SAT Program shall be deposited each month, or at regular
intervals as may be determined by the ICI SAT Prograrn, to the depository designated
by the ICI SAT Program and such contributions shall be reported on such forms as
may be designated by the ICI SAT Program
C The activities shall be determined by the ICI SAT Program and shall be financed
front the payments provided for herein The Employer expressly ratifies and adopts
the ICI SAT' policy. By execution orthis Agreement, the Employer ratifies all actions
taken by the ICI SAT Program within the scope of its authority
This Substance Abuse Testing Program has been ratified, signed and soared as of
by the
Negotiating Committee, Labor Relations Division of Indiana Consithactors, Inc
Dale Time
This Substance Abuse'lesling Program has been ratified, signed and sealed as of
by the Local Unions ofLianneW International Union of
North America State of Indiana District Council
AUTHORIZATION FOR CONSENTTO DRUG AND ALCOHOL
ANALYSIS
AND
AUTHORIZATION FOR RELEASE OF RESULTS
1, the undersigned
do heraby authorize the resting of my body fluids and/or breath for employment reasons and
understand and agree that the results of any such testing will be fumed over to the Employer and
the Union, further that the testing procedures will be limited to tests forpnombiled and illegal
drugs, and controlled substances and alcohol
I understand that the results of these tests map be used for employment and disciplinary
reasons and herel,vauthorize the release of such information from the laboratories in the
designated Employer and Union representatives
I further certify that any urine specimen collected from me is mine and not adulterated or
uttered I. any manner.
I hai c been ad% ised that matters affecting me relative to the interpretation or application
of the Drug Policy are subject exclusively to the grievance and arbitration procedure under my
Collective Bargaining Agreement
Signature of'Prospective employee/Employee
do
LE'l-FER OF UNDERSTANDING FOR THE AGREEMENT by and between Indiana
Consimclors, Inc Labor Relations Division and the Local Unions of Laborers' International
Union of North America State of Indiana District Council concerning the Substance Abuse
Testing Program
In regard to the Substance Abuse Testing Program, it is understood between the parties that
under this program, the following guidelines will be followed when a person tests positive
First Positive Test
Results in immediate lentrumpion
For Reinstatement:
Provide anegative "5-panel US DOT" test result as interpreted by an MRO.
Sporadic testing for one (1) year following reinstatement
Second Positive Test
Results in immediate lermination
For Reinstatement:
Be evaluated by an SAP
Complete an SAP -recommended rehabilitation program
Secure written release from the SAP to return to work
Provide a negative "5-panel US DOT" test result us interpreted by an MRO.
Sporadic testing for one (1) year following numnalemerif
Third and Additional Positive Test
Results in immediate lerrumalion; not eligible for reinstatement for six (6) months
For Reinstatement:
Be evaluated by an SAP
Complete an SAP-recornmended rehabilitation program
Secure written release from the SAP to return to work
Provide a negative "5-panel US DOT" test result as interpreted by an MRO.
Sporadic locking for [%%,a (2) Years following reinstatement
FURTHER it is understood that any costs associated with the SAP, MRO, Rehabilitation
Program, and testing required to be reinstated, are the employee's responsibility,
74
Im
14
Qmu"�j tni t11a,1IYa A 1rpfy > w,Au ty f,Wjjv,0-' List of Certified Companies
,,,,
M of Certified Coirnjpanes
Download the cornp I ete I! sting of or brows a the list. below.
Also, sea'5.7.0.
East ulxdatedJuly 1, 2019
A 0 C D. I JE fi 1i I K L M N Q E Q R S. 1 U.
.V. W X. y z
A
Updated July 1, 2019
ACCREIMT111) SURIETY AND CASUAILTY COMPANY, ll'JC.
(NAIC #26379)
BUSINESS ADDRESS: PO Box Orlando, 1-1 32814
PHONE: (40 7) 629 2131 ,
UNDERWRITING I.1101"M ION bl: K684,000,
SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT, DE, DC, FL, GA, HL ll), IL, IN, IA, KS, KY, L&
ME, MD, MA, MI, MIN, MS, MO, Toll, NE, NV, NH, NJ, NIV, NY, NC, ND, 011, OR, OR, PA, RI, SIC,
SD, I-N, IX, UT, VT, VA, WA, WV, WI, WY.
INCORPORATED IN: Florida.
ACIE American Insurance Company
MAW H)7F'671
PHONE: (717) 657 9671,
UNDERWRITING LIMITATION b/� $6,267,000.
SURFIYUCENSES c,f/: AL, AKA7, AR, CA, CO, CT, DE, DC, FL, CA, HI, ID, C, IN, I& KS, KY, LA,
ME, MD, ION MI, MN, MS, MO, IAi, NE, NV, NIT, NJ, NIIA, NY, NC, NID, 011, OK, OR, PA, ril, SC,
SK), TN, TX, 01, Vi, VA, WA, WV, WI, WY,
INCORPORATED IN: PermsyVano
AILIL AIMIERICA 11INSUJItAIMCIE COMPANY
(NAIC #20222)
BUSINESS ADDRESS: P.O. BOX 351, VAN WERI, OH 45891 0351
PHONE: (419)238-1010,
UNDERWRITING LAMITAIION bl: $15,980,000.
SURFIY LICENSES c,fl: AZ, AIR, CA, CO, C1, GA, ID, Il., IN, A, KY, ME, MD, MA, 1141, IIAIN, MS, MI,
NV, NH, NJ, NIA, NY, NC, OH, OK, OR, PA, SC, TN, IX, LIT, VT, VA, WA, WI
INCORPORATED IN: Cfilo.
A11legheny Casuallty Conipany
(NAIC N 13285)
BUSINESS ADDRESS: One Newark Center, 20th Floor, Newark, NJ 07102.
PHOIN[: (800) 333 41 6T
UNDERWRITING LIMITATION b/: $2,365,000,
SURETY LICENSES c,f(: AL, AK, AZ, AR, CA, CO, CF, DE, DC, I-L, GA, HI, 11), U., IN, A, KS, KY, LA,
ME, MD, MA, MI, MN, MS, MO, M F, NE-, NV, NH, NJ, NM, NY, NC, ND, ON, OK, Ott, PA, PR, RI,
SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY.
INCORPORATED IN: New Jersey.
AILILIEGIHEINY SUOUIETY COMPANY
(NAIC #34541)
BUSINESS AIDDRESS: 4217 Steubenville Pike, Pittsburgh, PA 15205,
PHONE: (412)921 3077.
WSINESSAIDDRESS: 436 Walnut Street P.Cl, Box 1000, Philadelphia, PA 19106.
MHONE: (215) 640-1000,
UNDERWRIT114G LIMHAJIOIN Jr!: $501,673,000,
SURETY LICENSES c,fl; At., AK, AZ, AR, CA, CO, C 1, DE, DC, FL, GA, HI, W, It., IN, IA, KS, YC LA,
ME, MD, IVIA, MI, MN, MS, MO, M F, NE, NV, NH, NJ, NM, NY, NC.;, ND, C. OK, OR, PA, PR, RI,
SC, EiD, TN, TX, Ul, VT, VA, WA, WV, WI, WY,
INCORPORATED ft Pennsylvania
ACIE Property and Casualty limurance Company
(NAIC 920699)
BUSINESS ADDRESS: 436 WALNUI STREEI, 1' 0 Fax 1000, Philadelphia, PA 19106,
NJONE: (215) 640 1000
UNDERWRITING LIMITATION bl: $290,236,000.
SURETY LICI NSFS cfl: C AL, AK, AZ, AR, CA, CO, C1, DE, DC, FL, CA, HI, ID, It., IN, A KS, KY,
LA, ME, MD, MA, 101, TAN, IMS, IiMO, Mi, NE, NV, NH, NJ, NIIA, NY, NC, ND, 011, OK, OR, PA, PR,
RI, SC, SID, TN, TX, UT, VT, VA, WA, WV, WI, WY,
INCORPORATED IN: Pennsylvania,
ACSIIAIR INSURANCE COMPANY
(NAIC U22950)
W.)SINESS ADDRESS: 30 SOUTH ROAD, FARMINGTON, CT 06032
P1 fONE: (860) 415 8400,
UNDLIRWRII ING LAMITAT ION bl; $2,278,000,
SURETY LICENSES c,fl: Al., AK, AZ, Art, CA, CO, CC D1, DC, FL, GA, HI, ID, R, IN, IA, KS, KY, LA,
ME, MD, MA, MI, MN, IAS, MO, MT, NE, NV, NH, NJ, NM, NY, NC, NE), 011, OK, OR, PA, PR, RI,
SC, SID, TN, TX, U I, VY, VA, VVA, W%1, WI, WY.
INCORPORATED IN: Illinois
Aeglis SecqfiirJty Ilinuirance Comparly
(NAIC #33898)
BUSINESS ADDRESS: P.O. Box 3153, Harrisburg, PA 17105�
SURETY LICENSES (:,f/: PA
INCORPORATED IN: Pennsylvania
ALILIJIF'.11) Property and Casualty Insurance Company
(NAIC ff42579)
W.J.'SINESS ADDRESS: ONE WEST NATIONWIDE BAND., 1 04-701, CMAIARUS, 01143215
2220,
PHONE: (515) 508-4211.
UNDERWRT ING LIMITATION h(: $5,957,000
SURETY LICENSES rjC AL, AZ, AR, CA, CO, CT, DE, DC, FL, GA, ID, R, IN, A, KS, KY, ME, MK),
MI, MN, MS, MO, MT, NE, NV, NH, NIIA, NY, NC, ND, ON, OR, PA, RI, SC, SD, TN, TX, UT, VT, VA,
VVA, WV, WI, WY,
INCORPORATED IN: Iowa.
AIIJJed World InSwrance Compairty
(NAIC #22730)
BUSINESS ADDRESS: 199 Wal:ev Street, New York, NY 10038
PHONE: (646) 794-01;00,
UNDERWRITING LIMITM ION bl: $50,985,000.
SURETY LKINSES cj/: AL, AV, AZ, AR, CA, C:O, CT, DE, DC, FL, GA, HI, 0, It, IN, IN KS, KY, M.
149F, MD, INA, MI, V19, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC, ND, CH, ON, OR, VIA, PR, RI,
SC, .SD, TIN, TX, UT, VT, VA, WA, WV, WI,.
INCORPORATED IN: New HampshIrc,
AIJIfled World Sjjpecuallty IInsuirance Conipany
(NAIC 416624)
BUSINESS ADDRESS: 199 WATER S1 REET, NEW YORK, NY 10038,
PHONE: (646) 794-0500.
UNDERWRITING ITIOPAlION b/: $34,151,000
SURETY LICENSES c,ff: AL, AK, AZ, AR, CA, CO, CT,
DE, DC, Ft., GA, lil, ID, IL, IN, IA, K5, KY, LA,
ME, MD. IAA, ML MIN. MS, MO, IVIT. NE. NV, NH. NI. IqM. NY, INC. ND, OH, OK OR PA, PR. RL
Sc, -,[:I, I N, TX, UT, VT, VA, WA, WV, WI, WY,
INCORPORATED IN: Delaware
AIMCO Insurance Company
(NAIC A 19100)
BUSINESS ADDRESS: ONE: WEST NAIIONWIDE BILVD, 1-04-101, COLLIM BUS, OH 43215 -
2220,
PHONE: (51S)5084211 x 2,
UNDIAWRITING LIM IIAT ION bl: $20,136,000
1iI.JRLTY LICENSES c,f/: At, AS, AR, CA, CO, C1, DI::, DC, H., GA, ID, 11, IN, IA, KS, BY, ME., MD,
MI, IMIN, MS, MO, MIT, NE, NV, NM, IVY, NC, ND, 011, OR, PA, RI, SC, SD, TIN, IX, Ut, \n, VA,
WA, WV, WI, WY,
INCORPORAIED IN: Iowa.
AIMIERICAIM AIL'TIERNATIME IIINSU11MINCIE CORIPORA11ION
(NAIC #19120)
BUS IN ESS ADDRESS: 555 COLLEGE ROAD LAST PO.BOXS241,PRINCEION,Nj095A3.
11HONF: (609) 24.3-1200
UNDERWRITING L111AIRATION bl: $21,434,000
CA, ML, IVVD, MA, MI, MY, MIS, MO, MT, NE, NV, NIL NJ, NM, NY, NC, 1,413, OH, OR, OR, :1A, PR,
RI, SC, SD, IN, TX, Ul, VI, VAS WA, WV, WI, WY
INCORPORAILD IN: Delaware
Aurnerlcaril Autoirnobile Insurance Company
(NAIC 921849)',
AMERICAN BANI 1t'4SU1LqNC11:. COMPANY 011:1101RIII1DA
(NAIC #10111)
BUSINESS ADDRESS: 11222 QUAIL ROOST DRIVE, MIAMI, FL 33157 - 6596
PHONE: (305) 25.3-2244,
UNDERWRITING; LIMITAI ON b/; $6.3,715,000
MR, IVA, IVYL AN, ME, MO, MI, HE, NV, NO, IVJ, NM, NY, NC, ND, 011, OK, OR, PA, RI, SC, SO,
TIN, TX, UT, VI, VA, WA, WV, WI, WY..
INCORPORATED IN: New Harripshire,
American Guarantee and ILIalWhity Insurance Company
(NAIC #26247)
BUSINESS ADDRESS: 1299 ZURICH WAY, LIN FLOOR, SCHAUMBLJRG, It. 601.96 1056,
PHONE: (847) 605 6000.
UNDERWRITING LIMIIAIION b/: $18,556,000
SURETY LICENSES c,fl: AL, AI(, AZ, AR, CA, CO, CO DE, DC, FL, GA, HI, ID, IL, IN, IA, KS, BY, LA,
OF., MID, IVA, MI, MN, MS, MO, EAT, NE, NY, NH, NJ, NM, NY, NC, ND, ON, OK, OR, PA, RI, SC,
SID, IN, TX, UT, VT, VA, WA, WV, WI, WY,
INCORPORATED IN: New York,
American Home Assurance Company
(NAIC 919380)
BUSINES'S ADDRF1,S:175 WAr LR SI RU 1, 18 Fid FLOOR, NF:W YORK, NY 10038
PI IONF: (2.12) 770 7000
UNDERWRII HIG LIMITATION b(: $592,154,000
SURE TY LICENSES c,f/: AL, AK, AS, AC CA, CO, CT, DE, RE, I L, GA, lil, ID, L, IN, A, KS, KY, LA,
ME, MD, MA, MI, MN, IAS, MO, MIT, NE, NV, NH, NJ, NM, NY, NC, NID, OH, OK, OR, PA, RI, SC,
SO, TN, TX, I.-H, VT, VA, WA, WV, WI, WY
INCORPORATED IN: New York,
American Insurance Counpany ffllhe)
(NAI( #21 8S /)'
AIMIER11CAIN ROAD INSURANCE COMPANY (I HIE)
(NAiC #19631)
BUSINESS ADE)RE.SS:Ore Arrierir.ariRoad, IIAD76f)O,K)eark)oiri,Ml48126 2701,
PHONE: (313).337-1102,
UNDERWRITING LIMPIATION b/: $32,378,000,
SURETY LICENSES c,fl: AL, AK, AZ, AR, CA, CF), CT, DE, DC, FL, GA, HI, IS, IL, IN, A, KS, W, YLA,
(VIE, MD, MA, MI, MY, MS, MO, MT, NE, N\S NH, NJ, NM, NY, NC, ND, OH, OK, OR, PA, PR, RI,
SC, SO, IN, TX, OF VI, VA, VI, WA, WV, WI, WY
114CORPORAI ED IN: Florida,
American Casualty Company of ReadIng, Pennsylvania
(NAIC 42042.7)
BUSINFSS ADDRESS: 151 N Franklin St, CHICAGO, IL 60606,
PHONE: (312) 822 S000.
UNDERWRITING LIMITAI ION ol: $13,209,000
SURETY LICENSES c,fl: AL, AK, AS, AR, CA, CO, CT, RE, D(.., NIL, GA, III, ID, III, IN, IA, KS, KY, LA,
ME, MD, IVA, IAl, MN, ME, MO, MI, NE, NV, NH, NJ, NIIA, NY, PIC, ND, 011, OR, OR, PA, PR, RI,
SC, 5D, I N, TX, UP, VF, VA, WA, WV, WI, WY,
INCORPORATED IN: Pennsylvania,
AMERICAN COIN IT RACI OIRS IINdIDIEMINd11TY COMPANY
(NAIC A 10216)'
ROSINESS ADDRESS: 801 South Figueroa oa Street, Sulks 700, Los Angeles, CA 90017
PHONE: (310) 649-0990,
ONDFRWRIIING LIMITATION b/: $12,646,000
.SURETY LICLINSLS c,fl: AL, AK, AS, AR, CA, CO, CT, DE, PIC, FL, GA, GU, HI, ID, IL, IN, IA, KS, KY,
LA, ME, MID, MI, MY, ME, V0, MT, NIL, NV, NJ, NM, NY, ND, OH, OK, Olt, PA, RI, SC, ED, I N,
TX, UT', VA, WA, WV, WI, WY,
INCORPORAILD IN: California
American Fire and Casualty Company
(NAIC #24066)
BUSINESS ADDRESS: 175 Berkeley.`. 1 reel, Boston, MA 02116
PHONE: (GI 7) 35 7-91;00,
UNDERWRITING, LIMITATION hl: $4,130,000
SURETY LICIFNSES Cf/: AL, AK, AZ, AR, CA, CO, Cl, DF, RE, FIL, GA, ID, I., IN, VC KS, KY, LA, ME,
,URlLIY LICFNS[S c,f/: AL, AK, AZ, AR, CA, CO, DF, DC.:, FL, GA, HI, ID, III, IN, A, KS, KY, LA, MF,
MD, MA, MI, MN, ME, 100, IAA, NE, NV, NO, NJ, NM, NY, NC, ND, OI1, OR, OR, PA, RI, SC, SD,
I N, TX, U I, \n, VA, WA, WV, WI, WY.
INCORPORATED IN: Michigan.
American Souldheirri Insurance Counpairfly
(NAIC410235)
BUSINESS ADDRESS: P 0 Box 723030, Atlanta, GA 31139. 00.30,
PHONE: (404) 266-959%
UNDERWRITING ING AMIIA1 ION ol: $4,347,(100
SURETY LICENSES c,fl: At, A7, Ali, CO, DE, DC, FIL, CA, II, IN, KS, KY, MD, MI, MN, MS, 100, NE,
NJ, NY, NC, DO, PA, SC, IN, Ul, VA, WA, VVV, WI, WY.
INCORPORATED IN: Kansas
Aurnedcan Surety Company
(NAIC N31380)
BU'.ANESS AIDDRFSS: 250 East 96LJI Street, Suite 202, Indianapolis, IN 46240
PHONF: (317) 875 8700
UNDERWRITINC, LIMITATION bf: $1,00.15,000,
SURETY LICENSES c,(/: AL, AS, AS, AR, CA, CO, CT, DE, DC, R., GA, HI, 11D, IL, IN, IA, KS, KY, LA,
ME, ME), MA, MI, MIN, MS, 1\40, BIT, NE, NV, NO, NJ, HIM, NY, NC, ND, ON, OK„ OR, PA, RC SC,
SD, TIN, EX, UT, VT, VA, WA, WV, WY,
INCORPORATED IN: Indiana,
Arney-Isure Insurance Company
(NAIC #19488)
BUSINESS ADDRESS: P. O. Box 2060, Farmington Hills, I'M 48.3.31 - 3586,
N iONF: (248) 615 9000
UNDERWRIT ING LIMPATION b/: $24,326,000
SUREIY 1. JCFNSF5 c,fl: Al., AK, AZ, AR, CO, DE, DC, FI_ GA, 111, ID, IL, IN, IA, KS, KY, LA, MD,
MA, MI, MN, MS, MO, MIT, NE, NY, N1 1, NJ, NM, NY, NC, ND, OH, OK, OR, PA, PR, RI, SC, SID,
TN rx 111' In VA WA VAA/ WI M
NCORPQRAIED ft Michigan.
Arrierisure Mufluall insurance Company
(NAIC #23396)
BUSINLSS ADDFIESS: P, 0, Box 2060, Farivnington Hills, MIT 48331 - 3586,
III fONE: (248) 61 S-9000,
UNDERWRITING 1-11VIPAIJOIN bi: $71,716,000,
SUIRLTY Ll(-ENSLS cj/:AlL, AIK, AZ, AR, CA, CO, Cl, DE, DC, IL, GA, HI, ID, I., IN, IA, KS, KY, LA,
ME, MD, MA, MI, ION, IVlS, MO, M F, NE, NV, NIT, NJ, NM, NY, NC, ND, 011, OK, CIP, PA, FIR, RI,
SC, SID, IN, IX, UT, VI, VA, WA, iAV, Wl, WY
INCORPORATED IN: Midilgan.
Amerilsiare IPartiners Insurance Company
(NAIC; #7 1050�
BUSINESS ADDRESS: P O. Box 2060, Farmington I Tills, I'Al 49331 - 3586
III QNEt (248) 615 9000
UNDERWRITING LIMITAI ION b/: $2,3/2,000
SURETY LICENSES c,f/: AL, AK, AZ, AR, CO, DF, DC, 1: 1, CA, HI, ID, L, IN, IA, KS, KY, LA, DID,
MA, MI, MN, MS, 100, M 1, NE, NV, NM, INC:, ND, (DH, OK, OR, PA, W, SC, SD, I N, I)(, UT, VT'
VA, WA, VVV, WTI, WY
INCORPORAILD IN: IOidiiy,,,an,
Andlies insurairKe Company
(NAIC 910308)
BUSINESS ADDRESS: PO Box 902:31507, Starr Juan, PR 00902 -3507
PHONE: (787) 474 4900
UNDERWRITING LIMITNT ION E/: $3,350,000,
SURETY LICENSES c,fl: FIR
INCORPORATED IN: Puvio Rica,
Arch insturance Company
BUSINESS ADDRESS. 175 Cap pal Boulevard, Suite 300, Rocky [fill, C-1 06067.
1:11 iol\]E: (860) 258 3S00.
UNDERWRIT ING I MITAI ION El: $54,53 1,000
SURETY LICENSIFS c,fl: AL, AK, AS, A7., AP, CA, CO, CT, DE, DC, Fl-, GA, GU, HI, (D, If, IN, [A, KS,
KY, LA, ME, MD, MA, 101, MIN, MS, MO, Ar, NE, NV, NI -I, NJ, KIM, NY, NC, ND, 011, OK, OR, PA,
11R, RI, SC., SID, I-N, TX, UT', VT, VA, VI, WA, VVV, VVI, WY,
INCORPORATED IN: Texas,
Associated indemnity Corporatlon
(NAIC 121865)"
AtIandc Spedalty insurance Company
(NAIC #27154)
BUSINESS ADDIU.SS: 605 Ifigliway 169 Nurffi, 13LAfte 800, Plyinoud), MN 55441,
1:11 TONE: (952) 852-2431
UNDF RWRIT INC, 1-11MITATI60N b/: $61,920,000
SURETY LICENSES Cf/; AL, AK, AS, AR, (.-.A, CO, CT, DF, DC, FL, GA, III, 11.), II.., IN, IA, KS, KY, UA,
MF, MID, IAA, MIT, MN, MS, MO, VI 1, NF, 114V, KIT 1, r1j, NM, NY, NC, NO, 011, 0K, OR, PA, PR, RI,
SC, SD, ITN, X, UT, VT, VA, VI, WA, WV, WL WY,
NCORPORAI'ED IN: New York.
Auto. -Owners insurance Company
(NAIC #18988)
BUSINESS ADDRESS: P.O, 9OX30660, LANSiNG, MI 0909 - 8160,
PRONE. (517)323 1200,
UNDERWRITING LIMIfNI ION IEP $1,101,760,000,
SURETY LICENSES cjl: Alf, AZ, AR, CO, FL, GA, ID, IL, IN, 1A, KS, KY, MI, MN, MIS, MO,NE, NV,
NM, INC, ND, 011, OR, PA, SC, 51), TN, UT, VA, WA, Wl,
INCORPOWST ED IN: Mid)(gan.
AXIS insurance Company
(NAIC #11 150)
M-S(NESS ADDRESS: I far borsid, 3, 210 Hudson Srrep.L, SuRe 300, JI.. RSEY CITY, Nj 0 7311 -
IT 0 7.
PHONE: (201) 743-40W
UNDERWRITING LIMITATION bl: $91,269,000,
SURETY LICENSES cj/: AL, AN, AZ, AR, CA, CO, CT, DE, DC, FL, GA, GU, III, ID, IL, IN, IA, KS, KY,
LA, ME, MD, MA, MIT, MN, IAA, MO, 1141', M L, NE, NV, NH, 1141, NM, NY, NC, ND, 01f, OK, OR, PA,
PR, Rl, SC, SD, IN, IS, IJT VT, VA, V1, WA, WV, WI, WY.
INCORPORATED IN:. Missouri
Arch Reinsurance Company
(NAIC #10348)
BUSINESS ADDRESS: 445 South R.rett, Sure. 220, P.O. Box 1988, Morristown, NJ 07962
1988
PHONE: (973) 898 9575
UNDERWRIT ING LIMITATION b/: $31,978,000,
SURETY LICENSES c,(/: AL, AK, AZ, AR, CA, CC), CT, DE, DC, FIT., CA, GU, III, ID, IL, IN, IA, Ks' Ky,
I -A, MID, MA, III, MIN, MS, 100, M1, NE, NV, NI f, NJ, NM, NY, ND, 011, OK, OR, PA, Rl, SC, SD,
TN, TX, UT, V I, VA, WA, VVV
INCORPORATED IN: Delaware,
Argonaut insurance Company
(NAIC #198011
BUSINLSS ADDIRIESS: 13100 Wordiaffi Center Drive Suite:. 290 Houston, Texas 77065
PI IONE; (800) 470-7959
UNDERWRITING 1_I MP'AI ON b/: $89,568,000
SURE TY LICENSES c,f/: AL, AT<, AZ, AR, CA, CO, Cl, DE, DC, FL, GA, GUT, I if, IT), IL, IN, IA, KS, KY,
LA, IME, TAD, MA, MI, MIN, 105, MO, MT, NIT., NV, NIL NJ, NIM, NY, NC, ND, OH, OK, OR, PA, PR'
Rl, SC, SID, rN, I'X, IA, VI, VA, VI, WA, WV' WIL VVY.
INCORPORIOED IN:, Illinois,
ASPEIN AMERICAN HIMSURAWIF. COMPANY
(NAICI W43460)
(NAIC 03/2/J)
BUSINESS ADDRESS: 11680 Great Oaks Way, Ste 500, Alpharetta, GA 30022
PHONE: (678) 746 9400
UNDERWRITING; I imi w ION bf: $55,899,000
SURETY LICENSES c,Q: AL, AK, AS, AZ, AR, CA, CO, (. I, ["IE, DC, FL, CA, 111, 11), IL, IN, IA, KS, KY,
LA, MI . MID, MA, Al, MN, MIS, MO, MIT, NE, NV, NH, NJ, NM, NY, NC, ND, 011, OK, OR, PA, Rl,
SC, ED, .IIV, TX, UT, VT, VA, WA, VVV, WI, WY
INCORPORATED IN: Illinois
AXIS Winsuraince Counpany
(NAIC #20370)
BUSINESS ADD FIESS: 11680 Grvm4 Oaks Way, Suite, 500, Alpharetta, CA 30022,
PI TONE: ((78) 746-9400.
UNDERWRITING LIMITATION bl: $96,705,0I0
SURETY LICEWWS cj/: AL, AK, AS, AZ, AR, CA, CO, CF, 13F, FL, GA, If[, 11.), IL, IN, [A, KS, dKY, LA,
ME, MET, MA, MI, MIS, MS, MO, 101, NE, NV, NI I, r4j, NM, NY, NC, ND, 011, OK, OR, PA, PR, RI,
SC, SD, TN, I X, U T', \(I, VA, VI, WA, VVV, VVI, WY,
INCORPORATED IN: New York
B
Bankers lirunAiraince Company
(NAIC #33162)
BUSINESS ADDRESS: P.O, BOX 15707, S f.. PET ERSBURG, Fl- 33733
PiONL: (727) 923 4000,
UNDERWRITING UMPATION El: $7,303,000,
SURETY LICENSES c,fl: AL, AK, AZ, AR, CA, CO, CT, DE, DC, FL, CA, 111, ID, IL, IN, IA, KS, KY, Uk,
ME, MI.), IAA, MI, 11AN, MIS, MC, IVI F, NIE, NV, Nfi, NJ, NM, NY, RTC, ND, 011, OK, OR, PA, Sc, SID,
ITN, T)( U-1, VT, VA, VVA, VVV, W1, WY,
INCORPORATED IN: Florida,
Bankers Standard Inwrance Company
(NAIC W18279)
BUS I NESS AD DIRESS: 436 WALNUT SI Rl;. L-7, 'r 0, Box 1000, Philadelphia, PA 19106
PHONE: (215) 640-1000.
UN D LRWIRil ING L.M411 A 110N Val,', $19,982,000.
SURILTY L CENWc,f/: AL, Al AR, CA, CO3 CT, IDF, DC, FL, GA, I I(, I D, IT, IN, IA, KS, KY, L.A,
ME, IVAD, MA, l Ill MIS, ll Il W., INV, NH, Il NM, ll ll ND, 0H, OK, OR, IPA, RI, SC,
SD, TN, TX, U I"„ VT, VA, VVA, WV, W, VVY,
INCORPORATEAD IN: Per hinsylvarlia
BeaAey lInsurance Company, Ill
(NAIL.: #37540)
13 IJ'.r I IN E SS AID D R 11: SS : 3 0 Ba Ue, r so n Part, Road, 'a rffi 6 ig, u., ri, C 10 6 032
F, V 10 IN E y860) 6 7 7 3700
UNDERWRITING LIMITATION l $17,291,000.
SURETY ll cj/:, All-, AK, AZ, AR, CA, CO, Cl, DIL, DC, f L, GA, III, ID, IL, IIV, [A, KS, KY, I A,
ME, MI.), MA, MI, MIN, MS, ll M 1, NE, NV, NI I, NJ, NM, NY, NC, NID, 0111, OK, OR, VIA, IRI, 5(,
SDI), IN, TX, t.J]I,Vf, VA, VVA, WV, lNI,VVY
INCORPORATED IN: Conn eclicuL
Il Insurance Company
(WOC 032603p
BUSINESS ADDRESS: 47.5 SHAWBOAT ROAD, GRFENWICI i, (."1 06830
IN K)NE; (203) 542 3800
UNDERWRITING LOWITA ITOIN bl: $460,644,000,
SUIRIETYLACEll 1 5 cjP AL, All AZ, Ali, CA, CO, CF, I.A., DC, 111, GA, GU, HI, IID, I[., IN, IA, I(S, KY,
TA, NAE, MID, MA, MI, l IIAS, NAO, MT, ll NV, NH, 141, 10A, NY, NC, ND, OH, 011 OR, PA, PR,
RI, SC, SD, rN, FX, U I, V1, VA„ VI, WA, WV, VVI, VVY.
INCORPORA I ED Ill ll a
(NAIC 9?0095)
BUSINESS ADDRESS: 3700 Il SQUARE CIRCLE, DAVENPORT, IA52807,
PHONE.: (800) 47SA477.
UNDERViffUTING LIMITATION bl: $26,669,000
9JRI TY LICIENSES c,fl: AL, AK AZ, AR, CA CO, CT, DE, DC, FL, GA, IID, IIIL, IN, IIA, KS, KY, LA, ME,
Il ll SARI, IrAK MS, hA0, NIT, NE, NY, NI, NIM, NY, INC, NID, OH, OK, 011 ll RI, '.SC, SD, TIN,
TX UT, Vf', VA, WA, dAk WI, VVY
wourDiwED, IN: Illinois
BOND SA IFEGUARID INSURANCE COMPANY
(NAICN27081)
11 USIN FS5 All R I SS:: 10002 Ywl l Road, Sulte 100, Loulsvi lie, IKY40223 2979
1111 IONE: (615) 553 9500
UNDERWRITING LIMITAI ION Val,', $4,IS5,000.
MIL, 11AD, NAA, MIN, MS, MO, ll Il IW, NH, NJ, (VIM, INC, ND, 011, OK, M, SC, SID, rN, TX, UT,
VT, VA, WA, WV, IAI WY
INCORPORATED ft 1.k".jrh Dall
Boil Insurance Company
(NAIC 912965�
BUSINESS ADDRESS: P.O, Box 6, Florham Park, NJ 07931
PHONE: (973) 177-7000
UND ERwi:uING LIPAIFATICAN JV: S366,000
sljrRE n(LICENSES c,Y: [A., NJ, NY, 11A,
INCORPORA I HON: Il Jersey,
Boston IInndemnIty Company, Inc.
(NAIC #30279)
WJSINESS ADDRESS: 800 Gfnsner Suke 600, Hoil rx 7702.4,
BeirkIley Il Insurance Company
(NAIC429580],
BUS I NESS ADD R ESS: 110 IIBOX 9190, DIES VOIN ES, IA 50306 9190
PIl 101l (515473.3000
UNDERW(UT ING IUIl IV: $75,794,000,
SURETY LICENSEcjI: AIL, AK, AZ, AR, CA, U), Cl, D11, IDC, FL, GA, fil, I11), IT, IN, IA, KS, KY, 11 A,
WE, MID, MA, 1\46 MIN, IMS, Il MI, NE, NV, ll NJ, ll NY, NC, IND, OH, OK, OR, PA, RI, SC,
SID, .IN, TX, UT, VT, VA, VVA, WV, VVT VVY
INCORPORATED ON: IWAfa
Berksll Hatil Hornestiate Insurance Compail
fll #20044)
BILPSINESS ADIDRESS: 1314 DoUplas Weer, Suit, 1300, Omaha, NE 69102 .1944
PHONE: (402)393-7255
UNDIEWNRI I ING LIMITA ION lb/: $149,531,000.
SURETY LICENSES r,f/: AL, AK, AZ, AIR, CA, CO, CT, D11.11 X, '11., GA, I UP Ill IL, IIIV, IA, KS, KY, LA,
ME, MD, ll W W Il MO, ll NE, INV, INK N.1, NNA, NY, NC, IND, CH, OK (DR, PA, RI, SC,
SID, IN, TX, IT V 1, VA, WA, WV, WI, WY
INCORPORATED IN: ll
BerkshIre Hathaway Sll Insurance Company
(NAIC 422276)
1944,
PI MINE: y402) 916 3000,
UNE)ERVVIRITINC, LIMITATION l $348,040,000,
YJRE1Y CICENSES c.fl; Al AK AZ, All (::A, (10, C r, D!EDC, FL, CA, 111, ID, K., IIN, A, KS, KY, LA,
ME, Il MA, MI, MIN, MS, MO, 1A `, NE, NV, NMI, NJ, DIM, NY, NC, ND, 011, oll OR, 111A, RT S(
SID, IN, TX, UT, VI, VA, W, WV, WI, VVY.
II IlED IN: Nebraska
BQTCO GENERAL INSIl CORPOIJkATION
LANDERWRIIIIING LIMITATION W: $2,565,000
SURETY LICENSES cjl; AL, A7, AIR, Cl, DE, 13C, FL, GA, IID, IN, KS, KY, J. , MY_', MA, MN, l MT,
IN 11.I, NV, INC, N D, 0 K, Il S D, 'IN, VVV
INCORPORATED IN: South Dakota
BderfielJd Insurance Company
(NAIC 81(1993)
9424.
I'll -NON(::.. (800) 226 3224
(DINIDERWRITING LIMITATION IN: $93CIl
SURETY LICENSES cjP AL, AIR, 11, CA, MS, TN.
INCOIRPORAIII.I.) IN: Aisslssippi.
BIRlITKH AIMIEROCAN IINSUUNCE', COMPANY
QNAIC H32875)
BUSINESS ADDIRESS: V1,D Box 1590, Dallas, TX 75221 -1590
I'l (214) 443-550f),
UNDERWRITING Lill Inl: $3,232,000,
SITIRENILICEIl D(
INCORPORATED IN: Texas
Rx'.k.1.9 Iap..
c
Cap kol Indemnity Carp oraflon
(NAIC 010472)
0900
ll (6013) 829 4200,
UNDERWRITING LIMITAI ION bl: $21,873,000
SURETY LICENSES c,fl: AL, AK, AZ, AR, CA, CO, C1, DE, DC, FIL, GA, If I, ID, IL, IN, IA, KS, KY, LA,
ME, MD, MA, MI, MIN, MS, 1VO, MT, NE, NV, NH, NJ, 111M, NY, NC, ME), GI I, OR, OR, PA, RI, SO
S D, I[ N, TX, UT, V1, VA, WA, WV, WI, WY.
INCORPORAT FID IN: Wisconsin.
Callpitoll Pireferred Insurance Counpairty, Inc.
(NAG # 10908)
BUSINESS ADDRESS: 2750 Cidancelloi sville M, Tallahassee, I-L 32312
PHONE: (850) 52 1-074rel
UNDERWRITING LIMITATION bl: $2,448,000
SURETY I ICFNSFS c,fl: Fl, GA, SC
INCORPORAI ED ft Florida
Carolina Casualty Insurance Coutripany
(NAIC 010510)
BUSINESS ADDRESS: PO BOX SUBS, DES MOINES, IA 50306 .9190
PHONE: (904) 363 0900
UNDERWRI TING LIMUIC ION bl: $10,753,000
SURF TY I [CFNSFS c,fl: At, AS, AZ, AR, CA, CO, CT, BE, DC, Fl., GA, III, ID, II.., IN, A, KS, KY, LA,
MF, MD, MA, MI, MR, MS, ISO, MI, Yl , NV, N11, NJ, NM, NY, NC, 11113, ON, OR, OR, PA, RI, SC'
SD, TN, D(, U if, VI, VA, WA, WV, WL WY
IN( ORPORAI FD IN: 1,.)w,,
Centenniall Casuallty Company
(INAIC 934568)
BUSINESS ADDRESS: 2200 Wooduest Place, Suite 200, Birmingham, Al.. 3520,
PHONE: (205) 414 2600,
UNDE.RWRI PING LIIAITAYION bl: $1,735,000
SURETY LICENSES cj/: At.
BUSINESS ADDRESS: 34200 Mound Road, Starling Heights, MI 48310
PHONE: (800) 201 0450 x 3400
UNDFIRWRITING LIMITATION bl: $1 B,6315,000
SURETY LICENSES c,f/: AL, AS, AR, CA, CO, CT, DE, N., GA, 11), L, IN, A, KS, NY, I A, MF, MD,
MA, MI, MR, MS, MC, MI, NE, NIX, 141, NIX, NY, NC, ND, ON, OK, OR, 11A, R!, SC, SD, TN, TX'
U T, VT, VA, WA, WV, VVI, WY
INCORPORATE IS IN: Michigan.
ClIKABIR IINUIIDEIhMINITY IINESORANICE COMPANY
(NAIC #12777)
BUSINESS ADDRESS: 202B Hall's Mill Road, Whkehouse Station, NJ 08989,
P1 IONE: is IS) 640-1000,
UNDIL.RWRITING 11 IMPATION E)A $17,620,000
SURFTY I JCENSFS c,fl: AL, AK, AZ, AIR, CA, CO, CT, DE, DO, 1-1, GA, Ifl, ID, II.., IN, IA, KS, KY, LA,
MF, MID, MA, ML MN, IMS, IVIO, MI, NE, NV, NH, N), 118A, NY, NO VI), ON, OR, OR, PA, RI, SC,
SID, Tel, FSC UT„ VT, VA, VVA, WV, WI, WY
INCORPORATED IN: New York
Cinciinulad CasuaJty Company (nie)
(NAIC #28665)
BUSINESSADDRESS: P.O. Box 145496, Cinchnnati3OFf 45250 5496
PHONE: (.,l 3) 810 2000,
UNDERWRITING I...IMP Al ION Ist: $39,8 1 0,000
St.)RFlYi.ICENSFSc,f(:AL, AK, AZ, AR, CA, CO, CT, DE, DC, FL, GA, HI, ID, lI..,IPA, IA, KS, KY, I..A,
ME, MD, MA, MI, MR, MS, IAA, Nit, 111.1, NV, Nil, NJ, NIM, NY, NC, ND, 011, OR, OR, PA, RI, SC,
SID, TN, I X, ET, VT, VA, WA, WV, WI, WY.
INCORPORATFD IN: OND,
CIHNCINIMAIIE 111MIDIElIVINIFIFY COMPANY, THIE
(NAIC #23280)
BUSINESS ADDRESS: P.(), BOX 145496, CINCINNAY 1, 01145250 - 5496
INCORPORATED IN: Alabama
C11:1101RAIL MUTUAL ONSUR.ANCE COMPANY
(NAIC N20230)
BUSINESS ADDRESS: PQ BOX M1, VAN WERT, Olt 4589Y - 0351
PHONF:(419)2381010
UNDFIRWRI] INC, I IMI 1A I[ ION h/: $64,982,000
SURETY LICENSES c,fl: Al, AR, CA, CO, CT, DF, CA, ID, K., IN, A, NY, IIAL, MD, MA, MI, MIN, MS,
MR, NV, NH, NJ, NM, NY, NC, OK OR, OR, PA, SC, TN, TX, U1, VI, VA, WA, W1
INCORPORATED IIIJ: Ohio,
CENTURY SURIFTY COMPANY
(NAIC #36951)
BUSINESS ADDRESS: 550 Polaris Parkway, Westerville, OH 43082
PHONE: (611) 895 2000,
UNDERWRITING L.IMIA)TON bl: $3,249,000
SURETY LICENSES c,fl: Al, OH, WV, WI,
INCORPORAILD ft (Adio,
Charter Oak Fire JuRsuirance Counpairly (It
(IIJAIC 425615)
BUSINESS ADDRESS: ONF TOWER SQUARE, HART IGIRD, (1-061F2,
PHONE: (960) 277-0111
UNDERWRITING I IMETAIION bl: $22,873,000
SURETY LICENSES c,fl: AL, AK, AZ, AR, CO, C1, DE, DC, FIL, GA, HI, 11), 11L, IN, A, KS, KY, LA, MF,
MI), MA, lull, MN, MS, MO, MI, NE, NV, NH, NJ, NM, NY, NC, ND, OH, OR, OR, P& 'R, It, SC,
51), TN,'TX, LIT, \n, VA, WA, WV, WI, WY
INCORPORATED IN: ConnecticuL
Cheirialkee Ilunsuulrance Counpany
(NAIL #10642)
"HONE: (513) 870 2000
UNDEAWRIIIING LIMITATION b/: $10,212,000
SURETY LICE NSFS cjf: Al, AK, A7, AR, CA, CO, CF, DE, DC, FL, CA, I I, ID, L, IN, IA, KS, KY, LA,
ME, MD, EAA, EAL MN, MS, MO, MT, RE, NV, Nil, NJ, NM, NY, NC, ND, OH, OK, OR, RA, RI, SC,
SD,'IN, N, IX, UT, VT, VA, WA, VW, WI, WY
INCORPORATED IN: Ohio.
Cinctirlinafi InsuiraurIce Counpany (The)
(NAIC V I Of, 77)
W.JSINESSADDRK.S5:P.C),BC)Xl4549(;,CINCINNAII,OH45250 1,496,
PHONF:(513)970-2000,
UNDERWRITING IAMUTATION El: $441,889,000,
SURETY LICENSES c,17: AL, AK, Al, AR, CA, CO, CT, DE, DC, FIL, GA, HI, ID, L, IN, IA, KS, KY, LA,
ME, MD, MA, MI, IVIN, MIS, NO, MI, NE, NV, NH, NJ, NIM, NY, NC, ND, 011, OK, OR, PA, I'R' RI,
SO, SE), TN, IX, UT, VT, VA, WA, WV, WI, WY
INCORPORATED IN: Ohio
C11ITIZEINS INSURANCE: COMPANY OF AMERICA
(NAIC #31534)
WJSINESS ADDRESS: 440 LINCOLN STREET, WORCESI ER, IVIA 01653 - 0002
PHONE: (509) K3 7200,
UNDERWRITING LIMITATION b/: $70,326,000
SURETY LICENSES c,fl: AL, AK, Al, AR, CO, CI, DE, DC, CA, HI, L, IN, A, KS, ME., MR, MA, 1111,
MR, MS, MO, MT, NE, NH, NJ, NIA, NY, NC, RD, 011, OR, PA, RI, SC, SD, 11% IX, u L, VI, VA, WA,
VW, WI,
(INCORPORATED IN: Michigan,
COLONIAL AMIE]RICAN CASUALTY AND SURETY COMPANY
(IVAIC: 434347)5
BUSINESS ADDRESS: 1299 ZURIC14 WAY, SIT I FLOOR, SCI IAUIIABURG, IL 60196 -1056.
PHONE: (847) 605-6000,
UNDERWR IT I NG LINT IT AT ION W: $2,286,000,
SURETY CLEINSES r,fl: AL, AK, AZ, AR, CA, C 0, C11 DE, SIC, FIL, GA, 111, ID, It., IN, IA, KS, KY, LA,
IIAE, MD, MA, MI, MN, ME, MO, IIAT, NE, NV, NI, NM, NY, NC, NID, CH, OR, OR, PA, RI, SC, ED,
IN, TX, U J, VT, VA, WA, WV, WI, VVY,
INCORPORATED IN: Illinois,
COLONIAL. SURETY COMPANY
(NAIC 4107E8)
BUSINESS ADDRESS! 123 1 ce [Boulevard, Suite 250, Woodcliff I.ake, 14J 07677
PIIONS: (201) 573 8788.
UINDFRVVIRA ING 1. IIIAIIATION El: $4,624,000,
SURETY LICIAqSES, c,(/: AL, AK, AZ, AR, CA, CO, CT, DE, DC, FIL, CA, GU, III, ID, 11, IN, IA, KS, KY,
LA, VK, ME), MA, MI, MN, VIS, MO, MR, MI, NE, NV, NH, NJ, NM, NY, ING, RID, ON, OK OR, PA,
PR, RI, SC, 1,D, IN, D(, UT, VT, VA, VI, WA, WV, WI, WY
IIRCORPORKT ED IN: Pennsylvania..
ContlnentM Casualty Compainy
(NAIC #20443)
BUSINESS ADDRESS: 151 N Franklin St, Cl HCAGO, IL 60606
PHONE,: (312) A22 1,000,
UNDERWRITING LIIAIJAI ION bl; $104/32,000,
SURETY I..ICLNSES c,f/: AL, AK, AS, AR, CA, CO, CT, DE, DC, FIL, GA, HI, IN, It, IN, A, AS, KY, LA,
ME, CID, MA, MI, IIAN, MIS, MO, IAT, NL, NV, NI 1, NJ, NM, NY, NC, IND, 011, OK, (DR, PA, PY, RI,
SC, BID, IN, IS, UT, VI, VA, VI, WA, WV, WI, VVY
INCORPORAIED IN: Illinois,:
COINIIINEINTAIL HERITAGE INSURAINICIE COMPANY
(NAIC #39551)
BILSINISS ADDRESS: 200 PARK AVENUE, SUIT 400, ORANGE VILLACA., 01144122,
PHONE: (877) 645 1871
UNDERWRITING LIMITATION bl: $2,S69,000
CoirePoInte Insurance Company
(NAIC 410499)
BUSINESS ADDRESS: PC) Boa( 81 2319, Bore Ratan, FL 334f31
PI IONF: (800) 782 9164,
UNDERWRITING LIMITATION bl: $1,412,000,
SURETY LICENSES c,rl: AL, AK, AS, AR, CA, CO, Cf, DI x, n.., GA, HI, IS, IIt, IN, IA, RE, KY, LA,
ME, MI.), MA, KILL IIAN, MIS, 100, TAT, NE, NY, NH, NJ, NM, NY, NC, NO, OEi, OR, OR, VIA, RI, SC,
SIEI, I N, TX, UT, VI, VA, WA, WV, WI, \AfY,
INCORPORATED IN: Delaware,
CUMIIS INSURANCE SOCIETY, IIINC,
(NAIC ff10847)
BUSINILSS ADDRESS: POST OFHCL BOX 1084, MADISON, W1 53701,
PHONE: (608) 23B S651,
UNIN:RWRI I ING I IMITAI101\1 b/: $89,491,000
':SURETY LICENSES cj/: AL, AK, AS, AR, CA, CO, C1, DE, DC, FL, GA, GU, HI, ID, R., IN, IA, KS, KY,
I A, ME, MR, IUA, TVsl, IIAN, IMS, MO, MT, NE, INV, NII, NJ, NIA, NY, NC, NET, OH, OR, OR, PA, PR,
RI, SC, SO, TN, TX, UT, VI, VA, VITA, WV, WI, WY
INCORPORATED IN: Iowa,
CILPIMIS SpecIalty Insurance Company, Inc.
(NAG #12758)
BUSINESS ADDRESS: Post Office Bo)(1 084, Madison, WI 53101,
WONE: (608) 238!,851,
UNDERWRITING LIMITATION W: $4,744,000.
SURETY LICENSES c,f/: AL, CA, CC DC, FL, GA, 111, 11), L., IN, IA, KS, KY, IIAD, MA, vil, MIN, MO,
Ilk, NV, NJ, NY, NC, ON, OK, OR, PA, SC, .SD, IX, J1, VA, WA, WI, WY.
INCORPORATED 1114: Iowa,
,ur, I r L", ", -, -, -, -, .... ...... ..
NI, ND, 011, PA, St:, SD, TIN, TX, UT, VA, WA, WV, WY,
INCORPORAI ED IN: Florida.
Contlinentall Ilunsuaralrice Conlipany (The)
(NAIC V35289)
BUSINESS ADDRESS; 151 N f ranklin St, Cl HCAGO, 11. GOGH,
PI IONF: (.112) V2 5000.
UNDERWRITING tIMITATION b/: $160,006,000
SURETY JCJ:NSFS CN: AL, AK, AS, AR, CA, CO, CT, DE, DC, FI., GA, GU, HI, ID, W, IN, A, KS, KY,
LA, KAE, MD, MA, MI, MN, MS, MO, IMP, MT, NL, NV, NH, N.), NM, NY, NC, ND, OH, OK, OR, IA,
PR, RI, SC, SID, YN, 1X, UT, VT, VA, VI, WA, WV, WI, WY
IN( ORPORATFD IN: Pennsylvania
CONTRACTORS II' ONIMING ANID INSURANCE COMPANY
(NAIC It.37206)
BUSINESS ADDRESS: 9025 N, Lindbergh Drive., Peoria, 11. 61615.
PHONE: (309) 692 1 000.
UNDERWRI I ING LIMITAUON El: $11,413,000
SURE:TY LICLINSILS .,f/: AL, AK, AS, AR, CA, CO, C 1, DF, DC, 11, GA, HI, 11), 11, IN, IA, KS, NY, I A,
W, LAID, MA, MI, MN, MS, MO, MT, NF, NV, N1 I, NJ, NM, NY, NC, ND, O@ 1, OR, OR, PA, RI, SC,
SID, 'TN,'IX, U1, VT, VA, WA, MI, WI, WY,
INCORPORATED IN: Illinois
Cooperadva de Seguras Muldples de Puerto lItico
(NAIC 418163)
BUSINESS AIDDRFSS: PO BOX 363846, SANJUAN, PR 009:36 - 3846,
PHONE: (787) 622 '357S x 2512
UNI)EIRWRIIING, LIMITATION b/: $12,545,000,
SURETY LICENSES c,f/: PR.
INCORPORATED llq: Puerto Rica.
11)
DeveJolpeirs Surety and Illnda unnity Company
(NAV: #12 7 18)
BUSINESS ADDRESS: " 0, BOX 19725, IRVIN [,CA 92623 9725
N IONE: (949) 263-3300
UNDERWRITING LIMITAIION Part: $10,140,000
SURELY LICENSES cjf: AL, AK, AS, AR, CA, CO, Cl, DE, DC, FIL, CA, HL ID, It., IN, IA, KS, KY, LA,
ME, IVID, MA, MI, MN, MS, MO, MT, NE, NV, NH, N), NM, NY, NC, IqD, OH, OK, OR, PA, RI, SC,
SD, TIN, TX, UT, VI, VA, VI, WA, WV, WI, WY,
INCORPORATED IN: California.
E.:
EimplJoyers Insurance Coirnpauly of Wausau
(NAIC #21458)
BUSINESS ADDRESS: 17S Berkeley!Areet, BosWn, MA 0211 G.
PHONE: (617) 3157-9500.
UNDERWRITING LIMITATION ILI: $150,955,000,
SURETY LICENSES C,(/: At., AK, AS, AR, CA, CO, CI, DR, DC, f 1, GA, HI, ID, H, IN, A, KS, KY, L&
IVE, MID, MA, MI, MIN, MS, M0, 101, NF, NV, NH, N1, NM, NY, NC, ND, OH, OK, OR, PA, PR, RI,
SC, ED, IN, IX, I.)T,VT, VA,Vl, WA, WV, WI, WY.
INCORPORATED IN: Wisconsin..
Employers MutuM Casualty Company
(NAIC 921415)
BUSINESS ADDRESS: P, O, BOX 712, DFS V10INIFS, IA 50306 0712,
RHONF: (515) 280 2511,
UNDERWRITING LIMITATION b/: $143,374,000,
St.) RE IY LICENSES c,[/: AL, MICAS, AR, CA, CO, CT, DIE, DC, IL, CA, I I 1, (1), IL, (IN, IA, KS, KY, LA,
ME, MO, MA, MI, IVIN, MS, INAD, NIT, NE., NV, NH, NJ, INIVI, NY, INC:, ND, 01 i, OR, OR, PA, RI, SQ
SD, TIN, TX, UT, VT, VA, WA, 'AN, VVI, VVY,
INCORPORAfED IN: Iowa,
Endurance Auneirican IInnsuurance Company
(NAIC 410641)
BUSINESS ADDRESS: 4 MANI IAT TANVILLE ROAD, PURCHASE, NY 10577
PI IONF: (914) 4(58 8000
UNDERWRITING I VIIIATION bk $54,690,000
SURETY I KTN!fl.'S Cf/: AL, AK, AS, AR, CO, DE, DC, GA, HI, li), 11, IN, IA, KS, KY, LA, MD, I4AA,
ME MS, M0, MIT, NE, NV, Nil, NJ, NM, NY, ND, MI, OK, OR, PA, RI, .,C, ED, 'TN, TX, I.FT, \n, WA,
vvv, WI, WY
INCORPORATED IN: Delaware.
Finduirance Assurance Corporation
(NAIC #11551)
BUSINI SS ADDRFSS: 4 MANIiXTIANVII Lf. ROAD, PURCHASE, IVY I OS/1.
PHONE; (914) 468 8000
UNDERWRITING LIMI I AT ION b/: $116,184,000
SURETY LICENSES c,f(: At, AK, AZ, AIR, CA, CO, CT, DL, DC, FIL, CA, GU, ill, 11), 11, IN, IA, KS, KY,
LA, I\AF, MID, MA, MI, MN, ME, MO, MI, NIL, NV, NJ, NO, NY, NC, ND, Oil, 0K, OR, PA, PR, RI,
W, SD, IN, TX, Uf, VT, VA, WA, WV, WY,
INCORPORATED IN: Delaware,
Eirle Insurance Company
(NAIC #26263)
BUSINESS AIDDRIESS: 100 dRiE. INSURANCE PLACE, ERIE, PA 16530.
PHONI,: (814) 870-n.00,
UNDERWRITING LIMITATION I:V: $37,647,000
INCORl'ORAfIFD ft Ohio
Executive Wsllc liadentinfty Inc.
(NAIC435181)
BUSINESS ADDRESS: 202B Hall's Mill Road, WIAKJiouse Station, NJ 08889
IIHONIL: (215) 640 1000
UNDERWRITING LIIVIITATIOIN bf: $15E,426,000,
SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, DE, DC, I L, CA, I it, ID, IL, IN, I& KS, KY, LA, ME,
IVID, MA, MI, ItAN, ME, MO, Mf, NE, NV, IqH, 111j, NM, NY, NC, ND, OH, OK, OR, PA, Ri, SC, ED,
TN, TX, UT, VT, VA, WA, M, WI, WY,
INCORPORATED IN: Delaware.
Exploreir Insuo,aince Company
(NAIC #40029)
BUSINESS ADDRESS: 11 0, BOX S09039, `..TAN EtEGO, CA 921 SO
PHONE: (8SO 350 2400
UNDERWRITING I INITAI ION BC $15,796,000
SURETY I CIFINSIES c,f/: AL, AK, AS, AZ, AR, CA, CD, CT, ISE, DC, FL, GA, 111, 11), 11, IN, IA, KS, KY,
LA, 101.., MD, MA, MI, ON, VIS, MC, I\A I, NE, NV, NJ, NM, NY, NC, OK OR, PA, RI, SC, SID, TIN, TX,
U 1, VT, VA, WA, WV, WI.
INCORPORAILD IN: California,
Barl-T.p Lq.p
F
Fair American Insurance and Reinsuiraince Counpany
(NAIC. 435157)
DUSINIFSS ADDRESS: One Ljbei[y Plaza, 165 Broadway, New York, NY 10006
PHONE'.: (212) 365 2200
UNDERWRITING LIMITATION W:$19,944,000
SURETY LICENSES c,f/: DC, IL, IN, KY, MI.), IVN, NY, NC, 011, PA, TN, VA, WV, WI.
INCORPORAI ED IN: PEumsylvania
Eullev liernnes INaalrth America insurance Company
(NAIC N20516)
BUSINESS ADDRESS: 800 Red Brook Flvd, Owings Mills, TAD 21117,
PHONE: (410) 753 075.3
UNDERWRITING I IMITATION b/: $11,842,000
SURIElY LICENSES c,W: AL, AK, AS, CA, CO, Cl, DIL, DC, CA, HI, 11.), L, IN, IA, KS, KY, LA, MI.),
MA, MI, Mill, MS, 100, NIT, NE, NV, NI 1, NJ, NM, NY, NC, ND, ON, ON, I1A, RI, SC, S.r), I N, TX,
U1, VT, VA, WA, WV, VVI, WY
INCORPORATED IN: Maryland
Eveirest Reinsurance Company
(BAR. #26921)
BUSINESS ADDRESS: 11,C) Box 830, Llbe.ay Comer, NJ 0/938 0830
PHONE: (908) 604-3000
UNDERWRITING LIMITATION b/: $365,059,000
`SURETY LICLINSLS cj/C A[, AK, A7, AR, CA, CO, (IT, WE, DC, I L, CA, [it, (1), IL., IN, A, KS, KY, LA,
Mi, MD, MA, IVI, MN, AP, IAO, IOP, Mf, W., NV, NH, NJ, NM, NY, NC, ND, 011, OK' OR, PA, RI,
SC, SID, TIN, TX, UT', \n, VA, WA, WV, W( WY
INCORANZATI-1) IN: Delaware
Evergreen Nationall Indemnity Compainy
(NAIC Y 12750)
ISU�,INIESS ADDRESS: 6140 PARKLAIND BIND, 5IF 321, MAYFIIFI 1) HIFIGI IIS, Oil 44124
PHONE: (440) 229 3420
UNDERWRITING LIMITATION b/: $3,443,000,
SLJREIY LICENSES Cf/: AL, AK, AS, AR, CA, CC), C1, DE, DC, I I., CA, ID, L, IN, IA, KS, KY, L.A, IVIE,
ME), IVIA, IVII, MIN, MS, I00, IVIT, NE., NV, Nil, NJ, INN, NY, NID, OH, OK, OR, PA, RI, SC, SD, IN,
IX, t.) T, V1, VA, WA, WI, VVY,
SURETY LICENSES c,17: At, At<, A7, AR, CA, CO, CT, RE, DC, FIL, CA, lit, ID, 11., IN, A, KS, NY, LA,
IME, MID, IMtA, MI, MN, IMS, MO, IIAT, NE, NV, NH, 14), NM, NY, NC, NI), OH, OK, OR, PA, 141, SC,
SE), IN, TX, UT, VT, VA, VI, WA, WV, WI, WY,
INCORPORKI FID IN. Nee Yoi k
Farmers Alliance IMuutuuM insittrance Counpainy
(NAIC #19194)
BUSINIESSADDRESS: P.0 F30X1401,M,:I:'licisoii,I<S67-160.
PIHONE(620)241 2200,
UNDERWRITT ING LIMITATION ION bu: $18,393,000
SURETY LICENSES cjl: CO, ID, IA, I<S, MN, MO, IIAT, NE, NM, ND, OK, ED,
INCORIFIC)RATID IN: Kansas
Fairimingtoin Casualty Company
(NAIC #41483)
BUSINESS ADDRESS: QNL IOWLR SQUARF, I iARTF(DRID, CI 06183
P1 IONIF: (860) 277-0111
UNIEtERWRITING LIMITKI-ION bC $28,62.1,000
SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, C 1, DE, DC, FL, GA, I It, 11), IL, IN, A, KS, KY, LA,
I'Al- MD, MA, Al, MIN, AS, MO, MI, NIE, NV, NH, NJ, NM, NY, NC, ND, CH, 01K, OR, PA, IS(, SC,
STD, TN, TX, Jf, VT, VA, WA, VW, WI, VVY,
INCORPOIYXI ED IN: Connecticut,
Fairmlland Mutuall Onsuirance Coryallpairty
(NAIC 413838)'
FCCII IIunsuulrance Company
(NAIC 410178)
BUSINLSS ALTEARESS: 6.300 Jnivrrsit:y Parkway, Sarasota, FIL 34240 8424
PI -ZONE: (800) 226-3224
UNDERWRITING LIMITATION 1)/: $55,070,000
SURETY LICENSEE CR: AL, AZ, AR, CO, DC, FIL, CA, IL, IN, [A, KS, NY, LA, IME), MI, IMS, MO, NE,
NC, OK OK, PA, SC, IN, T'X, VA.
INCORPORAI ED IN: Florida
Fedeirall Insimrance Company
(NAIC Y20281)
BUSINESS AIDDRUS: 202B Hall's Mill Road, WhRehouse Stal:ion, NJ 08889,
PHONE: (215) 640 1000
UNDERWRITING LAWAI ION IDI: $461,364,000,
SURETY LICENSES c,fl: AL, AN, A7, AR, CA, CO, CT, DE, DC, FL, GA, GU, 111, (1), IL, IN, A, KS, KY,
[A, ME, MD, MA, 101, MIN, IVIS, 100, IMP, MI, NF, NV, NJ 1, NJ, NM, NY, INC, ND, OH, OK, OR, IA,
PR, M, SC, SD, TIN, TX, Ul, VT VA, VI, WA, WV, WI, WY
INCORPORArFl) 1114: Indiana..
FEIDIEKATIED IMUITUAIL 111INSURANCE COMPANY
(INAIC #1393S)
BUSINESS ADDRLSS: 121 EASI PARK SQUARE, OWAI ONNA, MIN 55060
PI IONE: (50/) 4555200
,)NIDEi:iWRIrING I IMITAI ION Is/: $346,382,000,
SURETY I ICENSF; c,fl: AL, AK, AZ, AR, CA, CO, CT, DF, DC, 11, CA, ID, [IL, IN, 1A, KS, KY, LA, W.,
IVID, IVIA, K41, MIN, MS, IIAO, MIT, RE, NV, NI 1, NI, NM, NY, INC', ND, 011, OK, OR, P& R1, SC, SD,
'TN, TX, UT, VT VA, WA, Iffil, VVI, WY
INCORPORKI FD IN: Minnesota
111delity and IDelposk Compairty of Maryland
(NAIC #39306)'
BkJ5INI.SSADI,)RESS:1299ZI.JFiICHVVAY,lslifE:I,OOR,SCHAUM13LJRG,lI..60196 1056.
PHONE; (847) 005-6000,
UNDERWRITING LIMPATION IV: $27,371,000
SURETY LICENSE-S CV AL, AK, AZ, AR, CA, CO, Cl, DE, )C, 1:1, GA, GU, 111, 11), [IL, IN, IA, KS, KY,
LA, IIAL, AD, IVIA, "l, MN, MS, MO, IV1Iv, UP, NE, NV, INH, NJ, 114M, NY, NC, ND, OH, OR, OR, PA,
PR, RI, SC, SD, IN, TX, W, VT, VA, V( WA, WV, WI, VVY.
ii-linanciau racinc unsurance Loirnpany
(NAIC #.-31453)
BUSINFSS ADDRESS: 10 BOX 73909, CEDAR RAPID7, [A 52407 - 3909,
PRONE: (319) 399-5700
UNI)EWNRITING LIMITATION 1:1/: $10,176,000.
SURETY LICENSES rj/: AK, AZ, AR, CA, CO, FL, ID, IL., I& KS, MIN, MO, V1, NE, NV, NIA, NI:),
OK, (DR, !.SD, TX, UT, WA, W1
INCORPORATED IN: California.
Phreman's Fund Insurance Compauiy
(NAIC 421873)
BUSINILSS ADDRFSS: 22S W, WASHINGI ON STREET SUITE 1800, CHICAGO, IL 60606 3484
F11 IONE: (888) 466-7883,
UNDFRWRITING LIMITAI ION )/: $131,328,000
SURETY LICENSES r,f/: AL, AK, AZ, AR, CA, CO, CT, DE, ETC, FL, (V,, GU, HI, ID, IL, IN, IA, KS, KY,
LA, IVC, MD, MA, lUl, MN, MS, MO, IAA, NE, NV, IqH, NJ, NIIA, NY, NC, NO, 01H, OK, OR, PA, PR,
RI, SC, SID, I N, TX, LIT VT VA, VI, WA, WV, WI, WY.
INCORPORAIED ft California,
First Founders Assimiraince Company
(NAC # 12150)
BUSINESS ADDRESS: 6 Will Ridge Lane, Chester, NJ 07930 2486
PHONE: (909) 879 0990.
UNDERWRITING LIMIlAriON b/: $487,000.
SURETY LICENSES c,(/: 111j, NY,
INCORPORATED IIV. New Jersey.
First Insurance Corinpany of IHawaallll, ILtd.
(NAIC #41742)
BUSINESS AIDIDRESS: PO Box2.866, I lonolulu, Ill 96803
INCORPORATED IN: Illinois
11:111DIE11.37Y A141D WARAINTY 1114SUPAIMCIE COMPANY
(NAIC #35386)
BUSINESS ADDRESS: One Tower Square, Hartford, C7 06183,
III 40NE: (860) 277 0111,
UNDERWRITING LIMIFAI ON bl: $1,814,000
SURI. TY LICENSES c,Y: AIL, AN AZ, AR, CA, CO, CT', DE, DC, FIL, GA, 111, 11D, IL, IN, [A, K5, KY, LA,
ME, MD, IVIA, IMI, IIAN, IVIS, MO, MT, NL, NV, NI -I, NJ, NM, NY, NC, ND, 011, OK, OR, PA, RI, SC,
SD, TN, IX, UT, VT, VA, WA, WV, WI, WY
INCOVORAT ID IN: Iowa.
Fidelity and Guaranty IInsurance Underwrlteirs, IIInc,
(NAIC 925879)
13U.SINESS ADIDRUSS: One. lower Square, I farl,ford, C1 06183,
RiONE: (860) 277 0111,
UNDERWRITINC, LIMITATION :W: $8,892,000,
SURETY LICENSEE c,fl: AL, AN, AZ, AR, CA, CO, C 1, DE-, DC, 11, GA, [11, 11.), IL, IN, (A, KS, KY, LA,
MI., MD, MA, MI, MN, MS, 1\40, MIT, NL, NV, NH, NJ, NIVI, NY, NC, NJ), OH, OK, OR, ['A, RI, SC,
0, 1 N, TX, LIT, VT', VA, WA, WV, W( WY
INCORPORATED IN: Wisconsin
Finainciall Cauuallty & Suirety, IInc.
(v4AIC o3s009)
BUSINESS ADDRI! SS: 3131 East.side, Sure 600, P,.juston, Tx 77098,
PHONE: (800) 392 1604
UNDERWRITiNGLIMITAII0114 I/:V,KiXO
SURETY LICENSES c,fl: AZ, CA, CT, Dl:, FL, GA, D, IN, [A, KS, LA, MD, I'Al, MIN, MS, IIAO, MIT, NV,
NJ, NY, INC:, ND, 011, VIA, SC, SO, IN, IX, UT, VT, VA, WA, WV,
I NCORIFORATED ITN:. Texas,
PHONE: (809) 527 7777
UNDERWRITING LIKINIJON IV: $28,01.3,000
SURETY I KIF . LASES c,fk GU, 111
INCORPORATED IN: I iavvali
111irst Ulbeirty Jinsurance Corporation (The)
(NAIC #33588)
BUSINESS ADDM SS: 115 Berkeley Slu eet., Basl.an, MA 02116
PHONE: (617) 357-9500 X 4117T
UNDERWRIT ING LIMITATION bl: $2,267,000.
.SURETY LICI REES c,rl: AL, AK, A7, AR, CA, CO, CT, IN., DC, FL., GA, GLI, HI, ID, L, IN, IN KS, KY,
I A, ME, I'Al.), IVIA, Ivil, MIN, MS, MO, MT, NE, NV, NI -I, NJ, IUM, NY, INC, ND, 0H, OK, OR, PA, RI,
SC, SD, IN, TX, UT, VT, VA, V1, WA, WV, WI, WY,
INCORPORAII-D IN: Illinois
llimt Ne IInsulralnaeCrumpauny
(NAIC #10972)
BUSINESS ADDRESS: 42.4 WESIO'BRIEN DRIVE, SI-I.. 702, HAGAINA, GU 96910
PHONE: (G71 ) 477 8G13
UNDERWRITING LIMITATION b/: $1,332,000,
SURETY LICENSES C,fl: GU, 1\411.
INCORPORAI 1.1) IN:. Guaryt,
Frankenmuth IMutuall Insurance Company
(NAIC #13986)
BUSINESS ADDRESS: One Mutual Avenue, Frankeninuffi, Ml 48787 - 0001.
PHONE: (989) 652 6121
UNDERWRIT IING LIMITATION :W: $64,090,000
SURETY LICENSES c,f/: AL, AZ, AR, CO, CT, DE, FL, GA, ID, IL, IN, IA, KS, KY, LA, ME, IIAD, M&
MI, MIN, VIS, MO, MT, NE, NV, Nil, NJ, NIO, NY, NC, ND, OH, OK OR, PA, PI, SC, SD, I-N, IX, 01,
vr VA Mok Wit Val WY
INCORPORATED IN: Michigan,
mr'o"'Tp No
G
Generall Casualty Coumpany Of Wisconsin
(NAIC 424414)
BUSINESS ADDRESS: One QBF Way, Sun Prairie, WI 53E%
PHONE: (608) 825 Sl 60
UNDERWRITING LIMITATION b/: $18,041,000
SURE I IY LICENSE', cj/: At., AK, AZ, AR, CA, CO, CT, DF, DC, GA, HI, 11), 11 IN, IA, KS, KY, LA, AD,
MR, IN I, MIN, MS, IIAO, MT, NE, NV, NH, NJ, NM, NY, NC, KID, 011, OR, OR, PA, RI, SC, ED, I I'l,
TX, 1.) T, VI, VA, WA, WV, WI, WY
INCORPORATED IN: Wisconsin,
GeneraU Reinsurance Coirporafion
(NAIC Y22039)
BUSINESS ADDRLSS: 120 LONG RIDGE ROAD, STAMFORD, C1 06902 1843
PHONE: (2.03) 328 5000
UNDERWRITING LIMIIATCilkl b/: $1,055,014,000
SURE IY I..IC LNSES cfl:Al., AK, A7, AR, CA, CO, Cf, DE, DC, HL, GA, I), [I., III, V, KY, IA, MI.,
MID, MA, 101, MIN, MS, IiAO, MIT, NE, NV, Nil, Ni, NIM, NY, INC:, ND, Oil, Or, MC PA, RI, SC, SD,
TIN, TX, LJI, VT, VA, WA, WV, WI, VVY,
INCORPORAl ED IN: Delaware
uyRA14GIE IINNSUUIRAAINCIE COMIPA114Y
(NAIC 414060a'
BUSINESSADDRESS: 671 South High Street, Coluinbus, Oil 4320G 1014,
PHONE: (614) 445 2900
GRAY CASUALTY & SURIETY COMPANY ffllff::p
(NAIC 910671)
BUSINFISADDRFS.'�: P 0, Box 6202, Metairie, LA 70009 6202
Pl IONF: (504) 888 790
UNDERWRiTINC; LIMITATION bt: $1,559,000,
SURETY LICENSES c,f/: AI..,AZ, AIR, (A, DC, GA, I(.., KY, LA, MD, IIAS, MCI, NV, NIA, NY, NC, OK,
PA, SC, 'IN, TX,
INCORPORAIED IN: Louisiana
GRAY 11IMSUIlitANCIE COMPANY (Ti-fE)
(NAIC #36307)
91.0NESSADDRESS: P.O, BOX 6202, METAIRIE, CA 70009 6202,
PHONE: (504) 899-7790,
UNDFRWRITING I IMPATION bi: $11,264,000
SURFlY LICENSES c,11; AL, AK, AZ, AR, CA, CO, 0, DF, DC, FIL, GA, Jil, ID, IL, IN, A, KS, KY, I A,
Mr, IIAD, MA, MI, MIN, MS, MO, IIAT, NF, NV, Pit NJ, NIM, NY, NC, NE), DI 1, OR, OR, PA, RI, SC,
SD, TN,'TX, Ji, VT, VA, WA, WV, WI, WY
INCORPORATED IN: Louisiana
Great American Alliance Insurance CoryliparTy
((NAIC V26832)
BUSINESS ADI)RESS: 301 E. Fourth Sqeet, Cincinnati, C)I I 41i202'
PHONE: (513) 369 5000,
UNCDE:RWRIT ING LIMITATION bl: $2,848,000
SURETY LICENSES c,f/: AL, AK, A7, AIR, CA, CO, CT, DF, IDC, F L, GA, Ill, D, IL, IN, IA, KS, KY, LA,
IWE, MD, MA, MI, ION, MS, MC, I'Al, NE, V, N1 1, Nj, NM, NY, NC, ND, OH, OR, OR, PA, RI, SC,
I'D, TIN, TX, U1, VT, VA, WA, WV, WI, WY,
INCORPORATED IN: Ohia
Great Ainterican Insurance Company
UNDERWRITING LIMITATION bl: $128,18EWO0
.SURETY LICENSES c,fl: AL, GA, R., IN, IA, KS, KY, INN, MO, OH, PA, SC, TN, VA, WI.
IINCORRORATI: 1) IN: Ohio
GIRANGIE IIINSUURAAINCIE COMPANY 01F IMIC111111GAN
(NAIC #11136)
846IINESS ADDRE55: 671 Imuffi I Qll Streak, P.O. [lox 1218, Columbus, 01143216 1218.
PHONE: (614) 445-2900
UNDERWRITING LIMITAT ION bl: $4,528,000�
SURETY LICLINSLS C,U1141,
INCORPORNTFE) 1111: Ohio..
GRAIMITIE IRIE, INC.
(NAIC ft26310)
BUSINESS ADIDRESS: 14001 Quailbrook (Drive, Oklahoma City, OR 73134
PHONk: (405) 1112-2600
UNDERWRITING LIMITATION bl: $4,197,000
SURETY I ICFNSFS c,f/: AL, A7, AR, CO, Cl, DE, DC, FL, GA, I[), I[, IN, IA, Ks' KY, LA, ME, MD'
MA, MI, MIN, MIS, MO, AT, NF, NV, NH, NIA, NC, ND, CH, CIA OR, PA, RI, sC, SD, flq, IX, UT,
VI, VA, 01A, WV, WI, WY.
INCORPORATFIF) IN: Oklahoma
Granite State Insuravice Coirnpany
(NAIC #23809)
BUSINESS ADDRESS: 175 WAYK R .STREFT, 181111 FI OOR, NEW YORK, 19Y 10038
PHONE: (212) 770 7000
UNDERWRITING LIMPAT ION W: $3,487,000,
SURE IY EICE'.14SES c,f/: AL, AK, AZ, AR, CA, CO, CF, DC, FIL, GA, HI, ID, 1L, IN, A, KS, KY, LA, ME,
IVID,(VIA, MI, KIN, MS, MO, MI, NE, NV, NI 1, NJ, NM, NY, I\JC, ND, OH, OK, OR, PA, RI, SC„ sl),
IN, TX, IJ 1, VT, VA, WA, WV, WI, WY,
I'll uu ItIt i,
(NAIC It 16691)
BUSINESS AIDIDRFSS: 301 F Fourth Street, Cincinnati, OH 45202
PHONE: (513) 369 5000
UNDERWMFING I..IMIIAIIOI\j bl: $187,74'1,000
SURETY LICENSES c,fl: AL, AS, AZ, AR, CA, CO, CT, DE, DC, FL, GA, GU, 1% ID, IL, IN, IA, Ifs, KY,
LA, ME, MID, MA, MI, ON, AS, MO, MT, NE, NV, NH, 141, NM, NY, NC, IND, 011, OR, OR, PA, PR,
RI, SC, SD, TIN, DS -T, VT, VA, WA, WV, WI, WY
IINCORPCRAT k D IN: OhIn,
G11111EATAMIERICAN INSURANCE COMPANY 01F NIEW YORK
((NAIC H22136)
BI.)SllqF.-.SS ADDRESS: 301 E Fourth Street, Cincinnati, OH 45202
PHONE: (513) 3,59 5000,
LJNDFRWRFT ING LIMITATION bP $10,025,000,
SURETY LICENSES c,t/: AL, AK, AZ, AR, CA, CO, CT, DE, DC, FL, GA, 111, D, II, IN, IA, K15, l(Y, LA,
IIAE, 1\413, RNA, MI, ON, ME, MO, IViC NF, MR, IVH, N), NIA, NY, NC, NO, OH, OK, OR, PA, RI, SC,
SD, TN, TX, UT, VT, VA, WA, WV, WI, WY
INCORPORATED IN: New Y.rl(
Great MiJdwest IInsuarance Company
(NAIC T18694)
BUSINESS ADDRESS: 800 Gessner, SOW SEE, Iloustan,'l exas 77024,
PHONE: (713) 935 0226,
UNDERWRITING LIMITATION Ol: $10,291,000-
SURETY LICENSES c,V: Al, AS, AZ, AR, CA, CO, CI, DR, EN, Fl, GA, HI, ID, II.., IN, IA, KS, KY, LA,
ME, MD, MA, MI, MY, IIAS, IIAOC MT, NE, NV, NI -I, NJ, I'lM, NY, NC, ND, OH, OK, OR, PA, RI, SC,
SD, FIN, TX, U1, VA, VI, VT, VVA, WV, WI, WY,
INCORPORATED IN: Texas
Great Northern Insurance Company
(NAIC #20.30.3)
BUSINESS ADDRFSS: 202B Hall's 10111 Road, Whitehouse Station, NJ 08889,
PHONE: 1215) 640-1000,
ON DERWRIHNG LHO I TAlf ION bl: $38,499,000,
SURETY LICENSES c,f/: AL, AK, AS, AR, CA, CO, CL DE, DC, il., GA, HI, ID, K., IN, IA, KS, KY, LA,
ME, MID, IMA, MI, IIAN, IYS, MO, AT, NE, NV, NH, N), NM, NY, INC, ND, ON, OK, OR, PA, RI, Sc,
SI), 1 N,'TX, UT, VT', VA, WA, WV, WL VVY.
INCORPORATED IN: Indiana,
Guarantee Company of North Airneirica USA ('The)
(NAIC 1(.t6650)
BtJSINFSSADDRFSS:OrieTowne .scluare,Suitc.,14/0,Southfield, M148076 3725,
PHONE: (249) 281 0281 x 66012
UNDFRWRI-TING 1IIIAITAYION bl: $19,992,000
SURE I TY LICENSES cj/: AL, AK, AZ, AR, (-A, CO, C1, DE, DC, FIL, GA, 111, ID, L, IN, I& KS, KY, LA,
KIE, MID, VA, MI, IIAIN, MS, MO, MI, NE, NV, N1 1, NI, NIS, NY, NC, ND, OH, OK, OR, PA, FIR, RI,
SC, SK), TN, TX, U1, VT, VA, VI, WA, WV, WI, VVY,
INCORPORATED IN: IVlicpriKan.
pII
Hanover Insurance Counpany (The)
(NAIC 922292)
RF)SINESSA17I)RFSS:4401NCO[ N SIREEIIWORCESTER, MA01653 0002
PHONE: (508) 851-7200
UNDERWRITINCi LIWPATION b/: $138,546,000
SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CI, DE, DC, FL, GA, HI, IS, K., IN, IA, KS, KY, LA,
ME, MD, MA, Ml, MN, ME, MO, MI, NE, NV, NH, NJ, NIA, NY, NC, NID, 011, OK, OR, PA, RI, a'
SD, I N, IX, UT, VT, VA, WA, WV, WI, WY.
IIWORPORAf ED IN: New Hampshire.
tlqAkh.. if I vb�.6Zp
BUSINESS AIDDRESS:One. Hartford Plaza, Hanford,Cl 661S5 0001,
PI IONf: (860) S47 5000.
UNDERWRITING I IMITAI ON b/: $865,521,000
SURFTY LICF14SES cj/: AL, AK, AZ, AR, CA, CO, CT, DF, DC, FL, GA, GU, HI, ID, 11, IN, IA, KS, KY,
LA, IIAE, MIS, MA, I'Al, MIN, ME, MO, MY, lq[, NV, INK NJ, NM, NY, NC, NI:), OH, OK, OR, PA, f'R,
RI, SC, SD, IN, IX, UT, VT, VA, VVA, WV, WI, WY,
INCORPORAT ED IN: Cormec0cm
Wartfoird Ilin%ualr,ance Company of 1111finois
(NAIC #Wgg)
MF,INESSADDRESS: One liartforcIPlaza, liartroid,CIGC,15'i 0001
PHONE. (860) 547 50W
UNDLIRWRL'T ING LIMITATION W: $128,034,000
SI..PRETY[ICENSF5c,f/:AZ, 11.,KY, M1,MO, IVY, N(.:,OK, PA, I.iC,TN, T?(,Ll1,\tA,WV
INCORPORATED IN: Illinois,
Hartroird Inimirance Counpany of the MId west
(NAIC 937478)
BUSINESS ADDRESS: One , lartford Plaza, Hartford, CT 061550001
PHONE: (RED) 547-5000
UNDERWRITING LIMITATION ho $52,735,000
SURETY LICENSES c,f/: AL, AK, AZ, AIR, CA, CO, CT, DE, DC, r L, GA, I il, D, IL, IN, IA, KS, KY, LA,
ME, MD, MA, IVII, MN, MS, 100, MI, NE, NV, NH, NJ, NM, NY, NC, NI), OH, OK, OR, PA, RI, SC,
SD, IN, IX, Ul, VT, VA, WA, WV, Vol, WY.
INCOMIORNTED IN: Indiana,
Hartford Insurance Company ofthe Sout!IlIeast
(NAIC #38261)
BUSINCSSADDRESS: One Hartford Pla7a, Hartford, 0 06155 0001
miolqr: (860) 54 7 5000,
HARCO NAVIONAIL INSUlIMINCIE COMPANY
(NAIC: W26433)
BUSINESS ADDRESS: 702 OBERLIN ROAD, RALEIGH, NC21GOS 0900,
NiONE:(919)833 1600
UNDERWRI I ING LIMHAI ION bl: $15,455,000
SURETY I..IG:.ENR.5c,f/:AI..,AK, A7,AR, CA, CO, CT, r)E,l:)C,Il..,G'A,ID,IL, IN, IA, KS, KY, I.-AIIAE:,
MD, MA, 101, MN, MIS, IVO, MP, IVIT, NF, NV, NH, Nj, NM, NY, NC, ND, 011, OK, OR, PA, RI, SC.:,
SID, TIN, TX, UL, VI, VA, WA, VVA WI, WY
INCORPORAILD IN: Illinois.
Hartfoird Accident and IIndeunnIty Coirnpany
(INAIC #22357)
BUSINESS ADDRESS: One I layfford Plaza, I fartford, CT 06155 - 00G1
P[ IONIE: (860) 547-5000.
UNDLAWRIT INK, LIMITATION bl; $195,865,000,
SURETY LICENSES cdf: AL, AK, AZ, AR, (A, CO, CT, DE, L)C, FL, GA, HI, ID, L, IN, A, KS, KY, LA,
ME, MD, MA, MI, MIN, AS, 100, IIAT, NE, NV, NI I, IIJI, NM, NY, NC, NID, ON, OK, OR, P& FIR, RI,
SC, SID, TN, TX, JI, VI, VA, WA, WV, VVI, W
INCORPORATED IN: Coonecticuk,
Hartford Casualty Insurance Counpany
(NAIC 429424}
[WSINLSS ADDRLSS: Orie Hartford Plaza, I larOurd, C 1 06 155 - 0001.
PHONY.:: (860) 547 5000
UNDERWRITING LIMITATION b(: $89, A15,000
SURETY LICENSES c,f/: AL, AK, AZ, AS, CA, CO, CT, DE, DC, FL, GA, HI, ID, L, IN, IA, RE, KY, LA,
AE, MD, MA, MI, MIN, MS, IIAO, Iff, W, NV, NH, NJ, NIA, NY, NC, NID, OH, OK, OR, PA, RI, SC,
SK), TN, IX, LIT, VI, VA, VVA, VVV, WI, WY.
INCORPORATED IN; Indiana,
Hartford Hire Insurance Company
UNK)i RWRI FANG LIMI Ii A1 ION bl: $6,398,000,
SURETY LICENSES c,f/: AZ, C I, IHL, GA, KS, KY, LA, MD, MI, MO, PA, SC, TN, D( UT, VA, WV
INCORPORATED llq: Conneckicuk
Hudson Insurance company
(NAK U25054)
BUSINESS AIDI)RESS: 100 William Street, 5ai Floor, Now York, NY 100.18
PHONE: (212) 978 2900,
UNDERWRITING LIMITATION bo $44,149,000
SURETY LICENSES c,f/: Al, AK, AZ, AR, CA, CO, Cf, DE, DC, FIL, GA, HI, ID, ll, IN, IA, KS, KY, LA,
ME, IND, I"A, ML fvIN, MS, MO, 101, NE., NV, NH, NJ, NM, NY, NC, ND, CH, OK, OR, PA, PR, RI,
SC, SD, IN, TX, JI, VT, VA, WA, WV, VVI, VVY
INCORPORATED IN: Dolawar,,,
To Np-
11
IM7 Insurance Company
(NAIC #14257)
13-K
PYiONF; ('05. 327-2777
UNDERWRITING LIMITATION bl: $14,9.i6,000•
SURETY LICENSES cj/C AZ, IL, IA, MIN, MO, NF, ND, ED, WI.
INCORPORATED IN: Iowa
InderninIty Coirnpany of California
(NAIC #25550)
BUSINESS ADDRESS: P. 0, BOX 19 725, IRVINE, CA 92623 - 9725..
UNDERWRITING LIMITATION bl: $799,000
SURk1Y LICENSES c,fo AL, AK, AZ, AR, CA, CO, DE, DC, GA, HI, 11), IN, KS, KY, ILA, I'AID, MA, 101,
ION, MIS, MO, MI, NE, NV, NH, NJ, MIA NC, NO, OK, OR, PA, RI, SC, SD, VX, IJT, VT, VA, WA,
WV, WY,
IINCORi:,oRKrED IN: California,
Indemnity Insurance Company of Noirdh Allnerilca
(NAIC B435 15)
BUSINESS ADDRESS: 4H, WALNUT STRFET, F1 0 Box 1000, Philadelphia, PA 19106
PI LCNF(715) 640 1000
UNIDERWRII ING (..IMITATION LY: $15,289,000
U114DI RWRITIN(S LICENSE,,,UAl, AK, AS, AIR, CA, CO, CT, CK., DC, Ft., GA, HI, 11), L, IN, IA, KS,
KY, LA, ME, MI.), MA, MI, MN, MS, MO, MT, NE, NV, NI -I, NJ, NIVI, NY, NC, ND, 011, OR, OR, 1A,
RI, SC; SID, TIN, TX, UT, VT, VA, VI, WA, WV, WI, WY
INCORPORATED IN: Pennsylvania,
Indemnity INaatiiounall IIPnsuiraince Cornpany
(INAIK. #18468)
BUSINESS ADDRESS125 Cool Springs Blvd, Suite 600, Franklin, IN 37067'
PHONE: (GI 1') 120 8209
UNDERWRINING LIMITATION hk $7,254,000
SURFlY I WI..NSLS c,f/: AL, AZ, AR, CO, GA, 11, IN, KY, LA, IIAD, MS, MI, NV, ISM, 011, OR, PA,
SC, TIN, TX, U1, VA, WV
INCORPORATFID IN: IVissls ippi
Indiana ILuuumbeirmens Mutuall Insurance C01IT1pany
(NAIC # 14265)
BUSINESS ADDRESS; 2005 Market Street, Suite. 1200, Philadelphia, I>A 19103
PHONE: (267) 825 9204,
UNDERWRI I ING LIM I IATION 1.,/: $1,59 1,000
INLUKVUHAI A) ITV', HH11015,
Jinsuraince Company of the West
(NAIC 927947)
BUSINFS.i ADDRESS: P,O BOX 5090'39, SAN DIFG0, CA 92150
PHONE: (858) 350 2400
UNDERWRITING I. IMITA 1! K.)N J)/: $89,492,000,
SURETY Y LICENSES c,fl: At-, AK, AZ, AR, CA, CO, C F, DE, DC, R., GA, IiI, ID, It., IN, IA, KS, KY, LA,
IIAE, MID, AA, M 1, IIAN, LAS, 100, MT, NE, NV, NI -I, NJ, NM, NY, SIC, ND, OH, OK, OR, PA, RI, SC,
SD, I N, DC UT, VT, VA, WA, WV, WI, otY,
INCORPORAT ED IN: California.
Insuirors Indemnity Company
(NAIC 4432 73)
BUSINESS ADDRESS: P.O, Box 32577, Waco, TX 76702
PHONF: (254) 759 3727
UNDERWRII ING (..IMITATION is/: $2,505,000
SURETY LICENSES cfl: AZ, AR, NM, DIC TX
INCORPORATED IN: Texas
INTIEWIMNID ASSURANCIE COMPANY
(NAC V2.6778)'
Integrity Insurance Company
(NAIC #14303)"
BUSINt:SS ADDRESS: P.O..Box 539, Appleton, WI 54912 - 0539
PHONE: (920) 734-4511.
UNDERWRITING (..IMITATION b/: $5,776,000.
SURETY LICENSES cj(: K., IA, INN, CH, Wl.
INCORPORATED IN: Ohio
hnteirnathonap II idelity Insurance Company
UNDERWRIT ING LICENSES c,f/: AL, At<, AZ, AR, CA, CO, CT, DE, DC, FIL, GA, HI, Its, IL, IN, IA, K,,
KY, LA, ME, \AD, MA, VIL, MIN, AS, MO, IIAT, NE, NV, NH, NJ, IqM, NY, NC, NJ), 011, OK' OR, PA,
RI, SC, SD, TN, TX, UT, VI, VA, WA, WV, Oft, VVY,
IN(ORPORATE.D IN: Indiana.
Inland Insurance Company
(NAIC #23264)
BUS NFSS ADDRESS: P.O. Box 80468, Lincoln, NF 68501
PHONE: (402.) 435 4302
UNDERWRITING LIMA ATION b/: $23,259,000
SURETY LICL.NSLS c,f/: AZ, CO, A, KS, MN, MO, MI, NF, ND, OR, SD, WY
INCORPORATED IN; Nebraska
Insurance Coirripany Of North Air nerica
(NAIC #22 71 -S)
BUSINESS ADDRESS: 43G WALINO I STREET, R0, Box 1000, Philadelphia, PA 19106.
PIiCNE: (215) 640-1000
UNDERWRITING LIMITATION bl; $34,314,000
UNDFIRWRITING I I( ENIFS cj/C At, AK, A7, AR, CA, CO, CT, DE, DC, 1-1, C3A, GU, HI, ID, IL., IN,
V, KS, KY, LA, IAF, MD, MA, MI, MN, MIS, IYO, DIP, V11, NE, NV, NH, NJ, NIA' NY, NC, ND, OH,
OK, OR, PA, FIR, RI, SC, SD, IN, TX, Ul, VI, VA, WA, WV, WI, WY
INCORPORATED IN: Pemsylvania
insurance Company of the State of IPemmnsyllvapanda (The)
(NAIC R1 9429
BUSINESS ADDRESS: 175 WATER S FREET, 18111 FLOOR, NEW YORK, NY 10038
Pt fONE; (212) 770 7000
UNDERWRI I ING LIMPATION b(: $5,907,000
SUM TY LICENSES c,f/: AL, AK, AS, AR, CA, CO, Cl, DE, DC, FIL, GA, Fit, 11.), IL, IN, A, KS, KY, LA,
ME, MI:), VA, MI, ION, MS, DO, MT, NE, NV, NJI, IqJ, NM, NY, NC, ND, OH, OR, OR, PA, RI, SC,
S 1.), T N, TX, U1, VT, VA, WA, WV, WI, WY,
(I\JAIC 911592)"
BL)'iIIIJE:SSAOI)RESS:(:)rieNewark (..eritt,r,Newark, N.)07102 5207
PHONE: (973) 624 7200
UNDERWRITING(..IMITATION Jrh $7,222,000.
SURETY LICENSES CflAL, AK, AS, AR, CA, CO, CT, DIE, DC, FIL, GA, GU, Hit, 11.), It., IN, IA, KS, KY,
LA, ME, MID, MA, MI, MN, MS, 1\40, MIT, NE, NV, NH, IVf, NM, NY, NC, ND, OK OK OR, 1A, RR,
RI, SC, SD, TN, TX, UT, VT, VA, VI, WA, WV, WI, WY.
INCORPORAI ED IN: New Jersey,
111RONSHORIE 111411DEMNITY IINC,
(NAIC #23647)
BUSINESS ADDRESS: 175 Berkeley Street., Boston, MA 0211 b�
PHONF: (617) 357 9500 X41177,
UNDERWRITING LIMITATION b/: $8,642,000
SURETY LICENSES cf/:AL, AK, AS, AR, CA, CO, CT, DE, DC, It., CA, GO, 111, LID, K., IN, IA, KS, KY,
LA, ME, MI.), MA, MI, MIN, MS, 100, Mill NE, NV, Nil, LIL NIM, NY, NC, ND, OH, OK, OR, PA, PR,
RI, SC, 5D, TIN, TX LIT, VT, VA, WA, WV, WI, VVY
INCORPORATED IN: Minnesota
iSILAND IINdSUURAINCIE COMPAINY, L111MI)FEID
(NAIC #2284S)
BUSINESS ADDRESS: P,Q, Box 1520, Honolulu, HI 96806 1520,
PHONE: (SOB) 564 8200.
ONDERWRITING t IMITAT ION b/: $12,446,000
SJJRFTY I ICFNSF.S cfl: I H INCORPORKH:1) IN: Hawaii
INCORPORAFFID IN: Hawaii
pro4kh' I's'p
K 4 " k 10, j ru if
K
J10 r get9rp
LEXINGTON NATI)CINAIL IINSUIIRaAINCE CORPORATION
(NAIC #37940)
BUSINESS ADDRESS: P,() BOX 6098, I.T.)IIIERVILLE, 11AID 21094
PHONE: (410)1,25 0800,
UNDERWRITING, LHAIIAT ION W: $1,975,0W
SURETY LICENSES cfl: AL, AK, AS, AR, CA, CO, C1, DE, DC, FL, GA, HI, ID, IL, IN, A, KS, KY, LA,
ME, MD, MA, IN[, MN, IMS, EAO, IAl, NE, NV, NH, NJ, NM, NY, NC, ND, OH, OK, OR, PA, RI, SC,
SO, IN, IX, JAI, VI, VA, WA WV, WI, VVY.
INCORPORATFID llx: Florida,
Lexon finmirance Company
(NAIC H13301)
HUSINFSS ADDRESS: 10002 Shelbyville Rd, Suif:e 100, IumsvIlle, KY 402).'t
PHONE: (615) 55.39500
UNDERWRIMING HIMIYATION R/: $6,882,000,
SURETY LICENSES c,U; AL, AK, AS, AR, CA, CO, C1, DE, DC, FIL, GA, GO, If[, ID, IL, IN, A, KS, KY
LA, ME, BID, MA, 101, MN, MS, MO, Mrr MJ, NE, NV, NJ, 19M, NC, ND, Of -I, OK, OR, PA, Rl, Sc,
SD, Y I% IX, UT, VT, VA, WA, WV, WI, WY.
INCORPORAI ED IN: Texas.
Liberty Illnsullr,arace Corlporadoin
-,i-- -
PI ION[-: (617) 357 9500.
UNDERWRITING I 11"ITNTION E,(: $11,90C,000
UNDERWRI'l ING LICENSES c,11: AL, AK, Al, AR, CA, CO, CT, DE., DC, FI, GA, Gl.), III, ID, L, IN,
IA, KS, KY, LA, ME, 1MI), MA, MI, MIN, MS, MO, MR, MT, NE, NV, W, NJ, NM, NY, PIC, ND, Off,
OK, OR, PA, RI, SC, SD, TN, IX, Uf, VT, VA, VI, WA, WV, WI, WY,
INCORPORATED IN: Illinois,
Rod", !aw'jvp
im
Manufacturers Alliance Illnsnalralnce Company
(INAIC #36897)
BUSINESS ADDRESS: P.O. Box 3031, Blue Bell, PA 19422 0754
PHONE: (6 10) 397 5000
UNDERWRITING L IMIrATION bl: $7,220,000
SURETY I ICFNSFS c,t/: AL, AK, A7, AR, CO, C1, DE, DC, H), IN, KS, KY, LA, MF, MD, MI, IIAS' MO,
EAT, NE, NV, NIT 1, NJ, NM, IVY, NC, OH, PA, RI, SC, SO, TN, AT, VI, VA, WA
INCORPORATED IN: Pennsylvania,
MARKHEIL JINSURANCE COMPANY
(NAIC 938970)l'
BUSINESS ADDRESS: 4521 Highwoods Parkway, Glen Allen, VA 23060
PHONK.:(800)431 1270,
UNDERWRITING I IMITATION b/: $119,240,000.
SURFIY LR:.FNSES c,f/: AT, AK, A7, AR, CA, CO, CT, DE, DC, FIL' GA, ID, If., IN, A, IS, KY, LA, IVE,
MD, MA, I'Al, MIN, ISS, MO, MIT, NF, NV, NIT 1, NJ, 114M, NY, NC, ND, Off, Or, OR, PA, RI, SC, 51),
TN, JX, UT, VT, VA, WA, WV, WI, WY,
INCORPORKIED IN: Illinois.
IRA- ... h-.tt. iik-
(INAIC #42404)
BUSINESS ADDRESS: 175 Berkeley Street, SoAun, MA 02116,
PHONE: (617) 357 9500
UNDERWRITING LIMITATION bl: $24,960,000
SURETY LICENSES c,f/:Al.., AK, AZ, AR, CA, CO3 (i, DE, DC, 1-1, GA, GU, HI, ID, It, IN, IN KS, KY,
LA, ME, MID, MA, MI, MN, MS, MO, MP, MI, NE, NV, NH, NJ, NM, NY, NC, NO, 011, OK, OR, VIA,
PR, RI, SC, ED, TN, TX, U1, VT, VA, WA, WV, WI, WY,
INCORPORATED ll\: Illinois,.
Liberify Mutuall Fire ln!"Arance Cornpany
(NAIC #23035)
BUSINESS ADDRESS: 175 Berkeley Street, Boston, IMIA 02116
PI TONE: (6171.357 9500
UNDERWRITING LIMITATION bl: $157,521,000,
SURETY LICENSES c,f/: Al., AS, AZ, AR, CA, CO, CT, DE, DC, FIL, GA, GU, III, ID, IL, IN, IA, KS, KY,
LA, ME., MD, MA, MI, MR, MR, MO, MR, MI, hff., No, NH, NJ, NM, NY, NC, 'ID, OTI, Or, OR, PA,
PR, RI, SC, ED, TIN, I X, UT, VI, VA, VI, WA, WV, VVI, WY
INCORPORATED llr: Wisconsin,
Lilberty MutuM linsurance Conillpany
(NAIC B23043)
BUSINE:SS ADDRFSS: 175 Bei kaley Street, Bost.n, MA 02116
PHONE: (07) 35 7-9500
UNDERWRITING LIMIrAJION b/: $1,289,139,000,
SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, C1, DE, DC, I'L, GA, 111, ID, IL, IN, IA, KS, KY, LA,
IME, MID, MA, MI, MN, 1\45, EA0, MP, MT, NE, NV, NH, NJ, NM, NY, NC, NO, OH, OK, OR, PA, PR,
RI, SC, SO, TN, TX, UT, VT, VA, VI, WA, Vft WI, VVY,
INCORPORAI ED IN: Massachusetts,
LM Inswrance Corporation
(NAIC #33600)
(NAIC #22306�
[.IL61NKS'.iADI)RII.,S:44OLINCONS1FREFF,WORCFSTFR,MA0165.1 0002
PI IONL (508) 853Y200
UNDERWRITING LIMIJAIION bl: $6,577,000
.SURELY LICENSES c,f/: AL, AK AZ, AR, CA, co, cr, BE, DC, FL, GA, I H, ID, IL, IN, J& KS, KY, LA,
ME, MID, MA, Ml, INN, MS, 100, MY, NE, NV, NH, NJ, NK NY, PIC, ND, MI, OR, OR, PA, K SC,
SO, IN, IX, VI, VA, WA, WV, WI, WY
INCORPORATED IN: New Hampshlre,
Merchants Bondlng Company (Muftualy
(NAIC # 14494)
BUSINFSS ADDRESS: E1.0 K30X 14498, DES MOIIIJFS, A 50306 - 3498,
PHONE: (515) 243-8171
UNDERWRITING LIMITATION b/: $12,476,000
SURETY UCEINSES (j/; AL, AK, AZ, Alf, CA, CO, C1, DE, DC, FL, CA, HI, ID, IL, IN, IA, KS, KY, LA,
ME, MD, MY, MI, MIN, MS, MO, MIT, NE, NV, NH, NJ, NM, NY, INC., ND, OH, OK, OP, PA, RI, Sc,
SD, TN, JX, UT, VT, VA, WA, WV, WI, WY,
INCORPORATED IN: Iowa,
Merchants Nationall IlMinding, Onc,
(NAIC #11595)
BI.JSII\JFSS ADDRESS: P 0. Box 14498, DES MOINES, A 50.106 3498.
PHOINF: (515) 243-8171.
UNDERWRITING LIMITATION E,/: $1,722,000,
SURFTY LICFNSFS cfl: AL, AK, A7, AR, CO, Cl, DF, DC, FIL, GA, III, ID, II., IN, A, KS, KY, LA, W,
MD, MA, MI, MIN, ME, MO, MT, NF, NY, NJ, NIA, NY, NC, ND, 011, OK, OR, FIA, III, SC, SID, Tfq,
rX, U T, \rT, VA, WA, WV, WI, WY.
INCORPORATED IN: Iowa.
WIchigan Millers Mutuall Insurance Company
(NAIC#14508)
BUSTJESS` ADDRESS: P.. O. Box KITES, Laming, M1,18909 7560,
III IONE: (517) 482 6211 x 5115.
UNDERWRITING LIMILAICIIIJ b/: $6,829,000
SURETY LICENSES c,f/: AZ, AR, CA, CO, GA, ID, EL, IN, IA, KS, KY, MI, MIN, NO, MIT, NE, NY, NC,
NO, OH, OR, OR, PA, SD, I N, VA, WA, WI, VVY
INCORPORATED IN: Michigan,
Mlid-Century Insurance Company
(NAIC 421687)
BUSINESS ADIDRLSS: P.J. BOX 4402, WOODLAND HILLS, CA 9136'.:11
PHONE: (323) 9.32 -3200
-11NIDERWRITING LIMITATION b/: $378,5 10,000
SURETY LICENSES ,f/: AL, AZ, AR, CA, CO, T L, GA, HI, ID, II., IN, IA, KS, MA, DR, MN, MIS, MO,
MT, NE, NV, NJ, RIM, NY, NC, ND, OH, OK, OR, PA, SO, I N, TX, LIT, VI, VA, WA, WI, WY
INCORPORATED IN: California
M11ID-CONTINEINT CASUALTY COMPANY
(NAIC 403419)
BUSINESS ADDRESS: TI 0. Box 1409, Tulsa, OK 74101,
PHONL:(918)587 ?22.1
UNDERWRITING LIMITATION ILL: $15997,000
SURETY LICENSES c,fl: AL, A7, AR, CO, (1, IL, IN, IA, KS, KY, IA, 1AF, ION, 105, MO, MT, NE, NV,
Nil, N), NM, NC, 0H, OR, PA, SC, TIN, TX, UT, VA, INA, WY,
[NCORPORAY ED IN: Ohio,
MotorhAs Commerdiall MutuM Ilnsu iraince Company
(NAIC #13331)
BUSINESS ADDRESS: 471 East Broad Street, Colurnbus, OFf 43215.
PHONE: (614) 225-8211
1 11,11 6FPWP IT W(-. I I 1AFAT In KI by 4 ir., firs non
INCORPORATED IN: Delaware
PAIY'J'Iltu EI
N
Nationall American Ilnsuurance Caimpany
(NAIC #23663)
BUSINESS ADDRESS: P,O Box 9, Chandler, OR 74834.
PHONE: (405) 259 LIE304,
UNDERWRITING I IMITATION ba: $7,437,000,
SURETY LICENSES c,f(: AL., AN, AZ, AR, CA, CO, C), DF, DC, T L, GA, Ifl, ID, IL, IN, IA, KS, KY, LA,
VIE, 4VID, MA, MI, MIN, MS, MO, NIT, NE, NV, NH, NJ, NIIA, NY, NC, ND, 011, DR, OR, PA, RE SC,
SCL T N, IX, UL, VI, VA, WA, WV, WI, WY.
INCORPORATED IN: Oklahoma
NationaQ Casualty Coirwyany
(NAIC 011991)
BUSINESS ADDRESS! ONE WEST NATIONWIDE BLVD., 1 04 701, COLUMBUS, 01143215
2220,
PHONE: (480) 365 4000,
UNDERWRITING LIMITATION LI: $14,297,000
UNDERWRITING LICENSES c,f/: AL, AS, A7, AR, CA, CO, CT, DR, DC, FL, GA, HI, ID, lE., IN, IA, KS,
KY, LA, ME, RID, MA, I'Al, MN, MS, DID, MT, NE, No, NH, NJ, NI\4, NY, NC, NY), OH, OK, OR, PA,
RI, SC, SO, 1 N, TX, LIT, VT, VA, WA, WV, WI, WY.
INCORPORATED IN: Ohlo,
NAF1101MAIL. FARME116 UN11ON PROPIERTY ANID CASUAL."EY COMPANY
(NAIC,716217)
BUSINESS ADI.)RrSS: One QBE Way, Sun Prairie., WI 53596.
III IONE: (608) B25 5160
SURETY LICENSES c,FC AZ, CA, CO, C1, DE, DC, CA, ID, IL, IN, A, KS, KY, EAE, MID, MA, MI, ION,
MO, NE, NV, NH, NJ, NEVI, NY, INC, ND, OH, OR, OR, CA, RI, SC, ED, IN, TX, UT, V1, VA, WA, WV,
WIL VVY
INCORPORAT ED IN: Ohio.
Motoiri.sts Mutuall Insuirance Company
(NAIC ff'14621)
BUSINESS ADDRESS: 471 East Broad Street, Columbus, OH 43215,
PHONE.: (614)225 8211
UNDERWRITING ING LIMITATION 111: $4/1,985,000
SURETY LICENSES c,f/: IN, KY, MI, 011, PA, WV
INCORPORAXII) IN: Ohio
Motors Insurance Carporation
(NAIC P22012)
BUSINESS ADDRESS: 500 WOODWARD AVE, 14TIl FLOOR, DETROIF, M148226,
PHONE: (313) 656 5437
UNDFRINRITING, I IMITATION bl: $76,269,000,
SURETY LICENSES cfl: Al, AK, AS, A7, AR, CA, CO, CT, DF, DE, T 1, CA, 111, ID, 11, IN, IA, KS, KY,
LA, ME, MD, MA, ML IIAN, MS, MO, MY, NE, NV, Nil, NJ, NI\A, NY, NC, ND, ELL OR, OR, PA, RIL,
SC, SD, IN, TX, U1, VT, VA, WA, WV, WI, WY.
INCORPORATED IN: Michigan
Munich Reinsurance America, linc.
(NAIC it 1022 7)
BUSINESS ADDRESS: SSS COLLEGE ROAD EAST P.O.BOX S241,PRINCE)ON,Nj0&543
PHONE: (609) 243 4200
UNDERWRITING LIMILAT ION b/: $362,623,000.
UNDERWRITINC.. LICENSES cU: AL, AK, AZ, AR, CA, CO, CI, DE, DC, H., GA, GU, lil, ID, I., IN,
A, KS, KY, LA, ME, MID, MA, MI, MN, MS, MO, I1AT, HE, NIX NH, NJ, NIIA, NY, NC, ND, ON, OR,
OR, PA, PR, RI, SC, SO, TN, YX, LIT, VT, VIA, WA, WV, WI, WY,
UNDERWRITING LIMITATION bl: $4,147,000
SURETY LICENSES cj/�. Al., AK, A7, AR, CA, CO, BE, DC, GA, 111, ID, IL, IN, A, KS, KY, LA, MIS
MD, MA, MI, IIAN, MS, MO, NIT, NE, NV, NH, NJ, NY, NC, ND, 011, CK, OR, PA, RI, SC, SD, IN,
FX, LAI, in, VA, WA, WV, WI, WY.
INCORPORATED 114: Wisconsin,
NadonM Hire & Marine IInsaurance Company
(NAIC #20019)
Bt.)SINESSADDRI:;SS:13141)ouglasStr,.^et,Sultel4DD,Ovfi;.�ha,NE: 68102 1944,
PHONE:: (402) 916 3000
UNDERWRITING, LIMITATION hk $634,817,000,
UNDERWRLI ING 1. ICFNSES c,U: NE,
INCORPORATED IN: Nebraska.
Madonall Fire Insurance Company of Hartford
(NAIC #20478)
FUSINFSS AIDIDRFSS: 151 N, FIRAIMM IN SA, CHICAGO, 11 G0606
PHONE. (312) 922-5000
UNDERWRITING LIMIFIATION EEC $11,030,000
SURETY LCI . RISES c,f/: AL, AS, AZ, AR, CA, LID, C-1, DE, DC, FIL, CA, HI, ID, IL, IN, K, KS, KY, LA,
ME, MID, MA, NIT, IIAN, MS, MO, MI, NE, NV, NH, NJ, NM, NY, NC, ND, CH, OK, OR, PA, PR, RI,
SC, SD, IN, IX, OF, VT, VA, WA, WV, WI, WY
INCORPORATED W Illinois,
Madonall indeirminlity Company
(NAIC #20087)
BUSINESS ADDRFSS: 1314 Douglas Stre.et,.Iulte 1400, Omaha, RE 6RI02 1944,
PHONE: (402) 916 3000,
UNDFRWRIIING LIMLIATION ILI: $11,629L382,000
UNDERWRil INC-I LICENSES cj/: AL, AK, AZ, AR, CA, CO, Cr, DE, DC, FL, CA, ID, R., IN, TA, KS,
V, I I IlC .`II -I - -" -I - .11, �'W r+ NW -1 .", wu4r -,, 1II eI. I," "A"
I-N, TX, UT, Vf, VA, WA, WV, WI, WY,
INCORPORATED IN: Nebraska
Matiou'lall Liiabiilllty & Fk,e Ilrmuur,ance Company
(NAIC ff20052)
BU!;INESSADE)RESS: 13141)ouglasStreet, .Suite 1400,Orna[ia,NI..68102 1944
PHONE: (402) 916 3000,
UNDERWRITING; LIIIAITAIION b/: $114,703,000,
TJNDLRWRITING LICLNSES c,fl: AL, AK, CA, CT', LIE, DC, 111, 11), IL, IA, KS, KY, MID, IMA, MI, PAS,
IMO, NIL, NI i, Nj, NIIA, NY, ND, 011, OK, Td, SC, SD, (X, LIT, VT, VA, WA, WY
INCORPORATTID IN: ConnecticuL
Matjaanajl SkArety CorporatIon
(NAIC #21 B91 )'3
IMATOONALTRUST INSURANCIE COMPANY
(NAIC #2014 1)
HUSINFSSADI.)Rl:.SS:63001.JriiveisifyParkway, Sarasota, Fl..342..40 8424
1:11 IONE: (800) 226 3224.
UNDERWRITING I-LArIATION IV: $.3,844,000
SURETY LICI N5FS c,f(: M, Al, AIR, CO, DC, I'L, GA, R., IIV, IA, KS, KY, LA, ME), I'Al, MS, MO, NE,
NM, NC, 01K, PA, SC, IN, TX, UT, VA, VVV
INCORPORAI r D IN: Indiana
lVationall Union IFIre Ilrosurance Company of PIttsbuirgh, PA
(NAIC #19445)
BUSINESS AI:DDRESS: 175 WAY EIR STREET, 18111 FLOOR, NEW YORK, NY 10038
PHONE: (212) 770-7000
UNDERWRITING L111411-Af ION bl: $5S1,969,000,
SURETY UCENSFS cjl: AL, AK, AZ, AR, CA, CO, CT, DE, DC, FL, GA, GU, I% ID, IL, IN, IA, KS, KY,
LA, ME, MD, MA, MI, MN, 'AS, MO, ME, M1, NE, NV, NH, NJ, NY, NY, NC, ND, OH, OK, OR, FA'
RI, SC, SET, TN, D( LIT, VT, VA, WA, WV, WI, WY,
INCORPORICT HD IN: New York
New HaimpshIre Insurance Counpainy
(NAIC 023841)
BUSINESS ADDRESS: 175 WATER STREE T, I 8TI i FLOOR, NEW YORK, NY 10039.
PHONE: (212) 770-7000
UNDERWRITING LIPAIfAl ION bl: $6,238,000.
SURETY LICENSES c,fl:: AL, AIC AS, AR, CA, CO, CT, DE, DC, FL, GA, HI, 11.), L, 114, IA, Ks' ICY, LA,
ME, IVID, MA, MI, MN, NIS, MC, 101, NE, NV, NI i, Nj, NIIA, NY, NC, IqID, OFI, OR, OR, PA, PR, RI,
SC, SD, TN, iX, U I, V1, VA, WA, WV, WI, WY,
INCORPORATED IM Illinois.
11141114 Insurance Compailiy
(INAIC414788)
BUSINESS ADDRIE55:5.5 WEST ST REET, KEENE, NI 103431
PIiONF: (904) 380 72.82
UNDERWIRi r(NG LIMITATION EV: S9 1,366,000
SURI FY LICENSES c,fl: AL, AZ, AR, CO, C1, DE, DC, FL, GA, ID, IL, 1114, IA, KS, KY, LA, ME., MID,
MA, Nil, MS, IIAO, IIA I, NE, NV, NI 1, NJ, NIA, NY, RC, ND, 011, OK, OR, PA, RI, SC; SD, TN IX, IJI,
VT, VA, WA, WV, WI, VVY
INCORPORAI ED IN: Fludda,
MORTH AIMIE11111CAIM SPIECIIAIL'I'Y 11INSURANCE COMPANY
(NAIC N29974)
BUSINESS ADDRESS: 1200 MAIN SIREFT, SERIF 800, KANSAS CITY, TIAO 64105
1:11 fONU (913) 676 5200,
UNDERWRIPING LIMITATION 1)/
SURETY LICENSLS L,I/: AL, AK, AZ, AR, CA, CO, CT, DE, DC, FIL, GA, HI, ID, L, IN, A, KS, KY, LA,
IVIE, ME), MA, MI, MN, MS, MO, M1, NE, NY, M 1, Nj, NM, NY, NC, ND, 011, OK, OR, PA, PR' RI,
SC, SID, TN, `D, LIT', VT, VA, VI, WA, WV, WI, WY,
IIR, Ffl, SC, SID, Y N,TX, Ur, Vf, VA, WA, WV, WI, WY
INCORPORATE IN: Pennsylvania,
Nationwide Agirdbus4niess Insurance Company
(NAIC P28223)
BUSINESS ADDRESS: ONE WEST NAT IONWIDE BLVD,, 1 04 701, COLUMBUS, OH 43215
2220.
PHONE: (515)SO&DOO
UNDFRWRIFT ING LIMHATICIN V: $19,535,000,
UNDFRWRITING LICENSES c,M AL, AZ, AR, CA, CO, CT, DE, DC, FL, GA, ID, IL, IN, IA, KS, ICY,
LA, ME, MD, IAA, M1, MIN, MS, MO, VII, NE, NV, Nil, NJ, NM, NY, NC, RID, 011, OK OR, PA, RI,
SC, SID, I N, TX, LIT, VT, VA, WA, WV, WI, WY.
INCORPORATED IN. Iowa,
NaflonMde Mutuall Insurance Compaimy
(NAIC #2787)
BUSINESS ADDRESS: ONE. WEST 14KI IONWIDE BLVD., 1 04 70 1, COLUMBUS, 01143215
2220.
PHONE: (614) 249 7111,
UNDERWRITING LIKARA11ON IV: $1,145,96.3,000.
UNDERWRITING I ICFNSFS c,fl: AL, AK, A7, AR, CA, CO, CT, DE., DC, FIL, CA, GU, III, ID, IL, IN,
IA, KS, KY, LA, ME., IIAD, MA, I'Al, MN, MS, MO, MY, NE, NV, NH, NJ, NM, NY, NC, ND, OH, OR,
OR, PA, RI, SC, STD, TN, TX, UT, \n, VA, VI, WA, WV, WI, WY
INCORPORATED ft Ohio.
INAVI)GATORS lINSU1IU-4NC11:: COMPANY
(NAIC #42307)
BUSINESS ADDRESS: 400 Atiandc SUree(, Sth Floor, Stamford, CT06901
PHONE(203) 905 6090,
UNDERWRITING LIMITATION bP $100,W.8,000,
SURETY LICENSES c,fl: AL, AK, AS, AIR, CA, CO, CJ, DE, IDC, FIL, GA, GIL, HI, (D, IL, IN, J& KS, KY,
LA, ME, MID, MA, MI, MN, MS, MO, IIAT, NF, NV, Nii, NJ, NM, NY, NC, ND, 011, OK OR, PA, I1R,
INCORPORNI LD IN: New I iampshlre,
NOVA Casualty Company
(NAIC 442552)
BUSINFS'S ADDRESS: 440 LINCOLN STREET, WORCES FER, MA 01651- 0002
rHONF: (508) 853 7200
U10ERWRI'TING LIMITAI [ON b/: $9,112,000.
SURETY LICENSES CR: All., AK, AZ, AR, CA, CO, Cl, DE, DC, FL, CA, Til, ID, L, IN, [A, KS, KY, LA,
ME, NID, MA, MI, MN, IIAS, MO, Mr, NE, NV, Nil, 1\11, NINT NY, INC, ND, OH, OR, (.-,IR, PA, RI, SC,
SID, 1114, TX, IJI, \11, VA, WA, WI, M,
INCCRIFICNAIEID IN: New York
0
OlMo Casuality linsurance Counpainy (The)
(NAIC 4124074)
BUSINESS ADDRESS: 17513p.rkeley Street, Boston, IVIA 02116.
HiONE: (617) 357-9500 X 41177.
UNDERWRII 114G LIMITAT ION IV: $112,4 1 5,000,
SURETY LICENSES c,fl: AL, AK, AZ, AR, CA, CO, CT, DE, DC, FL, GA, I il, ID, L, IN, IA, IRS, KY, ILA,
ME., MD, MA, MIT MN, MS, NO, NIT, NE, NV, NI -I, NI, NM, NY, NC, ND, OH, OK, OR, PA, RI, SC,
SD, I N, TX, UT, VT, VA, WA, VVV, WI, WY,
INCORPORATED IN: New Hampshire.
Ohilo Farmers linsuirance Company
(NAIC #24104)
BUSINESS AI. DRLSS: P.O. Box 5001,Westflh4d Center, OH44251 5001,
PI -TONE: (330) 88 7 010 1.
UNDERWRIPING LIMITATION Ij/: $227,840X0.
SURETY LICENSES cjl: AL, AZ, AIR, CO, DC, DIE, FL, GA, IL., IN, IA, KY, LA, IIAD, MA, MIT, MIN, MS,
MO, Mn', NE, NV, NJ, NIM, NY, NC, ND, OH, OK, PA, RI, SC, SD, TN, IX IA, VA, VVA, WV, Wt, WY,
INCORPORAI ED ft Ohio.
Ohio indemnity Company
(NAIL 426565)
BUSINESS AIDDRHS� 250 F, Broad X, Ah I loor, Colurnbus, OH 4.3215 - 0000
PI IONIE: (614) 2.28 2800,
UNDERWRIT ING I IMITAI 1011T b/: $4,670,000.
UNDERWRIT ING LICENSES cjl: AL, AK, AZ, AR, CA, CO, CT, DF, DC, F1, GA, 111, HE), IL, IN, [A, KS,
KY, LA, ME, MD, 101, ION, MS, MO, MT, NE, NV, TNT -I, NJ, N11A NY, NC, ND, 0H, OK, Ort, BA, RI,
SC, SID, ITN, IX, 1) 1, VT, VA, WA, WV, WI, WY,
INCORPORATED IN: Ohlo
Ohio Security insurance Company
(NAIL #24082)
BUSINESS ADDRESS175 Berkeley Street, Boston, MA 02116,
PHONE: (617) 351-9500 A 411/7,
UNDERWRITING LIVIRATION bl: $1,365,0100
SITIFTY HUNSIFS cjl: At, AK, A7, AR, CA, CO, Cl, DE, DC, FL, GA, 11), 11, IN, IA, KS, KY, LA, IOL,
MD, MA, IVI[, ION, MS, MO, M1.. NE, NV, NH, N., NIVI, NY, NC, ND, 0H, OK, OR, PA, RI, SC, SD,
I N, IX, Ur, VT, V& WA, WV, 011, VVY
INCORPORATED IN: New I lampshre
00dahoma Surety Company
(NAIC #23426)
BUSINESS AIDDRESS:110 Bo)(1409,1ulsa,01<74101
1H0NL(91R)587-7221,
UNDERWRIT ING 1..111AH AT ION b/: $ t,69 1,000
S(JRLIY LICENSES c,f/: AR, KS, 01-1, 0K, IX,
lNCCRPOI:VJEDIN: Ohio.
BUSINESS ADDRESS: P.O.BOX 1635, MILWAUKLE, W153201 -163S
PI IONE: (262) 797-2640.
UNDERWRITING LIMITATION b/: $7,061,000.
SURETY LICENSES cj/� AL, AZ, AR, CA, CO, DC, Fl, GA, ID, IL, IN, IA, KS, 101), MN, ME, MO, IO7,
NE, V, NIA, NC, ND, 011, OK, OR, PA, SC, SD, TIN, D( LIT', VA, VVA, W, VVI, WY
INCORPORATED 11W Wisconsin.
W�kfvlsw
P
Pacilfic Indennitty Company
(INAIC #20346)
BUSINESS ADDRESS: 202B I Wt's Mill Road, Whitehouse Ration, N] 08689
PHONE: (21 S) 640-1000
LINDCRWRIT ING LIMITATION b/: $317,802,000
SURETY LICENSES c,f/: AT, AD, AZ, AR, CA, CO, CT, DE, DC, FL, GA, [it, 11), IL, IN, [A, KS, NY, I A,
ME, MID, MA, MIL Me, IVS, 1140, MT, NE, NV, NH, NJ, NIA, NY, NC, NO, 011, OK, OR, PA, F"_x,
SD, TN, IX, III, VT, VA, WA, WV, VVI, WY.
INCORFORAI ED IN: Wlg�onsln,
PAC111111C 11101i INSURANCE COMPANY
(NAIL #18380)
BUSINESS ADDRESS: 348 VVEST O'BRION DRIVE, HAGAI NA, GLJ 96910,
III TONE: (671) 477-9801,
UNDERWRIVING1,1101fAl ION b/:$2,438,000
SURIFTY LICENSES c.,Y: OCT, ME,
INCORPORAI ED IN: Guar),
PART'NER RIH NSIJ IRAN CTE COMPANY OF THIS U.S.
OLD DOMON1101M INSURANCE COMPANY
(INAIC #40231)
BUSINESS ADDRESS: 55 WEST SI RLE-1, KLENE, NH 03431.
PRONE.: (904) 390 7282.
UNDERWRITING LIMITATION b/: $3,634,000.
51.1REIY LICENSES c,f/: CT, DE, 11, GA, ME, MD, IMA, NH, NY, NC, PA, RI, SC, TN, VT, VA
INCORPOW0 ED IN: Florida,
Old Republic Generall insurance Corporation
(NAIL M24139)
BUSINESS ADDRESS: 307 NORT H MICHIGAN AVENUE, Cl KAGO, IL 60601
PHONE: (312) 346-8100
UNDERWRIT'ING LIMITATION b/: $66,847,000
SURETY LICENSES cjlAL., At<, AZ, AR, CA, CO, CT, ME, DC, IL, GA, ID, IL, IN, (A, KS, KY, VA, ME,
IVID, MA, Ml, MN, IIAS, 100, MT, NE, NV, NH, Nj, 1\1110, NY, NC, ND, OH, OK, OR, PA, RI, SC, SID,
IN, IX, IJI, VT, VA, WA, WV, Wl, WY
INCORPORATED IN: Illinois,
Oid Repubfic insurance Company
(NAIC #24147)
BUSINESS ADE)RLSS: 110. Box 789, Greensburg, IIA 115601 - 0789,
III IONL: (724) B34 5000
UNDERWRITING LIMPATION ILI: $110,790,000,
SUR13Y IJCEN9-S cjl: AL, AK, AS, AS, AR, CA, CO, CT, DE, DC, FIL, CA, GILT, lil, 11.), 11, IN, A, KS,
KY, LA, ME, AD, MA, IMI, MN, It MO, MP, MIT, NE, NV, NI 1, NJ, NIM, NY, NC, ND, 011, 01<, OR,
RA, PR, R1, SC, SID, I N, TX, UT, VI, VA, V1, WA, WV, VVI, WY
NCORPORAI ED IN: Pennsylvania.
Old RepublicSurety Company
(NAIC #404,14)
(NAIC H38636)
BUSINI.SSADDRILSS: 20OFirst Stamford Plane, Suit(^400,St.irriforc.1,CfO6902,
PHONE: (203) 485 4200.
UNDERWRITING LIMITA-TION L)/: $9P,,354,000
SlJREIY LICENSES c,fl: AL, AS, CA, CO, DC, IL, K'S, MI, IVIS, NE, NY, TX, U1, WA
INCORPORATIED IN: New York
PAIRTNERRE INSURANCE. COMPAINY OF NEW YORK
(NAIC #10006)
M.)SINESS ADDRIFSS: 200 First Starnfoi d Place, Suite 400, Starfiloi d, CT 06902.
r1l 10INE: (203) 485 4200
UNDERWRITING LIMITATION b/: $11,076,000,
SURELY LICENSES cjl: AL, AZ, CA CO, DIE, EX, ID, (I., IN, A, KS, KY, MID, MI, YIN, MS, IVIT, NEE
N.1, 11411A, NY, ND, 011, 01C, OR, PA, R1, SC, SO, IX, U1, VI, VA, WA, VVV, Wt.
INCORPORATED IN: New York
Peklin Insurance Company
(NAIL #24228)
B1.)51NIE5S ADDRESS: 2505 COURI 5f REET, PEKIN, I L 61 559 - 0001,
IT MNIF(309) 946 1161
UNDERWRITING LlMlTAIICN b/: $13,848,000,
SIJRLIY LICENSES cjl: AZ, 11.., IN, I& Toll, OIL W1,
NCORPORAI ED IN: Illinois
Pennsylivanta Manufacturers indernnRy Company
(NAIL #41424)
N.ISINES.I., ADDRIESS: P.O..Box 3031, Blue Bell, PA 19422 - 0754.
PHONE: (610) 397 5000,
UNDERWRITING LIMITAIMIN bl; $8,215,000,
SURETY LICENSEE CfI; At., AK, AZ, AR, CO, Cr, DE, DC, ICJ, IN, KS, KY, LA, VIE, MD, 101, IAA, VlCl,
IIAT, NE, NV, NI -I, NJ, Niv, NY, NC, OR PA, RI, SC, ED, TIN, UT, VT, VA, VVA,
INCORPORKTH.) IN: Pennsylvania.
Peninsylvairlia IMairitgfacture?,.s'Assox:iatiloin Insurance Company
(NAIC #12262)
BUSINFSS ADDRESS: P.O, Box 3031, Blue Bell, PA 19422 0754,
PHONE: (610) 391-1;000.
UNDFRWRII[ING I IMITA1101141bl:$32,524,000
SURE ry LICENSES cjl: At, AK, AR, CO, CT, DF, DC, F[, (.,A, [11, ID, II.., [A, KS, KY, LA, MF, MD,
MA, 101, INS, MO, IMI, NE, NV, N1 1, N), NIVI, NY, NC, 0H, OK, PA, RI, SC, ED, TN, TX, UT, V-1, WA,
VVV
INCORPORAI ED IN: llennsykwtia.
Pennsylvania Nationall Mutuall Casualty Insurance Company
(NAIC 9 14990)
BUSINESS AIDDRESS:P O. Box 2361, Hairisburg, PA17105 2361
PHONE: (717) 234 4941
UNI)F.RWRI I ING(..IMITATION h/: $58,016,000
SURETY LICENSES of/: AL, AS, AZ, AR, CO, Cl, I.A.- DC, EL, GA, ID, IL, IN, A, KS, KY, LA, ME,
AID, MA, MI, MN, ME, IVIO, IAT, NE, NJ, NM, NY, NC, 011, OK, OR, PA, [it, S(.., ED, IN, FX, U1, VT,
VA, WA, MI, WL
INCORPORATED IN: Pennsyvania
PHIL.AIDIFLIPHIA INIDIE]MINITY INSURANCE COMPANY
(NAIC #I P058)
BUSINESS ADDRIESS: One Bala Plaza Cast, Suite 100, Bala Cynwyd., PA 19004 1401
PHONE: (610) 206 78.36,
UNDERWRITING LIMHAT ION hl: $2.3E,91IOW
UNDI RWRIT ING LICENSES c,fil: AL, AK, AZ, Art, CA, CO, CT, DE, DC, FL, GA, HC ID, I., IN, IA, KS,
KY, LA, IIAE, MID, MA, IMI, ON, MS, MO, M1, NE, 114V, NH, NJ, NM, NY, NC, NID, OH, OK, OR, PA,
RI, SC, SID, ITV, fX, UT, VI, VA, WA, WV, WI, VVY.
(NAIC 1124260)
BUSINILSS ADIDRIESS: P 0 BOX 89490, C1 I.VEI AND, 01144101 G490
PHONE: (440)1461-5000,
UNDERWRITING LIMITATION bI: $2.57,058,000,
SURETY LICENSF.S cjl: AL, At(, AZ, AR, CA, CO, CT, DE, DC, FL, GA, I li, ID, IL., IN, IA, KS, KY, I -A,
ME, MID, MA, MI, MN, ME, MO, 11,11, 1\11.1, NV, NI 1, NJ, NM, NY, W.- ND, 011, (.)K, OR, PA, RI, EC,
SD, I N, f)(, UT, VT, VA, WA, WV, WC WY,
INCORPORATED IN: 01110,
Progiresshve Northwestern Insurance Company
(NAIC 442919)
BUSINESS ADDRESS: P,O, BOX 89490, CLEVELAND, 014 44 101 - 6490
PI IONI..: (440) 461 5000.
UINDFRWr"TING I IIIAPAT ION b/: $62,590,000
SURIF1 Y LICENSES cj/C At<, AS, CA, CO, CT, DIE, DC, GA, HI, 11.), IN, IA, KS, KY, I.A, ME, MD, MN,
MS, MO, MT, NE, NV, NJ, NM, NY, NC, ND, OH, CK, OR, III, SC, SD, I N, YX, L) I, VA, WA, WV, WI,
INCORPORATED IN: Qhlo,
Pirotecdve Insurance Company
(NAIC #12416)
BUSINESS ADDRI SS: 111 Congressional Blvd, Suite 500, Carmel, IN 460.32
PI IONE: (31 /1636-9800 x 14:33,
UNDERVORII(NG LIMITA-HON ls/: $2.5,889,000
LJNI)ERVVRI FINC..a LICENSES c,f/: At, AK, AZ, AR, CA, CO, CI', DE, DC, F L, GA, 111, 11.), R, IN, IA, K",
KY, LA, I'VIE, MID, MA, PAJ, IAN, MS, IVIO, M F, NE, NV, NH, NJ, NM, NY, NC, ND, 011, OK, OR, PA,
PR, RI, SC, ED, TN, TX, U1, Vr, VA, WA, WV, WI, WY
INCORPORATED IN: Indiana.
Protective Property & Casualty insurance Company
(NAIC 935 769)
INCORPORATED IN: Pennsylvania
PLATTE RIVIER IINSU RAINCIE COMPANY
(NAIC #18619)
BUSINESS ADIDRFS.S: P 0 Box 5900, Madison, W1 53705 - 0900,
PHONIL: (608J 929 4200
(C)INIM.RWRII INCS I IMITAROIN x(: $4,967,000,
SURETY LICENSIFS c,f/: A[, AK, AZ, AR, CA, CO, C1, DE, DC, ` L, (..,A, 111, ID, R, IN, IA, IfS, KY, LA,
ME, IIAID, MA, M(, MIN, INS, MO, VIT, NE, NV, NH, NJ, JIM, NY, INC, ND, OH, 01K, OR, PA, RI, SC,
SID, IN, T)(, UJ, %rT, VA, WA, WV, WI, WY,
INCORPORATED IN: (Nebraska,
Plan Ilmsuuraunce Conapainy
(NAIC #30945)
BUSINESS ADDRESS: 518 East Broad'Street, Columbus, 01143215,
PHONE: (614) 464-5000,
UNDERWRITING LIMHATION td: $2,402,000
SURETY LICENSES c,CI: AL, At(, AZ, AR, CA, CO, CT, DE, DC, FL, GA, 111, 11), 11, IN, IA, KS, KY, LA,
ME, Al.), MA, 11,41, MIN, ME, MID, AT, NF, NV, NH, N], NM, NY, NC, NID, 011, OK, OR, EA, :Q Sr.,
ED, IN, IX, UT, VI, VA, VVA, WV, VVI, WY
INCORPORAH:r) Pk Iowa
PiraCentuiry Insurance Coifiripany
(NAIC 921903)
BUSINFI. �5 ADDI SPO Polaris Parkway, Wer.,torviie, 01143082
P1 IONF: (614) 895 2000
UNDERWRITING LIMITATION 1:3/; $5,B28,000.
SLIRETY LICENSES c,fl: AK, AZ, AR, CA, DE, DC, CA, It., IN, 1A, lCS, LA, IME), MA, IVI, PIN, ME, MID,
MT, NE, NV, NJ, NM, NY, IND, OK, OR, PA, SC, SD,TX, UT, WV, W1, VVY,
INCORPORAT ED W Michigan
PHONIL: (636)5365600
UNDL.RWRII ING I IMITATION ld: $17383,000
UNDERWRITING I CHNEFS (jk At, AK, AZ, Art, CA, CO, C1, DE, DC, FIL, CA, HI, 11), 1., IN, IA, KS,
KY, LA, ME, MD, MA, MC PIN, ME, MO, IIAT, NE, NV, Nil, NJ, NM, NC, ND, 011, OK, OR, PA, IT,
RI, SC, SID, IN, TX, UT, Vf, VA, WA, WV, WI, WY
INCORPORATED IN: Missouri,
I
Q11511E Ilnsuir,ance Corporaflon
(NAIL U39217)
BUSINESS AIDDRIFSS: One 6mcxral Drive, Sun Prairie, W[ 53596,
PI -IONS: (608) 82S 5160
UNDERWRITING LIMITATION :V: $74,065,000
SURETY LICENSES cj/: AL, AK, AZ, AR, CA, CO, CST, DE, D(., FL, CA, III, ID, I., IN, IA, KS, KY, LA,
Ml, MD, IAA, MI, MN, IIAS, 11,10, IIAT, NE, NV, 114H, NJ, NM, NY, NC, ND, CH, OK, DIR, PA, RI, SC,
ED, IN, 1)( UT, VT, VA, WA, VVV, VVI, VVY,
INCORPORATED W Pennsylvania
Wm"N'A'p 1"lip
IR
Regent Ilinsursnce Company
(NAIC #24449)
Bt.61NIESS ADDRIESS: Ono QBIE Way, Sun Prah e, VVI 53596,
PHONE: (608) 225 51%
UNDERWRITING LHAITAUDIN bl: $3,263,000,
SURETY LICEINSES cjl: AL, AK, AZ, AR, CA, CO, DIE, DC, FL, G& HI, 117, L, IN, IA, KS, KY, LA, IIAID,
MA, MI, MN, IVIS, IAO, Mr, NE, NV, NIH, NI, NY, RIG, NID, ON, OIC OR, PA, RI, SC, SD, TIN, IX, UT,
VT, VA, WA, VVV, WI, WY.
INCORKTRATI D IN: Wisconsin,
RepublIc - FranIflin INnsuurance Company
(NAIC #12475)
BUSINESS ADDRESS: 11 0 Box 530, Utica, MY 13503 0530,
III iONIE: (315) 73/4 2000
UNDERWRIT IING LIMITATION ID/: $.5,660,000,
SURETY LICENSES c,f/: CT, DE, DC, GA, IT., IN, KS, IVID, MA, 101, NI 1, NJ, NY, NC, 011, PA, R( TN,
'IX, VA, W1
iNCORPORAT U.) IN: Ohio,
1111-11 Insurance Company
(NAIC fl 13056)
13LISINESS ADDRESS: 9025 IN LhdbLrgh Drive, Peoria, IL 61615
PHONE: (309) 692 '1000,
UNDERWRITING, LIMHATI(7N 1 $71,564,000
SURETY LICENSES cjl: AL, AK, AS, AR, CA, CO, CT, DE, DC, 1 1, GA, GU, I'll, ID, 11, IN, IA, KS, KY,
LA, ME, MR, MA, Al, MN, IVIS, MO, TAT, NE, NV, NH, N), NM, NY, PIC, I\JI), OH, OR, OR, PA, PIR,
R(, SC,S0, TN, TX, U1, VT, V& VI, WA, WV, WI, WY
INCORPORAILD ft Illinois.
Rodhe Surety and Casualty Counpany, IInc.
(NAIC #42706)
BUSINESS ADDRESS: 4107 IN I HPIES AVE 2IN0 FLOOR, TAMPA, r 1. 33607,
PHONE: (813) 623-5042,
UNOERWRI FING LIMIRAT [ON bl: $1,006,000,
SURETY LICENSES cfl: AL, AK, AS, AR, (-I, DE, FL, GA, I il, ID, IN, IA, KS, LA, MID, MI, IVIN, MS,
UNDERWRITING LIMITATION 1/: $236,691,000
SURETY I ICENSES (,f/: AL, AK, AZ, AR, CA, CO, C 1, DE., DC, 1: E., GA, GU, Al, C, Il, IN, IA, KS, KY,
LA, ME, MD, MA, IVII, JOIN, IVIS, MO, IV1T, NE, NV, NH, NJ, RIM, NY, NC, NID, 041, OK, OR, PA,
RI, SC, SID, I N, YX, UT, VT, VA, VI, WA, WV, VVI, WY.
INCORPORATED IN: Missouri
Sagannore Ilinsllulrance Company
(NAIC #40460)
BUSINESS ADDRESS: 111 Congresslonal Blvd,, Suite 500, Cannel, IN 46032.
PHONE: (31.7) 636 9800 x 1433
ONDERWRI ZING 111011 ATION lb/: $1.3,573,001)
UNDERWRITING LICENSES (:,f/: AL, AK, AZ, CO, (71, X., DC, GA, 111, ID, L, IN, IA, IRS, ICY, VIE,
MID, MA, MI, AN, ME, MO, IAl, NE, NJ, RIM, NY, NC, OH, OR, PA, RI, SC, SID, TN, IX, UT, VT,
WA, W, WI, WY
INCORPORAILD IM Indiana
SIECURA INSURANCE, A Mutual Company
(NAK #22543)
BUSINESS ADDRESS: P 0 Box 819, Appleton, WI 54912 0819
III iONIE: (920) 7?9 3 161
UNDERWRITING LIMITATION b/: $46,149,000
SURETY LICENSES (:,t/: AS, AR, CO, ID, IL, IN, IA, KS, KY, MI, NIN, IIAO, M 1, NE, NV, NIA, NE),
01 f, OK OR, PA, SC), TN, U1, WA, WI, WY
I NCC)RPORAT 11) IN: Wisconsin..
Selective Insurance Company oil Ainnedca
(NAK #1 2572)
13USINIE3S ADDRILSS: 40 WAIN [AGE. AVENUE, BRANCHWALL, PJJ 07890,
PHONE: (973) 948-3000,
WT)ERWRFING LIVIIIATION b/: $63,280,000,
SURETY LICENSES cjV AL, AK, AR, AZ, CO, CT, DE, I)C, GA, 11, IN, IA, KS, KY, IVID, MA, MI, MIN,
NO, M 1, NIL, NV, NI 1, NJ, NM, NY, NL, NU, Uh, UK, UK, I N, I A, U 1, A 1, VA, VVA
INCOFWORATEID IN: Florida.
Rockwood CaSUallty lInsuiraiiice CoiMilpaliqy
(NAIC #3r605)
BUSINFSS ADDRESS: I IT 00 WOrtharn Center Drive Suite 290 Houston, Texas.; 1/065,
III K)NF: (814) 926 4661
UNDERWRITING LIMITATION lb/$10,889,000
"SURETY LICENSES cjt: Al, AK, AZ, AR, CO, 31- DC, FL, GA, HI, ID, I., IN, A, KS, KY, LA, IMIL, Mi.),
VA, MI, ON, MS, MO. MIT, NE, NV, NH, NJ, NM, NY, NC, NET, OH, ON, OR, PA, RI, SC, SE), -DV
U T, VT, VA, WA, WV, WI, WY,
INCORPORAI ED IN: Pennsylvania
S
SAFIECO Insurance Company of Aiiryedca
(NAIL #24740)
BUSINESS ADDRESS: 175 13wrikeley Street, Roston, MA 021 1
PHONE: (617) 35 / 9500
UNDERWRITING LIMITAHON ID/: $156,64/,000
SURETY I ICENSFS cj/: AL, AK, AZ, AR, CA, CO, C1, DIL, DC, I I., GA, GU, III, IT), L, IN, IA, IRS, KY,
IA, JOE, MR, IMA, MI, MR, Ms, Vo, Mr, NE, NV, NIT, N), NM, NY, NC, RID, 0H, OR, OR, PA, RI,
X, SD, TIN, TX, U fVT, VA, WA, WV, VVI, WY,
INCORPORAI E D IN: New Hampshire
Safety NaAiOnal Casualty Corporation
(NAIC JMEUOE,)
BUSINESS ADDRESS: 1832 Schu07 Road, St. Louis, MO 63146 3540
III fOINE: (314) 995 5300,
IVIS, ING, MT, ME, IIIV, Nli, N1, NM, NY, NC, 011, OR, PA, RI, SC, SD, TN, TV, UT, VT, VA, WA, WV,
WI, VVY,
INCORPOR/O I D IN: New jeisey,
Seneca Ilnsuirallnce Cornpany. Inc.
(NAIC 9 10936)
13US119ESS ADDRESS: 160 Wal:er Street, New York, NY 10038 4922
PHONE: (212) 344 3000,
UNDERWRITING LIMITATION bl: $14,551,000
SURETY LICENSILS c,f/: AL, AK, AS, AR, CA, CO, Cl, DE, DC, I L, GA, III, ID, IL, IN, )A, KS, NY, LA,
ME, MI), MA, IMI, MN, MS, MO, PIT, NE, No, NH, NJ, RIM, NY, NC, ND, ON, OK, OR, PA, PR' RI,
SC, SID, IN, -IX, UT, VT, VA, WA, WV, WI, WY
INCORPORAI ED IN: New York
Sentry linsuirance A IMutual Company
(NAIC 424988)
13USINESS ADDRFCS: 1800 111ORYI4 POINT DRIVE, 'A EVEN, POINT, WI 54481 8020
PI IONL (715) 346 6000,
UNDERWRIT ING LIMITKI (ON bl: $519,098,000
SURETY LICENSEE cjC AL, AK, AZ, AR, CA, CO, CI, DE, DC, FL, GA, 111, ID, IL., IN, K, KS, KY, LA,
ME, 1AD, MA, 1\41, AN, MIS, IIAO, MT, NE., NIP, NI 1, NJ, NIA, NY, RIC, 1117, OH, OK, OR, PA, RI, SC,
SD, TN, TX, U 1, VT, VA, WA, WV, W( VVY
INCORPORATED IN: WNconsm
Sentry Select Insurance Comparhy
(NAIC #21180)
BUSINESS ADDRESS: 1800INOIYTI I POINT DRIVE., S I LVEINS POINT, WI 54481-8020.
PI IONE: (715) 346 6000
UNDERWRITING I RAIIA11C)IN b/: $22,581,000
SUREFY LICI NSF5 cjl: AL, AK, AS, AR, CA, CO, Cis DE, DC, FL, GA, I fl, IS, L, IN, IA, KS, ICY, LA,
ME, MD, MR, MI, MIN, MS, MO, MT, NE, NV, NI i, Nj, NM, NY, ING, NJ), OH, OK, OR, PA, RI, SC,
S D, IN, TX, U1, VT, VA, WA, WV, WI, OfY
I NCORPORNTED IN: Wiwonslo
SEIRVICIE IIINSUUPAaNCIE COMPANY
(NAIC #36560)
RI.JSINESSADDRESS: 702C)BERI..IN ROAD, RAI,.FIGII,N( 2/6010800,
PHONE: (919) 833-1600
UNDERWRITING LIMITATION J,/: $4,19.5,000
SURETY LICENSES (.,f(: At, AN, A7, AR, CA, CO, CT, DE, DC, HE., GA, III, ID, IL., IN, IA, KS, KY, IA,
ME, IIAID, MA, MI, MY, 105, MO, DIP, MIT, NE, NV, NH, Nj, No, NY, NC, ND, 011, OK, OR, RA, RI,
SC, SI), TIN, TX, Ul, VT', VA, VVA, WV, WI, WY,
INCORPORATED IN: Florida
SIERVICE INSURANCE COMPANY JINC, (TIVE)
(NEAR, #28240)
BUSINESS ADDR[:.`.-,S: 80 MAIN STREET, WE: St ORANGE, NJ 07052
PI fONE: (973) 731 7650
UNDERWRITING LIMIIATION b(: $909,000
SURETY LICENSES C,fl: CT, DE, DC, I L, VD, MA, NH, NJ, NY, NC, PA, RI, VA,
INCORPORATED ft New Jersey.
SIRIUS AMERICA IINSUIRAANCIE COMPANY
(NAIC 0381/6)
13k.)SINI..SSAE)E)RK:SF,:140F3RC)ADWAY 3?NDFl0OR,NEW YORK,NY10005 1108
PHONE: (212).312-2500
UNDFRWRITIN(, LIMrTATI(.)N bl: $52,220,000,
SURETY LICENSES c,fl; AL, AN, AZ, AR, CA, CO, DE, DC, GA, 111, 11), L, IN, IA, KS, KY, LA, MD,
MA, MI, KAS, MCC M1, NE, NV, N1 1, NJ, NM, NY, NC, ND, 011, OK, OR, PA, RI, SC, SD, TN, TX, Ell,
VT, VA, WA, WV, Wk W
INCORPORATED IN: New York
SOUTHWIEST IWAIRONE AND GIENIERAIL INSURANCE. COMPANY
BUSINESS ADDRI.SS: Orre Tower Square, Hartford, Cl 06183
PI IONE: (860) 217 0111,
UNDLRWRII ING LIMITAII ION 1.,(: $11,509,000
SURETY IKIFNSFS c,fl: Al., AK, AZ, AR, CA, CC), (.:T, DL, DC, FIL, GA, [it, 11), 11, IN, IA, KS, KY, LA,
IME, MD, MA, MI, MN, MS, 100, MI, NE, NV, N1 L NJ, HIM, NY, NC, IND, OH, OK, OR, PA, RI, SC,
.SD, TN, TX, UT, V1, VA, WA, VVV, WI, WY,
INCORPORATED IN: CorinectimI,
Standard Fire Insurance Company (The)
(NAIC #19070)
BUSINESS ADDRESS: ONE 1OVVHR SQUARE, HARI FORD, CI 06183,
PHONF: (860) 2110111
UNDERWRITING LIMITATION l,/: $122148,000
SURLlY LICENSES c,f/: At, AK, AZ, AR, CA, CO, CT, DE, DC, FL, GA, HI, ID, IL, IN, A, KS, KY, LA,
ME., IAD, M& 11AI, MN, MS, MO, MI, NE, NV, N11, NJ, NM, NY, NC, ND, ON, OK, OR, PA, RJR, Rk
SC, SID, FRI, TX, UC VF, VA, VI, WA, WV, WI, WY
INCORPORATED IN: Connecklcm,
Stair Insurance company
(NAIC # 18023)
BUSINESS ADDRESS: 26255 American Drive, SmAhfield, I'Al 48034,
PHONE: (248) 358-1100
UNDERWRII ING LIMITATION b/: $48,882,000
SURETY E. CENSES qfA Al., AA AZ, AIR, CA, CO, CT, DF, DC, I` E, GA, 111, ID, IL., IN, IA, KS, KY, EA,
ME, MD, MA, MI, IIAN, IIAS, MO, MT, NE, No, NH, NJ, NIA, NY, NC, ND, OH, OK, OR, 1A, RI, SC,
ED, IN, IX, U1, VP VA, WA, WV, WI, WY,
INCORPORAI ED IN: Michigao,
StarNet Insurance Compainy
(NAIC #40045)"
BUSINESS ADDRESS: PO BOX 9190, DES MOINES, IA 50306 -9190
(NAG #12294)
BUSINESS ADDRESS: 412 INt, Kernble Ave, Suite 300C, Morristown, NJ 07960,
PHONE: (800) 774 2755,
UNDFRWRITING LIMPATION r3l: $6,673,000
SURETY LICENSES c,fl: At, AK, A7, AR, CA, CO, CT, DE, DC, CA, HI, ID, It, IN, IA, KS, KY, I A, MF,
MID, MA, MI, INN, AS, MO, IAD NF, NV, NH, NJ, NM, NC, DID, OFf, OK, OR, PA, RI, SC, SD, IN,
TX, U1, VT, VA, WA, WV, WI, VVY,
INCORPORATED IN: Ari7w,a
St. Paull IFiire and Marline Onsurance Company
(NAIC #247671
BUSINESS ADDRESS: ONE TOWER SQUARE, HARM FORD, CT 06183,
PHONE: (860) 2 7 7-0111
UNDERWRITING LIIIAITAIIOIN b/: $443,919,000
SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, C1, DE, DC, FIL, GA, GIP, til, 11), IL., 1114, IA, KS, KY,
LA, ME, MID, INA, MI, IIAN, IAS, MO, IM, NE, NV, NI 1, NJ, NM, NY, NC, IND, 0H, OK OR, PA, PR,
RI, SC, SD, TIN, TX, UT, VT, VA, VI, WA, WV, WI, WY
INCORPORATED IN: Connerticut
ST. IRAUL GIEPARDIAN INSURANCE COMPANY
(NAIC #247711)
BUSINESS ADDRESS: Orie lower Square, Hartford, C[ 06183.
PHONE: (860) 211 0111
UNDERWRITING LIMITATION b/; $2,293,000,
SURETY I ICFNSFS c,f/: /Q, AK, AZ, AR, CA, CO, CT, f.7E, DC, FIL, CA, 1-11, 11.), 11, IN, IA, KS, KY, LA,
IME, MD, MA, MI, MIN, MS, MO, MT, NE, NV, NH, NM, NY, NC, ND, Oli, OK, OR, PA, RI, SC, SD,
TIN, TX, U V, V7, VA, WA, WV, WI, VVY,
INCORPORKTIED IN: Connecticut..
St. IPaull IMeircuiry Insurance company
(NAIC 424 791)
PHONE: (1300) 343 0592
UNDERWRI ING LIMIT ATBON bt: $11,602,000
SURL TY LICC.IYSLS C,fl: AL, AK, A7, AIR, CA, CO, CT, DE, DC, FL, GA, [it, 11), IL, IN, IA, KS, KY, EA,
ME, DID, MA, MI, IAN, MS, MO, MT I\IF, NV, NH, NJ, NM, NY, NC, ND, ON, OK OR, PA, RI, SC,
SD, TIN, TX, U'l, VT, VA, VVA, WV, WI, WY..
INCORPORATED IN: Iowa
Start, IndeirninRy & IEhIbIlity Coimpany
(NAIC #383 19)
BUSINESS ADDRESS: 399 Park Avenue, Mh l' loor, New York, NY 10022,
PHONE: (646) 227-6400
UNDFRWRITING LIMITATION b/: $202,390,000,
SURETY LICENSES c,f/: At., AK, AZ, AR, CA, CO, C1, DE, DC, F 1, GA, GU, 111, D, I., IN, K, KS, KY,
LA, ME, MD, MA, MI, MN, MIS, MO, MT, NF, NV, Ntl, NJ, NM, NY, NC, ND, OH, OK, OR, PA, Pp,
RI, SC, SD, I N, IX, U1, Vf, VA, WA, WV, WI, WY,
INCORPORATED IN: Texas.
State Auto Property and Casualty Insurance Company
(NAIC #25127)
BUSINESS ADDRESS: 518 EAST BROAD ST REE r, COB. UMBUS, OH 4.3215,
PHONE: (614) 464 5000,
UNDERWRITING UMITAT ION bl: $69,61S,000
SURETY LICENSES c,fl: AC AK, AZ, AR, CO, CT, DE, DC, FL, GA, 111, ID, It, IN, IA, KS, KY, LA, ME,
MD, MA, MI, ION, RIC, 100, MT, NE, NV, NJ, NY, NC, NO, 011, OK, OR, PA, RI, SC, SD, i N, TX, UT,
VT, VA, WV, WI, WY-
INCORPORKT[A) IN: Iowa,
State Automobille Mutthall Insurance Company
(NAIC 025135)
BUSINESS ADDRESS518 LAST BROAD 51 REFI, COLUMBUS, Oil 432.15
PI IONF: (614) 464 5000,
, U "T" "A' i..e Tr". .....
SURETY LICENSES c,f/: AL, Al AZ, AR, CO, CT, DE, DC, FIL, CA, HI, ID, II.., IN, IA, KS, KY, LA, ME,
MD, MA, 101, MN, MS, IVIO, MT, NE, NV, N I i, Nj, NIAL NY, NC, NO, 0 11, OK, OR, PA, RI, SC, SID,
TN, T-X, U I, VI VA, WA, WV, WI, WY
INCORPORATED IN: Oho,
State Favirn Fire and Casualty Compaury
(NAIC V25143)
BUSINESS ADDRESS: ONE STATE FARM PLAZA, BLOOMINGT ON, TL 61110
PHONE! (309) 766-2311
UNDFIRWRITING LIMITATION bl: $1,888,252,000
SURETY LICENSIS cjY Al, AK, AZ, AR, CA, CO, CY, DF, DC, FIL, (,A, 111, ID, IL., IN, A, KF, KY, IA,
ME, MD, MA, MI, MIN, IIAS, ll MT, NE, NV, NI -I, NJ, NO, NY, NC, NE), Olii, oK, OR, PA, RI, SC,
SID, TN, TX, UT, V1, VA, WA, WV, WI, WY,
INCORPORA'I ED IN: Illinois,.
Stiftater Property and Casualty Ilmsunramce Company
(NAIC #16578)
BUSINESS ADDRESS: P, 0, Box 4.5126, Jacksonville, 1- L 32232 .5126
PHONE: (800) 849 6140
T-Il HNG I IMITATION Il $11,92 1,000
SURETY LICENSES c,f/: AT, AK, AZ, AR, CO, CT, DC, FIL, GA, HI, ID, IL, IN, LA, KS, KY, LA, ME, AD,
MA, EAL IIAN, CAS, 100, Mi, NE, NV, NI 1, NI, IIJM, NY, INC, IND, 01T, OR, OR, PA, RI, fC, SD, IN,
TX, U 1, VT, VA, VI, WA, WV, WI, WY
INCORPORAIFID IN: New York
SureFec inmArance Courb1pany
(INAIC # 10916)
BUSINESS ADDRESS: 2103 City.West Boulevard, SmI.c 1300, 1 iouston, IX 77042
PI IONE(713) 812 0800
UNDERWRIT ING LIMITATION bl: $10,728,000
SURE I Y LICENSES cjl: Al., AT<, AZ, AR, CA, CO, CT, DE, DC, Fl, CA, Ill, ID, IL, Ill A, KS, KY, T A,
UNDERWRITING (..IMITATION bl: $441,461,000,
SURETY LICE.Il c,f/: AK, AZ, AR, CA, CO, DE, DC, CA, ID, IL, 114, A, KS, KY, LA, MI, ION, IAS,
NE, NV, NJ, ll NY, ON, OK, PA, SD, UT, WA, WI.
INCORPORATED IN: New York.
rraveJers Casuallty avid Surety Company
(NAIC #19038)
BUSINESS ADDRESS: ONE LOWER SQUARE, HARTFORD, CT 06193.
PHONE: (860)277-0111
UNDERWRITING (..IMITATION Io/: $425,039,000,
SURETY LICENSES cj/: AL, AK, AZ, AR, CA, CO, C1, DE, DC, FI, GA, GO, Til, ID, IlL, IN, A, KS, KY,
LA, ME, MD, MA, MI, VIN, IVIS, MO, M-1, NIL, NV, NH, NJ, NM, NY, INC, NID, 011, OR, OR, PA, PR,
RI, SC':', SD, TIN, TX, LIT, VT, VA, VI, WA, WV, VVI, WY
INCORPORATED IN: COFMeCtJOAT
'Travellers Casualky avid Surety Company ofAmerlica
(NAIC 4.0 194)
BUSINESS ADIDRFIS: ONE TOWER SQUARE, I 1ARTFORD, CI 06183,
PHONE: (860) 277-0111
UNDERWRITING LIMP AI ION b/: $21 1,123,000,
SURETY LICENSES c,r/: AL, AK, AZ, AIR, CA, CO, CS, DE, DC, FL, GA, GU, HI, 117, IL, IN, IA, KS, KY,
LA, ME, IIAID, IVA, MI, IVIN, ll MO, MT, NE, l NI -I, Il Ni NY, NC, NO, OH, OK, OR, PA, FIR,
RI, SC, SET, IN, TX, LJT, VT, VA, VI, WA, VVV, WI, WY.
INCORPORATED IN: Conn"tlruL
Travellers CasUallt,y Insurance Company of Aumerilca
(NAIC419046)
BUSINE.SS ADDRESS: ONE TOWER SQUARE, HART "FORD, CT 06183,
PHONE: (860) 277 0111
UNDERWRITING LIMITATION b/: $S5,265,000
IME, Il MA, MI, IIAN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, ll ND, 011, OK, OR, PA, RI, SC,
SID, To, YX, U1, VT, VA, WA, WV, WI, WY
INCORPORATED IN: Texa,5,
Still DONIDING COMPANY 01F AMERICA
(NAIC #24047)
BTJKNFSS ADIDRLSS: 151 N. FRANIKI IN S1 , CHICAGO, TL 60606,
l (312) 822-5000,
U14DERWRII ING, LILVII FATION bl: $776,000,
SURETY LICENSES c,f/: A' E A7, AR, CA, CO, DE., DC, (.-,A, ID, 11, IN, KS, ll MO, MI, NEE NV,
NM, NY, ND, OR, OR, SC, SD, TIN, FX, UT, WV, VVY,
INCORPORATED ft South Dakota
.Swiss Relinsurance Annerica Corporation
(NAIC N25364)
BUSINESPAIDDRESS: 175 KING STREET, ARMONK, NY 10504 1606,
PHONE: (914) 828 9000,
SI.JRFTYLICFlq;ES C,f/:AI..,AK, AZ, AR, CA,CO, CT, DL,DC, rL.,GA, HI, ID, 11,IN, IA, KS, i<Y,IA,
MF,IIAD,MA, IIAI,MN, IMS,MO, MT, NE, NV, NH, lV1,14M,NY, NC, IVD,Oli,01<,OZ,PA, RI, SC,
5 IT, T N, IX, 0 T, VT, VA, WA, WI,
INCORPORAH:D IN: New York,
03a-,RID-T-Qp.
T
'TRANSATLANTIC REINSURANCE COMPANY
(NAIC tE19453)
BUSINESSADDRESS: One Liberty Plaza, 165 Broadway, NEW YORK, NY 10006,
PHONE; (212) 365 2200
11)- 1 1 UN., "., , c"'. -, "', -, r-u, 41, ur, -, ".., .", m, w, IL, B[', IH, ", 'T, I.h,
ME, ME), MA, MI, MN, MS, MO, M1, NE, INS, Nil, NJ, NM, NY, INC, NID, OH, OK, OR, PA, RI, SCE
`SD, TN, D(, U1, VT, VA, WA, WV, WI, WY
INCORPORNT ED ft Connec I cut
Travellers indeunnity Coirnpany (The)
(l 4256!,;9)
BUSINESS ADDRESS: ONE TOWER SQUARE, I ARTFORID, Cr 0C,183
PHONE: (860) 277 0111,
UNDERWRITING LIMITATION b/: $663,330,000,
(SURETY LICENSES 0/: AL, AN, AZ, AR, CO, CT, ISE, DC, FIL, GA, G(J, Ifl, ID, L, IN, A, KS, KY, LA,
ME, CAD, MA, I'Al, ll ll MET, MI, NE, NV, NH, NJ, NM, NY, SIC, NIEC, OH, OK, OR, PA, PR, RI,
SC, SID, Y Il TX, U1, VT, VA, WA, WV, WI, VVY.
INCORPORATED IN: Conno.clicul-
I UIVIELIERS IIINIDIEMINIT'Y COMPANY OF AMERICA (THIE)
(NAIC #2S666)
BUSINESS ADDRESS: ONE'IOWER SQUARF, I 1AR11 FORD, CT 06183
PHONE: (860) 277 0111
UNDERWRITING LIMITATION IN: $18,251,000
SURETY LIC EIN.SES C,,r/: AL, AK, AZ, AR, CO, C 1, DC, r L, GA, 111, ID, IL., IN, IA, RE, KY, LA, ll MA,
10 1, MN, Il MO, N'Tr NE, NV, INH, NJ, HIM, NY, NC, ND, 01 C OK, OR, P& RI, SID, I N, IX, LT 1, \n,
VA, WA, WV, WI, WY
INCORPORATED IN: Connedicut
Travellers Indemnity Company of Connecdcut (The)
(NAIC 42%82)
BUSINESS ADDRESS: 011 TOWER SQUARE, I IARIi FORD, CT 06183
PHONE: (860) 27 7 0111
UNDERWRITING LIMITATION lx`C $33,279,000,
SURETY LICENSES c,f/: AL., AK, AZ, AR, CA, CO, CT, DE, DC, FIL, GA, 111, ID, II.., IN, IA, KS, KY, LA,
ME, MD, MA, Kill KIN, MS, MO, MT, NE, NV, NI 1, NJ, NIV, NY, NC, NEC, OH, OK, OR, PA, PR, RI,
b-, )1.), I IN, IA, Ly 1, V 1, VA, VI, VVA, VVV, VVB, VVY
INCORPORATED IN: (onn-.HaA,
Travelers Property Casuallty Company of America
(NAIC 025674)
BUSINESS ADDRESS: ONE IOWER SQUARE, HARFFORD, CT 06183
PHONE: (860) 277 0111
UNDLRWRII ING I WIRAICIN bP $4.3,745,000
SJRLTY LICENSIPS c,f/: AL, AK, AZ, AR, CA, CO, CT, SF, D(, FIL, GA, I I, ID, L, 1111, IA, KS, KY, LA,
IVIL, MD, MA, MI, MIN, MS, MO, 11AP, MI, W., NV, NH, Nj, NI\A NY, NC, ND, OH, OR, OR, PA, RI,
SDF TN, IX, UT, VI, VA, WA, VVV, WI, WY
INCORPORATED IN: Conne,.Acut
BAc-LI-Q-Tope
LJ
U.S. Spedafty Insurance Coimpany
(NAIC #29599)
BUSINESS ADDRFSS: 131403 Northwest Freeway, Houston, I)( 77040.
PHONE: (713) 462,1000
UNDERWRITING I.111AHATION E/: $59,367,000
SURETY LICLNSFS c,f/: AL, AK, AS, AS, AR, CA, CO, Cl, DE, DC, FIL, GA, I fl, ID, IL, IN, 1A, Ks' KY,
LA, ME, MD, MA, MI, I1AN, MS, MO, MIT, NE, NV, IN) 1, NJ, NO, NC NC, ND, OH, OK, OR, RA, RI,
K, SD, TN, 'TX, 1.) T, VT, VA, VVA, WV, WI, WY
INCORPORATED IN: Texas
UNITED CASUAILTY AND SURETY IINSURAINCE COMPAINY
(NAIC 0#36226)15 16
BUSINESS ADDRESS: 292 Nmbury Street, Suite 105, Boston, AA 02115
PHONE: (611) 471-1112,
SC, SO, IN, IX, UT', V1, VA, VI, WA, WV, WI, WY
IINCORPOR,M ED IN: Connecticut,
United States Fire Insurance Company
(NAIC #211131)
BUSINESS ADDRESS: 305 Madison Avenue, Morristown, NJ 07962
PHONE: (973) 490 6600,
UNDERWRII ING LIM I Ual ION bX $131,764,000,
SURETY LICE NSES c,fl: Al AK, AZ, AR, CA, CO, Cl, DE:, DC, R., CA, HI, 0, L, IN, IA, KS, BY, LA,
ME, MD, MA, MI, MN, MS, IMO, MT, NE, No, NH, NJ, IqM, NY, NC, ME), 01 f, OK, OR, PA, PR' RI,
SC, SIB), IN, TX, UT, VI, VA, VI, WA, WV, WI, WY.
INCORPORAILD IN: Delaware,
United States Surety Company
(NAIC #10656)
BUS114ESS ADDRLSS: One Texas Station Cour( Sulte 230, 1 rnoniunn, MD 21093',
PHONE: (410) 453-91522
UNDERWRITING LIMITATION ol: $5,466,000
SURE IY LICENSES rjl: CT, DE, DC., FIL, GA, ME, MID, MA, NI 1, NJ, NY, NC, OH, P& RI, SC, TN,
VT', VA, WV.
INCORPORATED IN: Maryland.
UNiTHEID SURIETY AND INDEMNITY COMPANY
(NAIC #44423)
BUSINESS ADDRESS: P 0, BOX 2111, SANJUAN, PR 00922 - 2111,
PHONE: (787) 625 1105,
LINDLIRWRIT ING LIMITATION bS $6,297,000,
SURETY LICENSI S c,f/: PR
INCORPORAI ED IN: Puerto Rico,
UniveirsM Surety Conipany
UNDERWRITING LIMITKII ION dal: $1,497,000,
SURETY LICENSES CR: AL., AK, AS, AR, CA, CO, Cl, DE, DC, FIL, GA, III, ID, L, IN, EA, KS, KY, f.A,
IVIE, MID, MA, MI, ION, ME, MCI, MT, NE, NV, NH, 111, NIIA, NY, NC, ND, OH, OK, OR, PA, RI, SC,
SD, TIN!, TX, Lff, VI, VA, WA, WV, WI, WY,
INCORPORATED IN: Nebraska
United 111re & Casuallty Comparty
(NAIC #13021)
BUSINFSS ADDRESS: P 0 BOX 73909, CEDAR RAPIDS, IA 52407 3909
PRONE: (319) 399 11700,
UNDERWRITING(..IMITATION h/: $65,336,000
SURETY I ICIFINSES cj/: AL, AK, A7, AR, CA, CO, DC, Fl, GA, 111, ID, 11L, IN, IA, KS, KY, LA, ME, MD,
MA, MI, MIN, MS, MO, MI, NF, NV, NJ, NIM, NY, INC, ND, ON, OK, OR, PA, SC, SD' TIN, TX, uT,
VT, VA, WA, WV, WI, WY
INCORPORAT ED IN: Iowa
UNITIED 11:111RIF & IlMIDE]MINITY COMPANY
(NAIC #19496)
BUSINE SS ADDRFSS: P 0, BOX 73909, CEDAR RAPIDS, IA 52,107 3909
PHONE: (3 19) 399 5700,
UNDFRWRI I ING (..IMITATION b/: $1,914,000
SURETY LICFNSFS c,f/: AL, CO, IN, KY, LA, 105, MO, NM, IX
INCORPOW FD IIIJ: I exaF
United States Ifidelity and Guaranty Company
(NAIK. #25887)
BUSINESS ADDRESS: ONE TOWER SQUARE, I IARTTORD, CT 06181
PHONE: (860) 27 70111,
UNDF..RWRII ING LIMITATION ION b/: $99,42 1,006.
SURE I Y LICENSES c,f(: AL, AK, AS, AR, CA, CO, Cl, DE, DC, FIL, G& 111, ID, IL, IN, IA, KS, KY, L&
ME, MI.), IOA, MI, MIN, IAS, MO, MT', NF, NV, NH, NJ, NO, NY, NC, ND, OH, OK, OR, PA, PIR, RI,
(NAIC P25933)
BUSINESS ADDRESS: P,O Box 80468, Lincoln, NE 58501
PHONE: (402) 435 4302.
UNDERWRII INC, LIMITATION Ed: $17,774,000
SURETY LICENSES c,f/: AZ, AR, CC), IS, IL, IN, I& KS, KY, MI, ION, MO, MIT, NE, NIA, ND, OH,
OK, SC, Sr.), TX, UT, WA, WI, WY.
INCORPORATED IN: Nebraska
UNIVERSAL UNIDEIRWRITEIRS INSURANCE COMPANY
(NAIC 441161)
BUSINESS ADDRESS: 1299 ZURICH VVAY,.';TFI FLOOR, SCHAUMBURG, 11 60196 1056
I'l IONE.: (847) 605 6000
UNDERWRITING LIMITATION b/: $33,104,000
UNDERWRINING LICENSES c,f/:AL, AK, AZ, AR, CA, CO, Cl, DE, DC, FIL, GA, IH, ID, IL, IN, IA, KS,
KY, LA, ME, MD, MA, MI, MIN, MS, MO, MI, NF, NV, NI 1, NJ, HIM, NY, NC, ND, 011, OK, OR, PA,
RI, SC, SD, IN, TX, UT, \n, VA, WA, WV, WI, WY..
INCORPORATED IN: Illinois
Utica IMuu&uaall IlnsumrarIce Company
(NAIC #25976)
BUSINESS ADIDRESS: POST Cli-FICE BOX 530, UT ICA, NY 13503 .0530,
PHONE: (315) 714 20W
UNDERWRI I ING I MHATION b/: $90,389,000,
SURETY LICENSFS c,f/: AL, AK, AS, AR, CA, CO, CT, DIE, DC, FL, GA, III, D, L, IN, [A, K.1;, KY, LA,
ME., IAD, MA, IMI, MIN, MS, MO, W, NE, NY, INK NJ, NM, INY, NC, IND, OH, OK, OR, PA, PR, RI,
SC, ED, TIN, IX, UT, V'), VA, WA, WV, WI, WY
INCORPORATED IN: New York
Vh",tSh Lp, p
v
VerTerra lu"urance Company
(IIJAIC #10024)
BUSINESS ADDRESS: P.O, 30)(509039, SAN FAFG0, CA 92150
PI -TONE:: (8S9) 350-2400,
UNDERVVRI [ ING LIM ITAT ION ol: $5,64 /,000.
SUId.. IY LICLNSES, c,f/: TX
INCORPORA I ED IN: I eXas
VIgIlaint Ilnsuraince Counpany
(NAIC #20397)
BUSINESS ADDffl2SS: 202B liall's lAill Road, VVIhfehoucie Station, NJ 08889
III i0NE: (21S) 640-1000
ONDERWRI I II\Kj LIIIAITAI ION b/; $33,314,000
SURETY LICENSES c,fl; AL, AK, AZ, AR, CA, CO, CI, DE, DC, FL, GA, III, ID, IL, IN, IA, KS, KY, LA,
K/F, MID, IVA, MI, ION, INS, MO, IAl, NF, NV, NH, NJ, NM, NY, NC, ND, OH, OK, OR, PA, RI, sC,
SD, TN, IX, U-1, VT' VA, VI, tN& WV, WI, VVY
W. ORPORA I LD IN: Ncvv Yoi k.
w
Washington InternadoriM Insurance Company
(NAIL #32778)
BUSINESS ADDRESS; 1200 IMAHN SI pl-EY, sNj rE 800, KANSAS CPY, MO 64105
PI f0NE: (816) 235-3700.
UNDERINFOY 11*5 LIIIAITAI ION bl: $8,539,000
SIARFTY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, C r, DE, DC, r 1, CA, GU, 111, ID, L, IN, V, KS, KY,
Western NaflonM IMuutuM Insurance Company
(NAIL 41.,3 / 1)
BUSINESS, ADDIU:S,: 110 BOX 1463, MINNEAP01 r', IIAN 55440
III iONE: (952) 835 5350,
UNDERWRIT ING LIMIIAI ION bl; $50,202,000
SURI . TY LIC1NSES (,f/: AK, AS, AR, CA, CO, DE, ID, II.., IN, 1A, KS, KY, IVID, MI, IIAN, MO, MIT, NE,
No, NJ, NO, RID, OH, OK, 01:1, PA, RI, SD, IX, III, WA, WI, WY,
INCORKMATED IN: Kfinnesata
Western Surety Counpany
(INAIC #13188)
BUSINESS ADDRLSS: 151 N, FRANKLIN Sl , CI IICAGO, II 60606
PiONE: (312) 822 5000
UNDLRVVRIT ING IJMIfAI ION b/: $153,38 1,000.
sijREry LICENSES c L: AL, AK, AS, AR, CA, CO, CI, DE, DC, I'1, 6A, I 11, ID, 11, IN, IA, KI, KY, LA,
ME, MID, MA, MI, ON, IMS, "0, MIT, N1, NV, NIL NJ, NIO, NY, NC, NI.), 011, ON, OR, PA, PR, RI,
SC, SIT, TIN, TX, UT, VT, VA, WA, WV, W1, VVY,
IN(ORPORATED IN: South Dakota.
Westfield Insurance Company
(NAIC 474112)
BUSINESS ADDRESS: 11 0 Box 5001, Westfield Center, DI 144251 - S001
PHONE: (330) 88 0101,
UNDERWRITING LIMP KfION 111: $115,55 1,000,
SURETY LICILNSIS cj/; Al, AK, A7., AIR, CO3 CT, DE, 13(1, V 1, GA, 111, ID, IL, IN, [A, KS, KY, LA, OF,
IND, IMA, IVI, IVIN, IAS, R/O, Iq F, ND, NE, NY, IV! -I, N.), NNI, NY, NC, OH, OR, OR, PA, RI, SC, SID,
IN, TX, UT, VI, VA, VVA, WV, WI, WY
INCORPORATED IIN: 011k),
Westfield Nafioir%M Insurance Cornpany
(NIAIF lfadl Xlr
LA, MI::, I"D, MA, 1141, ION, ME, k9), MT, NE, NV, NH, NJ, NIA, NY, RIC, ND, 011, 01(, OR, PA, PR'
III, SC, SD, IN, IX, UT, VT, VA, VI, WA, VVV, Vol, VW
INCORPORATED IN: Now Hainpshilre,
West American Insurance Company
(NAIC #44393)
BUSINESS ADDRESS: 17S Berkeley Boston, MA 02116,
PHOINL: (617) 357 9500
UNDERWIRP ING I IMITAI(ON bi: $5,131,000.
SUIRLTY I ICFNSIFS c,fl: AL, AK, AZ, AR, CO, CT, DF, DC, Fl, CA, ID, IL, IN, A, RE, KY, 1A, KID,
MA, IVII, ION, MS, MO, MIT, M, NV, NI -I, NJ, NO, NY, NC, NF), 011, OK OR, PA, RI, SC, ED, TN,
I X, UT, VA, WA, WV, W[, VVY
INCORPORAI ED IN: Indiana
WEST DIFIND MUTUAL IINSUIRANCE COMPAINY
(INAIC 01 5350)
BUSINESS ADDRESS: '1900 Sowh I&Ih Avenue, West Berid, WI 53095,
PHONE: (262) 334-5571
IJNDFRWRI-[INC LIMITATION b/: $113,906,000
SIJI:4:TY LICENSES c,r/; 11, IN, A, KS, KY, Ml, MIN, 100, NF, C)I 1, PA, TN, VVI
INCORPORATED IN: Wisconsin
Westchester Flire Msurance Company
(INAIC #10030)
BUSINESS ADDRESS: 436 WahW SI i cet, P.O,Box 1000, Philadelphia, PA 19106
PI IONE; (215) 640 1000
UNDERWRITING LIMPAIION 1:)/: $21,740,000
UNDLIRWRIT ING LICENSES dlAL, AK, AZ, AR, CA, C 0, CI, DE, DC, FL, GA, GLI, HI, ID, IL, IN,
A, KS, KY, LA, ME, MD, MA, IMI, IIAN, IMS, I\A(:), M11, MI, NI - ., NV, NH, NJ, NM, NY, RIC, ND, 01 L
0K, OR, PA, MR, RI, SC, SD, IN, IX, UT, VT, VA, VI, WA, WV, VVI, vm
INCOIUt ORAI ED IN: Pennsylvania.
BUSINESS ADDIUSS: P. 0 Dox 5001, Westfield CCIAET, 01144257 5001
PHONE (3:30) 887-0101,
UNDERWRITING I IMITATION bh $30,579,000
SURETY LICIFNSES cj/: AL, AZ, AR, CA, (.0, DF, Fl., GA, L, IN, IA, KY, MID, 101, ION, ING, NC, ND,
OH, 01K, PA, SC, ED, TN, TX, VA, VVV, VVI
INCORPORATED IN: Ohio,
Westport Insurance Corporatlon
(NAIL B39845)
BUSINESS ADDRESS: 1200 MAIN SIREEI, SUlf[ 800, KANSAS CHY, 100 64105
PI iONF: (816) 235 3700,
UNDERWRIT ING LIMITATION b/: $129,984,000,
SURETY LICENSES c,fl: A[, AK, AZ, AR, CA, CO, CT, DF, DC, FL, GA, GU, 111, ID, II.., IN, I& KS, KY,
LA, IVIL, MD, IVA, 101, ION, MIS, 100, ME, IVI F, NE, NV, NH, NJ, NM, NY, NC, I'm, 011, Or, OR, PA,
IIII, RI, SC, SD, TN, IX, U T, VT, VA, V1, WA, VVV, W( WY,
INCORPORAIED IN: Olssouii,
RIP
x
XL Reinsurance America Inc.
(NAIC #20583)
BUSINESS ADDRESS: 70 SEAVIEW AVENUE, STAMFORD, CT 06902.
PHONE: (203) 964-5200.
UNDERWRITING LIMITATION b/: $178,791,000.
SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT, DE, DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA,
MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC, ND, OH, OK, OR, PA, PR, RI, SC,
SD, TN, TX, UT, VT, VA, WA, WV, WI, WY.
INCORPORATED IN: New York.
XL Specialty Insurance Company
(NAIC #37885)
BUSINESS ADDRESS: 70 SEAVIEW AVENUE, STAMFORD, CT 06902.
PHONE: (203) 964-5200..
UNDERWRITING LIMITATION b/: $30,035,000.
SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT, DE, DC, FL, GA, GU, HI, ID, IL, IN, IA, KS, KY,
LA, ME, MD, MA, MI, MN, MS, MO, MP, MT, NE, NV, NH, NJ, NM, NY, NC, NO, OH, OK, OR, PA,
PR, RI, SC, SO, TN, TX, UT, VT, VA, VI, WA, WV, WI, WY..
INCORPORATED IN: Delaware.
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Zurich American Insurance Company
(NAIC #16535)
BUSINESS ADDRESS: 1299 ZURICH WAY, 5TH FLOOR, SCHAUMBURG, IL 60196 - 1056..
PHONE: (847) 605-6000,
UNDERWRITING LIMITATION b/: $638,519,000.
UNDERWRITING LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT, DE, DC, FL, GA, GU, HI, ID, IL, IN,
IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MP, MT, NE, NV, NH, NJ, NM, NY, NC, ND, OH,
OK, OR, PA, PR, RI, SC, SO, TN, TX, UT, VT, VA, VI, WA, WV, WI, WY.
INCORPORATED IN: New York.
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Part of State Form52414 (R2 / 2-13) Form 96 (Revised 2013)
BID OF
Walsh & Keliv, Inc.
(Contractor)
(Address)
South Bend IN 46614
FOR
PUBLIC WORKS PROJECTS
OF
City of South Bend Indiana
Centu Center Parking Lot Entry
Gateway Improvements
Project No. 118-035A
Filed September, 24t" 2019
Action taken
State Form 52414 (R / 9-10)
f"res rJbe b St to B(grd of Accounts Form No. 96 Revis 2 1
CONTRACTOR'S BID FOR PUBLIC WORK — FORM 96
PART 1
(To be completed for all bids. Please type or print)
Date (month, day, year): S ten-tber 24 19
1. Governmental Unit (Owner): City of South Bend Indiata
2. County: St. Joseph
3. Bidder (Firm):
Address:
City/State:
4. Telephone Number:
5. Agent of Bidder (If applicable):
Walsh &-KelIv .Inc.
24358 SR 23
South Fend IN 46614
�4 4 11
Pursuant to notices given, the undersigned offers to furnish labor and/or material necessary to complete the
public works project of Chit of Sottth .'Bend Indiana (Governmental Unit) in accordance with plans and
specifications prepared by Jones Petrie Rafinski and dated Att. ttst 0"' 2019 for the sum of See Attached
See Attached.
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 Governmental Unit. If the bid is to be awarded on a unit basis, the
itemization of the units shall be shown on a separate attachment.
The Contractor and his subcontractors, if any, shall not discriminate against or intimidate any employee, or
applicant for employment, to be employed in the performance of this contract, with respect to any matter directly or
indirectly related to employment because of race, religion, color, sex, national origin or ancestry. Breach of this covenant
may be regarded as a material breach of the contract.
CERTIFICATION OF USE OF UNITED STATES STEEL PRODUCTS
(If applicable)
I, the undersigned bidder or agent as a contractor on a public works project, understand my statutory obligation
to use steel products made in the United States. I.C. 5-16-8-2. I hereby certify I and all subcontractors employed by me
for this project will use U.S. steel products on this project if awarded. I understand that violations hereunder may result in
forfeiture of contractual payments.
The above bid is accepted this
Contracting Authority Members:
day of
ACCEPTANCE
subject to the following conditions:
PART II
(For projects of $150,000 or more — IC 36-1-12-4)
Governmental Unit: City of South Bend, Indiana
Bidder (Firm): Walsh & Kelly, Inc.
Date(month, day, year)•
&12tembet-24.2019
These statements to be submitted under oath by each bidder with and as part of his bid. Attach additional pages
for each section as needed.
SECTION I EXPERIENCE QUESTIONNAIRE
I . What public works
projects has your organization
completed for the period of
one (1) year prior to the date of
the current bid?
Contract Amount
Class of Work
When Completed
Name and Address of Owner
$12,926,200
Reconstruction
October 2017
INDOT
$ 5,970,162
Reconstruction
May 2017
Town of Merrillville
$ 5,521,779
Resurface
December 2017
City of Mishawaka
$ 2,646,574
Reconstruction
Se tmber 2017
St. Jose -ph Cty1� Deft.
3. What public works projects
are now in process of construction
by your organization?
Contract Amount
Class of Work
When to be Completed
Name and Address of Owner
$10,695,118
Reconstruction
November 2018
Walsh Construction
_.
$ 8,146,239
Resurface
...... _ ........
May 2018_
INDOT
$ 4,073,719
Reconstruction
July 2018
Cityof East Chicago, IN
$ 2,662,813
Reconstruction
October 2018
INDOT
4. Have you ever failed to complete any work awarded to you? If so, where and why?
5. List references from private firms for which you have performed work.
Catlin Plumbing,,.& Heatipg.,_ nc—I.J lwl E. Main St, Griffith 1N Ms. Clara. Mu. h
Gau.,gh, Inc, 2200 E. 881h Dr., Merrillville, IN 46410 Mr. Raymond Gough
D e� r Construction Co. 1716 Sheffield Avenue Dyer, IN Janet Furman
Grimmer Construction Co Inc 26191' ails,, t�qgt h, t�s�.tal. IN Mr. GI' g GriIt�Ilaer
SECTION II PLAN AND EQUIPMENT QUESTIONNAIRE
1. Explain your plan or layout for performing proposed work. (Examples could include a narrative of when you could
begin work, completed the project, number of workers, etc. and any other information which you believe would
enable the governmental unit consider your bid.)
As required by owner
2. Please list 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.
See Attached List
3. If you intend to sublet any portion of the work, state 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 governmental unit in the event that you
subsequently determine that you will use a subcontractor on the proposed project.
Will supply upon award of contract
4. What equipment do you have available to use for the proposed project? Any equipment to be used by subcontractors
may also be required to be listed by the governmental unit.
QUANTITY
ITEM
DESCRIPTION,
CONDITION
YEARS
PRESENT LOCATION
SIZE, CAPACITY,
OF
......_ - _
ETC.
................
SERVICE
5
Asphalt Plants
Various
Good
_...._.....
Griffith, South Bend,
Valparaiso, Lowell, LaPorte
19
Asphalt Pavers
Various
Good
_
Griffith, South Bend
4
Sli form Conc. Paver
Various
Good
Griffith, South Bend
3
..........._m
Road Widener
Various
........ .........
Good
Griffith, South Bend
5
Motor Graders
CAT/J.D.
Good
Griffith, South Bend
54
Rollers
Various
�........ ___._.
Good
......._
Griffith, South Bend
30
Rubber Tire Loaders
Various
Good
Griffith, South Bend
15
Excavators
Various
Good
Griffith, South Bend
9
Bulldozers
Various
Good
Griffith, South Bend
6
LowBoy Tractors
Various
Good
Griffith, South Bend
8
Flatbed Dumps
Various
Good
Griffith, South Bend
48
'/Z and 3/4 ton Pickups
Various
Good
Griffith, South Bend
65
1 Ton Crew Trucks
.........
Various
.......__ -
Good
Griffith, South Bend
..._..�..W ..___ 3 _
___� __ �___ __._..
Cold Planers
........
Wirtgen 1900
Good
Griffith, South Bend
DC
3
Tri-Axle Dum
Mack
Good
South Bend
5. Have you entered into contracts or received offers for all materials which substantiate the prices used in preparing
your proposal? Otherwise, please explain the rationale used which would corroborate the prices listed.
Yes, we received quotes from potential subcontractors and suppliers
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 governing body awarding
the contract must be specific enough in detail so that said governing body can make a proper determination of the bidder's
capability for completing the project if awarded.
SECTION IV CONTRACTOR'S NON -COLLUSION AFFIDAVIT
The undersigned bidder or agent, being duly sworn on oath, says that he 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.
He 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
SECTION V OATH AND AFFIRMATION
I HEREBY AFFIRM UNDER THE PENALTIES FOR PERJURY THAT THE FACTS AND INFORMATION
CONTAINED IN THE FOREGOING BID FOR PRBLIC WORKS ARE TRUE AND CORRECT.
Dated at South Bend __ this 24th day of
of Organization)
(Title of Person Signing)
ACKNOWLEDGEMENT
STATE OF Indiana........................................................�)
ss
COUNTY OF St. Joseph,,,, �)
Before me, a Notary Public, personally appeared the above -named Dustin Hilga and
swore that the statements contained in the foregoing document are true and correct.
Subscribed and sworn to before me this 24th day of Se tmber. 2019
1 �
m_.__ _.,
hAia Krueger, Notary Public
My Commission Expires: June 5 2022
77,
ALISHA KRUE
G E R
County of Residence: St. JOSe h r � Notary Public, State of Inatlm�gai'u
yt � Ay�, °� St. Joseph county
My Commission Expires
June 05, 2027.
a rurg
Form 96 Section II, #2
Subcontractors Used on Public Works Contracts Du
SUBCONTRACTORS
the Past 5 Years
COMPANY ADDRESS CITYISTATEIZIP PHONE FAX
SEWER
B & D Sewer
Deboer Egolf
Delta III
Dyer Construction
Gatlin Plumbing & Heating
Gough, Inc.
Grimmer Construction
Hasse Construction
HRP Construction
Rex Construction
Wirtz & Yates, Inc.
Woodruff & Sons
531 Winston Ct
5772 Melton Road
2063 W 1250 S
1716 Sheffield Avenue
1111 E. Main Street
2200 E. 88th Drive
2619 Main Street
10 Lincoln Avenue
5777 Cleveland Rd.
700 Schiller Avenue
P.O. Box 41
P.O. Box 450
Schererville, IN 46375
Portage, IN 46368
Hanna, IN 46340
Dyer, IN 46311
Griffith, IN 46319
Merrillville, IN 46410
Highland, IN 46322
Calumet City, IL 60409
South Bend, IN 46624
Schererville, IN 46375
Kentland, IN 47951
Michigan City, IN 46361
(219) 322-2300
(219) 763-9700
(219) 797-4004
(219) 865-2961
(219) 924-6972
(219) 756-2200
(219) 924-1623
(219 )932-1611
(574) 271-7800
(219) 322-8090
(219) 474-6542
(219) 872-8605
(219) 865-0065
(219) 763-9703
(219) 797-3008
(219) 865-2963
(219) 924-1401
(219) 756-2202
(219) 924-0328
(219) 932-6829
(574) 271-0524
(219) 322-0031
19) 8795339
MILLING
C.E. Hughes Milling, Inc.
3113 Holmans Lane
Jeffersonville, IN 47130
(812) 725-8665
(812) 725-8672
Javelina Construction, Inc.
13476 Britton Park Rd.
Fishers, IN 46038
(317) 841-8364
(317) 841-0075
Mid America Milling Co.
6200 W. Hwy 62, Ste 400 Jeffersonville, IN 47130
(812) 282-2751
(812) 283-9846
McCrite Milling
209 Quality Ave. Ste 9
New Albany, IN 47150
(812) 941-0252
(812) 941-0852
Specialties Company
9350 E. 30th St.
Indianapolis, IN 46229
(317) 594-0291
(317) 594-0271
ELECTRICAL INSTALLATION
Hawk Enterprises
Midwestern Electric
S/T Bancroft Electric
Sweney Electric Company
Trans Tech Electric
SIGN INSTALLATION
Hawk Enterprises
Midwestern Electric
RoadSafe Traffic Systems
State Barricading, Inc.
Traffic Control Specialists, Inc.
PAVEMENT MARKINGS
The Airmarking Company
Blackout Sealcoating
RoadSafe Traffic Systems
State Barricading, Inc.
Traffic Control Specialists, Inc.
Traffic Management Company
TRAFFIC CONTROL
RoadSafe Traffic Systems
Traffic Control Specialists, Inc.
Traffic Manaqement Companv
LANDSCAPE
Great American Landscape
Hubinger Landscape
Slusser's Green Thumb, Inc.
T & J Landscape Service
1850 E. North St
1620 E. Chicago Ave
25020 State Road 2
9111 Louisiana St.
4601 Cleveland Road
1850 E. North St
1620 E. Chicago Ave
3122 Olympia Dr
24963 U.S. Highway 20
1810 W Pacific Avenue
P.O. Box 526
7440 W. 87th Place
3122 Olympia Dr
24963 U.S. Highway 20
1810 W Pacific Avenue
3542 Hiqhwav Avenue
3122 Olympia Dr
1810 W Pacific Avenue
3542 Hiqhwav Avenue
P.O. Box 235
210 E. 113th Avenue
125 Montgomery Street
8253 Wicker Avenue
Crown Point, IN 46307
East Chicago, IN 46312
South Bend, IN 46619
Merrillville, IN 46410
South Bend. IN 46619
Crown Point, IN 46307
East Chicago, IN 46312
Lafayette, IN 47909
South Bend, IN 46628
Knox, IN 46534
Rochester, IN 46975
Bridgview, IL 60455
Lafayette, IN 47909
South Bend, IN 46628
Knox, IN 46534
Highland, IN 46322
Lafayette, IN 4790E
Knox, IN 46534
Highland, IN 46322
Dyer, IN 46311
Crown Point, IN 46307
Logansport,IN 46947
St. John, IN 46373
(219) 662-8090
(219) 397-4444
(574) 287-6490
(219) 769-6007
(574)272-9673
(219) 662-8090
(219) 397-4444
(317) 780-1825
(574) 287-2078
(574)772-7001
(574) 223-5817
(219) 864-2300
(317) 780-1825
(574) 287-2078
(574)772-7001
(291) 746-2433
(219) 662-8093
(219) 397-8888
(219) 769-0565
(574)271-0144
(219) 662-8093
(219) 397-8888
(574) 772-7002
(574) 223-7959
(708) 430-6910
(574)772-7002
(317) 780-1825
(574) 772-7001 (574) 772-7002
(219) 746-2433
(219) 322-7033 (219) 322-4419
(219) 662-9911 (219) 662-6206
(574) 722-3102 (574) 722-1628
(219) 374-9900 (219) 374-9950
6
.........................................................
----
GUARDRAIL/FENCING
Acorn Fence
2041 164th Street
Hammond, IN 46320
(219) 844-8400
(219) 844-8441
C Tech Corporation
5300 W. 100 North
Boggstown, IN 46110
(317) 835-2745
(317) 835-2781
James H. Drew Company
8701 Zionsville Rd.
Indianapolis, IN 46268
(317) 876-3739
(317) 876-3829
Security Industries
1000 Georgiana St.
Hobart, IN 46342
(219) 942-9447
(219) 942-9448
Specialties Company
9350 E. 30th St.
Indianapolis, IN 46229
(317) 594-0291
(317) 594-0271
TRUCKING/HAULING
C. Lee Construction Services
1011 S. Lake St
Gary, IN 46403
(219) 888-9554
(219) 888-9564
Condon Trucking, LLC
18245 Amberley Ln
South Bend, IN 46637
(574) 360-4326
(574) 271-8984
Fanio Services
28015 SR 23
North Liberty, IN 46554
(574) 233-3236
Gilmer Trucking
20390 New Road
South Bend, IN 46614
(574) 229-3233
Material Transfer Inc.
7811 West 101stAve.
Crown Point, IN 46307
(219) 865-9575
Morris Motor Service, Inc.
10525 W US Hwy 30 Bld
Wanatah, IN 46390
(219) 733-9430
7
P & C Trucking
4410 Ross Road
Gary, IN 46408
(219) 972-0193
Superior Construction Co., Inc.
1455 Louis Sullivan Dr
Portage, IN 46368
(219) 787-0850
V & R Trucking, Inc.
1845 Elmer St.
South Bend, IN 46628
(574) 329-2102
SRPM'S
K & S Markers, Inc.
2189 N 600 W
Thorntown, IN 46071
(765) 482-6184
(765) 482-6284
UNDERSEAL
Rieth-Riley Construction Co.,
2454 West CR 450 North
LaPorte, IN 46350
(219) 362-6178
Inc.
TREE REMOVAL
Dave's Tree Service
1555 Park West Circle
Munster, IN 46321
(219) 922-9829
(219) 922-9843
Homer Tree Service
14000 S. Archer Ave
Lockport, IL 60441
(815) 838-0320
Timber Masters LLC
P.O. Box 245
Dyer, IN 46311
(219) 864-8733
(219) 322-9391
LIME STABILIZATION
Mt. Carmel Sand & Gravel
1611 College Dr.
Mt. Carmel, IL 62863
(618) 262-5118
(618) 263-4084
Rock Solid Stabilization
5104 Mann Drive
Ringwood, IL 60072
(815) 653-2585
(815) 653-2583
Specialties Company
9350 E. 30th St.
Indianapolis, IN 46229
(317) 594-0291
(317) 594-0271
PIPE LINING
Indiana Reline, Inc.
312 E. Main Street
Sulphur Springs, IN
(765) 766-5040
(765) 533-5831
47388
SAW CUTTING
Diamond Coring Co., Inc.
11800 S Ewing Ave
Chicago, IL 60617
(773) 978-5000
Quality Saw & Seal, Inc.
7600 W. 79th Street
Bridgeview, IL 60455
(773) 767-9300
SEAL COATING/STRIPING
Site Services, Inc.
10117 Kennedy Ave
Highland, IN 46322
(219) 924-9944
Blackout Sealcoating
7440 W. 87th Place
Bridgview, IL 60455
(219) 864-2300
(708) 430-6910
UNDERDRAIN
3D Company, Inc.
3200 East CR 350 North
Muncie, IN 47303
(765) 288-3326
(765) 288-3344
General Form No. 96-a
Prescribed by the State Board of
Accounts of Indiana. Revised 1949.
AI ! d Questionnaires d
Financial Aitement for Bidders
Prescribed by
THE STATE BOARD OF ACCOUNTS OF INDMNA
For use in investigating and determining the qualifications of bidders on public
construction when the aggregate cost of any such work or improvement will be Five Thousand
Dollars or more.
These statements to be submitted under oath by each bidder with and as a part of his bid, as provided
by Chapter 306, page 1248, Acts of 1947
Submitted to ______,City_of South Bend Indiana
By _ Walsh & Kell Inc.
Address 24358 SR 23 South Bend IN 46614
Date submitted September 24, 2019 _...........................
Filed
._
AF. L9QDYCE t;'d;) M8.1M"atis, iSdaY,
fA Corporation
Sec. 2 of an Act entitled "AN ACT concerning the awarding of contracts for the performance of public work and
authorizing the board of accounts to prescribe certain forms to be used in ascertaining the responsibility of contractors who
submit bids for the performance of such work, providing for plans and specifications, providing for bids repealing certain laws
and declaring an emergency." (Approved March 13, 1947.)
Sec. 2. Whenever the aggregate costs of any work or improvement will be five thousand dollars ($5,000.00) or more, for
the purpose of enabling such board, commission, trustee, officer or agent to ascertain and determine which of the bidders
submitting bids for the performance of any such public work is, in the judgment of such board, commission, trustee, officer or
agent, the lowest and/or best bidder and to exercise intelligently the discretion hereby conferred on such board, commission,
trustee, officer or agent each bidder shall be required to submit under oath with and as a part of his bid a statement of his
experience, his proposed plan for performing such work and the equipment which he has available for the performance of such
work and a financial statement. The statements hereby required shall be submitted on forms which shall be prescribed by the state
board of accounts. The forms so prescribed shall be designated, respectively, as the experience questionnaire, the plan and
equipment questionnaire and the contractor's financial statement, and shall be based, so far as applicable, on the standard
questionnaires and financial statement for bidders as approved and recommended by the joint conference on construction
practices, for use in investigating the qualifications of bidders on public construction work, and the forms so prescribed are
hereby prescribed as the forms which shall hereafter be used by all such boards, commissions, trustees, officers and agents in
obtaining the information which is required in the administration of this act. If the information submitted by any bidder on the
forms herein prescribed is found, on examination, to be unsatisfactory, the bid submitted by such bidder shall not be considered.
(Burns Statutes 1933, Sec. 53-109) Sec. 2, Chapter 306, Acts of 1947.
TO THE BIDDER —
The following forms of questionnaires and financial statement are prescribed by the State Board of
Accounts in conformity with the statute set out on the preceding page.
These forms, properly filled out and attested, must accompany each bid of five thousand dollars or
more on any public work.
The forms are designed to cover all contracts for all kinds of work and the bidder is required to
answer such questions as are pertinent to the work upon which he is bidding. The purpose of the
questionnaire and financial statement, as set forth in the law, is to enable the awarding body to determine
the qualifications of the bidder to carry out successfully the contract if the same is awarded to him.
The bidder will find it to his advantage to answer fully all questions coming within the range of the
work upon which he is bidding. Particular attention should be given the "Financial Statement" and the
details relative to the assets and liabilities set out. This form is made in extensive detail so that the bidder
may explain his assets and liabilities in proper sequence and in a uniform manner.
T. M. HINDMAN,
State Examiner
91
Submitted by_mm,m,mmmwwwwwwwm,,,,,,m,,,,,,Walsh & Kell Inc,mmmmmm_,mm mm, , „ { x A Corporation
Principal Office at 1700 East Main Street Griffith, IN 46319
To City of South Bend, Indiana
EXPERIENCE QUESTIONNAIRE
The signatory of this questionnaire guarantees the truth and accuracy of all statements and of all answers
to interrogatories hereinafter made.
1. How many years has your organization been in business as a general contractor under your present
business name? 52 Years
2. How many years' experience in g avi asphalt n co
nstruction work has your organization had: (a)
As a general contractor 71 years (b) As a sub -contractor 71 _Years
3. What projects has your organization completed?
Contract Amount
Class of Work
When Com leted ......
Name mmand mmAddress of Ownermmmmmmm
$ 12,926,200
Reconstruction
October 2017
INDOT
$ 5,970,162
Reconstruction
May 2017
Town of Merrillville, IN
$ 5,521,799
�...
Resurface
.
December 2017
.......
Cityof Mishawaka, IN
$ 2,646,574
Reconstruction
September 2017
St. Joseph County Hwy
De artment
3-A. What projects has your organization now in process of construction?
CONTRACT AMT,
CLASS OF WORK
WHEN TO BE COMPLETED
NAME AND ADDRESS OF OWNER
$ 10,695,118
Reconstruction
November 2018
.................. ....... ...... ..... ....... ....... ....... ..... ............ ......... ................................................
Walsh Construction
$ 8,146,239
Resurface
Ma 2018
INDOT
........ _.. _.. ___.....
$ 4,073,719
_ _..__....... __........_......................._...........
Reconstruction
July 2018
.......
City of East Chicago, IN
$ 2,662,813
Reconstruction
October 2018
INDOT
4. Have you ever failed to complete any work awarded to you? No If so, where and why?
5. Has any officer or partner of your organization ever been an officer or partner of some other
organization that failed to complete a construction contract. No If so state name of individual
other organization and reason therefore_
6. Has any officer or partner of your organization ever failed to complete a construction contract
handled in his own name? No If so, state name of individual, name of owner and reason therefor
7. In what other lines of business are you financially interested? None
8. For what corporation or individuals have you performed work, and to whom do you refer?_
BP Amoco Whiting Indiana
__ITITITITITITITIT---�_. '______.__� _......... ....
Tonn & Blank Construction 1623 Greenwood Ave Michigan. Cif, IN 46360
Grimmer- Construction Co. lnc, 2619 Maiia Street,.1111and. �l� 4t�322
University of NotremD.ame, mSouth Bend Indiana
Gousih, Inc., 1151 E. Summit, Crown Point IN_..46307 �IT�
9. For what cities have you performed work and to whom do you refer?
Town of Griffith
Director of Public Works
Griffith IN
Town of Schererville
Town Manpggr ............. wwwwwmmmmmmmmIT
ITITITITIT Schererville IN
City of Hammond
CityEngineer
Hammond IN _ .............
City of South Bendtn.;it
I�I�t,i��I��er .
�
.......Souil� Bend, J
Town of St. John
Town Manager
St. John, IN
10. For what counties have you performed work and to whom do you refer?
Lake County
Ilialiway Sunetintenderit................
Crown Poill��i
Porter Count
._...._
Hhwa Superintendent
Valparaiso. IN .—_.____� __.. _...... ........
St Jose hp County
Highway ,Superintendent mm
South Bend, IN
Elkhart County
Hi hwa Superintendent
Elkhart, IN ......... _............._
LaPorte County ---Highway
u ri itondept
LaPorte IN
11. For what State bureaus or departments have you performed work and to whom do you refer?
Indiana Department of Transportation INDOT) LaPorte to District —,,...LaPorte IN
Department of Natural Resources „___ Indianapolis, IN
12. Have you ever performed any work for the U.S. Government Yes
If so, when and to whom do you refer?
US. Army Co s of Engineers Chicago, IL
............. ...______.........__.....
Indiana National Guard, Dept. of Administration ..... Indianolis,IN
Federal Highway Administration Sterlin.g, VA
13. What is the construction
experience of the
rin a1 individual
of our organization?
INDIVIDUAL'S NAME
PRESENT POSITION OR
YEARS OF
MAGNITUDE AND
IN WHAT CAPACITY
OFFICE
CONSTUCTION
TYPE OF WORK
EXPEREINCE
Kevin J. Kell
President.
_ 33
All Tomes
General Mana „er
JeffreyL. Swan
j Executive Vice President
34
All Tyes
Su t. Engineering
David J. Misirly
Vice President
33
�s
Bituminous
Engineer
Paving
Greg A. Hoffman
Vice President _______
31
Bituminous
Engineer
Paving
John C. Wall
...................................
Vice President
41
All types
En ineer
John M. Peisker
Vice President
33
All types
General Manager
J. Michael
Secretary/Treasurer
46
Administration
General Manager
Schaum
Jamie L. Tancos
Controller
14
Administration
General Manager
.......__
L J. Bauer
. ..._ .........
South Bend O s Mgr
23
Alltypes
En ineer
Dustin P. Hilary
'.....
South Bend Area M
18
All t es
Engineer
Mark E.
Engineer
28
All types
_..... ...........
Engineer
Krachenfels
...._...__.....
Keith A. Gardina .
Enineerw
23
._...._�
All types
En ink eer
Nikolas G. Relias
Engineer
16
Bituminous
Engineer
........ .....................
.....__�._.._._..__............ _ _......-.__.-_................................................ .................. laving
PLAN AND EQUIPMENT QUESTIONNAIRE
The signatory of this questionnaire guarantees the truth and accuracy of all statements and of all answers
to interrogatories hereinafter made.
1. In what manner have you inspected this proposed work? Explain in detail.
11 I, 1 q rlr t o 1� 1 rXt 1.11spections
2. Explain your plan or layout for performing the proposed work,
As dis-ecte cMpg� �gn Tinecr
3. The work, if awarded to you, will have the personal supervision of whom?�
l ev Kelly , J 1'i .1:. Win, � vid J. 11mm y, x c ly A.1 c11' i1 , Dtlstizi.h 3ilar +, and Lynn J.
4. *Do you intend to do the hauling on the proposed work with your own forces? Yes
If so, give amount and type of equipment to be used As needed
5. *If you intend to sublet the hauling or perform it through an agent, state amount of sub -contract or
agent's contract, and if known, the name and address of sub -contractor or agent, amount and type of
his equipment and financial . ... ......... ....._....._..__..._u______
Items 4,5,6 and 7 may not be applicable in all building contracts; if not, omit.
,6. *Do you intend to do the grading on the proposed work with your own forces?
If so, give type of equipment to be used
7. *If you intend to sublet the grading or perform it through an agent, state amount of sub -contract or
agent's contract, and, if known, the name and address of sub -contractor or agent, amount and type of
his equipment and financial respolsibility
8. Do you intend to sublet any other portions of the work? __...w_ ...mmIf so, state
amount of sub -contract, and, if known, the name and address of the sub -contractor, amount, and type
of this equipment and financial responsibility
9. From which sub -contractors or agents do you expect to require a bond? None
10. What equipment
do you own that
is available for the
proposed work?
....... ...... ..__._.......
QUANTITY
......
ITEM
DESCRIPTION,
_...._._..�....__.............
CONDITION
YEARS
PRESENT LOCATION
SIZE, CAPACITY,
OF
ETC.
SERVICE
..._................ .
5
Asphalt Plants
Various
Good
....... .......
..__
Griffith, South Bend,
... _ .
_._ ......
...W._
________._
Valparaiso, Lowell, LaPorte
19
Asphalt Pavers
Various
Good
Griffith South Bend
4
Slimpform Conc. Paver
Various
Good
Griffith, South Bend
.........-..
3
__
Road Widener
Various
Good
.......�.
Griffith, South Bend
5
Motor Graders
CAT/J.D.
Good
Griffith, South Bend
54
Rollers
Various
Good
Griffith, South Bend
30
..........._.......
Rubber Tire Loaders
.
Various
Good
Griffith, South Bend
1........._
5
�..
Excavators
Various
Good
....................
Griffith, South Bend
9
Bulldozers
Various
Good
Griffith, South Bend
6
_._
LowBoy Tractors
Various
_.......................................__.._..
Good
Griffith, South Bend
8
Flatbed Dum s
Various
Good
Griffith, South Bend
48
'/z and 3/ ton Picku s
Various
Good
-------
Griffith, South Bend
65
1 Ton Crew Trucks
Various
Good
Griffith, South Bend
._.......
3
.........
Cold Planers
Wirtgen 1900
Good
.........
Griffith, South Bend
DC
.. ........
...................
---
Tri-Axle Dum
Mack
Good
South Bend
7
11. What equipment do you intend to purchase for use on the proposed work, should the contract be
awarded to you?
QUANTITY ITEM DESCRIPTION, SIZE, CAPACITY, ETC. APPROXIMATE
�..........._... ww COST
None
_.................................. ............. _ ._ ... ............
.. .......................................
...............
.......................... ....................... ........ .....
.......... _.
12. How and when will you pay for the equipment to be purchased?_N/A
13. Do you propose to rent any equipment for this work?No If so, state type, quantity and reasons for
14. Have you made contracts or received firm offers for all materials within prices used in preparing your
proposal?
Do not give names of dealers or manufacturers............ ..... __.
Dated at ...B„end this 24th day of
............�.�...._....S.. .outh
(Name
IF
(Title of Person Signing)
Dustin Hilary being duly sworn deposes and says that he is VP of South Bend Area of the
above Walsh & Kelm, Inc.
(Name of Organization)
and that the answers to the questions in the foregoing questionnaires and all statements therein contained
are true and correct.
Subscribed and sworn to before me this 24th day o. 'September, 2019
. � .............._.
Alisha ru ej`, otar ly Public
y p June 5.2022
M Commission expires
N « �"°p ALISHA KRUEGER
�t �
g Notary Public, State of Indiana
r�° '' St. Joseph County
*:.
.,�.
My Commission Expires„„G0" June05,2022