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HomeMy WebLinkAboutOpening of Qualifications - Lead Hazard Reduction Program Pre-Qualified Contractors RFQ - A&B Environmental Construction Inc.CITY OF SOUTHBEND COMMUNITY INVESTMENT March 1, 2021 A & B Environmental Construction Inc. Mallory Jones 1534 N Mannheim Rd Stone Park, IL 60165 Dear Mallory Jones, The City of South Bend, Indiana has received two grants to fund its Lead Hazard Reduction Program, with the goal to control or eliminate lead hazards in properties owned or leased by low-income households. The City is currently soliciting responses (Responses) to a Request for Qualifications (RFQ) from qualified lead contractors. It is the purpose of this RFQ to establish a registry of pre -qualified lead contractors who will be notified of opportunities to bid on Lead Hazard Reduction Program work. The City of South Bend, Board of Public Works will receive sealed electronic Responses at bpwbids@southbendin.gov until 9:00 a.m., EST, on March 23, 2021. Interested firms must register at https://southbendin.gov/doing-business/invitations-to-bid-city-contracts/. Complete RFQ packages and instructions are available for free download at this web page. There is no scoring matrix for this RFQ. All lead contractors whose Response meet the Minimum Specifications and Program Conditions listed in the RFQ will be placed onto the registry of pre -qualified lead contractors. Contractors that are also licensed to perform heating, plumbing, and/or electrical work in South Bend are encouraged to provide license information as part of their Response, as additional work might be available to these contractors through this program. Questions about Response Requirements must be submitted via email no later than 5 p.m. on March 15, 2021 to Elizabeth Maradik at emaradik@southbendin.gov. Any questions received by the deadline will be addressed by an addendum to be issued no later than 5 p.m. March 17, 2021. Thank you, ti� (4 Elizabeth Maradik Director of Neighborhood Development EXCELLENCE ACCOUNTABILITY INNOVATION INCLUSION EMPOWERMENT 14005 County -City Building 227W. Jefferson Blvd. South Bend, Indiana 46601 p574.235.9371 wvwv.southbendin.gov Exhibit C: Lead Hazard Reduction Program — COVID-19 Policy City of South Bend COVID-19 Policy The City of South Bend ("the City') requires contractors participating in the Lead Hazard Reduction Program to follow physical distancing requirements established by the CDC, as well as rules and regulations from OSHA. Contractors participating in the program are strongly encouraged to perform a self -health check prior to visiting any residences. Contractors with a temperature greater than 100.40F or who has flu-like symptoms should not visit any City facility or any residence associated with the program. Contractors are required to wear a face mask that covers their mouths and noses at all times when at a residence enrolled in the program or at any City facility. Any contractor who believes they have COVID-19, has tested positive for COVID-19, or has been told to quarantine by a medical provider agree to the following: 1. Notify the City as soon as possible when they find out they have (or suspect they have) COVID- 19. 2. Refrain from working in any residence enrolled in the Lead Hazard Reduction Program until cleared by a medical provider. 3. Notify the City when they are cleared to return to work by a medical provider. Additionally, the City strongly encourages any contractor who has tested positive for COVID-19 or has been told to quarantine by a medical provider to participate in contact tracing thru the Indiana State Department of Health. I have read and agree to follow these requirements for a safe workplace during the COVID-19 pandemic. 11 Date Exhibit A: Lead Hazard Reduction Program Contractor Application City of South Bend Lead Hazard Reduction Program Contractor Application Company Name: Street Address: M00hpIrn�5�4 N F -d 1 City: l rb"N& pa' State: �� Zip Code: Business Owner's Name: Email: (Ah , en Phone: 1. Is applicant a Licensed Indiana Abatement Contractor?X"Yes ❑ No If yes, provide a copy of license. 2. Will the applicant have at least one licensed Lead Project Supervisor on-site?''Yes ❑ No If yes, provide a copy of licenses of Lead Project Supervisor(s) and Lead Worker(s) for all employees or subcontractors who will be performing lead abatement work. 3. Is applicant an EPA approved Renovation, Repair and Painting certified firm? Yes ❑ No If yes, provide a copy of certification. 4. Does applicant have required Commercial General Liability Insurance?Yes ❑ No If yes, provide a copy of the Statement of Coverage. It must include a minimum coverage of per Person in the amount of $50,000 and per Occurrence in the amount of $1,000,000. 5. Does applicant have Worker's Compensation Insurance?Yes ❑ No If yes, provide a copy of the Statement of Coverage. 6. Are you or any of your mployees licensed to do electrical, heating or plumbing work in the City of South Bend? ElYes `No (If yes, provide name and license information below): Name: License Type: License Number: Exhibit A: Lead Hazard Reduction Program Contractor Application 7. Is applicant registered, or willing to register, in the System for Award Management (SAM) and the 7Yeral Awardee Performance and Integrity Information System (FAPIIS)? es, currently registered ❑ Not currently registered, but willing to complete (the City can provide a registration guide) ❑ Not registered, and will not complete 8. Do you want to be placed on the registry for one rant or both? ElIHCDA Grant Only ElOLHCHH Grant Only Both Grants 9. Please list any residential property owned solely or co -owned by you within the City of South Bend: I certify that the answers provided are true and accurate to the best of my knowledge: Yes ❑ No I understand that if placed on the Registry, I will receive notice of opportunities to bid on Lead Hazard Reduction Progra m work. And I understand that work will be awarded to the lowest, responsive and responsible bid:Yes ❑ No I have read and agree to the minimum specifications and program conditions for participation in the Lead Hazard Reduction Program's Registry of Pre -Qualified Contractors. Z,Yes ❑ No Signature Ran 1 Name (Printed) 031 0112,1 Date Exhibit B: Lead Hazard Reduction Program — Non -Collusion Affidavit Whew the prospecmr Contractor is useable to ce7TO, to ant of the statements belox, rt shall attach an a Wanation to this .f'fdadt. CO'STR..kCTOR'S NON -C OLLt•SiON k% -D NON-DEB_kK11F_N-T IMANTT. C ERTMC ATION REGARDING MTSTIIE-N-T XI ITH iR�ti, EMPLOI IE'ST ELIGIBILiTI' N-ERIFIC TION, NO`-DISC'RL\HN ITIOti CO_ MTNIENT AND CERTIFIC ATION OF t'SE OF UINTFED STATES .STEEL PRODUCTS OR FOUNDRY PRODUCTS STATE OF (Must be completed for all quotes and bids. Please type or print) C OUB TTI" The under.cg`ed Consractoa. beme du -y -wom upon hu her tti oatE afm. under the penaltie- of peijur�, that. 1 Contractor has not_ nor has any other member_ representative. or agent of the firm company. corporation or partnerslvp represented by hini entered into any combination. collusion or agreement with any person relanve 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 an-,- other bid and without an�� agreement ~ understandine or combination with ani• other person in reference to such bidding_Contractor ftuther says that no person or persons, firms. or corporation has. have or will receive directly or indirectly. auy rebate. fee. c-ift. coninussion or thinE of value on account of such sale- and Contractor certifies b-,- 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 pamcipation in this traw. action by any Federal department or agency: and 3. Contractor ha. not, nor hai any mcces-or to. nor an agate of; Contractor. eneaged L im•: estnent acts hies in Iran. a. For purposes of this Ceaufication. `Iran.-- meati: the government of Iran ani any agency or m.trume=aliry of Iran. or as otherwise defined at Ind Code 5-22-16.5-5- as amended from: time-to-�me. b. A. pro;zded by Ird. Code 5-22-16.5-S, as amended from tune -to -tittle. a C outractor i. engaged in m:•e,tment actnities m Iraq if either: i Contractor. its .ucce-sor or it; affivate. prai-tde, goad:. or-er:z.e. of ficre�.- million dollars (S_10,000.000) or more m r=.1ue m the emern, sector of La: _ or u Conti -actor. its successor or its affiliate. i. a financial tn:,ntution that em -tend: Ment million dollar. "S_"(G.000.000) or more in credit to another person for forty-five (45) da-.-. or more. Lf that per on will (i) use the credit to prmades goods and .er.-ices in N= _aihi_=Nm-Lsi=a=xxc.Edrit'inzT=F� Exhibit B: Lead Hazard Reduction Program — Non -Collusion Affidavit the ere1 --%• sector to Iran: and iii) at the time the financial in_mtutton e:ctendL ci'eait. 1: a person identified on li-t pubs hen- b—. the Indian Deparmlew of muni=tiation. 4. Contractor does not knowingly employ or contract tVith an unauthorized alien. nor retain am emplo,ee or contract with a person that the Contractor subsequentlti learns is an unauthorized alien. Contractor agrees that he; she -it shall enroll in and t:enfv the work ehmbility status of x-11 of C'ontractor's newly hued employees through the E -Verify Program as defined by I.C. 22-5-1.7-3. Contractor's docuunentation of enrollment and participation in the E-Veri.fti• Program is in.cluded and attached as part of this bid:'quote: and Contractor ;hall req -Lure his.luents subcontractors performing work under this public contract to certify that the subcontractors do not l nowul;gly 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-Verifi,• Program. The Contractor agrees to maintain this certification throughout the term of the contract with the City of South Bend- and understands that the C*i.t% may ternunate the contract for default if the Contractor fails to cure a breach of this provision no later than hirr. (30i days after beizig notified by the City - 6 Persons, partnerships. corporations, association.;. orjoint venturers awarded a contract by he Cit} of South Bend through its agencies_ hoards. or commissions sl all not discriminate against any employee or applicant for employment in the performance of a City contract with respect to hire. tenure, terms_ conditions. or pnvileges of emplotiu-Nuor any matter directh• or indirectly related to employment because of race. sex. religion- color_ national origin_ ancestn-. age. gender expression. gender identity. sexual orientation or disability that does not affect that person's ability to perform the u-ork. In awardms! contracts for the purchase of work-. labor. sen•ices. supplies, equipment. materials. or anti- combination of the foregoing including. but not limited to. public works contracts awarded under public bidding la,.%•s or other contracts in which public bids are not required by law- the City. its agencies. boards. or comma signs may consider the Contractor* s Qood faith efforts to obtain participation by those Contractors. certified by the State of Indiana as a Afinont� Business (" fBE" or as a %Vomen's Business Enterprise (A BEj as a factor in determining the lowest, responsible. responsi;-e bidder. In no event shall persons or entities seeking the award of a City contract be required to award a subcontract to an NNE WBE: however. it may not unla-wfully discriminate against said A7BE-MBE A finding of a discrim_n.atory practice b1! the City's MBE`s BE Utdization Board shall prohibit that person or entity from being awarded a City contract for a period of one -:1 i year from the date of such determination- and such determination may also be zroimd:s for temunating the contact for which the di.scnnunaton- practice or noncompliance pertains. The undersigned contractor agrees that the folios;ung nondiscrimination comnumi at shall be made a part of ani,• contract which it may henceforth enter into with the Cite of South Bend- Indiana or :ins of its agencies_ boards or commiss:ons ` =4_-olh== `in-Dv_,Affidr it Nn L= Fr� 4 Exhibit B: Lead Hazard Reduction Program — Non -Collusion Affidavit Contractor agrees not to discrimtn:ite against or intimidate any emploi•ee or applicant for employment iu the performance of this contract with pnv:leges of employment_ or any matter directly or indirectly related to employment- because of race. reh2q*ou color. sem gender expression- gender identity,. sexual orientation. handicap. national origin or ancestry,'. Breach of this provision may be retarded as material breach of contract. I_ the undersigned bidder or agent as contractor on a public works proiect. understand my" statutory obligations to the use of steel products or foundry products made Mi the U ited States IC I hereby cerhfv that I and ail subcontractor-. 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 affumative du v- to notify" the City in my bid that m-" proposal does not include the use of steel products or foundrti product, 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. 1%-hv the cost of United States made steel or foundry- products is unreasonable. Prior to award and upon suubnussion of bid which does not use steel products or foundry products made in the United States. the Cltv. through its director of public works. shall make a determination if the price of united States made steel or foundn, is unreasonable. I understand that violations hereunder may result in forfeiture of contractual pa}ments. 1 herebN- affirm under the puna tae, of Del -:u ry that the tact=. and =btmmon contained un the fore:;omg 'Did for public work: are hue and colTect. Dated thL ') day of -102—( tti�� �w'iV 1 i ��1Y11ti'�f ConuactmSidder (Firm) Signature of Contractor Pnnted Name and Title Subscribed and sworn to befo.e rite thi:�� A;v Coinm,�.ion E pines" - 2` Z02,L4 Count-- of Residence ':m4-oIhi:im `ion-)✓skam= .Affidaat' = Tr= Foy 21,a3 MIREYA RO" NOTARY KOX - STATE OF ILUNM MY comhoss" EM*WS_ WW" Based upon the review of your license application, the Indiana Lead and Health Homes Program has determined that you have fulfilled the requirements of 410 IAC 32 and are eligible for licensing in the following lead-based discipline: Lead Contractor, Enclosed is your Lead Contractor license. This card must be available for review at all times while you are implementing a lead-based project. This license may be revoked, pursuant to 410 IAC 32-2-8, if you: (1) Violate any requirements of these rules (410 IAC 32), or any other federal, state, or local regulation pertaining to lead-based paint activities. (2) Falsify information on your application for licensing. (3) Fail to meet any qualifications specified in 410 IAC 32. (4) Conduct a lead-based paint project, or related lead-based activity, in a manner which is hazardous to the public health. Your license is valid effective 10/27/2020, and will expire on 10/27/2023, as indicated on your card. We suggest that you attend the required training and submit an application for license renewal early to insure your license does not lapse. In order to avoid re -taking the initial training course, you must attend a refresher in the discipline you are seeking a license within three (3) years from the date of issuance of your last training course certificate. -- 1 Indiana State Department of Health Mallory Jones The Designated Representative of: A & B Environmental Construction Inc. Lead Contractor License # IND001856 Effective: 10/27/2020 Expiration: 10/27/2023 Birth Date: Gender: Height: Eye Color: Weight: Hair Color: & .VitMR8eR1.. ;D. 11a e Indiana State Department of Health 100 N. Senate Avenue, N855 Indianapolis, Indiana 46204 Lead Cnntract Certificate Number Expiration Date IND001856 10/27/2023 Mallory Jones The Designated Representative of: A & B Environmental Construction Inc. Kristina Box, MD, FACOG Kristina Box, MD, FACOG State Health Commissioner Indiana State Department of Health (R2110-18) gni#�e�d �tttte� EUV*runmerttttt 13ratrdion Agrurij .EPA NAT -58606-3 Certification # November 19, 2020 Issued On 01 4t*s is to rrr#iflj #httt A & B Environmental Construction, Inc. has fulfilled the requirements of the Toxic Substances Control Act (TSCA) Section 402, and has received certification to conduct lead-based paint renovation, repair, and painting activities pursuant to 40 CFR Part 745.89 3111 Or 31jurtsbution of. All EPA Administered States, Tribes, and Territories This certification is valid from the date of issuance and expires December 03, 2025 Michelle Price, Chief Lead, Heavy Metals, and Inorganics Branch .� A&BEN-1 OP ID: TB COVERAGES CERTIFICATE NUMBER' REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ACORO CERTIFICATE OF LIABILITY INSURANCE lk� DATE(rv1r0JDDlYYYY) 1 03/10/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 618-692-9800 Assurance Brokers Ltd. 95 North Research Dr Ste 100 Edwardsville, IL 62025 ONTACT _. CNAE PHONNE618-692-9800 FAX 618-692-9865 (AIC, No, Ext): (AIC,No): MMS: INSURER(S) AFFORDING COVERAGE NAIC EACH OCCURRENCE $ 2'000'000 INSURER A:century Insurance Group 36951 MED EXP An one person)$ 10,000 INSURERB:star Insurance Company 18023 INSURED A & B Environmental Construction Inc INSURER C LM Insurance Co 33600 INSURER D: 1534 N. Mannheim Rd Stone Park, IL 60165 INSURER E : AUTOMOBILE LIABILITY A14Y AUTO i OWNED SCHEDULED AUTOS ONLY X AUTTOSW E AUTOS ONLY AIJTO�o ONI INSURER F: COVERAGES CERTIFICATE NUMBER' REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDLSUB INSD CITY OF SOUTH BEND POLICYNUMBER POLICY EFF MM/DD POLICY EXP MM/DD LIMBS A A A X I COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR LLUTION LIAB X CCP914171 CCP914171 CCP914171 09/06/2020 09/06/2020 09/06/2020 09/06/2021 09/06/2021 09/06/2021 EACH OCCURRENCE $ 2'000'000 DAMAGE TO RENTED 151 (Ea occ France) $ 100 000 MED EXP An one person)$ 10,000 NERAL CONT/LEAD PERSONAL&ADV INJURY $ 2,000,000 ZGE'L GREGATE LIMIT APPLIES PER: ICY 7 JECT EILAC ER GENERAL AGGREGATE 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 B AUTOMOBILE LIABILITY A14Y AUTO i OWNED SCHEDULED AUTOS ONLY X AUTTOSW E AUTOS ONLY AIJTO�o ONI CA0937340 09/06/2020 09/06/2021 COMBINED SINGLE LIMIT $ 1,000,000 BODILY INJURY Per person) $ _ BODILY INJURY Per accident P08Ed. AMAGE o $ A UMBRELLA LIAB X 1 EXCESS LIAB XCCUR CLAIMS -MADE CCP914172 09/06/2020 09/06/2021 EACH OCCURRENCE 1'000'000 AGGREGATE $ DED RETENTION $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PE{O� EI MTgO�RR EXC UDED9 CLRIVE Y� andatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N f A I I WC5-39S-344437-030 I 06/1212020 06/12/2021 X UATUTE OTH- ER 1,000,000 E L. EACH ACCIDENT E L. DISEASE - EA EMPLOYEE $ E L DISEASE - POLICY LIMIT A ,Professional Llab CCP914171 09/0612020109/06/2021 Ea Claim 2,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101. Additional Remarks Schedule, may be attached if more space is required) CITY OF SOUTH BEND, LEAD HAZARD REDUCTION PROGRAM IS INCLUDED AS AN ADDITIONAL INSURED. CFRTIFICATF 1-101 r)FR CANCELLATION CITYSOU SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF SOUTH BEND THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. LEAD HAZARD REDUCTION PROGRAM 227 W JEFFERSON BLVD SOUTH BEND, IN 46601 AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD January 6, 2021 Based upon the review of your license application, the Indiana Lead and Healthy Homes Program has determined that you have fulfilled the requirements of 410 IAC 32 and are eligible for licensing in the foliowing lead-based discipline: Lead Project Supervisor :iosed is your Lead Project Supervisor license card. This card must be availaole for review at all times while you are implementing a i -based project. This license may be revoked, pursuant to 410 IAC 32-2-8, if you: (1) Violate any requirements of these rules (410 IAC 32), or any other federal, state, or local regulation pertaining to lead-based paint activities. (2) Falsify information on your application for licensing. (3) Fail to meet any qualifications specified in 410 IAC 32. (4) Conduct a lead-based paint project. or related lead-based activity, in a manner that is hazardous to the public health. Your license is valid effective 01/06/2021, and will expire on 01i06/2024: as indicated on your card. We suggest that you attend the required training and submit an application for license renewal early to insure your license does not lapse. In order to avoid re -taking the initial training course, you must attend a refresher in the discipline you are seeking a license within three (3) years from the date of issuance of your last training course certificate. Indiana State Department of Health Edna Lomeli Lead Project Supervisor License # IND001891 Effective: 01/06/2021 Birth Date: 02/08/1982 Height: 5-08 Weight: 200 Expiration: 01/06/2024 Gender: F Eye Color: Brown Hair Color: Brown ErF. Indiana State Department of Health 100 N. Senate Avenue, N855 Indianapolis, Indiana 46204 late Lead Project Supervisor Certlticate Number Explratlon Date INDO 1 91 01/06/2024 Edna Lomeli Kristina Box, MD, FACOG Kristina Box, MD, FACOG State Health Commissioner Indiana State Department of Health SWC Institute 2819 S. Archer Ave. Chicago, IL 60608 Ph# 1.312.421.4505 Fax# 1.312.421.4505 Asbestos Lead HazMat This is to certify that EDNA LOMW has successfully completed the 1- day EPA model curriculum for Lead -Based Paint Abatement Contractor/Supervisor Refresher Course, and has passed the final exam with a minimum score of at least 70%. Training was in accordance with HUD Interim Guidelines (6-95); Illinois Department of Public Health, Lead Poisoning Prevention Code 77 ILL ADM Code (12-94), Title X Housing and Urban Development Act (1992). LEAD "AmmEPT COPTR4CToR/SUPE>RYISOR REFRESHER COURSE Accredited by the State of Illinois Department of Public Health Course Date: JAN. 23, 2021 Exam Date: JAN. 23, 2021 Exam Date: LCSR01230520211L Class Conducted at: 2819 S Archer Ave Suite 100. Chicago, IL 60608 2021 Training Dire Expires on: JAN. 23, 2024 January 6, 2021 Based upon the review of your license application, the Indiana Lead and Healthy Homes Program has determined that you have fulfilled the requirements of 410 IAC 32 and are eligible for licensing in the following lead-based discipline: Lead Worker .losed is your Lead Worker license card. This card must be available for review at all times while you are implementing a lead-based project. This license may be revoked, pursuant to 410 IAC 32-2-8, if you: (1) Violate any requirements of these rules (410 IAC 32), or any other federal, state, or local regulation pertaining to lead-based paint activities. (2) Falsify information on your application for licensing. (3) Fail to meet any qualifications specified in 410 IAC 32. (4) Conduct a lead-based paint project, or related lead-based activity, in a manner that is hazardous to the public health. Your license is valid effective 01/06/2021, and will expire on 01/06/2024. as indicated on your card. We suggest that you attend the required training and submit an application for license renewal early to insure your license does not lapse. In order to avoid re -taking the initial training course, you must attend a refresher in the discipline you are seeking a license within three (3) years from the date of issuance of your last training course certificate. Indiana State Department of Health Jorge A. Garcia Padilla Lead Worker License # IND001888 Effective: 01/06/2021 Expiration: 01/06/2024 Birth Date: 11/27/1979 Gender: M Height: 57' Eye Color: Brown Weight: 250 Hair Color: Black E nor Indiana State Department of Health N. P o100 N. Senate Avenue, N855 u, Indianapolis, Indiana 46204 VAft 1916 Lead Worker Certificate Number Expiration Date IND001888 01/06/2024 Jorge A. Garcia Padilla Kristina Box, MD, FACOG Kristina Box, MD, FACOG State Health Commissioner Indiana State Department of Health SWC INSTITUTE 2819 S. Archer Ave. Chicago, IL 60608 Ph# 1.312.421.4505 Fax# 1.312.421.4505 Asbestos Lead HazMat This is to certify that JORGE ARMANDO GARCIA PADILLA has successfully completed the 1 - day EPA model curriculum for Lead -Based Paint Abatement Worker Refresher Course, and has passed the final exam with a minimum score of at least 70%. Training was in accordance with HUD Interim Guidelines (6-95); Illinois Department of Public Health, Lead Poisoning Prevention Code 77 ILL ADM Code (12-94) Title X, Housing and Urban Development Act (1992). Dates of Course: DEC. 13, 2020 Examination Date: DEC. 13, 2020 Certificate # LWR1213022020 LEAD ABATEMENT WORKER REFRESHER COURSE Illinois Department of Public Health Accredited Gustavo De E irech�r This course was conducted in Spanish Expires on DEC. 13, 2023 OCCUPATIONAL TRSUPPLY INC. 7233 S. Adams Street ♦ Willowbrook, IL 60527 ♦ (630) 655-3900 ♦ www.otsafety.com s Lead Abatement Supervisor ln*t*al Occupational Training & Supply, Inc. certifies that Jose R. Pioquinto Garcia has successfully completed the Lead Abatement Supervisor Initial course and has passed the competency exam with a minimum score of 70%. This course is accredited by the Illinois Department of Public Health in accordance with the Illinois Lead Poisoning Prevention Code. Course Date: 9/23/2019 - 9/26/2019 Exam Date: 9/26/2019 Expiration Date: 9/26/2022 Certificate Number: LS1909261806 0 ------------ -----Dire -- ------------------ Kat DeSalvo, Director 11ra M _ 1111110 January 6, 2021 Based upon the review of your license application, the Indiana Lead and Healthy Homes Program has determined that you have fulfilled the requirements of 410 IAC 32 and are eligible for licensing in the following lead-based discipline: Lead Worker .losed is your Lead Worker license card. This card must be available for review at all times while you are implementing a lead-based ,act. This license may be revoked, pursuant to 410 IAC 32-2-8, if you: (1) Violate any requirements of these rules (410 IAC 32), or any other federal, state, or local regulation pertaining to lead-based paint activities. (2) Falsify information on your application for licensing. (3) Fail to meet any qualifications specified in 410 IAC 32. (4) Conduct a lead-based paint project, or related lead-based activity, in a manner that is hazardous to the public health. Your license is valid effective 01/06/2021, and will expire on 01/06/2024, as indicated on your card. We suggest that you attend the required training and submit an application for license renewal early to insure your license does not lapse. In order to avoid re -taking the initial training course, you must attend a refresher in the discipline you are seeking a license within three (3) years from the date of issuance of your last training course certificate. Indiana State Department of Health Jose R. Pioquinto Garcia Lead Worker License # IND001886 Effective: 01/06/2021 Expiration: 01/06/2024 Birth Date: 03/12/1997 Gender: M Height: 5'5" Eye Color: Brown Weight: 120 Hair Color: Black Indiana State Department of Health o, \1 100 N. Senate Avenue, N855 Indianapolis, Indiana 46204 eie Lead Worker Certificate Number Expiration Date IND001886 01/06/2024 Jose R. Pioquinto Garcia Kristina Box, MO, FACOG Kristina Box, MD, FACOG State Health Commissioner Indiana State Department of Health STATE FOF'. 4'22 92 . 18 r", 4 vim _3� I �f� ar.' \P Oil et"�, ,, ,.:."�� r ��!! •.1 a ..",15 a SWC INSTITUTE fid` 2819 S. Archer Ave. Chicago, IL 60608 Ph# 1.312.421.4505 Fax# 1.312.421.4505 °;". Asbestos - Lead - HazMat Off; i Q. r This is tip certify that ' JOSE L SOLIS has successfully completed the 1 - day EPA modoI curriculum for Load -Based Paint Abatement Worker Refresher 1,ourse, and has passed the final exam with a minimurn score of at least 70%. Training was in accordance with HUD Interim Guidelines (6-95); Illinois Department of Public He<3Ith, Lead Poisoning , Prevention. Code 77 ILL AM Code (12-94) Tiile X, Housing and Urban Developm ant Act (1992). 13052020 �' ,. a� Dates of Course: DEC 13, 20:?0 Examination Date: DE 13, 2020 Certificate # L R 14 4b� Aw d ;1 ;, LEAD ABATE�HENT WORKER REFRESHER COURSE lm` Illinois Department oF Public Health Accredited -n .I\ Gustavo DQ E irector Expires o i DE 13, 2023 This course was conducted in Spanish r r.. ��`� �s �, ,* -��• •jt �� ��� �,,2�- 6 `1�*� C� *�' d' �9- �i':�n'��';,".. 11i;�aE",'.s�9'�. �' L°t � :'�Ij•..��jj�: �L����1J�= �+�`��`4�..f.�i���l;�.�ele�E 17��� ��.`��%�e•�<\�'��.�d �*b� `�a�,�1!!�'e�'8�.�r,.• ,� ���°s' la��,`���� 4�!'a��Jf%Vi..4�'�•.�T !. t��•.�"" 1. �.1. ,.,�?'i, qi,. � �s>, �"y\. _ oRT� ,� _ 9��� - j 6 _ s It January 6, 2021 Based upon the review of your license application, the Indiana Lead and Healthy Homes Program has determined that you have fulfilled the requirements of 410 IAC 32 and are eligible for licensing in the following lead-based discipline: Lead Worker ;losed is your Lead Worker license card. This card must be available for review at all times while you are implementing a lead-based ,ect. This license may be revoked, pursuant to 410 IAC 32-2-8, if you: (1) Violate any requirements of these rules (410 IAC 32), or any other federali state, or local regulation pertaining to lead-based paint activities. (2) Falsify information on your application for licensing. (3) Fail to meet any qualifications specified in 410 IAC 32. (4) Conduct a lead-based paint project, or related lead-based activity, in a manner that is hazardous to the public health. Your license is valid effective 01/06/2021, and will expire on 01/06/2024, as indicated on your card. We suggest that you attend the required training and submit an application for license renewal early to insure your license does not lapse. In order to avoid re -taking the initial training course, you must attend a refresher in the discipline you are seeking a license within three (3) years from the date of issuance of your last training course certificate. Indiana State Department of Health Jose L. Solis Lead Worker License # IND001890 Effective: 01/06/2021 Expiration: 01/06/2024 Birth Date: 06/06/1982 Gender: M Height: 5'5" Eye Color: Brown Weight: 170 Hair Color: Black Indiana State Department of Health -sa 100 N. Senate Avenue, N855 Indianapolis, Indiana 46204 Lead Worker Jose L. Solis Kristina Box, MD, FACOG Kristina Box, MD, FACOG State Health Commissioner Indiana State Department of Health STATE FORM 49,22 IR2 10-1e, SWC INSTITUTE 2819 S. Archer Ave. Chicago, IL 60608 Ph# 1.312.421.4505 Fax# 1.312H221.445a 5 Asbestos Lead This is to certify that ALBERTO SUAREZ FERNANDEZ has successfully completed the 1 - day EPA model curriculum for Lead -Based Paint Abatement Worker Refresher Course, and has passed the final exam with a minimum score of at least 70%. Training was in accordance with HUD Interim Guidelines (6-95); Illinois Department of Public Health, Lead Poisoning Prevention Code 77 ILL ADM Code (12-94) Title X, Housing and Urban Development Act (1992). Dates of Course: DEC. 13, 2020 Examination Date: DEC. 13, 2020 Certificate # LWR1213042020 LEAD ABATEMENT WORKER REFRESHER COURSE Illinois Department of Public Health Accredited ('Sltuistm De iftect>Dr This course was conducted in Spanish Expires on DEC. 13, 2023 Details State of Indiana Name: Alberto Suarez City/State/Zip: North Salem IN 46165 (,„unto: Hendricks Lic #: IND001892 Status: Active Method: Reciprocity Profession: Lead Issued: 1/6/2021 Type: Lead Worker Expiration: 1/6/2024 No Related Licenses No Public Documents Available Secondary: 2/17/21, 3:26 PM https;//mylicense.in.gov/everification/Details.aspx?result=Of7908b4-0449-4dO9-8584-33395fdlf5f6 Page 1 of 1