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Home My WebLink AboutOpening of Bids - Prairie Avenue Water Main Loop Proj No. 117-068 - Woodruff & Sons, Inc.CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK Project Name PRAIRIE AVENUE WATER MAIN LOOP Project No. 117-068 For Bids Due NOVEMBER 9, 2021 PART (Must be completed for all bids. Please type or print) Date: November 9, 2021 Bidder (Firm): Woodruff & Sons. Inc. Address: 2125 E. US Highway 12 City/State/Zip: Michigan City IN 46360 Telephone Number: ( 219 ) 872-8605 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: Prairie Avenue Water Main Loop the City of South Bend, Indiana, in accordance with plans and specifications prepared by: Woodruff & Sons, Inc. and dated November 9. 2021 for the sum of (enter the Total Bid as shown on the Proposal) One Million Nine Hundred Forty Four Thousand Two Hundred Eight Dollars and Thirty Cents ($ 1,944,208.30 ) (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 needed, the cost of units must be the same as that shown in the original contract if accepted by the ity of South Bend. If the bid is to be awarded on a unit basis, the itemization of the units shall be shon a separate atf ch nt. By ure) Bruce (Printed Name of Person Signing) ACCEPTANCE The above bid is accepted this _ Subject to the following conditions: BOARD OF PUBLIC WORKS Elizabeth A. Maradik, President Gary A. Gilot, Member Murray L. Miller, Member day of Joseph R. Molnar, Member Jordan V. Gathers, Member Attest: Anne Fuchs, Clerk Version 08/16/2021 Contractor's Bid for Public Works - 2 WOODRUFF & SONS, INC. INTERNAL FINANCIAL STATEMENTS May 31, 2021 WOODRUFF & SONS, INC. Bradenton, Florida INTERNAL FINANCIAL STATEMENTS May 31, 2021 CONTENTS FINANCIAL STATEMENTS BALANCESHEETS... ........................... - .... .. . ...... . .. ......... ...... ..... .. When the prospective Contractor is unable to certify to any of the staternents 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: LaPorte COUNTY ) The undersigned Contractor, being duly sworn upon his/her/its oath, affirms under the penalties of perjury that: I. Contractor has not, nor has any other member, representative, or agent of the firm, company, corporation or partnership represented by him, entered into any combination, collusion or agreement with any person relative to the price to be bid by anyone at such letting nor to prevent any person from bidding nor to induce anyone to refrain from bidding, and that this bid is made without reference to any other bid and without any agreement, understanding or combination with any other person in reference to such bidding. Contractor further says that no person or persons, firms, or corporation has, have or will receive directly or indirectly, any rebate, fee, gift, commission or thing of value on account of such sale; and 2. Contractor certifies by submission of this proposal that neither contractor nor any of its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency; and 3. Contractor has not, nor has any successor to, nor an affiliate of, Contractor, engaged in investment activities in Iran. a. For purposes of this Certification, "Iran" means the government of Iran and any agency or instrumentality of Iran, or as otherwise defined at Ind. Code § 5-22-16.5-5, as amended from time -to -time. b. As provided by Ind. Code § 5-22-16.5-8, as amended from time -to -time, a Contractor is engaged in investment activities in Iran if either: i. Contractor, its successor or its affiliate, provides goods or services of twenty million dollars ($20,000,000) or more in value in the energy sector of Iran; or ii. Contractor, its successor or its affiliate, is a financial institution that extends twenty million dollars ($20,000,000) or more in credit to another person for forty-five (45) days or more, if that person will (i) use the credit to provides goods and services in the energy sector in Iran; and (ii) at the time the financial institution extends credit, is a person identified on list published by the Indiana Department of Administration. 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. Version 08/16/2021 Contractor's Bid for Public Works - 4 Contractor agrees that he/slue/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, firms, partnerships, corporations, associations, orjoint 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 contract or employment, or any matter directly or indirectly related to contracting or employment because of race, sex, religion, color, national origin, ancestry, gender expression, gender identity, sexual orientation, or due to age 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 will consider the Contractor's good faith efforts to obtain participation by those subcontractors 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. Contractors seeking the award of a City contract cannot be required to award a subcontract to an MWBE; however, they may not unlawfully discriminate against said MBE/WBE. On goal -eligible contracts, Contractors are required to either meet both MBE and WBE utilization goals or demonstrate that the Contractor has made good faith efforts to obtain participation from MBE and WBE subcontractors. A finding of noncompliance or a discriminatory practice shall prohibit that Contractor 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 to which the discriminatory practice or noncompliance pertains. 7. The undersigned Contractor agrees that the following nondiscrimination commitment shall be made a part of any contract which it may henceforth enter into with the City of South Bend, Indiana or any of its agencies, boards or commissions. Contractor agrees not to discriminate against or intimidate any employee or applicant for employment in the performance of this contract with privileges of employment, or any matter directly or indirectly related to employment, because of race, religion, color, sex, gender expression, gender identity, sexual orientation, handicap, national origin or ancestry. Breach of this provision may be regarded as material breach of contract. 1, the undersigned bidder or agent as contractor on a public works project, understand my statutory obligations to the use of steel products or foundry products made in the United States (I.C. 5-16-8-1).1 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 ajustification 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 08/16/2021 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 9th day of November , 20 21 Woodruff & Sons Inc. X ctorBid r (Finn) Signature of Contractor er or Its Agent Bruce R. Woodruff, Vice President Printed Name and Title Subscribed and sworn to before me this 9th day of November 2021 My Commission Expires August 30, 2025 County of Residence Notary Public i M NIC::: LEPERNlialorr StaInanCommisoNumb704738My Commisonxpiresug 30, 2025 : - Version 08/16/2021 Contractor's Bid for Public Works - 6 BID/PROPOSAL CITY OF SOUTH BEND Project Name: PRAIRIE AVENUE WATER MAIN LOOP Project Number: 117-068 For Bids Due: NOVEMBER 9, 2021 Contractor Name: Woodruff & Sons, Inc. Item No. Description Quantity Unit Unit Price Amount 1 Water Main, 12", DIP 6,030 LFT $121.33 $731,619.90 2 Structure Backfill, Type 1 or 2 3,500 CYD $21.96 $76,860.00 3 US 20 Jack & Bore (12" Carrier Pipe w/24" Steel Casing) 335 LFT $784.11 $262,676.85 4 Gate Valve and Box, 12" 6 EACH $3,707.80 $22,246.80 5 Fire Hydrant Assembly 4 EACH $7,763.94 $31,055.76 6 Air Release Valve and Vault 2 EACH $7,063.14 $14,126.28 7 Connection to Existing Water Main 2 EACH $3,749.95 $7,499.90 8 1" Corporation Stop for Water Service 7 EACH $759.49 $5,316.43 9 1" Type K Copper Water Service 80 LFT $92.14 $7,371.20 10 Curb Stop and Box 7 EACH $897,55 $6,282.85 11 HMA Surface, 9.5 mm, Type C 85 TON $205.37 $17,456.45 12 HMA Intermediate, 19.5 mm, Type C 140 TON $136.91 $19,167.40 13 HMA Base, 25.0 mm, Type C 390 TON $102.68 $40,045.20 14 PCCP, 12", SR 23 Pavement Base 750 SYD $315.54 $236,655.00 15 Recycled Concrete for Pavement Sub -base, No. 53 600 TON $72.96 $43,776.00 16 HMA for Approaches 175 TON $288.40 $50,470.00 17 PCCP For Approaches 60 SYD $135.28 $8,116.80 18 Stone Driveway Repair (Undistributed) 15 CYD $106.45 $1,596.75 19 Milling, 1-1/2" 5,320 SYD $7,47 $39,740.40 20 HMA for Resurface, Type C, 1-1/2" 445 TON $119,80, $53,311.00 21 Utility Allowance 1 ALLOW. $10,000.00 $10,000.00 22 Clearing Right -of -Way 1 LS $27,303:74 $27,303.74 23 Erosion Control 1 LS $25,653.97 $25,653.97 Version 08/16/2021 Contractor's Bid for Public Works - 7 BID/PROPOSAL CITY OF SOUTH BEND Project Name: PRAIRIE AVENUE WATER MAIN LOOP Project Number: 117-068 For Bids Due: NOVEMBER 9, 2021 Contractor Name: Woodruff & Sons, Inc. - BASE BID (Continued) Item Description Quantity Unit Unit Price Amount No. 24 Seeding and Restoration 5,450 SYD $10.46 $57,007.00 25 Pavement Marking, Thermoplastic, Solid 2,350 LFT $1.31 $3,078.50 White, 4" Pavement Marking at Four Winds Casino 26 Parking Lot, Thermoplastic, Solid Yellow, 4" 200 LFT $1,31 $262.00 (Undistributed) 27 Dewatering 1 LS $7,232.93 $7,232.93 28 Lawn Restoration, Sodding, and Topsoil 300 SY $38.72 $11,616.00 (Undistributed) 29 MaintenanceofTraffic 1 LS $28,011.18 $28,011.18 30 Construction Engineering 1 LS $25,558.31 $25,558.31 31 Mobilization/Demobilization 1 LS $246,043.88 $246,043.88 Total Base Bid Amount: $2,117,158.48 Version 08/16/2021 Contractor's Bid for Public Works - 8 BIDIPROPOSAL CITY OF SOUTH BEND Project Name: PRAIRIE AVENUE WATER MAIN LOOP Project Number: 117-068 For Bids Due: NOVEMBER 9, 2021 Contractor Name: Woodruff & Sons, Inc, MANDATORY ALTERNATE BID Item No. Description Estimated Quantity Addition or Deduction Unit Unit Price Amount 1 Water Main, 12", DIP -1,120 LFT $121.33 -$135,889.60 1A Water Main, 12", DIP, Directionally Drilled 1,120 LFT $196.42 $219,990.40 2 Structure Backfill, Type 1 or 2 -1,120 CYD $21.96 -$24,595.20 3 US 31 Jack & Bore (12" Carrier Pipe w/24" Steel Casing) 0 LFT $0.00 $0.00 4 1 Gate Valve and Box, 12" 0 EACH $0.00 $0.00 5 Fire Hydrant Assembly 0 EACH $0.00 $0.00 6 Air Release Valve and Vault 0 EACH $0.00 $0.00 7 Connection to Existing Water Main 0 EACH $0.00 $0.00 8 1" Corporation Stop for Water Service 0 EACH $0.00 $0.00 9 1" Type K Copper Water Service 0 LFT $0.00 $0.00 10 Curb Stop and Box 0 EACH $0.00 $0.00 11 HMA Surface, 9.5 mm, Type C -30 TON $205.37 -$6,161.10 12 HMA Intermediate, 19.5 mm, Type C -50 TON $136.91 -$6,845.50 13 HMA Base, 25.0 mm, Type C -150 TON $102.68 -$15,402.00 14 PCCP, 12", SR 23 Pavement Base -340 SYD $315.54 -$107,283.60 15 Recycled Concrete for Pavement Base, No. 53 -230 TON $7296 -$16,780.80 16 HMA for Approaches -25 TON $288.40 -$7,210.00 17 PCCP For Approaches 0 SYD $0.00 $0.00 18 Stone Driveway Repair (Undistributed) 0 CYD $0.00 $0.00 19 Milling, 1-1/2" -1,720 SYD $7.47 -$12,848.40 20 HMA for Resurface, Type C, 1-1/2" -145 TON $119.80 -$17,371.00 21 Utility Allowance 0 ALLOW. $0.00 $0.00 22 Clearing Right -of -Way 0 LS $0.00 $0.00 23 Erosion Control 0 LS $0.00 $0.00 24 Seeding and Restoration -1,250 SYD $10.46 -$13,075 Version 08/16/2021 Contractor's Bid for Public Works - 9 BID/PROPOSAL CITY OF SOUTH BEND Project Name: PRAIRIE AVENUE WATER MAIN LOOP Project Number: For Bids Due: 117-068 NOVEMBER 9, 2021 Contractor Name: Woodruff & Sons Inc. MANDATORY ALTERNATE BID (CONTINUED) Version 08/16/2021 Contractor's Bid for Public Works - 10 Estimated Item Description Quantity Unit Unit Price Amount No. Addition or Deduction 25 Pavement Marking, Thermoplastic, -1,120 LFT $1.31 -$1,467.20 Solid White, 4" Pavement Marking at Four Winds $0.00 26 Casino Parking Lot, Thermoplastic, 0 LFT $0.00 Solid Yellow, 4" (Undistributed) 27 Dewatering 0 LS $0.00 $0.00 28 Lawn Restoration, Sodding, and 0 SY $0.00 $0.00 Topsoil (Undistributed) 29 Maintenance of Traffic -1 LS $28,011.18 -$28,011.18 30 Construction Engineering 0 LS $0.00 $0.00 31 Mobilization/Demobilization 0 LS $0.00 $0.00 Mandatory Alternate Amount: -$172,950.18 Version 08/16/2021 Contractor's Bid for Public Works - 10 Contractor Name: Woodruff & Sons, Inc, BID SUMMARY: Base Bid Amount $ 2,117,158.48 Mandatory Alternate Bid Amount $-172,950.18 BID SUBMITTED BY: Bidder (Firm): Woodruff & Sons, Inc. Address: 2125 E. US Hi¢hwav 12 City/State/Zip: Michigan City, IN 46360 Telephone Numbe � ( 219 ) 872-8605 By: Ad,2&_a1& (Signa[ Bruce R. Woodruff, Vice President (Printed Name of Person Signing) Version 08/16/2021 Contractor's Bid for Public Works - 11 Q � 7 � BID/PROPOSAL CITY OF SOUTH BEND Project Name: PRAIRIE AVENUE WATER MAIN LOOP Project Number: 117.068 For Bids Due: NOVEMBER 9, 2021 Contractor Name: Woodruff & Sons, Inc, BID SUMMARY: Base Bid Amount $ 2,117,158.48 Mandatory Alternate Bid Amount $-172,950.18 BID SUBMITTED BY: Bidder (Firm): Woodruff & Sons, Inc. Address: 2125 E. US Hi¢hwav 12 City/State/Zip: Michigan City, IN 46360 Telephone Numbe � ( 219 ) 872-8605 By: Ad,2&_a1& (Signa[ Bruce R. Woodruff, Vice President (Printed Name of Person Signing) Version 08/16/2021 Contractor's Bid for Public Works - 11 ��U i'li E?IG CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM MBE -1.0i MBE UTILIZATION PLAN This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects involving MBE participation. It is the bidder's sole responsibility to verity whether any listed minority-owned business meets the MBE qualifications. Project Number: 117-068 Project Name; PRAIRIE AVENUE WATER MAIN LOOP Bidder: Woodruff & Sons, Inc. Total Bid Amount: $2,117,158.48 Mandatory Alternate Bid Amount: $1,944,208.30 Page __I_of 1 BASE BID MBE GOAL: 2.0% Name & Adtlress of MBE Primary Contact Person (Name/Telephone) Scope of Work to be Performed (Attach scope/schedule if you need additional space) Dollar Amount of MBE Component Percentage of TotalBid/Proposal Global Engineering & Land Surveying, LLC 601 Franklin St Suite 101, Michigan City, IN Shannon Hudson 218-872-4444 Field Engineering & Surveying $22,400 1.1 % C. Lee Construction Services 1011 S. Lake St., Gary, IN Chip Lee 219-888-9554 Trucking $6,000 0.2% BASE BID MBE GOALS $28,400 1.3% MANDATORY ALTERNATE BID MBE GOAL: 4.8% Name& Address of MBE Primary Primary Contact Person hone' ( p ) Scope of Work to be Performed (Attach scope/schedule if you need additional space) Dollar Amount of MBE Component Percentage of Total Bid/Proposal Global Engineering & Land Surveying, LLC 601 Franklin St. Suite 101, Michigan City, IN Shannon Hudson 219-872-4444 Field Engineering & Surveying $22,400 1.1 % C. Lee Construction Services 1011 S. Lake St., Gary, IN Chip Less 219-888-9554 Trucking $3,000 0.1 % MANDATORY ALTERNATE BID MEE GOALS $25,400 - 1.3% Submitted by: Bruce R. Woodruff, Vice President 54L `" November 9, 2021 Print Name ISignature WODate Version 08/16/2021 Contractor's Bid for Public Works - 12 R141'H\yF:i. CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM WBE-1.0 WBE UTILIZATION PLAN This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects involving WBE participation. It is the bidder's sole responsibility to verify whether any listed woman -owned business meets the WBE qualifications. Project Number: 117-068 Project Name: PRAIRIE AVENUE WATER MAIN LOOP Bidder: Woodruff & Sons, Inc. Total Bid Amount: $2,117,158.48 Mandatory Alternate Bid Amount: $1,944,208.30 Page 1 of 1 BASE BID WBE GOAL: 2.0% Name &Address of MBE Primary Contact Person Scope of Work to be Performed Dollar Amount of WBE Percentage of Total (NamelTele hone p ) (Attach scope/schedule if you need additional space) Component Bid/Proposal Slusser's Green Thumb, Inc John Williamson Landcaping & Erosion Control $30,771 1.5% 1610 Genesis Dr., LaPorte, IN 574-722-3102 x3210 KB Enterprise, Inc. Kelsey Bolakowski Material Supplier $424,200 20% 7007 E US Highway 20, New Carlisle, IN 574-3034780 TCS Traffic Control Specialists, Inc. Rik Ritzler Maintenance of Traffic $85,000 4% 1810 W. Pacific Ave., Knox, IN 574-772-7001 BASE BID WBE GOALS $539,971 25.5% MANDATORY ALTERNATE BID WBE GOAL: 4.8% Name &Address of MBE Primary Contact Person Scope of Work to be Performed Dollar Amount of WBE Percentage of Total (Namerrelephone) (Attach scope/schedule if you need additional space) Component BidlPro osal Slusser's Green Thumb, Inc. John Williamson Landscaping & Erosion Control $8,300 0.4% 1610 n Dr N 574-722- 1 21 KB Enterprise, Inc. 7007 E US Highway 20, New Carlisle, IN Kelsey Bolakowski 574-303-4780 Material Supplier $424,200 21.8% NDATORY ALTERNA�B BID WBE TOTALS /R . n 11 $432,500 Submitted by: Bruce R. Woodruff, Vice President Z�Au&% G✓// Print Name Signature Version 08/16/2021 Contractor's Bid for Public Works - 13 November 9, 2021 Date ��rrn CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM MBE -2.0 H� EVIDENCE OF GOOD FAITH EFFORTS 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 participation. Project Number: 117-068 Date: November 9, 2021 Project Name: PRAIRIE AVENUE WATER MAIN LOOP Bidder: Woodruff & Sons, Inc. Contact Person: Bruce R. Woodruff Telephone: 219-872-8605 Address: 2125 E. US Highway 12 City: Michigan City State: IN zip: 46360 Email: brucew(?D_woodruffandsons.com To determine whether a bidder has demonstrated good faith efforts to reach the MBE utilization goals set forth in the City of South Bend Public Works Project Specifications, the City and its agencies, boards, or commissions, REQUIRE ALL of the following Good Faith Efforts as listed in the table below*: Version 08/16/2021 Contractor's Bid for Public Works - 14 EVIDENCE OF GOOD FAITH EFFORTS MBE LIST(S): The bidder reviewed 1)the City of South Bend's Minority and Women Business Enterprise Inclusion Program Plan; 2) the list of certified MWBEs provided by the City; and 3) the Indiana Department of Administration list of Minority and Women Owned Businesses (both certified and non -certified) found at: http://www.in.goviidoa/. GOOD FAITH EFFORTS TO OBTAIN MBE PARTICIPATION The bidder shall initial each item below, as evidence of its good faith efforts to obtain MBE participation in the awarded contract. I affirm that I reviewed the City of South Bend's Minority and Women Business Enterprise Inclusion Program Plan and the Indiana Department of Administration's certified list of Indiana Minority and Women Business Enterprises, found on their website htt J/www,in, ov/idoa . - I affirm that I have made good faith efforts to select portions of the contract work to be performed by MWBEs, including, where appropriate, breaking out contract work items into economically feasible units to facilitate MBE participation. I affirm that I have made good faith efforts to solicit through all reasonable and available NMMr�/ means the interest of all MBEs in the scopes of work of the contract. I affirm that I attended all pre-bid meetings scheduled by the City of South Bend to inform MBEs of contracting and subcontracting opportunities. 1 affirm that I advertised in general circulation and/or trade association publications concerning subcontract opportunities and allowed MBEs reasonable time to respond to such advertisements. A I affirm that I performed any and all necessary steps to provide written notices in a manner reasonably calculated to inform MBEs of subcontracting opportunities and allowed sufficient time for MBEs to participate effectively. 1 affirm that I followed up on initial solicitations with interested MBEs. I affirm that I negotiated with interested MBEs in good faith, including providing such MBEs with adequate information about the plans, specifications and other requirements of the subcontract. I affirm that I have made good faith efforts to assist interested MBEs in obtaining bonding, lines of credit, or insurance as required by the City or the bidder, where appropriate. Version 08/16/2021 Contractor's Bid for Public Works - 14 CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM MBE -2.0 EVIDENCE OF GOOD FAITH EFFORTS -Proper demonstration of Good Faith Efforts 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 08/16/2021 Contractor's Bid for Public Works - 15 1 affirm that I have made good faith efforts to assist interested MBEs in obtaining necessary equipment, supplies, materials, or related assistances or services, where appropriate._ I affirm thatl did not reject any MBEs as unqualified withoutsound business reasons based on a thorough investigation of their capabilities. CONTRACT RECORDS: The bidder has maintained the following records for each MBE that has bid on the subcontracting opportunity: 1. Name, address, and telephone number; 2. A description of information provided by the bidder or subcontractor; and 3. A statement of whether an agreement was reached, and if not, why not, including any reasons for concluding that the MBE was unqualified to perform the job. -Proper demonstration of Good Faith Efforts 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 08/16/2021 Contractor's Bid for Public Works - 15 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 MWBE participation. - - - Project Number: 117-068 Project Name: PRAIRIE AVENUE WATER MAIN LOOP Bidder: Woodruff & Sons, Inc. Contact Person: Bruce R. Woodruff Date: November 9, 2021 Telephone: 219-872-8605 Address: 2125 E. US Highway 12 City: Michigan City State: IN zip: 46360 Email: brucew(cDwoodruffandsons.com To determine whether a bidder has demonstrated good faith efforts to reach the WBE utilization goals set forth in the City of South Bend Public Works Project Specifications, the City and its agencies, boards, or commissions, REQUIRE ALL of the following Good Faith Efforts as listed in the table below*: �" qn ni df ii CITY OF SOUTH BEND WBE LIST(S): The bidder reviewed 1) the City of South Bend's Minority and Women Business Enterprise MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN G. , el f FORM WBE-2.0-%% of Administration list of Minority and Women Owned Businesses (both certified and non -certified) found EVIDENCE OF GOOD FAITH EFFORTS r This completed form should be Included as part of the Bids documents related to City of South Bend Public Works Projects requiring Good Faith Efforts to obtain MWBE participation. - - - Project Number: 117-068 Project Name: PRAIRIE AVENUE WATER MAIN LOOP Bidder: Woodruff & Sons, Inc. Contact Person: Bruce R. Woodruff Date: November 9, 2021 Telephone: 219-872-8605 Address: 2125 E. US Highway 12 City: Michigan City State: IN zip: 46360 Email: brucew(cDwoodruffandsons.com To determine whether a bidder has demonstrated good faith efforts to reach the WBE utilization goals set forth in the City of South Bend Public Works Project Specifications, the City and its agencies, boards, or commissions, REQUIRE ALL of the following Good Faith Efforts as listed in the table below*: Version 08/16/2021 Contractor's Bid for Public Works - 16 EVIDENCE OF GOOD FAITH EFFORTS WBE LIST(S): The bidder reviewed 1) the City of South Bend's Minority and Women Business Enterprise Inclusion Program Plan; 2) the list of certified MWBEs provided by the City; and 3) the Indiana Department of Administration list of Minority and Women Owned Businesses (both certified and non -certified) found at: httr)://www.in.aov/idoa/` GOOD FAITH EFFORTS TO OBTAIN WBE PARTICIPATION The bidder shall initial each item below, as evidence of its good faith efforts to obtain WBE participation in the awarded contract. I affirm that I reviewed the City of South Bend's Minority and Women Business Enterprise Inclusion Program Plan and the Indiana Department of Administration's certified list of Indiana Minority and Women Business Enterprises, found on their website (hftp:ltwww.in.gov/jdoa). I affirm that I have made goad faith efforts to select portions of the contract work to be performed by WBEs, including, where appropriate, breaking out contract work items into economically feasible units to facilitate WBE participation. I affirm that 1 have made good faith efforts to solicit through all reasonable and available means the interest of all WBEs in the scopes of work of the contract. I affirm that I attended all pre-bid meetings scheduled by the City of South Bend to inform WBEs of contracting and subcontracting opportunities. I affirm that I advertised in general circulation and/or trade association publications concerning subcontract opportunities and allowed WBEs reasonable time to respond to such advertisements. I affirm that I performed any and all necessary steps to provide written notices in a manner reasonably calculated to inform WBEs of subcontracting opportunities and allowed sufficient time for WBEs to participate effectively. I affirm that I followed up on initial solicitations with interested WBEs. I affirm that I negotiated with interested WBEs in good faith, including providing such WBEs with adequate information about the plans, specifications and other requirements of the subcontract. I affirm that I have made good faith efforts to assist interested WBEs in obtaining bonding, e�NVN lines of credit, or insurance as required by the City or the bidder, where appropriate. Version 08/16/2021 Contractor's Bid for Public Works - 16 -t-roper aemonstraaon or uooa Tann Etrorts 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 08/16/2021 Contractor's Bid for Public Works - 17 CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN necessary equipment, supplies, materials, or related assistances or services, where FORM WBE-2.0 'r EVIDENCE OF GOOD FAITH EFFORTS — -t-roper aemonstraaon or uooa Tann Etrorts 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 08/16/2021 Contractor's Bid for Public Works - 17 I affirm that I have made good faith efforts to assist interested WBEs in obtaining necessary equipment, supplies, materials, or related assistances or services, where appropriate. — - - - I affirm that I did not reject any WBEs as unqualified without sound business reasons based on a thorough investigation of their capabilities. CONTRACT RECORDS: The bidder has maintained the following records for each WBE that has bid on the subcontracting opportunity: - 1. Name, address, and telephone number, 2. A description of information provided by the bidder or subcontractor, and 3. A statement of whether an agreement was reached, and if not, why not, including any reasons for concluding that the MWBE was unqualified to perform the job. -t-roper aemonstraaon or uooa Tann Etrorts 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 08/16/2021 Contractor's Bid for Public Works - 17 This Completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects requiring Good Faith Efforts to contact MBEs. It is the bidder's sole responsibility to verify whether any listed - - ---- minority-owned business meets the MBE qualifications. Attachadditional pages if necessary. — - - - PAGE 1 OF 1 Project Number: 117-068 Project Name: PRAIRIE AVENUE WATER MAIN LOOP MBE Participation Goal 2.0% (BASE BID) MBE Firm Global Engineering & Land Surveying, LLC Owner or Contact at MBE Firm Shannon Hudson Telephone: 219-8724444 Fax: 219-879-9920 TYPE OF WORK SOLICITED FOR THIS PROJECT: Field Engineering & Surveying Email: shannon@global-landsurveying.com RESULTS OF CONTACT WITH THE MBE FIRM: We are using their submitted proposal for Base Bid and Mandatory Alternate MBE Firm C. Lee. Construction Services Owner or Contact at MBE Firm Chip Lee Telephone: 219-888-9554 Fax: 219-888-9564 Email: TYPE OF WORK SOLICITED FOR THIS PROJECT: Trucking RESULTS OF CONTACT WITH THE MBE FIRM: We are using their submitted proposal for the Base Bid and Mandatory Alternate Version 08/16/2021 Contractor's Bid for Public Works - 18 �.qp Ilf l� CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM MBE -2.1 MBE CONTACTED (BASE BID) This Completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects requiring Good Faith Efforts to contact MBEs. It is the bidder's sole responsibility to verify whether any listed - - ---- minority-owned business meets the MBE qualifications. Attachadditional pages if necessary. — - - - PAGE 1 OF 1 Project Number: 117-068 Project Name: PRAIRIE AVENUE WATER MAIN LOOP MBE Participation Goal 2.0% (BASE BID) MBE Firm Global Engineering & Land Surveying, LLC Owner or Contact at MBE Firm Shannon Hudson Telephone: 219-8724444 Fax: 219-879-9920 TYPE OF WORK SOLICITED FOR THIS PROJECT: Field Engineering & Surveying Email: shannon@global-landsurveying.com RESULTS OF CONTACT WITH THE MBE FIRM: We are using their submitted proposal for Base Bid and Mandatory Alternate MBE Firm C. Lee. Construction Services Owner or Contact at MBE Firm Chip Lee Telephone: 219-888-9554 Fax: 219-888-9564 Email: TYPE OF WORK SOLICITED FOR THIS PROJECT: Trucking RESULTS OF CONTACT WITH THE MBE FIRM: We are using their submitted proposal for the Base Bid and Mandatory Alternate Version 08/16/2021 Contractor's Bid for Public Works - 18 CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM MBE -2.1 MBE CONTACTED (MANDATORY ALTERNATE) This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects requiring Good Faith Efforts to contact MBEs. It is the bidder's sole responsibility to verify whether any listed minority-owned business meets the MBE qualifications. Attach additional pages if necessary. -- --- - - - - PAGE -1 OF - 1 - 2.0% (MANDATORY Project Number: 117-068 MBE Participation Goal ALTERNATE) Project Name: PRAIRIE AVENUE WATER MAIN LOOP BiddW(SignlWatffre) oo uff S Inc. By: Vice President November 9, 2021 f1l(Title) (Date) MBE Firm Global Engineering & Land Surveying, LLC Owner or Contact at MBE Firm Shannon Hudson Telephone:_ 219-872-4444 Fax: 219-879-9920 Email. shannon@global-landsurveying.com TYPE OF WORK SOLICITED FOR THIS PROJECT: Field Engineering & Surveying RESULTS OF CONTACT WITH THE MBE FIRM: We are using their submitted proposal for Base Bk1& Mandatory Alternate MBE Firm C. Lee Construction Services Owner or Contact at MBE Firm Chip Lee Telephone: 219-888-9554 Fax: 219-888-9564 Email: TYPE OF WORK SOLICITED FOR THIS PROJECT: - Trucking RESULTS OF CONTACT WITH THE MBE FIRM: We are using their submitted proposal for Base Bid and Mandatory Alternate Version 08/16/2021 Contractor's Bid for Public Works - 20 lVTli f CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM WBE-2.1 WBE CONTACTED (BASE BID) This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects requiring Good Faith Efforts to contact WBEs. It is the bidder's sole responsibility to verify whether any listed woman -owned business meets the WBE qualifications. Attach additional pages if necessary'- -- PAGE 1 OF 2 Project Number: 117.068 WBE Participation Goal 4.8% (BASE BID) Project Name: PRAIRIE AVENUE WATER MAIN LOOP WBE Firm Slusser's Green Thumb, Inc. Owner or Contact at WBE Firm Telephone: 574-722-31020210 Fax: TYPE OF WORK SOLICITED FOR THIS PROJECT: and Erosion Control Email: JDW@slussers.com RESULTS OF CONTACT WITH THE WBE FIRM: We are using their submitted proposal for Base Bid and Mandatory Alernate - WBE Firm State Barricading Owner or Contact at WBE Firm James Michalski Telephone: 574-287-2078 Fax: 574-287-1744 Email statebarricade1@aol.com TYPE OF WORK SOLICITED FOR THIS PROJECT: Maintenance of Traffic RESULTS OF CONTACT WITH THE WBE FIRM: The were not the low quote for Maintenance of Traffic Version 08/16/2021 Contractor's Bid for Public Works -19 WBE This completed form should be supplied with Bids that pertain to City of South Bend. Public Works Projects requiring Good Faith Efforts to contact WBEs. It is the bidder's sole responsibility to verify whether any listed woman -owned business meets the WBE qualifications. Attach additional pages if necessary. -- - - - PAGE 2 OF 2 Project Number: 117-068 WBE Participation Goal 4.8% (BASE BID) Project Name: PRAIRIE AVENUE WATER MAIN LOOP WBE Firm KB Entemrise. Inc. Owner or Contact at WBE Firm Kesley Bolakowski Telephone: 574-303-4780 Fax: Email: Kelsey@kbenterpnse.us TYPE OF WORK SOLICITED FOR THIS PROJECT: Material Supplier RESULTS OF CONTACT WITH THE WBE FIRM: Will are using their submitted proposal for the Base Bid and Mandatory Alternate WBE Firm TCS - Traffic Control Specialists, Inc. Owner or Contact at WBE Firm Rik Ritzier Telephone: 574-772-7001 Fax: 574-772-7002 Email: TYPE OF WORK SOLICITED FOR THIS PROJECT: Maintenance of Traffice RESULTS OF CONTACT WITH THE WBE FIRM: We will be using their submitted proposal for the Base Bid Version 08/16/2021 Contractor's Bid for Public Works - 19 CITY OF SOUTH BEND �1 MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM WBE-2.1 WBE This completed form should be supplied with Bids that pertain to City of South Bend. Public Works Projects requiring Good Faith Efforts to contact WBEs. It is the bidder's sole responsibility to verify whether any listed woman -owned business meets the WBE qualifications. Attach additional pages if necessary. -- - - - PAGE 2 OF 2 Project Number: 117-068 WBE Participation Goal 4.8% (BASE BID) Project Name: PRAIRIE AVENUE WATER MAIN LOOP WBE Firm KB Entemrise. Inc. Owner or Contact at WBE Firm Kesley Bolakowski Telephone: 574-303-4780 Fax: Email: Kelsey@kbenterpnse.us TYPE OF WORK SOLICITED FOR THIS PROJECT: Material Supplier RESULTS OF CONTACT WITH THE WBE FIRM: Will are using their submitted proposal for the Base Bid and Mandatory Alternate WBE Firm TCS - Traffic Control Specialists, Inc. Owner or Contact at WBE Firm Rik Ritzier Telephone: 574-772-7001 Fax: 574-772-7002 Email: TYPE OF WORK SOLICITED FOR THIS PROJECT: Maintenance of Traffice RESULTS OF CONTACT WITH THE WBE FIRM: We will be using their submitted proposal for the Base Bid Version 08/16/2021 Contractor's Bid for Public Works - 19 CITY OF SOUTH BEND { } MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM WBE-2.11 ae WBE CONTACTED (MANDATORY ALTERNATE) — This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects requiring Good Faith Efforts to contact WBEs. It is the bidder's sole responsibility to verify whether any listed woman -owned business meets the WBE qualifications. Attach additional pages if necessary. _ PAGE 1 OF 1- 4.8% (MANDATORY . Project Number; 117-068 WBE Participation Goal ALTERNATEI Project Name: PRAIRIE AVENUE WATER MAIN LOOP A By: Vice November WBE Firm Slusser's Green Thumb, Inc. Owner or Contact at WBE Firm John Williamson Telephone: 574-722-3102x3210 Fax: Email: JDW@slussers.com TYPE OF WORK SOLICITED FOR THIS PROJECT: Landscaping and Erosion Control RESULTS OF CONTACT WITH THE WBE FIRM: We are using their submitted proposal for Base Bid and Mandatory Alternate WBE Firm KB Enterprises Owner or Contact at WBE Firm Kelsey Bolakowski Telephone: 574-303-4780 Fax: Email: kelsey@kbenterprise.us TYPE OF WORK SOLICITED FOR THIS PROJECT: Material Suoolier RESULTS OF CONTACT WITH THE WBE FIRM: We will be using their submitted proposal for the Base Bid and Mandatory Alternate Version 08/16/2021 Contractor's Bid for Public Works - 21 AIA Document asioTM - 2oio Bid Bond CONTRACTOR: SURETY: /Name, legal status and address) Wcodruff & Sons, Inc. (Name, legal status and principal place of business) Hartford Accident and Indemnity Company 2125 E. US Highway 12 One Hartford Plaza This document has important legal MiC�h_igan City, IN 46360 OWNER: Hartford, CT 06155 consequences. Consultation with an attorney is encouraged with (Name, legal status and address) respect to its completion or motl0lcation. City of South Bend, Indiana, Board of Public Works Any singular reference to 227 W. Jefferson Blvd Contractor, Surety, Owner South Bend, IN 41,601P BOND AMOUNT: Ive anent Of The Total Amount Bid (5%) r other party shall be considered ble. plural where applicable. PROJECT: Vame, location or address, and Pro/'ect number, if any) AIRIE AVENUE WATER MAIN LOOP, Project No. 117-068 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 terms 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 f imished 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. When this Bond has been furnished to comply with a statutory or other legal requirement in the location of the Project, any provision in this Bond conflicting with said statutory or legal requirement shall be deemed deleted herefrom 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 sealer this 9th day of November, 2021 smanl Vrojec (Witness (Seal) (77de)Bruce R. WoodruV/ Vice President (Seal) CAUTION: You should sign an original AIA Contract Document, on whlftflvnifpwiBrs in RED. An original assures that changes will not be obscured. AIA Document A310TM —2010 (rev. 1012010). Copyright ®1963, 1970 and 2010 by The American Institute of Architects. All rights reserved. Init. WARNING: This AIA" nocumant Is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA® Document, w :..,., , portion of it, may result In severe civil and criminal penalties, and will be prosecuted to the maximum extent possible undo the lavi. Purchasers are permitted to reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, email The American Institute of Architects' legal counsel, copyright[olaia.org. .wrmoee Direct Inquiries/Claims to: THE HARTFORD BOND, T-12 POWER OF ATTORNEY' HartfOne ord, Connecticut 06155 Bond.ClaimsOlhehartford.com call: 888.266.3488 or fax: 860-7575835 KNOW ALL PERSONS BY THESE PRESENTS THAT: Agency Name: AMERICAN GLOBAL LLC Agency Code: 21-212039 0 Hartford Fire Insurance Company, a corporation duly organized under the Imvs of the State of Connecticut = Hartford Casualty Insurance Company, a corporation duly organizedunder the laws of the State of Indiana 0 Hartford Accident and Indemnity Company, a corporation duly organized under the laws of the State of Connecticut Hartford Underwriters Insurance Company, a corporation duly organized under the laws of the State of Connecticut Twin City Fire Insurance Company, a corporation duly organized under the laws of the State of Indiana Hartford Insurance Company of Illinois, a corporation duly organized under the laws of the State of Illinois Hartford Insurance Company of the Midwest, a corporation duly organized under the laws of the State of Indiana Hartford Insurance Company of the Southeast, a corporation duly organized under the laws of the State of Florida having their home office in Hartford, Connecticut, (hereinafter collectively referred to as the "Companies") do hereby make, constitute uptotheamountof Unlimited : Theresa J. Foley of Jericho NY, Krystal L. Stravato, Kevin T. Walsh, Jr. of Whippany NJ, Ricardo Davila, William Griffin, Michael Marino, Torre Taylor of MIAMI, Florida their true and lawful Attomey(s)-in-Fact, each In their separate capacity if more than one Is named above, to sign its name as surety(ies) only as delineated above by ®, and to execute, seal and acknowledge any and all bonds, undertakings, contracts and other written instruments in the nature thereof, on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. In Witness Whereof, and as authorized by a Resolution of the Board of Directors of the Companies on May 6, 2015 the Companies have caused these presents to be signed by its Senior Vice President and its corporate seals to be hereto affixed, duly attested by Its Assistant Secretary. Further, pursuant to Resolution of the Board of Directors of the Companies, the Companies hereby unambiguously affirm that they are and will be bound by any mechanically applied signatures applied to this Power of Attorney. a�i� V'�\\40..,1416'• �Od� �e a4 } �,•..'""" 170 F 7979 seo".'N ;r� g ,co.•r ''%'_.-,�• r'"e'h, wn' u!`.P., /-k e John Gray, Assistant Secretary STATE OF CONNECTICUT Ss. Hartford COUNTY OF HARTFORD M. Ross Fisher, Senior Vice President On this 5th day of January, 2018, before me personally came M. Ross Fisher, to me known, who being by me duly sworn, did depose and say: that he resides in the County of Hartford, State of Connecticut; that he is the Senior Vice President of the Companies, the corporations described in and which executed the above instrument; that he knows the seals of the said corporations; that the seals affixed to the said instrument are such corporate seals; that they were so affixed by authority of the Boards of Directors of said corporations and that he signed his name thereto by like authority. 21" Kathleen T. Maynard Nolmy Public CERTIFICATE My Commission Expires hly 31,2021 I, the undersigned, Assistant Vice President of the Companies, DO HEREBY CERTIFY that the above and foregoing Is a true and correct copy of the Power of Attorney executed by said Companies, which Is still in full force effective as of November 9, 2021 Signed and sealed at the City of Hartford.It �r• 1;`3(:t.•t�le"a7�o4j\�l:T1:9eit �tYvm74 7w pn-ex *EDO 4r''rv.'y,le 5 ,.„`'�'.,�.• Kevin' Heckman, Assistant Vice President MA2M SOl TT{ 82 � oy 1316 COUNTY -CITY BUILDING C� r•'' PHONE 574/235-9251 227 W. JEFFERSON BOULEVARD IR6. FAX 574/ 235-9171 J SOUTH BEND, INDIANA 46601-1$30 TDD 574/235-$567 CTTY OF SOUTH BEND, JAMES MUELLER, MAYOR BOARD OF PUBLIC WORKS Date: October 29, 2021 To: All Planholders From Anne Fuchs, Clerk, Board of Public Works Subject Addendum Number: 1 Project Name: Prairie Avenue Water Main Loop Project Number: 117-068 ACKNOWLEDGEMENT OF RECEIPT OF ADDENDUM Date Received: November 1, 2021 This addendum is being forwarded to you for the above referenced project. Please sign below and acknowledge receipt of this Addendum by faxing this sheet to the Board of Public Works at (574) 235-9171 within 48 hours of receipt. A copy MUST also be included with your bid package upon submittal. THIS ADDENDUM MAY AFFECT YOUR BID. Notes: The attached documents are hereby added to the Specifications and Contract Documents and become a part of herein. Company: W Authorized Signature: e C.—Weisman, Project Manager Date: November 1, 2012 Version 4/2/2015 x Communication Result Report ( Nov. 1, 2021 11:55AM g z) Date/Time: Nov. 1. 2021 11:54AM file No, Mode Destination ----------------------------------------- 9811 Memory TX 5742359171 -------------------------------------------- Reas fo o oE. 1) Ha n up or line fail E.3) No answer E.5) Exceeded max. E-mail size Page Pg (S) Result Not Sent ----------------------------------------------- P. 1 OK E. 2) Busy E.4) No fans' 11 n . con c t i 1 E.6) Dest' tlo do esnot s P P o rt IP -Fax 3)16rmmr4nPuno �\�. E�w[ eWm�9m ]]W.Irrtmwev¢rra® __ _ Ine dWyLDlil ' — 9wmmq bnuuYYt.lAfe IVP f]V llLU6] CRVMSpV1nHP`V�IAAnSMVn ee MAYPR BoAnD of PutsuC WOM Dem: OmUr29,= To: All PfiasoWn From Moe Faras Clink B.nIdNbllewoda "a Add I 6jwx..m:Prefrla Avonuo Was. Maio Lapp Pmj.Nulvbm 11]-0fi8 ACKNOWLEDGEMENT OF MECEIPT OF ADDENDUM Dine RaeivW: Novembc i,aa2t 'Ibis eddradom u brmgfaWvded 0 .a for dm.bove ae<mmxd ,j.. Please alga below and acknowledge receipt of this Addendum by faring this sheet to the Board of Public Works at (574) 2)5-9171 within 48 hours of receipt A copy MUST also be included with your bid package upon submittal. THIS ADDENDUM MAY AFFECT YOUR DH): Norm TI. attuned documents me b.byaddcd to the Spmifcaa.. end Coauar2 Docuno* .ld bewmc a pant of herein. c My: waoa,ussM]/, p Aum«rad Sitoemrt�%yi—I 'nrtj�' — T Fis cWmAnr�PtlMmue D+mNovember] 2011 �45otiTH bg�i �i U bn y N R 1316 COUNTY -CITY BUILDING `` L- Xf J�j PHONE 574/235-9251 227 W. JEFFERSON BOULEVARDY„ eai s, ? FAX 574/ 235-9171 SOUTH BEND, INDIANA 46601-1830 '. TDD 574/ 235-5567 CITY OF SOUTH BEND, JAMES MUELLER, MAYOR BOARD OF PUBLIC WORKS Date: November 4, 2021 To: All Planholders From Anne Fuchs, Clerk, Board of Public Works Subject Addendum Number: 2 Project Name: Prairie Avenue Water Main Loop Project Number: 117-068 ACKNOWLEDGEMENT OF RECEIPT OF ADDENDUM Date Received: November 5, 2021 This addendum is being forwarded to you for the above referenced project. Please sign below and acknowledge receipt of this Addendum by faxing this sheet to the Board of Public Works at (574) 235-9171 within 48 hours of receipt. A copy MUST also be included with your bid package upon submittal. THIS ADDENDUM MAY AFFECT YOUR BID. Notes: The attached documents are hereby added to the Specifications and Contract Documents and become a part of herein. Company: Woodruff & Sons, Inc. Authorized Signature: C. Weisman, Project Manager Date: Version 4/2/2015 P. 1 x x x Communication Result Report ( Nov, 5, 2021 11:52AM) x x x 2) 2) Date/Time: Nov. 5. 2021 11:52AM file Page No, Mode Destination Pg (s) Result Not Sent —----------------------------------------- --------- -------- 9818 Memory TX 5742359171 P. 1 OK ---------------------------------------------------------------------------------------------------- Reason for erro E. I) Han g or line fail E.2) Busy E. 3) No an wrE.4) No fats iml le connecti E 5) Ex ce e clad ma n. E—mail size E.6) De st loot ion does not su000 rt IP—Fax 1nfOnanGrvrvaw.ry P ]ui]f9Ul noa.]ursaMBCUalr F eiVllHln . _ dAXtlacwlw'.wn—II6>]l lu Prig' ore x Sovm aew,l.uresMuvasa,Afnvoz BoAxnoFirwic Wom DOW Noarmhv4lMl ID: - AIIPlmlmhkm . Prom Anne Furh] Clnk HondofPohlb Wale Slddar AddmdumNumE;r: 2 P JWNeme: P.100AV... Who Mal. Loop Po,jwwundwe 117-0 9 ACKNOWLEDGEMENT OF RECEIPT OF ADDENDUM bakRaYivedr - Nortmber5 2021 ' 11d]vdderW naheir, fon Mbyou for the above rt ,s, P]JUX - Please sign below and acknowledge receipt of this Addendum by fazing this sheet to the Board of Public Works at (574) 235-9171 within 48 hours of receipt. A copy MUST also he included with your bid package upon submittal. TILS ADDENDUM MAY AFFECT YOUR BID. The edinhod docalaenis no hereby added to the Specifirenons arc Contract Documents sad become apart orhereh, cmep,.y: wwmmfasee:lee Aolhar¢d6ipVxoee;1� J' eCWea..x.a�ei�Mr a+ Dnc. Nevw6a5.2021 Addendum No. 1 CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK RESPONSIBLE BIDDER CHECKLIST Project Name PRAIRIE AVENUE WATER MAIN LOOP Project No. 117-068 For Bids Due NOVEMBER 9, 2021 Contractor Name: Woodruff & Sons, 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 11 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" 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 forcontinuation 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 01/13/2021 General Conditions - 10 Addendum No.1 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 01/13/2021 General Conditions - 11 Addendum No.1 PRE -QUALIFIED BIDDER CHECKLIST (a) Acknowledgements: (i) __ _ _ By checking this box, I hereby acknowledge that I am a pre -qualified bidder with the City of South Bend and that I have met the pre -qualification requirements within the last twelve (12) months. A copy of my Pre -Qualification verification letter is attached. (ii) _ By checking this box, I hereby acknowledge that the City reserves the right to request supplemental information, additional verification of any information provided by me, and may also conduct random inquiries of my current and prior customers. (b) Attachments: (i) _ Indiana Secretary of State's on-line records (ie. Business verification) dated within sixty (60) days of the submission of said document showing that business is in existence, current with the Indiana Secretary of State's Business Entity Report, and eligible for a certificate of good standing. (Not applicable to individuals, sole proprietors or partnerships). (ii) _ 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. (iii) _ 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 01/13/2021 General Conditions - 12 Addendum No. 1 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) _2L 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) x List identifying all former business names. (iii) _Z_ 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) _2L 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) _Z_ 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 01/13/2021 General Conditions - 13 Addendum No. 1 (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) 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. DaZM 2021 la (Sign Here) Al Bruce R. Woodruff, Vice President (Print Name Here) Woodruff & Sons. Inc. (Name of Company) 212E F LIS Hiphwa� 12 (Address of Company) Michioan Citv (City) (State) 219-872-8805 (Telephone Number) Version 01/13/2021 General Conditions -14 F pM1LY OWNED ANO p9ERATED AMERICAN BUStosss SINCE 1946 Woodruff & Sons, Inc. P.O. Box 10127 Bradenton, FL 34282-0127 Phone: 941-756-1871 Fax: 941-755-1379 Woodruff & Sons, Inc. P.O. Box 450 Michigan City, IN 46361 Phone: 219-872-8605 Fax: 219-879-5339 Equal Opportunity Employer November 9, 2021 RE: Pre -Qualification Checklist (For Bidders That Are Not Pre -Qualified) Attachments for the City of South Bend Board of Public Works Prairie Avenue Water Main Loop i. Please see attached Not Applicable iii. Not Applicable iv. Woodruff & Sons, Inc. is currently staffed by 210 employees between our two locations, with over 75 years of experience. We are also affiliated with Teamsters Local #135 and Local #142, Laborers Local #81 and Local #645, and Operators Local #150. v. Persons working on the project shall be lawfully employed by Woodruff & Sons, Inc. or their Subcontractors. All Woodruff & Sons, Inc. employees are verified through E -Verify. vi. See attached letter of our good standing with the Indiana Laborers Training Trust Fund along with additional documentation including certificates and apprentice training hours. vii. See attached copy of the BCRC Drug & Alcohol Policy. Woodruff & Sons, Inc. is affiliated with the BCRC Administrator Inc. viii. See attached evidence of Approved Sureties ix. Not applicable of any federal, state or local tax liens or tax delinquencies. x. List of most recent projects of similar scope performed in the last three years: 1) Sturdy Road Water Main Extension —Valparaiso City Utilities - $1,105,888.88 — Completed August 2020 2) Water Utility Improvements Div D Water Service Line Replacements — City of Crown Point - $1,100,383.84 — Completed May 2021 3) US 30 & Broadway Water Main Relocation — Indiana American Water Company- $208.401.88 —Completed September 2019 . 4) South Haven Water Main Replacement— Indiana American Water Company - $514,987.88 Completed May 2019 5) 511 Street Alley Sanitary Sewer Replacement - MichiganCity Sanitary District- $173,725.88 Completed June 2019 6) Mechanic Street Water Main Replacement — City of New Buffalo - $424,374.88 Completed October 2019 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 1 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 08/16/2021 Contractor's Bid for Public Works - 3 p PM,tV OWNED ANO ppEHATEa AMeICAN SUSV SS R SINCE 1946 Woodruff & Sons, Inc. P.O. Box 10127 Bradenton, FL 34282-0127 Phone: 941-756-1871 Fax: 941-755-1379 Woodruff & Sons, Inc. P.O. Box 450 Michigan City, IN 46361 Phone: 219-872-8605 Fax: 219-879-5339 Equal Opportunity Employer November 9, 2021 RE: Contractor's Bid For Public Work Part II — Prairie Avenue Water Main Loop Section I: Experience Questionnaire 1. Projects completed one year prior the dated of the current Bid a. Water Utility Improvements Div D for the City of Crown Point— Water Main and Service Replacements b. NW Water Main Replacements Package 2 for Indiana American Water Company — Water Main and Service Replacements c. Larkspur & US 421 Water Main Removal & Replacement for Michigan City Department of Water Works - Water Main Removal & Replacement d. Town of Trail Creek, IN Street Improvements Project Contract Division A for the Town of Trail Creek— Sanitary Sewer and Storm Sewer Repair 2. Projects currently in process of construction a. 109th Ave West Reconstruction for BR2C Development— Rock Revetment Wall b. Franciscan Health Crown Point Replacement Hospital for Tonn and Blank Construction—Site Utilities c. Franciscan Health Michigan City Legacy Hospital Renovations for Term and Blank Construction —Storm Water Lift Station d. NW Crews Service Side Replacements for Indiana American Water Company —Water Service Replacements 3. Woodruff & Sons, Inc. has never failed to complete any work we have been awarded. 4. List of references from private firms we have performed work for a. Blue Chip Casino — Michigan City, IN — Butch Shreve b. Shell Catalysts&Technologies — Michigan City, IN — SteveKrentz c. John A. Doyle & Associates— Michigan City, IN —John A. Doyle d. Tonn and Blank Construction — Michigan City, IN—Jon Gilmore e. Haas & Associates— Michigan City, IN -Timothy Haas Section II: Plan and Equipment Questionnaire 1. Explain your plan or layout for performing proposed work. ** Woodruff & Sons, Inc. will construct the work of the project in accordance with Contract Documents as issued by the Owner and as prepared by the Engineer. 2. List the names and addresses of all subcontractors that we have used on public works projects during the last five years with a brief description of the work they completed. Rieth-Riley Construction — Asphalt/Concrete — 2454 W CR 450 N Laporte, IN 46350 p P1A11.V OWNED Apo ppEBA760 AMERICAN BUS'" S' SINCE 1949 Woodruff & Sons, Inc. P.O. Box 10127 Bradenton, FL 34282-0127 Phone: 941-756-1871 Fax: 941-755-1379 Woodruff & Sons, Inc. P.O. Box 450 Michigan City, IN 46361 Phone: 219-872-8605 Fax. 219-879-5339 Equal Opportunity Employer b. Milestone Contractors—Asphalt/Concrete-2418 W CR 450 N Laporte, IN 46350 c. Slusser'sGreenThumb —Silt Fence/Sod/Seed-125 Montgomery St Logansport, IN 46947 d. UMC Union Mills Construction —Concrete -7271 S 700 W Union Mills, IN 46382 e. John A. Doyle & Associates— Field Engineering & Surveying — 2322 E. Michigan Blvd. Michigan City, IN 46360 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 expect to require a Bond. **Midwest Mole — Directional Drill -6814 W 350 N, Greenfield, IN **Homer Tree Service, Inc.—Clearing-16464 W 143'dStSte B, Lockport, IL **Milestone Contractors North—Asphalt-243581N-23, South Bend, IN **DBL Services, Inc. — Pavement Striping —1811 Clover Rd, Mishawaka, IN **Riley Trenchless —Jack & Bore — 2835 US 250, Norwalk, OH **Concrete Cutting & Breaking— Road Saw Cutting -1730 Markle Ave, Elkhart, IN No Bond Required from any Subcontractors 4. What equipment do you intend to use for the proposed project? **Woodruff & Sons, Inc. has available to use for the proposed project: Loaders, Backhoes, Mobile Mixer, Dump Trucks and Trailers, Pavers, Dozers, Compactors, Vertical Drill, Rollers, Boring Machines, Concrete Breakers, Pumps, Trench Protection Equipment, Conveyors, Graders, Scrapers, Wellpoint Systems, Cranes, and Compressors Have you made Contracts or received offers for all materials within prices used in preparing your proposal? ** Yes 7) 4`h& Bigger Street Gary Storm Sewer Replacements —Gary Storm Water Management - $253,918.88 Completed November 2019 8) NWI Gary Bid Package 1 Water Main Replacements— Indiana American Water Company - $897,448.88 Completed January 2019 9) White Ditch Water Line Replacement & Relocation— Michigan City Dept. Water Works - $195,158.88 Completed October 2018 10) Hupp Road Culvert — INDOT - $416,801.55 Completed December 2018 11) Lafayette/Brown/Campbell Streets Water Main Improvements— Valparaiso City Utilities - $395,858.88 Completed December 2018 Business Name: WOODRUFF & SONS, INC. Entity Type: Domestic For -Profit Corporation Creation Date: 03/28/1961 Principal Office Address: PO Box 10127, 2125 EAST US 12, Bradenton, FL, 34282, USA Jurisdiction of Formation: Indiana BUSINESS INFORMATION HOLLI SULLIVAN INDIANA SECRETARY OF STATE 10/14/2021 10:16 AM j 6 Business ID: 194316-057 Business Status: Active Inactive Date: Expiration Date: Perpetual Business Entity Report Due 03/31/2023 Date: Years Due: x NA rltt .e >» 1WE I Title Name Address Secretary WAKEMAN.LINDA. P.O. BOX 10127, BRADENTON, FL, 34282 - 0127, USA Vice President Bruce R Woodruff 2125 E US 12, Michigan City, IN, 46360, USA President Donald P. Woodruff P.O. Box 10127, Bradenton, FL, 34282 - 0127, USA Type: Individual Name: Bruce Woodruff Address: 2125 E US 12, Michigan City, IN, 46360, USA �pN,10 OWNED A.Va Op ERATEO AMERICAN BUSINE''B SINCE 1949 Woodruff & Sons, Inc. P.O. Box 10127 Bradenton, FL 34282-0127 Phone: 941-756-1871 Fax: 941-755-1379 Woodruff & Sons, Inc. P.O. Box 450 Michigan City, IN 46361 Phone: 219-872-8605 Fax: 219-879-5339 Equal Opportunity Employer November 9, 2021 City of South Bend Board of Public Works 227 W. Jefferson Blvd. South Bend, IN 46601 RE: Pre -Qualification Checklist (For Bidders That Are Not Pre -Qualified) Attachment vi With regards to compliance with IC 5-16-13-12 providing or participating in a job training program, the various Union training programs are in compliance with US Department of Labor as well as the Occupational Safety and Health Administration. All of our employees that work in the field are members of one Union or another and receive training thru their corresponding Unions. As part of each collective bargaining agreement, we pay a certain monetary amount per man hour for this training. In addition to that, we have training beyond what the Unions provide. As an example, we have everyone complete CPR and First Aid Training. Then depending on the job class of employee they also receive additional training. We recently had twelve field personnel take an updated trench safety program offered by The Construction Advancement Foundation (CAF) in Portage. The CAF is actually the Union affiliated extension that is responsible for training programs for multiple Unions. Another example ofthe Union training is whereby three of our laborers are actually in training for a week in April near Indianapolis dictated by their Union requirements. Beyond the required Union training, we actually conduct our own Safety Training Day every year where we hire outside instructors to teach various topics from trench safety, confined space, silica training, equipment safety, fire prevention, utility location, etc. Our Safety Training Day is a full eight hour day that all employees attend and like previously stated is over and above what the Union training requires. Feel free to contact me if you have any specific questions regarding this information. Sinnccejrrelly�,'' 4 '� Bruce R. Woodruff Vice President James M. Sweeney/Chairman David M. Snelten/Secretary Operating Engineers Local 150 Apprenticeship Fund A Joint Effort of Labor and Management to Further the Ahn of Industry www.asiploco1150.org Wednesday, October 12, 2021 To whom it may concern, Woodruff & Sons is a signatory contractor to the LLLO.E. Local 150, and therefore, also participates in the I.11.C.E. Local 150 Apprenticeship and Skill Improvement Program (ASIP), located at: 19800 W. South Arsenal Rd., in Wilmington, IL. The Local 150 ASIP is a DOL Registered Apprenticeship Program overseen by the DOL's Office of Apprenticeship (OA). Listed below are the number of graduates of its program during the years 2015-2019. 2020-105 • 2019-48 2018-88 2017-73 If there are any questions regarding the LU.O.E. Local 150 Apprenticeship, please feel free to contact me directly. Thank y�G�Mark Kara Kara Assistant Coordinator ASIP Local 150 Office: 815-722-3201 Email: mkara@asiplocall50.org 19800W South Arsenal Road - Wilmington, IL 60481 • 8151722-3201 =36 INDIANA LABORERS' TRAINING TR UST FUND David A. Frye Secretary -Treasurer Andrew Angel Jerry J. Balk Ricky Henson, Jr. Ramon Mendoza, Jr. Danny L. Stults P.O. Box 758 - Bedford, Indiana 47421 (812)279-9751 May 21, 2021 To Whom It May Concern: Sean Coakley, Director John P. Brown Chairman Kelly Abel Michael Ferrara Stan Meyer Nick Timmerman Jim Wiseman FAX: (812) 279-5545 Toll Free (800) 742-4086 This letter is to confirm that "Woodruff & Sons, Inc." is a signatory contractor in good standing with the Indiana Laborers' Training Trust Fund. The above mentioned company is a participant in the Joint Apprenticeship and Training Committee through this Union and has been an active participant in good standing for each of the past five plus consecutive years and is currently eligible to use our apprentices on a project. Further, our organization's program is approved by the U.S. Veterans Administration to participate in the GI educational benefits program. A copy of our approval letters are attached along with the collective bargaining agreement stating the ratios of Journey workers to Apprentices; which is one (1) Apprentice for every four (4) Journey workers and thereafter may not employ more that (1) Apprentice for every (3) Journey workers. Sincerely, Sean kley, Director SC:jb www.indianalaborerstraining.org tole WT Sun= of Apprenticts4lp anb 01raining Tatificat e of Wegistration INDIANA LABORER'S TRAINING TRUST FUND BEDFORD, INDIANA for the trade classification of CONSTRUCTION CRAFT LABORER ✓?eyisfereo( as parf of 1,ie �afiona� f�pprenliceskp J royram in accoro(ance miff fhe basic sfano�aros oagprenliceskD es2(a6f'sheo(6y fie c3ecrefary of December 14, 1995 Dade IN040-0528 girl�aGors JCo. SE�,�iay nflaGoR 2 Ne L.' J3uvsu of (+� :enf.'cca and ay.:ny EAd STATE OF INDIANA DEPARTMENT OF VETERANS AFFAIRS STATE APPROVING AGENCY 402 WEST WASHINGTON STREET ROOM W-469 INDIANAPOLIS, INDIANA 46204-2738 Jeremy Brewer Apprenticeship Coordinator Indiana Laborers Training Trust Fund -Apprenticeship 439 Patton Hill Rd. Bedford, IN 47421 Dear Jeremy Brewer, Eric Holcomb, Governor James M. Brown, Director January 9, 2019 The Indiana State Approving Agency conducted a supervisory visit on 01/8/2019 at Indiana Laborers Training Trust Fund -Apprenticeship. The purpose of the visit was to provide training to the Certifying Officials and review enrollment certifications, record retention and reporting procedures. The organization demonstrated proper record maintenance and record maintenance and reporting procedures: During the visit, we discussed the importance of reporting hours on a monthly basis, good record keeping techniques, and how to report a leave of absence or completion via VA Form 22-1999b. We also updated the Certifying Officials via VA Form 22-8794, work processes, and wage scale. If you need any assistance or have any questions regarding this technical visit please contact me directly attgriffm@dva.in.gov or (317) 232-3916. Thank you for the courtesy extended during my visit. The education and training opportunities that your organization continues to provide veterans and their dependents are appreciated. Sincerely, Taniqua Griffin Program Director Phone (317)-234-6062 Toll Free (800)-400-4520 Fax (317)-234-8744 0 9N9 , 19% X07 AAA 9 Rpt 9C�2 k> DEPARTMENT OF VETERANS AFFAIRS STATE APPROVING AGENCY 402 WEST WASHINGTON STREET ROOM W469 INDIANAPOLIS, INDIANA 462042738 Jeremy Brewer Apprenticeship Coordinator Indiana Laborers Training Trust Fund -Apprenticeship 439 Patton Hill Rd. Bedford, IN 47421 Dear Jeremy Brewer, Eric Holcomb, Governor James M. Brown, Director January 9, 2019 This will acknowledge receipt of your updated Wage Scale for the Construction Craft Laborer program offered by Indiana Laborers Training Trust Fund -Apprenticeship. The State Approving Agency has reviewed the document as listed below: Wage Scale: Construction Craft Laborer FACILITY CODE: 30004114 To the best of my knowledge Indiana Laborers Training Trust Fund -Apprenticeship does not utilize erroneous or misleading advertisement, either by actual statement, omission, or intimation. It is understood by Indiana Laborers Training Trust Fund -Apprenticeship that they will maintain a complete record of all advertising utilized by or on behalf of the Indiana Laborers Training Trust Fund -Apprenticeship in regards to their training programs during the preceding 12 months. Indiana Laborers Training Trust Fund -Apprenticeship's advertising will be available for review by any and all future supervisory visits by the SAA, or the U.S. Department of Veteran Affairs. Please Review the entire packet for content and accuracy. Approval is granted pursuant to the provisions of Title 38, U.S. Code 3687, with an effective date of April 1, 2018. If you have any questions, please feel free to give me a call at 317-232-3916 or email me at tgriffin@dva.in.gov. Thank you for what you do for our Veterans, and have a great day! Sincerely, Taniqua Griffin Program Director State Approving Agency Cc: VARO/ELR rNol -9 2p19 A fi� ."pRO (f cq "ftY STATE OF INDIANA DEPARTMENT OF VETERANS AFFAIRS STATE APPROVING AGENCY 402 WEST WASHINGTON STREET ROOM W-469 INDIANAPOLIS, INDIANA 46204-2738 Jeremy Brewer Apprenticeship Coordinator Indiana Laborers Training Trust Fund -Apprenticeship 439 Patton Hill Rd. Bedford, IN 47421 Dear Jeremy Brewer, Eric Holcomb, Governor James M. Brown, Director January 9, 2019 This will acknowledge receipt of your revised Work Processes for the Construction Craft Laborer program offered at Hoosier Energy, located in Bedford, Indiana. The State Approving Agency has reviewed the document as listed below: TI2AFUNG PROGRAM LENGTH DOT CODE Construction Craft Laborer FACILITY CODE: 30004114 4,000-7800 hours 47-2061.00 To the best of my knowledge Indiana Laborers Training Trust Fund -Apprenticeship does not utilize erroneous or misleading advertisement, either by actual statement, omission, or intimation. It is understood by Indiana Laborers Training Trust Fund -Apprenticeship that they will maintain a complete record of all advertising utilized by or on behalf of the company in regards to their training programs during the preceding 12 months. The company's advertising will be available for review by any and all future supervisory visits by the SAA, or the U.S. Department of Veteran Affairs. This approval is made pursuant to and under the provisions of Title 38, U. S. Code 3687, with an effective date of January 8, 2019. If you have any questions, please contact me at 317-232-3916. Sincerely, Taniqua Griffin Program Director State Approving Agency Cc:VARO/ELR ryas ✓qy ��G�d ro9 `9 1%9 9'0,0 �,% 4G 9G� Phone (317)-234-6062 Toll Free (800)-400-4520 Fax (317)-234-8744 Apprentice Status Report By Indenture Date Apprentices Indentured Between 1/1/2017 And 5/13/2020 Apprentice Program: IN2 Year Apprentice Status Apprentices 2017 O Active 156 22.67 %o Active Duty 1 0.15% Adv; to Journeyman 47 6,830/. Deceased 4 0.58% Graduated 45 6.54% Inactive 2 0.29 Journeyman 1 0.15% Med. Susp. 4 0.58% Reinstate 2 0,29% Suspended 5 0.73 % Terminated 396 517.569/o Voluntary withdraw 25 3.63 % Total Indentured 688 Active 283 32,38% Active Duty 3 0.34% Adv: to Journeyman 47 5,38% Deceased 3 0.34% Graduated 5 0.57 Inactive 101 1.14% Journeyman 2 0.23 % Med. Susp. 4 0.46% Reinstate 1S 1.72 Suspended 8 0.92 % Terminated 462 52,86 Voluntary withdraw 321 3.66 % Total Indentured 874 Printed: Wednesday, May 13, 2020 Page 1 of 2 Apprentice Status Report By Indenture Date Apprentices Indentured Between 1/1/2017 And 5/1312020 Apprentice Program: IN2 Year Apprentice Status Apprentices Percentage 2019 2020 Active 641 65.47% Adv, to Joumeyman 28 2,86% Deceased 3 ' 6,31%, Graduated 1 0.10% Inactive 11 1,12%o Journeyman 13 1,33% Med. 5usp. 2 0,20% Reinstate 29 2196% Suspended 4 0;41 % Terminated 201 20,53% Voluntary withdraw 46 4.70 % Total Indentured 979 Active 75 91-46% Med. Susp. 1 1.22% Wristat6 6 6.100/0 Terminated 1 1.22% Total Indentured 82 Printed: Wednesday, May 13, 2020 Page 2 of 2 Apprentice Status Report By Indenture Date Apprentices Indentured Between 1/1/2020 And 12/31/2020 Apprentice Program: IN2 Year Apprentice Status Apprentices Percentage 2020 Active 537 — 7&85'% Active Duty 2 0.29% Adv.'Yo Joumeyman 8 ;' 1.17% APPLICANT 1 0.15% Med. Susp. 3 " Oma/d Not Registered 6 0.88 Reinstate 27 '; 3;96 °/u: Suspended 4 0.59% T,enlnatetl g0 `. 1175 Voluntary withdraw 13 1.91% Total Indentured 681 Printed: Tuesday, January 12, 2021 Page 10/ 1 i UNION CRAFTS PARTICIPATING IN THE GEOGRAPHICAL JURISDICTION OF THE BCRC • BOILERMAKERS - LOCAL #374 • BRICKLAYERS -LOCAL #4 • IN/KY/OH REGIONAL COUNCIL OF CARPENTERS & MILLWRIGHTS • GLAZIERS - LOCAL #1165 • HEAT & FROST INSULATORS - LOCALS #17 & #75 • ELECTRICIANS - LOCALS #531 & #697 • ELEVATOR CONSTRUCTORS - LOCAL #2 • IRONWORKERS - LOCAL #395 • LABORERS - LOCALS #41, #819 & #645 • OPERATING ENGINEERS - LOCAL #150 • PAINTERS - LOCALS #460, #469, #1118, & #80 • PLASTERERS & CEMENT MASONS - LOCAL #692 • PILE DRIVERS - LOCAL #578 • PIPEFITTERS - LOCAL #597 • PLUMBERS -LOCAL #210 • ROOFERS - LOCALS #23 & #26 • SHEETMETAL WORKERS - LOCALS #20 & #218 • SPRINKLER FITTERS #281 • TEAMSTERS - LOCAL #142 • TECHNICAL ENGINEERS - LOCAL #130 This Policy has been adopted by the NWIBRT 04 14 ONWIESIRT 1�V Building & Construction Resource Center, Inc. Phone: (219) 764-9500 • Fax: (219) 764-9505 Toll Free: (877) 988-5400 6050 Southport Rd., Ste. B • Portage, IN 46368 www.BCRCNET.com Tish Roach Executive Director PerspectiveS (800) 456-6327 www.perspectivesltd.com Your Employee Assistance Program (EAP) INDEX PAGE Introduction ..... . .. . . .. .. . ... 1 The Policy .. .... . .. .. .. ... .. . 2 Definitions .. ... . . .. .. .. . .. ... 4 Drug Testing .. .. . . . . .. . . ... .. . 20 Drug Group ... . . .. . . . .. ... .. . 22 Alcohol Testing .. . . .. . . . . .. .. . 23 Payment for Testing . . . . . . . . . . . . . . 24 Initial Testing (Pre -Employment) . ... .. . 27 Random Testing .. . . .. . . .. .. . .. . 27 Vacation Status . .. . . .. ... . .. . .. . 28 Owner Requested On -Site Random Testing. .30 Probable Cause Testing . . . . . . ... . .. 31 Post-Accident/Incident Testing ........ 32 Rapid Test Prohibited . . . . . ... . .. 34 "Emergency" Work Assignments . . . . . . . 34 Card System .... . . .. . . .. ... . .. 36 Status Confirmation .. .. . . .. . .. ... 36 Reporting of Test Results . . ... .. . . .. 37 Insufficient Specimen . .. . . .. .. . ... 38 Dilute Specimen .. . . .. . .. . .. . .. . 38 Adulterated, Substituted, and/or Out -of -Temperature Specimen . .. .... 39 Consequences for a Non -Negative or Positive Test . . .. . . . . . . ... .. 40 Additional Consequences for Multiple Non -Compliant Events . . . . . . .. . .. 42 140170:1 Observed Return To Duty Testing .. .... . 44 Observed Follow -Up Testing .. .. ... . . 45 Disputed Positive Results . . .. .. ... . . 46 Appeals and Protections/Just Cause . ... . . 47 Illinois — "Drug Free Workplace Act" — 30 ILCS 580 .. .............. 49 Illinois — "Substance Abuse Prevention on Public Works Projects Act"— 820 ILCS 265 .... 50 Illinois — "Cannabis Regulation and Tax Act" — 410 ILCS 705 .. .............. 51 Indiana — Drug Testing for Public Works — IND. Code 4-13-18 ............. 51 Letters of Notice for Random Testing . .. . . 53 Attachment A — General Trades ........ 53 Attachment B — Non -Bargaining . . ... .. 54 Attachment C — Pipe Fitters Local #597 . .. 55 Attachment D — BCRC Authorization to Release and Disclose Information & Documents .. . 56 Attachment E — BCRC Application Form ... 59 — BCRC Permission Form to Obtain BCRC Status ..... 60 — BCRC Testing Information and Instruction Sheet .... . 61 Attachment F — BCRC On -Site Substance Abuse Testing Addendum ......... 62 Attachment G — BCRC Drug/Alcohol Testing Notification . .. . .. . . .. . . . 63 BUILDING AND CONSTRUCTION RESOURCE CENTER, INC. INTRODUCTION The Labor and Management representatives of the Building and Construction Industry for Northwest Indiana have formed an alliance to address the problems caused by drug and alcohol abuse. Management and Labor together have created the Building and Construction Resource Center, Inc. (hereafter "BCRC"), an independent not-for-profit corporation that offers a wide range of services to Employees in the unionized construction industry, which includes Employers and Labor Union organizations. It is BCRC's goal to assist Employers in establishing and maintaining workplaces that are free of the destructive effects caused when Employees use or abuse drugs and/or alcohol. BCRC's activities are not intended to interfere with normal practices of the Labor Unions or Management. BCRC recognizes its responsibility to communicate with and educate Employers and Employees in the unionized construction industry concerning this policy, as well as the harmful effects of drugs and alcohol in our society and in the workplace. BCRC also recognizes the need to provide a program of assistance to those persons for whom drugs or alcohol may be causing problems. Our Employee Assistance Program (EAP) provides support, counseling and resources for life issues that can take a toll on your emotional well-being or take time away from things you value the most, like work and family. Finally, while not wishing to violate the rights or invade the privacy of any Employee, BCRC's drug testing program will seek to identify those Employees who are unable or unwilling to conform to BCRC's program. This program has been established in accordance with the Drug and Alcohol Testing Industry Association (DATIA), the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Federal Department of Transportation Guidelines for specimen collection, laboratory analysis and review, and standards of integrity and confidentiality. E THE POLICY Persons who use or abuse drugs and/or alcohol, on or off their jobs, are likely to be less productive, to be less reliable, to be more frequently absent and to have other work-related problems that can cause increased costs, delays, accidents and injuries. These Employees can also risk the health, safety and well-being of other workers on the job. The unionized construction industry can control and reduce this problem through recognition of the problem, development of a comprehensive policy and program of education and information, promotion of an Employee Assistance Program (EAP) and implementation of fair and respectful drug testing that conforms to the Drug and Alcohol Testing Industry Association (DATIA), the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Federal Department of Transportation Guidelines for specimen collection and analysis. All of this is to be done with the utmost confidentiality and respect for the individual. All Employers (as defined herein) hereby adopt the following policy: No Employee may use, possess, distribute, deliver, or be under the influence of a drug, or use or be under the influence of alcohol, while performing any work for the Employer. In order to enhance substance abuse awareness among all Employers and Employees, educational seminars and training programs will be offered. The educational seminars will be directed toward education in regards to the seriousness of the nationwide drug and alcohol abuse problem and how the use of drugs and alcohol negatively impacts safety, productivity, and the competitive ability of the American workforce. Supervisors will be trained to identify Employees in potentially difficult situations and to recognize signs of impairment, as well as the Supervisors'responsibility to document, intervene and 2 follow-up with the troubled individual. These sessions will be offered as ongoing training programs. BCRC encourages all Employees troubled by their own or a family member's drug or alcohol abuse to seek professional care and treatment. Early recognition and treatment of alcohol and drug abuse provides the greatest opportunity for successful recovery. BCRC provides an Employee Assistance Program (EAP) for all Employees and their families who need professional guidance in assessing their substance abuse or alcohol-related problem and choosing an appropriate course of treatment. Current Employees will be referred to an EAP Representative as a result of a non -negative (positive) drug or alcohol test, a non-compliant event or upon an individual's own request. In either case, the content of the discussion with the EAP will be protected and confidential to the extent allowed by law. A Participant's use of and communications with the EAP are confidential and information regarding such confidential matters will not be released to BCRC or any of its subscribing organizations or participants without written release from the participant in accordance with the law. Employees who use the EAP as a consequence of a non -negative (positive) drug or alcohol test, or a non-compliant event, will be subject to the conditions established in the drug testing portion of this policy and as outlined by the EAP Counselor. The EAP staff has knowledge of the level and types of benefits available to BCRC Employees. Employees can access the services of the EAP through a hotline that is staffed twenty-four (24) hours a day, seven (7) days a week, throughout the entire year. Employees calling the EAP hotline are put in touch with a counselor who will conduct a professional assessment and who may meet with them to further assess the nature of the problem in order to provide a referral to the best and most appropriate level of care. The EAP is staffed by certified and Masters -level credentialed human services professionals who are sensitive to 3 the needs of the individual. Individuals who take the initiative to contact the EAP for assistance do so with the assurance that their calls will be treated respectfully and confidentially. The direct services provided by the EAP are sponsored by BCRC. In compliance with Public Law 100-690 (The Drug -Free Workplace Act), which applies only to Employers who have federal grants or federal contracts of more than $100,000, an Employee who is convicted of a workplace drug or alcohol violation and who is employed by a BCRC affiliated Employer must report this information to his/her immediate supervisor no later than five (S) days after such conviction. The Supervisor must report this information immediately to the Employer's Program Administrator. DEFINITIONS Addendums (i.e., Attachment F) may be approved by the Board of Directors on an as -needed basis. Adulterated Specimen means a specimen that has been altered, as evidenced by test results showing either a substance that is not a normal constituent for that type of specimen or showing an abnormal concentration of an endogenous substance. Air Blank means, in evidential breath testing devices (EBTs) using gas chromatography technology, a reading of the device's internal standard. In all other EBTs, a reading of ambient air containing no alcohol. Alcohol means the intoxicating agent in beverage alcohol, ethyl alcohol, or other low molecular weight alcohols including methyl and isopropyl alcohol. Alcohol Concentration (or content) means the alcohol in a volume of breath expressed in terms of grams of alcohol per 210 liters of breath as indicated by an evidential breath test under this policy (BrAC). M • Alcohol Confirmation Test means a subsequent test using an EBT, following a screening test with a result of 0.02 or greater, which provides quantitative data about the alcohol concentration. • Alcohol Screening Device (ASD) a breath or saliva device, other than an EBT, that is approved by the National Highway Traffic Safety Administration (NHTSA) and appears on the Office of Drug and Alcohol Policy and Compliance (ODAPC) web page for "Approved Screening Devices to Measure Alcohol in Bodily Fluids" because it conforms to the model specifications from NHTSA. • Alcohol Screening Test means an analytic procedure to determine whether an employee may have a prohibited concentration of alcohol in a breath specimen. • Alcohol Testing Site a place selected by the Employer where employees present themselves for the purpose of providing breath or saliva for an alcohol test. • Alcohol Use means the drinking or swallowing of any beverage, liquid mixture or preparation (including any medication), containing alcohol. • Aliquot means a fractional part of a specimen used for testing. It is taken as a sample representing the whole specimen. Ayy� lid means a person, Independent Contractor, or Employer, or person working for an Independent Contractor, or Employer who applies to become an Employee of a BCRC Contractor/Employer Participant, and includes a person who has received a job offer made contingent on the person passing a drug test. 5 Archived Status means the status of a person who has been inactive, deactivated, working outside of the geographic area covered by BCRC or otherwise taken out of the BCRC random pool. • Authorized Test means a drug and/or alcohol test performed in accordance with the provisions of this Policy and at the request (or direction) of BCRC. BCRC means Building and Construction Resource Center, Inc., which is a not-for-profit corporation formed by labor and management representatives of the building and construction industry for Indiana & Illinois, for the purpose of addressing problems of drugs and alcohol in the workplace. • BCRC Polite means all of the policies, procedures, and other matters set forth in this document (i.e., the BCRC Drug & Alcohol Policy) and all amendments and addenda to this document. • Breath Alcohol Technician (BAT) is a person who instructs and assists employees in the alcohol testing process and operates an Evidential Breath Testing device (EBT). Canceled Test means a drug or alcohol test that has a problem identified that cannot be or has not been corrected. A canceled test is neither a positive nor a negative test. An Employer is not permitted to take adverse job action based on a canceled test. • Card Manarer is the individual designated by each Employer who has the authority to access data information that will confirm the status of Employees by electronic mail. 0 CL or Clear means that an Employee is "cleared", available for work, and currently compliant with this Policy when used with respect to the BCRC status of an Employee. Chain of Custody the procedure used to document the handling of the urine specimen from the time the employee gives the specimen to the collector until the specimen is destroyed. This procedure uses the Federal Drug Testing Custody and Control Form (CCF) as approved by the Office of Management and Budget. • Collection Container means a container into which the Employee urinates to provide the specimen for a drug test. Collection Site means a place designated by BCRC where individuals present themselves for the purpose of providing a specimen to be analyzed for the presence of controlled substances or for purposes of providing a breath sample to be analyzed for alcohol concentration. Collector means a person who instructs and assists Employees at a collection site, who receives and makes an initial inspection of the specimen provided by those employees, and who initiates and completes necessary forms. • Company means an Employer/Contractor who is a member of BCRC. Confirmation (or confirmatory Drug Test a second analytical procedure performed on a different aliquot of the original specimen to identify and quantify the presence of a specific drug or drug metabolite. 7 ® Confirmation (or confirmatory) Validity Test a second test performed on a different aliquot of the original urine specimen to further support a validity test result. Confirmed DrugTests a confirmation test result received by an MRO from a laboratory. • Confirmatory Test a) For alcohol testing, a confirmatory test is a second test following a screening test with a result of 0.02 or greater, conducted 15-30 minutes later, that provides quantitative data of alcohol concentration. This test is conducted on an Evidential Breath Testing Device (EBT). b) For controlled substances testing, a confirmatory test is a second analytical procedure on the same specimen to identify the quantitation and presence of a specific drug or metabolite. This confirmatory test is independent of the initial test and uses a different technique and chemical principle from that of the screening test in order to ensure reliability and accuracy. Gas Chromatography/Mass Spectrometry (GC/MS) is the only authorized confirmation method for cocaine, marijuana, synthetic opiates, opioids, amphetamines and phencyclidine. Contractor Participant means an Employer who is contributing member of BCRC. Controlled Substance means marijuana (THC), cocaine, synthetic opiates, opioids, oxycodones, MDA -analogues, phencyclidine (PCP), amphetamines (including methamphetamines), methaqualone, barbiturates, benzodiazepine, propoxyphene, methadone, 6-acetymorphine and ecstasy. 0 ® Designated Employer Representative (DER) an Employee authorized by the Employer to take immediate action(s) to remove Employees from safety -sensitive duties or cause Employees to be removed from these covered duties and to make required decisions in the testing and evaluation processes. The DER also receives test results and other communications for the Employer consistent with the requirements of this policy. Service agents cannot act as DERs. Dilute Specimen means a specimen with creatinine and specific gravity values that are not consistent with medical expectations for human urine. DOT these terms encompass all DOT agencies, including, but not limited to, the Federal Aviation Administration (FAA), the Federal Railroad Administration (FRA), the Federal Motor Carrier Safety Administration (FMCSA), the Federal Transit Administration (FTA), the National Highway Traffic Safety Administration (NHTSA), the Pipeline and Hazardous Materials Safety Administration (PHMSA), and the Office of the Secretary (OST). For purposes of this part, the United States Coast Guard (USCG) in the Department of Homeland Security is considered to be a DOT agency for drug testing purposes only since the USCG regulation does not incorporate Part 40 for its alcohol testing program. These terms include any designee of a DOT agency. • Drugs mean the substances for which tests are required under this policy and include marijuana (THC), cocaine, amphetamines (including methamphetamines), methaqualone, phencyclidine (PCP), opioids, synthetic opiates, oxycodones, MDA -analogues, barbiturates, benzodiazepine, propoxyphene, methadone, 6-acetymorphine and ecstasy. 9 ® Drug Test means a test conducted for controlled substances. Employee means an Employee of a Company, or of a Contractor/Employer Participant, who is a member of BCRC. Employee Assistance Program (EAP) Counselor means a Masters -level professional with an education in psychology, social work, counseling, etc. with knowledge of and clinical experience in diagnosis and treatment of alcohol and controlled substance related disorders. The EAP will assess and make recommendations concerning education, treatment, Observed Follow -Up Testing and aftercare. Employer means a Company, or a Contractor/Employer Participant, who is a member of BCRC. Evidential Breath Testing Device (EBT) means a device approved by NHTSA for the evidential testing of breath at the .02 and .04 alcohol concentrations, placed on NHTSAs Conforming Products List (CPL) for "Evidential Breath Measurement Devices" and identified on the CPL as conforming with the model specifications available from NHTSAs Traffic Safety Program. First Occurrence Clause means if an Employee does not report for a random test, and it is the first time the Employee has failed to report, the Third Party Administrator (TPA or BCRC) may allow the Employee to take the test without reporting to the EAP for further review. Employees may utilize this clause only one time. Gas Chromatography/Mass Spectrometry Confirmation (GC/MS) is a state-of-the-art drug testing technology, providing a fingerprint of the detected drug. 10 ® HHS means the Department of Health and Human Services or any designee of the Secretary, Department of Health and Human Services. • HHS -Approved Laboratory any U.S. laboratory certified by HHS under the National Laboratory Certification Program as meeting the minimum standards of Subpart C of the HHS Mandatory Guidelines for Federal Workplace Drug Testing Programs; or, in the case of foreign laboratories, a laboratory approved for participation by DOT under this part. • Initial Test Lor drugs) means an immunoassay screen to eliminate negative urine specimens from further consideration. Initial ValidityTest means the first test used to determine if a specimen is adulterated, diluted or substituted. • Invalid Drug Test the result reported by an HHS certified laboratory in accordance with the criteria established by HHS Mandatory Guidelines when a positive, negative, adulterated or substituted result cannot be established for a specific drug or specimen validity test. • Laboratory any U.S. laboratory certified by HHS under the National Laboratory Certification Program as meeting the minimum standards of Subpart C of the HHS Mandatory Guidelines for Federal Workplace Drug Testing Programs; or, in the case of foreign laboratories, a laboratory approved for participation by DOT under this part. W • Licensed Medical Practitioner means a person who is licensed, certified, and/or registered, in accordance with applicable Federal, State, Local, or Foreign laws and regulations to prescribe controlled substances and other drugs. • Medical Review Officer (MRO) means a Licensed Physician, registered with the American Association of Medical Review Officers (www.aamro.com), responsible for receiving laboratory results generated by BCRC's drug testing program who has knowledge of substance abuse disorders and who has appropriate medical training to interpret and evaluate an individual's confirmed positive test result together with his/her medical history and any other relevant biomedical information. • N/A or Not Available means that an Employee is not available for work and is not currently compliant with this Policy when used with respect to the BCRC status of an Employee. (NOTE: An Employee can be N/A for several reasons, which may or may not include failing a drug or alcohol test). • New Employee/Applicant means a person who has not been previously tested by BCRC and includes a person referred for pre-employment testing. • Non -Compliant Event means any of the following: (a) a Positive Test for alcohol or drugs (which shall also include any Positive Tests that occur during any retesting), (b) an -Insufficient Specimen if an appropriate medical professional determines that there is no legitimate medical reason for the Insufficient Specimen, (c) a negative Dilute Specimen if the Employee fails to provide a second (2nd) testing sample within the applicable time period specified in this BCRC Policy 12 or a second (2nd) testing sample that is also a negative Dilute Specimen [provided, however, that a second (2nd) negative Dilute Specimen shall not constitute a Non -Compliant Event if. (1) the MRO determines that there is a valid medical reason for the second (2nd) Dilute Specimen, or (2) such treatment is prohibited by applicable law], (d) an Adulterated Specimen, (e) a Substituted Specimen, (f) an Out -of -Temperature Specimen, (g) any acts by an Employee that compromise the testing protocol (i.e., washes his/her hands, flushes the toilet, etc.) prior to being given direction from the collection professional, (h) a Refusal To Submit (to an alcohol or controlled substances test), (i) a failure to submit to Post-Accident/Incident Testing (which shall include a failure to test resulting from the Employee leaving the jobsite prior to such Post-Accident/Incident Testing), and 0) any other act or omission by an Employee that BCRC determines, in BCRC's sole discretion, to constitute a substantial or willful non-compliance with the policies and/or procedures set forth in this Policy. A Non -Compliant Event is also commonly referred to as a "strike." • Non -Negative means a urine specimen that is reported as an Adulterated Specimen, a Substituted Specimen, a Positive Test [for drug(s) or drug metabolite(s)], a Non -Compliant Event and/or invalid. • Observed Follow -Up Testing shall be required, based on an EAP evaluation for a Non -Negative or Positive Test result, missed random, incomplete test/walk outs and as provided in this BCRC Policy. All Follow -Up Testing will be administered by the TPA (BCRC) and must be observed. • Observed Return To Duty Test or Observed RTD Test is an observed test required by this BCRC Policy that 13 must be taken before an Employee can be returned to "clear" status. Such test is scheduled by the counselor at such time as the counselor deems appropriate after the EAP evaluation has been completed. This BCRC Policy requires such test following a Non -Negative test, missed random, walkout, Refuse to Submit as described in the BCRC Policy, or other Non -Compliant Event. If the test is not taken as directed by the EAP, the Employee will be required to return to the EAP. • Out -of -Temperature Specimen means a specimen that is below 90°F or above 100°F at the time the specimen is obtained at the collection site. Owner means a business or other entity (or individual) that hires a "Contractor Participant" to perform work at their facility, office, and/or property. Owner Requested Job -Site Random Testing means a Northwest Indiana Business Roundtable Owner, which has been approved by the Board of Directors, and may require a random drug test be done at their facility. The Employee will test within one hour of notification of the random test. The test may be performed at the Owner's facility no more than monthly provided there is an approved BCRC Collection Site at the facility. • Positive Test (alcohol) occurs when an Employee's confirmatory test result reads 0.02 BAC or higher. Positive Test (dynes) occurs when an HHS -certified laboratory reports a drug test as positive because a specimen contains a drug or drug metabolite equal to or greater than the cutoff concentrations. • Post-Accident/Incident Testing means drug and alcohol tests requested by an Employer following the occurrence of an accident and/or incident. • Probable Cause Testin2 maybe required when a Supervisor observes and documents unusual behavior. • Program Administrator means the individual who has administrative responsibilities for overseeing the drug and alcohol testing program for an Employer. The Program Administrator may serve as an Employer's DER. • Property means all Employer -owned 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. • Random Selection means a scientifically valid method for selection of Employees to be tested that result in an equal probability that any Employee from a group of Employees subject to the selection mechanism will be selected, and does not give an Employer discretion to waive the selection of any Employee under the mechanism. • Refuse To Submit (to an alcohol or controlled substances test) Means that an Employee: 1. Fails(ed) to appear for any test (except a pre-employment test) within a reasonable time, as determined by the BCRC Policy, after being directed to do so by the BCRC Policy; 2. Fails(ed) to remain at the testing site until the testing process is complete (a walk out); 15 3. Fails(ed) to provide a urine specimen for any drug test required by this BCRC Policy; 4. In the case of a directly observed or monitored collection in a drug test, fails to permit the observation or monitoring of the Employee's provision of a specimen; Fails(ed) to provide a sufficient amount of urine when directed, and it has been determined, through a required medical evaluation, that there was no acceptable medical explanation for the failure; Fails(ed) or declines to take a second test the Employer or collector has directed the Employee to take; 7. Fails(ed) to undergo a medical examination or evaluation, as directed by the MRO as part of the verification process, or as directed by the policy. In the case of a pre-employment drug test, the Employee is deemed to have refused to test on this basis only if the pre-employment test is conducted following a contingent offer of employment; S. Fails(ed) to cooperate with any part of the testing process (e.g., refuse to empty pockets when sq directed by the collector, behaves in a confrontational way that disrupts the collection process, provides incorrect or inaccurate information to the collection site or on necessary forms, or fails to complete all documents); 9. Provides a second (2nd) specimen that is dilute. Reinstatement Test is the test allowed by BCRC, which must be consistent with the Policy, to reactivate an Employee who has been on "Vacation" or "Archived 16 Status" for twelve (12) months or more and has not tested under the BCRC Policy in the past twelve (12) months. Rejected ForTesting the result reported by an HHS -certified laboratory when no tests are performed for a specimen because of a fatal flaw or a correctable flaw that is not corrected. Reporting Employee is an Employee who reports a work-related injury or illness that was caused by and/ or relates to the accident and/or incident for which the post-accident/incident drug or alcohol testing is requested by the Employer. Safe Site means a URL beginning with "https" which is a secure site for data transmission. SAMHSA means Substance Abuse and Metal Health Services Administration is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation. • Screening Test (or initial test) In drug testing, a test to eliminate "negative" urine specimens from further analysis or to identify a specimen that requires additional testing for the presence of drugs. • In alcohol testing, an analytical procedure to determine whether an employee may have a prohibited concentration of alcohol in a breath specimen. 17 • Screening Test Technician (STT) means a person who instructs and assists employees in the alcohol testing process and operates an Alcohol Screening Device (ASD). • Shipping Container means a container that is used for transporting and protecting urine specimen bottles and associated documents from the collection site to the laboratory. Specimen means a sample of urine, used for analysis and/or diagnosis. For the purpose of this policy; specimen is defined as urine. • Specimen Bottle means the bottle that, after being sealed and labeled according to the procedures in this policy, is used to hold the urine specimen during transportation to the laboratory. • Split Specimen means a part of the urine specimen that is sent to a first laboratory and retained unopened, and which is transported to a second laboratory in the event that the Employee requests that it be tested following a verified positive test of the primary specimen or a verified adulterated or substituted test result. • Substituted Specimen means a specimen with creatinine and specific gravity values that are so diminished that they are not consistent with human urine. • Testing Levels means levels at or above when a specimen is determined to be positive, and below when a specimen is determined to be negative. WIP ® 'Third Party Administrator (TPA) means an entity that provides or coordinates one or more drug and/or alcohol testing services to Employers. A TPA typically provides or coordinates the provision of a number of such services and performs administrative tasks concerning the operation of drug and alcohol testing programs for Employers. This term includes, but is not limited to, groups of Employers who join together to administer, as a single entity, the drug and alcohol testing programs of its Employees (e.g., having a combined random testing pool). • Traveler means a craft person who: (a) is coming to work in the geographic area covered by BCRC, and (b) is a member of a local union whose jurisdiction is outside of the geographic area covered by BCRC. • Unauthorized Test means a drug and/or alcohol test that is: (a) not performed in accordance with the provisions of this Policy, and/or (b) not performed at the request (or direction) of BCRC. Such tests include retests initiated by an Employer and/or an Employee that are not performed at the request (or direction) of BCRC. • Union means a Labor Organization that represents Employee(s) who are employed by a Company, or of a Contractor/Employer participant, who is a member of Building and Construction Resource Center, Inc. • Vacation Status means the status of an Employee who is temporarily removed from the BCRC random pool while on vacation or a non -work related absence. • Verified Test means a drug test result or validity testing result from a HHS -certified laboratory that has undergone review and final determination by the MRO. 19 DRUGTESTING BCRC will provide an identification card to each Participant which will reflect the results of the Drug & Alcohol Screen Test from the laboratory and/or as verified by the Medical Review Officer (MRO). To implement an appropriate and acceptable program, BCRC has adopted six (6) safeguards that reflect the standards established by the Drug and Alcohol Testing Industry Association (DATIA), U.S. Department of Health and Human Services (HHS) Substance Abuse and Mental Health Services Administration (SAMHSA) for testing mandated by the U.S. Department of Transportation.Those safeguards are as follows: 1. the integrity of collected urine specimens will be ensured by utilization of one collection procedure at all sites. Samples will be collected in accordance with federal standards that provide for a continuous Custody and Control Form and which recognize privacy concerns regarding the individuals being tested. 2. Testing will be conducted only by accredited labs that have obtained and retain HHS/SAMHSA certification. 3. All specimens that are positive in an initial screen must then be confirmed by gas chromatography/mass spectrometry (GC/MS). 4. A Medical Review Officer (MRO) will review all non -negative (positive) drug tests in order to verify positive test results.'Ihe MRO is a physician with specialty training and expertise in substance abuse and drug testing. The MRO will review lab -confirmed positive test results to ensure proper procedure, protocol and reporting.'Ihe MRO will make two (2) documented attempts, within twenty-four (24) hours of receiving the confirmed positive test result, to interview the individual who has a confirmed positive test result by 20 telephone to investigate whether a legal prescription (or other legitimate medical reason) has caused the specimen to test positive. If the individual does not consult with the MRO and provide the necessary information within forty-eight (48) hours of being contacted by the MRO (delays in responding caused by verifiable emergency or medical issues will be given consideration for exception) or he/she has no legal prescription, the MRO will take appropriate steps to report a verified positive to the BCRC Program Administrator, who will then invalidate the Employee's certification card. All persons who have tested positive must have their return to work cleared by the EAP. 5. All non -negative (positive) specimens will be retained frozen in a locked facility at the testing laboratory for one (1) year. The retained specimens will be available should the results of the initial test be disputed or should arbitration or litigation arise out of the actions taken because of the test results. 21 DRUG GROUP The BCRC drug -testing program will test for the following drugs at these levels: Drug Class Initial Test Confirmatory Level Test Level AMPHETAMINES 500 ng/mL Amphetamine 250 ng/mL Methamphetamine 250 ng/mL BARBITURATES 300 ng/mL Amobarbital 200 ng/mL Butalbital 200 ng/mL Pentobarbital 200 ng/mL Phenobarbital 200 ng/mL Secobarbital 200 ng/mL BENZODIAZEPINES 300 ng/mL Alprazolam Metabolite 200 ng/mL Oxazepam 200 ng/mL COCAINE METABOLITES 150 ng/mL 100 ng/mL MARIJUANA METABOLITES 50 ng/mL 15 ng/mL METHADONE 300 ng/mL 200 ng/mL METHAQUALONE 300 ng/mL 200 ng/mL MDA -ANALOGUES 500 ng/mL MDA 250 ng/mL MDMA 250 ng/mL OPIATES 2000 ng/mL Morphine 2000 ng/mL Codeine 2000 ng/mL OPIATES (SEMI -SYNTHETIC) 300 ng/mL Hydromorphone 100 ng/mL Hydrocodone 100 ng/mL 6-ACETYLMORPHINE 10 ng/mL 10 ng/mL OXYCODONES 100 ng/mL Oxymorphone 100 ng/mL Oxycodone 100 ng/mL PHENCYCLIDINE 25 ng/mL 25 ng/mL PROPDXYPHENE 300 ng/mL 200 ng/mL 22 ALCOHOLTESTING 1. Alcohol tests (screening and confirmatory) will be performed on a device that appears on the National Highway Traffic Safety Administration's (NHTSA) Conforming Products List (CPL) and that meets the DOT's testing requirements. 2. When a specific time for an Employee's test has been scheduled, and the Employee does not appear at the collection site at the scheduled time, the Breath Alcohol Technician (BAT) will contact the Designated Employer Representative (DER), who may determine that the Employee has refused to be tested. 3. For an alcohol screening test, a breath sample will be collected and analyzed by the Screening Test Technician (STT) or a Breath Alcohol Technician (BAT), using an Alcohol Screening Device (ASD). 4. If the result of the screening test indicates an alcohol concentration of 0.02 or greater,,a Breath Alcohol Technician (BAT) will perform a confirmatory test, no less than fifteen (15) and no more than thirty (30) minutes after the completion of the screening test. 5. If the confirmatory testis positive (0.02 and above, BrAC), the Breath Alcohol Technician (BAT) shall immediately notify the BCRC/Employer's DER. 6. Results of additional tests arranged by an Employee, or requested by a medical practitioner, will not be considered. This includes testing of blood samples, hair samples, DNA, or any other testing methods or protocols. 23 PAYMENT FOR TESTING Costs related to an Authorized Test will be paid by BCRC, except for the following tests: A. Department of Transportation (DOT); (1) Pre -Employment Testing, (2) Return To Duty Testing, (3) Follow -Up Testing. B. Industrial Cleaning; (1) Pre -Employment Testing, (2) Reinstatement Testing. C. Pre -Screening Testing of Applicants; (1) Apprenticeship Pre -Screening. D. The following testing for a New Employee/Applicant/ Traveler whose initial drug test is confirmed as a Positive Test; (1) Any Observed Return To Duty Test, (2) Any Observed Follow -Up Testing required by the EAP, (3) Including any Dilute Retest Under Observation. E. Unauthorized/UnnecessaryTests; (1) Late Random without calling BCRC first, (2) Testing on a Clear Status, (3) Crane Certifications, (4) Testing for Employer Required Time Frame, (5) Retest of Disputed Specimen. F. Any other types of testing that BCRC determines, in its sole discretion, should be paid in a different manner and/or by a person (or entity) other than BCRC. Employees can only be moved to "Archived Status" by a Participating Local Union, a Contractor Participant or the BCRC. When an Employee has been on "Archived Status" for twelve (12) months or more, has not tested under the BCRC Policy within the past twelve (12) months, and is returning to the active BCRC pool, the following will apply: M A. The Employee will be required to submit to a BCRC Reinstatement Test, which will be paid for by BCRC. B. If the BCRC Reinstatement Test is a Non -Compliant Event ("strike"); (1) The Employee shall report to the EAP. (2) At the direction of the EAP, the Employee shall sumbit to an Observed Return to Duty Test at the Member's expense. (3) If the Observed Return to Duty Test is Negative, the Employee will not have to pay for any Observed Follow -Up Testing unless the Employee has a subsequent confirmed Non -Negative or Positive Test or a Non -Compliant Event ("strike"). (4) If the Observed Return to Duty Test is confirmed Non -Negative or Positive or a Non -Compliant Event ("strike"), the Member must pay BEFORE taking any of the following; a. Observed Return to Duty, b. Observed Follow -Up Tests, c. Including any Dilute Retest Under Observation. Any subsequent testing required by the EAP; and any other types of testing that BCRC determines, in its sole discretion, should be paid in a different manner and/or by a person (or entity) other than BCRC. All tests described herein shall be administered pursuant to the observed collection protocol and procedures. After the BCRC has scheduled the observed test, the obligation to inform the collection site of the requirement for an observed test shall lie solely with the Employee. All costs related to an Unauthorized Test and all costs for re -testing of disputed test results by an Employee will be paid by the Employer or Employee who initiated such test. The costs to be paid by the Employer or Employee for such tests will be determined by BCRC, in BCRC's sole discretion, and shall be subject to change. 25 BCRC shall also have the right to terminate and/or restrict the Card Manager privileges, e-mail status confirmation system access, and any other access to information contained in any BCRC database for any Employer who fails to comply with this Agreement, the BCRC Policy, or any payment obligations to BCRC. If an Employee fails to pay for any testing costs and/or other costs for which the Employee is responsible under this BCRC Policy, the BCRC status of such Employee shall be listed as "N/A' unless and until the Employee fully pays all such costs for which the Employee is responsible under this BCRC Policy. The policies for payment for the Employee's time for testing are: For new or current union members, Employees seeking an initial test or the test is a condition of employment and Employees in the BCRC Policy will not be paid for their time in providing a specimen for the initial test. 2. All current Employees who are to test for any of the following reasons: late/missed random, probable cause, post -accident, diluted re -test, Observed Return To Duty, or Observed Follow -Up Testing, Reinstatement Test, 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 only be paid a stipend by BCRC for submitting to subsequent random testing: (a) required by the BCRC Policy (see Attachments A thru C) (b) in response to notification (by email, U.S. Mail or text message) from the BCRC Office (c) for which the Employee submits within seven (7) calendar days including the day BCRC gives notification for such random testing. It is understood that all testing will occur on the Employee's time.'Ihe Employee must submit for such testing within seven (7) calendar days including the day BCRC gives notification for such random testing. NO EXCEPTIONS! 04 4. All checks issued for such stipends must be cashed within ninety (90) calendar days from the date of the check. If an Employee does not cash a stipend check within ninety (90) calendar days from the date of the check, the Employee forfeits his/her right to such stipend, such stipend check shall be void and shall not be reissued under any circumstances or for any reason. 5. D.O.T., Non -Bargaining, Industrial Sector, Slag, and Pipe Fitter's Local #597 Employees are exempt from the stipend reimbursement. INITIAL TESTING (PRE-EMPLOYMENT) Prospective Employees and current Employees of BCRC affiliated Employers and Unions will be subject to the BCRC program. All persons who are eligible and who intend to obtain a BCRC card will complete an application (see Attachment E) that must be acknowledged by the applicable Local Union if submitted by a Contractor Participant. The individual will be directed by BCRC to report to an approved BCRC collection site for the purpose of providing a urine specimen for initial (pre-employment) test and a clear status before starting work for any Contractor Participant. These approved collection sites will have collection kits, Custody and Control Forms, and all other necessary supplies. RANDOMTESTING After the individual's completion of the initial drug test (with a negative result), he/she will be placed in the BCRC Random Pool after which he/she will be notified via U.S. mail to report to an approved collection site for a random drug test. The individuals chosen for a random drug test will be selected anonymously, from a computerized selection program. Fifty percent (50%) of the currently active BCRC individual cardholders will be selected annually for random testing. Then, on a monthly basis, one -twelfth (1/12) of the selected Employees will be notified to submit to a random test in order to update their BCRC identification cards and status. 27 Employees will be required to report to an approved collection site within seven (7) calendar days from the date of the Notice for Random Testing letter in order to maintain their BCRC identification card and status. No Employee will be required to submit to a random test more than twice (2) in a twelve (12) month period, unless chosen for an On -Site Random test. An Employee can be selected for an On -Site Random test every calendar month. All Employees will be selected for random testing at least once every two (2) years. If an Employee does not provide a sample at an approved collection site within seven (7) calendar days of BCRC issuing the notification of a random selection, his/her status in the BCRC Substance Abuse Program will be deemed "Not Available." Employees who fail to report for a random test in the required time forfeit their stipend and should contact the BCRC office. If an Employee does not report for a random test, and it is the first (1st) time the Employee has failed to report, the TPA (BCRC) may allow the Employee to take the test without reporting to the EAP for further review. Employees may choose to take a "First Occurrence Clause" at this time. Employees may utilize this clause only one (1) time. However, once this "First Occurrence Clause" has been utilized, an Employee who fails to report for a random test at any time in the future will be required to contact the EAP for evaluation and to receive instructions on the required procedure(s) for removing the "Not Available" status from his/her card. VACATION STATUS Subject to the requirements and exceptions set forth in this BCRC Policy, an Employee who has a "clear" status and is not subject to taking an Observed RTD Test or Observed Follow -Up Testing can call or e-mail the BCRC office to inform BCRC that the Employee will be traveling for vacation or a non -work related absence. Upon receipt of such notification, BCRC will switch the Employee to Vacation Status, which will make the Employee "Not Available." If the Employee is placed on Vacation Status, it is the Employee's responsibility to call BCRC upon returning so that the Employee's status can be updated. The Employee will return to the BCRC 910 random pool and be given a "clear" status if all of the following are true; (1) the Employee was tested under the BCRC Policy within the past 12 months, (2) the Employee's most recent test under the BCRC Policy resulted in the Employee being given a "clear" status and (3) the Employee has not been out of the BCRC random pool for more than 30 days. If any one (1) of the aforementioned criteria are not satisfied, the Employee will be required to take an immediate Reinstatement Test, the result of which will determine his/her status with the BCRC and potentially subject him/her to the protocol outlined herein for a non-compliant event. The BCRC can deny the use of Vacation Status to any Employee, if the BCRC determines, in its sole discretion, that the Employee has abused, or the granting of a requested Vacation Status will result in the abuse of, the Vacation Status provisions of this BCRC Policy. Examples of such abuse, include, but are not limited to, an Employee providing false information to BCRC concerning the Employee's request for Vacation Status, requesting or obtaining Vacation Status for any period of time when the Employee performs work in the geographic area covered by BCRC, failing to timely notify BCRC to terminate the Vacation Status when the reason for the Vacation Status (i.e., vacation, a non -work related absence) ends, requesting Vacation Status for the purpose of avoiding any testing under the BCRC Policy, and similar matters. If an Employee goes on vacation or takes a leave of absence for a non -work related issue despite being denied access to the Vacation Status option, he/she can notify BCRC before he/she goes on vacation or a non work related absence that he/she will be on vacation or a non work related absence during a specified period of time at a specified location. If BCRC receives such notification before the Employee goes on vacation or a non work related absence and the Employee is selected for a test, BCRC will call the Employee to schedule him/her to test at a collection site near his/her location. If the Employee does not report to test or fails to report as scheduled, it will be considered a Non -Compliant Event and will subject the Employee to the applicable provisions of this BCRC Policy. Under such provisions, the Employee will be given a "Not Available" status and will be referred to the EAP. 29 If an Employee gives proper and timely notice to BCRC and the Employee is at a remote location where BCRC cannot schedule the Employee for testing, BCRC will verify with the local participating Union and Contractor Participant that the Employee is out of the area.'Ihe Employee will then be put on Vacation Status until he/she returns and he/she will be subject to an immediate Observed BCRC Test when reporting back to work in BCRC's geographic area. Said test will be in addition to any Observed Follow -Up Test already assigned by the EAP Counselor. OWNER REQUESTED ON-SITE RANDOM TESTING An Owner may request that an "On -Site Random Selection" be done at their facility. An Owner's request must be approved by the BCRC Board of Directors and an addendum must be executed by both parties before the Owner is eligible to do such testing. Each Contractor Participant or Owner will submit a list of Employees working on-site that day or has access to the Owners' facility to the BCRC "Safe Site". The BCRC will then generate a random selection of the submitted pool and return the selections to the appropriate party. This random may be done on a monthly basis. These On -Site Random Selections shall include only those Employees submitted. Any confirmed Non -Negative Test at these facilities will require an EAP evaluation prior to returning to work. The testing will be consistent with the Addendum contained herein as Attachment E Any Post-Accident/Incident Testing and Probable Cause Testing of an Employee must be ordered by the immediate Employer of such Employee at the time of the accident, incident and/or event upon which such testing is based. Under this BCRC Policy, the Owner and/or any security service personnel cannot order Post-Accident/Incident Testing and/or Probable Cause Testing of an Employee who is employed by a Contractor Participant or is not their direct employee. Any requests for such testing by the Owner and/or any security service personnel must be directed to the immediate Employer of such Employee at the time of the accident, incident and/or event upon which the requested testing is based. 30 PROBABLE CAUSE TESTING An Employee may be subject to Probable Cause Testing based on a reasonable suspicion to believe that the Employee has violated the BCRC Policy regarding drug and/or alcohol use that is formed by specific, contemporaneous, articulable observations concerning the appearance, behavior, speech or body odors of the Employee. Such reasonable suspicion shall be determined by the Contractor Participant Representative(s) who made the observations (e.g., an immediate supervisor, other company official of the Contractor Participant, etc.), and should be confirmed by one other supervisor whenever possible. At least one of the Contractor Participant Representatives who made the observations shall document, in writing, the incident and the probable cause basis for such testing. The documentation shall: (1) specifically detail the appearance, behavior, speech and body odors of the Employee, (2) state the location, date, time of observation, conversations, witnesses (if any), and (3) be signed by at least one of the Contractor Participant Representatives who made the observations, witnessed the incident and prepared the documentation. Such Employees may request that a Union Representative be available or present prior to any action taken by a Contractor Participant, if any, at any stage of the policy and its administration. There is no stipend for these tests. By referring an Employee for Probable Cause Testing, the Contractor Participant represents to BCRC that the Contractor Participant has complied with these policies and procedures and any other policies and procedures required by law. BCRC has no obligation to determine or confirm that the Contractor Participant has complied with such policies and procedures. In the instances of Probable Cause Testing, it is recommended, but not required, that two (2) Contractor Participants shall transport the Employee to the testing facility. The Contractor Participant must complete the BCRC Drug and Alcohol Testing Notification Form. The form must be sent to the BCRC Office via email to info@bcrcnet.com or facsimile to 219-764-9510. A copy of the notification form can be found as Attachment G at the back of this booklet. The form must be received prior to the release of any testing information. 31 POST -ACCIDENT / INCIDENTTESTING A Contractor Participant may require an Employee to submit to Post-Accident/Incident Testing after the Employee's involvement in or cause of an accident/incident that causes injury to the Employee or another person.'Ihe Contractor Participant may also require an Employee to submit to Post-Accident/Incident Testing when the Employee is involved in or causes an accident and/or incident which results in damage or destruction to property. Post-Accident/Incident Testing must be both a Breath Alcohol Test (BAT) and a Urine Drug Screen (UDS) and must be completed within two (2) hours of the recorded accident/incident if a BCRC testing facility is located on the job site or within four (4) hours of the recorded accident/incident if an Employee is required to go off the job site to a BCRC testing facility. Any Employee suspected of unnecessarily delaying the testing process will be considered to have refused to submit to testing. If an Employee leaves the jobsite prior to submitting to Post-Accident/Incident Testing requested by the Contractor Participant, then the Employee will be considered to have refused to submit to testing; provided, however, this provision shall not apply if the Employee leaves the jobsite for the purpose of obtaining emergency medical treatment for the Employee or with the express authorization of the Contractor Participant and the Employee submits to such Post-Accident/Incident Testing as soon as reasonably possible under the circumstances. In instances of Post-Accident/Incident Testing the Contractor Participant shall transport the Employee to the testing facility. It is recommended, but not required, that two (2) persons, each of whom is either a Contractor Participant Representative or a Union Representative, should accompany the Employee to the testing facility. At the option of the Contractor Participant, the Employee may be suspended pending the test result. In the event a negative test result is reported, the Employee shall be compensated for all lost time at the appropriate rate within the Collective Bargaining Agreement, straight or premium pay. 32 When an Employee is injured in an accident and/or incident, priority must be given to the Employee's medical treatment before any consideration is given to collecting a specimen for drug and alcohol testing. Such Employees may request that a Union Representative be available or present prior to any action taken by an Employer, if any, at any stage of the policy and its administration. If an Employee is aggrieved by any action taken under this BCRC Policy and his/her complaint cannot be resolved, the complaint may, if the Employee or Union requests, be referred as a 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 BCRC Policy. There is no stipend for these tests. The following provisions apply to any Post-Accident/Incident Testing of a Reporting Employee (i.e., an Employee who reports the accident or incident), and shall limit and take precedence over any other provisions of this BCRC Policy relating to Post-Accident/Incident Testing. A Contractor Participant shall not refer a Reporting Employee for Post-Accident/Incident Testing unless the Employer has a reasonable basis for believing that drug or alcohol use by the Reporting Employee could have contributed to the injury or illness. The Contractor Participant shall consider the following factors in determining whether or not the Contractor Participant has a reasonable basis for believing that drug or alcohol use by the Reporting Employee could have contributed to the injury or illness: (1) Whether drug or alcohol use could have contributed to the injury or illness; (2) Whether the Employer is also requesting that other employees involved in the accident/incident be tested; (3) Whether the Employer has a heightened interest in determining if drug and/or alcohol use could have contributed to the injury or illness due to the hazardousness of the work being performed when the injury or illness occurred; and (4) All other relevant factors. 33 By referring an Employee for Post-Accident/Incident Testing, the Contractor Participant represents to BCRC that the Contractor Participant has complied with these policies and procedures and any other policies and procedures required by law. BCRC has no obligation to determine or confirm that the Contractor Participant has complied with such policies and procedures. The Contractor Participant must complete the BCRC Drug and Alcohol Testing Notification Form. The form must be sent to the BCRC Office via email to info@bcrenet.com or facsimile to 219-764-9510. A copy of the notification form can be found as Attachment G at the back of this booklet. The form must be received prior to the release of any testing information. RAPID TEST PROHIBITED A Rapid Test/Point of Collection Test shall not be used for any drug and alcohol testing performed for the BCRC Policy. "EMERGENCY" WORKASSIGNMENTS To accommodate Owners with emergency work, craft personnel who have not previously held a BCRC identification card or taken an initial drug test, the following provisions will apply when starting for emergency work assignments: Upon arrival at a job location for sign-up, the Designated Employer Representative or Card Manager shall request the Employee to present his/her BCRC identification card. 2. An individual who does not have a BCRC card at the time of hire will be requested to secure a card and submit to an initial drug test within one (1) day, in order to comply with the BCRC Policy. 3. An Employee without a BCRC identification card may work one (1) day. On the second (2nd) day, a Custody & Control Form (as proof of having submitted to a drug test) or a BCRC card must be presented. 34 4. An Employee who has provided a specimen for testing must bring to the job site his/her copy of the Custody & Control Form, given to him/her by the collection site, as proof that he/she has submitted to an initial test. 5. If the work assignments are consecutive, the Employee will be allowed to work for up to a maximum of four (4) days in order for the Employee to receive his/her BCRC identification card and have the Employers' Card Manager verify the Employee's status as "clear". 6. If the Employee's work assignment is terminated by his/her Contractor Participant before the Employee's status is verified within the allowable four (4) days for verification, and the individual is rehired, the Employee will have to provide the same Contractor Participant a BCRC identification card at the second (2nd) rehiring sign up, and a "clear" status. Except in the event that the rehire is less than four (4) days from the initial hire date. The Employee, the Local and the Home Local Union, shall accept and understand that should his/ her initial drug test results be reported as positive, said Employee shall be obligated to pay all costs for any Observed RTD Test, any Dilute Retest Under Observation, all Observed Follow -Up Testing required by the EAP and any subsequent testing required by the EAP. All tests described herein shall be administered pursuant to the observed collection protocol and procedures. After the BCRC has scheduled the observed test, the obligation to inform the collection site of the requirement for an observed test shall lie solely with the Employee. Furthermore, the Employee whose initial drug or alcohol test is confirmed as a Positive Test will be subject to disciplinary action up to, and including, termination without obligation for further compensation by the Contractor Participant. Such termination shall also be subject to the individual's rights under his/her Collective Bargaining Agreement. 35 CARD SYSTEM Employees will be required to give their BCRC Identification Card Number to their Contractor Participant's Card Manager in order for the Card Manager to access the e-mail confirmation system. Inquiries to the status confirmation system will provide the date of the Employee's last test and one (1) of the following BCRC status indicators: • N/A meaning "Not Available" • CL meaning "Clear" Employees can also access their own status and update contact information through the membership portal under the "Member Utilities" tab on the www.bcrcnet.com homepage. STATUS CONFIRMATION A Contractor Participant may verify the status of all BCRC Employees who are current Employees of the Contractor Participant (or persons offered immediate employment by the Contractor Participant subject to BCRC employment eligibility verification). This includes any former Employees who have been recalled for immediate re-employment by the Contractor Participant and any persons who were referred to the Contractor Participant by a Participating Union for immediate employment, subject to BCRC employment eligibility verification. However, a Contractor Participant is not permitted to access any information from the BCRC database for any individual who is not a current Employee of the Contractor Participant or a person offered immediate employment by the Contractor Participant subject to BCRC employment eligibility verification. The Contractor Participant is required to obtain appropriate written consent from its Employees to access any information about such Employees from the BCRC database and is required to comply with all provisions of this BCRC Policy regarding access to such information. Such access can be obtained by having C their card status verified on their job site in order to determine if the Employee is available or not available under the BCRC program.The Contractor Participant may also use the e-mail procedures for verification. A Contractor Participant who accesses any information from the BCRC database concerning an individual who is not a current Employee of the Contractor Participant or a person offered immediate employment by the Contractor Participant subject to BCRC employment eligibility verification, violates the BCRC Policy and is subject to appropriate sanctions for such unauthorized use of the BCRC database. Such sanctions may include terminating, or at least limiting, the access of such Contractor Participants to information in the BCRC database. When an Employee's status is Not Available (N/A), he/she will be advised to contact the BCRC office to resolve the N/A status. The Employee may be required to follow the protocol for a non-compliant event as prescribed in the BCRC Policy. The Contractor Participant may verify the Employee's card after four (4) days to reconfirm the status. If the Employee's status is still N/A, the Contractor Participant may terminate the Employee. Said Employee will be referred to the Employee Assistance Program (EAP) for assessment. Said employee will be required to follow the recommendations of the EAP Counselor before being considered for further assignments. This procedure will protect the Employee's confidentiality and allow the Contractor Participant to audit the status of his/her Employees, which may be required by the Owner to be submitted monthly. REPORTING OFTEST RESULTS For all D.O.T. testing, all test results shall be reported to the Contractor Participant and to any other persons and/or entities required by applicable law and/or regulations. For all On -Site Random Testing performed pursuant to a BCRC On -Site Substance 37 Abuse Testing Addendum or other testing agreements with owners, BCRC shall report test results in accordance with the provisions of such Addenda and/or Agreements. For all Post -Accident/ Incident Testing and all Probable Cause Testing, BCRC has the right to provide all test results to the Contractor Participant that requested such testing. The Contractor Participant must complete the BCRC Drug and Alcohol Testing Notification Form. The form must be sent to the BCRC Office via email to info@bcrcnet.com or facsimile to 219-764-9510. A copy of the notification form can be found as Attachment G at the back of this booklet.'The form must be received prior to the release of any testing information. INSUFFICIENT SPECIMEN An Employee who provides an insufficient specimen of urine or breath when required to do so shall be referred to an appropriate medical professional for evaluation at the Participant's expense. If the medical evaluation fails to reveal an acceptable medical explanation for the inability to provide a specimen, the donor shall be considered to have refused to test and shall be subject to the rules as outlined in this policy. If a legitimate medical reason is revealed, the Employee will be subject to hair follicle testing pursuant to this BCRC Policy. DILUTE SPECIMEN Any Employee providing a Negative Dilute Specimen will be required to return to a collection site within forty-eight (48) hours to provide a second (2nd) specimen, on his/her own time. This second specimen shall be given pursuant to observed collection protocol and procedures, unless prohibited by applicable law. After the BCRC has scheduled the observed test, the obligation to inform the collection site of the requirement for an observed test shall lie solely with the Employee. Employees should refrain from excessive consumption of fluids prior to the retest. No adverse action shall be taken against any 0 Employee based on a first (1St) Dilute Specimen, unless the first (1St) Dilute Specimen is confirmed to be a Positive Test or the Employee fails to provide the second (2nd) specimen in compliance with the applicable time period and procedures set forth herein. If the Employee timely provides the second (2nd) specimen in compliance with the applicable time period and procedures set forth herein, then the second test (and not the first test) shall be treated as the test result of record. A second (2nd) Negative Dilute Specimen will be treated as a refusal to submit to testing and a Non -Compliant Event, unless: (a) a Medical Professional determines that there is a valid medical reason for the second (2nd) Negative Dilute Specimen, or (b) such treatment is prohibited by applicable law. If the first (1St) Dilute Specimen is confirmed to be a Positive Test, then the first (1St) test shall be treated as a Positive Test and no retest shall be performed. If the second (2nd) Dilute Specimen is confirmed to be a Positive Test, then the second (2nd) test shall be treated as a Positive Test, regardless of the results of the first (11t) Dilute Specimen. ADULTERATED SUBSTITUTED AND/OR OUT -OF -TEMPERATURE SPECIMEN When a urine specimen is reported as an Adulterated Specimen, a Substituted Specimen, an Out -of -Temperature Specimen (meaning the specimen is below 90°F or above 100°F at the time the specimen is obtained at the collection site) or the Employee compromises the testing protocol (i.e., washes his/her hands, flushes the toilet, etc.) prior to being given direction from the collection professional, the Employee will be considered to have not cooperated with the testing process, the test will be considered a refusal to be tested, and the specimen/test will be treated as a Non -Compliant Event, unless such treatment is prohibited by applicable law. In all such cases, the Employee shall be referred to the TPA (BCRC) and he/she will be directed to contact the program's Employee Assistance Program (EAP) for consultation, c further review and evaluation. However, these procedures shall not prohibit the specimen collector from immediately conducting a new collection using direct observation procedures in those cases where required by law. In those cases where the MRO is unable to determine whether a specimen is an Adulterated Specimen and/or a Substituted Specimen, the MRO directs a retest under direct observation because the creatinine concentration of the specimen was not consistent with medical expectations for human urine. The Employee shall be required to submit to immediate recollection pursuant to observed collection protocol and procedures without any prior notification to the Employee. After the BCRC has scheduled the observed test, the obligation to inform the collection site of the requirement for an observed test shall lie solely with the Employee. In addition, the Employee who has refused to be tested, or who uses or possesses a counterfeit drug card, shall be subject to Employer discipline up to and including discharge, subject to t he grievance procedures set forth in the applicable Union's Collective Bargaining Agreements. CONSEQUENCES FORA NON -NEGATIVE OR POSITIVETEST 1. An Employee who tests Non -Negative or Positive for drugs shall be contacted directly by the Medical Review Officer (MRO). If the MRO verifies the results of the Non -Negative or Positive Test, the MRO will notify the Employee that he or she is ineligible for work and he/she will be directed to contact the TPA (BCRC). The BCRC will refer the Employee to the program's Employee Assistance Program (EAP) for consultation and review. If the MRO contacts the Employee and finds that there is a reason for the Non -Negative or Positive Test (i.e., an authorized prescription medication) .E the MRO will downgrade the result to a negative, and the Employee's card will be marked "CU. 2. In the case of a confirmed Non -Negative or Positive drug or alcohol test, the TPA (B CRC) will be notified that the Employee's status should be marked "N/A'. The "N/A'status will be effective at the moment that a confirmed Non -Negative or Positive Test is received. 3. Before returning to work, an Employee must: • (1) Complete an evaluation with the program's Employee Assistance Program provided by the BCRC EAP Provider; (2) Follow a treatment plan prescribed by the program's EAP; • (3) Obtain written documentation from the program's EAP verifying an Observed Return To Duty Test date; and • (4) Obtain a negative result on an Observed Return To Duty Test. The specimen for all Return To Duty Tests shall be given pursuant to observed collection protocol and procedures. After the BCRC has scheduled the observed test, the obligation to inform the collection site of the requirement for an observed test shall lie solely with the Employee. 4. An "N/A" status will not be the sole basis for termination of employment. An Employee must contact the BCRC office to resolve an "N/A" status. Only Employees who are in non-compliance with this BCRC Policy may be discharged. For the purposes of this provision, "non-compliance" shall mean one or more of the following: • Failure to report to the program's Employee Assistance Program as directed, • Failure to follow and/or complete an EAP -prescribed treatment program, • Failure to take an Observed Return To Duty Test or 41 any Observed Follow -Up Testing or any Observed Retests for a Diluted Specimen, • Failure to report for a random test request within seven (7) days, or • Failure to submit to a drug or alcohol test when requested to do so by the EAP. 5. If a New Employee/Applicant/Traveler has an initial drug or alcohol test that is confirmed as a Positive Test, BCRC shall notify the applicable Local Union or Contractor Participant of the test results and the applicable Local Union or Contractor Participant shall advise BCRC as to the Local Union's or Contractor Participant's intent and decision regarding such New Employee/Applicant/Traveler. If the Local Union or Contractor Participant decides to keep such New Employee/Applicant/Traveler, the New Employee/ Applicant/Traveler shall pay all costs for: • Any Observed Return To Duty Test(s), • Any Observed Follow -Up Testing required by the EAP, • Any subsequent testing required to be in compliance with the BCRC Policy. • Any costs associated with the Observed Return To Duty or the Observed Follow -Up tests including a retest for dilute will be the obligation of the employee. ADDITIONAL CONSEQUENCES FOR MULTIPLE NON-COMPLIANT EVENTS If any Employee has three (3) or more Non -Compliant Events within a twelve (12) consecutive month (rolling) period, the Employee shall not be permitted to take a Return To Duty Test until one (1) year after the most recent Non -Compliant Event within such twelve (12) consecutive month period and the Employee's BCRC Substance Abuse Card and status shall be N/A for the same time period. This policy and these procedures W are referred to in this BCRC Policy as the "3 Strike Rule." In addition, such Employee must complete an EAP -prescribed treatment program before returning to work. BCRC also performs On -Site Random Testing pursuant to the BCRC On -Site Substance Abuse Testing Addendum. The policies set forth in such Addendum (and/or other testing agreements with Owners) also impose additional consequences for Positive Tests and/or other Non -Compliant Events. Such additional consequences generally apply at the specific plants and locations covered by such Addenda (and/or other testing agreements with owners) and are in addition to any additional consequences set forth in this BCRC Policy. After an Employee has been N/A for the one (1) year time period pursuant to the 3 Strike Rule, the Employee can request a change in status under the BCRC Policy. If such a request is made by the Employee, the following shall apply: • The Employee shall report to the EAP and comply with all requirements of the EAP. At the direction of the EAP, the Employee shall submit to an Observed RTD Test at the Employee's expense, which test shall be taken within the time periods and requirements established by the EAP. After the BCRC has scheduled the observed test, the obligation to inform the collection site of the requirement for an observed test shall lie solely with the Employee. • If the Observed RTD Test is negative, BCRC will pay for any Observed Follow -Up Testing, unless and until the Employee has a subsequent confirmed Non -Compliant Event. Any subsequent confirmed Non -Compliant Event following the negative Observed RTD Test shall constitute a "strike" for purposes of the 3 Strike Rule, shall require the Employee (and not BCRC) to 43 pay for all subsequent Observed Follow -Up Testing and any Observed RTD Test(s), and shall require the Employee to return to the EAP for further evaluation and treatment. • If the Observed RTD Test is a confirmed Non -Negative Test, Positive Test, or Diluted Retest, it shall be a Non -Compliant Event, it shall constitute a "strike" for purposes of the 3 Strike Rule, it shall require the Employee to pay for all subsequent Observed Follow -Up Testing and any Observed RTD Test(s) in addition to the cost of the initial Observed RTD Test and shall require the Employee to return to the EAP for further evaluation and treatment. These policies and procedures apply each time that an Employee has been N/A for the one (1) year time period pursuant to the 3 Strike Rule and thereafter, requests a change in status under the BCRC Policy Therefore, if an Employee has a second one (1) year suspension pursuant to the 3 Strike Rule and thereafter requests a change in status under the BCRC Policy, BCRC will pay for any Observed Follow -Up Testing if the Observed RTD Test is negative, unless and until the Employee has a subsequent confirmed Non -Negative or Positive Test or other Non -Compliant Event. In such case, the Employee shall pay all costs for: • Any Observed Return To Duty Test(s), • Any Dilute Retest Under Observation, • Any Observed Follow -Up Testing required by the EAP, • Any subsequent testing required by the EAP. OBSERVED RETURN TO DUTY TESTING Observed Return To Duty test is required for an Employee to be reinstated into the BCRC program following any Non -Compliant Event (e.g., missed random, walkout, refusal to submit, etc.) as described in the Definitions of this BCRC Policy. The Participant must have a negative drug test before resuming performance of his/her job duties. Ibis test may not be taken until the Employee Assistance Program Counselor has set a date for the test. The specimen for all Return To Duty Tests shall be given pursuant to observed collection protocol and procedures. After the BCRC has scheduled the observed test, the obligation to inform the collection site of the requirement for an observed test shall lie solely with the Employee. OBSERVED FOLLOW-UP TESTING Observed Follow -Up Testing for drugs and/or alcohol is a requirement in order for a returning Employee to stay in compliance with the BCRC Program. Testing shall be determined by the Employee Assistance Program Counselor, and will be implemented and monitored by the TPA (BCRC) when the Employee returns to work. Observed Follow -Up Tests must be taken within forty-eight (48) hours from the time when the TPA (BCRC) attempts to contact or contacts the Employee, or the Employee will be considered non-compliant, made "N/A", and referred back to the EAP for further evaluation. A New Employee/Applicant/Traveler whose initial drug or alcohol test is confirmed as a Positive Test shall pay all costs for such Follow -Up Testing required by the EAP and any subsequent testing required by the EAP. 'Ihe specimen for all Follow -Up Testing shall be given pursuant to observed collection protocol and procedures. After the BCRC has scheduled the observed test, the obligation to inform the collection site of the requirement for an observed test shall lie solely with the Employee. M DISPUTED POSITIVE RESULTS An Employee who disputes the results of a Positive Test or a Non -Negative Test for drugs shall have the right to have his/her initial sample independently re -tested by a Department of Health and Human Services (HHS) certified laboratory of his/her choice, at his/her own expense, but such re -testing will only be performed if BCRC receives a cashiers check, money order, travelers check, or cash for such re -testing within ten (10) business days after the Employee was notified of the test results that the Employee elects to dispute. If the Employee timely requests and pays for the retesting, a portion of the initial sample (or split specimen) shall be forwarded under a Custody and Control Form directly by BCRC's testing laboratory to the HHS laboratory selected by the Employee. Review of the drug test result must be performed by a qualified MRO who has been approved by BCRC. If the second lab report shows the presence of a drug or drug metabolite equal to or greater than the cutoff concentrations, the test result will be considered Positive. If the second lab report test indicates no presence of a drug or drug metabolite equal to or greater than the cutoff concentration, then both tests will be considered negative. The following section only applies when the Employee tests due to Post-Accident/Incident Testing or Probable Cause Testing: If the test is negative, the affiliated Employer will reimburse the Employee for compensation lost at the appropriate rate within the Collective Bargaining Agreement, straight or premium pay, during the period of his/her disciplinary suspension or termination and will reimburse the Employee for the cost of the re -test. An Employee, whose test results are verified Positive by the MRO, will be referred to the EAP by the TPA (BCRC). The Employee is expected to attend all appointments with the EAP Counselor, and to follow the EAP Counselor's recommendations and requirements. A Positive alcohol test conducted on a breath sample cannot be re -tested. All problem situations shall be resolved in accordance with current guidelines and standards established by the U.S. HHS/SAMHSA or U.S. Department of Transportation. M APPEALS AND PROTECTIONSJUST CAUSE Employees who are subject to this BCRC Policy continue to have access to the usual protections provided as a part of their Union membership and/or as members of bargaining units covered by Collective Bargaining Agreements. Such Employees may request that a Union Representative be available or present prior to any action taken by an Employer, if any, at any stage of the policy and its administration. If an Employee is aggrieved by any action taken under this BCRC Policy and his/her complaint cannot be resolved, the complaint may, if the Employee or Union requests, be referred as a 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 provisions of this BCRC Policy. Any Employee, Contractor Participant, or Union shall have the right to have any decision, action, or other matter relating to the implementation of this BCRC Policy reviewed by the Board of Directors of BCRC (or a committee appointed by said Board) (hereinafter "Review Board") in accordance with the following procedures. Within thirty (30) calendar days of the decision, action, or other matter for which such review is requested, any Employee, Contractor Participant, or Union may submit a written request for review to the Executive Director of BCRC. The written request shall describe: (1) the decision, action, or other matter to be reviewed, (2) the reason for the requested review, and (3) the requested relief. The thirty (30) calendar day time period shall begin to run on the date of the occurrence of the decision, action, or other matter for which such review is requested, or if the decision, action, or other matter is continuing in nature, then the thirty (30) day time period shall begin to run on the first day of the decision, action, or other matter. If the thirtieth day is on a weekend or holiday, then the time period for requesting review shall be extended to the immediately following business day. 47 Upon receipt of a timely and proper written request for review, the Review Board shall perform the requested review. In performing the requested review, the Review Board (or any member or designated representative thereof) may, but is not required to, request additional information, obtain additional information, conduct interviews, hold hearings, and utilize any other procedures and/or methods that the Review Board deems appropriate. Any decisions of the Review Board shall be made by a majority vote of the members of the Review Board. Upon making any decision, the Review Board shall provide a written notice of such decision to the Employee, Contractor Participant, or Union that requested the review. Such written notice shall contain a description of the decision. The written notice may also contain a statement and/or summary of the reasons for the decision, but such a statement or summary is not required. Any decisions of the Review Board that relate to the interpretation and/or implementation of the BCRC Policy shall be final and binding and not subject to further review. However, any decisions of the Review Board that relate to compliance with federal, state, or local statutes, ordinances, and other laws may be submitted to binding arbitration pursuant to the Labor Arbitration Rules and Procedures of the American Arbitration Association (hereinafter "AAA"). Any such submission must be initiated within thirty (30) calendar days after the decision of the Review Board by filing a Demand for Arbitration with the AAA, paying the appropriate filing fees to the AAA, serving a copy of the Demand for Arbitration upon the Executive Director of the BCRC, and serving a copy of the Demand for Arbitration upon any other interested parties who were named in and/or who directly participated in the review conducted by the Review Board. If the thirtieth day is on a weekend or holiday, then the time period for requesting review shall be extended to the immediately following business day. In any such arbitration, the arbitrator (i.e., neutral) shall be bound substantively by the provisions of this BCRC Policy. All of the fees and expenses of the AAA and the arbitrator shall be paid by W •V the party filing the Demand for Arbitration, unless the arbitrator makes a different allocation in his/her award. Each party to the arbitration shall pay their own attorney fees and attorney expenses relating to the arbitration, and the arbitrator shall not have any authority: (1) to make any award for attorney fees and attorney expenses, or (2) to require any party to reimburse another party for attorney fees and attorney expenses. ILLINOIS — "DRUG FREE WORKPLACE ACT" - 30 ILCS 580 When working on public projects in the State of Illinois, Employers must comply with the Illinois Drug Free Workplace Act. This Act requires Employers to certify that it provides a drug free workplace by complying with certain steps. First, the Employer must publish a statement to its Employees notifying them that as a condition of employment, drug possession, use, etc. is prohibited at work and specify the actions taken if this is violated. Second, Employers must provide each Employee working in Illinois a copy of this published statement. Third, Illinois requires Employers to provide a drug free awareness program to inform Employees about drug abuse, the Employer's drug free policy, the availability of drug assistance programs, and penalties for drug violations. If the Employer receives notice of an Employee's criminal drug conviction, the Employer must notify the Illinois agency in the contract within ten (10) days. Finally, if an Employee violates the drug free policy, an Employer has thirty (30) days to take action against the Employee, up to and including termination or requires the Employee to satisfactorily participate in an approved drug abuse assistance program. If the Employer fails to follow the Drug Free Workplace Act provisions, the Illinois agency in the contract may suspend or terminate the contract. If the violation is serious, the Illinois agency may recommend debarment, which makes the Employer ineligible to be awarded any contract or grant by the State of Illinois for one to five (1-5) years. Me] For further reference, the Drug Free Workplace Act may be found at 30 ILCS 580; http.//www.ilga.govl7egislation/ilcs/ilcs3. asp?,4ctID=551 &Chapter1D=7. ILLINOIS—"SUBSTANCE ABUSE PREVENTION ON PUBLIC WORKS PROJECTS ACTS" - 820 ILCS 265 Employers who work on public works projects in Illinois must have a written substance abuse prevention program that meets or exceeds the following requirements: (1) at least a 9 panel urine drug test plus a test for alcohol (NOTE: blood testing may only be used in post -accident tests); (2) a list of prohibited actions and conditions listed below; (3) Employees must submit to pre -hire, random, reasonable suspicion, and post -accident drug and alcohol testing before the project begins, but not required for an Employee who has been participating in a random testing program during the 90 days preceding the date on which the Employee commenced work on the project; and (4) a procedure for notifying the Employee of any violations or refusal to submit to a drug test. The prohibited Employee actions include using, possessing, distributing, delivering, or being under the influence of a drug and/or alcohol while performing work on a public works project. Any Employee with a Blood Alcohol Content at or above 0.02 is considered to be under the influence. This written program must be filed with the Illinois agency and made publicly available. Any Employee who violates the drug policy, tests positive for drugs, or refuses to submit to a drug test may not work on a public works project until the Employee satisfies the following conditions: (1) the Employee has tested negative for presence of drugs and is not under the influence of alcohol; (2) the Employee has been approved to return to work in accordance with the Employer's written substance abuse prevention program; and (3) 50 the testing for drugs and alcohol was conducted in accordance with laboratory testing and Chain of Custody procedures as required by the U.S. Department of Health and Human Services. Upon meeting these conditions, an Employee may return to work if work for which he or she is qualified exists. For further reference, the Substance Abuse Prevention Program Requirements maybe found at 820 ILCS 265/10, 820 ILCS 265/15, and 820 ILCS 265/20; available at http✓/www.ilga.gov/ legislation/i1cs/i1cs3.asp ?ActID=2950&ChapterID=68 ILLINOIS — "CANNABIS REGULATION AND TAX ACT" - 410 ILCS 705 Employers who have offices in Illinois and/or perform work in Illinois may be subject to the Illinois Cannabis Regulation and Tax Act, which went into effect on January 1, 2020. However, the Illinois Cannabis Regulation and Tax Act does not apply to any work performed in Indiana. The Illinois Cannabis Regulation and Tax Act also expressly permits employers from adopting reasonable drug-free workplace policies, which can prohibit the smoking, consumption, storage, or use of cannabis at the workplace or while on call. The BCRC Policy expressly prohibits use, possession, distribution, delivery, and being under the influence of a drug or alcohol while performing any work for the Employer. Such prohibitions apply to cannabis, all other drugs, and alcohol, and apply to all work subject to the BCRC Policy, including any such work in Illinois. The Illinois Cannabis Regulation and Tax Act does not affect this BCRC Policy. INDIANA— DRUGTESTING FOR PUBLIC WORKS - IND. CODE 4-13-18 Employers working on public works projects in Indiana must comply with Indiana statutes requiring mandatory drug testing that are set forth in Indiana Code 4-13-18. The BCRC Policy is 51 intended to comply with the requirements of such statutes. Many of the policies and procedures set forth in the BCRC Policy exceed the minimum requirements for drug testing set forth in such statutes. However, if any of the policies and procedures set forth in the BCRC Policy fail to meet the minimum requirements for drug testing set forth in such statutes, then the BCRC Policy shall be deemed to include the requirements for drug testing set forth in such statutes to the extent necessary to make the BCRC Policy comply with the minimum requirements for drug testing set forth in such statutes. 52 Attachment A — General Trades: BCRC LETTER HEAD Letter of Notice for Random Testing Dear You have been selected by BCRC's computer generated random selection to take a random drug test for BCRC. You must be tested no later than midnight (dav) of (Month) 20 .Our computer program selects the names of BCRC cardholders for a random each month. You can be selected up to twice in a twelve month period. In order to stay in compliance with BCRC and possess a clear (CL) BCRC card status you will be required to report to an approved collection site within seven (7) days from the date on this "Notice of Random Testing" letter (the date on this letter is included in the seven days). Please verify that the BCRC card number in the upper right hand corner of this notice matches your BCRC card number. If it does not match your BCRC card number, please notify our office immediately! This random test is to be taken on your own time at any of the BCRC approved collection sites identified on the enclosed collection site list. You will be mailed a $30.00 stipend for the time necessary to secure random testing oul if your test is taken within the allotted seven (7) days of this notice. NO EXCEPTIONS! Failure to take your test by the date outlined above will result in your BCRC card status being deemed "Not Available" (N/A) and will require that you contact the BCRC office for instructions on the required procedure(s) for correcting the "N/A" status. In the event you are taking prescribed medication(s), DO NOT take them to the collection site. You will be contacted by our Medical Review Office (MRO), who will need your prescription information for the verification process. Please provide a legible and accurate telephone number on all forms at the collection site. Remember, it is your responsibility to keep your contact information current with BCRC. You can do so through the "Members Utilities" secure portal on the BCRC website at www.bercnet.com or by calling the BCRC office at the numbers listed below. Questions, contact the BCRC office @ 219-764-9500 or toll free @ 877-988-5400. Thank you for your cooperation. Sincerely, Tish Roach Executive Director As a member of BCRC, you and your family have access to Perspectives, a fully independent, professional Employee Assistance Program (EAP). Perspectives twenty-four (24) hour, seven (7) days a week hotline number is (800) 456-6327. All calls to Perspectives are confidential. 53 Attachment B — Non -Bargaining: BCRC LETTER HEAD Letter of Notice for Random Testing Dear You have been selected by BCRC's computer generated random selection to take a random drug test for BCRC. You must be tested no later than midnieht (day) of (Month) 20 .Our computer program selects the names of BCRC cardholders for a random each month. You can be selected up to twice in a twelve month period. In order to stay in compliance with BCRC and possess a clear (CL) BCRC card status you will be required to report to an approved collection site within seven (7) days from the date on this "Notice of Random Testing" letter (the date on this letter is included in the seven days). Please verify that the BCRC card number in the upper right hand corner of this notice matches your BCRC card number. If it does not match your BCRC card number, please notify our office immediately! This random test is to be taken on your own time at any of the BCRC approved collection sites identified on the enclosed collection site list. Failure to take your test by the date outlined above will result in your BCRC card status being deemed "Not Available" (N/A) and will require that you contact the BCRC office for instructions on the required procedure(s) for correcting the "N/A'status. In the event you are taking prescribed medication(s), DO NOT take them to the collection site. You will be contacted by our Medical Review Office (MRO), who will need your prescription information for the verification process. Please provide a legible and accurate telephone number on all forms at the collection site. Remember, it is your responsibility to keep your contact information current with BCRC. You can do so through the "Members Utilities" secure portal on the BCRC website at www.bcrcnet.com or by calling the BCRC office at the numbers listed below. Questions, contact the BCRC office @ 219-764-9500 or toll free @ 877-988-5400. Thank you for your cooperation. Sincerely, Tish Roach Executive Director As a member of BCRC, you and your family have access to Perspectives, a fully independent, professional Employee Assistance Program (EAP). Perspectives twenty-four (24) hour, seven (7) days a week hotline number is (800) 456-6327. All calls to Perspectives are confidential. 54 Attachment C — Pipe Fitters — Local #597: BCRC LETTER HEAD Letter of Notice for Random Testing Dear You have been selected by BCRC's computer generated random selection to take a random drug test for BCRC. You must be tested no later than midnight (day) of (Month) 20 .Our computer program selects the names of BCRC cardholders for a random each month. You can be selected up to twice in a twelve month period. In order to stay in compliance with BCRC and possess a clear (CL) BCRC card status you will be required to report to an approved collection site within seven (7) days from the date on this "Notice of Random Testing" letter (the date on this letter is included in the seven days). Please verify that the BCRC card number in the upper right hand corner of this notice matches your BCRC card number. If it does not match your BCRC card number, please notify our office immediately! This random test can be taken on your own time/taken on your Employer/Contractor's time at any of the BCRC approved collection sites identified on the enclosed collection site list. Failure to take your test by the date outlined above will result in your BCRC card status being deemed "Not Available" (N/A) and will require that you contact the BCRC office for instructions on the required procedure(s) for correcting the "N/A' status. In the event you are taking prescribed medication(s), DO NOT take them to the collection site. You will be contacted by our Medical Review Office (MRO), who will need your prescription information for the verification process. Please provide a legible and accurate telephone number on all forms at the collection site. Remember, it is your responsibility to keep your contact information current with BCRC. You can do so through the "Members Utilities" secure portal on the BCRC website at www.bcrcnet.com or by calling the BCRC office at the numbers listed below. Questions, contact the BCRC office @ 219-764-9500 or toll free @ 877-988-5400. Thank you for your cooperation. Sincerely, Tish Roach Executive Director As a member of BCRC, you and your family have access to Perspectives, a fully independent, professional Employee Assistance Program (EAP). Perspectives twenty-four (24) hour, seven (7) days a week hotline number is (800) 456-6327. All calls to Perspectives are confidential. 55 Attachment D AUTHORIZATIONTO RELEASE AND DISCLOSE INFORMATION AND DOCUMENTS TO: BUILDING AND CONSTRUCTION RESOURCE CENTER, INC., BCRC ADMINISTRATORS, INC., AND THEIR OFFICERS, EMPLOYEES, AGENTS, AND INDEPENDENT CONTRACTORS 6050 Southport Road, Suite B Portage, Indiana 46368 I, hereby authorize the entities and individuals referred to above (hereinafter referred to collectively as `BCRC") to release and disclose the following information and documents in their possession and/or control, concerning me and/or any drug and/or alcohol testing of me: Drug and alcohol testing information and documents related thereto Test results for drug and alcohol testing Communications regarding drug and alcohol testing and test results Referrals and follow-up reviews (e.g., to EAP, MRO, etc.) Other (Must Specify): [NOTE: If you do not authorize the release and disclosure of any of the items listed above, then you need to draw a line through any of the items listed above that you are not authorizing. If you want to authorize the release and disclosure of any other items, please list such items on the line listed above that follows "Other (Must Specify).] to the following entities and individuals (hereinafter referred to collectively as the "Receiving Parties") and to communicate with the Receiving Parties concerning such information and documents: Terms and Conditions: 1. I understand and acknowledge that I am hereby authorizing BCRC to release and disclose information and documents, and to communicate with the Receiving Parties concerning such information and documents, even though such information, documents, and communications may be protected from disclosure by federal laws, state laws, and/or BCRC policies. 2. I also understand and acknowledge that I have read this Authorization to Release and Disclose Information and Documents (hereinafter "Authorization"), that I understand all of the provisions of this Authorization, and that I am signing this Authorization as my free and voluntary act. 3. I also understand and acknowledge that I have the right to revoke this Authorization at any time by providing a written notice of revocation to BCRC at the address listed above. Any such revocation shall not be effective until BCRC receives such written revocation and any such revocation shall not be effective as to any action taken by BCRC with respect to this Authorization prior to BCRC's receipt of such written revocation. 4. I also understand and acknowledge that BCRC has no obligations to exercise any control over the use by the Receiving Parties, including further disclosure by the Receiving Parties, of any information and/or documents that BCRC releases and/or discloses to the Receiving Parties pursuant to this Authorization. I hereby release and waive any claims that I may have against BCRC relating to the use by the Receiving Parties, including further disclosure by the Receiving Parties, of any information and/or documents that BCRC releases and/or discloses to the Receiving Parties pursuant to this Authorization. 5. I agree to defend, indemnify and hold harmless BCRC from any and all claims and liabilities relating and/or arising from BCRC's compliance with this Authorization. Signature: Name (Printed): Address of Signer: Date Signed: BCRC ID No.: Soc. Sec. No. Date of Birth: Driver's License No: 57 Attachment E . BCRC Application Form . BCRC Permission Form to Obtain BCRC Status . BCRC Testing Information and Instruction Sheet Striving to be Drug Free for a Safe Industry BCRC ADMINISTRATOR INC. BCRC MEMBER APPLICATION FORM PHONE: (219)764-9500 FAX: (219)764-9505 **PLEASE MAKE COPIES AS NEEDED** TRADE CODE BCRC NUMBER (OFFICE USE ONLY) (OFFICE USE ONLY) **** PLEASE PRINT CLEARLY BCRC IS NOT RESPONSIBLE FOR MISDIRECTED MAIL BECAUSE YOUR HANDWRITING IS NOT CLEAR*** LOCAL UNION: TRADE: COMPANY NAME: TODAY'S DATE: / / DATE OF BIRTH: / / SOCIALSECUREPY# DRIVER'S LICENSE 4: STATE OF ISSUE EMPLOYEE LAST NAME: FIRST NAME: ADDRESS: CITY: CELL PHONE: MIDDLE INITIAL: ATE: ALTERNATE PHONE:( ❑ CHECK THIS BOX TO RECEIVE TEXT / E-MAIL NOTIFICATION FOR BCRC RANDOMS. CELL PHONE PROVIDER: E-MAIL ADDRESS: (AT&T, Sprint, T -Mobile, Verizon, Etc.) IMPORTANT! BE SURE TO CHECK THE APPROPRIATE BOX (ES) BELOW. YOU NEED TO COMPLETE THIS FORM TO RECEIVE A BCRC CARD. 1-1 NEW APPLICANT ❑CONSTRUCTION WORKER ❑ TRADE TRANSFER ❑ TRAVELER ❑ D.O.T. ❑ NON -BARGAINING ***THIS FORM IS CONFIDENTIAL AND MUST BE HELD IN A SECURED LOCATION AT ALL TIMES*** Application Acknowledged by Applicable Local Union Approved By: Please Print 59 Please Sign Attachment E PERMISSION FORM TO OBTAIN BCRC DRUG STATUS BYBCRC ID NUMBER OR SOCIAL SECURITY NUMBER Before an employee's BCRC status can be released to an employer verbally by BCRC, the employee must first sign for the release of his/her status by the use of his/her BCRC I.D. Number or Social Security Number. Per BCRC Policy Revision January 1, 2020, Page 36, Card System &Status Confirmation Article: The card manager shall maintain the strictest confidentiality of the BCRC membership. The Employer is required to obtain appropriate written consent from its Employees to access any information about such Employees from the BCRC database, and is required to comply with all provisions of the BCRC Policy regarding access to such information. Such access can be obtained by having their card status verged on their job site in order to determine if the Employee is available or not available under the BCRC program. I , give my permission for the following company to obtain (please print your full name) the information of my availability status from BCRC by using my BCRC I.D. Number or my Social Security Number. Company Name: Company Card Manager Name: Card Manager Contact Phone Number: Site Location: Employee/Member Name: Employee/Member BCRC I.D. #: Driver's License #: State of Issue: Or Employee/Member Social Security Number: - Employee/Member Signature Date Please fax form back to BCRC at (219) 764-9505 "PHIS FORM IS CONFIDENTIAL AND MUST BE HELD INA SECURED LOCATION AT ALLTIMES' Attachment E BCRC APPLICANT/CARDHOLDER DRUG TEST INFORMATION AND INSTRUCTION SHEET BCRC is exercising extreme care to ensure that strict quality control measures are followed in the collection, handling, and analysis of your specimen. You play an important role in this process and should be certain that you have provided an unadulterated specimen to the laboratory. Remember, you are certifying that the specimen which you provide is yours and is unadulterated. Any adulteration or switching of specimen is a breach of BCRC's rules and, if you are employed, may subject you to discipline up to and including termination by your Employer. For your own protection and peace of mind, we ask that you: • Provide a picture identification to the collection site/technician at time of arrival; • Be escorted to a collection room and asked to provide an unadulterated specimen in the collection bottle provided. The bottle should be filled to 45 ml; • Return the specimen bottle to the medical technician and witness, initial and date the integrity seals placed on your specimen; • Verify the proper spelling of your name as recorded on the log sheet; • Verify that your social security number has been properly recorded; • Verify that the social security number placed on your specimen bottle is the same as that recorded on the log sheet and the Custody and Control Form. I HAVE READ THE ABOVE AND HAVE HAD AN OPPORTUNITY TOASK QUESTIONS REGARDINGTHIS PROCEDURE. BCRC Applicant/Cardholder Signature Date 61 Attachment F BCRC On -Site Substance Abuse Testing Addendum Effective 20- 1) BCRC will cover all outside Contractors, non -bargaining personnel, and/or safety personnel working at heavy industrial facilities, light industrial facilities, health care facilities, and/or any public or private entity in Northwest Indiana for the purpose of substance testing, tracking and administration under the terms of this Addendum to the BCRC Policy. Testing will include Random On -Site Testing, Post-Accident/Incident Testing, Probable Cause Testing and Follow -Up Testing when required. 2) BCRC will identify to the Employer's and/or Owner's Designated Employer Representative (DER) anyone that has a non -negative (positive) test result, including walkouts or refusals to test, at the facilities where this amendment is adopted. Said participant would be "Not Available" (N/A) for employment at that facility until the participant has contacted the EAP for evaluation and to receive instructions on how to resolve their "N/A'status. If the result of the participant's Return To Duty Test is negative and he/she is and continues to comply with all the Follow -Up Testing protocol as outlined in the BCRC Policy the participant will be allowed to return to work. BCRC will identify anyone that has two confirmed non -negative (positive) tests, to include walkouts or refusal to test, at this facility to the Employer's/Owner's DER. 3) The Employer/Owner will provide BCRC with a list or "pool" from which random selections will be drawn. This list will consist only of Participants physically on the Owner's site on the day the random selection is requested. BCRC will notify the Employers/Owners DER or Card Manager of the random testing selections. Upon notification the selected participant has one hour plus travel time to report to an approved BCRC testing facility. Notification will be given during the same shift for which the pool was submitted and a minimum of two hours prior to the end of the participant's shift plus swipe time. Although no stipend will be paid, the test will count as a random test in the normal BCRC Policy. 4) Employers and Owners will be assigned a code number for access to the BCRC e-mail system for verification of availability of participants in their facility and internal auditing requirements. 5) Employers/Owners who require tests to be current within a specified time frame will be obligated for the administration, implementation and cost of these tests since these tests are not consistent with the BCRC Policy. Example: Owner "A'requires that all Employyees have a drug screen within the last one hundred eighty days (180). Any Employee that must test to be in compliance can do so provided it is not a violation of the applicable Collective Bargaining Agreement. This test will not be at the expense of BCRC. Gary Kebert, President BCRC Kevin Roach, Secretary BCRC Representative Date 62 Attachment G Striving to be Drug Free for a Safe Industry BCRC ADMINISTRATOR INC. BCRC MEMBER APPLICATION FORM PHONE : (219)764-9500 FAX: (219)764-9505 **PLEASE MAKE COPIES AS NEEDED** DRUG/ALCOHOLTESTING NOTIFICATION 'Me following form is to be utilized when sending a Donor/Employee for Post-Accident/Incident Drug Test, Probable Cause Drug Test and Alcohol Test. The DER/Supervisor is to take the Donor/Employee along with this form and valid picture identification, and present the above items at the time of his/her arrival at the collection site. Company Company Telephone # Requested by DER/Name Location Accident Took Place: Donor/Employee Name: Driver's License # or BCRC# Date of Test: Time of Test: Test Reason: (lease check Date of Injury: Post-Accident/Incident Testing Probable Cause Testing Please Test for Both: (lease check Drug and Alcohol Email to info@bcrcnet.com or Fax directly to BCRC r+ (219) 764-9510 63 Board • Directors MANAGEMENT Gary Kebert, President NWI Contractors Association Matt LaFree Nat'l Electrical Contractors Assoc. Rick Stovall, Finance Committee NWI Contractors Association Adam Vidimos, Finance Committee Northern IN Sheet Metal Cont. Assoc. Dewey Pearman CAF (At Large) Kelly Keough Plumbing & Piping Cont. Assoc. Bob Hoover Bricklayers Association Margie Hofmann, Treasurer NWI Contractors Association Tom Jarka NWI Contractors Association Larry Macuga NWI Contractors Association Tony Bochniak Finishing Contractors Association Ted Vrehas NWI Contractors Association Pete Korellis Roofing Contractors Association Bill Hasse NWI Contractors Association Kurt Schmiegel NWI Contractors Association UNION Kevin Roach, Secretary Laborers' Local 41 Ryan Reithel IBEW Local Union 697 Dennis Hahney Pipe Fitters' Local 597 Ted Bilski Teamsters' Local 142 Randy Palmateer Northwest Indiana Building Trades Council (At Large) Sal Espino Plumbers' Local 210 Jeremy Rivas Bricklayers' Local 4 Mark McCleskey, Vice President Cement Finishers' Local 406 Ronald Ware, Jr. Ironworkers' Local 395 John Sorensen Operating Engineers' Local 150 Shawn Solner Painters' Local 460 Jeff Hamilton, Finance Committee Sheet Metal Workers' Local 20 Joe Pozzi Roofers' Local 26 Scott Cooley, Finance Committee INKY/OH Regional Council of Carpenters' Bart Holzhauser Technical Engineers' Local 130 Surety Bonds - List of Certified Companies Puee 49 of 112 BUSINESS ADDRESS: 702 OBERLIN ROAD, RALEIGH, NC. 27605 - 0800. PHONE: (919) 833-1600, UNDERWRITING LIMITATION b/: $57,274,000. SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT, DE, DC, FL, GA, 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, Rl, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY, INCORPORATED IN: Illinois. Hartford Accident and Indemnity Company (NAIC #22357) BUSINESS ADDRESS: One Hartford Plaza, Hartford, CT 06155 - 0001. PHONE: (860) 547-5000. UNDERWRITING LIMITATION b/: $195,865,000. SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT, DE, DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, MME, 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: Connecticut. Hartford Casualty Insurance Company (NAIC #29424) BUSINESS ADDRESS: One Hartford Plaza, Hartford, CT 06155 - 0001. PHONE: (860) 547-5000. UNDERWRITING LIMITATION b/: $89,385,000. SURETY LICENSES c,f/: AL, AK, AZ, AR, CA, CO, CT, DE, DC, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, littps://w,,vw.fiscal.treasury.gov/surety-bonds/list-certified-conipai ies.htn-A 6/22/2020 Fsomx aFw d, CITY OF SOUTH BEND, INDIANA '• 'db5 '' CONTRACTOR'S BID FOR PUBLIC WORK CHECKLIST FOR BIDDERS Project Name PRAIRIE AVENUE WATER MAIN LOOP Project No. 117-068 For Bids Due NOVEMBER 9, 2021 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 M/WBE Utilization Plans [MBE -1.0 and WBE-1.0]. Also provide Evidence of Good Faith Efforts Forms [MBE -2.0 and WBE-2.0] and M/WBE Contacted Forms [MBE -2.1 and WBE-2.1]. X Acknowledge Receipt of 1_2 Addendum(s) included with the bid. X All required additional information is included with the bid. Proposal statements and other affidavits all signed by the proper party with name either X printed or typed underneath signature. x This checklist submitted with the Bid. This checklist is provided for bidder's use in assuring compliance with required documentation; however, it does not include all specifications requirements and does not relieve the bidder of the need to read and comply with the specifications. Bidder: Woodruff & Sons Inc. - Dater November 9, 2021 By Authorized Signature: Print Name & Version 08/16/2021 Contractor's Bid for Public Works -1