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HomeMy WebLinkAboutOpening of Bids - Liberty Tower TIF Project Proj No. 123-054 -Trisco System, Inc.ir�yil'IH C. •J� AT �i y,r CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK CHECKLIST FOR BIDDERS Project Name Liberty Tower TIF Project — Parking Garage Project No. 123-054 For Bids Due September 26, 2023 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 X WBE-2.1 ]. #1 dated #2 dated 9-19-23 9-22-23 X Acknowledge Receipt of Addendum(s) included with the bid. X All required additional information is included with the bid. Proposal statements and other affidavits all signed by the proper party with name either X printed or typed underneath signature. X This checklist submitted with the Bid. This checklist is provided for bidder's use in assuring compliance with required documentation; however, it does not include all specifications requirements and does not relieve the bidder of the need to read and comply with the specifications. Bidder: Trisco Systems, Inc. By Authorized Represe to Signature: - Print Name & Title: Brian U. Walter, Vice President Date: September 19, 2023 Version 09/29/2021 Contractor's Bid for Public Work - 1 Project Name Project No. For Bids Due CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK Liberty Tower TIF Project — Parking Garage 123-054 September 26, 2023 at 9:00 A.M. (local time) to BPWbids@southbendin.gov PART I (Must be completed for all bids. Please type or print) Date: September 19, 2023 Bidder (Firm): Trisco Systems, Inc. Address: 2000 Baty Road City/State/Zip: Lima, OH 45807 Telephone Number: ( 419 ) 339-3906 Agent of Bidder (if Applicable): N/A _ Pursuant to notices given, the undersigned offers to furnish labor and/or material necessary to complete the public works project of: Parking Garage Repairs at Liberty Tower Building — South Bend the City of South Bend, Indiana, in accordance with plans and specifications prepared by: KENNEDY CONSULTING GROUP LLC and dated 8/25/2023 for the sum of (enter the Total Bid as shown on the Proposal) Two million fifty thousand eight hundred sixty nine & 00/100 Dollars s 2,050,869.00 (Enter sum of Total Base Bid plus Alternates shown on Proposal) (Numerical) The undersigned further agrees to furnish a bond or certified check with this bid for an amount specified in the notice of the letting. If alternative bids apply, the undersigned submits a proposal for each in accordance with the notice. Any addendums attached will be specifically referenced at the applicable page. If additional units of material included in the contract are needed, the cost of units must be the same as that shown in the original contract if accepted by the City of South Bend. If the bid is to be awarded on a unit basis, the itemization of the units shall be showpd—p e hment. By (Signature) B ian U. Walter, Vice President (Printed Name of Person Signing) ACCEPTANCE The above bid is accepted this day of 20 Subject to the following conditions: BOARD OF PUBLIC WORKS Elizabeth A. Maradik, President Joseph R. Molnar, Vice President Gary A. Gilot, Member Allie Dolz-Lane, Member Murray L. Miller, Member Attest: Theresa Heffner, Clerk Version 09/29/2021 Contractor's Bid for Public Work - 2 PART II (For projects of $100,000 or more — IC 36-1-12-4) These statements to be submitted under oath by each bidder with and as part of his/her/its bid. Attach additional pages for each section as needed. SECTION I EXPERIENCE QUESTIONNAIRE 1. Attach information regarding projects your organization has completed for the period of one (1) year prior to the date of the current bid. 2. Attach a listing of public works projects currently in process of construction by your organization. 3. Attach information regarding any failure to complete any work awarded to you and the location thereof. 4. Attach references from private firms for which you have performed work. SECTION II PLAN AND EQUIPMENT QUESTIONNAIRE Attach an explanation of your plan or layout for performing proposed work. (Examples could include a narrative of when you could begin work, complete the project, number of workers, etc. and any other information which you believe would enable the City of South Bend to consider your bid.) 2. Attach a listing of the names and addresses of all subcontractors (i.e. persons or firms outside your own firm who have performed part of the work) that you have used on public works projects during the past five (5) years along with a brief description of the work done by each subcontractor. 3. If you intend to sublet any portion of the work, attach the name and address of each subcontractor, equipment to be used by the subcontractor, and whether you will require a bond. However, if you are unable to currently provide a listing, please understand a listing must be provided prior to contract approval. Until the completion of the proposed project, you are under a continuing obligation to immediately notify the City of South Bend in the event that you subsequently determine that you will use a subcontractor on the proposed project. 4. Attach a listing of equipment you have available to use for the proposed project. 5. Have you entered into contracts or received offers for all materials which substantiate the prices used in preparing your proposal? If not, attach an explanation for the rationale used which would corroborate the prices listed. SECTION III CONTRACTOR'S FINANCIAL STATEMENT Attachment of bidder's financial statement is mandatory. Any bid submitted without said financial statement as required by statute shall thereby be rendered invalid. The financial statement provided hereunder to the City of South Bend awarding the contract must be specific enough in detail so that said City of South Bend can make a proper determination of the bidder's capability for completing the project if awarded. Version 09/29/2021 Contractor's Bid for Public Work - 3 When the prospective Contractor is unable to certify to any of the statements below, it shall attach an explanation to this Affidavit. CONTRACTOR'S NON -COLLUSION AND NON -DEBARMENT AFFIDAVIT, CERTIFICATION REGARDING INVESTMENT WITH IRAN, EMPLOYMENT ELIGIBILITY VERIFICATION, NON- DISCRIMINATION COMMITMENT AND CERTIFICATION OF USE OF UNITED STATES STEEL PRODUCTS OR FOUNDRY PRODUCTS (Must be completed for all quotes and bids. Please type or print) STATE OF Ohio SS: Allen COUNTY The undersigned Contractor, being duly sworn upon his/her/its oath, affirms under the penalties of perjury that: 1. Contractor has not, nor has any other member, representative, or agent of the firm, company, corporation or partnership represented by him, entered into any combination, collusion or agreement with any person relative to the price to be bid by anyone at such letting nor to prevent any person from bidding nor to induce anyone to refrain from bidding, and that this bid is made without reference to any other bid and without any agreement, understanding or combination with any other person in reference to such bidding. Contractor further says that no person or persons, firms, or corporation has, have or will receive directly or indirectly, any rebate, fee, gift, commission or thing of value on account of such sale; and 2. Contractor certifies by submission of this proposal that neither contractor nor any of its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency; and 3. Contractor has not, nor has any successor to, nor an affiliate of, Contractor, engaged in investment activities in Iran. a. For purposes of this Certification, "Iran" means the government of Iran and any agency or instrumentality of Iran, or as otherwise defined at Ind. Code § 5-22-16.5-5, as amended from time -to -time. b. As provided by Ind. Code § 5-22-16.5-8, as amended from time -to -time, a Contractor is engaged in investment activities in Iran if either: Contractor, its successor or its affiliate, provides goods or services of twenty million dollars ($20,000,000) or more in value in the energy sector of Iran; or ii. Contractor, its successor or its affiliate, is a financial institution that extends twenty million dollars ($20,000,000) or more in credit to another person for forty-five (45) days or more, if that person will (i) use the credit to provides goods and services in the energy sector in Iran; and (ii) at the time the financial institution extends credit, is a person identified on list published by the Indiana Department of Administration. 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 09/29/2021 Contractor's Bid for Public Work - 4 Contractor agrees that he/she/it shall enroll in and verify the work eligibility status of all of Contractor's newly hired employees through the E-Verify Program as defined by I.C. 22-5-1.7-3. Contractor's documentation of enrollment and participation in the E-Verify Program is included and attached as part of this bid/quote; and 5. Contractor shall require his/her/its subcontractors performing work under this public contract to certify that the subcontractors do not knowingly employ or contract with an unauthorized alien, nor retain any employee or contract with a person that the subcontractor subsequently learns is an unauthorized alien, and that the subcontractor has enrolled in and is participating in the E-Verify Program. The Contractor agrees to maintain this certification throughout the term of the contract with the City of South Bend, and understands that the City may terminate the contract for default if the Contractor fails to cure a breach of this provision no later than thirty (30) days after being notified by the City. 6. Persons, firms, partnerships, corporations, associations, or joint venturers awarded a contract by the City of South Bend through its agencies, boards, or commissions shall not discriminate against any employee or applicant for employment in the performance of a City contract with respect to hire, tenure, terms, conditions, or privileges of 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. I, the undersigned bidder or agent as contractor on a public works project, understand my statutory obligations to the use of steel products or foundry products made in the United States (I.C. 5-16-8-1).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 a justification to the City, subject to review and approval, why the cost of United States made steel or foundry products is unreasonable. Prior to award and upon submission of bid which does not use steel products or foundry products made in the United States, the City, through its director of public works, shall make a determination if the price of United States made steel or foundry is unreasonable. I understand that violations hereunder Version 09/29/2021 Contractor's Bid for Public Work - 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. 19th September Dated this day of , 2023 NO SYST�F4 .' vrj SEAL s a Subscribed and swo to bef re me this My Commission Expires — 6 County of Resic Trisco Systems, Inc. Signftlure of Contractor/Bidder or Its Agent Brian U. Walter, Vice President Printed Name and Title SHERYL LYNN LYURGER Notary Public, State of Ohio My Commission Expires June 22, 2025 Version 09/29/2021 Contractor's Bid for Public Work - 6 LIBERTY TOWER GARAGE SOUTH BEND IN BASE BID QUANTITY & UNIT PRICE TABLE ITEM DESCRIPTION QTY. UNITS UNIT PRICE TOTAL 0.1 MOBILIZATION/DEMOBILIZATION 1 LS $ 8,684.00 0.2 GENERAL CONDITIONS 1 LS $ 208,829.00 0.3 SHORING ALLOWANCE 1 LS $ 25,000.00 0.4 OWNER'S CONTINGENCY 1 LS $ 100,000.00 1 FULL DEPTH SLAB REPAIR @ BEAM /GIRDER 304 SF $ 162.41 $ 49,372.00 2 FULL DEPTH SLAB REPAIR - FORMED 1146 SF $ 174.12 $ 199,544.00 3 1 PARTIAL DEPTH FLOOR REPAIR 80 SF $ 75.10 $ 6,008.00 4 CEILING DELAMINATION REPAIR 72 SF $ 116.13 $ 8,361.00 5 CONCRETE JOIST SPALL REPAIR 200 LF $ 226.91 $ 45,268.00 6 BEAM /GIRDER SPALL REPAIR 150 SF $ 347.18 $ 52,077.00 7 COLUMN SPALL REPAIR 10 SF $ 120.80 $ 1,208.00 8 GALVANIC ANODES INSTALLED 200 EA $ 292.11 $ 58,422.00 9 SCALED CONCRETE SURFACE REPAIR 8475 SF $ 7.21 $ 61,147.00 10 CONCRETE CURB REPAIR 24 SF $ 97.38 $ 2,337.00 11 EXPOSED CEILING REINFORCEMENT REPAIR 150 LF $ 24.20 $ 3,630.00 12 IGRIND EXISTING PATCH PERIMETERS 200 LF $ 13.57 $ 2,714.00 13 CRACK ROUT & SEAL 231 LF $ 8.53 $ 1,971.00 14 CONTROL JOINT SEALANT REPLACEMENT 1,080 LF $ 7.97 $ 8,606.00 15 DECK COATING REMOVAL 63,855 LF $ 4.08 $ 260,780.00 16 DECK COATING BASE COAT AT FLOOR PATCHES 400 SF $ 6.43 $ 2,573.00 17 DECK COATING RECOAT SYSTEM 24,785 SF $ 5.90 $ 146,332.00 18 DECK COATING FULL SYSTEM 63,865 SF $ 7.15 $ 456,683.00 19 BUMPER WALL JOINT SEALANT 320 LF $ 6.83 $ 2,185.00 20 FLOOR DRAIN GRATE REPLACEMENT 2 EA $ 1,652.50 $ 3,305.00 21 PEELED CEILING COATING REPAIR 3,690 SF $ 4.49 $ 16,564.00 22 REPAINT PAVEMENT MARKINGS 1 LS $ 8,260.00 TOTAL BASE BID $ 1,739,860 ALTERNATES ITEM DESCRIPTION QTY. UNITS UNIT PRICE TOTAL ALT 1 SECURITY SYSTEM MODIFICATIONS - OPTION 1 1 LSUM $ 85,609.00 ALT 2 SECURITY SYSTEM MODIFICATIONS - OPTION 2 1 LSUM $ 11,802.00 ALT 3 LEVEL 7 PLAZA PAVER INSTALLATION 4,470 SF 1 LSUM $ 213,598.00 TOTAL ALTERNATES BID $ 311,009 COMBINED BASE BID PLUS ALTERNATES (TRANSFER TO PAGE 2 OF BID FORM) $ 2,050,869 Project Name: Project Number: For Bids Due: Contractor Name: Bidder (Firm) Address: City/State/Zip: 1 •IyO ', BID/PROPOSAL CITY OF SOUTH BEND Liberty Tower TIF Project — Parking Garage 123-054 September 26, 2023 Trisco Systems, Inc. Trisco Systems, Inc. 2000 Baty Road Lima, OH 45807 Telephone Number: 419 39-3906 By (Signature) Brian U. Walter, Vice President (Printed Name of Person Signing) Version 09/29/2021 Contractor's Bid for Public Work - 8 CITY OF SOUTH BEND W MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM MBE-1.0 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 verify whether any listed minority -owned business meets the MBE qualifications. Project Number: 123-064 Project Name: Liberty Tower TIF Pra ect — Parking Garage Bidder: TI'ISCO Systems, Inc. Total Bid Amount: $1739,860.00 Name & Address of MBE Primary Contact Person I Scope of Work to be Performed I (Name/Telephone) (Attach scope/schedule if you need additional space) Contractor Connection, Inc. Maria Maculaitis Construction Material Supplier 1828 Perry Drive SW - Rear 330-479-9894 Canton, OH 44706 Submitted by: Brian U. Walter, Vice President i Print Name Signature Version 09/29/2021 Contractor's Bid for Public Work - 9 MBE Goal: 3.4% Page 1 of 1 Dollar Amount of MBE of Total Component Q;A/Mo -- $59,156.00 1 3.4% September 25, 2023 Date CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN 5 "F,CF. 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: 123-054 Project Name: Liberty Tower TIF Project — Parking Garage Bidder: TriscO Systems, Inc. Total Bid Amount: $1,739,860.00 WBE Goal: 4.5% Page 1 of Nami Triko, Im 244 Vinc New Alb & Address of WBE Primary Contact Person (Name/Telephone) Scope of Work to be Performed (Attach scope/schedule if you need additional space) Dollar Amount of WBE Component Percentage of Total Bid/Proposal ennes Street any, IN 47150 Krista Wells 812-945-1595 Construction Material Supplier $78,294.00 4.5% Submitted by: Brian U. Walter, Vice President Print Name Signature Version 09/29/2021 Contractor's Bid for Public Work - 10 September 25, 2023 Date CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN V bEACE }al. FORM MBE-2.0=+= 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: 123-054 Project Name: Liberty Tower TIF Project — Parking Garage Bidder: Trisco Systems, Inc. Contact Person: Address: City: Email: State: Date: September 25, 2023 Telephone: Zip: 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*: EVIDENCE OF GOOD FAITH EFFORTS NOT APPLICABLE 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: htt :llwww. in. ovhdoa/. 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 fhttf-,://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 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. I 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. 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. I 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 09/29/2021 Contractor's Bid for Public Work - 11 CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM MBE-2.0 EVIDENCE OF GOOD FAITH EFFORTS I 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 that I did not reject any MBEs 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 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 09/29/2021 Contractor's Bid for Public Work - 12 CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN „ErCE, +s" FORM WBE-2.0 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 MWBE participation. Project Number: 123-054 Project Name: Liberty Tower TIF Project — Parking Garage _ Bidder: Trisco Systems, Inc. Contact Person: Address: City: Email: State: Date: September 25, 2023 Telephone: Zip: 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": EVIDENCE OF GOOD FAITH EFFORTS NOT A P P L I C A B L E 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: httc://www.in.aovlidoal. 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. 1 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 httf:://www. in. , ov/idoa: . I affirm that I have made good 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. h- � i- I affirm that I 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, lines of credit, or insurance as required by the City or the bidder, where appropriate. Version 09/29/2021 Contractor's Bid for Public Work - 13 CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM WBE-2.0 EVIDENCE OF GOOD FAITH EFFORTS QtiSgISTH eF,. " PEACE t 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. "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 09/29/2021 Contractor's Bid for Public Work - 14 �rti BF�, CITY OF SOUTH BEND }?' MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN -. P..,CL FORM MBE-2.1 MBE CONTACTED 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 Project Number: 123-054 MBE Participation Goal 3.4% Project Name: Liberty Tower TIF Project — Parking Garage der: Trisco Systems, Inc., 2000 Baty Road, Lima, OH 45807 Vice President September 25, 2023 i ature I n U. Walter (Title) (Date) MBE Firm Contractor Connection, Inc. Owner or Contact at MBE Firm Maria Maculaitis Telephone: 330-479-9894 Fax: 888-934-3131 Email: mariamac@contcon.com TYPE OF WORK SOLICITED FOR THIS PROJECT Construction Material Supplier RESULTS OF CONTACT WITH THE MBE FIRM: Agree to provide construction material supplies. MBE Firm Owner or Contact at MBE Firm Telephone: Fax: Email: TYPE OF WORK SOLICITED FOR THIS PROJECT: RESULTS OF CONTACT WITH THE MBE FIRM: Version 09/29/2021 Contractor's Bid for Public Work - 15 r THIS CERTIFIES THAT NMSDC Contractor Connection Inc National Minority Supplier dba Contractor Connection Inc Development Council * Nationally certified by the: OHIO MINORITY SUPPLIER DEVELOPMENT COUNCIL *NAICS Code(S): 4441904425110:56149904237309561990042361D:561730:238130:238160 * Description of their product/services as defined by the North American Industry Classification System (NAICS) 10/25/2022 Issued Date 09/30/2023 Expiration Date Ying McGuire NMSDC CEO and President CN04100 Certificate Number George Simms, President & CEO By using your password (NMSDC issued only), authorized users may log into NMSDC Central to view the entire profile: http://nmsdc.org Certify, Develop. Connect, Advocat- * MBEs certified by an Affiliate of the National Minority Supplier Development Council, Inc so .ice ull CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN PT.46E FORM MBE-2.1 WBE CONTACTED 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 OF Project Number: 123-054 WBE Participation Goal 4.5% Project Name: Liberty Tower TIF Project — Parking Garage Trisco Systems, Inc., 2000 Baty Road, Lima, OH 45807 Vice President September 25, 2023 is U. Walter (Title) (Date) WBE Firm Triko, Inc. Owner or Contact at WBE Firm Krista Wells Telephone: 812-945-1595 Fax: 812-945-1555 TYPE OF WORK SOLICITED FOR THIS PROJECT: Construction Material SUDDIIer RESULTS OF CONTACT WITH THE WBE FIRM: Agree to provide construction material supplies. WBE Firm Owner or Contact at WBE Firm Telephone: Fax: TYPE OF WORK SOLICITED FOR THIS PROJECT: RESULTS OF CONTACT WITH THE WBE FIRM: Email: info@trikosupply.com Email: Version 09/29/2021 Contractor's Bid for Public Work - 16 RCW22688 1~ERTIKICATION NUMBER Certifies that: TRIKo, Inc. 01/14/25 EXPIRATION DATE has successfully met the requirements of the NWBOC national certification program for certification as a woman -owned and woman -controlled business. The Identified business has qualified as an eligible Woman Business Enterprise (WBE) as set forth in NWBOC standards and procedures, PHYLLIS WILL SLATER Board Chair, NWBOC 424690, 238390, 423390, 325510, 238150 NAICS Codes) WWW.NWBOC.ORG INFO;nNWBOC.ORG 1 800-794-6140 1 1lot East Cumberland Ave, Suite #301. Tampa, Florida 33602 01/15/22 Date TAMPERING OR ALTERING THIS CERTIFICATE 1S, IN THE DISCRETION OF NWBOC, GROUNDS FOR TERMINATION OF CERTIFICATION. TRISCO, e SYSTEMS, INC. sUresb FORM NO. 96 (Version 4/07/2015) PART II — SECTION I — EXPERIENCE UESTIONNAI 1. JOBS COMPLETED Contract Amount Class of Work When Completed Name and Address of Owner $9,000,000 Masonry & Concrete Restoration 2022 Electric Works, Ft Wayne, IN $ 450,000 Stucco & Sealant Restoration/Coatings 2022 Upper Valley Medical Center, Troy OH $ 410,000 Masonry Restoration 2022 Collins Park/Generator, Toledo OH $ 160,000 Masonry Joint Repair 2022 Lima Memorial Health System Main Building, Lima OH $ 200,000 Concrete & Masonry Repair 2022 Summit Chase Condominiums, Columbus OH $1,600,000 Masonry Restoration 2021 St. Rita's Medical Center Exterior, Lima OH $ 110,000 Masonry Flashing Repairs 2021 Lima Memorial Medical Park, Lima OH $ 46,000 Masonry Repairs 2021 Odd Fellows Lodge, Charleston WV $1,100,000 EIFS & Sealant Restoration 2021 BGSU Falcon Heights/Centennial, Bowling Green OH $ 500,000 Masonry & Concrete Restoration 2021 Hawks Nest State Park Lodge, Ansted WV $ 80,000 Masonry & Concrete Restoration 2021 Warsaw Elementary School, Warsaw OH $2,900,000 Concrete Restoration 2021 Cargill Grain Silos, Lima OH $ 200,000 EIFS Replacement & Restoration 2020 Homewood Suites, Beachwood OH $ 215,000 EIFS Restoration, Sealants, Coating 2020 Medical Arts MOB #3, Saginaw MI $ 300,000 Masonry & Concrete Restoration 2020 Twin Falls State Park Lodge, Mullens WV $ 135,000 Masonry Restoration 2020 Denison University Various Projects, Granville OH $1,057,000 EIFS Restoration 2020 Warren Plaza Apartments, Detroit MI $1,150,000 Masonry Restoration 2020 BGSU Offenhauer Towers, Bowling Green OH $ 140,000 Masonry Restoration 2020 Boone County High School, Florence KY $ 115,000 Terra Cotta Restoration 2020 Richland Bank High -Rise, Mansfield OH $ 200,000 Masonry Restoration 2020 Ohio Dominican Erskine Hall, Columbus OH $ 700,000 Masonry Restoration 2019 Washington State Community College, Marietta OH $ 513,000 Concrete & Masonry Restoration 2019 Anna HS & MS Renovation, Anna OH $ 110,000 Stone Restoration 2019 Marathon Donnell Building, Findlay OH $ 265,000 Masonry Restoration 2019 777 North Meridian, Indianapolis IN $ 832,000 Masonry Restoration 2019 The Landing Development, Ft Wayne IN $ 350,000 Masonry Restoration 2019 Dayton YWCA, Dayton OH 2. JOBS IN PROGRESS Contract When to be Amount Class of Work Completed Name and Address of Owner $ 1,200,000 Masonry Restoration 2023 Delco Building, Dayton OH $ 200,000 Sandstone Restoration 2023 BG Administration Building, Bowling Green OH $ 150,000 Masonry Restoration 2023 Arc of Mid -Ohio Valley, Parkersburg WV $ 137,000 Concrete Repair 2023 PUFW Parking Garage, Ft Wayne IN $ 121,000 Masonry Restoration 2023 Logan Village, Logan OH $ 200,000 Masonry Restoration 2023 ODNR Forestry, Chillicothe OH 2-1-23 dh Sealant, Waterproofing & Restoration Institute 2000 Baty Road, Lima, Ohio 458074�GFNEgq Phone: (419) 339-3906 Fax. (419) 339-3081 a C g office@triscosystems.com www.triscosystems.com AM�wP a`�NtllllygS SYSTEMS, INC. Slnes�936 FORM NO. 96 (Version 4/07/2015) PART II - SECTION I - EXPERIENCE QUESTIONNAIRE (Continued) 3. N/A 4. Central Soya J P Morgan Chase Bank, N.A. Historical Society of Lima C. B. Richard Ellis PART II — SECTION II — PLAN AND EQUIPMENT QUESTIONNAIRF� 1. Mobilize to site, gain building access, and perform the specified work in the area of our active control. We will provide sufficient labor to complete the work in time allotted. 2. N/A 3. We will provide a list if applicable. 4. Access equipment, compressor, hand tools 5. Yes A i.ysrnu3F. Sealant, Waterproofing & Restoration Institute 2000 Baty Road, Lima, Ohio 45807 EGGENEq Phone: (419) 339-3906 Fax: (419) 339-3081a ®� officeCMtriscosystems.com . t www.triscos semscom y Sr�AMEPWP rl"' 1316 COUNTY -CITY BUILDING � � ' PHONE 574/235-9251 227 W. JEFFERSON BOULEVARD µ -' 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: To: From Subject September 20, 2023 All Planholders Theresa Heffner, Clerk, Board of Public Works Addendum Number: 1 Project Name: Liberty Tower TIF Project — Parking Garage Project Number: 123-054 ACKNOWLEDGEMENT OF RECEIPT OF ADDENDUM Date Received: September 19, 2023 This addendum is being forwarded to you for the above referenced project. Please sign below and acknowledge receipt of this Addendum by including with your electronic bid submission. 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: Trisco Authorized Signature: Date: September 20, 2023 Inc. Brian U. Walter Vice President Version 8/11/2020 1316 COUNTY -CITY BUILDING 227 W. JEFFERsoN BOULEVARD SOUTH BEND, INDIANA 46601-1830 PHONE 574/235-9251 FAx 574/ 235-9171 TDD 574/ 235-5567 CITY OF SOUTH BEND, JAMES MUELLER, MAYOR BOARD OF PUBLIC WORKS Date: September 22, 2023 _ To: All Planholders From Theresa Heffner, Clerk, Board of Public Works Subject Addendum Number: 2 Project Name: Liberty Tower TIF Project — Parking Garage Project Number: 123-054 ACKNOWLEDGEMENT OF RECEIPT OF ADDENDUM Date Received: September 22, 2023 This addendum is being forwarded to you for the above referenced project. Please sign below and acknowledge receipt of this Addendum by including with your electronic bid submission. 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: Trisco Authorized Signature: Date: September 22, 2023 Brian U. Walter Vice President Version 8/11/2020 BID BOND TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA Hartford, Connecticut 06183 CONTRACTOR: (Name, legal status and address) Trisco Systems, Inc. 2000 Baty Rd. Lima, OH 45807 OWNER: (Name, legal status and address) City of South Bend, Board of Public Works 1316 County -City Building 227 West Jefferson Blvd. South Bend, IN 46601 BOND AMOUNT: $ 5% of Attached Bid SURETY: (Name, legal status and principal place of business) Travelers Casualty and Surety Company of America One Tower Square Hartford, CT 06183 PROJECT: (Name, location or address, and Project number, if any) Liberty Tower TIF-Parking Garage, Project No. 123-054 111 N. Main Street, South Bend, IN 46601 St. Joseph County 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 furnished in the prosecution thereof; or (2) pays to the Owner the difference, not to exceed the amount of this Bond, between the amount specified in said bid and such larger amount for which the Owner may in good faith contract with another party to perform the work covered by said bid, then this obligation shall be null and void, otherwise to remain in full force and effect. The Surety hereby waives any notice of an agreement between the Owner and Contractor to extend the time in which the Owner may accept the bid. Waiver of notice by the Surety shall not apply to any extension exceeding sixty (60) days in the aggregate beyond the time for acceptance of bids specified in the bid documents, and the Owner and Contractor shall obtain the Surety's consent for an extension beyond sixty (60) days. If this Bond is issued in connection with a subcontractor's bid to a Contractor, the term Contractor in this Bond shall be deemed to be Subcontractor and the term Owner shall be deemed to be Contractor. 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. The Company executing this bond vouches that this document conforms to American Institute of Architects Document A310, 2010 Edition 1 Signed and sealed this 26th day of September, 2023 Lvx (Witness) Diane Hines 2 -01 V-PAv, MXOMWAW� Mary Beth Stein Syst SYS -'SEAL' - • Title) Brian U,Walter, V.P. Travelers Casualty and Surety Company of America (Seal The Company executing this bond vouches that this document conforms to American Institute of Architects Document A310, 2010 Edition 2 Travelers Casualty and Surety Company of America Travelers Casualty and Surety Company TRAVELERS-1 St. Paul Fire and Marine Insurance Company POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company, and St. Paul Fire and Marine Insurance Company are corporations duly organized under the laws of the State of Connecticut (herein collectively called the "Companies"), and that the Companies do hereby make, constitute and appoint of their true and lawful Attorney -in -Fact to sign, execute, seal and acknowledge any and all bonds, recognizances, conditional undertakings and other writings obligatory 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, the Companies have caused this instrument to be signed, and their corporate seals to be hereto affixed, this 3rd day of February, 2017 State of Core iout CONN. s City of Robert L. Raney, Se for Vice President On this the 3rd day oT," ur ,Aw, before me personally appeared Robert L. Raney, who acknowledged himself to be the Senior Vice President of Travelers Casualty and Surely ompany of America, Travelers Casualty and Surety Company, and St. Paul Fire and Marine Insurance Company, and that he, as such, being authorized so to do, executed the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. In Witness Whereof, I hereunto set my hand and official seal. My Commission expires the 30th day of June, 2021 0 Marie C. Tetreault, Notary Public This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company, and St. Paul Fire and Marine Insurance Company, which resolutions are now in full force and effect, reading as follows: RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President, any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary may appoint Attorneys -in -Fact and Agents to act for and on behalf of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with the Company's name and seal with the Company's seal bonds, recognizances, contracts of indemnity, and other writings obligatory in the nature of a bond, recognizance, or conditional undertaking, and any of said officers or the Board of Directors at any time may remove any such appointee and revoke the power given him or her; and it is FURTHER RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company, provided that each such delegation is in writing and a copy thereof is filed in the office of the Secretary; and it is FURTHER RESOLVED, that any bond, recognizance, contract of indemnity, or writing obligatory in the nature of a bond, recognizance, or conditional undertaking shall be valid and binding upon the Company when (a) signed by the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary; or (b) duly executed (under seal, if required) by one or more Attorneys -in -Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority; and it is FURTHER RESOLVED, that the signature of each of the following officers: President, any Executive Vice President, any Senior Vice President, any Vice President, any Assistant Vice President, any Secretary, any Assistant Secretary, and the seal of the Company may be affixed by facsimile to any Power of Attorney or to any certificate relating thereto appointing Resident Vice Presidents, Resident Assistant Secretaries or Attorneys -in -Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof, and any such Power of Attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding on the Company in the future with respect to any bond or understanding to which it is attached. I, Kevin E. Hughes, the undersigned, Assistant Secretary of Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company, and St. Paul Fire and Marine Insurance Company, do hereby certify that the above and foregoing is a true and correct copy of the Power of Attorney executed by said Companies, which remains in full force and effect. Dated this 26th Please , 2023 >l-, r �� Kevin E. Hughes, Assistant Secretary fcay of this Power ofAttorney, please call us at f-800-421-3880, Attorney4n-Fact and the details of the bond to which the power is attached. CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK RESPONSIBLE BIDDER CHECKLIST Project Name Liberty Tower TIF Project — Parking Garage Project No. 123-054 For Bids Due September 26, 2023 Contractor Name: Trisco Systems, Inc. The City seeks to enhance its ability to identify responsive and responsible bidders on all City public works projects by institution of comprehensive submission requirements in compliance with State law. Quality workmanship, efficient operation, safety, and timely completion of projects requires that all bidders meet certain minimum requirements to be responsive and responsible bidders. THIS FORM MUST BE SUBMITTED WITH YOUR BID. INSTRUCTIONS: If you are a pre -qualified bidder, complete Section I only. If you are not a pre -qualified bidder, complete Section II only. Section II acts as an application for pre -qualification. Submission of Section II will allow the bidder to be considered for pre -qualification for bids with the City of South Bend Department of Public Works. Pre - qualified bidders will then be exempt from a portion of the submission requirements outlined in Section 6- 63 of The Responsible Bidding Ordinance No. 10594-18 (hereinafter, "Responsible Bidding Ordinance") for a period of twelve (12) months. Thereafter, contractors who are pre -qualified must submit a complete application for continuation of "pre - qualified" standing, on a form provided by the City ("Responsible Bidder Checklist (1) Pre -Qualified Bidders") by December 31s' for the upcoming calendar year, or within twelve (12) months of obtaining pre - qualified standing. If the status of any item changes within the twelve (12) months, it is the responsibility of the contractor to notify the City. Failure by any pre -qualified contractor to submit its complete application for continuation of "pre -qualified" standing within the time prescribed above shall result in automatic removal of the designation, effective January 1 of the following year, or immediately following the twelve (12) months of pre -qualified standing. However, the "removed" contractor or subcontractor shall still be permitted to bid on City public works projects, though the contractor must submit all required documents under 6-63 until "pre -qualified" status is re-established. Please Note: The City reserves the right to request supplemental information from the bidder, additional verification of any information provided by the bidder, and may also conduct random inquiries of the bidder's current and previous customers regardless of pre -qualified standing. It is the sole responsibility of the potential bidder to comply with all submission requirements applicable to the bidder in Section 6-63 of the Responsible Bidding Ordinance no later than the date of the public bid opening. Version 02/23/2022 General Conditions - 10 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 02/23/2022 General Conditions -11 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 02/23/2022 General Conditions -12 II. PRE -QUALIFICATION CHECKLIST (FOR BIDDERS THAT ARE NOT PRE -QUALIFIED) (a) Acknowledgements: (i) X By checking this box, I hereby acknowledge that I am not a pre -qualified bidder with the City of South Bend. (ii) X By checking this box, I hereby acknowledge that the City reserves the right to request supplemental information, additional verification of any information provided, and may also conduct random inquiries of my current and prior customers. The City reserved the right to utilize all information provided in this submission and all information obtained in inquiries or requests to determine if a bidder is responsive and responsible. Additionally, I acknowledge that all information provided to the City shall be regarded as public records. (iii) X By checking this box, I hereby acknowledge that copies of all Applicable apprenticeship certificates or standards for training programs applicable to the work performed on the project may be requested at any time and shall be furnished upon request. (iv) X By checking this box, I hereby acknowledge and ensure that I and all sub- contractors, from whom I have accepted a bid and/or intend to hire to perform work on the public work project, are properly licensed. Furthermore, I acknowledge my understanding that it is my responsibility to ensure that all sub -contractors have the necessary licenses to undertake the work called for in this bid. If a sub- contractor loses their license at any point, it is the responsibility of that sub- contractor to notify the City. (b) Attachments: (i) X Indiana Secretary of State's on-line records (ie. Business verification) dated within sixty (60) days of the submission of said document showing that business is in existence, current with the Indiana Secretary of State's Business Entity Report, and eligible for a certificate of good standing. (Not applicable to individuals, sole proprietors or partnerships). (ii) X List identifying all former business names. (iii) X Any determinations by a court or governmental agency any violations of federal state, or local laws including, but not limited to, violations of contracting or antitrust laws, tax or licensing laws, environmental laws, Occupational Safety and Health Act (OSHA), or federal Davis -Bacon and related Acts, within the preceding five (5) years. (iv) X Statement about staffing capabilities, including labor sources. This statement indicates and ensures I have sufficient employees on staff to complete the work I am bidding on OR outlines how I intend to meet the staffing needs of the work. (v) X Statement that individuals who will perform work on the public work project on my behalf will be properly classified as an employee or as an independent contractor under all applicable state and federal laws and local ordinances. (vi) X For every project, submit evidence of participation in apprenticeship and training programs, applicable to the work to be performed on the project, which are approved by and registered with the United States Department of Labor's Office of Apprenticeship, or its successor organization. (vii) X Copy of a written plan for employee drug testing that covers all of my employees who will perform work on the public work project and meets or exceeds the requirements set forth in IC 4-13-18-5 or IC 4-13-18-6. (viii) X Evidence that I am utilizing a surety company which is on the Bureau of Fiscal Service "Department of Treasury's Listing of Approved Sureties" as required in the bid specifications or contract. Version 02/23/2022 General Conditions - 13 (ix) X Written statement of any federal, state or local tax liens or tax delinquencies owed to any federal, state or local taxing body in the preceding three years. (i) X List of projects of similar size and scope of work performed in all areas, including the State of Indiana, within three (3) years prior to the date on which the bid is due. Date: September 19, 2023 (SigrrHerre) Brian U. Walter, Vice President (Print Name Here) Trisco Systems, Inc. (Name of Company) 2000 Baty Road (Address of Company) Lima (City) OH (State) 419-339-3906 (Telephone Number) Version 02/23/2022 General Conditions - 14 fir:,?Fp�1 SYSTEMS, INC. .Sj�AP l 36 LIBERTY TOWER TIF PROJECT — PARKING GARAGE CITY OF SOUTH BEND, INDIANA PROJECT NO. 123-054 Contractor's Bid For Public Work II. Prequalified Bidder Checklist (b) Attachments (i) See attached State of Indiana Certificate of Existence. (ii) Trisco Systems, Inc. has been in business under the same name for 87 years. (iii) There have been no such violations within the preceding five (5) years. (iv) Trisco operates about 16 crews and at this time we have at least 4 crews that are available for a fall start date. If this project begins in the spring we will have most all crews available. The typical crew size is 5-7 workers, and for a project like this we may utilize a crew of closer to 7-10 personnel depending on the efficiency and availability of the work. We usually have over 100 employees at the peak of the season. Regarding project control, Trisco operates under a cross -functional matrix structure, whereby the project team consists of personnel who belong to different managerial departments. This structure allows us to control quality and consistency across all of our projects. The balance of involvement will shift as needed throughout the project. Our current workload ("backlog") is on target with where we like to be at this point in the season. It is not excessive and therefore leaves plenty of availability and capacity for securing new projects such as this. We need to secure several projects each year in the $500,000 - $1 M range and this project is a perfect candidate. We have manpower prepared and are eager to begin work as soon as weather permits. We have the financial capacity and bonding capacity to support this project as well. (v) All employees for this project will be employed by Trisco Systems, Inc. or affiliate Companies. Some work may be subcontracted (surface preparation, security cameras, etc.) and those individuals will also comply with applicable state and federal laws and local ordinances. (vi) Trisco Systems, Inc. is signatory to the International Union of Bricklayers and Allied Craftworkers, and therefore all technicians have been through apprenticeship and training programs through the Union. All supervisors on this project will have OSHA 30- hour training and all technicians will have a minimum of OSHA 10-hour training. a iyyment Sealant, Waterproofing & Restoration Institute 2000 8aty Road, Lima, OH 45807 n Phone:419-339-3906 Fax:419-339-3081 office@triscosystems.com www.triscosystems.com LIBERTY TOWER TIF PROJECT — PARKING GARAGE CITY OF SOUTH BEND, INDIANA PROJECT NO. 123-054 Contractor's Bid For Public Work II. Prequalified Bidder Checklist (Continued) (b) Attachments (Continued) (vii) See attached Trisco Systems, Inc. Drug Testing Policy. (viii) See attached Surety Letter. (ix) There are no tax liens or delinquencies owed to any federal, state or local taxing body in the preceding three (3) years. (x) List of projects of similar size and scope of work performed in all areas, including the State of Indiana, within three (3) years prior to the date on which the bid is due. PUFW Parking Garage, Ft. Wayne IN Concrete Repair & Traffic Coatings, Roof Replacement $300, 000 Scheduled Completion: October 2023 Eggerss Stadium, Van Wert OH Concrete Repair & Pedestrian Deck Membrane $2,200,000 Timeframe: 2023 The Delco, Dayton OH Concrete Repair & Protective Coatings $1,400,000 Timeframe: 2023 Electric Works, Ft. Wayne IN Masonry & Concrete Restoration $9,000,000 Timeframe: 2022 St. Rita's Parking Garage, Lima OH Concrete Repair & Traffic Coatings $650, 000 Timeframe: 2018 — current (ongoing campus projects) Zimmer B3 Garage, Warsaw IN Concrete Repair & Traffic Coatings $200, 000 Timeframe: 2019 Please also refer to the attached list of current and past projects for more examples State of Indiana Office of the Secretary of State CERTIFICATE OF EXISTENCE To Whom These Presents Come, Greeting: I, DIEGO MORALES, Secretary of State of Indiana, do hereby certify that I am, by virtue of the laws of the State of Indiana, the custodian of the corporate records and the proper official to execute this certificate. I further certify that records of this office disclose that TRISCO SYSTEMS INC duly filed the requisite documents to commence business activities under the laws of the State of Indiana on October 03, 1967, and was in existence or authorized to transact business in the State of Indiana on September 18, 2023. I further certify this Foreign For -Profit Corporation has filed its most recent report required by Indiana law with the Secretary of State, or is not yet required to file such report, and that no notice of withdrawal, dissolution, or expiration has been filed or taken place. All fees, taxes, interest, and penalties owed to Indiana by the domestic or foreign entity and collected by the Secretary of State have been paid. A 1616 In Witness Whereof, I have caused to be affixed my signature and the seal of the State of Indiana, at the City of Indianapolis, September 18, 2023 DIEGO MORALES SECRETARY OF STATE 194529-140 / 20233376492 All certificates should be validated here: https://bsd.sos.in.gov/ValidateCertificate Expires an October 18, 2023. Am TRAVELERS September 18, 2023 Board of Public Works City of South Bend 1316 County -City Building 227 West Jefferson Blvd. South Bend, IN 46601 Lauren Piscitello Account Executive Travelers Bond Columbus, OH (614) 416-3560 One Easton Oval # 375 Columbus, OH 43219 RE: Liberty Tower TIF Project - Parking Garage- Project No. 123-054 To Whom it May Concern: Please consider this evidence that Trisco Systems, Inc. is utilizing Travelers Casualty and Surety Company of America for all their surety bond needs which is a surety company that is on the Bureau of Fiscal Service Department of Treasury's Listing of Approved Sureties. Please reach out if you have any additional questions. Best regards, TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA ofautea (fiscuedo Lauren Piscitello Trisco Systems, Inc. Drugs, Marijuana, and Alcohol Policy (Updated January 2023) Trisco Systems, Inc. 5 Drugs, Marijuana and Alcohol Policy 5 Purpose: Business Necessity 5 Statement of Policy drugs, Narcotics, and Alcohol 6 Medical Marijuana 7 Anti -Drug Policy 8 Drug Testing Procedures 8 Covered/Not Covered Employees 9 Affected Employees 9 Drug Testing Circumstances 10 Drug Testing Laboratory 12 Specimen Collection Procedures 13 Laboratory Analysis Procedures 20 Quality Assurance and Quality Control 20 Reporting and Review of Results 21 Reanalysis Authorized 22 Result Scientifically Insufficient 22 Disclosure of Information 23 Protection of Employee Records 23 Review of Drug Testing Results 24 Retention of Samples and Retesting 25 Substance Abuse Professional 26 Rehabilitation 26 Condition for Return to Work 27 Education and Training 27 Disciplinary Procedures for Positive Drug Test 31 Employee Notification 32 Conclusion 32 Alcohol Misuse Prevention Policy (AMPP) 33 Statement of Policy 33 Implementation of Alcohol Misuse Prevention Plan (AMPP) 33 Background 33 Preemption Provisions 34 Trisco Systems, Inc. Responsibilities 34 Employee/Supervisor Alcohol Testing Provisions 35 Affected Employees 35 Procedures for Notifying Covered Employees 36 Criteria for Employee Notification 36 Alcohol Tests Required 37 Random Testing 37 Post Accident Testing 38 Reasonable Suspicion Testing 39 Return to Duty Testing 42 2 Follow Up Testing 42 Provisions Governing Retesting of Covered Employees 43 Alcohol Prohibited Conduct 43 Alcohol Concentration 43 Pre Duty Use 43 On Duty Use 43 Use of Employee Who Refuses Alcohol Test 44 Disciplinary Actions 44 Required Referrals and Evaluations 44 Rehabilitation 44 Condition for Return to Work 45 Levels of Disciplinary Actions 45 Alcohol Testing Requirements 47 General 47 Alcohol Testing Equipment 47 Screening Devices 47 Confirmation Devices 48 NHTSA Conforming Products List 48 EBT Quality Assurance Plan 48 Breath Alcohol Technician (BAT) Guidance 48 Disclosure of Alcohol Information/Records 49 Disclosure Provisions 50 Employee Training 51 Scope of Program 51 Supervisor Training 51 Trisco Systems, Inc. Employee Obligation for Alcohol Intervention 51 Effects of alcohol misuse 52 Signs and Symptoms of Alcohol Misuse 53 Available Help 53 Recordkeeping Procedures 54 Record Retention Provisions 54 Maintenance of Specific Types of Records 55 Contractor Monitoring 56 APPENDIX A: 56 Drug and Alcohol Program Personnel and Services Contacts 57 APPENDIX B 57 Employee/Supervisory Positions Subject to Alcohol Testing 57 Affected Employees 57 APPENDIX C 59 Evidential Breath Testing (EBT) Collection Procedures 59 Alcohol Testing Form and Log Book 59 Breath Testing Locations 59 Breath Alcohol Testing Preparations 60 Screening Test Procedure 60 Confirmation Test Procedures 61 Refusals to Test and Uncompleted Tests 63 Inadequate Amount of Breath 63 Invalid Tests 64 APPENDIX D 65 Contractor Monitoring Procedures 65 ACKNOWLEDGMENT OF RECEIPT OF POLICY 66 SPECIFIC MEDICAL RELEASE 67 Appendix - Glossary of Definitions 68 DRUG DEFINITIONS 68 ALCOHOL MISUSE PREVENTION DEFINITIONS 69 Trisco Systems, Inc. Drugs, Marijuana and Alcohol Policy Purpose: Business Necessity Trisco Systems, Inc. recognizes the adverse effects that abuse of drugs, marijuana and alcohol can have on an employee's job performance and on our entire work environment. Additionally, Trisco Systems has the responsibility of complying with the Department of Transportation Drug and Alcohol Testing Procedures for DOT licensed drivers. We have chosen to include all employees we deem "safety sensitive" in our program. For your reference, italic print refers to Trisco Systems, Inc., Company Policy; standard block print refers to DOT specific policy which we are choosing to adopt for all designated, affected employees. The Company is legally responsible for providing a safe work environment. The Company also has a legal right to maintain a drug, marijuana and alcohol free workplace. In light of the Company's legal rights and responsibilities, the Company expects all employees to refrain from being under the influence of illegal drugs, marijuana or alcohol while on the job or on Company premises. The Company also expects Trisco Systems, Inc., employees to refrain from using, possessing, selling, purchasing, receiving or distributing illegal drugs, marijuana or alcohol while on the job or on Company premises, and to refrain from off -the -job abuse of illegal drugs, marijuana and alcohol which adversely affects job performance or threatens the property, safety or reputation of the Company or other employees. Trisco Systems, Inc., has adopted this Fitness for Duty Policy in order to maintain a safe and efficient workplace and to ensure a drug, marijuana and alcohol free environment. The Fitness for Duty Policy is an addendum to the current Employee Handbook. Nothing in this Fitness for Duty Policy alters, amends, or modifies the existing employment at will status of all Trisco Systems, Inc., employees. Trisco Systems, Inc., and its employees may terminate their employment relationship at any time, with or without notice, and for any or no reason not contrary to law. The Drug, Marijuana and Alcohol Fitness for Duty Policy is necessary to: Maintaining the safety of trucking and other safety sensitive operations by establishing a drug and alcohol free environment thereby minimizing the possibility of a drug or alcohol related operational accident; Provide direction to employees with substance abuse problems; Comply with the Department of Transportation Mandatory Drug and Alcohol Testing Programs, The Drug Free Workplace Act of 1986, and other applicable federal safety programs. Ensure the effective performance of employees; Guard against liability resulting from the actions of employees; Protect Company property and other employees against theft by persons who steal to support a substance abuse habit; Deter illegal activities; Provide an effective deterrent against pressure to experiment or continue use of deleterious compounds. Statement of Policy Drugs, Marijuana, and Alcohol It is the policy of Trisco Systems, Inc., to prohibit the use, sale, dispensing, possession, or manufacture of illegal drugs, controlled substances, and marijuana or alcoholic beverages on Company assignment. The use or possession of these controlled substances while on Company property, in any Company vehicle, or on Company time, including breaks or lunch, paid or unpaid, is strictly prohibited. Because each employee has a responsibility to themselves and others to deliver services in a safe and conscientious manner, employees will be subject to disciplinary action, up to and including immediate dismissal: For refusing to submit to a drug or alcohol test; 2 For bringing illegal drugs, controlled substances, marijuana or alcohol to work; 3 For being subject to the effects of illegal drugs, alcohol, marijuana or controlled substances while working; 4 For dispensing, distributing, manufacturing, or selling illegal drugs, controlled substances, marijuana or alcohol on Company premises and work sites; or S For bringing prescription drugs on Company premises for any person other than for whom it is prescribed. In order to promote as safe a job performance as possible, employees must be able to work in a drug free environment and be free from the effects of job impairing substances. When the Company has "reasonable cause " to believe an employee is under the influence of, or is using, possessing, selling, purchasing, receiving or distributing, "illegal drugs or alcohol" while "on the job " or on Company premises, or is otherwise abusing "illegal drugs or alcohol" in a manner which adversely affects job performance or threatens the property, safety or reputation of the Company or other employees, The Company may require the employee to submit to a search of.- (a) Any vehicle brought onto or parked on Company or Client premises, (b) Any pocket, package, briefcase, toolbox, athletic bag, lunch box, or other container brought onto Company premises, (c) Any desk, file cabinet, locker, toolchest, or other stationary container provided by the Company. The refusal to submit to a search can subject the employee to disciplinary action up to and including immediate dismissal. The disciplinary action imposed by this rule will be determined on a case -by -case basis following Company review of the facts. The Company does not prohibit employees from using prescription drugs while "on the job " or on Company premises, provided.• (a) the prescription drugs are prescribed for medical reasons by a licensed medical practitioner; and (b) the employee's use of prescription drugs does not adversely affect job performance or threaten the property, safety or reputation of the Company or other employees. The use of prescription drugs by employees while "on the job " or on Company premises shall be only in the manner, combination and quantity prescribed. The Company reserves the right to require submission to a fitness for duty exam and/or apply the disciplinary procedures of this policy to any employee who abuses prescription drugs in a manner which adversely affects job performance or threatens the property, safety or reputation of the Company and other employees. The Company prohibits employees from using over-the-counter drugs while on the job or on Company premises where such use: (a) adversely affects the employee's job performance; or (b) threatens the property, safety or reputation of the Company or other employees. The Company may apply the disciplinary procedures of this policy to any employee who uses over-the-counter drugs in a manner which violates either (a) or (b) of this paragraph. Being subject to the effects of an illegal drug or alcohol does not excuse an employee's misconduct which may violate any Company rule or policy. MEDICAL MARIJUANA. The State of Ohio legalized the use of Medical Marijuana effective September 8, 2018. The law authorized medical marijuana use by patients with 21 conditions, including cancer or chronic pain, in the form of edibles, oils, patches and vaporizing. Smoking is barred. The Ohio Code is clear in stating that the medical marijuana law does not affect how employers choose to establish and monitor drug use and testing policies for their employees. Trisco Systems, Inc. maintains its right to retain a drug, marijuana and alcohol free workplace. Therefore, Trisco Systems, Inc. will continue to test our employees for marijuana use, and to enforce policies that terminate, discipline, and/or refuse to hire individuals who have been using marijuana and fail drug testing policies as described here -in. Anti -Drug Policy Trisco Systems, Inc. shall require all employees, contracted employers, and contractors to follow all procedures, techniques, and methods outlined in 49 CFR Part 40, Part 382, and any applicable DOT agency regulation as of compliance date January 1, 1996 (382.115), as well as those outlined in this document. This written policy shall contain: Methods and procedures for compliance with all the requirements outlined in 49 CFR Part 40, Part 382, and any applicable DOT agency regulation; The name and address of the DAPM (Drug Abuse Program Manager) is found in Appendix A. The name and address of each laboratory that analyzed the specimens collected for drug testing. The name and address of Trisco System Inc.'s Medical Review Officer; and Procedures for notifying employees of the coverage and provisions of the policy. A contracted employer or a contractor shall allow access to property and records by the Company for the purpose of monitoring compliance with the requirements of this policy. Drug Testing Procedures If you have been selected for drug testing, the collection of your urine will be at a designated collection site and forwarded by them to a laboratory certified by the Department of Health and Human Services (DHHS). The procedures followed at the collection site should allow for individual privacy unless there is reason to believe that a particular individual may alter or substitute the urine specimen to be provided. The collection site person will take precautions to ensure that your specimen is not adulterated or diluted during the collection procedure. In addition, your specimen collection must follow strict chain of custody and security procedures. Responsibility for collection of your urine is solely that of the collection site facility. After the laboratory analysis, the results will be forwarded to the Medical Review Officer. The Medical Review Officer shall review and interpret any positive test results to determine if there is an alternative medical explanation for the confirmed positive test result. Prior to making a final decision to verify a positive test result to Trisco management, the Medical Review Officer will contact the employee at which time the employee will have an opportunity to discuss the test results with the Medical Review Officer and submit medical documentation of legally prescribed medications. Drug testing will be performed for any substance specified on Schedules I or II of the Controlled Substances Act, 21 U.S.C. 801.812 (1981 & 1987 Cum. P.P.) Including: marijuana, amphetamines, cocaine, opiates, phencyclidine, barbiturates, benzodiazepines, propoxyphene, and methadone. Screen and confirmation levels are found in Appendix B. Covered/Not Covered Employees The following classifications of jobs are considered a "Covered Employee" subject to drug testing under the Company's drug testing policy: Affected Employees 1. All new applicants for employment. 2. Any employee who appears to be impaired or is suspected of substance abuse (see reasonable cause) which may cause work impairment or safety considerations will be tested by a laboratory designated by the Company. In such cases, the employee will be placed on "involuntary" leave of absence immediately. If test results are positive, all benefits are terminated. Health insurance will lapse unless the employee is reinstated or provides otherwise in accordance to law. 3. Any employee who voluntarily admits to a substance abuse condition will be tested by a laboratory designated by the Company and will be placed on an immediate leave of absence and return to work only after a negative test result is obtained. 4. All management personnel, all supervisory personnel, all truck drivers, all sales staff, all field and production or warehouse personnel, and any other employee of Trisco Systems, Inc. including secretarial, clerical, and administrative staff, shall be subjected to periodic substance abuse testing. In addition, any applicant to any of these positions may be tested. S. Anyone involved in an accident on the job that requires medical attention or causes damage to product or facilities. 6. Any violation of Company Policies and/or Standards of Conduct and Discipline. NOTE: a) Refusal to take the substance abuse test shall be subject to immediate termination of employment. b) Any employee attempt to cheat on these tests or falsify test results shall be terminated. Therefore, Safety sensitive employees include; 1. All Project Managers. 2. All Foremen. 3. All Production Employees, including warehouse employees. 4. All operators of Trisco Systems, Inc., owned vehicles at any time. 5. All operators driving any other vehicle on Company business or during Company time. 6 All Sales, Clerical, Secretarial, and Administrative employees. The authority for DOT drivers' drug testing is derived from the Omnibus Transportation Employee Testing Act of 1991 and is conducted in accordance with the U.S. Department of Transportation's Drug Testing Procedures Rules: 49 CFR Part 40. The remainder of Trisco Systems Inc., employees are designated Safety -sensitive Employees by Company policy. Drug Testing Circumstances In order to improve the health of employees and help provide a safer workplace, the Company will conduct drug testing. All applicants and "covered" employees will be tested under the following circumstances: Pre -Placement Testing: Applicants for positions will be required to submit to drug testing. Positive results for any of the drugs screened will result in that applicant's disqualification for employment. Due to the nature of employment conditions, the Company may conduct Pre -Placement testing for a period prior to employment up to (30) days past hire date. 2 Post -Accident Testing: As soon as possible after an accident (but not later than 32 hours after an accident), the Company will drug test any employee whose performance either contributed to the accident or cannot be completely discounted as a contributing factor to the accident. If an employee is injured, unconscious, or otherwise unable to evidence consent to the drug test, all reasonable steps (listed below) must be taken to obtain a urine sample. Management may decide not to test under this paragraph, but such a decision must be based on the best information available immediately after the accident that the employee's performance could not have contributed to the accident or that, because of the time between that performance and accident, it is not likely that a drug test would reveal whether the performance was affected by drug use. POST ACCIDENT TESTING SHALL BE DONE: (a) On any surviving driver [who was performing safety sensitive functions with respect to the vehicle], of any motor vehicle involved in an accident, if the accident involved the loss of human life; (b) Who receives a citation under State or local law for a moving traffic violation arising from the accident; (c) Who, in the judgement of Trisco administration, has been involved in a high potential incident involving chemical or heavy equipment handling, or during critical procedure work, while that person was performing safety sensitive functions with respect to the incident. The Company must take all reasonable steps to obtain a urine sample from an employee following an accident. In the case of a conscious, but hospitalized employee, the supervisor should request that the hospital or medical facility obtain the sample from the employee. If an employee is injured, unconscious (employee is unable to communicate), or otherwise unable to evidence consent (employee is unable to sign custody and control form) to the drug test, all reasonable steps must be taken to obtain a urine sample from the employee. If an employee is conscious (employee can communicate) and he/she is able to evidence consent (employee able to sign custody 10 and control form) to the drug test and is able to void normally (without aid of catheters) the specimen shall be collected. If an employee who is subject to post accident testing is conscious, able to urinate normally (in the opinion of a medical professional), and refuses to be tested, that person must be removed from duty in accordance with 49 CFR 382.211. A supervisor shall develop written procedures/guidelines for employees and supervisors who are involved in accident situations which require post accident testing. A supervisor may decide not to test under the post accident provisions, but such a decision must be based on the best information available immediately after the accident that the employee's performance could not have contributed to the accident or that, because of the time between that performance and the accident, it is not likely that a drug test would reveal whether the performance was affected by drug use. 3 Random Drug Testing: Trisco Systems, Inc. shall administer, every 12 months, a number of unannounced random drug tests at an annualized rate equal to 15 percent of the total number of personnel in covered positions. The Company shall select or enroll in a consortium to select the employees for testing by using a random number table or a random number generator that is matched with an employee's social security number. The random drug testing will be conducted quarterly throughout the year. Trisco may decide to assign responsibility for random selection of tested employees to an outside responsible party (such as a consortium) ensuring true random testing. 4 Reasonable Cause Testing: Trisco Systems, Inc. shall drug test each employee when there is reasonable cause to believe the employee is using a prohibited drug. The decision to test must be based on a reasonable and articulable belief that the employee is using a prohibited drug on the basis of specific, contemporaneous physical, behavioral, or performance indicators of probable drug use. Supervisors, who are trained in detection of the possible symptoms of drug use according to 49 CFR Part 382.603, shall substantiate and concur in the decision to test an employee. 5 Return to Duty Testing: An employee who refuses to take or does not pass a drug test may not return to work until the employee passes a drug test and the medical review officer (MRO) has determined that the employee may return to duty. Refusal to take a drug test will be treated as if the employee failed the test. An employee returning to duty shall be subject to a reasonable program of follow up drug testing without prior notice for up to (1) year. If, during the follow up period, an employee tests positive for any of the drugs screened, the employee will be immediately discharged. If an employee fails an initial drug screening test (immunoassay), a confirmatory retest (gas chromatography/mass spectrometry) may be requested by, and paid for by the employee. When an employee transfers from a non safety sensitive position to a safety sensitive position, they shall immediately upon transfer, be subject to the provisions of this policy, including pre placement testing. 11 The urine specimens collected under DOT Regulations may only be used to test for controlled substances designated or approved for testing by the DOT and shall not be used to conduct any other analysis or test unless otherwise specifically authorized by the DOT. Drug Testing Laboratory Trisco Systems, Inc. shall use only drug testing laboratories certified by the Department of Health and Human Services under DOT procedures for drug testing. Preparation for Testing Trisco Systems, Inc., the collection site, and the certified laboratory shall develop and maintain clear and well documented procedures for collection, shipment, and accessioning of urine specimens under this policy. Such procedures shall include, at a minimum, the following: 1 Utilization of a standard drug testing custody and control form (Form #DOT 3900.9 or equivalent); 2 Use of a clean, single use specimen bottle that is securely wrapped until filled with the specimen, and the use of a tamper proof sealing system, designed in a manner such as to ensure against undetected opening; 3 Use of a shipping container in which the specimen and associated paperwork may be transferred and which can be sealed and initialed to prevent undetected tampering; Written procedures, instructions and training shall be provided as follows: a. Under normal circumstances, the Company will contract for and utilize when possible, an independent collection site. The independent collection site shall abide by all procedures, techniques, and methods outlined in 49 CFR Part 40, Part 382, and any applicable DOT agency regulation, as well as those outlined in this document. b. When an independent collection site is not available, the Company's collection procedures and training shall clearly emphasize that the collection site person is responsible for maintaining the integrity of the specimen collection and transfer process, carefully ensuring the modesty and privacy of the donor, and is to avoid any conduct or remarks that might be construed as accusatorial or otherwise offensive or inappropriate; C. The collection site person shall have successfully completed training to carry out this function, or shall be a licensed medical professional, or a technician who has been provided instructions for collection and certifies completion as required in this policy. d. Unless it is impracticable for any other individual to perform this function, a direct supervisor of an employee shall not serve as the collection site person for a test of the employee; and 12 In any case where a collection is monitored by non medical personnel or is directly observed, the collection site person shall be of the same gender as the donor. Specimen Collection Procedures Designation of collection site 1 The Company's drug testing program shall have one or more designated collection sites which have all necessary personnel, materials, equipment, facilities and supervision to provide for the collection, security, temporary storage, and shipping or transportation of urine specimens to a certified drug testing laboratory. 2 A designated collection site shall be a location having an enclosure within which private urination can occur, a toilet for completion of urination (unless a single use collector is used with sufficient capacity to contain the void), and a suitable clean surface for writing. The site must also have a source of water for washing hands, which if practicable should be external to the enclosure where urination occurs. Security 1 Procedures shall provide for the designated collection site to be secure. If a collection site facility is dedicated solely to urine collection, it shall be secure at all times. If a facility cannot be dedicated solely to drug testing, the portion of the facility used for testing shall be secured during drug testing by: (a) Ensuring other persons are not present. (b) Ensuring there is no undetected access through any rear doors. (c) Posting signs against access during the entire collection process. 2 If it is impractical to maintain continuous physical security of a collection site from the time the specimen is presented until the sealed mailer is transferred for shipment, the following minimum procedures shall apply: the specimen shall remain under the direct control of the collection site person from delivery to its being sealed in the mailer; and the mailer shall be immediately mailed, maintained in secure storage, or remain until mailed under the personal control of the collection site person. Authorized Personnel No unauthorized personnel shall be permitted in any part of the designated collection site where urine specimens are collected or stored. Only the collection site person may handle specimens prior to their securement in the mailing container or monitor or observe specimen collection. In order to promote security of specimens, avoid distraction of the collection site person and insure against any confusion in the identification of specimens, the collection site person shall have only one donor under their supervision at any time. For this purpose, a collection 13 procedure is complete when the urine bottle has been sealed and initialed, the drug testing custody and control form has been executed, and the employee has departed the site (or, in the case of an employee who was unable to provide a complete specimen, has entered a waiting area). Privacy 1 Procedures for collecting urine specimens shall allow individual privacy unless there is reason to believe that a particular individual may alter or substitute the specimen to be provided. 2 For purposes of this policy, the following circumstances are the exclusive grounds constituting reason to believe that the individual may alter or substitute the specimen: a. The employee has presented a urine specimen that falls outside the normal temperature range (32 - 38 C or 90 - 100 F), and: (I) the employee declines to provide a measurement of oral body temperature; or (II) Oral body temperature varies by more than 1 C or 1.8 F from the temperature of the specimen. b. The last urine specimen provided by the employee was determined by the laboratory to have a specific gravity of less than 1.003 and a creatinine concentration below 0.2 g/L; (Often the specimen returns dilute because the employee/applicant has taken a large amount of fluids to produce a urine specimen. However, the possibility of an adulterated specimen cannot be conclusively excluded. Therefore Trisco shall follow these rules :) i. Pre placement drug screen. If the Company supervisor so desires, the test may be canceled and the test recollected. The Company may require the recollection to be an observed urine drug screen collection procedure. ii. Periodic (annual) drug screen for employees. In this case the Company may require an observed urine drug screen collection procedure the next time a test would ordinarily be given. A dilute specimen is not reasonable suspicion/cause to require the donor to submit to another specimen collection. iii. Random drug screen. Trisco Systems, Inc. reserves the opportunity to require an observed urine drug screen collection procedure the next time a test would ordinarily be given. A dilute specimen is not reasonable suspicion/cause to require the donor to submit to another specimen collection. iv. Post -accident drug screen. A post accident canceled test may be recollected if still within the allotted 32-hour time frame. The Company may require an observed urine drug screen collection on the recollection. V. "For Cause" drug screen. A "for cause" canceled test may be recollected if the behavior that triggered the test in the first place 14 persists. Trisco Systems, Inc. may require an observed urine drug screen collection on the recollection. C. The collection site person observes conduct clearly and unequivocally indicating an attempt to substitute or adulterate the sample; or d. The employee has previously been determined to have used a controlled substance without medical authorization and the particular test was being conducted under a DOT agency regulation providing for follow up testing upon or after return to work. A higher level supervisor of the collection site person shall review and concur in advance with any decision by a collection site person to obtain a specimen under the direct observation of a same gender collection site person based upon the circumstances described in this section. Integrity and Identity of Specimen Precautions shall be taken to ensure that a urine specimen is not adulterated or diluted during the collection procedure and that information on the urine bottle and on the urine custody and control form can identify the individual from whom the specimen was collected. The following minimum precautions shall be taken to ensure that unadulterated specimens are obtained and correctly identified: 1 To deter the dilution of specimens at the collection site, toilet bluing agents shall be placed in toilet tanks wherever possible, so the reservoir of water in the toilet bowl always remains blue; 2 When an individual arrives at the collection site, the collection site person shall ensure that the individual is positively identified as the individual selected for testing (e.g., through presentation of photo identification or identification by a Company representative); 3 If the individual fails to arrive at the assigned time, the collection site person shall contact the Company Administration to obtain guidance on the action to be taken; 4 The collection site person shall ask the individual to remove any unnecessary outer garments such as a coat or jacket that might conceal items or substances that could be used to tamper with or adulterate the individual's urine specimen. The collection site person shall ensure that all personal belongings such as a purse or briefcase remain with the outer garments; 5 The individual shall be instructed to wash and dry their hands prior to urination; 6 After washing hands, the individual shall remain in the presence of the collection site person and shall not have access to any water fountain, faucet soap dispenser, cleaning agent, or any other materials which could be used to adulterate the specimen; 7 The individual may provide their specimen in the privacy of a stall or otherwise partitioned area that allows for individual privacy; 8 The collection site person shall note on the urine custody and control form any unusual behavior or appearance; 9 In the exceptional event that a Company designated collection site is not accessible and there is an immediate requirement for specimen collection (e.g., 15 circumstances requiring a post accident test), a public rest room may be used according to the following procedures: (i) A collection site person of the same gender as the individual shall accompany the individual into the public rest room which shall be made secure during the collection procedure. (ii) If possible, a toilet bluing agent shall be placed in the bowl and any accessible toilet tank. (iii) The collection site person shall remain in the rest room, but outside the stall, until the specimen is collected. (iv) If no blueing agent is available to deter specimen dilution, the collection site person shall instruct the individual not to flush the toilet until the specimen is delivered to the collection site person. (v) After the collection site person has possession of the specimen, the individual will be instructed to flush the toilet and to participate with the collection site person in completing the chain of custody procedures. 10 The collection site person shall instruct the employee to provide at least 45 ml of urine using the single method of collection. a. Since Trisco Systems, Inc. is subject to drug testing only under the testing rules of the Federal Highway Administration, the Company is required to use only the split sample method of collection. b. The following procedures shall be followed in this policy: vi. The collector may choose to direct the employee to urinate either directly into a specimen bottle or into a separate collection container. vii. If a separate collection container is used, the collection site person shall pour at least 30 ml of the urine from the collection container into the specimen bottle in the presence of the employee. This is to be used as the primary specimen. At least 15 ml shall be poured into the other bottle, to be used as the split specimen. viii. If a single specimen bottle is used as a collection container, the collection site person, in the presence of the donor, shall pour 15 ml of urine from the specimen bottle into a second specimen bottle (to be used as the split specimen) and retain the remainder (at least 30 ml) in the collection bottle (to be used as the primary specimen). ix. Nothing in this section precludes the use of a collection method or system that does not involve the physical pouring of urine from one container or bottle to another by the collection site person, provided that the method or system results in the subdivision of the specimen into a primary (30 ml) and a split (at least 15 ml) specimen that can be transmitted to the laboratory and tested in accordance with the requirements of 49 CFR Part 40.25. X. Both bottles shall be shipped in a single shipping container, together with copies 1, 2, and the split specimen copy of the chain of custody form, to the laboratory. xi. If the test result of the primary specimen is positive, the employee may request that the MRO direct that the split specimen be tested in a different DHHS certified laboratory for the presence of the drug(s) for which a positive result was obtained in the test of the 16 primary specimen. The MRO shall honor such a request if it is made within 72 hours of the employee having been notified of a verified positive test result. Trisco System, Inc. employees shall be responsible for the cost of any second test charges. xii. When the MRO informs the laboratory in writing that the employee has requested a test of the split specimen, the laboratory shall forward, to a different DHHS approved laboratory, the split specimen bottle, with seal intact, a copy of the MRO request, and the split specimen copy of the chain of custody form with appropriate chain of custody entries. xiii. The result of the test of the split specimen is transmitted by the second laboratory to the MRO. xiv. Action required by DOT agency regulations as the result of a positive drug test (e.g., removal from performing a safety sensitive function) is not stayed pending the result of the test of the split specimen. xv. If the result of the test of the split specimen fails to reconfirm the presence of the drug(s) or drug metabolite(s) found in the primary specimen, the MRO shall cancel the test, and report the cancellation and the reasons for it to the DOT, the employer, and the employee. 11 Upon receiving the specimen from the individual, the collection site person shall determine if it has at least 30 milliliters of urine. If the individual is unable to provide such a quantity of urine, the collection site person shall instruct the individual to drink not more than 24 ounces of fluids and, after a period of up to 2 hours, again attempt to provide a complete sample using a fresh collection container. The original insufficient specimen shall be discarded. If the employee is still unable to provide an adequate specimen, the insufficient specimen shall be discarded, testing discontinued, and the Company so notified. The MRO shall refer the individual for a medical evaluation to develop pertinent information concerning whether the individual's inability to provide a specimen is genuine or constitutes a refusal to test. (In pre placement testing, if the Company does not wish to hire the individual, the MRO is not required to make such a referral.) Upon completion of the examination, the MRO shall report their conclusions to Trisco Systems, Inc. in writing. 12 After the specimen has been provided and submitted to the collection site person, the individual shall be allowed to wash their hands. 13 Immediately after the specimen is collected, the collection site person shall measure the temperature of the specimen. The temperature measuring device used must accurately reflect the temperature of the specimen and not contaminate the specimen. The time from urination to temperature measure is critical and in no case shall exceed 4 minutes. 14 A specimen temperature outside the range of 32.5 - 37.7 C or 90.5 - 99.8 F constitutes a reason to believe that the individual has altered or substituted the specimen. In such cases, the individual supplying the specimen may volunteer to 17 have their oral temperature taken to provide evidence to counter the reason to believe the individual may have altered or substituted the specimen. 15 Immediately after the specimen is collected, the collection site person shall also inspect the specimen to determine its color and look for any signs of contaminants. Any unusual findings shall be noted on the urine custody and control form. 16 All specimens suspected of being adulterated shall be forwarded to the laboratory for testing. 17 Whenever there is reason to believe that a particular individual has altered or substituted the specimen, a second specimen shall be obtained as soon as possible under the direct observation of a same gender collection site person. 18 Both the individual being tested and the collection site person shall keep the specimen in view at all times prior to its being sealed and labeled. The specimen shall be sealed and labeled in the presence of the employee. 19 The collection site person and the individual being tested shall be present at the same time during procedures outlined in the policy. 20 The collection site person shall place securely on the bottle an identification label which contains the date, the individual's specimen number, and any other identifying information provided or required by the Company. 21 The individual shall initial the identification label on the specimen bottle for the purpose of certifying that it is the specimen collected from them. 22 The collection site person shall enter on the drug testing custody and control form all information identifying the specimen. The collection site person shall sign the drug testing custody and control form certifying that the collection was accomplished according to the applicable Federal requirements. 23 The individual shall be asked to read and sign a statement on the drug testing custody and control form certifying that the specimen identified as having been collected from them is in fact the specimen they provided. 24 The collection site person shall complete the chain of custody portion of the drug testing custody and control form to indicate receipt of the specimen from the employee and shall certify proper completion of the collection. 25 The urine specimen and chain of custody form are now ready for shipment. If the specimen is not immediately prepared for shipment, the collection site person shall ensure that it is appropriately safeguarded during temporary storage. 26 While any part of the above chain of custody procedures is being performed, it is essential that the urine specimen and custody documents be under the control of the involved collection site person. If the involved collection site person leaves their work station momentarily, the collection site person shall take the specimen and drug testing custody and control form with them or shall secure them. The collection site person shall not leave the collection site in the interval between presentation of the specimen by the employee and securement of the sample with an identifying label bearing the employee's specimen identification number and seal initialed by the employee. If it becomes necessary for the collection site person to leave the site during this interval, the collection shall be nullified and a new collection begun. ON Collection Control To the maximum extent possible, collection site personnel shall keep the individual's specimen bottle within sight both before and after the individual has urinated. After the specimen is collected, it shall be properly sealed and labeled. Transportation to Laboratory Collection site personnel shall arrange to ship the collected specimen to the drug testing laboratory. The specimens shall be placed in shipping containers designed to minimize the possibility of damage during shipment, (e.g., specimen boxes and/or padded mailers), and those containers shall be securely sealed to eliminate the possibility of undetected tampering with the specimen and/or the form. On the tape sealing the shipping container, the collection site person shall sign and enter the date the specimen was sealed in the shipping container for shipment. The collection site person shall ensure that the chain of custody documentation is enclosed in each container sealed for shipment to the drug testing laboratory. Since specimens and documentation are sealed in shipping containers that would indicate any tampering during transit to the laboratory and couriers, express carriers, and postal service personnel do not have access to the chain of custody forms, there is no requirement that such personnel document chain of custody for the shipping container during transit. Nor is there a requirement that there be a chain of custody entry when a specimen which is sealed in such a shipping container is put into or taken out of secure storage at the collection site prior to pickup by such personnel. This means that the chain of custody is not broken, and a test shall not be canceled because couriers, express carriers, postal service personnel, or similar persons involved solely with the transportation of a specimen to a laboratory, have not documented their participation in the chain of custody documentation or because the chain of custody does not contain entries related to putting the specimen into or removing it from secure temporary storage at the collection site. Failure to cooperate If the employee refuses to cooperate with the collection process, the collection site person shall inform the Company Administration and shall document the non -cooperation on the drug testing custody and control form. Employee requiring medical attention If the sample is being collected from an employee in need of medical attention (e.g., as part of a post accident test given in an emergency medical facility), necessary medical attention shall not be delayed in order to collect the specimen. 19 Laboratory Analysis Procedures Reporting results 1 The laboratory shall report test results to Trisco System's Medical Review Officer within an average of 5 working days after receipt of the specimen by the laboratory. The report shall identify the drugs/metabolites tested for, whether positive or negative, the specimen number assigned by the Company (if any), and the drug testing laboratory specimen identification number (accession number). 2 The laboratory shall report as negative all specimens that are negative on the initial test or negative on the confirmatory test. Only specimens confirmed positive shall be reported positive for a specific drug. 3 The laboratory shall send only to the Medical Review Officer the original or a certified true copy of the drug testing custody and control form which, in the case of a report positive for drug use, shall be signed by the individual responsible for day to day management of the drug testing laboratory or the individual responsible for attesting to the validity of the test reports, and attached to which shall be a copy of the test report. 4 The laboratory shall provide to the Company an aggregate quarterly statistical summary of urinalysis testing of the Company's employee. The laboratory shall provide the report to the Company not more than 14 calendar days after the end of the quarter covered by the summary. Laboratory confirmation data only shall be included from test results reported with that quarter. The summary shall contain only the following information: (a). Number of specimens received for testing; (b). Number of specimens confirmed positive for Marijuana metabolites, Cocaine metabolites, Opiates, Phencyclidine, and Amphetamine; (c). Number of specimens for which a test was not performed. Quarterly reports shall not contain personal identifying information or other data from which it is reasonable likely that information about an individual's test can be readily inferred. If necessary, in order to prevent disclosure of such data, the laboratory shall not send such a report until data are sufficiently aggregated to make such an inference unlikely. In any quarter in which a report is withheld for this reason, or because no testing was conducted, the laboratory shall so inform the Company in writing. Quality Assurance and Quality Control Employer blind performance test procedures 1 Trisco Systems, Inc. shall use blind testing quality control procedures. 2 The Company shall submit 3 blind performance test specimens for each 100 employee specimens it submits, up to a maximum of 100 blind performance test specimens submitted per quarter. The Company shall submit only blank samples, as an employer with fewer than 2000 employees. 3 Consortiums shall be responsible for the submission of blind samples on behalf of its members. The blind sampling rate shall apply to the total number of samples submitted by the consortium. 4 Should a false positive error occur on a blind performance test specimen and the error is determined to be an administrative error (clerical, sample mixup, etc.), the Company shall promptly notify the DOT agency concerned. The DOT agency and the Company shall require the laboratory to take corrective action to minimize the occurrence of the particular error in the future, and, if there is reason to believe the error could have been systemic, the DOT agency may also require review and reanalysis of previously run specimens. Reporting and Review of Results Positive test result I Prior to making a final decision to verify a positive test result for an individual, the MRO shall give the individual an opportunity to discuss the test result with them. 2 The MRO shall contact the individual directly, on a confidential basis, to determine whether the employee wishes to discuss the test result. 3 If, after making all reasonable efforts and documenting them, the MRO is unable to reach the individual directly, the MRO shall contact the Company's program administrator who shall direct the individual to contact the MRO as soon as possible. If it becomes necessary to reach the individual through the Company Supervisor, that Supervisor shall employ procedures that ensure, to the maximum extent practicable, the requirement that the employee contact the MRO is held in confidence. Exception: (a) If a test is verified positive the employee may present to the MRO information documenting that serious illness, injury, or other circumstances unavoidable prevented the employee from timely contacting the MRO. (b) If the MRO concludes that there is a legitimate explanation, the MRO may declare the test to be negative. 4 If, after making all reasonable efforts, the Company supervisor is unable to contact the employee, the Company may place the employee on temporary medical leave. 5 The MRO may verify a test as positive without having communicated directly with the employee about the test in 3 circumstances: (1) The employee expressly declines the opportunity to discuss the test; (2) The Company program administrator has successfully made and documented a contact with the employee and instructed the employee to contact the MRO, and more than 5 days have passed since the date the employee was successfully contacted by the Company supervisor; or (3) Other circumstances as provided for in applicable DOT agency drug testing regulations. 6 Before the MRO verifies a confirmed positive result for opiates, the MRO will determine that there is clinical evidence, in addition to the urine test, of 21 unauthorized us of any opium, opiate or opium derivative. (This requirement does not apply if the GUMS confirmation testing for opiates confirms the presence of 6-monocetylmorphine). [40.33(d)] 7 The MRO shall notify each employee who has a confirmed positive test that the employee has 72 hours in which to request a test of the split specimen, if the test if verified as positive. If the employee requests an analysis of the split specimen within 72 hours of having been informed of a verified positive test, the MRO shall direct, in writing, the laboratory to provide the split specimen to another DHHS certified laboratory for analysis. If the analysis of the split specimen fails to reconform the presence of the drug(s) or drug metabolite(s) found in the primary specimen, or if the split specimen is unavailable, inadequate for testing or untestable, the MRO shall cancel the test and report cancellation and the reasons for it to the DOT, the Company, and the employee. 8 If an employee has not contacted the MRO within 72 hours as provided above, the employee may present to the MRO information documenting that serious illness, injury, inability to contact the MRO, lack of actual notice of the verified positive test, or other circumstances unavoidably prevented the employee from timely contacting the MRO. If the MRO concludes that there is a legitimate explanation for the employee's failure to contact the MRO within 72 hours, the MRO shall direct that the reanalysis of the primary specimen or analysis of the split specimen, as applicable, be performed. Re -analysis Authorized Should any question arise as to the accuracy or validity of a positive test result, only the Medical Review Officer is authorized to order a re -analysis of the original sample and such retests are authorized only at laboratories certified by DHHS. The MRO shall authorize a re -analysis of the original sample if requested to do so by the employee within 72 hours of the employee's having received actual notice of the positive test. If the retest is negative, the MRO shall cancel the test. Result Scientifically Insufficient The MRO, based on review of inspection reports, quality control data, multiple samples, and other pertinent results, may determine that the result is scientifically insufficient for further action and declare the test specimen negative. In this situation the MRO may request re -analysis of the original sample before making this decision. (The MRO may request that re -analysis be performed by the same laboratory or, that an aliquot of the original specimen be sent for re- analysis to an alternate laboratory which is certified in accordance with DHHS Guidelines.) The laboratory shall assist in this review process a requested by the MRO by making available the individual responsible for day to day management of the urine drug testing laboratory or another employee who is a forensic toxicologist or who has equivalent forensic experience in urine drug testing, to provide specific consultation. 22 Disclosure of Information Except as provided in this paragraph, the MRO shall not disclose to any third party medical information provided by the individual to the MRO as a part of the testing verification process. 1 The MRO may disclose such information to Trisco Systems, Inc., a DOT agency or other federal safety agency, or a physician responsible for determining the medical qualification of the employee under an applicable DOT agency regulation, as applicable, only if: (1) An applicable DOT regulation permits or requires such disclosure; (2) In the MRO's reasonable medical judgment, the information could result in the employee being determined to be medically unqualified under an applicable DOT agency rule; or (3) In the MRO's reasonable medical judgment, in a situation in which there is no DOT agency rule establishing physical qualification standards applicable to the employee, the information indicates that continued performance by the employee of their safety sensitive function could pose a significant safety risk. 2 Before obtaining medical information from the employee as part of the verification process, the MRO shall inform the employee that information may be disclosed to third parties as provided in this policy and the identity of any parties to whom information may be disclosed. Protection of Employee Records Trisco Systems, Inc. contracts with laboratories shall require that the laboratory maintain employee test records in confidence, as provided in applicable DOT agency regulations. The contracts shall provide that the laboratory shall disclose information related to a positive drug test of an individual to the individual, the Company, or the decision maker in a lawsuit, grievance, or other proceeding initiated by or on behalf of the individual and arising from a certified positive drug test. Individual Access to Test and Laboratory Certification Results Any employee who is the subject of a drug test conducted under this policy shall, upon written request, have access to any records relating to their drug test and any records relating to the results of any relevant certification, review, or revocation of certification proceedings. Review of Drug Testing Results Medical Review Officer Appointment Trisco Systems, Inc. shall contract for a medical review officer (MRO). Medical Review Officer Qualifications 23 The MRO must be a licensed physician (medical doctor or doctor of osteopathy) with knowledge of substance abuse disorders and has appropriate medical training to interpret and evaluate an individual's confirmed positive test result together with their medical history and any other relevant biomedical information. The MRO must not be an employee of the laboratory conducting the drug tests. Medical Review Officer Duties The MRO shall perform the following functions for Trisco Systems, Inc: A. Review the results of ALL drug testing (both negative and positive) before they are reported to the Company; B. Review and interpret each confirmed positive test result to determine if there is an alternative medical explanation for the confirmed positive test result: 1 Conduct a medical interview with the individual tested; 2 Review the individual's medical history and any relevant biomedical factors; 3 Review all medical records made available by the individual tested to determine if a confirmed positive test resulted from legally prescribed medication; 4 If necessary, require that the original specimen be reanalyzed to determine the accuracy of the reported test result; and 5 Verify that the laboratory report and assessment are correct. C. Determine whether and when an employee who refused to take or did not pass a drug test administered under applicable DOT procedures may be returned to duty; D. Determine a schedule of unannounced testing, in consultation with Trisco Systems, Inc. management, for an employee who has returned to duty; and E. Ensure that an employee has been drug tested in accordance with applicable DOT procedures before the employee returns to duty. F. Not consider the results of urine samples that are not obtained or processed in accordance with this part. Medical Review Officer Determinations The following rules govern MRO determinations: A. If the MRO determines, after appropriate review, that there is a legitimate medical explanation for the confirmed positive test result other than the unauthorized use of a prohibited drug, the MRO is not required to take further action. B. If the MRO determines, after appropriate review, that there is no legitimate medical explanation for the confirmed positive test result other than the unauthorized use of a prohibited drug, the MRO shall refer the individual tested to Trisco Systems, Inc. for further referral to the Company's SAP (Substance Abuse Professional). C. Based on a review of laboratory inspection reports, quality assurance and quality control data, and other drug test results, the MRO may conclude that a particular drug test result is scientifically insufficient for further action. Before declaring 24 the scientifically insufficient test specimen negative, the MRO must consider the following: I A re -analysis of the original sample performed by the same laboratory; or 2 A re -analysis of the original sample to an alternate laboratory which is certified in accordance with DHHS Guidelines; or 3 Consultation with the drug testing laboratory concerning the drug test results. Under these circumstances, the MRO should conclude that the test is negative for the presence of a prohibited drug or drug metabolite in an individual's system. Retention of Samples and Retesting Samples that yield positive results on confirmation must be retained by the laboratory in properly secured, long term, frozen storage for at least 365 days as required by DOT procedures. Within this 365 day period, the employee (or their representative) or the Company may request that the laboratory retain the sample for an additional period. If, within the 365 day period, the laboratory has not received a proper written request to retain the sample for a further reasonable period specified in the request, the sample may be discarded following the end of the 365 day period. If the medical review officer (MRO) determines there is no legitimate medical explanation for a confirmed positive test result other than the unauthorized use of a prohibited drug, the original sample must be retested if the employee makes a written request for retesting within 60 days of receipt of the final test result from the MRO. The employee may specify retesting by the original laboratory or by a second laboratory that is certified by the Department of Heath and Human Services. The Company may require the employee to pay in advance the cost of shipment (if any) and reanalysis of the sample, but the employee must be reimbursed for such expense if the retest is negative. If the employee specifies retesting by a second laboratory, the second laboratory must be a DHHS certified laboratory, and the original laboratory must follow approved NIDA chain of custody procedures in transferring a portion of the sample. Since some analytes may deteriorate during storage, detected levels of the drug below the detection limits established in DOT procedures, but equal to or greater than the established sensitivity of the assay, must, as technically appropriate, be reported and considered corroborative of the original positive results. Substance Abuse Professional Trisco Systems, Inc. shall provide a Substance Abuse Professional for its employees and supervisory personnel. Employees who test positive on a drug test will be referred to Trisco Systems, Inc.'s Substance Abuse Professional for assessment, referral and case monitoring and may be granted an unpaid leave of absence to undertake rehabilitation treatment. An employee may use any accumulated 25 personal leave and/or vacation time to cover any absence. An employee may be granted leave for a maximum of 30 days for treatment, and may be extended up to an additional 30 days with evidence of continuing treatment. An employee can then return to work when they have complied with the Return to Duty Testing Requirements. The SAP is not designed to provide treatment, but rather to provide assessment and referrals to drug counseling and rehabilitation, education to the employees in the form of a Drug Free Awareness Program, and training of supervisory personnel in spotting and dealing with drug and substance abuse problems. Rehabilitation There are two general types of rehabilitation: a) Out patient visitation and/or counseling b) Institutional rehabilitation followed by outpatient counseling. For the purpose of this section, "Counseling and Out -Patient Counseling" shall be limited as follows: Employee will choose any approved counseling program recommended by the Substance Abuse Professional. If the employee elects to use a counseling service, the employee shall be responsible for all expenses in excess of his insurance paid. In addition, a weekly progress report from the counseling service will be submitted to Trisco Systems, Inc. The employee shall cooperate in executing a medical release providing Trisco Systems, Inc., with releasing information related solely to the drug addiction problem and counseling thereof. Three unexcused absences from either of the above referenced counseling programs shall subject the employee to immediate termination. Condition for Return to Work (after rehabilitation) 1) Employee will be tested at his expense two times during the first two months after returning to work. If the employee successfully completes this rehabilitation, he will be reimbursed one half of his drug test fees and expenses. Any additional testing will be at Trisco Systems, Inc., expense. 2) After the first year, Trisco Systems, Inc. may continue periodic testing at Trisco Systems, Inc., expense until the condition is considered fully cured. 3) Test results after returning to work: a) Any positive test result for a person who has had a prior `positive" shall be terminated immediately. b) For the first positive test result for anyone who voluntarily sought help prior to testing for rehabilitation, the employee shall be placed on an immediate leave of absence and return to work only after a "negative " is obtained. Any second positive test result shall be cause for immediate termination of employment. W. 4) Anyone who admits to a relapse after rehabilitation shall be placed on an immediate leave of absence and not returned to work until a negative is obtained. Any person who admits to more than one relapse shall be terminated. S) Once an employee has admitted himself/herself into a rehabilitation program, they may continue to work (OUTSIDE OF SAFETY SENSITIVE JOBS) provided that they cooperate with the recommendation of the administrators of such a program. If Trisco Systems, Inc. receives notice from the rehabilitation facility that the employee has failed to cooperate, then that employee shall be terminated immediately. Education and Training One of the primary responsibilities of Trisco Systems, Inc., in the drug and alcohol program, is for the training of supervisory personnel in the recognition of potential substance abusers and the education of employees on the hazards of substance abuse. (a) General requirements. Trisco Systems, Inc., shall provide educational materials that explain the requirements of this part and our policies and procedures with respect to meeting these requirements. (1) Trisco shall ensure that a copy of these materials is distributed to each affected employee prior to the start of alcohol and controlled substances testing under this part and to all employees subsequently hired or transferred into a position requiring driving a commercial motor vehicle. (2) Trisco shall provide written notice to representatives of employee organizations of the availability of this information. (b) Required content. The materials to be made available to employees shall include detailed discussion of at least the following: (1) The identity of the person designated by Trisco Systems, Inc., to answer questions about the materials; (2) Sufficient information about the safety -sensitive functions performed by those employees to make clear what period of the work day the employee is required to be in compliance with this part; (3) Specific information concerning employee conduct that is prohibited by this part; (4) The circumstances under which an employee will be tested for alcohol and/or controlled substances under this part; 27 (5) The procedures that will be used to test for the presence of alcohol and controlled substances, protect the employee and the integrity of the testing processes, safeguard the validity of the test results, and ensure that those results are attributed to the correct employee; (6) The requirement that an employee submit to alcohol and controlled substances tests administered in accordance with this part; (7) An explanation of what constitutes a refusal to submit to an alcohol or controlled substances test and the attendant consequences; (8) The consequences for employees found to have violated the drug and alcohol rules, including the requirement that the employee be removed immediately from the job and DOT drivers from safety -sensitive functions, and the procedures under § 382.605; (9) The consequences for employees found to have an alcohol concentration of 0.02 or greater but less than 0.04; (10) Information concerning the effects of alcohol and controlled substances use on an individual's health, work, and personal life; signs and symptoms of an alcohol or a controlled substances problem; and available methods of intervening when an alcohol or a controlled substances problem is suspected, including confrontation, referral to any employee assistance program and or referral to management. (d) Certificate of receipt. Trisco Systems, Inc shall ensure that each employee is required to sign a statement certifying that he or she has received a copy of these materials described in this section. Trisco shall maintain the original of the signed certificate and may provide a copy of the certificate to the employee. Education therefore shall include at least the following elements: 1 Display and distribution of informational materials; 2 Display and distribution of a community service hotline telephone number for employee assistance; and 3 Display and distribution of Trisco System Inc.'s Drugs, Narcotics, and Alcohol Policy regarding the use of prohibited substances. Training shall include at least the following elements: Training for supervisory personnel (who will determine whether an employee must be drug tested based on reasonable cause) shall include an initial 4-hour training session on the specific, contemporaneous physical, behavioral, and performance indicators of probable drug use with a 1-hour yearly refresher session. All field personnel will attend a 1-hour drug abuse session annually. Wl The following supervisory personnel shall receive the aforementioned training: A. All Trisco Systems Inc. Managers (Sales, Production, Office, and Project) B. Safety Director C. Job Site Foremen and Superintendents Recordkeeping In order to verify that the Company's Drug Policy is being followed, Trisco Systems, Inc. shall keep the following records for the periods specified and permit access to the records as provided by law: 1 Records that demonstrate the collection process conforming to this policy must be kept for at least 3 years; 2 Records of employee drug test results that show employees failed a drug test, and the type of test failed (e.g., post accident), and records that demonstrate rehabilitation, if any, must be kept for at least 5 years, and include the following information: (I) The functions performed by the employee who failed a drug test; (ii) The prohibited drug(s) which were used by the employee who failed a drug test; and (iii) The disposition of the employee who failed a drug test (e.g., termination, rehabilitation, leave without pay, etc.). 3 Records of employee drug test results that show an employee passed a drug test must be kept for at least 1 year. 4 A record of the number of employees tested, by the type of test (e.g., post accident), must be kept for at least 5 years; and 5 Records confirming that supervisory personnel and employees have been trained as required by this policy must be kept for at least 3 years. Privacy and Confidentiality With the exception of the testing laboratory, the MRO, and the Trisco Systems, Inc. Supervisor, information regarding an individual's drug testing results or rehabilitation may be released only upon the written consent of the individual, except that such information must be released regardless of consent to a DOT agency or other Federal safety agency or the representative of a state agency upon request as part of an accident investigation. Statistical data related to drug testing and rehabilitation that is not name specific and training records must be made available to the DOT upon request. To maintain confidentiality, written records shall be stored in locked containers or in a secured location. The MRO may disclose such information to the employer, a DOT agency or other Federal safety agency, or a physician responsible for determining the medical qualification of the employee under an applicable DOT agency regulation, as applicable, only if --(I) An applicable DOT regulation permits or requires such disclosure; (2) In the MRO's reasonable medical judgment, the information could result in the employee being determined to be medically unqualified under an applicable DOT agency rule; or (3) In the MRO's reasonable medical judgment, in a situation in which there is no DOT agency rule establishing physical qualification standards applicable to the employee, the information indicates that continued performance by the employee of his or her safety sensitive function could pose a significant safety risk. An employer may obtain, pursuant to a driver's written consent, any of the information concerning the driver which is maintained under this part by the driver's previous employers. Provisions under 49 CFR Part 382.413 (Release of alcohol and controlled substances test information by pervious employers) shall be followed. Removal from Safety -Sensitive Function" An employee will be removed immediately from a "safety -sensitive function" if that employee refuses to take a drug test or fails a drug test as follows: 1 An individual fails a drug test required by this policy, and the MRO determines there is no legitimate medical explanation for the confirmed positive test other than unauthorized use of a prohibited drug; 2 An individual refuses to take a drug test; 3 The only exceptions to item 2 above are as follows: A. Individuals who have passed a drug test following a positive test; B. Individuals who have been recommended by the MRO for Return to Duty; and, C. Individuals who have not failed a drug test after being returned to duty following a positive test. In addition, a person will not be used as an employee if that person refuses to take, or fails, a drug test or is in violation of this policy. Disciplinary Procedures for Positive Drug Test When an employee is tested positive for prohibited substances, the following procedures will be implemented.• I An immediate suspension from work activities for a minimum of (14) days unpaid medical leave will commence (unused vacation and/or personal leave may be utilized, or additional unpaid medical leave may be granted at the discretion of the Company); 2 The employee will be required to contact Trisco Systems, Inc. 's Substance Abuse Professional (SAP) counselor for evaluation and referral; 3 The employee will be required to abide by the decision of the SAP counselor regarding type of treatment, frequency of treatment, AANA meetings, etc.; 4 The employee will be required to complete all recommended treatment, counseling, etc. If outpatient aftercare and/or AA/NA meetings are recommended, these may be done while the employee is back to work. Out of town aftercare may be scheduled to meet work assignments. 5 At the appropriate time, the SAP counselor and the MRO will recommend a return to work drug test. If a negative test is received, the employee may return to work. If a positive test is received, employment termination will result. 6 An employee returning to duty shall be subject to a reasonable program of follow up drug testing without prior notice for up to (24) months. If, during the follow up period, an employee tests positive for any of the drugs screened or refuses to submit to a drug test, the employee will be immediately discharged. 7 Employment will not be terminated due to a first time positive drug test: (1) Post Accident; (2) Random; or (3) Reasonable Cause. 8 Employment WILL BE TERMINATED IMMEDIATELY if the employee elects not to follow and/or complete any of the procedures as described above, or as included in Trisco Systems Inc. 's Drugs, Narcotics, and Alcohol Policy. Referral Information Collection Sites St. Rita's Occupational Health Center 1875 South Dixie Highway Lima, Ohio 45804 (419) 226-9720 Or as directed by the service provider NIDA Certified Testing Laboratory Clinical Reference Laboratory 8433 Quivira Lenexa, KS 66215 Medical Review Officer Dr. Seth Portnoy 5456 W. Atlantic Blvd Margate, FL 33063 (954)-677-1200 Employee Assistance Program (SAP) ProMedica Employee Assistance Program Lima Professional Office Building I 1220 E. Elm St. Suite 240 Lima, Ohio 45802 (866)-327-3759 Employee Notification It is the policy of Trisco Systems, Inc. to make the Company's Drugs, Narcotics, and Alcohol Policy available to all employees. 31 All current employees will have an opportunity to review and copy the policy, and all new employees will have it reviewed with them within 5 working days upon commencement of work. A copy of the Company's Drugs, Narcotics, and Alcohol Policy shall be kept current and may be reviewed at the administrative office by contacting the Trisco Systems, Inc. Supervisor. Conclusion This Drugs, Narcotics, and Alcohol Policy is for informational purposes only and does not create an employment contract. The management of Trisco Systems, Inc. is committed to reviewing its policies continually; therefore, the policies outlined here are subject to review and change at any time. Alcohol Misuse Prevention Policy (AMPP) Introduction Statement of Policy 1 Trisco Systems, Inc. has a long standing commitment to maintain the highest standards for employee safety and health and to help prevent accident and injury resulting from the misuse of alcohol by employees. 2 In addition, Trisco Systems, Inc. must comply with all Department of Transportation regulations and other regulations which require affirmative actions to eliminate the impact of the misuse of alcohol in the workplace. The purpose of the alcohol misuse prevention plan is to reduce accidents that result from the misuse of alcohol, thereby reducing fatalities, injuries, and property damage. 3 The use or possession of alcoholic beverages while on Company property, in any Company vehicle, or on Company time, including breaks or lunch, paid or unpaid, is strictly prohibited. 4 The Alcohol Misuse Prevention Plan contained herein sets forth the requirements of 49 CFR Part 40 and Part 382. Trisco Systems, Inc. reserves the right to independent authority to require additional provisions (included here) with regard to alcohol testing procedures. Implementation of Alcohol Misuse Prevention Plan (AMPP) 1 Trisco Systems, Inc. has implemented the Federal Highway Administration Alcohol Regulations as set forth in 49 CFR Part 3 82, Subparts A thru F, and the Department of Transportation, Procedures for Transportation Workplace Alcohol Testing Programs as set forth in 49 CFR Part 40, Subpart C. 2 The privacy and confidentiality of any covered employee subject to this plan will be maintained at all times. Implementation of the Alcohol Misuse Prevention Plan is effective January 1, 1995 for Large Supervisors with more than 50 covered employees. 32 Implementation for Small Supervisors with 50 or fewer employees is January 1, 1996. [382.115] Background The catalyst for the alcohol misuse plan is Title 49 Code of Federal Regulations (CFR) Part 382, Subpart C, which requires FHWA employers to test their employees for misuse of alcohol under the following work related conditions: A. Random B. Post Accident C. Reasonable Suspicion D. Return to Duty E. Follow Up 2. Title 49 CFR Part 40 specifies procedures which must be followed by the Company when conducting alcohol misuse testing pursuant to regulations issued by agencies of the Department of Transportation. Preemption Provisions 1. Except as provided in paragraph 2 of this section, Part 382 Subpart C preempts any state or local law, rule, regulation, or order to the extent that: a. Compliance with both the state or local requirement and this regulation is not possible; b. Compliance with the state or local requirement is an obstacle to the accomplishment and execution of any requirement as set forth in 49 CFR Part 382; or 2. This provision shall not be construed to preempt provisions of state criminal law that impose sanctions for reckless conduct leading to actual loss of life, injury, or damage to property, whether the provisions apply specifically to employees, employers or to the general public. Trisco Systems, Inc. Responsibilities 1. Alcohol Program Manager (APM): Appendix A contains the name, address and telephone number of the responsible individual(s). The APM or other Company designated individual(s) shall be responsible for the preparation of an alcohol misuse plan which complies with requirements of the Department of Transportation regulations as set forth in 49 CFR Parts 382, and 49 CFR, Part 40, Subpart C. The APM shall be responsible for providing oversight and evaluation on the plan; providing guidance and counseling; reviewing of all discipline applied under this plan for consistency and conformance to human resources policies and procedures; scheduling for types of testing (post accident, reasonable suspicion, etc); maintaining a locked file system on all alcohol test results; and overseeing the referral of employees for evaluation and treatment as it is defined 33 in 49 CFR, Part 382.605. Trisco Systems, Inc. shall ensure that all covered employees are aware of the provisions and coverage of Trisco Systems, Inc.'s AMPP. 2. Supervisor(s): Trisco Systems, Inc. individuals responsible for observing the performance and behavior of employees; observation/documentation of events suggestive of reasonable suspicion; and post accident testing if determined that it is applicable. Normally this will be Trisco Systems, Inc.'s on site job foremen, Managers, or management personnel. 3. Employees: Trisco Systems, Inc. shall ensure that each employee is notified and aware of the provisions of the Trisco Systems, Inc.'s AMPP and is knowledgeable of the requirements of the Trisco Systems, Inc.'s AMPP and to fully comply with the provisions of the plan. Employee/Supervisor Alcohol Testing Provisions Individuals Subject to Alcohol Testing The following classifications of jobs are considered a "Covered Employee" subject to alcohol testing under the Trisco Systems, Inc.'s alcohol testing policy: Affected Employees 1. (NOTE: All new applicants for employment are subject to drug testing only.) 2. Any employee who appears to be impaired or is suspected of substance abuse (see reasonable cause) which may cause work impairment or safety considerations, will be tested by a laboratory designated by the Company. In such cases, the employee will be placed on "involuntary" leave of absence immediately. If test results are positive, all benefits, health insurance will lapse unless the employee is reinstated or provides otherwise in accordance to law. 3. Any employee who voluntarily admits to a substance abuse condition will be tested by a laboratory designated by the Company and will be placed on an immediate leave of absence and return to work only after a negative test result is obtained. 4. All management personnel, all supervisory personnel, all truck drivers, all sales staff, all field and production or warehouse personnel, and any other employee of Trisco Systems, Inc. including secretarial, clerical, and administrative staff, shall be subjected to periodic substance abuse testing. In addition, any applicant to any of these positions may be tested. S. Anyone involved in an accident on the he job that requires medical attention or causes damage to product or facilities. 6. Any violation of Company Policies and/or Standards of Conduct and Discipline. NOTE: a) Refusal to take the substance abuse test shall be subject to immediate termination of employment. b) Any employee attempt to cheat on these tests or falsify test results shall be terminated. 34 Therefore, Safety sensitive employees include; 1. All Project Managers. 2. All Foremen. 3. All Production Employees, including warehouse employees. 4. All operators of Trisco Systems, Inc., owned vehicles at any time. 5. All operators driving any other vehicle on Company business or during Company time. 6. All clerical, secretarial, and administrative employees. The authority for DOT drivers' drug and alcohol testing is derived from the Omnibus Transportation Employee Testing Act of 1991 and is conducted in accordance with the U.S. Department of Transportation's Drug and Alcohol Testing Procedures Rules: 49 CFR Part 40. The remainder of Trisco Systems Inc., employees are designated Safety -sensitive Employees by Company policy. Procedures for Notifying Covered Employees This AMPP shall be included in the appropriate Trisco Systems, Inc. Manual. Upon receipt of the Trisco Systems, Inc.'s AMPP, each manager shall post the plan in a prominent location that is readily accessible to all covered employees. All covered employees will be provided a complete copy of the AMPP plan. The entire plan may also be obtained at a later time for review by an employee. Criteria for Employee Notification General Criteria: Trisco Systems, Inc. shall provide written educational materials explaining the alcohol misuse requirements and Trisco Systems, Inc.'s policies and procedures on how they will comply with those requirements. Trisco Systems, Inc. will distribute to each covered employee prior to the start of alcohol testing and to each person subsequently hired/transferred to perform covered functions. Required Information: Trisco Systems, Inc. shall provide written materials to all covered employees that shall include detailed information and discussion of the following elements: 1. Name of Trisco Systems, Inc. representative designated to answer questions for covered employees about the alcohol regulations. (See Appendix A) 2. List of categories of covered employees who are subject to the alcohol regulations. (See Appendix B for a listing of employee/supervisory job classifications/titles) 35 3. Information about covered functions which provides sufficient guidance on which portions of the work day the covered employee is required to be in compliance with the AMPP. 4. Information concerning covered employee conduct which specifies what is prohibited by the AMPP. 5. Circumstances under which a covered employee will be tested for alcohol under the AMPP. 6. Procedures that cover: a. Testing for presence of alcohol; b. Protection of employee rights; C. Integrity of breath testing process; d. Safeguarding validity of test results; and e. Assignment of test results to proper employee. 7. Information concerning the requirement for a covered employee to submit to various types of alcohol tests. 8. Information detailing what constitutes a refusal, and consequences of such refusal. 9. Information detailing consequences of covered employees who violate the prohibitions as set forth in the AMPP. It must address removal from performing covered functions and guidance on referral for evaluation and/or treatment. 10. Information detailing consequences of covered employees who test at an alcohol concentration of 0.02 or greater but less than 0.04 11. Information detailing alcohol misuse and: a. How it impacts on an individual's health, work and personal life; b. Detecting signs and symptoms of an alcohol problem; and C. Intervening, evaluation and resolving problems associated with alcohol misuse (suspicions, confrontation, referral to SAP and referral to management official). Alcohol Tests Required Random Testing 1. The minimum annual percentage rate for random alcohol testing shall be 15 percent of the average number of safety -sensitive positions. 2. NOTE: The FHWA Administrator's decision to increase or decrease the minimum annual percentage rate for alcohol testing is based on the reported violation rate for the entire industry. Each year the FHWA Administrator will publish in the Federal Register the minimum annual percentage rate for random alcohol testing of drivers. The new minimum annual percentage rate for random alcohol testing will be applicable starting January 1 of the calendar year following publication. Trisco Systems, Inc. will then adhere to the new percentage rate for random testing. 3. The selection of safety -sensitive employees for random alcohol testing shall be made by a scientifically valid method, such as a random number table of a computer based random number generator that is matched with employees' Social Security numbers. Under the selection process used, each employee shall have an W. equal chance of being tested each time selections are made. As Trisco Systems, Inc. Administration conducts random testing for alcohol through a consortium, the number of employees to be tested is based on the total number of employees covered by the consortium who are subject to random alcohol testing at the same minimum annual percentage rate under this rule. 4. Trisco Systems, Inc. Safety Manager shall ensure that random alcohol tests conducted under this part are unannounced and that the dates for administering random alcohol tests are spread reasonable throughout the calendar year. 5. Trisco Systems, Inc. Safety Manager requires that each employee who is notified of selection for random alcohol testing proceeds to the test site immediately; provided, however that if the employee is performing a safety -sensitive function at the time of notification, the Trisco Systems, Inc. Safety Manager shall instead ensure that the driver ceases to perform the safety -sensitive function and proceeds to the testing site as soon as possible. 6. An employee shall only be tested for alcohol while the employee is performing safety -sensitive functions, just before the employee is to perform safety -sensitive functions, or just after the employee has ceased performing safety -sensitive functions. Post Accident Testing l . Trisco Systems, Inc. shall promptly determine and test each covered employee for alcohol if that employee's performance contributed to the accident or cannot be completely discounted as a contributing factor to the accident. The decision not to administer an alcohol test under this section shall be based on the Safety Manager's determination, using the best available information at the time of the determination that the employee's performance could not have contributed to the accident. 2. Trisco Systems, Inc. shall conduct an alcohol test within two hours of the accident. If the test is not conducted within two hours of the accident Trisco Systems, Inc. shall prepare and maintain a written document explaining why the test was not conducted. Trisco Systems, Inc. shall continue all efforts to conduct the alcohol test. If the test is not conducted within eight hours Trisco Systems, Inc. shall cease all attempts to conduct the test and shall prepare and maintain written documentation as to why the test was not conducted. 3. Employees should make every effort to obtain assistance in responding to an accident, including leaving the scene temporarily for that purpose where absolutely necessary. However, an employee who is subject to post accident testing who fails to remain readily available for such testing, including notifying the Trisco Systems, Inc. representative of their location if they leave the scene of the accident prior to submission of such test, may be deemed by Trisco Systems, Inc. to have refused to submit to testing. 4. The employee must remain available for alcohol testing and may not consume any alcohol for 8 hours following the accident or until the alcohol test has been conducted. Notwithstanding the previous statement, employees should seek and obtain emergency medical care whenever necessary. 37 5. The following steps will be used to guide the supervisor to a satisfactory outcome in a post accident situation: a. Verify the post accident decision. Does the definition of accident in the first part of this AMPP apply to the current situation? Does the possibility exist that the employee's performance contributed to the accident or cannot be completely discounted as a factor which contributed to the accident? Anonymous tips must be taken seriously, but should not be the sole reason to initiate a request for a specimen. If witnesses saw a specific event or behavior, ask them to describe what they saw. How far away were they? Before proceeding further, individual may need to obtain approval from management to proceed with post accident testing. b. Isolate and inform the employee. Remove the employee from the work place. Explain that you have reason(s) to believe their performance contributed to the accident or cannot be completely discounted as a contributing factor to the accident and therefore, they will be required to submit to an alcohol test. C. Transport the employee. The potentially affected employee should not be allowed to proceed alone to or from the collection site. In addition to the safety concerns for the employee, accompanying the employee also assures that there is no opportunity en route to the collection site for the employee to ingest anything that could affect the outcome of the alcohol test. d. Document the events. Record the activity performed that support the determination to conduct a post accident alcohol test. This documentation of the employee's activity should be prepared and signed by the supervisor and remain on file. e. Denial should be an expected reaction. If a person knows they will test positive, they may give many explanations and protestations, wanting to avoid submission to an alcohol test. If they are not under the influence of alcohol, vehement denial also would be expected. Listen to the employee and carefully evaluate the employee's explanation. Remember, a request for an alcohol test is not an accusation, it is merely a request for additional objective data. f. Following administration of alcohol test. After returning from the collection site, the employee should not be allowed to return to perform any covered functions if their alcohol test result is positive and if any disciplinary action is pending. Reasonable Suspicion Testing Reasonable suspicion testing is designed to provide management with a tool (in conjunction with supervisor training on the signs and symptoms of alcohol misuse) to identify alcohol affected employees who may pose a danger to themselves and others in their job performance. Employees may be at work in a condition that raises concern regarding their safety or productivity. Supervisors must then make a decision as to whether there is reasonable suspicion to believe an employee is using or has used alcohol. Testing shall be authorized using the W] following determinations only when observations are made during, just before or just after performing covered functions: 1. Supervisor Reasonable Suspicion Determinations: a. The Supervisor's determination that reasonable suspicion exists to require a covered employee to undergo an alcohol test shall be based on specific, contemporaneous, articulable observations concerning the appearance, behavior, speech, or body odors of the employee. The required observations shall be made by supervisors who have received at least 60 minutes of training in detecting the symptoms of alcohol misuse, in accordance with 382.603. b. The supervisor who makes such a determination that reasonable suspicion exists shall not be authorized to conduct the breath alcohol test on that employee. 2. In making a determination of reasonable suspicion, the factors to be considered include, but are not limited to, the following: a. Adequately documented pattern of unsatisfactory work performance, for which no apparent non impairment related reason exists, or a change in an employee's prior pattern of work performance, especially where there is some evidence of alcohol related behavior on or off the work site. b. Physical signs and symptoms consistent with alcohol abuse. C. Evidence of prohibited alcohol use, possession, sale, or delivery while on duty. d. Occurrence of a serious or potentially serious accident that may have been caused by human error, or flagrant violations of established safety, security, or other operational procedures. 3. The following steps will be used to guide the supervisor to a satisfactory outcome in a reasonable suspicion situation: a. Verify the reasonable suspicion decision. Anonymous tips must be taken seriously, but should not be the sole reason to initiate a request for a specimen. Hearsay is not an acceptable basis for reasonable suspicion referral. If witnesses saw a specific event or behavior, ask them to describe what they saw. How far away were they? How long did they observe the person? What, if anything, caused them to believe it was alcohol related? On what basis did they reach their conclusion? Before proceeding further, obtain concurrence or approval from management to proceed with reasonable suspicion alcohol testing. b. Isolate and inform the employee. Remove the employee from the work location. Explain that there is reasonable suspicion to believe the employee's performance is being affected by alcohol. Ask the employee to explain the suspected behavior and to describe the events that took place from their perspective. Ask if there is any medication or physical condition that would explain the behavior. A persuasive explanation may or may not deter you from asking for the employee to submit to an alcohol test. If there is still a reasonable belief that alcohol is a factor in the situation/incident, a request for testing should be made; if no reasonable MWO El 5. belief is determined then a request for testing should not be made. If the decision to test is made, inform the employee that they are being requested to accompany the appropriate Trisco Systems, Inc. representative to the specimen collection site to conduct an alcohol test. Inform the employee of the consequences of refusal to submit to alcohol testing. C. Review your findings. During the conversation, observe physical and mental symptoms. Be sure to document any characteristics that either support or contradict initial information. In all cases a reasonable suspicion decision must be made by 2 supervisors who have received the required training. This creates greater objectivity, provides additional observation, and generally strengthens the defensibility of the reasonable cause determination. d. Transport the employee. The potentially affected employee should not be allowed to proceed alone to or from the collection site. In addition to the safety concerns for the employee, accompanying the employee also assures that there is no opportunity en route to the collection site for the employee to ingest anything that could affect the alcohol test result. e. Document the events. Record the behavioral signs and symptoms that support the determination to conduct a reasonable suspicion alcohol test. This documentation of the employee's conduct should be prepared and maintained on file to document the request for reasonable suspicion alcohol testing. f. Denial should be an expected reaction. If a person knows they will test positive, they may give many explanations and protestations, wanting to avoid alcohol testing. If they are not under the influence or affected by alcohol, vehement denial also should be expected. Listen to the employee and carefully evaluate the employee's explanation. Remember, a request to submit to an alcohol test is not an accusation; it is merely a request for additional objective data. g. Following administration of alcohol test. After returning from the collection site, the employee should not be allowed to return to performing any covered functions if their alcohol test result is positive and if any disciplinary action is pending. The employee should make arrangements to be transported home. The employee should be instructed not to drive any motor vehicle due to the reasonable suspicion belief that they may be under the influence of alcohol. Trisco Systems, Inc. shall conduct an alcohol test within two hours of a determination to test under reasonable suspicion. If the test is not conducted within two hours of the reasonable suspicion determination Trisco Systems, Inc. shall prepare and maintain a written document explaining why the test was not conducted. Trisco Systems, Inc. shall continue all efforts to conduct the alcohol test. If the test is not conducted within eight hours Trisco Systems, Inc. shall cease all attempts to conduct the test and shall prepare and maintain written documentation as to why the test was not conducted. Trisco Systems, Inc. shall not permit a covered employee to report for duty or remain on duty requiring the performance of covered functions while the 40 employee is under the influence of or impaired by alcohol, as shown by the behavioral, speech, or performance indicators of alcohol misuse, nor shall the employee be permitted to perform or continue to perform covered functions as follows: a. No employee tested under the provisions of subpart C of 49 CFR Part 382 who is found to have an alcohol concentration of 0.02 or greater but less than 0.04 shall perform or continue to perform safety -sensitive functions for Trisco Systems, Inc.. b. No such employee shall perform a safety -sensitive function until the start of the next regularly scheduled duty period, but not less than 24 hours following administration of the test. 6. Except as provided above, Trisco Systems, Inc. shall not take any action under 49 CFR Part 382 against a covered employee based solely on test results showing an alcohol concentration less than 0.04. However, this does not prohibit Trisco Systems, Inc. from taking any disciplinary action otherwise consistent with local and/or state laws. Return to Duty Testing 1. Trisco Systems, Inc. shall ensure that before an employee returns to duty to perform covered functions after engaging in prohibited conduct, that employee shall undergo a return to duty alcohol test with a result indicating an alcohol concentration of less than 0.02. Trisco Systems, Inc. shall not permit an employee who refuses to submit to an alcohol test to perform or continue to perform covered functions. 2. If the substance abuse professional makes a determination that some form of evaluation and/or treatment is required, then the employee must comply with the recommended provisions in order to be considered eligible to return to duty. Follow Up Testing I. Following the determination that a covered employee is in need of assistance in resolving problems associated with alcohol misuse, the employee will be subject to announced follow up alcohol testing as directed by a substance abuse professional. An employee who returns to duty shall be subject to a reasonable program of follow up alcohol testing, with prior notice, for up to 60 months after their return to duty. 2. The employee shall be subject to at least 6 unannounced alcohol follow up tests during the first (24) months following their return to duty. The substance abuse professional may terminate the requirement for follow up testing at any time after the initial 6 tests have been completed, if the substance abuse professional makes the determination that such testing is no longer warranted. Testing shall be conducted just before the employee is to perform; while an employee is performing; or just after the employee has ceased performing a covered function. 41 3. Trisco Systems, Inc. may require a covered employee to submit to drug follow up testing when the substance abuse professional has reason to suspect drug involvement. The drug testing must comply with the requirements contained in 49 CFR Part 40, Subpart A. Provisions Governing Retesting of Covered Employees 1. A covered employee tested and found to have an alcohol concentration of 0.02 or greater but less than 0.04 shall not be permitted to perform or continue to perform covered functions until: a. The start of the employee's next regularly scheduled duty period, but not less than 24 hours following administration of the alcohol test. 2. Except as provided above, Trisco Systems, Inc. shall not take any action under 49 CFR Part 382 against a covered employee based solely on test results showing an alcohol concentration less than 0.04. However, this does not prohibit Trisco Systems, Inc. from taking any disciplinary action otherwise consistent with local and/or state law. Alcohol Prohibited Conduct Trisco Systems, Inc. shall provide guidance to all covered employees regarding the various types of alcohol prohibited conducts. Alcohol Concentration A covered employee shall be prohibited from reporting for duty or remaining on duty requiring the performance of covered functions while having an alcohol concentration of 0.04 or greater. If a Trisco Systems, Inc. representative has actual knowledge that a covered employee has an alcohol concentration of 0.04 or greater, the employee shall not be permitted to perform or continue to perform covered functions. Pre Duty Use Trisco Systems, Inc. shall prohibit a covered employee from using alcohol within 4 hours prior to performing covered functions, or if an employee is called to duty to respond to an emergency, within the time period after the employee has been notified to report for duty. If Trisco Systems, Inc. has actual knowledge that a covered employee has used alcohol within 4 hours prior to performing covered functions or within the time period after the employee has been notified to report for duty, the employee shall not be permitted to perform or continue to perform covered functions. 42 On Duty Use Trisco Systems, Inc. shall prohibit a covered employee from using alcohol while performing covered functions. If a Trisco Systems, Inc. representative has actual knowledge that a covered employee is using alcohol while performing covered functions, the employee shall not be permitted to perform or continue to perform covered functions. Use of Employee Who Refuses Alcohol Test Refusal to submit to a post accident, reasonable suspicion or follow up alcohol test shall result in the covered employee not being allowed to perform or to continue to perform any covered functions. Trisco Systems, Inc. may impose such additional disciplinary actions as is deemed appropriate. This may include removal from performing covered functions, suspension (with or without pay), and even termination. Disciplinary Actions General A covered employee who has an alcohol test administered and the alcohol concentration is greater than 0.02 shall not be permitted to perform covered functions or, if greater than 0.04, to continue to perform covered functions. Required Referrals and Evaluations No covered employee who has violated the rules on alcohol misuse or refuses to submit to testing can perform any covered function unless and until that employee has: 1. Been evaluated by a SAP to determine whether the employee is in need of assistance in resolving problems related to alcohol use. 2. Completed any treatment recommended by the SAP. 3. Been evaluated by a SAP to ensure that the employee has properly followed the treatment program. 4. Undergone a return to duty alcohol test with resulting alcohol concentration of less than 0.02. 5. Entered into a treatment program for approved evaluation and rehabilitation program and successfully completed the program. Rehabilitation There are two general types of rehabilitation: a) Out patient visitation and/or counseling b) Institutional rehabilitation followed by outpatient counseling. 43 For the purpose of this section, "Counseling and Out -Patient Counseling" shall be limited as follows: Employee will choose any approved counseling program recommended by the Substance Abuse Professional. If the employee elects to use a counseling service, the employee shall be responsible for all expenses in excess of his insurance paid. In addition, a weekly progress report from the counseling service will be submitted to Trisco Systems, Inc. The employee shall cooperate in executing a medical release providing Trisco Systems, Inc., with releasing information related solely to the alcohol addiction problem and counseling thereof. Three unexcused absences from either of the above referenced counseling programs shall subject the employee to immediate termination. Condition for Return to Work (after rehabilitation) 1) Employee will be tested at his expense two times during the first two months after returning to work. If the employee successfully completes this rehabilitation, he will be reimbursed one half of his alcohol test fees and expenses. Any additional testing will be at Trisco Systems, Inc., expense. 2) After the first year, Trisco Systems, Inc., may continue periodic testing at Trisco Systems, Inc., expense until the condition is considered fully cured. 3) Test results after returning to work: a) Any positive test result for a person who has had a prior `positive" shall be terminated immediately. b) For the first positive test result for anyone who voluntarily sought help prior to testing for rehabilitation, the employee shall be placed on an immediate leave of absence and return to work only after a "negative" is obtained. Any second positive test result shall be cause for immediate termination of employment. 4) Anyone who admits to a relapse after rehabilitation shall be placed on an immediate leave of absence and not returned to work until a negative is obtained. Any person who admits to more than one relapse shall be terminated. S) Once an employee has admitted himself/herself into a rehabilitation program, they may continue to work (OUTSIDE OF SAFETY SENSITIVE JOBS) provided that they cooperate with the recommendation of the administrators of such a program. If Trisco Systems, Inc., receives notice from the rehabilitation facility that the employee has failed to cooperate, then that employee shall be terminated immediately. 44 Levels of Disciplinary Actions (Trisco Systems, Inc. Policy) Disciplinary action as set forth below will be taken under each of the described circumstances: 1. Refusal to report for assessment with a substance abuse professional. If an employee refuses to report for assessment, evaluation, and/or referral for treatment with a substance abuse professional (SAP), employment will be terminated. 2. Refusal to enter or successfully complete a rehabilitation program. If an employee, after assessment, is referred for rehabilitation and the employee refuses to enter or successfully complete such a rehabilitation assessment program, employment will be terminated. 3. Repeat usage. In all cases of an employee having an alcohol concentration of 0.04 or greater, and who has tested a second time at alcohol concentrations of 0.04 or greater, employment will be terminated. 4. Refusal to submit to an alcohol test. An employee who refuses to provide an adequate breath for alcohol testing without a valid medical explanation after they have received notice of the requirement to be tested in accordance with the requirements of the AMPP, or who engages in conduct that clearly obstructs the testing procedures, employment will be terminated. 5. On duty use of alcohol. On duty use of alcohol on Trisco Systems, Inc. time, business or on Trisco Systems, Inc. premises or in Trisco Systems vehicles will result in employment termination. 6. Results of an alcohol (confirmation) test indicate an alcohol concentration of 0.04 or greater. When an employee has tested for alcohol in a concentration of 0.04 or greater, the employee will be removed from performing a covered function and shall be referred to the Trisco Systems, Inc. 's SAP program. The SAP shall determine what assistance, if any, the employee needs in resolving problems associated with alcohol misuse. 7. Results of alcohol (confirmation) test indicate an alcohol concentration of 0.02 or greater, but less than 0.04. When an employee has tested for alcohol in a concentration of 0.02 or greater, but less than 0.04, that employee will be removed from performing a covered function and suspended without pay for the remainder of their work day. 8. Results of a second alcohol (confirmation) test (within 60 days of the first test) indicate an alcohol concentration of 0.02 or greater, but less than 0.04. When an employee has an alcohol test conducted and the alcohol concentration is 0.02 or greater, but less than 0.04 on a second test, the employee will be removed from performing covered functions and shall be suspended for 15 working days without pay and referred to a substance abuse professional, and must follow all the recommendations of the assessment. Any subsequent test at 0.02 or greater will result in employment termination. 9. Results of a second alcohol (confirmation) test (within 60 days of the first test) indicate alcohol concentration of 0.02 or greater, but less than 0.04 after an alcohol test which had produced an alcohol concentration of 0.04 or greater. When an employee has an alcohol test conducted and the alcohol concentration is 45 0.02 or greater, but less than 0.04 after having had a prior alcohol concentration of 0.04 or greater, then that employee will be removed from performing covered functions and shall be suspended for 20 working days and referred to the substance abuse professional and any subsequent alcohol concentration of 0.02 or greater will result in employment termination. Alcohol Testing Requirements Scope 1. The alcohol testing procedures contained herein and in 49 CFR Part 382 shall be complied with by the designated alcohol testing sites. 2. These procedures address the requirements contained in 49 CFR Part 40, Subpart C. General 1. The alcohol testing site shall have all necessary personnel, materials equipment, facilities, and supervision to provide for the private testing and processing of alcohol test results. An independent medical facility may also be utilized as an alcohol testing site provided the other applicable requirements of Appendix C are met. 2. An alcohol testing site shall be any suitable location where a breath alcohol test can be collected under conditions set forth in Appendix C, including a properly equipped mobile facility. A designated alcohol testing site shall provide for visual and aural privacy during the testing period and completion of all necessary record procedures. 3. Detailed alcohol testing procedures are outlined in Appendix C. Alcohol Testing Equipment Trisco Systems, Inc. shall use only approved evidential breath testing (EBT) devices for conducting the alcohol testing provisions required in the AMPP. The type designated to be used for both screening and confirmation tests shall be a fuel -cell, CMI-Brand Intoxilyzer I-200 or the equivalent as reflected on the "Conforming Products List"; Federal Register "Notices," Volume 59 Number 16 dated Wednesday, April 20, 1994. [40.53(a)&(b)] Screening Devices I. Trisco Systems, Inc. shall utilize a log book to record information relative to screening alcohol tests, if the EBT being utilized does not have: a. Capabilities to be attached independently or by direct link to a separate printer, print a result in triplicate (or 3 consecutive identical copies) of each breath test; 46 b. Capabilities to assign a unique and sequential number to each completed test so that the number can be read by the BAT and the employee before each test and be printed out on each copy of the result; C. Capabilities of printing out the manufacturer's name of the device, serial number, and time of the test. 2. A log book shall be used for each device that does not meet the above criteria and the log book shall include the following information: test number, date of test, name of BAT, location of test, test result and initials of the employee taking each test. Confirmation Devices Trisco Systems, Inc. shall utilize an EBT for confirmation testing that has the capabilities listed above in paragraph 1. Each EBT shall also be able to distinguish alcohol from acetone; be capable of testing an air blank prior to each collection of breath, and performing an external calibration. NHTSA Conforming Products List All devices that will be used by Trisco Systems, Inc. for alcohol testing are NHTSA approved evidential breath alcohol testing devices. NHTSA has model specifications for evidential breath testing devices. NHTSA periodically publishes an updated Conforming Products List, which states which devices have met NHTSA standards. EBT Quality Assurance Plan Each EBT used for conducting breath alcohol screening tests shall have a Quality Assurance Plan (QAP) to include: (1) methods for conducting external calibration, (2) minimum intervals for performing an external calibration check, (3) tolerances on an external calibration check, (4) inspection, maintenance, and calibration requirements, all of which (5) have been approved by NHTSA for quality and accuracy. Trisco Systems, Inc. plan furthermore specifies: (1) Each EBT supervisor will maintain specific records to demonstrate execution of required external calibration checks; these checks shall be performed each Monday morning or the first day of each work week, and after every positive test result. (2) An EBT shall be taken out of service if it does not pass the self diagnostics test or if the instrument fails a calibration verification test. (3) All further required inspection, maintenance and calibration checks are to be conducted by the manufacturer or designated maintenance personnel. (4) Records of all external maintenance shall be maintained with the calibration log book. (5) When not in use at a testing site, the EBT shall be stored properly in accordance with the manufacturer's recommendations in a controlled access space. 47 Breath Alcohol Technician (BAT) Guidance General The BAT shall receive sufficient training and be certified to proficiency in the specific operation of the EMT they use in the required alcohol testing procedures as outlined in the AMPP. These procedures include the following: 1. Each BAT used by Trisco Systems, Inc. shall be able to demonstrate by successful completion of a course of instruction which, at a minimum, provides training in the principles of EBT methodology, operation, and calibration checks; the fundamentals of breath analysis for alcohol content; and the procedures required for obtaining a breath sample, and interpreting and recording EBT results. 2. Trisco Systems, Inc. shall ensure that only courses of instruction that are equivalent to the NHTSA, as amended, model course may be used to train BATS to proficiency. Upon request to NHTSA, they will review a BAT instruction to determine equivalency. 3. Trisco Systems, Inc. shall ensure that the course of instruction shall provide documentation that the BAT has demonstrated competence in the operation of the specific EBT(s) to be used by Trisco Systems, Inc.. 4. Trisco Systems, Inc. shall ensure that any BAT who will perform an external calibration check of an EBT shall be trained to proficiency in conducting the check on the particular model of the EBT to be used by Trisco Systems, Inc.. The BAT training shall also include practical experience and demonstrated competence in preparing the breath alcohol simulator or alcohol standard, and in maintenance and calibration of the particular EBT. 5. Trisco Systems, Inc. shall ensure the BATS receive sufficient additional training to ensure proficiency concerning new or additional devices or changes in technology for equipment used by Trisco Systems, Inc.. 6. Trisco Systems, Inc. or its designated agent who are involved in conducting alcohol testing, shall establish documentation regarding the training and proficiency testing of any BAT it uses to test employees. The documentation shall be maintained in accordance with the requirements of the AMPP. Trisco Systems, Inc. may authorize a BAT qualified supervisor of an employee to conduct an alcohol test for that employee if another BAT is unavailable to perform the required test in a timely manner. However, the supervisor who makes a determination that reasonable suspicion exists shall not be authorized to conduct the alcohol test on that employee. Disclosure of Alcohol Information/Records General 1. Trisco Systems, Inc. shall maintain all alcohol related testing information including all test results and other appropriate records in a secure manner to prevent the disclosure of such information to unauthorized personnel. 2. The APM or designee shall maintain a locked file system which will contain the alcohol testing information and records. This file shall be maintained as confidential. Employee files shall be handled on a strict "need to know" basis. 3. Alcohol test results shall not be included in personnel files. Disclosure Provisions 1. Trisco Systems, Inc. shall not release covered employee information that is contained in records as required to be maintained by the provisions of the AMPP and in accordance with federal requirements except as required by law or when expressly authorized or required by 49 CFR Parts 382 and 40. Alcohol testing data shall be maintained and reported to the DOT annually. 2. A covered employee is entitled, upon written request, to obtain copies of any records pertaining to the employee's use of alcohol, including any records pertaining to their alcohol tests. Trisco Systems, Inc. shall promptly provide the requested records. Access to an employee's records shall not be contingent upon payment for records other than those specifically requested. 3. Trisco Systems, Inc. shall permit access to all facilities utilized in complying with the requirements of 49 CFR Parts 382 and 40 to the Secretary of Transportation, and any DOT or state agency with regulatory authority over Trisco Systems, Inc. 4. Trisco Systems, Inc. shall make available copies of all results for alcohol testing and any other information pertaining to the administrative process of the Trisco Systems, Inc.'s AMPP as required by 49 CFR Parts 382 and 40 when requested by the Secretary of Transportation, any DOT or state agency with regulatory authority over Trisco Systems, Inc.. When specified by the agency the information shall include name specific alcohol test results, records, and reports 5. When requested by the National Transportation Safety Board as part of an accident investigation, Trisco Systems, Inc. shall disclose information related to Trisco Systems, Inc. s administration of any post accident alcohol tests administered following the accident under investigation. 6. Trisco Systems, Inc. shall make records available to a subsequent employer upon receipt of a written request from a covered employee. Disclosure to the subsequent employer is permitted only as expressly authorized by the terms of the employee's written request. 7. Trisco Systems, Inc. may disclose required information pertaining to a covered employee to that employee or to the decision maker in a lawsuit, grievance, or other proceeding initiated by or on behalf of the individual, and arising from the results of an alcohol test administered as required by the AMPP and the regulations set forth in 49 CFR Parts 382 and 40 or from Trisco Systems, Inc.'s 49 determination that the employee engaged in prohibited alcohol conduct including, but not limited to, a worker's compensation, unemployment compensation, or other proceeding relating to a benefit sought by the employee. 8. Trisco Systems, Inc. shall release information regarding a covered employee's records as directed by the specific, written consent of the employee authorizing release of the information to an identified person. Release of such information by the person receiving the information is permitted only in accordance with the terms of the employee's consent. Employee Training Scope of Program Trisco Systems, Inc. will provide education and training on alcohol misuse to all employees. The education shall include: 1. Informational material displayed on bulletin boards, employee break rooms, locker rooms, etc., and distributed to employees. 2. A community service hotline telephone number for employee assistance displayed on bulletin boards and distributed to employees; and 3. Distribution of Trisco Systems, Inc.'s policy regarding the alcohol misuse to all employees. The policy shall be displayed in prominent places throughout the Trisco Systems, Inc. administration (e.g., employee bulletin boards, break rooms, locker rooms). Supervisor Training Supervisory personnel responsible for those employees covered under Part 382 will receive training under the alcohol misuse prevention plan. The training shall include an initial 4-hour period of training and a 1-hour yearly refresher on the specific, contemporaneous physical, behavioral, speech, and performance indicators of probable drug or alcohol misuse. This training shall be for supervisors who may determine whether an employee must be alcohol tested for reasonable suspicion. Field employees will attend a yearly 1-hour session on the effects of drug and alcohol use and misuse. Trisco Systems, Inc. Employee Obligation for Alcohol Intervention Although Trisco Systems, Inc. has not had a history of substance abuse, we recognize that alcoholism and alcohol misuse are problems throughout America. 1. There are three good reasons why you should be concerned if any of your coworkers is using drugs or alcohol on the job: a. Your health and safety may be at risk out b. Alcohol misuse costs you money C. Alcohol creates a negative work environment 2. According to the National Institute on Alcohol Abuse and Alcoholism, drug and alcohol use on the job costs society an estimated $102 billion a year. Since most of this cost is passed on to you in the form of higher health insurance rates or in consumer prices, drug and alcohol use on the job costs you and your fellow workers a significant amount of money. 3. Absenteeism among problem drinkers or alcoholics is 3.8 to 8.3 times greater than normal. If your fellow workers don't come to work, you may have to do their jobs in addition to your own. 4. Workers who misuse drugs and alcohol don't function at their full potential. Not only is absenteeism a problem, when they are at work these employees may have reduced capabilities and productivity. 5. No matter what your position is in the organization, there is something you can do to ensure that drug and alcohol use on the job never becomes a problem at Trisco Systems, Inc. Acceptance of any misuse puts you, Trisco Systems, Inc., and the public at risk. Effects of alcohol misuse I. Alcohol is a central nervous system depressant. Taken in large quantities it causes not only the euphoria associated with being drunk, but also adversely affects your judgement, ability to think, and your motor functions. Drink enough alcohol fast enough and it can kill you. 2. Long term overuse of alcohol can cause liver damage, heart problems, sexual dysfunction, and other serious medical problems. 3. In some cases alcohol use can lead to physical and psychological dependence on alcohol. Alcoholism is a serious chronic disease. Left untreated it will inevitably get worse. 4. Workers who use alcohol (and other drugs) affect everyone. Studies show that compared to alcohol and drug free workers, substance abusers are far less productive, miss more workdays, are more likely to injure themselves or someone else, and file more workers' compensation claims. 5. The measurable dollar costs of workplace substance abuse from absenteeism, overtime pay, tardiness, sick leave, insurance claims, and workers' compensation can be substantial. However, the hidden costs resulting from diverted supervisory and managerial time, friction among workers, damage to equipment, and damage to Trisco Systems, Inc.'s public image mean that workplace substance abuse can further cut into budgeted monies. 51 6. Alcohol can also destroy relationships, lead to serious problems with the law (e.g., drunk driving), and even cause harm to the people you love. 7. If drinking affects your work life, it could lead to job loss and all the financial problems that would follow. Signs and Symptoms of Alcohol Misuse Any one or more of the following signs may indicate a drinking problem: Family or social problems caused by drinking Job or financial difficulties related to drinking Loss of a consistent ability to control drinking Blackouts or the inability to remember what happened while drinking Distressing physical and/or psychological reactions if you try to stop drinking A need to drink increasing amounts of alcohol to get the desired effect. Marked changes in behavior or personality when drinking Getting drunk frequently Injuring yourself or someone else while intoxicated Breaking the law while intoxicated Starting the day with a drink Available Help Outpatient programs exist in a variety of settings: 1. Community mental health centers 2. Full service agencies 3. Private physicians' and therapists' offices 4. Occupational settings 5. Specialized alcoholism treatment facilities Inpatient services, designed for those with more serious alcohol problems can be found in hospitals, residential care facilities, community halfway houses and some alcoholism clinics. Your local phone directory will list helpful referral organizations such as: 1. Local council on alcoholism 2. Alcoholics Anonymous 3. Community alcoholism or mental health clinic 4. Social services or human resources department The Substance Abuse Professional (SAP) for Trisco Systems, Inc. is St. Rita's Employee Assistance Program (EAP). The SAP can be reached at (419) 226-9171 or 1-800-752-7923. The 52 SAP will perform an initial evaluation, recommend any additional treatment if necessary, and refer employees needing assistance for treatment covered under their health insurance program. The SAP who determines that a covered employee who requires assistance in resolving problems associated with alcohol misuse will not refer the employee to the SAP's private practice or to a person or organization from which the SAP receives remuneration or has a financial interest. (This does not prohibit a SAP from referring an employee for assistance to a public agency; a person under contract with Trisco Systems, Inc. to provide treatment for alcohol on behalf of Trisco Systems, Inc.; the sole source of therapeutic treatment under the employee's health insurance policy; or sole source of treatment reasonable accessible to the employee.) Recordkeeping Procedures The Trisco Systems, Inc., APM (Alcohol Program Manager) or designee shall maintain the alcohol testing records in accordance with the provisions set out in the AMPP. Records shall be maintained for the specified periods of time as required in 49 CFR Parts 382 and 40. Record Retention Provisions I . The following types of records shall be maintained for a minimum period of 5 years: a. Records of employee alcohol test results with results indicating an alcohol concentration of 0.02 or greater. b. Documentation of refusals to take required alcohol tests. C. Calibration documentation of each EBT used in alcohol testing, including records of the results of external calibration checks. d. Employee evaluation and referrals. e. Management Information System (MIS) annual alcohol misuse report data (if required). f. Documents pertaining to "missed tests". (Missed test = a test that is not conducted within 8 hrs. "Missed test" information shall be submitted to OPS, (when the MIS information is submitted) for three years beginning in 1995. 2. The following types of records shall be maintained for a minimum period of 2 years. a. Records related to the collection process (except calibration of EBT devices). b. Records related to training. C. Records of the inspection and maintenance of each EBT used in employee testing. d. Documentation of Trisco Systems, Inc.'s compliance with the QAP for each EBT it uses for alcohol testing under the AMPP. e. Records of the training and proficiency testing of each BAT used in employee testing. f. Log books used in conjunction with EBTs. 53 3. The following types of records shall be maintained for a minimum period of 1 year. a. Records of all test results below 0.02. Maintenance of Specific Types of Records 1. The following types of records related to the collection process shall be maintained: a. Collection log books, if used. b. Calibration documentation for EBT devices. C. Documentation of BAT training. d. Documents generated in connection with decisions to administer reasonable suspicion alcohol tests. e. Documents generated in connection with decisions to administer reasonable suspicion alcohol tests. f. Documents verifying existence of a medical explanation of the inability of a covered employee to provide adequate breath for testing. 2. The following types of records related to test results: a. Trisco Systems, Inc.'s copy of the alcohol test form, including the results of the test. b. Documents related to the refusal of any covered employee to submit to a required alcohol test. C. Documents presented by a covered employee to dispute the result of an alcohol test administered under the AMPP. 3. Records related to other violations outlined in the AMPP.. 4. The following types of records related to referrals and evaluations: a. Records pertaining to a determination by a substance abuse professional concerning a covered employee's need for assistance. b. Records concerning a covered employee's compliance with eh recommendations of the substance abuse professional. 5. Records related to the Trisco Systems, Inc.'s MIS annual alcohol misuse testing data. Trisco Systems, Inc. shall submit the required alcohol misuse MIS testing data to FHWA annually as prescribed by the regulations. 6. The following types of records related to education and training of employees and supervisors: a. Materials on alcohol misuse awareness, including a copy of Trisco Systems, Inc.'s policy on alcohol misuse. b. Documentation of compliance with the requirements of 49 CFR Part 382.601 (Employer policy requirements). C. Documentation of training provided to supervisors for the purpose of qualifying the supervisors to make a determination concerning the need for alcohol testing based on reasonable suspicion. d. Certification that any training conducted under the AMPP complies with the requirements of 49 CFR Part 382 and 40. 54 Contractor Monitoring Trisco Systems, Inc. may: (1) Cover Contractor employees under Trisco Systems, Inc.'s plan; or (2) May provide in the contract that the contractor must establish and implement alcohol breath testing, education, and training in accordance with Part 382 and Part 40 for covered functions. Contractors shall retain copies of appropriate alcohol testing records as required by 49 CFR Part 382 and Part 40. The records and access to the contractor's property shall be readily accessible for inspection by Trisco Systems, Inc., FHWA and representatives of those state agencies under which jurisdiction of Trisco Systems, Inc. operates. Confirmation of contractor compliance/monitoring - Refer to Appendix D for specific guidance in how to develop an effective contractor compliance and monitoring program. Trisco Systems, Inc. can, as an alternative to the above guidance provide coverage for the contractor's employees by including them in Trisco Systems, Inc.'s alcohol testing program for the duration of the contract or work project. When contractor employees are covered under the Trisco Systems, Inc.'s AMPP, the contractor shall ensure that their employees comply with all the provisions contained in the Trisco Systems, Inc.'s AMPP. APPENDIX A: Alcohol Personnel and Services Contacts Alcohol Program Manager (APM) and Drug Abuse Program Manager (DAPM) Jack Dunbar 2000 Baty Road Lima, Ohio 45807 Fx. (419) 339-1597 Ph. (419) 339-3906 Substance Abuse Professional (SAP) St. Rita's Medical Center c/o St. Rita's Occupational Health Center 1875 South Dixie Highway Lima, Ohio 45804 (419) 226-9171 Hotline 1-800-752-7923 Breath Alcohol Technician (BAT) St. Rita's Occupational Health Center 1875 South Dixie Highway Lima, Ohio 45804 (419) 226-9720 55 APPENDIX B Employee/Supervisory Positions Subject to Alcohol Testing Individuals Subject to Alcohol Testing The following classifications of jobs are considered a "Covered Employee" subject to alcohol testing under the Trisco Systems, Inc.'s alcohol testing policy: Affected Employees 1. (NOTE: All new applicants for employment are subject to drug testing only). 2. Any employee who appears to be impaired or is suspected of substance abuse (see reasonable cause) which may cause work impairment or safety considerations, will be tested by a laboratory designated by the Company. In such cases, the employee will be placed on "involuntary" leave of absence immediately. If test results are positive, all benefits. Health insurance will lapse unless the employee is reinstated or provides otherwise in accordance to law. 3. Any employee who voluntarily admits to a substance abuse condition will be tested by a laboratory designated by the Company and will be placed on an immediate leave of absence and return to work only after a negative test result is obtained. 4. All management personnel, all supervisory personnel, all truck drivers, all sales staff, all field and production or warehouse personnel, and any other employee of Trisco Systems, Inc. including secretarial, clerical and administrative staff, shall be subjected to periodic substance abuse testing. In addition, any applicant to any of these positions may be tested. S. Anyone involved in an accident on the he job that requires medical attention or causes damage to product or facilities. 6. Any violation of Company Policies and/or Standards of Conduct and Discipline. NOTE: a) Refusal to take the substance abuse test shall be subject to immediate termination of employment. b) Any employee attempt to cheat on these tests or falsify test results shall be terminated. Therefore, Safety sensitive employees include; 1. All Project Managers. 2. All Foremen. 3. All Production Employees, including warehouse employees. 4. All operators of Trisco Systems, Inc., owned vehicles at any time. 5. All operators driving any other vehicle on Company business or during Company time. 6. All clerical, sales, secretarial, and administrative employees. W. Confirmation Levels 9-Panel SAMSH Certified Drug Screen Screen Confirmation Marijuana Metabolites ................ 50ng...................... 15ml Amphetamines .......................... 1000ng.................... 500ml Cocaine Metabolites ................... 300ng..................... 150ml Opiates .................................... 2000ng .................... 2000ml Phencyclidine ........................... 25ng ........................ 25ml Barbiturates ............................. 300ng..................... 200ml Benzodiazepines........................ 300ng ..................... 1000ml Propoxyphene........................... 300ng..................... 500ml Methadone ............................... 300ng ...................... 300ml The authority for DOT drivers' drug and alcohol testing is derived from the Omnibus Transportation Employee Testing Act of 1991 and is conducted in accordance with the U.S. Department of Transportation's Drug and Alcohol Testing Procedures Rules: 49 CFR Part 40. The remainder of Trisco Systems Inc., employees are designated Safety -sensitive Employees by Company policy. 57 APPENDIX C Evidential Breath Testing (EBT) Collection Procedures The evidential breath testing procedures set forth in this appendix address all the requirements as set forth in 49 CFR Part 40 and specifies the required form and disposition of such testing forms: Alcohol Testing Form and Log Book 1. The BAT shall utilize the Breath Alcohol Testing form provided by the EBT manufacturer. The alcohol testing form must comply with the provisions as contained in 49 CFR Part 40 with regard to the information that must be contained on the form. The form must address the specific requirements contained in 40.59. The Trisco Systems, Inc. provider may not modify or revise the form. 2. The Trisco Systems, Inc. provider may utilize a form generated by an EBT and may omit the space for affixing a separate printed result to the testing form. The form shall provide triplicate or three consecutive identical copies with Copy 1 (white copy) being transmitted to Trisco Systems, Inc., Copy 2 (green copy) shall be provided to the employee, and Copy 3 (blue copy) shall be retained by the BAT. 3. The Trisco Systems, Inc. provider shall use a log book in conjunction with any EBT used for screening tests that does not meet the requirements listed under the provisions of the AMPP. 4. The breath alcohol testing form may include such additional information as may be required for billing or other legitimate purposes necessary to the testing, provided that personal identifying information on the individual (other than the social security number or employee identification number) may not be provided. Breath Testing Locations 1. Trisco Systems, Inc. shall ensure that there are sufficient breath testing sites or the availability of BATS located within a reasonable proximity to each of the Trisco Systems, Inc.'s work locations. 2. Trisco System's provider shall conduct alcohol testing in a location that affords visual and aural privacy to the employee being tested. The location shall prevent unauthorized personnel from seeing or hearing test results. All necessary equipment, personnel, and materials for conducting the alcohol breath testing shall be provided at the testing site. 3. A mobile collection facility, such as a van that is equipped for alcohol testing, that meets the requirements set forth in the AMPP may be utilized. 4. No unauthorized persons shall be permitted access to the testing site when the EBT remains unsecured, or in order to prevent such individuals from seeing or hearing a test result. 5. In some circumstances the Trisco Systems, Inc. provider may have to conduct such alcohol testing outdoors at the scene of an accident that does not meet the ON requirements as specified in post accident provisions of the AMPP, then the BAT shall provide the necessary visual and aural privacy to the employee to the greatest extent practicable. 6. The BAT shall supervise only one employee's use of the EBT at a time. The BAT shall not leave the alcohol testing site while the testing process is in progress. Breath Alcohol Testing Preparations 1. When an employee arrives at the alcohol testing site, the BAT shall ensure that the individual is positively identified as the employee selected for alcohol testing (e.g., through presentation of a photo I.D. card or identification by a Trisco Systems, Inc. representative). If the employee's identity cannot be established, the BAT shall not proceed with the alcohol test. If the employee requests, the BAT shall show proper identification to the employee. 2. The BAT shall then explain the testing process to the employee. 3. If the employee fails to arrive at the assigned time, the BAT should contact the appropriate authority to obtain guidance on any action to be taken. Screening Test Procedure 1. The BAT shall begin the alcohol testing process by completing Step 1 on the Breath Alcohol Testing Form. The employee shall then complete Step 2 by signing the certification. Refusal by the employee to sign the certification shall be regarded as a refusal to take the test. 2. The BAT shall select an individually sealed mouthpiece and it shall be opened in full view of the employee and attach it to the EBT in accordance with the manufacturer's instructions. 3. The BAT shall instruct the employee to blow forcefully into the mouthpiece for at least 6 seconds or until the EBT instrument indicates that an adequate amount of breath has been obtained. 4. If the EBT does not meet the requirements listed in the AMPP, the BAT shall show the employee the result displayed on the EBT. The BAT shall record the displayed result, test number, testing device, serial number of the testing device, time and quantified result in Step 3 of the form. The employee shall then initial the log book entry. 5. If the EBT provides a printed result, but does not print the results directly onto the form, the BAT shall show the employee the result displayed on the EBT. The BAT shall then affix the test result printout to the breath alcohol test form in the designated space. The result shall be secured in such a manner that will provide clear evidence of removal, such as tamper evident tape. 6. If the EBT prints the test results directly onto the alcohol form, then the BAT shall show the employee the result displayed on the EBT. 7. If the result of the screening alcohol test is a breath alcohol concentration of less than 0.02, the BAT shall date the form and sign the certification in Step 3 of the form. The employee shall then sign the certification and fill in the date in Step 4 WO of the form. If the employee does not sign the certification in Step 4 or does not initial the log book entry for a test, it shall not be considered a refusal to be tested. In this event, the BAT shall note the employee's failure to sign or initial in the "Remarks" section of the form. 8. If a test result printed by the EBT does not match the displayed result, the BAT shall note the disparity in the "Remarks" section. Both the employee and the BAT shall initial or sign the notation. The test is invalid and the Trisco Systems, Inc. representative and the employee shall be so advised. 9. At this point, no further testing is authorized. The BAT shall transmit the result of less than 0.02 to the APM or other appropriate Trisco Systems, Inc. representative in a confidential manner. Trisco Systems shall receive and store the information so as to ensure that confidentiality is maintained as required in the AMPP. 10. If the result of the screening test is an alcohol concentration of 0.02 or greater, then the BAT shall perform a confirmation test. If the confirmation test will be conducted by a different BAT, then the BAT who conducts the screening test shall complete and sign the form and log book entry. The BAT will upon completion of the alcohol test provide the employee with Copy 2 of the breath alcohol testing form. Confirmation Test Procedures 1. When a BAT other than the one who conducted the screening test is required to conduct the confirmation test, the new BAT will require the employee to provide positive identification such as photo ID card or identification by a Trisco Systems representative. The BAT will upon request of the employee being tested provide such identification. 2. The BAT shall instruct the employee not to eat, drink, put any object or substance in their mouth, and, to the extent possible, not belch during the waiting period just prior to the confirmation test being conducted. This waiting period shall begin with the completion of the screen test and shall not be less than 15 minutes, but no later than 30 minutes after the completion of the screening test. The BAT shall explain to the employee that the reason for this is to prevent any accumulation of mouth alcohol leading to an artificially high reading and that it is for the benefit of the employee to comply with these instructions. The BAT shall also explain that the test will be conducted at the end of the required waiting period, even if the employee has disregarded the instructions. Should the BAT become aware that the employee has not complied with the instructions as provided, the BAT shall note the observations in the "Remarks" Section of the form. 3. When a BAT other than the one who conducted the screening test is required to conduct the confirmation test, the new BAT shall initiate a new Breath Alcohol Testing form. The BAT shall then complete Step I on the form and the employee shall then complete Step 2 by signing the certification. If the employee should choose not to sign the certification, the BAT shall then make an appropriate notation in the "Remarks" section indicating the employee's refusal to take the O alcohol test. The BAT shall note in the "Remarks" section that a different BAT conducted the screen test. 4. The BAT shall open, in the presence of the employee, a new individually sealed mouthpiece and attach the mouthpiece to the EBT in accordance with the manufacturer's instructions. The BAT will then instruct the employee to blow forcefully into the mouthpiece for at least 6 seconds or until the EBT indicates that an adequate amount of breath has been obtained. 5. The BAT shall ensure, prior to the confirmation test being administered to the employee, that the EBT shall register 0.00 on an air blank. If the reading is greater, the BAT shall conduct one more air blank. Should the EBT again register greater than 0.00, the testing shall not proceed using that EBT. An EBT taken out of service because of failure to perform an air blank accurately shall not be used for testing until a check of external calibration is conducted and the EBT is found to be within tolerance limits. Alcohol testing using another EBT may proceed. 6. In the event that the screening and confirmation test results are not identical, the confirmation test result is deemed to be the final result upon which any disciplinary action by Trisco Systems, Inc. may be taken in order to comply with the requirements of the AMPP and any applicable federal requirements. 7. If the EBT provides a printed result but does not print the results directly onto the form, the BAT shall show the employee the result displayed on the EBT. The BAT shall then affix the test result printout to the breath alcohol test form in the designated space. The result shall be secured in such a manner that will provide clear evidence of removal, such as the use of tamper evident tape. 8. If the EBT prints the test results directly onto the alcohol form, the BAT shall show the employee the result displayed on the EBT. 9. After the confirmation test is completed, the BAT shall date the form and sign the certification in Step 3 of the form. The employee shall then be instructed to sign the certification and fill in the date in Step 4. If the employee should elect to not sign the certification or to provide their initials in the log book entry for the test conducted, it shall not be considered a refusal to be tested. The BAT shall then note the employee's failure to sign or initial the log book entry in the "Remarks" section of the testing form. 10. If a test result printed by the EBT does not match the displayed result, the BAT and employee shall initial or sign the notation on the testing form. The test shall be considered "invalid" and the Trisco Systems, Inc. representative and the employee shall be so advised. 11. The BAT shall transmit all alcohol testing results to the APM or other designated Trisco Systems, Inc. representative in a confidential manner. All communications by BATS shall be to the APM or designee only and may be provided in writing, in person, or by telephone or electronic means. The BAT shall ensure that immediate transmission of the test results to Trisco Systems, Inc. is conducted in order for Trisco Systems, Inc. to prevent the employee from performing any safety sensitive functions. 12. Should the initial transmission not be in writing, but via telephone notification, the APM or designee shall establish a mechanism to verify the identity of the BAT providing the information. The BAT shall follow the initial transmission by 61 providing to the APM or designee the Trisco Systems, Inc.'s copy of the breath alcohol testing form. The test results shall be stored in such a manner so as to protect the confidentiality of the results and to eliminate the disclosure of information to unauthorized persons. Refusals to Test and Uncompleted Tests 1. Refusal by an employee to complete and sign Step 2 of the breath alcohol testing form, to provide breath, to provide an adequate amount of breath, or otherwise to cooperate with the testing process in any way that prevents the completion of the test, shall be noted by the BAT in the "Remarks" section of the form. The testing process shall be terminated and the BAT shall immediately notify the Trisco Systems, Inc. APM or designee. 2. If a screening or confirmation test cannot be completed or if an event occurs to invalidate the test, the BAT shall, if practicable, begin a new screening or confirmation test using a new breath alcohol testing form with a new sequential test number. Inadequate Amount of Breath 1. If the employee is unable, or alleges that they are unable, to provide a sufficient amount of breath to permit a valid breath test because of a medical condition, the BAT shall again instruct the employee to attempt to provide an adequate amount of breath. If the employee refuses to make the attempt, the BAT shall immediately notify the APM. 2. If the employee attempts and fails to provide an adequate amount of breath, the BAT shall so note in the "Remarks" section of the testing form and shall immediately inform the APM. The APM shall direct the employee to obtain, as soon as practical after the attempt, an evaluation from a licensed physician who is acceptable to Trisco Systems, Inc. concerning the employee's medical ability to provide an adequate amount of breath. 3. If the physician determines, in their reasonable medical judgment, that a medical condition has or could have precluded the employee from providing an adequate amount of breath, the employee's failure to provide an adequate amount of breath shall not be deemed as a refusal to take an alcohol test. The physician shall provide to the Trisco Systems, Inc. APM a written statement of the basis for their conclusion. 4. If the physician, in their reasonable medical judgment, is unable to make the determination that a medical condition has precluded the employee from providing an adequate amount of breath, the employee's failure to provide an adequate amount of breath shall be regarded as a refusal to take a test. The physician shall provide a written statement of the basis for their conclusion to the Trisco Systems, Inc. APM. 62 Invalid Tests A breath alcohol test shall be invalid under the following circumstances: 1. The EBT does not pass its next external calibration check. This invalidates all test results of 0.02 or greater on tests conducted since the last valid external calibration test. This would not invalidate any negative tests conducted. 2. The BAT does not observe the minimum 15 minute waiting period prior to conducting the confirmation test. 3. The BAT does not perform an air blank of the EBT before a confirmation test, or an air blank does not result in a reading of 0.00 prior to the administration of an alcohol test. 4. The BAT does not sign the breath alcohol testing form. 5. The BAT fails to note on the "Remarks" section of the form that the employee has failed or refused to sign the form following the recording or printing on or attachment to the form of the test result. 6. An EBT fails to print a confirmation test result. 7. The sequential test number or alcohol concentration displayed on the EBT is not the same as the sequential test number or alcohol concentration on the printed result. 63 APPENDIX D Contractor Monitoring Procedures In order to assure a contractor's compliance with DOT'S regulations, the following procedures are to be followed in determining compliance with the drug and alcohol misuse testing regulations as set forth in 49 CFR Part 382 and 49 CFR Part 40 Subpart C: Procedures for Determining Compliance 1. Qualifying Potential Contractor(s). Qualifications of the potential contractor as it pertains to drug and alcohol testing, education and training policies/procedures is assured by requesting the potential contractor to submit a copy of its Drug and AMPP for review and compliance with FHWA/DOT regulations. After review of the policies is completed, written correspondence to the contractor will advise it whether or not the plans are acceptable or in need of further additions, deletions, revisions or clarifying language. The review of the contractor plan shall be completed utilizing the criteria established in the FHWA Inspection forms. Addendums made to the contractor's plans shall be attached to the previously submitted Drug and AMPP plan. Upon approval of the addendum, a letter of acceptance is then sent to the contractor. The contractor is now eligible to bid on Trisco Systems, Inc. contract work that would be covered under Parts 382 and 40. 2. Monitoring Contractor's Compliance. The contractor may be required to provide information on their employees who will perform covered functions for Trisco Systems, Inc.. This information may include the name and job title of its employees who will perform any work or functions covered by Part 382 under that contract. A list of each contractor's covered employees may be distributed to appropriate Trisco Systems, Inc. field management personnel and job sites. 3. Statistical Submission. All contractors will be required to submit Drug and AMPP testing statistical information on a periodical basis which may be based on the duration of the contract. Typically this requirement will be conducted on a monthly or quarterly basis. Trisco Systems, Inc. may require a more frequent schedule for submission of data should they determine a need for such statistics. 4. Statistical Record Retention. Trisco Systems, Inc. shall maintain a complete file on each contractor's statistical drug and alcohol testing data reports. Trisco Systems, Inc. shall make available these reports when requested by the FHWA Administrator, designated representative, authorized customer representative, or representatives of those state agencies under which jurisdiction Trisco Systems, Inc. operates. 64 ACKNOWLEDGMENT OF RECEIPT OF POLICY This Drugs, Marijuana, and Alcohol Policy is for informational purposes only and does not create an employment contract. The management of Trisco Systems, Inc. is committed to reviewing its policies continually; therefore, the policies outlined here are subject to review and change at any time. I have carefully and thoroughly read the above Trisco Systems, Inc.'s Drug, Marijuana, and Alcohol Policy, and I agree without reservation, to follow that policy. Employee's Signature Date Employee's Name (Printed) Date received in Human Resources 65 SPECIFIC MEDICAL RELEASE Now comes who states that he/she is an employee for Trisco Systems, Inc., located at 2000 Baty Road Lima, Ohio 45807. The undersigned states that he/she was required to take a drug/alcohol test pursuant to his/her condition of employment at Trisco Systems, Inc., and hereby releases to Trisco Systems, Inc., any and all medical information relating to drug/alcohol test results based upon a drug/alcohol test administered on the day of 520 Further, the undersigned authorized the release of any medical information concerning rehabilitation as a result of the drug test performed on the above referenced date. Under no condition shall any other medical information unrelated to the drug testing or the rehabilitation thereof, be released to Trisco Systems, Inc. WITNESSES: EMPLOYEE: DATE: Appendix - Glossary of Definitions DRUG DEFINITIONS- For purposes of this anti -drug plan, the following definitions apply: 1. Accident - An incident reportable under any DOT Agency regulation. 2. Ali not - A portion of a specimen used for testing. 3. Chain of Custody - Means the procedures to account for the integrity of each urine specimen by tracking its handling and storage from point of specimen collection to final disposition of the specimen. These procedures shall require that an appropriate drug testing custody form be used from time of collection to receipt by the laboratory and that upon receipt by the laboratory an appropriate laboratory chain of custody form account for the sample within the laboratory. 4. Collection Site - Means the place(s) designated by Trisco Systems where an individual presents himself/herself for the purpose of providing a urine specimen to be analyzed for the presence of drugs. 5. Confirmatory Test - Means a second analytical procedure to identify the presence of a specific drug or metabolite which is independent of the initial test and which uses a different technique and chemical principle from that of the initial test in order to ensure reliability and accuracy. Gas chromatography/mass spectrometry (GC/MS) is the only authorized confirmation method. 6. Covered Employee - Means a person who performs as a CDL transportation driver regulated by the DOT Part 382 or other person identified by Company policy; An individual designated in a DOT agency regulation as subject to drug urine testing and the donor or a specimen. "Employee" and "Individual" or "Individual to be tested" have the same meaning for purposes of this policy. 7. DHHS - The Department of Health and Human Services, or any designee of the Secretary, Department of Health and Human Services. 8. DOT Agency - Means any agency of the United States Department of Transportation administering regulations requiring compliance with this policy, including, but not limited to, the Federal Highway Administration and the Federal Highway Administration (FHWA). 9. Initial Test - An immunoassay screen to eliminate "negative" urine specimens from further consideration (also known as screening test.) 67 10. Prohibited Drug - Means any of the following substances specified in Schedule I or Schedule II of the Controlled Substances Act, 21 U.S.C. 801.812 (1981 & 1987 Cum P.P.): Marijuana, Cocaine, Opiates, Amphetamines, and Phencyclidine (PCP). ALCOHOL MISUSE PREVENTION DEFINITIONS- For purposes of this alcohol misuse prevention plan the following definitions apply: 1. Accident - means an incident reportable under 49 CFR Part 40 and Part 382, or other incident as identified by Company policy. 2. Air Blank - means a reading by an Evidential Breath Testing device (EBT) of ambient air containing no alcohol. 3. Alcohol - means the intoxicating agent in beverage alcohol, ethyl alcohol or other low molecular weight alcohols including methyl or isopropyl alcohol 4. Alcohol Concentration - 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 conducted under the federal regulations. 5. Alcohol Use - means the consumption of any beverage, mixture, or preparation (including any medication) containing alcohol. 6. Breath Alcohol Technician (BAT) - means an individual who instructs and assists individuals in the alcohol testing process and operated an EBT. 7. Canceled or Invalid Test - means a test that is deemed to be invalid as listed with the QAP of the instrument. 8. Commerce - means (1) Any trade, traffic or transportation within the jurisdiction of the United States between a place in a State and a place outside of such State, including a place outside of the United States and (2) trade, traffic, and transportation in the United States which affects any trade, traffic, and transportation described in this definition. 9. Commercial Motor Vehicle - means a motor vehicle or combination of motor vehicles used in commerce to transport passengers or property if the motor vehicle -- (1) Has a gross combination weight rating of 26,001 or more pounds inclusive of a towed unit with a gross vehicle weight rating of more than 10,000 pounds; or (2) Has a gross vehicle weight rating of 26,001 or more pounds; or (3) Is designed to transport 16 or more passengers, including the driver; or (4) is of any size and is used in the transportation of materials found to be hazardous for the purposes of the Hazardous Materials Transportation Act and which require the motor vehicle to be placarded under the Hazardous Materials Regulations (49 CFR Part 172, subpart F). 10. Confirmation Test - means a second test, following a screening test with a result 0.02 or greater, that provides quantitative data of alcohol concentration. 11. Consortium - means an entity, including a group or association of employers or contractors, that provides alcohol or controlled substances testing as required by this part, or other DOT alcohol or controlled substances testing rules, and that acts on behalf of the employers. 12. Covered Employee - means Safety -sensitive employees including all personnel required to maintain a Commercial Drivers License (CDL) as a condition of employment and any other employee identified by Company policy. 13. Covered Function - (safety sensitive function) - means an operation, maintenance, or emergency -response function that is performed as defined above in the employment of Trisco Systems, Inc.. 14. Driver, - means any person who operates a commercial motor vehicle. This includes, but is not limited to: Full time, regularly employed drivers; casual, intermittent or occasional drivers; leased drivers and independent, owner operator contractors who are either directly employed by or under lease to an employer or who operate a commercial motor vehicle at the direction of or with the consent of an employer. For the purposes of pre-employment/pre-duty testing only, the term driver includes a person applying to an employer to drive a commercial motor vehicle. 15. EBT (or Evidential Breath Testing device) - means an EBT approved by the National Highway Traffic Safety Administration (NHTSA for the evidential testing of breath and placed on NHTSA's "Conforming Products List" (CPL) of evidential breath measurement devices. 16. Supervisor - means the foreman, project manager or supervisor of Trisco Systems, Inc.. 17. Performing a Covered Function - means an employee is considered to be performing a covered function (safety sensitive function) during any period in which they are actually performing, ready to perform, or immediately available to perform such covered functions. 18. Refusal to Submit (to an alcohol test) - means that a covered employee fails to provide adequate breath for testing without a valid medical explanation after they have received notice of the requirement to be tested in accordance with the provisions of 49 CFR Part 382 and the Trisco Systems, Inc.'s alcohol misuse prevention plan, or engages in conduct that clearly obstructs the testing process. 19. Screening Test (or initial test) - means an analytical procedure to determine whether an employee may have a prohibited concentration of alcohol in a breath specimen. .• 20. Substance Abuse Professional - (SAP) - means a licensed physician (Medical Doctor or Doctor of Osteopathy), or a licensed or certified psychologist, social worker, employee assistance professional, or addiction counselor (certified by the National Association of Alcoholism and Drug Abuse Counselors Certification Commission), with knowledge of and clinical experience in the diagnosis and treatment of alcohol related disorders. 70