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HomeMy WebLinkAboutOpening of Applications - 2024 Sewer Insurance Lateral Repair Program - Bob FrameCITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS REQUEST FOR APPLICATIONS Notice is hereby given that the City 0f Seiith Bend, Indiana, Board of Public or will receive sealed electronic Responses at bpwbids n„sonthbendin.eov until 9:00 a.m., EST, on February 13"i, 2024 for the following: 2024 SEWER INSURANCE LATERAL REPAIR PROGRAM SUMMARY: The Board of Public Works of the City of South Bend ("City"), on behalf of the Sewage Works Utility is soliciting applications from qualified vendors to serve as preferred vendors for its Lateral Repair Program at the rates herein for one calendar year. The City is authorized by Sections 17-56 through 17-54 of the City's Municipal Code to offer this Sewer Lateral Repair Program to repair sewer laterals located between the house or building and the public sewer main line which would otherwise be the sole responsibility of the property owner. It is the purpose of this request to establish a list of qualified vendors who will repair sewer lateral lines at the rates established herein. Complete application instructions are available for download by visiting the City of South Bends's web page at www.sotithbendin.gov: X Click on "BUSINESS" X Click on "Submit a City Contract Bid" X Click on "City Contracts - Invitations to Bid" X Click on the "Required Link" to register your company. Click on the "Required Link" to register your company. You must register to receive addenda and updates to the specific bid you are interested in. Failure to do so could render your bid non- responsive to the specifications. There is no charge for the specifications. Questions should be directed by email to Larry Parker or Kevin Dombrowski, at 1parker(r�southbendin.gov or ktdombro(a!southbendin.j, The City reserves the right to review and audit all documents related to this application and to request additional information as detennined necessary. Failure to comply with the City's request may be deemed grounds for dismissing the application. Applications must include the Non -Collusion Affidavit, Nun -Debarment Affidavit, Employment Eligibility Verification, and Non -Discrimination Commitment Form, BOARD OF PUBLIC WORKS Theresa Heffner, Clerk Publish two (Z) times: January 26th &February 2"d, 2024 ? pplications must meet the minimum specifications as provided herein. There is no scoring matrix as all qualified vendors whose applications meet the minimum specifications and who meet and accept the following required conditions will be accepted into the program: • Plumber Contractor License in Indiana; and • Worker's Compensation Insurance; and • Performance bond in the amount of $25,000 or cash bond in the amount of $25,000; and • Proof of Commercial General Liability Insurance per Person in the amount of $50,000; and • Proof of Commercial General Liability Insurance per Occurrence in the amount of $1,000, 000 Three (3) year warranty on all work performed through this program. • Must follow City of South Bend Department of Public Works Design & Construction Standards. • ; Availability for on -call emergency response scheduled on a weekly rotation which includes before/after normal business hours, weekends and holidays. Emergency repairs require completion within 24 hours. Regular repairs require completion within five working days. • Ability to work in year-round adverse weather conditions. • Must follow IUPPS 811 compliance prior to and throughout all excavation work performed. • Responsible for the planning, set-up and removal or subcontracting of all necessary traffic control according to INDOT requirements found in the Indiana Manual on Uniform Traffic Control Devices and the ability to work safely on heavily trafficked streets. Must be fully equipped to work safely in underground excavations five feet deep or greater in compliance with OSHA trenching and excavation safety requirements. Company safety manual must be followed and a. minimum requirement of two qualified persons for all excavations. • Responsible for repairing all grass/sod property damage caused by excavation work by spreading topsoil and grass seed within two calendar weeks of leak repair. A list of all repairs completed in grass during the winter season must be kept for returning to complete the topsoil and grass seed work at the start of the spring season. CITY OF SOUTH BEND, INDIANA SEWER INSURANCE PROGRAM POLICY Pursuant to Ind. Code § 36-9-6-10, as amended from time -to -time, the City of South Bend, Indiana ("City") acting by and through its Board of Public Works ("Board") is empowered to contract for and maintain all public drains or sewers necessary to carry off the drainage of the City. Chapter 7, Article 7 of the South Bend Municipal Code establishes a sewer service fiord ("Sewer Insurance Program") in order to address the repair of failing private sewer connections, and to address administrative and inspection costs associated with the Sewer Insurance Program. The goal of the Sewer Insurance Program is to provide City residents with an affordable insurance program that covers costs to the owners associated with the repair by a private contractor of a lateral sewer comiection to a residence with the City sewer system, subject to a deductible that is the responsibility of the property owner. The Board has determined that it is in the best interests of the health, safety, and welfare of its citizens to establish certain policies and procedures in order to ensure proper repair and operation of the City's sewers. The Board has further determined that it is in the best interests of the City to establish procedures for the operational implementation of the Sewer Insurance Program, as well as for pre -qualifying private contractors to perform repairs eligible for recovery under the Sewer Insurance Program. The operational implementation of the Sewer Insurance Program is based on the process established in Chapter 7, Article 7 of the Municipal Code. The pre - qualification of contractors for the Sewer Insurance Program is based upon contractor experience, financial strength, technical expertise, satisfactory past performance and compliance with law. This Policy delegates certain responsibilities to various decision -makers in order to provide for efficient administration and implementation of the Sewer Insurance Program. This Policy is intended to supplement the ordinances establishing the Sewer Insurance Program as same may be amended from time -to -time. The following definitions shall apply to the Sewer Insurance Program: a. "Cable Machine" shallmean the sewer cleaning technology used to clear out obstructions to a Private Sewer that meets Second Opinion pre -qualification requirements stipulated in the Table on Page 6. b. "Contractor" shall mean only those contractors meeting the Construction Specifications approved by the City's Board of Public Works (the Board) (see Exhibit G for Construction Specifications) and who have been pre -qualified and pre -approved by the City's Board of Public Works in accordance with this Policy to perform repairs eligible for recovery under the Sewer Insurance Program and are identified on a Registry maintained by the City's Sewer Insurance Program Administrator. C. "Private Sewer" shall mean all connections from the Public Sewer to the foundation wall of the structure located on private property, including any lateral sewer lines flowing into the Public Sewer. d. "Public Sewer" shall mean a sewer which is owned and maintained by the City of South Bend for the collection of sanitary sewer effluent. e. "Registry" shall mean a listing of Contractors that have been pre -qualified and pre -approved by the City's Board of Public Works to perform repairs eligible for recovery under the Sewer Insurance Program. The Registry shall consist of three separate pre -qualification categories as follows: i. Second Opinion Contractor: those contractors who are able to evaluate and perform immediate sewer cleaning and repair work to a Private Sewer ii. Excavation Contractor: those contractors who are able to perform repair of a Private Sewer through open cut excavation iii. Special Contractor: those contractors that are able to provide services that are beyond the requirements of typical repair by excavation (i.e. able to perform excavation at depths greater than eight feet, able to dewater, etc.) f. "Sewer Insurance Administrator" shall mean the City's Manager responsible for the administration, implementation and operation of the Sewer Insurance Program. g. "Repair" shall mean any work performed by the City or its designated Contractor to render a Private Sewer to full operational capacity. All work to inspect the Private Sewer shall be inclusive in the repair work as defined herein. It. "Homeowner" shall mean the person or persons who is/are the title holder of the recorded property deed for the property services by the Private Sewer in question including the beneficial owner under a written, recorded land contract. 2. Program Procedures: City staff and contractors operating under the Sewer Insurance Program are required to adhere to the following procedures. Failure by a contractor to adhere to these procedures shall result in removal from the Registry. a. A homeowner shall notify the Sewer Department through the City 311 system that their Private Sewer'is not functioning correctly. The homeowner or property manager representative shall demonstrate proof that they have attempted to have their Private Sewer repaired by a professional sewer cleaner within 90 days of their 311 call. if the homeowner chooses to clean their Private Sewer with his/her own equipment or rental equipment, this does not qualify as a clearing that would allow the homeowner to file a claim for sewer insurance. It. Once 311 receives the notification of a sewer backup, the Sewer Department shall inspect the sewer main to determine if the sewer backup was caused by a blockage or other issue with the Public Sewer. c. If the Sewer Departmetif determines that the sewer backup is due to a Private Sewer malfimction, and not the Public Sector, the case shall be referred to the Sewer Insurance Administrator. d. The Sewer Insurance Administrator shall open a Sewer Insurance case for the sewer backup location. The Sewer Insurance Administrator shall contact the City Water Works for a determination if the homeowner meets the following conditions: i. If the homeowner reporting the sewer Uackutp is in fact the owner of the property in question. ii. If the homeowner is current on their Sewer Insurance payments. If the homeowner meets the above conditions, the Sewer Insurance Administrator shall then engage the homeowner under the Sewer Insruance Program, and provide the homeowner with the Right of Entry and Release (Exhibit A), a blank Payment Agreement (Exhibit B), and the Sewer Insurance Information Sheet (Exhibit Q. Homeowners who are not considered "current" by Water Works need to work through the 311 system to address their Water Works account issues prior to receiving service through the Sewer Insurance Program. e. The homeowner shall complete the following actions prior to action being taken under the Sewer Insurance Program to repair the Private Sewer: i. Sign an Agreement for right of entry to property and Release furnished by the Sewer Department authorizing right of entry onto the affected private property for purposes of making said repairs and releasing the City from any claim arising from the City's entry onto the property for such repair purposes (form of which is attached hereto and incorporated herein as Exhibit A); ii. Execute a notarized Payment Agreement (form of which is attached hereto and incorporated herein as Exhibit B) with the City of South Bend Water Works for the payment of the 500 deductible that the homeowner is responsible to pay under the Sewer Insurance Program. £ The Sewer Insurance Administrator shall hire a contractor from the Registry to inspect and repair the Private Sewer. The contractor shall first attempt to clean the line by cable machine. The contractor shall only be released from their attempt to clean the Private Sewer with cable machine by the Sewer Insurance Administrator or his representative. g. If the contractor successfully cleans the Private Sewer through cable auger, the City shall reimburse the homeowner any difference in cost actually paid by the homeowner if the contractor's fee is less than the $500 program deductible. If the Contractor's cost is greater than, $500 the City will cover the difference in cost from the sewer service fund. if the total cost of repair is less than $500, the Sewer Insurance Administrator shall readjust the total amount due from the homeowner under any Reimbursement Agreement signed by the homeowner to match the actual fee. h. If the contractor is unsuccessful in cleaning the Private Sewer through use of a cable machine, the City may hue the next contractor from the Registry to repair the Private Sewer through excavation. i. As conditions warrant, the Sewer Insurance Administator may authorize a new sewer cleanout to be installed on a Private Sewer to facilitate fiuhure clean -out and repair activities on the Private Sewer at no cost to the homeowner minus the cost of the sewer insurance deductible. The homeowner shall ensure that their Private Sewer has an accessible 4-inch minimum clean -out to allow access by the City and its contractor. Toilets, floor drains, gutter downspouts, or roof vents are not considered acceptable access points. j. The Sewer Insurance Administrator may, as situation warrants, and as recommended by the Health Department, direct work to be performed render the Sewer Insurance Program where conditions in a residence threaten the health of the homeowner, tenants or neighboring residents. In such cases, work may proceed as directed with only a signed Right of Entry and Release form, with payment form to be signed after the work is complete. 3. Program Management a. The Board designates the Sewer Insurance Administrator as the decision -maker and manager charged with daily oversight and administration of the Sewer Insurance Program. The Sewer Insurance Administrator may prescribe and make recommendations concerning the work performed by Contractors listed on the Registry in order to ensure that the work performed is cost effective for the City and the property owner, with minimal disruption of City services and operations b. Pre -Qualification Process: The Sewer Insurance Administrator shall accept proposals from contractors who wish to be. pre -qualified as a contractor approved to perform repairs eligible for recovery under the City's Sewer Insurance Program. The pre -qualification process shall include the following: (1). Submission of a fiilly-completed Application for Pre -Qualification for the City of South Bend, Indiana Sewer Insurance Program (form of which is attached hereto and incorporated herein as Exhibit D); and (2). Submission of a financial statement or other evidence of financial responsibility; and (3). Submission of non -collusion affidavit (form of which is attached hereto and incorporated herein as Exhibit I); and (4), Any other documentation or criteria which the Sewer Insurance Administrator, in its sole discretion, requests in order to permit the Sewer Insurance Administrator to evaluate a contractor's experience, financial strength, technical expertise, satisfactory past perfornnance and compliance with law. Applications shall be accepted by the Board on a rolling basis. The Sewer Insurance Administrator reserves the rigint to request addit oral information from perspective contractors in order to fully evaluate a contractor's pre -qualification application. The Sewer Insurance Administrator, upon receipt of an application, shall present to the Board for approval to the Registry. The Board shall use its best efforts to approval the vendor's application in a timely fashion. ii. Upon submission of the following, Contractors who are accepted by the Board through the pre -qualification process described in Paragraph 3a, shall be listed on the City's Registry for a period up to one year commencing annually on January V: (1). Performance bond in the amount of $25,000 or cash bond in the amount of $25,000; and (2). Proof of Liability Insurance Per Person in the amount of $50,000; and (3). Proof of Liability Insurance Per Occurrence in the amount of $1,000,000; and (4). Worker's Compensation Insurance. The City reserves the right to reject any and all Applications for Pre -Qualification, and refuse to include a contractor on the Registry if the City determines in its sole discret on that the Contractor Packs sufficient experience, financial strength, technical expertise, or equipment to perform work under the City's Sewer Insurance Program, or has failed to comply with applicable statutes, ordinances, rales and regulation, or has failed to completely perform their work satisfactorily. The City may also limit the number of pre -qualified Contractors to be listed on the Registry. iv. In order for a Contractor to renew its listing on the Registry, the Contractor shall submit an updated Application for Pre -Qualification not later than December 15' of the year prior to the renewal term. v. The Registry shall be continuously updated pursuant to rolling applications. vi. 1n order for a Contractor to be approved for listing on the Registry, Contractor must not be under investigation for any criminal behavior by any State or Federal agency. A failure to disclose such investigation may impact a Contractor's determination of "responsible" under I.C. 36-1-245.5 on future City Public Work projects. c. Registry Management i. The Registry shall be maintained at the office of the Sewer Insurance Administrator, with a copy held by the Clerk for the City's Board of Public Works. ii. The Registry shall consist of three separate pre -qualification categories. The categories and pre -qualification requirements are as follows: Second Opinion Excavation Definition Those contractors who are able to evaluate and perform immediate repair work to a Private Sewer Those contractors who are able to per repair work to a Private Sewer through open cut excavation to a maximum depth of nine feet. NOTE: benching a trench excavation shalt only be authorized as mi approved method of trench excavation by the Seiner Insurance Administrator nn a case by ease basis and twill not be assumed as an authorized practice or technique forpre-qualhcation. Requirements Equupment: ® CCTV system (optional) • Cable machine; o Industrial gear driven device or equivalent; 0 3/4 I-IP motor o 3/a" cable minimum size; ability to clean a minimurn of 180' o Four blade cutter (2", 4") o Sharktooth cutter (2", 4" & 6") o Expanding cutter(s) (up to 6" expansion) o Blow bag (optional) o Retrievers (big & small) Experience: Demonstrate experience through reference covering use of required equipment on sewer line repair with a cable machine for lines up to 6" Equipment: • Trench box system to provide trench safety per OSHA at a trench width of four feet (outside width) • Excavation equipment sufficient for a trench width of no more than three feet wide and eight feet deep. Experience: Demonstrate experience through reference regarding sewer line repair trough open cut excavation and appropriate post - construction property restoration. Safety: OSHA confined space training 5 Pre -Qualification Category Definition Pre -qualification Requirements OSHA competent person training certification Special Those contractors who are able Equipment: to perform repair work under Trench box system to the following conditions: provide trench safety per ® Dewatering (any depth) OSHA for depths greater ® Open cut excavation than eight feet at a trench greater than nine feet deep width of four feet (outside width) Excavator able to support excavation depths deeper than eight feet with a trench width no greater than four feet. Experience: Demonstrate experience through reference for any special considerations or conditions Safety: OSHA confined space training certification OSHA competent person training certification iii. A contractor maybe pre -qualified for any combination of the categories within the Registry. iv. The Director of Public Works, or its designee, reserves the right to utilize a contractor not pre -qualified on the Registry on a conditional basis for emergency purposes only. Such emergency purposes shall be the sole discretion of the Director of Public Works. If such an emergency occurs, the Director of Public Works, or its designee, shall be required to follow Indiana law with respect to the use of an emergency purchase order. v. A contractor shall have one of the two following pre -qualified conditions assigned by the Sewer Insurance Administrator: (l). Fully pre -qualified: This condition indicates that the Sewer Insurance Administrator has determined that a contractor has demonstrated through actual work, technical skill, equipment on hand, or references that they have the capability to perform the work required for the pre -qualification category in question. (2). Probationary pre -qualified: This condition indicates that the Sewer Insurance Administrator has detenmined that the contractor has met one of the following situations: (a) The contractor has not demonstrated technical qualifications to the complete satisfaction of the Sewer Insurance Administrator, and is being placed on the Registry provisionally; or (b) The contractor's success rate in repair of a Private Sewer over a rotating six month basis has dropped below 75%; or (c) The contractor was fully pre -qualified, but has not demonstrated the technical competence claimed on the pre -qualification form provided. vi. `the Sewer insurance Administrator shall develop the three categorical lists within the Registry with order of contractors based on the date which their pre -qualification application was received. if multiple applications are received on the same date, contractors for that date shall be listed in the Registry in alphabetical order. vii. The Sewer Insurance Administrator shall call contractors front Lou Registry in the order each contractor appears on a rotational basis. If a contractor refuses a call, or is unable to respond by the following business day, said contractor shall forfeit until the next rotation. viii. The Sewer Insurance Administrator shall call contractors from the Registry when repair conditions change and the nature of the repair work moves from a Second Opinion to either an Excavation or Special condition. d. if the Sewer insurance Administrator determines that a Contractor is not fully complying with applicable statutes, ordinances, title and regulations or whose work has been determined to be unsatisfactory, or lacks sufficient financial strength, equipment or technical expertise to perform the work may be removed from the Registry for a period of up to three years from the date of the violation, and shall not be eligible for cost recovery under the Sewer Insurance Program. e. if either the Board or Sewer insurance Administrator learn of an ongoing criminal investigation of Contractor after approval to the Registry, the Board is authorized to take action to suspend Contractor from the Registry pending the outcome of such criminal investigation. Reinstatement to the Registry will be subject to the process described trader Section 3(f). f. Contractor Notification Process: if a contractor's status in the Registry changes in any way, the Sewer Insurance Administrator shall notify that Contractor of the Sewer Insurance Administrator's determination in writing within ten working days of the alleged violation, or pre - qualification status change. Contractors wishing to appeal the Sewer Insurance Administrator's determination shall file a written appeal to the Board not less than five business days following the date of the Sewer Insurance Administrator's notice to the Contractor. The Board shalt hear evidence on the Contractor's appeal at its next regular Board meeting, and the Board's decision shall be final and conclusive finless an appeal is taken as in all other civil matters. The Sewer Insurance Administrator's decision shall be entitled to deference by the Board unless it is arbitrary, capricious, an abuse of discretion, or inconsistent with the rules and regulations of this Program. g. Contractors shall, perform construction activities for repair work in accordance with the constriction specifications found in Exhibit G of this policy. h. The Director of Public Works, or its designee, may, from time -to -time, make recommendations to the Board concerning the safe and efficient operation of the Sewer Insurance Program, establish certain procedures to ensure that work completed by private contractors under the Sewer Insurance Program is consistent, cost effective and professionally performed, and shall keep the Board appraised as to unsatisfactory performance of a Contractor listed on the Registry to warrant being removed from the Registry. The Sewer Insurance Administrator shall select contractors from the Registry in a specific order set shall based on the date and time of application for pre -qualification annually. The order not change unless a contractor is removed from the registry. The Sewer insurance Administrator may not deviate from the order unless there is a unique situation where the selected contractor may not have uniquely qualifying experience to address. If a contractor is skipped in selection for this reason, they will maintain their place as the next available contractor on the Registry. The contractor selected out of turn will be counted as having performed a service and will be skipped in the normal rotation through the Registry until they come back on the list as the next normally available contractor. A contractor shall respond to the selection for work in a reasonable timeframe (max response timeframe is 24 hours or the next business day whichever is shorter). Contractors unable to respond in a reasonable timeframe shall notify the Sewer Insurance Administrator at the initial request for service. Inability to respond will count as work performed and the Sewer Insurance Administrator shall move to the next contractor on the pre -qualified list. A contractor may be removed from the Registry by the Sewer Insurance Administrator due to a pattern of lack of responsiveness on the part of the contractor. A pattern of lack of responsiveness shall be considered if a contractor does not accept over 50% of selections by the Sewer Insurance Administrator over a period of six months. The Sewer Insurance Administrator shall conduct a quarterly evaluation of contractors on the Registry to maintain a standard of quality performance. Contractors must successfully repair 75% of their cable auger repairs within a sustained six month period to maintain their fully pre - qualified. If a contractor fails to maintain a 75% success rate, they shall be reduced to a probationary pre - qualified status for the next quarter. Should a contractor's performance not improve during the first probationary quarter, the Sewer Insurance Administrator may elect to either remove the contractor for the remainder of the calendar year or grant an additional probationary quarter. A contractor may not have more than two consecutive probationary quarters in a calendar year. If a contractor improves their success rate to 75% or above, they shall be reinstated to a fully pre - qualified status on the Registry. k. The rate schedule for contractor costs incurred while performing work as directed by the Sewer Insurance Administrator as attached hereto under Exhibit E. These rates will be renewed by the Sewer Insurance Administrator annually and any revisions requested through the Board prior to the beginning of a new calendar year. Contractors may petition the Sewer Insurance Administrator to add or adjust rates within the rate schedule. If petitioned, the Sewer Insurance Administrator shall contact all pre -qualified contractors to determine if additional rate categories are needed. The Sewer Insurance Administrator shall report contractor petitions and response to the Board with recommendation regarding adding additional rates or re -setting the rate amounts. 1. The {Sewer Insurance Administrator shall provide a quarterly report to the Board with recommendations and analysis of the program. The quarterly report shall contain the following information: i. Contractor performance: include recommendations as to which jobs/cleanings cannot or should not be held against a contractor for determination of continued competency (provide proof of extreme conditions of the specific situation) ii. Contractor billings per job type. Use Exhibit F for definition of job types and levels of excavation. in. Contractors shall be'directly and solely liable to a homeowner for any damage to any Homeowner's person or property cartsed by the Contractor's acts, conduct or omissions arising from 'or'within the scope of this Program. Contractor shall release and fully indemnify the City from any claim or cause of action of any kind which Homeowner may make against the City for any act, conduct or omission by the Contractor under this Program. Indemnification includes but is not limited to Contractor's payment of any legal fees or legal expense incurred by the City in defending such Homeowner claim. ExhibitA AGREEMENT FOR THE PURPOSE Or TEMPORARY RIGHT OF ENTRY RELEASE AND INDEMNIFICATION WE, THE UNDERSIGNED, being the Owner(s) and/or Tenant(s) of the real estate described below, give the right, privilege and authority for the purpose of Temporary Right of Entry onto and/or across said real estate for the following purpose: Pru'pose of Entry: a. For inspection of the private sewer to determine if the line is broken and requires repair and replacement; and b. For making repairs to or replacement of said private sewer line by the City of South Bend, Indiana. Property Location: Dates: (property address) Beginning on and ending after South Bend, lndiana. The undersigned does/do hereby agree to jointly and severally, release, indemnify and hold the City of South Bend (the City), and its agents, employees, contractors, successors and assigns harmless from all suits, claims or proceedings of any kind, as a result of the City'3 entry on the above property tinder this Agreement. This does not include release from damage caused by a Program Contractor performing repair work. The undersigned further acknowledge(s) that this release includes but is not limited to any damage to the foundation, the foundation walls and/or the building line and exterior brick wall resulting from excavation necessary to make repair, and that South Bend Municipal Code See.17-61 expressly requires a property owner to he fully responsible for any repair of the lateral sewer line from inside the basement to the outside exterior brick wall of the above property. This means that any sewer line break or malfunction which exists under the building foundation is the owner's sole responsibility and is not covered under the City insurance program. Nor does the Sewer Insurance Program cover any costs relating to removal or replacement of trees, shrubbery, plants, lawns, sprinkler systems, or other landscaping features or hard surface improvements such as driveways, patios, and sidewalks, gas grills, and similar items per South Bend Municipal Code Sec. 17-58. This Agreement shall be interpreted and enforced according to the laws of the State of Indiana. The undersigned persons executing and delivering this Agreement represent and certify that they are the owners or tenants of the said property and have the authority to execute and deliver this Agreement and that all necessary action has been taken and done. DATE: OWNER(S) / TENANT(S):. Nnmc Nume Witness: (City enxployee reyeresting access to property) (printed name) ExhibitB SEWER REPAIR REIMBURSEMENT AGREEMENT City of South Bend, Indiana Billing Address: Date: Borrower's SSN: _ , (Borrower) of South Bend, Indiana promise to pay to the order of the Sewer Repair Fnnd, South Bend Water Works, 125 West Colfax Avenue, P.O. Box 1714, South Bend, Indiana 46634, the sum of $500 as follows: One hundred dollars ($100) at the time of the execution of t note, followed by I I monthly payments of $33.34, and one final payment of $33.26 (total 12), all added to my South Bend water bill at the address listed above which I agree to 1 understand that there will be no interest charged on the amount due pursuant to this note as long as my payments are current, but that during any period of delinquency, I will be charged interest at the rate of eight percent per annum. 1 hereby waive presentment for payment, protest, notice of protest, and nonpayment of this note, and agree that upon default in payment of this note, or any part when due, the whole amount remain ng.unpaid shall, without notice or nonpayment or demand of payment, immediately become due and payable, with attorney's fees and without relief whatsoever from valuation of appraisement laws. I understand that if the total cost of repair is less than $500, that Water Works shall amend my payment schedule to match the actual cost of the repairs. Contact Person for Borrower (excluding spouse): BORROWER: Naine & relationship to Borrower (Please print) (Signature) Telephone No: Telephone No: - F State of Indiana ) SS: St. Joseph Comity ) Subscribed and sworn to before me, a Notary Public in and for said County and State this day of ,20 Notary Public Commission Expiration Date Exhibit C PROPERTY OWNER FACT SHEET CITY OF SOUTH BEND SEWER INSURANCE PROGRAM What is the Sewer Insurance Program? The Sewer Insurance Program (the Program) assists South Bend homeowners in the repair of their sewer connection lines ji oni the outside oftheir building to the City main line usually located under the adjacent street. The repairs covered by the Program are those which do not result froin failure to perform regular maintenance and line cleaning. After a sewer line is repaired under the Program, the owner is responsible for removal or replacement of any trees, shrubbery, plants, lawns, sprinkler systems, or other landscaping features, and for replacing hard surface improvements such as asphalt, can crete, or brick driveways, patios, sprinkler systems, gas grills, utility lines, foundations, and any other surface or subsurface inrproven:ents, found on public or private property. Who qualifies for the Program? Ifyou are a residential water utility customer living in a dwelling with no more than two units or a commercial water utility customer, paying for sewer and water service within the City of'South Bend, you may have the option of filing a'sewer insurance claim with the City of South Bend. If I have a sewer back-up it my home what is the nroceditre� 1. Ifyou are experiencing aback -up in your home, please call the City's 311 service center. 2. The City's Sewer Department will determine if the blockage is a result of the City's sewer main or the residential sewer lateral to your home. 3. If the back-up is due to a blockage in your sewer lateral, you will be advised to first hire a private sewer cleaning contractor to attempt to open up your private lateral line. 4. If this attempt to open up the private lateral fails, the Sewer Insurance Administrator will work with the homeowner to sign up for the City's program, and will arrange for the owner's payment of the required $500 deductible. 5. The repair will be completed by one of the City's approved contractors with the repair and costs monitored, by the Sewer Insurance Administrator. Please explain the cost of the Program: Sewer line repairs often cost several thousaard dollars. Under the Program, the homeowner is responsible only, far payment of the $500 insurance deductible. Before a Program qualified contractor will repair your sewer connection, you must complete forms and pay the $500 deductible or at least $100. You can arrange to pay the balance in 12 equal installments as part ofyour water bill by signing a payment agreement. You mist also sign a separate form authorizing the City to enter your property to make repairs. Return the signed forms along with your deductible payment to: South Bend Water Warks 125 West Colfax Avenue P.O: Box 1714 South Bend, Indiana 46634 The Water Works also can notarize yourpayment agreement ifyou return it to them. in person. I1 ExhibitD APPLICATION PR&QUALIFICATION FOR THE CITY OF SOUTH BEND, INDIANA SEWER INSURANCE PROGRAM 12 Name ofComnanv t�Yj ��Casti,a (J\t�y��i,�� �R�irncf��C Pre -Qualification Category Second Oginion Excavation Special Attach copies of the following docrunents: 1. License Number 2. Bond letter stating limits for single project and aggregate prog'am 3. (Corp. or LLC Only) Corporate authority and/or proof of regishy with the Secretary of State to do business in Indiana Principal Place of Business: j1 p�y�°� -L�dtlrl eUt'k Ld UU Iq Mailing Address: Telephone: Cell: Fax: E-Mail: (V)) Ownership Information CUB 13 OSHA Confined Space Training Certification (Name of holder. expiration date) a - License Information (Name of holder. license type,�L- uniher) M . PC 1t �r 7c� 6b Equipment On Hand (Prorvdeproofofoumeishile and list of equipment owned by company.for use in determination ofpre-qualification) By sigiring and submitting this application, Uwe agree to follow all City of South Bend Prevailing Specifications and Special Provisions (enclosed in the Sewer Insurance Program Policy as Exhibit G) By signing and submitting this application for pre -qualification, Uwe understand that as a Contractor under the City Sewer Insurance Program, Uwes a e directly and solely liable to a Hoteowner for any damage to any Homeowner's person or property caused by the Contractor's acts, conduct or ornissions arising from or within the scope of this Program. Uwe shall release and fully indemnify the City from any claim or cause of action of any kind which Homeowner may make against the City for any act, conduct or omission by the Contractor under this Program. Indemnification includes but is not limited to Contractor's payment of any legal fees-oHega expense incurred by the City in defending such Homeowner claim. aStgn Sig! tore Signature L'.L•b q R-�CAA> V, rrdo Title Title Orate .. Dale Date !tit ExhibitE SEWER INSURANCE CONTRACTOR RATE SCHEDULE November 8.2016 Pre -qualification category: Second opinion Cable Angering $223.00 Hour Pre-gnalificatlmi category: Excavation Notes: 1. Total crew size shall be a maximum of two persons unless otherwise approved by the Sewer Insurance Administrator or representative thereof. 2. Equipment costs shall include operator for same. 3. Contractor shall invoice all other material used on an itemized basis. 4. No rate adjustments shall be made for overtime hours nor fees associated with travel rime. 5. There will be no feesassociated with use of pick-up trucks and trailers. Trip Charge for Excavator $334.00 Job Excavator $167.00 Hour Trip Charge for Other Equipment $139.00 Job Rubber tire backhoe $134.00 Hour Mini Excavator $134.00 Hour Air Compressor $123.00 Job Combination Cleaner Truck $334.00 Hour Compactor (hand) $56.00 Job Dump Truck (20 yd) $100.00 Hour F350 Drunp Truck or Similar / Trailer $78.00 Hour Laborer $77,00 Hour Saw Cutting $83.00 Job Trench box, 6' x 6' * $156.00 Job Trench box, 8' x 6' * $334.00 Job Trench box, 10' x 16' * $445,00 Job *When needed, steel sheeting included in cost of bench box. Pre -qualification category: Special Special conditions shall be address by the Sewer Insurance Administrator through City of South Bend emergency contracting procedures. ExhibitF SEWER INSURANCE REPORTABLE JOB CATEGORIES BY PRE -QUALIFICATION CATEGORY Pre -qualification category: Second opinion Cable Repair of a Private Sewer through cleanout of the line by cable machine. Au erin Clean -out Install of a clean -out by the Sewer Insurance Program as determined by the Sewer Insurance Administrator Pre -qualification category: Excavation Dig Level Definition • Slab home foundation (four to five feet deep) 1 • Repair work performed mainly by hand or backhoe at depths up to five feet • Home has a basement with floor drain 2 • Repair work performed mainly by backhoe at depth from five to eight feet Trench box may be required • Home has a basement with floor drain Repair work may require sidewalk removal and replacement 3 • Repair work requires working around water lines Repair work performed mainly by backhoe at depth from six to eight feet Trench box required • Home has a basement with floor drain; basement wall may be between sidewalk and curb line Repair work may require sidewalk removal and replacement 4 • Repair work requires working around water lines, tree removal required Repair work performed mainly by backhoe at depth from seven to ten feet Trench box required Pre -qualification category: Special Dig Level Definition Home has a basement with floor drain; basement wall may be between sidewalk and crab line; repair work involves work under the street pavement 5 Repair work may require sidewalk and curb removal and replacement • Repair work requires working around large diameter water lines (24" diameter), large gas mains (six-inch diameter), tree removal required • Repair work performed mainly by backhoe at depth from nine to 15 feet Trench box required 6 Replacing long sections of Private Sewer with new pipe or using liner to fix sections of pipe. 16 Exhibit G SEWER INSURANCE PROGRAM SPECIAL PROVISIONS • ► y ► ► 1 ► ► : Y ► a►11 • :.1 The City of South Bend's PREVAILING SPECIFICATIONS, most recent version, and DESIGN & CONSTRUCTION STANDARDS, most recent version, and the 1NDOT Standard Specifications, current edition with all Supplemental Specifications to date, are to be used in this program. Each contractor is specifically instmcted to become completely familiar with the PREVAILING SPECIFICATIONS and the DESIGN & CONSTRUCTION STANDARDS prior to submitting a pre -qualification application. These SPECIAL PROVISIONS will list only "Ad itions" or "Deletions" to the PREVAILING SPECIFICATIONS and are to be used only in conjunction with the PREVAILING SPECIFICATIONS. lit the -event of conflict between the SPECIAL PROVISIONS and the PREVAILING SPECIFICATIONS, the SPECIAL PROVISIONS will govern. A. Prevailing Specifications/INDOT Standard Specifications Section: None B. Additions: 1. Where the term "or equal" is used in these specifications, the contractor deviating from specified item shall file with his/her bid a letter fully explaining and justifying his her proposed article or equal with the Sewer Insurance Administrator. The Sewer Insurance Administrator shall be the sole judge in determining if the "or equal" offered meets the .specification. III. T X F .MPT A. Prevailing Specifications/1NDOT Standard Specifications Section: None B. Additions: 1. Materials and properties purchased under contract with the Owner that becomes a permanent part of the stntct re or facilities constructed are not subject to the Indiana Gross Retail Tax (Sales Tax). 1V. CONTROI. OF WORK A Prevailing Specifications/INDOT Standard Specifications Section: 105 B. Additions: 1. The complete responsibility for this project lies with the Director of Public Works of the City of South Bend, Indiana through his authorized representatives. 17 Construction Engineering - The Contractor shall provide all the necessary, qualified personnel, equipment and supplies to perform all work required under this item. There will Ue no direct payment for this item. a A. Prevailing Specifications/INDOT Standard Specifications Section: 107 B. Additions: 1. The Owner, where mentioned in these documents, !Stile City of South Bend. The Engineer, where mentioned in these documents, is the South Bend Department of Public Works, acting through its Bureau of Construction. 2. The Contractor shall apply for and obtain any and all required permits for the work from local, state, and federal agencies and shall comply with permit requirements, including the St. Joseph County / City of South Bend Building Department. 3.-.i If the Contractor awarded this contract is not a resident of Indiana, within thirty days, the Contractor shall provide the Engineer with proof that the Contractor is duly licensed, qualified and registered with the Secretary of State of Indiana to engage in business within the State of Indiana. Vl. YROSE UTION AND PROGRESS A. Prevailing Specifications/INDOT Standard Specifications Section: 108 B. Additions: 1. hr the evenfthat excessive inclement weather causes a delay in work, the Contractor may apply in Writing for an extension of work schedule. The Director of Public Works through his authorized representative will establish all time extensions. 2. Liquidated damages will be assessed at the cost of the day's work on the given day that the work is not completed as assigned or agreed upon. 3. All work will be done between 7:00 a.m. and 6:00 p.m. unless authorized otherwise by the Sewer Insurance Administration. The contractor shall not be paid for travel time and shall not bill for overtime hours. 4. The Contractor shall plan his work and provide signs, barricades, personal notifications, watchmen or any other necessary means to prevent damage to work site by vandals and passers-by. This effort is considered incidental to the work. No direct payment will be made. Vll. IN. W ANCE A. Prevailing Specifications/INDOT Standard Specifications Section: Iva B. Additions: 1. All Contractors and subcontractors doing business with the City of South Bend shall present a Certificate of Insurance showing coverage in the following minimum amount: a. General Liability: Premises -Completed Operations or Products, Bodily Injury and Property Damage Combined Single Limit - $1,000,000 or $50,000 per person. b. There shall be no exclusion for explosion, collapse or underground hazard. 18 c. Workmen's Compensation: Statutory State of Indiana Employer's Liability - $100,000. d. Auto Liability: Bodily Injury and Property Damage Combined Single limit - $1,000,000. e. City of South Bend shall be named as additional insured on the Certificate. A. Prevailing Specifications/INDOT Standard Specifications Section: None B. Additions: I. The Contractor shall be responsible for providing all materials necessary for the dewatering and protection of existing structures to perform the work included on this project. 2. The Contractor shall subinit a Dewatering and Protection of Existing Structures Plan to the Owner and Engineer for review prior to beginning any work affected by the control of ground water and protection of existing structures. The plan shall include drawings, calculations and descriptions, as necessary, to clearly describe the nature of the methods to be used by the Contractor. The plan must be prepared, signed and sealed by a Professional Engineer registered in the State of Indiana, who is experienced in dewatering techniques and support of structures and hydraulic loadings. The plan must be submitted, reviewed and comments addressed adequately before the start of construction. The responsible Professional Engineer shall supervise and monitor the installation and operation of the dewatering/protection of existing structures elements. The Contractor shall have full responsibility `for the adequacy of the dewatering methods of the diversionhetention systems used, and for protection of all existing structures. 3. Foundations and all other parts of the construction site shall be dewatered and kept free of standing water and muddy conditions, as necessary, for the proper execution of the work. The Contractor shall install, maintain, and operate all cofferdams, sumps, and other temporary diversion and protective works needed to control ground water and surface water at the site. Since the work will be performed in a residential/cominercial area, all continuously operating equipment such as pumps and generators must be muffled and enclosed in noise dampening structures so as not to cause a nuisance to nearby residences and commercial establishments. 4. 'Control of surface and groundwater shall be continuous during the period of construction so that damage to the work shall not occur. Removal of water from the construct on site shall be peiforned so that erosion and the transporting of sediment and other pollutants are minimized. When temporary works used for dewatering are no longer needed, the Contractor shall remove them and return the area to a condition similar to that which existed prior to construction. Ly, SANITARY SEWER AND LATERALS A Prevailing Specifications/INDOT Standard Specifications Section: 2001, 2100, 715 and City Standard Drawings WW-2, WW-3, WW-6, WW-7 and WW-8. B. Additions: 1. This wolk,shall'entail the removal of conflicting portions of existing sanitary laterals and the reinstatement of said laterals encotmtered in the progress and prosecution of the work and the installation of new sanitary sewer pipe and laterals and connection to the existing system. 19 2. Where proposed work conflicts with existing private building sewer laterals, a segment of the existing sewer lateral, in conflict, shall be removed and replaced/reinstated. Removal of existing sanitary laterals shall be limited to the first joint upstream and downstream of the portion of work in conflict with the proposed improvements, or as required to tie into existing lateral locations. This work will be measured on a per instance basis for conflicting laterals encountered during the course of the Work and shall include all labor, equipment and materials (including pipe, fittings and couplings). 3. Replacement work materials shall be PVC SDR 35 per ASTM D3034. New sanitary laterals and fittings shall be 6-inch diameter PVC SDR 35 per ASTM D3034 unless otherwise directed by the Owner. The pipe and fittings for the 12-inch and 8-inch Sanitary Sewer shall be PVC SDR 35 per ASTM D3034. 4. The work performed with this Pay item shall conform to the current City Standards and 1DEM's requirements 5. Watertight joints shall be provided at all connections. 6. Installation of the sanitary sewer pipe shall be in accordance with the pipe manufacturer's recommendations, ASTM D2321, the City of South Bend's requirements and 1DEM's requirements. Pipe installations shall be backfilled as shown on the Plans or as directed. 7. The termination point of each sanitary sewer lateral shall be marked with a steel reinforcing bar and with a wood stake. The reinforcing bar shall be size #4, installed flush with proposed grade and shall extend to the center of the sewer lateral pipe. The reinforcing bar shall be offset from the end of the lateral pipe such that it does not touch the pipe. The wood stake shall be pressure treated and shall be 2"x2"x24" long. The top of the stake shall protrude 6"above finish grade. The sanitary sewer lateral markers are incidental to the respective pay item. 8. Leakage tests of the sanitary sewer shall be conducted by the Contractor for infiltration or exfltration using a hydrostatic test. The hydrostatic test shall be performed with a minimum positive head of 2-feet. The rate of infiltration or exfiltration shall not exceed 100 gallons per inch diameter per mile per day for any section of the system. In lieu of the hydrostatic test, all sanitary sewer piping shall be subject to a low pressure air test per ASTM F1417. The City and Engineer shall be advised 48-hours prior to conducting all tests. 9. A five percent (5%) Mandrel Deflection Test shall be performed on all PVC sanitary sewer pipe. 10. These pipes shall be mandrelled with a rigid device sized to pass five percent (5%) or less deflection (or deformation) of the base inside diameter of the pipe. The Mandrel 'test shall be conducted no earlier than thirty (30) calendar days after reaching final trench backfill grade. Each pipe"material/type required to be Mandrel tested shall be tested with a Mandrel approved by'the' pipe manufacturer and meeting the requirements of this section. The test shall not be performed with the aid of a mechanical pulling device. 11. The mandrel shall be pulled by hand through all sewer lines in a manner acceptable to the City and any section of sewer not passing the mandrel shall be unem eyed, replaced or repaired to the City's satisfaction and retested. 12. The Contractor shall provide proving rings to check the mandrel. Drawings of mandrels with complete dimensions shall be furnished by the Cmrtractar to the City upon request for each diameter and specification of pipe. 13. Bypass pumping required to complete the work shall be discharged to the nearest existing sanitary sewer or as directed by the Owner. The sanitary sewer bypass pumping work item shall iuclirde all labor, equipment and materials as required to maintain contimrons sere ice of the existing sanitary sewer system. The bypass ptunping system shall operate such that surcharging and backups of the existing system does not occur. 21 Continuation Certificate PLUMBING CONTRACTOR !N CONSIDERATION of the payment of a premium of $ 100.00 Federated Mutual Insurance Company hereby continues in force to its bond No 60757G9 effective 07/12/2018 07-12-2024 in the sum of TWENTY-FIVE THOUSAND AND NO/100-- Dollars ($ 25,000.00 ), on behalf of BOB FRAME PLUMBING SERVICES INC represented by (if applicable) CITY OF SOUTH BEND BOARD OF PUBLIC WORKS Obligee subject to all its terms, conditions and limitations as set forth and expressed in said bond. Principal, in favor of This certificate is executed upon the express condition that the Company's liability under said bond and this and all continuation certificates issued in connection therewith shall not be cumulative, and shall not in any event exceed the amount set forth in said bond, or said amount as It may have been increased or decreased by any rider(s) or endorsement(s) properly issued by the Company. Dated this 15TH day of DUNE 2023 wI �Fe{Aeratifdr(llutual Insurance Company l By ' Rl 31Zn4TE- AD� Attorney -in -Fact * If Refteimalj9otedesi<red, Please Return Original Continuation Certificate with Power of Upon Receivin ImOrder to Return Premium. __- FEDERATED PO Box 328 Owatonna, MN 55060 eF-22 Etl. Oi-78 POWER OF ATTORNEY KNOW ALL MEN BY'i'HESE PRESENTS: That FEDERATED MUTUAL INSURANCE COMPANY, a corporation duly organized and existing under the laws of the State of Minnesota, and having its principal office in the City of Owatonna, State of Minnesota, does hereby constitute and appoint: nr KART GIGSTEAD of the City of OWATONNA State MINNESOTA its true and lawful attorney for the following purposes: 'fo sign its name as surety to, and to execute, affix the seal, acknowledge and deliver any and all surety bonds and penalties not exceeding: ONE HUNDRED THOUSAND DOLLARS ($100,000) EACH BOB FRAME PLUMBING SERVICES INC SOUTH BEND, IN The execution of such bonds or undertakings in pursuance of these presents shall be binding upon the Company as if they had been executed and acknowledged by the regularly elected officers of the Company. This Power of Attorney granted by Federated Mutual Insurance Company shall terminate when the designee ceases to be: I) Employed by Federated Mutual Insurance Company or 2) Employed by Federated Mutual Insurance Company in a job for which such Power of Attorney is required. IN WITNESS WHEREOF, the said FEDERATED MUTUAL INSURANCE COMPANY has caused this instrument be signed and its corporate seal to be affixed by its Executive V ice President and AssistantSeeretary his the =.3lkf!,°ts dayof December 2022 FEDERATED MUTUA NS,URANCF, COMPANY f _ BYlle (SC'AL}; _ Executive Vice President all and Bn�c ssisWnt Secretary STATE OF MINNESOTA COUNTY OF STEE LE On this 21st day of December , 2022 personally appeared before me, the undersigned notary public, Sean G. Pick and Jonathan R. Hanson to me personally known, who, each being duly sworn by me, did say that they are respectively the Executive Vice President and Assistant Secretary of the FEDERATED MUTUAL INSURANCE COMPANY and that the seal affixed to this instrument is the corporate seal of said Corporation and that this instrument was signed and sealed of behalf of said Corporation by authority of its Board of Directors and said Sean G. Pick and Jonathan R. Hanson acknowledge said instrument to be the free act and deed of said corporation, dENNIFER L. WAYNE NOTARY PNBtIC • s Jan. 20A(SEAL) ''��.�T �Y Gommission Expires Jan.37, 2e2t COPY OF RESOLUTION "BE IT RESOLVED that the President or any Vice President in conjunction with the Secretary is hereby authorized and empowered tinder the corporate seal of the Company, to appoint any person or persons as attorney or attorneys -in -fact, or agent or agents of the Company, in its name and as its act to execute and deliver, anywhere in the United States or Canada, any and all bonds and undertakings of suretyship and other documents that the ordinary course of surety business may require," "BE IT FURTHER RESOLVED that the Power of Attorney or other document appointing such person or persons as attorney or attorneysAnt-fact or agent or agents of the Company may either be personally signed by the President, any Vice President, the Secretary or may be executed by said officers by means of facsimile signatures. the said personal signatures or facsimile signatures shall not require the Company seal or any other seal and shall be valid and binding on the company if executed either by personal signature or facsimile signature and with or without the Company seal being afflixed thereto." 1, the undersigned, hereby certify that I am a Executive Vice President of the FEDERATED MUTUAL INSURANCE COMPANY, a Corporation duly organized and existing under the laws of the State of Minnesota and that the foregoing is a true and complete copy of the original Power of Attorney given by said Company to: KART GIGSTEAD _ of OWATONNA, MINNESOTA authorizing and empowering such person to sign bonds as therein set forth, which Power of Attorney has never been revoked and is still in full force and effect. I further certify that said Power of Attorney was given in pursuance of a resolution adopted at a regular meeting of the Board of Directors of said Company duly called and held at the office of the Company in the City of Owatonna, Minnesota on the & day of April, 19 $2_at which meeting a quorum was present and that the foregoing is a true and correct copy of said resolution, and the whole thereof as recorded in the minutes of the said meeting. PURSUANT to the By -Laws of Federated Mutual Insurance Company, Article g, Section I; in the absence of or inability of the Secretary to act, his duties shall be performed by the Assistant Secretaries in the order of their rank. IN 'FFSTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of the FEDfiE RATED MUTUAL INSURANCE COMPANY this the 15TH flay of JUNE tit ,it r FEDERATED MUTUAL INSURANCE COMPANY ti Y+ 3 A6) Executive Vice President Continuation Certificate W CONSIDERATION of the payment of a premium of $ 100.00 Federated Mutual Insurance Company hereby continues in force to 12-31-2024 its bond No. 0942853 effective 12/31/2015 in the sum of FIVE THOUSAND AND NO/100-- Dollars ($ 5,000.00 ), on behalf of BOB FRAME PLUMBING SERVICES INC represented by (if applicable) ,Principal, in favor of CITY OF SOUTH BEND BOARD OF PUBLIC WORKS Obligee subject to all its terms; conditions and limitations as set forth and expressed in said bond This certificate is executed upon the express condition that the Company's liability under said bond and this and all continuation certificates issued in connection therewith shall not be cumulative, and shall not in any event exceed the amount set forth in said bond, or said amount as it may have been increased or decreased by any rider(s) or endorsement(s) property issued by the Company. Dated this _ 1ST day of NOVEMBER 2023 Federated Mutual Insurance Company e Y * If Renewal Rt¢t Desired, Please Return Original Continuation Certificate with Power of Attorney Upon Receiving in Order to Return Premium. 11V1SURA1VCE f PO Box 328 Owatonna, MN 55060 BF-22 Ed. Q1-18 POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That FEDERATED MUTUAL INSURANCE COMPANY, a corporation duly organized and existing under the laws of the State of Minnesota, and having its principal office in the City of Owatonna, State of Minnesota, does hereby constitute and appoint: f(ARI GIGSTEAD of the City of OWATONNA __State Or MINNESOTA its true and lawful attorney for the following purposes: To sign its name as surety to, and to execute, aff x the seal, acknowledge and deliver any and all surety bonds and penalties not exceeding: ONE HUNDRED THOUSAND DOLLARS ($100,000) EACH 808 FRAME PLUMBING SERVICES IN SOUTH BEND, IN The execution of such bonds or undertakings in pursuance of these presents shall be binding upon the Company as if they had been executed and acknowledged by the regularly elected officers of the Company. This Power of Attorney granted by Federated Mutual Insurance Company shall terminate when the designee ceases to be: I) L-'mployed by Federated Mutual Insurance Company or 2) , Employed by Federated Mutual Insurance Company in a job for which such Power of Attorney is required. LN WITNESS WHEREOF, the said FEDERATED MUTUAL INSURANCE COMPANY has caused this instruh cirtwbesigned and its corporate seal to be affixed by its Executive Vice President and Assistant Secretary thisthe- 1st day of December 2022 FEDERATED MUTUALANWRANCE COMPANY my A�pj (SEAL,} -_ E/xeou�tive�Yi�ca/Prestdent and B STATE OF MINNESOTA COUNTY OF STEELE On this 21st day of December , 2022 personally appeared before me, the andersigned notary I Sean G Pick and Jonathan R. Hanson to me personally known, who, each being duly sworn by me, did say that they are respectively the Executive Vice President and Assistant Secretary of the FEDERATED MUTUAL INSURANCE COMPANY and that the seal affixed to this instrument is the corporate seal of said Corporation and that this instrument was signed and scaled of behalf of said Corporation by authority of its Board of Directors and said Sean G. Pick and Jonathan R. Hanson acknowledge said instrmnent to be the free act and deed of said corporation. JENNIFER 1. WAYNE .�,�`� NOTARYPUBLIO�MINN@SOTA (SEAL} , ., My CaMAPoelon Expires Jan, 8L 2027 COPY OF RESOLUTION "BE IT RESOLVED that the President or any Vice President in conjunction with the Secretary is hereby authorized and empowered under the corporate seal of the Company, to appoint any person or persons as attorney or attorneys -in -fact, or agent or agents of the Company, in its name and as its act to execute and deliver, anywhere in the United States or Canada, any and all bonds and undertakings of suretyship and other documents that the ordinary course of surety business may require." "BE IT FURTHER RESOLVED that the Power of Attorney or other document appointing such person or persons as attorney or attorneys -in -fact or agent or agents of the Company may either be personally signed by the President, any Vice President, the Secretary or may be executed by said officers by means of facsimile signatures. The said personal signatures or facsimile signatures shall not require the Company seal or any other seal and shall be valid and binding on the company if executed either by personal signature or facsimile signature and with or without the Company seal being affixed thereto." I, [he wtdersigned, hereby certify that I am a Executive Vice President of the FEDERATED MUTUAL INSURANCE COMPANY, a Corporation duly organized and existing under the laws of the State of Minnesota and that the foregoing is a true and complete copy of the original Power of Attorney given by said Company to: KART GIGSTEAD of OWATONNA, MINNESOTA authorizing and empowering sych person to sign bonds as therein set forth, which Power of Attorney has never been revoked and is still, in full force and effect. 1 further certify that said Power of Attorney was given in pursuance of a resolution adopted at a regular meeting of the Board of Directors of said Company duly called and held at the office of the Company in the City of Owatonna, Minnesota on the 20111 day of Avril, 19 82 at which meeting a quorum was present and that the foregoing is a true and correct copy of said resolution, and the whole thereof as recorded in the minutes of the said meeting. PURSUANT to the By -Laws of Federated Mutual Insurance Company, Article 8, Section 1 in'the•absehee of or inability of the Secretary to act, his duties shall be performed by the Assistant Secretaries lit the order ol'their: rank. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of the FEDERATED MUTUAL INSURANCE COMPANY this the 1ST day of NOVEMBER 2023 FEDERATED MUTUALINSURANCECOMPANY (SEAL): pry Executive Vice President State of Indiana DEIVIOGRAl"HIC INFUMV1IA'I IUN Name: Bob Frame Plumbing Services, Inc iLY"k1. INiJC7tiiUlAi"IE7fi! City/State/Zip: South BendlN 46614-3700 County: Saint Joseph LICENSE INFORMATION Lic #: CO81053737 Status: Active Method: Application Profession: Plumbing Commission Issued: 1/1/1900 CJISCIPLIIVE IN�C3LiMA71i)N RELATED LICENSES Type: Plumbing Corporation Expiration: 12/31/2025 Secondary: Lic #: PC88700840 Name: FRAME, DAVID P License Type: Plumber Contractor License Status: Active Relationship: Manager State of Indiana ��1�70�;',„r°zPf➢li; IS�if=C,`r?Ni ,i 1�?!^a Name: DAVID P FRAME ;iiiCiRES� ISLI=®Rf�iATltii�4 City/State/Zip: LAKEVILLE IN 46536 County: Saint Joseph L@CEN i� IPdP{JRPJl,ATIC7N Lic n: PC88700840 Profession: Plumbing Commission Status: Active Issued: 8/26/1987 Method: Examination [3iSCiC'LINI- 1(�E°t1R€iIiRTCCP4� RCLRE �D L€CEN5ES Lic u: C081053737 License Type: Plumbing Corporation Type: Plumber Contractor Expiration: 7 2/37/2025 Name: Bob Frame Plumbing Services, Inc License Status: Active �. r Secondary: Manager State of Indiana kJ F-jVIOGRAl HIG INI'UMVl,�4 KIN Name: Tyler M. Frame ALiLiR��� BN�"�?E�6VldliiCid''.9 City/State/Zip: CentreIN 46536 County: Saint Joseph LIG�N Sln INF C7Rt�li�FTIC)N Lic #: PC11200080 Profession: Plumbing Commission Status: Active Issued: 11/9/2012 Method: Examination �FL.P��i`E�J ImtC;�N`sh6`s Type: Plumber Secondary: Contractor Exp i ration: 12/31 /2025 No Related Licenses BOB FRAME PLUMBING SERVICES, Business Name: INC. Entity Type: Domestic For -Profit Corporation Creation Date: 05/16/1975 Principal Office Address: 2442 JACLYN CT, SOUTH BEND, IN, 46614 - 3700, USA Jurisdiction of Formation: Indiana BUSINESS INFORMATION DIEGO MORALES INDIANA SECRETARY OF STATE. 02/08/2024 02:56 PM Business ID: 197505-304 Business Sfatus: Active Inactive Date: Bxpiration Date: Perpehml Business Entily Report Due OS/31/2025 Date: Years Due: Title Name Address CEO David P Frame 2442 Jaclyn Court, South Bend, 1N, 46614 - UK USA President Tyler M. Frame 2442 Jaclyn Court, South Bend, IN, 46614, USA Vice President Amanda P. Frame 2442 Jaclyn Court, South Bend, IN, 46614, USA Type: Individual Name: David Frame ,address: 20700 ROCKSTROH ROAD, LAKEVILLE, IN, 46536 - 0000, USA Providing Service in: INVOICE Auditsfor: Commercial, Construction, andlndustrial (OSHA, & State OSHA Compliance) Code Reviews /Plan RevieivsICC Code Training for: Inspectors, Architects, Engineers Safety Consulting: Plant Safety, Insurance Companies Safety Training: (OSHA, & State OSHA Compliant) Technical Physics: Training Expert Witness: Depositions, Court Written Safetv Plans: (OSHA, & State OSHA Compliant) i i '._, 2311 E. Geyer 1 49120 , TO: Deb Priskovich Bob Frame Plumbing, Inc. 2442 Jaclyn Ct. South Bend, IN 46614-3700 Invoice Number: 23-1618 Date: Oct. 17, 2023 Job Number: Verbal P.O. Number: Verbal Job: Training — Training TERMS: Due Upon Receipt Note: A service fee of 1.5%per month will be added to all accounts with a balance past 10 days. Please pay from this invoice, no statement is sent. Please Detach and Return with Retnittance 0 .30 Days 31- 60 Days Over 60 Days Oct. 12, 2023 (Confined Space - Refiesher $ 150.00 Ylease Remit lms amount � lw.uv Remit To: Bybee-Julovich, LLC Thank You for Your Business! 2311 E. Geyer Rd. Niles, MI 49120 Invoice Number: 23-1618 Bylaee4 alo nigh, PLC P.O. Box 391Nilcs, MI, 49120 Ov cc: 269-684-4617 fox: 269-684-4672 �jJ jf i �pfety Training Attendance Roster ll�OJEce ®ct 12, 2023 Location. South Bend, IN Subject. 1-iazard Communications Compraluni Bob Frame, lnc. lfgnsi PnrcQ®n : IDr. Tom L. D bee, PhD, C. PE, CCS PLEASE PRINT YOUR NAME YOUR SIGNATURE and your position . 1. Sohn Doe - Sanitary Engineer 2. 3.k> t ,o 4. 5• In 6. �ne4� S��1uelew a- 7. �G// $. /tier/�e 10.Jill 11. 13. ' 14, f iy �n. _..__...... 15. ' 16. 17. 18. 19. .20. 21. I In ril ilii..i i11111 •i,d ui i,ir. !i.:iiii.. .n�, ;�.wui �u fill Flu.. I !Jill;:,, .,nialri-iel,�l i., Excavation Safety foY Competent PersonTrafning G,✓gi9Vi4`ef Renta � pavo Ytoss has attended — haws of oh"ling s In Trench and F.xcaCvahrlaad L,ntdsloy 2l2Tl15 Thepersonstatedonthlscardhasattendedthe United Rentals ' Excavation Safety for Competent person Training classd only thelr employee can designate them the Competent Person, A ComPeteot person Is one who is capable of identifying existing and predictable hazards In the surroundings or or working conditions which are unsanitary, r dangerous to employees and who has the authorization to take prompt corrective measures to eliminate them. comficeition Programs Cerlifioato of Qualifications 6AVII11iQS5 1D:001103083 Loca1:172 Tm n q records evaliablo upon roquast.dent r§ I hn Ce�l Type oildiffed rxbtros pr000 t1A0WA 0112012007 No EXplratinn 1011R All ..C uYt Type Qalitflod Expires PYo6tl6s United ASSOciatltstj j §§ cortl11oallon Prof7rama }i{y,it�l!� 7' UA03HA oa/'PA(2019 NO Expitnlion 10Hft Pellifloate of 6luallflcations 1'! TYLER M FrWyl ID:001680566 Lood:172 Trebling recoi'tls availabio upon request. General Prehaid Equipment List ® Up ated 02®0&24 Quantity Equipment 2 185 Sullair Air Compressor 3 Wacker Jumping Jacks - Compactors Wacker Plate - Compactor 1 4 Gorlitz HD Sewer Machines 2 General Jetter Machines 1 Picote Maxi Miller Drain Cleaning and Reinstatement Machine 1 Vactor Hydro Excavator Truck (Kenworth) 1 Vac -Con Hydro Excavator- Combo Jetter - Truck (MAC) 1 Vactor Combination Truck (Peterbilt) Envirosight Camera Truck 1 2 Envirosight Push Cameras Envirosight Quick View Camera 1 1 Max Liner System Trailer (Line 3" - 24") Sewers and 2'- 4' Long Patch 4 Speed Shore Safety Boxes 5' Deep -16' Deep 1 Kenworth 20-Yard Dump Truck 2 5-Yard One -Ton Dump Trucks 1 315 CAT Excavator 1 305 CAT Excavator 1 308 CAT Excavator Attachments: Compactor & Breaker _ 1 T190 Bobcat 1 Ingersull Rand Light Tower and Generator -- 3 Mode 400 Concrete Saws 1 Miller Confined Space_ Equipment _ 1 L1165 Pipe Laser 1 Arrow Board Report Selection Criteria: Certification: OSHA10, OSHA30 Certified Status: Certified, Expired Contractor Name: Frame Bob Plbg Services,, Inc Plumbers & Pipefitters 172 February06,2024 Certification Report Certification Expiration Date: I Certification Certification Member ID Full Name Type Local Certification Name Status Date 2747787 Caldwell, Ryan W APComm r172 OSHA10 Certified 01/01/2040'. 1680565 Frame, Tyler M JY/PF 172 OSHA10 Certified 03/15/2008 2679867Mark, KylerA' JY/PF i172 OSHA10 ,Certified 05/23,/2018;` O$HA30= Certified ` ffU01/2040' 2679868 Reinke III, William A JY/PF 172 OSHA10 Certified 05/23/2018 - I OSHA30 Certified 01/01/2090 2607547 Youngs, Jacob M JY/PF 172 OSHA30 Certified 11/23/2016 Number of Members Listed on Report :6 Page 1 of 1 Accimij, (MMIDD/YYYY) CERTIFICATELIABILITY INSURANCE 02/16/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER FEDERATED MUTUAL INSURANCE COMPANY HOME OFFICE: P.O. BOX 328 OWATONNA, MN 55060 ,�Td17 INSURED 264-429-2 INSURER B: BOB FRAME PLUMBING SERVICES INC INSURER C: 2442 JACLYN CT SOUTH BEND, IN 46614-3700 INSURER M INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 22 REVISION NUMBER: 0 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER gam POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR Y N 9403507 04/01/2023 04/01/2024 EACH OCCURRENCE $1,000,000 DA oAGE Tccorrenee ELATED PREMISES $100,000 MED EXP(Any one person) EXCLUDED PERSONAL &ADV INJURY $1000000 GENERAL AGGREGATE $2,000,000 GENL AGGREGATE LIMIT APPLIES PER: POLICY DECT LOG OTHER: PRODUCTS & COMP/OP ACC $2100%000 X AOWNED AUTOMOBILE LIABILITY JANYAUTO AUTOS ONLY HIREDAUTOS OWNLYHASCTEDHULED NOONQOWNLDY AUT(Per N N 9403507 04/01/2023 04/01/2024 E a BIaEeIDS INGLE LIMIT $11000,000 BODILY INJURY (Per Person) BODILY INJURY(Per Accidenq PROPERTY DAMAGE Acciduntl A X UMBRELLA LIAB EXCESS LIA6 X OCCUR CLAIMS -MADE N N 9403508 04/01/2023 04/01/2024 EACH OCCURRENCE $2,0002000 AGGREGATE $2,000,000 DED RETENTION A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERI EXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A N 9403509 04/01/2023 04/01/2024 X I PER STATUTE I OTHER E.L EACH ACCIDENT $500,000 E.L DISEASE EA EMPLOYEE $500,000 E.L DISEASE POLICY LIMIT $500,000 rERION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Atldidanal Remarks Schedule, may be afhchetl if more space is required) RTIFICATE HOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED - OWNERS, LESSEES OR CTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU ENDORSEMENT FOR GENERAL LIABILITY. CERTIFICATE HOLDER CANCELLATION CITY OF SOUTH BEND SOUTH BEND, IN 46601-1830 227 W JEFFERSON BLVD 220I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CG 20 33 12 19 !1 e � • • • This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section 11 -Who Is An Insured is amended to include as an additional insured any person or organization for whom you are performing operations when you artd such person or organization -have agreed'n writing in a contract or agreemenfthat such person or:, organization be added as an atlditional ;insured on your policy. Such person or organization is an additional insured only with respect to liability for "bodily injury", "property damage" or ."personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured. However, the insurance afforded to such additional insured: 1. Only applies to the eaten# permitted by law; and 2. Will not be :broader than that' which you are required by the contract or agreement to provide for such additional. insured. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are completed. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: 1. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of or the failure to render any professional architectural, engineering or surveying services. © Insurance Services Office, Inc., 2018 Page 1 of 2 CG 20331219 Policy Number: 9403507 Transaction Effective Date:04/01/2023 f 1 r�l; 2. "Bodily injury" or "property damage" occurring after: a. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or b. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III = Limits Of Insurance; The most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement you have entered into with the additional insured; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. Page 2 of 2 ©Insurance Services Office, Inc., 2018 CG 20 33 12 19 Policy Number: 9403507 Transaction Effective Date: 04/01l2023 IN LICENSE NO, PC88700840 2442 JACLTN COURT, SOUTH BEND, INDIANA 46614-3700 Telephone (574) 291-7511 FAX (574) 299-1297 February 7, 2024 Board of Public Works County City Building, Room 1316 227 W,Jefferson Blvd. South Bend, IN 46601 bpwbids@southbendin.Bov Re: Pre -Qualification Checklist for Water Works Utility Service Line Repair Program &Sewer Insurance Lateral Repair Program To Whom It May Concern: Section b (i) IN Secretary of State online copy of Business Entity Information (attached). (I it Prior business name: Bob Frame Plumbing & Heating, Inc. (!it) No violations within the preceding five (5) years. (iv) We utilize our staff on payroll which consists of members from Local #150 & Local #172, We have 3 operators, 5 plumbers, one apprentice, 2 maintenance tradesmen and 4 helpers to ensure that we have sufficient employees on staff to complete the work we are bidding on. (v) 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) See attached for evidence of participation in apprenticeship and training programs are approved by and registered with the United States Department of Labor's Office of Apprenticeship, or its successor organization, (vii) Written plan for employee drug testing from Local 172 attached, (viii) Statement attached re: utilizing a surety company which is on the Bureau of Fiscal Service " Dept. of Treasury's Listing of approved Sureties". (ix) We do not have 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) City of Mishawaka Thank you for your time and consideration. Sincerely, CITY OF SOUTH Di Project Name _AC)V k4 �Ree Q_C a,a�6'2clC� �O r'c� 4 t �'c �47�n� tJrl Project No, For Bids Due Contractor Name: P1t 1mbi nra `&6CQS TTQ The City seeks to enhance its ability to identify responsive and responsible bidders on all City public works projects by institution of comprehensive submission requirements in compliance with State law. Quality workmanship, efficient operation, safety, and timely completion of projects requires that all bidders meet certain minimum requirements to be responsive and responsible bidders. THIS FORM MUST BE SUBMITTED WITH YOUR BID. INSTRUCTIONS: If you are a pre -qualified bidder, complete Section I only. If you are not a pre -qualified bidder, complete Section II only. Section II acts as an application for pre -qualification. Submission of Section II will allow the bidder to be considered for pre -qualification for bids with the City of South Bend Department of Public Works. Pre - qualified bidders will then be exempt from a portion of the submission requirements outlined in Section 6- 63 of The Responsible Bidding Ordinance No. 10594=18 (hereinafter, "Responsible Bidding Ordinance") for a period of twelve (12) months. Thereafter, contractors who are pre -qualified must submit a complete application for continuation of "pre - qualified" standing, on a form provided by the City ("Responsible Bidder Checklist (1) Pre -Qualified Bidders") by December 31 s' for'the. upcoming calendar year, or within twelve (12) months of obtaining pre - qualified standing. If the status of any item changes within the twelve (12) months, it is the responsibility of the contractor to notify the City, Failure by any pre -qualified contractor to submit its complete application for continuation of "pre -qualified" standing within the time prescribed above shall result in automatic removal of the designation, effective January 1 of the following year, or immediately following the twelve (12) months of pre -qualified standing. However, the "removed" contractor or subcontractor shall still be permitted to bid on City public works projects, though the contractor must submit all required documents under 6-63 until "pre -qualified" status is re-established. Please Note: The City reserves the right to request supplemental information from the bidder, additional verification of any information provided by the bidder, and may also conduct random inquiries of the bidder's current and previous customers regardless of pre -qualified standing. It is the sole responsibility of the potential bidder to comply with all submission requirements applicable to the bidder in Section 6-63- of the Responsible Bidding Ordinance no later than the date of the public bid opening. 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'independbntverification of the information provided by the contractor. PRE -QUALIFIED BIDDER CHECKLIST (a) Acknowledgements: (i) _ By checking this box, I hereby acknowledge that I am apre-qualified bidder with the City of South Bend and that I have met the pre -qualification requirements within the last twelve (12) months. A copy of my Pre -Qualification verification letter is attached. (ii) _ By checking this box, I hereby acknowledge that the City reserves the right to request supplemental information, additional verification of any information provided by me, and may also conduct random inquiries of my current and prior customers. (b) Attachments: (i) _ Indiana Secretary of State's on-line records (ie. Business verification) dated within sixty (60) days of the submission of said document showing that business is in existence, current with the Indiana Secretary of State's Business Entity Report, and eligible for a certificate of good standing. (Not applicable to individuals, sole proprietors or partnerships). Statement on staffing capabilities, including labor sources. This statement indicates and ensures I have sufficient employees on staff to complete the work. It outlines how I intend to meet the staffing needs of the work. (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. 11, PRE -QUALIFICATION CHECKLIST (FOR BIDDERS THAT ARE NOT PRE -QUALIFIED) (a) Acknowle^drents, By checking this box, I hereby acknowledge that I am not a pre -qualified bidder 4✓with the City of South Bend. By checking this box, I hereby acknowledge that the City reserves the right to %I 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. By checking this box, I hereby acknowledge that copies of all Applicable 1 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)✓ 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) Attachment (i) Indiana Secretary of State's on-line records (ie. Business verification) dated within `J I 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). List identifying all former business names. 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) I/ years. (iv) 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) 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) 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) 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) Evidence that I am utilizing a surety company which is on the Bureau of Fiscal Service "Department of Treasury's Listing of Approved Sureties' as required in the bid specifications or contract. (ix) Written statement of any federal, state or local tax liens or tax delinquencies owed to any federal, state or local taxing body in the preceding three years. (i) List of projects of similar size and scope of work performed in all areas, including the State of Indiana, within three (3) years prior to the date on which the bid is due. Date: 1 (Sign H re) t^-ZAV�Gi P (Print Name Here) 1 b �cc "Q �1Lmb) nca �erYl i eS lrit . (Name of Company) (Address of Compan ) (City) (State) (Telephone Number) BOB FRAME PLUMBING SERVICES, Business Name: INC Entity Type: Domestic For -Profit Corporation Creation Date: 05/16/1975 Principal Office Address: 2442 JACLYN CT, SOUTH BEND, IN, 46614 - 3700, USA Jurisdiction of Formation: Indiana BUSINESS INFORMATION DIEGO MORALES INDIANA SECRETARY OF STATE 02/06/2024 09:29 AM Business [D: 197505-304 Business Status: Active Inactive Date: Expiration Date: Perpetual Business Entiy Report Due OS/31/2025 Date: Years Due: Title Name Address CEO David P Frame 2442 Jaclyn Court, South Bend, IN, 46614 - 37005 USA President Tyler M. Frame 2442 Jaclyn Court, South Bend, IN, 46614, USA Vice President Amanda P. Frame 2442 Jaclyn Court, South Bend, IN, 46614, USA Type: Individual Name: David Frame Address: 20700 ROCKSTROA ROAD, LAKEVILLE, IN, 46536 - 0000, USA SOUTH BEND PLUMBERS &e PIPEFITTERS JOINT APPRENTICESHIP &c TRAINING COMMITTEE 4172 Ralph Jones Court South Bend, IN 46628 Telephone:(574)273-0500 Fax:(574)2734560 February 6, 2024 To Whom It May Concern, Plumbers &Pipefitters Local 172 Joint Apprenticeship &Training Committee (J.A.T.C.) has been registered and certified with the US Department of Labor, Bureau of Apprenticeship and Training since December 22, 1941. The Office of Apprenticeship Administration number is IN020410001 (please see attached Certificate of Registration). Bob Frame Plumbing Services Inc. became a signatory contractor with Local Union 172 — Plumbers & Pipefitters in 1968 making them also a signatory with our Joint Apprenticeship Training program. Sincerely, Jeremy J. Lucas Apprentice Coordinator z O N 0 .�1 O 0 0 d r� U ^m lJ m z co m �u N N INDIANA STATE PIPE TRADES ASSOCIATION/MECHANICAL CONTRACTORS ASSOCIATION OF INDIANA STATEWIDE DRUG and ALCOHOL TESTING POLICY and PROGRAM Effective July 1, 2018, this policy supersedes all prior policies, procedures, and practices related to the use and/or abuse of drugs and/or alcohol. Table of Contents Pate A. POLICY STATEMENT......................................................................................................1 B. POLICY ADMINISTRATION...........................................................................................2 1. Prohibited Substances..............................................................................................2 2. Testing Procedures...................................................................................................2 3. Substance Abuse Policy Coordinator. . 6 0 d d a 1 0 0 0 0 * I I I I I I I q I I I I 1 0 4 6 d 0 w 1 4 1 0 1 1 1 1 q % * I I d 1 5 4. Testing Outside of Program.....................................................................................5 C. VOLUNTARY IDENTIFICATION AND REHABILITATION/TREATMENT..............5 D. TESTING OF PARTICIPANTS",,,,.,',, 41,16 "'w.6 a &**'I .......... * , , d , , 4 4 a 0 a a 4 4 w , * w 6 07 1. Initial Testing. 7 2. Random Testing....................................................................................................... 3. Annual Testing, 7 4. Reasonable Cause Testing...........................00..4111111:.......0.4..6..10..6..................0...04...0 9 5. Post -Accident Testing.............................................................................................. 6. Return To Work And Follow -Up Testing. . 0 6 * I I I 1 0 q q * 4 a 0 0 0 0 0 , I I I I I * I I I I I I I I 1 0 9 E. PRESCRIPTION / NONPRESCRIPTION DRUGS OR MEDICATIONS ......................10 F. SANCTIONS / CONSEQUENCES..................................................................................I I G. CONFIDENTIALITY, I 1 0 * * I I I I I q 4 1 d . . . . . . 6 . . . . . . . . 0 * a a d N 0 4 P * * 0 a 0 0 , , * 0 , d . . . . 4 * * . . . . . . . . o , , d 0 .... **Oomqqo 0,6600 ........... os,13 H. DUTY TO COOPERATE..................................................................................................13 1. AMENDMENTS TO POLICY. 1 4 1 1 d I I 1 0 14 1 1 d I 1 0 1 1 4 * I I I I 1 0 w w d a a **plow* 61 11101 1114 * * h000sq@P* laws I'll 4111111p* $1 13 J. DISPUTE RESOLUTION.................................................................................................14 K. DEFINITIONS.",',,, low ... & 6 0 0 N P 0 , 4 1 1 1 1 1 1 1 1 1 4 1 0 4 0 0 4 0 0 6 N N N P a 0 q . . . . . . . . . * , o . . . . . . . d . . . . . . . . . . 0 0 4 w , * * 614 L. ATTACHMENTS..................................................................................18 1. Sample Letter of Notice for Random Testing, 0 1 * * I I I 1 0 1 0 1 0 11 1 1 0 1 1 1 4 1 & a a 0 % I , o 0 0 d a 0 0 4 1 1 1 * I I d I 1 1 118 11. Drug Test Information and Instruction Sheet........................................................19 III. Sample Participant Consent Form and Testing Authorization Form", 110, * $*,I'll 11111120 IV. Card Status Confirmation Procedure....................................................................$21 A. POLICY STATEMENT MECHANICAL CONTRACTORS ASSOCIATION OF INDIANA, on behalf of its member contractors (collectively, the "MCAI"), and the INDIANA STATE PIPE TRADES and its affiliated United Association Local Union Nos. 136, t57, ]66, 172, 440, (collectively, the "Union"), together recognize that the use and abuse of drugs and alcohol can seriously impair a participant's ability to perform safely and efficiently his or her duties. Drug and alcohol use and abuse not only jeopardizes the public's, participant's and co -worker's safety, they undermine the public's confidence in the construction industry. Because the use of drugs and alcohol in the work place pose a significant threat to the safety of the public and participants, the MCAI and the Union have established this policy as a part of their ongoing efforts to maintain a drug and alcohol -free work place. All participants are expected to report to work free of alcohol and illegal drugs and not to sell, purchase, distribute, dispense, possess, or use or conspire to sell, purchase, distribute, dispense, possess, or use an illegal drug or alcohol on a job site or during working time. Likewise, all participants are expected not to misuse or abuse any prescription or nonprescription medications. MCAI and the Union look to all participants to support this policy to ensure quality service to the public and to betterthe overall safety, health, productivity, and welfare of all participants. Participants are asked to discourage co-workers from violating this policy and are expected to cooperate in efforts to enforce this policy and in any investigation of its violation. It is the intention of this policy to comply with state and federal laws. Where state and federal law differ, however, the policy will comply with federal law. For example, some state laws permit the use and possession of marijuana for medical and/or non -medical purposes. Federal law does not. Consistent with federal law, the policy considers marijuana to be an illegal drug for purposes of this policy. All participants and applicants for employment to positions covered by the collective bargaining agreements supplemented by this negotiated policy are subject to this policy: All non -bargaining unit Contractor participants that are directly involved in the piping industry at all locations of shops and or offices, within the above mentioned local jurisdictions, either full or part-time are subject to this policy if their Contractor chooses to have them participate. Each individual will be issued an Identification Card. To be eligible to work on a job site, an individual must possess a valid Identification Card, as defined in this policy. Upon a participant's arrival at a job site or office, the Contractor shall require the participant to present his/her Identification Card. Contractors may verify with DISA/Midwest Toxicology Services (DISA/Midwest Toxicology) or Construction Safesite (www constructionsafesite.org) the status of an individual, whether or not he/she presents a valid card. If the participant does not possess a valid card, he must take, and pass, an initial test, as described in this policy, prior to commencing work. Be POLICY ADMINISTRATION Prohibited Substances A drug is any substance which may impair mental or motor functioning including but not limited to illegal drugs, controlled substances, "designer" drugs, synthetic drugs, and, under certain circumstances described in this policy, prescription or nonprescription drugs and medications. Alcohol includes all beverages, mixtures, substances, medications, inhalants, or preparations which contain alcohol. Drugs and alcohol as defined above are prohibited substances. Although this policy prohibits the use of any illegal drug, at a minimum testing will be done for the following substances: Marijuana Cocaine Opiates — including: Morphine, Codeine, Heroin, Hydrocodone, Hydromorphone, Oxycodone and Oxymorphone Amphetamines/Methamphetam ines/Ecstasy Phencyclidine (PCP) Barbiturates Benzodiazepine Methadone Propoxyphene Depending upon the circumstances, testing may also be done for alcohol. Participants involved in an accident/incident, or who demonstrate a reasonable cause for testing, shall be required to take an alcohol and drug test. Tests for alcohol shall be performed using breath, 2. Testine'Procedures saliva or blood to determine a a. All urine collections for drug testing purposes shall be conducted in accordance with standard procedures that are patterned but are not exactly the same as those found in "49 CFR Part 40 Procedures for Transportation Workplace Drug and Alcohol Testing Programs." A separate urine collection procedure document has been developed for this program. b. All urine and blood testing shall be performed only by a laboratory certified by the U.S. Department of Health and Human Services. c. All drug and alcohol testing shall be conducted in accordance with the U.S. Department of Health and Human Services' "49 CFR Part 40 Procedures for Transportation Workplace Drug and Alcohol Testing Programs." d. Any result on a screening test which exceeds the levels set forth below -2 shall be confirmed by a subsequent test conducted using the Gas Chromatography/Mass Spectrometry assay or other approved method recognized by the U.S. Department of Health and Human Services. No adverse action or discipline shall be taken against any participant or applicant for employment on the basis of the result of a screening test which is not confirmed to be "positive" by such subsequent test. e. A "positive" drug test result shall mean that a drug(s) was detected at or above cutoff levels on both the screening test and the confirmatory test using the cutoff levels established by "Part 40 Procedures for Transportation Workplace Drug and Alcohol Testing Programs" or standard industry cutoff levels for those drug categories that are not included in Part 40. The following cutoff levels will be used to determine a positive drug test: Screening Levels Confirmation Levels ng/ml ng/ml Amphetamines Amphetamine' 500 250 Methamphetammc 500 250 MDMA, MDA, MDEA (Ecstasy) 500 250 Cocaine Metabolites I50 100 PCP -Phencyclidine 25 25 Opiate Metabolites 6-Acetylmorphine 10 10 Morphine 300 300 Codeine 300 300 Extend Opiates Hydrocodone 300 300/100* Hydromorphone 300 300 /100* Oxycodone 100 100 Oxymorphone 100 100 Marijuana Metabolites 50 15 Barbiturates 300 200 Benzodiazepine 300 300 Methadone 300 300 Propoxyphene 300 300 *Effective April 1, 2019, the Confirmation Levels for Hydrocodone and Hydromorphone will be 100 ng/ml. -3- A "positive" alcohol test result shall mean alcohol concentration at or above .04%. In the case of a "positive" drug test result, the participant shall be so advised by the Medical Review Officer ("MRO"), on a confidential basis, prior to the reporting of the results to the employer, and the participant shall have the right to discuss and explain the results including the right to advise the MRO of any medication prescribed by the participant's own physician which may have affected the results of the test. Expired prescriptions will not be accepted by the MRO as a valid explanation for a positive lab result. Use of hemp products will not be an acceptable explanation for a positive marijuana test result. Use of CBD oil that complies with Indiana law will not cause a participant's specimen to test positive for marijuana and therefor will not be an acceptable explanation for a positive marijuana test result. The MRO may order additional laboratory tests in the course of verifying a prescription that is known to contain THC, the metabolite of marijuana that is detected on the testing panel. After notification to the participant, the employer and the union shall be notified by 10:00 a.m. the following business day. The MRO may verify tests as positive without having communicated directly with an individual about the results if the individual expressly declines the opportunity to discuss the test or does not return a call to the MRO service in a timely manner. If the MRO needs assistance with reaching a collective bargaining participant, the MRO must only seek assistance from the participant's union, not the participant's contractor. g. A participant testing "positive" shall have the right to have the split specimen or the balance of the original sample tested at another SAMSHA accredited lab if the participant makes a written request to retest to the Substance Abuse Policy Coordinator within 72 hours of receipt of notice of a positive drug test from MRO. A retest is based on the presence of the controlled substance. If no presence is detected, the test will be considered negative, and the participant shall be allowed to resume work immediately and be reimbursed for the cost of the test, and lost time, if any. A retest will not be conducted until the participant has paid for the test. The participant must prepay the cost of retest at the time he/she requests the retest with an acceptable form of payment (credit card, cash, or money order.) h. Alcohol tests, when required, will be conducted by a trained Breath Alcohol Technician (BAT) if possible. Screening tests may be done using an evidential breath -testing device (EBT) or non -evidential screening deviceapproved by the National Highway Traffic Safety Administration. Confirmatory tests will be done using an evidential breath -testing device. If it is not possible to test using the breath, then a saliva test or blood draw may be performed. Standard DOT breath alcohol testing procedures will An MRO is a licensed physician who has knowledge of substance abuse disorders and the appropriate medical training to interpret and evaluate all positive test results together with an individual's medical history and any other relevant biomedical information. -4 be followed when possible. Individuals subject to this policy continue to have access to the usual protections provided as a part of their union membership and/or as members of bargaining units covered by collective bargaining agreements. Such individuals may request that a union representative be available or present prior to any action taken by an employer, if any, at any stage of the policy and its administration. 3. Substance Abuse Policy Coordinator DISA/Midwest Toxicology Services, an independent corporation with a history of managing drug testing programs, has been contracted to serve as the Substance Abuse Policy Coordinator (SAPC). It is the intent of the MCAI and the Union to outline the specific duties of the Substance Abuse Policy Coordinator and to govern ,those'activities by serving as advisors to the Substance Abuse Policy Coordinator. 4. Testine Outside of Program In the event that a contractor is required to test a participant but due to unforeseen events, the testing is not completed through the Substance Abuse Policy Coordinator, the contractor is responsible for providing a copy of the test results to the Substance Abuse Policy Coordinator of the program. C. VOLUNTARY IDENTIFICATION AND REHABILITATION/TREATMENT Any participant who:: voluntarily identifies himself as having adrug- or alcohol - related problem will not be subject to discipline for volunteering that fact. Rather, the participant must surrender his Card and pursue counseling, rehabilitation, or treatment to eliminate dependence on drugs or alcohol. Participants who volunteer such information and participate in a counseling/rehabilitation/ treatment program are not relieved of their obligation to comply with this policy and applicable rules concerning alcohol and drugs. Since the key to any rehabilitative effort is a participant's willingness to admit and seek to remedy the problem, this provision is not available to an participant who requests protection after being asked to submit to a test or after the participant's use of drugs or alcohol becomes a personnel issue based on direct observation or other reliable evidence, such as an arrest or criminal conviction for a drug- or alcohol -related offense. If the participant is actively participating or has successfully completed the counseling/rehabilitation/ treatment program as verified in writing by the Participant Assistance Program (EAP), the participant will be eligible to work after passing a return -to -work test, as described in this policy. Return from rehabilitation is also conditioned upon the participant's compliance with individual responsibilities, which may include obtaining follow-up counseling and/or treatment as recommended by the EAP. -5- Any costs associated with the voluntary counseling/rehabilitation/treatment program will be at the participant's expense unless the charge is specifically covered under the EAP or an applicable insurance policy, and the participant is an active participant in the insurance program. MCAI and the Union encourage all participants troubled by their own or a family member's drug or alcohol abuse to seek professional care and treatment. Early recognition and treatment of alcohol and drug abuse provides the greatest opportunity for successful recovery. MCAI and the Union provide an Employee Assistance Program (EAP) for all participants and their families who need professional guidance in assessing their substance abuse or alcohol -related problem and choosing an appropriate course of treatment. Current participants will be referred to an EAP representative as a result of a positive drug test or upon an individual's own'request. In either case, the content of discussion with the EAP will be totally protected and confidential to the extent it is allowed, by law, with the exception that the EAP will be free to speak with the privacy officer of your union regarding dates of contact with EAP and assigned counselor, compliance/noncompliance of recommendations, and appropriateness of recommendation if contested by member. EAP will also be free to communicate to the union's privacy officer the steps needed to be taken by member to be released to take a return to duty mine screen and to remain in compliance. A participant, who seeks the services of the EAP on his/her own, will never have his/her use of the program brought to the attention of MCAI and the Union or any of its subscribing organizations or participants. Individuals who use the EAP as a consequence of a positive drug test will be subject to the conditions established in the drug testing portion of this policy. The Employee Assistance Program (EAP) is a member resource sponsored by MCAI and the Union. The EAP provides confidential assistance to participants who are experiencing substance abuse or alcohol -related problems in their own lives, or who have family members with a similar problem that requires attention. Because alcohol and drug problems affect all areas of a person's life and because individuals and families often recognize the consequences of alcohol and drug problems without attributing these problems to the alcohol and/or drug use, the EAP is also available to assist with family, marital, parenting, emotional health, mental health, stress and financial issues. Addressing these issues not only uncovers cases of alcohol and drug abuse, but also provides preventive services to help' families cope with issues in everyday living that can lead to substance abuse. The staff of the'EAP`has knowledge of the level and types of benefits available to MCAI and the Union participants. Participants can access the service of the EAP through a hotline that is staffed twenty-four (24) hours a day, seven (7) days a week, throughout the entire year for emergency or crisis situations. Participants calling the EAP hotline are put in touch with a counselor who will conduct a professional assessment and may meet with them to further assess the nature of the problem in order to provide the best and most appropriate level of care. Participants that need to schedule a non -emergency appointment, should contact the EAP between 8:00 am and 4:30 pm (EST), Monday through Friday at 900/745-4838, ext. 2. The EAP is staffed by certified and credentialed human services professionals who are sensitive to the needs of the individual. Individuals who take the initiative to contact the EAP for assistance do so with the -6- assurance that their calls will be treated respectfully and confidentially. The direct services provided by the EAP are sponsored by MCAI and the Union. D. TESTING OF PARTICIPANTS The following are circumstances under which testing will be conducted. Participants may be eligible for a reimbursement check for initial, random, and annual reasons for testing. Reimbursement checks will be void after 60 days from the date of the check. I. InitiaLTesting All persons who are otherwise eligible to obtain an Identification Card will be instructed to report and provide a urine sample at an approved collection site at a specified time, under procedures that will be provided to the individual. 2. Random Testing In order to maintain a valid Identification Card, all individuals are subject to random testing. The participants will be chosen for a random drug test by one of the following methods: a. Participants will be selected anonymously from a computerized selection program. If an individual is selected for testing, he/she will be notified to report to an approved collection site as soon as possible, within 7 days of the date of the random letter. Random selection by this method will test 1/12th of the then -current covered workforce of each participating local Onion, each month, without prior notice. Only a drug test will be administered for this type of random testing. If a participant fails to report for the random test within the designated time frame but has an acceptable excuse that is approved by the Substance Abuse Policy Coordinator, their card status will be invalid until they report for the test. If a participant fails to report for the random testing within the designated time frame and does not have an acceptable excuse, a refusal to test violation will be recorded for the participant and they will be referred to the EAP. It is in the participant's best interest to contact EAP immediately after learning of the violation. If there is any delay, there is a greater chance that the participant may be delayed in being able to return to work in a timely manner. b. An owner/job site may require participants to be subject to random testing. If feasible and if the testing meets the program's requirements, the test results shall be submitted for entry into this program. 3. Annual Testing In order to maintain a valid Identification Card, each individual will be tested at least every twelve (12) months. 4. Reasonable Cause Testing When there is reasonable cause to believe that a participant is under the influence of drugs, testing shall be required. When there is reasonable cause to believe that a participant has used alcohol, testing shall be required. The EAP will make -7 available supervisory training in the signs and symptoms of alcohol and drug abuse in the workplace as well as in how to intervene with reasonable cause cases. The EAP will be available 24 hours a day to consult with supervisors regarding probable cause cases. "Reasonable cause" testing may be based upon such things as: a. Specific, contemporaneous, articulable observations concerning the appearance, behavior, speech, or body odors of the participant, including observation of drug use, drug possession, or possession of drug paraphernalia, physical signs or symptoms of being under the influence of a drug or alcohol, and signs and symptoms of chronic and/or withdrawal effects of drugs; b. A pattern of abnormal or erratic behavior as evidenced by the participant's work time actions, appearance, or conduct; c. Arrest for a drug -related offense while at the worksite or in company vehicle; d. Newly discovered evidence that the participant has tampered with a prior drug test. If feasible, the participant's conduct will be witnessed by at least two supervisors. If not feasible, one supervisor's observations are sufficient. Reasonable cause can also be based upon a report received from a third party observer if the report is independently corroborated. A copy of the report will be sent to the employer, participant and the union. If a participant is suspected of using illegal drugs or alcohol, the appropriate supervisor (one who was involved in the reasonable cause determination) will gather all information, facts, and circumstances leading to and supporting the suspicion. If the supervisor has evidence and/or specific indicators that the participant is using a controlled substance illegally that is not known to be detected under the program's normal testing panel, the employer may request that an expanded testing panel be used to detect the suspected controlled substance. A controlled substance may include any substance listed on Schedule I through V of Section 202 (21 U.S.C. 812) of the Controlled Substance Act (example: synthetic marijuana known as "K2" or "Spice", designer stimulants known as "bath salts"). Permission to test for additional drugs will be granted by the Substance Abuse Coordinator with approval by the Drug Testing Policy Committee. Should the participant test positive for a controlled substance not normally detected on the program's testing panel, the participant's card status will be changed to "not valid" and the participant will be required to complete the rehabilitation steps described in this policy. A participant who is required to submit to a reasonable cause drug screen will be, suspended until the results of the test are disclosed to the employer. If the test result is negative, the participant will be paid for the days of work missed., When the supervisor(s) has reasonable cause to believe that the participant has used drugs or alcohol, a written report detailing the circumstances, which formed -8 the basis to warrant testing, will be made, and the participant will be directed to submit to testing. A copy will be sent to the employer, participant and the union. Iu any reasonable cause situation, the employer will ensure that the participant is transported to an appropriate facility. The participant may request that a Union representative. also be present. In the absence or unavailability of a Union representative, the testing process will not be delayed. The employer will ensure the participant is transported back to the work site, where a spouse, family member, or other individual will be contacted to transport the participant to the participant's residence. In the event no such individual is available, the employer will provide transportation to the participant's residence. If the participant refuses to agree to any of these procedures and attempts to operate his or her own vehicle, the employer may take appropriate efforts to discourage the participant from doing so, up to and including contacting local law enforcement officials. Any participant failing to cooperate with any of the procedures described above will be subject to discharge and revocation of the Identification Card. 5. Post -Accident Testing For purposes of this policy, an accident is an event that occws while an participant is on working time or conducting a contractor's business, whether on or off a job site, when that event results in (1) death, (2) bodily injury to a person who receives medical treatment away from the scene of the accident, or (3) property damage. This will include serious near miss accidents. As soon as possible, but no later than two (2) hours after an accident, each participant whose performance either may have contributed to the accident or cannot be completely discounted as a contributing factor to the accident, will be tested fot• drugs and alcohol. A participant who is seriously injured and cannot provide a specimen at the time of the accident shall provide the necessary authorization for obtaining samples, hospital reports, and/or other documents that would indicate whether there were drugs or alcohol in his or her system at the time of the accident. A participant who refuses to provide such authorization will be considered to have refused to submit to testing. If there is a reasonable cause basis for the post -accident test, the participant will be subject to all the reasonable cause provisions. 6. Return To Work And Follow -Up Testing a. Any pa��ticipant returning to work after an absence of any duration for a positive test result and/or counseling/rehabilitation/treatment purposes must satisfactorily pass a drug screen to be eligible to work. b. Follow up tests will be required for a minimum of 12 months after an participant returns to work from a positive test result and/or counseling/rehabilitation/treatment and the time could be longer if recommended by the SAP. The participant will be subject to not less than four (4) unannounced follow-up tests. Four (4) follow up tests is the minimum number required and the SAP may recommend more than four (4). The Substance Abuse Policy Coordinator will schedule any -9- unannounced tests under this policy. The Substance Abuse Policy Coordinator will give the participant notice of such unannounced tests by phone or mail. The participant must take the test within twenty-four (24) hours after receiving notice; if not the participant will be considered to have failed the test. The participant may be marked as non -compliant by the SAPC f r any of the following reasons: i. The participant fails to report timely for afollow-up test due to an acceptable reason. ii. The participant is working out of the area and unable to do follow-ups while out of the area. The participant is incarcerated. The length of time to complete follow-up tests may be extended by the SAPC for any of the reasons above. c. If a follow-up test is dilute, the participant will be required to re -test. Under these circumstances the initial diluted test will not count as one of the required follow-up tests. d. If alcohol tests are required for follow-up testing the SAP will require the participant to sign appropriate releases for the monitoring of the alcohol follow-up test through his/her employer for the duration of follow-up testing. e. The program will pay for the return to duty and follow-up testing required after the first violation. The participant will be required to pay for the `return to duty and follow-up testing required after the second or subsequent violations. There will be no reimbursement for Return to Work and Follow -Up Testing. E. PRESCRIPTION /NONPRESCRIPTION DRUGS OR MEDICATIONS The misuse of any prescription or nonprescription drug or medication is also prohibited. If an individual is using a prescription drug that may impair his/her mental or motor functions so as to affect his/her ability to perform safely their duties and responsibilities, the individual must report the use of that prescription drug to his/her supervisor prior to reporting to work after its use. Each contractor reserves the right to determine whether an individual can safely perform his/her duties and responsibilities while taking the prescription drug. The contractor will determine the appropriate action to ensure workplace safety. If an individual is using anon -prescription medication that has a written warning that indicates use may impair mental or motor functions so as to affect his/her ability to perform safely their duties and responsibilities, the individual must report the use of that non-prescription medication to his/her supervisor if the -10- medication is taken prior to or during work time. The contractor will determine the appropriate action to ensure workplace safety. F. SANCTIONS/CONSEQUENCES Positive test results: a. A participant testing positive for the first time must surrender his/her Identification Card, will be ineligible to work, and will be discharged. The participant will be ineligible for work for a minimum period of thirty (30) days from the date the violation is reported to the union and/or contractor and, upon returning to work, is subject to unannounced Follow -Up testing for a minimum of one (1) year. b. A second positive test will result in the participant being discharged and revocation of the Identification Card. The participant will be ineligible for work for a minimum period of ninety (90) days from the date the violation is reported to the union and/or contractor and, upon returning to work, is subject to unannounced Follow -Up testing for a minimum of one (1) year. c. A third positive test will result in the participant being discharged and revocation of the Identification Card. The participant will be ineligible to retest or obtain the Identification Card for a minimum period of one (1) year. The participant will be ineligible for work for a minimum period of one (1) year from the date the violation is reported to the union and/or contractor. The participant may apply for reinstatement to the Drug Policy Committee after one (1) year. If the participant is reinstated, he/she is subject to unannounced Follow -Up testing for a minimum of one (1) year. Any subsequent positive tests will be treated the same as a third positive test. d. The participant will be directed to contact the EAP for evaluation and recommendations for assistance. The EAP can be reached at 1-800-745- 4838, ext. 2. It is in the participant's best interest to contact EAP immediately after learning of the violation. If there is any delay, there is a greater chance that the participant may be delayed in being able to return to work in a timely.manner. e. Before becoming eligible to work, the participant must complete an evaluation with the EAP, complete and/or continue to follow the treatment prescribed by the EAP, and obtain from the EAP a written report of compliance with the EAP's recommendations for assistance, which will be sent to DISA/Midwest Toxicology and will include a statement as to the participant's completion of EAP recommendations or the participant's required involvement in ongoing EAP recommendations as well as the recommended timing of the Return to Work test. f. The participant must also submit to a return to work test, as described in this policy, and is subject to unannounced follow-up testing as recommended by the EAP, and as described in this policy. g. The costs of the education/treatment described above are to be borne by the EAP program or the participant. Starting with the third violation the participant is responsible for all costs associated with the EAP program. h. If the participant is currently in a JATC sponsored apprenticeship program, additional sanctions/consequences may apply, up to and including discharge. Please refer to JATC policies for further guidance. 2. Participants whose test results show an alcohol concentration of at least 0,04 shall be deemed as testing positive and shall be discharged pursuant to the Sanctions/Consequences (P. Sanctions/Consequences, 1. Positive test results: a through g). Participants whose test results show an alcohol concentration 0.02 or greater but less than 0.04 shall be removed from the worksite for twenty-four (24) hours or until their next scheduled work shift, whichever is longer. 3. A diluted specimen result will require a retest. The Substance Abuse Policy Coordinator will report the dilute to the designated contractor and/or union representative in the event that the MRO assistant is unable to reach the participant to go over the following information. A participant providing a diluted specimen shall be given the opportunity to retest the following day after notification. The participant should refrain from consumption of fluids after 9:00 p.m. the night before recollection. The participant should limit fluid intake to a minimum the day of and up to collection time. If the participant cannot attend the retest the following day, the participant must receive approval from the Substance Abuse Policy Coordinator to retest at a later date. A second diluted test without a medical reason carries the same consequences as testing positive. The Substance Abuse Policy Coordinator can at their discretion reject the explanation. If the two parties cannot agree, the Drug Policy Committee may consider the matter further. 4. Participants who switch, tamper, or attempt to switch or tamper with any screening test or sample will be discharged and the Identification Card revoked. This would include an event where a collector discovers a prosthetic or other device designed to carry "clean" urine and urine substitutes on the participant in the course of conducting a urine collection for drug testing. The result will be considered a refusal to test, having the same consequences as a positive drug test. 5. Participants who refuse to submit to a drug or alcohol test as required by this policy or to execute any relevant documentation such as consent or release of information forms are subject to discharge and revocation of the Identification Card. The result will be considered a refusal to test, having the same consequences as a positive drug test. 6. Any participant who is convicted of, or pleads guilty to, a drug or alcohol related offense that occurred in the workplace will be discharged. The result will be treated as a positive drug test, having the same consequences as, a positive drug test. 7. Any participant who is convicted of, or pleads guilty to, an alcohol or drug related offense that occurred outside the workplace may be discharged :VA ; ; is part of the participant's duties and responsibilities. The result will be treated as a positive drug test, having the same consequences as a positive drug test. If the -12- participant is in his own vehicle and on his own time, it will not be treated as a positive. G. CONFIDENTIALITY Test results will be disclosed only to those management participants and union representatives with a "need to know." Any information related to a participant's drug or alcohol test results will otherwise be disclosed only if: (1) The participant gives written permission to release the information; (2) The information is released as evidence in an arbitration hearing, administrative proceeding, or legal action; (3) The information is released as part of a governmental investigation; or (4) Required by law, as follows: i. Lawsuits (e.g. wrongful discharge action) ii. Grievances (e.g. an arbitration concerning disciplinary action taken by the employer) iii. Administrative proceedings (e.g. an unemployment compensation hearing) IV, Criminal or civil actions — to the decision maker in the proceeding (e.g. the court in the lawsuit) All records and information regarding the personnel actions taken with respect to participants with verified positive test results will be maintained in a confidential file with the employer and/or the local union. H. DUTY TO COOPERATE As a condition of employment, participants are expected to abide by the terms of this policy. To enforce this policy, a contractor may, from time to time, as part of an investigation, inspect personal property and all contractor property and equipment. This does not include a participant's personal vehicle. Participants have an obligation to respond to the Substance Abuse Policy Coordinator or their union hall if either is attempting to reach the participant regarding this program. Failure to respond within a reasonable amount of time could result in an Invalid card status for the participant or a refusal to test to be recorded for the participant depending on the circumstances. Art participant's failure to cooperate with action to investigate and enforce this policy will subject the participant to discharge. I. AMENDMENTS TO POLICY The governing body of this Policy and Program is the Drug Testing Policy Committee, which is comprised of an equal number of labor and management representatives. This body may institute negotiated changes to the policy outside the scope of any general collective bargaining negotiations. This body will generally follow the DOT guidelines when periodically modifying preliminary cut off and confirmation levels and adding new drugs. -13- DISPUTE RESOLUTION The following procedures shall be used to resolve all disputes relating to the administration of this Drug Policy: Any dispute or disagreement concerning the application or interpretation of this Agreement shall be referred to the Drug Testing Policy Committee (The Committee) for resolution. As set forth in Article I, The Committee shall consist of an equal number of labor and management representatives. The Committee has full discretionary authority to interpret and administer all provisions of this Drug Policy. All disputes or requests for review must be set forth in writing and submitted via mail or email by a representative of the Local Union of the Complainant to The Committee in accordance with the time constraints of the grievance and arbitration provisions of the Complainant's collective bargaining agreement. The Drug Testing Policy Committee can waive the timeframe requirements of this section upon good cause shown by the Complainant. The Committee shall generally hear and decide all timely requests for review within three (3) business days of receipt of the request, unless extended by The Committee for cause. If an extension is necessary, The Committee will notify the parties in writing of the extension. All decisions of The Committee shall be accomplished only by a majority vote at a meeting at which a quorum is present. A quorum of The Committee shall consist of two (2) labor members and two (2) management members. The labor and management representatives shall have an equal number of votes, regardless of the number of committee members actually present at a meeting. In person hearings are not required. Decisions can be made upon review by The Committee of the evidence submitted and meetings may be conducted over the phone or via computer. Once a decision has $een reached by The Committee, the parties will be notified of the decision as soon as possible, but generally not later than three (3) business days after the decision has been reached. In the event of a deadlock of any issue, the dispute shall be referred as a grievance under the procedures set forth in the complainant's collective bargaining agreement. The Committee shall endeavor to answer any questions related to Drug Policy disputes for which no deadlock exists. Notwithstanding the provisions of this Article I, all individuals subject to this policy shall continue to have access to the usual protections provided as part of their union membership and/or as members of the bargaining units covered by a collective bargaining agreement, including the usual grievance and arbitration provisions of the individual's collective bargaining agreement. Any timeframes set forth in a local grievance procedure may be tolled and/or a grievance stayed while a dispute is pending before The Committee. K. DEFINITIONS TO ENSURE COMMON UNDERSTANDING OF TERMS, THE FOLLOWING DEFINITIONS SHOULD BE CONSISTENTLY USED: -14- Accredited Laboratory (SAMHSA): A federally certified laboratory approved by the Department of Health and Human Services (DDHS) for testing of prohibited items and substances. Accident/Incident: An accident is an event that occurs while a -participant is on working time or conducting a contractor's business, whether on or off a job site, when that event results in (1) death, (2) bodily injury to a person who receives medical treatment away from the scene of the accident, or (3) property damage. This will include any serious near miss accidents. Adulterated specimen: Tampering with a test sample by the substitution or addition of other ingredients to mask the presence or use of illegal drugs, resulting in a specimen that contains a substance that is not expected to be present in human urine, or contains a substance expected to be present but is at a concentration so high that it is not consistent with human urine. Alcohol: The, intoxicating agent in beverage alcohol, ethyl alcohol, or other low molecular weight alcohols including methyl and isopropyl alcohol. Alcohol concentration (or content): 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 (BrAC). Alcohol screening device (ASD): A breath or saliva device, other than an EBT, that is approved by the National Highway Traffic Safety Administration (NHTSA) and placed on a conforming products list (CPL) for such devices. Alcohol screening test: An analytic procedure to determine whether an --participant may have a prohibited concentration of alcohol in a breath or saliva specimen. Alcohol use: The drinking or swallowing of any beverage, liquid mixture or preparation (including any medication), containing alcohol. Annual Testing: Each participant's obligation to be tested at least every 12 months. Breath Alcohol Technician (BAT) is an individual who is certified as trained to operate an Evidential Breath Testing device (EBT) and who is proficient in breath -testing procedures. Collection site: A designated place where individuals present themselves for the purpose of providing a specimen of their urine to be analyzed for the presence of controlled substances, or for purposes of providing a saliva or breath sample to be analyzed for alcohol concentration. Confirmation Test: A second test performed by a SAMHSA — certified laboratory, on the same sample used for the screen test, which uses the more complex methodology of GUMS (Gas' Chromatography/Mass Spectrometry) or other approved method, that is more precise for the purposes of confirming or refuting screen test results. Contractor: An employer employing anyone working under an associated collective bargaining agreement. Controlled substances: Includes all illegal drugs as listed in this policy and per the Department of Transportation (DOT) limits (including controlled substances, look alike drugs and designer drugs), prescription drugs used by one for whom they were not -15- prescribed, overuse of prescription drugs prescribed for the user, drug paraphernalia, and alcoholic beverages in the personal possession of or being used by an -participant on the premises, or while assigned to work off premises. DHHS-approved laboratory: A laboratory that is certified under the U.S. Department of Health and Human Services Mandatory Guidelines for federal workplace drug testing programs. Diluted specimen: A urine specimen with creatinine and specific gravity values that are lower than expected for human urine. Drug test: A test conducted for controlled substances. Follow -Up Testing: For a minimum of twelve (12) months after a participant returns to work from a positive test result and/or counseling/rehabilitation/treatment, the participant will be subject to not less than four (4) unannounced follow-up tests. The Substance Abuse Policy Coordinator will schedule any unannounced tests under this policy. The Substance Abuse Policy Coordinator will send the participant notice of such unannounced tests by mail. The participant must take the test within twenty-four (24) hours after receiving notice; if not the participant will be considered to have failed the test. Initial test: (for drugs) An immunoassay screen to eliminate "negative" urine specimens from further consideration. Medical Review Officer: A licensed physician responsible for receiving laboratory results generated by a substance abuse testing program, who has knowledge of substance abuse disorders, and who has received appropriate medical training to interpret and evaluate an individual's confirmed positive test result together with the individual's medical history and any other relevant biomedical information. Negative Test: A negative test is obtained if: (t) the screen test indicated the absence of legal or illegal substance in excess of the screen limit; or, (2) the screen test indicates the presence of legal or illegal substances in excess of the screen limit but the confirming test indicates the absence of legal or illegal substance in excess of the confirmation limits; or, (3) the screen test and confirmation test indicated the presence of a legal or illegal substance(s) in excess of the limits but the donor had a valid medical reason for the substance being detected in the specimen. Non -Bargaining Unit Personnel:_ Includes all Union office employees either full or part-time including, but not limited to Business Managers, Assistant Business Managers, Business Agents, Field Representatives, Fulltime Financial Secretaries, etc. secretaries, clerks, receptionists, etc., and all office or shop employees of the Signatory Employer directly involved in the piping industry at all locations of shops and or offices, within the local jurisdictions noted earlier, either full or part-time, including but not limited to: office managers, clerics, salespersons, staff, shop hands, including truck drivers, superintendents, and others, whether or not such employee visits job sites. If participation is required by the employer, the employee shall be bound by all terms and conditions of this Alcohol and Drug Policy including all rehabilitation and discipline articles and sections. Participant: Anyone working under an associated collective bargaining agreement. All Non -Bargaining Unit Personnel. -I6- Positive Test (alcohol)_ A positive alcohol test is obtained when a participant's confirmatory test result reads 0.04% BAC or higher. Positive Test (drug): A positive drug test is obtained when a participant's confirmatory test or retest result is at or above cutoff levels listed in this policy, as verified by the MRO to be a positive test. Probable Cause/Reasonable Cause: Probable Cause/Reasonable Cause testing may be based upon such things as: (a.) Specific, contemporaneous, articulable observations concerning the appearance, behavior, speech, or body odors of the participant, including observation of drug use, drug possession, or possession of drug paraphernalia, physical signs or symptoms of being under the influence of a drug or alcohol, and signs and symptoms of chronic and/or withdrawal effects of drugs; (b.) A pattern of abnormal or erratic behavior as evidenced by the participant's work time actions, appearance, or conduct; (c.) Arrest for drug -related offense while at the worksite or in company vehicle; (d.) Newly discovered evidence that the participant has tampered with a prior drug test. Random Testing: An unannounced, unscheduled drug and/or alcohol test, pursuant to an objective method for random selection of participants to be tested. The selection must be truly random without discrimination or arbitrary selection. Refusal to Test: It is considered a refusal to test if the participant adulterated and/or substituted or refused to provide a urine specimen, or if the participant failed to appear for testing within a reasonable time, or to remain at the testing site until testing process is complete, or if the participant failed to provide a sufficient amount of urine without a medical reason, and/or failed to undergo an MRO directed medical evaluation for such a reason. Failure to cooperate with any part of the testing process, including the use of abusive language or behaving in a threatening manner, or behaving in a confrontational way that disrupts the testing procedure, or refusing to permit a direct observation collection when required by the policy, shall also be considered a refusal to test. It will also be considered a refusal if a participant is wearing a prosthetic device or possesses any other device, container, etc, that could be used to interfere with the collection process or if the participant admits to the collector or MRO that they adulterated or substituted their specimen. A refusal to test will be treated as a positive test. Return to Work Test: Any participant returning to work after an absence of any duration for a positive test result and/or counseling/rehabilitation/treatment purposes must satisfactorily pass a drug screen to be eligible to work. Substance Abuse Professional (SAP): A licensed physician (Medical Doctor or Doctor of Osteopathy), a licensed or certified psychologist, a licensed or certified social worker, a licensed or certified employee assistance professional, state licensed or certified marriage and family therapist, or alcohol and drug abuse counselor certified by the National Association of Alcoholism and Drug Abuse Counselors Certification Commission (NAADAC) or by the International Certification Reciprocity Consortium/Alcohol & Other Drug Abuse (ICRC)or by the National Board of Certified Counselors (NBCC), with knowledge of and clinical experience in the diagnosis and treatment of alcohol and controlled substances -related disorders. -17- Letter of Notice for Random Testing Date: (Example: April 82 2016) Re: Testing Procedure for MCAUIndiana State Pipe Trades (ISPTA) Identification Card Your name has been randomly picked by MCAT/ISPTA computer generated selection program to take a drug test as soon as possible in order to update your MCAI/ISPTA identification card. Our computer program selects the names of one -twelfth (1/12) of all participant cardholders for update each month. We want to re-emphasize that your selection for a test is purely a random one. You will' be taking the same test, which you initially took when you received your MCAIASPTA card. In order to avoid any potential interruption in the status of your card, you must be tested by (Example date: April 15, 2016). Tests are to be taken on your own time at any one of the facilities identified on the attached list. You will be mailed a $35.00 MCAI/ISPTA expense reimbursement check if your test is negative/valid. Reimbursement checks will be void after 60 days from the date of the check. All .MCAT/ISPTA participants who are working may have their MCAT/ISPTA card verified with the database administrator in order to determine if their card is "valid" or "not valid" under MCAI/ISPTA Program, This procedure will protect everyone's confidentiality. Please remember that if you fail to take the test by the date listed above, the result may be treated as a positive test. **Please be aware of the closing time of the collection facility you choose to report to for your random test. If you start the testing process you will be expected to finish the process (by providing a sufficient urine specimen) within 2 hours OR by the time the facility closes, which ever is sooner. , If you fail to finish the process, it will be considered a refusal to test which has the same consequences as a positive test result. Collection site hours are subject to change without notice - please call site to verify BEFORE going. Sincerely, Substance Abuse Policy Coordinator DISA/Midwest Toxicology Services, LLC PS: Remember it is your responsibiliTy to keep the MCAUIndiana State Pipe Trades and the Substance Abuse Policy Coordinator (800/358-8450, ext. 5014) informed of any change in your address or telephone number. PPS: Also remember the MCAI/Indiana State Pipe Trades offers a fully independent, professional Participant Assistance Program (EAP) for you and your family. The EAP's 24 hours, 7 day a week hotline number for the local area is 317/962-8001 or toll -free 800/745-4838, ext. 2. -18- MCAI/INDIANA STATE PIPE TRADES APPLICANT/CARDHOLDER DRUG TEST INFORMATION AND INSTRUCTION SHEET MCAI/Indiana State Pipe Trades is exercising extreme care to insure that strict quality control measures are followed in the collection, handling, and analysis of your mine specimen. You play an important role in this process and should be certain that you have provided an unadulterated urine specimen to the laboratory. Remember, you are certifying that the urine specimen, which you provide is yours and is unadulterated. Any adulteration or switching of urine is a breach of MCAI/Indiana State Pipe Trades rules and, if you are employed, may subject you to discipline up to and including termination by your employer. For your own protection and peace of mind, we ask that you: • provide a picture identification to the collection site/technician at time of arrival; • be escorted to a collection room and asked to provide an unadulterated urine specimen in the collection container provided. The container should be filled to 45ml; • return the specimen container to the collector and witness the collector pour your specimen into specimen bottles; • initial and date the integrity seals placed on your specimen bottles; • verify the proper spelling of your name as recorded on the chain of custody; ® verify that your social security number (or other identification number) has been properly ' recorded; • • verify that the identification number placed on your specimen bottle is the same as that recorded on the chain -of -custody form. If you provide an unacceptable specimen (ex, temperature of specimen that falls outside of the acceptable range (90400 degrees Fahrenheit)), the collector will inform you that they cannot accept the specimen and the specimen will be discarded. You will be required to provide another specimen under direct observation by the same gender. The observer will direct you to raise and lower clothing in order to conduct the direct observed collection properly in accordance with DOT guidelines. If there is not a same gender person to perform the observation, then the collection will occur unobserved. You must remain at the collection site until a valid specimen is provided or else a refusal to test may result. If you are unable to provide a specimen on your initial attempt, you will be allowed up to two (2) hour to provide a specimen. You may drink up to 40 ounces of fluids. You will not be allowed to leave the collection site until you provide a valid specimen. If you leave the collection site without providing a valid specimen, it could be deemed a refusal to test which has the same consequences as a positive test result. For alcohol testing: • If an initial (screening) breath alcohol test result has an alcohol concentration (BAC) of less than 0.02, no further testing is authorized. Any initial test indicating a BAC of .02 or greater will be confirmed on an EBT operated by a BAT. The confirmation test will be performed no sooner than fifteen (15) minutes and no later than thirty (30) minutes following the completion of the initial test • In the event the confirmation test indicates a BAC of .020 to .039, you shall be removed from the worksite for twenty-four (24) hours or until your next scheduled work shift, whichever is longer. Any confirmation test with a result of a BAC of .04 or greater is considered to be positive and will require the immediate removal from the worksite. The consequences for a positive alcohol test are outlined in the Sanctions/Consequences section of this policy. All alcohol tests shall be performed only while you are considered on duty. -19- 1VIechanical Contractors t�ssoc. of Indiana/Indiana State Pipe Trades (1VICAUISPT) PARTICIPANT CONSENT FORM AND TESTING AUTHORIZATION FORM PartlClparit lristrUCtIOriS: This form must be presented at the time of your drug and/or alcohol test. All blank spaces below must be filled out and witnessed by the collector. I, the undersigned, do hereby authorize the testing of my mine for employment reasons and understand and agree that the results of any such testing will be released to DISA/Midwest Toxicology Services, LLC and, further that the testing procedures will be limited to tests for prohibited and illegal drugs and controlled substances. I understand that the results of these tests may be used for employment and disciplinary reasons and hereby authorize the release of such information from the laboratory and MRO. I further certify that the urine specimen collected from me is mine and not adulterated or altered in any manner. I have been advised that matters affecting me relative to the interpretation or applicatiom'of the Drug Policy are subject exclusively to the grievance and arbitration procedure under my collective bargaining agreement (if applicable). Reason for Your Signature Deadline to Social Security Number: Telephone Number: Mailing address: City, State &Zip Code: Witness Please check only one box. Check local jurisdiction that you are currently working in. Union Local: ❑ 136 ❑ 157 ❑ 166 ❑ 172 ❑ 440 ❑ contractor participant (not covered by collective bargaining agreement) Current employer: ❑ Not currently working Instructions to Collector: FAX and then mail this form along with the MRO copy of the chain of custody to the MRO at 317/262-2222, 603 E. Washington St., Suite 200, Indianapolis, IN 46204. If you have any questions, please contact DISA/Midwest Toxicology Services at 800/358-8450 or 317/262-2200. After 5 pm, contact 317/941-1222 or 317/847-2309. -20- MLLUKKKASIRRUIM STATUS CONFIRMATION Participating contractors will verify the status of all MCA I/Indiana State Pipe Trades participants, who are working, in order to determine if the participant has a valid card under the MCAUIndiana State Pipe Trades program. All participating contractors are encouraged to verify the status of all MCAUIndiana State Pipe Trades participants on a weekly basis. When a participant's status is "Not Valid", he/she will be advised to contact the Substance Abuse Policy Coordinator's office to resolve the Not Valid status. The individual may be required to repeat the initial test procedure for non-compliance with the random test requirements or follow the protocol for a positive test within the MCAUIndiana State Pipe Trades Policy. This procedure will protect; the participant's confidentiality and allow the employer to audit the status of his' participants which may be required by the owner to be submitted monthly. Card status can be verified through the Construction Safesite system, www constructionsafesite.org, CARD MANAGER Each MCAI/Indiana State Pipe Trades participating employer will designate a person as card manager who will be able to access data information by phone, fax, email or a secure website which will confirm the status of participant's card for: 1. Not On File 2. Not Valid 3, Valid The card manager shall maintain the strictest confidentiality of the MCAUIndiana State Pipe Trades membership. When a member is not in possession of his/her MCAUIndiana State Pipe Trades identification card, the Card Manager may request to use the member's Social Security Number to secure the participant's status. The Card Manager shall receive permission from the individual through written consent, which is kept on file and good for that date only to use the Social Security Number and shall obtain a photo I.D. confirming the identity of the individual to the Social Security Number and make a copy of same to be maintained with said record. REFERRAL A MCAUIndiana State Pipe Trades participant must have a "Valid" status before being referred to work by his/her union. -21- February 6, 2024 Re: Bob Frame Plumbing Services, Inc. To Whom It May Concern: This is to advise you that, based upon our current information, we are willing to entertain bonds for this organization for construction contracts, subject to the usual underwriting criteria. Bob Frame Plumbing Services, Inc. is in good standing with Granite Re, Inc. Please understand that any arrangement for surety credit is a matter between contractor/applicant and ourselves and we assume no liability to you or any third parties if for any reason we do not supply said bond or bonds. This letter is not an assumption of liability nor is it a bond. It is issued only as a letter of recommendation requested from us by our client. Granite Re, Inc. is an "A+" rated company by A.M. Best and is a federally approved surety by the United States Department of the Treasury. Sincerely, Granite Re, Inc, Aaron Fischer, AFSB Underwriter 14001 Quailbrook Drive Oklahoma Cify, Oklahoma 73134 405/752-2600 Fax 405/749-6800 800/440 5953 Website: www.granftere.com ExhibitH When the prospective Contractor is unable to certify to any of the statements below, it shall attach an explanation to this Affidavit. CONTRAC"TOI2'SLAON-COLLUSION AND NON-DEBARIVIENT 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 �(� idp�) ) SS: S�. COUNTY ) The undersigned Contractor, being duly sworn upon his/her/its oath, afSrms under tite 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 airy of its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or vohmtarily excluded from participation in this transaction by any Federal department or agency; and 3. Contractor has not, nor has any successor fo, 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 trme- to-time, b. As provided by Ind. Code § 5-22-16.5-8, as amended from time -to -time, a Contractor is engaged in investment activities in Iran if either: i. Contractor, its successor or its affiliate, provides goods or services of twenty million dollars ($20,000,000) or more in value in the energy sector of Iran; or ii. Contractor, its successor or its affiliate, is a financial institution that extends twenty .million dollars ($20,OOQ000) 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. 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 bidlquote; and 5. Contractor shall require his/her/its subcontractors performing work under this public contract to certify that the subcontractors do not knowingly employ or contract with an unauthorized alien, nor retain any employee or contract with a person that the subcontractor subsequently learns is an unauthorized alien, and that the subcontractor has enrolled in and is participating in the E-Verify Program. The Contractor agrees to maintain this certification throughout the term of the contract with the City of South Bend, and understands that the City may terminate the contract for default if the Contractor fails to cure a. breach of this provision no later than thirty (30) days after being notified by the City. 6. Persons, partnerships, corporations, associations, or joint venturers awarded a contract by the City of South Bend through its agencies, boards, or commissions shall not discriminate against any employee or applicant for employment in the performance of a City contract with respect to hire, tenure, terms, conditions, or privileges of employment, or any matter directly or indirectly related to employment because of race, sex, religion, color, national origin, ancestry, age, gender expression, gender identity, sexual orientation or disability that does not affect that person's ability to perform the work. In awarding contracts for the purchase of work, labor, services, supplies, equipment, materials, or any combination of the foregoing including, but not limited to, public works contracts awarded under public bidding laws or other contracts in which public bids are not required by law, the City, its agencies, boards, or commissions may consider the Contractor's good faith efforts to obtain participation by those Contractors certified by the State of Indiana as a Minority Business ("MBE") or as a Women's Business Enterprise ("WBE") as a factor in determining the lowest, responsible, responsive bidder. In no event shall persons or entities seeking the award of a City contract be required to award a subcontract to an MBE/WBE; however, it may not unlawfully discriminate against said WBE/MBE. A finding of a discriminatory practice by the City's MBE/WBE Utilization Board shall prohibit that person or entity from being awarded a City contract for a period of one (1) year from the date of such determination, and such determination may also be grounds for terminating the contact for which the discriminatory practice or noncompliance pertains. 7. The undersigned contractor agrees that the following nondiscrimination commitment shall be made a part of any contract which itmay 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 1 and all subcontractors employed by me for this project will use steel products or foundry products on this project if awarded. 1 understand that violations hereunder may result in forfeiture of contractual payments. 23 1 hereby affirm under the penalties of perjury that the facts and information contained in the foregoing bid for public works are true and correct. Dated this (- P lh day of Fes¢ , 20�� Dnb �emnsLY�lbi/lCd �NIC4S�) f C, Contractor/. iffcfer (Firm) S nature of Contractor/Bidder or Its Agent Printed Name and Title Subscribed and sm orn to before in _n�h day of �R� 7. , My Commission Expires s' -� Notary Public County of Residence 3 � • 'tsotJ "-y � uuurn. o�Pev n�A, CAROL A. LASKOWSKI o; ;Notary Public, State o' Indiana t�SEAL^'. St. Joseph County ,'Rc Commission Number NP0747840. %�/40 ;pHP�o° My Commission Expires March 15, 2031 24