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Opening of Bids - Demolition of Rabbi Shulman Apartments Proj No 125-014 - Pitsch Companies
CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK Project Name Rabbi Shulman Apartment Building Demolition Project No. 125-014 For Blds Due 9:00am September 9, 2025 Date: Address: City/State/Zip: Email Address: PART I (Must be completed for all bids. Please type or print) 1- 5 - a S Bidder (Firm): bM1)uTt0r4 CoMTRACUS JIUG• AgA PTSCA tomP4N16S &a"D RP P(bs M, ps gTelephone Number: 61& 3103 CELL- (& I(p 1(06-5110 Agent of Bidder (if Applicable): Pursuant to notices given, the undersigned offers to furnish labor and/or material necessary to complete the public works project of: a SHutm" ApmtmENT' BUlL6W6 DEmDI<tTfW the City of South Bend, Indiana, in accordance with plans and specifications prepared by: A.BathMARCRE C0NsUL7A-1\J-t3 WC - and dated Av6u5't It , aoa5 for the sum of (enter the Total Bid as shown on the Proposal) Doe Aiutc,4 F�vE Ountba.Eb I=<f:-N '�-v 54ousaAts YwE Aums ei�, °after (s 1,555, 500. oo ) (Enter sum of Total Base Bid plus Alternates shown on Proposal) (Numerical) The undersigned further agrees to furnish a bond or certified check with this bid for an amount specified in the notice of the letting. If alternative bids apply, the undersigned submits a proposal for each in accordance with the notice. Any addendums attached will be specifically referenced at the applicable page. If additional units of material included in the contract are needed, the cost of units must be the same as that shown in the original contract if accepted by the City of South Bend. If the bid is to be awarded on a unit basis, the itemization of the units shall be shown on a s crate attapn e By I(� JrTEVE�1I P/ cl-f re} (Printed Name of Person Signing) ACCEPTANCE The above bid is accepted this day of Subject to the following conditions: BOARD OF PUBLIC WORKS President Members Version 5/20/2024 Contractor's Bid for Public Works - 2 20 BIDIPROPOSAL CITY OF SOUTH BEND Project Name: Rabbi Shulman Apartment Building Demolition Project Number: 125-014 For Bids Due: 9:00am September 9, 2025 Contractor Name: bwi4LmoA C0WTRA-c.-tt5P-5 lk)c • NSA crMp4ttlES BASE BID Item No. Description Quantity Unit Unit Price Total Amount Demolish Rabbi Shulman Apartment 1 Buidling at 628 W. Western Avenue, 1 LSUM 1 �{55, SUO t{5S� goa including Asbestos Abatement 2 Environmental Allowance — See 1 LSUM $100,000 $100,000 Addendum 2 Bidder (Firm): BASE BID TOTAL f555, S6� bErYtwx"M INC- �M -PI-FSC4 LMPAMtE5 Address: 0S R i G4{11' wL ST t� w City/State/Zip: Gin e0lbSS r All Telephone Number: S q qg6q ;Zk o - 5'7 I o l- ELL - By ch (Signature STE &J tT17-Sd/ (Printed Name of Person Signing) Version 1/3/2025 Contractors Bid for Public Works - 7 When the prospective Contractor is unable to certify to any of the statements below, it shall attach an explanation to this Affidavit. CONTRACTOR'S NON -COLLUSION AND NON -DEBARMENT AFFIDAVIT, CERTIFICATION REGARDING INVESTMENT WITH IRAN, EMPLOYMENT ELIGIBILITY VERIFICATION, NON- DISCRIMINATION COMMITMENT AND CERTIFICATION OF USE OF UNITED STATES STEEL PRODUCTS OR FOUNDRY PRODUCTS (Must be completed for all quotes and bids. Please type or print) STATE OF I C1416 A ) ) SS: E� COUNTY ) The undersigned Contractor, being duly sworn upon his/her/its oath, affirms under the penalties of perjury that: 1. Contractor has not, nor has any other member, representative, or agent of the firm, company, corporation or partnership represented by him, entered into any combination, collusion or agreement with any person relative to the price to be bid by anyone at such letting nor to prevent any person from bidding nor to induce anyone to refrain from bidding, and that this bid is made without reference to any other bid and without any agreement, understanding or combination with any other person in reference to such bidding. Contractor further says that no person or persons, firms, or corporation has, have or will receive directly or indirectly, any rebate, fee, gift, commission or thing of value on account of such sale; and 2. Contractor certifies by submission of this proposal that neither contractor nor any of its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency; and 3. Contractor has not, nor has any successor to, nor an affiliate of, Contractor, engaged in investment activities in Iran. a. For purposes of this Certification, "Iran" means the government of Iran and any agency or instrumentality of Iran, or as otherwise defined at Ind. Code § 5-22-16.5-5, as amended from time -to -time. b. As provided by Ind. Code § 5-22-16.5-8, as amended from time -to -time, a Contractor is engaged in investment activities in Iran if either: i. Contractor, its successor or its affiliate, provides goods or services of twenty million dollars ($20,000,000) or more in value in the energy sector of Iran; or ii. Contractor, its successor or its affiliate, is a financial institution that extends twenty million dollars ($20,000,000) or more in credit to another person for forty-five (45) days or more, if that person will (i) use the credit to provides goods and services in the energy sector in Iran; and (ii) at the time the financial institution extends credit, is a person identified on list published by the Indiana Department of Administration. 4. Contractor does not knowingly employ or contract with an unauthorized alien, nor retain any employee or contract with a person that the Contractor subsequently learns is an unauthorized alien. Version 5/20/2024 Contractor's Bid for Public Works - 4 Contractor agrees that he/she/it shall enroll in and verify the work eligibility status of all of Contractor's newly hired employees through the E-Verify Program as defined by I.C. 22-5-1.7-3. Contractor's documentation of enrollment and participation in the E-Verify Program is included and attached as part of this bid/quote; and 5. Contractor shall require his/her/its subcontractors performing work under this public contract to certify that the subcontractors do not knowingly employ or contract with an unauthorized alien, nor retain any employee or contract with a person that the subcontractor subsequently learns is an unauthorized alien, and that the subcontractor has enrolled in and is participating in the E-Verify Program. The Contractor agrees to maintain this certification throughout the term of the contract with the City of South Bend, and understands that the City may terminate the contract for default if the Contractor fails to cure a breach of this provision no later than thirty (30) days after being notified by the City. 6. Persons, firms, partnerships, corporations, associations, or joint venturers awarded a contract by the City of South Bend through its agencies, boards, or commissions shall not discriminate against any employee or applicant for employment in the performance of a City contract with respect to hire, tenure, terms, conditions, or privileges of contract or employment, or any matter directly or indirectly related to contracting or employment because of race, sex, religion, color, national origin, ancestry, gender expression, gender identity, sexual orientation, or due to age or disability that does not affect that person's ability to perform the work. In awarding contracts for the purchase of work, labor, services, supplies, equipment, materials, or any combination of the foregoing including, but not limited to, public works contracts awarded under public bidding laws or other contracts in which public bids are not required by law, the City, its agencies, boards, or commissions will consider the Contractor's good faith efforts to obtain participation by those subcontractors certified by the State of Indiana as a Minority Business ("MBE") or as a Women's Business Enterprise ("WBE") as a factor in determining the lowest, responsible, responsive bidder. Contractors seeking the award of a City contract cannot be required to award a subcontract to an MWBE; however, they may not unlawfully discriminate against said MBEIWBE. On goal -eligible contracts, Contractors are required to either meet both MBE and WBE utilization goals or demonstrate that the Contractor has made good faith efforts to obtain participation from MBE and WBE subcontractors. A finding of noncompliance or a discriminatory practice shall prohibit that Contractor from being awarded a City contract for a period of one (1) year from the date of such determination, and such determination may also be grounds for terminating the contact to which the discriminatory practice or noncompliance pertains. 7. The undersigned Contractor agrees that the following nondiscrimination commitment shall be made a part of any contract which it may henceforth enter into with the City of South Bend, Indiana or any of its agencies, boards or commissions. Contractor agrees not to discriminate against or intimidate any employee or applicant for employment in the performance of this contract with privileges of employment, or any matter directly or indirectly related to employment, because of race, religion, color, sex, gender expression, gender identity, sexual orientation, handicap, national origin or ancestry. Breach of this provision may be regarded as material breach of contract. I, the undersigned bidder or agent as contractor on a public works project, understand my statutory obligations to the use of steel products or foundry products made in the United States (I.C. 5-16-5-1). I hereby certify that I and all subcontractors employed by me for this project will use steel products or foundry products made in the United States on this project if awarded. I understand I have an affirmative duty to notify the City in my bid that my proposal does not include the use of steel products or foundry products made in the United States. I understand it is my sole obligation and responsibility to provide a justification to the City, subject to review and approval, why the cost of United States made steel or foundry products is unreasonable. Prior to award and upon submission of bid which does not use steel products or foundry products made in the United States, the City, through its director of public works, shall make a determination if the price of United States made steel or foundry is unreasonable. I understand that violations hereunder Version 5/20/2024 Contractors Bid for Public Works - 5 may result in forfeiture of contractual payments. I hereby affirm under the penalties of perjury that the facts and information contained in the foregoing bid for public works are true and correct. Dated this `J day of SePT- , 20 aS Subscribed and sworn to before me this SW My Commission Expires a - Q--? - -,;L� County of Residence Dr-mou-noty (!bgTmtmas, 1,J e- . Contractor/Bidder (Firm) r� Signatu a of Contract Bidder or Its Agent 57vve,,,! P ;5c# PQEs10ov-r- Printed Name and Title day of .SFPr , 20,QS- 4 V-0, L�� �J n Notary Public EN Version 5/20/2024 Contractor's Sid for Public Works - 6 z Q J IS, Q i9 z 0 in J U �z z z 1 LLJV)oa ❑ T z H 0� LLI � LLJ M 0 P. (nLLL � 0U)0F LL ~z w W z LU P- 0 Q N 0 z_ 9 C O c c 91 w o �n oa O V w O d m o- u o � Q c c 0 6 p- ¢EIq M � d c O OR El CL c o as � as m � m m 12 p O T p m m 0 V Q N Q 07 UQ U N U } � r � L � r m C do U Q_ �. m m t� ial W, C a) '' 1 Q o t -9 A m � �t CO � J r a [ d (n Lo ,I M a .j 19 co < m 2 UJ N z w ct f 3_ 4L ('n vi Q O m Z C Q T c 0 m m t0 m (D C O N in w V m u d) O tCi O CV 0 C�V O N C 0 2 z Q J O. 0 O w (. z O V5 J U �z z z 11! aj UlUOd R r z ' O F W — � OF�� �LZl�J O � LL F z m U c m z w n O z a O z N co E c m .Q z_ U N 4 o CO L A L E Z U IL co M M- o OL m F � �wfl. CLm w�1 5� C 0 o rz ¢0 LV ca 0 M v rz C a o E-0 C0 ma a� o � o � N c U o 1 N U coQ u L U Q C N � N G a� �m c 0 U m m CO Ev n. W N v Q N r0 z N fl T 'O .Q U) fn U Q O L3 In .pCo U C O U N O N O N Ln C O N CITY OF SOUTH BEND ! 1 \Y4 MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM MBE-2.0 EVIDENCE OF GOOD FAITH EFFORTS This completed form should be included as part of the Bids documents related to City of South Bend Public Works Projects requiring Good Faith Efforts to obtain MBE participation. Project Number: 125-014 Date: 7- 5- a S Project Name: Rabbi Shulman Apartment Building Demolition Bidder: bEYYournlcA Comer-CTD2.S 1"C. bBA P1TSCR LaMPArvIES Contact Person; 57aev1 1�►T5c{-} Telephone: Address: 615 R 1CkimcN11 ST KuJ City: GRAND IZA P I b S State: YVl l Zip: `i 9 S()y Email: 5A4- 4.n 1+sC.k&--ct. ccyvl To determine whether a bidder has demonstrated good faith efforts to reach the MBE utilization goals set forth in the City of South Bend Public Works Project Specifications, the City and its agencies, boards, or commissions, REQUIRE ALL of the following Good Faith Efforts as listed in the table below': EVIDENCE OF GOOD FAITH EFFORTS MBE LIST(S): The bidder reviewed 1) the City of South Bend's Minority and Women Business Enterprise Inclusion Program Plan; 2) the list of certified MWBEs provided by the City; and 3) the Indiana Department of Administration list of Minority and Women Owned Businesses (both certified and non -certified) found at: http://www.in.2ov/idoa/. GOOD FAITH EFFORTS TO OBTAIN MBE PARTICIPATION The bidder shall initial each item below, as evidence of its good faith efforts to obtain MBE participation in the awarded contract. affirm that I reviewed the City of South Bend's Minority and Women Business Enterprise Inclusion Program Plan and the Indiana Department of Administration's certi#ed list of Indiana Minority and Women Business Enterprises, found on their website (http://www.in.gov/idoa). I affirm that I have made good faith efforts to select portions of the contract work to be 4 performed by MWBEs, including, where appropriate, breaking out contract work items into economically feasible units to facilitate MBE participation. e�-e I affirm that I have made good faith efforts to solicit through all reasonable and available means the interest of all MBEs in the scopes of work of the contract. I affirm that 1 attended all pre -bid meetings scheduled by the City of South Bend to inform MBEs of contracting and subcontracting opportunities. I affirm that I advertised in general circulation and/or trade association publications concerning subcontract opportunities and allowed MBEs reasonable time to respond to such advertisements. /} I affirm that I performed any and all necessary steps to provide written notices in a manner reasonably calculated to inform MBEs of subcontracting opportunities and allowed sufficient time for MBEs to participate effectively. I affirm that I followed up on initial solicitations with interested MBEs, t affirm that I negotiated with interested MBEs in good faith, including providing such MBEs with adequate information about the plans, specifications and other requirements of the subcontract. n I affirm that 1 have made good faith efforts to assist interested MBEs in obtaining bonding, lines of credit, or insurance as required by the City or the bidder, where appropriate. Version 5/20/2024 Contractor's Bid for Public Works -10 CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM MBE-2.0 \� EVIDENCE OF GOOD FAITH EFFORTS affirm that I have made good faith efforts to assist interested MBEs in obtaining necessary equipment, supplies, materials, or related assistances or services, where appropriate. I affirm that I did not reject any MBEs as unqualified without sound business reasons based on a thorough investigation of their capabilities. CONTRACT RECORDS: The bidder has maintained the following records for each MBE that has bid on the subcontracting opportunity: 1. Name, address, and telephone number; 2. A description of information provided by the bidder or subcontractor; and 3. A statement of whether an agreement was reached, and if not, why not, including any reasons for concluding that the MBE was unqualified to perform the job. `Proper demonstration of Good Faith Efforts requires your initials next to all of the above boxes. Any omissions shall be considered grounds for rejection of the bid by the Board of Public Works. The City of South Bend reserves the right to request additional information. Version 5/20/2024 Contractors Bid for Public Works -11 ah CITY OF SOUTH BEND o-'f •,, MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN. FORM WBE-2.0 EVIDENCE OF GOOD FAITH EFFORTS This completed form should be included as part of the Bids documents related to City of South Bend Public Works Projects requiring Good Faith Efforts to obtain MWBE participation. Project Number: Project Name: Bidder: Contact Person: Address: 125-014 Date: 7- S - a5 Rabbi Shulman Apartment Demolition DMU ~7,3,-J lMc b8A P%-sc+4 CamPrtr lcS 5-teyr=-� i` t-SC14 Telephone: L06- W00- 5`Tf D VIS R1uimty Njb S•r NL0 City: GRA+Vb :APiflS State: MI Zip: 49SO4 Email: 54a aA tiA5Lk(2,1o(. Gam To determine whether a bidder has demonstrated good faith efforts to reach the WBE utilization goals set forth in the City of South Bend Public Works Project Specifications, the City and its agencies, boards, or commissions, REQUIRE ALL of the following Good Faith Efforts as listed in the table below*: EVIDENCE OF GOOD FAITH EFFORTS WBE LIST(S): The bidder reviewed 1) the City of South Bend's Minority and Women Business Enterprise Inclusion Program Plan; 2) the list of certified MWBEs provided by the City; and 3) the Indiana Department of Administration list of Minority and Women Owned Businesses (both certified and non -certified) found at: htt ://www.in. ov/idoa/. GOOD FAITH EFFORTS TO OBTAIN WBE PARTICIPATION The bidder shall initial each item below, as evidence of its good faith efforts to obtain WBE participation in the awarded contract. I affirm that I reviewed the City of South Bend's Minority and Women Business Enterprise Inclusion Program Plan and the Indiana Department of Administration's certified list of Indiana Minority and Women Business Enterprises, found on their website (http://www.in.gov/idoa). I affirm that I have made good faith efforts to select portions of the contract work to be performed by WBEs, including, where appropriate, breaking out contract work items into economically feasible units to facilitate WBE participation. 1 affirm that I have made good faith efforts to solicit through all reasonable and available means the interest of all WBEs in the scopes of work of the contract. — 41I affirm that I attended all pre -bid meetings scheduled by the City of South Bend to inform WBEs of contracting and subcontracting opportunities. 1 affirm that I advertised in general circulation and/or trade association publications concerning subcontract opportunities and allowed WBEs reasonable time to respond to such advertisements. I affirm that 1 performed any and all necessary steps to provide written notices in a manner reasonably calculated to inform WBEs of subcontracting opportunities and allowed sufficient time for WBEs to participate effectively. n �✓ 1 affirm that I followed up on initial solicitations with interested WBEs. n I affirm that 1 negotiated with interested WBEs in good faith, including providing such WBEs with adequate information about the plans, specifications and other requirements of the subcontract. I affirm that I have made good faith efforts to assist interested WBEs in obtaining bonding, lines of credit, or insurance as required by the City or the bidder, where appropriate. Version 5/20/2024 Contractor's Bid for Public Works -12 CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM WBE-2.0 EVIDENCE OF GOOD FAITH EFFORTS I affirm that I have made good faith efforts to assist interested WBEs in obtaining necessary equipment, supplies, materials, or related assistances or services, where appropriate. I affirm that I did not reject any WBEs as unqualified without sound business reasons based on a thorough investigation of their capabilities. CONTRACT RECORDS: The bidder has maintained the following records for each WBE that has bid on the subcontracting opportunity; 1. Name, address, and telephone number; 2. A description of information provided by the bidder or subcontractor; and 3. A statement of whether an agreement was reached, and if not, why not, including any reasons for concluding that the MWBE was unqualified to perform the job. *Proper demonstration of Good Faith Efforts requires your initials next to all of the above boxes. Any omissions shall be considered grounds for rejection of the bid by the Board of Pub[ic Works. The City of South Bend reserves the right to request additional information. Version 5/20/2024 Contractor's Bid for Public Works -13 CITY OF SOUTH SEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM MBE-2.1y/ MBE CONTACTED This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects requiring Good Faith Efforts to contact MBEs. It is the bidder's sole responsibility to verify whether any listed minority -owned business meets the MBE qualifications. Attach additional pages if necessary. PAGE I OF Project Number: 125-014 MBE Participation Goal 1.3% Project Name: Rabbi Shulman Apartment Demolition Bidder: DM uTdu Corv-Mr2 INC . bgq PATSC-14 CcmPAMES By: r plies ID ffncc (Signa re) (Title) (Date) MBE Firm 1Zr:FRE GA I Ru cr_%NG LI..C- Owner or Contact at MBE Firm 'DA}v I b Srn, —H Telephone: 59 q- a 76 q{ g;L Fax: Email: TYPE OF WORK SOLICITED FOR THIS PROJECT: -Mu a NU RESULTS OF CONTACT WITH THE MBE FIRM: = Itu �o2Pc7l+-A � i-il S eP,7�� i�ITD IM MBE Firm A EZ CONSTPUcnc r� Owner or Contact at MBE Firm RLEI-I s p 5 Telephone: 3lq_ ;tab- gl�t� Fax: Email: TYPE OF WORK SOLICITED FOR THIS PROJECT: L-AW- FjQ IA.S&esTvs R BATeynsNT A-t rt, bEMV LCno,n! WcbkV_ RESULTS OF CONTACT WITH THE MBE FIRM: = INCOP_Pp2ArTt;�!, His RAT%. 1kn-0 Version 5/20/2024 Contractor's Bid for Public Works - 14 CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM MBE-2.1,"` WBE CONTACTED This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects requiring Good Faith Efforts to contact WBEs. It is the bidder's sole responsibility to verify whether any listed woman -owned business meets the WBE qualifications. Attach additional pages if necessary. 3 PAGE OF Project Number: 125-014 WBE Participation Goal 4.7% Project Name: Rabbi Shulman Apartment Building Demolition Bidder: I flE►riO(✓I-ROA) &N7raA M14S IN c.. bSA Pt'�S CFI �smPflnl lE � By: kgs ti,ovT- (Signat re) (Title) (Date) WBE Firm 3 sisn= S LoGis-Inc-S LLC— Owner or Contact at WBE Firm L.r=Su E 1 R&SLE Telephone: a" tj_ RSi- 3qa5 Fax: Email: TYPE OF WORK SOLICITED FOR THIS PROJECT:-TRuUct14G RESULTS OF CONTACT WITH THE WBE FIRM: ~[}{ ijp KOT CAclim 7:mE 50AJ I Bt'itb WBE Firm A-1 ECc."Amrjb Owner or Contact at WBE Firm PCM ( SP{ RE S Telephone: �fja_St?_ 113LI Fax: Email: TYPE OF WORK SOLICITED FOR THIS PROJECT: --{-XLMtj�(6 RESULTS OF CONTACT WITH THE WBE FIRM: NO .AKSWEIL Thw_ Voice fAA}( L WAS Fut, _ Ik Counts NOT ACC.E"PT A NEW Rl!<55A6G- Version 5/20/2024 Contractor's Bid for Public Works -15 �Y CITY OF SOUTH BEND { ' MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN FORM MBE-2.1 WBE CONTACTED This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects requiring Good Faith Efforts to contact WBEs. It is the bidder's sole responsibility to verify whether any listed woman -owned business meets the WBE qualifications. Attach additional pages if necessary. PAGE a OF3 Project Number: 125-014 WBE Participation Goal 4.7% Project Name: Rabbi Shulman Apartment Building Demolition Bidder: G. By: - J_eP �. Nzes at- q- R - 115 (Signatur) (Title) (Date) WBE Firm A(,GgArgb liZE 5c,_u- i,!,J Owner or Contact at WBE Firm EUSki(k 7D2AKE Telephone: 31r1- Dk13_ oq j� Fax: Email: TYPE OF WORK SOLICITED FOR THIS PROJECT:-V-gVa%f46 RESULTS OF CONTACT WITH THE WBE FIRM: 15"i` IS Luc 1gh a HOURS P w4y p,tvD omLV ownts t -muu_ Bu i wts Acmuss To -. 1Y uZE. IF = 401 Loud 6 l D©EV_- + 5E-Lerrdh� — 3-- W l Ll_ CAn-A LT' HOP— 1-6 -M' 4 "ib USE✓ "E(Z 1F 54 e L,S lelTaZe5Te-> IrJ S �tNCs It,� A ' (CTE-L_ -bU2.tAJ6 'TVG7 i►IGr11 WBE Firm QLlof P, INC_ Owner or Contact at WBE Firm PLI MA j I LGAQ.rc Telephone: ,)Iq_ Q 73a - a %aj Fax: Email: TYPE OF WORK SOLICITED FOR THIS PROJECT: TRvcWJ& RESULTS OF CONTACT WITH THE WBE FIRM: 144E Pf lCg (A{ S wat3 Lh N c),T- 60 Tm1t)u bIA _ 1: 5E-Am A DE:-r met -ram k �{ Vt-AA j-(EA�& BOK- Version 5/20/2024 Contractor's Bid for Public Works -15 CITY OF SOUTH BEND MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN;" FORM MBE-2.1 x,wr'_ WBE CONTACTED This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects requiring Good Faith Efforts to contact WBEs. It is the bidder's sole responsibility to verify whether any listed woman -owned business meets the WBE qualifications. Attach additional pages if necessary. PAGE 3 OF Project Number: 125-014 Project Name: Bidder: By: WBE Participation Goal 4.7% Rabbi Shulman Apartment Building Demolition r nd KC 94.0)s (Date) WBE Firm � VJW `I -HP_ (16JI -NGd 5 ri-10, EXCEL- 5P2OAt�kSkg;_ LIST Owner or Contact at WBE Firm 6-F T AC. L&J gE Gr l -ME: Telephone: Fax: Email: IN S Ubpi. OP7 P.Pn1crv?S'i7ZPr'ZW TYPE OF WORK SOLICITED FOR THIS PROJECT: FEYL PLI- `f vQ:' 4M6 LaMPAIVIC S . 11AWC ApGntoN lnl Tat I H Sac` -( &5NI� ARCA. Ctc�s�-s-r IS �l-IN{� II'S .HOWL p,wprq IN vfl4pPrp-Ak5o , w. �17 RMc_40te , ouT TD Ti-eq &UT AVUS, flewRA QAcp- "T IE N `f CLOS(FS'i 06 oZ HoLaS AWpt`f Ire 1NbjR-&�A-Pol...tS . IP X: ANN `[+-(E 5e-Lem__IU God 2,4c--CDR- — = VJILL- rnoP_e 1-i(< lD I�I� CmPPIN+'`z RESULTS OF CONTACT WITH THE WBE FIRM: -�pr-r WILL I.(pLISr= `MtFi(_ Im¢I_Z,+IEe�- INJ ROTEZS bup,jG E wqnL .5n c4k� mE `tvE- H.-7 °Ta Gam 0F7- WBE Firm Owner or Contact at WBE Firm Telephone: Fax: TYPE OF WORK SOLICITED FOR THIS PROJECT: RESULTS OF CONTACT WITH THE WBE FIRM: Email: Version 5/20/2024 Contractor's Bid for Public Works -15 Amy Pethers From: South Bend Classifieds <classifieds@sbtinfo.com> Sent: Friday, August 29, 2025 11.41 AM To: Amy Pethers Subject: Thank you for placing your order with us. THANK YOU for your ad submission! This is your confirmation that your order has been submitted. Below are the details of your transaction. Please save this confirmation for your records. Note: We reserve the right to edit or cancel at our discretion. We appreciate you using our online self-service ads portal, available 2417. Please continue to visit South Bend Tribune's Classifieds Marketplace HERE to post your future ads. Job Details Order Number: CSBNO095498 Classification: General Package: Best - Employment Base amount: $863.12 Service fee: $34A4 Cash/Check/ACH El Discount: -$34,44 Total payment: $863.12 As an incentive for customers, we provide a discount off the total order cost equal to the 3.99% service fee if you pay with CashlChecklACH. Pay by Cash/Check/ACH and save! In no event are service fees refundable. Payment Type: ACH Account Details Lewis Pitsch 675 Richmond St NW Grand Rapids, MI 1149504 616-363-4895 amy@pitschco.com Pitsch companies Credit Card - ACH **********13 Schedule for ad number GSBNOO95498O Tue Sep 2, 2025 South Bend Tribune All Zones Wed Sep 3, 2025 South Bend Tribune All Zones Thu Sep 4, 2025 South Bend Tribune All Zones Fri Sep 5, 2025 South Bend Tribune All Zones Sun Sep 7, 2025 South Bend Tribune All Zones Mon Sep 8, 2025 South Bend Tribune All Zones Tue Sep 9, 2025 South Bend Tribune All Zones Wed Sep 10, 2025 South Bend Tribune All Zones Trucking company wanted Michigan contrac- tor looking for an Indiana - based subcontracting truck- ing company to haul broken concrete that is either a minority -owned business (MBE) or a woman -owned business (WBE). If inter- ested, please call Pitsch Companies at 6163634895. THANK YOU for your submission! Your notice has been submitted for publication. Below is a confirmation of your order. You will also receive an email confirmation. ORDER DETAILS Order Number: LSBN0367114 Order Status: Submitted Classification: Govt Bids & Proposals Package: General Package 1 Affidavit: 12.50 Base amount: 83.09 Service fee: 3.32 Cash/Check/ACH Discount: -3.32 Total payment: 83.09 As an incentive for customers, we provide a discount off the total order cost equal to the 3.99% service fee if you pay with Cash/Check/ACH.Pay by Cash/Check/ACH and save! In no event are service fees refundable. Payment Type: ACH User ID: L0117569 ACCOUNT INFORMATION Lewis Pitsch 675 Richmond NW Grand Rapids, MI 49504 616-363-4895 amy@pitschco.com Pitsch Companies Contract ID: PAYMENT DETAILS ACH**********13 TRANSACTION REPORT Date September 8, 2025 11:49:02 AM EDT Amount: 83.09 ADDITIONAL OPTIONS 1 Affidavit SCHEDULE FOR AD NUMBER LSBN03671140 PREVIEW FOR AD NUMBER LSBN03671140 Trucking Company Wanted A Michigan contractor is looking for an Indiana -based subcontracting trucking company to haul broken concrete that is either a minor- ity -owned business (MBE) or a woman -owned business (WBE). If interested, call Pitsch Companies at 616-363-4895. HSPAXLP September 10, 11, 12 2025 LSBNO367114 « Click here to print a printer friendly version >> 1316 COUNTY -CITY BUILDING 227 W. JEFFERSON BOULEVARD SOUTH BEND, INDIANA 46601-1830 PHONE 574/235-9251 Fax 574/235-9171 TDD 574/ 235-5567 CITY OF SOUTH BEND, .TAMES MUELLER, MAYOR BOARD OF PUBLIC WORKS Date: August 18, 2025 To: All Planholders From Hillary Horvath, Clerk, Board of Public Works Subject Addendum Number: 1 Project Name: 125-014 Project Number: Demolition of Rabbi Shulman Apartments ACKNOWLEDGEMENT OF RECEIPT OF ADDENDUM Date Received: F• /?- d5 This addendum is being forwarded to you for the above referenced project. Please sign below and acknowledge receipt of this Addendum by including with your electronic bid submission. THIS ADDENDUM MAY AFFECT YOUR BID. Notes: The attached documents are hereby added to the Specifications and Contract Documents and become a part of herein. Company: Domolrc i t ar\l Ccsr gkAcro2 S , itj c_ t>&A P1 i SCR C&,n *�1 I G_S Authorized Signature: Date: 9--S-as Version 8/11/2020 1316 COUNTY -CITY BUILDING 227 W.JEFFERSON BOULEVARD SOUTH BEND, INDIANA 46601-1830 PHONE 574/235-9251 FAX 574I235-9171 TDD 574/ 235-5567 CITY OF SOUTH BEND, TAMES MUELLER, MAYOR BOARD OF PUBLIC WORKS Date: August 29, 2025 To: All Planholders From Hillary Horvath, Clerk, Board of Public Works Subject Addendum Number: 2 Project Name: 125-014 Project Number: Demolition of Rabbi Shulman Apartments ACKNOWLEDGEMENT OF RECEIPT OF ADDENDUM Date Received: F - ,;L9 - aS This addendum is being forwarded to you for the above referenced project. Please sign below and acknowledge receipt of this Addendum by including with your electronic bid submission. THIS ADDENDUM MAY AFFECT YOUR BID. Notes: The attached documents are hereby added to the Specifications and Contract Documents and become a part of herein. Company: bEMC)u-ptr1 660 C Y25 , Ifrc- DBA P1'7SCk CamP4A11ES Authorized Signature: Date: 9-5-as- Version 8/11/2020 UIT CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK CHECKLIST FOR BIDDERS Project Name Rabbi Shulman Apartment Building Demolition Project No. 125-014 For Bids Due 9:00am September 9, 2025 From time to time the South Bend Board of Public Works finds it necessary to reject a bid because it does not comply with statutory requirements. In preparing your bid, please use the following checklist in order to make sure that your bid is done in the proper manner. ✓ Proper bid security included. The bidder has the option of providing either a Certified Check or Bid Bond. / Bid prepared on the City of South Bend Contractor's Bid for Public Work Form, completely ✓ executed. Contractor's Non -Collusion and Non -Debarment Affidavit, Certification Regarding Investments / with Iran, Employment Eligibility Verification, Non -Discrimination Commitment, and V Certification of use of United States Steel Products or Foundry Products. Proof of MA NBE Utilization Plans [MBE-1.0 and WBE-1.0]. Also provide Evidence of Good / Faith Efforts Forms [MBE-2.0 and WBE-2.0] and MIWBE Contacted Forms [MBE-2.1 and Y WBE-2.1]. Acknowledge Receipt of a Addendum(s) included with the bid. All required additional information is included with the bid. r% Proposal statements and other affidavits all signed by the proper party with name either printed or typed underneath signature. This checklist submitted with the Bid. This checklist is provided for bidder's use in assuring compliance with required documentation; however, it does not include all specifications requirements and does not relieve the bidder of the need to read and comply with the specifications. Bidder: eMOU_M34 C0NTkA-C_1Z2S Iruc• Date: q-S-as b&A CR C MP4M I ES By Authorized Representative? I Signature: Print Name & Title: STEYerI P T/5C-,q PRESI L,Our Version 5/20/2024 Contractor's Bid for Public Works - 1 CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK RESPONSIBLE BIDDER CHECKLIST Project Name Rabbi Shulman Apartment Building Demolition Project No. 125-014 For Bids Due 9:00am September 9, 2025 Contractor Name: pEMOLMarJ C0fjT1Z4c-cup6 1fqc. DM Pi-MCH %PANIGS 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. "THIS FORM ONLY APPLIES TO BIDS GREATER THAN $250,000. " INSTRUCTIONS: If you are a pre -qualified bidder, complete Section I only. If you are not a pre -qualified bidder, complete Section 11 only. Section II acts as an application for pre -qualification. Submission of Section II will allow the bidder to be considered for pre -qualification for bids with the City of South Bend Department of Public Works. Pre - qualified bidders will then be exempt from a portion of the submission requirements outlined in Section 6- 71 of The Responsible Bidding Ordinance No. 10975-23 (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") 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 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 6-71 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 6-71 of the Responsible Bidding Ordinance no later than the date of the public bid opening. Version 5/20/2024 General Conditions - 11 POST BID SUBMISSIONS: Post -bid submissions must be submitted in accordance with Section 6-72 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 two -hundred fifty thousand dollars ($250,000.00), shall be required to adhere to the requirements of Section l 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 for projects greater than $250,000 and all subcontractors performing work greater than $250,000 on a public works project are required to submit certified payroll utilizing the federal form known as WH-347 or a similar form on a bi-weekly basis, submitted within 10 days after the end of each bi-weekly payroll period. Certified payrolls shall identify the job title and craft for each employee. Certified payrolls shall be submitted electronically. Please Note: Submissions deemed inadequate, incomplete, or untimely by the City may result in the automatic disqualification of the bid. The City, after review of complete and timely submissions, shall, in its sole discretion, after taking into account all information in the submission requirements, determine whether a bidder is responsive and responsible, and provide a Pre -Qualification Verification Letter. The City specifically reserves the right to utilize all information provided in the contractor's submission and any information obtained by the City through its own independent verification of the information provided by the contractor. Version 5/20/2024 General Conditions -12 I. PRE -QUALIFIED BIDDER CHECKLIST (a) Acknowledgements: (i) _ By checking this box, I hereby acknowledge that I am a pre -qualified bidder with the City of South Bend and that I have metthe pre -qualification requirements within the last twelve (12) months. A copy of my Pre -Qualification verification letter is attached. — By checking this box, I hereby acknowledge that the City reserves the right to request supplemental information, additional verification of any information provided by me, and may also conduct random inquiries of my current and prior customers. (iii) _ By checking this box, I hereby acknowledge that apprenticeship and training programs that I participate in have graduated at least five (5) apprentices in each of the past five (5) years. (iv) By checking this box, 1 hereby acknowledge that all subcontractors performing work greater than $260,000 also meet the qualifications of the Responsible Bidder Ordinance. (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 1 have sufficient employees on staff to complete the work. It outlines how I intend to meet the staffing needs of the work. List of projects of similar size and scope of work performed in all areas, including the State of Indiana, within the last three (3) years. (iv) For every project, submit evidence of participation in apprenticeship and training programs, applicable to the work to be performed on the project, which are approved by and registered with the United States Department of Labor's Office of Apprenticeship, or its successor organization. This includes, but may not be limited to, letters from apprenticeship coordinators detailing the bidder's association with the program, and the United States Department of Labor Office of Apprenticeship Certificates of Registration of Apprenticeship Programs for each type of work to be performed on the project. Version 5/20/2024 General Conditions - 13 II. PRE -QUALIFICATION CHECKLIST (FOR BIDDERS THAT ARE NOT PRE -QUALIFIED) (a) Acknowled ements: (i) By checking this box, I hereby acknowledge that I am not a pre -qualified bidder / with the City of South Bend. By checking this box, I hereby acknowledge that the City reserves the right to request supplemental information, additional verification of any information provided, and may also conduct random inquiries of my current and prior customers. The City reserved the right to utilize all information provided in this submission and all information obtained in inquiries or requests to determine if a bidder is responsive and responsible. Additionally, I acknowledge that all information provided to the City shall be regarded as public records. (iii) '� By checking this box, l hereby acknowledge that copies of all Applicable apprenticeship certificates or standards for training programs applicable to the work performed on the project may be requested at any time and shall be furnished upon request. (iv) 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. (v) By checking this box, I hereby acknowledge that apprenticeship and training programs that I participate in have graduated at least five (5) apprentices in each of the past five (5) years. (vi) Z By checking this box, l hereby acknowledge that all subcontractors performing work greater than $250,000 also meet the qualifications of the Responsible Bidder Ordinance. (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). 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) years. Statement about staffing capabilities, including labor sources. This statement indicates and ensures I have sufficient employees on staff to complete the work l am bidding on OR outlines how I intend to meet the staffing needs of the work. 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. 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. This includes, but may not be limited to, letters from apprenticeship coordinators detailing the bidder's association with Version 5/20/2024 General Conditions -14 the program, and the United States Department of Labor Office of Apprenticeship Certificates of Registration of Apprenticeship Programs for each type of work to be performed on the project. (vi) Z 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 i requirements set forth in IC 4-13-18-5 or IC 4-13-18-6. / (vii) Z 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. (viii) `� 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. (ix) Z 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: (Sign Here) 5-'rVoi PT-SCq (Print Name Here) bemou-nW CoA(lx4maS AM 8,4 PTsc1W 6"A4,V1E5 (Name of Company) (Address of Company) &22 WD RiqPt05 (City) M I (State) (Telephone Number) Version 5/20/2024 General Conditions -15 MERCHANTS BONDING COMPANY. POWER OF ATTORNEY Know All Persons By These Presents, that MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC.. both being corporations of the State of Iowa, dlbla Merchants National Indemnity Company (in California only} (herein collectively called the "Companies') do hereby make, constilule and appoint, individually, Bayley Rewa-Snider; Beth Walker; Dan Cusenza; Dennis E Scully; Heather Buonodonn, Janice L Stickles. Lori A King Clyde; Quinn Deyer, Shannon Nyhuis their true and lawful Attorneys) -in -Fact, to sign its name as surely(ies) and to execute seal and acknowledge any and all bonds, undertakings. contracts and other written instruments in the nature thereof, on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. This Power -of -Attorney is granted and is signed and sealed by facsimile under and by authority of the following By -Laws adopted by the Board of Directors of Merchants Bonding Company (Mutual) on April 23. 2011 and amended August 14, 2015 and April 27. 2024 and adopted by the Board of Directors of Merchants National Bonding, Inc_ on October 16, 2015 and amended on April 27, 2024. "The President, Secretary, Treasurer, or any Assistant Treasurer or any Assistant Secretary o: any Vice President shall have power and authority to appoint Attorneys -in -Fact, and to authorize them to execute on behalf of the Company, and attach the seal of the Company thereto, bonds and undertakings, recognizances, contracts of indemnity and other writings obligatory in the nature thereof." 'The signature of any authorized officer and the seal of the Company may be affixed by facsimile or electronic transmission to any Power of Attorney or Certification thereof authorizing the execution and delivery of any bond, undertaking. recognizance, or other suretyship obligations of the Company, and such signature and seal when so used shall have the same farce and effect as though manually fixed." In connection with obligations in favor of the Florida Department of Transportation only, it is agreed that the power and out hority hereby given to the Attorney -in -Fact includes any and all consents for the release of retained percentages and/or final estimates on engineering and construction contracts required by the State of Florida Department of Transportation. It is fully understood that consenting to the Stale of Florida Department of Transportation making payment of the final estimate to the Contractor and/or its assignee, shall not relieve this surely company of any of its obligations under its bond. In connection with obligations in favor of the Kentucky Department of Highways only, it is agreed that the power and authority hereby given to the Attorney -in -Fact cannot be modified or revoked unless prior written personal notice of such intent has been given to the Commissioner - Department of Highways of the Commonwealth of Kentucky at least thirty (30) days prior to the modification or revocation. In Witness Whereof, the Companies have caused this instrument to be signed and sealed this 21st day of November 2024 " IONq� 0.N4 -' MERCHANTS BONDING COMPANY (MUTUAL) P�,•'• 4,�G Cork-.. � MERCHANTS NATIONAL BONDING, INC. O.• = : R ,-, A : dlbia MERCHANTS NATIONAL INDEMNITY COMPANY �2!r _o- 0':fl: �r�:�' o- Q : � ~ 2003 � � 1933 By President STATE OF IOWA • .•V? ¢7 `����• ...... ��a•! COUNTY OF DALLAS ss. On this 21sl day of November 2024 before me appeared Larry Taylor, to me personally known, who being by me duly sworn did say that he is President of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC.; and that the seals affixed to the foregoing instrument are the Corporate Seals of the Companies; and that the said instrument was signed and sealed in behalf of the Companies by authority of their respective Boards of Directors. A3 9�tA40 Penni Miller Commission Number 787952 ~ • is My Commission Expires FpWP January 20, 2027 Notary Public (Expiration of notary's commission does not invalidate this instrument) 1, Elisabeth Sandersfeld, Secretary of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC., do hereby certify that the above and foregoing is a true and correct copy of the POVVER-OF-ATTORNEY executed by said Companies,which is still in full farce and effect and has not been amended or revoked In Witness Whereof, I have hereunto set my hand and affixed the seal of the Companies on this 27 day of August , 2025 •'`'(;ii�tq ,.•(.�N Cod". q:. o•: • �.-moo A9 y'• /lj 1433 b �; Secretary lk POA0018 (6124) ''�'•,�...... L 1% i applicable to raid Company. NAiC# 14494 Department of insurance State of Indiana OFFICE OF IN TESTIMONY WHEREOF I her�3�rnto subscribe my tame and affix the seat of nay office the elate written above. low, Stephen W. Robertson INSURANCE COMMISSIONER Document A31 O TM -- 2010 Conforms with The American Institute of Architects AIR Document 310 Bid Bond CONTRACTOR: (Name* legal status and address) Demolition Contractors Inc. DBA Pitsch Companies 675 Richmond NW Grand Rapids, MI 49504 OWNER: (Name. legal staftrs and atkire ss) SURETY., (Name. legal status and principal place r f hti naxvj Merchants Bonding Company (Mutual) P.O. Box 14498 Des Moines, IA 50306-3498 Mailing Address for Notices City of South Bend, Indiana, Board of Public Works 212 W. Colfax Ave South Bend, IN 46601 BONG? AMOUNT: 5% Five Percent of Amount Bid PROJECT: (Natrid.>, loWdouoraddr= a ndPrajectxttntbcr, ifaI j Rabid Shulman Apartment Building Demolition / Project No. 125-014 This document has important legal consequences. Consultatlan with an attorney Is encouraged wish respect to its completion or modification, Any singular reference to Contractor, Surety, Owner or other party shall be considered pluratwhere applicable. The Contractor olid Sititty are bound to the Otvncr in tita amoulit SCE forth above, for the peyment of Which the Contractor and Surcty� bind themselves. tllcirticirs, executors. administrators, successors and as$ib+tls, joiilily and severally, as provided hcrcia. The conditions of this Bond arc slick Illat if the Olrnor acecpts the bid of the Contractor *violin the lime specified in the bid docutucnts, or within such time }period astray be agreed to by tiro Owner and Contractor, and tine Contractor either (l) enters into a contract tXilh tho Owner ill accordance with tine terills of such bid, and gives such bond or bonds as may be spaoitied in the bidding arContract Documents, tvitil n surety admitted in Ille,juiisdiction ofthe Project and otherwise acceptable to the Omicr, for the faithful performance ofsuch Contract and for tho prompt paviuent of labor and material furnished ill file prosecution tilereof,, or (2) pays to the O%viler the difference, not to exceed (Ito amount of this Bond, botween tilt at11nu1t specified ill said bid and such larger amount for which Ilte 0%mler may in good ;faith contract milk anotiler party lln Portbrill tilt-, work covered by'.aid bid, then this iibligaticnl shah he null and void, 01herwiNO ltl renlairt in Lull force and ell001. The Surety hereby waives any notice al'ali agreement between the Owner aid Contractor to eNtend the dine in mvhicll lice owner %lluy accept the bid. *Zlivex a'Cllolloa by the Surety shall %lot apply to any Juxtensi nl eacLadillo sixty (61i1) days in the aggrog4w beyond tllc time lllr acccptunee -,!'bids ;pcaiticd in the bid (Iticut1u:11tS, and the Oi%nor alai Coutrlc[or sEtuf I obtain the Surety"s coilwnt filr an exlension beyond sixEy (W) days. If'this Bond is issued in comicotion ►vilti A subcontractor's bid to a Contraoto , the term Contractor in Ibis Bond shall bps deemed to be Subcontractor and the icon Owner small be deemed to be Contractor. When lids hand has been kiirimiled to ea)uply With a statidory or otlier legal retttliretucnt ill the loeati%rtl alike PrirjeeL uriv pnleisiiln in this Tln»d coniiiethlg'vit► said statutory or legal requirement sliull be deemed deleted lnc-erroni and provision'. comjbm' ling to such '.tatutory or other legal requircineak shall be deemed incorgoruled herein, when sa furnished, tie intent is that this Dand %hall be vtnhsinicd US a statutory build and not its a comniun la►v bond, Siguod and scaled this 9th day. of September, 2025. fivitn&5s) Ximberly Ben tt S-00$4IAS VI Q Demolition Contractors Inc. DBA Pitsch Com anies JPriirclpa9 (seal) B; (Title) Merchants Bonding Company (Mutual) f4turt�j (5�i1} �. By, w _. Elle Lori A King de, Attorn -in-Fact r MERCHANPOWER BONDING COMPANY e... ATTORNEY - Know All Persons By These Presents, that MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONMNG, INC., both being corporations of the State of Iowa, and MERCHANTS NATIONAL INDEMNITY COMPANY, an assumed name of Merchants National Bonding, Inc.. (herein collectively called the "Companies") do hereby make, constitute and appoint, individually, Bayley Rewa-Snider; Beth Walker Dan Cusenza; Dennis E Scully; Heather Buonodono; Janice L Stickles; Lori A King Clyde; Quinn Deyer ; Shannon Nyhuls their true and lawful Attomey(s)-in-Fact, to sign its name as surety(ies) and to execute, seal and acknowledge any and all bonds, undertakings, contracts and other written instruments in the nature thereof, on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. This Power-of-Attomey is granted and is signed and sealed by facsimile under and by authority of the By -Laws adopted by the Board of Directors of the Companies. "The President, Secretary, Treasurer, or any Assistant Treasurer or any Assistant Secretary or any Vice President shall have power and authority to appoint Attorneys -in -Fact, and to authorize them to execute on behalf of the Company, and attach the seal of the Company thereto, bonds and undertakings, recognizances, contracts of indemnity and other writings obligatory in the nature thereof." `The signature of any authorized officer and the seal of the Company may be affixed by facsimile or electronic transmission to any Power of Attorney or Certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship o obligations of the Company, and such signature and seal when so used shall have the same force and effect as though manually fixed." in connection with obligations in favor of the Florida Department of Transportation only, it is agreed that the power and authority hereby given to the Attorney -in -Fact includes any and alt consents for the release of retained percentages andlor final estimates on engineering and construction contracts required by the State of Florida Department of Transportation. It is fully understood that consenting to the State of Florida Department of Transportation making payment of the final estimate to the Contractor and/or its assignee, shall not relieve this surety company of any of its obligations under its bond. In connection with obligations in favor of the Kentucky Department of Highways only, it is agreed that the power and authority hereby given to the Attorney -in -Fact cannot be modified or revoked unless prior written personal notice of such intent has been given to the Commissioner - Department of Highways of the Commonwealth of Kentucky at least thirty (30) days prior to the modification or revocation. In Witness Whereof, the Companies have caused this instrument to be signed and sealed this 2nd day of June 12025 °lidG (,' ,a�,,••././[r!!•! •yyM !°RphY MERCHANTS BONDING COMPANY MUTUAL ,�pap4"..�A .'�.°APOLl ' �$Q,,: �c`•���o e MERCHANTS NATIONAL BONDING, INC. �r+s : GO 9 -.2 . G?r'y�p 4j + ;' q a'i + a MERCHANTS NATIONAL INDEMNITY COMPANY O'er-° ��:�' �•gy: °jh; Ci 9 .,�� 1933 2003 C ` e ° f ...... STATE OF IOWA President COUNTY OF DALLAS ss, On this 2nd day of June 2025 before me appeared Larry Taylor, to me personally known, who being by me duly swum did say that he Is President of MERCHANTS BOND#NG COMPANY (MUTUAL), MERCHANTS NATIONAL BONDING, INC., and MERCHANTS NATIONAL INDEMNITY COMPANY; and that the seals affixed to the foregoing instrument are the Corporate Seals of the Companies; and that the said instrument was signed and sealed in behalf of the Companies by authority of their respective oards of Directors. Penn! Miller , L 7 Commission Number 797952 ® ® My Commission Expires (OWN January 20, 2027 CRN%_�� (Expiration of notary's commission (Votary Public does not invalidate this instrument) 1, Elisabeth Sandersfeld, Secretary of MERCHANTS BONDING COMPANY (MUTUAL), MERCHANTS NATIONAL BONDING, INC., and MERCHANTS NATIONAL INDEMNITY COMPANY do hereby certify that the above and foregoing is a true and correct copy of the POWER -OF - ATTORNEY executed by said Companies,which is still in full force and effect and has not been amended or revoked. In Witness Whereof, I have hereunto set my hand and affixed the seal of the Companies on this 9 day of September 12025 'a POP • sS .' �933 .^. POA 0018(5125) _ O#*0%%AL11VD �a0 •'�' °4ksei6* Secretary (0 No. 8509-26 REGISTRATION $125.00 ST. JOSEPH COUNTYAND CITY OF SOUTH BEND, INDIANA August 26, 2025 WHEREAS, PITSCH WRECKING, INC having this day paid to the Building Department the sum of One Hundred Twenty Five Dollars and Zero Cents is hereby REGISTERED to operate in the unincorporated areas of ST. JOSEPH COUNTY and the CITY OF SOUTH BEND, as a Demolition Contractor THIS REGISTRATION EXPIRES: August 21, 2o26 Randy James Building Commissioner 675 RICNMONQ NW Grand Rapld5, MI 49504 (616)363.4895 THIS REGISTRATION IS NOT TRANSFERABLE • Demolition Engineers • Asbestos Abatement • Salvaged Building Materials • Excavating & Underground Services • Concrete Recycling 4 Companies Prequalification information (b) (i11 Business Names: (b) (iii) (b) (iv) (b) (v) (b) (v) (b) (vi) • Landfill Operation • Transfer Station • Dumpster Service • Portable Toilet Service • Land Development Demolition Contractors, Inc. DBA Pitsch Wrecking Co. b15A Pt-MCH COMPAN IE5 We have no 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. We currently have a staff of 100 employees capable of completing the work for the Rabbi Shullman Demo Project. The employees on staff who will perform work on the Rabbi Shullman Demo Project are properly classified employees under all applicable state and federal laws. (b) (vii) We have training certificates/refreshers courses off all employees working on the Rabbi Shullman Demo Project for Lead/Cadmium & Silica, Type II Non -Specific Asbestos, Asbestos Awareness, 40 hour trained Asbestos Supervisors, along with all medical requirements under state and federal laws. -ri%SE WILL EW PROVll'et�' iF We AiZE `04G SEi ErTEL� �or.ST2gcTw� f < 'i�iC MPLcgE%E:S TNprT WILL- WORK WIJ _ US QRpjt-`CT 51NCE= WE +tAVL r11Grn3`4 �ivLPLo`l mP4s�sY «2rtFtcflT[ansS. -t'�lE Drina � 5 vefZ`{ 1(d Lu rvl lnr au s . We have a no tolerance drug policy required by the FMCSA and it is also used for our current employees. SeEV gTTRCtdc—. Surety company (see attached) HOME OFFICE: www.pitschco.com LANDFILL OFFICE: 675 Richmond, NW, Grand Rapids, MI 49504 7905 Johnson Rd., Belding, MI 49809 Telephone: (616) 363-4895 Telephone: (616) 794-3050 FAX: (61.6) 363-5585 FAX: (616) 794-1769 (b) (viii) (b) (ix) We have no federal, state or local tax liens or tax delinquencies owed to any federal, state or local taxing body. List of similar projects (see attached) Pitsch Companies FMCSA Combined Drug/Alcohol Substance Abuse Policy Effective Date: March 6, 2020 Section 1 Section 2 Section 3 Section 4 Section 5 Company Policy Supervisor Information Forms Records & Reports Resources & Regulations 2020 Drug Screens Plus. All Rights Reserved. (2) FMCSA 20200101 266 Section 1 Company Policy NOTE: In terms of DOT regulations, Section 1 constitutes a "condensed" version of the company's Substance Abuse Program. The entire plan, consisting of Sections 1 thru 5 and referenced DOT regulations, can be obtained by contacting the company's Designated Employer Representative (DER) listed in Section 1, Contacts. Page Contents: 4 Notice to Employees 5-6 CONTACTS: 7 A INTRODUCTION AND GENERAL REQUIREMENTS 8 B MATERIALS REQUIRED BY DOT REGULATIONS 8 B-1 DESIGNATED EMPLOYER REPRESENTATIVE 8 B-2 EMPLOYEES SUBJECT TO THIS POLICY 8 B-3 REQUIRED COMPLIANCE PERIODS 9-10 B-4 PROHIBITED CONDUCT 10-14 B-5 TESTS REQUIRED (pre -employment, post -accident, random, reasonable suspicion, return -to -duty, follow-up) 14-18 B-6 TESTING PROCEDURES 18 B-7 REQUIREMENT TO SUBMIT TO TESTING 18-19 B-8 REFUSAL TO SUBMIT TO TESTING 19-20 B-9 CONSEQUENCES OF VIOLATING THIS POLICY 20 B-10 ALCOHOL CONCENTRATION OF 0.02 - 0.039 20 B-11 EFFECTS OF ALCOHOL and CONTROLLED SUBSTANCE USE 20-21 C OPTIONAL PROVISIONS (stand -down, self -referral) 21 D CERTIFICATE OF RECEIPT REQUIREMENT Appendix A - Training Materials/Employees 22 Al Alcohol 23 A2 Marijuana 24 A3 Cocaine 25 A4 Amphetamine/Methamphetamine 26 A5 Opioids (Morphine/Codeine/Heroin/Other) 27 A6 PCP (Phencyclidine) 28-32 Appendix B — Supplemental Definitions 33 Appendix C — Specimen Collection Synopsis 35 Clearinghouse Educational Materials/Receipt 37 Certificate of Receipt for Employee's Copy of this Policy 39 Post -Accident Test Criteria (Flow Chart) cove DS+Model Program Agreement 2020 Drug Screens Plus_ All Rights Reserved. (3) FMCSA 20200101 266 To all Employees: The Federal Department of Transportation (DOT) has issued regulations (49 CFR 40) regarding Controlled Substances and Alcohol Use and Testing. Because the Company is required to comply with these regulations and with DOT agency regulations (including FMCSA's 49 CFR 382), we must issue a policy prohibiting substance abuse by our safety -sensitive employees. Alcohol consumption by our safety -sensitive employees is prohibited while performing, and for four (4) hours prior to performing safety -sensitive functions; and for eight (8) hours after an accident unless it has been determined by a Company official that a post -accident alcohol test is not required. Likewise, manufacturing, selling, buying, soliciting to buy or sell, transporting, using or possessing illegal drugs (including a drug prescribed for another person) is prohibited. For additional information about conduct prohibited by FMCSA, see Subpart B of 49 CFR 382 at FMCSA's website: www.fmcsa.dot. ov/ruies-re ulations/administration/fmcsr/fmcsr uidedetails.as ?re ulation=382 The regulations are very specific regarding what The Company must do to comply. We have developed a policy and procedures that will apply to you based upon the job functions you perform. The entire plan (consisting of Sections 1 thru 5 of this model program and referenced DOT regulations) can be obtained by contacting the company's Designated Employer Representative (DER) listed in Section 1, Contacts. We must conduct tests under certain specific situations to determine whether employees have used alcohol or drugs. The procedures and technology we will employ in this testing are specified in a Department of Transportation Regulation, Procedures for Transportation Workplace Drug and Alcohol Testing Program (49 CFR, Part 40). Internet users can access information about and/or changes to these regulations from the Drug Screens Plus website at: www.dsplus.com or the ODAPC (Office of Drug and Alcohol Policy and Compliance) website at: www.dot.gov/ostidapcldocuments.html?documents A positive drug or alcohol test or a refusal to test or to submit a specimen for a drug or alcohol test (see 49 CFR 40.191 and 40.261) or other violation of 49 CFR 40 or DOT agency drug and alcohol regulations is grounds for discharge, solely at the option of the Company. Each employee must read this policy and sign a statement certifying that he or she has received a copy. Refusal to sign for receipt of a copy of this policy is grounds for discharge, solely at the option of the Company. Thank you for your cooperation in implementing these important safety regulations. If you have any questions regarding the DOT regulations or the Company's policies and procedures; please contact the Company's Designated Employer Representative (DER) listed on the following page. 2020 Drug Screens Plus. All Rights Reserved. (4) FMCSA 20200101 266 266 Effective March 6, 2020 CONTACT: Designated Employer Representative (DER) for drug and alcohol policy, procedure information, or for referral to a Substance Abuse Professional (SAP). Medical Review Officer (MRO) Medical Review of Test Results Amy Pethers Pitsch Companies 675 Richmond NW Grand Rapids MI 49504 Ph: 616-363-4895 Fax: 616-363-5585 Email: amy@pitschco.com John Budnick, D.O., MRO-C DRUG SCREENS PLUS (DSf) 3625 Clyde Park SW, Suite B Grand Rapids MI 49509 (800) 459-9012 ext 785 Specimen Collection Site DRUG SCREENS PLUS (DSf) for Drug/Alcohol Testing. 3625 Clyde Park SW, Suite A Other site listings available. Grand Rapids MI 49509 See next page or below: 616-532-9034 Locating a SAP or Collection Site Jill Umfleet This office can assist you with DRUG SCREENS PLUS (L7Sfj arranging SAP evaluations and/or 3625 Clyde Park SW, Suite B specimen collection sites Grand Rapids MI 49509 throughout the U.S. (800) 459-9012 ext 784 Counseling/Treatment Referral will be made to Must be an entity other than the appropriate facility/service SAP who performed the evaluation. subsequent to SAP evaluation. DHHS Certified Labs Note: Primary lab may be used in any combination with Secondary Lab (e.g_ Secondary lab used as Primary lab) and the combination may change from time to time or according to circumstances (e.g., a post -accident 'cab pack"specifies one lab/air-carrier services, and pre- employment test specifies clinic with 2nd lab/courier service)_ Special Note: HHS certifies each lab separately and on its own merits"...a split specimen can be sent to a 2nd lab under the same corporate title" as the primary lab. Primary: (i.e., split -testing) MedTox Laboratories Inc 354 West County Road D Saint Paul MN 55112 Secondary: (i.e., primary testing) Quest Toxicology Network (QTN) Quest Diagnostics 10101 Renner Blvd Lenexa KS 66219 Substance Abuse Crisis Hotlines: Alcoholics Anonymous 800-356-9996 Cocaine 800-COCAINE (262-2463) Natl Institute on Drug Abuse 800-662-HELP (622-2255) 2020 Drug Screens Plus. All Rights Reserved. (5) FMCSA 20200101 266 REGARDING: CONTACT: Additional Designated Employer Tina Tankersley Representatives (DER) for drug and alcohol Pitsch Companies policy, procedure information, or for referral 675 Richmond NW to a Substance Abuse Professional (SAP). Grand Rapids MI 49504 Ph: 616-363-4895 Fax: 616-363-5585 Gene Gutting Pitsch Companies 675 Richmond NW Grand Rapids MI 49504 Ph: 616-363-4895 Fax: 616-363-5585 2020 Drug Screens Plus. AH Rights Reserved. (6) FMCSA 20200101 266 Pitsch Companies (The Company) FMCSA SUBSTANCE ABUSE POLICY A INTRODUCTION AND GENERAL REQUIREMENTS The US Department of Transportation (DOT) has issued regulations that govern the use of drugs and alcohol by employees within the transportation industry. 49 CFR 40 (see: www.dot.-gov/ost/dapc/documents.html?documents ) and FMCSA drug and alcohol regulations (see: www.fmcsa.dot. ov/rules-re ulations/administration/fmcsrffmcsr uidedetaiIs.as ?re ulation=382 ) require that the Company establish a program to conduct drug and alcohol testing at certain times and under the conditions described below. This policy is intended to implement these DOT regulations and to set forth the Company's own policies and requirements with respect to drug and alcohol use and testing. The terms "individual", "covered employee", and "employee" are used interchangeably and have the meaning of "employee" as defined in Part 40; and the term "employer" has the meaning of "employer" as defined in Part 40. The terms employer and employee as used in this policy shall not be used to construe an employer/employee relationship that does not otherwise exist independently of this policy (e.g., to construe an independent contractor as an employee of the company for tax purposes, benefits, unemployment, etc.). The term "s/he" means "she or he". REFERENCES to regulations are intended to facilitate identification of specific regulations and are not meant to exclude (e.g., by the absence of a reference) from coverage any individual or class of individuals with regard to any provision of this policy. Wherever the term "DOT regulations" appears, it means "49 CFR Part 40 and DOT agency drug and alcohol regulations". Wherever DOT regulations are cited without identifying the "CFR", the reference is to "49 CFR". In addition to policy provisions intended for compliance with DOT regulations, it is the Company's policy to provide a work environment that is free (to the maximum extent possible) of substance abuse. Therefore, some provisions of this policy will be enforced under the Company's own authority, whether or not expressly required or expressly permitted by DOT regulations. Wherever such provisions appear throughout this policy, they will be indicated by bold print. Paragraph headings/sub-headings in bold print are simply to assist in identifying and locating specific portions of the policy and not "policy provisions". Until amended in writing to reflect any change(s), each provision of this policy shall be enforced under Company authority to the fullest extent not prohibited by a DOT regulation. To the extent that any provision (or portion thereof) of this policy is deemed by a DOT authority (e.g., a DOT auditor or agency representative) or is otherwise known by the DER to be in non- compliance with a DOT regulation, that portion shall be enforced by the DER in a manner consistent with and in compliance with the regulation. The EFFECTIVE DATE of this edition of the policy is March 6, 2020. A-1 INDIVIDUAL COPY OF COMPANY POLICY All individuals hired into safety -sensitive positions with the Company (including existing personnel transferring to such positions) will be provided with a copy of this policy prior to being required to submit to its provisions. 2020 Drug Screens Plus. All Rights Reserved. (7) FMCSA 20200101 266 B MATERIALS REQUIRED BY DOT REGULATIONS This policy (with its definitions, references to, and explanations of DOT regulations) is part of the educational material provided to employees and to representatives of employee organizations pursuant to DOT regulations. B-1 Identity of Company's Designated Employer Representative (DER) (See: p-3 regarding DER and/or questions about this program.) B-2 INDIVIDUALS SUBJECT TO THIS POLICY [Ref 40.3, 382.107] General. The term "employee" means any person who is designated in a DOT agency regulation as subject to drug testing and/or alcohol testing. The term includes individuals currently performing safety -sensitive functions designated in DOT agency regulations and applicants for employment subject to pre -employment testing. For purposes of drug testing under this policy, the term employee has the same meaning as the term "donor" as found on CCF and related guidance materials produced by DHHS. FMCSA. This policy applies to any individual who is required by the Company to have a Commercial Driver's License (CDL), and whom the Company requires to operate (or to be qualified to operate) a Commercial Motor Vehicle (CMV). For the purposes of this policy, a CDL is required to operate a CMV which has a gross vehicle or gross combination weight rating in excess of 26,000 pounds, or regardless of the vehicles' size will be used to transport hazardous materials in a quantity which requires the vehicle to be placarded, or designed to transport 16 or more passengers (including the driver). This includes, but is not limited to, individuals who are: full-time, regularly employed drivers; casual, intermittent or occasional drivers; leased drivers and independent, owner -operator contractors who are either directly employed by or under lease to the Company or who operate a CMV at the direction of or with the consent of the Company; vehicle mechanics who will be required to operate a CMV in the course of maintaining and/or repairing the vehicle; or anyone who may be required to operate a CMV for any purpose on behalf of the Company. For the purposes of this policy, all such individuals shall be defined as "drivers". B-3 REQUIRED COMPLIANCE PERIODS [Ref 382 Subparts B, C, E] Employees are required to be in compliance with this policy and associated DOT regulations during any period in which they are actually performing, ready to perform, or immediately available (or required to be immediately available) to perform safety -sensitive duties on behalf of the Company. For purposes of the Company's policy and drug and alcohol testing program, with respect to drivers, safety -sensitive function [Ref 49 CFR 382.1071 includes but is not limited to the following: (a) driving; (b) waiting to be dispatched (whether at a carrier's or shipper's terminal, plant, facility or other property) unless the driver has been relieved from duty; (c) inspecting, servicing or conditioning equipment; (d) being in or on a commercial motor vehicle (except resting in the sleeper berth); (e) loading or unloading, including supervising or assisting in loading or unloading, attending a vehicle being loaded or unloaded; or (f) repairing, obtaining assistance, or attending a disabled vehicle. No driver required to take a post -accident test under this policy [See B-5(b)] shall use alcohol for 8-hours following an accident, unless a post -accident alcohol test has been completed. No driver shall report for duty within four hours after using alcohol. Other time periods or circumstances in which employees may be tested are explained below in section B-5 TESTS REQUIRED. 2020 Drug Screens Plus. All Rights Reserved. (S) FMCSA 20200101 266 B-4 PROHIBITED CONDUCT [Ref 382 Subpart B] The following conduct is strictly prohibited: (a) using, being under the influence of, or possessing illegal drugs (any drug listed in 21 CFR 1308 when the drug has been dispensed or used or is in the individual's possession in a manner not approved by the FDA), including a drug prescribed for another person; (b) using or being under the influence of legal drugs whose use can adversely affect the ability of the covered employee to perform his or her job safely [covered employees are required to obtain advice and instructions from the prescribing physician before performing safety -sensitive duties]; (c) manufacturing, selling, buying, soliciting to buy or sell, transporting, or possessing illegal drugs; (d) using [i.e., drinking or swallowing any beverage, liquid mixture or preparation (including any medication), containing alcohol] or being under the influence (i.e., breath alcohol concentration of 0.02 or greater) of alcohol at any time while performing any safety -sensitive function; (e) using alcohol within four (4) hours before performing or being required to perform any safety -sensitive function (e.g., a supervisor whose primary function is not safety -sensitive, but who is required to be available to perform such duties with little or no advance notice). (f) testing positive for drugs (i.e., MRO verified positive) or alcohol (i.e., breath alcohol concentration of 0.04 or greater); (g) refusing to be tested for drugs and/or alcohol or failing to submit to a drug and/or alcohol test as and when directed (as defined in Section B-8, and Appendix B of this policy, and/or in 49 CFR 40.191 & 40.261); (h) violating any DOT regulations or other applicable federal and/or state requirement governing the use of drugs or alcohol; (i) doing anything to obstruct the Company's goals with respect to drugs and alcohol. Special Notices & Conduct Prohibited under Company Authority: (j} Equipment may be randomly inspected for drugs or alcohol and related paraphernalia and all other controlled or illegal items, and covered employees shall have no expectation of privacy concerning their use of such equipment. Discovery of such items will result in termination and prosecution per company policies. In addition: (k) Covered employees may be terminated for parking at a tavern or bar with company equipment when not in the course of business (e.g., delivering, servicing), or for using alcohol or a controlled substance while on company property or in possession of company equipment whether on or off duty at any location. (1) Hemp products may contain substances that can result in a positive test for THC (whether or not THC is listed on a product label, if any). The use of any such product is prohibited. The use of products containing THC for gny reason (including "medical" or "nutritional") or even unknowingly (e.g., "passive ingestion") will not be considered a legitimate medical explanation for a positive drug test. (See: 49 CFR 40.151(f)) (m) Prescription or other use of Marijuana or THC will not be accepted as an explanation for a positive test (see 49 CFR 40.151(e)}. The only 2020 Drug Screens Plus, All Rights Reserved. (9) FMCSA 20200101 266 current legitimate medical explanation for the presence of THC is a valid prescription for Dronabinol (e.g., Marinol®) for an FDA - approved use (e.g., for the treatment of nausea and vomiting associated with chemotherapy). "Off -label" use (e.g., for glaucoma, migraine headaches, insomnia, weight management, p.m.s., etc.) is specifically prohibited by applicable law. Any use of THC in any form (even if accepted as a legitimate medical explanation for a positive drug test), may be reported by the MRO without your consent (see 49 CFR 40.327) to a third party (e.g., a medical examiner) who may determine that you are medically unqualified to perform safety -sensitive duties. (n) Use of Adulterants, Dilutants,_or Masking Agents. The use or attempted use of any substance for the purpose of masking the presence of any drug or drug metabolite in a specimen intended for drug testing is strictly prohibited. The use of (or attempt to use) specimen dilution, adulteration, or masking agents (as determined by a specimen collector, laboratory, Medical Review Officer or DER) will be considered a "Refusal to test" and will result in disciplinary action up to and including discharge. (o) Compliance with this policy is a condition of employment. Refusal or failure to take a required drug or alcohol test, testing positive on any such test, or any other violations of 49 CFR 40 or DOT agency drug and alcohol regulations shall result in removal from performing safety -sensitive duties and shall, as with any other prohibited conduct, subject the individual to disciplinary action up to and including discharge, solely at the option of the Company. B-5 TESTS REQUIRED [Ref 382 Subpart C(301-311)] GENERAL. Covered employees will be subject to testing for alcohol and controlled substances in accordance with DOT Procedures. Currently, such employees will be tested for alcohol and the following drugs and/or their metabolites: Marijuana, Cocaine, Opioids (e.g. Codeine, Morphine, 6- AM), Phencyclidine, and Amphetamines (Amp, Meth, MDMA, and MDA). See 49 CFR 40. Before performing a drug or alcohol test under FMCSA drug and alcohol regulations, the Company is required to notify the employee that the test is required by those regulations. This policy, together with notification by a company representative that you are required to submit to testing and the information provided to you on the CCF or ATF, constitutes such notice. The Company is prohibited from falsely representing that a test is required by those regulations. All alcohol tests conducted under this policy require the employee to provide a breath specimen for any confirmatory test conducted by, or on behalf of, the Company. In the case of an initial alcohol test, The Company may test the employee using either a DOT -approved breath or saliva testing device. In the case of an alcohol test conducted by a federal, state or local law enforcement officer following an accident, the employee will be required to provide either a breath or blood or other specimen, as directed by the law enforcement officer. Except as may be otherwise provided by this policy, employees required to submit to an alcohol test will submit to such testing either just before, during, or just after performing or being required to perform safety -sensitive functions. Drug testing will utilize urine specimens. At a minimum, the Company is required by DOT to conduct drug and/or alcohol tests under the following conditions or times: pre-employment/pre-duty: (for Drugs only); random/post-accident: (for 2020 Drug Screens Plus. All Rights Reserved. (10) FMCSA 20200101 266 Drugs and Alcohol), reasonable suspicion, return -to -duty, or follow-up (for Drugs and/or Alcohol). Other tests may also be required under DOT's regulations or Company authority. The Company's policy will direct whenever such other tests are required or permitted. The Company will notify an applicant or employee of his/her test results only if the test is positive, or upon the written request of the applicant or employee. An applicant or employee who (1) tests positive (i.e., a verified positive drug test or a positive alcohol test) on any drug or alcohol test required by this policy; (2) refuses to submit to testing (see B-8), including failure to report for testing (except pre -employment, see 40.191(a)) within a reasonable time, as determined by the Company, consistent with FMCSA regulations; or (3) fails to cooperate with testing procedures (e.g., to be escorted to or from a testing site for a reasonable suspicion test) is prohibited from performing or continuing to perform any safety - sensitive function for the Company (see B-9, for other consequences of violating this policy), and is subject to disciplinary action up to and including discharge, solely at the option of the Company. The Company's policies, procedures, and requirements for each of these tests include (together with the rest of this policy) the following: a. pre-employment/pre-duty: [Ref 382.3011 i. Drug testing is required before an applicant can be hired or transferred into a position for which the Company requires the person to hold a CDL and to operate (or be available to operate) a CMV for any purpose, or to otherwise perform (or be available to perform) any safety -sensitive function on behalf of the Company. Pre -employment alcohol testing is not required by DOT regulations and not required by the Company. ii. Employees will be provided educational materials, notification of the required drug test and an explanation of the collection procedures through the receipt of a copy of this policy. Applicants will likewise receive such information, notification and instructions prior to pre -employment testing. iii. The employee's signature on any custody and control form used with any test requested under this policy will constitute his or her consent to be tested and authorization to release any information permitted or required by applicable Federal or State Regulations or Company policy. iv. Applicants will be required to take and pass a drug test; authorize the Company to obtain applicant's DOT -required drug and alcohol test results (including refusals to be tested) from each company for whom s/he worked (or applied for work) within the previous 3 years [Ref 391.23 (e)] ;and comply with any other conditions or requirements of which s/he is advised in connection with the position. v. Driver/applicants will be required to register at the FMCSA clearinghouse at https:/tclearinghouse.fmcsa.dot.gov/ and they must authorize per- spective employers to run a full query pursuant to Part 382, Subpart G [Ref 382.703]. b. post -accident: [Ref 382.303] [See the Post -accident flow chart, p31.] General. A covered employee who is subject to post -accident testing who fails to remain readily available for such testing, including notifying a Company representative (e.g., the DER) of his/her location if s/he leaves the scene of the accident prior to submission to such test, may be deemed by the Company to have refused to submit to testing. This provision shall not be construed to require the delay of necessary medical attention for injured people following an accident or to prohibit a covered employee from leaving the scene of an accident for the period necessary to obtain assistance in 2020 Drug Screens Plus. All Rights Reserved. (11) FMCSA 20200101 266 responding to the accident or to obtain necessary emergency medical care. (See Section 3, Delayed test, Failure -to -test) i. As soon as practicable following an occurrence involving a CMV operating on a public road in commerce, each surviving driver must be tested for alcohol and controlled substances as follows: (1) If the accident involved the loss of human life; each surviving driver who was performing safety -sensitive functions (see def.- 49 CFR 382.107) must be tested regardless of whether or not the driver received a citation. Otherwise, (2) If the driver received a citation under State or local law for a moving traffic violation arising from the accident AND (a) the accident involved bodily injury to any person who, as aresult of the injury, immediately receives medical treatment away from the scene of the accident; OR (b) one or more motor vehicles incurred disabling damage as a result of the accident, requiring the motor vehicle to be transported away from the scene by a tow truck or other motor vehicle. ii Exception. DOT post -accident testing requirements do not apply to an occurence: (1) involving only boarding or alighting from a stationary motor vehicle; or (2) only the loading or unloading of cargo; or (3) in the course of the operation of a passenger car or multipurpose passenger vehicle (as defined in 49 CFR 571.3) by an employer unless the motor vehicle is transporting passengers for hire or hazardous materials of a type and quantity that require the motor vehicle to be marked or placarded in accordance with 49 CFR 177.823. iii. Employees who submit to drug or alcohol testing conducted by a law enforcement officer must contact their supervisor (or another Company official) immediately and provide the name, badge number and telephone number of the officer who conducted the testing. iv At the Company's discretion, employees who are required to submit to post -accident drug or alcohol testing may be assigned to non - safety -sensitive duties, or placed on non -disciplinary suspension, while awaiting the post -accident test results, c. random: [Ref 382.305] i. The Company is required by DOT regulations to test employees for drugs and alcohol at random and without prior notice. ii. Random tests will be conducted at a minimum rate set forth by FMCSA (see Section 4, Random Testing Program Verification). Selections will be made at least quarterly, but the Company may conduct random testing more frequently and employees may be subject to additional random selections and testing at any time throughout the year. Selections are made by a computer generated random (stochastic) process to ensure that employees cannot be singled out by name or by any other means. iii. Each employee in a random pool will have an equal chance of being selected from their pool during each selection and as a result may be required to submit to a random drug and/or alcohol test several times in the same year. 2020 Drug Screens Plus_ All Rights Reserved. (12 ) FMCSA 20200101 266 iv. Employees selected for random testing must report to the specimen collection site within a reasonable time (as determined by the DER), following notification (e.g., allowing only for reasonable travel time). d. reasonable suspicion/for-cause: [Ref 382.307, 603] i. For the purpose of requiring drug or alcohol testing, reasonable suspicion will exist when an employee's appearance, behavior, speech, breath or body odors indicate drug or alcohol use, or chronic or withdrawal effects of drugs. [See: Section 3/Forms/Observed Behavior Recording] ii. With regard to a reasonable suspicion drug test, such observations must be personally observed and documented by at least one Company official who has received a minimum of 60 minutes training covering the physical, behavioral, speech, and performance indicators of probable drug use. iii. With regard to a reasonable suspicion alcohol test, such observations must be personally observed and documented by at least one Company official who has received a minimum of 60 minutes training covering the physical, behavioral, speech, and performance indicators of probable alcohol misuse. iv. With regard to alcohol, such observations must be made by the Company official (and any required testing performed) just prior to, during, or just after the period of the work day that the employee is required to be in compliance (see B-3) with this policy. Third -party observations indicative of substance abuse must be personally confirmed by a Company official who has received the above training. The official who makes the reasonable suspicion determination for alcohol testing may not perform the alcohol specimen collection or testing. v. The employee will be transported to the specimen collection site and tested as directed by the Company (alcohol and/or drugs) as soon as possible. The Company will also attempt to contact a family member (or other person designated by the employee), or make arrangements for other suitable transportation in order to transport the employee home following reasonable -suspicion testing. vi. An employee required to take a reasonable suspicion test(s) is considered unqualified to work and placed on immediate suspension, without pay, pending results of their test(s). If the test results are negative and the employee has fully cooperated with the testing, reimbursement will be made for the time of the suspension. e. return -to -duty [Ref 382.309, 40.67(b)] Employer must require following the "directly observed specimen collection" procedures in 40.67. The Company is not obligated to (and by the inclusion of this provision in this Policy does not undertake or commit to any obligation under this policy to) reinstate, retain and/or rehire any employee who violates any DOT regulation or any Company policy concerning drugs and alcohol. Should the Company elect to consider reinstating or rehiring an employee who violates any DOT regulation or any Company policy concerning drugs and alcohol, those regulations and policies require that employee (before s/he will be permitted to return to duty) to: • execute the Company's "last -chance" agreement; • be evaluated by the Company's SAP who will determine what assistance, if any, the employee needs in resolving problems associated with alcohol misuse or controlled substances use; 2020 Drug Screens Plus. All Rights Reserved. (1 3) FMCSA 20200101 266 • be further evaluated by the Company's SAP to determine the employee's compliance with any education/treatment program prescribed by the SAP; and • pass a DOT return -to -duty drug and/or alcohol test. f. follow --up [Ref 382.311, 382.605(c)(2)(H), 40.67(b)]. Employer must require following the "directly observed specimen collection" procedures in 40.67. The Company is not required to reinstate or rehire an employee who violates any DOT regulation or any Company policy concerning drugs and alcohol, and by the inclusion of this provision does not obligate itself to do so. ii. Should the Company elect to reinstate or rehire such employee, s/he • must remain in full compliance with the provisions of a above; • must meet all other requirements of the position; and • will be subject to a minimum of 6 (or more, as determined by the SAP) unannounced follow- up tests over the 12 months after returning to duty. iii. At the direction of the SAP, the employee may be required to submit to further unannounced testing for up to four additional years. B-6 TESTING PROCEDURES GENERAL. To protect employees, the integrity of testing processes, and to ensure the validity of the test results, DOT has established stringent regulations to which the Company and its service agents will adhere. DOT's requirements include procedures covering: specimen collection processes; chain -of -custody for specimens; initial and confirmation tests; review of positive test results by a Medical Review Officer (MRO); reporting and recordkeeping. All agreements and arrangements, written or unwritten, between and among employers and service agents concerning the implementation of DOT agency drug and alcohol testing requirements are deemed, as a matter of law, to require compliance with all applicable provisions of 49 CFR Part 40 and FMCSA drug and alcohol testing regulations (see Section 5 for DOT agency regulations). Compliance with the regulations is a material term of all such agreements. A service agent who violates these regulations is subject to a Public Interest Exclusion (PIE) by FMCSA. The company is prohibited from using the services of a service agent who is subject to a PIE in accordance with 49 CFR part 40, subpart R. The PIE list is updated at: http://dot.goy/ost/dapc. a. specimen collection and chain -of -custody [Ref 40.31-73, 40.171-2771 General: For both alcohol and drug testing, specimen donors must report for testing immediately following notification. A DOT required Custody and Control Form (CCF) and/or Alcohol Testing Form (ATF) will be utilized. Specimen donors will receive a copy of the applicable CCF/ATF at the time specimens are to be provided. See Appendix C for additional information about specimen collection. The Collection Site Person (CSP), Breath Alcohol Technician (BAT) or Screening Test Technician (STT) respectively, is responsible for maintaining the integrity of the specimen collection and transfer process, ensuring the modesty and privacy of the specimen donor, and avoiding any conduct or remarks that might be construed as accusatorial or otherwise offensive or inappropriate. The collection site must provide for visual and aural privacy during the collection. The employee's direct supervisor is not permitted to serve as the urine specimen collector for a drug test unless it is impracticable for another individual to perform this function. In addition, specimen collection sites are required to implement a policy and procedures to prevent unauthorized personnel from entering any part of the site in which urine specimens are collected or stored. Only employees being tested, collectors/STTs/BATs and other collection or testing site workers, DERs, employee and employer representatives authorized by the DER or other company official, and DOT agency representatives are authorized access to respective drug or 2020 Drug Screens Plus. All Rights Reserved. (14) FMCSA 20200101 266 alcohol specimen collection sites. Representatives of the company's TPA shall be considered employer representatives for this purpose. All such persons who have been authorized access must remain under the supervision of a collector/STT/BAT at all times when permitted into the collection site; and, except for the observer/monitor in the case of an observed/monitored collection, no one is permitted to enter the restroom (including a multi -stall restroom) while the employee provides the specimen. Drug testing: Failure of the specimen donor to remain at the collection site or to provide an adequate specimen within 3 hours of the first unsuccessful attempt will be considered a "refusal to submit to testing" (See B-8, and 40.191(a)). The collection site person shall have successfully completed training to carry out this function in accordance with 49 CFR 40.33 and shall complete the specimen collection services in accordance with the DOT Urine Specimen Collection Procedures Guidelines available from DOT ODAPC W62- 300, 1200 New Jersey Avenue SE, Washington DC 20590; FAX: 202-366-3897 e-mail ODAPCWebMailCtD-dot.gov website: hftp://www.dot.gov/ost/dapc/ Dilute specimens When a pre -employment test is verified by the MRO as negative and dilute, the specimen donor will be required to submit to a second specimen collection. A second specimen collection will not be required if the specimen verified as dilute was for any other purpose, unless the specimen donor failed to report for testing in a timely manner, or the specimen collection was otherwise compromised (e.g., a "directly observed" specimen collection was required, but not conducted) as determined by the DER. Any such (second) specimen (1) becomes the test of record and (2) will not be collected under direct observation (unless there is another basis for use of direct observation [see 40.67(a)(b) & (c)]. A third specimen collection is only permitted when required by the MRO. (See 40.197) Direct observation. 40.67 specifies when and how a directly observed collection is to be conducted. In general, employees will be permitted to give a urine specimen in privacy and without being observed by collection site personnel. An employee forfeits this right if there is reason to believe that s/he may alter or substitute a specimen. In the event that an observed collection is required, the observer will be an individual of the same gender as the employee. The employer must {40.67(b)} require a direct observation specimen collection if the drug test is return -to -duty or a follow-up test. Note: In a directly observed specimen collection the employee is required {40.67(i)) to "raise his or her shirt, blouse, or dress/skirt, as appropriate, above the waist gust above the navel}, and lower clothing and underpants {to mid -thigh) to show ... by turning around" that they do not have prosthetic devices for beating the tests {see 40.191 re refusal to test). Alcohol testing: The specimen shall be collected only by a Breath Alcohol Technician (BAT), or Screening Test Technician (STT) trained to proficiency in the operation of the DOT -approved evidential breath testing (EBT) or alcohol screening device (ASD) used for the test. A positive initial test must be confirmed by EBT. Testing must conform to 49 CFR 40, subparts J, K, L, M, & N. Additional information about specimen collection procedures can be found in Appendix C of this policy, in 49 CFR 40, or on the ODAPC website above. b. initial, confirmation, and split testing Alcohol: For an initial alcohol test, the Company may test the employee using either a DOT - approved saliva testing device or non -evidentiary breath testing device (i.e., alcohol screening device or ASD), or evidential breath testing (EBT) device. An initial alcohol test with result of 0.02 or greater will be followed by a confirmation test using an EBT. A post -accident alcohol test conducted by a federal, state or local law enforcement officer will utilize whatever specimens and testing devices that have been approved for such use by the relevant authority. Drugs: Initial laboratory tests utilize an immunoassay screen to eliminate "negative" urine specimens from further consideration. Specimens also undergo validity testing for adulterants, 2020 Drug Screens Plus. All Rights Reserved. (15) FMCSA 20200101 266 dilutants and masking agents. To ensure reliability and accuracy of the lab result prior to review by the MRO, an initial lab positive, adulterated, substituted or invalid test result will be followed by confirmation tests performed in accordance with 49 CFR 40 and DHHS regulations. The split sample method of collection is mandatory for DOT -regulated drug testing. Under this methodology, the employee must provide at least 45 milliliters (ml) of urine, which is then divided into primary (30 ml) and secondary (15 ml) specimen bottles by the collector. In the event that the primary specimen is verified by the MRO as positive, adulterated or substituted, the second bottle will be sent by the primary testing lab to a second (DOT -approved) lab at the employee's request, which may be verbal or in writing. c. medical review of lab results General: The Company's Medical Review Officer (MRO) will review all drug test results confirmed by the lab as positive, adulterated, substituted, or invalid. Prior to reporting such results to the Company, the employee will be given a reasonable opportunity (72 hours from the time of contact by the DER, if not contacted directly by the MRO) to discuss the lab results with the MRO and to present a legitimate medical explanation (if any) for the lab result. The MRO has the discretion to extend the verification process for up to five days, if the MRO determines that there is a reasonable basis to believe that the employee will be able to produce relevant evidence concerning a legitimate medical explanation within that time. In the case of a confirmed positive for Opioids, the MRO may also require the employee to present him/herself to be examined for clinical evidence of substance abuse. Refusal to comply is equivalent to expressly declining to discuss the test result. If neither the MRO nor the DER are able to contact an employee within 10 days of the MRO's receipt of a certified test result from the lab, the MRO will verify the test result as a positive or refusal to test, as applicable, without the employee's input. For a period of 60 days from the MRO's verified report to the DER, the MRO must allow the employee to present information documenting that serious illness, injury, or other circumstances unavoidably precluded contact with the MRO and/or DER; and may, on the basis of such information, reopen the verification, allowing the employee to present information concerning whether there is a legitimate medical explanation for the confirmed test result. Even if an employee presents a legitimate medical explanation and the employee's drug test is verified as negative, the MRO may be required to bring fitness -for -duty considerations to the attention of third parties. [See 40.327] Once notified of a required drug test, the employee must remain available for contact by the Company and the MRO and must make contact with the Company at least daily. Failure to maintain contact with the Company shall be cause for disciplinary action up to and including discharge, solely at the option of the Company. ii. Except for the use of methadone, THC (or Marijuana), and medications containing alcohol, nothing in this policy prohibits an employee's use of a medication legally prescribed (for an FDA -approved use) by a licensed physician who: (a) is familiar with the employee's medical history and specific safety - sensitive duties, and (b) has advised the employee that the prescribed medication will not adversely affect the employee's ability to perform his or her safety - sensitive duties (e.g., to drive a commercial motor vehicle). iii. Medications prescribed for someone other than the employee will not be considered lawfully used by the employee under any circumstances. iv. Medications containing alcohol will not be considered lawfully used by the employee while on duty or within 4 hours prior to going on duty. 2020 Drug Screens Plus_ All Rights Reserved_ (16) FMCSA 20200101 266 v. Medications containing alcohol will not be considered a legitimate medical explanation if cited as an explanation for a positive alcohol test. vi. As part of the verification process, the MRO is prohibited from considering as a "legitimate medical explanation" (see 49 CFR 40.151 for full text): (a) evidence from other tests not collected or tested in accordance with Part 40 (e.g., by the employee's physician); (b) assertions by the donor (when disputed by the collector) not reflected on the CCF concerning matters occurring at the collection site; (c) whether the employer was correct in directing that a test occur (e.g., whether proper grounds existed under DOT regulations); (d) explanations that would not, even if true, constitute a legitimate medical explanation (e.g., marijuana brownies, passive inhalation, coca tea, etc.); (e) prescriptions or physician recommendations for the use of "Schedule I" controlled substances (e.g., under "medical marijuana" laws adopted by some states); (f) an assertion of consumption or other use of hemp or coca products (e.g., hemp oil, hemp seed, coca teas, etc,); (g) an assertion that there is a legitimate medical explanation for PCP, 6-AM (a metabolite of heroin), MDMA, or MDA in a specimen; (h) an assertion that soap, bleach, or glutaraldehyde entered a specimen through physiological means; (i) an assertion that the employee can produce urine with no detectable creatinine through physiological means. vii. An employee whose test has been verified by the MRO as adulterated, substituted (or otherwise determined to be a "refusal to test") or positive is unqualified to perform safety -sensitive duties and is subject to disciplinary action up to and including discharge, solely at the option of the Company, viii. As an employee, when the MRO has notified you that you have a verified positive drug test and/or refusal to test because of adulteration or substitution, you have 72 hours from the time of notification to request a test of the split specimen. The request may be verbal (e.g., by calling the MRO's office at 1-800-459-9012 ext 788 and leaving a message at any time, day or night) or in writing. If you make this request to the MRO within 72 hours, you trigger the (49 CFR 40) requirements for a test of the split specimen. There is no split specimen testing for an invalid result. Except as otherwise prohibited by law, an employee who requests a split specimen test will be required to pay for the testing. Split specimen testing is conducted without regard to the cutoff concentrations of 40.87. d. reporting, recordkeeping, and confidentiality [Ref 49 CFR 40.321-3331 General. The results of all alcohol and controlled substances tests will be considered confidential and will be maintained in a secure location with controlled access. Except as provided by DOT regulations or as otherwise provided by law, employers and their service agents are prohibited from releasing individual test results or medical information about an employee to third parties without the employee's specific written consent. L Employees are entitled, upon written request, to obtain copies of any records pertaining to the employee's use of alcohol or controlled substances and/or to have such records released to a specific identified person. (See 49 CFR 40.331) ii. Employees are required to provide the Company with written authorization 2020 Drug Screens Plus. All Rights Reserved. (17) FMCSA 20200101 266 to obtain drug and alcohol testing records (including positives and refusals to test) from each previous employer (including, whether or not hired, every employer to whom the employee applied to perform any duty designated as a safety -sensitive function by a DOT agency regulation) during the previous 3 years [(See 49 CFR 391.23 (e)]; iii. Likewise, the Company is required to provide such information about test results to potential employers when authorized by the employee in writing, or to others (e.g., in connection with legal proceedings) when required or permitted by Federal or State law. (See 40.25, 40.323-331) iv. The MRO must report drug test results and medical information obtained during the verification process to third parties (e.g., the employer, medical examiner, SAP, DOT agency, or NTSB) under various circumstances without the employee's consent if the MRO determines (in his/her reasonable medical judgment), that: (a) The information is likely to result in a determination that the employee is medically unqualified under an applicable DOT agency regulation; or (b) The information indicates that continued performance by the employee of his or her safety -sensitive function is likely to pose a significant safety risk. (See 49 CFR 40.327 for additional information.) v. In accordance with DOT regulations, the Company and its service agents will provide access to facilities, property, and records to DOT agency representatives; and, in accordance with 49 CFR 40.323, may release an employee's confidential information to officials involved in any action that arises by or on behalf of the employee (e.g., unemployment, worker's compensation hearings, etc.) without the employee's consent. However, the Company or service agent (e.g., MRO) must immediately notify the employee in writing of any such release of information. vi. MROs will be required to report verified positive, adulterated, and substituted controlled substances test results along with any refusal to test determinations to the National Clearinghouse [Ref 382.705 (a) (i, ii)] B-7 REQUIREMENT TO SUBMIT TO TESTING Employees are required to submit to all drug and/or alcohol testing required by DOT regulations or by this Company policy and must appear for such testing within a reasonable time (as determined by the Company), after being directed to do so by the Company. [See 40.61(a), 40.191(a) and Appx B def: "Immediately'] B-8 REFUSAL TO SUBMIT TO TESTING [See 40.25, .191, .261, 285, 382.213 and 382.107 definition of refuse to submit] General. In addition to consequences imposed by DOT agency regulations, an employee's Refusal to submit to testing at the direction of the Company or law enforcement personnel will subject the employee to disciplinary action up to and Including discharge, solely at the option of the Company. (a) As an employee, you have refused to take a drug or alcohol test if you: (1) Fail to appear for any test (except a pre -employment test) within a reasonable time, consistent with FMCSA regulations as determined by the Company, (or, if an owner -operator, by a C/TPA per 40.61(a)]; (2) Fail to remain at the testing site until the testing process is complete, Provided, That an employee who leaves the testing site before the testing process commences (see 40.63(c)) for a pre -employment test is not deemed to have refused to test; (3) Fail to provide a urine specimen for a drug test or fail to attempt to provide a saliva or breath specimen, as applicable, for a drug or 2020 Drug Screens Plus. All Rights Reserved_ (18) FMCSA 20200101 266 alcohol test required by DOT drug and alcohol regulations, Provided, That an employee who does not provide a urine specimen because s/he has left the testing site before the testing process commences (see 40.63(c)) for a pre -employment test is not deemed to have refused to test; (4) In the case of a directly observed or monitored collection in a drug test, fail to permit the observation or monitoring of your provision of a specimen (see 40.67(l) and 40.69(g)); (5) Fail to provide a sufficient amount of urine when directed, and it has been determined, through a required medical evaluation, that there was no adequate medical explanation for the failure (see 40.193(d)(2)); (6) Fail or decline to take a second test the Company or collector has directed you to take; (7) Fail to undergo a medical examination or evaluation, as directed by the MRO as part of the verification process, or by the DER following "shy bladder" procedures [see 40.193(d)], or as directed by the employer as part of the insufficient breath procedures [see 40.265(c)]. However, in the case of a pre -employment drug test, the employee is deemed to have refused to test on this basis only if the pre -employment test is conducted following a contingent offer of employment; or (8) Fail to cooperate with any part of the testing process (e.g., refuse to empty pockets when directed by the collector, behave in a confrontational way that disrupts the collection process, fail to wash hands after being directed to do so by the collector). (9) For an observed collection, fail to follow the observer's instructions to raise your clothing above the waist, lower clothing and underpants, and to turn around to permit the observer to determine if you have any type of prosthetic or other device that could be used to interfere with the collection process. (10) Possess or wear a prosthetic or other device that could be used to interfere with the collection process. (11) Admit to the collector or MRO that you adulterated or substituted the specimen. (b) As an employee, if the MRO reports that you have a verified adulterated or substituted test result, you have refused to take a drug test. (c) As an employee, if you refuse to take a drug test, you incur the consequences specified under DOT agency regulations for a violation of those DOT agency regulations. There are no consequences under DOT agency regulations for refusing to take a non -DOT test. B-9 CONSEQUENCES OF VIOLATING THIS POLICY [Ref 382 Subpart E] General. Except as provided in Section B-10 of this policy, an employee who has violated a DOT drug and alcohol regulation; e.g., a verified positive drug test, positive alcohol test, refusal to test, or any other violation of the prohibition on the use of alcohol or drugs under a DOT agency regulation cannot again perform any DOT safety -sensitive duties for any employer until and unless s/he has completed the SAP evaluation, referral, and education/treatment process set forth in 49 CFR 40, Subpart O. See Section 5 of this policy for DOT regulations. Any employer or safety -sensitive employee who violates 49 CFR 40 or DOT agency drug and alcohol regulations is subject to the penalty provisions of 49 U.S.C. 521(b); and such employees are subject to disciplinary action up to and including discharge, solely at the option of the Company, i. At a minimum, such employees will be prohibited from performing any 2020 Drug Screens Plus. All Rights Reserved. (19) FMCSA 20200101 266 safety -sensitive function for the Company and may be automatically suspended without pay. The Company has no obligation to reinstate, retain or rehire any employee who violates any DOT regulation or Company policy concerning drugs and alcohol. [Ref B-5(e) and (f)j An employee whose test result is positive for drugs or alcohol or who refuses a drug or alcohol test may also be subject to civil and criminal penalties imposed by DOT. B-10 AN ALCOHOL CONCENTRATION OF 0.02 - 0.039 (Ref 382.5051 If the violation is limited to an alcohol concentration of 0.02 or greater but less than 0.04, the employee will not be permitted to perform any safety sensitive function for the Company until the start of the employee's next regular shift, but not less than 24 hours following such result. Except as may otherwise be prohibited by law, the Company reserves at its sole option, the right to impose additional disciplinary action up to and including discharge. [Ref 49 CFR 382.505(b)] B-11 THE EFFECTS OF ALCOHOL AND CONTROLLED SUBSTANCE USE The Company will provide information and training to employees as to the effects of alcohol and controlled substances use on health, work, and personal life; signs and symptoms of an alcohol or a controlled substances problem; and available methods of intervening when an alcohol or a controlled substances problem is suspected (including confrontation) and referral to any assistance resources available to the employee or his/her dependents. Such information and training is considered a part of this policy and will be provided prior to the first request for a test administered under this policy. (See Appendix A) FMCSA regulations and Company policy require that all persons designated to supervise employees who perform safety -sensitive functions receive training regarding substance abuse. Assistance with intervention, confrontation or referral (whether to an SAP or to management) regarding substance abuse can be obtained from any such supervisor, or from the DER listed on page 3. C OPTIONAL PROVISIONS C-1. Stand -Down. The Company has not received a waiver (nor, at this time, applied for a waiver) to "Stand Down" employees from their safety -sensitive duties pending completion of the MRO verification process (see 40.21). C-2. Self -Referral and Unpaid Leave of Absence General. An employee who requests a leave of absence under this provision may provide the Company with actual knowledge of drug or alcohol use prohibited by DOT regulations and therefore be subject to consequences specified by DOT regulations and this policy. Following the request for leave of absence (whether or not the leave is granted) the employee will not be permitted to perform safety sensitive duties for the Company until the Company is satisfied that s/he has been evaluated and has successfully completed the requirements of 49 CFR 40, Subpart O. By the inclusion of this provision, the Company does not commit to retain, reinstate, or rehire the employee following either the request for leave of absence or (if granted) the completion of his or her leave of absence; any such decision will be based solely on the business needs of the Company as determined by the Company. (a) Subject to and consistent with the requirements of this provision, an employee may request an unpaid leave of absence (vs immediate discharge) not to exceed 90 days from the date of request for the purpose of referral, evaluation and treatment for substance abuse and/or alcoholism provided by a licensed SAP approved by the 2020 Drug Screens Plus. All Rights Reserved. (20) FMCSA 20200101 266 Company. (b) To be entitled to such leave, the employee: (i) must have first been clinically diagnosed as drug and/or alcohol dependent by a licensed substance abuse professional, and (ii) must be eligible for leave under the federal Family and Medical Leave Act (FMLA) or similar applicable state law. Contact the DER (page 3) to inquire about FMLA benefits, if any. (c) Such leave of absence shall not be permitted and the employee will be subject to disciplinary action up to and including immediate discharge solely at the option of the company, if the request occurs: (i) After the employee has performed any safety sensitive function for the Company on the day of the request, or (il) Following a request or attempted request by the DER for the employee to submit to a drug or alcohol test, or (iii) Following a request or attempted request by the DER (or other representative of the company) for the employee to submit to an interview regarding the employee's performance of his or her safety sensitive duties (e.g., a reasonable suspicion interview). D CERTIFICATE OF RECEIPT. Each employee is required to sign a certificate of receipt certifying that he or she has received a copy of the policy, training and educational materials required by FMCSA regulations. Do not sign for materials, information, or training that you have not received. You are entitled to receive a copy of the certificate of receipt. 2020 Drug Screens Plus. All Rights Reserved. (21) FMCSA 20200101 266 Appendix Al -Training Materials/Employees Alcohol Alcohol is the most widely abused of all drugs and belongs to the class of drugs known as depressants. Depressants affect the central nervous system; slowing down mental functions, depressing the pulse rate, blood pressure, respiration and other bodily functions. 60% of all automobile accident fatalities involve alcohol. Alcoholism is a progressive disease which typically passes through 5 stages: social drinking, increased tolerance, behavioral changes, concealment of drinking, complete dependency. In addition to the direct effects, even small amounts of alcohol can have a serious effect on an unborn child. Two-thirds of all Americans will be involved in an alcohol -related vehicle accident during their lifetimes. The rate of separation and divorce in families with alcohol dependency problems is 7 times the average. From 1982 through 1993, deaths from drunken driving accidents have dropped by nearly one third. This drop is attributed (by the CDC) to improved law enforcement, state's raising their drinking ages to 21 and lowering their legal limits for intoxication. Fewer people are drinking. There has been an increase in social pressure against driving drunk and heightened public awareness as a result of groups such as MADD. Signs and Symptoms: Typical Sources: Beer, wine, hard liquors. Physical Symptoms: Odor on breath; slurred speech; very bloodshot/ watery eyes; poor balance/ coordination; sleepy or stuporous condition; gaze nystagmus (spasmodic movement of eyes); possibly constricted pupils; greatly impaired driving ability; impaired judgment; inability to divide attention; lowered inhibitions; changes in sleep patterns. Behavioral Symptoms: excessive use of mouthwash or mints to cover odor of alcohol; focus on alcohol -related activities; hidden drinking, morning drinking, drinking before attending an activity that includes drinking; drinking instead of eating; chronic, unjustifiable problems with family, employer, other employees; excessive irritability and impatience; extreme changes in personality. Personal Health Safety, and the Work Environment: The annual alcohol -related death toll includes: 35,000 auto accident deaths; 15,000 in non -highway accidents; 40,000 deaths due to liver and brain disease or suicide; 125,000 in other alcohol -related conditions/accidents. Two-thirds of all homicides are committed by people who drink prior to the crime. Two to three percent of the drivers on the highway are legally drunk on a typical week -day, and four to six percent on nights and weekends. General Health Effects: ■ Reduced coordination and reflex action ■ Impaired vision and judgment ■ depressed genital reflexes and increased sexual dysfunction/impotency (in spite of reduced inhibitions) ■ vitamin/mineral deficiencies resulting from improper diet ■ increased risk of miscarriage/premature birth/birth defects ■ ruptured veins ■ high blood pressure ■ damage to stomach, pancreas, brain cells, esophagus, liver ■ increased danger of auto/boating accidents, slips/trips/falls, fire, drowning, or becoming a victim of violence, crime, murder. Safety and the Work Environment: Impairment in coordination and judgment can be objectively measured with as little as two drinks in the body (increasing with each additional drink) and resulting in an accident rate of up to 6 times the rate for an unimpaired individual. It takes an average person (150 pounds) about an hour to process one serving of an alcoholic beverage from the body. Over 40 percent of falls are alcohol -related. Overdose Effects: ■ Unconsciousness ■ Amnesia/Blackouts ■ Impotency ■ Coma ■ Death Withdrawal Syndrome: Alcohol withdrawal can be fatal. Symptoms can include ■ Sleep disturbance ■ Anxiety attacks ■ Decreased appetite/nausea/vomiting/cramps ■ Hallucinations ■ Sweating and tremors ■ Convulsions ■ Coma ■ Heart failure. The alcoholic requires professional medical attention during withdrawal. 2020 Drug Screens Plus. All Rights Reserved. (22) FMCSA 20200101 266 Appendix A2 -Training Materials/Employees Marijuana Marijuana use is very common; about one-third of all adult Americans have tried the drug. In the 1985 national Household Survey on Drug Abuse (NIDA, 1986b), about 10 percent of Americans over the age of 12 reported that they had used the drug within the month prior to their interviews. Among those young adults who have tried marijuana, 39 percent of males and 24 percent of females report using it more than 100 times. Regardless of any state or local statutes permitting the use of Marijuana or THC, such use (including a prescription by a licensed physician) violates Federal statutes. Passive inhalation of marijuana smoke does occur and can result in detectable levels of THC in blood and urine. However, it is highly unlikely that passive inhalation would result in a positive test result at the cutoff level currently used in DOT testing. Under DOT regulations, a Medical Review Officer (MRO) is not allowed to accept any claim of "passive ingestion" (e.g., the unwitting consumption of marijuana brownies or hemp oil, passive inhalation, etc.) as a legitimate medical explanation for a positive drug test for THC. Signs and Symptoms: Evidence of Presence: plastic bags (commonly used to sell marijuana); smoking papers; roach clip holder; small pipes of bone, brass, or glass; smoking bongs; distinctive odor (like burning rope). Physical Symptoms: reddened eyes (often masked by eye drops); stained fingertips from holding "joints'; chronic fatigue; irritating cough, chronic sore throat; accelerated heart beat; slowed speech; impaired motor coordination; altered perception; increased appetite. Behavioral Symptoms: impaired memory; time -space distortions; feeling of euphoria; panic reactions; paranoia; "I don't care" attitude; false sense of power. Personal Health Safety, and the Work Environment: Marijuana produces a pleasant euphoria or "high," commonly followed by drowsiness. Intoxication temporarily impairs concentration, learning, and perceptual -motor skills. Thus, for at least 4-6 hours after a dose of marijuana, drivers probably function with reduced abilities. Studies suggest that performance is impaired long after the acute subjective effects have ended. Experienced pilots in a flight simulator were impaired for at least 24 hours after a dose, long after the subjective "high" had disappeared. Functional impairments are less well understood in cases of prolonged, heavy marijuana use, because such users can develop behavioral and physiological tolerance. General Health Effects: ■ Chronic marijuana smoking causes emphysema -like conditions. • One "joint" is the cancer -causing equivalent of 112 to a full pack of tobacco cigarettes. ■ Marijuana is commonly contaminated with the fungus Aspergillis, which can cause serious respiratory tract and sinus infections. • Chronic marijuana smoking causes changes in brain cells and brain waves. Long-term brain damage is likely to occur. ■ The active chemical, THC, and 60 other chemicals in marijuana tend to concentrate in the ovaries and testes. ■ Chronic smoking of marijuana in males causes a decrease in the male sex hormone and an increase in the female sex hormone, which can lead to female sex characteristics including breast development. ■ Chronic smoking of marijuana in females causes a decrease in fertility and an increase in male sex hormones. • THC has been linked with: malformations of the brain, spinal cord, forelimbs, liver, and spine, and visuallophthalmic problems. Safety and the Work Environment: Regular use can cause: • delayed decision making ■ diminished concentration ■ impaired short-term memory ■ impaired signal detection (ability to detect a brief flash of light) ■ impaired tracking (the ability to follow moving objects with the eyes) and visual distance measurements ■ The mental impairments resulting from the use of marijuana produce reactions that can lead to unsafe and erratic driving behavior. • Distortions in visual perceptions, impaired signal detection, and altered reality can make driving a vehicle (or other safety - sensitive work) very dangerous. Overdose Effects: ■ Aggressive urges • Anxiety • Confusion • Fearfulness ■ Hallucinations ■ Heavy sedation • Immobility ■ Mental dependency ■ Panic • Paranoia ■ Distorted body image. Withdrawal Syndrome: ■ Sleep disturbance • Hyperactivity ■ Decreased appetite • Irritability ■ Gastrointestinal distress ■ Salivation, sweating and tremors. 2020 Drug Screens Plus. All Rights Reserved. (23) FMCSA 20200101 266 Appendix A3 -Training MaterialslEmployees Cocaine Cocaine is an alkaloid (organic base) derived from the coca plant. In its more common form, cocaine hydrochloride ("snorting coke") is a white to creamy granular or lumpy powder (chopped fine before use). Cocaine base, rock, or crack is a crystalline rock about the size of a small pebble. Cocaine hydrochloride is snorted into the nose, rubbed on the gums, or injected into the veins. Cocaine base is heated in a glass pipe and the vapor is inhaled. It is estimated that 5.8 million Americans use cocaine in any given month, and 5 percent of employed persons 20 to 40 years old reported using cocaine in the month prior to the N1DA survey. Cocaine first produces psychomotor and autonomic stimulation, with a euphoric subjective "high." Larger doses may induce mental confusion or paranoid delusions, and serious overdoses cause seizures, respiratory depression, cardiac arrhythmias, and death. Cocaine abusers, even if they do not use at work, often report vocational impairment due to exhaustion; they use the drug until late at night. Among chronic users, exhaustion, lethargy, and mental depression appear, and the stimulant effect may seem progressively weaker. Cocaine is highly reinforcing; repeated experiences with it tend to drive further episodes of self -administration. Many users say that although the drug no longer produces much "high," they are unable to abstain. Under DOT regulations, a Medical Review Officer (MRO) is not allowed to accept any claim of "passive ingestion" (e.g., the consumption of coca teas) as a legitimate medical explanation for a positive drug test for cocaine. Signs and Symptoms: Evidence of Presence: small folded envelopes, plastic bags, or vials used to store cocaine; razor blades; cut-off drinking straws or rolled bills for snorting; small spoons; heating apparatus. Physical Symptoms: dilated pupils; runny or irritated nose; profuse sweating; dry mouth; tremors; needle tracks; loss of appetite; hype rexcitability; restlessness; high blood pressure; heart palpitations; insomnia; talkativeness; formication (sensation of bugs crawling on skin). Behavioral Symptoms: increased physical activity; depression; isolation and secretive behavior; unusual defensiveness; frequent absences; wide mood swings; difficulty in concentration; paranoia; hallucinations; confusion; false sense of power and control. Personal Health Safety, and the Work Environment: General Health Effects: ■ may upset chemical balance of the brain ... speed up the aging process... cause irreparable damage to critical nerve cells ■ causes heart to beat faster and harder and rapidly increases blood pressure ■ causes spasms of blood vessels in the brain and heart... leading to strokes and heart attacks ■ Cocaine causes the strongest mental dependency of any known drug. ■ Treatment success rates are lower than those of other chemical dependencies. ■ Cocaine is extremely dangerous when taken with depressant drugs. Medical intervention for overdoses in such cases usually proves ineffective. Safety and the Work Environment: Regular use can cause the following effects: ■ Paranoia and hallucinations ■ Hyperexcitability and overreaction to stimulus - Difficulty in concentration ■ Wide mood swings ■ Withdrawal leads to depression and disorientation ■ Cocaine use results in an artificial sense of power and control which leads to a sense of invincibility. ■ Lapses in attention and the ignoring of warning signals greatly increase potential for accidents. ■ Paranoia, hallucinations, and extreme mood swings make for erratic and unpredictable reaction. ■ The cost of maintaining cocaine dependency frequently leads to workplace theft and/or dealing. ■ Forgetfulness, absenteeism, tardiness, and missed assignments can translate into lost business. Overdose Effects: ■ Agitation ■ Increase in body temperature ■ Hallucinations ■ Convulsions ■ Death Withdrawal Syndrome: ■ Apathy ■ Long periods of sleep ■ Irritability = Depression ■ Disorientation 2020 Drug Screens Plus, All Rights Reserved. (24) FMCSA 20200101 266 Appendix A4 -Training Materials/Employees Amphetamine/MethamphetaminelMDMA In their pure form, amphetamines are yellowish crystals. They are manufactured in a variety of forms including pill, capsule, tablet (ingested), powder (snorted), and liquid (injected). Amphetamine ("speed") is sold in counterfeit capsules or as white, flat, double scored "mini bennies." Methamphetamine is often sold as a creamy white, granular powder or in lumps wrapped In aluminum foil or tiny Zip -Lock bags. It looks like rock salt or crushed rock candy. Ecstasy (which can include MDMA, and/or MDA) in tablets and capsules may also contain amphetamine, meth - amphetamine, PCP, ketamine, with or without MDMA. These synthetic drugs are much less widely abused than cocaine or marijuana. However, its popularity is rapidly growing. About 4% of the population or an estimated 8.8 million have tried methamphetamine at some time in their life. Hawaii leads the nation in methamphetamine abuse. It is estimated that approximately 15% of young adults age 18-25 have used methamphetamine within the past 30 days, and the drug is widely abused in all age groups from 12 to 50. The stimulant effects of amphetamine and methamphetamine are similar to those of cocaine, but last longer. A single therapeutic dose enhances attention and performance, but performance deteriorates as the effects wear off, or with repeated dosing. These stimulant drugs are useful in treating narcolepsy and attention -deficit disorder, and are sometimes prescribed for depression which has not responded to other treatments. The drugs cause anorexia, but tolerance quickly develops, limiting their merit for treating obesity. Because of the abuse risk, medical boards in several jurisdictions have formally determined that it is inappropriate to treat obesity with these drugs for more than a few weeks. However, a tested individual producing a confirmed positive should be carefully queried about prescribed medications. By interfering with serotonin synthesis, MDMA-caused depletion of this (mood -regulating) neurotransmitter may be long-term. Signs and Symptoms., Evidence of Presence: Most frequently — glass pipes, tiny Zip -Lock bags, envelopes, vials for storing; Less frequently — pills, capsules, tablets, syringes, needles, tourniquets. Physical Symptoms: dilated pupils; sweating; increased blood pressure; palpitations; rapid heartbeat; dizziness; decreased appetite; dry mouth, headaches; blurred vision; insomnia; high fever (depending on the level of the dose). Behavioral Symptoms: confusion; panic; talkativeness; hallucinations; restlessness; anxiety; moodiness; false sense of confidence and power; "amphetamine psychosis" which might result from extended use. Personal Health. Safety, and the Work Environment: General Health Effects: + "Amphetamine psychosis" - Resembling schizophrenia, users may see, hear, and feel things that do not exist (hallucinations), have irrational thoughts or beliefs (delusions), and feel as though people are out to get them (paranoia). ■ Regular use produces strong psychological dependence and increasing tolerance to the drug. ■ The euphoria increases impulsive and risk taking behavior, such as bizarre and violent acts.. Intoxication may induce a heart attack or stroke due to spiking of blood pressure. • Chronic use may cause heart and brain damage due to severe constriction of capillary blood vessels. • Lack of sleep, weight loss, and depression also result from regular use. ■ users who inject drugs can get serious and life -threatening infections, lung or heart disease, and/or kidney damage). Safety and the Work Environment: Regular use can cause: ■ Restlessness ■ Anxiety ■ Moodiness it False sense of power. Extended use can result in: ■ Hallucinations ■ Delusions • Paranoia ■ Brain damage. • A false sense of alertness can result in risky driving behavior and increased accidents. • Employees who fail to get sufficient rest may use the drug to increase alertness and become dependent. ■ While limited doses cause short-term mental/physical improvement, greater use impairs functioning. • Amphetamine hangover effects (fatigue/depression) are a danger in safety -sensitive positions. Overdose Effects: ■ Agitation ■ Increase in body temperature r Hallucinations • Convulsions • Death Withdrawal Syndrome: • Apathy ■ Long periods of sleep • Irritability ■ Depression • Disorientation 2020 Drug Screens Plus. A!l Rights Reserved_ (25) FMCSA 20200101 266 Appendix A5 -Training Material slEmployees Oploids: Morphine/Codeine/Heroin/Others Natural and natural derivatives include: opium; morphine; codeine; and heroin (semi -synthetic). Synthetics include: meperidine (Demorol); oxymorphone (Numorphan); oxycontin, and oxycodone (Percodan). Taken in pill form, smoked, or injected, depending on the type of narcotic used. Because of the variety of compounds and forms, Opiolds are more difficult to clearly describe in terms of form, color, odor, and other physical characteristics. Opium and its derivatives can range from dark brown chunks to white crystals or powders. Since the body metabolizes codeine to morphine, both substances may occur in urine following the use of codeine. Poppy seeds contain trace amounts of morphine and codeine, so an employee who consumes poppy seed rolls may produce urine positives for morphine (with or without codeine). Laboratory tests use "cutoff concentrations" which provide the MRO with valuable information regarding the verified test result (e.g., sorting out the need for either clinical evidence of abuse, or a legitimate medical explanation). Clinical evidence of substance abuse includes but is not limited to: needle tracks or signs of intoxication or withdrawal... m oderate, nonlethal, "flu" -like abstinence syndrome with nausea, diarrhea, coryza, occasional vomiting, weakness, malaise, "gooseflesh," and mydriasis. 6-Acetylmorphine (6-AM) is a metabolite of heroin, but not of codeine or morphine. Therefore, the MRO is prohibited from accepting an assertion that there is a legitimate medical explanation for the presence of 6-AM in a drug test specimen. Signs and Symptoms: Evidence of Presence: Needles; syringe caps; eyedroppers; bent spoons; bottle caps; and rubber tubing (used in preparation and injection of the drug). Foil, glassine envelopes, or paper "bindles" (packets for holding drugs); balloons or prophylactics used to hold heroin; bloody tissues used to wipe the injection site; and burned matches used to heat the drug prior to injection. Physical Symptoms: constricted pupils; sweating; nausea and vomiting; diarrhea; needle marks or "tracks'; wearing long sleeves to cover "tracks'; loss of appetite; slurred speech; slowed reflexes; depressed breathing and heartbeat; and drowsiness and fatigue. Behavioral Symptoms: mood swings; impaired coordination; depression; apathy; stupor; and euphoria. Personal Health, Safety, and the Work Environment: General Health Effects:. Intravenous (IV) needle users have a high risk for contracting hepatitis and AIDS due to sharing of needles. ■ Because Opioids increase tolerance to pain, individuals may under -estimate the extent of injuries, leading to failure to seek medical attention after an accident. ■ Because the effects of Opioids are multiplied when used in combination with other depressant drugs and alcohol, overdoses are more likely. Safety and the Work Environment: Regular use can cause the following effects: ■ Depression ■ Apathy ■ Wide mood swings ■ Slowed movement . Slower reflexes ■ Physical or psychological dependence ■ The apathy caused by Opioids results in an "I don't really care" attitude towards performance. • Physical effects, depression, fatigue, slowed reflexes raise potential for accidents. Overdose Effects: ■ Slowlshallow breathing ■ Clammy skin ■ Convulsions ■ Coma ■ Death Withdrawal Syndrome: ■ Watery eyes ■ Runny nose • Yawning ■ Loss of appetite ■ Irritability ■ Tremors ■ Panic ■ Cramps ■ Nausea ■ Chills ■ Sweating 2020 Drug Screens Plus. All Rights Reserved. (26) FMCSA 20200101 266 Appendix A6 - Training Materials/Employees PCP (Phencyclidine) PCP is not used in medicine and does not occur in nature. PCP's use as a human anesthetic was discontinued because it produced psychotic reactions, and its more prolonged use as a veterinary tranquilizing agent also has stopped. Thus, the druq now has no therapeutic role; its use is strictly illegal. It is commonly sold as a creamy, granular powder (brown or white) and is often packaged in one -inch -square aluminum foil or folded paper packets. Occasionally, PCP is sold in capsule, tablet or liquid form. It is sometime smoked in marijuana, tobacco, or other leafy materials. Since monkeys repeatedly self-administer PCP intravenously, resulting in gross intoxication, the drug is said to reinforce self -administration behavior in animals. Some human beings also repeatedly and chronically self-administer PCP. This behavioral reinforcement is striking, considering the drug's pronounced adverse effects. The psychosis which sometimes develops with intoxication may be long-lasting, and there are suggestions of personality and cognitive changes persisting for months after chronic use. Its toxicity has given it a bad reputation even among drug users, who often are not very discriminating in these matters. It remains a popular drug of abuse in certain cities, notably Washington, DC, Los Angeles, CA, and Baltimore, MD.; but occurs sporadically elsewhere. Si ns and Symptoms: Evidence of Presence: foil or paper packets; stamps (off which PCP is licked); injection paraphernalia (needles, syringes, and tourniquets); leafy herbs (for smoking). Physical Symptoms: dilated or floating pupils; blurred vision; nystagmus (jerky eye movement); drooling; muscle rigidity; profuse sweating; decreased sensitivity to pain; dizziness; drowsiness; impaired coordination (e.g., drunken -like walk, staggering); severe disorientation; rapid heartbeat. Behavioral Symptoms anxiety; paniclfearlterror; aggressive/violent behavior; distorted perception; severe confusion and agitation; disorganization; mood swings; poor perception of time and distance; poor judgment; auditory hallucinations. Personal Health, Safety, and the Work Environment: General Health Effects: There are 4 phases to PCP abuse. ■ Phase 1/Acute toxicity: can last up to three days and can include combativeness, catatonia, convulsions, and coma. Distortions of size, shape, and distance perceptions are common. ■ Phase 21Toxic psychosis: while this phase does not always follow the first, users may experience visual and auditory delusions, paranoia, and agitation. ■ Phase 3lDrug-induced schizophrenia: may last a month or longer. • Phase 4/Drug-induced depression: suicidal tendencies and mental dysfunction can last for months. Safety and the Work Environment: Regular use can cause the following effects: ■ Irreversible memory loss ■ Personality changes ■ Thought disorders • Hallucinations ■ Extreme mental/anesthetic effects create high potential for accidents and for overdose emergencies. • Because the effects are aggravated by other depressant drugs such as alcohol, overdose potential is high. • PCP -induced hallucinations may be misdiagnosed as LSD -induced. The standard treatment for LSD -induced hallucinations is Thorazine, which when administered with PCP can be fatal. • Distortions in perception, and potential visual and auditory delusions make performance unpredictable and dangerous in safety -sensitive positions. • PCP use can cause drowsiness, convulsions, paranoia, agitation, or coma, all obviously dangerous in any safety -sensitive position. Overdose Effects: ■ Longer, more intense "trip" episodes ■ Psychosis ■ Coma ■ Death Withdrawal Syndrome: • None reported 2020 Drug Screens Plus. All Rights Reserved. (27) FMCSA 20200101 266 Appendix B: Definitions, including FMCSA-specific If a term is defined in 49 CFR 40.3 (included in Section 5 of this policy), that definition shall be used with respect to this policy, except to the extent (if any) that the definition is superseded by an applicable DOT agency definition or regulation. Otherwise, the following definitions shall be used with respect to this policy and the definition for any other term(s) shall be as determined solely by the Company, to the extent not prohibited by an applicable law. Accident With respect to DOT agency drug and alcohol post -accident testing: FMCSA (a) As soon as practicable following an occurrence involving a commercial motor vehicle operating on a public road in commerce, each employer shall test for alcohol and controlled substances each surviving driver: (1) Who was performing safety -sensitive functions with respect to the vehicle, if the accident involved the loss of human life; or (2) Who receives a citation under State or local law for a moving traffic vialation arising from the accident, if the accident involved: (i) Bodily injury to any person who, as a result of the injury, immediately receives medical treatment away from the scene of the accident; or (ii) One or more motor vehicles incurring disabling damage as a result of the accident, requiring the motor vehicle to be transported away from the scene by a tow truck or other motor vehicle. (b) Disabling damage means damage which precludes departure of a motor vehicle from the scene of the accident in its usual manner in daylight after simple repairs. (1) Inclusions. Damage to motor vehicles that could have been driven, but would have been further damaged if so driven. (2) Exclusions. (i) Damage which can be remedied temporarily at the scene of the accident without special tools or parts. (ii) Tire disablement without other damage even if no spare tire is available. (iii) Headlight or taillight damage. Actual knowledge An employer can obtain actual knowledge that a safety -sensitive employee has used alcohol or controlled substances based on the employer's direct observation of the employee, information provided by the employee's previous employer($), a traffic citation for driving a CMV (FMCSA) or revenue -generating vehicle (FTA) while under the influence of alcohol or controlled substance(s) or an employee's admission of alcohol or controlled substances use (unless any such admission meets the exemption requirements of a self -referral program in accordance with a DOT -agency drug and alcohol regulation; e.g., 49 CFR 382.217 for FMCSA-regulated employers). Adulterated specimen A specimen that has been altered, as evidenced by test results showing either a substance that is not a normal constituent for that type of specimen or showing an abnormal concentration of an endogenous substance. Air blank In evidential breath testing devices (EBTs) using gas chromatography technology, a reading of the device's internal standard. In all other EBTs, a reading of ambient air containing no alcohol. Alcohol The intoxicating agent in beverage alcohol, ethyl alcohol or other low molecular weight alcohols, including methyl or isopropyl alcohol. Alcohol concentration The alcohol in a volume of breath expressed in terms of grams of alcohol per 210 liters of breath as indicated by a breath test under this part. Alcohol concentration A subsequent test using an EBT, following a screening test with a result of 0.02 or test greater, that provides quantitative data about the alcohol concentration. Alcohol screening A breath or saliva device, other than an EBT, that is approved by the National Highway device (ASD) 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 employee may have a prohibited concentration of alcohol in a breath or saliva specimen. Alcohol testing site A place selected by the employer where employees present themselves for the purpose of providing breath or saliva for an alcohol test. Alcohol use The drinking or swallowing of any beverage, liquid mixture or preparation (including any medication), containing alcohol. Aliquot A fractional part of a specimen used for testing. It is taken as a sample representing the whole specimen. Applicants Individuals hired or transferred into positions that include safety -sensitive functions. 2020 Drug Screens Plus, All Rights Reserved. (28) FMCSA 20200101 266 Breath Alcohol means a person who instructs and assists employees in the alcohol testing process Technician (BAT) and operates an evidential breath testing device. Cancelled test A drug or alcohol test that has a problem identified that cannot be or has not been corrected, or which this part otherwise requires to be cancelled. A cancelled test is neither a positive nor a negative test. {Note: A cancelled DOT test does not provide a valid basis for an employer to conduct a non -DOT test [40.207(c)]) Chain of custody The procedure used to document the handling of the urine specimen from the time the employee gives the specimen to the collector until the specimen is destroyed. This procedure uses the Federal Drug Testing Custody and Control Form (CCF). Clearinghouse The FMCSA Clearinghouse is established to contain records of violations listed in 49 CFR Part 382, Subpart B. Violations include positive drug and/or alcohol test results and test refusals. Collection container A container into which the employee urinates to provide the specimen for a drug test. Collection site A place selected by the employer where employees present themselves for the purpose of providing a urine specimen for a drug test. Collector A person who instructs and assists employees at a collection site, who receives and (aka a Collection Site makes an initial inspection of the specimen provided by those employees, and who Person or CSP) initiates and completes the CCF. Confirmatory A second analytical procedure performed on a different aliquot of the original specimen drug test to identify and quantify the presence of a specific drug or drug metabolite. Confirmatory A second test performed on a different aliquot of the original urine specimen to further validity test support a validity test result. Confirmed drug test confirmation test result received by an MRO from a laboratory. Conforming products NHTSA's Conforming Products List of Evidential Breath Measurement Devices (CPL) list (CPL) Consent and release A service agent must not require an employee to sign a consent, release, waiver of form(s) liability, or indemnification agreement with respect to any part of the drug or alcohol testing process including but not limited to, collections, laboratory testing, MRO, and SAP services [40.355(a)]. Consortium/Third-party A service agent that provides or coordinates the provision of a variety of drug and administrator (C/TPA) alcohol testing services to employers. C/TPAs typically perform administrative tasks concerning the operation of the employers' drug and alcohol testing programs. This term includes, but is not limited to, groups of employers who join together to administer, as a single entity, the DOT drug and alcohol testing programs of its members. C/TPAs are not " employers" for purposes of this part. Continuing education Training for medical review officers (MROs) and substance abuse professionals (SAPS) who have completed qualification training and are performing MRO or SAP functions, designed to keep MROs and SAPs current on changes and developments in the DOT drug and alcohol testing program. Controlled substance Includes all substances listed on Schedules I through V of 21 CFR 1308. At a minimum, covered employees will be tested for the following drugs and/or their metabolites: Marijuana, Cocaine, Opioids, Phencyclidine, and Amphetamines. Covered employee An individual designated in a DOT agency regulation as subject to drug testing and/or alcohol testing (including an applicant). "Individual", "employee" or any other alternative term used with regard to such person has the same meaning. See "Employee". Custody and control The Federal Drug Testing Custody and Control Form (CCF) utilized for documenting form (CCF) the collection of a specimen for a DOT required or permitted urine drug test. Designated employer An employee authorized by the employer to take immediate action(s) to remove representative (DER) employees from safety -sensitive duties, or cause employees to be removed from these covered duties, and to make required decisions in the testing and evaluation processes. The DER also receives test results and other communications for the employer, consistent with the requirements of this part. Service agents cannot act as DERs. Detectable level of a controlled substance: the lowest level deemed by the testing laboratory to be scientifically sufficient to determine that the controlled substance is present. Dilute specimen A urine specimen with creatinine and specific gravity values that are lower than expected for human urine. Disabling damage means damage which precludes departure of a motor vehicle from the scene of the (FMCSA) accident in its usual manner in daylight after simple repairs, Inclusions: Damage to motor vehicles that could have been driven, but would have been further damaged if so 2020 Drug Screens Plus. All Rights Reserved. (29) FMCSA 20200101 266 driven. Exclusions: Damage which can be remedied temporarily at the scene of the accident without special tools or parts: e.g., tire disablement without other damage even if no spare tire is available; headlight or taillight damage; damage to turn signals, horn, or windshield wipers which make them inoperative. DOT, The Department, These terms encompass all DOT agencies, including, but not limited to, the DOTAGency United States Coast Guard (USCG), the Federal Aviation Administration (FAA), the Federal Railroad Administration (FRA), the Federal Motor Carrier Safety Administration (FMCSA), the Federal Transit Administration (FTA), the National Highway Traffic Safety Administration (NHTSA), the Pipeline and Hazardous Materials Safety Administration (PHMSA), and the Office of the Secretary (OST). These terms include any designee of a DOT agency. Driver Means any person who operates a commercial motor vehicle. This includes, but is not limited to: Full time, regularly employed drivers; casual, intermittent or occasional drivers; leased drivers and independent, owner -operator contractors who are either directly employed by or under lease to an employer or who operate a commercial motor vehicle at the direction of or with the consent of an employer. Drugs The drugs for which tests are required under this part and DOT agency regulations are marijuana, cocaine, amphetamines, phencyclidine (PCP), and Opioids. Drug test An analytic procedure to determine whether an individual has (confirmation test) or may have (screening test) a prohibited controlled substance in a body specimen. Employee Any person who is designated in a DOT agency regulation as subject to drug testing and/ or alcohol testing. The term includes individuals currently performing safety - sensitive functions designated in DOT agency regulations and applicants for employment subject to pre -employment testing. For purposes of drug testing under this part, the term employee has the same meaning as the term " donor' as found on CCF and related guidance materials produced by the Department of Health and Human Services. Employer A person or entity employing one or more employees (including an individual who is self-employed) subject to DOT agency regulations requiring compliance with this part. The term includes an employer's officers, representatives, and management personnel. Service agents are not employers for the purposes of this part. Error Correction Training provided to BATs, collectors, and screening test technicians (STTs) following Training an error that resulted in the cancellation of a drug or alcohol test. Error correction training must be provided in person or by a means that provides real-time observation and interaction between the instructor and trainee. Evidential Breath A device approved by NHTSA for the evidential testing of breath at the .02 and .04 Testing Device (EBT) alcohol concentrations, placed on NHTSA's Conforming Products List (CPL) for " Evidential Breath Measurement Devices" and identified on the CPI_ as conforming with the model specifications available from NHTSA's Traffic Safety Program. Follow-up testing Drug/alcohol testing of an employee determined to be in need of assistance in resolving problems with drugs/alcohol. [See also: 40.281-313] HHS The Department of Health and Human Services or any designee of the Secretary. Department of Health and Human Services. Immediately or within a With respect to random testing: as soon as possible consistent with safety reasonable time considerations. Failure of the employee to report for random testing within a reasonable time as determined by the DER is considered a refusal to test. See 40.191 regarding refusal to test and consequences. Initial drug test (also known as a "Screening Drug Test") The test used to differentiate a negative specimen from one that requires further testing for drugs or drug metabolites. Initial specimen validity The first test used to determine if a urine specimen is adulterated, diluted, substituted, test or invalid. Invalid drug test The result reported by an HHS-certified laboratory in accordance with the criteria established by HHS Mandatory Guidelines when a positive, negative, adulterated, or substituted result cannot be established for a specific drug or specimen validity test. Laboratory Any U. S. laboratory certified by HHS under the National Laboratory Certification Program as meeting the minimum standards of Subpart C of the HHS Mandatory Guidelines for Federal Workplace Drug Testing Programs; or, in the case of foreign laboratories, a laboratory approved for participation by DOT under this part. Limit of Detection The lowest concentration at which a measurand can be identified, but (for quantitative (LOD) assays) the concentration cannot be accurately calculated. Limit of Quantitation For quantitative assays, the lowest concentration at which the identity and fLOQ) concentration of the measurand can be accurately established. 2020 Drug Screens Plus. All Rights Reserved. (30) FMCSA 20200101 266 Medical Review Officer means a person who is a licensed physician and who is responsible for receiving and (MRO) reviewing laboratory results generated by an employer's drug testing program and evaluating medical explanations for certain drug test results. Negative result The result reported by an HHS-certified laboratory to an MRO when a specimen contains no drug or the concentration of the drug is less than the cutoff concentration for the drug or drug class and the specimen is a valid specimen. NHTSA National Highway Traffic Safety Administration Non -negative specimen A urine specimen that is reported as adulterated, substituted, positive (for drug(s) or drug metabolite(s)), and/or invalid. ODAPC The office in the Office of the Secretary, DOT, that is responsible for coordinating drug Office of Drug and and alcohol testing program matters within the Department and providing information Alcohol Policy and concerning the implementation of 49 CFR Part 40. For additional information visit the Compliance. ODAPC website at: www.dot.gov/ost/dapddocuments,html?documents Oxidizing adulterant A substance that acts alone or in combination with other substances to oxidize drugs or drug metabolites to prevent the detection of the drug or drug metabolites, or affects the reagents in either the initial or confirmatory drug test. Positive result (alcohol) Refusal to submit a specimen OR an alcohol concentration of 0.02 or greater on a test performed by a Breath Alcohol Technician on Evidential Breath Testing equipment or by other means (if required by circumstances and not prohibited by a Federal reg). (drugs) The result reported by an HHS-certified laboratory when a specimen contains a drug or drug metabolite equal to or greater than the cutoff concentration. Primary specimen In drug testing, the urine specimen bottle that is opened and tested by a first laboratory to determine whether the employee has a drug or drug metabolite in his or her system; and for the purpose of validity testing. The primary specimen is distinguished from the split specimen, defined in this section. Prohibited drug With regard to an employer having "actual knowledge" of an employee's misuse of drugs or alcohol, "prohibited drug" means any controlled substance where the controlled substance has been dispensed or used or is in the individual's possession in a manner not approved by the FDA, including a controlled substance prescribed for another person. Qualification Training The training required in order for a collector, BAT, MRO, SAP, or STT to be qualified to perform their functions in the DOT drug and alcohol testing program. Qualification training may be provided by any appropriate means (e.g., classroom instruction, internet application, CD-ROM, video). Reconfirmed The result reported for a split specimen when the second laboratory is able to corroborate the original result reported for the primary specimen. Redact To put into suitable literary form; revise; edit (See 40.329(c)). Refresher Training The training required periodically for qualified collectors, SATs, and STTs to review basic requirements and provide instruction concerning changes in technology (e.g.. new testing methods that may be authorized) and amendments, interpretations, guidance, and issues concerning this part and DOT agency drug and alcohol testing regulations. Refresher training can be provided by any appropriate means (e.g., classroom instruction, internet application, CD-ROM, video). Refusal to test or to Means any circumstance outlined in 49 CFR 40.191 and 40.261. submit a specimen See 49 CFR 40.355 (i) and 6) regarding limitations on Service Agents with regard to making a determination that an employee has "refused a drug or alcohol test". This determination is almost exclusively a "non -delegable" responsibility of the DER. Rejected for testing The result reported by an HHS-certified laboratory when no tests are performed for a specimen because of a fatal flaw or a correctable flaw that is not corrected. Return -to -duty testing Required following a violation of DOT drug and alcohol agency regs, [See 40,281-313] Safety -sensitive Any on -duty functions under 395.2(1)-(7). A driver is "performing" safety - function sensitive functions during any period in which the driver is actually performing, FMCSA: ready to perform, or immediately available to perform such functions. See individual DOT agency regulations for their respective definitions. Screening drug test See Initial drug test definition above. Screening Test means a person who instructs and assists employees in the alcohol testing process technician (STT) and operates an alcohol screening device. Service agent Any person or entity, other than an employee of the employer, who provides services specified under this part to employers and/ or employees in connection with DOT drug and alcohol testing requirements. This includes, but is not limited to, collectors, BATS 2020 Drug Screens Plus. All Rights Reserved_ (31) FMCSA 20200101 266 and STTs, laboratories, MROs, substance abuse professionals, and C1TPAs. To act as service agents, persons and organizations must meet the qualifications set forth in applicable sections of this part. Service agents are not employers for purposes of this part. Shipping container A container that is used for transporting and protecting urine specimen bottles and associated documents from the collection site to the laboratory. Specimen bottle The bottle that, after being sealed and labeled according to the procedures in this part, is used to hold the urine specimen during transportation to the laboratory. Specimen: (Breath alcohol test) A breath specimen that is sufficient to result in a valid test (on an EST or ASD) as determined by the BAT. (Saliva alcohol test) Saliva from the employee's mouth collected in the manner described by the manufacturer of the Alcohol Screening Device (ASD). (Urine drug test) A minimum of 45 ml of the tested employee's freshly voided urine as determined by the collection site person. Split -specimen In drug testing, a part of the urine specimen that is sent to a first laboratory and retained unopened, and which is transported to a second laboratory in the event that the employee requests that it be tested following a verified positive test of the primary specimen or a verified adulterated or substituted test result. Split -specimen A collection in which the urine collected is divided into two separate specimen bottles, collection the primary specimen (Bottle A) and the split specimen (Bottle B). Stand -down The practice of temporarily removing an employee from the performance of safety - sensitive functions based only on a report from a laboratory to the MRO of a confirmed positive test for a drug or drug metabolite, an adulterated test, or a substituted test, before the MRO has completed verification of the test result. Substance abuse Illicit use of a controlled substance or misuse of alcohol. Substance abuse means a person who evaluates employees who have violated a DOT drug and alcohol professions! (SAP) regulation and mates recommendations concerning education, treatment, follow-up testing, and aftercare. Substituted specimen A urine specimen with creatinine and specific gravity values that are so diminished or so divergent that they are not consistent with normal human urine. Verifred test A drug test result or validity testing result from an HHS-certified laboratory that has undergone review and final determination by the MRO. 2020 Drug Screens Plus. All Rights Reserved. (32) FMCSA 20200101 266 Appendix C - Specimen Collection Procedures: 49 CFR 40.31-73(urine); 40.211-277(alcohol) Employee Notice of procedures used to insure the integrity of the collection process • You are required to report to the collection site immediately following notification of a required drug and/or alcohol test (i.e., within a reasonable time as determined by the employer). Failure to do so is considered a refusal to test [see 40,191, 40.261]. ■ You will be required to provide a fresh specimen when you arrive at the collection site. An adulterated or substituted specimen is considered a refusal to test and (like a positive drug or alcohol test) constitutes a violation of DOT drug and alcohol regulations [see 40.25, 40.133, 40,145, 40,191, 40.285]. ■ You will be required to remove outer clothing (i.e., coveralls, jacket, coat, hat) that could be used to conceal items/substances used to tamper with a specimen, but not required to remove other clothing unless the collection is being made simultaneously with a DOT agency -authorized medical exam [40.61(f)(3)]. However, your possession of items or substances that may be used to tamper with a specimen require the collector to conduct an immediate directly observed specimen collection [40.61(f)(5), 40.63(e), 40.67]. Failure to cooperate is a refusal to test. ■ Direct observation. 40.67 specifies when and how a directly observed collection is to be conducted. In general, employees will be permitted to give a urine specimen in privacy and without being observed by collection site personnel. An employee forfeits this right if there is reason to believe that s/he may alter or substitute a specimen. In the event that an observed collection is required, the observer will be an individual of the same gender as the employee. The employer must {40.67(b)) require a direct observation specimen collection if the drug test is return -to -duty or a follow-up test. Note: In a directly observed specimen collection the employee is required (40.67(i)} to "raise his or her shirt, blouse, or dress/skirt, as appropriate, above the waist {just above the nave!}; and lower clothing and underpants {to mid -thigh) to show ... by turning around' that they do not have prosthetic devices for beating the tests {see 40.191 re refusal to test}. ■ In addition to consequences imposed by DOT for a refusal to test [40.285], any attempt to dilute, adulterate, or substitute a specimen may be cause for discipline up to and including discharge under Company authority and solely at the option of the Company. ■ You will be required to show a valid PHOTO I.D. issued by the employer (other than an owner -operator or other self- employed individual) or a Federal, state, or local government (e.g., a driver's license). Faxes or photocopies are not acceptable [40.61(c), 40.241(c)]. 1 You can NOT be required to sign a consent, release, waiver of liability, or indemnification agreement with respect to any part of the drug or alcohol testing process covered by 49 CFR Part 40 (including, but not limited to, collections, laboratory testing, MRO, and SAP services) [See 49 CFR 40.3551. Also, you must NOT list medications on the Custody and Control Form (CCF); you may make notes on the back of your (employee) copy of the CCF for your convenience, but these notes must not be transmitted to anyone else [40.61(g)] unless and until such information is requested by the MRO as part of the MRO verification process (40.141). ■ Failure to cooperate with any part of the testing process is a refusal to test [40.61(f), 40.191(a)(8), 40.261(a)(7)]. ■ Alcohol testing can be conducted only by a Breath Alcohol Technician (BAT) or Screening Test Technician (STT) meeting their respective requirements of 49 CFR 40, Subpart J (40.211-215). An STT can conduct only alcohol screening tests, but a BAT can conduct alcohol screening and confirmation tests [40.211]. ■ An Alcohol Screening Test will follow the procedures detailed in 49 CFR 40, Subpart L (40.241-247). If a drug test is also required, the alcohol test should be conducted before the drug test [40.241(b)(1)]. ■ If the screening test is positive (i.e., an alcohol concentration of 0.02 or greater) a confirmation test will be required following the procedures detailed in 49 CFR 40, Subpart M (40.251-255). ■ An employee's refusal to sign the Alcohol Testing Form (ATF) certification is a Refusal to test [40.241(g)]. See this policy (Section 1, 13-6; and Section 5), and 49 CFR Part 40 (included by reference in this policy) for additional information. 2020 Drug Screens Plus. All Rights Reserved. (33) FMCSA 20200101 266 2020 Drug Screens Plus. All Rights Reserved. (34) FMCSA 20200101 266 FMCSA DRUG AND ALCOHOL CLEARINGHOUSE DRIVER EDUCATION MATERIALS/RECEIPT The FMCSA Clearinghouse is an online database containing records of drug and alcohol violations. Employers are required to check the Clearinghouse for all new hires and also annually for all employed drivers. Drivers must give consent to their employer to run the annual Clearinghouse check. Drivers are only required to register in the Clearinghouse if they are seeking new employment or if there is driver information in the Clearinghouse on them. Drivers will be notified by the Clearinghouse whenever any information is added, revised, or removed. The notification will be sent by mail using the address associated with the driver's CDL if the driver is not registered with the Clearinghouse Driver information that will be reported to the Clearinghouse will include: 1. Any verified positive, adulterated, or substituted drug test 2. Any confirmed alcohol test result that is 0.04 or higher 3. Any refusal to submit to a DOT required test 4. Any verified and documented actual knowledge of drug/alcohol violations a. Any on -duty alcohol use b. Any alcohol use within 4 hours of going on duty c. Any alcohol use within 8 hours of an accident or before a post -accident test is completed d. Any prohibited drug use while on duty 5. Completion of the SAP evaluation and treatment 6. Any negative return to duty test results 7. Completion of the follow up testing determined by the SAP I acknowledge receiving educational material about the FMCSA Drug and Alcoho Clearinghouse as required under §382.601. Driver's name: Driver's signature: Date: 2020 Drug Screens Plus_ All Rights Reserved. (35) FMCSA 20200101 266 2020 Drug Screens Plus. All Rights Reserved. (36) FMCSA 20200101 266 Pitsch Companies Certificate of Receipt for Company Policy On Employment +® The employer shall ensure that each covered employee/applicant is required to sign a statement certifying that he or she has received educational materials that explain DOT drug and alcohol testing requirements (and the employer's policies and procedures with respect to meeting these requirements) before performing safety -sensitive duties for the employer. The employer shall maintain the original of the signed certificate and may provide a copy of the certificate to the employee/applicant. EMPLOYEE/APPLICANT NOTICE: READ BEFORE YOU SIGN The DOT requires the Company to provide covered employees/applicants (and representatives of employee organizations) with educational materials that explain DOT regulations regarding drug and alcohol use and abuse, Company policies and procedures for meeting those regulations, and other information and training concerning the effects of alcohol and controlled substances use. The DOT also requires you to sign a receipt certifying that you have received these materials. Refusal to sign this form upon receipt of the materials will be grounds for discharge. By signing this receipt you agree that you have received and read and are responsible to understand the Company policy, DOT regulations regarding alcohol and drug use testing, and all Company training materials included with or referenced in this material. Any questions you have regarding the above materials or this certification form may be addressed to the Designated Employer Representative (DER). See page 3 of your copy of the Company's Combined Drug/Alcohol Substance Abuse Policy for the Name, Address, and Phone Number of the DER. By signing this receipt, you are agreeing that your questions have been answered to your satisfaction. The original of this form will be retained by the Company in a separate file along with other Company records maintained for the Company's DOT drug and alcohol testing programs. Your copy of this receipt will be found in the back of your copy of the Company's Combined Drug/Alcohol Substance Abuse Policy. CERTIFICATION by Employee/Applicant: 1 certify that I have received a copy of the Company Substance Abuse Policy and other educational and training materials which the Company is required to provide as explained in the above notice, and that I have a record of the Name, Address, and Phone Number of the Company's current DER on page 3 of my copy of the Policy. Furthermore, I agree that I am responsible for reading, understanding and obeying all current Company policies and DOT regulations regarding alcohol and drug use testing and all future changes in or additions to those policies and regulations as they are adopted by the Company. I further understand and agree that I may be subject to disciplinary action and other liability for violating DOT regulations and/or Company policies. Prior to signing this Receipt, I read it carefully and any questions I had regarding the above materials and/or this form have been answered to my satisfaction. NOTE. 49 CFR 386 Appx B(a)(1-3) provides for penalties of (variously) $1,000/day (failure to prepare), $10,000 (knowing falsification of records), and $11,000 per (non-recordkeeping) violation of 49 GFR parts 382, 385, and 390-99 ($1,000/day provisions also apply to part 40). Employee Signature Print Name Witness Signature Print Name Date: Date: / 1 2020 Drug Screens Plus, All Rights Reserved. (37) FMCSA 20200101 266 2020 Drug Screens Plus. All Rights Reserved. (38) FMCSA 20200101 266 FMCSA POST ACCIDENT TEST CRITERIA D.O.T. T5 7acci.dent Qt S n REQUIRED Was immediate off -site medical treatment given? NO Did any vehicle incur disabling damage that required it to be towed? D.O.T. TESTS YE5 REQUIRED D.O. .E S REQUIRED Disabling Damage Inclusions: Damage to motor vehicles that could have been driven, but would have been further damaged if so driven. Exclusions: Damage which can be remedied temporarily at the scene of the accident without special tools or parts: e.g., tire disablement without other damage even if no spare tire is available; headlight or taillight damage; damage to turn signals, horn, or windshield wipers which make them inoperative.This page intentionally blank. 2020 Drug Screens Plus. All Rights Reserved. (39) FMCSA 20200101 266 omwlz- EE.VSs' Model Program Agreement Big Responsibility ... Smart Choice! 3625 Clyde Park SW Suite B Grand Rapids MI 49509 (616) 532-9299 FAX 532-4644 Effective Date: March 6, 2020 This is a legal agreement between you, Pitsch Companies (The Company), and Drug Screens Plus (DSf). By keeping the accompanying Model Program, you are agreeing to be bound by the terms of this agreement. If you do not agree to the terms of this agreement, promptly return the Model Program for a full refund. Limited Warranty DSf has made a good faith effort to prepare the accompanying Model Program Materials to facilitate your compliance with DOT drug and alcohol regulations. However, Pitsch Companies is responsible for complying with those regulations and accepts full responsibility for reviewing and/or modifying the Model Program to ensure that any use of these Materials in whole or in part is within the legal bounds of any Federal, State, and Local laws, statutes, or other regulations. Nothing in these materials is intended or should be considered legal advice. In making any legal decision(s), you should seek legal advice from an attorney. For ninety (90) days from March 6, 2020, in the event of any defect brought to our attention DSf will (at our discretion) either replace, refund, or edit the deflective Materials including print and/or computer media (if any). No Other Warranties DSf disclaims all other warranties, either express or implied, including but not limited to implied warranties of fitness for a particular purpose. Hold Harmless Pitsch Companies agrees to indemnify and hold DSf harmless from any claims, suits, damages, actions, or other costs by any party for any reason arising from the Company's use of and/or reliance upon these Materials. Any dispute concerning these materials shall be adjudicated by courts residing in Kent County, Michigan without regard to conflicts of law principles. Copyright Drug Screens Plus (DSf) is the sole and exclusive owner of the copyright (and owns all right, title and interest) in the accompanying Materials, whether printed or on computer disk or other media. Grant of Limited Non-exclusive License Upon receipt of payment by Pitsch Companies for an Enrollment Fee, Model Program Update Service Fee, or Annual (e.g., Copyright License or TPA) Fee, DSf grants to the Company a nonexclusive and nontransferable License to use, edit, revise, and/or copy these Model Program materials for the purpose of preparing and administering substance abuse policies solely for the use of the named Company. The License to use the Materials is limited to the Calendar Year indicated by the Effective Date of the Materials as issued to the company by DSf A continuation of this License in each subsequent year requires payment by the Company of an Annual (e.g., Copyright License or TPA) fee in the amount of $159 each Calendar Year (due on or before January 15fh), or other written Grant of License signed by an officer of DSf The Company shall not remove its name from these Materials, shall not allow these Materials to be copied or published under any name other than Pitsch Companies, and shall not remove or modify the Drug Screens Plus (DSf) copyright information wherever it occurs (including page "Footer" section). 2020 Drug Screens Plus, Ail Rights Reserved. (40) FMCSA 20200101 266 August 27, 2025 Demolition Contractors Inc. DBA Pitsch Companies 675 Richmond NW Grand Rapids, MI 49504 RE: Bond Capacity To Whom It May Concern: This will advise that Merchants Bonding Company (Mutual) serves as surety for Demolition Contractors Inc. DBA Pitsch Companies. We consider Demolition Contractors Inc. DBA Pitsch Companies to be capably managed and properly financed. Merchants Bonding Company (Mutual) provides a $5,000,000 single project and a $7,500,000 aggregate surety program to Demolition Contractors Inc. DBA Pitsch Companies with favorable consideration for higher limits as needed. Merchants Bonding Company (Mutual) is on the U.S. Treasury Department's Listing of Approved Sureties (Department Circular 570) and is rated A (Excellent) with a Financial Size Category of IX (USD 250 Million to Less than 500 Million) by A.M. Best Rating Services. Please be advised, Merchants Bonding Company (Mutual) reserves the right to underwrite any bond request. Underwriting of surety bonds depends on a variety of factors, including a detailed review of the plans and specifications for the project, the precise terms and conditions of the proposed contract, project financing, bond forms, and the completeness of other underwriting information at the time a bond is needed. We assume no liability for not issuing any bond for any reason. If you have any questions, please feel free to call. Sincerely, / JI— , Z�&"�� Heather Buonodono Merchants Bonding Company (Mutual) Attorney -In -Fact 4808 Broadmoor Ave., S.E., Kentwood, MI 49512 bonds@thecampbellgrp.com 800-748-1351 .Demolition Engineers ,Asbestos Abatement ,Salvaged Building Materials .Excavating & Underground Services .Concrete Recycling Compartles .Landfill Operation .Dumpster Service .Portable Toilet Service .Land Development MAJOR PROJECTS COMPLETED WITHIN THE PAST 5 YEARS Riverside Correctional Facilitv. . Ionia Michigan Services Provided: Abatement, Mass Demolition, Trucking and Removal of Debris, Site Restoration Owner: State of Michigan GC: TriMedia EE Project Description: This project entailed the abatement and demolition of over 26 buildings at a former correctional facility in Ionia. We installed soil erosion controls, abated asbestos containing materials, demolish all of the buildings, excavated the foundations, stripped all blacktop pavements, backfilled the basement cavities with sand and finished the entire area with topsoil and seed. Final Total Project Cost: $ 6,300,000 Duration of Project: 20 months, Finished in Spring 2024 Best Practices: We used excavators with pulverizers to chew through the concrete columns, slabs and foundations. We also used excavators with shear blades to cut down the steel -framed buildings and process steel members into manageable lengths. Concrete was staged at a neighboring pit and crushed into road gravel, some of which was re -used to stabilize the site. Multiple dust busters were used during the demolition work to eliminate fugitive dust. Team Members: Lewis Pitsch estimated and managed the project. We had multiple operators on site. Joe Zahm was the lead site superintendent and operated heavy equipment, communicated daily with the office regarding equipment and staffing needs, and was the GC`s field contact. Contact: Julie Tresedder, TriMedia EE (906) 228-5125 % Self Perfonned: 80% (Abatement was subcontracted to 2 separate firms) I1OME OFFICE: LANDFILL OFFICE: 675 Richmond, N .W., Grand Rapids, All 49504 7905 Johnson Rd., Belding, MI48B09 Telephone: (616) 363-4895 Telephone: (616) 794-3050 FAX: (616) 363-5585 FAX: (616) 794-1769 (6) White Pine Motel Abatement and Demolition GC: Julie Tresedder, TriMedia EE (906) 228-5125 Dollar Amount: $ 990,000 Description: Asbestos abatement and complete demolition of two multistory motel buildings in White Pine Michigan. Work included installation of SESC controls, abatement, demolition, excavation of basements and foundations, backfllling , grading of entire property and restoration. Completed: Fall2024 % Self Performed: 90% (subcontracted a portion of the asbestos abatement work) GR City_Office Relocation Proiect Owner: City of Grand Rapids GC: Clark Construction Co, Jamie Cardinal 616-889-4829 Dollar Amount: $ 600,000 Description: Selective Demolition of interior office space and service garage within a former county DPW facility, Demolition included removal of architectural and MEP as well as shoring and creating multiple OHD openings and floor slab removals. Completed: Summer and Fall of 2024. Still performing minor tasks as extras. % Self Performed: 100% Spectrum Health Employee Parking Ramp and CoGen Plant, Demolition Owner: Spectrum Corewell Health Systems, 100 Michigan NE, Grand Rapids GC: Pioneer Construction Scott Veine, VP, Sr PM 616.292.9437 John Morris, Superintendent, 616-889-1028 Dollar Amount: $ 650,000 Ramp, $ 120,000 CoGen Plant Description: Separation and complete demolition of four story concrete parking ramp. Cogen Plant: Building demo and manual removal of 8-story block exbaust stack Completed: In phases from May 2022 to March 2023 % Self Performed: 100% Academy Manor Residence, Grand Rapids, Michigan Owner: 3CPK Marywood 4 Limited Dividend Housing Association LLC GC: Pioneer Construction, Grand Rapids, MI Beverly Gerdes, Sr PM 616-389-8782 Mike Klapmust, Superintendent 616-550-2135 Dollar Amount: $ 800,000 Description: Major interior demolition of walls, ceilings and flooring in a 5 story complex involving over 150,000 square feet of floor area. Completed: September 2023 % Self Performed: 100% DEPARTMENT OF PUBIC WORKS CITY OF SOUTH BEND, INDIANA SPECIAL PROVISIONS Rabbi Shulman Apartment Building Demolition Project No. 125-014 PROJECT DESCRIPTION Work to be performed shall include furnishing all labor, services, materials, insurance and equipment to remove the asbestos and demolish the 6-story Rabbi Shulman Apartment Building according to the intent of the plans and specifications at 628 Western Avenue. I. PREVAILING SPECIFICATIONS AND DESIGN & CONSTRUCTION STANDARDS The City of South Bend's PREVAILING SPECIFICATIONS, most recent version, and DESIGN & CONSTRUCTION STANDARDS, most recent version, are to be used on this project. Each Bid provider is specifically instructed to become completely familiar with the most recent version of the PREVAILING SPECIFICATIONS and the DESIGN & CONSTRUCTION STANDARDS prior to submitting a Bid. Wherever the PREVAILING SPECIFICATIONS refer to "State Specifications," it shall mean the 2024 INDOT Standard Specifications for the letting effective after September 1, 2023. These SPECIAL PROVISIONS will list only "Additions" or "Deletions" to the PREVAILING SPECIFICATIONS and are to be used only in conjunction with the PREVAILING SPECIFICATIONS. In the event of conflict between the SPECIAL PROVISIONS and the PREVAILING SPECIFICATIONS, the SPECIAL PROVISIONS will govern. Ill. BIDDING REQUIREMENTS A. Prevailing Specifications: 2024, 1NDOT Standard Specifications Section 102 B. Additions: 1. Each Bid provider shall completely execute and submit the following documents with the Bid: a. City of South Bend Contractor's Bid for Public Work Form b. Bid Bond stating 5% of the total Bid or Certified Check of 5% of the bid. c. Contractor's Non -Collusion and Non -Debarment Affidavit, Certification Regarding Investment with Iran, Employment Eligibility Verification, Non -Discrimination Commitment and Certification of use of United States Steel Products or Foundry Products. d. Responsible Bidder Checklist IV. TERM "OR EQUAL" A. Prevailing Specifications: None Version 09/29/2021 Special Provisions - 1 PART 11 (For projects of $100,000 or more — IC 36-1-12-4) These statements to be submitted under oath by each bidder with and as part of his/her/its bid. Attach additional pages for each section as needed. SECTION I EXPERIENCE QUESTIONNAIRE 1. Attach information regarding projects your organization has completed for the period of one (1) year prior to the date of the current bid. SEE 47-Mcge-L . 2oa Y us7-. h -26a5 2. Attach a listing of public works projects currently in process of construction by your organization. 5G C 4 rT CHe6 .26 as LIST WITH �Et Loin li 1 GNLl GHTS 3. Attach information regarding any failure to complete any work awarded to you and the location thereof. NIA— NO1VE 4. Attach references from private firms for which you have performed work. SEE 4r7-*cq&-6 SECTION Il PLAN AND EQUIPMENT QUESTIONNAIRE 1. Attach an explanation of your plan or layout for performing proposed work. (Examples could include a narrative of when you could begin work, complete the project, number of workers, etc. and any other information which you believe would enable the City of South Bend to consider your bid.) 2. Attach a listing of the names and addresses of all subcontractors (i.e. persons or firms outside your own firm who have performed part of the work) that you have used on public works projects during the past five (5) years along with a brief description of the work done by each subcontractor. 3. If you intend to sublet any portion of the work, attach the name and address of each subcontractor, equipment to be used by the subcontractor, and whether you will require a bond. However, if you are unable to currently provide a listing, please understand a listing must be provided prior to contract approval. Until the completion of the proposed project, you are under a continuing obligation to immediately notify the City of South Bend in the event that you subsequently determine that you will use a subcontractor on the proposed project. 4. Attach a listing of equipment you have available to use for the proposed project. S67E-4T7;*cH6L . 5. Have you entered into contracts or received offers for all materials which substantiate the prices used in preparing your proposal? If not, attach an explanation for the rationale used which would corroborate the prices listed. YES. SECTION III CONTRACTOR'S FINANCIAL STATEMENT Attachment of bidder's financial statement is mandatory. Any bid submitted without said financial statement as required by statute shall thereby be rendered invalid. The financial statement provided hereunder to the City of South Bend awarding the contract must be specific enough in detail so that said City of South Bend can make a proper determination of the bidder's capability for completing the project if awarded. 5EC -477*C"6_1�" Version 5/20/2024 Contractor's Bid for Public Works - 3 IS W v w U J p � N Q N N U m m C W C_ y � V J E — N N O N C c C N 7 W v U i m C E o 71 co U Q7 :- X, 3 C a C. c� pis '^O 7 E �' N= m �F' x p q 03 Q. 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Companies MAJOR PROJECTS COMPLETED WITHIN THE PAST 5 YEARS Riverside Correctional Facilltv, , Ionia Michigan Services Provided: Abatement, Mass Demolition, Trucking and Removal of Debris, Site Restoration Owner: State of Michigan GC: TriMedia EE Project Description: This project entailed the abatement and demolition of over 26 buildings at a former correctional facility in Ionia. We installed soil erosion controls, abated asbestos containing materials, demolish all of the buildings, excavated the foundations, stripped all blacktop pavements, backfilled the basement cavities with sand and finished the entire area with topsoil and seed. Final Total Project Cost: $ 6,300,000 Duration of Project: 20 months, Finished in Spring 2024 Best Practices: We used excavators with pulverizers to chew through the concrete columns, slabs and foundations. We also used excavators with shear blades to cut down the steel -framed buildings and process steel members into manageable lengths. Concrete was staged at a neighboring pit and crushed into road gravel, some of which was reused to stabilize the site. Multiple dust busters were used during the demolition work to eliminate fugitive dust. Team Members: Lewis Pitsch estimated and managed the project. We had multiple operators on site. Joe Zahm was the lead site superintendent and operated heavy equipment, communicated daily with the office regarding equipment and staffing needs, and was the GC's field contact. Contact: Julie Tresedder, TriMedia EE (906) 228-5125 % Self Performed: 80% (Abatement was subcontracted to 2 separate firms) HOME OFFICE: LANDFILL OFFICE- 675 Richmond, N .W., Grand Rapids, MI 49504 7905 Johnson Rd., Belding, MI 48809 Telephone: (616) 363-4895 Telephone: (616) 794-3050 FAX: (616) 3 63-5 585 FAX: (616) 794-1769 White Pine Motel Abatement and Demolition GC: Julie Tresedder, TriMedia EE (906) 228-5125 Dollar Amount: $ 990,000 Description: Asbestos abatement and complete demolition of two multistory motel buildings in White Pine Michigan. Work included installation of SESC controls, abatement, demolition, excavation of basements and foundations, backfilling , grading of entire property and restoration. Completed: Fall2024 % Self Performed: 90% (subcontracted a portion of the asbestos abatement work) GR City Office Relocation Proiect Owner: City of Grand Rapids GC: Clark Construction Co, Jamie Cardinal 616-889-4829 Dollar Amount: $ 600,000 Description: Selective Demolition of interior office space and service garage within a former county DPW facility. Demolition included removal of architectural and MEP as well as shoring and creating multiple OHD openings and floor slab removals. Completed: Summer and Fall of 2024. Still performing minor tasks as extras. % Self Performed: 100% Spectrum Health Emplovee Parking Ramn and CoGen Plant. Demolition Owner: Spectrum Corewell Health Systems, 100 Michigan NE, Grand Rapids GC: Pioneer Construction Scott Veine, VP, Sr PM 616.292.9437 John Morris, Superintendent, 616-889-1028 Dollar Amount: $ 650,000 Ramp, $ 120,000 CoGen Plant Description: Separation and complete demolition of four story concrete parking ramp. Cogen Plant: Building demo and manual removal of 8-story block exhaust stack Completed: In phases from May 2022 to March 2023 % Self Performed: 100% Academv Manor Residence. Grand Ranids. Michigan Owner: 3CPK Marywood 4 Limited Dividend Housing Association LLC GC: Pioneer Construction, Grand Rapids, MI Beverly Gerdes, Sr PM 616-389-8782 Mike Klapmust, Superintendent 616-550-2135 Dollar Amount: $ 800,000 Description: Major interior demolition of walls, ceilings and flooring in a 5 story complex involving over 150,000 square feet of floor area. Completed: September 2023 % Self Performed: 100% • Demolition Engineers • Asbestos Abatement • Salvaged Building Materials • Excavating & Underground Services • Concrete Recycling AaCompanies CONTRACT SUPPORTING DOCUMENTS FOR RABBI SHULMAN APARTMENT BUILDING DEMOLITION PROJECT NO. 125-014 628 WESTERN AVENUE PART 11 SECTION II PLAN & EQUIPMENT QUESTIONNAIRE • Landfill Operation • Transfer Station • Dumpster Service • Portable Toilet Service • Land Development Our plan for performing the work is to abate the asbestos using Minority Business Enterprises (MBE) and then gutting out the entire building of landfill debris using both our own employees as well as MBE employees so that we can recycle as much concrete as possible so that it doesn't go to the landfill. We have searched and placed an ad in the South Bend Tribune to utilize WBE and have not found any at the time of our bid but we will continue to search in anticipation that we are the chosen contractor. We will bring in multiple excavators for the demolition and will utilize MBE for the trucking of the concrete to the recycle facility as well as for the sand backfill. We will be able to start the job as soon as we are given the go ahead to proceed. We plan on utilizing 12 — 18 labors for asbestos abatement and gutting the building; 2-3 operators and 8 —10 trucks. Our goal is to complete the work in 90 — 120 days once we start. 2. We generally perform all of our own work but often utilize many trucking companies to assist in hauling out concrete as well as hauling in sand backfill. Please see the list of MBE companies that we plan on using for asbestos abatement and trucking. 3. See attached list of MBE companies. HOME OFFICE: www.pitschco.com LANDFILL OFFICE: 675 Richmond, NW, Grand Rapids, MI 49504 7905 Johnson Rd., Belding, MI 48809 Telephone: (616) 363-4895 Telephone: (616) 794-3050 FAX: (616) 363-5585 FAX: (616) 794-1769