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Home My WebLink AboutContract 35339 (2)CONT Between CITY OF FORT WORTH and INTERCON ENVIRONMENTAL, INC. For Removal, Packaging, Transportation, and Disposal of Asbestos-Containing Materials From City-Owned Facilities DEM07:01-AOM Environmental Management Department May 15, 2007 CITY SECRETARY CGNTRACT NO . 3S-33j -'EU STATE OF TEXAS § § COUNTIES OF TARRANT, DENTON § AND WISE CONTRACT FOR REMOVAL, PACKAGING, TRANSPORTATION AND DISPOSAL OF ASBESTOS-CONTAINING AND MOLD-CONTAMINATED MATERIALS FROM CITY OWNED FACILITIES This Contract is entered into by and between the City of Fort Worth , a home-rule municipality located within Tarrant, Denton and Wise Counties, Texas , acting through Libby Watson, its duly authorized Ass istant City Manager ("City"), and Intercon Environmental, Inc., a Texas corporation, acting through Karen Andrews, its duly authorized President ("Contractor"). WHEREAS, on May 1, 2007 the City Council authorized the City Manager to execute an annual contract for asbestos abatement operations and maintenance services through M&C C-22094 ; and WHEREAS, the City has a number of facilities that have materials containing asbestos which occasionally require the disturbance and/or removal of a portion of the material containing asbestos; and WHEREAS, Federal and State laws require only licensed and trained professional perform such work ; and WHEREAS, the City desires to hire a professional firm knowledgeable and ex perienced in conducting such removal packaging, transporting , and disposal of asbestos; and WHEREAS , the Contractor has represented that it is staffed with personnel knowledgeable and experienced in conducting removal, packaging, transporting, and disposal of asbestos . WITNESSETH: NOW, THEREFORE , in consideration of the payments and agreements hereinafter mentioned to be made and the true and faithful performance of the mutual covenants herein contained, the City and Contractor hereby agree as follows: 1. DEFINITIONS In this Contract, the following words and phrases shall be defined as follows: Asbestos shall mean the asbestiform varieties of chrysotile, amosite , crocidolite, tremolite , anthophyllite , and actinolite and all materials containing one percent or more of any of those substances. Asbestos Abatement shall mean the removal, the encapsulation or the enclosure of asbestos. Asbestos Abatement Activity shall mean asbestos abatement and any on-site preparations or clean up related to the abatement. Asbestos-Containing Material (ACM) shall mean materials or products that contain more than one percent (1.0 %) of any kind or combination of asbestos , as determined by Environmental Protection Agency (EPA) recommended methods as listed in Section 40 of the Code of Federal Regulations, (CFR) Part 763 , Subpart F and 40 CFR 763 Subpart E, Appendix A. This means any one material component of a structure. Asbestos Removal shall mean any action that dislodges, strips, or otherwise takes away asbestos containing material (ACM). City shall mean the City of Fort Worth, Texas. Contract Documents shall mean this document, the Contractor's Response to the RFP or Project DEM:07-01 :AOM and all addendums attached as exhibit "A", all other exhibits as described in this Contract and all ancillary documents . Contractor shall mean Intercon Environmental Services, Inc. DEM shall mean the Department of Environmental Management. Director shall mean the Director of the City of Fort Worth's Environmental Management Department. Encapsulation shall mean a method of control of asbestos fibers in which the surface of asbestos containing material (ACM) is penetrated by or covered with a liquid coating prepared for that purpose. Enclosure shall mean the construction of an airtight, impermeable, semi-permanent barrier surrounding asbestos to prevent the release of asbestos fibers into the air. Environmental Damages shall mean all claims, judgments, damages , losses , penalties, fines , liabilities (including strict liability), encumbrances , liens, costs, and expenses of investigation and defense of any claim, whether or not such claim is ultimately defeated , and of any good faith settlement of judgment, of whatever kind or nature, contingent or otherwise, matured or unmatured, foreseeable or unforeseeable, including without limitation reasonable attorney's fees and disbursements and consultant's fees, any of which are incurred as a result of the existence of a violation of environmental requirements pertaining to the operations and maintenance abatement of asbestos, and including without limitation: a . Damages for personal injury and death, or injury to property or natural resources; Asbestos O&M Co ntra ct CRL03.29.0 7v l 2 b. Fees incurred for the services of attorneys , consultants , contractors, experts, laboratories and investigation or remediation of the monitoring wells resulting from any violation of environmental requirements including, but not limited to , the preparation of any feasibility studies or reports of the performance of any cleanup, remediation, removal, response , abatement, containment, closure, restoration or monitoring work required by any federal, state or local governmental agency or political subdi vision, or otherwise expended in connection with the existence of such monitoring wells or violations or environmental requirements, and including without limitation any attorney's fees , costs and expenses incurred in enforcing this contract or collecting any sums due hereunder; and c. Liability to any third person or governmental agency to indemnify such person or agency for costs expended in connection with the items referenced in subparagraph (b) herein. Environmental Requirements shall mean all federal , state and local applicable present and future statutes, regulations, rules, plans, authorizations, concessions, franchises, and similar items , of all governmental agencies, departments, commissions, boards, bureaus, or instrumentalities thereof and all applicable judicial, administrative, and regulatory decrees, judgments, and orders relating to the protection of human health or the environment, including without limitation: a. All requirements, including, but not limited to , those pertaining to reporting, licensing, emissions, discharges, releases , or threatened releases of hazardous materials, pollutants, contaminants or hazardous or toxic substances , materials, or wastes whether solid, liquid , or gaseous in nature, into the air, surface water, groundwater, storm water, or land, or relating to the manufacture, processing, distribution, use, treatment , storage, disposal, transport, or handling of pollutants, contaminants, or hazardous or toxic substances, materials , or wastes, whether solid, liquid, or gaseous in nature; and b . All requirements pertaining to the protection of the health and safety of employees or the public. NESHAP shall mean the United States Environmental Protection Agency National Emissions Standards for Hazardous Air Pollutants, as described in Title 40 CFR Part 61. Regulated Asbestos-Containing Material (RACM) shall mean ( a) friable asbestos material, (b) Category I non-friable ACM that has become friable, (c) Category I non -friable ACM that will be or has been subjected to sanding , grinding, cutting, or abrading , or (d) Category II non-friable ACM that has a high probability of becoming or has become crumbled, pulverized, or reduced to powder by forces expected to act on the material in the course of demolition or renovation operations . Subcontract shall mean a contract between the Contractor for this project and another person or company for any task listed in Paragraph 2 "Scope of Contractor 's Services." A purchase order is also considered a subcontract. A sbestos O&M Con tra ct CRL03.29.0 7v l 3 ----- Task Order shall mean a letter issued by the City that authorizes Contractor to begin work on a particular task. 2. SCOPE OF CONTRACTOR'S SERVICES A. Contractor agrees to furnish all labor, materials and equipment necessary for the removal, packaging, transportation, and disposal of asbestos -containing materials from City-owned facilities on an as-needed basis as determined by the Director. There shall be no minimum work guaranteed under this Contract. B. Contractor shall maintain all applicable licenses and certifications. C. Contractor shall perform tasks related to the removal, packaging, labeling, transportation and disposal of ACM, as directed by the Director, to include but not be limited to: • Maintenance of all applicable licenses and certifications ; • Removal of ACM ; • Packaging and labeling of ACM for disposal; • Transportation of ACM for disposal ; and • Disposal of ACM; • Removal of Mold-Contaminated Material ; • Packaging and labeling of Mold-Contaminated Material for disposal; • Transportation of Mold-Contaminated Material for disposal ; and • Disposal of Mold-Contaminated Material. D. Contractor shall transport ACM for disposal and dispose of ACM in a proper and lawful landfill. E. CONTRACTOR SHALL PERFORM ALL WORK IN ACCORDANCE WITH APPLICABLE FEDERAL, STATE AND LOCAL RULES AND REGULATIONS. CONTRACTOR IS REQUIRED TO STAY ABREAST OF ANY CHANGES TO APPLICABLE RULES AND REGULATIONS. A. B. C. D . 3 . SCOPE OF CITY SERVICES City agrees to designate a City representative to provide timely direction to the Contractor and render City decisions. City shall provide Asbestos assessment reports and Asbestos removal specifications. City shall provide site contact information and site access. City shall provide timely notice to Contractor in writing of ACM removal projects, detailing the location( s ), type of work, and other pertinent information. Asbestos O&M Cont ra ct CRL03 .29. 0 7v 1 4 E. City shall provide an Asbestos or Mold Consultant, Air Monitoring Technician, and Project Manager to oversee asbestos removal work. F. City shall pay applicable Texas Department of State Health Services (DSHS) asbestos notification fees. G . City shall prepare and revise notification to the DSHS for the work described herein. 4. FEDERAL, STATE AND LOCAL LAWS AND REGULATIONS In performing the services required under this Contract, Contractor agrees to comply with all applicable federal, state and local laws, statutes, regulations, environmental requirements, ordinances, and the Building and Construction Codes of the City of Fort Worth. 5. REQUIRED LICENSED AND PERMITS A. Contractor certifies that it or its subcontracts has all current and appropriate federal, state and local licenses and permits to remove and maintain such structures as described herein. B. Contractor agrees to maintain and require its subcontractor used to perform this Contract to maintain all required federal, state and local licenses and permits during the performance of this Contract, including a wrecking permit, and a City of Fort Worth Waste Hauler Permit. 6 . SUBCONTRACTORS If Contractor desires to subcontract any service or services listed under Section 2 "Scope of Contractor's Services" of this Contract, Contractor agrees to obtain the City's written acceptance of such subcontractor(s) before allowing such subcontractor(s) to perform such service or services. Failure of the Contractor to obtain the City's written acceptance of any and all of the Contractor's subcontractors used in the performance of this Contract is grounds for automatic termination. In addition, Contractor acknowledges that City may, at City's own discretion, perform on-site audits of all proposed subcontractor's facilities in order to determine acceptability. 7. WAGES PAID BY CONTRACTOR Contractor agrees that all persons employed in the performance of services under the Contract shall be paid standard wages, notwithstanding the foregoing, the Contractor agrees to comply with all requirements of Chapter 2258, Texas Government Code, including the payment of not less than the rates determined by the City Council of the City of Fort Worth to be the prevailing wage rates in accordance with Chapter 2258, Texas Government Code . A sbesto s O&M Con tra ct C RL03 .2 9.0 7v l 5 8 . INSURANCE REQUIREMENTS Contractor agrees to furnish the following proof satisfactory to City, that it or it's subcontractor(s) has secured and paid for the following policies of liability insurance for the term of this contract covering all risks related to the removal , packaging, transporting, and disposal of asbestos according to the specification in Exhibits "A ": (a) Insurance coverage and limits : 1. Commercial General Liability Insurance o $1,000,000 each occurrence o $2,000,000 aggregate 2 . Professional Liability Insurance -NOT APPLICABLE . 3. Automobile Liability Insurance - A. Coverage on vehicles involved m the work performed under this contract: o $1,000,000 per accident on a combined single limit basis o r: o $500,000 bodily injury each person; $500 ,000 bodily injury each accident; and $250,000 property damage B. Uninsured/Underinsured Motorist: o $20,000 bodily injury each person; $40,000 bodily mJury each accident; and$ l 5,000 property damage each accident The named insured and employees of Contractor shall be covered under this policy. The City of Fort Worth shall be named an Additional insured on Endorsement TE 9901 or equivalent, as its interests may appear. Liability for damage occurring while loading, unloading and transporting materials collected under the Contract shall be included under this policy. 4 . Worker's Compensation - o Coverage A: statutory limits o Coverage B: $100,000 each accident $500,000 disease -policy limit $100,000 disease -each employee 5. Environmental Impairment Liability (EIL) and/or Pollution Liability - $2 ,000,000 per occurrence. EIL coverage(s) must be included in policies listed in subsections 1 and 2 above; or, such insurance shall be provided under separate policy(s). Liability for damage occurring while loading, unloading and transporting materials collected under the contract shall be included under the Automobile Liability insurance or other policy(s). Asbestos O&M Co ntract CRL 03 .29.07vl 6 6. Asbestos Abatement Insurance -$2,000,000 each occurrence with no Sunset Clause. (b) Certificates of insurance evidencing that the Contractor has obtained all required insurance shall be delivered to the City prior to Contractor proceeding with the contract. 1. Applicable policies shall be endorsed to name the City an Additional Insured thereon , as its interests may appear. The term City shall include its employees, officers, officials , agents, and volunteers as respects the contracted services. 2. Certificate(s) of insurance shall document that insurance coverage specified according to items in section (a) above are provided under applicable policies documented thereon. 3. Any failure on part of the City to request required insurance documentation shall not constitute a waiver of the insurance requirements. 4. A minimum of thirty (30) days notice of cancellation or material change in coverage shall be provided to the City. A ten (10) days notice shall be acceptable in the event of non-payment of premium. Such terms shall be endorsed onto Contractor's insurance policies . Notice shall be sent to Brian Boemer, Director, Department of Environmental Management, City of Fort Worth, 1000 Throckmorton, Fort Worth, Texas 76102. 5. Insurers for all policies must be authorized to do business in the state of Texas or be otherwise approved by the City; and, such insurers shall be acceptable to the City in terms of their financial strength and solvency. 6. Deductible limits, or self-insured retentions , affecting insurance required herein shall be acceptable to the City in its sole discretion ; and, in lieu of traditional insurance, any alternative coverage maintained through insurance pools or risk retention groups must be also approved. Dedicated financial resources or letters of credit may also be acceptable to the City. 7. Applicable policies shall each be endorsed with a waiver of subrogation in favor of the City as respects the contract. 8. The City shall be entitled, upon its request and without incurring expense , to review the Contractor 's insurance policies including endorsements thereto and, at the City's discretion, the Contractor may be required to provide proof of insurance premium payments. Asbes tos O&M Co ntra ct CRL03 .2 9.0 7v l 7 9. 10. 11. 12 . The q ommercial General Liability insurance policy shall have no exclusions by en~orsements unless the City approves such exclusions . The City shall not be responsible for the direct payment of any insurance premiums required by the contract. It is understood that insurance cost is an allowable component of Contractor 's overhead . All insurance required in section (a) above , except for the Professional Liability insurance policy, shall be written on an occurrence basis in order to be approved by the City. Subcontractors to the Contractor shall be required by the Contractor to maintain the same or reasonably equivalent insurance coverage as required for the Contractor. When subcontractors maintain insurance coverage, Contractor shall provide City with documentation thereof on a certificate of insurance. Notwithstanding anything to the contrary contained herein, in the event a subcontractor 's insurance coverage is canceled or terminated, such cancellation or termination shall not constitute a breach by Contractor of the contract. 9. TERM OF CONTRACT AND TIME TO START TASK A. The term of this Contract shall be from May 15, 2007 through May 14, 2008. City shall have the right to extend this Contract for up to two (2) consecutive one (1) year renewal terms , provided City and Contractor agree in writing at least thirty (30) days prior to the end of the initial or renewal term . All renewals shall have the same terms , conditions and fees as set forth herein, unless agreed to otherwise in writing b y both parties in an amendment to this Contract. B. Contractor agrees to begin work on a particular Task no later than fourteen (14) days from the date of a Task Order (i .e. Asbestos Removal Request). In emergency situations, Contractor shall respond as requested by the Director. C . Upon completion of a Task, the Contractor shall submit to the Director, an itemized bill detailing the unit number, the property address, the price according to the Unit Price list included in Attachment A and the name of the landfill where each load of asbestos and demolition debris was delivered. 10 . INDEPENDENT CONTRACTOR The Contractor shall perform all work under this contract as an independent contractor and not as an officer, servant, or employee of the City. Contractor shall have the exclusiv e right to control the details of the work performed hereunder, and all persons performing same, and shall be solely responsible for the acts and omissions of its officers , agents, employees, and Asbestos O&M Contract CRL03.29.07v l 8 subcontractors . Nothing herewith shall be construed as creating a partnership or joint venture between the City and Contractor, its officers, agents, employees, and subcontractors; and the doctrine of respondeat superior shall not apply as between the City and Contractor. 11. COMPENSATION A. The City and Contractor agree that the total cost of this contract shall not exceed fifty thousand dollars ($50,000). B. The City shall not be liable for any costs in excess of the Not-to-Exceed amount specified in Paragraph 10 . A., unless the City has signed and issued a formal modification to the Contract. C. Contractor acknowledges that payment will not be rendered by City unless Contractor completes the removal or maintenance as described herein and the work is accepted by the Director. D. Payment will be made by City within thirty (30) days of receipt of complete and correct invoices for work completed up to 75% of the not-to-exceed value of this Contract. Final payment will be made forty-five (45) calendar days from the date of acceptance of the demolition and removal or maintenance of the structure by City. 12 . INDEMNIFICATION A. General Indemnification: CONTRACTOR DOES HEREBY COVENANTS AND AGREES TO AND SHALL INDEMNIFY, REIMBURSE, HOLD HARMLESS, AND DEFEND THE CITY, ITS OFFICERS, AGENTS, SUBCONTRACTORS, SERVANTS, EMPLOYEES, AND CONTRACTORS FROM AND AGAINST ANY AND ALL LOSSESS, DAMAGES, CAUSES OF ACTION, SUITS AND LIABILITY OF EVERY KIND, INCLUDING ALL EXPENSES OF LITIGATION, COURT COSTS, AND ATTORNEY'S FEES, WHICH MAY ARISE DUE TO ANY LOSS OR DAMAGE TO PERSONAL PROPERTY OR PERSONAL INJURY AND/OR DEATH ARISING OUT OF, IN CONNECTION WITH OR OCCURRING AS A CONSEQUENCE OF THE PERFORMANCE OF THIS CONTRACT WHEN SUCH INJURIES, DEATH OR DAMAGES ARE CAUSED BY THE ACTS, OMISSIONS OR NEGLIGENCE OF CONTRACTOR, ITS OFFICERS, AGENTS, EMPLOYEES OR SUBCONTRACTORS WHETHER OR NOT SUCH INJURIES, DEATH OR DAMAGES ARE CAUSED BY CITY'S THE JOINT NEGLIGENCE. IT IS THE EXPRESSED INTENTION OF CITY AND CONTRACTOR, THAT THE INDEMNITY PROVIDED FOR IN THIS PARA GRAPH IS INDEMNITY BY THE CONTRACTOR TO INDEMNIFY AND PROTECT THE CITY FROM THE CONSEQUENCES OF THE CITY'S OWN NEGLIGENCE. Asbesto s O&M Contra ct CRL03.2 9.0 7v ! 9 B. Environmental Indemnification: CONTRACTOR DOES HEREBY RELEASE, INDEMNIFY, REIMBURSE, DEFEND, AND HOLD HARMLESS THE CITY, ITS OFFICERS, AGENTS AND EMPLOYEES FROM AND AGAINST ANY AND ALL ENVIRONMENTAL DAMAGES AND THE VIOLATION OF ANY AND ALL ENVIRONMENT AL REQUIREMENTS RESULTING FROM THE HANDLING, COLLECTION, TRANSPORTATION, STORAGE, DISPOSAL, TREATMENT, RECOVERY, AND/OR REUSE, BY ANY PERSON, OF ASBESTOS CONTAINING MATERIAL WHICH IS HANDLED, DISINTERED AND/OR REMOVED UNDER THIS CONTRACT, WHEN SAID ENVIRONMENTAL DAMAGES OR THE VIOLATION OF SAID ENVIRONMENTAL REQUIREMENTS ARE THE RESULT OF ANY ACT OR OMISSION OF CONTRACTOR, ITS OFFICERS, AGENTS, EMPLOYEES, OR SUBCONTRACTORS, OR THE JOINT ACT OR OMISSION OF CONTRACTOR, ITS OFFICERS, AGENTS, EMPLOYEES, OR SUBCONTRACTORS AND ANY OTHER PERSON OR ENTITY. C. The obligations of the Contractor under this paragraph shall include, but not be limited to,the burden and expense of defending all claims, suits , and administrative proceedings (with counsel reasonably approved by the indemnified parties), even if such claims , suits or proceedings are groundless , false, or fraudulent, and in conducting all negotiations of any description, and paying and discharging, when and as the same become due, any and all judgments, penalties or other sums due against such indemnified persons . D . Upon learning of a claim, lawsuit, or other liability which Contractor is required hereunder to indemnify the City, the City shall provide Contractor with reasonable and timely notice. E. The obligations of the Contractor under this paragraph shall survive the expiration and the discharge of all other obligations owed by the parties to each other under this Contract. F. In all of its contracts with subcontractors for the performance of any work under this Contract, Contractor agrees to require the subcontractors to indemnify the City in a manner consistent with this paragraph. 13 . WARRANTY Contractor warrants that it understands the currently known hazards and suspected hazards , which are presented, to persons , property and the environment by asbestos containing material in the structure. Contractor further warrants that it will perform all services under this Contract in a safe, efficient and lawful manner using industry accepted practices , and in full compliance with all applicable federal, state and local laws governing its activities and is under no restraint or order which would prohibit performance of services under this Contract. Asbestos O&M Co ntra ct CRL03 .29.07vl 10 14. DEFAULT AND TERMINATION A. Contractor shall not be deemed to be in default because of any failure to perform under this Contract, if the failure arises from causes beyond the control and without the fault or negligence of Contractor. B. If the failure to perform is caused by the failure of a subcontractor of Contractor to perform, and if such failure was beyond the control of both the Contractor and the subcontractor, without their fault or negligence, Contractor shall not be deemed to be in default unless the subcontracted supplies or services were reasonably obtainable from other sources . C. If Contractor fails to begin work on said project and complete said project within the time specified in Paragraph 9. City shall have the right to take charge of and complete the work in such a manner as it may deem appropriate. If City ex ceeds the costs detailed in Paragraph 11, City may deliver to Contractor a written itemized statement of the total excess costs, and Contractor shall reimburse City for such excess costs without delay, or in the City's sole discretion, as reimbursement for said excess costs , City may withhold from Contractor any monies due or which might become due the Contractor under this Contract or any other contract with which the Contractor may have with City. D . Alternatively, if at any time during the term of this Contract the work of Contractor fails to meet the specifications of the Contract and all exhibits as incorporated herein, City may notify Contractor of the deficiency in writing. Failure of Contractor to correct such deficiency and complete the work required under this Contract to the satisfaction of City within ten (10) days after written notification shall result in termination of this Contract. All costs and attorneys fees incurred by City in the enforcement of any provision of this contract shall be paid by Contractor. E. City may terminate this Contract with or without cause upon thirty (30) days prior written notice to Contractor, provided that such termination shall be without prejudice to any other remedy City may have. In the event of termination, any work in progress will continue to completion unless specified otherwise in the notice of termination . The City shall pay for any such work in progress that is completed by Contractor and accepted by City. F. The remedies provided for herein are in addition to any other remedies available to City elsewhere in this contract. 15. RIGHT TO AUDIT Until the expiration of three (3) years after the final payment under this Contract, the City shall have access to and the right to examine any directly pertinent books , documents , papers and records of the Contractor and Guarantor involving transactions relating to this Contract. Contractor further Asbestos O&M Co ntract CRL 03.29.07v l 11 agrees to include in all its subcontracts hereunder a provision to the effect that the subcontractor agrees that the City shall, until the expiration of three (3) years after final payment under the subcontract, have access to papers and records of such subcontractor involving transactions relating to the subcontract. 16. MODIFICATION No modification of the Contract shall be binding on Contractor or City unless such modification(s) is in writing and signed by authorized persons from both parties . 17 . MINORITY AND WOMEN BUSINESS ENTERPRISES In keeping with the City's Minority/Women Business Enterprise (MWBE) ordinance, Contractor agrees to a minimum of ten percent (10 %) of the total dollar v alue of this Contract will be paid as compensation to certified MWBE firms , pursuant to the City's Ordinance. 18 . NON-DISCRIMINATION A. During the performance of this Contract, Contractor agrees not to discriminate against any employee or applicant for employment because of race, religion, color, sex or national origin, except where religion, sex or national origin is a bona fide occupational qualification reasonably necessary to the normal operation of the Contractor. Contractor agrees to post in conspicuous places, available to employees and applicants for employment, notices setting forth the provisions of the non-discrimination clause . B . Contractor also agrees that in all solicitations or advertisements for employees placed by or on behalf of this contract, that Contractor is an equal opportunity employer. C. Notices, advertisements, and solicitations placed in accordance with federal law, rule or regulation shall be deemed sufficient for the purpose of meeting the requirements of this section. 19. GOVERNINING LAW The City and Contractor agree that the validity and construction of this Contract shall be governed by the laws of the State of Texas, except where preempted by federal law. 20 . SEVERABILITY The provisions of this Contract are severable; and if for any reason any one or more of the prov isions contained herein are held to be invalid, illegal or unenforceable such invalidity, Asbestos O&M Con tract CRL 03.29.07v l 12 ·r:,:t'J· ·:. \ ~~f'nJ<w~ f ,·cL ' ... 1 Ji ,~<\:,1 \. 11~'1 "")l(c,: ;~f·®r\?!11 rp.v , . , ! 1L1;;;t • .si!hiO l_, :. ·?·JJJ~, V~t illegality, or unenforceability shall not affect any other provision of this contract, and which contract shall be construed as if such invalid, illegal or unenforceable provision had never been contained herein. 21. RIGHTS AND REMEDIES NOT WAIVED In no event shall the making by City of any payment to Contractor constitute or be construed as a waiver by City of any breach of covenant, or any default which may then exist, on the part of Contractor, and the making of any such payment by City while any such breach or default exists shall in no way impair or prejudice any right or remedy available to City with respect to such breach or default. Any waiver by either party of any provision or condition of the Contract shall not be construed or decreed to be a waiver of any other provision or condition of the Contract nor a waiver of a subsequent breach of the same provision or condition, unless such waiver be expressed in writing by the party to be bound. 22. VENUE Venue of any suit or cause of action under this Contract shall lie in Tarrant County, Texas. 23. NOTICES All notices, requests, demands and other communications under this Contract which are required to be in writing shall be deemed as having been duly given on the date of service, if served personally on the party to whom notice is to be given, or on the date of mailing, if mailed to the party to whom notice is to be given, by first class mail, registered or certified, postage prepaid, and properly addressed as follows: City: Contractor: Asbestos O&M Contract CRLOJ.29. 07v 1 Brian Boerner, Director Department of Environmental Management 1000 Throckmorton, Fort Worth, TX 76102 Karen Andrews, President Intercon Environmental, Inc. 2214 FM 1187 Building 6 Mansfield, Texas 76063 13 24. ENTIRETY This Contract, the contract exhibits, and any other documents incorporated by reference herein contain all the terms and conditions agreed to by City and Contractor, and no other contracts , oral or otherwise, regarding the subject matter of this contract or any part thereof shall have any validity or bind any of the parties hereto. 25 . ASSIGNMENT Contractor shall not assign, sub let, or transfer its interest in this contract without written consent of City. Nothing herein shall be construed as creating any personal liability on the part of any officer or agent of the City, nor shall it be construed as giving any rights or benefits hereunder to anyone other than the City and Contractor. 26. CONTRACT CONSTRUCTION The parties acknowledge that each party and, if it so chooses , its counsel have reviewed and revised this Contract and that the normal rule of construction to the effect that any ambiguities are to be resolved against the drafting party must not be employed in the interpretation of this Agreement or any amendments or exhibits hereto . 27 . NO THIRD-PARTY BENEFICIARIES This Contract shall inure only to the benefit of the parties hereto and third persons not privy hereto shall not, in any form or manner, be considered a third party beneficiary of this Agreement. Each party hereto shall be solely responsible for the fulfillment of its own contracts or commitments. 28 . NO JOINT VENTURE , PARTNERSHIP, AGENCY This Contract will not be construed in any form or manner to establish a partnership , joint venture or agency, express or implied , nor any employer-emplo yee , borrowed servant or joint enterpri se relationship by and among the parties . The City shall be an independent contractor and shall be responsib le at all times for directing its employees in the course of their duties . Contractor shall be responsible at all times for directing Contractor's employees in the course of their duties . Asbestos O&M Cont ra ct CRL03.29.07v l 29 . FISCAL FUNDING LIMITATION 14 In the event no funds or insufficient funds are appropriated and budgeted or are otherwise unavailable by any means whatsoever in any fiscal period for payments due under this contract, then the City will immediately notify Contractor of such occurrence and this Contract shall be terminated on the last day of the fiscal period for which appropriations were received without penalty or expense to the City of any kind whatsoever, except to the portions of annual payments herein agreed upon for which funds shall have been appropriated and budgeted or are otherwise available. Provided, however, that this Section 30 is not intended to grant to the City an independent ground for termination of this agreement separate and apart from any grounds for termination for non-appropriation or non-availability of funds which would be provided to City by reason of Tex. Const. Ann . Art. 11 , Sec . 5 and 7. 30. PARA GRAPH HEADINGS The paragraph headings contained herein are for the convenience in reference and are not intended to define or limit the scope of any provision of this Contract. IN WINESS WHEREOF, the City of Fort Worth and Contractor have ex ecuted this Contract in triplicate on this J 5.:Y day of J~ , 2007. / FORT W ORTH ATTE ST: APPROVED AS TO FORM c~~~-f<114 Assistant City Attorney Asbestos O&M Con tra ct CRL 03.29.0 7v l ..._ _______ _.. 15 INTER C ON ENVIRONMENT AL, INC. Karen Andrews P resident Corporate Sea l: Printed Name Contract Authorizatioa Date CONTRACTOR COMPLIANCE WITH WORKERS' COMPENSATION LAW Pursuant to V.T.C .A. Labor Code §406 .96 (2000), as amended , Contractor certifies that it provides workers' compensation insurance coverage for all of its employees employed on City of Fort Worth Department of Environmental Management Project No . DEM07- 01 :AOM. STA TE OF TEXAS COUNTY OF TARRANT § § § By : -\.~~~~~~~ll....l.,~~u '4>.re.n ArJrews ) Preside nt Title y./5(0 1 1 Date Before me, the undersigned authority , on this day personally appeared ~" A.a\ r-e1JJ'S' , known to me to be the person whose name is subscribed to the foregoing instrument, and acknowledged to me that he executed the same as the act and deed of .· _ (e ,::-: I d for the purposes and consideration the in expressed and in the capacity therein stated . Given Under My Hand and Seal of Office this § day of apL , 20 crJ . ~i.. &Jiw,~ed.t~ Notaryublic in andfortheS t ~ of Texas {;:.---..---------... · ' · .. -(.;::·~ Angelica Petruzzelli ,.~~-.. ~,.,. j"'( ··rt Notary Publi~, ~tate of_Texas i .. ~ . : .. 1 My Comm1ss1on Expires: 1,;:.• ....... fft/ ·,~..,r.ii,* February 28, 2008 ACORD™ CERTIFICATE OF LIABILITY INSURANCE I D A TE (MM/DD/YY) 02/05/2007 PRODUCER Seria l # 100207 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION THE WYATT AGENCY ONLY AND CONFERS NO RIGHTS UPON THE CER TIFIC AT E HOL DER TH IS CERTIF ICATE DOES NOT AMEND , EXTEND OR 1300 11TH STREET ALT ER THE COVERAGE AF FORDED BY TH E POLICIES BELOW. SUITE 305-E HUNTSVILLE, TX 77340 IN Sl.,JRERS AFFORDING COVERAGE NAI C# INSURE D INSU RER A: ARCH SPE CIA L TY IN SURANCE COMPANY INTER CON E NVIRONM ENTAL , IN C . INSURER B: MASSACH US ETTS BAY IN S. CO . 2214 FM 1187, BLDG. #6 INSURER c: TEXAS MU TUAL INSU RANCE CO MP ANY MANSFIELD , TX 76063 INSUR ER D: I INSU RER E : COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSU E D TO THE INSURED NAMED ABOVE FOR TH E POLICY PERIOD INDICATED. N OTWITHSTANDING AN Y R E QUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUE D OR MAY PERTAIN , T H E INSURANCE AFFO RDED B Y THE POLICES DESCRIB E D HERE IN IS SUBJECT TO ALL T HE TERMS , EXCLUS IONS AND CONDITION S OF SUCH POLICIES , AGGREGA TE LIMITS SHOWN MAY HAVE BEEN REDUCE D BY PAID CLAIMS. IIIISR ADD'L TYPE OF INSURAN CE POLICY NUMBER pgk1fJ ,~J,IJ'ii;{,'<,~ pgk'fEY /~~b~,W,N LIMITS LTR NSRC GENERAL LIABILITY EACH OCCURRENCE $ 1,000 ,000 -~~~~~~J~{f~~~nce ) A X CO MME RCIAL GENERAL LIA BILITY 12 EMP 43513 02 2/3/07 2 /3/0 8 $ 50 ,000 I CLAIMS MADE .[KJ OCCUR MED EXP (Any one person) $ 5 ,000 X ASBEST OS/LEAD ABATE PERSO NAL & ADV INJURY $ 1,000 ,000 -X POLLUTION LIAB ILITY GENERAL AGGREGATE $ 1,000 ,000 -GEN'L AGGR EGATE LIM IT APPLI ES PER: PRODUCTS · COMP/OP AGG $ 1,000 ,000 xl n PRO· POLIC Y J~CT n LOC AUTOMOBILE LIABILITY ADY-8744779-01 2/6/07 2/6/08 CO MBINED SING LE LIM IT -$ 1,000 ,000 B ANY AUTO (Ea acciden l ) -ALL OWN ED AUTOS BODI LY INJUR Y $ X SCHEDU LED AUTOS (Per person) -X HIRED AUTOS BODIL Y INJ URY -$ X NON-OWNED AUTOS (Pe r accident) --PROPER TY DAMAGE (Per accident ) $ GARAGE LIABILITY AUTO ONLY· EA ACCIDENT $ R AN Y AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY 12 EMX 43740 0 1 2 /3/07 2/3/08 EACH OCCURR ENCE $ 4 ,000 ,000 A O occuR D CLAIMS MADE AGGREGATE $ 4 ,000 ,000 $ ~ DEDU CTI BLE $ RETENTIO N $ $ WORKER'S COMPENSATI ON AN D 0001 142280 2/25/07 2 /25/08 X j we STATU· l TOR Y LIM ITS IOTH· ER C EMPLOYERS' LIABILITY AN Y PROP RIET OR/PARTNER/E XECUTIVE EL EAC H ACCIDENT $ 1,000 ,000 OFFICER/MEMBE R EXCLUD ED? <='L DISEASE · EA EMP LOY EE $ 1,000 ,000 If yes , describe unde r 1,000 ,000 SPECIAL PROVISIONS bel ow EL DISEAS E • POLIC Y LIM IT $ OTHER DESCRIPTIO N OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROV IS ION S PROJECT : VARIOUS FACILIT IES THE CITY OF FORT WORTH , ITS OFFICERS , AGENTS AND EMP LOYEES , REPRESENTATIVES AND VOLUNT EERS ARE ADDED AS ADDITIONAL IN SURED AS RESPECTS OPERATINS AND ACTIVITIES OF , OR ON BEHALF OF THE NAMED IN SURED , PERFORMED UNDER CONTRACT W ITH THE CITY OF FORT WORTH. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFO RE TH E EXPIRATION DATE THEREOF , THE ISSUIN G INSURER WILL END EA VOR TO MAI L 30 DAYS WR ITTEN -- CITY OF FORT WORTH NOT ICE TO THE CER TI FICATE HOLD ER NA ME D TO THE LEFT , BUT FAIL URE TO DO SO SHALL DEPT . OF ENVIRONMENTAL MANAGEMENT IMPOSE NO OBLIG AT IO N OR LIAB ILITY OF AN Y KIND UPON THE INSURER ITS AGENTS OR 1000 THROCKMORTON , LOWER LEVEL-S W . CORNER REPRESENTATI VES ..,.-· FORT WORTH , TX 76102 AUTHOR~~CV~ )\/ I ACORD 25 (2001/08 ) -( '\@ ACORD CORPORATION 1988 , Table of Contents 1. 1.0 Request for Proposals Notice of Intent 2.0 Proposal Documents 2.1 Proposal Document Checklist 2.2 Acknowledgement of Receipt of Addenda Addendum #1 2.3 Proposal Summary 2.4 Unit Costs 2.5 Bid Bond ENVI RONMENTAL, INC. 2. 2.6 Minority & Women Business Enterprise (M/WBE) Utilization Requ i re ments Subcontractors/Suppliers Utilization Form M/WBE Certificates lntercon Environmental , Inc. NCTRCA Certificate CBA Services , Inc. NCTRCA Certificate 3. 2. 7 Qualifications of the Provider lntercon Statement of Qualifications; Organization Chart; Resumes ; Wo rk History with the City of Fort Worth CBA Services Statement of Qualifications 4. 2.8 List of Subcontractors Department of State Health Services (DSHS) Asbestos Transporter License 5. 2. 9 Statement of Residency 2.10 Nondiscrimination 2.11 Prevailing Wage Rates 6. 2.12 Insurance Certificates 7. 2.13 Provider's Licenses & Certificates Department of State Health Services (DSHS) Asbestos Abatement Contractor's License Asbestos Transporters License Mold Remediation Company Lead Firm 8. 2.14 Contractor's Legal & Compliance History 9. 2.15 Inventory of Equipment 10. 2.16 Other Sample Invoice Sample Asbestos Job Close-Out Report to include Sample Daily Log Sh eet Sample Mold Job Close-out Report to include Mold Remediation Work Pl an 11. Health & Safety Plan 12. Health & Safety Records for the Past Three (3) Years (OSHA 300 Logs ) PROPOSAL PACKAGE CITY OF FORT WORTH ENVIRONMENTAL MANAGEMENT DEPARTMENT 1000 THROCKMORTON FORT WORTH, TEXAS 76102 fORTWORTH PROJECT: DEM0?-01 :AOM REMOVAL, PACKAGING, TRANSPORTATION, AND DISPOSAL OF ASBESTOS-CONTAINING MATERIALS AND MOLD CONTAMINATED MATERIALS FROM CITY-OWNED FACILITIES November 27, 2006 ·-· Submitted by : Intercon Environmental, Inc. Company Name 2214 FM 1187, Bldg 6, Mansfield, Texas 76063 Address 817-477-9995 Telephone 817-477-9996 Fax PresidenWiee Preside, ,t -Signature 12/27/06 Date TABLE OF CONTENTS 1 .0 REQUEST FOR PROPOSALS 1.1 PROJECT DESCRIPTION: 1.2 GENERAL REQUIREMENTS: 1.3 INTERPRETATION OF REQUEST FOR PROPOSAL DOCUMENTS: 1.4 CONFLICTS & QUESTIONS: 1.5 HOW TO SUBMIT A PROPOSAL: 1.6 SECURITY: 1.7 OPENING OF PROPOSALS: 1.8 TRADE SECRETS AND CONFIDENTIAL INFORMATION: 1.9 PROPOSAL EVALUATION CRITERIA: 1.10 CONTRACTTIME: 1.11 NEGOTIATION OF THE CONTRACT: 1.12 AWARD OF THE CONTRACT: 1.13 TAX EXEMPTION: 1 .14 RESERVATIONS: 2.0 PROPOSAL DOCUMENTS 2.1 PROPOSAL DOCUMENT CHECKLIST 2.2 ACKNOWLEDGEMENT OF RECEIPT OF ADDENDA 2.3 PROPOSAL SUMMARY 2.4 UNIT COSTS 2.5 BONDS 2 .6 MINORITY AND WOMEN BUSINESS ENTERPRISE (M;WBE) UTILIZATION REQUIREMENTS 2.7 QUALIFICATIONS OF THE PROVIDER 2.8 LIST OF SUBCONTRACTORS 2.9 STATEMENT OF RESIDENCY 2.10 NONDISCRIMINATION 2.11 PREVAILING WAGE RATES 2.12 INSURANCE CERTIFICATES 2.13 PROVIDER 'S LICENSES & CERTIFICATES 2.14 CONTRACTOR 'S LEGAL AND COMPLIANCE HISTORY 2.15 INVENTORY OF EQUIPMENT 2.16 OTHER DEM07-01:AOM November 27, 2006 Table of Contents i 1.0 REQUEST FOR PROPOSALS 1.1 PBQ,IECT DESCRIPTION· Proposals are being accepted by the City of Fort Worth ("City ") for the furnishing of all labor, materials and equipment necessary for the removal , packaging, transportation , and disposal of asbestos-containing materials and mold contaminated materials from Ci ty- owned facilities on an as-needed basis in support of operations and maintenance activities. There will be no minimum work guaranteed under this agreement. Note: All subcontractors are subject to acceptance by the City. The City reserves the right to perform on-site audits of all facilities prior to acceptance as a qualified subcontractor. The City performs asbestos abatement activities within City-owned facilities on a rout ine basis. Asbestos -containing materials (ACM) that may be encountered include but are not limited to floor tile and mastic, thermal system insulation , transite, spray-on fireproofing, wall and ceiling texture, joint compound , and roofing materials. The work req11ired 1mder this contract inch1des the fallowing tasks: • Maintenance of all applicable licenses and certifications ; • Removal of ACM; • Packaging and labeling of ACM for disposal; • Transportation of ACM for disposal; and • Disposal of ACM. • Removal of Mold-Contaminated Material • Packaging and labeling of Mold-Contaminated Material for disposal (if needed); • Transportation of Mold-Contaminated Material for disposal (if needed); and • Disposal of Mold-Contaminated Material (if needed). ALL WORK SHALL BE PERFORMED IN ACCORDANCE WITH APPLICABLE FEDERAL, STATE AND LOCAL RULES AND REGULATIONS. CONTRACTOR IS REQUIRED TO STAY ABREAST OF ANY CHANGES TO APPLICABLE RULES AND REGULATIONS. The City will perform the fallowing tasks 1mder this contract: • Provide Asbestos Assessment Reports and Asbestos Removal Specifications ; • Provide Mold Assessment Reports and Mold Remediation Protocol; • Provide site contact information ; • Provide site access; • Provide timely notice to Contractor in writing of ACM or Mold removal projects , detailing the location(s), type of work, and other pertinent information ; • Provide Asbestos or Mold Consultant, Air Monitoring Technician, and Project Manager to oversee asbestos or mold removal work; • Pay applicable Texas Department of State Health Services (DSHS) asbest os notification fees; and • File DSHS Notification and necessary amendments . DEM07-01:AOM November 27, 2006 1-1 1.2 GENERAL REOLJIREMENTS· 1.2.1 Obtaining Proposal Documents: Proposal documents, addenda, and specifications may be obtained from the Environmental Management Department web site at www.fortworthgov.org/dem/bids.htm in portable document format (PDF), or may be viewed at the Environmental Management Department, 908 Monroe Street (?'h Floor), Fort Worth, Texas 76102 during normal business hours. 1.2.2 Pre-Proposal Meeting: A Pre-Proposal Meeting will NOT be held for this proposal process. 1.2.3 Time Proposal to Remain Valid: Proposals submitted in accordance with this Request for Proposal shall remain valid for fill days after the due date. 1.2.4 Compliance With Laws: All Contractors shall be required to comply with: • Chapter 2258 of the Texas Government Code, with respect to the payment of prevailing wage rates for public works contracts; • Chapter 17, "Human Relations," Article Ill, "Discrimination ," Division 3, "Employment Practices," of the Code of the City of Fort Worth, prohibiting discrimination in employment practices; • Fort Worth ordinance 15530, Minority and Women Business Enterprises; and • The most recent revisions of applicable federal, state, and local laws, and the regulations established by the U.S. Environmental Protection Agency (EPA), the Texas Department of State Health Services (DSHS), the Occupational Health and Safety Administration (OSHA), the Texas Commission on Environmental Quality (TCEQ), the U.S. Department of Transportation (DOT), the Texas Department of Transportation (TXDOT), the City of Fort Worth and any other entity that may have jurisdiction over work being performed. 1.3 INTERPRETATION OF REOLJEST FOR PROPOSAL DOCUMENTS· 1.4 All requests for an interpretation of the Request for Proposal must be made in writing and received by the Environmental Management Department, by email format, at any time up to seven (7) calendar days prior to the deadline date for submitting proposals (i.e. Thursday, December 21, 2006 at 1 :30 PM). The person submitting the request will be responsible for its prompt delivery. No oral requests for interpretation will be answered. The City will issue any interpretation of the Request for Proposal as a formal addendum. The addenda will be posted at www.fortworthgov.org/dem/bids.htm. All addenda must be submitted with the Proposal in Section 2.2. It is the Contractor's obligation to determine whether addenda have been issued prior to the deadline for submitting the proposal. The City will not be responsible for any other explanations or interpretations . Each Contractor who intends to submit a proposal must e-mail Mr. Roger Grantham, Roger Grantham@fortworthgov org, with a notification of intent to submit in order to assure receipt of applicable addenda. CONFI lCTS & Ol JESTIONS· Should there be conflicts between the proposal documents and the final executed contract DEM07-01:AOM 1-2 November 27, 2006 Page 1 of 1 Karen Andrews From: Karen Andrews Sent: Friday, December 15, 2006 5:28 PM To: roger.grantham@fortworthgov.org Cc: Fernando Avila; Karen Andrews Subject: Project: DEM07-01 :AOM -Notice of Intent Roger, As per section 1.3 of the proposal documents for Project: DEM07-01 :AOM, lntercon Environmental , Inc. is submitting our Notice of Intent. If you have any questions, please let us know. Thank you, Karen Andrews President lntercon Environmental, Inc. 2214 FM 1187, Bldg 6 Mansfield , Texas 76063 817-477-9995 817-477-9996 Fax 12/15/2006 1.5 document, the final contract shall take precedence . Questions regarding this Request for Proposal should be directed immediately to: Ms. Roger Grantham Program Manager Environmental Management Department City of Fort Worth 1000 Throckmorton Street Fort Worth, TX, 76102-6311 Phone (817) 392-8592 Fax (817) 392-6359 Roger Grantham@fortwortbgav org HOW TO Sl JBMII A PROPOSAL· Each Contractor must submit ONE (1) bound original and three (3) bound copies of t heir proposal to the City . All items to complete the submittal must be included wit hi n t he proposal or the entire proposal may be considered non-responsive and reject ed. Please initial the upper right-hand corner of each page in Section 2.0. In case of ambiguity or lack of clarity, the City reserves the right to adopt the construction most advantageous to the City or to reject the proposal. Proposals must be submitted in a sealed envelope, addressed to the City of Fort Wo rt h Purchasing Division, 1000 Throckmorton , Fort Worth, Texas 76102. Proposals must be received by the Purchasing Division no later than 1 :30 p.m. on Thursday, December 28 , 2006. The project number must be clearly marked on the envelope and the stateme nt "PROPOSAL DOCUMENTS ENCLOSED, DELIVER TO PURCHASING DIVISION ON LY BEFORE 1 :30 on Thursday, December 28, 2006" placed in the lower left-hand corner of the envelope in which the documents are delivered. If the documents are placed in an envelope that is contained inside another envelope , the statement shall be placed on th e outermost envelope. Late proposals will be returned. They will not be opened nor considered in the evaluati on of the proposal. Proposals may be withdrawn at any time pr ior to the official opening . NO FAXED PROPOSALS WILL BE ACCEPTED 1.6 SECURITY· Proposals must be accompanied by a proposer's bond in the amount of five percent (5%) of the largest poss ible total of the cost estimate (maximum of $5 ,000). Alternatively , the City will accept a cashier's check, in said amount, with the Cit y named as payee, to be held in escrow until the successful Contractor signs the project Contract. This bond will serve as a guarantee that the successful Contractor will enter in t o an agreement with the City to perform the project. The City will only accept suret ies d u ly qualified and authorized by the State of Texas as corporate sureties to act as bond i ng entities. Personal sureties are unacceptable. DEM07-01:AOM November 27, 2006 1-3 1 .7 OPENING OF PROPOSAi S· 1.8 1.9 Proposals will be opened and read aloud at 2:00 PM on Thursday, December 28 , 2006 , in the Fort Worth City Council Chambers. The proposals shall be handled in order to avo id the disclosure of the remainder of their contents to competing offers and so as to keep such contents secret during negotiations. All proposals will be open for publ ic inspect ion after project award, as provided by paragraph 1.8 below. The Proposal Documents submitted in accordance with this Request for Proposal s hall remain valid for sixty (60) days after the due date. TRADE SECRETS AND CONFIDENTIAL INFORMATION· All material submitted to the City becomes public property and is subject to t he Texas Open Records Act upon receipt. However, the City will endeavor to protect from disclosu re a ny information in the Proposals that is subject to the trade secrets exception of the Public Information Act under §552 .110 of the Texas Government Code or the confidenti al information exception under §552 .101 of the Texas Government Code . It is the responsibility of the Contractor to clearly mark as such any information they deem trade secret or confidential. The final decision as to what information must be disclosed , however, lies with the Texas Attorney General. Failure of a Contractor to identify trade secret and confidential information in its Proposal will result in all unmarked sections be in g deemed non -proprietary and available upon public request. PROPOSAL EVALUATION CRITERIA· Proposals will be evaluated by qualitative measures and will be weighted as follows : FACTOR Contractor Caoabilities Costs Pavment and Written Documentation Work Historv with the Citv Qualifications / Exoerience Subcontractors TOTAL MAXIMU M WEIGH T: 25 ooints 30 ooints 10 oo ints :15 ooints 30 ooints 1s ooiots NOTE: Any of the above factors may be weighted as low as -5 points. The City will select the most highly qualified Proposer responding to the request based on the above criteria. The highest overall score will determine the City's first choice for the project award . The City may conduct such investigations as deemed necessary to assist in the evaluat io n of any Qualifications and to establish the responsibility , qualifications , and financial ab ility of the Provider , subcontractors, and other persons who are proposed to work on the proj ect. 1.10 CONTRACT TIME" The successful Contractor will be awarded a One-Year Contract with two One-Year Opt io ns to Renew . DEM07 -01:AOM November 27, 2006 1-4 1.11 NEGOTIATION OF THE CONTRACT The City will meet with the successful Contractor and negotiate any final changes to the Contract and any exceptions identified in the Proposal Documents. The City is not obligated to accept any exceptions made by Contractor. After the negotiations, the C ity will make final changes to the Contract documents and issue the Contract Documents w ith Notice of Awards to the successful Contractor. 1.12 AWARD OF THE CONTRACT The City may conduct such investigations as deemed necessary to assist in the evaluation of any proposal and to establish the responsibility, qualifications, and financial ab ility of the Contractor, subcontractors, and other persons who are proposed to work on the project. The City will send a Notice of Award letter to the successful Contractor with three (3) sets of contract documents. The successful Contractor must execute the Contract in each set and return all three sets to the City. Upon receipt of the three sets, the City will execute each set and issue one set to the successful Contractor with a letter entitled Notice to Proceed. T he letter authorizes work to begin and invoices to be paid. 1.13 TAX EXEMPTION· The City of Fort Worth is exempt from Federal Excise and State Sale Tax; therefo re, tax must not be included in this proposal. 1.14 RESERVATIONS' The City reserves the right to reject any or all propos~ls and waive any or all formalities . DEM07-01:AOM November 27, 2006 1-5 2.0 * * PROPOSAL DOCUMENTS ALL PROPOSAL DOCUMENTS MUST BE SUBMITTED IN THE SAME ORDER AS RECEIVED FROM THE CITY AND WITHIN A BOUND PACKAGE FAILURE TO SUBMIT ALL OF THE FOLLOWING ITEMS IN A SEALED ENVELOPE MAY RESULT IN THE PROPOSAL BEING CONSIDERED NON-RESPONSIVE DEM07-01:AOM November 27, 2006 2-1 2.1 PRQPQSAI DQGL JMFNJ GHFGKUSJ All Proposal Documents, including this Checklist, must be completed in full and submitted in a sealed envelope, in the requested order, or the proposal may be considered as a responsive submittal. *Note : The Request for Proposal cover page must precede the following documents in the submittal to the City. Proposal Documents Proposal Document Checklist Acknowledgement of Receipt of Addenda Proposal Summary Unit Costs Bonds MWBE Utilization Requirements Qualifications of the Provider List of Subcontractors Statement of Res idency Nondiscrimination Prevailing Wage Rates Insurance Certi fi cates Provider's Licenses & Certificates Contractor's Legal and Compliance History Inventory of Equipment Other Initial if Included I understand that all of these items will be revie ~ot included may result in my Proposal being considered oao-cespo · . Signature ~.D.L.l[}- DEM07 -01:AOM November 27, 2006 Name Title Karen Andrews President Company Intercon Environmental' Inc . 2-2 2.2 AGKNOWI FDGFMFNI OF BFGFIPI OF ADDENDA 2.2.1 Check if applicable _!__ The undersigned acknowledges the receipt of the following addendum(a) to t he Req uest fo r Proposals , and has attached all addenda following this page . (Add lines if necessary). Addendum Number 1 December 21 , 2006 (Date received) Addendum Number 2 (Date received) Addendum Number 3 (Date received) 2.2.2 Check if applicable __ The undersigned acknowledges the receipt of no addenda to the Request for Proposals. PROVIDER: Intercon Environmental, I nc. Company Name 2214 FM 1187, Bldg 6 Address Mansfield, Texas 76063 City, State , Z ip DEM07-01 :AOM November 27, 2006 BY: Ka ren Andrews (print or type name of signatory) ~~ President Title (print or type) 2-3 FORT WORTH ENVIRONMENTAL MANAGEMENT ADDENDUM TO: Interested Parties FROM: Roger Grantham, Environmental Program Manager Department of Environmental Management DATE: May 22, 2006 RE: Addendum #1 Professional Contract for Asbestos and Mold Abatement in City Fac ili t ies Project#: DEM07-01: AOM As of Thursday, December 21, 2006, the following apply; 1. Please utilize the attached Section 2.4 for completing the RFP. 2. Proposals are due at 1:30 pm, Thursday, December 28, 2006. 3. Please deliver all proposals to the Purchasing Division, Lower Level, City Hall, 1000 Throckmorton, Fort Worth, Texas, 76102. 4. Clearly mark exterior of proposal package with the project number and "Proposal". Note the following City of Fort Worth representative contact information : Roger Grantham Environmental Program Manager Department of Environmental Management City of Fort Worth 1000 Throckmorton Street Fort Worth, TX, 76102-6311 Phone (817) 392-8592 Fax (817) 392-6359 Roger.Grantham@fortworthgov.org 2.3 PROPOSAi SL JMMABY TO THE CITY OF FORT WORTH: The undersigned hereby proposes to furnish the equipment, labor mat eria ls, superintendence , and any other items or services necessary to perform removal , packaging , transportation , and disposal of asbestos-containing materials and mo ld contaminated materials from City-owned facilities on an as -needed basis in support of operations and maintenance activities. Contractor equipment and personnel are capable of performing each type of procedure listed in the Project Data either with in house resources or through subcontracts. All Proposal Documents have been submitted in one sealed envelope. Unit prices are provided within the Proposal Documents in Section 2 .5. Contractor shall begin work no later than fourteen (14) calendar days from date of Task Order (i.e ., Asbestos Removal Request). In emergency situations Contract or will respo nd as necessary. This Proposal Summary and the accompanying Proposal Documents are intended t o be complete and will remain valid for sixty (60) days from the date of submittal. PROVIDER: Int ercon Environment al, Inc. (Company Name) 2214 FM 1 1 87 , Bldg 6 {Address) (Signature) Mansfield, Texas 76063 President (City , State , Zip) Title (print or type) 817 -477-9995 817-4 7 7-9996 Phone) {FAX) DEM07 -01:AOM November 27, 2006 2-4 Scope of Work Proposals are being accepted by the City of Fort Worth ("City ") for the furnishing of all labor, materials and equipment necessary for the removal, packaging, transportation, and disposal of asbestos-containing materials and mold contaminated materials from City owned facilities on an as-needed basis in support of operations and maintenance activities . There will be no minimum work guaranteed under this agreement. Note: All subcontractors are subject to acceptance by the City. The City reserves the right to perform on-site audits of all facilities prior to acceptance as a qualified subcontractor. The City performs asbestos abatement activities within City owned facilities on a routine bas is. Asbestos-containing materials (ACM) that may be encountered include but are not lim ited to floor tile and mastic , transite, thermal system insulation, spray-on fireproofing, wall and ce iling texture , joint compound, and roofing materials . The work required 1mder this contract inch1des the following tasks : • Maintenance of all applicable licenses and certifications; • Removal of ACM ; • Packaging and labeling of ACM for disposal ; • Transportation of ACM for disposal; and • Disposal of ACM. • Removal of Mold-Contaminated Material • Packaging and labeling of Mold-Contaminated Material for disposal (if needed); • Transportation of Mold-Contaminated Material for disposal (if needed); and • Disposal of Mold-Contam inated Material (if needed). ALL WORK SHALL BE PERFORMED IN ACCORDANCE WITH APPLICABLE FEDERAL, STATE AND LOCAL RULES AND REGULATIONS. CONTRACTOR IS REQUIRED TO STAY ABREAST OF ANY CHANGES TO APPLICABLE RULES AND REGULATIONS. The City will perform the following tasks 1mder this contract: • Provide Asbestos Assessment Reports and Asbestos Removal Specifications ; • Provide Mold Assessment Reports and Mold Remediation Protocol • Provide site contact information; • Provide site access; • Provide timely notice to Contractor in writing of ACM or Mold removal projects , detailing the location(s), type of work, and other pertinent information ; • Provide Asbestos or Mold Consultant, Air Monitoring Technician , and Project Manager to oversee asbestos or mold removal work; • Provide approved OSHA Air Monitoring for asbestos abatement activities; • Pay applicable Texas Department of State Health Services (DSHS) asbestos notification fees and file DSHS notification and make necessary amendments. DEM07-01:AOM November 27, 2006 2-5 2.4 UNIT COSTS The Table below identifies various types of asbestos-containing materials (AC M). Contractor shall provide a cost for each type of ACM included on the Table . T he prices quoted in the Table below are for work within normal conditions (i.e., up to a max imum of 12-foot ceiling height, flat roof conditions for roof work , no holiday or weekend ho urs, etc .... ). Prices listed in the table shall include all labor, materials , and equ ipment to perform the function. Please initial this Unit Costs page in the lower right ha nd corner. Standard List of ACM Types and unit costs: +ACM Type % *CO ST Carpet (ONLY) $ . 75 / SF Floor aoolied Mastic (ONLY): $ 1.30/SF Floor Tile and Mastic $ 1.05/SF Note: Above listed orlces mav be used ALONE or In con/unction with each other . Plaster or stucco material: $ 3 .15 / SF Roof Flashing: $ 7.oo /SF Roofing Felt: $ 4.oo /SF Sheetrock Joint Compound: $ 2 . 25 / SF Spray-on Fireproofing (from % inch to 2 % inch thickness): $ 0.00 /SF Surfacing Material $ 0.00/SF Boiler Insulation: $ 0.00 /SF Rolled-on Texture: $ 2.50/SF Sprayed-on Texture (e.g. popcorn ceilina): $ 2.50/SF Trawled-on Texture: $ 2.50 /SF Thermal System Insulation (TSI) 0-6 inch OD $ 14 . oo / LF 6.1 -12 inch OD $ 10. oo / LF >12 inch OD $ 20.00/LF Fitting O - 6 inch OD each $ 40. oo / fi tting Fitting 6.1 -12 inch OD $ 50. oo / fitti ng Fitting > 12 inch OD $ Go . oo I fi tti ng Mastic on duct insulation $ 2. 50 / LF Transite Material: $ 1.75 /SF Wall, floor, or ceiling fibrous ACM board: $ 1.05 /SF List of Services NOT included in Standard List above: SERVICE COST Site Mobilization .... (once per job site) $ 500.00 / sit e I I I Construction of additional containments for abatement $ 250 .00 / cont ai nment Transportation and Disposal of Contaminated Debris not $ 20.00 / cubic ya rd associated with abatement work Hourly Rates for workers if UNIT PRICE table above does not apply: POSITION HOURLY RATE Licensed Worker $ 42.50 / hour Licensed Suoervisor $ 47.50 / hour Markup for Outside Services: If any re-build is requested as a direct result of abatement activities, it is to be billed at invoice plus __.:2_ % markup for the work. Whether the cont ractor or subcontractor performs the work , three bids may be required. 2.4 LJNII COSTS The Table below identifies various types of asbestos-containing materials (A ). Contractor shall provide a cost for each type of ACM included on the Table. The prices qu ed in the Table below are for work within normal conditions (i.e., up to a maximum of 12-foot c ,ling height, flat roof conditions for roof work , no holiday or weekend hours, etc.). Prices Ii ed in the table shall inc lude all labor, material, and equipment to perform the function. Please i 1tial this Unit Costs page in the lower right hand corner. Standard List of ACM Types and unit costs: for workers if UNIT PRICE table above does not apply: DEM07 -01:AOM November 27, 2006 ard 2-6 Markup for Outside Services: For materials, equipment, supplies , and services that are not included in the ove listed prices but are required at a job site the costs will be billed to the City with a o markup. DEM07 -01:AOM November 27, 2006 2-7 2.5 BONDS 2 .8.1 Bid Bond Proposals must be accompan ied by a proposer's bond in the amount of five percent (5%) of the largest possible total of the cost estimate , to a maximum of $5 ,000 . Alternati vely , the City will accept a cashier's check , in sa id amount, with the City named as payee , to be held in escrow until the successful Contractor signs the project contract. Th is bond will serve as a guarantee that the successful Contractor will enter into an agreement with the City to perform the project. The bid bond is subject to forfeiture in the event the successful Contractor fails to execute the contract documents within 1 O calendar days after the contract has been awarded. 2.8.2 Payment and Performance Bonds Before beginning the work, the Contractor shall be required to execute to the City of Fort Worth , a payment bond if the contract is in excess of $25 ,000 , and a performance bond if the contract is in excess of $100 ,000 . The payment bond is solely for the protection and use of payment bond beneficiaries who have a direct contractual relationship with the Contractor or subcontractor to supply labor or material ; and in 100% the amount of the Contract. The performance bond is solely for the protection of the City of Fort Worth ; in 100% the amount of the Contract; and conditioned on the faithful performance by Contractor of the work in accordance with the plans , specifications , and contract documents. Contractor must provide the payment and performance bonds , in the amounts and on the conditions required , within 14 calendar days after Notice of Award . 2.8 .3 Requirements for Sureties The bonds shall be issued by a corporate surety duly authorized and permitted to do bus i ness in the State of Texas , that is of sufficient financial strength and solvency to the satisfaction of the City . The surety must meet all requirements of Article 7 .19-1 of the Texas Insurance Code. All bonds furnished hereunder shall meet the requirements of Chapter 2253 of the Texas Government Code , as amended. In add it ion , the surety must (1) hold a certificate of authority from the Untied States Secretary of the Treasury to qualify as a surety on obligations permitted or required unde r federal law; or (2) have obtained reinsurance for any liability in excess of $100 ,000 from a re insurer that is authorized and admitted as a reinsurer in the state of Texas and is the holder of a certificate of authority from the Untied States Secretary of the Treasury to qualify as a surety on obligations perm itted or required under federal law. Satisfactory proof of any such reinsurance shall be provided to the City upon request. The City , in its sole discretion , will determine the adequacy of the proof required herein. No sureties will be accepted by the City that are at the time in default or del inquent on any bonds or which are interested in any litigation against the City. Should any surety on the Contract be determined unsatisfactory at any time by the City , notice will be given to the Contractor to that effect and the Contractor shall immediately provide a new surety sat isfactory to the City. ATTACH CASHIER'S CHECK OR BID BOND HERE DEM07-01 :AOM November 27, 2006 2-8 THE AMERICAN INSTITUTE OF ARCHITECTS I A/A Document 1\310 Bid Bond # ZA27294 that we KNOW ALL MEN BY THESE PRESENTS, INTER CON ENVIRONMENT AL INC (Here insert lull n•me •nd •ddtt1s or Ceg•l title of Contractor) TEXAS as Principal, hereinafter called the Principal, and ARCH INSURANCE COMP ANY (Here insert full name and address or legal title of Surety) 3 Parkway, Suite 1500, Philadelphia , PA 19102 a corporation duly organized under the laws of the State of MISSOURI as Surety, hereinafter called the Surety, are held and firmly bound unto CITY OF FORT WORTH /Here inmr lull n;ime ;ind ;iddress or leg;il rirle of Owner) TEXAS as Obligee, hereinafter called the Obligee, in the sum of FIVE PERCENT OF THE BID AMOUNT Dollars ($ TBD ), for the payment of which sum well and truly to be made, the said Principal and the said Surety, bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. WHEREAS, the Principal has submitted a bid for DEM07 -0l -AOM-ANNUAL AGREEMENT (Here insert lull name, address and description of projecl) NOW, THEREFORE, if the Obligee shall accept the bid of the Principal and the Principal shall enter into a Contract with the Obligee in accordance with the terms of such bid, and give such bond or bonds as may be specified in the bidding or Contract Documents with good and sufficient surety for the faithful performance of such Contract and for the prompt payment of labor and material furnished in the prosecution thereof, or in the event of the failure of the Principal to enter such Contract and give such bond or bonds, if the Principal shall pay to the Obligee the difference not to exceed the penalty hereof between the amount specified in said bid and such luger amount for which the Obligee may in good faith contract with another party to perform the Work covered by said bid, then this obligation shall be null and void, otherwise to remain in full force and effect. Signed and sealed this 12TH day of DECEMBER -'~l---~....--+--1c::O*i-'~-=-(W"-i-tn-es-,s) _______ 1 ARCH INSURANCE COMPANY AIA DOCUMENT A310 • 810 BONO • AIA ® • FEBRUARY 1970 ED • THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 N .Y. AVE., N.W., WASHINGTON, D. C. 20006 2006 (Seal) 1 POWER OF ATTORNEY ¥fa Know All Men By These Presents: -·cA)12gl{ That the Arch Insurance Company, a corporation organized and existing under the laws of the State of Missouri, having its · principal office in Kansas City, Missouri (hereinafter referred to as the "Company") does hereby appoint William A. Bailey, Maria A . Gonzalez. Anne M. Barber and Michael J . Friedrich of Bridgeview. IL (EACH) its true and lawful Attorney(s)-in-Fact, to make, execute. seal. and deliver from the date of issuance of this power for and on its behalf as surety, and as its act and deed: Any and all bonds and undertakings EXCEPTION : NO AUTHORITY is granted to make, execute, seal and deliver bonds or undertakings that guarantee the payment or collection of any promissory note, check, draft or letter of credit. This authority does not permit the same obligation to be split into two or more bonds in order to bring each such bond within the dollar limit of authority as set forth herein. The Company may revoke this appointment at any time . The execution of such bonds and undertakings in pursuance of these presents shall be as binding upon the said Company as fully and amply to all intents and purposes. as if the same had been duly executed and acknowledged by its regularly elected officers at its principal office in Kansas City, Missouri. This Power of Attorney is executed by authority of resolutions adopted by unanimous consent of the Board of Directors of the Company on March 3, 2003, true and accurate copies of which are hereinafter set forth and are hereby certified to by the undersigned Secretary as being in full force and effect: "VOTED, That the Chairman of the Board, the President. or any Vice President, or their appointees designated in writing and filed with the Secretary. or the Secretary shall have the power and authority to appoint agents and 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. and any such officers of the Company may appoint agents for acceptance of process." This Power of Attorney is signed . sealed and certified by facsimile under and by authority of the following resolution adopted by the unanimous consent of the Board of Directors of the Company on March 3, 2003 : VOTED , That the signature of the Chairman of the Board, the President. or any Vice President, or their appointees designated in writing and filed with the Secretary, and the signature of the Secretary, the seal of the Company, and certifications by the Secretary, may be affixed by facsimile on any power of attorney or bond executed pursuant to the resolution adopted by the Board of Directors on March 3, 2003, and any such power so executed, sealed and certified with respect to any bond or undertaking to which it is attached, shall continue to be valid and binding upon the Company . OOML0013 00 03 03 Page 1 of 2 Printed in U.S.A. In Testimony Whereof. the Company has caused this instrument to be signed and its corporate seal to be affixed by t,t,eir authorized officers. this 13th day of February , 2006 ---Arch Insurance Company Attested and Certified ~./ ' __ v g~ ··.·-~/) Gward M . Titus, ~ President ,>Martin J. Ni(sen , Secretary STATE OF NEW YORK SS COUNTY OF NEW YORK SS I Peter J. Calleo, a Notary Public. do hereby certify that Edward M . T itus and Martin J . Nilsen personally known to me to be the same persons whose names are respectively as Vice President and Secretary of the Arch Insurance Company , a Corporation organized and existing under the laws of the State of Missouri , subscribed to the foregoing instrument. appeared before me this day in person and severally acknowledged that they being thereunto duly authorized signed, sealed with the corporate seal and delivered the said instrument as the free an voluntary act of said corporation and as their own free and voluntary acts for the uses and purposes therein set forth . CERTIFICATION PETER J . CALLEO, ESQ. Notary Public, State of New Y.:>11< No. 02CA6109336 01 ·:!ified in New York County Commission Expires May 3, 2008 I, Martin J . Nilsen, Secretary of the Arch Insurance Company , do hereby certify that the attached Power of Attorney dated on behalf of the person(s) as listed above is a true and correct copy and that the same has been in full force and effect since the ilate thereof and is in full force and effect on the date of this certificate; and I do further certify that the said Edward M . Titus, who executed the Power of Attorney as Vice President, was on the date of execution of the attached Power of Attorney the du ly elected Vice President of the Arch Insurance Company . IN TESTIMON'. WHEB_EOF, I have ~nto subscribed my name and affi~t?.d the corpor.~t~ seal of the Arch Insurance Company on this \ ...2--day of C , 20 ~ . ~~/ , . , j/ .,. .1.,.;;, ./,.,.. /. -·/'/ / ,,./ }',.' 1.~(.J,'_1{,.,,.~. ;'/i:. t.t -·--···· ./ . . / . Martin J ..,Nilsen, Secretary This Power of Attorney limits the acts of those named therein to the bonds and undertakings specifically named therein and they have no authority to bind the Company except in the manner and to the extent herein stated. PLEASE SEND ALL CLAIM INQUIRIES RELATING TO THIS BOND TO THE FOLLOWING ADDRESS: Arch Surety 3 Parkway, Suite 1500 Philadelphia, PA 19102 OOML0013 00 03 03 Page 2 of 2 Printed in U.S.A. 2.6 MINORITY AND WOMEN BUSINESS FNJFRPRISF (M/WBF) UTILIZATION RFOUIRFMFNJS An M/WBE goal of 10% has been established for this project. The Contractor shall make a good faith effort to sub-contract with or purchase supplies from M/WBE firms. The Contractor must meet or exceed the stated goal or submit documentation of a good faith effort for all applicable contracts to permit a determination of compliance with the specifications . (1) An M/WBE Utilization Plan, hereinafter referred to as the utilization plan, must be submitted with the response to the Request for Proposals. The utilization plan must detail the steps taken to achieve M/WBE participation including but not limited to firms contacted , type of work discussed, criteria for sub-contractor selection , etc. The utilization plan must address each subcontracting opportunity available that may include professional services , waste transport, courier service, outside printing, equipment suppliers, etc. (2) The utilization plan must also include the point of contact (including name and title) that will be designated as responsible for implementing the utilization plan , reporting on the status of utilization plan, and performing liaison duties to the City as it relates to all M/WBE issues during the contract term . (3) The Contractor may utilize a joint venture arrangement with an M/WBE firm. In a joint venture, the Contractor may count the M/WBE portion of the joint venture toward meeting the utilization plan commitment (i.e., proposed goal is 40% and joint venture is 20% then separate M/WBE must be used for the remaining 20% not for the entire 40%). If a joint venture is proposed , the Joint Venture Eligibility Form must be completed and submitted. (4) All M/WBE firms must be currently certified or in the process of being certified by the North Central Texas Regional Certification Agency (NCTRCA), or Texas Department of Transportation (TXDOT), Highway Division and located in the nine county marketplace (Tarrant , Parker , Johnson , Collin, Dallas , Denton , Ellis , Kaufman and Rockwall). For the purpose of determining contract compliance under the M/WBE ordinance, businesses listed as MBE or WBE within the utilization plan must be certified as such prior to a recommendation for award being made to the City Council. If during the course of work under the contract a change of any of the MBE or WBE firms identified in the original utilization plan is needed then a Change Request must be submitted to the City of Fort Worth - M/WBE Office and the change approved by same. (5) All subcontracting and supplier opportunities directly attributed to this Contract from M/WBE firms, inclusive of 1st, 2nd, 3rd tiers , etc. sub-contractors and suppliers may be included in the utilization plan commitment. It is the sole responsibility of the Contractor to report and document all M/WBE participation dollars irrespective of tier level. The Contractor will be given credit toward the M/WBE plan when the M/WBE performs a commercially useful function. The successful Contractor will be required to submit executed contractual agreements (i.e., Master Service Agreements) or letters of intent prior to receiving the Contract Documents. DEM07-01 :AOM November 27, 2006 2-9 (6) M/WBE documentation consists of the Special Instructions To Proposers , the Subcontractor Utilization Form , the Prime Contractor Waiver Form , the Good Faith Effort Form , and the Joint Venture Form. Copies follow this section. a. If Contractor equals or exceeds the project goal , they must submit the Subcontractor Utilization Form or the Joint Venture Form . b. If Contractor does not have subcontracting and/or supplier opportunities , they must submit the Prime Contractor Waiver Form. c. If Contractor has subcontracting and/or supplier opportunities but does not include M/WBE participation in an amount which equals or exceeds the project goal , they must submit the Subcontractor Utilization Form and the Good Faith Effort Form and documentation. d. If Contractor has subcontracting and/or supplier opportunities but does not include any M/WBE participation , they must submit the Subcontractor Utilization Form and the Good Faith Effort Form and documentation . The Good Faith Effort documentation shall demonstrate the Contractor's commitment and honest efforts to utilize M/WBE(s). The burden of preparing and submitting the Good Faith Effort information is on the Contractor and will be evaluated as part of the responsiveness to the proposal. A Contractor who intentionally and/or knowingly misrepresents facts on the documentation submitted will constitute a basis for classification as non-responsive and possible debarment. Complete M/WBE requirements are contained in City of Fort Worth ordinance 15530 , Minority and Women Business Enterprises. Questions about M/WBE requirements may be directed to the City 's M/WBE Business Office at 817.392 .6104. Check the appropriate box t boxes· 1B The following M/WBE documents are included in this Proposal submittal , following this page , bound within the response : 0 Subcontractor Utilization Form D Joint Venture Form D Prime Contractor Waiver Form D Good Faith Effort Form CONTRACTOR: Intercon Env ironmenta l , I nc. Company Name 2214 FM 11 8 7 , Bldg 6 Address Mansfie l d , Texas 7 6 063 City, State, Z ip DEM07-0l:AOM November 27, 2006 Ka ren And rews (Signature) President Title (print or type) 2-10 FORT WORTH ~ PRIME COMPANY NAME: City of Fort Worth Subcontractors/Suppliers Utilization Form ~ ATIACHMENT 1A Page 1 of4 Check applicable block to describe prime Intercon Environmental, Inc. XI M/W/DBE I I PROJECT NAME: NON-M/W/DBE Removal, Packaging, Transportation and Disposal of asbestos-BID DATE Containing Materials and Mold Contaminated Materials from City-12 /28 /06 Owned Fac ilities City's M/WBE Project Goal: I Prime's M/WBE Project Utilization: PROJECT NU MBER 10 °/0 10 o/o DEM07-0 1 :AOM Identify all subcontractors/suppliers you will use on this project Failure to complete this form, in its entirety with requested documentation, and received by the Managing Department on or before 5:00 p.m. five (5) City business days after bid opening, exclusive of bid opening date, will result in the bid being considered non-responsive to bid specifications. The undersigned Offerer agrees to enter into a formal agreement witq the M/WBE firm(s) listed in this utilization schedule, conditioned upon execution of a contract with the City of Fort Worth. The intentional and/or knowing misrepresentation of facts is grounds for consideration of disqualification and will result in the bid being considered non-responsive to bid specifications M/WBEs listed toward meeting the project goal must be located in the nine (9) county marketplace or currently doing business in the marketplace at the time of bid. Marketplace is the geographic area of Tarrant, Parker, Johnson , Collin, Dallas , Denton , Ellis, Kaufman and Rockwall counties. Identify each Tier level. Tier is the level of subcontracting below the prime co11tractor, i.e., a direct payment from the prime contractor to a subcontractor is considered 1st tier, a payment by a subcontractor to its supplier is considered 2nd tier ALL M/WBEs MUST BE CERTIFIED BEFORE CONTRACT AW ARD. Certification means those firms , located or doing business at the time of bid opening within the Marketplace, that have been determined to be bonafide minority or women businesses by the North Central Texas Regional Certification Agency (NCTRCA), or the Texas Department of Transportation (TX DOT), highway division. Disadvantaged Business Enterprise (DBE) is synonymous with Minority/Women Business Enterprise (M/WBE). If hauling services are utilized, the prime will be given credit as .long as the M/)VBE listed owns and operates at least one fully licensed and operational truck to be used on the contract. The M/WBE may lease trucks from another M/WBE firm, including M/WBE owner-operators, and receive full M/WBE credit. The M/WBE may lease trucks from non-M/WBEs, including owner-operators, but will only receive credit for the fees and commissions earned by the M/WBE as outlined in the lease agreement. Rev. 5/30/03 '-' u V ATTACHM ENT 1A Pa ge 2 of 4 Primes are required to identify ALL sub co ntractors/s uppliers, regardless of statu s; i.e., Minority, Women and non-M/WBEs. Please list M/WBE firms first , use additional sheets if necessary . Certification N (check one) 0 SUBCONTRACTOR/SUPPLIER n T Detail Detail Company Name i N T Address e M w C X M Subcontracting Work Supplies Purchased Dollar Amount Telephone/Fax r B B T D w R 0 B E E C T E A CBA Services , Inc . 1 X X Waste Hauling & Unit Prices 5877 Barnett, Suite A Disposal Krum, Texas 76249 (940) 482-9900 (9 40 ) 482-3457 Fax Rev. 5/30/03 't}< ATIACHMENT 1A Page 3 of4 Primes are required to ident ify ALL su bcontractors/su ppl ie rs, regardless of statu s ; i.e., Minority, Women and non-M/WBEs. Please list M/WBE firms first, use additional sheets if necessary. Certification ' (check one) ( SUBCONTRACTOR/SUPPLIER T r Company Name i N T Detail Detail Address e M w C X I Subcontracting Work Supplies Purchased Do ll ar Amoun t T D \ Telephone/Fax r B B R 0 I E E C T I A Rev. 5/30/03 fORTWORTH ~ Total Dollar Amount of M/WBE Subcontractors/Suppliers Total Dollar Amount ofNon-M/WBE Subcontractors/Suppliers $ Unit Prices $ 0.00 ATIACHMENT 1A Page 4 of 4 TOTAL DOLLAR AMOUNT OF ALL SUBCONTRACTORS/SUPPLIERS $ Unit Prices The Contractor will not make additions, deletions, or substitutions to this certified list without the prior approval of the Minority and Women Business Enterprise Office Manager or designee through the submittal of a Request for Approval of Change/Addition . Any unjustified change or deletion shall be a material breach of contract and may result in debarment in accord with the procedures outlined in the ordinance. The contractor shall submit a detailed explanation of how the requested change/addition or deletion will affect the committed M/WBE goal. If the detail explanation is not submitted, it will affect the final compliance determination. By affixing a signature to this form , the Offeror further agrees to provide, directly to the City upon request, complete and accurate information regarding actual work performed by all subcontractors, including M/W/DBE(s) arrangements submitted with the bid. The Offeror also agrees to allow an audit and/or examination of any books, records and files held by their company. The bidder agrees to allow the transmission of interviews with owners, principals, officers, employees and applicable subcontractors/suppliers/contractors participating on the contract that will substantiate the actual work performed by the M/W/DBE(s) on this contract, by an authorized officer or employee of the City. Any intentional and/or knowing misrepresentation of facts will be grounds for terminating the contract or debarment from City work for a period of not less than three (3) years and for initiating action under Federal, State or Local laws concerning false statements. Any failure to comply with this ordinance and create a material breach of contract may result in a determination of an irresponsible Offeror and barred from participating in City work for a period of time not less than one (1) year . . "~ Karen Andrews Printed Signature President Title Contact Nameffitle (if different) Intercon Environmental, Inc. 817-477-9995 / 817 -477-9996 Company Na me Telephone and/or Fax 2214 FM 1187, Bldg 6 karen@intercon-environmental .com Address E-mail Address Mansfield, Texas 76063 12/27/06 City/State/Zip Date Rev . 5/30/03 NCTRCA Disadvantaged Business Enterprise Certification Disadvantaged Busine$s Enterprise has filed with the Agency au Affidavit as defmed by49 CFR part 26 and is hereby certified to prov1de service(s) in the following areas! 562910; Asbestos Contractor and Removal : Remediation Services; June .2006 This Certificad0,n is valid beginritng· a.nll superseded any registration o.r listing P!evlously issued, This certiftcati<>n must be uJd.ated annuaJly by sltbmtssion of an Anlll.i1'l Up<la~~Atlldavit, .Atany tim~ t~ere is a charg~ ht ownership or co .. trol of ti)~ fl.rm ; nofif,~ation must l>e mid.e lmme<Jia.tely to tJ1e N0,rtb Central Tu~s Reg}Qni.d Certification ,;.gertcy ~r 3n TUCP c~riifyfog entiJy: June 07 C~rtificate expiration ----------' 20 __ Issued date June 20 °6 --------------'-- CERTIF ICATION NO. WFDB31121Y0607 ~faf:e nf '<!t:exas Historically Underutilized Business Certification and Compliance Program ~h'\B Op?, ~ ~ ~ ~ The Texas Buil ding & Procurement Commission (TBPC), hereby certifies that INTERCON ENVIRONMENTAL, INC. has successfully met the established requirements of the State of Texas HistoricalJy Underutilized BusiAe.ss (HUB) Certification and Compl:iance Program to be rec6gnized as a HUB. This certificate, printed 13-MAR-2004, supe rsedes any iegistrat1ori and certifica:te·previousfy issued by the TBPC's HUB Certificat ion .and C'omplianee Ptogram . llthere are any qh~ng~ regarding the informa'tion (i.e., business structure, owner:ship. ,day-to-day management, 6~~0JW control, c!ddresses, pho11e and fax, numbers or authorized signatures) provjddd in the submissi{)n _q · tne: busJness' applieatton for regi stratio n/certification a.s a HU~, you must imm ediate ly (within :3() dax_s of $up,h ''(,hanges} notify ,the TB PC 's HUB program in writing. The Commission reserves the right to conduct a comptiailce review at any time to confirm HUB eligibility. HUB cer(ifi~tion may be suspended orrevbked upoil-fingings otineligibllity. CertificateNID Number: FileNendor Number: Approval Date: Expiration oan~: 1522437774500' 362-51 11-MAR-2004 11-MAR-2008 <:f>~-· A. C;~ Paul A. Gibson HUB Oertifio~on & COmf)lianoe Sup~rvi$Ot Texas Building & Procu rement Commission (512} 305-9071 Note: In order for State a'gendes and instituti ons of l;iighe.r edµ~tion (unil(~raities) t9 be Cfedit~d for utilizing this business as a HUB, they must award payment un dEir tn:.e CertlticateNID Number identified above. Agencres and universities are encouraged to validate HUB eertifi~tion prior -toJ isuin·g _a notice of award by accessing the lnt.emet (http://www.tbpc.state.tx.us) or by contacting the TBPC's HUB C'ert ificafion and Compliance Program at (888 ) 863-5881 or {512) 463-5872. NCTRCA Disadvantaged Business Enterprise Certification CBA Services, Inc. Disadvantaged Business Enterprise has fled witli the Agency an Affidavit as defined by 49 CFR part 26 and 15 hereby certified to provide service(&) ln -the-follow-in.g-areas: ----- 484220;562211;562219; Specialized Freight (except Used Goods) Trucking, Local; Hazardous Waste Treatment and Disposal; Other Nonhazardous Waste Treatment and Disposal; December 2005 This Certification is valid beginning and superseded any registration or listing previously Issued. This certification must be updated anouaUy by submi&.1lon of an Annual Update Affidavit At any time there is a charge in ownership or control of the finnt notification must be made immediately to the North Central Texas Regional Certification Agency or an TUCP certifying entity. December 06 Certificate expiration ___________ .20 __ December 05 Issued date 20 ______________ __,. CERTIFICATION NO. WFDB29555Y1206 C: C: :>,, " .... <: <: " 2.8 UST OF SUBCONTRACTORS Contractors shall complete the following information and submit it with the Proposal Documents to permit the City of Fort Worth to more fully evaluate the submittal's quality prior to awarding the contract. "'; Subcontractor's 'Name ··• CBA Services DEM0?-01 :AOM Novemb er 27, 2006 ' Ii' ' Slibcohtra t tor's Address ' Sti bcontractor·~. ·tt ;V Teleohone No . " . ~877 Barnett, Ste A 940-482-9900 Krum, Texas 76249 SUbt6htra efor•g\' ' !=AX Number 940-482-3457 ' Prooo i ei:I Tim ks . on the Proiect Asbestos Was te Hauling IF NECESSARY, PROVIDE MORE SHEETS TO DESCRIBE ADDITIONAL SUBCONTRACTORS. 2-12 ENVIRONMENTAL, INC. 2214 FM 1187. Bu il ding 6. Mansfield , Texas 76063 . Telephone (817) 477-9995 . Facsim ile (817) 477-9996 www . i ntercon-environmental .com City of Fort Worth; Project: DEM 07-01: AOM Removal, Packaging, Transportation and Disposal of Asbestos-Containing Materials and Mold Contaminated Materials from City-Owned Facilities Response to Section 2.8: Sub-Contractor Licenses: Texas DSHS Asbestos Transporter License No. 40-0312 TEXAS DEPARTMENT OF STATE HEALTH SERVICES (;.~:A SEitVICE$JNC is certifoa to peiform as a Asbestos Transporter in the State of Texas within the purview of Tex~ Occupations Code, clifIPter-195,t;, so tong as tliis license is notsuspended or revoked and is renewed according to the rules adopted by the Texas Board of Health. Uuatdo~ ::.. ~~5{ Commissioner of Jleaftfi License :Num5er. 400312 <£.ffectwt (!)ate: 5/8/2006 ~ation IDatr. saa• ('Jlgia~jur~ «>atej VOID IF ALTERED Control Number: !1:m NON· TRANSFERABLE Bid Documents /Specific /City of FW DEM 07-01 Sub-Contractor License 2.7 OUAUEICAJIONS OF THE PROVIDER Provider shall identify its company name, address , telephone number(s), and FAX number(s) for the local office as well as the headquarters. Provider shall attach a copy of its current Statement of Qualifications (25 pages maximum). If subcontractors are to be utilized for services to be provided , current Statements of Qualifications for those companies must also be included. Provider shall submit a brief resume (one page maximum , 10 pt type minimum) of each • professiona l person who will be assigned to this contract. Identify key persons by name and t itle and describe the primary work assigned as well as the percentage of time each person will devote to this contract. Document Provider's experience managing and performing removal , packaging , transportation, and disposal of asbestos-containing materials as well as mold a. If applicable , photos , schematic drawings , and vendor(s) brochures should be included with a narrative description. INCLUDE A COPY OF THE QUALIFICATIONS FOLLOWING THIS PAGE BOUND WITHIN THE PROPOSAL PACKAGE DEM07 -01:AOM November 27, 2006 2-11 EN V IRONMENTAL, INC. 2214 F M 1187 , B uilding 6, Mansfield , Texas 76063 , Telephone (817) 477-9995 , Facs i mile (817 ) 477 -9996 m a i l @i n t erc on -e n v i ro nm enta l . com www . i ntercon-envi ron men ta I . com Statement of Qualifications Prepared for: City of Fort Worth 1 000 Throckmorton Street Fort Worth, Texas 76102 Corporate Office 2214 FM 1187, Building #6 Mansfield, Texas 76063 Telephone: (817) 447-9995 Facsimile: (817) 447-9996 Dallas Field Office 3102 Maple Avenue, Suite 450 Dallas, Texas 75201 Telephone: (214) 969-0229 Facsimile: (214) 871-2005 1. About Us Intercon Environmental, Inc. is a women-owned , small business concern that sp eci al ize s in remediation , demolition , and disaster recovery. Intercon Environmental , Inc. perfo rms millions of dollars worth of work annually. In addition to our company possess ing contractor licenses for asbestos abatement , lead and lead based paint ab atement, mol d remediation and demolition , we also have the capabilities to perform re-cons truct ion an d rebuild, respond to emergencies providing tree trimming and removal services, as well as right-of-way clearing and tub grinding and perform general construction improvements. Intercon Environmental, Inc . has completed numerous projects in all of the se di scip lin es. Our abilities are only limited by your needs. All completed projects were on schedule; and in most instances the proj ects were completed well ahead of schedule. Intercon' s team members have performed emerge ncy clean-ups and rebuilds due to damages caused by other contractors with a respo nse time being less than two hours. Each and every project was completed to the owne rs ' total satisfaction. We take pride in every project we do. Intercon Environmental , Inc. has never ignored a request for service , ev en a la st mi nute issue. We have also never requested a change order for work we contracted to compl ete . Our team members have been in the Dallas / Fort Worth market for over 17 years, specializing in all aspects of the asbestos, lead and mold abatement and demol ition industries. Intercon maintains 16 full time employees to handle the needs of our clients and ensure that we can meet or exceed any project demands. Our telephones are answ ered 24 hours a day by knowledgeable company personnel with the ability to mo b ili ze personnel and equipment to a project site at a moments notice. Intercon Environmental , Inc. has developed in-house sources for wo rk normall y subcontracted to other firms. We have found this to be more reliable , effic ient and effective in meeting the needs of our clients. By self-performing tasks , we ha ve a much greater control on meeting deadlines and maintain a consistency of high qual ity work and customer satisfaction. We cover every aspect of the abatement and demolitio n proc es s from moving furniture to rebuilding or demolishing the facility . We mai ntain no minimum or maximum quantities of work. Our fleet of trucks and equipment helps us to get in and out of project si tes qui ckl y. During peak abatement and demolition seasons, we have the resources to obtain addi ti onal supervisors and workers from a select pool. Currently, we have the resources to staff and conduct six large abatement projects simultaneously. With additional workers fr om th e pool to supplement our own staff, we can effectively staff up to ten projects concurre ntl y. Our Project Managers are available at all times. All projects , large or small , are managed with the same urgency and attention. We process project closeout documents usu all y within 2-business days of project completion. Intercon Environmental, Inc. h as never missed a project deadline or failed to complete a project to the complete satisfaction of the building owner. 1 2. Safety is an Attitude! Intercon Environmental, Inc. recognizes first hand that the protection of workers and the environment is of primary importance to our daily operations. The severity of incidents in our industry underscores the need for all involved to maintain a "Safety Attitude" during all phases of each project. We believe that "Safety is an Attitude." Providing the vision and direction to meet this goal are seasoned, environmental professionals who comprise our management team, and who employ a hands-on approach to each project with an in-depth analysis and careful planning for delivery of a timely execution. State and local agencies, along with private industry, have recognized Intercon 's safety performance as a model that all contractors should strive for. Our proven track record features projects delivered safe and on time, while providing the best overall value to our clients. 3. Qualifications Intercon Environmental, Inc. has the experience, strength, and fast-track focus that are required to meet today's abatement and demolition challenges. Intercon's staff is composed of certified project managers and experienced professional field superintendents and foremen. Combined, the management has over 90 years experience in environmental remediation in private industry , school districts, and governmental arenas and has worked for engineering and architectural firms, industries, federal and state agencies, developers, general contractors and private owners. 4. Training We continue to review and utilize new industry technologies and blend them with currently effective proven hands-on construction principles. Our remediation and demolition teams receive ongoing training in up-to-the-minute techniques for the safe and efficient handling of hazardous and problem waste. Each team member has extensive experience in remediation, packaging and transportation of hazardous waste with strict conformity to all state and federal regulations. 5. Equipment In addition to our staff participating in professional development and training programs, we continually upgrade our equipment and facilities as needed. We currently have a fleet of trucks and equipment to provide the ability to complete numerous projects at the same time. 6. Services Intercon Environmental, Inc. currently offers the following comprehensive remediation and demolition services to our clients: • Asbestos Abatement • Demolition • Lead Abatement • Mold Remediation • Decontamination / Decommission • Hazardous Waste Clean-up 2 ~ 7. Certifications Program Name Certification Number Expires NCTRCA -DBE WFDB31121 Y0607 06/3 0/07 SCTRCA -SBE, DBE, WBE 204-10-4202 12/05/07 SCTRCA; City of Austin -DBE, WBE 204-10-4202 12/05/07 State of Texas -HUB 1522437774500 03 /11/0 8 Women's Business Enterprise National Council 234367 0 1/31/07 Minority Business Enterprise -City of Beaumont 10/1 2/08 Texas Department of State Health Services License Number Exp ires Contractor Asbestos Abatement License 80-0805 02/05/07 Asbestos Transporter License 40-0336 02/05/0 7 Contractor Lead Abatement License 2110368 09/02/07 Mold Remediation License RC0 0136 01/25/0 8 Texas Residential Construction Commission Builder Number Exp ire s Registered Builder 16680 02/28/0 8 Louisiana Dept of Environmental Q uality License Number Exp ire s Asbestos Removal & Abatement 42608 12/3 1/06 Asbestos Contractor / Supervisor 7S01993 04/26/07 8. Insuran ce General Liability Policy Number Exp ires Arch Specialty Insurance Company 12 EMP 43513 01 02/03/07 $5,000 ,000.00 Includes Pollution Liability Worker 's Compensation Policy Number Exp ire s I Texas Mutual Insurance Company 1142280 02/25/07 $5,000 ,000.00 Automobile Liability Policy Number Exp ires Hired Autos & Non-Owned Autos Massachusetts Bay Insurance Company 10UENTS3006 02/06/07 $5 ,000 ,000.00 Excess General Liability , Additional Insured and Waiver of Subrogation insuran ce i s available upon request. 9. Ban k References Wells Fargo 1640 West Henderson Cleburne, Texas 76031 Mr. Bart Cannon -(817) 556-5108 10. Cre dit Rat in g In fo rm ati on Dun & Bradstreet Rating: BB2 Paydex: 80 Duns# 143048119 (866) 705-5711 3 11. Client References & Current Contracts Owner Information Contract Amount City of Fort Worth 1000 Throckmorton, Fort Worth, Texas 76102 Mr. Roger Grantham, (817) 392-8592 Multi-year Asbestos Price Agreement -Various Facilities ........................... $1,300,000.00 Hwy 121 Demolition Project ........................................................................ $1,875,375.00 Texas Department of Transportation Dallas District P.O. Box 133067 Dallas, Texas 75313-3067 Mr. Larry Gilbert, (214) 320-6255 Multi-year Demolition Price Agreement ....................................................... $3,273,050.00 Fort Worth Independent School District 2808 Tillar Street Fort Worth, Texas 76107 Mr. Mike Lee , (817) 871-3293 Multi-year Asbestos Price Agreement -Various Schools ............................. $3,200,000.00 Multi-Year Floor Installation Price Agreement ................................................ $925,000.00 Richardson Independent School Di strict 400 South Greenville Avenue Richardson, Texas 75080 Ms. Melanie Rhea, ( 469) 593-0044 Multi-year Asbestos Price Agreement-Various Schools ............................. $1,650,000.00 University of North Texas P.O. Box 311310 Denton, Texas 76203 Mr. John Flippen, (940) 565-4837 Multi-year Asbestos Price Agreement -Various Campus Buildings ............ $1,500,000.00 City of Dallas Aviation Department LB 16 Love Field Terminal Building Dallas, Texas 75235 Mr. Sam Peacock, (214) 670-6654 Multi-year Asbestos Price Agreement -Love Field Airport.. ....................... $1,800,000.00 City of Garland -Garland Power & Light 13835 County Road 489 Nevada, Texas 75173 Mr. Ray Riedinger, (940) 591-5017 Multi-year Asbestos and Re-insulation Price Agreement.. ............................... $750,000.00 Lockheed Martin Fire & Missile Control P.O. Box 650003, M/S: LOl-11 Dallas, Texas 75265-0003 Mr. Devan Miller, (972) 603-9504 Multi-year Asbestos Price Agreement .............................................................. $500,000.00 4 12. Consultant References Resource Environmental Consulting, Inc. P.O. Box 801462 Dallas , Texas 75380 Contact: Dyana Lee (972) 385-4535 EcoSystems Environmental, Inc. 1408A Vantage Drive Carrollton, Texas 75006 Contact: Russ Gout or Garey Hackney (972) 416-0520 Pass Associates, Inc. 16800 North Dallas Parkway, Suite #120 Dallas , Texas 75248 Contact: Louis Jenson (214) 461-8743 ERI Consulting, Inc. 4796 Highway 377 South Fort Worth, Texas 76116 Contact: Kevin Sonnonstine (817) 560-1613 13. Conclusion Intercon has the resources and experience with complex projects to provide safe, quality turnkey construction services without affecting our clients ' schedule or budget. We are successful because we communicate with our clients to obtain their input and listen to their suggestions. Repeat business from our existing client base forms the backbone of our business. 5 Angelica Petruzzellj Executive Vice '1 President Dave Dun)lam Demo Project Manager .. Q-round. Crew BobMoFadin Demo Sales Jesse.Andrews Managing llirectJ~· Hugo Valderrama, Warehouse Supervisor Karen Andrews President Jerrold Andrews Vice President ENVIRONMENTAL, INC. Fern~do Avila .~aJ.C;\ Ma;n,ager , df ···'\-. ..-.-... -... · ··)\· Hector Medina~ Superviso1· Jose Contreras froject ~nager Eulogio Torres Supervisor Crew· Shannon Smith . Office ~anager •"/%{:>,. /h:jt td Jose Ramos Supe1·visor Karen Andrews Jerrold Andrews Appendix A Resumes President / CEO Lead Abatement Supervisor Vice President Corporate Health and Safety Officer Asbestos Abatement Supervisor Angelica Petruzzelli Executive Vice President Fernando Avila David Dunham Bobbie McFadin Jesse Andrews Shannon Smith Jose A. Contreras Hector Medina Eulogio Torres Sales Manager Special Operations Manager Asbestos Abatement Supervisor Demolition Project Manager Sales & Marketing Coordinator Asbestos Abatement Supervisor Fleet Operations Warehouse Operations Managing Director Office Manager Project Manager Safety Team Leader Asbestos Abatement Supervisor Site Supervisor Asbestos Abatement Supervisor Site Supervisor Asbestos Abatement Supervisor 6 Karen Andrews President / CEO Licensed Lead Abatement Supervisor Strong Leadership -Hands-on Philosophy -Results Orientated Ms. Andrews established Intercon Environmental, Inc. with the fundamental idea that good work and a job well done perpetuates its own opportunities and rewards , ensuring the success of this corporate venture. Ms. Andrews' Bachelor of Science in Biology with a minor in Chemistry, in- depth knowledge and 14 years experience in the abatement industry coupled with her hands-on management style begins the management team of Intercon Environmental, Inc. Prior to the commencement of Intercon Environmental, Inc., Ms. Andrews graduated from East Central University in Oklahoma and began employment for three years with an environmental consulting firm in the asbestos bulk sample analysis laboratory and as a field te chnici an. Ms. Andrews then made an upward move to work for an environmental contractor for nine years. Through this experience she maintains an expertise in all facets of the asbestos and lead industry, from project design and field operations to client relations and project closeouts. Ms. Andrews possesses a thorough knowledge of the laws and regulatory requirement s as they apply to the asbestos and lead abatement industries. Principal among Ms. Andrews duties are managing all aspects of the day-to-day operations of Intercon Environmental, Inc. and ensuring complete compliance with all levels of government regulatory and reporting requirements. She supervises the accounting staff with direct oversight of all payrolls, accounting, and banking activities. She supervises the sales and operation teams through meetings and regular site visits . She is technically proficient in spreadsheets, word processing, and accounting software. She manages all corporate financial functions, oversees purchasing and possesses an expertise of personnel and project management. Education EAST CENTRAL UNIVERSITY OF OKLAHOMA Bachelor of Science in Biology with a minor in Chemistry Certification and Training TEXAS DEPARTMENT OF STATE HEALTH SERVICES CERTIFICATIONS: Lead-Based Paint Hazard Identification and Abatement for Contractors and Supervisors License for Mold Assessment and Remediation ~ Lead Abatement Contractor / Supervisor Training ~ National Institute of Occupational Safety and Health ~ 582 Equivalency Training in Microscopy ~ National Voluntary Laboratory Accreditation Program ~ American Industrial Hygienists Association ~ Proficiency Analytical Testing 7 Jerrold Andrews Vice President of Operations Corporate Health and Safety Officer Licensed Asbestos & Mold Abatement Supervisor Corporate Management -Strategic Planning -Proven Leadership Mr. Andrews is a dynamic executive with outstanding success in managing multi-million dollar budgets. He leads negotiations with clients and suppliers, and has overseen financial and operational results that exceeded corporate goals. Mr. Andrews has achieved 100 % compliance with contractual obligations, managed billing and accounting of contracts . He has successfully generated pricing proposals fulfilling a wide array of requests. Mr. Andrews has also negotiated national vendor, supplier, and subcontractor contracts. Throughout his 15 years in the asbestos abatement and demolition industry he has become well respected for his sound judgments and his ability to administer project organization. Mr. Andrews possesses a comprehensive knowledge of the laws and regulatory requ irements, ensuring complete compliance with all levels of government regulatory and reporting requirements as they apply to the asbestos abatement and demolition industry . Combined with his twenty-three years in management, he has proven to be superlative in his industry. He manages his employees through training and improved communications. Safety is priority one and non-negotiable. He has organized and conducted full operations training, in particular, management development, employee development, strategic planning and safety. His hiring philosophy is to hire well-trained support team members and through training, make them better. Mr. Andrews directed the formation of E-based capabilities , including web site and E-sales. He is technically proficient in data base, spreadsheet, presentation and scheduling software. Extensive twenty-five year background in business management , fifteen of which has been in the environmental industry to include asbestos and lead abatement, demolition , PCB removal, re- construction , project management, general contracting and hazardous chemical disposal. Over 2,000 projects completed, totaling more than $40 Million dollars in his fifteen years in the environmental industry . Some of the projects he has acquired and managed are: Fort Worth ISO Price Agreement 5 Years Richardson ISO Price Agreement 10 Years Dallas Love Field Airport Contracts and Price Agreement 10 Years City of Dallas Price Agreement 7 Years UNT Housing Price Agreement 7 Years City of Fort Worth Price Agreement 3 Years TEXAS DEPARTMENT OF STATE HEALTH SERVICES CERTIFICATIONS: Asbestos Abatement Supervisor and Contractor $2 Million+ $3 Million+ $3 Mill ion + $5 Million+ $3 Milli on + $1 Million+ Lead-Based Paint Hazard Identification and Abatement for Contractors and Supervisors License for Mold Assessment and Remediation OCCUPATION HEALTH AND SAFETY CERTIFICATION Hazardous Waste Operations and Emergency Response Training STATE OF LOUISIANA DEPARTMENT OF ENVIRONMENTAL QUALITY Asbestos Contractor I Supervisor 8 Angelica Petruzzelli Executive Vice President Bold Administrator -Proven Track Record -Public R elations Expertis e Ms. Petruzzelli 's in-depth knowledge and experience in all aspects of office adm inistrati on combined with her knowledge and her 7 years of office management for env ironmental an d demolition operations make her a valuable addition to the Intercon Environmental , Inc. te am. Ms. Petruzzelli has superior communication skills interacting with executives, re gu lat ory agencies , clients, vendors and staff. She is fluent in English and Spanish. She is technically proficient in spreadsheets, word processing, tracking and accounting softw are. She has implemented computerized project tracking documents that has assisted Intercon become the efficient organization. Ms. Petruzzelli possesses a thorough knowledge of current personnel, administrative and clerical procedures. She ensures compliance in regulatory document preparation with all local , state and federal regulatory agencies. Principal among Ms. Petruzzelli' s duties are performin g all functions of the day-to-day office operations of Intercon Environmental, Inc., including: >" Regulatory Documents Preparation >" Accounts Payable >" Accounts Receivable }., Bookkeeping >" Payroll Documentation >" Invoicing >" Purchasing >" Personnel >" Record Keeping Certificates and Training MICROSOFT CERTIFICATION Microsoft Office Products Certification }., Advanced Business Software Training }., Office Administrative Courses }., Personnel and record keeping training }., Accounting Courses 9 Fernando Avila Sales & Special Operations Manager Licensed Asbestos Abatement Supervisor Sales Management -Proven Leadership Mr. Avila has twenty-five years of background in business management including his 15 years of experience in environmental and demolition management. Mr. Avila sales experience compliments the management team of Intercon Environmental, Inc. Among Mr. Avila's duties are obtaining projects through diligence, knowledge and experience. He also provides estimates and negotiates contracts with clients. Mr. Avila possesses a thorough knowledge of personnel and project management and all laws and regulatory requirements as they apply to the asbestos and lead abatement and demolition industries . Principal among Mr. Avila's duties are managing the day-to-day sales of In tercon Environmental, Inc. which includes walking projects, bids and proposals and supervision of the Operations Manager. He maintains strong communication skills and project insight that creates an effective work environment. Certifications and Training TEXAS DEPARTMENT OF STATE HEALTH SERVICES CERTIFICATIONS: Asbestos Abatement Supervisor and Contractor License for Mold Assessment and Remediation STATE OF LOUISIANA DEPARTMENT OF ENVIRONMENTAL QUALITY TRAINING Asbestos Contractor I Supervisor ~ Asbestos Abatement Contractor and Supervisor ~ Annual Refresher Courses ~ Hazardous Material Storage and Disposal ~ Train the Trainer Courses ~ Project Management Courses ~ Compliance with O.S.H.A. Regulations ~ Multiple Project Safety Courses Experience Fort Worth Independent School District Dallas Love Field Airport City of Dallas Lockheed Martin Missile & Fire Control City of Garland Power Plants City of Fort Worth Richardson Independent School District 10 David Dunham Demolition Project Manager Experienced Management -Quality Leadership -Training Expertise Mr. Dunham is an accomplished, experienced professional with proven success in demolition management. His twelve years of experience in all aspects of the transportation industry combined with his eight years of experience in the demolition and construction industry makes him a vital addition to the Intercon Environmental, Inc. team. Mr. Dunham possesses a thorough operating knowledge of all heavy equipment with experience in heavy hauling. He is current in every aspect of the transportation industry's regulations and procedures and has experience in first responder for accident and spill investigations. Principal among Mr. Dunham's duties are to oversee daily functions of the demolition division of Intercon Environmental, Inc. Mr. Dunham's other duties include the following: >-Demolition Project Management >-Demolition Personnel Management >-Heavy Equipment Operator; Maintenance & Inspection >-CDL Certified with all Endorsements Certifications and Training >-D.O.T Compliance Training >-Disaster Training >-HAZMAT Training >-Licensed Instructor for Driver Training >-Fleet Dispatch Training >-Maintenance and Inspection Recordkeeping >-Driver and Safety Training >-Completed CPR 1910.120 Training for the Transport and Handling of Hazardous Materials and Confined Space Entry >-Transportation Safety Workshops and Safety Seminars Experience City of Fort Worth Harley Service Center Emulsions/ Tank Removal City of Mansfield Former Library City of Fort Worth SH 121 Demolition Project Running Brook Apartments Tarrant County Demolition Texas Department of Transportation Demolition 11 Bob McFadin Sales and Marketing Coordinator Licensed Asbestos Abatement Supervisor Experienced Management -Quality Leadership -Training Expertise Mr. McFadin is an accomplished, seasoned professional with proven success in operati ons management. His thirty-two years of experience in all aspects of the transportation industry combined with his six years of experience in the environmental and demolition industry makes him a strategic addition to the Intercon Environmental, Inc. team. Mr. McFadin possesses a thorough knowledge of current transportation industry regulations and procedures. Principal among Mr. McFadin's duties are to oversee all functions of the day-to -d ay fleet, asbestos and demolition operations of Intercon Environmental, Inc. He is also our corporate trainer for fleet operations. Mr. McFadin's other duties include the following: ~ Driver and Safety Training ~ Regulatory Documents Preparation ~ Logistics Management ~ Fleet Dispatch ~ Maintenance and Inspection Record Keeping Certifications and Training TEXAS DEPARTMENT OF STATE HEALTH SERVICES CERTIFICATIONS: Asbestos Abatement Supervisor and Contractor ~ Hazardous Material Storage and Disposal ~ Proper use of 3M and North brand half-face respirators ~ Proper use of Typhoon, Survive Air, MSA and 3M brand PAPR respirators ~ Compliance with O.S.H.A. Regulations ~ D.O.T Compliance Training ~ Accident Investigation and Reconstruction Training ~ HAZMAT Training ~ Licensed National Safety Council DDC-PTD Instructor ~ Class III Licensed Instructor for Driver Training ~ Class IV Licensed Supervisory Instructor for Driver Training ~ Completed CFR 1910.120 Training for the Transport and Handling of Hazardous Materials and Confined Space Entry ~ Transportation Safety Workshops and Safety Seminars ; Multiple Office Administrative Courses 12 Jose A. Contreras Project Manager Licensed Asbestos Abatement Supervisor Safety Team Leader Expertise -Project Management -Site Safety Mr. Contreras, an accomplished and seasoned professional, possesses a comprehensive knowledge of all laws and regulatory requirements, and ensuring complete compliance with all levels of government regulatory and reporting requirements as they apply to the asbestos abatement and demolition industry. With his 18 years in the asbestos and demolition industry he has proven to be exceptional in his trade that makes him an integral part of the success of Intercon Environmental, Inc. He has supervised and completed successfully numerous asbestos abatement projects of a diverged magnitude during his tenure in his profession. Mr. Contreras boasts a zero lost time injury record in his 16 years. Mr. Contreras was the sound choice for our Safety Team Leader. Certifications and Training TEXAS DEPARTMENT OF STATE HEALTH SERVICES CERTIFICATIONS: Asbestos Abatement Supervisor and Contractor License for Mold Assessment and Remediation );,, Abatement Contractor and Supervisor ~ Annual Refresher Courses ~ Hazardous Material Storage and Disposal ~ Project Safety Courses ~ Confined Space Entry ~ Emergency Response Training ~ Proper use of 3M and North brand half-face respirators ~ Proper use of Typhoon, Survive Air, MSA and 3M brand P APR respirators ~ Compliance with O.S.H.A. Regulations Experience Fort Worth Independent School District Dallas Love Field Airport City of Dallas Lockheed Martin Missile & Fire Control City of Garland Power Plants University of North Texas Housing City of Fort Worth Richardson Independent School District 13 Hector Medina Licensed Asbestos Abatement Supervisor Exp ertis e -Project Managem ent Mr. Medina, an accomplished and seasoned professional , possesses a comprehensive knowle dge of all law s and regulatory requirements , and ensuring complete compliance with all levels of government regulator y and reporting requirements as they apply to the asbestos ab atem ent and demolition industry. With his 19 years in the asbestos industry with six years a s an As b es to s Abatement Supervisor, he has proven to be excellent in his trade that makes him an in tegral p ar t of the success of Intercon Environmental , Inc. He has supervised and completed successfully numerous asbestos ab atem ent projects of a diverged magnitude during his tenure in his trade. Mr. Medina, with his ability to w ork hard to get the project done and to hire crews , has put Mr. Medina into an important supe rv isor fo r Intercon Environmental , Inc. Certificates and Training TEXAS DEPARTMENT OF STATE HEALTH SERVICES CERTIFICATIONS: Asbestos Abatement Supervisor and Contractor License for Mold Assessment and Remediation )"' Asbestos Abatement Contractor and Supervisor )"' Annual Refresher Courses )"' Hazardous Material Storage and Disposal )o" Proper use of 3M and North brand half-face respirators )"' Proper use of Typhoon, Survive Air, MSA and 3M brand PAPR respirators )"' Compliance with O.S.H.A. Regulations Experience Fort Worth Independent School District Dallas Love Field Airport City of Dallas Lockheed Martin Missile & Fire Control City of Garland Power Plants University of North Texas Housing City of Fort Worth Richardson Independent School District 14 ENVIRONMENTAL, INC. 2214 FM 1187 , Bu il d ing 6 , Man sfield Texas 76063 , Telephone (8 1 7) 477-9995, Facs i m il e (817} 477-9996 mai l@i nte rc o n-e nvi ronmenta l. com www. intercon -envi ronmental .c om C ontractor s Wor k History wit h h t e City o f Fort Wort h THROUGH 12/27 /06 Project Name Project Location Contract Amount Former Cowtown Inn 6855 East Lancaster Street, Fort Worth , Texas 76112 $365,880.00 Public Safety Building 1000 Throckmorton Street, Fort Worth , Texas 76102 $1 ,726 .00 Hillside Community Center 1201 East Maddox Avenue , Fort Worth , Te xas 76104 $10 ,698 .90 Parks & Recreation S. District Service Center 5201 James Avenue , Fort Worth , Texas 76 11 5 $13 ,155 .00 RD Evans Recreation Center 3200 Lackland Road , Fort Worth , Texas 76116 $476.40 Meacham Airport Hangar 11 N 201 Aviation Wa y, Fort Worth , Texas 76106 $69,717 .1 0 Meacham Airport -Terminal Building 4201 North Main Street , Fort Worth , Te xa s 76106 $730.40 Meacham Airport -2nd Floor NW Office Area $5 ,488 .50 City Hall Physical Plant 1000 Throckmorton Street, Fort Worth , Texas 76102 $1 ,995.00 Fire Station #2 1000 Cherry Street, Fort Worth , Tex as 76102 $1 ,264.00 Fire Station #6 205 Un iversity Drive , Fort Worth , Texas 76107 $798 .00 Fire Station #12 120 NW 22nd Street, Fort Worth , Tex as 76106 $1 ,222.50 Fire Station #16 5933 Geddes , Fort Worth , Texas 76107 $5 ,422 .00 \.,.,,iire Station #17 212 E . Felix, Fort Worth Tex as 76115 $3,828 .00 Fire Station #26 6 124 Hulen Street , Fort Worth Tex as 76113 $3 ,427 .50 Fire Station #29 6400 Westcreek Drive, Fort Worth Texas 76133 $913.00 Convention Center Arena/Ex hibit Hall 1111 Houston Street, Fort Worth, Texas 76102 $3 ,957.00 City Hall -2nd Floor 1000 Throckmorton Street , Fort Worth , Texas 76102 $2 ,258 .50 Police South Division 3128 West Bolt Street, Fort Worth , Texas 76133 $1 ,206.50 RD Evans Recreation Center 3200 Lackland Road , Fort Worth , Tex as 76116 $446.80 Convention Center 1111 Houston Street, Fort Worth , Tex as 76102 $9 ,130 .00 Convention Center Emergency 111 1 Houston Street, Fort Worth , Tex as 76102 $2 ,132.00 Community Arts Cente r 1309 Montgomery Street, Fort Worth , Texas 76107 $1 ,214 .00 $1 ,356.00 Northside Community Center 1851 Harrington Avenue , Fort Worth, Texas 76106 $20 ,350 .00 Public Safety Building Municipal Complex 1000 Throckmorton Street , Fort Worth , Tex as 76102 $1,707.00 Residential Demolition 924 Evans Avenue , Fort Worth , Texas 76104 $17 ,900.00 Will Rogers Memorial Center Coliseum 3401 West Lancaster Avenue , Fort Worth , Texas 76 107 $1 ,395.25 $4 ,225.00 Fort Worth Community Art Center 1309 Montgomery Street, Fort Worth , Texas 76107 $1 ,560.50 Residence 1204 Sharondale Street, Fort Worth , Texas 76115 $1 ,341 .75 Code Compliance Building 715 Texas Street , Fort Worth , Texas 76102 $451 .00 $8 ,550 .00 yt•Y Stceet -SWPPP 3409 Harley Street , Fort Worth , Texas 76102 $130 ,000.00 arley Street -Emulsions , Tank Removal $52 ,983.80 $18 ,000.00 lntercon /BidDocs /CityFW -Project Li st City of Fort Worth -Projec t List Page 2 of 2 \_) Project Name Convention Center -Bat Guano Removal Water Service Center Municipal Parking Garage SH 121 -Parcel 55 SH 121 -Parcel 66 SH 121 -Parcel 67 SH 121 -Parcel 67 DEMO SH 121 -Parcel 71 DEMO SH 121 -Parcel 72 l J - SH 121 -Parcel 72 DEMO SH 121 -Parcel 78 DEMO ENVIRON MENTAL, INC. Project Location Contract Amount $1,200.00 $750 .00 1111 Houston Street, Fort Worth , Texas 76102 $750.00 $850 .00 $850 .00 2201 Daggett Street, Fort Worth, Texas 76102 $747 .00 913 Taylor Street , Fort Worth , Te xas 76102 $A856 .20 3519 W. Vickery Street , Fort Worth ,, Texas 76107 $2 ,200.00 4027-4033 W. Vickery Street , Fort Worth , Te x as 76107 $33 ,551.40 4021-4025 W. Vickery Street, Fort Worth , Texas 76107 $8 ,000.00 4021-4025 W . Vickery Street , Fort Worth , Texas 76107 $21,810 .10 4031 W . Vickery Street , Fort Worth , Texas 76107 $18,151.40 4133 W . Vickery Street , Fort Worth , Texas 76107 $3 ,000.00 4133 W . Vickery Street , Fort Worth , Texas 76107 $8 ,870.82 4309 w. Vickery Street , Fort Worth, Texas 76107 $3 ,989.20 ENV I RO N M ENTAL , INC. 2214 FM 11 87 . B uildi n g 6 . M ansfie ld T ex a s 76063 . T e l e ph one {817) 477-99 9 5 . F acsimi l e {817) 477-9996 www . interco n-en v i ronmental .com City of Fort Worth; Project: DEM 07-01: AOM Removal, Packaging, Transportation and Disposal of Asbestos-Containing Materials and Mold Contaminated Materials from City-Owned Facilities Response to Section 2. 7 Sub-Contractor Qualifications and Experience: CBA Services, Inc., a l 00% woman -owned small business is located at 5877 Barnett Road , Suite A, Kr u m, T exas 76249. The company was founded in 2001 providing services from hazardous waste t reatme nt, as bestos transportation and project management. CBA currently owns and /or operates roll-off trucks and end dump trucks . CBA provides 20 , 25 , a n d 30 Cubi c Yard (CY) open-top containers and 40 CY asbestos vaults. Below is a list of representative projects demonstrating CBA Services, lnc.'s past experience with pe rfo r ming ~mediation of Superfund Sites, hazardous waste remediation, transportation and disposal: Sweetwater, Texas: Provided 40 CY asbestos vaults for transportation and disposal of ap p ro xi mate ly l 0 loads of asbestos ; the demolition phase of the project required transportation of 35 loads of de m ol ition debri s utilizing 35 CY end dump trucks. San Antonio, Texas : Provided a permanent 40 CY asbestos vault for the transportat i on and dispos al of asbestos waste materials from a facility for the Department of Defense. Dallas. Texas: Provided semi-permanent 30 CY open -top roll-off containers for trans p o rtati on and disposal of construction debris from large Dallas facility for long term construction /renovat ion p roject s. Waxahachie, Texas: Responded to an emergency call within one hour time frame to provi d e four 30 CY open-top roll-off containers for the transportation and disposal of diesel-contaminated so il whi c h cau sed highway closure. Job complete within 2V2 hours. Fort Worth. Texas: Responded to an emergency call received at 2 :00 am ; within one hou r t im e fra m e to provide one 30 CY open-top roll-off container and two 30 CY watertight vacuum conta i ne r s from t ru c k opening a valve on 1-30 and dumped materi als into a nearby creek. Job complete with in fo u r ho urs . Denton. Texas: Provided four 40 CY asbestos vaults for the transportation and d i sposa l of as b estos waste materials from a University. Transpo rted 52 loads . ockwall. Texas: Provided three 30 CY open-top roll -off containers for the transport ati o n and d isp os al of contaminated materials from a Texas Commission of Environmental Quality funded clean-u p . Bid Documents /Specific /City of FW DEM 07-01 -Sub -Contractor Qual i fications 2.9 STATEMENT Of RESIDENCY The fo ll owing information is required by the City of Fort Worth in order to comply with provisions of state law, TEXAS GOVERNMENT CODE § 2252.001 , State or Political Subd ivision Contracts for Construction , Supplies, Services; Bids by Nonresident. Every bidder shall affirmatively state its principal place of business in its response to a bid invitation . Failure to provide the required information shall result in your bid being declared non- responsive . Bidders' cooperation in this regard will avoid costly time delays in the award of bids by the City of Fort Worth. For this reason , each bidder is encouraged to complete and return in duplicate, with its b id , the Statement of Residency Form , but in any event, the low bidder shall s u bmit this information within five (5) business days after the date of receipt of notification of apparent low bidder status from the Purchasing Division of the Finance Department. Failure to provide all required information within this designated period shall result in the apparent low b idder being considered non-responsive, and the second low bidder being considered for award . TEXAS GOVERNMENT CODE § 2252.001 defines a Texas "resident bidder" as a bidder w h ose principal place of business* is in the state of Texas, including a contractor whose ul ti mat e parent ·company or majority owner has its principal place of business in the state of Texas. TEXAS GOVERNMENT CODE § 2252 .001 defines a "Nonresident bidder" as a b id der whose parent company or majority owner does not have its principal place of business* in t he state of Texas. Bidder's complete company name: Intercon Envi ronmental' Inc . St ate your business address in the space provided below if you are a Texas Resident bidder: 2214 FM 1187, Bldg 6 , Mansfield, Texas 76063 State your business address in the space provided below if you are a Nonresident bidder: *The State Purchasing and General Services Commission defines Principal Place of Business as follows : Pri ncipal Place of Business in Texas means , for any type of business entity recognized in the State of Texas , that the business entity o has at least one permanent office located within the State of Texas, from which business activities other than submitting bids to governmental agencies are conducted and from which the bid is submitted, and o has at least one employee who ::rsm:e Texas office Form prepared by: ~~ DEM0 7-01 :AOM November 27, 2006 Name Ka ren Andrews , Presid e n t T itle 1 2/27 /06 Date 2-13 2.10 NONDISCRIMINATION All City contractors are required to comply with Chapter 17 , "Human Relations ," Article 111 , "Discrimination ," Division 3 , "Employment Practices ," of the Code of the City of Fort Worth , prohibiting discrimination in employment practices . Proposer agrees that Proposer, its employees, officers, agents , contractors or subcontractors , have fully complied with all provisions of such Ordinance, and that no employee, participant , applicant, contractor or subcontractor has been discriminated against according to the terms of such Ordinance by Proposer, its employees, officers, agents , contractor or subcontractors herein. PROPOSER: Intercon Environment a l , I n c . Company Name 2214 FM 1187, B l d g 6 Address Ma n sfield, T exas 76063 City , State , Zip DEM07-01:AOM November 27, 2006 Karen Andrews Pre siden t Title (print or type) 2-14 2.11 PREVAILING WAGE RATES A Contractor selected for this project will be required to comply with TEXAS GOVERNMENT CODE, Chapter 2258, with respect to payment of Prevailing Wage Rates for public works contracts. The current wage scale for members of the Building and Construction trade immediately follows this page. A worker employed on a public work by or on behalf of the City of Fort Worth shall be paid not less than the general prevailing rate of per diem wages for work of a similar character in the locality in which the work is performed; and not less than the general prevailing rate of per diem wages for legal holiday and overtime work. A worker is employed on a public work if the worker is employed by a contractor or subcontractor in the execution of a contract for the public work with the City of Fort Worth. The contractor who is awarded a public work contract, or a subcontractor of the contractor , shall pay not less than the prevailing wage rates to a worker employed by it in the execution of the contract. A contractor or subcontractor who violates this requirement shall pay to the City of Fort Worth, $60 for each worker employed for each calendar day or part of the day that the worker is paid less than the wage rates stipulated in the contract. This requirement does not prohibit the contractor or subcontractor from paying an employee an amount greater than the prevailing wage rate . The undersigned acknowledges the requirements of Chapter 2258 of the Texas Government Code , and intends to comply with same in the execution of this project. CONTRACTOR: Intercon Environmental, Inc. Company Name 2214 FM 1187, Bldg 6 Address Mansfield, Texas 76063 City , State, Zip DEM07-01:AOM November 27, 2006 Karen Andrews President Title (print or type) 2-15 Classifications IAir Conditionina Mechanic Air Conditionina Mechanic Heloer Acoustic Ceilina Installer Acoustic Ceilina Installer Heloer Bricklaver/Stone Mason Bricklaver/Stone Mason Heloer Caroenter Caroenter Heloer Concrete Finisher Concrete Finisher Heloer Concrete Form Builder Concrete Form Builder Heloer Drvwall Taoer Drvwall Taoer Heloer Electrician Journevman Electrician Heloer Electronic Technician Electronic Technician Heloer Floor Laver (Caroet) Floor Laver (Resilient) Floor Laver Heloer Glazier Glazier Heloer Insulator <Pioe) Insulator Heloer (Pioe) Laborer Common Laborer Skilled Lather Lather Heloer Metal Buildina Assembler Metal Buildina Assembler Heloer Painter Painter Heloer Pioefitter Pioefitter Heloer Plasterer Plasterer Heloer Reinforcina Steel Setter Roofer Roofer Heloer Sheet Metal Worker Sheet Metal Worker Heloer DEM07-01 :AOM November 27, 2006 Citv of Fort Worth Buildina & Construction Trades Prevailina Waae Rates For 2006 Hourlv Rates Classifications Hourlv Rates $17.55 Sheetrock Hanaer $13.37 $10.74 Sheetrock Hanaer Heloer $9.48 $14 .26 Sorinkler Svstem Installer $17.86 $10.53 Sorinkler Svstem Installer Heloer $13.33 $19.29 Steel Worker Structural $16.20 $13.07 Steel Worker Structural Heloer $11 .71 $15.76 Welder $15.88 $11.69 Welder Heloer $11.25 $14.29 $10.09 $12.16 $8.81 $13.25 $8.00 $19.79 Heavv Eauioment Ooerators Hourlv Rates Crane, Clamshell , Backhoe , $12.95 Derrick Draaline Shovel $16.07 $20.06 Forklift Ooerator $12.62 $12.27 Foundation Drill Ooerator $17.55 $15.17 Front End Loader Ooerator $13.27 $15.94 Truck Driver $12 .66 $11.00 $14.35 $10.32 $15.05 $10.12 $9 .21 $11.59 $15.94 $11.12 $14.29 $9.33 $12.86 $8.66 $18 .22 $12.90 $16.16 $9.98 $13.00 $15.33 $10 .24 Source is Fort Worth Chapter $15.73 Associated General Contractors (www.Quoin .org) $10.53 3/15/2006 2-16 2.12 INSURANCE CERTIFICATES A successful Contractor will be required by the contract to have insurance coverage as detailed below. Contractor must provide Certificates of Insurance in the amounts and for the coverages required to the Environmental Management Department , Adm inistrative Offices , within 14 calendar days after Notice of Award. (a) Insurance coverage and limits : 1. Commercial General Liability Insurance o $1 ,000 ,000 each occurrence o $2 ,000 ,000 aggregate 2. Professional I iability Insurance -NOT APPLICABLE. 3. Automobile I iability Insurance - 4. 5 . 6. A Coverage on vehicles involved in the work performed under this contract: o $1 ,000 ,000 per accident on a combined single limit basis .c.r: o $500 ,000 bodily injury each person ; $500 ,000 bodily injury each accident ; and $250 ,000 property damage B. Uninsured/Underinsured Motorist: o $20 ,000 bodily injury each person; $40 ,000 bodily injury each accident ; and$15 ,000 property damage each accident The named insured and employees of Contractor shall be covered under this policy . The City of Fort Worth shall be named an Additional insured on Endorsement TE 9901 or equivalent, as its interests may appear. Liability for damage occurring while loading , unloading and transporting materials collected under the Contract shall be included under this policy . Worker's Compensation - o Coverage A: statutory limits o Coverage B: $100 ,000 each accident $500 ,000 disease -policy limit $100 ,000 disease -each employee Environmental Impairment Liability (FIL) and/or Pollution Liability - $2 ,000,000 per occurrence. Ell coverage(s) must be included in policies listed in subsections 1 and 2 above ; or , such insurance shall be provided under separate policy(s). Liability for damage occurring while loading , unloading and transporting materials collected under the contract shall be included under the Automobile Liability insurance or other policy(s). Asbestos Abatement Insurance -$2 ,000 ,000 each occurrence with no Sunset Clause . (b) Certificates of insurance evidencing that the Contractor has obtained all required DEM07-01:AOM November 27, 2006 2-17 insurance shall be delivered to the City prior to Contractor proceeding with the contract. 1 . 2 . 3. 4. 5. 6. 7 . 8. 9. 10. 11 . DEM07-01 :AOM November 27, 2006 Applicable policies shall be endorsed to name the City an Additional Insured thereon , as its interests may appear. The term City shall include its employees, officers , officials , agents , and volunteers as respects the contracted services. Certificate(s) of insurance shall document that insurance coverage specified according to items in section (a) above are provided under applicable policies documented thereon . Any failure on part of the City to request required insurance documentation shall not constitute a waiver of the insurance requirements . A minimum of thirty (30) days notice of cancellation or material change in coverage shall be provided to the City. A ten (10) days notice shall be acceptable in the event of non-payment of premium. Such terms shall be endorsed onto Contractor's insurance policies. Notice shall be sent to Brian Boerner, Director, Department of Environmental Management, City of Fort Worth, 1000 Throckmorton , Fort Worth , Texas 76102. Insurers for all policies must be authorized to do business in the state of Texas or be otherwise approved by the City ; and , such insurers shall be acceptable to the City in terms of their financial strength and solvency . Deductible limits , or self-insured retentions , affecting insurance required herein shall be acceptable to the City in its sole discretion; and , in lieu of traditional insurance , any alternative coverage maintained through insurance pools or risk retention groups must be also approved . Dedicated financial resources or letters of credit may also be acceptable to the City . Applicable policies shall each be endorsed with a waiver of subrogation in favor of the City as respects the contract. The City shall be entitled , upon its request and without incurring expense , to review the Contractor's insurance policies including endorsements thereto and , at the City's discretion , the Contractor may be required to provide proof of insurance premium payments. The Commercial General Liability insurance policy shall have no exclusions by endorsements unless the City approves such exclusions . The City shall not be responsible for the direct payment of any insurance premiums required by the contract. It is understood that insurance cost is an allowable component of Contractor's overhead. All insurance required in section (a) above , except for the Professional Liability insurance policy , shall be written on an occurrence basis in order to be approved by the City. 2-18 12. Subcontractors to the Contractor shall be required by the Contractor to maintain the same or reasonably equivalent insurance coverage as required for the Contractor. When subcontractors maintain insurance coverage , Contractor shall provide City with documentation thereof on a certificate of insurance. Notwithstanding anything to the contrary contained herein , in the event a subcontractor's insurance coverage is canceled or terminated , such cancellation or termination shall not constitute a breach by Contractor of the contract. FOR PURPOSES OF EVALUATING THIS INVITATION TO BID, PLEASE ATIACH A COPY OF YOUR CURRENT INSURANCE CERTIFICATE(S) FOLLOWING THIS PAGE AND BOUND WITHIN THE PROPOSAL PACKAGE. DEM07 -01 :AOM November 27 , 2006 2-19 2.13 PROVIDER 'S I ICENSES & CERTIFICATES Contractor shall procure all permits and licenses , pay all charges , costs , and fees , and give all notices necessary and incident to the due and lawful prosecution of the work, except for DSHS notification and fees as specified in Section 2.4 of this Request for proposal. The undersigned acknowledges the requirements of this section , and intends to comply with same in the execution of this project. CONTRACTOR: Intercon Environment al , Inc . Karen Andrews Company Name 2214 FM 1 1 87 , Bldg 6 Address Mansfiel d , Texas 76063 President C ity , State , Zip Title (print or type) PLEASE INCLUDE APPLICABLE LICENSES AND CERTIFICATIONS FOLLOWING THE SECTION AND BOUND WITHIN THE PROPOSAL PACKAGE DEM07-01 :AOM November 27, 2006 2-20 DEPA.RTMENT OF STATE HEALTH SERVICES. BE IT KNOWN THAT lNTERCON ENVIRONMENTAL INC is ficQns!Xl a~1d ~ut]1oriz(ld l1:>.p.e,rf9nn ·(18 an Asbestos Abate.Jtt~nt Contractor itfth~ State ofTexas within the purview o suS,pended or revoked and is ren~wed .e, chapter 1954~ so long as this license is not the Tex.as Board of Health. .800805' Li~rise Nu1nl>er . 2/§12005 lsfu.e Dale .2!shoo1 Expiration D11'te This'certi:ficfate is void aftet.ex• ~:~4:·v:J,.;., ~ ·T~d f, Wjngler, l' .E . ·¢hi.cf; As.best0$'P©gr~ BrimcJ1 'f<>~"ri Substances ContmJ 19ivlsion ~~. M'' ' _-' ; ' ' . " ' ~ .' . " . . ,.; . ' ' . ',: ·" . , .. 13duardo J. Sarich.ez; M.D.) M.P.H. Cotni1tlsslo.riet oflleal.th .. TRANSFERABLE 83Sl4 -<;. DEPARTMENT OF STATE HEALTH SERVICES BE IT KNOWN THAT INTERCON ENVIRONMENTAL INC ) ' is licensed and authorized to perform as an inlhe State ofTexas within thepurviewo suspended or revoked and is renewe 400336 l.ic:¢11$1.1 Nuni1*r 2'/6/2005 rssit1i Date 2/5/2007 ltxpHation Date TW.s certificate is vQld aftef eip Asbestos T,ransporter .. ,'• de, chapter l 954 , so Jong as this license is not · the Texas Board ofHe,alth. T~ f . W,iugler; l'~B. Chief; lul>est6sJti:Qgrt!ill$ Brnll¢li: Toxic 'Stihstairees ¢'ontrol D.iv.iJion ~Q1t..:G.:. --'-li. ·.A --'1~.-.,-/"'-vw-1 E<luard<;i J, :Saix:h¢z:, M ,I),, M,P .H, Cotnntliisioner ofHealU1 -TRANSFERABLE 83541 TEXAS DEPARTMENT OF HEAL TH in the State of as ame11.decl, so the rules adopte Expiration Date VOID IF ALTERED , Article 902 9, eel acc:oi;du1g to I fof unenJal Lea d, Br.uwh a Subst1uwc11 Control Diviil'ion E[!jJ~KPB · NON-TRANSFERABLE 4532 DEPARTMENT OF STATE HEALTH SERVICES BE IT KNOWN THAT INTERCON ENVIRONMENTAL, INC is hereby licensed and authorized to perform as a MOLD REMEDIATION COMPANY in the State of Texas and is hereby governed by the rights, privileges, and responsibilities set forth in Title 25, Texas Administrative Code, Chapter 295, relating to Texas Mold Assessment and Remediation Rules, as long as this license is not suspended or revoked, and is renewed according to the law. RC00136 License Number 1/25/2006 Issued Date 1/25/2008 Expiration Date Void after expiration date VOID IF ALTERED Department of State Health Services Quade R. Stahl, Ph.D. Division of Regulatory Services Eduardo J. Sanchez, M.D ., M.P .H Commissioner NON-TRANSFERABLE CONTROL NUMBER: 3705 2.14 CONTRACTOR'S LEGAi AND COMPLIANCE HISTORY Contractor's legal and compliance history is a critical component of this Request For Proposals . Read this section with care and respond accordingly. Failure of the Contractor to provide all the information requested and to certify the report , will result in the Contractor's submittal being declared non-responsive . Contractor shall attach a written report of legal action brought against Contractor, Contractor's officers, Contractor's employees , At:lQ Contractor's proposed subcontractors relating to the protection of the environment The terms "legal action " and "relating to the protection of the environment" are defined below. The report shall include all legal action brought within five (5) years of the closing date of this Request for Proposals. The report shall detail the substance , status , and outcome of such legal action . This includes without limitation the names of the agency and/or persons bringing the action , all relevant dates , and all fines , judgments , and/or settlements. Include t he following information for each case at a minimum : • • • • Style of Case ( X vs. Y ) Cause Number Court Date of Disposition • • • • Settlement Info rmation (as appropriate) Names / Addresses of all parties named Counsel List and phone numbers Judgment and Order of Judgment "LEGAL ACTION " means : ANY enforcement action by the United States Env ironmental Protection Agency , the Occupational Safety and Health Administration , any other federal agency , the Texas Commission on Environmental Quality (including its predecessor agency the Texas Natural Resource Conservation Commission), the Texas Department of State Health Services (including its predecessor agency the Texas Department of Health), and any other state agency , commission or department, whether in Texas or elsewhere , when such enforcement action is a result of violations, real or alleged, of any laws , licenses , permits , judicial orders , or administrative orders , relating to the protection of the environment. In this context , enforcement action shall include without limitation , written warnings , notices of violation , consent orders or agreements , compliance orders , administrative hearings , civil litigation and criminal prosecution . Legal action also means any civil litigation brought by any person relating to the protection of the environment. "RELATING TO THE PROTECTION OF THE ENVIRONMENT" means : requirements pertaining to the manufacture , processing , distribution, use , handling , storage , transportation , reporting , records keeping , permitting , licensing , treatment , disposal , emission , discharge , spill , release , or threatened release of hazardous materials , hazardous substances, hazardous wastes , toxic substances , petroleum , industrial waste , solid waste , pollutants or contaminants into or onto the air , surface water , drinking water , groundwater, storm water , publicly owned treatment works , or land. THE REPORT SHALL BE SIGNED AND CERTIFIED by an authorized representative of the Contractor, using the form on the following page. The top portion of the form is to be completed if a report of legal action is attached. The bottom portion of the form is to be completed if Contractor has no legal action to report. Make certain that the appropriate portion of the form is filled out and signed. DEM07-0l :AOM 2-21 November 27 , 2006 AN AUTHORIZED REPRESENTATIVE OF THE CONTRACTOR shall mean: (1) if the Contractor is a corporation: the president, secretary , or treasurer, or a vice president of the corporation in charge of a principal business function, or any other person who performs similar policy or decision-making functions for the corporation ; (2) if the Contractor is a partnership , a general partner ; and (3) If the Contractor is a sole proprietorship , the sole proprietor. DEM07-01:AOM Nove mber 27, 2006 INCLUDE A COPY OF THE REPORT OF LEGAL ACTION FOLLOWING THE CERTIFICATION PAGE AND BOUND WITHIN THE PROPOSAL 2-22 Certification of Contractor's Legal and Compliance History Complete ONE of the Follow ing Cert ifications : Certification of Legal Action Report I cert ify unde r penalty of law that the attached Legal Action Report detailing Contractor's, Con t racto r's officers , Contractor's employees , and Contractor's proposed subcontractors legal and comp li ance history relating to the protection of the environment was prepared under my direction or supervision in accordance with a system des igned to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who ma nage the system , or those persons directly responsible for gathering the information , the in formation submitted is , to the best of my knowledge and belief, true , accurate , and complete . I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations. CONTRACTOR: (Company Name) BY : ___________ _ (s ignature ) (print or type name of signatory ) (title ) (date) Certification of NO Legal Action I cert ify under penalty of law that the legal and compliance history of Contractor, Contractor's officers , Contractor's employees , and Contractor's proposed subcontractors was researched under my direction or superv ision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted . Based on my inquiry of the person or pe rsons who manage the system , or those persons directly responsible for gathering the information , I hereby certify that no legal action relating to the protection of the environment was brought against Contractor, Contractor's officers , Contractor's employees , or Contractor's proposed subcontractors within the preceding five years . To the best of my knowledge and belief, this statement is true , accurate , and complete. I am aware that there are significant penalties for subm itting false information , includ ing the possibility of fine and imprisonment for knowing violations. Intercon Environmenta l , Inc . (Company Name ) BY:--1~~!,:Q!~...;;c.~~~~~-=- (signature) President (t itle) DEM07-01:AOM November 27, 2006 Karen Andrews (print or type name of signatory) 12/2 7/06 (date) 2-23 2.1 5 INVENTORY OF EQUIPMENT Each Provider shall submit a single copy of the equipment inventory owned by the company that will be used for completion of the asbestos and mold aspects of this request for proposals Eauioment Tvoe See a t tached DEM07-0l:AOM November 27, 2006 Ouantitv Condition Year Model 2-24 Equipment Type Quantity Condition Yea r Model > 2000 CFM Negative Air Machines 64 Excellent 2004 HEPA Vacuums 18 Excellent 2004 Air Movers -Rigid 3-speed 2,500 CFM 20 Excellent 2005 3M Brand Full Face P APR Respirators 80 Excellent 2004 3M Brand Full Face Respirators 20 Ex cellent 2004 North Brand 1/2 Face Respirators 70 Excellent 2004-2006 3M Brand 1/2 Face Respirators 70 Excellent 2004 GFCI Electrical Panel Boards 8 Excellent 2004 10 Gauge Extension Cords 100 Foot 200 Excellent 2004 -200 6 Small GFCI Outlets 60 Excellent 2004 Portable Light Stands 20 Excellent 2004 Generators 10 Excellent 2004 -2006 Showers 20 Excellent 2004 Shower Filtration Pumps 20 Excellent 2004 Water Heaters 20 Excellent 2004 -200 6 Digital Recorder / Printer Manometers 14 Excellent 2004 Volume Pumps 8 Excellent 2004 10 LB Fire Extinguishers 40 Excellent 2004 -2006 Battery Operated Fire Alarms 40 Excellent 2004 Full Body OSHA Harnesses 10 Excellent 2004-200 6 Shock Absorbing Lanyards 10 Excellent 2004-200 6 Hard Hats Safety Glasses 400+ Excellent 2004 -200 6 Propane Powered Floor Tile Machine 1 Excellent 2003 Floor Buffers 20 Excellent 2004 -200 6 Spud Bars 80 Excellent 200 6 Squeegees 25 Excellent 200 6 Scaffolding 70 Excellent 200 4 Power Washers 11 Excellent 2004 -2006 Airless sprayers 14 Excellent 2004-200 6 Type 1 A Fiberglass Ladders 83 Excellent 200 4-20 0 6 2.16 OTHER Each Provider shall submit a single copy of a sample of the following documents for review : Invoice Daily Log Sheet Sample Job Close-out Report Health and Safety Plan Health and Safety Records for the Past Three (3) Years INCLUDE ONE (1) COPY OF EACH DOCUMENT BOUND WITHIN THIS PROPOSAL PACKAGE FOLLOWING THIS PAGE DEM07-01:AOM November 27, 2006 2-25 ENV I RONMEN T AL, INC. 2214 FM 1187, Building #6, Mansfiel d, Texas 76063 T el ephone (817) 477 -9995 -Facsimile (817) 477-9996 Bill To Desc ript ion y}Invoice Date Invo i ce# 12/27/20 06 Proj ect Rate Am oun t Total $0.00 2214 FM 1187 • Building 6 • Mansfield, Texas 76063 • Phone: (817) 477 -9995 • Fax : (817) 477-9996 PROJECT CLOSE-OU Consultant tercon Environmental, Inc. Project No. 07-XXX Prepared for: Mr. Roger Grantham City of Fort Worth 1 000 Throckmorton Street Fort Worth, Texas 76102 December 27, 2006 ENVIRONMENTAL, INC. www.intercon-environmental .com ENVIRONMENTAL, I Table of Contents 1 . Notification 2. 3. i. ii. ~S,~S Asbestos Abatement License Asbestos Training Certificate Medical Surveillance of Asbestos Exposure 5. Texas DSHS Contractors License 6. Texas DSHS Transporter License 7. Waste Manifest (if applicable) F I C E u DEMOLITION/ RENOVATION NOTIFICATION FORM Department of State Health Services NOTE: CIRCLE ITEMS THAT A \O<AMENDED NOTIFICATION# ________ _ 1) Abatement Contractor: lntercon Environmental, Inc. DSHS License Number: 80-0805 Address: 2214 FM 1187, Building #6 City: Mansfield State: TX Zip:~7~6~06~3'---- 0ffice Phone Number: (817) 477-9995 Job Site Phone Number:__..._{8~1~7},._2=8~7~-=88=99~--------- Site Supervisor: Jose Contreras DSHS License Number:-=8=0--4=2a..:0~1 ___________ _ Site Supervisor: Hector Medina DSHS License Number :-=8=0~-4=0=2=7 ___________ _ Site Supervisor: Bob McFadin DSHS License Number :_.8=0'--4..:..;:5=2=5'------------- Site Supervisor: Eulogio Torres DSHS License Number:-=8~0--4~4~1-9~----------- Trained On-Site NESHAP Individual: Jose Contreras Certificat ion Date:~1~L3a.a0~/0~6'--___ _ s Demolition Contractor:"""'N-=/"'""A'------------ E Address:-'-N"'-/A:....:.... ____________ _ o 2) Project Consultant or Operator: _______________ _ N Mailing Address: __________________________ ,.,._""'-,--.,..:,..C------- L City: State :~T~X~_Zip: ____ _ y D T A H p A D N E A p D T 0 H D L V I 0 L A T I 0 N ? D y D N 0 3) Facility Owner: _______________ =-=-----.:::--'.------M----------- Attention: ________________ ...,,_~-...,___.....,_,_ ___ ___,..~----------- Mailing Address: ____________ __,.....-+----'s---+--~s------------------- City: State : TX Zip:___,;.::=:-,--::,.,.._- **Note: The invoice for the notification fee will be sen >to the" project is completed . 4) Description or Facility Name: ______ --;:,,;~---~...,..-""'=""------------------- Physical Address : __________ ',-.- Facility Phone Number_,,{ _ _.) __ ..,...._ ___ _ Description of Area/Room Number: ~~::::---;::---~r----..:----:7'"-------------------P r i or Use: _________ --"T~~--=~,....;.:.., Age of Building/Facility: _____ =~ _____ School (K -12): DYES D NO 5) Type of Work (CHECK ONLY ONE): Reno ation Work will be during: D Qa~ . D Evening D Night D Phased Project Description of work schedwi e: ______ . ,,..... -~------------------------ Is Building/Facility Occupied? r8J YES O NO 7) Notification Type: Original (10 orking days) If this is an amend ent, which al!l ndment number is this?_ (Enclose copy of original and/or last amendment) If an emergency, who cjjd Y..O tall< with at DSHS? Emergency#: ______ _ Date and Hour of Emergency (HH/MM/DD/YY): / / / Description of the sudde n;ynexpected event and explanation of how the event caused unsafe condi t ions or wou ld cause equipment damage (co · puters, machinery, etc ________________________ _ 8) Description of procedures to be followed in the event that unexpected asbestos is found or previously non-friable asbestos material becomes crumbled , pulverized, or reduced to powder: Stop work, notify owner, consultant and Texas Department of State Health Services. 9) Was an Asbestos survey performed? Yes Date: DSHS Inspector License No : __________ _ Analytical Method : PLM DSHS Laboratory License No:..:::3=0----------- (For T AHPA (public building) projects: an assumption must be made by a DSHS Licensed Inspector) 10) Description of planned demolition or renovation work, type of material, and method(s) to be used: ______ _ 11) Descriptio n of work practices and engineering controls to be used to prevent emissions of asbestos at t he v:J< demolition/renovation: _________________________________ _ 12) ALL applicable items in the following table must be completed: IF NO ASBESTOS PRESENT CHECK HERE 0 Approximate amount of Check unit of measuremen t Asbestos-Containing Building Material Asbestos 1-----~-----+--~.--~-~-~-~---l Type Pipes Surface Area Ln Ln SQ SQ Cu C u Ft M Ft M Ft M RACM to be removed RACM NOT removed Interior Cate o I non -friable removed Exterior Catego I non -friable removed Category I non-friable NOT removed Interior Catego II non-friable removed Exter ior Catego II non-friable removed Cate o II non -friable NOT removed RACM Off-Facility Component 13) Waste Transporter Name:"""C=B=A....a...=S=e"'-rv"""i=-ce=s"-'--"'ln'""'c=·--.,....,....___.,,___...,..._ ____ DSHS License Num ber : 40-0312 Address : 5877 Barnett Road, Suite A State: TX Z ip: 76249 Contact Person : Jana Osborn Phone Number: (940) 482-9900 f'demol ition order and identify Governmental Official be low: ~=----.-c;;--=,-----:,;.;.;:_. __ ..,;z.... ____ Registration No: ~N~/~A~----------- 16) Complete : __ 17) Scheduled Dates De olition/'}enovation (MM/DD/YY} Start: Complete : __ ** Note: If the start date on liJ.,s notification can not be met, the DSHS Regional or Local Program office Must be contacte d by phone prior to the start date. ailure to do so is a violation in accordance to TAHPA, Section 295 .61. I hereby certify that all information I have provided is correct , complete , and true to t he best of my k nowledg e. I acknowl edge that I am responsible for all aspects of the notification form , including , but not limiting , content and s ubmiss ion dat es . Th e maximum penalty is $10 ,000 per day per violation. (Signature of Building Owner/ Operator or Delegated Consultant/Contractor) Karen Andrews, Agent (Printed Name) (Date) MAIL TO: ENVIRONMENTAL HEALTH NOTIFICATIONS GROUP DEPARTMENT OF STATE HEALTH SERVICES •-.,.xes are not accepted* PO BOX 143538 AUSTIN , TX 78714-3538 PH : 512-834-6600 , 1-800-572-5548 (817) 477-9995 (Te lep hone) (817) 477-9996 (Fax Num be r) *Faxes are n ot a ccep ted* Form APB#5, dated 12/01/04. Replaces TOH form . For assistance in completing form , call 1-800-572-5548 CERTIFICATE OF LIABILITY INSURANCE I DATE (M M/D D/YY) 03/16/2006 PR ODUC ER Serial# 100193 THIS CERTIFICATE IS ISSUED AS A MATIER OF INFORMATIO N ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AME N D , EXTEND OR ALTER THE COVERAGE AFFORDED BY THE PO LI CIES BELOW. INSURED THE WYATT AGENCY 130011TH STREET SUITE 305-E HUNTSVILLE, TX 77340 INTERCON ENVIRONMENTAL, INC . 2214 FM 1187 , BLDG . #6 MANSFIELD , TX 76063 INSURERS AFFORDING COVERAGE IN SURER A : ARCH SPECIAL TY INSURANCE COMPAN Y INSUR ER B : MASSACHUSETIS BAY INS . CO . INSURER c: TEXAS MUTUAL INSURANCE COMPANY INSURER D : I INS URER E: _K - COVERAGES /¥" "'-. NAIC# THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE~LIO,Y PERIOD ll)J DICATED . NOTWIT HS TAN DING ANY REQUIREMENT , TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT T W HIC~~Hl S CER't:IF1C~E ~ BE ISS UE D OR MAY PERTAIN , THE INSURANCE AFFORDED BY THE POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS , EXCLUSIO NS A ND CO ~Ji/lTI ONS OF SUCH POLICIES , AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS . "'(° I\ A B A ~NERAL LI ABILITY • / EACH OC!3:U RRENCE /,I' $ X COMMERCIAL GENERAL LIA BILITY 12 EMP 43513 00 2/3/06 A , 2/3/07 ~~~~~~JO,~E~~cel $ -o CLAIMS MADE [K] OCC UR ~ MED El I? (Any 9!ll°person) $ X ASBESTOS/LEAD ABATE P ERSO~L & ADV INJURY $ JS_ POLLUTION LIABILITY 0 GENE~ A.i!"AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER : PRhNl)CTS -COMP/OP AGG $ rxi POLICY n ~rii= n LOG ,, -.... 1 .... , AUTOMOBILE LIABILITY -ANY AUTO -ALL OWNED AUTOS X SCHEDULED AUTOS -X HIRED AUTOS -X NON-OWNED AUTOS ------------ ADY-8744779-00 GARAGE LIABILITY '~~, \ , R ANY AUTO " ~ -\ EXCESS/UMBRELLA LIABILITY \ ~E 43740 00 "'\.V Q OCCUR D CLAIMS MADE~ )I' n DEDUCTIBLE )\,_ I RETENTION;::::;~ 2/3/06 2/25/06 2/3/07 2/25/07 AUTO ONLY -EA ACCIDENT OTH ER THAN AUT O ONLY: EACH OCC URRENCE AGGR EGATE EAACC $ AGG $ $ $ $ $ $ jqTH· ER C EMPLOYERS' LIAB 1ll1TY WORKER'S COMPltifsATION AND ~ OOOl ~j 42280 ANY PROPRIETO~).RTNERIEXECl:JT.IVE~, EL EACH ACCIDENT OF FICER/MEMBER ~EXCLU:DEO? \ If yes , descnbe under ---...._ SPECIAL PROVISIONS low---· '\ EL DISEASE -EA EMPLOYEE $ EL DISEASE -POLIC Y LIMIT OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNl;:HICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS FOR INFORMATION AND BIDDING PURPOSES ONLY CERTIFICATE HOLDER CANCELLATION 1,000 ,000 50,000 5 ,000 1,000,000 1,000 ,000 1,000 ,0 00 1,000 ,000 4,000 ,000 4 ,000 ,000 1,000,000 1,000 ,000 1,000,000 FOR INFORMATION AND BIDDING PURPOSES ONLY SHOULD ANY OF TH E ABOVE DESCRIB ED POLICIES BE CANCELLED BEFORE THE EXP IRATIO N DATE THEREOF, THE ISS UING INSUR ER WILL ENDEAVOR TO MA IL~DAYS WR ITIEN NOTICE TO THE CERTIFICATE HOLDE R NAM E D TO THE LEFT, BUT FAI LURE TO DO SO SHALL IMPOSE NO OBLI GATION OR LIA BILITY OF ANY KIND UPO~E INSURER, ITS AGENTS OR REPRESENTA~ • ,,,r I ACORD 25 (2001/08) AUTHORIZED REPl)NT1JWE \ ~ \. © ACORD CORPORATION 1988 Project Name I.....__ ____ ( ________ ___.. Date .__I --~( te ,con Project Number.___ _________ __. Shift ENVIRONMENTAL, INC. ShiftSupervisor DAILY PROJECT LOG Alfi,-----------' Day .__ __________ __, Time Activity Today's Work Areas Consulting Firm On Site Representatives Site Inspections Yes No D D D D D D Received Removed Dumpsters Today I ] Dumpsters To -Date 1-----1---~~ Daily Project Log Shift Supervisor Signature ======================= ENVIRONMEN T A L , INC. DAILY TIME SHEET Employee 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Daily Time Sheet Project Name!,__ ____ ( _________ __, Project Number '---------------~ Shift Supervisor Signature Date!.___ ___ ( ___ __. Shift Day .__ __________ __. Safety Meeting Topic Accidents or Incidents Today New Hires Today Total Hours To-Date Project Budget Hours .__ ______ __. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 EN VIRO N M ENTAL , I NC. CONTAINMENT LOG Employee Containment Log Project Name! .... -------( Date -1 ------( Shift Project Number ..__ _______________ ....... Shift Supervisor,~ r Time J 7 Social Security Time Out Time In .A' , \ , "'"\1 ' I , > ..... ~ I ~, - .~ ~ l~I ~ -· ~ // "'--r ' ll Al ~i I ~I'll ",._ ., II '( II~ .~ ~ v~ '( " ... Shift Supervisor Signature Time Out .~ ·~~ // T / /~ ~( ' Day ..__ _____________ ____. Containment Area Personal P rotection Equipment Used D D D ~ D D Stee I Toe Rubber Boots Sing le Tyvek Type Suit ble Tyvek Type Suit on Gloves berGloves Dou Cott Rub 1/2 Full Face Respirator I HEPA Filters Face Respirator /HEPA Filters R Re pirator I HEPA Filters ~~ Typ e C Respirator I Supplied Air 'fl: Har, 'ti tyGlasses dHats D ar D 0th D 0 th • • • .. • Con t rol No: 93411 .. es certifies that: GEBCO .JSOCIATES in cooperation ·with rHE UNIVERSITY OF NORTH TEXAS certifies .that e A. Contreras President Date of issu.e: 01/30/06 Certificate Number: 06042 4.839 GEBCO's Training Programs are proyiqed in cooperation with federal and state regulatpry agencies, and f'.ulfil al 1cable u· ements for accreditation . GEBCO is licensed for Asbestos Training under tht Texas Asbestos Health otection RuJ s. GEBCO Associates, LLC * 669 Airport Freeway, Suite 210 * Hurst, TX 76053 • ----------------·· -.. cs Phvsicia11's Written Statement M:.d ic;J SurveJ lanc:: :or .'\sbe stos Expcsur~ Re1,•l>itm l ioe nsi r& ,..,b<sto s t.i;¢<1$ins B01l{5i M l 4! er H!IS3 <-6610 Fa~: 5!2-Sl46614 App,! ,:,.,: i,i•ttC: ~:nl, M.l 1 !,In) Nef!\ ~ Quono~"1 A_-,clhe9 St<co,<~ddttu: lli ,:c;~~ de I1~mic:Ul o Onc :ulr> 4e P.pan:mw\!i) lf employed , the emplcyer pl(· ided, s:nd rev iew was n1ad, <l!, the em ployer's d~e,iption of Ibis emp 1 n!s du1i;s11$ .h ey relate m t he employees elposurt, the employt11 's representa,ive or mticipa.ted eitpocme It al, ;i e p!1$01ll protectiye and respira!OJY ~ :ipment tc be •tiiiied ,y Ilic empio:,~, a.~6 informat loo ~m t> !cus medi:al . e1mnina1lons of tile affected en .oloy=e t6at is not 01h•rwi1c availabl, to the pbysici111 . "" /\ physielll examination with tmphasis upon the pu :mouuy, card iovascular, end ga.itroin!estinal systo The pulmonary fu nction :ests ;f fore«! vial eap11::ity (FVC) and fbrcex;I e:,,,pirat<ey v ,1lume a.t cne secon P1Jin ,cco;dmce with NIOS-H znd t,.'I'S sundards, :ndiC6tc wht1hcr Dr not the phy Jician decided that m <•ray was re<tuircd lnd. was performed GJ~ or NO ___ A ches.troeatioocgram, pos1erlt1r-anterior, l~" x 1.1• or cum:nt film on me Witt inte!pr«s:ion ~ord~.nce with 29 en l 926 .Jl0l, Append ix E. ,:. ~: Accordiag to .l9 CF~ (92~.11 Ol{M)(2){11}(C), 1M requirement for • <ht.$t >-ray i. et tbc pbysi,ian'i distrdioo, ~.,,The emp loyee wu lnfom,ed by !h~ pbyiicia11 of th¢ rl:l ~itl 9fth!. c11~m znd of ilny medic.al ,ona t ion~ 1ila: may mull :'.<cm :Ub!sto1 o:~cstirc ir.c,uding the increasd :isk of lu .ng ea.~ur attr ibuttb!e tc the combined effeet of Sil\~kio: ,r,d u b-..·dos cxpvsure . Unl en o\acrwlse note<:! b.:iow, this cvaluotio11 indica~u that M mcd.i<.t.l cooditior.s wcr• c:!;~¢1<:d ll!it would plicc tilt i:111pl oyee•t an incrcil5cd r,$k oi m~terial hcalih lmpairrm;n1 from cxpoJ~rc 10 11$\>e5to!, •nd no limi1ation$ arc recomrr.e.ndrn an the em~ee C(>!le<:r,1og !ht U$t of pet,~nal p1ote,fr,c cquipmeri, er c~plrotor . Sy signing thb rorm, l acknowlecge that t.111 c:xan:inuon hs been p:rformcd in aw.>rd.m~with cithtr29 CFR 1926.ll .?r-.~o era 76~:l". ~!):_e$!~~:i:~:-·-V , •••• M,~ ,, Comments or tin:it ~tio~s. if any ------J~¢.~~:!C!..-faf.:---------------=---= .,. Ci t/ Zip =· . . 1'RIVACY.NCnFTCATION/NOTIF1 CACl •)NS0BRt ?1UVACll)A1) . . j \SI'.~~ ;("" ;:ti;'-;:·'..o:.s 1 y.,w,h,~c ~n;. :i&'-1 u:;1c:i(;,1 ~: t:'\'1 bc ,n!ormu;i 1'1:n.1 ; iorvrrn1tio n tha·. \t<t su.,tafT txu. tclieu.stoo \&. )O i:. You u ecr.c!j td to r·!U M m< :Mew ~;.:: ;~f;-::r!:::~~~-,~t r:.~U:!l.1 "tw Lho. t•~c th e ii&}. to-u k~ nat, ti,Lricy rotom,.c.i i r, nromm* '1-.ai i~ &..t..n:":!i~dt ob< 11,e<ntet Set ;,U,;, .. !t'.lt...&":\.'*fr te'St $$ ·)! !o· "f,~fC :~lor-:<.J.itOI\ ~r. P"t•VLC::!' Not!t'l-:.,,;?" flidc..:~i;!: Go\.'urm~-,tJ"C.,4;, S:::;ti~ sn.02 1, S.Sl C'2l. !,s 00).i.od s,-y Yr'} .... ,=' i::e> c ; ':"" ::~n ,t.:tr.W i",:t:tpoc-~:l , 'dt :C: (,~ e '.!.!t :he de 1oi~·tt1 yd( u: 1r.f~!i'Mdc uQ1!: Ii ~,~rn t 61!,\ ~~! c! Ettuk ck i tl.U tWtt: ,~~= \l'Hd I\ \.likd l ~ .,;; ~,-:;.c--;.;::;.·::t;r ;.! ~-; .. ~h~ .d~ rcr.rc.11 y "'iHE iii ;nf:m1:i (lr. 1! rcc~m:i e Ulltdta.'Tlbt(;, iic,,~ 41;·«.h1J Gt .x-Oi ~ ti~c it :agu c.1 uull; t(WiJ tG!liq lnt : u1rcrrr,t.i6n • ~-.t:. ·,._ .::~~-::r:,iro c~ \a >r'>!.=>"flC:ll. :O ii ;µu e hliU(\IJV.WU1h :tta~ P ·'• rr,U :r,forr,aci~r. iot.rt ~t ~~i!"1u.(;6'\ ~bre Pf ,vtt~6&d lRd'e,;~1• Gw·,,.,1-.noo1r.-1 -"';ult. 1t:(~Y';.~ ~~A ;n; .~,:; ~2.!. S~:i 00) )" H9 Mt) ~T°""P*NI $141 lrvln9 Bllfd. Sulf* 220 DIIIM, TX 75247 . . : I I l F C<.uitr<>I ijo: 9'3St1'. G&B·CO ASSOCIATES . in co9peration with TN · U IVERS/TY· OF N·ORTH TEXAS eertitles that has successfully<comp.let . This is. an EPA fully c;1pprqyed pc,ur · T'.$CJ\,"TitJ~ JI,: ItJQY~ff t<>)(~$}(s te ' ' Part '6), su~part M . • Preiitle.ot Date .oflss:u~: 1070~106 -Oerti'flcate Number:Jl6255 -1341 . under Section 20:6 '.Of ·:.~<fwi~.~-" uit-ement ·df-40 ~FR, ctor :.· cate · ~xpir~s t 101,0212001 GE.BCO's Traj.n\ilg fro gr~ms>a«: :pro video in cooperatien ·with -federaLand state ·regulatbo/, age ndes , .ao:d foJfilLa ll appUcabkreqqi rem ~nts for accr?4ita!iqn, ·OEBCO is licensed , for Asbestos Training ; under the Texas As bestos H ealth'ProtcctionJiules. r • OEBC0Assodates, LLC 1t ,669:Airport Freeway,,S.uite21.0 •· Hµr$t,.TX: 760~3 ·• l8l7)268-4006 ~ soo\llB!IJ!o ·~ tjtll iu!Uf!• Alf '11M Oj 1SOO oo 1• *'P ·~ ""'''l 01.,. i"* nm P"" "!Cl :1111 uo p1moJ 1uawd1n!r.> '>'11 ;o ""' .~ u; P"" . <:! tq VoU!ltll oq 1'"" n,lt')dm ;g11o,,1 .. 111 ljlJ. .. JX>flddm "'J no{ ltfj) ""JWl" ~ ._.0q, "lfl JOJ ~ 'O<jl ll}JA" llOJ!ilOO t,t>AOJd,U, ;mo J.. '.'.n'lU!ld~SDforu-NON .3.lµID J.VlJJ, IWitL ll:U VIDl!I Sl '13:>~'VO !>NO'l .JO'tll.\a(J, TDA\ .O ()A J;Y(U ~!-t'Vib mt.. !ra'~ata SO.tS31lSV a'lfflNl <INV axows JlOll. at ·itDiw.:, .m S'adn sn oravA..!UfA\ (ti()JNl'l N1rlltt S'ill ff&llli! SOlSHUSV {)SI'lVl!Nl 'S!lOltllfl!l<'V <I 31iNV;) ~ RLIM ':Jl\IDfliOA\ m.tppy l:>O[OJJ --------oira ------------=N"'•f<>lil aSlrapff .t3'fJ:()M pint lU:!~{r.lIA!.OfriPV S(.I3'fJ:O.M,JO ,Q~yp.13;) dxa w e1 1wp1 1sa1 •µau!)) pue an.Q SI ;>11oq• ilOtlll\WOJUI $Jlii 1e'1i a.aik l ._,. ... _ 'PAl'l,pal""I_W_"'P'OU.t'I...----UtM~'--•P ~»,-.ljnM-J!>--IR 'A>ltl'l!O--AMla,o-- /-. ... /' -7'-.- -7'_ -;- -,,-.- -/'--,,-- ilSal ~ ssod l~idpaoJ Pf(] 'l l:lY 1»-U<» a,nsu1 0.1 puno,a peaq .>all JO Sill ,,..ow pue =•= en p;,;1nbaJ jfflPfl\tpuj.81Q SIM lS8l!ffll08 <J4l ,15uµl\(l •9 <P"J'l~UIWP•-~ ~owse se1,1 ·s tJQlaJidsa., a>dA\ sM 10 a.,a, puv asn ~d "'II UO ~$Ul 1en.P1J1)pu1 "1¥1 SIM .,. t,f0\1Uldsa., a>d.1:\,11\A JO~ Uo,i;Rl,O,ld JbJe'j ·a4l illll\! pu,n,uapiln 1•np1•1p.u1 ~'ll S:\OQ • £ lt,aJalSIUJWP" -aJn$$a.,d a,pe~ pue ""ll!sod SIM 't t •i<l"l'OJW«> ,\iqe"'1tta.! ~idSaJ •tM 'l :az1s JOltJldSal! :pullJ9 ,011.11dsa1:1 "'fJ·ll*R ;adAJ. JOltJ!dsa1:I tz<Wos u;,qwnN :.a~<>1dw3 -------,-. l"'u"'fl>iW""".-.Jb .. jj3"'1'tTH--~.W4'N ~A0jdW3 1n the State /of Texas within the purview: o suspended or revoked and is renewed '.S'(fOSO'~t 'L ie<i nse N't'tmber l /6/2005 Issue p ,ate 2/S.tZ007 Expiration J'.>nte- This ceitifi @'te"is voi d after:ex p /. STATE HEALTH SERVICES 1' ' I.' •~ , ao long as this license is :not .,.,e.,,0 -0 of Health. RANS FERABLE 83'514 in the Sta:te of Tex:as within the p urview o suspended or revoked and i$ renew~d 400336 L.ic:¢nse Num~r 2l6J.2085 Issu~Date 2/5/2007 · Bxpiia'ticm t)~te This certificate is void after expu'a io F STATE HEALTH SERVICES Jong as this license is not ofHealth. Please print or type . (Form designe d for use on el ite (12-pitch) typewriter.) Form Approved. 0MB No. 2050-0039 i UNIFORM HAZARDOUS 1. Generator ID Number WASTE MANIFEST n/ a 2. Page 1 of 3. Emergency Response Phone 1 817-477-9995 4. ManifestTracking Number 000045584 WAS 5. Ge nerator's Na me and Ma il ing Add ress Gene rator's Site Address (i f different tha n mailing add re ss) a:: Gen erato r's Phone : 6. Transporter 1 mpany Name Intercon Environmental, Inc. 7. Transporter 2 Company Nam e CB A Services, Inc. 8. Designated Faci lity Name and Site Address DFW Landfill 1600 Railroad Street Lewisville, TX 7506 7 Fa cility's Phone : 9 7 2-31 5-54 21 9a. HM 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Numbe r, and Pack ing Group (ff any )) 1. 3. 4. Hazardous substnac e, solid, N.O.S. ORM-E, NA 9188 RQ=l pound 14. Special Handling Instructio ns and Additio nal Informa tion Disposal mus t be in accordance wi TAC 325.136(b)(6) other handling writing by TDSHS 15. D Export from U.S. U.S. EPA ID Number 13. Waste Codes n/a CBA Servic es , Inc. 58 77 Ba rnett Rd Ste A Krum, TX 76249 ear Port of entry /exit ------------------- Date leavin U.S.: ~ ------,..,...,..--,=--,-,.,------...,.._--------------ig-n-at'""ur-e-------------------~o-n-th--a-y-~e-a-r -1 0 Q. u,..,,,_ __ .....,..,...,.._=----------'---------------....... -----------------------'~-....... ---'~--1 ~ Transporter 2 Printed/Typed Name ignature Month Day Yea r a:: I-I 18 . Discrepancy I 18a. Discrepancy Indication Space ~ 18b. Alternate Facility (or Gene rator) ::::; LL~ Facili 's Phone: D Quantity Drype 0Residue D Partial Rejection D Full Rejection Man ifest Reference Number: U.S. EPA ID Number @ ""'1"'8c __ ..,,S,...ign_a..,.tu-re_o..,.f A""lt,...ern--,at-e ""Fa-c"'ility-,-(o-r G=-e-n-er-at-or"'") --------------------------------------,M.,...0-nth,----,D,-a-y -...,.Y,-ea-r-1 ~ z..._ ________________________________________________ __. __ _._ _ __. __ -1 19. Hazardous Waste Report Management Method Codes (i.e., cod es fo r haza rdous waste treatment , disposal , and recycli ng systems ) 1. 2. 3. 4. 1 20. Designated Facility Owner or Operator : Certifica tion of receipt of hazardous materials covered by the manifest exce pt as ncted in Item 18a Printed/Typed Name Signature Month Day Yea r EPA Form 8700-22 (Rev. 3-0 5) Previous editions are obso lete . DESIGNATED FACILITY TO DESTINATION STATE (I F REQUIRED ) 2214 FM 1187 • Building 6 • Mansfield , Texas 76063 • Phone: (817) 477 -9995 • Fax : (817) 477-9996 PROJECT CLOSE-OU , Consultant: tercon Environmental, Inc. Project No. 07-XXX Prepared for: Mr. Roger Grantham City of Fort Worth 1 000 Throckmorton Street Fort Worth, Texas 76102 December 28, 2006 ENVIRONMENTAL, INC. www.intercon-environmental .com ENVIRONMENTAL, INC. Table of Contents 1 . Certificate of Mold Damage Remed)ation 2 . 3 . 4. 5. 6. 8. Workers' Paperwork : ,. DSHS Mold Remed i ation License ii. Mold Remediation Training Certificate 9. Texas DSHS Mold Remediation Contractors License 1 0. Texas DSHS Mold Remediation Company License *formall y known as Texas Department of Health CERTIFICATE OF MOLD DAMAGE REMEDIATION 28 TAC §21. l 007 IDR-1 (Effective l /1 /04 ) PDF or MS Word Certificate Number !Date of Issuance Name Mailin Address !s tate !Zip ! Number Street !Lot ===:===:======+--_;c_:'-'-'-"<i!=""F==~-,F,.Z--------l lcity ddition or Tract Mold Assessment License Holder Certification • I hereby certify that based on visual , procedural an protocol. • mold management plan or remediation protoce5 t'i · that forms the basis for m erson named in this certificate . Mold Assessment License Holder Signature : ·--~-D_a_t_e ___________ J • MRC-0125 01 /06 /08 TDSHS Mold Remed iator's Lie. No. and Expiration Date Mold Assessor or Adjustor License Holder Certification letion. Date of Completion • I hereby certify that I have inspected the property described in this certificate and that based on my inspect i on I have determined that the property does not contain evidence of mold damage . A copy of the written evaluation that forms the basis for my certification has been provided to the person named in this certificate . Mold Assessor / Adjustor License Holder Si nature DR-1 (Effective l / l /04) TDSHS Mold Assessor / Adjustor License No. and Expiration Date For more information, contact : AutoHome @tdi.state.tx.us Date MOLD REMEDIATION WORK PLAN Name and Add.ress Mold Prepared For: Client Name and Address February 2, 2005 Jerrold Andrews, Vice President Mold Remediation Contractor License No. MRC0125 Expires: 1/6/2006 :o. MCR0125 1. 2. 3. 4. Mold Remediation Work Plan Table of Contents ENVIRONME NTAL, INC. MRC Initials: __ ENVIRONME NTAL, IN C. MRC Initials: __ February 2, 2005 Client Name RE: Mold Remediation Work Plan Project Address 1. Scope of Work Intercon's scope of work will be in ccordance with the Mold Remediation Protocol (Protocol) document prepared lzy Mr. J. Mark Swinnea, .E. of Brady Environmental Services, Inc. (Brady). Intercon's exceptions o th Protocol are hs ed in the "Qualifications To This Work Plan" section below. Intercon will r~move ,isi6ly m , 1i contaminated or water damaged building materials in the mas.ter bathroom sliower and aloset areas. The removal will include the basebo ar ds, sheetr ck, insulation, and . ood portions of the wood framing materials. In the master closet the removal will als,o.include selec ed cabinets and all the carpet, pad, and tack strips. The removal of all aierials i e tend at least two (2) feet beyond visible mold contamination or water damage. Once the afo ementioned materials have been removed, Intercon will clean all remaining exposed structural co . ponents and other surfaces by wire brushing or sanding them to remove visible mold contamination. These surfaces will also be wiped down with an anti-microbial disinfecting product. In the remainder of the residence Intercon will clean the surfaces of all contents by either HEP A vacuuming them or wiping them down with an anti-microbial disinfecting product to reduce any settled and/or airborne latent mold spores. Typically, Intercon will not open boxed items for cleaning. These types of items will remain closed/sealed. Intercon will also run au scrubbers/dehumidifiers throughout the residence during remediation activities to aid in the Mold Remediation Work Plan Project Address Page 2 of 4 MRC Initials: __ cleaning or scrubbing of the air and dehumidification. Additional cleaning of the contents or the cleaning of the contents by other methods is not included this Work Plan (i.e. steam cleaning, dry cleaning, etc.) with the exception of the mattresses which will be steam cleaned as specified in the Protocol. The cleaning of the HV AC units and ductwork is not in ct d this Work Plan. Intercon will coordinate the scheduling and sequence of its work with e homeowners' selected HV AC cleaning contractor. 2. Method of Removal methods written in the Brad~ regulations/guidelines/docUJll€ t 3. Project duration is estimated at four (4) to five (5) 10-hour shifts and 10 to 14 calendar days (allowing for owner's selected HVAC contractor, air clearance sample results and demobilization) for completion of Intercon's work. Intercon will staff the project to complete on or ahead of schedule. Intercon is prepared to start the project on Thursday, February 3, 2005. Mold Remediation Work Plan Project Address Page 3 of 4 4. Compensation The compensation for this project will be as stated in our separate Mold Re document (Revision 2) previously submitted to you. 5. Qualifications to this Work Plan MRC Initials: __ 1. All replacement or re-build of walls/floors/ceilings, cab ·11ets, HV AC units uctwor , etc. and other damaged building materials to be performed a , paid by others. Plea e . e that paint and/or substrate damage, delamination, peeling, c ipp· , etc. will Ii.le ly ~p ur during the removal of duct tape and adhesives utilize during remelliation activi ies. In addition, tapes/adhesives may leave a residue. Inter on is n t re~ n&"ble for the repair of these materials. This Work Plan and our related Mol calendar day/4 to 5 work shift project. The homeowner Oli others shall inventory and photograph, as necessary, all items identified for disposal (to.b hrown away) prior to Intercon's arrival at the jobsite. These items will be immediately djscarded by Intercon as the steps described in the Brady Protocol are completed. 2. Certain contents within the residence should be discarded in lieu of cleaning by Intercon. These consist of items that may not be adequately cleaned utilizing the specified techniques or items for which the cleaning costs (anticipated labor plus supplies) would exceed the value of the item. An example of this type of item might be floral arrangements, items with numerous intricate or delicate surfaces, etc. Mold Remediation Work Plan Project Address Page 4 of 4 MRC Initials: __ 3. In the master bathroom shower, Intercon will remove all materials (i.e. wood stud s, OSB, etc.) from inside the residence. The removal of the exterior brick and mortar should not be necessary during the removal operations but may be necessary in orde op operly replace the materials. The removal of the exterior brick shall be performed by e homeowner's selected remodeling contractor. In accordance with the Protocol, Intereon will no remove all the wood studs in the master shower; only the studs necessary to en u e co plete remove of visible mold contamination. ) Only the exterior surfaces of the washer, dryer, and r frigerator will be cleane . lie disassembly of these appliances for further cleaning is ot included in out Wo Plan. We a reciate the opportunit f to submit this Work Plan, and we look forward to the opportunity to demonstrate our pr fessional environmental remediation services. Sincerely, Jerrold Andrews, Vice President Mold Remediation Contractor License No. MRC0125 Expires: 1/6/2006 ie*.lf-1* 'TEXAS Department of State Health Services MOLD REMEDIATION NOTIFICATION FORM A mold remediation contractor or company shall notify the department of a mold remediation project when mold contamination affects a total surface area of 25 contiguous square feet or more. Notification shall be received by the department no less than five working days (not calendar days) prior to the anticipated start date of the activity. Date Received:_~-~/ __ Date Faxed:_~/---'-__ Date Emailed:_~/ __ /~- Walk-in Date:_--'-/--"'---Notification # ______ _ Please check only one box for the type of Notification: Ooriginal 0Amendment No. __ 0Emergency LOCATION Description or Residence/Facility Name: ____________ ....__...,:-"r--------'<!r----+:r---------- Physical Address: ______________ _ Facility Phone Number...___..__ _________ _ Description of Area/Room Number=-----------,-=-""----"-;,--,---...,._,_-:,,,,--....,..;,,,__ __________ _ Area of Mold to be Remediated=------~~~~ Owner of Residence/Facility (Last, First, M.l.) Telephone Number Address of Owner, if different State Zip Code Check only one box below: D Owner-occupied Residential Dwellin Other JECT INFORMATION ( ) Telephone Number Address City State Zip Code Telephone Number Laboratory License Number Name of Mold Analysis Laboratory Billing information (Check only one box below to indicate who should be billed and fill in the requested information): D Licensed Mold Remediation Contractor or Company: __________ License No.----------- 0 Other: Company Name ____________________ Attn: ____________ _ Address ______________________________ _ City _______________ State _________ Zip ____ _ Note: Do not send your Notification Fee with this form. An invoice will be sent to you for the amount due. PLEASE CHECK THE APPROPRIATE BOX BELOW AND FILL OUT ALL REQUESTED INFORMATION NOTIFICATION FORM IS CONTINUED ON BACK D Original scheduled dates of mold remediation (INITIAL NOTIFICATION): Start-date: __ / I Stop-Date: ___ / / __ mm dd yy mm dd yy s~heduled hours for remediation: _____ am until _____ pm D Weekdays (Mon.-Fri.) D Weekends (Sat.-Sun.) DSHS Central Office was notified by: D Hand delivery 0Mail/Courier D Facsimile (Fax): Date sent: ______ Time sent: ------- D Electronic mail (E-mail): Date sent: _______ Time sent: _____ _ Please provide an accurate description of the mold remediation project to be conducted. D Amendment Change start-date to: ___ /'----'-/ __ -=,,__ __ Time: ___ _ No Please give a description of the reasons for Emergency Mold Remediation .;::.;;,:..--''---.pm D Weekdays (Mon.-Fri.) D Weekends (Sat.-Sun.) If yes, DSHS Reference Number:--------- ________ Time: remediation: ----------------------------- I hereby declare that I have examined this notification and, to the best of my knowledge and belief, all information provided is complete, true, and correcl I affirm that I am the licensed contractor and that I am responsible for the fee associated with this notification. I also understand that I am responsible for notification to the departmenl Signature of Licensed Contractor: _________________________________ _ Printed Name and Title: ______________________________ Date: _____ _ Employer Company Name: Mail, fax, or email to: Rev 01/20/05 ENVIRONMENTAL HEALTH NOTIFICATIONS GROUP DEPARTMENT OF STATE HEALTH SERVICES 1100 WEST 49 TH STREET AUSTIN , TX 78756 PH : 512-834-6600 or 1-888-778-9440 FAX: 512-834-6644 EMAIL : mold .notification @d sh s.s tate .tx .us Tele hone Number FIS-12144 MOLD Notification form -interactive Project Name ._! _____ (..._ __________ _. Date.._! ___ .....,( ___ __, te ,con Project Number.__ _________ __. Shift E NV I RON M E N T AL, I NC . Shift Supervisor --~------------------' Day ~------------' DAILY PROJECT LOG Time Activity Today's Work Areas Consulting Firm On Site Representatives Site Inspections Yes No D D D D D D Received Re m o ved Dump sters To day I Dumpsters To-Date :============== Daily Project Log Sh i ft Supervisor Signat u re ======================= Project Name .... ! _____ ( _________ _. Project Number ---------------~ ENVIRONMENTAL, INC. DAILY TIME SHEET Employee 2 1------------------'~:±=.-:--:r---+----,,--,,,.,,......,.;-----t-----+-------i 3 1------------------+---..,,.....,,,.......,__..,....,,...... ___ -+-----+-------i 4 1------------------+--~--+--'+---+--+----.,.....=-,.----+-------i 5 1------------------+-----+---::1,.,...,.:--+--_.,..."""""....,,.'------+-------i 6 1------------------+-----+-......a.,-+---+-...,.,.-+-++-----+-------i 7 1----------------+-----t---..:..,:.r+---f--i--t---.::,-S'""7=+:,.=:;,----1 8 1-----------------+----;-----t----:'-::::,.......--;--r--::,---t----:t ........ rl 9 1----------------------1-----+-----+'--'-----+-............. -- 10 1-----------------..f.-----------------+,,---- 11 1------------------+-----+-----+-----+-__....,,.._.,...._-t---.;;;;;;;_--1 12 1------------------+-------------1---~-----t~ 13 1------------------+-------------1-----t---,---,,--,;-t 14 1------------------+-------------1----------1 15 1------------------+----4-----+------1-----+----......i•-,,,,,. 16 1------'------------..f.---------1-----+-----+-----l 17 1------------------+-------------1----------1 18 1------------------+-------------+----------1 19 1-----------------..f.-------------+-----+-----l 20 Daily Time Sheet Shift Supervisor Signature Date~' ____ ( ____ ~ Shift Day -----------~ Safety Meeting Topic Accidents or Incidents Today New Hires Today 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 ENVIRONM E NTAL, INC. CONTAINMENT LOG Employee ••·+ •i'., ' ,,,.;; .. ' ' Containment L og ~---( Project Name!~---------------- Project Number ._ _______________ __. Shift Supervisor: I~ Social Securj ty \ Time J >' Time Out Time In Time Out /r \ I y ~ '\ J I _,.... ~,. ~ ~, ~ II "" :r ~ ._/ / "' ,.,.. )/ ~/ff ~ I )I'll "\,, / ,1 ~ ---( Date .... I ______________ __, Shift Day ._ _____________ ___. Containment Area Personal Protection Equipment Used el Toe Rubber Boots D Ste D Sin gle Tyvek Type Suit D Dou ble Tyvek Type Sui t " I//~ ·~,,r I~ D Co tton Gloves 4 I,,........... ~ </ Rub berGloves ~v" /. D 1/2 Face Respirator I HEPA Filters " //11 ~El Fulf ~i,( D P. ' •?l i D yp e C Respirator I Supplied Air ' Sa~ etyGlasses ''' '" •Li• Har: D 0 " ' D ,; D 0th ' D 0th Shift Supervisor Signature GEBCO As'soclATES in cooperation with THE UNPril!RSITY OF NORTH TEXAS tertifies that Mold Remediat1 President Date of Issue: 12/13/06 Certificate Number : 06016 8129 the Environmental Training Program Refresher GEBCO's Training Program s are provided in coo1x:ration with federal and state regulatory agencies , and fulfill all applicable requirements for accreditation . GEBCO Associate s, LLC . • 669 Airport Freeway, Suite 210 • Hurst , TX 76053 • (817) 268-4006 cs ~ TE 3850 MOLD REMEDIATION THE INTERCON ENVIRONMENTAL, INC . 221 4 FM 1 1 87 , BUILDING #6 MANSFIELD , TEXAS 76063 8 1 7-477-9995 OF TEXAS DEPARTMENT OF STATE HEALTH SERVICES LICENSE RCOO 136 ,· _,-,:::;;;;;:;i/ c ~~--=::·-~:::.::::..-·---- I NSTRU C TOR: JERROLD L. ANDREWS Te x as Depa r tment of S tate H ea l th Services L icense No . MRC0 1 25 CERTIFICATE N O. 06002 1 TRAINING TEXAS 75220 COURSE RULES T raining • DEPARTMENT OF STATE HEALTH SERVICES BE IT KNOWN THAT JERROLD L ANDREWS is hereby licensed and authorized to perform as a l\tlOLD REMEDIATION CONTRACT@ in the State of Texas and is hereby governed by the rights, pri set forth in Title 25, Texas Administrative Code, Chapter ,, relat'n to Texas Mold Assessment and Remediation Rules , as long as this. license is n ed \r revoked and is renewed according to the !av,·'. ~1RCOl25 License 1' umber 1/6/2006 Js sued Date 1/6/2008 ·-----·-·············-----········-----Ex p i r:i t ion Dal' Void afte.r ex p iration date VOID IF ALTERED ~ ' "-:---:--~~~-,----·······---·· E duardo J. Sanchez, M .D .. M .P .H Commissioner NON-TR.\.NSFERABLE CONTROL 'LM B ER: 3660 ~ TE HEAL TH SERVICES , licensed and authorized to perform as a OLD REMEDIATION COMPANY in the State of Texa$ and is hereby governed by the rights, privileges, and responsibilities set forth in Title 25, Texas Administrative Code, Chapter 295, relating to Texas Mold Assessment and Remediation Rules, as long as this license is not suspended or revoked, and is renewed according to the law. RC00136 Li c ense Number 1/25/2006 Issued D ate 1 /25/2008 Expiration Date Void after expirati on date VOID IF ALTERED -1( .. 't Ill* .... ·· ~"· TEXAS Department of State Health Services Quade R . Stahl , Ph.D. Division of Regulato ry Services Eduardo J . Sanchez, M.D., M.P.H Conunissioner NON-TRANSFERABLE CONTROL NUivH3ER: 3 705 • ENVIRONMENTAL, INC. 2214 FM 1187, Building 6 , Mansfield, Texas 76063 , Telephone (817) 477-9995 , Facsimi l e (817 ) 477-9996 mai l@i ntercon-envi ron men ta I . com www.intercon-environmental.com HEALTH AND SAFETY PLAN Karen Andrews erro ld chews Health and Safety Officer Intercon Environmental, Inc. 12-27-06 Date 12-27-06 Date This page was left intentionally blank. Health & Safety Plan 2 Table of Contents Health & Safety Plan 1. Introduction ......................................................................................................................... 5 2. Health and Safety Responsibility ........................................................................................ 5 3. Medical Monitoring Program .............................................................................................. 5 4. Health and Safety Training ................................................................................................. 6 5. Exposure/Injury Reports ..................................................................................................... 6 5.1 Accident/Injury Reporting ............................................................................................ 7 5.2 First Aid Response ........................................................................................................ 7 5.3 Procedure if an Accident Occurs .................................................................................. 7 ' 5.3.1 First Aid .................................................................................................................. 7 5.3.2 Serious Injury .......................................................................................................... 7 6. Chemical Substances of Concern ........................................................................................ 8 7. Physical Hazards of Concern .............................................................................................. 8 7 .1. Trip, Slip, Fall Hazards ................................................................................................. 8 7.2. Noise ............................................................................................................................. 8 7.3. Confined Space ............................................................................................................. 9 7 .4. Hand and Power Tools .................................................................................................. 9 7 .5. Fixed udders ................................................................................................................ 9 7 .6. Portable udders ........................................................................................................... 9 7. 7. Manual Lifting .............................................................................................................. 9 7.8. Illumination ................................................................................................................. 10 7.9. Hot Processes -Steam ................................................................................................. 10 7.10. Inclement Weather ...................................................................................................... 10 7.11. Electrical Safety .......................................................................................................... 10 7.12. Heat Stress ................................................................................................................... 10 7.12.1. Symptoms .............................................................................................................. 11 7.12.2. Treatment .............................................................................................................. 11 7.13. Heat exhaustion ........................................................................................................... 11 7.13.1. Symptoms .............................................................................................................. 11 7.13.2. Treatment .............................................................................................................. 11 7.14. Heat Cramps ................................................................................................................ 11 7.14.1. Symptoms .............................................................................................................. 11 7.14.2. Treatment .............................................................................................................. 11 7.15. Heat Rash .................................................................................................................... 12 7.15.1. Symptoms .............................................................................................................. 12 7.15.2. Treatment .............................................................................................................. 12 7.16. Heat stroke .................................................................................................................. 12 7.16.1. Symptoms .............................................................................................................. 12 7.16.2. Treatment .............................................................................................................. 12 7.17. Measure Heart Rate ..................................................................................................... 12 7.18. Measure Body Temperature ........................................................................................ 13 7.19. Physiological Monitoring Schedule ............................................................................ 13 7.20. Working at Elevation .................................................................................................. 13 7.21. Utilities ........................................................................................................................ 14 Health & Safety Plan 3 7.22. Heavy Equipment. ....................................................................................................... 14 8. Biological Hazards of Concern ......................................................................................... 14 8.1. Bloodborne Pathogens ................................................................................................ 14 8.2. Animal Bites and Stings .............................................................................................. 14 8.3. Contact with Plants ..................................................................................................... 15 8.4. Animal and Bird Refuse .............................................................................................. 15 9. Basic Safety Work Rules .................................................................................................. 15 10. Emergency Response Plan ................................................................................................ 17 10.1. Evacuation Routes and Procedures ............................................................................. 17 10.2. Emergency Security and Control ................................................................................ 18 10.3. Emergency Decontamination Procedures ................................................................... 18 10.4. Fire or Explosion ......................................................................................................... 18 10.5. Spills and Leaks .......................................................................................................... 18 10.6. Medical Emergencies .................................................................................................. 19 11. Plan Approvals .................................................................................................................. 19 Health & Safety Plan 4 Intercon Environmental, Inc. Health and Safety Plan 1. Introduction The purpose of this Health and Safety Plan (Plan) is to define requirements and de signate protocols to be followed by employees during any and all project activities. This Pl an is designed to provide guidance to protect the health and safety of individuals working on- site and assist in compliance with all relevant health and safety regulations during the completion of any site activity. Specifically, the Plan has been prepared in strict accordance with OSHA 29 CFR 1910-Subpart 7. The Plan addresses standard operating and emergency procedures for anticipated site hazards related to asbestos abatement and other environmental activities A copy of this plan will be reviewed by all employees with the corporate health and safety officer. At which time any questions will be addressed. Upon completion of the plan review all employees will sign an authorization sheet acknowledging the ir understanding of the contents of this Plan. The original Plan will be maintained at Intercon Environmental, Inc. 's principal office and copies of the plan on every project site. Modifications to this Plan may be required to adjust for changing laws and project conditions. The Corporate Health & Safety Officer will make all changes. Permanent revisions will be attached as addenda to the Plan. 2. Health and Safety Responsibility Each Project Manager will be responsible for assuring that all site activities are performed in accordance with the protocols defined in this document. The Proj ect Manager will have a direct line of communication with the Corporate Health an d S afe ty Officer. All work performed by personnel shall be conducted in conformance with the Plan and appropriate regulations. Intercon will take appropriate steps to protect employees from unsafe acts or actions over which Intercon has no control and will be obliged, professionally, to bring any such actions, as well as any actions on any work location where there are work assignments, which constitute obvious or imminent hazard v iol ation of regulations to the attention of the appropriate client contact. Employe es are encouraged to report unsafe work place situations to the Corporate Health and S afe t y Officer without fear of recrimination. 3. Medical Monitoring Program In compliance with OSHA regulations, all employees who participate in asbestos rel ated activities will be enrolled in a medical monitoring program. Medical surveillance shall be provided to employees prior to employment, annually thereafter (minimum) and as a Health & Safety Plan 5 follow-up to injuries or over-exposures. All employees shall be required to maintain current medical fitness status with an annual physical examination. 4. Health and Safety Training All supervisory personnel are required to have the 40-hour health and safety training requirements, as specified in OSHA regulations (29 CFR 1910.120(e)/8 CCR 5 192). Employees and subcontractors successfully completing this course are cer tified to perform field activities in hazardous locations in EPA designated levels of protection B, C and D. Copies of training certificates shall be maintained on-site. This training must be renewed annually with an 8-hour refresher course. Each employee must also undergo an annual respirator fit test and be medically certified to perform fieldwork on an annual basis (all employees working with asbestos must be trained in accordance with 29 CFR 1926.1101). Intercon will conduct health and safety meetings at the beginning of every project and periodically as needed maintaining a minimum of one per week. During these health and safety training seminars, any questions regarding the Plan will be answered. The purpo se of these orientations is to ensure compliance with the Plan as well as fulfilling applicable right-to-know regulations. The issues to be addressed at this orientation will include: 1. Chemical hazards on-site; 2. Physical hazards on-site; 3. Biological hazards on-site; 4. Potential for exposure to hazardous materials on-site; 5. Monitoring procedures and protocols; 6. Levels of personal protection to be utilized and personal protective eq u ipment required to mitigate potential exposure; 7. Decontamination procedures; 8. Emergency and evacuation procedures; and 9. Site documentation procedures. 10. Any incident investigations 11. Modifications if any to the Health and Safety plan 5. Exposure/Injury Reports In the case of an injury or exposure, effective corrective actions must be taken , an incident investigation must be completed and an incident report filed. Health & Safety Plan 6 5.1 Accident/Injury Reporting If an injury or exposure occurs, the specific incident will be immediately reported to the Environmental Health and Safety Officer verbally as soon as possible. Intercon shall notify a representative of the client in the event of an accident or injury while on the site. Intercon will ensure that a written exposure or injury report is completed and reviewed with the employee(s), Contractors involved and supervisors. After review of an exposure or injury report is complete, Intercon will investigate and ensure that corrective measures were appropriate and are complete. 5.2 First Aid Response 1. First aid should be administered only by trained, certified personnel. 2. Do not move an injured or seriously ill person unless necessary to prevent further mJury. 3. If off-site medical treatment is obtained (without reporting to the appropriate supervisor) for a work-related injury or illness, notify the appropriate supervi sor at the start of the next scheduled work date. 4. Prior to returning to work after a disabling injury or illness, present a completed medical release from the attending physician to the appropriate supervisor. 5.3 Procedure if an Accident Occurs In the event of an accident, the following steps should be taken in the sequence listed: 5.3.1 First Aid Contact qualified first aid personnel. 5.3.2 Serious Injury 1. Call an ambulance, hospital, at 911, or physician. 2. Have qualified first aid personnel administer first aid as soon as possible. 3. Assist first aid and ambulance personnel as directed. 4. Notify the supervisor or designated alternate. 5. Assist in completion of appropriate accident information report and witness statements. Health & Safety Plan 7 6. Chemical Substances of Concern The Health and Safety Officer will maintain all Material Safety Data Sheets (MSDS ) for all chemicals used and stored on-site. These will include all those substances necess ary for equipment decontamination and samples analysis preparation. Copies of thes e MSDS are maintained in our office and at the project site. See Intercon 's Standard Op erating Procedure manual for full instruction on MSDS. 7. Physical Hazards of Concern The nature and extent of the field activities creates a number of potential physical h az ards on-site. Although engineering and administrative controls will be implemen ted to mitigate some hazards, the primary prevention will be based on a communication program. The program will start with the initial site briefing, which will be presented to all field personnel and reinforced at the weekly project safety meetings. The fi el d activities to be conducted during asbestos related activities will potentially req uire si te personnel to be in close proximity to various physical hazards. The specific haz ard s encountered will be dependent upon the task and the operation conducted. Below is a partial list of physical hazards that may be encountered during the ov ers ight activities at the site. Drilling Noise Hoists Portable Ladders, Scaffolds Heavy Equipment Confined Space Drum Handling Hot Processes Steam Weather Ropes, Slings, Chains and Hooks Manual Lifting Electrical Safety 7.1. Trip , Slip , Fall Hazards Use of Compressed Air Tools Power Tools/Hand Tools/A ir Tool s Utilities Excavations, Trenches Illumination Hot Work Heat/Cold Stress Pressure Washers Materials Handling Power Transmission, Mechanical Hazardous Material Use/Stora ge Personnel shall be reminded to maintain a workplace free of scattered tools an d sup pl ies. "Housekeeping" procedures will be discussed at the daily safety briefings. The importance of maintaining safe footing will be reinforced in daily safety briefings . 7.2. Noise Noise levels in excess of the 85 decibels, or dBA, the action level specified in 29 CFR 1910.95 and 8 CCR 5095, are not anticipated during completion of the work at the site . However, should you be exposed to elevated noise levels be encounter ed (a djacent to operational compressors , etc.), personnel shall utilize earplugs or hearing pro tecti on to attenuate noise levels. Noise dosimeters may be employed periodically to qu an tify personnel noise exposures. Health & Safety Plan 8 7.3. Confined Space Personnel will only enter a confined space if procedures defined in Intercon's Confined Space Manual are followed. A confined space may be defined as any area hav ing a limited means of egress where ventilation is not adequate to remove a toxic or fl ammable atmosphere or oxygen deficiency that may exist. Examples of confined spaces may include storage tanks, process vessels, bins, boilers, ventilation or exhaust ducts , sew ers, underground utility vaults, tunnels, pipelines and open-top spaces more than four fe e t in depth such as pits , tubs, vaults and vessels. 7.4. Hand and Power Tools Personnel shall be reminded at daily safety meetings of the importance of u s ing the correct tool to accomplish the various work tasks. Utilizing the wrong tool fo r the job can often lead to injuries. Throwing of tools or materials from one location to ano the r will be prohibited. All power tools shall be inspected prior to use. Any defectiv e tools shall be tagged out by the on-site project manager and prohibited from being used. 7 .5. Fixed Ladders Fixed ladders must be inspected prior to use. Moorings, hardware and rungs should be visually inspected to ensure that they are structurally sound. Efforts should be made to ensure that no more than one person at a time be present on a fixed ladder. Materi al s, tools and/or supplies should be passed up to elevated work areas or placed in a bu cke t or other vessel attached to a rope and hauled up rather than being hand-carried. 7 .6. Portable Ladders Portable ladders should be inspected prior to use. Attention should be paid to th e rungs and side rails of the ladder to ensure that they are not degraded or bent in any manner. Damaged ladders should be tagged out if they are repairable. If they are not, the y shall be destroyed. All ladders should be equipped with safety feet that are placed on a fi rm, flat surface. Straight extension ladders should extend at least three feet above the landing area. A spotter should be used at all times during ladder work. This individual shoul d steady the base of the ladder and be prepared to pass supplies or tools to the indivi dual working on the ladder. 7. 7. Manual Lifting Improper lifting can result in cuts, pinches, crushing and serious muscle strains and te ars. Daily safety meetings shall communicate the importance of proper lifting techniques to site personnel. Prior to lifting bulky or heavy objects, the object should be inspected for sharp edges, splinters and any signs of chemical or biological hazards (i.e. staini ng or insects/arthropods). The area should also be inspected prior to the lifting and moving of the object. The area should be checked to ensure that wet or slippery conditions a re no t present and that the route to be traveled is free of trip hazards. Where at all p ossibl e, assistance should be obtained in performing a lift. It will be stressed in the daily safety meeting that moving an object is not worth incurring an injury. If an object is no t re adi l y moved, mechanical means should be sought out and employed. Health & Safety Plan 9 7 .8. Illumination It is anticipated that electrical power and lighting systems shall be fully operational at the project site. Inadequate lighting can result in trips, falls and other inadvertent injuries incurred during work activities. If poor or inadequate lighting conditions are discovered , work shall be stopped in that specific area and the conditions shall be reported immediately. 7.9. Hot Processes .Steam Steam may be present in varying locations throughout the site. Steam represents a severe thermal burn hazard. It may condense and leave wet work surfaces and will displace oxygen in enclosed areas. The heat and high moisture content associated with steam may affect instrument and PPE function. Personnel shall be reminded to be cognizant of areas or structures that may contain steam (i.e. boiler rooms, steam lines). Caution should be taken when working around such structures. 7.10. Inclement Weather Potential hazards associated with inclement weather as they relate to this project may include heat, rain, wind and electrical storms. Should any of these conditions present a threat of injury of site personnel, work activities potentially exposed to these hazards shall be terminated. Heat may increase the likelihood of personnel experiencing heat stress and other heat related disorders. Extreme heat may also lead to increased rates of volatilization and increase the pressure on sealed containers, potentially increasing the risk of tox ic exposure or flammable/explosive atmospheres. Rain may increase slipping and tripping hazards and the braking distances of vehicles. Rain may also fill in depressions and obscure trip and fall hazards. Rain may also increase the potential of electrical shock when working in proximity to electrical equipment. Lightning represents a real hazard of electrical shock when working in flat, open spaces, elevated work places, or near tall structures such as stacks. 7.11. Electrical Safety Personnel shall remain cognizant of electrical lines and equipment within the work ar ea. Personnel and shall be prohibited from contacting electrical power circuits unless they are protected from electrical shock by de-energizing the circuit and grounding it or by guarding it effectively by insulation or other means. 7.12. Heat Stress Heat stress is an acute and dangerous reaction to heat caused by a failure of heat regulating mechanisms of the body, the individual's temperature control system that causes sweating stops working correctly. Body temperature rises so high that brain damage and death will result if the person is not cooled quickly. Health & Safety Plan 10 7.12.1. Symptoms Red, hot, dry skin, although person may have been sweating earlier; nau se a; dizziness; confusion ; extremely high body temperature; rapid resp irato ry and pulse rates; unconsciousness or coma. 7.12.2. Treatment Cool the victim quickly. If the body temperature is not brought do wn fast, permanent brain damage or death will result. Soak the victim in cool , bu t no t cold water; sponge the body with cool water or pour water on the body to re duce the temperature to a safe level (102°F). Observe the victim and obtain me dic al help. Do not give coffee, tea, or alcoholic beverages. 7.13. Heat exhaustion Heat exhaustion is a state of very definite weakness or exhaustion caused by th e lo ss of fluids from the body. The condition is much less dangerous than heat stroke, bu t it nonetheless must be treated. 7.13.1. Symptoms Symptoms are pale , clammy, moist skin, profuse perspiration and extre me weakness. Body temperature is normal, pulse is weak and rapid and breathin g is shallow. The person may have a headache, may vomit and may be dizzy. 7 .13.2. Treatment Remove the person to a cool , air conditioned place, loosen clothing, pla ce in a head-low position and ensure the individual remains immobile. C ons u lt physician, especially in severe cases. The normal thirst mechanism is n ot sensitive enough to ensure body fluid replacement. Have patient drink 1 to 2 c up s of water in-immediately and every 20 minutes thereafter until symptoms su bside . Total water consumption should be about 1 to 2 gallons per day. 7.14. Heat Cramps Heat cramps are caused by perspiration that is not balanced by adequate fluid inta ke. Heat cramps are often the first sign of a condition that can lead to heat stroke. 7.14 .1. Symptoms Symptoms of heat cramps are acute painful spasms of voluntary muscl es , e .g., abdomen and extremities. 7.14.2. Treatment Remove victim to a cool area and loosen clothing. Have patient drink 1 to 2 cups of water immediately and every 20 minutes thereafter until symptoms sub s id e . Total water consumption should be 1 to 2 gallons per day. Health & Safety Plan 11 7 .15. Heat Rash Heat Rash is caused by continuous exposure to heat and humid air and aggravated chafing clothes. The condition decreases ability to tolerate heat. 7.15.1. Symptoms A mild red rash occurs, especially in areas of the body that come into contact with protective gear. 7 .15 .2 . Treatment Decrease amount of time in protective gear and provide powder to help ab sorb moisture and decrease chafing. 7.16. Heat stroke Heat stroke is an acute and dangerous reaction to heat stress caused by a failure of he at regulating mechanisms of the body; the individual's temperature control sys tem that causes sweating stops working correctly. Body temperature rises so high th at bra in damage and death will result if the person is not cooled quickly. 7.16.1. Symptoms Red, hot, dry skin, although the person may have been sweating earlier; nausea; dizziness; confusion; extremely high body temperature; rapid respirator y and pulse rate; unconsciousness or coma. 7.16.2. Treatment Cool the victim quickly. If the body temperature is not brought down quickl y, permanent brain damage or death will result. Soak the victim in cool , bu t not cold, water; sponge the body with cool water or pour water on the body to reduce the temperature to a safe level (102°F). Observe the victim and obtain me dical help . Do not give coffee, tea , or alcoholic beverages. For strenuous field activities that are part of on-going site work activities in hot weather, the following procedures shall be used when appropriate to moni tor the body's physiological response to heat and to manage the work cycle , even if workers are not wearing impervious clothing. Awareness and limited monitoring procedures are to be instituted when the temperature exceeds 70°F. 7.17. Measure Heart Rate Heart rate should be measured by the radial or carotid pulse for 30 seconds as early as possible in the resting period. The heart rate at the beginning of the rest period shoul d not exceed 110 beats per minute. If the heart rate is higher , the next work period should be shortened by 33 %, while the length of the rest period stays the same. If the p ulse ra te still exceeds 110 beats per minute at the beginning of the next rest period , the follo w ing work cycle should be further shortened by 33%. The procedure is continued until the rate is maintained below 110 beats per minute. Health & Safety Plan 12 7.18. Measure Body Temperature With ambient temperatures over 90°, body temperatures should be me asured with a clinical thermometer as early as possible in the resting period. Oral temperature should be taken at the beginning of the rest period before the employee drinks an ything. Oral temperature (TO) at the beginning of the rest period should be shortened by 33 %, while the length of the rest period stays the same. If the TO exceeds 99.6°F at the beginning of the next rest period , the following work cycle should be further shortened by 33 %. The procedure is continued until the body temperature is maintained below 99.6°F. 7.19. Physiological Monitoring Schedule The following suggested frequency of physiological monitoring schedule for fi t and acclimated workers shall be used as a guideline. Temnerature Level D Level C 90°F or above After each 45 minutes of work After each 15 minutes of wo rk 87.5°F After each 60 minutes of work After each 30 minutes of work 82.5°-87.5°F After each 90 minutes of work After each 60 minutes of w ork 77 .5 ° -82.5 °F After each 120 minutes of work After each 90 minutes of work 72.5° -77 .5°F After each 150 minutes of work After each 120 minutes of w ork Measure the air temperature with a standard thermometer. The thermometer bulb used will be shielded from radiant heat. Estimate fraction of sunshine by judging what perce nt the sun is out. 100 % sunshine = no cloud cover = 1.0 sunshine = 50% cloud cover = 0.5 sunshine = full cloud cover = 0.0 adjusted temp. = actual temp. + 13 X (%sunshine factor) Frequency of physiological monitoring governs the length of work period. The length of the rest period is governed by physiological parameters (heart rate and oral temperature). For example , if an individual 's heart rate exceeds 110 beats per minute at the beginning of the rest period, that individual will remain on rest-time until his/her heart ra te drops well below 110 beats per minute and their next work period ( =duration of time befo re suggested physiological monitoring) is decreased by 33 %. 7.20. Working at Elevation Climbing stairs , working at elevation (more than four (4) feet above grade), on pl atform s, roofs or scaffolding; working on ladders, or performing activities where falls could resu lt in injury or contact with chemicals requires provisions for preventing falling. Ide ally fa ll prevention can be addressed through appropriate engineering controls includ ing safe ty railings etc. Fall protection PPE including harnesses and lanyards, may be required during the course of this project. The requirement for such PPE will be evaluated on a case-by-case basis. Health & Safety Plan 13 7 .21. Utilities Injury and death as a result of shock, electrocution, thermal bums and other utility re lated hazards can be avoided by remaining alert to the presence of utilities in the work area. Such utilities may include; electrical lines , gas lines, pipelines, steam lines , water lines, sewer lines and pressurized air lines. All utilities should be considered active unless a reliable source has documented them to be otherwise. Personnel will be instructed to avoid stepping or holding onto any such utility line. 7 .22. Heavy Equipment It is anticipated that a variety of heavy equipment will be present on the site during the completion of this project. All personnel shall be required to wear high-visibility safety vests at all times during site work. Site personnel and subcontractors shall be instructed to maintain eye contact with equipment operators when entering their work area(s). In addition, no personnel will be allowed to walk beneath elevated booms or buckets. 8. Biological Hazards of Concern This section identifies biological hazards that may be transmitted via human blood or blood products or through other modes of transmission including poisonous plants, insect and/or animal bites or stings. 8.1. Bloodbome Pathogens Bloodbome pathogens are pathogenic microorganisms that may be present in human blood and can cause disease in humans. These pathogens include, but are not lim ited to hepatitis B virus (HBV) and human immunodeficiency virus (HIV). OSHA requires compliance with 29 CFR 1910.1030/8 CCR 5193, Occupational Exposure to Bloodbome Pathogens Standard, where as a condition of employment , there is known or potential exposure to bloodborne pathogens. A source of occupational exposure may occur when an employee gives first aid and CPR to an individual w ho h as infectious blood. The occupational exposure occurs when potentially infectious materials come in contact with the employee 's eyes , mucous membranes , non-intact skin through cuts and abrasions while administering first aid and CPR. Additional sources of exposure are contact with infectious waste found at hazardous waste sites, glassware, needl es other sharp objects which have been involved in injuries to personnel resu lting in contamination with blood or related bodily fluids and laboratory personnel who may analyze samples containing infectious waste. Outlined below is a more detailed description of potential biological hazards that may be present on-site. 8.2. Animal Bites and Stings Animal bites or stings are usually nuisances (localized swelling, itching and m ino r p ain) that can be handled by first-aid treatments. The bites of certain snakes, lizards , spiders and scorpions contain sufficient poison to warrant medical attention. There are dise ases that can be transmitted by insect and animal bites. Examples are Rocky Mountain spotted fever, Lyme disease (tick), rabies (mainly dogs, skunks and foxes), malaria an d equine Health & Safety Plan 14 encephalitis (mosquitoes). The greatest hazard and most common cause of fatalities from animal bites _ particularly bees, wasps and spiders is a sensitivity reaction. Anaphylactic shock due to stings can lead to severe reactions in the circulatory, respiratory and central nervous systems, which can also result in death. 8.3. Contact with Plants Personnel are prohibited from eating any plant material that may grow on the site . Certain plants, including poison oak, produce adverse effects from direct dermal contact. The usual effect is dermatitis inflammation of the skin. The protective clothing and decontamination procedures used for chemicals also reduce the exposure risk from plant toxins. Cleaning the skin thoroughly with soap and water after contact will reduce risk. 8.4. Animal and Bird Refuse Buildings that have been inactive or have normally inaccessible areas such as high ceilings, crawlspaces, etc., may become refuges or nesting places for animals or roosting places, particularly for birds. Refuse in the form of nesting materials and droppings often accumulate around those nests or roosting places. This refuse often contains mold, fungus or bacteria, which represent respiratory system hazards, including lung diseases and allergies. It is expected that site personnel will have a minimum potential for exposure t o th ese biological agents. Those individuals who are involved in obtaining additional environmental samples may incur a greater risk of exposure to these materials during sampling. However, risks associated with exposure to these hazards can be greatly reduced through proper training, recognition and application of control mechanisms. 9. Basic Safety Work Rules Intercon is committed to the safety and health of all its employees. In our effort to make our project hazard free and provide the safest working conditions possible, we expect all site personnel to learn and practice the following basic safe work rules. In addition to the rules listed below, there are additional site-specific work rules that must be observed on this project. 1. Prior to beginning field activities, all site personnel will receive a Health and Safety briefing and sign a master sheet indicating they have read and understood this plan. 2. Prior to beginning field activities, the Project Manager will review site-specific Health and Safety items with all workers to be involved. 3. There will be no eating, drinking or tobacco use during the performance of drilling activities on the site. 4. As minimum, emergency eyewash will be located at Intercon's trailer located on- site. Health & Safety Plan 15 5. Fire extinguishers will be maintained on-site and in each project vehicle fo r u s e on equipment or small fires. 6. An adequately stocked first aid kit will be on scene and maintained by e ach supervisor in each work area at all times during operations. 7. A daily safety meeting will be conducted for all site personnel. Reco rds of these meetings will be kept at the project field office by Intercon. 8. All personnel will wash hands thoroughly after completing any activity p ri or to taking breaks and at the conclusion of each work shift. The project trailers sh all have a restroom equipped with a washbasin. 9. Approved and unaltered hard hats and sturdy work boots are required at all tim es in the work areas. 10. Sleev eless shirts and short pants will not be permitted. 11. Approved (Z.87.1) s afety glasses/goggles/eye protection shall be w o rn as required. 12. Hearing protection shall be worn in all high noise areas or while performing h igh noise tasks. 13. Approved respiratory protection shall be worn as required. 14. Proper gloves are required when handling material that cuts , b ums , or contaminates the skin. 15. Safety belts or harnesses and lanyards shall be worn by employees w orking on unguarded or unprotected work platforms six feet or more above the ground 16. Do not climb on or work from any handrail, mid-rail or brace. Use the l add er t o get on a scaffold. 17. Secure or cleat scaffold boards to prevent movement. 18. Inspect all ladders for damage or defects before use. Stepladders w ill only b e used in the fully opened position. 19. Extension ladders are not to be separated. They must have ladder fee t s et on a secure surface and tied off at the top. 20. Good housekeeping shall be practiced at all times. 21. Projecting nails shall be bent over or removed from lumber. Health & Safety Plan 16 22. Clean up spills immediately and remove oily, flammable, or combus tible waste/rags. 23. Compressed air shall not be used for blowing dust or dirt from clothing. 24. Access to safety and fire fighting equipment shall be kept clear at all times . Learn how to use an extinguisher before you need it. 25. Gasoline equipment shall not be refueled when running. 26. Secure all cylinders in the upright position with caps on when not in use. 27. Never enter a confined space/excavation until you check with your supervisor. Supplied air may be required. 28. Never enter an un-shored excavation over four feet deep unless the slopes are laid back or secured. 29. Excavations will be provided with an accessible ladder. 30. Horseplay, fighting gambling and stealing will not be tolerated. 31. All electrical cords shall be of the three-wire type. 32. Tagout and lockout rules are to be strictly enforced. 33. Wire rope chokers, slings, chainfall and come-a-longs are to be inspected by workers before use. 34. No employee, other than the operator, shall ride on trucks, loaders, shovels or moving equipment unless authorized. 35. Immediately report all near injuries, accidents and injuries to your supervisor. 36. Report unsafe conditions or practices to your supervisor. 10. Emergency Response Plan The emergency response plan is an integral part of the Plan and will be reinforced to site personnel during the daily safety meetings. Ideally, appropriate planning and control will preclude the need for a response action. However, it is imperative that all personnel are prepared to respond to an emergency to prevent further harm or injury. 10.1. Evacuation Routes and Procedures In the event of a site emergency requiring evacuation, the following alarm procedures will be implemented: Health & Safety Plan 17 1. In the event of an emergency situation, site personnel shall immediately notify the supervisor of the location and nature of the emergency. The supervisor on the site shall then contact the appropriate authorities. 2. Normal traffic flow patterns will be in effect unless a local detour is required. 3. Security will also contact the local police to assist with the traffic control of intersections outside of the site. 10.2. Emergency Security and Control Following the broadcast of an emergency alarm signal via radio, access to the site and immediate vicinity of the incident will be restricted. Depending upon the severity and location of the incident, physical barriers or banner guard will be used to delineate restricted areas. 10.3. Emergency Decontamination Procedures Normal decontamination procedures will be modified to suit the specifics of an incident. The orderly sequence of clothing removal may be adapted to facilitate quick exit of personnel from hazardous conditions. In the event of a medical emergency, a decision will be made concerning the priority of decontaminating the patient relative to the potential for life threatening injuries. If a patient is contaminated, outer clothing can be cut off and removed and/or the individual can be wrapped in plastic or a blanket. 10.4. Fire or Explosion In the event of an explosion, personnel will notify the base Fire Department immediate ly. This will occur concurrently with evacuation of appropriate personnel and accounting for personnel. Upon arrival of the fire department, Intercon will advise the fire commander of the location, nature and identification of the hazardous materials onsite. Providing it can be done safely, site personnel may: 1. Use fire extinguishers available on-site to control or extinguish a small, localized fire. 2. Remove or isolate flammable or other hazardous materials that may contr ibu te to the fire. 3. Begin containment and recovery of the spilled materials. 10.5. Spills and Leaks In the event of a spill from a fuel storage tank, personnel will: 1. Inform their supervisor immediately. 2. Locate the source of the spillage and stop the flow if it can be done safely. Health & Safety Plan 18 3. Take corrective actions to prevent similar occurrence. The location of emergency spill response equipment will be indicated on-site drawings and discussed with site personnel during site indoctrination training and periodically in safety meetings. 10.6. Medical Emergencies In the event of a medical emergency , the following procedures shall be implemen ted : 1. Call 911 (for outside emergency services) 2. Request assistance from emergency medical service and/or additional ass istance. 3. Identify location, request medical assistance, provide name and telep hone number. 4. The supervisor will contact the Environmental Health & Safety Officer. Any person who becomes ill or injured in the work area must be decontaminate d to the maximum extent possible. If the injury or illness is minor, full decontaminatio n shou ld be completed and first aid administered prior to transport. If the patient's condition is serious , at least partial decontamination should be completed (i.e., complete disro bing of the victim and redressing in clean coveralls or wrapping in a blanket). First aid sh ould b e administered while awaiting an ambulance or paramedics. All.injuries and ill nes ses must be reported immediately to the Corporate Health & Safety Officer. The firs t aid ki t location will be specially marked and provided with adequate water and oth er supplies necessary to clean and decontaminate bums, wounds, or lesions. 11. Plan Approvals This Plan and all modifications thereto , must be approved by the Corporate Health & Safety Officer or by individuals specifically designated by the Corporate Health & S afety Officer to approve . Health & Safety Plan 19 Att e ntion: This form contain~ information relating 0 S F to empl oyee health and must be used in a manner HA' s o rm 300 1ha1 protects the confidentiality of employees to the Y ea r 2006 extent possible while th e info rmation is being used Log of Work-Related Injuries and Illnesses foroccupation al safetyandhealthpurposes . Occup~;;:f~!!ya~~~:.~:A~~i~:i!~~ ~;.,w:-.-. ·~~~™™~ \\W,;,\,IW , • .__~• at~"3-:.:::im,.™"*. 44,;wv~u~ . _ ,~ .,.~_.,.;;;;;L;;. ;:;:;:;:;;.~;;;;;_,;;;;;;,...;:;,;;;w:,,;;;;.;;;:~;;;;;~;w;;_;;;. ;;;;:;,,,;;.,.;;;.~;;;; .... ;; .• ;..,,cw.., . ..., .. ., .• .,.~.,,"J'G"'"'-~•"'e"*~""·~~ac:;u .. w:;;e:...w:: .. w.,a~~,gi:eyM~W~ You must record information about every work-related injury or illness that involves loss of consciousness, restricted work activity or job transfer, days away from work, or medical treatment beyond first aid . Form approved 0MB no. 1218-0176 You mu st al so record significant work-related injuries and illnesses that are diagnosed by a physician or licensed health care professional. You must also record work-related injuries and illnesses that meet any of the specific recording criteria listed in 29 CFR 1904.8 through 1904.12. Feel free to use two lines for a single case if you need to . You mu st comp lete an injury and illne ss incid ent report (O SHA Form 301) or equivalent form for each injury or illness recorded on this form. If you're not sure whether a case is re cordable , call your local OSHA office for help . Estab li shment name lntercon Environmen tal, Inc. (A) Case No. (B) Empl oyee's Name (C) Job Title (e .g .. Weld er) (D) (E) Date of Where the event occurred (e .g . injury or Loading doc!< north end) o nset of illness (mo./day) Public reporting burden for this collection or information is estimated to average 14 minutes per response, including Ume to review the instruction, search and gather the data needed, and complete and review the collection of infonmation . Persons are not required to respond to the collection of infonmation unless it displays a currenUy valid 0MB control number. If you have any comments about these estimates or any aspects of this data collection , contact US Department of Labor, OSHA Office of Statistics, Room N-3644 , 200 Constitution Ave , NW, Washington , DC 20210 . Do not send the completed forms to this office. (F) Describe injury or illness, parts of body affecte d , and obje cVsubstance that directly injured or made pe rson ill (e.g . Second degree burns on right forearm from acetylene torch) Page totals City Mansfield State Texas Enter the number of days Using th ese categories, check ONLY th e most the inju red or HI wor ke r Check the ·injury" co lu mn or choose serious re sult for each case : was : one type of illn ess : ~,m-:"~~it:W,,,'!J,.M*"1-LWA'W~~Rii'St4Q:$..§~~~~~~ On job Away from transfer or work restriction (days) Job transfer Other record-(days) or restri cti on able c ases (G ) (H) (I) (J) (K) (L) 0 0 0 0 0 0 (M) l(l .; ~ 0 !11 0 c'.' :, C: ::i2 K (/) (1) (2) 0 0 ~ 0 C: -~ ~ 0." "C: QJ 0 er o (3) 0 "' C: ·c g ·5 0.. (4) 0 ~ ~ .; f; 0 '.,' (5) 0 ~ .; ('.' C "' "' :, ~ 0 .Q C: QJ ·c " Be su re to transfer th ese totals to the S um mary page (Form 300A) before you post it. £ -~ ~ 0 0 "' " " QJ 0 i8 ·5 ~ C 0.. .; ::i2 er (/) f; 0 ~ Page 1 of 1 (1) (2) (3) (4) (5) OSHA's Form 300A Year 2006 • U.S. Department of Labor Occupational Safely and He11lth Adminlstrallon Summary of Work-Related Injuries and Illnesses ~·-l!l'•••:;;.i(;if,.:C; lNf.'.%&\ '""'fW< 't,!!l&lillffllk*"",'iMf"-*W$,:,CV<'\l?'~'fl:)$'i!''""'"''"~~t:~"'-·"'""'·---.. ·"W""""""""""""'W"'·~·"' .. "'"'·*"'*"'"·"'·""·"'-""'*6!"'·""''"·~·~ ..... ,,,,,.a,.,:,,.s,,.,."'$;,.., ~~~., .......... w .. ,,,,,.-.,,,.,..,,.. • ..,"W"'iW"'--""".J(\'"""''·"'· ..... '"'·-"""""''"'"""''"·"''"''*m-mo--t•·~ Alf es tablishments covered by Part 1904 must complete this Summary page, even ;r no injuries or illnesses occurred during the year. Remember to review the Log to verify that the entries are complete Using the Log, count the indNiduat entries you made for each ca tegory. Then write the totals below, making s ure you've added the entries fro m every page of the log. If you had no cases write "O." Employees former employees, and the ir represen ta tives have th e right to re vie w th e OSHA Form 300 in its entire ty. They a lso have limn ed access to the OSHA Form 301 or its equivalent. See 29 CFR 1904 .35, in OS l-fA 's Recordkeeping rule , for further de tails on Ille access provisions for these form s . Tota l number of deaths 0 (G) Total number of days of job transfer or restricti on 0 (K) Total number of.. (M) (1) Injury (2) Skin Disorder (3) Respiratory Condition Total number of cases with days away from wor k 0 (H) 0 0 0 T otal numbe r of cas es with job transfer or restriction 0 (I) Total number of days away from work 0 (L) (4) Poisoning (5) All other illnesses To tal number of other re co rdable cases 0 (J) 0 0 Post this Summary page from February 1 to April 30 of the year following the year covered by the form Pub lic reporting burden for this collection of information is estimated to average 50 minutes per response. including time to review the instruction. search and gather the data need ed, and complete and review the collection of information . Persons are not required to respond to the collection of information unless tt displays a curre ntly valid 0MB control number. If you have any com ment s abo ut these es timates or any aspects of th is data collection , contact: US Department ot Labor, OSHA Off~ of Statistics. Room N-3644 , 200 Const~ution Ave , NW , Washington, DC 20210 . Do not send the com pleted fonns to this off"ice . Estab lishment information Your es tablishmen t mm1e lntercon Environmental, Inc. Stre et 22 14 FM 11 87, Bid 6 Ci ty Mansfield Slate Texas Zip Industry descripti on (e.g ., Manufacture of motor truck tr ail ers) Asbestos, Lead & Mold Abatement Standard Industrial Classifi cation (SIC), if known (e.g., SIC 37 15) 1799 -------- Employment Information Annual average number of employees 55 Total hours worked by all employees last year ~~SO Slgoho,o v~~ Knowingly falsifying thi s d ocument may result in a fine . I certify that I have examined this document and that to the bes t of my knowledge the entries are true, accurate, and complete. Karen Andrews President Company executive Title Form app,oved OMBno. 12 18-0176 76063 817 -477 -9995 9/22/2006 Ph one Date OSHA's Form 300 Lo g of Work-Related Injur ie s and Il lne sses Atte ntion: This form contains information relating to employee health and musl be used in a manner lhal protects th e confidentiality of employees lo the extent possiblo while the information is being used for occupali onal safety and health purposes . Ye a r 2005 U .S. Department of Labor Occ upational Safely and Health Administrati on U,;"!$'8o'tt~"i.:.. ~~~~~·#'-fiJtM'-#·~,~M~b!Jli''!l4 ... .,li>'fr.&Wt«J!iiiS~-~~$K~MO,j*'·SW-'·'W:·1'l-W¥if!\;.+i,~*.l\il\Z4ffl44..J~~~rtt,%4k:J.J4i.iJWi.;a.:,~><l~~~ You must record info rm ation about every work-related injury or illness that involves loss of consciousness, re stricted work activity or job transfer , days away from wo,k, or medical treatment beyond first aid . Form approved 0MB no. 121 8-0176 You must also record sig nifica nt work-rel ate d injulies an d illnesses Ulal are diagnosed by a physician or licensed healUl care professional. You must also record work-related injuries and illnesses lhal meet any of the specific recording crileria li sted in 29 CFR 1904 .6 lhrough 1904 .12 . Feel free lo use two lines for a single case if yo u need lo . You mus! complete an injury and illnes s in cide nt report (O SHA Form 301) or equivalent form for eac h injury or illne ss reco1 ded on this form . If you're not sure whether a case is recordable , call your local OSHA office for help . Estab li shment na me lnt erco n Environme nta l, In c. (A) Case No. (B) Employee's Name (C) Job Title (e .g .. Welder) (D) Date of injury or onset of illness (mo./day) (E) Where the event occurred (e .g. Loading dock north end) Public reporting burden for this collection of information is estimated lo average 14 minutes perresponse, including time to review the instruction, search and gaUler Ole data needed , and complete and review Ole collectio n of in formatio n. Perso ns are not required lo respond lo the collection of information unless il displays a curre ntly valid 0MB control number. If you have any comments about these estimates or any aspects of this data collection, contact US Department of Labor . OSHA Office of Statistics , Room N-3644, 200 Constitu tion Ave, NW . Washington, DC 202 10. Do not send Ole completed forms lo this office . City •mt·t. ,,, 7"'.m""1'l#f~*~,-~""-'ill/~~lf£ftfi.ef.1G!\Se .,~::;-F Mansfi eld (F) Describe injury or illness. parts of body affected, and objecVsubstance that directly injured or made pe rson ill (e.g . Second degree burns on right forearm from acetylene tor ch) Page totals Using these catego ri es. check ONLY the mo st serious result fo, each case: Job transfer Othe r record - or restriction able cases (G) (H ) (I) (J) 0 0 0 0 E nter the number of days the injured or ill wo rker was: On job Away from transfer or work restricti on (days) (days) (K) (L) 0 0 Be su re to tra nsfer th ese totals to th e Summ ary page (Form 300 A) before yo u pos t it. Page 1 of 1 State Texas Check the Minjury " column or choose one type of ill ness : --(M) (1) 0 ~ :, £ (1) .; ~ 0 <ll 0 ~ (/) (2) 0 .; " 0 .!'1 0 C x (/) (2) (3) (4) (5) 0 0 0 ~ C O> <ll -~ t C ., ·c <ll <ll 0 " <ll 0.. 0 '6 ~ ~ u (l_ ai a: '5 ;,: (3) (4) (5) OSHA's Form 300A Year 2005 Summary of Work-Related Injuries and Illnesses U .S. Department of Labor Occupational Safety and Health Admlnlslretlon ~~~"''7'~~-~~~~~~~af! .. w,...:,..;:;..,:./ilkrifi"'c'~~-=--------------.,_,,,. __ ...,.,,,..,.,,_,.z,.,.,.,.,.,._,,,.~ .. -"u"~"'"""'"'·"'""""'"·;,"''"" __ .,., __ w,,~~ Fo nn approved 0MB no. 12 10-0176 All establishments covered by Part 1904 must complete this Summary page, even if no injuries or illnesses occurred during th e year. Remember to review the Log to verffy that the entries are complete Us ing the Log, count the individual entries you made for each category. Then write the totals below, making s ure you've added the entries from every page of the log. If you had no cases wr#e "O. • Employees former e mployees, and their representatives have the righ t lo review the OSHA Form 300 in its entirety. They also l1ave limited access to the OSHA Form 301 or ff s equivalent. See 29 CFR 1904 .35, in OSHA 's Recordkeeping rule, for further details on the access provisions for these forms . Total number of deaths 0 (G) Total number of days of job transfer or re striction 0 (K) Total number of .. (M) (1) Injury (2) Skin Disorder (3) Resp iratory Condition Total number of cases with days away from work 0 (H) 0 0 0 Total number of cases with job transfer or restriction 0 (I) Total number of days away from work 0 (L) (4) Poisoning (5) All ot her illnesses Total number of othe r recordable cases 0 (J) 0 0 Post this Summary page from February 1 to April 30 of the year following the year covered by the form Public reporting burden for this collection of in formation is estimated to average 50 minutes per response , including time to review the instruction , search and gather the data needed, and complete and rev iew the collection of infonnation . Persons are not required to respond to the collection of infonnation unless ~ displays a currently valid 0MB contro l number. If you have any comments about these estimates or any aspects of this data collection, contact: US Department of Labor, OSHA Office of Statistics , Room N-3644, 200 Const~ution Ave , NW, Washington , DC 20210. Do not send the completed fonns to this office. Establishment information Your establishment name lnterc on Environmental, In c. Street 2214 FM 1187, Bldg 6 Cily Mansfield Slate Texas Zip Industry desc ription (e .g., Manufacture of motor tru ck trailers) Asbestos , Lead & Mold Abatement Standard Industr ial Classification (SIC), if known (e .g ., SIC 3715) 1799 Employment information Annual average numbe r of employees 35 Total hours worked by all employees last year Sign here Knowingly fal sifying this document may result in a fine. I certify that I have exam ined this document and that to the best ot my knowledge th e entries are true , accurate, and complete. Karen Andrews President Company executive Title 817 -477-9995 Phone Date 76063 t/1/2006 Attention : This form contains information relating 0 SH A l F to employee health and must be used in a manner s orm 300 that protects the confidentiality of employees to the Y ear 2 004 extent possible while 1he information is being used Log of Work-Related Injuries and Illnesses foroccupati onal safe~andhealthpurposes. Occu~t;;~l~::aa~n;::~:A~~i;;!~~~ ~~>'·M~~,M.®. ~s O 44 ~··, CM C §4'f.?4li'.Q a .tt ZWW4M • U.tW •;Q!!ai.;,11;.JUm.k '~"f-"--'"--·"'A®'1'!'tQt"11"''-""'"''"''""'*"''-~;;;;;_;;;;;; .. ;;,;,;,..;;-;;;,;;; .. ;:;;;,.;;; .. ;;;, .,,;;,;.;;;; .... ;;*"";;. ;;;;;;;;;;;;;;;,1;;;w~-·=-...... ;; ______ ~, ... _ .... _,,..;... _______ ,_,..,, You must record information about every work -rel ated injury or illness that involves loss or consciousness, restric ted work activity or job transfer, days away from work, or medical treatment beyond first Form approved 0MB no. 12 18 -0 176 aid . You must also record signifK;ant work.related injuries and ill nesses that are diagnosed by a physic ian or licensed health care professio nal. You must also record work -related injuries and illnesses tha t meet any of the specific recording criteria listed in 29 CFR 1904 .8 through 1904 .12. Feel free lo use two lines for a single case if you need lo . You must complete an inju,y and illness incident report (OSHA Form 301) or equivalent form for each inju,y or illness recorded on th is form . If you're not sure whether a case is reco rdable , call your local OSHA office for hel p. Establishment name lntercon Environme ntal, Inc . (A) Case No. (8) Employee's Name (C) Job Title (e.g ., Welder) (D) Date of injury or onset of illness (mo ./day) (E) Whore the event occurred (e .g. Loading dock north end) Public reporting burden for this collection of information is estimated lo average 14 minutes per re spo nse , including lime to rev-,w the instruction, se arch and gather lhe data needed , and complete and review the collection of information . Persons are not req uired to respond lo the collectio n of information unle ss ~ displays a currently valid 0MB control number. If you have any comments about these estimates or any aspect s of thi s data collec tion , contact : US Department of Labor, OSHA Office of Statistics, Room N-3644 . 200 Constitution Ave , NW. Wash ington , DC 202 10. Do not send the completed forms to this offK:e . City Mans field State _T_e_x_a_s ______ _ 'ii~.,_,,. -~111,~lfy the C8.Se 7'' ',<>,~tM,.,,,~,'}l"'li,"''''" •"''?';j;; .~~\J.'~ 6 ~w .. _ -~:;_,,,,' :¥QtJ (F) Describe injury or illness , parts of body affected, and object/substance that dir ec tly injured or made person ill (e .g. S econd degree burns on right forearm from ace~lene torch) Page totals Enter the number of days Using these categ ories, check ONLY the most the injured or ill worker Check the "injury" column or choo se serious result for each case: was: one type of illness: ;;usaaua::;.,;;;,;:;iiliiikJWJ™•·AAM~~1$;;\iW~~~~~ (M) "' " On job Away from "' Iii "' " trans fer or work ~ c:-~ 0 0 C en restri ctio n (days) "' ~ .g C Iii i5 ·2 Job transfer Other record · (days) c:-·a. i5 0 £ :, C VI C ·5 0 or restriction able cases :i: " 0 £ (/) a: u n_ ~ (G) (H) (I) (J) (Kl (l) (I) (2) (3) (4) (5) 0 0 0 0 0 0 0 0 0 0 0 c:-Iii ~~ en "' :, ~ C " "' Be sure to transfer these totals to the Summary page (Form 300A) before you post it. £ ·2 0 -[ l 0 "' "' "' " i5 ·5 ~ C i3u n_ Iii :i: a: (/) t ~ Page 1 of 1 (1) (2) (3) (4) (5) OSHA's Form 300A Year 200 4 Summary of Work-Related Injuries and Illnesses U .S. Department of Labor Occupational Safety and HHlth Admlnlslrallon ~--.. ,,,_,._,,_"!IL ___ .......... .,.,,_.,.,g_t.:WWW_0 _____ .4...,;,,,,,io .. _.,_ ....... .,,.. ......... ,,,,D.,,.UU ...... <!O-"'O""QQO"-WW,,O ... ,O .. ~--W.~ .... .,,,s::_,.~ ...... ,."",c'"'"'"·"'"'""'"WWW""""'''™",.__.,. ........ ., ... N .... W!MC,W""'·l!"9W' .... "~""''"*4-'~'·Jt3\ll'.l,l,!-... ~ .. --"' ..... i"'?"'G""".-.... ___ ... , ....... ..., .................... -_._.,,..,_ .. ,._...., _____ ,.. __ .,, __ ... All establishm ents covered by Part 1904 must complete this Summary page, even if no injuries or illnesses occurred during th e year. Remember to review th e Log to verify that the en tries are complete Using the Log, co unt the individua l entries you made for each ca tegory. Then write th e totals below, making sure you've added the entries from every page of the log . If you had no cases write "O. • Employees former employees, and their represen tatives have the right to review the OSHA Form 300 in its entirety. They also have limited access to the OSHA Form 301 or its equivalent. See 29 CFR 1904 .35, in OSHA 's Recordkeeping rule, for furth er details on the access provisions for th ese form s. Total number of deaths 0 (G) Tota l number of days of job tr ansfer or res triction 0 (K) Total numb er of ... (M) (1) Injury (2) Skin Disord er (3) Res piratory Condition Total number of cases with days away from work 0 (H) 0 0 0 Total number of cases with job transfer or restriction 0 (I) Total numb er of days away from work 0 (L) (4) Poisoning (5) All other illnesses Total number of oth er recordable cases 0 (J) 0 0 Post this Summary page from February 1 to April 30 of the year following the year covered by the form Public reporting burde n for th is collection of information is estimated to average SO minutes per response, includ in g time to review th e in struction. search and gather the data needed. and complete and review the co lle ctio n of information . Persons are not requ ire d to respond to the collection of info rmatio n unless it displays a curre ntly val id 0 MB con trol number . If you have any comments abou t these estimates or any aspects of th is data collectio n. con tact: US Departmen t of La bor. OSHA Office of Statis tics . Room N-3644 . 200 ConsUtulion Ave . NW. Washinoto n. DC 20210 . Do not send the comoleted forms to this office . Form approved 0 MB no . 12 18-0 176 Establishment information Your establishment name ~ln~t~e~rc~o~n~E~n~v~ir~o~n~m~e~n~ta~I~, l~n~c~. ------------ Street 22 14 FM 1187, Bldg 6 City Mansfi eld State Texas Zip Industry description (e .g ., Manufacture o f motor truck trailers) A sbestos A batement Standard Industria l C lassification (S IC ), if known (e .g ., SIC 3715) 1799 -------- Employment information Annual average number o f employees __ 3_5 Total hours worked by all employees last year L\D,409 Sign here Knowingly fa lsifying thi s document may result in a fine . 76063 I certify that I have examined this document and that to the best o f my knowledge the entries complete. Karen Andrews President Title 8 17-477-9995 1/1/2005 Phone Date Page 1 of 1 City of Fort Worth, Texas Mayor and Council Communication COUNCIL ACTION: Approved on 5/1/2007 DATE: Tuesday , May 01, 2007 LOG NAME: 52REV1SEINTERCO REFERENCE NO.: **C-22094 SUBJECT: Rescind Award of Contract to lntercon Environmental Services, Inc., and Authorize Execution of a Contract with lntercon Environmental , Inc ., for Removal, Packaging , Transportation and Disposal of Asbestos-Containing Materials and Mold Contaminated Materials from City-Owned Facilities RECOMMENDATION: It is recommended that the City Council : 1. Rescind the award of contract to lntercon Environmental Services , Inc .; and 2. Authorize the City Manager to execute a contract with lntercon Environmental, Inc. for removal , packaging , transportation and disposal of asbestos-containing materials and mold contaminated materials from City-owned facilities , for a one year contract with two successive one-year renewal options with an annual fee not to exceed $50 ,000 for each contract year. DISCUSSION: On March 6 , 2007 , (M&C C-21997) the City Council authorized the City Manager to execute a contract with lntercon Environmental Services , Inc., Subsequent to Council approval , it was determined that the legal name of the entity should be lntercon Environmental , Inc., rather than lntercon Environmental Services , Inc. lntercon Environmental , Inc ., is in compliance with the City 's M/WBE Ordinance by comm itting to 10 percent M/WBE participation . The City 's goal on th is project is 10 percent. FISCAL INFORMATION/CERTIFICATION: The Finance Director certifies that funds are available in the current operating budget, as appropriate , of the Environmental Management Fund .. TO Fund/Account/Centers Submitted for City Manager's Office by: Originating Department Head: Additional Information Contact: FROM Fund/Account/Centers R103 539120 0524106 $50 ,000.00 Libby Watson (6183) Brian Boerner (6647) Michael Gange (6569) http ://www.c fwne t.org/council_packet/Rep orts/mc_print.a sp 6/4/2 007 I • CIT Y SECRETA r- CONTRACT NO ~ 35°33 - STATE OF TEXAS COUNTIES OFT ARRANT DENTON AND WISE SECOND EXTENSION OF CITY SECRET ARY CONTRACT NO 35339 THIS SECOND EXTENSION to City Secretary Contract No. 35339 (hereinafter "Extension") is entered into by and between the City of Fort Worth ("City"), a home-rule municipality in the State of Texas , acting through Fernando Costa, its duly authorized Assistant City Manager, and Intercon Environmental , Inc ., a corporation registered in Texas, acting through Karen Andrews , its duly authori z ed President, hereinafter called "Contractor". WHEREAS , the City and Contractor entered into that certain agreement identified as City Secretary Contract No. 35339 (also the "Contract") commencing on May 15, 2007 and ending May 14 , 2008 with two consecutive one year renewal terms for removal , packaging, transportation and disposal of asbestos-containing and mold-contaminated materials from City owners facilities ; and WHEREAS , the City and Contractor wish to exercise the second extension option ; WHEREAS , the parties agree that all other conditions , terms and pricing shall remain the same as stated in City Secretary Contract No. 35339. NOW, THEREFORE, for and in consideration of the mutual covenants contained herein, and other good and valuable consideration , the receipt and sufficiency of which are hereby acknowledged and confessed, the parties hereto agree as follows: The Contract with Intercon Environmental, Inc ., for the removal, packaging, transportation and . disposal of asbestos-containing and mold-contaminated materials from City owned facilities known as City Secretary Contract No. 35339 shall be extended pursuant to Article 1 "Term " for its second one (1) year renewal beginning May 15 , 2009 and ending May 14, 2010. Seco nd Renewa l of lnt erco n Enviro nm ent al, In c. Co nt rac t C RL 10.26 .06v l -1- OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX 04 -7J -0 9 PC3 :'fo I N I • Page 2 of 2 Signature Page for Intercon Environmental, Inc. Contract Extension Executed this \ ~th day of _A ___ fh--~-' 2009. CITY OF FORT WORTH ~ .. ~r::L -Fernando Costa Assistant City Manager Approved as to Form and Legality: ~?t /l----- Assistant City Attorney Attest: City Secretary con tract Authorizati o • Date Seco nd Renewal of lnte rcon Enviro nm enta l, In c . Contract CRL I0 .26 .06 vl INTER CON ENVIRONMENT AL, INC. By ~ Karen Andrews President Witness : Narr{e: Dora Gomez -2- OFFICIAL RECO~D t CITY SECRETARY FT. WORTH, TX City of Fort Worth, Texas Mayor and Council Communication COUNCIL ACTION: Approved on 5/1/2007 DATE: Tuesday, May 01, 2007 REFERENCE NO.: **C-22094 LOG NAME: 52REVISEINTERCO SUBJECT: Rescind Award of Contract to lntercon Environmental Services , Inc ., and Authorize Execution of a Contract with lntercon Environmental , Inc ., for Removal, Packaging , Transportation and Disposal of Asbestos- Containing Materials and Mold Contaminated Materials from City-Owned Facilities RECOMMENDATION: It is recommended that the City Council : 1. Rescind the award of contract to lntercon Environmental Services, Inc.; and 2. Authorize the City Manager to execute a contract with lntercon Environmental, Inc . for removal, packaging , transportation and disposal of asbestos-containing materials and mold contaminated materials from City-owned facilities , for a one year contract with two successive one-year renewal options with an annual fee not to exceed $50 ,000 for each contract year. DISCUSSION: On March 6 , 2007, (M&C C-21997) the City Council authorized the City Manager to execute a contract with lntercon Environmental Services, Inc., Subsequent to Council approval, it was determined that the legal name of the entity should be lntercon Environmental, Inc ., rather than lntercon Environmental Services , Inc . lntercon Environmental , Inc ., is in compliance with the City 's M/WBE Ordinance by committing to 10 percent M/WBE participation. The City's goal on this project is 10 percent. FISCAL INFORMATION/ CERTIFICATION: The Finance Director certifies that funds are available in the current operating budget, as appropriate, of the Environmental Management Fund .. FUND CENTERS: TO Fund/Account/Centers CERTIFICATIONS: Submitted for City Manager's Office by: Originating Department Head: Additional Information Contact: ATTACHMENTS No attachments found. FROM Fund/Account/Centers R103 539120 0524106 Libby Watson (6183) Brian Boerner (6647) Michael Gange (6569) $50,000 .00