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HomeMy WebLinkAboutContract 40678CITY SECRETARY <-/ ol/J-t ~ CONTRACT NO. . · -· CONTRACT Between CITY OF FORT WORTH and INTERCON ENVIRONMENTAL, INC. For Removal, Packaging, Transportation and Disposal of Asbestos-Containing Materials and Mold Contaminated Materials from City-owned Facilities DEM 10-04: ACM Environmental Management Department July 2010 FT. WORTH, TX 08-11-10 AJ9:53 IN STATE OF TEXAS COUNTY OF TARRANT § § § KNOWN ALL BY THESE PRESENTS : This Contract is entered into by and between the City of Fort Worth ("City"), a home-rule municipality located within Tarrant, Denton, Parker, and Wise Counties, Texas, acting through Fernando Costa, its duly authorized Assistant City Manager, and lntercon Environmental, Inc., a Texas corporation ("Contractor"), acting through Karen Andrews, its duly authorized President. City and Contractor may be referred to herein individually as a Party, or collectively as the Parties . WITNESS ETH: That for and in consideration of mutual covenants and agreements herein contained, the Parties hereto mutually agree as follows: ARTICLE 1. DEFINITIONS Q!Y means the City of Fort Worth. Change Order means an officially authorized and executed written amendment to this contract or to a Task Order, issued by the City. Contract Documents means the this contract, Request for Proposals , Request for Qualifications, attachments, pre-bid amendments, and appendices to the, the Contractor's response to the Request for Proposal/Qualifications, and all ancillary documents submitted with the Contractor's response to the Request for Proposal/Qualifications . Contractor means lntercon Environmental, Inc. Notice to Proceed means the official letter issued by the City , pursuant to the Code of the City of Fort Worth and City ordinances and policies that authorizes Contractor to begin work . Task Order means an officially authorized and executed written description and specification directing the Contractor to perform specific services within the scope of this contract, issued by the City. Professional Services Contract -Asbestos & Mold O & M lntercon Environmental , Inc. OFFICIAL RECORD CITY SECRETARY FT. WO ijeT-?<o t g ARTICLE 2. SERVICES Contractor hereby agrees to perform as an independent contractor the services set forth in the Scope of Work attached hereto as Attachment "A ". This contract is to provide the City of Fort Worth with professional services for environmental consulting projects during the term of the agreement. There is no guarantee of work granted by th is contract and nothing in th is contract is to be construed as an exclusive agreement with the contractor to provide the City with professional services of this type , or as an agreement by the City to guarantee the Contractor any specific projects or quantities of work . THERE IS NO MINIMUM GUARANTEE OF ANY WORK UNDER THIS CONTRACT. Individual projects will be authorized on a Task Order basis when the City elects to proceed with each specific effort . City shall not pay for any work performed by Contractor or its subcontractors , subcontractors and/or suppliers that has not been spec ifically ordered by the City in writing on a duly executed Task Order or Change Order. Contractor shall not be compensated for any work that is verbally ordered by any person and shall rely only upon written authorizat ion to conduct work. ARTICLE 3. COMPENSATION Section 1. Fee Schedule. City and Contractor agree to the unit prices, employee labor rates, and other costs as specified in this contract. Contractor shall be compensated in accordance with the Fee Schedule shown in Attachment "B''. Payment shall be considered full compensation for all labor, materials, supplies , and equipment necessary to complete the services described in Attachment "A ". However the total fee paid by the City shall not exceed a total of fifty thousand dollars ($50,000) and the City will not be liable for any Contractor fees, costs, or other remuneration in excess of this amount unless the City has signed and issued a formal modification to this contract. Sect ion 2 . Task Orders . City will issue a Task Order to Contractor that details the work to be perfo rmed by the Contractor . Task Orders will include at a minimum a unique Task Order Number, project address , scope of work , date to commence work , time period to complete work and the not to exceed payment amount for the task . Professional Serv ices Contract -Asbestos & Mold O & M lntercon Env ironmental , Inc. r--------~ OFFICfAL ~ECORD CITY SECRETARY fT. WO ~IJi, I~ 1 ! Section 3. Invoice and Payment. The Contractor shall provide monthly invoices to the City. All invoices must reflect the City Task Order number. Invoices shall contain a detailed breakdown to include: labor including employee name , functional title, date and hours of work performed; internal supplies and services provided ; and external supplies and services provided . Payment for services rendered shall be due within thirty (30) days of the uncontested performance of the particular services so ordered and receipt by City of Contractor's invoice for payment of same. In the event of a disputed or contested billing, only that portion so contested may be withheld from payment, and the undisputed portion will be paid . No interest will accrue on any contested portion of the billing until mutually resolved. City will exercise reasonableness in contesting any billing or portion thereof. The Contractor shall also provide the City with quarterly updates showing the total and itemized costs incurred to the City for each task ordered and the amount remaining in the contract not-to-exceed amount. Contractor shall receive no additional compensation for work delays or hindrances except when direct and unavoidable extra costs to the Contractor are caused by the City 's gross negligence. ARTICLE 4. TERM Unless terminated pursuant to the terms herein, this Agreement shall be for a term of one year, beginning upon the date of its execution. In addition, the term may be extended by mutual agreement of the parties, for up to two (2) one-year terms. ARTICLE 5. INDEPENDENT CONTRACTOR Contractor shall operate hereunder as an independent contractor , and not as an officer , agent , servant , or employee of the City. Contractor shall have exclusive control of and the exclusive right to control the details of its work to be performed hereunder and all persons performing same , and shall be solely responsible for the acts and omissions of its officers, agents, employees , contractors and subcontractors . The doctrine of respondeat superior shall not apply as between City and Contractor, its officers, agents , employees, contractors, and subcontractors, and nothing herein shall be construed as creating a partnership or joint ,venture between City and Contractor. · Professional Services Contract -Asbestos & Mold O & M lntercon Environmental, Inc. OFFICIAL RECORD CITY ~ Y FT. WORTH, TX ARTICLE 6. PROFESSIONAL COMPETENCE AND INDEMNIFICATION Work performed by Contractor shall comply in all aspects with all applicable local , state and federal laws and with all applicable rules and regulations promulgated by the local , state and national boards , bureaus and agencies. Approvals issued by the City or another entity shall not constitute or be deemed to be a release of the respons ibility and liability of Contractor or its officers , agents, employees , contractors and subcontractors for the accuracy and competency of its services performed hereunder, which shall be performed in accordance with the appl icable professional standard of care. In accordance with Texas Local Government Code Section 271 .904 , the Contractor shall indemnify, hold harmless , and defend the City against liability for any damage caused by or resulting from an act of negligence , intentional tort, intellectual property infringement , or failure to pay a subcontractor or supplier committed by the Contractor or Contractor's agent, contractor under contract, or another entity over which the Contractor's exercises control. ARTICLE 7. INTELLECTUAL PROPERTY Section 1. Rights in data. The City shall have unlimited rights in all data delivered under this contract, and in all data first produced in the performance of th is contract. Section 2. Intellectual property rights and ownership . All work product developed by Contractor under this contract shall be the so le property of the C ity and the City shall have unlim ited rights in such work product. All work product developed by Contractor under this contract shall be considered "work for hire " and rights, title , and interests to all intellectual property shall vest in the City. Contactor affirmatively , by executing this contract , disclaims all such intellectual property interests in favor of the City . In the event that any rights , title , or interest shall by operation of law or otherwise fail to vest in the City or become void or vo idable , Contractor shall a) transfer all rights , title , and interest to intellectual property to the City ; or alternatively and at the discretion of the City the Contractor shall b) grant an unlimited and exclusive license for publication , sale , reproduction , or use by the i and its authon ed sublicensees of all intellectual property developed rr A C ct. Contractor agrees to timely execute any documents or t k i¥; ttR>Yi as : ~rqfess ional Services Contract -Asbestos & Mold O & M , lntercon Environmental , Inc . FT. WOR TH, TX may reasonably be necessary, or as the State may reasonably request, to perfect the State's ownership, license, or other rights to any work product. Contractor shall not use , sell, transfer, or authorize a third party to use any work product, copyrights, trademarks, or other intellectual property (or derivatives thereof) of the work product developed under this contract without the express written consent of the City . ARTICLE 8. INDEMNIFICATION Section 1. Definitions. In this paragraph, the following words and phrases shall be defined as follows: 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 work performed under this contract or by the operations of the Contractor and Subcontractors, and including without limitation: a. Damages for personal injury and death, or injury to property or natural resources; b. Fees incurred for the services of attorneys, consultants , contractors, experts, laboratories and investigation or remediation of the monitoring wells or 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 subdivision , 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 w,.· --...w::.w.i:2-__ J ;· ,.referenced . in subparagraph (b) herein. Professional Services Contract -Asbestos & Mold O & M lntercon Environmental , Inc. OFFICIAL RECORD CITY SECRETARY ,TX Environmental requirements shall mean all applicable present and future statutes , regulations , rules, plans , authorizations , concessions , franchises , and similar items, of all governmental agencies , departments, commissions, boards, bureaus, or instrumentalities of the United States, states , and political subdivisions 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 tox ic substances, materials , or wastes whether solid, liquid, or gaseous in nature, into the air, surfacewater, groundwater, stormwater, or land, or relating to the manufacture, processing , distribution, use , treatment, storage , disposal, transport , or handl ing 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. Section 2. General Indemnification. CONTRACTOR DOES HEREBY RELEASE, INDEMNIFY, REIMBURSE, DEFEND, AND HOLD HARMLESS THE CITY, ITS OFFICERS, AGENTS, AND EMPLOYEES, FROM AND AGAINST ANY AND ALL LIABILITY, CLAIMS, SUITS, DEMANDS, OR CAUSES OF ACTIONS WHICH MAY ARISE DUE TO ANY LOSS OR DAMAGE TO PERSONAL PROPERTY, OR PERSONAL INJURY, AND/OR DEATH, OCCURRING AS A CONSEQUENCE OF THE CONTRACTOR'S OPERATIONS UNDER THIS AGREEMENT, WHEN SUCH INJURIES, DEATH, OR DAMAGES ARE CAUSED BY THE SOLE NEGLIGENCE OF CONTRACTOR, ITS OFFICERS, AGENTS, EMPLOYEES, OR CONTRACTORS, OR THE JOINT NEGLIGENCE OF CONTRACTOR, ITS OFFICERS, AGENTS, EMPLOYEES, OR CONTRACTORS AND ANY OTHER PERSON OR ENTITY. Sect ion 3 . Environmental Indemnification . CONTRACTOR DOES HEREBY RELEASE, INDEMNIFY, DEFEND , REIMBURSE, AND HOLD HARMLESS THE CITY, ITS OFFICERS, AGENTS, AND EMPLOYEES, AGAINST ANY AND ALL ENVIRONMENTAL DAMAGES AND THE VIOLATION OF ANY AND ALL ENVIRONMENTAL REQUIREMENTS RESULTING FROM CONTRACTOR'S OPERATIONS UNDER THIS AGREEMENT WHEN SUCH ENVIRONMENTAL DAMAGES OR VIOLATION OF ENVIRONMENTAL REQUIREMENTS ARE Professi<:mal Services Contract -Asbestos & Mold O & M lntercon Environmental , Inc. OFFICIAL RECORD CITY SECRETARY Page 6 of 19 FT. WORTH, TX CAUSED BY THE ACT OR OMISSION OF CONTRACTOR, ITS OFFICERS, AGENTS, EMPLOYEES, OR CONTRACTORS, OR THE JOINT ACT OR OMISSION OF CONTRACTOR, ITS OFFICERS, AGENTS, EMPLOYEES, OR CONTRACTORS AND ANY OTHER PERSON OR ENTITY. Section 4 . The obligations of the Contractor under this Article shall include, but not be limited to, the burden and expense of defending all claims , su its and administrative proceedings (with counsel reasonably approved by the City), even if such claims , suits or proceedings are groundless , false , or fraudulent , and 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 indemn ified persons. Upon learning of a claim , lawsuit, or other liability which Contractor is required hereunder to indemnify , City shall provide Contractor with reasonable timely notice of same . All Contractors under this contract agree that they assume joint and several liability for any claim by the City or for a third party claim against the City for general or environmental damages caused by any of the Contractors herein. The obligations of the Contractor under this paragraph shall survive the expiration or termination of this Agreement and the discharge of all other obligations owed by the parties to each other hereunder. ARTICLE 9. INSURANCE AND BONDS Section 1. Contractor shall not commence work under this Agreement until it has obtained all insurance required under this Article and the City has approved such insurance , nor shall Contractor allow any subcontractor to commence work on its subcontract until all similar insurance of the subcontractor has been so obtained and approval g iven by the C ity ; provided , however, Contractor may elect to add any subcontractor as an add itional insured under its liability policies . A. Insurance coverage and li m its : 1. Commerc ial General Liability Insurance $1 ,000 ,000 each occurrence ; $2 ,000 ,000 aggregate 2. Professional Liability Insurance Not applicable. Professional Services Contract -Asbestos & Mold O & M lntercon Environmental , Inc. OFFICIAL RE qo ~ CfTY SEC TARY ft WORTH, TX 3. Automobile Liability Insurance Coverage on vehicles involved in the work performed under this contract: $1 ,000 ,000 per accident on a combined single limit basis or $500 ,000 bodily injury each person ; $1 ,000 ,000 bodily injury each accident ; and $250 ,000 property damage . The named insured and employees of Contractor shall be covered under this policy. The City of Fort Worth shall be named an Additional Insured, 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 . a . Worker's Compensation Coverage A: statutory limits Coverage B: $100 ,000 each accident $500 ,000 disease -policy limit $100 ,000 disease -each employee 5 . Environmental Impairment Liability (Ell) and/or Pollution Liability $4 ,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). 6. Asbestos Abatement Insurance $2 ,000 ,000 each occurrence with no Sunset Clause , if any abatement is to be performed and prior to commencement of such work. B. Certificates of Insurance evidencing that the Contractor has obta ined 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 Con t racted serv ices .. 2 . Cert ificate (s) of Insurance shall document that insurance coverage specified herein are prov ided under applicable policies documented thereon . 3 . Any failure on part of the City to request documentation shall not constitute a waiver of the ins I : S "'· • ~ • Professional Services Contract -Asbestos & Mold O & M lntercon Environmental , Inc. required insurance requirement . OFFICIAL RECORD CITY SECRETARY FT. WO R , ·j.f 1 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 Department of Risk Management, City of Fort Worth , 1000 Throckmorton Street, Fort Worth, Texas 76102. b. 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 . c. 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. d. Applicable policies shall each be endorsed with a waiver of subrogation in favor of the City as respects the Contract. e. 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. f. The Commercial General Liability insurance policy shall have no exclusions by endorsements unless the City approves such exclusions . g. 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. h. All insurance required above shall be written on an occurrence basis in order to be approved by the City . i. 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 constitut~ a breach by Contractor of the contract. Professional Services Contract -Asbestos & Mold O & M ln.tercon Environmental , Inc. OFFICIAL RECORD CITY SE 9 FT. WORTH, TX ARTICLE 10 . LICENSES AND PERMITS Contracto r certifies and warrants that on the day any work is to commence under this contract and during the duration of the contract it shall have and maintain all of the current, valid , and appropriate federal , state, and local licenses and permits necessary for the provision of services under this contract. Contractor also certifies that if it uses any subcontractor in the performance of this contract , that such subcontractor shall have and maintain all of the current , valid , and appropriate federal, state, and local licenses and permits necessary for the prov ision of services under this contract. ARTICLE 11. TRANSFER OR ASSIGNMENT City and Contractor each bind themselves , and their lawful successors and assigns, to th is Agreement. Contractor has been engaged as a consequence of Contractor's specific and unique skills ; Assignment will only be granted under unusual circumstances and at the sole discretion of the City. Contractor, its lawful successors and assigns , shall not assign , sublet or transfer any interest in this Agreement without prior written consent of the City . ARTICLE 12 . RIGHT TO AUDIT (a) Contractor agrees that the City shall , until the expiration of three (3) years after final payment under this Agreement , have access to and the right to examine any directly pertinent books , documents , papers and records of Contractor involving transactions relating to this Agreement. Contractor agrees that the City shall have access during normal working hours to all necessary facilities and shall be provided adequate and appropriate workspace in order to conduct audits in compliance with the provisions of this section . City shall give Contractor reasonable advance notice of intended audits . (b) Contractor f urther agrees to include in all its subcontracts hereunder, a prov is ion to the effect that the subcontracting contractor agrees that the C ity shall , until the expiration of three (3) years after final payment under the subcontract , have access to and the right to examine any directly pertinent books , documents , papers and records of such subcontractor , involv ing transactions to the subcontract , and further , that City shall have access during normal work ing hours to all subcontractor facilities , and shall be provided adequate and appropriate work space i duct audits in OFFICIAL RECORD :TV SECRETARY Profess ional Services Contract -Asbestos & Mold O a; I H TX Page 10 of 19 lntercon Environmental , Inc. fl. WORT , compliance with the provisions of this article. City shall give Contractor and any subcontractor reasonable advance notice of intended audit. (c) Contractor and subcontractors agree to photocopy such documents as may be requested by the City. The City agrees to reimburse Contractor for the cost of copies at the rate published in the Texas Administrative Code in effect as of the time copying is performed. ARTICLE 13. MINORITY AND WOMAN BUSINESS ENTERPRISE (M/WBE) PARTICIPATION In accordance with City Ordinance No. 15530, the City has goals for the participation of minority business enterprises and woman business enterprises ("M/WBE") in City contracts. Contractor agrees to a minimum M/WBE participation of 10% in accordance with its proposal and the aforementioned ordinance . Contractor acknowledges the M/WBE goal established for this Agreement and its commitment to meet that goal. Any misrepresentation of facts (other than a negligent misrepresentation) and/or the commission of fraud by the Contractor may result in the termination of this Agreement and debarment from participating in City contracts for a period of time of not less than three (3) years. ARTICLE 14. NON-DISCRIMINATION During the performance of this contract, Contractor shall not discriminate in its employment practices and shall comply with all applicable provisions of Chapter 17, Article Ill of the Code of the City of Fort Worth. Contractor agrees not to discriminate against any employee or applicant for employment because of because of age, race, color, religion, sex, disability, national origin , sexual orientation, transgender, gender identity or gender expression in any manner involving employment, including the recruitment of applicants for employment, advertising, hiring, layoff, recall , termination of employment, promotion, demotion, transfer, compensation, employment classification , training and selection for training or any other terms, conditions or privileges of employment. Contractor agrees to post in conspicuous places , available to employees and applicants for employment , notices setting forth the provisions of the non- discrimination clause . 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. Professional Services Contract -Asbestos & Mold O & M lntercon Environmental , Inc. 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. ARTICLE 15. OBSERVE AND COMPLY Contractor shall at all times observe and comply with all federal, state, and local laws and regulations and with all City ordinances and regulations which in any way affect this Agreement and the work hereunder, and shall observe and comply with all orders, laws ordinances and regulations which may exist or may be enacted later by governing bodies having jurisdiction or authority for such enactment. No plea of misunderstanding or ignorance thereof shall be considered. Contractor agrees to defend, indemnify and hold harmless City and all of its officers, agents and employees from and against all claims or liability arising out of the violation of any such order, law, ordinance, or regulation, whether it be by itself or its employees. ARTICLE 16 . DEFAULT If Contractor fails to begin work or to complete work within the time specified in a Task Order City shall have the right to take charge of and complete the work in such a manner as it deems appropriate. If the City exceeds the costs detailed herein or in the Task Order, City may deliver to Contractor a written itemized statement of the excess costs and Contractor shall reimburse the City for such excess costs without delay. If at any time during the terms of this contract, the work of the Contractor fails to meet the specifications of the Contract Documents or to meet the standards of duty, care, or proficiency of a reasonable and competent Contractor, City may notify the Contractor of the deficiency in writing. Failure of the Contractor to correct such deficiency and complete the work required under this contract or a Task Order to the satisfaction of the City within ten (10) days after written notice shall constitute default, and shall result in termination of this contract. Contractor shall not be deemed to be in default because of any failure to perform under this contract if the fa ilure arises solely from causes beyond the control of the Contractor and without any fault or negligence by the Contractor . Such causes shall include acts of God , acts of war or terrorism , fires , floods , epidemics , quarantine restrict ions , labor strikes , freight embargoes , and events of unusually severe weather. ARTICLE 17. TERMI NAT.,!.:IO~N.!-------, , · ProfessLo.nal Services Contract -Asbestos & Mold O lntercon Environmental , Inc. OFFICIAL RECORD CITY SECRETARY .WORTH,TX Page 12 of 19 City may terminate this contract without cause by giving thirty (30) days written notice to Contractor. In the event of termination , any work in progress will continue to completion unless otherwise specified in the notice of termination. If the City terminates this contract under this provision , City shall pay Contractor for all services performed prior to the termination. Termination shall be without prejudice to any other remedy the City may have . All data and completed or partially completed documents prepared under this contract shall be promptly turned over to the City upon termination of this contract. ARTICLE 18 . VENUE AND JURISDICTION If any action , whether real or asserted, at law or in equity , arises on the basis of any provision of this Agreement , venue for such action shall lie in state courts located in Tarrant County , Texas or the United States District Court for the Northern District of Texas -Fort Worth Division . This Agreement shall be construed in accordance with the laws of the State of Texas . ARTICLE 19 . CONTRACT CONSTRUCTION This contract incorporates by reference all contract documents , which shall be binding upon the parties as if included herein . In the event of a discrepancy, this contract shall control over the other contract documents . The Parties acknowledge that each party and , if it so chooses, its counsel have reviewed and revised this Agreement 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 th is Agreement or any amendments or exhibits hereto. ARTICLE 20 . HEADINGS The headings contained herein are for the convenience in reference and are not intended to define or limit the scope of any provision of this Agreement. ARTICLE 21 . COUNTERPARTS This Agreement may be executed in one or more counterparts and each counterpart shall , for all purposes, be deemed an original , but all such counterparts shall together constitute but one and the same instrument. ARTICLE 22 . SEVERABILITY Professional Services Contract -Asbestos & Mold O & M l nte rcon Environmental , Inc. The provisions of this Agreement are severable, and if any word , phrase, clause, sentence, paragraph, section or other part of this Agreement or the application thereof to any person or circumstance shall ever be held by any court of competent jurisdiction to be invalid or unconstitutional for any reason, the remainder of this Agreement and the application of such word, phrase , clause , sentence , paragraph , section, or other part of this Agreement to other persons or circumstances shall not be affected thereby and this Agreement shall be construed as if such invalid or unconstitutional portion had never been contained therein. ARTICLE 23. RIGHTS AND REMEDIES NOT WAIVED In no event shall the making by the City of any payment to Contractor constitute or be construed as a waiver by the 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 the City while any such breach or default exists shall in no way impair or prejudice any right or remedy available to the 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 this 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. All costs and attorneys fees incurred by the City in the enforcement of any provision of this contract shall be paid by the Contractor. The remedies provided for herein are in addition to any other remedies available to the City elsewhere in this contract and by law . ARTICLE 24. NOTICES Notices to be provided hereunder shall be sufficient if forwarded to the other Party by hand-delivery or via U.S. Postal Service certified mail return receipt requested , postage prepaid , to the address of the other Party shown below : If to the C ity : If to the Contractor: City of Fort Worth Department of Env ironmental Management Attn: Brian Boerner, CHMM , Director 1000 Throckmorton Street Fort Worth , Texas 76102-6311 lntercon Environmental , In ·oFFICIAL RECORD CITY SECRETARY Professional Services Contract -Asbestos & Mold O & M lntercon Environmental , Inc. Ft WORTH ge 4 of 19 • t Attn: Karen Andrews 210 S. Walnut Creek Drive Mansfield, TX 76063 ARTICLE 25 . WARRANTY Contractor warrants that it understands the currently known hazards and suspected hazards wh ich are presented to persons , property and the environment by contaminated soils , both generally and with specific regard to this project. 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 state and federal laws governing its activities and is under no restraint or order which would prohibit performance of services under this Contract. ARTICLE 26 . NO THIRD-PARTY BENEFICIARIES This Agreement 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 . ARTICLE 27. ENTIRETY This contract, the contract documents, and any other documents incorporated by reference herein are binding upon the parties and contain all the terms and conditions agreed to by the 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. In the event of any conflict between this contract and any other contract documents, then the terms of this contract shall govern. Rema inder of page is left blank int ent io nally . Profess iQN31 Services Contract -Asbestos & Mold O & M lntercon Env ironmental , Inc . ' OFFICIAL RECORD CITY SECRETARY Ft WORTH, TX Page 15 oT 9 ATTACHMENT A. SCOPE OF WORK The City performs asbestos abatement activities with i n City owned facilities on a routine basis. Asbestos-containing materials (ACM) that may be encountered include but are not limited to floor tile and mastic, transite , thermal system insulation , spray-on fireproofing , wall and ce il ing texture , joint compound , and roofing materials . Contractor will furnish 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 ma intenance activities. THERE IS NO GUARANTEE OF ANY MINIMUM QUANTITY OF WORK UNDER THIS CONTRACT. Types of work which the Contractor will perform upon specific written authorization by the City shall include the following , and related environmental and engineering consulting services: The work required under this contract includes 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-Contaminated Material (if needed). This list is i ntended to be illustrative and not exhaustive , and similar or related serv ices may be o rdered subj ect to the terms of th is contract and as autho ri zed by the City . 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 . Th _e City will perform the following tasks und:~e!...r t~h!!!iS~,llllJr.ilGf:--1 Professional Serv ices Contract -Asbestos & Mold O & M lntercon Env ironmental , Inc. OFFICIAL RECORD CITY SECRE't e 16 of 19 FT. WORTH, TX • Provide Asbestos Assessment Reports and Asbestos Removal Specifications ; • Provide Mold Assessment Reports and Mold Remediation Protocols ; • Provide site contact information ; • Provide site access ; • Provide timely notice to Contractor in writing of ACM or Mold removal projects , detai ling 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 notifications and make necessary amendments. Remainder of page is left blank intentionally. Professional Services Contract -Asbestos & Mold O & M lntercon Environmental , Inc. OFFICIAL RECORD ~ TARY FT. WORTH, TX ATTACHMENT B. FEE SCHEDULE Prices for professional services rendered under this contract will be as specified in the schedule provided in the Contractor 's proposal which follows in this attachment, and entitled "lntercon Contract Fee Schedule". The total fee for services under this contract shall not exceed fifty thousand dollars ($50,000). 2 .5 ~ Initial UNIT COSTS The Table below identifies various types of a sbestos-containing materials (ACM). Contractor shall provide a cost for each type of AC M included on the Table . Toe prices quoted in the table below are for work w ithin norm al conditions {i.e .• up to a maximu m 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, material, and equipment to perform the function. f Standard List o ACM TvMs and unit costs: ACMTvDe COST Ca1118t (ONL Yl $ .7 5 /SF Floor~ Mastic IONL Yl $ 1.30 /SF Floor Tie and Mastic. s 1 .85 /SF Note-: Abcwe IIS'ted nrlt!es mav _be used ALONE or ;n conjunction vrltJI each other. Planer ors1ucco material s 3.1 5 /SF Roof Flashlna s 4 .00 /SF Rnnfina Fell $ 4 .00 /SF ShNtrock Joint Comn,,unll s 2 .25 /SF s-Flreruooftna t'/i Inch to 2 Y. Inch ltllcknessl $ 8.00 /SF Sulfaclna Matartal s 2 .25 /SF Boller ,,.ulatlon $ 7 .00 /SF Rolled-on Textunt $ 1.85 /SF -Texture Ce.ta. D<'lncom celling) $ 1 .8 5 /SF Trawled-on Te>Ctunt $ 1.85 /SF Thermal Swtem Insulation ITSll: ,~ -~ 0 -61nchOD s 14.00 /LF 6.1 -12 Inch OD $ 18.00 JLF >121nch OD s 20 .00 /LF Flttlng O -6 Inch OD each $ 40.00 / flltina Atllna 6.1 -12 Inch OD .$ 5 0.00 /.fittfna · Flttfn9 > 12 Inch 00 ·$ 60.00 / flttfn!I -----Mastic on duct insulation $ 2 .50 /LF TransJlie Material $ 1 .75 /SF waa. ffoor or cetnna flbroos ACM board s 1 .85 /SF List of Services NOT included in Standard List above: b site $ 500.00 I site of ACM Waste $ 18.50 f cubic .. Hou Rates for workers if UNIT PRICE tab le above does not a POSmON HOURLY RA TE Liclensed Asbestos .Abatement Worker ~50 / hour Licensed .Asbestos Su or $ 4 7 .so I hour '. Professional Services Contract -Asbestos & Mold O & M lntercon Environmental , Inc. l IN WITNESS THEREOF , the parties hereto have made and executed this Agreement in multiple originals the day and year first above written , in Fort Worth , Tarrant County, Texas. CITY OF FORT WORTH : Fernando Costa Assistant City Manager INTERCON ENVIRONMENTAL , INC . ~~ Karen Andrews President ~~~. APPROVED AS TO FORM AND LEGALITY: ~j!l /j~-- Arthur N . Bashor Assistant City Attorney ATIEST: Marty Hendrix City Sec retary Angelica Petruzzelli , Executive VP Seal : i\ \\\-i-~u Date · NO M&C REQUIRED Professional. Serv ices Contract -Asbestos & Mold O & M lntercon Environmental , Inc. OFFICIAL RECORD Cl c$ RY FT. WORTH, TX CONTRACTOR COMPLIANCE WITH WORKERS' COMPENSATION LAW Pursuant to V.T .C.A. Labor Code §406.96 (2000), as amended , Contracto r cert ifies that it provides worke rs' compensation insurance cove rage fo r all of its employees employed on City of Environmental Management Department , Project DEM 10-04: Removal , Packaging, Transportation and Disposal of Asbestos-Containing Materials and Mold Contaminated Materials from City-owned Facilities . ST A TE OF TEXAS COUNTY OF TARRANT CONTRACTOR INTERCON ENVIRONMENTAL, INC. Karen Andrews Title President Date __ 7'-'/-=2::....:B""'/-'1"-'0"------------- § § § Before me, the undersigned authority, on this day personally appeared Karen Andrews, President, 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 Interc on Environmental, Inc. for the purposes and consideration therein expressed and in the capacity therein stated . Given Under My Hand and Seal of Office this 28th day of __ J_u~ly __ , 20 1 O Angelica Petruzzelli , Notarv ANGELICA PETRUZZELLI Notary Public, State of Texas My Commission Expires Februory 28. 2012 SU 110 7567 B THE S'fATE OF TEXAS COUNTY OF TARRANT PAYMENT BQND KNOW ALL MEN BY TnESE PRESENTS: That we, Intercon Enviro11ment2I, Inc., hereinafter called Principal and ARCH INSURANCE COMPANY . a corporation organized and existing under the laws of the State and fully 11uthorized to transact business in the State of Texas, as Surety, are held and firmly bound unto the City of Fort Worth, a municipal corporation organized and existing unde r the laws of the State of T exas hereinafter called Owner, in the pena l st1m of: Fifty thousand dollars (SS0,000,00) dollars in lawful money of the United States, to be paid in Fort Worth, Tarrant County, Texas, for the payment o f which sum well and truly be ma.do, we hereby bind ourselves, ou r heirs, execurors, administrators, and succes.sors, jointly and severally, finnly by these presents. THE CONDITION OF THIS OBLIGATION is such that Whereas, the Principal ontered into a certain contract w ith the City of Fort Worth, the O·wner, dated the ___ day of , 2010, a copy of which is hereto auached and made a part hereof, for the provision of: R<1mo-val, Packaging, Transpoi1atioa and Disposal of Asbcst.os-Containing Materials · and Mold Contaminated Materials "from City-owned F:«:ilities designated as Project Number DEM 10-04: ACM a c~py of which contract is hereto attached, referred t o , and made a part hereof as fully and to the same extent as if copies at length herein, such project and constructio n being hereinafter referred to as th~ "work". NOW THEREFORE, if the Principal shall well, truly and faid1fu!ly perform tl1e work in accordanci:, with the plans, specification, and contract do9ument during the original tenn thereof, and any extensions thereof which may be granted by the Owner, with or without notice to the Surety, and if he shall satisfy all daims and demands incurred under such contract, and shall fu lly indemnify and save harmless the 0'1'.'ller from all costs and damages which it may s11ffer by reason of fa ilure to do so, and shall reimburse and repay the ov.-n er all outlax and expense wl1ich the Owner may in cur in making good any default, then this obligation shall be void; otherwise to remain in full force and effect. PROVIDED FURTHER, that if any legal action be filed upon this bond, venue shall lie in Tarn1nt County, State of Texas . AND PROVIDED FURTHER, that the said Surety , for value received, hereby stipulates and agre.¢s that no change, cxfonsion of time, alteration or addition to the terms of the c ontract or to the work to be perfonned thereunder or the specifications accompanying the same shall il1 any wise affect its obligation on this bond, and it does h ereby waive notice of any such change, emension of time alteration or addit io n to th e terms of the contract ot to the work or to the specifications. v0/E0 39';;/d A:JN 39'i1 HVAM L 1 ZH 5Z9£5 zs :s1 010z;sz;L0 - -. IN WI11'·IE.SS WHEREOF, this instnnncnt is executed in _3_ Counterparts each one of which shall be deemed an original, this the 2 9TH day of JUL Y , 2010. AT ~ (Principal) Secretary Karen-Andrews, Secretary ~._:.. 3100 BROADWAY (Address) KANSAS CI TY, MO 6 4 111 urety Secretary \{J__ Note: {I) (}) (3) (4) (SJ Inte.rcon Envirouru.en1al, Inc. Principal (4) .By:~ · Karen Andrews. Presiden t (Printed Name/Title) 210 South Walnut A venue ADDlU..SS Mansfield, TX 76063 CITY/STATE/ZlP ARCH INSURANCE COMPAN Y (Surety) By: t1)rinted Attorney-in-Fact) Date ofBof\d must not be prior to date of Contract Con~c,1 name ofContrac1or A Cerporalion, a P<>rtn.rJh ip or Md 1'14ividual. as ,-cu~ h!lly /Js Corit:cl Name afS~rt(y ifCoN1-ac1or is parltl<fr~hip a/I !'armers s.hou!a execute bone! A tr.ie copy Q.(Pmrer Q/All.orr.cy i!:all be a11ached to bond by A1romey-1n-Facr t,0 /t:>0 39'iid A:::J N391;;1 11 'v AM L u ;n si9 E:6 is:st 010 i1 si1L0 POWER OF ATT.· ORN. EV . . ' SU 110 7567 B Know All Men By These Presents.: That :the Arch Insurance Company, a corporation organized and existing under the laws of the Slate of Missouri, having its principal office in Kansas City, M1$$ouri (hereinafter referred to as tht, ·Company") does hereby appoint William A. Bailey, Maria A. Gonzalez, Anne M. Barber, Michael J. Friedrich and Dana M. Kuber of Bridgeview, IL (EACH} itS 1rue aoc:r lawfuf ~y(s~ to make, execute, seal, and deiiver from the date of issuahce of this power for and on ils behalf as surety, and as 11s act and deed: Any and all bonds and undertaking$ Ea<oepl"ION: NO AUTHORJTY is granted to mllke, ~ .. seal encl deliver bonda .or utid .... kings that guarantee the ~ oreolfeCtion of any ptOmiSIOfY note. check. draft ·• letter· of credit, · This aulhodty does not permit 1he same Obligation to be spit Into two or more bonds In order to bring -=ti such bond fflirl the dol&. llrnlt of ~-as set forth...,. The ·Comparty may revoke this appoi1tment at any time. The ·.~. d .IQGh. bonds 1-ld unclertakings In ~-of ·---:p,reieilla}stlall be 8$ binding upon the said CfQmpaoy .• ·fl111y-, wopty .t,o atJtrtents d purpoaea, • If ... .,.....had~ dilly~ end~ by tts ~eleetadoffltersatlts_~iafflcelnf<ahWOI\Y, ~~~ ,. :>_' '' ;. :·. :. ,. ... -.. • Tht. Power of Attorney is 8X8Cl.lted by 8IJlhority of~ .. adopted by unanin\ous .consem of the · Board of Dilecl0rs of the Company on March 3, 2003. true and -accU.81* copiea of WbiGh ·se .bn.lnaftar set fm1h and are hereby certified to by ._ ~ Secret81y as .being in full force and elfact: "VQTEO, ·~ 1tle Chaimarl.of ..... Board. the~. or .,y··v. Pralldenl.-~ their ~1111 -~· in •wr11n.g and. flied wtlh the Secretary, or tfteSIGa-·Y ehall haWa .the power and ·aultlcdy to appoint ..... and~ and· 10 authorize them to execute .on behalf of the-Company. and attadl the 11881 of the Company theralQ, bonds a,ld undertaklngs •. racogn~ ~ of ...,...lty anti d.,t1,r ·~ ®'iJa.~-y fn '1t ..._ . ......,, •· a.ny ·$Ud'I o.fflcers of the Company rru.y. llJJPOlnt.aganta for ·~ d ptaC88$.. I this. Power cl .Attorney Is ~ ·sealed and tertifled by facsmle under and by authority of the following resolution adopted bythe unanlinousoonsentdtheBoar.dof 'Dlrectors oftheOomPfill'lYCJn March 3,2003: Vrf..'"Pr!r\, .._. .....,. •i..n..e..,,. -.· ·· ........ ,.._ .. ·."" ... · .... -... Board. . . ··. :--~.· or· · *"' "-.. ~~ or· ...... :.. ~. ···.· . ~-·~ •. J .. tJJU U,19 ...,._,..._:v UI ... Wt]Cqtf.1:ICllt VI q .llD . '. t :U .JV . . --...... ~ Y -Ril:I ..-:-, .......... ,~ ·u1111:1111 ~·~ deslgJ1atad in writing and fllecl wflh ht Secrelaly, and the stgnatura of the Seaata._y, the Nal of the Company~ and certlftcatious. by the Seca etay. ma1 • afflxad by facetnle Qfl. l!OY power of attorney or hood· .-dad pqrsuant to the reaoluQaQ ·adOpt,ed by the Baard -~ Directors 00 March 3; 2()03, and any auch power· IO executed, seated and certified with respect to any bond or undeftaking to which It Is attached, shall continue to be valld and binding upon the Company~ -.: r ... .,r_ .. - -~ .... OOML0013 00 03 03 Page 1 of 2 Printed In U.S.A. In Testimony Whereof. the Company has caused this instrument to be. figned and its corporate se;II to be afflxe<!cb~ theiu aµthorized Officers, this 1st <iayef May , 20...QL. Attested and Oertifled STATE OF PENNSYl,.VANIA SS COUNTY OF PHILAOELPHIA ·ss Arch Insurance. Company i, Bdari c. Kuhn, a Notary PUblfc, do hetaby certify that Madin J. NIisen and J •. Michael Pete personalty known -to:me to be the .same persons whose ~ f.V'8 respectlvefy as Seaetary· and Vtce President of the Arch Insurance Company, a r.e:£::::::a.'5s:~:== their own fi9e and voluntary aclsfor·.tbe uses and purposes therairul8l forth. . ~ .. ' ~~~ CetmFICATION I,~ J. :NihSSn, Secfetay ofihe Aroh lflltl'a1Ce ~y~ do ben,t)y oertlfY that the attached ~·of A,1m,neyated May 1, 2008 on behalf of the person(a) as listed above i!J a ti:u.· and correct copy and lt1a.tthe .,. has· been In ful fon:e and effect sinoe the cWa '*9of and is in full ~and~ Qn the: date of this ~; and I clo fur1her car1tfy · that .. eak1 J. Mtcbaef Pete. ·who axec;:uted lie 'Pows d Momey .. Vbt Pntaident. ... QA' the date'-of execution of the altaehed Power of Attorney 1114, duly electad Vice ~t fi thcJ-Amh ·lnllunlnc:e COn,paoy, IN TESTIMONY WHEREOF, I have fltaunto aubscrlbed my name. and aflb<ed 1he ~MV-ata. Companyonthls 29th •Qt JULY, 2010 20 __ . . of u,e . An.:b · Insurance Thlf ·Power of Attorney 11mn.1he .. of those named ·therein to the :bonds and undertakilga apeclfically named ·therein and they have no authority to binc:Uhe Campany exceptin the manner and bthe extent l'Nnin elafad. PLEASE SEND ALL CLAIM ltlQUIRES RELATING TO tHIS IIOND'TOTHE ,FOLLOWING ADDRESS: Atd'ISUrety 3Parkway, Ste.1500 Phfladelphla, PA 19102 OOML0013 00 03 03 Page2of2 Printed In U.S.A. 210 South Wa lnut Creek Drive • Mansfield , Texas 76063 • Phone : (817) 477-9995 • Fax : (817) 477 -9996 ENVIRONMENTAL, INC. www.i nte rco n-en v iro nme nta l .com ORIGINAL SEALED PROPOSAL Project: PROJECT: DEM 10-04: ACM REMOVAL, PACKAGING, TRANSPORTATION, AND DISPOSAL OF ASBESTOS-CONTAINING MATERIALS AND MOLD CONTAMINATED MATERIALS FROM CITY-OWNED FACILITIES Submitted by: lntercon Environmental, Inc. Proposal No. 04-10-039 Prepared for: City of Fort Worth Purchasing Division 1 000 Throckmorton Street Fort Worth, Texas 761 02 Bid Due: April 29, 2010@ 1 :30 P.M. ENVIRONMENTAL , INC. Table of Contents 1) Notice of Intent Request for Proposal Cover Page 1.0 Request for Proposal 2) 2.0 Proposal Documents 2.1 Proposal Document Checklist 2.2 Acknowledgement of Receipt of Addenda 2.3 Proposal Summary 2.4 Scope of Work 2.5 Unit Costs 3) 2.6 Bid Bonds 4) 2.7 MWBE Utilization Requirements: Subcontractors/Suppliers Utilization Form 5) 2.8 Qualifications of the Provider: lntercon's (Bidder) Statement of Qualifications lntercon's Experience -Asbestos I Demolition lntercon's Experience -Mold CBA Services (Subcontractor) Statement of Qualifications 2.9 List of Subcontractors 6) 2.10 Statement of Residency 2.11 Nondiscrimation 2.12 Prevailing Wage Rates 7) 2.13 Insurance Certificates 2.14 Provider's Licenses & Certificates 8) 2.15 Contractor's Legal & Compliance History 9) 2.16 Equipment List 10) 2.17 Other: Requested Sample Documentation, Health & Safety Plan, Health and Safety Records for the Pa st Three (3) Years Angelica Petruzzelli Angelica Petruzzelli From: -,nt: Monday, April 05 , 2010 4 :16 PM 'Grantham , Roger' Subject: Project: DEM 10-04 :ACM -Notice of Intent Importance: High Roger, As per section 1.3 of the proposal documents for Project: DEMl0-04:ACM, lntercon Environmental, In c. is hereby submitting our Notice of Intent. Thank you for the opportunity. Respectfully, A~f'etY~ Executive Vice President lntercon Environmental Inc. 210 S. Walnut Creek Drive Mansfield, Texas 76063 Phone: 817-477-9995 Fax: 817-477-9996 r~11ular: 817-507-8546 , ... ,.)w.intercon-environmental .com 1 Initial PROPOSAL PACKAGE CITY OF FORT WORTH ENVIRONMENTAL MANAGEMENT DEPARTMENT 1000 THROCKMORTON FORT WORTH, TEXAS 76102 FORT WORTH ENvJRONMENTALI\1ANAGEMENT PROJECT: DEM10-04: ACM REMOVAL, PACKAGING, TRANSPORTATION, AND DISPOSAL OF ASBESTOS-CONTAINING MATERIALS AND MOLD CONTAMINATED MATERIALS FROM CITY-OWNED FACILITIES March 26, 2010 Submitted by: lntercon Environmenta l, Inc. Karen Andrews, President Company Name Prysjd enWice-J?.resid~nt -Printed 21 OS . Walnut Creek Drive, Mansfield, Texas 76063 ~~ Address PresidenWice-President -Signature (817) 4 77-9995 ---'-!IAp~n,.,_,·1 2=9'-'--', 2=0'-'-1 O"'------ Telephone Date (817) 4 77 -9996 Fax ~ Initial TABLE OF CONTENTS 1.0 ................................................................................... REQUEST FOR PROPOSALS 1.1 PROJECT DESCRIPTION : 1.2 GENERAL REQU IREMENTS : 1.3 INTERPRETATION OF REQUEST FOR PROPOSAL DOCUMENTS : 1.4 CONFLICTS : 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 CONTRACT TIME: 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 SCOPE OF WORK 2.5 UNIT COSTS 2.6 BONDS 2.7 MINORITY AND WOMEN BUSINESS ENTERPRISE (M/WBE) UTILIZATION REQUIREMENTS 2 .8 QUALIFICATIONS OF THE PROVIDER 2 .9 LIST OF SUBCONTRACTORS 2.10 STATEMENT OF RESIDENCY 2.11 NONDISCRIMINATION 2.12 PREVAILING WAGE RATES 2.13 INSURANCE CERTIFICATES 2.14 PROVIDER 'S LICENSES & CERTIFICATES 2.15 CONTRACTOR 'S LEGAL AND COMPLIANCE HISTORY 2.16 INVENTORY OF EQUIPMENT 2.17 OTHER ~ Initial 1.0 REQUEST FOR PROPOSALS 1.1 PROJECT DESCRIPTION: Proposals a re being accepted by the City of Fort Worth (City) for the furnishing of all labor, materials a nd equipment necessary for the removal , packaging , transportation , and disposal of asbestos-containing materials and mold contam i nated materials from City- owned facilities on an as-needed basis in support of operations and maintenance activities. Refer to section 2.4 (Scope of Work for a more detailed description). There will be no m inimum work guaranteed under this agreement and a maximum not-to- exceed amount of $50 ,000 will be in place . 1.2 GENERAL REQUIREMENTS : 1.2.1 Obtaining Proposal Documents : Proposal documents , addenda , and specifications may be obtained from the City of Fort Worth Purchasing web site at http:/lwww.fortworthgov.org/ourchasin ql in portable document format (PDF), or may be viewed at the Environmental Management Department, 908 Monroe Street (7111 Floor), Fort Worth , Texas 76102 during normal business hours. 1.2.2 Time Proposal to Remain Valid : Proposals submitted in accordance with this Request for Proposal shall remain valid for 90 days after the due date. 1.2 .3 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 loca l 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 Admin istration (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 REQUEST FOR PROPOSAL DOCUMENTS : All requests for an interpretation of the Request for Proposals 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 , April 22 , 2010 at 1 :30 PM). The person submitting the request will be responsible for its prompt deli very . No oral requests for in terpretation will be answered. The City will issue any interpretation of the Request fo r Proposals as a forma l addendum. The addenda w ill be posted at http://www.fortworthgov.org/ourchasinql. All addend a must be submitted with the Proposal i n Section 2.2. It is the Contractor's o bli gation to determ in e whether addenda have been issued prior to the deadl ine for subm itti ng th e Initial 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 , Roqer.Gran tham@fortworthqov.org, with a notification of intent to submit. Requests for interpretation must be submitted to : Mr. Roger Grantham Environmental Supervisor Environmental Management Department City of Fort Worth 1000 Throckmorton Street Fort Worth, TX, 76102-6311 Phone (817)392-8592 Fax (817) 392-6359 Roger. Granth am@fortworthgov.org 1.4 CONFLICTS: Should there be conflicts between the proposal documents and the final executed contract document, the final contract shall take precedence . 1.5 HOW TO SUBMIT A PROPOSAL: Each Contractor must submit ONE (1) bound original and three (3) un-bound copies of their proposal to the City . All items to complete the submittal must be included within the proposal or the entire proposal may be considered non-responsive and rejected . Please initial the upper right-hand comer 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 Worth 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 , April 29, 2010. The project number must be clearly marked on the envelope and the statement "PROPOSAL DOCUMENTS ENCLOSED, DELIVER TO PURCHASING DIVISION ONLY BEFORE 1:30 on Thursday, April 29, 2010" placed in the lower left-hand comer 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 the outermost envelope . Late proposals will be returned . They will not be opened nor considered in t he evaluation process. Proposals may be withdrawn at any time prior to the official opening. NO FAXED PROPOSALS WILL BE ACCEPTED 1.6 SECURITY: Proposals must be accompanied by a proposer's bid bond in the amount of $2 ,500 . Alternatively, the City will accept a cashier's check, in sa id amou nt , w ith th e C ity named as payee, to be held in escrow unt il the successful Contract or signs t he proj ect Contract. ~ Initial This bond will serve as a guarantee that the successful Contractor will enter into an agreement with the City to perform the project. The City will only accept sureties duly qualified and authorized by the State of Texas as corporate sureties to act as bonding entities. Personal sureties are unacceptable . 1. 7 OPENING OF PROPOSALS : Proposals will be opened and read aloud at 2 :00 PM on Thursday, April 29, 2010, in the Fort Worth City Council Chambers. The proposals shall be handled in order to avoid 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 public in spection after project award, as provided by paragraph 1.8 below. The Proposal Documents submitted in accordance with this Request for Proposals shall remain valid for ninety (90) days after the due date. 1.8 TRADE SECRETS AND CONFIDENTIAL INFORMATION: All material submitted to the City becomes public property and is subject to the Texas Open Records Act upon receipt. However, the City will endeavor to protect from disclosure any 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 confidential 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 being deemed non-proprietary and available upon public request. 1.9 PROPOSAL EVALUATION CRITERIA: Proposals will be evaluated by qualitative measures and will be weighted as follows : FACTOR Contractor Capabilities Costs Payment and Written Documentation Qualifications / Experience Subcontractors TOTAL MAXIMUM WEIGHT 25points 3 5 points 10 points 40points 15points 125 points NOTE: Any of the above factors may be weighted as low as -5 points. The City will select the most highly qualified respondent 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 m the evaluation of any proposals and to establish the responsibility , qualifications , and finan cial ability of the Provider, subcontractors , and other persons who are proposed to work on the project. 1.10 CONTRACTTIME: The successful Contractor will be awarded a One-Year Contract with two One-Year Options Kt' In itial to Renew. 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 City will make final changes to the Contract documents and issue the Contract Documents with Notice of Awards to the successful Contractor. 1 .12 AWARD OF THE CONTRACT: 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. The 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 Sales Tax; therefore , tax must not be included in this proposal. 1.14 RESERVATIONS : The City reserves the right to reject any or all proposals and waive any or all formalities. DE Ml0-04: ACM March 26, 2010 1-4 2.0 * * KA Initial 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 fA Initial 2 .1 PROPOSAL DOCUMENT CHECKLIST 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 non- responsive submittal. *Note: The Request for Proposals 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 Residency Nondiscrimination Prevailing Wage Rates Insurance Certificates Provider's Licenses & Certificates Contractor's Legal and Compliance History Inventory of Equipment Other Initial if Included l$4: ~ KA u KA lb\: Ve \lh ~ Ilk k'Jt llA llA ilk 11A KA I understand that all of these items will be reviewed, and any items not included may result in my Proposal being considered non-responsive. Signature --~---=--=-=-... ~"""'-'-.;;......;::=------------- Name Karen Andrews Title President Company lntercon Environmental , Inc. KA Initial 2.2 ACKNOWLEDGEMENT OF RECEIPT OF ADDENDA 2.2 .1 Check if applicable l_ The undersigned acknowledges the receipt of the following addenda to the Request for Proposals , and has attached all addenda following this page . (Add lines if necessary). Addendum Number 1 April 26, 2010 (Date rece ived) 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: lntercon Environmental , Inc . BY : ___ K_a_r_e_n_A_n_d_re_w_s ____ _ Company Name (print or type name of signatory) 210 S. Walnut Creek Drive (~ Address Mansfield , Texas 76063 President City , State, Zip Title (print or type) TO: FROM: DATE: RE: FORT WORTH ENVIRO l\fEi. TAL fAl~AGEMENT ADDENDUM Interested Parties Roger Grantham, Environmental Program Manager Department of Environmental Management April 26, 2010 Addendum #1 DEM 10:04 ACM As of Monday, April 26, 2010, the following apply; 1. Will water and electric be available on site for the abatement contractor's use? Yes. 2. For the Labor rates indicated on the bid 'form, are we to include typical trade materials and equipment or is this just loaded labor burden labor rate? Typical materials and equipment. 3. Also, for all unit rates, do we assume that typical trade materials and equipment are to be included in these unit r ates? Yes, that is correct. 4. How will award be based on pricing? Will it be a total of all unit prices or will each line item be individually addressed? Each line item will be evaluated to come up with a fa i r and equitable ove.rall value score. 5. If Lead Paint is encountered on asbestos or mold removed materials, will the City require the remediation contractor to be state licensed for Lead Paint removal activities. Typically, the issue of lead paint during the abatements has not been a problem, but any certifications above the required levels would be advantageous. 6. Will there be guaranteed work under this contract? No 7. Why are subcontractors included in the bid forms? Subcontractor qualifications are an important part of the evaluation process in order to determine one's ability to perform all work as required. 8. Do we have to use MWBE vendors if we are a MWBE firm? Credit will only be given for work subcontracted to MWBE vendors. 9. Who will be scoring or grading the submittals? A selection committee comprised of several departments within the City that regularly may use the contract for performance of needed work. 10. When will the contract be awarded? It is anticipated to be active by June 1, 2010. 11. Where may I find the MWBE forms? The forms required for submittal are located on the City of Fort Worth website under the Housing and Economic Development Department's page. 12. Does the Health and Safety Plan have to be submitted in CD-ROM format only? The HASP may be submitted in any of the following formats: • Hard-copy (if total pages do not exceed 37 including the cover page) • CD-ROM • Thumb-drive ,.LA Initial 2 .3 PROPOSAL SUMMARY TO THE CITY OF FORT WORTH: The undersigned hereby proposes to furnish the equipment, labor, materials, superintendence, and any other items or services necessary to perform 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. Contractor equipment and personnel are capable of performing each type of procedure listed in the scope of work (Section 2.4) either with in house resources or through subcontracts. All Proposal Documents have been submitted in a 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 Contractor will respond as necessary. This Proposal Summary and the accompanying Proposal Documents are intended to be complete and will remain valid for ninety (90) days from the date of submittal. PROVIDER: lntercon Environmental, Inc. (Company Name) 210 S . Walnut Creek Drive (Address) Mansfield, Texas 76063 (City, State , Zip) (817) 4 77-9995 Phone) BY: Karen Andrews -------------(print or type name of signatory) ~~ (Signature) President Title (print or type) (817) 477-9996 (FAX) Ilk Initial 2.4 SCOPE OF WORK The City performs asbestos abatement activities within City owned facilities on a routine basis . 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 ceiling texture, joint compound , and roofing materi als. 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. The work required under this contract includes 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-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 following tasks under this contract: • Provide Asbestos Assessment Reports and Asbestos Remova l Specifications; • Provide Mold Assessment Reports and Mold Remediation Protocols ; • 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 Techn ici an , 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 notifications and make necessary amendments . .,- KA Initial 2 .5 UN IT C OSTS The T able below identifies various types of asbestos-containing materials (ACM). Contractor shall provide a cost for each type of ACM included on the Table. The prices quot ed in the table below are for work within normal conditions (i.e., up to a maximum of 12-foot ceiling height, flat roof conditions for roof work, no h oliday or weekend hours, etc.). Prices listed in the table shall include all labor, materia l, and equipment to perform the function. Sta dard L" t f ACM T d "t ts n IS 0 ypes an um cos . . ACM Type COST Carpet (ONLY) $ .75 /SF Floor aoolied Mastic (ONLY) $ 1.30 /SF Floor Tile and Mastic $ 1.85 /SF Note: Above listed prices may be used ALONE or in conjunction with each other. Plaster or stucco material $ 3.15 /SF Roof Flashing $ 4 .00 /SF Roofina Felt $ 4.00 /SF Sheetrock Joint Compound $ 2.25 /SF Sorav-on Fireproofing (Yz inch to 2 Yz inch thickness) $ 8.00 /SF Su.:_: .• _ Material $ 2.25 /SF Boiler Insulation $ 7.00 /SF Roled--0n Texture $ 1.85 /SF Soraved--0n Texture (e.g. ooocom ceiling) $ 1.85 /SF Trawled-on Texture $ 1.85 /SF Thennal Svstem Insulation (TSI): ~' * '}~"a, 1!' ' / 0-6 inch OD $ 14 .00 /LF 6.1 -12 inch OD $ 18.00 /LF >12inch OD $ 20 .00 /LF Fitting O -6 inch OD each $ 40 .00 /fitting Fitting 6.1 -12 inch OD $ 50 .00 /f"ltting Fitting > 12 inch OD $ 60.00 /fitting Mastic on duct insulation $ 2.50 /LF Transile Material $ 1.75 /SF Wall, floor, or ceiling fibrous ACM board $ 1.85 /SF List of Services NOT included in Standard List above: SERVICE COST Site MobifJzation once $ 500 .00 I site Trans rtation and Dis I of ACM Waste $ 18 .50 / cubic ard Hou Rates for workers if UNIT PRICE table above does not a I POSITION HOU RLY RA TE Licensed Asbestos Abatement Worker $ 42 .50 I ho ur Licensed Asbestos Su rvisor $ 47 .50 I hou r Markup for Outside Services: For materials, equipment, supplies , and services t hat a re n ot in cl uded in the a bove li st ed prices but are required at a j ob s ite t he cost s w ill be bi ll ed t o the C ity with a 15 % mark up. ,i ~ Initial 2 .6 BONDS 2.6.1 Bid Bond Proposals must be accompanied by a proposer's bond in the amount of $2 ,500. Alternatively, the City will accept a cashier's check, in said amount, with the City 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 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 10 ca lendar days after the contract has been awarded . 2.6.2 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 .6.3 Requirements for Sureties The bonds shall be issued by a corporate surety duly authorized and permitted to do business 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 addition , 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 under federal law; or (2) have obtained reinsurance for any liability in excess of $100 ,000 from a reinsurer that is authorized and admitted as a reinsurer in the state of Texas and is the holder of a certificate of authority from t he Untied States Secretary of the Treasury to qualify as a surety on obligations permitted or required under federal law. Satisfactory proof of any such reinsurance shall be provided to the C ity upon request. The City , in its sole discretion , will determine the adequacy of the proof required herein . No sureties will be accepted by the City that are at the t ime in default or delinquent on any bonds or which are int erested in any litigation against the C ity . Shou ld any surety on the Contract be determ ined unsatisfactory at any ti me by the C ity , notice will be given to the Contractor to that effect and the Contractor shall immed iately provide a new su rety satisf actory t o the City. ATTACH CASHIER'S CHECK OR BID BOND HERE THE AMERICAN INSTITUTE OF ARCHITECTS I AIA Document A310 Bid Bond# ZA34235 KNOW ALL MEN BY THESE PRESENTS, that we INTERCON ENVIRONMENT AL INC (Here insert full name and address or fepl title of Contractor) TEXAS as Principal, hereinafter called the Principal, and ARCH INSURANCE COMPANY (Here Insert lull name and address or legal title of Surety) 3 Parkway , Suite 1500-Philadelphia, PA 19102 a corporation duly organized under the laws of the State of MISSOURI as Surety, hereinafter called the Surety, are held and firmly bound unto CITY OF FORT WORTH !Here insert full name and Mldms or lepl lltle of Owner) TEXAS as Obligee, hereinafter called the Obligee, in the sum of TWO THOUSAND FIVE HUNDRED AND 00/100 Dollars ($ $2,500.00 ), 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 ASBESTOS ABATEMENT (Here insert full name, address and descripllon of pro;ecll DEMI0-04:ACM NOW, THEREFORE, if the Obllgee 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 larger amount for which the Obligee may In good faith contr1ct 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 5TH day of APRIL 2010 _.;...()~. A JJA ~' J"" 1. r ---'L>.{J=---=· ~~,,..._ieJK........,.__I , / /"\• c <7Prminc:c1ippaa1/J) ~(Witness}~ ~ INTERCON ENVIRONMENTAL INC Angelica Petruzzelli (T"tl ) Karen Andrews ' e President AIA DOCUMENT A310 • BIO BOND • AIA 9 • FEBRUARY 1970 ED • THE AMERICAN INSTITUTE OF ARCHITECTS, 173S N.Y. AVE., N.W., WASHINGTON, O. C. 20006 (Seal) (Seal) 1 rvwn;" ur A 1 I Ul'<Nt: Y Know All Men By These Presents: That the Arch lniUralice Company, a corporation organized and existing under the laws of the State of Missouri, having its principal office in Kansas City, Missouri (hereinafter ...,_ to as the "Coml)"1y") dQeS hereby appoint William A. Bailey, Maria A. Gonzalez, Anne M. Barber, Michael J . Friedrich and Dana M. Kuber of Bridgeview, IL (EACH) ·Its true and .~ ~•J4n-F• to make, execute, seal, and deliver from the date of Issuance of this pc,Mirfor and on 11s behalf as surety, and as tts act and deed: Any and aA bonds and undertaki,gs EXC.EPTION: NO AIJT.HORfTY Is graoted IQ make, ~. $881 and deliver bonds or ~kings that~ the .. ~ ~.,.. . l'Wffl~--~ draftorietten,t·credll ·· · ...... .,n-. .. OI' \Alll_...,.uutl "' any r"··-····--1 ·-· !li<!I-. . .. Thil aullorlly does . not .permit the ume Oblgation IQ. ·be spit klto two or more J>or,lds In order to bring ea!ICh U#:1 bond wfltlln the · doler lmlt·d ·eutt10llly as eat forth .. ,...... The Company may ·revoke this appolnb,aant at anytime. The axacuUon of ._.. ·bc;,nds and u~ ti pu~-of ,._.:·pre•••:*'8fl be as binding upon the l$ld c:.npanya1 ·fulY * .nlPIY co•..,.. ,no pLfp()ae,, •If-. -.ne1-tt ~ au;y executed anc1 acknowledged by its ~ eleclid offtcetaatlispr'a:lpal offlCe int<ahadlty, ~~ ·•. ::::._' .·.;. :··:'· : .. This PCMW d ~ Is executed by authority d ~ ·adopted by~-consent of the Board of .Di1licl0rs of the r--· 1.-...;.a..3 2003 true and accural$__._dwhlch arebarainalllllr Nt-·forth and· · ~ rtffied toby . _,..,..,,.on .-,..... • ·• . . . , -..-. . . 81'9 •-·-, CII .. the .uncienignad Sea-y .. being In Ml fOrce and affect: 'VOTED,. 'lbat ttllt ~ of ht 8-d. the ·~. or tlll1'/ vie. Praaidlnt -«·thelr epfM*dees dealgl1ated • in wrNlng al'MI flied wilh the S.•y, or 1tw SN•·Y thal have t,e pa.wet and ·liUlhadly ID. llPPOfnt agents and~ and to adhorlze thein to exacute on behalf of ht ·Company. and attach the NIii fl the Company thereto. bQnds llfld undarlalmga, ~~ mill• at~~ 8fld--. wrtlJlp, ~,y ·fr\ the nature #WeOf, .,.:t ft~ ·offlcars of the Company may appoint agama for .acceptance fl..,..... . . Thia .Pc:Mw cf Allamey· Is ~~ NIiied ~ certlffed by facnnie under and by authority of the following reaolullcm adopted by the unanimous consent of the Board-of Diactors of the Company 011 ·l.18rch 3, 2003: VO:n--!": ~ the · ekmtl•n d ,..._ ChalmlliR d 1111 i?e--::! ..._ .,._tdoenL • tNiv ,..._ .l');-,,-cld-* ,.,. +et-uc&I ·· ~. ... . ....-. --· -""111 ._... ---·, ~ ~ uw-.--.....,._, 191 cie.tgitaiad In wrillnO 111'1(1 tied wllh the Secrllliy,. lli'id the 8'gnab.n· of .. Sea.-.,~ the seal of the~-- cerllicationa by lie S.C.alaly, may be affixed by .,.... on .,y POMI" cf..., ar bfX.ld exec:utad ,,,-.-.no the ~ adopted by the Board of Dlractora on Mlrc:tl 3, 200a. ind ·q such power-1CJ executed, saaled and certlled with respect to any bond or llldertakilg to Whk:h It Is altN\ed, lhal1 con1inUe tobevaikl and binding upon the Corripany. OOML0013 00 03 03 Page 1 of 2 Printed In U.S.A. In Testinony Whereof, the Company has caused this lnstnanent to De signea anons corporate HIii w ue c1n1J1;au uy u1111n authorized officers, this 1st day of May 20..QL. Arch Insurance Company Attested and Certified STATE OF PENNSYLVANIA SS COUNTY OF PHILADELPHIA SS J. I, Br1ali C. Kuhn. a NOtiUy .PUblk:, do hereby certify .that Maidlrl J. Nllaan and J. Mlchael Pete perilonally known to:me to be the 181118 persons woo-. names ere respecilvaly as SaQletary and Vice President of thf/l Arch rnsll'llnce Compeny, a ·~ ~.-.8:114 ~ under ~ laws of• s.te d ~ri. ~ IQ ttl8 ~ .. lnatrur;nent, ..• . red~ me this iilau ·'1 . . . ·. and...., ... ~· that--.~ ..... to &,ha .~ ......... ~ .. . . ._, perlOl1 . ,, -~ .•. ..,,, -·"' . . . .n .. -, .. ..,...,..., sealed. with the COi ate teal and dellwred the said ·tnstrument as the he and ..J.,..._. act .J said . · · i'atiol-...... rpc>I · · · · · · . . •-•-7 .VI COl'polfl GIN 8S their own free and voluntary acts for the uees and purpoeea 1hlnln aet forth • . ·· -~ ... . "=-~ h;2_ 8riiD C. K11m. NaellJNUc · ~ C. Klnl. :Notary .Publk: . QyafftR t "t'r,Md 'jbh ·~ . Myoommlllion e,q,ires 12;.o&-2011 CERTIFICATION _.,, • : · n.... . »u I, M1111n J. N"-1, Sea•r of tte An:h lnuance eon,p.,y~ do ·'-'byoertifv that ... attact-, ~ of~dllted May 1, 2008 on betaf of the person(•) as .~·--·'-a true · and oam,ct copy·_... that the eame baa bee i1 fl.ill fine and effect sinQe ttl8 dale th8reof and Is In ™-" ·~ and .,,_ on the d$18 of 1tllis c:atiflcata, and I do -- c:artfy that"-said J. Mknall P91e, who axaculed "8 ~ fl Ntotrtey as ViQe Pn9eidllnt. Ml OJ'.l'the dal1r,of axecution of the attached Power d~the duly elected Vice Prwldlnt of .. An:h ·lnaurance eoms.,,. IN TESTIMONY WHEREOF, l 1HM hereunto~ my .name and afflX9d the OC: ,rpo- Company oo this 5th ~ of APRIL, 2010 · , ~-· . · · ·. oftheAn:h -~ Md they have no autharlty to bind the Ccmpany except· Jn the ma111ar and to the extent. herein stalled. PLEASE SEND ALL Ct.AIM INQUIRES RELATING TOTHli BOND TO TtE.F<>Ll.OVffG ADDRE8S: ArchSUrwty 3 Pai'kwly, Ste.1500 Phllalphla, PA 19102 OOML0013 00 03 03 Page 2 of2 Printed In U.S.~ 2.7 MINORITY AND WOMEN BUSINESS ENTERPRISE (M/WBE) UTILIZATION REQUIREMENTS An M/WBE goal of 10% has been established for this project. k'A Initial 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 (e.g., 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 letter s of intent prior to receiving the Contract Documents. ~ In itial (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 th is 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 P rime Contractor Waiver Form. c . If Contractor has subcontracting and/or supplier opportunities but does not include M/WBE pa rticipation in an amount which equals or exceeds the project goal, they m ust submit the Subcontractor Utilization Form and the Good Faith Effort Fonn and documentat ion . 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 docu mentation shall demonstrate the Contractor's commitment and honest efforts to utilize M/WBE(s). The burden of preparing and submitti ng 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/ boxes: Ix! The following M/WBE documents are included in this Proposal submittal , following this page , bound within the response: IXl Subcontractor Utilization Form D Joint Venture Form D Prime Contractor Waiver Form D Good Faith Effort Form CONTRACTOR: lntercon Environmental , Inc. BY: Company Name 210 S. Walnut Creek Drive , Address Mansfield , Texas 76063 City , Sta te, Zip Karen Andrews -------------(p ri nt or type name of signatory) ~ (Signature) Pres ident T itl e (print or ty pe ) ATTACHMENT 1A Page 1 of 4 FORT WORTH ~ City of Fort Worth Subcontractors/Suppliers Utilization Form PRIME COMPANY NAME: Check applicable block to describe prime lntercon Environmental , Inc . XI M/W/DBE I I PROJECT NAME: NON-M/W/DBE REMOVAL , PACKAGING , TRANSPORTATION , AND DISPOSAL OF ASBESTOS-CONTAINING BID DATE MATERIALS AND MOLD CONTAMINATED MATERIALS FROM CITY-OWNED FACILITIES APRIL 29 , 2010 City's M/WBE Project Goal: I Prime's M/WBE Project utilization: PROJECT NUMBER 10 % 10 % DEM10-04 :ACM 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, w ill result in the bid being considered non-responsive to bid specifications. The undersigned Offerer agrees to enter into a formal agreement with 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 contractor, 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 2"d tier ALL M/WBEs MUST BE CERTIFIED BEFORE CONTRACT AWARD. 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 bus inesses by the North Central Texas Regional Certification Agency (NCTRCA), or the Texas Department of Transportation (TX DOT), highway div ision . Disadvantaged Business Enterprise (DBE) is synonymous with Minority/Women Bus iness Enterp ri se (M/WBE). If hauling services are utilized, the prime will be g iven credit as long as t he M/WBE listed owns and operates at least one fully licensed and operational truck to be used on the con tract. The M/WBE may lease trucks from another M/WBE firm , including M/WBE owner-operators , and rece ive full M/WBE credit. The M/WBE may lease trucks from non -M/WBEs, includ i ng owner-operators, but will only receive credit for the fees and commissions earned by the M/WBE as o utlined in the lease aQreement. ., Rev. 5/3 0/0 3 v V V FOR T WORTH -....,....-- ATTACHMENT 1A Page 2 of4 Primes are required to identify ALL subcontraclors/suppliers , regardless of status ; 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 C X II Subcontracting Work Supplies Purchased Dollar Amount Address e M w T D w Telephone/Fax r B B R 0 B E E C T E A CBA Services , Inc. 5877 Barnett, Suite A Waste Hauling Unit Prices Krum , Texas 76249 1 xx & Disposal Phone : (940) 482-9900 Fax : (940) 482-3458 ' Rev. 5/30/03 f ORTWORTH ~ ATIACHMENT 1A Page 3 of4 Primes are required to identify Al..1. subcontractors/suppliers , regardless of status ; i .e ., Minority, Women and non-M/WBEs. Please list M/WBE finns first , use additional sheets if necessary. Certification N (check one) 0 SUBCONTRACTOR/SUPPLIER n T Detail Detail Company Name i N T C X M Subcontracting Work Supplies Purchased Dollar Amount Address e • w T D VI Telephone/Fax r B B R 0 B E E C T E A Rev. 5/30/03 FORT WORTH ~ Total Dollar Amount of M/WBE Subcontractors/Suppliers Total Dollar Amount of Non-M/WBE Subcontractors/Suppliers $ $ Unit Prices 0 .00 ATTACHMENT 1A Page 4 of4 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 w ill 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 Fernando Avila, VP Operations Title Contact Name/Title (if different) lntercon Environmental, Inc. (817) 477-9995 I (817) 477-9996 Company Name Telephone and/or Fax 210 S . Walnut Creek Drive karen@intercon-environmental.com Address E-mail Address Mansfield. Texas 76063 April 29 , 2010 City/State/Zip Date ' Rev. 5/30/03 KA Initial 2 .8 QUALIFICATIONS 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 ut ilized 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 professional person who will be assigned to this contract. Identify key persons by name and title 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 . 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. DEMl0-04 : ACM March 26 , 2010 INCLUDE A COPY OF THE QUALIFICATIONS FOLLOWING THIS PAGE WITHIN THE PROPOSAL PACKAGE 2-1 0 ENVIRONMENTAL, INC. 10 S W a lnut Cre ek D ri v e . Mans fi e l d Te x as 76063. Tel e pho n e (817) 477 -999 5. Facs im il e (81 7 ) 47 7 -9 996 Prepared for City of Fort Worth PROJECT: DEM10-04: ACM www .i ntercon -envi ron me nta I . com Response to Section 2.8; Qualifications of the Provider Bidder's Statement of Qualifications lntercon Environmental, Inc. possesses contractor licenses for asbestos abatement, lead and lead-based paint abatement, mold remediation and demolition projects. We are also qualified to demolish, rebuild or construct buildings, respond to emergencies and perform general construction improvements. lntercon Environmental, Inc. has completed numerous projects such as floor tile i nstallation, demolition, lead and mold decontamination, wall and ceiling installation and painting projects. Our abilities are only limited by your needs, as we require no minimum contract amount. lntercon's team members, fleet and equipment provide us with unique, effective capabiliti es. Our fleet of late- ,odel vehicles, state-of-the -art abatement, demolition, and transportation equipment allows us to get in and t of project sites quickly. Our demolition team is capable of performing multiple "full scale " demolition projects simultaneously. We have the ability to staff and perform six large abatement projects concurrently. During peak abatement season, we have the resources to obtain additional supervisors and laborers from a group that is licensed by the Texas Department of State Health Services to perform up to ten abatement projects simultaneously. Our Project Managers are available at all times during every project. Our team members have been in the Dallas/Fort Worth market for over 1 8 years, specializing in all aspects of the asbestos and lead abatement, mold remediation and demolition industries. lntercon maintains 24 full time employees to handle the needs of our clients and ensure that we can meet or exceed any project's demand. Our telephones are answered 24 hours a day by knowledgeable company representatives with the ability to mobilize personnel and equipment to a project site at a moments notice. lntercon Environmental, Inc. has in-house resources for work normally sub-contracted to other firms. We have found this to be more reliable, efficient, and effective in meeting the needs of our clients. By utilizing in- house resources, we have a much greater control on meeting deadlines and maintain i ng a consistency of high quality work and customer satisfaction. We cover every aspect of the abatement and demolition process. lntercon Environmental, Inc. will never disregard a request for servi ce, even in an emergency. lntercon's team members are averaging less than two hours response time for emergency clean-ups. All projects are ,mpleted on time or ahead of schedule. Each project was completed to the owners ' total satisfaction. We ve never requested a change order for work we contracted to complete. We take p r ide in every project we are awarded . Bid Documents /Specific /SQQ Statement of Qualifications Page 2 of 7 irm: Corporate / Main Office: Telephone: Officer: Email address: Karen Andrews, President COMPANY/ PERSONNEL INFORMATION lntercon Environmental, Inc. 210 South Walnut Creek Drive, Mansfield, Texas 76063 (817) 477-9995, Facsimile: (817) 477-9996 Karen Andrews, President karen@i nte rcon-envi ro nm e ntal. com ENV I RONMEN TAL, INC. Ms. Andrews possesses a Bachelor of Science in Biology with a minor in Chemistry and with her degree began in the environmental field in 1992 encompassing both operational and administrative duties i n various disciplines of the environmental industry. Presently she conducts all of lntercon's financial, operational, and regulatory responsibilities. She is currently licensed by Texas Department of State Health Services as a Lead Abatement Supervisor and maintains an expertise in all facets of the Asbestos, Lead, and Mold Industries utilizing her many years of experience in field operations, lab analysis, and all regulatory documentation required in the environmental industry. Jerrold Andrews, Vice President Mr. Andrews began his Business Management experience in 1 984. He transitioned to the Demolition and Environmental Industries in 1991. He has extensive experience and knowledge in all phases of Commercial and Residential Demolition and Construction, General Contracting and Project Management, Asbestos, Lead rid Mold Abatement, Hazardous Chemical and PCB Disposal. He is interactive with clients and suppliers on a aily basis and maintains a constant oversight of all of lntercon's financial and operational activities. He is licensed by the Texas Department of State Health Services as an Asbestos Abatement Supervisor and a Mold Remediation Supervisor. Fernando Avila, Vice President Operations Mr. Avila established his Business Management career in 1 984 and went on to successfully pursue a profession in the Environmental Industry in 1986. He is licensed by Texas Department of State Health Services as an Asbestos Abatement Supervisor, handling a multitude of projects including Asbestos Abatement, Mold Remediation, Lead Removal, and Demolition. With his vast knowledge of the abatement and demolition industries, he is able to competitively bid projects and secure opportunities with clients . Byron Davis, Vice President Field Operations Mr. Davis began working in 1979 in the construction industry building Hi-Rise Buildings in the Dallas-Fort Worth area. In 1 989, he entered the environmental industry as an asbestos abatement worker. His ability to learn this trade quickly and take charge aided him in his promotion to an asbestos abatement supervisor position. Mr. Davis has a vast knowledge of asbestos remediation in industrial, commercial, and residential. He has performed projects for various municipalities and educational facilities. He is a Texas Department of State Health Services as an Asbestos Abatement Supervisor. Bob McFadin, Demolition Sales Manager Mr. McFadin started in the transportation industry in 1972 and progressed to the Environmental and molition Industries i n 2000. He is licensed by the Texas Department of State Health Services as an Asbestos Abatement Supervisor and is educated in all transportation regulations and procedures and the Demolition and Abatement Industries. With this knowledge, he is able to procure both demol ition and asbestos projects. Bid Documents /Specific /SOQ-Asb&Demo Statement of Qualifications Page 3 of 7 Jose Contreras, Project Manager E N V I RO N MEN TAL, INC. Mr. Contreras began his career as an asbestos abatement worker in 1987 and within two years was promoted to a Texas Department of State Health Services Licensed Asbestos Abatement Supervisor. His ability to manage large crews effectively, expediently and profitably, has enabled him to further his position to Project Manager over lntercon's Supervisors for Asbestos Abatement, Mold Remediation, Lead Removal, and Demolition projects. David Dunham, Demolition Project Manager Mr. Dunham began in 1970 in the transportation industry and in 1998 moved over to the Construction and Demolition industries. His experience as a heavy equipment operator along with his Class A CDL License enables him to manage all facets of lntercon's Demolition Team. Keith Flowers, Demolition Sales In 1978, Mr. Flowers began in construction sales and progressed to various management positions. In 2001 he was certified by the US Army Corp of Engineers in Construction Quality Management. Additionally he was Superintendent of military construction projects for the US Navy and the US Air Force w ith a major l ocal construction firm. In 2002, Mr. Flowers entered the Environmental Industry as an Operations Manager and Estimator and obtained his Asbestos Abatement Supervisor's license through the Texas Department of State Health Services. ector Medina, Senior Asbestos Abatement Supervisor Mr. Medina began his environmental career in 1987 as an asbestos abatement worker, l icensed by the Texas Department of State Health Services, and in 1995 became licensed as an Asbestos Abatement Supervi sor directing crews over Asbestos Abatement, Mold Remediation and Lead Removal and Demolition projects. Based on his experience and his proven compliance record, he was promoted to Senior Supervisor to oversee lntercon's Supervisors . Eulogio Torres, Asbestos Abatement Supervisor Mr. Torres has been in the environmental industry since 1984, working as an asbestos abatement worker licensed by the Texas Department of State Health Services and in 2002 advanced to a successful licensed Asbestos Abatement Supervisor over crews performing Asbestos Abatement, Mold Remediation, Lead Remova l and Demolition projects. Moises Ramos, Asbestos Abatement Supervisor Mr. Ramos began his career in 1999 as an asbestos abatement worker, licensed by the Texas Department of State Health Services. In 2003 , he was promoted to a licensed Asbestos Abatement Supervi sor heading over crews performing Asbestos Abatement and Mold Remediat i on p r oj ects . Jorge Hernandez, Supervisor Mr. Hernandez began his career in 1998 as an asbestos abatement worker, licensed by the Texas Departm e n t of Sta t e Health Services. In 2001 , he was promoted t o a l icensed Asbestos Abatement Supervisor h e ading o v er 2ws performing Asbestos Abatement, Mold Remediation , Le ad Removal , and Demoliti on projects. Bi d Documen t s /Spec ific /SOQ-Asb&De m o .. Statement of Qualifications Page 4 of 7 ' Dave Dunham ' Demolition , Bob:McFadin Demolition Sales Manager Project Manager ,-...-----1 ' r Tuivers Keith Flowel'S Demolition Sales ORGANIZATION CHART r '- Baron Andrews President .) .Jer.rold Andrews ' v-.,., President ' .fflll6 Andrews ' :Managing Direcior '- 'Fernando Avila ' VP Operations '- Angelica. Petruzrelli E.xecntive Vjce President r r Jose Contreras "' ' Hector Medina ' - ENVIRONMENTAL, INC. , ' B y:J"On Davis VPField Operations -.-1 Project Manager Senior Supervisor ..... ---1 ----------- Operafors r Ground Crew I Eulogio Torres Supervisor I [ Crew l '- Bid Doc uments /Specific /SOQ -Asb&De mo I Moises Ramos Supervisor ,. I I Crew l ;, I I ' Jorge Hernandez Supenisor I Hugo Valderrama Warehouse Supenisor Statement of Qualifications Page 5 of 7 ENV I RONMENTAL, INC. 1ritercon Environmental, Inc. has successfully completed projects for the following governmental and ucational institutions: Federal Government Abilene National Guard Citv Government City of Arlington City of Carrollton City of Dallas City of Duncanville City of Fort Worth City of Dallas Love Field Aviation Dept. City of Garland Colleges and Universities Austin College Dallas Baptist University Dallas County Community College Dallas Theological Seminary School Districts Amarillo ISO Birdville ISO Eagle Mountain-Saginaw ISO Everman ISO Fort Worth ISO Hudson ISO Graford ISO Grand Prairie ISO Grapevine-Colleyville ISO Irving ISO Housing Authorities Balmorhea Housing Authority Grapevine Housing Authority Groesbeck Housing Authority Linden Housing Authority Mabank Housing Authority Bid Documents /Specific /SOQ-Asb&Demo State Government Texas Department of Transportation Countv Government Dallas County Tarrant County City of Haltom City City of Irving City of Mansfield City of Nacogdoches City of Plano City of Richardson City of River Oaks Grayson County Community College Tarrant County Community College Texas State Technical College Univers ity of North Texas Denton Kilgore ISO Mansfield ISO Neches ISO Prairiland ISO Richardson ISD Spearman ISO Tidehaven ISD Trenton ISO Valley Mills ISO Meridian Hous i ng Authority Poteet Housing Authority Teague Housing Authority Temple Housi n g Authority ,,- Statement of Qualifications Page 6 of 7 Current License and Certifications Program Name Certification Number NCTRCA-DBE WFD42229Y0910 SCTRCA -SBE, WBE 20702202 State of Texas -HUB 1522437774500 WBE National Council -WBE 234367 Texas Department of State Health Services License Number Contractor Asbestos Abatement License 80-0805 Asbestos Transporter License 40-0336 Contractor Lead Abatement License 2110368 Mold Remediation License RCOOl 36 Insurance General Liability Po l icy Number Arch Specialty Insurance Company 12 EMP 43513 00 $5,000,000.00 Includes Pollution Liability Worker's Compensation Policy Number Texas Mutual Insurance Company 1142280 $5,000,000.00 Automobile Liability Policy Number Hired Autos & Non-Owned Autos Arch Insurance Company 11CAB58237-00 $5,000,000.00 ENVIRONMENTAL, I N C . Expires 09 /20/10 02/28/11 01/15/12 01/31/11 Expires 02/05/11 02/05/11 09/02/11 01/25/12 Expires 02/03/11 Expires 02/25/11 Expires 02/06/11 Excess General Liability, Additional Insured and Waiver of Subrogation insurance is available upon request. 4 Bi d Documents /Specific /SOQ-Asb&Demo Statement of Qualifications Page 7 of 7 Additional References: Bank References: Mansfield Community Bank 1 700 East Broad Street Mansfield, Texas 76063 Mr. Chuck Wilson -(817) 453-7053 Credit Rating Information: Dun & Bradstreet Rating: 3A 1 Credit Score Percentile: 90% Paydex: 80 Duns# 143048119 Client References: Mr. Roger Grantham, City of Fort Worth Mr. Larry Gilbert, Texas Dept of Transportation ; R.O.W. Mr. John Flippen , University of North Texas Housing Ms. Lynda Hutson, University of North Texas Facilities Mr. Sam Peacock, City of Dallas Love Field Aviation Ms. Melanie Rhea, Richardson ISD Mr. Dave Casey , Richardson ISD Mr. Mark Smith, Lockheed Martin Fire & Missile Mr. George Reid, Fort Worth ISD Bi d Doc uments /Spec ifi c /SOQ-Asb &Dem o (81 7) 392 -85 92 (214) 320-62 5 5 (940) 565 -483 7 (940) 369-7345 (214) 670-6654 (469) 593-0044 (469) 628-1 770 (972) 603 -7288 (81 7) 871 -3293 EN VIR O NM EN TA L , I NC. ENVIRONMENTAL, INC. 210 S W a l nu t Creek D r ive . M a n sf i eld Texa s 760 63. T e l e pho ne (817) 477-999 5. F acsimile (817) 477-9 9 96 ma i l @ i ntercon -env i ronm e nta I . c o m www . i n t e r co n -envi ron men ta I . com Prepared for City of Fort Worth PROJECT: DEM10-04: ACM Response to Section 2.8; Bidder's Experience -ASBESTOS/DEMOLITION 1. Project Information : Client / Owner: Contact Information: Contract Information: Various Fac ilit i es , Fort Worth, Texas City of Fo rt Worth Roger Grantham , Env i ronmental Program Manager / (817) 392 -8592 6 -yr Asbe stos Price Agreement, Cowtown Inn , Various Contracts Contract Am ount / Billed to Date : $1 ,645,740.26 Asbestos & Demoliti on of Vickery Corridor for Right-of-Way (SH 121) Contract Am o u nt: $1,843,163.59 Oak Ho llow & Villa Del Rio Apartments Contract A m ount: $1, 534 ,772.39 Complet ion date : On-Goi ng 06 /09 05 /08 Consultant Information : IHST Environm ental , Inc. / (972) 478-741 5 Scope of work: Remova l of asbestos-containing sheetrock, fireproofing , floor t i le & mastic, thermal pipe 2. Project Informati on : Client/ Owner: Contact Information : Contract Information : Consultant Information : Scope of work: 3 . Project Information : Client / Owner: Contact Information : Contract Amount: Consultant Information : Scope of work: insulati on and thermal pipe fittings. SH 121 : Removal of asbestos -contain i ng materials and demolition of 39 parcels_ Apartme nts: Removal of asbestos -containing sheetrock, floor tile & mastic, ceiling texture, and lino le um ; demol ition of 35 two-story apartment build i ngs. 6 -Cou nty Demoliti on Price Agreement Texas Department of Transportation Larry Gilbert / (214) 320-6255 Annual Pri ce Agreement / Bi lled to Date : $5,580,149.83 Burcham Envi ronmental Servi ces / (512 ) 396-5725 Asbestos abate ment & demoliti on for the Dallas District. Love Fi e l d Airport, Dallas, Texas City of Dallas Avi ation Department Sam Peacock, Project Coord i nat or / (214) 670-6654 Billed to Date: $361 ,622 .85 Pass Associates , Inc./ (214) 461 -8743 Removal of as bestos -contai n i ng sheetrock, floor ti le & mastic, fireproofing, ther mal p i pe in sulati on and the rmal p i pe fitti n gs . nter co n/BidDocs/Major Project Client List-Asbesto s Abatement Pag e l of 2 Major Project / Client List Page 2 of 2 Project Information: Client / Owner: Contact Information : Contact Information : Contract Information : Consultant Information : Scope of work : 5. Project Information : Client / Owner: Contact Information: Contract Information: Consultant Information : Scope of work: 6. Project Information : Client / Owner: Contact Information: Contract Information : Consultant Information : Scope of work: 7 . Project Information : Client / Owner: Contact Information: Phone No.: Contract Information : Consultant Information : Scope of work: 8. Project Information : Client / Owner: Contact Information : Contract Information : Consultant Information : Scope of work: 9. Project Information : Cl i ent / Owner: Contact Informati on : Contract Information: Consul t ant lnf'brmati on : Scope of work: Vario u s facilities , Denton, Texas Un iversity of North Texas Lyn da Hutson, Scheduling Coordinator -Faciliti es / (940) 369-7345 John Fl ippen, Project Coordinator -Housing / (940) 565-4837 On-going 6-yr Annual Price Agreement / Billed to Date : $1,512 ,190.64 SW GeoSci ence / (214) 350-5469 Ext 206 ; REC, Inc. / (972) 385-4535 EN V I RON M ENTA L, INC. Removal of asbestos-containing sheetrock, fireproofing, floor tile & mastic, thermal pipe insu lation and thermal pipe fittings. Variou s Facilities, Richardson, Texas Ric hardson Independent School District Melan ie Rhea, Environmental Manager / (469) 593 -0044 On -goi ng 4-yr Annual Price Agreement / Billed to Date : $1, l 03, 783 . 90 Ecosyst ems Environmental, Inc. / (972) 416-0520 Removal of asbestos -containing sheetrock, fireproofing, floor tile & mastic, thermal pipe insulati on, thermal pipe fittings and ceiling tile. Various Facilities, Fort Worth, Texas Fort Worth Independent School District George Reid, Environmental Coordinator / (817) 871-3293 On-going 5-yr Price Agreement $3,200 ,000.00 / Billed to Date : $1,351,738.30 PASS Associates, Inc. / (214) 461-8743 Removal of asbestos-containing sheetrock, fireproofing, floor tile & mastic, thermal pipe insulati on , thermal pipe fittings, ceiling tile, and transite fume hoods. Ray Olinger, Spencer & C.E. Newman Power Plants, Garland & Nevada, Texas City o f Garland Paul Kelly, Maintenance Tech Lead Man (972) 485 -65 76 Annual Price Agreement/ Billed to Date : $539,400.52 and Demolition of C.E. Newman Sub Station; $61,693 .50 Pass Associates , Inc. / (214) 461-8743 Removal of asbestos -containing thermal pipe insulation and thermal pipe fittings. Lockheed Martin Fire & Missile Control , Grand Prairie, Texas Lockheed Martin Fire & Missile Control Devan M i ller/ (972) 603 -9504 ; Dennis Stephens / (972) 603-9503 On-going Annual Price Agreement/ Billed to date: $254,647.89 ERi Consulting, Inc. / (817) 560-161 3 Removal of asbestos -containing sheetrock, roofing , fireproofing, ceiling tile , floor tile & mastic, thermal pipe insulation and thermal p i pe fittings. Vari ous Facilities, Tarrant County, Texas Tarrant County Clarence Pre ssley / (817) 884-3708 Asbes t os & Demoli tion Projects / Billed to Dat e : $532,918.14 ER i Consul ting , Inc. / (81 7) 560 -1 61 3 Removal o f asbestos -contai ning sheetrock, floor til e & mastic , thermal pipe insulation a nd t herm al pi pe fi tti ngs. ntercon /BidDocs/Major Project Client List-Asbestos Abatement ENVIRONMENTAL, INC. 2 10 S Walnut C ree k D ri v e . Ma ns fi e ld T exa s 7606 3 . T elep h one (81 7) 4 7 7-99 9 5. Fa csi mil e (81 7) .477-9996 m ai l@i nte r con-envi ron mental . com www. i nterc on-envi ron men ta I .com 1. Project Information : Client / Owner: Contract Amount: Scope of work: Completion Date : 2. Project Information : Client / Owner: Contract Amount: Scope of work: Completion Date : 3. Project Information : Client / Owner: Contract Amount: Scope of work: Completion Date : 4. Project Information : Client / Owner: Contract Amount: Scope of work: Completion Date : 5. Project Information : Client / Owner: Contract Amount: Scope of work: Completion Date : Prepared for City of Fort Worth PROJECT: DEM10-04: ACM Response to Section 2.8; Bidder's Experience -MOLD 2304 West Illinois Avenue , Dallas, Texas . Qu i et Mi nd Construction $6,975 .00 Mo ld Removal & Asbestos Abatement January 2010 BHM Station in Birmingham, Alabama Southwest Airlines Co. $7,700.00 Mold Removal August 2009 8101 N. Stemmons Frwy, Dallas, Texas Ba rnett Interests, Inc. $30, l 28.00 Mol d Removal March 2009 200 Crescent Court, Dallas , Texas Crescent Real Estate $5,400.00 Mo l d Removal June 2009 7224 Fo r est Hill Drive, Fo r est Hi ll, Texas Seventh Day Adventi st Church $4,600.00 Mold Removal November 2008 ntercon/BidDocs/5 Mold Projects Page lof 2 .. ,. Initial 2.9 LIST OF SUBCONTRACTORS Contra ctors 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. Sub con tractor 's Subcontractor's Subcontractor's Subcontractor's Proposed Tasks Name Address Telephone No. FAX Number on the Project CBA Services , Inc. 5877 Barnett , Ste A (940) 482-9900 (940) 482-3457 Asbestos & Non-Asbestos Krum , Texas 76249 Waste Hauling & Disposal IF NECESSARY, PROVIDE MORE SHEETS TO DESCRIBE ADDITIONAL SUBCONTRACTORS . ENVIRO N MEN T AL , I N C. 210 S . Wa l n u t Creek D rive . Mansf ie ld, Te x as 76063 . T elep h on e (8 1 7 ) 47 7-9995 . Fa c simi l e (817) 477-9996 Prepared for City of Fort Worth PROJECT: DEM10-04: ACM Response to Section 2.8 Subcontractor's Statement of Qualifications www. i nte r c o n-environmental . c o m CBA Services, Inc., a 100% woman -owned small business is located at 5877 Barnett Road, Suite A, Krum, Texas 76249 . The company was founded in 2001 providing services from hazardous waste treatment, asbestos transportation and project management. CBA currently owns and /or operates roll-off trucks and end dump trucks. CBA provides 20, 25 , and 30 Cubic 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 performing remediation of Superfund Sites, hazardous waste remediation , t ransportation and disposal : Sweetwater. Texas: Provided 40 CY asbestos vaults for transportation and disposal of approximately 1 0 loads of asbestos ; the demolition phase of the project required transportation of 35 loads of demolition debri s utilizing 35 CY end dump trucks. San Antonio. Texas: Provided a permanent 40 CY asbestos vault for the transportation and disposal 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 transportation and disposal of construction debris from large Dallas facility for long term construction /renovation projects. Waxahachie. Texas: Responded to an emergency call with i n one hour time frame to provide four 30 CY open-top roll-off containers for the transportation and disposal of d iesel-contaminated so i l which caused highway closure. Job complete within 2~ hours. Fort Worth. Texas : Responded to an emergency call rece ived at 2:00 am; within one hour time frame to provide one 30 CY open-top roll -off container and two 30 CY watertight vacuum containers from truck opening a valve on 1-30 and dumped materials into a nearby creek. Job complete within four hours. Denton. Texas: Provided four 40 CY asbestos vaults for the transportation and disposal of asbestos waste materials from a Univers ity. T r ansported 52 loads. Rockwall. Texas: Provided three 30 CY open-top roll-off c ontainers for the transportation and disposal of contam i nated materials from a Texas Comm ission of Env i ron men tal Quality funded clean-up. Bid Documents /Spec ific /Subco ntr act or St atement of Qua lifications ~tale nf ~rxaJ Historically Uinderutilized Business Certif·ication and Compliance Program The Texas Building & Procurem,3nt Commission (TBPC), hereby certifiE!S that CBA SERVICl:S, INC. has successfully met the established requirements of the State of Texas Historically Unde rutilized Business (H~B) Certification and Compliance Program to be reco~nized a~ 'a HU~. This certificate, printed 19-AUG-2006, supersedes any r~Jistration and certitk:ate previously issued by ttie TBPC's HUB Certification and Compliance Program. If there are any changes regarding the informatit>n (i.e., business structure, ownership, day-to-day management, operational control, addresses, phone and fax numbers or authorized signatures) provided in the submission of the b~;iness' application tor registration/certification as a HUB, you must immediately (within 30 days of such changes; notify the T8PC's .HUB program in writing. The Commission reserves the right to condi.ct a compliance review at any time to confirm HUB eligibility. HUB certification may be suspended or revoked upon findings of ineligibility. CertiticateNID Number: 1020623415400 File/Vendor Number: 20396 Approval Date: 18-AUG-2006 Expiration Date: 18-AUG-2010 Paul A. Gibson HUB Certification :& Compliance Manager Texas Building & Procurement Commission (512) 305-9071 . ' Note: In order for State agencies and institutions of higher edu:ation (universities) to be credited for utilizing this business as a HUB, they must award payment under the Certiticate/VID Number identified above. Agencies and universities are encouraged to validate HUB certification prior to ·issuing a notice of award by accessing the Internet (http://www.tbpc.state.tx.us) or by contacting the TBPC s Hl:JB Certification and Compliance Program at (8B8) 863-5881 or (51.2) 463-5872. · ' 800/80 0 le) V8~ 1!:J OOES 3~6 NCTRCA Disadvantaged Business Enterprise Certification CBA Services, Inc. Disadvantaged Business Enterprise has filed with the Agency an Affidavit as defined by 49 CFR part 26 and is hereby certified to provide service(s) in the following areas: 484220 ; 562211; 562219; Specialized Freight (except Used Goods) Trucking, Local; Hazardous Waste Treatment and Disposal; Other Nonhazardous Waste Treatment and Disposal ; · This Certification is valid beginning March 2010 and superseded any registration or listing previously issued. This certification must be updated annually by submission of an Annual Update Affidavit. At any time there ls a charge In ownership or control of the firm, notification must be made immediately to the North Central Texas Regional Certitkatlon Agency or an TUCP certifying entity. Certificate expiration _____ M_a_r_c_h ____ 20_jj_ Certification Administrator Issued date ________ _.M.,....,a ..... rc ..... b ____ , 20 10 CERTIFICATION NO. Lithe . In U.S.A. Initial 2 .10 STATEMENT OF RESIDENCY The following 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 Subdivision 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 t ime delays in the award of bids by the City of Fort Worth. For this reason, each bidder is encouraged to com plete and return in duplicate, with its bid , the Statement of Residency Form , but in any event, th e low bidder shall subm it 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 Deparbnent. Failure to provide all required information within this designated period shall result in the apparent low bidder 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 whose principal place of business* is in the state of Texas, including a contractor whose ultimate 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 bidder whose parent company or majority owner does not have its principa l p lace of business * in the state of Texas. Bidder's complete company name : INTERCON ENVIRONMENTAL, INC . State your business address in the space provided below if you are a Texas Resident bidder: 210 S. Walnut Creek Drive , Mansfield , Texas 76063 State your business address in the space provided below if you are a Non resident bidder: *The State Purchasing and General Services Commission defines Principal P l ace of Business as follows: Principal 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 w hich business activities other than submitting bids to governmental agencies are con ducted and from which the bid is submitted , and o has at least one employee who works in the Texas office Form prepared by: DE Ml0-04: AC M March 26, 2010 Karen Andrews Name Pres ident T itl e April 29 , 2010 Date 2-12 .,- 2.11 NONDISCRIMINATION All City contractors are required to comply with 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. 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 again st according to the terms of such Ordinance by Proposer, its employees , officers, agents, contractor or subcontractors herein. PROPOSER: lntercon Environmental, Inc . Company Name 210 S. Walnut Creek Drive Address Mansfield, Texas 76063 City, State , Zip DEMl0-04: ACM March 26, 2010 BY=~~-K_a_re_n~A_n_d_re_w_s~~~~- (Print or type name of signatory) ~~ (Signature) President Title (print or type) 2-13 2 .12 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 may be found at: http:/lwww.texoassociati on .o rg/Ch apter/wagerates.asp . 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: lntercon Environmental , Inc. Company Name 210 S. Walnut Creek Drive Address Mansfield, Texas 76063 City, State , Zip DEM 10-04: ACM March 26, 2010 BY: __ K_a_r_e_n_A_n_d_re_w_s ____ _ (print or type name of signatory) ~ President Title (print or type) 2-14 Initial 2.13 INSURANCE CERTIRCATES 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, Administrative 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 . Automobile Liability Insurance - A. Coverage on vehicles involved in the work performed under this contract: o $1,000,000 per accident on a combined single limit basis Q!: 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 material s collected under the Contract shall be included under this policy. 3. Worker's Compensation - o Coverage A: statutory limits o Coverage 8: $100,000 each accident $500,000 disease -policy limit $100,000 disease-each employee 4. Environmental Impairment Liability (Ell) 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, unloacfmg and transporting materials collected under the contract shall be included un der the Automobile Liability insurance or other policy(s). 5. Asbestos Abatement Insurance -$2 ,000 ,000 each occurrence with no Sunset C.lau se. (b) Certificates of i n surance evidencing that the Contractor has obtained all required insurance shaD b e delivered to the City prior to Contractor proceeding with the contract. DEM 10-04: ACM March 26, 20 10 i 2-15 DEMl0-04: ACM March 26, 20 10 14 Initial 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 requiremen ts. 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 o nto Contractor's insurance policies . Notice sha ll be sent to Brian Boerner, 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 o r 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 discreti on; 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 th e City. 7. Applicable policies shall each be endorsed with a wa iver of subrogation in favor of the City as respects the contract. 8. The C ity shall be entitled , upon its request and without incurring expense, to review the Contractor's insurance policies including endorsements thereto and , at th e City's discretion , the Contractor may be req uired to provide proof of ins urance premium payments. 9. The Commercial Genera l Liability insurance pol icy sha ll have no exclusions by endorsements unless the City approves such exclus ions. 10. The City shall not be responsible for the direct payment of any insurance prem iums r equi red by t he contract. It is understood that in surance cost is an allowable component of Contractor's overhead . 11 . All insurance required in section (a) above, except for the Profess ional Liability insurance policy , shall be written on an occurrence basis in order to be approved by t he City. 12 . Subcontractors t o the Cont ractor shall be required by th e Con tra ctor t o 2-1 6 .,- 10 Initial 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 ATTACH A COPY OF YOUR CURRENT INSURANCE CERTIFICATE(S) FOLLOWING THIS PAGE WITHIN THE PROPOSAL PACKAGE. DEMl0-04: ACM March 26, 2010 2-17 ' tlA In iti al 2 .14 PROVIDER'S LICENSES & 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 th is Request for proposal. The undersigned acknowledges the requirements of this section, and intends to comply with same in the execution of this project. CONTRACTOR : lntercon Environmental , Inc. BY : Karen Andrews -------------Company Name (print or type name of signatory) 210 S . Walnut Creek Drive ~~ Address (Signature) Mansfield, Texas 76063 President City , State, Zip Title (print or type) PLEASE INCLUDE APPLICABLE LICENSES AND CERTIFICATIONS FOLLOWING THE SECTION WITHIN THE PROPOSAL PACKAGE DEMl0-04: ACM March 26, 2010 2-18 TEXAS DEPARTMENT OF STATE HEALTH SERVICES INTERCON ENVIRONMENTAL INC is certifiea to peiform as a Asbestos Abatement Contractor . in the State of Texas within the purview of.Texcls Occupations Code, chapter 1954, so long as this license is not sw,pended or revoked and is renewed according to the ,·ules adopted by the Texas Board of Health. · DAVID LAKEY, M.D . COMMISSIONER OF HEALTH License Number: 800805 Expiration Date: 2/5/2011 Control Number: 95442 (Void After Expiration Date) VOID IF ALTERED NON -TRANSFERABLE TEXAS DEPARTMENT OF STATE HEALTH SERVICES INTERCON ENVIRONMENTAL INC is certifiea to peif orm as a Asbestos Transporter in th e S(at e of Tex as within th e purvi ew of Te.,-cas Occupations Code, chapter 1954, so long as this license is not suspe11,ded or revoked and is renewed acc ording to th e rul es ad opt ed by th e Tex as Bo ard of Health. License Number: 400336 Expiration Date: 2/5/2011 Control Number: 95484 (Void After Expiration Date) VOID IF ALTERED NON -TRANSFERABLE ... ,. TEXAS DEPARTMENT OF STATE HEALTH SERVICES Be it known that INTERCON ENVIRONMENTAL, INC is licensed to perform as a Mold Remediation Company in the State a/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. David Lakey, M.D. Commissioner of Health License Number: RC00136 Control Number: 6619 Expiration Date: 1/25/2012 (Void After Expiration Date) VOID IF ALTERED NON-TRANSFERABLE .. ,. I ____ -- -------------------I ---------------~--· -------------------------------_I __ -. TEXAS DEPARTMENT OF STATE HEALTH SERVICES <Be it (nown tfiat INTERCON ENVIRONMENTAL INC is certifiecl to perform as a Lead Firm in tfie State of <Te:J(as ancl is fiere6y governecf Gy tfie rig/its, pri.viCeges ancl responsi6iuties set fortli in <Ie:J(as Occupations Cocfe, Cfiapter 1955 ancl<TitCe 25, '1.e:J(as }lclministrative Cocfe, Cnapter 295 reCating to '1.e:J(as P.nvironmenta{ Leacf <.R§auction, as Cong as tfiis ficense is not suspencfecl or revof<Jcl. License :Num6er: 211 0368 Contro{:Num6er 6151 <Davia£. La(ey, 'M_. <D. Commissioner of Jfeaftn VOID IF ALTERED NON-TRANSFERABLE <Expiration (})ate-. 9/2/2011 ('Void }ljter <Expiration (})ate) The Texas Comptroller of Public Accounts (CPA), hereby certifies that INTERCON ENVIRONMENTAL, INC. has successfully met the established requirements of the State of Texas Historically Underutilized Business (HUB) Program to be recognized as a HUB. This certificate, printed 19-JAN-2008, supersedes any registration and certificate previously issued by the HUB Program. If there are any changes regarding the infonnation (i.e., business structure, ownership, day-to-day management, operational control, addresses, phone and fax numbers or authorized signatures) provided in the submission of the business' application for registration/certification as a HUB, you must immediately (within 30 days of such changes) notify the HUB Program in writing. The CPA reserves the right to conduct a compliance review at any time to confirm HUB eligibility. HUB certification may be suspended or revoked upon findings of ine ligibility. CertificateNID Number: 1522437774500 Paul A. Gibson FileNendor Number: 36251 HUB Compliance Supervisor Approval Date: 15-JAN-2008 Expiration Date: 15-JAN-2012 Note: In order for State agencies and insfrtutions of higher education {universities) to be credited for utilizing this business as a HUB, they must award payment under the CertificateNID Number identified above. Agencies and universities are encouraged to validate HUB certification prior to issuing a notice of award by accessing the Internet (httpJ/www2.cpa.state.tx.us/cmbl/hubonly.html) or by contacting the HUB Program at (8 88) 863-5881 or (512) 463-5872. NCTRCA Disadvantaged Busine . s Enterprise Certificati n lntercon : nvironmental, Inc has filed with the Agency an Affid!'Jfl~~'ft'e?ih3 yfl~~Wlf~a'¥PiffJirfs hereby certified to provide I service(s) in te following areas: 56 91 O; 23891 O; Asbestos Contractor and Removal: R mediation Services; Site Preparation Contractors (pt); This Certification is valid beginning and superseded any registration or listing previously issued. This certification must be updated a nually by submission ofan Annual Update Affidavit.At any time there is a charge in ownership or control of the firm, notification must be made Immediately to the North Central Texas Regional Certification Agency or ~n TU P certifying entity. Certificate expltatlon September, 2 __ 10 CERTIFICATION NO. WFDB42229Y0910 llA: Initial 2.15 CONTRACTOR'S LEGAL 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, AND 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 the following information for each case at a minimum: • Style of Case ( X vs. Y ) • Settlement Information (as appropriate) • Cause Number • Names / Addresses of all parties named • Court • Counsel List and phone numbers • Date of Disposition • Judgment and Order of Judgment "LEGAL ACTION" means: ANY enforcement action by the United States Environmental 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. DEMl0-04: ACM March 26, 2010 2-19 ~ Initial AN AUTHORIZED REPRESENTATIVE OF THE CONTRACTOR shall mean: DEMl0-04: ACM March 26, 2010 (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. INCLUDE A COPY OF THE REPORT OF LEGAL ACTION FOLLOWING THE CERTIFICATION PAGE WITHIN THE PROPOSAL i 2-20 .¥t Initial Certification of Contractor's Legal and Compliance History Complete ONE of the Following Certifications: Certification of Legal Action Report I certify under penalty of law that the attached Legal Action Report detailing Contractor's, Contractor's officers, Contractor's employees, and Contractor's proposed subcontractors legal and compliance history relating to the protection of the environment was prepared under my direction or supervision 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 persons who manage the system , or those persons directly responsible for gathering the information , the information 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 : lntercon Environmental , Inc. BY :~me) (signature) President (t itle) Certification of NO Legal Action Karen Andrews (print or type name of signatory) April 29, 2010 (date) I certify 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 supervision 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 persons 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 submitting false information , including the possibility of fine and imprisonment for knowing violations. CONTRACTOR: (Company Name) BY : --------------(signature) (title) DEMl0-04: ACM March 26, 2010 (print or type name of signatory) (date) 2-21 � c , , � � � t 1 l [ � I � E I � 1 1 i � � � � r r ENVIRONMENTAL, INC. 210 S Walnut Cree k Drive. Mansfield , Texas 76063 . Telephone (817) 477 -9995 . Facsimile (817) 477-9996 Prepared for City of Fort Worth PROJECT: DEM10-04: ACM Response to Section 2.15 Contractor's Legal & Compliance History www .intercon -e nvironmental .com 8 lntercon Environmental, Inc. has the following citations from Texas Department of State Health Services (DSHS): -. Project Name/Address: Bear Creek Elementary; 401 Bear Creek Drive, Euless, Texas -. Case No. 1412080038 -. Violation: Failure to have Consultant's Mold Remediation Protocol on-site; (Report not provided to lntercon). -. Date of Violation: June 13, 2007 -. Settlement: Penalty paid $750.00 to DSHS Project Name/ Address: Liberty Elementary; 7976 Whitney Drive White Settlement, Texas • Case No. 1410080438 • Violation: Failure to fill out notification form correctly; (Address number was transposed, typographical error). 4 Date of Violation: June 28, 2007 4 Settlement: Penalty paid $100.00 to DSHS ........ DOCKET NO. All564-600-2008 CASE NO. 1412080038 IN THE MATTER OF INTERCON ENVIRONMENTAL, INCORPORATED MANSFIELD, TEXAS § § § § § § AGREED ORDER I. JURISDICTION BEFORE THE TEXAS DEPARTMENT OF STA TE HEAL TH SERVICES AUSTIN, TEXAS The Department of State Health Services ("department"), Division for Regulatory Services, is authorized to enforce the Texas Mold Assessment and Remediation Rules ("Rules"), Title 25 of the Texas Administrative Code (TAC), Chapter 295.301 et seq. II. RESPONDENT Intercon Environmental. Incorporated ("Respondent") is a licensed mold remediation company, performing regulated mold-related activities, and as such is subject to the aforementioned Rules. ID.FACTS On June 13, 2007, a representative from the department conducted a compliance inspection of the mold remediation project at Bear Creek Elementary School, 401 Bear Creek Drive, Euless, Texas. The purpose of the inspection was to determine the Respondent's compliance with the Rules as referenced in "I. Jurisdiction." As a result of a subsequent review of department files, it is determined that Respondent failed to comply with various provisions of the Texas Administrative Code or statute referenced in "I. Jurisdiction." The alleged violation is described in Certified Letter No. 7000 0520 0024 1486 1855 , dated January 23, 2008 (hereinafter, "Notice Letter"), referenced in "IV. Notice." The following violations were alleged: • Failure to have the mold remediation protocol on-site in violation of 25 TAC §295.326(b)(l )(A)-penalty amount of$1,500.00. IV.NOTICE By the Notice Letter, Ms. Alyson 0. Henry, Division for Regulatory Services, informed Respondent of the department's intent to assess an aggregate administrative penalty of $1,500.00. The letter was received by Respondent. V.RESPONSE Respondent responded to the department's Notice Letter by requesting an informal conference. ~ . ..., VI. SETTLEMENT On February 27, 2007 , an informal conference was held between representatives of the department and Respondent. The parties reached a proposed settlement, the terms of which are contained in the "It is Ordered" section of this Order, based on various factors including the desire to avoid litigation . Respondent agrees to terms of this Order as evidenced by signing this Order. The following terms were agreed upon: • Failure to have the mold remediation protocol on-site in violation of25 TAC §295.326(b )(1 )(A)-penalty amount of $750.00. Respondent has no objection to this Order being signed by the Commissioner of State Health Services or his designee. VII.COMPLETE SETTLEMENT The facts contained herein are the complete settlement of all issues regarding the alleged violation(s) described in "IV. Notice" of this Order. A.WAIVER OF HEARING In exchange for the execution of this Order, Respondent waives the right to a hearing. B. NO WAIVER WITH REGARD TO FUTURE VIOLATIONS The department does not waive the right to enforce future violations committed by Respondent. C. COMPLETE UNDERSTANDING The department and Respondent acknowledge that they understand the terms of this settlement, enter into the settlement freely, and agree to the terms. D. NO RIGHT TO APPEAL Respondent waives the right to judicial review of this Order. NOW THEREFORE, IT IS ORDERED that: 1. Respondent pay an administrative penalty, in the amount of $750.00 , in full settlement for the violation(s) that is/are the subject of this Order. Payment must be made by cashier's check or money order and mailed to : Department of State Health Services, MC 2003, P.O. Box 149347, Austin, Texas 78714- 9347. Each cashier's check or money order must be made payable to the Department of State Health Services and must also include the notation: "Deposit in Budget No. ZZl 56 , Fund No. 092, Case N o. 1412080038." 2 . Payment is due in one lump sum p ayment, thirty (30) days from the date this Order is signed by the de partment. . . ' .... ; . ·. . 3. Respondent shall henceforth comply with this Order and with all applicable laws, rules and regulations. Failure to comply will result in additional penalties. ,· ~af., F //1 / Signed and ordered this L/' day of__./%--'-//.,...'.A.,,._t _'~_-c_c_ef_LL-______ , 2008. / i_.7 //~/- v'C.~,z ~,,....-~L, {_ ,,-~._.A.,--= thryn C."'Perkins, RN, MBA Assistant Commissioner Division for Regulatory Services Jerrold Andrews Printed Name Vice President 3/4/08 Signature Date DOCKET NO. Al2440-560-2008 CASE N0.1410080438 IN THE.MAUER OF JNTE~CON ENVIRONMENTAL, us·coiu>oRATEo · MANSFIELD, TEXAS §. § § § § § AGREED ORDER I. JURISl)ICTION BEFORE THE TEXAS DJ3:P ARTMENT OF STATE HEAL TH SERVICES AUSTIN, TEXAS 'J'he Department of.State ~ealth §ervic.es,' Division for Regulatory Services ("department")is . ·auiliOI1:Zed to tmforce the Tex.as Asb~ti;>~ Health Piot~tion Act, Occupations Code, Chapter l 954 ("Act");the 'f~xas Asbestos Health _Prot~ti.on Rules (Rules), Title 2.5TAC, Part l, Cllapter 295; the Natiohal Emission Standards for H.izardous Air Pollutants (NESHAP), 40 CFR Part 6 i' Subpart M; arid the Asbestos Hazard Emergency Response Act (A.HERA), 40 CFR Part 763, Subpart E . . · --· ' . '-·· .. 11.RESPOND~NT Int~rco~Environmental, Incorporated ("Respon.d~t") is a licensed asbestos abatement contractor of .a .renovation/demolition P!Oject, and as such is subject to thei 1forementione<l Act and ,Rules . . III.FACTS. On June 28, 2007, a representative fromthe department co~ducted an asbestos inspect1on at the Liberty;Eleriie~tary located at 797f> Whitney Drive, White Settlement, Texas. The purpose -of the inspection was ·· to determine theproject's compliance with the · Rules,· Act or NESHAP as referenced m "I. Jurisdiction." . . . . ' ;:· As a result of the inspection and during a subsequent review of department files, it was determined that Respondent failed to comply with variousprovisions :of the Rules, Act or NESI-IAP as referenced in "I. Jurisdiction." Tli~ violation is described in Certified Letter No. 7QOO 0520 0024 ._ 1426 2355, dated May 26, 2008 (hereinafter, "Notice Letter"),, referenced in "IV. Notice." · The foHowing violation was alleged: , · ·· • Failure to properly complci:enotificationJorm in violation of25 TAC §295.61(a)-penalty amount of $100.00. .. . .. . . IV.NOTICE By the Notice Letter, Mr.Dustin K. Exner, Division ofRegulatory Services,informedllespondent of the department's intent to assess an administrative penalty of$100.00. The letter wru; received by Respondent. . V.RESPONSE Respondent responded to the departmenf~Notice Letter by paying the admiru.·.strative penalty of . . $100.00. VI. SETTLEMENT The part,iesreached apropos~ settleine11t,.the t~nnsof which are contained in the '.'It is Ordered"·. section' of this Order, based 'bri variousfactors including the .desire to avoid litigation. -: Respo11dent agrees to tenns 9 f th.is Order as evidenced by paying the administrative penalty of $100.00. The followingterms were agreed upon: , . . • Failure to properly complete notification form in violation of25 TAC §295.61(a) -penalty amount of $100.00. · ·· · The peilalty was paid on July 11, 2008.- Respon.deni -has no objection to this Order being signed by the Commissioner of St~te Health Services or his designee. . . . VII. COMPLETE SETTLEMENT . ,• . The fads contained hei:ehi are the compl~te s~ttlement of all issues regarding the violation(s) described in "IV. Notice'? ofthis Order. A. WAIVER OF HEARING In exchange for the exec~tion of this Order, Respondent waives the right to a hearing. . ' ,. ' . ··.,-.. .-. '.• B. NO WAIVER WITH ~EGARD TO FUTURE VIOLATIONS · The department does not waive the right to enforce future violations committed by Respondent. ._.. .· :-;-. ; ·• C. COMPLETE UNDERSTANDING The department and Respondent acknowledge that they understand the terms of this settlement, enter into the settlement freely, and agree to the terms. 2 ··-···'··-·----·-. D. NO RIGHT TO APPEAL Respondent waives the right to judicial review of this .Order. NOW THEREFORE, IT IS ORDERED that: Respondent shall comply w'jth this Ord~ and with all applicable laws, rules and regulations. Assistant Commissioner signed and ordered thjs ···rt/,'········ . . <• =77 day'of ·.~ ... ,2008. . 1;7 .. ··· ... ·~ .. ·•• J;;,~~ .. ·. . t'h:...~~ RN MB. A ..• u.u.7-1:~ . ' -' . Assistant Commissioner Division' for R~atory Services ,,- 3 ~ Initial 2.16 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 Eauipment Type See Attached Eauioment List DEM 10-04: ACM March 26, 2010 Quantity Condition Year Model 2-22 ENVIRONMENTAL, INC. 210 S Walnut Creek Drive . Mansfie ld Texas 76063 . Telephone (81 7 ) 477-9995 . Facsimi le (817) 477-9996 www.intercon-environmental.com EQUIPMENT LIST AIR MOVING EQUIPMENT < 2000 CFM Negative Air Machines ............................... 4 > 2000 CFM Negative Air machines ............................. 60 Small HEPA Vacuums .................................................. 10 RESPIRATORY PROTECTION EQUIPMENT 3M Brand Full Face PAPR Respirators ........................ 80 3M Brand Full Face Respirators ................................... 20 BEA VY EQUIPMENT-OWNED 963C Caterpillar Track Loader-2005 , SN # BBD02229 ......... 1 Ripper, SN# 9H10263 ........................................................... 1 963C Caterpillar Crawler Loader-2001, SN# DS020602 ....... 1 330CL Caterpillar Hydraulic Excavator, SN# KDD01109 Bucket Thumb, SN#581361195 ............................................ 1 60 " Bucket , 2 .5 CYD , SN# HHGA003923 ............................. 1 330CL Caterpillar Hydraulic Excavator, SN# CCDKY03044 1 52 " Bucket... .......................................................................... 1 Bucket Thumb ....................................................................... 1 330BLC Caterpillar Hydraulic Excavator, SN# 3YR01539 ... 1 52 " Bucket.. ........................................................................... 1 Bucket Thumb ....................................................................... 1 320CL Caterpillar Hydraulic Excavator, SN#PAB00377 ....... 1 2006 Heavy Duty Demolition Grapple, SN#ANA00357 ......... 1 48" Bucket. ............................................................................ 1 72" Skeleton Bucket , SN#SEC66231 .................................... 1 Bucket Thumb, SN# HGA6512 ............................................. 1 2002 Mack Semi Truck Trailer ............................................... 1 10#101 -VIN#1M1AE07Y62W012915 , Plate# R8SD26 2001 Mack Semi Truck Trailer ............................................... 3 10#102-VIN# 1M1AE07Y71W003915, Plate# R8SD27 10#103-VIN# 1M1AE07Y71W003920, Plate# R8SD28 10#104 -VIN# 1 M1AE07Y71W003929 , Plate# R8SD29 2005 Witzco Challenger 50 Ton Lowboy .............................. 1 10#101 -VIN# 1 W8A 11 E3455000273, Plate # X0307 4 2006 30-Yd Ranco Round Bottom End Dump Trailers ........ 2 I 0#106 -VIN# 1 R9ESB5066L008533 , Plate # TEMP 10#107 -VIN#1 R9ESB5066L008532 , Plate# TEMP 2007 CAT 345CL Hydraulic Excavator ................................. 1 SN#CAT0345CAP JW01713 2009 Talbert 55SA Trailer SN# 40FSK564091030467 ........... 1 VEIDCLES 2004 Chevy Pickup Trucks ....................................................... 6 2000 GMC Box Vans ................................................................ 3 2002 GMC Box Vans ................................................................ 2 2005 GMC Pickup Truck .......................................................... 1 2007 Chevrolet Tahoe .............................................................. 1 Flatbed Trailer .......................................................................... 1 VIN# 4ZECH202391062157 , Plate# 50ZWFN Chevy 2500 Cargo Vans .......................................................... 3 Large HEPA Vacuums ..................................................... 8 Air Movers -Rigid 3-speed 2 ,500 CFM ........................ 20 10 Gauge Extension Cords 100 Foot ......................... 200 Small GFCI Outlets ........................................................ 60 North Brand 1/2 Face Respirators ................................. 70 3M Brand 1/2 Face Respirators .................................... 70 2007 Clement Scrapstar End Dmnp Trailers ....................... 3 10#102-VIN# 5C2BB37B17M005756 , Plate# 5516FM 10#103-VIN# 5C2BB37BX7MD05755, Plate# 5517FM I 0#104 -VIN# 5C2BB37B87MD057 54 , Plate # 5518FM DFC 400 Hydraulic Concrete Crusher, SN#DFC0489 ............. 1 2008 Stihl 14" Gas Saw, SN#168683300 ................................ 1 2008 Panther Roof Saw, SN#608003RS ................................. 1 2006 Rockram 778STR Hydraulic Hammers ........................... 2 SN#591067 ;SN#591054 252B Skid Steer Loader-2006· ................................................ 1 SN# SCP03235 262C Skid Steer Loader-2008 ................................................ 1 SN# OMST02301 ; 72 " Bu cket SN# HAS 011033 2006 T6 Trencher, SN#KSK0265 .•.•........................................ 1 2006 Pallet Forks and Ca rri age ............................................... 2 SN#6555FP036237 ;SN #6555FP036247 2006 72" Grapple Bucket, S N#6555lG06917 .......................... 1 2006 72" Grapple Buckets w/BO Edge .................................... 2 SN#655560086307 ,SN#6555GP088065 2007 Brush/ Sweeper ............................................................. 1 SN#ODBP01129 / HSA009089 2007 Cat 262 Skid Steer Loader ........................................... 1 SN#CAT0262CHMST00385 2003 Cat 262 Skid Steer Loader ............................................. 1 SN#CAT00262HCED01875 2005 CAT TH560B 10,000 Lb 4:1.4x4 Telescopic Forklift .... 1 SN#CATTH569CSLG00933 1998 Freightliner ..........................•........................................ 1 10#121 -VIN# 2FUPFXYB5WA983789 330BLC CAT Hydraulic Excavamr ........................................ 1 SN# 3YR01539 52 " Bucket Thumb 2007 Chevy Diesel 1-Ton DooleyPidkup .............................. 1 10#108-VIN# 1GCJK33D37F139190, Plate# 65VYM4 2001 Dodge 3500 Utility Truck. _____ ,-····································· 1 10#106 -VIN# 3B6MC36661254482, Plate# 20LLK4 1994 GMC 2,450 Gallon Wates-Tiril.ldk.. .................................. 1 10#105 -VIN# 4V1 JBBDE4RRB28336 , Plate# R8XV18 2008 Ford Exped iti on ............•. ·-····-······· .. ···························· 1 ID #117-VIN# 1FMFU15581.A06925, Plate# 61JKJ6 EQUIPMENT LIST PAGE20F2 ELECTRICAL EQUIPMENT Kipor Light Towers .................................................................... 4 GFCI Electrical Panel Boards ................................................... 8 Portable Light Stands ............................................................. 20 Generator 10 ,000 Watts ........................................................... 2 D ECONTAMINATION EQUIPMENT Showers ................................................................................. 20 Shower Filtration Pumps ........................................................ 20 MONITORING EQUIPMENT Digital Recorder/ Printer Manometers ................................... 14 Low Volume Pumps .................................................................. 8 SAFETY EQUIPMENT 10 LB Fire Extinguishers ....................................................... .40 Battery Operated Fire Alarms ................................................ .40 Full Body OSHA Harnesses ................................................... 10 Shock Absorbing Lanyards ..................................................... 10 FLOOR TILE EQUIPMENT Propane Powered Floor Tile Machine ...................................... 1 Floor Buffers ........................................................................... 20 P NEUMATIC TOOLS 20 Ton Air Bottle Jack .............................................................. 2 Impact Wrenches ...................................................................... 8 Air Hammers ........................................................................... 10 HIGH REACH EQUIPMENT Scaffolding -Ladder 8 Foot .................................................. .40 WATER EQUIPMENT Gasoline Matsuki Submersible Pumps ..................................... 2 2006 4 ,000 PSI Hot Water Pressure Washers ......................... 2 Electric Power Washers ........................................................... 3 Gasoline Power Washers ......................................................... 6 LADDERS Type 1 A Fiberglass 2 foot Step ............................................... 9 Type 1 A Fiberglass 6 foot Step ............................................. 22 Type 1 A Fiberglass 8 foot Step ............................................. 18 Type 1 A Fiberglass 10 foot Step ............................................. 8 Type 1 A Fiberglass 12 foot Step ............................................. 8 CU1TINGIWELD1N G Truck Mounted Gasoline ARC Welders / Generator ................. 2 Electri c ARC Welders ............................................................... 1 Wi re Feed Welders ................................................................... 2 Oxy/Acetylene Torches ............................................................ 8 POWERTOOLS Powertrain 30 Gallon Air Compressor ...................................... 2 1 Inch A ir Impact W re nch ......................................................... 2 G ri nders .................................................................................. 10 Drills & Hammer Drills ............................................................ 25 Jack Hammers .......................................................................... 5 IIEAVY EQUIPME~7 -AVAILABLETORENT Backhoes S ki d St eers Trucks & Contai ners Box Blades ENV1RO NMENTA L, I NC. Generators 5 ,000 Watts ........................................................... 4 2006 Magnum Portable Light Tower. ....................................... 1 Water Heaters ........................................................................ 20 Dehumidifiers ........................................................................... 2 High Volume Pumps ................................................................ 4 Hard Hats ........................................................................... 200+ Safety Glasses .................................................................. 200+ Spud Bars ................................................ _ .......................... 80 Squeegees .............................................. -........................... 25 Jacks .......................................................... -........................ 10 30 gallon Powertrain A/C ......................... _ ............................ 1 Scaffolding -Ladder 3 Foot.. .................... -.......................... 30 Electric Airless sprayers ....................................................... 14 Fire Hose ......................................... ·-·-·--------.................... 400 Commercial Grade 5/8 inch hose .............. -........................ 100 Commercial Grade Sump Pumps .......... -... -........................... 4 Type 1 A Fiberglass 16 foot Extension _____ .............................. 6 Type 1 A Fiberglass 20 foot Extension . __ . ____ ........................... 4 Type 1 A Fiberglass 28 foot Extension . ____ .............................. 4 Type 1 A Fiberglass 40 foot Extension ______ ............................. 4 Propane Torches ...................................... ___ .......................... 6 Plasma Cu tte rs .......................................... -........................... 2 Diesel Powered K ipor Welder/ Generators ........................... 2 C ircu lar Saws ................................ ·----------------·········· ......... 15 Table & F in ish Saws ....................... ------·-····--··--.................... 8 Band , Reciprocati ng & J ig Saws ·--··--------.......................... 32 Sanders .............................................. ________ ......................... 8 Routers & Planers .......................... --------------·· ................... 10 Motor G raders Knu ckl eboom s Compacti o n Equipment Footed & S m ooth Rolle rs A ll equip ment is l ate model equip ment that i s in good to g reat cond i t ion . All equipment is r egu l arly maintrined in acc ordance t o the manufactu rer's spec i fi cation s. Initial 2 .17 OTHER Each Provider shall submit a single copy of a sample of the following documents for review: DEM 10-04: ACM March 26, 2010 Invoice Included in Sample Job Closeout Report Daily Log Sheet Included in Sample Job Closeout Report Sample Job Close-out Report See Attached Health and Safety Plan (CD ROM) Attached Health and Safety Records for the Past Three (3) Years See Attached INCLUDE ONE (1) COPY OF EACH DOCUMENT WITHIN THIS PROPOSAL PACKAGE FOLLOWING THIS PAGE 2 -2 3 210 Sooth Walnut Creek Drive • Mansfield , Texas 76063 • Phone : (817) 477 -9995 • Fax ; (817) 477-9996 PROJECT CLOSEOU Consultant: CONSUL TANT- ENTATION ir nmental, Inc. o.XX-XXX Prepared for: CLIENT/OWNER NAME CLIENT /OWNER ADDRESS DATE OF CLOSEOUT d ENV I RONMENTAL, l NC. www.intercon-environ mental .com ENVIRONMENTAL, INC. Table of Contents 1. Invoice 2. Notification 3. 4. Project Record • 5. i. Daily Logs ii. ii i. Training Certificate e ical Surveillance of Asbestos Exposure RFCI certificates exas DSHS Contractors License 7. Texas DSHS Transporter License 8. Waste Man i fest (if applicable) tercon ENVIRONMENTAL, INC. 210 S. WaJnut Creek Drive\ Ml:I.Il...<;Jield, Texas 7606iJ Telephone (817) 477-9995 -Fau,;imile (817) 477-9996 Bill 'l'o P.O.No. T)e,,;i,ripti.on Invoice Dat.c lnvofr.e # Amount Total $0.00 -+c*4 l*~TEXAS ~,,,,,~~: rer1ices ASBESTOS/DEMOLITION NOTIFICATION FORM r,:::::::::::;::::::;::::::;:::;:;:;:;:;;: TYPE OF NOTIFICATION: (Select one and flll in the requested information) 181 ORIGINAL O AMENDMENT No. __ N'-"'/-'-A'---- 0 EMERGENCY 0 CANCELLATION •Was emergency request made to the Regional Offic.e or Environmental Health Notifications 0Yes0No •If yes, the DSHS reference #:-'--N'-'--/'"""A _____ and name of the Regional or EHNG N/A Date: Ji.! ~-Time: N/A •Describe the reason for emergency: _N_/_A _________________ _____,.,,.._-=..------...,----- 0 ORDERED: (For structurally unsound facilities, attach copy of demolitjM Name: N/A Registration No . ..:..r(f:.:..:....;/(\--'-e--"~-----1"\,- Title: _N_/A _______ -.,..--,-----------,,,.-=--,-----,.,,,._......,,,.....,.-,----+=F- Date of order (MM/DDIYY):.Ji! .A)_ {x) Below II Amended AMENDMENTS: You must comp/de the f!IJJireform and mart the llJl indicau ll11lt!ndt!,I informatlon. TYPEOFWORK C8J Asbestos Abatement O Demolition D Annual Is this a phased project? 0 Yes 181 No FACILITY INFORMATION 1. Faclllty Location O ....... Description or Facility Name: ----"Ii:--=--=--=:,,., D ....... Physical Address: ________ ___,.,,_,___---=:,'-- 0 ....... County:_________ __.,,.,..,_ _______ Zip:-------------- 0 ....... Facility Contact __ __,,.......,,~ _____ __,_,,...,__,. NESHAP-Only 0Public SchooIK-12 Number of Floors: ___ _ WORK SCHEDULE/ ASBESTOS AMOUNTS (Note: if the start date(sJ enJered below cannot be md, the »ms Rq:lonal or Local Program office must be notified prior to the scheduled start date. Failure to do so ls a violation of TAHPA Section 29S.6L) 1. Asbestos Abatement Work Schedule: 0 ...... Start date: / / and En d date : / / 0 ...... Work days: []Mon~OTues. 0Wed. IlThurs~O Fri. 0Sat. Osun. 0 ...... Workinghours: Oa.m . Op.m . to _________ Oam.Op.m. 2. Demolition Work Schedule: D ...... Start d ate: N / A / and End date : N / A / O ...... Work days: 0Mon~Tues. Owed. 0Thurs~0Fri . 0 Sat. 0 Sun. 0 ...... Working hours: N/A D a.m. D p .m. to _N..c.../_A ________ Da.m. Op .rn. Fc1RM APD #5, REV 5/07 (i) Below if Amended C. ASBESTOS AMOUNTS D . .. . .. ls Asbestos Present? ~ Yes O No (Complete the table below if asbestos is present) Asbestos-Containing Building Material Type *Only mark thL boxes below on this chart if they are being amended Approximate amount of Asbestos Pipes Surface Area D ...... 1. Description of procedures t o be followed in the eveot that unexpected Lu La. SQ Ft M Ft material becomes crumbled, pulverized, or reduced to powder: _::St:.:o'...!'.p:....:..:_=::r'..:.:k:-...., n~=~:..:..::::..:_,_:::.:::.::=:.:;::,,;~~:....:..::=:'..-.--- De artment of State Health Services D ...... 2. Descriptioo of planned demolition or abatement work, ty,- 0 ....... 3. Desa-iption of work practices and engineering co PROJECT INFORMATION D ... ... A. FACILITY OWNER o .. Facility Owner Name: --------..::!!i::>r--=--=~-------------------- Phone #: ( >-----------'~----------------------- Attention: ------+=-=-------"<.?c--#------------------------ Mailing Address: ---~-==""'-.a:-------fu,l'------,------------------ City: ________ ...,,_..,_~...,. '"---~----Zip : _________________ _ D ...... c. ASBESTOS DSHS Asbestos C NT CONTRACTOR #2 (Only if there is more than one Contractor) License #: -'N-"/-'-'A'------- Contractor Name: _N __________________________________ _ Address: _N_/_A _______ ~--------------------------- City: _N_/_A ___________ State: _N~/_A ___ _ Zip : N/A Office Phone #: ( ) N/A Job-Site Phone #: ( ) N/A D. ASBESTOS SUPERVISOR D ...... DSHS Supervisor License #: _____ _ O ...... DSHS Supervisor License #: _____ _ FORM APB #5, REV 5/07 Site Supervi sor:-------------------- Site Supervisor:-------------------- (x) Below tr Amended E. NESHAP TRAINED INDIVIDUAL 0 ...... NESHAP Trained Individual :------------------------------ Certification Date: ..}D ~- O ...... F. DEMOLffiON CONTRACTOR Demolition Contractor: __ N_/_A _____________________________ _ Address: _N_/A _______ ---c-------------:---c---------------- City: NI A State: N/ A Zip: ~N=/ A'-'-----Phone #: ( ) N/ A 0 ...... G. PROJECT CONSULTANT OR OPERATOR DSHSLicense No.:---------- Project Consultant or Operator:-----------------------,,,.---------- Address: _____________ ........_.,-------........_.,-------..9=...------- City:---------~ State: Zip: _____ Phone #: ( D ...... H. Waste Transporter DSHS Waste Transporter License#: 40-0336 Waste Transporter: lntercon Environmental Inc. Address: 210 S. Walnut Creek Drive City: Mansfield State: TX Contact Person: Jerrold Andrews 0 ...... I. Waste Disposal Site TCEQ Permit#: --'1..c.0=2=5B=cc--------c-=c-,------ Waste Disposal Site: -=D-'-FW-=-"'=-_La'--n---'d_fi_ll ________ --z':+----'\:-"+---~c-=>=<;~-------- Address: 1600 Railroad Street City: Lewisville State: TIL.__ Phone #: ( 972)315-5421 Date: I I ------ (Printed Name & Title) Phone #: IMPORTANT INFORMATION o 1tion Notification form must be postmarked no less than ten working days (not calendar days) pn r to the start of any asbestos abatement or demolition . FILING FEE: An invoice will be mailed to the facility owner upon completion of the project. CALL FOR ASSISTANCE: MAIL FORM TO: FORM A PB #5, REV 5/07 (512) 834-6747 or (888) 778-9440 (toll free in Texas) ENVIRONM ENTAL HEAL TH NOTIF1CA TIONS GROUP TEXAS DEPARTMENT OF STATE H EAL TH SERVICES PO BOX 143538 AUSTIN, TX 78714-3538 .,r: .. ,. .----( Project Name ... I _____________ ____. te rco n Project Number...___ _________ _ ENVIRONMENTAL, I NC. Shift Supervisor ,___ _____________ ~ DAILY PROJECT LQ Activity .-----( Date ... I __________ _. Shift ....._ _________ __. Day ..__ _________ __. Today's Work Areas Consulting Firm On Site Representatives INTERCON TDH Site Inspections Yes No D D D D D D Received Removed Dumpsters Today I I Dumpsters To-Date============== Daily Project Log Shift Supervisor Signature======================== 2 3 4 5 6 7 8 9 10 11 12 4,3 14 15 16 17 18 19 20 Project Name '-----------------' tercon Project Number .__ ____________ ~ ENVIRONMENTAL, INC. Shift Supervisor~------------~ DAILY TIME SHEET ----'r ~~ Employee I 'fim,e In Time Out Time In Time Out Total ~' ' \ )v ,, ) t ~ ~ 1~·/ ~ I~/ I ' !/ !\ ~, ~ I ''" // I -'" II ~ "~~ V' // ~ ~ ~/ /,/ '\\ ,, / A--1) \.._ '{ -,,. /.,; ~ I// V: I/ ~ l\. ~ ~!r 1, ~ Daily Time Sheet Shift Supervisor Signature Date ....._ _________ __, Shift .__ _________ ......., Day __________ __. Safety Meeting Topic Accidents or Incidents Today New Hires Today 'P Percent Complete Total Houra Today Total Hours To-Date Project Budget Hours 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 ENVIRONMENTAL, INC. CONTAINMENT LOG Employee Con ta inment Log Project Name'------------------' Project Number ,__ ______________ __. Shift Sup_ervisor ~ r ·~ Socfal,Se{;urity ~. Tfmetn Timeout Time In Time Out /1, \\ l' ~ ho. J ,J ~ ~ 1'/1 ,,,.,, .. "Ill ~11 v-" '" 11 ~) ' :7 ,,, 'J // ......... ' /l_...4 1~r ' ... I,,,," // A ~ / / Y1\ ' // \.. /' V "'-""" ' / "-// "' ~ Shift Supervisor Signature Pers D D D D 0 0 0 0 D ~o 0 0 D Date ,__ ____________ ___. Shift Day _____________ ___. Containment Area onal Protection Equipment Used Steel Toe Rubber Boots Single Tyvek Type Sutt Double Tyvek Type Sult Cotton Gloves Rubber Gloves 112 Fae, RNpfr,tor I HEPA Fitters Full Face Respirator /HEPA Fitters PAPR Respirator I HEPA Fitters Other ________ _ ;rexas Department of State Health Services JOSE A CONT license No. 804201 Control No. 95798 Expiration Date: 07/22/20 · 0 GEBCO ASSOCIATES in cooperation with UNIVERSITY OF NORTH TEXAS certifies that e A. Contreras has successfully co Asbestos • President Date of issue : 01/04/10 Certificate Number: 10013 4839 FEB /05/2010/FR I 10: 50 AM Physician'-s Written Statement Medical Smveillance for Asbest~ .Exposure En:vimmucntal &. Sanitlltion Licensing Group 800/572-554! ar:512/834-6600 Fu; 51:Z-~14 Applicmt ~ (Fim, Z.U. 1m) Social ~ # Date ofBittb. D tw c.o. hi// !I,: L City . · Stttt: . . · lNDICA'I'E wm:CHITEMS WERE PERFORMED WITH.PHYSICIAN'S -0 (Any-that_.are not-appBC2ble, ntost still be initialed offin.2d · The above-rurmeci individnal was s~ on IJ Z ~ d 5: Zalt.J If etnployed. the employer provided. and review was made of: 1he empl relzt.e to 1he employee's ~ 1he employee's repiresc~li'i· fi~ttici~!ll respiratozy eqmpmcnt to be utilized by the employee, and •,mi~ emplQyee that is D.Ot otherwise available to 1he physi · 2Z_ A physical examination with emphasis UpOll the nary: c:adi.~SCUlar; S 7 The pulmonary :function tem_ of fureed vital · (FVC) accordalll::e wiihNIOSH aJJdATS standards. 1926.1101, Appendix E. *NO • ::It the~'s ~etion: P. 002 /00 4 UillC:35 otherwise noted below,~ c~ that no medical conditions w.e:re demcted that~ place the employee at an increased risk of matl:rial hEal\i impJII!ll. • ent · expom:e 1o asbestos, and no limit.ilions are reeomm~dcd on the employee conceming the use,of pe=mal ~e ~t or respirator. By signing this fomi., :I acknowledge 1bat fui.s e:nmination has been perlbrmed · with either 9 (?R..1926;1101 or40 CFR 763.122(a), as required. mm Jw.Jil0Pf1epalll Jose G. Trevno, M.D. 3141 Irving B1vd,Suite220 Dallas TX OZ8£"1Enll:xtl tt1FSB9.tIZ:111 itzst n ·seiien 1E :J1S 'l!A!B 3&i!aq ltl'l ~ .lll1M)9lll 214 630-1144 T~:Nm.mtt fmcluding area.cod") 75247 Zip l PRIVACY NOTIACATION I NOTIFICACION soaRt PIWACIDAD I With few exi::e-ptiol'I$, you ha Ve the tight to · tequast and De Informed about information 1l'iat tl'le Stme of. T exes CDllecti; aboUt you. You are entitled to T8C8!ve and rnviBIAI 1he informafion upon raquest. Ycn.1 B!r;o have the right ni ask: tt,e slate agency to con-ect any infonnat!on that le determined to he lnoorract See http://www.dshs.state.tx.w(b m= imotmatlon on Privacy Nol:ilication. (Referencei: Governor Code, Se.;licn 55.2.021, 552..023, 559,003 · and 559.004) Tan solo por unas cuantas exeapciones, ust&d 1k>n8 ~ darecho de solicitcr y de aer Inform.ado sobn! la _infolmaciiin que al Eslado de Texas Rlline sobrv usted. A u~ se le debe conceder el derecho de racibir y reviser la lnfonnaci6n .al reqUerlrla. U!:ted 1ambll'tn 1i811e el ~ de pedlr que la agenda e,,i;atal COmJ8 cualquier infonnacf6 que se ha determinado Ilea incorrecta. Olrljase a http:Jlwww.d~hs.st3f,jx.w( pera m~ informeci6n sobrn la Nolificacjon scb~ p livacidad. {Referancia: GoVll11Jl1leflt Code.._~ 552..021, 562.023, 559.003 y 55S.D04.) Revised May 2008 Publication# F1~11668 ENVIRONMENTAL, INC. 2 1 0 S Waln ut C r eek Dr i v e . Ma nsfie l d, T ex as 76063 . Te leph o n e (8 17) 477-99 95 . F a cs i m i l e {8 17 ) 477 -9996 ---····--····--· ,·----------- Employee Name: Respirator Fit Test _/ ;;-sc. C-c."n j >"cr~> DSHS License Number: Respirator Type: Half-face Respirator Brand: North Respirator Size: Medium (circle Question 1. Was respirator reasonably comfortable? 2. Was positive and negative pressure tes 3. Does the individual understand fully tl1 factor of this type respirator? 4. Was the individual instructed on care of this type respirator? 5. Was a smoke type test administe 6. During the actual test was the ind required to converse a . move his to insure correct fit? 7. Did recipient pass fit test? w ww .intercon-environmenta l.com No These items are my damage any, I will re1 lost or damaged. If I lose any of this equipment or negligently ironmental, Inc. the full list price for each article e is true and correct. Empie ,5': ~I/a~ Date of fit test ___ /_ 1 ___ I __ -OSHA Regulations (Standards -29 CFR) 1910.134(0(2) The employer sha ll ensure that an employee using a t ight-fitti ng facep iece resp i rator is f it tested pri or to i nitial use of the resp i rator, whenever a different resp i rator facepi ece {size, style, model or make) is used, and at least annually thereafter. 1910.134{0(3) The employer shall conduct an add itional fit test wh ene v er the empl oyee reports, or the em ployer, PL HCP, supervisor, or program admin i strat9r makes visual observations of, changes i n the employee 's physical cond it ion that could affect resp i rator fit. ~uch cond itions i nclude, but a r e not limited to, f acial scarri ng, dental changes, cosmetic surgery, or an obv ious change i n bod y we ight. Certifica-'--e o f ~rVorker' s Acknovdedgement and 'VV orke:r Release Intercon Environmental, Inc. Project Name -----· ___________ Date _________ _ Project Address 'WORKING \VITH ASBESTOS CA.!.'1 BE DA.:.~GEROUS. STOS FIBERS H AS BEEN LINKED Vi'ITH VARIOUS TYPES OF CANCER. IF YO · MO r . AND INHALE AS BESTOS FIBERS THE CHANCE THAT YOU \-VILL DE\ -~-..,OP L -G 'ANCER IS GREATER THAN THAT OF THE NON-SMOKING PlIBLIC. resp iratory protection manual issued by my cm to be used on the above project TRAINING COURSE: I have beetr,'llr:"au1.e Physical characteristics of, sbestos Health hazard:; associated \X..·' ....,s.._~-~= Respiratory protection Use of protective uipment Pressure Diffe tia JvfEDICAL EXAMINATIO~ ·_ I have h2d a medical examination \V ithin the past 12 months at no cost to m e _ This cxaminatr0n incfti:ded: health histery, pulmonary function tests and may have included an evaluation of a chest x-ray . By signing this document I am acknowledging only that the Owner of the building I am about to vrnrk in has advised me of my r ight.~ to training 211d protection relative m my employer, hiter con Environment.al, he. ,._,..- S: ~znatme: _ _j 0 .) r ' ~A · (,.,, n +r:e ~t:_c-~c: _____ _ .. ·, as Department of ~tat ealth Services HECTOR MEDINA License No. 804027 Control No. 95799 Ex p iration Date: 07/27/201 O ESCO ASSOCIATES in cooperation with UNIVERSITY OF NORTH TEXAS certifies that as e the exam given on the final day for the Environmental ining Prog am entitled Asbestos ervisor Refresher • President Date of issue : 08/31 /09 Certificate Number: 09238 1341 GEBCO's Training Programs are provided in cooperation with federal nnd state regulatory agencies , and fulfill JUN/27/20 09/S AT 12:38 PM Physician1 s Written Statemep.{ Medical Surveillmce for Asbestos Exposure · Environmental 8:, Simitatiou -Lic,ensi.ic G,oup 8001572~5548 or 5121g34-6600 Fax: 511-ll34-<i6J4- 6.3.:S 03 13 'I I DateofBi.m P. 002 INDICATE WHICH fl'J£MS 'WERE PERFORMED WITH.PEYSICLV (.A.E"'f that are sot app;i::able, ml!St m1l he initiaied off in add' · /_/jJrJ/:rio _ .. ~ "":~l<Oo:~:~~ o~~, ;;.:,_: _ q=tio,_ •ock :ID~ wif ::;;:;J pu_lmolla.y, =movascul~, au.e1 gas-cr-omres,mal sysrems per part 1 an o ot /f.1--If empioyed, the :;mpioyer provided., and revi!w was :mad:; of. ~ employ relate w tlle ~loyee's expcs1tr~, the CU1plcyee's ~ :rati-ve r anrici?ated exp r~spir:aro0:-eqw1)men~ 1:0 b.; ur-i"'ilZ5d. by th~ eri!ploy~ - v'Jj ,,/) eiuployec mm li :!lot ofa=lrwise availabie tc w ph /_.J{../_ / physical e~-cion with ~a5is upo:r; . e";lbi-r.u-r.-,,..--,,; offuis e.uiploye='s tlmies 2S they . e ie'\P...l. fue -perSonal proeci.ive and ·r.n~al ~mIDaricTIS of the ai~~c.red -!la;_ puirnonar::" fun::cion rests of fm·ced. vriitl ed expiratory volume ~ one s~ond (rEV 1) m ~-----~ ................ ~ -,..!"r ....... ~T' ..... _.J "'.'.: ......... _..J .... _.J .. C/h J/~~~a~~ \~~e~: -~~:~me v~ysi ~ ch~~ roemgenog.am, p0SL~.:.l04;7"~Qt ! 192.6.1101 , Appendix E. •NOTE: _ ~o, i at fu!: Pin•l.kiall's discretion. 'M Tne e~pi~:_v:e was .· by,he pbysicia.... ;, · _ r~"'!.iits of the e-,;a.m im.d of ®Y :medical canrl:irions ilia! may ;:-e;;ulr from ' ~sues-...os eJ..:DOSU!e men , -f hmg cim cer aurfrmw.ble IO the co:.;nb.i.Jed ~c;: of sm oking cn d ab:::stos uaiion :q:irli.cates thEl no medical condmoI!S were detected 1bE! wonld place .fue ~loyee ~ an in=ased ris'· i "i.al health !Ihpai.'1'.:'.lem from expos-..u-e to asbestos, and no limicEtions 2re i'XOIDID~detl m:, fue =ployee concemin!1: 1l!:!e i.!s~ of n=roa.l n:.m:eGtive eauimnen! or-Tl'!S!lfi"l!Wi". Bv sl~~ this frn i .a.cknowletk>;e im!± mis ex,,;:n~ation has be;n pcionDed ina:;co,~:ri..be:r J9 'FR l92o.ll0 1 or 4 0 CFR 763 .El (a), 2;; ;-equired. Jose G . "Trev:ifi.o. MD 3141 JrvimrBivc:l. I a'l -TX Sn-= .,o\o.dress PRIVACY NO'T!i=IGATJQT>! f NOTFICACIDN SOBR:: ?~lV."-CID.A.D Vvrtti . h;w ex.:eptlor:~! y~u _i---.zvc, _th3 right to raqu:est ,mo b2 iniurrrsd aboui information ·tt-..it the State of Texas ~lie= '!lf~l)l\lHf_,. e entitled to M::etva 2.nd r,3v c=w ~n~ 1nmrmauon upon re.quest . Yo u &.ls o have fil5 right to ask the stat= ag:ncy to ::;oTTcd t:tt~ ffl'formgtion'""f~!i~in:!d re b2 incorr.,:;t. S;:; iJ@fferww.dshs .st1mU:u:s/foo more iniorrr.ation on !"rn;acy Notification. (Reference: Governor Cote, S.e.::tkln 552.021.'~52.C23. C:59,003 anc 559.004) T.;,n solo .por unas e~2S a=p::ione,;;, l.!52d ii;.n: 2 1 de;re;r:.no da solicitor y daa saar infon-nado sobre ta inforrmi~qLE 31 =.stado de Texas reune sob:;; u~. A t:sted se· le debe eoncsatiEr 31 d:era::ho ci;, r:cioi;-"f revisa=r Ia inrormacion al requ!:rlrl2.. L!sted :tambien ten..-=1 d9m..'""ho de peal, que le agencia es.:a~a! corrU;a c:ualqu lar l nfu..noicio qua, sa, hi; det,mninadc: sae.s irn:orF-cta Dirij:asse a ht".o .'/twww.dshs.stett;,p,.w,' D~= mas infurrnacion soi::>re la t\l:,r.fir::irir'ln ~,..,r,,~ nri\!!>,....;~~,.: l'::l::i~r.::in:-i=• f:nv.=orMT"n.=o,,r r"'.ri.-i= c.=ir.;.-:i!"m, ~? 071 ~~? n?'~ ~~~ nr;_"{ V _::;5g_Q04_\ ·r.· ENVIRONMENTAL, INC. 210 S Walnut Creek Dr i v e. Mansfield. Texas 76063 . T ele p hone (817) 477-9995 . Facsi m i l e (817) 477-9996 ------------------------------------··-·-- WWW .intercon-environmental .com Employee Name: DSHS License Number: Respirator Type: Respirator Brand: Respirator Size: Question Respirator Fit Test tdEC _ToE?,., (V\G:DlN A Half-face North Medium ' 1. Was respirator reasonably comfortable? 2. Was positive and negative pressure tes 3. Does the individual understand fully tri factor of this type respirator? 4. Was the individual instructed on care of this type respirator? 5. Was a smoke type test administe e ? 6. During the actual test was the indi i required to converse a ove his r hen to insure correct fit? 7. Did recipient pass fit test. These items are my damage any, I will rei lost or damaged. Emplo e is true and correct. t/ , Y Tcs.-e Co.n jYc a:; > Title Supervisor experienced in the admin i stration of proper fit tests. "/24 1og Date of fit test ___ t" ___ I_ i __ OSHA Regulations (Standards -29 CFR} No 1910.134(f)(2} The empl oyer shall ensure that an employee using a tight-fitt ing f.a cep iece respirato r is fit tested p rio r to initial use of the resp irator, whenever a different respirator facep iece {size, style, model or make ) is used, and at least annually thereafter. 1910.134(0(3) The employe r shall co nduct a n additio nal fi t test whenever the employ e€ reports, or the empl oy er, PLHCP, su perviso r, or program adm inistrator makes visual observations of, changes in the employee 's physical " condition that could affect re spirator fit. Such conditi ons incl ude, but are not li mited to, facial scarring, dentald changes, cosmetic surgery, or an obvi ous change in body weight. Certificate of Worker's Acknowledgement and Worker Release Intercon Environmental, Inc. Project Name ________________ Date __________ _ Project Address---------------------------- ,vORKING 'WITH ASBESTOS CAN BE DANGEROUS. INHALING . ..,.....,,.,._. BEEN LINKED ,VITH VARIOUS TYPES OF CANCER. IF YO ASBESTOS FIBERS THE CHANCE THAT YOU WILL DE GREATER THAN' THAT OF THE NON-SMOKING PUBLIC. Your employer's contract with the Owner for the above project requires tha o proper respirator and be trained in its use, you be trained in af e work practice equipment found on the job, and you receive a medial ex~ · on. These th' gs · to have been done at no cost to you. By signing this certification you are assuring.} Owner th · your employer has met these obligations to you and are agreeing to hold th . r, hr C{;)nsul esting Laboratory, and representative harmless in any and all claims arisi.ng from lated t is oject. / RESPIRATORY PROTECTION: I have be~n tra . the ~yp e respirato~ to be use~ on the ab?ve'{eferen respiratory protection manual issued by myempl yer. to be used on the above project TRAINING COlJRSE: I have .• ~~---· asbestos dust and in proper or\~n:Q!~ covered in the course included the -, tl~~fs inherent in handling asbestos and breathing onal and area protective measures. The topics MEDICAL EXAMINATION: I have had a medical examination within the past 12 months at no cost to me. This ex · inatio1i':included: health history, pulmonary function tests and may have included an evaluation of a c sfx-ray. By signing this document I am acknowledging only that the Owner of the building I am about t o work in has advised me of my rights to training and protection relative to my employer, Intercon Environmental, Inc. Signature: l-.t ec+or-Med; f'\O.. ~redN]e~ 'i~@f? Texas Department of State Health Services Asbestos Abatement EULOGIO TORRES ., License No. 8044 Control No. 96 - Expiration Da • -I , I _/ I J I I ' ! I I f. I f If : '1' \ !, • -,-BCO ASSOCIATES in coope ration with UNIVERSITY OF NORTH TEXAS cer t ifi es tha t Torres A sbestos Co • ~~-~ Pres iden t Date of issue : 03/30/09 Cert ifica te Nu mber: 0909 0 107 7 GEB CO's Training Prol!rams are provided in cooperation wi th federa l and state regu latury agencies, an d ful ill all CEBCO is licensed for Asbes tos Training unde r th e Texas Asbes tos Heat P GEtlCO Associates, LP • 469 0 Di plomacy Road, Suite 120 JAN /0 4/2 010/MO N 05: 17 PM -,c*~ . I*~~. ,. TEXAS .. Dep.;,rtment cf . ta( · State Health Services www.tdh.state.tx.us/beh/asbestos Appli=it Nem,:: (F=r, M.l., Last) Street Aden=;: Physician's Written Statement Medical Surveillance for Asbestos Exposure En.vitom:,;,,to_ml &. Samtation Lic=ing Group 800/572-554& or 512183~600 Fiix: 51.2-834-6614 SocialS~# D.iie ofBin:h State P. 00 3 INDICATE wmc:e: ITEMS WERE !'ER.FORMED WITH PHYSICIAN'S OR (Any that are not applicable, n,:nst still be initialed off in additio The above-!lBIDed individual was seen on {)f tJ ;I-/2) clinic.) Completion and review of the standardized mcdica.). questionnaire and woi;Jehistory with sper-i'a1"-- pulmo:na:ry, cardiovascular, and gastrointestinal systems peipart 1 and 2 ·t'Appimdix Din 1926.110 57 The pUlmonary function tests of forced vital ca accordance with NIOSH and ATS standards. Indic!!!e whether or not the physician decided that chest roentgenogram, posterior-anterior, 14" x 11• or · 1926.1101, Appendix E .. *NOTE: Accf rding to :29 nt t.b.e physician's discretion. Jose G. T revno, M.D. 3141 lrving Blvd. Suite 220 l'rint .Physician's Name Dallas StrcetA~ City ··...,__ TX .Staie wi;l\ei:airnoyee 's d:utiei; as they personal protective and ~a:mi:oali'ons of~ affected . medAlERT Ocr:u,,ativni(:'' ... 3141 ~ S.220 Dalla$, 1X 15241 ·;· tel-214 630 1144 _ Tclcplumcl'i=bcr (including area code) 75247 [ . PRJVACY.NOT1FICATION/NOTIFICACJ6NsoaR.EPRrvAc1DAD :-,·-·, · ·:···:-• • I With few exceptions, you have the right to raquest and be informed about information that the State of Texas colledkal:ioui:.,yqu. You are entitled ·to recalve and review the iriformatlon upon rBqUB!it. · Yo1,1 als,;, have the right to ask the state ag·ancy to cor:rect any unQim~pi:l th.it ·is determined to be. lncorreci. See btl:D:llwww.dshs.state.b!.us/for more information on Privacy Notification. (Rei'ernnca: Govamor Cmde,:S:adio,n552:,021, 552.023, 559,003 and 559.0011) • · ·,::7 _·--'-· · Tan solo i,or unas cuantas i.xcepclones, ust~d tiene el derecho de solicitor ·y de ser informado sobre la lnfotmaciorr~;-~ ~$!if!.-de Te,rai; reune sobre usted. A ustad se-le debe conceder el derit.cho de racib lr y reviser la i11fotmaci6n al requerirla. Usted tambien tie~el dar&aio~ PQdlt que l;:; agencia estatal con1]a . cualquler iniormaci6 que se; ha deterrnlnado sea . fncorrecta. · Dlrfjase a http;lf,Nww,dshs.st;#e.tx.usl p a,.a -mas infonnaci6n sobr.:l la Notificac16n ·sobre privacidad. {Referencla~.-Gov emme.nt Coda~se:::cio11552 .D.21, 552.023, 559.003 y 559.004 .) · • . . . ,· Revisoo May 200s ENVIRON MENTAL, INC. 210 S Waln u t Creek D ri ve. Ma ns fiel d , Tex as 760 5 3 . T e l ep h o n e (817 } 477 -9 9 9 5 . Facsimi l e (8 1 7 ) 4 77-9996 www .inte r con-en v ir onmen t al.com Employee Name: DSHS License Number: Respirator Type: Respirator Brand: Respirator Size: Question Respirator Fit Test [ul9B•;o,OrreS Half-face North Medium 1. Was respirator reasonably comfortable? 2. Was positive and negative pressure tes 3. Does the individual understand fully th factor of this type respirator? 4. Was the individual instructed on care of this type respirator? 5. Was a smoke type test administe e ? 6. During the actual test was the ind i 1:9 required to converse a ove his :er hec to insure correct fit? 7. Did recip ient pass fit test? e is true and correct. -. i Y /C?Ke C('p Ji"c/c;-> Titl e S upervisor experienced in the admin istra tion of proper fit tests. Date of fit test ___ s-_/_1_1_/_c_·tj_· _ OSHA Regulations {Standards -29 CFR) No 1910.134(f}{2) The employer shall ensure that an employee u si ng a t i ght-fitting facepiece respi rator i s fit tested prior to initial use of the respirator, whenever a different respirator facepiece (s·ize, style, model or make) is used , and at least ann ually thereafter. 1910.134(f)(3) Th e employer shall cond uct an add itional fit test whenev er the employee reports, or the employer, PLHCP, supervisor, or program adm in istrator makes visual observations of, ch anges in the employee's physical cond ition t hat could affect respirator fit. Such cond itions i nclude, b ut are not limited t o, facial scarri ng, dental changes, cosmetic surgery, or an obvious change in body weight. Certificate of Vi orker'.s Acknowledgement and Worker Release Intercon Environmental, Inc. Project Name ________________ Date __________ _ Project Address---------------------------- WORKING \\1ITH ASBESTOS CAN BE DANGEROUS. Il\1HALING AS~STOS FIBERS HAS BEEN LTh:XED WITH VARIOUS TYPES OF CANCER. IF YOU .~OKE Al~D I1''1IALE ASBESTOS FIBERS THE CHANCE THAT YOU WILL DEVE OP L G CANCER IS GREATER THAN THAT OF THE NON-SMOKING PUBLIC. Physical characteristics of as Health hazards associated wi MEDICAL EXAMINATIQ . . I have had a medical examination within the past 12 months at no cost to me. This examination · .. c uded: health hjst ory, pulmonary function tests and may have included an evaluation of a chest x-ray. By signing this document I am acknowledgin g only that the Owner of the building I am about to work in has advised me of my rights to training and prot ection rel ativ e to ·my employer, Intercon Environmental. Inc. Social Security No. '-1.53 9 9 ( () "le P I'=, -~ ---~ rinted Name: ~ G i c /ei t re~ .. * MOISES RAMOS License No. 804432 Control No. 95747 Expiration Date: 04/06/201 O • President Date of issue : 03/15/1 O Certificate Number : 10087 8761 GEBCO ASSOCIATES in cooperation with UNIVERSITY OF NORTH TEXAS certifies that Ramos :uervisor Refresher tion under Section 206 of requirement of 40 CFR, OCT/06/200 9/TUE 11 : 14 AM ..;: * )f I* ~TEXAS Department« State Health Services www.tdh.state.tx.us/beb/asbestos Physician's Written Statement Medical Surveillance for Asbestos Exposirre Ei:lvironment.al & Sanitation Licensing Group 800/5TM548 or 512/834-6600 Fax; 512-834-6614 P. OD 1 AppliamtNBJnc: {Fust, M .L, Last) Social Security# Date ofBiJtb Telephone NumbQ" (includiagw code) INDICATE WHICH ITEMS WERE PERFORMED WITH PHYSICIAN'S OR (Any that are not applicable, must still be initialed off in add.itio The above-named individual was seen on / {) -1) (o-t) { r clinic.) zL 57 S7 21_ 57 rr reSJ)iratory equipment to be utilized by the employee, and infi employee that is not otherwise available to the physician. A physical examination with emphasis upon the pulm The pulmonary function tests of forced vital ca accordance with NIOSH and ATS standards. Indicate whether or not the physician decided that chest roentgenogram, posterior-anterior, 14" x 17" iii,imil!W'lll'film 1926.1101, Appendix E. at.NOTE: ccording to 29 at the physiciaD's discretion. oyee's duties as they personal protective and ~mw· 1111tions of the affected Unless otherwise noted below. • increased risk of material heal medical conditions were detected that would plaoo the employee at an ,,,,..~_.,..,,'Om ex osure tn asbestos. and no limitations are · recoIIIIDCildcd on the employee ~ respirator. By signing ~i~ ~~P,11,}. acknowkdge that 1hls cx:amination has been 1926 , 01 or40CF.R 763_122(a).asrequired. medAl[Rl Occupational 3141 lrvlng Blvd. S1! 220 Dallas, 1X 7S'l47 tel,214 .630.Il« •~.214-637.3829 medalertonline.com 214 63CH144 Pallas TX 75247 CHy Stnte .zip PRIVACY NOTIFICATION/ NOTIFICACION SOBR.E PRIVACIDAD With few exceptions, you have the right to request and be informed about Information that thG state of Texas collects about you_ You are enlltl9d to receiVe and review the 1nfonnation upon requ8St You also have the right lo ask the state agency to correct any infonnatlon that is determined to be Incorrect. See httD:llwww.dshs.state.br.us/for more information on Privacy Notification . (Reference : Governor Code, Seclion 552..021, 552 .023, 559,003 ar,d 559.004) -. .. -· , - Tan solo por unas cuantas eia;epcion~. 1,18led tiene el dellilcho de eQftcitOT y tie eer informado 8obre la informaci6n que el Emde de Texae reune eobre usted. A usted se le debe concadet el derecho de racibir y raVi68r le informscion el requerirla Usted tamb ien ·tiene el darecho de pedir que la egencia est.rtal ct1rrija cualquier informa ci6 que se ha determlnado sea ·Jnconee1a. Dlrl]ase a http:llwww.dshs.state.ocusl para mas informacl6n sobra la Nolificacion sobre privacidad. (Referencia: Government Code.._secclon 552_021 , 552..023, 559 _003 y 559_004 .) Revlsoo May 2008 f'ubJ1cation # 1"18-11669 ENVIRONM ENTAL, IN C. 210 S Wa l nu t C r eek Dr i ve . Mansf i e l d, Te xas 76063. Telepho n e (817) 477-99 9 5. Facs im ile (8 1 7) 4 77 -9996 -------··········-···· ------------ www .i ntercon -environmenta l .com Respirator Fit Test Employee Name: /\4o U;·e~ RA mctS DSHS License Number: Respirator Type: Half-face Respirator Brand: North Respirator Size: Medium (circle on Question 1. Was respirator reasonably comfortable? 2. Was positive and negative pressure tes ad 3. Does the individual understand fully t,t'j factor of this type respirator? 4. Was the individual instructed o care of this type respirator? 5. Was a smoke type test administe 6. During the actual test was the ind" required to converse ove his to insure correct fit? 7. Did recipient pass fit test . No These items are my damage any, I will re,..-.,,.uor-,,.....o. . If I lose any of this equipment or negligently ironmental, Inc. the full list price for each article lost or damaged. e is true and correct. -.. . ...-. ...... Y -r;!k Ca.o 1><c.rc .. s Title Supervi sor experienced in the administration of proper fit tests. ,~~I /oc; Date of fit test --~'/~- 1 ___ _ OSHA Regulat ions (Standards -29 CFR) 1910.134(f)(2} The employer shall ensure that an employee usin g a tight-fitting facepiece res pirator is fit tested prior to initi al u se of the respirator, whenever a different respira tor f acep i ece (size, styl e, model or make) is used, and at lea st annually thereafter. 1910.134{0{3) Th e employ er shall conduct an add itional fit test whenever the employee reports, or the employer, PLHC P, supervisor, or program administrator makes \'.1sual observation s of, changes in the employee's ph ysical condition that could affect respirator fit. Such conditfons indude, b ut are not limited to, facial scarring, dental changes, cosmetic surgery, or an obvious change in body w eight. Certificate of \Yorker's Ackno-·wledgement and Worker Release Intercqn En vironmental , Inc, Proj ect ____________________ Date ___________ _ Project Address------------------------------ Vi70RK.ING WITH ASBESTOS CAN BE DANGEROUS. INHALLNG ASBESTOS FIBERS HAS BEEN LIN!CED ·wrTH VARIOUS TYPES OF CANCER IF YOU S1v KE AN'D INHA.LE ASBESTOS FIBERS THE CH.A,._NCE TH.AT YOU WILL DEVEL L NG CANCER rs GREATER THA.N TRA..T OF THE NON-SMOKING PUBLIC. Your employer's contract v.itb the Owner for the above project requires proper res pirator and be trained in its use, you be trained in safe work pract ~viu equipment found o n the job, and you receive a medial examinaf . These thing at no cost to you. B y signing this certification you are assur · yo these obligations to you and are agreeing to hold the Owner, Ir €:onsultanL representative harmless in any and all claims arising fro ate '{C his proj RESPIRATORY PROTECTION: I have been tr . the type respirator to be used on the above r respiratory protection manual issued by my e · to be used on the above project mployer bas met g Laboratory, and TRAINING COURSE: I have been trained in ers in rent in handling asbestos and breathing The top ics ave had a medical examination within the past 12 months at no cost to health history, pulmonary function tests and may have included an By simino this document I am ackn ov.--Jedcin 2: onlv that the Owner of the buildin2: I am about to work in .. ....... ,:::, ...... ~ _, - has advised me of my righ1s to training and protection relative 10 m y employer, Imercon Em-ir on men tal, Inc. /-7 /(/ Signature: . ( CA \A.,..,..~ D L=" -s F irme 4 _,,,, P . d '"' ;_ .f _,. \ • V1 / ' <---. nnte · _-., ame : 1--z_./, v ~ ./ _,,, I\}\ 0 IS:~~<::, Empl o yee :!'-Jo . ~2S~0~4_4_3_d\~- .... ... epartment of r 1 -r:· JORGE M HERNANDE License No. 804409 Control No. 96221 Expiration Date: 08/07/2011 h Services GE B ,so ci ates certifies that Jorge M. Hernandez 604·26-4376 has succes slully complet ed the Te xas Depertmant of St ale Health Services ap proved course entll led : & ' ' . ASBESTOS CONTRACTOR/SUPERVISOR REFRESHER Certificate No ,: 10067 GEBCO Associates , LP • • 4690 Di plomacy, Suite 120 • Phone : 817-268-400 Fo rt Worth , TX 761 5 5 ' ESCO ASSOCIATES in cooperation with UNIVERSITY OF NORTH TEXAS certifies that e M. Hernandez the exam given 011 the final day for the Environmental ning P1·ogram entitled Asbestos ervisor Refresher Conducte a This is an EPA fully approve cour e TSC A, Ti tle II. It cov ers topic Part 61 , subpart M . • President Date of is sue : 02/15/10 Certificate Number: 10057 4376 GEUCQ 's Tra inin g Pro gra ms are pro vid ed in coo pera tio n with rederal and stat e reg ul atory agenc ie s, I ful fi ll II GEBC O Is lic ense d fo r Asbe stos Trainin g und er the Texas Asbe stos !!ti It 1 ~± ~,~Jl ~~d 1111111"-,,, f . State Health Sentic es www.tdh.state.tx.us/beb/asbestos Physician's Written Statement Medical Smveillance for Asbestos Exposure Environmental & Sanitation Licensing Group 800/572-5548 or 5 12/834-6600 Fax: 512-834-6614 ! 1 Jc; 7 17 ~ 7 li_\ Lt'j L\ -I otlfl Telepbone"Number (including area code) \ ~ l ' ' State INDICATE WHICH ITEl\-lS WERE PERFORMED WITH PHYSICIAN'S OR AS.""""'rrc,.,."'"' (Any that are not applicable, must still be initialed off in addition he N/ The above-named individual was seen on /) (' I S-~ //) ~ l S, i If employed, the employer provided, and review was made of, the em relate to the employee's exposure, the employee's representative or anticipa respiratory equipment to be utilized by the employee, and info · om p employee that is not otherwise available to the physician. <;1 A physical examination with emphasis upon the pulmo The pulmonary function tests of forced vital capac· accordance with NIOSH and ATS standards. volume at one second (FEV I) in Indicate whether or not the physician decided that an chest roentgenogram, posterior-anterior, 14" x 17" or c 1926.1101, Appendix E. *NOTE:. According to 29 s performed: YES ___ or _c-_,i interpretation in accordance wi~ (2)(ii){C), the requirement for a chest x-ray is at the physician's discretion . exposure. Unless otherwise noted below, this e increased risk of material health im Comments or Iimi 3141 Irving Blvd, Suite 220 Street Address f the exam and of any medical conditions that may result from attributable to the combined effect of smoking and asbestos medical conditions were detected that would place the employee at an e to asbestos, and no limitations are recornmen~ed on the employee irator. By signing this form, I aclmowledge that this examination has been or 40 CFR 763 .122(a), as required. medAlERT Occupational Jose G. Trevno, M.D. Print Physician's Name Dallas TX City State 3141 Jrving Blvd. Ste 220 Danas, 1X 75247 fei:214.630.1144 fax::214.63 7.3820 1ne.co111 214 ) 630-1144 Telephone N umber (including area code) 75247 Zip PRIVACY NOTIFICATION I NOTIFICACION SOBRE PRIVACIDAD With few exceptions, you have the right to request and be informed about information that the State of Texas collects about you. You are entitled to recei ve and review the information upon request You also have the right to ask the state agency to correct any i nformation that is determined to be incorrect See http://www.dshs .state.tx.us/for more information on Privacy Notification. (Reference: Governor Code, Section 552.021 , 552.023, 559 ,003 and 559.004) Tan solo per unas cuantas excepciones, usted tiene el derecho de soiicitor y de ser informado sobre la informaci6n que el Estado de Texas reune sobre usted . A usted se le debe conceder el derecho de recibir y reviser la informaci6n al requeriria. Usted tambien tiene el derecho de pedir que la agenda es tatal corrija cualquier informaci6 que se ha detenninado sea incorrecta. Dirijase a http://www.dsh s .state.tx.us/ para mas informaci6n sobre la Notificaci6n sobre privacidad. (Referencia: Government Code~secci6n 552.02 1, 552.023, 559.003 y 55 9.0 04 .) Revised May 2008 Publication# F18-11669 E NV I RON M ENTAL , INC. 2214 F M 1 187 , Bu i l d i r.g 6 . Mansf i e l d Texas 76063 . T e l eph one (817 j 477-9995 , Facs im il e (817 ) 477-9996 Emp l oyee Name: DSHS License Number : Resp i rator Type: Respirator Brand : Respirator S ize: Question Respirator Fit Test 3 o \,. g i' \J\ . \r\. ;£ YY40~ li '""' \ ~O~Yo q Half-f ace North Medium ( ci rcle 1. Was respirator reasonably comfortable? 2. Was posit ive and negative pressure tes 3. Does the i ndivi dual understand fully , factor of t his type resp irator? 4. Was the individual instructed on 5 . 6. 7. These items are my pe damage any, I will reim.F,u..--u lost or damaged. Test administ red b>;;, lo S:e .,.A · Can ire l'O... S 11 t he adm i n i st rati on of proper fit t ests . Date of fit test -~(p~---J.-~· _3_· ._/D_K:~- OSHA Regulati ons (Standards -29 CFR) www .i ntercon-envi ron men t a l .com No T i t le Su pe rvi s or 1910.134(f)(2} T h e e mployer sha ll e nsure that an e mployee u s ing a tight-fittin g f acepi e ce r es p irator is fit t e st ed prior to initial use of th e resp i rato r , wheneve r a different r e sp i rat or face piece (s ize , sty le, model or make ) is used , and at le as t annua lly thereafter. 1910.134(f) (3) T he employ er shall cond uct an additional fit test wheneve r the employee reports , or the employer, PL HCP , supervisor, or program administrator ma k es vi su al observati ons of, c han ges in the e mployee 's ph y s ical :onditio n th at cou ld affect respirator fit. Such cond itions i nclude , but a r et not lim ited to, facia l scarring, denta l changes, cosmetic surgery, or an obviou s ch ang e in body w e ight. Certificate -of Worker's Ackno-wledgement and Worker Release IntercQn Environmental, Inc. Project ___________________ Date __________ _ Project Address----------------------------- WORKING WITH ASBESTOS CAN BE DANGEROUS. INHALING ASBESTOS FIBERS HAS BEEN LINKED WITH VARIO US TYPES OF CANCER IF YOU S OKE AND INHALE ASBESTOS FIBERS THE CHANCE THAT YOU WILL DEVELO NG CANCER IS GREATER THAN THAT OF THE NON-SMOKING PUBLIC. RESPIRATORY PROTECTION: I have been trai the type respirator to be used on the above re ren respiratory protection manual issued by my e to be used on the above project TRAINING COURSE: I have been trained in e ers inliirent in handling asbestos and breathing , asbestos dust and in proper work rocedures ano pe ~~ ...... ~Uild area protective measures. The topics covered in the course included th oU--·-""- Physical characteristics of asbestos Health hazards associate with asbestos Respiratory protection Use of protective equipmen Pressure Differential System Work practice nfl ding han Personal deeontamination pro MEDICAL E~~-ON: ave had a medical examination within the past 12 months at no cost to me . This examination ind ded: health history , pulmonary function tests and may have included an evaluation of a ches -a By signing this document I am acknowledging only that the Owner of the building I am about to work in has advised me of my rights to training and protection relati v e to my employer , Intercon Environmental , Inc. Signature: _3 _ _;:6:;_'_r71.-u_!lL_· _l~_' ·-~--_·---------Employee No. Firme TEXAS DEPARTMENT OF STATE HEALTH SERVICES INTERCON ENVIRONMENTAL INC is wtifiea to peiform as a Asbestos Abatement Contractor i11 the State ofTer:m withi11 the purview of Texas Occupations Code, chapter /954 , so long as this license is not suspended or rei>oked a11d is renewed according to the rules adopted by the Texas Board of Health. License Number: 800805 Control Number: 95442 ,:..:} ) -/ _,,.;; /,/ ,,-....,i,,rff _y· I,! ./;·;/-7 _., / _,.,,.7'~/../ DAVID LAKEY, M .D. COMM!SSJONER.OF HEAL TH VOID IF ALTERED T OF STATE HEALTH SERVICES CON ENVIRONMENTAL INC is certifw{ to peifonn as a Asbestos Transporter in the State o exa 1in the purview of Texas Occupations Code , clrapter 1954, so /011g as this license is 1101 re11()ked a11d is renewed accordi11g to the rul es adopted by the Te;cas Bom ·d of Health. ;l,-~~_,,~t' ,'o/,,·7 ' / '7 ,/./ DAVID LAKEY. M .D. COMMISSIONER OF HEALTH License Number: 40033 6 Expiration Date: 2/5/2011 Control Number: 95484 (Void Afl er Expiration Date) VOID IF ALTERED NON-TRANSFERABLE Please print or type. (Fom1 des igned for use on elite {1 2-pitch) typewriter.) Qi -X)(X Form Approved . 0 MB No . 205 0-00 39 t u:~ ~~~~~US 1. Ge-n-er-ato-r =1D--:cN-um..,.b'-erN-'-iA--'---=----'-------.-,-=--\--:::Pa-g-e .,..1 o..,.f ir=": 7 '='Em 4 :,;..e...:;:..:;=~-'::~~"" 9 - 5 -se-=Ph,.,..o~-~ 4· M0053n~r89 18 J J K 5. GeneratOl's Name and Maili ng Ad dress Ge neralo(s S~e Address (ff different than mailing aiilress) name address lntercon Environmental Inc. 7. Transporter 2 Company Name 8. Designaled Facility Name and Site Address DFW Landfill 1600 Rairoad Street Lewisville, TX 75067 Facility's Phone : · hone# 972-315-5421 9a. 9b . U.S. DOT Description Vncl uding Proper Shipp ing Name, Hazard Clas s, ID Number, HM and Paddng Group (if any)) 1. ~ Hazardous substance, solid, N .O.S. (asbestos) j ob site address Ci No . U.S. EPAl>Number U.S. EPA ID Panber U.S. EPA DN!.mber 13. Waste Code s ~ ORM-E, NA 9188, RQ=1 Pound ~ l---l-2-.---------------------------il--..,,.:;;!--t----+-----+.~::a;;t.j---+--+----! ~ Waste which contains non-friable asbestos or waste conta ining non..friable asbestos 3. Hazardous substance, solid, N.O.S. (asbestos) ORM-E, NA 9188, RQ=1 Pound 4. Waste which contains non-friable asbestos or waste containin non-friable asbestos n/a -r--1 n/a I 15. tare fully and accu rately described above by the piq,er shipping name, arrl are dassffied , pa ckaged, ~ 16. Internationa l Shipme nts ~ 1 Ba . Discrepancy Indication Spa ce 1 18. Discrepancy ~ 18b . Alternate Faci lity (or Ge nerato r) -' u ~ Facll ty's Phone : @ 1Bc. Signature of AJiemate Facility (or Generato r) !ci: Sig nature Signature Drype Month Day Year Portofen!Jy/exif : ------------------ Dale lea11ing U.S.: Mont h Day Yea r Month Day Yaar 0Fu11Rejaction Manifest Reference Numbe r: U.S. EPAID~umber Mon1h Day Yea r zl------------------------------------------------~-~----'----1 * jg_ Hazardous Waste Rep ort Man agemen l Melhod Codes (i.e ., codes fo r hazardous waste trealmen~ disposal , and recycling systems) ~1 2 ~ j 20. Desi gnated Facility Owne r or Operator. Certi fi cation ol receipt of hazardo us materials covere d by the man ifest except as nded in ltBm 18a Printedffyped Name / Signatu re Month Day Year EPA Form 8700 -22 (Rev. 3-0 5) Previous ed iti ons are obsolete. DES IGN ATED FAC ILI TY TO D ESTJNATION STATE (IF REQUIRED) ENVIRONMENTAL, INC. 210 S . Walnut Creek Drive. Mansfield Texas 7 6063. Telephone (817 ) 477 -9995. Facsimile (817) 477-9996 www . i nte rcon-envi ronmental. com HEAL TH AND SAFETY PLAN Reviewed and Approved: Karen Andrews President ~=-~-In-c_. --:::::::::::.... - Jerrol An ews Health and Safety Officer Intercon Environmental , Inc. 04/29/10 Date 04/29/10 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/lnjury Reports ..................................................................................................... 6 5 .1 Accident/lnjury 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 Ladders ................................................................................................................ 9 7.6. Portable Ladders ........................................................................................................... 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. Treatm.ent .............................................................................................................. 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. Treatinent .............................................................................................................. 12 7 .1 7. 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 . Bloodbome 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 ................................................................................................ 1 7 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 ofthis Health and Safety Plan (Plan) is to define requirements and designate protocols to be followed by employees during any and all project activities. lbis Plan 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 their 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 assunng that all site activities are performed in accordance with the protocols defined in this document. The Project Manager will have a direct line of communication with the Corporate Health and Safety 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 violation of regulations to the attention of the appropriate client contact. Employees are encouraged to report unsafe work place situations to the Corporate Health and Safety Officer without fear of recrimination. 3. Medical Monitoring Program In compliance with OSHA regulations , all employees who participate in asbestos related activities will be enrolled in a medical monitoring program. Medical surveillance shall be provided to employees prior to employment, annually thereaft er (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 5192). Employees and subcontractors successfully completing this course are certified 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 purpose 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 equipment 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, effectiv e 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 supervisor 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 necessary for equipment decontamination and samples analysis preparation. Copies of these MSDS are maintained in our office and at the project site. See Intercon's Standard Operating 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 hazards on-site. Although engineering and administrative controls will be implemented 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 field activities to be conducted during asbestos related activities will potentially require site personnel to be in close proximity to various physical hazards . The specific hazards 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 oversight 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/Air Tools Utilities Excavations, Trenches Illumination Hot Work Heat/Cold Stress Pressure Washers Materials Handling Power Transmission, Mechanical Hazardous Material Use /Storage Personnel shall be reminded to maintain a workplace free of scattered tools and supplies. "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 encountered (adjacent to operational compressors, etc.), personnel shall utilize earplugs or hearing protection to attenuate noise levels. Noise dosimeters may be employed periodically to quantify personnel noise exposures. Health & Safety Plan 8 OSHA's Form 300 (Rev. 01/2004) Log of Work-Related Injuries and Illnesses j ,; • • " .. . .• . . • .<fl ' • ,· .' ;,J --·~.t . ' ~ ' ' .: Attention: Thi& form contains Information relating to employee heallh end must be uae d In a man ner that protect& tha conndantlallty of employaea to the extent poaalble while the Information la being used for occupational safety end he alth purposes . ....... !.: You must record lnfOfmaUon about eve,y worlHelated ,iju,y or Illness that Involves loss of consciousness, raslr\cted work acUvity Of job transfer, days away from work , or medical treatment beyond ru-sl aid . You must also record significant work-related injuries and Illnesses that are diagnosed by a physician or licens ed health care profess ional. You must also record WOf'k-related Injuries and Illnesses U1al meel any of the specific recording critarla lisled In 29 CFR 1904 .8 through 1904.12. Feel free lo use two lines for a sing le case~ you need to. You must complete an injury and Illness lncldenl repor1 (OSHA Form 30 1) or equivalent form for each Injury or Illness recorded on this form. If you're not sure whether a case is recordable, caU your local OSHA office for help . Establishment name Identify _th _e person (A) (8) Ca se Employee's Name No . 1 Jose Morales 2 Sam Jone s 3 Ale jandro Sontay 4 Jorge Gutierrez 6 10 11 12 13 (C) Job Tille (e .g .. Welder) La borer Laborer Laborer Laborer (D) Dale of Injury or onset of Illnes s (mo.lday) 217 41 1 6129 121 17 De_scribe ,the case '. :~...:; :.;.--· .. , .. __ , -· ... (E) Whe re the event occurred (e .g . Loading dock north end) Job Sile Job Site Job Site Job Sile (F) Describe injury or illness, parts of body affected, and objecVsubslance lhal directly Injured or made person Ill (e .g. Second degree bums on right forearm rnom acetylene torch) Low Back Strain Fall from Eq ui pment.Broken Ribs, Twisted Knee Cut finger Fall from Sca ffold ing, lower back Page tota ls City C!c1s.~lfy _t_he case _;, Mansfie ld ··i,.\ .. < CHECK ONLY ONE box for each case based on the most serious ou tcome for that case: or restriction able cases (G) (H) (I) (J) X X X X 0 0 Year 2009 U.S . Department of Labor Occupational Safety end Health Administration -":. ·'1-!, ,., .•• -----· Form app roved 0MB no . 1218-0176 lnlercon Er v ironmen lal , Inc. Stale Texas --·' -_:.,;.. .. :·{• Enter the number or days the injur d or Ill worker was : ·,: ', · 1 ~~eek the "inju ry" col umn or choose one type 1 oflllness: ·..1c--· ·.,·,:_ . ..,. Away f On jo b t ansrer or From estr lcllon Work (days) (d ays) (K) (L) 27 20 12 7 I l I 0 66 (M) ~ :, £ (1) (2) X X X X 4 0 ~ ti Q) 0 o::u (3) 0 g, ·c .~ ~ (4) 0 0 0 ~ :;; ~ C: "' "' "' :, 'E .gg C: "' ~ 'E 0 Be sure to transfer th ese to tals to the Summary page (Form 300A) before you post it. Public reporUng burden for U1is collection of information is estimated to averag e 14 minutes per response, including time to review the instruction, search and gather the data needed, and complete and review Uie collection of In formation. Person s are not required to respond to the collection of infonnation unless It dlsplays a currently valid 0MB control number. If you have any comments about U,ese estimates or any aspects of U,ls data collection, con tact: US Deparlmenl of Labor, OSHA O[~e of SlaUstics, Room N-3644, 200 Constitution Ave, NW , Washington, OC 20210. Do not send the completed forms lo U1ls office . Page E 1 of 1 (1) g ~ =a ·a a i5 ::l u C: " 0:: VJ (2) (3) g ...I j "' ·5 -~ a. :;; Q) I § ;,' (4) (5) (6) OSHA's Form 300A (Rev. 01/2004) Summary of Work-Related Injuries and Illnesses All esl•bllsllmen t, cov•red by Porl 1904 must complete thl• Summary page, •vsn If no ln/urie, or fllneises occurred during the yeer. Remember to review the Lop to verify that the entries ere complete Us ing the Log, count the lndfvldusl entries you made for each category. Then write the totals below, making sure you've added lhe entries from eve ry page of lhe log. ff you had no cases wn·ie "O." Employees former employees, and lhe ir representatives have the right 10 review lhe OSHA Fom1 300 in ff:; entire ty. They also ha ve lim ited acc~s.s to the OSHA Form 301 or Its equivalent. See 29 CFR 1904 ,36, In OSHA'• Rocordkeeping rule, for furl lier det•II• on the ectH! provfalon, for thoH fonns . Number of Cases . . ' Total number of deaths 0 (G) Number of, Days Tot al number of days away from 1A1nrk 0 (K) Total number of cases with days away from work 0 (H) Injury and Illness Types f \1 . ~: ... ·'.> .. ,.' ' •• . ·•":' ,·."~,,. I Total num ber of .. , (M) (1) Injury (2) Skin Dis ord er (3) Respi rat ory Condition 4 0 0 ,_ Tota l number of cases wi th job transfer or restri ction 4 (I) Total number of days of job transfer or restriction 66 (L) (4) Poisoning (5) Hearing Loss (6) All Other Illnesses Total number of other recordable cases 0 (J) 0 0 0 ,, ., l'ost this Summary page from February 1 to April 30 of the year following the year covered by the form Publlc repartlng burde n for this collecUon of lnftlfmaUon Is estimated lo average 50 minutes per response, Includ ing time to review the lns lruclioo, search and gather \he data needed , and complete and review lhe collection of information . Persons are not required lo respond lo \he collection of infofmalion unless ii d!splnys e currently valid 0MB control number. If you have any commen ts about these estimates or any aspects of this data collection, contact: US Department of Establishment Information Year 2008 U.S. Department of Labor Occupatlonal Safety and H11lth Administration .. F~ approvelOMe no·: 1218.011e· Your establishment name _ln_te~r~co~n_E~n_vi~ro~n~m~•~nt~al~, l~nc~·-------1------------- Street 210 South Walnut Creek Dri ve City Mensfleld State ~T~••~e~•-----+------- Industry description (e .g., Manufacture of motor truck ~allers) Asbestos, Lead & Mold Abatement. Demolition Standard Industrial Classification (S IC), if known (e.g., SIC 3715) _1 ___ 7 ___ 9 ___ 9_ OR North American Industrial Classification (NAICS), if known {e.g., 3362 12) _s ___ 6 ___ 2 ___ 9 ___ 1 ___ o_ Employment Information Annual average number of employees Total hours worked by all employees last yea r Sign here 96 101 663 Knowingly falslfylng this document may result In a fine. Zip .llQ!lL_ t certify that I have examined this document and that to the best of my knowledge the entries are true , accurate, and 00~ Campa ny execuUve President TIiie 817-417 -9995 1/112010 Phone Date labor, OSH A Olfioo ol Stallsllcs, Room N-3644 , 200 ConsUlu\ion Ave , NW , Weshlnoton. DC 202 10. Do not sel!<l tha comolele<l loons to lh;s office . 1,~~"alt!Xli!!W,U1MtSl'.3-'V?l:"~WSl::t!.ff''t'S&liall!L:tl'!:li'W";::·a,u~i:1"~';,n'!'W'tfi~t!no~"'l&'IU'~~.i&!D':tir~'lmlt'ii!1i~~~~·rt:;ziU.~,6"1'.,,~'i!:l~,.\~,W~fillfm~ OSHA's Form 300 (Rev. 0112004) Log of Work-Related Injuries and Illnesses Attention : This form contains Information relating to employee health and must be used In a manner that protects the confidentiality of employees to the extent possible while the lnfonnatlon Is being used for occupational safety and health purposes . You must record Information abo.ut every work-related Injury or Illness ~~t Involves lo!B of con;~louaness, reslrlcted worli acUvlty or Job tra;sl:r, days a~s~ from WO~~~r '~edlc;i°lr!a~;nt beyond first aid. You must also re cord slgnlncant work-related Injuries and Illnesses that are diagnosed by a physician or licensed health care professional . You must slso record work-related Injuries and Illnesses that meet any of the specmc recording cri teria listed In 29 CFR 1904 .B through 1904 .12. Feel free to use lwo lines for a single case If you need to . You must complete an injury and illnes s Inciden t report (OSHA Form 301) or equivalent form for each injury or Illness recorded on th is form . If you're not sure whether e case Is recordable, call your local OSHA office for help. .. •.• Establishment name City Mansfield (A) Case No . Identify the person (8) Employee's Name 1 David Dunham 2 Marlo Sandoval 3 Joh n Ho wa rd 4 Jeffrey Andrews 5 Jo rge Sanchez .. (C) Job Title (e .g., Welde r) Supervi so r Worker V...orker Worker Wo rker Descfibe the case .. Classify.Lh e .case (D) (E) Date of Where the event occurred (e .g. injury or Loading dock north end ) onset of illness (mo ./day) 02111/06 Job site 04103/08 Job slle 08/27108 Job slle 0812 7/08 Job alle 11/12108 Job si te (F) Describe Injury or illness, parts of body affected, and ob)ecVsubstance that directly Injured or made person Ill (e .g. Second degree burns on right forearm from acetylene torch} Crushed fingers on right hand Strain Right Knee Polson Ivy Ra sh Polson Ivy Ras h Left nnaer Page totals CHECK ONLY ONE box for each case based on the most serious outcome for that case : ..... _. ·1 Death Days away from work · (G) (H) X 0 :! -;, :-;; • . Remain.a~. at work • · .. . ~ . Job transfer Other record - or restriction able cases (I) (J) X X 2 0 I I Year 2008 U.S. Department of Labor Occupatlonal Safety and Health Admlnlatratlon Fem, approved 0MB no . 1218-0178 lntercon Environmental , Inc. State Texas : l-_ ~ :.,• .. -·· Enter the number of days the injured or ill Check the "injury " co lumn or choose one typ e worker was: of illn ess: ~.,., ... -. ., .::-.. .. (M) "' " "' Away On job Qi "' :!l transfer or "' @ 1:! c':' 0 From restriction f;l ~~ O> ..J Qi C: O> Work (days) i5 ·2 C: ~ c':' C: ·a.~ f;l ·c: (days) f "' C: "' :;; " 0 ·5 " <( en (l'. u n. I (K) (L) (1) (2) (3) (4) (5) (6) X 46 35 X X X 36 X I 46 71 3 2 0 0 0 0 c':' Qi c':' C: O> "' "' :, 1:! ~~ C: "' ~ ·2 0 Be sure to tran sfer these totals to the Summary page (Form 300A) befor I you post it Public reporting burd en for this collec tion of information is estima ted to average 14 minutes per response, including tim e to review th e instrucUon, se arch and gather U1 e dala neede d, and complete and review U1e co llection of inform ation. Persons are not req uired lo res pond to the collecUon of informa tion unless it displays a currenUy valid 0MB control number. If you have any comments about th ese esUmates or an y aspe cts of th is data collection, contact US Departmen t of Labor, OSHA Offi ce of Sta Ustics, Room N-364 4, 200 ConstiluUon Ave, NW, Washington. DC 202 10. Do not se nd the completed forms lo this office. Page 1 of 1 s (1 ) f;l ·a.§ i5 C: :!l u :;; (l'. en (2) (3) f;l ..J " O> § ·5 C: Cl. ·~ Qi " I £ 0 ;j' (4) (5) (6) OS HA 's Form 300A (Rev. 0 1/20 04) S ummary of Work-Related Injuries and Illnesses All establishments covered by Part 1904 must complete this Summary page, even if 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 individual entries you made for each ca tegory. Th en write the tota ls below, making sure you've added the entries fro m every page of the log. If yo u had no cases write "O." Employees forme r employees, and their representatives have the righ t to review the OSHA Form 300 in its en tirety. They also have limited access to the OSH A Form 301 or its equivalent. See 29 CFR 1904.35, in OSHA 's Recordkeeping rule, for furlher de tails on the access provisions for the se forms. Number of Cases · Total number of deaths 0 (G) Num b er of Days ~. ·-.-. ' ' •. Total number of days away fro m \Alnrk 46 (K) Total number of... (M) (1) Injury (2) Ski n Di so rde r (3) Respi rato ry Co ndition "'·· , . ,:: Total numb er of cases wit h days away from work 1 (H) 3 2 0 ,, ;-'". Total num ber of cas es w ith job trans fer or re str ictio n 2 (I) Tota l numbe r of da ys of job tra nsfer or re stri cti on 7 1 (L) (4) Poison in g (5 ) Hea rin g Loss (6) All Other Ill nesse s ' .: j ......... 1,.,. -~:..:.,,1 Total number of other recordable cases 0 (J) 0 0 0 Post this Sum m ary pa ge from February 1 to April 30 of the year fo llowing t he yea r cove red by the fo r m Public reporting burllen lor U,ls colleclkm ol lnforms\lon Is esllmsled to average 50 minutes per n,spons e, Including Ume to re~ew U,e lnstructton , &earth and galhe r U,e dale needed , and complele end re~ew U,e collection of lnformsllon. Persons en, not n,quln,d to respond lo the collection of lnfonnallon unless It dlspleya e currenlly valid 0MB control number. If you have any cotnmenls about Uiese estlmeles or an y aspects of this da ta colleotion, contaot: US Department ol Lelxi r. OSHA orno; ol Slollail\11 , Rcom N•3M4, ZOO Conelilullun Ave , NW, Wa &hlno lon , IJO 20i t0, Ori not 1and the colTllJlutad 1on111 to Ulla offloa . "'>"• ~ Year 2008 U.S. Department of Labor Occup atJo nal Safety and He alth Admini stratio n ~ • ..,-..-,-_ • .,-·c <t -.V' •• ,;.;.,.-;, ,..-.__-.,,,~.a-.+l•~'-"' _, ,, r<-••--U:,..,.-. ~~,,.•t",.., .. •.,:9f'.~.:,. "' •• • ...,..._,,., ' ..-•. , • -->; Establish ment Information You r estab li shmen t name lntercon En vironmen tal, Inc . Stree t 2 1 o South Walnut Creek Drive I City Ma nsfield State Texa l In dustry des cription (e .g., Manufacture of motor tru ck trai lers) As bes tos Lead & Mol d Abatemen t Demo lition Standard Ind ustria l Clas sification (SIC), If known (e.g .. SIC 371 _1 ___ 7 ___ 9 ___ 9 _ Fonn approved 0MB no. 121 8-0176 Zip~ OR North American Ind ustrial Classificatio n (NA ICS), if known (e .g. 33621 2) _s ___ 6 ___ 2 ___ 9 ___ 1 __ o_ Employment Information Annua l average nu mbe r of employee s Total hours worked by all employees last year Sign here 87 101,749 Kno wingly falsify ing th is document may result In a fine . I certi fy tha t I have exa mined this doc umen t and th at to th e bes t co~. ~ 8 17-477-9995 Phone f my knowledge the entries are true, accurate, and President Title 1/1/2009 Date OSHA's Form 30 0 (Rev . 01 /2004) Log of Work-Rela t ed Injuries and Il lnesses Attention : This form contains intormatlon relatingi to employee health and must be used in a manner that protects the confid entiality of employees to th extent possible while the information is being used tor occupational safety and health purposes. Year 200 7 U.S. Department of Labor Occ up ational Safety and Heal th Administration ~·;,:~,-~~-.:.m;~t~~c.r.-... l!;•r'-r·~t;:!::1--::-.!:.;o:•1=w~.::-.:.:-..:~~ ... n..;:-'";'.~':'C'i~J·~,c:-~~'=N·:S.!!-"'}~;;$.-!/1'il.;;-:!.....:"'.:"'..t-:... . .:.:.:1:a3~·s.:~r.=m~-~~~~.:.:.J.C-~~~~~~--.s-sr-~..-.. ..... sn~:.:a..~'!'rn~:;..x10.~T.:,lil~..;G.~=in~~~,:r~.:m..r-~~:2·~~3.~~"~ You must record Information about every work-relaled injury or illness that involves loss of consciousness , restricted work activily or job transfer , days away from work., or medical treatmenl Form approved OMB no . 12 18-0176 beyond first aid . You must also re cord significant work-related injuries and illnesses that are diagnosed by a physician or licensed heallh care professiona l. You must also record work.related injuries and illnesses that meet any of U1e specific recording criteria listed in 29 CFR 1904 .6 through 1904 .12. Feel free lo use lwo lines for a single case If you need to . You must complete an injury and illness in cident report (OSHA Form 301 ) or equivalent form for each injury or illness recorded on \his form. II you're no\ sure whether a case is recordable , call your local OSHA office 10< help . Establishment name lntercon Environmental , Inc . (Al Case No , (B) l:mployee 's Name 1 Danerv Hernandez 2 David Rey Ramos 3 Larry Dejoor (C ) Job Title (e .g., Welder) Laborer Laborer Laborer (D) Dale of IM)ury 0 1 OMS9\ of lllnes~ (mo ./day) 1/31/07 9/8/07 11/7/07 (E) Where \he avent occurred (e .g. ~o erl lMg dook north eMd) Arlington, Texas Eu less. Texas Fort Worth , Te,as Pubhc reporting burden for this coUeclion of information is estimated to average 14 minutes per response, including lime lo review th e instru ction, search and gather the data needed , and complele and review lhe collection ol information . Persons are no! required to respon d to the conect1on of inlormalion unless tt displays a currently valid OMS conlrol number . If you have any comments about these estimales or any aspects of this data collection , contact: US Department ol Laboi, OSHA Office of StaUsUcs , Room N-3(,44. 200 Constitu tion Ave . NW , Washing ton . DC 20210 . Do not send the completed lom,s lo this otf,ce . C ity Mansfield State Texas restriction Job trans fer Other record -(days) i!' :, E or restriction ab le cases (G) (H) (\) (J) (K) (L) (1) (2) Cut left index finger X 0 0 X Groin strain, Epididymitis X 8 8 X Corneal abralsion , back muscle strain X 41 X Page totals o 1 2 o 49 15 3 0 Be sure to transfer these tota ls to the Summary page (Form 300A) befor4 you post it. i!' :;; :, 'O E g i:5 C :ic (/) Page 1 of 1 (1) (2) (3) (4) (5) 0 0 0 >-C C, :;i g .g C 0 .~ ~ ·c -' g "' Cl. 0 ·5 ,,; ~u 0. ffi a: "' I (3) (4) (5) (6) 0 "' "' :;i i <ii .c 0 < (6 ) OSHA's Form 300A (Rev . 01 /2004) Year 2007 Summary of Work-Relate d Inj uries a nd Illnesses U.S. Department of Labor Occupational Selety and Health Adm inistration i;..-;.·T. ~ro1 •.. ·.•• :~,.; ., ·,;.:,~":':1' ·::·;-:-~.~-;,.1.-:-,t1~:..:;-::.;i;:-:•~.-;~ ·;.:~· .. ;· :i:_~;,.;:r:r·.c,.x:r~'7'1.~~:..-.:i.~.;i:;:r.-...-rt.!S':~·~rr,-:_-:-e~.c..i:C~~~:;c::IQ:~w~.:r,; ":.D~t,.i."S"c;...~,~._,1~·~J~·:."~·.:-,,:,a:~. ,i::r;:.·~.;.;ui.:.;w..;;.~.~~~~•·:;;;:1.:;....i;::i&.;: :;::..,~~~~•·•.t. ~:~w~·:··,-..··;.~.~~~~~r....::M;.,tr.J:..>::::; Form approved 0MB no . 1218-0 115 All establis hments co vered by Part 1904 must complete this Summary page. even if no injuries or illnesses occurred during the year . Remember to review the Log to verify that the entries are complete Using the Log. count tile individual entries you maa'e fo r each category . Then write the totals below, making sure youve added the entries from every page of the log . If you had no cases write "O . n Employees former employees . and their representatives have the right to review the OSHA Form 300 in fl s entirety . They also havP limited access to the OSHA Form 301 or its equivalent. See 29 CFR 1904 .35, In OSHA ·, R•cordkeeping rule . fo r further details on the access provisions fo r these forms . Total number of deaths 0 (G ) Total number of days away fro m wnrk 4 9 (Ki iotal number of (M) (1) Injury (2 ) Skin Disorder (3 ) Respiratory C o ndition Total number of cases with days away from work 1 (H) 3 0 0 Total number of cases with job transfer or restriction 2 (I ) Total number of days of job transfer or restriction 15 (L) (4) Poisoning (5) Hearing Lo$& (6) All Other 11\nessee Total nu mber of other recordable cases 0 (J) 0 0 0 Post t his Summ ary page from February 1 to Apr il 30 of the year following t he year covered by the f o rm Publi c raoort,n; burden lor lh,s colleclron of lnforma llon Is es lrmnled lo ave regn 50 minu1es per rnsponse , Includ ing lime lo f9view lhe lnslruclron , search and gather lhf oale ,reeoed , and complel e afl<i rnvlew the e<,leclioo of ln formelron . Pernons ,,. nol required lo f9Spond lo Iha collecllon of inlonnallon unless I: display, 1 t.U f!!nli)' valid OMS c:t,nt tol num ber II i ou ha ve an)' com ment s eboul lhes• esl lmales or any aspeels of this dale col ieclron, conlecl. US Depanrnenl tl' Lft l,or, OS~~ (lfilct ol S1;111tic1 , Re<Jt!l N,3G4 4, 200 ConilltUhull AVI , NW , W11 ht11aton , DC 202 10. Do no \ ,end the WiTia \1 \D<l IQflTl i 10 1h11 ott\ce . Establishment information Your establishment name lntercon Environmental , Inc . r • .1. State Street 2214 FM 1187. Bldg 6 City Mansfield Industry description (e .g ., Manufacture of motor truck trallers) Asbestos . Lead & Mold Abatement, Demolition Standard Industrial Classi fication (SIC), if known (e .g .. SIC 3715) _, ___ 7 ___ 9 ___ 9 _ OR North American Industrial Classification (NAICS), if known (e .g , 336212) _s ___ 6 ___ 2 ___ 9 ___ , ___ o_ Employment i nformation Annual ave rage number of employees Total hours worked by all employees last year Sign her e 86 90 ,080 Kno wi ngly fals ifying this document ma y re sult in a fine. Zip~ I oertlfy thal I hevo examined lhla documont and that to tho blB of my knowledge the entries ar e tr ue, accurate , end ~oJ1~ Company exec utive Pres iden t Title 817-477-9995 l /10,'200E' Phone Date