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River Valley Testing Corporation/Otter Ave Parking Lot
CITY OF OSHKOSH LEGAL DEPARTMENT 215 CHURCH AVENUE, P.O. BOX 1130, OSHKOSH, WI 54903-1130 PHONE: (920)236-5115 FAX(920)236-5106 LETTER OF TRANSMITTAL To: River Valley Testing Corp. Date: September 27, 2011 1060 Breezewood Lane, Suite 102 Project: Otter Avenue Parking Lot Neenah, WI 54956 From: Carol Marchant, Admin. Assistant Re: Agreement Attn: Jeremy A. McConnell Please find: ® Attached ❑ Under Separate Cover ❑ Copy of Letter ® Contracts ❑ A• mendment ❑ Report ❑ Agenda ❑ Meeting Notes ❑ Photos ❑ M• ylars ❑ Change Order ❑ Plans ❑ Specifications ❑ Estimates ❑ D• iskette ❑ Zip Disk ❑ Other Quantity Description 1 Signed Agreement These are being transmitted as indicated below: ❑ For Approval ® For Your Use ❑ As Requested ❑ For Review&Comment Remarks: Signed: &J4 "Met cc: City Clerk (original) Transportation Dept. (original) City Attorney (copy) AGREEMENT THIS AGREEMENT, made on the 13th day of September 2011, by and between the CITY OF OSHKOSH, party of the first part, hereinafter referred to as CITY, and RIVER VALLEY TESTING CORPORATION, 1060 Breezewood Lane, Suite 102, Neenah, WI 54956, hereinafter referred to as the CONSULTANT, WITNESSETH: That the City and the Consultant, for the consideration hereinafter named, enter into the following agreement. The City's Scope of Services and the Consultant's proposal is attached hereto and reflects the agreement of the parties except where it conflicts with this agreement, in which case this agreement shall prevail. ARTICLE I. PROJECT MANAGER A. Assignment of Project Manager. The Consultant shall assign the following individual to manage the project described in this contract: Jeremy A. McConnell, P.E., Construction Services Manager B. Changes in Project Manager. The City shall have the right to approve or disapprove of any proposed change from the individual named above as Project Manager. The City shall be provided with a resume or other information for any proposed substitute and shall be given the opportunity to interview that person prior to any proposed change. ARTICLE II. CITY REPRESENTATIVE The City shall assign the following individual to manage the project described in this contract: Christopher Strong, P.E., Director of Transportation ARTICLE III. SCOPE OF SERVICES The Consultant shall provide the services described in the City's Scope of Services and Proposal of the Consultant. If anything in the Proposal conflicts with the Scope of Services, the provisions in the Scope of Services shall govern. The Consultant may provide additional products and/or services if such products/services are requested in writing by the Authorized Representative of the City. All reports, drawings, specifications, computer files, field data, notes and other 1 documents and instruments prepared by the Consultant as instruments of service shall remain the property of the City. ARTICLE IV. CITY RESPONSIBLITIES The City shall furnish, at the Consultant's request, such information as is needed by the Consultant to aid in the progress of the project, providing it is reasonably obtainable from City records. To prevent any unreasonable delay in the Consultant's work the City will examine all reports and other documents and will make any authorizations necessary to proceed with work within a reasonable time period. ARTICLE V. TIME OF COMPLETION The work to be performed under this contract shall be commenced and the work completed within the time limits as mutually agreed upon between the parties. The Consultant shall perform the services under this agreement with reasonable diligence and expediency consistent with sound professional practices. The City agrees that the Consultant is not responsible for damages arising directly or indirectly from any delays for causes beyond the Consultant's control. For the purposes of this agreement, such causes include, but are not limited to, strikes or other labor disputes; severe weather disruptions or other natural disasters, failure of performance by the City, or discovery of any hazardous substances or differing site conditions. If the delays resulting from any such causes increase the time required by the Consultant to perform its services in an orderly and efficient manner, the Consultant shall be entitled to an equitable adjustment in schedule. ARTICLE VI. PAYMENT A. The Contract Sum. The City shall pay to the Consultant for the performance of the contract the total sum of $3,000.00, adjusted by any changes hereafter mutually agreed upon in writing by the parties hereto. B. Method of Payment. The Consultant shall submit itemized monthly statements for services. The invoice shall be broken down per city contract and contain the requested back-up documents as described in the Scope of Services. The City shall pay the Consultant within 30 calendar days after receipt of such statement. If any statement amount is disputed, the City may withhold payment of such amount and shall provide to Consultant a statement as to the reason(s) for withholding payment. C. Additional Costs. Costs for additional services shall be negotiated and set forth in a written amendment to this agreement executed by both parties prior to proceeding with the work covered under the subject amendment. 2 ARTICLE VII. CONSULTANT TO HOLD CITY HARMLESS The Consultant covenants and agrees to protect and hold the City of Oshkosh harmless against all actions, claims and demands of any kind or character whatsoever which may in any way be caused by or result from the intentional or negligent acts of the Consultant, his agents or assigns, his employees or his subcontractors related however remotely to the performance of this Contract or be caused or result from any violation of any law or administrative regulation, and shall indemnify or refund to the City all sums including court costs, attorney fees and punitive damages which the City may be obliged or adjudged to pay on any such claims or demands within thirty (30) days of the date of the City's written demand for indemnification or refund. ARTICLE VIII. INSURANCE The Consultant agrees to abide by the attached City of Oshkosh Insurance Requirements. ARTICLE IX. TERMINATION A. For Cause. If the Consultant shall fail to fulfill in timely and proper manner any of the obligations under this Agreement, the City shall have the right to terminate this Agreement by written notice to the Consultant. In this event, the Consultant shall be entitled to compensation for any satisfactory, usable work completed. B. For Convenience. The City may terminate this contract at any time by giving written notice to the Consultant no later than 10 calendar days before the termination date. If the City terminates under this paragraph, then the Consultant shall be entitled to compensation for any satisfactory work performed to the date of termination. This document and any specified attachments contain all terms and conditions of the Agreement and any alteration thereto shall be invalid unless made in writing, signed by both parties and incorporated as an amendment to this Agreement. 3 In the Presence of: CONSULTANT UfiAA-6— U-Q°c4)41Q- By: 0 • Vt7' +�1d Nn‘5 k Ve � w b%■ sir Q- �lucs 1 D.--nrt- (Seal of Consultant (Specify Title) if a Corporation.) By: (Specify Title) CITY OF OSHKOSH // 4 / i Mark`A. Rohloff, City Manager (Witness) / Oti6)--C-` /4) i /I. `'��. And: ( :ss) Pamela R. Ubrig, City Clerk APPROVED: I hereby certify that the necessary provisions have been made to pay the liability which will accrue under this contract. City Attor - e_040 3// City roller oller 4 PROPOSAL COST BREAKDOWN CONSTRUCTION MATERIALS TESTING 2011 CAPITAL IMPROVEMENT PROGRAM ITEM DESCRIPTION UNIT EST. BID UNIT PRICE PRICE BID TOTAL QTY. 1. Roundtrip Charge Each 165 $ 15.00 S 2,475.00 35.00 49,105.00 2. Field'Dine Hour 1,403 $ S 2.00 2,640.00 3. Equipment Rental Hour 1,320 S S 3.00 3,960.00 4. Vehicle Rental Hour 1,320 S S 50,00 2,500.00 5. Trench Backfill Testing Reports Each 50 $ $ 50.00 300.00 6. Asphalt Testing Reports Each 6 S S 88.00 1,320.00 7. Engineer Consultation Hour 15 $ S 5,920.00 00 R. Project Manager Hour 80 S 74.00 S 0 50 9. Sieve Analysis of Aggregate Each 12 S 67.50 S 810.0 .0 10. Standard Proctor Density Test 112 00 1,344.00 (aggregate) Each 12 S S II. Modified Proctor Density Test 140.00 280.00 (aggregate) Each 2 S S 147.00 294.00 12. Standard Proctor Density Test (clay) Each 2 S S 13. Modified Proctor Density Test 175.00 1,050.00 (clay) Each 6 S S 48.00 192.00 14. Atterbcrg Limits Each 4 S S 98.00 352.00 15. Grain Size Analysis Each 4 S S 250.00 S 2,500.00 16. Flexible Wall Permeability Tests Each 10 S 17. Asphalt Extraction/Gradation Each 4 S 144.00 S 576.00 75,618.00 TOTAL ----- RESPONSE TIME TO SITE 0.5 hours 1 Vvrin CMT FEE SCHEDULE LABORATORY: Fees 1. Laboratory Moisture-Density Relationship a. Standard Proctor (ASTM D698) $112.00/each b. Modified Proctor (ASTM DI557) $140.00/each c. One-Point Proctor Check (ASTM D698 or D1557) $60.00/point d. Clay Sample Preparation $35.00/each 2. Mechanical Analysis on Submitted Samples a. Through the#200 Sieve (ASTM C117 or C136) $67.50/each b. Through the #200 Sieve Only (ASTM C117) $36.00/each c. #10 Through 0.001 mm by Hydrometer Method (ASTM D422) $88.00/each 3. Atterberg Limits Including Plasticity Index (ASTM D4318) $48.00/each 4. Unconfined Compression Tests (ASTM D2166) $40.00/each 5. Compression Test of 6"x 12" Concrete Cylinders a. Cast by RVT $11.00/each b. Cast by Others $15.00/each 6. Handling of Backup Cylinders $9.00/each 7. Compressive Strength of 2" Mortar Cubes $11.50/cube 8. Bituminous Extraction & Mechanical Analysis of Aggregate (ASTM D2172, C136 & C117) $144.00/each EQUIPMENT: 6. Penetrometer Rental a. Half Day $20.00/'hday b. Daily $29.00/day 7. Concrete Equipment Rental $12.00/day 8. Cylinder Cure Box $30.00/project 9. Cylinder Molds (case of 20) $24.00/case 10. Vehicle Rental $6.00/hour TECHNICAL STAFF: 11. Level A Engineering Technician $30.00/hour 12. Level B Engineering Technician $35.00/hour 13. Level C Engineering Technician $39.00/hour 14. Level D Engineering Technician $44.00/hour 15. Clerical $34.00/hour PROFESSIONAL SERVICES: 16. Principal Registered Engineer $120.00/hour 17. Registered Engineer $88.00/hour 18. Project Engineer $74.00/hour REMARKS: The above rates are valid for calendar year 2011,or the duration of the project,whichever is longer. Services not listed on this schedule will be quoted on request. The minimum invoice for services provided during any month is$50.00. An overtime rate of 1.5 times the standard rate will apply for services performed over 8 hours per day or outside of 7:00 am to 6:00 pm on Monday through Friday, or anytime on Saturday. Personnel rates are portal to portal. A premium rate of 2.0 times the standard rate will apply for services performed on Sundays and holidays. One day advance scheduling is requested for all field testing services;same day scheduling may be subject to additional charges. River Valley Testing Corp Neenah Madison Green Bay www.rvtcorp.com 920.886.1406 608.222.9406 920.347-9040 �Ir. MEM13Ell "l kg " a bZ3h�`.% o I_r .,'2,;.11'5 id r°d Vy o i / *' i 1 z Z a p U O H r U W U °ce D CC . .\--1, _. 7:47,12-1.-',--- 1111.7i.„‘iiil, Millirrei �p0 r s i.r.11�11 i�r• fN o _ �_ 1.-.---111r. � � o S = imll.miisK 1141t ,, a pn I'�� �- � ��., 1l„te111urm�®gi=r � 1111um .: 0 IPIErte finr, 14 ., 1ii �� ium _E ' *- "Nt10..)?■ 414‘111111111..1.111riF;IIII-II:: :. -•--... ..— .. r�111 6. 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Z u.�m.°o_u nnnu :_arinnn u.o LL nnn 11; 0,F410 '..ll Nlllll - i-1 iP L— --t Ilul11 \ ix ”' x AL:,' '^Ll ul)LII \I - 0_ !Z! Y.y : o1J 11 II it II IIIFI''�ll nl '1' L II III •�•I III II 11 IIPII�Ln I llllnll 11 11.01LIIlla tI I, w Il ll nl I II Ilkll 11 11 nl II11111111-, 'flu llu 111 Z unnnnnn1111 nnnn-.4n l nnnn:nan n l nnn n=n n n l w 8 n.n..lrall..u:...nu..n nib n=n n n n . it .F ;sr III l tk ,; J7ig Pe 1• 1 ! • la e LI'i' ! c�c 000 w C)*Iiiii N7Ip1S Il augamossi ¢ra / g:;,'','? c,la = 7351,3a OJHKOJH ON THE WATER Insurance Requirements for the City of Oshkosh Revised: March 31, 2011 Original: January 14, 2011 1/14/1 1 City of Oshkosh Insurance Requirements INTRODUCTION It is important that the City of Oshkosh is adequately protected from loss due to the negligence of others (contractors, suppliers, vendors, etc.) who are working for, with, or on behalf of the City of Oshkosh. To help achieve this goal, the City of Oshkosh requires that other parties carry a certain level of insurance that will protect, defend and indemnify the City from losses arising out of their activities or from their products. The following standards have been established to help provide direction and consistency for City of Oshkosh Departments. Until the appropriate certificate of insurance verifying the required coverage is obtained, the City of Oshkosh will NOT be issuing a license, permit or entering into a contract. Insurance requirements for jobs or activities such as asbestos abatement, pollution clean up, oil recycling, hazardous waste removal, or any new contract or activity where it is not clear what level of insurance should be required will be determined by the City Attorney and the Safety & Risk Management Coordinator. The City Attorney and/or the Safety & Risk Management Coordinator are responsible for the review of all certificates of insurance to determine if they meet the insurance requirements. There may be times when an organization or contractor can not meet the insurance requirements. Any significant variance from the standards must be authorized by the City Attorney and/or the Safety & Risk Management Coordinator. 1/14/11 CITY OF OSHKOSH INSURANCE REQUIREMENTS IV. PROFESSIONAL SERVICES LIABILITY INSURANCE REQUIREMENTS The Contractor shall not commence work on subcontract until proof of insurance required of the Subcontractor has been provided to the applicable City department before the contract or purchase order is considered for approval by the City. It is hereby agreed and understood that the insurance required by the City of Oshkosh is primary coverage and that any insurance or self insurance maintained by the City of Oshkosh, its officers, council members, agents, employees or authorized volunteers will not contribute to a loss. All insurance shall be in full force prior to commencing work and remain in force until the entire job is completed and the length of time that is specified, if any, in the contract or listed below whichever is longer. 1. PROFESSIONAL LIABILITY A. Limits (1) $1,000,000 each claim (2) $1,000,000 annual aggregate B. Must continue coverage for 2 years after final acceptance for service/job 2. GENERAL LIABILITY COVERAGE A. Commercial General Liability (1) $1,000,000 each occurrence limit (2) $1,000,000 personal liability and advertising injury (3) $2,000,000 general aggregate (4) $2,000,000 products—completed operations aggregate B. Claims made form of coverage is not acceptable. C. Insurance must include: (1) Premises and Operations Liability (2) Contractual Liability (3) Personal Injury (4) Explosion, collapse and underground coverage (5) Products/Completed Operations must be carried for 2 years after acceptance of completed work (6) The general aggregate must apply separately to this project/location 3. BUSINESS AUTOMOBILE COVERAGE A. $1,000,000 combined single limit for Bodily Injury and Property Damage each accident B. Must cover liability for Symbol #1 - "Any Auto"— including Owned, Non-Owned and Hired Automobile Liability. IV- 1 1/14/1 1 4. WORKERS COMPENSATION AND EMPLOYERS LIABILITY— "If" required by Wisconsin State Statute or any Workers Compensation Statutes of a different state. A. Must carry coverage for Statutory Workers Compensation and an Employers Liability limit of: (1) $100,000 Each Accident (2) $500,000 Disease Policy Limit (3) $100,000 Disease— Each Employee 5. ADDITIONAL PROVISIONS A. Acceptability of Insurers - Insurance is to be placed with insurers who have an A.M. Best rating of no less than A- and a Financial Size Category of no less than Class VI, and who are authorized as an admitted insurance company in the state of Wisconsin. B. Additional Insured Requirements — The following must be named as additional insureds on the General Liability and Business Automobile Liability coverage arising out of project work...City of Oshkosh, and its officers, council members, agents, employees and authorized volunteers. On the Commercial General Liability Policy, the additional insured coverage must include Products — Completed Operations equivalent to ISO form CG 20 37 for a minimum of 2 years after acceptance of the work. This does not apply to Professional Liability, Workers Compensation and Employers Liability. C. Certificates of Insurance acceptable to the City of Oshkosh shall be submitted prior to commencement of the work to the applicable City department. These certificates shall contain a provision that coverage afforded under the policies will not be canceled or non renewed until at least 30 days' prior written notice has been given to the City Clerk —City of Oshkosh. IV - 2 A✓"°' CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDJYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Insurance Agency contact NAME: information,including street PHONE insurance Agent's FAX and PO Box if 1A/C.No: contact information. . applicable. (AI .No.Ext): _..._ _.._. �.... �. _.. _. E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE - NAIC# INSURER A: ABC Insurance Company NAIC# INSURED insured's contact information, including name,address and INSURER B: XYZ Insurance Company NAIC# phone number. INSURER c: LMN Insurance Company NAIC# INSURER D: Insurer(s)must have a minimum A.M.Best rating of A- - --- - - and a Financial Performance Rating ofVlorbetter. INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE AMY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR - --- ---- ADDL SUBR POLICYEFF POLICYEXP LTR f TYPE OF INSURANCE INSR WVD POLICY NUMBER (MMIDD/YYY) _ (MMIDDIYYY) '.. LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 AMAGE®=COMMERCIAL GENERAL LIABILITY ® ' ❑ General Liability Policy Number Policy effective and expiration date. PREM SESO(Es occurrence) $50,000 A ID CLAIMS-MADE El OCCUR MED EXP(Any one person) $5,000 E, ISO FORM CG 20 37 OR EQUIVALENT PERSONAL&ADV INJURY $1,000,000 ❑� GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS $2,000,000 , POLICY Z ECOT� ❑.,.LOC ..._ $ [AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $1,000,000 ®.ANYAUTO / ❑ Auto Liability Policy Number Policy effective and expiration date. BODILY INJURY(Per person) $ ALL OWNED SCHEDULED B AUTOS ' AUTOS BODILY INJURY(Per accident) $ ❑HIRED AUTOS El AUTOS NON-OWNED PROPERTY DAMAGE AUTOS (Per accident) $ Eli UMBRELLA LIAB ❑:'OCCUR El El ''..EACH OCCURRENCE $ !❑- ❑ CLAIMS-MADE AGGREGATE ❑;DED..... .❑RETENTION$_ C AND EMPLOYERS'LIABILITY ❑ 111 WORKERS COMPENSATION ® WC STATU-: TORY LIMITS I I OER ANY PROPRIETOR/PARTNER/EXECUTIVE • - -- --- -- OFFICE/MEMBER EXCLUDED? YIN Workers Compensation Policy Policy effective and expiration date. E.L EACH ACCIDENT $100,000 (Mandatory in NH) N Number If yes,describe under ! i E.L DISEASE—EA EMPLOYEE $100,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE—POLICY LIMIT $500,000 A PROFESSIONAL LIABILITY ® ❑ $1,000,000 EACH CLAIM Professional Liability Policy Policy effective and expiration date. '$1,000,000 ANNUAL AGGREGATE DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Additional Insureds on the Commercial General Liability and Automobile Liability arising out of project work shall be City of Oshkosh,and it's officers,council members,agents,employees and authorized volunteers. Certificates of Insurance acceptable to the City of Oshkosh shall be submitted prior to commencement of the work to the applicable City department. These certificates shall contain a provision that coverage afforded under the policies will not be canceled or non renewed until at least 30 days'prior written notice has been given to the City Clerk—City of Oshkosh. CERTIFICATE HOLDER CANCELLATION City of Oshkosh,Attn:City Clerk Insurance Standard IV SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 215 Church Avenue SAMPLE CERTIFICATE THE EXPIRATION DATE,THEREOF,NOTICE WILL BE DELIVERED IN PO Box 1130 ACCORDANCE WITH THE POLICY PROVISIONS. Oshkosh,WI 54903-1130 Please indicate somewhere on this certificate,the contract or project# AUTHORIZED REPRESENTATIVE this certificate is for. ©1988-2010 ACORD CORPORATION. All rights reserved. Acord 25(2010105) The ACORD name and logo are registered marks of ACORD Otter Avenue Parking Lot Reconstruction Construction Materials Testing/Scope of Services OTTER AVENUE PARKING LOT RECONSTRUCTION CONSTRUCTION MATERIALS TESTING SCOPE OF SERVICES This contract is to provide nuclear density testing services of trench backfill and asphalt along with laboratory testing of these materials. Responsibilities include providing qualified timely response, daily coordination and communication with contractors and city staff, and prompt professional reporting of test results. 1. Background A. This contract covers Contract 11-27—Otter Avenue Parking Lot Reconstruction. B. The required tests/activities under this scope are as follows: i. Onsite nuclear density testing of utility trench backfill ii. Documentation of soil density test locations by project station, offset, elevation, and utility trench type iii. Reporting laboratory and field results in PDF format via email to the City and the On- Site Engineer within 48 hours unless test requires longer to perform a. City Contact: Christopher Strong, P.E., Director of Transportation, cstrong @ci.oshkosh.wi.us b. On-Site Engineer: Ryan Arndt, Gremmer & Associates, namdt@gremmerassociates.com iv. Submitting a final summary report for this contract C. Testing shall be conducted at a minimum of two (2) testing locations to accept the compaction results as representative of the trench work. Additional locations may be selected upon approval of the City, at the request of the On-Site Engineer. The minimum locations are as follows (referencing the attached plan sheets): i. A random location in Otter Avenue between Structures 100 and 101 ii. A random location in the 12" utility run in the parking lot (between Structures 101 and 102) D. Testing shall be conducted at dates/times in coordination and consultation with the On- Site Engineer. City of Oshkosh Department of Transportation Page 1 of 3 Otter Avenue Parking Lot Reconstruction Construction Materials Testing/Scope of Services 2. Testing and Reporting A. All tests and reports shall be in conformance with the latest ASTM Standards. The consultant will be responsible for providing all necessary forms for labeling of samples and documentation of test results. Test results shall include the location, sample number, and be separated per City Contract number. B. Soils and Aggregate Testing (when and if necessary) Provide the necessary labor and equipment for clay liner testing, onsite nuclear density testing of utility trench backfill and associated laboratory material testing. Specifications will be based on the City of Oshkosh 2011 Standard Specifications and each contract's special conditions. The testing firm shall obtain all test samples from the construction site and may be required to obtain samples from various source sites. At a minimum, keep all lab samples until the end of the subject contract. Nuclear density testing will be performed on an as-needed basis dependent on the contractor's schedule. It is the testing firm's responsibility to verify the contractor's schedule and to coordinate with the On-Site Engineer daily. Nuclear density tests shall be located by project station, offset, elevation, and utility trench type. The density testing technician shall notify the On-Site Engineer and appropriate contractor of all failing tests. Failing areas shall be re-compacted and re- tested until passing results are achieved. All tests shall be documented. C. Asphalt Testing (when and if necessary) Provide the necessary labor and equipment for nuclear density tests on asphalt binder and surface courses and associated laboratory material testing. Specifications will be based on the City of Oshkosh 2011 Standard Specifications and each contract's special conditions. The testing firm shall obtain all test samples from the construction site. At a minimum, keep all lab samples until the end of the project. Nuclear density testing will be performed on an as-needed basis dependent on the contractor's schedule. It is the testing firm's responsibility to know the contractor's schedule and to coordinate with the On-Site Engineer. Nuclear density tests shall be located by project station, offset, and layer type. The density testing technician shall notify the On-Site Engineer and appropriate contractor of all failing tests. Failing areas shall be re-compacted and re-tested until passing results are achieved. All tests shall be documented. D. Reporting City of Oshkosh Department of Transportation Page 2 of 3 Otter Avenue Parking Lot Reconstruction Construction Materials Testing/Scope of Services i. All reports shall be typed in a professional manner according to the latest ASTM standards. 3. Invoices A. The consultant shall submit itemized monthly statements for services. The invoice shall be broken down per city contract. Required back-up information is as follows: i. A copy of any laboratory tests from the time period of the requested payment. ii. For approved consultation or additional project management time, include the date, a description of the discussion and/or activity and the name of the city staff person and the consultant's staff involved in the discussion. B. Invoices shall be submitted to: Christopher Strong, Director of Transportation, City of Oshkosh, 926 Dempsey Trail, Oshkosh, WI, 54902. C. Costs shall be billed according to the attached fee schedule provided by the Consultant. D. Additional invoicing and payment requirements are stated in the Agreement Form. 4. Contract Award A. The contract will be awarded on a time and materials basis with a not to exceed total. Changes to the contract will be completed per the requirements set forth in the City of Oshkosh Agreement document. B. The consultant will work solely under the terms and conditions of the City of Oshkosh. Besides prior negotiated agreements between the consultant and the City of Oshkosh, a consultant's terms and conditions will not be accepted as part of the contract. C. The consultant will provide insurance documents according to the attached requirements with the signed contracts within one week after receiving the official contract paperwork from the City of Oshkosh. D. The information contained within the signed agreement form, the Scope of Services with its attached documents, and the consultant's fee schedule shall become a part of the Contract with the Consultant selected to perform the services. 5. Project Schedule A. Construction of the parking lot is anticipated to begin September 6, 2011. This contract will terminate December 31, 2011 or upon the completion of any testing project started in 2011. City of Oshkosh Department of Transportation Page 3 of 3 DATE(MAVDOIYYYY) .qCf-- CERTIFICATE OF LIABILITY INSURANCE OP ID CT 03/18/11 THIS C-E�RTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the poilcy(tes)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certNcate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER I,ue+rn(., NAME: "PRONE FAX Johnson Insurance - Madison IJAIC.NNo,Ext): _WC,No): 525 Junction Road ADDRESS: Madison WI 53717 "PRODUCEFr CUSTOMERIDi RIVVA-1 Phone:608-203-3880 Fax:877-254-8586 INSURER(S)AFFORDING COVERAGE NAICi INSURED ti INSURER A: CNA Insurance 20427C River Valley Testing Corp.George Barker g INSURER e _v 1060 Breezewood Lane, Ste. 102 INSURER Neenah WI 54956 _. _.v INSURER D: INSURER E INSURER F: _ COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSW "A UBR �.."°"» POCTCY'EFF""PCflICAEXP"-"� LIMITS LTR TYPE OF INSURANCE INrI/WVDt POLICY NUMBER (MMIDOMAN) ImwDD)YY1"I) GENERAL LIABILITY r EACH OCCURRENCE $ I 17AltitAGrY0'KEN Ito COMMERCIAL_GENERAL.I.IABILITY j PREMISES(Fa occurrence) $ 1 CLAIMS-MADE El OCCUR MED EXP(My one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE.._.._..._. $____._._.________.._.._____. GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGO $ 11__ POLICY 1—ACT I I I UC $ $ AUTOMOBILE LIABILITY COMBINED SINGLE LIME (Ea acciaenl) ANY AUTO BODILY INJI IRY(Par parson) $ ALL OWNED AUTOS ...... __ GODLY INJURY(Par accident).$ SCHEDULED AUTOS 1 ...._._...._..._.._._.._____._—__..._...........:........................................._..---_...__...... PROPERTY DAMAGE $ HIRED AUTOS (Per accident) _ NON-OYVNED AAJTOS .---._...___..__...,.. $ UMBRELLA LIAB OCCUR EACH OCCURRENCE I EXCESS LIAB a AIMS-MADE AGGREGATE $ DEDUC BI E $ RETENTION $ WORKERS COMPENSATION WC STATE.). OI1+ AND EMPLOYERS'LIABILITY Y/N ' ,.,___.�O 1Y LIMITS I ER ANY PROPRIETOR1PARTNERIEXECUTIVE L�J N 1 A I E L EACH ACCIDENT $ OFFICERJMEMBER EXCLUDED? (Mandatory In NH) 17.L DISEASE:-EA EMPLOYEE $ If yes.describe under ...T-.._ ... DESCRIP1 ION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ A Professional Liab MCH114051875 03/01/11 03/01/12 Ea Occ 2000000 I Aggregate 2000000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Environmental Professional Liability & Contractor's Pollution Incident Liability CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE MOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITYOS1 THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Oshkosh City Clerk AUTHORIZED REPRESENTATIVE 215 Church Ave Oshkosh WI 54901 01988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD �,._-,040 OP ID:PA DATE(MM/DD1YYYY) '``i`°)RO CERTIFICATE OF LIABILITY INSURANCE 09/19/11 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 920-235-2764 Pam Krueger,CIC Servant Insurance - PHONE FAX 430 N Koeller Street 920-235-2694 rA:P, P,E 1 920-235-2764 ��- i s pop 920-235-2694 Oshkosh,WI 54902 nDDREESS pkrupgereservantinsurance.com Mary Murken "PRODUCER " ... S15TOM IXt-RVTQU-1 INSURER)fJ AFFORDING COVERAGE I NAIL A INSURED RVT Quality Systems Inc. INSURER A.Cincinnati Insurance Company Quality Mgmt Services Inc. INSURER e:TRI STATE INSURANCE CO OF MN AKA-River Valley Testing Corp Alex Barker INSURER 1060 Breezewood Ln Ste 102 INSURER Neenah,WI 54956 INSURERS INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR JAM'WO P_._.._-. __.. PULJ�l`p"F �OLIZ''1� 3fP'E LIMITS LTR TYPE OF INSURANCE !AlSR WVO POLICY NUMBER IMMIDO/YYYY)I(MMIDDIYYYYI I 4- i I GENERAL LIABILITY !EACH OCCURRENCE $ 1,000,000 ( DAMAGE TO RE/ ED A 'X I COMMERCIAL GENERAL LIABILITY X EPP0065218 02/16/11 02/16/12 I PREMISES(Ea occurrence) $ 100,000 -_-1 CLAIMS-MADE I Xi OCCUR MEDEXP(Any one person) S 10,000'. [ IMPERSONAL 3 ADV INJURY $ 1,000,000 { (GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: ( !PRODUCTS-COMP/OPAGG $ 2,000,000 1 POLICY I X I EIS I ....)LOC $ AUTOMOBILE LIABILITY X I COMBINED SINGLE LIMIT $ 1,000,000 ..__ ;(Ea accident) ' A X ANY AUTO EBA0065218 02/16/11 02/16/12 -.._.__ _ ......._...... ... .. _._...__.............._......._ I BODILY INJURY(Per person) $ ALL OWNED AUTOS '��Y INJURY I BODILY INJUR (Per accident) $ SCHEDULED AUTOS .,,_ ` PROPERTY DAMAGE $ X HIRED AUTOS i I(Per accident) X i NON-OWNED AUTOS I 1 $ X UMBRELLA LIAB [X OCCUR I I i EACH OCCURRENCE $ 5,000,000 EXCESS LIAB AGGREGATE S 5,000,000 A _l . € i EPP0065218 02/16/11 02/16/12 _ _ CLAIMS-MADE DEDUCTIBLE I I$ X RETENTION b 10000 I I I 3 r WORKERS COMPENSATION i X� �Q yR L MI S I I ER I AND EMPLOYERS'LIABILITY B i ANY PROPRIETOR/PARTNER/EXECUTIVE Y���Iry;N�� WC-48-02-013146-00 02/16/11 02/16/12 I I E L..EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? I -i I N I A (Mandatory In NH) ( c E.L.DISEASE-EA EMPLOYEE$ 1,000,000 If yes,describe under ._...._.__. I DESCRIPTION OF OPERATIONS below I I I I EL.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) City of Oshkosh,and Its officers,council members,agents,employees and authorized volunteers are provided additional status on the general` liability&auto liability as required in written contract.General liability AI is ongoing&completed operations.Policy has been endorsed to Provide 30 day notice for cancellation:except 10 days for non-navment. CERTIFICATE HOLDER CANCELLATION CIOS113 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF OSHKOSH ACCORDANCE WITH THE POLICY PROVISIONS. PO BOX 1130 OSHKOSH,WI 54903-1130 AUTHORIZED REPRESENTATIVE Mary Murken ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD ED OJHKOJH ON THE WATER CITY OF OSHKOSH CONTRACTOR SAFETY PROGRAM dilob::.1 Ilk ' la, -, 'Ila.. .,_..,,,,,,,Invcii /123 . 1 1 � • *Ifti,ImMir .. ,. --I 1 1 11 X 1k '' i-- PIPPPP * x f ill (0` rte... .. 1-----\\ Original:September 2006 Revised:March 2010 City of Oshkosh Contractor Safety Program TABLE OF CONTENTS, Introduction 1 General 1 Project Safety Coordinator Responsibility 2 City of Oshkosh 2 Contractor 2 Fire Prevention and Protection 2 Hot Work 2 Smoking Policy 3 Chemical Safety 3 Material Safety Data Sheets 3 Chemical Management 3 Container Labeling 3 Environmental Compliance 4 Waste Disposal 4 Hazardous Waste 4 Chemical Spills 4 Personal Protective Equipment 5 Elevated/Overhead Work 5 Excavation/Trenching 5 Summary 6 City of Oshkosh Project Manager Contractor Notes and Check List 7 Contractor Qualifications 7 Information Exchange Check List 8 Contractor Project Manager Contractor Safety Program Acknowledgement Form 9 Contractor Safety Program Qualification Questionnaire 10 INTRODUCTION Work-related accidents damage property, cause serious injury and may even result in death. Most accidents are preventable with good planning, up-to-date training, good communication and most of all . . . commitment. It is the intent of the City of Oshkosh, that all work conducted, is done in a safe, healthful and environmentally responsible manner. Employers have the duty and responsibility to provide a safe work place for their employees as well as contractor and vendor employees. Contractors, likewise, have a responsibility to keep their workers safe, and to work in a manner that does not compromise the safety of City of Oshkosh employees, while protecting, preserving and enhancing the environment. Therefore, the City expects contractors to meet all safety and health performance requirements and to comply with all applicable laws, regulations, ordinances and codes. For purposes of this program, a "Contractor" may be defined as: a) Construction contractor — project oriented work such as new construction or remodeling b) Service Contractor — a contractor that installs, services or performs maintenance of equipment, tools, systems or processes c) Vendor— a provider of definable services for a facility d) Task Oriented Contractor— performs a specific work task e) Sub-contractor— assumes some of the obligations of a primary Contractor f) Temporary Labor Contractor — provides workers on a temporary, as needed basis with on-site supervision by an employee of the Contractor On-the-job safety is especially important for contract workers. You are called upon to perform highly specialized and potentially hazardous tasks. Working conditions and safety procedures may change each day. Good communication between the contract employer, the City project manager and the contract crew is essential so that proper hazard control measures are followed. The following rules and guidelines promote safety and are an effort to highlight major safety and environmental concerns. THEY ARE NOT INTENDED OR DESIGNED TO BE COMPREHENSIVE, TO SUPPLEMENT OR LIMIT APPLICABLE LEGAL REQUIREMENTS OR TO RELIEVE THE CONTRACTOR OF ANY SAFETY, HEALTH AND ENVIRONMENTAL RESPONSIBILITIES. The Contractor should always refer to the specific requirements of applicable laws, regulations, codes and/or specific standards to assure safety and compliance. GENERAL The following information is provided to the Contractor by the City of Oshkosh, understanding that these guidelines are not intended in any way to be all-inclusive or to relieve the Contractor of any part of the responsibility for the safe performance of the work outlined in the Introduction of this document. The objective of this policy is to prevent the failures that cause injuries, illnesses, fatalities, property damage, or environmental pollution. 1 No portion of this document is to be construed as establishing a master-servant relationship between the Contractor and the City of Oshkosh. In all cases, the Contractor shall be deemed to be an independent contractor and the sole employer. As a minimum, Contractor safety rules, work practices, and procedures must be compatible with existing City of Oshkosh policies and procedures. PROJECT SAFETY COORDINATOR RESPONSIBILITY City of Oshkosh The City of Oshkosh project coordinator shall be your primary contact. The Safety & Risk Management Coordinator for the City of Oshkosh is Paul Greeninger. He has the overall responsibility for safety and health issues. If you have a concern regarding our safety policies, you may contact him at (920) 236-5117 or (920) 233-7852. Contractor Each Contractor shall designate a responsible member of its management team as the Safety Coordinator for the project. The designee's duty shall be prevention of accidents and other job losses. This person shall have control of and be familiar with day-to-day activities of the Contractor. This person will be responsible for initiating, maintaining, and supervising all safety and loss prevention programs and procedures. FIRE PREVENTION AND PROTECTION The Contractor shall take all necessary precautions to prevent fire and injuries or property damage relative to welding, cutting or other spark or flame producing processes and procedures. It is the responsibility of the Contractor to follow City of Oshkosh Hot Work permitting policies and procedures. Contractors shall also establish procedures for storage, handling and use of flammable or combustible materials, which comply with City of Oshkosh policies and procedures, as well as all applicable laws, regulations and fire codes. The Contractor shall ensure that employees and all Third Parties under their direction are familiar with fire protection and alarm systems in their work area. The Contractor shall also be responsible for supplying and maintaining a sufficient number of appropriate types of fire extinguishers to support the work. HOT WORK At any time during the work, where spark or flame producing operations are conducted (such as welding, cutting, grinding or open flame), the Contractor shall establish a fire watch during and after (for at least 60 minutes) such operations to ensure that fires do not ignite. The Contractor shall insure that fire watch personnel are trained in fire fighting and are aware of procedures for sounding alarms and making notifications in the event of fire. "Hot Work Permits" are required when working within buildings or within 35 ft. of combustible materials, including flammable liquids, vapors or dusts. 2 SMOKING Smoking is prohibited in all City of Oshkosh buildings. The Contractor based on the hazards present shall control smoking at outdoor job sites. CHEMICAL SAFETY Chemicals are important tools in a wide variety of work activities, but many chemicals can cause serious health and environmental issues. The Contractor shall obtain all information necessary to be fully aware of all potential exposures to hazardous materials in the performance of the work. The Contractor shall provide, to their employees, all information and training on the nature and scope of potential hazards as required by all laws, regulations, ordinances and codes, regardless of the source of such hazards. The Contractor is also responsible for communicating to the City of Oshkosh any hazards created by the work being performed. The City of Oshkosh also has the right to restrict the type and amount of chemicals being brought on to the job site. Products containing Methylene Chloride (CAS #75-09-2) and paints containing Isocyanates such as (CAS #91-08-7 or #584-84-9) are two examples of restricted chemicals. Certain other chemical and physical agents (asbestos, PCB's, lead-based paints, radiation sources, etc.) are specifically regulated by Federal, State and/or local agencies. When the work involves a potential exposure to any such hazards, the Contractor shall maintain compliance with all applicable regulations. MATERIAL SAFETY DATA SHEETS Material Safety Data Sheets (MSDS) must be provided to your City of Oshkosh contact for ALL chemicals prior to being brought on site. This requirement includes all liquids, pastes, powders and gas products. CHEMICAL MANAGEMENT Chemicals brought onto City of Oshkosh property must be removed when work has been completed. Any changes must have approval of the project manager and the Safety Coordinator. All waste materials must be managed as identified in the Environmental Compliance and Waste Disposal sections of this booklet. LABELING All containers shall be labeled in accordance with the OSHA Hazard Communication Standard. Waste containers shall be labeled according to all applicable federal, state and/or local laws, regulations, ordinances, codes and/or standards. 3 ENVIRONMENTAL COMPLIANCE The City of Oshkosh is committed to the responsibility to protect, preserve and enhance the environment wherever it conducts business. The Contractor shall be fully and solely responsible for compliance with all environmental laws and regulations applicable to the transportation, packing, labeling, handling, use, storage, or disposal of materials, including liquid and solid wastes and hazardous substances, brought onto City of Oshkosh property or used in the performance of work, or generated as a result of the work. WASTE DISPOSAL Waste and the disposal of many chemicals and products may result in damage to the environment. Environmental laws and regulations closely monitor waste handling and disposal. The City of Oshkosh, therefore, closely manages what happens to waste products, recycled chemicals and abandoned materials. Many chemicals and products are not to be disposed of into sanitary waste containers or into drains. Nothing may be discarded onto facility grounds, parking lots, or waterways. Some of the waste products that are controlled may include, but not limited to: used or waste oil and grease; paints, paint thinners, solvents and cleaning fluids; strong acids or caustics; sorbents, rags and materials used to cleanup wastes; electronic components, fluorescent light bulbs and ballast's; pesticides, herbicides and related chemicals. Because of the complexity and extensive lists of waste streams, prior approval must be obtained for disposal, and the method of disposal. HAZARDOUS WASTE The Contractor must receive approval from the City of Oshkosh to transport or dispose of hazardous waste from the work site. The Contractor shall provide the City of Oshkosh with copies of all records relating to waste management activities associated with the work including copies of hazardous waste manifests, waste disposal locations and waste transportation and disposal agreements. CHEMICAL SPILLS If spills or unauthorized releases of any product occur, the Contractor shall notify the City of Oshkosh Project Manager or Safety & Risk Management Coordinator immediately of the nature of the incident. If the contact or Safety & Risk Management Coordinator is not available, contact the Oshkosh Fire Department at 236-5700. The Contractor shall provide all required information necessary for reporting of the incident and to notify the appropriate agency(s) in a timely manner. A copy of the written notification to the agency(s) shall be provided to the City of Oshkosh Safety & Risk Management Coordinator. 4 PERSONAL PROTECTIVE EQUIPMENT All employees of the Contractor, and other persons entering City of Oshkosh property in connection with the work, shall wear appropriate personal protective equipment (PPE) such as, but not limited to, safety glasses, steel toe shoes, hard hats, and proper work clothing. Special personal protective devices and/or equipment must be used where needed based on the hazards of the work. This equipment shall include, but not limited to: • Hearing protection devices • Respiratory protection devices • Fall protection devices • Hand protection • Lifelines and body harnesses • Any other special equipment/devices necessary to provide appropriate protection ELEVATED/OVERHEAD WORK Whenever work is to be done above walking or working areas at a height greater than four feet, which may present a hazard to personnel or property below, all necessary safety precautions shall be taken by the Contractor. This action shall include, without limitations, roping off the area and posting warning signs to caution personnel below from falling materials. If necessary, a flagman shall be stationed below to warn persons in the area. All such barriers and signs shall be removed as soon as the work is completed. All personnel under Contractor supervision or control working at elevations greater than four feet shall be protected by guardrails, ANSI approved body harnesses and lanyards or lifelines, or other effective means that comply with applicable federal, state, and local regulations. The use of safety belts is prohibited as a fall protection device. The use of ladders, scaffolding or work platforms must comply with all federal, state, and local regulations. EXCAVATION/TRENCHING Contractors performing excavation/trenching must meet the qualifications set forth during the bid process. The Contractor shall comply with all OSHA/D-COMM regulations. The Contractor shall have a competent person or persons on the site to inspect the work and to supervise the conformance of Contractor's operations with the regulations. The Contractor shall take all necessary precautions for the safety of employees on the job site. 5 City of Oshkosh Project Manager Contractor Notes and Checklist Contractors are not only responsible for their tools and equipment and the safety of their employees, but also to our property and the safety and health of our employees. In addition, damage to the environment or failure to properly manage waste disposal may cause long term and costly issues to the City of Oshkosh. These issues pertain in different degrees to all vendors and contractors, anyone who performs a service for the City. A"Contractor" may be defined as: A) Construction Contractor- project oriented work such as new construction or remodeling, B) Service Contractor - a contractor that installs, services or performs maintenance of equipment, tools, systems, or processes C) Vendor-a provider of definable services for a facility D) Task-Oriented Contractor- performs a specific work task E) Sub-contractor- assumes some of the obligations of a primary contractor F) Temporary Labor Contractor - provides workers on a temporary, as needed, basis with onsite supervision by an employee of the Contractor G) The City expects its contractors to meet its safety and health performance requirements and to comply with all applicable laws, regulations, ordinances and codes. When selecting contractors, safety performance must be included in the selection process. Unsafe acts of contract employees can put our workers' safety in jeopardy. In addition, there are always potential legal and liability issues, including citations from EPA, DNR, or D-Comm. Contractor Qualification The Contractor Qualification process (and the qualification questionnaire), may not be required for contractors servicing their own equipment or contractors who have been designated by the manufacturer as the manufacturer's representative or distributor, when the contractor employee is performing a low risk activity. This exception does not apply to Construction Contractors or Service Contractors performing high risk work activities including hot work, use of hazardous chemicals, working with hazardous voltages, control of hazardous energy (lockout/tagout), operation of powered equipment, work at hazardous elevations, excavation work, or confined space entry. Contractors exempted from the qualification process are still required to meet all other requirements of the Contractor Safety Program, including the attached Acknowledgement Form. 7 Information Exchange Checklist for City Project Coordinators The following is a checklist to assist you,the City Project Coordinator,with contractor communication. Yes No N/A Do you have a list of the chemicals that may be found at the City project site and their potential hazards? W_ Have you reviewed these chemicals and their hazards with the Contractor? Have you notified the Contractor of the MSDS file location? _ Have you reviewed our policy of bringing chemicals on-site,including the approval process? See Chemical Safety section of guidebook. Does the Contractor understand this policy? Do they know that chemicals may not be left on premises without approval? Do you have a list of fire and/or physical hazards for the Contractor? Have you discussed these potential hazards with the Contractor? _ Have the City emergency procedures been provided to the Contractor? If Hot Work is to be performed, have you provided Hot Work Permit forms and reviewed the policy? Will the Contractor enter Confined Spaces? Have the areas been identified and procedures reviewed? ____ Have you instructed the Contractor about our policy on chemical spills? The City of Oshkosh is committed to protecting the environment. — Chemicals may not be disposed of into sanitary waste containers, into drains or onto grounds. Review the materials that the Contractor may be using and how they are to be handled and the waste disposed. Is the Contractor's Safety Acknowledgement Form on file'? Workers Compensation Certificate? Liability Insurance? Have you received and reviewed the Qualification Questionnaire? Are there any safety concerns? Have you scheduled weekly safety meetings if the project requires more than one week to complete? _ Was the Contractor given the opportunity to ask questions regarding the safety and environmental requirements for the project? City Project Manager Date 8 City of Oshkosh Contractor Safety Program Acknowledgement Form The City of Oshkosh (City) is required by law to carry Workers Compensation Insurance (WCI) on our permanent employees. As an independent contractor/vendor, your firm is required by law to carry WCI on your employees. As an independent contractor/vendor, you are not under the direct supervision of the City and are not covered by the WCI or Liability Insurance maintained by the City for their employees. Please attach a copy of your current Workers Compensation Certificate and a copy of your certificate of liability insurance. It is required that you notify the City immediately if any of the required insurance or bonding should be cancelled or notify the City within 30 days of a change in bond status or insurance carriers. Please complete and return to Paul Greeninger, City of Oshkosh, Safety & Risk Management Coordinator. Date: 3,t8'2711 Contractor/Vendor Name: tv€-( *ON t Tab Core. Address: (Q0 top 11,—Le a i& a� 4` U ,t- 112.. City, State, Zip: 41..)Qyi W■ Telephone Number: q2A•:st ,tap E-mail Address: 1W Cettintr iYV.C4nnCt I k ccfp.6001 Contractor/Vendor Representative: 3-e(t C.C.-Owlet i Title: `4 it, ) ,/.. ♦ , k 1, i l! r i Individual Responsible for: 1 fly_ Coordination: rk f t'4 Phone: Cr/O V •l` xo Environmental Issues: 61.011 MCCONVA 1 L Phone: I I understand that it is my obligation to notify my employees of their responsibilities for health and safety. I further understand that if any unsafe work activities are found, the City has the right to immediately contact the Contractor` Safety Coordin. .r. If ' unsafe practice is not corrected, the work may be stopped until corrective a be. * en T d a -* upon. Signed: 414611K- i' `i�. A A R9 Date: k r t]it( 7( Certificate of Insurance Attached $. Workers Compensation Insurance Certificate attached 9 City of Oshkosh Contractor Safety Program Qualification Questionnaire Date: 3.Q.1i ContractorNendor Name: , { � Person completing form: le t Title: Sa,______ItS___Cal4NIFO In keeping with the City of Oshkosh commitment to provide a safe and healthful workplace while protecting and preserving the environment, we require the following safety questionnaire be completed and returned to Paul Greeninger, City of Oshkosh Safety & Risk Management Coordinator, 215 Church Ave., Oshkosh, WI 54903. Completion of this questionnaire does not in any way relieve the contractor of their obligations to comply with all applicable legal requirements (federal, state, and local). This questionnaire has been designed to help the City to better understand your safety program and in no way does it represent a complete list of the Contractor's applicable safety obligations. Your response to some of the following questions may require that you provide documents, however, PLESE DO NOT SEND CONFIDENTIAL, PROPRIETARY OR TRADE SECRET INFORMATION. 1. Provide a brief description of the primary service your company provides the City. ri5h Ghw 111 %` A. , 1,ic_ offer • f( raft ' o� biro GAS{*C, t 1 l of a< L �: � t /' f04? . 4 bp fissa V 2. Do you require the following safety training programs? A. Right to Know/Hazard Communication Yes >e No B. Fire Prevention and Protection Yes X No C. Hot Work Permits Yes No X D. Environmental Compliance Yes X No E. Excavation/Trenching Yes X No 9 F. Working at Elevations > 4 feet Yes No G. Confined Space Entry Yes x No 10 H. Control of Hazardous Energy (lockout) Yes /\ No I. Operation of Powered Equipment/vehicles Yes i` No 7 J. Working with hazardous voltages Yes No K. Personal Protective Equipment Yes X No L. Process Safety Yes Na 3. If you answered NO to any of the above, please comment; 4. Are the training records available upon request? Yes X No 5. Please provide your Total OSHA Incident Rate and Lost Workday Rate for each of the last three years by completing the table below. �� ,n 'L�" 8 A. Year r� q �C, B. Number of employee hours worked 5U(U� RLSO 1$I ta C. Number of lost workday cases 3 D. Number of cases due to injury or 0 I `6 Illness defined as recordable E. Total number of recordable cases 5 (Add C and D above) F. Calculate your incident rate by using the following formula: Total cases on line E x 200,000 hours Employee hours on line B (D.g (0.3- iv) 6. Management C-=' r a Lion gh ....r► „.„. � s Date: It Signature: ., ti Print Name and Title: 4 • Gtt"t Qf`f 14� 11