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HomeMy WebLinkAboutGreat Lakes TV Seal, Inc./Sanitary Lateral Televising 2013 CITY OF OSHKOSH DEPARTMENT OF PUBLIC WORKS 215 CHURCH AVENUE, P.O. BOX 1130, OSHKOSH, WI 54903-1130 PHONE: (920)236-5065 FAX (920) 236-5068 LETTER OF TRANSMITTAL To: Mr. Jeff Healy Date: January 28, 2013 Great Lakes TV Seal Inc. Subject: Executed Agreement 3600 Kewaunee Road Sanitary Lateral Televising for 2013 Green Bay, WI 54311 CIP Please find: ® Attached ❑ Under Separate Cover ❑ Copy of Letter ® Contracts El Amendment El Report ❑ Agenda El Meeting Notes ❑ Photos El Mylars El Change Order ❑ Plans El Specifications ❑ Estimates ❑ Diskette El Zip Disk El Other Quantity Description 1 Executed Agreement These are being transmitted as indicated below: El For Approval ® For Your Use El As Requested El For Review&Comment Remarks: Enclosed is a copy of the executed agreement for the sanitary lateral television for the 2013 Capital Improvement projects. Please reference Res. #13-21 on all of your invoices. If you have any questions, please contact us. City Attorney's Office—Copy City Clerk's Office — Original �. cc: _ File—Original Signed: 1�t� Tracy Li for • I:1Engineering\Televising\2013\Contract\LOT-Great Lakes TV Seal Executed Agreement_1-28-13.docx AGREEMENT THIS AGREEMENT, made on the 2"1- day of -TAN. , 2013, by and between the CITY OF OSHKOSH, party of the first part, hereinafter referred to as CITY, and GREAT LAKES TV SEAL INC., 3600 KEWAUNEE ROAD, GREEN BAY, WI 54311, party of the second part, hereinafter referred to as the CONSULTANT, WITNESSETH: That the CITY and the CONSULTANT, for the consideration hereinafter named, enter into the following Agreement. The CONSULTANT's-Proposal and the City of Oshkosh's Request for Proposal are attached hereto and reflects the agreement of the parties except where they conflict 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 Agreement: Jeff Healy-Vice President 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 Agreement: Joe Sargent- Civil Engineer Senior ARTICLE III. SCOPE OF WORK The CONSULTANT shall provide the services described in the CONSULTANT's Proposal. The CONSULTANT may provide additional products and/or services if such products/services are requested in writing by the Authorized Representative of the CITY. I:(Engineering\Televising\2013\Contract\Great Lakes Agreement_1-22-13.docx Page 1 of 4 All reports, drawings, specifications, computer files, field data, notes, and other documents and instruments prepared by the CONSULTANT as instruments of service shall remain the property of the CITY. ARTICLE IV. CITY RESPONSIBILITIES 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 Agreement shall be commenced and the work completed within the time limits as agreed upon in the CITY's Request for Proposal. 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. COMPONENT PARTS OF THE AGREEMENT This Agreement consists of the following component parts, all of which are as fully a part of this Agreement as if herein set out verbatim, or if not attached, as if hereto attached: 1. This Instrument 2. City of Oshkosh Request for Proposal 3. Consultant's Proposal In the event that any provision in any of the above component parts of this Agreement conflicts with any provision in any other of the component parts, the provision in the component part first enumerated above shall govern over any other component part which follows it numerically except as may be otherwise specifically stated. I:1Engineenng\Televising\2D13\Contract\Great Lakes Agreement_1-22-13.docx Page 2 of 4 ARTICLE VII. PAYMENT A. The Agreement Sum. The CITY shall pay to the CONSULTANT for the performance of the Agreement the total sum as set forth below, adjusted by any changes hereafter mutually agreed upon in writing by the parties hereto: • Time and Materials Not to Exceed $108,201.41 (One Hundred Eight Thousand Two Hundred One Dollars and Forty One Cents). B. Method of Payment. The CONSULTANT shall submit itemized monthly statements for 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. ARTICLE VIII. 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 Agreement 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 IV. INSURANCE The CONSULTANT agrees to abide by the attached City of Oshkosh Insurance Requirements. ARTICLE X. 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 Agreement at any time by giving written notice to the CONSULTANT no later than 10 calendar days before the I:Engineering\Televising120131Contract\Great Lakes Agreement_1-22-13.docx Page 3 of 4 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. In the Presence of: CONSULTANT 411 U Co 4)00 By: no Vat/der Lour ', mss', cue. (Seal of Consultant (Specify Title if a Corporation.) By: s der- r — (Specify Title) CITY OF OSHKOSH By: (Witness) Mark i . Rohloff, City Mara er And: 3 (Witness) Pamela R. Ubrig, City CI rk tit -YU& APPROVED: I hereby certify that the necessary provisions have been made to pay the liability which �,�,,� which will accrue under this Agreement. T► .. _ ►,h�J — I ity Attorn-W City Comp ro er 1:1Engineering\Televising 1 20131Contractl Great Lakes Agreement_1-22-13.docx Page 4 of 4 DEPARTMENT OF PUBLIC WORKS 215 Church Avenue P.O.Box 1130 Oshkosh,Wisconsin 54903-1130 F .(920)236-5065 O�OJ,i-I f Fax(920)236-5068 ON THE WATER January 3,2013 Brett Healy Great Lakes TV Seal,Inc. 3600 Kewaunee Road Green Bay,WI 54311 RE:Request for Proposal for Sanitary Lateral Televising for the 2013 Capital Improvement Projects Dear Mr.Healy: The City of Oshkosh is hereby requesting proposals be submitted for sanitary sewer lateral televising of its 2013 Capital Improvement projects. The proposal shall include at a minimum: related project experience and a breakdown of costs as requested in the attached Scope of Services. The proposals will be reviewed for completeness and how well it is demonstrated that the needs of the City of Oshkosh can be met. The award of this work will not be based solely on cost of the proposal. Questions regarding this request for proposal shall be emailed to me at jsargent a,ci.oshkosh.wi.us(with the subject heading of"2013 Sanitary Sewer Lateral Televising RFP Questions") by 12:00 noon on Tuesday,January 8,2013. The questions and appropriate responses will be distributed to all parties receiving this Request for Proposals by 2:00 p.m.on Thursday,January 10,2013. Please submit four(4)copies of the proposal to my attention no later than 2:00 p.m.on Monday,January 14,2013. It is anticipated that award of this contract will be made by Friday,January 18,2012. Please ensure you have the proper insurance paperwork,so the award is not delayed. Attached to this letter are copies of the Scope of Services,Standard Engineering Services Agreement,Insurance Requirements,and the City of Oshkosh Contractor Safety Program.The information contained within these attachments shall become a part of the Contract with the Consultant selected to perform the Services. If you have any questions,please do not hesitate to contact us. Sincerely, Joseph R. Sargent,P.E. Civil Engineer Senior Enclosures cc: David Patek,P.E.,Director of Public Works Steve Gohde,P.E.,Assistant Director of Public Works Peter Gulbronson,P.E.,Civil Engineer Supervisor File SCOPE OF SERVICES FOR SANITARY SEWER LATERAL TELEVISING 2013 CAPITAL IMPROVEMENT PROJECTS 1. The scope of this contract consists of furnishing all labor, equipment, material, electrical power, and traffic control necessary to provide sanitary sewer lateral televising as indicated in herein. A. Approximately 463 sanitary sewer laterals are anticipated for the following Capital Improvement projects. i. Contract 13-04—Concrete Paving &Utilities a.West New York Avenue (Fox River to Spruce Street) b. 10th Avenue(Oregon Street to east end of E. 10th Avenue) c.Including at least one parcel on all cross streets and ends,which may include more than one segment. All laterals in a segment shall be televised. ii. Contract 13-05—Concrete Paving &Utilities a.Doty Street(W. 23`d Avenue to W. 24th Avenue) b.W. 24th Avenue (Lake Winnebago to Doty Street) c.W. 23`d Avenue (Montana Street to Doty Street) d.Montana Street(W. 23`d Avenue to W. 20th Avenue) e.W. 19th Avenue (Delaware Street to Iowa Street) f. Including at least one parcel on all cross streets and ends,which may include more than one segment. All laterals in a segment shall be televised. iii. Jackson Street—Fernau Avenue to the Railroad Tracks 2. The City of Oshkosh will perform the following tasks: A. Provide an engineering staff member to assist in locating all manholes. B. Pre-clean sanitary sewer mains as necessary. C. Provide initial notification to property owners of televising work that will be taking place. 3. Television Inspection: A. The contractor shall furnish all labor, equipment, and materials necessary to perform closed circuit television inspection of the designated sanitary sewer laterals from the sanitary sewer main to as far as possible. B. If the lateral camera cannot go further than 10' beyond the road right-of-way (back of sidewalk),then the contractor shall make arrangements with the property owner to televise the remaining portion of the lateral from inside the building. C. The contractor shall have access to the equipment necessary to perform televising of laterals in mains less than 24" in size. D. The view seen by the television camera shall be transmitted to a monitor located inside a mobile TV studio, which has the capabilities to produce a DVD copy. The contractor's mobile studio shall be large enough to accommodate up to three people for the purpose of viewing the monitor while the inspection is in progress. The CITY shall have access to view the television screen at all times. E. Televising shall be in compliance with NASSCO's PACP. F. Technicians shall be PACP certified by NASSCO. Contractor shall submit verification of certification prior to commencing work. G. Provide (5) five working days notice to the CITY prior to commencing work. Page 1 of 4 H. Provide (3) three working days notice to the CITY if sanitary sewer mains cannot be accessed and need to be cleaned. 4. Display A. The"Work Order" shall consist of the following information and shall be displayed at the beginning and end of the lateral segment. The Work Order shall be displayed for a minimum of 15 (fifteen) seconds or as long as it takes to say the information at the beginning. This Work Order shall be displayed once again at the end of the segment for a minimum of 5 (five) seconds. The computerized voice shall not be used for the beginning and ending Work Order information. Work Order Display Address Manhole ID that main line camera is in Distance from manhole Sewer Lateral Type"Sanitary Lateral" Weather Date Name of Technician The counter and date shall be displayed for the entire length of the lateral segment. The contractor shall display all incidents for a minimum of 5 (five) seconds. The computerized voice also may not be used for incidents. 5. Folder and File Naming A. Files should be organized per street with the Folder titled as follows: "Street Name" (i.e. West 24th Avenue). B. Each lateral shall be an individual folder within the street folder and shall be titled as follows: `Building Address—lateral distance at the main from manhole MH manhole#"(i.e. 564 W. 24th Ave—251ftMH0821). C. Each lateral folder shall contain both the lateral report and video footage of the particular Building Address. 6. Project Deliverables A. Schedule of Project Deliverables i. Contract 12-05: March 8, 2013 by 4:30 p.m. ii. Contract 12-04: March 29, 2013 by 4:30 p.m. iii. Jackson Street: April 12, 2013 by 4:30 p.m. B. Lateral Report i. The lateral report shall include the distance from manhole at the main, material type, any transitions or restrictions in the pipe with their respective locations, repairs that have been done to the pipe, locations of dips, cracks, roots, or any other defects, and locations of any taps/connections. The report shall also include any other pertinent information found during televising. C. Video i. The video recording shall be in DVD format and viewable via Windows Media Player. ii. See section 4 for video display requirements. D. The contractor shall deliver two DVD copies by the dates indicated above. The DVDs will become the property of the City of Oshkosh. The cost of furnishing,producing, Page 2 of 4 programming, copying and any other miscellaneous costs shall be included in the bid price for lateral televising. E. The contractor shall also deliver two bound copies of the lateral reports organized per street. F. Provide lateral locations at the City of Oshkosh Right of Way(typically back of sidewalk). This is to be done with a device capable of tracing the location of the camera head. The lateral location is then to be marked where it crosses the Right of Way with a pink paint mark on the sidewalk and with a 6" survey stake pounded flush with the existing ground. A lath shall then be placed behind the stake with the corresponding address written on it. The lath shall also be painted"pink" along with the stake top. Once a block is completed and located, contact the CITY so GPS shots can be taken. 7. Traffic Control A. All streets are to remain open to traffic. The consultant will be responsible to furnish all necessary barricades, flares or flashers, flag persons, etc.to provide adequate traffic control and still maintain the accesses as described herein. The signs shall conform to Sections 637 and 643 of the State of Wisconsin Standard Specifications for Highway and Structure Construction. 8. Proposal Cost Breakdown A. Sanitary Sewer Manhole Set-up(each) i. Set-up cost to include any time and expenses encountered in order to gain entry into the sanitary sewer manhole and travel through the sewer main. ii. Only one set-up per sanitary sewer segment will be considered. Should the contractor televise multiple segments in a row from one manhole, only one set-up will be considered. Estimated quantities are one set-up per segment. iii. This cost to also include mobilization, daily travel, and traffic control. B. Sanitary Sewer Lateral Launch (each) i. Cost to include effort to launch lateral camera from main line camera into the sanitary sewer lateral. ii. Only one launch per lateral done from the main will be paid. C. Sanitary Sewer Lateral Televising (linear foot) i. Cost to include televising of the sanitary sewer lateral from the main as described above. ii. Cost to provide deliverables as described above. D. Sanitary Sewer Lateral Televising from Inside the Building Set-up (each) i. Set-up cost to include any time and expense encountered in order to gain entry into the sanitary sewer lateral from inside the building. ii. Only one set-up per sanitary sewer lateral will be considered. Estimated quantities are calculated as 25%of the anticipated Lateral Launches. iii. Cost to include coordination with property owners and set-up. E. Sanitary Sewer Lateral Televising from Inside the Building(linear foot) i. Includes all costs necessary to televise the lateral from inside the building with same requirements including deliverables as described above. ii. Cost to include coordination with property owners,footage, and deliverables. iii. Estimated quantities are calculated as 25%of the estimated Lateral Footage quantity. F. Capped Lateral Verification (each) i. Includes all costs necessary to verify laterals are capped as claimed by the City of Oshkosh Street Department Televising Crew. Page 3 of 4 ii. If lateral is not capped, then it would be paid for as a Sanitary Sewer Lateral Launch and Sanitary Sewer Lateral Televising. 9. Additional Information A. This contract will be per the City of Oshkosh Agreement form only. A sample agreement form is attached to this RFP. B. All quantities in the cost breakdown are estimated and are not guaranteed. C. The majority of W. 23`d Avenue, W. 24th Avenue, and Doty Street main lines have not been televised to date; therefore,the estimated laterals are based on the number of parcels. Main line reports will be provided when they become available. There are also some miscellaneous segments that are missing reports, but will be provided when they become available. Page 4 of 4 12/21/11 CITY OF OSHKOSH INSURANCE REQUIREMENTS III. PROFESSIONAL SERVICES LIABILITY INSURANCE REQUIREMENTS The Contractor shall not commence work on contract until proof of insurance required 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. III - 1 12/21/11 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. UMBRELLA LIABILITY - If exposure exists, provide coverage at least as broad as the underlying Commercial General Liability, Watercraft Liability (if required), Automobile Liability and Employers Liability, with a minimum limit of$2,000,000 each occurrence and $2,000,000 aggregate, and a maximum self-insured retention of$10,000. 6. 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. III - 2 A�° CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYY) 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 Insurance Agent's address and PO Box if PHONE(A/C.No.Ext): contact information. FAX applicable. —_ !(A/C.No): E-MAIL .... ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC. INSURER A: ABC.Insurance Company NAIL# 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 of VI or better. 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 I SUBR .... . -. ..__._.__...._.._...._........_.._.._;_..._.POLICY EFF --...._POLI................------------------LTR TYPE OF INSURANCE I INSR I WVD POLICY NUMBER : POLICY EXP i ':, {MM1D0lYW) , (MM1DD/Yl'Y) ! LIMITS GENERAL LIABILITY • !EACH OCCURRENCE ! $1,000,000 _ COMMERCIAL GENERAL LIABILITY General Liability Policy Number Policy effective and expiration date. DAMAGE PREMISES occurrence) $50,000 ®; ® ❑ A '!❑1CLAIMS-MADEI®OOCCUR !MEDEXP Any one person) . ( $5,000 ® ISO FORM CG 20.37 OR EQUIVALENT !PERSONAL&ADV INJURY I $1,000,000 ❑' € 'GENERAL AGGREGATE__! $2,000,000 • • GEN'L AGGREGATE LIMIT APPLIES PER: I 'PRODUCTS—COMP/OP AGG i $2,000,000`- ............ ..........3 1 ........................................................................... ................................ r Ell POLICY ®IPEa❑!LOC j $ AUTOMOBILE LIABILITY ! ;COMBINED SINGLE LIMIT • !(Ea accident2._..__...__._...___...................$_.1,000,000_......... ®;ANY AUTO ® ❑ Auto Liability Policy Number Policy effective and expiration date. :BODILY INJURY(Per person) I $ ALL OWNED SCHEDULED ; B . MALL OWNED ❑! AUTOS I ! !BODILY INJURY(Per NON-OWNED : : ;PROPERTY DAMAGE I HIRED AUTOS I❑� AUTOS ! (Per accident)——,� 1_,...$ ❑j I $ ®;UMBRELLA LIAR ®f OCCUR ® ❑ ; EACH OCCURRENCE I $2,000,000 A ❑EXCESS LIAR ❑ CLAIMS-MADE Umbrella Liability Policy Number Policy effective and expiration date. AGGREGATE $2 000,000 I❑!DED In RETENTION$$10,000 I j j I $ C 'WORKERS COMPENSATION ! lo WC STATU-! OTH- AND EMPLOYERS'LIABILITY ❑ ❑ ! TORY LIMITS; ER ANY PROPRIETOR/PARTNER/EXECUTIVE . ......................................................................................_......__...._.....____........... OFFICE/MEMBER EXCLUDED? Y/N Workers Compensation Policy Policy effective and expiration date. (E.EL. ACCIDENT ! $100,000 (Mandatory in NH) N Number ! ! -----......._........_._.__..__._._.____.____..._.__........._._.......—._. If yes,describe under : 'E.L.DISEASE—EA EMPLOYEE': $100,000 DESCRIPTION OF OPERATIONS below ,._...._....___._....._.....__.__._....._._.__.._._.____........._._____..____..___._—.___. IE.L.DISEASE—POLICY LIMIT ' $500,000 A 'PROFESSIONAL LIABILITY ® ' ❑ ' ' 1$1,000,000 EACH CLAIM Professional Liability Policy 'Policy effective and expiration date.' $1,000,000 ANNUAL AGGREGATE Number 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 its 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 Ill 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 OJHKOJH ON THE WATER CITY OF OSHKOSH CONTRACTOR SAFETY PROGRAM . . , i - ,. , 4, t. _..,,, . , ,...„ A 4 ! r(4 ,„, 9 -, < , , 1 'NV 1. • I 1 • I i ). X \ . ; lEpppppp.. PI 11 $ I.., , ,,,,,,, ---'-" - i,,,...,.7 0 w 0 . , . ..,,,,:„...-,r,-,:„ -.. .. 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 SUMMARY Contractor safety takes teamwork. The City of Oshkosh is committed to providing a safe and healthful workplace while protecting and preserving the environment. We will work with you to help ensure that no injuries occur and that the environment is not harmed. Contractors are responsible for their employee's safety through training, ensuring that the information regarding hazards and safe work practices is communicated to them and making sure that they follow all safety and environmental rules. 6 ............... .... . 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? 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: ContractorNendor Name: Address: City, State, Zip: Telephone Number: E-mail Address: ContractorNendor Representative: Title: Individual Responsible for: Safety Coordination: Phone: Environmental Issues: Phone: I understand that it is my obligation to notify my employees of their responsibilities for health and safety. further understand that if any unsafe work activities are found, the City has the right to immediately contact the Contractor's Safety Coordinator. If this unsafe practice is not corrected, the work may be stopped until corrective action has been taken and agreed upon. Signed: Date: ❑ Certificate of Insurance Attached ❑ Workers Compensation Insurance Certificate attached 9 City of Oshkosh Contractor Safety Program Qualification Questionnaire Date: ContractorNendor Name: Person completing form: Title: 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. 2. Do you require the following safety training programs? A. Right to Know/Hazard Communication Yes No B. Fire Prevention and Protection Yes No C. Hot Work Permits Yes No D. Environmental Compliance Yes No E. Excavation/Trenching Yes No F. Working at Elevations > 4 feet Yes No G. Confined Space Entry Yes No 10 THE GREAT LAKES TV SEAL, INC. 2013 PROPOSAL FOR SANITARY SEWER LATERAL TELEVISING AND CAPITAL IMPROVEMENT PROJECTS IS AVAILABLE FOR REVIEW IN THE CITY CLERK’S OFFICE