HomeMy WebLinkAboutRes.2767.07-01-2013BILL NO. 13-90
RESOLUTION N0.
A RESOLUTION AUTHORIZING THE CITY MANAGER TO
EXECUTE AN AGREEMENT WITH NIP KELLEY EQUIPMENT
COMPANY, INC., FOR THE REPLACEMENT OF THE
CLEARWELL AT WATER TREATMENT PLANT NO. 2, IN THE
CITY OF CAPE GIRARDEAU, MISSOURI
BE IT RESOLVED BY THE COUNCIL OF THE CITY OF CAPE
GIRARDEAU, MISSOURI, AS FOLLOWS:
ARTICLE 1. The City Manager, for and on behalf of the City
of Cape Girardeau, Missouri, is hereby authorized to execute an
Agreement with Nip Kelley Equipment Company, Inc., for the
Replacement of the Clearwell at Water Treatment Plant No. 2, in
the City of Cape Girardeau, Missouri. A copy of said Agreement
is attached to this Resolution and made a part hereof.
PASSED AND ADOPTED THIS 151 DAY OF 2013.
Harry E. Rediger, Mayor
CITY OF CAPE GIRARDEAU
Water Plant No. 2 Clearwell
STANDARD FORM OF AGREEMENT
BETWEEN OWNER AND CONTRACTOR
ON THE BASIS OF A STIPULATED PRICE
THIS AGREEMENT is dated as of the day of in the year
2013 by and between the City of Cape Girardeau, Missouri (hereinafter called OWNER)
and Nip Kelley Equipment Co., Inc. (hereinafter called CONTRACTOR).
OWNER and CONTRACTOR, in consideration of the mutual covenants hereinafter set
forth, agree as follows:
GIIta Z I VLOA-0
CONTRACTOR shall complete all Work as specified or indicated in the Contract
Documents. The Work is generally described as follows:
The improvements consist of the demolition, removal, and disposal of an existing
250,000 gallon welded steel potable water ground storage tank and construction of a new
nominal 250,000 gallon ground storage/clearwell tank including electrical and
instrumentation.
Article 2. ENGINEER.
The City Engineer or his or her designee is to act as OWNER'S representative, assume all
duties and responsibilities and have the rights and authority assigned to ENGINEER in the
Contract Documents in connection with completion of the Work in accordance with the
Contract Documents.
Article 3. CONTRACT TIMES.
3.1 The work will be substantially completed within 180 calendar days after the date when
the Contract Times commence to run as provided in paragraph 2.3 of the General
Conditions, and completed and ready for final payment in accordance with paragraph
14.13 of the General Conditions within 195 calendar days after the date when the Contract
Times commence to run.
3.2 Liquidated Damages. OWNER and CONTRACTOR recognize that time is of the
essence of this Agreement and that OWNER will suffer financial loss if the Work is not
completed within the times specified in paragraph 3.1 above, plus any extensions thereof
allowed in accordance with Article 12 of the General Conditions. They also recognize the
delays, expense and difficulties involved in proving the actual loss suffered by OWNER if
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the Work is not competed on time. Accordingly, instead of requiring any such proof,
OWNER and CONTRACTOR agree that as liquidated damages for delay (but not as a
penalty) CONTRACTOR shall pay OWNER 1,000,0 for each day that expires after the
time specified in paragraph 3.1 for SLibstantial Completion until the Work is substantially
complete. After Substantial Completion, if CONTRACTOR shall neglect, refuse or fail to
complete the remaining Work within the time specified in paragraph 3.1 -for completion and
readiness for final payment or any proper extension thereof granted by OWNER,
CONTRACTOR shall pay OWNER $1,000.00 for each day that expires after the time
specified in paragraph 3.1 for completion and readiness for final payment.
Article 4. CONTRACT PRICE.
OWNER shall pay CONTRACTOR for completion of the Work in accordance with the
Contract Documents an amount in current funds equal to the sum of the amounts
determined pursuant to paragraphs 4.1 below:
4.1 for a Lump Sum Amount [Alternate No. 1 for the 250,000 gallon glass fused to steel
bolted ground storage tank/clearwell].
LUMP SUM CONTRACT AMOUNT Two Hundred Sixty-nine Thousand One
Hundred Sixty-eight Dollars and Thirty-five Cents ($ 269,168.35)
Article 5. PAYMENT PROCEDURES.
CONTRACTOR shall submit Applications for Payment in accordance with Article 14 of the
General Conditions. Applications for Payment will be processed by ENGINEER as
provided in the General Conditions,
5.1 Progress payments; Retainage. OWNER shall make progress payments on account
of the Contract Price on the basis of CONTRACTOR'S Application for Payment as
recommended by ENGINEER, on or about the 10th day of each month during construction
as provided in paragraphs 5.1.1 and 5.1.2 below. All such payments will be measured by
the schedule of values established in paragraph 2,9 of the General Conditions (and in the
case of Unit Price Work based on the number of units completed) or, in the event there is
no schedule of values, as provided in the General Requirements.
5.1.1 Prior to Substantial Completion, progress payments will be made in an amount equal
to the percentage indicated below, but, in each case, less the aggregate of payments
previously made and less such amounts as ENGINEER shall determine, or OWNER may
withhold, in accordance with paragraph 14.7 of the General Conditions.
90% of Work completed (with the balance being retainage). If Work has
been 50% completed as determined by ENGINEER, and if the character and
progress of the Work have been satisfactory to OWNER and ENGINEER,
OWNER, on recommendation of ENGINEER, may determine that as long as
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the character and progress of the Work remain satisfactory to them, there
will be no additional retainage on account of Work completed, in which case,
the remaining progress payments prior to Substantial Completion will be an
amount equal to 100% of the Work completed.
90% (with the balance being retainage) of materials and equipment not
incorporated in the Work (but delivered, suitably stored and accompanied by
documentations satisfactory to OWNER as provided in paragraph 14.2 of the
General Conditions).
5.1.2 Upon Substantial Completion, in an amount sufficient to increase total payments to
CONTRACTOR to 95% of the Contract Price (with the balance being retainage), less such
amounts as ENGINEER shall determine, or OWNER may withhold, in accordance with
paragraph 14.7 of the General Conditions,
5.2 Final Payment. Upon final completion and acceptance of the Work in accordance with
paragraph 14.13 of the General Conditions, OWNER shall pay the remainder of the
Contract Price as recommended by ENGINEER as provided in said paragraph 14.13.
Article 6. INTEREST.
All moneys not paid when due as provided in Article 14 of the General Conditions shall
bear interest at the maximum rate allowed by law at the place of the Project.
Article 7. CONTRACTOR'S REPRESENTATIONS.
In order to induce OWNER to enter into the Agreement, CONTRACTOR makes the
following representations:
7.1 CONTRACTOR has examined and carefully studied the Contract Documents
(including the Addenda listed in paragraph 8) and the other related data identified in the
Bidding Documents, including "technical data".
T2 CONTRACTOR has visited the site and become familiar with and is satisfied as to the
general, local and site conditions that may affect cost, progress, performance and
furnishing of the Work.
7.3 CONTRACTOR is familiar with and is satisfied as to all federal, state and local Laws
and Regulations that may affect cost, progress, performance and furnishing of the Work.
7.4 CONTRACTOR has carefully studied all reports of explorations and tests of
subsurface conditions at or contiguous to the site and all drawings of physical conditions in
or relating to existing surface or subsurface structures at or contiguous to the site (except
Underground Facilities) which have been identified. CONTRACTOR acknowledges that
such reports and drawings are not Contract Documents and may not be complete for
CONTRACTOR'S purposes. CONTRACTOR acknowledges that OWNER and ENGINEER
do not assume responsibility for the accuracy or completeness of information and data
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shown or indicated in the Contract Documents with respect to Underground Facilities at or
contiguous to the site. CONTRACTOR has obtained and carefully studied (or assumes
responsibility for having done so) all such additional supplementary examinations,
investigations, explorations, tests, studies and, data concerning conditions (surface,
subsurface and Underground Facilities) at or contiguous to the site or otherwise which may
affect cost, progress, performance or furnishing of the Work or which relate to any aspect
of the means, methods, techniques, sequences and procedures of construction to be
employed by CONTRACTOR and safety precautions and programs incident thereto.
CONTRACTOR does not consider that any additional examinations, investigations,
explorations, tests, studies or data are necessary for the performance and furnishing of the
Work at the Contract Price, within the Contract Times and in accordance with the other
terms and conditions of the Contract Documents.
7.5 CONTRACTOR is aware of the general nature of work to be performed by OWNER
and others at the site that relates to the Work as indicated in the Contract Documents.
7.6 CONTRACTOR has correlated the information known to CONTRACTOR, information
and observation obtained from visits to the site, reports and drawings identified in the
Contract documents and all additional examinations, investigations, explorations, tests,
studies and data with the Contract Documents.
7.7 CONTRACTOR has given ENGINEER written notice of all conflicts, errors, ambiguities
or discrepancies that CONTRACTOR has discovered in the Contract Documents and the
written resolution thereof by ENGINEER is acceptable to CONTRACTOR, and the Contract
Documents are generally sufficient to indicate and convey understanding of all terms and
conditions for performance and furnishing of the Work.
Article 8. CONTRACT DOCUMENTS.
The Contract Documents which comprise the entire agreement between OWNER and
CONTRACTOR concerning the Work consist of the following:
8.1 This Agreement (pages 1 to 7 inclusive).
8.2 Exhibits to this Agreement (pages BF -1 to BF -7, inclusive as revised forAddendum #
1).
8.3 Performance, Payment, and other Bonds, identified as exhibits and consisting of
pages.
8.4 Notice to Proceed.
8.5 General Conditions (pages 1 to 55, inclusive). (EJCDC No. 1910.8 1990 Edition)
8.6 Supplementary Conditions (pages SC -1 to SC- 5, inclusive).
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8.7 Specifications bearing the title Water Plant No. 2 Clearwell,
8.8 Drawings.
8.9 Addenda numbers 1 to 1 , inclusive.
8.10 CONTRACTOR'S Bid (pages BF -1 to BF -7 , inclusive as revised in Addendum #
1) marked exhibit "A" .
8.11 Pursuant to 285.530 R.S. Mo, the contractor must affirm its enrollment and
participation in a federal work authorization program with respect to the employees
proposed to work in connection with the services requested herein by 1) submitting a
completed, notarized copy of AFFIDAVIT OF WORK AUTHORIZATION and 2) providing
documentation affirming the bidder's enrollment and participation in a federal work
authorization program with respect to the employees proposed to work in connection with
the services requested herein.
8.12 Documentation submitted by CONTRACTOR prior to Notice of Award (pages ____to
inclusive).
8.13 The following which may be delivered or issued after the Effective Date of the
Agreement and are not attached hereto: All Written Amendments and other documents
amending, modifying or supplementing the Contract Documents pursuant to paragraphs
3.5 and 3.6 of the General Conditions.
The documents listed in paragraphs 8.2 et seq. above are attached to this Agreement
(except as expressly noted otherwise above).
There are no Contract Documents other than those listed above in the Article 8. The
Contract Documents may only be amended, modified or supplemented as provided in
paragraphs 3.5 and 3.6 of the General Conditions.
Article 9. MISCELLANEOUS.
9.1 Terms used in this Agreementwhich are defined in Article 1 of the General Conditions
will have the meanings indicated in the General Conditions.
9.2 No assignment by a party hereto of any rights under or interests in the Contract
Documents will be binding on another party hereto without the written consent of the party
sought to be bound; and, specifically but without limitation, moneys that may become due
and moneys that are due may not be assigned without. such consent (except to the extent
that the effect of this restriction may be limited by law), and unless specifically stated to the
contrary in any written consent to an assignment no assignment will release or discharge
the assignor from any duty or responsibility under the Contract Documents.
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9.3 OWNER and CONTRACTOR each binds itself, its partners, successors, assigns and
legal representatives to the other party hereto, its partners, successors, assigns and legal
representatives in respect to all covenants, agreements and obligations contained in the
Contract Documents,
9.4 Any provision or part of the Contract Documents held to be void or unenforceable
under any Law or Regulation shall be deemed stricken, and all remaining provisions shall
continue to be valid and binding upon OWNER and CONTRACTOR, who agree that the
Contract Documents shall be reformed to replace such stricken provision or part thereof
with a valid and enforceable provision that comes as close as possible to expressing the
intention of the stricken provision.
9.5 Pursuant to 292.675, R.S. Mo, the contractor is informed that all contractors or
subcontractors doing work on this project to provide, and require its on-site employees to
complete, a ten (10) hour course in construction safety and health approved by the
Occupational Safety and Health Administration ("OSHA") or similar program approved by
the Missouri Department of Labor and Industrial Relations which is at least as stringent as
an approved OSHA program. The training must be completed within sixty (60) days of the
date work on the project commences. On-site employees found on the worksite without
documentation of the required training shall have twenty (20) days to produce such
documentation.
9.6 The General Contractor shall provide to the City of Cape Girardeau City Engineer's
Office weekly certified payrolls from the General Contractor and all Subcontractors during
the course of the project. These must be provided on a weekly basis; if no work was done,
then a payroll stating "No Work Done" must be submitted.
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IN WITNESS WHEREOF, OWNER and CONTRACTOR have signed the Agreement in
multiple copies, One counterpart each has been delivered to CONTRACTOR and
ENGINEER and finro counterparts to the OWNER. All portions of the Contract Documents
have been signed, initialed or identified by OWNER and CONTRACTOR or identified by
ENGINEER on their behalf.
This Agreement will be effective on �, !v , 2013 (which is the
Effective Date of the Agreement).
OWNER Citv of Cape Girardeau CONTRACTOR
Scott Me r Ci Mana er Ni Kelle E ui ment Com an Inc.
By: gy;
E L) [C .RPO S L] vince �Cell.ey
President
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Attest Attest
Gayle . onrad, City Clerk Frank Myers
Address for giving notices Address for giving notices
401 Independence Street 41 North S�ri gg st
Cape Girardeau, MO 63703 Cape Girardeau, MO 63701
(If OWNER is a public body, attach License No. � 8800
evidence of authority to sign and
resolution or other documents Agent for service of process:
authorizing execution of Agreement.
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��' `�'? �'�''� attach evidence of authority to sign.)
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EXHIBIT "A"
CITY OF CAPE GIRARDEAU
Water Plant No. 2 Clearwell
BID FORM
(EJCDC 1910-18) (1990)
PROJECT IDENTIFICATION: The improvement consists of supplying all labor, materials,
equipment, tools and supervision for the construction of a nominal 250,000 gallon ground
storage/clearwell tank including electrical and instrumentation; the demolition, removal, and
disposal of the existing 250,000 gallon ground storage tank; and all other appurtenances
as specified in the bid documents for the City of Cape Girardeau, Missouri.
THIS BID IS SUBMITTED TQ. CITY OF CAPE GIRARDEAU, MO
401 INDEPENDENCE STREET
CAPE GIRARDEAU, MO 63703
1. The undersigned BIDDER proposes and agrees, if the,Bid is accepted, to enter into an
agreement with OWNER in the form included in the Contract Documents to perform -and
furnish all Work as specified or indicated in the Contract Documents for the Bid Price and
within the Bid Times indicated in this Bid and in accordance with the other terms and
conditions of the Contract Documents.
2. BIDDER accepts all of the terms and conditions of the Advertisement or Invitation to Bid
and Instructions to Bidders, including without limitation those dealing with the disposition of
Bid- security. This Bid will remain subject to acceptance for sixty days after the day of Bid
opening. BIDDER will sign and deliver the required number of counterparts of the
Agreement with the Bonds and other documents required -by the Bidding Requirements
within fifteen days after the date of OWNER'S Notice of Award.
3. In submitting this Bid, BIDDER represents, as more fully set forth in the Agreement,
that:
(a) BIDDER has examined and carefully studied the Bidding Documents and the
following:
Addenda, receipt of all which is hereby acknowledged. (List Addenda by Addendum Numberand bate)
Addendum #1 - 6/20/13
(b) BIDDER has visited the site and become familiar with and is satisfied as to the
general, local and site conditions that may affect cost, progress, performance and
furnishing of the Work;
(c) BIDDER)s familiar with and is satisfied as to all federal, state and local Laws and
BF -1 -
Regulations that may affect cost, progress, performance and furnishing of the Work.
(d) BIDDER has carefully studied all reports of explorations and tests of subsurface
conditions at or contiguous to the site and all drawings of physical conditions in or relating
to existing surface or subsurface structures at or contiguous to the 'site (except
Underground Facilities) which have been identified. BIDDER acknowledges that such
reports and drawings are not Contract Documents and may not be complete for BIDDER'S
purposes. BIDDER acknowledges that OWNER and Engineer do not assume
responsibility for accuracy or completeness of information and data shown or indicated in
the Bidding Documents with respect to Underground Facilities at or contiguous to the site.
BIDDER has obtained and carefully studied (or assumes responsibility for having done so)
all such additional or supplementary examinations, investigations, explorations, tests,
studies and data concerning conditions (surface, subsurface and Underground Facilities) at
or contiguous to the site or otherwise which may affect cost, progress, performance or
furnishing of the Work or which relate to any aspect of the means, methods, techniques,
sequences and procedures of construction to be employed by BIDDER and safety
precautions and programs incident thereto. BIDDER does not consider that any additional
examinations, investigations, explorations, tests, studies or data are necessary for the
determination of this Bid for performance and furnishing of the Work in accordance with the
times, price and other terms and conditions of the Contract Documents.
(e) BIDDER is aware of the general nature of Work to be performed by Owner and
others at the site that relates to Work for which this Bid is submitted as indicated in the
Contract Documents.
(f) BIDDER has correlated the information known to BIDDER, information and
observations obtained from visits to the site, reports and drawings identified in the Contract
Documents and all additional examinations, investigations, explorations, tests, studies and
data with the Contract Documents.
(g) BIDDER has given Engineer written notice of all conflicts, errors, ambiguities or
discrepancies that BIDDER has discovered in the Contract Documents and the written
resolution thereof by ENGINEER is acceptable to BIDDER, and the Contract Documents
are generally sufficient to indicate and convey understanding of all terms and conditions for
performing and fumishing the Work for which this Bid is submitted.
(h) This Bid is genuine and not made in the interest of or on behalf of any undisclosed
person, firm or corporation and is not submitted in conformity with any agreement or rules
of any group association, organization or corporation; BIDDER has not directly or indirectly
induced or solicited any other Bidder to submit a false or sham Bid; BIDDER has not
solicited or induced any person, firm or corporation to refrain from bidding; and BIDDER
has not sought by collusion to obtain for itself any advantage over any other Bidder or over
OWNER.
(i) Pursuant to 285.530 RSMo, the bidder must affirm its enrollment and participation in
a federal work authorization program with respect to the employees proposed to work in
connection with the services requested herein by
BF -2
submitting a completed, notarized copy of AFFIDAVIT OF WORK
AUTHORIZATION and
providing documentation affirming the bidder's enrollment and participation in a
federal work authorization program with respect to the employees proposed to worst
in connection with the services requested herein.
• httpJ(www.uscis gov/portal/site/uscis
(j) Bidders are informed that the Project is subject to the requirements of Section
292.675, R.S. Mo, which requires all contractors or subcontractors doing work on the
Project to provide, and require its on-site employees to complete, a ten (10) hour course in
construction safety and health approved by the Occupational Safety and Health
Administration ("OSHA") or similar program approved by the Missouri Department of Labor
and Industrial Relations which is at least as stringent as an approved OSHA program. The
training must be completed within sixty (60) days of the date work on the Project
commences. On --site employees found on the worksite without documentation of the
required training shall have twenty (20) days to produce such documentation.
4. BIDDER will complete the Work in accordance with the Contract Documents for the
following price(s):
Alternate No. 1: 250,000 Gallon Glass Fused to Steel Bolted Ground Storage
Tank/Clearwell
Lump Sum Contract Price
Two Hundred Sixty -Nine Thousand one Hundred Sixty 269,168,35
----------------------
(Figures)
Alternate No. 2: 250,000 Gallon Bolted Stainless Steel Tank(Clearwell
Lump Sum Contract Price
Three Hundred Twenty Thousand Seven Hundred Sixty E ght 320,768.08
( rs------ ------ 08/00 -------Z----1-------------
(Figures)
8 00 --------------------------
(Figures)
9W,
... .......
i
(a) The City of Cape Girardeau, MO at their sole discretion will select eitherAltemate
No. 1 or Alternate No. 2 without regard to bid price.
(Total bid amount is to be shown in both words and figures. In case of discrepancy, the
amount shown in words will govern.)
5. BIDDER agrees that the Work will be substantially complete within 180 calendar days
after the date when the Contract Times commences to run as provided in paragraph 23 of
the General Conditions, and completed and ready for final payment in accordance with
paragraph 14.13 of the General Conditions within 995 calendar days after the date when
the Contract Times commences to run.
BIDDER accepts the provisions of the Agreement as to liquidated damages in the event of
failure to complete the Work within the times specified in the Agreement.
6. The following documents are attached to and made a condition of this Bid:
(a) Required Bid Security in the form of bid bond or cashiers check.
(b) Exhibit Affidavit of Work Authorization -
(c) Exhibit Affidavit of Excessive Unemployment (if applicable)
(d) The E -Verify Program for Unemployment Verification Memorandum of
Understanding http://www.uscis.goy/files/nativedocum_ents/MOU.r)df
(e) Exhibit Affidavit of OSHA Training
(f) Certification Regarding Debarment, Suspension and Other Responsibility Matters
7. Bidder agrees to submit the following documents within three (3) business days after
the opening of Bids if requested:
(a) BIDDER'S Qualification Statement with supporting data.
8. Communications concerning this Bid shall be addressed to:
Name Vince Kelley
Address 41 N. Sprigg St., Cape Girardeau, MO 63701
(a) Performance and Payment Bonding Company j
Name merchant's Bonding Company
Address 2100 Fleur Drive, Des Moines, IA 50321
AgentlPower of Attorney Name (if used) Donald L. Wasoba
Address 22 Avacado Tree Cir, St. Peters, MO 63376-
9.
3376
9. Terms used in the Bid which are defined in the General conditions or Instructions will
have the meanings indicated in the General Conditions or Instructions.
r
SUBMITTED on June 25 , 20 1?
State Contractor License No. 0010575
IF BIDDER is:
An Individual
By
(SEAL)
(individual's Name)
doing business as
Business address:
Phone No.:
A Partnership
By
(SEAL)
(Firm Name)
(General Partner)
Business address:
Phone No.:
BF -5
A Corporation
By
By
Vince Ke
N'p Kelley Equipment Co., Inc.
(Corporation Name)
ur' i
of Incorporation)
y kI.a - .J1 i c1�Ui i i-.uu ILA i4au w Uiyi t1
Presi ent
(Title)
�ecretary) Frank Myers
Business address: 41. N. Sprigg St.
Cape Girardeau, MO 63701
Phone No.: 573-334-0553
Date of Qualification to do business is January 1974
A Joint Venture
By
EAL)
EAL)
EAL)
(Name)
(Address)
By (SEAL)
(Name)
(Address)
Phone Number and Address for receipt of official communications:
(Each joint venturer must sign. The manner of signing for each individual, partnership and
corporation that is a party to the joint venture should be in the manner indicated above.)
BREAKDOWN OF WORK FORCE (Required):
The Contractor shall be registered with the Missouri Secretary of State in order to work on
this project.
BIDDER hereby states that he will perform the following items of work directly without
employment of subcontractors:
All work except listed below.
It is anticipated that the following subcontractors will be employed for work on this project:
*SUBCONTRACTORS:
(Name of Company) (Type of Work)
Flo -Systems Glass fused to steel bolted tank
USA Tank Stainless Steel 'dank
RT Power Systems Electric
*All subcontractors shall be registered with the Missouri Secretary of State in order
to work on this project
BF -7
'PENAL sum FORM
BIDDBIt Ykwe angAddiarsi:
SLiB3 " YOfu.e aged AAdmn4P4te6d Elm
Merchant5_ Bondi Lag gpMp uY (mu t,,A I
2100 Fleur Drive
Des Maines, TA 50321 Telt 515-293-8171
t3WtwTER�Na� aa� �ldub,tssZ:
'��
SM OUEDATE: June 25, 2013
Water Plant No. 2 Clearwell
Dom-
BOND
orm BOND NUMBER: NjA
TIA.'L` - 0-Wlater thaaaBidIU*DWO; June 25, 2 -
7 .4L MAC- Five Percent of the- Amozmt Bid o i
IN W1`TNFsS$, WIWMF, Suctty end Ridder, bandhig to fit kgany bomd hert8y: sulimt to tb torms
prime ou :favctsa side hertof, dv 044 cause thio Bid Brod to be duly a wuted 04 its bebxlf by its
ae�ti;�cet�pgcnr, ar �tiue,
SURM
1 .i.IYM1.. MUM= yVlYL.itVv LVMPcIIVl (�[JA_Li aft � F.. $ �1 ti'�„�, .�•^-f%f'
SwetYs Nme and Cojporwo
J i r i •., : �oa
me and IWAtfth ftwer cif �,tto661:1. f
`I T SS. -�✓
Donald L. Wasoba Attorney-ire-Fa�tR
Witness
Sigaaftm And tic
SfrAtta and Witte
NUE: (4) Abave W&ckm are to be used for giving mquimd nobica.
(2) Any a nor jmfmm b Bidder, 5uretl►, Ow= m near party ebsli to ComWemd plumiwbem
a�tieable. .
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dfdautCd Arrant rt4a&Vd by lite Bidder U40nMnta tutdany
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3. This abligAti0 t $halt be mill usd void it:
3.i Ownit aCCtprg Bidders bid xad Biddardelivars Wid,4,
the time MgOitt d by the Bidding Doan ,.m (or=y
crctm*tm, tttrttafeg d to in writing by ) the
axmvted ftteewnt tcgoi>W by ft Bidding
dot:uunm turd euY perfamvm arta paYPWe bonds
tagWved by dW M"v; Oocumt is orad Coutraat
vomuauxrts, or
3,2 All bids are mjecW try t?waer, ar
3.3 OwncrNIS To ism a+rotim ofaw*itd to Siddcrwid ju
the titn0 Specified in tltG Ridditag t3uottiaestts (,Wady
extaopoa thereaf,rgteed is in writing by UW,;r nett, if
Wk*cm ttutatatcd In by Surety whm req, ted by
ptragno 5 huaaf)
d..f*Yment tmtd-F this Bond will Go dun itad pWbhr upon def al
Of Bidder lad v4ft 30 tmkadar day$ et}cr tec4pt by laidder end
SwrtY tat'w6UM notice of deffoult 6+ora Dwnor, which notice WW
be given m4t'h r=dnablepmtnpW=, idg4*jnj ibis Sand 7Md
him PWWcct Md inniudiAk it UaaFtt mt of'the uaouacdaa.
5. Surety ►valves naticc of trod any and aU ddeilsca based en or
aosfep nue ofuny tiv= taftdniion to lista notice afawm d avftd to
In writing by OwaGruud Sia", pravided ftetc time forimuing
nolia of award including oxamkms gW net in tht egg WOW
ellcead 120 days from j W Due Date wid wur Sm" wrkea
COtt tut
6. ta6 unit ar xttian 6100 be CortRxtc and under Itis Dowd pav is
30 calendar days after the notice Pf*huh rmuircd in patagsaph 4
"havt is rereivrd by Diddcrnd Surccp, and in no cezc lata th9n
one yFarWkr Bid Dna hart.
7. Any xdtoraccmr wxkr axis Bond shatl l+s coag only in
A coact of CORI{tOW jurisdiction i x2ftd itt the Sbytt in wi>" the
pmject is tat:nt C
B. Norrie, mqui.,W tareundar3dlaR ba Sit writes anti dart 10 Bidder
ood Surety ar theirreq=ilvc sddressm ehgm as the face of this
Rand_ 5uCh 130d r3 MV be seat by patrol dctivrry. ca int
sai,rierar by United Stxxas Aejjcrcdo,, Ceselficd Moria. TWul, t6-
ccipt �.1m PaiB. aid shell he deamw to be
affti ugrot ipt by the pay coucuutd.
9. sureE,* nilaJd suurztaaa snanc�a
W *4V DOW 41 Vurra:ttt And
atltccttrrr Powtx t+f Altuttwy ttritka�g Itre autbaripr of tht: �,
agaut or MI'M ottUOV0 who trxaeuted this Bond Eur bdotfofSt"
14 "Rule ow—aHyl VormhBMW Md bu mc. smq&grby.
10' This Bmtd is'ULM" to c mform T& all VPtkabk smmMry
ataGgtMWbt�ASW Applk*bk
�b=rte dMd 23M da Aoude dd& be deans d ba be
includod herein us i#•rst ibrtb at length, of cry proy;ciat vf'tite
E 1GC1C NU 4910200 1-Im Eddim) .B13-2
amdrmtut>rtWia WpmvW*afaayapptfft*
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eaapttue its fun 1brm aril COWL
t 1. T1tG Pam"bid" as used haxirit►inciudts a itid.offer or prnpussl
as�y*tigd'ale.
.h/tERCHANTS'10,-
BONDING COMPANY,
POWER OF ATTORNEY
Know All Persons By These Presents, that MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING,
INC., both being corporations duly organized under the laws of the State of Iowa (herein collectively called the 'Companies'),
and that the Companies do hereby make, constitute and appoint, individually,
Donald L Wasoba
of St Peters and State of M0 their true and lawful Attorney -in -Fact, with full power
and authority hereby conferred in their name, place and stead, to sign, execute, acknowledge and deliver in their behalf as surety
any and all bonds, undertakings, recognizances or other written obligations in the nature thereof, subject to the limitation that any
such instrument shall not exceed the amount of.,
TWO MILLION ($2,000,000.00) DOLLARS
and to bind the Companies thereby as fully and to the same extent as if such bond or undertaking was signed by the duly
authorized officers of the Companies, and all the acts of said Attorney -in -Fact, pursuant to the authority herein given, are
hereby ratified and confirmed.
This Power -of Attomey Is made and executed pursuant to and by authority of the following By -Laws adopted by the Board of
Directors of the Merchants Bonding Company (Mutual) on April 23, 2011 and adopted by the Board of Directors of Merchants National
Bonding, Inc., on October 24, 2011.
"The President, Secretary, Treasurer, or any Assistant Treasurer or any Assistant Secretary or any Vice President shall have
power and authority to appoint Attomeys-in-Fact, and to authorize them to execute on behalf of the Company, and attach the
seal of the Company thereto, bonds and undertakings, recognizances, contracts of Indemnity and other writings obligatory in
the nature thereof.
The signature of any authorized officer and the seat of the Company may be affixed by facsimile or electronic transmission to
any Power of Attorney or Certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance,
or other suretyship obligations of the Company, and such signature and seal when so used shall have the same force and
effect as though manually fixed."
In Witness Whereof, the Companies have caused this instrument to be signed and sealed this 2nd day of March , 2012,
STATE OF IOWA
COUNTY OF POLK ss.
. �p�N� Ct7,�•.
4:40 ,,4
O%
6' 1933 ; c
MERCHANTS BONDING COMPANY (MUTUAL)
MERCHANTS NATIONAL BONDING, INC.
/-,e-7 77�
President
On this 2nd day of March , 2012, before me appeared Larry Taylor, to me personally known, who being by me duly sworn did
say that he is President of the MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC.; and
that the seals affixed to the foregoing instrument is the Corporate Seals of the Companies; and that the said instrument was signed and
sealed in behalf of the Companies by authority of their respective Boards of Directors.
In Testimony Whereof, l have hereunto set my hand and affixed my Official Seal at the City of Des Maines, Iowa, the day and year
first above written.
MARANDA GREE NWALT
> Commission Number 770312 r
`,g8r My Commission Expires
" October 28, 2014
Notary Public, Polk County, Iowa
STATE OF IOWA
COUNTY OF POLK ss.
I, William Warner, Jr., Secretary of the MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC.,
do hereby certify that the above and foregoing is a true and correct copy of the POWER-OF-ATTORNEY executed by said Companies,
which is still in full force and effect and has not been amended or revoked.
In Witness Whereof, I have hereunto set my hand and affixed the seal of the Companies on
this P5th day of June , 2013
jk ;'U dRq�SQQ
�;= 203 ;�•�
POA 0014 (11/11)
z)
y 1933 c;
Secretary
r: =..
EDU BIT
AFFIDAVIT OF WORKAUTHORMATION
COMES NOW (N=,
Vince Kelley as (C)ffi=H,4 President
�
of(Con4=yW==/Cazt=�) Nip Kelley 'Equipment Co., aTudc&zst being duly sworn, on
my oath, aflittn as Mows:
1. (C—T-YN , Nip Kelley Equipment Co. i Inc.
__�
is enrolled. and wiR continue to participate in 2. falma work authorization. Ptqg=m iEL'teSPC6t to
employees that will. work in connection with the contmched services Vela to A-CJCCt N2.=)
Water Plant No. 2 Clearwellfox the d=tion of the coatmA-t in accotdance with RSMo
Chaptet 285.530(2).
2, Ialso 2E=ff1zt(C=VyN./cr) Nip Kelley Equipment qg,,,
Inc.
not and will not knowingly employ a person who is an unauthorized alien in connection with the
ContmCt setincestellind to (P=JCtName} Water Plant No. 2 Clearwell for
the duration of the contract
3. ,Attached heteto is documentation affirming Con *actor's entolknent and
parti4aho-a in a federal work auffiaft=tio_n progmm with respect to the employees 'working in
connection with the contracted sCrV'XCS_
FLIRT iER AFFLwr sAnA NOT.
IN AFFUM&TION THEREOF, the facts stated. above are true and correct (the
undersigned understands that false statements made in this filiiig are subject to the
penalties provided in Section 575.040, RSMo.) .
Nip �elley Equipment Co., Inc.
of COZP9Qft=)
WLE
F
AV PresideTrL
Al=
S= -Off'=)
Fra/nk Myers
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STATE OF MISSOURI )
ss.
COUNTY OF CAPE GIRARDEAU ) ,
On. this as -"ay of 20t before me appeared Y ,"Rt ICS le
to to pots known, by me duty sworn, did sap that he/she is the --,dWt i
of 7f yiDs >'La. M..,= Corporation, and that the seat affixed to the
forego ins eat is the seat of said Coxpotation, and that the said in. anent was signed and
sealed in behalf of said Corporation by authoriiy of its Board of Directors, and. ackao %edged said
instrutnemt to be the free act and deed of said CoTotation
IN FEST oNY WI ERFAF, I bave hereunto set my hand and affixed my official seal, at
my office in Cape CYitatdeau, Nfissouri the dap and peat first above vitteu.
t~
Notary Public
My Columission Expires: .�py,�;pU` . SFACI L. PEPPLE
moo, ��;, MyCammW0F Fxpkes
c� f �' � ' * • • *= Fe6n�ary9, 20 7
;�'• SEAL Sean Coon
�9 ,,L 6omtnissluii #13434217
.. _ E—Verify.-VXPS+Y T. A -9- DT
Company ID Number: 211168
THE &VERIFY PROGRAM FOR EMPLOYMENT VERIFICATION
MEMORANDUM OF UNDERSTANDING
ARTICLE I
PURPOSE AND AUTHORITY
This Memorandum of Understanding (MOU) sets forth the points of agreement between the
Department of Homeland Security (DHS) and NipKellen Egulpmehit Company, Ihc.
(Employer) regarding the Employer's participation in the Employment Eligibility Verification
Program (E -Verify). This MOU explains certain features of the E -Verify program and
enumerates specific responsiblilitles of DHS, the Social Security Administration (SSA), and the
Employer. E; -Verify is a program that electronically confirms an employee's eligibility to work in.
the United States after completion of the Employment Eligibility Verification Form (Form 1-9).
For covered government contractors, E -Verify is used to verify the employment eligibility of all
newly hired employees and all existing erimployees assigned to Federal contracts.
Authority for the E -Verify program is found in Title IV, Subtitle A, of the Illegal Immigration
Reform and Immigrant Responsibility Act of 1996 (IIRIRA), Pub. L. lb4-208, 110 Stat. 3009, as
amended (8 U.S.C. § 1324a note). Authority for use of the E -Verify program by Federal
contractors and subcontractors covered by the terms of Subpart 22.18, "Employment Eligibility
Verification", of the Federal Acquisition Regulation (FAR) (hereinafter referred to in this MOU as
a "Federal contractor) to verify the employment eligibility., of certain employees working on
Federal contracts is also found in Subpart 22.18 and in Executive Order 12989, as amended.
ARTICLE Il
FUNCTIONS TO BE PERFORMED
A. RESPONSIBILITIES OF SSA
1. SSA agrees to provide the Employer with available information that allows the Employer
to confirm the accuracy of Social Security Numbers provided by all employees verified under
this MOU and the employment authorization of U.S. citizens.
2. SSA agrees to provide to the Employer appropriate assistance with operational
problems that may arlse during the Employer's participation in the E -Verify program. SSA
agrees to provide the Employer with names, titles, addresses, and telephone numbers of SSA
representatives to be contacted during the E -Verify process.
3, SSA agrees to safeguard the information provided by the Employer through the E -Verify
program procedures, and to limit access to'such information; as is appropriate by law, to
individuals responsible for the verification of Social Security Numbers and for evaluation of the
E -Verify program or such other persono or entities who may be authorized by SSA as governed
by the Privacy Act (5 U,S.C, § 552a), the Social Security Act (42 U.S.C. 1306(a)), and SSA
regulations (20 CFR Part 401).
pages ofi"sslF-Ve-iiyM U)'OrEmplovadRuv�sbnDate W/2�3(t3E3 :' '
Company ID Number: 211168
4. S.SA agrees to provide a means of automated verification that is designed (in
conjunction with DHS's automated system if necessary) to provide confirmation or tentative
nonconfirmation of U.S. citizens' employment eligibility within 3 Federal Government work days
of the initial inquiry.
5. SSA agrees to provide a means of secondary verification (including updating SSA
records as may be necessary) for employees who "contest SSAIentative honconfirmations that
is designed to provide final confirmation or nonconfirmation of U.S. citizens' employment
eligibillty and accuracy of SSA records for both citizens and aliens within 10 Federal
Government work days of the date of referral to -SSA, unless SSA determines that more than 10
days may be necessary. In such cases, SSA will provide additional verification instructions,
B. RESPONSIBILITIES OF DHS
1. After SSA verifies the accuracy of SSA records for aliens "through E -Verify, DHS agrees
to provide the Employer access to selected data from DHS's database to enable the Employer
to conduct, to the extent authorized by this MOU:
e Automated verification checks on alien employees by electronic means, and
Is Photo verification checks (when available) on employees.
2. DHS agrees to provide to the Employer appropriate assistance with operational
problems that may arise during the Employer's participation in the" E=Verlfy Program. DHS
agrees to provide the "Employar names, titles, addresses, and telephone -numbers of DHS
representatives to be contacted during the E -Verify process.
& DHS agrees to provide to the Employer a manual (the E -Verify User Manual) containing
instructions on E -Verify policies, procedures and requirements for both SSA and DNS, including
restrictions on the use of E -Verify. DHS agrees to provide training materials on E -Verify.
4. DHS agrees to provide to the Employer a notice, which indicates. the Employer's
participation in the E -Verify program. DHS also agrees to provide to the Employer anti-
discrimination notices issued by the Office of Special Counsel for Immigration -Related Unfair
Employment Practices (OSC), Civil Rights Division, U.S. Department of Justice.
5. DHS agrees, to issue the Employer a user identification number and password that
permits the Employer to verify information provided by alien employees with DHS's database.
6. DHS agrees to safeguard the information provided to DHS by the Employer, and to limit
access to .such information to individuals responsible for the verification of alien employment
eEigibllity and for evaluation of the E -Verify program, or to such other persons or entities- as may
be authorized by applicable law. information vill be used only to verify the accuracy of Social
Security Numbers and employment eligibility, to enforce the Immigration and Nationality Act
(INA) and Federal criminal laws, and toadminister Federal contracting requirements,
7. DHS agrees to provide a means of automated verification that is designed (in.
conjunction with SSA verification procedures) to provide confirmation or tentative
Page 2 of 13JE-Ve6fy rMOU for 4rnpioVerlrelji,icr, Dale 10.129f08
-verify.
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Company ID Number: 211168
4. S.SA agrees to provide a means of automated verification that is designed (in
conjunction with DHS's automated system if necessary) to provide confirmation or tentative
nonconfirmation of U.S. citizens' employment eligibility within 3 Federal Government work days
of the initial inquiry.
5. SSA agrees to provide a means of secondary verification (including updating SSA
records as may be necessary) for employees who "contest SSAIentative honconfirmations that
is designed to provide final confirmation or nonconfirmation of U.S. citizens' employment
eligibillty and accuracy of SSA records for both citizens and aliens within 10 Federal
Government work days of the date of referral to -SSA, unless SSA determines that more than 10
days may be necessary. In such cases, SSA will provide additional verification instructions,
B. RESPONSIBILITIES OF DHS
1. After SSA verifies the accuracy of SSA records for aliens "through E -Verify, DHS agrees
to provide the Employer access to selected data from DHS's database to enable the Employer
to conduct, to the extent authorized by this MOU:
e Automated verification checks on alien employees by electronic means, and
Is Photo verification checks (when available) on employees.
2. DHS agrees to provide to the Employer appropriate assistance with operational
problems that may arise during the Employer's participation in the" E=Verlfy Program. DHS
agrees to provide the "Employar names, titles, addresses, and telephone -numbers of DHS
representatives to be contacted during the E -Verify process.
& DHS agrees to provide to the Employer a manual (the E -Verify User Manual) containing
instructions on E -Verify policies, procedures and requirements for both SSA and DNS, including
restrictions on the use of E -Verify. DHS agrees to provide training materials on E -Verify.
4. DHS agrees to provide to the Employer a notice, which indicates. the Employer's
participation in the E -Verify program. DHS also agrees to provide to the Employer anti-
discrimination notices issued by the Office of Special Counsel for Immigration -Related Unfair
Employment Practices (OSC), Civil Rights Division, U.S. Department of Justice.
5. DHS agrees, to issue the Employer a user identification number and password that
permits the Employer to verify information provided by alien employees with DHS's database.
6. DHS agrees to safeguard the information provided to DHS by the Employer, and to limit
access to .such information to individuals responsible for the verification of alien employment
eEigibllity and for evaluation of the E -Verify program, or to such other persons or entities- as may
be authorized by applicable law. information vill be used only to verify the accuracy of Social
Security Numbers and employment eligibility, to enforce the Immigration and Nationality Act
(INA) and Federal criminal laws, and toadminister Federal contracting requirements,
7. DHS agrees to provide a means of automated verification that is designed (in.
conjunction with SSA verification procedures) to provide confirmation or tentative
Page 2 of 13JE-Ve6fy rMOU for 4rnpioVerlrelji,icr, Dale 10.129f08
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Company ID Number: 211168
nonconfirmation of employees' employment eligibility within 3 Federal Government work days of
the initial inquiry.
8. DHS agrees 'to provide a means of secondary verification (including updating DHS
records as may be necessary) for employees who contest DHS tentative nonconfirmations and
photo non=match tentative rionconfirmations that is designed to protide final confirmation or
nonconfirmation of the employees' employment eligibility within 10 Federal Government work
days of the date of referral to DHS, unless DHS determines that more than 40 days may be
necessary. In such cases, DHS will provide additional verification instructions.
C. RESPONSIBILITIES OF THE EMPLOYER
I , -The Employer agrees to display the notices supplied by DHS in a prominent place that is
clearly visible to prospective employees and all employees who are to be verified through the
system.
2, The Employer agrees to provide to the SSA and OHS the'narnes, titles, addresses, and
telephone numbers of the Employer representatives to be contacted regarding E -Verify.
3. The Employer agrees to become familiar with and comply with the most recent version
of the E -Verify User Manual.
4, The Employer agrees that any Employer Representative who will perform employment
verification queries will complete the E -`,verify Tutorial before that individual initiates any
queries.
A. The Employer agrees that all Employer representatives will take the refresher
tutorials initiated by the E -Verify program as a condition of continued use of E -
Verify, including any tutorials for Federal contractors if the Employer is a Federal
contractor.
B. Failure to complete a refresher tutorial will prevent the Employer from continued
use of the program.
5. The Employer agrees to comply with current Form 1-9 procedures, with two exceptions:
• If an employee presents a "List B" identity document, the Employer agrees to only
accept "List B" documents that contain a photo. (List B documents identified in 8 C:F.R.
274a.2(b)(1)(B)) can be presented during the Form 1-9 process to establish identity.) If
an employee objects to the photo requirement for religious reasons, the Employer
should contact E -Verify at 888-464-4218.
• if an eMployee presents a DHS Form 1-551 (Permanent Resident Card) or Form 1-765
(Employment Authorization Document) to complete the Form 1-9, the Employer agrees to
make a photocopy of the document and to retain the photocopy with .the employee's
Form 1-9. The employer will use the photocopy to verify the photo and to assist DHS
with its review of photo non -matches that are contested by employees. Note that
employees retain the right to present any List A, or List B and List C, documentation to
complete the Form 1-9. DHS may in the future designate other documents that activate
the photo screening tool.
Page 3 of 131E -Verify MMU for Enpioyerilr evision Date f i}.° -9M
Company ID Number: 211168
6- The Employer understands that participation in E -Verify does not exempt the Employer
from the responsibility to complete, retain, and make available for inspection Forms 1-9 that
relate'to rIts employees, or from other requirements of appricable regulations or laws, including
the obligation to comply with the antidiscrimination requirements of section 2748 of the INA with
respect to Form 1-9 procedures, except for the foNowing modified requirements applicable by
reason of the Employer's participation in E -Verify: (1) identity documents must have photos, as
described in paragraph 5 above; (2) a rebuttable presumption Is established that the Employer
has not violated section 274A(a)(1.)(A) of the Immigration and Nationality Act (INA) with respect
to the hiring of any individual if it obtains confirmation of the identity and employment eligibility of
the Individual in compliance with the terms and conditions of E -Verify; (3) the Employer must
notify DHS if it continues to employ any employee after receiving a final nonconfirmation, and is
Subject to a civil money penalty between $550 -and $1,100 for -each failure to notify DNS of
continued employment following a final nonconfirmation; (4) he Employer is subject to a
rebuttable presumption that it has knowingly employed an unauthorized alien in violation of
section 274A(a)(1)(A) if the Employer continues to employ an employee after receiving a final
nonconfirmation; and (5) no person or entity participating In E -Verify is civilly or criminally liable
under any law for any action taken in good faith based on information provided through the
confirmation system. DHS reserves the right to conduct Form 1-9 compilance Inspections during
the course of E -Verify, as well as to conduct any other enforcement activity authorized by law.
7. The Employer agrees to initiate E -Verify verification procedures for new employees
within 3 Employer business days after each employee has been hired (but after both sections 1- .
and 2 of the Form 1-9 have been completed), and to complete as many (but only as many) steps
of the E -Verify process as are necessary according to the E -Verify User Manual. The: Employer.
is prohibited from initiating verification procedures before the employee has been hired and -the
Form 1-9 completed. If the automated system to. be queried is temporarily unavailable, the 3 -day
time period is extended until it is again operational in order to accommodate the Employer's
attempting, in good faith, to make inquiries during the period of unavailability. In all -cases, the
Employer must use the SSA verification procedures first, and use DHS verification' procedures
and photo screening tool only after the SSA verification response has been given. Employers
may initiate verification by notating the Form 1-9 in circumstances where the employee has
applied for a Social Security Number (SSN) from the SSA and is waiting to receive the SSN,
provided that the Employer performs an E -Verify employment verification query using the
.employee's SSN as soon as the SSN becomes available,
S. The Employer agrees not to use E-Verffy procedures for pre-employment screening of
job applicants, in support of any unlawful employment practice, or for any other use not
authorized by this MOU. Employers must use E -Verify for all new employees, unless an
Employer is a Federal contractor that qualifies for the exceptions described In Article iLDAX,
Except as provided in Article ILD, the Employer will not verify selectively and will not verify
employees hired before the effective date of this MOU. The Employer understands that If the
Employer uses E -Verify procedures for .any purpose other than as authorized by this MOU, the
Employer may be subject to appropriate legal action and termination of its access to SSA and
DHS information pursuant to this MOU.
9. The Employer agrees to follow appropriate. procedures (see Article Ill. below) regarding
tentative nonconfirmations, including notifying employees of the finding, providing written
referral instructions to employees, allowing employees to contest the finding, and not taking
Pap 4 of 13JE-Vef y MOM for i m.0overlRevision Base 1 CY29108, _F-•--"rr :._:. <? _;_r:;
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Company ID Number: 211168
6- The Employer understands that participation in E -Verify does not exempt the Employer
from the responsibility to complete, retain, and make available for inspection Forms 1-9 that
relate'to rIts employees, or from other requirements of appricable regulations or laws, including
the obligation to comply with the antidiscrimination requirements of section 2748 of the INA with
respect to Form 1-9 procedures, except for the foNowing modified requirements applicable by
reason of the Employer's participation in E -Verify: (1) identity documents must have photos, as
described in paragraph 5 above; (2) a rebuttable presumption Is established that the Employer
has not violated section 274A(a)(1.)(A) of the Immigration and Nationality Act (INA) with respect
to the hiring of any individual if it obtains confirmation of the identity and employment eligibility of
the Individual in compliance with the terms and conditions of E -Verify; (3) the Employer must
notify DHS if it continues to employ any employee after receiving a final nonconfirmation, and is
Subject to a civil money penalty between $550 -and $1,100 for -each failure to notify DNS of
continued employment following a final nonconfirmation; (4) he Employer is subject to a
rebuttable presumption that it has knowingly employed an unauthorized alien in violation of
section 274A(a)(1)(A) if the Employer continues to employ an employee after receiving a final
nonconfirmation; and (5) no person or entity participating In E -Verify is civilly or criminally liable
under any law for any action taken in good faith based on information provided through the
confirmation system. DHS reserves the right to conduct Form 1-9 compilance Inspections during
the course of E -Verify, as well as to conduct any other enforcement activity authorized by law.
7. The Employer agrees to initiate E -Verify verification procedures for new employees
within 3 Employer business days after each employee has been hired (but after both sections 1- .
and 2 of the Form 1-9 have been completed), and to complete as many (but only as many) steps
of the E -Verify process as are necessary according to the E -Verify User Manual. The: Employer.
is prohibited from initiating verification procedures before the employee has been hired and -the
Form 1-9 completed. If the automated system to. be queried is temporarily unavailable, the 3 -day
time period is extended until it is again operational in order to accommodate the Employer's
attempting, in good faith, to make inquiries during the period of unavailability. In all -cases, the
Employer must use the SSA verification procedures first, and use DHS verification' procedures
and photo screening tool only after the SSA verification response has been given. Employers
may initiate verification by notating the Form 1-9 in circumstances where the employee has
applied for a Social Security Number (SSN) from the SSA and is waiting to receive the SSN,
provided that the Employer performs an E -Verify employment verification query using the
.employee's SSN as soon as the SSN becomes available,
S. The Employer agrees not to use E-Verffy procedures for pre-employment screening of
job applicants, in support of any unlawful employment practice, or for any other use not
authorized by this MOU. Employers must use E -Verify for all new employees, unless an
Employer is a Federal contractor that qualifies for the exceptions described In Article iLDAX,
Except as provided in Article ILD, the Employer will not verify selectively and will not verify
employees hired before the effective date of this MOU. The Employer understands that If the
Employer uses E -Verify procedures for .any purpose other than as authorized by this MOU, the
Employer may be subject to appropriate legal action and termination of its access to SSA and
DHS information pursuant to this MOU.
9. The Employer agrees to follow appropriate. procedures (see Article Ill. below) regarding
tentative nonconfirmations, including notifying employees of the finding, providing written
referral instructions to employees, allowing employees to contest the finding, and not taking
Pap 4 of 13JE-Vef y MOM for i m.0overlRevision Base 1 CY29108, _F-•--"rr :._:. <? _;_r:;
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adverse action against employees if they choose to contest the finding. Further, when
employees contest a tentative, nonconfirmation basted upon a photo non -match, the Employer is
required to take affirmative. steps (see Article I.II.B. below) to contact DFfS with information
necessary to resolve the challenge,
10. The Employer agrees not to take any adverse action against an employee based upon
the employee's perceived employment eligibility status while SSA or DHS is processing the
verification request unless the Employer obtains knowledge (as defined in 8 G.F.R. §-274a.10))
that the employee is not work authorized. The Employer understands that an initial inability of
the .SSA or DHS automated verification system to verify work authorization, -a tentative
nonconfirmation, a case in continuance (indicating the need for additional time for the
government to resolve a case), or the finding of a photo non -match, does not establish, and
Should not be interpreted as evidence, that the employee is not work authorized. in any of the
cases listed above, the employee must be provided a full and fair -opportunity to contest the
finding, and if he or she does so, the employee may not be terminated or suffer any adverse
employment consequences based upon the employee's perceived employment eligibility --status
(including dere✓ing, reducing, or extending work hours, delaying or preventing training, requiring
an employee to work in poorer conditions, refusing to assign the employee to a Federal contract
or other assignment, or otherwise subjecting an employee to any assumption that he or she is
unauthorized to work) until and unless secondary -verification by SSA or DHS has been
completed and a final nonconfirmation has been issued. if the employee does not choose to
contest a tentative nonconfirmation or a photo non -match or if a secondary verification is
completed and a final nonconfirmation is issued, then the Employer can find the employee is not
work authorized and terminate the employee's employment. Employers or employees with
questions about a final nonconfirmation may call E -Verify at 1-888-464-4218 or OSG at'1-800-
255-8155 or 1800-237-2515 (TDD).
11. The Employer agrees,to comply with Title Vil of the Civil Rights Act of 1964 and -section
2748 of the INA by not discriminating unlawfully against any individual in hiring, firing, or
recruitment or referral practices because of his or her national origin or, in the ease of a
protected individual as defined in” soation 2748(a)(3) of the INA, because of his or her
citizenship status. The Employer understands that such illegal practices can include selective
verification or use of E -Verify except as provided in part D below, -or discharging or refusing to
hire employees because they appear or sound "foreign" or have received tentative
nonconfirmations. The Employer further understands. that any violation of the unfair
immigration -related employment practices provisions in section 274B of the INA .Could subject
the Employer to civil penalties, back pay' awards, and other sanctions, and violations of Title VII
could subject the Employer to back pay awards, compensatory and punitive damages.
Violations of either section 274E of the INA or Title Vil may also lead to the termination of its
participation in E -Verify. If the Employer has any questions relating to the anti -discrimination
provision, it should contact OSC at 1-800-255-8455 or 1=$00-237-2515 (TIDO).
12. The Employer agrees to record the case verification number on the employeeis Form 1-9
or to print the screen containing the case verification number and attach it to the. employee's
Form -1-9.
13. The Employer agrees that it will use tate information it receives from S.SA or DHS
pursuant to E -Verify and this MOU only to confirm the employment eligibility of employees as
Page 5 of 131E Vatify MOU for C npltlyerlPerision Nle 101/29/00 vnir .,,�_!. 7 .-.f!-^,, r : ,, r ; , °
Company ID Number: 211168
authorized by this MOU. The Employer agrees that It will safeguard this information, and means
of access to it (such as PINS and passwords) to ensure that it is not used for any other purpose
and as necessary to protect its confidentiality, including ensuring that it is not disseminated to
arty person other than employees of the Employer who are authorized to perform the
Employer's responsibilities under this MOU, except for such dissemination as may be
authorized in advance by SSA or DHS for legitimate purposes.
14. The Employer acknowledges that the information which- it receives from $SA is
governed by the Privacy Act (5 U.S.C. § 552a(i)(1) and (3)) and the Social Security Act (42
U.S.G. 1306(x)), and that any person who obtains this information under false pretenses or uses
it for any purpose other than as provided for in this MOU may be subject to criminal penalties.
15. The Employer agrees to cooperate with DHS and SSA in their com.pliance-monitoring
and evaluation of E -Verify, including by permitting DHS and SSA, upon reasonable notice, to
review Forms 1-9 and other employment records and to interview it and its employees regarding
the Employer's use of E -Verify, and to respond in a timely and accurate manner to DMS
requests for information relating to their participation in E -Verify.
M RESPONSIBILITIES OF FEDERAL CONTRACTORS
1. The Employer understands that if it is a Federal contractor subject to the
employment verification terms in Subpart 22.18 of the FAR it must verify the employment
eligibility of any "employee assigned to the contract' (as defined in .FAR 22.1601.) in. addition to
verifying the,employment eligibility of all other employees required to be verified under the, FAR.
Once an employee has been verified through E-Verify.by the Employer, the Employer may not
reverify the employee through E -Verify.
a. -Federal contractors not enrolled at the time of contract- award: An Employer that
I$ not enrolled in E -.Verify as a Federal contractor at the time of a contract award must enroll as
a Federal contractor in the E -Verify program within 30 calendar days of contract award and,
within 90 days of enrollment, begin to use E-Verifyto initiate verification of employment eligibility
of new hires of the Employer who are working in the United States, whether or not assigned to
the contract. Once the Employer begins verifying new hires, such verification of new hires must
be initiated within 3 business days after the date of hire. Once enrolled in E-Verlfy-as a Federal
contractor, the Employer must initiate verification of employees assigned to the contract within
90 calendar days after the date of enrollment or within 30 days of an employee's assignment to
the contract, whichever date is later.
b. Federal contractors already enrolled at the time of a contract award: Employers
enrolled in E -Verify as a Federal contractor for 90 days or more at the time of a contrapt award
must use E -Verify to initiate verification of employment eligibility for new hires of the Emplayer
who are working in the United States, whether or not assigned to the contract, within 3 business
days after the date of hire. If the Employer is -enrolled in E -Verify as � Federal contractor for 90
calendar days or less at the time of contract award, the Employer must, within 90 days of
enrollment, begin to use E -Verify to initiate verification of new hires ,of the contractor who are
working in the United States, whether or not assigned to the contract. Such verification of new
hires must be initiated within 8 business days after the date of hire. An Employer enrolled as a
Federal contractor in E -Verify must lroliate verification of each employee assigned to the
ttcfs 6 of 131E•Verly MOU for Emp1oyer)Rev1s1on Dale 1U12M8
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Company ID Number: 211168
authorized by this MOU. The Employer agrees that It will safeguard this information, and means
of access to it (such as PINS and passwords) to ensure that it is not used for any other purpose
and as necessary to protect its confidentiality, including ensuring that it is not disseminated to
arty person other than employees of the Employer who are authorized to perform the
Employer's responsibilities under this MOU, except for such dissemination as may be
authorized in advance by SSA or DHS for legitimate purposes.
14. The Employer acknowledges that the information which- it receives from $SA is
governed by the Privacy Act (5 U.S.C. § 552a(i)(1) and (3)) and the Social Security Act (42
U.S.G. 1306(x)), and that any person who obtains this information under false pretenses or uses
it for any purpose other than as provided for in this MOU may be subject to criminal penalties.
15. The Employer agrees to cooperate with DHS and SSA in their com.pliance-monitoring
and evaluation of E -Verify, including by permitting DHS and SSA, upon reasonable notice, to
review Forms 1-9 and other employment records and to interview it and its employees regarding
the Employer's use of E -Verify, and to respond in a timely and accurate manner to DMS
requests for information relating to their participation in E -Verify.
M RESPONSIBILITIES OF FEDERAL CONTRACTORS
1. The Employer understands that if it is a Federal contractor subject to the
employment verification terms in Subpart 22.18 of the FAR it must verify the employment
eligibility of any "employee assigned to the contract' (as defined in .FAR 22.1601.) in. addition to
verifying the,employment eligibility of all other employees required to be verified under the, FAR.
Once an employee has been verified through E-Verify.by the Employer, the Employer may not
reverify the employee through E -Verify.
a. -Federal contractors not enrolled at the time of contract- award: An Employer that
I$ not enrolled in E -.Verify as a Federal contractor at the time of a contract award must enroll as
a Federal contractor in the E -Verify program within 30 calendar days of contract award and,
within 90 days of enrollment, begin to use E-Verifyto initiate verification of employment eligibility
of new hires of the Employer who are working in the United States, whether or not assigned to
the contract. Once the Employer begins verifying new hires, such verification of new hires must
be initiated within 3 business days after the date of hire. Once enrolled in E-Verlfy-as a Federal
contractor, the Employer must initiate verification of employees assigned to the contract within
90 calendar days after the date of enrollment or within 30 days of an employee's assignment to
the contract, whichever date is later.
b. Federal contractors already enrolled at the time of a contract award: Employers
enrolled in E -Verify as a Federal contractor for 90 days or more at the time of a contrapt award
must use E -Verify to initiate verification of employment eligibility for new hires of the Emplayer
who are working in the United States, whether or not assigned to the contract, within 3 business
days after the date of hire. If the Employer is -enrolled in E -Verify as � Federal contractor for 90
calendar days or less at the time of contract award, the Employer must, within 90 days of
enrollment, begin to use E -Verify to initiate verification of new hires ,of the contractor who are
working in the United States, whether or not assigned to the contract. Such verification of new
hires must be initiated within 8 business days after the date of hire. An Employer enrolled as a
Federal contractor in E -Verify must lroliate verification of each employee assigned to the
ttcfs 6 of 131E•Verly MOU for Emp1oyer)Rev1s1on Dale 1U12M8
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Company ID Number: 211168
contract within 90 calendar days after date of .contract award orwithin 30 days after assignment
to the contract, whichever is later.
C. institutions of Nigher education, State, local and tribal .governments and sureties-,
Federal contractors thatare institutions of higher education (as defined at 20 U.S.C. 1001(a)),
State or local governments, governments of Federally recognized Indian tribes, or sureties
performing under a takeover agreement entered into with a .Federal agency pursuant to a
performance bond may choose to only verify new and existing employees assigned to the
Federal contract. Such Federal contractors may, however, elect to verify all new hires, and/or
all existing employees hired after November 6, 1986. The provisions of Article ILD, paragraphs
1.a and 1.b of this MOU providing timeframes for initiating employment verification of employees
assigned to a contract apply to such institutions of higher education, State, local and tribal
governments, and sureties.
d. Verification of all employees: Upon enrollment, Employers who are Federal
contractors may elect to verify employment eligibility of all existing employees working in the
United States who were hired after November 6, 1986, instead of verifying only those
employees assigned to a covered Federal contract_ After enrollment, Employers must elect to
do so only in the manner designated by DHS and initiate E -Verify verification of all existing
employees within 1-80 days after the election,
e. Form 1-9 procedures for Federal contractors: The Employer may use a
previously completed Form 1-9 as the basis for initiating E -Verify verification of an employee
assigned to a contract as long as that Form 1-9 is complete (including the SSN), ccrirplies with
Article II.C.5, the employee's work authorization has not expired, and -the Employer has
reviewed the information reflected in the Form 1-9 either in person or in communications.Wth the
employee to ensure that the employee's stated basis in section f of the Form 1-9 for work
authorization has not changed (including, but not limited to, a lawful permanent resident alien
having become a-riaturalized U.S. citizen). If the Employer is unable to determine that the Form
1-9 complies with Article iI.G;5, if the employee's basis for work authorization as attested in
section 1 has expired or changed, or if the Form 1-9 contains no SSN or is otherwise incomplete,
the Employer shall complete a new 1-9 consistent with Article II.C.5, or update the previous 1-9
to provide the necessary information. If section .I of the Form 1-9 is otherwise valid and up-to-
date and the form otherwise complies with Article II.C.5, but reflects documentation (such as a
U.S- passport or Form 1-551) that expired subsequent to completion of the Form F-9, the
Employer shall not require the production of additional documentation, or use the photo
screening tool described in Article II.C.5, subject, to any additional or superseding instructions
that may be provided on this subject in the E -Verify User Manual. Nothing in this section shall
be construed to require a second verification using E -Verify of any assigned employee who has
previously been verified as a newly hired employee under this MOU, or to authorize verification
of any Existing employee by any Employer that is not a Federal contractor.
2. The Employer understands that if it is a Federal contractor, its compliance with this MOU
is a performance requirement under the terms of the Federal contract .or subcontract, and the
Employer consents to the release of information relating to compliance with its verification
responsibilities under this ,MOU to contracting officers or other officials authorized to review the
Employees compliance with Federal contracting requirements.
Pags 7 of talk-Vedfy i %U for EmployedRovisiorl DEde;14?2alt08
Company ID Number: 211168
ARTICLE 111
AEFERRAL OF INDIVIDUALS TO SSA AND DHS
A. REFERRAL Tt? SSA
1. If the Employer receives a tentative nonconfirmation issued by -SSA, the Employer must
print the tentative nonconfirmation notice as directed by the automated system and provide it to
the- employee so that the employee may determine whether he or she will contest the tentative
nonconfirmation.
2. The Employer will refer employees to SSA field offices only �as_ directed by the
automated system based on a tentative nonconfirmation, and only after the Errjployer records
the case verification number, reviews the input to detect any transaction errors, and determines
that the employee contests the tentative nonconfirmation. The Employer will transmit the Social
Security Number to SSA for verification again if this review indicates a need to do so. The
Employer will determine whether the employee contests the tentative nonconfirmation as soon
as possible after the Employer receives it.
3. If the employee contests an SSA tentafive nonconfirmation, the Employer will provide
the employee with a system -generated referral letter and instruct the employee -to visit an SSA
office.within 8 Federal Government work days. SSA will electronically transmit the result of the
referral to the Employer within 10 Federal Govemmerit work days of the referral unless -it.
determines that more than *10 days is necessary. The Employer agrees to check. the E -Verify
system regularly for case updates.
4.. The Employer agrees not to ask the employee 'to obtain a printout from the Social
Security Number database (the Numident) or other written verification of the Social Security
Number from the SSA.
B. REFERRAL TO DHS
1. If the Employer receives a tentative nonconfirmation issued by DHS -,.the Employer must
print the tentative nonconfirmation notice as directed by the automated system and provide It to
the employee so that the employee may determine whether he or she will contest the tentative
nonconfirmation.
2. If the Employer finds a photo non -match for an employee who provide$ a document for
which the automated system has transmitted a photo, the employer must print the photo non -
match tentative nonconfirmation notice as directed by the automated system and provide It to
the employee so that the employee may determine -whether he or she will contest the finding.
3. The Employer agrees to refer individuals to QRS only when the employee chooses to
contest a tentative nonconfirmation received from DHS automated verification process or when
the Employer issues a tentative nonconfirmation based .upon a photo non -match. The Employer
will determine whether the employee contests the tentative nonconfirmation as soon as possible
Page 8 or I3JE-Verify IMOU for CTmr oywli3avisian Dain la -29108
44 �4
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Y.C-VPRIYY'19 A SZK4 Ce M
Company ID Number: 211168
after the Employer receives It.
4. if the employee contests a tentative nonconfirmation issued by'DHS, the Employer -w-III
provide 'the employee. with a referral letter apd instruct the employee to contact: IHS through its
toll-free hotline (as found on the referral letter) within 8 Federal Government work days.
5 It the employee contests a tentative nonconfimaation based upon a photo non -match, the
Employer will provide the employee with a referral letter to DHS_ DHS will electronically transmit
the result of the referral to the Employer within 10 Federal Government work days of the referral
.unless it determines that more than 10 days is necessary. The Employer agrees to check the E -
Verify system regularly for case updates.
.5. The Employer agrees that if an employee contests a tentative nonconflrmation based
upon a photo non -match, the Employer will send a copy of the employee's Form 1-551 or Form
1-766 ta.DHS for review by:
• • Scanning and uploading the document, or
Sending a photocopy of the document by an .express mail account (furnished and paid
for by DHS).
7, The Employer understands that if it cannot determine whether there 1-s a photo
match/non-match, the Employer is required to forward the employee's documentation to DHS by
scanning and uploading, or by sending the document as described in the preceding paragraph,
and resolving the case as specified by the Immigration Services 'Verifier at DHS who will
determine the photo match or non -hatch.
ARTICLE IV
SERVICE PROVISIONS
SSA and DHS will not charge the Employer for verification services performed under this MOU.
The Employer is responsible for providing equipment needed to make inquiries. To access the
E -Verify System, an Employer will need,a personal computer with Internet access.
ARTICLE V
PARTIES
A. This MOU is effective upon the signature of all parties, and shall Continue in effect for as
long as the SSA and DHS conduct the E -Verify program unless modified in writing by the mutual
consent of all parties, or terminated by any party upon 30 days prior written notice to the others.
Any and all system enhancements to the E -Verity program by IHS or SSA, including but not
limited to the E -Verify .checking against additional data sources -and instituting new verification
procedures, will be covered under this MOU and will not cause the need for a supplemental
MOU that outlines these. changes. DHS agrees to train employers -on all changes made to E -
Verify through the use of mandatory refresher tutorials and updates to the E Verify User
'Manual. Even without changes to E -Verify, DHS reserves the right to require employers to take
Porge 9 of 131E.Ve6/ MO Eat". oyerlRevision Date 10129be
t; 7. 1111111
„, a-vaaxri xs :, seaYxna oe n
Company ID Number: 211168
mandatory refresher tutorials. An Employer that is a Federal contractor may terminate this
MOU vvhein the. Federal contract that requires its participation in E -Verify is terminated or
completed. In such a circumstance, the Federal contractor must provide written notice to DHS:
If an Employer that is a Federal contractor fails to provide such notice, that Employer will remain
a participant in the E -Verify program, will remain bound by the terms of this MOU that apply to
non -Federal contractor participants, and will be required to use the E -Verify procedures to verify
the employment eligibility of all newly hired employees.
B. Notwithstanding Article V, part A of this MOU, DHS may tert'ninate this. MOU if deemed.
necessary because of the requirements of law or policy, or upon a determination by SSA or
DHS that there has been a breach of system integrity. or security by the Employer, or a failure
on the part of the Employer to comply with established procedures or legal requirements. The
Employer understands that If it Is a Federal contractor, termination of this MOU by any party for
any reason may negatively affect its performance of its contractual responsibilities.
C. Some or all SSA and DHS responsibilities under this MOU may be performed by
contractor(s), and SSA and DHS may adjust verification respohsibilitles Between each other as
they may determine necessary. By separate agreement with DHS, SSA has agreed to perform
its responsibilities as described in this MOU.
D... Nothing in this MOU is intended, or should be cbnstrued, to'create any right or benefit,
substantive or procedural, enforceable at law by any third party against the United States, its
agencies, officers, or employees, or against the Employer, its agents, officers, or employees.
E. Each party shall be solely responsible for defending any claim or action against it arising
out of or related to E -Verify or this MOU, whether civil or criminal, and for any liability
wherefrom, including (but not limited to) any dispute between the Employer and any other
person or entity regarding the applicability of Section ,403(d) of iIRIRA to any action taken or
allegedly taken by the Employer.
F, The Employer understands that the fact df its participation in E -Verify is not confidential
information and may be disclosed as authorized or required by law and DHS or SSA policy,
including 'but not limited to, Congressional oversight, E -Verify publicity and media inquiries,
determinations of compliance with Federal contractual requirements, and responses to inquiries
under the Freedom of Information Act (FOIA).
G. The foregoing constitutes the full agreement on this subject between DHS and the
Employer.
H. The individuals whose signatures appear below represent that they are authorized to
enter into this MOU on behalf of the Employer and DHS respectively.
Page 10 of 131E-Venty MMU foremployedRe<Ision pate 1rvzS W
Company 10 Number: 211168
To be accepted as a pqrficipant in 5 -Verify, you :should only sign the Employer's Section
of the signature page. it you have any questions, contact E -Verify at -880-464421 8.
Emptay6r Nip Kelley Equfpmewrompany, Inc.
Vince Keliq
Name (Pice.se Type or Print)
E7
Signature
Department of Hornaland Security - Verification Division
USCIS Verification Division
flares (Please Typp. or Pilni)
signature
Page 11 of 0IF-Verily MOO (or Emooye.flRevislon Date WM'09
()SM/2009
Date
Date
SE,,
-Verffy
Company 10 Number: 211168
To be accepted as a pqrficipant in 5 -Verify, you :should only sign the Employer's Section
of the signature page. it you have any questions, contact E -Verify at -880-464421 8.
Emptay6r Nip Kelley Equfpmewrompany, Inc.
Vince Keliq
Name (Pice.se Type or Print)
E7
Signature
Department of Hornaland Security - Verification Division
USCIS Verification Division
flares (Please Typp. or Pilni)
signature
Page 11 of 0IF-Verily MOO (or Emooye.flRevislon Date WM'09
()SM/2009
Date
Date
3 F0
Company I D Number: 2111168
Information Required for the E -Verify Program
Information relating to your Company:
Company Name: N' fp-Kelley Equipment 0ot-ppanyinc,
company rdoility Address, 41 North $prigg
Cape Girardeau. MO 63761
Company Alternate
Addresw.
County or Parish: CAPEWRARDEAU
Employer Identification
Number. 431086200
North American Industry -
Classification Systems
Code: 237
.Parent Company. NIP.Kelley Equipment Company, Inc.
Number of Ej--npluya9,9-. 2D to 99
Number of Sites Verified
for. I
Are you verifying for more thah I site? if yes, please provIdath6 number of sites verified fir in
each State:
IP MISSOURI 1 site($)
page 12 of I 3jE-kfadiy MOU for Fj-r.,p!oyeYjRN,.!w Gala 10142W -W
Company ID Number: 211168
Information relating to the Program Administrator(s) for -your. Company on policy -questions or
operational problems:
Name-, Stacl L Pepple
Telephone Number (573) 334 - 0553 Fax Number (M) 334- 2025
E-mail Address: spepple@nipkelleyco.com
Name: Vince L 61ley
Telephone Number: (573) 334 - 0553 Fax Number. (573) 334 - 2021�
E-mail , 11 Address., vkelley@nipkelleyed.com *
Page 13 af'l 31E-Voil-ify MOU for Eir.,ployerlRevisiai Date 10.12a,)08
U
Company ID Number: 211168
Information relating to the Program Administrator(s) for -your. Company on policy -questions or
operational problems:
Name-, Stacl L Pepple
Telephone Number (573) 334 - 0553 Fax Number (M) 334- 2025
E-mail Address: spepple@nipkelleyco.com
Name: Vince L 61ley
Telephone Number: (573) 334 - 0553 Fax Number. (573) 334 - 2021�
E-mail , 11 Address., vkelley@nipkelleyed.com *
Page 13 af'l 31E-Voil-ify MOU for Eir.,ployerlRevisiai Date 10.12a,)08
s 11:
•■11 i * "RUIZ
COMMS NOW (Name) Vince Kelley as (offs r
.11,q President
of (C0=1M11Y24==,C=b=t4 Nip Kelley Equipment Co_ ,aJ4Wmtbeing &ATswotn, on
ray oath, affitm ia connection widh the contracted services related to Water Plant No. 2
Clearwell p-ij Name) for the dura im o£the tong as £allows:
Ask
i • n • -r•r. • • . _ * i `Iq� .�a Via+ .:_,g1• .p_•,�r. a■ • i wnr • • -_ . `.v. • rs 1 • - • .a .- al -
Project The construction safety program sbaU iucTnde a course in constm tion safety and hmitft,
that is approved by OSHA. or a similar program approv-ed by t� Missouti Department o£Labor and
rndnctri-A Rrlations which is at least as stringent as an approved OSHA progtana as requited by.
Section. 292675, RSMo.
r •v' •. net Ya:• al •. c tr:• u- \.1- •• •a u- a • •nn:., - :. ■ :. •• e•f
292-675, ■ 1 •
3. Conftactnt acknowledges and agmez that any of CuIes employees found on
t. - P • - sitewithoutdocamtntation of the Y. r w ! C01hpledm of •• 1 ....! • tsifety
r • yr_.••-Z'hall . " :• 1 i. u • • u■ ■ ■ • • u■■ �a u ■ • , u , + as 1 ■ . • I • • • :.r
•a� ,r. -gr• _ ! . i ■:q ■ ■' , 1 • , • ru, •v. y1• ■ • ■� • , ••� ■
u - ■ian■wi.■ • a •
- aarl•r�■w
Section. 292-675, RSMo.
S. Cozz#tactot acknowledges thst pursuant to Section 292.675, RSMo., Contractor shall.
•• a ,i1- 110111111 Fall "1\ •• .•,• :• •fir"■ 11111 ■1 •a l ... a •fi.,
li 11 r •, tin wa• •• :u. ••:. •• •,.r n • a r,r•■.r. • • r. rr 1w,•"r
• • • • ■ • a allaw ■ .. . • a YO- -Oak TO • 1 - •M 11 ■1
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• ee - a �■ . ■ • :, .■ . M.N." .: .r. ■• .•• .,. eau .■.
.• aur. Mui :•s gClr�a .i- 0. . a •• - -MM. ■.u,1 .,M- T e3■ • �. r- sn■ w• • • ■
•
u+ ■. +:+a. ■-i ► .+ ■ r ■.t •ni►r + a■ r►■ .I u■r ■+ .an+ :a ►. +r■ as
• • r • • ...r aar. ,.aa • ► . ■■ wa a, u r s av r+r ■u + r, rr ua ■v_
%
r ��r File
IN AFFIRMATION THEREOF, the facts stated above are true and. correct (the
undesigued understands that false statemenft made in this filing are subject to the
P=Itiesprovided in Section 575.04U, RShfo.)
Nip Kegey Equipment Co., Inc.
(name of r� '
By.
(name of
5 ry(oroff=offar)! Frank Myers
r - 013 GORPIQRAT1ON)
G:OT3 Y OF CAPE GWODEAU }
of�) Vince Kelley
President
On this -8:day of -- 4 t4 o i . 2A 3 before me appeared V il4.0 K d ('y a
to me personally known, whob ' by rue duly sworn, did say that pe she is the `(9/161 di r< f
o£' i k*M Cow a AfssouriCorporatian, and that the seat 2Etmd to the
foregwng the seal of said Corporation, and that the said instrame t.was signed and
sealed in behalf of said Cotpom icm by azdhority- of its Board of Directots, and acknowledged said
mstrto be the free act and deed of said Corporation.
7N'CESTIMONX VVEM .oF, I have bea=m set may band and zT=ed my official seal, at
my office in Cape Gam, Musmd, the day and fttst above W t m
i&A
Notary Public
My Commission r
op1tYP(j��
STACI L PEPPI.E
—e'NMAAY.' �'=
�` * * ;
Mydommfss nExpires
SEAL
`
nlary 9, 2017
scoff Cotmt
SAI
COmmissfon#13434217
CITYQfCAPE
G 1 R A R D E A D
Certification :Regarding
Debarment, Suspension and Other Responsibility Matters
The contractor hereby certifies to the best of its knowledge and belief and that it and its principals
and its subcontractors and their principals:
(a) Are not presently debarred, suspended, proposed for debarment, declared ineligible or
voluntarily excluded from covered transactions by any Federal or State department or agency;
(b) Have not within a three (3) year period,preceding this proposal been -convict -A of or had a
civil judgment rendered against them for commission of fraud or a criminal offense in
connection with obtaining, attempting to obtain or performing a public (Federal, State or
Local) transaction or contract under a public transaction; violation of Federal or State antitrust
statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of
records, making false statements or receiving stolen properly;
P4
(c) Are not presently indicted for or otherwise criminally or civilly charged by a government
entity (Federal, State or Local) with commission of any of the offenses enumerated in
paragraph (1)(b) of this certification; and
(d) Have not within a three-year period preceding this subcontract had one or more public
transactions (Federal, State or Local) terminated for cause or default.
1 understand that a false statement on this certification. may be grounds for rejection of this
contractor or termination of the contract. ]In addition, under IS USC Sec. 1001., a false
statement may result in a fine of up to. $10,000 or imprisonment for up to five (S) years or
both.
Vince
Typed NE
lley, President
& Title of Authorized Representative
Representative
Date
Q I am unable to certify to the above statement. My explanation is attached.