HomeMy WebLinkAboutRES.2642.09-06-2011 .
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BILL NO. 11-141 RESOLUTION NO. a� �
A RESOLUTION AUTHORIZING THE CITY MANAGER
TO EXECUTE A CONTRACT WITH JOKERST, INC. ,
FOR THE COUNTY ROAD 618 LIFT STATION AND
FORCE MAIN PROJECT, 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 a
Contract with Jokerst, Inc . , for the County Road 618 Lift
Station and Force Main Project, in the City of Cape Girardeau,
Missouri . A copy of said Contract is attached to this
Resolution and made a part hereof .
PASSED AND ADOPTED THIS � DAY OF , 20 ��
/
Ha� E. ediger, Mayor
� GIRqR�
ATTEST: , ' G4,,4 �'„��
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Gayle . Conrad, City *THE UNI H ��
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SEAL
- ,
CITY OF CAPE GIRARDEAU
COUNTY ROAD 618
LIFT STATION AND FORCE MA/N
STANDARD FORM OF AGREEMENT
BETWEEN OWNER AND CONTRACTOR
ON THE BASIS OF A STIPULATED PRICE
THIS AGREEMENT is dated as of the �Br.� day of C����R in the year
2011 by and befinreen the City of Cape Girardeau, Missouri (hereinafter called OWNER)
and Jokerst, Inc. (hereinafter called CONTRACTOR).
OWNER and CONTRACTOR, in consideration of the mutual covenants hereinafter set
forth, agree as follows:
Article 1. WORK.
CONTRACTOR shall complete all Work as specified or indicated in the Contract
Documents. The Work is generally described as follows:
The furnishing and installing of a package lift station with concrete wet well,
duplex pumps, electrical service, controls, SCADA equipment and perimeter
fence. Site work includes grading, concrete box culvert ditch crossing and
gravel surface access drive.Approximately 49 If of 8-inch gravity sewer, one
manhole and 850 If of 3-inch force main are also included. Work shall be
completely compatible with existing pump stations and SCADA equipment.
The project shall include any other appurtenances as specified in the bid
documents for the City of Cape Girardeau, Missouri.
Article 2. ENGINEER.
The City Engineer or his 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 Ninetv (90) 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 One hundred twenty (120) days after
the date when the Contract Times commence to run.
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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
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 Seven hundred dollars ($700.00) for
each day that expires after the time specified in paragraph 3.1 for Substantial 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 Seven hundred dollars
($700.00) for each day that expires after the time specified in paragraph 3.1 for
completion and readiness for final payment.
Article 4. CONTRACT PRICE.
OWNER shall pay CONTRACTOR for completion of the Work in accordance with the
Contract Documents an amount in current funds equal to the sum of the amounts
determined pursuant to paragraphs 4.1 and 4.2 below:
4.2 for all Unit Price Work, an amount equal to the sum of the established unit price for
each separately identified item of Unit Price Work times the estimated quantity of that item
as indicated in the bidding documents.
TOTAL OF ALL UNIT PRICES: one hundred and fifty thousand dollars and no cents
($ 150,000.00)
As provided in paragraph 11.9 of the General Conditions estimated quantities are not
guaranteed, and determinations of actual quantities and classification are to be made by
ENGINEER as provided in paragraph 9.10 of the General Conditions. Unit prices have
been computed as provided in paragraph 11.9.2 of the General Conditions.
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
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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
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 Fina/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".
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7.2 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
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 fiurnishing 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:
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8.1 This Agreement (pages 1 to 7 inclusive).
8.2 Exhibits to this Agreement (pages BF- to BF- , inclusive).
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).
8.7 Specifications bearing the title County Road 618 Lift Station and Force Main .
8.8 Drawings.
8.9 Addenda numbers 1 to 2 , inclusive.
8.10 CONTRACTOR'S Bid (pages BF- 1 to BF- 8 , inclusive) 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.
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Article 9. MISCELLANEOUS.
9.1 Terms used in this Agreement which 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.
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 ��Pr�nj�f � , 2011 (which is the
Effective Date of the Agreement).
OWNER City of Cape Girardeau CONTRACTOR
Scott Me e i ana er Jokerst, Inc. -
By: .l, . � c��JL1L.I.�NN `�. -'.TC?�ER�T= '
[CO PO S L) [CORP RATE SEAL_J --���'RES�DENF.—_
� � - .. -�.
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Attest � Attest . �y,f, `"r l. C'���',�,�� __
Gayle Conrad, City Clerk
Address for giving notices Address for giving notices
401 Independence Street 16444 HIGHWAY 32
Cape Girardeau, MO 63703 STE. GENEVIEVE, Mo. 63670
(If OWNER is a public body, attach License No.
evidence of authority to sign and
resolution or other documents Agent for service of process:
authofi ' execution of Agreement.
�GIRA
�,,t (If CONTRACTOR is corporation,
attach evidence of authority to sign.)
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BEAL
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� �
Exhiblt "A"
� CITY OF CAPE GIRARDEAU
COUNTY ROAD 618
� LIFT STATION AND FORCE MAIN
� BID FORM
(EJCDC 1910-18) (1990)
� PROJECT IDENTIFICATION: The improvement consists of furnishing and installing a
package lift station with concrete wet well, duplex pumps, electrical service, controls,
� SCADA equipment and perimeter fence. Site work includes grading, concrete box culvert
ditch crossing and gravel surface access drive.Approximately 49 If of 8-inch gravity sewer,
one manhole and 850 If of 3-inch force main are also included. Work shall be completely
� compatible with existing pump stations and SCADA equipment. The project shall include
any other appurtenances as specified in the bid documents for the City of Cape Girardeau,
Missouri.
� THIS BID IS SUBMITTED TO 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 ofi the terms and conditions-�f#he A�dvertisement-orinvi#ation to 81d - - -
� 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, f@C@IPt Of aII WIIICh IS Il@f2IJy aCICf10WI2CIg2CJ: �List Addenda by Addendum Numba and Date)
�
� BF-1
�
, '
ADDENDUM #1 - AUGUST 11, 2011 _ �
ADDIIVDUM #2 - AUGUST 18, 2011
i
(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 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.
(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.
(fl 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 I
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 I
and conditions for performing and furnishing the Work for which this Bid is submitted.
B F-2 �
�
�' •
� Any questions, comments, or concerns regarding the design of this project should be
addressed to David Whitaker, P.E., City of Cape Girardeau at 573-339-6327.
' (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
r
• 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 work
in connection with the services requested herein.
� • http://www.uscis.qov/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_io pc�uide,and require its on-site employees#o complete, a#en(10j 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.
�
M
I
� BF-3
�
4. BIDDER will complete the Work in accordance with the Contract Documents for the
following price(s):
UNIT PRICE BID
NO ITEM UNIT EST. UNIT TOTAL
Q-N. PRICE EST. PRICE
1. Removal of Existing LS 1 $�- d � ����,�D
Improvements
2. Mobilization �S 1 $ � d p $ ��Q.O 0
3. Furnish and Install Package LS 1 $b_��� ���f�g� �,
Lift Station, Complete
4. Fumish and Install SCADA LS 1 $ t Q� � ``� � V p I
System, Complete — '�� `
5. Furnish and Install Electrical LS 1 ��o-�.�� $ C,
Service, Complete - - I
. 6. Furnish and Install 3-inch_ -' LF 850 V $ 8. s � $����dd
Force Main, Complete -
I, I� 7. Furnish and I�stall 8-inch LF 49 ';' � �
Gravity Sewer Connection,
Complete I
8. Construct Standard 4-foot EA 1 $ � Q� � $ ���$���d
Diameter Manhole, Complete
9. Adjust Existing Manhole, EA 1 I
_ $ 0. U $ �G. � _ _ _ --- _
Complete
10. Construct 4 x 10 Box Culvert �s � � ` �p�,�p ��� - ,GD I
and Wing Walls, Complete
11. Construct Gravel Access TONS 190 � ��.,(�p � /-�. J$D p0 �
Drive, Complete —�-�—
12. Construct Chain Link Fence LF 224 � $ —� p� �
and Gate, Complete
13. Install Electric Fence Gate, LS 1 � � � � d �
Complete
14. Temporary Erosion Controls, LS 1 $ �Q��,c�c.� �v� $ 1 r���� '
Complete �t;
15. Seed/Straw all Disturbed ACRE 1.2 � �11C��,,�Q �����
Areas, Complete �
B F-4 '
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16. Rock excavation CY 0 $ 150.00 $ Q
TOTAL BID FOR ALL UNIT PRICES � l��f �DO. CO�
��� ,�i-.�, �� 1� �Z�� �i��CtTldr�.�'�.�`✓1c. /�rl
�
�� �.r�-' PQ.�,,�
(Written figure)
(Total bid amount is to be shown in both words and figures. In case of discrepancy, the
amount shown in words will govern. In case of error in extension, the unit and lump sum
prices under each Pay Item will be considered correct, and these sums when properly
extended, shall constitute the Bid.)
Unit Prices have been computed in accordance with paragraph 11.9.2 of the General
Conditions.
BIDDER acknowledges that quantities are not guaranteed and final paymentwill be based
on actual quantities determined as provided in the Contract Documents.
5. BIDDER agrees that the Work will be substantially complete within Ninetv days (90)
calendar days after the date when the Contract Times commences 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 One hundred finrenty
. davs (120) 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) Any Addenda issued.
(c) Exhibit Affidavit of Work Authorization
(d) Exhibit Affidavit of Excessive Unemployment (if applicable)
(e) The E-Verify Program for Unemployment Verification Memorandum of
Understanding http�//www uscis qov/files/nativedocuments/MOU.pdf
(fl Exhibit Affidavit of OSHA Training
(g) Certification Regarding Debarment, Suspension and Other Responsibility Matters
BF-5
7. Bidder agrees to submit the following documents within three (3) business days after
the opening of Bads if requested:
(a) BIDDER'S Qualification Statement with supporting data.
8. Communications concerning this Bid shall be addressed to:
Name DARRELL HIBBITS OR TIMOTHY JOKERST
Address 16444 HIGHWAY 32 STE. GENEVIEVE, M0. 63670
(a) Performance and Payment Bonding Company
Name
Address
Agent\Power of Attorney Name (if used)
Address
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.
SUBMITTED on AUGUST 24 � 2011
State Contractor License No.
_ _ - 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:
B F-6
Phone No.:
�aspro+uox
A Corporation �•'
��=.�° _
B JOKERST, INC. v-,� ��A `
Y '���� ��a °° `.
(Corporation Name) �' `''
�.� 1,x
MISSOURI r �; ' � � , __,3�
(State of Incorporation) . �'-� r'F "
.- � � �y
By LYNN M. SCHREMP ` '�'S EAL�` ,r�r`�4y
(Name of Person Authorized to Sign) "`" '•��`,Y�v°
VICE PRESIDENT �'� .: �,��'
(Title)
(Corporate Seal)
Attest ���. v.,f,t.L� KIM M. WEILER
(Secretary)
Business address: 16444 HIGHWAY 32
STE. GIIVEVIEVE, M0. 63670
Phone No.: (573)883-7401
Date of Qualification to do business is 19�2
. A Joint Venture
BY (SEAL)
(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.)
B F-7
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:
_ �i� w��Rl�
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_ �G'i2G�t� m ,�,�✓
�/`? �/� 7/ �✓
It is anticipated that the following subcontractors will be employed for work on this project:
*SUBCONTRACTORS:
(Name of Company) (Type of Work�
-�� _ � ,
- .- I �r��s�i� vNS`T c�/�N' ��.if� �G,� '��---�,�
:��i��' G�- ri 1 x-r'i(Z! n�' � �,C�C'�T y��C
*All subcontractors shall be registered with the Missouri Secretary of State in order to work
on this project.
B F-8
' ' . ;
� THE AMERICAN INSTITUTE OF ARCHITECTS
AIA Document A310
� � Bid Bond
KNOW ALL MEN BY THESE PRESENTS,thatwe .lokHese ns rtfuilnameandaddressorlegaltitleofContractor)
16444 Hwy 32
Ste Genevieve MO 63671
as Principai, hereinafter called the Principal, and American Southern Insurance Company
(Here insert full name and address or legal title of Surety)
1301 Hightower Trail Ste 210
Atlanta GA 30350
a corporation duly organized under the laws of the State of Kansas
as Surety, hereinafter called the Surety,are held and firmly bound unto City of Cape Girardeau, MO
(Here insert full name and address or legal title of Owner)
as Obiigee, hereinafter called the Obligee, in the sum of Five Percent of Amount Bid Not to Exceed Seven
Thousand Five Hundred and no/100
Do�lars($ 7,500.00
),for the payment of which sum well and truly to be made,the said Principal and the said Surery,bind ourselves,our
heirs,executors,administrators,successors and assigns,jointly and severally,firmly by these presents.
WHEREAS, the Principal has submitted a bid for County Road 618 Lift Station and Force Main
(Here insert fuli name,address and description of project)
---_ _
-
NOW, THEREFORE, if the Obligee shall accept the bid of thE-Principal and the P{incipal shall enter into a_ _on_rac_ _ _ _
with the Obligee in accordance with the terms of such bid, and give such bond or bonds as may be specified in the bidding
or Contract Documents with good and sufficient surety for the faithful performance of such Contract and for the prompt
payment of labor and material furnished in the prosecution thereof, or in the event of the failure of the Principal to enter
such Contract and give such bond or bonds, if the Principal shall pay to the Obligee the difference not to exceed the penalty
hereof between the amount specified in said bid and such larger amount for which the Obligee may in good faith contract
with another party to perform the Work covered by said bid, then this obligation shail be null and void, otherwise to remain
in full force and effect. �"°"�°`
Signed and sealed this 24th dayof August � '��':�•}�••._`,
`r �.,
���o �� .. ., ..
\� Jokerst Inc. �"°� ,V`j. �'� — .
�/ �i � r}-� �'�-`'�,.
'''V t� //� J_ p „ (Principal� 'z �,:n(S�1�'� " - ..
V \Jl.L(�v� ' � . � u �
1/�����'�,�''�>� ,
(Witness) "'"a �` ,
(Title)
. � �'= o . . .s
American Southern 1ns�,irance Qo'Fnpany
' ��.�;'r y) (Seal)
�':
(Witness) .—. � �
F ; r ,,.1,It�8� .'.
_ � 1 �f �.. ,��� ' � .
� David'�.,Br�tt� A�orney-in�Fact
AIA DOCUMENT A310-B1D BOND-AIA 310-FEBRUARY 1970 ED • THE AMERICAN ' �
iNST1TUTE OF ARCHITECTS,1735 N.Y.AVE.,N.W.,WASHTNGTON,D.C.20006 '` , ;: _
� Printed on Recycled Paper 9/93
AMERICAN SOUTHERN INSURANCE COMPANY � , � �
Home Office: 3715 Northside Parkway, NW Mailing Address: P. O. Box 723030
Bldg. 400, Suite 800 Atlanta, GA 31139-0030
Atlanta, Georgia 30327
GENERAL POWER OF ATTORNEY
Know all men by these Presents, that the American Southern Insurance Company had made, constituted and
appointed, and by these presents does make, constitute and appoint Stefan E. Tauger of Parker, Colorado; Donald J. Kersey
of Birmingham, Alabama; Arthur S. Johnson of Atlanta, Georgia; Donald H. Gibbs of Atlanta, Georgia; Andrew C. Heaner of
Atlanta, Georgia; Richard L. Shanahan of Atlanta, Georgia; Jeffery L. Booth of Parma, Ohio; James E. Feldner of West Lake,
Ohio; Cheryl L. Torrao of Lutz, Florida; Garry W. Black of Murfreesboro, Tennessee; Martha G. Ross of Charlotte, North
Carolina; David R. Brett of Columbia, South Carolina; Melanie J. Stokes of Atlanta, Georgia; Jason S. Centrella of
Jacksonville, Florida; Brian Clark of Matthews, North Carolina; Michael K. Thompson of Atlanta, Georgia; Julie Klinner of
Birmingham, Alabama; Kelley E.M. Nys of Decatur, Georgia; or Diane L. McLain of Fitchburg, Wisconsin, EACH as its true
and lawful attorney for it and its name, place and stead to execute on behalf of the said company, as surety, bonds,
undertakings and contracts of suretyship to be given to all obligees provided that no bond or undertaking or contract of
suretyship executed under this authority shall exceed in amount of the sum of$1,000,000 (one million dollars), including but
not limited to consents of surety for the release of retained percentages and/or final estimates on construction contracts or
similar authority requested by the Department of Transportation, State of Florida; and the execution of such undertakings,
bonds, recognizances and other surety obligations, in pursuance of the presents, shall be as binding upon the Company as if
they had been duly signed by the President and attested by the Secretary of the Company in their own proper persons.
This Power of Attorney is granted and is signed and sealed by facsimile under and by the authority of the following
Resolution adopted pursuant to due authorization by the Executive Committee of the Board of Directors of the American
Southern Insurance Company on the 26th day of May, 1998:
RESOLVED, that the Chairman, President or any Vice President of the Company be, and that each or any of them
hereby is, authorized to execute Powers of Attorney qualifying the attorney named in the given Power of Attorney to execute
in behalf of the American Southern Insurance Company bonds, undertakings and all contracts of suretyship; and that any
Secretary or any Assistant Secretary be, and that each or any of them hereby is, authorized to attest the execution of any
such Power of Attorney, and to attach thereto the seal of the Company.
FURTHER RESOLVED, that the signature of such officers and the seal of the Company may be affixed to any such
Power of Attorney or to any certificate relating thereto by facsimile, and any such Power of Attorney or certificate bearing
such facsimile signatures or facsimile-seal-shaA be-valid--andbinding upon the Company when so affixed and in the future,
with respect to any bond undertaking or contract of suretyship to which it is attached.
In Witness Whereof, the American Southern Insurance Company has caused its official seal to be��h�e�etb�a6f�,ed, and
these presents to be signed by its President and attested by its Secretary this 4th day of Februarv, 2011��`�„r� T. �'� _'��,,�
;���, ...... ,,�i��',,
Attest: ;�.'- ' '-� American Southem Insurance Com�i� ' �• ,y �
_�.�'' '�✓� �'��=�.i By: _� :'t*1(j T!�4'�v�'•�'i�v=
Gail A. Lee, Secretary , / _ = �� � '
Scott . Thompson, President ;�:;R U a�-� `�:•CS�
STATE OF GEORGIA ��'F �•�, ,.•'��\��
SS: ,����'��••..,.. �� �`��
COUNTY OF FULTON �� u ��
On this 4th day of Februarv, 2011, before me personally came Scott G.Thompson to me known,who being by me duly swdrry� ���gP`��'and say
that he resides in Atlanta, in the County of Fulton, State of Georgia, at 421 Hollydale Court; that he is the President of American du4�ern Insurance
Company,the corporation described in and which executed the above instrument;that he knows the seal of the said corporation;that the seal a ixed to the
said instrument is such corporate seal;that it was so affixed and that he signed;h s'name thereto pursuant to due authorization
, ' Canda�e T.Cheatham i
STATE OF GEORGIA Notary Pubiic,State of Georgia
SS: , �ualified in DeKalb County �
COUNTY OF FULTON Co�mission Expires December 7,2013
,-" t,,.V� .
I,the undersigned, a Vice President of American Sputhefn In�ut�+'i�e"y,�ompany, a,Kansas Corporation, DO HEREBY CERTIFY that the foregoing
and attached Power of Attorney remains in full force and has,r1ot be�ri'reY��ed; and, furthermore, that the Resolution of the Executive Committee of the
Board of Directors set forth in the Power of Attomey is now in fpfce. ' q � <' p
ri ' ' ` ' :
Signed and sealed at the City of Atlanta,Dated 4he 241`1?lday of At�t� 2011.
John R. u
Power 25062 Vice President
American Southern Iusurance Compan},
NAIC Company Code 1023�
NATC Group Code�37
Statutor}�Financi.l�Sf:1�C111Cl1t
As of Deccmbcr 31, 2010
LIABII,I'I'IGS
ASSCTS
13onds
$G2,S32,979 Rcscrve for Lossc:s and Loss E�pcnsc �31,)50,255
Stocks
22,G38,217 1Zeserve for[Jnearned Premiums 17,b5G,�)3G
Casli and Short-Tcrm Investmenls ��
-078,377 Reseive for Lspenses,Taxes,Licenses and Pees 3,SS4,183
Agcnts I3alances
4,GO1,538 I'ayable to Parents,SubsiJiaries and AfFliates 2�3.Z�3
Other Assels
2,411,017 OLherLiaUilities 5,395,757
ReccivaUles for securities
4,084,764 Tofal Liabililics 59,390,3G4
POLICYIIOLDC[LS' SURPLUS
Capital Stock 3,000,000
' Suiplus 35,71 G,523
Total Policyholdcrs' Smplus 38,71 G,528
7'ol:sl Assets $98,]06,892 Tot:ii liaUilities and Policyholders'Smplus $95,106,892
IIonds and s[ocks are valued in accordance with the hasis adopled by lhe National Associatio»of Insurance Commissioners(NA1C).
C�RTIrICATG
. _ _ _ - - _ _ _ _ _ .
_ -_ - --
llic officcrs of tltis reporting entity being duly swo�r,cach dcpose and say lhal thcy arc lhe dcscriUcd officers of s•rid rePorling entity,an t�al
on lhe reporling period staled aUove,all of lhe l�erein described assets were the absohde property of lhe said reporting entity,free and clear from
any tiens or cluims ihereon,except as herein sLaled,and lhat this slalement,togelher with relaced exhiUits,schedules and cxplanations therein
containcd,anncxed or rcferred to,is a full and true statcmcnt of all lhc asscis and 1iaUilitics and of fhe condition and affairs of the said reporting
cntily as of lhc rcporling period slatcd above,anJ of its income and deJuclious Lhcrefrom for lhc period ended,and have Ucen completcd in
accordancc wilh lhe NAIC Annual Statement h�sn�uccions and Accomiting Praclices and Procedure.e manual excepl to the exlent lhat:(1)state
law niay difCer;or,(2)that state rules or rc;ulations rcquire diffcrences in rcporting not rclatcd to accountiug practices and procedures,according
to the Uest oE lheir information,knowledge and Uclicf,respcctively. F%�
� •
Chief Pina�cia licei
Pr Jcn
Statc ot'Gcorgia
Counly oF Fullon
On ihc 2Sth day of Fcbruaiy 201 1,bcforc mc camc thc abovc naincd ofliccrs of lhc Amcrican Southcrn Insurancc Compairy��n�c personally
kno�vn u�hc thc individuals and officers dcscrihcd hcrcin,and�cknowlcdgc that thcy cxcculcd thc forcgoin�instrumcnt and alCxcd thc scal of
said company thcrcto by authority of thcir of�cc.
Mcic�nic Cn�ipola,Not�ry Puhlic
nd)�Conunission Expires, May 17,2014
�' .
� EXHIBIT
AFFIDAVIT OF WORK AUTHORIZATION
� COMES NOW (Name) LYNN M. SCHREMP as (Office Held) VICE PRESIDENT
of(Company Name/Contractor) JOKERST INC. and first being duly sworn, on
, my oath, affirm as follows:
1. (Company Name/Contractor) JOKERST, INC.
, is enrolled and will continue to participate in a federal work authorization program in respect to
emp�loyees that will work in connection with the contracted services related to (Project Name)
CITY OF CAPE GIRARDEAU COUNTY
� RnAT1 h1 R T TFT �TATT�N ANl] for the duration of the contract in accordance with RSMo
gORCE�I�� 2
Chapter ( )•
� 2. I also aEflrm tI'►at (Company Name/Contractor) JOKERST, I1�1C. does
not and will not knowuzgly employ a person who is an unauthorized alien in connection with the
�IZyI(�g Cp,pEF�IRAR� COUNTY ROAD 618 Llfo
� contract services related to (Project Name) TAT N AND R�E
the duration of the contsact.
3. Attached hereto is documentation affirming Contractor's enrollment and
participation in a federal work authorization program with respect to the employees working in
connection with the contracted services.
FURTHER AFFIANT SAITH NOT.
IN AFFIRMATION THEREOF, the facts stated above are true and correct (the
-_ ____ _ _ <
_ _
undersigned understands that false statements made iri`'tfiis fili�g are -su��ect-to e
penalties provided in Section 575.040, RSMo.)
JOKERST, INC.
(name of corporation)
, ; z By: p`�(.X,.�, m -�"�`^l�
LYNN M. SCHREMP/VICE PRE
a''� '�, ' (n e of officer of corporation and tide)
�` y�ef �r
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($E�AL�,QF CORPORATION)
I
STATE OF MISSOURI )
) ss. I
COUNTY OF )
STE. GENEVI �
On this��' day of �,� , 20� before me appeared k- ��, � , '
to me er onall�y known,who`,be g by me duly sworn,did say that he/sh is the � - � "
of���+�r���.���k.-� . , a Missouri Corporation, and that the seal affixed to the
foregoing instrument is the seal of said Corporation, and that the said instrument was signed and
sealed in behalf of said Corporation by authoriry of its Board of Directors, and acknowledged said
instrument to be the free act and deed of said Corporation.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my offi 'al seal, at
rny office in Cape Girardeau, Missouri, the day and:year first above written.
( , � �
� ���� � ,
Notary P lic �
.o'�•�.�(,�s s CYNTHIA E.KER1Z �
My Commission Expires: _z:'Np� �c�- h�lyCommissionExpires
=*' ��-*.= 3eptember9,2011
9 �) /� / .'�'�. 3�1k-•; a Ste.Genevieve County
� / � / ( '���,;� COmmission#07419342 �
_ _ _ ' .
�
�
� '
� EXHIBIT
AFFIDAVIT REGARDING EXCESSIVE UNEMPLOYMENT
� COMES NOW (Name) LYNN M. SCHREMP as (Office Held) VICE PRE�IDENT
of(Company Name/Contractor) JOKERST, INC. and first being duly sworn, on
� my oath, affirm as follows:
1. Whenever there is a period of excessive unemployment in the State of Missouri, as
� defined in Section 290.550, et seq., RSMo, the contractor will comply with all of the provisions of
this Statute in res ect to em lo ees that will work in connection with the contracted services related
�ITY OF �E GIRARDEAU COUNTY ROAD
� to (Project Name) 618 LIFT STATION AND FORCE MAIN for the duration of the contract.
2. I also affirm that(Company Name/Contractor) JOKERST, INC.
� does not and will not knowingly employ a laborer who is not a "Missouri Laborer" or a "Laborer
from a Nonrestrictive State", as those terms are defined in Section 290.550, et seq., RSMo, except
� that other laborers may be used if such required laborers are not available, or are incapable of
performing that particular type of worked involved, if so certified by the contractor and approved by
� the City of Cape Girardeau, or unless otherwise pernutted by that Statute, in connection with the
contracted services related to (Projecc Name) 6I8-LQ����ivr A1�U"��RGE��e duration of the
� contract.
FURTHER AFFIANT SAITH NOT.
�
IN AFFIRMATION THEREOF, the facts stated above are true and correct (the
� undersigned understands that false statements made in this filing are subject to the
penalties provided in Section 575.040, RSMo.)
� JOKERST, INC.
(name of coiporation)
� gY: "� � /� LYNN M. SCHREMP/VTCE
(nam oE officer of corporation a d tide) P�S
.�' ' " "
� �'`� `
�" .,o..; „
.
G/`y:s y �,�t�r
`.�/��,�.1.��Z,�r r.
��� � ..
,��' £ i` I�7 �;/ (- •Zl.�t1�/
' `�°�;�� �'=>
��ja'�ec4eCary�a7 othtr"�f�tcer)
��'' �'�. ``�" � ;
'�� ry.
�`p .. .a n��+.�`�y
�
(SEAI:�F`CORPORATION)
' . ^ �
I
I
STATE OF MISSOURI )
) ss. I
COUNTY OF )
�TE. GIIVEVI � � �
3 '
On th.i '�day of Z �� , 201,�before me appeared h11 h�� � �"� �ly'�;��'
to mel�per onally kn�.vvn,who, be� g by me duly sworn, did say that he/she is e � ' ,'`,°
of�/I1 �� n/��!;� , , a Missouri Corporation, and that the seal affixed to the
foregoing instrument is the seal of said Corporation, and that the said instrument was signed and
sealed in behalf of said Corporation by authoxity of its Board of Directors, and acknowledged said
instrument to be the free act and deed of said Corporation.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my official seal, at '
my office in Cape Girardeau, Missouri, the day anc�.ye� first above written.
,� � ,
f �, � � 'i
.� ��:',� � _
Notary Pu 'c
�,,��,,,; �
'�PAY?UBG; �YNTHIA E.KEHTZ �
,d.• R
"='�NOTARY:�'- Nh'�Afnmlesion Expir�s ,
My Commission Expires: _" •- '= �pt�mber9,2011
=y� SEAL. ��
�/ � � '�l ,�'pf M��,��� �M07 183M12 I
_ _ _ _. _
M� . � - .
� EXHIBIT
AFFIDAVIT OF OSHA TRAINING
� COMES NOW (Name) LYNN M. SCHREMP as (Office Held) VICE PRESIDFNT
oE(Company Name/Conuactor) JOKERST� ING _ and first being duly sworn, on
� my oath, affirm in connection with the contracted services related to CITY OF CAPE GIRARDEAU COUNTY
ROAD 618 LIFT�project Name) for the duration of the contract,as follows:
� STATION AND FORCE MAIN
1. Contractor shall provide a ten (10) hour Occupational Safety and Health
Administration (OSHA) consttuction safety program for all employees who will be on-site at the
� Project. The construction safety program shall include a course in construction safety and health
that is approved by OSHA or a similar program approved by the Missouri Department of Labor and
� Industrial Relations which is at least as stringent as an approved OSHA program as required by
Section 292.675, RSMo.
� 2. Contractor shall require its on-site employees to complete a construction safety
program within sixty (60) days after the date work on the Project commences, as required by Section
� 292.675, RSMo.
3. Contractor acknowledges and agrees that any of Contractor's employees found on
� the Project site without documentation of the successful completion of a construction safery
program shall be required to produce such documentation within twenty (20) days, or will be subject
� to removal from the Project.
4. Contractor shall require all of its Subcontractors to comply with the requirements of
_ __ --—
Secrion 292.675, RSMo. . _ _ _ _ __ _ _ _
�
5. Contractor acknowledges that pursuant to Section 292.675, RSMo., Contractox shall
� forfeit to City as a penalry two thousand five hundred dollars ($2,500.000), plus one hundred dollars
($100.00) for each on-site employee employed by Contractor or its Subcontractor, for each calendar
� day, or portion thereof, such on-site employee is employed without the construction safety training
required in Section 292.675, RSMo.
� 6. Contractor acknowledges that violations of Section 292.675, RSMo, and imposition
of the penalties described therein shall be investigated and determined by the Missouri Department
of Labor and Industrial Relations.
7. Contractor acknowledges that in the event that the Missouri Department of Labor
and Industrial Relations has determined that a violation of Section 292.675, RSMo., has occurred
• . , �
and that a penalty shall be assessed, the Ciry shall withhold and retain all sums and amounts due and I
owing when making payments to Contractor under this Contract.
FURTHER AFFLANT SAITH NOT. I
IN AFFIRMATION THEREOF, the facts stated above are true and correct (the +
undersigned understands that false statements made in this filing are subject to the I
penalties provided in Section 575.040, RSMo.) �
JOKERST, TNc.
(name of corporation) I
By: ��� �� / ` �.� LYNN M. SCHREMP/VICE PRES
(name of officer of corporahon and tide) i
A'I`TEST: . , ! �
yvt�. �(,.t,�,�L' �
Secretary(or other officer) ,
(SEAL OF CORPORATION) ,
STAT'E OF MISSOURI ) �
) ss. ,
_ _ COUNTY OF _ _ � : _
STE. GENEVI
On this ��day of %-��, - , 20� before me appeared Ll� YL- ✓'� `�� J`�� •
to me pe sona�y known,ho,�be� g by rne duly sworn, did say that he/she�'s the � '-�
of � C ���-�`S� � l�ti * , a Missouri Corporarion, and that the seal affixed to the
foregoing instrument is the seal of said Corporation, and that the said instrument was signed and
sealed in behalf of said Corporation by authority of its Board of Directors, and acknowledged said
instrument to be the free act and deed of said Corporation.
IN TESTIMONY WHEREOF, I have h�unto set my hand and affixed y official seal, at
my office in Cape Girardeau, Missouri, the day�nd yea# first above writt
v , ,_ , �� _
-�,� �..� � ���
Notary Py�lic f
My Commission Expires:
�:�pgY P(jB, CYNTHIA E.KERTZ
�% �� ��/ ;��•'����''G�: My Commission Expires
=* , �T�:*- Sepfember 9,2011
��'•. SEAL.��': Ste.Genevieve Coun
"9�,•....••o, ry
� ,OFM\`��,'' Commission#07419342
• ��,rA'yh ,�, C(`J
f„ � ,� � .
� _ � � ���iy.��
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�1ko 5�� 1rI�IS.�.Rw
� ... tw 6-VEAIFY IS A SERJICE OF DHS
Company ID Number: 200980
THE E-VERIFY PROGRAM FOR EMPLOYMENT VERIFICATION MEMORANDUM OF
UNDERSTANDING FOR DESIGNATED AGENTS
ARTICLE I
PURPOSE AND AUTHORITY
The parties to this Agreement are the Department of Homeland Security (DHS), and JOKERST,
INC. (Designated Agent). The purpose of this Agreement is to set forth terms by which SSA and
DHS will provide information to JOKERST. INC. (Designated Agent) on behalf of the
Designated Agent's client (the Employer). This MOU explains certain features of the E-Verify
program and enumerates specific responsibilities of DHS, SSA, the Employer, and the
Designated Agent. References to the Employer include the Designated Agent when acting on
behalf of 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 I-9). For covered government contractors, E-Verify is used to verify the
employment eligibility of all newly hired employees and all existing employees assigned to
Federal contracts.
The Employer is not a party to this MOU. The E-Verify program requires an initial agreement
between DHS and the Designated Agent as part of the enrollment process. After agreeing to the
MOU as set forth herein, completing the tutorial, and obtaining access to E-Verify as a
Designated Agent, the Designated Agent will be given an opportunity to add a client once
logged into E-Verify. All parties, including the Employer, will then be required to sign and submit
a new MOU. The responsibilities of the parties remain the same in each MOU.
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. 104-208, 110 Stat. 3009, as
_ _amendesl�8 U.�.C,_§ 1324_a—_noie).___Authority__f�r use_ of..tk�E_ E-Ver_ify_progcam._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 II
FUNCTIONS TO BE PERFORMED
A. RESPONSIBILITIES OF SSA
1. SSA agrees to provide the Employer (through the Designated Agent) with
available information that will allow 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 the Employer and Designated Agent appropriate
assistance with operational problems that may arise during the Employer's
participation in the E-Verify program. SSA agrees to provide the Designated Agent
with names, titles, addresses, and telephone numbers of SSA representatives to
be contacted during the E-Verify process.
Page 1 of 15�E-Verlfy MOU for qesigna?e�Agent�Revisian Uate10;291�i8 �� �;��.������,-;`��.-�<��,#.�
, �EQr-`f +�L li(`J? , .
� � �'�/i�.§m�
��� ��, t� ����!i�l���,�
���NO �� St
p� E-VBAIFY ?S A SER.VICE OF DHS
Company ID Number: 200980
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 persons 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).
4. SSA 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 SSA tentative
nonconfirmations that is designed to provide final confirmation or nonconfirmation
of U.S. citizens' employment eligibility 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 (through the Designated Agent) access to selected
data from DHS's databases to enable the Employer (through the Designated
Agent) to conduct, to the extent authorized by this MOU:
• Automated verification checks on alien employees by electronic means,
_ __ __ _ - _ _ _ _
. _ _ and
• Photo verification checks (when available) on employees.
2. DHS agrees to provide to the Employer and Designated Agent appropriate
assistance with operational problems that may arise during the Employer's
participation in the E-Verify program. DHS agrees to provide the Designated Agent
names, titles, addresses, and telephone numbers of DHS representatives to be
contacted during the E-Verify process.
3. DHS agrees to provide to the Employer (through the Designated Agent), the E-
Verify User Manual containing instructions on E-Verify policies, procedures and
requirements for both SSA and DHS, 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 (through the Designated Agent) a notice,
which indicates the Employer's participation in the E-Verify program. DHS also
agrees to provide to the Emp�oyer (through the Designated Agent) 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.
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5. DHS agrees to issue the Designated Agent a user identification number and
password that will be used exclusively by the Designated Agent, on behalf of the
Employer, to verify information provided by alien employees with DHS's databases.
6. DHS agrees to safeguard the information provided to DHS by the Employer
(through the Designated Agent), and to limit access to such information to
individuals responsible for the verification of alien employment eligibility and for
evaluation of the E-Verify program, or to such other persons or entities as may be
authorized by applicable law. Information will 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 to administer 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
nonconfirmation of employees' employment eligibility within 3 Federal Government
workdays 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 nonconfirmations that is designed
to provide 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 10 days may be necessary. In such cases,
DHS will provide additional verification instructions.
C. RESPONSIBILITIES OF THE EMPLOYER
1. The Employer shall display the notices supplied by DHS (through the Designated
Agent) in a prominent place that is clearly visible to prospective employees and all
--__ __ _ —__ __ _
employees who are to be verified through fhe system.
2. The Employer shall provide to the SSA and DHS the names, titles, addresses, and
telephone numbers of the Employer representatives to be contacted regarding E-
Verify.
3. The Employer shall become familiar with and comply with the most recent version
of the E-Verify User Manual. The Employer will obtain the E-Verify User Manual
from the Designated Agent.
4. The Employer shall comply with current Form I-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
I-9 process to establish identity.) If an employee objects to the photo
requirement for religious reasons, the Employer should contact E-Verify at
1-888-464-4218.
• If an employee presents a DHS Form I-551 (Permanent Resident Card) or
Form I-766 (Employment Authorization Document) to complete the Form I-
9, the Employer agrees to make a photocopy of the document and to retain
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the photocopy with the empioyee's Form I-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 I-9. DHS may in the future designate other documents
that activate the photo screening tool.
5. Participation in E-Verify does not exempt the Employer from the responsibility to
complete, retain, and make available for inspection Forms I-9 that relate to its
employees, or from other requirements of applicable regulations or laws, including
the obligation to comply with the antidiscrimination requirements of section 274B of
the INA with respect to Form I-9 procedures, except for the following modified
requirements applicable by reason of the Employer's participation in E-Verify: (1)
identity documents must have photos, as described in paragraph 4 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 DHS of continued employment following a final
nonconfirmation; (4) the 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 I-9 compliance inspections during the course of E-Verify, as well as
to conduct any other enforcement activity authorized by law.
6. The Employer shall initiate E-Verify verification procedures (through the
Designated Agent), for new employees within 3 Employer business days after each
employee has been hired (but after both sections 1 and 2 of the Form I-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 I-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
(through the Designated Agent) 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, through
the Designated Agent, by notating the Form I-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 (through the Designated
Agent) performs an E-Verify employment verification query using the employee's
SSN as soon as the SSN becomes available.
7. The Employer may not use E-Verify procedures for pre-employment screening of
job applicants, in support of any unlawful employment practice, or for any other use
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not authorized by this MOU. Employers must use E-Verify (through its Designated
Agent) for all new employees, unless an Employer is a Federal contractor that
qualifies for the exceptions described in Article II.D.1.c. Except as provided in
Article II.D, 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.
8. The Employer (through the Designated Agent) shall follow appropriate procedures
(see Article III. 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 adverse action against
employees if they choose to contest the finding. Further, when employees contest
a tentative nonconfirmation based upon a photo non-match, the Employer is
required to take affirmative steps (see Article III.B. below) to contact DHS with
information necessary to resolve the challenge.
9. The Employer shall not 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 C.F.R. § 274a.1(I)) 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 findin�, and if he or she does_so,_the_employee_ma�r not__ _
__._ _ _ _
be terminated or suffer any adverse employment consequences based upon the
employee's perceived employment eligibility status (including denying, 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, or otherwise mistreating an employee) 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 OSC at 1-800-255-8155 or 1-800-237-2515 (TDD).
10. The Employer shall comply with Title VII of the Civil Rights Act of 1964 and section
2746 of the aNA 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 case of a protected individual as defined in section 2746(a)(3) of the INA,
because of his or her citizenship status. The Employer shall not engage in such
illegal practices as 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
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sound "foreign" or have received tentative nonconfirmations. The Employer further
understands that any violation of the unfair immigration-related employment
practices provisions in section 2746 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 274B of the INA or Title VII 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-
8155 or 1-800-237-2515 (TDD).
11. The Employer shall record the case verification number on the employee's Form I-
9 or to print the screen containing the case verification number and attach it to the
employee's Form I-9.
12. The Employer will use the information it receives from SSA or DHS (through its
Designated Agent) pursuant to E-Verify and this MOU only to confirm the
employment eligibility of employees as 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 any 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.
13. The information that the Employer receieves through the Designated Agent from
SSA is governed by the Privacy Act (5 U.S.C. § 552a(i)(1) and (3)) and the Social
Security Act (42 U.S.C. 1306(a)), and that any person who obtains this information
under false pretenses or uses it for any purpose other than as provided for in this
_ _ — - ___ _ _ _ _ _ _ _
M(OU may be subject to criminal penalties.
14. The Employer agrees to cooperate with DHS and SSA in their compliance
monitoring and evaluation of E-Verify, including by permitting DHS and SSA, upon
reasonable notice, to review Forms I-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 DHS requests for information relating
to their participation in E-Verify.
D. EMPLOYERS THAT ARE FEDERAL CONTRACTORS
1. If the Employer 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 22.1801) 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 is 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
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calendar days of contract award and, within 90 days of enrollment, begin to
use E-Verify to 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-Verify 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 contract award must use E-Verify to initiate verification of
employment eligibility for new hires of the Employer 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 a 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 3 business days after the date of hire. An Employer
enrolled as a Federal contractor in E-Verify must initiate verification of each
employee assigned to the contract within 90 calendar days after date of
contract award or within 30 days after assignment to the contract, whichever
is later.
c. Institutions of higher education, State, local and tribal governments and
sureties: Federal contractors that are institutions of higher education (as
-- __ _ _ _ _ _
defined at 20 U.S.C. 1001(a)), State or local governments, governments of
�ederally recognized Indian tribes, or sureties perfo�ming 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 II, part D, 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 enrotlment, Employers must elect to do so only in the manner
designated by DHS and initiate E-Verify verification of all existing employees
within 180 days after the election.
e. Form I-9 procedures for Federal contractors: The Employer (through its
Designated Agent), may use a previously completed Form I-9 as the basis
for initiating E-Verify verification of an employee assigned to a contract as
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long as that Form I-9 is complete (including the SSN), complies with Article
II.C.4, the employee's work authorization has not expired, and the Employer
has reviewed the information reflected in the �orm I-9 either in person or in
communications with the employee to ensure that the employee's stated
basis in section 1 of the Form I-9 for work authorization has not changed
(including, but not limited to, a lawful permanent resident alien having
become a naturalized U.S. citizen). If the Employer is unable to determine
that the Form I-9 complies with Article II.C.4, if the employee's basis for work
authorization as attested in section 1 has expired or changed, or if the Form I-
9 contains no SSN or is otherwise incomplete, the Employer shall complete a
new I-9 consistent with Article II.C.4, or update the previous I-9 to provide the
necessary information. If section 1 of the Form I-9 is otherwise valid and up-
to-date and the form otherwise complies with Article II.C.4, but reflects
documentation (such as a U.S. passport or Form I-551) that expired
subsequent to completion of the Form I-9, the Employer sha�l not require the
production of additional documentation, or use the photo screening tool
described in Article II.C.4, 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. If the Employer 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 Employer's compliance with Federal contracting
-
requirements.
E. RESPONSIBILITIES OF DESIGNATED AGENT
1. The Designated Agent agrees to provide to the SSA and DHS the names, titles,
addresses, and telephone numbers of the Designated Agent representatives who
will be accessing information under E-Verify.
2. The Designated Agent agrees to become familiar with and comply with the E-Verify
User Manual and provide a copy of the manual to the Employer so that the
Employer can become familiar with and comply with E-Verify policy and
procedures
3. The Designated Agent agrees that any Designated Agent Representative who will
perform employment verification queries will complete the E-Verify Tutorial before
that individual initiates any queries.
A. The Designated Agent agrees that all Designated Agent 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.
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B. Failure to complete a refresher tutorial will prevent the Designated
Agent and Employer from continued use of the program.
4. The Designated Agent agrees to obtain the necessary equipment to utilize E-
Verify.
5. The Designated Agent agrees to provide the Employer with the notices described
in Article 11.B.4 above.
6. The Designated Agent agrees to initiate E-Verify procedures on behalf of the
Employer in accordance with the E-Verify Manual and E-Verify Web-Based
Tutorial. The Designated Agent will query the automated system using information
provided by the Employer and will immediately communicate the response back to
the Employer. 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 Designated Agent's attempting, in good faith, to make inquiries
on behalf of the Employer during the period of unavailability. In all cases, the
Designated Agent will use the SSA verification procedures first, and will use DHS
verification procedures only as directed by the SSA verification response.
7. The Designated Agent agrees to cooperate with DHS and SSA in their compliance
monitoring and evaluation of E-Verify, including by permitting DHS and SSA, upon
reasonable notice, to review Forms I-9 and other employment records and to
interview it and its employees regarding the use of E-Verify, and to respond in a
timely and accurate manner to DHS requests for information relating to their
participation in E-Verify.
_ _ _ _ ___ _ ARTICLE 111 __ _ _ _ _ __
REFERRAL OF INDIVIDUALS TO SSA AND DHS
A. REFERRAL TO 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
Employer records the case verification number, reviews the input to detect any
transaction errors, and determines that the employee contests the tentative
nonconfirmation. The Employe� (through the Designated Agent), 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 tentative nonconfirmation, the Employer will
provide the employee with a system-generated referral letter and instruct the
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employee to visit an SSA office within 8 Federal Government work days. SSA will
electronically transmit the result of the referral to the Employer (through the
Designated Agent) 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.
4. The Employer shall not 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 provides 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 shall refer individuals to DHS 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 after the Employer receives it.
4. If the employee contests a tentative nonconfirmation issued by DHS, the Employer
shall provide the employee with a referral letter and instruct the employee to
contact DHS through its toll-free hotline (as found on the referral letter) within 8
Federal Government work days.
5. If the employee contests a tentative nonconfirmation 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.
6. If an employee contests a tentative nonconfirmation based upon a photo non-
match, the Employer shall send a copy of the employee's Form I-551 or Form I-766
to 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. If the Employer cannot determine whether there is a photo match/non-match, the
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Employer is required to forward the emptoyee'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-match.
ARTICLE IV
SERVICE PROVISIONS
The SSA and DHS will not charge the Employer or the Designated Agent for verification
services performed under this MOU. DHS is not responsible for providing the equipment needed
to make inquiries. A personal computer with Internet access is needed to access the E-Verify
System.
ARTICLE V
PARTIES
A. This MOU is effective upon the signature of the 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-Verify program by DHS
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
- _ __--- — _ _
tufo�ials and updates fo the E-Verify User Manual. Even without changes to E-Verify,
DHS reserves the right to require Designated Agents to take mandatory refresher
tutorials. A Designated Agent for an Employer that is a Federal contractor may
terminate this MOU when the Federal contract that requires the Employers participation
in E-Verify is terminated or completed. In such a circumstance, the Designated Agent
must provide written notice to DHS. If the Designated Agent fails to provide such notice,
it will remain a participant in the E-Verify program on behalf of the Employer, 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
the Employer's newly hired employees.
B. Notwithstanding Article V, part A of this MOU, DHS may terminate access to E-Verify if it
is 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 Designated Agent or the Employer, or a failure on the part of either to
comply with established procedures or legal requirements. The Designated Agent
understands that if the Employer is a Federal contractor, termination of this MOU by any
party for any reason may negatively affect the Employer's performance of its contractual
responsibilities.
C. Some or all SSA and DHS responsibilities under this MOU may be performed by
Page 11 of 15�E-Verify MOU for Designated Agent�Revision Datei0129108 ,�sar,�;,�la�.�csvt�-��r�#y
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TM E-VEAIFY ° A SE2VICE OF DHS
Company ID Number: 200980
contractor(s), and SSA and DHS may adjust verification responsibilities 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 construed, 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 Designated Agent, the
Employer, or their 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 Designated Agent or
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 Designated Agent or the
Employer.
F. 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
Designated Agent.
The individuals whose signatures appear below represent that they are authorized to enter into
this MOU on behalf of the Designated Agent and DHS respectively.
If you have any questions, contact E-Verify at 1-888-464-4218.
_ _
Page 12 of 15,E-Verify MC7U for Dzsign�ted Ager;t�Revision Date?Oi29/08 � _�� a?� � 3 "� '.����`�
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.� TM E-VERIFY IS A SERVICE OF DHS
Company ID Number: 200980
Approved by:
€mployer JOKERST, INC.
KIM WEtLER
_� �, _�.______.�_---_...--------:.__...__.._ .._.____.__.._ __. _.a.___..�_,---.--.:.__.__. __.__.._,�_.__:----------.-__._��__.---.----
Name{Please 7ype or Print} TitEe
E/eetforricalfy S%gned Q3/25l2Q09
Signature C►ate
Department of Homeland Security-Verification:Division
USCIS Verification Division
Name(Please Type or Print}. ' 7itle
Electronica/I�Sr`�ned 03l25f2U09
------------
Signature ---- --- -------------
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Qate ------__
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Page 13 of 15jE-Verify MOU�or Designated Agent�Revision Date10129/08 �����,�;,°�.��,�F�-�°������
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yy B VERIFY _�A SERVICE OF DHS
Company ID Number: 200980
Information Required for the E-Verify Pragram
lnformation relating to your Company:
Gompany Narr�e: JOKERS7,iNC.
Company Facitity Acfdress: 16444 HWY 32
STE GE(�EVIEVE, f1�0 fi36T0
Company Atternate
Address:
County or Parish: SAINTE GENEVI�YE
Employer ldentification
NuiTtbet': 43�1810'f 12
North American [ndustry
Ctassificatian Sys#ems
Gode: 237
Parent Cornpany:
_.._......._._._......_._..._.............._.............._..........................._..........._.__........_....:......_........_................_................__...__................_..............__.._..................._..._.........._._................__........
Number of Employees; 20 to 99
Number af 5ites Verified
fior: 1
Are you verifying for more than 1 site? If yes, please provide the number of sites verified for in
each State:
. MISSOURI 1 site(s)
Page 14 of 15!E-Verifij tJ�OU'or Uasigr,atea Agert)R�visicn Date10i29;08 �� :�.��.r.a'p��� ,Y:v,� � =4
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� ' }b E V6RIFY IS A SLRVICE OF DXS
Company ID Number: 200980
information relating to:the Program Administrator(s)for your Cornpany on policy questions o�
operational problems: .
Name; KIM M WEILER
Telephone Number: (573)883'-7401 Fax Number: (573)883-7403
E-mail Address: jokerstinc@yahoo.com
Fage 15 0#1SiE-Verify MOU#or De�ignated Age�t�Revision Da#�i0?Z9;�B �����;�,-5���,z��:�:,s,f�=a��ti;��,`�
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Project Number
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� Certification Re ardin
g g
� Debarme�t, Suspension and Other 12esponsibility 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 convicted 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 property;
(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) ofthis 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.
� I understand that a false statement on this certification may be grounds for rejection of this
contractor or termination of the contract. In addition, under 18 USC Sec. 1001, a false
� statement may result in a fine of up to $ 10,000 or imprisonment for up to five (5)years or
both.
�
LYNN M. SCHREMP/VICE PRESIDENT
� Typed Name & Title of Authorized Representative
.r �
8/24/11
� Signa ure of Authorized Represe tative Date
�
❑ I am unable to certify to the above statement. My explanation is attached.
�
�