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Home My WebLink AboutRES.2596.03-21-2011 BILL NO. 11-32 RESOLUTION NO. �59� A RESOLUTION AUTHORIZING THE CITY MANAGER TO EXECUTE AN AGREEMENT WITH K & K ELECTRIC COMPANY FOR THE WATER SUPPLY WELLS PROJECT, IN THE CITY OF CAPE GIRARDEAU, MISSOURI BE IT RESOLVED BY THE COUNCIL OF THE CITY OF CAPE GIRARDEAU, MISSOURI, AS FOLLOWS : ARTICLE l . The City Manager, for and on behalf of the City of Cape Girardeau, Missouri, is hereby authorized to execute an Agreement with K & K Electric Company for the Water Supply Wells Project, in the City of Cape Girardeau, Missouri . A copy of said Agreement is attached to this Resolution and made a part hereof . 5�' PASSED AND ADOPTED THIS �-�' DAY OF , 20 I� Harry E Rediger, Mayor ATTEST: ,:�`'�; �IRA� ��y� �� G � , ,� 0 � n / �� ! _ ,.S! . ��'K��i�.�/r{a, � � r ,,. Ga , �Conrad,, C ' C �e�'7�c ..�'� Ii �� Y � —=�-= --'��`�III� �' j�•� W'��' �r '�� Q` r!`ti y!:w ;1, `,��Y.� 'r1�,K � CITY OF CAPE GIRARDEAU WATER SUPPLY WELLS & CONTROLS DR/NKING WATER STATE REVOLVING FUND PROJECT 291010-09 STANDARD FORM OF AGREEMENT BETWEEN OWNER AND CONTRACTOR ON THE BASIS OF A STIPULATED PRICE THIS AGREEMENT is dated as of the >a�, day of � �°R!L in the year 20 4l by and between the City of Cape Girardeau, Missouri (hereinafter called OWNER) and K & K Electric Company (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 work to be performed under these Contract Documents consists of... Contract 5 - Water System Contract —Water Supply Wells & Controls (4) 1,800 GPM Well Pumps, Foundations, Platforms, Power Supply & Controls 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 one hundred twentv (120� 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 eiqhty 1( 80) 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 A - 1 E � 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 one thousand finro hundred twenty-five ($ 1,225.00) for each day that expires after the time specified in paragraph 3.1 for Substantial Completion untit 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 one thousand two hundred twenty-five ($ 1,225.00) 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: finro million four thousand eight hundred and sixty-five dollars and no cents ($ 2,004,865.00)**. **base bid of$2,012,830.00 with deduction 2 in the amount of$ 7,965.00 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 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. A - 2 � � 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! Paymenf. 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". 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. A - 3 a .� 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 in the Supplementary Conditions as provided in paragraph 4.2.1 of the General Conditions. CONTRACTOR accepts the determination set forth in paragraph SC-4.2 of the Supplementary Conditions of the extent of the "technical data" contained in such reports and drawings upon which CONTRACTOR is entitled to rely as provided in paragraph 4.2 of the General conditions. 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 furnishing of the Work. Article 8. CONTRACT DOCUMENTS. A - 4 t 1 The Contract Documents which comprise the entire agreement befinreen 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- 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- 6 , inclusive). 8.7 Specifications bearing the title WATER SUPPLY WELLS & CONTROLS . 8.8 Drawings. 8.9 Addenda numbers 1 to 2 , inclusive. 8.10 CONTRACTOR'S Bid (pages BF- 1 to BF- 9 , inclusive) marked exhibit "A". 8.11 Documentation submitted by CONTRACTOR prior to Notice of Award (pages _to , inclusive). 8.12 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 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 A - 5 1 ..t 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 The General Contractor shall provide to the City of Cape Girardeau City Engineer's O�ce weekly certified payrolls from the General Contractor and all Subcontractors during the course of the project. These may be provided on a weekly basis or submitted monthly with each pay request. A - 6 IN WITNESS WHEREOF, OWNER and CONTRACTOR have signed the Agreement in multiple copies, One counterpart each has been delivered to CONTRACTOR and ENGINEER and two 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 /q��J� �� , 20L(which is the Effective Date of the Agreement). OWNER Citv of Cape Girardeau CONTRACTOR � c�. �—, ��--��C- �- Scott Cit Mana er By: � y' ORPO E EAL] [CO PORATE SEAL � Attest Attest GRyI, C. �'onlr�pD� G�r� Cl.ERK Address for giving notices Address for giving notices 401 Independence Street �3� Crru„n�.� �� 3� Cape Girardeau, MO 63703 �Q,�� i 2:�{��-f�C..t ��-� c,��z'GJ (If OWNER is a public body, attach License No. 1 �� evidence of authority to sign and resq.l ' ther documents Agent for service of process: a � i,�,r�a � 'on of Agreement. .� �'-%� � ��'' �� ,. r� (If CONTRACTOR is corporation, � �`� ��=� :.-. � attach evidence of authority to sign.) 1� � ; ,t. , � � -� ,� �!�, � � `� `� :� �� ;;�� , - �,, , � ��`��• ' j;:�',•�"`�"�� ;�, �,� \��„' °e��. !��M _ �• ��i;;,.'`�� -�1'Y � A-7 1 + Sxhibit "A" I CITY OF CAPE GIRARDEAU � WATER SUPPLY WELLS AND CONTROLS DRINKING WATER STATE REVOLV/NG FUND PROJECT 291090-09 i BID FORM � (EJCDC 1910-18) (1990) 1 PROJECT IDENTIFICATION: The improvement consists of : (4) 1,800 GPM Well Pumps, Foundations, Platforms, Power Supply, & Controls and all 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 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: BF-1 a � � � Addenda, feC@Ipt Of aII WI11CIl IS h2feby aCI(t10WI8CIgeCI: �ListAddenda byAddendum Numberand Date) �1 -- ��%��/�J { �� - �/�/�� (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, pe►fiormance and furnishing of the Work; f (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 � • �.�_ ��,__�.:_ ____....,r�,,,.,.:. a�,,, CletefllllClatlOtl Oi ZF11S tilCl TOC p@ITOfCT1af1Ce af1Q fUrfilS�lli�g 6T[ne vvui t�i►i a��uai wG vv�t�'i u�c ' 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 Idata 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 I B F-2 1 . � � .. are generally sufficient to indicate and convey understanding of all terms and conditions for � ormin and furnishing the Work for which this Bid is submitted. perf 9 (h) This Bid is genuine and not made in the interest of or on behalf of any undisclosed � ' m or cor oration and is not submitted in conformity with any agreement or rules person, fir P 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; BID�nd BIDDER solicited or induced any person, firm or corporation to refrain from bidding; 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 � o of AFFIDAVIT OF WORK . submitting a completed, notarized c py � 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 � ' the services requested herein. in connection with • 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 to provide, and require its on-site employees to c ccu I ateonale Sa ety�and�Health construction safety and health approved by the O p Administration("OSHA"j or simiiar prograrr� a��r��eu Uy th��"��r; r�PP?rtmPnt Qf 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): � � � B F-3 � i � .t ' CONTRACT 3 - WATER SUPPLY IMPROVEMENTS Cape Girardeau Water System Improvements � SRF Project No. 291010-01 LIST OF ESTIMATED QUANTITIES AND UNIT AND LUMP SUM PRICES � The undersigned bidder agrees to complete all work and place into successfui operation the new water well, foundation, pumping equipment,controls, piping and appurtenances as � set out in the contract documents, specifications and plans for the following lump sum amounts: � EST. UNIT TOTAL NO ITEM UNIT QTY. PRICE EST. PRICE � o �' °° �. Water Wells and Pumps EA. 4 $��7�.,b7 /. _ ��--- a, �t.�l� � 2, Water Well Pump Platforms EA. 4 $�7��_ 3. Well Controls&Site Elect�ical EA. 4 � (�r7��,� ��9 a•�7d�� m 4. Electrical Service Lump Sum $ _ � iTOTAL BID FOR ALL UNIT PRICES $c�,�Ul�, g�o`� � - � �r � �� -`(�t-�`� l� � �"�J \1Alrittgn fi��iral � (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.) Alternate Addition 1 do � �. Installation of 1500 KW Generator Lump Sum $ �� — with Wiring, and Appurtenances � Alternate Addition 2 �. Installation of 2000 KW Generator Lump Sum ��a6� d� with Wiring,and Appu�tenances � � B F-4 � � � 2 i Alternate Deduct 1 `�' � Delete Well Pump Flow Meters, Lump Sum �T_ utilize pressure gauge&PLC for Bow � te Deduct 2 � P�Iterna � "? , ��7 _ � Eliminate security cameras,security Lump Sum ' sensors,&dusk to dawn lights Unit Prices have been computed in accordance with paragraph 11.9.2 of the General iConditions. BIDDER acknowledges that quantities are not guaranteed ct Dolcuments.ent will be based � on actuai quantities determined as provided in the Contra 5. BiDDER agrees that the Work will be substantially � mmencesltol run1as p ov dedOn � lendar days after the date when the Contract Times co ca paragraph 2.3 of the General Conditions, and completed and ready for final payment in accordance with paragraph 14.13 of the General Conldit�ences'tol run180 davs (001 � d calendar days after the date when the Contract Times co�� 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. � followin documents are attached to and made a condition of this Bid: 6. The 9 � (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 O (e) The E-Verify Program for Unemployment Verification Memorandum of Understanding (f) Exhibit Affidavit of OSHA Training �9) Certification Regarding Debarment, Suspension and Other Responsibility Matters �_ (h) MBE/WBE Business Enterprise Utitization Worksheet (i) Certification of Nonsegregated Facilities ; , BF-5 � t '' �t � 7. Communications concerning this Bid shall be addressed to: Name �1�� .��.�,C. �; �i'Iv: �o� �� ' / Address `�7�'�� t��. Co3g i �-D� �c 2��c��kc.�. ��c ��/ ' a Performance and Payment Bonding Company � ) ' Name �(-�� L P� � ��-�� .1 Address � l % �� V� �� E�C� �c�C �J�'�'-�l , ��DA-�Z. ��d�;� ' Agent\Power of Attorney Name (if used)�SC c ( �-�k c��wv�-��z ' Address �� !vl�� 0� �-rr��A-e� � �10 (G��o/ ' 8. 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 Lo , 20 i I . State Contractor License No. �Y�_r�.�'J-� �aa��81 r� �%'� ��F-� Gc�� -I��.�-�E� 1�5' IF BIDDER is: An Individual � gy (SEAL) (Individual's Name) ' doing business as Busin�� ddress: � � Phone No.: A Partnership � gy (SEAL) (Firm Name) I (General Partner) Business address: I ( Phone No.: BF-7 I i ; 4�,i �' � � � ti �� :. � f��, , '�, �� :b � 9 ,�� - � � 3 � f, � :>.i �. ° i d � � ,� . q Corporation , t �� St��1L��'�� , � �. ��E��fZ�LC_ �'"� e,' �� Y � By , ' •y i (Corporation Name) � � "� , � `t, � �b , r;. m� s � k� � �,,, , ,�� x , :. (State of Incorporation) ' '�� '� � ,. , � �`��# � � � By x �' , , , ( ame of Person Authorized to Sign) , ��' ,-�� `„ '�,'F � + (j` �-�"'��-.�� "" 1 f� �ti Tf i � C. � _ (Title) v� �� .;� ' �`,' a ,, � (Corporate Seal ° `'" ° ina5 � � Ee ,.1 Attest r (Secretary) �� ..6 p� -t-- ' ess address: '�-�� P�� Busin .., "("`(1�- �v�'�/ Phone No.: �� -��`�� Date of Qualification to do business is ��7g A Joint Venture (SEAL) By (Name) (Address) (SEAL) By ��am�; (Address) Phone Number and Address for receipt of officiat communications: Each joint venturer must sign. The manner of signing for each �a�n de alnd cated abo e ) corporation that is a party to the �oint venture should be in the BF-8 ! n � � BREAKDOWN OF WORK FORCE (Required): r ntractor shall be registered with the Missouri Secretary of State in order to work on � The Co this project. BIDDER hereby states that he will perform the following items of work directly without employment of subcontractors: �� Q o��-(L. It is anticipated that the following subcontractors will be employed for work on this project: Ail subcontractors listed have been found to be in good standing by with the Missouri Secretary of State. SUBCONTRACTORS: �Type of Work) (Name of Company) n, r ' ,� �i..t� t�.�,r,,..� � ��'\�'1,1P� �`�-1'V''`-"`'`'''�C� �Y ,,�„� ; . . � ' C , �� - � �.=,� � B F-9 � � UNITED FIRE 8� CASUALTY COMPANY 118 Second Avenue SE, PO Box 73909 Cedar Rapids, lowa 52407-3909 319-399-5700 (A Stock Company) BID BOND KNOW ALL BY THESE PRESENTS,that we K&K ELECTRIC COMPANY INC 433 COUNTY ROAD 638,CAPE GIRARDEAU,MO 63701 as Principal, hereinafter called the Principal, and the UNITED FIRE &CASUALTY COMPANY, a corporation duly organized under the laws of the State of IOWA, as Surety, hereinafter called the Surety, are held and firmly bound anto CITY OF CAPE GIRARDEAU 401 INDEPENDENCE,CAPE GIRARDEAU,MO 63701 as Obligee, hereinafter called the Obligee, in the sum of �,,,�pa��r„rtne Bid nmo�nc — Dollars ($5°�� ), for the payment of which sum well and truly to be made, the said principal and the said Surety, bind ourselves,our heirs, executors, administrators, successors and assigns,jointly and severally,firmly by these presents. WHEREAS, the Principal has submitted a bid for WATER SUPPLY WELLS&CONTROLS DRINKING WATER STATE REVOI.VING FUND PROJECT NO.291010-01,CITY OF CAPE GIRARDEAU,MISSOURI NOW, THEREFORE, if the Obligee shall accept the bid of the Principal and the Principal shall enter into a contract with the Obligee in accordance with the terms of such bid, and give such bond or bonds as may be specified in the bidding or contract documents with good and sufficient surety for the faithful performance of such contract and for the prompt payment of labor and material furnished in the prosecution thereof, or in the event of the failure of the Principal to enter such contract and give such bond or bonds, if the Principal shall pay to the Obligee the difference not to exceed the penalty hereof between the amount specified in said bid and such larger amount for which the Obligee may in good faith contract with another party to perform the work covered by said bid, then this obligation shall be null and void,qtherwise to remain in full force and effect. Signed and sealed this 10th day of March ,20 �� ,; -1 - rs r �.:: « ��?�.4" ;i��'�� Z^�u �' , ,- , K&K ELECTRIC COMPANY INC � "-� C;� .' �' $ � � � {> .oA - --r. � r� � a (Sc'al) "� �� (PRINCIPAL) ',' �F ( , � ;'"�' � � � �� t��r�� (WITNESS) (TITLE) a' � .• �a ,'�� -,� UNITED FIRE &CASUALTY COMPA�1�` .• �S��'%�'�-,= (SURE Y) - ^e.• £'� ��- •_ �!I .�; � ' / . �.: � j� ..'. l� ' a'�'� " � �.• m By (WITNESS) (ATTORNEY-IN-FACT) � , �' i �p�' .� �. , Priscilla B. Hunter �� '. ��"� , '. wr I S p _t 't e . . ' . -{ .•�.�« .. CONT 0001 0899 :i�"o....,... . . -.. . . . . . ,:�..::. - . . � ' � � . . _ . . . . _ . .• ' . . ... . " . . . . . . . � .. . . . � .. � . � � . . . ' � .. / ACKNOWLEDGIYIENT OF SIJRETY State of Missouri � County of C�e'Girardeau On this 1Othday of March, 2011 Personally appeared before me Priscilla B. Hunter �yho being duly sworn did depose and say that he/she is the attorney-in-fact of the United Fire and Casualty Company of Cedar Rapids, Towa,that the seal affixed to the attached instrument is the Corporate Seal of said Corporation, and that said instrument was signed and sealed on behalf of said Corporation by authority of its Board of Directors and the said priscilla B. Hunter acknowledged that he/she executed said instrument as such attorney-in-fact and as the free act and deed of said Corporation. Notary Pablic MARY MONAHAN Notary Public, Notary Seal State of Missouri uND-za3in Bollinger County Commission # 10509451 My Commission Expires April 07, 2014 � `� BID BOND-00012353 UNITED FIRE&CASUALTY COMPANY Bond # Home Office-Cedar Rapids, lowa Certified Copy of Power of Attomey Obligee (Original on file at Home Office of Company -See Certification) 401TNDEPENDENCE CAPE GIRARDEAU,MO 63701 KNOW ALL MEN BY THESE PRESENTS,That the UNITED FIRE &CASUALTY COMPANY, a corporation duly organized and existing under the laws of the State of lowa, and having its principal office in Cedar Rapids, State of lowa, does make, consti- tute and appoint CHARLES W DECKER,OR SHARON GLASCO,OR ALAN H RAUSENBERGER,OR JASON RAUSENBERGER,CARBONDALE,IL,OR TODD A WARD, OR NANCY STRAUSER,OR PRISCILLA B WUNTER ALL INDIVIDUALLY of CAPE GIRARDEAU,MO 63701 its true and lawful Attorney(s)-in-Fact with power and authority hereby conferred to sign, seal and execute in its behalf all law- ful bonds, undertakings and other obligatory instruments of similar nature as follows: $io,000,000.00 and to bind UNITED FIRE &CASUALTY COMPANY thereby as fully and to the same extent as if such instruments were signed by the duly authorized officers of UNITED FIRE & CASUALTY COMPANY and all the acts of said Attorney, pursuant to the authority hereby given are hereby ratified and confirmed. The Authority hereby granted shall expire�uly 9th,2011 unless sooner revoked. This power of Attorney is made and executed pursuanc to and by authority of the foliowing By-Law duly adopted by the Board of Directors of the Company on April 18, 1973. "Article V-Surety ftonds and Undertakings" Section 2,Appointment oi Attorney-mFact."The President or any Vice president,or any other officer of the Company,may,from time to time,appoint by written certi6cates attorneys-in-fact to act in behalf of the Company in the execution of policies of insurance,bonds,undertakings and other obligarory instru- ments of like nature.The signature of any officer authorized hereby,and the Corporale seal,may be affixed by facsimile to any power of attorney or special power of attorney or certification of either authorized hereby;such signature and seal,when so used,being adopted by the Company as the original signa- ture of such officer and the original seal of the Company,to be valid and binding upon the company with the same force and effect as though manually affixed.Such attomeys-in-fact,subject co the limitafions set forth in their respxtive certificates of authority shall have full power co bind the Compa�y by their signature and executiun o�any such instrumen�s and to anach the seal of the Company thereio.The Presidem or any Vice President, Ihc�Board ot C�irectors ur any otha�r ufficer of the Cumpany mav at any time revoke all power and audu�rity previously given to any attorney-in-lact. IN WITNESS WHEREOF, the UNITED FIRE &CASUALTY COMPANY has caused these ;�"'�ASV"��. presents to be signed by its vice president and its corporate seal to be hereto affixed this ��,��." "�rr�� 8th day of March ,2011 . =9 coeronnre °�s' UNITED FIRE &CASUALTY COMPANY �F. N� :Z —•— �_ �y �n SEAL ;; r�-0 �/�-�/vWa.-��\'�71...-�-.—^.��. °''4°R anrrog`.��``` �� V cf e P' resident ��/p�inUN"� State of lowa, County of Linn,ss On this$th day of March ,2011 before me personally came Dennis Richmann to me known, who being by me duly swom, did depose and say: that he resides in Cedar Rapids, State of lowa; that he is a Vice President of the UNITED FIRE &CASUALTY COiV1PANY, the corporation described in and whidi executed tne above instrument; that he knows the seal of said corporation; that the seal affixed to the said instrument is such corporate seal; that it was so affixed pursuant ro authority given by the Board of Directors o(said corporation and that he signed his name thereto pursuant to like authority, and acknowledges same to be the act and deed of said corporation. A�, �� Mary A.Jansen W � � lowa Notarial Seal Commission number 773273 No Publi • ov�► My Commission Expires 10/26/2013 My Conimission exF�ires October 26,2013 CERTIFICATION I, David A. Lange, Secretary of UNITED FIRE & CASUALTY COMPANY, do hereby certify that I have compared the foregoing copy of the Power of Attorney and aKidavit, and the copy of the Section of the by-laws of said Company as set forth in said Power of Attorney, with the ORIGINALS ON FILE IN THE HOME OfFICE OF SAID COMPANY, and that the same are correct transcripts thereof, and of the whole of the said originals, and that the said Power of Attorney has not been revoked and is now in full force and effect. In testimony whereof I have hereunto subscribed my name and affixed the corporate seal of the said Company 10th ��" this day of Marcn ,20�� ``��,��S�,�T,,� ,� } o o co: A ��Y CORPORATE �� y/ =Z —�— �c /7` _ �� SEAL K� '-°F a�,= Sec r t .,o o,. '��iR RAPtDS`�� BPOA0041 102007 ��u��• 1 � UNITED FIRE & CASUALTY COMPANY UNITED LIFE INSURANCE COMPANY 118 Second Avenue, S.E., P.O. Box 73909, Cedar Rapids, Iowa 52407 NOTICE TO MISSOURI SURETY BOND HOLDERS Should you have a question abou't your bond or policy, please contact your insurance agent first. If you are unable to contact or abtain information from your agent, you may contact our company at address and phone number below: UNITED FIRE & CASUALTY COMPANY ATTENTION: BOND DEPARTMENT P.O. BOX 73909 CEDAR RAPIDS,IOWA 52407 1-800-343-9130 o � � �.1 � EXHIBIT AFFIDAVIT OF WORK AUTHORIZATION � COMES NOW(Name) �� as (Office Held) �P �S t Lj�',-�3 I o{ (CompanyName/Concractor) �E�� °�-c� � and first being duly swom, on � my oath,affirm as follows: 1, (CompanyName/Contractor) � \ � `�Z ��C— �L�� is enrolled and will continue to participate in a federal work authorization program in respect to employees that will work in connection with tI�►e contracted services related to (Proje�c Name} w�-�e � ��'i� `��- 5 �� n-Ea��s `1.72�� . luc for th�uration of the contract in accordance with RSMo ��t- . ��c,ra-ot ,� Chapter 285.530(2). , > � 2. I also affirrn that(CompanyName/Contractor) -�`��-� �'��'' �- � does not and will not l�owingly employ a pe�n�w�o is anPiuiaut�h�`nlzedA lie� �co��s.n�� t�� , contract seroices related to (Project Name) w�-�e �-k�k� ��o�v�ti� r�� a�`�o� for rhe duration of the contract. ; 3. Attached hereto is documentation affirining Contracto�'s enrollment and participation in a federal work authorization program with respect to the employees working in connection with the contracted services. FLJRTHER AFFIANI'SAITH NOT. �.. IN AFFIRll�IATION THEREOF, the facts stated above are t►ue and correct (the undersi�ned undetstands that false statements made in this filing are subject to the penalties provided in Section 575.040,RSMo.) �� (name of corporation) " By: 0 o icer of oraaon an ut e � � � � �(��ii��N l ATTEST: .+�� ;,, r �%' �z � � �r"%4�� '�-'��.�1 %'.�` .`� . . . � �'��1-e�atye(�sr otK'es�''�fftcer) � _ �,.,�,eC /Ya:'�'r ��:'-4�.f � [� t � '' , / �� ../�+ ��+krt�r� � L H� r J - �:.� ��G��T?CQRATIOI� ;� � 7��,�. ,• � , . ' . . ':� �� s�p _ � � 1 3�. STATE OF MISSOURI ) ) ss. CpUN'I'Y OF CAPE GIRARDEAU ) � On this 1� day of rY�� , 20�� before me appeared �o� ' who,being by me duly swom,did say that he/she is the��r to me perso all own, . of �� F��c� �rv��;(a Missouri Corporation, and that the seal affixed to the foregoing instrument is the seal of said �rPo� of i Boardtof Direc�to t d cl�owledged aid sealed in behalf of said Corporat�on by authonty instnunent 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 and year first above written. C,�� `�lu-- � Nota P blic JEANA AA.KOCH Plotaty Public-Notary Seal STATE OF MISSOUF21 My Commission Expires: Cape Glrardeau Coune� Commission#085181 5 �� ^�� Q� r� My Commission�aires,�pt.15,2012 O` .K' - � � � EXHIBIT AFFIDAVIT REGARDING EXCESSIVE UNEMPLOYMENT � COMES NOW(Name) �� t� as (Office Hel� �-�5��+-�rt" Of(CompanyName/Contraccor) �� ' and first being dulysworn, on �: myoath,affirm as follows: l. 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 respect to employees tl�at will work in connection with the contracted services related � t� St�p rc� c,.��t 5 a�� C�tzz�ls �ir��g , to (Project Name)�xz�� .-1a� R�o��i�� c.�vw �,i�cfi for the duration of the contract. `" a9/ott�-o ��('.�-fL-�� n�� 2. I also affirm that(CompanyName/Contractor) � does not and will not l�owingly employ a laborer who is not a "Missouri Labore�' or a "Laborer from a Nonrestrictive State", as those tem�s 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 perforcning that particular type of workcd involved, if so certified bythe contractor and approved by � the City of Cape Girardeau, or unless othervY�se ernutted by that Statute, in connection with the cr�-�e�ppl� w��s �� e or,-�ts c�NfG�=,ng contracted services related to (Project Name)w,�#�-� �� (Z�-��vrN� F�D for the duration of the � P��c-�-a.4��t contract. FURTT�ER AFFIANT SAITH NOT. � IN AFFIRMATION THEREOF, the facts stated above are true and correct (the � undetsi�ned understands that false statements made in this filin� are subject to the penalties provided in Section 575.040, RSMo.) � i ��. �`�-�-2 l� I�t'��vt,c-! � (name o tpontion) � .. B � ame of officer of corporauon and title) ��?��L��-�� c DE�� ATI�ST• � r _ , � ��y L �{n � .��r�. .'�, � + � Secxetai�(ot other�ffice'r) � �M r 1 1 .e.; t� r- n y � r, r,� Y._t j 1..� .�w. 4 � ";_(S•��F.00,�ORATIOI� � �� , [ � y � i S. , � STATE OF MISSOURI ) I ) ss. COUNI'Y 4F CAPE GIRARDEAU ) r�. � pn this I� day of �_, 201�, before me appeared �o� � to me pers n yl�own,who,being byme dulysworn,did saythat he/she is the PP-.�-��T of �L �„�f �,�.�(� ��t.tl��i, a Missouri Corporation, and that the seal affixed to the � foregoing instrument is the seal of said �o�°.��tof i Boardtof Direc o St ande cknowledged sa d sealed in behalf of said Corporauon by a ty 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 and y�ar fixst above written. � ( �� "(�(,c� � Nota ublic � JEANA FA.KOCH Notary Public-Notary Seal 1Viy Commission E�cpires: STATE OF MISSOURI Caps Girardsau County � Commisston#08518155 �� A �� 5 �pra My Commission��i«:SePt•�5,2012 � � � � � � � � � �,�t\�. `�t�crv — � s/..�y. � YSA •2 _ �y� S;v1�l��rt ��' n. �sn� C-�CfifT 1_• � :[�.Vt:[ '{ (�M.` Company ID Number: 183009 THE E-VERIFY PROGRAM FOR EMPLOYMENT VERIFICATION MEMORANDUM OF UNDERSTANDING ARTICLE I PURPOSE AND AUTHORITY This Memorandum of Understanding (MOU) sets fo�th the points of agreement between the Department of Homeland Security (DHS) and K AND K ELECTRIC COMPANY (Employer) rega�ding 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 responsibilities 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 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. Authority for the E-Verify program is found in Title IV, Subtitle A, of the tllegal Immigration Reform and Immigrant Responsibility Act of 1996 (IIRIRA), Pub. L. 104-208, 110 Stat. 3009, as amended (8 U.S.C. § 1324a note). Authority for use of the E-Verify program by Federal contracto�s 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 contracto�') to verify the employme�t 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 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 arise 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 o� 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). Paye 1 0(13�E�/erl�y h40U for Employer�R2�isfon Dals 10129I08 �"r�� T�-,«bb � � ��r�� v�UB�� - er� _ . :,. wc �+�w ad A'I.M� �.. E tiE►.i�t 15 7� SCFV::L<•f[�Y.: Company ID Number: 183009 4. SSA agrees to provide a means of automated ve�ification that is designed (in conjunction with DHS's automated system if necessary) to provide confi�mation 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 �ecords 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 access to selected data from DHS's database to enable the Employer 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 appropriate assistance with operational problems that may arise during the Employe�'s participation in the E-Verify prog�am. DHS agrees to provide the Employer names, titles, addresses, and telephone numbers of DHS representatives to be contacted during the E-Verify process. 3. DHS ag�ees 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 OHS, including rest�ictions 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 �mpioyer'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 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 ve�ify the accuracy of Social Security Numbers and employment eligibility, to enforce the Immig�ation 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 Paye 2 of 13�E-Verify P�OU f�r Ernployer�Re+•ision Datc 10�9/G� Wfr' `l.`t�;4 '� � �}^ ° ��us��: ;,;�r!,: �'%. �IQII� .� .. - er� �.��.� ..�,F�,�. �.�.�� ,. . :�...t:. ..< <�: Company ID Number. 183009 nonconfirmation of employees' employment eligibility within 3 Federai Government work days of the initial inquiry. _ g, 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 dete�mines 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 agrees to display the notices supplied by DHS in a prominent place that is clearly visible to p�ospective employees and all employees who are to be verified through the system. 2. The Employer agrees to 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 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 prog�am as a condition of conti�ued use of E- Verify, including any tutorials for Federal cont�actors if the Employer is a Federat contractor. B. Failure to complete a refresher tutorial will p�event the Employer from continued use of the program. 5. The Employer agrees to comply with current Form I-9 procedures, with two exceptions: . If an employee presents a "�ist 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 p�esented during the Form I-9 process to establish identity.) If an employee objects to the photo requirement fo; religious reasons, the Employer should contact E-Verify at 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 the photocopy with the employee's Form I-9. The emptoyer 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. Paye 3 nf 13�E-Veniy t:40U fo�Ernployer�Re��ision Dal� 10f29/08 d�j1t �v- '4 — �L)�� i "��'��r � . — er� 4a�.a�'� '�+o�st�r^ .. E�Y[/IST IF A+LIW:CL!•f FM.L ti Company ID Number: 183009 g. The Employe� understands that 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, o� from other requirements of applicable regulations or laws, including the obligation to comply with the antidisc�imination requi�ements of section 2748 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 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 individuat 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 befinreen $550 and $1,100 for each failure to notify DHS of continued employment following a final nonconfirmation; (4) the Employe� 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 unde� 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. 7. The Employer agrees to initiate E-Verify verification p�ocedures for new employees within 3 Employer business days after each employee has been hired (but after both sections 1 and 2 of the Fo�m 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 Ma�ual. The Employer is prohibited f�om initiating verification procedures befo�e 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 must use the SSA verification procedures first, and use DHS veri�cation procedures and photo screening tool only after the SSA verification response has been given. Employers may initiate verification by notating the Form I-9 in circumstances where the employee has applied for a Social Seeurity Number (SSN) from the SSH and is wait�r�� tc rec�it'e ths ��N, provided that the Employer performs an E-Verify employment ve�ification query using the employee's SSN as soon as the SSN becomes available. g. The Employer agrees not to use E-Verify 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 qualifles for the exceptions described in A�ticle II.D.1.c. Except as provided in Article II.D, the Employer will not verify selectively and will not verify employees hi�ed 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 app�opriate 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 A►ticle 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 Paye 4 of 13�E-Verify AAOU for Employer�Revisicn Dzle 10/29i0a o.��\�. `�,�cf:4i 1 •�U� r�� • � '-1. IIIIIII C _2 _ ��' -��,�>° '�v�snr� [.Y[►SfT IS F. _�LFYI:L !i f�N: Company ID Number. 183009 adverse action against employees if they choose to contest the finding. Further, when empioyees contest a tentative nonconfirmation based upon a photo non-match, the Employer is requi�ed to take affirmative steps (see Article 111.8. below) to contact DHS 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 knowfedge (as defined in 8 C.F.R. § 274a.1(I)) that the employee is not work autho�ized. The Employer understands that an i�itial inability of the SSA or DHS automated ve�ification 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 emptoyee is not work autho�ized. 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 o� 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 woric in poore�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-Ve�ify at 1-888-464-4218 or OSC at 1-800- 255-8155 or 1-800-237-2515 (TDD). 11. The Employer agrees to comply with Title VII of the Civil Rights Act of 1964 and section 2746 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 case of a protected individual as defined in section 274B(a)(3) of the INA, because of his or her citizenship status. The Employer understands that such illegal practices can inciude seiective 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 2748 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). 12. The Employer agrees to record the case verification number on the employee's Form t-9 or to print the screen containing the case verification number and attach it to the employee's Form I-9. 13. The Ernployer agrees that it will use the info�mation it receives from SSA or DHS pursuant to E-Verify and this MOU only to confirm the employment eligibility of employees as Paye 5 of 13��-Verity PAOU fcr Ernplcyer�RE:ision 02t� 10129tOG �.ur, �ri Scr.� -��`J' t� � � '��'� - er� � :,. �� t ._ �4�w�t� �HI<1��'1 L-YCfItY 1: A^_[�Y1:£ :•f LY.: Company ID Number: 183009 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 Employers 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 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 MOU may be subject to criminal penalties. 15. The Employer agrees to cooperate with DHS and SSA in their compliance monito�ing 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 intenriew it and its employees rega�ding the Employer's use of E-Verify, and to respond in a timely and accu�ate manner to DHS requests for information �elating to their participation in E-Verify. D. 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 22.1801) in addition to verifying the employment eligibility of all other employees required to be ve�ified under the FAR. Once an employee has been verified through E-Verify by the Employer, the Employer may not reverify the employee th�ough 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 calendar days of contract award and, within 90 davs 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 fa the contract. Once the Employer begins verifying new hi�es, 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 Fede�al contractor for 90 days or more at the time of a contract award must use E-Verify to initiate verification of employment eligibility fvr 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 Emp�oyer must, within 90 days of enrollment, begin to use E-Verify to initiate verification of new hires of the contractor who are wo�king 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 Paye 6 of 13�E-Verify t�lOU for Employer�Revisicn Date 10/29/G8 ��•. �� l :p e�� j3 r. . ' �\�h�. ':, Illllllc - - er� M.� ..,��.� c •:c►�rr 1= A S[fY11i ^F cn_ Company ID Number. 183009 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 govemments 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 Federally recognized Indian tribes, o� 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 contracto�s may, however, elect to verify all new hires, and/or all existing employees hired after November 6, 1986. The provisions of Article II.D, paragraphs 1.a and 1.b of this MOU providing timeframes fo�i�itiating employment verification of employees assigned to a contract apply to such institutions of higher education, State, local and t�ibal governments, and sureties. d. Verification of all employees: Upon enrollment, Employers who are Fede�al 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 cove�ed 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 180 days after the election. e. Form I-9 procedures for Federal contractors: The Employer may use a previously completed Form I-9 as the basis for initiating E-Verify verification of an employee assigned to a contract as long as that Form I-9 is complete (including the SSN), complies with Article II.C.S, the employee's work authorization has not expired, and the Employer has reviewed the info�mation reflected in the Form 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.S, 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 othervv�se incomplet q .,�..� the Employer shall complete a new I-9 consistent with Articie ii.�.�, o� upuQ�G t�� ,�� -� 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 A�ticle II.C.S, 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 shall not require the production of additionat documentation, or use the photo screening tool described in A�ticle II.C.S, 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 �equire a second verification using E-Verify of any assigned empfoyee 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 requi�ement under the terrns of the Federal contract or subcontract, and the Employer consents to the release of information relating to compliance with its verification responsibilities unde� this MOU to contracting officers or other officials authorized to review the Employer's compliance with Federal cont�acting requirements. paye 7 of 13�E-�/en'ry F10U for Fmployer�Revlsior�Oat2 10/291G4 � ��' ' ;�us�L`, � ��',� :,;,Illllil t - er� .. �.. �: � ._ C K►l!Y 1: T _[�'I:t[ ��f[�M.f � Company ID Number: 183009 ARTICLE III REFERRAL OF INDIVIDUALS TO SSA AND OHS q. REFERRAL TO SSA �. 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 �ecords the case verification number, reviews the input to detect any transaction errors, and determines that the employee contests the tentative nonconfirmation. The Employer will t�ansmit 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 employee to visit an SSA o�ce within 8 Federal Govemment work days. SSA will electronically transmit the result of the referral to the Employer within 10 Federal Govemment work days of the referral unless it determines that more than 10 days is necessary. The Emptoyer 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 Numbe� 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 no�confirmation. 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 agrees to refer individuals to OHS only when the employee chooses to contest a tentative nonconfirmation received from DHS automated verification process o� 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 Paqe 8 oF 13�E-Veri'ry f�40U for Empfoyer�Revision Date 10�291Gt3 � �i •z�i. �: - - 'ti iuiu� t ,, : -t - er� ....� . � . (VLIS�Y IS �=CF'I:CC =•f fi'• Company ID Number: 183009 after the Employer receives it. 4_ If the empioyee contests a tentative a nstr ct the' employeeto on ac DHS hrough its provide the employee with a referral letter an toll-free hotline (as found on the referral letter) within 8 Federal Government work days. 5. If the employee contests a tentative eferral let er to DHSeDHS will elect oni ally t ansm t Employer will provide the employee with a r the �esult of the referral to the Employer withis necessara! The Employe\r ag ees to check the E� unless it determines that more than 10 days rY Verify system regularly for case updates. g, The Employer agrees that if an emple d a co teof thetemployee's Fo�m I 551 o bForm upon a p h o t o n o n-m a t c h, t h e E m p l o y e r w i l l s p Y 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. The Employer understands that�to forwa d the employee's documentation to DHS by matchlnon-match, the Employer is require scanning and uploading, or by sending the doclmmi ratione Servi ces Verif�ier aa DHSawhoaWh'i and resolving the case as specified by the 9 determine the photo match or non-match. ARTI_LE IV SERVICE PROVISIONS �SA and DHS will not charge the Employer for verification Jse►vices perfor�med under this MOU. The Employer is responsible for providing eq onalecom�uter with�lnternet accessTo access the E-Verify System, an Ernployer will need a pers P ARTICLE V PARTIES q. This MOU is effective upon the signaif re o�f a121 rpaunless mod fied in wr ti g by he mutual long as the SSA and DHS conduct the E-Ve y P g rior written notice to the others. consent of all parties, or terminated by any party upon 30 days p Any and all system enhancements to the Eit onal data sourbes�and nssu ng new Iveribcatfon limited to the E-Verify checking against add lemental procedures, will be covered unesf DHS ay eestoVtrain�employers on alla hanges made to E- MOU that outlines these chang Verify through the use of mandatory refreshS rese�rves the�right�tot equ�etemp yers to take Manual. Even without changes to E-Verify, DH p�ye 9 of 13�F-�lerit�A�iOU for Fmplc;er,Revision Ga�e 1G/29I00 R .�: . �`��iise � �.�. ��-�,,�u�� r � - er� .. � . � � ��V[�.ItY 1: •�[P.vICE •'-f [�f5 S' Company ID Number: 183009 mandatory refresher tutorials. An Employe� that is a Federal contractor may terminate this MOU when the Federal contract that requires its pa�ticipation in E-Verify is terminated or completed. In such a circumstance, the Federal contracto�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. g. Notwithstanding Article V, part A of this MOU, DHS may terminate this MOU if deemed necessary because of the �equirements of law o� 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 pa�t of the Employer to comply with established procedures or legal requirementa�Tfo Employer understands that if it is a Fede�al contractor, termination of this MOU by any p y 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 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. p. 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 pa�ty 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 fo� 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 �mployer understands that the fact of its participation in E-Verify is not confidential information and may be disclosed as authorized or required by iaw a�� H� c; �SA �nti�y, 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. paye 10 0l 13�E-Verify t�lOU for Employer�Revision Date t0129l08 l s��t :'�"``'�. � �� '�us� < .t 'S�Y✓,r 'i. ��'�� .r - er� ��.<< ..�.�r.�1 c•:n�rr t� n ucsut ct wa: Company ID Number: 183009 To be accepted as a participant in E-Verify, you should only sign the Employer's Section of the signature page. If you have any questions, contact E-Verify at 888-464-4218. Employer K AND K ELECTRIC COMPANY JEANA KOCH _ --- _ i ic �. ly ._----.-.— Name(Please Type or Print) � Title Flect�anically Signed 01l21/2009 - — -- —_._ Date --- ----------- Signature Department of Homeland Security-Verification Division USCIS Verification Division ----. -------------------- �-- Name(Please Type or Print) Titie Electronica/!y Signed __ 01I29f2G09 __ - --.._. -__. - ---_------------------ Date ----------- -------._. Signature Paye 11 of 13�F-Venfy I��OU for Employer�Revisfor.Da?� 10/29106 � � �. �` �- -- Fwt+n a�s[��nce a as oo ss. � Company ID Number: ��j � S_ I Information relating to the Program Administrator(s) for your Company on policy questions or operational problems: Name: �U� � . Telephone Number: �� .� � 3"t' —� � � Fax fdumber. �/ �� 3� " ��-��'�'� E-mailAddress: �O��d�,�l��+•c-C�`^'� Name� �%}-��- �c�l Telephone Number: 5� 3";�3�-'-C�� Fax Number. ��3 �— �`i-- v�-�� E-mail Address:��ti;.4�=' �.�h� ��C—�_� _ Page 110(12�E-Verify MOU�cr Employer�P,easion Oate 10�29J08� � � ` . EXHIBIT AFFIDAVIT OF OSHA TRAINING � COMES NOW(Name)� `��—+"� � (4ffice Held) ��_S i D E i=�T o{(CompanyName/Concractor)-�� • and fust being duly sworn, on ��--t��'- �(�P�y W�CIS A�-`� � my oath,aff irm in connection with the contracted services related to con�.�ls DRf��NQ wa�--E�e. `�jolt�t F�-Nb p� -+.� c,ro�,-ol�roject Name) for the duration of the contract, as follows: �' 1, Contractor shall provide a ten (10) hour Occupational Safety and Health Administration (OSHA) construction 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 siirvlar 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 safery program within sixty(60) days after the date work on the Project commences, as required by Section r292.675,RSMo. 3. Contractor acknowledges and agrees that any of Contracto�'s employees found on � the Project site without documentation of the successful completion of a construction safety 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 � Section 292.675,RSMo. S. Contractor acknowledges that pursuant to Section 292.675, RSMo., Contractor shall �' forfeit to City as a penalty 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 employ�e is employed without the construction safety training required in Section 292.675,RSMo. � 6, Contractor acl�owledges that violations of Section 292.675, RSMo, and imposition of the penalties described therein shall be investigated and deternlined by the Missouri Department � of Labor and Industrial Relations. 7. Contractor aclmowledges that in the event that the Missouri Department of Labor � and Industrial Relations has deterniined that a violation of Section 292.675, RSMo., has occurred � �� • � _ � and that a penalty shall be assessed, the City shall withhold and retain all sums and amounts due and owing when mal�ing payments to Contractor under this Contract. �, FURTHER AFFIANT SAITH NOT. � I1�J AFpIRMATION 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.) �� f' �� 1�` � (name orporation) B � ame of of icer o corporation an tide �p�� '�S 1 O�,N�" � ATrE . �4 ��. � Se{c�ta;�a(or�ther officer >�',� I � ��.' ; ;�•(SF�,��C�7R�'ORATIOI� �f S:r , .S: � � .;7 . . :�f+ ' �^�,. ... � �� \ � � �y'� :. �. � �''�,��y3�r.a.f I f � ,.P"MISSOURI f <,�� ) ss. - �� .,: ,. ;�`�C�`CjN'I'Y OF CAPE GIRARDEAU ) -- � , On this (� day of ��^ , 201(., before me appeared �c��- -�a-�'1 � to me ersonally lmown,who,being by me duly swom,did say that he/she is the Q2-�S��-�T of +� , a Missouri Corporauon, and that the seal affixed to the foregoing instrument is the sea 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 instnunent to be the free act and deed of said Corporation. IN TESTIMONY WI�REOF, I have hereunto set my hand and affixed my official seal, at my office in Cape Girardeau,Missouri,the day and year first above written. ; �� Nota lic My Commission Expires: JEANA M.KOCH Notary Public-Notary Seal STATE OF MISSOURI � . l� �I Cape Girardeau County c Commission#08518155 My Commiss��n Fx��=res:SE�t. 15,2012 � t • DWSRF 291010-01 � � Pm�ect Control Numh r � � United States Environmentat Protection Agency Washington,DC 20400 Certification Regarding � Debarment, Suspension, and other Responsibility Matters The prospective participant certifies to the best of its knowledge and belief that it and its Iprincipals, 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 department or agency. (b) Have not within a three year period preceding this proposal been convicted of or had a � civil judgement 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 indicated 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 1 (d) Have not within a three-year period preceding this application/proposal had one or more � public transactions (Federal, State, or local) terminated for cause or default. I understand that a false statement o�n this �erti_f,_�at;r�„,,,? }�e 4rnnnrle fnr YP1Pl�*1IlH „�+r• y ..., d..,.,....� .�. ..,�..,,�..,...,. �.�s I proposal or termination of the award. In addition, under 18 USC Sec. 1001, a false statement may result in a fine of up to $10,000 or imprisonment for up to 5 years, or both. � �� e.ES.t p�� ITyped Name &Title of Authori ed Representative � �_ i�-F f i� ignature of Authorized Representative Date I am unable to certify to the above statements. My explanation is attached. EPA Fonn 5700-49(I I-88) .� ,.�i This form to be submitted with Bid: � ERPRISE UTILIZATION WORKSHEET M�p�Ty �D WOMEN'S BUSINESS ENT � Grant Applicant �f� °�� n�� '- ProjectNumber D(�-�� ' ' -� �,�-�-�1� ��+rY1G��"`-� Contractor/Engineer ��p mo �� Address, City, State, and Zip�v3�-�-�� o-�' �� Contact Person -5�� Telephone No �Z � Amount of Contract MBE Percentage I l.�-k WBE Percentage: �-`� 1 Mgg ✓ Subcontractor ��.h� ��6�� i �tEE Address, City, State, Zip �3 Contact Person � �h i�, Amount of Subcontract � C�',�°= Tax ID Number��87 S�l��lg� , Scope Of Work ~ ' ° ��, 2. MBE Subcontractor �� 1 y � wgE ✓ Address, City, State, Zip 3f��-� ,�A--,{� , Contact Person � ��Q��`-' Amount of Subcontract °a Tax ID Number/�43 (� �.Q�1 3 � Scope Of Work � � 3. MBE Subcontractor WBE Address, City, State, Zip � Contact Person Amoun't oi Su'bcoi��i4�t Tax IT�Number � Scope Of Work � 4. MBE Subcontractor �E Address, City, State, Zip � Contact Person Amount of Subcontract Tax ID Number Scope Of Work � � � � y. { � 4. MBE Subcont�actor WB$ Address � Contact Ferson Tel�phone No_ OA MBFJW�E Certification Nurnber �� MODOT IvIBFJ'WBE Certificatiorz('Yes) (No) � Amount of Subcontract Scope of'UVork 5. MBE Subc�nh-actor Y'VBE AddrEss � Con�tact Person � Telephone No. � OA M�E�WBE Certx�cation N'umber MODOT MB�JWBE Certification (�es) {No) . T` Annount oC Subcontrac� Sco�e of Work '� '� 6. MB,� Subcoz�tracior WBE .A.ddress '"� Contact Person, Telephone No_ OA MBEfW��Ccrtification Number �� M0170T MBE1W$E Certification (Yes} � �(�(o} Amount of Subcontract Scopc of W'ork _ y �Ori1zT1Ent5 Y /! � �f // Prepared ` Telep ne umber. ..._._ �'��`� �3�—C7�� ._.. __ . . ._.. Date= f � �p( uA., m�ra�no TOTAL P.02 � L •• � Region VII Procedures for Implementation Minority Business Enterprise/Women's Business Enterprise � Each bidder/offeror must fully comply with the requirements, terms, conditions of EPA's regulations to award a fair share of subagreements to minority and women's businesses. The � bidder/offeror commits itself to taking affirmative steps contained herein. Bidders/offerors will take affirmative ste�s prior to submission of bids/pronosals. � Affirmative Steps 1. The grantee and subgrantee will take all necessary affirmative steps to assure that � minority firms,women's business enterprises, and labor surplus area firms are used when _ possible. � 2. Affirmative steps shall include: � a. Placing qualified small and minority businesses and women's business enterprises on solicitation lists; � b. Assuring that small and minority businesses, and women's business enterprises are solicited whenever they are potential sources; � c. Dividing total requirements, when economically feasible, into smaller tasks or quantities to permit maximum participation by small and minority businesses, and women's business enterprises; � d. Establishing delivery schedules, where the requirement permits, which encourage participation by small and minority businesses, and women's business enterprises; � P. iJsin the services and assistance of the Small Business Administration and the � Minority Business Development Agency of the Department of Commerce; and � £ Requiring the prime contractor, if subcontracts are to be let, to take the affirmative � steps listed in paragraphs 2a through 2e of this section. Determination of Compliance � It is to be noted that bidders/offerors must demonstrate compliance with MBE/WBE requirements in order to be deemed responsible. Demonstration of compliance shall include, but � is not limited to, the following information: 1. Names, addresses and phone numbers of MBE/WBEs expected to perform work; 2. Work to be performed by the MBEs and WBEs; 3. Aggregate dollar amount of work to be performed by MBEs and WBEs, showing aggregate to MBEs and aggregate to WBEs separately; �. f '. 4. Description of contacts to MBE and WBE organizations, agencies and I; associations which serve MBE/WBEs, including names of organizations, agencies and associations and dates of contacts; � 5. Description of contacts to MBEs and WBEs, including number of contacts, fields, (i.e. equipment or material supplier, excavators, transport services, electrical � subcontractors, plumbers, etc.) and dates of contacts. All bidders/offerors should complete the Minority and Women's Business Enterprise Utilization iWorksheet and submit to the funding recipient with the bid. � � � � � � � � � � � � � � � w � U.S. ENVIRONMENTAL PROTECTION AGENCY WATER QUALITY OFFICE � ACILITIES CERTIFICATION OF NONSEGREGATED F � (Applicable to federally assisted construction contracts and related sub-contracts exceeding $10,000 which are not exempt from the Equal Opportunity clause.) . � The federally assisted construction contractor certifies that he does not maintain or provide for his employees any segregated facilities at any of his establishments, and that he does � not permit his employees to perform their services at any location, under his control,where segregated facilities are maintained. The federally assisted construction contractor certifies further that he will not maintain or provide for his employees any segregated facilities at any of his � establishments, and that he will not permit his employees to perform their services at any location, under his control, where segregated facilities are maintained. The federally assisted construction contractor agrees that a breach of this certification is a violation of the Equal Opportunity clause in � this contract. As used in this certification, the term"segregated facilities" means any waiting rooms, work areas, rest rooms and wash rooms, restaurants and other eating areas, time clocks, locker rooms and other storage or dressing areas, parking lots, drinking fountains, recreation or � entertainment areas, transportation, and housing facilities provided for employees which are segregated by explicit directive or are in fact segregated on the basis of race, creed, color, or � national origin,because of habit, local custom, or otherwise. The federally assisted construction , contractor agrees that(except where he has obtained identical certifications from proposed subcontractors for specific time periods)he will obtain identical certifications from proposed � subcontractors prior to the award of subcontracts exceeding$10,000 which are not exempt from the provisions of the Equal Opportunity clause, and that he will retain such certifications in his files. � ,� :�, , - � �-- 10- 1 � � Signature Date �� tZ�`�S-�9�tJ \ � Name and Title of Signer (Please Type) � �g.� ��E�:-��C'._ C�-y1�-,�-t-1 Firm Name NOTE: The penalty for making false statements in offers is prescribed in 18 U.S.C. 1001. f� �. .4 �11 CERTIFICATION REGARDING GOVERNMENT-WIDE RESTRICTION ON LOBBYING � (For contracts, grants, cooperative agreements, and loans over$100,000) The undersigned certifies, to the best of his or her knowledge and belief, that: � (1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the � undersigned, to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in con.nection with the awarding of any Federal contract, the making of any � Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. � (2) If any funds other than Federal appropriated funds have been paid or will be aid to an P Y person for influencing or attempting to influence an officer or employee of any agency, a ' Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in con.nection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Forrn LLL, "Disclosure Form to Report � Lobbying," in accordance with its instructions. � (3) The undersigned shall require that the language of this certification be included in the award documents for all subawards (at all tiers, including contracts under grants, loans, and cooperative agreements, subcontracts, and subgrants) over$100,000, and that all subrecipients ' shall certify and disclose accordingly. T'his certification is a material representation of fact upon which reliance was placed when this r transaction was made or entered into. Submission of this certification is a prerequisite for p making or entering into this transaction impost by Section 1352,Title 31, U.S.C. Any person who fails to file the req_uired certification shall be sub;eCt tn a ciyil r�en�ltv nf nnt 1Pcc than ( $10,000 and not more than $100,000 for each such failure. � °� � `� � �'�<L- ��r1�c�rn� �--lc�—c � Name of Entity(city, county, contractor, etc.) I Na o Certifying Of cial (Mayor, Presiding Commissioner, President, etc.) Signature of Certifying Official Date