HomeMy WebLinkAboutRES.2571.11-01-2010 }
CITY OF CAPE GIRARDEAU
Fire Station #1, Roof Replacement
Energy Grant Project: DE-EE0002927
9 South Sprigg Street
Cape Girardeau, Missouri
STANDARD FORM OF AGREEMENT
BETWEEN OWNER AND CONTRACTOR
ON THE BASIS OF A STIPULATED PRICE
THIS AGREEMENT is dated as of the � day of �Jc�m in the year
2010 by and between the City of Cape Girardeau, Missouri (hereinafter called OWNER)
and Drury 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:
Roof replacement to consist of tear-off of existing roof inembrane, add
insulation to roof, raise miscellaneous roof curbs, replace stair penthouse
door and frame, new flashing as required, new roof inembrane to be white
TPO membrane roof.
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 60 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 90 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 three hundred dollars—($300) 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 three hundred dollars—
300 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.
LUMP SUM CONTRACT AMOUNT: $123, 261.00 (one hundred twenty-three thousand
two hundred sixty-one dollars & zero cents)
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.
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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°/a of the Work completed.
90% (with the balance being retainage) of materials and equipment not
incor�orated in the Work(but delivered, suitably stored and accompanied by
documentations satisfactory to OWNER as provided in paragraph 14.2 of the
General Conditions).
5.1.2 Upon Substantial Completion, in an amount sufficient to increase total payments to
CONTRACTOR to 95%of the Contract Price (with the balance being retainage), less such
amounts as ENGINEER shall determine, or OWNER may withhold, in accordance with
paragraph 14.7 of the General Conditions.
5.2 Final Payment. Upon final completion and acceptance of the Work in accordance with
paragraph 14.13 of the General Conditions, OWNER shall pay the remainder of the
Contract Price as recommended by ENGINEER as provided in said paragraph 14.13.
Article 6. INTEREST.
All moneys not paid when due as provided in Article 14 of the General Conditions shall
bear interest at the maximum rate allowed by law at the place of the Project.
Article 7. CONTRACTOR'S REPRESENTATIONS.
In order to induce OWNER to enter into the Agreement, CONTRACTOR makes the
following representations:
7.1 CONTRACTOR has examined and carefully studied the Contract Documents
(including the Addenda listed in paragraph 8) and the other related data identified in the
Bidding Documents, including "technical data".
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
.
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.
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Article 8. CONTRACT DOCUMENTS.
The Contract Documents which comprise the entire agreement between OWNER and
CONTRACTOR concerning the Work consist of the following:
8.1 This Agreement (pages 1 to 7 inclusive).
8.2 Exhibits to this Agreement labeled
8.3 Performance, Payment, and other Bonds, identified as exhibits "A" 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- 7 , inclusive).
8.7 Specifications bearing the title Fire Station #1, Roof Replacement, dated July 13,
2010.
8.8 Drawings. (see attached sheet)
8.9 Addenda numbers 1 to 1 , inclusive.
8.10 CONTRACTOR'S Bid (pages BF- 1 to BF- 9 , inclusive) marked exhibit "B"
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.
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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 wifl 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.
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NOV-08-2010 13�46 CITY OF CAPE GIRARDEAU 573 651 a860 P,02
fN WITNESS WHEREOF, OWNER and CONTRACTOR have signed the Agreement in
multiple copies, One counterpart each has been delive�ed to CONTRACTOR and
ENGlNEER and two counterparts to the OWNER. Ali portions of the Contract Documents
have been signed, initi�led or identified by OWNER and CONTRACTOR or identified by
ENGINEER on their behalf.
This Agreement will be effective on _ IV��i�rn/�, J�T�, 2p 1��Which is the
Effective Date of the Agreement).
OWNER _Citv of Cape Girardeau C NTRACT R , Com an
Scott Me � r ana er
gy er Cummins, President
�
A�test Attest
GA Y� •�,. Co�✓P,�4D �,-� Ct��K
(CO ORATE S�AL] [CORPORATE SEALj
Address for giving notices Address for giving notices
�01 Independence Street 4072 State Hi Way K
Cape Girard�au MO 63703 Cane Girardeau MO 63702
(If OWNER is a pub(ic body, attach License No.
evidence of authority to sign and
resolution or other documents gent f r se ' � of process:
authorizing execution of Agre�ment. �
;,��, GI���� C RACTOR is corpo�ation,
�� �'.,�� at ch evidence of authority to sign.)
O , �"' , �';;
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y+ � � v✓��{1t`y:i �,
M� j� �j`jl��"' C. 1
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�T��� UNION �'�' �
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TOTAL P.02
,
� EXHIBIT "B"
CITY OF CAPE GIRARDEAU
Fire Station #1, Roof Replacement
Energy Grant Project: DE-EE0002927
9 South Sprigg Street
CAPE GIRARDEAU, MISSOURI
BID FORM
(EJCDC 1910-18) (1990)
PROJECT IDENTIFICATION: The roof replacement to consist of tear-off of existing roof
membrane, add insulation to roof, raise miscellaneous roof curbs, replace stair penthouse
door and frame, new white TPO roof inembrane and flashing as required. The building is
located at 1 South Sprigg Street, Cape Girardeau, Missouri.
THIS BID IS SUBMITTED TO: Kelly Green, P. E.
City Engineer
City of Cape Girardeau
401 Independence Street
Cape Girardeau, Missouri 63703
1. The undersigned BIDDER proposes and agrees, if the Bid is accepted, to enter into ar��
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(60)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
, ,
. ' .
Addenda, receipt of all which is hereby acknowiedged: �LlstAddendabyAddendumNumberand0ate),
Addenda #1 , dated 9/16/10 -
(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 in the Supplementary Conditions as
provided in paragraph 4.2.1 of the General Conditions. BIDDER 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 BIDDER is entitled to
rely as provided in paragraph 4.2 of the General Conditions. 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 8idding Documents with respect to Underground Facilit'ies at or contiguous to the site.
BIDDER has obtained and carefullystudied (orassumes responsibilityforhaving 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 considerthat any additional
examinations, investigations, explorations, tests, studies or data are necessary for the
determination of this Bid for performance and furnishing of the Woric in accordance with the
times, price and other terms and conditions of the Contract Documents. '
(e) BIDDER is aware of the general nature of Work to be performed by Owner and
others at the site that relates to Work for which this Bid is submitted as indicated in the
Contract Documents.
(f) BIDDER has correlated the information known to BIDDER, information and
observations obtained from visits to the site, reports and drawings identified in the Contract
Documents and all additional examinations, investigations, explorations,tests, studies and
data with the Contract Documents.
BF-2
. '
,
�g� BIDDER has given Engineer written notice of all conflicts, errors, ambiguities or
discrep�ncies that BIDDER has discovered in the Contract Documents and the written
resolution thereof by EN�INEER is acceptable to BIDDER, and the Contract Documents
are genF ally :�u�ficient to indicate and convey understanding of all terms and conditions for
perforrr:ing ar furnishing the Work for which this Bid is submitted.
�h) This B� � is genuine and not made in the interest of or on behalf of any undisclosed
person, firm ��� 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
OWfvER.
4. BIDDER will complete the Work in accordance with the Contract Documents for the
f�llowing price:
Base Bid:
Total Base Bid: $ 123,261 ,00
VUritten Fiqure (Base Bid): one xundred Twentv '�hree Thousand, �ao xundred
Sixt� One Dollars & 00/100------------------------------------------- Dollars
(Total bid amount is to be shown in both words and figures. In case of discrepancy, the
amount shown in words will govern.
B F-3
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5. BIDDER agrees that the Work will be substantialiy complete by 60 Calendar Days.The
Work will be completed and ready for final payment in accordance with paragraph 14.13 of
the General Conditions by 90 Calendar Days.
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) Required BIDDER'S Qualification Statement with supporting data.
(c) Any Addenda issued.
(d) Minority and women's business enterprise utilization worksheet.
(e) Certification of bidder regarding equal employment opportunity.
(f) Certification regarding lobbying.
(g) Certification of bidder regarding section 3 and segregated facilities.
(h) Affidavit of work authorization.
(i) Certification regarding debarment, suspension and other responsibility matters.
(j) The E-Verify program for employment verification memorandum of understanding.
(k) All bid form documents and roofing contractor's qualification form.
7. Communications concerning this Bid shall be addressed to:
Name Charles Menz, Dept Manacier -
Address P O Box 1 544 C'a� ('i rarr7Pai� Mc"1 ti37�?
(a) Performance and Payment Bonding Company
. Name The Hanover Insurance Co
Address �500 College Blvd, Overland Park KS 66213
Agent\Power of Attorney Name (if used) Robert E Miller Group
Address 373 W 101 st Terrace, Kansas City MO 64114 _
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 09/23�10 , 20_•
Contractor License No.
B F'-4
A Corporation (SEAL)
B y Drurv Con►p�nv
(Corporation Name)
Missouri
(State of Incorporation)
By �7erry Cti�,�,r�,; G _ (SEAL)
(Name of Person Authorized fo Sign)
President
(Title)
; (Corporate Seal)
>>
Attest
(Secretary)
Business address:
Cape Girardeau MO 63702
Phone No.: 573.334 8271
Date of Qualification to do business is FPhn�arvi 1959
A Joint Venture '(SEAL)
By N/A
(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-6
�� " .
r
� � gR�AKDOWN OF WORK FORCE (Required): �
BIDDER hereby states that he will perform the following iterns of work directly without
emplcymert of subcontractors
—_--------_.
Roof REplacement
,'
} ;:
It is anticipated that the following subcontractors will be employed for work on this project:
SUBCONTRACTORS:
- Roofing: �t/A
(Attach roof subcontractor's qualification sheet)
Hollow metal door and frame: N/A
Mechanical / Plumbing work: N,L�
��' Electrical: N/A
,�:
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B F-7
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��--�� Document A3� OTM - 197a
��
Brd Bond
KNOW ALL MEN BY THESE PRESENTS,that we
(Here insert full name and address or lega!title of Contrc�ctor)
D�u�y Cornpat�y
4072 State Highway K
Cape Girardeau, MO 63701
as Principal,hereinafter called the Principal,and
(Here insert full�urrne und acldress o1•lega!title of Surery)
The Hanover Insurance Company
440 Lincoln Street
Worcester, MA 01653
a corporation duly organized under ehe laws of the State c�f New Hampshire
as Surety, hereinafter called the Surety, are held and firmly bound unto
�Here irzsert ficll izame and address ot•legal title of Owner)
City of Cape Girardeau
401 Independence
Cape Girardeau, MO 63701
as Obligee,hereinafter catled the Obligee,in the sum of *****Five Percent of The Total Amount Bid*"***
Dollars($ 5% ),for the payment
of which sum well anci truly to be r-iade,the said Principal and the said Surety,bind ourselves,our heirs,executors,
administrators,successors and assiD s,joindy and severally,�rmly by these presents.
VJHEREAS,the Principal has submitted a bid for Energy Grant Project#DE-EE0002927, Fire Station #1, Roof
(Here insert full name, address and description of project)
Replacement
NOW,THEREFORE,if the Obligee sha11 accept the bid of the Principal and the Principal shall enter into a Conuact
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 w�ith good and sufficient surety for�he faithful performance of such Contract and for the
prompt payment of labor and materia] fucnished in[he prosecution thereof,or in the e��ent of the failure of the Principal
to enter such Contrac[and give such bond or Uonds,if the Principal shall pay[o the Obligec the difference not to exceed
the penalty hereof between the amount specified in said bi.d and such larger amount for which the Obligee may in good
faith conuact;.�ith another par:y to perform the�'Vork cove:ed by said bid,then this obligation shall be null and void,'-`'
otherwise to remain in fuIl force and effect. � '"""""f+,;-,
zf:�� � � ��i .
£t a,
Signed and sealed this 23rd day of S ptembe 2010 '"A; :'�� �
i: � �'�. t
�`;� ;' `.=� �--�.,, ''
Dru Co an �� � ° +�,."{ �
(Principal (�ea1}�;.� � a �
, -
_ _.__._. ._ .
s Jerrv 'ns, President %�,� `-� 'f� -a1
(Title) -,. �.�� .... �°
'�"�;�,. �' �t ``«.
The Hanover Insurance Company � ����l+�,���fz��•
� ��__a Surery•) ��r;,: � ,,
�p M
1/'�.`� y�f�,t�� �
LI 2 S� _ r�'
�"Tirle) Denise A. Iverson (Se y� �c��.; �-
Attorney-in-Fact '.t'� �, �� .-
,k •F� ,r�. ✓
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AIA Document A310T*'—1970.Copyrigfit�1963 and 1970 by The American Institute of Architects.
�...
. ,.
THE HANOVERINSURANCE COMPANY ' �
MASSACHUSETTS BAYINSURANCE COMPANY "
CITIZENS INSURANCE COMPANY OF AMERICA
POWERS OF ATTORNEY
CERTIFIED COPY �
KNOW ALL MEN BY THESE PRESENTS: That THE HANOVER INSURANCE COMPANY and MASSACHUSETTS BAY INSURANCE COMPANY,
both being corporations organized and existing under the laws of the State of New Hampshire, and CITIZENS INSURANCE COMPANY OF
AMERICA, a corporation organized and existing under the laws of the State of Michigan,do hereby constitute and appoint
Jiii A.Farnsworth,Denise A.Iverson,D.C.Pruett,Matthew J.Miller,Sean R.Miller,Omar G.Guerra and/or Dale A.Gabauer
of Kansas City,MO and each is a true and lawful Attorney(s)-in-fact to sign,execute,seal,acknowledge and deliver for,and on its behalf,
and as its act and deed any place within the United States,or, if the following line be filled in,only within the area therein designated
any and ali bonds,recognizances,undertakings,contracts of indemnity or other writings obligatory in the nature thereof,as follows:
Any such obligations in the United States,not to exceed Twenty Million and No1100($20,000,000)in any single instance
and said companies hereby ratify and confirm all and whatsoever said Attorney(s)-in-fact may lawfully do in the premises by virtue of these presents.
These appointments are made under and by authority of the following Resolution passed by the Board of Directors of said Companies which
resolutions are still in effect:
"RESOLVED, That the President or any Vice President, in conjunction with any Assistant Vice President, be and they are hereby authorized and
empowered to appoint Attorneys-in-fact of the Company,in its name and as its acts,to execute and acknowledge for and on its behalf as Surety any and
all bonds,recognizances,contracts of indemnity,waivers of citation and all other writings obligatory in the nature thereof,with power to attach thereto the
seal of the Company.Any such writings so executed by such Attorneys-in-fact shali be as binding upon the Company as if they had been duly executed
and acknowledged by the regulariy elected officers of the Company in their own proper persons." (Adopted October 7, 1981 -The Hanover Insurance
Company;Adopted April 14,1982—Massachusetts Bay Insurance Company;Adopted September 7,2001-Citizens Insurance Company of America)
IN WITNESS WHEREOF, THE HANOVER INSURANCE COMPANY, MASSACHUSETTS BAY INSURANCE COMPANY and CITIZENS
INSURANCE COMPANY OF AMERICA have caused these presents to be sealed with their respective corporate seals, duly attested by a Vice
President and an Assistant Vice President,this 3rd day of December 2009.
TNE tiANOUER It�S�UI?ANGE�OM(��1N3!;
MP;SSACFiUSBT';'S BAY(NSl11�ANC�Cr)M"PANY
;�„w�ww, � .r"�"� ,,,,�� CITIZENS�SURAIVCE COMPANY OF"AM1'I�RiCA '
S. . �. ,��. ��ffi�Y4i, l.�/` �� .
1
�� � � '� � ��.�;���.�-__..`
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� � �.` �, Ma[y Jeanne� d; �on, �ce Presitle-L �
{;����
Robert K,Gtennan,Assistan ice Presiden�
THE COMMONWE4LTH OF MASSACHUSETTS )
COUNTY OF WORCESTER )ss.
On this 3rd day of December 2009, before me came the above named Vice President and Assistant Vice President of The Hanover insurance
Company, Massachusetts Bay Insurance Company and Citizens Insurance Company of America, to me personally known to be the individuals and
officers described herein, and acknowledged that the seals affixed to the preceding instrument are the corporate seals of The Hanover Insurance
Company Massachusetts Bay Insurance Company and Citizens Insurance Company of America, respectively,and that the said corporate seals and
their signatures as officers were duly affixed and subscribed to said instrument by the authority and direction of said Corporations.
°,�,,,,,°'�"'a` ,�-`��--�/',�,�_ � �:�.��.�';��i-
c��d�..r�a i �+JOfSfy f'Ub1IC
r�ca.��ea.raam
My commission expires on November 3,2011
t, the undersigned Assistant Vice President of The Hanover Insurance Company, Massachusetts Bay Insurance Company and Citizens Insurance
Company of America, hereby certify that the above and foregoing is a full, true and correct copy of the Original Power of Attorney issued by said
Companies,and do hereby further certify that the said Powers of Attorney are still in force and effect.
This Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of The Hanover Insurance
Company,Massachusetts Bay Insurance Company and Citizens Insurance Company of America.
"RESOLVED, That any and all Powers of Attorney and Certified Copies of such Powers of Attorney and certification in respect thereto, granted and
executed by the President or any Vice President in conjunction with any Assistant Vice President of the Company,shall be binding on the Company to the
same extent as if all signatures therein were manually a�xed, even though one or more of any such signatures thereon may be facsimile." (Adopted
Odober 7, 1981 -The Hanover Insurance Company;Adopted April 14, 1982 Massachusetts Bay Insurance Company;Adopted September 7, 2001 -
Citizens I�surance Company of America)
GIVEN under my hand and the seals of said Companies,at Worcester,Massachusetts,this 23rd day of September ,20 10 .
, THE HANOVER INSURANCE COMPANY
MASSACHUSETTS BAY tNSURANCE COMPANY
CITI S INSU �lCE CO�PANY OF ERICA
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_ ( �r F-�E�-�,,�-,'� _
Step�r`e .8�aul,Assistant Vice Pres nt
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,
,
ROOFING CONTRACTOR QUALIFICATION INFORMATION
Contractor Name: � � •
Contractor Adress: P O Box 1544
City, State, Zip Code: �1� Girardeau MO 63702
Phone Number: 573.334.8271
Fax Number: 573.334.0089
Contact Person: Charles Menz�D�t�1a1�a��~' —
Proposed Material: Firestone .060 TPO Membrane
Proposed materials manufacturer. F;rPGt-nnP -
I
� How long has the installer been an approved, authorized or licensed by the proposed roofing material
manufacturer to install the project: 25 years
IProvide a written letter from the manufacturer sfating that the roofing contractor/subcontractor is an approved
and experienced installer. ** S� Attached
I
Provide four(4) references of projects of similar size and complexity that the roofi�g contractorlsubcontractor
( has successfully completed in the past four(4) years.
1. Property Owner name: S�uthP�st Mi ccniiri u������� -�'aT��'P7"' Center
IContact person: Jerry Bender Phone#: 573.334.4822
Project address: 1701 Lacey St
� Cape Girardeau MO 63701
When was the project completed: 08/01 /10
Type of roofing materi�l used: .060 TPO Membrane
� Approximate square footage: _�Q.,000 s f -
Instaliation time period: 02/10 thru
� Roofing cost:
i
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2. Prope�ty Owner name: SII�IO Hospital Helipad
Contact person: Jerry Bender Phone#: 573.334.4822
Project address: 1701 Lacev St
Cape Girardeau MO 63701
When was the project completed: 05/07/10
Type of roofing material used: _�80 TPc) Membrane
Approximate square footage: 20,000
Installation time period: 12/08 thru 04/09
Roofing cost: .q,�59,fi18.00
3. Property Owner name: Ste Genevieve Co Memorial HOspital
Contact person: Kevis Schweiss Phone#: 573.883.2751
Project address: HiWay 61 & 32
Ste Genevieve MO
When was the project completed: 12/12/09
Type of roofing material used: .060 EPDM Membrane, Adhered
Approximate square footage: _���
Installation time period: 11/09 thru 12/09
Roofing cost: $55,280.00
4. Property Owner name: _Good Humour (Unilever) So Freezer Room
Contact person: Tim Marlcworth Phone#: 573.472.8100
P�oject address: 2400 Park West
Sikeston MO 63801
When was the project completed: 4/12/09
Type of roofing material used: .060 EPDM - Adhered
Approximate square footage: 15,384 s.f.
Instaliation time period: thru 4/09
Roofing cost: $150,884.00
� '���es�°��t�
BUtI.DING PRODUCTS
Pirestone euilding
Products Compaay, LLC
250 West 96th Street
Indianapolis, IN 46260
F�bru�ry i6, 201G r�one: 317-575-700i,
Fax: 317-575-7100
Re: Firestone Red Shield Warranty Coverage
To Whom It May Concern:
The �oofing industry, including Firestone Building Products Company, has devetoped the common practice of
offering full system warranties that incfude warranty coverage that is wlthout monetary Hmitations.
Firestone's warranty series that meets this criterion is the Firestone Red Shield Roofing System Lfmited
Warranty. Please refer to our promise in the first pa�agraph of the Red Shieid Warranty, where it states that
"Firestone will, subject to the TeRns, Conditions and Limitations set forth below, repair any leak in the
Firestone Roofing System ("System'�. This includes repair of any leak in the Firestone Roofing System caused
by the ordinary wear and tear af the elements, manufacturing defect in Firestone brand materials, and the
workmanship used to install these materials.
There are no limits stated for how many times the roof system can be repaired and returned to a watertight
condition, nor does it limlt how much money Firestone can spend servicing the obligations of the warranty.
Firestone Building Products Co. cannot specifically use the term"No Dollar Limit"or the acronym"NDL"in its
Red Shield Warranty because this particular phrase has been copyrighted by another manufacturer. A Red
Shiefd-warranted roofing system must be installed using Firestone components by a Firestone Licensed
Appiicator and pass a successful inspectfon by a Firestone Field Services Technical Representative to properly
quality for warranty. The phrasing used in our warranty allows for the broadest warranty coverage of the
roofing system and Firestone is pleased to offer this warranty to building owners for qua(ifying Firestone
systems.
Please refer to the Firestone Roofing Systerns Technical Database on the Firestone web site at
www.firestonebpco.com for detailed assembJy information and requirements. If you have any questions, or
require further assistance, please do not hesitate to contact me at 800-428-4511 Ext. 57162.
Sincerely,
Firestone Build(ng Products Company
� �, _C_��
t-
Ryan L. Parrish
Mid-Atlantic Regiona( Coordinator
Cc: Dale Economon - Roofing Sates Assoc.
O•`O�O� `aK1RA(ipPj
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- NOBODY COVERS YOU BETTERT"" � `
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http://www.firestonebpco.com °iqOR'"'� °
AILIANCE FOR p� !SS
PRO&RESS
�
FY2009CDBG Administrative Manual
Contract Management �
This form to be submitted with Bid:
MINORITY AND WOMEN'S BUSINESS ENTERPRISE UTILTZATION
WORKSHEET
Grant Applicant NOT APPLICABLE
Project Number
Contractor/Engineer
Address, City, State, and Zip
Contact Person Telephone No
Amount of Contract MBE Percentage WBE Percentage:
1. MBE Subcontractor
WBE Address, City, State, Zip
Contact Person
Amount of Subcontract Tax ID Number
Scope Of Work
2. N]L3L �u�cuntrac�or
WBE Address, City, State, Zip
Contact Person
Amount of Subcontract Tax ID Number
Scope Of Work
3. MBE Subcontractor
WBE Address, City, State, Zip
Contact Person
Amo�mt of Subcontract Tax ID Number
Scope Of Work
4. MBE Subcontractor
WBE Address, City, State, Zip
Contact Person
Amount of Subcontract Tax ID Number
Scope Of Work
VI[I-72 •
r
CERTIFICATION OF BIDDER
REGA.RDING EQUAL EMPLOYMENT OPPORTtJNITY
INSTRUCTIONS
This certifi�ation is required pursuailt to Executive Order 11246 (30 F. R. 12319-25).The
implementing rules and regulations provide that any bidder or prospective contractor, or any of their •
proposed subcontractoi-s, shall state as an initial part of the bid or negotiations of the contract whether
it has participated in any previous contract or subcontract subject to the equal opportunity clause, a»d,
if so, ��vhether it has fifed a(I compliance reports due under applicable instructions.
Where the certification indicates that the bidder has not filed a compliance report due under app(icable
instructions, such bidder shall be required to submit a compliance report ��vithin seven calendar da}�s
after bid opening. No contract shall be awarded unless such report is submitted.
CERTIFICATION BY BIDDER
NAME AND ADDRESS OF BIDD�R (Include ZIP Code):
Drury Company — P O Box 1544 — Cape Girardeau MO 63702 _
1. Bidder l�as participated in a previous contract or subcontract subject to the Equal Opportunity
Clau,c..
C� Y�S ❑ NO
2. Compliance reports �vere required to be. filed in connection with such contract or subcontract. °
C�YES ❑ NO
3. Bidder I�as filed afi compliance reports due under applicable instructions.
C�YCS ❑ NO
4. 1-Iave you ever been or are ��ou being considered for sanction due to violation of Executive Order
1 1246, as amended?
❑ YCS [� NO
NAME AND TITLE OI= S[GNER (Please type): '
Je 'ns, Presi ent _
09-23-10
SIGN UR� DATE
.
CEIt'f'IFICATION REGARDING LOBBYING
Certification fa-Contracts,Grants, Lnans,and Cooperative P,greeme�rts
A. Is your organizatiai classified as nonprofit? YES NO X
If y�,what is the {RS classification? 501(c)(3) 501(c)(4j Other
B. Does the organizati on engage in lobbying? YES NO X
!f you answered YES to both queslionr and your Agency is classified as a S01(c)(4)organizatiai who engages in lobbying
accivities,yozu�o�g�nization is ineligible fo��receip�o/'Federa!junds. Please do not su6mit an app[ication.
C. The undersigned certifies, to the best of his or her knowledge and belie� that: .
l. No Federal appropriated fuilds have been paid or wi fl 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 ofa Member of Cangress in connection with the awarding of any Federal
contract, the making of any Federal gran t,the maki ng 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 agreemait.
2. Ifany funds other than Federal appropri�ted funds have been paid or will be paid to any person for influencing
or attempting to in fluence an officer or employee of any agency,a Member of Congress,an Officer or employee of
Con?ress.�r an em Pl���ec nf�T�4em hcr of('nn�re�c in con necti on�vith the Feder�I contract,gr�nt, loan,or
cooperative agreement, tlie undersig�ed shall complete and submit Standard Form LLL,"Discicsure Form to �
Report Lobbying," in accordance with its instructions.
3. The undersigned shafl require tliat the language of this certifiration be included in the award documents for ail
sub-awards at all tiers(including subcontracts, sub-grants,and contracts under grants,foans,and cooperative
agreements)and that all sub-recipientsshall certifyand discloseaccordingly.
This certification is a material representation of fact upon wliich reliance was placed when this transaction was made or
entered into. Subm' ' � of this certi fication is a prerequisi te for making or entenng into this transaction imposed by
section 1352 ' e 31, U. S. Code. An persons who fails to file the required certification shall be subject to a civil penalty of'
not less an 310,000 id not mo an �100,000 for each such failure.
09/23/10
H� of A y or Organization Datc .
erry Cummins, President
Typed N ame a�d Ti�le
Name and Address of Agency/Organiza.tion:
DrurY �PanY �
P O Box 1544 - Cape Girardeau MO 63702
Note: use ofthis form is optional. You may providethis same information on your letterhead.
Infonnation on Lobbvin� Restrictions based on EPA Office of General Counsel Guidance
GUIDANCE ON LOBBYING RESTRICTIONS
The purpose of this guidance is to remind nonprofit organizations,universities, and other non-
government recipients of EPA grants' that, with very limited exceptions, you may not use Federal grant
funds or your cost-sharing funds to conduct lobbying activities. The restrictions on lobbying are explamed .
in Office ofManagemerrt and Budget(OMB) Circular No. A-21, "Cost Principles for Educational
Institutions", 61 Fed. Reg. 20880 (May 8, 1996),Z and OMB Circular No. A-122, "Cost Pr�c�les for
Nonprofit Organizations; `Lobbying' Revision", 49 Fed. Re�. 18260 (April27, 1984). (The two Circulars
are attached to this guidance as Attachments A and B. Additional, detailed guidance on spec�c issues
regarding the lobbymg restrictions of OMB Circular No. A-122, contained in correspondence from OMB
to Congress at the time the Circular was issued, is attached here as Attachment C.) As a recq�ient ofEPA
funds, you must be aware of and comply with these restrictions.3
I The general objective of the restrictions is to prohibit the use of appropriated funds for lobbymg,
publicity, or propaganda puiposes designed to support or defeat legislation. The restrictions do not affect
the normal sharing ofinformation or lobb}nng activities conducted with your own funds (so long as they
Iare not used to match the grant funds).
Unallowable Lobbyin� Activities
IUnder Circulars /�-21 and .�-1��, tl�c cosls of che fo11o4ving aclivi[ies are unallo�vable:
(1) Contr�butions, endorsements,publicity or similar activities intended to influence Federal, State
� or local elections, referenda, initiatives or similar processes.
(2) Direct and indirect financial or admmistrative support of political parties, campaigns,
I politicaf action committees, or other organizations created to influence elections. Recipients may
help collect and interpret infonnation. These efforts must be foreducationat ptu-poses only,
l�owever, and cannot involve political pai-ty activity or steps to infltience an election.
� (3) Attempts to infliience the introdlicing, ��ssing, oi� changing of Federal or State Iegislatio�l
through contacts with members or e�nployees of Congress or State legislatures, including atte�ripts ,
�
' The tenn "gi-anP' as used in this guidance refers to grants and cooperative
� agreements.
Z Grants awarded before May 8, 1996 are subject to the previous version of Circular
� No. A-21, but the provisions on lobbying have remained essentially unchanged.
' This guidance does not address the restrictions on lobbying contained in 40 CFR
� Part 34, the EPA regulations implementing section 319 of P. L. No. 101-121, known as the `Byrd
Amendment", general(y prohibit recipients of Federal grants, contracts, and loans from using
Federal funds for lobbying the Executive or Leg�slative Branches of the Federal Government in
� connection with a specific grant, contract, or loan. Part 34 includes detailed certification and
disclosure requirements. This guidance also does not address section 18 of the Lobbying
Disclosure Act of 1995, P. L. No. 104-65, wh�ch provides that orgarrizations descrbed in section
� 501(c)(4) of the Irrternal Revenue Code that engage in lobbying activities are not eligible for
Federal grants or loans.
�
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to use State and local officials to lobby Congress or State legislatures. For example,you may not
charge a grant for your costs of sendmg information to Members of Congress to encourage them
; to take a palticular action. Also prohbited are contacts with anygovernment official or employee
to ir►f�uence a decision to sign or veto Federal or State legislation The restriction does not
address lobL�ying at the local level.
` (4) Attemp�;to influence the introducing, passing, or changing of Federal or State legislation by
prepaz-ing, using, or distributing publicity or propaganda, i.e., gass roots lobbying efforts to obtain
group action by members of the public, a�cludmg attempts to affect public opinion and encourage
; group action. For example, the costs of printing and distributing to members of the public or the
media a report produced under a grant, if intended to influence legislation, are unaIlowable.4
I (5) Attending legislative sessions or committee hearings, gathering mformation about
legislation, and sanilar activities, when �tended to support or prepare for unallowable lobbying.
! Except ions
I There are three exceptions to this list of unallowable lobbying activities in Circulars A-21 and A-
122. These exceptions do not necessa�-ily make the cost ofthese activities allowable; they make the costs
potentially allowable. Allowability will be determmed based on whether the costs in a particular case are
� reasonable, necessary, and al(ocable to the grant.
�
The fu-st exception is for technical and factual (not advocacy) presentation to Congress, a State
I leg}slattn-e, meinber, or staff, on a topic directly related to performance of the grarrt, in response to a
request (not necessarily in writing) from the legislative body or individual. For requests that are not made
in writing, recipients should �r�ake a note for therc files documenting the requests. The uiformation '
I presented must be readily availab(e and deliverable. Costs for travel, hotels, and meals related to the
presentation are generally unallowable unless related to testimony at a regu(arly scheduled Congressional
hearing at the written request of the chairperson or ranking minority member of the congressional
i
committee.
i
Tl�e second exception is foi- actioils intended to influence State legislation in order to directly
reduce t}�e actual cost ofperfarming the Federal grarrt project or to protect the recipient's authority to
perforin tl-ie project. The exception does not apply to actions that are intended merely to shift costs from
one source to another. For examp(e, in response to Federal funding cutbacks, a Federally-funded
recipient lobbies far State funds to replace or reduce the Federal share of project costs for next year. The
cost of that lobbying activity wou(d not be allowable because its purpose is not to directly reduce the
actual cost of prefonnv�g the work but merelyto shift from Federal furxiing to State funding.
Finally, Circulars A-21 and A-122 allow lobbying costs if theyare specifically authorized by law.
° Circular A-122 addresses public information service costs that do not relate to •
lobbying. Attachment B to the Circular, at paragraph 36, makes allowable,with prior approval of
the Federal agency, costs associated with pamphlets, news releases and other forms of information
services if their purpose is: to inform or instruct individuaLs, groups or the general public; to
interest individuals or groups in participata�g m a service program of the recipient;or to
disseminate the results of sponsored and non-spo nsored activities.
Indirect Cost Rate
When you seek reimbursement for indirect costs(overhead),you must identify your total lobbying
co sts in you r ind irec t c ost rat e pr op osa I so t hat the Go vernment can avoid subs idizing lobbyin g. T his is
consistent with the c�culars' requu�emerrt of disclosure of the o�sts spent on allunallowable activities.
This requirement is necessary to that when the Government calculates the amount of an organization's
indirect costs that it w�ll pay, it does not include the costs ofunallowable activities that the organization
happens to count as indirect costs.
Enforc ement
In cases ofiiriproper lobbying with grant fimds, EPA may recover the misspent money, suspend or
terminate the grant, and take action to prevent the recipient from receiving any Federal grants for a certain
period. To avoid improper lobbying activities, please review carefully this guidance and the attacYnnents:
Circular A-21, the Lobbying Revisio�l to Circufar A-122, and the OMB correspondence. Your project
officer is available to handle any questions or concerns.
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CEFt�"�IFI���`gON OF BIDDER R�GA6�tDI1V� ,
� SECTION 3 �
' AND SEGREGATED FACILII'YES .
�
Fire Sta #1 , Roof Replacement
J1J�y r.*L/�l�Il'�(�77
Drury c��v
' N�me of Prime Contractor Project Name & Number
The undersigned hereby certifies that:
(a) Section 3 provisions are included in the Contract
(b) A written Section 3 plan was prepared and submitted as part of
the bid proceedings (if bid equals or exceeds $100,000).
(c) No segregated facilities will be maintained.
Name
Jer Cummins Presid t
Na & Titl of Signer (Print or Type):
09-23-10
Si tu Date
_ _ .�..�,�.���::�
�� ,
� CERTIFICATION OF PROPOSED SUBCONTRACTOR REGARDING
� SECTION 3 AND SEGREGATED FACILITIES
Dutch F�terprises #DE-EE00029 7
� Name of Sub Contractor Project Name &Number
� The undersigned hereby certifies that:
1. Section 3 provisions are included in the Contract.
� 2. A written Section 3 plan was prepare.d and submitted as part ofthe bid proceedings (if bid equals
or exceeds $(00,000).
3. No segregated Cacilicies will be maintained as required by Title VI of the Civil Rights Act of 1964.
i
� Jer 'ns, President i
�N e &Ti e of Sigi int or Type)
1
9 2.��10 —
� S� natu Date
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� PR-HQ-09-121�8
�
I , 5 PROHIBITION OF SEGREGATED FACILITIES (FAR 52.222-21) (FEB 1999)
� "Se re ated facilities," as used in this clause, means any waitinq
(al g 9
rooms, work areas, rest rooms and wash rooms, restaurants and other eata�gin
� areas, time clocks, locker rooms and other storage or dressinqransportation,g
lots, drinkinq fountains, recreation or entertainment areas,
and housing facilities provided for employees, that are segregated by explicit
directive or are in fact segregated on the basis of race, color, religion,
� sex, or national oriqin because of written or oral policies or employee
custom. The term does not include separate or single-user rest rooms or
necessary dressing or sleepinq areas provided to assure privacy
� between the sexes.
(b) The Contractor agrees that it does not and wi11 not maintain or provide
for its employees any segregated facilities at any of its establishments, and
� that it does not and will not permit its employees to perform their services
at any location under its control where segregated facilities are maintained.
The Contractor aqrees that a breach of this clause is a violation of the Equal
Opportunity clause in this contract.
� de this clause in every subcontract and
(cl The Contractor shall inclu
purchase order that is subject to the Equal Opportunity clause of this
� contract.
I. 6 COMPETITION IN SUBCONTRACTING (FAR 52.244-5) (DEC 1996)
� or shall select subcontractors (includinq suppliers) on a
(a) The Contract
competitive bas.i.s to the maximum practical extent consistent with the
� obj�ctives and requirements of the contrac.t.
(b1 If the Conr_ractor a.s an approved mentor under the Department of Defense
� Contr.actor�maytawagd subcontractb underOthisOcontractno83a noncompetaLivehe
basis to its pr.oteges.
�
I.7 SUBCONTRACTS EOR COM[�RCIAL ITEMS (FAR 52.244-6) (DEC 2009)
� (a) Definitions. As used in this clause--
� "Commercial item" has the meaninq contained in Federal Acquisition
Regulation 2. 101, Definitions.
� Page I-5 of 8
�
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, FY2009CABG Administradve Manual
' Contract Management
BIDDER
SECTION 3 PLAN FD�AT
(name of contractor� agrees to implement the following
If award is received,_______.
specific afiirmative actior�steps directed at increasing the utilization of lower income residents an
businesses wtthu� die City of ' '
1. To ascertain trom the locality's CDBG program oek the ass stance of local officials Sn preparing
covered project area, and where advantageous, se
and implementing the affirmative action plan.
2. To attempt to recruit from within the city the necessaryte forb he� rojectr and ommun y S through
local advertising media, signs placed at the proposed s P
organizations, and public or private institutions operaOtin o�1htiesrIndustr alhzapon Center(OIC),
as Service Employment and Redevelopment(SER), pp
Urban League, Concentrated Employment Program, Hometown Plan, or the U.S. Employment
Service.
3. To maintain a list of all lower incom o rsuchS1ersons,hf othe wpp el g b�eea d ►f aevacancy exists.
re ferra l f r o m a n y s o u r c e, a n d t o e m p l y p
000 to obtain
4. To insert the Section 3 Contract Proc�o�na d to obt an all docutmentat on fo OOomP letion of
Tables A and B from said subcontra ,
"Cables C and D prior to final payment. (Loans, grants, contracts, and subsidies tor tess than
$100,000 will be exempt.)
5. To contact unions, subcontractors, and trade associations to secure their cooperation for this
program.
6. To ensure that all appropriate project area business concerns are notified of pending sub
contractual opportunities.
7. `l,o maintain records, including copies of correspon d�ne e, memoranda, etc., which document that
( all of the above aftirmative action steps have been �ia� Q or�unity Officer
S. To appoint or recruit an e�ecutive official of the company or agency as Cq pp
to coordinate tlle implementation of this Section 3 plan.
� 9. To list on Table A, inforrnation related to proposed subcontracts to be awarded to Section 3
businesses.
10.To list on Table B, all projected workforce needs for all phases of this project by occupation,
' trade, skill level, and number of positions.
1 1. If successful bidder, to submit prior to final payment Tables C and D to city/county grantees
� which includes all applicable hirees and subcontractors utilized on this pr.oject.
�
�
� VIII-73
_ .� .
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' a3 �y � �„ -_ .�„ _,z..._.._.____.��.._.__. ,
• � =:i;
FY2009CDBG Administrative Manual
Contract Management �
As officers and representatives of �
(Name of Bidder)
we the unde ' ; ave read and fully agree to this Affirmative Action Plan, and become a party to ;
� lementat' n of this pro ram. £
the fu 'np
,.
Sign �r
t,
Jerry �»i n� Prc�[�Pnf-
Date
Title i :
<� ::
,{'
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Signature '
----- 'ri'
Date -
Title '4
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VIII-74
1�
� , FY2009CDBG Administrative Manual
� Contract Ma�iagement ,
TABLE A
� BIDDER'S PROPOSED SECTION 3 CONTRACTS/SUBCONTRACTS
� Type of Contract Estiil�ated Total Estimated No. of Estimated vollar
(Business or Total No. Dollar Amount Contracts to Section Amount to Section 3
Profession 3 Businesses Businesses
! Roofing 1 $119,961 .00 p 0
� HVAC 1 3 300.00
�
� -
�
1
1
�
� Section 3 Business Concern Dn.�rv�anv
A business concern, which is located in or Company
owned in substantial part (at least 51%) by Fire Sta #1 , Roof Replacement
I persons residing in the same non-metropolitan
county as the project. Project Name
I DE—E:E0002927
Project Number
Charles Menz, Dept Manager
Person Completing Form
0�/2�/�n
Date
v[I I-75
NOT APPLICABLE � � .
FY2009CDDG Adminis[rative Manual ,
Contract Managemen[ �
TABLE B
BIDDER'S SECTION 3 ESTIMATED NEW HIRES
Estimated No. of Positions
Totai Positions Occupied by No. of No. of Positions to be
Job Category Needed for Perinanent Positions Not Filled with Section 3
Pro'ect Em lo ees Occupied Residents
Offcer/Su ervisors �
Professionals
Teclulicai
Hs Sales/Rental M mt.
Office/Clerical
Service Workers
Others
TRADE:
Journe men
Nelnere
A� rentices
Trainees
Others
TRADE:
Journe men
Hel �ers
/1 renlices
Trainees
Others
Section 3 Resident D�'Y �l�Y
Individual residing within the non- Company
metropolitan county in which the Section 3 Fire Sta #1 , Roof REplacement
covered project is located and wl�ose i�lcome project Name
does not exceed 80% of tl�e I�igf�er of the
median income, adjusted by family size, for DE—EE0002927
the county of residence of the non- Project Number
inetropolitan are of the state. Charles Menz, Dept Manager
Person Completing Form '
09-23-10
Date
vltl-76
�. � , Not Applicable
� FY2009CDBG Administrative Manua(
Contract Management
TABLE C
CONTI�AC'�OR'S SECTION 3 NEW HIRES REPORT •
� Estimated No. of Positions No. af No. of Positions to be
Tota( Positions Occupied by
Job Category Positions Not Filled with Section 3
Needed for Permanent Occupied Residents
Project Em lo ees
Officer/Su ervisors 0 0
Professionals
Techn ical ,
Hsq Sales/Rental
M mt.
Office/Clerical
Service Workers `
Others
TRADE:
Journe men
Hel ers
A rentices
Traiilees
Others
TRADE:
Journe men
Hel ers
A �rentices
Trainees
Others
Section 3 Resident Drury Com�n_.y —
Individual residing within the non- Company
metropolitan county in which the Section 3 F;rP Stat-i nn #l1,�lv�f__R�13r'.F'lIlen�"
covered project is located and whose income project Name
does ilot exceed 80% of the higl�er of tt�e DE-EE0002927
median income, adjusted by famify size, for
the county of residence of the non- Project Number
metropolitan are of the state. Charles Menz Dept Manaqer
Person Co►npleting Form
09-23-10
Date
VIII-77
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� DE-EE0002927
' Project Number
� : /ASrI.::rxi::l� cy3.:A.�N� I:i�.:..
�a:
0 � . Cet-tifecatio�21_�eg�t-c�ing
� Debarment, Suspension and Other Responsibility 1VIatters
ITl7e c�ntractor hereby cei�tifies to the best of its knowledge and belief and that it and its principals
and its subcontractors and their principals:
I (a) Are not presently debai-red, suspended, proposed for debarment, declared ineligible or
voluntarily excluded from covered transactions by any Federal or State department or agency;
I (b) Have iiot within a tl-u-ee (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
i connection with obtai�ling, attempting to obtain or performing a public (Federal, State or
Local) transaction or contract under a public transaction; violation of Federal or State antiti-u�t
statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of
Irecords, making false statements or receiving stolen property;
(c) Are not presently indicted for or othei�vise. criminally or civilly charged by a government
I ei7tity (Federal, State or Local) with commission of any of the offenses enumerated in
paragraph (1)(b) of this cei-tification; and
: (d) Have not �vithin a tluee.-year period preceding this subcontract had one or more public
transactions (Federal, State or Local) terminated for cause or default.
1 �rndersfand that a false stafement on tl�is certification may be grounds for rejection of this
conh�actor or termination of thc confr�ct. In addition, under 18 USC Sec. 1001, a false
statement m��� result in a fine of up to � 10,000 or i�nprisonment for up to five (5) years oo-
botf�.
Jerr-y 'ns, President
Typed ame � Titl thorized Representative
� 09-23-10
Sig re Authorized Representative Date
� I am unable to cei-tify to the above stateinent. My explanation is attached.
AFFTDAVTT OF WORK AUTTiORTZATiON , ' �
�
rqTE oF Missouri ) '
;piJNTY OF �Pe Gir�xdeau
On this day of September ,2�1� ,before me appeared pa„��r�g ,personally known
o me or proved to me on the basis of satisfactory evidence to be a person whose name is subscribed to this affidavit,who being by me duly swom,
ieposed as follows:
My name is n,^�-- Ts�^�-� ,and I am of sound mind,capable of making this affidavit,and personally certify the facts
nerin stated,as required by Section 285.530,RSMo,to enter into any contract agreement with the state to perform any job,task,employment,labor,
personal services,or any other activity for which compensarion is provided,expected,or due,including but not limited to all activities conducted by
business entities:
of DY'l]1'V C�� � and I am duly authorized,directed,and/or
I am the Hl]I113ri ResourcP ManaCJPr Business Name
Title
empowered to act officially and properly on belialf of this business entity.
I hereby af�irm and warrant that the aforementioned business entity is enrolled in a federal work authorization program operated by the
United States Department of Homeland Security to verify information of newly hired em{�loyees,and the aforementioned business entity shall
participate in said program with respect to all employees working in connection with the cootra�cted services related to DE—EE0002927 wid�
Project Number
the ('i t�� nf .[have attached documentation to this affidavit to evidence enrollmendparticipation
�� Fu ding ecipient
by the aforementioned business entity in a federal work authorization program,as required by Section 285.530,RSMo.
In acidition, (hcreb��af(inn and •.�:inxnl tli:rt tli�sforcmcntic�ncd husincs�entitY does not and shall nnt knowinEly emrl���. in
Cit of Cape Girardeau �an alien`°�'°d°�`
connectian to work under the within sta[e contract agreement with the Y Fundmg Recipient
not have the legal right or authorization under federal law to work in the United States as defined in 8 U.S.C. 1324a(h)(3).
[am aware and recognize that,unless certain contract and affidavit conditions are satisfied pursuant to Section 285.530,RSMo,the
aforementioned business entity may be held liable under Section 285.525 through 285.555,RSMq for subcontractors that knowingly employ�or
continue to emp(oy any unauthorized alien to work within the State of Missouri.
[n accordance with sections 285.525 to 285.550,RSMo a general contractor or subcontractor of any tier shall not be liable when such
contractor or subcontractor contracts witf�its direct subcontnetor who violates subsection 1 of section 285.530,RSMo if the cont�act bindine tfie
concractor and subcontractor lffinnativcly states that the direct subcontractor is not knowingly in violation of subsection 1 of section 285.530, RSMo
and shall not henceforth be in such violation and the contractor or subcontractor receives a sworn�davit under the penalty of perjury attestin�to
the fact that the direct subcontractor's employees are lawfully present in the United States.
[acknowledge thal I am signing this affidavit as a free act and deed of the aforementioned business entity and not under duress.
�C�1
'�
Affidavit Sign re
Subscribed and sworn to before me this ���day of $�te�hPr .2��_D__—�
o bli
Ll'NN R FAYh1E
Notary Publlc-�ofary Seal
My Commission expires: \�`�3�`� State of Missouri, Scoti County
Commission # 0645b798
Page 1 of 1 �Y Commission Expires Oct 23, 20�o
I
. ,
: •` Company ID Number: 150180
ARTICLE I
PURPOSE AND AUTHORITY
This Memorandum of Understanding (MOU) sets foi�th the points of ajreement between the
Social Security Administration (SSA), the Depai�tment of Homeland Security (DHS) and Drurv
Company (Employer) regarding the Employer's participation in the Employment Elijibility
Verification Program (E-Ve►-ify). E-Verify is a program in which the employment eli�ibility of all
newly hired employees wifl be confirmed after the Employment Eligibiliry Verification Form
(Form I-9) has been completed.
Authority for the E-Verify program is found in Title IV, Subtitle A, of the Illegal Immigration
Reform and Immigrant Responsibility Act of ]996 (IIRIRA), Pub. L. 104-208, 1 10 Stat. 3009, �s
amended (8 U.S.C. § ]324a note).
ARTICLE IT
FUNCTIONS TO BE PERFORMED
A. RESPONSIBILITIES OF THE SSA
I. Upon completion of the Form I-9 by the employee and the Employer, and provided the
Employer complies with the requirements of this MOU, SSA agrees to provide tl�e Employer
with available i»formation that allows the Employer to confirm the accuracy of Social Security
Numbers provided by all newly hired employees and the employment authorization of U.S.
citizens.
2. Tl�e SSA agrees to provide to tl�e Employer appropriate assistance witli operational
problems that may arise during the Employer's participation in the E-Verify progr�m. The 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. The SSA agrees to safeguard the infonnation provided by the Employer through fhe 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 N�unbers and for evaluation of the
E-Verify program or sucl� otl�er persons or entities wl�o may be autl�orized by tl�e 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 establisl� a means of automated verification tl�at is designed (in
conjunetion with DHS's autornated system if necessary) to provide confirmation or tentative
nonconfinnation of U.S. citizens' employment eligibility and accuracy of SSA recurds for both
citizens and aliens within 3 Federal Government worl< days of the initial inquiry.
5. SSA agrees to establish a means of secondary verification (including updating SSA
records as may be necessary) for einployees wl�o contest SSA tentative nonconfirmations tl�at is
designed to provide final confirmation or nonconfirmation of U.S. citizens' employment
. ' .
Company ID Number: 150180 � '
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 THE DEPARTM�NT OF HOMELAND SECURITY
1. Upon completion of the Form I-9 by the employee and the Employer and after SSA
verifies tl�e accuracy of SSA records for aliens ti�rougl� E-Verify, DHS agrees to provide tl�e
Employer access to selected data from DHS's database to enable tlie Employer to conduct:
� Automated verification checl<s on newly hired alien employees by electronic means, and
• Photo verification checks (��hen available) on newly hired alien employees.
2. DHS agrees to provide to the Employerappropriate assistance with operational problems
that may arise during the Employer's participation in the E-Verify program. DFIS agrees to
provide the Employer names, titles, addresses, and telephone numbers of DHS representatives to
be contacted during tl�e E-Verify process.
3. DHS agrees to provide to the Employer a manual (the E-Verify Manu�l) containing
instructions on E-Verify policies, procedures and requirements for both SSA and D}{S, including
restrictions on the use of E-Verify.. DHS agrees to provide training materials on E-Verify.
4. DHS agrees to provide to the Employer a notice, which indicates thc� Employer's
participation in the E-Verify program. DHS also agrees to provide to the Eniployer anti-
discrimination notices issued by the Office of Special Counsel for Immigration-Related Unfair
Employment Practices (OSC), Civil Rights Division,and 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. DNS agrees to safeguard tl�e 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 autl�orized by applicable law. Information will be used only to verify tl�e accur;icy of Social
Security Numbers and employment eligibility, to enforce the Immigration and N�tionality Act
and federal criminal laws, and to ens�u-e accurate wage repoits to the SSA.
7. DHS agrees to establish a means of automated verification that is designed (in
COI1Jl1IlCtlOf1 witli SSA veriFcation procedures) to provide confirmation or tentative
nonconfirmation of employees' ernployment eligibility within 3 Federal Government worl< days
of tl�e initial inquiry.
8. DHS agrees to establisl� a means of secondary verification (including u��datin� 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 l0 days may be
necessary. In sucl� cases, DHS will provide additional verification instructions.
�
: ' Company ID Number: 150180
C. RESPONSIBTLITTES OF THE EMPLOY�R
I. The Employer agrees to display the notices supplied by DHS in a prominent place that is
clearly visible to prospective employees.
2. Tl�e Employer agrees to provide to tl�e SSA and DHS tl�e names, titles, acldresses, 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 E-Verify Manual.
4. The Employer agrees that any Employer Representative who will perform employment
verification queries will complete the E-Verify Tutorial before that individual initiates any
queries.
A. The employer agrees that all employer representatives will take the refresher
tutorials initiated by the E-Verify program as a condition of continued use of E-
Verify.
B. Failure to complete a refresher tutorial will prevent the employer frc�m continued
use of the program.
5. The Employer agrees to comply with established Form 1-9 procedures, wifh two
exceptions:
• If an employee presents a "List B" identity document, the Employer agrees to only accept
"List B" dociui�ents that contain a photo. (List B documents identified in 8 C.F.R. §
274a.2 (b) (1) (B))can be presented during the Forrn I-9 process to establish identity).
• If an employee presents a DHS Form I-S51 (Permanent Resident Card} or Form [-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 thc employee's
Form I-9. The employer will use tlie pl�otocopy to verify the photo and to assist tl�e
Department with its review of photo non-matches that are contested by employees. Note
that emp�oyees 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.
6. The Employer understands lhat participation in E-Verify does not exempt che Employer
from the responsibility to complete, retain, and mal<e available for inspection Forms I-9 that relate
to its employees, or from other requirements of applicable regulations or laws, except fa� the
following modified requirements applicable by reason of tlie Employer's participation in E-
Verify: (1) identity documents must have photos, as described in paragraph 5 above; (2) a
rebuttable presumption is established tl�at tl�e Employer I�as not violated section 274A(a)(1)(A) of
tlie Immigration and Nationality Act (INA) witl� respect to tlie hiring of any inclividual if it
obtains confirmation of the identity and employment eligibility of the individual in cornpliance
with the terms and conditions of E-Verify ; (3) tlie Employer must notify DHS if il continues to
employ any employee after receiving a fina) nonconfirmation, and is subject to a civil money
penalty between $500 and $],000 for each failure to notify DHS of continued employment
following a final nonconfinnation; (4) the Employer is subject to a rebuttable presumption that it
I�as knowingly employed an unauthorized alien in violation of section 274A(a)(1)(A) if tlie
Employer continues to employ any 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
.�►
Company ID Number: 150180 �
action taken in good faith on information provided through the confirmation system. DHS
reserves the right to conduct Form I-9 compiiance inspections during the course of E-Verify, as
�vell as to conduct any other enforcement activity authorized by la�v,
7. Tl�e Employer agrees to initiate E-Verify verification procedures 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-Vcrify process
as are necessary according to the E-Verify Manual. The Employer is prohibited from initiating
verification procedures before the employee has been hired and the Fonn I-9 completed. If the
automated system to be queried is temporarily unavailable, the 3-day time periocl is extended
until it is again operational in order to accommodate the Employer's attempting, in Sood faith, to
make inquiries during the period of unavailability. In all cases, the Employer must use the SSA
verification procedw-es first, and use DHS verification procedtn�es and photo screening tool only
after the the SSA verification response has been given.
8. Tl�e Employer agrees not to use E-Verify procedures for pre-employment screening of
job applicants, support for any unlawful employment practice, or any other use not��uthorized by
this MOU. The �mployer must use E-Verify for all new employees and will nol verify only
certain etnployees selectively. The Employer agrees not to use E-Verify procedures for re-
verification, or for employees hired before tl�e date tl�is MOU is in effect. Tl�e 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 approp►-iate legal action and the
immediate termination of its access to SSA and DHS infonnation pursuant to this MOU.
9. The Employer agrees to follow appropriate procedures (see Article III.B. below)
regarding tentative nonconfirmatiot�s, including notifying employees of the finding, providing
written referral instructions to employees, allowing employees to contest the finding, and not
tahing adverse action against employees if they choose to contest the finding. Further, when
ei7�ployees contest a tentative nonconfirmation based upon a photo non-match, the Gmployer is
required to take affirmative steps (see Article IU.B. below) to contact DHS with information
necessary to resolve the challenge.
10. Tl�e Employer agrees not to take any adverse action against an employee based upon the
employee's employment eligibility status while SSA orDHS is processing the verification request
unless the Employer obtains I<nowledge (as defined in 8 C.F.R. § 274a.] (I)) that thc employee is
not worl< authorized. The Employer understands that an initial inability of the SSA or DHS
autornated verification to verify work authorization,a tentative nonconfirmation,or the finding of
a photo non-match, does not mean, and should not be interpreted as, an indication that the
employee is not work authorized. In any of tl�e cases listed above, tl�e employee must be provided
the �pportunity to contest the finding, and if he or she does so, may not be tennin�ited or suffer
any adverse employment consequences until and w�less 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, then the Employer can find the
employee is not work authorized and take the appropriate action.
11. The Employer agrees to comply with section 274B of the INA by not discriminating
unla��•f�ully 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�I,e; INA, because of I�is or her citizensl�ip status. Tlie Employer understands that such illegal
practices can include selective verification or use of E-Verify, discharging or refusing to I�ire
eligi�le employees because they appear or sound "foreign", and premature termination of
M .
• � Cor�ipany ID Number: 150180
employees based upon tentative nonconfirmations, and that any violation of the unfair
immigration-related employment practices provisions of the INA could subject the Employer to
civil penalties pursuant to section 274B of the INA and the termination of its participation in E-
Verify. If the Employer has any questions relating to the anti-discrimination provision, it should
contaet OSC at 1-800-255-7688 or I-800-237-2515 (TDD).
12. The Employer agrees to 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.
13. The Employer agrees that it will use the information it receives from the SSA or DHS
pursiiant to E-Verify and this MOU only to confirm the employment eligibility o1'newly-hired
employees afier completion of the Form I-9. 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 ;:�ny other purpose and as necessary to protect its confidentiality, including ensuring that it is
not ciisseminated to any person other than employees of the Employer who are authorized to
perform the Employer's responsibilities under this MOU.
l4. 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 allow DHS and SSA, or their autl�orized agents or designees, to
mal:e periodic visits to the Employer for the purpose of reviewing E-Verify -related records, i.e.,
Forrns J-9, SSA Transaction Records, and DHS verification records, which were created during
the (�,rnployer's participation in the E-Verify Program. In addition, for the purpose of evaluating
E-Vcrify, the Employer agrees to allow DHS and SSA or their authorized agents or designees, to
interview it regarding its experience with E-Verify, to interview employees hired during E-Verify
use coneerning their experience with the pilot, and to make employment and E-Verify related
records available to DHS and the SSA, or their designated agents or designees. Failure to comply
with the tenns of this paragraph may lead DHS to terminate the Employer's access tc� E-Verify.
ARTICLE III
R�I'�RRAL OF INDIVIDUALS TO TH�SSA AND TH� D�PARTMENT OF
HOMLLAND S�CURITY
A. R�F�RRAL TO TH� SSA
I. If the Employer receives a tentative nonconfirmation issued by SSA, the Employer must
print rhe tentative nonconfinnation notice as directed by the automated system and provide it to
the ernployee so that the ernployee may determine whether he or she will contest the tentative
noncc�nfirmation.
2. The Employer will refer employees to SSA field offices only as directed by the
autornated system based on a tentative nonconfinnation, and only after the Employe�r records the
case ��erification number, reviews tl�e input to detect any transaction errors, and decermines tl�at
the cmployee contests the tentative nonconfinnation. The Employer wilf transmit the Social
Security Number to SSA for verification again if this review indicates a need to do so. The
�
. ,� .
Compan}� ID Number: 150180 "
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 �vill provide
the employee with a referral (etter and inst►-uct the employee to visit an SSA office to resolve the
discrepancy within 8 Federal Government work days. The Employer will make a second inquiry
to the SSA database using E-Verify proced�n-es on the date that is 10 Federal Government work
days after the date of the referral in order to obtain confirmation, or final nonconfirmation, unless
otherwise instructed by SSA or unless SSA determines that more than 10 days is necessary to
resolve the tentative nonconfirmation..
4. The Employer agrees not to aslc the employee to obtain a printout from the Social
Security Number database (the Numident) or other written verification of the Social Security
N�nnber from the SSA.
B. R�FERRAL TO THE DEPARTMENT OF HOMELAND SECURITY
I. 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 alien 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 tl�e automated system and provide it to the
employee so that the employee may determine whether he or she will contest the finding.
3. "t�he Employer agrees to refer individuals to DHS only when the employee chooses to
contest a tentative nonconfirmation received from DHS automated verifieation process or when
the Employer issues a tentative nonconfirrnation based upon a photo non-match. The Employer
will determine whether the employee contests the tentative nonconfinnation as soon as possible
after the �mployer receives it.
4. If the employee contests a tentative nonconfirmation issued by DHS, the Gmployer will
provide the employee with a referral letter and instruct the employee to contact thc Department
through ils toll-free hotline within 8 Federal Government work days.
5. I1�the employee contests a tentative nonconfirmation based upon a photo non-match, the
Employer will provide the employee with a refen�al letter to DHS. DHS will electronically
transmit tlic result of the referral to the Employer within 10 Federal Government worlc days of the
referral unless it determines that more than 10 days is neeessary.
6. Tl�e Employer agrees that if an employee contests a tentative nonconfirmation based
upon a photo non-match, the Employer will send a copy of the employee's Form I-5�1 or Form 1-
766 to DHS for review by:
• Scanning and uploading the document, or
• Scnding a photocopy of the document by an express mail account(furnished and paid for
by DHS).
�
% ` Company ID Number: 150180
7. 'l,he Employer understands that if it cannot detennine whether there is a photo
match/non-match, the Employer is required to forward the employee's documentation to DHS by
scanninb and uploading, or by sending the doc�nnent as described in the preceding paragraph, and
resolvinb the case as specified by the Immigration Seivices Verifier at DHS who �.vill determine
the photo match or non-matcll.
ARTICLE IV
SERVICE PROVISIONS
The SSA and DHS will not charge the Employer for verification services performed under this
MOU. `I'he Employer is responsible for providing equipment needed to make inquiries. To access
the E-Verify System, an Employer will need a personal computer with Internet access.
ARTICLE V
PARTIES
This MOU i� effective upon the signature of all parties, and shall continue in effect for as long as
the SSA and DHS conduct the E-Verify program unless modified in writing b�� the mutual
consent of all parties, or terminated by any party upon 30 days prior written notice co the others.
Any and all system enhancements to the E-Verify program by DHS or SSA, including but not
limitcd to the E-Verify checking against additional data sources and insticuting ne���� verification
procedures, will be covered under this MOU and will not cause the need for a supplemental MOU
that c>��tlines these changes. DHS agrees to train employers on all changes made to E-Verify
throu7h (lie use of mandatory refresher tutorials and updates to the E-Verify m;u�ual. Even
without cl�anges to E-Verify, the Department reserves the right to require emplc�yers to take
mandatory refresher tutorials.
Terrnination by any party shall tenninate the MOU as to al) parties. The SSA or DHS may
tern�inate this MOU withoirt prior notice if deemed necessary because of the requirements of law
or policy, or upon a determination by SSA or DHS that there has been a brelch of system
ir�tegrity or security by the Employer, or a failure on the part of the Empfoyer to comply with
esta�lished procedures or legal requirements. Some or all SSA and DHS responsibilities under
this MOU may be performed by contractor(s), and SSA and DHS may adjusl verification
responsibilities between each other as they may determine.
Nothing in chis MOU is intended, or should be construed, to create any righc or beneft,
subslantive or procedural, enforceable at law by any third party against the Unitcd States, its
agencies, officers, or employees, or against the Employer, its agents, officers, or em��loyees.
Cach party shall be solely responsible for defending any claim or action against it arising out of or
related to F-Verify or this MOU, whether civil or criminal, and for any liability wherefrom,
including (but not limited to) any dispute between the Employer and any other person or entity
regarding the applicability of Section 403(d) of 1[RIRA to any action taken or allegedly taken by
the Employer.
The employer understands that the fact of its participation in E-Verify is not confidential
inf�ormatic�n and may be disclosed as authorized or required by law and DHS or SSA policy,
including but nat limited to, Congressional oversight, E-Verify publicity and media inquiries,
and responses to inquiries under the Freedom of Information Act (FOIA).
. �
Company ID Number: 150180 � � �
INFORMATION REQUIRED
FOR THE E-VERIFY PROGRAM
[nformation relating to your Company:
Coinpany 1�ame: Drury Company
Cornpany I�acilify Address: 4072 State High�v�y K
C�pe Girardeau,MO 63702
Company Aliernate Address: P.O. BOX 1544
CAPE GiRARDGAU,IVtO 63702
County or Parish: CAPE GIRARD�AU
CmF�loyer ldeiitification Number: 430674475
Nortli American Industry
Classification Systems Code: 236
Parent Coiripany:
100 to
Nurnher of k;mployees: 499 Number of Sites Verified for. 1
Are you verifying for more than I site? If yes, please provide fhe number of sites verified for in each Slate.
. N1ISSOURI 1 sice(s)
Inforrnation relaling to the Program Administrator(s)for your Company on policy questions or operaticmal problems
Narne: Payne Lynn
Tclephone N�nnber. (573)334-8271 .ext Z31231 Pax Number. (573)334-0089
E-inail Address: Ip�ync@druryco.com
Nanie: Hicks Paula
l'eleplione Number: (573)334-8271 .ext 212 Pax Number. (573)334-0089
Gmail Address: paula_hicics@druryco.com
,.
� + Co�npany ID Number: 150180
The foregoing constitutes the full agreement on this subject between the SSA, DHS, and the
En��loyer.
"I'he individuals whose signatures appear below represent that they are authorized to enter into
tl�is MOU on bel�alf of the Employer and DHS respectively.
To bc :iccepted as a participant in E-Verify, you should only sign the Employer's Section of
the si�nature page. Il� you I�ave any questions, contact E-Verify Operations �t 888-464-
4215.
Fn���ic�yer Drury Company
Hici;s Paula
--------�---------------------------- -------- --- _-------- __
Nan�e (Please type or print) Title
Eleccronicr�lly Srgnerl 09/08/2008
----____----.. ----------------------- ----------------------__---.
Si��,�������re Date
Dep;��-tment of Hometand Security—Verification Division
USCTS Verificatioii Division
Na�nc (Please rype or print) -- Title---------------
I.ilec�ro�ticall��Si�ized 09/�8/2008
--_..- ------- --- ------ -------------------- .
Si��;;�,t�.u-e Date
.
i
_ .....
.�
��rBIT ..
AFFIDA�4TIT OF OSHA TR�iiI'�IING
COMES NOW(Nnn�e) Paula Hicks � (Office Held) Human REsource Manager ,
OE(Company Name/Contrnctor) Dn�rv Company and first being duly sworn, on
mp oath, af�rrn in connecrion with the con�rracted services related to Fi re Sta #1 , Roof REplacetnent
(Project N;�me) for the duca�ion of the contrac� as follows: ^
1• Contractor s1�a11 provide a ten (10) hour Ocai�ational Safety and Health
Administration {OSHA) construction saFety program For all emplovees who will be on-site at d�e
Project. The construction saFetp prog-cam shal.! include a course in construction safety and hea�(1�
h]�at is approved 6p OSHA or a siFnilar progracn approved by the Missoc�ri Department oFLabor and
Industriai Relations which is at- least as stringent as an approved OSHA program as required i.iy
Section 2)2.675, RSMo.
2• Contractor shall require its on-si�e employees to complete a construction safety
program within sixtp (60) days after the date work on the Project commences, as cequired by Section
292.G75, RSI��fo.
3• Conixactoc acicno�vledges and agrees dlat an3r of Contracmr's �nployees found on
the Project site tivithout documentation of d7e successful con-cpEetioa of a construction safety
program shall be requu:ed to produce such documentation within twentp (20) daqs, or wil! be subject
to remova( from the Project.
4• Contractor sli�ill require afl oF it� Subcoiiiractors to compl�wi�E� the �equirements ot
Section 292,675, RSIv1o,
5• Contcactor acluio�vledges t�iat puisuant tz� Section 292.675, RSMo., Cont�actot shall •
forFeit to City as a penalty two d�ousand C�ve hundred doIlars (�'2,500.000), plus one hundred dollars
(f�100,00) For each on-s'rte employee emploped by Contractot or its Su6�oniractor, For each calendar
day, or port�on thereof, such on-site emplopee is employed without the construction safetp maining
requixed in Sectian 292.675, RSMo.
�• Contractor acknowledges that violations of Section 292.G75, RSMo, and imposition
of the penalt�es described d�erein si�all be investigated and detem�.ined by tl�e Missouri Derartment
of Labor and industcia! Relabons.
7• Cont•ractor acknowIedges d�at in the event tl-iat the Missouri Deparnnent of Labor
and Industrial Reladons has deterrnined that a violation oF Section 292.G75, RSMo., has occurred :
�
r
and that a penalty shall be a.ssessed, the City shall withhold and retain all sums and arnounts.due and
ovving when making paymei�ts to Contractor under�is Contract.
FURTHLR A.FFIANT S_AITH NOT.
� IN APFIRMATION THEREDF, the facts stated above are true and correct (the
undersigned understands that faIse statements made in this filing axe subject to �t�.e �
I ......... . :
penalties provided in Section 575.040, RSMo.)
I D �
(name of corpo don}
1 BY�
(n foEfic Fwrporation und titie)
erry 'ns, President
� ATTEST•
� Sec .. nrt' (nrnrhe offi.Pr)
� (SEAL OI�CORPOFATIOl�
� STAT'E O F A4ISSOUR i )
) ss.
' COUNTY OF CAPE GIP.f1RUEAU )
0�7 dus da� of September �, 2p10, befora me appeared �7P� C_Lmmins
to me personaUy known, who, being bp me duly swom, did say tliat�ie/slze is the PrP�i c3Pnt
' of Dnu-.�Cam�anv , a Missouri Corporation, and that rhe seal affixed to die
foregoing insirument is the seal of said Corporat�on, and that the said instrument was signed and
sealed in behalf of said Corporation by autlioritq of its Board oE Directors, and acknowledged sa�d •
' instzument to be tl�e Eree act and deed oE'said Corporation.
IN TESTIMONY WI-�REOF, I have hereunto set mp hand and aEFised my official seal, at
� mp oEfice in Cape Girardeau, Missouri, the dap and ear first above written..
� Notary P lic
I�Ip Commission F�cpires:
' `Q\'a��Q LYNN R PAYNE
Notary Public-hotary Seaf
State of Mlssouri, Scott County
� Commission # 06956798 ,
My Commission Expires Oct 23, 2010
�