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RES 2022-0683 - PO to Environmental Restoration for Soil Remediation Program Group No. 496 City Clerk Office Use Only: Publication Date(if.pplic.ble): RESOLUTION NO. f)2ZTi)L! 7 Agenda Date: Department: ;1 Submitter: GC l 1" . I /I.2 — CITY OF OMAHA LEGISLATIVE CHAMBER Omaha, Nebraska RESOLVED BY THE CITY COUNCIL OF THE CITY OF OMAHA: WHEREAS, bids were received on June 8, 2022 for the 5001 Davenport Street, 5107 Cass Street, 4927 N 19 Street , 4955 N 19 Street, 1821 Spencer Street , 120 S 50 Street, 724 N 50 Street , 2801 N 52 Street, 5132 Northwest Radial Highway, North 24 Street & Locust Street City of Omaha Soil Remediation Program Project; and, WHEREAS, Environmental Restoration, LLC submitted a bid of $259,000.00, being the lowest and best bid within the bid specifications for the 5001 Davenport Street, 5107 Cass Street, 4927 N 19 Street , 4955 N 19 Street, 1821 Spencer Street , 120 S 50 Street, 724 N 50 Street , 2801 N 52 Street, 5132 Northwest Radial Highway, North 24 Street & Locust Street City of Omaha Soil Remediation Program Project; and, WHEREAS, Environmental Restoration, LLC has complied with the City's Contract Compliance Ordinance No. 28885 in relation to Civil Rights- Human Relations.; and, NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF OMAHA: That, as recommended by the Mayor, the Purchasing Agent be authorized to issue a Purchase Order to Environmental Restoration, LLC for the 5001 Davenport Street, 5107 Cass Street, 4927 N 19 Street , 4955 N 19 Street, 1821 Spencer Street , 120 S 50 Street, 724 N 50 Street , 2801 N 52 Street, 5132 Northwest Radial Highway, North 24 Street & Locust Street City of Omaha Soil Remediation Program Project; and that the Finance Department is authorized to pay the cost of the project in the amount of $259,000.00 from City of Omaha - U.S. EPA Cooperative Agreement Assistance ID No. V -97748601 out of Lead Hazard Fund 12136, Organization 128104. 3267 jmc Adopted: JUL ! 9 2022 1 APPROVED AS TO FORM: Attest: / [�/24 Z�. City Clerk ASSISTANT CITY TTORNEY DATE <k> -±2{AL Approved: Mayor BID BOND: 5% NC Douglas County Purchasing TABULATION OF BIDS ON: CITY OF OMAHA Soil Remediation Group #496 Environmental Page 1 Restoration, LLC Date of Opening Department Wednesday, June 8, 2022 PLANNING - EPA PASS THRU Quantity DESCRIPTION UNIT PRICE B 5001 Davenport St BID/each: $26,000.00 5107 Cass St. BID/each: $27,000.00 4927 N. 19th St. BID/each: $9,000.00 4955 N. 19th St. BID/each: $16,000.00 1821 Spencer St BID/each: $15,000.00 120 S. 50th St. BID/each: $19,000.00 724 N. 50th St. BID/each: $30,000.00 2801 N. 52nd St. BID/each: $8,000.00 5132 Northwest Radial Highway BID/each: $9,000.00 North 24th St. & Locust St. BID/each: $100,000.00 ALL OR NONE TOTAL BID: $259,000.00 Bid Bond Received: Yes Terms: 100% Net 60 Delivery: 30 Calendar Days NC DOUGLAS COUNTY REQUEST FOR BID AND BID SHEET ON: CITY OF OMAHA Soil Remedlatlon Group#496 RETURN BIDS TO: Published: Wednesday,May 25,2022 Page 1 CITY CLERK 1819 Farnam Street BID BOND OR CERTIFIED CHECK REQUIRED IN THE AMOUNT 5% LC-1 Omaha-Douglas Civic Center IF THE TOTAL AMOUNT FOR THE ITEM OFFERED IS$20,000 OR MORE. Omaha,NE 88183 BID BOND OR CERTIFIED CHECK SHALL BE MADE PAYABLE TO "CITY OF OMAHA" NOT AN ORDER Bid Opening Time&Date: 11:00 a.m.CT on Wednesday,June 8,2022 IMPORTANT 1. Bid must be in the office of the CITY CLERK,1819 Famam Street,LC-1, 4 Right is reserved to accept or reject any or all bids in their entirety and the bidders shall OMAHA-DOUGLAS CIVIC CENTER,Omaha,NE 68183 have the right to appeal any decision to the Omaha City Council. by the opening date and time indicated in a sealed envelope marked: 5 When submitting bid on items listed,bidder may on a separate sheet,make BID ON:CITY OF OMAHA Soil Remedlatlon Group#496 suggestions covering reduction in costs wherever this is possible through 2. As evidence of good faith a bid bond or certified check must be submitted with bid. redesign,change of material or utilization of standard items or quantity change. Bid bond or certified check shall be made payable to'City of Omaha" 6 Bid tabulation are available on the Douglas County Purchasing website: FAILURE TO DO SO IS CAUSE FOR REJECTION. www.douglascountypurchasing.org. DO NOT CALL FOR THIS INFORMATION. 3 The City of Omaha Is tax exempt. Tax exempt certificates will be provided upon request Quote your lowest price,best delivery and terms,F.O.B.delivery point on the item(s)listed below: QUANTITY DESCRIPTION UNIT PRICE EXTENSION The City of Omaha is seeking bids for Soil Remediation as described in the attached specifications. Only bidders who are pre-qualified to do Soil Remediation work with the City of Omaha Planning Department may bid on this project. Any bidder who submits a bid and is not pre- qualified will be considered non-compliant with specifications and their bid will be rejected. DAVIS BACON ACT For questions regarding this bid, or questions on how to qualify to become a bidder for this or future bids with this scope of work, contact Mr. Thomas Roza at(402)444- 5150, ext. 2003. SEE PAGE 2 FOR ADDRESSES. ALL OR NONE TOTAL BID: $ 259,000.00 (5%Bid Bond is to be based upon this amount,if over $20,000.00) NOTE: Must be a pre-qualified contractor for bid submission to be considered. Questions regarding this bid should be sent via email to bidquestions@douglascounty-ne.gov. Vendor must include the bid title in the subject line. The deadline to submit questions on this bid is 11:00 a.m. on the Thursday before the bid opening date. Answers to questions will be posted via an addendum no later than the Friday before bid opening at www.douglascountypurchasing.org. (PLEASE PRINT LEGIBLY OR TYPE) Payment Terms 100 %NET 60 Firm:Environmental Restoration, LLC Incorporated In:1997 Delivery(or completion) Name:Adam Detrich Signature: at fte,...c.c. ao calendar days following Title:Vice President Phone:636-227-7477 Fax:636-227-6447 award Address:1666 Fabick Drive Fenton Missouri 63026 Street/P.O.Box City State Zip Email Address:a.detrich@erllc.com DOUGLAS COUNTY REQUEST FOR BID ON: CITY OF OMAHA- Soil Remediation Group#496 NOT AN ORDER Page 2 QUANTITY DESCRIPTION UNIT PRICE EXTENSION 5001 Davenport St. BID: $26,000.00 5107 Cass St. BID: $27,000.00 4927 N. 19th St. BID: $9,000.00 4955 N. 19th St. BID: $ 16,000.00 1821 Spencer St. BID: $ 15,000.00 120 S. 50th St. BID: $ 19,000.00 724 N. 50th St. BID: $30,000.00 2801 N. 52nd St. Type text here BID: $8,000.00 5132 Northwest Radial Highway BID: $9,000.00 North 24th St. & Locust St. BID: $100,000.00 ALL OR NONE TOTAL BID (Please put this amount on Page 1): $259,000.00 (5%Bid Bond is to be based upon this amount If over $20,000.00) SIGN ALL COPIES6<2 ' Firm Environmental Restoration, LLC By Adam Detrich Title Vice President CONTINUATION SHEET DOUGLAS COUNTY REQUEST FOR BID ON: CITY OF OMAHA-Soil Remediation Group#496 NOT AN ORDER Page 3 BID CLAUSES -TERMS AND CONDITIONS REQUIREMENTS FOR BID BOND: The surety company issuing the bid bond should be licensed by the State of Nebraska and listed on the current edition of Circular 570 of the United States Department of the Treasury. A certified check, an official bank check, or cashier's checks drawn on a national bank or a bank chartered under the laws of the state, payable to the City of Omaha, or lawful money of the United States, or a United States Government Bond (negotiable) are acceptable substitutes for bond requirements. LETTERS OF CREDIT AND COMPANY CHECKS ARE NOT ACCEPTABLE SUBSTITUTES FOR A BID BOND AND WOULD BE CAUSE FOR REJECTION OF BID. If a bidder submits more than one bid, only one bid bond is required; however,the 5% bid bond must be calculated using the highest bid amount of all submitted bids. Vendor Restrictions: From the date the bid is issued until a determination is announced regarding the selection of the contractor, contact regarding this project between potential consultants/vendors/contractors and individuals employed by the City of Omaha(Omaha)is restricted to only written communication with the person designated as the point of contact for this bid. Once a contractor is preliminarily selected,that contractor is restricted from communicating with Omaha employees with the exception of employees designated to negotiate, discuss or finalize a contract. Violation of this condition may be considered sufficient cause to reject a contractor's proposal and/or selection irrespective of any other condition. Conflict of Interest: Pursuant to Section 8.05 of the Home Rule Charter and all state and local rules, CONTRACTOR assures City of Omaha(CITY)that no elected Official or any officer or CITY employee shall have a financial interest, direct or indirect, in any CITY agreement. In the performance of this agreement, CONTRACTOR will avoid all conflicts of interests or appearances of conflict of interest. CONTRACTOR will report any conflict of interest immediately to the CITY. CONTRACTOR did not and will not provide any money or other benefit of any kind to any CITY employee in the procuring of, facilitation of, and execution of or during the duration of this Agreement. Drug Free Policy: CONTRACTOR assures City of Omaha that CONTRACTOR has established and maintains a drug free workplace policy. Unavailability of Funding: Due to possible future reductions including but not limited City of Omaha (CITY), State and/or Federal appropriations,the CITY cannot guarantee the continued availability of funding for this Agreement, notwithstanding the consideration stated in this Agreement. In the event funds to finance this Agreement become unavailable either in full or in part due to such reduction in appropriations, the CITY may terminate the Agreement or reduce the consideration upon notice in writing to Contractor. The notice shall be delivered by certified mail, return receipt requested, or in person with proof of delivery. The CITY shall be the final authority as to the availability of funds. The effective date of such Agreement termination or reduction in consideration shall be specified in the notice as the date of service of the notice or the actual effective date of the CITY, State and/or Federal funding reduction,whichever is later. Provided, that reduction shall not apply to payments made for services satisfactorily completed prior to the effective date. In the event of a reduction of consideration, Contractor may cancel this Agreement as of the effective date of the proposed reduction upon the provision of advance written notice to CITY. PAYMENT TERMS: Net 30 payment terms shall apply to all invoices billed to the City of Omaha. Payment of invoice amount will occur within 30 days following receipt of invoice or receipt of goods/services,whichever is later. This is an All or None bid. Vendors must bid on every item listed in the bid sheets, or it will be cause for rejection of bid. Solid Waste Disposal: Pursuant to an Interlocal agreement between the City of Omaha (Res. 124) and Douglas County(Res. 85) dated January 31,2012, all solid waste collected and/or processed pursuant to City or County contracts is required to be taken to the Douglas County Pheasant Point Landfill. This includes trash, rubbish, construction, and other solid waste. This is a requirement that will not be waived. C&D, hazardous waste, untreated medical waste, asbestos and recycled materials would be exempt from this directive. SIGN ALL COPIES Firm Environmental Restoration, LLC By Adam Detrich Title Vice President CONTINUATION SHEET DOUGLAS COUNTY REQUEST FOR BID ON: CITY OF OMAHA-Soil Remediation Group#496 NOT AN ORDER Page 4 BID CLAUSES -TERMS AND CONDITIONS INSURANCE: Each bidder must provide a Certificate of Insurance with their bid documents which details their current levels of coverage. FOLLOWING AWARD OF CONTRACT: For City projects where the scope of work will be less than$200,000.00, it is required that the awarded contractor provide a Certificate of Insurance meeting or exceeding the following levels of insurance:(1) adequate workers'compensation (statutory); (2)commercial general liability in an amount not less than $250,000 for any person for any number of claims arising out of a single occurrence and not less than $500,000 for all claims arising out of a single occurrence; and (3) property damage insurance in an amount not less than $500,000; and naming CITY OF OMAHA as an additional insured, except for Workers' Compensation policies/certificates, for the term of the agreement. Certificates of Insurance are required before service begins. FOLLOWING AWARD OF CONTRACT: For City projects where the scope of work will exceed$200,000.00, it is required that the awarded contractor provide a Certificate of Insurance meeting or exceeding the following levels of insurance: (1) adequate workers'compensation (statutory); (2) commercial general liability in an amount not less than $1,000,000 for any person for any number of claims arising out of a single occurrence and not less than $5,000,000 for all claims arising out of a single occurrence; and (3) property damage insurance in an amount not less than $500,000; and naming CITY OF OMAHA as an additional insured, except for Workers'Compensation policies/certificates,for the term of the agreement. Certificates of Insurance are required before service begins. REQUIREMENTS FOR PERFORMANCE BOND: The successful vendor shall provide a performance bond equal to the vendor's bid within ten (10) calendar days from award of the contract. The surety company issuing the performance bond should be licensed by the State of Nebraska and listed on the current edition of Circular 570 of the United States Department of the Treasury. Assignment and Delegation: This Agreement is exclusive to the Parties and rights may not be assigned nor duties delegated by either Party except on prior written consent of the other. Any attempted assignment or delegation without such approval shall be void and shall constitute a material breach of contract. Any and all additional fees, charges, costs or expenses, which result from an approved assignment or delegation, shall be paid by the assigning/delegating Party. COMMUNICATON WITH STAFF: From the date this bid is issued until a contract is awarded, communication regarding this solicitation between potential vendors and individuals employed by the City of Omaha is prohibited. Only written communication via email to bidquestions@douglascounty-ne.gov is permitted. Once an award is made the vendor will be permitted to speak with person(s) participating in contract negotiations. Violation of these conditions may be considered sufficient cause to reject a vendor's bid and/or selection irrespective of any other condition. The following exceptions to these restrictions are permitted: (1) Contacts made pursuant to any pre-existing contracts or obligations; (2) City staff and/or vendor staff present at a Pre-Proposal Conference, if scheduled, when recognized by the City as staff facilitating the meeting for the purpose of addressing questions; and, (3) Presentations, key personnel interviews, clarification sessions or discussions to finalize a contract, as requested by the City of Omaha. FEDERAL DEBARMENT OR SUSPENSION Has bidder or its principals been debarred or suspended from Federal contracts? YES x NO (failure to provide a response may be cause for rejection of bid) Bidder certifies by submission of this bid that neither it nor its principals are presently debarred or suspended from participation in Federal contracts. If during the term of the agreement the awarded bidder or any person engaged in performing this agreement becomes debarred or suspended such Party shall notify the City of Omaha immediately. SIGN ALL COPIES Firm Environmental Restoration,LLC By Adam Detrich Title Vice President CONTINUATION SHEET DOUGLAS COUNTY REQUEST FOR BID ON: CITY OF OMAHA-Soil Remediation Group#496 NOT AN ORDER Page 5 BID CLAUSES-TERMS AND CONDITIONS Form CC-1: All bidders awarded a City contract in the amount of$10,000 or more must comply with the Contract Compliance Ordinance by having a current Contract Compliance Report(Form CC-1)on file with the Human Rights & Relations Department. This report shall be in effect for 24 months from the date received by the Human Rights& Relations Department. Any questions regarding the Contract Compliance Ordinance should be directed to the Human Rights & Relations Department at(402)444-5055. Bidders are encouraged to use the following weblink to determine if they have a current Form CC-1 on file (search by company name): https:llhumanrights.cityofomaha.org/cc-1-search Equal Employment Opportunity: In accordance with the Nebraska Fair Employment Practice Act, Neb. Rev. Stat. §48-1122, the Contractor agrees that neither it nor any of its subcontractors shall discriminate against any employee, or applicant for employment to be employed in the performance of this Agreement,with respect to hire,tenure, terms, conditions, or privileges of employment because of the race, color, religion, sex, disability, or national origin of the employee or applicant. New Employee Work Eligibility Status(Neb. Rev.Stat.§4-108-114) The Contractor is required and hereby agrees to use a federal immigration verification system to determine the work eligibility status of new employees physically performing services within the State of Nebraska. A federal immigration verification system means the electronic verification of the work authorization program authorized by the Illegal Immigration Reform and Immigrant Responsibility Act of 1996, 8 U.S.C. 1324a, known as the E-Verify Program, or an equivalent federal program designated by the United States Department of Homeland Security or other federal agency authorized to verify the work eligibility status of a newly hired employee. If the Contractor is an individual or sole proprietorship,the following applies: 1. The Contractor must complete the United States Citizenship Attestation Form,available on the Department of Administrative Services website at www.das.state.ne.us . 2. If the Contractor indicates on such attestation form that he or she is a qualified alien, the Contractor agrees to provide the US Citizenship and Immigration Services documentation required to verify the Contractor's lawful presence in the United States using the Systematic Alien Verification for Entitlements(SAVE) Program. 3. The Contractor understands and agrees that lawful presence in the United States is required and the Contractor may be disqualified or the contract terminated if such lawful presence cannot be verified as required by Neb. Rev. Stat. §4-108. SIGN ALL COPIES ,., ;,1 Firm Environmental Restoration,LLC %_. By Adam Detrich Title Vice President CONTINUATION SHEET Responsible Contractor Compliance Form RC-1 0g , CMAHA''VA: ?r G � tA h• 1. Regulation: 044 41)FEDO'*¢y A.Article IV,Division I of Chapter 10 of the Omaha Municipal Code thereon require: 1.That all contractors who submit a bid to City of Omaha shall designate a representative who on behalf of the Contractor,shall fill out completely a Responsible Contractor Compliance Form (RC-1). An incomplete or unsigned RC-1 form will make your bid null and void. 2. Filing this Report(please initial in the boxes below): Contractor agrees that Contractor will not knowingly employ or hire an employee not lawfully AD authorized to perform employment in the United States and that the Contractor and all sub- contractors shall use E-Verify to determine work eligibility. AD Contractor agrees that Contractor will not knowingly violate Nebraska's Misclassification of Employee law(Neb.Rev. Stat.Section 48-2901 et seq.). AD Contractor agrees that Contractor will not knowingly violate Nebraska's Fair Labor Standards Law(Neb.Rev.Stat.Section 73-104 et seq.). AD Contractor has not been convicted of any tax violations(local,State and Federal)within the last three years from the date this bid is submitted. Contractor has not,upon final determination by the Occupational Safety and Health AD Administration,been convicted of a criminal,repeat,or willful violation of the Occupational Safety and Health Act(OSHA)or been convicted of 3(three)separate"serious"OSHA violations within the past three(3)years. AD Contractor agrees to make a good faith effort to ensure all subcontractors employed on this project comply with the provisions of the Responsible Contractor Compliance Form RC-1. ,,,,.2"."1„,„ 06/07/2022 Signature Date By signing,I verify on behalf of the Contractor that the information above is true and correct. Filing false information carries a penalty of up to a$500 fine or six months in jail. In addition,the contractor and sub- contractors can be subject to immediate disqualification and prohibited from any future City of Omaha contract for a period of 10 years. 1 EMPLOYEE CLASSIFICATION ACT: Each contractor who performs construction or delivery service pursuant to this contract shall submit with their bid submission an affidavit attesting that (1) each individual performing services for such contractor is properly classified under the Nebraska Employee Classification Act, 2010 LB 563 ("the Act"); (2) such contractor has completed a Federal I-9 Immigration form and has such form on file for each employee performing services; (3) such contractor has complied with Neb. Rev. Stat. Section 4-114 (Federal Immigration Verification System--E- Verify); (4) such contractor has no reasonable basis to believe that any individual performing services for such contractor is an undocumented worker; and (5) as of the time of the contract, such contractor is not barred from contracting with the state or any political subdivision pursuant to the Act. The contractor shall follow the provisions of the Act. A violation of the Act by a contractor is grounds for rescission of the contract by City of Omaha/Douglas County. CONTRACTOR shall follow the provisions of the Employee Classification Act (Act). A violation of the Act will be a material breach and, in addition to any other remedies, be grounds for immediate contract rescission. If CONTRACTOR is performing construction or providing delivery service, CONTRACTOR shall submit an affidavit that complies with the Act. CONTRACTOR will also ensure that all subcontractors performing services for Contractor will also complete affidavits that comply with the Act. Contractor may submit the affidavit(s) with their bid submission. In all circumstances, Contractor shall provide the affidavits before work or services are undertaken pursuant to this Agreement. Following award, if CONTRACTOR changes or adds additional subcontractors, CONTRACTOR shall ensure that the subcontractor provides an Employee Classification Act affidavit to Douglas County Purchasing Department before that subcontractor begins work or services. All Employee Classification Act affidavits shall be sent to: Douglas County Purchasing Agent, 1819 Farnam Street,Room 902, Omaha NE 68183. FAIR LABOR STANDARDS: CONTRACTOR agrees to maintain FAIR LABOR STANDARDS as defined in Neb. Rev Stat § 73-104. CONTRACTOR has filed with Douglas County (City/County Purchasing) a statement that it is complying with and will continue to comply with, fair labor standards as provided in Neb. Rev. Stat. §§73-102 & 73-104. In addition, CONTRACTOR assures County that it will continue to comply with statutory fair labor standards throughout its performance under this contract. AFFIDAVIT FOR EMPLOYEE CLASSIFICATION ACT & FAIR LABOR STANDARDS I, N (X,YYN Id 0 vv\ , beingduly first sworn under oath, state and depose as follows: 1. I am competent to testify to, and have personal knowledge of,the matters stated in this affidavit. 2. I am (a contractor) or (the authorized agent of the contractor) for 'iL(l'k umfie4 1 k4t.A ak 9 \‘1-1-e--Company, (hereinafter "Contractor"). I attest to the following: (a) each individual performing services for Contractor is properly classified under the Nebraska Employee Classification Act, ("the Act"), (b) Contractor has completed a federal I- 9 immigration form and has such form on file for each employee performing services, (c) Contractor has complied with Neb. Rev. Stat. §4-114 (use of federal immigration verification system), (d) Contractor has no reasonable basis to believe that any individual performing services for Contractor is an undocumented worker, (e) as of the time of the contract, Contractor is not barred from contracting with the state or any political subdivision pursuant to the Act, and (f) Contractor is complying with and will continue to comply with, fair labor standards as provided in Neb.Rev.Stat. §§73-102 & 73-104, as applicable and as amended hereinafter. Contractor will also ensure that all subcontractors execute affidavits in compliance with the Act. FURTHER AFFIANT SAYETH NAUGHT Affiant(Contractor) SUBSCRIBED AND SWORN TO bef re me this51 day ofs 14., , 20:99. SHARON HENRY Notary Public-Notary Seal otary ublic State of Missouri Commissioned for Jefferson County My Commission Expires:December 17,2025 Commission Number:13901328 • • Ur:S trvlranntet tat r ectlan gent y nd Llty ctf Omah . oQp rat ve l r f ht°11 91:7�R61 �: 0: E aha Le d Ott+w::&alt`fe n an&R ln, IStl t1 t �rnpliance wtth ttie t P'ks Program fat`C�lwtl[ atio g la t1,Minar fy d' iameh` u lni ss . tlterp ises,the it o a :ec epta the fdlfauu n r`elr share"g+ �sj® ►fie t�ves negotIat d h the EMA by th Nebrasje Deportti:ent of Ettvlron mehtal Qtuallty(NOg.C)''. • ebpesk ,8 • lqutpm, G%` . • Senticee 5 %: g:►latrta tlan 6 ;:. ,8% : • 4 • `i hese"f lr hare' b�ec Ives should be"included in ar d dacurriants far subca�ttrectors;f; r palgt sabttiatidtl;and alt rerrtt~dlattn - • • • • • • • : 1. .. u ; „! t'PAINT S. 'AB ILtz TION•.. SO : 17 �`� T " Thy Ne#;raska i tupioyec Cias f ication Ac requires that cot1ractor ' hci etforn4 ecust i t on crviccs shad suf,mi at_., £icdavit for;:Etpf oyee Classifi,cation'Mt to tt'e City,oft ahi,; T is A 'i•ayf t^uviil q iztciuded ire each bid packages It. ay be"shed:and rtoiuded with the bid or xttrrxay be Sigrx d aid rotclrned to tihe Patat,Stabil zatiot f ,oii otttodtation aff ee after sue ce sfui bk s are determirlsd _. T'Ihe Affidavit cr E tpi ec Ciasslff efitton Act for,m ust be sti,i-d ‘notarzzd-and submitted.:to the nt,Stabilizatiot/Soil Remediati n rfFicebefore a tt ecd(? :St i11 c.'issuccl,; 'i`he Affidavit in st be submitted each time a contractor ts"the stzceessti1 bidder If the curter 0t0r: • wins more than. ne project ina bid groups one signed Affidavit.Is stiff cient.at that tune If'you have any tio$tio(ie abotat this tcq)irernent; picas + orate t t ;ve Ziv , at :62 r515 • p�-•yip ♦;: t :�: ... Lead-..''.ams iviarzaget :. • 1JN1TD STATE+S T'riz smP,ATTES TATK 4 FC)IRM Forr the §§ uses��'cod �ytxtg;with N�� R.��r,"Strati. 4 �QS t�� :�14E Z�'tte�t. �a. � s I am a citizen of.the t,}'n t 4 States,. GTi 5 I a a qualified alien under the ;Federal Tin tz ratio and Nationality Aet, My itn 4h n status,and alien number as fpT:lt s ' and I agree to F��pde a copy tf the: U SCTS (United. ' States ,e tzzensht `' and': Tm x tatin iaervicei) documentation upon request required to•verify the Contract's.?t law iul presence the ij'intlett States us .g the ysteiiatic Alien Verification for Entit enietits(SA`VE)P`p am hea eby hest tlsat y response c the t'ormaticn pxovxded on thr iortz and any related, a pltgat,on fox public benefits are n•1ei c tna lete `and scours:e and i understand that this : - - i a atxor tray.lie used to vezi#`y Yn la fill tree a#aa the 11 itedStates I understand d agree tl atlaw �l p esence to the United States is equrred and tile:cornraotox maybe disqualified or,the contract:t uaated if, such lawful r Bence •camiett be verified:as xequ red.by Nob.: Rev. .:T'RIN',• • Adam Detrick 13y: :SIGNATU :: DATE: 06/07/2022 . • • Created and rtpp'aved,I Xft,9/2009 ,Jl l 4b — U11J, / t t� "t � �'f,'"r 1,1�6 l�°l.f it y Ch/rQ,,Jl •� '"';T`^<Tn3 ' '� r''tet, , 1 Mt:at,'r. 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W ,:. r r ry\�Z�!j '3541 t.l f {I� J "' `f ;.:�� a..{;f t 7!z,:\� r..,•�I \:: s1�4£A�$ ';�11i .� ,5 ,t„r2t, • 461.,;:. )ii,glurszylac*A-„ 1•,:, r \t,,p)"1> .rr;¢t.41t 1; 1, /'' n ' 4, 1tL:a'Z ,. •t•.. r...41:• i.t( /4,iJ t4...„. {1. , \,h:, a!C.!Od 1'.,�+ ,w/�-[\tr//u.n�'•./,/. i.. ,: J,�� ! J.I'fi � •�.1 Fr ' Q. ``iwtik�'c i �;, -..44 - 'v�<'.. J' `'". "' 'i l:_ fart q�a{.Y"X�:al)Y' \"w�.` •4;�y�y..�ti1 r.. `i"..iJri�if�� A�RD'® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/VINY) 120/2021 . THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS • CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES • BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE'HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(Ies)must have ADDITIONAL INSURED provisions or be endorsed. • If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT Pauline Warnecke NAME: AssuredPartners of Missouri,LLC (A/C No,Eat): (314)523-8800 FAX No): (314)453-7555 12645 Olive Blvd;Suite 300 a ADDRESS: pwamecke@APMIssourl.cam INSURER(S)AFFORDING COVERAGE NAIC N _ St Louis MO 63141 INSURER A: Nautilus Insurance Company • 17370 INSURED INSURER B: Great Divide Insurance Company 25224 Environmental Restoration,L.L.C. INSURER C: 1666 Fabick Drive INSURER 0 INSURER E: Fenton MO 63026 INSURER F: COVERAGES CERTIFICATE NUMBER: 21-22 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 1LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF POLICY EXP YT X COMMERCIAL GENERAL LIABILITY (MMIDD/YY/1� (MMroD/YYYY) LIMITS 1 000,000 EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE n OCCUR PREMISES(Ea occurrence) $ 300,000 X Deductible:$10,000 MED EXP(Any one person) $ 25,000 A ECP0154311420 12/22/2021 12/22/2022 PERSONAL 8ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑X JEtaT LOC PRODUCTS-COMP/OPAGG $ 2.000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ B/B OWNED SCHEDULED BAP154314120/MAA200734419 12/22/2021 12/22/2022 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A X EXCESS LIAB CLAIMS-MADE FFX154311320 12/22/2021 12/22/2022 AGGREGATE $ 5,000,000 DED RETENTION$ $ WORKERS COMPENSATION X PER STATUTE ERH AND EMPLOYERS'LIABILITY B/A ANY PROPRIETOR/PARTNERIEXECUTIVE Yn N/A WCA200734619/WCA20166261 12/22/2021 12/22/2022 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 Per Occ Ded-$10,000 $1,000,000 NA Contractor on l Llaban Lla-Claims Macurrenc ECP0154311420 12/22/2021 12/22/2022 Professional Liability-Claims Made Retro 12/22/97,Ded$20k $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Omaha ACCORDANCE WITH THE POLICY PROVISIONS. 1819 Farnam Street Suite 706 AUTHORIZED REPRESENTATIVE Omaha NE 68183 lj.r.► — r I irr ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 00001861 LOC#: ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMED INSURED AssuredPartners of Missouri,LLC Environmental Restoration,L.L.C. POLICY NUMBER • CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance:Notes EXTENSIONS OF COVERAGE: Named Insured Includes:Quality Safety Products,LLC COMMERCIAL GENERAL LIABILITY(Occurrence Form)/CONTRACTORS'POLLUTION LIABILITY(Occurrence Form)/PROFESSIONAL LIABILITY (Claims-Made Form) A)Blanket Additional Insured with respect to work performed by the Named Insured,as required by written contract; B)Blanket Additional Insured Primary and Non-Contributory,as required by written contract; C)Blanket Additional Insured,Primary and Non-contributory applies to Ongoing and Completed Operations,as required by written contract; D)Blanket Waiver of Subrogation with respect to work performed by the Named insured,as required by written contract; E)Blanket Additional Insured-Lessor of leased/rented equipment,as required by written contract; F)Blanket Contractual Liability-Railroads,as required by written contract; G)Watercraft Liability for watercraft owned or operated by the Insured; H)Stop Gap provided for ND,OH,WA,WY,PR USVI; I)Coverage provided for Incidents occurring within 50'of railroad property; J)General Aggregate Limit applies per Project; K)Transportation Pollution Liability and Contingent Transportation Pollution Liability included; L)Contractual Liability provided for liability for damages assumed in an"Insured contract"as definined In the Commercial General Liability terms,conditions, and exclusions; M)Commercial General Liability does not exclude explosion,collapse,and underground hazards(XCU); N)Asbestos Abatement Liability covered under the Contractor's Pollution Liability coverage; 0)Blanket Non-Owned Disposal Site Coverage-Off Site Only,Retroactive Date-6/11/2012. COMMERCIAL AUTO LIABILITY A)Blanket Additional Insured,as required by written contract; B)Blanket Additional Insured&Loss Payee-Lessor for rented vehicles,as required by written contract; C)Blanket Primary and Non-Contributory,as required by written contract; D)Blanket Waiver of Subrogation,where permitted by law and as required by written contract; E)Hired Car Physical Damage Is ACV to cost of repair of$250,000,which is less,minus$100 Comprehensive Deductible and$1,000 Collision Deductible; F)MCS-90 Form includes Pollution Liability and Public Liability,if required by written contract; G)Coverage for Certain Operations in Connection with Railroads included; H)CA9948-Pollution Liability-Broadened Coverage for Covered Autos-Business Auto and Motor Carrier Coverage Forms. WORKERS'COMPENSATION/EMPLOYERS LIABILITY A)Blanket Waiver of Subrogation where permitted by law and as required by written contract; B)Longshore and Harbor Workers Compensation Act,and Maritime Coverage,all applicable states C)Owners/Partners/Executive Officers are not excluded from coverage. EXCESS LIABILITY A)Follow Form of above policies as respects Additional Insured,Primary and Non-contributory,and Waiver of Subrogation provision; B)Excess Liability limits shown are excess and in addition to Commercial General Liability,Contractors Pollution Liability(Occurrence Form),Professional Liability(Claims-Made Form),Business Auto Liability,and Employers Liability. SUBJECT TO POLICY TERMS,CONDITIONS AND EXCLUSIONS ACORD 101(2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 1,7.:....;. . i .We../$.*: ft . .14-.‘1; •-•%14. i 0 c un t U 8 e Ii oo 8 is c v2 ea ./3 I If 8 § m r .g ... M 2 ' LL z in Lx iin t� ' s . I 0°U I Oh . . ..... Z', (§ ! NC DOUGLAS COUNTY REQUEST FOR BID AND BID SHEET ON: CITY OF OMAHA Soil Ri medlation Group#496 RETURN BIDS TO: Published: Wednesday,May 26,2022 Page 1 CITY CLERK 1819 Farnam Street BID BOND OR CERTIFIED CHECK REQUIRED IN THE AMOUNT 5% LC-1 Omaha-Douglas Civic Center IF THE TOTAL AMOUNT FOR THE ITEM OFFERED IS$20,000 OR MORE. Omaha,NE 68183 BID BOND OR CERTIFIED CHECK SHALL BE MADE PAYABLE TO "CITY OF OMAHA" NOT AN ORDER Bid Opening Time&Date: 11:00 a.m.CT on Wednesday,June 8,2022 IMPORTANT 1, BId must be In the office of the CITY CLERK,1819 Famam Street,LC-1, 4 Right is reserved to accept or reject any or all bids In their entirely and the bidders shall OMAHA-DOUGLAS CIVIC CENTER,Omaha,NE 68183 have the fight to appeal any decision to the Omaha City Council. by the opening date and time indicated In a sealed envelope marked: 5 When submitting bid on items listed,bidder may on a separate sheet,make BID ON:CITY OF OMAHA Soil Remedlation Group#496 suggestions covering reduction In costs wherever this is possible through 2. As evidence of good faith a bid bond or certified check must be submitted with bid. redesign,change of material or utilization of standard Items or quantity change. Sid bond or certified check shall be made payable to'City of Omaha" 6 Bid tabulation are available on the Douglas County Purchasing website: FAILURE TO DO SO IS CAUSE FOR REJECTION. www.dougiascountypurchasing.org. DO NOT CALL FOR THIS INFORMATION. 3 The City of Omaha Is tax exempt Tax exempt certificates will be provided upon request Quote your lowest price,best delivery and terms,F.O.B.delivery point on the item(s)listed below: QUANTITY DESCRIPTION UNIT PRICE EXTENSION The City of Omaha is seeking bids for Soil Remediation as described in the attached specifications. Only bidders who are pre-qualified to do Soil Remediation work with the City of Omaha Planning Department may bid on this project. Any bidder who submits a bid and is not pre- qualified will be considered non-compliant with specifications and their bid will be rejected. DAVIS BACON ACT For questions regarding this bid,or questions on how to qualify to become a bidder for this or future bids with this scope of work, contact Mr. Thomas Roza at(402)444- 5150, ext.2003. SEE PAGE 2 FOR ADDRESSES. ALL OR NONE TOTAL BID: $ 259,000.00 (5%Bid Bond is to be based upon this amount,if over $20,000.00) NOTE: Must be a pre-qualified contractor for bid submission to be considered. Questions regarding this bid should be sent via email to bidquestions@douglascounty-ne.gov. Vendor must include the bid title in the subject line. The deadline to submit questions on this bid is 11:00 a.m.on the Thursday before the bid opening date. Answers to questions will be posted via an addendum no later than the Friday before bid opening at www.dougiascountypurchasing.org. (PLEASE PRINT LEGIBLY OR TYPE) Payment Terms toe %NET 60 Firm:Environmental Restoration, LLC (Incorporated In:1997 Delivery(or completion) Name:Adam Detrich !Signature: % St 30 calendar days following Title:Vice President Phone:636-227-7477 Fax:636-227-6447 award Address:1666 Fabick Drive Fenton Missouri 63026 Street/P.O.Box City State Zip Email Address:a.detrich@erllc.com DOUGLAS COUNTY REQUEST FOR BID ON: CITY OF OMAHA -Soil Remediation Group#496 NOT AN ORDER Page 2 QUANTITY DESCRIPTION UNIT PRICE EXTENSION 5001 Davenport St. BID: $26,000.00 5107 Cass St. BID: $27,000.00 4927 N. 19th St. BID: $9,000.00 4955 N. 19th St. BID: $ 16,000.00 1821 Spencer St. BID: $ 15,000.00 120 S. 50th St. BID: $ 19,000.00 724 N. 50th St. BID: $30,000.00 2801 N. 52nd St. Type text here BID: $8,000.00 5132 Northwest Radial Highway BID: $9,000.00 North 24th St. & Locust St. BID: $100,000.00 ALL OR NONE TOTAL BID (Please put this amount on Page 1): $259,000.00 (5%Bid Bond is to be based upon this amount If over $20,000.00) SIGN ALL COPIES Firm Environmental Restoration, LLC By Adam Detrich Title Vice President CONTINUATION SHEET DOUGLAS COUNTY REQUEST FOR BID ON: CITY OF OMAHA-Soil Remediation Group#496 NOT AN ORDER Page 3 BID CLAUSES -TERMS AND CONDITIONS REQUIREMENTS FOR BID BOND: The surety company issuing the bid bond should be licensed by the State of Nebraska and listed on the current edition of Circular 570 of the United States Department of the Treasury. A certified check, an official bank check, or cashier's checks drawn on a national bank or a bank chartered under the laws of the state, payable to the City of Omaha, or lawful money of the United States,or a United States Government Bond(negotiable)are acceptable substitutes for bond requirements. LETTERS OF CREDIT AND COMPANY CHECKS ARE NOT ACCEPTABLE SUBSTITUTES FOR A BID BOND AND WOULD BE CAUSE FOR REJECTION OF BID. If a bidder submits more than one bid, only one bid bond is required; however,the 5% bid bond must be calculated using the highest bid amount of all submitted bids. Vendor Restrictions: From the date the bid is issued until a determination is announced regarding the selection of the contractor, contact regarding this project between potential consultants/vendors/contractors and individuals employed by the City of Omaha(Omaha)is restricted to only written communication with the person designated as the point of contact for this bid. Once a contractor is preliminarily selected,that contractor is restricted from communicating with Omaha employees with the exception of employees designated to negotiate,discuss or finalize a contract. Violation of this condition may be considered sufficient cause to reject a contractor's proposal and/or selection irrespective of any other condition. Conflict of Interest: Pursuant to Section 8.05 of the Home Rule Charter and all state and local rules, CONTRACTOR assures City of Omaha(CITY)that no elected Official or any officer or CITY employee shall have a financial interest, direct or indirect,in any CITY agreement. In the performance of this agreement, CONTRACTOR will avoid all conflicts of interests or appearances of conflict of interest. CONTRACTOR will report any conflict of interest immediately to the CITY. CONTRACTOR did not and will not provide any money or other benefit of any kind to any CITY employee in the procuring of,facilitation of, and execution of or during the duration of this Agreement. Drug Free Policy: CONTRACTOR assures City of Omaha that CONTRACTOR has established and maintains a drug free workplace policy. Unavailability of Funding: Due to possible future reductions including but not limited City of Omaha(CITY), State and/or Federal appropriations,the CITY cannot guarantee the continued availability of funding for this Agreement, notwithstanding the consideration stated in this Agreement. In the event funds to finance this Agreement become unavailable either in full or in part due to such reduction in appropriations,the CITY may terminate the Agreement or reduce the consideration upon notice in writing to Contractor. The notice shall be delivered by certified mail, return receipt requested, or in person with proof of delivery. The CITY shall be the final authority as to the availability of funds. The effective date of such Agreement termination or reduction in consideration shall be specified in the notice as the date of service of the notice or the actual effective date of the CITY, State and/or Federal funding reduction,whichever is later. Provided,that reduction shall not apply to payments made for services satisfactorily completed prior to the effective date. In the event of a reduction of consideration, Contractor may cancel this Agreement as of the effective date of the proposed reduction upon the provision of advance written notice to CITY. PAYMENT TERMS: Net 30 payment terms shall apply to all invoices billed to the City of Omaha. Payment of invoice amount will occur within 30 days following receipt of invoice or receipt of goods/services,whichever is later. This is an All or None bid. Vendors must bid on every item listed in the bid sheets,or it will be cause for rejection of bid. Solid Waste Disposal: Pursuant to an Interlocal agreement between the City of Omaha(Res. 124)and Douglas County(Res. 85)dated January 31,2012, all solid waste collected and/or processed pursuant to City or County contracts is required to be taken to the Douglas County Pheasant Point Landfill. This includes trash, rubbish, construction, and other solid waste. This is a requirement that will not be waived. C&D, hazardous waste, untreated medical waste, asbestos and recycled materials would be exempt from this directive. • SIGN ALL COPIES Firm Environmental Restoration, LLC By Adam Detrich Title Vice President CONTINUATION SHEET DOUGLAS COUNTY REQUEST FOR BID ON: CITY OF OMAHA -Soil Remediation Group#496 NOT AN ORDER Page 4 • BID CLAUSES-TERMS AND CONDITIONS INSURANCE: Each bidder must provide a Certificate of Insurance with their bid documents which details their current levels of coverage. FOLLOWING AWARD OF CONTRACT: For City projects where the scope of work will be less than$200,000.00, it is required that the awarded contractor provide a Certificate of Insurance meeting or exceeding the following levels of insurance:(1) adequate workers'compensation (statutory); (2)commercial general liability in an amount not less than $250,000 for any person for any number of claims arising out of a single occurrence and not less than$500,000 for all claims arising out of a single occurrence; and (3) property damage insurance in an amount not less than $500,000; and naming CITY OF OMAHA as an additional insured, except for Workers' Compensation policies/certificates, for the term of the agreement. Certificates of Insurance are required before service begins. FOLLOWING AWARD OF CONTRACT: For City projects where the scope of work will exceed$200,000.00, it is required that the awarded contractor provide a Certificate of Insurance meeting or exceeding the following levels of insurance: (1) adequate workers'compensation (statutory); (2)commercial general liability in an amount not less than $1,000,000 for any person for any number of claims arising out of a single occurrence and not less than $5,000,000 for all claims arising out of a single occurrence; and (3) property damage insurance in an amount not less than $500,000; and naming CITY OF OMAHA as an additional insured, except for Workers'Compensation policies/certificates, for the term of the agreement. Certificates of Insurance are required before service begins. REQUIREMENTS FOR PERFORMANCE BOND: The successful vendor shall provide a performance bond equal to the vendor's bid within ten (10)calendar days from award of the contract. The surety company issuing the performance bond should be licensed by the State of Nebraska and listed on the current edition of Circular 570 of the United States Department of the Treasury. Assignment and Delegation: This Agreement is exclusive to the Parties and rights may not be assigned nor duties delegated by either Party except on prior written consent of the other. Any attempted assignment or delegation without such approval shall be void and shall constitute a material breach of contract. Any and all additional fees, charges, costs or expenses, which result from an approved assignment or delegation, shall be paid by the assigning/delegating Party. COMMUNICATON WITH STAFF: From the date this bid is issued until a contract is awarded, communication regarding this solicitation between potential vendors and individuals employed by the City of Omaha is prohibited. Only written communication via email to bidquestions@douglascounty-ne.gov is permitted. Once an award is made the vendor will be permitted to speak with person(s) participating in contract negotiations. Violation of these conditions may be considered sufficient cause to reject a vendor's bid and/or selection irrespective of any other condition. The following exceptions to these restrictions are permitted: (1) Contacts made pursuant to any pre-existing contracts or obligations; (2) City staff and/or vendor staff present at a Pre-Proposal Conference, if scheduled, when recognized by the City as staff facilitating the meeting for the purpose of addressing questions; and, (3) Presentations, key personnel interviews, clarification sessions or discussions to finalize a contract, as requested by the City of Omaha. FEDERAL DEBARMENT OR SUSPENSION Has bidder or its principals been debarred or suspended from Federal contracts? YES x NO (failure to provide a response may be cause for rejection of bid) Bidder certifies by submission of this bid that neither it nor its principals are presently debarred or suspended from participation in Federal contracts. If during the term of the agreement the awarded bidder or any person engaged in performing this agreement becomes debarred or suspended such Party shall notify the City of Omaha immediately. SIGN ALL COPIES Firm Environmental Restoration,LLC By Adam Detrich Title Vice President CONTINUATION SHEET DOUGLAS COUNTY REQUEST FOR BID ON: CITY OF OMAHA-Soil Remediation Group#496 NOT AN ORDER Page 5 BID CLAUSES -TERMS AND CONDITIONS Form CC-1: All bidders awarded a City contract in the amount of$10,000 or more must comply with the Contract Compliance Ordinance by having a current Contract Compliance Report(Form CC-1)on file with the Human Rights & Relations Department. This report shall be in effect for 24 months from the date received by the Human Rights& Relations Department. Any questions regarding the Contract Compliance Ordinance should be directed to the Human Rights &Relations Department at(402)444-5055. Bidders are encouraged to use the following weblink to determine if they have a current Form CC-1 on file (search by company name): https://humanrights.cityofomaha.org/cc-1-search Equal Employment Opportunity: In accordance with the Nebraska Fair Employment Practice Act, Neb. Rev. Stat. §48-1122, the Contractor agrees that neither it nor any of its subcontractors shall discriminate against any employee, or applicant for employment to be employed in the performance of this Agreement,with respect to hire, tenure, terms, conditions, or privileges of employment because of the race, color, religion, sex,disability, or national origin of the employee or applicant. New Employee Work Eligibility Status(Neb. Rev.Stat.§4-108-114) The Contractor is required and hereby agrees to use a federal immigration verification system to determine the work eligibility status of new employees physically performing services within the State of Nebraska. A federal immigration verification system means the electronic verification of the work authorization program authorized by the Illegal Immigration Reform and Immigrant Responsibility Act of 1996, 8 U.S.C. 1324a, known as the E-Verify Program, or an equivalent federal program designated by the United States Department of Homeland Security or other federal agency authorized to verify the work eligibility status of a newly hired employee. If the Contractor is an individual or sole proprietorship,the following applies: 1. The Contractor must complete the United States Citizenship Attestation Form, available on the Department of Administrative Services website at www.das.state.ne.us 2. If the Contractor indicates on such attestation form that he or she is a qualified alien, the Contractor agrees to provide the US Citizenship and Immigration Services documentation required to verify the Contractor's lawful presence in the United States using the Systematic Alien Verification for Entitlements(SAVE) Program. 3. The Contractor understands and agrees that lawful presence in the United States is required and the Contractor may be disqualified or the contract terminated if such lawful presence cannot be verified as required by Neb. Rev. Stat. §4-108. SIGN ALL COPIES Firm Environmental Restoration,LLC � � By Adam Detrick Title Vice President CONTINUATION SHEET Responsible Contractor Compliance Form RC-1 OMAHA,1E, U~� � f9 ¢r� y 1. Regulation: o"iwn rzuaur4a A.Article IV,Division I of Chapter 10 of the Omaha Municipal Code thereon require: 1.That all contractors who submit a bid to City of Omaha shall designate a representative who on behalf of the Contractor,shall fill out completely a Responsible Contractor Compliance Form (RC-1). An incomplete or unsigned RC-1 form will make your bid null and void. 2. Filing this Report(please initial in the boxes below): Contractor agrees that Contractor will not knowingly employ or hire an employee not lawfully AD authorized to perform employment in the United States and that the Contractor and all sub- contractors shall use E-Verify to determine work eligibility. AD Contractor agrees that Contractor will not knowingly violate Nebraska's Misclassification of Employee law(Neb.Rev. Stat.Section 48-2901 et seq.). AD Contractor agrees that Contractor will not knowingly violate Nebraska's Fair Labor Standards Law(Neb.Rev.Stat.Section 73-104 et seq.). AD Contractor has not been convicted of any tax violations(local,State and Federal)within the last three years from the date this bid is submitted. Contractor has not,upon final determination by the Occupational Safety and Health AD Administration,been convicted of a criminal,repeat,or willful violation of the Occupational Safety and Health Act(OSHA)or been convicted of 3 (three)separate"serious"OSHA violations within the past three(3)years. AD Contractor agrees to make a good faith effort to ensure all subcontractors employed on this project comply with the provisions of the Responsible Contractor Compliance Form RC-1. 06/07/2022 Signature Date By signing,I verify on behalf of the Contractor that the information above is true and correct. Filing false information carries a penalty of up to a$500 fine or six months in jail. In addition,the contractor and sub- contractors can be subject to immediate disqualification and prohibited from any future City of Omaha contract for a period of 10 years. EMPLOYEE CLASSIFICATION ACT: Each contractor who performs construction or delivery service pursuant to this contract shall submit with their bid submission an affidavit attesting that (1) each individual performing services for such contractor is properly classified under the Nebraska Employee Classification Act, 2010 LB 563 ("the Act"); (2) such contractor has completed a Federal I-9 Immigration form and has such form on file for each employee performing services; (3) such contractor has complied with Neb. Rev. Stat. Section 4-114 (Federal Immigration Verification System--E- Verify); (4) such contractor has no reasonable basis to believe that any individual performing services for such contractor is an undocumented worker; and (5) as of the time of the contract, such contractor is not barred from contracting with the state or any political subdivision pursuant to the Act. The contractor shall follow the provisions of the Act. A violation of the Act by a contractor is grounds for rescission of the contract by City of Omaha/Douglas County. CONTRACTOR shall follow the provisions of the Employee Classification Act (Act). A violation of the Act will be a material breach and, in addition to any other remedies, be grounds for immediate contract rescission. If CONTRACTOR is performing construction or providing delivery service, CONTRACTOR shall submit an affidavit that complies with the Act. CONTRACTOR will also ensure that all subcontractors performing services for Contractor will also complete affidavits that comply with the Act. Contractor may submit the affidavit(s) with their bid submission. In all circumstances, Contractor shall provide the affidavits before work or services are undertaken pursuant to this Agreement. Following award, if CONTRACTOR changes or adds additional subcontractors, CONTRACTOR shall ensure that the subcontractor provides an Employee Classification Act affidavit to Douglas County Purchasing Department before that subcontractor begins work or services. All Employee Classification Act affidavits shall be sent to: Douglas County Purchasing Agent, 1819 Farnam Street,Room 902, Omaha NE 68183. FAIR LABOR STANDARDS: CONTRACTOR agrees to maintain FAIR LABOR STANDARDS as defined in Neb.Rev Stat § 73-104. CONTRACTOR has filed with Douglas County (City/County Purchasing) a statement that it is complying with and will continue to comply with, fair labor standards as provided in Neb. Rev. Stat. §§73-102 & 73-104. In addition, CONTRACTOR assures County that it will continue to comply with statutory fair labor standards throughout its performance under this contract. AFFIDAVIT FOR EMPLOYEE CLASSIFICATION ACT & FAIR LABOR STANDARDS I, NrAlkYYN Id n C) \ , being first duly sworn under oath, state and depose as follows: 1. I am competent to testify to, and have personal knowledge of,the matters stated in this affidavit. 2. I am (a contractor)�� or (the authorized agent of the contractor) for 111-c cr\W.Q cti cJ i __ Company, (hereinafter "Contractor"). I attest to the following: (a) each individual performing services for Contractor is properly classified under the Nebraska Employee Classification Act, ("the Act"), (b) Contractor has completed a federal I- 9 immigration form and has such form on file for each employee performing services, (c) Contractor has complied with Neb. Rev. Stat. §4-114 (use of federal immigration verification system), (d) Contractor has no reasonable basis to believe that any individual performing services for Contractor is an undocumented worker, (e) as of the time of the contract, Contractor is not barred from contracting with the state or any political subdivision pursuant to the Act, and (f) Contractor is complying with and will continue to comply with, fair labor standards as provided in Neb.Rev.Stat. §§73-102 & 73-104, as applicable and as amended hereinafter. Contractor will also ensure that all subcontractors execute affidavits in compliance with the Act. FURTHER AFFIANT SAYETH NAUGHT Affiant(Contractor) 51— SUBSCRIBED AND SWORN TO bef re me this 51 day oftr64, , 20:99. SHARON HENRY Notary Public-Notary Seal otar ublic State of Missouri Y Commissioned for Jefferson County My Commission Expires:December 17 2025 Commission Number:139013228 U,°:$.f»nvtranmental ht�otectlon•Agency.ar�d tfty cff,Omaha. • C gperative f' en E y97y7 E r aha Lead$,lte�S.altTestIngafld,Retned1Otlor� : trE`compliance with the EPA Pr rgram`fof�UtitizatiorL o,?f Sn)a i+MlnQrlty erid Wor»en's Business. r >rt terprlses,the City of Untaha acc•epts°the following'`,fair share"gaarsfcbjectives teSottated with the PA'by the Nebr:as papartrm ent tit Envlronmehtal QuslJty fri,,. . ,r1ask .I Supplies- 5% .Equipment 6 1 .• . Sorvlcea 5f a 1% C strUctIon 6% .8% . j . Th:�ese"fair share'!•olajeatives shaUld.la0`lnc[fa'clad in any Ltd documentstoracbcatstr.actors for ,. paint tatxiiizatlari;and snit rern diatlen , -PATT STABILIZATION1V D AT f N Q T TO S. The=l etsraska l xr�pleyee Classification Act equi s that`contract rs who perform construction rv• ea shall submit an Affidavit for;:employe•e Cl sifio tozn Mt to tk e City oft ,-...-: This 1 fiiavit will he: in f uded.0 ea i bid paokage,~ It ay be sighed and irtc1ttded with:the bid or it maybe`sign1,±d aid turned to the P•aint atabilzzati , l it lteanedr "loll aff ee after successful bids are determined. .:, 'he.Affld t kbt'Ett pt ee l si cat- - :,••of for must• be si tied notanz d,arid sul�nittecl to the �a rit tabx i atio / ail l efnedl' ticsn iffce before a?,..,-. j rde� +ill_be ssue :: `he ff avit r zi t be ubmitt d each:tune :aunt actcx�s the snocessf`il biddde•r.. Ift e onrttractor: wins•znor than sine project in".a bid group-one signed Affidavit i sufficient at that tea, If you have any queatie about this� quo ezne tx plea cant t. t ve 7iv y; at :62,� rS 15:0< Steve ZiynX " Lea pin.grams Manage . irSitED STATES CITIZENSIIzP ATTESTATJQJt PcRRIVM •• For tfte Tait oses o 'oomplying•with Neff .I;e t, Stat. §§.4 1.08 through 4-1 l4;I.1ittO4t:lig faiiu vs . . Q I:am a citizen ofC,}'nc the te Stated.,. . , , OR. , I azrl a ualifled alienunder the ;Federal lmixtigrati fin N d a realit te y .act, My i nz gratian stat a and aIien,number as fallouts. , ,. and I agree`to provide a caps ....If the LTSf IS (United. ' States Citi ensbup' atld` liniu gtetign 'aervieea) docu lentatison upor�l request required to,,,--verify the Coiitr�tctor.'s-lawful presence t e:: X ttett,States usfug the: ystefi atio Alien V ifieaii6A for Fntztlet rieitts((AV'E), to.$tar . . I be reb tt e t that y-re t�irxse and the 1nfa atzon provided tltas torrxi ailed y related; appllgntlou for pubite beret is are nee, corm lete and acout`ate a id I understand teat this infortxlatiQ1i may°be use d to verify miy la'wfizl presence:I the Unted StatesF;' I understand;;ai 4 , agre,0 that lawfirt ptese a0.e in the tIn ted states xs required'and the cantraotox max be dlsgnal led or dte contract:tei'llimated tf.such lawfitl presence cannot be ve ifie .-as tech irccl.by l eb...Rev. Stat.§4.,4a$,... 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Ac J� \ h;- .i1.4ir0.::•" y4/r--•c�t�"r/�'1'•;.:A:,'t.r" 0.` 11t r1�1:.�' •(ill 1t:;,l:i "L�� ' t't '.�+f t ,+� .;::.r?,V,ylllJ .t'1..k \-1� �_ •".ci4rar ' �.°. �+4a +:.\`4' y' `',; r „r !.-- . :.�r,l +d, - AcoRar CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) far./" 12/21/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER: • IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the pollcy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT ONT CT Pauline Warnecke AssuredPartners of Missouri,LLC (PHONE /C No.Ext)Pwamecke@APMIssouri.com 523-8800 FAX No): (314)453-7555 (NC12845 Olive Blvd;Suite 300 AooRESS: pwamecke@APMlssouri.com INSURER(S)AFFORDING COVERAGE NAIC# _ St Louis MO 63141 INSURER A: Nautilus Insurance Company 17370 INSURED INSURER B: Great Divide Insurance Company 25224 Environmental Restoration,L.L.C. INSURER C: 1668 Fablck Drive INSURER D INSURER E: Fenton MO 63026 INSURER F: COVERAGES CERTIFICATE NUMBER; 21-22 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE NSU D WVD POLICY NUMBER POLICY EFF POLICY EXP (MWDDIYYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE 1-1 OCCURPREMISES(Be occurrence) $ 300,000 X Deductible:$10,000 MED EXP(Any one person) $ 25,000 A ECP0154311420 12/22/2021 12/22/2022 PERSONAL BAOVINJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY jEa n LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ee accident) X ANY AUTO BODILY INJURY(Per person) $ B/B OWNED SCHEDULED BAP154314120/MAA200734419 12/22/2021 12/22/2022 BODILYINJURY(Per accident) $ AUTOS ONLY AUTOSt X HIRED NON- WNED PROPERTY DAMAGE AUTOS ONLY X AUTOS ONLY (Per accident) $ $ UMBRELLA LIAB X OCCUR 5,000,000 EACH OCCURRENCE $ A X EXCESS LIAB CLAIMS-MADE FFX154311320 12/22/2021 12/22/2022 AGGREGATE $ 5,000,000 DED RETENTION$ $ WORKERS COMPENSATION X 'STATUTE OTH- ER AND EMPLOYERS'LIABILITY YI N B/A OFFICER/MEMBER ER EXCLUDED?ANY ECUTIVE I I N IA WCA200734619/WCA20166261 12/22/2021 12/22/2022 E.L.EACH ACCIDENT $ 1,000,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 Per Occ Ded-$10,000 $1,000,000 NA Contractor l Llabon Lla-ClaimsMaourrenc ECP0154311420 12/22/2021 12/22/2022 Professional Liability-Claims Made Retro 12/22/97,Ded$20k $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more apace Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Omaha ACCORDANCE WITH THE POLICY PROVISIONS. 1819 Farnam Street SUlte 706 AUTHORIZED REPRESENTATIVE Omaha NE 88183 I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 00001861 LOC#: ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMED INSURED AssuredPartners of Missouri,LLC Environmental Restoration,L.L.C. POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance:Notes EXTENSIONS OF COVERAGE: Named Insured Includes:Quality Safety Products,LLC COMMERCIAL GENERAL LIABILITY(Occurrence Form)/CONTRACTORS'POLLUTION LIABILITY(Occurrence Form)/PROFESSIONAL LIABILITY (Claims-Made Form) A)Blanket Additional Insured with respect to work performed by the Named Insured,as required by written contract; B)Blanket Additional Insured Primary and Non-Contributory,as required by written contract; C)Blanket Additional Insured,Primary and Non-contributory applies to Ongoing and Completed Operations,as required by written contract; D)Blanket Waiver of Subrogation with respect to work performed by the Named Insured,as required by written contract; E)Blanket Additional Insured-Lessor of leased/rented equipment,as required by written contract; F)Blanket Contractual Liability-Railroads,as required by written contract; G)Watercraft Liability for watercraft owned or operated by the Insured; H)Stop Gap provided for ND,OH,WA,WY,PR USVI; I)Coverage provided for incidents occurring within 50'of railroad property; J)General Aggregate Limit applies per Project; K)Transportation Pollution Liability and Contingent Transportation Pollution Liability Included; L)Contractual Liability provided for liability for damages assumed in an"Insured contract"as deflnined in the Commercial General Liability terms,conditions, and exclusions; M)Commercial General Liability does not exclude explosion,collapse,and underground hazards(XCU); N)Asbestos Abatement Liability covered under the Contractor's Pollution Liability coverage; 0)Blanket Non-Owned Disposal Site Coverage-Off Site Only,Retroactive Date-6/11/2012. COMMERCIAL AUTO LIABILITY A)Blanket Additional Insured,as required by written contract; B)Blanket Additional Insured&Loss Payee-Lessor for rented vehicles,as required by written contract; C)Blanket Primary and Non-Contributory,as required by written contract; D)Blanket Waiver of Subrogation,where permitted by law and as required by written contract; E)Hired Car Physical Damage is ACV to cost of repair of$250,000,which is less,minus$100 Comprehensive Deductible and$1,000 Collision Deductible; F)MCS-90 Form includes Pollution Liability and Public Liability,If required by written contract; G)Coverage for Certain Operations in Connection with Railroads Included; H)CA9948-Pollution Liability-Broadened Coverage for Covered Autos-Business Auto and Motor Carrier Coverage Forms. WORKERS'COMPENSATION/EMPLOYERS LIABILITY A)Blanket Waiver of Subrogation where permitted by law and as required by written contract; B)Longshore and Harbor Workers Compensation Act,and Maritime Coverage,all applicable states C)Owners/Partners/Executive Officers are not excluded from coverage. EXCESS LIABILITY A)Follow Form of above policies as respects Additional Insured,Primary and Non-contributory,and Waiver of Subrogation provision; B)Excess Liability limits shown are excess and in addition to Commercial General Liability,Contractors Pollution Liability(Occurrence Form),Professional Liability(Claims-Made Form),Business Auto Liability,and Employers Liability. SUBJECT TO POLICY TERMS,CONDITIONS AND EXCLUSIONS ACORD 101(2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD (‘'',,---:;%'..-.,',1..-..'V.. O' o ii:0,:-..y . .:;*P.::: :i5E .. lie! 0 aiiiall C 2 coo um g ild - oakc .52 :s IT 0 iii i ' 12- g § co tg M 2N- LL W 0 ,_ 0 0 1. s y 0Z u .. og8M 12§Z4 to RU Zi , • NC • DOUGLAS COUNTY REQUEST FOR BID AND BID SHEET ON: CITY OF OMAHA Soil Remedlation Group#496 RETURN BIDS TO: Published: Wednesday,May 25,2022 Page 1 CITY CLERK 1819 Farnam Street BID BOND OR CERTIFIED CHECK REQUIRED IN THE AMOUNT 5% LC-1 Omaha-Douglas Civic Center IF THE TOTAL AMOUNT FOR THE ITEM OFFERED IS$20,000 OR MORE. Omaha,NE 68183 BID BOND OR CERTIFIED CHECK SHALL BE MADE PAYABLE TO "CITY OF OMAHA" NOT AN ORDER Bid Opening Time&Date: 11:00 a.m.CT on Wednesday,June 8,2022 IMPORTANT 1. Bid must be in the office of the CITY CLERK 1819 Famam Street,LC-1, 4 Right is reserved to accept or reject any or all bids m their entirety and the bidders shall OMAHA-DOUGLAS CIVIC CENTER,Omaha,NE 68183 have the right to appeal any decision to the Omaha City Council. by the opening date and time indicated in a sealed envelope marked: 5 When submitting bid on items listed,bidder may on a separate sheet,make BID ON:CITY OF OMAHA Soil Remediatlon Group#496 suggestions covering reduction in costs wherever this is possible through 2. As evidence of good faith a bid bond or certified check must be submitted with bid. redesign,change of material or utilization of standard items or quantity change. Bid bond or certified check shall be made payable to'City of Omaha° 6 Bid tabulation are available on the Douglas County Purchasing website: FAILURE TO DO SO IS CAUSE FOR REJECTION. www.douglascountypurchasing.org. DO NOT CALL FOR THIS INFORMATION. 3 The City of Omaha Is tax exempt.Tax exempt certificates will be provided upon request Quote your lowest price,best delivery and terms,F.O.B.delivery point on the ltemis)listed below: QUANTITY DESCRIPTION UNIT PRICE EXTENSION The City of Omaha is seeking bids for Soil Remediation as described in the attached specifications. Only bidders who are pre-qualified to do Soil Remediation work with the City of Omaha Planning Department may bid on this project. Any bidder who submits a bid and is not pre- qualified will be considered non-compliant with specifications and their bid will be rejected. DAVIS BACON ACT For questions regarding this bid, or questions on how to qualify to become a bidder for this or future bids with this scope of work, contact Mr. Thomas Roza at(402)444- 5150, ext. 2003. SEE PAGE 2 FOR ADDRESSES. ALL OR NONE TOTAL BID: $ 259,000.00 (5%Bid Bond is to be based upon this amount,if over $20,000.00) NOTE: Must be a pre-qualified contractor for bid submission to be considered. Questions regarding this bid should be sent via email to bidquestions@dougiascounty-ne.gov. Vendor must include the bid title in the subject line. The deadline to submit questions on this bid is 11:00 a.m.on the Thursday before the bid opening date. Answers to questions will be posted via an addendum no later than the Friday before bid opening at www.douglascountypurchasing.org. (PLEASE PRINT LEGIBLY OR TYPE) Payment Terms 100 %NET 60 Firm:Environmental Restoration, LLC Incorporate 1997 Delivery(or completion) Name:Adam Detrich Signature: /7 30 calendar days following Title:Vice President Phone:636-227-7477 Ga` Fax:636-227-6447 award Address:1666 Fabick Drive Fenton Missouri 63026 Street/P.O.Box City State Zip Email Address:a.detrich@e rl Ic.com DOUGLAS COUNTY REQUEST FOR BID ON: CITY OF OMAHA- Soil Remediation Group#496 NOT AN ORDER Page 2 QUANTITY DESCRIPTION UNIT PRICE EXTENSION 5001 Davenport St. BID: $26,000.00 5107 Cass St. BID: $27,000.00 4927 N. 19th St. BID: $9,000.00 4955 N. 19th St. BID: $ 16,000.00 1821 Spencer St. BID: $ 15,000.00 120 S. 50th St. BID: $ 19,000.00 724 N. 50th St. BID: $30,000.00 2801 N. 52nd St. Type text here BID: $8,000.00 5132 Northwest Radial Highway BID: $9,000.00 North 24th St. & Locust St. BID: $ 100,000.00 ALL OR NONE TOTAL BID (Please put this amount on Page 1): $259,000.00 (5%Bid Bond is to be based upon this amount if over $20,000.00) SIGN ALL COPIES a'd67 ? Firm Environmental Restoration, LLC By Adam Detrich Title Vice President CONTINUATION SHEET DOUGLAS COUNTY REQUEST FOR BID ON: CITY OF OMAHA- Soil Remediation Group#496 NOT AN ORDER Page 3 BID CLAUSES -TERMS AND CONDITIONS REQUIREMENTS FOR BID BOND: The surety company issuing the bid bond should be licensed by the State of Nebraska and listed on the current edition of Circular 570 of the United States Department of the Treasury. A certified check, an official bank check, or cashier's checks drawn on a national bank or a bank chartered under the laws of the state, payable to the City of Omaha, or lawful money of the United States, or a United States Government Bond (negotiable)are acceptable substitutes for bond requirements. LETTERS OF CREDIT AND COMPANY CHECKS ARE NOT ACCEPTABLE SUBSTITUTES FOR A BID BOND AND WOULD BE CAUSE FOR REJECTION OF BID. If a bidder submits more than one bid, only one bid bond is required; however,the 5% bid bond must be calculated using the highest bid amount of all submitted bids. Vendor Restrictions: From the date the bid is issued until a determination is announced regarding the selection of the contractor, contact regarding this project between potential consultants/vendors/contractors and individuals employed by the City of Omaha(Omaha) is restricted to only written communication with the person designated as the point of contact for this bid. Once a contractor is preliminarily selected,that contractor is restricted from communicating with Omaha employees with the exception of employees designated to negotiate, discuss or finalize a contract. Violation of this condition may be considered sufficient cause to reject a contractor's proposal and/or selection irrespective of any other condition. Conflict of Interest: Pursuant to Section 8.05 of the Home Rule Charter and all state and local rules, CONTRACTOR assures City of Omaha(CITY)that no elected Official or any officer or CITY employee shall have a financial interest, direct or indirect, in any CITY agreement. In the performance of this agreement, CONTRACTOR will avoid all conflicts of interests or appearances of conflict of interest. CONTRACTOR will report any conflict of interest immediately to the CITY. CONTRACTOR did not and will not provide any money or other benefit of any kind to any CITY employee in the procuring of, facilitation of, and execution of or during the duration of this Agreement. Drug Free Policy: CONTRACTOR assures City of Omaha that CONTRACTOR has established and maintains a drug free workplace policy. Unavailability of Funding: Due to possible future reductions including but not limited City of Omaha (CITY), State and/or Federal appropriations,the CITY cannot guarantee the continued availability of funding for this Agreement, notwithstanding the consideration stated in this Agreement. in the event funds to finance this Agreement become unavailable either in full or in part due to such reduction in appropriations,the CITY may terminate the Agreement or reduce the consideration upon notice in writing to Contractor. The notice shall be delivered by certified mail, return receipt requested, or in person with proof of delivery. The CITY shall be the final authority as to the availability of funds. The effective date of such Agreement termination or reduction in consideration shall be specified in the notice as the date of service of the notice or the actual effective date of the CITY, State and/or Federal funding reduction,whichever is later. Provided, that reduction shall not apply to payments made for services satisfactorily completed prior to the effective date. In the event of a reduction of consideration, Contractor may cancel this Agreement as of the effective date of the proposed reduction upon the provision of advance written notice to CITY. PAYMENT TERMS: Net 30 payment terms shall apply to all invoices billed to the City of Omaha. Payment of invoice amount will occur within 30 days following receipt of invoice or receipt of goods/services,whichever is later. This is an All or None bid. Vendors must bid on every item listed in the bid sheets,or it will be cause for rejection of bid. Solid Waste Disposal: Pursuant to an Interlocal agreement between the City of Omaha (Res. 124) and Douglas County(Res. 85)dated January 31,2012, all solid waste collected and/or processed pursuant to City or County contracts is required to be taken to the Douglas County Pheasant Point Landfill. This includes trash, rubbish, construction, and other solid waste. This is a requirement that will not be waived. C&D, hazardous waste, untreated medical waste, asbestos and recycled materials would be exempt from this directive. SIGN ALL COPIES Fim, Environmental Restoration, LLC 44,-€ By Adam Detrich Title Vice President CONTINUATION SHEET DOUGLAS COUNTY REQUEST FOR BID ON: CITY OF OMAHA -Soil Remediation Group#496 NOT AN ORDER Page 4 BID CLAUSES -TERMS AND CONDITIONS INSURANCE: Each bidder must provide a Certificate of Insurance with their bid documents which details their current levels of coverage. FOLLOWING AWARD OF CONTRACT: For City projects where the scope of work will be less than$200,000.00, it is required that the awarded contractor provide a Certificate of Insurance meeting or exceeding the following levels of insurance:(1)adequate workers'compensation (statutory); (2) commercial general liability in an amount not less than $250,000 for any person for any number of claims arising out of a single occurrence and not less than $500,000 for all claims arising out of a single occurrence; and (3) property damage insurance in an amount not less than $500,000; and naming CITY OF OMAHA as an additional insured, except for Workers' Compensation policies/certificates, for the term of the agreement. Certificates of Insurance are required before service begins. FOLLOWING AWARD OF CONTRACT: For City projects where the scope of work will exceed $200,000.00, it is required that the awarded contractor provide a Certificate of Insurance meeting or exceeding the following levels of insurance: (1) adequate workers'compensation (statutory); (2) commercial general liability in an amount not less than $1,000,000 for any person for any number of claims arising out of a single occurrence and not less than $5,000,000 for all claims arising out of a single occurrence; and (3) property damage insurance in an amount not less than $500,000; and naming CITY OF OMAHA as an additional insured, except for Workers'Compensation policies/certificates, for the term of the agreement. Certificates of Insurance are required before service begins. REQUIREMENTS FOR PERFORMANCE BOND: The successful vendor shall provide a performance bond equal to the vendor's bid within ten (10) calendar days from award of the contract. The surety company issuing the performance bond should be licensed by the State of Nebraska and listed on the current edition of Circular 570 of the United States Department of the Treasury. Assignment and Delegation: This Agreement is exclusive to the Parties and rights may not be assigned nor duties delegated by either Party except on prior written consent of the other. Any attempted assignment or delegation without such approval shall be void and shall constitute a material breach of contract. Any and all additional fees, charges, costs or expenses, which result from an approved assignment or delegation, shall be paid by the assigning/delegating Party. COMMUNICATON WITH STAFF: From the date this bid is issued until a contract is awarded, communication regarding this solicitation between potential vendors and individuals employed by the City of Omaha is prohibited. Only written communication via email to bidquestions@douglascounty-ne.gov is permitted. Once an award is made the vendor will be permitted to speak with person(s) participating in contract negotiations. Violation of these conditions may be considered sufficient cause to reject a vendor's bid and/or selection irrespective of any other condition. The following exceptions to these restrictions are permitted: (1) Contacts made pursuant to any pre-existing contracts or obligations; (2) City staff and/or vendor staff present at a Pre-Proposal Conference, if scheduled, when recognized by the City as staff facilitating the meeting for the purpose of addressing questions; and, (3) Presentations, key personnel interviews, clarification sessions or discussions to finalize a contract, as requested by the City of Omaha. FEDERAL DEBARMENT OR SUSPENSION Has bidder or its principals been debarred or suspended from Federal contracts? YES x NO (failure to provide a response may be cause for rejection of bid) Bidder certifies by submission of this bid that neither it nor its principals are presently debarred or suspended from participation in Federal contracts. If during the term of the agreement the awarded bidder or any person engaged in performing this agreement becomes debarred or suspended such Party shall notify the City of Omaha immediately. SIGN ALL COPIES Firm Environmental Restoration,LLC 4ez By Adam Detrich Title Vice President CONTINUATION SHEET DOUGLAS COUNTY REQUEST FOR BID ON: CITY OF OMAHA-Soil Remediation Group#496 NOT AN ORDER Page 5 BID CLAUSES -TERMS AND CONDITIONS Form CC-1: All bidders awarded a City contract in the amount of$10,000 or more must comply with the Contract Compliance Ordinance by having a current Contract Compliance Report(Form CC-1)on file with the Human Rights & Relations Department. This report shall be in effect for 24 months from the date received by the Human Rights& Relations Department. Any questions regarding the Contract Compliance Ordinance should be directed to the Human Rights & Relations Department at(402)444-5055. Bidders are encouraged to use the following weblink to determine if they have a current Form CC-1 on file (search by company name): https://humanrights.cityofomaha.org/cc-1-search Equal Employment Opportunity: In accordance with the Nebraska Fair Employment Practice Act, Neb. Rev. Stat. §48-1122, the Contractor agrees that neither it nor any of its subcontractors shall discriminate against any employee, or applicant for employment to be employed in the performance of this Agreement,with respect to hire, tenure, terms, conditions, or privileges of employment because of the race, color, religion, sex,disability, or national origin of the employee or applicant. New Employee Work Eligibility Status(Neb. Rev. Stat.§4-108-114) The Contractor is required and hereby agrees to use a federal immigration verification system to determine the work eligibility status of new employees physically performing services within the State of Nebraska. A federal immigration verification system means the electronic verification of the work authorization program authorized by the Illegal Immigration Reform and Immigrant Responsibility Act of 1996, 8 U.S.C. 1324a, known as the E-Verify Program, or an equivalent federal program designated by the United States Department of Homeland Security or other federal agency authorized to verify the work eligibility status of a newly hired employee. If the Contractor is an individual or sole proprietorship,the following applies: 1. The Contractor must complete the United States Citizenship Attestation Form, available on the Department of Administrative Services website at www.das.state.ne.us . 2. If the Contractor indicates on such attestation form that he or she is a qualified alien, the Contractor agrees to provide the US Citizenship and Immigration Services documentation required to verify the Contractor's lawful presence in the United States using the Systematic Alien Verification for Entitlements(SAVE) Program. 3. The Contractor understands and agrees that lawful presence in the United States is required and the Contractor may be disqualified or the contract terminated if such lawful presence cannot be verified as required by Neb. Rev. Stat. §4-108. SIGN ALL COPIES Firm Environmental Restoration,LLC By Adam Detrich Title Vice President CONTINUATION SHEET Responsible Contractor Compliance Form RC-1 O�0MAHA, v4._ R1 .r. Gr' Mr 1. Regulation: 44TFn MO''�� A. Article IV,Division I of Chapter 10 of the Omaha Municipal Code thereon require: 1. That all contractors who submit a bid to City of Omaha shall designate a representative who on behalf of the Contractor,shall fill out completely a Responsible Contractor Compliance Form (RC-1). An incomplete or unsigned RC-1 form will make your bid null and void. 2. Filing this Report(please initial in the boxes below): Contractor agrees that Contractor will not knowingly employ or hire an employee not lawfully AD authorized to perform employment in the United States and that the Contractor and all sub- contractors shall use E-Verify to determine work eligibility. AD Contractor agrees that Contractor will not knowingly violate Nebraska's Misclassification of Employee law(Neb.Rev. Stat. Section 48-2901 et seq.). AD Contractor agrees that Contractor will not knowingly violate Nebraska's Fair Labor Standards Law(Neb.Rev.Stat.Section 73-104 et seq.). AD Contractor has not been convicted of any tax violations(local,State and Federal)within the last three years from the date this bid is submitted. Contractor has not,upon final determination by the Occupational Safety and Health AD Administration,been convicted of a criminal,repeat,or willful violation of the Occupational Safety and Health Act(OSHA)or been convicted of 3 (three)separate"serious"OSHA violations within the past three(3)years. AD Contractor agrees to make a good faith effort to ensure all subcontractors employed on this project comply with the provisions of the Responsible Contractor Compliance Form RC-1. az.,:ie, 06/07/2022 Signature Date By signing,I verify on behalf of the Contractor that the information above is true and correct. Filing false information carries a penalty of up to a$500 fine or six months in jail. In addition,the contractor and sub- contractors can be subject to immediate disqualification and prohibited from any future City of Omaha 1 contract for a period of 10 years. EMPLOYEE CLASSIFICATION ACT: Each contractor who performs construction or delivery service pursuant to this contract shall submit with their bid submission an affidavit attesting that (1) each individual performing services for such contractor is properly classified under the Nebraska Employee Classification Act, 2010 LB 563 ("the Act"); (2) such contractor has completed a Federal I-9 Immigration form and has such form on file for each employee performing services; (3) such contractor has complied with Neb. Rev. Stat. Section 4-114 (Federal Immigration Verification System--E- Verify); (4) such contractor has no reasonable basis to believe that any individual performing services for such contractor is an undocumented worker; and (5) as of the time of the contract, such contractor is not barred from contracting with the state or any political subdivision pursuant to the Act. The contractor shall follow the provisions of the Act. A violation of the Act by a contractor is grounds for rescission of the contract by City of Omaha/Douglas County. CONTRACTOR shall follow the provisions of the Employee Classification Act (Act). A violation of the Act will be a material breach and, in addition to any other remedies, be grounds for immediate contract rescission. If CONTRACTOR is performing construction or providing delivery service, CONTRACTOR shall submit an affidavit that complies with the Act. CONTRACTOR will also ensure that all subcontractors performing services for Contractor will also complete affidavits that comply with the Act. Contractor may submit the affidavit(s) with their bid submission. In all circumstances, Contractor shall provide the affidavits before work or services are undertaken pursuant to this Agreement. Following award, if CONTRACTOR changes or adds additional subcontractors, CONTRACTOR shall ensure that the subcontractor provides an Employee Classification Act affidavit to Douglas County Purchasing Department before that subcontractor begins work or services. All Employee Classification Act affidavits shall be sent to: Douglas County Purchasing Agent, 1819 Farnam Street,Room 902, Omaha NE 68183. FAIR LABOR STANDARDS: CONTRACTOR agrees to maintain FAIR LABOR STANDARDS as defined in Neb. Rev Stat § 73-104. CONTRACTOR has filed with Douglas County (City/County Purchasing) a statement that it is complying with and will continue to comply with, fair labor standards as provided in Neb. Rev. Stat. §§73-102 & 73-104. In addition, CONTRACTOR assures County that it will continue to comply with statutory fair labor standards throughout its performance under this contract. AFFIDAVIT FOR EMPLOYEE CLASSIFICATION ACT & FAIR LABOR STANDARDS I, NIX,YYN , being first duly sworn under oath, state and depose as follows: 1. I am competent to testify to, and have personal knowledge of, the matters stated in this affidavit. 2. I am (a contractor) or (the authorized agent of the contractor) for v1 c oNY1Q (Q1441A odi 9."tl- t--Company, (hereinafter "Contractor"). I attest to the following: (a) each individual performing services for Contractor is properly classified under the Nebraska Employee Classification Act, ("the Act"), (b) Contractor has completed a federal I- 9 immigration form and has such form on file for each employee performing services, (c) Contractor has complied with Neb. Rev. Stat. §4-114 (use of federal immigration verification system), (d) Contractor has no reasonable basis to believe that any individual performing services for Contractor is an undocumented worker, (e) as of the time of the contract, Contractor is not barred from contracting with the state or any political subdivision pursuant to the Act, and (f) Contractor is complying with and will continue to comply with, fair labor standards as provided in Neb.Rev.Stat. §§73-102 & 73-104, as applicable and as amended hereinafter. Contractor will also ensure that all subcontractors execute affidavits in compliance with the Act. FURTHER AFFIANT SAYETH NAUGHT • Affiant(Contractor) SUBSCRIBED AND SWORN TO4rt me this day ofAx4, , 20:)a SHARON HENRY Notary Public-Notary Seal State of Missouri Y Commissioned for Jefferson County My Commission Expires:December 17,2025 Commission Number:13901328 t v . Cr�vlr rrrnat4t;.al Praxectlan tgertry.tind 0tV of Qt ah .`: C operative 1:i.er ientV—�37'1486D2:D : . Qt atha .ead$i So1L rest1rr and etned} > _•.-. f � SRC.. .,..... �?i :.. � .. , t' j. h com liat�ce with the EC'Q' Program."rtn iliatiorl; f Sma1�l,Mi.. prfty aid Women's A.-.:„t. siness" k Enterprises,the:pity a brr eha accept:the `allow n$r`,tilt share"g,Sas/c�h ett1ves. egotlat d wlth the ERA by t1: a CVebras Department 0l''.Envlran»ehtal QuaY�ty(ND, q)` d _ r kft' EquT n ent,. 6%. 1t Sarkis: � ' . Carl trl ttan 6% • 8% s • c •datktd dticumentts fors hcortractprs;fpr h se"fair ahatiroen�anb_.yes ilve•i mheo ulladtto•nei" (ude inry . palntstabi iza ti r • • , :` ;PAINT STAB1LTZ: 1V. DIATZQN Q T A Tf The>Nebraska k rnpt ce Class fication,Aot,regwres that:contractors who potfor r egnstru tion se ces se tt submt ar Aida rit for:. rxtpl ee l ss�fie twn t to tl�.e.,Ci y. f ma ra.. ThI' A�f ittavit will be ino1udtrd try each l tdpaoksge I•t maskbastgried and rnclgded with the bid oar zt may a:Igrrec`a. rd retcirned try tyre 'arnt Stab hzatio, / 11 R r diet an office Aft, r success.u' bids aro determined ' '; = ", } 'k e;Affida'yrt Qr .pt 'ee Clas'slf caUork,fat for test b sigzted, not nzod and,snbmrtted:to the hd. ftab izatlon oil kefiied atbn office before aPio�ecd Ordq�will.beis tre�3., , The:Affidavit Mist lie submitted.c ch time ¢contractor zs the uocesst`ut bidder.. If the aorttraotor vans rnr se anxdr e 7ro cot in.a bid rout o e signed Aff davit is sufficient at that time I`f yt u have an :'" -forts about this equlxemerit,please contact ste to Zivny at 402 444r51S: < teve Zlvny Lead Prtograms..MarSa er 1' :1:TE1i$T ;'ptS GfIZENSmF ATTESTATION E(,R1 .,..„::::, . . , .:-.,...:..::..,,,.'„:„.:,- ., ,.. ,....,..., :::-:,:,:, :., ;.::..:. r Fox tie ores 'oot plyu ig with Neh Revv Stat. §§4 1:08 through 4R114,I attest s fo o s.' rain a citizen of the I,?'n ted States, :: I axr a qualifid lit i an te '.Fral lrn ig�°,1*' _aid: Z1l'.4-,#: #.7 Act;;' , y Inn gratiain statu es an ad when tl dtitnr hber as f edeallcw,stxa : and I agree to provide ' ft ., � �0 Q� the: �.rS � ..zute�. Stafies ��t�zesYslulr .atz�1 Tmm �iat��:. ��zvioes _ doctus�entafilon upon, request required to verify the Contractof laws l p esenoe it the;, .: .., ....'':...,..„: .,;.::,,,.::: Unitedto es us g tll ystematra Iien'V � Kati n i"or Entztl eztts(S VE) io rai . 1 �eh ; lest that " re�tpo? se ry1 the I i atzo , cv ed .. t is 6,:- and auy rel. ,t d, a p1 cntic n fbr ppbUi benefits are ante, catty s1ete n9nd accurate and .. understand That;:dais " talo atpc tray b'e-used'to; er#fy my lawful x�esenee In the flied StatesF: I understand:•and ogre it a law u1 p:esence in the United Mates is requi red`anti#lie coutraotor may bs d s ,t,l1fied or tt a contract terminated tf such lawful resence cannot be r ei Pied as x e `trod b - 1ebt.Rev p y ,y " t .§4408 . , : :.: „:::•,, , „ „ .. , -. J.:.„.„-,,.. „ ••,. -. ,„ ,.. -,. . „,.. .-:,, , ..,., : .;•,.:::, : ., ,• :..:- ,-, -::. -.,. - . •,- .....: _ .. . -- - - -- - :::.,.... : - ,•, .H. -•:-,-. --,:.: , ...:,.....: ::.-..,, ,,,„,„.„:::::,..,.. ,.,.,,,..:. „ ,••. ,, .,••:. - :,-.- -.:• ,..-: . • , . .. . . . , : : . . . . _ . . , ,_ . .:, „ , . . - ' . - ' ' PRINTNA. , Adam.Detach... .. SIGNATURE::: . DATE: - 0.6/07/2022_ • p tit d unit rrp�axed/!1 / 00 _ •r`/i {\ f„ f � , t � t :�•' � � � �-'' rf .l/.S� � � � t ' } � " 3 c\ J /ft; n ' 11\ /� 1 �fJA\ I : ` : 1 /� \. W/4 RT /t /ij� .•:,-,,,v,•,-, ' %f!e irol 1 ` rC 40 /,0, , '\ JrY (CJ I ._ ..._ -fi ,,.- :.,..,..-:,\ , , , - ,ovia:: ,,,,,7::.(:,,,-,:a, . • - . . . • . __Inv, ,1 t.,,,,,..)-145:.i.i?; .-,,i tit , •+ • • . ,. ,. 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It:::t:::1 :,:•,.11,,t,:st,i4.',,0„v 4:i Fe4 (74\ v i,P4:‘..,:-f: . . ?-.....4:{r . ,< C ' -1.-V ''' Pro; • • !:' 1,1:1.:...,,.. • ;. )i j e cft, ` S .L. _: ;r; `• >h'r'•r • wf�6�%.J57 U'n�tS riW'9FAYtx+Xa,!�cu'votaAttwYAxx�t3A�hAraRW'9i1�A,. _. .._. .• ...�- air ly rs•• ( ,•(�, . . $risrAA'OiiA�ATtL� „4.,n :.. . .�, •:dS b?.WYi n • 7� d•,.` l0?-1 •"�^'i h• •AttrC‘• ..•tt'•. 1: ;`•j� `'� �T -• ! .0 ( 'T-ib_ .''� 1•'�. .Y, h ,( tl' 1:1�Y ,�y j �.'.� ^• t•i ,,j".` YV '• ��1�•F• �• �,t�':i'r.• 4, y � *- ' f I r s• WiF'� rl!,z, ,.tJ•,,;t .7•,;'�r. . ... „,,v, F. ,A4: r vo :tj.,`'E,svR 44,41:4t p g° ',i ,i• ,I't2 ",1�ihI ,ti j��y, ".^ �✓�'r ,'''$�W ef�M l r/,' t - t i t�+v�, ll' 1st' 1 , N, A,�(;{{ft� t,sy, / yw cs fjV?� )A�,Z.. �filiV 11( , • ;,aFa1j ;NLN [ Ac R® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) t*„�..i 12/21/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS • CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES • • BELOW. .THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER: IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the pollcy(les)must have ADDITIONAL INSURED provisions or be endorsed. -- -" If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT Pauline Warnecke NAME: AssuredPartners of Missouri,LLC PHONE (314)523-8800 FAX (314)453-7555 (A/C,No,Ext): (A/C,No): 12645 Olive Blvd;Suite 300 aooREss: pwamecke@APMissouri.com INSURER(S)AFFORDING COVERAGE NAIC#- _ St Louis MO 63141 INSURER A: Nautilus Insurance Company • 17370 INSURED INSURER B: Great Divide Insurance Company 25224 Environmental Restoration,L.L.C. INSURER C: 1666 Fabick Drive INSURER D: • INSURER E: Fenton MO 63026 INSURER F: COVERAGES CERTIFICATE NUMBER; 21-22 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR AODL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DDIYYYY) (MMIDD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 • DAMAGE TO RENTED 300000 CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ , X Deductible:$10,000 25,000 MED EXP(My one person) $ A ECP0154311420 12/22/2021 12/22/2022 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 2,000,000 POLICY❑X JEC LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ B/B OWNED SCHEDULED BAP154314120/MAA200734419 12/22/2021 12/22/2022 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS xHIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _AUTOS ONLY (Per accident) $ • UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A X EXCESSLIAB CLAIMS-MADE FFX154311320 12/22/2021 12/22/2022 AGGREGATE $ 5,000,000 DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY X STATUTE ER B/A ANY PROPRIETOR/PARTNER/EXECUTIVE Y(� NIA WCA200734619IWCA20166261 12/22/2021 12/22/2022 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? I „ (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yea,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Per Occ Ded-$10,000 $1,000,000 NA Contractor Pollution Liability-Occurrenc Professional Liability-Claims Made ECP0154311420 12/22/2021 12/22/2022 Retro 12/22/97,Ded$20k $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Omaha ACCORDANCE WITH THE POLICY PROVISIONS. 1819 Farnam Street SUlte 706 AUTHORIZED REPRESENTATIVE Omaha NE 68183 / _ r I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 00001861 -�-� LOC#: ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMED INSURED AssuredPartners of Missouri,LLC Environmental Restoration,L.L.C. POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance:Notes EXTENSIONS OF COVERAGE: Named Insured Includes:Quality Safety Products,LLC COMMERCIAL GENERAL LIABILITY(Occurrence Form)/CONTRACTORS'POLLUTION LIABILITY(Occurrence Form)/PROFESSIONAL LIABILITY (Claims-Made Form) A)Blanket Additional Insured with respect to work performed by the Named Insured,as required by written contract; B)Blanket Additional Insured Primary and Non-Contributory,as required by written contract; C)Blanket Additional Insured,Primary and Non-contributory applies to Ongoing and Completed Operations,as required by written contract; D)Blanket Waiver of Subrogation with respect to work performed by the Named Insured,as required by written contract; E)Blanket Additional Insured-Lessor of leased/rented equipment,as required by written contract; F)Blanket Contractual Liability-Railroads,as required by written contract; G)Watercraft Liability for watercraft owned or operated by the Insured; H)Stop Gap provided for ND,OH,WA,WY,PR USVI; I)Coverage provided for incidents occurring within 50'of railroad property; J)General Aggregate Limit applies per Project; K)Transportation Pollution Liability and Contingent Transportation Pollution Liability included; L)Contractual Liability provided for liability for damages assumed in an"Insured contract"as definined in the Commercial General Liability terms,conditions, and exclusions; M)Commercial General Liability does not exclude explosion,collapse,and underground hazards(XCU); N)Asbestos Abatement Liability covered under the Contractor's Pollution Liability coverage; 0)Blanket Non-Owned Disposal Site Coverage-Off Site Only,Retroactive Date-6/11/2012. COMMERCIAL AUTO LIABILITY A)Blanket Additional Insured,as required by written contract; B)Blanket Additional Insured&Loss Payee-Lessor for rented vehicles,as required by written contract; C)Blanket Primary and Non-Contributory,as required by written contract; D)Blanket Waiver of Subrogation,where permitted by law and as required by written contract; E)Hired Car Physical Damage is ACV to cost of repair of$250,000,which is less,minus$100 Comprehensive Deductible and$1,000 Collision Deductible; F)MCS-90 Form includes Pollution Liability and Public Liability,if required by written contract; G)Coverage for Certain Operations in Connection with Railroads included; H)CA9948-Pollution Liability-Broadened Coverage for Covered Autos-Business Auto and Motor Carrier Coverage Forms. WORKERS'COMPENSATION/EMPLOYERS LIABILITY A)Blanket Waiver of Subrogation where permitted by law and as required by written contract; B)Longshore and Harbor Workers Compensation Act,and Maritime Coverage,all applicable states C)Owners/Partners/Executive Officers are not excluded from coverage. EXCESS LIABILITY A)Follow Farm of above policies as respects Additional Insured,Primary and Non-contributory,and Waiver of Subrogation provision; B)Excess Liability limits shown are excess and in addition to Commercial General Liability,Contractors Pollution Liability(Occurrence Form),Professional Liability(Claims-Made Form),Business Auto Liability,and Employers Liability. SUBJECT TO POLICY TERMS,CONDITIONS AND EXCLUSIONS • ACORD 101(2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 7./ '/•l/j.. 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