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RES 2023-0486 - PO to EGM, Inc for Soil Remediation Group No. 501 City Clerk Office Use Only: RESOLUTION NO.203-1A-19 Publication Date(if pplicable): Agenda Date: 17) 2 2 OZ3 Department: / Submitter: i, CITY OF OMAHA LEGISLATIVE CHAMBER Omaha, Nebraska RESOLVED BY THE CITY COUNCIL OF THE CITY OF OMAHA: WHEREAS, bids were received on March 29, 2023 for the 2116 Pinkney St., 1016 North 41 Street, 2573 Mary Street, 2204 Binney Street, 915 N 51 Street, 2423 Larimore Avenue, 3236 Lafayette Avenue, 115 South 37 Street, 3304 Maple Street, 1812 Miami Street, 128 N 38 Avenue, 2580 Manderson Street, 3858 Cass Street, 5503 North 25 Street, 3935 N 37 Street City of Omaha Soil Remediation Program Project; and, WHEREAS, EGM Inc. submitted a bid of $342,500.00, being the lowest and best bid within the bid specifications for the 2116 Pinkney St., 1016 North 41 Street, 2573 Mary Street, 2204 Binney Street, 915 N 51 Street, 2423 Larimore Avenue, 3236 Lafayette Avenue, 115 South 37 Street, 3304 Maple Street, 1812 Miami Street, 128 N 38 Avenue, 2580 Manderson Street, 3858 Cass Street, 5503 North 25 Street, 3935 N 37 Street City of Omaha Soil Remediation Program Project; and, WHEREAS, EGM Inc. 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 EGM Inc. for the 2116 Pinkney St., 1016 North 41 Street, 2573 Mary Street, 2204 Binney Street, 915 N 51 Street, 2423 Larimore Avenue, 3236 Lafayette Avenue, 115 South 37 Street, 3304 Maple Street, 1812 Miami Street, 128 N 38 Avenue, 2580 Manderson Street, 3858 Cass Street, 5503 North 25 Street, 3935 N 37 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 $342,500.00 from City of Omaha - U.S. EPA Cooperative Agreement Assistance ID No. V-97799901 out of Lead Hazard Fund 12136, Organization 128104. 3387 jmc Adopted: MAY 0 2 2023 L -D APPROVED AS TO FORM: Attest: ` /,�►/?r,u) City Cork ASAS— T CITY ATTORNEY DATE Approved: , Mayor Bid bond 5% MLH Douglas County Purchasing TABULATION OF BIDS ON: CITY OF OMAHA Soil Remediation Group#501 EGM Environmental Shekar Page 1 Restoration Engineering Date of Opening Department Wednesday, March 29, 2023 PLANNING - EPA PASS THRU Qty. DESCRIPTION UNIT UNIT UNIT UNIT UNIT UNIT PRICE B PRICE B PRICE B PRICE PRICE PRICE Soil Remediation Group#501 ALL OR NONE TOTAL BID: $342,500.00 $475,835.69 $393,600.00 Bid Bond Received: Yes Yes Yes INTER-OFFICE COMMUNICATIONS 3/8/2023 TO: Michelle Horton, Purchasing Department FROM: Steve Zivny, City Planning Department RE: Soil Remediation, Group #S01 Please solicit bids for the following projects: To Be Awarded As All or None. 2116 Pinkney St. 1016 North 41 Street 2573 Mary Street 2204 Binney Street 915 N 51 Street 2423 Larimore Avenue 3236 Lafayette Avenue 115 South 37 Street 3304 Maple Street 1812 Miami Street 128 N 38 Avenue 2580 Manderson Street 3858 Cass Street 5503 North 25 Street 3935 N 37 Street (1) 1 of 214 MLH DOUGLAS COUNTY REQUEST FOR BID AND BID SHEET ON: CITY OF OMAHA Soil Remedlation Group#501 RETURN BIDS TO: Published: Wednesday,March 15,2023 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,March 29,2023 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 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 Remedlation Group 4501 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 link to "Attachment A" for list of addresses and bid lines, Bidders must input bid prices into Attachment A and include a hard copy with their submitted bid. ALL OR NONE TOTAL BID (from Attachment A): $ $342,500,00 (5%Bld 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 % Firm: EGM, INC. or t In: NEBRASKA Delivery(or completion) Name: PACO KEOPANYA Signature: /'v- catendar days following Title: PRINCIPAL Phone: 402-350-91 3 IFax: award Address: 32005 PAW N E E RD Street/P.O.Box city VAI I FY state NF zip 6RO64 Email Address: PACO@EGMINC.BIZ DOUGLAS COUNTY REQUEST FOR BID ON: CITY OF OMAHA-Soil Remediation Group#501 NOT AN ORDER Page 2 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 Interlocai 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 EGM, INC. By PACO KEOPANYA Title PRINCIPAL CONTINUATION SHEET DOUGLAS000NTY REQUEST FOR BID ON: CITY OF OMAHA - Soil Remediation Group#501 NOT AN ORDER Page 3 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/delegatinq 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 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 Omah ' me ' tely. SIGN ALL COPIES Firm EGM, INC. By PACO KEOPANYA Title PRINCIPAL CONTINUATION SHEET DOUGLAS COUNTY REQUEST FOR BID ON: CITY OF OMAHA- Soil Remediation Group#501 NOT AN ORDER Page 4 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:Uhumanrights.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 EGM, INC. By PACO KEOPANYA w !,`N Title PRINCIPAL CONTINUATION SHEET Responsible Contractor Compliance Form RC-1 ��Oe pMAHA,ti���y rey y.Fir Ary' o�°Tsa fiLtoWt'y I. Regulations A Section 1-108 of the Omaha Municipal Code and the Rules and Regulations based 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. 11. Filing this Report(please initial in the boxes below): gContractor agrees that Contractor will not, nor will the Contractor allow any of the Contractor's sub-contractors on this project, to employ or hire an employee not lawfully authorized to perform employment in the United States and that the Contractor and all sub-contractors shall use E- Verify. gContractor agrees that Contractor will not, nor will the Contractor allow any of the Contractor's sub-contractors on this project, to violate Nebraska's Misclassification of ee Em to Ref.Stat. Section 48-2901 et seq.). Employee law (Neb. igContractor agrees that Contractor will not, nor will the Contractor allow any of the Contractor's sub-contractors on this project, to violate Nebraska's Fair Labor Standards Law(Neb. Rev. Stat. Section 73-104 et seq.). gContractor has not,nor has any of the sub-contractors to be used by the Contractor on this project, been convicted of any tax violations(local,State and Federal) within the last three years from the date this bid is submitted. NCContractor has n ,nor has any of the sub-contractors to be used by the Contractor on this project, had a "will iol ion' of the Occupation Safety and Health Act or a "Final Determination"by the Occu Iona] afe and Health Administration within the past three years from the date this bid is s. mitte 3/29/202 Sig ure 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 and thirty days 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. United States Citizenship Attestation Form For the purpose of complying with Neb. Rev. Stat. §§ 4-108 through 4-114, I attest as foll ws: I am a citizen of the United States. —OR- r I am a qualified alien under the federal Immigration and Nationality Act, my immigration status and alien number are as follows: and I agree to provide a copy of my USCIS documentation upon request. I hereby attest that my response and the information provided on this form and any related application for public benefits are true, complete, and accurate and I understand that this information may be used to verify my lawful presence in the United States. PRINT NAME 4N0 e ar\ first mid a last %*"....i SIGNATURE V 1-\'-----% \ ---- 4Th DATE ^ Z -----'42D., 1/19/2010 AFFIDAVIT FOR EMPLOYEE CLASSIFICATION ACT STATE OF 1 1Q6 ) COUNTY OF s.,...0 t )§ I, PAc c D K 2 C�X� 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)(the authorized agent of the contractor E M.... n c. ). I attest to the following (a) each individual performing services for such contractor is properly classified under the Nebraska Employee Classification Act, 2010 LB 563 ("the Act"), (b) such contractor has completed a federal I-9 immigration form and has such form on file for each employee performing services,(c)such contractor has complied with Neb. Rev. Stat. section 4-114 (federal immigration verification system), (d) such contractor has no reasonable basis to believe that any individual performing services for such contractor is an undocumented worker,and(e)as of the time of the contract, ch contractor is not barred from contracting with the state or any political subdivision pursuant to the Act. FURTHER AFFIANT SAYETH NAU Affrant SUBSCRIBED AND SWORN TO before me this ca2Cr day of 1 ,243-H.02:) ' �.�X lt-t �� GENERAL NOTARY-State of Nebraska Notary Publi! G 7 GASSY L W1L1JPM(SEN '' MY Comm.Exp.December 22,2024 A opaoFATA Approved 6/1/10 Client#: 774485 EGMINC ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 4/19/2023 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 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT INSPRO, a Marsh&McLennan PHONE Allyson402-9Perry, CISR FAX Agency LLC, Company {E MA No,EXt):402-941-1925 (A/C,No): 4000 Pine Lake Road ADDRESS: Allyson.Perry@MarshMMA.com INSURER(S)AFFORDING COVERAGE NAIC# Lincoln, NE 68506 INSURER A:Columbia National Insurance Company 19640 INSURED INSURER B:GuideOne Specialty Insurance Company 14559 EGM, Inc. INSURER C Amerisafe,Inc. 999999 32005 Pawnee Road National IndemnityCompany 20087 Valley, NE 68064 INSURERD: p y INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYI) LIMITS B COMMERCIAL GENERAL LIABILITY X X CENV562011459 08/20/2022 08/20/2023 EACH OCCURRENCE $3,000,000 CLAIMS-MADE OCCUR PREMISES Ea RENTED $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 POLICY X PR - POLICY LOC PRODUCTS-COMP/OP AGG $3,000,000 OTHER: $ D AUTOMOBILE LIABILITY X X 74APB005749 09/06/2022 09/06/2023 (Ea aocideDt)INGLE LIMIT $1,000,000 ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY X AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ $ B X UMBRELLA LIAB X OCCUR X X ENV56201145900 08/20/2022 08/20/2023 EACH OCCURRENCE $3,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $3,000,000 DED X RETENTION$0 $ C WORKERS COMPENSATION X AVWCNE3115762022 08/20/2022 08/20/2023 AND EMPLOYERS'LIABILITY Y/N STATUTE EORH OFFICER/MEMBER EXCLUD PROPRIETOR/PARTNER/EXECUTIVE N N/A E.L.EACH ACCIDENT $500,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 B Pollution Liab ENV56201145400 08/20/2022 08/20/2023 3M/3M B Professional Liab ENV56201145400 08/20/2022 08/20/2023 3M/3M DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION City of Omaha SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1819 Farnam Street, Ste 502 ACCORDANCE WITH THE POLICY PROVISIONS. Omaha, NE 68183 AUTHORIZED REPRESENTATIVE I ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S 12676697/M 12597498 URAZP DESCRIPTIONS (Continued from Page 1) 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 defined 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 AIDS 7R NSMITTED BY CII'CLERIt OPENED BY COMMITTEE MAR 2 0 2023 AS PER ORD#37n, SAGITTA 25,3(2016/03) 2 of 2 i-et:erred to Purchasing Agent #S195831/M192769 4/19/23,3:40 PM 20230419_150510.jpg V E.B R SK Good life.Great Connections. DEPARTMENT OF LABOR Contractor Registration Certificate This certificate is non-transferable Registration # 72398-22 Date Expiring:7/31/2023 EGM Inc. 32005 Pawnee Road Valley, NE 68064 Nebraska Department of Labor 550 South 16th Street Lincoln,NE 68508 14.J�} 402-471-2239 t.CJ01�"' ommissionerofLabor I https://mail.google.com/mail/u/0/#inbox/WhctKKXwtnrXZDWnwkFMNjshCVvVgICKjl3tfDHIQIKKKXwfPnTxCMDdrKbmjsrvdzGcJhFV?projector=1 1/1 4\' aY c tau+ a i{fit t;+. .1-1/ ('YI z.�.y� iif1�1 sfs4i� };�h*.Y�l'' t�� �y�. i �. 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