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Attachment C Bidder's Response to the ITB Bid No.: 2015-191-YG ATTACHMENT C Bidder's Response to the ITB BID NO: 2015-191-YG CITYOF MIAMI BEACH MIAMI BEACH 11 r mi•Ep FHP TECTONICS CORP. ..,_:N GENERAL CONTRACTORS City of Miami Beach ITB 2015-191-YG South Pointe Park Water Feature Remediation ORIGINAL Deliver To: City of Miami Beach Procurement Department 1755 Meridian Avenue, 3rd Floor Miami Beach, Florida 33139 Bid Opening: September 16, 2015,3:00 PM 2 SOUTH FEDERAL HIGHWAY • DANIA BEACH, FL 33004 PHONE (305) 940-0264 • FAX (305) 940-0265 www.fhpaschen.corn 1p FHP TECTONICS CORP. N GENERAL CONTRACTORS • Tab A Identification Page and Table of Contents 2 SOUTH FEDERAL HIGHWAY • DANIA BEACH, FL 33004 PHONE(305) 940-0264 • FAX(305) 940-0265 www.fhpaschen.com f' FHP TECTONICS CORP. N GENERAL CONTRACTORS Applicant Firm Identification Name of Bidder: FHP Tectonics Corp. Address of Bidder: 2 South Federal Highway Dania Beach, Florida 33004 Phone: 305-940-0264 Fax: 305-940-0265 Email Address: droyAfhpaschen.com Phone / Fax Numbers: 305-940-0264 /305-940-0265 FEIN: 36-4136428 Form of Ownership: Corporation Local Rep: David P. Roy, Senior Project Manager Phone: 954-548-0030 E-mail: droy @fhpaschen.com September 16,2 015 David P. Roy, Senior Project Manager 2 SOUTH FEDERAL HIGHWAY • DANIA BEACH, FL 33004 PHONE(305) 940-0264 • FAX (305) 940-0265 www.fhpaschen.com CERTIFICATE I do hereby certify that the following is a true, complete and correct copy of a resolution adopted by the Board of Directors of said Corporation pursuant to a Consent,dated May 3 I,2013,signed by all of said Directors: "RESOLVED, that the following are hereby authorized to execute and deliver for and on behalf of FHP Tectonics Corp., contracts of all kinds, including but not limited to, construction proposals, bids, construction contracts,joint venture agreements,change orders, bid bonds,payment and performance bonds, letters of credit, and any and all documents, instruments and papers which in their discretion may be necessary, expedient, or proper for the presentation of a proposal and if awarded, a contract for the construction upon wich FHP . Tectonics Corp is engaged or will become engaged as a Contractor or Manager. Frank H.Paschen Chairman, Director,Chief Executive Officer,Treasurer James V. Blair President James Habschmidt Chief Financial Officer,Secretary Joseph V. Scarpelli Executive Vice President Robert F.Zitek Sr. Vice President W. Mark Barkowski Vice President Timothy B.Stone Vice President Leo Wright Vice President David P. Roy Sr.Project Manager . Michael P.Thiele Sr. Project Manager Riley Barron Operations Manager I do hereby further certify that said resolution has not been amended or repealed and is in full force and effect. IN WITNESS WHEREOF I have hereunto set my hand and affixed the Corporate seal of said Corporation,this 11"day of February,2014. /1"770.7Q424.4.4.49 . ames Habschmidt Secretary (Corporate Seal) State of Illinois • County of Cook Subscribed and sworn to before me this 1 l tI' day of February,2014. • �� / t Notary Public .4r.;n..q,.:::I4G'4.'Lt••E.R-['p,{y.,jy wa 3IR a-f..y.tR•I.'"',,' I.Atrli.EEN pm r'iSOt •i \, t)I(•i i S P,I 4�t, ,1.'- trj• I,u:Uy�I'tidtl:t..(;)1(JihItuni4 '''',:.',-'.'%';f' , 141'••(,itt,.'ttllS:iiiiii 1:<€J,PC // .201-: ,■.tltwt4:1 24. � FFP FHP TECTONICS CORP. �'.. 1V 1�1 GENERAL CONTRACTORS Table of Contents Tab A — Identification Page & Table of Contents Tab B — Minimum Qualifications & Requirements Tab C — Financial Statements Tab D — Experience & Key Personnel Tab E — Bid Price 2 SOUTH FEDERAL HIGHWAY • DANIA BEACH, FL 33004 PHONE (305) 940-0264 • FAX(305) 940-0265 www.fhpaschen.com i r FHP TECTONICS CORP. N GENERAL CONTRACTORS Tab B Minimum Qualifications and Requirements 2 SOUTH FEDERAL HIGHWAY • DANIA BEACH, FL 33004 PHONE (305) 940-0264 • FAX(305) 940-0265 www.fhpaschen.com State of Department of State I certify from the records of this office that FLIP TECTONICS CORP. is an Illinois corporation authorized to transact business in the State of Florida, qualified on May 23,2003. The document number of this corporation is F03000002688. I further certify that said corporation has paid all fees due this office through December 31, 2015,that its most recent annual report/uniform business report was filed on January 9, 2015, and its status is active. I further certify that said corporation has not filed a Certificate of Withdrawal. Given under my hand and the Great Seal of the State of Florida at Tallahassee,the Capital,this the Ninth day of January,2015 ji^,. `�=`�fl��i,`„jam' _•\ , ='? '.tip_ �;:�' I��,�' +7',f.,1,-.-- •' �'�� `*�,� _. of State t Secretary Authentication ID:CC7728239979 To authenticate this certillcate,vlsit the following site,enter this ID,and then follow the instructions displayed. https://efile.sunbiz.org/certauthver.html File Number 5894-500-5 1 4 . I a qi. .vg A •,. ___,_------.,-='- -,-- ----.--.,_.._".T._-_,_- .-.....„ •;." L I 1. t o 0/7..... It- O L`. -yam �I iy E i i13. f/JI/(„�• R .• A� _~ ` t'.�-Trig M ._-'irJ /� �: !I �y.. -, - '(� - :=. _fit 9 , ! / ck,.... / ..),,, . To all to whom these Presents Shall Come, Greeting: I, Jesse White, Secretary of State of the State of Illinois, do hereby certify that FHP TECTONICS CORP.,A DOMESTIC CORPORATION,INCORPORATED UNDER THE LAWS OF THIS STATE ON JULY 08,1996,APPEARS TO HAVE COMPLIED WITH ALL THE PROVISIONS OF THE BUSINESS CORPORATION ACT OF THIS STATE RELATING TO THE PAYMENT OF FRANCHISE TAXES,AND AS OF THIS DATE,IS IN GOOD STANDING AS A DOMESTIC CORPORATION IN THE STATE OF ILLINOIS. �� \km. In Testimony Whereof I hereto set `1, STATE O`>>„� 04� ;_ �` II) my hand and cause to be affixed the Great Seal of t \� , ; A' the State of Illinois, this 12TH• : ��t\�, 4 , day of APRIL A.D. 2010 . 'ili,* '1*,„..*) Ira' .-.7.: -la 1 Z t u;. i '111 1%10.a.26 1$4$ = i AWhenllcallan a: 1010201542 Q-D,....t,d../..., Authenticate et:hltpJMww.cyberdrtvegpncls.com SECRETARY OF STATE 000379 Local Business Tax Receipt P Miami-Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 6278246 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES FHP TECTONICS CORP RENEWAL SEPTEMBER 30, 2015 DOING BUSINESS IN DADE COUNTY 8543897 Must be displayed at place of business Pursuant to County Code Chapter BA-Art.9&10 OWNER SEC.TYPE OF BUSINESS PAYMENT RECEIVED FHP TECTONICS CORP 196 GENERAL BUILDING CONTRACTOR BY TAX COLLECTOR Worker(s) 12 CGC1518886 f $93.50 02/26/2015 CREDITCARD-15-.021494 This Local Business Tax Receipt only',"confirms payment al the Like!Business Tex.The Receipt is net license. permit.or a certhlicaifon of the holder's qualifications,to do business.Holder mast comply with any governmental or nongovernmental regulatory lows end requirements which apply to the business. The RECEIPT NO.above must be displayed on all commercial vehicles-Miami-Dade Code Sec 8a-278. For more information,visit Erww.mlemidade.cor taxcollecter BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895—954-831-4000 VALID OCTOBER 1,2014 THROUGH SEPTEMBER 30,2015 DBA:FHP TECTONICS CORP Receipt#:GENERALO�ONTRACTOR (GENERAL Business Name: Business Type:CONTRACTOR) Owner Name:DAVID PAUL ROY Business Opened:11/12/2003 Business Location:2 S FEDERAL HIGHWAY State/County/Cert/Reg:CGC1518886 DANIA BEACH Exemption Code: Business Phone:305-940-0264 Rooms Seats Employees Machines Professionals 10 For Vending Business Only Number of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 3.00 0.00 0.00 0.00 0.00 30.00 • THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non-regulatory in nature. You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location.This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: DAVID PAUL ROY Receipt #30B-14-00004804 2 S FEDERAL HIGHWAY Paid 02/20/2015 3.00 DANIA BEACH, FL 33004 2014 - 2015 BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895—954-831-4000 VALID OCTOBER 1, 2014 THROUGH SEPTEMBER 30, 2015 DBA:FHP TECTONICS CORP Receipt#: 180-8700 Business Name: Business Type:GENERAL CONTRACTOR (GENERAL CONTRACTOR) Owner Name:DAVID PAUL ROY Business Opened:11/12/2 0 0 3 Business Location: 2 S FEDERAL HIGHWAY State/County/Cert/Reg:CGC1518 8 8 6 DANIA BEACH Exemption Code: Business Phone: 305-940-0264 Rooms Seats Employees Machines Professionals 10 Signature For Vending Business Only Number of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 3.00 0.00 0.00 0.00 0.00 30.00 Receipt #30B-14-00004804 Paid 02/20/2015 3.00 itf STATE OF FLORIDA ` DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ~r ! '-. , \.-." :. ` - CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 °- 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 ROY, DAVID PAUL FHP TECTONICS CORP 5515 NE RIVER RD CHICAGO IL 60656 . Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and ; Professional Regulation. Our professionals and businesses range ;} a►9�. STATE OF FLORIDA from architects to yacht brokers,from boxers to barbeque restaurants, a ,t�l:I DEPARTMENT OF BUSINESS AND and they keep Florida's economy strong. '' (" ' PROFESSIONAL�REGULATION Every day we work to improve the way we do business in order to : CGC1518886 •.r ISSUED:- 06/16/2014 . serve you better. For information about our services,please log onto , A:zr. www.myfloridalicense.com. There you can find more information `r CERTIFIED GENERAL CONTRACTOR about our divisions and the regulations that impact you.subscribe ROY,DAVID PAUL to department newsletters and learn more about the Department's r, FHP TECTONICS-CORM . - initiatives. Our mission at the Department is License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your - customers. Thank you for doing business in Florida, IS CERTIFIED under the provisions of Ch.489 FS, and congratulations on your new license! Expiration data:AUG 31.2016 L1406160001039 DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION !, `7'Ir, CONSTRUCTION INDUSTRY LICENSING BOARD ,' LICENSE NUMBER , ;�. ti■• CGC1518886 �!�{ The GENERAL CONTRACTOR :, ;N:°+j Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31,2016 0 ' ' 0• ROY, DAVID PAUL "+ FHP TECTONICS CORP .._N 5515 NE RIVER RD *- ' CHICAGO IL 60656 . , ISSUED: 06/16/2014 DISPLAY AS REQUIRED BY LAW SEa# L1406160001039 ACO CERTIFICATE OF LIABILITY INSURANCE DATE 12015 M(YY) �� 04ro3r201s 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 POUCIES 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 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 NT MARSH USA INC, ------e -• -----•---- -.___ 540 W.MADISON PHONE FAX- -- 540W.CHICAGO,IL 60661 E-MAIL`Nq,Eall -_------r-i-WC.Noh_- ------ --•-- Attn:chicago.CertRequest @marsh cam ►DnaFgg;-- -- --— -- ------ - --T•-- -- . INSURER(S).AFFOROING COVERAGE 1 NAIC a INSURER A:Zurich American Insurance Company j16535 INSURED INSURER e:American Zurich Insurance Company - 140142 FHP Tectonics Corp. Illinois National Insurance Company 2 South Federal Highway INSURER C: p Y 23617 Dania Beach,FL 33004 INSURER D:Endurance American Insurance Company_ - 1 10641 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: CHI-004252220-21 REVISION NUMBER:6 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 -TACbL'SUERr-- -- f POLICY EFF POLICY EXP •LTR I TYPE OF INSURANCE I?NSR 'NV + POLICY NUMBER T � - (MMIDQIYYYYI IMMIODIVYYYL LIMITS A 1 GENERAL LIABIUTY GLO 5933476-02 ;10/01/2015 1,000,000 X� { I 110/0112014 I EACH OCCURRENCE I S _ �- t DAMXGETO-R•ENTED— - -- COMMERCIAL GENERAL LIABILITY j P�e�1LSE$IrrenoaZ S 300,000 .CLAIMS-MADE 1 X1 OCCUR I 1 MED EXP(Any one person) 5 10,000 _ 1,000,000 I PERSONAL S ADV INJURY S _, ._ -__- GENERAL AGGREGATE 5 2,000,000 GEN'L AGGREGATE LIMIT APP_UES PER: I PRODUCTS-COMP/OP AGO 1S 2,000,000 X POLICY PRO• I----I I IECT I �I LOC � f -- 1 S - A I AUTOMOBILE LIABILITY f I BAP5833474-02 '10/01/2014 10/01/2015 COMBINED SINGLE LIMIT E - 1,000,006 X ANY AUTO I ill BODILY INJURY(Per person) 5 ALL OWNED SCHEDULED BODILY INJURY(Per accident I S AUTOS _ AUTOS 1 _` X HIRED AUTOS X- NON-OWNED UPERTYMpAMA(iE I S k.- Via ni) I rs C ' X UMBRELLA LIAR 1 X i OCCUR 10 I I6E 051731161 10/01/2014 10101/2015 •EACH OCCURRENCE S 25,000,000 EXCESS LIAR DED 1 X f RETENTIONS CLAIMS-MADE,000 AGGREGATE ;{5 - 25,000,000 I B WORKERS COMPENSATION !WC 5833475-02(AOS) 10/01/2014 10101/2015 1 X WC STATU- 0TH-1 B AND EMPLOYERS'LIABILITY V/N !WC 5833477-02(WI) 10/01/2014 10/01/2015 - -I TORY LIMIT I I - 1,000.00(1 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? © NIA E.L EACH ACCIDENT S (Mandatory In NH) E L DISEASE-EA EMPLOYE 3 1,000,000 II yes,describe under - - -- DESCRIPTION OF OPERATIONS below I E L.DISEASE-POLICY LIMIT;5 1,00C,OCO 0 Excess Layer Liability IEXC10004227001 10/01/2014 10101/2015 Each Occurrence: 25,000,000 I Aggregate: 25,000,000 I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) RE:EVIDENCE OF INSURANCE. CERTIFICATE HOLDER CANCELLATION FHP Tectonics Corp. SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE 2 South Federal Highway THE EXPIRATION GATE THEREOF, NOTICE WILL BE DELIVERED IN Dania Beach,FL 33004 ACCORDANCE WITH THE POUCY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee �CA..naek.■ ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD -if SNN BUCKINGHAM FOUNTAIN SUBSTATION PHASE 2 CLIENT: Chicago Park District 541 N.Fairbanks Chicago,IL Patrick Levar,Chief Operating Officer 0 (312)742-4200 patrick.levar@chicagoparkdistrict.com *° ARCHITECT: N/A START DATE: , , tv: _ 1 i, 6/24/2009 t t COMPLETION DATE: 4 ,'.. '' 6/12/2012 .,,___ .�_ : __ .� ; `'_.... VALUE: $1,200,000 i 4 t'r*t______, . .• , i -. Ali.t• " . all.- a 4 PROJECT DESCRIPTION This project consisted of the conversion of the unused bathrooms at Buckingham Fountain into a new Electrical Substation for the fountain.The existing bathrooms were gutted to the support walls and the rooftop deck was removed to install new transformers and heavy electrical equipment.One side of the bathroom was converted into a ComEd substation and the other side was converted into a CPD substation.Other aspects included: Precast concrete vault tops made for the substation,waterproofing the underground substation,painting,fencing, ventilation,fire alarm,sump pumps,landscaping&pavers. az FHP TECTONICS CORP. N GENERAL CONTRACTORS New Splash Park for Juan Pablo Duarte Park Project This project consisted of the installation of a new splash park,including the new water features and filtration system,colored concrete pad and associated sidewalks. Owner Nelson Cuadras ' .%,: , _r.- City of Miami—Capital Improvements ..- 444 SW 2nd Ave., 8`h Floor ........ :... .�. . Miami, FL 33130 .., ncuadras @miamigov.com Architect/Engineer - ' ,.. Aquatic Technologies 515 NE 42nd Street Oakland Park, FL 33334 Contract Amount • - $250,104.00 Start Date September 2011 ,: o '`� 1V! ._Y �- f - 1, .Ard► t. Completion Date y . f -r r ,Ifir;II December 2011 tiiii;i1.0.......„_. ,, . ,....-- ._:- , .,.....:50;100; 1-'." a ' r'llg:;!*. . ' i... ..tiaLa, ,. 4 - *Alt, AFA:c.-„,wer---7,, p,, ,4,T144111, ! i , • •..., r . - ..- - .,'!... ,.„, .f. .,,,i4.r ....,'"" all,f N"' 'ta,' .,la litt kik—. 14. 4' , • it 'f Jill.I I1, 4 ,. I 1LIIIii r « . 2 SOUTH FEDERAL HIGHWAY • DANIA BEACH, FL 33004 PHONE (305) 940-0264 www.fhpaschen.com INE in p r FHP TECTONICS CORP. BRI1N GENERAL CONTRACTORS Great Lakes Naval Station Pool Deck Replacement The scope of this project was to replace the existing pool deck, install or replace selected mechanical components including pool filters,several modulating valves and controllers,and replace the underwater lighting. The project required a high degree of coordination that was embraced by all parties in an occupied, in-use training facility, but was not without its challenges.The team successfully integrated the separate installation of variable frequency drives(VFDs)for facility pumps by the Owner during the course of our mechanical work. Replacement of the pool deck was accomplished in a coordinated, phased manner. After the project was substantially complete,the pool was filled with water,but a challenge was encountered.The pool was losing water at an unexpected rate.Testing revealed that water was leaking from several of the underwater light recesses cast into the pool structure. Sealing of the rusted conduit at the cable exit of each --ter ' ji ..,.....• , _ . , recess had been observed during the �, '"� gill removal and was reinstalled at all recesses , as a precaution.This did not prevent the • leaking and a new sealing approach was I _ .. i, immediately reviewed with the Owner. A -' II 111191 I two-step approach was developed and : I"_lip FHP TECTONICS CORP. BRNn GENERAL CONTRACTORS Bates Fountain Renovation at Lincoln Park Zoo This project began with the removal and replacement of the concrete fountain vault and replacing the piping and controls. All broken piping was replaced,as were the corroded water supply,return,and electrical conduit lines. Before completion,the bronze features were cleaned and restored,and the water supply lines were pressure-tested. Pavers were reset in the plaza,and all disturbed areas were sodded. Owner Chicago Park District Contract Amount $275,000 Completion Date May 24,2011 ,,..4&:4 ,.*,Pt i , ' , ' II i ' /51 * '. it 4 If - '• '-•,i' r • s+ Y` y •' , - . "':''' :- - '` *al. il li, , ' R 1g-*i ii t 1 _, .• - • , ....,--- -IC- -'..4-_. •-•.-•--..- '4' .r. t * 4.011 .,. " ''' lvt., , :;., .-4"-- 411 ii ... isAmpiaidismiiim , , -. 11 .111 1. y r f ... ,,.....„.._,..„, _ .. .. .. _. _ . ,, , . . , . . - - . c, . ,c 4. -'''',,,;,,„ --.1., ;, 'i. --. , . - . ,-, -, , ,. -- . . , � if f .'y X'f r , 9 _ - , 1 1 s 1. t. 2 South Federal Highway • Dania Beach, FL 33004 Phone: (305) 940-0264 • Fax: (305) 940-0265 r FHP TECTONICS CORP. N GENERAL CONTRACTORS Bayfront Park Baywalk- Pond Renovation Project This project included the renovation/restoration of the reflection pond.The scope of work included draining and cleaning the existing pond,concrete restoration,new lining and pump repairs. Owner Architect/Engineer Danny Perez None. Manager Bayfront Park - . ,:• j `, ' 'r r 301 N. Biscayne Blvd. �', Miami, FL 33132 - i. • Phone:305-373-8788 --,, -- f danperez @ci.miami.fl.us --',.! Contract Amount .,,, - $25,238.56 .. _ Start Date January 2010 _-....-- MIMI , Completion Date _ -« March 2010 ;`S `'' '"`` } . 4� : • I MEM 'MOO. ',°14:, ',* ,� t� ►4,4 . ,,,,,., ..., .., ,47''4"'T fe, ',0%.,.. . . s_ r ,,,..,.. °IP,. .-D. . -icy '4j .,•'?s . R 1 V ♦.r " 4.1j': ' ' 1'-2l M lo.! 1 f. .4 to + C- : - i Aai yap .. / 1.4.0- 2 SOUTH FEDERAL HIGHWAY • DANIA BEACH, FL 33004 PHONE (305) 940-0264 • FAX(305) 940-0265 www.fhpaschen.com iminp r FHP TECTONICS CORP. SHN GENERAL CONTRACTORS Fuller Children's Court Pavement Replacement The Fuller Children's Court Pavement project consisted of a restoration of the deteriorated and unsafe walkways and stairs at the park. In order to match the original historical concrete a combination of concrete sidewalk with colored pavers was used to match the existing pattern.Circular concrete stairs were poured to match the original stairs as well.ADA ramps were installed at the three doors of the fieldhouse.The existing steel fencing and gates were repaired and reinstalled after the pavement work was completed. Additionally,the entire veranda ceiling and ._. 000° walls were painted at the end of the project. fi '� r , Chicago Park District � er t ' f Contract Amount ' L itle . - , 0 111;4 7, $203,993 . 1 1,. w3 .44111 Completion Date _. "' "" e August 7,2009 • 41' 4 s 4glNmmmaatz=:„..,- a,"`‘`.4* e. M * 4 P. . a• 2 South Federal Highway • Dania Beach, FL 33004 Phone: (305) 940-0264 • Fax: (305) 940-0265 11.11.? r FHP TECTONICS CORP. SNN GENERAL CONTRACTORS Children's Fountain This project consisted of building a new foundation,bowl and pedestal,and refinishing and relocating the children's fountain that was previously located on Wacker Drive. FHP sent the fountain to Georgia to be refinished.A new foundation,concrete bowl and concrete pedestal were built for the fountain. The fountain and the existing granite slabs that surrounded the fountain were then reinstalled. The fountain is approximately 30'in diameter and stands approximately 30'high. Owner Chicago Department of Transportation Contract Amount $471,455 Completion Date August 1,2005 .�• - ► •, f '' ,.. . 1 y .1 .I w : _ .ij— t r w t.. • � 76 � ' V • -,�' ( iii:M 45. ,,, �• • .- - ..... ]., r- - '.- '''1.-,-Ter-, . :. .4. .,c,-,t..i, ._ - . I' Illikk _ 4: ...,--: .. f Z ' A 4,11.• ,_ , . . - „ ...4 ... ...,_et.,..„, ._ .„.. is _tti",;. A ;.„,., , 4.. • ........... • , • •,, • . air.."....- ■ '...., 1 . -,, . } 2 South Federal Highway • Dania Beach, FL 33004 Phone: (305) 940-0264 • Fax: (305) 940-0265 -pp SRN HARRISON RECREATION CENTER PLAYGROUND " " . CLIENT: DC Department of General Services `i , ► h j • I 2000 14th St.,NW 8th Floor, Washington,D.C. It • R,.�. • �' Avon Wilson(McKissack&McKissack 9C Ai : Owner's Representative) - ' & (202)347-1446 in l lulusilik 1.151:i' :t • • L.. I li I „ . - ARCHITECT: • r + r . • , ot ;miv,,01,t v • ;, LSG Landscape Architecture .r- .... _ _ t,r ... .. r START DATE: 7,-;dipiiii. A 4/3/2013 .max COMPLETION DATE: A,, ,°,' .4" 9/20/2013 ,► VALUE: ..410•440 -: .,- ,�I x , al $1,544,000 'a�.*r= r .',- ' , . II S " "ril A. a ai - i -1 _,-. i,. 4 Als4L,17:- ..-0)'gni ..,..=0 - **sr PROJECT DESCRIPTION This project was a Design-Build modernization to an existing park. Work included dismantling and removing the existing playground and replacing it with new play equipment,PIP Safety equipment,and a mist station/ spray feature.The spray feature/mist station included excavation for pad&equipment areas,concrete pads for tanks and vaults,piping and drainage for water features,water&equipment valves,water feature embed& fixture installation,finish surface for splash pad,connection of electrical and fresh water connection,and sanitary connection.The basketball court received new fencing and backstops,lighting was repaired,and a picnic area, landscaping,and butterfly garden planter were installed. Located in the heart of the U Street Corridor,the park has strong ties with the surrounding Victoria-era neighborhood.The influence of music was key to the design of the new playground,and includes musical themed spray features. imimpo r FHP TECTONICS CORP. f GENERAL CONTRACTORS Eric Solorio Academy High School This new 206,000 sf.,3-story building achieved LEED Gold certification and includes a gymnasium with deployable bleachers and a stage for conversion to an auditorium area,indoor swimming pool,cafeteria, library,offices,science labs,art I music room,and classrooms.The skeleton of the building is a steel frame with a hollow-core precast plank flooring system.The ventilation system of the school is supplied by five air handling units ranging from 12,000 to 60,000 cfm.,and supporting ductwork is oversized to reduce noise levels.The plumbing system is designed for efficiency with a goal to reduce water use by 40%.Additionally,many of the electrical and lighting ef : systems will be controllable to reduce future energy costs. - ;6- -- _- _- ,- ,- -"--}-- -- -' Owner ".' r Public Building Commission &` i _ a i' EA — ;�_s , G.�rL 1 Contract Amount -"�°-.-_- ' 1 � =..... il $71,189,000 !. — Completion Date ., September 3,2010 IV r .. ` r Y 1 1' ,,,, - er.., i d -...,,,,,,,,,,,,,,,,,....„ C iii , ' _ "^^i1iii,,j �. rw T it 1NIP iali _ .4;04ottL A 2 South Federal Highway • Dania Beach, FL 33004 Phone: (305) 940-0264 • Fax: (305) 940-0265 I� FHP TECTONICS CORP. 3 GENERAL CONTRACTORS Central Los Angeles High School #1 Pool Repair This project began as a new pool,built by another contractor,that settled due to poor soil conditions. Therefore,the foundation cracked and water was leaking,compromising a retaining wall adjacent to the nearby Hollywood Freeway.The water leakage was causing erosion under the roadway and the retaining wall so repairs had to be made very quickly.FHP was brought in to remove the existing tile,install 250 micropiles under the existing pool foundation, pressure-inject grout into the existing cracks,and install new tile throughout the pool. Owner Los Angeles Area Unified School District Contract Amount $1,400,000 Completion Date August 30,2009 • • • 40 2 South Federal Highway • Dania Beach, FL 33004 Phone: (305) 940-0264 • Fax: (305) 940-0265 =IF? r FHP TECTONICS CORP. eNN GENERAL CONTRACTORS Fenger High School Pool Renovation This project consisted of renovations to the Natatorium and Locker Rooms. Included in the Natatorium renovation was masonry restoration of the interior walls and scraping existing structural beams at the roof level. Installations included new fireproofing,ventilation system,stainless steel guardrails at the stadium seating, lighting,and a complete replacement of the pool liner and deck. Modifications to the seating areas to accommodate wheelchair access were made,as well.The pool equipment was replaced with new pumps, hot water heater,and chemical treatment system. The Locker Rooms were completely demolished and new showers, lockers, flooring,and benches were installed. Doors throughout both the Natatorium and Locker Rooms were removed and replaced. _ - `. Owner ,r. .,, „ 11 --- •Chicago Public Schools •-- - Contract Amount $2,563,264 I! .L 1!.i. Completion Date -,/:. . February 8,2008 . ----___- a w . A x i is r: 'me tier Y iliiit fiii.-' .• it -it / .. Y 1 ■ �jsj ittP ig '7. 10°)P ;.,...'771_....4 -^i.-� ' j.. `1 „'phi +v + t MAP *► ,'''''* 2 South Federal Highway • Dania Beach, FL 33004 Phone: (305) 940-0264 • Fax: (305) 940-0265 main? r FHP TECTONICS CORP. ENN GENERAL CONTRACTORS Model Yacht Basin Complete renovation of the Model Yacht Basin,built in 1930,located at Harold Washington Park in Hyde Park.The concrete retaining walls and sidewalks were repaired or replaced and a waterproof membrane,a new foundation,concrete access ramps,lighting and fountain were also installed.The donated sculpture,Ecstacy,was also installed in the center of the basin. • Repair deteriorated concrete and retaining walls— 13,000 square yards(SY) • Replace deteriorated concrete sidewalk— 10,500 SF • Install waterproofing membrane material—13,000 SY • Install donated sculpture • Build new foundation • Install concrete ramp for access • Install lighting • Install fountains • Install sculpture Construction started in the fall,was �►. ; , ....._....- substantially completed the next rdµ_ spring,and landscaping was finalized by the end of the summer.There was a '• winter shut-down and multiple scope changes in the interim. * ;' - VD Owner Chicago Park District Contract Amount $434,787 i + • x y- Completion Date itor April 15,2007 as A :+ mot' ! • 2 South Federal Highway • Dania Beach, FL 33004 Phone: (305) 940-0264 • Fax: (305) 940-0265 ma im p r FHP TECTONICS CORP. 3 GENERAL CONTRACTORS Skinner Park Tranquility Garden FHP installed new garden,walks,and seating: • Completed the layout and grading for the new gardens • Installed block walls and stairs • Placed aggregate walks and paver walks • Constructed new planters • Ran conduit and electrical service • Erected five poles and lights along walks • Put in the underground sprinkler system for garden • Set six benches and two trash receptacles with concrete bases Owner Chicago Park District Contract Amount $166,697 Completion Date August 4, 2006 ' . 'r r „.1,•try-- AL . 4 jj• ter. 411PAII.:.:-. _ . .,; .44/0 x 2 South Federal Highway • Dania Beach, FL 33004 Phone: (305) 940-0264 • Fax: (305) 940-0265 ■iii? r FHP TECTONICS CORP. ENN GENERAL CONTRACTORS York Commons Pool Renovation In June 1999,demolition began on the existing York Commons swimming pool. The new concrete pool consists of a zero depth shallow end,a water slide,diving board and several other features in the pool and on deck including water cannons,mushroom-shaped fountains,and sprayers.There is a sand playground that connects to the pool with a shower tower.A new mechanical system of pumps and filters was also installed. After digging 9 '/2 feet down for the diving well, excavators hit an underground spring that kept filling the hole.The diving well was supposed to Alt.....,,1 be 12 feet deep.To stabilize • Mikt the soil,plumbing and ;-• . lateral drainage sheet piling, " a"well point system",steel A : F -- - , - li support modifications were '` installed. Work was then ..,,.r--k �_c. ' able to resume and the ', : �" --4+' � _inalin project was completed on --'ice "-. '% • tiler 1 schedule in May 2000. , lk- Owner Elmhurst Park District (II • -- - A. �r Contract Amount �{ : $1,728,558 4u�s� _ T Completion Date , . .. May 1,2000 0 1 999 T g i i f" 1 C4'iiii i ' ;lit s'., ii. `' • �... _ ..! _ T om.. .�.. . r. 2 South Federal Highway • Dania Beach, FL 33004 Phone: (305) 940-0264 • Fax: (305) 940-0265 r FHP TECTONICS CORP. ENN GENERAL CONTRACTORS Stevenson Park Pool Remodeling Construction began in October 1999 on the renovation of the Stevenson Park Pool in Burbank, Illinois. The project consisted of building a new wading pool,zero depth to two feet,which included play features such as tumble buckets,water and ground jets,and a sand play area. In addition, FHP completely renovated the 4,000 sf. bathhouse for ADA compliance and reconfigured the landscaping and concrete decks around the main pool. A trellis and"Funbrellas"were scattered around the deck to provide shade in areas around the pool. A new mechanical system was installed for the wading pool and bathhouse. Owner Burbank Park District Contract Amount $1,315,120 Completion Date June 1,2000 • - 110 vir • ..;.7.44 s ,otto 414 • • • as• _ .a•aA�..a antes' •0► •„lilt 'I`�` • • • . 2 South Federal Highway • Dania Beach, FL 33004 Phone: (305) 940-0264 ■ Fax: (305) 940-0265 Emil.? r FHP TECTONICS CORP. ONN GENERAL CONTRACTORS Water Playgrounds at 5 Parks New water playgrounds were built at five parks—Humboldt Park,Pulaski Park,McKinley Park,Graver Park, and Hale Park.The project included installing all new interactive playgrounds and pools.All were 60' in diameter and went from 0 depth to 3'6".Ornamental metal fencing surrounded each new pool and concrete deck. Owner Chicago Park District Contract Amount $2,430,388 Completion Date December 1, 1999 ; 1 illi'4"7".'"":,._ ,I 'v 1 ' d_ ........amilliiiii vL -1 q�. 2 South Federal Highway • Dania Beach, FL 33004 Phone: (305) 940-0264 • Fax: (305) 940-0265 . #L a r FHP TECTONICS CORP. BIRdN GENERAL CONTRACTORS Pool Renovations (4) Swimming pool renovation projects at four parks for the Chicago Park District-Avalon,Tuley, Blackhawk,and McGuane Pools.The work was broken down as follows: Avalon Park Pool • Installed new interactive water playground,60 feet in diameter,0 depth to 3'6" • Installed new filter building and equipment for the existing 25 yard,6 lane pool • Installed new ornamental iron fence Tuley Park Pool • Installed stainless steel gutter • Built new bathhouse to match historical architecture on the existing building • Poured new concrete deck • Painted 50 yard, 8 lane pool Blackhawk Park Pool • Renovated existing filtration system • Installed new stainless steel gutter • Repaired tile McGuane Park Pool • Renovated existing filtration system for 25 yard,6 lane pool Owner Chicago Park District Contract Amount $2,027,522 A Completion Date �; . • , 4 Junel 1998 • i. ( `r1r `'; 11111111111110 1111 armr4e§t1 —• 2 South Federal Highway • Dania Beach, FL 33004 Phone: (305) 940-0264 • Fax: (305) 940-0265 r FHP TECTONICS CORP. ENN GENERAL CONTRACTORS Pool Renovations (5) Although FHP was the low bidder on only four of the parks,a fifth was added because of our expertise in these renovations,as well as the excellent working relationship FHP has developed with the Park District. Work began immediately at Norwood Park and Chase Park Pools on the North Side,and Hamilton Park, Grand Crossing Park,and Trumbull Park Pools on the South Side. The work at Chase, Hamilton,Trumbull,and Grand Crossing consisted of the following: • Pool—25 meters,6 lanes—C/H;40 meter,7 lanes—GC/T • New Stainless Steel Recirculation System—H/GC/T • Demo Existing and Install New Filtration System—T • New PVC Liner System—C/H/T • Paint Aluminum Pool Interior—GC • Concrete Deck Replacement or Repairs • Minor Fence Repair • New Deck Equipment • New Sewage Ejector Systems for Pool Drainage and Backwash The Norwood Park Pool was different in that it is a 50 meter,7 lane pool and in addition to the above repairs,the following items were also installed:a new pool heater,a 9' ornamental wrought iron fence,a one meter diving board as well as a waterslide and pump equipment. These projects were constructed on a fast-track basis. T Owner alto Chicago Park District • Contract Amount $2,565,103 • 1 { Completion Date ;7:41' ! ,. June 1997 gab 1 ' { +.e;,.,.?v2.s+.e 'k'.ftVar.,+n•�+rtrt., ,.,,..'.v�...e�wM"szaW1•-;EV.^s«e"J+a ,_.d!„�.'. _..._........,,...�_...� ... 2 South Federal Highway • Dania Beach, FL 33004 Phone: (305) 940-0264 • Fax: (305) 940-0265 al.? FHP TECTONICS CORP. Al GENERAL CONTRACTORS Ultrafest Music Festival 2012 Preparation - Bayfront Park Project This project involved multiple park renovations to accommodate the annual Ultrafest Music Festival. Work included the relocation of multiple trees, construction of a retaining wall and the installation of a staging/performance area. Owner Architect/Engineer Ray Steinman Eduardo Rodriguez Jr. Production Director Braniff Engineering Festival Productions MXT,LLX 3641 NW 46th Street 1000 NE 14th Street Miami,FL 33142 Miami,FL 33136 Phone:305-300-0835/Fax:305-638-9957 Phone:954-609-7786/Fax:413-683-3255 mstein @aol.com Contract Amount l $542,545.36 t r,1 Start Date • • .' •. ri t 1 � .� � .fir. February 2012 , ,r •• 1 t Completion Date March 2012 -1. 4 Y Or' .-- w ' , 1 r s e a • I; �, t � r"�1 yy ' t, , ! •s Y• I. 2 SOUTH FEDERAL HIGHWAY • DANIA BEACH, FL 33004 PHONE (305)940-0264 www.fhpaschen.com r' FHP TECTONICS CORP. N GENERAL CONTRACTORS Museum Park Baywalk and Promenade, Phase II and III Project This project consisted of the complete construction of a large park along Miami's waterfront. The scope of work included, but is not limited to, complete site demolition and excavation, concrete, pavers, irrigation, landscaping,furnishings, lighting and electrical. Owner Architect/Engineer City of Miami/Miami, FL Chen-Moore and Associates 444 SW 2nd Avenue,8th Floor 500 West Cypress Creek Road, Suite 630 Miami, FL 33130 Fort Lauderdale, FL 33309 Phone:954-730-0707 Contract Amount $9,145.015.93 Start Date ," March 2013 •°:; Completion Date _'� �. — ,,,,;4. , -' June 2014 +,�'``� `,, .,..44.,:,.� I `4 _ - y��i � tom,.-,-'.� '�, •-+� �' T Nat\ )4tip. '. - •e.• H l o - it q 40 ll I 4.1fliiii‘ 2 SOUTH FEDERAL HIGHWAY • DANIA BEACH, FL 33004 PHONE (305) 940-0264 www.fhpaschen.com -Fp FHP TECTONICS CORP. :- -N GENERAL CONTRACTORS 1814 Brickell Avenue Park Project This project consisted of the construction of a new park in downtown Miami. Numerous obstacles were encountered, including the discovery of historical artifacts and remains throughout the site. Because of these findings,multiple changes were made to avoid disturbance. Owner City of Miami—Capital Improvements 444 SW 2nd Ave.,8th Floor J Miami,FL 33130 Architect/Engineer = Enea Garden Design ,oti®-- 3898 Biscayne Blvd. Miami,FL 33137 Contract Amount __ $840,924.00 ` - -•ft""N• Start Date r , _= : ' September 2011 ' �� _ Op Completion Date `, April 2012 ' g. '-V iter- 4 it * r ' 4 �r�. r • ag% "I.ZAK.. 4 iiir ` ' i :! . 4P # ' '' ': "j !. '' IS 41i* t . 2 SOUTH FEDERAL HIGHWAY • DANIA BEACH, FL 33004 PHONE(305)940-0264 www.fhpaschen.com r F.H. PASCHEN, NIELSEN & ASSOC., LLC iGENERAL CONTRACTORS Bayfront Park Baywalk Project This project consisted of the removal of existing sidewalks to facilitate the installation of the proposed landscaping. Also included was the installation of a new irrigation system on the south side of the park, irrigation pump, benches and trash receptacles. Owner City of Miami/Miami,FL Architect/Engineer ConsulTech,Curtis+Rogers Design Studio, Inc. �• 11,•1 .. , , 1 v lJ • • • . t aka /I • k_ s. ...a 111 PI , 22-4440i0ipqm 2 SOUTH FEDERAL HIGHWAY • DANIA BEACH, FL 33004 PHONE (305) 940-0264 www.fhpaschen.com References Provide information including names, phone numbers and functions relating to contracts and or established programs for which you presently providing similar services. 1. Name of Firm or Agency: City of Fort Lauderdale Address: 100 N.Andrews Avenue City/State/Zip Fort Lauderdale,FL Contact Christopher Bennett Title: Project Manager Telephone: 954-828-6522 Email:cbennettefortlauderdale.aov Scope of Work: This project involved the upgrading and construction of new roadways. The scope of work included, but was not limited to, clearing and grubbing, asphalt paving, sidewalks, curb&gutter, street lighting and landscaping. 2. Name of Firm or Agency: City of Tamarac Public Works Address: 6011 Nob Hill Road City/State/Zip:Tamarac,FL Contact:Alan Lam Title: Project Engineer Telephone:954-597-3707 Email: AIan.Lamca tamarac.ora Scope of Work: This project involved drainage improvements which included infiltration trench pipe and drainage structures within the landscaped medians at NW 108`h Terrace / NW 80th Street between McNab Road &Nob Hill Road. 3. Name of Firm or Agency: City of Mami, Bayfront Park Address: 301 N. Biscayne Blvd. City/State/Zip: Miami, FL 33130 Contact:Tim Schmand Title Executive Director Telephone: 305-373-8780 Email:tschmandAci.miami.fl.us Scope of Work: (Bayfront Park)This project consisted of the removal of existing sidewalks to facilitate the installation of the proposed landscaping.Also included was the installation of a new irrigation system on the south side of the park, irrigation pump, benches and trash receptacles 4. Name of Firm or Agency: City of New Orleans Address: 1300 Perdido Street City/State/Zip: New Orleans, LA 70112 Contact: Julio Viteri Title: Project Manager Telephone: 504-658-3600 Email:jmviteri @nola.com Scope of Work: (Joe Brown Park)New Construction of the Park that had been decimated by Hurricane Katrina, which included a new Recreation Center, baseball fields,picnic shelters,concession stands and landscape. ' 5. Name of Firm or Agency: City of Miami Address:444,SW 2nd Avenue City/State/Zip: Miami, FL 33130 Contact: Jeovanny Rodriguez Title:Assistant Director Telephone: 305-416-1280 Email:jeovannvrodriquez arniamigov.com Scope of Work: (Museum Park)This project was done in 2 phases. Phase 1 was the Baywalk which consisted of a pedestrian walkway for emergency access, landscaping,irrigation, lighting and civil site work. Note: Additional references may be provided References Phase 2 was the Promenade which consisted of a pedestrian walkway for special events and emergency access, landscaping, irrigation, lighting,a parking lot for 40 cars, and restrooms. Concrete stairs,ADA access ramps and retaining walls were also constructed. Note: Additional references may be provided Adrienne C.Stevenson Vice President Marsh USA Inc. MI MARSH 540 West Madison Street Chicago,IL 60661-3630 +1 312 627 6772 Adrienne.C.Stevenson @marsh.com www.marsh.com August 24,2015 Ms.Yusbel Gonzalez ' Senior Procurement Specialist City of Miami Beach 1700 Convention Center Drive,4th Floor Miami, Florida 33139 ` Re: FHP Tectonics Corp. F Project: South Pointe Park Water Feature Remediation ITB No.2015-191-YC To Ms. Gonzalez: r Continental Casualty Company is the Surety for FHP Tectonics Corp. since 2002 and Marsh USA Inc. is their surety agent that currently has the privilege of providing bonds for FHP Tectonics Corp. FHP Tectonics Corp.'s financial strength and management capabilities have qualified them for bonding on any project,which they have chosen to undertake. As such, Continental Casualty Company highly recommends them for your favorable consideration on your project. FHP Tectonics Corp. has been extended a bonding facility, which has supported individual projects up to $250,000,000.00 and an aggregate work program in the $1,000,000,000.00 range. FHP Tectonics Corp. currently has in excess of$500,000,000.00 in available bond capacity. Surety bonds are issued through the Continental Casualty Company which is rated A XV by AM Best and is listed in the Federal Register as an acceptable surety authorized to do business in the Commonwealth of Virginia. State of Incorporation is Illinois; 333 S. Wabash Avenue;41st Floor;Chicago, Illinois 60604. Continental Casualty Company holds FHP Tectonics Corp. in the highest regard. We heartily endorse their organization and will provide the requisite bonding should the project be awarded to FHP Tectonics Corp. This commitment is subject to acceptable contractual and underwriting terms and conditions. Sincerely, Continental Casual Company 414944L,_ .,. e Adrienne C.—Stevenson Attorney-in-Fact 000 MARSH&McLENNAN LEADERSHIP,KNOWLEDGE,SOLUTIONS...WORLDWIDE. COMPANIES STATE OF ILLINOIS COUNTY OF COOK I, Rebecca J. Hobbs , a Notary Public in and for said County do hereby certify that Adrienne C. Stevenson Attorney-in-Fact, of these: Continental Casualty Company An Illinois Corporation American Casualty Company of Reading Pennsylvania A Pennsylvania Corporation National Fire Insurance Company of Hartford A Connecticut Corporation , Western Surety Company A South Dakota Corporation who is personally known to me to be the same person whose name is subscribed to the foregoing instrument appeared before me this day in person, and, acknowledged that they signed, sealed, and delivered said instrument for and on behalf of: Continental Casualty Company An Illinois Corporation American Casualty Company of Reading Pennsylvania A Pennsylvania Corporation National Fire Insurance Company of Hartford A Connecticut Corporation Western Surety Company A South Dakota Corporation for the uses and purposed therein set forth. Given under my hand and notarial seal at my office in the City of Chicago in said County, this 24th day of Au.ust A.D. 2015 . --Whiv. . , .- , o ary b cc OFFICIAL SEAL .1 REBECCA J. HOBBS Notary Public-State of Illinois ,;My Commission Expires 8/06/2018 POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY-IN-FACT Know Ali Men By These Presents,That Continental Casualty Company,an Illinois insurance company,National Fire Insurance Company of Hartford,an Illinois insurance company,and American Casualty Company of Reading,Pennsylvania,a Pennsylvania insurance company(herein called "the CNA Companies"),are duly organized and existing insurance companies having their principal offices in the City of Chicago,and State of IIlinois, and that they do by virtue of the signatures and seals herein affixed hereby make,constitute and appoint C R Hernandez, Beatriz Polito,Adrienne C Stevenson, John K Johnson, Amy B Wickett, Katherine J Foreit, Michael Dougherty,Triniy Garcia,Rebecca Hobbs ,Individually of Chicago,IL,their true and lawful Attorney(s)-in-Fact with full power and authority hereby conferred to sign,seal and execute for and on their behalf bonds,undertakings and other obligatory instruments of similar nature -In Unlimited Amounts- and to bind them thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of their insurance companies and all the acts of said Attorney,pursuant to the authority hereby given is hereby ratified and confirmed. This Power of Attorney is made and executed pursuant to and by authority of the By-Law and Resolutions,printed on the reverse hereof,duly adopted,as indicated,by the Boards of Directors of the insurance companies. In Witness Whereof,the CNA Companies have caused these presents to be signed by their Vice President and their corporate seals to be hereto affixed on this 9th day of June,2015. eas�v��, �asugq�, �vNMrco Continental Casualty Company �� , . `' oo ,�°° 'Po National Fire Insurance Company of Hartford QaRP.NATF I S ocalutw rEa' American Cast Ity Company of Reading,Pennsylvania 0 I JULYY 31. g C6 SEAL 'c i. 1897 Haa • dga...../7, Paul T.Bruflat Vice President State of South Dakota,County of Minnehaha,ss: On this 9th day of June,2015,before me personally came Paul T.Bruflat to me known,who,being by me duly sworn,did depose and say: that he resides in the City of Sioux Falls,State of South Dakota;that he is a Vice President of Continental Casualty Company,an Illinois insurance company, National Fire Insurance Company of Hartford,an Illinois insurance company,and American Casualty Company of Reading,Pennsylvania,a Pennsylvania insurance company described in and which executed the above instrument;that he knows the seals of said insurance companies;that the seals affixed to the said instrument are such corporate seals;that they were so affixed pursuant to authority given by the Boards of Directors of said insurance companies and that he signed his name thereto pursuant to like authority,and acknowledges same to be the act and deed of said insurance companies. 4 :.. + S. ETCH ia� NOTARY PUBLIC/its • SOUTH OAKOTA i *%4..t.....4......k..........%%%%%+ My Commission Expires February 12,2021 S.Eich otary Public CERTIFICATE I,D.Bult,Assistant Secretary of Continental Casualty Company,an Illinois insurance company,National Fire Insurance Company of Hartford,an Illinois insurance company,and American Casualty Company of Reading,Pennsylvania,a Pennsylvania insurance company do hereby certify that the Power of Attorney herein above set forth is still in force,and further certify that the By-Law and Resolution of the Board of Directors of the insurance companies printed on the reI'14 'a hereof is still in force. In testimony whereof I have hereunto subscribed my name and affixed the seal of the said insurance companies this day of Au c.c 4- ,oZQl� . L� (IIy Continental Casualty Company O' National Fire Insurance Company of Hartford 0 3 of aWP0R4 American Casualty Company of Reading,Pennsylvania JULY31.z ' , t9ot 4. . .Gk. o ±- 7891 HA4CIO • D.Butt Assistant Secretary Form F6853-4/2012 rip FHP TECTONICS CORP. N GENERAL CONTRACTORS Financial Information (Attached in Yellow Envelope) 2 SOUTH FEDERAL HIGHWAY • DANIA BEACH, FL 33004 PHONE (305) 940-0264 • FAX (305) 940-0265 www.fhpaschen.com s Fl-P FHP TECTONICS CORP. A 1 GENERAL CONTRACTORS Tab C Financial Statements 2 SOUTH FEDERAL HIGHWAY • DANIA BEACH, FL 33004 PHONE (305) 940-0264 • FAX(305) 940-0265 www.fhpaschen.com D&B Supplier Qualifier Report: FHP TECTONICS CORP. Page 1 of 2 Supplier Qualifier Report pig FHP TECTONICS CORP. a Print Entire Report Decide with Confidence D-U-N-S®Number 15-427-8118 ®E-mail Report lal Save HTML Report Copyright 2014 Dun&Oradsti eet-Provided under contract for the exclusive use of subscriber 100150009 ATTN: FHP TECTONICS CORP. Report Printed:APR 15 2014 In Date f1 I History. Products& I j Overview Operations Services Payments I finance Public Filings ! Operations OVERVIEW BUSINESS INFORMATION (?7 About Business tnformati,sn Business Information FHP Tectonics Corp.does not subscribe to D&B PAYDEX® FHP TECTONICS CORP. Summary Analysis 5515 N East River Rd Dun&Bradstreet,thus our history is identified as Risk Score Analysis Chicago, IL 60656 "Incomplete". Probability of Ceased To reflect the financial stability of the company.please find the Inactive nstsacominq Rating Change nact attached letter from MB Financial dated August 24,2015. Diversity Do not confuse with with F H Paschen,SN Neilsen, D-U-N-5® Customer Service Inc. Duns#87-633-2040.. 15-427-8118 HISTORY&OPERATIONS • This Is a single location. Number: History Telephone: 773 444-3474 Business Reelstration 0 D&S Rating: -- Operations Chief executive: JAMES BLAIR,PRES Formerly PRODUCTS&SERVICES • 1R3 UNSPSC Year started: 1996 •lump to: Summary NAICS Analysis SIC SeCtio Employs: 250 PAYMENTS D&B Supplier 8 • D&B PAYDEX History: INCOMPLETE Risk: Payment Summary payment Details Financing: SECURED SUPPLIER EVALUATION RISK(SER)RATING Payment Trends •Jump to: finance Section FOR THIS FIRM:8 • • FINANCE V Financq 9 I 7 6 5 4 3 2 1 PUBLIC FILINGS • UCC Filings High Medium Low Government Activity D&B PAYDEX@ ® About D&B PAYDEX@ D&B PAYDEX: 58 D&B PAYDEX Key When weighted by dollar amount, payments to suppliers average 24 days beyond terms. • High risk of late payment o —� 100 (average 30 to 120 days beyond terms) ❑ Medium risk of late payment 120 days slow 30 days slaw Prompt Anticipates (average 30 days or less beyond terms) • Low risk of late payment (average prompt to 30+ days sooner) Based on up to 24 months of trade. •Jump to: Payments Section Q 0&B Score Interpretation Table. SUMMARY ANALYSIS U About Summary Analysis 0 D&B Rating:-- The Rating was changed on June 3, 2013 because of D&B's overall assessment of the company's financial, payment and history Information.The blank rating symbol should not be interpreted as indicating that credit should be denied. it simply means that the information available to D&B does not permit us to classify the company within our rating key and that further enquiry should be made before reaching a decision.Some reasons for using a"-"symbol include:deficit net worth,bankruptcy proceedings, insufficient payment information,or incomplete history Information.For more Information, see the D&B Rating Key. Below Is an overview of the company's rating history since 05/08/00: • D&B Rating Date Applied file://C:\Documents and Settings\vlee\I_,ocal Settings\Temporary Internet Files\Content.Out... 4/15/2014 D&B Supplier Qualifier Report: FHP TECTONICS CORP. Page 2 of 2 06/03/13 1R3 04/11/12 02/17/09 1R3 10/17/06 4A2 05/19/04 4A3 05/15/03 05/08/00 The Summary Analysis section reflects information In D&B's file as of April 14, 2014. RISK SCORE ANALYSIS About.Risk Score Anelysiq SER COMMENTARY: - Higher risk industry based on Inactive rate for this industry. - Proportion of past due balances to total amount owing. - Proportion of slow payment experiences to total number of payment experiences reported. - Recent high balance past due. PROBABILITY OF CEASED OPERATIONS/BECOMING INACTIVE SUPPLIER EVALUATION RISK RATING:8 The probability of ceased operations/becoming Inactive indicates what percent of U.S. businesses Is expected to cease operations or become inactive over next 12 months. Probability of Supplier Ceased 13.0% (1,300 PER 10,000) Operations/Becoming Inactive: Percentage of US business with same SER 12% (1,200 PER 10,000) score: Average Probability of Supplier Ceased 5.60% (560 PER 10,000) Operations/Becoming Inactive: -Average of Businesses in D&B's Supplier Database Q CREDIT DELINQUENCY SCORE: 296 DIVERSITY 0 About Diversity Minority-Owned Business: N/A Historically Underutilized Business: N/A Women-Owned Business: N/A Veteran-Owned Business: N/A Disadvantaged Business Enterprise: N/A Vietnam Veteran Business: N/A Small Disadvantaged Business: N/A Disabled-Owned Business: N/A HUB-Zoned Certified Business: N/A Historical College Classification: N/A • SBA 8(a)Certified: N/A Labor surplus area: YES (2014) Small Business: N/A CUSTOMER SERVICE If you have questions about this report,please call our Customer Resource Center at 1.800.234.3867 from anywhere within the U.S. If you are outside the U.S.contact your local D&B office. ***Additional Decision Support Available*** Additional D&B products, monitoring services and specialized investigations are available to help you evaluate this,company or its industry.Call Dun&Bradstreet's•Customer Resource Center at. 1 anaLir386"intrra81Mil.khin thePtacili.i ►RrebsiF-S Ig yr r►i1.rc trc4 Public t,tir�ga Print Entire Report g-mall Report Save HTML Report Order an Investigation Copyright 2014 Dun&Bradstreet-Provided under contract for the exclusive use of subscriber/00150009 file://C:\Documents and Settings\vlee\Local Settings\Temporary Internet Files\Content.Out... 4/15/2014 i Adrienne C.Stevenson Vice President Marsh USA Inc. Oil 1011/`1 R S 540 West Madison Street /�1 Chicago,IL 60661-3630 +1 312 627 6772 Adrienne.C.Stevenson @marsh.com www.marsh.com August 24,2015 Ms. Yusbel Gonzalez Senior Procurement Specialist City of Miami Beach 1700 Convention Center Drive,4'h Floor Miami,Florida 33139 Re: FHP Tectonics Corp. Project: South Pointe Park Water Feature Remediation [TB No.2015-191-YC To Ms.Gonzalez: Continental Casualty Company is the Surety for FHP Tectonics Corp. since 2002 and Marsh USA Inc. is their surety agent that currently has the privilege of providing bonds for FHP Tectonics Corp. FHP Tectonics Corp.'s financial strength and management capabilities have qualified them for bonding on any project,which they have chosen to undertake. As such, Continental Casualty Company highly recommends them for your favorable consideration on your project. FHP Tectonics Corp. has been extended a bonding facility, which has supported individual projects up to $250,000,000.00 and an aggregate work program in the $1,000,000,000.00 range. FHP Tectonics Corp. currently has in excess of$500,000,000.00 in available bond capacity. Surety bonds are issued through the Continental Casualty Company which is rated A XV by AM Best and is listed in the Federal Register as an acceptable surety authorized to do business in the Commonwealth of Virginia. State of Incorporation is Illinois; 333 S. Wabash Avenue;41st Floor;Chicago,Illinois 60604. Continental Casualty Company holds FHP Tectonics Corp. in the highest regard. We heartily endorse their organization and will provide the requisite bonding should the project be awarded to Fl-IF Tectonics Corp. This commitment is subject to acceptable contractual and underwriting terms and conditions. Sincerely, Continental Casual Compan L e Adrienne C. Stevenson Attorney-in-Fact • 000 MARSH&MCIES LENNAN LEADERSHIP,KNOWLEDGE,SOLUTIONS..WORLDWIDE. COM STATE OF ILLINOIS COUNTY OF COOK I, Rebecca J. Hobbs ,a Notary Public in and for said County do hereby certify that Adrienne C. Stevenson Attorney-in-Fact, of these: Continental Casualty Company An Illinois Corporation American Casualty Company of Reading Pennsylvania A Pennsylvania Corporation National Fire Insurance Company of Hartford A Connecticut Corporation Western Surety Company A South Dakota Corporation who is personally known to me to be the same person whose name is subscribed to the foregoing instrument appeared before me this day in person, and, acknowledged that they signed, sealed,and delivered said instrument for and on behalf of: Continental Casualty Company An Illinois Corporation American Casualty Company of Reading Pennsylvania A Pennsylvania Corporation National Fire Insurance Company of Hartford A Connecticut Corporation Western Surety Company A South Dakota Corporation for the uses and purposed therein set forth. Given under my hand and notarial seal at my office in the City of Chicago in said County, this 24th day of Au.ust A.D. 2015 . 710-Ati, . 1 .— ' ' oar ' ib is �. OFFICIAL SEAL REBECCA J.HOBBS N Notary Public-State of Illinois . My Cornrnission Expires 8/06/2018' ' , POWER OF ATTORNEY APPOINTLNG INDIVIDUAL ATTORNEY-IN-FACT • Know All Men By These Presents,That Continental Casualty Company,an Illinois insurance company,National Fire Insurance Company of Hartford,an Illinois insurance company,and American Casualty Company of Reading,Pennsylvania,a Pennsylvania insurance company(herein called I "the CNA Companies"),are duly organized and existing insurance companies having their principal offices in the City of Chicago,and State of Illinois, and that they do by virtue of the signatures and seals herein affixed hereby make,constitute and appoint C R Hernandez, Beatriz Polito, Adrienne C Stevenson, John K Johnson, Amy B Wickett,Katherine J Foreit, Michael Dougherty,Triniy Garcia,Rebecca Hobbs ,Individually of Chicago,IL,their true and lawful Attorney(s)-in-Fact with full power and authority hereby conferred to sign,seal and execute for and on their behalf bonds,undertakings and other obligatory instruments of similar nature -In Unlimited Amounts- and to bind them thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of their insurance companies and all the acts of said Attorney,pursuant to the authority hereby given is hereby ratified and confirmed. This Power of Attorney is made and executed pursuant to and by authority of the By-Law and Resolutions,printed on the reverse hereof,duly adopted,as indicated,by the Boards of Directors of the insurance companies. In Witness Whereof,the CNA Companies have caused these presents to be signed by their Vice President and their corporate seals to be hereto affixed on this 9th day of June,2015. 10--ASUZ Continental Casualty Company r �.� twsuRgycF �y0 ►vwnc�o'Fc National Fire Insurance Company of Hartford o POAarfi i �'0,oavoagrto"3 American Cas illy Company of Reading,Pennsylvania Ov SEAL z ! r JULY I' . / / 1897 HARD • --7, Paul T.Bruflat Vice President State of South Dakota,County of Minnehaha,ss: On this 9th day of June,2015,before me personally came Paul T.Bruflat to me known,who,being by me duly sworn,did depose and say: that he resides in the City of Sioux Falls,State of South Dakota;that he is a Vice President of Continental Casualty Company,an Illinois insurance company, National Fire Insurance Company of Hartford,an Illinois insurance company,and American Casualty Company of Reading,Pennsylvania,a Pennsylvania insurance company described in and which executed the above instrument;that he knows the seals of said insurance companies;that the seals affixed to the said instrument are such corporate seals;that they were so affixed pursuant to authority given by the Boards of Directors of said insurance companies and that he signed his name thereto pursuant to like authority,and acknowledges same to be the act and deed of said insurance companies. y rrltirl�00.HhrlKti..re.....r+ S.EICH # i%NOTARY PUBLIC; o SOUTH OAKOTA s avva.►narr•..♦ . My Commission Expires February 12,2021 S.Eich otary Public CERTIFICATE 1,D.Bult,Assistant Secretary of Continental Casualty Company,an Illinois insurance company,National Fire Insurance Company of Hartford,an Illinois insurance company,and American Casualty Company of Reading,Pennsylvania,a Pennsylvania insurance company do hereby certify that the Power of Attorney herein above set forth is still in force,and further certify that the By-Law and Resolution of the Board of Directors of the insurance companies printed on the reverse hereof is still in force. In testimony whereof I have hereunto subscribed my name and affixed the seal of the said insurance companies this_ 6(144-1\ day of Ati v 4- ,eZOls— • foiwoRAre cA„suc,�� tasueq,� Continental Casualty Company - �, �� t° National Fire Insurance Company of Hartford . Ci_ cg �r, ��c�+P ail, American Casualty Company of Reading,Pennsylvania ', AWL y f±..) SEAL Y '� t at 19oZ Ar 1897 HAR • D.Bult Assistant Secretary Form F6853-4/2012 FHP TECTONICS CORP. N GENERAL CONTRACTORS Financial Information (Attached in Yellow Envelope) 2 SOUTH FEDERAL HIGHWAY • DANIA BEACH, FL 33004 PHONE (305) 940-0264 • FAX(305) 940-0265 www.fhpaschen.com rf FHP TECTONICS CORP. N GENERAL CONTRACTORS Tab D Experience and Key Personnel 2 SOUTH FEDERAL HIGHWAY • DANIA BEACH, FL 33004 PHONE (305)940-0264 • FAX(305)940-0265 www.fhpaschen.com 1" FHP TECTONICS CORP. _N GENERAL CONTRACTORS Project Management Approach The approach that FHP will take to this project is to operate as a team,together with the Owner and Architect.Throughout each phase,the value we add to the process will begin during permitting and procurement, increasing during construction,and continuing through close-out. Our approach is to support the successful execution of the work,contributing scheduling/sequencing,budget control, quality control,and safety expertise from the moment we're on board. Agenda items at each meeting will include discussion of each of these topics.The Team will track all documentation, including correspondence, submittals,change orders, RFIs,billings,meeting minutes,transmittals,daily reports,etc. Field Survey We have thoroughly reviewed the documents,and after the site walk-through,we have a detailed understanding of the areas and conditions where the work will be taking place.After award,we will complete an expedited investigation of existing conditions with minimal wall penetrations and ceiling examinations,so that unforeseen conditions are further minimized. This will be done in two stages:once before design of a phase of work,and again after the areas have been demolished.These surveys will reveal conditions that would otherwise be"unforeseen"—virtually eliminating the chance of delay. Logistics Planning& Scheduling/Phasing The best way to sequence construction adjacent to public activity is with a detailed yet flexible work plan,built upon a foundation of open,precise communication. We will always have a current,exhaustive awareness of your needs within the adjacent,occupied areas,and have the phasing and logistics plans to accommodate these needs. We will be prepared to reschedule project tasks,because each task and its predecessors and successors, as well as the project milestones on the critical path,will be in our CPM scheduling software. When considering the tasks to reschedule,we will easily see which tasks can be built out-of-sequence,which can run in parallel,and which have to remain part of the critical path. Phasing decisions will take into account potential cost efficiencies,such as opportunities to utilize subcontractor forces' time more effectively,purchasing and delivering goods efficiently,minimizing the durations of equipment rentals,etc. We understand that needs often change.Examples of such changes include operation's immediate need for spaces that were to be occupied by construction,or events that require adjustments to logistics plans. We will be flexible in order to accommodate changes such as these.The best way to prepare for these occurrences is by proactively preparing alternate phasing plans. If construction sequencing"Plan A"is disrupted,we will always have a"Plan B"at the ready. 2 SOUTH FEDERAL HIGHWAY • DANIA BEACH, FL 33004 PHONE(305) 940-0264 • FAX (305) 940-0265 www.fhpaschen.com MINE I"11.1 p FHP TECTONICS CORP. N GENERAL CONTRACTORS •• As spaces near completion,we will work with you to outline and re-confirm the priorities for group relocations,activities and events that may prevent access to areas during certain times,and other factors that influence project scheduling options.The end result will be that transitions of all relocating of groups to their new locations to be efficient and seamless—for the employees and the general public. Permitting(Expediting) We are well-versed in the City building permit process and have strong relationships with employees in the permitting office. We will utilize this knowledge to fast-track progression through the various stages of approval. If it becomes necessary, we will enlist the support of a permit expediting service.This comprehensive approach will ensure the project documents are expedited through the approval process and construction will be allowed to begin as soon as possible. Procurement The long lead items and/the components that are tied to early stages of the critical path will be identified on the schedule,and submittals for those critical items will receive special handling through the submittal process.Orders will be placed for long lead items as soon as practical and their progress through fabrication will be tracked on the project schedule. If material fabrication is completed before those materials are needed in the field,we will take early delivery of that material so it will not adversely affect the progress of the work. Staging and Site Cleanliness FHP will work with the Owner to develop the most efficient staging plan to minimize any inconvenience. The staging plan shall include but not be limited to the following: • Construction site cleanliness • Dust control • Site safety and access • Equipment movement • Truck and delivery access • Off-site storage • Construction worker access • Demolition and debris removal • Pedestrian access outside of the construction areas Debris will be kept to a minimum,and construction site cleanliness will be a priority.Any demolition activities will be broom-swept as they occur. FHP will stage all surplus work materials behind temporary partitions. Any materials staged outside of these areas shall be for immediate use of the particular construction task for which the materials are required. As with all of our renovation and build-out projects,we will work hand-in-hand with Owner's staff to minimize disruptions.This will be accomplished by keeping open lines of communication and 2 SOUTH FEDERAL HIGHWAY • DANIA BEACH, FL 33004 PHONE (305) 940-0264 • FAX(305) 940-0265 www.fhpaschen.com Fl-P FHP TECTONICS CORP. -: N GENERAL CONTRACTORS maximizing efficiency during any periods in which the area is not occupied or minimally utilized. Utility shutdowns,work that creates a large amount of noise or other activities that should only be done when the area is as vacated as possible will be coordinated with you accordingly. FHP will coordinate process plans,shut-down notices,and any needed signage,graphics and/or illustrations required,all in order to keep all parties informed of changes in access/egress routes as needed throughout the duration of the project. Quality The FHP Team takes its responsibility to monitor and control quality very seriously.Our process assures that all work will be in compliance with the Contract Documents and meet all applicable federal,state, local,and department building codes. • Project:Our Project Superintendent will conduct regular inspections of the jobsite to ensure that all work is being installed to the established standards of quality.The Project Manager will fortify his efforts with their daily project oversight.Any unsatisfactory work will be rejected and reinstalled as required throughout the project,so that the punch-list by the final walkthrough is minimal. • Personnel:Our program begins by hiring the best subcontractors,who not only provide competitive pricing but also deliver a quality product. At contract negotiation,we will define the level of quality expected from a subcontractor. Prior to work shifts,the Project Superintendent will meet with the work crews—comprised of both FHP employees and those of all active subcontractors on-site—to review a detailed Job Hazard Analysis(JHA)for the day.The team will discuss the work to be • performed and outline any Quality Control testing scheduled for that day.Not only does this program reduce accidents and injuries, it fosters a team spirit consistent with the theme of"looking out for each other."This approach raises the awareness of craftsmen,so that the final product is high-quality and delivered on time,in a safe manner,and within budget. Safety Paschen is committed to safety on all our projects.All of our staff goes through the OSHA 30-hour training program.Our safety approach will include an assessment of the construction site and establish site-specific procedures to help insure a safe work environment.Our Project Superintendent, with support from the Project Manager,will manage project safety.They will continually monitor the project to prevent unsafe work practices and eliminate work harards before accidents occur.They will advise the project staff of changes that should be made to improve the overall safety on the project,and this information will be incorporated into the monthly report. There are several means by which we will assure the safety of personnel and the general public. • Where required,physical barriers will be erected and visual notifications posted to restrict all public access to the work areas. • Physical barricades will be erected at the perimeter of each construction area in order to cordon off all work areas from the traffic of personnel. • Visual notifications will be posted to further reinforce the need to separate employees from construction operations. 2 SOUTH FEDERAL HIGHWAY • DANIA BEACH, FL 33004 PHONE (305) 940-0264 • FAX(305) 940-0265 www.fhpaschen.com INNI r' FHP TECTONICS CORP. N GENERAL CONTRACTORS • Direct,daily,written communication will be conducted with management,which can be readily dispersed as memos to employees to inform of current construction tasks and upcoming events. • Our project team will create and submit for approval,a haul route to be used by vehicles for the transportation of materials and equipment to and from the project site. This plan will be devised with the requirements of all operations in mind. Project Close-Out For all work,we will establish a Contractor's pre-final punch-list prior to completion. It will be prepared in spreadsheet form and distributed to our subcontractors.Throughout the performance of the contract, we will be updating as-built documentation to include Operations& Maintenance information and warranties.The Project Superintendent will be in charge of monitoring the progress of the outstanding items and push for the preparation of the project for inspection and acceptance: We will schedule and document on-site training for all equipment as required.Once these tasks are finished,we will submit a complete package with all of the closeout documents and request final acceptance on the project. As-built drawings will be produced and maintained by the Project Superintendent as the work progresses. At project completion,the Project Manager will review the as-built drawings and then turn them over after he has certified they are accurate and complete.Once all of the contract work has been completed, punch-list items have been properly resolved,and all contractually required paperwork has been submitted,the Project Manager will issue a final Notice of Completion.This will certify that all contract requirements have been completed by the contractor. Experienced construction administration is key. Knowledge,as well as application of established procedures is often revealed in a company's track record for Quality Assurance.The completeness and accuracy of the following documents,which are maintained throughout the process,is the best indicator of what will result. • Meeting Minutes • Schedules • Diaries • Reports • Health and Safety Standards • Materials Samples • As-Built Records • Test and Inspection Filing 2 SOUTH FEDERAL HIGHWAY • DANIA BEACH, FL 33004 PHONE (305) 940-0264 • FAX (305) 940-0265 www.fhpaschen.com cn c 0 co a) 0. 0 ea 10 i _0 LL r co L U I. a) c c c L OA c O a C s. CC • to V Cl) �, G., o .°_ .v O a2 °' ; ; C. °' 'o H ° a .o'' O.F CA W a. 0 4 a' — 0 as :o an c -4 O L 'L y «d R U. a c 'N CT N f— i 4.1 0 a) '0 ct > Q 4 0 2 O +. , a a �, ,� :� C o z 0. cc O. Li] Q o co 0 •c � •ea .o a .aw O C!) Q ,.., 'Q �. a. Q a z Riley Barron Operations Manager 1 f- , Professional Experience Riley has nine years of industry experience,including five years with FHP.He joined .. the Company as a Project Engineer,was promoted to Project Manager and recently was 1 - ,r promoted to Operations Manager overseeing all department activities on an operational , ii iii, , ,�.iii,; I; level in our Florida office,including the Museum Park Baywalk&Promenade. He is I, i ,, vi:: *(7:1;17.1 °+ s 1. experienced in overseeing all phases of multimillion-dollar construction projects,for e't1•, hret a t both public and private-sector clients. Prior to moving to Florida,Riley oversaw the hi:it:I:NU i a' i IA ,:. . construction of the new South Plaquemines High School in Buras,LA. Riley is also an active member of FHP's Corporate Safety Committee. Registrations/Certifications • Construction Quality Management for Contractors • OSHA 30 HR Education • BradIey University B.S.,Civil Engineering&Construction Minor Accounting& Business Management Representative Projects CITY OF MIAMI • Museum Park Baywalk& Promenade Ph II& III $8,553,620-The Museum Park project consisted of Phases H&III. Phase 2 consisted of soil remediation, demolition,earthwork, underground drainage and water utilities,a new paver baywalk,new concrete sidewalks and pathways,tree transplants,new lighting,new site furnishings,new landscaping and sod,and new irrigation. Phase 3 consisted of a new paver promenade walkway,concrete stairs and ramps,concrete sidewalks and pathways,retaining walls,new lighting,new site furnishings,new landscaping and sod,and new irrigation for the promenade walkway. • Armbrister Park $1,100,000—Design/Build project consisting of a 108,000 SF synthetic turf field to accommodate an American football field,soccer field,and a softball field including all sub-base and base preparation and drainage. Four existing metal bleachers were also repaired,painted,and relocated,after which the existing concrete pads were demolished,and electrical poles,lighting,fencing and trees were relocated or removed as necessary for the construction of the new fields. Additional features included: • Long Jump Pit • 4 lanes 50 meters straight away running track with 10 meters run-out room at each end • Drainage system/permeable base for the synthetic turf system installation PLAQUEMINES PARISH SCHOOL BOARD • South Plaquemines High School,Buras,LA $37,164,000-The new South Plaquemines High School was elevated 17' to be above the flood plain and was constructed on wood piling with concrete foundations,columns,and elevated slab.The new 152,932 sf school contains an 11,166 sf auditorium/theater with seating for 647 people,classrooms,science labs,gymnasium,and child facilities.The building is designed and built to meet hurricane wind loads of 145 MPH. Riley Barron Operations Manager Previous Project Experience US Army Corps of Engineers,Chicago Harbor Breakwater Repair,Chicago,IL Approximately 5000 LE of structural repairs to the Chicago Harbor Exterior Breakwater system that is located 1.5 miles east of Navy Pier. Deterioration due to low lake levels caused structural damage over time that initiated failure to the concrete cap of the breakwall. Repairs consisted of drilling holes through the existing concrete cap and injecting a specialized grout mixture into the structure to fill voids and enhance structural capacity. RDM Development,Vision on Division,Chicago,IL The Vision on Division development is 33 condos,about 9,000 square feet of commercial space and roughly 11 l parking spots in the underground parking structure.33,000-square-foot mixed-use development is planned for a vacant lot just east of the MB Financial bank at the corner of Ashland and Division. The structure is a cast in place concrete system with caisson foundations,and the envelope is primarily a impact resistant curtain wall system. Chicago Transit Authority,Blue Line Tie Replacement,Chicago, IL This project focused on eliminating slow zones on the CTA Blue Line branch from Addison to O'Hare.The contract includes 105,000 track feet of rebuilt railroad,65,000 new composite ties and 28,000 track feet of new steel.The rebuilt railroad will allow the trains to average 55 mph. RTD and Denver Transit Partners,Eagle P3 Project, Denver,CO Eagle P3 is a public-private partnership comprised of RTD's East Rail Line,Gold Line,Commuter Rail Maintenance Facility and Northwest Rail Line Westminster segment.The total 36 miles of new commuter rail lines are scheduled to open one at a time in sequence in 2016.Job duties included overseeing the front end design of the superstructures associated with the thirty-four bridges to be constructed from the Denver International Airport to Denver Union Station Illinois Department of Transportation,"Upgrade 74", Peoria, IL The$461 million,three-year project consisted of three stages aimed at providing motorists with a safer,better looking highway. Under the plans created by eight engineering firms, 1-74 from East Peoria through Peoria was completely removed and replaced;all the ramps will be removed and replaced with safer ramps;40 bridges were constructed or reconstructed;and new overpasses,additional lanes,new pavement,new lighting and landscaping were added. David Roy Senior Project Manager Professional Experience David has 16 years of construction industry experience including 14 years with Paschen. After working in our West Lafayette office and at our Corporate Headquarters in Chicago, David was promoted to Senior Project Manager and transferred to lead our Florida operations. David s responsibilities include _. planning,directing,and the coordination of all job requirements.He is tasked with �` ensuring that the goals and objectives specified for successful operations area b accomplished according to established priorities,project schedules,and budget 4 concerns. He currently oversees a growing staff of seven Project Managers, Engineers and Field Superintendents. Registrations/Certifications • State of Florida-Certified General Contractor • OSHA 30 Hour • 30 HR OSHA Refresher • OSHA 10 Hour • First Aid CPR AED • ASHE-Healthcare Construction Certificate Education • Purdue University B.S., Building Construction Management Representative Projects CITY OF MIAMI • Museum Park Baywalk&Promenade Ph II&III $8,553,620-The Museum Park project consisted of Phases H& III. Phase 2 consisted of soil remediation, demolition,earthwork, underground drainage and water utilities,a new paver baywalk,new concrete sidewalks and pathways,tree transplants,new lighting,new site furnishings,new landscaping and sod,and new irrigation. Phase 3 consisted of a new paver promenade walkway,concrete stairs and ramps,concrete sidewalks and pathways,retaining walls,new lighting,new site furnishings,new landscaping and sod,and new irrigation for the promenade walkway. • Black Police Precinct and Museum Restoration $2,078,835-This was a restoration of a historic police precinct to its original state with improvements.The building also now includes a museum and courthouse. • Curtis Park Sports Turf Improvements&Bleachers $1,630,904-Installation of synthetic field turf football/soccer field, including new drainage system,artificial turf surface manufactured by Field Turf,rubberized track repair, field goals and soccer goals,new pole vault and reconstructed long jump. • Henry Reeves Park Community&Service Building $238,381 -2,500 sf renovation to community center including new windows,roll down security shutters,new restrooms, new computer lab,HVAC upgrades,new finishes David Roy Senior Project Manager • Antonio Maceo Community Building $1,133,769-New community center on the west side of Antonio Maceo Park. The community center includes NET offices,computer lab,art room,patio,and multi-purpose room. • Bayfront Park Baywalk $507,710-Removal of existing sidewalks to facilitate the installation of the proposed landscaping.Also included was the installation of a new irrigation system in the south side of the park,an irrgiation pump,benches,and trash receptacles. • New Hadley Park Restroom/Concession Bldg. Value: $976,360-Construction of a new restroom and concession building at Hadley Park. CITY OF MIAMI BEACH • Fairway Park Pavilion $605,435-Construction of new community center/pavilion with restrooms,decorative fencing,associated sitework and landscaping. CITY OF MIAMI JOC 04-05-048(2804) $25 million job order contract over five terms for repair and renovation to various roads/bridges. Fifty-seven work orders were issued worth over$8 million ranging in value from$3,000 to over$1 million.The jobs consisted of miscellaneous"horizontal"projects including,but not limited to,park renovations,intersection improvements, storm water drainage,roadway improvements and bridge renovations.This contract was renewed for each term but not"maxxed out"due to lack of work orders issued by the City of Miami. Sample work orders: • Silver Bluff Traffic Calming Circles $1,031,608 • Shenandoah Traffic Calming Circles $1,377,336 • Battersea/Douglas Rd.Storm Upgrades $646,517 • Morningside Park Shoreline Stabilization $549,973 • Margaret Pace Park Shoreline Stabilization $593,859 CITY OF MIAMI JOC-VERTICAL CONSTRUCTION(2822) Value: $16,000,000 The$16 million Vertical Contract began in October 2009 and ran through October 2013. 112 work orders were awarded for a total value of$7,747,164.Typical work consisted of repair and renovation of vertical facility buildings owned by the City of Miami including interior renovation,abatement,selective demolition, HVAC upgrades and replacement,sitework,landscaping,etc. Sample work orders: • Juan Pablo Duarte Park Gazebo& Roof Remodeling $126,686 • Icon Park Playground $88,065 CHICAGO DEPARTMENT OF GENERAL SERVICES Marine Safety Station $3,747,987-The Marine Safety Station was designed to provide safety and security on Chicago's waterways and houses federal,state and local agencies. Built in 1935,the Marine Safety Station is eligible for listing on the National Register of Historic Places. Work on the 12,467 sf. building included: underwater repair of concrete columns,structural concrete repair,replacement of concrete caps and elevator deck,and replacement of concrete causeway. Some of the major features of this project included a command center,a conference center,and a floating boat dock. This facility is LEED Certified,which was accomplished while maintaining the building's original historic appearance. Adam Schaibley Project Engineer Professional Experience Adam has five years of construction industry experience,including three years with FHP. He joined the company as a laborer in 2012 and was promoted to Foreman six months into the job and later to Project Engineer in our Florida office. Adam's experience with field work as well as construction management allows him to better control projects from a scheduling(field work)and monetary (management)aspect. Prior to moving to Florida,Adam was assigned to the South Plaquemines High School project in Buras,LA where he was Foreman overseeing a labor crew of 15-20 daily,adhering to strict scheduling deadlines. Registrations/Certifications • First Aid/CPR • OSHA Certified Scaffold Builder Education • University of St. Francis B.S.,Business Management(Minor:Accounting&Finance) Representative Project Experience CITY OF MIAMI • Museum Park Baywalk& Promenade Ph 11& III $8,553,620-The Museum Park project consisted of Phases II& Ill. Phase 2 consisted of soil remediation,demolition,earthwork,underground drainage and water utilities,a new paver baywalk,new concrete sidewalks and pathways,tree transplants,new lighting,new site furnishings,new landscaping and sod,and new irrigation.Phase 3 consisted of a new paver promenade walkway,concrete stairs and ramps,concrete sidewalks and pathways,retaining walls,new lighting,new site furnishings,new . landscaping and sod,and new irrigation for the promenade walkway. • Moore Park ADA Renovations $30,000-This project consisted of the demolition of a City of Miami Public Works interior restroom located at Moore Park Tennis Center.The scope of working included removing existing and replacing shower floors,grab bars, fixtures,seats and handrails in order to meet ADA requirements. • Peacock Park Renovations $80,000-This project consisted of the demolition and interior reconstruction of a building at Peacock Park. The scope of work included abatement of tile floor,removing and replacing concrete slabs,asphalt restoration,removing and replacing sanitary lines,HVAC and electrical work and ADA modifications. CITY OF HALLANDALE BEACH • 39th Year CDBG Drainage Improvements $18 1,329-This project consisted of removing existing catch basins and French drains and replacing them with larger structures and pipe. There were a total of 16 structures and 600LF of CAP with multiple connections using RCP. Also included was the demolition and replacement of existing asphalt,concrete sidewalks,"F"and Drop curbs and installation of new sod. Adam Schaibley Project Engineer PLAQUEMINES PARISH SCHOOL BOARD • South Plaquemines High School,Buras,LA $37,164,000-The new South Plaquemines High School was elevated 17' to be above the flood plain and was constructed on wood piling with concrete foundations,columns,and elevated slab.The new 152,932 sf school contains an 11,166 sf auditorium/theater with seating for 647 people,classrooms,science labs, gymnasium,and child facilities.The building is designed and built to meet hurricane wind loads of 145 MPH. r Emif FHP TECTONICS CORP. N GENERAL CONTRACTORS Staffing Plan Operations Manager • Riley Barron • 2 South Federal Highway, Dania Beach, FL 33004 • E-mail: rbarron(afhpaschen.com • Cell: 224-645-6941 Senior Project Manager • David P. Roy • 2 South Federal Highway, Dania Beach, FL 33004 • E-mail: drov(a,fhpaschen.com • Cell: 954-548-0030 General Superintendent • Todd Gavitt • 2 South Federal Highway,Dania Beach, FL 33004 • E-mail: tgavitt(a�fhpaschen.com • Cell: 305-940-0264 Project Engineer • Adam Schaibley • 2 South Federal Highway, Dania Beach, FL 33004 • E-mail: aschaibley @fhpaschen.com • Cell: 773-951-6429 Subcontractors 2 SOUTH FEDERAL HIGHWAY • DANIA BEACH, FL 33004 PHONE(305) 940-0264 • FAX(305) 940-0265 www.fhpaschen.com Fl-P FHP TECTONICS CORP. N GENERAL CONTRACTORS Tab E Bid Price 2 SOUTH FEDERAL HIGHWAY • DANIA BEACH, FL 33004 PHONE (305) 940-0264 • FAX(305) 940-0265 www.fhpaschen.com APPENDIX A Price Form, Bid Tender Form, & Supplements ATTACHMENT A-1: ITB Price Form &Unit Price Breakdown form ATTACHMENT A-2: Bid Tender Form ATTACHMENT A-3: Supplement to Bid Tender Form: Contractor Qualification Statement ATTACHMENT A-4: Supplement to Bid Tender Form: Non-Collusion Certificate ATTACHMENT A-5: Supplement to Bid Tender Form: Drug Free Workplace Certification ATTACHMENT A-6: Supplement to Bid Tender Form: Equal Benefits Ordinance ATTACHMENT A-7: Supplement to Bid Tender Form: Trench Safety Act ATTACHMENT A-8: Supplement to Bid Tender Form: Recycled Content Information MIAMIBEACH BID NO:2015-191-YG CITYOF MIAMI BEACH BE BEACH N 49 A-1 City of Miami Beach ITB Price Form The TOTAL BASE BID amount includes the all-inclusive total cost for the work specified in this bid, consisting of furnishing all materials, labor, equipment, shoring, supervision, mobilization, demobilization, overhead and profit, insurance, permits, and taxes to complete the work to the full intent as shown or indicated in the contract documents. Any or all alternates, if applicable, may be selected at the City's sole discretion and based on funding availability. BIDDER MUST SUBMIT THIS ITB PRICE FORM FULLY COMPLETED, INCLUDING SECTIONS 1 AND 2, AS PART OF THE BID RESPONSE. FAILURE TO DO SO SHALL DEEM THE BIDDER NONRESPONSIVE. In the event of arithmetical errors between the division totals and the total base bid, the Bidder agrees that the total base bid shall govern. In the event of a discrepancy between the numerical total base bid and the written total base bid,the written total base bid shall govern. In absence of totals submitted for any division cost,the City shall interpret as no bid for the division,which may disqualify bidder. Section 1—Bidders Price: PROJECT TITLE: ITB 2015-191-YG: SOUTH POINTE PARK WATER FEATURE REMEDIATION COMPANY NAME:FHP Tectonics Corp. Cost 01-General Requirements $361,500.00 02-Site Work $450,000.00 03-Concrete $250,000.00 04-Thermal and Moisture Protection $1,000.00 05-Special Construction $425,000.00 06-Plumbing $30,000.00 07-Electrical $300,000.00 Permit Allowance $5,000.00 Owner's Contingency of 10%* $202,500.00 **Lump Sum Grand Total (Total Base Bid) (Divisions 01 to 07, Including Permit Allowance $2,025,000.00 and Owners Contingency of 10%) *ANY UNUSED PORTION OF THE 10%OWNER'S CONTINGENCY AT THE CONCLUSION OF THIS PROJECT SHALL BE RETURNED TO THE OWNER. **PROJECT SHALL BE AWARDED TO THE LOWEST, RESPONSIVE, RESPONSIBLE BIDDER OFFERING THE LOWEST LUMP SUM GRAND TOTAL(TOTAL BASE BID) 14 BID ALTERNATES: Total Alternate 1 Concrete Plaza with Shell Stone Aggregate $28,000.00 (Drawing HS-02 Detail 5A) Total Alternate 2 $ 12,000.00 Mat Foundation at Fountains(Drawing HS-120) Total Alternate 3 $93,000.00 Coral Stone Bench (Drawing LA-03 Detail 1A) Section 2-Bidder's Affirmation: Company: FHP Tectonics Corp. Address Line 1: 2 South Federal Highway Address Line 2: Dania Beach,FL 33004 Telephone: ,I ... :.� , Em- i oy @th I , .n.co Signatur- Alb A J Title/Printed Name: David P. I , enior Project Manager 15 Section 2-Bidder's Affirmation: Company: FHP Tectonics Corp. Address Line 1: 2 South Federal Highway Address Line 2: Dania Beach,Florida 33004 • Telephone: 31 ' 'i' Emai : dry (a : .con Signature: Title/Printed Name: David P.Roy,Senior Project Manager Submitted: September 16,2015 Date Balance of Page Intentionally Left Blank BID NO:2015-191-YG CITYOF MIAMI BEACH BE AC H 51 A-2 City of Miami Beach, Florida 1700 Convention Center Drive Miami Beach, Florida 33139 The undersigned, as Bidder, hereby declares that the only persons interested in this bid as principal are named herein and that no person other than herein mentioned has any interest in this bid or in the Contract to be entered into; that this bid is made without connection with any other person, firm, or parties making a bid; and that it is, in all respects, made fairly and in good faith without collusion or fraud. The Bidder further declares that it has examined the site of the Work and informed itself fully of all conditions pertaining to the place where the Work is to be done; that it has examined the Contract Documents and all addenda thereto furnished before the opening of the bids, as acknowledged below; and that it has satisfied itself about the Work to be performed; and all other required information with the bid; and that this bid is submitted voluntarily and willingly. The Bidder agrees, if this bid is accepted, to contract with the City, a political subdivision of the State of Florida, pursuant to the terms and conditions of the Contract Documents and to furnish all necessary materials, equipment, machinery, tools, apparatus, means of transportation, and all labor necessary to construct and complete within the time limits specified the Work covered by the Contract Documents for the Project entitled: INVITATION TO BID(ITB) No. 2015-191-VG SOUTH POINTE PARK WATER FEATURE REMEDIATION The Bidder also agrees to furnish the required Performance Bond and Payment Bond or alternative form of security, if permitted by the City, each for not less than the total bid price plus alternates, if any, provided in the ITB Price Form in Section 00408 and to furnish the required Certificate(s)of Insurance. In the event of arithmetical errors between the division totals and the total base bid in the ITB Price Form, the Bidder agrees that the total base bid shall govern. In the event of a discrepancy between the numerical total base bid and the written total base bid, the written total base bid shall govern. In absence of totals submitted for any division cost, the City shall interpret as no bid for the division, which may disqualify bidder. 16 A-2 Acknowledgment is hereby made of the following addenda (identified by number)received since issuance of this Solicitation: Amendment 1 August 20,2015 Amendment 6 Amendment 2 August 27,2015 Amendment 7 Amendment 3 September 3,2015 Amendment 8 Amendment 4 September 9,2015 Amendment 9 Amendment 5 Amendment 10 Attached is a Bid Bond ❑, Cash ❑, Money Order 0, Unconditional Letter of Credit ❑, Treasurer's Check ❑, Bank Draft ❑, Cashier's Check 0, or: Certified Check ❑ No. Not Applicable. Bank of for the sum of Dollars ($ ). The Bidder shall acknowledge this bid by signing and completing the spaces provided below. Name of Bidder: FHP Tectonics Corp. Address Line 1: 2 South Federal Highway Address Line 2: Dania Beach,Florida 33004 Telephone Number: 305-940-0264 • E-mail Address: droy @bpaschen.com Social Security Number: OR Federal l.D. Number: 36-4136428 Dun & Bradstreet No.: 157-427-8118 If a partnership, names and addresses of partners: Not Applicable. (Sign below if not incorporated) WITNESSES: (Type or Print Name of Bidder) Not Applicable. (Signature) (Type or Print Name Signed Above) BID NO:2015-191-YG CITYOF MIAMI BEACH BEACH 53 MIAMIBEACH City of Miami Beach,1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gov DEPARTMENT OF PROCUREMENT Tel: 305-673-7490 Fox: 786-394.4002 ADDENDUM NO. 1 INVITATION TO BID(ITB) NO. 2015-191-YG SOUTH POINTE PARK WATER FEATURE REMEDIATION AUGUST 20, 2015 This Addendum to the above-referenced ITB is issued in response to questions from prospective bidders, or other clarifications and revisions issued by the City. The ITB is amended in the following particulars only. 1. ITB DUE DATE AND TIME. The deadline for the receipt of bids is extended until 3:00 p.m., on Monday, August 31, 2015, at the following location. Please note the submittal address has been corrected: Miami Beach City Hall Procurement Department , 4- loor 1755 Meridian Avenue, 3`d Floor Miami Beach, Florida 33139 Note: This location is not in City Hal!. Vendors are cautioned to become familiar with the new location prior to the due date for bids or proposals. Late bids will not be accepted. Bidders are cautioned to plan sufficient time to allow for traffic or other delays for which the Bidder is solely responsible. A FORTHCOMING ADDENDUM WILL CONTAIN ANSWERS TO THE QUESTIONS RECEIVED AND UPDATED PLANS AND SPECIFICATIONS. Any questions regarding this Addendum should be submitted in writing to the Procurement Management Department to the attention of the individual named below, with a copy to the City Clerk's Office at RafaelGranado @miamibeachfl.gov. Procurement Contact: Telephone: Email: Yusbel Gonzalez 305-673-7000, ext. 6230 YusbelGonzalez @miamibeachfl.gov Proposers are reminded to acknowledge receipt of this addendum as part of your ITB submission. Potential proposers that have elected not to submit a response to the ITB are requested to complete and return the"Notice to Prospective Bidders"questionnaire with the reason(s)for not submitting a proposal. Sincer- i Alex DO" Procur-ment Director A David P.Roy,Senior Project Manager 1 MIAMIBEACH City of Miami Beach,1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachil.gov DEPARTMENT OF PROCUREMENT Tel: 305-673-7490 Fax: 786-394-4002 ADDENDUM NO. 2 INVITATION TO BID(ITB) NO. 2015-191-YG SOUTH POINTE PARK WATER FEATURE REMEDIATION AUGUST 27, 2015 This Addendum to the above-referenced ITB is issued in response to questions from prospective bidders, or other clarifications and revisions issued by the City. The ITB is amended in the following particulars only. 1. ITB DUE DATE AND TIME. The deadline for the receipt of bids is extended until 3:00 p.m., on Monday, September 7, 2015, at the following location. Please note the submittal address has been corrected: • Miami Beach City Hall Procurement Department , '1-Floor 1755 Meridian Avenue, 3`d Floor Miami Beach, Florida 33139 Note: This location is not in City Hall. Vendors are cautioned to become familiar with the new location prior to the due date for bids or proposals. Late bids will not be accepted. Bidders are cautioned to plan sufficient time to allow for traffic or other delays for which the Bidder is solely responsible. A FORTHCOMING ADDENDUM WILL CONTAIN ANSWERS TO THE QUESTIONS RECEIVED AND UPDATED PLANS AND SPECIFICATIONS. Any questions regarding this Addendum should be submitted in writing to the Procurement Management Department to the attention of the individual named below, with a copy to the City Clerk's Office at RafaelGranado @miamibeachfl.gov. Procurement Contact: Telephone: Email: Yusbel Gonzalez 305-673-7000, ext. 6230 YusbelGonzalez@miamibeachfigov Proposers are reminded to acknowledge receipt of this addendum as part of your ITB submission. Potential proposers that have elected not to submit a response to the ITB are requested to complete and return --"Notice to Prospective Bidders"questionnaire with the reason(s)for not submitting a proposal. cer�l Procurement Director David P.Roy, entor Project Manager 1 MAMIBEACH City of Miami Beach, 1700 Convention Center Drive,Miami Beach,Florida 33139,www.miamibeachfl.gov DEPARTMENT OF PROCUREMENT Tel: 305-673-7490 Fax: 786-394-4002 ADDENDUM NO. 3 INVITATION TO BID(ITB)NO. 2015-191-YG SOUTH POINTE PARK WATER FEATURE REMEDIATION SEPTEMBER 3, 2015 This Addendum to the above-referenced ITB is issued in response to questions from prospective bidders, or other clarifications and revisions issued by the City. The ITB is amended in the following particulars only. 1. ITB DUE DATE AND TIME. The deadline for the receipt of bids is extended until 3:00 p.m., on Monday, September 14, 2015, at the following location. Please note the submittal address has been corrected: Miami Beach City Hall Procurement Department 34-goof 1755 Meridian Avenue. 3rd Floor Miami Beach, Florida 33139 Note: This location is not in City Hall. Vendors are cautioned to become familiar with the new location prior to the due date for bids or proposals. Late bids will not be accepted. Bidders are cautioned to plan sufficient time to allow for traffic or other delays for which the Bidder is solely responsible. A FORTHCOMING ADDENDUM WILL CONTAIN ANSWERS TO THE QUESTIONS RECEIVED AND UPDATED PLANS AND SPECIFICATIONS. Any questions regarding this Addendum should be submitted in writing to the Procurement Management Department to the attention of the individual named below, with a copy to the City Clerk's Office at RafaelGranado @miamibeachfl.gov. Procurement Contact Telephone: Email: Yusbel Gonzalez 305-673-7000, ext. 6230 YusbelGonzalez @miamibeachfl.gov Proposers are reminded to acknowledge receipt of this addendum as part of your ITB submission. Potential proposers that have elected not to submit a response to the ITB are requested to complete and return the"Notice to Prospective Bidders"questionnaire with the reason(s)for not submitting a proposal. Sincer:i� Alex D:a• Procur= ent Director C7Lg.) David P.Roy,Senior Project Manager { 1 MIAMI BEACH City of Miami Beach, 1755 Meridian Avenue,3`d Floor Miami Beach,Florida 33139,www.miamibeochfl.gov DEPARTMENT OF PROCUREMENT Tel: 305-673-7490 Fox: 786.394.4002 ADDENDUM NO.4 INVITATION TO BID(ITB) NO. 2015-191-YG SOUTH POINTE PARK WATER FEATURE REMEDIATION September 9,2015 This Addendum to the above-referenced ITB is issued in response to questions from prospective proposers, or other clarifications and revisions issued by the City. The ITB is amended in the following particulars only. 1. ITB DUE DATE AND TIME. As a reminder, the deadline for the receipt of proposals is 3:00 p.m., on September 16, 2015, at the following location. Please note the submittal address has been corrected. City of Miami Beach Procurement Department -790 1755 Meridian Avenue, 3r° Floor Miami Beach, Florida 33139 Note: This location is not in City Hall. Vendors are cautioned to become familiar with the new location prior to the-due date for bids or proposals. Late proposals will not be accepted. 2. PROCUREMENT CONTACT CHANGE. The Procurement Contact for this project has been changed to: Procurement Contact: Telephone: Email: Kristy Bada 305-673-7000, ext. 6218 KristvBadaCc�miamibeachfl.gov Please send all questions and/or requests for clarifications to the contact named above, with a copy to the City Clerk's Office at RafaelGranado Amiamibeachfl.gov. 3. REVISED PLAN DRAWINGS AND SPECIFICATIONS. Plan drawings and specifications have been revised. Please refer to the revised drawings and specifications shown in Exhibit A of this Addendum. Revised plan drawings and specifications may be downloaded from Public Purchase OR are available on CD for pick up from the Procurement Department for a fee of $20.00. Contractors who previously purchased the CD will not be charged for a new CD with the revised plan drawings and specifications. 4. ADDITIONAL DOCUMENTS. Civil drawing indicating location of existing water and sewer connections, design calculations for light poles, and geotechnical report for the South Pointe Park Plaza where the water features is located are shown in Exhibit B of this Addendum. 5. REVISED ITB PRICE FORM AND BID ALTERNATE DETAILS. Please refer to Exhibit C for revised ITB Price Form. The ITB Price form has been revised to indicate that the Lump Sum Grand Total shall be inclusive of the permit allowance and owner's contingency. Furthermore, the ITB Price form has been revised to show a total of three (3) alternates. Please refer to Exhibit D of this Addendum for bid alternate details. 6. PRE-BID MEETING SIGN-IN SHEET AND PLAN HOLDERS LIST. Please refer to Exhibit E of this Addendum. ANSWERS TO QUESTIONS SUBMITTED BY PROSPECTIVE BIDDERS: 01: Regarding the ITB Price form A-1 on page 50 of ITB, the lump sum grand total (Base Bid) box indicates to add division 01 to 07 only. Are the Permit Allowance and the Owner's Contingency of 10%to also be added to this figure or not? Please clarify. Al: Yes. Please refer to the revised ITB Price Form shown in Exhibit C of this Addendum. Q2: The contract documentation does not contain the Geo-tech reports and sub-soil investigation including soil borings and drainage testing. Please provide a copy of all soil investigation reports. Report shown in Exhibit B of this Engineer A2: Please refer to the Geotechnical En Services Re 9� Addendum. Q3: The plans show concrete piling required in sheet HS-104 and mentions the Geo-tech report in keynote#1 but no design for such piles, as to type, length, capacity, etc... Please provide copy of Geo-tech report and Foundation Recommendation by engineering firm that would include the piling requirements. A3: Please refer to the Geotechnical Engineer Services Report shown in Exhibit B of this Addendum. Q4: The plans show a new base and sub-base under all concrete slab work at the new plaza. Please provide Foundation Recommendation by engineering firm that would include the procedure to stabilize the required sub-base under the new concrete plaza slabs. A4: Please refer to the Geotechnical Engineer Services Report `Evaluations and Recommendations', pages 3—4,shown in Exhibit B of this Addendum. Q5: The provided plan sheet PG&D-01 for Paving, Grading & Drainage is not legible in either the digital format or after printing. Please provide a new digital file with better resolution that could be read clearly. A5: Please refer to the revised plans dated 2015.08.10 shown in Exhibit A of this Addendum. Q6: The plan sheet HS-104, keynote#3 shows the structure for the water features to be "waterproof structure". Is the intent of the drawings to add a waterproofing agent to the concrete itself? Please clarify and provide specifications for the intended products to be used. A6: That is correct. The written specifications provide the specifications for the waterproofing admixture. Please refer to Exhibit A, Bid Set Specifications, 03300 Cast-In-Place Concrete, Section 2.4—Admixtures. Q7: Plan sheet HS-117 shows piling requirements also for the RO System foundation but fails to show the pile layout. Please clarify how many piles are required at this location and provide a pile layout with locations. A7: A piling plan was added to HS-117 in response to plan reviewer comments. See bid set dated 08.10.2015 for piling layout and quantities (Refer to Exhibit A of this Addendum). Q8: Plans calls for the removal and reinstallation of the existing park benches. Please provide information on the existing size, length and weight as well on original supplier and installer information and recommended method for removing and reinstallation. 2 A8: Existing benches are currently located within the existing plaza area. See LA-02, detail 1 for additional information. Supplier/Company: Landscape Forms/Escofet Website: www.landscapeforms.com Bench: Socrates(cast stone) Size: 20"x18"x95" Weight: 3307 lbs See Manufacturer's specifications/Installation Guide for additional information. Q9: Plan LA-01 shows an "Alternate" required for supplying new 41 park benches but only shows height and width dimensions. What is the required length of these new benches? Please clarify. A9: See updated LA-03 for layout and Alternate Coral Stone Bench. The bench length, 5'-0", has been updated on the plan and detail. Q10: Please advise as to what facilities are existing within the proposed work area such as drain wells capable of handling the dewatering operations required and indicate size, location, drain capacity, etc...Please advise. A10: All existing drainage facilities should be shown on the survey. Please note that the contractor will need to obtain necessary dewatering permits from DERM and FDEP prior to dewatering activities if a dewatering plan is necessary. Q11: Please advise if the City will allow the Contractor to use the entire sidewalk area at Inlet Drive to the North, in front of the "limit of work area", as an area for unloading/staging area for materials, trucks, etc. Al 1: No. See DM-01, note 19 for further clarification. Q12: Please advise if the City will allow the Contractor to rent at least 16 parking spaces at the Inlet parking areas for the exclusive use of the construction/subcontractor personnel. Al2: No. It is up to the contractor to secure parking spaces. • Q13: Please advise if the City will allow the Contractor to have a staging area on City property adjacent to the entire West of the site and the entire South of the existing vault—approx an added 60' wide strip (see attached sketch). A13: No. Contractor must working within the boundaries. Q14: After also doing a time analysis of the duration of the project, we found the 180 days inadequate for the proposed scope of work. Please advise if the City can revise the project duration from 180 calendar days to at least 270 days to substantial completion A14: No. Q15: Specification section 015000-2.2-B mentions the possible need of a field office for the owner and for project meetings. Please clarify if the Owner will require the use of an office trailer keeping in mind the extremely limited site. A15: A field trailer is not required by the City of Miami Beach. It is up to the discretion of the Contractor to determine if a field office is necessary for the work. Q16: Plans and documents mention that there are existing water services and meters at the site but fail to properly identify locations and service sizes. Please identify existing water services, size of 3 services, locations and clarify which one is the one chosen for the new supply line to the equipment vault as shown in HS-112. Also please confirm if the chosen service already has a backflow preventer assembly installed or if it requires a new one. A16: Refer to HS-105 in Exhibit A of this Addendum. Q17: From the existing water services mention in previous questions, please indicate service size and which one the Contractor will be allowed to draw temporary water from for use in dewatering operations and as temporary water service. A17: At the time of construction the City shall provide a location from which water can be drawn. A temporary water meter may be required. Q18: The scope of work requires the need for dewatering and drain wells. The survey sheet ECOO indicates the location of 4 separate injections wells, three of them located outside the "limit of work" area but fairly close to it. Please provide the following: A. Indicate if all four (4) wells are available for discharge during dewatering operations- we required a minimum of two wells. B. Indicate size, depth and absorption capacity of each well-we required approx 2200 GPM. C. Indicate how recent have these wells been reconstituted or if we need to include also. D. Indicate whether we can pressure feed these City wells. A18: A. The existing drainage wells are only permitted for stormwater management; they are not to be used for any dewatering. If the contractor is planning dewatering for any of the construction; the contractor shall be responsible for providing the required dewatering system that may require separate permits from agencies with jurisdiction, including but not limited to, FDEP and Miami-Dade DERM. B. Response: See above C. Response: See above D. Response: See above Q19: Specification sec 015000-3.3-F mentions the need of a project sign. Please clarify if Owner will provide such sign or provide size and specs for us to include in bid numbers. A19: A project sign will be required. ITB Section 0500, Sub-Section Section 50 of the ITB states that "Any requirement for a project sign shall be paid by the Contractor as specified by City Guidelines." Q20: Specs 024119-3.4 calls for the removal of the existing benches and cannons/grills and transfer them to the Owner for storage. Are we to load them unto Owner's trucks? Or transport them to a location?Where? Unload them also? Is a forklift available at Owner's storage site? Please clarify what this operation should include as part of the GC responsibilities. A20: Contractor shall be responsible for the transportation and storage, on or offsite, and handling of all benches, cannons/grates and any other material to be reused during construction prior to final placement of the materials. Q21: Sheet PG&D-01 tries to define (is not readable) a new surface drainage system and shows a 4 connection to the East side, outside the "limits of work", where it drains into a structure/tank of sorts. Please confirm the structure/tank and drain well are existing and are to remain as is, with no improvements being part of this contract. A21: The design intent is to replicate the original drainage system designed as part of the parking improvements. The new drainage system will connect to the existing drainage well as shown in the PG&D sheet. Q22: Sheet PG&D-01 shows a new drainage line connection to the East side, outside the "limits of work", where it drains into a structure/tank. This drainage line would require the cutting and repairs of the existing sidewalk to the East which will impact the use of such sidewalk by the park visitors. Please confirm if this is a new drainage piping or is there an existing piping to be reuse at this location west of sidewalk. A22: The 12-inch pipe indicated in the plans is required to convey the runoff to the existing drainage well. The contractor shall include in the bid connection to the existing pipe as shown in the plans, and adjusting the proposed structure location to align with this existing pipe. If the existing pipe is smaller than 12-inches or is higher than the new pipe, then the contractor shall include a line item to install the new pipe directly into the well box, along with the cutting/repair of the sidewalk. The sidewalk can be temporarily closed by the contractor, as coordinated with the City, to facilitate this pipe installation in a timely manner to minimize disruptions to use of the sidewalk. (see Exhibit B in this Addendum for additional information) Q23: Plan sheet HS-100, in the "responsibility matrix" mentions the HVAC/cooling of equipment room to be the contractor responsibility. We cannot find any plans requiring an AC/cooling system at the vault. Please confirm if such systems already exist at the vault or clarify intent of drawings regarding any cooling system requirements. A23: The ventilation system is existing. Contractor to ensure that the ventilation system is operational upon completion of construction. Q24: Plan sheet DM-101, in the General Notes, mentions the GC is responsible for dismantling and removing all existing equipment that is not to be reused. As far as we understand the documents only are calling to reuse the "cannon assemblies and grates" equipment. Everything else is new equipment. Please confirm this is the intent of the drawings. A24: This is correct. Q25: Plan sheet DM-101 calls for the GC to remove all existing equipment from the existing underground vault. Is the entire top of the vault a removable slab? Weight of top slab? Please provide as-built drawings of existing vault structure and what the procedure is to fully open the vault to remove the equipment and install new equipment. A25: No, the slab is not removable. All existing equipment is to be removed through the hatch opening.All new equipment is to be lowered through the hatch opening. Q26: Plan sheet DM-101 calls for the GC to remove all existing equipment from the existing underground vault. Please provide as-built drawings showing all existing equipment to be removed so we can estimate the removal operations. A26: There are no as-built drawings given that the original project was never completed. For reference purposes, Exhibit F of this Addendum contains some of the available original project"design" drawings. 5 Q27: Plan sheet DM-101 calls for the waterproofing of the"exterior face of the vault wall" after installing all new piping. Please clarify if this refers only to the East wall of the vault where all the new pipes go thru. A27: Waterproofing is to be applied to the East wall only where the penetration modifications will occur. Q28: Demolition plans do not show the underground existing fountain structures that requires demolition. Please provide plan showing the underground fountain structures to be demolish, including materials, dimensions, etc... A28: DM-101 provides the locations for the existing elements to be removed. There are no as- built drawings given that the original project was never completed. For reference purposes, Exhibit F of this Addendum contains some of the available original project "design" drawings. Q29: Demolition plans do not show the existing fountain piping that requires removal. Please provide as-built plans showing the existing underground fountain piping to be demolish, including locations, size of pipes, depths of piping, etc... A29: There are no as-built drawings given that the original project was never completed. For reference purposes, Exhibit F of this Addendum contains some of the available original project"design" drawings. Q30: Plan sheet HS-107, item #5, calls for a tile finish on the interior basin of the water features. Please provide manufacturer, size, color and specifications for this product. A30: Refer to sheet HS-107 for fountain finish specifications. All sections and details on this sheet have been amended to reflect true finish dimensions. Independent Finish detail provided, and respective keynote callouts added, and existing callouts modified to include finish specifications. Q31: Plan sheet HS-107, item #3, calls for a tile wall cladding on the vertical weir walls of the water features. Please provide manufacturer, size, color and specifications for this product. A31: Refer to sheet HS-107 for fountain finish specifications. All sections and details on this0020sheet have been amended to reflect true finish dimensions. Independent Finish detail provided, and respective keynote callouts added, and existing callouts modified to include finish specifications. Q32: Plan sheet HS-107, item#2, calls for a "granite coping" at weir walls of the water features. Please provide granite type, color and specifications for this product. A32: Refer to sheet HS-107 for fountain finish specifications. All sections and details on this sheet have been amended to reflect true finish dimensions. Independent Finish detail provided, and respective keynote callouts added, and existing callouts modified to include finish specifications. Q33: Plan sheet HS-107, item#15, calls for a stainless steel "angle support"for a granite cover above the supply water pipes of the water features. Please provide design and details for such a structure. Is this a removable structure? How is the granite attached to the steel? Please provide details for what is required and attachment details. 6 A33: Clarification —the interior of the basin is to be tiled so the cover plate should be finished with tile to match. This is intended to be a custom fabricated item by the contractor. The intent is to provide a diffuser plate and to obscure the recessed inlet sump view with the top of the diffuser plate level with the remaining basin floor. A 23"x23" square, recessed SST plan is to be fabricated. The recessed pan is to be finished with the tile. The finished plate is to be supported on all four corners by SST legs permanently attached to the floor of the recessed inlet sump. Submit shop drawings for approval. Q34: Re-purposed mist cannon nozzles banks shown in HS-108 are being relocated to new locations but plans show few details of the new base structure upon which they will rest. Sections show a 2.5' x1.5" concrete base but show no reinforcing, or dimensions for the channel required for pipes. Please provide further details for the proposed structure to install the cannon banks as a base, including dimensions and reinforcing. Also, existing base seems to have steel angles at the perimeter as a seat to receive the grates and cannons but no such angle is shown on plans on the new bases. If angle is required, please clarify if it is stainless steel. Please clarify new design for base. A34: Refer to sheet HS-108 in Exhibit A of this Addendum for reinforcement details. Plan - Q35. fa sheet HS 108 calls for re-using the grate hardware at the cannon banks. But the new cannon banks are a different length, since they require only 6 cannons now. Are we to reuse the angles and adapt them to the new dimension? Please provide further details on the stainless steel hardware required to attach the grates and the cannons to the base. A35: The intent is for the existing outer grating pieces to be reused, and the quantity of the cannons within to be reduced per the remediation design documents. All materials of good condition inclusive of the angles, frames, and hardware are permitted to be reused and modified as needed to complete the installation. The contractor shall be responsible for providing and installing all additional materials required to complete the installation. Contact the Procurement Department for original design drawings for Cannon Shroud and Grate assembly(Reference L-507). Q36: Plan sheet HS-108, item #15, calls for a "French drain" on the base of the cannon banks. Please provide details of the installation of this French Drain, length, depth, ECT...Please clarify what is required. A36: Refer to HS-108 in Exhibit A of this Addendum for additional detail. The intent is to provide a drainage of the cannon base due to rain or mist water accumulating. Q37: Plan sheet HS-108 calls for six cannons to be installed at each cannon bank. Sheet HS-113 which includes a piping diagram is calling for 7 cannons at each bank. Please clarify how many cannons are to be included at each bank location. A37: Six cannons is the correct quantity. Refer to HS-108 in Exhibit A of this Addendum for revised diagram. Q38: Plan sheet HS-113 shows the RO system also requires a 1" potable water line but plans fail to indicate where this line will come from. Please clarify origin and location of proposed water line. A38: Refer to HS-105 in Exhibit A of this Addendum. Q39: Plan sheet HS-117 including the RO system vault shows a base for the vault but fails to detail such a base. Is this also a concrete base? Size? Reinforcement? Please clarify and provide details. 7 A39: Refer to HS-117 in Exhibit A of this Addendum for additional detail of the concrete base. Refer to the specs for concrete specification. Reinforcing as indicated and Grade 60, #4 @ 12" OCEW. Q40: Plan sheet E-02, site plan note #1, includes a statement that existing fixtures are not operational and requires contractor to provide repairs to remediate the problem. This statement is too vague and we would require more specific information on what is being required. In lieu of specifics, we could only include all new fixtures at the four locations shown in plans. Please provide specific information on the problem or clarify if the Owner wants to include new fixtures for these locations. A40: Fountain Area Panel. Existing circuit shown and controls are based on original Design Documents. All existing fixtures shall remain in place, it is assumed this is a broken circuit line and the lighting fixtures are operational. Contractor shall provide repair of broken circuit from control timer to first existing fixture since this is the assumed broken circuit. Contractor to verify location of the break and tie in the existing lighting circuit with proposed new lights as indicated on the plans. Lamps shall be replaced in all existing light fixtures with new lamps. Contractor shall notify the Landscape Architect within 30 days of the commencement of the project if the light fixtures are not operational, extending beyond the assumed broken circuit line. Q41: Plan sheet LA-01 shows 31 new "CNX" palms being required. Please confirm these palms are "nevi'to be provided for this locations and not being relocated from existing locations. A41: Please refer to Exhibit A of this Addendum for clarity. See sheet LA-01 plant list for the quantities of new palms and relocated palms. 1 Q42: Plan sheet LA-01 shows the typical bench detail and has a note specifying 16 existing benches are to be relocated in total but actual drawing has 41 benches shown. Is the intent of the documents to install only the 16 relocated benches? If so, please provide locations for the relocated 16 benches. Are the 25 added benches part of the "Alternate" mention in sheet LA-2 requiring 41 benches? Please clarify. A42: Please refer to Exhibit A of this Addendum for clarity. { See sheet LA-01 for the new location of the 16 existing concrete benches. The 41 Coral Stone benches shall be to be priced as an alternate. See sheet LA-03 for layout. Q43: Plan sheet DM-101 includes a "Tree disposition" table showing some existing palms to be relocated "by others" and are not included in this contract. Please confirm these relocations are not a part of this contract and not part of the new palms shown in landscape drawings. A43: When the original bid document was sent out to bid, the trees relocation plan was not in the scope of service. The updated bid plans states that the relocation now does occur within this scope. Refer to Exhibit A of this Addendum for additional information. Q44: Plan sheet .LA-04 calls for an irrigation system tie to the existing system but irrigation specifications sec 328400-2.14-A calls for a new comptroller and sec 328400-1.2-B calls for a new water meter and service. Please confirm the existing system, its water meter and comptroller are to remain as existing and do not require any improvements as part of this contract documents. 8 A44: Contractor shall tie into the existing system. The specifications have been revised accordingly. Any questions regarding this Addendum should be submitted in writing to the Procurement Management Department to the attention of the individual named below, with a copy to the City Clerk's Office at RafaelGranado @miamibeachfl.gov. Procurement Contact: I Telephone: Email: Yusbel Gonzalez 305-673-7000, ext. 6230 YusbelGonzalez@miamibeachfl.gov Proposers are reminded to acknowledge receipt of this addendum as part of your RFQ submission. Potential proposers that have elected not to submit a response to the RFQ are requested to complete and return the "Notice to Prospective Bidders" questionnaire with the reason(s) for not submitting a proposa . Son fy Ale enis Prement Director pl David P.Roy,Senior Project Manager 9 A-2 (Sign below if incorporated) FHP Tectonics Corp. ATTEST: (Type or Print Name of Corporation) "xowateot,Pccrt ` Kathleen Pattison Asst.Secretary Senior Project Manager gnature and Title) (CORPORATE SEAL) David P.Roy (Type or Print Name Signed Above) Incorporated under the laws of the State of: Illinois BID NO:2015-191-YG CITYOF MIAMI BEACH 13E.,ACH A-3 SUPPLEMENT TO BID/TENDER FORM: - CONTRACTOR QUALIFICATION STATEMENT THIS COMPLETED FORM SHOULD BE SUBMITTED WITH THE BID; HOWEVER, ANY ADDITIONAL INFORMATION NOT INCLUDED IN THE SUBMITTED FORM AS DETERMINED IN THE SOLE DISCRETION OF THE CITY, SHALL BE SUBMITTED WITHIN SEVEN(7)CALENDAR DAYS OF THE CITYS REQUEST. The undersigned authorized representative of the Bidder certifies the truth and accuracy of all statements and the answers contained herein. 1. Please list all Licenses, Certifications, and/or Registrations your organization may possess. Please also indicate the number of years your organization has been in possession of these licenses, certifications, and/or registrations. License/Certification#/Registration# #Years CGC 1518886(David P.Roy) 6 Years 2. Attach a list of the Key Personnel, the intended role for this Project, and resumes for each individual. See Attached. 3. What business are you in? General Contractor 4. Please indicate the last project of similar scope and volume that your organization has completed and its completion date. Chicago Park District-Buckingham Fountain Substation Phase 2(SEE ATTACHED) City of Miami-New Splash Park for Juan Pablo Duarte Park(SEE ATTACHED) 5. Have you ever failed to complete any work awarded to you? If so,where and why? No. 6. List owner names, addresses and telephone numbers, and surety and project names, for all projects for which you have performed work, where your surety has intervened to assist in completion of the project, whether or not a claim was made. None. 7. References & Past Performance. Bidder shall submit at least three (3) references for whom the proposer has completed work similar in size and nature as the work referenced in solicitation. SUBMITTAL REQUIREMENT: Proposer shall submit a minimum of three (3) references, including the following information: 1) Firm Name, 2) Contact Individual Name & Title, 3) Address, 4)Telephone, 5)Contact's Email and 6) Narrative on Scope of Services Provided. BID NO:2015-191-YG CITYOF MIAMI BEACH State of o ri a Department of State t I certify from the records of this office that FHP TECTONICS CORP. is an Illinois corporation authorized to transact business in the State of Florida, qualified on May 23,2003. The document number of this corporation is F03000002688. I further certify that said corporation has paid all fees due this office through December 31, 2015,that its most recent annual report/uniform business report was filed on January 9, 2015, and its status is active. I further certify that said corporation has not filed a Certificate of Withdrawal. Given under my hand and the Great Seal of the State of Florida at Tallahassee,the Capital,this the Ninth day of January,2015 Ast:';_--7:-., .,i-1-.1•27: :.5.;.'/:::.te itgoik j �;- • °'``'�rL , , f•, . 4.'„,,,f-:1,. - Secretary of State Authentication ID:CC7728239979 To authenticate this certificate,visit the following site,enter this ID,and then follow the instructions displayed. https://eiile.sunbiz.org/certauthver.html File Number 5894-500-5 4. ) o • O it-,91 Z. ) , ..,... 1.,,b, . . ei_. . 4&r.~"_'' _ tax, E : . .‘__,_,_r....:. 7 "z. --:_-i::,,.. ..,..,. \ 6) ....:,/ .)::.... . ..•_ . . ., ..,...... . . . . ••••,. . To all to whom these Presents Shall Come, Greeting: I, Jesse White, Secretary of State of the State of Illinois, do hereby certify that FHP TECTONICS CORP.,A DOMESTIC CORPORATION,INCORPORATED UNDER THE LAWS OF THIS STATE ON JULY 08,1996,APPEARS TO HAVE COMPLIED WITH ALL THE PROVISIONS OF THE BUSINESS CORPORATION ACT OF THIS STATE RELATING TO THE PAYMENT OF FRANCHISE TAXES,AND AS OF THIS DATE,IS IN GOOD STANDING AS A DOMESTIC CORPORATION IN THE STATE OF ILLINOIS. ___....��,.„.„ In Testimony Whereof, I hereto set _ ESTATt.� ,�1 f o4� If_'`r{`'±►,! mJ hand and cause to be affixed the Great Seal o f� o% the State of Illinois, this 12TH ri Nziguitfi.'• ' fA y da o PRI 201,, -� _,_; ,t � f APRIL A.D.A I� 2010 01 4. " !6•!5,::::?. T i i 1`Z,G 2\b.T 51$r= Authentication/: 1010201542 Q-1UIda )1/3&:&, Authenticate al:hltpJ/www.cyberdrtveltlhols.com SECRETARY OF STATE 000379 Local Business Tax Receipt IBT Miami—Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 6278246 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES FHP TECTONICS CORP RENEWAL SEPTEMBER 30, 2015 DOING BUSINESS IN DADE COUNTY 8543897 Must be displayed at place of business Pursuant to County Code Chapter SA-Art.9&10 OWNER SEC.TYPE OF BUSINESS PAYMENT RECEIVED FHP TECTONICS CORP 196 GENERAL BUILDING CONTRACTOR BY TAX COLLECTOR CGC1518886 Worker(s) 12 I $93.50 02/26/2015 CREDITCARD-15-021494 This Local Business Tax Receipt only conlimts payment of ilia Local Business Tex.The Receipt is not s license, permit,or a certification of the holder's qualifications.to do business.Holder must comply with any governmental or nongovernmental regulatory lows and requirements which opply to the business. The RECEIPT NO.above must be displayed on all commercial vehicles-Miami-Dade Code Sec 8e-275. For more information,visit yvww.miemidede.gov/lexcollectot BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895—954-831-4000 VALID OCTOBER 1,2014 THROUGH SEPTEMBER 30,2015 DBA:PEP TECTONICS CORP Receipt#:GENERALOOCONTRACTOR (GENERAL Business Name: Business Type:CONTRACTOR) Owner Name:DAVID PAUL ROY Business Opened:11/12/2 0 0 3 Business Location:2 S FEDERAL HIGHWAY State/County/Cert/Reg:CGC1518886 DANIA BEACH Exemption Code: Business Phone:305-940-0264 Rooms Seats Employees Machines Professionals 10 For Vending Business Only Number of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 3.00 0.00 0.00 0.00 0.00 30.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non-regulatory in nature. You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location.This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: DAVID PAUL ROY Receipt #30B-14-00004804 2 S FEDERAL HIGHWAY Paid 02/20/2015 3.00 DANIA BEACH, FL 33004 2014 - 2015 BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895—954-831-4000 VALID OCTOBER 1, 2014 THROUGH SEPTEMBER 30, 2015 DBA: FHP TECTONICS CORP Receipt#: 180-8700 Business Name: Business Type:GENERAL CONTRACTOR (GENERAL CONTRACTOR) Owner Name: DAVID PAUL ROY Business Opened:11/12/2003 Business Location: 2 S FEDERAL HIGHWAY State/County/Cert/Reg:0001518886 DANIA BEACH Exemption Code: Business Phone: 305-940-0264 Rooms Seats Employees Machines Professionals 10 Signature For Vending Business Only Number of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 3.00 0.00 0.00 0.00 0.00 30.00 Receipt #309-14-00004804 Paid 02/20/2015 3.00 7t. �1,-, STATE OF FLORIDA 41, F.' :' °�` DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION 9 p,. CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 I: d''', V 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 ROY, DAVID PAUL FHP TECTONICS CORP 5515 NE RIVER RD CHICAGO IL 60656 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business.and Professional Regulation. Our professionals and businesses range ,f' ,,�: STATE OF FLORIDA from architects to yacht brokers,from boxers to barbeque restaurants, 4'1' DEPARTMENT OF BUSINESS AND and they keep Florida's economy strong. •-'' ' PROFESSIONALREGULATION Every day we work to improve the way we do business in order to CGC1518886 ISSUED: 06/16/2014 serve you better. For information about our services,please log onto www.myfloridalicense.com. There you can find more information ; GENERAL CONTRACTOR about our divisions and the regulations that impact you,subscribe ROY,DAVID PAUL to department newsletters and learn more about the Department's FHP TECTONICS CORP initiatives. Our mission at the Department is:License Efficiently, Regulate Fairly. • We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, IS CERTIFIED under the provisions of Ch.489 FS. and congratulations on your new license! Expiration date.AUG 31,2016 L1406160001039 DETACH HERE RICK SCOTT, GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD ,?'11- �"3 r, LICENSE NUMBER CGC1518886 '. The GENERAL CONTRACTOR 11' `s', Named below IS CERTIFIED �; ►.t Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 ROY, DAVID PAUL • '5+ FHP TECTONICS CORP 5515 NE RIVER RD � CHICAGO IL 60656 ISSUED: 06/16/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1406160001039 AC® CERTIFICATE OF LIABILITY INSURANCE D04/O 2O1DDlYYYYI N C E U4,0312G,5 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(les)must 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 CCCNMEAC1 MARSH USA INC. PHONE _.____ — -- -�`FAx-- 540 W.MADISON ..lA1C..No.Eat):. .,._.. _ , --F FA'c..1.4_0.1:_____, CHICAGO,IL 60661 ADDRESS: __.....i ,_ Altn:chicago.CartRequest rCJmarsh,com --�- --- --� —- --- .- INSURER(S)AFFORDING COVERAGE ^I NAIL a INSURER A:Zurich American Insurance Company a 16535 INSURED _-_--_..___..___..�. _�____ .._-. INSURER 8:American Zurich Insurance Company �_[0142 FHP Tectonics Corp. w Illinois National Insurance Company _ 4 L 2 South Federal Highway INSURER c: y _ 123817 Dania Beach,FL 33004 INSURER D:Endurance American Insurance Company 110641 INSURER E• _ - _—__ - J _-___________ C--— , INSURER F: r COVERAGES CERTIFICATE NUMBER: CHI-004252220-21 REVISION NUMBER:6 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 rApDL,Sij8R1 •i PQLICY EFF POLICY EXP j-- -- ----"" LTR I TYPE OF INSURANCE 1 INSR 1 WVD• POUCY NUMBER IMMIODY Vi 1MMIDOMrYY)I LIMITS A 1 GEN1ERAL LIABIUTY i I IGLO5833476-02 110,01/2014 110101/2015 -EACH OCCURRENCE I5 1,000.000 GaheliC,E r0-REruTEI} X COMMERCIAL GENERAL LIABILITY I t I?REMISES.iga occuminco)_- I S 300,000 riri CLAIMS-MADE 1-X I OCCUR MED EXP(Any one person) $ 10,000 1 I D EX P �._�__� -__ __�V a^ I PERSONAL&ADV INJURY�l S 1,000,000 M I GENERAL AGGREGATE—1 g 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: i JPRODUCTS-COMP/OP AGG 15 2,000,000 X I POLICY ni 2,97:T• 1 I LOC I (S iI A I AUTOMOBILE LIABILITY BAP5633474-02 10/0112014 10101/2015 I(Ee aBlcc deEi)INGLE LIMIT s 1,000,000 1 ! !ANY AUTO _ BODILY INJURY(Per person) }s ALL OWNED SCHEDULED -80DILY INJURY(Per accident) S� AUTOS AUTOS i _ �� I X HIRED AUTOS x NON-OWNED I nP'ROPE VT:AMAGE S AUTOS !I _�Mr acgdgrtl)� _� i • 1 �15 C X-j UMBRELLA UAe I X I OCCUR ;BE 051731161 10/01/2014 10/01/2015 EACH OCCURRENCE __ S 25,000,000 { 1 EXCESS LUIS CLAIMS-MADE i I AGGREGATE 3 25,000,000 X I 10,000 - !OED 1 t RETENTION S i n I S B WORKERS COMPENSATION WC 5633475-02(ADS) 10/01/2014 110101/2015 X WC STATU- 0TH- ANO EMPLOYERS'LIABILITY E f_IORYUMITS I LEIZI- B ANY PROPRIETOR/PARTNER/EXECUTIVE Y l N 1 WC 5833477.02(WI) .10101P1014 10/01/2015 E L EACH ACCIDENT 1 S 1,000,000 OFFICER/MEMBER EXCLUDED'? © N r A` _ (Mandatory In NH) 1 E L.DISEASE-EA EMPLOYE S 1,000,000 If yes,describe under • DESCRIPTION OF OPERATIONS below I . 1 E L.DISEASE-POLICY LIMIT]s ),000,000 1 • 0 Excess Layer Lability . EXC10004227001 '10/01/2014 '10/01/2015 Each Occurrence: 25,000,000 [ I Aggregale: 25,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule.If more apace Is required) RE:EVIDENCE OF INSURANCE. CERTIFICATE HOLDER CANCELLATION FHP Tectonics Corp. SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE 2 South Federal Highway THE EXPIRATION DATE THEREOF, NOTICE WILL BE OEUVERED IN Dania Beach,FL 33004 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee _.IKavA.aos.: ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Riley Barron Operations Manager Professional Experience J' Riley has nine years of industry experience,including five years with FHP.He joinedthe Company as a Project Engineer,was promoted to Project Manager and recently was P romoted to Operations Manager overseeing all department activities on an operational s s 1t i: s r 1, 1;1,1 a .: • level in our Florida office,including the Museum Park Baywalk& Promenade.He is UUstt:), 41 P t;�=t. experienced in overseeing all phases of multimillion-dollar construction projects,for 4; ,, ,•t..:�.., both public and private-sector clients. Prior to moving to Florida,Riley oversaw the 111. ::,s.;..,";:s :1.1.70 construction of the new South Plaquemines High School in Buras,LA.Riley is also an "'p active member of FHP's Corporate Safety Committee. Registrations/Certifications • Construction Quality Management for Contractors • OSHA 30 HR Education • Bradley University B.S.,Civil Engineering&Construction Minor Accounting& Business Management Representative Projects CITY OF MIAMI • Museum Park Baywalk&Promenade Ph II& III $8,553,620-The Museum Park project consisted of Phases II& [II.Phase 2 consisted of soil remediation, demolition,earthwork, underground drainage and water utilities,a new paver baywalk,new concrete sidewalks and pathways,tree transplants,new lighting,new site furnishings,new landscaping and sod,and new irrigation. Phase 3 consisted of a new paver promenade walkway,concrete stairs and ramps,concrete sidewalks and pathways, retaining walls,new lighting,new site furnishings,new landscaping and sod,and new irrigation for the promenade walkway. • Armbrister Park $1,100,000—Design/Build project consisting of a 108,000 SF synthetic turf field to accommodate an American football field,soccer field,and a softball field including all sub-base and base preparation and drainage. Four existing metal bleachers were also repaired, painted,and relocated,after which the existing concrete pads were demolished,and electrical poles, lighting, fencing and trees were relocated or removed as necessary for the construction of the new fields. Additional features included: • Long Jump Pit • 4 lanes 50 meters straight away running track with 10 meters run-out room at each end • Drainage system/permeable base for the synthetic turf system installation PLAQUEMINES PARISH SCHOOL BOARD • South Plaquemines High School,Buras,LA $37,164,000-The new South Plaquemines High School was elevated 17' to be above the flood plain and was constructed on wood piling with concrete foundations,columns,and elevated slab.The new 152,932 sf school contains an 11,166 sf auditorium/theater with seating for 647 people,classrooms,science labs,gymnasium,and child facilities.The building is designed and built to meet hurricane wind loads of 145 MPH. Riley Barron Operations Manager Previous Project Experience US Army Corps of Engineers,Chicago Harbor Breakwater Repair,Chicago,IL Approximately 5000 LF of structural repairs to the Chicago Harbor Exterior Breakwater system that is located 1.5 miles east of Navy Pier. Deterioration due to low lake levels caused structural damage over time that initiated failure to the concrete cap of the breakwall. Repairs consisted of drilling holes through the existing concrete cap and injecting a specialized grout mixture into the structure to fill voids and enhance structural capacity. RUM Development,Vision on Division,Chicago,IL The Vision on Division development is 33.condos,about 9,000 square feet of commercial space and roughly 111 parking spots in the underground parking structure.33,000-square-foot mixed-use development is planned fora vacant lot just east of the MB Financial bank at the corner of Ashland and Division.The structure is a cast in place concrete system with caisson foundations,and the envelope is primarily a impact resistant curtain wall system. Chicago Transit Authority,Blue Line Tie Replacement,Chicago,IL This project focused on eliminating slow zones on the CTA Blue Line branch from Addison to O'Hare.The contract includes 105,000 track feet of rebuilt railroad,65,000 new composite ties and 28,000 track feet of new steel.The rebuilt railroad will allow the trains to average 55 mph. RTD and Denver Transit Partners,Eagle P3 Project,Denver,CO Eagle P3 is a public-private partnership comprised of RTD's East Rail Line,Gold Line,Commuter Rail Maintenance Facility and Northwest Rail Line Westminster segment.The total 36 miles of new commuter rail lines are scheduled to open one at a time in sequence in 2016.Job duties included overseeing the front end design of the superstructures associated with the thirty-four bridges to be constructed from the Denver International Airport to Denver Union Station Illinois Department of Transportation,"Upgrade 74",Peoria,IL The$461 million,three-year project consisted of three stages aimed at providing motorists with a safer,better looking highway. Under the plans created by eight engineering firms,I-74 from East Peoria through Peoria was completely removed and replaced;all the ramps will be removed and replaced with safer ramps;40 bridges were constructed or reconstructed; and new overpasses,additional lanes,new pavement,new lighting and landscaping were added. David Roy Senior Project Manager *°a! ; °. ; Professional Experience David has 16 years of construction industry experience including 14 years with Paschen. After working in our West Lafayette office and at our Corporate Headquarters in Chicago, David was promoted to Senior Project Manager and transferred to lead our Florida operations. David's responsibilities include planning,directing,and the coordination of all job requirements. He is tasked with ensuring that the goals and objectives specified for successful operations are accomplished according to established priorities,project schedules,and budget `s concerns. He currently oversees a growing staff of seven Project Managers, Engineers and Field Superintendents. Registrations/Certifications • State of Florida-Certified General Contractor • OSHA 30 Hour • 30 HR OSHA Refresher • OSHA 10 Hour • First Aid CPR AED • ASHE-Healthcare Construction Certificate Education • Purdue University B.S.,Building Construction Management Representative Projects CITY OF MIAMI • Museum Park Baywalk&Promenade Ph II& III $8,553,620-The Museum Park project consisted of Phases II&III.Phase 2 consisted of soil remediation, demolition,earthwork, underground drainage and water utilities,a new paver baywalk,new concrete sidewalks and pathways,tree transplants,new lighting,new site furnishings,new landscaping and sod,and new irrigation. Phase 3 consisted of a new paver promenade walkway,concrete stairs and ramps,concrete sidewalks and pathways,retaining walls,new lighting,new site furnishings,new landscaping and sod,and new irrigation forthe promenade walkway. • Black Police Precinct and Museum Restoration $2,078,835-This was a restoration of a historic police precinct to its original state with improvements.The building also now includes a museum and courthouse. • Curtis Park Sports Turf Improvements&Bleachers $1,630,904-Installation of synthetic field turf football/soccer field,including new drainage system,artificial turf surface manufactured by Field Turf,rubberized track repair,field goals and soccer goals,new pole vault and reconstructed long jump. • Henry Reeves Park Community& Service Building $238,381 -2,500 sf renovation to community center including new windows,roll down security shutters,new restrooms,new computer lab,HVAC upgrades,new finishes David Roy Senior Project Manager • Antonio Maceo Community Building $1,133,769-New community center on the west side of Antonio Maceo Park.The community center includes NET offices,computer lab,art room,patio,and multi-purpose room. • Bayfront Park Baywalk $507,710- Removal of existing sidewalks to facilitate the installation of the proposed landscaping. Also included was the installation of a new irrigation system in the south side of the park,an irrgiation pump,benches,and trash receptacles. • New Hadley Park Restroom/Concession Bldg. Value: $976,360-Construction of a new restroom and concession building at Hadley Park. CITY OF MIAMI BEACH • Fairway Park Pavilion $605,435 -Construction of new community center/pavilion with restrooms,decorative fencing,associated sitework and landscaping. CITY OF MIAMI JOC 04-05-048(2804) $25 million job order contract over five terms for repair and renovation to various roads/bridges. Fifty-seven work orders were issued worth over$8 million ranging in value from$3,000 to over$1 million.The jobs consisted of miscellaneous"horizontal"projects including,but not limited to,park renovations, intersection improvements, storm water drainage,roadway improvements and bridge renovations.This contract was renewed for each term but not"maxxed out"due to lack of work orders issued by the City of Miami. Sample work orders: • Silver Bluff Traffic Calming Circles $1,031,608 • Shenandoah Traffic Calming Circles $1,377,336 • Battersea/Douglas Rd.Storm Upgrades $646,517 • Morningside Park Shoreline Stabilization $549,973 • Margaret Pace Park Shoreline Stabilization $593,859 CITY OF MIAMI JOC-VERTICAL CONSTRUCTION(2822) Value:$16,000,000 The$16 million Vertical Contract began in October 2009 and ran through October 2013. 112 work orders were awarded for a total value of$7,747,164.Typical work consisted of repair and renovation of vertical facility buildings owned by the City of Miami including interior renovation,abatement,selective demolition,HVAC upgrades and replacement,sitework,landscaping,etc. Sample work orders: • Juan Pablo Duarte Park Gazebo& Roof Remodeling $126,686 • Icon Park Playground $88,065 CHICAGO DEPARTMENT OF GENERAL SERVICES Marine Safety Station $3,747,987-The Marine Safety Station was designed to provide safety and security on Chicago's waterways and houses federal,state and local agencies. Built in 1935,the Marine Safety Station is eligible for listing on the National Register of Historic Places. Work on the 12,467 sf.building included: underwater repair of concrete columns,structural concrete repair,replacement of concrete caps and elevator deck,and replacement of concrete causeway. Some of the major features of this project included a command center,a conference center,and a floating boat dock.This facility is LEED Certified,which was accomplished while maintaining the building's original historic appearance. Adam Schaibley Project Engineer .:fir Professional Experience Adam has five years of construction industry experience,including three years with FHP.He joined the company as a laborer in 2012 and was promotedto Foreman six months into the job and later to Project Engineer in our Florida office. Adam's experience with field work as well as construction management allows him to better control projects from a scheduling(field work)and monetary (management)aspect. Prior to moving to Florida,Adam was assigned to the South Plaquemines High School project in Buras,LA where he was Foreman overseeing a labor crew of 15-20 daily,adhering to strict scheduling deadlines. Registrations/Certifications • First Aid/CPR • OSHA Certified Scaffold Builder Education • University of St.Francis B.S.,Business Management(Minor:Accounting&Finance) Representative Project Experience CITY OF MIAMI • Museum Park Baywalk&Promenade Ph II& III $8,553,620-The Museum Park project consisted of Phases II& III.Phase 2 consisted of soil remediation,demolition,earthwork,underground drainage and water utilities,a new paver baywalk,new concrete sidewalks and pathways,tree transplants,new lighting, new site furnishings,new landscaping and sod,and new irrigation.Phase 3 consisted of a new paver promenade walkway,concrete stairs and ramps,concrete sidewalks and pathways,retaining walls,new lighting,new site furnishings,new landscaping and sod,and new irrigation for the promenade walkway. • Moore Park ADA Renovations $30,000-This project consisted of the demolition of a City of Miami Public Works interior restroom located at Moore Park Tennis Center.The scope of working included removing existing and replacing shower floors,grab bars, fixtures,seats and handrails in order to meet ADA requirements. • Peacock Park Renovations $80,000-This project consisted of the demolition and interior reconstruction of a building at Peacock Park.The scope of work included abatement of tile floor,removing and replacing concrete slabs,asphalt restoration,removing and replacing sanitary lines,HVAC and electrical work and ADA modifications. CITY OF HALLANDALE BEACH • 39th Year CDBG Drainage Improvements $181,329-This project consisted of removing existing catch basins and French drains and replacing them with larger structures and pipe.There were a total of 16 structures and 600LF of CAP with multiple connections using RCP.Also included was the demolition and replacement of existing asphalt,concrete sidewalks,"F"and Drop curbs and installation of new sod. Adam Schaibley Project Engineer PLAQUEMINES PARISH SCHOOL BOARD • South Plaquemines High School,Buras,LA $37,164,000-The new South Plaquemines High School was elevated 17' to be above the flood plain and was constructed on wood piling with concrete foundations,columns,and elevated slab.The new 152,932 sf school contains an 11,166 sf auditorium/theater with seating for 647 people,classrooms,science labs, gymnasium,and child facilities.The building is designed and built to meet hurricane wind loads of 145 MPH. References Provide information including names, phone numbers and functions relating to contracts and or established programs for which you presently providing similar services. 1. Name of Firm or Agency: City of Fort Lauderdale Address: 100 N.Andrews Avenue City/State/Zip Fort Lauderdale,FL Contact Christopher Bennett Title: Project Manager Telephone: 954-828-6522 Email:cbennettcca_fortlauderdale.gov Scope of Work: This project involved the upgrading and construction of new roadways. The scope of work included, but was not limited to, clearing and grubbing, asphalt paving, sidewalks, curb&gutter, street lighting and landscaping. 2. Name of Firm or Agency: City of Tamarac Public Works Address:6011 Nob Hill Road City/State/Zip:Tamarac,FL Contact:Alan Lam Title: Project Engineer Telephone: 954-597-3707 Email: AIan.Lam(a.tamarac.orq Scope of Work: This project involved drainage improvements which included infiltration trench pipe and drainage structures within the landscaped medians at NW 108th Terrace / NW 80"'Street between McNab Road &Nob Hill Road. 3. Name of Firm or Agency: City of Mami, Bayfront Park Address: 301 N. Biscayne Blvd. City/State/Zip: Miami, FL 33130 Contact:Tim Schmand Title Executive Director Telephone: 305-373-8780 Email:tschmand@ci.miami.fl.us Scope of Work: (Bayfront Park)This project consisted of the removal of existing sidewalks to facilitate the installation of the proposed landscaping.Also included was the installation of a new irrigation system on the south side of the park, irrigation pump, benches and trash receptacles 4. Name of Firm or Agency: City of New Orleans Address: 1300 Perdido Street City/State/Zip: New Orleans, LA 70112 Contact: Julio Uteri Title: Project Manager Telephone: 504-658-3600 Email:imviteri@nola.com Scope of Work: (Joe Brown Park) New Construction of the Park that had been decimated by Hurricane Katrina, which included a new Recreation Center, baseball fields, picnic shelters,concession stands and landscape. 5. Name of Firm or Agency: City of Miami Address:444 SW 2"d Avenue City/State/Zip: Miami, FL 33130 Contact: Jeovanny Rodriguez Title:Assistant Director Telephone: 305-416-1280 Email:jeovannvrodriquezt miamigov.com Scope of Work: (Museum Park)This project was done in 2 phases. Phase 1 was the Baywalk which consisted of a pedestrian walkway for emergency access,landscaping,irrigation, lighting and civil site work. Note: Additional references may be provided References Phase 2 was the Promenade which consisted of a pedestrian walkway for special events and emergency access, landscaping, irrigation, lighting, a parking lot for 40 cars, and restrooms.Concrete stairs,ADA access ramps and retaining walls were also constructed. 1 Note: Additional references may be provided -Fp SRN BUCKINGHAM FOUNTAIN SUBSTATION PHASE 2 CLIENT: Chicago Park District 541 N. Fairbanks Chicago,IL Patrick Levar,Chief Operating Officer (312)742-4200 patricic.levar@chicagoparkdistrict.com ARCHITECT: ::.. . N/A START DATE: 6/24/2009 "`� ! 3 COMPLETION DATE: 4 "" 6/12/2012 VALUE: 1• $1,200,000 - ' ' ----. -,.,-,--_ r 1 . . , . . r ✓ �,•,• ' i \--- .. .' ' >i . •` r 0 '÷. t .01 , r PROJECT DESCRIPTION This project consisted of the conversion of the unused bathrooms at Buckingham Fountain into a new Electrical Substation for the fountain.The existing bathrooms were gutted to the support walls and the rooftop deck was removed to install new transformers and heavy electrical equipment.One side of the bathroom was converted into a ComEd substation and the other side was converted into a CPD substation.Other aspects included: Precast concrete vault tops made for the substation,waterproofing the underground substation,painting,fencing, ventilation,fire alarm,sump pumps, landscaping&pavers. ow r ii.p FHP TECTONICS CORP. N GENERAL CONTRACTORS New Splash Park for Juan Pablo Duarte Park Project This project consisted of the installation of a new splash park,including the new water features and filtration system,colored concrete pad and associated sidewalks. Owner Nelson Cuadras '�`� _ : City of Miami—Capital Improvements I"'•�'rwil '�° _ _ 444 SW 2"d Ave., 8th Floor 1 .._.,. 111 - Miami, FL 33130 _ ncuadras@miamigov.com Architect/Engineer Aquatic Technologies 515 NE 42nd Street Oakland Park, FL 33334 Contract Amount ,„,;.s $250,104.00 Start Date `{-4; .�: . 1 • September 2011 fr: _Flip r FHP TECTONICS CORP. BNN GENERAL CONTRACTORS Great Lakes Naval Station Pool Deck Replacement The scope of this project was to replace the existing pool deck, install or replace selected mechanical components including pool filters,several modulating valves and controllers,and replace the underwater lighting.The project required a high degree of coordination that was embraced by all parties in an occupied, in-use training facility, but was not without its challenges.The team successfully integrated the separate installation of variable frequency drives(VFDs)for facility pumps by the Owner during the course of our mechanical work. Replacement of the pool deck was accomplished in a coordinated, phased manner. After the project was substantially complete,the pool was filled with water,but a challenge was encountered.The pool was losing water at an unexpected rate.Testing revealed that water was leaking from several of the underwater light recesses cast into the pool structure.Sealing of the rusted conduit at the cable exit of each - a �, _ -- recess had been observed during the ; —.� .,--m .. it removal and was reinstalled at all recesses °' .--.4 as a precaution.This did not prevent the . ,,, leaking and a new sealing approach was y , immediately reviewed with the Owner. A i 611111 . two-step approach was developed and � 3 1 implemented, involving a sealant block,an ' '1 • I anchoring grommet and a second sealant block.This two-step approached was _ .".- 4 L. applied at the cabling exit of each light . PP g gh recess and securely prevented water from - ' leaking via the deteriorated conduits _ through which the cabling passes.A costly `p' �-- removal and replacement of the conduits was avoided as a result. , ..� r Owner , NAVFAC Midwest-PWD Great Lakes lfrolig.4 Contract Amount $547,000 i Completion Date January 27,2012 2 South Federal Highway • Dania Beach, FL 33004 Phone: (305) 940-0264 • Fax: (305) 940-0265 r FHP TECTONICS CORP. ENN GENERAL CONTRACTORS Bates Fountain Renovation at Lincoln Park Zoo This project began with the removal and replacement of the concrete fountain vault and replacing the piping and controls.All broken piping was replaced,as were the corroded water supply,return,and electrical conduit lines.Before completion,the bronze features were cleaned and restored,and the water supply lines were pressure-tested.Pavers were reset in the plaza,and all disturbed areas were sodded. Owner Chicago Park District Contract Amount $275,000 Completion Date May 24,2011 a,0 % :...' ` • 'vP 2 South Federal Highway • Dania Beach, FL 33004 Phone: (305) 940-0264 • Fax: (305) 940-0265 mi.? FHP TECTONICS CORP. N GENERAL CONTRACTORS Bayfront Park Baywalk- Pond Renovation Project This project included the renovation/restoration of the reflection pond.The scope of work included draining and cleaning the existing pond,concrete restoration, new lining and pump repairs. Owner Architect/Engineer Danny Perez None. Manager Bayfront Park , r • -,..--, 301 N. Biscayne Blvd. ` ?. Miami, FL 33132 . ' M • Phone: 305-373-8788 __ 1• danperez @ci.miami.fl.us ,. _.,,..,-• -j 4ik Contract Amount �-` _ $25,238.56 _ ... Start Date ,=- January 2010 ' "'? Completion Date �•--- - March 2010 mow --......: r . . .. w s •Er . . _ _ . . ,,, ,-. , ... , r 4, II\ ,,,_Tull , •. lg . - - jai+ ' .� i , 1•• . y- Bpi e ..e. ^ ii -- + '', :6 ' .tilliiiitir ,';., '; .! w 1. d ./.. �ZI l ♦ It 2 SOUTH FEDERAL HIGHWAY • DANIA BEACH, FL 33004 PHONE (305) 940-0264 • FAX (305) 940-0265 www.fhpaschen.com ...il? r FHP TECTONICS CORP. BRIIN GENERAL CONTRACTORS Fuller Children's Court Pavement Replacement The Fuller Children's Court Pavement project consisted of a restoration of the deteriorated and unsafe walkways and stairs at the park. In order to match the original historical concrete a combination of concrete sidewalk with colored pavers was used to match the existing pattern.Circular concrete stairs were poured to match the original stairs as well. ADA ramps were installed at the three doors of the fieldhouse.The existing steel fencing and gates were repaired and reinstalled after the pavement work was completed. Additionally,the entire veranda ceiling and .y,. walls were painted at the end of the project. Owner ',. Chicago Park District 1101,111 111 'VII 1 .. .1!i % II s .Contract Amount 0011 $203,993 l �,i i • :' • i tr •3. Completion Date �' _ -- August 7,2009 ...00.0 .X.N. •=) ser . V 1 ��.. .1 440iimarniamailia, "04,4444,44, >. .. • Aiiii 2 South Federal Highway • Dania Beach, FL 33004 Phone: (305) 940-0264 • Fax: (305) 940-0265 imi.? r FHP TECTONICS CORP. ONN GENERAL CONTRACTORS Children's Fountain This project consisted of building a new foundation, bowl and pedestal,and refinishing and relocating the children's fountain that was previously located on Wacker Drive. FHP sent the fountain to Georgia to be refinished.A new foundation,concrete bowl and concrete pedestal were built for the fountain. The fountain and the existing granite slabs that surrounded the fountain were then reinstalled. The fountain is approximately 30' in diameter and stands approximately 30'high. Owner Chicago Department of Transportation Contract Amount $471,455 Completion Date August 1, 2005 �. . 4 1. T .tom , ? J J of ' ' !Y ,' ` y'• ,, 1 * . > ,` is ' -4 r. ? tete5eatesmit____ I t 2 South Federal Highway • Dania Beach, FL 33004 Phone: (305) 940-0264 • Fax: (305) 940-0265 rEp BUM HARRISON RECREATION CENTER PLAYGROUND ' . . CLIENT: 4.*: - ' • DC Department of General Services • lit- �` y 2000 14th St.,NW 8th Floor, Washington,D.C. Avon Wilson(McKissack&McKissack — ` Owner's Representative) T--.si-,i' , (202)347-1446 ,i.. aii VP'ii: • -- , ARCHITECT: ,lit ;-. "1 ,' LSG Landscape Architecture At --43,---- START DATE: •— \ } 4/3/2013 _J 1 • 115e 111111111‘111111111 COMPLETION DATE: apaallt— Ay 9/20/2013 VALUE: mr- .E. '.• --L: ' •1 $1,544,000 — i,v _ r �„" 4 Y. PROJECT DESCRIPTION This project was a Design-Build modernization to an existing park.Work included dismantling and removing the existing playground and replacing it with new play equipment,PEP Safety equipment,and a mist station/ spray feature.The spray feature/mist station included excavation for pad&equipment areas,concrete pads for tanks and vaults,piping and drainage for water features,water&equipment valves,water feature embed& fixture installation,finish surface for splash pad,connection of electrical and fresh water connection,and sanitary connection.The basketball court received new fencing and backstops,lighting was repaired,and a picnic area, landscaping,and butterfly garden planter were installed.Located in the heart of the U Street Corridor,the park has strong ties with the surrounding Victoria-era neighborhood.The influence of music was key to the design of the new playground,and includes musical themed spray features. imlimp r FHP TECTONICS CORP. E��(� GENERAL CONTRACTORS Eric Solorio Academy High School This new 206,000 sf.,3-story building achieved LEED Gold certification and includes a gymnasium with deployable bleachers and a stage for conversion to an auditorium area, indoor swimming pool, cafeteria, library,offices,science labs,art/music room,and classrooms.The skeleton of the building is a steel frame with a hollow-core precast plank flooring system.The ventilation system of the school is supplied by five air handling units ranging from 12,000 to 60,000 cfm.,and supporting ductwork is oversized to reduce noise levels.The plumbing system is designed for efficiency with a goal to reduce water use by 40%. Additionally,many of the electrical and lighting 4; systems will be controllable=---�~ — --- -----to reduce future energy costs. -- Owner Public Building Commission ! :.ie i +_3, . _! ,J Contract Amount =: t •= $71,189,000 ---- _ . Completion Date J - r 1 September 3,2010 4 ter f f -- - ,'' 011it • .400,0011.., A ,/ itr. ,, is :„-;47 .. .--. `> *"�ia�i14',i ' .ate I/Illll'�, It . 40 ApAr 41 j ■4%11,17,'Al!".t 2 South Federal Highway • Dania Beach, FL 33004 Phone: (305) 940-0264 • Fax: (305) 940-0265 mu I"imp FHP TECTONICS CORP. SHIN GENERAL CONTRACTORS Central Los Angeles High School #1 Pool Repair This project began as a new pool,built by another contractor,that settled due to poor soil conditions. Therefore,the foundation cracked and water was leaking,compromising a retaining wall adjacent to the nearby Hollywood Freeway.The water leakage was causing erosion under the roadway and the retaining wall so repairs had to be made very quickly.FHP was brought in to remove the existing tile, install 250 micropiles under the existing pool foundation,pressure-inject grout into the existing cracks,and install new tile throughout the pool. Owner Los Angeles Area Unified School District Contract Amount $1,400,000 Completion Date August 30,2009 •rt A • ' 4 e k' 2 South Federal Highway • Dania Beach, FL 33004 Phone: (305) 940-0264 • Fax: (305) 940-0265 I" FHP TECTONICS CORP. SNN GENERAL CONTRACTORS Fenger High School Pool Renovation This project consisted of renovations to the Natatorium and Locker Rooms. Included in the Natatorium renovation was masonry restoration of the interior walls and scraping existing structural beams at the roof level. Installations included new fireproofing,ventilation system,stainless steel guardrails at the stadium seating,lighting,and a complete replacement of the pool liner and deck. Modifications to the seating areas to accommodate wheelchair access were made,as well.The pool equipment was replaced with new pumps,hot water heater,and chemical treatment system.The Locker Rooms were completely demolished and new showers, lockers,flooring,and benches were installed. Doors throughout both the Natatorium and Locker Rooms were removed and replaced. Owner � , _ r Chicago Public Schools Contract Amount ,° r $2,563,264 d Completion Date February 8,2008 . t ----�_ t , • ' -" ,ji s..r-_a.. �.-. "' ,� - soliPt 411118'' 2 South Federal Highway • Dania Beach, FL 33004 Phone: (305) 940-0264 • Fax: (305) 940-0265 • N.in? r FHP TECTONICS CORP. SNN GENERAL CONTRACTORS Model Yacht Basin Complete renovation of the Model Yacht Basin,built in 1930,located at Harold Washington Park in Hyde Park.The concrete retaining walls and sidewalks were repaired or replaced and a waterproof membrane,a new foundation,concrete access ramps, lighting and fountain were also installed.The donated sculpture, Ecstacy,was also installed in the center of the basin. • Repair deteriorated concrete and retaining walls— 13,000 square yards(SY) • Replace deteriorated concrete sidewalk— 10,500 SF • Install waterproofing membrane material—13,000 SY • Install donated sculpture • Build new foundation • Install concrete ramp for access • Install lighting • Install fountains • Install sculpture Construction started in the fall,was substantially completed the next ' -. '' � spring,and landscaping was finalized -' by the end of the summer.There was a winter shut-down and multiple scope • changes in the interim. t Owner Chicago Park District "L swtfi „i, r ice'' Contract Amount r , if$434,787 a. Completion Date +,' , . 4-,April 15,2007 I! - _ Arr _ _, . : , 4 -41(0- .._ 4..t..,/,..-A. 2 South Federal Highway • Dania Beach, FL 33004 Phone: (305) 940-0264 • Fax: (305) 940-0265 mil I�lim p FHP TECTONICS CORP. B EfJ N GENERAL CONTRACTORS Skinner Park Tranquility Garden FHP installed new garden,walks,and seating: • Completed the layout and grading for the new gardens • Installed block walls and stairs • Placed aggregate walks and paver walks • Constructed new planters • Ran conduit and electrical service • Erected five poles and lights along walks • Put in the underground sprinkler system for garden • Set six benches and two trash receptacles with concrete bases Owner Chicago Park District Contract Amount $166,697 Completion Date August 4, 2006 * :1 f r r. . y. :6 .1 :,-. ,.r. , ...-, ,.. , 11 4,,,4. ve'.... .`e 1 ' ...#' ..r.; ,, "ror ,, ,.y , , 2 South Federal Highway • Dania Beach, FL 33004 Phone: (305) 940-0264 • Fax: (305) 940-0265 I� FHP TECTONICS CORP. SNN GENERAL CONTRACTORS York Commons Pool Renovation In June 1999,demolition began on the existing York Commons swimming pool. The new concrete pool consists of a zero depth shallow end,a water slide,diving board and several other features in the pool and on deck including water cannons,mushroom-shaped fountains,and sprayers.There is a sand playground that connects to the pool with a shower tower.A new mechanical system of pumps and filters was also installed. After digging 9'/2 feet down for the diving well, excavators hit an underground spring that kept filling the hole.The diving well was supposed to Al% ' , be 12 feet deep.To stabilize -"` ..' . : the soil,plumbing and lateral drainage sheet piling, . . a"well point system",steel , .,_,zs- ,i„t sia.;. -.. . . - . r ;6 support modifications were --f . installed.Work was then able to resume and the - - - 1110411k,- �.,nar SP' . ,,project was completed on ��t �••.r �sn■r schedule in May 2000. Owner Elmhurst Park District �' ---- -siv ,6 Contract Amount 'i4f .= � _ $1,728,558 0.1. Completion Date - May 1,2000 . ;/. r: I -- -011 ) . ,. ,r, , .! :,- : ,w 10,-*,,, ii„„„,-... At* . 2 South Federal Highway • Dania Beach, FL 33004 Phone: (305) 940-0264 • Fax: (305) 940-0265 imin? r FHP TECTONICS CORP. BRON GENERAL CONTRACTORS Stevenson Park Pool Remodeling Construction began in October 1999 on the renovation of the Stevenson Park Pool in Burbank,Illinois. The project consisted of building a new wading pool,zero depth to two feet,which included play features such as tumble buckets,water and ground jets,and a sand play area. In addition,FHP completely renovated the 4,000 sf. bathhouse for ADA compliance and reconfigured the landscaping and concrete decks around the main pool. A trellis and"Funbrellas"were scattered around the deck to provide shade in areas around the pool. A new mechanical system was installed for the wading pool and bathhouse. Owner Burbank Park District Contract Amount $1,315,120 Completion Date June 1,2000 m _ ippormo fit Y •. • • No•:::40 a,iszeion •, • . - ., - ■ ill I.1111111 4 : .......r -... ,. A. . , al ,...• • . 2 South Federal Highway • Dania Beach, FL 33004 Phone: (305) 940-0264 • Fax: (305) 940-0265 mil"? r FHP TECTONICS CORP. BMN GENERAL CONTRACTORS Water Playgrounds at 5 Parks New water playgrounds were built at five parks—Humboldt Park, Pulaski Park, McKinley Park,Graver Park, and Hale Park. The project included installing all new interactive playgrounds and pools.All were 60' in diameter and went from 0 depth to 3'6".Ornamental metal fencing surrounded each new pool and concrete deck. Owner Chicago Park District Contract Amount $2,430,388 Completion Date December 1, 1999 s. �..r:'- •r1.?i�a .,�..,... -ice.► - - - ',' ' 4`- 2 South Federal Highway • Dania Beach, FL 33004 Phone: (305) 940-0264 • Fax: (305) 940-0265 r FHP TECTONICS CORP. EMN GENERAL CONTRACTORS Pool Renovations (4) Swimming pool renovation projects at four parks for the Chicago Park District-Avalon,Tuley, Blackhawk,and McGuane Pools.The work was broken down as follows: Avalon Park Pool • Installed new interactive water playground,60 feet in diameter,0 depth to 3'6" • Installed new filter building and equipment for the existing 25 yard,6 lane pool • Installed new ornamental iron fence Tuley Park Pool • Installed stainless steel gutter • Built new bathhouse to match historical architecture on the existing building • Poured new concrete deck • Painted 50 yard, 8 lane pool Blackhawk Park Pool • Renovated existing filtration system • Installed new stainless steel gutter • Repaired tile McGuane Park Pool • Renovated existing filtration system for 25 yard,6 lane pool Owner Chicago Park District 4 • - Contract Amount .< . $2,027,522 _ .: .- • • Completion Date • • June 1, 1998 T • ti oft! u� 1111121111111111111111111Mill u"� 2 South Federal Highway • Dania Beach, FL 33004 Phone: (305) 940-0264 • Fax: (305) 940-0265 r FHP TECTONICS CORP. N GENERAL CONTRACTORS Ultrafest Music Festival 2012 Preparation - Bayfront Park Project This project involved multiple park renovations to accommodate the annual Ultrafest Music Festival. Work included the relocation of multiple trees, construction of a retaining wall and the installation of a staging/performance area. Owner Architect/Engineer Ray Steinman Eduardo Rodriguez Jr. Production Director Braniff Engineering Festival Productions MXT, LLX 3641 NW 46th Street 1000 NE 14th Street Miami, FL 33142 Miami,FL 33136 Phone:305-300-0835/Fax: 305-638-9957 Phone:954-609-7786/Fax:413-683-3255 rnstein @aol.com Contract Amount $542,545.36 ,i ,fit Start Date 0 . • � : � 4 l 16 . 1111.February 2012 ,t i. A Completion Date March 2012 i, I . 1 . itli . f v V zy - -a 2 SOUTH FEDERAL HIGHWAY • DANIA BEACH, FL 33004 PHONE (305) 940-0264 www.fhpaschen.com 1" FHP TECTONICS CORP. "N GENERAL CONTRACTORS Museum Park Baywalk and Promenade, Phase II and III Project This project consisted of the complete construction of a large park along Miami's waterfront. The scope of work included, but is not limited to, complete site demolition and excavation, concrete, pavers, irrigation,landscaping, furnishings,lighting and electrical. Owner Architect/Engineer City of Miami/Miami, FL Chen-Moore and Associates 444 SW 2`d Avenue,8`h Floor 500 West Cypress Creek Road,Suite 630 Miami, FL 33130 Fort Lauderdale,FL 33309 Phone:954-730-0707 Contract Amount $9,145.015.93 Start Date March 2013 Completion Date �..— esr,,,,� -,-_,„...t. June 2014 4 - V., *41c, _ -ieillr--waek-2111;:-..-:',n VP 4 , =-.. .--' - -...t. --ali--------. -,...-,--Alix, - --... attr 7 ' -'' —' : : ''''- -: - -• • vim.:••r- � _ y am• \ f ..:r.`.z, •f / i• 4 w , ••.• • Yilit r, ii . 2 SOUTH FEDERAL HIGHWAY • DANIA BEACH, FL 33004 PHONE (305) 940-0264 www.fhpaschen.com r'FP FHP TECTONICS CORP. N GENERAL CONTRACTORS 1814 Brickell Avenue Park Project This project consisted of the construction of a new park in downtown Miami. Numerous obstacles were encountered,including the discovery of historical artifacts and remains throughout the site. Because of these findings,multiple changes were made to avoid disturbance. Owner City of Miami—Capital Improvements 444 SW 2nd Ave.,8th Floor Miami,FL 33130 Architect/Engineer - Enea Garden Design - 3898 Biscayne Blvd. '"= Miami, FL 33137 + Contract Amount .. r. $840,924.00 itr - - Start Date F .T; September 2011 . Completion Date ;' *s" April 2012 � .� +`- �,,.r riN1s liso ' OF q4 II i IV le— iir Apo . 4--4taft• • •a; "Nit il ir 4. - . , , . , . . . .. ..,,*..„,,,, 4 o s iti* - _ , - • 2 SOUTH FEDERAL HIGHWAY • DANIA BEACH, FL 33004 PHONE(305) 940-0264 www.fhpaschen.com I�1.01,1p F.H. PASCHEN, g` NIELSEN & ASSOC., LLC EIHN GENERAL CONTRACTORS Bayfront Park Baywalk Project This project consisted of the removal of existing sidewalks to facilitate the installation of the proposed landscaping. Also included was the installation of a new irrigation system on the south side of the park, irrigation pump, benches and trash receptacles. Owner City of Miami/Miami, FL Architect/Engineer ConsulTech, Curtis+Rogers Design Studio, Inc. B } 4,4 r 1 ' .any 4 \4 ,.� ^. tillf I \4. k 1 ' ' -____-__.:_ ,..jaia •1 :all r i `ar .._ -_...-!:_.-L..--_-•- fir! .____._ _ . ..`-. -_____ Y "ti .. ..E - - .• - N.2 SOUTH FEDERAL HIGHWAY • DANIA BEACH, FL 33004 PHONE (305) 940-0264 www.fhpaschen.com r FHP TECTONICS CORP. R(j N GENERAL CONTRACTORS Pool Renovations (5) Although FHP was the low bidder on only four of the parks,a fifth was added because of our expertise in these renovations,as well as the excellent working relationship FHP has developed with the Park District. Work began immediately at Norwood Park and Chase Park Pools on the North Side,and Hamilton Park, Grand Crossing Park,and Trumbull Park Pools on the South Side. The work at Chase,Hamilton,Trumbull,and Grand Crossing consisted of the following: • Pool—25 meters,6 lanes—C/H;40 meter,7 lanes—GC/T • New Stainless Steel Recirculation System—H/GC/T • Demo Existing and Install New Filtration System—T • New PVC Liner System—C/H/T • Paint Aluminum Pool Interior—GC • Concrete Deck Replacement or Repairs • Minor Fence Repair • New Deck Equipment • New Sewage Ejector Systems for Pool Drainage and Backwash The Norwood Park Pool was different in that it is a 50 meter,7 lane pool and in addition to the above repairs,the following items were also installed:a new pool heater,a 9'ornamental wrought iron fence,a one meter diving board as well as a waterslide and pump equipment. These projects were constructed on a fast-track • basis. Owner Chicago Park District Contract Amount - $2,565,103 � ... • ... 4 ,f i , Completion Date �� : 4 lir June 1997 ., . ... u T 6. e.. a M:IY•' A'I,:yr 2 South Federal Highway • Dania Beach, FL 33004 Phone: (305) 940-0264 • Fax: (305) 940-0265 A-3 8. Attach a list including the following information concerning all contracts in progress as of the date of submission of this bid. (In case of co-venture, list the information for all co-venturers): See Attached. a. Name of Project b. Owner and Point of Contact(Minimum of Phone Number& E-mail Address) c. Original Contract Value d. Current Contract Value e. Projected Date of Completion per Contract f. Percent(%)Completion to Date of Bid Submittal 9. Has a representative of the Bidder completely inspected the proposed project and does the Bidder have a complete plan for its performance? ® Yes DNo 10. State the true, exact, correct and complete name of the partnership, corporation or trade name under which you do business and the address of the place of business. (If a corporation, state the name of the president and secretary. If a partnership, state the names of all partners. If a trade name, state the names of the individuals who do business under the trade name). Additional Sheets may be attached as necessary. A. The correct name of the Bidder is: FHP Tectonics Corp. B. The business is a: El Sole Proprietorship D Partnership ® Corporation C. The address of principal place of business is: 2 South Federal Highway,Dania Beach,FL 33004 D. The names of the corporate officers, or partners, or individuals doing business under a trade name, are as follows: WM* Tine James V.Blair President Joseph V.Scarpelli,Robert F.Zitek,Mark Barkowski, Timothy B.Stone,David Wainwright and Leo Wright Vice President James Habschmidt Secretary Jeanette Charon and Kathleen Pattison Assistant Secretary Frank H.Paschen Treasurer BID NO:2015-191-YG CITYOF MIAMI BEACH BEACH 56 CERTIFICATE I do hereby certify that the following is a true, complete and correct copy of a resolution adopted by the Board of Directors of said Corporation pursuant to a Consent,dated May 31,2013,signed by all of said Directors: "RESOLVED, that the following are hereby authorized to execute and deliver for and on behalf of FHP Tectonics Corp., contracts of all kinds, including but not limited to, construction proposals, bids, construction contracts,joint venture agreements,change orders,.bid bonds,payment and performance bonds, letters of credit, and any and all documents, instruments and papers which in their discretion may be necessary, expedient, or proper for the presentation of a proposal and if awarded a contract for the construction upon wich FHP Tectonics Corp is engaged or will become engaged as a Contractor or Manager. Frank H. Paschen Chairman,Director,Chief Executive Officer,Treasurer James V. Blair President James Habschmidt Chief Financial Officer, Secretary Joseph V. Scarpelli Executive Vice President Robert F.Zitek Sr.Vice President W. Mark Barkowski Vice President Timothy B.Stone Vice President Leo Wright Vice President David P. Roy Sr. Project Manager Michael P.Thiele Sr.Project Manager Riley Barron Operations Manager I do hereby further certify that said resolution has not been amended or repealed and is in full force and effect. IN WITNESS WHEREOF I have hereunto sct my hand and affixed the Corporate seal of said Corporation,this I I"'day of February,2014. Q42442-6an-Lfd ames Habschmidt Secretary (Corporate Seal) State of Illinois County of Cook Subscribed and sworn to before me this 1 1111 day of February,2014. . IJkLP4hery Notary Public 1.. 7 ::.,—.............,-.......,26.40......,....a S,r'vi,' '-i,, r;A1111 f.1>`1 PA f1SON f f�. +::', f ` 4,.r+, 1,rtital�t,.Idts,t∎!llltrio?s o? tvi.p l.!rmr issii4,1 f .„„:S il "4';':4.-,,,c.,;-.' .. ""tUSt 2 21114 1 r ? FHP TECTONICS CORP. - - IV 1�1 GENERAL CONTRACTORS Current Projects 2 SOUTH FEDERAL HIGHWAY • DANIA BEACH, FL 33004 PHONE (305) 940-0264 • FAX (305)940-0265 www.fhpaschen.com moi 1" FHP TECTONICS CORP. �R 1 GENERAL CONTRACTORS Current Experience Maintenance/Unit Price Contracts • Public Health Trust/Jackson Health System o Job Order Contract-1TB 13-1 1 538-JE • Up to$4,000,000 Per Year For 5 Years • Scope: Misc.Building Projects. • Contract In Process • City of Miami o Job Order Contract No. 13-884—ITB 11-12-017 Horizontal Construction • Up To$2,000,000 Per Year For 4 Years • Scope: Roadway Projects. • April 2013 to Present • City of Miami o Job Order Contract No. 13-888—ITB 11-12-017 Vertical Construction • Up To$2,500,000 Per Year For 4 Years • Scope: Misc. Building Projects. • April 2013 to Present • Public Health Trust/Jackson Health System o Job Order Contract-ITB 08-6060/GC-04 • Up to$4,000,000 Per Year For 5 Years • Scope: Misc.Building Projects. • May 2009 to Present • National Joint Power Alliance o Job Order Contract • Unlimited Capacity Scope: Misc. Building Projects. • Scope: Misc. Building and Roadway Projects. • August 2009 to Present 2 SOUTH FEDERAL HIGHWAY • DANIA BEACH, FL 33004 PHONE(305) 940-0264 • FAX(305) 940-0265 www.fhpaschen.com r FHP TECTONICS CORP. 1\1 GENERAL CONTRACTORS Lump Sum Contracts • City of Hallandale Beach o 39th Year Public Works Improvement Block Grant Project • Owners Rep.: Cecilia Espejo, Engineer • Bid Amount: $169,039.57 • Scope: Storm Drain Installation • January 2015 to March 2015 • Company Trade Personnel: 4 Per Day • City of Doral o Illuminated Bicycle&Pedestrian Trail • Bid Amount: $662,169.82 • Scope: New Bike Path • February 2015 to July 2015 • Company Trade Personnel: 0 Per Day • United States Postal Service o Okeechobee Main Post Office—Replace Pavement • Owners Rep.: Matthew Kalandranis, Project Manager • Contract Amount: $554,075.00 • Scope: Driveway Replacement • November 2014 to April 2015 • Company Trade Personnel: 0 Per Day • City of Miami o Downtown Miami Beautification Project • Owners Rep.: Mario Darrington, Procurement Contracting Manager • Contract Amount: $9,737,426.16 • Scope: New Hardescape(including Demolition,Storm Drainage, Sidewalks, Asphalt,Lighting,Signalization,Landscaping and Utility Relocation. • April 2015 to Current • Company Trade Personnel: 6 Per Day • City of Oakland Park o Bid Package 13 Park Lane Phase V • Owners Rep: Ronald Desbrunes • Contract Amount:$1,108,413.00 • Scope: Roadway Beautification (Demolition,Storm Drainage,Sidewalks, Asphalt,Landscaping and Lighting) • September 2015 to February 2016 • Company Trade Personnel: 3 Per Day 2 SOUTH FEDERAL HIGHWAY • DANIA BEACH, FL 33004 PHONE(305) 940-0264 • FAX (305) 940-0265 www.fhpaschen.com A-3 E. List all organizations which were predecessors to Bidder or in which the principals or officers of the Bidder were principals or officers. F.H.Paschen,S.N.Nielsen and Associates.LLC F. List and describe all bankruptcy petitions (voluntary or involuntary) which have been filed by or against the Bidder, its parent or subsidiaries or predecessor organizations during the past five (5) years. Include in the description the disposition of each such petition. None. G. List and describe all successful Performance or Payment Bond claims made to your surety(ies) during the last five (5) years. The list and descriptions should include claims against the bond of the Bidder and its predecessor organization(s). None. H. List all claims, arbitrations, administrative hearings and lawsuits brought by or against the Bidder or its predecessor organization(s) during the last five (5) years. The list shall include all case names; case, arbitration or hearing identification numbers; the name of the project over which the dispute arose; a description of the subject matter of the dispute; and the final outcome of the claim. See Attached. BID NO:2015-191-YG CITYOF MIAMI BEACH • B,F cti es IA' r 1+ y a0 s r 0 4`'.; -cl 4-, .2 0 se) c`a > C on y C in a g O .0 5-0 �Co g a� E. 3 = t aQ y M .G •v c u _ ¢ c E u °1 v ¢ • cu O C v c �_ c :a'!" • `s4 - L 4 u 3 c j ▪ M •C A - b y a c E E .. ti- - v 01 v, 0 `' G U °� b �� Q a, _ ' = = r ° A IJ ') •5 t / .C w C 4 & _4 O iii ' 0 n o, - . E obi g. w ?,,8 i ` •a uv a.5 4 4' ( p C� G N d Y . CD c ,G O .i, ,0 O 0 l 3 O r' 'Jr A s` , C o) a� _E b 4 0 69 r • C p n c C. 'il O u ... > 0 w o) O ^ O -J 2V v y O 3k "C p iii 0 p e 'LI o� a n 2 y 7 >, Q cj rn t. c y • .0 c 1..1 0J >, . z .6:y •�" V V V a� c� '��. 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List and describe all criminal proceedings or hearings concerning business related offenses in which the Bidder, its principals or officers or predecessor organization(s) were defendants. None. J. Has the Bidder, its principals, officers or predecessor organization(s)been debarred or suspended from bidding by any government during the last five (5) years? If yes, please provide details. No. K. Under what conditions does the Bidder request Change Orders? Changes in scope of work. • L. Provide the names of all individuals or entities (including your sub-consultants)with a controlling financial interest and the percentage of ownership. The term "controlling financial interest" shall mean the ownership, directly or indirectly, of 10% or more of the outstanding capital stock in any corporation or a direct or indirect interest of 10%or more in a firm. The term "firm" shall mean any corporation, partnership, business trust or any legal entity other than a natural person. See Attached. BID NO:2015-191-YG CITYOF MIAMI BEACH BEACH A-3 11. Individuals or entities (including our sub-consultants) with a controlling financial interest: have have not contributed to the campaign either directly or indirectly, of a candidate who has been elected to the office of Mayor or City Commissioner for the City of Miami Beach. Please provide the name(s) and date(s) of said contributions and to whom said contribution was made. 12. Has the Corporation, Officers of the Corporation, Principal Stockholders, Principals of the Partnership or Owner of Sole Proprietorship ever been indicted, debarred, disqualified or suspended from performing work for the Federal Government or any State or Local Government or subdivision or agency thereof? ❑Yes ®No 13.Are any indictments, debarments, disqualifications, or suspensions referenced on the previous page current? ID Yes ®No If the answer to either number 12 or 13 is yes, attach a written detailed explanation. 14. Is the business entity owned by a certified service-disabled veteran, and or a small business owned and controlled by veterans, as defined on Section 502 of the Veteran Benefit Health, and Information Technology Act of 2006, and cited in the Database of Veteran-owned Business? ❑Yes ®No BID NO:2015-191-YG CITYOF MIAMI BEACH - BEACH A-3 CONTRACTOR QUALIFICATION STATEMENT VALIDATION: The undersigned certifies that the information provided in this questionnaire is correct and accurate. IF PARTNERSHIP: Signature Print Name of Firm icabl Print Na e• Title: IF CO POAr" � FHP Tectonics Corp. p Signature Print Name of Corporation 2 South Federal Highway David P.Roy Dania Beach,FL 33004 Print Name Address Title: Senior Project Manager W NES : 'P Signature Vaniqua Lee Print Name Title: Administrative Assistant (CORPORATE SEAL) Attest: Vr I Asst.Secretary Kathleen Pattison BID NO:2015-191-YG CITYOF MIAMI BEACH 11),E.��t. L,) A-4 SUPPLEMENT TO BID/TENDER FORM: NON-COLLUSION CERTIFICATE THIS FORM MUST BE SUBMITTED PRIOR TO AWARD FOR BIDDER TO BE DEEMED RESPONSIBLE. Submitted this 16th day of September 2015.. The undersigned, as Bidder, declares that the only persons interested in this Bid are named herein; that no other person has any interest in this Bid or in the Contract to which this Bid pertains; that this Bid is made without connection or arrangement with any other person; and that this Bid is in every respect fair and made in good faith,without collusion or fraud. The Bidder agrees if this Bid is accepted, to execute an appropriate City of Miami Beach document for the purpose of establishing a formal contractual relationship between the Bidder and the City of Miami Beach, Florida, for the performance of all requirements to which the Bid pertains. The Bidder states that this Bid is based upon the documents identified by the following number: Bid No. 201 SIGNA David P.Roy PRINTED NAME Senior Project Manager TITLE (IF CORPORATION) BID NO:2015-191-YG CITYOF MIAMI BEACH • RE H fit ,: A-5 SUPPLEMENT TO BID/TENDER FORM: DRUG FREE WORKPLACE CERTIFICATION The undersigned Bidder hereby certified that it will provide a drug-free workplace program by: (1) Publishing a statement notifying its employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the offeror's workplace, and specifying the actions that will be taken against employees for violations of such prohibition; (2) Establishing a continuing drug-free awareness program to inform its employees about: (i) The dangers of drug abuse in the workplace; (ii) The Bidder's policy of maintaining a drug-free workplace; (iii) Any available drug counseling, rehabilitation, and employee assistance programs; and (iv) The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace; (3) Giving all employees engaged in performance of the Contract a copy of the statement required by subparagraph (1); (4) Notifying all employees, in writing, of the statement required by subparagraph (1), that as a condition of employment on a covered Contract, the employee shall: (i) Abide by the terms of the statement; and (ii) Notify the employer in writing of the employee's conviction under a criminal drug statute for a violation occurring in the workplace no later than five (5) calendar days after such conviction; (5) Notifying the City in writing within ten (10) calendar days after receiving notice under subdivision (4) (ii) above, from an employee or otherwise receiving actual notice of such conviction. The notice shall include the position title of the employee; (6) Within thirty (30) calendar days after receiving notice under subparagraph (4) of a conviction, taking one of the following actions with respect to an employee who is convicted of a drug abuse violation occurring in the workplace: (i) Taking appropriate personnel action against such employee, up to and including termination; or (ii) Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a federal, state, or local health, law enforcement, or other appropriate agency; and (7) Making a good faith effort to maintain a drug-free workplace program through implementation of subparagraphs(1)through (6). BID NO:2015-191-YG CITYOF MIA MI BEACH • [1,1E/ ; H A-5 SUPPLEMENT TO BID/TENDER FORM: DRUG FREE WORKPLACE CERTIFICATION N11114:1.110 David P.Roy (Bidder ignature) FHP Tectonics Corp. (Print Vendor Name) STATE OF FLORIDA COUNTY OF BROWARD The foregoing instrument was acknowledged before me this 16th day of September 2015 , by David P.Roy as (name of person whose signature is being notarized) Senior Project Manager (title)of FHP Tectonics Corp. (name of corporation/company) known to me to be the person described herein, or who produced as identification, and who did/did not take an oath. NOTARY PUBLIC: f ' 1 ,11 J .g2 (Signature) ' +„oIF VANIOUA T.LEE ary Public-State ofVaniqua T.Lee,Notary ommission I FF 190(Print Name) omm.Elpires Mar 31,2019 0 My commission expires:March 31,2019 BID NO:2015-191-YG CITYOF MIA MI BEACH 1-?)F AC,C i A-6 SUPPLEMENT TO BID TENDER FORM: EQUAL BENEFITS ORDINANCE SUMMARY The foregoing analysis provides a summary of the major points of the proposed Ordinance: 1) What is the intent of the Ordinance? The proposed Ordinance will require certain contractors doing business with the City of Miami Beach, who are awarded a contract pursuant to competitive bids, to provide "Equal Benefits" to their employees with Domestic Partners, as they provide to employees with spouses. 2) How are "Equal Benefits" defined and what kind of "Benefits" does the Ordinance cover? "Equal Benefits" means that contractors doing business with the City who are covered by the Ordinance shall be required to provide the same type of benefits that they offer to employees and their spouses, to employees with Domestic Partners. The type of "Benefits" defined by the Ordinance and which may be offered by a contractor include: sick leave, bereavement leave, family medical leave, and health benefits. The "Benefits" defined in the Ordinance are the same type of benefits that the City provides to Domestic Partners of City employees, pursuant to Section 62-128 of the City Code]. Notwithstanding the definition of "Benefits" in the Ordinance, to comply with the Ordinance a Contractor is not required to provide all the above-described benefits. Contractors are only required to offer the same type of Benefits they offer to their employees with spouses, to employees with Domestic Partners. Additionally, a Contractor who offers no benefits to employees or their spouses, would not be required to offer any benefits to employees with Domestic Partners (and would still be in compliance with the Ordinance).] 3) Who is considered a "Domestic Partner" under the Ordinance? A "Domestic Partner" shall mean any two (2) adults of the same or different sex who have registered as domestic partners with a government body pursuant to state or local law authorizing such registration, or with an internal registry maintained by the employer of at least one of the domestic partners. 4) What type of Contracts and/or which Contractors are covered by the Ordinance? The Ordinance only applies to the following: • Competitively bid City contracts (bids, RFP's, RFQ's, RFLI's, etc.), • Contracts valued at over$100,000, • Contractors who maintain 51 or more full time employees on their payrolls during 20 or more calendar work weeks in either the current or the preceding calendar year, • Contractors covered by the Ordinance are only required to comply as to employees who: 1) either work within the City limits of the City of Miami Beach; or 2) the contractor's employees located in the United States, but outside of the City limits, only if those employees are directly performing work on the City contract(covered by the Ordinance). BID NO:2015-191-YG CITYOF MIAMI BEACH l:AC H A-6 5) In what cases does the Ordinance not apply? The provisions of the Ordinance do not apply where: • The City contract has been has been entered into prior to the effective date of the Ordinance(including renewal terms contained in such contracts); • The City contract is not competitively bid; • The City contract is valued at less than $100,000; • The contractor has less than 51 employees; • The contractor does not provide Benefits either to employees' spouses or to employees' Domestic Partners; • The contractor is a religious organization, association, society or any nonprofit charitable or educational institution or organization operated, supervised or controlled by or in conjunction with a religious organization, association or society; • The contractor is another government entity. The following City contracts are not covered by the Ordinance: • Contracts for sale or lease of City property; • Development Agreements; • Contracts/grants for CDBG, HOME, SHIP, and Surtax funds administered by the City's Office of Community Development; • Cultural Arts Council grants; • Contracts for professional NE, landscape NE, or survey and mapping services procured pursuant to Chapter 287.055, Florida Statutes ("The Consultants Competitive Negotiation Act"; • Contracts for the procurement of life, health, accident, hospitalization, legal expense, annuity insurance, or any and all other kinds of insurance for the officers and employees of the City and their dependents, from a group insurance plan. The Ordinance provides, upon written recommendation of the City Manager, that the City Commission may, by 5/7ths vote, waive application of the Ordinance for the following: • Emergency contracts; • Contracts where only one bid response is received; • Contracts where more than one bid response is received, but none of the bidders can comply with the requirements of the Ordinance. The City's ability to apply the Ordinance may also be preempted in instances where the Ordinance impacts health, retirement, or pension program which fall within the jurisdiction of the Employee Retirement Income Security Act (ERISA), and may under certain circumstances be held invalid under Federal preemption. 6) How is the Ordinance enforced by the City? • City contracts that are covered by the Ordinance shall notify potential bidders/proposers of the Ordinance and its requirements in the ITB documents; • At the time of entering into the contract with the City, the proposed City contractor shall certify to the City that it intends to provide Equal Benefits, along with the description of its employee benefits plan, which needs to be delivered to the Procurement Director prior to entering into the contract; BID NO:2015-191-YG CITYOF MIAMI BEACH RE ACH 65 A-6 • The City has the ongoing right to investigate/audit contracts for compliance with the provisions of the Ordinance; • The contractor is required to post notice to its employees at its place of business that it provides Equal Benefits. 7) Is there another way for a Contractor who does not provide Equal Benefits to comply with the Ordinance? If a contractor covered by the Ordinance has made a reasonable yet unsuccessful effort to provide Equal Benefits, it can still comply with the Ordinance by providing an employee with the "Cash Equivalent" of the similar benefit(s) offered to the contractor's employees and their spouses. 8) What are the penalties for non compliance? Failure of a contractor to comply with the requirements of the Ordinance may result in the following: • Breach/default under the contract; • Termination of the contract; • Monies due under the contract may be retained by the City until compliance is achieved; • Debarment of contractors from City work, as prescribed by the City Code. Balance of Page Intentionally Left Blank BID NO:2015-191-YG CITYOF MIAMI BEACH BEACH 66 A-6 MIAMIBEACH DECLARATION: NONDISCRIMINATION IN CONTRACTS AND BENEFITS Section 1.Vendor Information Name of Company: FHP Tectonics Corp. Name of Company Contact Person: David P.Roy Phone Number: 305-940-0264 Fax Number. 305-940-0265 E-mail: droy @tbpaschen.com Vendor Number(if known): N/A Federal ID or Social Security Number 36-4136428 Approximate Number of Employees in the U.S.: 1,291 (If 50 or less,skip to Section 4,date and sign) Are any of your employees covered by a collective bargaining agreement or union trust fund? Y es X No Union name(s): Section 2.Compliance Questions Question 1.Nondiscrimination-Protected Classes A. Does your company agree to not discriminate against your employees, applicants for employment, employees of the City, or members of the public on the basis of the fact or perception of a person's membership in the categories listed below? Please note: a "YES" answer means your company agrees it will not discriminate; a "NO" answer means your company refuses to agree that it will not discriminate. Please answer yes or no to each category. Race XYes No Sex X Yes No Color X Yes_No Sexual Orientation XYes_No Creed X Yes_No Gender Identity(transgender status) X Yes_No Religion XYes_No Domestic partner status XYes_No National origin XYes_No Marital status XYes_No Ancestry X Yes_No Disability X Yes_No Age X Yes_No AIDS/HIV status XYes_No Height X Yes_No Weight X Yes_No B. Does your company agree to insert a similar nondiscrimination provision in any subcontract you enter into for the performance of a substantial portion of the contract you have with the City? Please note:you must answer this question,even if you do not intend to enter into any subcontracts. X Yes_No BID NO:2015-191-YG CITYOF MIAMI BEACH BE ACH A-6 Question 2.Nondiscrimination-Equal Benefits for Employees with Spouses and Employees with Domestic Partners. When awarding competitively solicited contracts valued at over $100,000 whose contractors maintain 51 or more full time employees on their payrolls during 20 or more calendar work weeks, the Equal Benefits for Domestic Partners Ordinance 2005-3494 requires certain contractors doing business with the City of Miami Beach, who are awarded a contract pursuant to competitive bids, to provide "Equal Benefits" to their employees with domestic partners, as they provide to employees with spouses. The Ordinance applies to all employees of a Contractor who work within the City limits of the City of Miami Beach, Florida; and the Contractor's employees located in the United States, but outside of the City of Miami Beach limits, who are directly performing work on the contract within the City of Miami Beach. A. Does your company provide or offer access to any benefits to employees with spouses or to spouses of employees? X YES NO B. Does your company provide or offer access to any benefits to employees with (same or opposite sex)domestic partners* or to domestic partners of employees? x YES NO C. Please check all benefits that apply to your answers above and list in the "other" section any additional benefits not already specified. Note: some benefits are provided to employees because they have a spouse or domestic partner, such as bereavement leave; other benefits are provided directly to the spouse or domestic partner, such as medical insurance. BENEFIT Firm Provides Firm Provides Firm does not for Employees for Employees Provide Benefit with Spouses with Domestic Partners Health x x Sick Leave x X Family Medical Leave X Bereavement x x Leave If Proposer cannot offer a benefit to domestic partners because of reasons outside your control, (e.g., there are no insurance providers in your area willing to offer domestic partner coverage) you may be eligible for Reasonable Measures compliance. To comply on this basis, you must agree to pay a cash equivalent and submit a completed Reasonable Measures Application (attached) with all necessary documentation. Your Reasonable Measures Application will be reviewed for consideration by the City Manager, or his designee. Approval is not guaranteed and the City Manager's decision is final. Further information on the Equal Benefits requirement is available at: www.miamibeachfl.gov/procurement/ BID NO:2015-191-YG CITYOF MIA MI BEACH BEACH A-6 Section 3.Required Documentation YOU MUST SUBMIT SUPPORTING DOCUMENTATION to verify each benefit marked in Question 2C. Without proper documentation,your company cannot be certified as complying with the City's Equal Benefits Requirement for Domestic Partner Ordinance. For example, to document medical insurance submit a statement from your insurance provider or a copy of the eligibility section of your plan document;to document leave programs,submit a copy of your company's employee handbook. If documentation for a particular benefit does not exist,attach an explanation. Have you submitted supporting documentation for each benefit offered? u Yes No Section 4.Executing the Document I declare under penalty of perjury under the laws of the State of Florida that the foregoing is true and correct, and that I am authorized to bind this entity contractually. E e ; is 16th day of September,in the year 2015 ,at 3:00 , PM 4D, AB,• 2 South Federal Highway Signat Mailing Address David P.Roy Dania Beach,Florida 33004 Name of Signatory City,State,Zip Code Senior Project Manager Title BID NO:2015-191-YG CITYOF MIAMI BEACH BEACH H 69 PLAN DOCUMENT AND SUMMARY PLAN DESCRIPTION FOR THE EMPLOYEES OF F.H. PASCHEN COMPANIES MEDICAL AND DENTAL PLAN EFFECTIVE: November 1,2014 TABLE OF CONTENTS PAGE THE VALUE OF YOUR HEALTH BENEFIT PLAN 3 SCHEDULE OF BENEFITS 4 DENTAL SCHEDULE OF BENEFITS 9 PLAN PARTICIPATION 10 ELIGIBLE EMPLOYEES 10 WHEN EMPLOYEES BECOME ELIGIBLE 10 WAITIiVG PERIOD 10 ENROLLMENT DATE 10 EMPLOYEE EFFECTIVE DATE OF COVERAGE 10 LATE ENROLLMENT I I EMPLOYEES WHO ARE NOT ELIGIBLE 11 WHEN EMPLOYEES CEASE TO BE ELIGIBLE I 1 LEAVE OF ABSENCE 12 FAMILY MEDICAL LEAVE ACT(FMLA) 12 UNIFORMED SERVICES EMPLOYMENT AND REEMPLOYMENT RIGHTS ACT OF 1994(USERRA) 13 ELIGIBLE DEPENDENTS 15 QUALIFIED MEDICAL CHILD SUPPORT ORDER(QMCSO) 16 ( SPECIAL ENROLLMENT PERIODS 16 DEPENDENTS EFFECTIVE DATE OF COVERAGE 17 WHEN DEPENDENTS CEASE TO BE ELIGIBLE 18 PREFERRED PROVIDER ORGANIZATION(PPO) 20 UTILIZATION REVIEW PROGRAM 21 PRE-ADMISSION REVIEW 21 CONTINUED STAY REVIEW 22 RETROSPECTIVE REVIEW 22 PRE-SURGICAL REVIEW 23 VOLUNTARY SECOND SURGICAL OPINION BENEFIT 23 CASE MANAGEMENT SERVICES 25 MEDICAL EXPENSE BENEFIT • 26 THE DEDUCTIBLE AMOUNT 26• FAMILY DEDUCTIBLE 26 CARRY-OVER DEDUCTIBLE 26 CO-INSURANCE FACTOR 26 OUT-OF-POCKET MAXIMUM 26 FAMILY OUT-OF-POCKET MAXIMUM 26 COVERED MEDICAL EXPENSES 27 HUMAN ORGAN TRANSPLANT BENEFIT 32 EXTENDED CARE FACILITY 33 HOME HEALTH CARE 34 HOSPICE CARE 35 PRE-ADMISSION TESTING BENEFIT 36 PRESCRIPTION DRUG PROGRAM 37 MEDICAL EXPENSE EXCLUSIONS AND LIMITATIONS 38 DENTAL EXPENSE BENEFIT 41 DEDUCTIBLE AMOUNT 41 CO-INSURANCE FACTOR 41 CALENDAR YEAR MAXIMUM BENEFIT 41 _.{ LATE ENROLLMENT LIMITATION 41 TABLE OF CONTENTS PAGE ALTERNATE TREATMENT PLANS 41 TREATMENT PLAN 42 ORTHODONTIC EXPENSE BENEFIT 43 ORTHODONTIC DEDUCTIBLE 43 COVERED SERVICES 45 DENTAL EXPENSE EXCLUSIONS AND LIMITATIONS 47 EXTENSION OF BENEFITS 49 GENERAL EXCLUSIONS AND LIMITATIONS 50 OTHER HEALTH BENEFIT PLAN INFORMATION 52 COORDINATION OF BENEFITS 52 SUBROGATION 55 MEDICARE PROVISIONS 57 COBRA 59 CONVERSION PRIVILEGES 64 DEFINITIONS OF TERMS 65 HOW TO SUBMIT A CLAIM 77 MEDICAL CLAIMS 77 MEDICARE CLAIMS 77 DENTAL CLAIMS 77 CLAIMS REVIEW PROCEDURE 78 RESPONSIBILITIES FOR PLAN ADMINISTRATION 85 PLAN ADMINISTRATOR 85 DUTIES OF THE PLAN ADMINISTRATOR 85 PLAN ADMINISTRATOR COMPENSATION 85 FIDUCIARY 85 FIDUCIARY DUTIES 86 THE NAMED FIDUCIARY 86 ASSETS UPON TERMINATION 86 THE TRUST AGREEMENT 86 PLAN IS NOT AN EMPLOYMENT CONTRACT 86 GENDER AND NUMBER 86 HEADINGS 86 CONFORMITY WITH LAW 87 LIABILITY OF OFFICERS AND EMPLOYEES 87 CLERICAL ERROR 87 AMENDING AND TERMINATING THE PLAN 87 CERTAIN EMPLOYEE RIGHTS UNDER ERISA 87 RESCISSION OF COVERAGE 88 PRIVACY AND PROTECTED HEALTH INFORMATION 89 THE USE AND DISCLOSURE OF PROTECTED HEALTH INFORMATION 90 GENERAL PLAN INFORMATION 93 2 THE VALUE OF YOUR HEALTH BENEFIT PLAN This document is a description of the F.H. Paschen Companies Medical and Dental Plan (the Plan). No oral interpretations can change this Plan. We recognize the fact that everyone at some time or another is going to need some medical attention which would create a major financial burden. Because we value you as an employee, we wish to protect you and your family against such happenings. Therefore,we have established a Plan to pay medical and dental claims up to a specific amount per person and we have purchased Excess Insurance to pay the catastrophic claims over that Specific amount if they incur. Coverage under the Plan will take effect for you and your eligible Dependents when you and such Dependents satisfy the waiting period and all eligibility requirements of the Plan. The Company fully intends to maintain this Plan indefinitely. However, it reserves the right to terminate, suspend, discontinue,or amend the Plan at any time and for any reason. Changes in the Plan may occur in any or all parts of the Plan including benefit coverage, Deductibles, maximums, Co- payments,exclusions,limitations,definitions,eligibility and the like. The Plan will pay benefits only for the expenses incurred while this coverage is in force. No benefits are payable for expenses incurred before coverage began or after coverage terminated, even if the expenses were incurred as a result of an Accident, Injury or disease that occurred,began,or existed while coverage was in force. An expense for a service or supply is incurred on the date the service or supply is furnished. If the Plan is terminated,the rights of Covered Persons are limited to covered charges incurred before termination. This document summarizes the Plan rights and benefits for Covered Employees and their Dependents,explaining: • How you become eligible to participate, • What benefits are available to you and your family,and • How the Plan is administered. We hope you will take the time to review your benefit coverage from F.H. Paschen Companies and share with your family ways to do your part to make the health care system work cost effectively and efficiently for you. Please contact your Human Resources Department and/or Claims Administrator should you have any questions regarding your Plan. 3 SCHEDULE OF BENEFITS DEDUCTIBLE/OUT-OF-POCKET/PENALTIES SUMMARY OF SERVICES NETWORK PROVIDERS I NON-NETWORK PROVIDERS Hospital Pre-Admission And Pre-Surgical Review Refer To The Section Entitled"Utilization Review Program" Non-Compliance Penalty Outpatient Surgeries $300 Hospital Admissions(Hospitals,Skilled $300 Nursing Facilities,Residential Treatment Facilities,OP Behavioral Health Treatment Facilities providing partial hospitalization,day treatment or intensive OP treatment) Diagnostic Imaging(CAT Scans, MRI's) $300 Annual Maximum Benefit Unlimited Lifetime Maximum Benefit Unlimited Calendar Year Deductible Individual $500 Family $1,000 Note:Network/Non-Network expenses will be combined towards the satisfaction of the Network/Non-Network Deductible amounts. The Family Deductible Maximum includes covered expenses which are used to satisfy Deductibles for all family members combined. Out-of-Pocket Maximum(includes Deductible and Co-insurance) } Individual $1,750 Family $3,500 Note: Network/Non-Network expenses will be combined towards the satisfaction of the Network and Non-Network Out-of-Pocket Maximums. The Family Out-of-Pocket Maximum includes Out-of-Pocket expenses for all family members combined. SPECIAL COVERAGES Refer to Specific Section for Details SUMMARY OF SERVICES NETWORK PROVIDERS NON-NETWORK PROVIDERS Expanded Women's Preventive Care 100%No Deductible 70%No Deductible Services as required under the Patient Protection and Affordable Care Act(PPACA) Preventive Care Services as required 100%No Deductible 70%No Deductible under the Patient Protection and Affordable Care Act(PPACA)include the following: • Evidence-based items or services with an A or B rating recommended by the United States Preventive Services Task Force; • Immunizations for routine use in children,adolescents,or adults recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention: • Evidence-informed preventive care and screenings provided for in comprehensive guidelines supported by the Health Resources and Services Administration (HRSA)for infants,children and adolescents:and • Evidence-informed preventive care and screenings provided for in comprehensive guidelines supported by HRSA for women. • The complete list of recommendations and guidelines can be found at: http://www.hhs.gov/healthcare/prevention/index.html Organ Transplants [ 90%Deductible Applies 70%Deductible Applies Travel and lodging expenses are covered to a maximum benefit of$5,000. These expenses are covered when received at a Network Transplant Provider Facility more than 50 miles from your residence. 4 PHYSICIAN AND OFFICE SERVICES Including Psychiatric and Substance Abuse Care SUMMARY OF SERVICES NETWORK PROVIDERS NON-NETWORK PROVIDERS Office Visits 90%Deductible Applies 70%Deductible Applies Surgeon 90%Deductible Applies 70%Deductible Applies Surgery 90%Deductible Applies 70%Deductible Applies Diagnostic X-Ray&Lab 90%Deductible Applies 70%Deductible Applies Independent Lab,Radiologist& 90%Deductible Applies 70%Deductible Applies Pathologist *Services Performed by a Non-Network Provider Which The Patient Did Not Have The Option To Choose Which Relate To In-Network Services will be payable at the In- Network rate. Allergy Injections 90%Deductible Applies 70%Deductible Applies Allergy Testing 90%Deductible Applies 70%Deductible Applies Chemotherapy 90%Deductible Applies 70%Deductible Applies Physical Therapy 90%Deductible Applies 70%Deductible Applies Occupational Therapy 90%Deductible Applies 70%Deductible Applies z , Speech Therapy 90%Deductible Applies 70%Deductible Applies Chiropractic Services Office Visits 90%Deductible Applies 70%Deductible Applies Manipulations 90%Deductible Applies 70%Deductible Applies X-Rays 90%Deductible Applies 70%Deductible Applies Calendar Year Maximum-20 Visits Acupuncture Services 90%Deductible Applies 70%Deductible Applies Calendar Year Max imum 20 Visits Podiatric Services(No Routine Foot Care) Office Visits 90%Deductible Applies 70%Deductible Applies Surgery 90%Deductible Applies 70%Deductible Applies X-Ray&Lab 90%Deductible Applies 70%Deductible Applies Orthotics 90%Deductible Applies 70%Deductible Applies Infertility Services Infertility Treatment/Testing Not Covered Not Covered TMJ Care Office Visits 90%Deductible Applies 70%Deductible Applies Surgery&Related Services 90%Deductible Applies 70%Deductible Applies Appliances 90%Deductible Applies 70%Deductible Applies Physical Therapy 90%Deductible Applies 70%Deductible Applies All Other Covered Services 90%Deductible Applies 70%Deductible Applies Other Covered Services 90%Deductible Applies 70%Deductible Applies 5 OUTPATIENT HOSPITAL&AMBULATORY SURGICAL CENTER SUMMARY OF SERVICES NETWORK PROVIDERS NON-NETWORK PROVIDERS Facility 90%Deductible Applies 70%Deductible Applies Emergency Room Emergency 90% Network Deductible and Network Out-of-Pocket Applies Non-Emergency 90%Deductible Applies 70%Deductible Applies Diagnostic X-Ray&Lab 90%Deductible Applies 70%Deductible Applies Pre-Admission Testing 90%Deductible Applies 70%Deductible Applies Surgeon/Surgery 90%Deductible Applies 70%Deductible Applies Physical Therapy 90%Deductible Applies 70%Deductible Applies Occupational Therapy 90%Deductible Applies 70%Deductible Applies 0 0 Speech Therapy 90%Deductible Applies 70%Deductible Applies Chemotherapy&Radiation Therapy 90%Deductible Applies 70%Deductible Applies Independent Lab,Emergency Room 90%Deductible Applies 70%Deductible Applies Physician Assistant Surgeon, *Services Performed by a Non-Network Provider Which The Patient Did Not Have The [ Anesthesiologist,Pathologist,Radiologist Option To Choose Which Relate To In-Network Services will be payable at the In- 1 � &Consulting Physician Network rate. Other Covered Services 90%Deductible Applies I 70%Deductible Applies INPATIENT HOSPITAL Including Psychiatric&Substance Abuse Care SUMMARY OF SERVICES NETWORK PROVIDERS NON-NETWORK PROVIDERS Facility 90%Deductible Applies 70%Deductible Applies Room.Board&Miscellaneous 90%Deductible Applies _ 70%Deductible Applies Nursery 90%Deductible Applies 70%Deductible Applies Baby&Mother's Charges Will Be Combined. Baby's charges are covered under mom only until the mother's confinement ends.In order for the baby's coverage to continue he/she must be added Diagnostic X-Ray&Lab 90%Deductible Applies 70%Deductible Applies Surgeon 90%Deductible Applies 70%Deductible Applies Physician Visits 90%Deductible Applies 70%Deductible Applies Cardiac Rehabilitation 90%Deductible Applies 70%Deductible Applies Must be completed within siz 6)months of Inpatient stay Assistant Surgeon,Anesthesiologist, 90%Deductible Applies J 70%Deductible Applies Radiologist,Pathologist&Consulting *Services Performed by a Non-Network Provider Which The Patient Did Not Have The Physician Option To Choose Which Relate To In-Network Services will be payable at the In- Network rate. Other Covered Services 90%Deductible Applies I 70%Deductible Applies r 6 OTHER COVERED SERVICES SUMMARY OF SERVICES NETWORK PROVIDERS NON-NETWORK PROVIDERS Extended Care Facility 90%Deductible Applies 70%Deductible Applies Calendar Year Maximum 30 Days(treatment&confinement) Home Health Care 90%Deductible Applies 70%Deductible Applies Calendar Year Maximum-100 Visits Hospice Care Inpatient Hospice 90%Deductible Applies _ 70%Deductible Applies Calendar Year Maximum-5150 per day.up to 56.000 Outpatient Hospice 90%Deductible Applies 70%Deductible Applies Calendar Year Maximum-$4.000 Bereavement Counseling Not Covered Not Covered Private Duty Nursing (provided by an 90%Deductible Applies 70%Deductible Applies R.N.) Calendar Year Maximum-SO Visits Ambulance 90%Network Deductible Applies Durable Medical Equipment 90%Deductible Applies 70%Deductible Applies Limited to the lesser of the purchase price or the total anticipated rental charges. Pre- approval is required if the purchase price or anticipated rental exceeds 51,000 Prosthetic Appliances 90%Deductible Applies 70%Deductible Applies Includes replacements which are medically necessary or required by pathological change or normal growth i 7 PRESCRIPTION DRUG PLAN RETAIL PRESCRIPTION PLAN If obtained through the Prescription Drug Plan—100%after satisfaction of applicable co-payment:-Per 30 day supply Generic 1 $10 Preferred Brand $20 Non-Preferred Brand $30 Brand if no Generic Available $30 Brand if patient mandates $30 Brand if physician mandates $30 Generic FDA approved forms of contraceptives for Women 100%No Co-payment MAIL ORDER PRESCRIPTION PLAN If obtained through the Mail Order Prescription Drug Plan—100%after satisfaction of applicable co-payment:-Per 90 day supply Generic $20 Preferred Brand 1 $40 Non-Preferred Brand ' $60 Brand if no Generic Available $60 Brand if patient mandates $60 Brand if physician mandates •$60 COVERAGE INCLUDES COVERAGE EXCLUDES • Federal Legend Drugs • Growth Hormone(prior authorization required) • Insulin ♦ Diagnostic Agents • Diabetic Supplies(lancets,needles,test strips,alcohol • Hair Loss Products swabs) ♦ Needles&Syringes ♦ Medical Devices • Migraine Medications • Injectable Fertility,Fertility Drugs ♦ lnjectables • Vitamins • ADHD Drugs • RhoGAM • Prenatal Vitamins • Anorexiants,Diet Drugs ♦ Retin-A to age 23(prior authorization required thereafter) • OTC Counterparts • Accutane to age 23(prior authorization required • Cosmetic Drugs thereafter) • Genetically Engineered Drugs • Injectable Fertility,Fertility Drugs • Contraceptives(oral,patch and Depo-Provera) • Vaccinations/Immunizations • Smoking Cessation Products(prior authorization required) ♦ Lifestyle Drugs ♦ FDA approved forms of Contraceptives for Women Acute Medications - those drugs used primarily for short term use such as antibiotics, pain relievers,etc. Maximum thirty (30) days supply. Maintenance Medications — those drugs used primarily to treat chronic conditions such as heart medications, high blood pressure medications,etc. Maximum ninety(90)day supply with three(3)refills. Expenses Related To Prescription Drug Co-payments,Charges In Excess Of Benefit Maximums,Charges In Excess Of Reasonable And Customary Fees And Non-Compliance Penalties Do Not Accumulate Toward The Out-of-Pocket Maximum. Any Maximums Which Are Stated In Dollar Amounts,Number Of Days Or Number Of Treatments And Which Limit Either The Maximum Benefits Payable Or The Maximum Allowable Covered Expense Are The Combined Maximums Under The Network and Non-Network Level Of Benefits. 8 DENTAL SCHEDULE OF BENEFITS Calendar Year Maximum Benefit $1,500 For Preventive,Basic and Major Services Calendar Year Deductible Individual $50 Family _ $100 For Basic and Major Services. The Deductible does not apply to Preventive Services. Note:Two(2)family members must satisfy Individual Deductibles.Partial Deductibles do not count toward the Family Maximum. Co-insurance Factor Preventive Services 100% Basic Services 80% Major Services 50% Orthodontia* Deductible $50 Co-insurance 50% Lifetime Maximum $1,000 *Limited to Dependent Children To Age 19 9 PLAN PARTICIPATION You must enroll for coverage under this Plan by obtaining an enrollment form from the Human Resources Department. Complete the form in full,sign and return it promptly to the Human Resources Department. ELIGIBLE EMPLOYEES You may participate in the PLAN if you are classified by FHP MANAGEMENT, INC., or any of their subsidiaries or affiliates, (hereinafter"Employer")as a regular employee compensated through the permanent payroll of Employer and you are regularly scheduled to work at least 30 hours at a location,other than your residence,in the conduct of the business of the Employer. Officers are included in the definition of employee. Additionally, Officers are included wherever the word "employee"is referenced throughout the Plan document. Additionally,those employees eligible for benefits under a collective bargaining agreement to which Employer is a signatory are not eligible for benefits under the PLAN. WHEN EMPLOYEES BECOME ELIGIBLE WAITING PERIOD A"Waiting Period"is the time between the first day of employment and the first day of coverage under the Plan. } ENROLLMENT DATE The "Enrollment Date"is the first day of coverage. You are eligible to participate in the PLAN after completing thirty(30)continuous days of employment from the date you are hired in an eligible employee classification. To enroll yourself and any eligible dependents,you must elect coverage within 30 days of the date you become eligible for the PLAN. You may also make an enrollment election each year during the annual enrollment period(which generally occurs during the month of October)and your election is effective on November 1. An employee does not become covered under the PLAN until such time as the employee completes and returns any and all necessary enrollment forms. If you return from a Leave of Absence which qualifies under the Family and Medical Leave Act(FMLA)and you chose not to retain health coverage under this Plan during such leave, your coverage will be reinstated upon return from such leave, without any waiting period,if you previously satisfied any applicable waiting period. EMPLOYEE EFFECTIVE DATE OF COVERAGE Your coverage begins on the date on which you become eligible for Plan benefits provided you have completed an enrollment card and make any required contributions. Coverage begins on November 1 if you are adding coverage or adding new dependents during annual enrollment(generally the period of October 1 through October 3 1). For new hires,coverage begins the date after the individual completes thirty(30)days of continuous service in an eligible employee classification. If you were an employee of Employer and covered under the PLAN at the time your employment terminated and are rehired by Employer within one year of the date of your termination of employment,coverage for you and your dependents(if any) will be effective on your rehire date and you do not have to satisfy the thirty(30)day waiting period. ENROLLMENT PERIODS 10 Initial Enrollment Period When you are eligible for coverage in the Company's Group Health and Dental Care Plan,you have the option to enroll in the Participating Provider Organization(PPO and or Dental Plan. You can select either or both options for yourself and your covered Dependents. Annual Re-Enrollment Period Re-enrollment is available only for those Employees (and their Dependents) that are currently enrolled in the Health and Dental Care Plan. The change in health care coverage you make during the annual re-enrollment period will be effective on the following November Pt. Your coverage in either plan will be effective on the following November 1st even though you are not actively-at-work due to Injury or Illness or your Dependent is Hospital confined on that date. LATE ENROLLMENT "Late Enrollee"means an individual who enrolls under the Plan other than during the first thirty(30)day period in which the individual is eligible to enroll under the Plan or during a Special Enrollment Period. } If you do not apply for coverage within thirty (30) days of the date you become eligible, or during a Special Enrollment Period, or if you previously elected to end your coverage in the Plan, you may apply for coverage during the annual enrollment period. The effective date of coverage will be the following November 1st. If an individual loses eligibility for coverage as a result of terminating employment or a general suspension of coverage under the Plan, then upon becoming eligible again due to resumption of employment or due to resumption of Plan coverage, only the most recent period of eligibility will be considered for purposes of determining whether the individual is a Late Enrollee. EMPLOYEES WHO ARE NOT ELIGIBLE People not classified by Employer as an employee, including contractors, are not eligible for benefits under the Plan. Employer's classification of a person as an employee or non-employee is conclusive and binding for purposes of benefit eligibility. If for any reason a person is reclassified from a non-employee to an employee status, that person will not be retroactively eligible for benefits. People classified by Employer as temporary, leased, part-time or seasonal employees are not regular employees,and are not eligible for benefits. Temporary, leased, part-time or seasonal classification may generally be determined by reference to customary weekly employment on an essentially full-time or part-time schedule for no more than a nine-month period.Again, the Employer's classification of a person as temporary,leased,part-time or seasonal is conclusive and binding for purposes of benefit eligibility. If for any reason a person is reclassified from temporary, leased, part-time or seasonal to regular full-time employee status, or found to be a common law employee of the Employer,that person will not be retroactively eligible for benefits for any time period during which they were not treated as an employee by the Employer. WHEN EMPLOYEES CEASE TO BE ELIGIBLE All Plan coverage will terminate on the earliest of the following dates: • The date following the date your employment terminates. The date following the date you cease to be in a class of Employees eligible for coverage. The date following the date you cease to be an eligible Employee. t1 The date on which you retire. The end of the period for which you made any required contributions,if you fail to make any further required contributions. The date the Plan is terminated. The date after the death of a covered employee or dependent. In the event of the covered employee's death,coverage for eligible dependents will also terminate on the date after the covered employee's death. The date on which you enter active military duty for more than thirty-one(3 1)days. After thirty-one(31)days you may be entitled to continue coverage under the Uniformed Services Employment and Reemployment Rights Act(USERRA). Contact the Claims Administrator regarding your rights under USERRA. Upon completion of active military duty,contact Employer for information about the possible reinstatement of your coverage. LEAVE OF ABSENCE 1. If you are absent from work due to a temporary layoff or leave of absence,coverage may be continued for a period of up to three (3) months. Any period of continuation permitted by this section may be extended at the discretion of the Employer in each individual case, provided that, in so continuing an employee's coverage, the Employer acts in ( accordance with a practice which precludes individual selection. 2. If you are absent from work due to a disability, sickness or accidental bodily injury, coverage may be continued at the discretion of the Employer,but in no event beyond three(3)months from the date active work ceased due to sickness or accidental bodily injury. However,continuation of coverage due to(1)and(2)above will cease if: (l) The employee becomes eligible,as an employee,under another group health plan. (2) The employee is capable of returning to full-time active work but does not do so(however,this does not apply to continuation due to leave of absence). This Plan intends to comply with the provisions of the Family and Medical Leave Act(FMLA)effective August 5, 1993. Refer to the section entitled COBRA for information regarding continued coverage after you cease to be eligible under the Plan. FAMILY MEDICAL LEAVE ACT(FMLA) If a Covered Employee ceases active service due to a Company approved Family Medical Leave of Absence in accordance with the requirements of Public Law 103-3 (or in accordance with any state or local law which provides a more generous medical or family leave and requires continuation of coverage during leave),coverage will be continued under the same terms and conditions which would have been provided had the Covered Employee continued active service. If the Covered Employee does not return to active service after the approved Family Medical Leave or if the Covered Employee has given the employer notice of intent not to return to active service during the leave,or if the Covered Employee has exhausted the FMLA leave entitlement period,coverage may be continued under the Continuation of Coverage(COBRA) provision of this Plan, provided the Covered Employee elects to continue under the COBRA provision. Continuation of Coverage(COBRA)will be provided only if the following conditions have been met: 1. the Covered Employee or Covered Dependent was covered under this Plan on the day before the FMLA leave began or becomes covered during the FMLA leave;and 12 2. the Covered Employee does not return to active service after an approved FMLA leave;and 3. without COBRA,the Covered Employee or Covered Dependent would lose coverage under this Plan. However, these conditions do not entitle a Covered Employee to COBRA if the Company eliminates, on or before the last day of the Covered Employee's FMLA leave,coverage under this Plan for the class of Employees(while continuing to employ that class of Employees) to which the Covered Employee would have belonged if the Covered Employee had not taken FMLA leave. Continuation of Coverage(COBRA)will become effective on the last day of the FMLA leave as determined below: 1. the date a Covered Employee fails to return to active service after an approved family medical leave; 2. the date the Covered Employee informs the Company of intent not to return to active service;or 3. the date a Covered Employee exhausts the FMLA leave entitlement period and does not return to active service. The Covered Employee will be totally responsible for the contributions during the COBRA continuation if elected. Coverage continued during a family or medical leave will not be counted toward the maximum COBRA continuation period. If a Covered Employee declines coverage during the FMLA leave period or if the Covered Employee elects to continue coverage during the family or medical leave and fails to pay the required contributions,the Covered Employee is still eligible under the Continuation of Coverage(COBRA) provision at the end of the FMLA leave. COBRA continuation will become effective on the last day of the FMLA leave. The Covered Employee will be totally responsible for the contributions during the COBRA continuation if elected;however, the Covered Employee is not required to pay any unpaid contributions for the time coverage had lapsed during the leave. If a Covered Employee voluntarily terminates coverage under this Plan during the FMLA leave or if coverage under this Plan was terminated during an approved family medical leave due to non-payment of required contributions by the Employee and the Employee returns to active service immediately upon completion of that leave, coverage will be reinstated as if the Employee remained in active service during the leave, including Dependent coverage, without having to satisfy any waiting period or evidence of good health provisions of this Plan, provided the Employee makes any necessary contribution and enrolls for coverage within thirty-one(31)days of the return to active service. UNIFORMED SERVICES EMPLOYMENT AND REEMPLOYMENT RIGHTS ACT OF 1994(USERRA) The Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA) established requirements that employers must meet for certain Employees who are involved in the uniformed services(defined below). In addition to the rights that you have under COBRA,you(the Employee)are entitled under USERRA to continue the coverage that you(and your covered Dependents,if any)had under the Medical and/or Dental Plan. You Have Rights Under Both COBRA and USERRA Your rights under COBRA and USERRA are similar but not identical. Any election that you make pursuant to COBRA will also be an election under USERRA, and COBRA and USERRA will both apply with respect to the continuation coverage elected. If COBRA and USERRA give you(or your covered Spouse or Dependent Children)different rights or protections, the law that provides the greater benefit will apply. Definitions "Uniformed Services"means the Armed Forces, The Army National Guard, and the Air National Guard when engaged in active duty for training, inactive duty training, or full-time National Guard duty(i.e., pursuant to orders issued under federal law), the commissioned corps of the Public Health Service,and any other category of persons designated by the President in time of war or national emergency. "Service in the uniformed services"or "service"means the performance of duty on a voluntary or involuntary basis in the uniformed services under competent authority, including active duty, active duty for training, initial active duty for training, inactive duty training, full-time National Guard duty, a period for which a person is absent from employment for an 13 • examination to determine his or her fitness to perform any of these duties, and a period for which a person is absent from employment to perform certain funeral honors duty. It also includes certain service by intermittent disaster-response personnel of the National Disaster Medical System. Duration of USERRA Coverage General Rule: Twenty-four(24) month maximum. When a Covered Employee takes a leave for service in the uniformed services, USERRA coverage for the Employee(and covered Dependents for whom coverage is elected)begins the day after the Employee(and covered Dependents)lose coverage under the Plan,and it can continue for up to twenty-four(24)months. However, USERRA coverage will end earlier if one of the following events takes place: 1. A premium payment is not made within the required time; 2. You fail to return to work within the time required under USERRA(see below)following the completion of your service in the uniformed services;or 3. You lose your rights under USERRA as a result of a dishonorable discharge or other conduct specified in USERRA. Returning to Work: Your right to continue coverage under USERRA will end if you do not notify the Company of your intent to return to work within the time required under USERRA following the completion of your service in the uniformed services by either reporting to work(if your uniformed services was for less than thirty-one [3 1] days) or applying for reemployment (if your uniformed services was for more than thirty [30] days). The time for returning to work depends on the period of uniformed services,as follows: Period of Service Return-to Work Requirement Less than 31 days The beginning of the first regularly scheduled work period on the day following the completion of your service,after allowing for safe travel home and an eight-hour rest period, or if that is unreasonable or impossible through no fault of your own,as soon as is possible. More than 30 days but less than 181 days Within 14 days after completion of your service or,if that is unreasonable or impossible through no fault of your own, the first day on which it is possible to do so. More than 180 days Within 90 days after completion of your service. Any period if for purposes of an examination for fitness to The beginning of the first regularly scheduled work period perform uniformed service on the day following the completion of your service,after allowing for safe travel home and an eight-hour rest period, or if that is unreasonable or impossible through no fault of your own,as soon as is possible. Any period if you were Hospitalized for or are convalescing Same as above(depending on length of service period) from an Injury or Illness incurred or aggravated as a result except that time periods begin when you have recovered of your service from your injuries or Illness rather than upon completion of your service. Maximum period for recovering is limited to two years,but the two-year period may be extended if circumstances beyond your control make it impossible or unreasonable for you to report to work within the above time periods. COBRA and USERRA coverage are concurrent. This means that COBRA coverage and USERRA coverage begin at the same time. However,COBRA coverage can continue for up to eighteen(18)months(it may continue for a longer period and is subject to early termination, as described in the COBRA section. In contrast, USERRA coverage can continue for up to twenty-four(24)months,as described above. Premium Payments for USERRA Continuation Coverage 14 If you elect to continue your health coverage(or your Spouse or your Dependent Children's coverage)pursuant to USERRA, you will be required to pay one hundred two percent(102%)of the full premium for the coverage elected(the same rate as COBRA). However, if your uniformed service period is less than thirty-one(31)days,you are not required to pay more than the amount that you pay as an active Employee for that coverage. Questions If you have any questions regarding this information or your rights to coverage,you should contact your Human Resources Department. Reinstatement of Coverage after Military Leave When coverage under this Plan is reinstated,all provisions and limitations of this Plan will apply to the extent that they would } have applied if you had not taken military leave and your coverage had been continuous under this Plan. The eligibility ` waiting period will be waived. (This waiver of limitations does not provide coverage for any Illness or Injury caused by or f aggravated by your military service, as determined by the VA. For complete information regarding your rights under the Uniformed Services Employment and Reemployment Rights Act,contact your employer). ELIGIBLE DEPENDENTS If you are covered under the PLAN, your eligible dependents may also be covered by the same PLAN. Your eligible dependents include: (1) Your legal spouse as determined by the law of the state of celebration. If you have a working Spouse/Domestic Partner that is eligible for health insurance benefits through their Employer/Company,they will no longer be eligible for benefits under the F.H. Paschen Health Plan. If you are a Tectonics employee and have a working spouse or a Domestic Partner that is eligible for health insurance through their Employer/Company, they will no longer be eligible for benefits under the F.H.Paschen Health Plan. kt (2) Your child,who has not yet attained 26 years of age; The term"dependent"will not include any person who is eligible as an employee,nor any foster children,nor any person who is in full-time military, naval or air service, nor a spouse of your adult dependent child. Nor will it include grandchildren unless the grandchild resides with you and you are legally and financially responsible for at least half of his/her support and maintenance as determined by tax laws. When you enroll specific dependent(s), you are affirmatively representing that you have reviewed the PLAN's eligibility terms and your dependent(s)are eligible for coverage. You have an affirmative obligation to notify the PLAN when any one of your enrolled dependents no longer meets the criteria to remain eligible for participation in the PLAN. In addition to the above, individuals employed by FHP Tectonics Corp.can enroll a Domestic Partner and his or her eligible unmarried children where the individual employed by FHP Tectonics Corp. and his or her domestic partner affirms and executes the Plan's affidavit form attesting to the domestic partnership status of the relationship. Whenever the term"spouse" is used,we also mean Domestic Partner.(see Section XI for the definition of: Domestic Partner). An employee who elects to cover a domestic partner under the Plan is responsible for any applicable taxes on the value of the employer paid portion of the domestic partner's benefit coverage. Eligibility for domestic partner coverage does not apply to those individuals who are employed by other corporate entities affiliated with the Plan, including but not limited to F. H. Paschen, S. N. Nielsen, Inc., S. N. Nielsen & Associates LLC, Westcoast Corp.,Stalworth Underground LLC and FHP Management,Inc. Eligibility for Disabled Children If your covered dependent is incapable of self-sustaining employment because of mental retardation or physical handicap,his Medical Expense Benefits will be continued in force during the period of such incapacity provided (1) he was covered immediately before the attainment of the termination age, and(2)you submit satisfactory proof of such incapacity upon the Plan Administrator's request no sooner than two months prior to the attainment of the termination age or at any reasonable 15 time thereafter. However, if we do not request proof of his incapacity,his Medical Expense Benefits will continue while the PLAN remains in force,unless terminated earlier as provided in the next paragraph. This extension will continue until the earliest of: (1) The date your dependent ceases to be eligible for reasons other than age (2) The date your dependent ceases to be incapacitated,or (3) The 60th day after we request proof of your dependent's incapacity if you fail to furnish such proof,or (4) The date she your dependent no longer is dependent on you for his/her support. Dependent Children may not be covered by more than one Employee. If both a husband and a wife are Covered Employees and the Spouse carrying Dependent coverage terminates coverage under the Plan, Dependent coverage can be transferred to the Spouse who remains covered by the Plan provided the Employee continues to be an eligible Employee. If both a husband and wife are Covered Employees and one terminates coverage with the Plan,he or she may be covered as a Dependent under the remaining spouse's coverage. QUALIFIED MEDICAL CHILD SUPPORT ORDER(QMCSO) If a Qualified Medical Child Support Order is issued for a Plan Participant's Child,that Child will be eligible for coverage as required by the order and the Plan Participant will not be considered a Late Entrant for Dependent coverage. A description of the QMCSO procedures is available from the Plan Administrator upon request,free of charge. SPECIAL ENROLLMENT PERIODS In certain circumstances,you or your Dependent may be eligible to enroll in the Plan outside the initial enrollment period or an annual enrollment period. In other words, you may enter the Plan during a "Special Enrollment Period". This section explains how an individual may be eligible for Special Enrollment rights. Any mid-year changes must be made in accordance with Section 125 rules. The enrollment date for anyone who enrolls under a Special Enrollment Period is the first date of coverage. 1. Individual losing other coverage. An Employee (or Dependent) who is eligible, but not enrolled in this Plan, may enroll if each of the following conditions is met: a. The Employee(or Dependent) was covered under a Group Health Plan or had health insurance coverage at the time ( coverage under this Plan was previously offered to the individual. b. If required by the Plan Administrator,the Employee stated in writing at the time that coverage was offered that the other health coverage was the reason for declining enrollment. c. The coverage of the Employee (or Dependent) was terminated as a result of loss of eligibility (including legal separation,divorce,death,termination of employment,or reduction in the number of hours of employment),and no COBRA was elected, or the coverage was provided through COBRA and the COBRA coverage was exhausted, or employer contributions toward the coverage were terminated. • d. The Employee requests enrollment in this Plan not later than thirty(30)days after the date of exhaustion of COBRA coverage or the termination of coverage or employer contributions,described above. If the Employee (or Dependent) lost the other coverage as a result of the individual's failure to pay premiums or for cause (such as making a fraudulent claim),that individual does not have a Special Enrollment right. 2. Dependent beneficiaries. If: a. The Employee is a Participant under this Plan (or has met the waiting period applicable to becoming a Participant under this Plan and is eligible to be enrolled under this Plan but for a failure to enroll during a previous enrollment period),and 16 b. A person becomes a Dependent of the Employee through marriage,birth,adoption or placement for adoption then the Dependent(and if not otherwise enrolled,the Employee)may be enrolled under this Plan as a covered Dependent of the Covered Employee. In the case of the birth or adoption of a Child,the Spouse of the Covered Employee may be enrolled as a Dependent of the Covered Employee if the Spouse is otherwise eligible for coverage. The Dependent Special Enrollment Period is a period of thirty-one(31)days and begins on the date of the marriage, birth, adoption or placement for adoption. The coverage of the Dependents enrolled in the Special Enrollment Period will become effective: j ♦ In the case of marriage, not later than the first day of the first month beginning after the date the completed request for enrollment is received. s ♦ In the case of a Dependent's birth,as of the date of the birth;or • In the case of a Dependent's adoption or placement for adoption,the date of the adoption or placement for adoption. 3. Children's Health Insurance Program Reauthorization Act of 2009. An Employee(or Dependent)who is eligible, but not enrolled in this Plan,may enroll if Ek a. The Employee or Dependent was covered under Medicaid or the Children's Health Insurance Program at the time coverage under this Plan was previously offered to the individual;and If required by the Plan Administrator, the Employee stated in writing at the time that coverage was offered that coverage under Medicaid or the Children's Health Insurance Program was the reason for declining enrollment;and ( The Employee or Dependent loses eligibility for Medicaid or the Children's Health Insurance Program;and The Employee or Dependent requests enrollment in this Plan not later than sixty(60)days after the date Medicaid or the Children's Health Insurance Program coverage ends;or b. The Employee or Dependent has declined enrollment for himself or Dependent and later becomes eligible for a premium assistance subsidy for group health coverage through Medicaid or the Children's Health Insurance Program;and The Employee or Dependent requests enrollment in this Plan not later than sixty(60)days after the date of eligibility determination for a premium assistance subsidy for group health coverage through Medicaid or the Children's Health Insurance Program. Effective Date Coverage will become effective not later than the first day of the first month beginning after the date the completed request for enrollment is received. DEPENDENTS EFFECTIVE DATE OF COVERAGE You must enroll your Dependents for coverage under this Plan by completing an enrollment form and authorizing any required contributions. Dependent coverage begins on the date on which you become eligible for Plan benefits. If you apply for Dependent coverage on or before your eligibility date,or within thirty(30)days after your original eligibility date,coverage for your Dependents will begin on your original eligibility date. 17 If you acquire a Dependent after your original effective date of coverage,you must make written application for coverage for that Dependent within thirty (30) days of the date of the marriage, birth or adoption. If you apply for coverage for a Dependent within thirty(30)days following the date you acquire such Dependent,coverage for that Dependent will begin on the date of the marriage,birth or adoption. If you do not apply for coverage within thirty(30)days after the date you become eligible,or thirty(30) days after the date you acquire your first eligible Dependent, or during a Special Enrollment Period, or if you previously elected to end Dependent coverage in the Plan, you may apply for coverage during the annual enrollment period. The effective date of coverage will be the following November lst A newborn Child will automatically be covered at birth for thirty(30)days. For coverage to continue beyond thirty(30)days, you must notify the Company of the birth and authorize any required contributions. If notification and required contributions are not made,coverage for the newborn Child will terminate at the end of the thirty(30)day period. Submission of a medical ► claim is not considered notification for continuation of coverage. WHEN DEPENDENTS CEASE TO BE ELIGIBLE All Plan coverage will terminate on the earliest of the following dates: In the case of all your Dependents, the date your coverage terminates or the Dependent ceases to be a Dependent as defined in this Plan. In the case of your Spouse, when you are legally separated or divorced. In the case of your Domestic Partner(for Tectonics Employees Only), when you no longer meet the definition of a domestic partnership. In the case of a Dependent Child, at the end of the month upon attaining age twenty-six(26). For a child who is entitled to coverage through a Qualified Medical Child Support Order(QMCSO),the date on which the earliest of the following occurs: 1) The Plan Administrator is supplied with satisfactory written evidence that the QMCSO ceases to be effective. 2) The Plan Administrator is supplied with satisfactory written evidence that the child has immediate and comparable coverage under another plan. 3) The employee who is ordered by the QMCSO to provide coverage is no longer eligible for the PLAN. 4) Employer terminates family or dependent coverage. 5) Employer terminates the PLAN. 6) The relevant premium or contribution toward the premium is last paid. 7) The date the child is no longer a dependent under the terms of the PLAN. The date after the death of a covered employee or dependent. In the event of the covered employee's death,coverage for eligible dependents will also terminate on the date after the covered employee's death. In the case of a Disabled Child, when the Dependent is no longer Disabled or Dependent upon you for support. The date the Dependent Coverage is discontinued under the Plan. The date the Dependent enters active military duty for more than thirty-one(31)days. After thirty-one(31)days you may be entitled to continue coverage under the Uniformed Services Employment and Reemployment Rights Act(USERRA). Contact 18 the Claims Administrator regarding your rights under USERRA. Upon completion of active military duty,contact Employer for information about the possible reinstatement of your coverage. The end of the period for which you made any required contributions,if you fail to make any further required contributions. Refer to the section entitled COBRA for information regarding continued coverage after a Dependent ceases to be eligible under the Plan. 1 1 ' } I`! (7f { 19 PREFERRED PROVIDER ORGANIZATION (PPO) Certain Hospitals and Physicians may participate in a PPO Network. PPO providers have entered into an agreement to provide services at a discounted fee arrangement. The PPO offers access to quality health care services by conveniently located providers at substantial savings to the Covered Persons. Each Covered Person is responsible for verifying a provider's network membership status prior to each and any service to ensure the claim is covered at the higher benefit level. If your current providers are not participating in the PPO Network, ask your providers to contact the Network for an application for participation or, you can nominate the provider on the Network's website or call their provider referral department. The PPO Network can only provide the names, addresses, and phone numbers of participating providers; they cannot pre-certify a procedure or verify eligibility or benefits. A list of the Hospitals and Physicians participating in the PPO is also available through the Internet or by calling the provider network that is listed on the ID card. A Covered Person has freedom of choice in selecting a health care provider;however,there are benefit differences depending on whether services are rendered by a Network Provider or by a Non-Network Provider. These differences are shown on the Schedule of Benefits. If a Covered Person is located in an area where Network Providers are not available,the Non-Network benefits will apply. If a Covered Person requires treatment for an Accident or medical emergency,as defined,and you do not have a PPO hospital or facility within 25 miles of your location,benefits for the initial treatment by a Non-Network Provider will be paid as shown on the Schedule of Benefits. Additionally, if a Covered Person is admitted to a Non-Network Hospital as a result of a medical emergency, benefits for stabilization and initiation of treatment will be paid at the Network benefit level until it is medically appropriate for the Covered Person to be transferred to a Network Hospital.The determination of when the transfer is medically appropriate will [ be made by the Covered Person's Physician and the Utilization Review Service. If the Covered Person chooses to remain in a Non-Network Hospital after it has been determined that he could have been transferred to a Network Hospital,covered expenses will be paid at the Non-Network benefit level. If charges are incurred for services performed by a Non-Network Provider which the patient did not have the option to choose,which relate to: • A Network Confinement; • A Network Out-Patient Procedure;or • A Network Physician/Office Visit, (i.e., Assistant Surgeon, Anesthesia, Independent Lab, Pathology & X-Ray, etc.) benefits will be paid as shown on the Schedule of Benefits. Should you choose a provider that is participating in the PPO network, that provider will discount fees charged for the services rendered. Such discounts will be identified on your Explanation of Benefits(EOB). The discounts offered by the participating providers will be credited to your billing record. Should you ever be billed by a PPO provider for the discounts, notify the Claims Administrator who will then contact the provider for the appropriate adjustment. The Plan does not make warrants or representations regarding the quality of care that may be rendered by any Network Provider. Any Network Providers or other managed care providers with which the Plan has contracted are independent contractors of the employer. IMPORTANT The requirements of the Utilization Review program described below must be followed in order to receive full benefits under the Plan,whether a Network or Non-Network Provider is used. In addition,when using a Network Provider,benefits must be assigned to that provider. 20 UTILIZATION REVIEW PROGRAM The benefits provided by this Plan are limited to charges for any non-emergency, Elective Surgery or Hospital confinement and Advanced Imaging, only if the surgery or Hospital confinement, or the length of Hospital confinement, Advanced Imaging is necessary for the care and treatment of an Illness or Injury. This Plan has implemented a program of Utilization Review so that you understand the Medical Necessity of a proposed Hospital confinement or surgery recommended by your Physician. The Utilization Review Service is staffed by medical professionals who consult with you and your Physician to determine the type of care required,the appropriate setting for such care,and quality,yet cost effective care for your condition. An additional$300 deductible per occurrence will apply for failure to obtain pretreatment review for the following: • Admission to the following facilities: Hospitals, Skilled nursing facilities, residential behavioral health treatment facilities,outpatient behavioral health treatment facilities providing partial hospitalization,day treatment or intensive outpatient treatment. ♦ Any Outpatient services, i.e. Cat Scans, MRI's, surgical procedures, for which benefits are payable,except surgical procedures for which the surgeon's charges are $400 or less, or the surgical procedures are performed on an out- patient basis within forty-eight(48) hours of an accidental injury, extensive drug therapies anticipated to last more than six(6)months in duration. ♦ This Plan conforms to the procedures, protocols and methodologies of the contracted Pre-Certification Vendor of Service. PLEASE REFER TO YOUR HEALTH BENEFIT I.D.CARD FOR THE TELEPHONE NUMBER OF THE UTILIZATION REVIEW SERVICE. ALL BENEFITS PROVIDED BY THIS PLAN FOR CHARGES FOR HOSPITAL CONFINEMENTS OR ELECTIVE SURGERY ARE SUBJECT TO THE FOLLOWING REQUIREMENTS: PRE-ADMISSION REVIEW For Non-Emergency Hospital Admissions: A pre-admission authorization is required at least twenty-four(24) hours prior to admission to a Hospital as a bed patient. You, a member of your family,your Physician or the Hospital must call the Utilization Review Service whenever a Hospital admission is recommended. The Utilization Review Service will evaluate your planned treatment based upon the diagnosis provided by your Physician and established standards for medical care. After consultation with your Physician the Utilization Review Service will provide written authorization to you,the Hospital,and the Claims Administrator. The Utilization Review Service's authorization does not verify eligibility or benefits. Questions regarding eligibility or benefits must be directed to the Claims Administrator. For Emergency Hospital Admissions: "Emergency Hospital Admission" means an admission for Hospital confinement which, if delayed,would result in disability or death. In case of an emergency Hospital admission,you,your Physician,the Hospital or a member of your immediate family must inform the Utilization Review Service of the admission,by telephone,within forty-eight(48)hours after such admission. 21 For Maternity Hospital Admissions: Maternity admissions are not considered emergencies. A pre-admission authorization is recommended at least two(2)months prior to the estimated date of delivery. You, a member of your family or your Physician must call the Utilization Review Service. Although the Plan does require you to notify the Utilization Review Service of your Pregnancy in advance of an admission, the first 48 hours following a vaginal delivery,or 96 hours following a cesarean section are automatically authorized. Stays in excess of the 48 or 96 hours will require authorization through the Utilization Review Service. Under Federal law, Group Health Plans may not restrict benefits for any Hospital length of stay in connection with Childbirth for the mother (if a Covered Person) or newborn Child(if a Covered Person)to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, Federal law generally does not prohibit the mother's or newborn's attending provider,after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours(or 96 hours as applicable). The pre-certification requirement shall be waived for all admissions outside of the United States; however,all other provisions apply. The Utilization Review Service must be informed of: • The name and birth date of the patient ♦ The name and social security number of the Employee • The date of Hospital admission or surgery • The name of the employer ♦ The admitting diagnosis • The name of the hospital ♦ The name and telephone number of the attending Physician CONTINUED STAY REVIEW Before your scheduled discharge the Utilization Review Service will call the Hospital and your Physician to confirm your discharge. If additional days of confinement are required because of complications or other medical reasons,the Utilization Review Service will again evaluate the treatment and diagnosis in consultation with your Physician. This process will continue until you are discharged from the Hospital. If Hospital charges are incurred by a Covered Person for a period of Hospital confinement which has NOT been authorized under the Continued Stay Review provisions,the eligible Hospital charges for such confinement will be limited to the charges incurred during the period of Hospital confinement initially authorized. IF UTILIZATION REVIEW IS NOT USED If Hospital charges are incurred by a Covered Person for a period of Hospital confinement and such confinement has NOT been authorized by the Utilization Review Service as set out under the Pre-Admission Review provisions, the penalty, as shown on the Schedule of Benefits,will apply. THE NON-COMPLIANCE PENALTIES WILL NOT ACCUMULATE TOWARD THE REQUIRED DEDUCTIBLE(S)OR TO THE OUT-OF-POCKET MAXIMUMS. RETROSPECTIVE REVIEW The Utilization Review Service will review and evaluate the medical records and other pertinent data of an individual whose Hospital stay,or a portion of his stay,was not authorized under the Pre-Admission and/or Continued Stay Review provisions of the Plan. 22 Requests for such review must be made, in writing,by the attending Physician or Hospital and must define the medical basis for the review. Benefits will be limited to only those expenses incurred during the period of hospitalization which would have been authorized. Benefits are not payable for expenses related to any period of Hospital confinement which is deemed not Medically Necessary. PRE-SURGICAL REVIEW Non-Emergency Surgery: If your Physician recommends non-emergency surgery, meaning any surgery that can be postponed without causing undue risk to the patient, you, a member of your family or your Physician must contact the Utilization Review Service at least twenty-four(24)hours prior to the proposed surgery for pre-authorization. Pre-Surgical Review is not required for minor surgical and diagnostic procedures performed in a Physician's office. THE NON-COMPLIANCE PENALTY WILL NOT ACCUMULATE TOWARD THE REQUIRED DEDUCTIBLE(S)OR TO THE OUT-OF-POCKET MAXIMUM. VOLUNTARY SECOND SURGICAL OPINION BENEFIT if your Physician recommends non-emergency surgery, meaning surgery ry that can be postponed without causing undue risk, the Plan will pay for any necessary Physician,x-ray or laboratory expense incurred for a second surgical opinion(and a third opinion,if the second opinion does not agree with the first opinion),if: • The Physician providing the second or third opinion is not associated with the Physician who first recommended surgery. i ♦ The Physician providing the second or third opinion does not perform the surgery. ♦ The second or third opinion is obtained before the recommended surgery. • The Physician providing the second or third opinion is a Board Certified specialist in the appropriate specialty. ♦ The Physician places the second or third opinion in writing. An opinion confirming the advisability of surgery may provide greater peace of mind, and a non-confirming opinion may { provide an alternative non-surgical method of treatment for the medical condition. If the patient does not use the Benefit, he will be passing up the chance to get additional medical advice. The Second Surgical Opinion Benefit DOES NOT apply to expenses incurred for or in connection with: ♦ Surgical procedures which are not covered under the Plan; ♦ Minor surgical procedures that are routinely performed in a Physician's office,such as incision and drainage of an abscess or excision of benign lesions; • An opinion obtained more than three(3)months after a surgeon first recommended the elective surgical procedure. Prior Authorization The Claims Administrator reviews services to verify that they are medically necessary and that the treatment provided is the proper level of care. Prior authorization from the Claims Administrator is recommended before you receive selected services so that you avoid incurring charges for services that may not be considered medically necessary. 23 You will need to check with the provider to determine if prior authorization will be obtained for you.You are responsible for obtaining prior authorization if your provider does not provide this service.The Claims Administrator recommends that you or the provider contact them at least 15 days prior to receiving the care to determine if the services are eligible.The Claims Administrator will notify you of their decision within 15 days, provided that the prior authorization request contains all the information needed to review the service. With prior authorization, the PLAN guarantees payment for services approved in advance if the services are otherwise covered under the PLAN and you are covered on the date you receive care. All applicable general exclusions,deductibles, copayments, and coinsurance provisions continue to apply. The prior authorization will indicate a specified time frame in which you may receive the services. Any service not performed in the specific time frame will need to go through prior authorization again. You will be responsible for payment of services that the Claims Administrator determines is not medically necessary. While all services must be medically necessary,prior authorization should be obtained for the following services: •Acupuncture. •Bariatric surgeries and weight loss services for morbid obesity. •Benefit substitution. •Bone growth stimulators. •Durable medical equipment,prosthetics and non-durable medical supplies. •Growth hormone replacement therapy. •Home health care,except for early maternity discharge. •Home infusion therapy. •Hospice. •Implantable hearing devices. •Organ or bone marrow transplant/stem cell rescue. •Physical,speech and occupational therapy. •Reconstructive,cosmetic or plastic surgery. •Sleep studies: initial for children and repeat for adults. •Surgeries for sleep apnea and/or snoring. •Temporomandibular joint(TMJ)disorder or craniomandibular disorder treatment. •Vagus nerve stimulation. Requests for prior authorization must be submitted to the Claims Administrator in writing at: Benefit Administrative Systems,L.L.C. 17475 Jovanna Drive,Suite 18 Homewood,IL 60430 (708)799-7400 24 CASE MANAGEMENT SERVICES Case Management is an added service which is used to assist seriously ill or injured Covered Persons requiring long term care. Case Management nurses can provide intensive planning and management for these special situations by recommending alternate Treatment Plans, arranging home health care services and equipment rental and coordinating the services of the many providers that may be involved in these designated situations. Examples of Illnesses or injuries which may benefit from Case Management services are stroke,premature birth,some forms of cancer,severe burns and head Injury. The Covered Person must cooperate with the Case Manager and provide all relevant medical information regarding his condition;however,the choice of the course of treatment is the patient's. Certain circumstances may cause the Plan Administrator to allow charges that would not otherwise be covered if the proposed alternative is shown to be cost effective. Prior to any final determination,the severity of the condition and the prognosis are taken into consideration. The Plan Administrator shall have the right to waive the normal provisions of the Plan when it is reasonable to expect a cost effective result without sacrifice to the quality of patient care. The recommendations are not binding and the final decision on a course of treatment will be made by the covered person,his family,and the Attending Physician. Failure to follow any Case Management recommendations will not result in any loss of benefits and any/or penalties. • 25 MEDICAL EXPENSE BENEFIT To receive benefits under the Medical Expense Benefit,you must satisfy the Deductible amount shown on the Schedule of Benefits.Once you have satisfied the Deductible,benefits are payable as shown on the Schedule of Benefits. THE DEDUCTIBLE AMOUNT The Individual Deductible amount is shown on the Schedule of Benefits and is the total amount of Covered Medical Expenses that you or your Dependents must satisfy in a Calendar Year before you or your Dependents are eligible to receive the Medical Expense Benefit. Note: Network/Non-Network expenses will he combined towards the satisfaction of the Network/Non-Network Deductible amounts. The Family Deductible Maximum includes covered expenses which are used to satisfy Deductibles for all family members combined. , FAMILY DEDUCTIBLE When Covered Family Members have satisfied the Family Deductible amount as shown on the Schedule of Benefits in a Calendar Year (no person can contribute more than the Individual Deductible amount), the Plan will not apply Medical Expense Deductibles to the remaining Covered Medical Expenses for all Covered Family Members for that Calendar Year. CARRY-OVER DEDUCTIBLE Any Covered Medical Expenses incurred and applied toward the Individual and Family Deductible amounts during the last three (3) months of the year (October, November and December) are applied to the Individual and Family Deductible amounts for both the present and the following Calendar Years.Out-Of-Pocket reimbursement of 100%does not carry over. CO-INSURANCE FACTOR After the Deductible is satisfied, the Plan will pay the applicable percentages of eligible Medical Expenses as shown on the Schedule of Benefits. is OUT-OF-POCKET MAXIMUM If, in a Calendar Year, a Covered Person accumulates an Out-of-Pocket amount which equals the amount shown on the Schedule of Benefits,the Plan will pay 100%of any further Covered Medical Expenses incurred during the remainder of that Calendar Year. Note: Network/Non-Network expenses will be combined towards the satisfaction of the Network and Non-Network Out-of-Pocket Maximums. The Family Out-of-Pocket Maximum includes Out-of-Pocket expenses for all family members combined. FAMILY OUT-OF-POCKET MAXIMUM When Covered Family Members have satisfied the Family Out-of-Pocket Maximum amount shown on the Schedule of Benefits in a Calendar Year,the Plan will not apply the Co-insurance Factor to and will pay 100%,from that date forward,of any further Covered Medical Expenses for all Covered Family Members for the remainder of that Calendar Year. Prescription Drug Co-payments, Charges In Excess Of Benefit Maximums, Charges In Excess Of Reasonable And Customary Fees,And Non-Compliance Penalties Do Not Accumulate Toward The Out-Of-Pocket Maximum. Any Maximums Which Are Stated In Dollar Amounts,Number Of Days Or Number Of Treatments And Which Limit Either The Maximum Benefits Payable Or The Maximum Allowable Covered Expense Are The Combined Maximums Under The Network and Non-Network Level Of Benefits. 26 COVERED MEDICAL EXPENSES Reasonable and customary charges incurred by, or on behalf of, a Covered Person for the following Medically Necessary items,if performed or prescribed by a Physician for an Injury or Illness,subject to the Exclusions and Limitations of the Plan, are covered by the Medical Expense Benefit: I. Hospital Room and Board including bed and board, general nursing care, meals and dietary services provided by the Hospital.All semi=private or ward accommodations are covered. a. For private rooms,an allowance will be paid equal to the Hospital's semi-private room charge. b. If the Hospital only has private room facilities,private room charges will be considered as semi-private charges. c. If a private room is Medically Necessary for isolation purposes,the private room charge will be considered as semi- private. d. If Intensive Care, Coronary and Intermediate Care accommodations are Medically Necessary, the Hospitals actual charges are covered. 2. Miscellaneous Hospital services and supplies including equipment and medications and general nursing care provided to registered Inpatients. 3. Hospital charges for Medically Necessary Outpatient services. 4. Services and supplies furnished by an Ambulatory Surgical Center. 5. Extended Care Facility services(refer to the specific section for coverage details). 6. Home Health Care services(refer to the specific section for coverage details). 7. Hospice Care services(refer to the specific section for coverage details). ( 8. Physician's services for surgery or other necessary medical care,including second surgical opinions,whether rendered in the office,Hospital,home,Extended Care Facility or hospice. Charges for the Assistant Surgeon are not to exceed 20% of the primary Surgeon's Usual and Customary charges. ( 9. Consultations when rendered at the request of an attending physician by another Physician,consisting of such Physician's advice in the diagnosis or treatment of a condition which requires skill or knowledge. No benefits will be provided for: (a) any staff consultations which are required by Hospital rules and regulations;or (b) consultations by a Physician who later, during the same Hospital admission, renders Surgery, (only the initial consultation is covered). 10.Chiropractic care,by any name called,including all professional services for the detection and correction by manual or mechanical means (with or without the application of treatment modalities such as, but not limited to diathermy, ultrasound, heat and cold)to restore proper articulation of joints,alignment of bones or nerve functions. Such care may not be considered a covered expense if it is determined to be maintenance palliative. Benefits are limited to the amount shown on the Schedule of Benefits. 11. Licensed Psychologist's and licensed clinical Social Workers'professional medical services for the treatment of psychiatric disorders and Substance Abuse that would be covered if provided by a doctor of medicine(M.D.)and only when the psychologist or social worker is acting within the scope of his license. The Mental Health Parity and Addiction Equity Act provides that mental health and/or substance abuse benefits,if provided under the Plan,must generally be provided on the same basis as medical benefits. 27 12. Shock Therapy Treatments. 13. Chemotherapy or radiation therapy by x-ray, radium, radon or radioactive isotopes, or other such treatment or care recommended or prescribed by a Physician. 14.Renal dialysis treatment,including equipment and supplies when such services are provided in a Hospital,Dialysis Facility or in the home under the supervision of a Hospital or Dialysis Facility. 15.Charges for Physical and/or Occupational Therapy rendered by a licensed physical or occupational therapist for improvement of physical functions impaired due to Injury, Illness or congenital defect and in accordance with a Physician's orders. The type,frequency and duration of Physical and/or Occupational Therapy must be under reasonable expectations that significant improvement within a reasonable period of time and accepted standards of medical practice is obtained. 16.Charges for Speech Therapy rendered by a qualified speech therapist in accordance with a Physician's orders when such therapy is administered to restore or rehabilitate speech impairment due to a congenital defect or due to an Injury or due to an Illness that is other than a Non-Organic/Functional disorder(i.e. lisping, stuttering, and stammering), a non-curable developmental disorder(i.e.mental retardation,down's syndrome,delayed speech or other learning development disorder. Inpatient Speech Therapy benefits will be provided only if Speech Therapy is not the only reason for an admission. 17.Charges for Cardiac Rehabilitation Service-benefits will be provided for Cardiac Rehabilitation Services only when such services are rendered to a Covered Person within a six(6)month period following a Covered Person's eligible Inpatient Hospital admission for either myocardial infarction, coronary artery bypass surgery, percutaneous transluminal coronary angioplasty,or other open heart surgery 18.Charges for reconstructive or Cosmetic Surgery provided the following conditions are met: a. The surgery must be required to correct a condition that results from an Illness or Injury;or b. The surgery is required to correct the congenital anomaly of a Dependent Child. 19. Benefits provided under the Women's Health and Cancer Rights Act of 1998(WHCRA),including: Charges for the following expenses related to breast reconstruction in connection with a mastectomy in a manner determined in consultation with the attending Physician and the patient: a. Reconstruction of the breast on which the mastectomy has been performed; b. Surgery and reconstruction of the other breast to produce a symmetrical appearance;and c. Prostheses and physical complications in all stages of mastectomy,including lymphedemas. 20. Charges made by a Registered Nurse(R.N.)or Licensed Practical Nurse(L.P.N.)for private duty nursing services when the attending Physician certifies that such nursing care is Medically Necessary.Benefits for Private Duty Nursing Service will be provided to a Covered Person who is an inpatient in a hospital or other health care facility only when it is determined that the services provided are of such a nature and/or such a degree of complexity or quantity that they could not be or are not usually provided by the regular nursing staff of the Hospital or other health care facility. Benefits will be provided to a Covered Person in the home only when the services provided are of such a nature that they cannot ordinarily be provided by non-professional personnel. No benefits will be provided when such nurse ordinarily resides in the Covered Person's home or is a member of the Covered Person's immediate family. See Summary of Benefits for Limits 21.Anesthesia and its administration when rendered by a Physician other than the operating surgeon or by a Certified Registered Nurse Anesthetist. However, benefits will be provided for anesthesia services administered by oral and maxillofacial surgeons when such services are rendered in the surgeon's office or an ambulatory surgical facility. 28 22.Elective abortions 23.Charges for obstetrical care are paid on the same basis as any other Illness,including pre-natal care,Pregnancy,and miscarriages. Benefits are provided for the Pregnancy of a Dependent Child; however, benefits are not payable for the newborn unless and until the Employee(the grandparent)becomes the legal guardian for that Child. Although the Plan does require you to notify the Utilization Review Service of your Pregnancy in advance of an admission, the first 48 hours following a vaginal delivery, or 96 hours following a cesarean section are automatically authorized. Stays in excess of the 48 or 96 hours will require authorization through the Utilization Review Service. Under Federal law, Group Health Plans may not restrict benefits for any Hospital length of stay in connection with Childbirth for the mother(if a Covered Person)or newborn Child(if a Covered Person)to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, Federal law generally does not prohibit the mother's or newborn's attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours(or 96 hours as applicable). 24.Charges incurred in connection with a Birthing Center(in lieu of Hospital confinement)and Medically Necessary supplies furnished to the mother and necessary supplies furnished to the covered newborn Child. Including services by a Certified Midwife rendered in a Birthing Center. 25. Routine newborn care while Hospital confined,including Hospital nursery care and other Hospital services and supplies and Physicians charges for pediatric care and circumcision during the mother's confinement in a hospital and not a be a result of a bodily injury or sickness. 26. Voluntary sterilizations,but not the reversal of such procedures. 27.Preventive Care Services as required under the Patient Protection and Affordable Care Act(PPACA). Refer to the Schedule of Benefits for additional information. This benefit does not include any expenses incurred in connection with a diagnosed Illness,school physicals or physicals required by a third party. Expenses in excess of the maximum benefit are not considered eligible expenses under any other provision of this Plan. Includes routine Colonoscopy once every 10 years for those ages 50 and after. 28. Blood and blood plasma to the extent not donated or replaced. 29. Allergy Shots and Allergy Surveys. 30. X-ray and laboratory examinations,including allergy testing,for diagnostic or treatment purposes. 31. Professional Ambulance service to and from a Hospital or Extended Care Facility where medical care and treatment necessary for the Illness or Injury can be provided,or a. Between Hospitals and extended care facilities when a transfer is necessary to provide adequate care,or b. Regularly scheduled airline or railroad or air Ambulance from the city in which the Covered Person became ill or was injured to and from the nearest Hospital that provides treatment for such Illness or Injury. Only charges incurred for the first trip to and from a Hospital shall be included 32. Durable Medical Equipment limited to the lesser of the purchase price or the total anticipated rental charges. Pre-approval is required if the purchase price or anticipated rental exceeds$1,000. For therapeutic treatment of an injury or illness which: a. Can withstand repeated use; b. is primarily and customarily used to service a medical purpose;and c. is not generally useful to a person except in the treatment of an injury or illness. 29 33.Charges for artificial limbs,eyes and other prosthetic devices to replace physical organs and body parts,including replacements which are Medically Necessary or required by pathological change or normal growth. Covered charges do not include expenses for the repair or replacement of damaged,lost or stolen devices. 34.Charges for Custom-made Orthotic Appliances that are worn in shoes to alleviate pain and/or to maintain proper balance following treatment of any injury,illness,or following foot surgery. Coverage will be limited to one orthotic(one for the right foot and one for the left foot). Benefits will be provided for replacement or repair of a covered orthotic when required because of wear,change in the patient's condition,or changes due to natural growth. 35.Charges for surgical hose,stump stocks,and mastectomy bras(limited to two per calendar year),a cranial prosthesis(wig) if hair loss is due to local or systemic disease. The cranial prostheses in not covered if hair loss is a result of genetic factors or aging. 36.Medical and surgical supplies including bandages and dressings. 37.Casts,splints,crutches,cervical collars,head halters,traction apparatus and orthopedic braces. 38. Oxygen and rental of equipment for its administration. 39. The first pair of glasses or contact lenses,but not both,prescribed to treat glaucoma or keratoconus or resulting from cataract surgery. 40.Drugs and medications requiring a Physician's written prescription including insulin,insulin syringes,birth control drugs, contraceptive devices. Drugs and medications purchased through the Prescription Drug Plan will be covered as shown on the Schedule of Benefits. Maintenance medications obtained through a Mail Order Prescription Drug Plan are payable as shown on the Schedule of Benefits. 41.Charges for the diagnosis and treatment of Temporomandibular Joint Dysfunction(TMJ). Covered services include diagnostic services, orthopedic devices, adjustments to devices and therapeutic injections into the Temporomandibular joint. Benefits are limited as shown on the Schedule of Benefits. 42. Expenses for the following dental related services and supplies: a. Treatment for the repair or alleviation of damage to sound natural teeth,jaw, mouth or face due to an accidental Injury,other than from eating or chewing.. b. Excision of a tumor,cyst,or foreign body of the oral cavity and related anesthesia. c. Biopsies of the oral cavity and related anesthesia. 43. Emergency Medical Care and Emergency Accident Care: The initial Outpatient treatment of a medical emergency or an accidental Injury rendered in a Hospital or by a Physician. The initial treatment must be rendered within seventy-two(72)hours of the Injury or the onset of symptoms. The term "Medical Emergency" means the sudden and unexpected onset of a medical condition manifesting itself by symptoms severe enough that the absence of medical attention could reasonably result in serious and permanent dysfunction of any bodily organ or part,or other serious and permanent medical consequences. Examples of medical emergencies include, but are not limited to,chest pain,suspected poisoning,severe and persistent abdominal pain,convulsions and emergencies by broadly accepted medical standards. 30 44. FDA approved medications used for conditions other than those for which they received FDA approval,when considered the standard of care and not part of a clinical study or in conjunction with any experimental treatment. For the purposes of this Plan,Standard of Care is defined as,charges for any care,treatment,services or supplies that are approved or accepted as essential to the treatment of any Illness or Injury by the American Medical Association,U.S.Surgeon General, U.S.Department of Public Health,or the National Institute of Health,and recognized by the medical community as potentially safe and efficacious for the care and treatment of the Injury or Illness. (Unless otherwise stated under the Clinical Trial section) 45.Charges for drugs or medicines requiring a written prescription,including contraceptives to prevent pregnancy and Nicoderm patches. They must be dispensed by a licensed pharmacist and for medically necessary care and treatment of the patient. The Plan also allows contraceptive devices and/or IUD's that require physician implantation. Excluded from the above: Experimental drugs Nicorette Gum,or any other smoking deterrent medication(except Nicoderm Patches as noted above) Non prescription contraceptive aids that can be purchased over the counter,nor does it include RU486(Mifeprex)and abortifacient. 46. Charges for"Routine patient costs"incurred by a"qualified individual"in an"approved Clinical Trial"subject to the terms of this Plan. For purposes of this benefit the following definitions will apply: "Routine patient costs" include all items and services consistent with the coverage provided in the Plan that is typically covered for a covered person who is not enrolled in a clinical trial. Routine patient costs do not include 1) { the investigational item, device or service itself 2) items and services that are provided solely to satisfy data collection and analysis needs and that are not used in the direct clinical management of the patient;and 3)a service that is clearly inconsistent with the widely accepted and established standards of care for a particular diagnosis. A "qualified individual" means a covered person who is eligible to participate in an "approved clinical trial" according to the trial protocol with respect to treatment of cancer or other life-threatening disease or condition and either the individual's doctor has concluded that participation is appropriate or the covered person provides medical and scientific information establishing that their participation is appropriate. "Approved clinical trial" is defined as a Phase I, II,III or IV clinical trial for the prevention,detection or treatment of cancer or a life threatening disease or condition likely to lead to death, unless the course of the disease or condition is interrupted. The "approved clinical trial" is federally funded or either conducted under an investigational new drug application reviewed by the Food and Drug Administration or a drug trial that is exempt from having an investigational new drug application. 47. Extension of Medical Expense Benefits Listed Above-Not Applicable to Other Medical Expense Benefits. If on the date your insurance terminates,you are totally disabled,we will pay benefits for hospital confinement which commences,or surgery or treatment which is performed,or examination which is made within three months following such date;provided you have remained continuously so disabled and the policy is in effect on such date. The extension also applies to any dependent who is totally disabled on the date his insurance terminates. 31 HUMAN ORGAN TRANSPLANT BENEFIT Coverage includes benefits for Medically Necessary expenses related to human organ, bone marrow/stem cell and tissue transplants at only Designated Facilities. The human body organ or tissue transplants must be medically necessary and not experimental or investigational and appropriate for the Covered Employee or Covered Dependent for the condition being treated. This does not include: a) non-human or artificial organs and their implantation: or b) bone marrow or peripheral stem cell rescue associated with high dose chemotherapy for solid tissue tumors(except for neuroblastoma in children and breast cancer). This includes treatment services,or supplies otherwise covered under the Plan if furnished to a Dependent under the Plan. However, the donor: a) must be charged for these services; and b) must not have coverage elsewhere. This coverage is subject to the following conditions and limitations: Transplant services include the recipient's medical, surgical and hospital services; inpatient immunosuppressive medications; and cost for organ or bone marrow/stem cell procurement. Transplant services are covered only if they are required to perform any of the following human to human organ or tissue transplants: bone marrow/stem cell, cornea, heart,heart/lung,kidney,kidney/pancreas,liver,lung,pancreas(when condition is not treatable by use of insulin therapy. All other types of organ and tissue transplants will be considered experimental and will be excluded. If shown as a covered expense in the Schedule of Benefits,Reasonable Travel expenses, except for Cornea Transplants, are covered for transportation,lodging and food for the recipient and one companion to and from the transplant site. No benefits are available where the member is a donor. The following are excluded travel expenses: •Travel within fifty(50)miles of your home; •Laundry; •Telephone; •Alcohol or Tobacco products; •Transportation that exceeds Coach Class rates. If a separate contracted Transplant Network is utilized,covered medical expenses,relating to the transplant, will be payable as shown in the Schedule of Benefits. The Transplant Network contracted rate supersedes any negotiated Preferred Provider Network discount. TRANSPLANT NETWORK FACILITY: A medical facility participating in the National Benefit Resources Transplant Network at the time of admission for the transplant procedure. The Plan is not responsible for any Covered Employee or Covered Dependent's decision to receive treatment, services, or supplies from a Transplant Network Facility, nor does the Plan make warrants or representations regarding the qualification of providers of treatment,services or supplies provided by a Transplant Network Facility. Pre-Certification Requirement: In order to obtain the Network Benefits,all organ transplants must be coordinated you must contact the Transplant Coordinator designated by the Plan Administrator as soon as you are informed that you may be a candidate for one of the covered transplant procedures. Please call the Transplant Coordinator at:Inside Illinois: 1-800-843-3831.Outside Illinois: 1-800-523-0582. 32 EXTENDED CARE FACILITY The Plan will provide benefits to the maximum shown on the Schedule of Benefits for charges made by an Extended Care Facility for convalescing from an Illness or Injury. Covered charges include: • Room and Board including charges for services such as general nursing care made in connection with room occupancy. The charge for daily Room and Board is limited to the semi-private room rate, • Use of special treatment rooms,x-ray and laboratory examination,physical,occupational,or Speech Therapy and other medical services customarily provided by an Extended Care Facility except private duty or special nursing services or Physician's services, ♦ Drugs,biological solutions,dressings,casts and other Medically Necessary supplies. Benefits are provided when an individual is confined in an Extended Care Facility if: ♦ He becomes confined in a Hospital for at least three(3)consecutive days for treatment of an Illness or Injury and, ♦ He is confined in the Extended Care Facility within seven(7)days after the end of that Hospital confinement,and • The attending Physician certified that twenty-four(24)hour nursing care is necessary,for the recuperation from an Injury or Illness which required the Hospital confinement,and i ♦ He is confined in the Extended Care Facility to receive skilled nursing and physical restorative services for convalescence from the Illness or Injury that caused that Hospital confinement. 33 HOME HEALTH CARE The Plan will provide benefits to the maximum shown on the Schedule of Benefits, for charges made by a licensed Home Health Care Agency for the following services and supplies furnished to a Covered Person in his home, or the place of residence used as such person's home for the duration of his Illness or Injury,for care in accordance with a Home Health Care Plan. The care must be administered in lieu of a Hospital or Extended Care Facility confinement. Expenses for,but not limited to, the following are covered under this benefit: • Part-time or intermittent nursing care by a Registered Nurse(R.N.)or a Licensed Practical Nurse(L.P.N.). • Part-time or intermittent Home Health Aide services. ♦ Physical,occupational,respiratory and Speech Therapy. • Medical supplies,drugs and medicines prescribed by a Physician,and x-ray and laboratory services. ♦ Medical social services. • Nutritional counseling. ♦ Renal Dialysis. The following Home Health Care Expenses are not covered under the Plan: • Meals,personal comfort items and housekeeping services. ♦ Services or supplies not prescribed in the Home Health Care Plan. ♦ Services of a person who ordinarily resides in your home,or who is a member of your or your spouse's family. ♦ Transportation services. i ♦ Treatment of psychiatric conditions of any type,including Substance Abuse. 34 HOSPICE CARE The Plan will provide benefits for care received through a home or Inpatient Hospice Care program to which a Terminally Ill Patient with a prognosis of six months or less to live and was referred by his attending Physician. Expenses for, but not limited to,the following are covered under this benefit: ♦ inpatient Hospice,limited to 150%of the semi-private room rate in the geographical area in which the hospice facility is located. ♦ Part-time or intermittent nursing care by a Registered Nurse(R.N.)or by a Licensed Practical Nurse(L.P.N.). tF • Physical,occupational,respiratory and Speech Therapy. ♦ Medical social services. • Part-time or intermittent Home Health Aide services. • Medical supplies,drugs,and medicines prescribed by a Physician,and x-ray and laboratory services. • Physician's services. • Dietary counseling. The following Hospice Care expenses are not covered under the Plan: • Transportation services. j ♦ Financial or legal counseling for estate planning or drafting a will. • Bereavement counseling for immediate family members. 35 PRE-ADMISSION TESTING BENEFIT The Plan will pay as shown in the Schedule of Benefits, for Medically Necessary diagnostic x-ray and laboratory examinations performed under a Pre-Admission testing program in the Outpatient department of a Hospital, an ambulatory surgical facility or other facility recognized by the Hospital or Physician provided they are made in contemplation of hospitalization and are made within ten(10)days of a scheduled Hospital confinement. If a confinement is canceled or postponed this benefit will not be payable unless the cancellation or postponement is due to Medical Necessity or the admission is canceled by the Hospital or attending Physician. • { { { �k \ { 36 • 3 PRESCRIPTION DRUG PROGRAM The Plan provides benefits for eligible prescription drugs and medicines through a Prescription Drug Program. Present your I.D.card to the participating pharmacist at the time you fill or refill a prescription for yourself or your covered Dependent. You will pay a Co-payment for each prescription,or the actual cost if less than the Co-payment.The Co-payment amounts are shown on the Schedule of Benefits. Prescription drugs will be covered under the Medical Expense Benefit portion of the Plan,subject to the Deductible and Co- insurance factor,if not purchased through the authorized Prescription Drug Program. Maintenance prescription drugs and medications requiring a Physician's written prescription are available through the Mail Order Prescription Drug Program. For further details refer to the Mail Order brochure available from the Human Resources Department. For more information regarding the Prescription Drug Plan,please call the number of the Prescription Drug Vendor listed on your I.D.Card. f 4. 37 MEDICAL EXPENSE EXCLUSIONS AND LIMITATIONS In addition to Exclusions and Limitations stated elsewhere in this Plan,the Medical Provisions of this Plan do not cover any loss caused by,incurred for or resulting from: I. Hospitalization,services or supplies which are not Medically Necessary.Medically Necessary hospitalization,services or supplies are those which are required for treatment of the Illness or Injury for which they are performed, which meet } generally accepted standards of medical practice, and which are provided in the most cost-effective manner. Medically Necessary Hospital Inpatient services are those which require Inpatient care in an acute care Hospital and cannot safely and effectively be provided in a Physician's office,Hospital Outpatient department or other facility. 2. Charges for Experimental drugs that: a. Are not commercially available for purchase; b. Are not approved by the Food and Drug Administration(FDA) for general use; c. Are not being used for the condition or Illness for which they received FDA approval,except as shown as a Covered Expense; d. Are not recognized by state or national medical communities, Medicare, Medicaid or other governmental financed programs. 3. Charges for any care,treatment,services or supplies that are: a. Not approved or accepted as essential to the treatment of any Illness or Injury by any of the following:the American Medical Association, the U.S. Surgeon General,the U.S. Department of Public Health, or the National Institute of Health;or b. Not recognized by the medical community as potentially safe and efficacious for the care and treatment of the Injury or Illness. 4. Custodial Care - That type of care or service, wherever furnished and by whatever name called, which is designed primarily to assist a Covered Person, whether or not totally Disabled, in the activities of daily living. Such activities include,but are not limited to: bathing,dressing,feeding, preparation of special diets,assistance in walking or in getting in and out of bed and supervision over medication which can normally be self-administered. 5. Milieu therapy or any confinement in an institution primarily to change or control one's environment. 6. Any charges for stand-by surgeons. 7. Services or supplies received during an Inpatient stay when the stay is primarily for behavioral problems or social maladjustment or other anti-social actions which are not specifically the result of mental Illness. 8. Reconstructive or Cosmetic Surgery, except for reconstructive surgery following a mastectomy or the correction of congenital deformities or conditions resulting from an Illness or injury. Cosmetic Surgery related to acne is not a covered expense. 9. Services and supplies rendered or provided for human organ or tissue transplants other than cornea, kidney, bone marrow,heart,lungs,liver,heart valve,muscular-skeletal or parathyroid human organ or tissue transplants. 10. Autologous Bone Marrow transplants unless such transplant is for the treatment of acute leukemia,chronic myelogenous leukemia,Hodgkin's disease,Non Hodgkin's lymphoma,sickle cell anemia or aplastic anemia 38 1 1. Personal hygiene, comfort or convenience items that do not qualify as Durable Medical Equipment and are generally useful to the Covered Person's household,including but not limited to: a. All types of beds,other than Hospital type beds that qualify as a Covered Expense; b. Air conditioners, humidifiers (unless attached to covered equipment), air cleaners, filtration units and related apparatus; c. Whirlpools,saunas,swimming pools and related apparatus; d. Medical equipment generally used only by Physicians in their work; e. Vans and van lifts,stair lifts and similar other ambulatory apparatus; f. Exercise bicycles and other types of physical fitness equipment. 12. Special braces,splints,equipment,appliances,battery or anatomically controlled implants unless Medically Necessary. 13. Procurement or use of prosthetic devices,special appliances and surgical Transplants which are for cosmetic purposes, the comfort and convenience of the Covered Person,or unrelated to the treatment of a disease or injury. 14. Physical or Occupational Therapy when it is not a constructive therapeutic activity designed and adapted to promote the improvement of physical function and expenses for supportive(maintenance/palliative) care treatment when maximum therapeutic benefit has been reached. 15. Speech Therapy unless it is required because of a physical impairment caused by an Illness, Injury, or congenital deformity or when rendered for the treatment of psychosocial speech delay, behavioral problems (including impulsive behavior and impulsivity syndrome),attention disorder,conceptual handicap or mentally disabled. 16. Recreational or educational therapy or forms of non-medical self-care or self-help training and any diagnostic testing. 17. Hospital charges that are incurred prior to the first Monday of a confinement that begins on a Friday,Saturday or Sunday, unless: a. Such confinement is due to a Medical Emergency;or b. Surgery is performed within twenty-four(24)hours after such confinement begins. 18. Charges for nutritional supplements, vitamins or minerals (except for treatment of anemia). Charges for nutritional formulas and dietary supplements, except as shown as a Covered Expense, including but not limited to, nutritional formulas and dietary supplements that can be purchased over the counter; vitamins and food replacements,such as infant formulas and nutritional formulas. 19. Charges for services to restore or enhance fertility, including, but not limited to, artificial insemination, in vitro fertilization,embryo transfer procedures and sterilization reversal. 20. Charges for any of the following items,including their prescription or fitting,except as shown as a Covered Expense: a. Hearing aids or examinations;. b. Optical or visual aids,including contact lenses and eyeglasses;visual analysis testing,vision therapy,training related to muscular imbalance of the eye or eye exercises; c. Wigs(unless required due to chemotherapy)and hair transplants; d. Orthopedic shoes; 39 • e. Any examination to determine the need for,or the proper adjustments of any item listed above;and f. Any procedure or surgical procedure to correct refractive error. 21. Charges for testing,training or rehabilitation for educational,developmental or vocational purposes. 22. Charges for marriage counseling and/or sexual therapy. 23. Charges in connection with obesity,weight reduction,dietetic control,except for morbid obesity and disease etiology;or for suction lipectomy. 24. Charges for treatment of a learning disability. 25. Assistant surgeon and co-surgeon services related to podiatry surgery. 26. Foot care resulting from: a. Weak,strained,unstable,unbalanced or flat feet; b. Metatarsalgia or bunions,unless an open cutting operation is performed;or c. Routine Foot care including the treatment of corns, calluses or toenails, unless at least part of the nail root is removed or care is necessary for metabolic or peripheralvascular disease;or corrective shoes. 27. The care and treatment of the teeth, g ums (except tumors or cysts) or alveolar process, and dentures, a pp liances or • supplies used in such care and treatment,extraction,restoration and replacement of teeth;medical or surgical treatments of dental conditions and services to improve dental clinical outcomes; except as shown as Covered Expenses. Removal 1 of impacted teeth are not covered under the Medical Plan,see Dental Plan. 28. Services for sex transformations or services for sexual dysfunctions which are not related to an organic disease including, but not limited to,surgery,implants or related hormone treatment. 29. Any charges for reversal procedures in connection with previous male or female sterilization. 30. Travel for health. 31. Charges for designated or autologous blood donations. 32. Drugs or medicines which do not require a prescription. 33. Routine or periodic health examinations or immunizations except as shown as a Covered Expense. 34. Charges for chelation(metallic ion)therapy. 35. Charges for services or supplies related to alternative or complimentary medicine. Services include,but are not limited to holistic medicine, homeopathy, hypnosis, aroma therapy, massage therapy, reike therapy, herbal, vitamin or dietary products or therapies, naturopathy, thermograph, orthomolecular therapy, contact reflex analysis, bioenergial synchronization technique(BEST)and iridology study of the iris. 36. Any item shown in General Exclusions and Limitations. 37. Complications arising from any item listed in this Medical Expense Exclusions and Limitations section or any other procedures excluded by the Plan. 40 DENTAL EXPENSE BENEFIT The Dental Expense Benefit has been designed to help you pay for your family's dental expenses and orthodontic treatment. This benefit covers only those dental expenses which are performed by a licensed Dentist or by a licensed Dental Hygienist if rendered under the supervision and guidance of a Dentist. Covered dental expenses are further limited to those services and supplies customarily employed for treatment of dental conditions only if rendered in accordance with accepted standards of dental practice. This benefit covers the services included in the List of Covered Services,appearing on later pages. The list is divided into Preventive,Basic,Major and Orthodontic services. If a dental service is performed that is not on the list and the service is not excluded by this Plan,but the list contains a similar service that is suitable for the condition being treated,then benefits will be payable as if the listed service was the one actually performed. A charge will be considered to be incurred: ♦ For dentures or partials-on the date the impression is taken; ♦ For fixed bridgework,crowns,inlays or onlays-on the date the tooth or teeth are prepared and the final impressions are made; ♦ For root canal therapy-on the date the pulp chamber is opened and explored;and • For all other services-on the date the service is performed. r � DEDUCTIBLE AMOUNT The Dental Deductible, if applicable, is the amount of Covered Dental Expenses which you must pay before benefits are payable by the Plan.The Dental Deductible is shown on the Schedule of Benefits and must be satisfied each Calendar Year. CO-INSURANCE FACTOR After the Calendar Year Deductible is satisfied,the Plan will pay benefits at the applicable Co-insurance percentage shown on the Schedule of Benefits for all eligible Dental Expenses incurred by that individual during the remainder of that Calendar Year. CALENDAR YEAR MAXIMUM BENEFIT The Maximum Benefit shown on the Schedule of Benefits applies separately to you and to each of your Covered Dependents for all dental services,not including orthodontic services,received in any one Calendar Year. LATE ENROLLMENT LIMITATION 1 f you do not enroll for coverage under the Plan within thirty (30) days of the date on which you or your Dependents first become eligible for coverage, you must wait to enroll until the annual enrollment period and the effective date will be the following November ls` ALTERNATE TREATMENT PLANS In all cases in which there are alternate plans of treatment carrying different treatment costs, payment will be made only for the least expensive procedure which will produce a professionally satisfactory result, with the balance of the treatment cost remaining the responsibility of the patient. 41 TREATMENT PLAN If a course of treatment can reasonably be expected to involve Covered Dental Expenses of$500 or more,a description of the procedures to be performed and an estimate of the Dentist's charges should be filed with the Claims Administrator before beginning dental care. Many Dentists require that you agree to the proposed treatment and charges before treatment begins.Therefore,it is valuable for you to know what the Dental benefit will pay before you make a financial commitment. Have the Dentist submit a written description of the proposed treatment,the estimated cost and x-rays.This process allows the Claims Administrator the opportunity to review Plan specifications such as Deductibles, Co-insurance percentages, benefit maximums,limitations and exclusions. The Claims Administrator will notify the Dentist of the benefits payable.Consideration will be given to alternate procedures, services or courses of treatment that may be performed in order to accomplish the desired result. If a Treatment Plan is not submitted in advance, the Claims Administrator reserves the right to make a determination of benefits payable considering alternate procedures, services, or courses of treatment, based on accepted standards of dental } practice. This Treatment Plan requirement will not apply to courses of treatment under$500 or to emergency treatment,routine oral examination x-rays,prophylaxis and fluoride treatments. 42 ORTHODONTIC EXPENSE BENEFIT DEPENDENT CHILD COVERAGE ONLY When your Covered Dependent Child under age 19 incurs expenses on the accompanying "List of Covered Orthodontic Services" and such expense is incurred while this coverage is in force for your Dependent Child and treatment is rendered by a Dentist as defined herein,the Plan will pay the benefits as determined for the reasonable charges actually incurred. ORTHODONTIC PROCEDURE Orthodontic procedures means movement of teeth by means of active appliances to correct the position of maloccluded or malpositioned teeth. ORTHODONTIC TREATMENT PLAN The charges must be a part of an Orthodontic Treatment Plan which,prior to the performance of the procedures,has been(a) submitted to the Claims Administrator and(b)reviewed and returned to the Dentist showing estimated benefits. Submission of an Orthodontic Treatment Plan is not required if charges made or to be made total$500 or less.Such Treatment Plan must: 1. Provide a classification of the malocclusion, 2. Recommend and describe necessary treatment by orthodontic procedures, 3. Estimate the duration over which treatment will be completed, 4. Estimate the total charge for such treatment,and 5. Be accompanied by cephalometric x-rays,study models and such other supporting evidence as the Claims Administrator may reasonably require. COVERED CHARGES The total covered charges scheduled to be made in accordance with an Orthodontic Treatment Plan shall be payable in equal quarterly installments over a period of time equal to the estimated duration of the Orthodontic Treatment Plan;however,the number of quarterly installments shall not exceed eight(8). The first installment shall become payable on the date on which the orthodontic appliances were first installed, and subsequent installments shall become payable at the end of each three- month period thereafter. Charges are covered only to the extent that they are made in connection with an orthodontic procedure which is required by one or more of the following conditions: 1. Overbite or overjet of at least four(4)millimeters. 2. Maxillary(upper)and mandibular(lower)arches in either protrusive or retrusive relation of at least one cusp. 3. Cross-bite. 4. An arch length discrepancy of more than four(4)millimeters in either the upper or lower arch. ORTHODONTIC DEDUCTIBLE The Covered Dependent must first satisfy the Orthodontic Deductible indicated on the Schedule of Benefits before any payment will be made by the Plan. Only those dental expenses which would otherwise be payable under the Orthodontic benefit may be included in computing the Orthodontic Deductible. The Orthodontic Deductible must be satisfied once in a Lifetime. 43 ORTHODONTIC MAXIMUM BENEFIT The Maximum Benefit shown on the Schedule of Benefits applies separately to each of your covered Dependents for all Orthodontic benefits received in a lifetime. LIMITATION Orthodontic procedures must commence prior to a Covered Dependent Child attaining age nineteen(19)and the first active appliance must be installed while the Child is covered under this Plan. If these provisions are met, benefits for Orthodontic Services may continue beyond age nineteen(19) if the Dependent still meets the eligibility requirements. r Orthodontia,including surgical procedures performed for orthodontic purposes is limited to dependent children to age 19 and I only after 12 months of coverage. { pf { { { 44 COVERED SERVICES Covered Dental Expenses: Eligible Dental Expense Charges shall consist of charges incurred with respect to dental treatment for any of the following services(other than for service performed by your spouse, or a parent,child, brother or sister of you or your spouse),supplies or treatment except as provided in the Exclusions section of this Plan. 1'. Type I-Preventive A.Oral Exams-routine oral examinations,including diagnosis,but not more than two such examinations with respect to the same Covered Individual during any calendar year. B.Prophylaxis-including cleaning,scaling and polishing, but not more than two times in any calendar year with respect to the same Covered Individual. C.X-rays- including full mouth X-rays not to exceed one such series in any three year period, and bitewing X-rays not more than two times per calendar year. D.Fluoride Treatment-limited to children nineteen(19)years of age and under. E.Space Maintainers F.Palliative Emergency Treatment(including exam) 2. Type II—Basic/Regular Dental A.Restorations-fillings of amalgam or synthetic Process but specifically excluding the following: (1) Posterior or anterior crowns or jackets,and (2) Initial placement of full or partial Dentures and replacement of dentures and fixed bridge units. B.Simple(routine)Extractions C.Surgical Extractions D.Oral Surgery E.Root Canals F.Alveolectomy G.Anesthesia H.Therapeutic Injections I. Laboratory Tests and other Diagnostic Examinations J. Endodontics K.Periodontics 3. Type Ill—Major/Special Dental A.Inlays B.Onlays 45 C.Crowns D.Prosthetics-including bridges and dentures: 1) The initial installation of,or addition to full or partial dentures or fixed bridge work shall be eligible provided; a) that such installation or addition is required as a result of an extraction of one or more injured or diseased natural teeth on or after the effective date of the Covered Individual's coverage hereunder, b) that the installation or addition referred to above includes the replacement of such an extracted tooth and, c) that such denture or bridgework is completed within twelve (12) months following the date of the extraction. Dentures and bridgework shall be considered initially installed only if such dentures and bridgework do not replace any existing dentures or bridgework. 2) The replacement or alteration of full or partial dentures or fixed bridgework shall be considered for payment if the replacement or alteration is necessary, occurred on or after the effective date of the Covered Individual's coverage under the Plan and is completed within twelve(12)months after one of the following: a) an accidental injury which requires surgical treatment or b) any such replacement shall in no event be made less than six (6) months after the effective date of the Covered Individual's coverage under this Plan 3) Denture Repair and Bridge Repair { 4. Type IV-Orthodontia Orthodontia,including surgical procedures performed for orthodontic purposes is limited to dependent children to age 19 and only after 12 months of coverage. i r 46 DENTAL EXPENSE EXCLUSIONS AND LIMITATIONS The Dental Benefit provisions of this Plan do not cover any loss caused by,incurred for,or resulting from: I. Any services,for which no charge is made to the covered individual,or any charges for services or supplies which are,or may be, obtained without cost in accordance with the laws or regulations of any government or government agency, except to the extent, if any, that a charge is made which the covered individual is legally required to pay; "government" being deemed to include any nation,government,or any political subdivision; 2. Any charges for services received from the dental or medical department of any employer, union, employee benefit association, trustee, or similar organization, or for services of a dentist or clinic contracted for or by any such organization; 3. Any charges for care or services made necessary as a result of the covered individual's commission of, or attempt to commit,an assault,battery,felony,or act of aggression,insurrection,rebellion,or participation in a riot,or resulting from an act of or in the course of war,declared or undeclared; 4. Any charges for replacement of teeth extracted prior to the effective date of the covered individual's coverage under this Plan unless the replacement satisfies one of the conditions listed under the"inclusions"provision in this Plan; 5. Any charges for dentures,crowns,inlays,only s,bridgework or appliances or services for increasing vertical dimensions; Y g Y �onlays, PP� g 6. Any charges for denture or bridgework adjustments within six months of the placement of a denture or bridgework; 7. Any charges for replacement of a lost or stolen prosthesis,or for a duplicate prosthesis; 8. Any charges for oral hygiene,dietary,or plaque control instructions and programs; 9. Any charges for injury or disease arising out of or in the course of any occupation or any employment for compensation, profit,or gain; 10.Any charges for athletic mouthguards; 11.Any charges for a temporary denture or bridge that,when combined with the charge for the permanent denture or bridge, exceeds the reasonable and customary amount payable for the permanent denture or bridge; 12.Any charges made by a dentist for the patient's failure to appear as scheduled for an appointment; 13.Any charges for implantology; 14.Any charges for drugs, other than injectable antibiotics administered by a dentist or physician as a result of dental treatment; 15.Any charges for procedures, services, or supplied, which do not meet accepted standards of dental practice, including charges for procedures,services or supplies which are experimental in nature. 16. More than two oral examinations,two prophylaxis and two bitewing x-rays during any Calendar year. 17. More than one full mouth x-ray in any three year period. 18. Placement of crowns,bridges or dentures within the first six(6)months of coverage. 19. Orthodontia charges in connection with a treatment program which began before the covered person became covered under the Plan; before the covered person has been continuously covered under plan for at least 12 consecutive months; and for any individual who is age 19 or older. 47 20. Any item shown in the General Exclusions and Limitations. 21. Complications arising from any item listed in this Dental Expense Exclusions and Limitations section or any other procedures excluded by the Plan. r 48 EXTENSION OF BENEFITS No payment will be made under the Plan for dental services or supplies furnished on or after the date of termination of your or your Dependent's coverage,except under the following specified circumstances: If, within one month after the covered person ceases to be covered, you incur expenses for any services or supplies in connection with a dental procedure which began prior to the date of termination, we will pay benefits for such expense, provided dental expenses are still covered under the Plan on the date the expense is incurred. For purposes of this provision, X-rays and prophylaxis treatment will not be considered as the beginning of a dental procedure. The above benefits are subject to all other conditions,limitations,and exclusions contained in this Plan. } )¢i p[1 II t4 49 GENERAL EXCLUSIONS AND LIMITATIONS This Plan does not cover and no benefits shall be paid for any toss caused by,incurred for or resulting from: 1. Charges in excess of reasonable and customary fees. 2. Services or supplies received from either an Employee's or Employee's spouse's relative, any individual who ordinarily resides in the Employee's home or any such similar person. 3. Charges for failure to keep a scheduled visit or charges for completion of a claim form or for medical records. 4. Charges for telephone conversations. 5. Services or supplies for which there is no legal obligation to pay or for which no charge would be made in the absence of this coverage. 6. Services and supplies for any illness or injury arising out of and in the course of employment for which benefits and/or compensation are available in whole or in part under the provisions of any Workers' Compensation Law, Temporary Disability Benefits Law,Occupational Disease Law or similar legislation of the United States of America or any State of the United States or any foreign country or any agency or political subdivision of any of the foregoing,whether or not the Covered Person claims such compensation or receives such benefits and whether or not any recovery is had by the Covered Person against such third party for damages resulting from such illness or injury. 7. Charges for or in connection with an Injury or Illness arising out of or in the course of war, declared or undeclared, { service in any military, naval, or air force of any country or international organization, or in any auxiliary or civilian noncombatant unit serving with such forces. i .. 8. Services or supplies that are provided by the local, state or federal government and that part of the charges for any services or supplies for which payment is provided or available from the local, state or federal government (i.e., Medicare)whether or not that payment is received,except as otherwise provided by law. 9. Services and supplies which do not meet accepted standards of medical or dental practice; and Investigation/Experimental Services and Supplies and all services and supplies related thereto. 10. Any charges incurred as the result of suicide or as the result of an intentionally self-inflicted injury unless the intentional or self-inflicted injury results from a medical condition of the individual. 11. Charges for or in connection with an injury or Illness arising out of the participation in, or in consequence of having participated in an assault,battery,strike,riot,insurrection or civil disturbance or the commission of a felony. 12. Services or supplies furnished by a Hospital owned or operated by the United States Government or agency thereof, or furnished by a Physician employed by the United States Government or agency thereof,to the extent permitted by law. 13. Charges incurred outside the United States if: a. The Covered Person traveled to such location to obtain medical services,drugs or supplies;or b. Such services,drugs or supplies are unavailable or illegal in the United States. 14. Charges for services required by any employer as a condition of employment,or rendered through a medical department, clinic or other similar facility provided by an employer or by a union Employee benefit association or similar group of which the person is a member. 50 15. Health examinations required for the use of a third party. 16. Treatment of any condition not caused by Illness or not resulting from bodily Injury, except as shown as a Covered Expense. 17. Expenses submitted more than Fifteen(15)months after the date incurred,except that failure to submit within the stated time shall not invalidate or reduce any claim if it shall be shown not to have been reasonably possible to submit such claim in a timely manner and that the claim was submitted as soon as was reasonably possible. 18. Charges in excess of the benefits specified in this Plan. 19. Services and supplies not specifically provided for in this Plan. I } } I ' 51 OTHER HEALTH BENEFIT PLAN INFORMATION COORDINATION OF BENEFITS The Coordination of Benefits provision is intended to prevent payments of benefits which exceed expenses. It applies when the Employee or any eligible Dependent who is covered by this Plan is also covered by any other plan or plans. When more than one coverage exists,one plan normally pays its benefits in full and the other plan(s)pay a reduced benefit. This Plan will always pay either its benefits in full or,when this Plan has secondary responsibility,a reduced amount which,when added to the benefits payable by the other plan or plans,will not exceed 100%of the total allowable expenses. Only the amount paid by this Plan will be charged against the Plan maximums. The Coordination of Benefits provision applies whether or not a claim is filed under the other plan or plans. If requested, authorization must be given to this Plan to obtain information as to benefits or services available from the other plan or plans, or to recover overpayment. All benefits contained in this Plan are subject to this provision. There is no Coordination of Benefits within this Plan. Coordination is applicable only with other plans. DEFINITIONS The term "Plan" as used herein will mean any plan providing benefits or services for, or by reason of, medical or dental treatment and such benefits or services are provided by: • Group insurance or any other arrangement for coverage for Covered Persons in a group, whether on an insured or uninsured basis;or • Group,blanket or franchise coverage;or • Hospital or medical service organization on a group basis,group practice and other group prepayment plans;or ♦ A licensed Health Maintenance Organization(HMO);or ♦ Any coverage under Governmental programs,and any coverage required or provided by a statute;or ♦ Individual automobile insurance coverage based upon the principle of"No Fault"coverage;or ♦ Any coverage under a labor-management trusteed plan, union welfare plan, employer organization plan, Employee benefit organization plan or such similar plan. The term"Plan"does not mean individual or family plans or contracts,or any coverage for students which is sponsored by,or provided through a school or other educational institution. The term "Plan" will be construed separately with respect to each policy, contract or other arrangement for benefits or services,and separately with respect to that portion of any such policy,contract or other arrangement which reserves the right to take the benefits or services of the other plans into consideration in determining benefits and that portion which does not. The term "Allowable Expenses" means any necessary item or expense, the charge for which is reasonable, regular and customary,at least a portion of which is covered under at least one of the plans covering the person for whom claim is made. When a plan provides benefits in the form of services rather than cash payments, the reasonable cash value of each service rendered will be deemed to be both an allowable expense and benefit paid. The term"Claim Determination Period"means a Calendar Year,or that portion of a Calendar Year during which the Covered Person for whom a claim is made has been covered under this Plan. 52 COORDINATION PROCEDURE Notwithstanding the other provisions of this Plan, benefits that would be payable under this Plan will be reduced so that the sum of benefits and all benefits payable under all other plans will not exceed the total Allowable Expenses incurred during any Claim Determination Period with respect to Covered Persons eligible for: 1. Benefits either as an insured person or Employee or as a Dependent under any other plan which has no provision similar in effect to this provision;or 2: Dependents' benefits under this Plan for a Dependent who is also eligible for benefits as an insured person or Employee under any other plan or as a Dependent covered under another group plan;or 3. Benefits under this Plan for an Employee who is also eligible for benefits as an insured person or Employee under any other plan,and has been covered continuously for a longer period of time under such other plan;or 4. If an eligible Dependent elects membership in a Health Maintenance Organization (HMO) as an Employee of another employer, benefits under this Plan are limited to Co-insurance and/or Deductibles not covered under the HMO and eligible expenses that are specifically excluded under the HMO. There will be no coverage under this Plan for any item not covered by the HMO because the Dependent chose not to avail himself to the HMO participating provider. ORDER OF BENEFIT DETERMINATION In Coordination of Benefits, the Plan first decides which plan has primary responsibility for providing benefits. Primary responsibility is decided by these rules in the following order: 1. The Plan pays secondary to any and all PIP, Med-Pay or No-Fault coverage. The Plan has no duty of obligation to pay claims until PIP,Med-Pay or No-Fault coverage is exhausted. If you live in a state with no-fault auto insurance(PIP),your car insurance is the primary plan for medical expenses relating to an automobile accident. This Plan is secondary to PIP but only if you exceed the PIP maximum coverage limits. This Plan does not permit participants to opt out of no-fault auto insurance as the primary plan. If you should opt out,be aware that this Plan will reimburse you as the secondary plan only under the assumption that you have received primary reimbursement from your auto insurance to the maximum limit available. In other words,you will receive little or no reimbursement f r o m this Plan...unless the accident expenses exceed the PIP maximum. Therefore,in order to be eligible for secondary reimbursement for automobile-accident related medical costs,a Plan participant:(1)must have maximum PIP coverage,and(2)must have exceeded that coverage limit; 2. The other plan has primary responsibility if it has no Coordination of Benefits provision; 3. Whichever plan provides benefits for the sick or injured person as a Participant(Employee),has primary responsibility before the plan covering the person as a Dependent; 4. The plan that covers the person(and his Dependents)as an active Employee,pays before the plan that covers the person as a retired or laid-off Employee or COBRA continuant. 5. If the claim is for a Dependent Child,the plan of the parent whose birthday falls earlier in a Calendar Year has primary responsibility,or if both parents have the same birthday,the plan covering the parent longer has primary responsibility. If the other plan does not have this rule but instead has a rule based on the gender of a parent,and,as a result the plans do not agree on the order of benefits,then the rule in the other plan will determine the order of benefits. Dependent Child of Separated or Divorced Parents 1. If two or more plans cover a person as a Dependent Child of divorced or separated parents, benefits for the Child are determined in this order: a. First,the plan of the parent with custody of the Child; 53 b. Then,the plan of the Spouse of the parent with custody;and c. Finally,the plan of the parent without custody of the Child. 2. However, if the specific terms of a court decree state that one parent is responsible for the health care expenses of the Child and the entity obligated to pay or provide the benefits of the plan of that parent has actual knowledge of those terms,that plan is the primary plan.This paragraph does not apply with respect to any benefit period or Plan Year during which any benefits are actually paid or provided before the entity has actual knowledge. 3. If the order of responsibility cannot be determined by the above rules, such as when the same individual is covered by two group plans, whichever plan has covered the ill or injured person for the longer period of time has primary responsibility. The Company has the right: I. To obtain or share information with an insurance Company or other organization regarding Coordination of Benefits without the Covered Person's consent;and 2. To require that the Covered Person provide the Company with information on such other plans so that this provision may be implemented;and 3. To pay the amount due under this Plan to an insurer or other organization if this is necessary, in the Company's opinion, to satisfy the terms of this provision. WHEN ANOTHER PLAN HAS PRIMARY RESPONSIBILITY When another plan has primary responsibility, it must first pay its full benefit.This Plan will then pay any remaining covered expenses up to the amount that it would have paid if it had primary responsibility,unless payment is excluded by a provision of the Plan. RIGHT TO RECEIVE AND RELEASE NECESSARY INFORMATION For the purpose of determining the applicability of and implementing this provision of the Plan or any provision of similar purpose of any other plan,the Plan Administrator may,without the consent of or further notice to any person or entity,release to or obtain from any other insurance Company,organization,or person any information,with respect to any person, which the Plan Administrator deems necessary for such purposes.Any person claiming benefits under this Plan shall furnish to the Plan Administrator such information as may be necessary to implement this provision. FACILITY OF PAYMENT Whenever payments which should have been made under this Plan in accordance with this provision have been made under any other plan, the Plan Administrator shall have the right, exercisable alone and in its sole discretion, to pay over to any organization making such other payments any amounts it shall determine to be warranted in order to satisfy the intent of this provision and amounts so paid shall be deemed to be benefits paid under this Plan and,to the extent of such payments,the Plan Administrator shall be fully discharged from liability under this Plan. The benefits that are payable will be charged against any applicable maximum payment or benefit of this Plan rather than the amount payable in absence of this provision. RIGHT OF RECOVERY Whenever payments have been made by the Plan Administrator with respect to Allowable Expenses in a total amount which is,at any time, in excess of the maximum amount of payment necessary at that time to satisfy the intent of this provision,the Plan Administrator shall have the right to recover such payments,to the extent of such excess,from any person or entity to,or for,or with respect to,whom such payments were made. 54 I I SUBROGATION Subrogation/Right of Recovery When the plan pays for expenses that were either the result of the alleged negligence of,or which arise out of any claim or cause of action which may accrue against, any third party responsible for Injury or death to the Covered Employee or Dependent of the Covered Employee(hereinafter named the Covered Person)by reason of their eligibility for benefits under 1 the Plan,the Plan has a right to equitable restitution and will advance benefits if the Covered Person agrees to the following. The Covered Person will reimburse the Plan out of the Covered Person's recovery for all benefits paid by the Plan. The Plan will be reimbursed in full prior to the Covered Person receiving any monies recovered from any party or their insurer as a result of judgment,settlement or otherwise. The duty and obligation to reimburse the Plan also applies to any insurance. The Covered Person is obligated to repay the Plan out of the Covered Person's recovery even if the Covered Person is not fully compensated or made-whole from any money they receive. The Covered Person agrees to include the Plan's name as a co- payee on any settlement check. The Plan is paying benefits in reliance upon the Covered Person's agreement to the terms contained in this section. The Plan has the right to the Covered Person's full cooperation in any case involving the alleged negligence of a third party. In such cases,the Covered Person is obligated to provide the Plan with whatever information,assistance,and records the Plan may require to enforce the rights in this provision. The Covered Person further agrees that in the event that the Plan has reason to believe that the Plan may have a subrogation lien, the Plan will require the Covered Person to complete a subrogation questionnaire, sign an acknowledgment of the Plan's Subrogation rights and an agreement to provide ongoing information;before the Plan pays,or continues payments of claims according to its terms and conditions. Upon receipt of the requested materials,the Plan will commence,or continue,payments of claims according to its terms and conditions provided that said payment of claims in no way prejudices the Plan's rights. If the Covered Person does not agree to the terms and conditions of the Plan's Subrogation Provision,related claims may be subject to disqualification,denial or loss of benefits. The Plan may,but is not obligated to,take any legal action it sees fit against the third party or the Covered Person,to recover the benefits the Plan has paid. The Plan's exercise of this right will not affect the Covered Person's right to pursue other forms of recovery,unless the Covered Person and his legal representative consent otherwise. In the event that the Claims Payer determines that a subrogation recovery exists,the Claims Payer retains the right to employ the services of an attorney to recover money due to the Plan. The Covered Person agrees to cooperate with the attorney who is pursuing the subrogation recovery. The compensation that the Plan's attorney receives will be paid directly from the dollars recovered for the Plan. The Plan specifically rejects the"common fund"doctrine, whereas, it has no duty or obligation to pay a fee to the Covered Person's attorney for the attorney's services in making any recovery on behalf of the Covered Person. The Covered Person is obligated to inform their attorney of the subrogation lien and to make no distributions from any settlement or judgment which will in any way result in the Plan receiving less than the full amount of its lien without the written approval of the Plan. The Covered Person further agrees that he will not release any third party or their insurer without prior written approval from the Plan,and will take no action which prejudices the Plan's subrogation right. The Covered Person agrees to refrain from characterizing any settlement in any manner so as to avoid repayment of the Plan's lien or right to reimbursement. The Plan Administrator retains discretionary authority to interpret this and all other plan provisions and the discretionary authority to determine the amount of the lien. The Plan pays secondary to any and all PIP, Med-Pay or No-Fault coverage. The Plan has no duty of obligation to pay any claims until PIP, Med-Pay or No-Fault coverage is exhausted. In the event,the Plan pays claims that should have been paid by PIP, Med-Pay or No-Fault coverage under this provision,then the Plan has a right of recovery from the PIP, Med-Pay or • No-Fault carrier. 55 If you live in a state with no-fault auto insurance(PIP),your car insurance is the primary plan for medical expenses relating to an automobile accident. This Plan is secondary to PIP but only if you exceed the PIP maximum coverage limits. This Plan does not permit participants to opt out of no-fault auto insurance as the primary plan. If you should opt out,be aware that this Plan will reimburse you as the secondary plan only under the assumption that you have received primary reimbursement from your auto insurance to the maximum limit available. In other words, you will receive little or no reimbursement from this Plan . . . unless the accident expenses exceed the PIP maximum. Therefore, in order to be eligible for secondary reimbursement for automobile-accident related medical costs,a Plan participant:(1) must have maximum PIP coverage,and (2)must have exceeded that coverage limit. Under the terms of the Plan, it is the absolute obligation of the Covered Person to reimburse the Plan out of the Covered Person's recovery even if the Covered Person recovers from the other party or insurer,without the Plan's knowledge,for the amount of benefits paid by the Plan for the Injury,Illness or Death. Failure to reimburse the Plan shall permit the Plan to offset the amount due against the Covered Persons' future claims submitted by covered members of his or her family. This Plan's subrogation right is subject to ERISA,which preempts individual state law. g{+i Fi Ef pE 56 MEDICARE PROVISIONS Medicare means Title XVIII(Health Insurance for the Aged)of the United States Social Security Act,as added by the Social Security Amendments of 1965 or as later amended. Full Medicare Coverage means coverage for all the benefits provided under Medicare including benefits provided under the voluntary program(Medicare Part B-doctor's portion)established by Medicare. Medical Charges as used in this Provision with respect to any services, treatments or supplies, means the charges actually made for such services,treatments or supplies to the extent reasonable and customary. ACTIVE EMPLOYEES AGE SIXTY-FIVE(65)OR OVER For active Employees age sixty-five(65)or over who continue to participate in this Plan,this Plan will provide its full regular benefits first and Medicare coverage would provide supplemental benefits for those expenses not paid by this Plan. If the active Employee's Spouse is also enrolled in this Plan, this provision would apply to the Spouse during the period of time the Spouse is sixty-five(65)or over,regardless of the age of the Employee. This provision does not apply to individuals entitled to Medicare because of end stage renal disease(ESRD)and/or disability. This provision intends to comply with the TEFRA Act of 1982,the DEFRA Act of 1985,the COBRA Act of 1985 and the OMBRA Act of 1986 and all similar Federal acts. CERTAIN DISABLED INDIVIDUALS (Employers with 100 or more Employees) This Plan will be the primary payor and Medicare will be the secondary payor for the payment of benefits for Disabled individuals who are "currently working" (as defined by Medicare) Covered Employees or covered Dependents of such Employees. Effective August 10, 1993, Medicare will be the primary payor and this Plan will be the secondary payor for the payment of benefits for Disabled individuals who are not"currently working" (as defined by Medicare)Covered Employees or covered Dependents of such Employees. The benefits of Medicare and this Plan are fully coordinated to provide benefits totaling not more than the actual expenses incurred. This provision does not apply to "currently working" Disabled individuals entitled to Medicare because of end stage renal disease (ESRD) during the period of time which Medicare is the primary payor and the Plan is the secondary payor as prescribed by law. This provision intends to comply with the OMBRA Act of 1986 and 1993. CERTAIN DISABLED INDIVIDUALS (Employers with less than 100 Employees) For covered individuals who are totally Disabled who are eligible for Medicare benefits, both Medicare Part A (Hospital portion)and Medicare Part B(doctor's portion)will be considered the primary payor in computing benefits under this Plan. The benefits of Medicare and this Plan are fully coordinated to provide benefits totaling not more than the actual expenses incurred. INDIVIDUALS WITH END STAGE RENAL DISEASE For covered individuals with end stage renal disease (ESRD) who are eligible for Medicare benefits, this Plan will be the primary payor and Medicare will be the secondary payor for the payment of benefits for the period of time specified by law, after which time Medicare will become the primary payor and this Plan will be the secondary payor. Both Medicare Part A (Hospital portion) and Medicare Part B (doctor's portion) will be considered in computing benefits under this Plan. The benefits of Medicare and this Plan are fully coordinated to provide benefits totaling not more than the actual expenses incurred. This provision intends to comply with the OMBRA Act of 1993. 57 RETIRED INDIVIDUALS AND THEIR COVERED DEPENDENTS For covered retired individuals who are eligible for Medicare benefits,both Medicare Part A(Hospital portion)and Medicare Part B(doctor's portion)will be considered in computing benefits under this Plan. The benefits of Medicare and this Plan are fully coordinated to provide benefits totaling not more than the actual expenses incurred. Note: These Medicare Provisions Apply From The Date The Covered Individual Is First Eligible For Medicare Coverage (Either Part A -Hospital Coverage Or Part B-Physician Coverage) Whether Or Not The Covered Individual Is Enrolled And Is Receiving Medicare Benefits. Ff{! 1[t ! r 58 COBRA CONTINUATION COVERAGE RIGHTS UNDER COBRA The following contains important information about your rights to COBRA continuation coverage, which is a temporary extension of coverage under the Plan.This generally explains COBRA continuation coverage,when it may become available to you and your family and what you need to do to protect the right to receive it. The right to COBRA continuation coverage was created by a federal law,the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA continuation coverage can become available to you when you would otherwise lose your group health coverage. It can also become available to other members of your family who are covered under the Plan when they would otherwise lose their group health coverage. This information is included as part of the Plan Document/Summary Plan Description. For additional information about your rights and obligations under the Plan and under the federal law,you should contact the Plan Administrator. What Is COBRA Continuation Coverage? a would otherwise end because of a life event COBRA continuation coverage is a continuation of Plan coverage when coverage g g ( known as a"Qualifying Event". Specific Qualifying Events are listed later in this notice. After a Qualifying Event,COBRA continuation coverage must be offered to each person who is a "Qualified Beneficiary". You, your Spouse and your Dependent Children could become Qualified Beneficiaries if coverage under the Plan is lost because of the Qualifying Event. Under the Plan, Qualified Beneficiaries who elect COBRA continuation pay a must a y the full cost of COBRA continuation coverage(the full cost means the Employee and Employer cost of coverage)before the group health coverage is continued and monthly payments must be made in order to continue the coverage. If you are an Employee,you will become a Qualified Beneficiary if you lose your coverage under the Plan because either one of the following Qualifying Events happens: • Your hours of employment are reduced;or • Your employment ends for any reason other than gross misconduct. If you are the Spouse of an Employee,you will become a Qualified Beneficiary if you lose coverage under the Plan because any of the following Qualifying Events happens: 4 ♦ Your Spouse dies; • Your spouse's hours of employment are reduced; • Your spouse's employment end for any reason other than gross misconduct; • Your Spouse becomes entitled to Medicare benefits(Part A,Part B or both);or • You become divorced or legally separated from your Spouse. Your Dependent Children will become Qualified Beneficiaries if they lose coverage under the Plan because any of the following Qualifying Events happens: • The parent-Employee dies; • The parent-Employee's hours of employment are reduced; • The parent-Employee's employment ends for any reason other than gross misconduct; • The parent-Employee becomes entitled to Medicare benefits(Part A,Part B or both); • The parents become divorced or Iegally separated;or • The Child stops being eligible for coverage under the Plan as a"Dependent Child". Sometimes,filing a proceeding in bankruptcy under title eleven(I I)of the United States Code can be a Qualifying Event,but only if the Plan offers retiree coverage. If a proceeding in bankruptcy is filed with respect to the Employer, and that bankruptcy results in the loss of coverage of any retired Employee covered under the Plan,the retired Employee will become a Qualified Beneficiary with respect to the bankruptcy. The retired Employee's Spouse, surviving Spouse and Dependent Children will also become Qualified Beneficiaries if bankruptcy results in the loss of their coverage under the Plan. 59 When Is COBRA Coverage Available? The Plan will offer COBRA continuation coverage to Qualified Beneficiaries only after the Plan Administrator has been notified that a Qualifying Event has occurred. When the Qualifying Event is the end of employment or the reduction of hours of employment, death of Employee, commencement of a proceeding in bankruptcy with respect to the Employer, or the Employee becoming entitled to Medicare benefits(Part A, Part B or both),the Employer must notify the Plan Administrator within thirty(30)days of any of these events. You Must Give Notice Of Some Qualifying Events For the other Qualifying Events (divorce or Ieeal separation of the Employee and Spouse or a Dependent Child's losing eligibility for coverage as a Dependent Child),you must notify the Plan Administrator. The Plan requires you to notify the Plan Administrator in writing within sixty(60)days after the Qualifying Event occurs.Your written notice should include the date of the Qualifying Event. If you or your Spouse are notifying the Plan Administrator of a divorce or legal separation,you or your Spouse should provide a copy of the legal separation papers or divorce decree. You must provide this notice to: F.H. Paschen Companies. If you fail to give written notice with the sixty(60)day time period,the Spouse and/or Dependent Child shall lose the right to elect COBRA continuation coverage. How Is COBRA Coverage Provided? Once the Plan Administrator receives notice that a Qualifying Event has occurred, COBRA continuation coverage will be offered to each of the Qualified Beneficiaries. Each Qualified Beneficiary has an independent right to elect COBRA continuation coverage. Covered Employees may elect COBRA continuation coverage on behalf of their spouses and parents may elect COBRA continuation coverage on behalf of their Children. COBRA continuation coverage is a temporary continuation of coverage. When the Qualifying Event is the death of the Employee,your divorce or legal separation,a Dependent Child's losing eligibility as a Dependent or loss of coverage due to Medicare Entitlement(under Part A,Part B or both),COBRA continuation lasts for up to a total of thirty-six(36)months. When the Qualifying Event is the end of employment or reduction of the Employee's hours of employment,and the Employee became entitled to Medicare benefits less than eighteen (18) months before the Qualifying Event, COBRA continuation coverage for Qualified Beneficiaries other than the Employee lasts until thirty-six (36) months after the date of Medicare entitlement. For example,if a Covered Employee becomes entitled to Medicare eight(8)months before the date on which his employment terminates,COBRA continuation coverage for his Spouse and Children can last up to thirty-six(36)months after the date of Medicare entitlement,which is equal to twenty-eight(28)months after the date of the Qualifying Event(thirty-six (36)months minus eight(8)months). Otherwise, when the Qualifying Event is the end of employment or reduction of the Employee's hours of employment, COBRA continuation coverage generally lasts for only up to a total of eighteen (18) months. There are two ways in which this eighteen(18)month period of COBRA continuation coverage can be extended. Disability Extension Of The Eighteen(18)Month Period If you or anyone in your family covered under the Plan is determined by the Social Security Administration to be Disabled and you notify the Plan Administrator in writing in a timely fashion,you and your entire family may be entitled to receive up to an additional eleven(11)months of COBRA continuation coverage,for a total maximum of twenty-nine(29)months. The disability would have to have started some time before the sixtieth(60`'') day of COBRA continuation coverage and last at least until the end of the eighteen(18)month period of COBRA continuation coverage. A copy of the Notice of Award from the Social Security Administration must be submitted to the Plan Administrator and the COBRA Administrator within sixty (60) days of receipt of Notice of Award and before the end of the eighteen (18) month period of COBRA continuation coverage. Second Qualifying Event Extension Of Eighteen(18)Month Period If your COBRA covered family members experience another COBRA Qualifying Event within the first eighteen(18)months of COBRA continuation coverage, the Spouse and Dependent Children in your family may be eligible to receive up to eighteen(18)additional months of COBRA continuation coverage, for a maximum of thirty-six(36)months, if notice of the 60 secondary event is properly given to the Plan. This extension may be available to the Spouse and any Dependent Children receiving COBRA continuation coverage if the Employee or former Employee dies, or is divorced or legally separated,or if the Dependent Child stops being eligible under the Plan as a Dependent Child. In all cases,the eighteen(18)month extension is available only if the second Qualifying Event would have caused the Spouse or Dependent Child to lose coverage under the Plan had the first Qualifying Event not occurred. The following example shows how the second Qualifying Event rule works. Former Employee A elects eighteen(18)months of COBRA continuation coverage for the entire family. After the first six (6) months of COBRA continuation coverage, former Employee A becomes entitled to Medicare (Part A, Part B or both). If former Employee A were still actively employed, entitlement to Medicare would not result in a loss of coverage under the Employer's Group Health Plan. The additional eighteen (18) month extension is not available for the former Employee's Spouse and Dependents because if Medicare entitlement had occurred during active employment there would have been no loss of Employer Group Health Plan coverage. En all of these cases,you must notify the Plan Administrator within sixty(60)days of the second Qualifying Event. Early Termination Of COBRA Continuation Coverage COBRA continuation coverage will terminate before the end of the maximum period if: • The Qualified Beneficiary fails to make the required contributions when due; • The Qualified Beneficiary becomes covered under another Group Health Plan after the date of the COBRA election; • The Qualified Beneficiary becomes entitled to Medicare benefits(Part A,Part B or both)after electing COBRA continuation coverage;or • The Employer ceases to provide any Group Health Plan for its Employees. How Can You Elect COBRA Continuation Coverage? To elect COBRA continuation coverage,you must complete the Election Form and furnish it according to the directions on the form. You and your family members will have sixty(60)days from the later of the date coverage is lost or the notice of the right to continuation coverage is received to complete an election of continuation of coverage. If the election is not received within the 60-day period,you will not continuation coverage and will have no further rights to elect such coverage. Each Qualified Beneficiary has a separate right to elect COBRA continuation coverage. For example, the Employee's Spouse may elect COBRA continuation coverage even if the Employee does not. COBRA continuation coverage may be elected for only one,several or for all Dependent Children who are Qualified Beneficiaries.A parent may elect to continue COBRA continuation coverage on behalf of any Dependent Children. The Employee or the Employee's Spouse can elect COBRA continuation coverage on behalf of all of the Qualified Beneficiaries. You should take into account that you have special enrollment rights under federal law. You have the right to request special enrollment in another Group Health Plan for which you are otherwise eligible(such as a plan sponsored by your spouse's employer)within thirty (30)days after your group health coverage ends because of the Qualifying Event listed above. You will also have the same special enrollment right at the end of COBRA continuation coverage if you elect COBRA continuation coverage for the maximum time available to you. How Much Does COBRA Continuation Coverage COST? Generally,each Qualified Beneficiary may be required to pay the entire cost of COBRA continuation coverage.The amount a Qualified Beneficiary may be required to pay may not exceed one hundred two percent (102%) (or, in the case of an extension of COBRA continuation coverage due to a disability, one hundred fifty percent(150%)of the cost to the Group Health Plan (including both employer and Employee contributions) for coverage of a similarly situated plan Participant or Beneficiary who is not receiving COBRA continuation coverage. You may be able to get coverage through the Health Insurance Marketplace that costs less than COBRA continuation coverage. You can learn more about the Marketplace below. What is the Health Insurance Marketplace? 61 The Marketplace offers"one-stop shopping"to find and compare private health insurance options. In the Marketplace, you could be eligible for a new kind of tax credit that lowers your monthly premiums and cost-sharing reductions(amounts that lower your out-of-pocket costs for deductibles, coinsurance, and copayments) right away, and you can see what your premium,deductibles,and out-of-pocket costs will be before you make a decision to enroll. Through the Marketplace you'll also learn if you qualify for free or low-cost coverage from Medicaid or the Children's Health Insurance Program (CHIP). You can access the Marketplace for your state at www.HealthCare.gov. Coverage through the Health Insurance Marketplace may cost less than COBRA continuation coverage. Being offered COBRA continuation coverage won't limit your eligibility for coverage or for a tax credit through the Marketplace. When can I enroll in Marketplace coverage? I You always have 60 days from the time you lose your job-based coverage to enroll in the Marketplace. That is because losing your job-based health coverage is a"special enrollment"event. After 60 days your special enrollment period will end and you may not be able to enroll, so you should take action right away. In addition, during what is called an "open Y Y � Y g Y � g P enrollment"period,anyone can enroll in Marketplace coverage. To find out more about enrolling in the Marketplace,such as when the next open enrollment period will be and what you need to know about qualifying events and special enrollment periods,visit www.HealthCare.gov. If I sign up for COBRA continuation coverage,can I switch to coverage in the Marketplace? What about if I choose Marketplace coverage and want to switch back to COBRA continuation coverage? If you sign up for COBRA continuation coverage, you can switch to a Marketplace plan during a Marketplace open enrollment period. You can also end your COBRA continuation coverage early and switch to a Marketplace plan if you have another qualifying event such as marriage or birth of a child through something called a"special enrollment period." But be careful though - if you terminate your COBRA continuation coverage early without another qualifying event,you'll have to wait to enroll in Marketplace coverage until the next open enrollment period,and could end up without any health coverage in the interim. Once you've exhausted your COBRA continuation coverage and the coverage expires, you'll be eligible to enroll in Marketplace coverage through a special enrollment period,even if Marketplace open enrollment has ended. If you sign up for Marketplace coverage instead of COBRA continuation coverage, you cannot switch to COBRA continuation coverage under any circumstances. Can I enroll in another group health plan? You may be eligible to enroll in coverage under another group health plan(like a spouse's plan),if you request enrollment within 30 days of the loss of coverage. If you or your dependent chooses to elect COBRA continuation coverage instead of enrolling in another group health plan for which you're eligible,you'll have another opportunity to enroll in the other group health plan within 30 days of losing your COBRA continuation coverage. What factors should I consider when choosing coverage options? When considering your options for health coverage,you may want to think about: • Premiums: Your previous plan can charge up to 102%of total plan premiums for COBRA coverage. Other options, like coverage on a spouse's plan or through the Marketplace,,may be less expensive. • Provider Networks:If you're currently getting care or treatment for a condition,a change in your health coverage may affect your access to a particular health care provider. You may want to check to see if your current health care providers participate in a network as you consider options for health coverage. 62 • Drug Formularies: If you're currently taking medication,a change in your health coverage may affect your costs for medication-and in some cases,your medication may not be covered by another plan. You may want to check to see if your current medications are listed in drug formularies for other health coverage. • Severance payments: If you lost your job and got a severance package from your former employer, your former employer may have offered to pay some or all of your COBRA payments for a period of time. In this scenario,you may want to contact the Department of Labor at 1-866-444-3272 to discuss your options. • Service Areas:Some plans limit their benefits to specific service or coverage areas-so if you move to another area of the country, you may not be able to use your benefits. You may want to see if your plan has a service or coverage area,or other similar limitations. • Other Cost-Sharing: In addition to premiums or contributions for health coverage, you probably pay copayments, deductibles, coinsurance, or other amounts as you use your benefits. You may want to check to see what the cost- sharing requirements are for other health coverage options. For example, one option may have much lower monthly premiums,but a much higher deductible and higher copayments. When and How Must Payment for COBRA Continuation Coverage be Made? First Payment For COBRA Continuation Coverage If you elect COBRA continuation coverage, you do not have to send any payment with the Election Form. However, you must make your first payment for COBRA continuation coverage not later than forty-five (45) days after the date of your election. (This is the date the Election Notice is post-marked, if mailed.) If you do not make your first payment for COBRA continuation coverage in full within forty-five(45)days after the date of your election,you will lose all COBRA continuation coverage rights under the Plan. You are responsible for making sure that the amount of your first payment is correct. You may contact the COBRA Administrator or Plan Administrator to confirm the correct amount of your first payment. Periodic Payments For COBRA Continuation Coverage After you make your first payment for COBRA continuation coverage,you will be required to make periodic payments for each subsequent coverage period. The amount due for each coverage period for each Qualified Beneficiary is shown on the Election Notice. The periodic payments can be made on a monthly basis. Under the Plan,each of these periodic payments for COBRA continuation coverage is due on the first day of each month for that coverage period. If you make a periodic payment on or before the first day of the coverage period to which it applies,your coverage under the Plan will continue for that coverage period without any break. The Plan will send periodic notices of payments due for these coverage periods. Grace Periods For Periodic Payments Although periodic payments are due on the dates shown above,you will be given a grace period of thirty(30)days after the first day of the coverage period to make each periodic payment. Your COBRA continuation coverage will be provided for each coverage period as long as payment for that coverage period is made before the end of the grace period for that payment. However, if you pay a periodic payment later than the first day of the coverage period to which it applies, but before the end of the grace period for the coverage period,your coverage under the Plan will be suspended as of the first day of the coverage period and then retroactively reinstated(going back to the first day of the coverage period)when the periodic payment is received. This means that any claim you submit for benefits while your coverage is suspended may be denied and may have to be resubmitted once your coverage is reinstated. If you fail to make a periodic payment before the end of the grace period for that coverage period,you will lose all rights to COBRA continuation coverage under the Plan. Your first payment and all periodic payments for COBRA continuation coverage should be sent to the Plan Administrator or COBRA Administrator. Payments for continuation coverage must be sent to the following address: Benefit Administrative Systems,L.L.C. Attention:COBRA Dept. 17475 Jovanna Drive,Suite I B Homewood,IL 60430 63 If You Have Questions Questions concerning your Plan or your COBRA continuation rights should be addressed to the contact identified below. For more information about your rights under ERISA, including COBRA, the Health Insurance Portability and Accountability Act (HIPAA), and other laws affecting Group Health Plans, contact the nearest Regional or District Office of the U.S. Department of Labor's Employee Benefit Security Administration (EBSA) in your area or visit the EBSA website at www.dol.zov/ebsa Keep Your Plan Informed In order to protect your family's rights, you should keep the Plan Administrator informed of any change in marital status, Dependent status or address change. You should also keep a copy, for your records, of any notices you send to the Plan Administrator. Plan Contact Information F.H.Paschen Companies 5515 N.East River road Chicago,IL 60656 (773)444-3474 CONVERSION PRIVILEGES If the PLAN provides for conversion privileges,the PLAN must offer this option within the 180 day period that ends on the expiration date. However, no conversion will be provided if the qualified beneficiary does not actually maintain COBRA coverage to the expiration date. 64 DEFINITIONS OF TERMS The terms are capitalized to highlight their use. ACCIDENT-An Injury which is: 1. Caused by an event which is sudden and unforeseen;and 2. Exact as to time and place of occurrence. ACTIVELY WORK/ACTIVELY AT WORK - means performing all the normal duties of the employee's job for a full work day (a) while physically present at your normal place of employment; or(b) at some place of business the Employer requires you to go. ADVERSE BENEFIT DETERMINATION -A denial, reduction or termination of, a rescission of coverage, or failure to provide or make payment(in whole or in part)for,a benefit,or to provide or make payment that is based on a determination of Participant's or Beneficiary's eligibility to participate in a plan,with respect to Group Health Plans. Included is failure to provide or make payment(in whole or in part)for,a benefit resulting from the application of any utilization review,as well as a failure to cover an item or service for which benefits are otherwise provided because it is determined to be Experimental or investigational or not Medically Necessary or appropriate. ALTERNATE RECIPIENT-Any Child of a Participant who is recognized under a medical Child support order as having a right to enrollment under a Group Health Plan. A person who is an Alternate Recipient under a QMCSO shall be considered a Beneficiary under the Plan. AMBULANCE - Emergency local transportation in a specially equipped duly certified vehicle from a Covered Person's home or scene of accident or medical emergency to a Hospital,between Hospital and Hospital,between Hospital and Skilled Nursing Facility or from a Skilled Nursing Facility or Hospital to the Covered Person's home when such Hospital or Skilled Nursing Facility would ordinarily be expected to have the appropriate facilities for the treatment needed and would be the nearest facility from the place where such transportation began or from the destination of such transportation. If there are no facilities in the local area equipped to provide the care needed, Ambulance Transportation then means transportation to the closest facility that can provide the necessary service. AMBULATORY SURGICAL CENTER-A specialized facility or a facility affiliated with a Hospital which is approved by the Joint Commission on Accreditation of Healthcare Organizations(JCAHO) or licensed in accordance with the applicable laws in the jurisdiction in which it is located and is established, equipped and operated primarily for the purpose of performing surgical procedures on an ambulatory basis. ANESTHESIA SERVICES - means the administration of anesthesia and the performance of related procedures by a Physician or Certified Registered Nurse Anesthetist which may be legally rendered by them,respectively. APPLICABLE PREMIUM - The cost to the Plan for the continuation coverage, calculated in accordance with Section 604 of ERISA. ASSIGNMENT OF BENEFITS- Assignment of Benefits occurs when the Covered Person files a claim and authorizes the Plan to pay the Physician or Hospital directly. BENEFICIARY - The person named to receive the Covered Person's Life Insurance Benefit and/or Accidental Death Benefit,or any person or persons(including but not limited to,an individual,trust,estate,executor,administrator or fiduciary, whether corporate or otherwise) designated to receive benefits pursuant to the terms of the Plan or any insurance policies, contracts or administrative service agreements,constituting the Plan. BIRTHING CENTER-A specialized facility or a facility affiliated with a Hospital which: 65 l. Provides twenty-four(24)hour a day nursing service by or under the supervision of registered graduate nurses(R.N.)and certified nurse midwives;and 2. Is staffed,equipped and operated to provide: a. Care for patients during uncomplicated Pregnancy,delivery,and the immediate postpartum period; b. Care for infants born in the center who are normal or have abnormalities which do not impair function or threaten life; and c. Care for obstetrical patients and infants born in the center who require emergency and immediate life support measures to sustain life,pending transfer to a Hospital. CALENDAR YEAR-For the purposes of this Plan,a length of time beginning on January 1 and ending on December 31. CERTIFIED REGISTERED NURSE ANESTHETIST(CRNA)-A person who: 1. Is a graduate of an approved school of nursing and is duly licensed as a Registered Nurse; 2. Is a graduate of an approved program of nurse anesthesia accredited by the Council of Certification of Nurse Anesthetists or its predecessors; 3. Has been certified by the Council of Certification of Nurse Anesthetists or its predecessors;and 4. Is recertified every two(2)years by the Council on Recertification of Nurse Anesthetists. CHEMOTHERAPY - means the treatment of malignant neoplastic conditions by pharmaceutical and/or biological anti- neoplastic drugs. CHILD - The Employee's Children under twenty-six(26)years of age. The term "Child" shall include natural Children, a legally adopted Child(including the period of probation when the Child is placed with the adopting parents),a step-Child,a Child related to the Employee by blood or marriage and for whom the Employee has assumed legal guardianship,or a Child whom the Employee must cover due to a Qualified Medical Child Support Order(QMCSO), subject to the conditions and limits of the law. An unmarried Child who is physically or mentally incapable of self-support upon attaining age twenty-six (26), may be covered under the health care benefits, while remaining incapacitated, subject to the Covered Employee's own coverage continuing in effect. Such Child will be considered a Covered Dependent if he was Disabled prior to his twenty-sixth(26th) birthday. To continue Covered Dependent status of a Child under this provision,proof of incapacity must be received by the Company within thirty-one(31)days after coverage would otherwise terminate. Additional proof will be required from time to time. Evidence satisfactory to the Company of Dependent eligibility under the Plan may be requested; for example,birth records or Federal Income Tax returns. CLAIMS ADMINISTRATOR-Benefit Administrative Systems,L.L.C. CODE-The Internal Revenue Code of 1986,as amended from time to time,and the regulations thereunder. CO-INSURANCE - That portion of Covered Medical Expenses to be paid by the Plan in accordance with the coverage provisions as stated in the Plan. It is the basis used to determine any out-of-pocket expenses in excess of the Deductible which are to be paid by the Employee. COMPANY—F.H.PASHCEN COMPANIES CONTINUATION PREMIUM - The amount charged by the Plan to a Qualified Beneficiary for a specified period of continuation coverage under the Plan. 66 COORDINATION OF BENEFITS - If an individual is covered by another group plan of health care, this Plan will coordinate its payment of benefits with the other plan to allow as complete a claim reimbursement as possible without providing duplicate payments. CO-PAYMENT - That portion of Covered Medical Expenses which must be paid by or on behalf of the Covered Person incurring the expense. COSMETIC SURGERY- Surgery that is intended to improve the appearance of a patient or preserve or restore a pleasing appearance. It does not mean surgery that is intended to correct normal functions of the body. This does not include reconstructive surgery resulting from an Illness or Injury. COVERED EMPLOYEE - An Employee who has satisfied all applicable Eligibility provisions of the Plan and for whom coverage has not terminated. COVERED PERSON-A Covered Employee or Covered Dependent as herein described. CUSTODIAL CARE - Care which is not a necessary part of medical treatment for recovery but provides services and support to assist the Covered Person in the activities of daily living including,but not limited to,walking,bathing or feeding. It also consists of care which any person may be able to perform with minimal instruction, including, but not limited to, recording temperature, pulse and respirations; suctioning of the pharynx; administering and monitoring feeding systems or drugs and medicines which are usually self-administered. DEDUCTIBLE - The amount of Covered Medical and/or Dental Expenses that a Covered Person must pay before he can receive a benefit payment under the Medical and/or Dental Expense Benefits. DENTIST-A duly licensed Dentist practicing within the scope of his license and any other Physician furnishing any dental services which he is licensed to perform. DENTAL HYGIENIST-A person who is currently licensed to practice dental hygiene by the governmental authority having jurisdiction over the licensing and practice of Dental Hygiene,and who works under the direct supervision and direction of a Dentist. DEPENDENT - For the purposes of this Plan, the Employee's legal Spouse as determined by the law of the state in which you reside, domestic partner and Children to the age of twenty-six(26),(see definition of"Child"),and Disabled Children,if such incapacity occurred prior to the limiting age specified. DIAGNOSTIC SERVICE - means tests rendered because of symptoms and which are directed toward the diagnosis, evaluation or progress of a condition,disease or injury. Such tests include,but are not limited to,x-ray, pathology services, clinical laboratory tests, pulmonary function studies, electrocardiograms, electroencephalograms, radioisotope tests, and electromyograms. DIALYSIS FACILITY - A facility(other than a Hospital) whose primary function is the provision of maintenance and/or training dialysis on an ambulatory basis for renal dialysis patients and which is duly licensed by the appropriate governmental authority to provide such services. DISABLED- I. The Covered Person's complete inability as an active Employee, to perform any and every duty pertaining to his occupation or employment or for any occupation for wage or profit,or 2. The Covered Dependent's complete inability to perform the normal activities of a person of like age and sex,or 3. The Covered Person's complete inability,as a retired Employee,to perform the normal activities of a person of like age and sex. 67 DOMESTIC PARTNER - means a person, of the same or opposite sex, with whom you have entered into a Domestic Partnership. DOMESTIC PARTNERSHIP -means a long-term committed relationship of indefinite duration with a person who meets the following criteria: 1. You and your Domestic Partner have lived together for at least six(6)months. 2. Neither you nor your Domestic Partner is married to anyone else or has another Domestic Partner. 3. Your Domestic Partner is at least 18 years of age and mentally competent to consent to a contract. 4. Your Domestic Partner resides with you and intends to do so indefinitely. 5. You and your Domestic Partner have an exclusive mutual commitment similar to marriage,and 6. You and your Domestic Partner are jointly responsible for each other's common welfare and share financial obligations. 7. You and your Domestic Partner both execute the Plan's affidavit form attesting to the domestic partnership status of the relationship DURABLE MEDICAL EQUIPMENT-Only that equipment and those supplies that: 1. Are primarily and customarily used to serve a medical purpose; 2. Would not be generally useful to a person in the absence of an Illness or Injury; 3. Are designed for repeated use;and 4. Either: a. Are Medically Necessary to: i. Treat an Illness or Injury; ii. Effect improvement of a Covered Person's medical condition;or iii. Arrest or retard deterioration of a Covered Person's medical condition;or b. Are alternatives to chair or bed confinement. ELECTIVE SURGERY-Surgery that is not emergency in nature or is not performed to correct a life-threatening situation. EMERGENCY DENTAL CARE - An urgent, unplanned diagnostic visit and/or alleviation of acute or unexpected Dental condition. EMERGENCY MEDICAL CARE-The initial treatment,including necessary related diagnostic services,of the unexpected and sudden onset of a medical condition manifesting itself by symptoms severe enough that the absence of immediate treatment could result in serious and/or permanent medical consequences. EMPLOYEE -The word "Employee" as used herein shall mean any person employed and compensated for services by the Company on a regular full-time permanent basis. ERISA -The Employee Retirement Income Security Act of 1974, as amended. As a Participant of the Plan,the Covered Person has a number of rights under ERISA as outlined. EXPERIMENTAL AND/OR INVESTIGATIONAL - The use of any treatment, procedure, facility, equipment, drug, device or supply which is not accepted as standard medical treatment of the condition being treated, or any such items requiring Federal or other government approval which has not been granted at the time services are rendered. In determining if any treatment,procedure,facility,equipment,drug,device or supply is Experimental,the Plan Administrator may consider the views of the state or national medical communities and the views and practices of Medicare, Medicaid and other 68 government financed programs. Although a Physician may have prescribed treatment,such treatment may still be considered Experimental by the Plan Administrator in its sole discretion within this definition. One or more of the following is true of an experimental and/or investigational treatment,procedure,device,drug or medicine: 1. It cannot be lawfully marketed without U.S. Food and Drug Administration approval;and approval for marketing for the condition treated has not been given at the time the device,drug or medicine is furnished. 2. Reliable evidence shows that to determine its maximum tolerated dose, toxicity, safety, efficacy (efficacy as compared with the standard means of treatment or diagnosis): a. it is undergoing phase I,II or III clinical trials or is under study;or b. further clinical trials or studies are needed,according to the experts'consensus of opinion. Reliable evidence means only published reports and articles in the authoritative medical and scientific literature;or the written } protocol or written informed consent used by the treating facility (or by another facility studying substantially the same treatment,procedure,device,drug or medicine). Experimental or Investigational shall also mean: a. any treatments,services,supplies or related expenses that are educational or provided primarily for research;or b. treatments,procedures,devices,drugs or medicines or other expenses relating to the transplant of non-human organs. EXTENDED CARE FACILITY(CONVALESCENT FACILITY)- I. A Skilled Nursing Facility, as the term is defined in Medicare, which is qualified to participate and eligible to receive payments under and in accordance with the provisions of Medicare,except for a Skilled Nursing Facility which is part of a Hospital,as defined,or; 2. An institution which fully meets all of the following tests: a. it is operated in accordance with the applicable laws of the appropriate governmental authority where it is located. b. It is under the supervision of a licensed Physician, or Registered Nurse (R.N.), who is devoting full-time to such { supervision. c. It is regularly engaged in providing Room and Board and continuously provides twenty-four(24)hour-a-day skilled nursing care of ill and injured persons at the patient's expense during the convalescent stage of an Injury or Illness. d. It maintains a daily medical record of each patient who is under the care of a duly licensed Physician. e. It is authorized to administer medication on the order of a duly licensed Physician. f. It is not, other than incidentally, a home for the aged, the blind or the deaf, a hotel, a domiciliary care home, a maternity home,or a home for Alcoholics or drug addicts or the mentally ill. FREESTANDING AMBULATORY SURGICAL FACILITY - means a facility other than a Hospital whose primary } function is the provision of surgical procedures on an ambulatory basis and is duly licensed by the appropriate state and local authority to provide such services. } FREESTANDING DIALYSIS FACILITY- means a facility other than a Hospital whose primary function is the treatment and/or provision of maintenance and/or training dialysis on an ambulatory basis for renal dialysis patients and is duly licensed by the appropriate governmental authority to provide such services. FREESTANDING SUBSTANCE ABUSE TREATMENT FACILITY - means a facility other than a Hospital whose primary function is the treatment of Substance Abuse and is duly licensed by the appropriate state and local authority to 69 provide such services. It does not include half-way houses, boarding houses or other such facilities that provide primarily a supportive environment whether or not individual and/or group counseling is provided in such facilities GENERIC DRUGS-Prescription drugs and prescription medicines which are not protected by a trademark. GROUP HEALTH PLAN-Any plan or arrangement constituting a Group Health Plan under Section 607(1)of ERISA. HEALTH BENEFITS-Benefits provided under a Group Health Plan for medical care as defined pursuant to Section 213(d) of the Code. HOME HEALTH AIDE - A person who provides care of a medical or therapeutic nature and reports to and is under the direct supervision of a Home Health Care Agency. HOME HEALTH CARE AGENCY-Is either: 1. An Agency that is certified to participate as a Home Health Care Agency under Medicare; 2. A Hospital that has a valid operating certificate and is certified by the appropriate authority to provide home health services; 3. An agency licensed as such,if such licensing is required,in the state in which such Home Health Care is delivered;or 4. A public agency or private organization or subdivision of such that meets the following requirements: a. It is primarily engaged in providing nursing and other therapeutic services; b. It is duly licensed,if such licensing is required,by the appropriate licensing authority,to provide such services; c. It is federally certified as a Home Health Care Agency. HOME HEALTH CARE PLAN-A Home Health Care program,prescribed in writing by a person's Physician,for the care and treatment of the person's Illness or Injury in the person's home. In the Plan,the Physician must certify that an Inpatient stay in a Hospital, a Convalescent Nursing Home, or an Extended Care Facility would be required in the absence of the services and supplies provided as part of the Home Health Care Plan. The Home Health Care Plan must be established in writing no later than fourteen (14)days after the start of the Home Health Care. An inpatient stay is one for which a Room and Board charge is made. HOSPICE CARE- I I. A coordinated, interdisciplinary Hospice-provided program meeting the physical, psychological, spiritual and social needs of dying individuals,and 2. Consists of palliative and supportive medical, nursing and other health services provided through home or Inpatient care during the Illness to a Covered Person who has no reasonable prospect of cure and as estimated by a Physician,has a life expectancy of fewer than six(6)months; and consists of bereavement counseling for members of such Covered Person's immediate family. HOSPICE CARE FACILITY-Is either: 1. A free-standing facility which is fully staffed and equipped to provide for the needs of the terminally ill (and their families);or 2. An Inpatient facility which is part of a Hospital but designated as a Hospice unit or is an adjacent facility, administered by a Hospital and designated as a Hospice unit. 70 A Hospice Care Facility must be approved by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) or must meet the standards of the National Hospice Organization (NHO) and the appropriate licensing authority,if such licensing is required. HOSPITAL-A legally operated institution which meets either of these tests: 1. Es accredited as a Hospital under the Hospital accreditation program of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), or is accredited by the proper authority in the country in which the hospital is located,or 2. Is a Hospital, as defined, by Medicare, which is qualified to participate and eligible to receive payments under an in accordance with the provisions of Medicare,or 3. Is supervised by a staff of Physicians, has twenty-four (24) hour-a-day nursing services, and is primarily engaged in providing either: a. General Inpatient medical care and treatment through medical, diagnostic and major surgical facilities on its premises or under its control,or b. Specialized Inpatient medical care and treatment through medical and diagnostic facilities (including x-ray and laboratory) on its premises, or under its control, or through a written agreement with a Hospital (which itself qualifies under this definition)or with a specialized provider of these facilities. c. A psychiatric Hospital primarily engaged in diagnosing and treating mental Illness,if it meets all of the requirements set forth in clause(a)other than the major surgery requirement. d. A free standing treatment facility, other than a Hospital, whose primary function is the treatment of Alcoholism or drug abuse provided the facility is duly licensed by the appropriate governmental authority to provide such service. e. A rehabilitative Hospital which is an institution operated primarily for the purpose of providing the specialized care and treatment for which it is duly licensed,and which meets all of the requirements of an accredited Hospital. In no event will the term "Hospital"include a nursing home or an institution or part of one which: a. Is primarily a facility for convalescence,nursing,rest,or the aged,or b. Furnishes primarily domiciliary or Custodial Care,including training in daily living routines,or c. Is operated primarily as a school. ILLNESS - A bodily disorder, disease, Pregnancy, or mental infirmity. All bodily injuries sustained by an individual in a single Accident or all Illnesses which are due to the same or related cause or causes will be deemed one Illness. INCURRED EXPENSE-A charge which the Covered Person is legally obligated to pay and shall be deemed to be incurred on the date the purchase is made or on the date the service is rendered for which the charge is made. Anticipated expenses are not Incurred Expenses. INJURY - An unforeseen happening to the body, requiring medical attention, including all related symptoms and recurrent conditions resulting from the Accident. INPATIENT - A person receiving Room and Board while undergoing treatment in a Hospital, Hospice or other covered facility. INTENSIVE CARE UNIT-A section,ward or wing within a Hospital which is operated exclusively for critically ill patients and provides special supplies, equipment and constant observation and care by professional nurses or other highly trained personnel,excluding any Hospital facility maintained for the purposes of providing normal post-operative recovery treatment or services. 71 LEAVE OF ABSENCE -A period of time during which the Employee does not work but which is of stated duration after which time the Employee is expected to return to active full-time work. LICENSED PRACTICAL NURSE/LICENSED VOCATIONAL NURSE - An individual who has received specialized nursing training and practical nursing experience and who is licensed to perform such service,other than one who ordinarily resides in the patient's home or who is a member of the patient's immediate family. LIFETIME-When used in reference to benefit maximums and limitations, "Lifetime" is understood to mean while covered under this Plan. Under no circumstances does"Lifetime"mean during the lifetime of the Covered Person. MAINTENANCE OCCUPATIONAL, PHYSICAL OR SPEECH THERAPY-means therapy administered to a Covered Person to maintain a level of function at which no demonstrable and measurable improvement of a condition will occur. MEDICAL EXPENSE BENEFIT - After satisfaction of the applicable Deductible, benefits will be provided for covered medical expenses for an Illness or Injury in a Calendar Year. MEDICALLY NECESSARY/MEDICAL NECESSITY - Services and supplies which are determined by the Plan Administrator,or its authorized agent to: 1. Be appropriate,consistent and necessary for the symptoms and diagnosis and treatment of a medical condition; 2. Be in accordance with standards of good medical practice within the organized medical community; 3. Not be solely for the convenience of the patient,Physician or other health care provider;and 4. Be the most appropriate and cost effective supply or level of service which can be safely provided. For hospitalizations,this means that acute care as an Inpatient is necessary due to the kind of services the Covered Person is receiving or the severity of the Covered Person's medical condition,and that safe and adequate medical care cannot be received as an Outpatient or in a less intensified medical setting. The fact that the service is prescribed, ordered, recommended or approved by a Physician does not, of itself, mean the service is Medically Necessary. In an effort to make treatment convenient, to follow the wishes of the patient or the patient's family, to investigate the use of unproven treatment methods, or to comply with local Hospital practices, a Physician may suggest or permit a method of providing care that is not Medically Necessary. MEDICARE-Title XVIII of the Social Security Act of 1965,as amended from time to time,and the regulations thereunder. NETWORK PROVIDER - A health care provider who agrees to provide Medically Necessary care and treatment at a negotiated rate. NOTICE OR NOTIFICATION -The ability to reasonably ensure actual receipt of the materials and specifically includes the normal mailing through the U.S.Mail. OCCUPATIONAL THERAPY-Treatment rendered as a part of a physical medicine and rehabilitation program to improve functional impairments where the expectation exists that the therapy will result in practical improvement in the level of functioning within a reasonable period of time. Benefits are not provided for diversion,recreational and vocational therapies (such as hobbies,arts&crafts). ORTHOTIC APPLIANCE-An external device intended to correct any defect in form or function of the human body. OUT-OF-POCKET MAXIMUM -The maximum covered expense that a Covered Person or family must pay before the Plan pays 100%of the balance of eligible medical expenses for such person or family for the remainder of the Calendar Year. OUTPATIENT-When a Covered Person receives diagnosis,treatment or twenty-three(23)hour observation in a Hospital or treatment facility but is not admitted as an Inpatient. 72 PARTICIPANT-An Employee of the Plan Administrator who participates in the Plan. PHARMACY-Any licensed establishment in which the profession of Pharmacy is practiced. PHYSICAL THERAPY - Treatment by physical means including modalities such as whirlpool and diathermy; procedures such as massage, ultrasound, manipulation and subluxation; as well as tests of measurement requirements to determine the need and progress of treatment. Such treatment must be given to relieve pain, restore maximum function, and to prevent disability following Illness, Injury or loss of body parts. Treatment must be for acute conditions where rehabilitation potential exists and the skills of a Physician or other professional are required. PHYSICIAN - A medical doctor (M.D.), an osteopath (D.0.), a Dentist or dental surgeon (D.D.S., D.M.D.), a podiatrist (D.P.M.),a chiropractor(D.C.),a psychologist(Ph.D.,Psy.D.)or an optometrist(D.0.)or other medical professional who is duly licensed under the laws of the appropriate governmental authority to practice medicine, to the extent they, within the scope of their license are permitted to perform the services provided by this Plan. (The term shall also include a Social Worker for the treatment of psychiatric disorders and Substance Abuse). A Physician shall not include the Covered Person or any close relative of the Covered Person. PLAN-F.H.Paschen Companies Medical and Dental Plan. PLAN ADMINISTRATOR- The entity responsible for the day to day functions and management of the Plan. The Plan Administrator may employ persons or firms to process claims and perform other services related to the Plan. PLAN DOCUMENT-The legal document according to which the Plan is administered and governed. PLAN YEAR-For purposes of this Plan,a length of time beginning on November ls`and ending on October 31st. PRE-ADMISSION TESTING-X-rays, laboratory examinations or other tests performed in the Outpatient department of a Hospital or other facility prior to Outpatient treatment or to confinement as an Inpatient provided: 1. Such tests are related to the scheduled Hospital confinement; 2. Such tests have been ordered by a duly qualified Physician after a condition requiring such confinement has been diagnosed. 3. The Covered Person is subsequently admitted to the Hospital, or the confinement is canceled or postponed because a Hospital bed is unavailable, or under the directions of the attending Physician, or because there is a change in the patients condition which precludes the confinement. PREFERRED PROVIDER - A health care provider who agrees to provide Medically Necessary care and treatment at a negotiated rate under this Plan. PREGNANCY - That physical state which results in Childbirth, abortion or miscarriage, and any medical complications arising out of,or resulting from,such state. PRIVATE DUTY NURSING SERVICE - means Skilled Nursing Service provided on a one-to-one basis by an actively practicing registered nurse or licensed practical nurse who is not providing such service as an employee or agent of a Hospital or other health care facility. Private Duty Nursing Services does not include Custodial Care Services. PROSTHETIC DEVICE-A device which: 1. Replaces all or part of a missing body organ and its adjoining tissue;or 2. Replaces all or part of the function of a permanently useless or malfunctioning organ. PSYCHIATRIC DISORDER-Neuroses,psychoneurosis,psychosis,or mental or emotional disease or disorder of any kind. 73 PSYCHIATRIC TREATMENT-Treatment or care for: 1. A mental or emotional disease or disorder; 2. A functional nervous disorder;or 3. Psychological effects of Substance Abuse. QUALIFIED BENEFICIARY - Any Beneficiary who is a Qualified Beneficiary as defined under Section 607(3) of ERISA. QUALIFIED MEDICAL CHILD SUPPORT ORDER(QMCSO)— A QMCSO is a medical Child support order issued under State Law that creates or recognizes the existence of an Alternate Recipient's right to, or assigns to an Alternate Recipient the right to,receive benefits for which a Participant or eligible Dependent is eligible under a Group Health Plan. Enrollment of a Child may not be denied on the grounds that: 1. The Child was born out of wedlock; 2. The Child is not claimed as a Dependent on the Participant's Federal income tax return; 3. The Child does not reside with the Participant or in the plan's services area;or 4. Because the Child is receiving benefits or is eligible to receive benefits under the State Medicaid plan. If the plan requires that the Participant be enrolled in order for the Child(ren) to be enrolled, and the Participant is not currently enrolled, the Plan Administrator must enroll both the Participant and the Child(ren). All enrollments are to be made without regard to open season restrictions. REASONABLE AND CUSTOMARY FEE LIMITATION-An amount measured and determined by comparing the actual charge with the charges customarily made for similar services and supplies to individuals of similar medical conditions in the locality concerned. The term "locality" means a county or such greater geographically significant area as is necessary to establish a representative cross section of persons, or other entities regularly furnishing the type of treatment, services or supplies for which the charge was made. The Plan Administrator declines to pay flat rate charges when procedures, fees and/or time involved are not itemized. An Expense is considered to be incurred on the date the service or supply is rendered or obtained. REGISTERED NURSE-A professional nurse who has the right to use the title Registered Nurse(R.N.)other than one who ordinarily resides in the patient's home or who is a member of the patient's immediate family. REGISTERED CLINICAL PSYCHOLOGIST - means a Clinical Psychologist who is registered with the Illinois Department of Registration and Education pursuant to the Illinois "Psychologist Registration Act" (Illinois Revised Statutes Chapter 91 %2; paragraph 401 et seq. as amended or substituted) or a state where statutory licensure exists, the Clinical Psychologist must hold a valid credential for such practice and if practicing in a state where statutory licensure does not exist, such person must meet the qualifications specified in the definition of a Clinical Psychologist. Clinical Psychologist - means a psychologist who specializes in the evaluation and treatment of Mental Illness and who meets the following qualifications: (a) has a doctoral degree from a regionally accredited University,College or Professional School;and (b) is a Registered Clinical Psychologist with a graduate degree from a regionally accredited University or College;and RESIDENTIAL TREATMENT FACILITY-Means a facility(other than a hospital)whose primary function is the treatment of a mental or emotional disease or disorder,functional nervous disorder,the treatment of alcoholism,chemical dependency or drug addiction and which is duly licensed by the appropriate governmental authority to provide such services. 74 RELEVANT DOCUMENT - A document, record or other information that was relied upon in making the benefit determination; was submitted,considered,or generated in the course of making the benefit determination(whether or not the information was relied upon to make a benefit determination);demonstrates compliance with the administrative process and safeguards required in making the benefit determination; or in the case of a group health or disability plan, information that constitutes a statement of policy with respect to the denied treatment option or benefit for the claimant's diagnosis. ROOM AND BOARD - Services regularly furnished by the Hospital as a condition of occupancy, but not including professional services. SKILLED NURSING FACILITY - means an institution or a distinct part of an institution which has a transfer agreement with one or more Hospitals and which is primarily engaged in providing comprehensive post-acute Hospital and rehabilitative inpatient care, is duly licensed by the appropriate governmental authority to provide such services,and has been certified in accordance with the guidelines established by Medicare. It does not include institutions which provide only minimal care, custodial care, ambulatory or part-time care services or institutions which primarily provide for the care and treatment of Mental Illness,pulmonary tuberculosis or Substance Abuse. SKILLED NURSING SERVICE-means those services provided by a registered nurse(R.N.)or license practical nurse (L.P.N.)which require the technical skills and professional training of an R.N.or L.P.N.and which services cannot reasonably be taught to a person who does not have such specialized skill and professional training. The inherent complexity of the service provided must be such that the service can safely and effectively be performed ONLY by professional licensed (R.N.or L.P.N.)nursing personnel. Skilled Nursing Services do not include Custodial Care Services SOUND NATURAL TOOTH-A tooth which: 1. Is free of decay,but may be restored by fillings; 2. Has a live root;and 3. Does not have a cap or a crown. fi SPEECH THERAPY - Active treatment for improvement of an organic medical condition causing a speech impairment. Treatment must be either post-operative or for the convalescent stage of an Illness or Injury. Speech therapy does not include educational training or services designed and adapted to develop a physical function. SPOUSE-The person who is legally married to the Employee,as determined by the law of the state of celebration,and while the Employee is covered under this Plan. SUBSTANCE ABUSE - An excessive use of Alcohol and/or drugs that results in physiological and/or psychological Dependency of such substances. TEMPOROMANDIBULAR JOINT DYSFUNCTION (TMJ) - Pain, swelling, clicking, grinding, popping, dislocation, locking, malposition, bite discrepancies or other pathological conditions which create a loss or decrease of function in or around one or both of the jaw joints. TERMINALLY ILL PATIENT - A person with a life expectancy of six(6) months or less as certified in writing by the attending Physician. TREATMENT PLAN-A Dentist's report,on a form satisfactory to the Company,which: 1. Itemizes the dental services recommended by him for the necessary and customary dental care of an Insured;and 2. Shows his charge for each dental service;and 3. Es accompanied by supporting pre-operative X-rays or other appropriate diagnostic materials as required by the Company. 75 WORKERS' COMPENSATION - A fund administered under any Workers'Compensation,Occupational Diseases Act or Law or any other act or law of similar purpose to which the Company contributes, which provides the Employee with coverage for job-related accidental injuries and Illnesses. !i Fp EFE 17 76 HOW TO SUBMIT A CLAIM MEDICAL CLAIMS Every medical claim must include a Physician's statement specifying the nature of the Illness or Injury for which reimbursement is requested.The Claims Administrator will accept such a diagnostic statement on any form which your doctor prefers to use. WITHOUT A DIAGNOSIS, YOUR CLAIM CANNOT BE PROCESSED. All bills,except those for drugs,must indicate the patient's full name,the nature of the Illness or Injury,the date(s)of service, the type(s)of service and the charge for each service and the name,address and tax identification number of the provider. When prescription drugs are purchased through the Prescription Drug Plan,a claim submission is not necessa ry• Your only responsibility is to pay the applicable Co-payment at the time you purchase the prescription. Should there be a primary insurance carrier for a member of your family, it is important to submit a copy of the itemized claim with a copy of the primary carrier's Explanation of Benefits statement indicating payment or denial of the charges. MEDICARE CLAIMS A Medicare claim is submitted as previously explained; however, when you submit the claim, be sure you also submit the Explanation of Benefits(EOB)which you receive from Medicare. The Claims Administrator may be unable to accurately determine benefits payable under the Plan without the Medicare EOB. DENTAL CLAIMS Discuss the Treatment Plan with your Dentist. If the services will exceed$500,ask your Dentist to submit a"Pre-Treatment Estimate". The Claims Administrator will advise your Dentist of the amount the Plan can pay toward your treatment. If the services are for emergency treatment or less than$500,a Treatment Plan is not required. WHERE TO SUBMIT A CLAIM Itemized bills must be submitted to the address indicated on your Health Benefit I.D.Card. } 77 CLAIMS REVIEW PROCEDURE Under the Plan,there are four types of claims: Pre-service(Urgent and Non-urgent),Concurrent Care and Post-service. • Pre-service Claims. A"Pre-service Claim"is a claim for a benefit under the Plan where the Plan conditions receipt of the benefit,in whole or in part,on approval of the benefit in advance of obtaining medical care. A "Pre-service Urgent Care Claim" is any claim for medical care or treatment with respect to which the application of the time periods for making non-urgent care determinations could seriously jeopardize the life or health of the Covered Person or the Covered Person's ability to regain maximum function,or, in the opinion of a Physician with knowledge of the Covered Person's medical condition, would subject the Covered Person to severe pain that cannot be adequately managed without the care or treatment that is the subject of the claim. If the Plan does not require the Covered Person to obtain approval of a specific medical service prior to getting treatment, then there is no Pre-service Claim. The Covered Person simply follows the Plan's procedures with respect to any notice which may be required after receipt of treatment,and files the claim as a post-service claim. • Concurrent Claims. A "Concurrent Claim" arises when the Plan has approved an on-going course of treatment to be provided over a period of time or number of treatments,and either: • The Plan Administrator determines that the course of treatment should be reduced or terminated;or • The Covered Person requests extension of the course of treatment beyond that which the Plan Administrator has approved. If the Plan does not require the Covered Person to obtain approval of a medical service prior to getting treatment,then there is no need to contact the Plan Administrator to request an extension of a course of treatment. The Covered Person simply follows the Plan's procedures with respect to any notice which may be required after receipt of treatment,and files the claim as a Post-service Claim. • Post-service Claims: A"Post-service Claim"is a claim for a benefit under the Plan after the services have been rendered. When Health Claims Must Be Filed Post-service health claims must be filed with the Claims Administrator within twelve(l 2)months from the date charges for the service was incurred. Failure to file a claim within this time limit will not invalidate the claim provided that the Covered Person submits evidence satisfactory to the Plan Administrator that it was not reasonably possible to file the claim within the time limit. Benefits are based upon the Plan's provisions at the time the charges were incurred. Claims filed later than that date shall be denied. A Pre-service Claim(including a Concurrent Claim that also is a Pre-service Claim)is considered to be filed when the request for approval of treatment or services is made and received by the Claims Administrator in accordance with the Plan's procedures. Upon receipt of the required information,the claim will be deemed to be filed with the Plan. The Claims Administrator will determine if enough information has been submitted to enable proper consideration of the claim. If not, more information may be requested as provided herein. This additional information must be received by the Claims Administrator within forty- five(45)days from receipt by the Covered Person of the request for additional information. Failure to do so may result in claims being declined or reduced. Timing of Claim Decisions The Plan Administrator shall notify the Covered Person, in accordance with the provisions set forth below, of any Adverse Benefit Determination(and, in the case of Pre-service Claims and Concurrent Claims, of decisions that a claim is payable in full)within the following timeframes: • Pre-service Urgent Care Claims: 78 • If the Covered Person has provided all of the necessary information, as soon as possible, taking into account the medical exigencies,but not later than seventy-two(72)hours after receipt of the claim. • If the Covered Person has not provided all of the information needed to process the claim,then the Covered Person will be notified as to what specific information is needed as soon as possible, but not later than twenty-four (24) hours after receipt of the claim. The Covered Person will be notified of a determination of benefits as soon as possible,but not later than forty-eight(48)hours,taking into account the medical exigencies,after the earliest of: • The Plan's receipt of the specified information;or • The end of the period afforded the Covered Person to provide the information. • Pre-service Non-urgent Care Claims: • If the Covered Person has provided all of the information needed to process the claim,in a reasonable period of time appropriate to the medical circumstances, but not later than fifteen (15) days after receipt of the claim, unless an extension has been requested,then prior to the end of the fifteen(15)day extension period. • If the Covered Person has not provided all of the information needed to process the claim,then the Covered Person will be notified as to what specific information is needed as soon as possible, but not later than five(5)days after { receipt of the claim. The Covered Person will be notified of a determination of benefits in a reasonable period of time appropriate to the medical circumstances, either prior to the end of the extension period (if additional information was requested during the initial processing period), or by the date agreed to by the Plan Administrator and the Covered Person(if additional information was requested during the extension period). • Concurrent Claims: • Plan Notice of Reduction or Termination. If the Plan Administrator is notifying the Covered Person of a reduction or termination of a course of treatment(other than by Plan amendment or termination),before the end of such period of time or number of treatments. The Covered Person will be notified sufficiently in advance of the reduction or termination to allow the Covered Person to appeal and obtain a determination on review of that Adverse Benefit Determination before the benefit is reduced or terminated. • Request by Covered Person Involving Urgent Care. If the Plan Administrator receives a request from a Covered Person to extend the course of treatment beyond the period of time or number of treatments that is a claim involving urgent care,as soon as possible,taking into account the medical exigencies, but not later than seventy-two(72)hours after receipt of the claim, as long as the Covered Person makes the request at least seventy-two(72) hours prior to the expiration of the prescribed period of time or number of treatments. If the Covered Person submits the request with less than twenty-four(24)hours prior to the expiration of the prescribed period of time or number of treatments, the request will be treated as a claim involving urgent care and decided within the urgent care timeframe. • Request by Covered Person Involving Non-urgent Care. If the Plan Administrator receives a request from the Covered Person to extend the course of treatment beyond the period of time or number of treatments that is a claim not involving urgent care, the request will be treated as a new benefit claim and decided within the timeframe appropriate to the type of claim(either as a Pre-service non-urgent Claim or a Post-service Claim). • Post-service Claims: • If the Covered Person has provided all of the information needed to process the claim,in a reasonable period of time, but not later than thirty(30)days after receipt of the claim,unless an extension has been requested,then prior to the end of the fifteen(15)day extension period. • If the Covered Person has not provided all of the information needed to process the claim and additional information is requested during the initial processing period, then the Covered Person will be notified of a determination of benefits prior to the end of the extension period, unless additional information is requested during the extension period,then the Covered Person will be notified of the determination by a date agreed to by the Plan Administrator and the Covered Person. 79 • Extensions—Pre-service Urgent Care Claims. No extensions are available in connection with Pre-service Urgent Care Claims. • Extensions—Pre-service Non-urgent Care Claims. This period may be extended by the Plan for up to fifteen(15)days, provided that the Plan Administrator both determines that such an extension is necessary due to matters beyond the control of the Plan and notifies the Covered Person, prior to the expiration of the initial fifteen (15) day processing period,of the circumstances requiring the extension of time and the date by which the Plan expects to render a decision. • Extensions—Post-service Claims. This period may be extended by the Plan for up to fifteen(15)days,provided that the Plan Administrator both determines that such an extension is necessary due to matters beyond the control of the Plan and notifies the Covered Person, prior to the expiration of the initial thirty(30)day processing period,of the circumstances requiring the extension of time and the date by which the Plan expects to render a decision. • Calculating Time Periods. The period of time within which a benefit determination is required to be made shall begin at the time a claim is deemed to be filed in accordance with the procedures of the Plan. Notification of an Adverse Benefit Determination The Plan Administrator shall provide a Covered Person with a notice,either in writing or electronically(or,in the case of Pre- service Urgent Care Claims, by telephone, facsimile or similar method, with written or electronic notice), containing the following information: • A reference to the specific portion(s)of the Plan Document and Summary Plan Description upon which a denial is based; • Specific reason(s)for a denial; • A description of any additional information necessary for the Covered Person to perfect the claim and an explanation of why such information is necessary; • A description of the Plan's review procedures and the time limits applicable to the procedures,including a statement of the Covered Person's right to bring a civil action under section 502(a) of ERISA (if applicable) following an Adverse Benefit Determination on final review; • A statement that the Covered Person is entitled to receive, upon request and free of charge, reasonable access to, and copies of,all documents,records and other information relevant to the Covered Person's claim for benefits; • The identity of any medical or vocational experts consulted in connection with a claim,even if the Plan did not rely upon their advice(or a statement that the identity of the expert will be provided,upon request); • Any rule,guideline,protocol or similar criterion that was relied upon in making the determination(or a statement that it was relied upon and that a copy will be provided to the Covered Person, free of charge,upon request); • In the case of denials based upon a medical judgment (such as whether the treatment is Medically Necessary or Experimental),either an explanation of the scientific or clinical judgment for the determination,applying the terms of the Plan to the Covered Person's medical circumstances,or a statement that such explanation will be provided to the Covered Person, free of charge,upon request;and • In a claim involving urgent care,a description of the Plan's expedited review process. Appeals of Adverse Benefit Determinations Full and Fair Review of All Claims In cases where a claim for benefits is denied, in whole or in part, and the Covered Person believes the claim has been denied wrongly,the Covered Person may appeal the denial and review pertinent documents. The claims procedures of this Plan provide a Covered Person with a reasonable opportunity for a full and fair review of a claim and Adverse Benefit Determination. More specifically,the Plan provides: 80 • Covered Persons at least one hundred eighty (180) days following receipt of a notification of an initial Adverse Benefit Determination within which to appeal the determination and one hundred eighty (180) days to appeal a second Adverse Benefit Determination; • Covered Persons the opportunity to submit written comments,documents,records,and other information relating to the claim for benefits; • For a review that does not afford deference to the previous Adverse Benefit Determination and that is conducted by an appropriate named fiduciary of the Plan, who shall be neither the individual who made the Adverse Benefit Determination that is the subject of the appeal,nor the subordinate of such individual; • For a review that takes into account all comments, documents, records, and other information submitted by the Covered Person relating to the claim,without regard to whether such information was submitted or considered in any prior benefit determination; • That, in deciding an appeal of any Adverse Benefit Determination that is based in whole or in part upon a medical } judgment, the Plan fiduciary shall consult with a health care professional who has appropriate training and experience in the field of medicine involved in the medical judgment, who is neither an individual who was consulted in connection with the Adverse Benefit Determination that is the subject of the appeal,nor the subordinate of any such individual; • For the identification of medical or vocational experts whose advice was obtained on behalf of the Plan in connection with a claim,even if the Plan did not rely upon their advice; • That a Covered Person will be provided, upon request and free of charge, reasonable access to, and copies of, all documents, records, and other information relevant to the Covered Person's claim for benefits in possession of the Plan Administrator or the Claims Administrator; information regarding any voluntary appeals procedures offered by the Plan; any internal rule, guideline, protocol or other similar criterion relied upon in making the adverse determination; and an explanation of the scientific or clinical judgment for the determination,applying the terms of the Plan to the Covered Person's medical circumstances;and • In an Urgent Care claim, for an expedited review process pursuant to which: • A request for an expedited appeal of an Adverse Benefit Determination may be submitted orally or in writing b q p PP Y Y g Y the Covered Person;and • All necessary information, including the Plan's benefit determination on review, shall be transmitted between the Plan and the Covered Person by telephone,facsimile or other available similarly expeditious method. First Appeal Level Requirements for First Appeal The Covered Person must file the first appeal in writing(although oral appeals are permitted for Pre-service Urgent Care Claims)within one hundred eighty(180)days following receipt of the notice of an Adverse Benefit Determination. For Pre-service Urgent Care Claims, if the Covered Person chooses to orally appeal,the Covered Person may telephone: F.H. Paschen Companies (773)444-3474 To file an appeal in writing,the Covered Person's appeal must be addressed as follows and mailed or faxed as follows: F.H.Paschen Companies 5515 N.East River road Chicago,IL 60656 (773)444-3474—Call this number for a Secure Fax Note:Claim Appeals sent to the Claims Administrator indicated on the back of your l.D.Card will be considered as if you had submitted it to the Plan Administrator above. 81 It shall be the responsibility of the Covered Person to submit proof that the claim for benefits is covered and payable under the provisions of the Plan. Any appeal must include: • The name of the Employee/Covered Person; • The Employee/Covered Person's social security number; • The group name or identification number; • All facts and theories supporting the claim for benefits. Failure to include any theories or facts in the appeal will I i result in their being deemed waived. In other words,the Covered Person will lose the right to raise factual arguments and theories which support this claim if the Covered Person fails to include them in the appeal; • A statement in clear and concise terms of the reason or reasons for disagreement with the handling of the claim;and • Any material or information that the Covered Person has which indicates that the Covered Person is entitled to benefits under the Plan. If the Covered Person provides all of the required information, it may be that the expenses will be eligible for payment under the Plan. Timing of Notification of Benefit Determination on First Appeal The Plan Administrator shall notify the Covered Person of the Plan's benefit determination on review within the following timeframes: • Pre-service Urgent Care Claims: As soon as possible, taking into account the medical exigencies, but not later than seventy-two(72)hours after receipt of the appeal. • Pre-service Non-urgent Care Claims: Within a reasonable period of time appropriate to the medical circumstances, but not later than fifteen(15)days after receipt of the appeal. • Concurrent Claims: The response will be made in the appropriate time period based upon the type of claim—Pre-service Urgent,Pre-service non-urgent or Post-Service. • Post-service Claims: Within a reasonable period of time,but not later than thirty(30)days after receipt of the appeal. • Calculating Time Periods. The period of time within which the Plan's determination is required to be made shall begin at the time an appeal is filed in accordance with the procedures of this Plan, without regard to whether all information necessary to make the determination accompanies the filing. Manner and Content of Notification of Adverse Benefit Determination on First Appeal The Plan Administrator shall provide a Covered Person with notification,with respect to Pre-service Urgent Care Claims, by telephone, facsimile or similar method, and with respect to all other types of claims, in writing or electronically,of a Plan's Adverse Benefit Determination on review,setting forth: • The specific reason or reasons for the denial; • Reference to the specific portion(s)of the Plan Document and Summary Plan Description on which the denial is based; • The identity of any medical or vocational experts consulted in connection with the claim,even if the Plan did not rely upon their advice; • A statement that the Covered Person is entitled to receive, upon request and free of charge, reasonable access to, and copies of,all documents,records,and other information relevant to the Covered Person's claim for benefits; 82 • If an internal rule,guideline, protocol,or other similar criterion was relied upon in making the adverse determination,a statement that such rule, guideline, protocol, or other similar criterion was relied upon in making the adverse determination and that a copy of the rule,guideline,protocol,or other similar criterion will be provided free of charge to the Covered Person upon request; • If the Adverse Benefit Determination is based upon a medical judgment,a statement that an explanation of the scientific or clinical judgment for the determination,applying the terms of the Plan to the Covered Person's medical circumstances, will be provided free of charge upon request; • A description of any additional information necessary for the Covered Person to perfect the claim and an explanation of why such information is necessary; • A description of the Plan's review procedures and the time limits applicable to the procedures; • For Pre-service Urgent Care Claims, a description of the expedited review process applicable to such claims; • A statement of the Covered Person's right to bring an action under section 502(a)of ERISA(if applicable), following an Adverse Benefit Determination on final review;and • The following statement: "You and your Plan may have other voluntary alternative dispute resolution options,such as mediation. One way to find out what may be available is to contact your local U.S.Department of Labor Office and your state insurance regulatory agency." Furnishing Documents in the Event of an Adverse Determination In the case of an Adverse Benefit Determination on review, the Plan Administrator shall provide such access to, and copies of, documents, records, and other information described in the section relating to "Manner and Content of Notification of Adverse Benefit Determination on First Appeal"as appropriate. Second Appeal Level Adverse Decision on First Appeal; Requirements for Second Appeal Upon receipt of notice of the Plan's adverse decision regarding the first appeal, the Covered Person has one hundred eighty(l 80)days to file a second appeal of the denial of benefits. The Covered Person again is entitled to a"full and fair review"of any denial made at the first appeal, which means the Covered Person has the same rights during the second appeal as he or she had during the first appeal. As with the first appeal,the Covered Person's second appeal must be in writing (although oral appeals are permitted for Pre-service Urgent Care Claims) and must include all of the items set forth in the section entitled"Requirements for First Appeal". Timing of Notification of Benefit Determination on Second Appeal The Plan Administrator shall notify the Covered Person of the Plan's benefit determination on review within the following timeframes: • Pre-service Urgent Care Claims: As soon as possible,taking into account the medical exigencies, but not later than seventy-two(72)hours after receipt of the second appeal. • Pre-service Non-urgent Care Claims: Within a reasonable period of time appropriate to the medical circumstances, but not later than fifteen(15)days after receipt of the second appeal. • Concurrent Claims: The response will be made in the appropriate time period based upon the type of claim—pre- service urgent,pre-service non-urgent or post-service. • Post-service Claims: Within a reasonable period of time, but not later than thirty (30) days after receipt of the second appeal. • Calculating Time Periods. The period of time within which the Plan's determination is required to be made shall begin at the time the second appeal is filed in accordance with the procedures of this Plan,without regard to whether all information necessary to make the determination accompanies the filing. 83 Manner and Content of Notification of Adverse Benefit Determination on Second Appeal The same information must be included in the Plan's response to a second appeal as a first appeal,except for: • A description of any additional information necessary for the Covered Person to perfect the claim and an explanation of why such information is needed; • A description of the Plan's review procedures and the time limits applicable to the procedures;and • For Pre-service Urgent Care Claims, a description of the expedited review process applicable to such claim. See the section entitled"Manner and Content of Notification of Adverse Benefit Determination on First Appeal". Furnishing Documents in the Event of an Adverse Determination In the case of an Adverse Benefit Determination on the second appeal,the Plan Administrator shall provide such access to,and copies of,documents,records,and other information described in the section relating to"Manner and Content of Notification of Adverse Benefit Determination on First Appeal"as is appropriate. Legal Action All claim review procedures provided for in the Plan must be exhausted before any legal action is brought. Any legal action for the recovery of any benefits must be commenced within three (3) years after the Plan's claim review procedures have been exhausted. External Review When a Covered Person has exhausted the internal appeals process outlined above, the Covered Person has a right to have that decision reviewed by independent health care professionals who has no association with the Plan, or the Plan Administrator. If the Adverse Benefit Determination involved making a judgment as to the Medical Necessity, appropriateness, health care setting, level of care or effectiveness of the health care service or treatment you requested, you may submit a request for external review within four(4) months after receipt of a denial of benefits. For standard external review, a decision will be made within forty-five(45)days of receiving your request. If you have a medical condition that would seriously jeopardize your life or health or would jeopardize your ability to regain maximum function if treatment is delayed, you may be entitled to request an expedited external review of the denial. If our denial to provide or pay for health care service or course of treatment is based on a determination that the service or treatment is experimental or investigation,you also may be entitled to file a request for external review of our denial. Please contact your Plan Administrator with any questions on your rights to external review. 84 { RESPONSIBILITIES FOR PLAN ADMINISTRATION PLAN ADMINISTRATOR E.H. Paschen Companies Medical and Dental Plan is the benefit Plan of F.H. Paschen Companies, the Plan Administrator, also called the Plan Sponsor. It is to be administered by the Plan Administrator in accordance with the provisions of ERISA.An individual may be appointed by F.H.Paschen Companies to be Plan Administrator and serve at the convenience of the Employer. If the Plan Administrator resigns, dies or is otherwise removed from the position, F.H. Paschen Companies shall appoint a new Plan Administrator as soon as reasonably possible. The Plan Administrator shall administer this Plan in accordance with its terms and establish its policies, interpretations, practices, and procedures. It is the express intent of this Plan that the Plan Administrator shall have maximum legal discretionary authority to construe and interpret the terms and provisions of the Plan,to make determinations regarding issues which relate to eligibility for benefits,to decide disputes which may arise relative to a Covered Person's rights,and to decide questions of Plan interpretation and those of fact relating to the Plan. The decisions of the Plan Administrator will be final and binding on all interested parties. Service of legal process may be made upon the Plan Administrator. DUTIES OF THE PLAN ADMINISTRATOR 1. To administer the Plan in accordance with its terms. 2. To interpret the Plan,including the right to remedy possible ambiguities, inconsistencies or omissions. 3. To decide disputes which may arise relative to a Covered Person's rights. 4. To prescribe procedures for filing a claim for benefits and to review claim denials. 5. To keep and maintain the Plan Documents and all other records pertaining to the Plan. 6. To appoint a Claims Administrator to pay claims. 7. To perform all necessary reporting as required by ERISA. 8. To establish and communicate procedures to determine whether a medical Child support order is qualified under ERISA Sec.609. 9. To delegate to any person or entity such powers,duties and responsibilities as it deems appropriate. PLAN ADMINISTRATOR COMPENSATION The Plan Administrator serves without compensation;however,all expenses for plan administration,including compensation for hired services,will be paid by the Plan. FIDUCIARY A fiduciary exercises discretionary authority or control over management of the Plan or the disposition of its assets,renders investment advice to the Plan or has discretionary authority or responsibility in the administration of the Plan. 85 FIDUCIARY DUTIES A fiduciary must carry out his or her duties and responsibilities for the purpose of providing benefits to the Employees and their Dependent(s),and defraying reasonable expenses of administering the Plan. These are duties which must be carried out: 1. with care,skill,prudence and diligence under the given circumstances that a prudent person,acting in a like capacity and familiar with such matters,would use in a similar situation; 2. by diversifying the investments of the Plan so as to minimize the risk of large losses,unless under the circumstances it is { clearly prudent not to do so;and 3. in accordance with the Plan Documents to the extent that they agree with ERISA. THE NAMED FIDUCIARY A"named fiduciary is the one named in the Plan.A named fiduciary can appoint others to carry out fiduciary responsibilities (other than as a trustee) under the Plan. These other persons become fiduciaries themselves and are responsible for their acts under the Plan. To the extent that the named fiduciary allocates its responsibility to other persons,the named fiduciary shall not be liable for any act or omission of such person unless either: 1. the named fiduciary has violated its stated duties under ERISA in appointing the fiduciary,establishing the procedures to appoint the fiduciary or continuing either the appointment or the procedures;or 2. the named fiduciary breached its fiduciary responsibility under Section 405(a)of ERISA. ASSETS UPON TERMINATION The assets of the Plan will be used to pay for any benefits incurred prior to the termination of the Plan. THE TRUST AGREEMENT If this Plan is established under a Trust agreement, that agreement is made a part of the Plan. A copy of the appropriate agreement is available for examination by Employees and their Dependent(s) at the office of the Plan Administrator during normal business hours. Also, upon written request, the following items will be furnished to an Employee, Retiree or Dependent: A copy of the Trust agreement. A complete list of employers and Employee organizations sponsoring the Plan. Service of legal process may be made upon a Plan trustee. PLAN IS NOT AN EMPLOYMENT CONTRACT The Plan is not to be construed as a contract for or of employment. GENDER AND NUMBER Wherever any words are used herein in the masculine, feminine or neuter gender,they shall be construed as though they were also used in another gender in all cases where they would so apply,and whenever any words are used herein in the singular or plural form,they shall be construed as though they were also used in the other form in all cases where they would so apply. HEADINGS 86 The headings and subheadings of this Plan Document and Summary Plan Description have been inserted for convenience of reference and are to be ignored in any construction of the provisions thereof. CONFORMITY WITH LAW If any provision of the Plan is contrary to any law to which it is subject,such provision is hereby amended to conform to the minimum requirements thereof. This Plan intends to comply with any laws to which it is subject,whether or not this Plan has been specifically amended accordingly. These laws include ERISA, TEFRA, DEFRA, COBRA, The Family and Medical Leave Act of 1993 (FMLA), Budget Reconciliation Acts, HIPAA, MHPA, MNHPA, WHCRA, and any other laws which may have been enacted already or which may be enacted in the future. LIABILITY OF OFFICERS AND EMPLOYEES No officer or Employee of the Employer who ma or may not be acting in a fiduciary capacity shall incur any personal may Y g arY P tY YP liability of any nature for any act done or omitted to be done in good faith in connection with his duties in connection with the Plan,except in cases of wanton or willful negligence,or willful misconduct. Such officers or Employees shall be indemnified and saved harmless by the Employer from and against any liability to which any of them may be subjected by reason of any such good faith act or conduct in their official capacity,or by reason of conduct consistent with such prudent man rule acting in such fiduciary capacity,including all expenses reasonably incurred in their defense to the extent permitted by law. CLERICAL ERROR Any clerical error by the Plan Administrator or an agent of the Plan Administrator in keeping pertinent records or a delay in making any changes will not invalidate coverage otherwise validly in force or continue coverage validly terminated. An equitable adjustment of contributions will be made when the error or delay is discovered. If, due to a clerical error,an overpayment occurs in a Plan reimbursement amount,the Plan retains a contractual right to the overpayment. The person or institution receiving the overpayment will be required to return the overpayment. AMENDING AND TERMINATING THE PLAN If the Plan is terminated,the rights of the Covered Persons are limited to expenses incurred before termination. The Employer intends to maintain this Plan indefinitely; however, it reserves the right, at any time, to amend, suspend or terminate the Plan in whole or in part. This includes amending the benefits under the Plan or the Trust agreement(if any). The Employer may amend or terminate the Plan by written instrument adopted by the Employer's Board of Directors. CERTAIN EMPLOYEE RIGHTS UNDER ERISA Covered Persons in this Plan are entitled to certain rights and protections under the Employee Retirement Income Security Act of 1974(ERISA). ERISA specifies that all Covered Persons shall be entitled to: Receive Information About Your Plan and Benefits Examine,without charge,at the Plan Administrator's office,all Plan Documents and copies of all documents filed by the Plan with the U.S.Department of Labor,such as detailed annual reports and Plan descriptions. Obtain copies of all Plan Documents and other Plan information upon written request to the Plan Administrator. The Plan Administrator may make a reasonable charge for the copies. Receive a summary of the Plan's annual financial report. The Plan Administrator is required by law to furnish each Covered Person with a copy of this summary annual report. Continue Group Health Plan Coverage 87 Continue health care coverage for yourself,Spouse or Dependents if there is a loss of coverage under the Plan as a result of a Qualifying Event. You or your Dependents may have to pay for such coverage. Review this Summary Plan Description and the documents governing the Plan on the rules governing your COBRA continuation coverage rights. Prudent Actions by Plan Fiduciaries In addition to creating rights for Covered Persons, ERISA imposes obligations upon the individuals who are responsible for the operation of the Plan. The individuals who operate the Plan, called "fiduciaries" of the Plan, have a duty to do so prudently and in the interest of the Covered Persons and their beneficiaries. No one, including the Employer or any other person, may fire a Covered Person or otherwise discriminate against a Covered Person in any way to prevent the Covered Person from obtaining benefits under the Plan or from exercising his or her rights under ERISA. Enforce Your Rights If a Covered Person's claim for a benefit is denied, in whole or in part,the Covered Person will receive a written explanation of the reason for the denial. The Covered Person has the right to have the Plan review and reconsider the claim. Under ERISA there are steps that the Covered Person can take to enforce the above rights. For instance, if the Covered Person requests materials from the Plan and does not receive them within thirty(30)days,that person may file suit in federal court. In such a case, the court may require the Plan Administrator to provide the materials and to pay the Covered Person up to $110 a day until he or she receives the materials,unless the materials were not sent because of reasons beyond the control of the Plan Administrator. If the Covered Person has a claim for benefits which is denied or ignored, in whole or in part,that Participant may file suit in state or federal court. If it should happen that the Plan fiduciaries misuse the Plan's money, or if a Covered Person is discriminated against for asserting his or her rights, he or she may seek assistance from the U.S. Department of Labor, or may file suit in a federal court. The court will decide who should pay court costs and legal fees. If the Covered Person is successful,the court may order the person sued to pay these costs and fees. If the Covered Person loses,the court may order him or her to pay these costs and fees,for example,if it finds the claim or suit to be frivolous. Assistance With Your Questions If the Covered Person has any questions about the Plan, he or she should contact the Plan Administrator. If the Covered Person has any questions about this statement or his or her rights under ERISA or the Health Insurance Portability and Accountability Act (HIPAA), that Covered Person should contact either the nearest area office of the Employee Benefits Security Administration, U.S. Department of Labor listed in the telephone directory or the Division of Technical Assistance and Inquiries, Employee Benefits Security Administration, U.S. Department of Labor at 200 Constitution Avenue, N.W., Washington,DC 20210. RESCISSION OF COVERAGE A rescission of your coverage means that the coverage may be legally voided back to the day the Plan began to provide you with coverage,just as if you never had coverage under the Plan. Your coverage may only be rescinded if you(or a person seeking coverage on your behalf), performs an act, practice or omission that constitutes fraud; or unless you (or a person seeking coverage on your behalf)makes an intentional misrepresentation of material fact,as prohibited by the terms of your Plan. You will be provided with thirty(30)calendar days'advance notice before your coverage is rescinded. You have the right to request an internal appeal of rescission of your coverage. Once the appeal process is exhausted,you have the additional right to request an independent external review. Refer to the"CLAIMS REVIEW PROCEDURE"section for more information. 88 PRIVACY AND PROTECTED HEALTH INFORMATION A federal law,the Health Insurance Portability and Accountability Act of 1996(HIPAA)and the Privacy and Security Rules promulgated thereunder,requires that health plans protect the confidentiality of your private health information. A complete description of your rights under HIPAA can be found in the Plan's privacy notice, which was distributed to you upon enrollment and is available from the Human Resources Manager. This Plan, and the Plan Sponsor,will not use or further disclose information that is protected by HIPAA("protected health information") except as necessary for treatment, payment, health plan operations and plan administration,or as permitted or required by law. By law, the Plan has required all of its business associates to enter into agreements to protect the confidentiality of protected health information. In particular, the Plan will not, without authorization, use or disclose } protected health information for employment-related actions and decisions or in connection with any other benefit or Employee benefit plan of the Plan Sponsor. Under HIPAA,you have certain rights with respect to your protected health information, including certain rights to see and copy the information,receive an accounting of certain disclosures of the information and,under certain circumstances,amend the information. You also have the right to file a complaint with the Plan or with the Secretary of the U.S. Department of Health and Human Services if you believe your rights under HIPAA have been violated. This Plan maintains a privacy notice,which provides a complete description of your rights under HIPAA's privacy rules. For a copy of the notice, please contact the Human Resources Department. If you have questions about the privacy of your protected health information or if you wish to file a HIPAA complaint,please contact the Human Resource Department. Genetic Information Nondiscrimination Act The Genetic Information Nondiscrimination Act provides certain restrictions on the collection and use of genetic information by the Plan. kF If 89 1 THE USE AND DISCLOSURE OF PROTECTED HEALTH INFORMATION The Health Insurance Portability And Accountability Act of 1996(HIPAA)and its implementing regulations restrict the Pian Sponsor's ability to use and disclose Protected Health Information,or PHI. The following HIPAA definition of PHI applies to this Plan: Protected Health Information. Protected health information means information that is created or received by the Plan and relates to the past, present or future physical or mental health or condition of a Participant;the provision of health care to a Participant; or the past, present or future payment for the provision of health care to a Participant; and that identifies the Participant or for which there is a reasonable basis to believe the information can be used to identify the Participant. Protected health information includes information of persons living or deceased. The Plan Sponsor shall have access to PHI from the Plan only as permitted under this Plan Amendment or as otherwise required or permitted by HIPAA. 1. Use and Disclosure of PHI The Group Health Plan will use PHI to the extent of and in accordance with the uses and disclosures permitted by HIPAA. Specifically,the Plan will use and disclose PHI for purposes related to health care treatment,payment for health care and health care operations. Payment includes activities undertaken by the Plan to obtain premiums or determine or fulfill its responsibility for } coverage and provision of plan benefits that relate to an individual to whom health care is provided. Those activities include,but are not limited to,the following: a. determination of eligibility,coverage and cost sharing amounts(for example, cost of a benefit,plan maximums and Co-payments as determined for an individual's claim); b. Coordination of Benefits; c. adjudication of health benefit claims(including appeals and other payment disputes); d. subrogation of health benefit claims; e. establishing Employee contributions; f. risk adjusting amounts due based on enrollee health status and demographic characteristics; g. billing,collection activities and related health care data processing; h. claims management and related health care data processing,including auditing payments,investigating and resolving payment disputes and responding to Participant inquiries about payments; i. obtaining payment under a contract for reinsurance(including stop-loss and excess loss insurance); j. Medical Necessity reviews or reviews of appropriateness of care or justification of charges; k. utilization review,including pre-certification,pre-authorization,concurrent review and retrospective review; I. disclosure to consumer reporting agencies related to the collection of premiums or reimbursement(the following PHI may be disclosed for payment purposes: name and address,date of birth, Social Security number, payment history, account number and name and address of the provider and/or health plan);and m. reimbursement to the Plan. Health Care Operations include,but are not limited to,the following activities: a. quality assessment; 90 b. population-based activities relating to improving health or reducing health care costs, protocol development, case management and care coordination, disease management, contacting health care providers and patients with information about treatment alternatives and related functions; c. rating provider and plan performance,including accreditation,certification,licensing or credentialing activities; d. underwriting, premium rating and other activities relating to the creation, renewal or replacement of a contract of health insurance or Health Benefits, and ceding, securing or placing a contract for reinsurance of risk relating to health care claims(including stop-loss insurance and excess loss insurance); e. conducting or arranging for medical review,legal services and auditing function,including fraud and abuse detection and compliance programs; f. business planning and development, such as conducting cost-management and planning-related analyses related to managing and operating the Plan, including formulary development and administration, development or improvement of payment methods or coverage policies; g. business management and general administrative activities of the Plan,including,but not limited to: i. management activities relating to the implementation of and compliance with HIPAA's administrative simplification requirements,or ii. customer service,including the provision of data analyses for policyholders,plan sponsors,or other customers; h. resolution of internal grievances;and i. due diligence in connection with the sale or transfer of assets to a potential successor in interest, if the potential successor in interest is a"covered entity"under HIPAA or,following completion of the sale or transfer,will become a covered entity. 2. The Plan Will Use and Disclose PHI as Required by Law and as Permitted by Authorization of the Participant or Personal Representative. 3. For Purposes of This Section,F.H.Paschen Companies is the Plan Sponsor. The Plan will disclose PHI to the Plan Sponsor only upon receipt of certification from the Plan Sponsor that the Plan Documents have been amended to incorporate provisions included in sections 4 through 7. 4. With Respect to PHI,the Plan Sponsor Agrees to Certain Conditions The Plan Sponsor agrees to: a. not use or further disclose PHI other than as permitted by the Plan Document or as required by law; b. ensure that any agents, including a subcontractor,to whom the Plan Sponsor provides PHI received from the Plan agree to the same restrictions and conditions that apply to the Plan Sponsor with respect to such PHI; c. not use or disclose PHI for employment related actions and decisions unless authorized by an individual; d. not use or disclose PHI in connection with any other benefit or Employee benefit of the Plan Sponsor unless authorized by an individual; e. report to the Plan any PHI use or disclosure that is inconsistent with the uses or disclosures provided for of which it becomes aware; f. make PHI available to an individual in accordance with HIPAA's access requirements; 91 g. make PHI available for amendment and incorporate any amendments to PHI in accordance with HIPAA; h. make available the information required to provide an accounting of disclosures in accordance with HIPAA; i. make internal practices, books and records relating to the use and disclosure of PHI received from Plan available to the l-IHS Secretary for the purposes of determining the Plan's compliance with HIPAA; j. ensure that adequate separation between the Group Health Plan and the Plan Sponsor is established as required by ( HIPAA(45CFR 164.504(f)(2)(iii);and k. if feasible, return or destroy all PHI received from the Plan that the Plan Sponsor still maintains in any form, and retain no copies of such PHI when no longer needed for the purpose for which disclosure was made(or if return or destruction is not feasible, limit further uses and disclosures to those purposes that make the return or destruction infeasible). 5. Adequate Separation Between the Plan and the Plan Sponsor Must Be Maintained In accordance with HIPAA,the following is a list of individuals,by class,that may be given access to PHI: a. Designated officers of the Company; b. Designated personnel of the Human Resources Department; c. Designated personnel of the Benefits Department; d. Designated personnel of the Accounting Department;and e. Employees designated from time to time by the Plan Sponsor. 6. Limitations of PHI Access and Disclosure The persons described in section 5 may only have access to and use and disclose PHI for plan administrative functions that the Plan Sponsor performs for the Plan. 7. Noncompliance Issues If the persons described in section 5 do not comply with this Plan Document, the Plan Sponsor has established a mechanism for resolving issues of noncompliance,including disciplinary sanctions. 8. The Plan Sponsor has implemented administrative, technical and physical safeguards that reasonably and appropriately protect the confidentiality, integrity,and availability of electronic PHI that it creates,maintains or transmits on behalf of the Plan. 9. The adequate separation set forth in sections 5 through 7 are supported by reasonable and appropriate security measures. 10. The Plan Sponsor has,or shall,as the case may be,ensure that any agent,including a subcontractor,to whom it provides electronic PHI agrees to implement reasonable and appropriate security measures. 11. The Plan Sponsor shall report to the Plan any security incident of which it becomes aware. 92 GENERAL PLAN INFORMATION TYPE OF ADMINISTRATION This Employee Benefits Plan sponsored by F. H. Paschen Companies is intended to comply with the Welfare Benefit Plan Provisions of the Employee Retirement Income Security Act of 1974. The following information together with the information contained in this Booklet is in accordance with the requirements of the Act. Benefits are paid directly from the Plan through the Claims Administrator. The Plan is a self-funded plan and the administration is provided through a third party Claims Administrator. The Plan is not insured. Plan contributions for Employee and Dependent coverage are made by the Company and Employee. PLAN NAME(Commonly known): F.H. PASCHEN COMPANIES MEDICAL AND DENTAL PLAN PLAN NAME(Official): F.H.PASCHEN COMPANIES: F.H.PASCHEN,S.N.NIELSEN,INC. F.H.PASCHEN,S.N.NIELSEN&ASSOCIATES LLC WESTCOAST CORP. STALWORTH UNDERGROUND LLC FHP TECTONICS CORP. FHP MANAGEMENT,INC. PLAN NUMBER 501 TAX ID NUMBER 36-4518446 PLAN AMENDED AND RESTATED November 1,2014 PLAN YEAR ENDS September 30th EMPLOYER INFORMATION PLAN ADMINISTRATOR/SPONSOR F.H.Paschen Companies Attn:Chief Financial Officer 5515 N.East River road F.H.Paschen Companies Chicago,IL 60656 5515 N.East River road (773)444-3474 Chicago,IL 60656 (773)444-3474 NAMED FIDUCIARY AGENT FOR SERVICE OF LEGAL PROCESS F.H.Paschen Companies Burke Burns&Pinelli,Ltd. 5515 N.East River road 70 W.Madison Street Chicago,IL 60656 Chicago,IL 60602 (773)444-3474 (312)541-8600 CLAIMS ADMINISTRATOR Benefit Administrative Systems,L.L.C. 17475 Jovanna Drive, l D Homewood,IL 60430 (708)799-7400 93 N/A - FHP TECTONICS CORP. DOES NOT DISCRIMINATE IN BENEBFITS A-6 MIAMIBEACH REASONABLE MEASURES APPLICATION Declaration: Nondiscrimination in Contracts and Benefits Submit this form and supporting documentation to the City's Procurement Department ONLY IF you: A. Have taken all reasonable measures to end discrimination in benefits; B. Are unable to do so; and C. Intend to offer a cash equivalent to employees for whom equal benefits are not available. You must submit the following information with this form: 9 The names, contact persons and telephone numbers of benefits providers contacted for the purpose of acquiring nondiscriminatory benefits; 10 The dates on which such benefits providers were contacted; 11 Copies of any written response(s)you received from such benefits providers,and if written responses are unavailable,summaries of oral responses;and 12 Any other information you feel is relevant to documenting your inability to end discrimination in benefits, including, but not limited to, reference to federal or state laws which preclude the ending of discrimination in benefits. I declare (or certify) under penalty of perjury under the laws of the State of Florida that the foregoing is true and correct,and that I am authorized to bind this entity contractually. Name of Company(please print) Mailing Address of Company Signature City,State,Zip Name of Signatory(please print) Telephone Number Title Date BID NO:2015-191-YG CITYOF MIAMI BEACH BOAC H N/A - FHP TECTONICS CORP. DOES NOT DISCRIMINATE IN BENEFITS A-6 Definition of Terms A. Reasonable Measures The City of Miami Beach will determine whether a City Contractor has taken all reasonable measures provided by the City Contractor that demonstrates that it is not possible for the City Contractor to end discrimination in benefits. A determination that it is not possible for the City Contractor to end discrimination in benefits shall be based upon a consideration of such factors as: 1. The number of benefits providers identified and contacted, in writing, by the City Contractor, and written documentation from these providers that they will not provide equal benefits; 2. The existence of benefits providers willing to offer equal benefits to the City Contractor;and 3. The existence of federal or state laws which preclude the City Contractor from ending discrimination in benefits. B.Cash Equivalent "Cash Equivalent" means the amount of money paid to an employee with a Domestic Partner(or spouse, if applicable) in lieu of providing Benefits to the employees' Domestic partner (or spouse, if applicable). The Cash Equivalent is equal to the employer's direct expense of providing Benefits to an employee for his or her spouse. Cash Equivalent. The cash equivalent of the following benefits apply: • A. For bereavement leave, cash payment for the number of days that would be allowed as paid time off for death of a spouse. Cash payment would be in the form of wages of the domestic partner employee for the number of days allowed. B. For health benefits, the cost to the Contractor of the Contractor's share of the single monthly premiums that are being paid for the domestic partner employee, to be paid on a regular basis while the domestic partner employee maintains the such insurance in force for himself or herself. C. For family medical leave, cash payments for the number of days that would be allowed as time off for an employee to care for a spouse that has a serious health condition. Cash payment would be in the form of wages of the domestic partner employee for the number of • days allowed. BID NO:2015-191-YG CITYOF MIAMI BEACH REAL H N/A - FHP TECTONICS CORP. DOES NOT DISCRIMINATE IN BENEFITS A-6 MIAMI BEACH SUBSTANTIAL COMPLIANCE AUTHORIZATION FORM Declaration: Nondiscrimination in Contracts and Benefits This form, and supporting documentation, must be submitted to the Procurement Department by entities seeking to contract with the City of Miami Beach that wish to delay ending their discrimination in benefits pursuant to the Rules of Procedure, as set out below. Fill out all sections that apply.Attach additional sheets as necessary. A. Open Enrollment Ending discrimination in benefits may be delayed until the first effective date after the first open enrollment process following the date the contract with the City begins, provided that the City Contractor submits to the Procurement Department evidence that reasonable efforts are being undertaken to end discrimination in benefits. This delay may not exceed two years from the date the contract with the City is entered into, and only applies to benefits for which an open enrollment process is applicable. Date next benefits plan year begins: Date nondiscriminatory benefits will be available: Reason for Delay: Description of efforts being undertaken to end discrimination in benefits: BID NO:2015-191-YG CITYOF MIAMI BEACH 72 BEACH N/A - FHP TECTONICS CORP. DOES NOT DISCRIMINATE IN BENEFITS A-6 B. Administrative Actions and Reauest for Extension Ending discrimination in benefits may be delayed to allow administrative steps to be taken to incorporate nondiscriminatory benefits into the City Contractor's infrastructure. The time allotted for these administrative steps shall apply only to those benefits for which administrative steps are necessary and may not exceed three months. An extension of this time may be granted at the discretion of the Procurement Director, upon the written request of the City Contractor. Administrative steps may include, but are not limited to, such actions as computer systems modifications, personnel policy revisions, and the development and distribution of employee communications. Description of administrative steps and dates to be achieved: If requesting extension beyond three months, please explain basis: C. Collective Bargaining Agreements(CBA) Ending discrimination in benefits may be delayed until the expiration of a City Contractor's Current collective bargaining agreement(s)where all of the following conditions have been met: 1. The provision of benefits is governed by one or more collective bargaining agreement(s); 2. The City Contractor takes all reasonable measures to end discrimination in benefits either by requesting that the Unions involved agree to reopen the agreements in order for the City Contractor to take whatever steps necessary to end discrimination in benefits or by ending discrimination in benefits without reopening the collective bargaining agreements; and 3. In the event that the City Contractor cannot end discrimination in benefits despite taking all reasonable measures to do so, the City Contractor provides a cash equivalent to eligible employees for whom benefits are not available. Unless otherwise authorized in writing by the Procurement Director, this cash equivalent payment must begin at the time the Unions refuse to allow the collective bargaining agreements to be reopened, or in any case no longer than three (3)months from the date the contract with the City is entered into. For a delay to be granted under this provision,written proof must be submitted with this form that: • The benefits for which the delay is requested are governed by a collective bargaining agreement; • All reasonable measures have been taken to end discrimination in benefits (see Section C.2, above); and • A cash equivalent payment will be provided to eligible employees for whom benefits are not available. BID NO: 2015-191-YG CITYOF MIAMI BEACH AC i-i 73 N/A - FHP TECTONICS CORP. DOES NOT DISCRIMINATE IN BENEFITS A-6 I declare (or certify) under penalty of perjury under the laws of the State of Florida that the foregoing is true and correct,and that I am authorized to bind this entity contractually. Name of Company(please print) Mailing Address of Company Signature City,State,Zip Name of Signatory(please print) Telephone Number Title Date BID NO:2015-191-YG CITYOF MIAMI BEACH • BEACH 74 U) O .7 CD O •- I- O - ti CNI 1 dN' N O ti W r .-- a _. Co O N 0 0 •-- 0 0 0 0 .4 0 9 0) W -; a Co Z a_ x h Co 0 ' s . C W• L Cyl CV Q' z a 0 0 0 0 0 0 0 0 0 0 0 0 a W (D J C .f W N CG O 0 ti <_ 2F o a z z .. p. z 0 0 0 0 0 0 0 0 0 o w z w Z a• C] "0 a Q . .. } Z 4. C] Ili C� M , • y J W 0 0 0 0 0 0 0 0 0 0 0 0 W ' LL w N d 0 .1 a�CV !. h F. } Q Z� ° r. CC ( W i Z I' O N L) 0 0 0 c0 0 e- O �t Co W 1- 1 cu • o z . c7 N U Z O , i J a i r •O y d a c • "r:Fv WW tj w W 0 0 O 0 .- ti 0 0 0 CO 0 . t LL LL a •.l ti X UUTr ee V 0 0 C 4 0 0 0 0 1 0 0 0 U7 v ZZ aN Ca & Lil ¢Qr) z Z Z mmo 1.- 0 J o 0 0 0 0 0 0 0 r 0 In 00 m 0OZ cG F— 1- JQ z Dh. CL (.. " U W cD " 0 0 X 0 0 0 .- O N O 00 CD J J W cu — Q u O > " Z . F—H LJU W v) C.- co w < OZ H-F-F- O } O Q v) - " ��! a. J z 0 �", 5 O O O 0 0 O .- O O O .- O , a 0 Z O W.r, w Z C7 4, ? x^ Q ca M CO a W Z < Zv .4 .4- CQ• r W - . ` V 2 1.0 E- I o a 0 U LL 1!)Cl U >- • . N w N " z s O U) •ct O O t- 0 0 T CO J J A " e 2 C') T O) C) v W W * < � Q II O H_' I.ii'i . H " In Cr) f- U7 O a- ti O O a- CS C) " W Cr) 0 00 00 00 W Li Ti" ^r r N UI Li " Y 3 O e- M 0 0 cO to 0 00 0 ('5 N = Z Z (Ni N OHO L v. Z Z 0 w O O V O tD 0 •.— O O CO O 0p0p O .- .- N F" Z O ,- 1- CO co N O 0 Q Z r r ` Z u Jo . � a o OE y (/j Q FQ., x � z - O HCC Q F- Wa= ce O 0 Q U ` Ua O• O > w q N F- 'D <_ a J u. Q Z(� a 0� cn - O �� Q F-,, W L 0 u 0 0'■a w Z U s > d `' W c( CC W LL v cc Crp ty�n V �Z/� O (0 W - n u�. 4 v. 1 S d >' V r�^ Q1 0' , V/ Z N Q 1 W_ W l7 z d d W . L. < /►,� V O E O O LlI O C� j 9. ..� 4 f" 7 cc - Ii V Z^ V O. w W° a nU = LL = z Oa p U. p O � 0 U LI _ < Ili WW2 O (O U ill W A-7 SUPPLEMENT TO BID/TENDER FORM: TRENCH SAFETY ACT IF APPLICABLE, THIS FORM MUST BE SUBMITTED WITH BID FOR BID TO BE DEEMED RESPONSIVE. (SEE SECTION 00407) On October 1, 1990 House Bill 3181, known as the Trench Safety Act became law. This incorporates the Occupational Safety & Health Administration (OSHA) revised excavation safety standards, citation 29 CFR.S.1926.650, as Florida's own standards. The Bidder, by virtue of the signature below, affirms that the Bidder is aware of this Act, and will comply with all applicable trench safety standards. Such assurance shall be legally binding on all persons employed by the Bidder and subcontractors. The Bidder is also obligated to identify the anticipated method and cost of compliance with the applicable trench safety standards. BIDDER ACKNOWLEDGES THAT INCLUDED IN THE VARIOUS ITEMS OF THE BID AND IN THE TOTAL BID PRICE ARE COSTS FOR COMPLYING WITH THE FLORIDA TRENCH SAFETY ACT. THESE ITEMS ARE A BREAKOUT OF THE RESPECTIVE ITEMS INVOLVING TRENCHING AND WILL NOT BE PAID SEPARATELY. THEY ARE NOT TO BE CONFUSED WITH BID ITEMS IN THE SCHEDULE OF PRICES, NOR BE CONSIDERED ADDITIONAL WORK. The Bidder further identified the costs and methods summarized below: Quantity Unit Description Unit Price Price Extended Method Angle of Repose CY $0.00 $0.00 $0.00 Trench Box MO $0.00 $0.00 $0.00 Total $0.00 HAEltairaisp. Na o ''- — Alio David P.Roy Authorize. - gnature of Bidder BID NO:2015-191-YG CITYOF MIAMI BEACH ' BeACH 75 A-7 CONSIDERATION FOR INDEMNIFICATION OF CITY Consideration for Indemnification of City $25.00 x Cost for compliance to all Federal and State requirements of the Trench Safety Act* [NOTE: If the box above is checked, the Bidder must fill out the foregoing Trench Safety Act Form (Attachment A-7) in order to be considered responsive.] BID NO:2015-191-YG CITYOF MIAMI BEACH BEACH 76 A-8 RECYCLED CONTENT INFORMATION In support of the Florida Waste Management Law, Bidders are encouraged to supply with their bid, any information available regarding recycled material content in the products bid. The City is particularly interested in the type of recycled material used (such as paper, plastic, glass, metal, etc.); and the percentage of recycled material contained in the product. The City also requests information regarding any known or potential material content in the product that may be extracted and recycled after the product has served its intended purpose. Percentage 1 of Recycled laMiali Used Content There will be no recycled materials used for this job. BID NO:2015-191-YG CITYOF MTT BEACH I BEACH APPENDIX B List of Plans and Specifications MIAMIBEACH BID NO:2015-191-YG CITYOF MIAMI BEACH BEACH 78 B LIST OF PLANS & SPECIFICATIONS CONTRACT DOCUMENTS AS DEVELOPED BY CITY OF MIAMI BEACH CAPITAL IMPROVEMENT DEPARTMENT Page Sheet No./ Title/Description Spec.No. ITB 2015-191-YG:SOUTH POINTE PARK WATER FEATURE REMEDIATION- DRAWINGS G-00 COVER SHEET&INDEX OF DRAWINGS G-01 GENERAL NOTES EC-01 EXISTING CONDITIONS/TOPOGRAPHIC SURVEY DM-01/101 DEMOLITION HS-01-03 HARDSCAPE PLANS&DETAILS PG&D-01- PAVING,GRADING,&DRAINAGE PLAN AND NOTES 02 FP-100 PRELIMINARY ELEVATIONS&FLOODPLAIN STATEMENT HS-100- SPECIALTY LEGENDS/PLANS/DETAILS/SCHEDULES 119 E-01-03 SITE ELECTRICAL PLANS/DETAILS/NOTES E-01-05 WATER FEATURE ELECTRICAL PLANS/DETAILS/NOTES LA-01-05 LANDSCAPE&SITE FURNISHING PLAN/NOTES/DETAILS IR-01 IRRIGATION PLANS&NOTES ITB 2015-191-YG:SOUTH POINTE PARK WATER FEATURE REMEDIATION- SPECIFICATIONS DIVISION 1—GENERAL REQUIREMENTS 011000 SUMMARY 012500 SUBSTITUTION PROCEDURES 012600 CONTRACT MODIFICATION PROCEDURES 012900 PAYMENT PROCEDURES 013100 PROJECT MANAGEMENT AND COORDINATION 013200 CONSTRUCTION PROGRESS DOCUMENTATION 013300 SUBMITTAL PROCEDURES 014000 QUALITY REQUIREMENTS 015000 TEMPORARY FACILITIES AND CONTROLS 015639 TEMPORARY TREE PROTECTION 016000 PRODUCT REQUIREMENTS 017300 EXECUTION 017700 CLOSEOUT PROCEDURES 017823 OPERATION AND MAINTENANCE DATA 017839 PROJECT RECORD DOCUMENTS 017900 DEMONSTRATION AND TRAINING BID NO: 2015-191-YG CITYOF MIAMI BEACH 79 DIVISION 2-EXISTING CONDITIONS 024119 SELECTIVE STRUCTURE DEMOLITION DIVISION 3-CONCRETE 033000 CAST-IN-PLACE CONCRETE DIVISION 26-ELECTRICAL 260126 ELECTRICAL TESTING 260500 BASIC ELECTRICAL MATERIALS AND METHODS 260519 CONDUCTORS AND CABLES 260526 GROUNDING AND BONDING 260533 RACEWAYS AND BOXES 260923 LIGHTING CONTROL DEVICES 262416 PANELBOARDS 262813 FUSES 262816 ENCLOSED SWITCHES AND CIRCUIT BREAKERS 265113 LIGHTING FIXTURES DIVISION 31-EARTH WORK 311000 SITE CLEARING 312000 EARTH MOVING 313116 TERMITE CONTROL DIVISION 32-EXTERIOR IMPROVEMENTS 321313 CONCRETE PAVING-SITE 321316 DECORATIVE CONCRETE PAVING FINISHES-SITE INTEGRALLY COLORED 328400 PLANTING IRRIGATION 329001 CITY OF MIAMI BEACH LANDSCAPE INSTALLATION AND SPECIFICATION 329119 FINE GRADING 329200 TURF AND GRASSES 329300 EXTERIOR PLANTS 329643 TREE RELOCATION AND PROTECTION BID NO:2015-191-YG CITYOF MIAMI BEACH BE L\(j-1 80 i4 iy } EXHIBIT D t BID ALTERNATE DETAILS 1 17 BASE DETAILS ALTERNATE DETAILS Sheet . Detail Name Sheet Detail Name 1 HS-02 Concrete Plaza HS-02 Concrete Plaza with Shell Stone Aggregate Detail 5 Detail 5A • This alternate includes the addition of shell aggregate.See detail for additional information. 2 HS-107 Piling Foundation at Fountains HS-120 Mat Foundation at Fountains • This alternate includes constructing the fountain basin foundations with a mat foundation,in lieu of piles. • See updated General Notes,Key, and Details for additional information 3 LA-02 Concrete Bench LA-03 Coral Stone Bench Detail 1 • Bench Layout provided on Detail 1A • Bench Layout provided on sheet sheet LA-01 LA-03 • Existing benches in existing • Replacement of the existing plaza area benches within new stone benches • See detail for additional information. 18 AppENDix Required Forms for Bid Submittal (Note:Attachments below only apply if the adjacent box is checked) ❑ ATTACHMENT C-1: Bid Guaranty Form; Unconditional Letter Of Credit ❑ ATTACHMENT C-2:,Statement Of Compliance: Prevailing Wage Rate Ordinance ❑ A M • State nt - - ': - e is o a • MIAMI BEACH BID NO:2015-191-YG CITYOF MIA MI BEACH LIB`ACl„1 D&B Supplier Qualifier Report: FHP TECTONICS CORP. Page 1 of 2 • : Supplier Qualifier Report DAB FHP TECTONICS CORP. Print Entire Report Decide with Confidence D-U-N-SO Number 15-427-811$ E-mail Report Save HTML Report Copyright 2014 Dun&Bradstreet-Provided under contract for the exclusive use of subscriber 100150009 ATTN: FHP TECTONICS CORP. Report Printed:APR 15 2014 In Date I Overview \ Hr-story b Products& Operations Services Y pa menns finance Public Filings ' OVERVIEW BUSINESS INFORMATION About Business Information Business information FHP Tectonics Corp.does not subscribe to DGBPAYDEX© FHP TECTONICS CORP. Dun&Bradstreet thus our history Summary Analysis 5515 N East River Rd ry is identified as Risk Score Analysis Chicago,IL 60656 "Incomplete". probability of Ceased To reflect the financial stability of the company.please find the Operations/Becoming Rating Change ac Ive , attached letter from MB Financial dated August 24,2015. Diversity Do riot confuse with with F H Paschen,SN Neilsen, D-U-N-S® Customer Service Inc. Duns #87-633-2040.. Number: 15-427-8118 HISTORY&OPERATIONS - This is a single location. History Telephone: 773 444-3474 Business Registration ®D&B Rating; -- Operations Chief executive: JAMES BLAIR,PRES Formerly PRODUCTS&SERVICES 1R3 UNSPSC Year started: 1996 •Jump to- Summary NAICS Analysis ZLC section Employs: 250 PAYMENTS D&B Supplier 8 D&B PAYDEX History: INCOMPLETE Risk: Payment Summary Payment Details Financing: SECURED SUPPLIER EVALUATION RISK(SER)RATING Payment Trends •Jump to: finance Section FOR THIS FIRM:8 FINANCE a Finance, 9 S 7 6 5 4 3 2 1 PUBLIC FILINGS UCC Fllincg High Medium Low Government Activity D&B PAYDEXO (�About 0&B PAYDEXO D&B PAYDEX: 58 D&B PAYDEX Key When weighted by dollar amount, payments to suppliers average 24 days beyond terms. • High risk of late payment o tin (average 30 to 120 days beyond terms) ` C Medium risk of late payment (average 30 days or less beyond terms) 120 days slow 30 days slow Prompt Anticipates • Low risiic of fate payment (average prompt to 30+ days sooner) Based on up to 24 months of trade. •Jump to: Payments Section D&B Score Interpretation Table SUMMARY ANALYSIS () About Summary Analysis 0 D&B Rating:-- The Rating was changed on June 3, 2013 because of D&B's overall assessment of the company's financial, payment and history information. The blank rating symbol should not be interpreted as indicating that credit should be denied.It simply means that the information available to D&B does not permit us to classify the company within our rating key and that further enquiry should be made before reaching a decision.Some reasons for using a "-"symbol include: deficit net worth,bankruptcy proceedings, insufficient payment information, or incomplete history information. For more information,see the D&B Rating Key, Below Is an overview of the company's rating history since 05/08(00: D&B Rating Date Applied file://C:\Documents and Settings\vlee\Local Settings\Temporary Internet Files\Content.Out... 4/15/2014 D&B Supplier Qualifier Report: FHP TECTONICS CORP. Page 2 of 2 06/03/13 1R3 04/11/12 02/17/09 1R3 10/17/06 4A2 05/19/04 4A3 05/15/03 05/08/00 The Summary Analysis section reflects information In D&B's file as of April 14, 2014. RISK SCORE ANALYSIS ®Aboi.t Risk core Analysis SER COMMENTARY: - Higher risk industry based on Inactive rate for this industry. - Proportion of past due balances to total amount owing. - Proportion of slow payment experiences to total number of payment experiences reported. - Recent high balance past due. PROBABILITY OF CEASED OPERATIONS/BECOMING INACTIVE SUPPLIER EVALUATION RISK RATING: If The probability of ceased operations/becoming Inactive indicates what percent of U.S.businesses is expected to cease operations or become inactive over next 12 months. Probability of Supplier Ceased 13.0% (1,300 PER 10,000) Operations/Becoming Inactive: Percentage of US business with same SER 12% (1,200 PER 10,000) score: Average Probability of Supplier Ceased 5.60% (560 PER 10,000) Operations/Becoming Inactive: -Average of Businesses In D&B's Supplier Database QQ CREDIT DELINQUENCY SCORE: 296 DIVERSITY 0 About Diversity Minority-Owned Business: N/A Historically Underutilized Business: N/A Women-Owned Business: N/A Veteran-Owned Business: N/A Disadvantaged Business Enterprise N/A Vietnam Veteran Business: N/A Small Disadvantaged Business; N/A Disabled-Owned Business: N/A HUB-Zoned Certified Business: N/A Historical College Classification; N/A SBA 8(a)Certified; N/A Labor surplus area: YES (2014) Small Business: N/A CUSTOMER SERVICE if you have questions about this report, please call our Customer Resource Center at 1.800.234.3867 from anywhere within the U.S. if you are outside the U.S.contact your local D&B office. *1-*Additional Decision Support Available'"a` Additional D&B products,monitoring services and specialized investigations are available to help you evaluate this.company or its industry.Cali Dun&Bradstreet's,Customer Resource Center at. t 19avU1 3867 fRa fiiviligi fi8i{ho,trz ,44rrr�rafe ' 'it}lt<'bs"eb l-WA1g--'=iyri,'Aitce. purlii4 1=i irk � qa Print Entice Report g-mall Rouort Savo HTML Report Order an Inveetioation Copyright 2014 Dun&Bradstreet-Provided under contract for the exclusive use of subscriber 100150009 file://C:\Documents and Settings\vlee\Local Settings\Temporary Internet Files\Content.Out... 4/15/2014 Adrienne C.Stevenson Vice President MARSH Marsh USA Inc. _ 000 540 West Madison Street Chicago,IL 60661 3630 +1 312 627 6772 Adrienne.C.Stevenson @marsh.com www.marsh.com August 24,2015 Ms. Yusbel Gonzalez Senior Procurement Specialist City of Miami Beach 1700 Convention Center Drive,4h Floor Miami,Florida 33139 Re: FHP Tectonics Corp. Project: South Pointe Park Water Feature Remediation ITB No.2015-191-YG To Ms.Gonzalez: Continental Casualty Company is the Surety for FHP Tectonics Corp. since 2002 and Marsh USA Inc. is their surety agent that currently has the privilege of providing bonds for FHP Tectonics Corp. FHP Tectonics Corp.'s financial strength and management capabilities have qualified them for bonding on any project,which they have chosen to undertake. As such, Continental Casualty Company highly recommends them for your favorable consideration on your project. FHP Tectonics Corp. has been extended a bonding facility, which has supported individual projects up to $250,000,000.00 and an aggregate work program in the $1,000,000,000.00 range. FHP Tectonics Corp. currently has in excess of$500,000,000.00 in available bond capacity. Surety bonds are issued through the Continental Casualty Company which is rated A XV by AM Best and is listed in the Federal Register as an acceptable surety authorized to do business in the Commonwealth of Virginia. State of Incorporation is Illinois;333 S.Wabash Avenue;41st Floor; Chicago, Illinois 60604. Continental Casualty Company holds FHP Tectonics Corp. in the highest regard. We heartily endorse their organization and will provide the requisite bonding should the project be awarded to FHP Tectonics Corp. This commitment is subject to acceptable contractual and underwriting terms and conditions. Sincerely, Continental Casual Compan e Adrienne C. Ste enson Attorney-in-Fact 000 MARSH&McLENNAN LEADERSHIP,KNOWLEDGE,SOLUTIONS...WORLDWIDE. COMPANIES STATE OF ILLINOIS COUNTY OF COOK Is Rebecca J. Hobbs a Notary Public in and for said County do hereby certify that Adrienne C. Stevenson Attorney-in-Fact, of these: Continental Casualty Company An Illinois Corporation American Casualty Company of Reading Pennsylvania A Pennsylvania Corporation National Fire Insurance Company of Hartford A Connecticut Corporation Western Surety Company A South Dakota Corporation who is personally known to me to be the same person whose name is subscribed to the foregoing instrument appeared before me this day in person,and, acknowledged that they signed, sealed, and delivered said instrument for and on behalf of: Continental Casualty Company An Illinois Corporation American Casualty Company of Reading Pennsylvania A Pennsylvania Corporation National Fire Insurance Company of Hartford A Connecticut Corporation Western Surety Company A South Dakota Corporation for the uses and purposed therein set forth. Given under my hand and notarial seal at my office in the City of Chicago in said County, this 24th day of August A.D. 2015 . 7/Off(' vary ' b is OFFICIAL SEAL REBECCA J. HO BBS I Notary Public-State of Illinois C My Cornmissiof expires 8/06/2018 0 • POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY-IN-FACT ' Know All Men By These Presents,That Continental Casualty Company,an Illinois insurance company,National Fire Insurance Company of Hartford,an Illinois insurance company,and American Casualty Company of Reading,Pennsylvania,a Pennsylvania insurance company(herein called "the CNA Companies"),are duly organized and existing insurance companies having their principal offices in the City of Chicago,and State of Illinois, and that they do by virtue of the signatures and seals herein affixed hereby make,constitute and appoint C R Hernandez, Beatriz Polito,Adrienne C Stevenson,John K Johnson, Amy B Wickett, Katherine J Foreit, Michael Dougherty,Triniy Garcia,Rebecca Hobbs ,Individually of Chicago,IL,their true and lawful Attorney(s)-in-Fact with full power and authority hereby conferred to sign,seat and execute for and on their behalf bonds,undertakings and other obligatory instruments of similar nature -In Unlimited Amounts- and to bind them thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of their insurance companies and all the acts of said Attorney,pursuant to the authority hereby given is hereby ratified and confirmed. This Power of Attorney is made and executed pursuant to and by authority of the By-Law and Resolutions,printed on the reverse hereof,duly adopted,as indicated,by the Boards of Directors of the insurance companies. In Witness Whereof,the CNA Companies have caused these presents to be signed by their Vice President and their corporate seals to be hereto affixed on this 9th day of June,2015. CASU. , BaBR44, 09100 OA Continental Casualty Company AO' 4r,-0 ee ��-4 ` National Fire Insurance Company of Hartford co a/ e °ci, - f ocaaro>r�Tfo t American Cas alty Company of Reading,Pennsylvania Z r a JULY 31. y Ou SEAL v V 19D2 r 1897 OA 1�aRY�O� • Paul T.Bruflat Vice President State of South Dakota,County of Minnehaha,ss: On this 9th day of June,2015,before me personally came Paul T.Bruflat to me known,who,being by me duly sworn,did depose and say: that he resides in the City of Sioux Falls,State of South Dakota;that he is a Vice President of Continental Casualty Company,an Illinois insurance company, National Fire Insurance Company of Hartford,an Illinois insurance company,and American Casualty Company of Reading,Pennsylvania,a Pennsylvania insurance company described in and which executed the above instrument;that he knows the seals of said insurance companies;that the seals affixed to the said instrument are such corporate seals;that they were so affixed pursuant to authority given by the Boards of Directors of said insurance companies and that he signed his name thereto pursuant to like authority,and acknowledges same to be the act and deed of said insurance a .companies. S.ETCH s NOTARY AKOTACR1 i SOUTH O�AKOTA � ,A., .........E.4t..r...........f My Commission Expires February 12,2021 S.Eich Notary Public CERTIFICATE I,D.Bult,Assistant Secretary of Continental Casualty Company,an Illinois insurance company,National Fire Insurance Company of Hartford,an Illinois insurance company,and American Casualty Company of Reading,Pennsylvania,a Pennsylvania insurance company do hereby certify that the Power of Attorney herein above set forth is still in force,and further certify that the By-Law and Resolution of the Board of Directors of the insurance companies printed on the revere hereof is still in force. In testimony whereof I have hereunto subscribed my name and affixed the seal of the said insurance companies this ( `4-i' day of Au t 4- ,p'OfS"- • GA.S� 111SUR4'�' tey ,to Continental Casualty Company Company ,� National Fire Insurance Company of Hartford cOPPORATr g3 .,�tt�ort to a American Casualty Company of Reading,Pennsylvania 1 StE:� .� .t �ul�r�1. i �� . ' k <j' 12a) .'L.S2.•••iol" 1897 maalidg) • D.Bult Assistant Secretary Form F6853-4/2012 FHP Tectonics Corp. Consolidated Financial Statements Years Ended December 31, 2014 and 2013 The report accompanying these financial statements was issued by D BDO USA,LLP,a Delaware limited liability partnership and the U.S.member of OD BDO International Limited,a UK company limited by guarantee. FHP Tectonics Corp. Consolidated Financial Statements Years Ended December 31, 2014 and 2013 FHP Tectonics Corp. Contents Independent Auditor's Report 3-4 Financial Statements Consolidated Balance Sheets as of December 31, 2014 and 2013 5-6 Consolidated Statements of Operations for the Years Ended December 31, 2014 and 2013 7 Consolidated Statements of Stockholders' Equity for the Years Ended December 31, 2014 and 2013 8 Consolidated Statements of Cash Flows for the Years Ended December 31, 2014 and 2013 9 Notes to Consolidated Financial Statements 10-15 2 I BDO Tel: 312-856-9100 330 N. Wabash, Suite 3200 Fax: 312-856-1379 Chicago, IL 60611 www.bdo.com Independent Auditor's Report The Board of Directors FHP Tectonics Corp. Chicago, Illinois We have audited the accompanying consolidated financial statements of FHP Tectonics Corp. (the "Company"), which comprise the consolidated balance sheets as of December 31, 2014 and 2013, and the related consolidated statements of operations, stockholders' equity and cash flows for the years then ended, and the related notes to the consolidated financial statements. Management's Responsibility for the Consolidated Financial Statements Management is responsible for the preparation and fair presentation of these consolidated financial statements in accordance with accounting principles generally accepted in the United States of America; this includes the design, implementation, and maintenance of internal control relevant to the preparation and fair presentation of consolidated financial statements that are free from material misstatement, whether due to fraud or error. Auditor's Responsibility Our responsibility is to express an opinion on these consolidated financial statements based on our audits. We conducted our audits in accordance with auditing standards generally accepted in the United States of America. Those standards require that we plan and perform the audit to obtain reasonable assurance about whether the consolidated financial statements are free from material misstatement. An audit involves performing procedures to obtain audit evidence about the amounts and disclosures in the consolidated financial statements. The procedures selected depend on the auditor's judgment, including the assessment of the risks of material misstatement of the consolidated financial statements, whether due to fraud or error. In making those risk assessments, the auditor considers internal control relevant to the Company's preparation and fair presentation of the consolidated financial statements in order to design audit procedures that are appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness of the Company's internal control. Accordingly, we express no such opinion. An audit also includes evaluating the appropriateness of accounting policies used and the reasonableness of significant accounting estimates made by management, as well as evaluating the overall presentation of the consolidated financial statements. We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our audit opinion. BDO USA,LLP.a Delaware limited liability partnership,is the U.S. member of BDO International Limited,a UK company limited by guarantee.and forms part of the international BDO network of independent member firms. BDO is the brand name for the BOO network and for each of the BDO Member Firms. 3 3D0 Opinion In our opinion, the consolidated financial statements referred to above present fairly, in all material respects, the financial position of FHP Tectonics Corp. as of December 31, 2014 and 2013, and the results of its operations and its cash flows for the years then ended in accordance with accounting principles generally accepted in the United States of America. ED e U1 ) LLP Chicago, Illinois April 21, 2015 BDO USA, LLP,a Delaware limited liability partnership,is the U.S. member of BDO International Limited,a UK company limited by guarantee,and forms part of the international BDO network of independent member firms. BOO is the brand name for the BDO network and for each of the BDO Member Firms. 4 Consolidated Financial Statements II FHP Tectonics Corp. Consolidated Balance Sheets December 31, 2014 2013 Assets Current Assets Cash and cash equivalents $ 10,963,098 $ 19,021,198 Contract Receivables Current 4,839,516 9,952,519 Retention 6,206,729 4,764,916 Total Contract Receivables 11,046,245 14,717,435 Costs and estimated earnings in excess of billings on uncompleted contracts (Note 3) 3,204,149 3,702,507 Other current assets 28,633 28,633 Total Current Assets 25,242,125 37,469,773 Property and Equipment, net (Note 4) 139,426 210,638 Total Assets $ 25,381,551 $ 37,680,411 5 FHP Tectonics Corp. Consolidated Balance Sheets December 31, 2014 2013 Liabilities and Stockholders' Equity Current Liabilities Billings in excess of costs and estimated earnings on uncompleted contracts (Note 3) $ 725,055 $ 3,619,571 Accounts Payable Trade 491,778 453,337 Subcontractor 3,056,375 9,049,397 Retention 3,442,100 2,868,024 Total Accounts Payable 6,990,253 12,370,758 Affiliated company payables (Note 7) 165,921 1,078,602 Accrued expenses 87,035 158,738 Total Current Liabilities 7,968,264 17,227,669 Commitments and Contingencies (Notes 5, 10, 11 and 12) Stockholders' Equity Class A, voting, no par value, 550 shares authorized, 170.5 shares issued and outstanding at December 31, 2014 and 2013 853 853 Class B, nonvoting, no par value, authorized 5,000 shares at December 31, 2014 and 2013, 810 and 830 shares issued and outstanding at December 31, 2014 and 2013, respectively 152,913 155,138 Retained earnings 17,259,521 20,296,751 Total Stockholders' Equity 17,413,287 20,452,742 Total Liabilities and Stockholders' Equity $ 25,381,551 $ 37,680,411 See accompanying notes to consolidated financial statements. 6 FHP Tectonics Corp. Consolidated Statements of Operations Year ended December 31, 2014 2013 Contract Revenues $ 47,951,421 $ 52,778,954 Contract Costs 50,468,197 54,894,883 Gross loss (2,516,776) (2,115,929) Selling, general and administrative expenses 476,159 423,134 Loss from Operations (2,992,935) (2,539,063) Other Income Equity in earnings from unconsolidated joint venture (Note 8) - 5,609 Interest income, net (Note 7) 43,480 30,564 Total Other Income 43,480 36,173 Net Loss $ (2,949,455) $ (2,502,890) See accompanying notes to consolidated financial statements. 7 FHP Tectonics Corp. Consolidated Statements of Stockholders' Equity Common Stock Class A Class B Paid-in Paid-in Retained Total Shares Capital Shares Capital Earnings Equity Balance,January 1,2013 170.5 $ 853 830.0 $ 155,138 $ 22,799,641 $ 22,955,632 Net loss - - - (2,502,890) (2,502,890) Balance, December 31,2013 170.5 853 830.0 155,138 20,296,751 20,452,742 Net loss - - - - (2,949,455) (2,949,455) Stock redemption - - (20.0) (2,225) (87,775) (90,000) Balance, December 31,2014 170.5 $ 853 810.0 $ 152,913 $ 17,259,521 $ 17,413,287 See accompanying notes to consolidated financial statements. 8 FHP Tectonics Corp. Consolidated Statements of Cash Flows Year ended December 31, 2014 2013 Cash Flows From Operating Activities Net loss $ (2,949,455) $ (2,502,890) Adjustments to reconcile net loss to net cash used in operating activities Depreciation 71,212 69,710 Equity in income from unconsolidated joint venture - (5,609) Changes in operating assets and liabilities Contract receivables 3,671,190 (5,031,840) Costs and estimated earnings in excess of billings on uncompleted contracts 498,358 (1,994,227) Billings in excess of costs and estimated earnings on uncompleted contracts (2,894,516) 2,173,235 Accounts payable and accrued expenses (5,452,208) 1,541,484 Affiliated company payables (912,681) 171,847 Net cash used in operating activities (7,968,100) (5,578,290) Cash Flows From Investing Activities Purchases of property and equipment - (15,000) Distribution from unconsolidated joint venture - 701,040 Net cash provided by investing activities - 686,040 Cash Flows From Financing Activities Stock redemptions (90,000) - Net Decrease in Cash and Cash Equivalents (8,058,100) (4,892,250) Cash and Cash Equivalents, beginning of year 19,021,198 23,913,448 Cash and Cash Equivalents, end of year $ 10,963,098 $ 19,021,198 See accompanying notes to consolidated financial statements. 9 FHP Tectonics Corp. Notes to Consolidated Financial Statements 1. Business Description FHP Tectonics Corp. (the "Company") is a general contractor within the construction industry. The work is primarily performed under lump sum and job order contracts. The length of the Company's contracts varies but is typically one to five years in duration. These contracts are undertaken by the Company alone or in partnership with other contractors through joint ventures. 2. Summary of Significant Accounting Principles Principles of Consolidation The consolidated financial statements include the accounts of the Company and its wholly owned subsidiary, FHP Tectonics Corp. II. Contract Receivables and Allowance for Doubtful Accounts Current contract receivables are carried at original invoice amount less the payments received. Retention receivables are for contract work completed and billed as of the balance sheet date that will typically be collected from customers upon reaching certain contract milestones. Retention receivable carrying amounts are typically calculated using fixed percentages of the adjusted contract amount for each stage of the project per the contract terms. Management determines the allowance for doubtful accounts by regularly evaluating individual receivables on a job-by-job basis and considers the counterparty's financial condition, credit history and current economic conditions. Contract receivables are written off when deemed uncollectible. Recoveries of contract receivables previously written off are recorded when received. Interest is not charged on past due receivables unless allowed by the contract. No allowance was recorded as of December 31, 2014 and 2013. Revenue and Cost Recognition Revenues from contracts are recognized on a percentage-of-completion basis. Earned revenue is based on the percentage of incurred costs to date divided by total estimated costs after giving effect to the most recent cost estimates. Earned revenue reflects the original contract price adjusted for agreed-upon change orders, if any. Changes in job conditions, job performance and estimated profitability may result in revisions to income and are recognized as such revisions are determined. The Company does not recognize profit on jobs 10% or less complete. Provisions for estimated losses on contracts are recorded when identified. In determining estimates, management uses the best information available. Future events could have a significant effect on contract revenue. Contract costs include all direct material, labor, equipment, and subcontract costs and those indirect costs related to contract performance, such as indirect labor, supplies, tools and repairs costs. General and administrative costs are charged to expense as incurred. The asset, "Costs and estimated earnings in excess of billings on uncompleted contracts," represents revenue recognized in excess of amounts billed. The liability, "Billings in excess of costs and estimated earnings on uncompleted contracts," represents billings in excess of revenues recognized. 10 FHP Tectonics Corp. Notes to Consolidated Financial Statements Lump Sum Contracts Lump sum contracts are competitively bid contracts whereby the owner agrees to pay a contractor a specified fixed amount for completing a scope of work that includes all costs, including equipment, labor, materials and overhead. The current contract value reflects the adjusted contract amount, which is the initial fixed contract amount adjusted for any approved change orders. Job Order Contracts Job order contracts ("JOC") are competitively bid with firm prices and indefinite contract quantities. They include a collection of individual detailed construction work orders and specifications that have established unit prices. A JOC work order is placed with a contractor for the accomplishment of repair, alteration, modernization, rehabilitation, construction, etc. of infrastructure, buildings, structures or other real property. Ordering is accomplished by means of issuance of individual purchase orders to perform specific work orders against the contract. As JOC requirements are identified, the contractor will be issued a request for proposal. Price is determined by an examination of the scope of the required work. Price proposals are submitted for agency review and compared with the agency's own independent estimates. The parties may negotiate over the final "bottom line" price for the "scope of work." As work is completed under a specific work order, payment is made by the agency and the work order is closed out. Property and Equipment Equipment is stated at cost. Depreciation is provided using straight-line methods over the expected useful lives of the assets or the term of lease if shorter. Expenditures for maintenance and repairs are charged against income, while renewals and betterments are capitalized as additions to the related assets. Retirements, sales and disposals of assets are recorded by removing the cost and related accumulated depreciation from the accounts with any resulting gain or loss reflected in income. Use of Estimates The preparation of financial statements in conformity with accounting principles generally accepted in the United States of America requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Actual results could differ from those estimates. Concentrations of Credit Financial instruments that potentially subject the Company to significant concentrations of credit risk consist principally of cash and receivables. The Company maintains cash with a financial institution which, at times, may exceed federally insured limits. The Company believes it is not exposed to any significant credit risk on cash. During the year ended December 31, 2014, three customers had revenues greater than 10% of total revenues for the year. Revenues from these customers were approximately $31,883,000, or 66%, of total revenues for the year then ended. Contract receivables due from these customers were approximately $2,908,000, or 26%, of contract receivables at December 31, 2014. During the year ended December 31, 2013, five 11 I FHP Tectonics Corp. Notes to Consolidated Financial Statements customers had revenues greater than 10% of total revenues for the year. Revenues from these customers were approximately $43,591,000, or 83%, of total revenues for the year then ended. Contract receivables due from these customers were approximately $11,065,000, or 75%, of contract receivables at December 31, 2013. The Company had three customers that made up more than 10% of contract receivables as of December 31, 2014. Contract receivables from these customers were approximately $6,378,000, or 58%, of total receivables at December 31, 2014. The Company monitors the contract receivables on an ongoing basis. Income Taxes The Company, with the consent of its stockholders, has elected to be taxed under sections of the federal and state income tax laws as an S corporation which provide that, in lieu of corporate income taxes, the stockholders separately account for their pro rata shares of the Company's items of income, deductions, losses and credits. Therefore, the consolidated financial statements for periods covered by this election will not include a provision for corporate income taxes except for certain state franchise and income taxes. No provision has been made for any amounts which may be advanced or paid to the stockholders to assist them in paying their personal income taxes on the income of the Company. The Company's practice is to pay distributions which will assist the stockholders in meeting their tax liability on the Company's activity. Cash and Cash Equivalents For the purpose of the cash flow statements, the Company considers all highly liquid investments purchased with a maturity of three months or less to be cash equivalents. • 3. Costs and Estimated Earnings on Uncompleted Contracts Costs and estimated earnings on uncompleted contracts at December 31, 2014 and 2013 are as follows: 2014 2013 Cost incurred on uncompleted contracts $ 185,595,419 $ 141,923,693 Estimated losses (6,214,126) (3,617,418) Less: Billings to date (176,902,199) (138,223,339) Total $ 2,479,094 $ 82,936 The above is included in the accompanying balance sheets under the following captions: 2014 2013 Costs and estimated earnings in excess of billings on uncompleted contracts $ 3,204,149 $ 3,702,507 Billings in excess of costs and estimated earnings on uncompleted contracts (725,055) (3,619,571) Total $ 2,479,094 $ 82,936 12 FHP Tectonics Corp. Notes to Consolidated Financial Statements Total contract value on uncompleted contracts at December 31, 2014 and 2013 was approximately $189,897,000 and $188,223,000, respectively. The Company has incurred net losses for the years ended December 31, 2014 and 2013 which were primarily the result of material contract losses incurred in one jurisdiction. The Company has re-evaluated future contract work in that jurisdiction, resulting in contract work which will be on a smaller scale and management expects it to be profitable. 4. Property and Equipment Property and equipment consist of the following at December 31, 2014 and 2013: December 31, 2014 2013 Construction equipment $ 715,928 $ 715,928 Furniture and fixtures 65,546 65,546 Vehicles 510,635 510,635 Leasehold improvements 106,427 106,427 Computer hardware and software 14,545 14,545 1,413,081 1,413,081 Less: Accumulated depreciation (1,273,655) (1,202,443) Total $ 139,426 $ 210,638 Depreciation expense was approximately $71,000 and $70,000 for the years ended December 31, 2014 and 2013, respectively. 5. Line of Credit The Company and its affiliates, F.H. Paschen, S.N. Nielsen, Inc., F.H. Paschen, S.N. Nielsen Et Associates LLC, Westcoast Corp., FHP Management, Inc., and Stalworth Underground LLC, have an uncollateralized $50,000,000 line of credit under a loan and security agreement which expires July 31, 2015. Covenants of the agreement require the Company and its aforementioned affiliates, among other things, to maintain a minimum combined tangible net worth, a minimum ratio of current assets to current liabilities and a minimum EBITDA. The Company and its affiliates may make distributions provided that they are in compliance with the above noted covenants and, if the line of credit has an outstanding balance, the lender is notified as required by the agreement. The date and principal amount of each revolving loan made are evidenced by a promissory note. The interest rate is the greater of the prime rate minus 0.5% or 2.0%. At December 31, 2014, the prime rate was 3.25% and the effective interest rate on the line of credit was 2.75%. The Company had no outstanding borrowings under this agreement at December 31, 2014 or 2013, while affiliates of the Company had borrowings of $18,600,000 and $16,000,000 at December 31, 2014 and 2013, respectively. As a result of the affiliates' borrowings, there was $31,400,000 and $34,000,000 available under the line at December 31, 2014 and 2013, respectively. Subsequent to December 31, 2014, the affiliates repaid all borrowings on the line of credit. At April 21, 2015, there were no borrowings outstanding and $50,000,000 was available under the line. By stockholder agreement dated January 2, 1997 (the "Agreement"), upon the death or permanent disability of any stockholder, the executor, administrator or personal representative of that stockholder shall have a five-year option to sell to the Company the shares owned. If the 13 FHP Tectonics Corp. Notes to Consolidated Financial Statements option is not exercised within the five years, the Company may buy the shares in accordance with the Agreement. If a stockholder terminates employment, the Company will buy the shares in a lump sum payment or in installments as allowed by the Agreement. During 2014, an agreement was reached between the Company and a former stockholder, settling the former stockholder's full equity interest in the Company consisting of 20 shares of Class B common stock for $90,000. There were no stockholder redemptions during 2013. 7. Related-Party Transactions The Company had a decrease in affiliated company P a ables at December 31, 2014 compared to December 3 1, 20 1 3 due to t h e timing of payments o n outstanding affil i ate bala n ces, subcontract act work performed by affiliates, interest on affiliated company payables and the allocation of office rent (see Note 11). The Company recognized interest income of approximately $43,000 and $26,000 in 2014 and 2013, respectively, related to outstanding affiliated company payables. 8. Investment in Unconsolidated Joint Venture On July 28, 2006, the Company and IHC Construction Companies, L.L.C. ("INC") formed a joint venture called "IHC Construction/FHP Tectonics, A Joint Venture" (the "Venture"), to perform hydraulic improvements at a water reclamation plant in Chicago (the "Contract"). The Company owns 51% of the Venture, however, the managing Venturer is IHC Construction and, therefore, the Venture is accounted for using the equity method. The Company's share of income from the Venture for the year ended December 31, 2013 was $5,609. The contract work of the Venture was completed during 2012 and the remaining joint venture equity was disbursed to the Venturers during 2013. As a result, the Venture no longer existed as of December 31, 2013. 9. Employee Benefits The Company co-sponsors an employee retirement and savings plan covering certain employees of the Company and affiliated companies. Company contributions to the plan are at the discretion of the Company's Executive Management. The Company made contributions to the plan of $26,000 and $18,750 in 2014 and 2013, respectively. 10. Self-Insurance The Company and its affiliates are self-insured for a portion of their workers' compensation, general liability and health insurance. An insurance policy limits the aggregate claims the Company and its affiliates may pay, up to $500,000 per individual per year for workers' compensation and $250,000 per occurrence for general liability, not to exceed an aggregate cap of approximately $6,751,000. A health insurance policy limits the aggregate claims the Company and its affiliates may pay, up to $160,000 per covered individual per year, not to exceed an aggregate cap of approximately $3,084,000. 14 FHP Tectonics Corp. Notes to Consolidated Financial Statements 11. Leases The Company has an office operating lease agreement with a third party which expires in October 2017. The future minimum lease commitments are as follows: Year ending December 31, 2015 $ 104,000 2016 104,000 2017 80,000 $ 288,000 Rent expense for a third party operating lease was approximately $104,000 and $104,000 during the years ended December 31, 2014 and 2013, respectively. Rent expense for office space allocated to the Company from a related party was approximately $25,000 and $43,000 during the years ended December 31, 2014 and 2013, respectively. 12. Commitments and Contingencies The Company is subject to various legal proceedings and claims that have arisen in the ordinary course of business. These actions when ultimately concluded will not, in the opinion of management, have a material adverse effect upon the financial position or liquidity of the Company. 13. Subsequent Events The Company has evaluated subsequent events through April 21, 2015, the date the consolidated financial statements were approved for issuance by management. Subsequent to year-end, all affiliated company borrowings on the line of credit were paid in full. 15 ATTACHMENT D Insurance BID NO: 2015-191-YG CITYOF MIAMI BEACH MIAMI BEACH 12 APPENDIX A-1 : Form of Performance Bond 1 BID NO: 2015-191-YG CITYOF MIAMI BEACH MIAMI BEACH 13 ■ A-1 FORM OF PERFORMANCE BOND BY THIS BOND, We , as Principal, hereinafter called Contractor , and , as Surety, are bound to the City of Miami Beach, Florida, as Obligee, hereinafter called City, in the amount of Dollars ($ ) for the payment whereof Contractor and Surety bind themselves, their heirs, executors, administrators, successors and assigns, jointly and severally. WHEREAS, Contractor has by written agreement entered into a Contract, Bid/Contract No.: , awarded the day of , 20 , with City which Contract Documents are by reference incorporated herein and made a part hereof, and specifically include provision for liquidated damages, and other damages identified, and for the purposes of this Bond are hereafter referred to as the "Contract"; THE CONDITION OF THIS BOND is that if Contractor: 1. Performs the Contract between Contractor and City for construction of , the Contract being made a part of this Bond by reference, at the times and in the manner prescribed in the Contract; and 2. Pays City all losses, liquidated damages, expenses, costs and attorney's fees including appellate proceedings, that City sustains as a result of default by Contractor under the Contract; and 3. Performs the guarantee of all work and materials furnished under the Contract for the time specified in the Contract; then THIS BOND IS VOID, OTHERWISE IT REMAINS IN FULL FORCE AND EFFECT. Whenever Contractor shall be, and declared by City to be, in default under the Contract, City having performed City obligations thereunder, the Surety may promptly remedy the default, or shall promptly: 3.1. Complete the Project in accordance with the terms and conditions of the Contract Documents; or 3.2. Obtain a bid or bids for completing the Project in accordance with the terms and conditions of the Contract Documents, and upon determination by Surety of the lowest responsible Bidder, or, if City elects, upon determination by City and Surety jointly of the lowest responsible Bidder, arrange for a contract between such Bidder and City, and make available as work progresses (even though there should be a default or a succession of defaults under the Contract BID NO: 2015-191-YG CITYOF MIAMI BEACH MIAMI BEACH 14 A-1 FORM OF PERFORMANCE BOND (Continued) or Contracts of completion arranged under this paragraph) sufficient funds to pay the cost of completion less the balance of the Contract Price; but not exceeding, including other costs and damages for which the Surety may be liable hereunder, the amount set forth in the first paragraph hereof. The term "balance of the Contract Price," as used in this paragraph, shall mean the total amount payable by City to Contractor under the Contract and any amendments thereto, less the amount properly paid by City to Contractor. No right of action shall accrue on this bond to or for the use of any person or corporation other than City named herein. The Surety hereby waives notice of and agrees that any changes in or under the Contract Documents and compliance or noncompliance with any formalities connected with the Contract or the changes does not affect Surety's obligation under this Bond. Signed and sealed this day of , 20 WITNESSES: (Name of Corporation) Secretary By: (Signature) (CORPORATE SEAL) (Print Name and Title) IN THE PRESENCE OF: INSURANCE COMPANY: By: Agent and Attorney-in-Fact Address: (Street) (City/State/Zip Code) Telephone No.: BID NO: 2015-191-YG CITYOF MIAMI BEACH MIAMI BEACH 15 APPENDIX A-2: Form of Payment Bond BID NO: 2015-191-YG CITYOF MIAMI BEACH MIAMI BEACH 16 A-2 FORM OF PAYMENT BOND BY THIS BOND, We , as Principal, hereinafter called Contractor , and , as Surety, are bound to the City of Miami Beach, Florida, as Obligee, hereinafter called City, in the amount of Dollars ($ ) for the payment whereof Contractor and Surety bind themselves, their heirs, executors, administrators, successors and assigns, jointly and severally. WHEREAS, Contractor has by written agreement entered into a Contract, Bid/Contract No.: , awarded the day of , 20 , with City which Contract Documents are by reference incorporated herein and made a part hereof, and specifically include provision for liquidated damages, and other damages identified, and for the purposes of this Bond are hereafter referred to as the "Contract"; THE CONDITION OF THIS BOND is that if Contractor: 1. Pays City all losses, liquidated damages, expenses, costs and attorney's fees including appellate proceedings, that City sustains because of default by Contractor under the Contract; and 2. Promptly makes payments to all claimants as defined by Florida Statute 255.05(1) for all labor, materials and supplies used directly or indirectly by Contractor in the performance of the Contract; THEN CONTRACTOR'S OBLIGATION SHALL BE VOID; OTHERWISE, IT SHALL REMAIN IN FULL FORCE AND EFFECT SUBJECT, HOWEVER, TO THE FOLLOWING CONDITIONS: 2.1. A claimant, except a laborer, who is not in privity with Contractor and who has not received payment for its labor, materials, or supplies shall, within forty-five (45) days after beginning to furnish labor, materials, or supplies for the prosecution of the work, furnish to Contractor a notice that he intends to look to the bond for protection. 2.2. A claimant who is not in privity with Contractor and who has not received payment for its labor, materials, or supplies shall, within ninety (90) days after performance of the labor or after complete delivery of the materials or supplies, deliver to Contractor and to the Surety, written notice of the performance of the labor or delivery of the materials or supplies and of the nonpayment. 2.3. No action for the labor, materials, or supplies may be instituted against Contractor or the Surety unless the notices stated under the preceding conditions (2.1) and (2.2) have been given. 2.4. Any action under this Bond must be instituted in accordance with the Notice and Time Limitations provisions prescribed in Section 255.05(2), Florida Statutes. BID NO: 2015-191-YG CITYOF MIAMI BEACH MIAMI BEACH 17 A-2 The Surety hereby waives notice of and agrees that any changes in or under the Contract Documents and compliance or noncompliance with any formalities connected with the Contract or the changes does not affect the Surety's obligation under this Bond. Signed and sealed this day of , 20 Contractor ATTEST: (Name of Corporation) By: (Secretary) (Signature) (Corporate Seal) (Print Name and Title) day of , 20 IN THE PRESENCE OF: INSURANCE COMPANY: By: Agent and Attorney-in-Fact Address: (Street) (City/State/Zip Code) Telephone No.: BID NO: 2015-191-YG CITYOF MIAMI BEACH MIAMI BEACH 18 APPENDIX A-3: Certificate of Corporate Principle BID NO: 2015-191-YG CITYOF MIAMI BEACH MIAMI BEACH 19 A-3 CERTIFICATE AS TO CORPORATE PRINCIPAL I, , certify that I am the Secretary of the corporation named as Principal in the foregoing Performance and Payment Bond (Performance Bond and Payment Bond); that , who signed the Bond(s) on behalf of the Principal, was then of said corporation; that I know his/her signature; and his/her signature thereto is genuine; and that said Bond(s) was (were) duly signed, sealed and attested to on behalf of said corporation by authority of its governing body. (SEAL) Secretary(on behalf of) Corporation STATE OF FLORIDA ) SS COUNTY OF MIAMI-DADE ) Before me, a Notary Public duly commissioned, qualified and acting personally, appeared to me well known, who being by me first duly sworn upon oath says that he/she has been authorized to execute the foregoing Performance and Payment Bond (Performance Bond and Payment Bond) on behalf of Contractor named therein in favor of City. Subscribed and Sworn to before me this day of , 20 My commission expires: Notary Public, State of Florida at Large Bonded by BID NO: 2015-191-YG CITYOF MIAMI BEACH MIAMI BEACH 20 APPENDIX A-4: Performance and Payment Guaranty Form: Unconditional Letter of Credit BID NO: 2015-191-YG CITYOF MIAMI BEACH MIAMI BEACH 21 A-4 PERFORMANCE AND PAYMENT GUARANTY FORM UNCONDITIONAL LETTER OF CREDIT: Date of Issue Issuing Bank's No. Beneficiary: Applicant: City of Miami Beach Amount: 1700 Convention Center Drive in United States Funds Miami Beach, Florida 33139 Expiry: (Date) Bid/Contract Number We hereby authorize you to draw on (Bank, Issuer name) at by order (branch address) of and for the account of (contractor, applicant, customer) up to an aggregate amount, in United States Funds, of available by your drafts at sight, accompanied by: 1. A signed statement from the City Manager or his authorized designee, that the drawing is due to default in performance of certain obligations on the part (contractor, applicant, customer) agreed upon by and between the City of Miami Beach, Florida and (contractor), pursuant to the (applicant, customer) Bid/Contract No. for (name of project) and Section 255.05, Florida Statutes. Drafts must be drawn and negotiated not later than (expiration date) Drafts must bear the clause: "Drawn under Letter of Credit No. (Number), of (Bank name) dated This Letter of Credit shall be renewed for successive periods of one (1) year each unless we provide the City of Miami Beach with written notice of our intent to terminate the credit herein extended, which notice must be provided at least thirty (30) days prior to the expiration date of the original term hereof or any renewed one (1) year term. Notification to the City that this Letter of Credit will expire prior to performance of the contractor's obligations will be deemed a default. This Letter of Credit sets forth in full the terms of our undertaking, and such undertaking shall not in any way be modified, or amplified by reference to any documents, instrument, or agreement referred to herein or to which this Letter of Credit is referred or this Letter of Credit BID NO: 2015-191-YG CITYOF MIAMI BEACH MIAMI BEACH 22 A-4 relates, and any such reference shall not be deemed to incorporate herein by reference any document, instrument, or agreement. We hereby agree with the drawers, endorsers, and bona fide holders of all drafts drawn under and in compliance with the terms of this credit that such drafts will be duly honored upon presentation to the drawee. Obligations under this Letter of Credit shall be released one (1) year after the Final Completion of the Project by the (contractor, applicant, customer) This Credit is subject to the "Uniform Customs and Practice for Documentary Credits," International Chamber of Commerce (1993 revision), Publication No. 500 and to the provisions of Florida law. If a conflict between the Uniform Customs and Practice for Documentary Credits and Florida law should arise, Florida law shall prevail. If a conflict between the law of another state or country and Florida law should arise, Florida law shall prevail. Authorized Signature BID NO: 2015-191-YG CITYOF MIAMI BEACH MIAMI BEACH 23 APPENDIX A-5: Certificate of Substantial Completion BID NO: 2015-191-YG CITYOF MIAMI BEACH MIAMI BEACH 24 A-5 CERTIFICATE OF SUBSTANTIAL COMPLETION: PROJECT: Consultant: (name, address) BID/CONTRACT NUMBER: TO (City): Contractor : CONTRACT FOR: NOTICE TO PROCEED DATE: DATE OF ISSUANCE: PROJECT OR DESIGNATED PORTION SHALL INCLUDE: The Work performed under this Contract has been reviewed and found to be substantially complete and all documents required to be submitted by Contractor under the Contract Documents have been received and accepted. The Date of Substantial Completion of the Project or portion thereof designated above is hereby established as which is also the date of commencement of applicable warranties required by the Contract Documents, except as stated below. DEFINITION OF DATE OF SUBSTANTIAL COMPLETION The Date of Substantial Completion of the Work or portion thereof designated by City is the date certified by Consultant when all conditions and requirements of permits and regulatory agencies have been satisfied and the Work, is sufficiently complete in accordance with the Contract Documents, so the Project is available for beneficial occupancy by City. A Certificate of Occupancy must be issued for Substantial Completion to be achieved, however, the issuance of a Certificate of Occupancy or the date thereof are not to be determinative of the achievement or date of Substantial Completion. A list of items to be completed or corrected, prepared by Consultant and approved by City, is attached hereto. The failure to include any items on such list does not alter the responsibility of Contractor to complete all work in accordance with the Contract Documents. The date of commencement of warranties for items on the attached list will be the date of final payment unless otherwise agreed in writing. BID NO: 2015-191-YG CITYOF MIAMI BEACH MIAMI BEACH 25 A-5 Consultant BY DATE In accordance with Section 2.2 of the Contract, Contractor will complete or correct the work on the list of items attached hereto within from the above Date of Substantial Completion. Consultant BY DATE City, through the Contract Administrator, accepts the Work or portion thereof designated by City as substantially complete and will assume full possession thereof at (time) on (date). City of Miami Beach, Florida By Contract Administrator Date The responsibilities of City and Contractor for security, maintenance, heat, utilities, damage to the work and insurance shall be as follows: BID NO: 2015-191-YG CITYOF MIAMI BEACH MIAMI BEACH 26 APPENDIX A-6: Final Certificate of Payment BID NO: 2015-191-YG CITYOF MIAMI BEACH MIAMI BEACH 27 A-6 FINAL CERTIFICATE OF PAYMENT: PROJECT: Consultant: (name, address) BID/CONTRACT NUMBER: TO (City): Contractor: CONTRACT FOR: NOTICE TO PROCEED DATE: DATE OF ISSUANCE: All conditions or requirements of any permits or regulatory agencies have been satisfied. The documents required by Section 5.2 of the Contract, and the final bill of materials, if required, have been received and accepted. The Work required by the Contract Documents has been reviewed and the undersigned certifies that the Work, including minor corrective work, has been completed in accordance with the provision of the Contract Documents and is accepted under the terms and conditions thereof. Consultant BY DATE City, through the Contract Administrator, accepts the work as fully complete and will assume full possession thereof at (time) (date) City of Miami Beach, Florida By Contract Administrator Date BID NO: 2015-191-YG CITYOF MIAMI BEACH MIAMI BEACH 28 APPENDIX A-7: Form of Final Receipt BID NO: 2015-191-YG CITYOF MIAMI BEACH MIAMI BEACH 29 A-7 FORM OF FINAL RECEIPT: [The following form will be used to show receipt of final payment for this Contract.] FINAL RECEIPT FOR CONTRACT NO. Received this day of , 20 , from City of Miami Beach, Florida, the sum of Dollars ($ ) as full and final payment to Contractor for all work and materials for the Project described as: This sum includes full and final payment for all extra work and material and all incidentals. Contractor hereby indemnifies and releases City from all liens and claims whatsoever arising out of the Contract and Project. Contractor hereby certifies that all persons doing work upon or furnishing materials or supplies for the Project have been paid in full. In lieu of this certification regarding payment for work, materials and supplies, Contractor may submit a consent of surety to final payment in a form satisfactory to City. Contractor further certifies that all taxes imposed by Chapter 212, Florida Statutes (Sales and Use Tax Act), as amended, have been paid and discharged. [If incorporated sign below.] Contractor ATTEST: (Name of Corporation) By: (Secretary) (Signature) (Corporate Seal) (Print Name and Title) day of , 20 [If not incorporated sign below.] Contractor WITNESSES: (Name of Firm) By: (Signature) (Print Name and Title) day of 20 BID NO: 2015-191-YG CITYOF MIAMI BEACH MIAMI BEACH 30