HomeMy WebLinkAboutRD GOTTBTATH PARKWAY PHASE II IMPROVEMENTS PROJECTS EXCEL EXCAVATING, INC.
13.0 BID FORMS
NOTE: INSERT AND ATTACH TO FORM 96, DO NOT USE THE
CONTRACTOR'S BID SECTION ON FORM 96. BE SURE TO SIGN
BID, NOTARIZE BID AND EXFCUTE NON-COLLUSION
AFFIDAVIT.
CONTRACTOR'S BID FORM
JEFFERSONVTT.LE REDEVELOPMENT COMMISSION
500 QUARTERMASTER COURT
JEFFERSONVILLE,INDIANA 47130
RE: GOTTBRATH PARKWAY PHASE II IMPROVEMENTS PROJECT
JOB NO. 16031
Gentlemen:
We submit, herewith, our sealed proposal to furnish all necessary labor, material and
equipment to construct the above captioned project, in accordance with the subject plans and
specifications at the unit prices listed herein.
VVe acknowledge: Addendum#1 dated September 14, 2018
Addendum#2 dated September 18, 2018
A-205
S:\projects\16031-Bridgepoint Commons\Specifications-Phase 2\Section A-'.doc
EXCEL EXCAVATING, INC.
BID FOR
4
GOTTBRATH PARKWAY PHASE II IMPROVEMENTS PROJECT
JOB NO. 16031
CITY OF JEFFERSONVILLE
CLARK COUNTY, INDIANA
RESPECTFULLY SUBMI IThD,
EXCEL EXCAVATING, INC.
NAME OF FI'
../ .-?P'f '' ..../
PERSON : William -. 'cc-a, Vice President
PERSON ' �
ll
A N" ST : Greg Dennis, Estimator/PM
September 19, 2018
DAU
Accepted this / day of &10 f ; 2018
REDEVELOPMENT COMMISSION
CITY JEFFERSONVILLF,,,INDIANA
ion:
I
G'ty Snelling, resi.- t
A-206
S:\projects\16031-Bridgepoint Commons\Specifications-Phase 2\BID FOR.doc
EXCEL EXCAVATING, INC.
City of Jeffersonville Job No. 16031
Gottbrath Parkay Phase II Improvements
ITEM DESCRIPTION QUANTITY UNIT UNIT PRICE TOTAL COST
INSTALLED
1 Mobilization and Demobilization 1 LS $ 26,000.00 $ 26,000.00
2 Construction Engineering&Stakeout 1 LS $ 24,300.00 $ 24,300.00
3 Clearing of Right-of-Way 1 LS $ 25,000.00 $ 25,000.00
4 Maintenance of Traffic 1 LS $ 5,000.00 $ 5,000.00
5 Erosion Control 1 LS $ 16,000.00 $ 16,000.00
6 Common Excavation 19,800 CYS 5 6.00 $ 118,800.00
7 HMA Surface,Type B 1,000 TON $ 60.00 $ 60,000.00
8 HMA Intermediate,Type B 1,675 TON 5 52.00 $ 87,100.00
9 HMA Base,Type B 2,680 TON $ 48.50 $ 129,980.00
10 Asphalt for Tack Coat 6.0 TON $ 600.00 $ 3,600.00
11 Compacted Aggregate,No.53,Base 5,480 TON 5 15.50 $ 84,940.00
12 Subgrade Treatment,Type 1B 13,500 SYS $ 5.74 $ 77,490.00
13 Shot Rock 8,420 TON $ 8.25 $ 69,465.00
14 Geotextile for Shot Rock 8,420 SYS $ 1.25 $ 10,525.00
15 Concrete Curb and Gutter,2'-0"Width 5,440 LFT $ 14.50 $ 78,880.00
16 6"Perforated Underdrain 3,100 LFT $ 10.00 $ 31,000.00
17 4"Thick Concrete Sidewalk 3,000 SYS 5 36.00 $ 108,000.00
18 Concrete Curb Ramp 4 EA $ 1,000.00 $ 4,000.00
19 9"PCCP for Driveways 165 SYS 5 87.00 $ 14,355.00
20 10'x6'Precast Concrete Box Culvert 140 LFT $ 618.00 $ 86,520.00
21 24"Storm Sewer 23 LFT $ 90.00 5 2,070.00
22 18"Storm Sewer 840 LFT $ 30.00 $ 25,200.00
23 15"Storm Sewer 860 LFT $ 26.00 $ 22,360.00
24 12"Storm Sewer 1,330 LFT $ 28.00 5 37,240.00
25 Modified INDOT Inlet Type J-10 19 EA $ 1,450.00 $ 27,550.00
26 Modified INDOT Inlet Type M-10 19 EA $ 1,450.00 $ 27,550.00
27 Modified INDOT Inlet Type C-15 2 EA $ 1,800.00 $ 3,600.00
28 Headwall with Wingwalls for 10'x6'Box Culvert 2 EA $ 13,000.00 $ 26,000.00
29 Concrete,Class A,Footer for Box Culvert 5 CYS $ 740.00 5 3,700.00
30 Revetment Rip-Rap, 18" 100 SYS $ 50.00 $ 5,000.00
31 12"PVC Sanitary Sewer 2,660 LFT $ 70.00 $ 186,200.00
32 8"PVC Sanitary Sewer 935 LFT $ 75.00 $ 70,125.00
33 Sanitary Manhole Type'B' 11 EA $ 3,090.00 $ 33,990.00
34 Sanitary Manhole with External Drop Connection 1 EA $ 5,700.00 $ 5,700.00
35 2"Lighting Conduit with Pull String 5,230 LFT $ 7.75 $ 40,532.50
36 18"PVC Casing 360 LFT $ 95.00 $ 34,200.00
37 Conduit Bank-3-6"Conduit 2,720 LFT $ 19.00 $ 51,680.00
38 6"PVC Conduit 2,720 LFT $ 6.00 $ 16,320.00
6"PVC Conduit(undistributed amount for $ 2,160.00
39 utility crossings,locations to be determined) 180 LFT $ 12.00
40 Water Main,PVC pipe,12" 1,020 LFT $ 40.00 $ 40,800.00
41 Water Main Hydrant Assembly and Valve 4 EA $ 4,150.00 $ 16,600.00
42 Water Main,Valve,12" 4 EA $ 2,200.00 $ 8,800.00
43 20"x12"Tapping Sleeve and Valve 5 EA $ 7,000.00 $ 35,000.00
Pavement Message Marking,Lane Indication $ 1,320.00
44 Arrow 12 EA $ 110.00
45 Pavement Message Marking,Word ONLY 2 EA $ 250.00 $ 500.00
46 Transverse Markings,Stop Line,24" 35 LFT $ 12.00 $ 420.00
47 Line,Thermoplastic,Solid,White,4" 100 LFT $ 0.95 $ 95.00
48 Line,Thermoplastic,Solid,Yellow,4" 5,340 LFT $ 0.95 $ 5,073.00
49 Line,Thermoplastic,Broken,Yellow,4" 1,290 LFT $ 0.95 $ 1,225.50
50 Transverse Markings,Crosswalk Line,White,6" 140 LFT $ 3.00 $ 420.00
New Sheet Sign on New Post(Type I, $ 1,290.00
51 Reinforced Anchor Base) 6 EA $ 215.00
52 Remove Existing Sign and Post 2 EA $ 30.00 $ 60.00
A-207(revised 9/18/2018)
i
53 Remove and Replace Ex.Sign with New Sign 1 EA $ 110.00 $ 110.00
54 Sod 2,400 SYS $ 3.25 $ 7,800.00
55 Mulched Seeding 10,820 SYS 5 0.30 $ 3,246.00
56 Landscaping 1 LS $ 20,000.00 $ 20,000.00
57 Erosion Control Blanket 145 SYS $ 2.00 5 290.00
58 Monument,Type B 1 EA $ 1,000.00 $ 1,000.00
59 Sanitary Sewer Closed Circuit Television Inspection 1 LS $ 3,950.00 $ 3,950.00
60 Utility Relocation Allowance 1 LS $ 10,000.00 $ 10,000.00
61 Unidentified Rock Removal 200 CYS $ 160.00 5 32,000.00
62 Undercut/Stabilization of Unsuitable Subgrade(If Required) 880 CYS $ 45.00 5 39,600.00
63 Asphalt Price Adjustment 1 LS $ - $ -
64 Unidentified Conflict Contingency 1 LS $ 50,000.00 5 50,000.00
65 Bore and Jack 24"Sanitary Sewer Casing Pipe 50 LFT $ 750.00 $ 37,500.00
Transverse Markings, Thermoplastic, $ 250.00
66 Crosshatch,Solid, White, 12" 50 LFT $ 5.00
TOTAL BID PRICE=Total of Items 1 thru 66= $ 1,999,482.00
Contractor:EXCEL EXCAVATING,INC.
A-208(revised 9/18/2018)
EXCEL EXCAVATING, INC.
CONTRACTORS STATEMENT OF
UNDERSTANDING OF UTILITY
CONFLICTS & ISSUES
By submitting this bid, we understand the challenges and issues involved with the
potential conflict with existing utilities during the execution of this project. We acknowledge that
the location of the utilities shown may not be accurate; however, our bid takes this into
consideration and we understand that no additional compensation will be made for working
around or near a utility that is not shown on the plans or that is shown incorrectly. Any changes
in the plans due to utilities shall be paid for based on the unit prices provided on the bid form.
Additional contract days may be awarded if deemed necessary by the OWNER.
Our bid price takes into consideration the costs required to coordinate the relocation of
any and all affected utilities, and the potential interruption and delays of operation in
constructing this project. However, it is understood that we, the CONTRACTOR, will not be
held responsible for schedule delays attributable to a given utility company's lack of cooperation
or completion of relocation.
GOTTBRATH PARKWAY PHASE 2
PROJECT NA
S 1:MITTED B
EXCEL EXCAVATING, INC.
CONTRACTOR
William Galligan, Vice President
BY: (Printed Name and Title)
September 19, 2018
DATE
S:\projects\16031-Bridgepoint Commons\Specifications-Phase 2\Utility Conflicts.doc
A-209
EXCEL EXCAVATING, INC.
PROVISIONS REGARDING
EMPLOYMENT OF UNAUTHORIZED ALIENS
As required by IC 22-5-1.7,the Contractor affirms under the penalties of perjury that:
A. It does not knowingly employ an unauthorized alien.
13. The Contractor shall enroll in and verify the work eligibility status of all its newly hired
employees through the E-Verify program as defined in IC 22-5-1.7-3. The Contractor is not
required to participate should the E-Verify program cease to exist.
C. The Contractor shall not knowingly employ or contract with an unauthorized alien. The
Contractor shall not retain an employee or contract with a person that the Contractor subsequently
learns is an unauthorized alien.
D.The Contractor shall require its subcontractors who perform work under this Contract to certify
to the Contractor that the subcontractor does not knowingly employ or contract with an
unauthorized alien and that the subcontractor has enrolled and is participating in the E-Verify
program.The Contractor agrees to maintain this certification throughout the duration of the term of
a contract with a subcontractor.
E.The Town may terminate for default if the Contractor fails to cure a breach of this provision no
later than thirty (30) days after being notified by the Owner.
I, on behalf of myself or the person being awarded this contract, hereby certify that I have read
Indiana Code 5-22-16.5 in its entirety, as enacted and amended and further certify that neither I nor
the person being awarded this contract am engaged in investment activities in Iran as defined in
Indiana Code 5-22-16.5 as enacted and amended.
IGNED
William Galligan
PRINTED NAME
Vice President
TITLE
A-210
I
Selective Insurance Company of America
40 Wantage Avenue
Branchville,New Jersey 07890 B 1206159
973-948-3000
BID BOND
KNOW ALL MEN BY THESE PRESENTS:
That Excel Excavating,Inc.
P 0 Box 412 Sellersburg,IN 47172 (hereinafter called the Principal)
as Principal, and the SELECTIVE INSURANCE COMPANY OF AMERICA, a corporation created and
existing under the laws of the State of New Jersey, with its principal office in Branchville, New Jersey
(hereinafter called the Surety), as Surety,
are held and firmly bound unto Redevelopment Commission of City of Jeffersonville
(hereinafter called the Obligee)
in the full and just sum of 5% Percent of the Total Bid Amount
( 5% ), good and lawful money of the United States of America, to the payments of which sum of
money well and truly to be made, the said Principal and Surety bind themselves, their and each of their heirs,
executors,administrators, successors and assigns,jointly and severally,firmly by these presents.
Signed, sealed and dated this 19th day of September A.D. 2018.
THE CONDITION OF THIS OBLIGATION IS SUCH, That, if the Obligee shall make any award within 60
days to the Principal for
Gottbrath Parkway Phase II Improvements Project
according to the terms of the proposal or bid made by the Principal therefor, and the Principal shall duly make
and enter into a contract with the Obligee in accordance with the terms of said proposal or bid and award and
shall give bond for the faithful performance thereof with Surety or Sureties approved by the Obligee; or if the
Principal shall, in case of failure so to do, pay to the Obligee the damages which the Obligee ma er by
reason of such failure, not exceeding the penalty of this bond, then this obligation shall Will Mitr OW
otherwise it shall be and remain in full force and effect. ````�} X OV e.....,..°• %.
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In Testimony Whereof,the Principal and Surety have caused these presents to be duly sig rckand�se �•,\ i'
Excel Excavating,Inc. = (j) "ATF z
WITNESS: - �' " AL) I
/- - •: SEAQ,.
(If individual or Firm) . �� psi IN I
, e ..••••......6.0,6 46
Prifi lft,1II00-
ATTE
(If Corporation)
SELE IVE INSURANCE COMPANY OF AMERICA ,
Atto S -in-Fact
— ,
Nikki Rutledge
B-201 (1/86) . ��
Selective Insurance Company of America
SELECTIVE ® 40 Wantage Avenue
Branchville,New Jersey 07890 BondNo.B 1206159
973-948-3000
POWER OF ATTORNEY Public Bid
SELECTIVE INSURANCE COMPANY OF AMERICA, a New Jersey corporation having its principal office at 40
Wantage Avenue, in Branchville, State of New Jersey("SICA"),pursuant to Article VII, Section 1 of its By-Laws, which
state in pertinent part:
The Chairman of the Board, President, Chief Executive Officer, any Executive Vice President,
any Senior Vice President or any Corporate Secretary may, from time to time, appoint attorneys
in fact, and agents to act for and on behalf of the Corporation and they may give such appointee
such authority, as his/her certificate of authority may prescribe, to sign with the Corporation's
name and seal with the Corporation's seal, bonds, recognizances, contracts of indemnity and
other writings obligatory in the nature of a bond, recognizance or conditional undertaking, and
any of said Officers may, at any time, remove any such appointee and revoke the power and
authority given him/her.
does hereby appoint Nikki Rutledge
,its true and lawful attomey(s)-in-fact,full authority to execute on SICA's behalf fidelity and surety bonds or undertakings
and other documents of a similar character issued by SICA in the course of its business,and to bind SICA thereby as fully
as if such instruments had been duly executed by SICA's regularly elected officers at its principal office,in amounts or
penalties not exceeding the sum of: Two Million Dollars($2,000,000.00)
Signed this 19th day of September , 2018
SELECTIVE INSURANCE COMPANY OF • ,'t;t CO404�
O ��N„ � 2 kV GOpPORgi�
7.
SEAL 1g
U w ,=,
By._ :26
A Brian C. Sarisky d•\ti�,
przW Its SVP,Strategic Business Units,Commer 1� �'
*
STATE OF NEW JERSEY :
W :ss. Branchville
U COUNTY OF SUSSEX .
On this 19th day of Septemb, 2018 before me,the undersigned officer,personally appeared Brian C«$arislky,,who
acknowledged himself to be the Sr.Vice President of SICA,and that he,as such Sr.Vice President,being it ,, • •
do,executed the foregoing instrument for the purposes therein contained,by signing the name of the cl 1i''
,
as Sr.Vice President and that the same was his free act and deed the free act and deed of SICA. „V- TA
+0 AO), •S
Charlene Kimble / —'
Notary Public of New Jersey / • • s " i P
My Commission Expires&212021 Notary Public % ••
The power of attorney is signed and sealed by facsimile under and by the authority of the following Resoluti6Ii'dtipTd by
the Board of Directors of SICA at a meeting duly called and held on the 6th of February 1987,to wit:
"RESOLVED,the Board of Directors of Selective Insurance Company of America authorizes and approves the use of a
facsimile corporate seal,facsimile signatures of corporate officers and notarial acknowledgements thereof on powers of
attorney for the execution of bonds,recognizances,contracts of indemnity and other writing obligatory in the nature of a
bond,recognizance or conditional undertaking."
CERTIFICATION % CQ%
I do hereby certify as SICA's Corporate Secretary that the foregoing extract of SICA's By-Laws and Reso'i .viSagft4S4
force and effect and this Power of Attorney issued pursuant to and in accordance with the By-Laws is val ' SEAL
1926 2Signed this 19th day of September , 2018 . 0 si I" •••
cgo dr 4 li/P Air lie JEO
hael H. Lanza,SICA Corporate ecretary
IImportant Notice: If the bond number embedded within the Notary Seal does not match the number in the upper B91(4-14)
right-hand corner of this Power of Attorney,contact us at 973-948-3000.
CONTRACTOR'S BID FOR PUBLIC WORK - FORM 96
a� ` State Form 52414(R2/2-13)/Form 96(Revised 2013)
r>.,._ Prescribed by State Board of Accounts
PART I
(To be completed for all bids. Please type or print)
Date (month, day, year): September 19, 2018
1. Governmental Unit (Owner): City of Jeffersonville Redevelopment Commission
2. County : Clark
3. Bidder(Firm): EXCEL EXCAVATING, INC.
Address: PO Box 412
City/State/ZlPcode: Sellersburg, IN 47172
4. Telephone Number: 812-246-0857
5. Agent of Bidder (if applicable):
Pursuant to notices given, the undersigned offers to furnish labor and/or material necessary to complete
the public works project of GOTTBRATH PARKWAY PHASE 2
(Governmental Unit) in accordance with plans and specifications prepared by Jacobi, Toombs & Lanz, Inc.
and dated August 31, 2018 for the sum of
On( , 11r4e hvnd,.exrt t 4-/h,%�t ��ivvs4.�.d, $ i,9q9,4 ..oo
r Av,d red 1,4/;? faro do,yc a '"‘/.4o.
The undersigned further agrees to furnish a bond or certified check with this bid for an amount specified in the
notice of the letting. If alternative bids apply, the undersigned submits a proposal for each in accordance with the
notice. Any addendums attached will be specifically referenced at the applicable page.
If additional units of material included in the contract are needed, the cost of units must be the same as
that shown in the original contract if accepted by the governmental unit. If the bid is to be awarded on a unit
basis, the itemization of the units shall be shown on a separate attachment.
The contractor and his subcontractors, if any, shall not discriminate against or intimidate any employee,
or applicant for employment, to be employed in the performance of this contract, with respect to any matter
directly or indirectly related to employment because of race, religion, color, sex, national origin or ancestry.
Breach of this covenant may be regarded as a material breach of the contract.
CERTIFICATION OF USE OF UNITED STATES STEEL PRODUCTS
(If applicable)
I, the undersigned bidder or agent as a contractor on a public works project, understand my statutory
obligation to use steel products made in the United States (I.C. 5-16-8-2). I hereby certify that I and all
subcontractors employed by me for this project will use U.S. steel products on this project if awarded. I
understand that violations hereunder may result in forfeiture of contractual payments.
ACCEPTANCE
The above bid is accepted this 26.,- 7t1 day of ----o1" -,ye-l<' 24fS, subject to the
following conditions: NaNe
Contreytting Authorit Members: N./cr,, '-.2.sb,v✓>/ie, ,e&c-614 ) �� - -v 4{-wv
//1/7
PART II
(For projects of$150,000 or more— IC 36-1-12-4)
Governmental Unit: City of Jeffersonville Redevelopment Commission
Bidder(Firm) EXCEL EXCAVATING, INC.
Date (month, day, year): September 19, 2018
These statements to be submitted under oath by each bidder with and as a part of his bid.
Attach additional pages for each section as needed.
SECTION I EXPERIENCE QUESTIONNAIRE
1. What public works projects has your organization completed for the period of one (1)year prior to the
date of the current bid?
Completion
Contract Amount Class of Work Date Name and Address of Owner
ATTACHMENT A
2. What public works projects are now in process of construction by your organization?
Expected
Contract Amount Class of Work Completion Name and Address of Owner
Date
ATTACHMENT B
3. Have you ever failed to complete any work awarded to you? No. If so, where and why?
4. List references from private firms for which you have performed work.
Silver Creek Water
Watson Water
Indiana American Water
E&B Paving
Hall Contracting of Kentucky
SECTION II PLAN AND EQUIPMENT QUESTIONNAIRE
1. Explain your plan or layout for performing proposed work. (Examples could include a narrative of when
you could begin work, complete the project, number of workers, etc. and any other information which you
believe would enable the governmental unit to consider your bid.)
Locate utilities, layout project, perform cuts and fills, install underground utilities,
stabilized subbase, underdrain, aggregate base/curb, HMA Base & Intermediate,
grade behind curb, install sidewalk, landscaping, seed/sod, then pave surface,
stripe and sign.
2. Please list the names and addresses of all subcontractors (i.e. persons or firms outside your own firm
who have performed part of the work)that you have used on public works projects during the past five (5)
years along with a brief description of the work done by each subcontractor.
HTA Enterprises-Louisville, KY Drill & Shoot Rock
R & J Horizontal-Nicholasville, KY Bore & Jack Casing
Earth Images-Floyd Knobs, IN Landscape,Seed & Sod
E&B Paving-Clarksville, IN Asphalt Paving
Atlantic Construction, Louisville, KY Pavement Markings
3. If you intend to sublet any portion of the work, state the name and address of each subcontractor,
equipment to be used by the subcontractor, and whether you will require a bond. However, if you are
unable to currently provide a listing, please understand a listing must be provided prior to contract
approval. Until the completion of the proposed project, you are under a continuing obligation to
immediately notify the governmental unit in the event that you subsequently determine that you will use a
subcontractor on the proposed project.
L.L. Patel - Fled Kru4s , 4)
,e r
40-2.,,A41.I - Nc4lar,71e, //y 40 Awl h9 're
'S r/,�,�s/Q f - "4y sVr//i //V 41c/ 40-acd
4. What equipment do you have available to use for the proposed project? Any equipment to be used by
subcontractors may also be required to be listed by the governmental unit.
ATTACHMENT C
5. Have you entered into contracts or received offers for all materials which substantiate the prices used in
preparing your proposal? If not, please explain the rationale used which would corroborate the prices
listed.
Yes.
SECTION III CONTRACTOR'S FINANCIAL STATEMENT
Attachment of bidder's financial statement is mandatory. Any bid submitted without said financial
statement as required by statute shall thereby be rendered invalid. The financial statement provided hereunder to
the governing body awarding the contract must be specific enough in detail so that said governing body can make
a proper determination of the bidder's capability for completing the project if awarded.
SECTION IV CONTRACTOR'S NON - COLLUSION AFFIDAVIT
The undersigned bidder or agent, being duly sworn on oath, says that he has not, nor has any other
member, representative, or agent of the firm, company, corporation or partnership represented by him, entered
into any combination, collusion or agreement with any person relative to the price to be bid by anyone at such
letting nor to prevent any person from bidding nor to include anyone to refrain from bidding, and that this bid is
made without reference to any other bid and without any agreement, understanding or combination with any other
person in reference to such bidding.
He further says that no person or persons, firms, or corporation has, have or will receive directly or
indirectly, any rebate, fee, gift, commission or thing of value on account of such sale.
SECTION V OATH AND AFFIRMATION
I HEREBY AFFIRM UNDER THE PENALTIES FOR PERJURY THAT THE FACTS AND INFORMATION
CONTAINED IN THE FOREGOING BID FOR PUBLIC WORKS ARE TRUE AND CORRECT.
Dated at 11:30AM EST this 19th day of September 2018
EXCEL EXCAVATING, INC.
(Name of Organization)
By /
William Galligan, Vice President
(Title of Person Signing)
ACKNOWLEDGEMENT
STATE OF INDIANA
CLARK )ss
COUNTY OF )
Before me, a Notary Public, personally appeared the above-named William Galligan and
swore that the statements contained in the foregoing document are true and correct.
""
19th
Subscribed and sworn to before me this day of Se ptembe 2018
0\14-. .
P !c
.44
My Commission Expires: March 31, 2022 %" -•
County of Residence: CLARK
Part of State Form 52414(R2/2-13)/Form 96(Revised 2013)
BID OF
EXCEL EXCAVATING, INC.
(Contractor)
PO Box 412
(Address)
Sellersburg, IN 47172
FOR
PUBLIC WORKS PROJECTS
OF
GOTTBRATH PARKWAY PHASE 2
Filed
Action taken
Excel Excavating,Inc. and Affiliate
Consolidated Financial Statement
Year Ended December 31,2017
Excel Excavating,Inc. and Affiliate
Table of Contents
Year Ended December 31,2017
Page
Independent Auditor's Report 1 -2
Consolidated Financial Statements
Consolidated Balance Sheet 3
Consolidated Statement of Income 4
Consolidated Statement of Changes in Equity 5
Consolidated Statement of Cash Flow 6
Notes to Consolidated Financial Statement 7- 12
Supplementary Information
Consolidating Balance Sheet
December 31,2017 13
Consolidating Statement of Income
Year Ended December 31,2017 14
Schedule of Contracts in Progress
December 31,2017 15
M*I
CPAs & ADVISORS
Independent Auditor's Report
To the Board of Directors and Stockholders
Excel Excavating,Inc.and Affiliate
We have audited the accompanying consolidated financial statements of Excel Excavating, Inc. (a wholly-owned
subsidiary of GKH Holding, Inc.) and Affiliate (collectively referred to as the "Company"), which comprise the
consolidated balance sheet as of December 31, 2017, and the related consolidated statements of income, changes in
equity and cash flow for the year 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 the 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 is 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 audit.
We conducted our audit 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.
Kentucky MCM CPAs &Advisors LLP
P I F 812.6703400
Indiana 702 North Shore Drive I Suite 500(Jeffersonville, IN 4/130
wvvw.rticrncpa.corn 1888.587.1715
Ohio A Member at PrimeGlabal-An Association of Independent Accounting Firms
Independent Auditor's Report(Continued)
Opinion
In our opinion, the consolidated financial statements referred to above present fairly, in all material respects,
the financial position of Excel Excavating, Inc. and Affiliate as of December 31, 2017, and the results of their
operations and their cash flows for the year then ended in conformity with accounting principles generally accepted
in the United States of America.
Report on Supplementary Information
Our audit was conducted for the purpose of forming an opinion on the consolidated financial statements taken as a
whole. The supplementary information on pages 13 through 15 is presented for the purposes of additional analysis
and is not a required part of the consolidated financial statements. Such information is the responsibility of
management and was derived from and relates directly to the underlying accounting and other records used to prepare
the consolidated financial statements. The information has been subjected to the auditing procedures applied in the
audits of the consolidated financial statements and certain additional procedures,including comparing and reconciling
such information directly to the underlying accounting and other records used to prepare the consolidated financial
statements or to the consolidated financial statements themselves,and other additional procedures in accordance with
auditing standards generally accepted in the United States of America. In our opinion,the information is fairly stated
in all materialeriaalrespects in
relation to the consolidated financial statements taken as a whole.
4,17 1( diNii,1.440e/1.4s t,t.1*
Jeffersonville, Indiana
March 31,2018
-2-
Excel Excavating,Inc.and Affiliate
Consolidated Balance Sheet
December 31,2017
Assets
Current Assets
Cash and cash equivalents $ 873,665
Contract receivables,net 569,889
Costs and estimated earnings in excess of billings 251,683
Current portion of note receivable-related party 1,097,828
Related party receivable 291,728
Prepaid expenses and other current assets 67,235
Total Current Assets 3,152,028
Property and Equipment
Equipment 4,170,884
Vehicles 1,297,3 83
Office equipment 18,845
5,487,112
Less: accumulated depreciation (3,828,261)
Property and Equipment,net 1,658,851
Other Assets
Note receivable-related party,less current portion 400,000
Total Assets $ 5,210,879
Liabilities and Equity
Current Liabilities
Current portion of long-term debt $ 69,831
Accounts payable 144,765
Billings in excess of costs and estimated earnings 59,440
Accrued expenses and deposits 40,981
Shareholder payable 32,904
Total Current Liabilities 347,921
Long-term Debt,less current portion 56,187
Total Liabilities 404,108
Equity
Common stock;no par value;200 shares authorized,
issued and outstanding 200
Additional paid-in capital 47,767
Retained earnings 3,475,843
Members'capital 1,282,961
Total Equity 4,806,771
Total Liabilities and Equity $ 5,210,879
See accompanying notes.
-3-
Excel Excavating, Inc. and Affiliate
Consolidated Statement of Income
Year Ended December 31, 2017
Revenue
Contract revenue $ 6,080,781
Cost of Revenue
Materials 854,070
Labor,taxes,and benefits 1,188,457
Subcontractor costs 1,389,001
Equipment rental 235,347
Indirect job costs 178,489
Depreciation 288,932
Total Cost of Revenue 4,134,296
Gross Profit 1,946,485
Operating Expenses
Office salaries and benefits 517,495
Occupancy expense 224,581
Professional fees 49,264
Other operating expenses 91,324
Total Operating Expenses 882,664
Income From Operations 1,063,821
Other Income (Expense)
Interest income 49,483
Other nonoperating income,net 138
Total Other Income,net 49,621
Net Income $ 1,113,442
See accompanying notes.
-4-
Excel Excavating,Inc.and Affiliate
Consolidated Statement of Changes in Equity
Year Ended December 31,2017
Additional
Common Stock Paid-in Retained Members'
Shares Amount Capital Earnings Capital Total
Balance,December 31,2016,as previously reported 200 $ 200 $ 47,767 $ 2,866,730 $ 1,309,000 $ 4,223,697
Deconsolidation of Sellersburg Properties,LLC - - - - (350,368) (350,368)
Balance,December 31,2016,as restated 200 200 47,767 2,866,730 958,632 3,873,329
Net Income - - - 1,059,113 54,329 1,113,442
Contribution from GKH Holding,Inc. - - - - 270,000 270,000
Distributions to GKH Holding,Inc. - - - (450,000) - (450,000)
Balance,December 31,2017 200 $ 200 $ 47,767 $ 3,475,843 $ 1,282,961 $ 4,806,771
See accompanying notes.
-5-
Excel Excavating, Inc. and Affiliate
Consolidated Statement of Cash Flow
Year Ended December 31, 2017
Cash Flows from Operating Activities
Net Income $ 1,113,442
Adjustments to reconcile net income to net cash
provided by operating activities:
Depreciation 288,932
(Increase) decrease in:
Contract receivables 334,698
Costs and estimated earnings in excess of billings (157,998)
Prepaid expenses and other current assets (11,696)
Increase (decrease)in:
Accounts payable 44,691
Billings in excess of costs and estimated earnings (54,973)
Accrued expenses and deposits (5,793)
Shareholder payable 20,914
Net Cash Provided by Operating Activities 1,572,217
Cash Flows from Investing Activities
Notes receivable -related parties (48,994)
Purchases of property and equipment (480,113)
Net Cash Used in Investing Activities (529,107)
Cash Flows from Financing Activities
Payments on long term debt (133,761)
Contribution from GKH Holding Inc. 270,000
Distributions to GKH Holding Inc. (450,000)
Net Cash Used in Financing Activities (313,761)
Increase in Cash and Cash Equivalents 729,349
Cash and Cash Equivalents,Beginning of Year 144,316
Cash and Cash Equivalents,End of Year $ 873,665
See accompanying notes.
-6-
Excel Excavating,Inc. and Affiliate
Notes to Consolidated Financial Statement
Year Ended December 31,2017
Note A-Nature of Organization and Operations
Excel Excavating, Inc. ("Excel"),an Indiana corporation, and Affiliate (collectively "the Company")performs land
excavating for residential and commercial development predominantly in the southern Indiana and Louisville,
Kentucky areas. The majority of the business is excavating for streets, sewer lines, storm sewers, and commercial
site preparation. The work is performed primarily under contracts, including: cost-plus-fee contracts, fixed-price
contracts,and fixed-price contracts modified by incentive and penalty provisions. The length of contracts varies but
is typically less than one year. Galligan Equipment, LLC ("Galligan"), an Indiana limited liability company, is a
commonly-owned subsidiary. Galligan leases equipment on short-term contracts to Excel. Excel and Galligan are
wholly-owned subsidiaries of GKH Holding Inc.
Accounting principles generally accepted in the United States of America ("GAAP") require the consolidation of
certain"variable interest entities."Based on the facts and circumstances present at December 31,2017, Galligan has
been identified as a variable interest entity that is required to be consolidated with Excel under this guidance as Excel
was deemed the primary beneficiary.
The Company previously consolidated the accounts of Sellersburg Properties,LLC,a variable interest entity in which
the Company holds a variable interest and is deemed to be the primary beneficiary.During 2017,the Company elected
to apply Accounting Standards Update ("ASU") 2014-07, Consolidation (Topic 810): Applying Variable Interest
Entities Guidance to Common Control Leasing Arrangements, to its qualifying lease arrangements (see Note I).
This standard requires retrospective application.The Company therefore deconsolidated Sellersburg Properties,LLC
effective January 1,2017.
The consolidated financial statements for December 31, 2017 include the activities of Excel and Galligan.
All significant intercompany transactions have been eliminated in consolidation.
Note B-Summary of Significant Accounting Policies
1. Basis of Accounting: The accompanying consolidated financial statements have been prepared on the accrual
basis of accounting in accordance with accounting principles generally accepted in the United States of America
("U.S. GAAP"). The Accounting Standards Codification ("ASC") as produced by the Financial Accounting
Standards Board("FASB")is the sole source of authoritative U.S. GAAP.
2. Use of Estimates: The preparation of the consolidated financial statements in conformity with GAAP 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 consolidated financial statements and the
reported amounts of revenues and expenses during the reporting period.The nature of the Company's business
requires making significant estimates and assumptions in the normal course of business. The estimates are
primarily related to its construction contracts and, among other things,the one-of-a-kind nature of most of its
projects, long - term duration of its contract cycle and the type of contract utilized. The most significant
estimates with regard to these consolidated financial statements relate to total contract revenues, costs and
profits for individual contracts.Actual results could differ from those estimates.
3. Cash Equivalents:The Company considers all short-term investments with an original maturity of three months
or less to be cash equivalents.There were no cash equivalents at December 31, 2017.
-7-
Excel Excavating,Inc.and Affiliate
Notes to Consolidated Financial Statement(Continued)
Year Ended December 31,2017
Note B- Summary of Significant Accounting Policies(Continued)
4. Contract Receivables: The Company uses the allowance for bad debts method of valuing doubtful contract
receivables which is based on historical experience, coupled with a review of the current status of existing
receivables. The balance of the allowance for doubtful accounts was $20,842 at December 31, 2017 and has
been deducted against contract receivables to properly reflect the estimated realizable value.
5. Property and Equipment:Property and equipment are recorded at cost.Maintenance and repairs are charged to
expense as incurred; material renewals or betterments are capitalized. Gain or loss on retirements or
dispositions of assets is charged to operations,and respective costs and accumulated depreciation are eliminated
from the accounts.
Depreciation of property and equipment is provided on the basis of estimated useful lives of the assets
using the straight-line method. The estimated useful lives are 5 - 10 years for vehicles and equipment.
The Company periodically reviews the carrying values of property and equipment for impairment whenever
adverse events or changes in circumstances indicate the carrying value of the asset may not be recoverable.
6. Revenue and Cost Recognition: Revenues and related costs from fixed price contracts are recognized on the
percentage-of-completion method of accounting, measured by the percentage of cost incurred to date to
estimated total cost for each contract.Management considers total cost incurred to date to be the best available
measure of progress on the contracts.
Contract costs include all direct material and labor costs and other direct costs related to contract performance.
Selling, general and administrative costs are charged to expense as incurred.Provisions for estimated losses on
uncompleted contracts are made in the period in which such losses are determined.Changes in job performance,
job conditions and estimated profitability may result in revisions to cost and income,which are recognized in
the period in which the revisions are determined.Precontract costs are expensed as incurred.
The asset, "Costs and estimated earnings in excess of billings", represents revenues recognized in excess of
amounts billed.The liability, "Billings in excess of costs and estimated earnings",represents billings in excess
of revenues earned.
Noncontract revenue,generally time and material jobs, is recognized as work is performed and invoiced to the
customer. Management has concluded the difference between recognizing revenue related to these short-term
contracts on the percentage-of-completion method and recognizing revenue based on progress billings is
immaterial to the consolidated financial statements.
7. Advertising Costs: Advertising costs are expensed during the period they are incurred. Advertising expense
was$4,843 for the year ended December 31,2017.
8. Subsequent Events:The Company has evaluated events and transactions for potential recognition or disclosure
through the date on the Independent Auditor's report which is the date the consolidated financial statements
were available to be issued.
-8-
Excel Excavating,Inc.and Affiliate
Notes to Consolidated Financial Statement(Continued)
Year Ended December 31,2017
Note B- Summary of Significant Accounting Policies(Continued)
9. New Accounting Pronouncements: In May 2014, the FASB issued Accounting Standards Update ("ASU")
2014-09, Revenue from Contracts with Customers. The standard's core principle is that a company will
recognize revenue when it transfers promised goods or services to customers in an amount that reflects the
consideration to which the company expects to be entitled in exchange for those goods or services.
This standard also includes expanded disclosure requirements that result in an entity providing users of
financial statements with comprehensive information about the nature, amount, timing, and uncertainty of
revenue and cash flows arising from the entity's contracts with customers. This standard will be effective for
the calendar year ending December 31,2019.
In February 2016, the FASB issued ASU 2016-02, Leases. The standard requires all leases with lease terms
over 12 months to be capitalized as a right-of-use asset and lease liability on the balance sheet at the date of
lease commencement.Leases will be classified as either finance or operating. This distinction will be relevant
for the pattern of expense recognition in the income statement. This standard will be effective for the calendar
year ending December 31,2020.
In June 2016, the FASB issued ASU 2016-13, Financial Instruments-Credit Losses. The standard requires a
financial asset(including trade receivables)measured at amortized cost basis to be presented at the net amount
expected to be collected. Thus, the income statement will reflect the measurement of credit losses for
newly-recognized financial assets as well as the expected increases or decreases of expected credit losses that
have taken place during the period. This standard will be effective for the calendar year ending
December 31,2021.
The Company is currently in the process of evaluating the impact of adoption of these ASUs on the consolidated
financial statements.
Note C- Contract Receivables
Contract receivables consist of the following at December 31,2017:
Contract receivables:
Completed contracts $ 114,240
Contract in progress 397,970
Retainage 78,521
590,731
Less allowance for uncollectible contract receivables (20,842)
Contract Receivables,net $ 569,889
-9-
Excel Excavating,Inc. and Affiliate
Notes to Consolidated Financial Statement(Continued)
Year Ended December 31,2017
Note D-Costs and Estimated Earnings on Uncompleted Contracts
At December 31,2017,costs and estimated earnings on uncompleted contracts were as follows:
Costs incurred on uncompleted contracts $ 1,511,122
Estimated earnings 370,957
1,882,080
Less:billings to date (1,689,838)
Total $ 192,242
The foregoing amounts are included in the accompanying Consolidated Balance Sheets under the following captions:
Costs and estimated earnings in excess of billings $ 251,683
Billings in excess of costs and estimated earnings (59,440)
Total $ 192,242
Note E-Long Term Debt
Long term debt as of December 31, 2017 is as follows:
Note payable to Brandeis Equipment due in monthly
installments of $2,761 non-interest bearing and secured by
equipment,maturing January 2018 $ 2,742
Note payable to GMC Financial due in monthly installments
of $233, non-interest bearing and secured by equipment,
maturing August 2022,expected to be paid off in 2018 11,535
Note payable to Brandeis Equipment due in monthly
installments of $4,858 non-interest bearing and secured by
equipment,maturing November 2019 111,741
126,018
Less current maturities 69,831
Long-term Debt $ 56,187
-10-
Excel Excavating,Inc. and Affiliate
Notes to Consolidated Financial Statement(Continued)
Year Ended December 31,2017
Note E- Long Term Debt(Continued)
At December 31,2017,long-term debt is scheduled to mature as follows:
2018 $ 69,831
2019 56,187
$ 126,018
Note F-Line of Credit
Excel has a line of credit with a bank which expires in January 2018. The variable interest rate applicable to this line
of credit is the prime rate, but not less than 3.25%. The prime rate was 4.50% at December 31, 2017. The amount
available for borrowing is $1,000,000. There were no borrowings outstanding under this line of credit at
December 31, 2017. The note was renewed subsequent to year end and now expires January 1, 2019.
Note G-Employee Retirement Plan
The Company has established a 401(k) plan (the "Plan") for employees who meet certain eligibility requirements.
Under the Plan,the Company matches the first 3%of participant contributions and 50%of the next 2%of participant
contributions. The Company's Plan expenses and matching contributions for the year ended December 31, 2017 was
$28,654.
Additionally, the Company can make discretionary profit sharing contributions to the Plan. These contributions are
allocated to each participant based on a ratio of the individual participant's compensation to the total compensation
for all eligible participants. There were no discretionary profit sharing contributions to the Plan for the year ended
December 31, 2017.
Note H-Income Taxes
Excel and Galligan have elected,with the consent of their shareholders and members,to be taxed as S corporations
under provisions of the Internal Revenue Code ("IRC"). Under these provisions, taxable income is reported on the
tax returns of the individual shareholders or members. The states in which the Company operates also recognize the
S corporation status, thus no provision has been made for federal or state income tax in the accompanying
consolidated financial statements.
GAAP defines tax positions applicable to pass-through entities, such as S corporations and partnerships, and only
requires income taxes attributed to the reporting entity, and not the individual owners,to be considered tax positions.
Management has concluded that there are no tax positions attributed to the reporting entity which meet the
more-likely-than-not criterion for recognizing a liability for uncertain tax positions.Accordingly,the accompanying
consolidated financial statements do not include any provision for uncertain tax positions, and no related interest or
penalties have been recorded.
-11-
Excel Excavating,Inc. and Affiliate
Notes to Consolidated Financial Statement(Continued)
Year Ended December 31,2017
Note I-Related Party Transactions
The Company maintains its principal office and warehouse in a leased facility owned by Sellersburg Properties,LLC
("Sellersburg"), a related party through common ownership. The lease term is month-to-month and the monthly
payment is $10,000. Sellersburg is a limited liability company also owned by the stockholders of the Company.
Total rent expense was $120,000 for the years ended December 31, 2017.
The Company has a note receivable due from Sellersburg totaling $1,497,828, including interest receivable of
$97,988 at December 31,2017.This note was for the purchase of a subdivision and is being paid back as the Company
sells lots. At December 31,2017, $1,097,828 is included in current assets as Sellersburg expects to pay this amount
in 2018.
The Company also has a related party receivable due from Sellersburg totaling $291,728 as of December 31, 2017
for contract work completed in prior years. This amount was paid off subsequent to year end.
The Company has a shareholder payable of$32,904 as of December 31, 2017. This has been classified as a current
liability on the consolidated balance sheet.
Note J- Significant Concentrations
Cash Concentration Risk
The Company maintains cash in deposit accounts with federally insured financial institutions.At times,the balances
in these accounts may be in excess of federally insured limits.
Contract Receivables Credit Risk
Financial instruments that potentially subject the Company to concentration of credit risk consist primarily of contract
receivables. The Company grants credit to its customers but generally does not require collateral to support contract
receivables.
Major Customers Concentration
Excel,by the nature of its work,bids on various construction jobs. The customer base typically fluctuates from year
to year.Accordingly,in any given year,a customer could account for more than 10%of its revenue and/or receivables.
The Company conducted business with three major customers who comprised approximately 42%of the Company's
contract revenue for the year ended December 31, 2017. Contract receivables from three major customers comprised
approximately 51%of the Company's contract receivables at December 31,2017.
-12-
Supplementary Information
Excel Excavating,Inc.and Affiliate
Consolidating Balance Sheet
December 31,2017
Excel Galligan
Excavating, Equipment, Consolidated
Inc. LLC Eliminations Balance
Assets
Current Assets
Cash and cash equivalents $ 813,966 $ 59,699 $ - $ 873,665
Contract receivables,net 569,889 - - 569,889
Costs and estimated earnings
in excess of billings 251,683 - - 251,683
Current portion of note receivable-related party 1,097,828 - - 1,097,828
Related party receivable 291,728 - - 291,728
Prepaid expenses and other current assets 34,331 32,904 - 67,235
Total Current Assets 3,059,425 92,603 - 3,152,028
Property and Equipment
Equipment - 4,170,884 - 4,170,884
Vehicles 1,297,383 - - 1,297,383
Office equipment 18,845 - - 18,845
1,316,228 4,170,884 - 5,487,112
Less:accumulated depreciation (967,877) (2,860,384) - (3,828,261)
Property and Equipment,net 348,351 1,310,500 - 1,658,851
Other Assets
Note receivable-related party,less current portion 400,000 - 400,000
Total Assets $ 3,807,776 $ 1,403,103 $ - $ 5,210,879
Liabilities and Equity
Current Liabilities
Current portion of long-term debt $ 11,535 $ 58,296 $ - $ 69,831
Accounts payable 139,106 5,659 - 144,765
Billings in excess of costs
and estimated earnings 59,440 - - 59,440
Accrued expenses and deposits 40,981 - - 40,981
Shareholder payable 32,904 - - 32,904
Total Current Liabilities 283,966 63,955 - 347,921
Long-term debt,less current portion - 56,187 - 56,187
Total Liabilities 283,966 120,142 - 404,108
Equity
Common stock;no par value;200 shares
authorized,issued and outstanding 200 - - 200
Additional paid-in capital 47,767 - - 47,767
Retained earnings 3,475,843 - - 3,475,843
Members'capital - 1,282,961 - 1,282,961
Total Equity 3,523,810 1,282,961 - 4,806,771
Total Liabilities and Equity $ 3,807,776 $ 1,403,103 $ - $ 5,210,879
See accompanying independent auditor's report.
-13-
Excel Excavating,Inc.and Affiliate
Consolidating Statement of Income
Year Ended December 31,2017
Excel Galligan
Excavating, Equipment, Consolidated
Inc. LLC Eliminations Balance
Revenue
Contract revenue $ 6,080,781 $ - $ - $ 6,080,781
Rental revenue - 320,864 (320,864) -
Total Revenue 6,080,781 320,864 (320,864) 6,080,781
Cost of Revenue
Materials 854,070 - - 854,070
Labor,taxes,and benefits 1,188,457 - - 1,188,457
Subcontractor costs 1,389,001 - - 1,389,001
Equipment 556,211 - (320,864) 235,347
Indirect job costs 133,546 44,943 - 178,489
Depreciation 82,016 206,916 - 288,932
Total Cost of Revenue 4,203,301 251,859 (320,864) 4,134,296
Gross Profit 1,877,480 69,005 - 1,946,485
Operating Expenses
Office salaries and benefits 517,495 - - 517,495
Occupancy expense 224,581 - - 224,581
Professional fees 49,264 - - 49,264
Other operating expenses 76,452 14,872 - 91,324
Total Operating Expenses 867,792 14,872 - 882,664
Income From Operations 1,009,688 54,133 - 1,063,821
Other Income(Expense)
Interest income 49,425 58 - 49,483
Other nonoperating income,net _ 138 - 138
Total Other Income(Expense),net 49,425 196 - 49,621
Net Income $ 1,059,113 $ 54,329 $ - $ 1,113,442
See accompanying independent auditor's report.
-14-
Excel Excavating,Inc.and Affiliate
Schedule of Contracts in Progress
December 31,2017
Excess Excess
Total Total Earned Gross Gross Billings Costs
Job Percent Estimated Estimated Costs Billings Revenue Profit Profit% Over Over
Number Complete Contract Costs To Date To Date To Date To Date To Date Costs Billings
378 35.2% $ 543,620 $ 300,000 $ 105,457 $ 244,427 $ 191,095 $ 85,638 44.8% $ 53,332 $ -
389 66.9% 1,081,500 900,000 602,004 729,517 723,408 121,404 16.8% 6,108 -
390 72.4% 649,928 533,705 386,310 386,505 470,435 84,125 17.9% - 83,930
397 76.5% 384,963 307,902 235,530 245,087 294,477 58,948 20.0% - 49,391
398 1.1% 982,000 895,648 9,667 - 10,599 932 8.8% - 10,599
399 73.1% 255,000 229,045 167,426 84,302 186,398 18,972 10.2% - 102,096
400 1.2% 474,000 395,534 4,729 - 5,667 938 16.6% - 5,667
Totals $ 4,371,011 $ 3,561,834 $ 1,511,122 $ 1,689,838 $ 1,882,080 _$ 370,957 19.7% $ 59440 $ 251,683
See accompanying independent auditor's report.
-15-
ATTACHMENT A
Excel Excavating, Inc. Recent Work Experience
KYTC 171021 Jefferson County Various Sidewalks
Kentucky Transportation Cabinet
Contact: Kevin Bailey 502-210-5400
$385,000.00 Spring 2018 Completion
KYTC 171015 Jefferson-Louisville Main Street Streetscape
Kentucky Transportation Cabinet
Contact: Kevin Bailey 502-210-5400
Historic Sidewalk/Curb with Street Lighting and Hardscape features
$650,00.00 June 2018 Completion
Lexington Area Main Replacements
Louisville Water Company
Contact: Eric Walls 502-569-3600
6,800 LF of main replacement 4"-12" diameter with restoration
$1,100,000 Spring 2018 Completion
Oak Street Area Water Main Replacement
Louisville Water Company
Contact: Eric Walls 502-569-3600
7,200 LF of main replacement 4"-12" diameter with restoration
$1,399,000 Spring 2017 Completion
International Drive Ph II
River Ridge Development Authority
Contact: Marc Hildenbrand 812-285-8979
Complete roadway reconstruction with mass grading, storm sewer, water main,
grade & drain, ornamental signing and phased MOT.
$2,100,000 completed October 2016
Lenz Ave Phase II
River Ridge Development Authority
Contact: Marc Hildenbrand 812-285-8979
Complete roadway reconstruction with mass grading, storm sewer, ornamental
signing and phased MOT.
$216,000 completed July 2016
Salem Road Water Main Relocation
River Ridge Development Authority
Contact: Marc Hildenbrand 812-285-8979
1,300LF of 12" Water Main construction
$106,000 completed July 2016
JCTC- First Street Pedestrian Improvements-Phase 2
Jefferson Community and Technical College
David Reed Qk4 Engineers
Storm drainage, curb, sidewalk, fencing, landscaping and decorative fencing
$535,000 Completed August 2016
KYTC 151049 Oldham County Sidewalks
Kentucky Transportation Cabinet
Contact: Kevin Bailey 502-210-5400
$197,810.00 June 2016 Completion
KYTC 151252 Jefferson County Sidewalks
Kentucky Transportation Cabinet
Contact: Kevin Bailey 502-210-5400
$128,870.00 April 2016 Completion
Grinstead Drive Water Main Replacement
Louisville Water Company
Contact: Jamie Long 502-569-3600
$489,000 Spring 2016 Completion
East 5th Street Sidewalks
City of New Albany Redevelopment Commission
Contact: John Rosenbarger 812-948-5333
Remove and Replace Curb, Sidewalks, and ADA Ramps
$174,000 Completed March 2016
Scenic Valley Area Pressure Sewer System Project
Board of Commissioners of Floyd County
Contact: Matt Robinson 812-282-8201
Install —4,300If of small diameter force main and 55 services by both open cut and
trenchless methods
$215,312.50 Completed March 2016
River Ridge Sewer Replacement
City of Jeffersonville, Indiana
Contact: Len Ashack 812-285-6451
4,800 LF of 12" Gravity Sewer and Manholes
$372,000 completed June 2015
Paul Garrett Avenue Ph II
River Ridge Development Authority
Contact: Marc Hildenbrand 812-285-8979
Complete roadway reconstruction with mass grading, storm sewer, water main,
grade & drain, ornamental signing and phased MOT.
$1,800,000 completed October 2015
Lentzier Creek Sanitary Sewer Division 2
City of Jeffersonville, IN
Contact: Len Ashack 812-285-6451
Installation of Dual 18" Force Main
$2,421,660.00 Completed in 2014
Seneca Loop Extension
Louisville Metro Public Works- Louisville, KY
Installing Walking Path
$806,000.00 Completed in 2014
Oat Street Streetscape Improvements
Louisville Metro Government-Louisville, KY
Contact: Dirk Gowin 502-574-5925
$475,000 Completed in 2014
Bean Road Relocation
Clark County Air Board- Sellersburg, IN
Contact: Chris Snyder 317-299-7500
New roadway grading, bridge, rail crossing, storm pipe
$2,036,055.55 Started 11/27/2013- completed November 2015
New Albany Bank & Main Street Sewer Replacement
New Sewer and Manholes, New Sidewalk and landscaping/restoration
$440,000.00 completed December 2014
Trey Street Improvements Ph III
River Ridge Development- Jeffersonville, IN
Contact: Marc Hildenbrand 812-285-8979
Earthwork, Water Main, Storm Drain, Lime Stabilized Base, Asphalt and curb for
"2,900LF of new roadway construction
$1,700,000.00 completed June 2015
Daisy Lane Road Reconstruction
City of New Albany Redevelopment-New Albany, IN
Contact: John Rosenbarger 812-948-5333
Road widening and reconstruction through a phased MOT.
$2,100,000 completed 2011
Jeffersonville Marketplace
City of Jeffersonville
Contact: Andy Crouch 812-285-6476
New roadway construction
$1,150,000 completion May 2012
Midtown Sidewalks
City of New Albany Redevelopment-New Albany, IN
Contact: John Rosenbarger 812-948-5333
$677,500 completion August 2012
Charlestown Road Rehabilitation
City of New Albany Redevelopment-New Albany, IN
Contact: John Rosenbarger 812-948-5333
$1,177,000 completion November 2010
Broadway Street Improvements
City of Clarksville, Indiana
Contact: Brad Cummings 812-283-8233
Reas Lane /Grant Line Road Extension
City of New Albany Redevelopment-New Albany, IN
Contact: John Rosenbarger 812-948-5333
New roadway construction and wetland mitigation
$2,232,500 completion November 2014
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ATTACHMENT C
Equipment Number Description Status Fleet Code Model Serial Number 1
EQO1 CASE 580SM BACKHOE Active BACKHOE 580SM JJG0279992
EQ02 CASE 580SL BACKHOE Active BACKHOE 580 SL JJG0201465
EQ03 CAT D6R DOZER Active DOZER D6R 5Ln02761
EQ04 CASE 850 DOZER Active DOZER 850 JJG0253769
EQ05 KOMATSU PC 300-6 EXCAVATOR Active EXCAVATOR PC300-6 A83113
EQ06 KOMATSU PC 220-7 EXCAVATOR Active EXCAVATOR PC-220 A86306
EQ07 KOMATSU PC 200-6 EXCAVATOR Active EXCAVATOR PC-200 84369
EQ08 John Deer Farm Tractor 4430 Active 4430 017593R
EQ09 CAT 953 HIGH LIFT TRACKLOADER Active HIGH LIFT 953C 2ZN01246
EQ10 JOHN DEER 5300 TRACTOR Active TRACTOR 5300 LV5300C120750
EQ13 CAT 924 Wheel Loader Active TRACTOR 924 0924GLAAN01143
EQ14 REYNOLDS 17 E Pull Pan Active TRACTOR 17E 33530
EQ15 REYNOLDS 17 E PULL PAN Active TRACTOR 17E 33531
EQ18 CAT CP433 Soil Drum Compactor Active TRACTOR CP433 2JM00788
EQ22 CAT 120 H Motor Grader Active TRACTOR 12011 4MK00802
EQ24 KOMATSU D39 Dozer Active DOZER 039 26333709SN1536
EQ25 CAT CS-433C SOIL DRUM COMPACT Active ROLLER CS-433C 3TM01044
EQ26 SULLINAR 185CFM AIR COMPRESSOR Active MISC 185CFM 004-139752
EQ27 KOMATSU PC78 MR Mini Excavator Active EXCAVATOR PC78 MR6 1349
EQ28 KOMATSU PC220 Excavator Active EXCAVATOR PC220 LC7 A86884
E029 CAT High Lift Active TRACTOR 977L 11K08096
EQ31 JOHN DEER 9520 4WD SCRAPER TR Active TRACTOR 9520 4WD AG339814
EQ32 Broom,Blade,&Brackets Active
EQ33 CASE 580 SM Backhoe Active BACKHOE 580 SM N5C393316
EQ34 CASE 580 SM BACKHOE Active BACKHOE 580SM N5C393314
EQ36 CATERPILLAR D8K CRAWLER DOZER Active DOZER 08K 77V5442
EQ38 SKAG Wildcat Mower Active MISC Skag
EQ39 KOMATSU Excavator PC-78MR-6 Active EXCAVATOR PC-78MR-6 3016
EQ40 Cat 246 SKID STEER LOADER Active LOADER 246C JAY0O411
EQ41 CASE 570 XLT GRADE TRACTOR Active GRADE TRAC 570 XLT JJG0224573
EQ42 Air Compressor SULLAIR Active MISC 185 004-138271
EQ43 IR DD11O ROLLER Active ROLLER DD11O 5332SAD
EQ44 CASE 580 SM BACKHOE Active BACKHOE 580 SM N7C431222
EQ45 ALLIED S-27 HAMMER Active MISC 5-27 27AAA1246
EQ46 HONDA BUNYAN STRIKER Active MISC PT#SHD4O
EQ47 KOMATSU PC88MR-8 Excavator Active EXCAVATOR PC88-MR-8 A90040
EQ48 Allied Hoe Pac Active ATTACHMENT 1000B 573458C
EQ49 VOLVO A35 ARTICULATED TRUCK Active TRACTOR A35 2273
EQ50 VERMEER V3S0 Trencher Active MISC Vermeer/V3550 1VRM080V511000972
EQ51 KOMATSU PC400 LC-8 Excavator Active EXCAVATOR PC-400 L-C A88330
EQ52 CB214 C ROLLER Active CB214C NO PAPERWORK
EQ54 KOMATSU PC-138 Excavator Active EXCAVATOR PC-138 40064
EQ55 Komatsu DS1PXI Dozer Active DOZER D51PXI B13750
EQ56 Case 580M Backhoe Active BACKHOE 580M JJG0308507
EQ57 VERMEER D7X11Directional Drill Active MISC D7X11 1VRZ130Z481000822
EQ58 kOMATSU PC88 Mini Excavator Active EXCAVATOR PC88MRD KMB51160
EQ59 BLAW KNOX WIDENER Active PAVER RW 195 813-007
EQ60 CAT 740 ARTICULATED TRUCK Active TRUCK 740 B1P06122
EQ61 WACKERR82SC TRENCH ROLLER Active ROLLER R82SC 57876615
EQ62 KOMATSU PC 360-10 Excavator Active EXCAVATOR PC360-10 A33250
EQ63 CAT 279D XPS Skid Steer Active MISC 279D XPS GTL03589
EQ64 Cat 304 E2 Excavator Active EXCAVATOR 30400 17200-1
EQ65 Cat 7408 Haul Truck Active HAUL TRUCK 740b T4R00416
ATTACHMENT C
Equipment Number Description Status Fleet Code Model Serial Number 1
El DODGE RAM 2500 Pick up Truck Active PICK UP 2500 3D7KU26C24G107844
E2 Kodiack Utility Truck Active UTILITY GMC 7000 1GBL7HIJ8U204000
E3 DODGE 2500SLT WHITE PJU Truck Active PICK UP 2500 SLT 3D7KU428633G775786
E4 MACK DM6905 TRI AXLE Active TRI AXLE DM6905 1M2B209C2RM014869
E6 PETER Single Axle Dump Truck Active SINGLE AXL 375 1XPBDB9X2JN253106
E8 MACK White Tri Axle Dump Truck Active TRI AXLE RD688S 1M2P267C6RM019391
El0 PETERBUILT Lowboy Tractor Active LOWBOY 377 1XPCD99X8TN395928
E12 Chevy Pick up Truck Active PICK UP K1500 1GCEK14K5SZ182245
E13 Trail King Lowboy Trailer Active LOWBOY 35 Ton 1TKH04326HM079470
E14 International 1600 Fuel Truck Active PICK UP 1600 AWD 846060H815938
E16 Dodge 2500 Reg Cab 4X4 PU Active PICK UP 2500 3B7KF2661YM230802
E17 Dodge Pick-Up Truck Active PICKUP D250 1BTKE2685M218867
E18 Entire PRTNSSTO3 Trailer Black Active TRAILER PRTNSSTO3 1E92861664E111233
E19 Mack CH-613 Lowboy Tractor Active LOWBOY CH-613 1M2AA18Y81W134489
E21 Eager Beaver 20XPT Trailer Active TRAILER 20XPT 2H8V3265L069001
E23 Dodge Utility Truck Active UTILITY D350 1B6ME3653MS212493
E24 Mack Tri Axle Dump Truck Active TRI-AXLE CV713 1M2AG11C46M037225
E28 International 8100 SINGLE AXLE Active SINGLE AXL 8100 IHSHBAHN0TH283757
E30 MACK 700 CL713 DUMP TRUCK Active TRI AXLE CL713 1M2AD38C51MO11509
E31 MACK 700 CL713 DUMP TRUCK Active TRIAXLE CL713 1M2AD38C11M011510
E33 International 4200 Water Tk Active TRUCK 4200 23196
E34 Eager Beaver 20 KPT Trailer Active TRAILER 20XPT 112H8V3207L073144
E35 FORD F350 Active TRUCK F350 1FDHF37H0SEA14397
E36 Dodge Ram 3500 Water Crew TK Active TRUCK Ram 3500 3D6WG46A67G729097
E39 ChevyC3500 Silverado Truck Active TRUCK C3500 Silverado 1GB3CZCL1BF116648
E40 International 4000 SERIES 4300 Active TRUCK 4300 1HTMMAAL14H662748
E41 Chevy Tahoe(White) Active SUV Tahoe 1GNSKCEOXBR390673
E42 Chevy Tahoe Black Active SUV Tahoe 1GNSKCE0XBR377485
E43 DODGE RAM 3500 ST/SLT Active 3500 3C7WDSBL5CG249804
E44 CHEVY SILVERADO K1500 LS TRUCK Active PICK UP K1500 3GCPKREA4DG242824
E45 Ram 3500 TRUCK Active PICKUP RAM 3500 LARAM 3C63R3ML6EG119710
E46 FORD EXPLORER WHITE Active SUV Explorer 1FM5K7D81FGA68649
E47 Freightliner SD TriAxle Active TRI-AXLE 114SD 3ALMG3DVXFDGL4265
E48 Ram 3500 Service Truck Active TRUCK 3500 3C7WRTALOFG690611
E49 2015 CHEVY 2500 DIESEL CREW CA Active TRUCK Silverado K2500 1GC1KWE82GF110961
E50 INTERNATIONAL S1754 SING AXLE Active SINGLE AXL 51754 1HTLCHXM5EHA35823
E51 GATOR Aardvark 14K Trailer Active TRAILER Aardvark 14K 4Z1HD202XGS027285
E52 Corn Pro 18+5 7K TRAILER Active TRAILER 18+5 7K 4MJFB2327HE06951
E53 CORN PRO UT-12 LS TRAILER Active TRAILER UT-12 LS 4MJUB1211HE069123
E54 Chevy Silverado 1500 Active Silverado 1500 3GCUKREC8HG517699
Excel Excavating, Inc.
A„,Drip-FKee 141.-p1141,0ce Polley
_Purpose
The Company values its employees and recognizes their need for a safe and healthy work
environment. Furthermore, employees abusing drugs and alcohol are less productive and are
often a risk to the safety, security and productivity of our company. The establishment of a
Substance-Abuse Policy is consistent with the company's desired culture and is in the best
interest of the company.
Policy
it is the policy of the company to maintain a workplace free from the use and abuse of drugs and
alcohol. Compliance with this policy is a condition of continued employment. It supersedes any
other company policy or practice on this subject. At any time, the company may unilaterally, at
its discretion, amend, supplement, modify, or change any part of this policy. The policy does not
represent an expressed or implied contract, and it does not affect your status as an at-will
employee. If you have any questions about this policy, please direct them to Human Resources.
To maintain a Drug and Alcohol-Free Workplace, the company has established the following
policy effective 01/01/2004 with regard to the use,possession, and sale of drugs and alcohol.
Drug and alcohol testing practices will be adopted to identify employees or applicants using
drugs and/or alcohol.
Drug a:z d Alcohol Prohibitions
"Illegal Drug" means: any drug (1) which is not legally obtainable, or (2)which is legally
obtainable but has not been legally obtained, or (3) which is a controlled substance. The term
includes prescribed drugs not legally obtained and prescribed drugs not being used for prescribed
purposes.
1. Any employee involved in any of the following activities, whether or not on company
business, premises or property, is in violation of the company policy and subject to
disciplinary action:
a) bringing illegal drugs and/or alcohol onto company premises or property, including the
company owned or leased vehicles, or a customer's premises;
b) having possession of, being under the influence of, or having in one's system illegal drugs
and/or alcohol; or
c) using, consuming, transforming, distributing or attempting to distribute, manufacturing or
dispensing illegal drugs and/or alcohol; or
d) switching, tampering with, altering or adulterating any specimen or sample collected
under this policy or attempting to do so.
2. In addition, the company strictly prohibits the abuse of alcohol or prescription drugs.
3. Any employee refusing to cooperate with or submit to questioning, medical or physical tests
or examinations, when requested or conducted by the company or its designee, is in violation
of the company policy and subject to disciplinary action.
48
.DrPg znofi ALcailcl Tri
The company asserts its legal right and prerogative to test any employee for drug and/or alcohol
abuse. Employees may be asked to submit to a medical examination and/or submit to urine,
saliva, breath, sweat, and/or hair testing for drugs or alcohol. Any information obtained through
such examinations may be retained by the company and is the property of the company.
In particular, the company reserves the right, in its discretion and within the limits of federal and
state laws, to examine and test for the presence of drugs and alcohol (as stated above) in
situations such as, but not limited tc, the following:
1, Post job Offer: All offers of employment for CDL drivers will be made subject to the
results of a drug test. Applicants will be required to voluntarily submit to a urinalysis test and
sign an acknowledgment form, which will release the company from liability, the company
will not discriminate against applicants for employment because of past drug abuse. It is the
current abuse of drugs which prevents employees from properly performing their jobs. •
2. Post-Accident: A drug and/or alcohol test will be conducted on all employees involved in
accidents occurring during work time or while on company property. Covered accidents
included, but are not limited to, accidents that the employee caused or contributed to that
involve:
a) personal injury to employees or others which necessitates medical attention (beyond first
aid) or results in lost work time; and/or
b) damage to the company's property
Employees are expected to make themselves available for post-accident testing. If
circumstances require an employee to leave the scene of an accident, the employee must
make a good faith attempt to be tested and to notify the company of his/her location.
Failure to report any accident which meets the post-accident testing criteria is in violation of
the company policy and subject to disciplinary action. Employees testing positive or refusing
to submit to a drug and/or alcohol test, under certain state laws, may be ineligible for workers'
compensation benefits.
3. :Random: For the added safety and health of the company employees, as well as the direct
impact on the company's profitability, image and reputation as a drug-free organization, all
employees with a CDL license are subject to random, unannounced drug tests at any time the
Company deems necessary to ensure a Drug-Free Workplace. The'rate of random selection
will be a percentage of the annual average employee or consortium base. Every employee has
an equal chance of being chosen every time a random selection is made.
4. Be icion/Cause: Any employee may be asked to submit to a drug and/or
alcohol test if reasonable cause exists to suggest that the employee's health or ability to
perform expected job duties is currently impaired.
5. •Return-to-tp : An employee who has tested positive and has been removed from his or
her job duties must submit to and furnish a negative drug test prior to returning to their job
duties.
5. ;9,c7ollovvi-njz Any employee who has been removed voluntarily or otherwise from his or her
49
job assignment due to drug or alcohol abuse must agree to be tested on a random and,
discretionary basis anytime for up to 24 months from the return to work date. Employees
will be required to sign and abide by a last chance agreement.
Employee Assistance
A fundamental purpose of the company's Substance-Abuse Prevention Program is to assist
employees and family members who suffer from drug or alcohol abuse. The company offers an
Employee Assistance Program (EAP) for employees and their dependents. If you need
confidential help with a drug or alcohol problem, contact the EAP at (PHONE) or the company
Medical Department. If you are enrolled in the company's Medical Plan, your health care
benefits may pay a portion of your rehabilitation costs (beyond the maximum free consultations
allowable through the company sponsored-EAP). If eligible, you will be granted a medical leave •
- • of absence for rehabilitation. Any additional costs are the employee's responsibility. -
It is the employee's responsibility to seek assistance before drug or alcohol abuse leads to
disciplinary action. The employee's decision to seek prior assistance from the EAP will not be
used as the basis fordisciplinary action and will remain confidential. Contacting the EAP or
Medical Department will not be a defense to avoid disciplinary action where the facts proving a
violation of this policy or giving rise to other disciplinary action are obtained outside of this
consultation.
. Drug Testing Procedures
Whenever possible, the drug test will be performed from urine specimens collected at a qualified.
collection site or at the company facility using an onsite testing kit. A breath or saliva alcohol
test will be performed for all post-accident and reasonable-cause situations. If the saliva alcohol
test reads positive, a breath alcohol test will be performed at the collection site.
The collection site (or the company facility for onsite testing) will take necessary steps to avoid
any dilution or alteration of the specimen. However, the test shall be conducted in a professional •
and sanitary manner with due regard for-the individual's privacy, dignity, and confidentiality.
Proper handling of the specimens will be maintained so that the specimen results can be traced to
the proper individual.
• The specimen will be analyzed for the following controlled substances. Some of the common - •
drug names are included in parentheses:
• Cannabinoids (Marijuana)
Cocaine •
Opiates (Heroin, Morphine, Codeine)
Amphetamines (Stimulants like Benzedrine and Didrex)
Phencyclidine (PCP)
Barbiturates (Depressants like Phenobarital And Secobarbital)
Benzodiazepines (Depressants like Valium and Xanax)
Propoxyphene (Narcotics like Darvon and Darvocet)
All specimens that were not analyzed initially by an onsite testing kit will undergo an initial
50
Enzyme Multiplied Immunoassay Technique (Elvin) screening. Any positive EMIT or onsite
testing kit screens will be confirmed through Gas Chromatography with Mass Spectrometry
(GC/MS) by a laboratory certified by the Substance Abuse and Mental Health Services
Administration (SAMHSA). Any positive result from this GC/MS test will be reviewed by an
independent Medical Review Officer(1\, R.0)prior to the result being cornmunicated.to the
company. The MRO will give you the opportunity to rebut an positive test result and provide
evidence of the proper use of a prescription drug. This will ensure that positive results are not
due to prescription drugs or other factors which the MRO feels justifies the presence of
controlled substances.
Any employee who is tested will have the right, upon request, to see the results of his/her test and
to request a retest of the original specimen at a different SAIVITISA-certified laboratory(at the -
employee's expense)within 10 business days of being notified of a positive test result.
All information regarding the drug and/or alcohol test results or failure to complete rehabilitation
will remain confidential and will only be given out on a strict need-to-know basis.
•
Disciplinary _Actions
The company reserves the right to use disciplinary actions, up to and including termination of
-employment, depending upon the seriousness of the violation, the employee's present job
assignment, the employee's record with the company, and other factors, including the impact of
the violation upon the conduct of the company business. Any employee who refuses to submit to
drug/alcohol testing or attempts to adulterate or alter the specimen will be subject to disciplinary
actions.
AckiloWiedginent
As a condition of continued employment, employees must sign the attached acknowledgment
form.
•
•
51
Excel Excavating, Inc.
Acknowledgment }"o'rn
I hereby acknowledge receipt of the company's Substance-Abuse Policy regarding drugs and alcohol,
My signature acknowledges my understanding and concurrence with the procedures outlined in the above
referenced policy. It is my consent to submit to medical testing, including but not limited to giving urine,
breath,blood, sweat, and/or saliva sample(s)to be used for drug and alcohol analysis under the conditions
outlined in the policy.
In connection with and consistent with the provisions of the Substance-Abuse Policy:
(I) I authorize the release of any urine,breath, blood, sweat, and/or saliva sample(s) and the results of any
tests and examinations performed thereon to the company and any doctor, medical personnel, hospital,
medical center, clinic, etc.,or any representatives with whom they may choose to consult regarding the
sample tests or examination results. I will be given an opportunity to explain a positive test result to the
Medical Review Officer before the test result is reported to the company as a verified positive test result.
(2)[understand that the test results may be released by the company to applicable state unemployment
agencies and to the company's workers'compensation insurer(s),where permitted or required by law. I
understand that if I test positive for drugs or alcohol following an on-the-job accident or refuse to submit
to any drug and/or alcohol test required by this policy, I may be ineligible for workers'compensation
and/or unemployment benefits.
(3)I understand that refusal to submit to any test required by this policy, a positive test result, or refusal to
authorize the release of the results is grounds for disciplinary action up to and including termination of
employment.
I recognize that the company's policy on drugs and alcohol does not constitute an expressed or implied
contract of employment.
EMPLOYEE NAME SOCIAL SECURITY NO._y
(Printed)
EMPLOYEE SIGNATURE DATE
WITNESS SIGNATURE