AGREEMENT between BROWARD COUNTY and Cummings ...

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Enrollment Application Form 3 BROWARD COUNTY, Exhibit 2 FL Form-3 Numbers reference attached instructions Page 134 of 379 Page 2 of 3 F. Subcontract Information: List all Subcontractors that will be working for you on this project (complete the information in the following table). Use additional paper if necessary: 1 Subcontractor 2 Subcontract $ 3 Contact Person 4 Address 5 6 Phone Number Estimated Start Date G. Enrollment Questions: Answer each question. Use additional paper if necessary. 1 Will you have any off-Site(s) location(s) 100% dedicated to this project Yes No If yes, please provide address: 2 3 Please check if: Any aircraft used on this project Any watercraft used on this project Please indicate if labor from the following sources will be used: Employee Leasing Firm Temporary Labor Agency 4 Employee Leasing Company Name 5 Employee Leasing Company address 6 Employee Leasing Company Ctiy, State and Zip 7 What is your firm’s Worker’s Compensation Experience Modifier (EMR) H. WARRANTY APPLICABLE TO PROGRAM INSURANCE COVERAGE 1 2 3 4 5 6 Premiums for this Program are the responsibility of BROWARD COUNTY and I agree any and all return of premium, dividends, discounts, or other adjustments to any Program policy(ies) is assigned, transferred and set over absolutely to BROWARD COUNTY. This assignment applies to the Program policy(ies) as now written or as subsequently modified, rewritten or replaced. Rights of Cancellation for all Program insurance policy(ies) arranged by BROWARD COUNTY are assigned to BROWARD COUNTY. I will pay the cost of premium(s) for non-Program insurance coverage, specified in the Contract Documents. I authorized the release of all claim information for all insurance policies under this Program. It is my responsibility to notify my insurance carrier(s) that I am en in this Program. I have omitted from my bid the insurance costs for the coverage provided by BROWARD COUNTY. I further agree to the Aon Verified Insurance Cost Rate as described in the Insurance Manual. The statements in this insurance application are true to the best of my knowledge. I. Signature Block : I verify the information presented above and attachments are correct: Name: Title: (please print) Date: Signature: Note: Information can be submitted on-line at www.aonwrap.aon.com. Please contact your Administration Staff to obtain a user ID and Password. Fax or Mail to: Diana Schrader Phone: 407.804.2418 Aon Risk Services, Inc. of Florida Fax: 407.804.1077 400 International Parkway, Suite 100 Email: Diana.Schrader@aon.com Heathrow, FL 32746
Exhibit 2 Page 135 of 379 Enrollment Application BROWARD COUNTY, FL Form-3 Instruction Page 3 of 3 This form must be completed and submitted by each successful Contractor and Subcontractor of any tier prior to Site(s) mobilization for each contract awarded. The Contractor and Subcontractor will submit the completed form to Aon Risk Services. Upon receipt of this form, Aon will issue to the Contractor or Subcontractor a Certificate of Insurance evidencing coverage in the Controlled Insurance Program. The completed Certificate of Insurance and Workers’ Compensation insurance policy will be mailed to the Enrolled party. A. Contractor Information 1 Enter your company’s Federal ID number. This number can be found on filings made to the federal government such as your tax return. 2 Enter your company’s name, mailing address and phone/fax number for your company’s primary office location. 3 Enter the name of the person Aon should contact if questions arise. Include mailing address, phone/fax and email address, if different than A2. 4 Identify your company’s legal structure by checking the box that applies. If the correct legal structure is not specifically listed, please check the “Other” box and specify in the space provided. B. Contract Information 1 Enter the Contract Number or Purchase Order Number that was included in BROWARD COUNTY’s originating documentation. 2 Supply the Date this Contract was awarded to your organization. 3 Provide a brief description of the work you will be performing at the project Site(s). 4 Identify the total amount of your contract. 5 Identify the amount of work that you anticipate will be self-performed. 6 Check the appropriate box that identifies if you contract directly with BROWARD COUNTY or are a Subcontractor. 7 If you are a Subcontractor, identify the entity with whom you are under contract. 8 Enter the Date you anticipate starting work and then mark whether the date provided is actual or estimated. 9 Enter the Date you anticipate completing the described work and then mark whether the date provided is actual or estimated. C. Contacts (Requested Contact information is for specific functions. It is possible to have a single person fulfill multiple responsibilities.) 1 Identify the name of the person and their title for each function. These individuals should be located, if at all possible, on-Site(s). 2 Provide the phone number for each person identified above. 3 Provide the fax number for each person identified above. 4 Provide the email address for each person identified above, if applicable. 5 Identify the physical location where your payroll records are retained. Provide the Address, City, State, Zip Code, Telephone, Fax Number and Email Address of the person responsible for maintaining the payroll information. D. Workers’ Compensation Information (Duplicate or attach additional sheets if necessary. You may create an electronic version of this document if all requested information is included.): 1 a Enter the two letter abbreviation for the state in which the work will be performed. b Enter each Workers’ Compensation class code that applies to the work identified in B2. (Most states use a 4 digit Number) c Enter the Workers’ Compensation class code description that applies to the work identified in D1b. d Enter the estimated Man-hours required to complete the described work by Workers’ Compensation class code. 2 e Enter the estimated Payroll required to complete the described work for each Workers’ Compensation class code. Use only unburdened payroll and exclude the premium portions of any overtime pay. Total all estimated Man-hours for each class code. Be sure to include information from additional pages if used. 3 Total all estimated Payroll for each class code. Be sure to include information from additional pages if used. E. Current Off-Site(s) Workers’ Compensation Information (Information relates to your corporation’s existing coverage; identify each modification factor that applies.) 1 Enter the State that the Modification Information applies to. 2 Enter your Bureau File Number also referred to as your Risk Identification Number. This number can also be found on your Modification worksheets. 3 Enter the Bureau Rating Agency. In most states this is NCCI. 4 Provide your Company’s Anniversary Rating Date. Information can be located on your bureau’s WC Experience Modification worksheets. 5 Identify your insurance carrier for Workers’ Compensation Coverage. 6 Provide your Workers’ Compensation Policy Number. 7 Provide the effective date of your Workers’ Compensation policy. 8 Provide the expiration date of your Workers’ Compensation policy. F. Subcontractor Information (Provide the following information for each Subcontractor that will be performing work at the project Site(s). Use additional sheets, if necessary.) 1 Identify the name of the Subcontracting firm. 2 Provide the estimated value of the subcontracted activity. 3 Provide a contact name, preferably the project manager, for the Subcontractor. 4 Provide the mailing address for the Subcontractor. 5 Provide the phone number for the Subcontractor. 6 Provide the date the Subcontractor is scheduled to begin work. G. Enrollment Questions 1 Determine if you will have any locations, off-Site(s), that will be 100% dedicated to this project. Include material/supply storage as a possible location. Mark the appropriate box (yes/no). If you answer yes – provide the address of each location you identified as 100% dedicated. 2 Mark the box or boxes that apply. Contemplate only work performed under this contract. 3 Mark the box or boxes that apply. Employee Leasing Firm are those firms that supply the labor force for your company (You direct the activities of the Leasing Company’s employees). Temporary Labor Firms supplement your labor force. H. Warranty Statements: 1-6 Read each Warranty statement thoroughly. If you have questions regarding any of these statements, contact the Aon administrator identified on page 2. I. Signature Block: This form must be signed by a representative of your company knowledgeable of its accuracy. Forward the completed Enrollment Application to the Aon administrator identified at the bottom of page 2 of this form. The administrator prior to the start of your work on-Site(s) must receive this form.
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Exhibit 2 Page 1 of 379 AGREEMENT b
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Exhibit 2 Page 3 of 379 Terminal 4
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Page 83 and 84: Exhibit 2 Page 83 of 379 Terminal 4
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Page 87 and 88: Terminal 4 Gate Replacement - Weste
Page 99 and 100: Exhibit 2 Page 99 of 379 Owner Cont
Page 101 and 102: Exhibit 2 Page 101 of 379 TABLE OF
Page 103 and 104: Exhibit 2 Page 103 of 379 OVERVIEW
Page 105 and 106: Exhibit 2 Page 105 of 379 OVERVIEW
Page 107 and 108: Exhibit 2 Page 107 of 379 OCIP PROG
Page 109 and 110: Exhibit 2 Page 109 of 379 OCIP INSU
Page 111 and 112: Exhibit 2 Page 111 of 379 OCIP INSU
Page 113 and 114: Exhibit 2 Page 113 of 379 CONTRACTO
Page 123 and 124: Exhibit 2 Page 123 of 379 CLAIM REP
Page 125 and 126: Exhibit 2 Page 125 of 379 CLAIM REP
Page 127 and 128: AONWRAP WEB INSTRUCTION Exhibit 2 P
Page 129 and 130: AONWRAP WEB INSTRUCTION 10. Type yo
Page 131 and 132: AONWRAP WEB INSTRUCTION Exhibit 2 P
Page 133: Exhibit 2 Page 133 of 379 Form-3 En
Page 137 and 138: Form-4 On-Site(s) Payroll Report In
Page 139 and 140: Form-5 Notice of Work Completion In
Page 141 and 142: Exhibit 1 - Sample Certificate of I
Page 143 and 144: Exhibit 3 - First Report of Injury
Page 145 and 146: Exhibit 2 Page 145 of 379
Page 147 and 148: TABLE OF CONTENT Exhibit 2 Page 147
Page 149 and 150: Exhibit 2 Page 149 of 379 SECURITY
Page 151 and 152: INTRODUCTION Exhibit 2 Page 151 of
Page 153 and 154: DEFINITIONS Exhibit 2 Page 153 of 3
Page 155 and 156: ACRONYMS Exhibit 2 Page 155 of 379
Page 157 and 158: Conduct hazard communication traini
Page 159 and 160: 12. Review and evaluate contractors
Page 161 and 162: or minimize exposures that will or
Page 163 and 164: 2) Positioning device system allows
Page 165 and 166: F. Welding and Cutting Exhibit 2 Pa
Page 167 and 168: 13) Complete and file on site a Loc
Page 169 and 170: M. Job Safety Analysis Exhibit 2 Pa
Page 171 and 172: SAFETY TRAINING Exhibit 2 Page 171
Page 173 and 174: 4. Contractor Safety Audit This Saf
Page 175 and 176: d) The OCIP insurance carrier perso
Page 177 and 178: Exhibit 2 Page 177 of 379 EMERGENCY
Page 179 and 180: Obtain a hurricane tracking and inf
Page 181 and 182: SECURITY Exhibit 2 Page 181 of 379
Page 183 and 184: D. Security - General Project Rules
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I. Delivery and Removal of Material
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Exhibit 2 Page 187 of 379 FIRST REP
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Exhibit 2 Page 189 of 379 CONTRACTO
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Exhibit 2 Page 191 of 379 d. Analyz
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Exhibit 2 Page 193 of 379 4. PPE cu
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Exhibit 2 Page 195 of 379 WITNESS S
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Exhibit 2 Page 197 of 379 Sequence
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Exhibit 2 Page 199 of 379 LOCK-OUT
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Exhibit 2 Page 201 of 379 ORIENTATI
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Exhibit 2 Page 203 of 379 SAFETY OB
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Exhibit 2 Page 205 of 379 CONTRACTO
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Exhibit 2 Page 207 of 379 DIVISION
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DIVISION 1 SPECIFICATIONS - SECTION
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DIVISION 1 SPECIFICATIONS SECTION 0
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Exhibit 2 Page 329 of 379 PART 1 -
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Exhibit 2 Page 331 of 379 Broward C
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Badging Requirements and Ramp Drivi
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Exhibit 2 Page 349 of 379 EXHIBIT 1
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Exhibit 2 Page 351 of 379 NUMBER VE
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TERMINAL 4 GATE REPLACEMENT - WESTE
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Exhibit 2 Page 359 of 379 TERMINAL
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Exhibit 2 Page 361 of 379 TERMINAL
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Exhibit 2 Page 363 of 379 FORM 1: C
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Exhibit 2 Page 365 of 379 FORM 3 FO
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Exhibit 2 Page 367 of 379 FORM 4: F
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Exhibit 2 Page 369 of 379 FORM OF P
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Exhibit 2 Page 371 of 379 FORM OF P
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MONTHLY (CBE) UTILIZATION REPORT Ex
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FINAL (CBE) UTILIZATION REPORT Exhi
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Exhibit 2 Page 377 of 379 CBE UNAVA
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Exhibit 2 Page 379 of 379 CERTIFICA
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AGREEMENT between BROWARD COUNTY and Cummings ...

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