ADDENDUM 1 TO BID DOCUMENTS FOR ... - Port Canaveral

More documents

Recommendations

Info

CANAVERAL HARBOR 44 FOOT CHANNEL PROJECT – PACKAGE 1PUR-ITB-13-5/CN1-8-10-12-014AForm-1ENROLLMENT APPLICATIONINSTRUCTIONSPage 3 of 4CANAVERAL PORT AUTHORITY PROJECTThis form must be completed and submitted by each successful Subcontractor and Lower-Tiered Subcontractor prior to execution of the subcontract and Project Site mobilization foreach Subcontract awarded. The Subcontractor and Lower-Tiered Subcontractor must submit the completed form to the SOCIP Administrator. Upon receipt of this form, SOCIPAdministrator will issue to the Subcontractor or Lower-Tiered Subcontractor a Certificate of Insurance evidencing coverage in the Controlled Insurance Program. The completedCertificate of Insurance and Workers’ Compensation insurance policy will be mailed to each Enrolled party.1. Subcontractor/Lower-Tiered Subcontractor Legal Name: Fill in your company’s legal name.2. Address: Fill in the complete field office or home office addresses, including city, state and zip code.3. Entity: “” Appropriate box describing the type of company.4. Federal ID. Number: Fill in your company’s Federal Tax Identification #.5. Telephone Number: Fill in your company’s home office phone and fax numbers, including area codes.6. Insurance Contact: Fill in the name and phone number of your company’s insurance representative.7. Payroll Contact: Fill in the name and phone number of your company’s accounting/payroll representative.8. Safety Coordinator: Fill in the name and phone number of your company’s safety coordinator for the project.9. Location of Accounting Records: Fill in the actual street address of your accounting records if they are maintained at a location different from the address in #2above, such as the home office location, if applicable. This information is essential to the insurer for physical audits.10. Contract #: Fill in the Contract number assigned to your project. If you are a Lower-Tiered Subcontractor, contact your Subcontractor forthis number.11. Contract Award Date: Fill in the date of your Contract award.12. Estimated Start Date: Fill in the date you anticipate starting Work at the Project Site.13. Estimated Completion Date: Fill in the date on which you expect to finish all Work at the Project Site.14. Total Contract Amount: Fill in (numerically) the dollar amount of your initial Subcontract.15. Self-Performed Amount Fill in the amount of total Contract award for Work that your company will perform itself (i.e., non-subcontracted work).16. Description of Work to be Performed: Fill in the type of services your firm will be doing at the project. Examples: Structural Steel, HVAC.17. Your Status at this Project: “” Appropriate box depending upon whether or not your firm is a Subcontractor or Lower-Tiered Subcontractor.18. Name of Subcontractor for whom you are working. Fill in the name of the Subcontractor you are working for.19. List Lower-Tiered Subcontractors Identify the Lower-Tiered Subcontractors that will be working for you on this Project. Include contact person, phone numberand dollar amount of the subcontract.20. Off-Site Locations Indicate whether or not your company will be using any locations away from the Project Site that will be dedicated 100% tothe Project. If so, provide address.21. Aircraft/Watercraft “” One or both boxes if your company owns, leases, operates or hires any aircraft or watercraft for this Project or any otherof your company’s operations.22. Regular Workers’ Compensation Insurer Provide the name of the insurance company that provides Workers’ Compensation coverage for your regular operations.23. Workers’ Compensation Experience Modifier Fill in the Workers’ Compensation experience modifier obtained from your current Workers’ Compensation policy orinsurance agent.24. Experience Rating Date Provide the effective date of your regular Workers’ Compensation policy.25. Bureau File Number (Risk ID Number) Fill in your company’s Bureau File Number obtained from your regular Workers’ Compensation policy or your insuranceagent.2012-10/436743 00 73 16.11 - 3 <strong>ADDENDUM</strong> #1
CANAVERAL HARBOR 44 FOOT CHANNEL PROJECT – PACKAGE 1PUR-ITB-13-5/CN1-8-10-12-014AAForm-1State & Class CodeINSURANCE WORKSHEETINSTRUCTIONSPage 4 of 4CANAVERAL PORT AUTHORITYPROJECTIndicate the state in which the work will be performed and the Workers’ Compensation classification codes that are applicable to those employeesperforming Work for the Project. Workers Compensation codes that do not properly identify the type of work performed will be corrected during the bidreview process. The financial consequences of coding errors are the responsibility of the subcontracting and lower-tiered subcontracting party.B Description Provide the Workers’ Compensation class code descriptions that apply to the codes entered in column A.C Rate Enter rate your firm pays for coverage for each class code. This information can be obtained from your Workers’ Compensation policy.D Work-hours Provide your estimated work-hours, by class code, for work that will be performed on-site.E Payroll Calculate your estimated payroll, by class code, for work that will be performed on-site. Divide each total by 100.F WC Premium For each classification entered in column A, multiply the Payroll by the Rate.26. Totals Calculate totals for columns D, E and F.27. Employers Liability Rate 1) Calculate the premium by multiplying line 26 F Modified Premiums by line 27 a) the rate indicated. 2) Enter the result on line 27 b).28.Drug-free Workplace PremiumSafety PremiumIdentify any drug-free workplace and/or safety premiums, if applicable to your Workers’ Compensation policy. 1) Compute the Drug-free Amount bymultiplying line 27 b) the Modified Premium by the Drug-Free Workplace Rate indicated. 2) Enter the result in the Amount line. Subtract this Amountfrom line 27 b) and enter results on line 28 a). 3) Compute the Safety Amount by multiplying line 28 a) by the Safety Rate indicated. 4) Enter the resultin the Amount line. Subtract this Amount from line 28 a) and enter results on line 28 b).29. Workers’ Comp ExperienceModifierEnter your experience modification factor. This number is located on your Workers’ Compensation policy and on the Bureau’s rating sheets. If you donot have an experience modifier, use 1.00.30. Modified Premium Multiply the total on line 28 b) by your Workers’ Compensation Experience Modifier on line 29 and enter that amount on line 30.31. Modification Premium Factors Identify the premium modification factors that apply to your Workers’ Compensation policy. These factors may include a “Self-Insured”,“Stock/Premium Discount”, or “Other Discounts” 1) determine which modifiers/discounts apply to your company (refer to the Declaration Page of yourWorkers Compensation Policy), 2) enter the rate that applies in the “Rate” column for each modifier/discount that apply, 3) compute the amount of thefirst modifier/discount that applies by multiplying the Modified Premium on line 30 by the rate associated with the first modifier/discount that applies, 4)enter the results in the “Amount” column on the line of the modifier/discount that apply and subtract this amount from line 30. 5) Enter the results online 31 of the modifier/discount that apply “a)”, “b)”, “c)”, “d)”, or “e)”, 6) compute the amount of the next modifier/discount by multiplying the resultsreceived in 5) by the next modifier/discount rate. 7) Enter the results in the “Amount” column on the line of the modifier/discount that apply and subtractthis amount from the results received in 5). 8) Enter the results on line 31 of the modifier/discount that apply “a)”, “b)”, “c)”, “d)”, or “e)”. Once all of themodifier/discounts have been calculated, go onto #32 of the Instructions32. Total Workers’ CompPremiumInsert the results from line 31 e). This represents you Total Workers Compensation Premium.33. General Liability a) Enter the General Liability rate. b) “” The box corresponding to the basis on which the rate applies. (If the basis is “Deductible Amount,” specify inthe space provided, provide documentation and your loss charge rate) c) “” Whether the rate factor is per $100 or $1,000 of the basis amount.Insert the General Liability Premium arrived at by using the formula: (Rate Basis ÷ Rate Factor) x (General Liability Rate). If you are using a compositerate you will need to provide your General Liability Loss Charge. Consult SOCIP Administrator with questions on how to calculate.34. Builder’s Risk/InstallationFloaterEnter the rate. b) Enter the Proposed Contract Cost identified in the Bid Information Section. C) Insert total of a) x b).35. Excess/Umbrella Liability a) Enter your Excess or Umbrella Liability rate. b) “”The box identifying the basis to which the rate applies. (If the basis is “Other,” specify in the spaceprovided.) c) “” Whether the rate factor is ($100 or $1,000) of the basis amount. d) Insert the Excess or Umbrella Liability Premium by using theformula: (Rate basis ÷ Rate Factor) x Excess or Umbrella Rate.36. Total of all InsurancePremiumsInsert the sum of lines 32, 33d, 34b and 35d.37. Overhead/Profit a) Insert the percent of Overhead & Profit included in your pricing structure. b) Insert the result of applying that percentage to line 36 (Total of AllInsurance Premiums).38. Total Insert the sum of lines 36 and 37.39. Insurance Composite Rate Divide the line 38 (Total Initial Insurance Credit) by line 26E (Total Payroll).Signature and CompanyNameHave an authorized representative of the company sign and date the completed form. Repeat the name of the company.2012-10/436743 00 73 16.11 - 4 <strong>ADDENDUM</strong> #1
Page 1 and 2: ADDENDUM 1TO BID DOCUMENTSFORCANAVE
Page 3 and 4: CANAVERAL HARBOR 44 FOOT CHANNEL PR
Page 13 and 14: PROJECT NAMEPUR-ITB-13-5/CN1-8-10-1
Page 23: CANAVERAL HARBOR 44 FOOT CHANNEL PR
Page 33 and 34: CANAVERAL HARBOR 44 FOOT CHANNELPRO
Page 35 and 36: CANAVERAL HARBOR 44 FOOT CHANNELPRO

ADDENDUM 1 TO BID DOCUMENTS FOR ... - Port Canaveral

Create successful ePaper yourself

Delete template?

Save as template?