Request for Quotation

353 Pleasant Avenue Demolition Town of Hamburg, Erie County, New York Project No. 11119304 (8) February 2020

11119304 (8) – February 2020

TOWN OF HAMBURG ERIE COUNTY, NEW YORK

353 PLEASANT AVENUE DEMOLITION

REQUEST FOR QUOTATION

NOTICE TO BIDDERS INFORMATION FOR BIDDERS

PROPOSAL CONTRACT AND AGREEMENT TECHNICAL SPECIFICATIONS

FEBRUARY 2020

Warning Altering any item in this document is in violation of the law, excepting as provided in Section 7209, Part 2 of the New York State Education Law.

Prepared by: GHD Consulting Services Inc., 285 Delaware Avenue, Suite 500

Buffalo, New York 14202

11119304 (8) – January 2020 TOC - 1 TABLE OF CONTENTS

TOWN OF HAMBURG ERIE COUNTY, NEW YORK

353 PLEASANT AVENUE DEMOLITION

REQUEST FOR QUOTATION

TABLE OF CONTENTS

UPage

NOTICE TO BIDDERS NTB-1

INFORMATION FOR BIDDERS IFB-1 1. Proposals Received IFB-1 2. Work Included IFB-1 3. Proposal IFB-1 4. Late and Irregular Proposals IFB-1 5. Contractor's Insurance IFB-2 6. Responsibility of Contractor IFB-2 7. Familiarity with the Work IFB-2 8. Right to Reject IFB-3 9. Award of Project IFB-3 10. Withdrawal of Quotes IFB-3 11. Time of Completion IFB-3

PROPOSAL FORM PF-1

PROPOSAL FORM CERTIFICATES PFC-1 Certified Copy of Resolution of Board of Directors PFC-2 Non-Collusive Bidding Certificate PFC-3

AUTHORIZATION OF WORK CA-1

TECHNICAL SPECIFICATIONS

SECTION 01010 Summary of Work 01010-1 SECTION 01340 Submittal and Correspondence Procedure 01340-1

PROJECT DRAWINGS - BOUND HEREIN

APPENDICES

Appendix A – Town of Hamburg Sample Insurance Documents

GHD | Town of Hamburg – Request for Quotation 353 Pleasant Avenue Demolition – 11119304 (8) | NTB - 1 NOTICE TO BIDDERS

TOWN OF HAMBURG ERIE COUNTY, NEW YORK

353 PLEASANT AVENUE DEMOLITION

Notice to Bidders

All work will be in accordance with the Contract Drawings and Specifications and as directed by ENGINEER. Separate sealed Bids will be received by the Town of Hamburg until 10:00 a.m. local time on March 6, 2020 at the office of the Town Clerk, Town of Hamburg, 6100 South Park Avenue, Hamburg, New York 14075, and then at that time and place be publicly opened and read aloud. All Bids shall be made on the forms furnished and shall be enclosed in a sealed envelope marked "353 PLEASANT AVENUE DEMOLITION" and directed to Town of Hamburg. This project consists of selective demolition to a Town of Hamburg owned building in part to accommodate the removal of an existing railcar as shown and specified, and as determined in the field by the Town Engineer. Removal of the railcar is not included in the Project. THERE IS A PRE-BID MEETING SCHEDULED FOR 10:00 AM ON THURSDAY, FEBRUARY 27, 2020 AT THE PROJECT SITE. ALL PROSPECTIVE BIDDERS ARE STRONGLY RECOMMENDED TO ATTEND. The Contract Documents may be examined at the following locations:

GHD Consulting Services Inc. 285 Delaware Avenue, Suite 500 Buffalo, NY 14202

Town of Hamburg Engineering Department

Town Hall 6100 South Park Avenue Hamburg, NY 14075

The Contract Documents may be viewed and obtained at the Office of the Town Clerk, Town of Hamburg Town Hall, 6100 South Park Avenue, Hamburg, NY 14075. Bids must be submitted upon the proposal form(s) furnished in the Proposal Booklet, and Umust not be detachedU from the booklet. Failure to submit a bid on the proposal form(s) furnished in the Proposal Booklet, or submittal of form(s) detached from the Proposal Booklet will result in automatic disqualification of bid. Addendum pages, if issued, shall be stapled to the original pages of the Proposal Booklet and submitted as part of the Bid. The Town of Hamburg is exempt from the payment of sales and compensating use taxes of the State of New York and of cities and counties on all materials, equipment, and supplies sold to the Town of Hamburg pursuant to this Contract. Also exempt from such taxes are purchases by the Contractor and his Subcontractors of materials, equipment, and supplies to be sold to the Town of Hamburg pursuant to this Contract, including tangible personal property to be incorporated in any structure, building, or other real property forming part of the Project. These taxes are not to be included in the Bid. The Town of Hamburg reserves the right to waive any informalities or to reject any or all bids.

GHD | Town of Hamburg – Request for Quotation 353 Pleasant Avenue Demolition – 11119304 (8) | NTB - 2 NOTICE TO BIDDERS

Bidders are required to certify, under penalty of perjury, that bids have been prepared without collusion with other bidders, subcontractors, suppliers, etc. This certification is included with the Bid Proposal, which each Bidder must sign in the space provided. Date: February 21, 2020 TOWN OF HAMBURG ENGINEER: GHD Consulting Services Inc. 285 Delaware Avenue, Suite 500 Buffalo, New York 14202

11119304 (8) – January 2020 IFB - 1 INFORMATION FOR BIDDERS

TOWN OF HAMBURG ERIE COUNTY, NEW YORK

353 PLEASANT AVENUE DEMOLITION

INFORMATION FOR BIDDERS 1. PROPOSALS RECEIVED

The Town of Hamburg (hereinafter called the OWNER) will receive sealed proposals for the work included in these documents at the time and place and under the conditions stated in the Notice to Bidders.

2. WORK INCLUDED

A description of the work included under this Project is included in Section 01010, Summary of Work. The Work shall generally be as indicated in Appendix B.

3. PROPOSAL

Proposals must be made upon the forms contained herein.

The proposals, as submitted, shall not be separated from the volume containing the other Documents which are bound with it. The blank spaces in the Proposal must be filled in correctly where indicated, for each and every item, and the CONTRACTOR must state, both in words and in numerals, written or printed in ink, the price(s) for which he proposes to do each item of the work contemplated. In case of discrepancy between the words and the numerals, the words shall govern. Ditto marks are not considered writing or printing and shall not be used.

The CONTRACTOR shall sign his Proposal correctly. If the Proposal is made by an individual, his name and post office address must be shown. If made by a firm or partnership or by a corporation, the Proposal must be signed and sealed by an official of the firm, partnership or corporation. The following original signatures are required to be affixed to the documents:

UItem U USignature ReceivedU* Proposal CONTRACTOR Certified Copy of Resolution of Board of Directors CONTRACTOR Non-Collusion Certificate CONTRACTOR

* Seal and authorized signature required, if quote is by a Corporation.

4. LATE AND IRREGULAR PROPOSALS

Proposals may be rejected if they show any omissions, alterations of form, additions not called for, conditional or alternate items other than those provided for in the proposal form, quotes containing escalation clauses, or irregularities of any kind. Quotes received by mail or otherwise after the time specified in the Notice to Bidders will not be accepted and will be returned to the CONTRACTOR unopened.

11119304 (8) – January 2020 IFB - 2 INFORMATION FOR BIDDERS

5. CONTRACTOR'S INSURANCE

The CONTRACTOR shall, prior to the start of work, secure and maintain in force during the full term of this Project and such times thereafter that the CONTRACTOR enters upon the property to maintain or repair during the warranty period, insurance from an insurance company authorized to write the required insurances in the State of New York as will protect himself, his subcontractors, the OWNER, and the ENGINEER from claims for bodily injury, death or property damage which may arise from operations under this Project. The CONTRACTOR shall not commence or proceed to work until he has obtained all insurance required and accepted by the OWNER and until he shall have filed the certificate of insurance or the certified copy of the insurance policy with the OWNER. Each insurance policy shall contain a clause providing that in the event of cancellation, change or non-renewal of the policies, the insurance company will give thirty (30) days' advance written notice to the OWNER. The certificate of insurance shall be completed and executed prior to the start of work. The certificate of insurance shall have the name, address and telephone numbers of both the insurance company and the insurance company agent.

The CONTRACTOR shall also secure and maintain in force during the time required by the insured, the various insurances that might be required by any other governing and regulatory agency.

The CONTRACTOR's insurance company, if not a New York State Corporation, must have on file with the Secretary of State of New York a certificate of authority to conduct business in New York State. This certificate, inter alia, names the Secretary of State as agent to accept service of a summons on behalf of the insurance company. Please see Appendix A – Town of Hamburg Sample Insurance Documents for reference.

6. RESPONSIBILITY OF CONTRACTOR

The CONTRACTOR shall be responsible for any loss or damage that may happen to the work or any part thereof during its progress; and also whereby the CONTRACTOR shall make good any defects or faults that may occur within the warranty period after its completion and acceptance by the OWNER. He shall indemnify and save harmless the OWNER from any damages or costs to which it may be put by reason of injury to the person or property of another resulting from negligence or carelessness in the performance of the work under this Project as set forth in the Information for Contractors.

7. FAMILIARITY WITH THE WORK

CONTRACTORS shall carefully examine all Documents and all available information with respect to project conditions, if available; shall visit the site to make a thorough investigation of conditions that may in any manner affect the performance of the work; shall familiarize themselves with federal, state, and local laws, ordinances, rules and regulations affecting performance of the work; and shall carefully coordinate their observations with the requirements of the Project. The CONTRACTOR's obligations hereunder shall include, but not be limited to, making such additional surveys and investigations as they may deem necessary to determine their price(s) for performance of the work.

The successful CONTRACTOR agrees that he will make no claim for additional payment, or for an extension of time for completion of the work, or for any other concession, because of any misinterpretation or misunderstanding, on his part, of the Documents, or because of any failure, on his part, to fully acquaint himself with all conditions relating to the work, or for any other reason.

The submission of a quote will constitute an incontrovertible representation by the CONTRACTOR that he has complied with every requirement of this section of the Information for Contractors.

11119304 (8) – January 2020 IFB - 3 INFORMATION FOR BIDDERS

8. RIGHT TO REJECT

The OWNER reserves the right to reject any and all proposals, quotes, or Alternates, or to accept any proposal deemed to be for the best interest of the OWNER.

9. AWARD OF PROJECT

Determination of the low CONTRACTOR’s quote for this Project will be made based upon the lowest value of dollars as shown in the Proposal form and as described in Section 01010, Summary of Work, and the lowest responsible, responsive quote for that Item to be in the best interest of the OWNER.

10. WITHDRAWAL OF QUOTES

If the OWNER fails to award the work within forty-five (45) days from the date of receipt of quotes, the CONTRACTOR may nullify or withdraw his quote by communicating his purpose, in writing, to the OWNER. After expiration of the forty-five (45) day time period, and in the absence of written notice of withdrawal thereafter, the quote shall be deemed to be in full force and effect. Written notice of acceptance from the OWNER shall be considered an award.

11. TIME OF COMPLETION

The work shall be completed and accepted by the Town within 30 days of the date of Notice to Proceed.

Time is of the essence of this Project with respect to the work to be performed. The

CONTRACTOR shall proceed expeditiously with the work with adequate forces. The CONTRACTOR hereby confirms that the times set forth above for completion of the work is reasonable for performing and completing the work.

11119304 (8) – January 2020 PF - 1 PROPOSAL FORM

TOWN OF HAMBURG ERIE COUNTY, NEW YORK

353 PLEASANT AVENUE DEMOLITION

REQUEST FOR QUOTATION

PROPOSAL OF _______________________________________________(NAME OF CONTRACTOR)

PROPOSAL FORM

(This Proposal shall not be detached from this Document and the entire booklet shall be included with each signed quote.)

The undersigned, as CONTRACTOR, declares that no person or persons other than those named herein are interested in this Quote; that this quote is made without collusion with any other person, firm or corporation; that he has carefully examined the location of the proposed work; that no person or persons acting in any official capacity for the OWNER is directly or indirectly interested therein or in any portion of the profit thereof; and that he proposes and agrees, if this proposal is accepted, to provide all necessary equipment, tools, and other means of construction, to do all work and furnish all the materials shown and specified in this Document and according to the requirements of the ENGINEER as therein set forth, and then he will take in full payment therefore, the following sums to wit:

CONTRACTOR agrees to perform all the following work described in the Specifications and shown on the Drawings for the following fixed maximum, fixed minimum, unit prices or lump sums. The CONTRACTOR also agrees that the unit prices or lump sum prices and the fixed maximum and fixed minimum shall be full compensation for furnishing all labor, materials, tools, equipment, profit and overhead necessary to perform the work as shown and specified.

11119304 (8) – January 2020 PF - 2 PROPOSAL FORM

Estimated Computed UDescriptionU UQuantitiesU UTotals ITEM 1 – UBuilding Demolition

For all building demolition, as described in Section 01010, Summary of Work, the Lump Sum Price of Dollars and Cents ($ ) Lump Sum $

ITEM 2 – UHazardous Materials Assessment

For all hazardous materials assessment services, as described in Section 01010, Summary of Work, the Lump Sum Price of

Dollars and Cents ($ ) Lump Sum $

ITEM 3 – UHazardous Materials Abatement Allowance

This allowance is to cover the cost of additional work as directed by the ENGINEER, as described in Section 01010, Summary of Work, the Unit Price of

U Two Thousand Five Hundred U Dollars andU zero U Cents ($ 2,500.00 ) Allowance Allowance $U 2,500.00

GRAND TOTAL AMOUNT OF QUOTE, ITEMS NO. 1 - 3 Dollars and Cents

(Written)

$ (Figures)

11119304 (8) – January 2020 PFC - 1 PROPOSAL FORM CERTIFICATES

The above computed total is for convenience of comparing quotes and will be used for that purpose only. (Amounts to be shown in both words and figures. In case of discrepancy, the amount in words will govern). The OWNER does not assume any responsibility for these quantities, nor shall the CONTRACTOR plead misunderstanding or deception because of such estimate of quantities or of the character of the work, location or other condition including site and underground conditions of soil, rock, utilities, etc. pertaining thereto.

The above lump sum prices shall include all labor, materials, baling, shoring, removal, overhead, taxes, profit, bonds, insurance, etc., to cover the finished work as specified herein. The signing of the proposal and submission of a quote shall constitute a release of the OWNER and the ENGINEER, their officers and their agents or employees, from all claims whatsoever with respect thereto. In the event that the OWNER requires more than forty-five (45) calendar days after the date specified in the Notice to Contractors to award the Work and the lowest qualified CONTRACTOR does not grant an extension of time for the OWNER to award the Work, the OWNER reserves the right to award to the second lowest qualified CONTRACTOR. Respectfully submitted,

by

Signature

Typed or Printed Name

Title

Business Name

(SEAL - if quote is by a corporation) Business Address

Business Phone Number

Email Address

11119304 (8) – January 2020 PFC - 2 PROPOSAL FORM CERTIFICATES

CERTIFIED COPY OF RESOLUTION OF BOARD OF DIRECTORS OF

(Name of Corporation)

RESOLVED that (Person Authorized to Sign)

_______________________ to __________________________________________________________ (Title) (Name of Corporation) be authorized to sign and submit the quote for proposal of this corporation for the following:

The foregoing is a true and correct copy of the resolution adopted by

(Name of Corporation)

at a meeting of its Board of Directors held on the _________ day of ___________________, 20_____.

By Title

(S E A L)

The above form must be completed if the Contractor is a Corporation.

11119304 (8) – January 2020 PFC - 3 PROPOSAL FORM CERTIFICATES

NON-COLLUSIVE BIDDING CERTIFICATE

By submission of this proposal, the Contractor certifies that: (1) the prices in this quote have been arrived at independently without collusion, consultation, communication, or agreement, for the purpose of restricting competition, as to any matter relating to such prices with any other Contractor or with any competitor; (2) Unless otherwise required by law, the prices which have been quoted in this proposal have not been knowingly disclosed by the Contractor and will not knowingly be disclosed by the Contractor prior to opening, directly or indirectly, to any other Contractor or to any competitor; and (3) No attempt has been made or will be made by the Contractor to induce any other person, partnership or corporation to submit or not to submit a quote for the purpose of restricting competition.

The person signing this quote or proposal certified that: (a) He has fully informed himself regarding the accuracy of the statements contained in this Certification, and under the penalties being applicable to the CONTRACTOR, as well as to the person signing in its behalf; and (b) that attached hereto (if a corporate Contractor) is a certified copy of the resolution authorizing the execution of this certificate by the signator of this proposal on behalf of the corporate Contractor.

(Name of Individual, Partnership or Corporation)

By: (Person authorized to sign)

(Title) (S E A L)

11119304 (8) – January 2020 CA - 1 AUTHORIZATION OF WORK

TOWN OF HAMBURG ERIE COUNTY, NEW YORK

353 PLEASANT AVENUE DEMOLITION

REQUEST FOR QUOTATION

AUTHORIZATION OF WORK

This Authorization of Work, made this ______ day of __________________, in the year 2020, between the UTown of HamburgU, hereinafter called the OWNER, party of the first part, and , hereinafter called the CONTRACTOR, party of the second part.

Under this Authorization of Work, the CONTRACTOR shall furnish goods and services for the 353 Pleasant Avenue Demolition Project. Signature by both parties constitutes authorization for the CONTRACTOR to proceed with any parts of this Work including, but not limited to, material purchases. OWNER: UTOWN OF HAMBURG _____________________________________________ (Signature) _____________________________________________

(Print Name) _____________________________________________

(Title)

CONTRACTOR: (Company) _____________________________________________ (Signature) _____________________________________________

(Print Name) _____________________________________________

(Title)

(SEAL, if by a Corporation)

11119304 (8) – January 2020 SECTION 01010 - 1 SUMMARY OF WORK

SECTION 01010

SUMMARY OF WORK PART 1 GENERAL 1.1 SITE LOCATION

A. Project Location – 353 Pleasant Avenue, Hamburg, New York 14075.

1.2 WORK COVERED BY DOCUMENTS

A. Request for Quotes – 353 Pleasant Avenue Demolition Project.

1. General: It is the intent and purpose of these Documents and accompanying Figure to describe the general work associated with this Project.

2. CONTRACTOR is advised that this demolition is required to facilitate removal of the

existing train car. Removal of the train car is not included in this project. 3. The CONTRACTOR shall return to original condition, satisfactory to OWNER, any

damaged facilities caused by the CONTRACTOR’s operations at the CONTRACTOR’s expense.

4. The CONTRACTOR shall supply all supervision, labor, equipment, and materials to

complete the work outlined in this Section and shown on the attached contract drawing unless specified otherwise.

5. The work under the Project includes, but is not limited to, the following:

a. Item 1 – Building Demolition

1) Selective demolition of the building as shown on the attached contract drawing.

2) Disconnection of all existing water and electrical lines. Lines shall be cut and

capped at the interior of the building space to remain.

3) Framing new enclosure as shown.

4) Installation of new temporary hollow metal double door. 5) Repair of existing roofing system. 6) Removal and disposal of all demolition debris.

Payment: Payment for the work under item shall be made in one lump sum payment for this item following completion of all demolition work as shown and specified and accepted by the OWNER.

b. Item 2 – Hazardous Materials Assessment

Under this Item, the CONTRACTOR shall provide the services of a third party consultant to assess the presence of any hazardous materials in the area of the work including, but not

11119304 (8) – January 2020 SECTION 01010 - 2 SUMMARY OF WORK

limited to: asbestos containing materials and lead based paint. This assessment will be limited only to the area(s) to be disturbed by the work as directed by the CONTRACTOR. The CONTRACTOR will only receive payment under this Item for actual extra Work performed and invoiced to the CONTRACTOR for sampling and analysis. c. Item 3 – Hazardous Materials Abatement Allowance

Under this Item, the CONTRACTOR shall provide the services of a qualified third party subcontractor for the abatement of any hazardous materials identified under Item 2 above. Work under this item shall also include any required containment, air sampling, materials disposal and conformance with any and all applicable laws and regulation. The CONTRACTOR will only receive payment under this Item for actual invoiced extra Work performed and invoiced to the CONTRACTOR for hazardous materials abatement. In the event that any work under this item will be performed by CONTRATOR forces, payment shall be made on a time and materials basis. In the event that the CONTRACTOR believes that work under this item will exceed the allowance amount, CONTRACTOR shall notify OWNER prior to start of work under this item.

1.3 MODIFICATION

A. The right is reserved by the OWNER to make such changes in the order and execution of the Work to be done under these Specifications as, in the judgment of the OWNER, may be necessary or expedient to carry out the intent of the design of the Project.

1.4 HOURS OF OPERATIONS

A. The CONTRACTOR shall only perform work during normal business hours, 7:00 a.m. to 5:00 p.m. on Monday through Friday.

1.5 AVAILABLE DATA AND PHYSICAL DATA

A. The CONTRACTOR shall be required to be fully informed concerning the location of facilities and

structures on, under, or over the Project Site, which may interfere with the operations of the CONTRACTOR, and it shall be assumed that the CONTRACTOR has prepared the quote in full understanding of the conditions to be encountered and responsibility of the CONTRACTOR in connection therewith.

B. "As-Built" information for the existing facilities has been brought to the attention of the OWNER.

However, in some instances, information only from investigations and field surveys has been shown. The indication on the Contract Drawings of such facilities shall not be assumed to relieve the CONTRACTOR of any responsibility with respect thereto; neither shall the OWNER be held responsible for any omission or failure to give notice to the CONTRACTOR of any other facility or structure on, under, or over the Project Site.

1.7 SPECIAL CONDITIONS

A. SCHEDULE OF NEW YORK STATE MINIMUM WAGE RATES

1. The labor on this Project shall be performed in all respects in full accordance with the Labor Law of the State of New York. In accordance with Section 220, Subdivision 3, and Section 220-D of the Labor Law, the Industrial Commissioner has designated as the

11119304 (8) – January 2020 SECTION 01010 - 3 SUMMARY OF WORK

minimum hourly rates to be paid to employees on this work. 2. Article 8, Section 220 of the Labor Law, as amended by Chapter 750 of the Laws of 1956,

provides, among other things, that it shall be the duty of the fiscal officer to make a determination of the schedule of wages and supplements to be paid all laborers, workmen and mechanics employed on public works projects.

3. Article 8 of the New York State Labor Law was amended on July 15, 1983 to provide that

wages for public projects are to be paid pursuant to the existing bargaining agreement in the area where the work is to be performed. Wages are to be paid on this Project as herein set forth or pursuant to the collective bargaining agreement in effect in Erie County, New York, whichever is higher.

4. The CONTRACTOR shall make provisions for disability benefits, workmen's compensation,

unemployment insurance and social security, as required by law.

B. NON-DISCRIMINATION IN EMPLOYMENT

1. The CONTRACTOR will not discriminate against any employee or applicant for employment because of race, creed, color, or national origin and will take affirmative action to ensure that they are afforded equal employment opportunities without discrimination because of race, creed, color or national origin. Such action shall be taken with reference, but not limited to: recruitment, employment, job assignment, promotion, upgrading, demotion, transfer, layoff or termination, rates of pay or other forms of compensation, and selection for training or retraining, including apprenticeship and on-the-job training.

2. The CONTRACTOR will send to each labor union or representative or workers with which

he has or is bound by a collective bargaining or other agreement or understanding, a notice to be provided by the State Commission for Human Rights, advising such labor union or representative of the CONTRACTOR's agreement under "non-discrimination clauses." Such labor union or representative will affirmatively cooperate within the limits of its legal and contractual authority, in the implementation of the policy and provisions of these non-discrimination clauses.

3. This Project may be forthwith canceled, terminated or suspended, in whole or in part, by

the OWNER upon the basis of a finding made by the State Commission for Human Rights that the CONTRACTOR has not complied with these non-discrimination clauses, and the CONTRACTOR may be declared ineligible for future Contracts until he has satisfied the State Commission for Human Rights.

4. If this Project is canceled or terminated, in addition to other rights of the OWNER upon its

breach by the CONTRACTOR, the CONTRACTOR will hold the OWNER harmless against any additional expenses or costs incurred by the OWNER in completing the Work or in purchasing the services, materials, equipment or supplies contemplated by this Project, and the OWNER may withhold payments from the CONTRACTOR in an amount sufficient for this purpose if necessary.

PART 2 PRODUCTS – NOT USED PART 3 EXECUTION – NOT USED

END OF SECTION

11119304 (8) – January 2020 SECTION 01340 - 1 SUBMITTAL AND CORRESPONDENCE PROCEDURE

SECTION 01340

SUBMITTAL AND CORRESPONDENCE PROCEDURE PART 1 GENERAL 1.1 SECTION INCLUDES

A. Submittal procedures.

B. Construction progress schedules.

C. Proposed products list.

D. Shop Drawings.

E. Product data.

F. Samples.

G. Manufacturer’s installation instructions.

H. Manufacturers’ certificates. 1.2 SUBMITTAL PROCEDURES

A. Submittals of Shop Drawings shall be made to: Town of Hamburg, 6100 South Park Avenue, Hamburg, New York 14075, Attention: Town Engineer. All submittals and drawings shall be in the English language.

B. OWNER will provide CONTRACTOR with a list of required Shop Drawings to be submitted. CONTRACTOR shall return the list with the anticipated scheduled submittal dates for the Shop Drawings at the Preconstruction meeting. Omission of any Shop Drawings from the list shall not relieve CONTRACTOR from responsibility to submit all items for approval.

C. Shop Drawings for components of systems shall be submitted as one complete package, reviewed and coordinated by CONTRACTOR, for all aspects of the system. Partial submittal packages will not be reviewed.

D. A letter of transmittal shall accompany each submission. If data for more than one Section of the Specifications are submitted, a separate transmittal letter shall accompany each Section submitted.

E. At the beginning of each letter of transmittal and each letter of inquiry, provide a reference

heading indicating the following:

1. OWNER's Name 2. Project Name 3. Contract No. 4. Transmittal No. 5. Section and Item No.

11119304 (8) – January 2020 SECTION 01340 - 2 SUBMITTAL AND CORRESPONDENCE PROCEDURE

F. If Shop Drawing submittals show variation from the requirements of the Contract because of standard shop practices or for other reasons, CONTRACTOR shall make specific mention of such variation in his letter of transmittal.

G. All Shop Drawing submittals for approval shall have an identifying title. The CONTRACTOR should have a rubber stamp made for affixing this title. The Section and Item number shall be completed in ink.

H. All Shop Drawing shall bear the stamp of approval and signature of the CONTRACTOR as

evidence that the CONTRACTOR has reviewed them. Submittals without this stamp of approval will not be reviewed by the OWNER and will be returned to the CONTRACTOR, at the expense of the CONTRACTOR. The stamp shall contain the following minimum information:

CONTRACTOR'S NAME: Date: -----------------Reference---------------- Item: Specifications: Section:

Page No.: Para. No.:

Drawing No.: of Location:

Submittal No.: Approved By:

I. A number shall be assigned to each submittal by the CONTRACTOR starting with No. 1 and

thence numbered consecutively. Resubmittals shall be identified by the same number followed by the suffix "A" for the first resubmittal, the suffix "B" for the second resubmittal, etc.

J. CONTRACTOR shall initially submit to OWNER a minimum of three hard copies of all submittals, in addition to the number CONTRACTOR requires returned. In lieu of submitting hard copies, a File Transfer Protocol (FTP) site may be set up for this Project for ease of data transfer. Project related Shop Drawings, submittals, data, etc. can be uploaded/downloaded to this FTP site. Procedures, usernames, and passwords will be discussed for the FTP site during or prior to the preconstruction meeting.

K. After the OWNER completes his review, the Shop Drawing submittal will be marked with one of

the following notations:

1. Approved.

2. Furnish as Corrected.

3. Revise and Resubmit.

4. Rejected.

L. If a submittal is accepted, it will be marked "Approved" or "Furnish as Corrected". Upon return of a submittal marked "Approved" or "Furnish as Corrected," CONTRACTOR shall order, ship or fabricate the materials included on the submittal, provided it is in accordance with the corrections indicated. For extensive corrections or corrections of major importance affecting other items, OWNER may require that CONTRACTOR make the corrections indicated thereon and resubmit for a final review.

M. If a submittal is unacceptable, it will be marked with "Revise and Resubmit" or "Rejected". Upon return of a submittal marked "Revise and Resubmit," CONTRACTOR shall make the corrections

11119304 (8) – January 2020 SECTION 01340 - 3 SUBMITTAL AND CORRESPONDENCE PROCEDURE

indicated and repeat the initial approval procedure. The "Rejected" notation is used to indicate material or equipment that is not acceptable. Upon return of a submittal so marked, CONTRACTOR shall repeat the initial approval procedure utilizing acceptable material or equipment.

N. Shop Drawings or other submittals not bearing OWNER's "Approved" or "Furnish as Corrected" notation shall not be issued to Subcontractors nor utilized for construction purposes. No work shall be performed or equipment installed without an "Approved" or "Furnish as Corrected" notation on the Shop Drawing or submittal.

O. In the event CONTRACTOR obtains OWNER's approval for the use of equipment other than that which is shown or specified, CONTRACTOR shall, at his own expense and using methods approved by OWNER, make all changes to the Work, including structures, piping, electrical, equipment and controls, that may be necessary to accommodate this equipment.

P. Shop Drawings shall be submitted well in advance of the need for the material or equipment for construction and with ample allowance for time required to make delivery of material or equipment after data covering such is approved. CONTRACTOR shall assume the risk for all materials or equipment which are fabricated or delivered prior to the approval of Shop Drawings. No materials or equipment will be permitted to be incorporated into the Work nor will such be included in monthly estimates until approval thereof has been obtained in the specified manner.

Q. OWNER will review and process all submittals promptly, but a reasonable time should be allowed for this, for the Shop Drawings being revised and resubmitted, and for time required to return the approved drawings to CONTRACTOR.

R. It is CONTRACTOR's responsibility to review submittals made by his suppliers and Subcontractors before transmitting them to OWNER to assure proper coordination of the Work and to determine that each submittal is in accordance with his desires and that there is sufficient information about materials and equipment for OWNER to determine compliance with the Contract. Incomplete or inadequate submittals will be returned for revision without review.

S. Approval of Shop Drawings shall not relieve CONTRACTOR from the responsibility of furnishing materials and equipment of proper dimension, size, quality, quantity, and all performance characteristics to efficiently perform the requirements and intent of the Contract Documents. Approval shall not relieve CONTRACTOR from responsibility for errors of any sort on the Shop Drawings. Approval is intended only to assure general conformance with the design concept of the Project and compliance with the information given in the Contract Documents. CONTRACTOR is responsible for dimensions which shall be confirmed and correlated at the Project site. CONTRACTOR is also responsible for information that pertains solely to the fabrication process or to the technique of construction and for the coordination of the work of all trades.

1.3 PRODUCT DATA

A. Submit the number of copies which the CONTRACTOR requires plus two (2) copies which will be retained by the OWNER.

B. Mark each copy to identify applicable products, models, options, and other data. Supplement

manufacturers’ standard data to provide information unique to this Work. C. Indicate product utility and electrical characteristics, utility connection requirements, and location

of utility outlets for service for functional equipment and appliances. D. After review, distribute in accordance with the Submittal Procedures article above and provide

copies for record documents.

11119304 (8) – January 2020 SECTION 01340 - 4 SUBMITTAL AND CORRESPONDENCE PROCEDURE

1.4 SAMPLES

A. Submit samples to illustrate functional and aesthetic characteristics of the product, with integral parts and attachment devices. Coordinate sample submittals for interfacing work.

B. Submit samples of finishes from the full range of the standard colors of the manufacturer,

textures, and patterns for selection by the OWNER. C. Include identification on each sample, with full Project Information. D. Submit the number and size of samples specified in individual specification sections herein. E. Reviewed samples which may be used in the Work are indicated in individual specification

sections. 1.5 MANUFACTURER’S CERTIFICATES

A. When specified in individual specification sections, submit certificate by manufacturer, which indicates that material or product conforms to, or exceeds, specified requirements. Submit supporting reference data, affidavits, and certifications as appropriate.

PART 2 PRODUCTS – NOT USED PART 3 EXECUTION – NOT USED

END OF SECTION

GHD | Town of Hamburg – 353 Pleasant Avenue Demolition Project | 11119304 (8)

Project Drawings – Bound Herein

GHD | Town of Hamburg – 353 Pleasant Avenue Demolition Project | 11119304 (8)

Appendices

GHD | Town of Hamburg – 353 Pleasant Avenue Demolition Project | 11119304 (8)

Appendix A Town of Hamburg Sample Insurance Documents

SAMPLE

no other option is available with this insurer No changes madeYes and

GL policy (including endorsements) does not cover the additional insured for claims involving injury to employees of the named insured orsubcontractors (not workers' compensation)

I.

no other option is available with this insurer No changes madeYes and

"Insured contract" exception to the employers liability exclusion is removed or modified (GL policy)H.

no other option is available with this insurer No changes madeYes and

Blanket contractual liability located in the "insured contract" definition (Section V, Number 9, Item f. in the ISO CGL policy) is removed orrestricted

G.

no other option is available with this insurerNo andYes

Additional insured will receive advance notice if insurer cancels (GL policy)F.

no other option is available with this insurerNo andYes

According to the terms of this GL policy, the additional insured has primary and noncontributory coverageE.

Title:#:

CG 20 38CG 20 37CG 20 33CG 20 32CG 20 26

Other:

CG 20 10

Additional insured endorsement (GL policy)D.

[see attached endorsement]

[see attached declarations / endorsement]

Designated work

Classifications

Building height:

Type of construction:

Location:

Specific operations excluded or restricted (GL policy)C.

Other

ISO / ISO modified

General Liability (GL) policy formB.

Excess line or free trade zone

Admitted / authorized

InsurerA.

Attach to ACORD 25ACORD 855 NY (2014/05) © 2014 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD

REVISION NUMBER:CERTIFICATE NUMBER:ADDENDUM INFORMATION

EFFECTIVE DATE

NAMED INSURED(S)

POLICY NUMBER NAIC CODECARRIER

AGENCY

NEW YORK CONSTRUCTION

AGENCY CUSTOMER ID:

THIS ADDENDUM SUMMARIZES SOME OF THE POLICY PROVISIONS IN THE REFERENCED INSURANCE POLICIES AND IS ISSUED AS AMATTER OF INFORMATION ONLY; IT CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. ALL TERMS, EXCLUSIONS AND CONDITIONSIN THE ACTUAL POLICY SHOULD BE CONSULTED FOR A MORE DETAILED ANALYSIS OF COVERAGE, AS THIS ADDENDUM DOES NOTAFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES.

CERTIFICATE OF LIABILITY INSURANCE ADDENDUMDATE (MM/DD/YYYY)

Page 2 of 2

DATE (MM/DD/YYYY)AUTHORIZED REPRESENTATIVE SIGNATURE

no other option is available with this insurerNo andYes, by endorsementYes, by specific policy provision

Excess / umbrella policy is primary and non-contributory for additional insuredsM.

no other option is available with this insurer No changes madeYes and

Property damage to work performed by subcontractors (exception to the "damage to your work" exclusion in the ISO CGL policy) is excludedor restricted

L.

no other option is available with this insurer No changes madeYes and

Insured vs. insured suits (cross liability in the ISO CGL policy) are excluded or restricted (other than named insured vs. named insured)K.

no other option is available with this insurer No changes madeYes and

Earth movement, excavation or explosion / collapse / underground property damage is excluded or restricted (GL policy)J.

ADDENDUM INFORMATION (continued)AGENCY CUSTOMER ID:

ACORD 855 NY (2014/05)

Understanding New York Workers Compensation Board

Workers Compensation and N.Y.S Disability Benefits Liability

NOTE: ACORD Certificates of Insurance are not acceptable proof. Must use one of the forms

noted above:

This is a brief description for governmental organizations to validate vendor workers compensation and

NYS Disability Benefits coverage. These requirements should be used when applying for permits, licenses

or secure contracts. Copies should be obtained not only at the initial issuance but at renewal as well. A full

instruction manual can be obtained from the Workers Comp Board.

The forms discussed are:

1) Form CE-200- Affidavit of Exemption (obtain at: https://www.wcb.ny.gov/icexempt/index.jsp)

Acceptable proof that the business listed is exempt from providing workers’ compensation

and/or disability insurance coverage.

2) Workers Compensation

Form C-105.2: Certificate of Workers Compensation (WC) (Obtain from your insurance agent)

All private NYS licensed workers’ compensation carriers are required to issue the C-105.2.

Form SI- 12: Certificate of WC when self-insured. (Obtain from workers compensation board)

Only the Self-Insurance Office of the Workers’ Compensation Board issues the SI-12. The

Self-Insurance Office can be contacted at 518-402-0247. Only one legal name and Federal

Employer Identification Number can be listed on each Form SI-12. (Multiple legal entities

must not be listed.)

Form GSI- 105.2: Certificate of WC when participating in a group self-insured program.

The self-insurance administrator of the group completes the form.

Form U-26.3: Certificate of WC

Acceptable proof that the business has workers’ compensation coverage through the New

York State Insurance Fund. Only available through (NYSIF).

3) New York State Disability Benefits Law (DBL)

Form DB-120.1: Certificate of DBL Insurance (obtain from workers compensation board)

The DB-120.1 must be completed by either the NYS statutory disability benefits insurance

carrier, or a licensed NYS insurance agent of that carrier. The form can be obtained by

contacting the Bureau of Compliance. (certificates@wcb.state.ny.us)

Form DB-155: Certificate of DBL Self-Insurance

The Self-Insurance Office of the Workers’ Compensation Board issues the DB-155. The

Board’s secretary will approve the DB-155. The Self-Insurance Office can be contacted at

518-402-0247.

4) Exemption 1, 2, 3, or 4 Family, Owner Occupied residence (http://www.wcb.ny.gov/content/main/forms/bp-1.pdf)

Prove It to Move It

Form CE-200

New York State Workers' Compensation Board 16

STATE OF NEW YORK WORKERS’ COMPENSATION BOARD

CERTIFICATE OF NYS WORKERS’ COMPENSATION INSURANCE COVERAGE

1a. Legal Name & Address of Insured (Use street address only)

Work Location of Insured (Only required if coverage is specifically

limited to certain locations in New York State, i.e., a Wrap-Up

Policy)

1b. Business Telephone Number of Insured

1c. NYS Unemployment Insurance Employer Registration Number of Insured

1d. Federal Employer Identification Number of Insured or Social Security Number

2. Name and Address of the Entity Requesting Proof of Coverage (Entity Being Listed as the Certificate Holder)

3a. Name of Insurance Carrier

3b. Policy Number of entity listed in box “1a”

3c. Policy effective period

____________________ to ____________________

3d. The Proprietor, Partners or Executive Officers are included. (Only check box if all partners/officers included)

all excluded or certain partners/officers excluded.

This certifies that the insurance carrier indicated above in box “3" insures the business referenced above in box “1a” for workers’ compensation under the New York State Workers’ Compensation Law. (To use this form, New York (NY) must be listed under Item 3Aon the INFORMATION PAGE of the workers' compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box “2". The Insurance Carrier will also notify the above certificate holder within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverageindicated on this Certificate. (These notices may be sent by regular mail.) Otherwise, this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in box “3c", whichever is earlier.

Please Note: Upon the cancellation of the workers’ compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder, the business must provide that certificate holder with a new Certificate of Workers’ Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers’ Compensation Law.

Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referencedabove and that the named insured has the coverage as depicted on this form.

Approved by: ________________________________________________________________________ (Print name of authorized representative or licensed agent of insurance carrier)

Approved by: ________________________________________________________________________

(Signature) (Date)

Title: ________________________________________________________________________ Telephone Number of authorized representative or licensed agent of insurance carrier: _______________________ Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are NOT

authorized to issue it. C-105.2 (9-07) www.wcb.state.ny.us

SAMPLE

Workers’ Compensation Law

Section 57. Restriction on issue of permits and the entering into contracts unless compensation is secured. 1. The head of a state or municipal department, board, commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter, and notwithstanding any general or special statute requiring or authorizing the issue of such permits, shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that compensation for all employees has been secured as provided by this chapter. Nothing herein, however, shall be construed as creating any liability on the part of such state or municipal department, board, commission or office to pay any compensation to any such employee if so employed. 2. The head of a state or municipal department, board, commission or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter, notwithstanding any general or special statute requiring or authorizing any such contract, shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that compensation for all employees has been secured as provided by this chapter.

C-105.2 (9-07) Reverse

SAMPLE

ELE

SAM

SS

STATE OF NEW YORKWORKERS' COMPENSATION BOARD

CERTIFICATE OF I SURANCE COVERAGE DER THE YS DISABILITY BE EFITS LAW

PART 1. To be completed by Disability Benefits Carrier or Licensed Insurance Agent of that Carrier

I a Legal Name and Address of Insured (Use street address only)

2 I arne and Address of the Entity Reque ling Proof ofCoverage (Entity Being Listed a the Certificate Holder)

State Univer ity of ew YorkRoom 3021400 Washington AvenueAlbany, Y 12222

Ib Busine s Telephone Number oflnsured

Ie. NYS Unemployment Insurance Employer RegistrationNumber ofInsured

1d Federal Employer Identification umber of Insured orSocial Security Number

3a Name oflnsurance Carrier

3b Policy Number of entity Ii ted in box" Ia":

3c. Policy effectiveperiod:______.,,----:-__ to

4 Policy cover:

a. D All of the employer's employees eligible under the ew Yo,k Disability Benefits Law

b. 0 Only the following class or clas e of the employer's employee:

Under penalty of perjur y, I certify that I am an amhorized repre entative or licensed agent of the insurance can ier referenced above andthat the named insured has NYS Di ability Benefits insurance coverage a described above

Date Signed--------,,.---:....

By----------------------------

Telephone NumberIMPQRTA T:

PART 2.

(Sign8lUre of ;nsul1lnce callier's authorized representative 01 NYS Licensed Insurance Agent of that insurance caniol)

Title

YS Licensed Insurance Agent of that

According to information maintained by the NYS WOlkels' Compensation Board. the above-named employel ha complied with the NYSDisability Benefits Law with lespeer to all of his/her employee

Date Signed _

Telephone Number _

By _

( ignalU.e of NYS Workers' Compensation Board Employee)

Titlc, _

Please Note: OnLy insurance carrier' licensed to write NYS disability benefit in urance poLicies and NYS Licensed insurance agenlS of{hose insurance carrier. are autlzolized to issue Form 08-120 J. Insurance broker are NOT authorized to issue this form.

DB-120.1 (5-06)

Prove It to Move It

FORM DB-155

New York State Workers' Compensation Board 39

Affidavit of Exemption to Show Specific Proof of Workers’ Compensation Insurance Coverage for a 1, 2, 3 or 4 Family, Owner-occupied Residence

**This form cannot be used to waive the workers’ compensation rights or obligations of any party.**

Under penalty of perjury, I certify that I am the owner of the 1, 2, 3 or 4 family, owner-occupied residence (including condominiums) listed on the building perm it that I am applying for, and I am not required to show specific proof of workers’ com pensation insurance cove rage for such residence because (please check the appropriate box):

I am performing all the work for which the building permit was issued.

I am not hiring, paying or compensating in any way, the individual(s) that is(are) performing all the work for which the building permit was issued or helping me perform such work.

I have a homeowners insurance policy that is curre ntly in effect and covers the property listed on the attached building permit AND am hiring or paying individuals a total of less than 40 hours per week (aggregate hours for all paid individuals on the jobsite) for which the building permit was issued.

I also agree to either: ♦ acquire appropriate workers’ compensation coverage and provide appropriate proof of that coverage on

forms approved by the Chair of the NYS Workers’ Compensation Board to the government entity issuing the building permit if I need to hire or pay individuals a total of 40 hours or more per week (aggregate hours for all paid individuals on the jobsite) for work indicated on the building permit, or if appropriate, file a CE-200 exemption form; OR

♦ have the general contractor, perform ing the work on the 1, 2, 3 or 4 fam ily, owner-occupied residence (including condominiums) listed on the building permit that I am applying for, provide appropriate proof of workers’ compensation coverage or proof of exemption from that coverage on forms approved by the Chair of the NYS W orkers’ Compensation Board to the gove rnment entity issuing the building perm it if the project takes a total of 40 hours or more per week (aggregate hours for all paid individuals on the jobsite) for work indicated on the building permit.

___________________________________ ___________________ (Signature of Homeowner) (Date Signed) ___________________________________ Home Telephone Number ___________________ (Homeowner’s Name Printed)

Property Address that requires the building permit: __________________________________ __________________________________ __________________________________ __________________________________ Once notarized, this BP-1 form serves as an exemption for both workers’ compensation and disability benefits insurance coverage. BP-1 (12/08) NY-WCB

LAWS OF NEW YORK, 1998 CHAPTER 439

The general municipal law is amended by adding a new section 125 to read as follows:

125. ISSUANCE OF BUILDING PERMITS. NO CITY, TOWN OR VILLAGE SHALL ISSUE A BUILDING PERMIT WITHOUT OBTAINING FROM THE PERMIT APPLICANT EITHER:

1. PROOF DULY SUBSCRIBED THAT WORKERS’ COMPENSATION INSURANCE AND DISABILITY BENEFITS COVERAGE ISSUED BY AN INSURANCE CARRIER IN A FORM SATISFACTORY TO THE CHAIR OF THE WORKERS’ COMPENSATION BOARD AS PROVIDED FOR IN SECTION FIFTY-SEVEN OF THE WORKERS’ COMPENSATION LAW IS EFFECTIVE; OR

2. AN AFFIDAVIT THAT SUCH PERMIT APPLICANT HAS NOT ENGAGED AN EMPLOYER OR ANY EMPLOYEES AS THOSE TERMS ARE DEFINED IN SECTION TWO OF THE WORKERS’ COMPENSATION LAW TO PERFORM WORK RELATING TO SUCH BUILDING PERMIT.

Implementing Section 125 of the General Municipal Law 1. General Contractors -- Business Owners and Certain Homeowners

For businesses and certain homeowners listed as the general contractors on building permits, proof that they are in compliance with Section 57 of the Workers’ Compensation Law (WCL) is ONE of the following forms that indicate that they are: ♦ insured (C-105.2 or U-26.3), ♦ self-insured (SI-12), or ♦ are exempt (CE-200), under the mandatory coverage provisions of the WCL. Any residence that is not a 1, 2, 3 or 4 Family, Owner-occupied Residence is considered a business (income or potential income property) and must prove compliance by filing one of the above forms.

2. Owner-occupied Residences

For homeowners of a 1, 2, 3 or 4 Family, Owner-occupied Residence, proof of their exemption from the mandatory coverage provisions of the Workers’ Compensation Law when applying for a building permit is to file form BP-1.

♦ Form BP-1shall be filed if the homeowner of a 1, 2, 3 or 4 Family, Owner-occupied Residence is listed as the general

contractor on the building permit, and the homeowner:

◊ is performing all the work for which the building permit was issued him/herself,

◊ is not hiring, paying or compensating in any way, the individual(s) that is(are) performing all the work for which the building permit was issued or helping the homeowner perform such work, or

◊ has a homeowner’s insurance policy that is currently in effect and covers the property for which the building

permit was issued AND the homeowner is hiring or paying individuals a total of less than 40 hours per week (aggregate hours for all paid individuals on the jobsite) for the work for which the building permit was issued.

♦ If the homeowner of a 1, 2, 3 or 4 Family, Owner-occupied Residence is hiring or paying individuals a total of 40

hours or MORE in any week (aggregate hours for all paid individuals on the jobsite) for the work for which the building permit was issued, then the homeowner may not file the “Affidavit of Exemption” form, BP-1(11/04), but shall either:

◊ acquire appropriate workers’ compensation coverage and provide appropriate proof of that coverage on forms

approved by the Chair of the NYS W orkers’ Compensation Board to the governm ent entity issuing the building permit (the C-105.2 or U-26.3 form), OR

◊ have the general contractor, (perform ing the work on the 1, 2, 3 or 4 fam ily, owner-occupied residence

(including condominiums) listed on the building permit) provide appropriate proof of workers’ compensation coverage, or proof of exemption from that coverage on forms approved by the Chair of the NYS W orkers’ Compensation Board to the government entity issuing the building permit.

BP-1 (12/08) Reverse www.wcb.state.ny.us