HomeMy WebLinkAboutLeach and Russell Mechanical Contractors, Inc./CFD/$2,600 per quarter/HVAC PM - Station 41By Jon Oberlander at 9:39 am, May 26, 2020
DocuSign Envelope ID: 732A505D-E6DE-4438-9213-8B9D9BB87998
DocuSign Envelope ID: 732A505D-E6DE-4438-9213-8B9D9BB87998
DocuSign Envelope ID: 732A505D-E6DE-4438-9213-8B9D9BB87998
DocuSign Envelope ID: 732A505D-E6DE-4438-9213-8B9D9BB87998
DocuSign Envelope ID: 732A505D-E6DE-4438-9213-8B9D9BB87998
DocuSign Envelope ID: 732A505D-E6DE-4438-9213-8B9D9BB87998
6/9/2020
6/4/2020
6/4/2020
6/4/2020
DocuSign Envelope ID: 732A505D-E6DE-4438-9213-8B9D9BB87998
DocuSign Envelope ID: 732A505D-E6DE-4438-9213-8B9D9BB87998
DocuSign Envelope ID: 732A505D-E6DE-4438-9213-8B9D9BB87998
DocuSign Envelope ID: 732A505D-E6DE-4438-9213-8B9D9BB87998
EXHIBIT B
Invoice
Date:
Name of Company:
Address & Zip:
Telephone No.:
Fax No.:
Project Name:
Invoice No.
Purchase Order No:
Goods Services
Person Providing
Goods/Services
Date
Goods/
Service
Provided
Goods/Services Provided
(Describe each good/service
separately and in detail)
Cost Per
Item
Hourly
Rate/
Hours
Worked
Total
GRAND TOTAL
Signature
Printed Name
DocuSign Envelope ID: 732A505D-E6DE-4438-9213-8B9D9BB87998
EXHIBIT C
INSURANCE COVERAGES
Worker’s Compensation & Disability Statutory Limits
Employer’s Liability:
Bodily Injury by Accident/Disease: $100,000 each employee
Bodily Injury by Accident/Disease: $250,000 each accident
Bodily Injury by Accident/Disease: $500,000 policy limit
Property damage, contractual liability,
products-completed operations:
General Aggregate Limit (other than
Products/Completed Operations): $500,000
Products/Completed Operations: $500,000
Personal & Advertising Injury
Policy Limit: $500,000
Each Occurrence Limit: $250,000
Fire Damage (any one fire): $250,000
Medical Expense Limit (any one person): $ 50,000
Comprehensive Auto Liability (owned, hired and non-owned)
Bodily Single Limit: $500,000 each accident
Injury and property damage: $500,000 each accident
Policy Limit: $500,000
Umbrella Excess Liability
Each occurrence and aggregate: $500,000
Maximum deductible: $ 10,000
DocuSign Envelope ID: 732A505D-E6DE-4438-9213-8B9D9BB87998
ddl"
being first duly sworn, deposes and says that
he/she is familiar with and bas personal knowledge of the facts herein and, if called as a witness in this
matter, could testify as follows:
I , I am over eighteen (18) years of age and am competent to testify to the facts contained
herein.
2. 1 am now and a all times relevant herein have been employed by
L, e (the "Employer')
in the position of — lJ `q -YA
3. I am familiar with the employment policies, practices, and procedures of the Employer and
have the authority to act on behalf of the Employer.
4. The Employer is enrolled and participates in the federal E -Verify program. Documentation
of this enrollment and participation is attached and incorporated herein.
5. The Employer does not knowingly employ any unauthorized aliens.
b. To the best of my information and belief, the Employer does not currently employ any
unauthorized aliens.
7. .FURTHER AFFIANT SAYETH NOT.
EXECUTED on the 1"Ntt
day of 2QJ-4,
Printed: _LLti 111,N' _Q? L"^
I certify under the penalties for perjury under the laws of the United States of America and the State of
Indiana that the foregoing factual statements and representations are true and correct.
Printed: Yye
DocuSign Envelope ID: 732A505D-E6DE-4438-9213-8B9D9BB87998
DocuSign Envelope ID: 732A505D-E6DE-4438-9213-8B9D9BB87998