Demolition Contractor Prequalification Questionnaire

Former Asarco Smelter Demolition Contractor Prequalification Questionnaire El Paso, Texas

Texas Custodial Trust

Instructions:  Completed questionnaires are due to the Texas Custodial Trust by close of business Friday, September 24, 2010.  Late and/or incomplete questionnaires will not be reviewed and the contractor will be excluded from the bid process.  As requested, attach supporting information to this completed form.  An officer of your Company must sign at the end of this form (in Part VI).  Submit an electronic copy of the completed form and supporting information to [email protected]. Email submittals will be limited to 20 MB or less. A confirmation email will be provided to the sending address within a few days. Questions regarding the technical submission process can be directed to Mr. Jake Hook of ERM at [email protected] or 281-579- 5427. In lieu of electronic submittals, hard copies can be sent to:

Jeffery L. Bauguss, P.E. Environmental Resources Management 15810 Park Ten Place, Suite 300 Houston, Texas 77084

PART I. GENERAL INFORMATION

1. Company general information

Company Legal Name(s):

SIC Code: NAICS Code: Company Physical Address:

Company Mailing Address:

El Paso Office Address and Contact Information: If you do not have a local office/crew, please state that here

2. Contact people within your Company

Health & Safety Contact Main Business Contact Name:

Phone Number:

Fax Number: E-mail:

3. Work will be completed for the Texas Custodial Trust. Project Navigator, Ltd has been named the Trustee and ERM will be responsible for demolition oversight and management. As such, if you have worked with Project Navigator and/or ERM previously, provide your Company’s main contact within Project Navigator and/or ERM below. Also reference the project that you completed with either company.

4. Complete the table below regarding your Company’s recent history.

Number of Full-time Last 3 Years (list) Employee Hours Worked Employees Gross Revenue ($) 2009 2008 2007

5. Provide a current Statement of Qualification (SOQ) for your Company’s demolition qualifications, including relevant recent work experience. Attach that to this completed form.

The SOQ is attached: Yes No Why:

6. Provide five (minimum) project summaries for completed projects similar in nature to the El Paso Smelter decontamination and demolition project, with current references and telephone numbers.

The Project Summaries are attached: Yes No Why:

PART II. OSHA AND ACCIDENT INFORMATION

1. Provide your Company’s OSHA Injury/Illness Logs (200/300) for the last three years. Attach them to this completed form.

The OSHA Logs are attached: Yes No

2. If your Company is not required to submit OSHA logs, then attach a certification on company letterhead signed by a company official with information about the specific injury/illness record by year for the last three years.

My Company is not required to complete OSHA logs. Yes No Documentation to this effect is attached:

3. Complete the table below regarding your Company’s OSHA recordable injury incidence rates for the last three years and the basis for the rates, even if OSHA Log completion is not required for your Company.

Last 3 Years (list) TRIR Number of Incidents 2009 2008 2007 (TRIR equals number of OSHA recordable injuries times 200,000 divided by the total number of man-hours worked.)

CONFIDENTIAL This document contains proprietary information furnished for evaluation purposes only; except with the express written permission of Texas Custodial Trust, such information shall not be published, disclosed, or used for any other purpose. 4. Has your Company experienced any OSHA violations in the last three years? If so what were the issues and how were they resolved?

5. What is the most serious injury that your Company has experienced in the last 5 years?

PART III. INSURANCE AND LICENSE INFORMATION

1. On your insurance carrier’s letterhead, provide your Company’s Workman’s Compensation Experience Modifier Rate (EMR) for the last three years (2009, 2008, 2007). Attach that to this completed form.

The last 3 years’ EMR information is attached: Yes No Why:

2. Provide a sample Certificate of Insurance identifying all coverage and maximum available limits, including Workman’s Compensation Insurance. Attach that to this completed form.

The sample Certificate of Insurance is attached: Yes No Why:

3. Are you able to provide, if requested, insurance with the following limits:

Workers' Compensation $1,000,000 Yes No General Liability Per Occurrence $1,000,000 Yes No Aggregate $2,000,000 Yes No Umbrella Liability Per Occurrence $5,000,000 Yes No Aggregate $10,000,000 Yes No Professional + Pollution $5,000,000 Yes No Automobile $2,000,000 Yes No

CONFIDENTIAL This document contains proprietary information furnished for evaluation purposes only; except with the express written permission of Texas Custodial Trust, such information shall not be published, disclosed, or used for any other purpose. 4. Using the table below, provide a list of all current licenses held by your Company that may be applicable to this job (i.e. federal and Texas). Attach a separate sheet if additional space is required.

License Description License Number Expiration

An additional sheet of information is attached: Yes No

PART IV. SAFETY MANAGEMENT AND EMPLOYEE TRAINING INFORMATION

1. Using the table below, indicate whether your Company has the following plans or programs in place. Attach additional information to this completed form as requested.

Plan or Program Description Yes No Behavioral based safety program Written Safety and Health Program (if yes, attach the table of contents to this completed form) Written Emergency Action Plan Written Lead Monitoring Program Written Drug and Alcohol Program Written Contingency Plan dealing with business interruption issues Employee Craft Training Program

2. How does your Company assure that subcontractors have good safety performance and are prepared to work safely on your Company’s projects?

CONFIDENTIAL This document contains proprietary information furnished for evaluation purposes only; except with the express written permission of Texas Custodial Trust, such information shall not be published, disclosed, or used for any other purpose. 3. Using the table below, indicate whether your Company trains employees on the following topics.

Topic Yes No Respiratory Protection

40-hr HAZWOPER

Lockout/Tagout

Heat Stress

Electrical Safety

Hazard Communication

Hazard Recognition/Hazard Assessment

Hearing Conservation

Personal Protective Equipment

Fork Lift/Industrial Powered Trucks

Confined Spaces

Lifting Devices

Fall Protection

Asbestos and Non-Asbestos Respirable Fibers

1. What is your company’s Bonding capacity? $______million.

2. Identify your Bonding Underwriter. ______

3. Provide a copy of current audited financial statement.

4. Has your company ever defaulted on a bonded job? ______If yes, attach an explanation.

5. Is your company Dunn and Bradstreet rated, if so what is the rating?

6. Has your company received a violation, notice, warning, fine or similar from a regulatory agency or governmental unit for any action or activity related to demolition, environmental or health and safety issues, including asbestos work within the last 5 years? ______If so, attached a description of the nature of all such incidents.

7. Attach a description of any suits, enforcement actions, or other legal actions against your company or any of its parent, subsidiaries or affiliates, that are currently pending or have been adjudicated or settled within the last three years, that involve or involved, as applicable, allegations that your company breached a contract, violated a law or regulation, or was negligent. For each, identify the parties, the action number, the date initiated, and the date settled or adjudicated if applicable, and briefly describe the circumstances and nature of the claim, the outcome if applicable, and the current status. In the description, specifically highlight any issues or allegations relating to safety or job performance. Also identify whether the circumstances involved demolition, decontamination, and/or decommissioning.

PART VI. CONTRACTOR / SUPPLIER SIGNATURE BLOCK

Company Officer’s Name (Print):

Title:

Signature:

Date: