HomeMy WebLinkAbout19E - RFP - NPDESREQUEST FOR
COUNCIL ACTION
CITY COUNCIL MEETING DATE: CLERK OF COUNCIL USE ONLY:
OCTOBER 17, 2011
TITLE APPROVED
REQUEST FOR PROPOSALS FOR ? As Recommended
DRAINAGE AND EMERGENCY ? As Amended
CLEANUP SERVICES REQUIRED El Ordinance on 1S' Reading
? Ordinance on 2"d Reading
UNDER THE NPDES STORMWATER ? Implementing Resolution
PROGRAM ? Set Public Hearing For
CITY MANAGER
CONTINUED TO
FILE NUMBER
RECOMMENDED ACTION
Authorize the Public Works Agency to send a Request for Proposals to qualified consultants to
provide on-call services to comply with the requirements of the NPDES permit.
DISCUSSION
The Santa Ana Regional Water Quality Control Board (SARWQCB) under the Federal Water
Quality Act has adopted the National Pollution Discharge Elimination System (NPDES) permit for
storm water management. The NPDES permit controls the direct discharges that enter into
navigable waters. Direct discharges or "point source" discharges are from sources such as storm
drain pipes and sewers.
Each City within the SARWQCB boundaries that is responsible for the maintenance of drainage
facilities must comply with water quality regulations described in the NPDES permit. The NPDES
permit requires that all drainage facilities are clean and clear of debris that could lead to pollution
contributing to downstream water bodies.
To meet the requirements of the NPDES fourth term permit, outside services and support will be
required in the following areas:
Catch Basin Cleaning
Culvert Cleaning
As Needed Emergency Cleanup Services
Staff is requesting City Council approval to issue a Request for Proposals to qualified consulting
firms, soliciting proposals to provide the required services (Exhibit 1).
19E-1
Request for Proposals
For Support of the NPDES Program
October 17, 2011
Page 2
ENVIRONMENTAL IMPACT
There is no environmental impact associated with this action.
FISCAL IMPACT
There is no fiscal impact associated with seeking proposals.
Rau odinez II
Executive Directo
Public Works Agency
RG/J P
Exhibit 1: Scope of Work
19E-2
CITY OF SANTA ANA REQUEST FOR PROPOSAL
FOR DRAINAGE AND EMERGENCY CLEANUP SERVICES
1. INTRODUCTION & BACKGROUND
The City of Santa Ana Public Works Agency desires to enter into an agreement with a
qualified consultant that has the ability to perform catch basin facility cleaning.
The City of Santa Ana has prepared a Drainage Facility Inspection and Cleaning
Program that the consultant must adhere to. The Consultant shall perform all work as
set forth in the requirements of: Scope of Work below; Attachment A, Inspection and
Cleaning Drainage Facilities Protocol; and submit an approved Health and Safety Plan
further described below. A sample Health and Safety plan is attached as Attachment C.
A citywide drainage facility map is attached as Attachment D.
II. CONTENT OF PROPOSAL
In order to maintain a uniformity with all proposals furnished by Consultants, it is hereby
requested the proposals be limited to a maximum of 5 pages (excluding front and back
covers, section dividers and resumes) and includes the following:
A. A project understanding statement containing any suggestions or special concerns
that the City should be made aware of, and a project approach containing any
additional scope of work tasks you feel are necessary for the successful completion
of the project.
B. A project team organization chart identifying those who will perform work and their
past experience including similar type projects in which they have been directly
involved, along with a list of equipment owned by the company that will be used to
perform the work must be submitted with this proposal. Identify the Project
Manager (PM) proposed for this project. The PM will be the primary contact person
to represent your firm. Sub-consultants, if any shall be identified with the same
requirements as for the prime consultant.
C. List of similar projects which your firm completed within the last 2 years. Project
information should include project description, agency or client name along with the
person to contact and the telephone number(s), year completed and project cost.
D. Proposed schedule indicating stages of work, time frames, and ability to perform
the required services in a timely manner.
E. Fee shall be broken down by the following fees:
(1) Cost per Catch Basin Cleaned. Cost shall include all costs required to
remove, transport and dispose of all debris in a proper disposal facility. Cost
Exhibit 1
19E-3
shall also include the proper implementation of traffic control measures
which adhere to the Work Area Traffic Control (WATCH) handbook or
approved traffic control required to divert traffic around maintenance
equipment. The City of Santa Ana has 1657 catch basins within the City and
the average catch basin opening is 10.5 feet.
(2) Cost per drainage culvert cleaned. Cost shall include all costs required to
remove, transport and dispose of all debris in a proper disposal facility. Cost
shall also include the proper implementation of traffic control measures
which adhere to the Work Area Traffic Control (WATCH) handbook or
approved traffic control required to divert traffic around maintenance
equipment. The City of Santa Ana has approximately 1600 drainage culverts
within the City. Unit length of 25 foot of culvert will be used for bid cost
purposes. Final pay will be base on actual length of culvert cleaned adjusted
proportionally.
F. Proposal submittal and signature. Five (3) copies of your proposal shall be signed
by a company official with the power to bind the company in its proposal. All
proposals must be completely responsive to the RFP.
III. SCOPE OF WORK
Drainage Facility Inspection & Cleaning
Contractor shall:
Commence inspection and cleaning of drainage facilities after proper execution of
contract agreement. The City of Santa Ana has 1657 catch basins within the City, see
attached Citywide map of catch basin locations(Attachemt D). Consultant shall clean all
drainage facilities and be called upon on an as needed basis. A maximum 3 hour
response time to request for cleaning will be required. Individual grid type maps will be
provided for field use.
2. Set up proper traffic controls to inspect and clean the drainage facilities.
3. Remove manhole covers/grates to inspect and clean the drainage inlets/catch basins.
Assistance may be requested from the City for manhole covers that are locked, stuck, or
broken.
4. Record observations and measurements, and complete all sections of Catch
Basin/Channel Inspection and Cleaning Log according to protocols as established by the
City (See Attachment A and Attachment B).
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19E-4
5. Clean the drainage inlets/catch basins using vacuum trucks.
6. Transport and dispose of collected debris from drainage facility to an appropriate
disposal facility.
7. Submit the original completed Drainage Facility Inspection and Cleaning Logs to the City
on a weekly basis after commencement of work.
8. Enter data collected for each catch basin (catch basin debris depth, catch basin interior
length, catch basin interior width) into a Microsoft Excel spreadsheet provided by the
City. Spreadsheet will calculate estimated volume of debris collected for each catch
basin. Submit completed spreadsheets to the City on a weekly basis.
9. The Consultant must adhere to all of the requirements of the City of Santa Ana's
NPDES(Stormwater) Permit while performing the work required for this contract.
Health and Safety Plan
The Contractor shall provide a copy of a Health and Safety Plan (HASP) for the inspection
and cleaning scope of work. The City will provide a Health and Safety Plan (HASP)
Template as guidance for the City Contractors providing drainage facility inspection and
cleaning. However, the contractors will conduct their work activities under their respective
HASP. See Attachment C for an example HASP.
IV.
CONSULTANT SELECTION COMMITTEE
The City has established a Consultant Selection Committee to evaluate consultant's
proposals. The evaluation of each proposal will be based on technical criteria and
qualifications listed within the RFP, reference checks, and other information which will be
gathered independently.
V.
ESTABLISHING OF FEES
A fee proposal is to be submitted separately in a sealed envelope plainly labeled "Fee
Proposal". The fee proposal will not be opened until the consultants have been
evaluated by the proposal selection committee. In conformance with the Brooks Act, the
City will select the consultant based on qualifications. The fee proposal should be
determined based on section II(E) Content of Proposal, schedule, scope of work and
past experience.
VI. PROFESSIONAL SERVICES AGREEMENT
A sample Professional Services Agreement is enclosed for your review, as Attachment
"D". The RFP and the consultant's proposal will be attached and become part of the
agreement as exhibits.
19E? 5
VII. INSURANCE REQUIREMENTS
A certificate of insurance is enclosed for your reference as Attachment "E". Please refer
to the sample agreement for the necessary amounts of general liability, automotive, and
worker's compensation. The appropriate endorsements are also shown within the
sample contract agreement. The certificate shall include the City of Santa Ana, its
officers and employees as insured or additional insured.
VIII. CITY RESPONSIBILITY
The City of Santa Ana will be responsible for the following:
A. Providing all available existing plans and records.
IX. EXAMINATION OF SITE PRIOR TO SUBMITTING PROPOSAL
Each consultant must inform himself fully of the conditions relating to the project and the
employment of labor thereon. Failure to do so will not relieve a successful consultant of
the obligation to carry out the provisions of the contract.
X. RIGHT TO REJECT PROPOSALS
A. The City of Santa Ana reserves the right to reject any or all proposals submitted
and no representation made hereby that any contract will be awarded pursuant to
this RFP or otherwise.
B. All costs incurred in the preparation of the proposal, the submission of additional
information and/or any aspect of a proposal prior to award of a written contract will
be borne by the respondent. The City will provide only the staff assistance and
documentation specifically referred to herein and will not be responsible for any
other cost or obligation of any kind, which may be incurred by the respondent. All
proposals submitted to the City of Santa Ana become the property of the City.
XI. SCHEDULE
The city's tentative schedule for this project is as follows:
City Releases RFP October 17, 2011
Proposal Due November 4, 2011
RFP Review Period November 11, 2011
Tentative Council Award November 21, 2011
Upon issuance of Notice to Proceed, the Consultant shall submit a detailed schedule for
the project.
XIII. PROPOSAL SUBMITTAL DEADLINE
Proposals are due in the office of the Executive Director of the Public Works Agency at
20 Civic Plaza, 3rd Floor, Public Works Counter Santa Ana, CA on or before 3:00 p.m.
on November 4, 2011.
19E-6
6
XIV. ISSUING OFFICE
Santa Ana Public Works Agency, office of the Executive Director.
XV. ADDENDA
Any subsequent changes in the RFP from the date of issuance to date of submittal will
result in an addendum by the issuing office.
XVI. PRIME CONSULTANT RESPONSIBILITIES
The selected consultant will be required to assume responsibilities for all services
offered in his proposal. The selected consultant will be the sole point of contact with
regard to contractual matters, including payment of any and all charges resulting from
the contract.
XVII. DELAYS
The City reserves the right to delay scheduled dates if it is to the advantage of the City of
Santa Ana.
XVIII. PROJECT CONTROL
Control of the project shall remain the total responsibility of the City of Santa Ana.
XIX. RULES FOR PROPOSALS
The signer of the proposal must declare in writing that the only person, persons,
company or parties interested in the proposal as principals are named therein; that the
proposal is made without collusion with any other person, persons, company, or parties
submitting a proposal; that it is in all respects fair and in good faith without collusion or
fraud; and, that the signer of the proposal has full authority to bind the principal
proposer.
XX. METHOD OF PAYMENT
The consultant shall submit invoices to the City of Santa Ana. The invoice shall include
a detailed breakdown of number of catch basin facilities cleaned, and must correspond
to the weekly record of cleaning submitted by the consultant per the requirements of the
scope of work. It should be noted that no more than 90 percent of the total payment
amount will be made prior to the final completion and approval of all work.
XXI. REGULATIONS
The selected consultant shall be expected to comply with all applicable federal and state
regulations, and contract provisions. The ensuing contract shall contain such contractual
provisions and conditions necessary to define a sound and complete agreement.
XXII. THE CITY'S AFFIRMATIVE ACTION PROGRAM
The City has an affirmative action program. The purpose of the affirmative action
program is to encourage certified minority business enterprises and women business
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19E-7
enterprises. All Submitting firms must have established affirmative action programs
approvable by the City. The attached Attachment F, "Certification of Non-Discrimination
by Contractors" shall be completed by each submitting firm and included in the proposal.
6
19E-8
Attachment A
Inspection and Cleaning Drainage Facilities Protocol
The procedures herein are established to act as a guideline for proper storm water
management and infrastructure maintenance. However, they are not intended to be
all inclusive. Emergency situations may call for actions outside of these policies, and
such actions will be reviewed after completion and may be established as policy if
necessary.
The following are the general procedures for conducting drainage facility inspection
and cleaning as approved by the City.
Prior to commencement of work, each Contractor will provide a copy of its
Health and Safety Plan for the inspection and cleaning work.
Document Code
2. Each City Contractor will be provided the list of drainage facilities identified
by Facility Identification ID and maps indicating the location of each drainage
facility.
3. Documentation will be required for each drainage facility inspected and
cleaned. The Catch Basin and Channel Inspection and Cleaning Log shall be
used to document inspection and cleaning activities.
After each catch basin drainage facility is located, the following procedures are to be
followed:
Catch Basin Inspection and Cleaning Protocol
Catch Basin Inspection
The Catch Basin Inspection and Cleaning Log is pre-printed with the Facility ID
numbers.
2. Fill in name of inspector and date of inspection.
3. Fill in name of nearest cross-street(s).
4. Inspect the catch basin by removing the manhole covering.
5. Note the type of catch basin: Standard Type "B," Type "C," or "Other." (Refer to
Figure B-1 or B-2).
6. Measure the interior dimensions of the catch basin (length and width). Provide
units of measurement.
7. Check for the presence of a catch basin filter device. Note findings.
A-1
19E-9
8. Note the inlet type - whether it has a curb inlet or inlet grate.
9. Note if debris is present - check "Yes" or "No."
10. Note any unusual debris accumulation or odor.
Catch Basin Cleaning
1. Take measurement from the top of debris in the catch basin to the top of manhole
access (Refer to Figure B-1/B-2).
With a tape measure, measure, via the manhole access, from the top of the debris
in the catch basin to the top of the manhole rior to cleaning (Pre-Clean Depth).
2. Clean the catch basin. [Note method used for removing debris (e.g., vacuum
truck, other methods (specify), etc.].
3. By the same method, measure from the bottom of the catch basin to the top of the
manhole after cleaning the catch basin (Post-Clean Depth).
4. Calculate Debris Depth:
Debris Depth = [Post-Clean Depth] - [Pre-Clean Depth]
A-2
19E-10
Channel Inspection and Cleaning Protocol
Channel Inspection
1. Fill in name of inspector and date of inspection.
2. Fill in name of nearest cross-street(s).
3. Fill in channel name
4. Note nearest cross street(s)
5. Note if debris is present: "Yes" or "No"
6. Note any unusual debris accumulation or odor.
Channel Cleaning
1. Estimate the linear feet of channel cleaned.
2. Estimate debris volume (cubic feet) removed. For instance, if debris is bagged,
then estimate the volume based on bag size (i.e., 30-gallon trash bags, etc).
3. Note method of debris removal: vacuum truck, hand removal, or other method.
A-3
19E-11
19E-12
Attachment B
19E-13
City of Santa Ana
Catch Basin Inspection & Cleaning Log
Name of Inspector
Date of Inspection
Facility ID
Cross Street(s)
Catch Basin Inspection
Catch Basin Type Type 'B' Type 'C' Other
[Refer to Figure B-1 or Figure B-2]
Dimension of Catch Basin (feet-inches x feet-inches)
Filtered ElYes E]No
Inlet Type Curb Grate
Debris Present ElYes MNo
Comment: (Note any unusual debris accumulation, odors, etc.)
Catch Basin Cleanin
Pre-Cleaning Depth
Post-Cleaning Depth
Debris Depth
Method of Debris Removal
Provide units (feet, inches, etc.)
Provide units (feet, inches, etc.)
[Post-clean depth] - [Pre-clean depth]
Vacuum Truck El Other Method (Specify)
B-1
19E-14
Figure B-1
TAKE PRE-CLEANING MEASUREMENT:
Read
Measurement
Debris
Catch Basin Type "B" -
Longitudinal Section
TAKE POST-CLEANING MEASUREMENT:
Read
Measurement
atch Basin T e "B" -
ongitudinal Section
B-2
19E-15
Figure B-2
TAKE PRE-CLEANING MEASUREMENT:
Read
Measurement
Debris
Catch Basin Type "C" - Longitudinal Section
TAKE POST-CLEANING MEASUREMENT:
Read
Measurement
Catch Basin Type "C" - Longitudinal Section
B-3
19E-16
BARS @ 6"C.C. TOP AND BOTTOM SLABS
SLAB5 AT 6" C.C.
3 BARS, BEND INFIELD
AS SHOWN
3/47C LEAK
;co TYPICAL
SLOPE
'v?r I PER FT.
PLA
HAMBRA A-1532 WITH BOLTS
OR APPROVED EQUAL.
22" CLEAR OPENING
2"CLEARANCE
1?r LEARANCE
.4-2.
? SEE STD.
GALV. STEPS q
. 305A
?
-?-
RAD-4 a >
Z R C.C.
APRON
?.
,
? `
?
3 BARS Q I1" C.C. w
13 BARS @ 6„ C.C. tt o "RADIUS •°
r
SLOPE FLOOR
? OUTLET
. TOWARDS OUTLET PIPE a
v
LONGITUDINAL SECTION
NOTES' CROSS SECTION
PLACE ONE I" DIAM. SUPPORTING BOLT FOR EVERY 7' LENGTH OF CATCH BASIN
OPENING > SPACED EVENLY OVER THE ENTIRE OPENING.
WHERE SIDEWALK EXISTS ADJACENT TO CATCH 'BASIN,TOP SLAB. SHALL 5E EXTENDED
TO JOIN SIDEWALK. TRANSVERSE STEEL IN TOP SLAB SHALL EXTEND
12" BEYOND WALK.
SEE STANOARD ""305 ? 305A FOR DETAIL OF CATCH BASIN INLET AND DEPRESSION.
BACKFILL MATERIAL TO SUBGRADE SHALL BE SAND, PLACED A MINIMUM OF 2'
LATERALLY AROUND STRUCTURE.
rEOF KCVIJIV/rJNATUREOr CITY OF SANTA ANA IMPROVEMENT STANDARD
STD.
8-72 Q?
Q?'
? COVER AND
ARMOR CHNG. .
CATCH BASIN TYPE "B" NO.
7-74
' BACKFILL NOTE N
10-74 (2'Zz4,J
REV. W
APPROVED (, ?' ,? CITY ENGINEER DATE IcIZz I65 0
NO. 3 BARS TOP AND BOTTOM SLABS A, 6" ON CENTERS
NO. 3 BARS; BEND IN FIELD AS SHOWN
W `I
PLAN VIEW
ALHAMBRA A-1532 WITH BOLTS
N OR APPROVED EQUAL
22" CLEAR OPENING/
NOTE FOR TYPE `C' CATCH BASIN
1" IF `V' IS 4' OR LESS. WALL
REINFORCEMENT MAY BE
OMITTED.
O 2. IF `V' IS MORE THAN 4', BUT
1 LESS THAN 8, USE SAME
WALL REINFORCEMENT AS
FOR TYPE `B' CATCH BASIN.
co 3. BACKFILL MATERIAL TO SUBGRADE
T SHALL BE SAND, PLACED A MIN-
I OF 2'LATERALLY AROUND BASIN.
PC"
V LGALVSTEP E °
APRON
ADIUS OUTLET
F.T. PIPE
ACE OF CURB
2'I
-SEE STD.
6 305A
N
> v
".q 3/4
GALV. STEPS
pJ
1.
_18"
?-
3'- 0'
vD:P
a.d (v
a
- •,- cn?fl
NOTES: CROSS SECTION
PLACE ONE I" DIA. SUPPORTING BOLT FOR EVERY 7' LENGTH OF
CATCH BASIN OPENING, SPACED EVENLY OVER THE ENTIRE OPENING.
WHERE SIDEWALK EXISTS ADJACENT TO CATCH BASIN, TOP SLAB
SHALL BE EXTENDED TO JOIN SIDEWALK. TRANSVERSE STEEL IN
TOP SLAB SHALL EXTEND 12" BEYOND WALL.
SEE STANDARD 305 AND 305A FOR DETAIL OF CATCH BASIN
INLET AND DEPRESSION,
wr of rrc viaw"D NATURE of CITY OF SANTA ANA IMPROVEMENT STANDARD STD.
/vo.
CATCH BASIN TYPE ` C
0
APPf EO , '? c G -p CITY EG/NEIDATE 31317ty '`'
City of Santa Ana
Channel Inspection & Cleaning Log
Name of Inspector
Date of Inspection
Channel Name
Cross Streets
Provide segments cleaned (e.g., identify cross-street to cross-street)
Additional Descriptive Location Information
%?iianntPi inspection
Debris Present YES NO
Comment (Note any unusual debris accumulation, odors, etc.)
v11a111it:i %..1edmn
Linear Feet Cleaned
Estimated Debris Volume
Method of Debris Removal
Provide units (feet)
Provide units (cubic feet)
Vacuum Truck M Hand-removal
Other Method (Specify)
B-6
19E-19
19E-20
Attachment C
Sample
Health and Safety Plan
19E-21
City of Santa Ana
Drainage Facility Inspection & Cleaning
Health and Safety Plan (HASP)
EXAMPLE TEMPLATE
CONTRACTOR NAME
DATE
19E-22
Contents
Section 1 Introduction .............................................................................................................1-1
Section 2 Project Health and Safety Personnel .................................................................. 2-1
Section 3 Work Activities Covered by Health and Safety Plan ...................................... 3-1
Section 4 Hazard Assessment ................................................................................................4-1
Section 5 General Health and Safety Requirements ......................................................... 5-1
5.1 Site and Safety Meetings ......................................................................................... 5-1
5.2 Incident Reporting ................................................................................................... 5-1
Section 6 Emergency Response Procedures and Information for Nearest
Hospitals and Fire Departments ......................................................................... 6-1
Appendices
Appendix A Health and Safety Plan Forms
Appendix B Hospital Location Maps
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19E-23
Section 1
Introduction
This Health and Safety Plan (HASP) identifies the health and safety procedures for
work to be conducted for the City of Santa Ana drainage facility inspection and
cleaning program. Implementation of a HASP is the responsibility of the
CONTRACTOR Project Manager. The CONTRACTOR Project Manager is
responsible at the work site by enforcing the requirements of the HASP and has
authority to suspend work in order to protect worker health and safety. The
CONTRACTOR Project Manager may suspend or limit work, or direct changes in
work practice, if the HASP and/or work practices used are deemed inadequate.
This plan is to be followed by all field personnel. All personnel included in the field
activity shall be responsible for reading this plan and following its procedures.
The CONTRACTOR will be responsible for providing health and safety management.
This includes joint planning, management, site control, reporting and problem solving
with the City of Santa Project Manager. The CONTRACTOR is also responsible for its
employees in accordance with the CONTRACTOR's existing health and safely
policies.
1-1
19E-24
Section 2
Project Health and Safety Personnel
This section identifies key project health and safety personnel involved in the City of
Santa Ana Drainage Facility Inspection and Cleaning. Table 2-1 presents the names,
titles and phone numbers of these individuals.
Table 2-1 Health & Safety Contact Information
Title Name Number
CONTRACTOR Health (xxx) xxx- xxxx (office)
& Safe Manager Name xxx xxx-xxxx cell
CONTRACTOR Project (xxx) xxx- xxxx (office)
Manager Name xxx xxx-xxxx cell
The specific responsibilities of these individuals in terms of health and safety are
described below:
CONTRACTOR Health and Safety Manager
¦ Oversees CONTRACTOR Health & Safety Program
¦ Review, approve or disapprove HASP
¦ Monitor compliance with HASP
¦ Conduct health and safety investigations as needed.
CONTRACTOR Project Manager
¦ Assure project is performed in a manner consistent with the CONTRACTOR
Health and Safety Program
¦ Assure that project HASP is prepared, approved, and properly implemented
¦ Assure that adequate resources are allocated to fully implement the project HASP
¦ Direct health and safety activities on-site
¦ Report all safety-related incidents or accidents to the CONTRACTOR Health and
Safety Manager
¦ Maintain health and safety equipment on-site
¦ Implement emergency procedures as required
2-1
19E-25
Section 3
Work Activities Covered by Health and
Safety Plan
The general tasks performed by CONTRACTOR field crews will consist of:
(1) inspecting storm drainage facilities (catch basins or channels); (2) measuring and
documenting depth of accumulated debris; and (3) cleaning debris from each
drainage facility.
These activities will require CONTRACTOR crews to locate City of Santa Ana
drainage facilities located in commercial, residential, and industrial areas. The main
issues of concern are traffic/vehicle hazards, driving, heavy lifting (manholes covers),
and potential heat stress.
3-1
19E-26
Section 4
Hazard Assessment and Site Specific
Safety Requirements
The main hazards associated with the work performed during drainage facility
inspection and cleaning include being involved in a vehicle accident while driving to
or from a drainage facility site or being struck by a vehicle while working at each
drainage facility site. Other hazards include experiencing heat stress and slips, trips,
and falls.
Traffic hazards will be encountered when working at the site of or in a roadway.
These hazards will be increased during times of reduced visibility. The primary
threats associated with working in or alongside roadways are workers being struck by
passing vehicles, involvement in vehicular collisions or being struck by flying debris
from passing vehicles. The following guidelines should be followed to avoid
traffic/ vehicular hazards:
¦ Use extreme caution
¦ Drive safely
¦ Implement appropriate traffic control - beacon, cones, signage, etc.
¦ Observe traffic - buddy system
Additionally, the following protective equipment will be used during fieldwork by all
field staff:
¦ Hard hat
¦ Reflective safety vest
¦ Closed toe shoes
4-1
19E-27
Section 5
General Health and Safety Requirements
5.1 Tailgate Safety Meetings
All personnel assigned to perform work described in this HASP must be (1) given a
personal copy of this HASP; (2) briefed on the health and safety requirements of this
HASP by a CONTRACTOR Health and Safety Manager; and (3) acknowledge receipt
and willingness to comply with provisions of the plan by signing the Employee
Acknowledgement form in Appendix A. Individuals refusing to sign the agreement
will not be permitted to conduct field work for this project. Completed agreements
will be provided to the CONTRACTOR Project Manager, who will file them with the
CONTRACTOR Health and Safety Manager. A tailgate safety meeting will be
conducted prior to commencing drainage inspection and cleaning activities.
5.2 Incident Reporting
All health and safety incidents shall be reported to City of Santa Ana Project Manager,
CONTRACTOR Project Manager, and CONTRACTOR Health and Safety Manager
immediately. The prompt investigation and reporting of incidents will reduce the
risk of future incidents, better protect all field crews.
Incident reports shall be prepared by completing an Injury/ Illness Report. This form
may be obtained from the CONTRACTOR Project Manager and is located in
Appendix A.
5-1
19E-28
Section 6
Emergency Response Procedures and
Information for Nearest Hospitals and Fire
Departments
In the event of an injury, illness, or accident that may require the attention of a
physician, the CONTRACTOR Health & Safety Manager, CONTRACTOR Project
Manager, and City of Santa Ana Project Manager must be notified immediately. In
the event of an emergency, the City of Santa Ana Project Manager and the City Health
and Safety Officer will also be notified immediately:
City of Santa Ana Joe Parco
Project Manager:
CONTRACTOR NAME
Project Manager:
CONTRACTOR
Health & Safety Manager: NAME
(xxx) xxx-xxxx (office)
(xxx) xxx-xxxx (cell)
(xxx) xxx-xxxx (office)
(xxx) xxx-xxxx (cell)
(xxx) xxx-xxxx (office)
(xxx) xxx-xxxx (cell)
If a person(s) is transported to a medical facility, the location of this facility must be
given to the CONTRACTOR Health and Safety Officer. In emergency situations, field
personnel should call 911 for an emergency response team. All contractors must be
familiar with the location and route to the nearest hospital. Location maps and routes
to local hospitals and fire departments are provided in Appendix B and must be
carried in the field vehicle at all times. Local hospital and fire department contact
information is listed in Table 6-1.
Table 6-1 Hospital and Fire Information
Hospital Name
Location
Directions
Phone Number Fire
Department
Information
From 405, Exit
Coastal 2701 South Bristol Street, Go Call Fire
Communities Bristol Ave, North for 714-754-5454 Dispatch for
Hospital Santa Ana, 92704 approximately 2 emergencies:
miles 911
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19E-29
1001 N
Tustin From 55, exit 17th Call Fire
Western .
Ave, Santa Ana and go west one 714-953-3500
-953-3500 Dispatch for
Medical Center ,
92705 block. Turn left emergencies:
onto Tustin Ave 911
6-2
19E-30
Appendix A
Health and Safety Form
19E-31
Injury/Illness Report
Section 1- To be completed by Employee.
Information about Injured, Ill, or Involved Employee:
First Name:
Last Name:
SSN:
Employee Number:
Name of Firm:
Address and Phone No.:
Employment Category:
Regular Full time
L Regular Part time
Temporary
Ll Non-employee
Length of Employment:
In training 1 3-5 years
l <6 months 5-10 years
L 6 mos-1 yr 10-20 years
L 1-3 years 20+ years
Time in Occupation:
In training L 3-5 years
C: <6 months 5-10 years
7 6 mo-1 yr LI 10-20 years
1-3 years L1 20+ years
Section 2 - To be completed by Employee.
Information about Accident/lujur /Illness:
Date of Accident/Incident
Specific Location of Accident/Incident:
Witness(es) to the Accident/Incident:
Employee's Usual Occupation:
Occupation at Time of Accident/Incident:
Direct Manager /Supervisor
Injury or Illness? Injury Illness
Property Damage? 1 Yes No
Vehicle Involved? Yes No
Phase of Employee's Workday at Time of Injury:
L Performing Work Duties L During Meals
Entering or Leaving Workplace C Other
Health And Safety Program
Middle Initial:
Sex: I M I F Age:
Time:
During Rest Period
A-1
19E-32
Injury/Illness Report
General Type of Task Being Performed at Time of Injury/Illness:
Specific Activity Being Performed at Time of Injury/Illness:
Employee Was Working:
Alone With a Crew or Fellow Worker I Other Crew size:
Supervision at Time of Accident:
11 Directly Supervised ? Indirectly Supervised 11, Not Supervised L Supervision Not Feasible
Description of Accident:
Recommendations for Corrective Actions:
Name, Address, and Phone Number of Attending Physician (If Applicable):
Name and Address of Hospital:
Description of first aid or medical treatment provided to injured employee:
Health And Safety Program
A-2
19E-33
Injury/Illness Report
Section 3 - Evaluation-of Accident, Illness or Incident
Body Part Affected (circle all that are applicable):
Abdomen Ear Head
Ankle Elbow Heart
Arm Eye Hips
Back Face Kidneys, Intest.
Brain Finger Knee
Chest Foot Leg
Digestive Hand Lungs
Injury Type (circle al l that are applicable):
Amputation Contusion Elec. Shock
Asphyxia Crush/Bruise Fracture
Burn/Chemical Cut/Puncture Freezing
Burn/Heat Dermatitis Hearing Loss
Concussion Dislocation Hernia
Injury Source (circle all that are applicable):
Air Pressure Clothing Heat
Animals Coal/Petroleum Hoists
Animal Product Cold Infectious
Body Motion Drugs & Agents
Boilers Medicines Ladders
Boxes/ Electricity Liquids
Containers Fire/Smoke Machines
Buildings/ Food Products Molten Metal
Structures Furniture Miner/Metallic
Ceramics Glass Minerals/
Chemicals Hand Tool Nonmetallic
Accident Type Code (circle all that are appl icable):
Struck Against Fall on Same Rub/Abrasion
Struck By Level Bodily Reaction
Fall From Caught In/ Overexertion
Elevation Between Electrocution
Health And Safety Program
Multiple
Musc. Skel.
Neck
Nervous Sys.
Scalp
Shoulder
Skull
Heat Stroke
Infect. Disease
Inflammation
Multiple
Occ. Disease
Noise
Paper
Particles
Plants
Plastics
Power Tools
Power Trans.
Apparatus
Pumps
Radiating
Substances
Temp. Extremes
Radiations/
Caustics
Public Transport
Thigh
Toe
Wrist
Other _
Unknown
Poisoning
Radiation
Scratch
Sprain/Strain
Other _
Unknown
Soaps
Silica
Scrap/Debris
Steam
Textiles
Vehicles/
Forklifts
Wood
Working Surfaces
Other
Unknown
Motor Vehicle
Other
Unknown
A-3
19E-34
Hazardous Conditions (circle all that are applicable):
InjuryAllness Report
Defects in Dress/Apparel Inadequately Placement Hazards Other
Environmental Hazards Guarded Work Public Hazards Unknown
Hazardous Procedures Environment None
Accident Part Code (circle all that are applicable):
Parts of Boilers Parts of Conveyors Hand Tools Parts of Vehicles None
Parts of Buildings Parts of Hoists Power Tools Machines
Other
Place a check in the box of each factor that applies to this incident.
EQUIPMENT - Was a Hazardous Condition a Contributing Factor?
Lj Defect in Equipment/Tools
J Hazardous Condition Not Recognized
Hazardous Condition Not Reported
Employee Not Informed/Job Procedure Not Specified
? No Equipment Inspection Procedure
Inspection Procedure Failed to Detect Hazard
Correct Equipment/Tools Not Used
1 l Correct Equipment Not Available
0 Employee Not Informed of Correct Equipment
[J Substitute Equipment
Equipment Design Contributed to Operator Stress/Error
C Design/Quality of Tool Contributed to Hazardous Condition
11 Other/Unknown
ENVIRONMENT - Was the Location/Position of Equipment, Materials, or Employee a Contributing Factor?
1 Location/Position Contributed to a Hazardous Condition
Hazardous Condition Not Recognized
Hazardous Condition Not Reported
Employee Not Informed of Correct Job Procedure for Hazard
Employee Did Not Belong in the Area
Hazardous Condition Not Visible to Employee
? Insufficient Workspace
11 Poor Environmental Control
-l Uncontrolled Release of Hazardous Material
Other/Unknown
PEOPLE - Was the Job Procedure(s) a Contributing Factor?
Aggravation of a Pre-existing Condition
No Written/Known Procedure
i Job Procedure Inadequate
Employee Not Trained on Proper Job Procedure
Employee Deviated from Proper Job Procedure
Employee Not Physically/Mentally Capable of Performing Job
Job Procedure Too Difficult
1 Job Procedure Encourages Deviation
F1 Other/Unknown
Health And Safety Program
A-4
19E-35
Injury/Illness Report
PERSONAL PROTECTIVE EQUIPMENT (PPE)
Employee not using PPE
C' PPE Not Specified for Task
1-1 PPE Unavailable
Employee Not Advised of PPE
Employee Not Properly Trained in PPE
PPE Used Incorrectly
? PPE Inadequate
Emergency Equipment Not Specified (Shower, Eyewash, Etc)
Ll Emergency Equipment Not Available
? Emergency Equipment Not Used
? Emergency Equipment Malfunctioned
Other/Unknown
MANAGEMENT - Was a Management Defect a Contributing Factor?
Supervisor Failed to Detect/Anticipate/Report Hazardous Condition
Supervisor Failed to Detect/Correct Deviations from Job Procedure
I No Supervisor Review of Hazards and Job Procedures
J Supervisor Responsibility Not Defined/Understood
Supervisor Not Trained in Accident Prevention
i Failure to Initiate Corrective Action for Known Hazard
Other/Unknown
OCCUPATIONAL HEALTH - Was a Chemical or Physical Agent a Contributing Factor?
Physical Agent:
Noise, Vibration
? Temperature Extremes
Ionizing Radiation - X, Gamma, Beta, or Alpha Radiation
I Non-ionizing Radiation - Microwave, Laser, Ultraviolet, or Radio Frequency
? Ergonomic - Repetitive Motion Trauma, Inappropriate Lighting, Glare, Incorrect
or Insufficient Tooling, Benches, Seating
Chemical Agent:
? Solvents Solvent Name
'I Acid, Bases Acid or Base Name
Particulates Particulate Name
I 1 Other Toxic Chemicals Chemical Name
Biological Agent:
I Microorganism Microorganism
Insect Insect's Name
Animal Animal Species
Allergens Allergen Name
Health And Safety Program A-5
19E-36
Injury/Illness Report
CORRECTIVE ACTION(s) REQUIRED:
ASSIGNED TO:
Signatures:
Direct Manager/ Supervisor
Health & Safety Manager
Human Resources
Date
Date
Date
Section 4 - To be filled out by Health and Safety Manager,
Accident, Illness, Incident Classification:
Injury/Illness Severity: OSHA Illness Code:
? First Aid Only ? Occupational Skin Diseases or Disorders
? Medical Treatment ? Dust Diseases of the Lungs
? Lost Workdays - Restricted Activity ? Respiratory Conditions Due to Toxic Agents
? Lost Workdays - Away from Work ? Poisoning
? Fatality Date: ? Disorders Due to Physical Agents
? Total Number of Lost Days: ? Disorders Associated with Repeated 't'rauma
? All Other Occupational Illnesses
For Office Use Only:
Case Nos. of Others Injured, Ill, or Involved in the Same Accident:
Case No.: OSHA Recordable? Yes - No
Region: Address:
Project No.: Accident or Diagnosis Date:
Health And Safety Program
A-6
19E-37
Injury/Illness Report
rnotos Kelating to AccideaVInjury
(Make copies of this page as necessary.)
Insert photos here.
Health And Safety Program
A-7
19E-38
Injury/Illness Report
witness statement - To be completed by witnesses to the accident
(Make copies of this page as necessary.)
Name:
Address:
Employer:
Position/Craft:
Phone:
This statement is in reference to:
Site of accident (job name, location):
Date of accident:
Describe what you know about the accident, what you saw or heard, what you were doing before the accident, what you
did after the accident (Use additional pages as necessary):
This statement is true to the best of my knowledge and memory.
Signature
Health And Safety Program
Date
A-8
19E-39
Appendix B
Hospital Location Maps
19E-40
Z
c
y
Western Medical Center
1001 N Tustin Avenue
Santa Ana, CA
7
D
N
N
55
JQ'
?c
?a
ot`
?Q
Coastal Communities Hospital
2701 S Bristol Street
Santa Ana, CA
Warner Avenue
19E-41
19E-42
ATTACHMENT D
19E-43
19E-44
Attachment E
ACORiDM CERTIFICATE OF LIABILITY INSURANCE 0 D1/31/I20001
01 /31 /
01
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
INSURED
INSURER A:
INSURER B:
INSURER C:
INSURER D:
INSURER E:
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR TYPE OF INSURANCE
POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION
LIMITS
GENERAL LIABILITY X111111111 01/01/2001 01/01/2002 EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL L?IABILITY FIRE DAMAGE (Any one fire) $ 50,000
CLAIMS MADE L-? OCCUR MED EXP (Any one person) $ 5,000
- PERSONA 1
000
000
L & ADV INJURY ,
$
,
- GE 2
000
000
NERAL AGGREGATE ,
,
$
GEN'L AGGREGATE LIMIT APPLIES PER:
PRO- PRODUCTS - COMP/OP AGG $ 2,000,000
POLICY
LOC
AUTOMOBILE LIABILITY
X ANY AUTO X222222222 01/01/2001 01/01/2002 COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,000
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per person)
$
HIRED AUTOS
NON-OWNED AUTOS
BODILY
(Peer r accident) nt)
$
PROPERTY DAMAGE
(Per accident) $
SEE ATTACHED ADDITIONAL
GAR AGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO INSURED ENDORSEMENT EA ACC
OTHER THAN $
AUTO ONLY:
AGG $
EXCESS LIABILITY EACH OCCURRENCE $
OCCUR CLAIMS MADE COVERAGES DEPEND ON TYPE AGGREGATE $
OF AGREEMENT/CONTRAC $
DEDUCTIBLE T
RETENTION $ $
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY XXX333333333 01/01/2001 01/01/2002 X 'y`/C Srnru- oTH-
E.L. EACH ACCIDENT $ 1,000,000
E.L. DISEASE - EA EMPLOYEE $ 1,000,000
OTHER
Professional Liability
PL444444
01/01/2001
01!01/2002 E.L. DISEASE - POLICY LIMIT $ 1,000,000
Each Occurrence 1,000,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHIC LES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Certificate Holder is additional insured per attached.
Project No..
(_F;0TICI!`ATC Unl MOO
City of Santa Ana
20 Civic Center Plaza - Ross Annex (M-
Santa Ana, CA 92701
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
AUTHORIZED REPRESENTATIVE
ACORD 25-S (7/97)
(a ACORD CORPOROTInN 19RA
19E-45
ADDITIONAL INSURED ENDORSEMENT
FOR COMMERCIAL GENERAL LIABILITY POLICY
Insurance Company
This endorsement modifies such insurance as is afforded by the provisions of Policy
# relating to the following:
1. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California
92701; its officers, employees, agents, volunteers and representatives are named as
additional insureds ("additional insureds") with regard to liability and defense of suits
arising from the operations and uses performed by or on behalf of the named insured.
2. With respect to claims arising out of the operations and uses performed by
or on behalf of the named insured, such insurance as is afforded by this policy is primary
and is not additional to or contributing with any other insurance carried by or for the
benefit of the additional insureds.
3. This insurance applies separately to each insured against whom claim is
made or suit is brought except with respect to the company's limits of liability. The
inclusion of any person or organization as an insured shall not affect any right which such
person or organization would have as a claimant if not so included.
4. With respect to the additional insureds, this insurance shall not be
cancelled, or materially reduced in coverage or limits except after thirty (30) days written
notice has been given to the City of Santa Ana, 20 Civic Center Plaza, Santa Ana,
California 92701.
(Completion of the following, including countersignature, is required to make this
endorsement effective.)
Effective
Policy # _
Issued to
this endorsement form as a part of
Named Insured
Countersigned by
Authorized Representative
19E-46
ATTACHMENT F
CERTIFICATION OF NON-DISCRIMINATION BY CONSULTANTS
As suppliers of goods or services to the City of Santa Ana, the Firm listed below certifies
that it does not discriminate in its employment with regard to race, color, religion, sex, or
national origin; that it is in compliance with all federal, state and local directives and
executive orders regarding non-discrimination in employment; and that it agrees to
demonstrate positively and aggressively the principle of equal opportunity in
employment.
WE AGREE SPECIFICALLY:
1. To take affirmative steps to hire minority employees with the company.
2. To establish or observe employment policies within affirmative promotion
opportunities for minority persons at all job levels.
3. To communicate this policy to all persons concerned, including all company
employees, outside recruiting services, especially those servicing minority
communities, and to the minority communities at large.
FIRM
NAME
PRINTED NAME
TITLE OF PERSON SIGNING
SIGNATURE
DATE
Please include any additional information available regarding equal opportunity
employment programs now in effect within your company.
19E-47
19E-48