UCIP Insurance Manual

Transcription

1 The Regents of the University of California University Controlled Insurance Program (UCIP) UCIP Insurance Manual UCIP Insurance Manual Revision 04/27/2012

2 UNIVERSITY CONTROLLED INSURANCE PROGRAM Insurance Manual THE REGENTS OF THE UNIVERSITY OF CALIFORNIA 1111 Franklin Street, 10th Floor Oakland, CA UCIP Insurance Manual Revision 04/27/2012

3 Table of Contents 1. OVERVIEW... 1 UCIP DEFINITIONS... 2 ABOUT THIS MANUAL UCIP PROJECT DIRECTORY UCIP INSURANCE COVERAGE... 7 ELIGIBLE PARTIES... 7 ENROLLED PARTIES... 7 EXCLUDED PARTIES... 7 EVIDENCE OF COVERAGE... 8 SUMMARY DESCRIPTION OF UCIP COVERAGES... 8 Workers Compensation and Employers Liability... 9 Commercial General Liability... 9 Excess Umbrella Liability... 9 CONTRACTOR OBLIGATION COVERAGE OF OFF-SITE LOCATIONS UCIP TERMINATION OR MODIFICATION INSURANCE REQUIRED FROM ALL CONTRACTORS AND SUBCONTRACTORS, INCLUDING EXCLUDED PARTIES WORKERS COMPENSATION AND EMPLOYER S LIABILITY COMMERCIAL GENERAL LIABILITY/UMBRELLA LIABILITY AUTOMOBILE LIABILITY PROPERTY INSURANCE ADDITIONAL INSUREDS WAIVER OF SUBROGATION CONTRACTOR AND SUBCONTRACTOR RESPONSIBILITIES DECLARATION OF MINIMUM OCCUPATIONAL SAFETY & HEALTH QUALIFICATIONS CONTRACTOR AND SUBCONTRACTOR BIDS ADJUSTMENTS FOR UCIP INSURANCE COSTS CHANGE ORDERS ENROLLMENT COVERAGE OF OFF-SITE LOCATIONS SAFETY STANDARDS PAYROLL REPORTS INSURANCE COMPANY PAYROLL AUDIT CLOSE OUT PROCEDURES CLAIM REPORTING PROCEDURES GENERAL PROCEDURES WORKERS COMPENSATION CLAIMS LIABILITY CLAIMS AUTOMOBILE CLAIMS FORMS UCIP Insurance Manual Revision 04/27/2012

4 SECTION 1 OVERVIEW Section 1 1. Overview Welcome to The Regents of the University of California s University Controlled Insurance Program. The Regents of the University of California has arranged for this Project to be insured under the University Controlled Insurance Program, or UCIP. The UCIP is a single insurance program that insures the University of California, Enrolled Contractors, Enrolled Subcontractors, and other designated parties for Work performed at the Project Site. Certain Contractors or Subcontractors are excluded from the UCIP. These parties are identified in Section 3 of this Manual. Coverage under the UCIP includes Workers Compensation/Employer s Liability, General Liability, and Excess Liability. will pay the insurance premiums for the UCIP coverages described in this Insurance Manual. You should notify your insurance broker/insurer(s) of the coverages provided under the UCIP for on-site activities to avoid the duplication of coverage. Each bidder is required to bid net of all insurance costs for coverages provided by the University of California. NOTE: Insurance coverages and limits provided under the UCIP are limited in scope and are specific to work performed after the inception date of your enrollment into this program. Your insurance representative should review this information. Any additional coverage you may wish to purchase will be at your option and expense. UCIP Insurance Manual Revision 04/27/2012 1

5 OVERVIEW UCIP Definitions The following definitions shall apply throughout this manual: TERM BID NET OF COST OF UCIP COVERAGES: CONTRACT: CONTRACTOR: DEFINITION A bid submitted by Contractor or Subcontractors to perform Work or a portion of the Work, which is net of the Contractor s or Subcontractors Cost of UCIP Coverages. The term Contract means the written Agreement between the Contractor and Owner as set forth in the Contract Documents. The term Contractor means the person or firm identified as the Contractor, CM/Contractor, Design Builder, or Prime Trade Contractor in the Agreement, and is referred to throughout the Contract Documents as if singular in number. COST OF UCIP COVERAGES: ELIGIBLE PARTIES: See page 7. ENROLLED PARTIES: See page 7. EXCLUDED PARTIES: See page 7. Cost of UCIP Coverages shall mean Contractor s or Subcontractor s projected or actual cost to provide the workers compensation and employer s liability, commercial general liability insurance, and excess liability insurance being provided under the UCIP. The Cost of UCIP Coverages includes insurance premiums, related taxes and assessments, markup on the insurance premiums, and losses retained through the use of a self-funded program, self-insured retention, or deductible program. The cost of insurance must include expected losses within any retained risk. OWNER: PROJECT: The Regents of the University of California, also referred to as the University of California The term Project means the Work of the Contract and all other work, labor, equipment, and materials necessary to accomplish the construction of the improvement of which the Work is a part. UCIP Insurance Manual Revision 04/27/2012 2

6 OVERVIEW SUBCONTRACTOR: UCIP ADMINISTRATOR: The term Subcontractor means a person or firm that has a contract with Contractor or with a Subcontractor to perform a portion of the Work. Unless otherwise specifically provided, the term Subcontractor includes Subcontractors of all tiers. The entity hired by the University of California to administer the UCIP. The UCIP Administrator is: Aon Risk Insurance Services West, Inc. 199 Fremont Street, Suite 1500 San Francisco, California UCIP COVERAGES: UCIP INSURER: UCIP POLICIES: UCIP: WORK: The insurance coverages provided under the UCIP, as set forth in the UCIP Policies, and as summarized in this Insurance Manual. Any of the insurance companies providing insurance under the UCIP. The insurance policies issued by a UCIP Insurer for the UCIP. s University Controlled Insurance Program. The term Work means all construction, services, and other requirements of the Contract Documents as modified by Change Order, whether completed or partially completed, and includes all labor, materials, equipment, tools, and services provided or to be provided by Contractor to fulfill Contractor's obligations. The Work will constitute a part of the Project. Enrollment in the UCIP is mandatory for all Eligible Parties. In addition to the insurance provided under the UCIP, Enrolled Parties shall obtain and maintain, and shall require each of their Subcontractors of all tiers to obtain and maintain, the insurance coverage specified in Section 4. Excluded Parties and parties no longer enrolled in, or covered by, the UCIP shall obtain and maintain, and require each of their Subcontractors to obtain and maintain, the insurance coverage specified in Section 4. UCIP Insurance Manual Revision 04/27/2012 3

7 OVERVIEW About This Manual This Insurance Manual has been prepared by Aon, the UCIP Administrator, and the University. The Insurance Manual is designed to provide an overview of the UCIP and identify, define and assign responsibilities for the administration of the UCIP. This Insurance Manual may be updated as necessary during the course of construction to reflect any changes in State Rules and/or Regulation or Procedures that may become applicable. Said revisions shall replace all previous versions. Copies of any revised Insurance Manual shall be distributed by the UCIP Administrator. What This Manual Does This Manual: Sets forth the responsibilities of the various parties involved in the Project, including the insurance-related obligations of Contractors and Subcontractors, whether or not enrolled in the UCIP Describes the general structure of the UCIP Provides a basic description of UCIP coverages Describes audit and administrative procedures Provides answers to basic questions about the UCIP What this Manual Does Not Do This Manual does not: Provide complete information about coverages Amend, modify or change the policy Provide coverage interpretations or answer specific claims questions Refer questions concerning the UCIP, its administration, insurance coverages, or claims to the appropriate party identified in the Project Directory. The Directory immediately follows this introduction. DISCLAIMER: The information in this Manual is intended to outline the UCIP Program. If any conflict exists between this Manual and the UCIP insurance policies or Contracts between the University of California and the Contractor or their Subcontractors, the insurance policies or Contracts will govern. UCIP Insurance Manual Revision 04/27/2012 4

8 UCIP PROJECT DIRECTORY Section 2 2. UCIP Project Directory The following list includes key personnel involved in the program UCIP Administrator Aon Risk Insurance Services West, Inc. 199 Fremont Street, 17 th Floor Phone: (415) San Francisco, CA Fax: (415) Sr. Program Administrator Phone: (415) Scott Brama scott.brama@aon.com Program Manager Phone: (415) Josh Schultz josh.schultz@aon.com Regional Safety Director Phone: (213) Scott Maxey scott.maxey@aon.com Project Safety Consultant Phone: TBD TBD TBD General Contractor / Construction Manager TBD TBD Phone: TBD TBD Fax: TBD Contracts Manager/Administrator Phone: TBD TBD TBD Project Manager Phone: TBD TBD TBD Project Superintendent Phone: TBD TBD TBD Project Safety Manager Phone: TBD TBD TBD UCIP Insurance Manual Revision 04/27/2012 5

9 UCIP PROJECT DIRECTORY University TBD TBD Project Manager Phone: TBD TBD TBD Contracts Manager/Administrator Phone: TBD TBD TBD Director of Risk Management Campus Phone: TBD TBD TBD Insurance Programs Manager OP Phone: (510) Cindy Low Director of Risk Management OP Phone: (510) Grace Crickette UCIP Insurer Zurich in North America 560 Mission Street, Suite 2300 San Francisco, CA Regional Safety Manager Phone: (916) Doug Stohlman Adjuster WC Medical Only Phone: (916) Marilyn Carpenter Lost Time Examiner Tier II Phone: (916) Terry Woodcock Lost Time WC Handler Tier III Phone: (818) Edmond Eddie Sedigh WC Team Manager Phone: (818) Michelle Abram-Hogan UCIP Insurance Manual Revision 04/27/2012 6

10 UCIP INSURANCE COVERAGE Section 3 3. UCIP Insurance Coverage This section provides a brief description of UCIP Coverages. You must refer to the actual policies for details concerning coverage, exclusions and limitations. Eligible Parties Unless excluded (see below), each of the following who will perform any labor at the Project site (labor may be performed either by the party or by a Subcontractor to a party) are an Eligible Party: Contractor, all Subcontractors of all tiers, and such other persons or entities as University may designate, in its sole discretion. Enrolled Parties Enrolled Parties are named insureds on the UCIP policies. Enrolled Parties include:, and s Representative; A Contractor that is eligible for and enrolls in the UCIP; Subcontractors who are eligible for, and enroll in the UCIP, Any other Eligible Party that enrolls in the UCIP. Parties named as additional insureds include other parties that the University of California is required under contract to add as additional insureds. These parties are also referred to as insureds. Excluded Parties Excluded Parties are: 1. Heavy and/or structural demolition, hazardous materials remediation, removal and/or transport companies and their consultants; 2. Architects, surveyors, engineers, and soil testing engineers, and their consultants (except for architects, surveyors, engineers and soil testing engineers that are employees of Contractor or Subcontractor). UCIP Insurance Manual Revision 04/27/2012 7

11 UCIP INSURANCE COVERAGE 3. Vendors, suppliers, fabricators, material dealers, truckers, haulers, drivers, common carriers and others who do not perform work at the Project site or who merely transport, pick up, deliver, or carry materials, personnel, parts or equipment, or any other items or persons to or from the Project site; 4. Subcontractors of all tiers that do not perform any actual labor on the Project site with their own forces or through a Subcontractor; 5. Temporary labor services; 6. Persons or Entities who are not an Eligible Party who are enrolled in the UCIP; and 7. Any other person or entity that the University, acting in its sole discretion, elects to exclude, even if otherwise eligible. Excluded Parties are not eligible to enroll in the UCIP. The UCIP does not provide any coverage to an Excluded Party. All Excluded Parties, and any party no longer enrolled in, or covered by, the UCIP shall obtain and maintain, and shall require each of their subcontractors of any tier to obtain and maintain, the insurance coverage specified in Section 4. Evidence of Coverage The UCIP Administrator will provide upon enrollment a Certificate of Insurance evidencing workers compensation, general liability, and excess liability coverage to each Enrolled Party, each of whom will then be a named insured on the UCIP policies. A Certificate of Insurance is a document providing evidence of coverage for a particular insurance policy or policies. Other documentation including claim reporting forms, posting notices, etc., will be furnished to each Enrolled Party. Each Contractor will receive a copy of the workers compensation policy, and copies of the remaining UCIP insurance policies will be available for your review upon a written request to the UCIP Administrator. Summary Description of UCIP Coverages This summary is not an insurance policy and is not intended to amend, alter, or extend the coverage afforded by the UCIP Policies. The coverage provided under the UCIP Policies is governed by the terms, conditions, exclusions, and limitations of the UCIP Policies. The following descriptions provide a summary of the insurance coverages provided under the UCIP: UCIP Insurance Manual Revision 04/27/2012 8

12 UCIP INSURANCE COVERAGE A single General Liability Policy will be issued covering all insureds. Contractor and Subcontractors of all Tiers Will Be Responsible for a General Liability Obligation Per Occurrence for any Claim Due To CM/Contractor or Subcontractor s Negligence as Shown In Its Contract Language For Any Third Party Damages/Injuries Caused By The CM/Contractor Or Its Subcontractors. The Specific Amount of This Obligation Is Based On Contract Value. Workers Compensation and Employers Liability State: California LIMITS OF LIABILITY Part One - Workers Compensation: Statutory Part Two - Employer s Liability: Bodily Injury by Accident, each accident $2,000,000 Bodily Injury by Disease, each employee $2,000,000 Bodily Injury by Disease, policy limit $2,000,000 Commercial General Liability Per Project Limits Shared by All Insureds General Aggregate $4,000,000 Products/Completed Operations Aggregate $4,000,000 Bodily Injury & Property Damage Each Occurrence $2,000,000 Personal/Advertising Injury Each Occurrence $2,000,000 Fire Damage Legal Liability $1,000,000 Medical Expense $5,000 Products & Completed Operations Extension is 10 Years This insurance will NOT provide coverage for products liability to any insured party, vendor, supplier, off-site fabricator, material dealer or other party for any product manufactured, assembled or otherwise worked upon away from the Project Site. The policy contains exclusions. Some of these exclusions are: Real & Personal Property in the care, custody or control of the insured; Asbestos; Lead; EFIS; Discrimination & Wrongful Termination; ERISA; Architects & Engineers Errors & Omissions; Owned & Non-Owned Aircraft, Watercraft, Pollution and Automobile Liability; Nuclear Broad Form Liability, and other exclusions referred to in Exhibit 1A, the UCIP Coverage Summary. Excess Umbrella Liability Per Project Limits Shared by All Insureds Each Occurrence Limit $100,000,000 Annual General Aggregate Limit $100,000,000 The Policies follow form (provisions, coverage, exclusions, etc.) of underlying Commercial General Liability and Employer s Liability policy wording. University of California reserves the right to supply additional limits upon final review. UCIP Insurance Manual Revision 04/27/2012 9

13 UCIP INSURANCE COVERAGE Contractor Obligation In the event of a Commercial General Liability loss covered by the UCIP, Contractor shall pay to the University an amount as set forth below. Payment pursuant to the preceding sentence shall not in any way limit the liability of Contractor to University or otherwise. The amount to be paid, which is based on the Contract Sum of the Contractor s Contract at the time of the loss is reported, is as follows: Contract Sum Amount to be Paid $1,000,000 or Less $1,000 $1,000,001 to $10,000,000 $5,000 $10,000,001 and Over $25,000 NOTE: Insurance coverage and limits described in this Section are limited in scope and are specific to Work performed at the Project Site and after the inception date of your enrollment into this Program. Your insurance representative should review this information. Any additional coverage you may wish to purchase will be at your option and expense. Coverage of Off-site Locations Work (as defined in the General Conditions) that is performed at a fully project dedicated off site location, which is not specified in the General Conditions, can, at the University s sole discretion, be treated as on site Work provided that at the time of enrollment in the UCIP the off site location is identified to the UCIP Administrator and scheduled on the UCIP policies. Contact the UCIP Administrator in order to schedule an off site location with the UCIP; allow thirty (30) days to schedule the off site location on the UCIP policies. UCIP Insurance Manual Revision 04/27/

14 UCIP INSURANCE COVERAGE NOTE: Contractor and Subcontractors are advised to arrange their own insurance for Contractor or Subcontractors owned or leased equipment and materials not intended for inclusion in the Project. The UCIP will not cover Contractor or Subcontractor s property. UCIP Termination or Modification University may, for any reason, modify the UCIP Coverages, discontinue the UCIP, or request that Contractor or any of its Subcontractors of any tier withdraw from the UCIP upon thirty (30) days written notice. Upon such notice Contractor and/or one or more of its Subcontractors, as specified by University in such notice, shall obtain and thereafter maintain during the performance of the Work, all (or a portion thereof as specified by University) of the UCIP Coverages. The form, content, limits of liability, cost, and the insurer issuing such replacement insurance shall be subject to University s approval. The University shall pay Contractor for the reasonable cost of replacement coverage approved by the University. UCIP Insurance Manual Revision 04/27/

15 INSURANCE REQUIRED Section 4 4. Insurance Required From All Contractors and Subcontractors, Including Excluded Parties Enrolled Contractor and Enrolled Subcontractors are required to maintain insurance coverages to protect against losses that occur away from the Project Site or that are otherwise not insured by the UCIP. Contractors and Subcontractors are required to maintain insurance coverage that protects the University of California from liability for claims for damages. These liabilities may arise from the Contractor s and Subcontractors operations performed off the Project Site at locations that have not been disclosed to the UCIP Administrator and scheduled on the UCIP policies, from activities not insured by the UCIP or from operations performed by Excluded Parties. There are two types of Contractors and Subcontractors: Enrolled Contractors and Subcontractors and Excluded Contractors and Subcontractors. See Section 7 for sample Certificate of Insurance. Enrolled Contractor and Subcontractors are to provide evidence of Workers Compensation and General Liability Insurance for off-site activities and Automobile Liability Insurance for both on-site and off-site activities via a Certificate(s) of Insurance with additional insured endorsements as per the insurance specifications in the Contract. Excluded Subcontractors must provide evidence of Workers Compensation, General Liability, Auto Liability Insurance, and for other insurance as required by scope of work (i.e. Hazardous Remediation Pollution Liability), if any, for all activities including both on-site and off-site activities via a Certificate(s) of Insurance with additional insured endorsements as per the insurance specifications in the Contract. Subcontractors must submit verification of insurance in the form of a Certificate of Insurance on a standard ACORD 25 form. They must provide a Certificate of UCIP Insurance Manual Revision 04/27/

16 INSURANCE REQUIRED Insurance to the UCIP Administrator prior to mobilization on site, and within ten (10) days of any renewal, change or replacement of coverage. A sample of an acceptable Certificate of Insurance is provided in Section 7. Certificate of Insurance 5 days prior to mobilization and within ten (10) days of renewal, change or replacement of coverage, Contractor and Subcontractor will submit to the University of California a Certificate of Insurance evidencing the coverage and limits as specified in this section. A notice of cancellation provision, waiver of subrogation and additional insured status is required on all Certificates. Contractor must provide a certificate of insurance providing a notice of cancellation clause in accordance with the policy provisions. The additional insured endorsements shall state that the coverage provided to the additional insureds is primary and noncontributing with respect to any other insurance available to the additional insureds. Pursuant to the Instructions to Bidders, Contractor shall provide its certificates of insurance to University within 10 days after receipt of notice of selection as the apparent lowest responsive and responsible Bidder. All other parties shall provide, prior to mobilization, their certificates of insurance directly to the UCIP Administrator. The limits of liability shown for the insurance required of the Contractor and Subcontractors are minimum limits only and do not restrict the liability imposed on the Contractor and Subcontractors for Work performed under their Contract. Limits required below can be provided by a combination of primary and umbrella/excess liability insurance. If umbrella/excess liability coverages are to be provided, such policies shall be follow form (provisions, coverage, exclusions, etc.) of underlying Commercial General Liability, Employer s Liability and Automobile Liability policy wording. Workers Compensation and Employer s Liability Part One - Workers Compensation: Statutory Limit Eligible Contractors shall provide evidence of workers compensation insurance for off-site activities. Excluded Contractors shall provide evidence of workers compensation applicable to on and off-site project. Part Two - Employer s Liability: Annual Limits Bodily Injury by Accident, each accident $1,000,000 Bodily Injury by Disease, each employee $1,000,000 Bodily Injury by Disease, policy limit $1,000,000 Commercial General Liability/Umbrella Liability Limits of Liability Enrolled / Excluded General Aggregate $2,000,000 / $4,000,000 Products/Completed Operations Aggregate $2,000,000 / $4,000,000 UCIP Insurance Manual Revision 04/27/

17 INSURANCE REQUIRED Eligible Contractors shall provide evidence of general liability insurance for off-site activities. Excluded Contractors shall provide evidence of general liability insurance applicable to on and off-site projects and must add the University of California and other parties as additional insureds to their policy. Automobile Liability Contractor and Subcontractors shall provide evidence of automobile liability. The UCIP does not cover automobile liability. Personal/Advertising Injury Aggregate $1,000,000 / $2,000,000 Each Occurrence Limit $2,000,000 / $2,000,000 Coverage must be on an Occurrence Form and it must apply to bodily injury and property damage for operations (including explosion, collapse and underground coverage), independent Contractor or Subcontractor, products and completed operations. Automobile Liability A Commercial Business Auto Policy which covers all owned, hired and non-owned automobiles, trucks and trailers with coverage limits not less than $1,000,000. This can be a combination of the Automobile Liability and Excess Policy, each accident for bodily injury and property damage on-site and off-site. Property Insurance Contractor and Subcontractors are advised to arrange their own insurance for owned and leased equipment (not to be permanently installed or incorporated into the Project), whether such equipment is located at a Project Site or in transit. Contractor and Subcontractors are solely responsible for any loss or damage to their personal property including Contractor and Subcontractor tools and equipment, temporary structures (including construction trailers), whether owned, used, leased or rented by the Contractor and Subcontractor. Contractor and Subcontractors are also responsible for any loss or damage to property or materials created or provided under the Contract until the property or materials arrives at the Project Site. Additional Insureds With exception to Workers Compensation and Employer s Liability insurance, the following shall be included as additional insureds as required by contract: The University of California, its officers, employees, related entities, representatives and Authorized Representatives. Refer to the sample Certificate of Insurance provided with this Insurance Manual. The list of additional insureds may be updated at any time due to contractual requirements of the University of California. Waiver of Subrogation Contractor and Subcontractors of all tiers waive subrogation as set forth in Section of the General Conditions. UCIP Insurance Manual Revision 04/27/

18 CONTRACTOR AND SUBCONTRACTOR RESPONSIBILITIES Section 5 5. Contractor and Subcontractor Responsibilities Throughout the course of the Project, Contractor and Subcontractors will be responsible for reporting and maintaining certain records as outlined in this section. Additionally, Subcontractors will be required to provide a completed Declaration of Contractor or Subcontractor Minimum Occupational Safety and Health Qualifications prior to commencement of Work by the Subcontractor. The Contractor and Subcontractors are required to cooperate with the University of California and its UCIP Administrator in all aspects of UCIP implementation and administration. Responsibilities include the following: Contractor and all Subcontractors must enroll in the UCIP, if eligible, prior to mobilization. Prime Contractor has the responsibility to ensure that all eligible Subcontractors are enrolled prior to the Subcontractor s commencement of Work. Contractor and Subcontractors must provide copies of their current Workers Compensation, General Liability and Excess Liability rate and declaration pages, deductible endorsements and any other required documentation. See Adjustments for UCIP Insurance Costs. Contractor and Subcontractors must provide timely evidence of required insurance to the UCIP Administrator, prior to mobilization and upon renewal, modification or material change of insurance. Contractor and Subcontractors must include UCIP provisions in all contracts with Subcontractors. Contractor must provide each Subcontractor with a copy of the UCIP Insurance Manual. The UCIP Insurance Manual may be updated during the course of construction to reflect any changes in state rules and/or regulations or procedures that may be necessary, and said revisions shall replace all previous versions. Copies of any revised Insurance Manual shall be distributed by the UCIP Administrator. Contractor must notify the UCIP Administrator of all subcontracts, including lower tier subcontracts. UCIP Insurance Manual Revision 04/27/

19 CONTRACTOR AND SUBCONTRACTOR RESPONSIBILITIES Contractor and Subcontractors must maintain and electronically report monthly payroll records. Contractor and Subcontractors must cooperate with the UCIP Administrator s requests for information. Contractor shall be responsible for monitoring and ensuring that its Subcontractors of all tiers comply with the requirement for providing Certificates of Insurance. Contractor and Subcontractors must notify the UCIP Administrator immediately of any insurance cancellation, modification, material change or non-renewal of required insurance. Subcontractors are required to provide work status reports to the Contractor following an injury sustained at the Project Site. Provide Medical Provider Network (MPN) packet to all employees working at the project site. See Section 6 for more information. Declaration of Minimum Occupational Safety & Health Qualifications Prior to commencement of Work by a Subcontractor, the Subcontractor must provide to the UCIP Administrator the completed Declaration of Contractor or Subcontractor Minimum Occupational Safety and Health Qualifications form demonstrating that the Subcontractor meets the following minimum occupational safety and health qualifications: A. The Subcontractor must have had no serious and willful violations of Part 1 (commencing with Section 6300) of Division 5 of the Labor Code during the five-year period prior to bid opening. B. The Subcontractor must have maintained a Workers' Compensation Experience Modification Rate (EMR) that averages below 1.15 for the past five years. (If Subcontractor has been in business for less than five years, then Subcontractor must have maintained a Workers' Compensation Experience Modification Rate (EMR) that averages below 1.15 for all years Subcontractor has been in business.) C. The Subcontractor must have instituted an injury prevention program pursuant to Section or of the Labor Code. A Subcontractor will not be allowed to Work on the Project until it submits the completed Declaration of Contractor or Subcontractor Minimum Occupational Safety and Health Qualifications form. UCIP Insurance Manual Revision 04/27/

20 CONTRACTOR AND SUBCONTRACTOR RESPONSIBILITIES See Section 7 for forms that can help identify your insurance costs. See Section 2 for information on contacting the UCIP Administrator. Contractor and Subcontractor Bids shall pay all premiums for the UCIP. Each Bidder is required to submit bids for the Project that are net of Contractor s and Subcontractors Cost of UCIP Coverages. The section below, Adjustments for UCIP Insurance Costs, describes the procedure for identifying the Costs of UCIP Coverages when bidding so these costs can be removed from the bid price. Section 7 of this Insurance Manual contains worksheets that can be used to estimate your insurance costs, and those of your Subcontractors, for the coverages provided under the UCIP. Adjustments for UCIP Insurance Costs Each Eligible Contractor and Subcontractor is required to exclude from their bid the cost of the insurance that is provided under the UCIP. To aid the Contractor and its Subcontractors in determining the cost of insurance to remove from the bid, the Insurance Cost Worksheet form (Aon Form-1a) and Insurance Cost Summary form (Aon Form-2) are provided in Section 7. A separate Aon Form-1a is required from the Contractor and each Subcontractor. Each Enrolled Contractor and Enrolled Subcontractor will be required to submit the insurance documentation listed below. Documentation will include the following pages from the Workers Compensation, General Liability and Excess Liability policies: Declarations or information page Rate page(s) rates must reflect first dollar coverage; no composite rates or corporate allocations based on deductible/retention programs Deductible endorsements, if applicable Verification of experience modification (Workers Compensation only) 3 Years of loss history from the insurance carrier, and including self-paid losses, for entities that retain losses through deductible, self-insured, or high retention programs in the amount of $5,000 or more. Change Orders Change orders will be priced by the Enrolled Contractor and Subcontractors to exclude the cost of insurance provided under the UCIP. Contractor and Subcontractors are responsible for ensuring that their Subcontractors of all tiers also remove the Cost of UCIP Coverages from their Bid and Change Orders. UCIP Insurance Manual Revision 04/27/

21 CONTRACTOR AND SUBCONTRACTOR RESPONSIBILITIES UCIP Administrator will assist the Contractor and Subcontractors in verification of Subcontractors insurance reduction calculations. See Section 7 for sample UCIP forms. Enrollment Enrolled Contractor shall provide details about its Subcontractors to the UCIP Administrator in order to enroll them in the UCIP. The Contractor and Subcontractors must complete and submit the Enrollment Application (Aon Form-3). This form can be found in Section 7. The Enrollment Application must be completed and submitted to the UCIP Administrator and accepted prior to commencing work On Site to obtain coverage under the UCIP. Enrolled Contractor and enrolled Subcontractors will receive a Confirmation Letter and UCIP Certificate of Insurance. A Confirmation Letter is a letter issued by the UCIP Administrator that confirms acceptance of the applicant into the UCIP. These documents will clearly identify the effective dates of the UCIP coverages for the Contract. A separate Workers Compensation policy will be issued and sent to each enrolled Contractor and Subcontractor. A Claims Kit will be provided to each Enrolled Contractor and Subcontractors with the Confirmation Letter. Should an enrolled Contractor or Subcontractor perform work under several Contracts, an Enrollment Application must be completed for each contract. A separate Confirmation Letter and Certificate of Insurance confirming acceptance of the applicant s enrollment into the UCIP will be issued for each Contract. NOTE: Enrollment into the UCIP is required, but not automatic. All Eligible Contractors and all Eligible Subcontractors MUST complete the enrollment forms and participate in the enrollment process to obtain UCIP coverage. Access to the Project Site will not be permitted until Enrollment into the UCIP is complete. Safety Standards establish minimum standards for Contractor safety programs. Safety Standards are provided to all participants during the bidding process. Coverage of Off-site Locations Work (as defined in the General Conditions) that is performed at a fully project dedicated off site location, which is not specified in the General Conditions, can, at the University s sole discretion, be treated as on site Work provided that at the time of enrollment in the UCIP the off site location is identified to the UCIP Administrator and scheduled on the UCIP policies. Contact the UCIP Administrator in order to schedule an off site location with the UCIP; allow thirty (30) days to schedule the off site location on the UCIP policies. UCIP Insurance Manual Revision 04/27/

22 CONTRACTOR AND SUBCONTRACTOR RESPONSIBILITIES Safety Standards Each Contractor and Subcontractor is required to have a written safety program and to provide a designated safety representative who is on site when any Work is in progress. Minimum standards for Contractor and Subcontractor safety programs are outlined in the University of California's Safety Standards Manual. A Drug Test Program has been implemented for this project for post accident and for probable cause. The financial burden associated with these tests will be the responsibility of the employer of the affected worker(s). The designated occupational clinic for the UCIP projects will administer the drug test at their facility. Please see the clinic address in the Claims Section. An employer representative will transport all injured workers (for non-emergency cases ONLY) to the designated occupational clinic facility for treatment. Please see the contract documents or Contractor s Drug Test Program for more details. Payroll Reports Enrolled Parties must submit monthly payroll reports to the UCIP Administrator identifying man-hours and payroll for all work performed at the Project Site by Contract and by Workers Compensation Classification Codes. Enrolled Parties shall submit payroll reports prior to the 10 th of the following month through the online AonWrap Web Portal. Contact the UCIP Administrator for a User ID and Password to report payroll online if you do not receive this information during the Enrollment process. The monthly man-hour and payroll reports should include supervisory and clerical personnel on-site and cover all Work performed at or emanating directly from the Project Site. Payroll for overtime should be included only at the normal hourly rate (DO NOT INCLUDE EXTRA WAGES OR PREMIUM PORTION OF OVERTIME PAY WHEN CALCULATING ONSITE REPORTABLE PAYROLL). Overtime means those hours in excess of 8 hours worked each day, 40 hours in any week or on Saturdays, Sundays, or holidays, but only when there is an increase in the hourly rate to work such hours. Insurance Company Payroll Audit Each Enrolled Party is required to maintain payroll records for each Contract. Such records will allocate the payroll by Workers Compensation classification(s) and exclude the excess or premium paid for overtime (i.e., only the straight time wage rate will apply to overtime hours worked). Furthermore, such records will limit the payroll for UCIP Insurance Manual Revision 04/27/

23 CONTRACTOR AND SUBCONTRACTOR RESPONSIBILITIES Executive Officers and Partners/Sole Proprietors to the limitations as stated in the state manual rules. It is important that you properly classify payrolls, as these are reported to the rating bureau for promulgation of future Experience Modification Ratings for your firm. All Enrolled Parties shall make available their books, vouchers, contracts, documents, and records, of any and all kinds, to the UCIP insurance carrier(s) auditors or the University s representatives. Availability of records must be for a reasonable time during the policy period, any extension, or during a final audit period as required by the insurance policies. Close Out Procedures Enrolled Parties must submit the Notice of Work Completion form (Aon Form-5) when all Work at the Project Site is complete and they no longer have workers on site. The completed Notice of Work Completion form will signal the final payroll report and initiate the audit of payroll by the UCIP Insurer. A copy of the Notice of Work Completion form with instructions on the proper method for completion is found in Section 7. Failure to fill out the Notice of Work Completion and report all Payrolls in a timely manner may result in the University of California withholding issuance of final payment and release of retention pursuant to Article 9 of the General Conditions. UCIP Insurance Manual Revision 04/27/

24 CLAIM REPORTING PROCEDURES Section 6 6. Claim Reporting Procedures This section describes basic procedures for reporting various types of claims including Workers Compensation, liability, and damage to the project. General Procedures All Parties involved with the Project shall report all injuries, occupational-related illnesses, or property damage to the Safety Manager immediately. Contractor, Subcontractors, and any other party involved with the Project will instruct employees and other personnel to report, in writing, within 24 hours all accidents and occurrences resulting in bodily injury or property damage to the Safety Manager. GC/CM Safety Manager: Cell Phone: UCIP Safety Manager: Cell Phone: TBD TBD TBD TBD TBD TBD Media Inquiries Make no statements to the media. Refer all questions from the media to the Communications Office at the University of California location where the project is located. Investigation Assistance Contractor and all Subcontractors will report the claim promptly and assist in the investigation of any accident or occurrence involving injury to persons or damage to property. Contractor and all Subcontractors will cooperate with the companies involved UCIP Insurance Manual Revision 04/27/

25 CLAIM REPORTING PROCEDURES in adjusting any claim by securing and giving evidence and obtaining the participation and attendance of witnesses required for the investigation and defense of any claim or suit. Claims Kits will be available to all Contractors. It will include details about claim reporting and is intended for use at the Project Site. Workers Compensation Claims The main responsibility for all Parties is to first see that the injured worker receives immediate medical care. The designated medical facilities for Enrolled Party employees injured on this Project are: Non-Emergency Injuries TBD Occupational Health Clinic Street XXX, CA TBD Phone: XXX-XXX-XXXX Hours: 8:00 a.m. to 5:00 p.m. M F Closed Weekends & Holidays Emergency & After Hours Injuries TBD Hospital Street XXX, CA TBD Phone: XXX-XXX-XXXX 24 Hours & Emergency Services Driving directions to the facilities listed above are included in Section 7. Injuries occurring after hours or on weekends and holidays will be treated at the designated hospital listed above. For emergency treatment, the paramedics will determine the best emergency facility available for treatment. All Parties involved with the Project shall report all injuries or occupational-related illnesses to the Safety Manager as soon as possible. Enrolled Party personnel will follow these procedures if an employee sustains bodily injury or an occupationalrelated illness while working at the Project Site: Claims Monitoring CM/Contractor will participate in monitoring Workers Compensation claims for Subcontractors. 1. Injured Workers should report to the Contractor job-site offices for injury assessment. Where medical treatment is required beyond the scope of First-Aid that can be administered on-site, the injured Worker will be referred to the designated Occupational Health Clinic or Hospital. The injured worker or accompanying supervisor should secure a Treatment Authorization Form from Contractor if they do not already have this form. 2. Contact the designated medical facility to advise them that an injured Worker will be arriving. Present the Treatment Authorization Form found in Section 7 of this manual to the clinic or hospital upon registration to identify the injured Worker as a UCIP participant working at a UCIP Project site. Contractor and Subcontractors must designate a representative at the site to UCIP Insurance Manual Revision 04/27/

26 CLAIM REPORTING PROCEDURES escort an injured Worker to the medical facility. This individual is to remain with the injured employee at the medical facility while he/she is being treated. The treating physician will provide a Work Status Form stating whether or not the injured employee can return to work, a list of restrictions, if any, and the estimated length of time the injured worker must be on modified duty. Copies of the Work Status Form should be provided to the Employee, Employer, and the Contractor Safety Manager. If the Work Status Form is not submitted to the Contractor, the Contractor will request a copy from the injured Worker s employer. 3. As soon as possible, and within 24 hours of notice of injury sustained at the Project Site, the employer of an injured worker shall do the following: Provide employee Workers' Compensation Claim Form (DWC-1) Conduct a Supervisor's Accident Investigation Fill out Employee and Employer sections of the DWC-1 and send it in to the insurance company when filing the claim Prepare the Employer s Report of Occupational Injury or Illness (Form 5020) Report the Claim in one of the following ways: Call Zurich at: Fax Zurich at: Zurich at: Upload via Website at: USZ_CareCenter@Zurichna.com Click on Claims Under Report a Claim Click on ZNA Online Claims When an employer reports the claim through one of the above methods, Zurich, the UCIP insurance company, will fill out the Employer s Report of Occupational Injury or Illness (Form 5020) and send a completed copy to the State and back to the employer. This satisfies the employer s requirement to provide the Report of Injury to the State Industrial Relations Division. The UCIP Insurance Company will also send a Claims Acknowledgement to the reporting employer with the assigned Claim Number and the Claim Adjuster contact information, as it becomes available. 4. Cooperate with the Claims Adjuster and keep Contractor informed of the UCIP Insurance Manual Revision 04/27/

27 CLAIM REPORTING PROCEDURES current Work Status of the injured Worker. Drug Test Program A Drug Test Program has been implemented for this project for post accident and for probable cause. The provisions of the Drug Test Program will meet or exceed the Contractor s corporate program. The financial burden associated with these tests will be the responsibility of the employer of the affected worker(s). Modified Duty / Early Return to Work Policy has implemented a Modified Duty/Early Return to Work program. The purpose of this program is to keep injured workers gainfully employed during recovery. Modified duty benefits the injured worker as well as the contractor. This policy establishes basic guidelines for an Early Return to Work (transitional duty) work assignment for injured workers. Each Employer shall have a written Early Return to Work Program that shall be implemented on this project unless specifically prohibited by the terms of a Collective Bargaining Agreement. Please see the UCIP Safety Standards Manual, page 27, for more information relating to Early Return to Work. Contractor or Subcontractors are responsible for notifying the Occupational Safety and Health Administration (Cal-OSHA) when one or more of their employees are seriously injured. A detailed incident report must be completed and turned in to the UCIP Safety Manager and Contractor s Safety Manager within twenty-four (24) hours of the accident/incident. The Employer will forward any additional documentation to the insurance carrier and to the UCIP Administrator. Each Employer will be required to attend all claims meetings and participate in the management of claims for their employees. When additional information is requested by the insurance carrier, the Employer is required to cooperate with the assigned claims adjuster. Medical Provider Network (MPN) Contractor and Subcontractors working on a UCIP Project will utilize the Medical Provider Network (MPN) program for industrial injuries. This program is a benefit UCIP Insurance Manual Revision 04/27/

28 CLAIM REPORTING PROCEDURES to the employer as it allows for more effective medical control for the life of the claim and may reduce many of the Workers Compensation costs associated with each claim. The MPN contains an extensive number of occupational medicine facilities and other medical providers from which the injured worker is obligated by law to select if (1) the employer (Contractor/Subcontractor) has properly fulfilled its responsibilities and (2) the injured worker has not pre-designated his own personal physician. MPN packets will be distributed to all enrolled participants by the UCIP Administrator at the time of their enrollment approval. These packets must be distributed to all employees who will work at the Project Site. The Contractor will also include the notification packets in their safety orientation to all employees attending the orientation. Report all Liability claims to the UCIP Administrator. Liability Claims Incidents or accidents at or around the Project Site, or at a designated off-site location that has been added to the UCIP policies (see definition of Project Site on page 2), resulting in damage to property of others (other than your own work product), or personal injury or death to a member of the public, must be reported immediately to the designated Project and Safety Managers. Follows these Procedures in the event of such and incident or accident: 1. Take appropriate emergency measures to prevent additional injury or damage, including contacting the police or fire authorities, as required by law. Claims Monitoring CM/Contractor will participate in monitoring Workers Compensation claims for Subcontractors. 2. Report the incident and all subsequent inquiries or correspondence about an insured loss or claim, including a summons or other legal documents, to the Safety Manager. 3. Report the Claim in one of the following ways: Call Zurich at: Fax Zurich at: Zurich at: Upload via Website at: USZ_CareCenter@Zurichna.com Click on Claims Under Report a Claim Click on ZNA Online Claims UCIP Insurance Manual Revision 04/27/

29 CLAIM REPORTING PROCEDURES Report all Auto claims to your insurance carrier and the UCIP Administrator. Automobile Claims No insurance coverage is provided for automobile accidents under the UCIP. It is the sole responsibility of Contractor and Subcontractors to report accidents/claims involving their automobiles to their own insurers. However, all accidents occurring in or around the Project Site must be reported to the designated Project and Safety Representatives. (See Section 2 for contact information). The accident will be investigated to determine any liability arising out of the project construction activities that could result in future claims (i.e., due to the conditions of the roads, etc.). Contractor and Subcontractors shall cooperate in the investigation of all automobile accidents. UCIP Insurance Manual Revision 04/27/

30 FORMS Section 7 7. Forms This section contains the forms needed for enrolling into the UCIP, reporting payroll and overall administration of the UCIP. This section contains the following forms: Notice of Subcontract Award Aon Form-1 Insurance Cost Worksheet Aon Form-2 Insurance Cost Summary Aon Form-3 Enrollment Application Aon Form-5 Notice of Work Completion Exhibit 1 Sample Certificate of Insurance (Acord 25) Exhibit 2 Sample Additional Insured Endorsement General Liability Exhibit 3 Sample Additional Insured Endorsement Auto Treatment Authorization Form Designated Medical Clinic/Hospital Driving Directions Form 5020 (CA) Employer's Report of Occupational Injury or Illness Form DWC-1 Workers Compensation Claim Form Notice of Occurrence Liability (Acord 3) For assistance completing these forms, please contact the UCIP Administrator: Scott Brama Phone (866) Aon Risk Solutions Fax (415) Fremont Street, Suite scott.brama@aon.com San Francisco, CA UCIP Insurance Manual Revision 04/27/

31 Notice of Subcontract Award To: Scott Brama From: Fax #: Fax #: Phone #: Phone #: Today s Date The subcontractor named below will be issued a contract to perform work on the following: Project: Contract Number: Contract Value: $ Check here if the subcontractor is to be enrolled in the UCIP Check here if the subcontractor is to be excluded from the UCIP Check here if the subcontractor will be an excluded prime tier fabricator with eligible (enrolled) sub-tier erector/installer 1. Name of subcontractor: 2. Subcontractor address: 3. Subcontractor FEIN: 4. Subcontractor contact person: 5. Subcontractor phone number: 6. Subcontractor fax number: 7. Subcontractor address: 8. General description of work: 9. Date of award: 10 Anticipated on-site start date: 11. Anticipated completion date: Notes 1. Please attach the subcontractor s Declaration of Minimum Occupational Safety & Health Qualifications Form (Exhibit 1b). 2. If available, please attach the subcontractor s certificate of insurance evidencing required coverage.

32 INSURANCE COST WORKSHEET Form-1a (Fixed Price Type Contracts) Numbers reference attached instructions A. Contractor Information: Federal ID # or Soc. Sec. #: 1 UCIP Project Company Name & dba: Contact Name & Title: Address: City, State, Zip Code: Telephone: Fax: E.mail Address: Business Information (headquarters) 2 3 Contact Information (address questions to..) B. Bid Information: Bid Package No.: 1 Description of Work: 2 Proposed Contract Price $: 3 Are you Submitting a bid to : 5 Yes No Amount of Self Performed Work $: 4 If No, identify to whom: 6 1 C. Workers Compensation Insurance Information for Work Described Above: (a) (attach a separate sheet if necessary) a State b Class Code c Description d Rate (per $100 payroll) e Man-hours f Payroll g WC Premium (Payroll * Rate / 100) Totals Identify the Amount of Your Claim Retention 5 Your Company s Workers Compensation Experience Modifier: 6 Modified Premium (line C4 x C6): 7 Employers Liability Rate: 8 Employers Liability Premium: 9 10 Modification & Discount Premium Factors 11 Rate 12 Amount Mod 1: + or - Mod 2: + or - Mod 3: + or - Mod 4: + or - Mod 5: + or - Total Modification Amount (Total of all amounts entered in column C12): 13 D. General Liability: (a) Rate: 1 2 Based On: Total Payroll (C3) Contract Price (B3) Other Excess/Umbr Liab: (a) Rate: 6 7 Based On: Total Payroll (C3) Contract Price (B3) Other Total Workers Compensation Premium (line C7 + C9 + C13): 14 3 Rate factor: Per 100 Per 1,000 8 Rate factor: Per 100 Per 1,000 4 Identify the Amount of Your Claim Retention: GL Premium (D2 D1 D3): Excess/Umbr Premium (D7 D6 D8): 5 9 E. Builder s Risk/Installation Floater: (1) Rate: 1 2 Rate factor Per 100 Per 1,000 Builder s Risk/Installation Floater Premium (B3 E1 E2): 3 F. Other Insurance Premiums: (1) (Enter total premium costs identified on page 2) 1 G. Totals Total of all Insurance Premiums (Total of lines C14 +D5 + D9 + E3 + F1): 1 Overhead & Profit on Insurance Prem. %: 2 15% O/H & Profit Amount (G1 x G2): 3 Total Initial Insurance Cost (Total of lines G1 + G3): 4 Contractor s Initial Insurance Cost Rate (Line G4 divided by total payroll in line C3 100): 5 H. Signature Block : I verify the information presented above and attachments are correct: Name: Date: Title: (please print) Signature: Completion of this form is a required part of your bid and must accompany your bid documents. Complete a separate form for each contractor, known subcontractor(s) and trades not currently awarded to a subcontractor. Duplicate this form as needed. (a) Please provide copies of the following documents to support your insurance cost calculations: Schedule of Values General Liability declaration and rate pages Workers Compensation declaration and rate pages Umbrella/Excess Liability declaration and rate pages Experience Modification worksheet 5 years actual loss experience for each line of coverage in which Contractor retains more than $5,000.

33 Form-1a INSURANCE COST WORKSHEET (Instructions for Fixed Price Type Contracts) UCIP Project Complete a separate form for each contractor, known subcontractor and trade not currently awarded to a subcontractor. Duplicate this form as needed. Completion of this form is a required part of your bid and must accompany your bid documents. A. Contractor Information 1 Enter your company s Federal ID number. This number can be found on filings made to the federal government such as your tax return. 2 Enter your company s name, mailing address and phone/fax number for your company s main office location in the space provided below. 3 Enter the name of the person Aon should contact if questions arise. Include the mailing address, phone/fax and e.mail address if different than A-2 B. Bid Information 1 Enter the Bid Package Number, Contract Number or Purchase Order Number that was included in s originating documentation. 2 Provide a brief description of the work you will be performing at the project site. 3 Identify the total amount of your bid. Include both labor and material. 4 Identify the amount of work that you anticipate will be self-performed. Include both labor and material. 5 Check the appropriate box that identifies if you contract directly with or are a subcontractor. 6 If you are a Subcontractor, identify the entity with whom you are under contract. C. Workers Compensation Insurance Information (Duplicate or attach additional sheets if necessary. You may create an electronic version of this document if all requested information is included): 1 a Enter the two letter abbreviation for the state in which the work will be performed. b Enter each Workers Compensation class code that applies to your work identified in B2. (Most states use a 4 digit Number) c Enter the Workers Compensation class code description that applies to each class code identified in C1b. d Enter the Workers Compensation rate that applies to the specified class code. e Enter the estimated Man-hours required to complete the described work for each Workers Compensation class code. f Enter the estimated Payroll required to complete your work. Use only unburdened payroll and exclude the premium portion of any overtime pay. g Calculate the WC Premium by multiplying the Payroll (C1f) by the Rate (C1d) and dividing the result by 100. Repeat this calculation for each WC class code. 2 Total the estimated Man-hours for each class code. Be sure to include information from additional pages if used. 3 Total the estimated Payroll for each class code. Be sure to include information from additional pages if used. 4 Total the Workers Compensation Premium for each class code. Be sure to include information from additional pages if used. 5 Enter the amount of the Claim Retention / Deductible your company has on their existing Workers Compensation. 6 Enter your WC Experience Modifier. This Information can be located on your Workers Compensation policy or on your NCCI Bureau Rating Sheet. 7 Calculate the Modified Premium by multiplying the WC Premium (C4) by the Experience Modifier (C6). 8 Enter your Employer s Liability Insurance Rate. This information can be found in your Workers Compensation policy. 9 Calculate your Employer s Liability Premium by multiplying the Modified Premium (C7) by the Employer s Liab. Rate (C8). 10 Identify the Modifiers that apply to your Workers Compensation Premium. This information can be located on your Workers Compensation Policy. 11 Enter the Rate for each identified Modifier. The information can be located on your Workers Compensation Policy 12 Calculate the Modified Premium Factor Amount by multiplying the Modified Premium (C7) by the Modified Premium Rate (C11) and dividing by 100. Be sure to identify if the Modification factor is an addition or reduction to your premium. 13 Total the Modified Premium Amounts by adding the numbers in column C Calculate the Total Workers Compensation Premium by adding the Modified Premium (C7) to the Employer s Liab Premium (C9) and adding the Premium Modifications (C12). D. General Liability & Umbrella/Excess Liability Insurance 1 Enter the General Liability Rate. This number can be found on your General Liability Policy 2 Identify the base the General Liability Rate applies to. If the base is other than Payroll or Revenue, enter the amount and the description in the space provided. 3 Identify the General Liability Rate factor by marking the box. 4 Identify the amount of your Claim Retention. 5 Calculate the General Liability Premium by multiplying the Bases (D2) by the Rate (D1) and dividing by the factor (D3). 6 Enter the Excess/Umbr Liability Rate. This number can be found on your Excess/Umbr Liability Policy 7 Identify the base the Excess/Umbr Liab. Rate applies to. If the base is other than Payroll or Revenue, enter the amount and description in the space provided. 8 Identify the Excess/Umbr Liability Rate factor by marking the box. 9 Calculate the Excess/Umbr Liability Premium by multiplying the Bases (D7) by the Rate (D6) and dividing by the factor (100 or 1,000). E. Builder s Risk/Installation Floater 1 Enter the Builder s Risk/Installation Floater Rate. Locate this information on your Property Policy or Builder s Risk Policy. 2 Identify the base factor that it applies to (100 or 1,000). 3 Calculate the Premium by multiplying the Proposed Contract Price (B3) by the Rate (E1) and dividing it by the Factor (E2). F. Other Insurance Premiums 1 For each of the Insurance Lines of Coverage identified below, Identify the Rate, Base and Factor. Calculate the Premium by multiplying the Base x Rate Factor. Total the Other Insurance Premiums in the space provided and carry that amount to the front page. Line of Coverage Rate Base Factor Premium Total Premium Coverage A G. Totals 1 Calculate the Total of all Insurance Premium by adding Workers Compensation (C14), General Liability (D5), Excess/Umbr Liability (D9), Builder s Risk/Installation Floater (E3), and Other Insurance Premiums (F1). 2 Identify the Overhead & Profit Percentage that was applied to this project during the tabulation of the Proposed Contract Price. 3 Calculate the Overhead & Profit Amount by Multiplying the Total of all Insurance Costs (G1) by the Overhead & Profit Percentage (G2). 4 Calculate the Total Initial Insurance Cost by adding the Overhead & Profit Amount (G3) with the Total of all Insurance Premium (G1) 5 Calculate your rate by Dividing the Total Initial Insurance Cost (G4) by the Estimated Payroll (C3) and multiplying by 100. H. Signature Block: This form must be signed by a representative of your company with the authority to Verify the information is correct. Note: Please provide copies of the following documents as part of your submittal: Schedule of Values Workers Compensation declaration and rate pages Experience Modification worksheet General Liability declaration and rate pages Umbrella/Excess Liability declaration and rate pages 5 years actual loss experience for each line of coverage in which Contractor retains more than $5,000.

34 Form-2 A. Bid Information Name of Prime Contractor: Proposed Contract Cost $: 3 B. Aon Form-1a Summary Contracting Parties & Trades Aon Form-1a Reference No. Prime Contractor : (Attach the Aon Form-1a) 1 INSURANCE COST SUMMARY Numbers reference attached instructions Proposed Subcontract Amount B3 (Form-1a Ref.) Bid or Purchase Order No.: Estimated Manhours C2 (Form-1a Ref.) UCIP Project 2 Estimated Payroll C3 (Form-1a Ref.) Initial Insurance Cost G4 (Form-1a Ref.) Your Known Subcontractors (Attach a Separate Aon Form-1a from each) List Additional Trades NOT yet assigned to a subcontractor (attach an Aon Form 1a) 9 List by Trade or Function C. Total for Contract: (Total all Column Entries) D. Composite Insurance Cost Rate for Contract: (Line C4 C3 x100) 1 E. Signature Block: I verify the information presented above and attachments are correct: Name: Date: (please print) Title: Signature: Completion of this form is a required part of your bid and must accompany your bid documents. Duplicate this form as needed. An Aon Form-1a must be attached for each line entry made on this form. In addition, the following documentation must accompany each Aon Form-1a. Schedule of Values General Liability declaration and rate pages Workers Compensation declaration and rate pages Umbrella/Excess Liability declaration and rate pages Experience Modification worksheet 5 years actual loss experience for each line of coverage in which Contractor retains more than $5,000.

35 Form-2 INSURANCE COST SUMMARY INSTRUCTIONS UCIP Project This form is to be used by a Prime Contractor to summarize subcontract activity. This form may also be used by Subcontracts that must summarize sub subcontract activity of any tier. Submit this form with your Bid Documents. A. Bid Information 1 Enter the Name of the Contractor whose activity is being summarized. For purposes of these instructions they will be called a Prime Contractor regardless of the fact that they may not hold a contract directly with. 2 Enter the Bid Package Number, Contract Number or Purchase Order Number. This number accompanied The University of California s original documentation. 3 Enter the Amount you have proposed as the Contract Price. B. Aon Form-1a Summary (Information will either be found on the Contractor s Aon Form-1a or in situations where the subcontract uses additional tiers of subcontractors, the information will be found on an Aon Form-2 that summarizes their activity with their subcontracted activity.) Aon Form-1a Reference No. Aon Form-2 Reference No 1 For the Prime Contractor enter the Estimated Man-hours C2 2 For the Prime Contractor enter the Estimated Payroll C3 3 For the Prime Contractor enter the Total Initial Insurance Cost G4 4 For each Subcontractor, enter the firm s Name A2 A1 5 For each Subcontractor, enter the Proposed Contract Cost B3 A3 6 For each Subcontractor, enter the Estimated Man-hours C2 C2 7 For each Subcontractor, enter the Estimated Payroll C3 C3 8 For each Subcontractor, enter the Total Initial Insurance Cost G4 C4 9 For the Activity that has not been assigned to a Subcontractor, enter the Trade or Functional Description A2 10 For the Activity that has not been assigned to a Subcontractor, enter the Estimated Contract Amount B3 11 For the Activity that has not been assigned to a Subcontractor, enter the Estimated Man-hours C2 12 For the Activity that has not been assigned to a Subcontractor, enter the Estimated Payroll C3 13 For the Activity that has not been assigned to a Subcontractor, enter the Estimated Initial Insurance Credit G4 C. Total Estimates for Contract 1 Total the Proposed Subcontract Amount for the identified activity. 2 Total the Estimated Man-hours for the identified activity. 3 Total the Estimated Payroll for the identified activity. 4 Total the Initial Insurance Cost for the identified activity. D. Composite Insurance Cost Rate for Contract 1 Calculate the Composite Rate for the Contract by dividing the Total Initial Insurance Cost (C4) by the Total Estimated Payroll (C3) and multiplying by 100. E. Signature Block: This form must be signed by a representative of your company knowledgeable of its accuracy. Completion of this form is a required part of your bid and must accompany your bid documents. Duplicate this form as needed. An Aon Form-1a must be attached for each line entry made on this form. In addition, the following documentation must accompany each Aon Form-1a. Schedule of Values General Liability declaration and rate pages Workers Compensation declaration and rate pages Umbrella/Excess Liability declaration and rate pages Experience Modification worksheet 5 years actual loss experience for each line of coverage in which Contractor retains more the $5,000.

36 Form-3 ENROLLMENT APPLICATION Numbers reference attached instructions UCIP Project Page 1 of 2 Examine your current Workers Compensation and General Liability Policies or contact your Insurance Agent to assist you with completing this form. *** NOTICE *** Enrollment is not automatic and requires the satisfactory completion of the Aon Form-1a or Form-1b, Form-2 and Form-3. In addition, submit a Certificate of Insurance providing evidence of your off-site coverage. Please refer to the Insurance Manual for coverage requirements. A. Contractor Information: Federal ID # or Soc. Sec. #: Company Name & dba: Contact Name & Title: Address: City, State Zip Code: Telephone: Fax: Address: Indicate your Organization s Structure: Business Information (headquarters) Corporation Joint Venture Partnership Sole Proprietor 1 S-Corporation Other Contact Information (address questions to..) B. Contract Information: Contract No.: 1 Date Contract Awarded: 2 Description of Work: 3 Proposed Contract Price $: 4 Are you Submitting a bid to : 6 Yes No Amount of Self Performed Work $: 5 If No, identify to whom: 7 Start Date: C. Contacts: (Complete if Applicable) 8 Actual Estimated Completion Date: 9 Actual Estimated Position 1 Name & Title 2 Phone 3 Fax 4 address Project Mngr: Res. Engineer: Insurance: Contract Admin: Payroll: Claims: Safety Rep: Provide Location of payroll records if 5 different than Corporate address: Phone: City, State, Zip Code: Fax: D. Workers Compensation Insurance Information for Work Described Above: (attach a separate sheet if necessary) a State b Class Code c Description d Man-hours 1 e Payroll Totals 2 3 E. Provide your current Off-Site Workers Compensation Information: (for each state you will perform work in) Applicable State Risk ID Number Rating Bureau Anniversary Rating Date Your WC Insurance Carrier: 5 Policy #: 6 Effective Date: 7 Expiration Date: 8

37 Form-3 ENROLLMENT APPLICATION Numbers reference attached instructions UCIP Project Page 2 of 2 F. Subcontract Information: List all Subcontractors that will be working for you on this project (complete the information in the following table). Use additional paper if necessary: 1 Subcontractor 2 Subcontract $ 3 Contact Person 4 Address 5 Phone & Fax No 6 Estimated Start Date G. Enrollment Questions: Answer each question. Use additional paper if necessary. 1 Will you have any off-site location(s) 100% dedicated to this project? Yes No If yes, please provide address: Please check if: Any aircraft used on this project Any watercraft used on this project Please indicate if labor from the following sources will be used: Employee Leasing Firm Temporary Labor Agency H. WARRANTY APPLICABLE TO PROGRAM INSURANCE COVERAGE Premiums for this Program are the responsibility of The Regents of the University of California and I agree any and all return of premium, dividends, discounts, or other adjustments to any Program policy(ies) is assigned, transferred and set over absolutely to The Regents of the University of California. This assignment applies to the Program policy(ies) as now written or as subsequently modified, rewritten or replaced. Rights of Cancellation for all Program insurance policy(ies) arranged by The Regents of the University of California are assigned to The Regents of the University of California. I will pay the cost of premium(s) for non-program insurance coverage, specified in the Contract Documents. I authorized the release of all claim information for all insurance policies under this Program. It is my responsibility to notify my insurance carrier(s) that I am enrolling in this Program. I have omitted from my bid the insurance costs for the coverage provided by The Regents of the University of California. The statements in this insurance application are true to the best of my knowledge. I. Signature Block : I verify the information presented above and attachments are correct: Name: Date: (please print) Title: Signature: Fax or Mail to: Scott Brama Phone: (415) Aon Risk Insurance Services West, Inc. Fax: (415) Fremont Street, Suite 1500 San Francisco, CA Scott.brama@aon.com

38 Form-3 ENROLLMENT APPLICATION INSTRUCTION UCIP Project This form must be completed and submitted by each successful Contractor and Subcontractor of any tier prior to Site mobilization for each contract awarded. The Contractor and Subcontractor will submit the completed form to Aon Risk Services. Upon receipt of this form, Aon will issue to the Contractor or Subcontractor a Certificate of Insurance evidencing coverage in the Controlled Insurance Program. The completed Certificate of Insurance and Workers Compensation insurance policy will be mailed to the Enrolled party. A. Contractor Information 1 Enter your company s Federal ID number. This number can be found on filings made to the federal government such as your tax return. 2 Enter your company s name, mailing address and phone/fax number for your company s primary office location. 3 Enter the name of the person Aon should contact if questions arise. Include mailing address, phone/fax and e.mail address, if different than A2. 4 Identify your company s legal structure by checking the box that applies. If the correct legal structure is not specifically listed, please check the Other box and specify in the space provided. B. Contract Information 1 Enter the Contract Number or Purchase Order Number that was included in s originating documentation. 2 Supply the Date this Contract was awarded to your organization. 3 Provide a brief description of the work you will be performing at the project site. 4 Identify the total amount of your contract. Include both labor and material. 5 Identify the amount of work that you anticipate will be self-performed. Include both labor and material. 6 Check the appropriate box that identifies if you contract directly with or are a Subcontractor. 7 If you are a Subcontractor, identify the entity with whom you are under contract. 8 Enter the Date you anticipate starting work and then mark whether the date provided is actual or estimated. 9 Enter the Date you anticipate completing the described work and then mark whether the date provided is actual or estimated. C. Contacts (Requested Contact information is for specific functions. It is possible to have a single person fulfill multiple responsibilities.) 1 Identify the name of the person and their title for each function. These individuals should be located, if at all possible, on-site. 2 Provide the phone number for each person identified above. 3 Provide the fax number for each person identified above. 4 Provide the e.mail address for each person identified above, if applicable. 5 Identify the physical location where your payroll records are retained. Provide the Address, City, State, Zip Code, Telephone, Fax Number and E.mail Address of the person responsible for maintaining the payroll information. D. Workers Compensation Information (Duplicate or attach additional sheets if necessary. You may create an electronic version of this document if all requested information is included.): 1 a Enter the two letter abbreviation for the state in which the work will be performed. b Enter each Workers Compensation class code that applies to the work identified in B2. (Most states use a 4 digit Number) c Enter the Workers Compensation class code description that applies to the work identified in D1b. d e Enter the estimated Man-hours required to complete the described work by Workers Compensation class code. Enter the estimated Payroll required to complete the described work for each Workers Compensation class code. Use only unburdened payroll and exclude the premium portions of any overtime pay. 2 Total all estimated Man-hours for each class code. Be sure to include information from additional pages if used. 3 Total all estimated Payroll for each class code. Be sure to include information from additional pages if used. E. Current Off-Site Workers Compensation Information (Information relates to your corporation s existing coverage; identify each modification factor that applies.) 1 Enter the State that the Modification Information applies to. 2 Enter your Bureau File Number also referred to as your Risk Identification Number. This number can also be found on your Modification worksheets. 3 Enter the Bureau Rating Agency. In most states this is NCCI. 4 Provide your Company s Anniversary Rating Date. Information can be located on your bureau s WC Experience Modification worksheets. 5 Identify your insurance carrier for Workers Compensation Coverage. 6 Provide your Workers Compensation Policy Number. 7 Provide the effective date of your Workers Compensation policy. 8 Provide the expiration date of your Workers Compensation policy. F. Subcontractor Information (Provide the following information for each Subcontractor that will be performing work at the project site. Use additional sheets, if necessary.) 1 Identify the name of the Subcontracting firm. 2 Provide the estimated value of the subcontracted activity. 3 Provide a contact name, preferably the project manager, for the Subcontractor. 4 Provide the mailing address for the Subcontractor. 5 Provide the phone number for the Subcontractor. 6 Provide the date the Subcontractor is scheduled to begin work. G. Enrollment Questions 1 Determine if you will have any locations, off-site, that will be 100% dedicated to this project. Include material/supply storage as a possible location. Mark the appropriate box (yes/no). If you answer yes provide the address of each location you identified as 100% dedicated. 2 Mark the box or boxes that apply. Contemplate only work performed under this contract. 3 Mark the box or boxes that apply. Employee Leasing Firm are those firms that supply the labor force for your company (You direct the activities of the Leasing Company s employees). Temporary Labor Firms supplement your labor force. H. Warranty Statements: 1-6 Read each Warranty statement thoroughly. If you have questions regarding any of these statements, contact the Aon administrator identified on page 2. I. Signature Block: This form must be signed by a representative of your company knowledgeable of its accuracy. Forward the completed Enrollment Application to the Aon administrator identified at the bottom of page 2 of this form. The administrator prior to the start of your work on-site must receive this form.

39 Form-5 A. General Information NOTICE OF WORK COMPLETION Numbers reference attached instructions UCIP Project Contractor Name: 1 Under contract With: 2 Contract #: 3 UCIP Project Description of Work: Performed: 4 Date Work Completed: 5 Date this Contract Completed: 6 Final Contract Value: 7 B. Work Completion The following Subcontractors have completed their Work at the Project Site: (Add attachment if more space is needed) a Subcontractor s Name b Contract Number c Description of Work d Date Completed 1 Location of your payroll records (Receipt of this form will initiate the payroll audit process): Address: 2 City, State, Zip Code: Contact/Phone #: C. Signature Block The undersigned acknowledges request for termination of Coverage under the OCIP as of the date indicated above for the specified Contract. Should we return to the work Site, we will be working under our own insurance program and must provide with a Certificate of Insurance showing our own Coverage as detailed in our contract. Signed by: Approved by: 1 Name & Title 2 Construction Manager (Name & Title) Date Date Fax or Mail to: Scott Brama Phone: (415) Aon Risk Insurance Services West, Inc. Fax: (415) Fremont Street, Suite 1500 San Francisco, CA Scott.brama@aon.com

40 Form-5 NOTICE OF WORK COMPLETION Instructions UCIP Project This form will be completed and returned to the UCIP Administrator by the contractor or Subcontractor whenever work is completed for each Contract or Subcontract. This form will initiate the final payroll audit process for the Contractor/Subcontractor identified in item 1. Final Payments and Release of Retainage will not occur until all payroll work is complete and finalized. A. General Information 1 Provide the name of the Contractor completing their work. 2 Provide the name of the entity your contract is with ( or Parent Contractor) 3 Enter the contract number for the work being completed. 4 Provide a brief description of the work being completed. 5 Provide the Date the Work was completed. 6 Provide the Date the Contract was completed, if other than work completion date. 7 Document final contract value (original contract amount plus change orders, purchase orders or work orders) B. Work Completion 1a Enter the name of each Subcontractor that performed work for you that has also completed their work. b Enter Subcontractors Contract Number. c Provide a brief description of their work. d Provide the Date they completed their work. 2 Identify the physical location of where your payroll records are retained. Provide the Address, City, State, Zip Code, Contact Name and Telephone Number of the person responsible for maintaining the payroll information for audit purposes. C. Signature Block 1 This form must be signed by a representative of your company with the authority to Verify that the information is correct. 2 Have this form approved by the Construction Manager for the Project Site.

41 Exhibit 1 Sample Certificate of Insurance CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 01/11/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Insurance Broker/Agent Name & Address CONTACT NAME: PHONE (A/C, No, Ext): ADDRESS: INSURER A : Broker Name Broker Phone Broker Address FAX (A/C, No): Broker Fax INSURER(S) AFFORDING COVERAGE NAIC # Carrier Name INSURED INSURER B : Carrier Name Contractor / Subcontractor Name & Address INSURER C : INSURER D : INSURER E : Carrier Name Carrier Name INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR A B C D TYPE OF INSURANCE GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY GEN'L CLAIMS-MADE x OCCUR AGGREGATE LIMIT APPLIES PER: PRO- POLICY JECT LOC AUTOMOBILE LIABILITY X ANY AUTO X ALL OWNED SCHEDULED AUTOS AUTOS X X NON-OWNED HIRED AUTOS AUTOS X UMBRELLA LIAB X OCCUR EXCESS LIAB CLAIMS-MADE DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) X X Policy Number Date Date X X Policy Number Date Date X X Policy Number Date Date X Policy Number Date Date LIMITS Each Occurrence $2,000,000 General Aggregate $2,000,000 Products - Comp Op Agg $2,000,000 Personal & Adv. Injury $1,000,000 Damage to Rented Prem. $50,000 Medical Expense $5,000 Combined Single Limit $1,000,000 Each Occurrence See Section 4 Aggregate See Section 4 X WC STATU- TORY LIMITS OTH- ER E.L. Each Accident $1,000,000 E.L. Disease - Each Employee $1,000,000 E.L. Disease - Policy Limit $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) (The General Contractor and/or Construction Manager should be added if they are not the named insured), The Regents of the University of California,, University, the UCIP Administrator, and each of their Representatives, consultants, officers, agents, employees, each of their Representative's consultants, and all enrolled parties regardless of whether or not identified in the Contract Documents or to the Contractor in writing, are included as additional insureds on the general liability policy as required by contract and pursuant to additional insured endorsement CG2010 (11/85) or a combination of both CG 2010 (10/01) and CG 2037 (10/01) but only in connection with (name of project). Coverage is primary and non-contributory as respects off-site coverage. Waiver of Subrogation is included for General Liability and Workers Compensation. General Liability and Workers Compensation Coverages apply off-site only. CERTIFICATE HOLDER CANCELLATION The Regents of the University of California c/o Aon Risk Insurance Services West, Inc, Attn: UCIP Administrator 199 Fremont Street, Suite 1500 San Francisco, CA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2010/05) ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD

42 Exhibit 2 Sample Additional Insured Endorsement General Liability POLICY NUMBER: XXXXXXXXXXXX CONTRACTOR NAME Sample COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED OWNERS, LESSEES OR CONTRACTORS (FORM B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE Name of Person or Organization: TBD (General Contractor), the University of California, the University's consultant and its consultants, the UCIP Administrator, and each of their respective officers, agents, and employees (If no entry appears above, information required to complete this endorsement will be shown in the declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of your work for that insured by or for you. PRIMARY INSURANCE: This insurance will be primary for the additional insured but only with respect to liability arising out of your work for that additional insured by or for your. NOTE: This policy to include a WAIVER OF SUBROGATION. CG Copyright Insurance Services Office Inc., 1984

43 Exhibit 3 Sample Additional Insured Endorsement Auto POLICY NUMBER XXXXXXXX COMMERCIAL AUTO CONTRACTOR NAME Sample THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM TRUCKERS COVERAGE FORM BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Endorsement effective Named Insured Countersigned by (Authorized Representative) SCHEDULE Who is an insured is changed to include as an "insured" the named insured listed below. Insurance Company: Additional Insured: TBD (General Contractor), the University of California, the University's consultant and its consultants, the UCIP Administrator, and each of their respective officers, agents, and employees Address: Description of operations/vehicle As respects to all operations performed for or on behalf of the Additional Insured PRIMARY INSURANCE: This insurance will be primary for the additional insured but only with respect to liability arising out of your work for that additional insured by or for your. NOTE: This policy to include a WAIVER OF SUBROGATION.

44 UNIVERSITY CONTROLLED INSURANCE PROGRAM (UCIP) UNIVERSITY OF CALIFORNIA SAMPLE TREATMENT AUTHORIZATION FORM *Please present this form to the medical provider s front desk* Address: Phone: Office Hours: TBD TBD TBD TBD TBD Friday TBD Saturday Contractor OR Subcontractor: UCIP WC Policy#: Insurance Company: Zurich Insurance SITE CODE: Contact Person: Employee: Contact Phone: Date of Injury: Authorization for Work Injury Treatment Drug Screen Non-DOT Quick Test Reason: Post Accident For Cause Comments: DIRECTIONS: TBD TBD TBD TBD TBD EMERGENCY & AFTER HOURS INJURIES TBD TBD Phone: TBD Hours: 24 Hours & Emergency Services ATTENTION Zurich Billing Information: Zurich - W.C. Claims 1400 American Lane Schaumburg, IL Tel: (877) Fax: (877)

45 UNIVERSITY CONTROLLED INSURANCE PROGRAM (UCIP) UNIVERSITY OF CALIFORNIA SAMPLE Clinic US Healthworks Medical Group 1717 S. Main Street, Milipitas, CA (408) Hours: M-F 7am 7pm DIRECTIONS FROM PROJECT SITE Kato Road, Fremont, CA Start out going SOUTHEAST on KATO RD toward PAGE AVE.. Turn RIGHT onto MILMONT DR. Turn RIGHT onto DIXON LANDING RD. Merge onto I-880 S toward SAN JOSE. Take the MONTAGUE EXPWY exit, EXIT 7. Take the MONTAGUE EXPWY EAST ramp. Merge onto MONTAGUE EXPY. Turn LEFT onto S MAIN ST S MAIN ST is on the LEFT. 24 Hours - Urgent Care / Hospital Washington Hospital 2000 Mowry Ave, Fremont, CA (510) DIRECTIONS FROM PROJECT SITE Kato Road, Fremont, CA Start out going NORTH on KATO RD toward AUBURN ST. Turn RIGHT onto W WARREN AVE. Turn LEFT onto WARM SPRINGS BLVD. Turn LEFT onto MISSION BLVD/CA-262 W. Merge onto I-880 N toward OAKLAND. Take the MOWRY AVENUE exit, EXIT 17, toward CENTRAL FREMONT. Turn RIGHT onto MOWRY AVE MOWRY AVE is on the RIGHT.

46 INSURER Zurich North America Insurance Telephone Reporting

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53 TEACHING AND LEARNING CENTER FOR HEALTH SCIENCES University of California, Los Angeles Project No EXHIBIT 1d UCIP SAFETY STANDARDS MANUAL SEE ATTACHED CM/Contractor EX USSM 05/07/10 UCIP Safety Standards Manual Exhibit 1d - 1

54 ADDENDUM TO INSURANCE MANUAL CAPIITAL DEVELOPMENT PROGRAM UNIIVERSIITY CONTROLLED INSURANCE PROGRAM (UCIP) UCIIP SAFETY STANDARDS MANUAL Rev. 2 Page 1 of 109

55 TABLE OF CONTENTS TABLE OF CONTENTS... 2 I. INTRODUCTION AND BASIC ELEMENTS... 5 SAFETY PHILOSOPHY... 5 PROGRAM OBJECTIVES... 5 PROJECT EXECUTIVE SAFETY OVERSIGHT COMMITTEE... 6 CONFLICT BETWEEN CODES AND SAFETY STANDARDS... 6 DEFINITIONS... 7 ACRONYMS... 9 GENERAL EMERGENCY PROCEDURES: JOB SITE EMERGENCIES (FIRE, INCIDENTS, & MEDICAL EMERGENCIES FIRE MEDICAL EMERGENCY PROJECT CONDUCT AND SITE SECURITY INFORMATION EMPLOYEE CONDUCT NEWS MEDIA AND CONTRACTOR CONDUCT CONSTRUCTION VEHICLE PARKING IDENTIFICATION ASSIGNED WORK AREA II. RESPONSIBILITIES SAFETY RESPONSIBILITIES SUBCONTRACTOR SAFETY RESPONSIBILITIES PROJECT SAFETY PERSONAL ROLES AND RESPONSIBILITIES DEFINITIONS CONTRACTOR SAFETY MANAGER (CSM) REQUIREMENTS SUBCONTRACTOR SAFETY MANAGER (SSM) REQUIREMENTS CONTRACTOR AND SUBCONTRACTOR SAFETY MANAGER (CSM/SSM) QUALIFICATIONS CONTRACTOR AND SUBCONTRACTOR SAFTY REPRESENTATIVES (CSR/SSR) REQUIREMENTS CONTRACTOR AND SUBCONTRACTOR SAFTY REPRESENTATIVES (CSM/SSM) QUALIFICATIONS CONTRACTOR S SAFETY MANAGER / REPRESENTATIVE RESPONSIBILITIES CONTRACTOR S OVERALL RESPONSIBILITIES SITE-SPECIFIC SAFETY PROGRAM (SSSP) PROJECT SAFETY COMMITTEE PROJECT PLANNING AND PROJECT MEETINGS JOB SAFETY ANALYSIS CONTRACT PROGRESS MEETINGS INCIDENT REVIEW MEETINGS PRE-SHIFT CREW MEETINGS (PRODUCTION and SAFETY) UCIP SAFETY RESPONSIBILITIES REPORTS AND FORMS CONTRACTOR/SUBCONTRACTOR SAFETY NON-COMPLIANCE SUBSTANCE ABUSE PREVENTION POLICY RETURN TO WORK PROGRAM III. FORMS, REPORTS AND DISTRIBUTION INSTRUCTIONS Loss Control Survey Form (SAF-1) Environmental Health & Safety Investigation Report (SAF-3) Near-Miss Incident Report (SAF-4) Monthly Non-Compliance Item Summary (SAF-10) IV. CONTRACTOR SAFETY STANDARDS AIR TESTING EQUIPMENT ASBESTOS Rev. 2 Page 2 of 109

56 BARRICADES Fencing BURNING, WELDING AND HOT WORK Hot Work CLOTHING / PROFESSIONAL DEMEANOR Clothing Shoes Professional Demeanor COMPRESSED GAS CYLINDERS, GAS CUTTING AND WELDING CONCRETE AND MASONRY CONSTRUCTION Concrete Construction Cutting, Grinding and Profiling CONFINED SPACE ENTRY CONNECTIONS TO UTILITIES CRANES, BOOM TRUCKS AND RIGGING Rigging, Slings and Hooks CRITICAL LIFTS (CRANES, BOOM TRUCKS, DERRICKS, ETC.) DEMOLITION ELECTRICAL ELEVATING WORK PLATFORMS AND AERIAL DEVICES Aerial Devices Elevating Work Platforms EMERGENCY ACTION / EVACUATION PLAN Contents Emergency Contact List ENVIRONMENTAL CONTROLS EQUIPMENT/TOOLS EXCAVATIONS FALL PROTECTION Training and Retraining Methods of Fall Protection Positioning Device Systems Personal Fall Restraint FIRE PROTECTION AND PREVENTION FIRST AID FLAMMABLES AND COMBUSTIBLES FORKLIFTS (INDUSTRIAL TRUCKS AND TRACTORS) HAZARD COMMUNICATION HEATERS, PORTABLE HEAVY EQUIPMENT/MATERIAL HANDLING AND EARTHMOVING EQUIPMENT HORIZONTAL BORING / PIPE JACKING HOUSEKEEPING LADDERS Extension Ladders Step Ladders LEAD LIQUIDS - CORROSIVE ACIDS AND CAUSTICS LOCKOUT - TAGOUT / CONTROL OF HAZARDOUS ENERGY LOCATING UNDERGROUND UTILITIES BEFORE EXCAVATING MOTOR VEHICLES ORIENTATION OVERHEAD UTILITIES PERMITS PERSONAL PROTECTIVE EQUIPMENT Rev. 2 Page 3 of 109

57 POSTING REQUIREMENTS POWDER-ACTUATED TOOLS PUBLIC PROTECTION PLAN Considerations Components SANITATION SCAFFOLDS STEEL ERECTION TAR AND MELTING POTS WARNING SIGNS WORK ZONE TRAFFIC CONTROL Flagging Operations Plate Bridging V. APPENDICES A. Advance Planning Suggestions for Construction Work B. Personal Fall Arrest System Guidelines C. Sample Pre-Planning Matrix D. Activity Hazard Analysis ( AHA ) E. Severe Weather Guidelines F. Model Contractor/Subcontractor Safety Plan (CSSP) G. Risk Mitigation Three-Week Look-Ahead Form H. Root Cause Analysis Chart I. Incident Investigation Data Form Rev. 2 Page 4 of 109

58 I. INTRODUCTION AND BASIC ELEMENTS SAFETY PHILOSOPHY (UC) is dedicated to the principle that a safe project is a successful and profitable project for all of our Construction Programs and our Contractors. We are committed to the safety of our project workers, the surrounding community, and the environment. Safety is viewed as an integral component of the construction process, the other key components being production and quality. However, safety is a primary component of the success of this project. The Contractor shall be responsible for initiating, maintaining, supervising, and enforcing all safety precautions and programs in connection with the performance of the contract. Their employees and their subcontractors share in that responsibility as well. All project workers are expected to work safely and to contribute to the safety of others. In fact, this is an important condition of employment for everyone working on any UC project governed by the (UCIP). Incident prevention contributes to the Contractor s well being by avoiding injury or illness to the Contractor and its Subcontractor s employees, improving productivity, contributing to quality, and reducing costs. The community also benefits directly from incident prevention efforts when potential damage to the environment or members of the community is effectively managed. To say that all incidents can be prevented is a realistic goal, not just a theoretical objective. It is achievable, in part by eliminating sources of hazards and unsafe acts, and also by incorporating measures such as safety representative controls, project leadership accountability, proper training, safe operating procedures and personal protective equipment to meet this goal. In order for all UC UCIP Construction Program Employers to understand this Safety Philosophy and to meet its expectations, both general and specific training is required. That training is the responsibility of every level of supervision for each employer. Safety training and the prevention of incidents are logical and appropriate parts of how we expect the operations of each Contractor and Subcontractor to be conducted. PROGRAM OBJECTIVES The construction safety standards ( Safety Standards ) contained in this Manual have been designed to establish the minimum standards for which the Contractor s and each Employer s Site-Specific Safety Program must meet or exceed. The Safety Standards contained in this document were developed as minimum guidelines to assist the Employer in the elimination or reduction of hazards and risk associated with the construction project. These minimum guidelines also assist the Employer s efforts to prevent incidents, ensure the safety of the general public, reduce worker injuries, prevent damage to property, promote efficiency, and effect savings by reduction of unplanned business interruption. The University, its authorized representatives, and the UCIP Administrator will neither assume nor relieve any Employer of their direct responsibility for the safety and health of their Employees, the protection of visitors and the public, or the protection of equipment and property. The University, through its UCIP Administrator and Safety Staff, will actively participate in making these Safety Standards effective by monitoring the efforts of the Contractor and Subcontractors in their performing the following tasks: Rev. 2 Page 5 of 109

59 1. Providing a safe and healthy environment for site Employees during construction. Examples of this task include: 1.1. New hire safety orientations Toolbox/tailgate safety meetings Safety training, i.e., hazard communication, trenching shoring, confined space, lockout/tagout, respiratory protection and respirator fit testing, etc Mandatory personal protective equipment (PPE) programs Injury reporting and record keeping maintaining up-to-date incident experience and trend analysis Using Incident investigation information to correct deficiencies and eliminate additional losses Implementing appropriate and effective Safety Management Systems 2. Using safety planning, such as Job Safety Analysis and Pre-Planning, as a tool to eliminate workplace injuries and property damage. 3. Conducting safety audits/inspections to identify, prioritize, and correct non-compliance conditions. 4. Protecting public and private property adjacent to all construction site work zones. 5. Informing the Authorized Representative and UCIP Safety Staff of any visit from a regulatory agency such as OSHA, EPA or SCAQMD. 6. Educating and training Employees by implementing their respective safety programs. PROJECT EXECUTIVE SAFETY OVERSIGHT COMMITTEE An Executive Safety Oversight Committee to oversee and monitor project safety at an executive level for all projects wrapped into the UCIP will be developed as needed. This committee will, at a minimum, be comprised of executive representatives from UC Risk Management, University Safety, the Construction Managers, the Authorized Representative(s), UCIP Safety and the Contractors. Others may be added to this Committee or requested to attend meetings of this Committee at the discretion of the Committee leadership. CONFLICT BETWEEN CODES AND SAFETY STANDARDS 1. In the case of conflict between codes, Safety Standards, reference standards, drawings and other Contract Documents, the most stringent requirements shall govern. 2. Conflicts shall be brought to the attention of the Authorized Representative. UC reserves the right to issue a final determination for conflicts. 3. The Contractor shall bid for the most stringent requirements. Rev. 2 Page 6 of 109

60 DEFINITIONS The following titles and acronyms may not reflect the actual titles and acronyms in use by all entities on this project and do not have any force or effect beyond their use in the Safety Standards. Due to such differences in nomenclature among Owners and Contractors, the following are used throughout the UCIP Safety Standards Manual to establish the functional framework for the UCIP Safety Program. Aon Risk Services (ARS). The party responsible for brokering and administering the UCIP Insurance Program and developing and monitoring compliance with the Safety Standards. Authorized Person. (In reference to an employee's assignment) Selected by the employer for that purpose. Competent Person. One who is capable of identifying existing and predictable hazards in the surroundings or working conditions which are unsanitary, hazardous, or dangerous to employees, and who has authorization to take prompt corrective measures to eliminate them. Contractor. The term Contractor means the person or firm identified as the Contractor, CM/Contractor, Design Builder, or Prime Trade Contractor in the Agreement, and is referred to throughout the Contract Documents as if singular in number. Contractor s Project Manager (CPM). The senior on-site management person for the Contractor with responsibility for execution of the contract, including compliance with the Safety Standards. In some cases, the actual on-site representative may be a Superintendent or a Foreman. In such cases, this is the applicable person when the CPM is referenced. The CPM is responsible for the ongoing implementation and enforcement of the Contractor s Site-Specific Safety Program. Contractor s Project Superintendent (CPS). The senior on-site Superintendent for the Contractor with responsibility for execution of the contract, including compliance with the Safety Standards. In some cases, the actual on-site representative may be an Assistant Superintendent or a Foreman. In such cases, this is the applicable person when the CPS is referenced. The CPS is responsible for and accountable for the ongoing implementation and enforcement of the Contractor s Site-Specific Safety Program. Contractor s Safety Manager (CSM). Contractor Employee dedicated to the responsibility of implementing the Contractor s Safety Program and/or Injury and Illness Prevention Program, including ongoing identification and correction of hazards. Contractor s Safety Representative (CSR). Contractor Employee assigned the responsibility of implementing the Contractor s Safety program and/or Injury and Illness Prevention Program, including ongoing identification and correction of hazards. Employee. Person employed by an Employer as defined by this section. Employer. Firm or entity that has Employees working on site and is enrolled in the UCIP program. The term Employer includes the Contractor and Subcontractors of all tiers. For the purposes of the Safety Standards, vendors, suppliers, and service providers on the project for the furtherance of the project are covered by this definition and are subject to the provisions of the Safety Standards even though they are not covered by the UCIP. OSHA. OSHA as used in the context of these Safety Standards refers to the State or Federal agency with jurisdiction over workplace occupational safety and health at the project site. Owner. University of California Owner s Authorized Representative. The Owner s Employee or agent with overall responsibility for the project and/or UCIP. Qualified Person, Attendant or Operator. A person designated by the employer who by possession of a recognized degree, certificate, or professional standing, or who, by extensive knowledge, training and experience, has successfully demonstrated his/her ability to solve or resolve problems relating to the subject matter, the work, or the project. Rev. 2 Page 7 of 109

61 Site-Specific Safety Program (SSSP). The Employer s Site-Specific Safety Program prepared in accordance with the requirements of this document and the Contract. Subcontractor. Firm or other entity awarded work by a Contractor on a particular construction project. Subcontractor as used herein shall apply to all tiers of Subcontractors, as well as vendors and service providers performing work for the benefit of the Contractor. For the purposes of the Safety Standards, vendors, suppliers, and service providers on the project for the furtherance of the project are covered by this definition and are subject to the provisions of the Safety Standards even though they may not be enrolled in the UCIP. Subcontractor s Project Manager (SPM). The senior on-site management person for the Subcontractor with responsibility for execution of the contract, including compliance with the Safety Standards. In some cases, the actual on-site representative may be a Superintendent or a Foreman. In such cases, this is the applicable person when the SPM is referenced. The SPM is responsible for and accountable for the ongoing implementation and enforcement of the Subcontractor s Site-Specific Safety Program. Subcontractor s Project Superintendent (SPS). The senior on-site management person for the Subcontractor with responsibility for execution of the contract, including compliance with the Safety Standards. In some cases, the actual on-site representative may be an Assistant Superintendent or a Foreman. In such cases, this is the applicable person when the SPS is referenced. The SPS is responsible for and accountable for the ongoing implementation and enforcement of the Subcontractor s Site-Specific Safety Program. Subcontractor Safety Representative (SSR). Subcontractor Employee assigned the responsibility of implementing the Contractor s Injury and Illness Prevention Program, including ongoing identification and correction of hazards. UCIP Safety. Aon, Insurance Carrier, or University Risk Management representative(s) responsible for monitoring, evaluating and coordinating the Contractor s safety, health, and environmental compliance. University Controlled Insurance Program (UCIP). Owner s (UC) wrap-up insurance program which provides insurance coverage for eligible and enrolled owner s representatives, Contractors, and Subcontractors of any tier, working on the UC UCIP project sites. The Owner identifies program participants. Rev. 2 Page 8 of 109

62 ACRONYMS Following is a list of acronyms used in this document. ACM Asbestos Containing Material AHA Activity Hazard Analysis ANSI American National Standards Institute ARS Aon Risk Services CDL Commercial Drivers License CPM Contractor s Project Manager CPR Cardio Pulmonary Resuscitation CPS Contractor s Project Superintendent CSM Contractor s Safety Manager CSR Contractor s Safety Representative EPA Environmental Protection Agency GVW Gross Vehicle Weight HEPA High Efficiency Particulate Air JHA Job Hazard Analysis LBP Lead Based Paint LEL Lower Explosive Limit MSDS Material Safety Data Sheet MUTCD Manual on Uniform Traffic Control Devices NFPA National Fire Protection Association NOTAM Notice to Airmen OCIP Owner-Controlled Insurance Program OSHA Cal/OSHA and/or Federal OSHA (refer to context) PACM Presumed Asbestos Containing Material PPE Personal Protective Equipment SPM Subcontractor s Project Manager SPS Subcontractor s Project Superintendent SSR Subcontractor s Safety Representative SSSP Site-Specific Safety Program UL Underwriters Laboratories UCIP University-Controlled Insurance program USDOT United States Department of Transportation WATCH Work Area Traffic Control Handbook Rev. 2 Page 9 of 109

63 GENERAL EMERGENCY PROCEDURES: JOB SITE EMERGENCIES (FIRE, INCIDENTS, & MEDICAL EMERGENCIES 1. All job site emergencies must be reported immediately to the Contractor (if applicable), Authorized Representative and UCIP Safety. 2. Job Site Emergency Telephone Numbers shall be posted on the job site bulletin board. 3. A local street map clearly identifying the project and active entrances shall be maintained and posted on the job site bulletin board by the Emergency Telephone Numbers. 4. A sufficient number of Employees shall be trained in First Aid and CPR to provide for adequate coverage of the project. 5. In the event that there are no hard-wire ( land line ) telephones available at the project site, the Employer shall identify and post an alternate number (in addition to 911) to be used to contact emergency service providers via cell phone. This is necessary, as dialing 911 on a cell phone does not always provide a direct connection to local Emergency Services. FIRE 1. Call 911 or the Local Fire Department/Agency 1.1. At minimum, provide the building, floor and area of the incident. 2. In case of fire in any building: 2.1. Evacuate the immediate area, and 2.2. Activate the fire alarm system (if available), and 2.3. Call the Fire Department. 3. For fire outside of buildings: 3.1. Evacuate the immediate area, and 3.2. Call the Fire Department. 4. Call the Authorized Representative and UCIP Safety. MEDICAL EMERGENCY 1. Call 911 or the local Emergency Medical Services. 2. Call or report the job site emergency immediately to the Contractor. 3. Render first aid promptly to the injured Employee. 4. The preferred provider for serious traumatic injuries is: Consult the Job Site Posting Notice 5. The designated provider for non-life threatening or minor injuries requiring medical treatment is: Consult the Job Site Posting Notice 6. Call the Authorized Representative and UCIP Safety. Rev. 2 Page 10 of 109

64 PROJECT CONDUCT AND SITE SECURITY INFORMATION EMPLOYEE CONDUCT 1. All project workers must maintain professional behavior at all times. Horseplay, fighting, sexual harassment, possession or use of alcohol and/or unauthorized drugs, possession of firearms, gambling, unsafe conduct, and destructive or abusive behavior are not allowed and will result in disciplinary action, up to and including immediate removal of the worker and/or the worker(s) from the site. NEWS MEDIA AND CONTRACTOR CONDUCT 1. Employers and their employees shall refer questions from news media personnel (radio, television, newspaper) to the Authorized Representative. 2. Project accidents/incidents resulting in news media coverage (radio, television, newspaper) shall be immediately reported to the Authorized Representative. CONSTRUCTION VEHICLE PARKING 1. Park in authorized areas only. Do not block or obstruct intersections, fire lanes and fire hydrants, traffic lanes, driveways or parking lot entrances. Offending vehicles may be towed without notice at the vehicle owner s expense. 2. Private vehicles are not permitted on the project except in authorized and designated parking areas. IDENTIFICATION 1. Contractor and Subcontractor Employees shall obtain and wear at all times while on the project a valid UC-issued photo identification badge. 2. All Contractor Employee hard hats must display the Contractor s name and or logo. 3. Contractor equipment and vehicles entering and/or working at the site must have the company name/identification clearly displayed on the vehicle as required by the Special Conditions. ASSIGNED WORK AREA 1. Contractors and Subcontractors are confined to their assigned work areas. 2. Wandering throughout the site is strictly prohibited. Rev. 2 Page 11 of 109

65 II. RESPONSIBILITIES SAFETY RESPONSIBILITIES The Contractor shall be responsible for initiating, maintaining, supervising, and enforcing all safety precautions and programs in connection with the performance of the Contract for the on-site safety of their Employees and Subcontractors performing work for the benefit of this project. This includes responsibilities for vendors, delivery and transportation services, and service providers at the project location. Each Employer shall be responsible for initiating, maintaining, supervising, and enforcing all safety precautions and programs in connection with the performance of the contract for the safety of its Employees, its Subcontractors, the public, and the work site in general. The Employer shall comply with all applicable provisions of Federal, State, and local laws, ordinances, codes and regulations affecting safety and health, including but not limited to the OSHA Act, and OSHA Standards. Each Contractor and Subcontractor shall comply with the most stringent of the following: 1. Applicable State OSHA Standards and Safety Orders or Federal OSHA Standards (Code of Federal Regulations, Title 29), 2. The Contractor s Site-Specific Safety Program, 3. Applicable consensus standards, including ANSI, NFPA, etc., 4. The Safety Standards contained in this Manual. The Contractor must have full-time safety coverage for all construction activities associated with the UCIP project at any time the project has a total of more than 100 field workers ony particular project. SUBCONTRACTOR SAFETY RESPONSIBILITIES Subcontractors are responsible for initiating, maintaining, supervising and enforcing the safety requirements outlined by Safety Standards and the Contractor s Site-Specific Safety Program, even though the requirements may be above and beyond the Subcontractor s own safety policies and federal and state OSHA requirements. PROJECT SAFETY PERSONAL ROLES AND RESPONSIBILITIES DEFINITIONS Alternate Contractor Safety Manager (ACSM): Individual meeting the same requirements of the CSM that assumes the role of the CSM on a temporary basis. Alternate Contractor Safety Representative (ACSR): Individual meeting the same requirements of the CSR that assumes the role of the CSR on a temporary basis. Alternate Subcontractor Safety Manager (ASSM): Individual meeting the same requirements of the SSM that assumes the role of the SSM on a temporary basis. Rev. 2 Page 12 of 109

66 Contractor Safety Manager (CSM): Each Contractor shall have a CSM assigned to the project full time to carry out the duties described in this document. Notwithstanding the preceding sentence, a CSM is not required for projects with less than 100 field workers on site for each and every day of field work. Contractor Safety Representative (CSR): Contractor Employee assigned safety responsibilities for shift work and distinct work locations as required. The CSR reports to the CSM. Additional SSR personnel shall cover shift work and distinct work locations as required. The Contractor can delegate the CSR duties to an on-site Field Supervisor. CSR responsibilities cannot be delegated to an office or staff Employee. Subcontractor Safety Manager (SSM): Each Subcontractor shall have an SSM assigned to the project full time. The SSM has the same responsibilities for safety for the Subcontractors that the CSM has for the Contractor. The SSM must be available on-site during the period of any subcontractor construction activities. Notwithstanding the preceding sentences, an SSM is not required for projects with less than 100 field workers working for or under the Subcontractor on site for each and every day of field work. Subcontractor Safety Representative (SSR): Contractor Employee assigned safety responsibilities for shift work and distinct work locations as required. Each subcontractor must have a designated SSR for the project at all time when subcontractor construction work is being performed. Additional SSR personnel shall cover shift work and distinct work locations as required. The Subcontractor can delegate the SSR duties to an on-site Field Supervisor. SSR responsibilities cannot be delegated to an office or staff Employee. CONTRACTOR SAFETY MANAGER (CSM) REQUIREMENTS 1. The CSM shall be identified in writing to the UC Authorized Representative prior to the commencement of work. 2. The Contractor shall submit the resume of the CSM candidate to the UC Authorized Representative and OCIP Safety for review, prior to the start of on-site work. 3. UC reserves the right to direct the removal and replacement of the CSM and/or SSM if necessary. 4. A CSM shall be present at all times when work is taking place If the Contractor has multiple distinct work locations within the scope of the OCIP, each location shall have a CSM or CSR present when work is taking place. 5. An Alternate Contractor Safety Manager (ACSM) or Contractor Safety Representative (CSR) meeting the same qualifications as the CSM shall be present when the CSM is not present at the project. The ACSM shall hold the same responsibilities as the CSM. ACSM duties may be assumed by a similarly qualified project Supervisor The Contractor shall notify UC Authorized Representative in writing when the CSM will not be present on the project. This notification shall include the name of the ACSM. 6. The Contractor shall maintain a list of all Subcontractor Safety Managers and all Contractor and Subcontractor Safety Representatives. This list shall be available for review upon request. 7. The Contractor will be required to maintain a list of all competent persons for technical aspects for regulatory compliance. Rev. 2 Page 13 of 109

67 SUBCONTRACTOR SAFETY MANAGER (SSM) REQUIREMENTS 1. A Subcontractor will have an approved SSM when subcontractor workforce is 50 or more subcontractor workers. 2. The SSM shall be identified in writing to the Contractor before their workforce is expected to be at or above 50 workers under their contract. 3. The subcontractor shall submit the resume of the SSM candidate to the Contractor Safety Manager for approval before their workforce is 50 or more workers under their contract. 4. The Contractor and UC reserve the right to direct the removal and replacement of the SSM if necessary. 5. A SSM shall be present at all times when work is taking place when 50 or more workers are engaged in construction activities. 6. An Alternate Subcontractor Safety Manager (ASSM) meeting the same qualifications as the SSM shall be present when the SSM is not present at the project. The ASSM shall hold the same responsibilities as the SSM. ASSM duties may be assumed by a similarly qualified project Supervisor. 7. The Subcontractor shall notify the Contractor in writing when the SSM will not be present on the project. This notification shall include the name of the ASSM. CONTRACTOR AND SUBCONTRACTOR SAFETY MANAGER (CSM/SSM) QUALIFICATIONS 1. The CSM and SSM shall have a minimum of three (3) to five (5) years of qualified project safety experience on large, similar type construction projects that is representative of the planned construction activities. 2. Evidence of completing either the OSHA 10 or 30 Hour Construction Outreach Training within the last three years. 3. Current First Aid and CPR training from a provider recognized by OSHA. 4. Ability to stop work in the event of workplace hazards until corrective actions have been implemented. 5. Understanding of the applicable Federal and Cal-OSHA regulations. 6. Capable of conducting detail incident investigations. 7. Communicate effectively with the field staff and project leadership on relevant safety issues. CONTRACTOR AND SUBCONTRACTOR SAFTY REPRESENTATIVES (CSR/SSR) REQUIREMENTS 1. Each Subcontractor must have a designated Subcontractor Safety Representative (SSR) who is assigned the responsibilities for managing all safety aspects associated with their subcontractor. 2. Contractors are required to have a qualified Contractor Safety Representatives (CSR) to assure adequate coverage on distinct and isolated work locations. Rev. 2 Page 14 of 109

68 3. The CSR and SSRs must be approved by the Contractor Safety Manager based on their experience and qualification to administer and manage safety programs. 4. CSR and CSR will be accountable to the Contractor Safety Manager for all safety-related issues. 5. The Contractor and UC reserve the right to direct the removal and replacement of a CSR or SSR if necessary. 6. Safety Representatives will be required to implement their employer s Injury and Illness Prevention Program (IIPP) and the Contractors Site-Specific Safety Plan for the project. 7. A CSM or CSR and, at a minimum, a SSR shall be present at all times when work is taking place. 8. All CSRs and CSRs will be required to participate as a member of the Project Safety Committee. CONTRACTOR AND SUBCONTRACTOR SAFTY REPRESENTATIVES (CSM/SSM) QUALIFICATIONS 1. The CSM and SSM shall have a minimum of three (5) years of construction experience with representative safety experience (primary project duty) for the trade and type of work being performed. 2. Evidence of completing either the OSHA 10 or 30 Hour Construction Outreach Training within the last three years. 3. Current First Aid and CPR training from a provider recognized by OSHA. 4. Ability to communicate in some manner, in all representative languages, with the filed crews. 5. Be able to effectively conduct weekly tailgate training sessions. 6. Capable of stopping work in the event of workplace hazards until corrective actions have been implemented. CONTRACTOR S SAFETY MANAGER / REPRESENTATIVE RESPONSIBILITIES 1. Specific responsibilities of the Contractor s Safety Manager / Representative must include, but are not limited to, completing or overseeing the completion of the following by their Employer and all Subcontractors For Subcontractors, these are the responsibilities of the Subcontractor Safety Representative. RESPONSIBILITIES: 1. Assure project-specific safety orientation sessions are conducted for workers who are new to the site, prior to their beginning work. 2. Conduct, participate in, or assist Field Supervisors with weekly toolbox safety meetings. 3. Conduct weekly supervisory and management safety meetings. 4. Instruct and inform supervisors and management on safety rules and regulations. 5. Instruct supervisors and Employees in the proper use and care of personal protective equipment (PPE). Rev. 2 Page 15 of 109

69 6. Instruct supervisors and Employees concerning special procedures (e.g. confined space entry, trench shoring, lockout/tagout, etc.) 7. Complete incident investigation reports in accordance with the Insurance Manual and Safety Standards. Records are to be maintained at the site, and distributed as described in these Safety Standards. 8. Conduct and document weekly (at minimum) project safety inspections. Documentation shall be created and maintained for corrective action taken to correct deficiencies identified during inspections. Records of inspections and corrections are to be maintained at the site Forward copies of inspection and corrective action records to the Authorized Representative and UCIP Safety. 9. Maintain training documentation. Records are to be maintained at the site available for review upon request. 10. Implement site-specific safety policies and procedures. 11. Demonstrate, by example, proper safety behavior. 12. Ensure that required first aid supplies are adequate. 13. Coordinate transportation of Employees with minor injuries to the designated Medical Clinic 14. Inform the CSM/CSR (where applicable), Authorized Representative and UCIP Safety informed of any safety related problems that have or may develop. 15. Maintain records in accordance with OSHA Recordkeeping requirements The OSHA 300 Log for the Contractor is to be available for review upon request by the Authorized Representative or UCIP Safety. 16. Review Loss Control Survey forms received from UCIP Safety that identifies safety non-compliance items Disseminate the Loss Control Survey forms to Subcontractors if necessary Ensure corrective action is taken Return the completed Loss Control Corrective Action (SAF-2) form within 48 hours to UCIP Safety and others as required on this project. Forms will be presented at the Pre- Construction Meeting. CONTRACTOR S OVERALL RESPONSIBILITIES 1. The Contractor shall be responsible for initiating, maintaining, supervising and enforcing all safety precautions and programs in connection with the performance of the contract for the on-site safety of his/her Employees and Subcontractors performing work for the benefit of this project. This includes responsibilities for vendors, delivery and transportation services, and service providers at the project location. 2. Each Contractor shall have at least one copy of all applicable OSHA regulations available for use and reference at the job site. 3. The Contractor shall design and executive all worker orientation training after they have been issued a UC badge and cleared from the Substance Abuse Prevention Program. 4. The Contractor shall assure all employers are compliant with the Substance Abuse Prevention Program and that an that the Return-to-Work provisions and guidelines are appropriately followed. SITE-SPECIFIC SAFETY PROGRAM (SSSP) Rev. 2 Page 16 of 109

70 5. Each Employer shall have an effective and written Site-Specific Safety Program in accordance with OSHA and the UC UCIP requirements. This Site-Specific Safety Program shall also include, but not be limited to, the following site-specific components as they apply to the Employer s work: 5.1. Safety and Health Policy Statement 5.2. Assignment of accountability and responsibilities for key personnel responsible for implementation of the Safety Program 5.3. Identification of Competent Persons and Qualified Persons 5.4. Scope of Work Evaluation 5.5. Hazard/Risk/Exposure Assessment 5.6. Control Measures / Activity Hazard Analysis 5.7. Three Week Look Ahead Planning 5.8. Procedures for effectively communicating safety and health matters to Employees 5.9. Safety Incentive Program / Safety Recognition Program Progressive Disciplinary Action Program Workplace Hazard Identification Inspection and Corrective Action Program Safety Training Program (including provisions for Supervisory and Craft Employee training) Project-specific Employee Safety Orientation Program Provisions for maintaining orientation, training, inspection, corrective action and investigation records Hazard Communication Program To include Material Safety Data Sheets for all products at the site Job Safety Analysis (Job Hazard Analysis) Program Emergency Response and Evacuation Plan Fire Prevention Program Hot Work Program Drug Free Workplace / Substance Abuse Prevention Program Incident Investigation Program Near Miss Incident Investigation Program Fall Prevention Program Training and rescue shall be addressed in the Fall Protection Program Scaffold Safety Scaffold Inspection, Scaffold Erector Training, and Scaffold User Training shall be addressed in the Scaffold Safety Program Confined Space Entry Program Lockout/Tagout / Control of Hazardous Energy Program Excavation Safety Program Site Logistics Plan Other written programs required by this and other contract documents or regulatory agencies List of Attachments 6. The Contractor shall submit to the Authorized Representative within 30 days of contract award an electronic copy of the Contractor s Site-Specific Safety Program ( Program ) for review The Program will be reviewed for inclusion of the requirements of the UCIP Safety Standards and applicable sections of the Project Specifications. Rev. 2 Page 17 of 109

71 6.2. The approval of the Program will be based solely on the content of the Program relative to conformance with the UCIP Safety Standards and Project Specifications. Receipt of program does not constitute approval Failure to attain approval of the Program prior to the scheduled commencement of contract work is not grounds for a time extension Upon approval of the Program for conformance to said requirements, the Contractor shall submit two copies of the Program signed by the Contractor s Owner or CEO to the Authorized Representative. 7. The Contractor scope shall include these UCIP Safety Standards. This shall include all services required for the complete performance of the contract work in accordance with the requirements of the UCIP Safety Standards. 8. All Contractor and Subcontractor Site Managers, Field Superintendents and Dedicated Safety Personnel shall complete an OSHA 10-Hour Construction Outreach Training Program or have Training and certification in the OSHA 500 Construction Outreach 10/30 hour Programs within the past 3 yrs prior to mobilization. Applicable personnel assigned to the project after mobilization shall complete this training within 30 days of assignment. 9. All Contractor and Subcontractor Employees shall receive a project site safety orientation that at minimum reviews the Project Safety Rules and regulations, and applicable Emergency and Evacuation Plans prior to their start of work Vendors and visitors shall be provided with an orientation that is appropriate for their exposures during their time on site The Contractor is to provide this orientation. 10. The Contractor shall conduct monthly (at minimum) Project Safety Meetings with their Subcontractors to properly coordinate the work within the trades and resolve matters related to safety and health and project work. Minutes shall be kept of each meeting, including topics covered and attendees, and made available to the Authorized Representative or UCIP Safety upon request The Owner reserves the right to request additional Project Safety Meetings be conducted by the Contractor when requested by the Authorized Representative or UCIP Safety to address specific areas of concern. 11. The Employer shall conduct toolbox safety meetings with their Employees at least once a calendar week. Minutes of these toolbox meetings are to be prepared and maintained by the Contractor, and available for review by the Authorized Representative or UCIP Safety, upon request Meeting minutes shall contain the following: Employee names in a legible format Identifier for each Employee Employer name Date of meeting Description of meeting topics Name(s) of person(s) conducting the meeting Rev. 2 Page 18 of 109

72 12. The Contractor and Employer shall ensure that all personnel are properly trained and instructed for all jobs that require specific training and/or competency to meet all applicable OSHA regulations, state and federal law, and the requirements herein. 13. Each Contractor and Subcontractor (via the Contractor) shall submit to the Authorized Representative a list of (a) Competent Persons and Qualified Persons as applicable to the Employer s scope of work, and (b) First Aid / CPR trained personnel prior to starting work Each list shall be clearly dated, and updated as required throughout the contract period. Each time the list is updated, a copy shall be provided to the Authorized Representative. 14. Each Employer is responsible for handling, on a daily basis, rubbish and debris generated by its work. The contractor must keep the work place clean. 15. The Contractor is responsible for ensuring that corrective action is taken when Loss Control Survey forms are issued to the Contractor. 16. The Loss Control Corrective Action form must be completed by the Contractor and returned within 48 hours of receipt to UCIP Safety and others as required by these Safety Standards. Copies of these forms will be provided separately at the Pre Construction Meeting. 17. The Contractor will cooperate in inspections by OSHA and other regulatory agencies. 18. The cited Employer(s) shall submit copies of all regulatory agency citation notices to the Contractor (if applicable), Authorized Representative and UCIP Safety immediately upon receipt The Contractor shall ensure that the cited Employer posts copies of all citations as required by OSHA or the applicable regulatory agency. PROJECT SAFETY COMMITTEE 1. The Contractor s Project Manager shall serve as the Chair for the Project Safety Committee. 2. At minimum, the Committee shall include the CSM, CSR, and the SSR of each first-tier Subcontractor, the Construction Manager, UC Safety and UCIP Safety. 3. The Committee shall meet no less than once per calendar quarter, or as needed. PROJECT PLANNING AND PROJECT MEETINGS 1. Safety and loss control activities are key elements in the success of this project. 2. Safety and loss control activities are to be integrated into the work plan such that safety is an integral component of the construction process, rather than treated as a separate activity. 3. There are five main elements to the planning and meeting component of the UCIP Safety Standards Project Survey: Prior to the start of work, the Contractor shall conduct a physical survey of the job site. The Contractor shall also review the plans and specifications Construction Process Plan: From the Project Survey, the Contractor shall develop a written Construction Process Plan. The Construction Process Plan shall identify tasks and activities under four main categories: Rev. 2 Page 19 of 109

73 Construction sequence and procedures Temporary Structures / Shoring / Reshoring / Bracing / Retention Systems required Critical Structures or Processes Description of required tests and approvals 3.3. Job Hazard Analysis: Job Hazard Analysis (JHAs) needs may be pre-determined in part by reviewing the Construction Process Plan and Construction Schedule. The JHA should be prepared far enough in advance of the task or activity to ensure that changes or revisions will not affect the scheduled execution of the task or activity. JHA s are further discussed later in this section Contract Progress Meetings: These meetings are typically held on a weekly or bi-weekly basis, and are typically chaired by the Authorized Representative. A sample minimum Safety and Loss Control Agenda is included in this section The Contractor shall prepare a Risk Mitigation Three-Week Look-Ahead Schedule (form found as Appendix G) and submit same for review prior to each Contract Progress Meeting Pre-Phase Planning Meetings: Pre-phase meeting needs may be identified from the Construction Process Plan. A sample Pre-Planning Matrix is provided in the Appendices The Contractor shall schedule the Pre-Phase Planning Meeting far enough in advance of the start of the relevant phase to ensure that changes or revisions to JHA s and coordination efforts will not affect the scheduled execution of the relevant phase of work The Pre-Phase Meeting shall include the Authorized Representative and UCIP Safety, as well as all Contractors and Subcontractors involved in that phase of work. This meeting shall identify and address the safety and coordination issues of the relevant phase of work Pre-Phase Hazard Analysis shall be prepared using the JHA form (or an acceptable equivalent); specific JHAs are to be prepared using the Pre-Phase Hazard Analysis as a guide Subsequent meetings may be required throughout the phase of work to maintain safety and coordination efforts. JOB SAFETY ANALYSIS 1. A Job Hazard Analysis (JHA) is to be developed by the Employer (or Employers) for any significant activity identified by the employer, contractor, program management, UCIP safety team and/or the Project Safety Committee. Each crew shall review the JHA(s) applicable to their tasks to be conducted during their work shift prior to the start of each shift The JHA is a task/operation driven document to ensure that the job task or operation receives proper safety planning prior to beginning work. In actuality, the JHA is a written work plan that incorporates safety procedures into the work procedure. Refer to Section 2 for a list that describes some of the operations and tasks that will require a JHA. 2. JHA s are to be completed by a supervisor familiar with the task to be performed When specific tasks require a JHA, the CSM/CSR/SSR shall facilitate the JHA process and document review of the JHA with the supervisor(s) in advance of the work shift. Rev. 2 Page 20 of 109

74 3. To conduct a JHA utilizing the JHA form contained in Section 2 of these standards, follow these basic steps: 4. Select the job to be analyzed. Use the following factors as a guide in selecting jobs to be analyzed, remembering that those with the worst incident experience shall be evaluated first Frequency of incidents 4.2. Disabling injuries Potential for severe injury New operations/jobs. 5. Break the job down into successive steps. (Avoid making the breakdown too detailed or too general) 5.1. Select an experienced and cooperative Employee to perform the job Explain the purpose of the analysis Observe the Employee as the job is performed Record each job step in the breakdown Review with the Employee and seek comments. 6. Identify the hazards and the potential incidents Is there a danger of striking again, being stuck by, or incurring other injurious contact with an object? 6.2. Can the work be caught in, between, or by objects? 6.3. Is there a potential slip, trip, or fall hazard? 6.4. Are there strain exposures from pushing, pulling, reaching, twisting or lifting? 6.5. Are there environmental hazards in the form of gases, vapors, fumes, mists, or dusts? 7. Develop ways to eliminate hazards and prevent potential incidents Find a new way to do the job Change the physical conditions that create hazards. CONTRACT PROGRESS MEETINGS Following is a suggested agenda for the Safety and Loss Control component of the Progress Meeting. This agenda may be modified to reflect project needs. 1) Contractor: a) Report of incidents involving the Contractor or its Subcontractors since the last progress meeting i) If the UCIP SAF-3 form has not been filed relevant to any incident discussed, it shall be distributed and discussed by the Contractor at this meeting. (1) Contractor discussion is to include corrective or preventative action taken to prevent a reoccurrence b) Report of injuries to Employees of the Contractor or its Subcontractors since the last meeting i) If the UCIP SAF-3 form has not been filed relevant to any incident discussed, it shall be distributed and discussed by the Contractor at this meeting (1) Contractor discussion is to include corrective or preventative action taken to prevent a reoccurrence ii) Contractor shall report on the work status of each injured Employee until said Employee returns to full duty c) Report of near-miss incidents involving the Contractor or its Subcontractors since the last meeting Rev. 2 Page 21 of 109

75 i) If the UCIP SAF-4 form has not been filed relevant to any incident discussed, it shall be distributed and discussed by the Contractor at this meeting (1) Contractor discussion is to include corrective or preventative action taken to prevent a reoccurrence d) Provide a description of work activities until the next meeting, including anticipated Employee and public safety concerns and non-routine tasks/activities i) Contractor is to report on pre-planning that has been done i.e. steps that will be taken to minimize these hazards. ii) Contractor is to be prepared to discuss pedestrian and vehicular traffic controls that will be employed. e) Provide a brief description of activities anticipated for the next three weeks to identify potential concerns in advance to facilitate pre-planning by all parties i) A Job Safety Analysis or Activity Hazard Analysis may be requested from the Contractor for future activities 2) UCIP Safety: a) Report of Non-Compliance Items identified on Loss Control Surveys that have not been responded to b) Report of Non-Compliance Items identified on Loss Control Surveys that have been responded to, but have not been corrected c) Report of Non-Compliance Items identified on Loss Control Surveys that are repeat items (i.e. the same item, or substantively similar item has been identified in the past, and has reoccurred) d) Report of incidents involving the Contractor or its Subcontractors since the last progress meeting e) Report of injuries involving the Contractor or its Subcontractors since the last progress meeting f) Report of Near-Miss Incidents involving the Contractor or its Subcontractors since the last progress meeting g) Report of any existing or emerging trends in the Contractor s safety performance h) Report of future activities that require pre-planning i) Pedestrian and vehicular traffic control ii) Job Safety Analysis 3) Owner / Authorized Representative: a) Reporting or discussion of any item(s) described herein. b) Any additional other topic(s)/item(s) not described herein. INCIDENT REVIEW MEETINGS 1. The Contractor s Safety Manager (CSM) shall adopt a practice of scheduling an Incident Review Meeting within 24 hours of the occurrence of an incident. 2. For the purposes of this section, Incident may be defined as any or all of the following: (As determined by owners authorized representatives.) 2.1. Near-Miss Incident 2.2. First-Aid Case 2.3. Recordable Injury 2.4. Lost-Time Injury 2.5. Vehicular Incident 2.6. General Liability / Third-Party Incident 2.7. Incident review as determined by owner s representative. 3. The intent and purpose of this meeting is to interactively and cooperatively identify causal factors that had, or may have had, a role in the incident, and to identify corrective action(s) and practice(s) to implement to avoid potential reoccurrence of the incident. It is NOT a faultfinding or blamefinding event. Rev. 2 Page 22 of 109

76 4. Attendees should include: 4.1. Authorized Representative 4.2. CPM 4.3. CPS 4.4. CSM / CSR 4.5. SSR (if applicable) 4.6. UCIP Safety 4.7. Contractor / Subcontractor (Assistant) Superintendent(s) accountable via functional structure of the project for the incident 4.8. Contractor / Subcontractor (General) Foreman / Foremen accountable via functional structure of the project for the incident 4.9. Craftperson(s) involved with the incident. (Optional) Rev. 2 Page 23 of 109

77 PRE-SHIFT CREW MEETINGS (PRODUCTION and SAFETY) 1. Each Contractor and Subcontractor crew shall conduct a pre-shift production and safety meeting at the start of each shift. 2. These meetings shall: 2.1. Review of production activities for the shift 2.2. Review of safety activities that are a component of the production activities 3. Such meetings are to generally be five (5) to ten (10) minutes long, and are, at minimum, to focus on the following: 3.1. Tasks for the shift Applicable Job Safety Analysis 3.2. Tools and equipment needed for those tasks 3.3. Materials needed for those tasks 3.4. Proper material handling techniques 3.5. Safe work procedures to perform those tasks 3.6. PPE needed to safety perform those tasks 3.7. Questions from the crew 4. These meetings shall be documented in the same manner as the weekly Safety Meeting. UCIP SAFETY RESPONSIBILITIES UCIP Safety is responsible for monitoring and evaluating the Contractor s safety, health, and environmental compliance. UCIP Safety reports these findings to the Authorized Representative and the Contractor for corrective action and enforcement actions. Responsibilities and duties of UCIP Safety may include, but are not limited to the following: 1. Compile, follow-up, and maintain safety performance statistics for the project Communicate above information to the Authorized Representative and other Owner personnel to ensure they are informed and involved in the safety program. 2. Keep apprised of new regulations and developments to assist in keeping the safety policies and procedures current and effective. 3. Conduct job site safety surveys of Contractors and Subcontractors activities to observe safety performance, make recommendations and document non-compliance items. 4. UCIP Safety will document non-compliance items, recommendations, and or comments on the Loss Control Survey form. UCIP Safety will submit copies of the completed Loss Control Survey forms to the Authorized Representative and Contractor. The Loss Control Corrective Action form will be submitted to the Contractor when a written response is required. 5. Review and communicate methods and procedures to the Contractor s Safety Representative and the Authorized Representative to foster the highest level of incident prevention performance possible. 6. Provide special consulting to the Owner, Authorized Representative, Contractor and Subcontractors regarding problems and challenges that may arise on the project. Rev. 2 Page 24 of 109

78 7. Conduct incident investigations if required If performed, such reports shall not relieve the Owner, Contractor, Employer, or Insurer of their obligation to perform their own investigation, or of any responsibility they have to complete and file notices, reports and forms in accordance with applicable regulatory requirements. 8. Review all Contractor incident investigation reports to ensure thorough investigations were conducted and controls instituted to prevent future incidents or incidents. REPORTS AND FORMS 1. The Contractor is responsible for ensuring that corrective action is taken when Loss Control Survey forms are issued to the Contractor. The Loss Control Corrective Action Form must be completed by the Contractor and returned to the Authorized Representative and UCIP Safety, within 48 hours of receipt. 2. Each Employer shall maintain copies of weekly toolbox safety meeting reports on site for review upon request by the Authorized Representative and/or UCIP Safety. 3. Each Employer shall maintain weekly project inspection reports and corresponding corrective action records on site for review upon request by the Authorized Representative and/or UCIP Safety. 4. Each Employer shall electronically submit to the Authorized Representative via the Contractor on a weekly basis a copy of: 4.1. Weekly safety meeting reports 4.2. Weekly inspection reports 4.3. Corrective action records (may be on the same form as the inspection reports). 5. The Contractor will furnish the Aon UCIP Administrator, UCIP Safety and Authorized Representative with a copy of the completed (SAF-3 and SAF-4) forms no later than 24 hours after knowledge of the incident or injury NOTE: The forms do not constitute notice to the Carrier, and do not replace the Employer s First Report of Injury that must be filed with the Project s Workers Compensation Insurance Carrier by the Employer of the injured/ill Employee. CONTRACTOR/SUBCONTRACTOR SAFETY NON-COMPLIANCE 1. UCIP Safety has the right to stop any work activity imminently dangerous to life or health until safety violations are corrected. 2. An initial violation by a Contractor s/subcontractor s Employee will result in a notification to the Contractor s supervisory personnel and the Authorized Representative A second violation may result in the Authorized Representative requiring the Contractor Employee to be excluded from the site for a period designated by the Owner. 3. The removal procedure may be accelerated and/or expanded to include removal of a Contractor s/subcontractor s entire workforce by the Authorized Representative where the violation of safety regulations is widespread, or where the Contractor/Subcontractor does not demonstrate good faith effort. 4. Employers that are unresponsive to safety issues or that have an unsatisfactory safety evaluation may be deemed ineligible to bid additional contracts for a period designated by the Owner. Rev. 2 Page 25 of 109

79 5. Employers may report legitimate unsafe actions/activities of other contractors to the Authorized Representative or UCIP Safety. SUBSTANCE ABUSE PREVENTION POLICY 1. PURPOSE 1.1. In order to maintain a safe, healthful and efficient work environment, and to minimize absenteeism and tardiness, all Employers shall implement a Substance Abuse Prevention Policy that, at minimum, includes testing as prescribed by this section The Employer s program shall utilize a test procedure and protocol that mirrors or exceeds the Contractor s internal substance abuse testing parameters and protocols. 2. FUNDAMENTAL REQUIREMENTS 2.1. Employers shall implement and enforce a policy that prohibits the possession, distribution, promotion, manufacture, sale, use or abuse of illegal and unauthorized drugs, drug paraphernalia, controlled substances and alcoholic beverages by Employees, agents or any person otherwise under the control of the Employer, including Employees and agents of Subcontractors and consultants while on the work site, or while otherwise covered by the OCIP while working on the Project. Further, Employees shall be prohibited from reporting to the premises under the influence of drugs or alcohol The Policy must apply to all personnel, including but not limited to regular, part-time, probationary, casual and contract Employees of the company, as well as to Employees and agents of Subcontractors and consultants. The Employer shall take whatever legally permissible steps are necessary or appropriate to enforce compliance with this policy Employees governed by this policy may possess a prescription medication in its original container and prescribed for current use of the person in possession by an authorized medical practitioner; provided that the Employer provides a mechanism to ensure that Employees taking prescription medicine inform their Employer about potential side effects of medication which may affect the Employee s work ability (particularly their alertness and coordination), safety and the safety of others Any Employee covered under the OCIP shall be drug and alcohol tested in accordance with the provisions of the Employer s program: When involved in any type of incident, whether injury or property damage was incurred or not. All injuries required medical attention will be subject to testing For reasonable suspicion of impairment which has been validated by a third party The cost of all testing will be the responsibility of the employer of the effected worker. 3. Any Employee who fails or refuses to take a drug and alcohol screen in accordance with the terms of the contract shall be removed from the project. 4. Items 2.4, 2.4.1, 2.4.2, and 3 are subject to the terms of any Project Labor Agreement. Rev. 2 Page 26 of 109

80 RETURN TO WORK PROGRAM Purpose: This is to establish basic guidelines for an Early Return to Work (transitional duty) work assignment for injured workers. Each Employer shall have a written Early Return to Work Program that shall be implemented on this project unless specifically prohibited by the terms of a Collective Bargaining Agreement. Definitions 1. Injured Worker An injured Employee who has sustained a job related injury or illness that results in a Workers Compensation claim. 2. Transitional Duty Work Temporary job that the injured worker can perform while recovering from the work related injury or illness. Transitional duty is the same thing as Temporary Modified Duty. The job may be limited to a specific time frame. Benefits 1. Effectively impacts the Employer s Experience Modification Rating and contributes to reduced insurance premiums. 2. May eliminate the need for vocational rehabilitation. 3. Boosts Employee morale and demonstrates that the Employer wants to cooperate with the injured worker. 4. A worker on transitional duty can be of value to an Employer if there is an alternative plan or job description available. Fundamental Requirements 1. Construction Employees who are disabled by an injury or illness suffered at work are entitled to receive workers compensation payments including both the cost of medical treatment and replacement of lost wages during the period of their disability. 2. Employers shall implement an Early Return to Work Program that provides transitional jobs in certain specified instances. A transitional job is work, which requires the Employee to avoid certain types of physical activity, depending on the nature of the Employee s injury. 3. A transitional duty assignment will not change a worker s benefits, coverage and premium amounts. Any injured worker will be considered for transitional work to comply with the doctor s restrictions. How To Identify Transitional Work 1. Review all job descriptions for modification. 2. Identify transitional work in each department. 3. Make sure transitional duties are within Employee s stated capabilities 4. Communicate with other departments to share transitional duty worker. Examples of Modified (Transitional) Jobs 1. Flagging or directing traffic. 2. Monitoring quantity of export/import materials. 3. Monitoring safety requirements of co-workers. 4. Conducting safety meetings and training. 5. Delineating trenches, excavations or danger areas. 6. Cross-training for another job or offsite training. Rev. 2 Page 27 of 109

81 7. Assisting the estimating department by delivering estimates, blue prints, etc. 8. Assisting in warehouse or tool cribs. Rev. 2 Page 28 of 109

82 III. FORMS, REPORTS AND DISTRIBUTION INSTRUCTIONS This section illustrates the forms that will be used on this project. Electronic copies of the SAF-03, SAF-04 and SAF-06 forms will be provided to the Contractor prior to the start of the project. UC reserves the right to change, modify, or substitute these forms. Loss Control Survey Form Loss Control Corrective Action Form Environmental Health & Safety Investigation Report Near-Miss Accident/Incident Report Job Safety Analysis Form Monthly Non-Compliance Item Summary (SAF-1) (SAF-2) (SAF-3) (SAF-4) (SAF-6) (SAF-10) Rev. 2 Page 29 of 109

83 Loss Control Survey Form (SAF-1) The Loss Control Survey is completed by UCIP Safety to document non-compliance items observed on or related to the project. The Loss Control Survey is distributed to the General Contractor, Owner, and Owner s Agent / Representative. Loss Control Surveys are not prepared for individual subcontractors all surveys on a contract package will be issued to the General Contractor. Some Loss Control Surveys will require a written response by the General Contractor to demonstrate and document corrective action on the part of the General Contractor or its subcontractors. Such surveys have an R in the Response Required column beside a non-compliance item. Items identified with an R require a response using the SAF-2 Form that will be provided by UCIP Safety. Items identified with an NR do not require a written response. Rev. 2 Page 30 of 109

84 Loss Control Corrective Action Form (SAF-2) The Loss Control Corrective Action Form is provided to the Contractor with the SAF-1 when the Loss Control Survey requires written evidence of correction to be provided by the Contractor. The Contractor is to complete the form in its entirety and return the form to the designated recipients for this project within 48 hours of receipt for correction of the items noted on the Loss Control Survey and provision of the written response to the Loss Control Survey. Rev. 2 Page 31 of 109

85 Environmental Health & Safety Investigation Report (SAF-3) The Environmental Safety & Health Investigation Report is to be completed by the Contractor for all applicable incidents within 24 hours of the incident. If the incident involves a subcontractor, both the Contractor and Subcontractor are to provide independent, completed reports. NOTE: The Incident Investigation Data Form (Appendix I) is to be used in conjunction with the Root Cause Analysis Chart (Appendix H) to investigate the following types of incidents: Incidents resulting in an OSHA recordable injury or illness Incidents resulting in business interruption Incidents resulting in process interruption Near-miss incidents with potential high-severity consequences If the incident requires a Root Cause Analysis to be performed, the SAF-3 is considered to be a preliminary report for initial notification purposes. Distribution of the Root Cause Analysis as documented on the Incident Investigation Data Form shall include the Deputy Executive Director of Projects and Facilities. Rev. 2 Page 32 of 109

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87 Near-Miss Incident Report (SAF-4) The Near-Miss Incident Report is to be completed by the (Sub) Contractor for all applicable incidents within 24 hours. If the incident involves a Subcontractor, both the Contractor and Subcontractor are to provide independent, completed reports. NOTE: The Incident Investigation Data Form (Appendix I) is to be used in conjunction with the Root Cause Analysis Chart (Appendix H) to investigate near-miss incidents with potential high-severity consequences If the incident requires a Root Cause Analysis to be performed, the SAF-4 is considered to be a preliminary report for initial notification purposes. Distribution of the Root Cause Analysis as documented on the Incident Investigation Data Form shall include the Deputy Executive Director of Projects and Facilities. Rev. 2 Page 34 of 109

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