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Bm BOND
PENAL SUM FORM

BIDDER (Name and Address):

Brox Industries, Inc.
1471 Methuen Street
Dracut MA 01826-5439

SURETY (Name and Address of Principal Place of Business):
Fidelity and Deposit Company of Maryland

1299 Zurich Way, 5th Floor
Schaumburg, IL 60196-1056

OWNER (Name and Address):
City of Nashua, NH

Central Purchasing 229 Main Street City Hall Room 128
Nashua, NH 03061-2019

BID
BID DUE DATE: February 12. 2019
PROJECT (Brief Description Including Location):
IFBO660-020719 2019 Paving Program - Arterial Roadways

BOND
BOND NUMBER:_ N/A
DATE: (Not later than Bid Due Date): _February 7, 2019
PENAL SUM: Five Percent of Amount Bid 5%
(Words) (Figures)

IN WITNESS WHEREOF, Surety and Bidder, Intending to be legally bound hereby, subject to the terms
printed on the reverse side hereof, do each cause the Bid Bond to be duly executed on its behalf by its
authorized officer, agent, or representative.

BIDDER SURETY
Brox Industries, Inc. (Seal) Fidelity and Deposit Company of Maryland (Seal)
Bidder’s Name and Corporgte Seal Surety’s Name and Corporate Seal
—
By: 3 4x7 Bys YN >
a Signature 4nd Tifle Signaturé and Title Donna M. Planeta, Attorney-in-Fact

(Attach Power pf Attorney)
/
Attest: iN / Fa
Signature and fitle ! Ssigeatinve’and Title Lorina Garcia, Witness
Deborah MacCallum Contract Admin. /

Ea

Stephen M. Brox esident

Attest?

Note: (1) Above addresses are to be used for giving required notice. = “——~
(2) Any singular reference to Bidder, Surety, OWNER or other party shall be considered plural where applicable.

BB - 1 0f2

maintain and complete work in accordance with the requirements of the contract or determination
of the City of Nashua. Professional Engineer is responsible for requesting clarification or
interpretation and is solely liable for any cost or expense arising from its failure to do so.

TERMINATION OF CONTRACT

A. TERMINATION, ABANDONMENT, OR SUSPENSION AT WILL. The City of Nashua, in its sole
discretion, shall have the right to terminate, abandon, or suspend all or part of the project and
contract at will. If the City of Nashua chooses to terminate, abandon, or suspend all or part of the
project, it shall provide Professional Engineer 10 day's written notice of its intent to do so.

If all or part of the project is suspended for more than 90 days, the suspension shall be treated as a
termination at will of all or part of the project and contract.

Upon receipt of notice of termination, abandonment, or suspension at will, Professional Engineer
shall:

|. Immediately discontinue work on the date and to the extent specified in the notice.

2. Place no further orders or subcontracts for materials, services, or facilities, other than as
may be necessary or required for completion of such portion of work under the contract
that is not terminated.

3. Immediately make every reasonable effort to obtain cancellation upon terms satisfactory
to the City of Nashua of all orders or subcontracts to the extent they relate to the
performance of work terminated, abandoned, or suspended under the notice, assign to
the City of Nashua any orders or subcontracts specified in the notice, and revoke
agreements specified in the notice.

4. Not resume work after the effective date of a notice of suspension until receipt of a
written notice from the City of Nashua to resume performance.

In the event of a termination, abandonment, or suspension at will, Professional Engineer shall
receive all amounts due and not previously paid to Professional Engineer for work satisfactorily
completed in accordance with the contract prior to the date of the notice and compensation for work
thereafter completed as specified in the notice. No amount shall be allowed or paid for anticipated
profit on unperformed services or other unperformed work.

B. TERMINATION FOR CAUSE This agreement may be terminated by the City of Nashua on 10
calendar day’s written notice to Professional Engineer in the event of a failure by Professional
Engineer to adhere to any or all the terms and conditions of the contract or for failure to
satisfactorily, in the sole opinion of the City of Nashua, to complete or make sufficient progress on
the work in a timely and professional manner. Professional Engineer shall be given an opportunity
for consultation with the City of Nashua prior to the effective date of the termination. Professional
Engineer may terminate the contract on 10 calendar days written notice if, through no fault of
Professional Engineer, the City of Nashua fails to pay Professional Engineer for 45 days after the
date of approval by the City of Nashua of any Application for Payment.

Upon receipt of notice of termination for cause, Professional Engineer shall:

t. Immediately discontinue work on the date and to the extent specified in the notice.

2. Provide the City of Nashua with a list of all unperformed services.

3. Place no further orders or sub-contracts for materials, services, or facilities, other than as
may be necessary or required for completion of such portion of work under the contract
that is not terminated.

4. Immediately make every reasonable effort to obtain cancellation upon terms satisfactory
to the City of Nashua of all orders or sub contracts to the extent they relate to the

GC 4 of 11

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Bidder and Surety, jointly and severally, bind

themselves, their heirs, executors, administrators, 7.

successors, and assigns to pay to OWNER upon
default of Bidder the penal sum set forth on the face
of this Bond.

Default of Bidder shall occur upon the failure of
Bidder to deliver within the time required by the
Bidding Documents (or any extension thereof
agreed to in writing by OWNER) the executed
Agreement required by the Bidding Documents and
any performance and payment bonds required by
the Bidding Documents and Contract Documents.

This obligation shal] be null and void if:

3.1. OWNER accepts Bidder’s bid and Bidder
delivers within the time required by the
Bidding Documents (or any extension thereof
agreed to in writing by OWNER) the executed
Agreement required by the Bidding Documents
and any performance and payment bonds
required by the Bidding Documents and
Contract Documents, or

3.2 All bids are rejected by OWNER, or

3.3 OWNER fails to issue a notice of award to
Bidder within the time specified in the Bidding
Documents (or any extension thereof agreed to
in writing by Bidder and, if applicable,
consented to by Surety when required by
paragraph 5 hereof).

Payment under this bond will be due and payable
upon default by Bidder and Within 30 calendar
days after receipt by Bidder and Surety of written
notice of default from OWNER, which notice will
be given with reasonable promptness, identifying
this Bond and the Project and including a statement
of the amount due.

Surety waives notice of and any and al] defenses
based on or arising out of any time extension to
issue notice of award agreed to in writing by
OWNER and Bidder, provided that the time for
issuing Notice of Award including extensions shall
not in the aggregate exceed 120 days from Bid Due
Date without Surety’s written consent.

No suit or action shall be commenced under this
Bond prior to 30 calendar days after the notice of
default required in paragraph 4 above is received by
Bidder and Surety, and in no case later than one
year after Bid due date.

BB-2o0f2

Any suit or action under this Bond shall be
commenced only in a court of competent
jurisdiction located in the state in which the Project
is located.

Notice required hereunder shall be in writing and
sent to Bidder and Surety at their respective
addresses shown on the face of this Bond. Such
notices may be sent by personal delivery,
commercial courier or by United States Registered
or Certified Mail, return receipt requested, postage
pre-paid, and shall be deemed to be effective upon
receipt by the party concerned.

Surety shall cause to be attached to this Bond a
current and effective Power of Attorney evidencing
the authority of the officer, agent or representative
who executed this Bond on behalf of Surety to
execute, seal and deliver such Bond and bind the
Surety thereby.

. This Bond is intended to conform to all applicable

statutory requirements. Any applicable requirement
of any applicable statute that has been omitted from
this Bond shall be deemed to be included herein as
if set forth at length. If any provision of the Bond
conflicts with any applicable provision of any
applicable statute, then the provision of said statute
shall govern and the remainder of this Bond that is
not in conflict therewith shall continue in full force
and effect.

. The term “Bid” as used herein includes a Bid, offer

or proposal as applicable.

ZURICH AMERICAN INSURANCE COMPANY
COLONIAL AMERICAN CASUALTY AND SURETY COMPANY
FIDELITY AND DEPOSIT COMPANY OF MARYLAND
POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS: That the ZURICH AMERICAN INSURANCE COMPANY, a corporation of the State of New
York, the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, a corporation of the State of Maryland, and the FIDELITY
AND DEPOSIT COMPANY OF MARYLAND a corporation of the State of Maryland (herein collectively called the "Companies"), by
MICHAEL BOND, Vice President, in pursuance of authority granted by Article V, Section 8, of the By-Laws of said Companies, which
are set forth on the reverse side hereof and are hereby certified to be in full force and effect on the date hereof, do hereby nominate,
constitute, and appoint Donna M. PLANETA, Joshua SANFORD, Aimee R. PERONDINE, Aiza LOPEZ, Danielle D. JOHNSON,
Michelle Anne McMAHON, Saykham CHANTHASONE and Noah William PIERCE, all of Hartford, Connecticut, EACH its true
and lawful agent and Attorney-in-Fact, to make, execute, seal and deliver, for, and on its behalf as surety, and as its act and deed: any and all
bonds and undertakings, and the execution of such bonds or undertakings in pursuance of these presents, shall be as binding upon said
Companies, as fully and amply, to all intents and purposes, as if they had been duly executed and acknowledged by the regularly elected
officers of the ZURICH AMERICAN INSURANCE COMPANY at its office in New York, New York., the regularly elected officers of the
COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at its office in Owings Mills, Maryland., and the regularly elected
officers of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at its office in Owings Mills, Maryland., in their own proper
persons.

The said Vice President does hereby certify that the extract set forth on the reverse side hereof is a true copy of Article V, Section 8, of
the By-Laws of said Companies, and is now in force.

IN WITNESS WHEREOF, the said Vice-President has hereunto subscribed his/her names and affixed the Corporate Seals of the said
ZURICH AMERICAN INSURANCE COMPANY, COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and
FIDELITY AND DEPOSIT COMPANY OF MARYLAND, this 9th day of July, A.D. 2018.

ATTEST:

ZURICH AMERICAN INSURANCE COMPANY
COLONIAL AMERICAN CASUALTY AND SURETY COMPANY
FIDELITY AND DEPOSIT COMPANY OF MARYLAND

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By:
Assistant Secretary Vice President
Joshua Lecker Michael Bond

State of Maryland

County of Baltimore

On this 9th day of July, A.D. 2018, before the subscriber, a Notary Public of the State of Maryland, duly commissioned and qualified, MICHAEL

BOND, Vice President, and JOSHUA LECKER, Assistant Secretary, of the Companies, to me personally known to be the individuals and officers
described in and who executed the preceding instrument, and acknowledged the execution of same, and being by me duly sworn, deposeth and saith, that
he/she is the said officer of the Company aforesaid, and that the seals affixed to the preceding instrument are the Corporate Seals of said Companies, and that
the said Corporate Seals and the signature as such officer were duly affixed and subscribed to the said instrument by the authority and direction of the said
Corporations.

IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my Official Seal the day and year first above written.

Constance A. Dunn, Notary Public
My Commission Expires: July 9, 2019

POA-F 063-9180A

CONSTRUCTION CONTRACTOR’S
QUALIFICATION STATEMENT

On Schedule A, attached, list major engineered construction projects completed by this
organization in the past five (5) years. (If joint venture, list each participant’s projects separately).

On Schedule B, attached, list current projects under construction by this organization, (If joint
venture, list each participant’s projects separately).
Name of Surety Company and name, address, and phone number of agent.
Fidelity & Deposit Company of Maryland
Agent: Willis Towers Watson 10 State House Square, Floor 11 Hartford, CT 06103
Erin L. Kiernan Sr. Client Manager (860) 241-4428

Is your organization a member of a controlled group of corporations as defined in LR.C. Sec.
1563?

L]Yes [XINo

If yes, show names and addresses of affiliated companies.

N/A

Furnish on Schedule C, attached, details of the construction experience of the principal
individuals of your organization directly involved in construction operations.

Please See Attached
Has your organization ever failed to complete any construction contract awarded to it?

[Yes [XINo

If yes, describe circumstances and provide details on attachment.

N/A
Has any Corporate officer, parter, joint venture participant or proprietor ever failed to complete
a construction contract awarded to him or her in their own name or when acting as a principal of
another organization?

[}¥es [KXINo

If yes, describe circumstances and provide details on attachment.
N/A

In the last five years, has your organization ever failed to substantially complete a project in a
timely manner?

[Tes [XINo
L]Yes [X]No

If yes, describe circumstances and provide details on attachment.

N/A

CQ-1of7

10.

1.

12.

14,

15,

Does your organization now have any legal suits or arbitration claims pending or outstanding
against it or any officers?

[TYes [XJNo

If yes, describe circumstances and provide details on attachment.
Has your organization had a contract partially or completely terminated for default (cause) within
the past five years?

[]Yes [XINo

If yes, describe circumstances and provide details on attachment.

List the licensed categories of work that your company normally performs with its own
workforce._ Highway Construction, Sitework, Paving, Excavation, Milling,
Cold Planing, Sidewalk & Curbing Pavement

If required, can your organization provide a bid bond for this project?
[XlYes [JNo

What is your approximate total bonding capacity?

[1$500,000 to $2,000,000

[$2,000,000 to $5,000,000

[_J$5,000,000 to $10,000,000

[X]$10,000,000 or more

Describe the permanent safety program you maintain within your organization. Use attachment if
necessary.

Please See Attached

Fumish the following information with respect to an accredited banking institution familiar with
your organization.

Name of Bank Citizens Bank
Address 25 Mall Road, Suite 203
Burlington, MA _ 01803
Account Manager Marc J. Lubelezyk, Sr. Vice President
Telephone (781) 565-2239

CQ-2o0f7

State of NH
Department of Labor
PO Box 2076
Concord, NH 03302-2076

SAFETY SUMMARY FORM FOR JANUARY 1, 2011

COMPANY NAME: BROX INDUSTRIES, INCORPORATED

COMPANY ADDRESS: 1471 METHUEN ST., DRACUT, MA 01826

N.H. LOCATIONS OF REPORT: HUDSON, HOOKSETT, ROCHESTER, MILFORD

CONTACT PERSON: VICTOR L. GOULET, SAFETY DIRECTOR

PHONE NO: (978) 805-9740 NUMBER OF EMPLOYEES: 180

S.C. CODE: 1611, 1429, 1442, 2951, 7538, 7699 FEDERAL ID. NO.: 04277 2247
6531, 4959 & NAICS 551114

1.) LIST POTENTIAL SAFETY AND HEALTH HAZARDS OF YOUR COMPANY.

EMPLOYEES AT PLANTS WORKING ON OR AROUND HEAVY EQUIPMENT AND
MACHINERY HAVE POTENTIAL FOR FALLS, MUSCLE STRAIN, CAUGHT IN, CRUSHING OR
"STRUCK-BY” TYPE INJURIES. ALL PLANTS AND EQUIPMENT ARE GROUNDED AND/OR
GFCI’S ARE USED FOR PROTECTION FROM ELECTRICAL HAZARDS. HIGHWAY PAVING
OPERATIONS ARE EXPOSED TO PUBLIC TRAFFIC, HEAVY EQUIPMENT AND VARIOUS

WEATHER CONDITIONS.

2, WHO IS RESPONSIBLE FOR YOUR INSPECTIONS AND HOW OFTEN ARE THEY DONE?

THE COMPANY SAFETY DIRECTOR CONDUCTS UNANNOUNCED MONTHLY (AT
LEAST), DOCUMENTED INSPECTIONS AT ALL PLANTS AND J OBSITES. THE COMPANY
ALSO UTILIZES OUTSIDE SAFETY /HEALTH CONSULTANTS TO CONDUCT FORMAL,
DOCUMENTED SAFETY INSPECTIONS OF MATERIAL PROCESSIN G PLANTS AND THE
VARIOUS PAVING AND CONSTRUCTION PROJECTS. A LOSS CONTROL CONSULTANT
FROM OUR WORKERS' COMP INSURANCE PROVIDER INSPECTS EACH PLANT AT LEAST
ANNUALLY AS WELL AS VARIOUS CONSTRUCTION AND PAVIN G SITES. THESE ARE ALSO

—___DOCUMENTED, AND SUPERVISORS ARE RESPONSIBLE TO. RESPOND LWRI HING-AS
WHAT AND WHEN CORRECTIONS WERE MADE FOR EACH SAF ETY DEFICIENCY. BROX
SUPERVISORS ARE REQUIRED TO CONDUCT SAFETY INSPECTIONS OF THEIR WORK
LOCATION AT LEAST ONCE PER SHIFT AND DOCUMENT THEIR FINDINGS AND THE
CORRECTIVE ACTION TAKEN. ALL DOCUMENTATION OF PLANT AND JOBSITE
INSPECTIONS ARE FORWARDED TO THE COMPANY SAFETY DIRECTOR. MINING
OPERATIONS ARE INSPECTED BY MSHA ONCE OR TWICE A YEAR. MA DEPT. OF LABOR
PERFORMS A COMPLIANCE ASSISTANCE INSPECTION OF OUR DRACUT, MA PLANTS. ALL
EQUIPMENT OPERATORS AND TRUCK DRIVERS ARE REQUIRED TO PERFORM A PRE-
DRIVING/OPERATION INSPECTION OF THEIR VEHICLEOR EQUIPMENT. THIS
DOCUMENTATION IS SENT IN TO THE PLANT MANAGER OR EQUIPMENT MAINTENANCE

DIVISION DAILY.

3. LIST THE MEMBERS OF YOUR COMPANY'S JOINT LOSS MANAGEMENT
COMMITTEE BY NAME AND JOB TITLE. PLEASE INDICATE WHICH MEMBERS
REPRESENT THE EMPLOYER AND THOSE WHICH REPRESENT EMPLOYEES, IDENTIFY

CHAIRPERSON.

* MANAGEMENT MEMBERS (SUPERVISORY)

E. STEVENSON (CHAIRMAN), PROJECT MANAGER, RE/PCS DIVISION
D. THOMPSON, PLANT MANAGER, MTLS. DIV.

M. SHEEHAN, SUPERVISOR, CONTRACTING DIV.

* EMPLOYEE MEMBERS (NON-SUPERVISORY)

R. PERETTI, PLANT OPERATOR, MTLS. DIV. (LABOR REP.)

D. ROMA, FOB SALES, SALES/MARKETING DIV.

D. ARSENAULT, LABORER, CONTRACTING DIV. (LABOR REP.)

V. GOULET, SAFETY DIRECTOR (COMMITTEE ADVISOR)
4. SPECIFY YOUR EMERGENCY RESPONSE PROCEDURES.

EXITS ARE MARKED AND EMERGENCY:PHONE NUMBERS ARE POSTED BY THE
PHONES AT ALL LOCATIONS. SUPERVISORS ARE REQUIRED TO CONDUCT EMERGENCY
PROCEDURE TRAINING FOR NEW EMPLOYEES, IF PROCEDURES CHANGE AND AT LEAST
ANNUALLY.

EMPLOYEES ARE INSTRUCTED TO MEET IN THEIR PARTICULAR WORK
LOCATION'S DESIGNATED AREA WHERE A HEAD COUNT WILL BE DONE BY THE
DESIGNATED PERSON. OTHER DESIGNATED PERSONS WILL CALL FOR THE NECESSARY
ASSISTANCE AND STAND BY TO DIRECT EMERGENCY PERSONNEL AS THEY ARRIVE.
TRAINING DOCUMENTATION MUST BE TURNED IN TO THE COMPANY SAFETY DIRECTOR.

5. IDENTIFY PERSON (S) BY NAME AND TITLE RESPONSIBLE FOR SAFETY AND
HEALTH INSTRUCTION FOR YOUR EMPLOYEES AND YOUR J OINT LOSS
MANAGEMENT COMMITTEE.

V. GOULET, SAFETY DIRECTOR

N. SAUCIER, CONTRACTING MANAGER

L. MELLO, CONTRACTING SUPERVISOR

W. KAATZ, CONTRACTING SUPERVISOR

M. SHEEHAN, CONTRACTING SUPERVISOR
J. LABRANEY, CONTRACTING SUPERVISOR
S MOYNIHAN, EQUIPMENT SUPERVISOR

J. BROSKT, EQUIPM. FOREMAN

D. PERRY, DRACUT MA PLANT MANAGER
D. THOMPSON, HUDSON NH PLANT MANAGER
R. FORCIER, IPSWICH MA PLANT MANAGER

No

(# 5 CONTINUED...)

P. JACKSON, MARLBORO MA PLANT MANAGER

W. CARROLL, MERRIMAC MA PLANT MANAGER

D. CLUFF, ROCHESTER / HOOKSETT NH PLANT MANAGER
E. STEVENSON, RE/PCS DIV. SUPERVISOR

S. NEWTON, GRADING SUPERVISOR

L. VALENTE, GRADING FOREMAN

E. WELCH, PAVING SUPT.

F. RAWSON, PAVING SUPT.

R. VILAMARIM, PAVING SUPT.

B. KENNEDY, PAVING FOREMAN

J. SHEA, PAVING FOREMAN

M. BUCUZZO, TRUCKING SUPERVISOR

C. NICKERSON, CONTROLLER

M. REILLY, SALES/MARKETING DIVISION MANAGER
G. MACKENZIE, CONTRACTING DIVISION MANAGER
D. PERRY, MATERIALS DIVISION MANAGER

G. HALL, RE/PCS DIVISION MANAGER

6. IDENTIFY PERSON (S) BY NAME AND TITLE QUALIFIED TO TAKE CORRECTIVE
ACTIONS ON SAFETY AND HEALTH HAZARDS.

S. BROX, PRESIDENT & ALL OTHERS LISTED IN QUESTION #5 (ABOVE)

7. INDICATE YOUR PROCEDURES TO ASSURE COMPLIANCE WITH SAFETY AND
HEALTH STANDARDS BY SUBCONTRACTORS.

OUR SUBCONTRACTOR'S SPECIFIC SAFETY REQUIREMENTS ARE OUTLINED IN-QUR.
CO. SAFETY BOOKLET AS WELL AS OUR SUBCONTRACT AGREEMENT. THE COMPANY
SAFETY DIRECTOR CONDUCTS REGULAR SAFEETY INSPECTIONS OF THE SUB'S PROJECTS
AND COMPLETES A FOLLOWPUP REPORT WHICH ARE SENT TO THE COMPANY CEO,
BROX'S SUPERVISOR ADDRESSES EACH NOTED VIOLATION WITH THE SUB'S SUPERVISOR
ON THE DAY OF THE INSPECTION. THE BROX SUPERVISOR ON EACH PROJECT IS TO
ADVISE THE SUB OF ANY SAFETY OR HEALTH ISSUES AS THEY ARISE.

OUR WORKERS' COMP CARRIER AND OUR SAFETY CONSULTANTS ALSO INSPECT
AND REPORT THEIR FINDINGS OF INSPECTIONS AT VARIOUS PROJECTS. SUBS ARE
ADVISED THAT SERIOUS SAFETY OR HEALTH PROBLEMS ARE TO BE CORRECTED AS
SOON AS POSSIBLE OR THEY MAY BE REMOVED FROM THE JOB SITE.

lod

8. SUMMARIZE YOUR DISCIPLINARY POLICY WITH REGARD TO VIOLATIONS OF
YOUR SAFETY AND HEALTH POLICIES.

VERBAL WARNING AND INSTRUCTION IS GIVEN AT FIRST AND F URTHER
VIOLATIONS MAY RESULT IN WRITTEN REPRIMAND, SUSPENSION AND/OR TERMINATION

FROM EMPLOYMENT.

9. SUMMARIZE YOUR POLICY FOR PROVIDING ADEQUATE RESOURCES DEDICATED
TO SAFETY.

BROX INDUSTRIES IS COMMITTED TO ENSURING A SAFE AND HEALTHY
ENVIRONMENT FOR EMPLOYEES. THIS IS AN ONGOING PROCESS BY WHICH THE
COMPANY PROVIDES SAFETY AND HEALTH TRAINING (AT ALL "LEVELS") SPECIFIC TO
EACH WORK AREA. ALL NECESSARY PERSONAL PROTECTIVE EQUIPMENT IS PROVIDED
EXCEPT FOR THE REQUIRED SAFETY TOE SHOES FOR WHICH EMPLOYEES ARE
REIMBURSED $40.00/YR. BY THE COMPANY. SCHEDULED MEDICAL SURVEILLANCE IS
CONDUCTED AND THE COMPANY PERFORMS PRE-EMPLOYMENT, POST ACCIDENT,
REASONABLE CAUSE AND RANDOM DRUG TESTING ON ALL EMPLOYEES.

10. HOW ARE EMPLOYEES PROVIDED ACCESS TO YOUR SAFETY AND HEALTH
POLICIES? ;

ALL EMPLOYEES RECEIVE AND SIGN FOR A COPY OF THE CURRENT CO. SAFETY
BOOKLET AND SAFETY ORIENTATION FOR NEW EMPLOYEES IS PROVIDED BY THE
COMPANY SAFETY DIRECTOR AND THEIR SUPERVISOR. SAFETY AND HEALTH
INSTRUCTION ARE ALSO PROVIDED THROUGH WEEKLY SAFETY MEETINGS, "PAYCHECK
BULLETIN" ARTICLES, THE MINUTES OF THE "BROX SAFETY MANAGEMENT TEAM"
MEETINGS ARE POSTED FOR ALL EMPLOYEES AND AN ANNUAL 8 HOUR SAFETY
SEMINAR IS CONDUCTED BY THE COMPANY FOR EMPLOYEES EVERY SPRING.

SIGNATURE OF PERSON COMPLETING FORM:

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7 Ya yo oe

VIGOR GOULET, SAFETY DIRECTOR, BROX INDUSTRIES, INC.

_June 1.2012

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