Statement of Qualifications

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1 2013 Statement of Qualifications Prepared for: Prospective Customer By: Matthew J. Schimpf Green Environment Specialists, Inc. 3/1/2013

2 Table of Contents Statement of Qualifications Table of Contents: CORPORATE PHILOSOPHY... 4 INSURANCE... 4 SERVICE HIGHLIGHTS... 4 Industrial Maintenance/Decontamination & Site Remediation... 4 Subsurface Investigation and Remediation Service... 5 Storage Tank Management... 6 Packaged Laboratory Chemicals - (PLC)... 6 Waste Removal and Disposal... 7 Product Sales... 7 PARTIAL CUSTOMER LISTING... 8 PERSONNEL PROFILES James G. Greig Matthew J. Schimpf Linda Faust Charles P. Litten David C. Ramming APPENDIX A... 15

3 Abstract Green Environment Specialists, Inc. (GES) is a full service environmental & industrial restoration contractor, incorporated in the State of New York in From modest beginnings, GES has grown to service numerous public and private sector clients through-out the empire state as well as New Jersey, Pennsylvania and portions of Ohio. GES capabilities are manifold as we have successfully executed projects as small as a 50-gallon oil/water separator clean-out to manufacturing facility decontamination, decommissioning and eventual demolition and just about everything in between those extremes. GES boasts an excellent credit rating; is financially secure and has the requisite risk instruments in place to function in a thoroughly professional capacity. In 1994, as a response to increasing business demands in conjunction with our need to expand, GES opened a sister company Environmental and Industrial Contracting Services, Inc. (i.e. EICS.) EICS is a stand-alone business concern that is governed under the auspices of NYCRR part 360, and is focused on receiving and processing for final disposal, a variety of non-hazardous waste materials. EICS was granted an operating permit by the New York State Department of Environmental Conservation (NYSDEC) in January of The advent of EICS has our family of companies uniquely positioned to respond to client needs with greater speed, exactitude and efficiency. All of GES' field personnel are thoroughly trained with respect to Occupational Safety and Health Administration (OSHA), Resource Conservation & Recovery Act (RCRA), and Department of Transportation (DOT) regulations. With the aid of GES' large contemporary resource capabilities, all employees are continuously being advised of the latest regulation changes and updates. In addition to annual regulation refresher courses, GES personnel are trained in First Aid and CPR by the American Red Cross.

4 Statement of Qualifications CORPORATE PHILOSOPHY GES takes client needs, expectations and relationships very seriously and constantly strives to focus on customer service and satisfaction. As such, GES develops solutions that: I. Resolve client environmental concerns promptly, cost effectively, efficiently, safely, and in accord with all applicable rules & regulations. II. Provide the appropriate documentation and backup data necessary to ameliorate any discrepancies, problems, or questions regulatory agencies may have. III. Achieve the project objectives in such a professional and forthright manner that the client welcomes GES' assistance wherever and whenever it is required. INSURANCE Green Environment Specialists; Inc. and it s sister company Environmental and Industrial Contracting Services, Inc. (EICS) have the requisite financial instruments in place to properly insure its employees and customers, alike. Included in this coverage are Professional & General Liability, Auto, Workman's Compensation and Pollution Liability. As an added benefit, GES has unlimited bonding capabilities. A Copy of GES & EICS insurance can be found in appendix A. SERVICE HIGHLIGHTS Industrial Maintenance/Decontamination & Site Remediation GES has the experience, equipment, and properly trained personnel to perform a wide variety of industrial maintenance and/or decontamination procedures, including but not limited to: Oil/Water Separator Installation & Cleaning (including associated piping, trenching and impoundments.) Surface decontamination using high-pressure wash, high-pressure water blasing (10,000 psi) steam, or chemical treatment deactivators. Plating line decontamination, cleaning and/or dismantling. Green Environment Specialists, Inc. Page 4

5 Statement of Qualifications Reactor/storage vessel clean out, decontamination or dismantling. Sewer line flushing & cleaning and general abatement. Influent/Effluent line computer aided tunneling videography. Above: Computer Aided Video Tunneling Equipment Because GES has successfully completed many of these projects of various sizes and complexities; the company's personnel have a thorough understanding of the task(s) in general and their hazards in particular. Armed with the proper equipment, a broad knowledge & experience base, as well as a strong work ethic, GES routinely completes the aforementioned services well within estimated time frames and budgets. Subsurface Investigation and Remediation Service GES personnel have performed many subsurface investigations and site restorations for private business and government agencies. Our staff is skilled in determining a sites unique requirements with respect to investigations and remedial action plans. Technologies employed include: Soil gas surveys Soil borings and monitoring well installations Groundwater flow and quality determination Remedial system design and installation Ongoing operation, and maintenance Reporting to regulatory agencies ORF (Overflow Retention Facility) decontamination, decommissioning and retrofitting. GES s approach to each project is based on the sites own characteristics and needs, as well as the clients requirements. Application of the proper technology and investigative techniques has proven to aid in the efficient and cost-effective closure of many sites. Green Environment Specialists, Inc. Page 5

6 Storage Tank Management Statement of Qualifications GES' storage tank management program is based on over 25 years of practical experience, and can be custom designed to meet client maintenance schedule & budgetary and manufacturing restrictions/limitations. All appropriate personnel are well versed in confined space entry techniques, practiced, and qualified to engage in any or all of the following: Tank Inspection, Testing, and Record keeping. Tank cleaning/maintenance. Underground Storage Tank (UST) excavation. Sectioning, decommissioning, and disposal. Soil testing and remediation. Permit application & appropriate documentation. As always employee safety is a primary consideration, thus; regular safety meetings are held, safety equipment is meticulously maintained (or replaced as needed), and tank atmospheres continuously monitored when necessary. All applicable regulations, including petroleum bulk storage (NYCRR ), NYCRR parts 362, 363, 370, and chemical bulk storage (NYCRR ), are observed. Packaged Laboratory Chemicals - (PLC) One of the more technically complex services that Green Environment Specialists, Inc. provides is the identification, segregation, and packaging of small quantity materials for disposal; otherwise known as lab-packs. With crews highly trained and proficient in determining chemical properties/compatibility s and applying associated rules and regulations promulgated by DOT & EPA, clients are assured timely, effective management of their lab pack wastes. Additionally, with the aid of custom designed software, GES can oftentimes reduce on-site packing time significantly and prepare computer generated tracking documentation of all wastes transported. Due to the intrinsically complicated and variable nature of lab-pack projects, some waste may be handled only on a case by case basis (e.g. peroxided ethers, shock sensitive compounds, explosives, etc.), while others are not acceptable for disposal at all (e.g. "mixed RCRA/TSCA waste and DOT forbidden materials). Green Environment Specialists, Inc. Page 6

7 Waste Removal and Disposal Statement of Qualifications GES offers a comprehensive waste removal and disposal program to operate in a full cycle fashion -- from initial analysis, identification, and characterization to packaging or (repackaging), labeling, marking, document preparation, and transportation. With a network of fully permitted and insured Transfer, Storage & Disposal facilities (TSDF's) available; in conjunction with a sound less - than - load (LTL) schedule, GES can be competitive and efficacious in managing the following waste types: Solvents (flammable, non-flammable, halogenated, non-halogenated, and aqueous.) Acids & Caustics. Solids & Sludges. Polychlorinated Biphenyls (PCB's). Below: Preparing to clean, via turbo vac., a below grade confined space, grit chamber. Non-Regulated Materials. Soils. Batteries. Process Waste Debris. Furthermore, GES monitors all waste tracking activities via computer and is capable of generating government mandated reports as an additional service. Product Sales Green Environment Specialists, Inc. is also a distributor of industrial absorbents and other spill control products in the New York / Pennsylvania area. With a warehouse full of various types of absorbents (pads, booms, socks, clay and organic spill control media) and spill control products (SpillPallets, SpillCollectors, Funnels, DrumTrays, PopUp Pools, DrainSeals, DrainPlugs, and SpillBerms), GES is poised to respond quickly to a customer's spill containment needs. In combination with the preceding, GES offers spill response services to existing customers. GES is currently researching, and will soon be distributing, biological products and delivery systems for use to control TPH (total petroleum hydrocarbon), TSS (total suspended solids), COD (chemical oxygen demand), and BOD (biological oxygen demand) in oil/water separator tanks. Green Environment Specialists, Inc. Page 7

8 Statement of Qualifications PARTIAL CUSTOMER LISTING Air Force Reserve (914th Airlift Wing) Base Civil Engineering Building 403 Niagara Falls I.A.P., N.Y Globe Metallurgical Inc Highland Avenue Niagara Falls, NY Cleveland Hills School 105 Mapleview Drive Cheektowaga, N.Y WASTE MANAGEMENT, INC. CWM Chemical Services, L.L.C Balmer Road Model City, NY Goodyear/Dunlop Tire Co., Inc. Sheridan Dr. Tonawanda, NY Ecology & Environment 368 Pleasantview Drive Lancaster, N.Y County of Erie 95 Franklin Street Rm Buffalo, N.Y FedEx 299 Cayuga Dr. Cheektoawga, NY FMC Corp., Inc. 100 Niagara Street Middleport, N.Y Gibraltar Metals Corp Military Road Kenmore, N.Y Grand Island Waste Water Treatment Plant 3500 Baseline Road Grand Island, N.Y New York Air National Guard (107th) Environmental Management Office Niagara Falls I.A.P., N.Y NYS Dept. of Environmental Conservation 270 Michigan Avenue Buffalo, N.Y New York State Dept. of Transportation 938 West Linden Avenue East Rochester, N.Y New York State Electric & Gas (Somerset Plant) 7725 Lake Road Barker, N.Y Niagara Falls International Airport Porter Road Niagara Falls, N.Y Niagara Mohawk Power Corporation 3500 River Road - CR Huntley Station Tonawanda, N.Y NFTA 181 Ellicott St. Buffalo, NY Occidental Chemical Corp. - Niagara Plant 47th St. & Buffalo Avenue Niagara Falls, N.Y United Parcel Service, Inc James E. Casey Dr. Buffalo, NY Occidental Chemical Corp. - Durez Division 5000 Packard Road Niagara Falls, N.Y Yellow Freight System, Inc. 66 Milens Road Tonawanda, N.Y Green Environment Specialists, Inc. Page 8

9 Statement of Qualifications FINANCIAL REFERENCES Banks Bank of America 1263 Military Road Niagara Falls, N.Y Certified Public Accountant Paul Rojek & Assoc Hertel Ave. Buffalo, NY Insurance and Bonding First Niagara Risk Management, Inc. 726 Exchange Street Suite 900 Buffalo, NY Green Environment Specialists, Inc. Page 9

10 Statement of Qualifications PERSONNEL PROFILES James G. Greig Owner/President Mr. Greig, owner and president of Green Environment Specialists, Inc., brings over 20 years of practical experience to the company. Mr. Greig is an experienced project supervisor with respect to tank and reactor vessel clean-out, confined space entry procedures, process line decon. and demolition, emergency spill response and packaging laboratory chemicals. Mr. Greig is also a class B licensed driver with experience in operating some heavy equipment and multi-purpose vacuum trucks. Education: Graduated Niagara Falls High School Continuing training with respect to OSHA, EPA and DOT regulations Employment Brief: B - Quick Stores, Sanborn, NY (Asst. Night Manager) EICS, Inc., Niagara Falls, NY (Project Supervisor) Green Environment Specialists, Inc., Niagara Falls, NY 1993 present Forte:. Personnel supervision, contract/scope of work execution and adherence, vac truck operations and maintenance, high pressure water washing packaging,transportation and disposal of hazardous & non-hazardous waste. 40 hour OSHA, CPR and first aid trained. Green Environment Specialists, Inc. Page 10

11 Statement of Qualifications Matthew J. Schimpf Technical Coordinator Mr. Schimpf's responsibilities include project management, cost estimation, document preparation (e.g. manifests, bills of lading, waste characterization reports, lab pack inventories, chain of custody forms, project closure reports, quarterly tax reports etc.). Utilizing his vast experience in, - and knowledge of - the environmental industry, Mr. Schimpf ensures that all projects undertaken by GES are done in complete accordance with applicable regulations. Education: B.S. Chemistry Buffalo State University College Employment Brief: Frontier Chemical Waste Process, Inc., Niagara Falls, N.Y. (Technical Manager-Customer Service Dept.) Kimmins Thermal Corp. Inc., Niagara Falls, N.Y. (Project Manager/Chemist) Arrowhead/Luxall Ltd., Tonawanda, N.Y. Chemical Waste Management, Inc., Model City, N.Y. (Project Manager/Chemist) Forte: Hazardous waste identification, characterization, transportation and disposal, packing laboratory chemicals, waste analysis, project estimation, regulatory compliance, report writing & waste tracking. Green Environment Specialists, Inc. Page 11

12 Linda Faust Office Manager/Project Coordinator Statement of Qualifications Ms. Faust has over twenty years experience in office management, with particular emphasis on business administration, contract administration & procurement and general accounting functions. Ms. Faust maintains all insurance, tax, and human resource files. Education: Bryant & Stratton Business College Employment Brief: Prior Aviation Service, Inc.; Buffalo, NY Forte: Customer relations, contract administration and management, office management, payroll determination & corporate bookkeeping/tax preparation. Green Environment Specialists, Inc. Page 12

13 Charles P. Litten Inbound Waste Coordinator Statement of Qualifications Mr. Litten is the Facility Inbound Waste Coordinator, with over twenty years progressive experience within the industrial cleaning, environmental remediation industry. Detailoriented individual with high-level communication, organization and problem-solving skills. Well-balanced person who excels in industrial project management and purchasing; strong lead individual, also able to work in team setting. Experienced heavy equipment operator; Vacuum Truck, High Pressure Unit, Tow Motor, Excavator, and other specialized heavy equipment. Strong technology skills; Microsoft Excel, Word, Outlook, and NetSuite CRM Education: Niagara Wheatfield Senior High: Graduated with a General Diploma Attended Niagara/Orleans BOCES, completed courses for welding, automobile collision and painting. Graduated and received NYS Welding Certificate. Employment Brief: National Vacuum Corp., Niagara Falls, New York (Facility Manager and Superintendent) Litten s Autobody & Collision, North Tonawanda, New York (Owner/Operator) Forte: Responsible for negotiating and ensuring most reasonable purchase price, quality, and value for all supplies, equipment and services; safety equipment (PPE), industrial equipment, chemicals, engineering. Oversee and manage three supervisors, 30+ union employees, and maintenance personnel, responsible for managing regional budget plan and overhead cost; project management, job estimating and quoting. Green Environment Specialists, Inc. Page 13

14 Statement of Qualifications David C. Ramming Equipment Operator/Chemical Technician Mr. Ramming has been in the environmental industry for nearly two years and has received extensive training through the United State Army National Guard. Education: Lockport Senior High School GES Program - Completed Employment Brief: U.S. Army National Guard: CERS-P, Specialists E-4 Rank Green Environment Specialists, Inc., Niagara Falls, NY Forte: Mr. Ramming has extensive military training in confined space entry, personal protective equipment, Ropes & Rescue, Bridging and Shoring and has been trained on Dozers, Scrappers, Graders, Front-end loaders and C-Trucks. Green Environment Specialists, Inc. Page 14

15 Statement of Qualifications APPENDIX A Insurance Certificates Green Environment Specialists, Inc. Page 15

16 COMMERCIAL GENERAL LIABILITY CLAIMS-MADE GEN'L AGGREGATE LIMIT APPLIES PER: PRO- X POLICY JECT LOC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS UMBRELLA LIAB EXCESS LIAB DEDUCTIBLE CERTIFICATE OF LIABILITY INSURANCE OCCUR OCCUR CLAIMS-MADE RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) EACH OCCURRENCE $ AGGREGATE $ WC STATU- TORY LIMITS E.L. EACH ACCIDENT OTH- ER E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ $ $ $ DATE (MM/DD/YYYY) 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). CONTACT Linda Miranda, CISR PRODUCER First Niagara Risk Management, Inc 726 Exchange Street Suite 900 Buffalo NY INSURED Green Environment Specialists Inc 8335 Quarry Road Niagara Falls NY COVERAGES CERTIFICATE NUMBER: LA Poll Prof -name REVISIONNUMBER: 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 ADDL SUBR LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS GENERAL LIABILITY A B X X X Pollution liab X X X N / A NAME: PHONE FAX (A/C, No, Ext): (716) (A/C, No): (716) ADDRESS: PRODUCER CUSTOMER ID #: INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : PKGE /12/2012 2/12/2013 CAA /12/2012 2/12/2013 INSURER(S) AFFORDING COVERAGE 4/13/2012 Medical Expense $ 5,000 Underinsured motorist $ 1,000,000 $ $ $ $ $ NAIC # Rockhill Insurance Co Cincinnati Insurance Company A Professional Liab PKGE /12/2012 2/12/2013 $3,000,000 General aggregate Claims made $3,000,000 each accident 3,000,000 50,000 5,000 3,000,000 3,000,000 3,000,000 1,000,000 CERTIFICATE HOLDER CANCELLATION Globe Metallurgical 3807 Highland Ave Niagara Falls, NY 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 M Strakhov/LMIRAN ACORD 25 (2009/09) INS025 (200909) ACORD CORPORATION. All rights reserved. The ACORD name and logo are registeredmarks of ACORD

17 ~. ~ 658 STATE OF NEW YORK WORKERS' COMPENSATION BOARD 659 :.: EST ADO DE NUEVA YORK - JUNTA DE COMPENSACION OBRERA statewide Fax Line :. NOTICE OF COMPLIANCE AVISO DE CUMPLIMIENTO. TO EMPLOYEES IMPORTANT INFORMATION FOR EMPLOYEES WHO ARE INJURED OR SUFFER AN OCCUPATIONAL DISEASE WHILE WORKING_ 1. By posting this notice and information concerning your 1. rights as an injured worker, your employer is incompliance w1th the Workers' Compensation Law. 2. If you do not notify your employer within 30 days of the 2. date of your injury your claim may be disallowed, so do so immediately. 3. You are entitled to obtain any necessary medical treatment 3. and should do so 1mmed1ately. 4. You may choose any doctor, podiatrist, chiropractor or J:)sychologist referred by a medical doctor that accepts NY State Workers' Compensation patients and is Board authorized. However. if your employer is involved in a certified preferred provider organization (PPO) you must first be treated by a provider chosen by your employer and your employer must give you a written statement of your rights concerning further medical care. 5. You should tell your doctor to file copies of medical reports concerning your claim with the Workers' Compensation Boara and with your employer's insurance company, which is indicated at the bottom of this form. 6. You may be _entitlked to lostf time benefits if yohur 5. work -related injury eeps you rom work for more t an seven days, compels you to work at lower wages or results in permanent disability to any part of your body. You may be entitled to rehabilitation services if you need help returning to work You should not pay any medical providers directly. They should send their bi Is to your employer's insurance carrier. If there is a dispute, the provider must wait until the Board makes a decision 'before it attempts to collect payment from you. If you do not pursue your claim or the Board rules that your injury is not work -related, you may be 7. responsible for the payment of the bills. 8. You are entitled to be represented by an attorney or licensed representative but 1t is not required. If you do hire a representative Clo not pay him/her directly. Any fee will be set by the Board and will be deducted from your award. 9. If you have difficulty in obtaining a claim form or need 8. help in filling it out, or if you have any other questions or problems about a job-related injury, contact any office of the Workers' Compensation Boara. WORKERS' COMPENSATION BOARD OFFICES Albany, Broadway-Menands - (866) *Brooklyn, Livingston St. - Brooklyn - (800) Binghamton, State Office Bldg.-44 Hawley St.- (866) Buffalo, Franklin Street - (866) *Hauppauge, Rabro Drive - Suite (866) * Hempstead, Fulton Avenue - (866) * New York, W.1 25th St. - Manhattan - (800) * Peekskill, North Division St. - (866) * Queens, st Ave. - Jamaica (800) Rochester, Main Street West - (866) Syracuse, James St. - (866) *DOWNSTATE MAIL ADDRESS Claims-related mail for the Hauppauge, Hempstead, Peekskill and all NYC offices should be mailed to: PO Box 5205 Binghamton, NY A EMPLEADOS INFORMACION IMPORTANTE PARA EMPLEADOS QUE SEAN LESIONADOS 0 SUFRAN UNA ENFERMEDAD OCUPACIONAL MIENTRAS TRABAJAN. Su patrono esta cumpliendo Ia Ley de Compensaci6n Obrera cuando despliega este comunicado concerniente a sus derechos como trabajador lesionado. Si usted no notifica a su patrono dentro del termino de 30 dias de haber sufrido su lesi6n su reclamacion podria ser desestimada, por eso notifique inmediatamente. Usted tiene derecho a recibir cualquier tratamiento medico necesario relacionado con su lesion y debe gestionario inmediatamente. 4. Para el tratamiento de cualquier lesion o enfermedad relacionadacon el trabajo, usted puede escoger cualquier medico, podiatra, quiropractico 6 psicologo (si es referido por un medico autorizado) que este autorizado y acepte pacientes de Ia Juntade Compensacion Obrera. Sin embargo, si su patrono esta autorizado a participar una organizacion certificada de proveedores preferidos (PPO) usted debera obtener tratamiento inicial para cualquier lesion o enfermedad relacionada con el trabajo de Ia correspondiente entidad. Patronos que participen en cualquier de estos programas establecidos por ley estan obligadosa proveer a sus empleados notificacion escrita explicando sus derechos y obligaciones bajo el programa a que este acogido. Usted debera requerir de su Medico que radique copias de los informes medicos de su caso en Ia Junta de Compensacion Obrera y en Ia compania de seguros de su patrono, que se indica al final de esta forma. Usted tiene derecho a compensacidn si su lesidn relacionada con el trabajo le impide trabajar por mas de siete dias, le obliga a trabajar a sueldo mas bajo o resulta en incapacidad permanente de cualquier parte de su cuerpo. Usted puede tener derecho a servicios de rehabilitaci6n si necesita ayuda para regresar al trabajo. No pague a ningun proveedor medico directamente por tratamiento de su lesion o enfermedad relacionada con el trabajo. Ellos deben enviar sus facturas al asegurador de su patrono. Si el caso es cuestionado. el proveedor debera esperar hasta que Ia Junta decida el caso. antes de iniciar gesti6n de cobro alguna contra usted. Si usted no tramita su caso o Ia Junta falla que su lesion o enfermedad no esta relacionada con el trabajo, usted podria ser responsable del pago de las facturas. No es obligatorio el estar representado en ninguno de los procedimientos de Ia Junta, pero es un derecho que usted tiene, el estar representado por abogado 6 por representante licenciado si usted asi lo desea. Si es representado, no pague al abogado 6 al representante licenciado. Cuando Ia Junta decida su caso, los honorarios seran determinados por Ia Junta y descontados de sus beneficios. Si tiene dificultad en conseguir un formulario de reclamaci6n o necesita ayuda para llenario 6 tiene dudas sobre cualquier situacion relacionada con una lesion o enfermedad comuniquese con Ia oficina mas cercana de Ia Junta. Robert E. Beloten Chair (Presidente) Workers' Compensation Benefits, when due, will be paid by (Los beneficios de Compensacion Obrera, cuandos debidos, seran pagados por): t-h_e_s_t_a_t_e-in_s_u_r_a_n_c_e-fu_n_d, Name of employer (Nombre de patrono) 199 Church Street, New York, N. Y ~ (212) Effective From... 5/2.5/?.Q.l.Z.... (En Vigor Desde) Policy No.... (Poliza No.) B )) _ ~f:i... ~.Z.f3. ::-:J To (Hasta C-105 ( ) PRESCRIBED BY CHAIR s. I. F. U- 30 WORKERS' COMPENSA TION BOARO "U30SIF /SN" STATE OF NEW YO RK cancellation cancellation) GREEN ENVIRONMENT SPECIALISTS INC 8335 QUARRY ROAD NIAGARA FALLS NY THIS NOTICE MUST BE POSTED CONSPICUOUSLY IN AND ABOUT THE EMPLOYER'S PLACE OR PLACES OF BUSINESS. Failure by an employer to post this notice in and about the employer's place or places of business may result in a $250 penalty for each violation. :

18 ~ 803 STATE OF NEW YORK WORKERS' COMPENSATION BOARD 804 EST ADO DE NUEVA YORK - JUNTA DE COMPENSACION OBRERA statewide Fax Une: NOTI CE OF COMPLIANCE t- AVISO DE CUMPLIMIENTO TO EMPLOYEES IMPORTANT INFORMATION FOR EMPLOYEES WHO ARE INJURED OR SUFFER AN OCCUPATIONAL DISEASE WHILE WORKING. A EMPLEADOS INFORMACION IMPORTANTE PARA EMPLEADOS QUE SEAN LESIONADOS 0 SUFRAN UNA ENFERMEDAD OCUPACIONAL MIENTRAS TRABAJAN. 1. By posting this notice and information concerning your 1. Su patrono esta cumpliendo Ia Ley de Compensaci6n Obrera rights as an injured w orker, your employer is incompliance cuando despliega este comunicado concerniente a sus derechos With the Workers' Compensation Law. como trabajador lesionado. 2. If you do not notify your employer within 30 days of the 2. Si usted no notifica a su patrono dentro del termino de 30 dias date of your injury your claim may be disallowed, so do so de haber sufrido su lesi6n su reclamaci6n podria ser immediately. desestimada, por esc notifique inmediatamente. 3. You are entitled to obtain any necessary medical treatment and should do so immediately. 4. You may choose any doctor, podiatrist, chiropractor or!;)sychologist referred by a medical doctor that accepts NY State Workers' Com ~ e n sat i o n pat ients and is Board authorized. However, if your emplo yer is involved in a certified preferred provider organization (PPO) you must first be treated by a provi der chosen by your. employer and your employer must g1ve you a wr1tten statement of your rights concerning furtner medical care. 5. You should tell your doctor to file copies of medical reports concerning your claim with the Workers' Compensation Boara and with your employer's insurance company, which is indicated at the bottom of this form. 6. You may be entitled to lost time benefits if your work -related injury keeps you from work for more than seven days, compels you to work at lower wages or results in permanent disability to any part of your body. You may be entitled to rehabilitation services if you need help returning to work. 7. You should not pay any medical providers directly. They should send their bi Is to your employer's insurance carrier. If there is a dispute, the provider must wait until the Board makes a decision before it attempts to collect payment from you. If you do not pursue your claim or the Board rules that your injury is not work -related, you may be responsible for the payment of the bills. 8. You are entitled to be represented by an attorney or licensed representative_~ but 1t is not required. If you d.o hire a representative uo not pay him/her direct ly. Any fee will be set by the Board and w ill be deducted from your award. 9. If you have difficulty in obtaining a claim form or need 8. hel~ in filling it out, or if you have any other questions or problems about a job-related injury, contact any office of the Workers' Compensation Boara. WORKERS' COMPENSATION BOARD OFFICES Albany, Broadway-Menands - (866) *Brooklyn, Livingston St. - Brooklyn - (800) Binghamton, State Office Bldg.-44 Hawley St.- (866) Buffalo, Franklin Street - (866) *Hauppauge, Rabro Drive - Suite {866) *Hempstead, Fulton Avenue - (866) *New York, W. 125th St. - Manhattan - (800) *Peekskill, North Division St. - (866) *Queens, st Ave. - Jamaica (800) Rochester, Main Street West - (866) 2n-0644 Syracuse, James St. - (866) *DOWNSTATE M AIL ADDRESS Claims-related mail for the Hauppauge, Hempstead, Peekskill and all NYC offices should be mailed to: PO Box 5205 Binghamton, NY Workers' Compensation Benef its, when due, will be paid by r t-h_e_s_t_a_t_e- IN_S_U_R_A_N_C_E_F_U_N_D, 199 Church _.St reet, New York, N. Y (212) Ef fective From... 5./.0.8/ To cancellation (Hasia -----canceii-aiion) (En Vigor Desde) Policy No... ~ ~.. ~... ;>.9.7.=.?.: (Paliza No.) C-1 05 ( ) PRES CRIB ED BY CHAIR s. I. F. U-30 WORK ERS ' CO MPENSATION BOARD 11 U30SIF/SN" STAT E OF HE W Y ORK 3. Usted tiene derecho a recibir cualquier tratamiento medico necesario relacionado con su lesi6n y debe gestionario inmediatamente. 4. Para el tratamiento de cualquier lesion o enfermedad relacionadacon el trabajo, usted puede escoger cualquier medico, podiatra, quiropractico 6 psicologo (si es referido por un medico autorizado) que este autorizado y acepte pacientes de Ia Juntade Compensacion Obrera. Sin embargo, s1 su patrono esta autorizado a participar una organizacion certificada de proveedores preferidos (PPO) usted debera obtener tratamiento inicial para cualquier lesion o enfermedad relacionada con el trabajo de Ia correspondiente entidad. Patronos que participen en cualquier de estes programas establecidos por ley estan obligadosa proveer a sus empleados notificacion escrita explicando sus derechos y obligaciones bajo el programa a que este acogido. 5. Usted debera requerir de su Medico que radique capias de los informes medicos de su caso en Ia Junta de Compensaci6n Obrera y en Ia campania de seguros de su patrono, que se indica al final de esta forma. 6. Usted tiene derecho a compensacidn si su lesidn relacionada con el trabajo le impide trabajar por mas de siete dias, le obliga a trabajar a sueldo mas bajo 6 resulta en incapacidad permanente de cualquier parte de su cuerpo. Usted puede tener derecho a servicios de rehabilitaci6n si necesita ayuda para regresar al trabajo. 7. No pague a ningun proveedor medico directamente por tratamiento de su lesi6n o enfermedad relacionada con el trabajo. Ellos deben enviar sus facturas al asegurador de su patrono. Si el caso es cuestionado. el proveedor debera esperar hasta que Ia Junta decida el caso, antes de iniciar gesti6n de cobro alguna contra usted. Si usted no tramita su case o Ia Junta falla que su lesion o enfermedad no esta relacionada con el trabajo, usted podria ser responsable del pago de las facturas. No es obligatorio el estar representado en ninguno de los procedimientos de Ia Junta, pero es un derecho que usted tiene, el estar representado por abogado 6 por representante licenciado si usted asi lo desea. Si es representado, no pague al abogado 6 al representante licenciado. Cuando Ia Junta decida su caso, los honorarios seran determinados per Ia Junta y descontados de sus beneficios. Si tiene dificultad en conseguir un formulario de reclamaci6n o necesita ayuda para llenario 6 tiene dudas sobre cualquier situaci6n relacionada con una lesi6n o enfermedad comuniquese con Ia oficina mas cercana de Ia Junta. Robert E. Beloten Chair (Presidente) (Los beneficios de Compensacion Obrera, cuandos debidos, ser!n pagados por): Name of employer (Nombre de patrono) ENVIRONMENTAL & INDUSTRIAL CONTRACTING SERVICES INC TA EICS 8335 QUARRY RD NIAGARA FALLS NY THIS NOTICE M UST BE POSTED CONSPICUOUSLY IN AND ABOUT THE EM PLOYER'S PLACE OR PLACES OF BUSINESS. Failure by an employer to post this notice in and about the employer's place or places of business may result in a $250 penalty for each violation

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