4300150.pdf

STATE OF MICHIGAN

ENTERPRISE PROCUREMENT

Department of Technology, Management, and Budget 320 S. Walnut Street 2nd Floor Lansing, MI 48933

P.O. BOX 30026 LANSING, MICHIGAN 48909

CONTRACT CHANGE NOTICE

CONTRACT SUMMARY

RE-TRAC Connect

INITIAL EFFECTIVE DATE INITIAL EXPIRATION DATE INITIAL AVAILABLE OPTIONS EXPIRATION DATE

BEFORE

September 11, 2014 September 10, 2015 8 - 12 Months September 10, 2026

PAYMENT TERMS DELIVERY TIMEFRAME

ALTERNATE PAYMENT OPTIONS EXTENDED PURCHASING

MINIMUM DELIVERY REQUIREMENTS

P-Card Direct Voucher (PRC) Other Yes No

401-250 McDermot Ave

Winnipeg MB R3B 0S5

Jennifer Peters

204-772-7239 ap@emergeknowledge.com

CV0067009

EMERGE KNOWLEDGE DESIGN INC.

C O

N

TR

A C

TO

R

Jarrod Barron

(517) 249-0406

DTMB

Various Various

BarronJ1@michigan.gov

C ontract

A dm inistrator Program M anagerSTA

TE

Change Notice Number 16

Contract Number MA071B4300150C to

DESCRIPTION OF CHANGE NOTICE

OPTION EXTENSIONLENGTH OF OPTION LENGTH OF EXTENSION REVISED EXP. DATE

CURRENT VALUE VALUE OF CHANGE NOTICE ESTIMATED AGGREGATE CONTRACT VALUE

$1,564,429.01 $0.00 $1,564,429.01

DESCRIPTION

Effective 2/14/2025, the parties add the following language to the Contract:

"Accessibility Requirements.

The State is required to comply with the Americans with Disabilities Act of 1990 (ADA) and has adopted standards and procedures regarding accessibility requirements for websites, applications, content, and electronic documents. Due to a change in the law, the State is required to comply with specific accessibility standards for websites, applications, content and documents.

Starting 4/24/2026, throughout the Term, all websites, applications, software, content, and electronic documents, including but not limited to mobile applications, text, images, sounds, videos, controls, animations, links, and documents (including files in the following formats: PDF, word processing, presentation, and spreadsheet), created, provided, or made available by the Contractor under this Contract, must comply with WCAG 2.1 Level AA."

Per Contractor, Agency, and DTMB Procurement approval. Internal State Note: Remaining Ad Board funds after this CN: $179,354.99

AGENCY NAME PHONE EMAIL

EGLE Carlie Money 517-897-4805 MoneyC@michigan.gov

DTMB Laura Brancheau 517-335-1334 BrancheauL@michigan.gov

Program Managers for

Multi-Agency and Statewide Contracts

CHANGE NOTICE NO. 16 TO CONTRACT NO. MA071B4300150C

ENTERPRISE PROCUREMENT

Department of Technology, Management, and Budget 320 S. Walnut Street 2nd Floor Lansing, MI 48933

P.O. BOX 30026 LANSING, MICHIGAN 48909

CONTRACT CHANGE NOTICE

CONTRACT SUMMARY

RE-TRAC Connect

INITIAL EFFECTIVE DATE INITIAL EXPIRATION DATE INITIAL AVAILABLE OPTIONS EXPIRATION DATE

BEFORE

September 11, 2014 September 10, 2015 8 - 12 Months September 10, 2024

PAYMENT TERMS DELIVERY TIMEFRAME

ALTERNATE PAYMENT OPTIONS EXTENDED PURCHASING

MINIMUM DELIVERY REQUIREMENTS

P-Card Direct Voucher (PRC) Other Yes No

401-250 McDermot Ave.

Winnipeg MB R3B 0S5

Jennifer Peters

204-772-7239 ap@emergeknowledge.com

CV0067009

EMERGE KNOWLEDGE DESIGN INC.

C O

N

TR

A C

TO

R

Jarrod Barron

(517) 249-0406

DTMB

Various Various

BarronJ1@michigan.gov

C ontract

A dm inistrator Program M anagerSTA

TE

Change Notice Number 15

Contract Number MA071B4300150C to

DESCRIPTION OF CHANGE NOTICE

OPTION EXTENSIONLENGTH OF OPTION LENGTH OF EXTENSION REVISED EXP. DATE

CURRENT VALUE VALUE OF CHANGE NOTICE ESTIMATED AGGREGATE CONTRACT VALUE

24 Months September 10, 2026

$1,564,429.01 $0.00 $1,564,429.01

DESCRIPTION

Effective 8/26/2024, the State exercises two option years, utilizing $303,800.00 of existing contract funds to renew ongoing services ($151,900 for each year). The parties also revise and fully restate the Schedule A Key Personnel list from the current version the attached list. All other terms, conditions, specifications and pricing remain the same. Per Contract, agency, and DTMB Central Procurement approval. Internal State Note: Remaining Ad Board funds after this change: $179,354.99.

DTMB Laura Brancheau 517-335-1334 BrancheauL@michigan.gov

EGLE Steve Noble 517-449-6153 NobleS4@michigan.gov

Program Managers for

CHANGE NOTICE NO. 15 TO CONTRACT NO. MA071B4300150C

SCHEDULE A

KEY PERSONNEL

For Contract Number 071B4300150

Contractor designates the following staff as Contractor Key Personnel:

1. Jennifer Peters, Administrative Officer (jen@emergeknowledge.com)

2. Hudson Gevaert, Director of Software Engineering (hudson@emergeknowledge.com)

3. Dan Butcher, Senior Solutions Manager [also called Senior Customer Success Manager] (dan@emergeknowledge.com) mailto:jen@emergeknowledge.com mailto:hudson@emergeknowledge.com mailto:dan@emergeknowledge.com

CENTRAL PROCUREMENT SERVICES

Department of Technology, Management, and Budget

320 S. WALNUT ST., LANSING, MICHIGAN 48933

P.O. BOX 30026 LANSING, MICHIGAN 48909

CONTRACT CHANGE NOTICE

Change Notice Number 14 to Contract Number 071B4300150

Various

Sarah Platte ap@emergeknowledge.com

Jennifer Peters

Winnipeg, MB R3B 0S5

EMERGE KNOWLEDGE DESIGN INC.

CV0067009

204-772-7239

401-250 McDermot Ave.

517-219-2406 S

T A

T E

P ro g ra m

M a n a g e r

C o n tra ct

A d m in istra to r

C O

N T R A C T O

R

DTMB

plattes3@michigan.gov

$1,564,429.01

September 11, 2014 September 10, 2024

RE-TRAC CONNECT

September 10, 2015

INITIAL AVAILABLE OPTIONS EXPIRATION DATE

BEFORE

8 - 1 Year

PAYMENT TERMS DELIVERY TIMEFRAME

ALTERNATE PAYMENT OPTIONS EXTENDED PURCHASING

☐ P-Card ☐ PRC ☐ Other ☐ Yes ☒ No

MINIMUM DELIVERY REQUIREMENTS

DESCRIPTION OF CHANGE NOTICE

OPTION LENGTH OF OPTION EXTENSION LENGTH OF EXTENSION REVISED EXP. DATE

☐ ☐ September 10, 2024

CURRENT VALUE VALUE OF CHANGE NOTICE ESTIMATED AGGREGATE CONTRACT VALUE

$0.00 $1,564,429.01

Effective 11/27/2023, the parties add the attached Statement of Work is to add services to Configure, conduct quality assurance, and deploy analytical reports as identified in the Deliverables section of this document. Additionally, this change will allow for a move of $33,530.00 from Discovery SOW to this Statement of Work and a move of $113,000.00 from Discovery SOW to Enhancements Statement of Work. This is a zero dollar change.

Per DTMB contractor and agency agreement, DTMB Central Procurement Services approval, and the State Administrative Board approval on 8/8/2023.

INITIAL EXPIRATION DATEINITIAL EFFECTIVE DATE

DESCRIPTION

CONTRACT SUMMARY

EGLE

Program Managers for

CHANGE NOTICE NO. 14 TO CONTRACT NO. 071B4300150

Steve Noble 517-449-6153 NobleS4@michigan.govEGLE

Laura Brancheau 517-335-1334 BrancheauL@michigan.govDTMB

MICHIGAN DEPARTMENT OF TECHNOLOGY,

MANAGEMENT AND BUDGET

IT SERVICES

STATEMENT OF WORK FOR IT CHANGE NOTICES

Project Title:

Re-TRAC Analytics Services Requesting Department: Department of Environment, Great Lakes, and Energy (EGLE) – Materials Management Division (MMD)

Date:

10/25/2023

Agency Project Manager:

Noble, Steve

Phone:

517-449-6153

DTMB Project Manager:

Brancheau, Laura

Phone:

517-335-1334

Brief Description of Services to be provided:

BACKGROUND:

The Solid Waste Section of the Materials Management Division (MMD) is continuing its buildout of the Re-TRAC Connect™ platform to modernize its registration, reporting, and materials management programs as required by various regulations.

Upon acceptance, this SOW would be governed by the terms and conditions of Contract 071B4300150.

PROJECT OBJECTIVE:

Obtain Professional Services for configuration, quality assurance, and deployment of new analytical reports to expand upon the current use of the existing Re-TRAC™ reporting system.

SCOPE OF WORK:

• Configure, conduct quality assurance, and deploy analytical reports as identified in the

Deliverables section of this document. Detailed requirements as reviewed and agreed upon are outlined in Appendix A and Appendix B of this document.

• Move funds from the Discovery SOW of the project (as outlined in Change Notice #10) as follows:

• Move $33,530.00 from Discovery SOW to this Statement of Work

• Move $113,000.00 from Discovery SOW to Enhancements SOW

PROFESSIONAL SERVICES:

Emerge Knowledge agrees to provide Professional Services to configure, conduct quality assurance, and deploy the new analytical reports requested by EGLE/MMD as itemized in the Deliverables section of this document.

DELIVERABLES:

Deliverables will not be considered complete until the Agency Project Manager has formally accepted them.

Deliverables for this project include the following ten (10) analytical reports configured, quality assurance completed, and deployed to production:

Group 1: Source Separated and Recyclable Materials

1. MRF Origin by Material & County

2. In-State Material Totals

3. Out-of-State Material Totals

4. Registration Summary Report

5. Contact Information

6. Shipped To Report

Group 2: Diverted Materials Authorization Program

1. Materials Shipped Total

2. Shipped Total By Facility

3. Materials Received by Facility

4. Materials Received Totals

ACCEPTANCE CRITERIA:

Deliverables will not be considered complete until the EGLE Project Manager has formally accepted them. The following acceptance criteria apply to this project’s deliverables:

• Analytical reports reviewed on a test site (non-production) for compliance with requirements and with acceptance provided in writing via email. This step is necessary to prevent requested changes to reports after they are deployed to production. A minimum of 15 days is needed after EGLE provides acceptance of the analytical reports, as reviewed on the test site, for Emerge to conduct quality assurance and deployment of the analytical reports to production.

• Analytical reports deployed to production.

PROJECT CONTROL AND REPORTS:

A billing invoice will be submitted upon the completion of services for each grouping (one report and one invoice for each group). In the event that all ten (10) reports are completed on the same schedule, one billing invoice will be submitted.

SPECIFIC DEPARTMENT STANDARDS:

Agency standards, if any, in addition to DTMB standards.

PROJECT SCHEDULE

The parties estimate the services will be provided according to the following schedule. The parties may modify this schedule by mutual agreement if needed.

Item Proposed Start Date Proposed End Date Group 1 Source Separated and Recyclable Materials

November 1, 2023 February 5, 2024

Group 2 Diverted Materials Authorization Program

November 1, 2023 February 5, 2024

PAYMENT SCHEDULE:

Contractor will invoice for Professional Services at the rates outlined in the IT Professional Services Hourly Rate by Labor Category table in the contract. Total cost will not exceed

$33,530.00. DTMB will pay Contractor upon receipt of properly completed invoice(s) which shall be submitted to the billing address on the State issued purchase order or to DTMB-Accounts- Payable@michigan.gov if specified by DTMB, not more often than monthly. DTMB Accounts Payable area will coordinate obtaining Agency and DTMB Project Manager approvals. All invoices should reflect actual hours expended and actual work completed by payment date and must be approved by the Agency and DTMB Project Manager prior to payment. The invoices shall describe and document to the State’s satisfaction a description of the work performed and fees.

EXPENSES:

The State will NOT pay for any travel expenses, including hotel, mileage, meals, parking, etc.

PROJECT CONTACTS:

The designated Agency Project Manager is:

Steve Noble

Materials Management Division Constitution Hall 525 W Allegan St Lansing, MI 48933 517-449-6153 Nobles4@michigan.gov

The designated DTMB Project Manager is:

Laura Brancheau

DTMB

Agency Services supporting EGLE, DNR, MDARD, DMVA Constitution Hall, Floor 1, North Tower 525 W Allegan St Lansing, MI 48933

BrancheauL@michigan.gov

AGENCY RESPONSIBILITIES:

EGLE (Agency) will provide staff to be available to answer questions that may arise during the configuration of the analytical reports and for review of the analytical reports on the test system prior to deployment to production.

LOCATION OF WHERE THE WORK IS TO BE PERFORMED:

All services to be provided remotely from Contractor’s location. Contractor is responsible for providing web conference and audio conference tools as needed to support project communication from its (remote) work location.

EXPECTED CONTRACTOR WORK HOURS AND CONDITIONS:

Work hours are not to exceed eight (8) hours a day, forty (40) hours a week. Normal working hours of 8:00 am to 5:00 pm EST are to be observed unless otherwise agreed to in writing. No overtime will be permitted.

mailto:DTMB-Accounts-Payable@michigan.gov mailto:Nobles4@michigan.gov mailto:BrancheauL@michigan.gov

Appendix A

Appendix B

Department of Technology, Management, and Budget

320 S. WALNUT ST., LANSING, MICHIGAN 48933

P.O. BOX 30026 LANSING, MICHIGAN 48909

CONTRACT CHANGE NOTICE

Change Notice Number 13 to Contract Number 071B4300150

Various

Sarah Platte ap@emergeknowledge.com

Jennifer Peters

Winnipeg, MB R3B 0S5

EMERGE KNOWLEDGE DESIGN INC.

CV0067009

204-772-7239

401-250 McDermot Ave.

517-219-2406 S

T A

T E

P ro g ra m a n a g e r

C o n tra ct

A d m in istra to r

C O

N T R A C T O

R

DTMB

plattes3@michigan.gov

$1,412,529.01

September 11, 2014 September 10, 2023

RE-TRAC CONNECT

September 10, 2015

INITIAL AVAILABLE OPTIONS EXPIRATION DATE

BEFORE

8 - 1 Year

PAYMENT TERMS DELIVERY TIMEFRAME

ALTERNATE PAYMENT OPTIONS EXTENDED PURCHASING

☐ P-Card ☐ PRC ☐ Other ☐ Yes ☒ No

MINIMUM DELIVERY REQUIREMENTS

DESCRIPTION OF CHANGE NOTICE

OPTION LENGTH OF OPTION EXTENSION LENGTH OF EXTENSION REVISED EXP. DATE

☒ 1 Year ☐ September 10, 2024

CURRENT VALUE VALUE OF CHANGE NOTICE ESTIMATED AGGREGATE CONTRACT VALUE

$151,900.00 $1,564,429.01

Effective 8/11/2023, the State will be exercising one of the option years available on the Contract and the revised expiration date is 9/10/2024. Funds in the amount of $151,900.00 to support this option year was established in CN 7.

Additionally, the parties add the attached Statement of Work. As agreed, it removes some of the items that were added to the Contract on Change Notice 4. The uncompleted items to be removed are outlined in the Statement of Work.

Per DTMB contractor and agency agreement, DTMB Central Procurement Services approval, and the State Administrative Board approval on 8/8/2023.

INITIAL EXPIRATION DATEINITIAL EFFECTIVE DATE

DESCRIPTION

Program Managers for

CHANGE NOTICE NO. 13 TO CONTRACT NO. 071B4300150

Department of Technology, Management, and Budget

320 S. WALNUT ST., LANSING, MICHIGAN 48933

P.O. BOX 30026 LANSING, MICHIGAN 48909

CONTRACT CHANGE NOTICE

Change Notice Number 12 to 071B4300150Contract Number

Various

Sarah Platte ap@emergeknowledge.com

Jennifer Peters

Winnipeg, MB R3B 0S5

EMERGE KNOWLEDGE DESIGN INC.

CV0067009

204-772-7239

401-250 McDermot Ave.

517-219-2406 S

T A

T E

P ro g ram an ag er C o n tract A d m in istrato r

C O

N T

R A

C T

O R

DTMB

plattes3@michigan.gov

$1,260,629.01

September 11, 2014 September 10, 2023

RE-TRAC CONNECT

September 10, 2015

INITIAL AVAILABLE OPTIONS EXPIRATION DATE

BEFORE

8 - 1 Year

PAYMENT TERMS DELIVERY TIMEFRAME

ALTERNATE PAYMENT OPTIONS EXTENDED PURCHASING

☐ P-Card ☐ PRC ☐ Other ☐ Yes ☒ No

MINIMUM DELIVERY REQUIREMENTS

DESCRIPTION OF CHANGE NOTICE

OPTION LENGTH OF OPTION EXTENSION LENGTH OF EXTENSION REVISED EXP. DATE

☐ ☐ September 10, 2023

CURRENT VALUE VALUE OF CHANGE NOTICE ESTIMATED AGGREGATE CONTRACT VALUE

$151,900.00 $1,412,529.01

Effective 11/14/2022, the State adds funding in the amount of $151,900.00 to support the one-year option that was taken in Change Notice 11. Funds for additional option years was established in CN 7.

Per DTMB contractor and agency agreement, DTMB Central Procurement Services approval, and the State Administrative Board approval on 9/7/2021.

INITIAL EXPIRATION DATEINITIAL EFFECTIVE DATE

DESCRIPTION

Program Managers for

CHANGE NOTICE NO. 12 TO CONTRACT NO. 071B4300150

Department of Technology, Management, and Budget

320 S. WALNUT ST., LANSING, MICHIGAN 48933

P.O. BOX 30026 LANSING, MICHIGAN 48909

CONTRACT CHANGE NOTICE

Change Notice Number 11 to 071B4300150Contract Number

Various

Sarah Platte ap@emergeknowledge.com

Jennifer Peters

Winnipeg, MB R3B 0S5

EMERGE KNOWLEDGE DESIGN INC.

CV0067009

204-772-7239

401-250 McDermot Ave.

517-219-2406 S

T A

T E

P ro ag er C o n tract A d m in istrato r

C O

N T

R A

C T

O R

DTMB

plattes3@michigan.gov

$1,260,629.01

September 11, 2014 September 10, 2022

RE-TRAC CONNECT

September 10, 2015

INITIAL AVAILABLE OPTIONS EXPIRATION DATE

BEFORE

8 - 1 Year

PAYMENT TERMS DELIVERY TIMEFRAME

ALTERNATE PAYMENT OPTIONS EXTENDED PURCHASING

☐ P-Card ☐ PRC ☐ Other ☐ Yes ☒ No

MINIMUM DELIVERY REQUIREMENTS

DESCRIPTION OF CHANGE NOTICE

OPTION LENGTH OF OPTION EXTENSION LENGTH OF EXTENSION REVISED EXP. DATE

☒ 1 year ☐ September 10, 2023

CURRENT VALUE VALUE OF CHANGE NOTICE ESTIMATED AGGREGATE CONTRACT VALUE

$0.00 $1,260,629.01

Effective 8/19/2022, the State will be exercising one of the option years available on the Contract and the revised expiration date is 9/10/2023. Funding for this option year was established in CN 7.

Per DTMB contractor and agency agreement, DTMB Central Procurement Services approval, and the State Administrative Board approval on 9/7/2021.

INITIAL EXPIRATION DATEINITIAL EFFECTIVE DATE

DESCRIPTION

Program Managers for

CHANGE NOTICE NO. 11 TO CONTRACT NO. 071B4300150

Department of Technology, Management, and Budget

525 W. ALLEGAN ST., LANSING, MICHIGAN 48913

P.O. BOX 30026 LANSING, MICHIGAN 48909

CONTRACT CHANGE NOTICE

Change Notice Number 10 to 071B4300150Contract Number

Various

Sarah Platte ap@emergeknowledge.com

Jennifer Peters

Winnipeg, MB R3B 0S5

EMERGE KNOWLEDGE DESIGN INC.

CV0067009

204-772-7239

401-250 McDermot Ave.

(517) 241-7000 S

T A

T E

P ro ag er C o n tract A d m in istrato r

C O

N T

R A

C T

O R

DTMB

plattes3@michigan.gov

$895,684.01

September 11, 2014 September 10, 2022

RE-TRAC CONNECT

September 10, 2015

INITIAL AVAILABLE OPTIONS EXPIRATION DATE

BEFORE

3 - 1 Year

PAYMENT TERMS DELIVERY TIMEFRAME

ALTERNATE PAYMENT OPTIONS EXTENDED PURCHASING

☐ P-Card ☐ PRC ☐ Other ☐ Yes ☒ No

MINIMUM DELIVERY REQUIREMENTS

DESCRIPTION OF CHANGE NOTICE

OPTION LENGTH OF OPTION EXTENSION LENGTH OF EXTENSION REVISED EXP. DATE

☐ ☐ September 10, 2022

CURRENT VALUE VALUE OF CHANGE NOTICE ESTIMATED AGGREGATE CONTRACT VALUE

$350,000.00 $1,245,684.01

Effective 3/18/2022, the parties add the attached Statements of Work to the Contract. The first one is to obtain professional services that will alow the State to expand the current use of the existing Re-TRAC reporting system to include additional Authorizations Programs and the Materials Management Planning program. The second Statement of Work outlines the operational procedures for minor enhancements to the Re-TRAC Connect platform. To support the new Statements of Work, the State adds $350,000.00 in funding to the Contract.

All other terms, conditions, specifications, and pricing remain the same. Per Contractor, Agency, and DTMB Central Procurement approval.

INITIAL EXPIRATION DATEINITIAL EFFECTIVE DATE

DESCRIPTION

Program Managers for

CHANGE NOTICE NO. 10 TO CONTRACT NO. 071B4300150

MANAGEMENT AND BUDGET

IT SERVICES

STATEMENT OF WORK FOR IT CHANGE NOTICES

Project Title:

Re-TRAC Requirements Gathering/Discovery Services Requesting Department: EGLE – Materials Management Division Date:

01/19/2022 Agency Project Manager:

Noble, Steve

Phone:

517-449-6153

DTMB Project Manager:

Brancheau, Laura

Phone:

517-335-1334

Brief Description of Services to be provided:

BACKGROUND:

The Solid Waste Section of the Materials Management Division (MMD) is continuing its buildout of the Re-TRAC Connect™ platform to modernize its registration, reporting, and materials management programs as required by various regulations.

Upon acceptance, this SOW would be governed by the terms and conditions of Contract 071B4300150.

PROJECT OBJECTIVE:

Obtain Professional Services for discovery, requirements analysis, requirements documentation and finalization to expand upon the current use of the existing Re-TRAC™ reporting system to include additional Authorizations Programs and the Materials Management Planning (MMP) program.

SCOPE OF WORK:

• The scope of work includes professional services for discovery, requirements analysis, and related documentation to expand the use of the Re-TRAC Connect™ reporting system to the MMP program and any additional Authorizations Programs. The scope for this effort will include a high level analysis of the programs required as well as requirements analysis needed to define and configure the surveys and document the report specifications.

• The scope of this work will be broken into four phases.

o The first phase (Phase I) of the work under this Statement of Work is to engage

Emerge in a series of discussions to define future programs, how those programs interrelate, determine the dependencies between programs and produce a schedule for developing those programs.

o The second phase (Phase II) is to define the surveys and reports required for the Authorization Programs and MMP program, (or next prioritized program as defined in the initial phase) and configure draft surveys to support those programs. Discussions will be held to determine what surveys are required, define the fields contained in the surveys, define the fields for the reports/analytics and define the report output.

o The third phase (Phase III) is to secure approval/signoff and complete quality assurance to finalize the surveys and secure approval/signoff on the final report specifications.

o The fourth phase (Phase IV) would be to deploy/launch to production the surveys that have been configured and approved for a given program, at EGLE’s direction.

Note: Each new program would need to follow Phase II, Phase III and Phase IV in that order.

For any analytical report specifications approved/signed off in Phase III, a separate SOW would be developed for the configuration, quality assurance, and deployment of those analytical reports.

If/when legislative changes occur, Emerge and EGLE would work together to revise the order of work outlined in the project plan under Phase I and develop an agreed upon schedule.

PROFESSIONAL SERVICES:

Emerge Knowledge agrees to provide Professional Services to support the identification of the programs that EGLE would like to develop, any dependencies between programs, and a high level timeline. The output of those activities will be a ‘roadmap’ that outlines programs to be developed, estimated timeframes, and dependencies.

Emerge Knowledge also agrees to provide Professional Services for discovery and requirements analysis activities for the MMP program and any additional Authorizations Programs. This will include configuration of draft surveys, definition of report fields and output, and documentation of the report specifications.

DELIVERABLES:

Deliverables will not be considered complete until the Agency Project Manager has formally accepted them.

Deliverables for this project include the following items as supported by the SOW budget (i.e., “total cost will not exceed” dollar amount):

• Phase I o Discovery activities to outline specific programs, dependencies, and timeline for additional EGLE programs including the Materials Management Planning (MMP) and any Authorization Programs (AP). Determine dependencies for data entry from the EGLE Mega Data project and Emerge’s Municipal Measurement Program (eMMP)

• Phase II o Discovery and requirements analysis for the MMP program and any additional

Authorizations Programs o Discovery and requirements analysis for analytics and reports to support the MMP program and any additional Authorizations Programs o Draft configured surveys for the MMP program o Draft configured surveys for additional Authorizations Programs o Participation in review and feedback cycles o Explore importation of data from external sources and multiple Re-TRAC programs

• Phase III o Signoff/approval of draft surveys outlined in Phase II including quality assurance (in a non-production environment) for finalization of surveys o Participation in review and feedback cycles o Signoff/approval of report specifications

• Phase IV o Surveys configured in Phase II and approved in Phase III, deployed/launched in the production environment

• Document deliverables to include:

o Schematic (or similar documentation) to outline programs to be configured and related configuration timeline. Updates may occur to this document as additional programs are added.

o Draft and final requirements documentation which specifies the layout and data contained in the analytics (reports) needed to support the MMP program and any additional Authorizations Programs identified o Project status reports

• Project Review meetings

ACCEPTANCE CRITERIA:

Deliverables will not be considered complete until the EGLE Project Manager has formally accepted them.

The following acceptance criteria apply to this project’s deliverables:

1. Requirements sessions complete

2. Review and feedback cycles complete

3. Final requirements documents complete

4. Draft surveys configured and quality assurance completed (in a non-production environment) ready to launch to production)

PROJECT CONTROL AND REPORTS:

For efficiency (and to achieve cost savings while also achieving quality project control), Emerge Knowledge will submit a monthly progress report to the Agency and DTMB Project Managers throughout the life of this SOW. This report will be submitted with the billing invoice. Each monthly progress report will contain the following:

1. Hours: Indicate the number of hours expended during the past reporting month, the amount of time spent on each high level task, and the cumulative totals to date for the project.

2. Accomplishments: Indicate what was worked on and what was completed during the current reporting period.

3. Funds: Indicate the amount of funds expended during the current reporting period, and the cumulative total to date for the project.

SPECIFIC DEPARTMENT STANDARDS:

Agency standards, if any, in addition to DTMB standards.

PROJECT SCHEDULE

The parties estimate the services will be provided according to the following schedule. The parties may modify this schedule by mutual agreement if needed.

Item Proposed Start Date Proposed End Date Phase I Minimum of one (1) working meeting per week for first four (4) weeks (Feb 7 – March 5)

February 7, 2022 March 25, 2022

Phase II March 28, 2022 Varies by program Phase III Varies by program Varies by program Phase IV Varies by program Varies by program

It is anticipated that each program will follow the phases sequentially. If changes are required to add new programs due to legislative changes or other priorities that arise, Emerge and EGLE will revisit the schedule that was developed in Phase I to make necessary, agreed upon changes.

PAYMENT SCHEDULE:

Contractor will invoice for Professional Services at the rates outlined in the IT Professional Services Hourly Rate by Labor Category table in the contract. Total cost will not exceed $250,000.00. DTMB will pay Contractor upon receipt of properly completed invoice(s) which shall be submitted to the billing address on the State issued purchase order or to DTMB-Accounts-

Payable@michigan.gov if specified by DTMB, not more often than monthly. DTMB Accounts Payable area will coordinate obtaining Agency and DTMB Project Manager approvals. All invoices should reflect actual hours expended and actual work completed by payment date and must be approved by the Agency and DTMB Project Manager prior to payment. The invoices shall describe and document to the State’s satisfaction a description of the work performed and fees. Progress of the project will be described and documented on the supporting project reports.

EXPENSES:

The State will NOT pay for any travel expenses, including hotel, mileage, meals, parking, etc.

PROJECT CONTACTS:

The designated Agency Project Manager is:

Steve Noble

EGLE

Materials Management Division Constitution Hall 525 W Allegan St Lansing, MI 48933 517-449-6153 Nobles4@michigan.gov

The designated DTMB Project Manager is:

Laura Brancheau

DTMB

Agency Services supporting EGLE, DNR, MDARD, DMVA Constitution Hall, Floor 1, North Tower 525 W Allegan St Lansing, MI 48933 517-335-1334 BrancheauL@michigan.gov

AGENCY RESPONSIBILITIES:

EGLE (Agency) will provide staff to be available for requirements validation, project status meetings and document review.

LOCATION OF WHERE THE WORK IS TO BE PERFORMED:

All services to be provided remotely from Contractor’s location. Contractor is responsible for providing web conference and audio conference tools as needed to support project communication from its (remote) work location.

EXPECTED CONTRACTOR WORK HOURS AND CONDITIONS:

Work hours are not to exceed eight (8) hours a day, forty (40) hours a week. Normal working hours of 8:00 am to 5:00 pm EST are to be observed unless otherwise agreed to in writing.

No overtime will be permitted.

mailto:DTMB-Accounts-Payable@michigan.gov

MANAGEMENT AND BUDGET

IT SERVICES

STATEMENT OF WORK FOR IT CHANGE NOTICES

Project Title:

Enhancement Update Services Requesting Department: EGLE - MMD - Solid Waste

Date:

01/19/2022

Agency Project Manager:

Noble, Steve

Phone:

517-449-6153

DTMB Project Manager:

Brancheau, Laura

Phone:

517-335-1334

Brief Description of Services to be provided:

BACKGROUND:

The Solid Waste Section of the Materials Management Division (MMD) is continuing its onboarding of the Re-TRAC Connect™ platform to modernize its registration, reporting, and materials management programs as required by various regulations.

Upon acceptance, this SOW would be governed by the terms and conditions of Contract 071B4300150.

PROJECT OBJECTIVE:

To outline operational procedures for requests for minor enhancements and updates to existing surveys, analytics, and any changes needed within Programs. Each request cannot exceed 50 hours in effort. Work charged against these hours must be pre-approved. Any single enhancement that exceeds the above number of hours will require a separate contract change notice. Once the total enhancements exceed an annual amount of $100,000.00, contract change notices must be initiated to include the increase to that year’s annual amount. Update services include activities that take under 1 hour to complete by Emerge and can be accommodated without a prior estimate or approval. These may include but are not limited to activities such as opening and closing surveys, various member update activities, and small analytic tweaks.

SCOPE OF WORK:

The scope of work for any individual enhancement item will be documented and requested via email. The request will include a target delivery date for the enhancement. Attachments such as documents, mockups or spreadsheets should be included to provide detailed information for the request. Additional correspondence, including remote meetings, may be required to clarify requirements.

PROFESSIONAL SERVICES:

For each enhancement request received, Emerge Knowledge agrees to provide a high level estimate of number of hours in order to determine if the work falls under the maximum number of hours per request. If the request would fall under the threshold stated in the Project Objective section of this document, EGLE will approve the work and Emerge can add the enhancement to the schedule. If multiple enhancements have been requested, EGLE will work with Emerge to determine the priority of items to be developed. Note: Any request (such as opening or closing surveys) which takes less than 1 hour can be accommodated without a prior estimate and can be completed by Emerge upon EGLE’s request.

DELIVERABLES:

Deliverables will not be considered complete until the Agency Project Manager has formally accepted them.

Deliverables for each enhancement request will be outlined in the request. Deliverables for this project may include but are not limited to the following items:

• Deployment of any edits (and quality assurance as required) to existing surveys or analytics in production environment as outlined in each approved request

• Opening and closing of surveys per schedule provided by EGLE

• Deployment of any new or edits to existing JSON exports

• Changes/updates to Program Manager access

• Email changes from the system

• Changes to member type by program

ACCEPTANCE CRITERIA:

Deliverables will not be considered complete until the EGLE Project Manager has formally accepted them. The following acceptance criteria apply to this project’s deliverables:

1. Updates to existing surveys and analytics have been successfully deployed to the production environment

2. Updates have been completed as outlined in submitted and approved request

PROJECT CONTROL AND REPORTS:

For efficiency (and to achieve cost savings while also achieving quality project control), Emerge Knowledge will submit a monthly progress report to the Agency and DTMB Project Managers throughout the life of this project. This report will be submitted with the billing invoice. Each monthly progress report will indicate what was worked on and what was completed during the current reporting period.

1. Hours: Indicate the number of hours expended during the past reporting month for a given enhancement request. Indicate remaining hours for a given enhancement request.

2. Accomplishments: Indicate what was working on and what was completed during the current reporting period of a given enhancement request.

3. Funds: For a given enhancement, indicate the amount of funds expended during the current reporting period.

SPECIFIC DEPARTMENT STANDARDS:

Agency standards, if any, in addition to DTMB standards.

PROJECT SCHEDULE

Requests will be scheduled based on the target completion date requested by EGLE and the availability of Emerge staff to complete the request. The parties may modify the schedule by mutual agreement if needed.

Contractor will invoice for Professional Services at the rates outlined in the IT Professional Services Hourly Rate by Labor Category table in the contract. DTMB will pay Contractor upon receipt of properly completed invoice(s) which shall be submitted to the billing address on the State issued purchase order or to DTMB-Accounts-Payable@michigan.gov if specified by DTMB not more than monthly. DTMB Accounts Payable area will coordinate obtaining Agency and DTMB Project Manager approvals. All invoices should reflect actual work completed by payment date and must be approved by the Agency and DTMB Project Manager prior to payment. The invoices shall describe and document to the State’s satisfaction a description of the work performed and associated fee amounts.

The designated Agency Project Manager is:

Steve Noble

Materials Management Division Constitution Hall 525 W Allegan St Lansing, MI 48933

The designated DTMB Project Manager is:

Agency Services supporting EGLE, DNR, MDARD Constitution Hall, Floor 1, North Tower 525 W Allegan St Lansing, MI 48933

EGLE (Agency) will provide staff to be available for requirements validation, project status meetings and document review.

All services to be provided remotely from Contractor’s location. Contractor is responsible for providing web conference and audio conference tools as needed to support project communication from its (remote) work location.

Work hours are not to exceed eight (8) hours a day, forty (40) hours a week. Normal working hours of 8:00 am to 5:00 pm EST are to be observed unless otherwise agreed to in writing.

No overtime will be permitted.

Department of Technology, Management, and Budget

525 W. ALLEGAN ST., LANSING, MICHIGAN 48913

P.O. BOX 30026 LANSING, MICHIGAN 48909

CONTRACT CHANGE NOTICE

Change Notice Number 9 to 071B4300150Contract Number

Various

Sarah Platte ap@emergeknowledge.com

Jennifer Peters

Winnipeg, MB R3B 0S5

EMERGE KNOWLEDGE DESIGN INC.

CV0067009

204-772-7239

401-250 McDermot Ave.

(517) 241-7000 S

T A

T E

P ro ag er C o n tract A d m in istrato r

C O

N T

R A

C T

O R

DTMB

plattes3@michigan.gov

$895,684.01

September 11, 2014 September 10, 2022

RE-TRAC CONNECT

September 10, 2015

INITIAL AVAILABLE OPTIONS EXPIRATION DATE

BEFORE

3 - 1 Year

PAYMENT TERMS DELIVERY TIMEFRAME

ALTERNATE PAYMENT OPTIONS EXTENDED PURCHASING

☐ P-Card ☐ PRC ☐ Other ☐ Yes ☒ No

MINIMUM DELIVERY REQUIREMENTS

DESCRIPTION OF CHANGE NOTICE

OPTION LENGTH OF OPTION EXTENSION LENGTH OF EXTENSION REVISED EXP. DATE

☐ ☐ September 10, 2022

CURRENT VALUE VALUE OF CHANGE NOTICE ESTIMATED AGGREGATE CONTRACT VALUE

$7,995.00 $903,679.01

Effective 12/07/2021 the State adds $7,995.00 to the Contract. The parties also add the attached Statement of Work to the Contract for the purpose of continuing the onboarding of the Re-TRAC Connect platform.

All other terms, conditions, specifications, and pricing remain the same. Per contractor, agency, and DTMB Central Procurement approval.

INITIAL EXPIRATION DATEINITIAL EFFECTIVE DATE

DESCRIPTION

Program Managers for

CHANGE NOTICE NO. 9 TO CONTRACT NO. 071B4300150

Updates to Authorization Programs and Analytics

Requesting Department: EGLE - MMD - Solid Waste

Date:

Agency Project Manager:

Noble, Steve

Phone:

517-449-6153

DTMB Project Manager:

Brancheau, Laura

The parties estimate the services will be provided according to the following schedule pending that the Change Notice authorizing this SOW is approved on or before December 6, 2021. The parties may modify this schedule by mutual agreement if needed.

Attachment A: Scrap Tire Hauler Registration analytic

Item Responsibility Proposed Schedule (dates) Configuration of draft analytic (report) according to specification in Attachment A

Contractor Will begin promptly upon SOW approval

Review and provide feedback (in writing) of any changes required to comply with the specification in Attachment A (note: new changes not documented in the specification cannot be accommodated excepting for minor text changes) OR review and provide acceptance (in writing) that the draft analytic complies with specification in Attachment A

EGLE 12/20/21 – 12/24/21

Implement feedback (if any) and QA Contractor 12/27/21 – 12/31/21 Deployment (after EGLE Business Hours) Contractor 01/14/2022 Michigan Scrap Tire Hauler Registration analytic available to EGLE

Contractor 01/17/2022

Attachment B: Scrap Tire Collection Site Survey updates

Configuration of draft analytic (report) Survey updates according to specification in Attachment B

Contractor Will begin promptly upon SOW approval

Review and provide feedback (in writing) of any changes required to comply with the specification in Attachment B (note: new changes not documented in the specification cannot be accommodated excepting for minor text changes) OR review and provide acceptance (in writing) that the draft analytic complies with specification in Attachment B

EGLE 12/20/21 – 12/24/21

Implement feedback (if any) and QA Contractor 12/27/21 – 12/31/21 Deployment (after EGLE Business Hours) Contractor 01/14/2022

Michigan Scrap Tire Collection Site survey edits

Attachment C: Scrap Tire Collection Site Registration analytic specification in Attachment C

Contractor Will begin promptly upon SOW approval

Review and provide feedback (in writing) of any changes required to comply with the specification in Attachment C (note: new changes not documented in the specification cannot be accommodated excepting for minor text changes) OR review and provide acceptance (in writing) that the draft analytic complies with specification in Attachment C

EGLE 12/20/21 – 12/24/21

Implement feedback (if any) and QA Contractor 12/27/21 – 12/31/21 Deployment (after EGLE Business Hours) Contractor 01/14/2022 Scrap Tire Collection Site Registration analytic

Attachment D: Scrap Tire End-user Survey updates

Configuration of draft analytic (report) Survey updates according to specification in Attachment D

Contractor Will begin promptly upon SOW approval

Review and provide feedback (in writing) of any changes required to comply with the specification in Attachment D (note: new changes not documented in the specification cannot be accommodated excepting for minor text changes) OR review and provide acceptance (in writing) that the draft analytic complies with specification in Attachment D

EGLE 12/20/21 – 12/24/21

Implement feedback (if any) and QA Contractor 12/27/21 – 12/31/21

Scrap Tire End-user Survey Edits available to EGLE Contractor 01/17/2022

Attachments E and F: Compost Facility Annual Report analytic specification in Attachments E and F

Contractor Will begin promptly upon SOW approval

Review and provide feedback (in writing) of any changes required to comply with the specifications in Attachments E and F (note: new changes not documented in the specification cannot be accommodated excepting for minor text changes) OR review and provide acceptance (in writing) that the draft analytic complies with specifications in Attachments E and F

EGLE 12/20/21 – 12/24/21

Implement feedback (if any) and QA Contractor 12/27/21 – 12/31/21 Deployment (after EGLE Business Hours) Contractor 01/14/2022 Composting Facility Annual Report analytic available to EGLE

Compost Facility Metric Report analytic (no attachment needed)

Composting Facility Metric Report analytic available to EGLE

Contractor 01/17/2022

Stock Analytics to Electronics and Compost Program

Item Responsibility Proposed Schedule (dates)

Stock Analytics available to EGLE Contractor 01/17/2022

MICHIGAN EGLE SCRAP TIRE HAULER REGISTRATION

Department of Environment, Great Lakes, and Energy, Materials Management Division

This scrap tire hauler registration is issued under Part 169, Scrap Tires, of the Natural Resources and Environmental Protection Act, 1994 PA 451, as amended, MCL 324.16901 et seq., (NREPA) (Part 169), to register the scrap tire hauler in the state of Michigan. This registration does not obviate the necessity of obtaining other authorizations as may be required by law.

This Registration is subject to revocation by the Department of Environment, Great Lakes, and Energy (Department) if the Department finds that the Registrant is not operating in accordance with Part 169. This Registration shall be retained by the applicant during the registration period and remains the property of the Department. Failure to comply with the terms and provisions of this registration may result in legal action leading to criminal penalties as stipulated in Part 169. The Registrant may only haul to registered collection sites, disposal areas licensed under Part 115, Solid Waste Management, of the NREPA, end-users, scrap tire processors, tire retailers or scrap tire recyclers that are in compliance with Part 169.

Jeff Spencer, Supervisor

Sustainable Materials Management Unit

Solid Waste Section

Materials Management Division

Department of Environment, Great Lakes, and Energy

YEAR: 2021

REGISTRANT/APPLICANT NAME: 8 Mile Service Shop

REGISTERED AGENT/OWNER: Rawny Markoz

SITE SPECIFIC NAME: 8 Mile Service Shop

HAULER PHYSICAL ADDRESS: 5435 East 8 Mile Road, Warren, Michigan, 48091

WDS ID NUMBER: 475611

MICHIGAN CORPORATE ID NUMBER: 800515299

COUNTY: Macomb

REGISTRATION NUMBER: H-50-03-0519

ISSUE DATE: 05/20/2021

EXPIRATION DATE: 01/31/2022

CONTACT: Rawny Markoz

PHONE NUMBER: (586) 443-1133

MAILING ADDRESS: 5435 East 8 Mile Road, Warren, Michigan, 48091

TYPE OF REGISTRATION: New

Attachment A

SCRAP TIRE COLLECTION SITE FACILITY FORM

Registration is required under authority of Section 16905 of Part 169, Scrap Tires, of the Natural Resources and Environmental Protection Act, 1994 PA 451, as amended. Failure to comply with the provisions of Part 169 may result in fines and/or imprisonment. For additional information, review Scrap Tire Program and Contact Information document, Scrap Tire FAQ, or contact EGLE- ScrapTire@michigan.gov.

SCRAP TIRE COLLECTION SITES ARE REQUIRED TO PAY AN ANNUAL FEE OF $200 WITH THEIR

REGISTRATION APPLICATION. TO PAY THIS FEE ONLINE, PLEASE VISIT the State of Michigan’s Scrap Tire PayPlace.

For other payment options, print out the Scrap Tire Collection Site Payment Information form along with a $200 check and mail to the cashier’s office.

*NOTE: THIS APPLICATION IS NOT ADMINISTRATIVELY COMPLETE UNTIL PAYMENT IS RECEIVED.

Throughout this survey PTE is defined as 1 Passenger Tire Equivalent.

EGLE MANAGED

Bond Number:

Use abbreviations followed by the bond number: Surety Bond (SB), Letter of Credit

(LOC), Certificate of Deposit (COD), Cash Bond (CB)

Type of Bond: (Select all that apply)*

Surety Bond

Enter Bond Amount:

Attachment B https://gcc01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.michigan.gov%2Fdocuments%2Fdeq%2FDEQ-WMRPD-PART-169-SCRAP-TIRE-PROGRAM-INFORMATION-SHEET_640118_7.pdf&data=02%7C01%7CMoneyC%40michigan.gov%7C1d5229ac41834f1c731508d85a5cc4e4%7Cd5fb7087377742ad966a892ef47225d1%7C0%7C0%7C637358701766244010&sdata=R0%2BCz7RteaxwSQ06oyWe5Ql0PYx60yR0bxrqFF2kLts%3D&reserved=0 https://gcc01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.michigan.gov%2Fdocuments%2Fdeq%2FDEQ-WMRPD-PART-169-SCRAP-TIRE-PROGRAM-INFORMATION-SHEET_640118_7.pdf&data=02%7C01%7CMoneyC%40michigan.gov%7C1d5229ac41834f1c731508d85a5cc4e4%7Cd5fb7087377742ad966a892ef47225d1%7C0%7C0%7C637358701766244010&sdata=R0%2BCz7RteaxwSQ06oyWe5Ql0PYx60yR0bxrqFF2kLts%3D&reserved=0 https://gcc01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.michigan.gov%2Fdocuments%2Fdeq%2Fdeq-tou-waste-faq-ScrapTireStatute_643652_7.pdf&data=02%7C01%7CMoneyC%40michigan.gov%7C1d5229ac41834f1c731508d85a5cc4e4%7Cd5fb7087377742ad966a892ef47225d1%7C0%7C0%7C637358701766244010&sdata=XGD5%2BNRRojtghaVifMFqWBetsQrsZUEFfeANZm2nWpo%3D&reserved=0 mailto:EGLE-ScrapTire@michigan.gov mailto:EGLE-ScrapTire@michigan.gov https://www.thepayplace.com/mi/deq/scraptire https://www.thepayplace.com/mi/deq/scraptire https://www.michigan.gov/documents/egle/EGLE-MMD-PART-169-SCRAP-TIRE-COLLECTION-SITE-REGISTRATION-PAYMENT-INFORMATION_711386_7.pdf

Irrevocable letter of credit

Enter Bond Amount:

Certificate of deposit

Enter Bond Amount:

Cash bond

Enter Bond Amount:

District Office: [picklist] [Options: Bay City, Cadillac, Detroit, Gaylord, Grand Rapids, Jackson, Kalamazoo, Lansing, Marquette, Warren]

Inspection Complete [Yes, No]

If Yes, Date of Inspection:

Registration Number: [text and number response]

Is this application administratively complete? [Yes, No]

If Yes, Date Administratively Complete:

If No, If administratively incomplete, EGLE Notes: [Text box]

Has this year’s registration been issued? [Yes, No]

If Yes, Date of Issuance: [date field]

Type of Registration: [First, Renewal, New New, Renewal, Lapsed]

Fee Received: [Yes, No]

If Yes, Date Received: [date field]

PORTABLE SHREDDING OPERATION

Does your facility use a portable tire chipper(s) for processing scrap tires? [Yes, No]

If Yes, Does the facility act as a collection site AND a Portable Shredding Operation?

[Yes, No the member only acts as a portable shredder]

If Yes, answer portable shredder bond info and then Continue through survey

PORTABLE SHREDDING OPERATIONS *

This section is voluntary but should be filled out if bonds are in place for portable shredding operations.

Bond Amount: $[number response only]*

Type of Bond: (Select all that apply)*

Surety Bond

Surety Bond Location Code

[EGLE managed field]

Irrevocable letter of credit

Irrevocable letter of Credit

Location Code [EGLE managed field]

Certificate of deposit

Certificate of Deposit Location

Code [EGLE managed field]

Cash bond

Cash Bond Location Code [EGLE managed field]

If No the Member only acts as a portable shredder, Is the portable shredder leased or rented? [yes, no]

What is the physical storage address for the member’s portable shredder(s)? *If rented, please provide address for the rental facility.

Street Address

City

State

Zip

PORTABLE SHREDDING OPERATIONS *

This section is voluntary but should be filled out if bonds are in place for portable shredding operations.

Bond Amount: $[number response only]*

Type of Bond: (Select all that apply)*

Surety Bond

Surety Bond Location Code [EGLE managed field]

Irrevocable letter of credit

Irrevocable letter of Credit Location

Code [EGLE managed field]

Certificate of deposit

Certificate of Deposit Location Code

[EGLE managed field]

Cash bond

Cash Bond Location Code [EGLE managed field]

*skip to certification at the end of this survey, no other questions are needed

If no, continue through survey

FACILITY INFORMATION

Is the owner or operator of the site a scrap tire processor? [Yes, No]

If Yes

Has the facility been in compliance for AT LEAST one year AND qualifies to be exempt from bonding? [Yes, No]

If Yes, [User is given access to the Scrap Tire Collection Site Annual

Report (IF Bond Exempt)

The member has been determined to be Bond Exempt. A new

Annual Report survey will be available once this Facility Form is submitted as complete.

Commercial Collection Site: If the site accepts scrap tires from other than your own business/residence and you want the site to be listed on the website as a commercial collection site, select ‘yes’ otherwise select ‘no’.

Is the facility a commercial collection site? [Yes No]

Are there multiple addresses/parcels within this location? [Yes, No]

If Yes, how many parcels? [number response]

Please provide a brief description of the property: [ text box description]

Please upload a legal description of property. Documentation will be required to be uploaded at the end of this survey.

LOCAL FIRE DEPARTMENT COVERING COLLECTION SITE

Fire Department Name:

Phone Number:

Format: ### - ### - ####

Address:

City:

State:

Zip Code:

A Scrap tire collection site may request a variance as described in Section 324.16903(1)(f).

Has the collection site requested a Tire Storage Requirement Variance from their local fire department: [Yes, No]

If Yes, Please check the applicable variance granted by the local fire department. Only one of the three can be granted by the local fire department.

Scrap tires shall be accumulated in piles no greater than 15 feet in height with horizontal dimensions no greater than 200 by 40 feet.

If selected, please describe the reason for the variance [type in response]

Scrap Tires shall not be within 20 feet of the property line or within 60 feet of a building or structure.

If selected, please describe the reason for the variance [type in response]

There shall be a minimum separation of 30 feet between scrap tire piles.

The open space between the piles shall at all times be free of rubbish, equipment, and other materials.

If selected, please describe the reason for the variance [type in response]

DOCUMENTATION OF PROPERTY OWNERSHIP

Does the facility have documentation of property ownership? [yes, no]

If Yes, What type of documentation does the facility have? (Select one of the following) [Warranty Deed; Land Contract; Other (describe)]

If Warranty Deed, how many parcels? [number response]

If Land Contract, how many parcels? [number response]

If…