Common use of EMPLOYEE PERSONAL INJURY DATA COLLECTION Clause in Contracts

EMPLOYEE PERSONAL INJURY DATA COLLECTION. (If injuries are in connection with rail equipment accident/incident, highway rail grade crossing accident or automobile accident, ensure that appropriate information is obtained, forms completed and that data entry personnel are aware that injuries relate to that specific event.) Injured Person Type: Passenger on train (C) Non-employee (N) (i.e., emp of another railroad, or, non-BNSF emp involved in vehicle accident, including company vehicles) Contractor/safety sensitive (F) Contractor/non-safety sensitive (G) Volunteer/safety sensitive (H) Volunteer/other non-safety sensitive (I) Non-trespasser (D) - to include highway users involved in highway rail grade crossing accidents who did not go around or through gates Trespasser (E) - to include highway users involved in highway rail grade crossing accidents who went around or through gates Non-trespasser (J) - Off railroad property If train involved, Train ID: Transmit attached information to Accident/Incident Reporting Center by: Fax 0-000-000-0000 or by Phone 0-000-000-0000 or email to: Xxxxxxxx-Xxxxxxxxx.Xxxxxx@XXXX.xxx Officer Providing Information: (Name) (Employee No.) (Phone #) REPORT PREPARED TO COMPLY WITH FEDERAL ACCIDENT REPORTING REQUIREMENTS AND PROTECTED FROM DISCLOSURE PURSUANT TO 49 U.S.C. 20903 AND 83 U.S.C. 490 NON-EMPLOYEE PERSONAL INJURY DATA COLLECTION INFORMATION REQUIRED TO BE COLLECTED PURSUANT TO FEDERAL REGULATION. IT SHOULD BE USED FOR COMPLIANCE WITH FEDERAL REGULATIONS ONLY AND IT IS NOT INTENDED TO PRESUME ACCEPTANCE OF RESPONSIBILITY OR LIABILITY.

EMPLOYEE PERSONAL INJURY DATA COLLECTION. (If injuries are in connection with rail equipment accident/incident, highway rail grade crossing accident or automobile accident, ensure that appropriate information is obtained, forms completed and that data entry personnel are aware that injuries relate to that specific event.) Injured Person Type: Passenger on train (C) Non-employee (N) (i.e., emp of another railroad,empof anotherrailroad, or, ,non-BNSF emp involved in vehicle accidentBNSFempinvolvedinvehicleaccident, including company vehicles) Contractor/safety sensitive (F) Contractor/non-safety sensitive (G) Volunteer/safety sensitive (H) Volunteer/other non-safety sensitive (I) Non-trespasser (D) - to include highway users involved in highway rail grade crossing accidents who did not go around or through gates Trespasser (E) - to include highway users involved in highway rail grade crossing accidents who went around or through gates Non-trespasser (J) - Off railroad property If train involved, Train ID: Transmit attached information to Accident/Incident Reporting Center by: Fax 0-000-000-0000 or by Phone 0-000-000-0000 or email to: Xxxxxxxx-Xxxxxxxxx.Xxxxxx@XXXX.xxx AND COPY TO: ROADMASTER Xxxxxx.Xxxxxxx0@XXXX.xxx & MANAGER PUBLIC PROJECTS Xxx.Xxxx@XXXX.xxx Officer Providing Information: (Name) (Employee No.) (Phone #) REPORT PREPARED TO COMPLY WITH FEDERAL ACCIDENT REPORTING REQUIREMENTS AND PROTECTED FROM DISCLOSURE PURSUANT TO 49 U.S.C. 20903 AND 83 U.S.C. 490 NON-EMPLOYEE PERSONAL INJURY DATA COLLECTION INFORMATION REQUIRED TO BE COLLECTED PURSUANT TO FEDERAL REGULATION. IT SHOULD BE USED FOR COMPLIANCE WITH FEDERAL REGULATIONS ONLY AND IT IS NOT INTENDED TO PRESUME ACCEPTANCE OF RESPONSIBILITY OR LIABILITY.

EMPLOYEE PERSONAL INJURY DATA COLLECTION. (If injuries are in connection with rail equipment accident/incident, highway rail grade crossing accident or automobile accident, ensure that appropriate information is obtained, forms completed and that data entry personnel are aware that injuries relate to that specific event.) Injured Person Type: Passenger on train (C) Non-employee (N) (i.e., emp of another railroad, or, non-BNSF emp involved in vehicle accident, including company vehicles) Contractor/safety sensitive (F) Contractor/non-safety sensitive (G) Volunteer/safety sensitive (H) Volunteer/other non-safety sensitive (I) Non-trespasser (D) - to include highway users involved in highway rail grade crossing accidents who did not go around or through gates Trespasser (E) - to include highway users involved in highway rail grade crossing accidents who went around or through gates Non-trespasser (J) - Off railroad property If train involved, Train ID: Transmit attached information to Accident/Incident Reporting Center by: Fax 0-000-000-0000 or by Phone 0-000-000-0000 or email to: Xxxxxxxx-Xxxxxxxxx.Xxxxxx@XXXX.xxx Officer Providing Information: (Name) (Employee No.) (Phone #) REPORT PREPARED TO COMPLY WITH FEDERAL ACCIDENT REPORTING REQUIREMENTS AND PROTECTED FROM DISCLOSURE PURSUANT TO 49 U.S.C. 20903 AND 83 U.S.C. 490 NONDocuSign Envelope ID: 882BBF40-EMPLOYEE 212E-4175-9AD8N-O6FN6-8E7M5P1LBO2FY6EFE PERSONAL INJURY DATA COLLECTION INFORMATION REQUIRED TO BE COLLECTED PURSUANT TO FEDERAL REGULATION. IT SHOULD BE USED FOR COMPLIANCE WITH FEDERAL REGULATIONS ONLY AND IT IS NOT INTENDED TO PRESUME ACCEPTANCE OF RESPONSIBILITY OR LIABILITY.

EMPLOYEE PERSONAL INJURY DATA COLLECTION. (If injuries are in connection with rail equipment accident/incident, highway rail grade crossing accident or automobile accident, ensure that appropriate information is obtained, forms completed and that data entry personnel are aware that injuries relate to that specific event.) Injured Person Type: Passenger on train (C) Non-employee (N) (i.e., emp of another railroad, or, non-BNSF emp involved in vehicle accident, including company vehicles) Contractor/safety sensitive (F) Contractor/non-safety sensitive (G) Volunteer/safety sensitive (H) Volunteer/other non-safety sensitive (I) Non-trespasser (D) - to include highway users involved in highway rail grade crossing accidents who did not go around or through gates Trespasser (E) - to include highway users involved in highway rail grade crossing accidents who went around or through gates Non-trespasser (J) - Off railroad property If train involved, Train ID: Transmit attached information to Accident/Incident Reporting Center by: Fax 0-000-000-0000 or by Phone 0-000-000-0000 or email to: Xxxxxxxx-Xxxxxxxxx.Xxxxxx@XXXX.xxx AND COPY TO: ROADMASTER Xxxx.Xxxxxxx@XXXX.xxx & MANAGER PUBLIC PROJECTS Xxx.Xxxx@XXXX.xxx Officer Providing Information: (Name) (Employee No.) (Phone #) REPORT PREPARED TO COMPLY WITH FEDERAL ACCIDENT REPORTING REQUIREMENTS AND PROTECTED FROM DISCLOSURE PURSUANT TO 49 U.S.C. 20903 AND 83 U.S.C. 490 NON-EMPLOYEE PERSONAL INJURY DATA COLLECTION INFORMATION REQUIRED TO BE COLLECTED PURSUANT TO FEDERAL REGULATION. IT SHOULD BE USED FOR COMPLIANCE WITH FEDERAL REGULATIONS ONLY AND IT IS NOT INTENDED TO PRESUME ACCEPTANCE OF RESPONSIBILITY OR LIABILITY.

EMPLOYEE PERSONAL INJURY DATA COLLECTION. (If injuries are in connection with rail equipment accident/incident, highway rail grade crossing accident or automobile accident, ensure that appropriate information is obtained, forms completed and that data entry personnel are aware that injuries relate to that specific event.) Injured Person Type: Passenger on train (C) Contractor/safety Non-employee (N) (i.e., emp of another railroad, or, non-BNSF emp involved in vehicle accident, including company vehicles) Contractor/safety sensitive (F) Contractor/non-safety sensitive (G) Volunteer/safety sensitive (H) Volunteer/other non-safety sensitive (I) Non-trespasser (D) - to include highway users involved in highway rail grade crossing accidents who did not go around or through gates Trespasser (E) - to include highway users involved in highway rail grade crossing accidents who went around or through gates Non-trespasser (J) - Off railroad property If train involved, Train ID: Transmit attached information to Accident/Incident Reporting Center by: Fax 0-000-000-0000 or by Phone 0-000-000-0000 or email to: Xxxxxxxx-Xxxxxxxxx.Xxxxxx@XXXX.xxx Accident- Xxxxxxxxx.Xxxxxx@XXXX.xxx Officer Providing Information: (Name) (Employee No.) (Phone #) REPORT PREPARED TO COMPLY WITH FEDERAL APPLICABLE ACCIDENT REPORTING REQUIREMENTS AND PROTECTED FROM DISCLOSURE PURSUANT TO 49 U.S.C. 20903 AND 83 U.S.C. 490 OTHERWISE THAN IN ACCORDANCE WITH APPLICABLE LAWS NON-EMPLOYEE PERSONAL INJURY DATA COLLECTION INFORMATION REQUIRED TO BE COLLECTED PURSUANT TO FEDERAL REGULATIONPlease complete this form and provide to the BNSF supervisor, who will input this information into the EHS Star system. IT SHOULD BE USED FOR COMPLIANCE WITH FEDERAL REGULATIONS ONLY AND IT IS NOT INTENDED TO PRESUME ACCEPTANCE OF RESPONSIBILITY OR LIABILITYFor questions, call (000) 000-0000 or email Xxxxxx.XxxxxxxxXxxxxxxxx@XXXX.xxx. Accident City/State: Date: Time: County: Temperature: Weather: (if non-BNSF location) Name (Last/First/MI): Age: Gender (if available): Company: eRailsafe Badge Number: Expiration Date: BNSF Contractor Badge Number: Expiration Date: Injury: _ Body Part: (e.g., laceration) (e.g., hand) Description of accident (including how accident occurred, potential cause, etc.): Work activity in progress at time of accident: Tools, machinery, or hazardous materials involved in accident: Treatment: □ First Aid Only □ Required Medical Treatment □ Other Medical Treatment: Dr. Name: Date:

EMPLOYEE PERSONAL INJURY DATA COLLECTION. (If injuries are in connection with rail equipment accident/incident, highway rail grade crossing accident or automobile accident, ensure that appropriate information is obtained, forms completed and that data entry personnel are aware that injuries relate to that specific event.) Injured Person Type: Passenger on train (C) Non-employee (N) (i.e., emp of another railroad, ,empofanotherrailroad,or, non-BNSF emp involved in vehicle accidentBNSFempinvolvedinvehicleaccident, including company vehicles) Contractor/safety sensitive (F) Contractor/non-safety sensitive (G) Volunteer/safety sensitive (H) Volunteer/other non-safety sensitive (I) Non-trespasser (D) - to include highway users involved in highway rail grade crossing accidents who did not go around or through gates Trespasser (E) - to include highway users involved in highway rail grade crossing accidents who went around or through gates Non-trespasser (J) - Off railroad property If train involved, Train ID: Transmit attached information to Accident/Incident Reporting Center by: Fax 0-000-000-0000 or by Phone 0-000-000-0000 or email to: Xxxxxxxx-Xxxxxxxxx.Xxxxxx@XXXX.xxx Officer Providing Information: (Name) (Employee No.) (Phone #) REPORT PREPARED TO COMPLY WITH FEDERAL ACCIDENT REPORTING REQUIREMENTS AND PROTECTED FROM DISCLOSURE PURSUANT TO 49 U.S.C. 20903 AND 83 U.S.C. 490 NON-EMPLOYEE PERSONAL INJURY DATA COLLECTION INFORMATION REQUIRED TO BE COLLECTED PURSUANT TO FEDERAL REGULATION. IT SHOULD BE USED FOR COMPLIANCE WITH FEDERAL REGULATIONS ONLY AND IT IS NOT INTENDED TO PRESUME ACCEPTANCE OF RESPONSIBILITY OR LIABILITY.

EMPLOYEE PERSONAL INJURY DATA COLLECTION. (If injuries are in connection with rail equipment accident/incident, highway rail grade crossing accident or automobile accident, ensure that appropriate information is obtained, forms completed and that data entry personnel are aware that injuries relate to that specific event.) Injured Person Type: Passenger on train (C) Non-employee (N) (i.e., emp of another railroad, or, non-BNSF emp involved in vehicle accident, including company vehicles) Contractor/safety sensitive (F) Contractor/non-safety sensitive (G) Volunteer/safety sensitive (H) Volunteer/other non-safety sensitive (I) Non-trespasser (D) - to include highway users involved in highway rail grade crossing accidents who did not go around or through gates Trespasser (E) - to include highway users involved in highway rail grade crossing accidents who went around or through gates Non-trespasser (J) - Off railroad property If train involved, Train ID: Transmit attached information to Accident/Incident Reporting Center by: Fax 0-000-000-0000 or by Phone 0-000-000-0000 or email to: Xxxxxxxx-Xxxxxxxxx.Xxxxxx@XXXX.xxx Accident- Xxxxxxxxx.Xxxxxx@XXXX.xxx Officer Providing Information: (Name) (Employee No.) (Phone #) REPORT PREPARED TO COMPLY WITH FEDERAL ACCIDENT REPORTING REQUIREMENTS AND PROTECTED FROM DISCLOSURE PURSUANT TO 49 U.S.C. 20903 AND 83 U.S.C. 490 NON-EMPLOYEE PERSONAL INJURY DATA COLLECTION INFORMATION REQUIRED TO BE COLLECTED Please complete this form and provide to the BNSF supervisor, who will input this information into the EHS Star system. For questions, call (000) 000-0000 or email Xxxxxx.XxxxxxxxXxxxxxxxx@XXXX.xxx. Accident City/State: Date: Time: County: Temperature: Weather: (if non-BNSF location) Name (Last/First/MI): Age: Gender (if available): Company: eRailsafe Badge Number: Expiration Date: BNSF Contractor Badge Number: Expiration Date: Injury: _ Body Part: (e.g., laceration) (e.g., hand) Description of accident (including how accident occurred, potential cause, etc.): Work activity in progress at time of accident: Tools, machinery, or hazardous materials involved in accident: Treatment: □ First Aid Only □ Required Medical Treatment □ Other Medical Treatment: Dr. Name: Date: Dr. Street Address: City: State: Zip: Hospital Name: Hospital Street Address: City: State: Zip: Diagnosis: THIS REPORT IS PART OF BNSF’S ACCIDENT REPORT PURSUANT TO FEDERAL REGULATION. IT SHOULD THE ACCIDENT REPORTS STATUTE AND, AS SUCH SHALL NOT “BE ADMITTED AS EVIDENCE OR USED FOR COMPLIANCE WITH FEDERAL REGULATIONS ONLY AND IT IS NOT INTENDED TO PRESUME ACCEPTANCE ANY PURPOSE IN ANY SUIT OR ACTION FOR DAMAGES GROWING OUT OF RESPONSIBILITY OR LIABILITYANY MATTER MENTIONED IN SAID REPORT….” 49 U.S.C. § 20903. See 49 C.F.R. § 225.7(b). EXHIBIT "C-1" Agreement Between BNSF RAILWAY COMPANY and the CONTRACTOR Railway File: Agency Project: , (hereinafter called “Contractor”), has entered into an agreement (hereinafter called “Agreement”) dated , 20 , with The City of Minneapolis the performance of certain work in connection with the following project: Construction of the Xxx Xxxxx Trail in Minneapolis, MN. Performance of such work will necessarily require Contractor to enter BNSF RAILWAY COMPANY (hereinafter called "Railway") right of way and property (hereinafter called "Railway Property"). The Agreement provides that no work will be commenced within Railway Property until the Contractor employed in connection with said work for The City of Minneapolis (i) executes and delivers to Railway an Agreement in the form hereof, and (ii) provides insurance of the coverage and limits specified in such Agreement and Section 3 herein. If this Agreement is executed by a party who is not the Owner, General Partner, President or Vice President of Contractor, Contractor must furnish evidence to Railway certifying that the signatory is empowered to execute this Agreement on behalf of Contractor. Accordingly, in consideration of Railway granting permission to Contractor to enter upon Railway Property and as an inducement for such entry, Contractor, effective on the date of the Agreement, has agreed and does hereby agree with Railway as follows: