HomeMy WebLinkAbout2011-195 Contract - Brenntag Pacific Contract for Goods and Services
C I T Y OF CONTRACTOR: Brenntag Pacific, Inc.
ASHLAND CONTACT: Sam DeBellis
20 East Main Street
Ashland, Oregon 97520 ADDRESS: 5700 NW Front Ave, Portland, OR 97210
Telephone: 541/488-6002
Fax: 541/488-5311 TELEPHONE: 541-912-7104 (Cell)
DATE AGREEMENT PREPARED:06/30/2011 FAX: 503-223-1055
BEGINNING DATE: July 1, 2011 COMPLETION DATE: June 30, 2011K
COMPENSATION:
WTP— Sodium Hypochlorite (Hasa $1.35/Gal, Delivery charge $27.50 per order, No tote deposit)
WTP— Soda Ash (FMC $0.209/Lb, Delivery charge $27.50 per order)
WWTP—Sodium Hypochlorite (Hasa $1.35/Gal, Delivery charge $27.50 per order, No tote deposit)
WWTP — Citric Acid RZBC $1.149/Lb, Delivery charge $27.50 per order
GOODS AND SERVICES TO BE PROVIDED: WTP &WWTP Chemicals as specified and resulting from
Invitation to Bid 2011-101. Contract approved by City Council June 21, 2011.
ADDITIONAL TERMS:
NOW THEREFORE, pursuant to AMC 2.50.090 and after consideration of the mutual covenants contained herein the
CITY AND CONTRACTOR AGREE as follows:
1. All Costs by Contractor: Contractor shall, provide all goods as specified above and shall at its own risk and
expense, perform any work described above and, unless otherwise specified, furnish all labor, equipment and
materials required for the proper performance of such work.
2. Qualified Work: Contractor has represented, and by entering into this contract now represents, that any personnel
assigned to the work required under this contract are fully qualified to perform the work to which they will be assigned
in a skilled and worker-like manner and, if required to be registered, licensed or bonded by the State of Oregon, are
so registered, licensed and bonded. Contractor must also maintain a current City business license.
3. Completion Date: Contractor shall provide all goods in accordance with the standards and specifications, no later
than the date indicated above and start performing the work under this contract by the beginning date indicated
above and complete the work by the completion date indicated above.
4. Compensation: City shall pay Contractor for the specified goods and for any work performed, including costs and
expenses, the sum specified above. Payments shall be made within 30 days of the date of the invoice. Should the
contract be prematurely terminated, payments will be made for work completed and accepted to date of termination.
5. Ownership of Documents: All documents prepared by Contractor pursuant to this contract shall be the property of
City.
6. Statutory Requirements: ORS 2796.220, 2796.225, 279B.230, 27913.235, ORS Chapter 244 and ORS 670.600 are
made part of this contract.
7. Living Wage Requirements: If contractor is providing services under this contract and the amount of this contract
is $18,703 or more, Contractor is required to comply with chapter 3.12 of the Ashland Municipal Code by paying a
living wage, as defined in this chapter, to all employees performing work under this contract and to any subcontractor
who performs 50% or more of the work under this contract. Contractor is also required to post the notice attached
hereto as Exhibit B predominantly in areas where it will be seen by all employees.
8. Indemnification: Contractor agrees to defend, indemnify and save City, its officers, employees and agents harmless
from any and all losses, claims, actions, costs, expenses,judgments, subrogations, or other damages resulting from
injury to any person (including injury resulting in death), or damage (including loss or destruction)to property, of
whatsoever nature arising out of or incident to the performance of this contract by Contractor(including but not limited
to, Contractor's employees, agents, and others designated by Contractor to perform work or services attendant to this
contract). Contractor shall not be held responsible for any losses, expenses, claims, subrogations, actions, costs,
judgments, or other damages, directly, solely, and proximately caused by the negligence of City.
9. Termination:
a. Mutual Consent. This contract may be terminated at any time by mutual consent of both parties.
b. City's Convenience. This contract may be terminated at any time by City upon 30 days' notice in writing
and delivered by certified mail or in person.
C. For Cause. City may terminate or modify this contract, in whole or in part, effective upon delivery of
written notice to Contractor, or at such later date as may be established by City under any of the following
Contract for Goods and Services, Page 1 of 5
conditions:
i. If City funding from federal, state, county or other sources is not obtained and continued at levels
sufficient to allow for the purchase of the indicated quantity of services;
ii. If federal or state regulations or guidelines are modified, changed, or interpreted in such a way
that the services are no longer allowable or appropriate for purchase under this contract or are
no longer eligible for the funding proposed for payments authorized by this contract; or
iii. If any license or certificate required by law or regulation to be held by Contractor to provide the
services required by this contract is for any reason denied, revoked, suspended, or not renewed.
d. For Default or Breach.
I. Either City or Contractor may terminate this contract in the event of a breach of the contract by
the other. Prior to such termination the party seeking termination shall give to the other party
written notice of the breach and intent to terminate. If the party committing the breach has not
entirely cured the breach within 15 days of the date of the notice, or within such other period as
the party giving the notice may authorize or require, then the contract may be terminated at any
time thereafter by a written notice of termination by the party giving notice.
ii. Time is of the essence for Contractor's performance of each and every obligation and duty under
this contract. City by written notice to Contractor of default or breach, may at any time terminate
the whole or any part of this contract if Contractor fails to provide services called for by this
contract within the time specified herein or in any extension thereof.
iii. The rights and remedies of City provided in this subsection (d) are not exclusive and are in
addition to any other rights and remedies provided by law or under this contract.
e. Obligation/Liability of Parties. Termination or modification of this contract pursuant to subsections a, b, or
c above shall be without prejudice to any obligations or liabilities of either party already accrued prior to such
termination or modification. However, upon receiving a notice of termination (regardless whether such notice is
given pursuant to subsections a, b, c or d of this section, Contractor shall immediately cease all activities under
this contract, unless expressly directed otherwise by City in the notice of termination. Further, upon termination,
Contractor shall deliver to City all contract documents, information, works-in-progress and other property that are
or would be deliverables had the contract been completed. City shall pay Contractor for work performed prior to
the termination date if such work was performed in accordance with the Contract.
10. Independent Contractor Status: Contractor is an independent Contractor and not an employee of the City.
' Contractor shall have the complete responsibility for the performance of this contract.
11. Non-discrimination Certification: The undersigned certifies that the undersigned Contractor has not discriminated
against minority, women or emerging small businesses enterprises in obtaining any required subcontracts.
Contractor further certifies that it shall not discriminate in the award of such subcontracts, if any. The Contractor
understands and acknowledges that it may be disqualified from bidding on this contract, including but not limited to
City discovery of a misrepresentation or sham regarding a subcontract or that the Bidder has violated any
requirement of ORS 279A.110 or the administrative rules implementing the Statute.
12. Asbestos Abatement License: If required under ORS 468A.710, Contractor or Subcontractor shall possess an
asbestos abatement license.
13. Assignment and Subcontracts: Contractor shall not assign this contract or subcontract any portion of the work
without the written consent of City. Any attempted assignment or subcontract without written consent of City shall be
void. Contractor shall be fully responsible for the acts or omissions of any assigns or subcontractors and of all
persons employed by them, and the approval by City of any assignment or subcontract shall not create any
contractual relation between the assignee or subcontractor and City.
14. Use of Recyclable Products: Contractor shall use recyclable products to the maximum extent economically feasible
in the performance of the contract work set forth in this document.
15. Default. The Contractor shall be in default of this agreement if Contractor: commits any material breach or default of
any covenant, warranty, certification,or obligation it owes under the Contract; if it loses its QRF status pursuant to
the QRF Rules or loses any license, certificate or certification that is required to perform the work or to qualify as a
QRF if Contractor has qualified as a QRF for this agreement; institutes an action for relief in bankruptcy or has
instituted against it an action for insolvency; makes a general assignment for the benefit of creditors; or ceases doing
business on a regular basis of the type identified in its obligations under the Contract; or attempts to assign rights in,
or delegate duties under, the Contract.
16. Insurance. Contractor shall at its own expense provide the following insurance:
a. Worker's Compensation insurance in compliance with ORS 656.017, which requires subject employers to
provide Oregon workers' compensation coverage for all their subject workers
b. General Li ti ce with a combined single limit, or the equivalent, of not less than Enter one:
$200,000, $500,00 , 1 000,000 $2,000,000 or Not Applicable for each occurrence f r o i ry and Property
Damage. It shall include con f tual liability coverage for the indemnity provided under this contract.
C. Automobile Jg4bi ance with a combined single limit, or the equivalent, of not less than Enter one:
$200,000, $500,000 Not Applicable for each accident for Bodily Injury and Prope Damage,
includin covera a for o ned—hired or non-owned vehicles as applicable.
Contract for Goods and Services, Page 2 of 5
d. Notice of cancellation or change. There shall be no cancellation, material change, reduction of limits or
intent not to renew the insurance coverage(s)without 30 days' written notice from the Contractor or its insurer(s) to
the City.
e. Additional Insured/Certificates of Insurance. Contractor shall name The City of Ashland, Oregon, and its
elected officials, officers and employees as Additional Insureds on any insurance policies required herein but only
with respect to Contractor's services to be provided under this Contract. As evidence of the insurance coverages
required by this Contract, the Contractor shall furnish acceptable insurance certificates prior to commencing work
under this contract. The contractor's insurance is primary and non-contributory. The certificate will specify all of the
parties who are Additional Insureds. Insuring companies or entities are subject to the City's acceptance. If
requested, complete copies of insurance policies, trust agreements, etc. shall be provided to the City. The
Contractor shall be financially responsible for all pertinent deductibles, self-insured retentions and/or self-
insurance.
17. Governing Law; Jurisdiction; Venue: This contract shall be governed and construed in accordance with the laws
of the State of Oregon without resort to any jurisdiction's conflict of laws, rules or doctrines. Any claim, action, suit or
proceeding (collectively, "the claim") between the City(and/or any other or department of the State of Oregon)and
the Contractor that arises from or relates to this contract shall be brought and conducted solely and exclusively within
the Circuit Court of Jackson County for the State of Oregon. If, however, the claim must be brought in a federal
forum, then it shall be brought and conducted solely and exclusively within the United States District Court for the
District of Oregon filed in Jackson County, Oregon. Contractor, by the signature herein of its authorized
representative, hereby consents to the in personam jurisdiction of said courts. In no event shall this section be
construed as a waiver by City of any form of defense or immunity, based on the Eleventh Amendment to the United
States Constitution, or otherwise, from any claim or from the jurisdiction.
18. THIS CONTRACT AND ATTACHED EXHIBITS CONSTITUTE THE ENTIRE AGREEMENT BETWEEN THE
PARTIES. NO WAIVER, CONSENT, MODIFICATION OR CHANGE OF TERMS OF THIS CONTRACT SHALL
BIND EITHER PARTY UNLESS IN WRITING AND SIGNED BY BOTH PARTIES. SUCH WAIVER, CONSENT,
MODIFICATION OR CHANGE, IF MADE, SHALL BE EFFECTIVE ONLY IN THE SPECIFIC INSTANCE AND FOR
THE SPECIFIC PURPOSE GIVEN. THERE ARE NO UNDERSTANDINGS, AGREEMENTS, OR
REPRESENTATIONS, ORAL OR WRITTEN, NOT SPECIFIED HEREIN REGARDING THIS CONTRACT.
CONTRACTOR, BY SIGNATURE OF ITS AUTHORIZED REPRESENTATIVE, HEREBY ACKNOWLEDGES THAT
HE/SHE HAS READ THIS CONTRACT, UNDERSTANDS IT, AND AGREES TO BE BOUND BY ITS TERMS AND
CONDITIONS.
19. Nonappropriations Clause. Funds Available and Authorized: City has sufficient funds currently available and
authorized for expenditure to finance the costs of this contract within the City's fiscal year budget. Contractor
understands and agrees that City's payment of amounts under this contract attributable to work performed after the
last day of the current fiscal year is contingent on City appropriations, or other expenditure authority sufficient to allow
City in the exercise of its reasonable administrative discretion, to continue to make payments under this contract. In
the event City has insufficient appropriations, limitations or other expenditure authority, City may terminate this
contract without penalty or liability to City, effective upon the delivery of written notice to Contractor, with no further
liability to Contractor.
20. Prior Approval Required Provision. Approval by the City of Ashland Council or the Public Contracting Officer is
required before any work may begin under this contract.
21. Certification. Contractor shall sign the certification attached hereto as Exhibit A and herein incorporated by
reference.
Contractor: City of Ashland
BY By e
Sig a dre Department Head
Print Name V. Print Name
Title Date
W-9 One copy of a W-9 is to be submitted with A roved as to form:
the signed contract.
Date
Purchase Order No. '✓���
CWW �P�
Contract for Goods and Services, Page 3 of 5
EXHIBIT A
CERTIFICATIONS/REPRESENTATIONS: Contractor, under penalty of perjury, certifies that (a) the
number shown on the attached W-9 form is its correct taxpayer ID (or is waiting for the number to be
'issued to it and (b) Contractor is not subject to backup withholding because (i) it is exempt from
backup withholding or (ii) it has not been notified by the Internal Revenue Service (IRS) that it is
subject to backup withholding as a result of a failure to report all interest or dividends, or (iii) the IRS
has notified it that it is no longer subject to backup withholding. Contractor further represents and
warrants to City that (a) it has the power and authority to enter into and perform the work, (b) the
Contract, when executed and delivered, shall be a valid and binding obligation of Contractor
enforceable in accordance with its terms, (c) the work under the Contract shall be performed in
accordance with the highest professional standards, and (d) Contractor is qualified, professionally
competent and duly licensed to perform the work. Contractor also certifies under penalty of perjury
that its business is not in violation of any Oregon tax laws, and it is a corporation authorized to act on
behalf of the entity designated above and authorized to do business in Oregon or is an independent
Contractor as defined in the contract documents, and has checked four or more of the following
criteria:
(1) 1 carry out the labor or services at a location separate from my residence or is in a
specific portion of my residence, set aside as the location of the business.
(2) Commercial advertising or business cards or a trade association membership are
purchased for the business.
(3) Telephone listing is used for the business separate from the personal residence listing.
(4) Labor or services are performed only pursuant to written contracts.
(5) Labor or services are performed for two or more different persons within a period of one
year.
(6) I assume financial responsibility for defective workmanship or for service not provided
as evidenced by the ownership of performance bonds, warranties, errors and omission
insurance or liability insurance relating to the labor or services to be provided.
Contractor/ (Date)
Contract for Goods and Services, Page 4 of 5
EXHIBIT A
City of Ashland
90 N. Mountain Avenue
Ashland, Oregon 97520
(541) 488-5354
FAX (541)488-5320
BID FORM
I, the undersigned, an authorized representative of the bidder whose name is:
/Sr e .,r f a p 4
Address: _�` i 0 f� /V l a J �r a (/-e—
City, State& r Zip: _ Job f 7.2 /O
Phone No.&KI_0 -_�`! ' 02—OOFAX No. --Z Z_> 3 — /
have read and thoroughly understand the contract documents including the Invitation to Bid,
general conditions, special conditions, specifications, and all other conditions of the Invitation to
Bid issued by the City of Ashland for CHEMICALS FOR THE WATER &WASTE WATER
TREATMENT PLANTS.
Acting on behalf of my firm which is listed above, I do attest that the goods and services offered
by this firm meets the City's specifications in every respect except those described on the
attached list of exceptions, and that all exceptions are equal to, or better than, the goods and
services specified.
Barring circumstances beyond our control, we agree to deliver within (as specified) days
from receipt of an order.
This bid is set forth as follows: (Note:Pricing shall be provided as required in the specifications)
Arl have attached to this bid a copy of all the bid documents issued by the City of Ashland for this bid.
By:
ig ,aaur/e_
Y<
Print Print Name
Title:
Date: f/
ITB—Chemicals for WTP&WWTP, Page 18 of20,4/29/2011
EXHIBIT B
Certificate of Compliance
Residency Statement
In compliance with ORS 279B.060(10),each bid must contain a statement as to whetherthe bidder
is a'Resident bidder'.This is defined by ORS 279A.120:"Resident bidder"means a bidder that has
paid unemployment taxes or income taxes in this state during the 12 calendar months immediately
preceding submission of the bid, has a business address in this state and has stated in the bid
whether the bidder is a "resident bidder".
Yes, I certify that I am a "Resident bidder' as defined by ORS 279A.120.
No, I certify that I am not a"Resident bidder' as defined by ORS 279A.120.
I am domiciled in the State of (Indicate State)
Compliance with Oregon Tax Laws:
In compliance with OAR 137-047-0255(2)(c)(C)(e), I hereby attest or affirm under penalty of perjury:
That I am authorized to act on behalf of the contractor in this matter, that I have authority and
knowledge regarding the payment of taxes, and that contractor is,to the best of my knowledge, not
in violation of any Oregon Tax Laws, as defined in ORS 305.380.
Compliance with Nondiscrimination Laws:
In compliance with ORS 279A.110(4), 1 hereby attest or affirm under penalty of perjury that I am
authorized to act on behalf of contractor in this matter, and to the best of my knowledge the
contractor has not discriminated against minority,women or emerging small business enterprises in
obtaining any required subcontracts, and that the Bidder is not in violation of any Discrimination
Laws.
By:
ignattuure /
40tr
Print Name IF
Title:�fS
Date:...—<--
1TB—Chemicals for WTP&W WTP.Pale 19 of20.429.2011
INVITATION TO BID 2011-101, WTP & WWTP CHEMICAL May 31, 2011
CHEMICAL BRENNTAG CASCADE NORTHSTAR SIERRA UNIVAR
COLUMBIA CHEMICAL CHEMICAL
Hasa Hasa
WTP- $1.7175/Gal
Tote d
$1.35/Gal Tote deposit
CHEMICAL#1: . Hasa $1.59/Gat $700.00-Deposit
SODIUM on Tote(Paid
Delivery charge waived unless
HYPOCHLORITE once/Credit
12.5% $27.50 per damaged by the No Bid No Bid memos issued)
(6)'totes/12 times order City($200) $95.00-Delivery
No Tote *$25.00 Energy
per year charge is charged
Deposit surcharge per
once, per each
Required invoice
delivery
WTP- $1.33/Lb $1.271/Lb
CHEMICAL#2: Delivery charge Minimum(4)
CYTEC $27.50 per drums per order
SUPERFLOC C- order $1.42/Lb Delivery charge
573 Cost per order: *$25.00 Energy $95.00 per order
FLOCCULANT- (4) 50OLb surcharge per No Bid No Bid Cost per order:
No Substitution Drums, $665.00 invoice (4) AOLb Drums,
(4)Drums/Every 6 per drum,plus $635.50 per drum,
weeks on average $27.50= plus $95.00=
(9 orders) $2,687.50 $2,637.00
WTP- $2.70/Lb
CHEMICAL#3: $3.11/Lb Delivery charge
CYTEC *$25.00 Energy $95.00 per order
SUPERFLOC N- surcharge per Minimum(6)bags
300 LMW invoice (one pallet)per
FLOCCULANT- No Bid Cost per order: No Bid No Bid order
No Substitution (6) 55.12Lb Bags, Cost per order: (6)
(6)Bags/Every 12 $171.42 per bag, 55.12Lb Bags,
weeks on average plus $25.00= $148.81 per bag,
(4 orders) $1,053.52 plus $95.00=
$987.86
Univar/FMC
FMC Solvay FMC $0.1955/Lb
WTP $0.209/Lb $0.265/Lb $0.185/Lb Delivery charge
CHEMICAL#4: Delivery charge *$25.00 Energy Cost per order $350.00 per order
SODA ASH, $27.50 per surcharge per (Changed per Minimum 4
DENSE,FREE order invoice bidder to 864 pallets(216 bags)
FLOWING
Cost per order: Cost per order: No Bid Bags/16 per order
Or Equivalent (54Bgs/Pallet) (49Bgs/Pallet) Pallets) Cost per order:
(216)Bags/Every 50Lb Bags,(4) 50Lb Bags,(4) Cost per order (54Bgs/Pallet)
3-4 weeks on Pallets, Pallets, $7,992.00 50Lb Bags, (4)
average(15 orders) $2,257.20;plus $2,597.00,plus Delivery Pallets,
$27.50= $25.00= Charge $2,111.40,plus
$2,284.70 $2,622.00 $2,100.00 $350.00=
$2,461.40
ITB 2011-101 WTP&W WTP CHEMICALS,PAGE 1 OF 2,05/31/2011
INVITATION TO BID 2011-101, WTP & WWTP CHEMICAL May 31, 2011
CHEMICAL BRENNTAG CASCADE NORTHSTAR SIERRA UNIVAR
COLUMBIA CHEMICAL CHEMICAL
Hasa
WWTP Hasa $1.7175/Gal
CHEMICAL 95: $1.35/Gal Hasa $700.00-Deposit
SODIUM $27 charge Hasa Gal on Tote(Paid
HYPOCHLORITE $27.50 per *$25.00 Energy No Bid No Bid
12.5% surcharge per once/Credit
order memos issued)(3)Totes/3 Times No Tate invoice $95.00-Delivery
Deposit charge is charged
per year Required once, per each
delivery
Univar/RZBC
RZBC JBL $1.135/Lb
$1.149/Lb $1.25/Lb JBL Delivery charge
WWTP- Delive char e *$25.00Ener $1.19/Lb
ry g � Delivery $95.00 per order
CHEMICAL#6: $27.50 per surcharge per Minimum 1 pallet
CITRIC ACID order invoice included (43 bags)per
Cost per order: No Bid
Or Equivalent
Cost per order. Cost per order: order
(43)Bags/Two(2) 43 Bags/I Pallet 40 Bags/1 Pallet 40 Bags/1 Pallet Cost per order:
times per year $2,470.35,plus $2,500.00, plus $2,380.00 43 Bags/1 Pallet
$27.50= $25.00= (Delivery
included) $2,440.25,plus
$2,497.85 $2,525.00 $95.00=
$2,535.25
WWTP-
CHEMICAL#7:
ALUMINUM
SULFATE $0.121/Lb
Cascade Columbia No Bid *$25.00 Energy No Bid
No Substitution surcharge per
(4,000) Gal/Every invoice
2 weeks/May-
November
Declined to bid:
Sterling Water Technologies
Polydyne
Olin Corporation
ITB 2011-101 WTP&WWTP CHEMICALS,PAGE 2 OF 2,05/31/2011
Substitute Form W-9
REQUEST FOR TAXPAYER
IDENTIFICATION NUMBER AND CERTIFICATION
Requester's name and address
NAME: Brenntag Pacific, Inc NAME:
STREET: 10747 Patterson Place STREET:
CITY/STATE: Santa Fe Springs, CA. 90670 CITY/STATE:
In compliance with Internal Revenue Service regulations, please provide us with your taxpayer identification
Number(TIN). Your name and your business name by completing the form shown below. We are required by
law to obtain this information when making a reportable payment to our vendors. Failure to provide us your
TIN may subject you to 31% federal income tax backup withholding and a$50.00 penalty. Even if your
business is exempt from receiving information returns,we must have this information.
Please return completed form by fax or mail. Thank you for your cooperation.
Please check appropriate box: ❑ Individual/Sole Proprietor ❑ Partnership
®Corporation ❑ Other
Legal Name: Brenntaa Pacific, Inc.
Business Name: 10747 Patterson Place
Santa Fe Springs, CA. 90670
TAXPAYER IDENTIFICATION NUMBER
For individuals,enter social security number
For sole proprietors,enter owner's social security number
For partnerships,corporations and others,enter employer 1 20-0552611
Identification number
CERTIFICATION
Under penalties of perjury,I certify that:
1. The number shown on this form is my correct taxpayer identification number(or I am waiting for a number to be issued to me),
and
2. I am not subject to backup withholding because: (a)I am exempt from backup withholding,or(b)I have not been notified by the
Internal Revenue Service that I am subject to backup withholding as a result of a failure to report all interest or dividends,or(c)
the IRS has notified me that I am no longer subject to backup withholding(does not apply to real estate transactions,mortgage
interest paid,the acquisition or abandonment of secured property,contributions to an individual retirement arrangement and
payments other than interest÷nds).
Certification Instructions—You must cross out item 2 above if you have been notified by the IRS that you are currently subject to
backup withholding because of under reporting interest or dividends on your tax return.
Signature Date
DATE(MMIOOIYYYY)
CERTIFICATE OF LIABILITY INSURANCE 12/172010
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(fes)must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder In lieu of such endorsement(s).
PRODUCER CONTACT
Nash USA lm. NAME:
TWO LOGAN SQUARE PHONE a No:
PHILADELPHIA,PA 19103.2797 E-MAIL
Am:PHILADELPHIA.CERTS(o1MARSH.00 FAX-212846-0360 p DRESS::
CUSTOMERIDA
42478VALL-GAIN-1142 INSURERS AFFORDING COVERAGE NAIC•
INSURED INSURER A:Insurance Company Of The Slab Of PA 19429
BRENNTAG PACIFIC,INC. Gmmwzh Ifnlr&Ita Company
10747 PATTERSON RACE INSURER B:
SANTA FE SPRINGS,CA 90670 INSURER C:XL Specialty Insurance Company
INSURER D:
NSURER E:
NSURER F:
COVERAGES CERTIFICATE NUMBER: CLE-002767141-11 REVISION NUMBER:3
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,
I�jq TYPE OFINSURANCE ADUS
POUCYNUMBER ewLICY EFF laww E%P LIMITS MU
INSR A GENERAL LIABILITY 0696955 01N12011 01AI2012 EACH OCCURRENCE $ 1,000.000
X COMMERCIALGENERALLNBIUTY PREMISES a urmnce $ 1'000.000
GAIMSMADE II OCCUR - MEDEXP(Anyoneperson) $ 10.000
PERSONAL B ADV INJURY $ 1.000,000
GENERAL AGGREGATE $ 2•OOO•000
OWL AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPA)PAGO $ 1,000.000
X POLICY PRO- LOC $
JECT
B AUTOMOBILE UABIUTY RAD943713306(ADS) 01101/1011 01/012012 COMBINED SINGLE LIMIT $ iODO000
B X ANY AUTO RAD943713106(MA) 01/012011 01/012012 (Ea acclden0
BODILY INJURY(Per person) $
ALL ONTIED AUTOS
BODILV INJURV(Poracddent) $
SCHEDULED AUTOS PROPERTY DAMAGE
HIREDAUTOS (Per amided) $
NON-0vYNEDAUUOS $
UMBRELLA UAB OCCUR EACH OCCURRENCE $
E%CESS UAB CLAIMS-MADE AGGREGATE $
DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION X V,RSIATLL OTH-
AND EMPLOYERS'LIABILITY I ER
C ANY PROPRIETOR/PARTNERIE%ECUTNE YIN RWR94350M(WI) 01/012011 011012012 E.L.EACH ACCIDENT $ 1.000.000
C
OFFICER/MEMBER EXCLUDED? ❑N NIA RWD9435091 A0.5 01/012011 011012012 1,000.000
(Mandatory In NH) ) EL DISEASE-EA EMPL $
If edmdr
DES RIPTIONOFOP ERATIONSI)D EL.OISFASE-PCUCYUMIT $ 1.000.000
DU=PnONOFOPERATIONS ILOCATIONSIVEHICLES(Affach ACORD101,Addk[ nal Remarke Schedule,Nmomspaceisrequired)
RE SUPPLYING CHEMICALS TO THE WATERTREATMENT PLANTLOCATED AT:90 N.MOUNTAIN AVENUE,ASH-AND,OR 97520
THE CITY OF ASHLAND.OREGON,AND ITS R.ECTED OFFICIALS,OFFICERS AND EMPLOYEES ARE INCLUDE)AS ADDITIONAL INSURED,EXCEPT FOR WORKERS COMPENSATION,WHERE
REQUIRED BY WRITTEN CONTRACT.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
CITY OF ASHLAND,OR THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ATTN:KART OLSON ACCORDANCE WITH THE POLICY PROVISIONS.
90 NORTH MOUNTAIN AVENUE
ASHLAND,OR 97520 AUTHORREO REPRESENTATIVE
of Mmsh USA InQ
Donna Clampift GO- C<e X
®1988-2009 ACORD CORPORATION. All rights reserved.
ACORD 26(2009/09) The ACORD name and logo are registered marks of ACORD
CITY RECORDER Page 1 / 1
�. CITY OF
ASHLAND DATE . --.t - ``.PO NUMBER
20 E MAIN ST. 7/13/2011 1 1 10286
ASHLAND, OR 97520
(541)488-5300
VENDOR: 011148 SHIP TO: Ashland WWTP
BRENNTAG PACIFIC, INC (541)488-5348
FILE#2674 1295 OAK STREET
LOS ANGELES, CA 90074-2674 ASHLAND, OR 97520
FOB Point: Req.No.:
Terms: Net 30 days Dept:
Req. Del.Date: contact: David Gies
Special Inst: Confirming? No
{-uw,- -_ _,. ... _. .. . _
..Quanti �, i.Unit,,;,.. .. .? I .., . . .. Descri lion r`.r. ._ .-..r. .,`.:.. Unit Pnce'�` Ext.Price Lh
THIS IS A REVISED PURCHASE ORDER
2.00 Ordr Invitation to Bid#2011-101 2,497.85 4,995.70
CITRIC ACID
2 Orders
43 Bags/1 Pallet per order
RZBC$1.149/Lb
Delivery charge $27.50 per order
3.00 Ordr SODIUM HYPOCHLORITE 1,364.00 4,092.00
3 Orders
$1.35 per gallon
330 Gal/Tote, 3 Totes/Per order
Delivery charge: $27.50
SUBTOTAL j 9,087.70
BILL.TO:Account Payable TAX 0.00
20 EAST MAIN ST FREIGHT 0.00
541-552-2028 'TOTAL 9,087.70
ASHLAND, OR 97520
`... i:AccounCNumbe4:4. . .__ �P,roject Number .- ;:_!,AMount,. [,.AccountNumber ,. `�Project;Number „ 1':,�,1�_ _ .'Amount — ,
E 675.08.19.00.60150 9,087.70
non Ai c
Authorized Signature VENDOR COPY
r ._, RECORDER
Page 1 / 1
J� CITY OF "'TY O
. ASH LAND DAT
P W 'PO NUMBER -•
20 E MAIN ST. 7/13/201
AS 1 10286'
HLAND, OR 97520
(541)488-5300
VENDOR: 011148 SHIP TO: Ashland WWTP
BRENNTAG PACIFIC, INC (541)488-5348
FILE#2674 1295 OAK STREET
LOS ANGELES, CA 90074-2674 ASHLAND, OR 97520
FOB Point: Req.No.:
Terms: Net 30 days Dept.:
Req.Del.Date:. contact: David Gies
Special Inst: Confirming? NO
Deschpubn1 - .r :. , Unit Pace Extf13
2.00 Ordr Invitation to Bid#2011-101 2,497.85 4,995.70
CITRIC ACID
2 Orders
43 Bags/1 Pallet per order
RZBC $1.14911-b
Delivery charge $27.50 per order
SUBTOTAL 4,995.70
BILL TO:Account Payable TAX 0.00
20 EAST MAIN ST FREIGHT 0.00
541-552-2028 TOTAL 4,995.70
ASHLAND, OR 97520
T'Account Number 'Project Number Amount ' - .'Account Number Project Numil _' Amount. -
E 675.08.19.00.601500 4,995.70
Authori�Q Signature VENDOR COPY
FORM #3 CITY OF
ASHLAND
REQUISITION Date of request: 7 d73-
Required date for delivery:
Vendor Name r
Address,City,State,Zip
Contact Name&Telephone Number
Fax Number
SOLICITATION PROCESS
❑ Exempt from Competitive Bidding Emergency
❑ Written Findings(Form attached) Invitation to Bid (Copies on file) ❑ Written findings attached
❑ Quote or Proposal attached Date approved by Council: O ❑ Quote or Proposal attached
❑ Small Procurement Cooperative Procurement
Less than$5,000 ❑ Request for Proposal (Copies on file) ❑ State of Oregon
Note:Total contract amount,including any Dale approved by Council: Contract#
amendments may not exceed$6,000 ❑ State of Washington
Intermediate Procurement ❑ Sole Source Contract#
GOODS&SERVICES ❑ Written Findings(Form attached) ❑ Other government agency contract
$5,000 to$100,000 ❑ Quote or Proposal attached Agency
❑ (3)Written quotes attached Contract#
PERSONAL SERVICES ❑ Special Procurement ❑ Intergovernmental Agreement
$5.000 to$75,000 ❑ Written Findings(Form attached) Agency
❑ Less than$35,000,by direct appointment ❑ Quote or Proposal attached Contract#
❑ 3 Written proposals attached Date approved by Council: Date approved by Council:
Description of SERVICES Total Cost
C-?kr`/G Qcr6� a,- -ne4 --4i7P
f
Item # Quantity Unit Description of MATERIALS Unit Price Total Cost
r iwe�/r . f7,3S' y9YO.70
*'lil yAL COST
F-1 Per attached QUOTE S
Project Number---------- AccountNumbe0? 600-4i 1,500 Account Number-------------------
Account Number Account Number _
'Expenditure must be charged to the appropriate account numbers for the financials to reflect the actual expenditures accurately. Attach extra pages if needed.
By signing this requisition form,l certify that the information provided above meets the City's public contracting requirements,and the documentation can be provided
upon request.
Employee Signature: 3 JILT Department Head Signature: M..1 6Q, O
Additional signatures(if applicable):
Funds appropriated for current fiscal year: 9 NO ix� 7A111-
Finance Director ate
Comments:
G:FinancelProcedure\APlFormskForm 43-Requisition.doc Updated on:321/1011