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1991 IRFQ 18/19-100 Oxygen Cylinders Compressed Gas SolutionsWednesday, November 14, 2018 7,1, 1,44U-42* To: City Clerk/Mayor RE: IRFQ 18/19-100 Oxygen Cylinder's —Compressed Gas Solutions Inc The item(s) noted below is/are attached and forwarded to your office for the following action(s): ❑ Development Order ME I� � • � • rl N 4?51"dEA89'iFINANCE DEPARTMENT Wednesday, November 14, 2018 7,1, 1,44U-42* To: City Clerk/Mayor RE: IRFQ 18/19-100 Oxygen Cylinder's —Compressed Gas Solutions Inc The item(s) noted below is/are attached and forwarded to your office for the following action(s): ❑ Development Order ❑ Mayor's signature ❑ Final Plat (original mylars) ❑ Recording ❑ Letter of Credit ❑ Rendering ❑ Maintenance Bond Safe keeping (Vault) ❑ Ordinance Deputy City Manager ❑ Performance Bond ❑ Payment Bond ❑ Resolution ❑ City Manager Signature ❑ ❑ City Clerk Attest/Signature ❑ City Attorney/Signature Once completed, please: ❑ Return originals to Purchasing- Department ❑ Return copies El Special Instructions: The PO's are less than $50,000 does not need CC approval. Mcitri,-&(, Ord4-1;�,&z \ -z- � -�?_A I �� - From Date SharePoint Finance_ Purchasing_Forms - 2018.doc AGREEMENT BETWEEN THE CITY OF SANFORD AND COMPRESSED GAS SOLUTIONS, INC./IRFQ 18/19-100 OXYGEN CYLINDERS THIS AGREEMENT (hereinafter the "Agreement") is made and entered into this day of K(OyeM y- , 2018, by and between the City of Sanford, Florida, a Florida municipality, (hereinafter referred to as the "City"), whose mailing address is 300 North Park Avenue, Sanford, Florida 32771, and Compressed Gas Solutions, Inc., a Florida corporation, authorized to do business in the State of Florida, whose contact and corporate address is 2450 Shader Road, Orlando, Florida 32804, (hereinafter referred to as "CGS"). The City and CGS may be collectively referenced herein as the "parties". WITNESSETH: IN CONSIDERATION of the mutual covenants, promises, and representations contained herein and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the parties hereto agree as follows: Section 1. Recitals. The above statements are true and form a material part of this Agreement upon which the parties have relied. Section 2. Authority. Each party hereto represents to the other that it has undertaken all necessary actions to execute this Agreement, and that it has the legal authority to enter into this Agreement and to undertake all obligations imposed on it. The persons executing this Agreement for each party certify that they are authorized to bind the party fully to the terms of this Agreement. Section 3. Scope of Agreement; Direction of Services. (a). This Agreement is for the services set forth in the attachments hereto and CGS agrees to accomplish the provision of goods and services and actions specified in the attachments for the compensation set forth in those documents relating to oxygen cylinders. Goods and services may be ordered and directed by the City by means of City purchase orders/work orders. (b). It is recognized that CGS shall perform services as otherwise directed by the City all of such services to include all labor and materials that may be required including, but in no way limited to, the services provided by subconsultants as may be approved by the City. (c). The City's contact/project manager for all purposes under this Agreement shall be the following: Craig Radzak Fire Chief Fire Department Headquarters 1303 William Clark Avenue Sanford, Florida 32771 Telephone number: 407.688.5044. E-mail address: craig.radzak@sanfordfl.gov. provided, however, that all notices under this Agreement shall be copied to: Ms. Marisol Ordonez Purchasing Manager Finance -Purchasing Division City of Sanford Post Office Box 1788 Sanford, Florida 32772 Phone: 407.688.5028 Section 4. Effective Date and Term of Agreement. This Agreement shall take effect on the date that this Agreement is fully executed by the parties hereto. This Agreement shall be in effect for a term of 1 year and, upon the exercise of an option to renew by the City, for 3 additional terms of 1 year each. In any event, this Agreement shall remain in effect until the services to be provided by CGS to the City under each work order have been fully performed in accordance with the requirements of the City; provided, however, that, the indemnification provisions and insurance provisions of the standard contractual terms and conditions referenced herein shall not terminate and the protections afforded to the City shall continue in effect subsequent to such services being provided by CGS No services have commenced prior to the execution of this Agreement that would entitle CGS for any compensation therefor. Notwithstanding the foregoing, the City may unilaterally terminate this Agreement in the event that the City is not satisfied with the goods or services provided by CGS within the 6 calendar months commencing on the first day of the first month after this Agreement commences. Section 5. Compensation. The parties agree to compensation as set forth in the attachments hereto and as may be set forth in each purchase/work order issued by the City. Section 6. Standard Contractual Terms and Conditions. All "Standard Contractual Terms and Conditions", as provided on the City's website, apply to this Agreement. Such Terms and Conditions may be found at the City's website (www. SanfordFL.gov). The parties shall also be bound by the purchasing policies and procedures of the City as well as the controlling provisions of Florida law. Work orders shall be used, in accordance therewith, in the implementation of this Agreement to the extent deemed necessary by the City in its sole and absolute discretion. Section 7. CGS's Mandatory Compliance with Chapter 119, Florida Statutes, and Public Records Requests. (a). In order to comply with Section 119.0701, Florida Statutes, public records laws, CGS must: (1). Keep and maintain public records that ordinarily and necessarily would be required by the City in order to perform the service. (2). Provide the public with access to public records on the same terms and conditions that the City would provide the records and at a cost that does not exceed the cost provided in Chapter 119, Florida Statutes, or as otherwise provided by law. (3). Ensure that public records that are exempt or confidential and exempt from public records disclosure requirements are not disclosed except as authorized by law. (4). Meet all requirements for retaining public records and transfer, at no cost, to the City all public records in possession of CGS upon termination of the contract and destroy any duplicate public records that are exempt or confidential and exempt from public records disclosure requirements. All records stored electronically must be provided to the City in a format that is compatible with the information technology systems of the City. (b). If CGS does not comply with a public records request, the City shall enforce the contract provisions in accordance with this Agreement. (c). Failure by CGS to grant such public access and comply with public records requests shall be grounds for immediate unilateral cancellation of this Agreement by the City. CGS shall promptly provide the City with a copy of any request to inspect or copy public records in possession of CGS and shall promptly provide the City with a copy of CGS's response to each such request. (d). IF THE CONTRACTORIVENDOR HAS QUESTIONS REGARDING THE APPLICATION OF CHAPTER 119, FLORIDA STATUTES, TO THE CONTRACTOR'S (VENDOR'S) DUTY TO PROVIDE PUBLIC RECORDS RELATING TO THIS CONTRACT CONTACT THE CUSTODIAN OF PUBLIC RECORDS AT (407) 688-5012', TRACI HOUCHIN, CMC, FCRM, CITY CLERK, CITY OF SANFORD, CITY HALL, 300 NORTH PARK AVENUE, SANFORD, FLORIDA 32771, TRACI. HOUCHI N@SAN FORDFL.GOV. Section 8. Time is of the Essence. Time is hereby declared of the essence as to the lawful performance of all duties and obligations set forth in this Agreement. Section 9. Entire Agreement/Modification. This Agreement, together with all "Standard Contractual Terms and Conditions", as provided on the City's website and the attachments hereto (the documents relative to the procurement activity of the City leading to the award of this Agreement) constitute the entire integrated agreement between the City and CGS and supersedes and controls over any and all prior agreements, understandings, representations, correspondence and statements whether written or oral in connection therewith and all the terms and provisions contained herein constitute the full and complete agreement between the parties hereto to the date hereof. This Agreement may only be amended, supplemented or modified by a formal written amendment of equal dignity herewith. In the event that CGS issues a purchase order, memorandum, letter, or any other instrument addressing the services, work, and materials to be provided and performed pursuant to this Agreement, it is hereby specifically agreed and understood that any such purchase order, memorandum, letter, or other instrument shall have no effect on this Agreement unless agreed to by the City, specifically and in writing in a document of equal dignity herewith, and any and all terms, provisions, and conditions contained therein, whether printed or written or referenced on a Web site or otherwise, shall in no way modify the covenants, terms, and provisions of this Agreement and shall have no force or effect thereon. Section 10. Severability. If any term, provision or condition contained in this Agreement shall, to any extent, be held invalid or unenforceable, the remainder of this Agreement, or the application of such term, provision or condition to persons or circumstances other than those in respect of which it is invalid or unenforceable, shall not be affected thereby, and each term, provision and condition of this Agreement shall be valid and enforceable to the fullest extent permitted by law when consistent with equity and the public interest. Section 11. Waiver. The failure of the City to insist in any instance upon the strict performance of any provision of this Agreement, or to exercise any right or privilege granted to the City hereunder shall not constitute or be construed as a waiver of any such provision or right and the same shall continue in force. Section 12. Captions. The section headings and captions of this Agreement are for convenience and reference only and in no way define, limit, describe the scope or intent of this Agreement or any part thereof, or in any way affect this Agreement or construe any provision of this Agreement. Section 13. Counterparts. This Agreement may be executed in any number of counterparts, each of which shall be deemed an original, but all of which, taken together, shall constitute one and the same document. Section 14. Binding Effect. This Agreement shall be binding upon and inure to the benefit of the successors in interest, transferees and assigns of the parties. Each party hereto represents to the other that it has undertaken all necessary actions to execute this Agreement, and that it has the legal authority to enter into this Agreement and to undertake all obligations imposed on it. The signatories hereof represent that they have the requisite and legal authority to execute this Agreement and bind the respective parties herein. Section 15. Remedies. The rights and remedies of the parties, provided for under this Agreement, are in addition to any other rights and remedies provided by law or otherwise necessary in the public interest. Section 16. Governing law, Venue and Interpretation. This Agreement is to be governed by the laws of the State of Florida. Venue for any legal proceeding related to this Agreement shall be in the Eighteenth Judicial Circuit Court in and for Seminole County, Florida. This Agreement is the result of bona fide arms length negotiations between the City and CGS, and all parties have contributed substantially and materially to the preparation of the Agreement. Accordingly, this Agreement shall not be construed or interpreted more strictly against any one party. than against any other party and all provisions shall be applied to fulfill the public interest. IN WITNESS WHEREOF, the City and CGS have executed this instrument for the purpose herein expressed. ATTEST. CITY OF SANFORD Traci Houchin, CMC, FCRMTriplett City Clerk or \A I Approved as to form and 87 legal sufficiency. VENDOR/COMPRESSED GAS SOLUTIONS, INC. By: Robert Lea—man Authorike'd CorporcW Authority President Herbie King Dated: BIDDER INFORMATION: S <tA"ATE: September 20, 2018 at 2:00 P.M. Local Time Name of Firm:.., -....6.1. .. .Ste`..... City of Sanford Purchasing Division Contact Person: Marisol Ordonez, Purchasing Manager ............. Address. ........... Address: 300 N. Park Avenue Suite 243A City, State, Zip: Sanford, Florida 32771 Address: ....................................................................................... Phone Number: 407.688.5028, or ext. 5030 Fax Number: 407.688.5021 Fax -chasing(&,sanfordfl.gov City/State/Zip Code: C -Y . ...... ...... Email: put ry.4 For Div./Dept./Office: Shirley Brinson, Fiscal Technician Contact PersoAXb,..-.0 ....... . ... ............................ 407.688.5048 Delivery Address: 1303 S. French Ave. Phone Number .. . .... la .... 0 .... ................................ Snaford, FL 32771 Fax..............................................................c ISSUED DATE: September 6, 2018 BIDDER'S SIGNATURE:. .:� — .................. BIDDER'S PRINTED NAME:.. ...... Date:........... Title:.. ke�C4 k- -9,3 ... .......... .. ...................... ............................. . .......... ........ - -------------------- - ----- ---------------- [PLEASE RETURN BY DUE DATE AND TIME VIA FAX, MAIL OR EMAIL TO CONTACT PERSON STATED ABOVE) 1. Intent. The intent of this solicitation is to select a successful Bidder for the provision of oxygen cylinders filled/hydro - tested as needed. 2. Deliverables, and Scope of Services. The successful Bidder shall provide all necessary material, goods, labor, etcetera to: 1. Customer owned D cylinders picked up, filled with oxygen for EMS, and delivered to ST31 bay area 2. Customer owned M cylinders picked up, filled with oxygen for EMS, and delivered to ST31 bay area 3. Customer owned l# cylinders picked up, filled with nitrous oxide and delivered to ST31 bay area 4. Sonic and ultrasonic cylinder examination of customer owned cylinders when required S. Daily rental of Vendor cylinders filled with oxygen or nitious oxide as needed Delivery and Set -Up: Delivery shall be made to ST31: City of Sanford Fire Department Station 31/Public Saftey Complex at 1303 William Clark Ave, Sanford, FL 32771 after issuance of a Purchase Order and with coordination from the Fire Department. The successful Bidder shall be responsible for coordinating the delivery of all goods/services in a timely manner. Partial deliveries or deliveries on any other date and time shall not be allowed unless written authorization has been obtained from the appropriate City authorized representative. The successful Bidder shall be responsible for all risk of loss, any damage and/or stolen materials and equipment while in transit to City of Sanford Fire Department Station 31/Public Saftey Complex. Delivery and Time Performance: At approximately 30 days after issuance of the purchase order by the City, the successful Bidder shall update the appropriate City representative providing a tentative delivery schedule and project commencement date. Permitting: The successful Bidder shall be solely responsible for all pertinent permits required as well as adhering, meeting and or exceeding all local, state, and national building codes. City Responsibility: The City shall be responsible for: a. Provide a designated area to deliver all cylinders. b. Provide access to the work area; ,UK-r—lz 7 Rcv. 032016 City of Sanford I Finance Department I Purchasing Division & kNFORD PINANC5 DPART"MT 300 N. Park Avenue, Sanford, Florida 32771 Phone: 407.688.5028, or extension 5030 1 Fax: 407.688.5021 FORM IRFO-" V INFORMAL REQUEST FOR QUOTE 11"Q 18/1 Oxygen Cylinders BIDDER INFORMATION: S <tA"ATE: September 20, 2018 at 2:00 P.M. Local Time Name of Firm:.., -....6.1. .. .Ste`..... City of Sanford Purchasing Division Contact Person: Marisol Ordonez, Purchasing Manager ............. Address. ........... Address: 300 N. Park Avenue Suite 243A City, State, Zip: Sanford, Florida 32771 Address: ....................................................................................... Phone Number: 407.688.5028, or ext. 5030 Fax Number: 407.688.5021 Fax -chasing(&,sanfordfl.gov City/State/Zip Code: C -Y . ...... ...... Email: put ry.4 For Div./Dept./Office: Shirley Brinson, Fiscal Technician Contact PersoAXb,..-.0 ....... . ... ............................ 407.688.5048 Delivery Address: 1303 S. French Ave. Phone Number .. . .... la .... 0 .... ................................ Snaford, FL 32771 Fax..............................................................c ISSUED DATE: September 6, 2018 BIDDER'S SIGNATURE:. .:� — .................. BIDDER'S PRINTED NAME:.. ...... Date:........... Title:.. ke�C4 k- -9,3 ... .......... .. ...................... ............................. . .......... ........ - -------------------- - ----- ---------------- [PLEASE RETURN BY DUE DATE AND TIME VIA FAX, MAIL OR EMAIL TO CONTACT PERSON STATED ABOVE) 1. Intent. The intent of this solicitation is to select a successful Bidder for the provision of oxygen cylinders filled/hydro - tested as needed. 2. Deliverables, and Scope of Services. The successful Bidder shall provide all necessary material, goods, labor, etcetera to: 1. Customer owned D cylinders picked up, filled with oxygen for EMS, and delivered to ST31 bay area 2. Customer owned M cylinders picked up, filled with oxygen for EMS, and delivered to ST31 bay area 3. Customer owned l# cylinders picked up, filled with nitrous oxide and delivered to ST31 bay area 4. Sonic and ultrasonic cylinder examination of customer owned cylinders when required S. Daily rental of Vendor cylinders filled with oxygen or nitious oxide as needed Delivery and Set -Up: Delivery shall be made to ST31: City of Sanford Fire Department Station 31/Public Saftey Complex at 1303 William Clark Ave, Sanford, FL 32771 after issuance of a Purchase Order and with coordination from the Fire Department. The successful Bidder shall be responsible for coordinating the delivery of all goods/services in a timely manner. Partial deliveries or deliveries on any other date and time shall not be allowed unless written authorization has been obtained from the appropriate City authorized representative. The successful Bidder shall be responsible for all risk of loss, any damage and/or stolen materials and equipment while in transit to City of Sanford Fire Department Station 31/Public Saftey Complex. Delivery and Time Performance: At approximately 30 days after issuance of the purchase order by the City, the successful Bidder shall update the appropriate City representative providing a tentative delivery schedule and project commencement date. Permitting: The successful Bidder shall be solely responsible for all pertinent permits required as well as adhering, meeting and or exceeding all local, state, and national building codes. City Responsibility: The City shall be responsible for: a. Provide a designated area to deliver all cylinders. b. Provide access to the work area; ,UK-r—lz 7 Rcv. 032016 c. Provide access to designated delivery area as required; d. The City shall make the facility available for evaluation and inspection accompanied by a City Representative by calling 407-688-5048 to schedule an appointment; and, e. Appointments will be given on a first come, first serve basis based on availability and will be given between the hours of 8:30 A.M. and 4:30 P.M., Monday through Thursday schedule permitting. Obligations of the Successful Bidder: It is understood that the successful Bidder shall provide and pay for all labor, tools, materials, permits, equipment, transportation, supervision, and any and all other items or services, of any type whatsoever, which are necessary to fully complete and deliver the goods/services requested by the City, and shall not have the authority to create, or cause to be filed, any liens for labor and/or materials on, or against, the City, or any property owned by the City. Such lien, attachment, or encumbrance, until it is removed, shall preclude any and all claims or demands for any payment expected by virtue of this project. The successful Bidder will ensure that all of its employees, agents, sub- contractors, representatives, volunteers, and the like, fully comply with all of the terms and conditions set herein, when providing services for the City in accordance herewith. The successful Bidder shall be solely responsible for the means, methods, techniques, sequences, safety programs, and procedures necessary to properly and fully complete the work set forth in the Scope of Services. The successful Bidder shall use appropriate tools and/or equipment which are in good repair and proper working order, so as to enable the successful Bidder to complete the services required hereby. Public Emergencies: It is hereby made a part of this bid that before, during, and after a public emergency, disaster, hurricane, tornado, flood, or other acts of God, City of Sanford shall require a "First Priority" for goods and services. It is vital and imperative that the health, safety, and welfare of the citizens of Sanford are protected from any emergency situation that threatens public health and safety as determined by the City. The Bidder agrees to rent/sell/lease all goods and services to the City or governmental entities on a "first priority" basis. The City expects to pay contractual prices for all products and/or services under the awarded Agreement in the event of a disaster, emergency, hurricane, tornado, flood, or other acts of God. Should the Bidder provide the City with products and/or services not under the awarded Agreement, the City expects to pay a fair and reasonable price for all products and/or services rendered or contracted in the event of a disaster, emergency, hurricane, tornado, flood, or other acts of God. The City shall select the lowest quote that is most responsive to the needs of the City as outlined herein. The bidder's price response shall be accompanied by a detailed description of the requirement service to be offered. 3. Price Submittal. In accordance with the terms, conditions and specifications, Uwe, as authorized signatory to commit the firm, do hereby accept in total all the terms and conditions stipulated and referenced in this IRFQ document and hereby submit the following prices for IRFQ 18/19-100 Oxygen Cylinders as follows: Item Description Unit Price Quantity Extended Price Raired eq Customer owned D cylinders picked up, filled with 1. oxygen for EMS, and delivered to ST31 bay area 2. Customer owned M cylinders picked up, filled with $ oxygen for EMS, and delivered to ST31 bay area c7 - Customer owned l# cylinders picked up, filled with -3. nitrous oxide and delivered to ST31 bay area $ SCE0A) $ Sonic and ultrasonic cylinder examination of 4. customer owned cylinders when required $ 0, .7 - Daily rental of Vendor cylinders filled with oxygen 0,/o 5. or nitious oxide as needed $ �./o $ o± Delivery Fee 4. $ $ Rl:v. 2Z12.2018 INFORMAL Rei. 2.22.2013 Fuel Surcharge Additional Costs: $. $ -c 7 7. $ $ g, TOTAL QUOTE PRICE No= $ Additionally, please respond to the following questions by placing a check mark (v) on the appropriate answer: Question Response Response YES NO FItem Did you include a copy of your Certificate of Liability Insurance (COI) with your cote submittal? . Would you consider accepting payment for services rendered via a Purchasing Card without the addition of convenience and/or service fees of any kind? 3. include a copy of your Florida State License and W9 a. The City will not consider alternates to the items listed above. if alternates are offered, the City will have the sole and unilateral right to reject the alternate and purchase from vendor providing compliant items. Delivery time will be a factor in the evaluation of this IRFQ. b. All prices quoted shah remain firm for period of one (1) year after award of this IRFQ. The City will be awarding a one (1) year contract with four (4) one (1) year optional renewals for a potential total of a five (5) year contract. c. Unit Price Accuracy: Please check the stated unit prices before submitting your quote; as no change in prices shall be allowed after the due date and time. All prices and notations must be in ink or typewritten. In cases of extended price irregularities, unit price shall rg eva . Please note that the City reserves the right to clarify and correct extended price amount errors. d. City of Sanford is exempt from Sales Tax. Certificate No. 85-80126216810-8. e. If you are offering pricing which is based on other entity or agency solicitation pricing, clearly state so and include a copy of the applicable solicitation with your submittal. f. Please read all terms and conditions, complete the requested information, and sign in the space provided on page 1. g. If not submitting a quotation, please indicate "NO BID" and return this form. Critical Data: a. Please return your quote submittal via fax, mail or email to the requesting Division/Department/Office as outlined on page 1; by no later than the due date and time outlined on page 1 or as revised thereof via written addenda. b. Please email questions regarding this quotation only to the requesting Division/Department/Office. Any interpretations, clarifications, or changes made will be in the form of written addenda issued by requesting DivisioruDepartment/Office. c. Pursuant to Section 2.2 of the City of Sanford Purchasing Policy, lobbying is strictly prohibited. d. Please note that all documents sent to the City as part of this IRFQ are considered a Public Record; as prescribed by Chapter 119, Florida Statutes. e. Bidder must submit a copy of their Certificate of Insurance with their quote. f. Any order resulting from this IRFQ shall be subject to the attached General Terms and Conditions and all applicable laws, policies and procedures. INFORMAL Rei. 2.22.2013 ACOR©®DATE CERTIFICATE OF LIABILITY INSURANCE (MM/DD/YYYY) 7131/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or 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 The Horton Group 10320 Orland Parkway Orland Park IL 60467 CONTACT PHONE FAX • 708-845-3917(AIC,No): 866-202-5917 ADDRESS: Certificates@thehortongroup.com INSURER(S) AFFORDING COVERAGE NAIC # Y INSURER A: Granite State Insurance CO. 23809 02 -LX -001825678-11 INSURED COMPGAS-01 Compressed Gas Solutions, Inc. 2450 Shader Rd. INSURER B: National Union Fire Insurance 19445 INSURER C : INSURERD: Orlando FL 32804 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 1449937840 REVISION NUMBER THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVQ POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y 02 -LX -001825678-11 2/15/2018 2/15/2019 EACH OCCURRENCE $1,000,000 CLAIMS -MADE OCCUR _ DAMAGES (ERENTED ccrsPREMISES Ea occurrence) $100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,0D0,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ❑ JERa F—] LOC PRODUCTS - COMP/OP AGG $2,000,000 OTHER: A AUTOMOBILE LIABILITY Y Y 02 -CA -001825991-11 2/15/1018 2/15/2019 COEa acciMBINED SINGLE LIMITdent $1,000,000 _ BODILY INJURY (Per person) $ X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ X NON -OWNED AUTOS ONLY AUTOS ONLY HIRED 1xx PROPERTY DAMAGE $ Per accident Comp/Coll Ded. $1,000/1,000 X FL PIP $10,000 B X UMBRELLA LIAB X OCCUR 29 -UD -001825679-11 2/15/2018 2/15/2019 EACH OCCURRENCE $ 4,000,000 AGGREGATE $4,000,000 EXCESS LIAB CLAIMS -MADE DED I X I RETENTION$ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N Y WC 005 70 6844 4/8/2018 4/8/1019 X STATUTE ETH E.L. EACH ACCIDENT $ 500,000 ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? N/A ----- E.L. DISEASE - EA EMPLOYEE $ 500,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 A Commercial Property 02 -LX -001825678-11 2/15/2018 2/15/2019 Building/BPP 1,245,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Additional insured on a primary and non-contributory basis with respect to general liability and additional insured on a primary basis with respect to auto liability only when required by written contract. Waivers of subrogation apply to the general liability, auto liability, and workers compensation in favor of the stated of the additional insureds only when required by written contract. Umbrella follows form. Additional Insured: City of Sanford CERTIFICATE HOLDER CANCFI_I ATiON ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Sanford 300 N. Park Ave. Sanford FL 32771 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD A`C40R'H CERTIFICATE OF LIABILITY INSURANCE FDATE (MMIYYY OfY ) 018 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(les) must have ADDITIONAL INSURED provisions or 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 The Horton Group 10320 Orland Parkway Orland Park IL 60467 CONTACT PHONEFAX e ; 708-845-3917 A1C No): 866-202-5917 ADDRESS: Certificates@thehortongroup.com INSURERS AFFORDING COVERAGE i NAIC S j 2115/2019 I � INSURER A: Granite State Insurance Co. 23809 MED EXP (Any one person) $5,000 INSURED COMPGAS-01 Compressed Gas Solutions, Inc. INSURER B: National Union Fire Insurance I 19445 l j 2450 Shader Rd. INSURER C: INSURERD: Orlando FL 32804 INSURER E : I PRODUCTS-COMPtOPAGG $2,000,000 INSURER F: OTHER: COVERAGES CERTIFICATE NUMBER- 67820684.1i RFVIgInN NUMRFR- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR { .LTR, TYPEOFINSURANCE ADDLIS BI ff POLICY EFF POLICYNUMBERi MMIDD POLICY EXP MM1DD i LIMITS 'EACH A I X COMMERCIAL GENERAL LIABILITY 1-7-1 ' CLAIMS -MADE OCCUR Y I � Y I I { 02 -LX -001825678-11 { 2115/2018 E j 2115/2019 I � OCCURRENCE 51,000,000 DAMAGE � PREMISES (Ea occurrence ) a S100,000 MED EXP (Any one person) $5,000 l j I ( PERSONAL&ADV INJURY $1,000,000 1 GEN'L AGGREGATE LIMIT APPLIES PER: { , POLICY "JET = LOC '�± GENERAL AGGREGATE52,000,000 PRODUCTS-COMPtOPAGG $2,000,000 { 5 OTHER: II 3 A AUTOMOBILE LIABILITY Y Y 02 -CA -001825991-11 2/1542018 2/15/2019 (Ea BINED1SINGLE LIMIT g 1,000,000 BODILY INJURY (Per person) S X i ANY AUTO I I OWNED 7-7 SCHEDULED AUTOS ONLY ii AUTOS X HIRED I AUTOS ONLY ` X AUTOS ONLY � i X I FL PIP X 510.000 ( I S f { f I I I i BODILY INJURY (Per accident) 5 PROPERTY DAMAGE I S (Per accident I Com !Colt Ded. I S 1,00011,000 13 i X UMBRELLA LIAB I X I OCCUR i 29 -UD -001825679-11 ! 2/15/2078 2/1542079 EACH OCCURRENCE ($4,000,000 { EXCESS LIAR n CLAIMS -MADE ( i 2 AGGREGATE { $4.000,000 I ; DED , X I RETENTION $ 10 OW Is A WORKERS COMPENSATION IAND EMPLOYERS' LIABILITY YIN ( I Y j WC 005 70 6844 { 4/8/2018 j 418!2019 ! j( !PER OTH- STATUTE i I ER E.L. EACH ACCIDENT S 500,000 1 ANYPROPRIETOR/PARTNER/EXECUTIVE i OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under � N f A 'i I ((( i I E.L. DISEASE - EA EMPLOYEE $ 500.000 s DESCRIPTION OF OPERATIONS below , E.L. DISEASE - POLICY LIMIT $ 500.000 A i Commercial Property I 02 -LX -001825678-11 I 2/1542018 � 2/15/2019 j Building/BPP i 1.245,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if morel space is required) Additional insured on a primary and non-contributory basis with respect to general liability and additional insured on a primary basis with respect to auto liability only when required by written contract. Waivers of subrogation apply to the general liability, auto liability, and workers compensation in favor of the stated of the additional insureds only when required by written Contract. Umbrella follows form. 193iillrilti113i1091S J Ail Sanford Fire Department 1303 William Clark Ave Sanford FL 32771 IIRFG 18/18-100 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE E0 V11-----_ A ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD WA Request for Taxpayer Give Form to the Form (Rev. November 2017) Identification Number and Certification requester. Do not t '"a"I fReevvenueas�ce ► Go to uvww.1MgovlF0rMW9 for instructions and the latest information. ury send to the IRS. I Name (as shown on your income tax return). Name is required on this Eine; do not tam this Eine blank. Compressed Gas Solutions, inc. 2 Business name/disregarded entity name, if different from above cco 3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the 4 Exemptions (codes apply only to following soven boxes. certain entities, not individuals; see 4y Instructions on page 3): p ❑ tndividuaVsole proprietor or ❑ C Corporation R S Corporation ❑ Partnership ❑ Trusuestate e single -member LLC Exempt payee code (d any) o ❑Umited liabilityconpang. Enter the tax classification {C=C corporation, S=S corporation, P-PartnershiA)► p Note. Check the appropriate box In the line above for the tax classification of the single -member owner. Do not check Exemption from FATCA reporting LLC If the LLC Is classified as a single -member LLC that is disregarded from the owner unless the owner of the LLC Is 4 code (d any) y another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single -member LLC that is disregarded from the owner should check the appropriate box for the tax classification of its owner. V ❑ Other (we Instructions) ► Wuvra:ro•coac,umaanrsnw«,rrta•rn.us.J N5 Address (number, street, and apt. or suits no.) See Instructions. Requester's name and address (optional) N 2450 Shader Road e City, state, and ZIP code Orlando, FL 32804 7 Ust account number(s) here (optional) IMB Taxpayer Identification Number (rIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid Social security number backup withholding. For individuals, this is generally your social security number (SSN. However, for a —M — m _ resident alien, sole proprietor, or disregarded entity, see the instructions for Part i, laterr. For other entities, it is your employer identification number (EiN). If you do not have a number, see Now to gate FM FT TIN, later. or Note: If the account is In more than one name, see the instructions for line 1. Also see What Name and I Employer identification number Number To Give the Requester for guidelines on whose number to enter. m _ ��rn i 3 4 2 0 6 7 2 3 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. t am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b)1 have not been notified by the internal Revenue Service QRS) 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; and 3.1 am a U.S. citizen or other U.S. person (defined below); and 4. The FATCA code(s) entered on this form Of any) indicating that 1 am exempt from FATCA reporting Is correct. Certification Instructions. You must cross out (tern 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax renin. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, carKellation of debt, contributions to an individual retirement arrangement PRA), and generally, payments other than Interest and d you .are nA requfrto sign the certification, but you must provide your correct TIN. See the Instructions for Part it, later. , Here I u.s. General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Future developments. For the latest information about developments related to Form W-9 and its instructions, such as legislation enacted after they were published, go to www.lrs.gov1FormW9. Purpose of Form An Individual or entity (Form W-9 requester) who is required to file an Information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number ([TIN), adoption taxpayer identification number (ATIN), or employer Identification number (EiN), to report on an Information return the amount paid to you, or other amount reportable on an Information return. Examples of Information returns Include, but are not limited to, the following. • Form 1099-iNT (Interest earned or paid) Date 10- * • Form 1099 -DIV (dividends, including those from stocks or mutual funds) • Form 1099-MISC (various types of income, prizes, awards, or gross proceeds) • Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) • Form 1099-S (proceeds from real estate transactions) • Form 1099-K (merchant card and third party network transactions) • Form 1098 (home mortgage Interest), 1098-E (student loan Interest), 1098-T (tuition) • Form 1099-C (canceled debt) • Font 1099-A (acquisition or abandonment of secured property) Use Form W-9 only If you are a U.S. person (including a resident afien), to provide your correct TIN. if you do not return Form W-9 to the requester with a 77N, you might be subject to backup withholding. See What is backup withholding, later. Cat, No. 10231X Form w-9 (Rev. 11-2017) 05-iz DEPARTMENT OF REVENUE I 58-8012227501-1 Certificate Number This certifies that COMPRESSED GAS SOLUT',ON—': INC 2450 SHADER RD ORLANDO FL 32804-2737 ate of Registration I to Chapter 212, Florida Statutes 7— 10/01/02 e Date Opening Date DR -11 R. 01/11 MONTHLY Filing Frequency has met the sales and use tax registration requirements for the business location stated above and is authorized to collect and remit tax as required by Florida law. This certificate is non -transferable. POST THIS CERTIFICATE IN A CONSPICUOUS PLACE ---- -------- Tax Collector Scoff Randolph Local Business Tax Receipt Orange County; Florida This local Business Tax Receipt is in addition to and not in lieu of any other tax required by law or municipal ordinance. Businesses are subject to regulation of zoning, health and other lawful authorities. This receipt is valid from October 1 through September 30 of receipt year. Delinquent penalty Is added October 1. 2018 3200 RETAIL STORE $30.00 TOTAL TAX $60.00 PREVIOUSLY PAID $60.00 TOTAL DUE $0.00 2450 SHADER RD U - ORLANDO, 32804 PAID: $60.00 0099-00841928 7/25/2018 EXPIRES 9/30/2019 3200-0561291 5 EMPLOYEES 3501 DIST MEDICAL SUPPLIES $30.00 5 EMPLOYEES COMPRESSED GAS SOLUTIONS INC COMPRESSED GAS SOLUTIONS 2450 SHADER RD ORLANDO FL 32804 This receipt is official when validated by the Tax Collector. cx� � p, •� ' r,f FINANCE DEPARTMENT October 23, 2018 Contract/Agreement Name: Approval: urchasing Manager Finance Di ector IRFQ 18/19-100 Oxygen Cylinder's — Compressed Gas Solutions Inc., the PO's are less than $50,000 does not need CC approval. Date Date C' ttorney Date