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2295 PBA 20/21-14 Corrosion Inhibitor piggyback w/HawkinsY OF NFORD Ex ) ),s FINANCE DEPARTMENT PURCHASING DEPARTMENT iii jjZ1111i TO: City Clerk/Mayor RE: PBA 20/21-14 Corrosion Inhibitor - Hawkins The item(s) noted below is/are attached and forwarded to your office for the following action(s): F-1 Development Order F-1 Mayor's signature F-1 Final Plat (original mylars) F-1 Recording ❑ Letter of Credit F-1 Rendering F-1 Maintenance Bond Z Safe keeping (Vault) F-1 Ordinance [:] Deputy City Manager F-1 Performance Bond F-1 Payment Bond F-1 Resolution F-1 City Manager Signature 1-1 ❑ City Clerk Attest/Signature F-1 City Attorney/Signature Once completed, please: F-1 Return originals to Purchasing- Department F-1 Return copies El Special Instructions Li.4,� f3oa.&zZ4&v- From SilarePoiilt—Fitiatice—Purchasiiig_Fori-ns - 2018.doc 3 -1412 -02 -1 - Date Hawkins, Inc. Piggyback Contract (PBA 2012144) Corrosion Inhibitor The City of Sanford ("City") enters this "Piggyback" Contract with Hawkins, Inc., (which acquired substantially all the assets of The Dumont Company, Inc.), a Minnesota corporation (hereinafter referred to as the "Vendor"), whose address is 2381 Rosegate, Roseville, Minnesota 55113, under the terms and conditions hereinafter provided. The City and the Vendor agree as follows: (1). The Purchasing Policy for the City of Sanford allows for "piggybacking" contracts. Pursuant to this procedure, the City is allowed to --piggyback 'an existing government contract, and there is no need to obtain formai or informal quotations, proposals or bids. The parties agree that the Vendor has entered a contract with the government of the City of Zephyrh ills, Florida entitled "Blanket Purchase Agreement", as may have been amended, in order for the Vendor to provide goods and services relating to the City's need for corrosion inhibitor as described in Section 2.0 of the City of Zephyrhills RFP form (said original aggregate contract documents being referred to as the "original government contract' herein all of which are based upon procurement activity conditions). Hawkins, Inc. distributes, blends, dilutes and manufactures bulk and specialty chemicals for its customers in a wide variety of industries. The Dumont Company, Inc. served the chemical needs of Florida customers since 1955. With its primary chemical markets include municipal water and wastewater treatment, private utilities, commercial swimming pools, irrigation water treatment and food processing. ..__._.-_.---. —..- 11 P a g e ..___11Page (2). The original government contract documents are incorporated herein by reference and attached as Exhibit "A" to this Contract. All of the terms and conditions set out in the original government contract are fully binding on the parties and said terns and conditions are incorporated herein; provided, however, that the City will negotiate and enter work orders/purchase orders with the Vendor in accordance with City policies and procedures for particular goods and services. (3). Notwithstanding the requirement that the original government contract is fully binding on the parties, the parties have agreed to modify certain technical provisions of the original government contract as applied to this Contract between the Vendor and the City, as follows: (a). Time Period ("Term") of this Contract: (state N/A if this is not applicable). NIA. (b). Insurance Requirements of this Contract: (state NIA if this is not applicable). N/A. (c). Notwithstanding anything in the original government contract to the contrary, the City's terms and conditions relating to the Issuance of purchase orders or work orders, or referenced in such documents, shall prevail over any inconsistent provisions of the original government contract. (d). Address change for the City: Notwithstanding the address and contact information for the government entity as set out in the original goverment contract, the Vendor agrees that he/she/ii shall send notices, invoices and shall conduct all business with the City to the attention of City Manager, at: City of Sanford, 300 North Park Avenue; Sanford, Florida 32771. The City Manager's designated representative for this Contract 21Page is Marisol Ordoflez, Purchasing Manager, Finance -Purchasing Division, 300 North Park Avenue; Sanford, Florida 32771, telephone number (407) 688-5028 and whose e-mail address is Marisol.ordonez@sanfordfl.gov. (e). Notwithstanding anything in the original government contract to the contrary, the venue of any dispute will be in Seminole County, Florida. Litigation between the parties arising out of this Contract shall be in Seminole County, Florida in the Court of appropriate jurisdiction. The law of Florida shall control any dispute between the parties arising out of or related to this Contract, the performance thereof or any products or services delivered pursuant to such Contract. (f). Notwithstanding any other provision in the original government contract to the contrary, there shall be no arbitration with respect to any dispute between the parties arising out of this Contract. Dispute resolution shall be through voluntary and non-binding mediation, negotiation or litigation in the court of appropriate jurisdiction in Seminole County, Florida, with the parties bearing the costs of their own legal fees with respect to any dispute resolution, including litigation. (g). Notwithstanding any other provision in the original government contract to the contrary, the Vendor shall provide the City with most favored nation pricing. (h). All the services to be provided or performed shall be in conformance with commonly accepted industry and professional codes and standards, standards of the City, and the laws of any Federal, State or local regulatory agency. 3 1 P a g e (I). Public Records Requirements. (I). IF THE CONTRACTORIVENDOR HAS QUESTIONS REGARDING THE APPLICATION OF CHAPTER 119, FLORMA STATUTES, TO THE CONTRACTOR'S jJW I -• 1 1 i I RELATING TO THIS CONTRACT, CONTACT THE CUSTODIAN OF PUBLIC RECORDS AT (407) 688-5012Y TRACI HOUCHIN, MMCj FCRM., CITY CLERK, CITY OF SANFORD, CITY HALL, 300 NORTH PARK AVENUE, SANFORD, FLORIDA 327719 TRACI.HOUCHIN@SANFORDFL.GOV. (11). In order to comply with Section 119.070 1, Florida Statutes, public records laws, the Vendor must: (A). Keep and maintain public records that ordinarily and necessarily would be required by the City in order to perform the service. (13). 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 excted the cost provided in Chapter 119, Florida Statutes, or as otherwise provided by law. 4 1 P a g e (C). Ensure that public records that are exempt or confidential and exempt from public records disclosure requirements are not disclosed except as authorized by law. (D).Meet all requirements for retaining public records and transfer, at no cost, to the City all public records in possession of the Vendor upon termination of this 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. (III), if the Vendor does not comply with a public records request, the City shall enforce the provisions of this Contract in accordance with the terms and conditions of this Contract. (IV), Failure by the Vendor to grant such public access and comply with public records requests shall be grounds for immediate unilateral cancellation of this Agreement by the City. The Vendor shall promptly provide the City with a copy of any request to inspect or copy public records in possession of the Vendor and shall promptly provide the City with a copy of the Vendor's response to each such request. 0). All other provisions in the original government contract are fully binding on the parties and will represent the agreement between the City and the Vendor. Entered on the last date of a signatory hereto as set forth below. SIGNATURE BLOCKS FOLLOW: 5 1 P a g e Attest: Attest: CIA Traci 1-14111n, City CClerk, NIC, FCRIVI XtLC-t T . rl' U-eopio) L 0602 Approved as to form and legal sufficiency. olbert Citq*ofnev y dV Hawkins, Inc., a Minnesota corporation. Patrick Hawkins Chief Executive Officer Date: 11, -- ®A,, F-141 ; --N.1-1 6 1 P a g e Ir lit SL a 2a 0 Pr m W -g 10 0 3 Ir w lit SL a 2a @ro W w w 3 f0 w ? c m Si wIRRro n m R � a 5. m ro 0 yK. I X w G O N 0 0 �• I � H � O (p � � n row w K Z 6 43 -1. 2 a s, •� G � a w ;� a re ? � p 0•n -awc w N. n •� C7 °. G N 'a A '° ro n ^_ ata n µ "� a N' a 3 nmo o 3 m. m er<o o ro m< a c w' c •� m n 1" m a o. ; w m "— ° 3 '19" Q• c et N m c A' o ego �, c �• R. c S a 0. p? O1 m u 0. 'E?.ir m 'o ro o a ,� a „oo„ " °. o o. ° n a m n •'a °• ». m g. � o' — _ sro mSm W �. c n •p � o � ro o' m � � ii � o°, ro a o a °' °' w N w. m w� ry m a K •wc � N w �' w � � 'a •''4 'o 'o w � w ro � m x � $. s ° m '" •c m ro v, m 0 3 n n ryiE o u ro N '" ro R PV SL m a IV V p I&i i 0; R P F, P F P Q 05 K'_o •;a 0- alm 3 11 ql fi, st m Zo o ia j- o cL Q6 2� o :E g Ro Rm ro n, :wl Q6 jg Fr s W tF Q W ler jL o A cz P IN, F P IP IP O 51 1 1 1 t 1 11 * f 1 * 1 H 1 1 ASK I - 1 .: no top! its 51 EI air lw PO iF 30 2 0 9� 0 j T .55 0 13 g g 'a ti 2. . w -� 3- a 0 e 0 M M R 0 3 Z& & 0 0, 0- n V A R A 0 o 5r No > T� 3 K !� .. - Z' 9 p M. -o Aa gr om 11 a 0 2 0 A 0. OR :E m go gSl I a. I a 19 2 21 9 4T ilk S.9 Aw SUBMIT BID RESPONSE TO:•'. REQUEST FOR P'R©POSAL CITY OF ZEPHYRHILLS ATTN. PURCHASING DEPT Response Acknowledgement 5335 STM STREET t. ZEPHYRHILLS, FL 33542 PURCHASING AGENT: Karen Miller AIV EQUAL OPPORTUNITY EMPLOYER Phone: 813-780-p000 x9536 FLORIDA TAX EXEMPT d85 -8012740166C-4 Email: Purchasingl@ci,zephyrhfffs.fl.us FEDERAL IDENTIFICATION NUMBER #59-6000455 BID/PROPOSAf pOCUMMTS MAV 8E OBTpit gig AT: Public Purchase (https://www.publlcpurchase-com/gems/register/vendor/register) www.cLzephyrhllis,fLus, select bids/quotes/auction, select open bids (Only Oates) 5335 8th Street, Zephyrhills, Florida 33542 at the Purchase Department PRCIPOSMM61M ER . D(S7Rt8U fidfV t}AT� :: ' : :::. - B!D/PRC!PbSAL TITLti BID/PROPOSAL RESPONSES OPENING DATE/TIME 35.1.5-03 March 11, 2015 Corrosion inhibitors April 2, 2015 - THURS - BEFORE 3:00 P,M, PRE CONFERENCE DATE/TIME/LOCATION ci Strongly Recommended g None RESPONSES RECEIVED AFTER ABOVE DATE: No Meeting TIME: DATE AND TIME City of Zephyrhills Council Chambers, 5335 8th Street, Zephyrhills, FL WILL NOT BE ACCEPTED ."'.—VENDOR MUST COMPLETE THE BELOW -AREAS AND RETURN FORM; -NOTARIZED. FORM IS REQUIRED. RESPONDER'S NAME/ADDRESS: ( C 0 df.f/Fi -Rrt.x't if returning as a "NO" state reason: aa� O - l f ►— r~ 3a °3 ��A TELPHONE NUMBER: EMAIL ADDRESS: I certify this Response Is made without prior understanding, agreement, or connections with any corporation, FEDERAL EMPLOYER ID NUMBER OR SS NUMBER: firm or person submitting a Response for the same materials, supplies or equipment, and is In all respects fair j . and without collusion or fraud. I agree to all conditions of this Bid/Proposal and certfly, that i am authorized to sign this Response for the company. In submitting a Response to the City of Zephyrhills the Responder offers and agrees that if this Response is accepted, the Company will convey, sell, assign or transfer to the Cit Zephyrhiiis all rights, title, and Interest in and to all causes of action It may now or hereafter acquire under the J Anti-trust laws of the United States and the State of Florida for price fixing relating to the particular - 'AUT ORtzED iGNATURE commodities or services purchased or acquired by the City of Zephyrilis, At the City's discretion, such assignment shall be made and become effective at the time the City tenders final payment to the Company. GSW b oon 2 f f Y E'S , a� PRINTED N E/Tt LE '' • THIS FORM MiSTBE,NOTARLZED BELOW: Sworn to and subscribed to me this _ _ day of Lt9(i41 , 2015 AFFIX NOTARY STAMP 0FtOW Personally known:x Or prooused Identification: to 'type of ICY - --� . P� .. 'o MARC1A A. STIVANSON 1 MY OOMMISSION 1 EE 1791$2 EXPIRES: April 20, 2016 Notary Signature State �Or ftWWThN6utV N*q sW*M My commission expires: THE CITY OF apivRHJLL5 RESERVES THB RIGHT TO RIwircr ANY OR ALL PROPOSALS, To WAiVE iNFORMALMIES, AND TO ACCEPT ALL OR ANY PART OF ANY RESPONSE/PROPOSAL AS MAY BE DEEMED TO BE IN THE BEST INTEREST OF THE CITY UNLESS OTHERWISE NOTED, PAYMENT OF GOOD$ OR SERVICES PROVIDED AS A RESULT OF THiS SOUC rATfON WILL BE MADE PER FLORIDA STATUTE ALL VENDORS MUST SUBMIT A COMPLETED W-9 FORM. 0 kvw kvpip-Tel ag a 0 RFP RESPONSE FORM Page K 1.0 Introduction to Request for Proposal 4-5 1l.1 Invitation 1.2 Agreement Terms & Conditions 1.3 Additional Information or Clarification 1.4 Award of Agreement 1.5 Agreement Execution 1.6 Submittal Instructions 1.7 Changes/Alternations 1.8 Sub -contractor 1.9 Discrepancies, Errors and Omissions 1.10 Disqualification 1.11 Proposer's Expenditures 2.0 Scope of Services 6-8 2.1 Minimum Standards 2.2 Background 2.3 Acceptable Product Standards 2.4 Total Volume 2.5 Delivery Locations 2,6 Supplier Requirements 2.7 Performance 2.8 Terms of Contract 2.9 Proposer Submittals 2.10 Proposal Evaluation 3.0 Indemnification & Insurance Requirements 9-10 3.1 Indemnification 3.2 Insurance 4.0 RFP Time Table 10 5.0 RFP Availability 11 6.0 Proposal Submission 11 7.0 Informality Waiver/Rejection of Bids 11 8.0 Appropriations Clause 11 9.0 Oral Presentation 11 10.0 Exception to the RFP 11 11.0 Openness of Procurement Process 12 12.0 Negotiations 12 13.0 Right to Protest 12 14.0 Evaluation Criteria & Ranking Process 12 15.0 Public Records 13 16,0 Additional RFP Forms 14 1117 P 35-15-03 Corrosion Inhibitors Page 2 City of Zephyrhills RFA Form PROJECT IDENTIFICATION NUMBER: 35-15.03 PROJECT NAME: Corrosion Inhibitors RFP DEADLINE: April 2, 2015 AT 3:00 PM The undersigned, hereby declares that no person or other persons other than the undersigned are Interested In this RFP, as principal, and this response to request for proposal Is made without collusion with others; and that we have carefully read and examined the specifications, and with full knowledge of all conditions under which the services herein is contemplated must be furnished, hereby proposed and agree to furnish this service according to the requirements set out in the specifications for said purchase and service. Federal Employer identification Number: �'� K �7l,7q"3 Re aired Documents: :e' Supplierinformation/Location/Resources e( Supplier's Account Manager m' Information/Resume Supplier's Resumes of Key Personnel GK Supplier's Resumes of Technical Representatives Manufacturer's Location/Description of Operations m' Distributor's Location/Description of Resources ci' ANSI/NSF Documentation Certification ay" Product Certificate of Compliance/Certified Analysis V Technical Support documentation provided over past 10 years V Drug Free Workplace Form iv� Non -Collusive Affidavit d Public Entity Crimes er Addenda Receipt Acknowledgement cr References, Business Tax Receipt and Licenses K)/ cover Sheet Cost initial Year:��,�!!O FIRM NAME: LK"�o-n SUBMITTER'S NAME/TITLE;_ ADDRESS: _ � 3 UV& . . TELEPHONE NUMBER 90D ":53b - EMAIL ADDRESS V0a e- 0— b.eft1.�C-f'I'I Firm Representative Signature: L FAXw(Ja�-�3d� Seal RFP 35-1.5-03 Corrosion Inhibitors Page 1.0 INTRODUCTION TO REQUEST FOR PROPOSAL 1.1 tftyftgtiap,: The City of Zephyrhilis (the "City"), Invites responses ("Responses") which offer to provide the services described In Section 2.0: "Scope of Services." RFP documents, plans, addendums can be viewed and downloaded from Public Purchase (htt : ubllc a e.com ms brow hom . All addendums will be posted on Public Purchase only. It is your responsibility to ensure you have downloaded all addendums published before the bid opening. You must be a registered vendor for the City of Zephyrhiils. Registration Is FREE. Should you have questions concerning this site, there Is a CHAT feature located on their website in the upper left corner to provide assistance. Your response and all required documentation are to be submitted to the City of Zephyrhills — Purchasing, 5335 8th Street, Zephyrhiils, Florida 33542. 1.2 Agreement Terms and Conditions: The Proposer(s) selected to provide the service(s) requested herein (the "Successful Proposers)") shall be required to execute an Agreement with the City. 1.3 Ad_ditLgnal Information or Clarification: Requests for additional information or clarifications be trade In writing and Proposers may fax or a -mal[ their requests for additional Information or clarifications In accordance with Article 1.4 Cone of Silence. Facsimiles must have a cover sheet that Includes the Proposer's name, the RFP number and title, and the number of pages transmitted. Any request for additional information or clarification must be received in writing no later than Friday, March 27, 2025 by 3:00 PM. The City will issue responses to Inquiries and any other corrections or amendments it deems necessary in written addenda Issued prior to the Response Submission Date. Proposers should not rely on any representations, statements or explanations other than those made in this RFP or in any written addendum to this RFP. Where there appears to be conflict between the RFP and any addenda issued, the last addendum issued shall prevail. It Is the Proposer's responsibility to assure receipt of all addenda. Proposer shall acknowledge receipt of all addenda in their cover letter. 1.4 Award of Agreement: An Agreement may be awarded to the Successful Proposer(s) by the City Council as applicable, based upon the requirements reflected herein. The City reserves the right to execute or not execute, as applicable, an Agreement with the Successful Proposer(s) that is determined to be in the City's best Interest. 1.5 Agreement Execution: By submitting a Response, the Proposer(s) agree to be bound to and execute the Agreement for: Corrosion inhibitors. Without diminishing the foregoing, the Proposer may request clarification and submit comments or proposed revisions to the language concerning the Agreement for City's consideration. only comments and proposed revisions to the Agreement Included within the Response will be considered by the City. Any such comments or proposed revisions Identified after the Response has been received need not be considered by the City, Furthermore, any requests to negotiate provisions of the Agreement not identified in the response after the Response has been received may be grounds for dismissal. None of the foregoing shall preclude the City from seeking to negotiate changes to the Agreement during the negotiation process. 1.6 Submittal i s r ctions: Careful attention must be given to all requested items contained in this RFP. Proposers are Invited to submit Responses In accordance with the requirements of RFP 35-15-03 Corrosion Inhibitors Page 4 this RFP. PLEASE READ THE ENTIRE SOLICITATION BEFORE suBMrITING A RESPONSE. Proposers shalt make the necessary entry In all blanks and forms provided for the Response. The entire set of documents constitutes the RFP. Responses shall be submitted In a sealed envelope or package with the RFP number and opening date clearly noted on the outside of the envelope. 1.7 Changes Alteratjans: Proposer may change or withdraw a Response at any time prior to Response Submission Deadline. All changes or withdrawals shall be made In writing to the Purchasing Agent. Oral/Verbal modifications will not be allowed. Written modifications will not be accepted after the Response deadline, 1.8 �a, b:s:ontrgroC: A sub -contractor Is an Individual or firm contracted by the Proposer to assist In the performance of services required under this RFP. A sub -contractor shall be paid through Proposer or Proposer's firm and not paid directly by the City. Sub -contractor are allowed by the City In the performance of the services delineated within this RFP. Proposer must clearly reflect in Its Response the major Sub -contractors to be utilized In the performance of required services. The City retains the right to accept or reject any Sub- contractor proposed in the Response of Successful Proposer(s) or proposed prior to Agreement execution. Any and all liabilities regarding the use of a Subcontractor shall be borne solely by the Successful Proposer(s) and Insurance for each Sub -contractor must be maintained In good standing and approved by the City throughout the duration of the Agreement. Neither the Successful Proposer(s) nor any of Its Sub- contractors are considered to be employees or agents of the City. Failure to list all major Sub- contractors and provide the required Information may disqualify any proposed Sub -contractors from performing work under this RFP. Proposers shall Include In their Responses the requested Sub -contractors) information and Include ail relevant Information required of the Proposer, 1.9 Discrepancies, Errors, and Omissions: Any discrepancies, errors, or ambiguities in the RFP or addenda (if any) should be reported in writing to the City of Zephyrhiiis Purchasing Agent In the manner prescribed In RFP Section 1.3. Should it be necessary, the City will issue a written addendum to the RFP clarifying such conflicts or ambiguities. 1.10 Dlsgualificat o : The City reserves the right to disqualify Responses before or after the submission date, upon evidence of collusion with intent to defraud or other illegal practices on the part of the Proposer, It also reserves the right to waive any Immaterial defect or Informality In any Response; to reject any or all Responses in whole or In part, or to reissue a Request for Proposals, 1.11 Prol2osgrls E'x a ditures: Proposers understand and agree that any expenditure they make In preparation and submittal of Responses or In the performance of any services requested by the City in connection with the Responses In response to this RFP are exclusively at the expense of the Proposers. The City shall not pay or reimburse any expenditure or any other expense Incurred by any Proposer In preparation of a Response or anticipation of an Agreement award or to maintain the approved status of the Successful Proposer(s) if an Agreement Is awarded. RIP 35.15-03 Corrosion Inhibitors Page 5 2.0 Rip SCOPE OFERS VICES: The purpose of this RFP Is to establish a contract for the purchase of Poly - orthophosphate and Orthophosphate corrosion Inhibitor to be provided on a routine delivery or as needed when required for use by the City of Zephyrhills Utilities. nd : No Pre Conference will be scheduled. 2.1 Minimum Stangar,ds. Because of the nature of the product and the fact it is going In the potable water supply quality Is extremely Important factor. The City of Zephyrhllls has imposed the following minimum standards which It acknowledges may exceed the minimum regulatory required standards. 2.1.1 Product must be certified to meet NSF Standard 60 Direct Additives for Drinking Water and shall be found to be acceptable for potable use In Florida by State regulatory agencies. 2.1.2 supplier must be able to supply each facility with direct fill 1n a method to make sure the chain of custody of the NSF 60 certification is not broken and remains valid. 2.1.3 Supplier must have its distribution facilities within one hundred (100) miles of Zephyrhills to facilitate quality assurance (QA) visits at the Supplier's facilities. 2.1.4 Supplier must provide bulk tanks at each location which have been weighed tested on certified scales to establish gallons per Inch for accurate measurement of the product. Labels must be present on tanks with minimum one (1) inch tape letters. 2,1.5 All deliveries are to be made In mint bulk deliveries or In sealed manufactured containers and directly pump Into tanks. 2.1.6 A Certificate of Analysis (C of A) identifying the product must be provided prior to delivery. 2.1.7 Deliveries must be scheduled In advance with the Water superintendent between the hours of 8:00 AM to 3:00 PM during normal business days. 2.1.8 Number of gallons per delivery site must be listed on the Bill of lading. 2.1.9 In the event of an emergency, delivery must be made within 24 hours of order. 2.1.10 Chemical System Emergency such as a red water customer complaint by a local Zephyrhills citizen, a Supplier's representative must respond to call within one (1) hour and a technical representative must be on-site within three (3) hours, 2.1.11 Supplier must provide an evaluation of the City of Zephyrhills corrosion control process bi-annually, by either a Florida Licensed Water Operator or oegreed Technician, 2.1.12 supplier must provide the City of Zephyrhills an Account Manager who lives within one hundred (100) miles of Zephyrhills to oversee a complete corrosion control feed program to meet the City of Zephyrhills high water quality standards. 2.2B6CKGQt,(__fiD.,. _, ephyrh ills Utilities has successfully used a blended poly -orthophosphate and orthophosphate corrosion Inhibitor in the potable distribution system, The Utilities department continues to achieve optimized corrosion control under the Lead & Copper Rule (LCR) and qualifies for reduced triennial monitoring at LCR sites and continues to lower RFP 35-15-03 Corrasion Inhibitors page 6 heavy metals concentrations in wastewater sludge for lead and copper. it is the Intent of zephyrhilis Utilities to purchase only corrosion Inhibitor that has demonstrated performance during use under the Utilities water quality conditions. 2.3 ACCEPTABLE PRODUCT STANDARDS Products shall be dosed to maintain a 1 mg/L (one milligram per liter) as PO4 in the distribution system. The products shall be a clear, slightly mazy liquid. 2.3.1 ROM - 25/75 Poly -orthophosphate with a blend ratio of 9% poly and 27% ortho having a 36% active Ingredient as PO4 with a specify gravity of 1.38-1.4. The pH shall be in the range of 4-7. 2.3.2 item 02�; 100% Orthophosphate with a ratio of 36% ortho having a 36% active Ingredlent as PO4 with a specify gravity ofl.38-1.4. The pH shall be in the range of 4- 7. 2.4 jotalVolu -e.,-,The total anticipated annual volume (not guaranteed) Is 5,000 gallons. 2.5 Delivery Locations. To include any new wells which are placed in service during the contract term, Poly-orthophosphM WTP #1/ 38410 6th Ave (by city hall - 7th & 6th) WTP 02/ 3850012th Ave (12th & 11th) WTP #3/ 38150 3rd Ave (3rd Ave & Beltram Or) WTP #5/ 6217 North 8th St (8th & Henry Or, by high school) WTP #10/ 8524 23rd St & Richland Rd WTP #11/39311 Richland Rd & 23`a St WTP #12/39923 Richland Rd & Terra Ct. 100% Orthog iggobItl WTP #4/ 370015th Ave (15th & 14th Ave) WTP #9/ Valor & Piscina (Spanish Trails West) 2.6 SypplieLftWEeMents, 2.6.1 The final manufactured products shall be doubled filtered through a 1 micron filter to assure that there Is no contamination. 2.6.2 Corrosion Inhibitor Is a direct additive used in the treatment of potable water. This material must be certified as suitable drinking water chemical by an accredited certification organization in accordance with ANSI/NSF Standard 60 Drinking Water Treatment Chemicals -Health Effects, 2.6.3 The Supplier shall conduct an annual one (1) hour chemical safety seminar for facility staff. 2.6.4 The Supplier must be able to supply each facility with tanks and be able to direct fill tanks on a routine delivery and also be able to delivery a minimum of a 10 gallons and a maximum of i0o gallons. 2.6.5 The Supplier's Account Manager must visit the treatment plants on a minimum of two (2) times per year to coordinate shipping, safety, delivery and Inspection of tanks. • The contractor will perform as a minimum one (1) annual analysis during the course of the contract period to determine the proper blending of poly and/or orthophosphates as the blends may change accordingly. 2.6.6 The Supplier will make deliveries between the business hours of 8:00 AM and 3:00 PM, Monday through Friday and be able to make emergency delivers afterhours, weekends and Holidays when needed. 2.6.7 The Supplier shall make "normal' deliveries within three (3) to five (5) days after receipt of RFP 35-15-03 Corrosion Inhibitors Paf e 7 order and must make "emergency" deliveries within 24 hours. 2.6.8 The Supplier shall be responsible for any spills resulting from failure of Its tanks or delivery equipment. 2.6.9 The Supplier shall Insure that all equipment (Le. tanks, pumps, valves, hoses) used for transfer is free of any containments. 2.7 Corroslon Inhlbltor Performance. Distribution system performance will be measured by lead and copper analysis, microbiological analysis, and system tests for PO4. 2.7.1 Water quality characteristics may change over the course of the contract. The Poly/Ortho blends specified In this RFP have been used and are expected to be used throughout the contract period. However, other blends (of Poly/Ortho phosphates) may be needed due to unknown or changing conditions. 2.8 Terms of ont acct. The successful Proposer shall be awarded an Initial five (S) year contract with two (2) five (5) year renewal options at the sole discretion of the City. During the course of each term of this contract, the supplier shall not raise the prices of the product or service. 2.8.1 The Supplier shall submit a renewal request in writing ninety (90) days prior to contract end date, reflecting any changes to price or services and must be agreed to by both parties. 2.9 proposer Submittals. The Proposer must submit the following items with their RFP response. Failure to submit any of the below -listed Items may result in a Supplier's proposal being considered nonresponsive: 2.9.1 General Information on Supplier including locations and resources available to support this contract. 2.9.2 Name, contact information and resume of Supplier's local Account Manager who must reside within one hundred (100) miles of Zephyrhills to facilitate emergency response. 2.9.3 Resumes of all of Supplier's "Key" personnel to Include additional support and Technical Representatives who would be assisting City of Zephyrhills, 2.9.4 Manufacturer's Location and description of manufacturing operations 2.9,5 Distributor's Location (if applicable) and description of resources 2.9.6 Documentation of ANSI/NSF Standard 60 Drinking Water Treatment Chemicals certification for manufacturer (god d rib to If they are different 7.9.7 rprtiFir-atp of rnmplfanep and a cprtiflpd anaiysls, A"+ to the comprisitlnn of the producr with the bid. 2.9.8 Details of Five Cases of Technical Support the Supplier has provided to its customers over the past ten years including the contact information for the City of Zephyrhills confirm the information. At least three of these cases must involve a similar product to what Is being bid. 2.9.9 Fire (5) References whereby the Supplier delivers chemicals Including the name, title and phone number which can attest to Supplier's reliability, quality of product, safety record and service. All references must be either water treatment supervisors, superintendents, managers or directors, no purchasing agents shall be considered as a reference, 2.10 Proposal Fvgluation, Because of the nature of the product and Its relatively short shelf —life as well as the need for personalized service at very small water treatment plants, the City of Zephyrhifis shall consider the Supplier's quality, safety record, reliability, and previous performance in the industry when awarding the contract for this product. RFP 35.1503 Corrosion Inhibitors Page 8 3.0 1„NEz,p MNIFICATION AND INSURANC, REQUIREMENTS 3.1 J.ndemni cation ; The Proposer shall hold harmless, indemnify and defend the City, Its elected officials, officers and employees, ,against any claim, action, lawsuit, loss, damage, injury (whether mental or physical, and include death to persons, or damage to property), liability, cost and expense of whatsoever kind or nature Including, but not by way of limitation, attorney's fees and court costs, caused by negligent acts or omissions of Actuarial services. The City shall also be held harmless against all claims for financial loss with respect to the provision of or failure to provide professional or other services resulting in professional malpractice, or errors or omissions liability arising out of performance of the agreement or contract, unless such claims are a result of the city's own negligence. 3.2 Insurance: 12.1 Without limiting its liability under the contract, the Proposer shall procure and maintain at Its sole expense during the life of the contract, Insurance of the types and the minimum amounts stated. 4�'rrliii. ry,3. 1a,.`.r'Y t''�' Si ,y a2w.. Sxh k'£Mt\I niu'7�isra% r Z R x' f iii . Professional Liability 2,000,000 Comprehensive Or Commercial General Liability 1,000,000 Com rehensive Or Business Automobile Liability 11000,000 Worker's Compensation Coverage as imposed by State Law $Statutory Employers LEability $100000/$100000/$500000 3.2.2 The Proposer's comprehensive general liability policy shall include contractual liability on a blanket or specific basis to cover this indemnification. 3.2.3 Such insurance shall be written by a company or companies licensed to do business In the State of Florida and satisfactory to the City. Prior to commencing any work under this contract, certificates evidencing the maintenance of said insurance shall bre furnishPri to and approved by the City's Risk Management, 3.2.4 The insurance coverage's and conditions required shall not be suspended, voided, canceled or modified except after thirty (30) days prior written notice has been given by certified mail, return receipt requested, to the City's Risk Management Office. 3.2.5 The City may require a copy of the Proposer's insurance policies. 3.2.6 All Insurance policies required within this RFA and any contract RIP 35-15.03 Corrosion Inhibitors page 9 subsequently entered into between the parties shall provide full coverage from the first dollar of exposure unless otherwise stipulated. No deductibles or self-insurance retention will be accepted without prior approval from the City. The Proposer's deductible/self- Insurance retention's tSiRsj shall be disclosed to the City and may be disapproved by the City. They shall be reduced or eliminated at the option of the City. The Proposer Is responsible for the amount of any deductible or SIR. 3.2.7 Except for workers' compensation and professional liability insurance, the Proposer's Insurance policies shall be endorsed to name the City as an additional insured to the extent of the city's Interest. 3.2.8 insurance required of the Proposer or any other Insurance carried by the Proposer shall be considered primary and any insurance of the City shall be considered excess as may be applicable to claims under any contract or agreement between City and Proposer. 3.2.9 Any party providing services or products to the City will be expected to enter into a written agreement, contract, or purchase order with the City that incorporates, either in writing or by reference, all of the pertinent provisions relating to insurance and Insurance requirements as contained herein. A failure to do so, may, at the sole discretion of the City, disqualify any party from performing services or selling products to the city provided, however, the City reserves the right to waive any such requirement. 3.2.10 If a claims made from of professional liability coverage is provided, the retroactive date of coverage shall be no later than the inception date of claims made coverage, unless prior policy was extended indefinitely to cover prior acts. Coverage shall be extended beyond the policy year either by a supplemental extended reporting period (ERP) of as great duration as available, and with no less coverage and with reinstated aggregate limits, or by requiring that any new policy provide a retroactive date no later than the inception date of claims made coverage. 4.0 RFP TIME TABLE. The anticipated schedule for the RFP and contract approval is as follows: l RFP Distribution 3-11-2015 wear Deadline for Receipt of questions 3-27.2015 Friday 3:00 PM Deadline for Receipt of Proposals 4-02-2015 Thursday 3:00 PM Review of Proposals & Select Candidates for Presentations 4.3-2015 - 4-08-2015 Recommendation to City Council 4-13-2015 Monday 6:00 PM RFP 35-15-03 Corrosion Inhibitors Pale 10 5.0 RFP AVAILABILITY. RFP documents may be obtained by downloading from the City of Zephyrhills website, www.cl.zephyrhII s.fE,us. Select "Bids", "Open Bids" from our home page. All open project documentations and addendums will be available at this location. it is the sole responsibility of all interested parties to ensure the receipt of any addendums. 6.0 PROPOSAL. SU3MI50QN, Two (2) origlnafs and seven (7) copies (a total of nine{ shall be delivered to the City of Zephyrhills, 5335 eh Street, Zephyrhllis, FL 33542, prior to the Opening time of 3,00 p.m., EDT, on Thursday, April 2, 2015. Proposals shall be as brief and to the point as possible while still meeting proposal requirements. The delivery of the proposals to the City of Zephyrhills prior to the specified date and time Is solely and strictly the responsibility of the proposing firm. The City shall not, under any circumstances, be responsible for delays caused by the United States Postal Service or any private delivery service, or for other delays. All responses must be manually and duly signed by authorized authority to bind said firm or individual, and Proposer must affix their corporate seat (If any) to the proposal. In the absence of a corporate seal, the proposal must be notarized by a Notary public, The submittal of a proposal by a preparer will be considered by the City as constituting an offer by the proposer to perform the required services at the stated fees, The Stated fees shall be considered locked in for 180 days from the time of receipt, ach proposer Is solely responsible for the reading and completely understanding the requirement of this RFP, The opening time shall be and must be scrupulously observed. Under no circumstances will proposals delivered after the specified delivery time be considered, late submissions shall be returned unopened to the firm or individual with the notation "the Proposal was receive after the delivery time designated for the receipt and opening of the proposals." 7.0 INFORMALITY WAiVER/REJECTIQN ! E BIDS. The City reserves the right to reject any or all responses and to waive any Irregularity, variance or Informality whether technical or substantial In nature, In keeping with the best Interests of the City, 8.0 APPROPRIATIONS Q,8USE. The City, as an entity of government, Is subject to the appropriation of funds by Its legislative body In an amount sufficient to allow continuation of its performance in accordance with the terms and conditions of this contract for each and every fiscal year following the fiscal year In which this contract shall remain In effect. Upon notice that sufficient funds are not available in the subsequent fiscal years, the City shall therefore be released of all terms and other conditions. 9.0 ORAL R ENT TiO . A formal oral presentation may be required by each firm that is selected during the Initial review process (at the sole option of the City). If required, presentations should be in support of the firm's proposal or to exhibit or otherwise demonstrate the Information contained therein. If the Committee wishes additional clarification of any Information or additional information, any of the firms may be requested to submit that Information in writing, 10.0 EXCEPTION TO THE RFP. Proposers may take exceptions to any of the terms of this RFP unless the RFP specially states where exceptions may not be taken, Should a Proposer take exception where none is permitted, the proposal will be rejected as nonresponsive. All exceptions taken must be specific, RFI' 35-15.03 Corrosion Ittjxlbitors Page 11 and the proposer must Indicate clearly what alternative is being offered to allow the City a meaningful opportunity to evaluate and rank proposals. Where exceptions are permitted, the City shall determine the acceptability of the proposed exceptions and the proposals will be evaluated based on the proposals as submitted. The City, after completing evaluations, may accept or reject the exceptions. Where exceptions are rejected, the City may request that the Proposer furnish the services or goods described herein, or negotiate an acceptable alternative, 11„0 OPENNESS -Of PROC. UREMENT PROCESS. Written competitive proposals, other submissions, correspondence, and all records made thereof, as well as negotiations conducted pursuant to this RFA, shall I be handled in compliance with Chapters 119 and 286 Florida Statutes. The City gives no assurance as to the confidentiality of any proposal once submitted. 12.0 NEGOTIATIONS, The City may award a contract on the basis of initial offers received, without further negotiations, or may negotiate a final contract. Therefore, each initial offer should contain the Proposer's best terms from a cost or price and technical standpoint. The City reserves the right to enter Into contract negotiations with the selected Proposer. If the City and the selected Proposer cannot negotiate a successful contract, the City may terminate said negotiations and begin negotiations with the next selected Proposer, This process will continue until a contract has been executed or all Proposers have been rejected, No Proposer shall have any rights against the City arising from such negotiations. 13.0 RIGHT TO PROT5_T. Any actual or prospective Proposer who Is aggrieved in connection with the solicitation or award of a contract may seek resolution of its complaints by contacting the City Manager. 14, EVALUAIION CRITERIA AND RANKING PROCESS 14.1 GEUL. The evaluation and ranking of all competitive proposals received shall be accomplished utilizing the criteria described In this Section and Item 2.10. Information and data included in the Actuarial Services proposal shall be considered In the evaluation and ranking process. 14.2 SELECTION CRITERIA. All proposals shal I be equally evaluated with respect to the completeness of the data provided, support for all claims made, and the overall approach taken. The following criteria sha 11 be utilized in the evaluation of the proposal: 50% (1) Firm & personnel Qualifications 4S% (2) Costs to Provide the Product & Various Services 95% SubTotal (5) References (if needed) 100'/a References may be called regarding the level of satisfaction with services rendered by the proposing firm, technical ability, cost, and education of and presentation to governing bodies. REP 35.1.5.03 Corrosion inhibitors Page 12 15.0 Public Records: In accordance with 119.0701 F.S. Contractor shall: a. Keep and maintain public records that ordinarily and necessarily would be required by the public agency In order to perform the service; b. Provide the public with access to such public records on the same terms and conditions that the public agency would provide the records and at a cost that does not exceed that provided In Chapter 119, F.S,, or as otherwise provided by law; C. Ensure that public records that are exempt or that are confidential and exempt from public record requirements are not disclosed except as authorized by law; and d. Meet all requirements for retaining public records and transfer to the public agency, at no cost, all public records in possession of the contractor upon termination of the contract and destroy any duplicate public records that are exempt or confidential and exempt. All records stored electronically must be provided to the public agency In a format that is compatible with the information technology systems of the agency I acknowledge and understand the requirements set forth In this RFQ package. Date In witness whereof, the Bidder has hereunto set his signature and affixed his seal this 3I day ofNath A.D. 2015. (seal) By. Title: PAY TO THr= 00911 ?5P WEDS FARGO RANK, N.A. 063107513 FOR DEPOSIT ONLY THE DUMONT COMPANY, INC. 1661952943 RFP 35-15-03 Corrosion inhibitors Page 13 DRUG-FREA E WORKPLACE FORM The undersigned vendor in accordance with Florida Statute 287.087 hereby certifies that of Business) 1. Publish a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the workplace and specifying the actions that will be taken against employees for violations of such prohibition. 2. Inform employees about the dangers of ding abuse in the workplace, the business's policy of maintaining a drug-free workplace, any available drug counseling, rehabilitation, and employee assistance programs, and the penalties that may be imposed upon employees for drug abuse violations. 3. Give each employee engaged in providing the commodities or contractual services that are under bid a copy of the statement specified in subsection (1). 4. In the statement specified in subsection (1), notify the employees that, as a condition of working on the commodities or contractual services that are under bid, the employee will abide by the terms of the statement and will notify the employer of any conviction of, or plea of guilty or nolo contendere to, any violation of Chapter 893 or of any controlled substance law of the United States or any state, for a violation occurring in the workplace no later than five (5) days after such conviction. 5. Impose a sanction on, or require the satisfactory participation in a drug abuse assistance or rehabilitation program if such is available in the employee's con-rnunity, by any employee who is so convicted. G. Make a good faith effort to continue to maintain a drag -free workplace through implementation of tivs section. As the person authorized to sign the statement, I certify that this co lie��'/ with the a ove requirements. j , f ,I Biddcr's Si ature t� 3131115 Date rev. 10/97 SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(a), FLORIDA STATUTES ON PUBLIC ENTITY CRIMES THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICIAL AUTHORIZED TO ADMINISTER OATHS. A. This swn state leis submitted to q n , LwN r 1, 114 (print nam of Of L public entity) CD�l (print individual's name and RIC for h -c b Rynvyj W`,N (print name of entity submitting sworn statement) whose business address is V4 3; W'3 an (if applicable) its Federal Employer Identification Number (FEIN) an(if (If the entity has no FEIN, include the ocial Security Number of the individual signing this sworn statement: N Ik B. I understand that a "public entity crime" as defined in Paragraph 287.133(1)(g), Florida Statutes, means a violation of any state or federal law by a person with respect to and directly related to the transaction of business with any public entity or with an agency or political subdivision of any other state or of the United States, including, but not limited to, any bid or contract for goods or services to be provided to any public entity or an agency or political subdivision of any other state or of the United States and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation, C. I understand that "convicted" or "conviction" as defined in Paragraph 287.133(1)(b), Florida Statutes, means a finding of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, in any federal or state trial court of record relating to charges brought by indictment or information after July 1, 1989, as a result of a jury verdict, nonjury trial, or entry of a plea of guilty or nolo contendere. D. I understand that an "affiliate" as defined in Paragraph 287.133(1)(a), Florida Statutes means: a. A predecessor or successor of a person convicted of a public entity crime; or b. An entity under the control of any natural person who is active in the management of the entity and who has been convicted of a public entity crime. The term "affiliate" includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in the management of an affiliate. The VVVOenSh' by One person of shares constituting Gcontrolling interest inanother 40 o. person, orapooling ofequipment mrincome among persons when not for fair market value under an arm's length agreement, shall be a prima facie case that one person controls another person. Aperson who knowingly enters into m joint maniUna with a person who has been convicted of public entity crime iAFlorida during the preceding 36months shall beconsidered mMaffiliate. E. I understand that a"persoN" as defined in Pa[agraph2U7.1J3M\(e). Florida Statutes means any natural person or andh/ organized under the bamm of any state nrofthe United States with the |agm| power to enter into a binding contract and which bids or applies to bid on contracts for the provision of goods or services let by a public entity, or which otherwise transacts or applies to transact business with a public entity. The term "Person" includes those officers, directors, executives, partners, shareholders, employees, members, and agents Who are active in management of an entity, F. Based on information and belief, the statement which |have marked below istrue in relation to the entity submitting this sworn statement. (Indicate which statement applies.) JaNeither the entity submitting this sVVon1 statement, nor any Of its office[s, diroctora, emeuWbveu, pgrtnmro, shareholders, employees, nnennbero, oragents who are active in the management of the entity, nor any affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, 1989. —nThe entity submitting this mV00 S|ateOVent. or one Or more of its OOioerG, dinacto[o, execWUvas, pa[tD8re, shareholders, amnp|oyaam, rna0b8re, oragents who are active in the OnoOaAeDleOt of the entih/, or an affiliate of the entity has been charged with and convicted ofapublic entity crime subsequent tVJuly 1'188Q. —aThe entity submitting this sworn etobernant or one or more of its officers, directors, executives, partnana, ohanaho}dem, employees, members, oragents who are active in the management of the entity, or an affiliate Of the eOt|b/ has been charged with and convicted of a public entity crime subsequent to July 1, 1989� Hovvevmr, there has been a subsequent proceeding before a Hearing Officer ofthe State of Florida, Division of Administrative Hearings and the Final Order entered by the Hearing Officer determined that it was not in the public interest to place the entity submitting this wVvorU statement on the convicted vendor list. (attach a copy of the final order) | UNDERSTAND THAT THE QUBK8|SS|C)N OF THIS FORM TO THE CONTRACTING OFFICER FOR THE PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 1 (ONE) ABOVE IS FOR THAT PUBLIC ENTITY ONLY AND, THAT THIS FORM IS VALID THROUGH DECEMBER 31 {lFTHE CALENDAR YEAR IN WHICH IT IS FILED. I ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERING INTO A CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION 287-017, FLORIDA STATUTES FOR CATEGORY TWO OF ANY CHANGE IN THE INFORMATION CONTAINED IN THIS FORM. Sworn t and subscribed before me this gk-rfk , 20 L5 Personally known Or Produced identification Notary Public — State of identifications My commission expires (Type of Identification * 1j (Printed, Typed or stamped commissioned name of —not Form PUR 7068 (Rev. 06118/92) P1,, , ZZIE ej I D11 ' .51 day of Public) Addenda Receipt Acknowledgment Addendum # Date An (, Initials Addendum # Date Addendum # Date Addendum # Date Bidder's Experience List Initials Initials Initials The following are contracts similar in scope to this project which the Contractor has performed within the past five (5) years: Subcontractors List The following are Subcontractors to be employed by the Contractor: Name /\6 f - Manufacturers List Description of Work The following are Manufacturers of materials and equipment to be utilized by the Contractor: Name Description of Materials and Equipment __r— a-n r ( hfa-(rfDA OT- 3395 9 C) 0 CZ14 (D w 0 C4 00 000, m W 00 wW 01 -�) m 00 O 00 CD CN ,�►cORD CERTIFICATE OF LIABILITY INSURANCEDATEWMIDDNYYY) �.,..- 10/24/2014 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 INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) 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 PRODUCER Marsh & McLennan Agency LLC 7225 Northiand Dr N #300 Minneapolis MN 55428 INSURED HAWKINS Hawkins, Inc. d/b/a The Dumont Company 2381 Rosegate Roseville, MN 55113 e Landmark a:Great Divide Insurance A+ X COVERAGES CERTIFICATE NUMBER: 1222243327 REVISION NUMBER: 7370 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. MLTRSR TYPE OF INSURANCE IN. O POLICY NUMBER M{MDDUIYYY Y EPP MMW/OCUY EXP LIMITS C X COMMERCIAL GENERAL LIABILITY CLAtMS-MADE Fx-] OCCUR X Incl Prod Poll GLP201280210 130/2014 /30/2015 EACHOCCURRENCE $1,000,000 PREMISES fEa octane a $1,000,000 MED EXP (Any one person) $25,000 PERSONAL &ADV INJURY $1,000,000 GEN'L AGGREGATE LIM IT APPLIES PER: POLICY ❑ JECOT a LOC OTHER: GENERAL AGGREGATE $2,000,000 PRODUCTS-COMP/OPAGG $2,000,000 $ B AUTOMOBILE 1xMCS_90 LIABILITY ANY AUTO AUTOS NED AUTOSU�D NON-OWNEDHIRED AUTOS AUTOS X CA 9948 BAP201278510 /30/2014 /30/2015 Ea COMBIKED $1,000,000 BODILY INJURY (Por person) $ BODILY INJURY (Per accident) $ Peracolldent $ $ A _x1 UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE SXS655436805 N30120114 /3012015 EACH OCCURRENCE. $10,000,000 AGGREGATE $10,000,000 DED X I RETENTION $0 $'•'�.��.` B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE O FICC IMFMBER EXCLUDED? (M O I(yos, dosaribe undar DESCRIPTION OF OPERATIONS below N / A CA201280110 /3012014 913012016 X sEA T OET'1'RND Slop Gap E.L. EACH ACCIDENT $1,000,000 ....�_^`_.^ . E.L. DISEASE E -EA EMPLOYE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,ODO A I Pollution Uabl$ty PC655432303 130/2012 /30:2015 Limit $25M Occt$25M Agg DBSCRIPTION OF OPERATIONS ILOCATIONS I VEHICLES (ACORn 101, Additional Remarks Schedule, may be attached If mare apace Is roquired) This insurance is issued pursuant to the Minnesota surplus lines insurance act. The insurer is an eligible surplus lines insurer but is not otherwise licensed by the State of Minnesota. In case of insolvency, payment of claims Is not guaranteed. Company A and Company C are subject to statutes and regulations of surplus lines carriers. CERTIFICATE HOLDER CANCELLATION O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) 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 For informational Purposes Only ACCORDANCE WITH THE POLICY PROVISIONS. AUTHOREPRESENTATIVE ,AR,IZZEDD �'b'�'""'" oto''-" O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD R. WM9 Request for Taxpayer Giive Foran to ft PUY December 2014) Identification Number and Certification requester: De not ;r�tiav�w z oww to the MIL 1 Name � sthown tm yar(rwo►rts tact ttt4ram). Name � required on ffi ; rrot karro Yrs Ha Mns, Nuc. 2 thtsatrtess r&vWdlaropadod onft nan», N dUtvro t,tom abm dba The Dumont Company 3 Cheek appmptl4W box for federal tax olasiftatlon; ohook o* case of the telt,3wkro save,, boner 4 ExemptMata (codes apply o* to ❑ singis=hr w,,www or ❑r Comporat ❑ S Coporatkat ❑ PafrwWV ❑ T"Nesbds oastabt antAlea' not tt3raEa sera IrxNniWN+otn tN► page tMj: Limited 1011ft owr4Wy. Ender the to dassMicakon (CwC ompwdk n, s�.s ce"moon, P.paf wrehip) ► Ex^T tt Mae ewe M Wo ,Nota. For a einglo-Member !LG that Is dkhrogarded, do not check LCC; clank the apprgpdate bot In the One above for BOMptim ft*n FATSreporting the tax alaeal3catbn of the single4nombst owner. ❑Other (ewfrutrsrcikttte)Do VffmMS*w *MAA Wdwaa to U04 4 Address (number, street, and W. or sulfa n o4 Requsawa name wW address (optimal) 2389 Rosegate 8 City, stater and ZIP code Roselle, MAI 55113 7 Ust account numbegs) two (optional) T er WenWfoatian Number 1 Fatter your TIN In the appropriate bore. The TIN pwvldal must match the name givan on Une 1 to avoid 19,301019001-wily—bar resIdbackup wW*aim, t ole, For Individuals, r dla this d tdn y your socialII(MI security number pap . Fbr ver,ollh fora IM _ 11:1 ' M- 77N teafdettt any sate proprtetot, of 01st etttRy, seethe Part t ktstruct{ohs on page 3. Fo� other entW", it to your employer identttton number (EN4). If you do rot have a number, see tfow to get a on page S. or Nota. N the account In In more than ons nano, see the instructions for One 1 anal the ch art on page 4 for I Employ r idantifiesdrot number g Adsllrow on whose number to enter. F—l—i I-- I I I -i-- f der penalties of penury, I certify that The number sham on tide form Is my correct taxpayer Identification number (or i am waling for a number to be issued to ane), and 1 am not subject to backup whhhofdino because: (a) I am exempt from backup vAthholr8nq, or (b) I have not best nothled by the internal Revenue $enrice W* that I act subject to backup Whitholdtng as a mutt of a fallufe to report all Inttrrest or dlvktetWo, or (o) the I RS has notified me that I an no kAW subW to backup wf tltolding; and 3, I am a tJ.ti. often or other U.S. person (defined below), and 4. The FATCA oods(s) entered on We form Of any) Indlcadktg that t am exempt from FATCA grating Is confect, Cort9loatlon Instructions. You must cross out Rem 2 above It you two been notified by the M that you are curwtiy subjeot to backup withholding because you have falled to report all interest and dvWwKb or your tax returL For real estate tratsac"one, Rem 2 does not apply. For mortgago Interest paid, acqulaition or abandonment of secured property, cancellation of dell, contributions to an Individual rollrsmerrt arrangement (IRA}, and generally, payments other than interest and dividends, you are not required to dp the certification, but you must provide your caTect TIN. See the Instructkrne on page 3. signal," of UAL person► Gmeral Instructions SOGWn Mhewices are 10 the tttfental Rwenue Code uitaas otherwise noted.. Fatars dawl6pmant Udo nation abotd developments afteoknp Form W.9 (wVh as (aMdedfan ensaksd after we amerces ly is atWWW.tta.p Moa. Purpose of Fot`m An ln*AduW or entity tFohm W-9 roquester) who is requtrod to ire an Information rotten with the RS roust obtain your owed taugoaysr WWJ#catkm numbar MPP whkh may be your mold sechaky number (GSM, ktdlvidusl taxpayer ktl6caon number loyer W -A tcstIOn MMA rd�oMIA report annaann W os r (411M, im tier amount paid to Include, de tart ae Ursot�i Itedd to. ffm loilowon an G> mum Eicannpt°sof InMormattan • Form 1090-W QhM(W owned or setts • Form 1099 -MV ("ends, ktoltKinp die from atooke or mmual funds) • Form 10WMIS0 *lot's types of means, prizes, awatde, or groes prowsde) • Formm� 0WB (stork or nor W fund &Wse and certain other transectione by brol• Form 1098.5 (proceeds from teat sales treneactlote) • Fomn 10WK (nurofant card and thkd party netwwk ttwmactions) Dater 3 ('Z • Fpm IWO (honro n-Va" interest), 1009-E (student loan tnten9sq,10WT • Form 1089-0 (otaaosled debit • Form 10W A (acquksklon or abartetonmortof saouned property) Use Form W-9 only It you are a U.S, person ( wNdInt; a reskient shft tD provide your oonsa Til. #YOU do notrehrtn Form W-9 to *6 requesterwM a TIM, you n*U basubfrct to baskW wMMokMZ Sea What Is bookip wimhoOV2 of page 2. By aW*0 thetffed-out form, you;' 1. Cottfy #tat the 11N you are ghgnp is correct (err you aro WaMng for a Clients to be, lowoA 2. Cerkty that you aro not subject to back* wlthhoWkV, or B. Claim exarnptktrt Rom bsciwp Witiftidltp it YOU era a U.B. aucem)t PaY40, if applicable, You are also cathYng that as a U.B. parson, your altoosuo stare of Any e Income from a UJL trade or nolthe vAt Wt an foreign paemw sharp of effootiv eiyauomteaied ttnaane, and 4. W*j that FATOK coda(e) attared of this form (k an Ix#ostl ng the you aro axsnrpt 1 om the FATCA roporNttp, is correct. Sae What to ATCA mp~ on pop 2 for Anther R&M,41tlon. Cat. No.1D231X Farm W. 9 (Rev. 12-2014} DUMONT A HAWKINS COMPANY Description of Resources Dumont manufactures and distributes chemicals throughout Florida from Starke, Labelle, Tarrytown, Hollywood, Big Pine Key, and Monticello FL, to serve the North Florida and South Georgia areas. Dumont's center of operations and main office is in Apopka, FL. Dumont strives to enhance relationships by focusing on product quality and delivery process. We look at our clients as partners and our emphasis is on long-term clients through how well we serve you from a drum of product to a tanker load. Our chemical market includes municipal and private water facilities, wastewater facilities, commercial swimming pools and agricultural applications. Every warehouse is stocked with product inventoried for the related customers. Dumont has setup warehouses in strategic locations from the center of operation so that each warehouse is backed up by another, which gives clients the certainty that they will never run out of product even in emergency conditions. Dumont has distinguished itself from other chemical distributors by consistently furnishing high quality products and making service to our customer our top priority. Our phone is answered 24/7 including weekends and holidays by a real person answering service. They will have you in touch with one of our management team within minutes of your call. If you have an emergency, we will respond within hours so that you don't run out of chemicals. And there is never an extra charge for good service. Our team includes people who have many years of experience in their field and some who are licensed operators or degreed technicians. 2263 Clark Street, Apopka, Florida 32703 $91,H)sTelephone: 800-330-1369 Fax: 800-524- ouMONr A HAWKINS COMPANY Operatiniz Facilities The Dumont Company has 7 -full service facilities located throughout the state: Apopka Distribution Center: 2263 Clark Street Apopka, FL 32703 Tarrytown Operating Facility: 13825 SR 471 Webster, FL 33597 Starke Operating Facility: 419 Edwards Drive Starke, FL 32091 Big Pine Key Operating Facility: 100 Industrial Road Trucks Big Pine Key, FL 33043 Hollywood Operating Facility: 5705 Dewey Street Hollywood, FL 33023-1917 Labelle Operating Facility: 871 Industrial Court Labelle, FL 33935 Monticello Operating Facility: 33 Too Long Keen Road Monticello, FL 32344 2263 Clark Street, Apopka, Florida 32703 owtelephone: 800-330-1369 Rex: 800-524- D M NT A HAWKINS COMPANY TECHNICAL SUPPORT CASES Case #1 The City of Zephyrhills Nathan Coleman Water Supervisor 813-714-6311 The water utility contacted us concerning the corrosion control and water quality. The system was using a 70/30 poly -orthophosphate by the name of Aqua Mag, The utility was having water complaints and was experiencing water quality issues. The system was only treating 4 of the 9 wells. Dumont's technical staff performed a desktop study for the system and determined that the systems were using the wrong blend for the raw water quality. A recommendation was made to the Water Supervisor for proper corrosion control treatment for the entire system, Once the proper blend ratio was put in place for all 9 wells the system complaints and water quality issues ceased. Case #2 Dunes Community Development David Boss Plant Supervisor 386-445-9045 The utility contacted us about the concern of corrosion control. The system was experiencing complaints of discolored water. Dumont's technical staff did a complete system study and determined that the plant had no buffer capacity. The system's alkalinity leaving the plant was 10 with a pH of 8.0. The technical staff worked with the utility on 2 pilot studies to increase alkalinity. Case #3 Polk County Utilities Mark Lowenstine 863-298-1400 Polk County Utilities has many water systems throughout Polk County. Over the last several years the utility converted the systems from chlorination to obloramination. Dumont's technical team assisted in dosage and chemical feed system start ups through this transition. Recently our technical team performed a table top study to convert the corrosion control system from pH adjustment by sodium hydroxide to microscopic film formation by poly -orthophosphate. 2263 Clark Street, Apopka, Florida 32703 I"Felephone: 800-330-1369 ranx: 800-524- M NT A HAWKINS COMPANY Case #4 City of West Palm Reach Dave Whitely 561-662-2001 The Dumont Company currently supplies the corrosion control chemical (poly -orthophosphate) and the fluoridation chemical (Hydrofluosilicic acid) for the utility. The utility upgraded the chemical feed systems throughout the treatment plant. During the process, Dumont assisted in the start up and staff training for the chemical feed systems. Throughout Dumont's training program, operators were taught safety, dosage rates and regulatory requirements. Case #5 City of Bunnell Bill Green 386-586-5159 The Dumont Company supplies all of the chemicals for both water and wastewater for the utility. Our technical team has assisted the operational staff on many occasions. Technical support has ranged from chloramination, corrosion control, and pH adjustment to coagulation and flocculation. 2263 Clark Street, Apopka, Florida 32703 VINs Telephone: 800-330-1369 Rex: 800-524- Certificate Number 20090323 — MH46303A Report Reference MR46303, March 05, 2008 Issue Date 2009 March 23 Asued to: DUMONT CO INC 381 S CENTRAL AVE OVIEDO, FL 32765 USA Page I of 2 Underwriters U0 L Laboratories Inc.% This is to certify that Drinking Water Treatment Chemicals rlepre.venealivc, samples of Model Descriptions: PT1034 PT5032 PT9041 PT4030 PT9030 PT1233 PT5036 PT6036 PT5024 PT9 031 PT1532 PT6036 PT1025 PT5027 PT7528 PT2032 PT7036 PT1224 PT6030 PT8031 PT -2536 I PT7541 PT1524 PT7035 PT3030 PT3034 PT8037 PT2024 PT7529 PT3032 PT8539 PT2523 PT8028 PT4036 PT9040 PT3024 PT8529 Have been investigated k), Underwriters Laboratories Ina 0 in accordance with the Standard(s) indicated on flyhv Certificate. Standard(s).for Sqfqy: The basic standard used to investigate products in this category is ANSI/NSF 60- 2005, "Drinking Water Treatment Chemicals - Health Effects." A delitional J11fol-111(ltion: The following inaxitnuni use level restrictions: (Coat.) maxilnual Use Maximum Use Product Level, mg/L Product Level, rug/l, PT1034 28.0 PT1524 38.0 PT1233 P1`2024 29.0 37.0 PT1532 PT2523 29.0 38.0 Addhimiallnrination: 0 Page 2 of 2 Underwriters Laboratories Inc., Maximum Use Product Level, mg/L Product maximum Use Level, mg/L M032 28.0 PT3024 36.0 PT2536 32.0 PT4030 48.0 PT3034 28.0 PT5024 32,0 M032 27.0 PT5027 28.0 PT4036 32.0 PT6030 52.7 PT5032 25.0 PT7035 23.0 FT50-36 22.0 PT7529 24.0 PT6036 40.0 PT8029 25.0 PT7036 35.0 PT8529 23.0 PT7541 18.0 PT9030 22.0 PT8037 19.0 PT9031 21.0 PT8539 18.0 PT7529 47.0 PT9040 17.0 PT8031 56.3 PT9041 16.0 PT3030 40.0 37.0 PT1224 38.0 Only those products bearing the UL Listing Mark should be considered as being covered. by Ul"S Listing find Follow-up Service. The UL Listing Mark generally includes the following elements: the symbol UL in a circle- @ with the word 'LISTED"; a control number (may be alphanumeric) assigned by UL, and the product category unme (product identifier) is indicated in the appropriate U1, Directory, Look for tine UL Listing Mark on the product Issued Y: Irfr ", jim Larin tusit'6' 9P9Iais -ire d' erjlek',� ecti6fi Imin. .1 -iC: .�T Any inforrrtation and, documentation involving UL,Ma'rk'services r4q.d �_Id qn.bq, alf'o _U oratd '6ranV authdrized,-., pr9m z For questl I b I ns . I,6 The 'United Statosi ofArnorfoa you mayc , n11'1-8-77-UL44E1:M �Gerttflcato Number 20090323 — MH46303C Report Reference MH46303, March 07, 2008 Issue Date 2009 March 23 Issued to: DUMONT CO INC 381 S CENTRAL AVE OVIEDO, FL 32765 USA Page 1 of 2 UUnderwriters 01 Laboratories Inc.6 This is to certify that Drinking Water Treatment Chemicals representative samples of Model Descriptions: PT 1717 PT 7777C OT 3636 OT 5757C PT 5033 PT 3535 PT 5757C OT 3737 ZO 1212 PT 7030 PT 3737 PT 8989C OT 3535 OT 2727T PT 3029T PT 2727 PT 8585C OT 2525 OT 1414T PT 7032T PT 3434 OT 7272 OT 7878C PT 8032 PT 7171C OT 8282 OT 656501 PT 7032 11ave been investigated by 0iderwriters Laboratories Inc.0 in accordance with the Standard(s) ittilicated ou this Certificate. Sttjjjdard(,v) for Stn ty: The basic standard used to investigate products in this category is ANSI/NSF 60- fie 2005, "Drinking Water Treatment Chemicals - Health Effects." Additional hiformation: (Cont.) The following maximum use level restrictions: Product Maximum Use Level, nig/L Product Maximum Use Level, mg/L PT 1717 65,6 OT 3535 20.0 PT 3535 28.9 OT 2525 30.0 Additional Information: (Cont.) &Underwriters UO L Laboratories Ince Product Maximum Use Level, ing/L Product maximum Use Level, mg/L PT 3737 25.4 OT 7878C 12.6 PT 2727 40.0 OT 6565C 15.0 PT 3434 32.4 OT 5757C 16.0 PT 7171C 14.0 ZO 1212 16.0 PT 7777C 1219 PT 8032 30.0 PT 5757C 17.4 PT 7032 30.0 PT 8989C 10.7 PT 5033 30.0 PT 8585C 12.0 PT 7030 30.0 OT 7272 12.0 PT 3029T 30.0 OT 8282 12.0 PT 7032T 30.0 OT 3636 20,0 OT 2727T 30.0 OT 3737 20.0 OT 1414T 55.0 Only those products bearing the UL Listing Mark should be Considered as beill g covered by UL's Listing and Follow -Up Service. The UL Listing Mark generally includes the following elements: the symbol UL in a circle: NZv with the word "LISTED"; a control number (may be alphanumeric) assigned by UL, and the product category name (product identifier) as indicated In the appropriate UL Directory. Look for the UL Listing Mark on the product issued t Reviewed Y: Y: Larin J1 U�tLCp. _A In '; Mer_ ery ceSpecc &Imagic Il : .Uncldrw_ rlto'rsL:a- iLaboratories '-,- '_* Ina" .Any int6rmati6h*and :d"M."!ItAt9�ln-.! behalf ba Anie-r c yo , u mav tall-1�07-61_, HE'LOS. liconsq'� 9f IJL:,:-' For duestlom" in3h6Ui6fted8tat6i'of I' i; GlearFlow PT 2536 Polyorthophosphate DUMONT • ANSI/NSF Standard 60 Certified • Effective Fe/Mn sequestration • Reduces need for pH adjustment • Maintains corrosion protection Usage PT 2536 is a liquid polyorthophosphate 25/75 blend designed for protection of drinking water distribution lines. It has been formulated to actively provide both corrosion protection and sequestration. By forming a microscopic film, corrosion protection is maintained. This limits lead, copper and iron from being released resulting in greater chlorine residuals in the system. In addition, PT 2536 sequesters iron and manganese thus reducing stains, discoloration and rusty water. This sequestration minimizes chlorine consumption. Description Appearance Clear liquid % PO4 36.0 Specific Gravity 1.38-1.52 pH 4.0-7.0 Application This product should be applied using a metering pump, fed neat from the storage vessel without dilution. Passivation dosage is 10 -- 15 ppm while maintenance requires 3 — 9 ppm. Handling PT 2536 is non -hazardous and not regulated by DOT guidelines. Avoid contact with skin or eyes and wash affected areas with water if contact is made. Refer to the MSDS for more detailed instructions. Shipping PT 2536 is packaged in drums and totes. It is also available in full tanker loads and in smaller quantities through our Mini -Bulk service. Customer Service Dumont can provide a complete chemical feed program to meet your water quality needs including equipment and set up.. We deliver all chemicals used for drinking water systems and most are available through our Mini -Bulk service. For complete details on all of our products and services, please contact: 1,j/jj'1P]14A 381 S. Central Ave. Oviedo, FL 32765 Ph: 800-330-1369 Fax: 800-524-9315 www.dumontchemicals.com The Information provided has been obtained from sources believed to be reliable and Is accurate to the best of our knowledge. Government regulations and standards change without notice. Further, handling and use of the product is beyond our control. Dumont provides no warranties, either expressed or Implied, and assumes no responsibility for the accuracy or completeness of the data contained herein. This information is offered for your consideration and investigation. You should satisfy yourself that you have all current data relevant to your particular use. CERTIFICATE OF ANALYSIS Trade Name: Cleafflow IT 2536 Chemical Name: Ortho Polyphosphate Blend Lot #: PT030315 PT 2536 PROPERTY SPECIFIED LIMITS RESULTS Certified to ANSI/NSF Std. 60 Appearance • PO4, Ortho • PO4, Poly %, PO4, Total pH Specific Gravity Clear, amber liquid 26.0-28.0 8.5-9.5 35.0-37.0 4.0-7.0 1.38-1.52 N Pass 26.9 9.3 36.2 4.6 1.42 I certify that all tests as stipulated in the required specifications were performed in accordance with approved test methods and that the results as reported are true, correct and within specified limits, Eddie Norton/Mike Hilinski Technicians Dumont Chemical, 2263 Clark St, Apopka, FL 32703 Phone 800 330 1369 Fax 800 524 9315 Material Safety Data Sheet Provided by: The Dumont Company, Inc. 381 S. Central Ave., Oviedo, FL. 32765 Phone (800) 330-1369/Fax (800) 524-9315 I. Chemical Product Identification Product Name: ClearFlow PT 2536 CAS -Number: NIA Synonyms: Condensed Inorganic Phosphate Blend Chemical Name, Corrosion Inhibitor Emergency Phone: 800-330-1369 Date of Issue: 10/01/2006 Revised Date: 01/25/2008 1 11. Composition Components Percent TLV -TWA This product contains no hazardous ingredients as defined 7in 29 CFR 1910,1200 None known 111. Health Hazards I Eye Contact: Possible irritation if exposed to individual sensitivity Skin Contact., Possible irritation of exposed tissue due to individual sensitivity Inhalation: No known risk of overexposure Ingestion: Slightly toxic Carcinogenicity: Not listed by NTP, IARC, or OSHA IIV. First Aid Procedures Eye Contact: Immediately flush eyes with water for at least 20 minutes. Skin Contact: Immediately flush skin with water for at least 20 minutes. Avoid spreading material on unaffected skin. Inhalation: Avoid breathing dust or vapors. Move victim to fresh air. Call emergency medical service. Give artificial respiration If victim is not breathing. Ingestion: Give large amounts of water and induce vomiting. Call emergency medical service. *do not use mouth-to-mouth if victim ingested or inhaled substance; give artificial respiration with the aid of a pocket mask equipped with a one-way valve. ClearFlow PT 2536 V. Personal Protection Information Page 2 Respiratory Protection: Wear NIOSH approved mist respirators. Ventilation: Area should be well ventilated, Protective Gloves: Rubber. Eye/Face Protection: Chemical splash goggles. Other Protection: Eye bath and safety shower. Work Practices: Use good personal hygiene practices. Wash hands before eating, drinking, smoking, or using toilet facilities. Promptly remove soiled clothing and wash thoroughly before rouse, Shower after work using plenty of soap and water. IVI. Fire and Explosion Hazard 7 Flash Point Method: Flammable Limit: Extinguishing Media: Special Fire Fighting Procedures: >200 F TOC N/A Dry Chemical, foam and CO2 A self-contained breathing apparatus should be worn by firefighting personnel. LEL: N/A UEL: N/A VII. Measures for Accidental Release I - Steps to be taken in case of Dike area to contain as much spilled material as possible. Absorb or cover with release or spill: dry earth, sand, or other non-combustible material and transfer to containers. VIII. Handling and Storage Keep container tightly closed when not in use. Store in a cool, dry, well -ventilated area, away from heat and incompatible materials. Protect containers from physical damage. IX. Physical Data Boiling Point ('C) >100C Vapor Pressure (mmHG): N/A Solubility (H20): Infinite Vapor Density (Air -1): N/A pH: 4.0-7.0 Specific Gravity (H20=1): 1.37-1.43 Appearance/Odor: Clear, odorless liquid Evaporation Rate: N/A ClearFlow PT 2636 IReactivity Stability: Stable Incompatibility: None known DecompositioniByproducts: None known Hazardous Polymerization: Will not occur Conditions to Avoid* None known I X1. Waste -Disposal Method Dispose of waste according to all Federal, State and local regulations. IXH. Transport Information USA Dot Shipping Name: Not Regulated Hazard Class: Non -hazardous Page 3 HMIS Hazard Rating Health: 0 Fire: 0 Reactivity: 0 0 -Least 1 -Slight 2 -Moderate 3 -High 4 -Extreme XIII. Other Information EPA Pesticide Registration Number: N/A UL Maximum Use Level for Potable Water (Standard 60): 40 TSCA (Toxic Substance Control Act), 40 CFR 710. N/A Sources of the raw materials used in this mixture assure that all chemical ingredients present are In compliance with Section 8(b) Chemical Substance Inventory, or are otherwise in compliance with TSCA. Disclaimer of Warranty The information provided in this Material Safety Data Sheet has been obtained from sources believed to be reliable. Dumont provides no warranties, either expressed or implied, and assumes no responsibility for the accuracy of completeness of the data contained herein. The other information is offered for your information, consideration and investigation. You should satisfy yourself that you have all current data relevant to your particular use. Dumont knows of no other medical condition other than those noted on this Material Safety Data Sheet, which are generally recognized as being aggravated by exposure to this product. CNearflow OT 3535 DUMONT Ortho Phosphate --- - ------ ANSI/NSF Standard 60 Certified 0 Nonhazardous orthophosphate Reduces need for pH adjustment e Maintains corrosion protection Usage PT3737ksaliquid prthonhoaohetedeo|gned for protection ofdrinking water transmission lines. Through formation ofamicroscopic film, corrosion protection is maintained. This limits lead, copper and iron from being released nmsV|UDg ingreater chlorine residuals inthe system. PT3737isanonhazardous form oforthophosphate. (tiecertified to ANG|/NSFStandard 00atamu|of20mgU. �� F�'on —~~~'r~nf Appearance Clear liquid % PO4 35.0 Specific Gravity 1,40-1.48 pH 4.O-7.0 Anp)'c@tnD This product should bmapplied using e metering pump, fed neat from the packageor storage tank without dilution. PasoivaUpD dosage is1O-15ppm while maintenance requires 3—@ppm. PT3737is non -hazardous, non-regulated by DOT guidelines. Avoid contact with skin or eyes and wash affected areas with water if contact is made. Refer kuthe K8GDS for more detailed Sh'pU^M[1 PT3737is packaged in drums, totes and pails. Itiaavailable inbulk quantities toonsite storage tanks. Product containers should bekept closed when not in use. Customer Service Dumont Chemicals can provide acomplete tneatOle[dprogram tomeet your water quality needs. On-site inspection, system assessment, chemical recommendations and continued technical support are all apart ofthe Dumont appnooCh. For additional information, please contact your sales professional o[Dumont customer service. DUMONT 321G 32785 The information provided has been obtained from sources believed to be reliable and is accurate to the best of our knowledge, Government regulations and standards change without notice. Further, handling and use of the product is beyond our control. Dumont provides no warranties, either expressed or implied, and assumes no responsibility for the accuracy or completeness of the data contained herein. This information Is offered for your consideration and investigation. You should satisfy yourself that you have all current data relevant to your particular use. Product Name: ' Synonyms: ChmmicaiNamm Emergency Phone �� Sheet Material �� &�� Provided by: The Dumont Company, Inc. 381 3.Central Axo.'Oviedo, FL. 32785 Phone (800) 330-1369/Fax (800) 524-9315 1. Chemical Product Identification ClomrFhw[T3B5 Condensed Inorganic Phosphate Blend Corrosion Inhibitor 800-330-1369 CAS -Number: NIA Date mfIssue: 11X04/2008 Revised Date: 11/04/2008 I U. Composition 7 Components Percent TLV -TWA This product contains no hazardous Ingredients as defined in 29 CFR 1910, 12ob None known 1— 111. Health Hazards Eye Contact: Possible irritation Ifexposed huindividual sensitivity Skin Contact: Possible irritation ofexposed tissue due toindividual sensitivity Inhalation: Noknown risk ofoverexposure Ingestion: Slightly toxic Carcinogenicity: Not listed by NTP, IARC, or OSHA IV. First Aid Procedures Eye Contact: Immediately flush eyes with water for o6least 20minutes. Skin Contact: Immediately flush skin with water for at least 20 minutes. Avoid spreading material onunaffected skin. Inhalation: Avoid breathing dust orvapors. Move victim bufresh air. Call emergency medical service. Give artificial respiration |fvictim ianot breathing. Ingestion: Give large amounts of water and induce vomiting. Call emergency medical service. *do not use mouth-to-mouth if victim ingested or inhaled substance; artificial ClearFlow OT 3535 IPersonal Protection Information Page 2 Respiratory Protection: Weer NIOSH approved mist respirators. Ventilation: Area should be well ventilated. Protective Gloves: Rubber, Eye/Face Protection: Chemical splash goggles. Other Protection: Eye bath and safety shower, Work Practices: Use good personal hygiene practices. Wash hands before eating, drinking, smoking, or using toilet facilities, Promptly remove soiled clothing and wash thoroughly before reuse. Shower after work using plenty of soap and water. IV1. Fire and Explosion Hazard Flash Point Method: Flammable Limit: Extinguishing Media: Special Fire Fighting Procedures: >200 F TOG N/A Dry Chemical, foam and CO2 A self-contained breathing apparatus should be worn by fire fighting personnel. LEL: N/A UEL: N/A I VH. Measures for Accidental Release I Steps to be taken in case of Dike area to contain as much spilled material as possible. Absorb or cover with release or spill: dry earth, sand, or other non-combustible material and transfer to containers. IV111. Handling and Stora e I Keep container tightly closed when not in use. Store in a cool, dry, well -ventilated area, away from heat and incompatible materials. Protect containers from physical damage. I Physical Data Boiling Point (*C) >100C Vapor Pressure (mmHG): N/A Solubility (H20): Infinite Vapor Density (Air -1): N/A pH: 4.0-7.0 Specific Gravity (H20=1): 1.40-1.48 Appearance/Odor: Clear, odorless liquid Evaporation Rate: N/A OlearFlowOT35B I X. Reactivity Stability: Stable None known Decomposition/Byproducts: None known Hazardous Polymerization: Will not occur Conditions tuAvoid: None known I X1. Waste Disposal Method I Dispose of waste according toall Federal, State and local regulations, IX11. Transport Information I USA Dot Shipping Name: Not Regulated Hazard Class: Non -hazardous HMIS Hazard Rating Beolth:O Flre:0 Rmoctivity:0 0 -Loan 1 -Slight 2 -Moderate 3 -High 4 -Extreme X111. Other Information EPA Pesticide Registration Number: N/A ULMaximum Use Level for Potable Water (Standard 60): 20.0 TSControl AcN,40 CFR 710: N/A Sources ofthe raw materials used \nthis mixture assure that all chemical ingredients present are incompliance with Section 8(b) Chemical Substance Inventory, or are otherwise in compliance with TSCA. Disclaimer of Warranty The information provided in this Material Safety Data Sheet has been obtained from sources believed to be reliable. Dumont provides no warranties, either expressed or implied, and assumes no responsibility for the accuracy of completeness of the data contained herein. The other information is offered for your information, consideration and investigation. You should satisfy yourself that you have all current data relevant to your particular use. Dumont knows of no other medical condition other than those noted on this Material Safety Data Sheet, which are generally recognized as being aggravated by exposure to this product. CERTIFICATE OF ANALYSIS Trade Name: CleaarFlow OT 3535 I Chemical Name: Orthophosphate Blend Lot P OT022615 OT 3535 PROPERTY SPECIFIED LIMITS RESULTS Certified to ANSYNSF Std 60 Appearance % PO4, Ortho pH Specific Gravity Clear, amber liquid. 34.0-36.0 4.0-7.0 1.36-1.44 Pass Pass 35.2 4.2 1.40 I certify that all tests as stipulated in the required specifications were performed in accordance with approved test methods and that the results as reported are true, correct and within specified limits. Eddie Norton/Mike Hilinski Technicians Dumont Chemical, 2263 Clark St, Apopka, FL 32703 Phone 800 330 1369 Fax 800 524 9315 Erica Latker Bio Erica Latker Area Manager, SE Florida Ph: 954-397-9799 ericaW ,,duniontchemicals.com DINMT A HAWKINS COMPANY Erica Latker has BS degrees in both Chemistry and Biology with 23 years experience in the water/wastewater industry. Ms. Latker has worked extensively in her career in troubleshooting and improving water and wastewater treatment facilities by reviewing process and equipment details. She began her career as a field engineer and chemist, running pilot trials for three major water and wastewater equipment manufacturers on the eastern seaboard. 2263 Clark Street, Apopka, Florida 32703 welephone: 800-330-1369 Pax: 800-524- Compliance Group, LLC Regulatory and Distribution Services 2707 W. Price Avenue, Tampa, Florida 33611 Phone: 813-433-4979 Profile For: David a. Rivers Masters of Occupational Safety & Health /Ersvironmental Managenfent In-depth study and research in Safety and Accident Prevention, Safety Engineering, Ergonomics, Industrial Hygiene and Air Quality, Fire Protection, Toxicology and Environmental Management. Certified Safe-ty Pro essional CSP - License No. 18117 The CSP designation is accredited and issued by the Board of Certified Safety Professionals after extensive review of experience, educational background, and testing of competence in those regulatory based standards and sciences of workplace and construction safety included in 29 CFR, ANSI, and NFPA among others. Certified 11azardous Materials Manax,►er (CHMM) - License No. 11483 The CHMM designation, which covers regulatory competence of Hazardous Materials, Hazardous Waste, and Workplace Safety through formal testing and evaluation by a third party, is issued by the Institute of Hazardous Materials Managers and accredited by the Council of Engineering and Scientific Specialty Boards and the American National Standards Institute (ANSI). Certified Environmental, Health and Safety -Trainer (CLT) — Certification No. 22-083 The CET designation is issued by the Board of Examiners of the Board of Certified Safety Professionals. The CET is awarded after completion of extensive review of instructional ability, subject competence, and final examination of instructional science in specialty areas of expertise including Occupational Health and Safety, Hazardous Materials Transportation and Hazardous Waste, Over 20 Years of Experienee in the Transportation, Manufacturing and Chemical Distribution industries HS&E Management Repackaging Process Engineering Manufacturing Crash and Spill Response Hazardous Waste Quality Systems Auditing Training and Presentation Workplace Safety OSHA, EPA, DOT Regulations Membership and Affiliations Hazardous Materials Efficiency Studies Equipment Design Chemical Processing Environmental Remediation American Society of Safety Engineers, National Environmental, Safety and Health Training Association Institute of Hazardous Materials Management, Alliance of Hazardous Materials Professionals, Biography David Rivers most recently served as the Regulatory Programs Director for R&S Compliance Group, LLC where he has conducted compliance audits, performed seminars and represented the private sector in regulatory compliance initiatives. Prior to beginning his partnership at R&S, David worked for Brenntag Mid -South and DSI Transports, Inc. where he served as the operations manager of multi -model hazardous material distribution facilities. David offers over 20 years of private sector industrial experience in chemical handling, engineering, safety, transportation and regulatory compliance. In addition to the private sector, David had the distinct honor to serve as the Senior Transportation Specialist for the Hazardous Materials Enforcement section of the Federal Motor Carrier Safety Administration, a division of the US Department of Transportation, in Washington, DC. IMS Compliance Group, LLC Certified Hazardous Materials Managers (CHdMf), Certified Enviramnental Heattb and Safety Trainom (CET), Certified Safety Professionals (CSP), Professional Geologists (PG), Certified Environmental Specialists (GES), and professional Engineers (PE) Resume: David Boston 204 West Lady lake blvd. lady lake, F.L. 32159 (352)350-0294 bostonwlndows30@yahorJ,corn Experience: Company name: Boston Windows, L.L.C. (self-employed) owner Lady Lake, F.L. Window installer 07109- 12/10 Work.aerfatmed., I subcontracted for 84 lumber Co. Performed new window installs, for new homes Serviced windows for customers, after moved into homes, Performed windows install for existing windows, and ordered the proper windows for customer needs. Installed windows, to building codes. Overseeing production of four other associates. Overseeing scheduling. Inspecting every house before and after jobs. Qompanv name: International Security Management Group. Tampa, U. (Security officer) - Supervisor 07107-12/09 Contact information: Santos Rivera (Mcir.) 362-536-5708 Work performed: * Class D license * Responsible for training, * Overseeing 12 associates, and improving security. Responsible for cost analysis, for any downtime. Serving public, at a professional manner, and a secured environment. Monitoring security cameras, at a hospital environment, doing regular patrols, watching over boisterous people, and making sure hospital personnel and property was secure at all times.. * Reviewed all incident reports, and discussed each report with the proper officer. Responding to all alarms, and codes. Overseeing Monthly employee reviews. Responsible for all scheduling. Payroll, raises. C+-mpanv name: Ro-mac Lumber & Supply Co. Leesburg, F.L. (352) 787-4545 Install & Service Manager.(Asst.store Manager) 06103-07/09 Contact Information: Mike Chavis (store Mgr.) Work performed, Responsible for project planning for installs, cost analysis, payroll Responsible for surveying crews, production site plans, ( blueprints) and ordering what was needed. Overseeing training, and performed all scheduling, on a timely fashion. led a team of 30 associates, with 12 different crews, Improved customer service by 60% Reduced overall cost by 30% and achieved production time, and overtime.. Consulted with 50 different builders, making team work a priority, Purchased products at a reduction cost working together with the manufacturing companies. Working at a fast paced environment ability to think quickly, and successfully handle difficult clients. Excellent people skills, understanding what the customer needs and wants., Performing window install on existing homes, ordering what the customer wanted, and delivering the information to the crews, that was per -forming the install. ***Note: I started with this company as an Install helper, working hard and later becoming lead supervisor, and a year later Becoming the install/ service manager. ComDanv name: Custom Windows, Systems: Ocala, F.L. Production supervisor 06100-06/03 Work performed • Manufactured windows from scratch, cutting aluminum all the way to putting a final product together. * Started out as a production laborer, learning all jobs on this line, and later being promoted to a line supervisor. * Working in a very fast pace environment, k Supported new products, and testing. k Improved customer service. k Reduction facility downtime, to achieve aggressive production downtime, to get product out at a timely fashion, * Traveled with the install and service crews, to Make sure We were making what the customer wanted, and also to better our customer relationships. *Overseeing production control * Manufacturing, purchasing and returned materials, by Improving 50% In labor utilization, and reduction In cost of rework of customer returns, goompanv name: Cabletron Systems, Inc. Rochester, N.H. Warehouse Manager 07/94-06/00 Work performed: * Huge warehouse environment, picking items from warehouse, and shipping them to different customers, we manufactured, All computers for Dell, and also Heward Packard, and reworks, and also upgrades needed for customers Stocked over 50,000 items in the warehouse, Used forklifts, pickers, and stackers, to better my job Performance. on a timely fashion., Unloading products from trucks, receiving them into the system, and reviewing what was needed for production, and putting the remaining Into stock locations. * Pulling pieces from stock daily, it trucks to be shipped to customers on a daily basis. * Very fast paced environment * Managed 22 associates Overseeing trucks coming in and leaving, making sure right product was coming in, Inspecting the product and checking with production on what they needed, * Used computer system for communication of what was in stock, but also reports of product coming in, and what was needed for production a head of schedules, for production, * Worked closely With Fed -ex, and Ups, * Worked closely with five different trucking company, to ship product out, on a timely but cost officiate level. Daily report, of incoming product, checking P.O. and making sure the right product coming in. worked closely with buyers, Overseeing hours of employees, raises, classes, scheduling, *excel, word, working closely with production, inventory daily, up.9,fed-x, Education: Seauldlhtir high school, • Graduated 1994 ( Rochester, N.H.) GPA, 3,0 McIntosh College: 16 Graduated 2009 (Dover, N.H.) Bachelors degree, Business Management United S8t tes ArmyReserves• 1995-1999 E-4 honorable discharge. Jocl T. Rainey 6740 Polls L.amt Columbia, TN 38401 1931 1) 840-0945 OBJECTIVE: Informational EX.PVRVENCE: 0-S. Aquatech VN - Operations Prirnar} responsibility for all technical functiori% including manufacturing, 2005 - Present compliance, product development, raw material approwils and Salts support. U.S, Aquatech is a manufacturer and supplier at' water treatment chemicals for drinking water as certified under the ANSI,'NSF Standard 6U. Sweetwater Technologies, Temecula, CA. VP --Operations Sweetwater is a nianuracturer anti markewr of %, awr treatment Chemicals used 1996-2005 primarily in potable Hater, As YK I heti otiversight ornit wrens ol'the business - manufacturing, compliance, sales, marketing. personnel, product development. technical issues, municipal bids, ra%% material npprmaPpurehasing, etc. CPS Chemical Company, told Bridge, NJ Regional Sales Manager Management or area sales representati%es in western :lurth America ti�a5 the 1995 1996 responsibility itt this position, Coordination bet« een upper management targets and speeitiu salos ell'orls was paramount, as ttell as direct sales support at key accounts. The terriaKy consisted or 10 U -S states, Nle�ieo and %tiestern Canada. Account Executive Territorial account mana6omenl tv#rs tho priman roc:us, directed at increased 1987- 1995 sales of specialty chemicals and manufacturing services, Exlonsis-c planning and organization tiaere paramount to coordinate travel, appointments, entertainment, etc. The product line consisted ofcationic. flocculants Sold primarily through resellers or distributors and specialty monomers, Champion Technologies, Fresno, TX Group Leader Primary focus involved management ul*all asp4cts of the water clarifier and 1986-1987 reverse emulsion breaker'product line, Dutias included research and product develupment in both lab and field settings, inttrnotion with eontpany sates personnel and major oil company staff along with solving itnntediate problems kin location, Product development included synthesis, field evalua(kin arid manufacturing support. Daher (Al Treating, Houston, TX Product Specialist The scope of work centered upon development OffeVel-SC efflUlgitln hrCAkurS 1984— 1986 and waterulnrifiers, field evaluations and manufacturing consultation. Efforts centcrod upun short term projects with particular attention given to specific field situations requiring support and training, New product introduction involved cost analysis, IvISDS preparation, ran matvrial sourcing and manufacturing procedure advisement. Nalco Cbernical Company, Sugar Land, TX Technical Representative Duties its an outside: stales representadve involved finished product additives in 1984 refineries along the Texas gulf coast. The prtiduct line cormi%tcd of4chazers, corrasion inhibitors, sweeteiiers, stabilizers and ��ax modifiers for high pour crudes. Duties included servicing existent customers and surveying mm upponunities, Research Chemist Mq or responsibilities included long term research and dekelopnient of reverse 1981 — 1984 emulsion breakcrs&ater clarifiers, manuf4eluring support during upgrade of new products and technical response toward immediate field prohlems. Research projects consisted of synthesis, blending, field testing and manufacture upgrade. FDUCATION! B.S. Chemistm, June, 1979, ljiliversit% ol"runnessee at Martin. Graduated with highost honors'. Post -graduate %wrk in Medicine, 1979-90. Universitl of Tennessee Center l'or Hculth Sciuncvs. Memphis, IN. TOTAL P.002