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2319 IRFQ 20/21-100 Manhole Rim and Coverst, iSXKFORD FINANCE DEPARTMENT - D The item(s) noted below is/are attached and forwarded to your office for the following action(s): F-1 Development Order I L_ Mayor's signature ❑ Final Plat (original mylars) ❑ Recording F-1 Letter of Credit Rendering ❑ Maintenance Bond 4 Safe keeping (Vault) ❑ Ordinance Deputy City Manager ❑ Performance Bond F-1 Payment Bond F1 Resolution ❑ City Manager Signature City Clerk Attest/Signature ❑ City Attorney/Signature Once completed, please: — Return originals to Purchasing- Department F] Return copies El Special Instructions under 50k, doesn't need to go to Commission Li,vt.�(ye�y 6ojaotzi. v- From SharePoint—Fiiiance—Ptirchasing—Fortils - 2018.doe Date AGREEMENT BETWEEN CITY OF SANFORD AND FORTUNE INC., / IRFQ 20/21-100; MANHOLE RIM AND COVERS THIS AGREEME T (,�ereinafter the "Agreement') is made and entered into this day of �-d�naji by and between the City of Sanford, Florida, a Florida municipality, (hereinaler referred to as the "City"), whose mailing address is 300 North Park Avenue, Sanford, Florida 32771, and Fortiline Inc., a South Carolina corporation, whose principal address is 7025 Northwinds Dr. NW Concord, NC 20827, (hereinafter referred to as "Fortiline"). The City and Fortiline may be collectively referenced herein as the "parties". WITNESSETH: IN CONSIDERATION of the mutual covenants, promises, and representations contained herein and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the parties hereto agree as follows: Section 1. Recitals. The above statements are true and form a material part of this Agreement upon which the parties have relied. Section 2. Authority. Each party hereto represents to the other that it has undertaken all necessary actions to execute this Agreement, and that it has the legal authority to enter into this Agreement and to undertake all obligations imposed on it. The persons executing this Agreement for each party certify that they are authorized to bind the party fully to the terms of this Agreement. Section 3. Scope of Agreement; Direction of the Provision of Goods and services. (a). This Agreement is for the provision of goods and services set forth in the Purchasing Division Requisition Form, the 3 -page letter, dated January 29, 2020 from Chuck Smith of Fortiline to Mack McKinley, P.E., of the City, and the provisions of the City's solicitation relating to Informal Requests For Quotes (IRFQ) Number 19120-141 which are the only attachments hereto and Fortiline agrees to accomplish the provision of goods and services specified in the said attachments for the compensation set forth in those documents relating the provision of ozone related services as set forth in the attachments and as may be agreed upon by the parties as set forth in issued purchase orders. (b). It is recognized that Fortiline shall provide goods and services as directed by the City. (c). The City's contact/project manager for all purposes under this Agreement shall be the following: I I P a g e Marisol Ordohez Purchasing Manager Finance -Purchasing Division City of Sanford Post Office Box 1788 Sanford, Florida 32772-1788 Phone: 407-688- 5028 Email: Marisol,ordonez@sanfordfl.gov Section 4. Effective Date and Term of Agreement. Notwithstanding the provisions of page 3 of the attached letter (Section 5.0 of the letter), this Agreement shall take effect on the date that this Agreement is fully executed by the parties hereto. Further, this Agreement shall be in effect for a term of 1 year with the opportunity for additional 1 -year renewal periods when in the best interest of the City in its sole .discretion. However, the total length of this Agreement, including all renewals, shall not exceed 5 years. The decision to renew or extend this Agreement shall be at the discretion of the City. Fortiline shall review the quality and status of the goods and services pertaining to the provision of fire extinguishers with the City on an annual basis at which time(s) the City may terminate this Agreement is its sole and absolute discretion. In any event, this Agreement shall remain in effect until the goods and services to be provided by Fortiline to the City under each purchase order have been fully provided in accordance with the requirements of the City; provided, however, that, the indemnification provisions and insurance provisions of the standard contractual terms and conditions referenced herein shall not terminate and the protections afforded to the City shall continue in effect subsequent to such goods and services being provided by Fortiline. No goods, services or actions have been provided prior to the execution of this Agreement that would entitle Fortiline for any compensation therefor. Section 5. Compensation. The parties agree to compensation as set forth in the attachments hereto, with the initial purchase of goods and services being in the amounts set forth in the attachments hereto and, subsequently, as may be agreed upon by the parties as set forth in issued purchase orders. Section 6. Standard Contractual Terms and Conditions. All "Standard Contractual Terms and Conditions", as provided on the City's website, apply to this Agreement. Such Terms and Conditions may be found at the City's website; which can be reached at: (https://www.sanfordfl.gov/departments/finance/purchasing/contract- terms-and-conditions or www.SanfordFLgov). The parties shall also be bound by the purchasing policies and procedures of the City as well as the controlling provisions of Florida law. Purchase orders shall be used, in accordance therewith, in the implementation of this Agreement to the extent deemed necessary by the City in its sole and absolute discretion. 2 1 P a g e Section 7. Fortiline's Mandatory Compliance with Chapter 119, Florida Statutes, and Public Records Requests. (a). In order to comply with Section 119.0701, Florida Statutes, public records laws, Fortiline must: (1). Keep and maintain public records that ordinarily and necessarily would be required by the City in order to provide goods and services. (2). Provide the public with access to public records on the same terms and conditions that the City would provide the records and at a cost that does not exceed the cost provided in Chapter 119, Florida Statutes, or as otherwise provided by law. (3). Ensure that public records that are exempt or confidential and exempt from public records disclosure requirements are not disclosed except as authorized by law. (4). Meet all requirements for retaining public records and transfer, at no cost, to the City all public records in possession of Fortiline upon termination of the contract and destroy any duplicate public records that are exempt or confidential and exempt from public records disclosure requirements. All records stored electronically must be provided to the City in a format that is compatible with the information technology systems of the City. (b). If Fortiline does not comply with a public records request, the City shall enforce the contract provisions in accordance with this Agreement. (c). Failure by Fortiline to grant such public access and comply with public records requests shall be grounds for immediate unilateral cancellation of this Agreement by the City. Fortiline shall promptly provide the City with a copy of any request to inspect or copy public records in possession of Fortiline and shall promptly provide the City with a copy of Fortiline's response to each such request. (d). IF THE CONTRACTO RIVEN DOR HAS QUESTIONS REGARDING THE APPLICATION OF CHAPTER 119, FLORIDA STATUTES, TO THE CONTRACTOR'S (VENDOR'S) DUTY TO PROVIDE PUBLIC RECORDS RELATING TO THIS CONTRACT, CONTACT THE CUSTODIAN OF PUBLIC RECORDS AT (407) 688-5412, TRACI HOUCHIN, MMC, FORM, CITY CLERK, CITY OF SANFORD, CITY HALL, 300 NORTH PARK AVENUE, SANFORD, FLORIDA 32771, TRACI.HOUCHIN@SANFORDFL.GOV. 3 1 P a g e Section 8. Time is of the Essence. Time is hereby declared of the essence as to the lawful performance of all duties and obligations set forth in this Agreement. Section 9. Entire Agreement/Modification. This Agreement, together with all "Standard Contractual Terms and Conditions", as provided on the City's website and the attachments hereto (the documents relative to the procurement activity of the City leading to the award of this Agreement) constitute the entire integrated agreement between the City and Fortiline and supersedes and controls over any and all prior agreements, understandings, representations, correspondence and statements whether written or oral in connection therewith and all the terms and provisions contained herein constitute the full and complete agreement between the parties hereto to the date hereof. This Agreement may only be amended, supplemented or modified by a formal written amendment of equal dignity herewith. In the event that Fortiline issues a purchase order, memorandum, letter, or any other instrument addressing the goods and sevices and materials to be provided and performed pursuant to this Agreement, it is hereby specifically agreed and understood that any such purchase order, memorandum, letter, or other instrument shall have no effect on this Agreement unless agreed to by the City, specifically and in writing in a document of equal dignity herewith, and any and all terms, provisions, and conditions contained therein, whether printed or written or referenced on a Web site or otherwise, shall in no way modify the covenants, terms, and provisions of this Agreement and shall have no force or effect thereon. Section 10. Severability. If any term, provision or condition contained in this Agreement shall, to any extent, be held invalid or unenforceable, the remainder of this Agreement, or the application of such term, provision or condition to persons or circumstances other than those in respect of which it is invalid or unenforceable, shall not be affected thereby, and each term, provision and condition of this Agreement shall be valid and enforceable to the fullest extent permitted by law when consistent with equity and the public interest. Section 11. Waiver. The failure of the City to insist in any instance upon the strict performance of any provision of this Agreement, or to exercise any right or privilege granted to the City hereunder shall not constitute or be construed as a waiver of any such provision or right and the same shall continue in force. Section 12. Captions. The section headings and captions of this Agreement are for convenience and reference only and in no way define, limit, describe the scope or intent of this Agreement or any part thereof, or in any way affect this Agreement or construe any provision of this Agreement. Section 13. Counterparts. This Agreement may be executed in any number of counterparts, each of which shall be deemed an original, but all of which, taken together, shall constitute one and the same document. Section 14. Binding Effect. This Agreement shall be binding upon and inure to the benefit of the successors in interest, transferees and assigns of the parties. 4 1 P a g e Each party hereto represents to the other that it has undertaken all necessary actions to execute this Agreement, and that it has the legal authority to enter into this Agreement and to undertake all obligations imposed on it. The signatories hereof represent that they have the requisite and legal authority to execute this Agreement and bind the respective parties herein. Section 15. Remedies. The rights and remedies of the parties, provided for under this Agreement, are in addition to any other rights and remedies provided by law or otherwise necessary in the public interest. Section 16. Governing law, Venue and Interpretation. This Agreement is to be governed by the laws of the State of Florida. Venue for any legal proceeding related to this Agreement shall be in the Eighteenth Judicial Circuit Court in and for Seminole County, Florida. This Agreement is the result of bona fide arms length negotiations between the City and Fortiline, and all parties have contributed substantially and materially to the preparation of the Agreement. Accordingly, this Agreement shall not be construed or interpreted more strictly against any one party. than against any other party and all provisions shall be applied to fulfill the public interest. IN WITNESS WHEREOF, the City and Fortiline have executed this instrument for the purpose herein expressed and Fortiline represents and affirms that the signatories below have full and lawful authority to bind Fortiline in every respect. ATTEST. Q�w ffa'n� Traci 1166in, MMC, FCftM ity Cler , S to Appr form and legal sufficiency. CIT By: Art Date: m L. Colbert --City At or DDITIONAL SIGNATURE BLOCKS 5 Page ATTESTIWITNESSES: FORTUNE INC., a South Carolina Corporation. By. Witness# 1 Signature F7 I .��n tu re 6f p ra e Authority IX TI-' e -T VVitrk -#1 Print Na m e Printed Ma Date Winss #2. Si n t 7 7 (A Witness # 2 Printed Name 6 1 P a g e 2291 WEST AIRPORT BLVD • SANFORD, FL 32771 • TELEPHONE 407-688-9191 • FAX 407-688-9180 City of Sanford 300 N Park Avenue, Suite 243 Sanford, FL 32771 I R FQ#: 20/21/ 100 Manhole Rim and Covers Due: November 24, 2020 by 2pm Primary Contact: Blake Velz •. Sales blake.velz@fortiline.corn KNOWLEDGE * EXPERIENCE * SERVICE FOR ADDITIONAL LOCATIONS AND INFORMATION, VISIT US ON THE WEB AT WWW.FORTILINE.COM FORTUNE WATERWORKS a MORSCO brand 2291 WEST AIRPORT BLVD * SANFORD, FL 32771 # TELEPHONE 407-688-9191 9 FAX 407-688-9180 Local Branch IN ITGml - Fortiline, Waterworks Inc. 2291 West Airport Blvd Sanford, FL 32771 407-688-9191 407-688-9180 Name: Blake Valz Title: Municipal Sales Email: blake.valz@fortiline.com Name: Terry Scheuering Title: Branch Manager Email: terry.schuer zf@fortiline.com D99L= Corporate Office Phone: Fax: Name: Title: Email: Fortiline, Waterworks Inc. 7025 Northwinds Drive, NW Concord, NC 28027 704-788-9859 704-788-9896 Sheri Smith Regional Bid Coordinator sheri.smith@foi,tiline.com Remit to: Fortiline, Inc. PO Box 744053 Atlanta, GA 30384-4053 KNOWLEDGE * EXPERIENCE * SERVICE FOR ADDITIONAL LOCATIONS AND INFORMATION, VISIT US ON THE WEB AT WWW.FORTILINE.COM State of Florida Department o State !f I certify from the records of this office that FORTILINE, INC. is a South Carolina corporation authorized to transact business in the State of Florida, qualified on October 4, 2010. The document number of this corporation is F10000004477. I further certify that said corporation has paid all fees due this office through December 31, 2017, that its most recent annual report/uniform business report was filed on July 19, 2017, and that its status is active. I ftirther certify that said corporation has not filed a Certificate of Withdrawal. Given under my hand and the Great Seal of the State o Florida .f at Tallahassee, the Capital, this the Twenty-first day of March, 2018 J-% I Secretary ofState Tracking Number: CU0078656904 To authenticate this certificate,visit the following site,enter this number, and then follow the instructions displayed. https:Hservices.sunbiz.org/Filiiigs/CertificateOfStatus/CertificateAutlientication Enter your TIN in the appropriate box, The TIN provided must match the name given on line 1 to avoid W. 9 Request for Taxpayer U Give Form to the Form = = (Rev. October 2018) Identification Number and Certification entities, it is your employer identification number (EIN). If you do not have a number, see How to get a requester. Do not Department of the Treasury send to the IRS. Internal Revenue Service 0* Go to www.irs.gov/FormW9 for instructions and the latest information. 1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank. Fortiline Inc., DBA Fortiline Waterworks 2 Business nameldisregarded entity name, if different from above co a) 3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the 4 Exemptions (codes apply only to M following seven boxes. certain entities, not individuals; see C . ❑ Individual/sole proprietor or n,/' C Corporation El S Corporation El Partnership ❑ Trust/estate instructions on page 3): 4; 0) single -member LLC Exempt payee code (if any) ❑0.9 Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) 11. 0 Note. Check the appropriate box in the line above for the tax classification of the single -member owner. Do not check Exemption from FATCA reporting S LLC if the LLC is classified as a single -member LLC that is disregarded from the owner unless the owner of the LLC is LLC is disregarded from for code (if an aanother that not the owner U.S. federal tax purposes. Otherwise, a single -member LLC that .2 is disregarded from the owner should check the appropriate box for the tax classification of its owner. (❑ Other (see instructions) o, Mpofies to aCCOUMS Mainta;ned outside the U.S.) 0)CL 6 Address (number, street, and apt. or suite no.) See instructions. Requester's name and address (optional) 00) 7025 Northwinds Drive, NW 6 City, state, and ZIP code Concord, NC 28027 7 List account number(s) here (optional) Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box, The TIN provided must match the name given on line 1 to avoid Social security number backup withholding. For individuals, this is generally your social security number (SSN). However, fora resident alien, sole proprietor, or disregarded entity, see the instructions for Part 1, later. For other U T] _M entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN, later. or Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and I Employer identification number Number To Give the Requester for guidelines on whose number to enter. F51 71 —1 0 1 8 1 1 1 9 1 1 1 9 1 0 Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and 2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and 3. 1 am a U.S. citizen or other U.S. person (defined below); and 4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part 11, later. 5lign Signature ofLf�_ Here I U.S. person ► :-9au , General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Future developments. For the latest information about developments related to Form W-9 and its instructions, such as legislation enacted after they were published, go to wwwJrs.gov1FdrmW9. Purpose of Form An individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following. * Form 1099 -INT (interest earned or paid) Date 0- 11/20/20 o Form 1099 -DIV (dividends, including those from stocks or mutual funds) - Form 1099-MISC (various types of income, prizes, awards, or gross proceeds) * Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) • Form 1099-S (proceeds from real estate transactions) • Form 1099-K (merchant card and third party network transactions) • Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition) • Form 1099-C (canceled debt) • Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN. If you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding, later. Cat. No. 10231X Form W-9 (Rev. 10-2018) CITY OF CITY OF SANFORD SANFOPJ) Building Division - Licensing FLORIDA PO Box 1788, Sanford, FL 32772-1788 RDW LOCAL BUSINESS TAX RECEIPT VALID THROUGH SEPTEMBER 30, 2020 FORTLINE INC 15850 Dallas Pkwy Dallas TX 75248 This receipt is a local business tax only. It does not permit the local business taxpayer to violate any existing zoning or regulatory laws of the state or county, nor does it exempt the business taxpayer from any other license or permits required by law. Issue Date: 10/01/2019 BTR #: BTR1 9-025297 Business Location: 2291 West AIRPORT Boulevard Classification Amount Fire Inspection Fee 75.00 Merchants, Retail and/or Wholesale 2,977.00 10% Late Fee 297.70 TOTAL: 3,349.70 Comments: Restrictions: SEMINOLE COUNTY TAX RECEIPT REQUIRED ORIGINAL TAX RECEIPT MUST BE DISPLAYED ON PREMISES City of Sanford I Finance Department ( Purchasing Division 300 N. Park Avenue, Sanford, Florida 32771 CITY of Phone: 407.688.5028 1 Fax: 407.688.502.1 FARM `SA�40RD INFORMAL REQUEST FOR QUOTE I ,i pINANCF UkPARIMCMT mo' Q IRFQ 20/21-100 MANHOLE RIM AND COVERS BIDDER INFORMATION: DUE DATE: Tuesday, November 24, 2020 Name of Firm: .............................................................................. 2:00 P. M. Local Time Address: .................................................. .................................... Address: ....................................................................................... City/State/Zip Code: .................................................................... Contact Person: ...................................... ..................................... PhoneNumber: ............................................................................ FaxNumber:................................................................................ Email: .................................................................... BIDDER'S PRINTED NAME: ....................................... Title: ............................................................................................ Citv of Sanford Purchasina Division Contact Person: Lindsey Bojadzijev, Purchasing Analyst Address: 300 N. Park Avenue Suite 243 City, State, Zip: Sanford, Florida 32771 Phone Number: 407.688.5028, or ext. 5030 Fax Number: 407.688.5021 Email: purchasing a.sanfordtl.gov For Div./Dept./Office: Cedric Coleman, Operations Manager 407.688.2815 422 W. 141" Street Sanford, FL 32771 ISSUED DATE: Tuesday, November 10, 2020 QUESTION END DATE: Tuesday, November 17,^ 2020 BIDDER'S SIGNATURE: ............................................................. Date: ................................................................................................ PLEASE RETURN BY DUE DATE AND TIME VIA FAX, MAIL OR EMAIL TO CONTACT PERSON STATED ABOVE. Intent. The intent of this solicitation is to select a successful Bidder to provide the City of Sanford with manhole covers 2. Deliverables and Scone of Services. The successful Bidder shall provide all necessary material, goods, labor, See Exhibit A for Specifications Manhole Covers a) Covers b) Cover - black c) Custom logo or tread pattern molded into substrate in center position d) Lock hole e) Top arch for molded into substrate custom marking f) 30 molded in lowered lettering g) Bottom arch for molded into substrate custom marking h) AASHTO M-306 designation i) Concealed pick hole (2) 316 SS inserts installed j) Two (2) lock holes Cover Side a) Date of manufacture — format (MM/DD/YY) b) Hole to bolt clearances c) Paddle lock feature Frame a) Date of manufacture — format (MM/DD/YY) b) Anchor hole --1.06 in (4) c) Installed neoprene gasket PUR-F-302 7 Rev. 03/2016 Frame Section a) All hardware Is 316 Stainless Steel b) Detectable by standard metal detectors c) Compression Molded Thermoset Composite - no metal reinforcement d) Passed M306 H20/H25 Proof Load Delivery and Set-Up: Delivery shall be made to the City of Sanford, Utility Department, located at 422 W. 14th Street Sanford, FL 32771 between the hours of 7:30 A.M. and 4:00 P.M. Monday through Thursday. The successful Bidder shall be responsible for coordinating the delivery of all goods/services in a timely manner. Partial deliveries or deliveries on any other date and time shall not be allowed unless written authorization has been obtained from the appropriate City authorized representative. The City shall not pay for any storage charges, Cash on Delivery (C.O.D.) shipments, or packaging or drayage charges. The successful Bidder shall be responsible for all risk of loss, any damage and/or stolen materials and equipment while in transit to the City of Sanford, Utility Department. Delivery and Time Performance: At approximately 10 days after issuance of the purchase order by the City, the successful Bidder shall update the appropriate City representative providing a tentative inspection/recertification scheduled commencement date. This delivery schedule shall be further updated two days prior to actual delivery to ensure the facility is accessible and ready to receive delivery. Any costs associated with deliveries not properly coordinated with the appropriate City representative shall be borne by the successful Bidder. Permitting: The successful Bidder shall be solely responsible for all pertinent permits required as well as adhering, meeting and or exceeding all local, state, and national building codes. City Responsibility: The City shall be responsible for: a. Provide a designated set-up area for the successful Bidder to deliver all necessary materials and equipment required for this project. b. Provide access for delivery. c. Contact person: Cedric Coleman, Operations Manager office: 407.688.2815 to arrange delivery. d. Delivery hours only: from Monday through Thursday 8:OOAM to 4:OOPM Friday's from 8:OOAM to Noon Must have authorization before delivering the manholes. Obligations of the Successful Bidder: It is understood that the successful Bidder shall provide and pay for all labor, tools, materials, permits, equipment, transportation, supervision, and any and all other items or services, of any type whatsoever, which are necessary to fully complete and deliver the goods/services requested by the City, and shall not have the authority to create, or cause to be filed, any liens for labor and/or materials on, or against, the City, or any property owned by the City. Such lien, attachment, or encumbrance, until it is removed, shall preclude any and all claims or demands for any payment expected by virtue of this project. The successful Bidder will ensure that all of its employees, agents, sub- contractors, representatives, Volunteers, and the like, fully comply with all of the terms and conditions set herein, when providing services for the City in accordance herewith. The successful Bidder shall be solely responsible for the means, methods, techniques, sequences, safety programs, and procedures necessary to properly and fully complete the work set forth in the Scope of Services. Tile successful Bidder shall use appropriate tools and/or equipment which are in good repair and proper working order, so as to enable the successful Bidder to complete the services required hereby. Clean-Up: (if applicable) The successful Bidder shall be responsible for the removal, hauling, and legal disposal of all debris generated as a result of performing the services for this turn-key solution on a daily basis; including up to, but not be limited to all existing equipment removed, all packaging materials, crating, cardboard, protective packaging, liners, plastic, etcetera. Any dumpsters; located within the City of Sanford shall not be used by the successful Bidder. The successful Bidder shall broom clean the premises at the end of each day. Punch List: The designated City representative and the successful Bidder shall perform an inspection of all items delivered by the successful Bidder. In the event any deficiencies are identified, a punch list shall be created to outline all deficiencies discovered. After the punch list is issued to the successful Bidder, the successful Bidder shall have 10 days to respond and correct all items listed on the punch list. In the event an item must be replaced, an expected delivery date for said item shall be given to the City. Similarly, in the event an area must be redone, an expected completion date shall be given to the City. Final acceptance and subsequent invoice processing shall not be done by the City until all items on the punch list have been completed. INFORMAL REQUEST FOR QUOTE Public Emergencies: It is hereby made a part of this bid that before, during, and after a public emergency, disaster, hurricane, tornado, flood, or other acts of God, City of Sanford shall require a "First Priority" for goods and services. It is vital and imperative that the health, safety, and welfare of the citizens of Sanford are protected from any emergency situation that threatens public health and safety as determined by the City. The Bidder agrees to rent/sell/lease all goods and services to the City or governmental entities on a "first priority" basis. The City expects to pay contractual prices for all products and/or services under the awarded Agreement in the event of a disaster, emergency, hurricane, tornado, flood, or other acts of God. Should the Bidder provide the City with products and/or services, not under the awarded Agreement, the City expects to pay a fair and reasonable price for all products and/or services rendered or contracted in the event of a disaster, emergency, hurricane, tornado, flood, or other acts of God. The City shall select the lowest quote that is most responsive to the needs of the City as outlined herein. The bidder's price response shall be accompanied by a detailed description of the required set -vice to be offered. 3. Price Submittal. In accordance with the terms, conditions, and specifications, I/we, as authorized signatory to commit the firm, do hereby accept in total all the terms and conditions stipulated and referenced in this IRFQ document and hereby submit the following prices for IRFQ 20/21-100 Manhole Rim and Covers as follows: Item Description Unit Price Extended Price 1. Manhole Cover Qty 30 $ 742.86 $ 22,285.80 2. 1 Delivery/Shipping Fees .00 .00 3. TOTAL QUOTE PRICE 2,285.80 Additionally, the following forms must be completed and included with your bid submittal: Item 1. Include a copy of your Certificate of Liability Insurance (COI) With Your quote submittal. V 2. Include a copy of your Florida State License and W9 V 3. Attachments A -H I 4. Exhibit A V a. The City will not consider alternates to the items listed above. If alternates are offered, the City will have the sole and unilateral right to reject the alternate and purchase from the vendor providing compliant items. Delivery time will be a factor in the evaluation of this IRFQ. b. All prices quoted shall remain firm for a period of one (1) year after the award of this IRFQ with a (1) year renewal of this IRFQ Probationary period of 90 days. c. Unit Price Accuracy: Please check the stated unit prices before submitting your quote.. as no change in prices shall be allowed after the due date and time. All prices and notations must be in ink or typewritten. In cases of extended price irregularities, the unit price shall prevail. Please note that the City reserves the right to clarify and correct extended price amount errors. d. The city of Sanford is exempt from Sales Tax. Certificate No. 8S -8012621681C-8. e. If you are offering pricing, which is based on other entity, or agency solicitation pricing, clearly state so and include a copy of the applicable solicitation with your submittal. f. Please read all terms and conditions, complete the requested information, and sign in the space provided on page 1. g. If not submitting a quotation, please indicate -NO BID", and return this form. INFOnIAL Critical Data: a. Please return your quote submittal via tax, mail or email to the requesting Division/Department/Office as outlined on page I by no later than the due date and time outlined on page I or as revised thereof via written addenda. b. Please email questions regarding this quotation only to the requesting Division/Department/Office. Any interpretations, clarifications, or changes made will be in the form of written addenda issued by requesting D ivision/Department/O Mee. C. Pursuant to Section 2.2 of the City of Sanford Purchasing Policy, lobbying is strictly prohibited. d. Please note that all documents sent to the City as part of this IRFQ are considered a Public Record; as prescribed by Chapter 119, Florida Statutes. c. Bidder must submit a copy oftheir Certificate of Insurance with their quote, f Any order resulting from this IRFQ shall be subject to the attached General Terms and Conditions and all applicable laws, policies, and SECTION 00618 Insurance Requirements City of Sanford, Florida INSURANCE REQUIREMENTS OUTLINED BELOW APPLICABLE TO CONTRACTS FOR SERVICES WHEN THE CONTRACTOR PERFORMS ON OR OFF CITY PREMISES ecceed "0/ "A n Employers Employers Employers Liability Liability Liability Workers' Compensation $1,000,000 $500,000 $500,000 Each Accident Each Accident Each *Certificates of exemption are not acceptable in lieu of workers $1,000,000 $500,000 Accident compensation insurance Disease Disease $500,000 $1,000,000 $500,000 Disease $ 500,000 Commercial General Liability shall include- Bodily injury liability, $1,000,000 $500,000 $ 3,000,000 Per Property Damage Liability; Personal Injury liability and Per Per Occurrence Advertising injury liability Coverages shall include: Premises/ Occurrence Occurrence $3 Operations; Products/Completed Operations; Contractual liability,- $1,000,000 $500,000 Ge�0eral00,000 Independent Contractors, Explosion; Collapse; Underground. General General Aggregate When required by the City, coverage must be provided for sexual Aggregate Aggregate harassment, abuse, and molestation $1,000,000 $1,000,000 $500,000 "any Combined Single Combined Per Comprehensive Auto Liability, CSL, shall include auto,, or Limit Single Limit Occurrence shall include all of the following: owned, leased, hired, non -owned $1,000,000 $ 1,000,000 $500,000 autos, and scheduled autos. General General General Aggregate Aggregate Aggregate $1,000,000 $1,000,000 $1,000,000 Professional Liability (when required) Minimum Minimum Minimum Builder's Risk (when required) shall include theft, sinkholes, off- 100% of the 100% of the 100% of the site storage, transit, installation and equipment breakdown. completed value completed completed Permission to occupy shall be included and the policy shall be of additions and value of value of endorsed to cover the interest of all parties, including the City of structures additions and additions and Sanford, all contractors, and subcontractors structures structures $1,000,000 $500,000 $3,000,000 Aggregate: No Aggregate: Aggregate: No per per vehicle No per Garage Keepers (when required) vehicle maximum maximum vehicle preferred preferred maximum referred $3,000,000 $1,000,000 $500,000 Combined Single Combined Combined Limit Single Limit Single Limit Garage Liability (when required) $3,000,000 $1,000,000 $500,000 General General General Aggregate Aggregate Aggreqate 1. It is noted that Professional Liability, builder's risk, garage keepers and garage liability is not required unless applicable conditions exist. If clarification is needed the CONTRACTOR must request clarification from the City of Sanford Purchasing Office. 11. Vendor, Contractor, the bidder shall provide, to the City of Sanford "City," prior to commencing any work, a Certificate of Insurance which verifies coverage in compliance with the requirements outlined below. Any work initiated without completion of this requirement shall be unauthorized and the City will not be responsible. Ill. The City reserves the right, as conditions warrant, to modify or increase insurance requirements outlined below as may be determined by the project, conditions, and exposure. Certification Terms and Conditions IV. It is noted that the City has a contractual relationship with the named vendor, contractor or provider (collectively referred hereinafter as Contractor) applicable to a purchase order, work order, contract or other forms of commitment by the City of Sanford, whether in writing or not and has no such contractual relationship with the Contractor's insurance carrier. Therefore, the onus is on the Contractor to ensure that they have the insurance coverage specified by the City to meet all contractual obligations and expectations of the City. Further, as the Contractor's insurance coverage is a matter between the vendor and its insurance carrier, the City will turn to the Contractor for relief as a result of any damages or alleged damages for which the Contractor is responsible to indemnify and hold the City harmless. It is understood that the Contractor may satisfy relief to the City for such damages either directly or through its insurance coverage; exclusions by the insurance carrier notwithstanding, the City will expect relief from the Contractor. a. The insurance limits indicated above and otherwise referenced are minimum limits acceptable to the City. Also, all contractor policies shall to be considered primary to City coverage and shall not contain co-insurance provisions. b. All policies, except for professional liability policies and workers compensation policies shall name the City of Sanford as Additional Insured. c. Professional Liability Coverage, when applicable, will be defined on a case by case basis. d. In the event that the insurance coverage expires prior to the completion of the project, a renewal certificate shall be issued 30 days prior to said, expiration date. e. All limits are per occurrence and must include Bodily Injury and Property Damage. f. All policies must be written on an occurrence form, not on claims made Form, except for Professional Liability. g. Self-insured retentions shall be allowed on any liability coverage. h. In the notification of cancellation: The City of Sanford shall be endorsed onto the policy as a cancellation notice recipient. Should any of the above- described policies of Sanford in accordance with the policy provisions. I. All insurers must have an A.M. rating of at least A -VII. j. It is the responsibility of the Prime CONTRACTOR to ensure that all sub -contractors retained by the Prime CONTRACTOR shall provide coverage as defined here -in before and after and are the responsibility of said Prime CONTRACTOR in all respects. k. Any changes to the coverage requirements indicated above shall be approved by the City of Sanford, Risk Manager. I. Address of "Certificate Holder" is the City of Sanford; P 0 Box 1788 (300 N. Park Avenue); Sanford, Florida 32771; Attention Purchasing Manager; Phone 407.688.5028/5030 Fax 407.688.5021. m. All certificates of insurance, notices, etc. must be provided to the above address. n. In the description of the certificate of insurance please also add the solicitation number and project name. AFFIANT SIGNATURE Sheri Smith Typed Name of AFFIANT Regional Bid Coordinator Title STATE OF FLORIDA COUNTY OF S?,rn,,2 I HEREBY CERTIFY that on this day, befqgi, f I fflcer d auth r,ze to administer oaths and rtake acknowledgments, personally appeared V eI an o ,, 11 XX who is personally known to me or () who produced as identification a ackriow1p,dge efore me that s/he executed the same. Sworn and subscribed before me, by by means of ( ) physical presence or .online notarization on the :2 day of 2020, the said person did take an oath and was first duly sworn by me, on oath, said person, further, deposing and saying that s/he has read the foregoing and that the statements and allegations contained herein are true and correct. WITNESS my hand and official seal in the County and State las foresaid this jtgLl day of r 2020. '0Y % Notary Public State of Florkla Terry J Scheuering My Commission GG 123732 Expires 07/1212021 otary Publidin Vd for tWe County and State Tentioned) SEAL My commission expires: The City reserves the unilateral right to modify the insurance requirements set forth at any time. PLEASE COMPLETE AND SUBMIT tV'Failure to submit this form may be grounds for disqualification of your submittal -10 ATTACHMENT "A" PRICE PROPOSAL IRFQ 20/21-100 MANHOLE RIM AND COVERS Uwe, the undersigned, as authorized signatory to commit the firm, do hereby accept in total all the terms and conditions stipulated and referenced in this IRFQ document and do hereby agree that if a contract is offered or negotiated it will abide by the terms and conditions presented in the IRFQ document or as negotiated pursuant thereto. The undersigned, having familiarized him/herself with the terms of the IRFQ documents, local conditions, and the cost of the work at the place(s) where the work is to be done, hereby proposes and agrees to perform within the time stipulated, all work required in accordance with the requirement and technical specifications and other documents including Addenda, if any, on file at the City of Sanford Purchasing Division for the price set forth herein in Attachment "A" Offer to Purchase and Acceptance of Informal Request for Quote Terms and Conditions. The signature(s) below is an acknowledgment of my/our full understanding and acceptance of all the terms and conditions set forth in this IRFQ document or as otherwise agreed to between the parties in writing, Bidder/Contractor Name Mailing Address: Telephone Number: Authorized Signatory Fortiline Inc., DBA Fortiline Waterworks 2291 West Airport Blvd, Sanford, FL 32771 407-688-9191 Fax Number: 407-688-9180 E-mail Address: 'heri.smith@foililine.com Regional Bid Coordinator Title STATE OF FLORIDA COUNTY OF le' Sheri Smith Printed Name 11/20/20 Date FEIN: 57-0819190 I HEREBY CERTIFY that on this day, before me, an office duly auth rized to administer oaths and take acknowledgments, personally appeared 2who is personally known to me or f ) who produced as identification and ac nowledge efore me that s/he executed the same. Sworn and subscribed before me, b —_ <Z'-� �'�4 ik- by means of { ) physical presence or V online notarization on the day of 2020, the said person did take an oath and was first duly sworn by me, on oath, said person, further, deposing and saying that s/he has read the foregoing and that the statements and allegations contained herein are true and correct. WITNESS my hand and official seal in the County and State last aforesaid thisday ofJZ / L�' 2020. I ogNNotary Public State of Florida M?a Terry J Scheuering A Z' My Commission GG 123732 Nlpo,wdF Expires 07/12/2021 Public'm SEAL My commission expires: for ffi County and Stat4 Aforementioned) 19'7,,.,2, IL, PLEASE COMPLETE AND SUBMIT WITH YOUR IRFQ RESPONSE `V'Failure to submit this form may be grounds for disqualification of your submittal -'10 GENERAL TERMS AND CONDITIONS - READ CAREFULLY Questions relating to this Request for Quotation must be directed to the City of Sanford, Purchasing Division, hereinafter referred to as "City", at 407.688.5028 or ext, 5030. RESERVED RIGHTS OF THE CITY The City reserves the right to unilaterally cancel this Request for Quotation, at its sole discretion. WRITTEN COMMUNICATIONS The terms and conditions of this Request for Quotation shall not be modified verbally. All communication shall be in writing. APPLICABLE LICENSING The Vendor, at its sole expense, shall obtain all required federal, state, and local licenses, occupational and otherwise, required to successfully provide the goods/services set forth herein. QUALITY All materials or services furnished on this order must be as specified and subject to City inspection within a reasonable time after delivery at destination. Variations in materials or services from those specified in this order must not be made without prior written authorization from the Procurement Administrator. Material rejected will be returned and shall be done so at the vendor's sole risk and expense. QUANTITY/PRICE The number of materials ordered or the prices specified must not be exceeded without written authority being first obtained from the Purchasing Division. INDEMNITY The Vendor hereby agrees to indemnify and save harmless the City, its officers, agents and employees from and against any and all liability, claims, demands, damages, fines, fees, expenses, penalties, suits, proceedings, actions, and cost of actions, including attorney's fees for trial and on appeal, of any kind and nature arising or growing out of or in any way connected with the performance of this Agreement whether by act or omission of the Vendor, its agents, servants, employees, or others, or because ofor due to the mere existence of this Agreement between the parties. PATENT/COPYRIGHT HOLD HARMLESS The Vendor shall pay all royalties and assume all costs arising from the use of any invention, design, process, materials, equipment, product or device which is the subject of patent rights or copyrights. Vendor shall, at its own expense, hold harmless and defend the City against any claim, suit or proceeding brought against the City which is based upon claim, whether rightful or otherwise, that the goods or services, or any part thereof. furnished under this Purchase Order, constitute an infringement of any patent or copyright of the United States. The Vendor shall pay all damages and costs awarded against the City. PACKING If awarded a purchase order or Agreement, all invoices and package lists must clearly be marked with shipper's name, address and Purchase Order Number. Charges are not allowed for boxing, crating or special deliveries unless previously agreed upon in writing. DELIVERY All materials must be shipped F.O.B. Destination. The City will not pay freight or expense charges, except by previous agreement. In the event of the City agreeing to F.O.B. Shipping Point, the Vendor must PREPAY SHIPPING CHARGES AND ADD TO INVOICE. Delivery must be effected within the time stated on Purchase Order. The City reserves the right to cancel this order and purchase elsewhere if the Vendor fails to meet the delivery date specified on .Purchase Order. Deliveries shall be made between 7:00 AM and 4:30 PM on regular working days unless otherwise stated. Transport deliveries must be unloaded and ready for inspection prior to 4:30 PM. In case of -default by the Vendor, the City may procure the articles or services covered by this order from other sources and hold the Vendor responsible for any additional cost occasioned thereby. MATERIAL SAFETY DATA SHEET As necessary, the Vendor agrees to furnish the City with a current Material Safety Data Sheet (MSDS) on or before delivery of each and every hazardous chemical or substance purchased which is classified as toxic under Chapter 422, Florida Statutes. Appropriate labels and MSDS's shall be provided for all shipments. Send a copy of the MSDS's and other pertinent data to the City Purchasing Division and include the same with product delivery. OSHA REQUIREMENT The Vendor hereby guarantees the City that all materials, supplies, and equipment as listed on the resulting Purchase Order shall meet the requirements, specifications, and standards as provided under the U.S. Department of Labor Occupational Safety and Health Act of 1970, as from time to time amended and in force at data hereof. COMPLIANCE WITH LAWS, GUIDELINES, REGULATIONS The Vendor, at its sole expense shall comply with all laws, ordinances, judicial decisions, orders, and regulations of federal, state, county and municipal governments, as well as their respective departments, commissions, boards, and officers, which are in effect at the time of award or are adopted at any time following the award. AWARD The City reserves the right to reject any or all parts of this solicitation, waive technicalities and to award to most responsive, responsible bidder, as in the best interest of the City. Failure of a Vendor that is awarded a Purchase Order to deliver according to the Purchase Order or to comply with any of the terms and conditions therein may disqualify the Vendor from receiving future orders. PAYMENT TERMS Payment terns are net 30 days upon delivery and acceptance. 'The City pays in accordance with the Prompt Payment Act — Section 218.70, Florida Statutes. APPLICABLE LAW, VENUE AND JURY TRIAL The laws of the State of Florida shall govern all aspects of this order. In the event it is necessary for either party to initiate legal action regarding this order, venue shall lie in Seminole County, Florida. 'The parties hereby waive their right to trial by jury in any action, proceeding or claim, arising out of This order, which may be brought by either of the parties hereto. AUDITING, RECORDS AND INSPECTIONS The Vendor shall keep books, records, and accounts of all activities, related to this order, in compliance with generally accepted accounting procedures. If required, books, records, and accounts related to the performance of this order shall be open to inspection during regular business hours by in authorized representative of the City and shall be retained by the Vendor, for a period of three (3) years after termination or completion of the services or until the full City audit is complete, whichever comes first. The City shall retain the right to audit the books during the three-year retention period. All books, records, and accounts related to the performance ofthis order shall be subject to the applicable provisions of the Florida Public Records Act, chapter 119, Florida Statutes. The City also has the right to conduct an audit within sixty (60) days from the effective date of this order to determine whether the Vendor has the ability to fulfill its contractual obligations to the satisfaction of the City. The City has the right to terminate this order based upon time findings in this audit without regard to any notice requirement for termination. WARRANTY The Vendor agrees to provide a fill warranty to the City for all materials and services which it provides hereunder for one fill year following the date ofdelivery or completion of services. In the event that the Vendor is called to perforin warranty work, the Vendor will be responsible for all costs incurred in repairing the areas under warranty. [fit is determined that new problem areas have appeared which were riot areas repaired by the Vendor under the Scope of Services set forth herein, the City will be responsible for the costs incurred in repairing the new areas. The manufacturer's warranty on materials received and installed shall extend for the fill warranty period. INSURANCE The Vendor shall have at a minimum the insurance limits listed hereunder; however the City reserves the unilateral and sole right to modify said limits when the type of product or services requested merit a modification of the insurance limits listed herein. The Vendor shall submit a copy of their Certificate of Liability Insurance with their quote submittal. GENERAL LIABILITY: $1,000,000.00 PROFESSIONAL LIABILITY: $1,000,000.00 (only if professional services are to be provided) VEHICLE INSURANCE: $1,000,000.00 Combined Property & Bodily Injury WORKER'S COMPENSATION: $1,000,000.00 PRODUCTS LIABILITY: $1,000,000.00 (only if a product is being provided) Upon award, the Vendor shall name City of Sanford as a Certificate Holder and/or as additional insured and shall maintain the coverage limits set forth during the entire tern of performing services under this award. NOTE: ANY AND ALL SPECIAL CONDITIONS ATTACHED HERETO WHICH VARY FROM THESE GENERAL CONDITIONS SHALL HAVE PRECEDENCE. Issued by: Finance/Purchasing Division Sanford, Florida IRFQ 20/2 1 -100 Manhole Covers Due; 'Tuesday, November 24, 2020 at 2:00 P.M. Local 'lime (✓ Reason i \I ��'�(� 2"d Floor Suite 236 Sanford, Florida 32771 Phone: 407.6$$.502$ or 5030 Fax: 407.G$$.502.1 City of Sanford (Finance Department � Purchasing Solicitation INFORMAL REQUEST FOR QUOTE (IRFQ} Due Date: CITY 9F Division 300 N. Park Avenue November 24, 2020 MANHOLE RIM AND COVERS Unable to meet. insurance or bond requirements. Scope of Services unclear (please explain below). Other ( leases eci below). Exhibit "B" Statement of "No Bid Submittal" If you do not intend to submit on this requirement, please complete and return this form prior to date shown for receipt of proposals to the City of Sanford, Purchasing Division, 300 N. Park Avenue 2"d Floor Suite 236, Sanford, Florida 32771. I/WE HAVE DECLINED TO SUBMIT A BID FOR IRFQ 20/21-100 Manhole Rim and Covers titled for the following reason(s): [Please place a checkmark (✓) next to the reason(s) as applicable] REMARKS: N/A Company Name: Mailing Address: Telephone Number: Fax Number: E-mail Address: FEIN: Authorized Signatory Printed Name Title Date (✓ Reason i \I ��'�(� 2"d Floor Suite 236 Sanford, Florida 32771 Phone: 407.6$$.502$ or 5030 Fax: 407.G$$.502.1 IRFQ 20/21-100 FINANCE DEPARTMENT INFORMAL REQUEST FOR QUOTE (IRFQ} Due Date: Our schedule would not permit us to perform. TERM CONTRACT November 24, 2020 MANHOLE RIM AND COVERS (✓ Reason Bid requirements too '"restrictive". Insufficient time to respond to the Invitation for Bid. We do not offer this service. Our schedule would not permit us to perform. Unable to meet requirements. Unable to meet. insurance or bond requirements. Scope of Services unclear (please explain below). Other ( leases eci below). Attachment "C" Conflict of Interest Statement A. lamthe of Regional Bid Coordinator with a local office in Fortiline, Inc. Sanford, FL [Insert Title] [Insert Company Name] and principal office in Concord, NC B. The entity hereby submits an offer to IRFQ 20/21-100 titled Manhole Rim and Covers C. The AFFIANT has made a diligent inquiry and provided the information in this statement affidavit based upon its full knowledge. D. The AFFIANT states that only one submittal for this solicitation has been submitted and tendered by the appropriate date and time and that said above -stated entity has no financial interest in other entities submitting a proposal for the work contemplated hereby. E. Neither the AFFIANT nor the above named entity has directly or indirectly entered into any agreement, participated in any collusion or collusive activity, or otherwise taken any action which in any way restricts or restraints the competitive nature of this solicitation, including but not limited to the prior discussion of terms, conditions, pricing, or other offer parameters required by this solicitation. F. Neither the entity nor its affiliates, nor anyone associated with them, is presently suspended or otherwise prohibited fi-cm, participation in this solicitation or any contract to follow thereafter by any government entity. G. Neither the entity nor its affiliates, nor anyone associated with them, have any potential conflict of interest because and due to any other clients, contracts, or property interests in this solicitation or the resulting project. H. I hereby also certify that no member of the entity's ownership or management or staff has a vested interest in any City Division/Department/Office. 1. 1 certify that no member of the entity's ownership or management is presently applying, actively seeking, or has been selected for an elected position within the City of Sanford government. J. In the event that a conflict of interest is identified in the provision of services, 1, the undersigned will immediately notify the City in writing. By the signature(s) below, I/we, the undersigned, as an authorized signatory to commit the firm, certify that the information as provided in Attachment "C", Conflict of Interest Statement, is truthful and correct at the time of submission. J" AFFIANT SIGNATURE Sheri Smith Typed Name of AFFIANT COUNTY OF STATE OF FLORIDA On this ,k �_day of 20 JIM—) before me, the undersigned Notary Public of the State of Florida, personally appeared Ale r_1 - whose name(s) is/are subscribed to the ,w�wment,au,d he/she/they acknowledge that he/she/they executed it. WITNESS my hand and official seal. He/She is ,wrsoriall)4 bmwL1QriaDr_has_Produced as identification. 10 1FAry blic/ and the County and State Afo(ementioned) !I Zy Acommission expires: An'Z/ PLEASE COMPLETE AND SUB'MITVITH YOUR IRFQ RESPONSE -Failure to submit this form may be grounds for disqualification of your submittal - 2 City of Sanford I Finance Department I Purchasing Solicitation Division Number: OF 300 N. Park Avenue 2"d Floor Suite 236 Sanford, Florida 32771 IRFQ 20/21-100 SCITY ORD Phone: 407.688.5028 or 5030 1 Fax: 407.688.5021 INFORMAL REQUEST FOR QUOTE (IRFQ) Due Date: FINANCE DEPARTMENT TERM CONTRACT November 24, 2020 MANHOLE RIM AND COVERS Attachment "C" Conflict of Interest Statement A. lamthe of Regional Bid Coordinator with a local office in Fortiline, Inc. Sanford, FL [Insert Title] [Insert Company Name] and principal office in Concord, NC B. The entity hereby submits an offer to IRFQ 20/21-100 titled Manhole Rim and Covers C. The AFFIANT has made a diligent inquiry and provided the information in this statement affidavit based upon its full knowledge. D. The AFFIANT states that only one submittal for this solicitation has been submitted and tendered by the appropriate date and time and that said above -stated entity has no financial interest in other entities submitting a proposal for the work contemplated hereby. E. Neither the AFFIANT nor the above named entity has directly or indirectly entered into any agreement, participated in any collusion or collusive activity, or otherwise taken any action which in any way restricts or restraints the competitive nature of this solicitation, including but not limited to the prior discussion of terms, conditions, pricing, or other offer parameters required by this solicitation. F. Neither the entity nor its affiliates, nor anyone associated with them, is presently suspended or otherwise prohibited fi-cm, participation in this solicitation or any contract to follow thereafter by any government entity. G. Neither the entity nor its affiliates, nor anyone associated with them, have any potential conflict of interest because and due to any other clients, contracts, or property interests in this solicitation or the resulting project. H. I hereby also certify that no member of the entity's ownership or management or staff has a vested interest in any City Division/Department/Office. 1. 1 certify that no member of the entity's ownership or management is presently applying, actively seeking, or has been selected for an elected position within the City of Sanford government. J. In the event that a conflict of interest is identified in the provision of services, 1, the undersigned will immediately notify the City in writing. By the signature(s) below, I/we, the undersigned, as an authorized signatory to commit the firm, certify that the information as provided in Attachment "C", Conflict of Interest Statement, is truthful and correct at the time of submission. J" AFFIANT SIGNATURE Sheri Smith Typed Name of AFFIANT COUNTY OF STATE OF FLORIDA On this ,k �_day of 20 JIM—) before me, the undersigned Notary Public of the State of Florida, personally appeared Ale r_1 - whose name(s) is/are subscribed to the ,w�wment,au,d he/she/they acknowledge that he/she/they executed it. WITNESS my hand and official seal. He/She is ,wrsoriall)4 bmwL1QriaDr_has_Produced as identification. 10 1FAry blic/ and the County and State Afo(ementioned) !I Zy Acommission expires: An'Z/ PLEASE COMPLETE AND SUB'MITVITH YOUR IRFQ RESPONSE -Failure to submit this form may be grounds for disqualification of your submittal - 2 Attachment "D" COMPLIANCE WITH THE PUBLIC RECORDS LAW AFFIDAVIT I. If and when the City of Sanford transmits records to the Contractor/Vendor which are exempt from public disclosure, the Contractor/Vendor shall execute an "Acknowledgement of Receipt of Exempt Public Records and Agreement to Safeguard" which will be provided with the exempt records. A sample form is attached for the bidder/proposer's information. 11. Upon award recommendation or 30 days after opening, it is understood that all submittals shall become "public records" and shall be subject to public disclosure consistent with Chapter 119, Florida Statutes, and Section 24(a), Article I of the Constitution of the State cif Florida, and other controlling law (collectively the "Public Records Laws"). If the City of Sanford (City) rejects all replies submitted in response to a competitive solicitation and provides notice of its intent to reissue the solicitation, the replies remain exempt from disclosure until the City provides notice of intent to award or withdraws the reissued solicitation. If no award is made, responses are not exempt for longer than 12 months after the initial notice rejecting all responses. Proposers/Bidders must invoke the exemptions to disclosure provided by law as applicable to the response to the solicitation, must identify the data or other materials to be protected, and must state the reasons why such exclusion from public disclosure is necessary. The submission of a proposal authorizes the release of your firm's credit data to the City. If a Proposer/Bidder submits information exempt from public disclosure, the Proposer/Bidder must specifically and in detail identify with specificity which pages/paragraphs of their bid/proposal package are exempt from the Public Records Laws, identifying the specific exemption under the Public Records Laws that applies to each. The protected information must be submitted to the City in a separate envelope marked accordingly. By submitting a response to this solicitation, the Proposer/Bidder agrees to defend, indemnify and hold the City harmless in the event the City litigates the public records status of the Proposer's/Bidder's documents this provision including the obligation to pay the full legal costs of the City including, but not limited to, attorney's fees, court costs, and any and all other charges, regardless of what level of trial or appeal. Fortiline Inc., DBA Fortiline Waterworks Proposer/Bidder ,f 11/20/20 Signature of Authorized Representative (Affiant) Date Sheri Smith, Regional Bid Coordinator Printed or Typed Name and Title of Authorized Representative (Affiant) 3 City of Sanford ( Finance Department I Purchasing Solicitation CITY of Division 300 N. Park Avenue 2"1 Floor Suite 236 Sanford, Florida 32771 Number: 20/21-100 Ski4FO G,)v Phone: 407.688.5028 or 5030 Fax: 407.688.5021IRFQ INFORMAL REQUEST FOR QUOTE (IRFQ) Due Date: FINANCE DEPARTMENT TERM CONTRACT November 24, 2020 MANHOLE RIM AND COVERS Attachment "D" COMPLIANCE WITH THE PUBLIC RECORDS LAW AFFIDAVIT I. If and when the City of Sanford transmits records to the Contractor/Vendor which are exempt from public disclosure, the Contractor/Vendor shall execute an "Acknowledgement of Receipt of Exempt Public Records and Agreement to Safeguard" which will be provided with the exempt records. A sample form is attached for the bidder/proposer's information. 11. Upon award recommendation or 30 days after opening, it is understood that all submittals shall become "public records" and shall be subject to public disclosure consistent with Chapter 119, Florida Statutes, and Section 24(a), Article I of the Constitution of the State cif Florida, and other controlling law (collectively the "Public Records Laws"). If the City of Sanford (City) rejects all replies submitted in response to a competitive solicitation and provides notice of its intent to reissue the solicitation, the replies remain exempt from disclosure until the City provides notice of intent to award or withdraws the reissued solicitation. If no award is made, responses are not exempt for longer than 12 months after the initial notice rejecting all responses. Proposers/Bidders must invoke the exemptions to disclosure provided by law as applicable to the response to the solicitation, must identify the data or other materials to be protected, and must state the reasons why such exclusion from public disclosure is necessary. The submission of a proposal authorizes the release of your firm's credit data to the City. If a Proposer/Bidder submits information exempt from public disclosure, the Proposer/Bidder must specifically and in detail identify with specificity which pages/paragraphs of their bid/proposal package are exempt from the Public Records Laws, identifying the specific exemption under the Public Records Laws that applies to each. The protected information must be submitted to the City in a separate envelope marked accordingly. By submitting a response to this solicitation, the Proposer/Bidder agrees to defend, indemnify and hold the City harmless in the event the City litigates the public records status of the Proposer's/Bidder's documents this provision including the obligation to pay the full legal costs of the City including, but not limited to, attorney's fees, court costs, and any and all other charges, regardless of what level of trial or appeal. Fortiline Inc., DBA Fortiline Waterworks Proposer/Bidder ,f 11/20/20 Signature of Authorized Representative (Affiant) Date Sheri Smith, Regional Bid Coordinator Printed or Typed Name and Title of Authorized Representative (Affiant) 3 COUNTY OF STATE OF Ft-dR16A On this 42' day of 20 before me, the undersigned Notary Public of the State of Florida, personally appeared whose name(s) is/are subscribed to the rl, ,Ilk wit tr rnenl,-,�nd he/she/they acknowledge that he/she/they executed it. WITNESS my hand and official seal. He/She is t personally known to m6)Dr has produced as identification. Notsry Public Stat* Of Fw,'- 4— '40t �Ie -4�� 32 I u M Terry J Scheuedng (Rot Public in an far 1e County and Stat Afio?e entioned) 10 My commission GG 123732 LEXPires 07AV2021 mission expires: PLEASE COMPLETE AND SUBMIT WITH YOUR IRFQ RESPONSE 'w"Failure to submit this form may be grounds for disqualification of your submittal - 4 City of Sanford I Finance Department I Purchasing Solicitation SCITY OF ORD Division 300 N. Park Avenue 2"d Floor Suite 236 Sanford, Florida 32771 Phone: 407.688.5028 or 5030 1 Fax: 407.688.5021 Number: IRFQ 20/21-100 FINANCE DEPARTMENT INFORMAL REQUEST FOR QUOTE (IRFQ) Due Date: TERM CONTRACT November 24, 2020 MANHOLE RIM AND COVERS COUNTY OF STATE OF Ft-dR16A On this 42' day of 20 before me, the undersigned Notary Public of the State of Florida, personally appeared whose name(s) is/are subscribed to the rl, ,Ilk wit tr rnenl,-,�nd he/she/they acknowledge that he/she/they executed it. WITNESS my hand and official seal. He/She is t personally known to m6)Dr has produced as identification. Notsry Public Stat* Of Fw,'- 4— '40t �Ie -4�� 32 I u M Terry J Scheuedng (Rot Public in an far 1e County and Stat Afio?e entioned) 10 My commission GG 123732 LEXPires 07AV2021 mission expires: PLEASE COMPLETE AND SUBMIT WITH YOUR IRFQ RESPONSE 'w"Failure to submit this form may be grounds for disqualification of your submittal - 4 Project Name: Attachment "E" E -VERIFY'' COMPLIANCE AFFIDAVIT Manhole Rim and Covers Bid No.: IRFQ 20/21-100 The Affiant identified below attests to the following: That the Contractor is currently in compliance with and throughout the term of the above -identified project and will remain in compliance with Executive Order 11-02, issued by the Office of the Governor, State of Florida, requiring the use of the Department of Homeland Security's Status Verification ("E -Verify"} System to ensure that all employees of the Contract and the Contractor's subcontractors performing work under the above -listed Contract are legally permitted to work in the United States. 2. Each Contractor that performs work under the Project referenced above shall provide the City of Sanford, Florida, a copy of the "Edit Company Profile" screen indicating enrollment in the E -Verify Program. 3. The Contractor will register and participate in the work status verification for all newly hired employees of the contractor and for all subcontractors performing work on the above -listed Contract. 4. The Contractor agrees to maintain records of its compliance with the verification requirements as outlined in this Affidavit and, upon request of the any Authority having jurisdiction over the Project, including, but not limited to, the State of Florida, agrees to provide a copy of each such verification to that Authority. 5. That all persons assigned by the Contractor or its subcontractors to perform work under the above -identified project will meet the employment eligibility requirements as established by the Federal Government and the government of the State of Florida. 6. That the Contractor understands and agrees that its failure to comply with the verification requirements as set forth herein or its failure to ensure that all employees and subcontracts performing work under the above -identified project are legally authorized to work in the United States and the State of Florida constitute a breach of contract for which the City of Sanford may immediately terminate the Contract without notice and without penalty. Contractor further understands and agrees that in the event of such termination, the Contractor shall be liable to the City for any costs incurred by the City as a result of the Contractor's breach. 7. That for the purposes of this Affidavit, the following definitions apply: "Employee" — Any person who is hired to perform work in the State of Florida. "Status Verification System" — the procedures developed under the Illegal Immigration Reform and Immigration Responsibility Act of 1496, operated by the Department of Homeland Security and known as the "E -Verify Program", or any successor electronic verification system that may replace the E -Verify Program. 5 City of Sanford f Finance Department J Purchasing Solicitation Division Number: CITY or r;K S ORD 300 N. Park Avenue 2"1 Floor Suite 236 Sanford, Florida 32771 Phone: 407.688.5028 or 5030 1 Fax: 407.688.5021 IRFQ 20/21-100 INFORMAL REQUEST FOR QUOTE (IRFQ) Due Date: FINANCE DEPARTMENT TERM CONTRACT November 24, 2020 MANHOLE RIM AND COVERS Project Name: Attachment "E" E -VERIFY'' COMPLIANCE AFFIDAVIT Manhole Rim and Covers Bid No.: IRFQ 20/21-100 The Affiant identified below attests to the following: That the Contractor is currently in compliance with and throughout the term of the above -identified project and will remain in compliance with Executive Order 11-02, issued by the Office of the Governor, State of Florida, requiring the use of the Department of Homeland Security's Status Verification ("E -Verify"} System to ensure that all employees of the Contract and the Contractor's subcontractors performing work under the above -listed Contract are legally permitted to work in the United States. 2. Each Contractor that performs work under the Project referenced above shall provide the City of Sanford, Florida, a copy of the "Edit Company Profile" screen indicating enrollment in the E -Verify Program. 3. The Contractor will register and participate in the work status verification for all newly hired employees of the contractor and for all subcontractors performing work on the above -listed Contract. 4. The Contractor agrees to maintain records of its compliance with the verification requirements as outlined in this Affidavit and, upon request of the any Authority having jurisdiction over the Project, including, but not limited to, the State of Florida, agrees to provide a copy of each such verification to that Authority. 5. That all persons assigned by the Contractor or its subcontractors to perform work under the above -identified project will meet the employment eligibility requirements as established by the Federal Government and the government of the State of Florida. 6. That the Contractor understands and agrees that its failure to comply with the verification requirements as set forth herein or its failure to ensure that all employees and subcontracts performing work under the above -identified project are legally authorized to work in the United States and the State of Florida constitute a breach of contract for which the City of Sanford may immediately terminate the Contract without notice and without penalty. Contractor further understands and agrees that in the event of such termination, the Contractor shall be liable to the City for any costs incurred by the City as a result of the Contractor's breach. 7. That for the purposes of this Affidavit, the following definitions apply: "Employee" — Any person who is hired to perform work in the State of Florida. "Status Verification System" — the procedures developed under the Illegal Immigration Reform and Immigration Responsibility Act of 1496, operated by the Department of Homeland Security and known as the "E -Verify Program", or any successor electronic verification system that may replace the E -Verify Program. 5 Fortiline, Inc. d/b/a Fortiline Waterworks Contractor A C-1 Signature ffiant) Tina Long, Director, Employee Relations Printed or Typed Name and Title of Authorized Representative (Affiant) COUNTY OF Tarrant STATE OFT Texas Date 0 17 day of November -120 2020 before me, the undersigned Notary Public of the State of 9ho�ly appeared Tina Long whose names) is/are subscribed to the within instrument, and he/she/they acknowledge that he/she/they executed it. WITNESS my hand and official seal. He/She is personally known to me or has produced Drivers L!pepse, as identification. -^------c�-�-RO'BERT AP.N1111mr- X e 0 lb hil� jPtibl in NOTARY" STATE OF TEXAS I D is D I MY Gomm. Explre ) the County and State Aforementioned) PLEASE COMPLETE AND SUBMIT WITH YOUR IRFQ RESPONSE —Failure to submit this form may be grounds for disqualification of your submittal -w City of Sanford I Finance Department I Purchasing Solicitation Division Number: CITY OF 300 N. Park Avenue 201 Floor Suite 236 Sanford, Florida 32771 IRFQ 20/21-100 S,ki!4F0RD Phone: 407.688.5028 or 5030 1 Fax: 407.688.5021 INFORMAL REQUEST FOR QUOTE (IRFQ) Due Date: FINANCE DEPARTMENT TERM CONTRACT November 24, 2020 MANHOLE RIM AND COVERS Fortiline, Inc. d/b/a Fortiline Waterworks Contractor A C-1 Signature ffiant) Tina Long, Director, Employee Relations Printed or Typed Name and Title of Authorized Representative (Affiant) COUNTY OF Tarrant STATE OFT Texas Date 0 17 day of November -120 2020 before me, the undersigned Notary Public of the State of 9ho�ly appeared Tina Long whose names) is/are subscribed to the within instrument, and he/she/they acknowledge that he/she/they executed it. WITNESS my hand and official seal. He/She is personally known to me or has produced Drivers L!pepse, as identification. -^------c�-�-RO'BERT AP.N1111mr- X e 0 lb hil� jPtibl in NOTARY" STATE OF TEXAS I D is D I MY Gomm. Explre ) the County and State Aforementioned) PLEASE COMPLETE AND SUBMIT WITH YOUR IRFQ RESPONSE —Failure to submit this form may be grounds for disqualification of your submittal -w City of Sanford I Finance Department I Purchasing Solicitation Division Number: ,20/ 1 10] 300 N. Park Avenue 2n' Floor Suite 236 Sanford, Florida 32771 2 _ 0 CITY OF IRFQ 20/21-100 S.Iki4FORD Phone: 407.688.5028 or 5030 1 Fax: 407.688.5021 FINANCE DEPARTMENT INFORMAL REQUEST FOR QUOTE (IRFQ) Due Date: TERM CONTRACT November 24, 2020 MANHOLE RIM AND COVE' RS Attachment "V Americans With Disabilities Act Affidavit I By executing this Certification, the undersigned CONTRACTOR certifies that the information herein contained is true and correct and that none of the information supplied was for the purpose of defrauding the City of Sanford (CITY). The CONTRACTOR will not discriminate against any employee or applicant for employment because of physical or mental handicap in regard to any position for which the employee or applicant for employment is qualified. The CONTRACTOR agrees to comply with the rules, regulations and relevant orders issued pursuant to the Americans with Disabilities Act (AFA), 42 USC s. 12101 el seq. It is understood that in no event shall the CITY be held liable for the actions or omissions of the CONTRACTOR or any other party or parties to the Agreement for- failure to comply with the ADA. The CONTRACTOR agrees to hold harmless and indemnify the CITY, its agents, officers or employees from any and all claims, demands, debts, liabilities or causes of action of every kind or character, whether in law or equity, resulting from the CONTRACTOR's acts or omissions in connection with the ADA. Fortiline, Inc. d/b/a Fortiline Waterworks Contractor (Pt4�_f_ 11/17/2020 Signature of Authorized Representati e ffifiant) Date Tina Long, Director, Employee Relations Printed or Typed Name and Title of Authorized Representative (Affiant) COUNTY OF Tarrant STATE, Or I On this 17th day of November 20 2020, before me, the undersigned Notary Public of the State of HMAMS personally appeared Tina Long whose name(s) is/are subscribed to the within instrument, and he/she/they acknowledge that he/she/they executed it. WITNESS my hand and official seal. He/She is personally known to me or has produced drivers License as identification. --RTARWINE V'q P oj t. NoTARY P I P ZZ Uj A ota Public in and le C unty ai d State Aforementioned) SPATE 1E: 0 r T IE X 36, ID # 11398622 - '10 miss expires: MyCoinnI.r*T0G10-- mission expires: PLEASE COMPLETE AND SUBMIT WITH YOUR IRF, RESPONSE `'Failure to submit this form may be grounds for disqualification of your submittal`' 7 Attachment "G" Addendum Receipt Acknowledgement Certification The undersigned acknowledges receipt of the following addenda to the solicitation document(s) (Give number and date of each): Addendum No. None Dated: Addendum No. Dated: Addendum No. Dated: Addendum No. Dated: Addendum No. Dated: By the signature(s) below, I/we, the undersigned, as authorized signatory to commit the firm, certify that the information as provided in Attachment "G", Addendum Receipt Acknowledgement Certification, is truthful and correct at the time of submission. Bidder/Contractor Name: Mailing Address: Fortiline Inc.. DBA Fortiline Waterworks 2291 West Airport Blvd, Sanford, FL 32771 Telephone Number: 407-688-9191 Fax Number: 407-688-9180 E-mail Address: sheri.smith@fortiline.com Authorized Signatory Regional Bid Coordinator Sheri Smith Printed Name 11/20/20 Title Date FEIN: 57-0819190 PLEASE COMPLETE AND SUBMIT WITH YOUR IRFQ RESPONSE `Failure to submit this form may be grounds for disqualification of your submittal`' City of Sanford ( Finance Department ( Purchasing Solicitation Division Number: / CITY of { 1S.A.i!4FO 300 N. Park Avenue 2"' Floor Suite 236 Sanford, Florida 32771 Phone: 407.688.5028 or 5030 1 Fax: 407.688.5021 IRFQ 20/21-100 FINANCE DEPARTMENT - INFORIYIAL REQUEST FOR QUOTE (IRFQ) Due Date: TERM CONTRACT November 24, 2020 MANHOLE RIM AND COVERS Attachment "G" Addendum Receipt Acknowledgement Certification The undersigned acknowledges receipt of the following addenda to the solicitation document(s) (Give number and date of each): Addendum No. None Dated: Addendum No. Dated: Addendum No. Dated: Addendum No. Dated: Addendum No. Dated: By the signature(s) below, I/we, the undersigned, as authorized signatory to commit the firm, certify that the information as provided in Attachment "G", Addendum Receipt Acknowledgement Certification, is truthful and correct at the time of submission. Bidder/Contractor Name: Mailing Address: Fortiline Inc.. DBA Fortiline Waterworks 2291 West Airport Blvd, Sanford, FL 32771 Telephone Number: 407-688-9191 Fax Number: 407-688-9180 E-mail Address: sheri.smith@fortiline.com Authorized Signatory Regional Bid Coordinator Sheri Smith Printed Name 11/20/20 Title Date FEIN: 57-0819190 PLEASE COMPLETE AND SUBMIT WITH YOUR IRFQ RESPONSE `Failure to submit this form may be grounds for disqualification of your submittal`' C h N c E �i Z`o 0 `c V_ .m U W W no,o o E 0 E Jp' NguLL U- a) q NO m KKo c Erin � maw 0 CSN cu O = b vI (] m u a(q aOUCL -NM } ru z IdOue zw co p co W° o13 W -JXW-j WW c W < m3:-~ t - r" Co LL O OW o -j ZJ Z -i (.._.. mCry U O N • €LL7 0 w u " =Zg Q GWi QCL awl F- ;Zi U %i �.er �.► C h N c E �i Z`o 0 `c V_ .m U W W no,o o E 0 E Jp' NguLL U- a) q NO m KKo c Erin � maw 0 CSN cu O = b vI (] m u a(q aOUCL -NM } • ° ox= amu, • u " C h N c E �i Z`o 0 `c V_ .m U W W no,o o E 0 E Jp' NguLL U- a) q NO m KKo c Erin � maw 0 CSN cu O = b vI (] m u a(q aOUCL -NM } AC" R" CERTIFICATE OF LIABILITY INSURANCE FDATE 11/16/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Arthur J. Gallagher Risk Management Services, Inc. Park 7 12750 Merit Drive, Suite 1000 CONTACT NAME: Matt Banker PHONE FAX Alc , 972 813-2160 A/c No): 972 991-4061 ADORess: matt banker@ajq.com INSURERS AFFORDING COVERAGE NAIC # Dallas TX 75251 INSURER A: Travelers Property Casualty Co of America 25674 OGLG4666484A INSURED MORSINC-01 INSURER B: ACE American Insurance Company 22667 M Inc. Namedmeed Insured Continued See Attached In INSURER C : ACE Property & CasualtyInsurance Co 20699 INSURER D: 15850 Dallas Parkway, Suite 210 INSURER E: Addison TX 75248 INSURER F: COVERAGES CERTIFICATE NUMBER: 1325619533 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL SUER POLICY NUMBER MMILDD/YYVY POLICY LIMITS B X COMMERCIAL GENERAL LIABILITY OGLG4666484A 4/30/2020 4/30/2021 EACH OCCURRENCE $1,000,000 CLAIMS -MADE FKOCCUR DAMAGE TRENTED PREMISES Ea occurrence $100,000 MED EXP (Any one person) S5,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 �POLICY � JECT LOC PRODUCTS-COMP/OPAGG $2,000,000 $ OTHER: A AUTOMOBILE LIABILITY TC2J-CAP-5H600032-20 4/30/2020 4/30/2021 COMBINED SINGLE LIMIT $2,000,000 Ea accident BODILY INJURY (Per person) S X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) S PROPERTY DAMAGE $ Per accident HIRED NON -OWNED AUTOS ONLY AUTOS ONLY S X UMBRELLA LIAB X OCCUR XOO 646664887 4/30/2020 4/30/2021 EACH OCCURRENCE $ 4,000,000 AGGREGATE $ 4,000,000 EXCESS LIAB CLAIMS -MADE DED X RETENTIONS non S FAC WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOR/PARTNER/EXECUTIVEN FN I UB -1L155252 -20-51-K 4/30/2020 4/30/2021 X I PER OTH- STATUTE ER E.L. EACH ACCIDENT S1,000,000 OFFICER/MEMBER EXCLUDED? /A E.L. DISEASE - EA EMPLOYEE $1,000,000 (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) FULL NAMED INSURED SCHEDULE ATTACHED General Liability policy includes BLANKET ADDITIONAL INSURED under policy forms CG 20 10 04-13 / CG 20 37 04-13 / CG 20 11 04-13 / CG 20 15 04-13 General Liability policy includes BLANKET WAIVER OF SUBROGATION under Policy form CG 24 04 12 19 General Liability policy includes Primary and Noncontributory under Policy form CG 20 01 12-19 Automobile Liability policy includes BLANKET ADDITIONAL INSURED under Policy form CA T4 37 02 16 Automobile Liability policy includes BLANKET WAIVER OF SUBROGATION Policy Form CA T3 40 02 15 See Attached... CERTIFICATE HOLDER CANCELLATION ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Sanford 300 N. Park Avenue AUTHORIZED REPRESENTATIVE �� /!tt vav tN Sanford FL 32771 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: MORSINC-01 Ul 9 -11 H rel LOC #: Page i of 1 AGENCY NAMED INSURED Arthur J. Gallagher Risk Management Services, Inc. MORSCO, Inc. Named Insured Continued See Attached 15850 Dallas Parkway, Suite 210 POLICY NUMBER Addison TX 75248 CARRIER NAIC CODE EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Automobile Liability policy includes Primary and Non -Contributory under Policy Form CA T4 74 02 16 Compensation policy includes BLANKET WAIVER OF SUBROGATION under Policy Form WC 00 03 13(00) - 001 Umbrella Policy is Follow Form to the General Liability, Automobile Liability and Workers Compensation policies shown on this certificate of insurance. RE: IRFQ 20121-100 Manhole Rim and Covers litional Insured status applies to City of Sanford on a Primary and Non -Contributory basis on the above liability policies where required by written contract per above and included endorsements. ACORD 101 (2008/01) @ 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD MORSCO, Inc. DeVore & Johnson Eagle Underground Utility Supply, Inc Express Pipe & Supply Express Pipe & Supply Co. LLC Expressions Home Gallery Farnsworth Wholesale Supply Fortiline, Inc. Fortiline, LLC FWC Supply FWC Supply, LLC Kiva Kitchen & Bath Mainline Holding Company, LLC Mainline Supply of Asheville, LLC Mainline Supply of Atlanta, LLC Mainline Supply of Charlotte, LLC Mainline Supply of Florida, LLC Mainline Supply of Greensboro, LLC Mainline Supply of Greenville, LLC Mainline Supply of Jonesboro, LLC Mainline Supply of South Carolina, LLC Mainly Supply Company, Inc. (old pipeline) Morrison Supply Company Morrison Supply Company, LLC MSC Waterworks Company Inc _ MSC Waterworks LLC MSC Waterworks of Atlanta, LLC Murray Supply Company Patriot Supply Holdings, Inc Patriot Supply Intermediate, Inc Pipeline Sales, LLC Pipeline Supply Company, LLC PSCI Acquisition Corporation LWholesale Specialities WS Supply WS Supply, LLC Mainline Holding Company, Profit Sharing MORSCO HVAC Supply dba Busch Supply Morrison Supply Company, LLC dba Builders Discount Appliance Mart Morrison Supply Company, LLC dba American Supply Company 1 Morrison Supply Company, LLC, Express Pipe & Supply Co., LLC and FWC Supply, LLC dba Expressions Home Gallery Morrison Supply Company, LLC and Express Pipe & Supply Co., LLC dba Kiva Kitchen and Bath Morrison Supply Company, LLC dba Empire Plumbing Supply Morrison Supply Company, LLC dba EP Supply Morrison Supply Company, LLC dba Dixie Utility Supply Morrison Supply Company, LLC Western Wholesale Supply Co Morrison Supply Company, LLC dba Murray Supply Company Morrison Supply Company, LLC Devore & Johnson WS Supply, LLC dba Wholesale Specialities WS Supply, LLC dba Farnsworth Wholesale Supply Mainline Holding Company, LLC Morrison Supply Company LLC, DBA American Supply Mainly Supply Company, Inc. (Old Pipeline) Eagle Underground Utility Supply, Inc. Pipeline Sales, LLC PSCI Acquisition Corporation Pipeline Supply Company, LLC MSC Waterworks, LLC MSC Waterworks Company, Inc. MSC Waterworks of Atlanta, LLC Devore & Johnson Express Pipe & Supply Expressions Home Gallery Todd Pipe Holdings, Inc. LegendMRO, LLC Todd Pipe & Supply, LLC MORSCO Supply, LLC d/b/a Reece Plumbing MORSCO Supply, LLC d/b/a Reece HVAC Fortiline Inc., d/b/a Reece Waterworks Fortiline Inc., d/b/a Fortiline Waterworks 4