HomeMy WebLinkAboutPK10-148 - Original - Crystal Springs - Service Club Ballfields Water Service - 06/07/2010 Records Marragement.
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KENT Document
WASH IN GTOH + �
CONTRACT COVER SHEET
This is to be completed by the Contract Manager prior to submission
to City Clerks Office. All portions are to be completed.
If you have questions, please contact City Clerk's Offices.
Vendor Name: �) J
Vendor Number: 2 (0o 3 )- I
ID Edwards Number
Contract Number:
This is assigned by City Clerk's Office
Project Name: 2 irV t C12
Description: ❑ Interlocal Agreement ❑ Change Order ❑ Amendment dcontract
❑ Other: '1 p
Contract Effective Date: I I ® I Termination Date:
Contract Renewal Notice (Days):
Number of days required notice for termination or renewal or amendment
. I
Contract Manager.Cv S�a1 r Department: Va IGS
Detail: (i.e. address, location, parcel number, tax id, etc.):
q� ,0 E 2 � 8 '3z--'+.
A 9 oq
S•Publlc\RecordsManagement\Forms\ContractCover\adcc7832 11/08
DS Waters of America, Inc. • 1-800-4-WATERS 1856761
4170 Tanners Creek Dr., Flowery Branch, GA 30542
SERVICE AGREEMENT
�ffi® cA'�"y' . w•.e�.-' ( cP:110
aphable 1
4. Products & Equipment
brand (Selection varies by market)
�g�sm cPr nys Standard Budget Plan ElKomen Budget Plan
Includes dispenser(s) Indicated below, if applicable, and
of the products Indicated below each billing period
(quantity)
Authorized Company Signature Date Oracle No at$ per billing period
! r See reverse side for more Information
Account # F, �� f J �-� —
PRODUCTS
Bill to # l!K5-Gal at $ /bottle
(quantry) (type)
_ El 3-Gal / at $ /bottle
Associate i(A",e�i Rte. # �2 q�antay) (type)
❑ 1/2-Gal / at$ /case
(Include ID illiquannTy) (Type)
(The following sections are to be completed by Associate) ❑ 1/2-Liter / at $ /case
(quantity) (type)
Customer1. ❑ Pkgd Wtr_/ / at $ /case
(sae) (quantayq (type)
❑ Residential ❑ Commercial ❑ Cups / at $ /
(size) (type) lance) (quantity)
Name ` ' Cal t ti ❑ Other / at $ /uantrt
Service Address it yet D 5 �e % O (type) (price)
DISPENSERS
yy Apt/Ste )^ - .Rm Temp/Cold(Flr-Ctr), i` $ .it /invoice
City 4.�1�\ Stated -� YV Zip Code (circle one) (quantity)
Previous Address Apt/Ste Hot/Cold (Flr-Ctr), $ /invoice
(circle one) (quantity)
(If less than one year) _ Crock, $ /Invoice
City State_ Zip Code (quantity)
Home Work Dispenser Serial No(s)
Phone Phone O '}/� ! 7 a
E-mail address C FILTRATION SERVICE
Filtration Reverse Osmosis
❑ Please send my invoices to the email address above Under Counter System
SS# — — DOB */T /
� U81 ouskiffirill rA,,� _ Bottleless Cooler
Tax ID # Photo ID Verif Type Other
(for commercial customers)
2. Payment Information $ /invoice
Payment Method L Check Cash I I Credit Card Debit Card $ Installation Fee
Type of Credit/Debit Card. ❑ MC C Visa `Am Ex Li Discover Equipment Serial No(s)
Credit/Debit Card # - - _ ❑COFFEE SERVICE & EQUIPMENT
Expiration Date Coffee_ / quantav) (sae) $(type) (price)
Amount Received $ Equipment $ /invoice
(quantity) (type)
❑ Recurring Credit/Debit Card Payment Equipment $ /invoice
❑ One-Time Credit/Debit Card Payment (quantity) (type)
Credit/Debit Card Authorization #
Equipment Serial No(s).
(As it appears on credit/debit card)
Name The prices set forth in Section 4 above exclude applicable tax.
Billing Address Bottle Deposits: A $ deposit may be charged
an each returnable bottle delivered. Bottle deposits are
Apt/Ste. refunded upon return of all empty bottles in good condition.
City State_ Zip Code (See Section 4 on reverse side.)
Energy Surcharge: A variable Energy Surcharge may
3. Initial Term of Agreement be applied per billing period during the term of this
(Check all that apply) Agreement. (See Section 4 on reverse side.)
Ll 1 Year ❑ Period-to-Period Cancellation Fee: Up to$100.00 (See Section 2 reverse side.)
❑ Dispenser Rental &Water Service Late Fee: See Section 4 on reverse side.
❑ Water Service ❑Coffee Service Returned Check/Debit Card Fee: $25.00 per returned
L Filtration Service check/debit card (See Section 4 on reverse side.)
El Promotion Code: See reverse for additional information on deposits and fees
Important Terms and Conditions. Read Before Signing.
SEE ADDITIONAL TERMS AND CONDITIONS ON THE REVERSE SIDE
You acknowledge that you are the Customer or person authorized by the Customer to accept the terms and conditions of this Agreement You authorize
DS Waters of America, Inc ("DSW")to obtain your consumer credit report to determine your credit worthiness, and you understand and acknowledge
DSW may report information about your DSW account to credit bureaus and similar Institutions You acknowledge that you received a copy of this
Agreement,and you agree to the terms and conditions above and on the reverse side.
Print Customer or Customer Representative's Name '<'' ' 4 Title
( (for commercial customers)
Customer or Customer Representative's Signature _ Date '7
You may cancel this Agreement at anytime prior to midnight of the third business day from the date of execution of this Agreement
without incurring any penalty or fee.See the attached DSW Notice of Cancellation form for an explanation of this right.
CUSTOMER COPY Page 1 of 2
DS WATEAS OF AMERICA, INC. (DSW)SERVICE AGREEMENT(Agreement)
TERMS AND CONDITIONS
1. Water/Coffee Delivery and Dispenser Rental. "Customer," disuensers and equipment delivered by us to you Under no
"you," and your" mean the person who signed this contract as circumstances shall we be liable to you or any other party for
the Customer "We," "us," and "our" mean DSW We will provide any monetary damages in connection with this Agreement or
the products and services described in Section 4 on the front the products or services provided by us Any monetary liability
page of this Agreement on the terms and conditions set out in this imposed on us shall be limited to the lesser of actual damages or
Agreement Bottles, dispensers and equipment are our property, an amount equal to payments made by you in the three (3) billing
and payments do not apply toward the purchase of the dispenser periods preceding such assessment of liability You assume the
or equipment You will agree to follow our ordering and delivery risk of loss, damage or destruction of all bottles, dispensers and
procedures and take good care of all bottles, dispensers and equipment in your possession You are responsible for any and all
equipment in your possession You will not permit anyone other claims, damage, injury or liability incurred by you arising from your
than us to repair or alter dispensers or equipment without our use of bottles dispensers, or equipment You indemnify and hold
consent in writing us harmless in respect of any and all claims, damage, injury, cost,
2. Term/Cancellation. A period means DSW's standard billing liability, expense (including reasonable attorneys' fees) or other
period of approximately 28 days This Agreement begins on the loss suffered or incurred by us in connection with this Agreement
date of your first delivery and set-up and continues for 1 year (the You acknowledge that water/coffee can damage surfaces and that
Initial Term), or, if indicated in Section 3 on the front page of this leaks may occur You are responsible for selecting the location
Agreement, from penod-to-period Upon expiration of the Initial for placement of bottles, dispensers or equipment and have full
Term, if applicable, this Agreement automatically shall renew on responsibility for any damage or loss that occurs You acknowledge
a penod-to-penod basis (the Renewal Term) You may cancel that installation,use or removal of bottles,dispensers or equipment
this Agreement at any time by providing written notice to us at is your responsibility and may change your personal property,
least one full period prior to the desired cancellation date If you home or office All filtration equipment is intended to be used
cancel this Agreement before the end of the Initial Term, to improve the quality of safe and potable, non-infectious, non-
we may charge you an early cancellation fee of $100. polluted drinking water You acknowledge that proper cleaning
If you cancel this Agreement during the Renewal Term and maintenance of bottles, dispensers or equipment (including
(or at any time if the term of this Agreement is period- filtration equipment) is your responsibility and that failure to
to-period), we may charge you an administration fee of properly clean and maintain such equipment may lead to personal
$35 per unit of equipment. Within fourteen(14) da;s following injury We are not responsible or liable for any costs, expenses,
any cancellation of this Agreement, you agree to return all bottles, claims or other liability related to any damage, loss or change
dispensers and equipment in good condition, normal wear and tear to your personal property, home or office, or for any personal
excepted, to your Route Sales Representative injury to you or any other person, resulting from the installation,
3. Payments. You will pay us for (i) all products, services and maintenance, use or removal of bottles, dispensers or equipment
equipment delivered under this Agreement, plus applicable tax, (including filtration equipment) DSVV shall not be liable to you
and(u)the dispenser rental fee, plus applicable tax,and(m)all other for any damage, loss or non-performance caused by government
fees and charges as provided in this Agreement These amounts action, war, fire, explosion, flood, strike, lockout, embargo, act of
are due by the date specified on each invoice If you choose God or any similar cause beyond the control of DSW
to pay by credit or debit card, you authorize as to automatically 7. Notices. All notices must be in writing and delivered by U S
withdraw payment for service on a recurring basis, and to place mad, certified mad or personal delivery or facsimile with written
a $50 refundable hold charge against your credit or debit card confirmation of receipt to the Customer address and to DSW at the
account. You may request to change your method of payment by address shown on the front of this Agreement You agree to notify
providing written notice to DSW Customer Service Subject to DS DSW promptly of a change in your address
Waters credit standards In some instances, you may be required 8. Dispute Resolution.You will first attempt to resolve any dispute
to provide an advance payment of$50 wnich will be applied toward with DSW arising out of this Agreement using good faith efforts
your initial service and installation to negotiate a resolution Any dispute that remains unresolved
4. Fees. You also agree to pay the following fees: a late for forty-five (45) days shall be resolved either in Small Claims
fee in an amount up to the maximum allowable by law will Court or through binding arbitration before a neutral arbitrator in
be charged for any payment which is past the payment accordance with the Commercial Dispute Resolution Procedures
due date (Maryland customers will be charged a late and Supplementary Procedures for Consumer-Related Disputes
fee of 1.5% of the amount in default); a returned check/ of the American Arbitration Association ("AAA') Any arbitration
debit card fee of$25 for any check or debit card that is shall be held in the largest city by population in your state of
returned unpaid; a replacement fee for any dispenser, residence or as mutually agreed in writing by the parties, with
coffee equipment, or related equipment that is lost or no right to jury trial and only limited judicial review according to
damaged while in your possession, normal wear and applicable arbitration statutes If there is an arbitration you may
tear excepted; a bottle deposit in the amount set forth be represented by counsel of your choice, at your expense, and
on the front page of this Agreement,which is refundable, you will be responsible for your share of AAA and arbitrator fees as
subject to the return of empty bottles in good condition, set forth in the Supplementary Procedures for Consumer-Related
normal wear and tear excepted. We reserve the right to Disputes
charge a variable Energy Surcharge per billing period, 9. Personal Information. You agree that DSW may use the
based on the Monthly U.S, Average On-Road Diesel personal information disclosed in Section 1 on the front page of this
Price as published by the U.S. Department of Energy, Agreement to improve our products and service to you You agree
Energy Information Administration. For details, go to that DSW may use your personal information to contact you and
http://www.water.com/energysurcharge. deliver information to you that may be targeted to your interests,
5 Default. You will be in default of this Agreement if you fad to such as special product and service offerings If you do not wish to
make a payment when due or fail to comply with any other term of receive these communications, or if you have questions regarding
this Agreement If you are in default, and do not cure the default DSW's use of your personal information, contact Customer
within the time period specified in our notice, we may cancel this Service by e-mail at customerser�, atercom or by calling
Agreement and demand immediate payment of the entire unpaid 1-800-492-8377
balance due, together with an early cancellation fee of $100, or 10. General. We may change the terms of this Agreement at any
an administration fee of $35 per unit of equipment if the term of time, upon prior written notice to you If you do not consent to the
this Agreement is period-to-period In the event of an uncured change,you will notify us to cancel your service in accordance with
default, we also reserve the right to cease delivery of bottled water this Agreement The terms of this Agreement may only be waived
and/or coffee and you agree to immediately return the dispenser, or amended in writing Failure or delay in exercising any right will
equipment and bottles to the Route Sales Representative You not be a waiver We may assign this Agreement and any of its
agree to pay all costs, including attorneys' fees and collection rights under it to a third party without notice You may not assign
costs, incurred by us in connection with your default or the exercise this Agreement and any such assignment will be null and void If
of our remedies, to the maximum extent permitted by law any provision of this Agreement is held invalid or unenforceable,
6. Liability. DSW DISCLAIMS ANY AND ALL EXPRESS OR all other provisions will remain in full force and effect THIS
IMPLIED WARRANTIES UNDER THIS AGREEMENT Our total AGREEMENT IS GOVERNED BY THE LAWS OF THE STATE OF
liability shall be limited to repairing or replacing defective bottles, GEORGIA.
MASTER-SA-ALL(10/2009) Page 2 of 2
DS Waters of America, Inc. • 1-800-4-WATERS 1856761
4170 Tanners Creek Dr., Flowery Branch,GA 30542
SERVICE AGREEMENT
NOTICE OF CANCELLATION
A 111�° cN'�"y' s.,vnvo.•,�� 1 Cincle 1
�apphcable I
" brand I
HI terry S�lCtts-
C You may cancel this Agreement, without any
Authorized Company Signature bath Oracle No penalty or fee, prior to midnight of the third
business day from the date of execution of this
Account# — — Agreement. If you cancel, any payments made
Bill to by you under this Agreement (less any amounts
for water opened, used or consumed) will be
_ returned to you within ten (10) business days
Associate Rte. # �Iob following receipt by DS Waters of America, Inc.
(include to#) (DSW) of your Notice of Cancellation.
(The following sections are to be completed by Associate)
Customer1. If you cancel, you must make available to DSW
❑ Residential ❑ Commercial at your service address, in the same condition
as when received, any goods delivered to you
Name T Y. U i # under this Agreement (less water opened,
Service Address D 5F -6 I used or consumed), or you may comply with
the instructions of DSW regarding the return
Apt./Ste., _._ shipment of the goods at the risk and expense
City State_ Zip Code of DSW.
Previous Address Apt/Ste. If DSW does not pick up the goods within
(If less than one year)
twenty (20) days of receiving your Notice of
City State_ Zip Code Cancellation, you may retain or dispose of the
Home Work
Phone Phone cn3 goods without any further obligation. If you fail
to make the goods available to DSW, you will
E-mail address remain liable for performance of all obligations
under this Agreement.
To cancel this Agreement,mail or deliver a signed
and dated copy of this Notice of Cancellation to
DSW at the address shown at the top of this
Agreement, not later than midnight on the third
business day after the date of your first delivery
and set-up.
PLEASE RETAIN A COPY OF THIS NOTICE OF
CANCELLATION FOR YOUR RECORDS.
I HEREBY CANCEL THIS AGREEMENT.
Customer Signature Date
CUSTOMER COPY
DS Waters of America,Inc. • 1-800-4-WATERS 18 8 b,.
4170 Tanners Creek Dr.,Flowery Branch,GA 30542
SERVICE AGREEMENT
NOTICE OF CANCELLATION
ryI�1Rqy JAM.
,
m 6iY/NOS•� uB � y Cr Ole
�apphc d
#"f\ brand
r, s so'tts•
! t You may cancel this Agreement, without any
Authorized Company Signature Date Oracle No penalty or fee, prior to midnight of the third
business day from the date of execution of this
Account# — — Agreement. If you cancel, any payments made
Bill to # by you under this Agreement (less any amounts
for water opened, used or consumed) will be
returned to you within ten (10) business days
Associate `1 f Rte # following receipt by DS Waters of America, Inc.
(Include ID#(
(DSW) of your Notice of Cancellation.
(The following sections are to be completed by Associate)
Customer1. If you cancel, you must make available to DSW
❑ Residential ❑ Commercial at your service address, in the same condition
as when received, any goods delivered to you
Name i - '` under this Agreement (less water opened,
Service Address U used or consumed), or you may comply with
the instructions of DSW regarding the return
Apt/Ste.- shipment of the goods at the risk and expense
City State_ Zip Code of DSW.
Previous Address Apt/Ste. If DSW does not pick up the goods within
(If less than one year)
twenty (20) days of receiving your Notice of
City State_ Zip Code Cancellation, you may retain or dispose of the
Home Work -
Phone Phone (� ��' 7� goods without any further obligation. If you fail
to make the goods available to DSW, you will
E-mail address remain liable for performance of all obligations
under this Agreement.
To cancel this Agreement,mail or deliver a signed
and dated copy of this Notice of Cancellation to
DSW at the address shown at the top of this
Agreement, not later than midnight on the third
business day after the date of your first delivery
and set-up.
PLEASE RETAIN A COPY OF THIS NOTICE OF
CANCELLATION FOR YOUR RECORDS.
I HEREBY CANCEL THIS AGREEMENT.
Customer Signature Date
DSW COPY