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Records Manvageme-
11
ZKENT
WASHINGTON Document
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 Office.
Vendor Name: Airgas-Norpac, Inc.
Vendor Number:
JD Edwards Number
Contract Number: p(.4-)i 1 - o o d-,
This is assigned by City Clerk's Office
Project Name: 2011 Water Treatment Chemicals
Description: ❑ Interlocal Agreement ❑ Change Order ❑ Amendment ® Contract
❑ Other:
Contract Effective Date: Date of the Mayor's signatureTermination Date:
Contract Renewal Notice (Days):
Number of days required notice for termination or renewal or amendment
Contract Manager: Sean Bauer Department: PW Operations
Detail: (i.e. address, location, parcel number, tax id, etc.):
Termination of the Goods and Services Agreement which was executed on 12/17/10_�
S.Pubiic\Records Management\Forms\ContractCover\a dcc7832 1 11/08
MUTUAL TERMINATION OF AGREEMENT
THIS AGREEMENT is made by and between the City of Kent, a Washington
municipal corporation (hereinafter the "City"), and Airgas-Norpac, Inc., a Delaware
corporation (hereinafter '1Airgas-Norpac"), organized under the laws of the State of
Washington, hereinafter collectively known as the "Parties."
The Parties hereby agree to terminate the Goods & Services Agreement (the
"Agreement"), entered into between the City and Airgas-Norpac on December 17,
2010 (which is attached and incorporated herein as Exhibit A), and that such
Agreement is null and void.
IN WITNESS, the Parties below execute this Agreement, which shall become
effective on the last date entered below.
Airgas-Norpac City of Kent
Pnn Name: G /`1-1 int e: Suzette Cooke
Its: Sao o p1 Its: M or
Date: D
n\Clvll\Flea\Open Files\0177-2010 public Works General\Mutual Termimdon of Agreement-Almas-Norpac docx
Mutual Termination of Agreement - 1
City of Kent and Airgas-Norpac
EXHIBIT A
400
KENT
W n 5 H I N G T O N
GOODS & SERVICES AGREEMENT
between the City of Kent and
-Air asNor ac
9 P
THIS AGREEMENT is_made by and between the City of Kent, a Washington municipal
corporation (hereinafter the "City"), and Airgas-Norpac organized under the laws of the State of
Washington, located and doing business at 22001 68th Ave. S., Kent, WA 98032, Phone: (253)
872-8664/Fax. (253) 872-5274, Contact: Steve Gettmann (hereinafter the "Vendor").
AGREEMENT
I. DESCRIPTION OF WORK.
Vendor shall provide the following goods and materials and/or perform the following
services for the City:
The Vendor shall supply the City of Kent Water Department with water treatment
chemicals (bid items 1 - 5) according to the bid proposal submitted November 23,
2010, which is attached as Exhibit A and incorporated by this reference.
Vendor acknowledges and understands that it is not the City's exclusive provider of these
goods, materials, or services and that the City maintains its unqualified right to obtain these
goods, materials, and services through other sources.
II. TIME OF COMPLETION. Upon the effective date of this Agreement, Vendor shall
complete the work and provide all goods, materials, and services by December 31, 2011.
III. COMPENSATION. The City shall pay the Vendor an amount not to exceed Ten
Thousand, Nine Hundred Ninety Dollarws ($10,990.00), including applicable Washington State
Sales Tax, for the goods, materials, and services contemplated in this Agreement. The City shall
pay the Vendor the following amounts according to the following schedule:
Delivery will be scheduled upon execution of this agreement. Vendor shall be paid
after submittal of invoice.
GOODS & SERVICES AGREEMENT - 1
(Over$10,000.00, including WSST)
If the City objects to all or any portion of an invoice, it shall notify Vendor and reserves
the option to only pay that portion of the invoice not in dispute. In that event, the parties will
nmediately make every effort to settle the disputed portion.
A. Defective or Unauthorized Work. The City reserves its right to withhold payment
from Vendor for any defective or unauthorized goods, materials or services. If
Vendor is unable, for any reason, to complete any part of this Agreement, the City
may obtain the goods, materials or services from other sources, and Vendor shall
be liable to the City for any additional costs incurred by the City. "Additional costs"
shall mean all reasonable costs, including legal costs and attorney fees, incurred by
- — - the City beyond the maximum Agreement price specified above. The City further -
reserves its right to deduct these additional costs incurred to complete this
Agreement with other sources, from any and all amounts due or to become due the
Vendor.
B. Final Payment: Waiver of Claims. VENDOR'S ACCEPTANCE OF FINAL PAYMENT
SHALL CONSTITUTE A WAIVER OF CLAIMS, EXCEPT THOSE PREVIOUSLY AND
PROPERLY MADE AND IDENTIFIED BY VENDOR AS UNSETTLED AT THE TIME
REQUEST FOR FINAL PAYMENT IS MADE.
IV. INDEPENDENT CONTRACTOR. The parties intend that an Independent
Contractor-Employer Relationship will be created by this Agreement. By their execution of this
Agreement, and in accordance with Ch. 51.08 RCW, the parties make the following
representations:
A. The Vendor has the ability to control and direct the performance and details
of its work, the City being interested only in the results obtained under this
Agreement.
B. The Vendor maintains and pays for its own place of business from which
Vendor's services under this Agreement will be performed.
C. The Vendor has an established and independent business that is eligible for a
business deduction for federal income tax purposes that existed before the
City retained Vendor's services, or the Vendor is engaged in an
independently established trade, occupation, profession, or business of the
same nature as that involved under this Agreement.
D. The Vendor is responsible for filing as they become due all necessary tax
documents with appropriate federal and state agencies, including the Internal
Revenue Service and the state Department of Revenue.
E. The Vendor has registered its business and established an account with the
state Department of Revenue and other state agencies as may be required
by Vendor's business, and has obtained a Unified Business Identifier (UBI)
number from the State of Washington.
F. The Vendor maintains a set of books dedicated to the expenses and earnings
of its business.
GOODS & SERVICES AGREEMENT - 2
(Over$10,000.00, including WSST)
V. TERMINATION. Either party may terminate this Agreement, with or without
cause, upon providing the other party thirty (30) days written notice at its address set forth on
the signature block of this Agreement.
VI. CHANGES. The City may issue a written amendment for any change in the goods,
materials or services to be provided during the performance of this Agreement. If the Vendor
determines, for any reason, that an amendment is necessary, Vendor must submit a written
amendment request to the person listed in the notice provision section of this Agreement,
section XIV(D), within fourteen (14) calendar days of the date Vendor knew or should have
known of the facts and events giving rise to the requested change. If the City determines that
the change increases or decreases the Vendor's costs or time for performance, the City will
make an equitable adjustment. The City will attempt, in good faith, to reach agreement with the -
Vendor on all equitable adjustments. However, if the parties are unable to agree, the City will
determine the equitable adjustment as it deems appropriate. The Vendor shall proceed with the
amended work upon receiving either a written amendment from the City or an oral order from
the City before actually receiving the written amendment. If the Vendor fails to require an
amendment within the time allowed, the Vendor waives its right to make any claim or submit
subsequent amendment requests for that portion of the contract work. If the Vendor disagrees
with the equitable adjustment, the Vendor must complete the amended work; however, the
Vendor may elect to protest the adjustment as provided in subsections A through E of Section
VII, Claims, below.
The Vendor accepts all requirements of an amendment by: (1) endorsing it, (2) writing a
separate acceptance, or (3) not protesting in the way this section provides. An amendment that
is accepted by Vendor as provided in this section shall constitute full payment and final
settlement of all claims for contract time and for direct, indirect and consequential costs,
icluding costs of delays related to any work, either covered or affected by the change.
VII. CLAIMS. If the Vendor disagrees with anything required by an amendment,
another written order, or an oral order from the City, including any direction, instruction,
interpretation, or determination by the City, the Vendor may file a claim as provided in this
section. The Vendor shall give written notice to the City of all claims within fourteen (14)
calendar days of the occurrence of the events giving rise to the claims, or within fourteen (14)
calendar days of the date the Vendor knew or should have known of the facts or events giving
rise to the claim, whichever occurs first . Any claim for damages, additional payment for any
reason, or extension of time, whether under this Agreement or otherwise, shall be conclusively
deemed to have been waived by the Vendor unless a timely written claim is made in strict
accordance with the applicable provisions of this Agreement.
At a minimum, a Vendor's written claim shall include the information set forth in
subsections A, items 1 through 5 below.
FAILURE TO PROVIDE A COMPLETE, WRITTEN NOTIFICATION OF CLAIM
WITHIN THE TIME ALLOWED SHALL BE AN ABSOLUTE WAIVER OF ANY
CLAIMS ARISING IN ANY WAY FROM THE FACTS OR EVENTS
SURROUNDING THAT CLAIM OR CAUSED BY THAT DELAY.
A. Notice of Claim. Provide a signed written notice of claim that provides the following
information:
1. The date of the Vendor's claim;
2. The nature and circumstances that caused the claim;
GOODS & SERVICES AGREEMENT - 3
(Over$10,000.00, Including WSST)
3. The provisions in this Agreement that support the claim;
4. The estimated dollar cost, if any, of the claimed work and how that
estimate was determined; and
5. An analysis of the progress schedule showing the schedule change or
disruption if the Vendor is asserting a schedule change or disruption.
B. Records. The Vendor shall keep complete records of extra costs and time incurred
as a result of the asserted events giving rise to the claim. The City shall have
access to any of the Vendor's records needed for evaluating the protest.
The City will evaluate all claims, provided the procedures in this section are
followed. If the City determines that a claim is valid, the City will adjust payment--
for work or time by an equitable adjustment. No adjustment will be made for an
invalid protest.
C. Vendor's Duty to Complete Protested Work. In spite of any claim, the Vendor shall
proceed promptly to provide the goods, materials and services required by the City
under this Agreement.
D. Failure to Protest Constitutes Waiver. By not protesting as this section provides,
the Vendor also waives any additional entitlement and accepts from the City any
written or oral order (including directions, instructions, interpretations, and
determination).
E. Failure to Follow Procedures Constitutes Waiver. By failing to follow the procedures
of this section, the Vendor completely waives any claims for protested work and
accepts from the City any written or oral order (including directions, instructions,
interpretations, and determination).
VIII. LIMITATION OF ACTIONS. VENDOR MUST, IN ANY EVENT, FILE ANY LAWSUIT
ARISING FROM OR CONNECTED WITH THIS AGREEMENT WITHIN 120 CALENDAR DAYS FROM
THE DATE THE CONTRACT WORK IS COMPLETE OR VENDOR'S ABILITY TO FILE THAT SUIT
SHALL BE FOREVER BARRED. THIS SECTION FURTHER LIMITS ANY APPLICABLE STATUTORY
LIMITATIONS PERIOD.
IX. WARRANTY. This Agreement is subject to all warranty provisions established
under the Uniform Commercial Code, Title 62A, Revised Code of Washington. Vendor warrants
goods are merchantable, are fit for the particular purpose for which they were obtained, and will
perform in accordance with their specifications and Vendor's representations to City. The Vendor
shall correct all defects in workmanship and materials within one (1) year from the date of the
City's acceptance of the Contract work. In the event any part of the goods are repaired, only
original replacement parts shall be used—rebuilt or used parts will not be acceptable. When
defects are corrected, the warranty for that portion of the work shall extend for one (1) year
from the date such correction is completed and accepted by the City. The Vendor shall begin to
correct any defects within seven (7) calendar days of its receipt of notice from the City of the
defect. If the Vendor does not accomplish the corrections within a reasonable time as
determined by the City, the City may complete the corrections and the Vendor shall pay all costs
incurred by the City in order to accomplish the correction.
X. DISCRIMINATION. In the hiring of employees for the performance of work under
phis Agreement or any sub-contract, the Vendor, its sub-contractors, or any person acting on
behalf of the Vendor or sub-contractor shall not, by reason of race, religion, color, sex, age,
GOODS & SERVICES AGREEMENT - 4
(Over$10,000.00, Including WSST)
sexual orientation, national origin, or the presence of any sensory, mental, or physical disability,
discriminate against any person who is qualified and available to perform the work to which the
employment relates.
Vendor shall execute the attached City of Kent Equal Employment Opportunity Policy
Declaration, Comply with City Administrative Policy 1.2, and upon completion of the contract
work, file the attached Compliance Statement.
XI. INDEMNIFICATION. Vendor shall defend, indemnify and hold the City, its
officers, officials, employees, agents and volunteers harmless from any and all claims, injuries,
damages, losses or suits, including all legal costs and attorney fees, arising out of or in
connection with the Vendor's performance of this Agreement, except for that portion of the - --
injuries and damages caused by the City's negligence.
The City's inspection or acceptance of any of Vendor's work when completed shall not be
grounds to avoid any of these covenants of indemnification.
IT IS FURTHER SPECIFICALLY AND EXPRESSLY UNDERSTOOD THAT THE
INDEMNIFICATION PROVIDED HEREIN CONSTITUTES THE VENDOR'S WAIVER OF IMMUNITY
UNDER INDUSTRIAL INSURANCE, TITLE 51 RCW, SOLELY FOR THE PURPOSES OF THIS
INDEMNIFICATION. THE PARTIES FURTHER ACKNOWLEDGE THAT THEY HAVE MUTUALLY
NEGOTIATED THIS WAIVER.
In the event Vendor refuses tender of defense in any suit or any claim, if that tender was
made pursuant to this indemnification clause, and if that refusal is subsequently determined by a
court having jurisdiction (or other agreed tribunal) to have been a wrongful refusal on the
'endor's part, then Vendor shall pay all the City's costs for defense, including all reasonable
expert witness fees and reasonable attorneys' fees, plus the City's legal costs and fees incurred
because there was a wrongful refusal on the Vendor's part.
The provisions of this section shall survive the expiration or termination of this
Agreement.
XII. INSURANCE. The Vendor shall procure and maintain for the duration of the
Agreement, insurance of the types and in the amounts described in Exhibit B attached and
incorporated by this reference.
XIII. WORK PERFORMED AT VENDOR'S RISK. Vendor shall take all necessary
precautions and shall be responsible for the safety of its employees, agents, and subcontractors
in the performance of the contract work and shall utilize all protection necessary for that
purpose. All work shall be done at Vendor's own risk, and Vendor shall be responsible for any
loss of or damage to materials, tools, or other articles used or held for use in connection with the
work.
XIV. MISCELLANEOUS PROVISIONS.
A. Recyclable Materials. Pursuant to Chapter 3.80 of the Kent City Code, the City
requires its contractors and consultants to use recycled and recyclable products whenever
practicable. A price preference may be available for any designated recycled product.
B. Non-Waiver of Breach. The failure of the City to insist upon strict performance of
any of the covenants and agreements contained in this Agreement, or to exercise any option
GOODS & SERVICES AGREEMENT - 5
(Over$10,000 00, Including WSST)
conferred by this Agreement in one or more instances shall not be construed to be a waiver or
relinquishment of those covenants, agreements or options, and the same shall be and remain in
full force and effect.
C. Resolution of Disputes and Governing Law. This Agreement shall be governed by
and construed in accordance with the laws of the State of Washington. If the parties are unable
to settle any dispute, difference or claim arising from the parties' performance of this
Agreement, the exclusive means of resolving that dispute, difference or claim, shall only be by
filing suit exclusively under the venue, rules and jurisdiction of the King County Superior Court,
King County, Washington, unless the parties agree in writing to an alternative dispute resolution
process. In any claim or lawsuit for damages arising from the parties' performance of this
Agreement, each party shall pay all its legal costs and attorney's fees incurred in defending or
bringing such claim or lawsuit, including all appeals, in addition to any other recovery or award
provided by law; provided, however, nothing in this paragraph shall be construed to limit the
City's right to indemnification under Section XI of this Agreement.
D. Written Notice. All communications regarding this Agreement shall be sent to the
parties at the addresses listed on the signature page of the Agreement, unless notified to the
contrary. Any written notice hereunder shall become effective three (3) business days after the
date of mailing by registered or certified mail, and shall be deemed sufficiently given if sent to
the addressee at the address stated in this Agreement or such other address as may be
hereafter specified in writing.
E. Assignment. Any assignment of this Agreement by either party without the written
consent of the non-assigning party shall be void. If the non-assigning party gives its consent to
any assignment, the terms of this Agreement shall continue in full force and effect and no
arther assignment shall be made without additional written consent.
F. Modification. No waiver, alteration, or modification of any of the provisions of this
Agreement shall be binding unless in writing and signed by a duly authorized representative of
the City and Vendor.
G. Entire Agreement. The written provisions and terms of this Agreement, together
with any Exhibits attached hereto, shall supersede all prior verbal statements of any officer or
other representative of the City, and such statements shall not be effective or be construed as
entering into or forming a part of or altering in any manner this Agreement. All of the above
documents are hereby made a part of this Agreement. However, should any language in any of
the Exhibits to this Agreement conflict with any language contained in this Agreement, the terms
of this Agreement shall prevail.
H. Compliance with Laws. The Vendor agrees to comply with all federal, state, and
municipal laws, rules, and regulations that are now effective or in the future become applicable
to Vendor's business, equipment, and personnel engaged in operations covered by this
Agreement or accruing out of the performance of those operations.
I. Counterparts. This Agreement may be executed in any number of counterparts,
each of which shall constitute an original, and all of which will together constitute this one
Agreement.
IN WITNESS, the parties below execute this Agreement, which shall become
effective on the last date entered below.
GOODS & SERVICES AGREEMENT - 6
(Over$10,000,00, Including WSST)
VENDOR: CITY OF KENT:
,y: �" By:
(signature) (signature)
Print Name: P nt N Suzette Cooke
Its I Ma or
(hale)
DATE: I�- I I I l0 DATE: CZ'i7��o
NOTICES TO BE SENT TO: NOTICES TO BE SENT TO:
VENDOR: CITY OF KENT:
Steve Gettmann Timothy J. LaPorte, P.E.
Airgas-Norpac City of Kent
22001 68th Ave. S. 220 Fourth Avenue South
Kent, WA 98032 Kent, WA 98032
(253) 872-8664 (telephone) (253) 856-5500 (telephone)
(253) 872-5274 (facsimile) (253) 856-6500 (facsimile)
APPROVED AS TO FORM:
:��W I 2L ![ILA—,
Kent Law Department
Alrgas Norpac-2011 Chemicals/Bauer
1
GOODS & SERVICES AGREEMENT - 7
(Over$10,000,00, including WSST)
DECLARATION
CITY OF KENT EQUAL EMPLOYMENT OPPORTUNITY POLICY
The City of Kent is committed to conform to Federal and State laws regarding equal opportunity.
As such all contractors, subcontractors and suppliers who perform work with relation to this
Agreement shall comply with the regulations of the City's equal employment opportunity
policies.
The-foilowing-questions-specifically -identify-the-requirements—tire-City--deems--necessary-for--any -
contractor, subcontractor or supplier on this specific Agreement to adhere to. An affirmative
response is required on all of the following questions for this Agreement to be valid and binding.
If any contractor, subcontractor or supplier willfully misrepresents themselves with regard to the
directives outlines, it will be considered a breach of contract and it will be at the City's sole
determination regarding suspension or termination for all or part of the Agreement;
The questions are as follows:
1. I have read the attached City of Kent administrative policy number 1.2.
2. During the time of this Agreement I will not discriminate in employment on the basis of
sex, race, color, national origin, age, or the presence of all sensory, mental or physical
disability.
a
During the time of this Agreement the prime contractor will provide a written statement to
all new employees and subcontractors indicating commitment as an equal opportunity
employer.
4. During the time of the Agreement I, the prime contractor, will actively consider hiring and
promotion of women and minorities.
5. Before acceptance of this Agreement, an adherence statement will be signed by me, the
Prime Contractor, that the Prime Contractor complied with the requirements as set forth
above.
By signing below, I agree to fulfill the five requirements referenced above.
Dated this day of n �1h - , 20 io.
By: -��
For:
Title: ry r P G",�r-
Date:
EEO COMPLIANCE DOCUMENTS - 1 of 3
CITY OF KENT
ADMINISTRATIVE POLICY
NUMBER: 1.2 EFFECTIVE DATE: January 1, 1998
-S-UME-CT,. MINORITY-AND-WOMEN - SUPERSEDES:—April 1-1996 - - -
CONTRACTORS APPROVED BY Jim White, Mayor
POLICY:
Equal employment opportunity requirements for the City of Kent will conform to federal and
state laws. All contractors, subcontractors, consultants and suppliers of the City must guarantee
equal employment opportunity within their organization and, if holding Agreements with the City
amounting to $10,000 or more within any given year, must take the following affirmative steps:
1. Provide a written statement to all new employees and subcontractors indicating
commitment as an equal opportunity employer.
2. Actively consider for promotion and advancement available minorities and women.
.ny contractor, subcontractor, consultant or supplier who willfully disregards the City's
nondiscrimination and equal opportunity requirements shall be considered in breach of contract
and subject to suspension or termination for all or part of the Agreement.
Contract Compliance Officers will be appointed by the Directors of Planning, Parks, and Public
Works Departments to assume the following duties for their respective departments.
1. Ensuring that contractors, subcontractors, consultants, and suppliers subject to these
regulations are familiar with the regulations and the City's equal employment opportunity
policy.
2. Monitoring to assure adherence to federal, state and local laws, policies and guidelines.
EEO COMPLIANCE DOCUMENTS - 2 of 3
CITY OF KENT
EQUAL EMPLOYMENT OPPORTUNITY COMPLIANCE STATEMENT
This form shall be filled out AFTER COMPLETION of this project by the Contractor awarded the
Agreement.
I,the-undersigned;-a duly-represented-agent of — —
Company, hereby acknowledge and declare that the before-mentioned company was the prime
contractor for the Agreement known as that was entered into on
the (date), between the firm I represent and the City of
Kent.
I declare that I complied fully with all of the requirements and obligations as outlined in the City
of Kent Administrative Policy 1.2 and the Declaration City of Kent Equal Employment Opportunity
Policy that was part of the before-mentioned Agreement.
Dated this day of , 20
By:
For:
Title:
Date:
EEO COMPLIANCE DOCUMENTS - 3 of 3
EXHIBIT A
WATER TREATMENT CHEMICAL SUPPLY FOR 2011
PROPOSALFORM
The undersigned hereby proposes to provide all equipment, labor, materials and supplies to
perform the service as specified In this contract (see Special Provisions 1.1 & 1.6) for the
following fees: A t
Bidder' Name: �f Iv- c r a-c.
Item Estimated Description Bid Unit Total
Annual Unit Prices
Usage
1 6 Chlorine Gas in One-Ton Containers 1 $
TONS FOB Clark Springs TON CONT.
�a
Total $ �.
A, tr y
Company bmltting Proposal
Authorized Signature
Note: Contractor must submit a firm proposal for the contract term(s).
a
i
WATER TREATMENT CHEMICAL SUPPLY FOR 2011
PROPOSALFORM
The undersigned hereby proposes to provide all equipment, labor, materials and supplies to
perform the service as specified in this contract (see Special Provisions 1.1 & 1.6) for the
following fees:
Bidder' Name:
Item Estimated Description Bid Unit Total
Annual Unit Prices
Usage
a
2 5 Chlorine Gas in One-Ton Containers 1 $
TONS FOB Kent Springs TON CONT. JJ
Total $ C� 77c)
k!a o c
Company ' bmitting Proposal
Autrorized Signature
Note: Contractor must submit a firm proposal for the contract term(s),
WATER TREATMENT CHEMICAL SUPPLY FOR 2011
PROPOSALFORM
The undersigned hereby proposes to provide all equipment, labor, materials and supplies to
perform the service as specified in this contract (see Special Provisions 1.1 & 1.6) for the
following fees:
Bidder' Name: tr"('l .�— rUa.-c —
Item Estimated Description Bid Unit Total
Annual Unit Prices
Usage
3 1,800 Chlorine Gas in 150 Lb. Containers 150
LBS FOB East Hill Well LB CYL.
Total $
A i PJ04,0cx
Company bmitting Proposal
Authorized Signature
Note: Contractor must submit a firm proposal for the contract term(s).
WATER TREATMENT CHEMICAL SUPPLY FOR 2011
PROPOSALFORM
The undersigned hereby proposes to provide all equipment, labor, materials and supplies to
perform the service as specified in this contract (see Special Provisions 1.1 & 1.6) for the
following fees:
Bidder' Name: hl f R a
Item Estimated Description Bid Unit Total
Annual Unit Prices
Usage
a�
4 600 Chlorine Gas in 150 Lb Containers 150
LBS FOB Armstrong Springs Well #1 LB CYL.
Tota 1 $
Company Slibmitting Proposal
—Az -
Aut orized Signature
Note: Contractor must submit a firm proposal for the contract term(s).
WATER TREATMENT CHEMICAL SUPPLY FOR 2011
PROPOSALFORM
The undersigned hereby proposes to provide all equipment, labor, materials and supplies to
perform the service as specified in this contract (see Special Provisions 1.1 & 1.6) for the
following fees: ^
Bidder' Name: I t�s Nar'j)a-c
Item Estimated Description Bid Unit Total
Annual Unit Prices
Usage
a
5 600 Chlorine Gas in 150 Lb. Containers 150
LBS FOB Seven Oaks Well LB CYL. J
Total 0
' rz� °-
Compan Su mitting Proposal
Authorized Signature
Note; Contractor must submit a firm proposal for the contract term(s),
EXHIBIT B
INSURANCE REQUIREMENTS FOR
SERVICE CONTRACTS
Insurance
The Contractor shall procure and maintain for the duration of the Agreement,
insurance against claims for injuries to persons or damage to property which
- may arise from or in connection with the performance of the work hereunder
by the Contractor, their agents, representatives, employees or - --
subcontractors.
A. Minimum Scope of Insurance
Contractor shall obtain insurance of the types described below:
1. Automobile Liability insurance covering all owned, non-owned,
hired and leased vehicles. Coverage shall be written on Insurance
Services Office (ISO) form CA 00 01 or a substitute form providing
equivalent liability coverage. If necessary, the policy shall be
endorsed to provide contractual liability coverage.
2. Commercial General Liability insurance shall be written on ISO
occurrence form CG 00 01 and shall cover liability arising from
premises, operations, independent contractors, products-completed
operations, personal injury and advertising injury, and liability
assumed under an insured contract. The Commercial General
Liability insurance shall be endorsed to provide the Aggregate Per
Project Endorsement ISO form CG 25 03 11 85. The City shall be
named as an insured under the Contractor's Commercial General
Liability insurance policy with respect to the work performed for the
City using ISO additional insured endorsement CG 20 10 11 85 or a
substitute endorsement providing equivalent coverage.
3. Workers' Compensation coverage as required by the Industrial
Insurance laws of the State of Washington
B. Minimum Amounts of Insurance
Contractor shall maintain the following insurance limits:
1. Automobile Liability insurance with a minimum combined single
limit for bodily injury and property damage of $1,000,000 per
accident.
2. Commercial General Liability insurance shall be written with limits
no less than $1,000,000 each occurrence, $2,000,000 general
aggregate and a $2,000,000 products-completed operations
aggregate limit.
EXHIBIT B (Continued)
C. Other Insurance Provisions
The insurance policies are to contain, or be endorsed to contain, the following
provisions for Automobile Liability and Commercial General Liability
insurance:
- _ 1.--The Contractor'sinsu ran ce-coverage shall be primary-insurance as - --- -
respect the City. Any Insurance, self-insurance, or insurance pool
coverage maintained by the City shall be excess of the Contractor's
insurance and shall not contribute with it.
2. The Contractor's insurance shall be endorsed to state that coverage
shall not be cancelled by either party, except after thirty (30) days
prior written notice by certified mail, return receipt requested, has
been given to the City.
3. The City of Kent shall be named as an additional insured on all
policies (except Professional Liability) as respects work performed
by or on behalf of the contractor and a copy of the endorsement
naming the City as additional insured shall be attached to the
Certificate of Insurance. The City reserves the right to receive a
certified copy of all required insurance policies. The Contractor's
Commercial General Liability insurance shall also contain a clause
stating that coverage shall apply separately to each insured against
whom claim is made or suit is brought, except with respects to the
limits of the insurer's liability.
D. Acceptability of Insurers
Insurance is to be placed with insurers with a current A.M. Best rating of not
less than ANII.
E. Verification of Coverage
Contractor shall furnish the City with original certificates and a copy of the
amendatory endorsements, including but not necessarily limited to the
additional insured endorsement, evidencing the insurance requirements of
the Contractor before commencement of the work.
F. Subcontractors
Contractor shall include all subcontractors as insureds under its policies or
shall furnish separate certificates and endorsements for each subcontractor.
All coverages for subcontractors shall be subject to all of the same insurance
requirements as stated herein for the Contractor.
a
C" CERTIFICATE OF LIABILITY INSURANC, , DaTE(MMroorcrrn
ACORO
7/2011 12/1 Y2010
PRODUCER Lockton Companies,LLC-I Kansas City THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Suite 900 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
444 W 47th Street,Snre Kansas47tyMO6490 HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
(816)960-9000
INSURERS AFFORDING COVERAGE NAIC#
INSURED AIRGAS-NOR PAC,INC INSURER A National Union Fire Ins Co Pittsburgh PA 19445
1066143 11900 NE 95TH STREET INSURER B INSURANCE CO THE THE STATE OF PA*
SUITE#400
VANCOUVER,WA 98682 INSURERC II,LINOIS NATIONAL INS CO is
INSURER *AIG-NEW YORK
INSURER E
CERTICOVERAGES AIRIN01 YE SIURiS),IAUTTH..¢EE OF INDR�EPRESENTATIVE OR PROCE DOES NOT IDUCER AND TTUTE A HE CERMCT CATE EN THE
HOLDERING
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED Ti 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 AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
INSR DD' POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMfTS
LTR NSR TYPE OF INSURANCE DATE MMIDDNYYY DATE MM/DDNYYY
X GENERAL LIABILITY EACH OCCURRENCE 2,000,000
B X COMMERCIAL GENERAL LIABILITY GL4807589 12/17/2010 12/17/2011 DAMAGETORENTED
PREMISES Ea currents $ 2,000,000
CLAIMS MADE aX OCCUR MED EXP(Any one peri $ 10,000
X CONTRACTUAL LIAB PERSONAL i INJURY $ 2,000,000
GENERAL AGGREGATE $ 10,000,000
GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOPAGG $ 5,000,000
POLICY X JEGT PRO LOC
X AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
B X ANYAUTO CA6505654(AOS) 12/17/2010 12/17/2011 (Ea accident) $ 2,000,000
B ALL OWNED AUTOS CA6505652(MA) 12/17/2010 12/17/2011 BODILY INJURY
B SCHEDULED AUTOS CA6505653(VA) 12/17/2010 12/17/2011 (Per person) $ XXXXXXX
HIRED AUTOS BODILY INJURY
NON-OWNED AUTOS (Per accident) $ XXXXXXX
PROPERTY DAMAGE
(Per accident) $ XXXXXXX
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ XXXXXXX
ANY AUTO NOT APPLICABLE OTHER THAN EA ACC $ XXXXXXX
AUTOONLY AGG $ XXXXXXX
X EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ 10,000,000
A X OCCUR ❑ CLAIMS MADE 15972627 12/17/2010 12/17/2011 AGGREGAiE S 10,000,000
a X
UMBRELLA $ XXXXXX
DEDUCTIBLE FORM $ XXXXXXX
RETENTION $ $ XXXXXXX
WORKERS COMPENSATION X TWC STATUORYLIMITS OER
B AND EMPLOYERS'LIABILITY Y/N WC1591799(CA) 12/17/2010 12/17/2011
B ANY PROPRIETORIPARTNEWEXECUTIVE WC]591798(AZ,ID,MD,VA) 12/17/2010 12/17/2011 EL EACH ACCIDENT $ 1,000,000
OFFICER/MEMBER EXCLUDED? N
B (Mandatory In Ni WCI591800(AOS) 12/17/2010 12/17/2011 E L DISEASE-EA EMPLOYEE $ 1,000,000
C If yes describe under WC1591801 TL,MI,MN,NY,UT) 12/17/2010 12/17/2011
SPECIAL PROVISIONS below EL DISEASE-POLICY LIMIT $ 1,000,000
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES f EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
CITY OF KENT,WA IS INCLUDED AS ADDITIONAL INSURED ON A PRIMARY BASIS WHERE REQUIRED BY WRITTEN CONTRACT,BUT ONLY
IN ACCORDANCE WITH POLICY TERMS,CONDITIONS,AND EXCLUSIONS
CERTIFICATE HOLDER CANCELLATION (CG2m011851
11099482 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BECANCELLED BEFORETHE EXPIRATION
CITY OF KENT DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
ATTN NANCY YOSHITAKE NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
400 WEST GOWE IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
(CENT WA 98032 REPRESENTATIVES
AUTHOR PRESENTATNE
OL—
ACORD 25(2009101) @ 1988-2099ACPDRD CORPORATION. All rights reserved
The ACORD name and logo are registered marks of ACORD
For questions regarding this oertiflole,contact the number listed in the ProduceY sedion above and specify the clleM code'AIRINat
-%NNW
POLICY NUMBER: GL4807589 COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED -- OWNERS, LESSEES OR
CONTRACTORS (FORM B)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART.
SCHEDULE
Name of Person or Organization: CITY OF KENT, WA
(If no entry appears above, information required to complete this
endorsement will be shown in the Declarations as applicable to this
endorsement. )
WHO IS AN INSURED (Section II) is amended to include as an insured the
person or organization shown in the Schedule, but only with respect to
liability arising out of "your work" for that insured by or for you.
CG 20 10 11 85 Copyright, Insurance Services Office, Inc., 1984
s
Attachment Code CG20101185
Certificate ID 11099482
Verify Workers'Comp Premium Status-Employer Liability Certificate Page l of I
z
Washington State Depent of ,_r Employer Liability
Labor and Industries Certificate
s`t
�k
Department of Labor and Industries
Employer Liability Certificate
- -- Date: 0912012010
UBI##: 601 129 876 d
Legal Business Name: AIRGAS NOR PAC INC
i
Account##: 555,172-00
Doing Business As'Name: AIRGAS NOR PAC INC
Estimated Workers Reported: Quarter 2 of Year 2010"Greater than 100 Workers"
(See Description Below)
Workers' Comp Premium Status: Account is current. Firm has voluntarily reported and
paid their premiums.
Licensed Contractor? Yes
License: AIRGAP1955KU
Expire Date: 5/31/2011
Account Representative: T3/THOMAS BOYLE(360)902-4886-Email:
BOYT235@lr)i.wa.gov
lni.wa.gov
What does "Estimated Workers Reported" mean?
Estimated workers reported represents the number of full time position requiring at least 480
hours of evork per calendar quarter. A single 480 hour position may be filled by one person,or
several part time workers.
Industrial Insurance Information
Employers report and pay premiums each quarter based on fours of employee work already
performed, and are liable for premiums found later to be due. Industrial insurance accounts have
no policy periods, cancellation dates, limitations of coverage or waiver of subrogation(See RCW
51.12.050 and 51.16 19Q.
https://fortress.w,&gov/lni/crpsi/AcctlnfoPrint.aspx?Accountld=55517200&AccountManag... 9/20/2010