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Exh 4A r ~' AGENDA ITEM NO: ~1'9 DATES- Z~- 99 CITY OF ATLANTIC BEACH CITY COMMISSION MEETING STAFF REPORT AGENDA ITEM: SUBMITTED BY: DATE: BACKGROUND: Crushed Limerock for the Public Works Dept. -12 Month Period Bid Number 9899-23 Robert S. Kosoy, Director of Public Works 1~~U- ~~ May 6, 1999 The bid opening for Limerock was held on May 5, 1999. The City received two bids: John L. Shadd Trucking, Inc. and Bulldog Truck Lines. Bulldog Truck Lines' bid was rejected because it was an incomplete bid, as they did not provide proof of an occupational license, references or an original insurance certificate. John L. Shadd Trucking, Inc. bid $11.25 per ton. We are presently purchasing Limerock from Bulldog Truck Lines. Their prices have ranged between $11.00 and $11.05 per ton over the past year. Our average purchase of Limerock is approximately 600 tons per year. Therefore, this bid represents an annual increase of about $150.00. RECOMMENDATION: Award bid to John L. Shadd Trucking, Inc. ATTACHMENTS: Bids and Tabulation of Bids Sheet ~~ REVIEWED BY CITY MANAGER: -l REQUEST FOR BID CRUSHED LIMEROCK FOR THE PUBLIC WORKS DEPARTMENT Page 4 of 4. CRUSHED LIMEROCK BID SUMMARY FORM _~ BIDDER'S NAME: v ~ ~ ~ u I This bid will be base on per ton prices. All Limerock will be deli ered to the Public Works Yazd at 1200 Sandpiper Lane. Crushed Ocala Formation Limerock shall conform to specifications for Limerock Stabilized Base material in Section 911 of the Florida Department of Transportation, Standard Specification for Road and Bridge Construction, 1991 Edition or later. 1. The minimum percentage of carbonates of calcium and magnesium in the Limerock material shall be 70%. 2. Limerock material shall be produced under a Producer Quality Control Program approved by the Florida Department of Transportation. . 3. Individual certifications shall be fiunished with each load of material delivered identifying the Mine No. assigned to the source by DOT and attesting that the material was produced under a DOT approved Producer Quality Control Program and that the most recent Quality ~' control tests indicate that the material conforms to the requirements of the current DOT specification for Limerock Material. CRUSHED LIMEROCK PER TON ~ ~~ - ? ~ SUBMITTAL: BIDDER BY ~U g~ ~ ~D ~ BUSINESS ADDRESS CQ~~ ~~. SIGNATURE ~. ,~ Laos Z~ ~~ CITY, STATE & ZIP CO E TITLE DATE BUSINESS TELEPHONE t CITY OF ATLANTIC BEACH INVITATION TO BID BID N0. 9899-23 DOCU:U;NTS REQUIREMENTS CHECKLIST Iii t :-J i ORIGINAL Insurance Certificates (copies, Xeroxes, or facsimiles are UNACCEPTABLE), naming the City of Atlantic Beach as Certificate Holder, showing they have obtained and will continue to carry Workers' Compensation, public and private liability, and property damage insurance during the life of the contract. Three (3) references from companies or individuals for whom the bidder has completed work during the past 12 months, of a comparable size and nature as this project. However, naming the City of Atlantic Beach as a reference on past completed projects is UNACCEPTABLE. Proof of OCCUPATIONAL (Copies ARE acceptable) Licence(s). Signed copy of Documents Requirements Checklist. Bid submitted IN TRIPLICATE. z The above requirements have been noted and are understood by bidder. SIGNED: ~~A //~ ~~~R. C%`'_ (Bidder or Agent) DATE: _ C~ ~~- / BID N0. ~ ~~ 9 . ~, 3 Form 1N-9 Request for Taxpayer Give form to the (Rev. December 1996) requester. Do NOT Department or theTreas identification Number and Certification ~r send to the IRS. Internet Revenue Service /''\ Name (Il a Joint ant or you changed your na ,see Specific Inswctions on page 2.) ( eu w th .fin e.. o Business name, if different from above. (See Specific Inswetions on pa 2.) c ~o, Check appropriate box: ~ IndividuaUSole proprietor Corporation ~ Partnership ~ Other - ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, Address (number, street, and apt. or suite no.) Requester's name and address (opUonaq a SOb City, state, and ZIP code e-~ ~~- 3a~SY Taxpayer Ideritification Number Enter your TIN in the appropriate box. For individuals, this is your social security number (SSN). However, if you are a resident alien OR a sole proprietor, see the Instructions on page 2. For other entities, it is your employer identification number (EIN). If you do not have a number, see How To Get a TIN on page 2. Note: if the account is in more than one name, see the chars on page 2 for guidelines on whose number [o enter. Certification Under penalties of perjury, 1 certify that: Employer IdenGfieation number ~o~ s~~~ For Payees Exempt From Backup Withholding (See the instructions on page 2.) 1. The number shown on this farm 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 vrithholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that 1 am subject to backup vrithholding 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. Certification Instructions.-You must cross out item 2 above if you have been notified by the IRS that you are currently subject to baci:up withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. ~~or mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement jrrangement (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 on page 2.) Sign Here Signature - ~ ~ ~~~~ Date -~ ~~ y- 9 Purpose of Form.-A person who is required to file an Information return vrith the IRS must get your correct taxpayer identification number (I'IN) to report, for example, income paid to you, real estate transactions, mortgage Interest you paid, acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA. Use Form W-9 to give your correct TIN to the person requesting it (the requester) and, when applicable, to: 1. Certify the TlNyou are giving is correct (or you are waiting for a number to be issued), 2. Certify you are not subject to backup withholding, or 3. Claim exemption from backup withholding if you are an exempt payee. Note: if a requester gives you a form other than a W-9 to request your TIN, you must use the requester's form if it is substantially similar to this Form W-9. What Is Backup Withholding?-Persons ,eking certain payments to you must f ~hhold and pay to the IRS 31% of such Nayments under certain conditions. This is called "backup withholding." Payments that may be subject to backup withholding Social security number OR last account number(s) here (optionaq include interest, dividends, broker and barter exchange transactions, rents, royalties, nonemployee pay, and certain payments from fishing boat operators. Real estate transactions are not subject to backup withholding. '~ If you give the requester your correct TIN, make the proper certifications, and report all your taxable interest and dividends on your tax return, payments you receive will not be subject to backup,, withholding. Payments you receive vrilt be' subject to backup withholding if: 1. You do not furnish your TIN to the requester, or 2. The IRS felts the requester that you , furnished an incorrect TIN, or 3. The IRS tells you that you are subject to backup withholding because you did not report all your interest and dividends on your tax return (for reportable interest and dividends only), or 4, You do not certify to the requester that you are not subject to backup withholding under 3 above (for reportable interest and dividend accounts opened after 1983 only), or 5. You do not certify your TIN when required. See the Part III instructions on page 2 for details. Certain payees and payments are exempt from backup withholding. See the Part II instructions and [he separate Instructions for the Requester of Farm W-9. Penalties Failure To' Furnish T[N.-tf you fail to furnish your correct TIN to a requester, you are subject to a penalty of 350 for each such failure unless your failure is due to reasonable cause and not to willful neglect. Civil Penalty for False Information With Respect to Withholding.-If you make a false statement with no reasonable basis that results in no backup withholding, you are subject to a 3500 penalty. Criminal Penalty for Falsifying Information.- Willfully falsifying certifications or affirmations may subject you to criminal penalties including fines and/or imprisonment. Misuse o! TINs.-If the requester discloses or uses TINS in violation of Federal law, the requester may be subject to civil and criminal penalties. Cat. No. 10231x Form W-9 (Rev. 12.961 ( 1 . .i~ • 1~ t r~~~ aT! Rttr<IOGrr'r? AGO ~Lv `b ~' 1 ~ : - ~ Y . _ .3~ . _ _ ts:....,....Rrwwaw•:ix:_...... . •:l t;. ~'.i:-.i. ++...-....;2..... 4,...-,...:y . . a«'=;"=>rJ . ~~ 03/~ •T.^" ^a.. ~ rrtooclcER THts cEHTIFlCATE I6 ItsueD As A MATTER OF INFORMATION EDGE ltxD EDGE, IlIC, OttLY APlD CONFERS HO RICiH78 UPON THE CERTIFICATE P9 pGX toga x HOLDER. THlB CERTIFICATE OOE8 NOT AMEND, EXTEND oR aLTEA THE covERAaE AFFORDED BY 7HE POUCIEa BELOW fJl1xESYILLE FL 32613 . 352-31C-6317 COMPAtilE8 AFFORDiNQ COVERACIE ---• Ocx~cyAm A AtIQtT[AA 2URICy IMSl1it1,11CE CRiP,uIY CCy1?ANY SPfCULTY QFLGYM LEASING INC. B 1-aco-Sao-naaz 34~1i1 L. SIUIDO E1fiERPSLISES, INC -- -~-`-' - Pa m~ sob cct.lrur* tJU;E WL7E4 fl 32051 C ._.. _ 352-a96-2631 ~,p~ O ~/~-~~.y~~y~.~Yr ri ~:t ..• •%~:'^ ~ _ :w'«.:: i1rJ ~i n-.w•~.iAi:::~~ ~ ., ~)i:..~: ~ ~ ~ir~.w ~...w~. ..;.--.....,mow.: _.,/.»...~..~. :1'~~ .~11I+~".Th:w.'r«-.. lii :: ~.i ~'•~:::"1~..:t•~ii~ .- .., ~, ~ f rW:l' . ..: r,J:I::.'!'y,•t. .'."."'..%,.,+vw..:.i.:~.+.w..4t4'~t.`,'!'f-rw,.a.::[w-«~ ~,. w~.•1...:~i «.~. ,S-~.~.:.::. :: jtT: wt:vnkf•i.~ .- ::: 1 v :fR ijkiw ^: S~~;f v' ~- ~ . . . . . . f :.: . { ««.ww, :i „w.Nw Tests is TO CERrtt7 iWlT THE POt.tCIE6 OP INaufu-NCE UsTED oELOw HAVE 6EEN IasuED TO T-+E INSURED tLt.MEO AsovE fOA THE POLICY PERIOp INDfCAT[:D. NOTWRti4TANDtNCi ANY REQVIREMENT, TEAM OR CONDRION OP ANY CONTCIACT OR OTHEfI DOCU1.tENT WffH RESPECT TO WHICH Tkt8 ctt~itfICATE MAY 8E t65VED OR MAY PERTAIN, THE INSURANGt: AffoRaED BY THE POItCtES DESCRIBED HEREIN t9 SUBJECT TO A,LL TttE TERMS , ExClll9fON9 ANO GONDtTtONB OF SUCH POLFClEb. UMIT8 SHOWN MAY HAVE BEEN REDUCED BY P~110 CLAIMS. •._ [b MEOr wvtuwct ptlCtlcVroUt Lr1r 1'oucT CrrLCT1YE PPUCT' Lxhtu T)ON L1nti~ wtclrtuOOrtTy OATLawvorw! 11L.ltcluL UAti1UTY t1jNEFiAL AGGFE:CATt; i CAI~+~ftYULOENffiV.WBXfK .. PFi~X:TY•COAIP.CPAt G _ t •. CWM6 rA~E ~ ~~ ~ DER.lCtL~L d AITI Nt.uJti'( I CW++'£Q'8 L CONTR+IGTI'siB PHOT E~Ut OC:C:UAJ~ENCE i Lin tYr «,. I = ' Au tvrotuct uwun x1Y wuto COr~tE-4ED 5n+att: uMrt s _. _... ~LtOwNtt1wT05 ccrxw.EO~urc7 Nt"''K°iP.,,,~u i HaEn AUTIIS F,cx.t,.r~owurw ~'~ t oaJafttTY o~+.1~of t u1tLa,C t1aAiUTT •uTOOr1~Y • FJ, I~GC7fKNT •NY/uJTO OTttER T1tANAUtDONIT: f~C]t ACCtOE4T . i +~clAEnnTE a •.~..-- izC ESi ItAD+LrtY EJ~1 OCCURRENCE _.. . t U1.tOFELLI f C.ul ' A66PCG~TE i OtTSER tNAN V>•t8REL1A t OC~1.1 ---.. S YrOnKEAs eoxrtK>;.no« Axc • O w. X E31r1.OYEFS tsurm _ . I wti _ •` A wa U WC 28-71-566.00-O1 61/0199 Oz/O1/00 t'..LEfC.NACCIOEt~fi _ t S00 OOA Cxn1vE E EICGCJ~SE•POt2.'TLR.9i t 600 000 ~~~'~~ E~cCL - OTMLp FJ kusF~s1<-cAEU~oTEE t 500 000 • CLIEJR 1 149A LOCATION coYERAGE PE4I00: 01/01/99 Oa/O1/00 OfDCAtr Tial P/ IX!llirlofl LioC~Tla I+~lV t1llCl.Ei/1<PELiti tTEit6 CCYERAGL TS P7tffYTDEO FUR ONLY THOSE E}SALOYEES LEASED TO JOti1 1. SKADCI ExTERPRISES, ETAL btlT f10T SUlSCCtM'TRitCTOttS OF: F9 BOX jOS :~ .,,,.1 r~ ~ .-... Llt![£ BUTCER FL 32055 .. .. 7G:•i G:~!7:~3fY;2Y.~ ':'•.~.~'n'~ry'~;l!..~.~4,w~~.~,~,//.~,..~~ iK •:~~ ~ .1"t< ~~in .. • ..(r.:. ~...r.....r... . •5:~.... ~.: r ~ ' f ', ' T . .. ,. ~J.7.;~! ~ ~ ^ • . f 1 ... .w ,`m ~."«~: ,.. ~ r ~=,~:v Rw.~ ...v.:"...~1:1!.t~A~•(.), ~).Yl.-rHM '~,:l.~e ~S•~l.~tY~w ~ CITY Of ATW(TIC t3E.tCN . wove axr or m1 •soYE DtiCAletO vouclte EL CJJICtLUO lcF9Hi Trii 1200 SJUtOPIt~ LA,xE ATL-XTIC oEACN FL tYrtnwnoK wrc T>.ctuor, rnt roGVtrW CoNr~K• wxa [rnu,voa ro wui 32211-a3d1 ~p_ a-Yi YvrtlTTjM NOTfCt t0 IPE CtRTIf}0.11Ti HOI,OLp 1L-+I[ta TO tftL LLrT, /K ratLVpY TO AV p0 CC SMLL fMl•OOE 110 0611WT>oN Ow L1U tUTT O+ IJ1T T E C Y-/~JIT, 1r6 liDEMTY 011 tl[PPltf!(TLTtYYL 1WTTIOp+ZCOh Cb ~~',:.~•xP.i~; :aft%=Y>:s.;~'~I:.,s,r~cl•.jy.Fa ~~ ~~{ •4 :,,..~?.-•^r ~~. .~; •.,.. , , • ~ SHADDTRUCKING ~a~:e:~:~:, CERTIFICATE OF INSURANCE Si3`i99°`~' PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION BROWN & BROWN INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 22~ SOUTH RIDGEWOOD AVENUE ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. BOX 2412 ; COMPANIES AFFORDINGCOVERAGE D[-,)(TONA BEACH, FL 32115 _ _______ i COMPANY , A CRUM _ & FORSTER IND CO _ _ _ ______ __ INSURED ~ JOHN L. SHADD TRUCKING, INC. _ I COMPANY I BGENERAL SECURITY PO BOX 506 _ LAKE BUTLER, FL 3 2 0 54 ~ COMPANY ~ CST PAUL FIRE MARINE INS I COMPANY - ~ I D COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD WOICATED, NOTWRHSTANDING ANY REQUIREMENT, TERM OR CONDRION OF ANY CONTRACT OR OTHER DOCUMENT W(iH 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. UMRS SHOWN tv1AY HAVE BEEN REDUCED BY PAID CLAIMS. _ CO: TYPE OF INSURANCE i POLICY NUMBER LTR~ j POLICY EFFECTIVE POLICYEXPIRATIONi LIMITS DATE(MMJDDJYY) : OATE(MM/DDJYY) A ~ GENERALLIABILITY ~ 5430725856 11./22/98 11/22/99 IGENERALAGGREGATE !32, GOO, OOO MERCIALGENERALLIABILIT M CO X ;PRODUCTS-COMP/OPAGG~S2 OOO OOO ; - ~ i ICLAIMS MADE ~ OCCURI _ PERSONAL d ADV INJURY ISl , O O O , O O O ~- ~ OWNER'S b CONTRACTOR'S PROT I EACH OCCURRENCE IS1 , O O O , __ ~ O O O ' I !FIRE DAMAGE (Any one f ire)'31 O O O O O ~ •MEDEXP(Anyoneperson) IS5 OOO B ' auTOMOBILELIABILITY ' TP1005636 • 11/22/98 11/22/99 i . X~ ANY AUTO ~COMBINEDSINGLELIMIT 51~ OOO ~ 000 _. • 'AIL OWNEDAUTOS ~BOOILYINJURY ' S _ SCHEDULED AUTOS ;(Per person) ~ I HIREDAUTOS __ ~ 'BODILY INJURY ~S • X :NON-OWNED AUTOS ~ ~ ,(Peraeeident) -- •• X - 'PROPERTY DAMAGE IS GARAGE LIABILITY ~ l`n L~ AUTO ONLY-EA ACCIDENT 'S __ I ANYAUTO ~ ` ~ ~ \` iOTHERTHANAUTOONLY: ~ I k ~ i EACH ACCIDENT 'S _ ~ I / `J ~ _ i ' ~ AGGREGATE !S EXCESS LIABILITY 'EACH OCCURRENCE 'S ~ UMBRELLAFORM I iAGGREGATE 'S _- _ j OTHERTHANUMBRELLAFORM~ iS i WORKERSCOMPENSATIONAND ~ ~STATUTORYIIMITS !~ ~ 'EMPLOYERS' LIABILITY I ~ _ ' :EACH ACCIDENT ,S i • THE PROPRIETOR/ ~ INCL I ' _ ~ DISEASE•POLICYLIMIT S -- ; PARTNERS/EXECUTIVE ! OFFICERS ARE: ~ EXCL' OISEASE•EACHEMPLOYEE~S ('' ;OTHER MOTOR TRUCK IM06802217 11/22/98 11/22/99 ; $50, 000 ANY ONE ' CARGO ~ ' i I VEHICLE/$2,500 DED. I I I DESCRIPTION OF OPERATIONSlLOCATIONSJVEHICLES/SPECIAL ITEMS BID #9899-23 CERTIFICATE HOLDER ~: ~. • . ~ CANCELLATION .. "`~:.•. ~ ~. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE CITY OF ATLANTIC BEACH FLORIDA EXPIRATION OATETHEREOF,THEISSUINGCOMPANYWILLENOEAVORTOMAII 12 O O SAND PIPER LANE ~Q_ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, ATLANTIC BEACH, FL 32233-4381 BUT FAILURE TOMAILSUCHN071CESHALLIMPOSENOOBUGATIONORLIABILITY OF ANY KIND UPON THE COMPANY ITS AGENTS OR REPRESENTATIVES. AUTHO EDREPRESE TIVE ACORD25-S (3/93)1 ot1~~S48449~M37280 CCR oACORDCORpORAT10N1993 t l ` o~ 1 O ~ ~i[ I V ~~ }- ~~ 'a ' ^ ~. ~, ~ ~ U3 LC O (~ (O, Z ; J ~O~ 3 a~ ~ I L O- W~"W ~ c }- WWfn ~ W W W ~ ~ ~~~J'~ ~ $ no LL ] rl Z W ~ `cvZ'J W ~'j... ~ oz~WO Qm~~u~U~~ a r~ Qa N>~ c~ ~ I 2 . ' :~, -'zw0 O~ ~ gY O Z n cu n~ ,, a ~~~i-- , Q E a Og ~' ~ w ~ z ~ N O ° W ~ D3 ~ o ; ~ ~ Z ! D U V ~,,, W ' C ~~ z U W ~•- I I o t/. , E I -I ~ C o ` OZ J I~'' I I z0 J to ~ ~c ;~, ~ I Oaa ; I d }~ . v rn Zc w c ` ~ Z U V V ~ ~ ~ ~ •°- = n O ~~ W I"1 !~ ~ ~ ~ O ~ N z j~~'? r O 2 ~ °9 F-{ U Z u yU=Z v. ~ UJ M r.~ ~n O U v cn H a ~ o i J ~ lJ Ca Lz+ ` o . O~ ~ L u. ~ O l ~, lD O ?C ~ ~ ~ t 1s ;... ; ` W v] ~ 3 ~ y N L Q I LL F~ Q CA ' n o I .~ ~. U !7W~ '~ . ~~o J ~ c5 _ ~c r- O ` ~ o~ }- - ~ o '~~ 3 ~ C ~~ a m ~, c ~ o O ~ v r as" a ~ c o ~ a N N ~ O C C ~ S W v ~ C ° ~ Q ~ ~' a .~ - ~ ~ r . L~3~~ r~ r~uc~w~, .rwc. 1M~wo~rw+.~::.a.:»w~.l».....dd,~w:~1:1.: Wow.r:lwiwLJo7.::L.Www wSLL.Y.:+w:l,Wxi ..J+..y.'...L:.Lw+G..iwuwWLw ~+N~W,.w~w.irrw.:.n.L' i~J::.'.~i.ywliw:17.5wS:Cw10..w::,U,r~wrxw~ P.O. Box 626 Lake Butler, Florida 32054 Phone (904) 496-1991 Fax (904) 496-1531 To Whom It May Concern: Shadd Trucking has helped our company provide prompt service to our customers for several years. We depend on Shadd Trucking to help with our hauling of limerock and stone. Our company has been very pleased with there propt service and reasonable prices. We will continue to do business with Shadd Trucking for serveral years to come. Sincerely, ~ ~~ ~- ~ ~.~' Cassandra Driggers President ~~ John R. Trowel) Trucking, Inc To Whom It May Concern: John L. Shadd Trucking has been providing our company with limerock for approximately two years. We have been very satisfied with the company's prompt service and sensible prices. We enjoy working with Shadd Trucking's employees, who have made our j ob less taxing and more enjoyable. We will continue to count on there reliable service for our business. Sincerely, ~uz ~ ~~2~~1-~. John R Tro~vell President and Owner Rt 4 Box 3455 ~ Lake Butler, FL 32054 Phone (904) 496-1952 ~ Fax (904) 496-1952 .FROM R & E CONTP,ACTING, INC. FAX N0. 904 646 0897 May. 04 1999 01:07PM P1 ~, R & B CONTRACTING, 1NC~ Post Office Box 11833 Jacksonville, FL 32239-1833 (904) b46-3551 Fax <904) 646-0897 May 4, 1999 Subject: John L Shadd Trucking, Inc. To Whom It May Concern: Please be advised that John L Shadd Trucking, Inc. ("Shadd"), has been providing us with limerock and stone for over 7 years. Shadd has been extremely reliable and responsive to our recuests for materials, in addition to providing very competitively priced products. It has been a pleasure relying on Shadd to provide us with material where, and when, it was needed. ~~ Should additional information be desired regarding our experience obtaining materials from Shadd, we would be pleased to have the opportunity to provide same. Yours truly, onna Brooks President CU C053361 CG C058704 CF C056993 ~' REQUEST FOR BID CRUSHED LIMEROCK FOR THE PUBLIC WORKS DEPARTMENT Page 4 of 4. CRUSHED LIMEROCK BID SUMMARY FORM BIDDER'S NAME: ~ ('~ c1,1 ~ ~ c This bid will be base on per ton prices. All at 1200 Sandpiper Lane. S will be delivered to the Public Works Yard Crushed Ocala Formation Limerock shall conform to specifications for Limerock Stabilized Base material in Section 911 of the Florida Department of Transportation, Standard Specification for Road and Bridge Construction, 1991 Edition or later. 1. The minimum percentage of carbonates of calcium and magnesium in the Limerock material shall be 70%. 2. Limerock material shall be produced under a Producer Quality Control Program approved by the Florida Department of Transportation. 3. Individual certifications shall be furnished with each load of material delivered identifying the Mine No. assigned to the source by DOT and attesting that the material was produced under a DOT approved Producer Quality Control Program and that the most recent Quality control tests indicate that the material conforms to the requirements of the current DOT specification for Limerock Material. ~` CRUSHED LIMEROCK PER TON SUBMITTAL: BIDDER ~CS G~~~ ~ 31 l BUSINESS ADDRESS ~~/~ G~ ~ ~r~3:' ~L~ BY s~ CITY, STATE & ZIP CODE TITLE DATE BUSINESS TELEPHONE :a ,- '" •#YY 'S . ~,t: ~' r!4-, . i ~ ~~ ~, t CITY OF ATLAtJTIC BEACH INVITATION TO BID BID N0. 9899-23 DOCU:'~ENTS REQUIREPIENTS CHECF~LIST .. i i ~ ~' S •-~'~ ~~~ The above requirements have been noted and are understood by bidder. SIGNED: ~1"' ~.~, ~ (Bidder or Agent) DATE: _'s' 3 - I ~j BID N0. ~ ~C 4-- Z ~ ORIGINAL insurance Certificates (copies, Xeroxes, or facsimiles are UNACCEPTABLE), naming the City of Atlantic Beach as Certificate Holder, showing they have obtained and will continue to carry Workers' Compensation, public and private liability, and property damage insurance during the life of the contract. Three (3) references from companies or individuals for whom the bidder has completed work during the past 12 months, of a comparable size and nature as this project. However, naming the City of Atlantic Beach as a reference on past completed projects is UNACCEPTABLE. Proof of OCCUPATIONAL (Copies ARE acceptable) Licence(s). Signed copy of Documents Requirements Checklist. Bid submitted IN TRIPLICATE. Form 1lt1-9 Request for Taxpayer (Rev. December 1996) tdentiflcation Number and Certification Department or the Treasury tnterrul Revenue Service d n _T 0 c a d a Give form to the requester. Do NOT send to the IRS. Name pf a Joint account or you changed your name, see Specific tnswctions on page 2.) Eiusiness name, if different from above. (See Specific Inswctions on page 2.) J~~ Check appropriate box: ^ IndividuaVSote proprietor Corporation ^ Partnership ^ Other ~ ...................................... Address (number, strceL and apt. or suite no.) Requester's name and address (optionaq City, state, and ZIP code L a f,z f3:~L1: ~1~ Taxpayer Identification Number Enter your TIN in the appropriate box. For individuals, this is your social security number (SSN). Hovrever, if you are a resident alien OR a sole proprietor, see the instructions on page 2. For other entities, it Is your employer identification number (EIN). If you do not have a number, see How To Get a TIN on page 2. Note: !(the account is in more than one name, see the chart on page 2 for guidelines on whose number to enter. Social security number Ust account number(s) here (optional) OR Employer identification number ~~~) x~~~r~~~3 For Payees Exempt From Backup Withholding (See the instructions on page 2.) cation Under penalties of perjury, I certify that: 1. The number shown on this form is my coaeet taxpayer identification number (or t am waiting for a number to be issued to me), and 2. I zm not subject to backup vrithholding because: (a) I am exempt from backup vrithholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that l 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 1 am .• ~ longer subject to backup withholding. Certification Instructions.-You must cross out item 2 above if you Have been notified by the IRS that you are currently subject to backup ~\witllholding because you have failed to report alt 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 arc not required to sign the Certification, but you must provide your correct TIN. (See the instructions on page 2.) Sign `- -~ _f~ Nere Signature ! ~ ~tL~t7,~ .`~ Q Date - t'S• ~ "~ j Purpose of Form.-A person vrho is required to file an information return with the IRS must get your correct taxpayer identification number (TIN) to report, for example, Income paid to you, real estate transactions, mortgage interest you paid, acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA. Use Form W-9 to give your correct 71N to the person requesting it {the requester) and, when applicable, to: 1. Certify the TlNyou are giving is correct (or you are waiting for a number to be issuedj, 2. Certify you are not subject to backup withholding, or 3. Claim exemption from backup withholding if you are an exempt payee. Note: !f a requester gives you a form other than a W-9 to request your TIN, you must use the requester's form if it is substantially similar to this Form W-9. what Is Backup Withholding?-Persons eking certain payments to you must .vithhold and pay to the IRS 31% of such payments under certain conditions. This is called "backup withholding." Payments that may be subject to backup withholding include interest, dividends, broker and barter exchange transactions, rents, royalties, nonemployee pay, and certain payments from fishing boat operators. Real estate transactions are not subject to backup withholding. It you give the requester your correct . TIN, make the proper certifications, and report alt your taxable interest and dividends on your tax return, payments you receive will not be subject to backup.. withholding. Payments you receive will be' subject to backup vrithholding if: 1. You do not furnish your TIN to the , requester, or 2. The IRS tells the requester that you , furnished an incorrect TIN, or 3. The IRS tells you that you are subject to backup withholding because you did not report all your interest and dividends on your tax return (for reportable interest and dividends only), or 4. You do not certify to the requester that you are not subject to backup withholding under 3 above (for reportable interest and dividend accounts opened after 1983 only}, or 5. You do not certify your TIN when required. See the Part III instructions on page 2 for details. Certain payees and payments are exempt from backup vrithholding. See the Part II instructions and the separate Instructions for the Requester of Form L'V-9. Penalties Failure To~Fumish TIN.-If you fail to furnish your correct TIN to a requester, you are subject to a penalty of S50 for each such failure unless your failure is due to reasonable cause and not to vrillful neglect. Civil Penalty for False Information With Respect to Withholding.-If you make a false statement with no reasonable basis that results in no backup withholding, you are subject to a 5500 penalty. Criminal Penalty for Falsifying Information.- Willfully falsifying certifications or affirmations may subject you to criminal penalties including fines and/or imprisonment. Misuse of TINS.-t! the requester discloses or uses TINS in violation of Federal law, the requester may be subject to civil and criminal penalties. Cat. No. 10231X Form 111f-9 (Rev. 12-9G) vv .a ... .. a,•a ,av.vY l:t.t v\~..vJ•lVVI+~ t\L:1~~1, Vt\!Il'1'• +~J 1111,; (-~;•~ IC~;~T~~~0 IaCO~~r~ :C~~RTI~F: U 1-t,~N ~ ~?CSR°~DW.:::.: .. ~,.,,..,,,~..., •~L ~.PRITR=2 03/19/99 , . ~ ~ •~ • •~~• ~ {~ ~ ~~ ~ • ~ . •.. • • I' • . -• •••• • +••.• • ~•• . • ~ •TI•II<3 CER7IPIC/~TE IS ISSUED AS A MATTER OF 1NF(~RMATiON PRODUCER ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Neace xukan3 'HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1',0*~,u~svil3e Offica ALTER TI IC COVERAGG AI"~ORDED BY THE POLICIES BELOW, a] roWxtf3 Lan© Lo.._aville XY 40207 COMPANIES AFFORDING COVERAGE Alan J. Donee COMPANY ~. A CIG27A Companies none NO. 502-894-2100 Fax NO.502-894-II602 tN3UJtE~L.LI19>rt TLt1CI 11~(/ =nC• Bulldog Truck L1naA, Inc. ~ GpMPANY g Aaterican Xnternationn7. Cos. Bulldog Environmental, Inc • Chun Traneportntian, Inc. CQMPnNY C Firamann fund InnurancH Co. Thomas Drr~llor Iliglir-ay 3-D1, I.O. Box 311 coMrANv Lake Butler FL 32054: D '+. <... .! •~: 'K'IM^w '~~i u.• ?~Y.a t ~~n.i..v •. \•. r.•r::': . . .. ... .'i+• . .:y. ~Ol:9 ". VE r:<`s O . ............. ..::....::.... . TH1315 TO CERTIFY THAT TH5 POLICIES Of INSURANCE LISTED ©EL01V HAVE BEEN ISSUED TO THE INSURED NAtdEO At70VE FOR THE POLICY PERIOD NOTWITHSTANDING ANY REQUIREMENT, TERh10R COrJ01T10N OF A11Y CONTRACT OR OTNER OOCUhtENT Y11TH RESPECT 70 WHICN THIS INDICATED , CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFfORUEU (IY 1 HE POLICIES Ue3l:woeU rlEttEtN q auaccT YO ALL THG rERttO, LIMITS SHO'1+TJ MAY HAVE BEEN REDUCED 8Y PAID ClA1MS. ANO CONDITIONS OF SUCI1 POLICIES N . E)(CLUSIO S CO TYPE OF INSURANCE POLICY NUME3E rouCY [PFGCTIVC rouCY ExPIPAnnN LvvT3 R oATE (MMJDDKY) DATE (MAVDDm) LTR GENERAL AGGREGATE s 3, D 0 0, 0 0 0 pEtIEr+A~ LIADILRY GENERALIIAettflY OGLG19322725 03/30/99 03/30/00 PRODUCTS-COMP/OPAGG S 1, DOD, 000 A X COMMERCtAL i~AnF Q OCCUR PERSONAL b ADV INJURY S 1. 0 0 0, 0 0 0 w... CLAIMS b CONTMCTORS PROT EACH OCCURRENCE S 1, O O O, O O O OWNERS gl Liah t t FIRE DAMAGE(a,yonofre) ~ S 50,000 X u rnc Con - MED EXP (Any ono person) ~ 1 S, D O O AUTOM08ILE UABILffY U7Q ISAH07320668 03/30/99 03/30/OD COr.f01NED SINGt F 1 IM~r I t T, D Q Q, D D Q : ~, g ANYA •. ALL O'NNED AUT03 OOOILY INJURY S U705 (Ptf I1CI9Uf1) SCHEDULED A , HIRED AUTOS DOOtLY INJURY S WrIED AUTOS N (rci ocuam,q - .O NO X TRIICItERS PROPERTY OA6IAGE S X Pollution Liab! GE 11A81L1TY AUTO ONLY - EA ACCIDENT ~ S GA RA ANYAUfO U I HER THAN AU ro UNIY: EACH ACCIDENT S - AOCrtcOnTC S L1A01lITY EACH OCCURRENCE 5 4, 0 0 0, 0 0 0 ~ ~ FORht L BE3572527 03/30/99 03/30/06 AccncoATC s ft, Q00, 000 $ g UMDREL A 07tiERTHAlJ UMBRELLA FORM S OMPENSATION AtJO YIORKERS C EMPLOYERS UAtSILITY EL EACH ACCIDENT THE PROPRICTOrV INCL aL OISE~SE . pOLlr_Y I IM+r t PARTNERSlEXECUTNE OFFICERS ARE: EXCL EL DISEASE - FJ1 EMPLOYEE S A ornert Physical Dnmago ISAII0732oGGII 03/30/99 03/30/00 Comp. $2,50D Dod. C Trdllii/Motor Truck Dt}CI003GG219 03/30/99 03/30/00 Coll. a2,5D0 Dod. oEaCFVryf10N Of OrcnATiONSrLOCAT10NgNENICI.FrJSPECIAL ITEA15 Motor Truck Cargo-$1o0 000 aingltz conveyanco $100,000 pox disusLor $2,500 00 6b ~ erchange Agroo daducC3ble. Trailer Tn . mant $ ,0 .<::,...:....::~;..,:°~r,CANCELLAT[nN~ <.,..~~~: :; Q ~. (fir ~ ~ ~ w ~~, ~ b ~ DEPEN-2 sH0UL0 ANY OFTHE AnOVE DESCRIBED POLICIES D[ CANCELLED DEFORE THE EXPIRATION GATE THEREOF, THE ISSUING COMPANY\YILL ENDEAVOR TO t.fAll I 3 O PAYS WR117EN iJOT1CE TO THE CERTIFICATE HOLDER NAMED TO THE LCFT, Iv1 fie. ~ „~ ~ T I ~,.~, i3 ~ I ~ ~ DUT FAILURE TO MAtt, SUCH NOTICE SlUltl IMPOSE NO OBCIGAnON OR LIAOIUTY OF ANY 1(INO UPON THE COMPANY. ITS AGENTS OEZ RErREuENTATNES. ~p AUTt10RlZED REPRESENTATNE ~i ~ .-•>..... ,;~a:~':~n'~'tesrara~i?:x .: > ..,:~,:~..<.,.-,. ,...__. ..r............_.-_. glan J. 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