Exh 4Ar
AGENDA ITEM NO: A
COMMISSION MEETING DATE: ~ " Z ~' ~9
CITY OF ATLANTIC BEACH
CITY COMMISSION MEETING
STAFF REPORT
AGENDA ITEM: Chlorine and Sulfur Dioxide for Water/Wastewater Treatment Plants
Bid No. 9899-24
SUBMITTED BY: Robert S. Kosoy, P.E., Public Works Director ~~.~
DATE: June 21, 1999
BACKGROUND: The project is to provide an annual contract for providing chlorine and sulfur dioxide
to the City for use~in the water and wastewater treatment facilities. Chlorine is used for disinfection of
treated wastewater and for disinfection of drinking water. Sulfur dioxide is needed to dechlorinate the
wastewater effluent, as chlorine is toxic to aquatic organisms in the receiving stream. The use of both
chemicals is required per our Department of Environmental Protection permits.
Two bids were received by the Awards Committee on June 9, 1999, for Chlorine and Sulfur Dioxide, City
Bid No. 9899-24. The low bidder was Allied Universal Corporation, with an annual cost of $25,924.50,
based on our estimated usage. However, Allied Universal's bid was incomplete, as they failed to submit
acknowledgment of receipt of Addendum Number 1, and a copy of their Year 2000 Compliance Statement.
The second bidder, Jones Chemical, Inc. submitted all required documents, with a bid of $26,687.50.
RECOMMENDATION: Approve the bid of Jones Chemical, Inc. in the amount of $26,687.50 and
authorize the City Clerk to send notification of award to the bidder.
ATTACHMENTS: 1.
2.
3.
Bid Tabulation Form
Bid Specifications
Addendum Number 1
RE'~WED BY CITY MANA
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CITY OF ATLANTIC BEACH
INVfTATION TO BID
BID NO. 9899-~4
Notice is hereby given that the City of Atlantic Beach, Florida, tivill receive sealed bids, IN
TRIl'LICATE, in the Office of the Purchasing Agent, 1200 Sandpiper Lane, Atlantic Beach,
Florida 32233, until 2:30 P.FI., Wednesday, June 9, 1999, for CHLORINE AND SULFUR
DIOXIDE FOR WATER/WASTEWATER TREATML-NT PLANTS FOR TWELVE (12)
MONTHS. Thereafter, at 3:00 P.M., the bids will be opened in the City Hall Commission
Chambers, 800 Seminole Road, Atlantic Beach, Florida.
Bids shall be enclosed in an envelope endorsed "BID N0.9899-24 -CHLORINE AND SULFUR
DIOXIDE FOR WATER/WASTEWATER TREATMENT PLANTS FOR TWELVE (12)
F10NTHS, TO BE OPENED AT 3:00 P.M., WEDNESDAY, June 9, 1999."
A MANDATORY PRE-BID MEETING will be held on Wednesday, May 26, 1999 at 2:00 P.M.,
at the Buccaneer Utility Office at 902 Assisi Lane, Jacksonville, Florida 32233. A SITE VISiT
to all the delivery locations specified is required prior to the Pre-Bid Fleeting. Contact Tim
Townsend at 904-247-5842 for an appointment to visit the Atlantic Beach facilities (Water Plant
Nos. 1 and 2, Wastewater Plant No. 1), and contact Harry Mci`lally at 904-247-5838 for an
appointment to visit the Buccaneer Utility District facilities (Water Plant Nos. 3 and 4,
Wastewater Plant No. 2).
Bidding Documents, specifications and information regarding the bid may be obtained from the
Office of the Purchasing Agent, 1200 Sandpiper Lane, Atlantic Beach, Florida, 32233, telephone
(904) 247-5818.
DOCUivtENTS REQUIRED TO BE SUBMITTED IN BID PACKAGE AT B1D OPENiNG•
I. ORIGINAL Insurance Certificates (copies, Xeroxes, and facsimiles are
UNACCEPTABLEI, naming the City of Atlantic Beach as Certificate Holder, sho~~inQ
they have obtained and will continue to carry Workers' Compensation, public and private
liability, and property damage insurance durinu the life of the contract.
2. Three (3) references from companies or individuals to whom the bidder has provided
chlorine and sulfur dioxide for the past I2 months. However, naming the City of Atlantic
Beach as a reference on past completed projects is UNACCEPTABLE.
3. Proof of Occupational License.
4. Bid submitted in tri~iicate.
5. Acknowledgment of receipt of any addenda.
6. List of Drivers with Commercial Driver License.
7. Certification of Drivers' training for Process Safety Flanagement, FDOT shipping and
handling of chlorine and sulfur dioxide, and respiratory protection.
8. Last two years of OSHA 2001ogs.
9. Signed copy of Documents Requirements Checklist.
ITB-1
Bid prices shall remain valid for ninety (90) days after the public opening of the bids. Goods
and services proposed shall meet all requirements of the Ordinances of the City of Atlantic
Beach. The City of Atlantic Beach reserves the right to reject any and alI bids or pacts of bids,
waive informalities and technicalities, make award in whole or in part with or without cause,
and to make the award in what is deemed to be in the best interest of the City of Atlantic Beach.
Under no circumstances should any prospective proposer or any person or persons acting for or
on behalf of the said prospective proposer, seek to influence or gain the support of any member
of the City Council or the City Stafffavorable to the interest of any prospective proposer or seek
to influence or gain the support of any member of the City Council or City Staff against the
interest of any prospective proposer. Any such activities shall result in the exclusion of the
prospective proposer from consideration by the City.
A person or affiliate who has been placed on the convicted vendor list following a conviction for
a public entity crime may not submit a~bid on a contract to provide any goods or services to a
public entity, may not submit a bid on a contract with a public entity for construction or repair of
a public building or public work, may not submit bids on leases of real property to a public
entity, may not be awarded or perform work as a contractor, supplier, subcontractor, or
consultant under a contract with any public entity, and may not transact business with any public
entity in excess of the threshold amount provided in Section 287.017 for a period of 36 months
from the date of being placed on the convicted vendor list. (Section 287.133(2), FLORIDA
STATUTES).
Joan LaVake
Purchasing Agent
ITB-2
DRUG FREE WORKPLACE COMPLIANCE FORM
IDENTICAL TIE BIDS -Preference shall be given to businesses with drug-free workplace
programs. Whenever two or more bids which are equal with respect to price, quality, and
service are received by the State or by any political subdivision for the procurement of
commodities or contractual services, a bid received from a business that certifies that it has
implemented adrug-free workplace program shall be given preference in the award process.
Established procedures for processing tie.bids will be followed if none of the tied vendors have a
drug-free workplace program. In order to have adrug-free workplace program, a business shall:
10) Publish a statement notifying employees that the unlawful manufacture, distribution,
dispensing, possession, or use of a controlled substance is prohibited in the workplace
and specifying the actions that will be taken against employees for violations of such
prohibition.
2) Inform employees about the dangers of drug abuse in the tivorkplace, the business' policy
of maintaining a drums free workplace, any available drug counseling, rehabilitation, and
employee assistance programs, and the penalties that may be imposed upon employees
for drus abuse violations.
3) Give each employee engaged in providing the commodities or contractual services that
are under bid a copy of the statement specified in subsection (1}.
4) In the statement specified in subsection (1), notify the employees that, as a condition of.
working on the commodities or contractual services that are under bid, the employee will
abide by the terms of the statement and will notify the employer of. any conviction of, or
plea of guilty or nolo contenders to, any violation of chapter 893 or of any controlled
substance law of the United States or any state, for a violation occurring in the workplace
no later than five (5) days after such conviction.
5) Impose a sanction on, or require the satisfactory participation in a drug abuse assistance
or rehabilitation program if such is avaiIable in the employees' community, by any
employee who is so convicted.
6) ivl~e a good faith effort to continue to maintain adrug-free workplace through
implementation of this section.
As the person authorized to sign the statement, I certify that this firm complies fully tivith the
above requirements.
VENDOR'S SIGNATURE
' ~ April 20,1999
CITY OF ATLANTIC BEACH
X200 SANDPIPER LAiYE
ATLANTIC BEACH, FLORIDA 32233
(904) 247-5834
1.0 CONTRACT -Chlorine and Sulfur Dioxide for Water/'tiVastewaterTregtment
Plants -Annual Contract
I.1 Resulting Contract
It is the intention of the City of Atlantic Beach to retain one contractor to supply chlorine
and sulfur dioxide.
Any agreement or contract resulting from acceptance of a bid shall be on forms either
supplied by or approved by the City and shall contain, as a minimum, applicable
provision of the request for bid The City reserves the right to reject any agreement
which does not conform to the Request For Bid and any City requirements for
agreements and contracts.
1.2 Renegotiation
During the contract period, the City reserves the right to restate and/or renegotiate with
the Contractor such additions, deletions, or changes to the contract as may be
necessitated by Iaw or changed circumstances. In the event that the City and the
Contractor cannot come to a mutual agreement and negotiation on any such addition,
deletion or change, that portion of the contract concerning the services in the addition,
deletion, or change shall be terminated.
1.3 C.'ontractor Contract Performance
During the contract period, the Public Works Director or their designee shall
assess the Contractor's performance on the contract and reserves the right to inspect the
Contractor's materials and methods during any specific project. In the event of a breach
of the contract by the Contractor or unsatisfactory performance as assessed by the Public
Works Director, or if the Contractor performs in a manner that precludes the City from
administering its functions in an effective and efficient manner, and if, after (30) davs
follotiving written notice to the Contractor, the City shall be authorized to cancel the
contract, thereafter reserving the right to proceed against the Contractor for any and alI
damages permitted by Iaw arising from said breach. The Contractor shall not be held
responsible for any failure determined to the satisfaction of the Public Works Director to
be due to any action or inaction on the part of the City.
Page 1
I.4 Tax Identification Number
Bidder must note Federal Employer I.D. Number on bid summary form. The City's
Federal Employer I.D. Number is 59-60000267.
I.S. Intent and Duration
It is the intent of the City to select one contractor to provide chlorine and
sulfur dioxide needed for the City's Water and Wastewater Treatment
Plants. The objectives are to obtain the best services while minimizing cost
to the City.
The period of the contract for'chlorine and sulfur dioxide shall commence
within thirty (30) days of selection of the Contractor and shall terminate on one
(1) year after the date of commencement. The City reserves the right to renew
the contract for two additional one-year periods pending a mutual agreement
bettiveen the City and the Contractor, and a review of contract per#'ormance by
the Contractor for the previous year.
Prices, terms and conditions shall remain firm through this contract period
unless modified or canceled in accordance with the provisions of the bid. Bids
shall be received unti12:30 P.M.. June 9. 1999. at the office of the Purchasing
Agent at 1200 Sandpiper Lane. V
I.6 cheduie for Selection
May 26, 1999 -Mandatory Pre-Bid Meeting
2:00 P~'~I.
June 9, 1999 ,
-Receive Bids Prior to 2:30 P.I~I. .
June 28, 1999 -Anticipated Conunission Approval
June 28, 1999 - Anticipated Implementation Date of Contract
June 28, 2000 -Anticipated Termination of Contract
1.7 id Forms
Bids aze to be submitted on the attached Bid Summary Form or copies thereof.
Bids will not be considered unless they are submitted on this form.
It shall be assumed that services which are offered, meet or exceed the
requirements as stated in the accompanying specifications. This Bid Invitation
presents the City's requirements under proposed methods of operation.
Responses to this request should address these requirements.
Page 2
1.8 The Citv's Riuht to Use Other Contractors:
The City reserves the right to provide for additional services from other
contractors, if the City so deems necessary. If the City elects to exercise this
right, the contract covered by the bid shall remain in effect as regards all terms,
agreements and conditions without penalty or diminution of ongoing services as
contained therein and previously provided by the successful Contractor in this
bid.
2.0 SriFETY REQUIItEMENTS
2.1 Compliance with safety requirements shall be a primary criterion in the
selection of the contractor. '
2.2 The Contractor shall provide the City with copies of the last two years' OSHA
200 logs.
2.3 All applicable requirements 'of the following federal regulations shall be met by
the Contractor:
• DOT, Department of Transportation chemical shipment, 49 CFR 171 to 179
• OSHA, Occupational Safety and Health Administration, Process Safety
Management 29 CFR 1910.119 .
• OSHA, Occupational Safety and Health Administration, Hazard Communication
29 CFR 1200.
• EPA, Environmental Protection Agency, Risk Ivlanagement Program 40 CFR 68
3.0 GE~~ERA.L REQUIl2EitiIENTS
3.1 The City intends to apply very strict requirements for timely delivery, hivh
quality product, accurate invoicing and more specific requirements as will be
necessary.
3.2 Bidder shall furnish cylinders and containers on loan basis tivithout charve.
4.0 SPECIFIC REQUIl2EitiIENTS
4.1 PRODUCT QUALITY
4.1.1 The Chlorine shall be Industrial Grade Chemical, minimum ninety-nine percent
{99%) purity. Chlorine must be certified to meet ANSUNSF Standard 60.
Page 3
4.1.2 The Sulfur Dioxide shall be Industrial Grade Chemical, minimum ninety-nine
percent (99%} purity.
4.1.3 A Certif Cate of Analysis for the product shall be provided with each shipment
of chlorine and/or sulfur dioxide.
4.1.4 All processing of both containers and chemicals shall meet Chlorine Institute
specifications for quality and safety.
4.1.5 Any cylinders or containers discovered to be defective shall be immediately
removed from City premises by the Vendor, and a credit issued to the City.
4.2 DELIVERY
4.2.1 Individual acceptance orders tivill be issued from time to time as supplies are
needed during the period of this contract.
4.2.2 All deliveries shall be made to the specified location within twenty-four (24)
hours after receipt of individual orders.
4.2.3 All deliveries shall be made bettiveen the following hours only:
Between the hours of 7:30 a.m. and 11:00 a.m.
Behveen the hours of 1:30 p.m. and 4:00 p.m.
4.2.4 Delivery locations include water and wastewater treatment facilities as foIlo~vs:
Water PIant No. I
Water Plant No. 2:
Water Plant No. 3:
1~Vater Plant No. 4:
Wastewater Plant No. 1
tiVastewater Plant No. 2
469 1 l~' St., Atlantic Beach, >~I.32233
2301 lvfayport Rd. Atlantic Beach, FL 32233
902 Assisi Ln., Jacksonville, FL ;22;3
2348 Mayport Rd., Jacksonville, FL, 32233
1100 Sandpiper Lane, Atlantic Beach, FL 3233
739 Wondenvood Rd., Jacksomzlle, FL 32233
4.2.E The requested number of full containers of chlorine and~or sulfur dioxide shall
be delivered, and all empty containers of chlorine and/or sulfur dio:cide shall be
removed at time of delivery. Under no circumstances shall additional
containers of chlorine, sulfur dioxide or other chemicals not requested by the
City be left at any of the facilities.
4.2.6 Delivery vehicles shall be sized, equipped, maintained, inspected and marked to
meet all local, state and federal regulations for land transportation of chlorine
and sulfur dioxide.
Page 4
4.2.7 Delivery vehicles shall be equipped at a minimum with a hydraulic liftgate, with
minimum 3 ton capacity, complete with hydraulic outriggers. Preferred vehicle
equipped with Lift boom arm tivith outriggers.
4.2.8 Delivery vehicle shall be of proper size to allow safe entry, exit, loading and
unloading at each specific site.
4.2.9 All shipping and handling of chlorine and sulfur dio:cide to be in conformance
with specif cations in The Chlorine 11~Ianzral, 6`~ Edition, Pamphlet 76, published
by The Chlorine Institute, Inc.
4.3 DRIVER QUALIFICATIONS
4.3.I Vendor must provide a list ofDrivers holding current, valid, required
Commercial Driver Licenses.
4.3.2 Drivers shall be certified through the Florida Departrnent of Transportation
(FOOT) in the shipping and handling of chlorine and sulfur dio:cide. Vendor
shall provide documentation.ofdrlver certification.
4.3.3 Drivers shall be trained in Process Safety Management (OSHA 29 CFR
1910.119C) and Risk Management Program (EPA 40 CFR 68.87) regarding the
shipping and handling of chlorine and sulfur dio:cide. Vendor must provide
documentation of driver training in Process Safety Management/Risk
Nfanagement. A copy of the OSHA Contractor Requirement is attached.
4.3.4 Drivers shall be trained in the use of respiratory protection, and shall have
respiratory protection equipment available in vehicle during delivery. Vendor
shall provide documentation of driver training in respiratory protection.
4.3.5 On the initial delivery to each plant site, and every year thereafter, each driver
shall be trained by City personnel in Site Specific Emergency Policies and
Procedures.
5.0 ESTIMATED QUANTITIES AND BID A`W'ARD
The City reserves the right to increase or decrease the following estimated quantities by
as much as needed, to meet the actual needs of the City during the 1.2 Month Contract
period. The bid will be awarded based on lowest total annual cost for all items, using
the bidder's~unit~~price~times the~estimated annual quantities. ~:~
Page S
DESCRIPTION. ESTIMATED QUANTITY
Chlorine, Liquid in 1-Ton Container 50 Tons
Chlorine, Liquid in 150 Pound Cylinders 25 Cylinders
HTH (Granular Chlorine), 100 Pound Containers 20 Containers
Sulfur Dioxide, Liquid in I.-Ton Container 25 Tons
~.
Page 6
BID SCHEDULE
,item Unit Price Estimated Total Annual Cost
Quantity
Chlorine, Liquid in 1-Ton 50 Tons
Containers
Chlorine, Liquid in 150 Pound 25 Cylinders
Cylinders
HTH (Granular Chlorine), 100 20 Containers
Pound Containers
Sulfur Dio;~ide, Liquid in 1-Ton 25 Tons
Containers
TOTAL A.I~UAL COST
FOR ALL ITEMS
SUBivIITTAL:
NAME OF COMPANY (BIDDER)
BUSINESS ADDRESS
CITY, STATE & ZIP CODE
DATE:
~,
' BY:
SIGNATURE
TITLE
TELEPHONE:
FAX N0:
BIDDER'S FEDERAL Eti1PLOYER I.D. NUMBER:
Page 7
CITY OF ATLANTIC BEACH
AOCIJIylE~N1' REOUTREIVIENTS CHECKLIST
^ 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 or provided a product 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 projects is UNACCEPTABLE.
^ Proof of Occupational License (copies ARE acceptable)
^ Bid submitted IN TRIPLICATE (three (3) sets).
^ Acknowledgment of receipt of any addenda.
^ List of Drivers with Commercial Driver License.
^ Certification of Drivers' training for Process Safety Management,
FDOT shipping and handling of chlorine and sulfur dioxide, and
respiratory protection.
^ Last rivo years of OSHA 200 logs.
^ Sued copy of Documents Requirements Checklist.
Signature Date
Page 8
Form 'lIV-9 Request for Taxpayer Give form to the
(Rev. December 7996) Identification Number and Certification requester. Do N07
Department or Ne Treasury send to the IRS.
Internal Revenue Service
Name (If a joint account or you changed your name, see Specific Instructions on page Z.1
a
T
Business name, if different from above. (See Specific Inswctions on page 2.)
0
c
,n Check appropriate box: ^ Individual/Sole proprietor [] Corporation ^ Partnership ^ Other Y ,,,,,,,,,,,,,,,,,,,,,,,,,,,,
..........
N Address (number, street. and apt. or suite no.) Requester's name and address (optional)
n
r,
a
City. state, and 21P code
Tax a er Identification Number (TIN) list account number(s) here (optional)
Enter your TIN in the appropriate box. For
individuals, this (s your Social security number Social security number
(SSN). However, if you are a resident alien OR a
sole proprietor, see the inswctions on page 2.
For other entities, it is your employer OR For Payees Exempt From Backup
identification number (EIN}. If you do not have a Withholding (Sep the instructions
number, see Now To Get a TIN on page Z. Employer identification number on page 2.)
Note: If the account is in more than one name,
see the chart on page 2 for guidelines on whose
number to enter. )•
Certification
Under penalties of perjury, l certify that:
7. The number shovm on this form is my correct taxpayer identification number (or I am waiting ter a number to be issued to me), and
2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, cr (b) I have not bean noti ied by the.lnternal
Revenue Service (IRSJ that I am subject to backup withholding as a result of a failure to report all interest cr dividends, cr (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 su~iect 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 mortoaee 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 Sian the Certification, but you must
provide your correct TIN. (See the instructions on page 2.)
Sign
Here Signature Y Date )•
Purpose of Form.-A person who is
required to file an information return with
the IRS must get your correct taxpayer
identification number (TIN) [o 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 fnade 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 TIN you are giving is
correct (or you are walling 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 ocher
than a W-9 to request your TlN, you must
use the requester's (orm if it is substantially
similar to this Form W-9.
What is Backup Withholding?-Persons
making certain payments to you must
withhold and pay to the 1RS 31% of such
payments under certain conditions. This is
~Iled 'backup withholding." Payments
chat may be subject to backup withholding
include interest, dividends, broker and
boner 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 wilt be
subject to backup withholding if:
1. Yau do not furnish your TIN to the
requester, or
2. The IRS tells the requester that you
furnished an incorrect TIN, or
3. The 1RS tells you that you are subject
to backup withholding because you did not
report all your interest and dividends an
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 ~.vhen
required. See the Part III instructions on
page 2 for details.
Certain payees and payments are
exempt from backup withholding. See the
Part ll instructions and the separate
Instructions for the Requester of Form
VJ-9.
Penalties
Failure To Furnish TlN.-(! 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 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 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.-If the requester
discloses or uses TINS in violation of
Federal law, the requester may be subject
to civil and criminal penalties.
Cat. No. 70237X Form W-9 (Rev. 72.96)
Form W-9 (Rer. 72.96)
• _ Page 2
Specific Instructions
Name.-If you are an individual, you must
generally enter the name shown on your
social security card. However, if you have
changed your last name, for instance, due
to marriage, without informing the Social
Security Administration of the name
change, enter your first name, the Iasi
name shown on your social security card,
and your ne~nr last name.
If the account is in joint names, list first
and then circle the name of the person or
entity whose number you enter in Part I of
the form.
Sofe Proprietor.-You must enter your
individual name as shown on your social
security card. You may enter your
business, trade, or "doing business as"
name on the business name line.
Other Entities.-Enter the business name
as shown on required Federal tax
documents. This name should match the
name shovrn on the charter or other legal
document creating the entity. You may
enter any business, trade, or "doing
business as" name on the business name
line.
Part I-Taxpayer Identification Number
(TIN)
You must enter your TIN in the appropriate
box. If you are a resident alien and you do
not have and are net eligible to get an
SStV, your TIN is your IRS individual
taxpayer identification number (ITIN), Enter
it in the social security number box. If you
~o not have an ITIN. see Now To Ge[ a
1N be!ovr.
If you are a sale proprietor and you have
an EIN, you may enter either your SSN or
EIN. No~vever, using your EIN may result in
unnecessary notices to the requester.
Note: See the chart on this page for further
clari~catfon of name and T!N combinations.
How To Get aTIN.-if you do not have a
TIN, apply for one immediately, To apply
for an SSN, get Form SS-5 from your focal
Social Security Administration office. Get
Form W-7 to apply for an ITIN ar Form
SS-d to apply for an E1N, You can get
Forms'r+f-7 and SS-d from the IRS by
calling 1-800-TAX-FORM
(1.800-829-3676).
ff you do not have a T1N, vrrite "Applied
For" in the space for the TIN, sign and
date the form, and give it to the requester.
For interest and dividend payments, and
certain payments made with respect to
readily tradable instruments, you will
generally have 60 days to get a TIN and
give it to the requester. Other payments
are subject to backup withholding.
Note: Writing Applied For" means That
you have already applied fora T1N OR that
you intend to apply for one soon.
Part II-For Payees Exempt From
Backup Vthholding
Individuals (including sole proprietors) are
not exempt from backup withholding.
Corporations are exempt from backup
withholding for certain payments, such as
interest and dividends. For more
information on exempt payees, see the
separate Instructions for the Requester of
Form W-9.
If you are exempt from backup
withholding, you should still complete this
form to avoid possible erroneous backup
withholding. Enter your correct TIN in Part
I, write "Exempt" in Part II, and sign and
date the form.
tf you are a nonresident alien or a foreign
entity not subject to backup withholding,
give the requester a completed Form W-8,
Certificate of Foreign Status.
Part Ill-Certification
For a joint account, only the person whose
TIN is shovrn in Part I should sign (vrhen
required).
1. Interest, Dividend, and Barter
Exchange Accounts Opened Before 1984
and Broker Accounts Considered Active
During 1983. You must give your correct
TIN, but you do not have to sign the
certification.
2. Interest, Dividend, Broker, and
Barter Exchange Accounts Opened After
1923 and Broker Accounts Considered
Inactive During 1923. You must lion the
certification or backup withholding will
apply, If you are subject to backup
withholding and you are merely providino
your correct TIN to the requester, you must
cross out ite.•n 2 in the certification before
signing the form.
3. Real Estate Transactions. You must
sign the certification. You may cross cut
item 2 of the certification.
4. Other Payments. You must give your
correct TIN, but you do not have to sign
the certification unless you have been
notified that you have previously given an
incorrect 7IN, "Other payments" include
payments made in the course of the
requester's Vade or business for rents,
royalties, goods (other than bills for
merchandise), medical and health care
services (ncluding payments to
corporations), payments to a nonemployee
far services (including attorney and
accounting fees), and payments to certain
fishing boat crew members.
5. Mortgage Interest Paid by You,
Acquisition or Abandonment of Secured
Property, Cancellation of Deht, or IRA
Contributions. You must give your correct
TIN, but you do not have to sign the
certification.
Privacy Act Notice
Section 6109 of the Internal Revenue Code
requires you to give your correct TIN to
persons who must file information returns
with the 1RS to report interest, dividends,
and certain other income paid to you,
mortgage interest you paid, the acquisition
oc abandonment of secured property,
cancellation of debt, or contributions you
made to an IRA. The IRS uses the
numbers for identification purposes and to
help verify the accuracy of your tax return.
The 1RS may also provide this information
to the Department of Justice for civil and
criminal litigation and to cities, states, and
the District of Columbia to carry out their
tax laws.
You must provide your TIN whether or
not you are required to file a tax return.
Payers must generally vrithhold 31% of
taxable interest, dividend, and certain other
payments to a payee vrho does not give a
TIN to a payer. Certain penalties may also
apply,
What Name and Number To
Give the Requester
For this type of account:) Give name and SS,`t of:
1. individual The individual
2. Twa or mare The actual ovmer or the
individuals (joint accwnt or, if comCine•~
account) funds. L.e first individual
on trz account '
3. Custodian accwnt ar The miner r
a manor (Uniform Gitt
to 1.tinors AC.)
4. a. The usual The granter-trustee '
rev«aCle savings
oust (grantor is
also trust[::)
C. So•eallef. Vust The .;c:ual ev:rw_• '
ae:wnt trot is net
a legal or valid uus•
under state la:v
=. Sole praprietc:snip The c:yrer r
Fcr tt;is tjpe of account: I Give :.ar,.e and E)N oL•
6. Sole proprietusnip Tta cwrtt '
7. A valid trust. e<ate. a Lecal enuty'
pension vus2
e. Corpcvato Tne rrrcra;ion
°. nS50C:aflOn, club. The crcan:za:.cn
religious. ehari:atte,
r'ucatlorwl, or ocher
tax-exempt
CrCaniIatJOn
10. Partnership The part~e ~ tip
t t. A broker or regrs:ered The Crcr.er cr r;,minee
nominee
1:. ACCwnf x•ith the The p~"1K eraty
Dt:~arttnent or
Agriculturo in tno name
of a public entity (such
as a state or 1«0l
government sthool
district. or prison) that
receives agricVlttraf
procram payments
~ List first and circle the name of the person whose
ru:mber you furnish, tf only one person on a joint
account rtins an SSN, that person's rx:mter must Lr:
furnished.
Circe the minor's name and furnish t.'k miner's SSN.
'You must show your individual tome, but you may also
enter your Cosiness or 'doing business as' name. You
may use either your SsN or EIN (! yw nave one).
Ust Mai and circle the name or the legal true, estate,
or pension trust (Do not furnish the T1N of the personal
rrpresentativo or trustee unless the Legal entity itself is
not des mated in tho account fide.)
Note: !! no name rs circled when more than one
name is listed, the number will be considered to
be that or the r+rst name listed.
CITY OF ATLANTIC BEACH
BID NO A899-24
CHLORINE AND SULFUR DIOXIDE FO~2 WATER/WASTEtiVATER TREATIZENT
PLANTS FOR TWELVE MONTHS
ADDENDUM NO. I
Add Section 3.3 Bidder shall furnish a statement of Year 2D00 Compliance to City with bid
documents.
CITY OF ATLANTIC BEACH
DOCUMENT REOUIl2EMENTS CHECKLIST
^ BID BOND (If required on this project)
^ 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 or provided a product 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 projects is UNACCEPTABLE.
^ Proof of Occupational License (copies ARE acceptable)
^ Bid submitted IN TRIPLICATE (three (3) sets).
^ Acknowledgment of receipt of any addenda.
^ List of Drivers with Commercial Driver License.
^ Certification of Drivers' training for Process Safety Management,
FDOT shipping and handling of chlorine and sulfur dioxide, and
respiratory protection.
^ Last rivo years of OSHA 200 logs.
^ Signed copy of Documents Requirements Checklist.
^ Year 2000 Compliance Statement.
Signature Date
Page 8