HomeMy WebLinkAboutResolution - 2018-R0250 - Shannon Chemical Corporation - 08/09/2018Resolution No. 2018-RO250
Item No. 6.7
August 9, 2018 RESOLUTION
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK:
THAT the Mayor of the City of Lubbock is hereby authorized and directed to execute for
and on behalf of the City of Lubbock, Contract No. 14213 for Water Treatment Facilities —
Treatment Chemicals as per ITB 18-14 15 1 -JM, by and between the City of Lubbock and Shannon
Chemical Corporation, of Malvern, Pennsylvania, and related documents. Said Contract is
attached hereto and incorporated in this resolution as if fully set forth herein and shall be included
in the minutes of the City Council.
Passed by the City Council on Aupust 9, 2018
DANIEL M. POPE, MAYOR
ATTEST:
R,b,a +G,-a,?,t—y�ecrctary
APPROVED AS TO CONTENT:
CDMM---) -
ca McEachern, Assistant City Manager
APPROVED AS TO FORM:
vw:ccdocstRES.Contract 14213.WaterTremment Facilities - rreatment Chemicals
07.24.2018
Cheryl Brock
Changed On Description Before After Current Balance Cost of GoocUSerinces, Additional Info
OW11-018
Approved User ID
[none]
Back, Cheryl
$3.038,432si)
$410,939.M
Item Review (Budget Director)
0812W2018
Completed
No
Yes
$3,038,432.80
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0812117.018
Complete Date
[none]
MWO18
$3.038,432,80
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Item Review (Budget Director)
0812112018
Item Review Status ID
Und.,R.vi.
Approved
$3.038,432.80
$410,939.00
Item Review (Budget Director)
OMI/7018
Passed
No
Yes
S3.038.432.110
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here Review (Budget Director)
Owl,2018
St.W.CluingedDat.
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mirzals
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$410,909.00
ftern Review (Budget Director)
Josica McEachern
Changed 0.
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Before
After
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Cost of Good/Services
Additional Into
08�D,2018
Approved User ID
[none]
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08r0/2D18
Completed
No
Yes
$3,038.432.80
$410,939�W
Item Review (Assistant COY ManagerrCFO)
OWDILDIII
Complete Date
[now]
82112018
$3,038.432all
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Item Review (Assistant City Marager1CFO)
08/20/ZD18
Item Review Status ID
Under Review
Approved
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Item Review (Assistant City Manager1CFO)
ollaoi-018
Passed
No
Yes
$3,038,432.8a
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Item Review (Assistant City ManagerCFO)
OW0,2018
StatusChanedDate
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081231-018
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[no.]
Morrison, Lamey
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Item Review (Risk Management Coordinator)
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Completed
No
Yes
$3,038.432ZO
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Item Review (Risk Management Coordinator)
OM3,7018
Complete Date
(none]
W=018
$3,038.432.80
S410.9WOO
Item Review (Risk Management Coordinator)
OW312018
Item Review Status ID
Under Review
Approved
$3,038.432.80
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Item Review (Risk Management Coordinator)
OM3/2018
Passed
No
Yes
$3,038.432,80
$410,939,00
Item Review (Risk Management Coordinator)
08a3/2018
StatusChangedDate
[none]
82=018
$3,038,432.80
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Item Review (Risk Management Coodinator)
Augusl23.2018 Page 1 of I
Resolution No. 2018-RO250
Contract 14213
City of Lubbock, TX
Contract For
Water Treatment Facilities — Treatment Chemicals
THIS CONTRACT made and entered into this 21L day of August , 20189 by and between the
City of Lubbock ("City"), and Shannon Chemical Corporation, ("Contractor").
WITNESSETH:
WHEREAS, the City of Lubbock duly advertised for bids for Water Treatment Facilities -
Treatment Chemicals and bids were received and duly opened as required by law; and
WHEREAS, after careful consideration of the bid submitted by Contractor, the City authorized
the execution, in the name of the City of Lubbock a contract with said Contractor covering the purchase
and delivery of the said Water Treatment Facilities - Treatment Chemicals.
NOW, THEREFORE, in consideration of the mutual agreement contained herein, as well as the
financial consideration hereinafter referred to, the parties hereby covenant and agree as follows:
1. In accordance with City's general conditions and Contractor's bid, copies of which are attached
hereto and made part hereof, Contractor will deliver to the City, Treatment Chemicals for Water
Treatment Plants, and more specifically referred to as Item four on the bid submitted by the
Contractor or in the specifications attached hereto.
2. The City promises and agrees to employ, and does employ, the Contractor to cause to be done
the work provided for in this Contract and to complete and finish the same according to the
attached specifications, offer, and terms and conditions contained herein.
3. The Contractor shall perform the work according to the procedures outlined in the Bid Form
General Conditions, and Specifications attached hereto. The contract shall be for a term of one
year with the option of four, one year extensions said date of term beginning upon formal
approval. The City of Lubbock does not guarantee any specific amount of compensation, volume,
minimum, or maximum amount of services under this proposal and resulting contract. The
Contractor must maintain the insurance coverage required during the term of this contract
including any extensions. It is the responsibility of the Contractor to ensure that valid insurance
is on file with the Purchasing and Contract Management Department as required by contract or
contract may be terminated for non-compliance.
4. This contract shall remain in effect until the first of the following occurs: (1) the expiration date,
(2) performance of services ordered, or (3) termination of by either party with a 30 day written
notice. The City of Lubbock reserves the right to award the canceled contract to the next lowest
and best bidder as it deems to be in the best interest of the city.
5. Contractor shall at all times be an independent contractor and not an agent or representative of
City with regard to performance of the Services. Contractor shall not represent that it is, or hold
itself out as, an agent or representative of City. In no event shall Contractor be authorized to
enter into any agreement or undertaking for or on behalf of City.
6. The contractor shall obtain and maintain in full force and effect during the term of the contract,
commercial general liability coverage with insurance carriers admitted to do business in the State
Texas. The insurance companies must carry a Best's Rating of A- VII or better. The policies will be
written on an occurrence basis, subject to the following minimum limits of liability:
INSURANCE COVERAGE REQUIRED
TYPE OF INSURANCE COMBINED SINGLE LIMIT
GENERAL LIABILITY
® Commercial General Liability ❑ Other General Aggregate $1,000,000
❑ Claims Made ® Occurrence Products-Comp/Op AGG x
❑ W/Heavy Equipment ❑ XCU Personal & Adv. Injury x
❑ To Include Products of Complete Operation Endorsements Contractual Liability x
AUTOMOTIVE LIABILITY
® Any Auto ❑ All Owned Autos Per Occurrence $1,000,000
® POLLUTION $1,000,000
® WORKERS COMPENSATION —STATUTORY AMOUNTS OR OCCUPATIONAL MEDICAL AND DISABILITY
® EMPLOYERS' LIABILITY $1,000,000
OTHER: COPIES OF ENDOSEMENTS ARE REQUIRED
® City of Lubbock named as additional insured on AultolGeneral Liability on a primary and non-contributory basis.
® To include products of completed operations endorsement.
® Waiver of subrogation in favor of the City of Lubbock on all coverages, except
The City of Lubbock shall be named as additional insured on a primary and Non -Contributory basis on
Auto/General Liability, with a waiver of subrogation in favor of the City of Lubbock on all coverages.
Copies of all endorsements are required.
The contractor will provide a Certificate of Insurance to the City as evidence of coverage. The certificate
will provide 30 days' notice of cancellation, and under the cancellation section, the wording "endeavor
to" and "but failure to mail such notice shall impose no obligation or liability of any kind upon the
company, its agents or representatives" will be crossed out. A copy of the additional insured endorsement
attached to the policy will be included with the certificate.
The contractor shall also maintain workers compensation insurance in the statutory amount.
If at any time during the life of the contract or any extension, the contractor fails to maintain the required
insurance in full force and effect, all work under the contract shall be discontinued immediately. Any
failure to maintain the required insurance may be sufficient cause for the City to terminate the contract.
7. Neither the City nor the Contractor shall- assign, transfer or encumber any rights, duties or interests
accruing from this Contract without the written consent of the other.
8. The City reserves the right to exercise any right or remedy available to it by law, contract, equity, or
r I'll crv." sr% 1?!lilt..^.tl.on. 0,•• rf?I'll In .^^C1' ^.'t'r ??!1 ,III �Inl?S f` 1 1v1;Cf:11 n cm,?'
jurisdiction. i-urther, ilie City shall not be subject to any Arbitration process prier to exercising its
unrestricted right to seek judicial remedy. The remedies set forth herein are cumulative and not exclusive,
and may be exercised concurrently. To the extent of any conflict between this provision and another
provision in, or related to, this document, this provision shall control.
9. At any time during the term of the contract, or thereafter, the City, or a duly authorized audit representative
of the City or the State of Texas, at its expense and at reasonable times, reserves the right to audit
Contractor's records and books relevant to all services provided to the City under this Contract. In the
event such an audit by the City reveals any errors or overpayments by the City, Contractor shall refund
the City the full amount of such overpayments within thirty (30) days of such audit findings, or the City,
at its option, reserves the right to deduct such amounts owing the City from any payments due Contractor.
10. All funds for payment by the City under this contract are subject to the availability of an annual
appropriation for this purpose by the City. In the event of non -appropriation of funds by the City Council
of the City of Lubbock for the goods or services provided under the contract, the City will terminate the
contract, without termination charge or other liability, on the last day of the then -current fiscal year or
when the appropriation made for the then -current year for the goods or services covered by this contract
is spent, whichever event occurs first. If at any time funds are not appropriated for the continuance of
this contract, cancellation shall be accepted by the Seller on thirty (30) days prior written notice, but
failure to give such notice shall be of no effect and the City shall not be obligated under this contract
beyond the date of termination.
11. The Contractor shall not assign or sublet the contract, or any portion of the contract, without written
consent from the Director of Purchasing and Contract Management. Should consent be given, the
Contractor shall insure the Subcontractor or shall provide proof on insurance from the Subcontractor that
complies with all contract Insurance requirements.
12. This Contract consists of the following documents set forth herein; Invitation to Bid No.
18-14151-JM, Specifications, and the Bid Form.
13. Contractor acknowledges, by supplying any Goods or Services that the Contractor has read, fully
understands, and will be in full compliance with all terms and conditions and the descriptive material
contained herein and any additional associated documents and Amendments. The City disclaims any
terms and conditions provided by the Contractor unless agreed upon in writing by the parties. In the event
of conflict between these terms and conditions and any terms and conditions provided by the Contractor,
the terms and conditions provided herein shall prevail. The terms and conditions provided herein are the
final terms agreed upon by the parties, and any prior conflicting terms shall be of no force or effect.
14. HB 89 - The Contractor warrants that it complies with Chapter 2270, Subtitle F, Title 10 of the Texas
Government Code by verifying that:
(1) The Contractor does not boycott Israel; and
(2) The Contractor will not boycott Israel during the term of the Agreement.
15. SB 252 prohibits the City from entering into a contract with a vendor that is identified by The Comptroller
as a company known to have contracts with or provide supplies or service with Iran, Sudan or a foreign terrorist
organization.
INTENTIIONAL LEFF BLANK
IN WITNESS WHEREOF, the parties hereto have caused this Contract to be executed the day and
year first above written. Executed in triplicate.
CITY OF LUBBOCK
Daniel M. Pope, Mayor
ATTE-ST:
Reb4-ca Garza, City ScoretaryU
r -
AF P VED AfS /TOONTENT:
11
rey t, Dir-ec-t-o—r`orWater Utilities
Sr7q.
APPROVED AS T
"-I
'�ommm:7'ty City Azw--
CONTRACTOR
BY �)(- 2 /
Authorized Representative
Daniel C. Flynn
Print Name
P.O. Box 376
Address
Malvern, PA 19355
City, State, Zip Code
Revised:
BID FORM
Water Treatment Facilities — Treatment Chemicals
City of Lubbock, TX
ITB 18-141514M
In compliance with the Invitation to Bid 18-14151-JM, the undersigned Bidder having examined the Invitation to Bid and
Specifications, and being familiar with the conditions to be met, hereby submits the following Bid for furnishing the material,
equipment, labor and everything necessary for providing the items listed below and agrees to deliver said items at the locations
and for the prices set forth on this form. A bid will be subject to being considered irregular and may be rejected if it shows
omissions, alterations of form, conditional alternate bids, additions or alternates in lieu of the items specified, if the unit prices
are obviously unbalanced (either in excess of or below reasonably expected values), or irregularities of any kind. The Invitation
to Bid 18-14151-JM is by reference incorporated in this contract. The Bid Form must be completed in blue or black ink or by
typewriter.
QTY
UNIT OF
UNIT PRICE* BID
EXTENDED
Delivery
Days
ITEM
t/-)
MEASURE
DESCRIPTION
COST
ARO**
1.
30,000
Pounds
78.0% Sulfuric Acid
No Bid
For South Water Treatment Plant,
asspecified.
2.
927,830
Gallons
12.5% Sodium I lypochlorite
No Bid
All 3 Plant Facilities, asspecified.
3.
195,275
Gallons
Liquid Ammonium Sulfate 40%
No Bid
w/w
All 3 Plant Facilities, asspecified.
4.
24,500
Pounds
50.0% Citric Acid
For South Water Treatment Plant,
$0.834/#
$20,433.00
7-10
asspecified.
5.
2,056
Pounds
38.0% Sodium Bisulfite
For South Water Treatment Plant,
asspecified.
No Bid
6.
26,400
Pounds
50.0% Sodium I lydroxide
For South Water Treatment Plant,
No Bid
asspecified.
7.
949
Tons
Aluminum Sulfatc/Polymer Blend
No Bid
Total Cost (Items 1-7)
S20,433.00
*PRICE: F.O.B. Destination, Freight Pre -Paid and Allowed **Days after Receipt of Order (ARO)
Unless otherwise specified herein, the City may award the bid on an all -or -none basis.
The City of Lubbock is seeking a contract for Water Treatment Facilities - Treatment Chemicals with one or more
contractors. In order to ensure adequate coverage, the City may make multiple awards, selecting multiple vendors to
provide the products desired, if multiple awards are in the best interest of the City. A decision to make a multiple award
of this Bid, however, is an option reserved by the City, based on the needs of the City.
PAYMENT TERMS AND DISCOUNTS - Bidder offers a prompt payment discount of 0 %, net _ calendar 30 days.
Discounts will not be considered in determining low bid. Unless otherwise indicated on the Bid Form, payment terms will be
NET THIRTY DAYS. The City will pay the successful bidder within thirty days after the receipt of a correct invoice or after the
date of acceptance, whichever event occurs later. Discounts for prompt payment requiring payment by the City within a
stipulated number of days will be interpreted as applying within the stipulated number of calendar days after the date of receipt
by the City of a correct invoice or after the date of acceptance that meets contract requirements, whichever event occurs later.
Discounts for payment in less than ten days will not be considered.
MOST FAVOURED PRICING: The Bidder certifies that the price quoted is not in excess of the lowest price charged anyone
else, including its most favored customer, for like quality and quantity of the products/services; does not include an element of
profit on the sale in excess of thal normally obtained Ly the Bidder on llic sale of producbiNervices of like duality and
quantity; and does not include any provision for discounts to selling agents. If at any time during the contract period, the supplier
should sell or offer for sale to any other customer, an equal or less quantity of similar contract products of like or better quality,
at a lower net price(s) than provided herein, supplier agrees to notify the City and sell same product(s) at the lower price(s) on all
deliveries made during the period in which such lower price(s) is effective.
INTERLOCAL PURCHASING (optional): The City desires to make available to other local governmental entities of the State
of Texas, by mutual agreement with the successful bidder, and properly authorized interlocal purchasing agreements as provided
for by the Interlocal Cooperation Act (Chapter 791, Government Code), the right to purchase the same services, at the prices
quoted, for the period of this contract. Each bidder shall indicate on the Bid Form in the space provided below if he/she will
honor Political Subdivision orders in addition to orders from the City of Lubbock. Should these other governmental entities
decide to participate in this contract, would you (the bidder) agree that all terms, conditions, specifications, and pricing would
apply?
Other governmental entities that might have interests in this contract are Friendship Independent School District,
Lubbock Housing Authority, Lubbock County, Lubbock County Hospital District, Lubbock Independent School District,
South Plains Association of Governments, City of Texarkana, Texas Tech University, West Texas Municipal Power
Agency, Lynn County, and City of Wolfforth.
YES NO X
• Ifyou (the bidder) checked YES, the following will apply:
• Governmental entities utilizing Interlocal Agreements for Cooperative Purchasing with the City of Lubbock will be
eligible, but not obligated, to purchase materials/services under the contract(s) awarded as a result of this solicitation.
All purchases by governmental entities other than the City of Lubbock will be billed directly to that governmental entity
and paid by that governmental entity. City of Lubbock will not be responsible for another governmental entity's debts.
Each governmental entity will order their own materials/service as needed.
THIS BID IS SUBMITTED BY Shannon Chemical a corporation organized under the laws of the State of
Pennsylvania , or a partnership consisting of
of the City of
Firm: Shannon Chemical Corporation
or individual trading as
Address: P.O. Box 376
City: Malvern State: PA Zip 19355
Bidder acknowledges receipt of the following addenda:
Addenda No. 1 Date 06.28.18 Addenda No. 3 _ Date 07.02.18
Addenda No. 2 Datc 07.02.18 Addenda No. 4 Date 07.03.18
M/WBE Firm:
Woman I I Black American I I Native American
Hispanic American I I Asian Pacific Americ_ I Other (Specify)
By ID ( i / Date: 07/03/18
Authorized Representative - must sign by hand
Officer Name and ,l,itle: Daniel C. Flynn, V.P.-Operations
Please Print
Business Telephone Number.
610-363-9090
E-mail Address: dcflynn@shannonchem.com
FAX: 610-524-6050
FOR CITY USE ONLY
Bid Form Item Number(s) Awarded to Above Named Firm/Individual:
Date of Award by City Council (for biers over S25, 000): Date Y.O./Contract Issued:
RETURN COMPLETED & SIGNED BID FORM ALONG WITH CITY OF LUBBOCK SPECIFICATIONS.
LABEL THE OUTSIDE OF YOUR SEALED BID WITH THE ITB NUMBER, THE CLOSING DATE AND TIME,
AND YOUR COMPANY NAME AND ADDRESS.
Revised:
City of Lubbock, TX
Water Treatment Facilities — Treatment Chemicals
ITB 18-14151-JM
SPECIFICATIONS
SCOPE
It is the intent of these specifications to describe various chemicals and anticipated quantities of chemical products to be used
in the water treatment process at the City of Lubbock South Water Treatment Plant, North Water Treatment Plant, and Bailey
County Well Field.
PRODUCT SPECIFICATION
Treatment Chemicals purchased for use at the City of Lubbock South Water Treatment Plant, North Water Treatment Plant,
and Bailey county Well Field shall contain no soluble inorganic or organic substances capable of producing deleterious or
injurious effects upon the health of those consuming the water, or that would otherwise render it unfit for public consumption.
All treatment chemicals must have NSF/ANSI Certification for use in potable water treatment plants. Bidder shall submit a
certificate of analysis which will include the specific gravity and pH. The material safety data sheets (MSDS) for the product
and NSF/ANSI certification shall also be submitted with the bid. In any event, all products used must have NSF/ANSI
certification for use in drinking water treatment plants, any product bid that does not contain NSF/ANSI Certification will be
determined unusable and not be considered.
PRODUCT PERFORMANCE
Bidders must submit a list with a minimum of three (3) potable water treatment plants with phone numbers and contact
persons that are currently using the product(s). References will be thoroughly checked and will figure prominently into the
selection of a successful bidder.
PRODUCT QUALITY PER LOAD
Upon delivery of each load of product, the transport driver must present a certificate of analysis containing specific gravity
and pH. Plant operations staff may also perform specific gravity and pH analyses on the product in the presence of the
transport driver. A delivered product that exhibits any unusual color or appearance compared to previous acceptable deliveries
will be refused, as will deliveries containing any form of foreign material. If the product meets the required minimum
standards, the product may then be off loaded. If desired, the vendor may provide their own hydrometer and perform an
additional specific gravity analysis in the presence of the plant operations staff. In the event the product does not meet the
required minimum standards, the load will be refused and the vendor must provide another acceptable load within forty eight
(48) hours. No additional freight or shipping charges shall be assessed by vendor.
TECHNICAL SUPPORT
Vendor shall provide acceptable technical support and response time whenever problems are encountered relating to product
use and/or performance. A telephone response time of one (1) business day is required of vendor in cases of product
performance problems. A site visit by the vendor may be requested by the owner if owner feels it is necessary to solve any
significant problem related to product performance. If a non -routine site visit is requested, the vendor will have five (5)
business days to respond and arrive on -site.
QUANTITIES AND PRICING
The anticipated annual consumption of required treatment chemicals are listed below. Prices quoted for product shall be FOB
City of Lubbock South Water Treatment Plant, 5114 East FM 1585 Lubbock, Texas 79404, North Water Treatment Plant 6001
North Guava Lubbock, Texas 79403, and Bailey County Well field 2380 East HWY 84 Muleshoe, Texas 79347. The contract
shall be for a term of one year with the option of four, one year extensions said date of term beginning upon formal approval.
The City of Lubbock does not guarantee any specific amount of compensation, volume, minimum, or maximum amount of
services under this proposal and resulting contract.
The rates may be adjusted upward or downward at that time at a percentage not to exceed the effective change in the
Consumer Price Index (CPI) for the previous 12 months. The effective change rate shall be based on the index average rate for
all items.
DELIVERY / SECURITY
Successful vendor shall be required to deliver the product(s) to the City of Lubbock South Water Treatment Plant, North
Water Treatment Plant, and Bailey County Well Field within five (5) days after order is placed. Unloading to plant storage
tanks is to be performed by the driver under the direction of operations personnel. Successful vendor shall provide any and all
special equipment necessary to perform unloading at no cost to the City of Lubbock. All deliveries will be unloaded between
the hours of 9:00 A.M. and 4:00 P.M., Monday through Friday. No exceptions will be made unless prior approval is agreed
upon with the water treatment plant's operations personnel. The transporter is required to furnish certified, dated, and stamped
weight tickets with each load of bulk product delivered before and after unloading. All delivery people will display photo
security ID upon arrival at the site. All delivery vehicles shall meet OSHA and DOT regulations and be operated in a safe
manner while on site.
All delivery personnel will be identified by the vendor before arrival at the site; preferably at the time an order is placed.
Upon arrival at the City of Lubbock South Water Treatment Plant, delivery personnel will check in with plant representative,
present photo identification, and then be directed to the unloading site. All shipments shall be sealed and the seal will be
broken only in the presence of the plant representative. If any of the security measures are violated, the shipment will be
refused.
Individual Chemical Specifications
78.0% Sulfuric Acid
Annual usage of 78% Sulfuric Acid is estimated to be 30,000 +/- lbs. 78.0% Sulfuric Acid will be received in totes and
offloaded at the chemical receiving station located at the City of Lubbock South Water Treatment Plant. Product must be
NSF/ANSI Certified for use in public water treatment. Specific gravity of 78.0% Sulfuric Acid shall be 1.71 at 16 C (61 F)
with a pH of 1.0 at 1.0 wt/wt%.
12.5% Sodium Hypochlorite
Annual usage of 12.5% Sodium Hypochlorite is estimated to be 927,830 +/- gallons. 12.5% Sodium Hypochlorite must adhere
to American Water Works Association specification B300-10 or latest revision thereof. Specific gravity of 12.5% Sodium
Hypochlorite shall be 1.2 g/ml or 10 Ib/gallon at 20 C (68 F) with a 1.0% solution pH of 11.2-11.4. (See below for individual
facility and storage tank sizes)
Liquid Ammonium Sulfate 10% w/w
Annual usage of Liquid Ammonium Sulfate (LAS) is estimated to be 195,275 +/- gallons. Specific gravity of Liquid
Ammonium Sulfate at 21 C (71 F) shall be 1.216-1.228. Neat pH shall be 3.0-5.0 with a density of 10.15-10.25 lbs/gal.
(NH4)2SO4 percentage shall be 3840% with equivalent NH3 of 9.8- 10.3%. (See below for individual facility and storage
tank sizes)
50.0% Citric Acid
Annual usage of 50.0% Citric Acid is estimated to be 24,500 +/- lbs/year. Delivery of 50.0% Citric Acid will be received in
totes and offloaded at the chemical receiving station located at the City of Lubbock South Water Treatment Plant. Product
must be NSF/ANSI Certified for use in public water treatment. Specific gravity of 50% Citric Acid shall be 1.24 with a pH of
0.6.
38% Sodium Bisulfite
Annual usage of 38.0% Sodium Bisulfite is estimated to be 2,056 +/- Ibs/year. Delivery of 38.0% Sodium Bisulfite will be
received in totes and offloaded at the chemical receiving station located at the City of Lubbock South Water Treatment Plant.
Product must be NSF/ANSI Certified for use in public water treatment. Specific gravity of 38% Sodium Bisulfite shall be 1.33
with a ph of 3.8-5.2.
50.0% Sodium Hydroxide
Annual usage of 50.0% Sodium Hydroxide is estimated to be 26,400 +/- lbs/year. Delivery of 50.0% Sodium Hydroxide will
be received in totes and offloaded at the chemical receiving station located at the City of Lubbock South Water Treatment
Plant. Delivered 50.0% Sodium Hydroxide must adhere to American Water Works Association specification B501-08 or latest
revision thereof. Specific gravity of 50% Sodium Hydroxide shall be 1.53 at 15.5 C (60 F) with a as is pH of 13.7.
Coagulant for South Water Treatment Plant
The City of Lubbock owns and operates a membrane filtration plant, only Aluminum Chlorohydrate(ACH) will be considered.
No product containing polymer will be considered due to membrane fouling. The coagulant purchased for use at the City of
Lubbock South Water Treatment Plant shall strictly adhere to AWWA Standard B408-14 for ACH Aluminum Chlorohydrate
or latest revisions thereof. The coagulant blend must have NSF/ANSI Certification for use in potable water treatment plants.
Bidder shall submit a certificate of analysis which will include the specific gravity and pH. The material safety data sheets
(MSDS) for the product shall also be submitted with the bid. If the successful bidder is not the manufacturer of the coagulant
bid, bidder must provide a copy of a legal contract between the bidder and the coagulant manufacturer that will be used to
produce the blend. In any event, all products used must have NSF/ANSI certification for use in drinking water treatment
plants. The same coagulant manufacturer must be used throughout the term of the contract. Throughout the term of the
contract, the successful bidder may not change the formulation of the coagulant in any way without the express written
consent of the Water Treatment Superintendent. No exceptions, an unauthorized change in the formulation of the
product will result in contract termination.
If product being bid has not been previously tested for performance at the City of Lubbock South Water Treat Plant bidder
may be required by the City to visit the site and perform testing using standard jar testing methods. The test results must
include settled water and final water turbidities, pH and temperature. A sample of the product being tested will be left at the
facility for additional jar testing by Operations personnel. At the Cities' discretion full plant testing will be required based on
results of previous tests; the City will pay for a full delivery (approximately 48,000 lbs.) at the price submitted in the bid
document to conduct full plant testing. Water Treatment Operations personnel will evaluate product performance based on
settled water quality, pH, filter effluent turbidities, and cost effectiveness. Bidders must submit a list with a minimum of three
(3) potable water treatment plants with phone numbers and contact persons that are currently using the product. References
will be thoroughly checked and will figure prominently into the selection of a successful bidder.
SUPPLEMENTAL ADDITIVE SPECIFICATION
Buyer requests the option of having copper sulfate, containing at least 99% CuSO4.51-12O, added to the coagulant. The copper
sulfate must have NSF Certification for use in potable water treatment plants. The copper sulfate would be added per load at
the buyer's request to control algae growth. Algae growth occurs when the water reaches a temperature of 72°F. The yearly
average of this temperature is between the middle of April to the end of September. The amount of additive will be based on
the coagulant feed rate at the time the load was ordered and would be determined by the operations staff, a 1.0% copper sulfate
additive is to be expected.
Coagulant for North Water Treatment Plant
The aluminum sulfate/polymer blend purchased for use at the City of Lubbock Water Treatment Plant shall contain no soluble
inorganic or organic substances capable of producing deleterious or injurious effects upon the health of those consuming the
water, or that would otherwise render it unfit for public consumption. The aluminum sulfate/polymer blend must have
NSF/ANSI Certification for use in potable water treatment plants. Bidder shall submit a certificate of analysis which will
include the specific gravity and pH. The City of Lubbock North Water Treatment Plant will require the product to have
a pH in the range of 1.3 to 2.8 (slightly more stringent than AWWA Standard). The material safety data sheets (MSDS)
for the product shall also be submitted with the bid. Due to the fact that successful aluminum sulfate/polymer blends are 90%
or more aluminum sulfate by weight, it is preferable that the bidders be a manufacturer of liquid aluminum sulfate. If the
successful bidder is not a manufacturer of aluminum sulfate, bidder must provide a copy of a legal contract between the bidder
and the aluminum sulfate manufacturer that will be used to produce the blend. In any event, all products used must have
NSF/ANSI certification for use in drinking water treatment plants. The same aluminum sulfate manufacturer must be used
throughout the term of the contract. Throughout the term of the contract, the successful bidder may not change the
formulation of the alum / polymer blend in any way without the express written consent of the Water Treatment
Superintendent. No exceptions, an unauthorized change in the formulation of the product will result in contract
termination.
Products to be considered for bid will he tested by the manufacturer using standard jar testing methods at the City's North
Water Treatment Plant site. The test results must include settled water and final water turbidities, pH and temperature. A
sample of the product being tested will be left at the facility for additional jar testing by Operations personnel, if additional
pilot plant testing is necessary an additional amount of sample will be required. At the Cities' discretion full plant testing will
be required based on results of previous tests; the City will pay for a full delivery (approximately 48,000 lbs.) at the price
submitted in the bid document to conduct full plant testing. Water Treatment Operations personnel will evaluate product
performance based on settled water quality, pH, filter effluent turbidities, and cost effectiveness. Bidders must submit a list
with a minimum of three (3) potable water treatment plants with phone numbers and contact persons that are currently using
the product. References will be thoroughly checked and will figure prominently into the selection of a successful bidder.
SUPPLEMENTAL ADDITIVE SPECIFICATION
Buyer requests the option of having copper sulfate, containing at least 99% CuSO4.5H20, added to the Aluminum
Sulfate/Polymer blend. The copper sulfate must have NSF Certification for use in potable water treatment plants. The copper
sulfate would be added per load at the buyer's request to control algae growth. Algae growth occurs when the water reaches a
temperature of 72°F. The yearly average of this temperature is between the middle of April to the end of September. The
amount of additive will be based on the coagulant feed rate at the time the load was ordered and would be determined by the
operations staff, a 2.0% or 3.0% copper sulfate additive is to be expected.
Facility and Storage
South Water Treatment Plant = 2 — 6,000 gallon 12.5% Sodium Hypochlorite bulk storage tanks
2 — 3,000 gallon Liquid Ammonium Sulfate 10.0% w/w bulk storage tanks
North Water Treatment Plant = 3—18,000 gallon 12.5% Sodium Hypochlorite bulk storage tanks
2 — 7,000 gallon Liquid Ammonium Sulfate 10.0% w/w bulk storage tanks
Bailey County Well Field = 2 — 8,000 gallon 12.5% Sodium Hypochlorite bulk storage tanks
2 — 8,000 gallon Liquid Ammonium Sulfate 10.0% w/w bulk storage tanks
�Q CERTIFICATE OF
LIABILITY INSURANCE
7iz�izo�BD"�"''
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the
Certificate holder In lieu of sucb_qndMemenIls1.
PRODUCER
SASSA & CONCANNON INSURANCE
PO Box 187
Norwood, PA 19074-0187
=ACTSteve Hollingsworth
PHONE 0ir W. 610 583-3523 (610)583-3406
- .steve insurance gmai .com
INSURERISI AFFORDING COVERAGE
NAI •
Nautilus Insurance Company
17370
INSURED Shannon Chemical Corporation
PO Box 376
Malvern, PA 19355
610-363-9090
UISURERB: Great Divide Insurance Company
25224
1NsUgFg r. Aspen specialty Insurance Company
10717
INSURER 0:
r-nVFRAr;FS cFRTIFICATF MI?JPFR• RFVLSIrw MIMRM.
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BYPAID CLAIMS.
tMsR
TYPE OF INSURANCE
AWL
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CLAIMS -MADE Dx OCCUR
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06/01/2019
6/01/2019
EACH OCCURR NCE
S 1,000,000
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AUTOMOBILE LIABILITY
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MIRED AOS UTOS �( NON -OWNED
AUTOS
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Y
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BAP2018248-12
6/o1/zole
6/Ol/2019BODILY
COMSINEOSINGLELIMIT
S 1,000,000
BODILYINJURY(Perperson)
S
INJURY (Per soddent)
S
PROPERTY DAMAGE
$
$
CEXCESS
UMBRELLA LMB
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6/01/2019
EACH R
9,000,000
AGGREGATEr
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EMPLOYERS' LIABILITY
PCEWMENBER EXCLUDED?
(Mandatory In NH)
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1, 000, 000
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Y
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SSP2018250-12
6/01/2019
6/01/2019
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$2 000 000 Aggregate
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101. Ad Oe"Remw10 Sd+edit,may be auadredN mwespm is regWred)
City of Lubbock TX is named as an additional insured where required by
written contract.
11CCMc1r-ATC LMV MD rAMr I I ATInM
City of Lubbock
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
1625 13th street
Lubbock,'TX 79401
THE EXPIRATION DATE THEREOF, NOTICE W[ L BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED RESENTATIVE
01988-2014 ACORD CORPORATINN. All righlc reserved.
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY
WC 00 0313 04 84
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS
ENDORSEMENT
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not
enforce our right against the person or organization named in the Schedule. (This agreement applies only to the
extent that you perform work under a written contract that requires you to obtain this agreement from us.)
This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.
Schedule
Any Principal wherein such waiver has been included before loss as part of a contractual undertaking by the
Named Insured.
WC 00 0313 04 84 m 1983 National Council on Compensation Insurance Page 1 of 1
POLICY NUMBER: BAP2018248-12
COMMERCIAL AUTO
CA 04 44 10 13
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US (WAIVER OF SUBROGATION)
This endorsement modifies insurance provided under the following:
AUTO DEALERS COVERAGE FORM
BUSINESS AUTO COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless
modified by the endorsement.
This endorsement changes the policy effective on the inception date of the policy unless another date is
indicated below.
Named Insured: Shannon Chemical Corporation
Endorsement Effective Date: 06/01/18
SCHEDULE
Name(s) Of Per3on(s) Or Organization(s):
Any Principal wherein such waiver has been Included before loss as part of a contractual undertaking by the
Named Insured
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or
organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accidenr or
the *loss" under a contract with that person or organization.
rA 04 44 10 1.1 Pr" Insurnnr-F�(,n,icr!r Offinn, Inr.,2011 I -f 1
BSUM CA 06 02 13
ENDORSEMENT
This endorsement forms a pad of the policy to which it is attached. Please read it carefully.
Business Auto - Additional Insured
When Required by Contract or Agreement
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
Section 11 — Liability Coverage A. — Coverage, 1. Who is an Insured. is amended to add
d. Any person or organization to whom you become obligated to Include as an additional insured under this
policy, as a result of any contract or agreement you enter Into, excluding contracts or agreements for
professional services, which requires you to furnish insurance to that person or organization of the type
prouided by this policy, but only with respect to liability allsing out of your operations or premises owned by or
rented to you. However, the insurance provided will not exceed the lesser of:
1. The coverage and/or limits of this policy; or
2. The coverage and/or limits required by said contract or agreement.
ALL OTH ER TERMS AND CONDITIO NS OF THE POLICY SHALL AP P LY AN 0 REMAI N J NC HAN GE D.
Includes ropi material of Insurance Semites Offics Inc., used by permission
BSUM CA 06 02 13 Page 1 of I
POLICY NUMBER: GLP2018247-12
COMMERCIAL GENERAL LIABILITY
CG 20 10 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - SCHEDULED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s)
Or Organization(s)
Location(s) Of Covered Operations
As required by those entities with whom the Named
All locations of the named insured.
Insured executes a written contract.
on required to complete this Schedule, If not shtn above, will be shown In the Declarations.
A. Section 11 — Who Is An Insured is amended to
include as an additional insured the person(s) or
organization(s) shown in the Schedule, but only
with respect to liability for "bodily Injury", "property
damage" or "personal and advertising Injury"
caused. in whole or in part, by:
1. Your acts or omissions: or
2. The acts or omissions of those acting on your
behalf-,
in the performance of your ongoing operations for
the additional insured(s) at the location(s)
designated above.
However:
1. The insurance afforded to such additional
insured only applies to the extent permitted by
law; and
2. If coverage provided to the additional insured is
!equired by a contract or agreement, the
insurance afforded to such additional insured
will not be broader than that which you are
required by the contract or agreement to
provide for such additional Insured.
B. With respect to the insurance afforded to these
additional insureds, the following additional
exclusions apply:
This Insurance does not apply to "bodily injury" or
.property damage" occurring after:
1. All work, including materials, parts or
equipment fumished in connection with such
work, on the project (other than service,
maintenance or repairs) to be performed by or
on behalf of the additional Insured(s) at the
location of the covered operations has been
completed; or
2. That portion of "your work7 out of which the
injury or damage arises has been put to its
Intended use by any person or organization
other than another contractor or subcontractor
engaged in performing operations for a
principal as a part of the same project.
CG 20 10 04 13 @ Insurance Services Office, Inc., 2012 Page I of 2
C. With respect to the insurance afforded to these
additional insureds, the following is added to
Section III — Limits Of Insurance:
If coverage provided to the additional Insured Is
required by a contract or agreement, the most we
will pay on behalf of the additional Insured Is the
amount of insurance:
1. Required by the contract or agreement; or
2. Available under the applicable Limits of
Insurance shown in the Declarations;
whichever is less.
This endorsement shall not increase the
applicable Limits of Insurance shown In the
Declarations.
Page 2 of 2 Q Insurance Services Office, Inc., 2012 CG 20 10 04 13
POLICY NUMBER: GLP2018247-12
COMMERCIAL GENERAL LIABILITY
CG 20 10 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - SCHEDULED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s)
I Inr nrnan1v!m#i^nfa% I Location(s) Of Covered Operations
I The City of Cincinnati and all assigned subcontractors I All locations of the named Insured.
Information
A. Section 11 — Who Is An Insured is amended to
include as an additional Insured the person(s) or
organization(s) shown In the Schedule, but only
with respect to liability for "bodily injury", "property
damage* or "personal and advertising injury"
caused, in whole or in part, by:
1. Your acts or omissions: or
2. The acts or omissions of those acting on your
behalf,
In the performance of your ongoing operations for
the additional insured(s) at the location(s)
designated above.
However:
1. The Insurance afforded to such additional
insured only applies to the extent permitted by
law; and
2. If coverage provided to the additional insured is
required by a contract or agreement, the
insurance afforded to such additional insured
will not be broader than that which you are
required by the contract or agreement to
provide for such additional insured.
B. With respect to the insurance afforded to these
additional insureds, the following additional
exclusions apply:
This insurance does not apply to "bodily injury" or
.property damage" occurring after:
1. All work, including materials, parts or
equipment furnished in connection with such
work, on the project (other than service,
maintenance or repairs) to be performed by or
on behalf of the additional insured(s) at the
location of the covered operations has been
completed; or
2. That portion of "your work" out of which the
injury or damage arises has been put to its
Intended use by any person or organization
other than another contractor or subcontractor
engaged in performing operations for a
principal as a part of the same project.
CG 20 10 04 13 0 Insurance Services Office, Inc., 2012 Page I of 2
C. With respect to the insurance afforded to these
additional insureds, the following is added to
Section III — Limits Of Insurance:
If coverage provided to the additional Insured is
required by a contract or agreement, the most we
will pay on behalf of the additional insured Is the
amount of insurance:
1. Required by the contract or agreement; or
2. Available under the applicable Limits of
Insurance shown in the Declarations;
whichever Is less.
This endorsement shall not increase the
applicable Limits of Insurance shown In the
Declarations.
Page 2 of 2 0 Insurance Services Office, Inc., 2012 CG 20 10 04 13
POLICY NUMBER: GLP2018247-12
COMMERCIAL GENERAL LIABILITY
CG 20 1104 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - MANAGERS OR
LESSORS OF PREMISES
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Designation Of Premises (Part Leased To You):
All locations of the named insured.
Name Of Person(s) Or Organization(s) (Additional Insured):
As required by those entities with whom the named insured executes a written contract.
Additional Premium: $N/A
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section 11 — Who Is An Insured is amended to
Include as an additional insured the person(s) or
organization(s) shown In the Schedule, but only
with respect to liability arising out of the
ownership, maintenance or use of that part of the
premises leased to you and shown in the
Schedule and subject to the following additional
exclusions:
This insurance does not apply to:
1. Any "occurrence* which takes place after you
cease to be a tenant in that premises.
2. Structural alterations, now construction or
demolition operations performed by or on
behalf of the person(s) or organization(s)
shown In the Schedule.
However:
2. If coverage provided to the additional insured
Is required by a contract or agreement, the
insurance afforded to such additional insured
will not be broader than that which you are
required by the contract or agreement to
provide for such additional insured.
B. With respect to the insurance afforded to these
additional insureds, the following is added to
Section III — Limits Of Insurance:
If coverage provided to the additional insured is
required by a contract or agreement, the most we
will pay on behalf of the additional insured is the
amount of insurance:
1. Required by the contract or agreement; or
2. Available under the applicable Limits of
Insurance shown in the Declarations.
1. The Insurance afforded to such additional whichever is less.
Insured only applies to the extent permitted This endorsement shall not increase the
by law; and applicable Limits of Insurance shown in the
Declarations.
CG 20 1104 13 0 Insurance Services Office, Inc., 2012 Page I of I
POLICY NUMBER: GLP2018247-12
COMMERCIAL GENERAL LIABILITY
CG 20 15 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED -VENDORS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s) Or Your Products
Organization(s) (Vendor)
As required by those entities with whom the Named All chemicals on file with the Company distributed by
Insured executes a written contract. the Insured.
on required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section 11 — Who Is An Insured is amended to
include as an additional insured any person(s) or
organization(s) (referred to throughout this
endorsement as vendor) shown in the Schedule,
but only with respect to "bodily Injury" or "property
damage" arising out of "your products" shown In
the Schedule which are distributed or sold in the
regular course of the vendor's business.
However:
1. The insurance afforded to such vendor only
applies to the extent permitted by law; and
2. If coverage provided to the vendor is required
by a contract or agreement, the insurance
afforded to such vendor will not be broader
than that which you are required by the
contract or agreement to provide for such
vendor.
B. With respect to the insurance afforded to these
vendors, the following additional exclusions apply:
1. The insurance afforded the vendor does not
apply to:
a. "Bodily injury" or "property damage" for
which the vendor Is obligated to pay
damages by reason of the assumption of
liability in a contract or agreement. This
exclusion does not apply to liability for
damages that the vendor would have in the
absence of the contract or agreement;
b. Any express warranty unauthorized by you;
c. Any physical or chemical change in the
product made intentionally by the vendor,
d. Repackaging, except when unpacked solely
for the purpose of inspection,
demonstration, testing, or the substitution of
parts under instructions from the
manufacturer, and then repackaged in the
original container;
CG 20 15 04 13 @ Insurance Services Office, Inc., 2012 Page 1 of 2
e. Any failure to make such inspections,
(2) Such inspections, adjustments, tests or
adjustments, tests or servicing as the
servicing as the vendor has agreed to
vendor has agreed to make or normally
make or normally undertakes to make in
undertakes to make in the usual course of
the usual course of business, in
business, in connection with the distribution
connection with the distribution or sale
or sale of the products;
of the products.
f. Demonstration, Installation, servicing or
2. This insurance does not apply to any insured
repair operations, except such operations
person or organization, from whom you have
performed at the vendoes premises in
acquired such products, or any ingredient, part
connection with the sale of the product;
or container, entering into, accompanying or
g. Products which, after distribution or sale by
containing such products.
you, have been labeled or relabeled or
C. With respect to the insurance afforded to these
used as a container, part or ingredient of
vendors, the following is added to Section III —
any other thing or substance by or for the
Limits Of Insurance:
vendor. or
If coverage provided to the vendor is required by a
h. "Bodily injury" or "property damage" arising
contract or agreement, the most we will pay on
out of the sale negligence of the vendor for
behalf of the vendor is the amount of insurance:
its own acts or omissions or those of its
1. Required by the contract or agreement; or
employees or anyone else acting on Its
behalf. However, this exclusion does not
2. Available under the applicable Limits of
apply to:
Insurance shown in the Declarations;
(1) The exceptions contained in Sub-
whichever is less.
paragraphs d. or f.; or
This endorsement shall not increase the
applicable Limits of Insurance shown in the
Declarations.
Page 2 of 2 0 Insurance Services Office, Inc., 2012 CG 20 15 04 13
POLICY NUMBER: GLP2018247-12
COMMERCIAL GENERAL LIABILITY
CG 20 37 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - COMPLETED OPERATIONS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s)
Or Organization(s)
Location And Description Of Completed Operations
As required by those entities with whom the named
When required by written contract.
Insured executes a written contract.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section 11 — Who Is An Insured Is amended to
Include as an additional insured the person(s) or
organization(s) shown in the Schedule, but only
with respect to liability for "bodily injury" or
.property damage" caused, in whole or in part, by
.your work" at the location designated and
described In the Schedule of this endorsement
performed for that additional insured and
included in the "products -completed operations
hazard'.
However.
1. The insurance afforded to such additional
Insured only applies to the extent permitted
by law; and
2. If coverage provided to the additional insured
is required by a contract or agreement, the
insurance afforded to such additional insured
will not be broader than that which you are
required by the contract or agreement to
provide for such additional Insured.
B. With respect to the Insurance afforded to these
additional insureds, the following is added to
Section Ill — Limits Of Insurance:
If coverage provided to the additional insured is
required by a contract or agreement, the most we
will pay on behalf of the additional Insured is the
amount of Insurance:
1. Required by the contract or agreement; or
2. Available under the applicable Limits of
Insurance shown in the Declarations;
whichever is less.
This endorsement shall not increase the applicable
Limits of Insurance shown In the Declarations.
CG 20 37 04 13 0 Insurance Services Office. Inc., 2012 Page I of I
CERTIFICATE OF INTERESTED PARTIES FORM 1295
loll
Complete Nos. 1 - 4 and 6 if there are interested parties.
OFFICE USE ONLY
Complete Nos. 1, 2, 3, 5, and 6 if there are no interested panies.
CERTIFICATION OF FILING
Certificate Number:
1
Name of business entity filing form. and the city, state and country of the business entity's place
of business.
2018-389326
Shannon Chemical Corporation
malvern, PA United States
Date Filed:
08/0812018
2
Name of governmental entity or state agency that Is a party to the contract for which the form is
being filed.
City of Lubbock
1
Date Aftnowledged:
08/08/2018
3
Provide the Identification number used by the governmental entity or state agency to track or identify the contract, and provide a
description of the services, goods, or other property to be provided under the contract.
14151
Water Treatment Chemicals
4
Name of interested Party
City, State, Country (place of business)
Nature of interest
(check applicable)
controlling
Intermediary
5
Check only if there is NO Interested Party. El
6
UNSWORN DECLARATION
My name is and my date of birth Is
My address is
(street) (city) (state) (zip code) (country)
I declare under penalty of perjury that the foregoing is true and correct.
Executed in County, State of on the day of 20
(month) (year)
Signature of authorized agent of contracting business entity
(IJUdawit)
Forms provided by Texas Ethics Commission vmw.eth1CS.State.tX.US version VI.U.6711
CERTIFICATE OF INTERESTED PARTIES FORM 1295
loll
Complete Nos. I - 4 and 6 If there are Interested parties.
OFFICE USE ONLY
Complete Nos. 1, 2. 3, 5. and 6 If there are no interested parses.
CERTIFICATION OF FILING
Certificate Number:
2018-389326
I
Name of business entity filing form, and the city, state and country of the business entity's place
of business.
Shannon Chemical Corporation
malvern, PA United States
Date Filed:
2
Name of governmentaii entity or state agency that Is a party to the contract for which the form Is
being filed.
0810812018
City of Lubbock
Date Acknowledged:
3
Provide the Identification number used by the governmental entity or state agency to track or Identify the contract, and provide a
description of the services, goods, or other property to be provided under the contract.
14151
Water Treatment Chemicals
Nature of Interest
4
Name of Interested Party
City. State, Country (place of business)
(chock a plicable)
—6o-n-t—rollIng
Intermediary
5
Chock only If there Is NO Interested Party.
6 UNSWORN DECLARATION
My name is T)anitzl r- PlMnn and my date of birth Is
My address Is 602 Jeffers Circle gxtnn, pA jg34 _.USA
(Street) (city) (state) (zip code) (country)
I declare under penalty of perjury that the foregoing Is true and coffecL
Executed In Chester ounty, State of PA -.onthe--8-day0f Aug .20--14
(month) (year)
signature of authorized agent of contracting business entity
rorin7 provided by Texas Elh!cs Comm!ssion v.,.,Av.cthir,;.smve.txms versioll V.L.V.013�1