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Home My WebLink AboutOpening of Bids - Water Treatment Chemicals 2021-2022 - Polydyne Inc.NOTICE TO BIDDERS Notice is hereby given that the City of South Bend, Indiana, Board of Public Works wit, receive sealed electronic Responses at bowbidsfrDsouthbend in.gov until 9:00 a.m., EST, on April 13, 2021 for the following: Water Treatment Chemicals 2021-2022 Specifications are available for download by visiting the City of South Bend's web page at www southbendin.gov: X Click on "I'm Looking For" X Click on "Doing Business in South Bend" X Click on "City Contracts — Invitations to Bid" X Click on the "Required Link" to register your company. you must register to receive addenda and updates to the specific bid you are interested in. Failure to do so could render your bid non -responsive to the specifications. There is no charge for the specifications. The specifications are also available for review only during regular working hours in the Department of Public Works, Ste, 1316, County -City Building, 227 W. Jefferson Blvd., South Bend, Indiana 46601. Bids received after 9:OOAM, Local Time, on April 13, 2021, will be returned unopened. Bids must be on the City of South Bend Bid/Proposal form provided, which includes a Non -Debarment Affidavit, Non -Discrimination Commitment form, and a Non -Collusion Affidavit Form. Certified Check or Bid Bond in the amount of not less than 10% must be submitted with the bid. A refund of the bid security will be issued upon satisfaction of Bid Award. The Board reserves the right to reject any or all bids or to accept a full or partial award of the bid or bids which, in its judgment, will be to the best interests of the City of South Bend. If the Board elects to award the base bid plus an alternate(s), the Board will look at the totality of the cost when determining the lowest, most responsible bid. The Board may reject any bid that does not conform to these requirements as non -responsive. The Board reserves the right to reject any or all bids or to accept a full or partial award of the bid or bids which, in its judgment, will be to the best interest of the City of South Bend. BOARD OF PUBLIC WORKS Anne Fuchs, Clerk Publish two times: March 29, 2021 April 5, 2021 07/24/2018 CITY OF SOUTH BEND, INDIANA SELLER'S BID FOR SALE OR LEASE OF MATERIALS BID NAME Water Treatment Chemicals 2021-2022 FOR BIDS DUE April 13, 2021; 9:00 AM, Local Time Date: Address: City/State/Zip: 04/12/21 Bidder (Firm): Polydyne Inc. One Chemical Plant Rd. Riceboro, GA 31323 Telephone Number: (912 )880-2035 Agent of Bidder (if Applicable): When the prospective Contractor is unable to cert(jy to any ojthe statements below, it shall attach an explanation to this AJfrdavit. CONTRACTOR'S NON -COLLUSION AND NON -DEBARMENT AFFIDAVIT, CERTIFICATION REGARDING INVESTMENT WITH IRAN, EMPLOYMENT ELIGIBILITY VERIFICATION, NON-DISCRIMINATION COMMITMENT AND CERTIFICATION OF USE OF UNITED STATES STEEL PRODUCTS OR FOUNDRY PRODUCTS (Must be completed for all quotes and bids. Please type ot• print) STATE OF Georgia ) ) SS: Liberty COUNTY ) The undersigned Contractor, being duly sworn upon his/her/its oath, affirms under the penalties of perjury that: 1. Contractor has not, nor has any other member, representative, or agent of the firm, company, corporation or partnership represented by him, entered into any combination, collusion or agreement with any person relative to the price to be bid by anyone at such letting nor to prevent any person from bidding nor to induce anyone to refrain from bidding, and that this bid is made without reference to any other bid and without any agreement, understanding or combination with any other person in reference to such bidding. Contractor further says that no person or persons, firms, or corporation has, have or will receive directly or indirectly, any rebate, fee, gift, commission or thing of value on account of such sale; and 2. Contractor certifies by submission of this proposal that neither contractor nor any of its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency; and 3. Contractor has not, nor has any successor to, nor an affiliate of, Contractor, engaged in investment activities in Iran. a. For purposes of this Certification, "Iran" means the government of Iran and any agency or instrumentality of Iran, or as otherwise defined at Ind. Code § 5-22-16.5-5, as amended from time -to -time. b. As provided by Ind. Code § 5-22-16.5-8, as amended from time -to -time, a Contractor is engaged in investment activities in Iran if either: i. Contractor, its successor or its affiliate, provides goods or services of twenty million dollars ($20,000,000) or more in value in the energy sector of Iran; or ii. Contractor, its successor or its affiliate, is a financial institution that extends twenty million dollars ($20,000,000) or more in credit to another person for forty-five (45) days or more, if that person will (i) use the credit to provides goods and services in the energy sector in Iran; and (ii) at the time the financial institution extends credit, is a person identified on list published by the Indiana Department of Administration. 4. Contractor does not knowingly employ or contract with an unauthorized alien, nor retain any employee or contract with a person that the Contractor subsequently learns is an unauthorized alien. Contractor agrees that he/she/it shall enroll in and verify the work eligibility status of all of Contractor's newly hired employees through the E-Verify Program as defined by I.C. 22-5-1.7-3. Contractor's documentation of enrollment and participation in the E-Verify Program is included and attached as part of this bid/quote; and 5. Contractor shall require his/her/its subcontractors performing work under this public contract to certify that the subcontractors do not knowingly employ or contract with an unauthorized alien, nor retain any employee or contract with a person that the subcontractor subsequently learns is an unauthorized alien, and that the subcontractor has enrolled in and is participating in the E-Verify Program. The Contractor agrees to maintain this certification throughout the term of the contract with the City of South Bend, and understands that the City may terminate the contract for default if the Contractor fails to cure a breach of this provision no later than thirty (30) days after being notified by the City. 6. Persons, partnerships, corporations, associations, or joint venturers awarded a contract by the City of South Bend through its agencies, boards, or commissions shall not discriminate against any employee or applicant for employment in the performance of a City contract with respect to hire, tenure, terms, conditions, or privileges of employment, or any matter directly or indirectly related to employment because of race, sex, religion, color, national origin, ancestry, age, gender expression, gender identity, sexual orientation or disability that does not affect that person's ability to perform the work. In awarding contracts for the purchase of work, labor, services, supplies, equipment, materials, or any combination of the foregoing including, but not limited to, public works contracts awarded under public bidding laws or other contracts in which public bids are not required by law, the City, its agencies, boards, or commissions may consider the Contractor's good faith efforts to obtain participation by those Contractors certified by the State of Indiana as a Minority Business ("MBE") or as a Women's Business Enterprise ("WBE") as a factor in determining the lowest, responsible, responsive bidder. In no event shall persons or entities seeking the award of a City contract be required to award a subcontract to an MBEJW BE; however, it may not unlawfully discriminate against said WBE/MBE. A finding of a discriminatory practice by the City MBE/WBE Utilization Board shall prohibit that person or entity from being awarded a City contract for a period of one (1) year from the date of such determination, and such determination may also be grounds for terminating the contact for which the discriminatory practice or noncompliance pertains. 7. The undersigned contractor agrees that the following nondiscrimination commitment shall be made a part of any contract which it may henceforth enter into with the City of South Bend, Indiana or any of its agencies, boards or commissions. Contractor agrees not to discriminate against or intimidate any employee or applicant for employment in the performance of this contract with privileges of employment, or any matter directly or indirectly related to employment, because of race, religion, color, sex, gender expression, gender identity, sexual orientation, handicap, national origin or ancestry. Breach of this provision may be regarded as material breach of contract. I, the undersigned bidder or agent as contractor on a public works project, understand my statutory obligations to the use of steel products or foundry products made in the United States (I.C. 5-16-8-1). 1 hereby certify that I and all subcontractors employed by me for this project will use steel products or foundry products made in the United States on this project if awarded. I understand I have an affirmative duty to notify the City in my bid that my proposal does not include the use of steel products or foundry products made in the United States. I understand it is my sole obligation and responsibility to provide a justification to the City, subject to review and approval, why the cost of United States made steel or foundry products is unreasonable. Prior to award and upon submission of bid which does not use steel products or foundry products made in the United States, the City, through its director of public works, shall make a determination if the price of United States made steel or foundry is unreasonable. I understand that violations hereunder may result in forfeiture of contractual payments. I hereby affirm under the penalties of perjury that the facts and information contained in the foregoing bid for public works are true and correct. Dated this 12th day of April 20 21 Polydyne Inc. �entrae or/Bidde Firm) Si ature of Contractor/Bi er r Its Agent Boyd Stanley, Sr. Vice -President Printed Name and Title Subscribed and swV$iQpnUpp 12th d April 20 21 Dec.17, 2022 My Commission Expires Notary Public County of Residence Liberty County NOT APPLICABLE To be completed only by Contractors/Bidders claiming to be a "local Indiana business" pursuant to 1. C. 36-1-12-22) INDIANA LOCAL BUSINESS PREFERENCE CLAIM A "local Indiana business" refers to any of the following: (1) A business whose principal place of business is located in an affected county. (2) A business that pays a majority of its payroll (in dollar volume) to residents of affected counties. (3) A business that employs residents of affected counties as a majority of its employees. (4) A business that makes significant capital investments in the affected counties as defined in rules adopted by the political subdivision. (5) A business that has a substantial positive economic impact on the affected counties as defined by criteria in rules adopted by the political subdivision. An "affected county" refers to St. Joseph County, Indiana, or the following counties located adjacent to St. Joseph County: Elkhart County, Marshall County, Starke County and LaPorte County There are the following price preferences for supplies purchased from a local Indiana business: • 5% for a purchase expected by the purchasing agency to be less than $50,000 • 3% for a purchase expected by the purchasing agency to beat least $50, 000 but less than $100,000. • 1 % for a purchase expected by the purchasing agency to beat least $100 000. Date: Pursuant to I.C. 36-1-12-22, claims a local Indiana business preference for Project (Project # ) located within the City of South Bend, St. Joseph County, Indiana. ❑ The location of the principal place of business is (Adtlre ❑ St. Joseph County, Indiana ❑ The following county located adjacent to St. Joseph County, Indiana: ❑ The majority of the business's payroll for the 12 months prior to the date of this Bid is to residents of St. Joseph County, Indiana or the adjacent county noted above. ❑ The majority of the business's employees for the 12 months prior to the date of this Bid are residents of St. Joseph County, Indiana, or the adjacent county noted above. If the business is deemed to be the apparent lowest, responsible, responsive bidder, then it shall provide supporting documentation for the 12 month period prior to the date of the Bid of (i) the total payroll amount paid to all employees of the business, and (ii) the total payroll amount paid to employees who are residents of St. Joseph County and the adjacent county noted above. WHEN SUPPLYING SUPPORTING PAYROLL RECORDS, BIDDER SHALL REDACT ALL SOCIAL SECURITY NUMBERS. Dated this day of , 20_. Contractor/Bidder (Firm) Signature of Contractor/Bidder or Its Agent Printed Name and BID NAME FOR BIDS DUE SPECIFICATIONS CITY OF SOUTH BEND Water Treatment Chemicals 2021-2022 April 13, 2021; 9:00 AM, Local Time Pursuant to notices given, the undersigned offers bid(s) to the City of South Bend in accordance with the following attachment(s) which specify the class or item number or description, quantity, unit, unit price BLENDED PHOSPHATE SEQUESTRANT CORROSION INHIBITOR CHLORINESPECIFICATIONS................................................................................................................................................... 1 DRY POLYMER FLOCCULENT ................................ FERRIC CHLORIDE ........................................ FLUORISILICIC ACID .................... LIQUID CALCIUM NITRATE 66 POTASSIUM PERMANGANATE.. SALT SPECIFICATION ................... SODIUM HYPOCHLORITE 12.5 SODIUM PERMANGANATE......... 10 STRUVITE REMOVER/PREVENTATIVE................................................................................................12 SULFURDIOXIDE........................................................................................................................................................................ 7 IYater IPorks facility delivw•ies are to be made an normal work days belwew+ 7:00 a.m. and 11:00 a.m. will+ unloading to be completed before l:00 p.m, {�astewater facility deliveries are to be made between the haws oj6:00 AM and 4:00 PM Monday through Friday. No stop -off or fuel surcharges allowed; however, demurrage charges will be allowed after 2 hours per stop. All deliveries are F.O.B. Delivery Point. Awards of this bid will be divisible by product. Awards will be based on the lowest responsive and responsible bidder per unit prices on the attached schedule. All prices quoted are to be effective May 1, 2021 through April 30, 2022 (One Year). Prices are to be firm throughout that period without increases. Quantities are estimated and not guaranteed. The City reserves the right to exceed the estimate at the price quoted here in. I. CHLORINE SPECIFICATIONS INCLUDE BOTH LOU" AND TON CYLINDERS A. GENERAL 1. Only containers which currently are authorized by regulation for chlorine, which have been inspected and reconditioned as described herein, and which have been tested within the period required by regulations should be filled. It is illegal to ship chlorine containers that have been filled by or without the consent of lire owner. 2. Due to the volatile nature of this chemical, the chlorine provider must be able to have one (1) accredited Safety and Handling of Chlorine class per year for South Bend Personnel. 3. Chlorine quotes should be deposit-fi•ee. No cylinder deposit should be included in the quote. Boilin Point -29.29°F-34.05°C Critical Density 35.77 lb./cu. ft. Critical Pressure 1118.4 sia 76.1 Atmos. Critical Temperature 2916200 144 °C Critical Volume 0.02796 cu. ft./lb. Latent Heat of Va orization 123.7 Btu./lb. Boiling point Liquid Gas Relationship: 1 volume liquid chlorine = wt. at 457.6 volumes of chlorine, 825 @ standard conditions Melting Point I49.76°F-100.98°C Specific Gravity - Dry Gas 2,482 Specific Gravity — Liquid 1,468 0 ° - 40C B. CHLORINE I50 POUND CYLINDERS 1. Construction a) All cylinders must be compatible with Chlorine Instihute Emergency Kit "A". All kit devices mull be useable on any cylinder in chlorine service. TJue maximum neck ring diameter that ivill accommodate an 'A" hood is 4-314 inches. 2. Cylinder Types a) Chlorine cylinders must comply wide DOT specs, 3A480, 3AA480, 250 3, 3BN480 or 3EI800. The regulations permit only one opening in chlorine cylinders - at the top for the valve connection. 3. Cylinder Styles a) Cylinders Wray be of three styles: fooh•ing, bmnped bollonu, or double bottom. 4. Cylinder Threads a) The tiveads in new cylinders are NGT Threads 3/4-14NGT(CI). 5. Chlorine Ton Containers a) All ton containers must be compatible with Chlorine Inswule Emergency Kit "B". 6. on Container Types a) Chlorine ton container types must comply with DOT spec. 106ASOOX, DOT a ICC 106A500, 27, BE27. b) Ton Container iValve and Fuse Plug Opening Threads c) The threads in new ton containers are 31444NGT (CI). 7. Valve Protection a) The cylinder attd tone container vah�es are protected during slaipntent and storage by a removable steel valve protective housing or cap. Pressure relief devices shall not be covered by the housing. 8. Cylinder and Ton Container Capacity a) In cases where the capacity of a chlorine container is not known, it can be determined by weighing it ennpty and again when completely filled with water, and by nn itiplying the weight of ivater at 60017by 1.25. This is the maeinnon allowable weight of chlorine allowed in the cylinder or ton container. C. STAMPING 1. Cylinder Stamping a) When manufactured, cylinders are stamped with DOT specification number, serial nnonber, and owners and/or builders identifying symbols as well as inspector's official mark and initial test date [DOT Section 173.34(c)] of 49CFR. 2. Ton Container Stamping a) When manufactured, ton containers are stamped with DOT specification number, material, serial number, inspectors of(rcial mark, name, mark of initials of company for whose use the tank is made, (or builder's synnbol and serial nunnber), date of test, and water• capacity [DOT Section 179.300-18]. Tare weights may be stamped by builder. Changes in stamping must be made in compliance with DOT Section 173.31(d) or 49CFR. 3. Retest Stamping a) Relented cylinders (DOT 49 CFR, Section 173.34 (e)(6)J and ton containers [DOT 49 CFR, Section 173.31(d)(7)J must be stamped to show date of retest. For cylinders, the stamp must include the test facility's certification number in a prescribed pattern. Ton containers do not require the lest facility's number on the container. 4. Tare -Weight Stamping a) It is recommended that all new chlorine cylinders and torn containers be stamped with the original tare weight by the container manufacturer. D. VALVES 1. Cylinders a) Chlorine cylinders are to have a single chlorine Teflon style valve produced by Sherwood or Tekno which is equipped with afirsible metal plug -type relief device. This is a must comply safety requirement. 2. Ton Container Valves a) Chlorine ton containers are to have hvo identical Tef on style valves produced by Sherwood or• Tekno near the center of one head. This is a must comply safety requirement. When vertically aligned, the valve in the upper position is used for gas Withdrawal, and the lower one for liquid withdrawal. The standard ton container valve is identical to the cylinder valve except that it has no fuusible metal type relief device, and the valve seat diameter may be larger than on most cylinder valves. There are tow sizes of ton container valves: 314 inch NGT and 1 inch NGT. 3. Valve Outlet Threads a) Outlet threads on cylinder and ton containers are special sh•aighl threads (1,030" - 14NGO-RH-EXT) which conform to connection number CGA 820 and B20C Which utilize a yoke -type connection. These threads are to accommodate the outlet cap only and are not to be used for chlorine hose connections. E. PRESSURE RELIEF DEVICES 1. Cylinders a) The relief device on chlorine cylinders is a fusible metal plug inn the cylinder valve located below the valve seat. The f usible metal is cast into an Alloy 'B" or Alloy A" holder which is screwed into a tapped hole in the valve body. The fusible plugs are designed to melt between 158 degrees F and 165 degrees F. 2. Ton Containers a) Tor? container valves contain no fusible plugs. The container itself is equipped with six threaded fuusible plugs, three in each head, spaced approximately 1200 apart. 3. Ton Container and Cylinder Inspection, Cleaning, and Reconditioning a) In addition to the required period retest, it is recommended that each ton container and cylinder be internally and externally inspected prior to each filling. This includes all appurlenances, such as valves and fusible plugs. Criteria.for such inspection is outlined in "Cylinder and Ton container Procedure for Chlorine Packaging, " Chlorine Institute Pamphlet 17, Sections 3, 4, and 5. F. PERIODIC RETESTING AND RE -INSPECTION 1. Cylinder and Ton Containers to be Tested a) Cylinders (except DOT 3E 1800) and ton containers inttsi be retested at lease once in five years (DOT Section 173.34e and Section 173.31 d). b) Cylinders cannot be filled until they are retested after the five year• anniversary of the month ha ivhich it ivas tested. Ton containers can be filled until the end of the calendar year during ivhich their five year test is due. c) Retests are also required after any reheat treatment. In addition, retest any container ivhich shows evidence of iveakness at any time, or show a S percent or more loss in weight. 2. Test Procedure a) Cylinders and ton containers are laydr•ostaltcally retested by llae hydrostatic expansion method [DOT Section 173.34 (a) and Section 173.31 (d)J. If at the lime of requalification a container shows a leak or a permanent expansion which exceeds 10% of the total expansion, it must be condemned. 3. Container Records a) Records vrusl be kept showing results of the test. Each container must have the lest date plainly and permanently stamped into the metal ofone head or the chine of each task passing the hydrostatic retest. G. CONDITIONS OF DELIVERY I. A South Bend Water Works representative shall specify the location for chlorine cylinder and ton container deliveries. 2. Delivery Locations: Location T e of Container Address North Station on Container 830 North Michigan Street Carria e Hills Cylinder 52290 Shenandoah Drive Erskine Cylinder 4116 South Fellows Street South M on Container 3600 South Main Street Cleveland Southlinder 4900 Cleveland Road Cleveland Northlinder 4949 Cleveland Road Wastewater 12,000, lb. Ton Container 3113 Riverside Drive 3. Vendor personnel shall conduct all activities related to the loading and unloading of cylinders. 4. Ton containers will need to be delivered with a cherry picker. 5. Minimum deliveries are one (1) ton containers and twelve (12) 150# cylinders. 6. Supplier must be able to guarantee delivery within 3 to 4 calendar days after order placement 7. Vendor personnel shall not unload any filled cylinders or ton containers prior to live inspection by South Bend Water Works Personnel. 8. Vendor personnel shall assist South Bend personnel in the visual inspection of each cylinder or ton container for: a) External damage or defect b) Proper installation of valve protection housing or caps c) Visual inspection of valves and fusible plugs i) All old wire from previous hung tags are to be removed prior to delivery H) All fusible plugs should be defect free (no pits or holes ) d.) Determination of markings of retest and recertification Motor vehicles used to ship ton containers shall be properly equipped with lift equipment suitable for handling containers to any point where the container is to be loaded upon or unloaded from the vehicle. 1. Cylinders containing chlorine shall be securely lashed in an upright position, loaded into racks securely attached to the motor vehicle, or packed in boxes or crates of such dimensions as to prevent their overturning. E.) FERRIC CHLORIDE A. GENERAL bI DELIVERY i. Normal concentration percent by Weight; 33-35% Specific Gravity: 0.33 i. Full truck deliveries (4500 gallons) to the Ferric feed facility Plant located at; 3113 Riverside Drive, South Bend, IN 46628 F.) FLUORISILICIC ACID A. GENERAL i. The Fluorisilicic Acid supplied under these specifications shall be clean and free of visible suspended matter and shall not contain more than 0.020 percent of the "heavy metals", mercury, lead, bismuth and copper expressed as lead (Ph); and shall contain no soluble mineral or organic substances in quantities capable of a deleterious or injurious effect upon the health of those consuming water that has been treated properly with fluorsilicic acid. ii. Product to meet the latest AW WA standard for Fluorisilicic Acid (B703). iii. Price is to be based on a 23%solution. Bidders shall quote price per gallon. Prices must be submitted and billed in cost per gallon with freight included billed to the nearest nenny. B. DELIVERY i. The vendor shall deliver bulk fluoride to the following well locations in the quantities as specified by a representative of the South Bend Water Works. All deliveries shall be made within 48 hours of the request ii. 23% Fluorisilicic Acid delivered in tank truckloads. iii. Deliveries are estimated at thirteen (13) tank trucks with two to four stop -offs per 20,000 lb. load. iv. No stop -off or fuel surcharges allowed however, demurrage charges will be allowed after 2 hours per stop. v. Suppliers must furnish own unloading hose at least 40 feet in length with proper couplings to hook onto two male N.P.T., and must blow off hose to bulk tank at each stop. vie City will not accept delivery of more than 10% over the order quantity. vii. Delivery Locations: Location Bulk Tank Address North Station 1600 allons 830 North Michi an Street Carria e Hills 400 gallons 52290 Shenandoah Drive Edison 1350 gallons... 2708 Rockne Drive Erskine 400 allons 4116 South Fellows Street South 600 allons 3600 South Main Street Cleveland South 1100 gallons 4900 Cleveland Road Cleveland North 600 gallons 4949 Cleveland Road Pinhook 900 gallons 3801 Riverside Drive Olive 2400 gallons 915 South Olive Street G.)POTASSIUM PERMANGANAT> A. MATERIAL i. Free Flowing Grade Potassium Permanganate shall meet the requirements of AW WA Specification 603-98 and shall be manufactured domestically and certified suitable for use in public water supply by appropriate state and federal agencies. B. DELIVERY i. The potassium permanganate shall be delivered in 55 pound pails made of 24- gauge steel or plastic and shall be equipped with a handle. 1. The pails shall remain the property of the South Bend Water Works. 2. The pails shall be unloaded and neatly stacked at the popping stations. ii. Deliveries will be ordered on an as needed basis with each delivery consisting of approximately 8 to 16 (55 Lb.) pails. Deliveries must be made within 5 days of placement of the order. iv. Vendor shall deliver pails to the following site: 1. Water Works North Station — 830 North Michigan Street H.) PYROPHOSPHATE SEOUESTRANT AGENT A. STANDARDS i. Product shall be a minimum of 8514 sodium pyrophosphate. ii. The remaining ingredient(s) shall also be sodium phosphate material(s). Product must already be listed in the latest National Sanitation Foundation (NSF) Standard 60 directory. iii. The percent phosphate as PO4 must be disclosed and by Indiana law, be marked on the outside of the container. B. TECHNICAL ASSISTANCE i. The successful vendor giving a quote must also provide on -site technical assistance to the Authority for an eight hour day per month for the first six months of product usage. ii. After the first 6 months of on -site technical assistance, the Authority will request further on -site technical assistance on an as needed basis. iii. The vendor shall provide a per visit cost in their quote for the additional site visits. iv. Each visit will be one workday (Monday through Friday only), from 7:00 a.m. to 3:30 p.m. EST. v. Vendor must submit the name(s) and resume(s) of the technical representative that will perform the on -site assistance with your quote submittal. vi. The technical representative shall be an employee or certified representative of the vendor and have a minimum of three years of experience in the application of pyrophosphate sequestering products in municipal water supply and be available Monday through Friday from 7:00 a.m. to 3:30 p.m. EST to answer questions which may arise in applying their product. C. REQUIREMENTS i. A list of two municipal references within a one hundred mile radius of South Bend using the product for a minimum of one year. ii. Each reference must include the name of the municipality, the superintendent's name, and phone number. A one pint sample must be submitted with bid for analysis. iv. During the contract period, additional sampling and analysis will be made. v. Contract can be nullified if testing indicates unauthorized changes have been made to product. vi. Samples of product being used by references may also be sampled. vii. Evaluation . Testing ix. Other evaluation: x. Certified Analysis 1. Sample product analysis 2. Reference interview and possible sample analysis 3. Verification of ingredients. 1. The City reserves the right to submit samples of the polyphosphate product to an independent laboratory of the City's choice for chemical, biological, and physical analysis and testing. 2. Any product which, in the City's opinion, contains hazardous or deleterious substance or fails to comply with these specifications will be disqualified. 3. The cost of this analysis and testing will be incurred by the vendor with the understanding that a maximum of ten samples per year will be submitted. 4. Guaranteed minimum available phosphate percentage as PO4 is to be Eighty Percent (80%). 1. List of data that confirms products effect on (a) copper, (b) sequestration 2. List of data that confirms company' experience in other cities and technical support. I. Tlne supplier shall provide a certified chemical analysis of a pyrophosphate product sample Laken fi an the production facilityfrom which he proposes to supply the City of South Bend. 2. He shall further certify analysis to be representative of the product he proposes to provide the City. xi. Performance Requirements 1. When applied at a rate yielding riot mm e than foes (4) parts ofpyrophosphate as PO4 to each part of iron and manganese, the product shall be capable of holding iron and manganese in solution for no fewer than five (5) days at seventy (70) degrees Fahrenheit in the presence of one-half milligram per liter (0.5 rng/1) free chlorine residual and for no less than tiven0 fora• (24) hours at 140 degree F. 2. The City reserves the right to run performance tests once a month. 3. Any product i ch, in the City's opiniar, does not vreet the specified performance requirements or fails to comply ivith the specifications ivill be disqualified. D. COVERAGE These specifications cover pyrophosphate compounds used to stabilize or sequester soluble iron and manganese in potable water. E. PHYSICAL FORM Product shall be a granular Form. Powdered material will not be accepted. PHYSICAL STANDARDS Phosphate blend shall comply with the following physical requirements: 1. Color: While 2. Solubility: Completely miscible in ivater 3. Percent Phosphate as PO4 Mininnon of 80% 4. Physical Form: Granular G. CHEMICAL STANDARDS i. Phosphate blend shall contain only NSP approved phosphorous ingredients. ii. No amines or other chelating agents shall be used. Blended phosphate product formulation shall be only sodium salts of phosphate compounds. iv. No potassium salts shall be used. v. Impurities in pyrophosphate products shall not exceed the following concentrations: Arsenic as AS 0.001 mg/1 Co eras CU 0.2 m /1 Heavy Metals total as Pb 0.001 m /l Iron FE 0.1 m /I Manganese as MN <.05 mg/ I Organics as C None Silica as SIO2 1.0 Zinc as ZN 0.01 m /I vis In addition to the above standards, pyrophosphate products shall contain no substance, for which the Indiana Pollution Control Board has established a limit in potable water, in a concentration exceeding the limit established for potable water. H. PACKAGING &DELIVERY Product shall be shipped in 50 pound bags and stored locally. Deliveries are to be made within two to three days of notice. iii. Vender will be required to deliver product weekly or as needed to each well field in order to maintain specified stock levels. iv. Weekly delivery receipts will be issued. v. Delivery sites are as follows: Location Address Carria e HillsEa doaERRnad Erskine lowSouth ainCleveland Southnd Cleveland Northand I.) SULFUR DIOXIDE A. PROPERTIES Boiling Point -10°C Color Colorless Specific Gravity 800E 1.363 Critical Temp. 314.82°F Critical Pressure 1141.5 PSIA B. USAGE Estimated annual usage is 100 tons, more or less, to be delivered in 2,000 Ib containers of liquid S02 in truckload lots of 10 containers. C. DELIVERY Supplier must be able to guarantee delivery of 10 tons (20,000 Ibs) within five (5) calendar days from release of requirement. Material to be delivered F.O.B. freight surcharges allowed. iv. Billing must be submitted on a CWT unit basis. v. Delivery Location: Wastewater Treatment Plant located at 3113 Riverside Drive, South Bend, Indiana 46628. J.) DRY POLYMER FLOCCULENT A. GENERAL i. The purpose of this specification is to outline minimum acceptable properties of a polymer at the Bureau of Wastewater in the treatment process. ii. Quantity of the polymer stated in this specification is intended as an estimated usage during a 12 month period rather than an absolute quantity. iii. Polymer is considered a performance product and must meet certain standards due to compliance related issues on the NPDES Permit. iv. Any supplier that has not been previously approved must perform bench testing on any polymer bid to prove the product will meet the standards necessary to ensure permit compliance. v. When samples are required, such samples shall be delivered or shipped at the vendor's expense to the following name and address: Nancy Clay, 3113 Riverside Dr. South Bend, IN 46628. vi. Samples must be clearly labeled with your company's name, address, and (item number). vii. All samples must be representative of the item bid. viii. All samples will become the property of the City of South Bend, and will not be returned. B. PROPERTIES i. Products will be a high molecular weight cationic polyelectrolyte, supplied as a micro -bead or in granular form. ii. The product must be completely non -dusting, free flowing and completely soluble in water with a very rapid dissolving rate. Typical Properties Bulk Densit 50 lbs. ep r cubic ft. Particle Size 95°/u less than 1 mm H of 1 % Solution 3.5 — 4.5 C. PACKAGING/DELIVERY i. Packaging to be in 50 — 55 Ib polyethylene bags. ii. Must be able to guarantee delivery of 9,000 lbs within 14 calendar days after order placement. iii. Prices must be submitted in cost per pound with freight included. iv. Material to be delivered F.O.B. the Wastewater Treatment plant located at 3113 Riverside Drive, South Bend, IN. 46628. K.) LIOUID CALCIUM NITRATE 66% A. GENERAL The estimated annual usage of Liquid Calcium Nitrate (66%) is 45,000 gallons, more or less. Supplier must be able to guarantee delivery of 4,000 to 5,200 gallons within five (5) calendar days after order placement. B. TYPICAL PROPERTIES Concentrations: Ca Os 2 46.34% Ca Os 2. 4H2O 66.5% Ca 11.2% Mn m Less than 1 Specific Gravity: 1.454 /ml at 20°C H: 6.00 at 20°C C. DELIVERY i. Full truck load quantities are to be approximately 3,500 gallons ii. Delivery will be to two separate remote locations. Geyer Ditch GPS location 41,695653 46.40614. Sage Road GPS location 41.71024,-86.41629. iii. Remote locations are accessed via a combination lock. Delivery requests will include the combination lock if City personnel will not be on -site during deliveries. If City personnel will be on -site the combination will be omitted from the manifest. iv. Prices must be submitted in cost per gallon with freight included. L.) SODIUM HYPOCHLORITE 12,5% A. GENERAL i. The estimated annual usage of Sodium Hypochlorite is 62,000 gallons more or less. ii. The City owns multiple 2,550+ gallon tanks for the storage of Sodium Hypochlorite 12.5%. iii. These tanks come equipped with all necessary fittings and outlets, as well as secondary containment for increased safety. iv. Supplier must have necessary hoses and connectors to connect to a 2 inch quick disconnect fitting. v. Product delivered to a Water Filtration Facility must meet the required ANSIINSF Standard 60. vi. No stop -off fees or surcharges allowed however, demurrage charges will be allowed after 2 hours per stop B. TYPICAL PROPERTIES Concentrations Sodium Hypochlorite 12.5% Specific Gravity 1,1964 H 12.5 to 13.5 Molecular Weight 74.44 Boiling Point >212°F Freezing Point -11°F C. DELIVERY i. Supplier must be able to guarantee delivery of 1,800 to 4,500 gallons within 3 to 4 calendar days after order placement. All deliveries shall be made within 48 hours of the request ii. Full truck load quantities of approximately 1,800 to 4,500 gallons are to be delivered, F.O.B. to: a.) Wastewater Treatment Plant, 3113 Riverside Drive, South Bend, IN. 46628. b.) Pinhook Filtration Plant, 2801 Riverside Drive, South Bend, IN 46628. c.) Edison Filtration Plant, 2708 Rockne Drive, South Bend, IN 46615. d.) Olive GAC Building, 915 S. Olive Street, South Bend, IN 46613. 3.) Prices must be submitted and billed in cost per gallon with freight included, billed to the nearest penny. 4.) Multiple stops per load are to be expected. m.) SODIUM PERMANGANATE a. GENERAL: i. The bid will be for two separate line items for the same product (20% Liquid Sodium Permanganate) ii. One line item will be for deliveries of 275-gallon totes. . The other will be for deliveries between 500 and 550 gallon increments. b. TYPICAL PROPERTIES i. Product shall be bulk 20% (by weight) +/- 0.5%liquid sodium permanganate (NaMn04), ii. 20% Liquid Sodium Permanganate shall be produced domestically with in the United States. iii. Product shall meet or exceed ANSI/AW WA standard 13603-03 or subsequent revisions. iv. Product shall be listed by the NSF as being in full compliance with NSF Standard No. 60 for Drinking Water Treatment Chemicals — Health Effects. C. DELIVERY 1. All deliveries shall be made within 48 hours of the request to the following address: 2801 Riverside Drive, South Bend IN 46628, 2. The product is to be delivered in clean containers/tanks and is free of contamination. Contamination of stock shall render the contractor liable for disposal of contaminated material, cleanup of storage facilities and full replacement of stock at the Supplier's expense. 3. All deliveries shall be made on weekdays (excluding holidays) between the hours 7:00 AM and 11:00 AM 4. The off-loading of the 275-gallon totes containing sodium permanganate from the delivery vehicle to the City's storage location will be performed by pressurizing the container to our point of delivery or by transfer pump. 5. Deliveries must be coordinated with the City. The Identity of the driver must be made known by fax or email 24 hr. prior to delivery. The delivery vehicle operator must call the City contact no less than one hour prior to delivery. 6. The Contractor and shipper shall be responsible for all health, safety, and costs associated with the transportation of the product to the Pinhook WTP. 2801 Riverside Drive 46628. 7. The City reserves the right to reject any delivery which does not conform to these specifications or which has been contaminated. N.) STRUVITE REMOVER AND PREVENTATIVE A. GENERAL i. The purpose of this specification is to outline minimum acceptable properties of a struvite remover/preventative at the Bureau of Wastewater in the treatment process. ii. Quantity of the product stated in this specification is intended as an estimated usage during a 12 month period rather than an absolute quantity. B. PROPERTIES i. The product must be non -toxic and require no additional PPE to handle and/or maintain. ii. Vendor shall supply (at no charge) and maintain (at no charge) all chemical feed pumps, spray bars, spray nozzles and injection equipment (where applicable). . Product must have a minimum dilution rate of 40.000:1. iv. Vendor must have a minimum of five (5) installations with five (5) years of proven process application of sh•uvite removal and prevention v. Product must be manufactured and distributed solely from the U.S.A vi. Typical Properties Flammabilit None H Neutral Solubility Miscible C. PACKAGING/DELIVERY i. Packaging to be in 275 gallon totes. ii. Must be able to guarantee delivery of 275 gallons within 10 calendar days after order placement. iii. Material to be delivered F.O.B. the Wastewater Treatment plant located at 3113 Riverside Drive, South Bend, IN. 46628. BID NAME FOR BIDS DUE BIUWKUrUSAL CITY OF SOUTH BEND Water Treatment Chemicals 2021-2022 on, 13, 2021 : 9:00 a.m., Local Time Item Est, City, Item Units Unit Price Total No. Per Year 1 150 Chlorine — 1 Ton Cylinders Ton $ No Bid $ 2 140 Chlorine — 150 Lb. Cylinder Cyl $ No Bid $ 3 9000000 Ferric Chloride Gal. $ No Bid $ Fluorisilicic Acid — 23% Gal. 4 13,000 Price Below 1943 gallons Price Above 1943 gallons $ No Bid $ Potassium Permanganate — 55 Lb. Pails Lbs. 5 11600 $ No Bid $ 6 22,500 Pyrophosphate Sequestrant Agent Lbs. $ No Bid $ 7 100 Sulfur Dioxide — 1 Ton Cylinders Ton $ No Bid $ Dry Polymer Flocculent — 50 / 55 Lb. Lbs. 8 40,000 Polyethylene Bag Clarifloc CE-1463 $ 1.890/Lb. $ 7500.00 Liquid Calcium Nitrate Gal. 9 25,000 $ No Bid $ Sodium Hypochlorite — 12.5% Gal. 10 62,000 Price Below 1800 gallons Price Above 1800 gallons $ No Bid $ Sodium Permanganate Gal. 11 1100 275 Gallon Totes $ No Bid $ Sodium Permanganate Gal. 12 250 500 Gallon Bulk $ No Bid $ 13 1100 Struvite Remover 275 Gallon Totes Gal. $ No Bid $ TOTAL $ 75,600.00 Bidder (Firm): Address: Polydyne Inc. One Chemical Plant Rd. City/State/Zip: Riceboro, GA 31323 Telephone Number: (912)880-2035 BOARD OF PUBLIC WORKS Elizabeth A. Maradik, President Gary A. Gilot, Member Jordan V. Gathers Fax Number: (912) 880-2078 (Sign Boyd Stanley (Printed Name) Sr. Vice -President (Title) Joseph R. Molnar, Member Attest: Anne Fuchs, Clerk CITY OF SOUTH BEND INSTRUCTIONS TO BIDDERS BID FORMS AND EXECUTION A. Bidders are expected to examine the Drawings, Specifications, Proposal and all Instructions. Failure to do so will be at the Bidder's risk. B. Each Bidder shall furnish all information required by the Notice, Instructions to Bidders and Specifications. Bids must be made on the form provided. The Bidder shall sign the Proposal and Non -Collusion Affidavit, which is a part of the provided form, where indicated, provide a notary signature and provide all other information required. C. The Bidder shall sign the Proposal in the following manner: If the Proposal is made by an individual, his/her name and post office address must be shown. If made by a partnership or joint venture, the name and post office address of each member of the partnership or joint venture must be shown. If made by a corporation, the Proposal must be signed by an officer of the corporation or by a representative duly authorized by the corporation to execute the Proposal in its behalf. 2. SEALED BIDS ONLY A. The City of South Bend, Indiana, Board of Public Works will receive sealed electronic Responses at bowbidsQ).southbend i n. eov. B. "Bid for Computer Equipment," "Bid for Front End Loader," or "Bid for Office Supplies." C. When samples are required, such samples shall be delivered or shipped at the bidder's expense to the address specified in the Invitation to Bid. Samples must be shipped separately from bid documents and labeled clearly with the Bidder's name, address and the commodity or equipment classifications and documents, the item (and item number, if any), and Material Safety Data Sheets (if applicable). All samples must be representative of the commodities or equipment which will be supplied by the successful Bidder. All samples will become the property of the City of South Bend and none will be returned, unless otherwise stated in the Specifications. D. In the event of an inconsistency between provisions of the contract documents, the inconsistency shall be resolved by giving precedence in the following order: 3. ORDER OF PRECEDENCE A. Bid Form attached Proposal B. Amendments to Specifications C. Specifications D. Special Provision E. Instructions to Bidders F. Notice to Bidders 4, DELIVERY OF BIDS The City of South Bend, Indiana, Board of Public Works will receive sealed electronic Responses at bowbids(a)southbendin..g 5. ADDENDA — NO VERBAL INTERPRETATIONS A. No inquiries by Bidders relative to interpretation of Plans, Specifications, Special Provisions, or other Bidding Documents will be answered verbally. If any prospective Bidder is unable or unwilling to comply with one or more requirements of the bidding document, such Bidder should so inform the Board of Public Works in writing. Upon receipt of such information, consideration will be given to the advisability of issuing an Addendum which would thereupon become applicable to all Bidders. Any such inquiry must be submitted at least seven (7) days prior to the bid opening date in order to give the Board sufficient time to consider any necessary Addendum. All answers to such inquiries, in the form of Addenda, will be furnished to all prospective Bidders who have registered with the City. All Bidders are required to acknowledge receipt of any Addenda by inserting the Addendum number and the issuing date on executed Proposals. 6. REJECTION OF PROPOSALS CONTAINING ALTERATION ERASURES INCOMPLETE BIDS AND ETC, A. Proposals shall be rejected if they show any alteration of form, additions not called for, conditional or alternate bids (except when and insofar as are invited), incomplete bids, erasures or irregularities of any kinds. B. All blank spaces for bid prices must be filled in, in ink, with the unit price and total price for each item (This does not apply to divisible bids). In case of incorrect totaling of amounts and where the unit price and the extension thereof do not agree, the unit price for each item shall govern, and the City is authorized to correct all erroneous extension and totals for the purpose of comparing bids. 7. TRADE DISCOUNTS A. Trade discounts shall not be shown separately, but shall be incorporated in the Bidder's unit price, unless otherwise specified. 8. VEHICLE BIDS A. Bidders may bid on one (1) or more vehicles, provided however, that the bid submitted for each vehicle is delivered in a separate, sealed envelope, by vehicle, with the envelope clearly labeled on Bidders may bid on one (1) or more vehicles, provided however, that the bid submitted for each vehicle is delivered in a separate, sealed envelope, by vehicle, with the envelope clearly labeled on the outside as to the specific vehicle for which the bid is being submitted. Bidders may submit separate bid bonds for each vehicle being bid upon OR may submit one (1) bid bond equal to 10% of the combined total of all vehicle bids submitted. 9. The Board may reject any bid that does not conform to these requirements as non- responsive. 10, TAX EXEMPTIONS A. The City of South Bend is exempt from the payment of federal excise and transportation taxes levied under the provision of the Internal Revenue Code. It is also exempt from the Indiana State Gross Retail Tax (sales tax). The City will furnish the successful Bidder with any certificate of exemption required. 11, WITHDRAWAL OF BIDS A. Withdrawal of bids will be allowed only in those cases in which a written request to withdraw a bid is received by the Board of Public Works prior to the date and hour for receiving and opening bids. In such cases, the same will be returned to Bidder unopened. 12, ESCALATOR OR CONTINGENT CLAUSES A. The use of escalator clauses or other contingent clauses by the Bidder is prohibited, unless requested or permitted by the Invitation to Bid. No Proposal shall contain nor be accompanied by any writing purporting to limit or qualify the City's right to accept such Proposal or purporting to alter such Proposal or any Contract which may be executed pursuant thereto. 13, PRICES MUST BE DELIVERED PRICES A. The bid price shall be a delivered price. All materials shall be shipped F.O.B. destination as specified in the Invitation to Bid. No fuel surcharges accepted. 14. AWARD — WAIVER OF TECHNICALITIES A. The Award of Bid, if any award be made, will be made within sixty (60) calendar days after the opening of Proposals to the lowest responsible and responsive Bidder who's Proposal complies with all the requirements prescribed, exclusive of technicalities waived. Until the final award of the Bid, however, the right is reserved by the City to reject any and all Proposals and to waive technical errors. Is. SPLITTING OF AWARDS/DIVISIBLE BIDS A. Bids will be awarded on the basis of the total dollar amount for all items in the Proposal unless the bid is described by the City as a Divisible Bid. The City may award a Divisible Bid to the lowest responsible and responsive Bidder for each item or class of items as indicated in the bid documents. I6, BIDDER QUALIFICATION A. The City may require any Bidder to submit evidence of qualifications, and may consider any evidence of the financial, technical, and other qualifications and abilities of the Bidder. The City will not award a Contract to a Bidder who, in its opinion, is not fully qualified on the basis of financial resources and responsibility, possession of adequate equipment, personnel, experience, and past record of performance to perform the obligations to be undertaken competently and without delay. 17, PURCHASE ORDERS A. A Purchase Order will be issued to the successful Bidder after formal acceptance of the bid is made by the City. 18, NEW MANUFACTURE A. Unless otherwise specified in the Invitation to Bid, the items offered shall all be new and the latest model of manufacture. 19, SOURCE OF SUPPLY A. If the Bidder is not a manufacturer, the source of supply must be shown and all sub- contractors must be identified. 20, PACKAGING A. All items shall be delivered strongly packed and marked according to accepted commercial practice unless otherwise directed in the Specifications. No charge shall be made for containers and the City shall have no obligation to return containers unless otherwise provided by the Specifications or Special Provisions. Any items not received in good condition will be rejected. 21, INSPECTION OF GOODS A. The City of South Bend reserves the right to inspect and have any goods tested after delivery for compliance with the specifications. Notice of latent defects, which would make the item unfit for the purposes for which they are required, may be given at any time within one year after discovery of the defects. B. All items rejected must be removed immediately by the Contractor at the expense of the Contractor. If the Contractor fails or refuses to remove the rejected items, they may be sold by the City of South Bend, C. The above provision shall not be construed in limitations of any rights the City may have under any laws including the Uniform Commercial Code. 22, ASSIGNMENTS A. No person to whom a Contract has been awarded may assign his interest in the Contract without the consent, in writing, of the City. 23, CANCELLATION A. The City of South Bend reserves the right to cancel any Contract for failure or refusal of performance, fraud, deceit, misrepresentation, collusion, conspiracy, or any other misconduct on the part of the Contractor. 24, DEDUCTION OF DAMAGES A. If the City cancels the contract for any cause, it shall deduct from whatever is owed the Contractor on the Contract or any other Contract, any amount sufficient to compensate the City for any damages suffered by it because of the Contractor's wrongdoing. 25, METHOD OF INVOICING FOR PAYMENT A. Contractor shall bill the City of South Bend 1. On regular invoice form giving a complete and detailed description of the goods delivered, including purchase order number. 2. If the Contractor allows a discount, the period of time in which the City must make payment to qualify for the discounts shall be computed from the date the City received the invoice (completely filled out), or the date the goods are delivered and accepted, whichever may be later, and shall not be less than twenty (20) days. 3. If more than one shipment is made under the Contract and on the same purchase order, the City will make partial payments on a basis that is agreeable to both parties. 26. OWNERSHIP OF GOODS A. The goods which are the subject of the Contract shall remain property of the Contractor until delivered to and accepted by the City of South Bend. 27. ESTIMATED QUANTITIES A. If the quantity set forth in the Notice to Bidders and Proposal is approximate and represents the estimated requirements of the City for a specified period of time, the unit price and the extended total price thereof shall be used only as a basis for the evaluation of bids. The actual quantities necessary may be more or less than the estimate, but the City shall neither be obligated nor limited to any specific amount. The City will, if at all possible, restrict increases to twenty percent (20%) of the estimated quantity and will, if at all possible, restrict decreases to twenty percent (20%) of the estimated quantity. 28. TERM "OR EQUAL" A. Where the term "OR EQUAL" is used in these Specifications, the Bidder deviating from specified item shall file with his/her bid a letter fully explaining and justifying his/her proposed article or equal. The City of South Bend shall be the sole judge in determining if the "OR EQUAL" offered meets the Specifications. 29, INDEMNIFICATION CLAUSE A. The Contractor agrees to indemnify, defend, and hold harmless the City of South Bend, its agents, officers, and employees from all costs, losses, claims and suits, including court costs, attorney fees, and other expenses, arising from or out of the negligent performance of this Contract by the Bidder or because or arising out of any defect in the goods, materials or equipment supplied by the Bidder. Company ID Number:32855 Client Company ID Number:385743 THE E-VERIFY MEMORANDUM OF UNDERSTANDING FOR EMPLOYERS USING A WEB SERVICES E-VERIFY EMPLOYER AGENT ARTICLE i PURPOSE AND AUTHORITY The parties to this agreement are the Department of Homeland Security (DHS), the SNF Holding Company (Employer), and the Web Services E-Verify Employer Agent. The purpose of this agreement is to set forth terms and conditions which the Employer and the Web Services E-Verify Employer Agent will follow while participating in E-Verify. E-Verify is a program that electronically confirms an employee's eligibility to work in the United States after completion of Form I-9, Employment Eligibility Verification (Form I-9). This Memorandum of Understanding (MOU) explains certain features of the E-Verify program and describes specific responsibilities of the Employer, the E-Verify Employer Agent, the Social Security Administration (SSA), and DHS. References in this MOU to the Employer include the Web Services E-Verify Employer Agent when acting on behalf of the Employer. For purposes of this MOU, the E-Verify browser refers to the website that provides direct access to the E-Verify system: https://e-verify.uscis.gov/emp. You may access E-Verify directly free of charge via the E-Verify browser. Authority for the E-Verify program is found in Title IV, Subtitle A, of the Illegal Immigration Reform and Immigrant Responsibility Act of 1996 (IIRIRA), Pub. L. 104-208, 110 Stat. 3009, as amended (8 U.S.C. Section 1324a note). The Federal Acquisition Regulation (FAR) Subpart 22.18, "Employment Eligibility Verification" and Executive Order 12989, as amended, provide authority for Federal contractors and subcontractors (Federal contractor) to use E- Verify to verify the employment eligibility of certain employees working on Federal contracts. ARTICLE II RESPONSIBILITIES A. RESPONSIBILITIES OF THE EMPLOYER 1. For purposes of this MOU, references to the Employer include the Web Services E-Verify Employer Agent when acting on behalf of the Employer. 2. By enrolling in E-Verify and signing the applicable MOU, the Employer asserts that it is a legitimate company which intends to use E-Verify for legitimate purposes only and in accordance with the laws, regulations and DHS policies and procedures relating to the use of E-Verify. 3. The Employer agrees to display the following notices supplied by DHS (though the Web Services E-Verify Employer Agent) in a prominent place that is clearly visible to prospective employees and all employees who are to be verified through the system: A. Notice of E-Verify Participation B. Notice of Right to Work 4. The Employer agrees to provide to the SSA and DHS the names, titles, addresses, and telephone numbers of the Employer representatives to be contacted about E-Verify. The Employer also agrees to keep such information current by providing updated information to SSA and DHS whenever the representatives' contact information changes. 5. The Employer agrees to become familiar with and comply with the most recent version of theE-Verify User Manual. The Employer will obtain the E-Verify User Manual from the Web ServicesE-Verify Employer Agent, and will be notified by the Web Services E-Verify Employer Agent when a new version of the E-Verify User Manual becomes available. 6. The Employer agrees to comply with current Form I-9 procedures, with two exceptions: A. If an employee presents a "list B" identity document, the Employer agrees to only accept "List B" documents that contain a photo. (List B documents identified in 8 C.F.R. 274a.2(b)(1)(B)) can be Page 1 of 17 I E-Verify MOU for Employers Using a Web Services Employer Agent i Revision Date 06/01/13 �� . � `•mac �nl ni o Company ID Number:32855 Client Company ID Number:385743 presented during the Form 1-9 process to establish identity.) If an employee objects to the photo requirement for religious reasons, the Employer should contact E-Verify at 888-464-4218. B. If an employee presents a DHS Form 1-551 (Permanent Resident Card), Form 1-766 (Employment Authorization Document), or U.S. Passport or Passport Card to complete Form 1-9, the Employer agrees to make a photocopy of the document and to retain the photocopy with the employee's Form 1-9. The Employer will use the photocopy to verify the photo and to assist DHS with its review of photo mismatches that employees contest. DHS may in the future designate other documents that activate the photo screening tool. Note: Subject only to the exceptions noted previously in this paragraph, employees still retain the right to present any List A, or List B and List C, document(s) to complete the Form 1-9. 7, The Employer agrees to record the case verification number on the employee's Form 1-9 or to print the screen containing the case verification number and attach it to the employee's Form 1-9. 8, The Employer agrees that, although it participates in E-Verify, the Employer has a responsibility to complete, retain, and make available for inspection Forms 1-9 that relate to its employees, or from other requirements of applicable regulations or laws, including the obligation to comply with the antidiscrimination requirements of section 274E of the INA with respect to Form 1-9 procedures. A. The following modified requirements are the only exceptions to an Employer's obligation to not employ unauthorized workers and comply with the anti -discrimination provision of the INA: (1) List B identity documents must have photos, as described in paragraph 6 above; (2) When an Employer confirms the identity and employment eligibility of newly hired employee using E-Verify procedures, the Employer establishes a rebuttable presumption that it has not violated section 274A(a)(1)(A) of the Immigration and Nationality Act (INA) with respect to the hiring of that employee; (3) If the Employer receives a final nonconfirmation for an employee, but continues to employ that person, the Employer must notify DHS and the Employer is subject to a civil money penalty between $550 and $1,100 for each failure to notify DHS of continued employment following a final nonconfirmation; (4) If the Employer continues to employ an employee after receiving a final nonconfirmation, then the Employer is subject to a rebuttable presumption that it has knowingly employed an unauthorized alien in violation of section 274A(a)(1)(A); and (5) no E-Verify participant is civilly or criminally liable under any law for any action taken in good faith based on information provided through the E-Verify. B. DHS reserves the right to conduct Form 1-9 compliance inspections, as well as any other enforcement or compliance activity authorized by law, including site visits, to ensure proper use of E-Verify. 9, The Employer is strictly prohibited from creating an E-Verify case before the employee has been hired, meaning that a firm offer of employment was extended and accepted and Form 1-9 was completed. The Employer agrees to create an E-Verify case for new employees within three Employer business days after each employee has been hired (after both Sections 1 and 2 of Form 1-9 have been completed), and to complete as many steps of the E-Verify process as are necessary according to the E-Verify User Manual. If E- Verify is temporarily unavailable, the three-day time period will be extended until it is again operational in order to accommodate the Employer's attempting, in good faith, to make inquiries during the period of unavailability. 10, The Employer agrees not to use E-Verify for pre -employment screening of job applicants, in support of any unlawful employment practice, or for any other use that this MOU or the E-Verify User Manual does not authorize. 11, The Employer must use E-Verify (through its Web Services E-Verify Employer Agent) for all new employees. The Employer will not verify selectively and will not verify employees hired before the effective date of this MOU. Employers who are Federal contractors may qualify for exceptions to this requirement as described in Article 11.13 of this MOU. 12, The Employer agrees to follow appropriate procedures (see Article III below) regarding tentative nonconfirmations. The Employer must promptly notify employees in private of the finding and provide them with the notice and letter containing information specific to the employee's E-Verify case. The Employer agrees to provide both the English and the translated notice and letter for employees with limited English proficiency to employees. The Employer agrees to provide written referral instructions to employees and instruct affected employees to bring the English copy of the letter to the SSA. The Employer must allow employees to contest the finding, and not take adverse action against employees if they choose to contest the finding, while their case is still pending. Further, when employees contest a tentative nonconfirmation based upon a photo mismatch, the Employer must take additional steps (see Article IILB below) to contact DHS with information necessary to resolve the challenge. 13, The Employer agrees not to take any adverse action against an employee based upon the employee's Page 2 of 17 1 E-Verify MOU for Employers Using a Web services Employer Agent I Revision Date 06/01/13 Company ID Number:32855 Client Company ID Number:385743 perceived employment eligibility status while SSA or DHS is processing the verification request unless the Employer obtains knowledge (as defined in 8 C.F.R. Section 274a.1(p) that the employee is not work authorized. The Employer understands that an initial inability of the SSA or DHS automated verification system to verify work authorization, a tentative nonconfirmation, acase in continuance (indicating the need for additional time for the government to resolve a case), or the finding of a photo mismatch, does not establish, and should not be interpreted as, evidence that the employee is not work authorized. In any of such cases, the employee must be provided a full and fair opportunity to contest the finding, and if he or she does so, the employee may not be terminated or suffer any adverse employment consequences based upon the employee's perceived employment eligibility status (including denying, reducing, or extending work hours, delaying or preventing training, requiring an employee to work in poorer conditions, withholding pay, refusing to assign the employee to a Federal contract or other assignment, or otherwise assuming that he or she is unauthorized to work) until and unless secondary verification by SSA or DHS has been completed and a final nonconfirmation has been issued. If the employee does not choose to contest a tentative nonconfirmation or a photo mismatch or if a secondary verification is completed and a final nonconfirmation is issued, then the Employer can find the employee is not work authorized and terminate the employee's employment. Employers or employees with questions about a final nonconfirmation may call E-Verify at 1-888-464-4218 (customer service) or 1-888-897-7781 (worker hotline). 14. The Employer agrees to comply with Title VII of the Civil Rights Act of 1964 and section 274B of the INA as applicable by not discriminating unlawfully against any individual in hiring, firing, employment eligibility verification, or recruitment or referral practices because of his or her national origin or citizenship status, or by committing discriminatory documentary practices. The Employer understands that such illegal practices can include selective verification or use of E-Verify except as provided in part D below, or discharging or refusing to hire employees because they appear or sound "foreign" or have received tentative nonconfirmations. The Employer further understands that any violation of the immigration -related unfair employment practices provisions in section 274B of the INA could subject the Employer to civil penalties, back pay awards, and other sanctions, and violations of Title VII could subject the Employer to back pay awards, compensatory and punitive damages. Violations of either section 2746 of the INA or Title VII may also lead to the termination of its participation in E-Verify. If the Employer has any questions relating to the anti -discrimination provision, it should contact OSC at 1-800-255-8155 or 1-800-237-2515 (TDD). 15. The Employer agrees that it will use the information it receives from E-Verify (through its Web Services E- Verify Employer Agent) only to confirm the employment eligibility of employees as authorized by this MOU. The Employer agrees that it will safeguard this information, and means of access to it (such as Personal Identification Numbers and passwords), to ensure that it is not used for any other purpose and as necessary to protect its confidentiality, including ensuring that it is not disseminated to any person other than employees of the Employer who are authorized to perform the Employer's responsibilities under this MOU except for such dissemination as may be authorized in advance by SSA or DHS for legitimate purposes. 16. The Employer agrees to notify DHS immediately in the event of a breach of personal information. Breaches are defined as loss of control or unauthorized access to E-Verify personal data. All suspected or confirmed breaches should be reported by calling 1-888-464-4218 or via email at E-Verify@uscis.dhs.gov. Please use "Privacy Incident -Password" in the subject line of your email when sending a breach report to E-Verify. 17. The Employer acknowledges that the information it receives from SSA through its Web ServicesE-Verify Employer Agent is governed by the Privacy Act (5 U.S.C. Section 552a(i)(1) and (3)) and the Social Security Act (42 U.S.C. 1306(a)). Any person who obtains this information under false pretenses or uses it for any purpose other than as provided for in this MOU may be subject to criminal penalties. 18. The Employer agrees to cooperate with DHS and SSA in their compliance monitoring and evaluation of E- Verify, which includes permitting DHS, SSA, their contractors and other agents, upon reasonable notice, to review Forms I-9 and other employment records and to interview it and its employees regarding the Employer's use of E-Verify, and to respond in a prompt and accurate manner to DHS requests for information relating to their participation in E-Verify. 19. The Employer shall not make any false or unauthorized claims or references about its participation in E- Verify on its website, in advertising materials, or other media. The Employer shall not describe its services as federally -approved, federally -certified, or federally -recognized, or use language with a similar intent on its website or other materials provided to the public. Entering into this MOU does not mean that E-Verify endorses or authorizes your E-Verify services and any claim to that effect is false. 20. The Employer shall not state in its website or other public documents that any language used therein has been provided or approved by DHS, USCIS or the Verification Division, without first obtaining the prior written consent of DHS. 21. The Employer agrees that E-Verify trademarks and logos may be used only under license by DHS/USCIS (see M-795 (Web)) and, other than pursuant to the specific terms of such license, may not be used in any manner that might imply that the Employer's services, products, websites, or publications are sponsored by, endorsed by, licensed by, or affiliated with DHS, USCIS, or E-Verify. Page 3 of 17 E-Verify MOU for Employers Using a Web Services Employer Agent I Revision Oate 06/01/13 ��. ■. °� Illpll2,a h1S14 Company ID Number:32855 Client Company ID Number:385743 22. The Employer understands that if it uses E-Verify procedures for any purpose other than as authorized by this MOU, the Employer may be subject to appropriate legal action and termination of its participation in E- Verify according to this MOU. B. RESPONSIBILITIES OF THE WEB SERVICES E-VERIFY EMPLOYER AGENT 1. The Web Services E-Verify Employer Agent agrees to complete its Web Services interface no later than six months after the date the Web Services User signs this MOU. E-Verify considers your interface to be complete once it has been built pursuant to the Interface Control Agreement (ICA), submitted to E-Verify for testing, and approved for system access. 2. The Web Services E-Verify Employer Agent agrees to perform sufficient maintenance on the Web Services interface in accordance with the requirements listed in the ICA. These requirements include, but are not limited to, updating the Web Services interface to ensure that any updates or enhancements are incorporated no later than six months after the issuance of an ICA. Web Services E-Verify Employer Agents should be aware that this will require the investment of time and resources. Compliance with the requirements of the ICA must be carried out to the satisfaction of DHS and or its assignees. 3. The Web Services E-Verify Employer Agent agrees to provide to SSA and/or DHS the names, titles, addresses, e-mail addresses, and telephone numbers of the Web Services E-Verify Employer Agent representative who will access information, as well as ensure cooperation, communication, and coordination with E-Verify. In addition, Web Services E-Verify Employer Agents must provide to SSA and/or DHS the names, titles, addresses, and telephone numbers of its clients and their staff who will access information through E-Verify. Web Services E-Verify Employer Agents must ensure the contact information is updated with SSA and DHS whenever the points of contact change. 4. The Web Services E-Verify Employer Agent agrees to become familiar with and comply with theE-Verify User Manual and provide a copy of the most current version of the manual to the Employer so that the Employer can become familiar with and comply with E-Verify policy and procedures. The Web Services E-Verify Employer Agent agrees to obtain a revised E-Verify User Manual as it becomes available and to provide a copy of the revised version to the Employer no later than 30 days after the manual becomes available. 5. The Web Services E-Verify Employer Agent agrees that any person accessing E-Verify on its behalf is trained on the most recent E-Verify policy and procedures. 6. The Web Services E-Verify Employer Agent agrees that any of its representatives who will perform employment verification cases will complete the E-Verify Tutorial before that individual initiates any cases. A. The Web Services E-Verify Employer Agent agrees that all of its representatives will take the refresher tutorials initiated by E-Verify as a condition of continued use of E-Verify, including any tutorials for Federal contractors, if any of the Employers represented by the Web Services E-Verify Employer Agent is a Federal contractor. B. Failure to complete a refresher tutorial will prevent the Web Services E-Verify Employer Agent and Employer from continued use of E-Verify. 7, The Web Services E-Verify Employer Agent agrees to grant E-Verify access only to current employees who need E-Verify access. The Web Services E-Verify Employer Agent must promptly terminate an employee's E- Verify access if the employee is separated from the company or no longer needs access to E-Verify. 8. The Web Services E-Verify Employer Agent agrees to obtain the necessary equipment to use E- Verify as required by the E-Verify rules and regulations as modified from time to time. 9. The Web Services E-Verify Employer Agent agrees to, consistent with applicable laws, regulations, and policies, commit sufficient personnel and resources to meet the requirements of this MOU. 10, The Web Services E-Verify Employer Agent agrees to provide its clients with training on E-Verify processes, policies, and procedures. The E-Verify Employer Agent also agrees to provide its clients with ongoing E- Verify training as needed. E-Verify is not responsible for providing training to clients of E-Verify Employer Agents. 11. The Web Services E-Verify Employer Agent agrees to provide the Employer with the notices described in Article II.B.2 below. 12. The Web Services E-Verify Employer Agent agrees to create E-Verify cases for the Employer it represents in accordance with the E-Verify Manual, the E-Verify Web -Based Tutorial and all other published E-Verify rules and procedures. The Web Services E-Verify Employer Agent will createE-Verify cases using information provided by the Employer and will immediately communicate the response back to the Employer. If E-Verify is temporarily unavailable, the three-day time period will be extended until it is again operational in order to accommodate the Web Services E-Verify Employer Agent's attempting, in good faith, to make inquiries on behalf of the Employer during the period of unavailability. If, however, the Web Services interface is unavailable due to no fault of E-Verify, then the three-day time period is not extended. In such a case, the Page 4 of 17 1 E-Verify MOU for Employers Using a Web Services Employer Agent I Revision Date 06/01/13 ��■ ■■ s" ,a9lnr. �,.,,� Company ID Number:32855 Client Company ID Number:386743 Web Services E-Verify Employer Agent must use the E-Veriry browser during the outage. 13. The Web Services E-Verify Employer Agent agrees to ensure that all notices, referral letters and any other materials otherwise including instructions regarding tentative nonconfirmations, will be consistent with the most current E-Verify tentative nonconfirmation notices and referral letters, which are available on E-Verify's website. 14. The Web Services E-Verify Employer Agent agrees that any system or interface it develops will follow the steps for creating E-Verify cases and processing tentative nonconfirmations, as laid out in the ICA, this MOU and the User Manual, including but not limited to allowing an employer to close an invalid case where appropriate, allowing an employer to refer a tentative nonconfirmation only when an employee chooses to contest a tentative nonconfirmation (no automatic referrals), and referring a tentative nonconfirmation to the appropriate agency at the time the employer prints the referral letter and provides the letter to the employee. The Web Services E-Verify Employer Agent understands that any failure to make its system or interface consistent with proper E-Verify procedures can result in DHS terminating the Web Services E-Verify Employer Agent's agreement and access with or without notice. 15. When the Web Services E-Verify Employer Agent receives notice from a client company that it has received a contract with the FAR clause, then the Web Services E-Verify Employer Agent must update the company's E-Verify profile within 30 days of the contract award date. 16. If data is transmitted between the Web Services E-Verify Employer Agent and its client, then the Web Services E-Verify Employer Agent agrees to protect personally identifiable information during transmission to and from the Web Services E-Verify Employer Agent. 17. The Web Services E-Verify Employer Agent agrees to notify DHS immediately in the event of a breach of personal information. Breaches are defined as loss of control or unauthorized access toE-Verify personal data. All suspected or confirmed breaches should be reported by calling 1-888-464-4218 or via email at . Please use "Privacy Incident -Password" in the subject line of your email when sending a breach report to E- Verify. 18. The Web Services E-Verify Employer Agent agrees to fully cooperate with DHS and SSA in their compliance monitoring and evaluation of E-Verify, including permitting DHS, SSA, their contractors and other agents, upon reasonable notice, to review Forms I-g, employment records, and all records pertaining to the Web Services E-Verify Employer Agent's use of E-Verify, and to interview it and its employees regarding the use of E-Verify, and to respond in a timely and accurate manner to DHS requests for information relating to their participation in E-Verify. A. The Web Services E-Verify Employer Agent agrees to cooperate with DHS if DHS requests information about the Web Services E-Verify Employer Agent's interface, including requests by DHS to view the actual interface operated by the Web Services E-Verify Employer Agent as well as related business documents. The Web Services E-Verify Employer Agent agrees to demonstrate for DHS the functionality of its interface to E-Verify upon request. B. The Web Services E-Verify Employer Agent agrees to demonstrate, if requested by DHS, that it has provided training to its clients that meets E-Verify standards. Training programs must provide a focused study of the topics covered in the E-Veriry User Manual and pertinent Supplemental Guides. Furthermore, training programs and materials must be updated as E-Verify changes occur. The Web Services E-Verify Employer Agent is encouraged to incorporate information from existing E-Verify materials, including the Enrollment Quick Reference Guide, the E-Veriry Employer Agent Client Handbook (formerly known as the Designated Agent Client Handbook), and existing tutorials and manuals into their training program. E-Verify also encourages the Web Services E-Verify Employer Agent to supervise first-time use of the E-Verify browser or Web Services interface by its staff and Employer clients as part of any training program. The Web Services E-Verify Employer Agent agrees to submit Its training program materials to DHS for review upon request. Failure to provide adequate training could, in some instances, lead to penalties as described in Article V.F.1. of this MOU. 19. The Web Services E-Verify Employer Agent shall not make any false or unauthorized claims or references about its participation in E-Verify on its website, in advertising materials, or other media. The Web Services E-Verify Employer Agent shall not describe its services as federally -approved, federally -certified, or federally -recognized, or use language with a similar intent on its website or other materials provided to the public. Entering into this MOU does not mean that E-Verify endorses or authorizes your Web Services E- Verify Employer Agent services and any claim to that effect is false. 20. The Web Services E-Verify Employer Agent shall not state in its website or other public documents that any language used therein has been provided or approved by DHS, USCIS or the Verification Division, without first obtaining the prior written consent of DHS. 21. The Web Services E-Verify Employer Agent agrees that E-Verify trademarks and logos may be used only Page 5 of 17 I E-Verify MOU for Employers Using a Web Services Employer Agent I Revision Date 06/Ol/13 Company ID Number:32855 Client Company ID Number:385743 under license by DHS/USCIS (see ) and, other than pursuant to the specific terms of such license, may not be used in any manner that might imply that the Web Services E-Verify Employer Agent's services, products, websites, or publications are sponsored by, endorsed by, licensed by, or affiliated with DHS, USCIS, or E- Verify. 22. The Web Services E-Verify Employer Agent understands that if it uses E-Verify procedures for any purpose other than as authorized by this MOU, the Web Services E-Verify Employer Agent may be subject to appropriate legal action and termination of its participation in E-Verify according to this MOU. C. RESPONSIBILITIES OF FEDERAL CONTRACTORS The Web Services E-Verify Employer Agent shall ensure that the Web Services E-Verify Employer Agent and the Employers it represents carry out the following responsibilities if the Employer is a Federal contractor or becomes a federal contractor. The Web Services E-Verify Employer Agent should instruct the client to keep the Web Services E- Verify Employer Agent informed about any changes or updates related to federal contracts. It is the Web Services E- Verify Employer Agent's responsibility to ensure that its clients are in compliance with all E-Verify policies and procedures. 1. If the Employer is a Federal contractor with the FAR E-Verify clause subject to the employment verification terms in Subpart 22,18 of the FAR, it will become familiar with and comply with the most current version of the E-Verify User Manual for Federal Contractors as well as the E-Verify Supplemental Guide for Federal Contractors. 2. In addition to the responsibilities of every employer outlined in this MOU, the Employer understands that if it is a Federal contractor subject to the employment verification terms in Subpart 22.18 of the FAR it must verify the employment eligibility of any "employee assigned to the contract" (as defined in FAR 22.1801). Once an employee has been verified through E-Verify by the Employer, the Employer may not reverify the employee through E-Verify. A. An Employer that is not enrolled in E-Verify as a Federal contractor at the time of a contract award must enroll as a Federal contractor in the E-Verify program within 30 calendar days of contract award and, within 90 days of enrollment, begin to verify employment eligibility of new hires using E- Verify. The Employer must verify those employees who are working in the United States, whether or not they are assigned to the contract. Once the Employer begins verifying new hires, such verification of new hires must be initiated within three business days after the hire date. Once enrolled in E-Verify as a Federal contractor, the Employer must begin verification of employees assigned to the contract within 90 calendar days after the date of enrollment or within 30 days of an employee's assignment to the contract, whichever date is later. B. Employers enrolled in E-Verify as a Federal contractor for 90 days or more at the time of a contract award must use E-Verify to begin verification of employment eligibility for new hires of the Employer who are working in the United States, whether or not assigned to the contract, within three business days after the date of hire. If the Employer is enrolled in E-Verify as a Federal contractor for 90 calendar days or less at the time of contract award, the Employer must, within 90 days of enrollment, begin to use E-Verify to initiate verification of new hires of the contractor who are working in the United States, whether or not assigned to the contract. Such verification of new hires must be initiated within three business days after the date of hire. An Employer enrolled as a Federal contractor in E-Verify must begin verification of each employee assigned to the contract within 90 calendar days after date of contract award or within 30 days after assignment to the contract, whichever is later. C. Federal contractors that are institutions of higher education (as defined at 20 U.S.C. 1001(a)), state or local governments, governments of Federally recognized Indian tribes, or sureties performing under a takeover agreement entered into with a Federal agency under a performance bond may choose to only verify new and existing employees assigned to the Federal contract. Such Federal contractors may, however, elect to verify all new hires, and/or all existing employees hired after November 6, 1986. Employers in this category must begin verification of employees assigned to the contract within 90 calendar days after the date of enrollment or within 30 days of an employee's assignment to the contract, whichever date is later. D. Upon enrollment, Employers who are Federal contractors may elect to verify employment eligibility of all existing employees working in the United States who were hired after November 6, 1986, instead of verifying only those employees assigned to a covered Federal contract. After enrollment, Employers must elect to verify existing staff following DHS procedures and begin E-Verify verification of all existing employees within 180 days after the election. E. The Employer may use a previously completed Form 1-9 as the basis for creating an E-Verify case for an employee assigned to a contract as long as: I. That Form 1-9 is complete (including the SSN) and complies with Article II.A.6, Page 6 of 17 1 E-Verify MOU for Employers Using a Web Services Employer Agent I Revision Date 06/01/13 �. ..� �.Yii%al.�5. �L. Company ID Number:32855 Client Company ID Number:385743 ii. The employee's work authorization has not expired, and iii. The Employer has reviewed the information reflected in the Form 1-9 either in person or in communications with the employee to ensure that the employee's Section 1, Form I-9 attestation has not changed (including, but not limited to, a lawful permanent resident alien having become a naturalized U.S. citizen). F. The Employer shall complete a new form I-9 consistent with Article II.A.6 or update the previous Form I-9 to provide the necessary information if: i. The Employer cannot determine that Form I-9 complies with Article II.A.6, ii. The employee's basis for work authorization as attested in Section 1 has expired or changed, or iii. The Form I-9 contains no SSN or is otherwise incomplete. Note: If Section 1 of Form I-9 is otherwise valid and up-to-date and the form otherwise complies with Article II.C.S, but reflects documentation (such as a U.S. passport or Form I- 551) that expired after completing Form I-g, the Employer shall not require the production of additional documentation, or use the photo screening tool described in Article II.A.S, subject to any additional or superseding instructions that may be provided on this subject in the E- Verify User Manual. G. The Employer agrees not to require a second verification using E-Verify of any assigned employee who has previously been verified as a newly hired employee under this MOU or to authorize verification of any existing employee by any Employer that is not a Federal contractor based on this Article. 3. The Employer understands that if it is a Federal contractor, its compliance with this MOU is a performance requirement under the terms of the Federal contract or subcontract, and the Employer consents to the release of information relating to compliance with its verification responsibilities under this MOU to contracting officers or other officials authorized to review the Employer's compliance with Federal contracting requirements. D. RESPONSIBILITIES OF SSA 1. SSA agrees to allow DHS to compare data provided by the Employer (through the E-Verify Employer Agent) against SSA's database. SSA sends DHS confirmation that the data sent either matches or does not match the information in SSA's database. 2. SSA agrees to safeguard the information the Employer provides (through the E-Verify Employer Agent) through E-Verify procedures. SSA also agrees to limit access to such information, as is appropriate by law, to individuals responsible for the verification of Social Security numbers or responsible for evaluation of E- Verify or such other persons or entities who may be authorized by SSA as governed by the Privacy Act (5 U.S.C. Section 552a), the Social Security Act (42 U.S.C. 1306(a)), and SSA regulations (20 CFR Part 401). 3. SSA agrees to provide case results from its database within three Federal Government work days of the initial inquiry. E-Verify provides the information to the E-Verify Employer Agent. 4. SSA agrees to update SSA records as necessary if the employee who contests the SSA tentative nonconfirmation visits an SSA field office and provides the required evidence. If the employee visits an SSA field office within the eight Federal Government work days from the date of referral to SSA, SSA agrees to update SSA records, if appropriate, within the eight -day period unless SSA determines that more than eight days may be necessary. In such cases, SSA will provide additional instructions to the employee. If the employee does not visit SSA in the time allowed, E-Verify may provide a final nonconfirmation to the E-Verify Employer Agent. Note: If an Employer experiences technical problems, or has a policy question, the employer should contact E-Verify at 1-888-464-4218. E. RESPONSIBILITIES OF DHS 1. DHS agrees to provide the Employer with selected data from DHS databases to enable the Employer (through the E-Verify Employer Agent) to conduct, to the extent authorized by this MOU: A. Automated verification checks on alien employees by electronic means, and B. Photo verification checks (when available) on employees. 2. DHS agrees to assist the E-Verify Employer Agent with operational problems associated with its participation in E-Verify. DHS agrees to provide the E-Verify Employer Agent names, titles, addresses, and telephone numbers of DHS representatives to be contacted during the E-Verify process. Page 7 of 17 I E-Verify MOU for Employers Using a Web Services Employer Agent i Revision Date 06/Ol/13 Company ID Number:32855 Client Company ID Number:385743 3. DHS agrees to provide to the E-Verify Employer Agent with access to E-Verify training materials as well as an E-Verify User Manual that contain instructions on E-Verify policies, procedures, and requirements for both SSA and DHS, including restrictions on the use of E-Verify. 4. DHS agrees to train E-Verify Employer Agents on all important changes made to E-Verify through the use of mandatory refresher tutorials and updates to the E-Verify User Manual. Even without changes to E-Verify, DHS reserves the right to require E-Verify Employer Agents to take mandatory refresher tutorials. 5. DHS agrees to provide to the Employer (through the E-Verify Employer Agent) a notice, which indicates the Employer's participation in E-Verify. DHS also agrees to provide to the Employer anti -discrimination notices issued by the Office of Special Counsel for Immigration -Related Unfair Employment Practices (OSC), Civil Rights Division, U.S. Department of justice. 6. DHS agrees to issue each of the E-Verify Employer Agent's E-Verify users a unique user identification number and password that permits them to log in to E-Verify. 7. DHS agrees to safeguard the information the Employer provides (through the E-Verify Employer Agent), and to limit access to such information to individuals responsible for the verification process, for evaluation of E- Verify, or to such other persons or entities as may be authorized by applicable law. Information will be used only to verify the accuracy of Social Security numbers and employment eligibility, to enforce the INA and Federal criminal laws, and to administer Federal contracting requirements. 8. DHS agrees to provide a means of automated verification that provides (in conjunction with SSA verification procedures) confirmation or tentative nonconfirmation of employees' employment eligibility within three Federal Government work days of the initial inquiry. 9. DHS agrees to provide a means of secondary verification (including updating DHS records) for employees who contest DHS tentative nonconfirmations and photo mismatch tentative nonconfirmations. This provides final confirmation or nonconfirmation of the employees' employment eligibility within 10 Federal Government work days of the date of referral to DHS, unless DHS determines that more than 10 days may be necessary. In such cases, DHS will provide additional verification instructions. ARTICLE III REFERRAL OF INDIVIDUALS TO SSA AND DHS A. REFERRAL TO SSA 1. If the Employer receives a tentative nonconfirmation issued by SSA, the Employer must print the notice as directed by E-Verify. The Employer must promptly notify employees in private of the finding and provide them with the notice and letter containing information specific to the employee's E-Verify case. The Employer also agrees to provide both the English and the translated notice and letter for employees with limited English proficiency to employees. The Employer agrees to provide written referral instructions to employees and instruct affected employees to bring the English copy of the letter to the SSA. The Employer must allow employees to contest the finding, and not take adverse action against employees if they choose to contest the finding, while their case is still pending. 2. The Employer agrees to obtain the employee's response about whether he or she will contest the tentative nonconfirmation as soon as possible after the Employer receives the tentative nonconfirmation. Only the employee may determine whether he or she will contest the tentative nonconfirmation. 3. After a tentative nonconfirmation, the Employer will refer employees to SSA field offices only as directed by E-Verify. The Employer must record the case verification number, review the employee information submitted to E-Verify to identify any errors, and find out whether the employee contests the tentative nonconfirmation. The Employer will transmit the Social Security number, or any other corrected employee information that SSA requests, to SSA for verification again if this review indicates a need to do so. 4. The Employer will instruct the employee to visit an SSA office within eight Federal Government work days. SSA will electronically transmit the result of the referral to the Employer within 10 Federal Government work days of the referral unless it determines that more than 10 days is necessary. 5. While waiting for case results, the Employer agrees to check the E-Verify system regularly for case updates. 6. The Employer agrees not to ask the employee to obtain a printout from the Social Security Administration number database (the Numident) or other written verification of the SSN from the SSA. B. REFERRAL TO DHS 1. If the Employer receives a tentative nonconfirmation issued by DHS, the Employer must promptly notify employees in private of the finding and provide them with the notice and letter containing information specific to the employee's E-Verify case. The Employer also agrees to provide both the English and the translated notice and letter for employees with limited English proficiency to employees. The Employer must Page 8 of 17 1 E-Verify MOU for Employers Using a Web services Employer Agent I Revision Date 06/01/13 WWII ■ "hl:�lr3 Company ID Number:32855 Client Company ID Number:385743 allow employees to contest the finding, and not take adverse action against employees if they choose to contest the finding, while their case is still pending. 2. The Employer agrees to obtain the employee's response about whether he or she will contest the tentative nonconfirmation as soon as possible after the Employer receives the tentative nonconfirmation. Only the employee may determine whether he or she will contest the tentative nonconfirmation. 3. The Employer agrees to refer individuals to DHS only when the employee chooses to contest a tentative nonconfirmation. 4. If the employee contests a tentative nonconfirmation issued by DHS, the Employer will instruct the employee to contact DHS through its toll -free hotline (as found on the referral letter) within eight Federal Government work days. 5. If the Employer finds a photo mismatch, the Employer must provide the photo mismatch tentative nonconfirmation notice and follow the instructions outlined in paragraph 1 of this section for tentative nonconfirmations, generally. 6. The Employer agrees that if an employee contests a tentative nonconfirmation based upon a photo mismatch, the Employer will send a copy of the employee's Form 1-551, Form 1-766, U.S. Passport, or passport card to DHS for review by: A. Scanning and uploading the document, or B. Sending a photocopy of the document by express mail (furnished and paid for by the employer). 7. The Employer understands that if it cannot determine whether there is a photo match/mismatch, the Employer must forward the employee's documentation to DHS as described in the preceding paragraph. The Employer agrees to resolve the case as specified by the DHS representative who will determine the photo match or mismatch. 8. DHS will electronically transmit the result of the referral to the Employer within 10 Federal Government work days of the referral unless it determines that more than 10 days is necessary. 9. While waiting for case results, the Employer agrees to check the E-Verify system regularly for case updates. ARTICLE IV SERVICE PROVISIONS A. NO SERVICE FEES 1. SSA and DHS will not charge the Employer or the Web Services E-Verify Employer Agent for verification services performed under this MOU. The Employer is responsible for providing equipment needed to make inquiries. To access E-Verify, an Employer will need a personal computer with Internet access. ARTICLE V SYSTEM SECURITY AND MAINTENANCE A. DEVELOPMENT REQUIREMENTS 1. Software developed by Web Services E-Verify Employer Agents must comply with federally -mandated information security policies and industry security standards to include but not limited to: 2. Public Law 107-347, "E-Government Act of 2002, Title III, Federal Information Security Management Act (FISMA)," December 2002. 3. Office of Management and Budget (OMB) Memorandum (M-10-15), "FY 2010 Reporting Instructions for the Federal Information Security Management Act and Agency Privacy Management," April 2010. 4. National Institute of Standards and Technology (NIST) Special Publication (SP) and Federal Information Processing Standards Publication (FIPS). 5. International Organization for Standardization/International Electrotechnical Commission (ISO/IEC) 27002, Information Technology - Security Techniques - Code of Practice for Information Security Management. 6, The Web Services E-Verify Employer Agent agrees to update its Web Services interface to reflect system enhancements within six months from the date DHS notifies the Web Services User of the system update. The Web Services User will receive notice from DHS in the form of an Interface Control Agreement (ICA). The Web Services E-Verify Employer Agent agrees to institute changes to its interface as identified in the ICA, including all functionality identified and all data elements detailed therein. 7. The Web Services E-Verify Employer Agent agrees to demonstrate progress of its efforts to update its Web Services interface if and when DHS requests such progress reports. Page 9 of 17 1 E-Verify MOU for Employers Using a Web services Employer Agent I Revision Date 06/01/13 ,e "o illUll c Company ID Number:32855 Client Company ID Number:385743 8. The Web Services E-Verify Employer Agent acknowledges that if its system enhancements are not completed to the satisfaction of DHS or its assignees within six months from the date DHS notifies the Web Services User of the system update, then the Web Services User's E-Verify account may be suspended, and support for previous releases of E-Verify may no longer be available to the Web Services User. The Web Services E-Verify Employer Agent also acknowledges that DHS may suspend the Web Services User's account after the six-month period has elapsed. 9, The Web Services E-Verify Employer Agent agrees to incorporate error handling logic into its development or software to accommodate and act in a timely fashion should an error code be returned. 10. The Web Services E-Verify Employer Agent agrees to complete the technical requirements testing which is confirmed upon receiving approval of test data and connectivity between the Web Services E-Verify Employer Agent and DHS. 11. DHS will not reimburse any Web Services E-Verify Employer Agent or software developer who has expended resources in the development or maintenance of a Web Services interface if that party is unable, or becomes unable, to meet any of the requirements set forth in this MOU. 12. Housing, development, infrastructure, maintenance, and testing of the Web Services applications may take place outside the United States and its territories, but testing must be conducted to ensure that the code is correct and secure. 13. If the Web Services E-Verify Employer Agent includes an electronic Form I-9 as part of its interface, then it must comply with the standards for electronic retention of Form I-9 found in 8 CFR 274a.2(e). B. INFORMATION SECURITY REQUIREMENTS Web Services E-Verify Employer Agents performing verification services under this MOU must ensure that information that is shared between the Web Services E-Verify Employer Agent and DHS is appropriately protected comparable to the protection provided when the information is within the DHS environment [OMB Circular A-130 Appendix III]. To achieve this level of information security, the Web Services E-Verify Employer Agent agrees to institute the following procedures: 1. Conduct periodic assessments of risk, including the magnitude of harm that could result from the unauthorized access, use, disclosure, disruption, modification, or destruction of information and information systems that support the operations and assets of the DHS, SSA, and the Web ServicesE-Verify Employer Agent and its clients; 2. Develop policies and procedures that are based on risk assessments, cost-effectively reduce information security risks to an acceptable level, and ensure that information security is addressed throughout the life cycle of each organizational information system; 3. Implement subordinate plans for providing adequate information security for networks, facilities, information systems, or groups of information systems, as appropriate; 4. Conduct security awareness training to inform the Web Services E-Verify Employer Agent's personnel (including contractors and other users of information systems that support the operations and assets of the organization) of the information security risks associated with their activities and their responsibilities in complying with organizational policies and procedures designed to reduce these risks; 5. Develop periodic testing and evaluation of the effectiveness of information security policies, procedures, practices, and security controls to be performed with a frequency depending on risk, but no less than once per year; 6. Develop a process for planning, implementing, evaluating, and documenting remedial actions to address any deficiencies in the information security policies, procedures, and practices of the organization; 7. Implement procedures for detecting, reporting, and responding to security incidents; 8. Create plans and procedures to ensure continuity of operations for information systems that support the operations and assets of the organization; 9. In information -sharing environments, the information owner is responsible for establishing the rules for appropriate use and protection of the subject information and retains that responsibility even when the information is shared with or provided to other organizations [NIST SP 800-37j. 10. DHS reserves the right to restrict Web Services calls from certain IP addresses. 11. DHS reserves the right to audit the Web Services E-Verify Employer Agent's application. 12. Web Services E-Verify Employer Agents and Software Developers agree to cooperate willingly with the DHS assessment of information security and privacy practices used by the company to develop and maintain the Page 30 of 17 i E-Verify MOU for Employers Using a Web Services Employer Agent I Revision Date 06/Ol/13 �e Company ID Number:32855 Client Company ID Number:385743 software. .DATA PROTECTION AND PRIVACY REQUIREMENTS 1. Web Services E-Verify Employer Agents must practice proper Internet security; this means using HTTP over SSL/TLS (also known as HTTPS) when accessing DHS information resources such as E-Verify [NIST SP 800- 95]. Internet security practices like this are necessary because Simple Object Access Protocol (SOAP), which provides a basic messaging framework on which Web Services can be built, allows messages to be viewed or modified by attackers as messages traverse the Internet and is not independently designed with all the necessary security protocols for E-Verify use. 2. In accordance with DHS standards, the Web Services E-Verify Employer Agent agrees to maintain physical, electronic, and procedural safeguards to appropriately protect the information shared under this MOU against loss, theft, misuse, unauthorized access, and improper disclosure, copying use, modification or deletion. 3. Any data transmission requiring encryption shall comply with the following standards: A. Products using FIPS 197 Advanced Encryption Standard (AES) algorithms with at least 256-bit encryption that has been validated under FIPS 140-2. B. NSA Type 2 or Type 1 encryption. 4. User ID Management (Set Standard): All information exchanged between the parties under this MOU will be done only through authorized Web Services E-Verify Employer Agent representatives identified above. 5. The Web Services E-Verify Employer Agent agrees to use the E-Verify browser instead of its own interface if it has not yet upgraded its interface to comply with the Federal Acquisition Regulation (FAR) system changes. In addition, Web Services E-Verify Employer Agents whose interfaces do not support the Form 1-9 from 2/2/2009 or 8/7/2009 should also use the E-Verify browser until the system upgrade is completed. 6. The Web Services E-Verify Employer Agent agrees to use the E-Verify browser instead of its own interface if it has not completed updates to its system within six months from the date DHS notifies the Web Services E- Verify Employer Agent of the system update. The Web Services E-Verify Employer Agent can resume use of its interface once it is up-to-date, unless the Web Services E-Verify Employer Agent has been suspended or terminated from continued use of the system. D. COMMUNICATIONS 1. Web Services E-Verify Employer Agents and Software Developers agree to develop an electronic system that is not subject to any agreement that would restrict access to and use of by an agency of the United States. 2, The Web Services E-Verify Employer Agent agrees to develop effective controls to ensure the integrity, accuracy and reliability of its electronic system. 3. The Web Services E-Verify Employer Agent agrees to develop an inspection and quality assurance program that regularly, at least once per year, evaluates the electronic system, and includes periodic checks of electronically stored information. The Web Services E-Verify Employer Agent agrees to share the results of its regular inspection and quality assurance program with DHS upon request. 4. The Web Services E-Verify Employer Agent agrees to develop an electronic system with the ability to produce legible copies of applicable notices, letters, etc. 5. All information exchanged between the parties under this MOU will be in accordance with applicable laws, regulations, and policies, including but not limited to, information security guidelines of the sending party with respect to any information that is deemed Personally Identifiable Information (PII), including but not limited to the employee or applicant's Social Security number, alien number, date of birth, or other information that may be used to identify the individual. 6. Suspected and confirmed information security breaches must be reported to DHS according to Article II.A.17. Reporting such breaches does not relieve the Web Services E-Verify Employer Agent from further requirements as directed by state and local law. The Web Services E-Verify Employer Agent is subject to applicable state laws regarding data protection and incident reporting in addition to the requirements herein. E. SOFTWARE DEVELOPER RESTRICTIONS 1. The Web Services E-Verify Employer Agent agrees that if it develops a Web Services interface and sells such interface, then it can be held liable for any misuse by the company that purchases the interface. It is the responsibility of the Web Services E-Verify Employer Agent to ensure that its interface is used in accordance with E-Verify policies and procedures. Page 11 of 17 1 E-Verify MOU for Employers Using a Web services Employer Agent I Revision Date 06/01/13 Company ID Number:32855 Client Company ID Number:385743 2. The Web Services E-Verify Employer Agent agrees to provide software updates to each client who purchases its software. Because of the frequency Web Services updates, an ongoing relationship between the software developer and the client is necessary. 3. DHS reserves the right to terminate the access of any software developer with or without notice who creates or uses an interface that does not comply with E-Verify procedures. 4. Web Services Software Developers pursuing software development independent of serving clients as a Web Services E-Verify Employer Agent are not eligible to receive an ICA. At this time, E-Verify does not permit Web Services software development without also being a Web Services E-Verify Employer Agent or Web Services Employer. F. PENALTIES 1. The Web Services E-Verify Employer Agent agrees that any failure on its part to comply with the terms of the MOU may result in account suspension, termination, or other adverse action. 2. DHS is not liable for any financial losses to Web Services E-Verify Employer Agent, its clients, or any other party as a result of your account suspension or termination. ARTICLE VI MODIFICATION AND TERMINATION A. MODIFICATION 1. This MOU is effective upon the signature of all parties and shall continue in effect for as long as the SSA and DHS operates the E-Verify program unless modified in writing by the mutual consent of all parties. 2. Any and all E-Verify system enhancements by DHS or SSA, including but not limited to E-Verify checking against additional data sources and instituting new verification policies or procedures, will be covered under this MOU and will not cause the need for a supplemental MOU that outlines these changes. B. TERMINATION 1. The Web Services E-Verify Employer Agent may terminate this MOU and its participation in E-Verify at any time upon 30 days prior written notice to the other parties. In addition, any Employer represented by the Web Services E-Verify Employer Agent may voluntarily terminate its MOU upon giving DHS 30 days' written notice. The Web Services E-Verify Employer Agent may not refuse to terminate the Employer based upon an outstanding bill for verification services. 2. Notwithstanding Article V. part A of this MOU, DHS may terminate this MOU, and thereby the Web Services E-Verify Employer Agent's participation in E-Verify, with or without notice at any time if deemed necessary because of the requirements of law or policy, or upon a determination by SSA or DHS that there has been a breach of system integrity or security by the Web Services E-Verify Employer Agent or Employer, or a failure on the part of either party to comply with established E-Verify procedures and/or legal requirements. The Employer understands that if it is a Federal contractor, termination of this MOU by any party for any reason may negatively affect the performance of its contractual responsibilities. Similarly, the Employer understands that if it is in a state where E-Verify is mandatory, termination of this by any party MOU may negatively affect the Employer's business. 3. A Web Services E-Verify Employer Agent for an Employer that is a Federal contractor may terminate this MOU when the Federal contract that requires its participation in E-Verify is terminated or completed. In such cases, the Web Services E-Verify Employer Agent must provide written notice to DHS. If the Web Services E- Verify Employer Agent fails to provide such notice, then that Employer will remain an E-Verify participant, will remain bound by the terms of this MOU that apply to non -Federal contractor participants, and will be required to use the E-Verify procedures to verify the employment eligibility of all newly hired employees. 4. The Web Services E-Verify Employer Agent agrees that E-Verify is not liable for any losses, financial or otherwise, if the Web Services E-Verify Employer Agent or the Employer is terminated from E-Verify. ARTICLE VII PARTIES A. Some or all SSA and DHS responsibilities under this MOU may be performed by contractor(s), and SSA and DHS may adjust verification responsibilities between each other as necessary. By separate agreement with DHS, SSA has agreed to perform its responsibilities as described in this MOU. B. Nothing in this MOU is intended, or should be construed, to create any right or benefit, substantive or procedural, enforceable at law by any third party against the United States, its agencies, officers, or employees, or against the Web Services E-Verify Employer Agent, its agents, officers, or employees. Page 12 of 17 1 E-Verify MOU for Employers Using a Web Services Employer Agent I Revision Date 06/01/13 ��. .. �°�6 .� Illllllro 'hsfa^ Company ID Number:32855 Client Company ID Number:385743 C. The Web Services E-Verify Employer Agent may not assign, directly or indirectly, whether by operation of law, change of control or merger, ali or any part of its rights or obligations under this MOU without the prior written consent of DHS, which consent shall not be unreasonably withheld or delayed. Any attempt to sublicense, assign, or transfer any of the rights, duties, or obligations herein is void. D. Each party shall be solely responsible for defending any claim or action against it arising out of or related to E-Verify or this MOU, whether civil or criminal, and for any liability wherefrom, including (but not limited to) any dispute between the Web Services E-Verify Employer Agent or the Employer and any other person or entity regarding the applicability of Section 403(d) of IIRIRA to any action taken or allegedly taken by the Web Services E-Verify Employer Agent or the Employer. E. The Web Services E-Verify Employer Agent understands that its participation in E-Verify is not confidential information and may be disclosed as authorized or required by law and DHS or SSA policy, including but not limited to, Congressional oversight, E-Verify publicity and media inquiries, determinations of compliance with Federal contractual requirements, and responses to inquiries under the Freedom of Information Act (FOIA). F. The individuals whose signatures appear below represent that they are authorized to enter into this MOU on behalf of the Employer, the Web Services E-Verify Employer Agent and DHS respectively. The Web Services E-Verify Employer Agent understands that any inaccurate statement, representation, data or other information provided to DHS may subject the Web Services E-Verify Employer Agent, as the case may be, its subcontractors, its employees, or its representatives to: (1) prosecution for false statements pursuant to 18 U.S.C. 1001 and/or; (2) immediate termination of its MOU and/or; (3) possible debarment or suspension. G. The foregoing constitutes the full agreement on this subject between DHS, the Employer, and the E-Verify Employer Agent. SNF Holding Company (Employer) hereby designates and appoints Maricel Salazar (E- Verify Employer Agent), including its officers and employees, as the E-Verify Employer Agent for the purpose of carrying out (Employer) responsibilities under the MOU between the Employer, the E-Verify Employer Agent, and DHS. Page 13 of 17 I E-Verify MOU for Employers Using a Web Services Employer Agent I Revision Date O6/Ol/13 Company ID Number:32855 Client Company ID Number:385743 If you have any questions, contact E-Verify at 1-888-464-4218. Approved by: Employer Name (Please Type or Print) Title Signature Date E-Verify Employer Agent ADP, tnc, Name {Please Type or Print) Maricel Salazar Title Signature Electronically Signed Date Fepruary 09, 2021 Department of Homeland Security:- Verification Division Name Title Signature Date Page 14 of 17 I E-Verify MOU for Employers Using a Web Services Employer Agent I Revision Date O6/Ol/13 ��...��, iN/.vliR��6 e�' Company ID Number:32855 Client Company ID Number:385743 Information Required for the E-Uerlfy Program Information:relating to your Company; Company Name SNF Holding Company Company Facility Address One Chemical Plant Roatl Riceboro, GA 31323 Company Alternate Address County or Parish Liberty Employer Identification Number 51-0329277 North American Industry Classification Systems Code Chemical Manufacturing: (325) Parent Company Number of Employees 1,000 to 2,499 Number of Sites Verified for 0 Page 15 of 17 (E-Verify MOU for Employers Using a Web Services Employer Agent I Revision Date 06/Ol/13 �... �P>�'+ � Illpl Fta h,.,,a Company ID Number:32855 Client Company ID Number:385743 Are you verifying for more than 1 site? If yes, please provide the number of sites verified for in each State: Page 16 of 17 I E-Verify MOU for Employers Using a Web Services Employer Agent I Revision Date 06/O1/13 �� ,°�—.c�` �c pllllir. YIs1R� Company ID Number:32855 Client Company ID Number:385743 Information relating to the Program Administrators) for your Company on policy questions or operational problems: Name Jennifer Hinze Phone Number (912) 880-8091 Faz Number Email Address jenniferhQsnfhc'tcom Page 17 of 17 I E-Verify MOU for Employers Using a Web Services Employer Agent I Revision Date 06/Ol/13 POLYDYNE CLARIFLOC CL- 463 POLYMER PRINCIPAL USES CLARIFLOC CE-1463 is a high charge cationic polyacrylamide that is used as a flocculant in a wide variety of municipal and industrial wastewater treatment applications. It has been successfully applied in all liquid/solids separation systems including clarification, thickening, flotation, and dewatering. TYPICAL PROPERTIES Physical Form White Granular Powder Cationicity 80 % pH (0.25% Sol'n) 3.5 PREPARATION AND FEEDING CLARIFLOC CE-I463 is water soluble, but certain p«cautions should be followed to obtain total dissolution with minimum loss of activity. Complete wetting of the individual polymer particles is the single most important factor in the preparation of powdered polymer solutions. One method to achieve good wetting is to use an aspirator type disperser that draws the solid polymer particles into the water stream using a vacuum created by water pressure. A water pressure of 30 psig or greater is required to implement this method. The wetted polymer from the aspirator should be discharged into a vessel equipped with a high speed mixer capable of stirring the entire tank. The polymer solution should be stirred for 15-60 minutes or until dissolution is complete. The suggested make -down concentration for CLARIFLOC CE4463 is 0.1 - 0.5 % by weight. Completely automated equipment is commercially available. MATERIALS OF CONSTRUCTION Cross -linked polyethylene, fiberglass, stainless steel or lined steel are the preferred materials fordissolution tanks. Unlined mild steel, black iron, galvanized steel, copper or brass should not be used in any part of the feed system. Stainless steel or PVC are recommended for pump heads and feed lines. MANUFACTURING SPECIFICATIONS Moisture <8 UL Viscosity 2.6 - 3.2 cPs %Insolubles <2.0 HANDLING AND STORAGE Suggested in -plant storage of CLARIFLOC CE-I463 is one year in unopened bags. Store in a cool, dry area. For spills of dry CLARIFLOC CE4463, sweep up the material and reuse, if possible. Do not spray water on spilled dry product because the resulting gel is very slippery and difficult to clean up. For spills of CLARIFLOC CE-1463 solutions, sprinkle sawdust or vermiculite over the spill area and sweep into approved chemical disposal containers. Rock salt cuts slipperi-ness. SAFETY INFORMATION CLARIFLOC CE-1463 can potentially irritate the skin, eyes and lungs, so gloves, goggles and filter type respirator should be worn while handling this product. CLARIFLOC CE-1463 is not readily ignited, but it will support an existing fire. Foam, CO, or dry chemical methods should be used because polymer -water mixtures are very slippery. Anyone responsible for the procurement, use or disposal of CLARIFLOC CE-1463 should familiarize themselves with the appropriate safety and handling precautions outlined in the POLYDYNE Material Safety Data Sheet. In the event of an emergency with CLARIFLOC CE-1463, contact Chemtrec anytime day or night at (800) 424-9300. SHIPPING CLARIFLOC CE-1463 is shipped in 55 pound bags and supersacks. Bulk quantities are also available. ADDITIONAL INFORMATION To place an orderorobtain technical information from anywhere in the continental United States, call toll free: 1 8001848-1059 For additional information, please refer to the Safety Data Sheet (SDS) All statements, information and data given herein are believed to be accurate, but are presented without warranty, expressed or implied. Statements concerning possible use are made without representation or wen'mrty that any such use is free of patent infringement, and is not a recommendation to infringe on any patent. The user shouldnot assume Wal all safely measures are indicated or WatoWer measures maynot be required. Any determination of the suitability ofaparlicular product for any use contemplated bythe user is the sole responsibility of tite user. ® 2016 StJF Holding Company Ate"' P"1P0 POlYDYNE SAFETY DATA SHEET According to U.S. Code of Federal Regulations 29 CFR 1910.1200, Hazard Communication. SECTION 1 Identification of the substancelmixture and of the com�anvlundertaking 1.1. Product identifier Product name: CLARIFLOCTM CE-1463 Type of product: Mixture. 1.2. Relevant identified uses of the substance or mixture and uses advised against Identified uses: Processing aid for industrial applications. Uses advised against: None. 1.3. Details of the supplier of the safety data sheet Polydyne Inc. Company: I Chemical Plant Road PO BOX 279, Riceboro, GA 31323 United States Telephone: 1-800-848-7659 Teletax: (912)-884-8770 E-mail address: 1.4. Emergency telephone number 24-hour emergency number: 1-800-424-9300 SECTION 2: Hazards identification 2.1. Classification of the substance or mixture Classification according to paragraph (d) of 29 CFR 1910.1200: Not classified. 2.2. Label elements Labelling according to paragraph (f) of 29 CFR 1910.1200: Print Date: 12104/2021 Revision date: 07I1312020 Page: 1 / 15 SAFETY DATA SHEET Hazard symbol(s): CLARIFLOC'm CE-1463 None. Signal word: None. Hazard statement(s): None. Precautionary statement(s): None. 2.3. Other hazards Aqueous solutions or powders that become wet render surfaces extremely slippery. For explanation of abbreviations see Section 16. SECTION 3: Compositionlinformation on ingredients 3.1. Substances Not applicable, this product is a mixture. 3.2. Mixtures Hazardous components Adipic acid Concentration/ -range: CAS Number: Classification according to paragraph (d) of 29 CFR 1910.1200: Sulfmnic acid Concentration/ -range: CAS Number: Classification according to paragraph (d) of 29 CFR 1910.1200: For explanation of abbreviations see section 16 SECTION 4: First aid measures 4.1. Description of first aid measures 124-04-9 Eye Irrit. 2A;H319 5329-14-6 Skin brit. 2H315, Eye brit. 2A;H319 Print Dale: 12104/2021 Revision date: 0711312020 Page: 2115 SAFETY DATA SHEET CLARIFLOCTM CE-1463 Inhalation: Move to fresh air. Get medical attention if symptoms occur. Skin contact: Wash off with soap and plenty of water. Get medical attention if imitation develops and persists. Eye contact: Rinse immediately with plenty of water, also under the eyelids. Get medical attention. Ingestion: Rinse mouth. If conscious, give the victim plenty of water to drink. Induce vomiting, but only if victim is fully conscious. 4.2. Most important symptoms and effects, both acute and delayed Powder can cause localised skin irritation in folds of the skin or under tight clothing. Contact with dust can cause mechanical irritation or drying of the skin. 4.3. Indication of any immediate medical attention and special treatment needed None. Other information: No information available. SECTION 5: Firefighting measures 5.1. Extinguishing media Suitable extinguishing media: Water. Water spray. Foam. Carbon dioxide (CO2). Dry powder. Warning! Aqueous solutions or powders that become wet render surfaces extremely slippery. Unsuitable extinguishing media: None known. 5.2. Special hazards arising from the substance or mixture Hazardous decomposition products: Thermal decomposition may produce: hydrogen chloride gas, nitrogen oxides (NOx), carbon oxides (COx). Ammonia (NH3). Hydrogen cyanide (hydrocyanic acid) may be produced in the event of combustion in an oxygen deficient atmosphere. 5.3. Advice for firefighters Protective measures: Wear self contained breathing apparatus for fire fighting if necessary. Other information: Aqueous solutions or powders that become wet render surfaces extremely slippery. SECTION 6: Accidental release measures 6.1, Personal precautions, protective equipment and emergency procedures Print Date: 12104/2021 Revision date: 07/7312020 Page: 3 / 15 SAFETY DATA SHEET CLARIFLOCTM CE.1463 Personal precautions: Avoid contact with skin and eyes. Avoid dust formation. Avoid breathing dust. Aqueous solutions or powders that become wet render surfaces extremely slippery. Protective equipment: Wear adequate personal protective equipment (see Section 8 Exposure Controls/Personal Protection). Emergency procedures: Keep people away from spill/leak. Prevent further leakage or spillage if safe to do so. 6.2. Environmental precautions As with all chemical products, do not flush into surface water. 6.3. Methods and material for containment and cleaning up Small spills: Do not flush with water.Clean up promptly by sweeping or vacuum. Large spills: Do not flush with water.Prevent unauthorized access. Sweep up and shovel into suitable containers for disposal. Residues: Sweep up to prevent slip hazard. After cleaning, flush away traces with water. 6A Reference to other sections SECTION 7: Handling and storage; SECTION 8: Exposure controls/personal protection; SECTION 13: Disposal considerations; SECTION 7: Handling and storage 7,1. Precautions for safe handling Avoid contact with skin and eyes. Avoid dust formation. Avoid breathing dust. Wash hands before breaks and at the end of workday. 7.2, Conditions for safe storage, including any incompatibilities Keep in a dry place. Incompatible with oxidizing agents. 7.3. Specific end use(s) This information is not available. SECTION 8: Exposure controlslpersonal protection 8.1. Control parameters Occupational exposure limits: Print Date: 12/0412021 Revision date: 0711312020 Page: 4115 SAFETY DATA SHEET Adipic acid ACGIH: 5 mg/m3 (8 hours) CLARIFLOC'm CE•1463 8.2. Exposure controls Appropriate engineering controls: Use local exhaust if dusting occurs. Natural ventilation is adequate in absence of dusts. Individual protection measures such as personal protective equipment: a) Eye/face protection: Safety glasses with side -shields. Do not wear contact lenses where this product is used. Use equipment for eye protection tested and approved under appropriate government standards such as NIOSH (US) or EN 166 (EU). b) Skin protection: i) Hand protection: PVC or other plastic material gloves. The selected protective gloves have to satisfy the specifications of EU Directive 89/689/EEC and the standard EN 374 derived from it. ii) Other: Chemical resistant apron or protective suit if splashing or repeated contact with solution is likely. The type of protective equipment must be selected according to the concentration and amount of the dangerous substance at the specific workplace. c) Respiratory protection: Dust safety masks recommended where working powder concentration is more than 10 mg/m3. Use respirators and components tested and approved under appropriate government standards such as NIOSH (US) or CEN (EU). d) Additional advice: Wash hands before breaks and at the end of workday. Wash hands before breaks and immediately after handling the product. Handle in accordance with good industrial hygiene and safety practice. Environmental exposure controls: Do not allow uncontrolled discharge of product into the environment, SECTION 9• Physical and chemical properties 9.1. Information on basic physical and chemical properties a) Appearance: b) Odour: c) Odour Threshold: d) pH: e) Melting point/freezing point: Granular solid, White. None. Not applicable. 2.S - 4.5 @ 5 g/L (See Technical Bulletin or Product Specifications for a more precise value, if available) > 100°C Print Date: 12/0412021 Revision date:0711312020 Page: 5115 SAFETY DATA SHEET t) Initial boiling point and boiling range: g) Flash point: h) Evaporation rate: i) Flammability (solid, gas): j) Upperhower flammability or explosive limits: k) Vapour pressure: I) Vapour density: m) Relative density: n) Solubility(ies): o) Partition coefficient: p) Autoignition temperature: q) Decomposition temperature: r) Viscosity: s) Explosive properties: t) Oxidizing properties: 9.2. Other information None. SECTION 10Stability and reactivity 10.1. Reactivity Hazardous polymerisation does not occur. 10.2. Chemical stability Stable. 10.3. Possibility of hazardous reactions Oxidizing agents may cause exothermic reactions. 10A Conditions to avoid None known. 10.5. Incompatible materials Oxidizing agents. CLARIFLOC'm CE.1463 Not applicable. Not applicable. Not applicable. Not combustible. Not expected to create explosive atmospheres. Not applicable. Not applicable. 0.6 - 0.9 (See Technical Bulletin or Product Specifications for a more precise value, if available) Soluble in water. <0 Not applicable. > 200°C See Technical Bulletin. Not expected to be explosive based on the chemical structure. Not expected to be oxidising based on the chemical structure. Print Date: 12/04/2021 Revision dale: 0711312020 Page: 6115 SAFETY DATA SHEET CLARIFLOCTm CE-1463 10.6. Hazardous decomposition products Thermal decomposition may produce: hydrogen chloride gas, nitrogen oxides (NOx), carbon oxides (COx). Ammonia (NH3). Hydrogen cyanide (hydrocyanic acid) may be produced in the event of combustion in an oxygen deficient atmosphere. SECTION 11: Toxicological information 11.1. Information on toxicological effects Information on the product as supplied: Acute oral toxicity: LD50/oraUrat > 5000 mg/kg Acute dermal toxicity: LD50/dermal/rat > 5000 mglkg. Acute inhalation toxicity: The product is not expected to be toxic by inhalation. Skin corrosiondrritation: Not irritating. Serious eye damage%ye irritation: Testing conducted according to the Draize technique showed the material produces no corneal or iridial effects and only slight transitory conjuctival effects similar to those which all granular materials have on conjuctivae. Respiratory/Skin sensitisation: The results of testing on guinea pigs showed this material to be non -sensitizing. Mutagenicity: Not mutagenic. Carcinogenicity,* Not carcinogenic. Reproductive toxicity: Not toxic for reproduction. STOT - Single exposure: No known effects. STOT - Repeated exposure: No known effect. Aspiration hazard: No hazards resulting from the material as supplied. Relevant information on the hazardous components: Adipic acid Acute oral toxicity: LD50/oraUrat = 5560 mg/kg (OECD 401) Acute dermal toxicity: LDO/dermaUrabbit >= 3176 mg/kg Acute inhalation toxicity: LCO/inhalatio»/4 hours/rat > 7.7 mg/L (OECD 403) Skin corrosionfirritation: Slightly irritating. Print Date: 12/04/2021 Revision date: 07113/2020 Page: 7115 SAFETY DATA SHEET CLARIFLOCTM CEw1463 Serious eye damage%ye irritation: Not irritating. (OECD 405) (SNF) Respiratory/skin sensitisation: Not sensitizing. Mutagenicity: Negative in the Ames Test (OECD 471). Negative in the In vitro Mammalian Cell Gene Mutation Test (OECD 476). Carcinogenicity: Based on available data, product is not expected to be carcinogenic. Carcinogenicity study in rat: NOAEL > 750 mg/kg/day Reproductive toxicity: Based on available data, product is not expected to be toxic for reproduction. NOAEL/Maternal toxicity/rat >= 288 mg/kg/day NOAEL/Developmental toxicity/rat >= 288 mg/kg/day STOT -Single exposure: No known effects. STOT -Repeated exposure: No knovmr effect. Aspiration hazard: No known effects. Sulfamic acid Acute oral toxicity: LD50/oraUrat = 2065 - 2140 mgJkg Acute dermal toxicity: NOAEL/dermal/rat = 2000 mg/kg (OECD 402) Acute Inhalation toxicity: The product is not expected to be toxic by inhalation. Skin corrosion�rritation: Not irritating. (OECD 404) (SNF) Serious eye damage%ye irritation: Moderately h'ritathig to the eyes. (EPA OPPTS 870.2400) Respiratory/skin sensitisation: The product is not expected to be sensitizing. Mutagenicity: Negative in the Ames Test (OECD 471). Negative in the In vitro Mammalian Cell Gene Mutation Test (OECD 476). No[ nru[agenic. (OECD 472, 487) Carcinogenicity: Based on the absence of mutagenicity, it is unlikely that the substance is carcinogenic. Reproductive toxicity: Based on available data, product is not expected to be toxic for reproduction. Prenatal Development Toxicity Study (OECD 4l4) - NOAEL/Maternal toxicity/rat = 200 mg/kg/day - NOAEL/Developmental toxicity/rat = 200 mg/kg/day Print Date: 12104/2021 Revision date: 0711312020 Page: 8115 SAFETY DATA SHEET STOT - Single exposure: STOT-Repeated exposure: Aspiration hazard: SECTION 12: Ecological information 12.1. Toxicity Information on the product as supplied: Acute toxicity to fish: Acute toxicity to invertebrates: Acute toxicity to algae: Chronic toxicity to fish: Chronic toxicity to invertebrates: Toxicity to microorganisms: Effects on terrestrial organisms: Sediment toxicity: CLARIFLOCT" CE-1463 No known effects. No known effect. No known effects. LC50/Danio rerio/96 how•s = 5 - l0 mg/L (OECD 203) EC50/Daphnia magna/48 hours = 20 - 50 mg/L (OECD 202) Algal inhibition tests are not appropriate. The flocculation characteristics of the product interfere directly in the test medium preventing homogenous distribution which invalidates the test. No data available. No data available. No data available. No data available. Readily biodegradable, exposure to soil is unlikely. No data available. Readily biodegradable, exposure to sediment is unlikely. Relevant information on the hazardous components: Arlipic ncid Acute toxicity to fish: LCO/Danio rerio/96 hours >= 1000 mg/L Acute toxicity to invertebrates: ECSO/Daphnia magna/48 hours = 46 mg/L (OECD 202) Acute toxicity to algae: IC50/Selenastrwn capricornutum/72 hours = 59 mg/L (OECD 201) Chronic toxicity to fish: No data available. Chronic toxicity to invertebrates: NOEC/Daphnia rnagna/21 days = 6.3 mg/L (OECD 211) Toxicity to microorganisms: EC50/activated sludge/3 hours = 4747 mg/L (OECD 209) Print Dale: 1210412021 Revision date: 0711312020 Page: 9115 SAFETY DATA SHEET Effects on terrestrial organisms: No data available. Sediment toxicity: No data available. Sulfamic acid CLARIFLOC'm CE-1463 Acute toxicity to fish: LC50/Pimephales promelas/96 hours = 70.3 mg/L (OECD 203) Acute toxicity to invertebrates: EC50lDaphnia magna/48 hours = 71.6 mg/L (OECD 202) Acute toxicity to algae: IC50/Scenedesmus subspicahrs/72 hours = 48 mg/L (OECD 201) Chronic toxicity to fish: NOEC/Danio rerio/34 days >= 60 mg/L (OECD 210) Chronic toxicity to invertebrates: NOEC/Daphnia magna/21 days = 19 mg/L (OECD 211) Toxicity to microorganisms: EC50/activated sludge/3 hours > 200 mg/L (OECD 209) Effects on terrestrial organisms: No data available. Sediment toxicity: No data available. 12.2. Persistence and degradability Information on the product as supplied: Degradation: Based on degradation data of components, this product is expected to be readily (bio)degradable. Hydrolysis: At natural pHs (>6) the polymer degrades due to hydrolysis to more than 70% in 28 days. The hydrolysis products are not harmful to aquatic organisms. Photolysis: No data available. Relevant information on the hazardous components: Adipic acid Degradation: Readily biodegradable. > 70% / 28 days (OECD 301 D) Hydrolysis: Does not hydrolyse. Photolysis: Half-life (indirect photolysis): = 2.9 days Print Date: 12/04/2027 Revision date:0711312020 Page:10115 SAFETY DATA SHEET Suijum c acid Degradation: Hydrolysis: Photolysis: Not relevant (inorganic). Does not hydrolyse. No data available. 12.3. Bioaccumulativeyotential Information on the product as supplied: The product is not expected to bioaccumulate. Partition co -efficient (Log Pow): < 0 Bioconcentration factor (BCF): No data available. Relevant information on the hazardous components: Adipic acid Partition co -efficient (Log Pow): 0.093 @ 25°C, pH 3.3 Bioconcentration factor (BCF): No data available. Suffande acid Partition co -efficient (Log Pow): 4.34 @ 200C Bioconcentration factor (BCF): No data available. 12.4. Mobility in soil Information on the product as supplied: No data available. Relevant information on the hazardous_comoonents Ad%p%C acid Koc: No data available. CLARIFLOCTm CE.1463 Print Date: 12/0412021 Revision date: 0711312020 Page:11 115 SAFETY DATA SHEET Suffamic acid Koc: 12.5.Other adverse effects None known. No data available. SECTION 13: Disposal considerations 13.1. Waste treatment methods CLARIFLOCra CE•1463 Waste from residues/unusedprnducts: Dispose in accordance with local and national regulations. Can be landfilled or incinerated, when in compliance with local regulations. Contaminated packag4hq: Rinse empty containers with water and use the rinse -water to prepare the working solution. If recycling is not practicable, dispose of in compliance with local regulations. Can be landfilled or incinerated, when in compliance with local regulations. Recycling: In accordance with local and national regulations. SECTION 14: Transport information Land transport (DOT) Not classified. Sea transport (IMDG) Not classified. Air transport (IATA) Not classified. SECTION 15: Regulatory information 15.1. Safety, health and environmental regulations/legislation specific for the substance or mixture Information on the product as supplied: TSCA Chemical Substances Inventory: All components of this product are either listed as active on the inventory or are exempt from listing. US SARA Reporting Requirements: Print Date: 12/04/2021 Revision date: 0711312020 Page:12115 SAFETY DATA SHEET SARA (Section .511/112) hazard class: Not concerned. SARA Title 111 Sections: Section 302 (TPQ) - Reportable Quantity: Not concerned. Section 304 - Reportable Quantity: Not concerned. Section 313 (De minimis concentration): Not concerned. Clean Water Act Section 311 Hazardous Substances (40 CFR 117.3) - Reporable Quantity: Contains one or more of the listed substances. Clean AirAct Section 112(r) Accidental release prevention requirements (40 CFR 68) - Reportable Quantity: Not concerned. CERCLA Hazardous Substances List (40 CFR 302A) - Reportable Quantity: Contains one or more of the listed substances. RCRA status: Not RCRA hazardous. California Proposition 65 Information: CLARIFLOC'm CE•1463 WARNING! This product contains a chemical known to the State of California to cause cancer and birth defects or other reproductive harm, Aciylamide Relevant information on the hazardous components: Adipic acid Clean Water Act Section 311 Hazardous Substances (40 CFR 117.3) -Reportable Quantity: 5000 Ibs CERCLA Hazardous Substances List (40 CFR 302.4) -Reportable Quantity: 5000 Ibs Print Date: 12/0412021 Revision date: 07I13/2020 Page:13115 SAFETY DATA SHEET DOT RQ (Ibs): SECTION 16: Other information NFPA and HMIS Ratiny� NFPA: Health: 0 Flammability: 0 Instability: 0 HMIS: Health: Flammability: Physical Hazard: PPE Code: This data sheet contains changes from the previous version in sections 5000 lbs CLARIFLOC'm CE-1463 SECTION 3. Composition/information on ingredients, SECTION 5. Fire -fighting measures, SECTION 8. Exposure controls/personal protection, SECTION 16. Other Information. Key or legend to abbreviations and acronyms used in the safety data sheet: Acronyms STOT = Specific target organ toxicity Abbreviations Eye lrrit. 2A = Serious eye damage/eye irritation Category Code 2A Skin In'it. 2 = Skin corrosion/irritation Category Code 2 Hazard statements H315 - Causes skin irritation H319 - Causes serious eye irritation Training advice: Print Date: 12/0412021 Revision date: 07113/2020 Page:14115 SAFETY DATA SHEET CLARIFLOC'm CE.1463 Do not handle until all safety precautions have been read and understood. This SDS was dared in accordance with the following: U.S. Code of Federal Regulations 29 CFR 1910.1200 Version: 20.O1.a PRCC003 The information provided in this Safety Data Sheet is correct to the best of our knowledge, information and belief at the date of its publication. The information given is designed only as a guidance for safe handling, use, processing, storage, transportation, disposal and release and is not to be considered a warranty or quality specification. The information relates only to the specific material designated and may not be valid for such material used in combination with any other materials or in any process, unless specified in the text. Print Dale: 1210412021 Revision date: 0711312020 Page:15115 SNF RESPONSIBLE CHEMISTRY To: Citv of South Bend From: Polydvne Inc. Opened: 04/13/21 TABULATIONS FOR BID State: IN Fax No. (9121880-2078 Subject: Bid for Water Treatment Chemicals 2021- 2022 polydyne.snf.com Please provide us with tabulations on the subject bid by filling out this form or attaching your tabulations form to it. A self-addressed stamped envelope is included for your use. If possible, please fax us these tabulations to the above -referenced number. Awarded: YES/NO (circle one) If YES, indicate awarded vendor with an If NO, indicate expected date of award. Calculation based on: Participants Product Code Price/Lb Pol d ne Inc. CE4463 $1.890 Thank you for your assistance. Sincerely, Randal Vickery Bids &Contracts Department (912) 880-2035 Database ID: 121-115 SNF Polydyne • 1 Chemical Plant Road • Riceboro, GA 31323 USA •Tel 800.848.7659 Bond No. BB01130 BID BOND KNOW ALL DY THESE PRESENTS, That we, polydyne Inc. of Um Chemical Plant Road, Riceboro, GA 31323 (hereinafter called the Principal), as Principal, and Liberty Mutual Insurance Company (hereinafter called the Surety), as Surety arc held and tinily bound unto 46601 City of South Bend, 227 Wesl Jefferson, South Bend, IN (hereinafter called llte Obligee) in the penal sum of Ten Percent (10%) of the Amount Did and 00/100 Dollars ($ 10%of the amount bid for the payment of which the Principal and the Surety bind themselves, their heirs, executors, administratorssucccssors and assigns, jointly and severally, firmly by these presents. THE CONDITION OF THIS ODLIGATION IS SUCH, Thal WHEREAS, the Principal has submitted or is about to submit a proposal to the Obligee on a contract for Water Treatment Chemicals 2021-2022 NOW, THEREFORE, If the said Contract be timely awarded to the Principal and the Principal shall, within such time as may be specified, enter into the Contract in writing, and give bond, if bond is required, with surety acceptable to the Obligee for the faithful performance of the said Contract, then this obligation shall be void; otherwise to remain in full force and effect. Signed and sealed this 12th day of April 2021 Mark Schlag, Vice —President Witness au a •rty, s- o- urety Witness polydyne Inc. (Seal) IPrincipal 1ce—President 46ydtan�leyr Title Liberty yMutual lIIn�s�ur�ancce Company By /�/y� Marisol Mojica, U Attomcy-in-Fact n, PO IPO i^ ACKNOWLEDGEMENT NOTE: Persons signing in more than one capacity (i.e. president and as individual) must be acknowledged for each capacity. State of New Jersey l County of Hudson ) SS On the 121h day of April 2021 Before me, Victoria L. Ernest , personally appeared Marisol Moiica as Attorney in Fact of the Liberty Mutual Insurance Comnany [:]Personally known to me —OR- ® proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/h it authorized capacity(ies), and that by his/her/their signatures) on the instrument the person(s), or the entity upon beh IP ich the person(s) acted, executed the instrument. L ictoria L. Ernest NOTARY PUBLIC rail'�' ATE OF NEW JERSEYID N 50087965MISSIONEXPIRESA ust9.2023 nary public till OPTIONA ❑ Individual ❑ Corporate Officer ® Attomey-in-Pact ❑ Partner- Limited ❑ Partners- Genel Trustee Guardian or Conservator ❑ Titles s : ❑Other. Stare aj County of } SS On the day of 20 Before me, ,personally appeared ❑ Personally known to me -OR- ❑ proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. Nolaq� Public OPTIONAL — f I Individual ❑Corporate Officer ❑Attomey-in-Fact or stare of } SS County of ❑ Partner —Limited ❑ Partner —General On the day of 20 Before me, ,personally appeared ❑ Personally known to me -0R- ❑proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument, Pub/!c• OPTIONAL — ❑ Individual ❑Corporate Officer ❑Attomey-in-Faces Trustee ❑ Partner —Limited ❑ Partner —General IX)NACK O')OI05 10 Liberty Mutuall. SURETY Assets LIBERTY MUTUAL INSURANCE COMPANY FINANCIAL STATF.MF.N7'— DECEMBER 31, 2019 Cash and an Deposits .......................................... S778,754,989 •Bonds—U.S Government ...................................... 2,780,808,610 *Other Bonds............................................................ 125645,608,792 *Stocks ...................................................................... 16,3851435,431 RealEslatc............................................................... 2359608,378 Agents' Balances or Uncollected Premiums........... 6,217,983,641 Accrued Interest and Rents", ....... 1111.40 .... ... 0', 1029273,390 Other Admitted Assets ............................................ 11 5957, 1065292 Liabilities lJncamcdPremiums............................................... SR,007,146;182 Reserve for Claims and Claims Expcnsc................ 219532,853,787 Funds I Ield Under Reinsurance Treaties ................ 507w8689920 Rcscrvc for Dividends to Policyholders .................. I,143,826 Additional Statutory Reserve..... I ............................ 125,7220000 Rcscrvc for Commissions, Taxes and Other Liabilities ................................................ 4, 117,460,075 Total................................................................. S34,2929195,090 532,76R,443 Capital Stock.,...".".,.., .... 6"00 ........ 101000,075 Paid in Surplus.,, .......................... 10,044,978,933 Unassigned Surplus ..................... 69723,6369983 Total Admitted Assets.....................................cst.ln�, T 5� Surplus to Policyholders.................................16,811,J84,J34 Total Liabilities and Surplus. . I . 0 0 1111111116 & 6 1 & 0 0 6 0 0 D 4 0 0 4 , 0 f51 103.i79524 i ,f• 6 � •Bonds are slated at amortized or investment value; Stocks at Association Market Values. t9tz i The foregoing financial information is taken from Liberty Mutual Insurance Company's financial cMi statement riled with the state of Massachusetts Department of Insurance. 1, TIM MIKOLAJEWSKI, Assistant Secretary of Liberty Mutual Insurance Company, do hereby certify that the foregoing is a true, and correct statement of the Assets and Liabilities of said Corporation, as of December 31, 2019, to the best of my knowledge and belief. IN WITNESS WBBREOf, 1 have hereunto set my hand and affixed the seal of said Corporation at Seattle, Washington, This 271s day of March, 2020. Assistant Secretary x�rrrirri,r: xi? 4i. Gl3vl�` stsazunicra aao