HomeMy WebLinkAboutOpening of Bids - Waste Treatment Chemical Wastewater 2025-2026 - Polydyne IncBID/PROPOSAL
CITY OF SOUTH BEND
BIB NAME Water Treatment Chemicals Wast¢wat¢r 2026-2026
FOR BIDS DUE May t3, 2026 9:00 a.m., Local Time
4� 9
�_���
•res
Item
No.
Est. Qty.
Per Yaar
Item
Units
Unit Price
Total
'I
1 50
Chlorine — 1 Ton Cylinders
Ton
$
$
2
90,000
Ferric Chloride
Gal.
$
$
3
1 00
Sulfur Dioxide — I Ton Cylinders
Ton
$
$
4
40,000
Dry Polymer Flocculent — 50 / 55 Lb.
Polyethylene Ba�LARIFLOC CE-1463
Lbs.
$2.09/Lb.
$83,600.00
TOTAL
$83,600.00
Bidder (Firm): Polytlyn® Inc.
Address: One Chemical Plant Road
City/State/Zip: Riceboro, GA 3'1323
Telephone Number: (800) 848-7659 Opt. 2 Fax ber: ( 2) 8 -2078
By /
(Sign u
o d nle
(Printed Na
Sr. Vice -President
(Title)
BOARD OF PUBLIC WORK3
Elizabeth A. Maradik, President
Joseph R. Molnar, Vica-President
Murray L. Millar, Member
B reana N. Micou, Member
Gary A. Gilot. Member Attest: Theresa M. Heffner, Clark
CITV OF SOUTH BEND. IN DIANA
SELLER'S BID FOR SALE OR LEASE OF MATERIALS
BID NAME
FOR BIDS DUE
Bladar
Date: 5/6/25 (Firm): Polydyn® Inc.
Aaarass: One Chemical Plant Road
City/statatzip: Riceboro, GA 3'1323 Telephone Number. ( 800)848-7659 Opt. 2
Agent of Binder (if Applicable):
Wheu th¢ prospective Coutrac<or is unable to cetvtJy to any of the statetuents below, t<shall aaach au explauatton m this Ajjldavit.
CONTRACTOR'S NON -COLLUSION AND NON -DEBARMENT AFFIDAVIT,
CERTIFICATION REGARDING INVESTMENT WITB 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 or print)
STATE OF Georgia )
Liberty ) SS:
COLINTY )
The undersigned Contractoq being duly sworn upon his/her/its oath, affirms under the penalties o£perjury
tnar
1. Contractor has not, nor has any other membey 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, giR, 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 £or debarment, declared
ineligible, or voluntarily excluded from participation in this transaction by any Federal
department or agency; and
3. Contractor nas not, nor has any successor tq nor an atHliate o£, Contractor, engaged in
investment activities in Iran.
a. For purposes o£this CettiPacation, "Iran" means the government o£Iran and any agency
or instrumentality of Iran, or as otherwise defined at Ind. Code § 5-22-16.5-5, as
amended @om 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 MBE/WBE; however, it may not unlawfully discriminate against
said WBE/MBE. A finding of a discriminatory practice by the City's 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). I 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 o£ perjury that the £acts and information contained in the foregoing bid
£or public works are true and correct.
Dated this 6th day of May , Zp20
Polydyne Inc.
Co � Bidder (F' m) -
Si n re o£ actor i der or Its ent
oyd Stanley, Sr. Vice-Presi t
Printed Name and Title
Subscribed and sworn to before me this 6tFl /lay
p 25
.
My Comrttlsslon F�Ires /
My Commission Expires 11ar.�ber t]• 2026 G
No ary Public
County o£Residence LibBrty
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Bond No. BBO 1691
BID BOND
FNOW' ALI BV 'I'14 SY PRF SENTS. That we, Polvdvn¢ Inc.
of (One Chemical Plant Road, Riceboro, GA 31323)
(hereinafter called the Principal I. as Principah and Liberty Mutual Insurance Company (195 Berkeley
S[re¢q Boston, MA 021 16)
(here inaf[er cNicd the Gpch ). as Surely are held antl firmly bound unto City of South Bend
(229 W. Jefferson Blvd., Ste. 1316, City -County Building, South bend, IN 46601)
(hereinafter called the t thlige:�l in [he penal sum of $Ten Perc¢n[ o£Total Amount Bid
Dollars ( $
10 % of Total Amount Bid )
fir the Vay-n cnl of .�b�ch the 1'ri nciPal and the Surety bind themselves, their heirs, executors, admire isb'atorti..uecessmz
and a. sigy\s.
jointly and severally. finnl) by these presents.
TI-IE CON DITIU\ of "f111S OBLIGATTON IS SUCH, Thai WHEREAS, [he Principal has submitted or
is about [o submit a proposal
to the OFligec on a cuntrao O.r Water Treatment Chemicals Wastewater 2025-2026
_ _ _
NOW'. THERFP[lRF_ if the said Contract be timely awarded to the Principal antl the Principal shall,
within such time a nay be
tfaiOtful
specified, enter ina, the <'untract in writing, and Give bond, if bond i required, with s rety a ceptable
to the Obligee R.r Ote
performance of the .mJ ('ontract [hen this obligation shall be void; otherwise to remain in £ull £orce and effect.
Signed and sealed thi. �[h day of Ma 2025
P e Inc
(Seal)
Principal
Mark Schlag, V1ce—Presient Witness
ca—President
Boyd n e
Tiric
Liberty Mutual Insurance
pony
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John E. t Witness By-_j j�_j��_�
�Mo11Y
Speranza L'ce
k371 _O�A[torney-in-Pact
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Molly So¢ za. Attorney -in -Fact (IN Licenu #3'J120291
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Surety Acknowledemeni
State of Georgia
County of Gwinnett
On this 7�^ day of Mav 2025 before me Kim berly Chatmon a Notary Public in and
for said County, personally appear¢d Molly Soera nza ,personally known to me, who being by
me duly sworn did say that she is the aforesaid Attorn ev-in-Fact of Liberty Mutual Insurance
Com oa nv. a corporation duly organized and existing under the laws of the State of
Massachusetts, that the seal affixed to the foregoing instrument is the corporate seal of said
corporation, that the said instrument was signed, sealed and executed on behalf of said
corporation by authority of its Board of Directors, and further acknowledge that the said
instrument and the execution thereof to be a voluntary act and deed of said corporation.
IN WITNESS WHEREOF, I have hereunto 5u bscribed my name and affixed my official seal the day
and year last above written.
My Commission Expires:
December 18 2026
Kimberly Chatm
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�IpLiberty
Mutual.
SURETY
This Power of Attorney limits the acts of those named herein, and they have no authority to
bind the Company except in the manner and to the extent herein stated.
Liberty Mutual Insurance Company
The Ohio Casualty Insurance Company
West American Insurance Company
POWER OF ATTORNEY
Certificate No: 8211888 - 976364
KNOWN ALL PERSONS BY THESE PRESENTS: That The Ohio Casualty Insurance Company is a corporation duly organized under the laws of the State of New Hampshire, that
Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts, and West American Insurance Company is a corporation duly organized
under the laws of the State of Indiana (herein collectively called the "Companies"), pursuant to and by authority herein set forth, does hereby name, constitute and appoint, John E.
Genet. Kim Chatmon. Mollv Speranza
all of the city of Atlanta state of GA each individually if there be more than one named, its true and lawful attorney -in -fact to make,
execute, seal, acknowledge and deliver, for and on its behalf as surety and as its act and deed, any and all undertakings, bonds, recognizances and other surety obligations, in pursuance
of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper
persons.
IN WITNESS WHEREOF, this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed
thereto this 24th day of MaN , 2024 .
to
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t County of MONTGOMERY
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On this 24th day of MaN , 2024 before me personally appeared David M. Carey, who acknowledged himself to be the Assistant Secretary of Liberty Mutual Insurance o'
Company, The Ohio Casualty Company, and West American Insurance Company, and that he, as such, being authorized so to do, execute the foregoing instrument for the purposes —
therein contained by signing on behalf of the corporations by himself as a duly authorized officer.
Liberty Mutual Insurance Company
\NSU,Q Vtl INS& \Nsuk The Ohio Casualty Insurance Company
�JPGOttPOI�gT�y� yJP'40RP0rzyr'Qgy `VP GORPo�T 2� West American Insurance Company
J .' �o cr Q• 3 `�o n � ? �o Cn
1912 0 0 1919 1991 0
Y�jI1SACHUS��.dD Z0�iphAMPs�\,aa3 `ls �'�DiAN1` ,aD3 ?
)7 B * tit * t.� �M * �� Y
David M. Carey, Assistant Secretary
IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my notarial seal at Plymouth Meeting, Pennsylvania, on the day and year first above written.
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@ ONW� Commonwealth of Pennsylvania - Notary Seal
tip cap ��� Teresa Pastella, Notary Public
1-1P Montgomery County
OF
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My commission expires March 28, 2025 By:X&��
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Commission number 1126044
Member, Notaries Teresa Pastella, Notary Public
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Pennsylvania Association of
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This Power of Attorney Is made and executed pursuant to and by authority of the following By-laws and Authorizations of The Ohio Casualty Insurance Company, Liberty Mutual
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Insurance Company, and West American Insurance Company which resolutions are now in full force and effect reading as follows:
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ARTICLE IV - OFFICERS: Section 12. Power of Attorney.
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Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President, and subject to such limitation as the Chairman or the
' r-
President may prescribe, shall appoint such attorneys -in -fact, as may be necessary to act in behalf of the Corporation to make, execute, seal, acknowledge and deliver as surety
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any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys -in -fact, subject to the limitations set forth in their respective powers of attorney, shall
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have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so executed, such
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instruments shall be as binding as if signed by the President and attested to by the Secretary. Any power or authority granted to any representative or attorney -in -fact under the
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provisions of this article may be revoked at an time b the Board, the Chairman, the President or the officer or officers granting such power or authority.
P Y Y Y Y 9 9 P ty
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ARTICLE XIII - Execution of Contracts: Section 5. Surety Bonds and Undertakings.
Any officer of the Company authorized for that purpose in writing by the chairman or the president, and subject to such limitations as the chairman or the president may prescribe,
shall appoint such attorneys -in -fact, as may be necessary to act in behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings,
bonds, recognizances and other surety obligations. Such attorneys -in -fact subject to the limitations set forth in their respective powers of attorney, shall have full power to bind the
Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When so executed such instruments shall be as binding as if
signed by the president and attested by the secretary.
Certificate of Designation - The President of the Company, acting pursuant to the Bylaws of the Company, authorizes David M. Carey, Assistant Secretary to appoint such attorneys -in -
fact as may be necessary to act on behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety
obligations.
Authorization - By unanimous consent of the Company's Board of Directors, the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the
Company, wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds, shall be valid and binding upon the Company with
the same force and effect as though manually affixed.
I, Renee 0. Uewollvn, the undersigned, Assistant Secretary, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and West American Insurance Company do
hereby certif that the original power of attorney of which the foregoing is a full, true and correct copy of the Power of Attorney executed by said Companies, is in full force and effect and
has nut been revoked.
If! TESTIMONY WHEREOF. I have hereunto set my hand and affixed the seals of said Companies this 7th day of May , 2025 .
\NSUR V11 INS& \NSUR
j pooRPORyTQyc+ yJPGoVLPOT0 `VPGoaPOR4, I
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2 1912 0 0 1919 n 2 1991 0
d�9ssacrtu5``�da do y�� �o ' 3 By.
7 * �a 41 A*PS*�aa �s�� °*" *�da Renee C. Llewellyn, Assistant Secretary
LMS-12873 URIC CCIC WAIC Multi Co 02/21
NOTICE TO BIppER$
Notice is h¢r¢by given that the City of South B¢nd, Indiana, Board of Public Works will
rec¢iv¢ sealed el¢ctronic R¢spons¢s at bpwbids(7asouthbevdin.eov until 9:00 a.m., EST, on
May 13, 2025, for the following:
Water Treatment Chemicals Wastewater 2026-2026
Specifications era available for download by Visiting the City of South Bend's web page at
wwwsoutnbend�n aoV:
X Click on "BUSINESS"
X Click on "Submit a City Contract Bid"
X Click on "City Contracts —Invitations to Bid'
X Click on the "Required Link" to register your company. You must rag/star Yo race/ve
addenda and updates to the specff/c bid you are /nterestad /n. Fa//ura [o do so
cou/d render your bid non-responslV¢ to the specifications.
Tnera 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. '13'I6, County -City Building, 227 W.
Jefferson BiVd., Soutn Bend, Indiana 4660'1.
Bids received after 9:00 AM, Local Time, on May '13, 2026, will ba returned unopened.
Bids must be on the City of South Band Bid/Proposal form provided, which includes a Non-pabarmant
Affidavit, Non -Discrimination Commitment form, and allon-Collusion Affidavit Form. Certified Check or Bld
Bond in the amount of not less than t O% must be submitted with the bid. A refund of the bid security will
ba 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 eleMs to award
the base bid plus an alternate(s), the Boartl will look at the totality of the cost when tletermining the
lowest, most responsible bid.
Tha Board may reject any bid that does noY conform to these requirements as non -responsive.
The Boartl reserves the right to reject any or all bitls 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 Soutn Bend.
BOARD OF PUBLIC WORKS
Theresa M. Heftnar, Clerk
Publish two times:
April 25, 2025
May 2, 2025
O t/24/2018
V gF
W
1316 COVNTV-CIiv BVIGDMG � rLt.�. PHGNe 504/235-9251
227 W.]Evvea3ow BOVLEvwan d. Fq% 574/235-91T
$OVTH BEND, INDIANA 46601-1830 �� _ TOO 694/236-3569
Has _y
CITY OF SOUTH BHNn JAMES MUELLER. MAYOR
BOARD OF PilBLIC WORKS
Date: 05
To: Al
From Tt
Subject AI
Project Name:
Project No.:
Water Treatment Chemicals -Wastewater 2025-2026
ACKNOWLEDGEMENT OF RECEIPT OF ADDENDUM
Date Received: 5/9/25
This addendum is being forwarded to you for the above referenced project.
Please sign below and acknowledge receipt of this Addendum
by faxing this sheet to the Board of Public Works at (574) 235-9171
within 48 hours of receipt. A copy MUST also be included with your
bid package upon submittal.
THIS ADDENDUM MAY AFFECT YOUR BID.
Notes
The attached documents aze hereby added to the Specifications and Contract
Documents and become a part of herein. The updated specification is a full
replacement specification document and includes corrected Bid Dates and supply
period for the material supply contract(s).
Comps
Author
Date:
Not Applicable
(To be completed only by Contractors/Bidders claiming to be a "local Indiana business" pursuant to I.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,
preference for Project
South Bend, St. Joseph County, Indiana.
claims a local Indiana business
(Project # ) located within the City of
❑ The location of the principal place of business is
(Address)
❑ 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 120.
Contractor/Bidder (Firm)
Signature of Contractor/Bidder or Its Agent
Printed Name and Title
��r e
SPECIFICATIONS � ��'�:
CITY OF SOUTH BEND ��ss+��
a.<,�
B1O NAME Water Treatment Chemicals Wastewater 2025-2026
FOR BIAS DUE May 13, 2026; 9:00 AM, Local Tlme
Pursuant to notices given, the undersigned offers bid (s) to the City of South Bend in
accordance with the following attach ment(s) which specify the class or item number or
description, quantity, unit, unit price
CHLORINE TON CONTAINERS............................................................................................. 1
FERRIC CHLORIDE...................................................................................................................2
SULFUR DIOXIDE...................................................................................................................... 3
DRY POLYMER FLOCCULENT.............................................................................................. 4
FOR ALL CHEMICALS
For seta rite purposes vendors shall cont:rm via fax a conv of the delivery driver's license.
truck and trail¢r information alone with th¢ anticipated time of arrival not later than 24
hours prior to arrival Failure to do so will b¢ cause for rei¢ction of mat¢ria1. no bi11ab1¢
time will be accented.
Water Works Facility deliveries are to be made on normal workdays, Monday through Friday,
between 7:00 AM and 1 I :00 AM. with unloading to be completed before 1 :00 PM.
Wastewater facility deliveries are to be made on normal workdays, Monday through Friday,
between 6:00 AM and 4:00 PM..
No stop -off or £uel surcharges allowed; however, demurrage charges will 6e allowed aRer 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 14, 2025, through May 13, 2026 (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.
1. CHLORINE SPECIFICATIONS
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 the 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 -free. No cylinder deposit should be
included in the quote.
4. All bid prices must be honored for no less than 4 months, even in force
majeure conditions.
Boiling Point
-29.29°F (-34.05°C
Critical Density
35.77 lb./cu. ft.
Critical Pressure
1118.4 psia 76.1 Atmos.
Critical Temperature
291.200 (144.°C)
Critical Volume
0.02796 cu. ft./lb.
Latent Heat of Vaporization
123.7 Btu./lb. ABoiling point
Liquid Gas Relationship:
1 volume liquid chlorine = wt. at
457.6 volumes of chlorine, 825 @
standard conditions
Melting Point
-149.76°F-100.98°C
Specific Gravity - Dry Gas
2.482
Specific Gravity — Liquid
1.468(° - 4°C)
B. Chlorine Ton Containers
a) All ton containers must be compatible with Chlorine Institute Emergency Kit "B".
2. Ton Container Types
a) Chlorine ton container types must comply with DOT spec. 106A500X, DOT or
ICC 106A500, 27, BE27.
b) Ton Container Valve and Fuse Plug Opening Threads
c) The threads in new ton containers are 314-14NGT (CI).
3. Valve Protection
a) The ton container valves are protected during shipment and storage by a
removable steel valve protective housing or cap. Pressure relief devices shall
not be covered by the housing.
4. Ton Container Capacity
a) In cases where the capacity of a chlorine container is not known, it can be
determined by weighing it empty and again when completely filled with water,
and by multiplying the weight of water at 60OF by 1.25. This is the maximum
allowable weight of chlorine allowed in the cylinder or ton container.
Cf�`7 FWMU181 10
1. Ton Container Stamping
a) When manufactured, ton containers are stamped with DOT specification number,
material, serial number, inspector's official mark, name, mark or initials of
company for whose use the tank is made, (or builder's symbol and serial
number), date of test, and water capacity [DOT Section] 79.300-18]. Tare
weights may be stamped by builder. Changes in stamping must be made in
compliance with DOT Section 173.31(d) or 49CFR.
2. Retest Stamping
a) Ton containers do not require the test facility's number on the container.
3. Tare -Weight Stamping
a) It is recommended that all new chlorine ton containers be stamped with the
original tare weight by the container manufacturer.
D. VALVES
1. Ton Container Valves
a) Chlorine ton containers are to have two identical Teflon 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 fusible
metal type relief device, and the valve seat diameter may be larger than on most
cylinder valves. There are two sizes of ton container valves: 314 inch NGT and 1
inch NGT.
2. Valve Outlet Threads
a) Outlet threads on ton containers are special straight 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. Ton Containers
a) Ton container valves contain no fusible plugs. The container itself is equipped
with six threaded fusible plugs, three in each head, spaced approximately 1200
apart.
2. Ton Container Inspection, Cleaning, and Reconditioning
a) In addition to the required period retest, it is recommended that each ton
container be internally and externally inspected prior to each filling. This
includes all appurtenances, 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. Ton Containers to be Tested
a) Ton containers must be retested at least once in five years (DOT Section 173.34e
and Section 173.31 d).
b) Ton containers can be filled until the end of the calendar year during which their
five-year test is due.
c) Retests are also required after any reheat treatment. In addition, retest any
container which shows evidence of weakness at any time, or show a S percent or
more loss in weight.
2. Test Procedure
a) Ton containers are hydrostatically retested by the hydrostatic expansion method
[DOT Section 173.34 (a) and Section 173.31 (d)J. If at the time 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 must be kept showing results of the test. Each container must have the
test date plainly and permanently stamped into the metal of one head or the
chime of each task passing the hydrostatic retest.
G. CONDITIONS OF DELIVERY
1. Delivery Location:
Location
Type of Container
Address
Wastewater
25000 lb. Ton Container
3113 Riverside Drive
2. Vendor personnel shall conduct all activities related to the loading and
unloading of ton containers.
3. Minimum deliveries are one (8) ton containers.
4. Supplier must be able to guarantee delivery within 3 to 4 calendar days
after order placement. Failure to meet delivery times shall result in
vendor beinj4 disqualified and award nullified.
5. Vendor personnel shall not unload any filled cylinders or ton containers prior
to live inspection by South Bend Wastewater personnel.
6. Vendor personnel shall assist South Bend personnel in the visual inspection of
each 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
ii) All fusible plugs should be defect free (no pits or holes)
d.) Determination of markings of retest and recertification
i. Wastewater facility has overhead crane for offloading ton containers.
2. FERRIC CHLORIDE
A. GENERAL
i. Normal concentration percent by Weight; 33-35%
ii. Specific Gravity: 0.33
b. DELIVERY
i. Full truck deliveries (4,000 gallons) to the Ferric feed facility Plant
located at; 3113 Riverside Drive, South Bend, IN 46628
3. SULFUR DIOXIDE
A. GENERAL
i. Sulfur quotes should be deposit -free. No cylinder deposit should be
included in the quote.
ii. All bid prices must be honored for no less than 4 months, even in
force majeure conditions.
B. PROPERTIES
Boiling Point
-10°C
Color
Colorless
Specific Gravity
80°F
1.363
Critical Temp.
314.82°F
Critical Pressure
1141.5 PSIA
i. Estimated annual usage is 100 tons, more or less, to be delivered in 2,000 lb
containers of liquid S02 in truckload lots of 10 containers.
D. DELIVERY
i. Supplier must be able to guarantee delivery of up to 8 tons (20,000 lbs) within
three (3) to five (5) calendar days from release of requirement.
ii. Material to be delivered F.O.B.
iii. No 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.
4. 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. Following bench testing any previously untested polymer must prove its
performance over a 90-day period. If, at any time during that period, the
polymer fails to perform, or its usage creates process irregularities at the
wastewater treatment plant such polymer and supplier shall be disqualified.
vi. Any polymer previously used at the plant that begins to decline in
performance may be disqualified. Vendor will have the opportunity to
provide an alternative product, not to exceed the bid price of the original
product for testing. If a secondary product fails to perform, the vendor
will be disqualified, and polymer needs will go to the open market.
vii. 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 Drive, South Bend, IN 46628.
viii. Samples must be clearly labeled with your company's name, address, and
(item number).
ix. All samples must be representative of the item bid.
X. All samples will become the property of the City of South Bend and will not
be returned.
B. PROPERTIES
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.
iii. Typical Properties
Bulk Density
50 lbs. per cubic ft.
Particle Size
95% less than 1 mm
H of 1 % Solution
3.5 — 4.5
C. PACKAGING/DELIVERY
i. Packaging to be in 50 — 55 lb polyethylene bags.
ii. Must be able to guarantee delivery of 9,000 lbs within 10 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.
S VSB
CITV OF SOUTH BEND 2. r s
INSTRUCTIONS TO BIDDERS -�'�"'�"�
�� a �v
1. BID FORMS AND EXECUTION e�,..tim
A. Bidders are expectatl to examine the Drawings, Specifications, Proposal, and all Instructions.
Failure to do so will ba at the BidtlaYs risk.
B. Each Bidder shall furnish all information required by the Notice, Instructions to Bitlders and
Specifications. Bids must ba 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, provitl¢ 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 ba shown. If made by a partnership or
joint venture, the Hama and post office address of each member of the partnership orjoint
venture must be shown. If made by a corporation, the Proposal must ba signatl 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 bowbitls�southbandin.aov.
B. "Bid for Water Treatment Chemicals Wastewater 2024-2025 —Bidder's Name" shall be
Included in the subject Ifne of the electronic Bid.
C. When samples are required, such s mples shall ba delivered or shipped a[ the bidder's
expense to the address specified in the Invitation to Bid. Samples must ba 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 Malarial Safety Data Shoats (if applicable). All samples must ba representative of the
commodiYles or equipment which will be supplied by the successful Bidder. All samples will
become the property of She Gity of South Band, and none will be returned, unless otherwise
stated in the Specifications.
D. Include Bid Bond of 'I O % for [he total Bid with the Bid Proposal.
E. In the event of an in istency between provisions of the contract tlocuments, the
inconsistency shall be resolved by giving pracatlanca 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 Bitlders
4. DELIVERY OF BIDS
The City of South Bend, Indiana, Board of Public Works will receive sealed electronic
Responses at bowbids�southbendin.aov.
5. ADDENDA —NO VERBAL INTERPRETATIONS
A. No inquiries by Bitlders relative to interpretation of Plans, Specifications, Spacial Provisions,
or ocher Bitlding 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
shoultl so inform the Board of Publfc Works in writing. Upon receipt of such information,
consideration will be given to the ativisability 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.
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.
TRADE DISCOUNTS
A. Trade discounts shall not be shown separately, but shall be incorporated in the Bidder's unit
price, unless otherwise specified.
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.
i VITJaMM181 anylyna we] agm
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 whose 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.
15. 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.
16. 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.
POLYDYNE INC
CERTIFICATE OF RESOLUTIONS
I, Christopher J, Gannon, Secretary of Polydyne Inc., a Delaware corporation (the
"Company"), do hereby certify that at a duly called meeting of the Board of Directors of the
Company, held on January 8, 2020, the Board of Directors unanimously approved the following
Resolutions:
RESOLVED, that Boyd Stanley, Rang Pich, John Pittman, Mark Schlag, Bobby
Wises and Kan Luka ba and hereby are authorized, empowered and directed to
bid, in the Hama of and on behalf of the Corporation, upon such municipal
projects as ha may deem appropriate; and further
RESOLVED, that Boyd Stanley, Reno Pich, John Pittman, Mark Schlag, Bobby
Wise and Ken Luke be and hereby are authorized and empowered to execute
and deliver, in the name of and on behalf of the Corporation, all documents,
instruments, certificate, agreements and papers as he may deem advisable or
necessary or proper to effect the Corporation's municipal bids or the
transactions contemplated thereby; and further
RESOLVED, that any Officer of the Corporation ba and hereby is authorized
and empowered, and to the eMant necessary or advisable, directed, to attest
the execution of any document executed pursuant to these resolutions, and to
affix the seal of the Corporation thereto, and to certify under seal to any
municipality the adoption of these resolutions; and further
RESOLVED, that the authorizations granted under these Resolutions shall
wntinue 'in full force and affect until successors to the foregoing
representatives of the Corporation shall have been duly appointed or until the
death, resignation or removal of each such representative.
IN WITNESS WHEREOF, the undersigned has signed this Certificate of Resolutions with
effect this 8`" day of January 2020.
SEAL
1995
;L•�iticity of this copy of the Resolution of the Board of Directors. This resolution is still valid
of date signed.
Mark Schlag
Vice President Finance, Assistant -Secretary Sr Treasurer
Dale: 5/625
Polydyne Inc.
General Information
Federal Identification No. 34-1810283
State of Incorporation: Delaware
Date of Incorporation: August 21, 1995
Administrative Offices: P.O. Box 279,
1 Chemical Plant Road
Riceboro, GA 31323
Payment Address: P.O. Box 404642
Atlanta, GA 30384-4642
Board of Directors
John Pittman
Officers
President
John Pittman
Secretary
Christopher Gannon
VP -Finance, CFO, Treasurer & Assistant Secretary
Mark Schla
Senior Vice President
Boyd Stanley
Vice President
Ken Luke
'Authorized Signers -Non Officers
Bobby Wise I Controller
Ownership Disclosure
Corporation
Percent Ownership
Owner
Pol d ne Inc.
100
SNF Holding Company
SNF Holding Company
100
SPCM SA
SPCM SA
100
Mr. Rene PICH holds
and/or controls 100% of the
shares of SPCM SA, a
company duly organized and
existing under the laws of
France, whose registered
office is in ZAC de Milieux,
Andrezieux, (42163),
FRANCE, registered under
the number 312 327 737 in
the Commercial Registry of
the town of Saint -Etienne
(42000), FRANCE.
Rev. 11/2022
filliit
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 1-9, Employment Eligibility Verification (Form 1-9). 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 11
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 1-9 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 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
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 274B 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 111.13 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
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perceived employment eligibility status while SSA or OHS Is processing the verification request unless the
Employer obtains Knowledge (as defined in 8 C.F.R. Section 274a.1(D) that the employee Is not work
authorized. The Employer understands that an initial inability of the SSA or OHS automated verification
system [o verify worK authorization, a tentative nonconfirmation, acase In continuance (indicating the need
for addi[lonal time far the government to resolve a case), or the finding of a photo mismatch, does not
establish, and should not be Interpreted a evidence that the employee is not work authoriz¢d. In any of
such cases, the employee must be provided a full and Pair opportunity to contest the finding, and if he or
she does so, the employee may no[ be terminated or suffer any adverse employment consequences based
upon the employee's perceived employment eligibility status (Including denying, reducing, or extending
worK hours, tlelaying 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 una uthorized to work) until and unless secondary verification by SSA or OHS has been
completed and a final nonconfirmation has been Issued. If the employee does not choose to contest a
tentative n onormation or a photo mismatch or If a secondary verification is completed and a final
nonconfirmation Is Issued, then [he 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 1-866-464-4218 (customer servic¢) or 1-886-897-77H1 (worker hotline).
14. The Employer agrees [o comply with Title VII of [he CIv1i 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 U below, or discharging or
refusing to hire employees because they appear or sound "foreign" or have received tentative
onfirmatlons. The Employer further understands Thai any violation of [he Immigration -related unfair
employment practices provisions In section 274B oP 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 punlilve damages. Violations of eliher section 2746 of the INA or Tltie VII may
also leatl to the termination of its participation in E-Verify. If the Employer has any questions relating io the
anti -discrimination provision, It should contact OSC at 1-BOO-255-6155 or 1-800-237-2515 (TOE).
15. The Employer agrees that It will use the infortnatlon It receives from E-Verify (through its Web Services E-
Verlfy Employer Agent) only [o confirm the employment eligibility of employees as authorized by this MOU.
The Employer agrees Ghat It will safeguard [his Information, and means of access to It (such as Personal
ItlenBfication Numbers and passwords), to ensure the[ i[ is no[ used for any ocher purpose and as necessary
to protect Its confldentiallty, including ensuring that it is not disseminated to any person other than
employees of [he Employer who are authorized to pertorm the Employer's responsibilities under this MOU
except for such dissemination as may be authorized in advance by SSA or OHS for legitimate purposes.
16. The Employer agrees to no[Ify OHS Immediately In the event of a breach of personal Information. Breaches
are defined as loss of control or unauthoriaed 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-Verifyguscis.dhs.9ov. Please use
"Privacy Incident - Passwor'd" in the sub)ec[ 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 ServlcesE-Verify
Employer Agent is governed by [he Privacy Act (5 U.S.C. Section 652a(I)(1) and (3)) and the Social Security
Ac[ (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.
16. The Employer agrees to cooperat¢ with OHS and SSA in their compliance monitoring and evaluation of E-
Verify, which Includes permitting OHS, 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 oP E-Verify, and to respond in a prompt and accurate manner to OHS requests for
Information relating to their particlpatlon in E-Verify.
19. The Employ¢r shall not make any false or unauthorized claims or references about Its particlpatlon In E-
Verify on Its webslte, In advertising materials, or other media. The Employer shall not describe Its services
as federally -approved, federally-certiPietl, or federally -recognized, or use language with a similar intent on
Its website or other maierla is provltled [o the public. Entering Into this MOU does no[ mean that E-Verify
¢ndorses or authorizes your E-Verify services and any claim to [hat effect Is false.
20. The Employer shall not stale In lis website or other public documents that any language used therein has
been provided or approved by OHS, USCIS or the Verification Oivislon, without firs[ obtaf Wing the prior
written consent of OHS.
21. The Employer agrees that E-Verfy tratlemarKs antl logos may be used only under license by OHS/USCIS (see
M-795 (yy¢p)) and, other than pursuant to the specific terms of such license, may not be usetl in any
manner [hat might Imply that the Employer's services, products, websites, or publications are sponsored by,
endorsetl by, Ilcensetl by, or affiliated with OHS, USCIS, or E-Verify.
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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
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FE-M
Company ID Number:32855 Client Company ID Number:385743
Web Services E-Verify Employer Agent must use the E-Verify 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 1-9, 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-Verify 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-Verify 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
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Company ID Number:32855
kM- viol on V�.
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.
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.
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,
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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 1-9
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 1-9 consistent with Article II.A.6 or update the previous
Form 1-9 to provide the necessary information if:
The Employer cannot determine that Form 1-9 complies with Article II.A.6,
The employee's basis for work authorization as attested in Section 1 has expired or changed,
or
The Form 1-9 contains no SSN or is otherwise incomplete.
Note: If Section 1 of Form 1-9 is otherwise valid and up-to-date and the form otherwise
complies with Article II.C.5, but reflects documentation (such as a U.S. passport or Form I-
551) that expired after completing Form 1-9, the Employer shall not require the production of
additional documentation, or use the photo screening tool described in Article II.A.5, 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.
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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 111
REFERRAL OF INDIVIDUALS TO SSA AND DHS
I!UMa4- ;140 7_1 M%x*_1=1
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
FM_ WIWI on
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
V son
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 1-9 as part of its interface, then it
must comply with the standards for electronic retention of Form 1-9 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 800-37].
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
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Company ID Number:32855 Client Company ID Number:385743
software.
C. 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-
951. 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.
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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
Company ID Number:32855
6M- VION
MW
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, all 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.
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1wM- wwo
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, Inc.'
Name (Please Type or Print)
Maricel Salazar
Title
Signature
Electronically Signed
Date
February 09, 2021
Department of Homeland Security - Verification Division
Name
Title
Signature
Date
Page 14 of 17 1 E-Verify MOU for Employers Using a Web Services Employer Agent 1 Revision Date 06/01/13
w INN
taRr sec r'cra,rt-
Company ID Number:32855 Client Company ID Number:385743
Information Required for the E-Verify Program
Information relating to your Company:
Company Name
SNF Holding Company
Company Facility Address
One Chemical Plant Road
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 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
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 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
Information relating to the Program Administrator(s) for your Company on policy questions or
operational problems:
Name Jennifer Hinze
Phone Number (912) '880-8091
Fax Number
Email Address jenniferh@snfhc.com
Page 17 of 17 1 E-Verify MOU for Employers Using a Web Services Employer Agent I Revision Date 06/01/13
SNF
WATER SCIENCE
PO LY�YN E
CLARIFL OC CE-I463 POL YMER
PRINCIPAL USES
CLARIFLOC CE-1463 a high charge cationic polyacrylamitle
[ha[i sad a a flocculent wide v iety of n cipal antl
industr el wastewater hroahnent applicationsrlt has beans ssfully
applied in all liquid/solitls sapara[ion systtms including clerificatioq
hUckening,flotation, and dewatering.
TYPICAL PROPERTIES
Physical Porm White Grenuler Powder
Catiovicity g0%
pH (023%Sol'nj 3-5
PREPARATION AND FEEDING
CLARIFLOC CE-]463 is water soluble, but certain
pre autions shoWd be £ollowetl [o obtain total tlissolution with
m loss of activity. Complete wetting of [he individual
polymer particles the Ingle os[ unportant factor tl+e
prepemtton of powdered polym solutians. One mthod to achieve
gootl welling is m u espimtor type diaper r that draws the
solitl polymer particles into the water streameu ing a
reamd by water pwssure. A water ptrossure of 30 psig or greeter 1s
regnired to implement this methotl. The weHetl polymer ttom Me
aspirator should be discharged into a vassal equipped with a higfi speed
capable ofs[irxing the entire lank. Tha polymer solution should
be stirred for IS-60 m antes o until dissolutiov is mplere. Tl+a
mlggesced make -down concentration for CLAAiFLOC CE-1463
O.l - 0.3 % by weight. Completely vummaced equipment is
Tally aveilabl<.
MATERIALS OF CONSTRUCTION
Cross-linketl polyethylenq Hberglesa, stainless steel or lined sceel are
the preferred materiels for tlissolution tanks. Unlinetl miltl steel, black
n, galvanimd steel, copper or brass shoals not be used in any part
ofhte feed system. gminl¢as steel or PVC ere recommended for pump
neeaa ana race ❑nee.
MANUFACTURING SPECIFICATIONS
%Moisture <g
UL Viscosity 2.6 - 3.2 cPa
%lnsolublas c2.0
H.9NDLING AND STORAGE
Suggested in -plant storage of CLARIFLOC CE-1463 ne year
mopened bags. Store i ool, tlry are For spills of dry
CLAAIPLOC CE-1463, sweep cup tM material antl + if
possible. Do no[ spray water o spilled dry pwtluct be ease the
sultir+g gd is very slippery antl dit£cul[ to clean up. For spills
of CLARtFLOC CE-1463 solutions, sprinKle sawdust o
culite o r the spill a vntl sweep into approved chemical
duposel containers. Aock aaR cuts slipperi-yeas.
SAFETY INFORMATION
CLARIFLOC CE-1463 en potrntially in ifate th¢ skin, eyes and
lungs, so gloves, goggles antl filter type respirator afiould be w
while handling this produce CLARIFLOC CE-1463 is no[ rceaity
ignited. but it will support av existing tire. Foavr, CO+ or dry the cal
methotls afiould be used because polymer -water mixtures a very
slippery. Anyone responsible for the procurement,
disposal of CLARIFLOC CE-1463 shoultl famil erize
themselves with the appmpriace safety end handling pre autions
outlined in the POLVDVIYE Materiel Safety Data Sheet. cin the
ant of a ergency with CLARiFLOC C1Y 1463, contact
Chemtrec anytime day or night at (gOOJ 424-9300.
SHIPPING
CLAAIFLOC CE-t463 is shipped in 33 pound bags and
supersecks. Bvik quartities arc also available.
ADDITIONAL INFORMATION
To piece en oMm orobtain technical inforn+ation f�mn anywhere in the
¢nntinental unites states. can mu r e:
[0001 048-7659
For oddirionol informorionr please refer ro fhe Sofefy oofo Sh®of (sosj
All a le, Infermanen end dap Bive^ hera:n o e behevod le be oawore, bW ro preaemed wilM1eul werreny, exprawad er implied. Slelemenle ceneming passible
ode wllhe repro rang Ihn any such uw Is hee of paten inhingam and ie mdelten InFinge any peb I. The should
e Ihal all aefey m Wndie led or IFaI olAor meanwoa may norobe mQuirod. Any delerminaxen of the auilabiby et a penleuler pr«iuel {e Bony ese
conremplatad by IM1e user le Ihe�ole roeponeibiliy of Iha near.
® 2023 POLYOYNE ING. i 0323
'�1
rn
�_
Z
Health-Sa/ery
Envlronmeni
SAFETY DATA SHEET
According to U.S. Code of Federal Regulations 29 CFR 7970.7200, Hazard Communication.
SECTION 7: Identlficat
7.7. Product /dent/fler
Product name: CLARIFLOCT"" CE-1463
Type of product: M�tTire-
7.2. Relevant identified uses of the substance or m/xture and uses adv/sed ago/nst
/dentified uses: Processing aid £or industrial applications.
Uses advised against: None.
7.3. Deta//s of the supplier of the safety data sheet
Company: - POLYDYNE INC
1 Chemical Plant Road
PO BOX 279
Riceborq GA 31323
Telephone: 1-800-848-7659
Te/efax: (912)-884-8770
E-mat/address: -
7.4. Emergency to/ephone number
24-hour emergency number: I-800-424-9300
SECTION 2: Hazards identification
Z7. C/asslflcatlon of the substance or m/xture
C/essit/cat/on according to paragraph (d) of 29 CFR >970A200:
Not classified.
2.2. Labe/elements
Label/ing according to paragraph (tJ of 29 CFR 7970.7200:
Print Oa[e: OS/O6/2025 Revlafon tlafe: 02/24/2a25 Page: 7 / 75
SAFETY DATA SHEET
CLARIFLOCTM CE-1463
Hazard symbol(s): 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: Composition/information on ingredients
3.1. Substances
Not applicable, this product is a mixture.
3.2. Mixtures
Adipic acid
Concentration/ -range:
CAS Number.
Classification according to paragraph (d)
of 29 CFR 1910.1200:
Sul famic 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
Inhalation:
Move to fresh air. Get medical attention if symptoms occur.
<= 2.5%
124-04-9
Eye Irrit. 2A;H319
<= 2.5%
5329-14-6
Skin Irrit. 2;H315, Eye Irrit. 2A;H319
Print Date: 05/06/2025 Revision date: 02/24/2025 Page: 2 / 15
SAFETY DATA SHEET
CLARIFLOCTM CE-1463
Skin contact:
Wash off with soap and plenty of water. Get medical attention if irritation 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: Firefiahtina 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
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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 fi-om 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.
6.4. 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 uses)
This information is not available.
SECTION 8: Exposure controlslpersonal protection
8.1. Control parameters
Occupational exposure limits:
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SAFETY DATA SHEET
Adipic acid
ACGIH: 5 mg/m3 (8 hours)
CLARIFLOCTM 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 exaosure 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:
t) Initial boiling point and boiling range:
g) Flash point:
Granular solid, White.
None.
Not applicable.
2.5 - 4.5 @ 5 g/L (See Technical Bulletin or Product
Specifications for a more precise value, if available)
> 100°C
Not applicable.
Not applicable.
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SAFETY DATA SHEET
h) Evaporation rate:
i) Flammability (solid, gas):
j) Upper/lower flammability or explosive limits:
k) Vapour pressure:
I) Vapour density:
m) Relative density:
n) Solubility(ies):
o) Partition coefficient n-octanol/water (log value):
p) Autoignition temperature:
q) Decomposition temperature:
r) Viscosity.
s) Kinematic viscosity:
t) Explosive properties:
u) Oxidizing properties:
v) Particle characteristics:
9.2. Other information
None.
SECTION 10: Stability and reactivitX
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.
10.4. Conditions to avoid
None known.
70.5. Incompatible materials
CLARIFLOCTm CE-1463
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.
> 2000C
See Technical Bulletin.
No data available.
Not expected to be explosive based on the chemical structure.
Not expected to be oxidising based on the chemical structure.
No data available.
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SAFETY DATA SHEET
Oxidizing agents.
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/oral/rat > 5000 mg/kg
Acute dermal toxicity:
LD50/dermal/rat > 5000 mg/kg.
Acute inhalation toxicity:
The product is not expected to be toxic by inhalation.
Skin corrosion/irritation:
Serious eye damage/eye irritation:
Respiratory/skin sensitisation:
Mutagenicity:
Carcinogenicity:
Reproductive toxicity:
STOT - Single exposure:
STOT - Repeated exposure:
Aspiration hazard:
Not irritating.
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.
The results of testing on guinea pigs showed this material to be non -sensitizing.
Not mutagenic.
Not carcinogenic.
Not toxic for reproduction.
No known effects.
No known effect.
No hazards resulting from the material as supplied.
Relevant information on the hazardous components:
Adipic acid
Acute oral toxicity: LD50/oral/rat = 5560 mg/kg (OECD 401)
Acute dermal toxicity. LDO/dermal/rabbit >= 3176 mg/kg
Acute inhalation toxicity: LCO/inhalation/4 hours/rat > 7.7 mg/L (OECD 403)
Skin corrosion/irritation: Slightly irritating.
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SAFETY DATA SHEET CLARIFLOCTM CE-1463
Serious eye damage/eye 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 known effect.
Aspiration hazard:
No known effects.
Sulfamic acid
Acute oral toxicity:
LD50/oral/rat = 2065 - 2140 mg/kg
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/irritation:
Not irritating. (OECD 404) (SNF)
Serious eye damage%ye irritation:
Moderately irritating 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). Not mutagenic. (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 414)
- NOAEL/Maternal toxicity/rat = 200 mg/kg/day
- NOAEL/Developmental toxicity/rat = 200 mg/le-g/day
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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.
CLARIFLOCTM CE-1463
No known effects.
No known effect.
No known effects.
LC50/Danio rerio/96 hours = 5 - 10 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:
Adipic acid
Acute toxicity to fish: LCO/Danio rerio/96 hours >= 1000 mg/L
Acute toxicity to invertebrates: EC50/Daphnia magna/48 hours = 46 mg/L (OECD 202)
Acute toxicity to algae: IC50/Selenastrum capricornutum/72 hours = 59 mg/L (OECD 201)
Chronic toxicity to fish: No data available.
Chronic toxicity to invertebrates: NOEC/Daphnia magna/21 days = 6.3 mg/L (OECD 211)
Toxicity to microorganisms: EC50/activated sludge/3 hours = 4747 mg/L (OECD 209)
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SAFETY DATA SHEET
Effects on terrestrial organisms: No data available.
CLARIFLOCTM CE-1463
Sediment toxicity:
No data available.
Sulfamic acid
Acute toxicity to fish:
LC50/Pimephales promelas/96 hours = 70.3 mg/L (OECD 203)
Acute toxicity to invertebrates:
EC50/Daphnia magna/48 hours = 71.6 mg/L (OECD 202)
Acute toxicity to algae:
IC50/Scenedesmus subspicatus/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 suaalied:
Degradation: Based on the degradability data of the components, this product is expected to be
readily (bio)degradable according to OECD criteria.
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
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SAFETY DATA SHEET
Sul famic acid
Degradation: Not relevant (inorganic).
Hydrolysis: Does not hydrolyse.
Photolysis: No data available.
12.3. Bioaccumulative potential
Information on the product as supplied:
The product is not expected to bioaccumulate.
Partition co -efficient (Log Pow): < 0
Bioconcentration factor (BCF): —0
Relevant information on the hazardous comaonents:
Adipic acid
Partition co -efficient (Log Pow):
Bioconcentration factor (BCF):
Sulfamic acid
Partition co -efficient (Log Pow):
Bioconcentration factor (BCF):
0.093 @ 25°C, pH 3.3
out
-4.34 @ 200C
12.4. Mobility in soil
Information on the product as supplied:
No data available.
Relevant information on the hazardous comaonents:
Adipic acid
Koc:
No data available.
CLARIFLOCTM CE-1463
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SAFETY DATA SHEET
Sulfamic acid
Koc: No data available.
12.5. Other adverse effects
None known.
SECTION 13: Disposal considerations
13.1, Waste treatment methods
CLARIFLOCTM CE-1463
Waste from residues/unused products:
Dispose in accordance with local and national regulations. Can be landfilled or incinerated, when in compliance with local
regulations.
Contaminated packaging
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:
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SAFETY DATA SHEET
SARA (Section 3111312) hazard class:
Not concerned.
SARA Title /I/ 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) - Reportable Quantity.
Contains one or more of the listed substances.
Clean Air Act
Section 112(r) Accidental release prevention requirements (40 CFR 68) - Reportable Quantity:
Not concerned.
CERCLA
Hazardous Substances List (40 CFR 302.4) - Reportable Quantity:
Contains one or more of the listed substances.
RCRA status:
Not RCRA hazardous.
CLARIFLOCTM CE-1463
California Proposition 65 Information:
WARNING! This product contains a chemical known to the State of California to cause cancer and birth defects or other
reproductive harm, Aclylamide
Relevant information on the hazardous components:
Adipic acid
Clean Water Act
Section 311 Hazardous Substances (40 CFR 117.3) - Reportable Quantity. 5000 lbs
CERCLA
Hazardous Substances List (40 CFR 302.4) - Reportable Quantity: 5000 lbs
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SAFETY DATA SHEET CLARIFLOCTM' CE-1463
DOT RQ (lbs):
SECTION 16: Other Information
NFPA and HM/S Ratinos
NFPA:
Health: O
Flammability: O
Instability: O
0
a♦
HM/S
Health: O
flammability: O
Physical Hazazd: O
PPE Code: B
5000 lbs
SECTION 3. Composition/i�'orrna.tion on ingredients, SECTION 5. Fire -fighting measures, SECTION S. Exposure
controls/personal protection, SECTION 16. Other Information.
vi /
Acronyms
STOT =Specific target organ toxicity
AbbreNatlons
Eye Init. 2A =Serious eye damage eye irritation Category Code 2A
Skin Irrit. 2 =Shin corrosion/irritation Category Code 2
Hazard statements
H315 -Causes slrin irritation
H319 -Causes serious eye irritation
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SAFETY DATA SHEET
Do not handle until all safety precautions have been read and understood.
This SDS was prepared in accordance with the following.-
U.S. Code of Federal Regulations 29 CFR 1910.1200
Version: 20.01.a
PRCCO03
CLARIFLOCTM CE-1463
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.
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