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HomeMy WebLinkAboutBid PacketLANDSCAPE FERTILIZATION TOTAL THIS IS TO BE THE FIRST PAGE OF ENTIRE QUOTE. TOTAL ORIGINAL PRICE: NATURE SAFE ORGANIC j 20 FERTILIZER r ALTERNATE PRICE: NON-ORGANIC G NIC FERTILIZER � THIS IS TO BE THE FIRST PAGE OF ENTIRE QUOTE. EXHIBIT D AFFIDAVIT being first duly sworn, deposes and says that he/she is familiar with and has personal knowledge of the facts herein and, if called as a witness .in this matter, could testify as follows: 1. 1 am over eighteen (IS) years of age and am competent to testify to the facts contained herein. 2. I. am now and, at all times relevant herein have been employed by,. (the "Employer"). in the position of 1 Z `A"q`�SS � 3. 1 am familiar with the employment policies, practices, and procedures of the Employer and have the authority to act on behalf of the Employer. 4. The Employer is enrolled and participates in the federal E -Verify program; Documentation of this enrollment and participation is attached and incorporated herein: S. The Employer does not knowingly employ any unauthorized aliens. 6. To the best of my information and belief, the Employer does not currently employ any unauthorized aliens. 7. FURTHER AFFIANT SAYETH NOT. EXECUTED on the day of �'�^' , 20Ak. Printed: ,3Awre S 2g -t 1 certify under the penalties for perjury under the laws of the United .States of America and the State of Indiana that the foregoing factual statements and representations are true and correct. Pri /4 • Pratt, James From: Sent: To: Subject: Kennedy, Elizabeth Tuesday, March 01, 2016 12:48 PM St. Peters, Cricket; Pratt, James EVerify 1-9 MANAGEMENT M Elizabeth A Ke Home Privacy Policy 0 Hdip [!9- Logoutj,;�O TruGreen Limited 'Part S-7 75, _ � - �� ,1. �w� `,� .`':���'.ti.1���� I MOM L■ 4 1 1 Create a new 1-9 online and sign it with electronic signatures. Search For Employees Search for employees by entering a First or Last Name, SSN, Location, 1-9, Type or all of the above. 1 (151-111 M& _Pending 5 1504*�A F �p 7 Reygrification Due-- 0 SSN AE)plied For EmVerify Issues -Ap Ll nj Conversion Errors F -6F;>,;,4- Status: r CUMfItt �Y] AVajlab'fp_ Refresh All EXHIBIT D AFFIDAVIT being first duly sworn, deposes and says that _ he/she is familiar with and has personal knowledge of the facts herein and, if called as a witness in this matter, could testify as follows: 1. I am over eighteen (18) years of age and am competent to testify to the facts contained herein. 2. I am now a jW at all times relevant herein have been employed by ( / £ (the. "Employer"), in the position of 'W` S; f �� I 3. I am familiar with the employment policies, practices, and procedures of the Employer and have the authority to act on behalf of the Employer. 4. The Employer is enrolled and participates in the federal E -Verify program. Documentation of this enrollment and participation is attached and incorporated herein. 5. The Employer does not knowingly employ any unauthorized aliens. 6. To the best of my information and belief, the Employer does not currently employ any unauthorized aliens. 7. FURTHER AFFIANT SAYETH NOT. EXECUTED on the I day of 7Prin 1 certify under the penalties for perjury under the laws of the United: States -of America and the State of Indiana that the foregoing factual statements and representations are true and correct. Azr lv• P,L� Pratt, James From: Kennedy, Elizabeth Sent: Tuesday, March 01, 2016 12:48 PM To: St. Peters, Cricket; Pratt, James Subject: EVerify " ? Create a new I-9 online and sign it with electronic signatures. ,!t I -n searcli For F. . Search for emolovees by entering a First or Last Name, SSN, Location, I-9 Type, or all of the above. 1 Status: V Cuirrent`ly AvaIlabl Refresh All Pending. 5S Reverification Due 0 Receipt Due SSN Applied For E -Verify Issues 0 —� Missincr 15 - I ` �• Conversion Errors 0 —� Status: V Cuirrent`ly AvaIlabl Refresh All All quotes must include Exhibit B & C Insurance Coverage and E -Verify documentation, which includes a computer ScreenShot of the business' E -Verify webpage. Failure to include any of the above requirements will void the quote. City of Carmel Street Department Landscape Fertilization Exhibit D Notice Exhibit D needs to be filled out completely and returned with 2 copies of the bid. ACOR 7 0 CERTIFICATE OF LIABILITY INSURANCE DATE (MWDDIYYM 1/4/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemen s . PRODUCER Arthur J. Gallagher Risk Management Services, Inc. 5500 Maryland Way, Suite 330 Brentwood TN 37027 CONTACT NA E: JoAnn Warpool PHONE 615-377-5153 FAX c 615-263-5853 E-MAIL ADDRESS.JoAnn Warpool@ajg.com INSURERS AFFORDING COVERAGE NAIC # 1/1/2016 INSURERA:Commerce and Industry Insurance Com 19410 EACH OCCURRENCE $3,000,000 INSURED TRUGHOL-01 INSURERB:National Union Fire Insurance Coma 19445 TruGreen Limited Partnership INSURERC:New Hampshire Insurance Company 23841 860 Ridge Lake Blvd FI 3 Memphis TN 38120 INSURER D: Insurance Company of State of PA 19429 PRODUCTS - COMP/OP AGG sin $20,000,000 $ INSURER E INSURER F • LIABILITY ANY AUTO AUTOS NED AUTOSULED HIRED AUTOS NON -OWNED AUTOS CnVFROr.FS CFRTIFICOTF NIIMRER- 923851264 RFVISInN NI IMRFR• THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE INSO WVD POLICYNUMBER POLICY EFF MMIDD POLICY EXP MMIDD LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS-MADEX❑ OCCUR GL2039140 1/1/2016 1/1/2017 EACH OCCURRENCE $3,000,000 DA AGE TO RENTED PREM SES Ea occurrence) $3,000,000 MED EXP (Any oneperson) $5,000 PERSONAL &ADV INJURY $3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑PRO LOC JECT OTHER: GENERAL AGGREGATE $20,000,000 PRODUCTS - COMP/OP AGG sin $20,000,000 $ B D B AUTOMOBILE X LIABILITY ANY AUTO AUTOS NED AUTOSULED HIRED AUTOS NON -OWNED AUTOS CA9734247(AOS) CA9734248(VA) CA9734249(MA) 1/1/2016 1/1/2016 1/1Y2016 1/1/2017 1/1/2017 1/1/2017 Ea accident E 1 $5,000,000 BODILY INJURY (Perperson) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident UMBRELLA LIAB EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ C C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNER/EXECUTIVEF__] OFFICERIMEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A VVC068022459 WC068022460 1/1/2016 1/1/2016 1/1/2017 1/1/2017 X PER OTH- STATUTE ER E.L EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached I more space Is required) See Additional Remarks Schedule for additional information TruGreen Limited Partnership 860 Ridge Lake Blvd Memphis TN 38120 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©19HO-2074 AGORD GORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD ,4t9Ma ADDITIONAL REMARKS SCHEDULE Page 2 of 3 AGENCY Arthur J. Gallagher & co. NAMED INSURED TruGreen Limited Partnership POLICY NUMBER see certificate CARRIER INAICCODE See certificate EFFECTIVE DATE: 1/1/16 AnnTTTONAT. REMARKS THISADDITIONAL REMARKS FORM ISA SCHEDULE TOACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of 1_ati _ .y Insurance INSURER(S) AFFORDING COVERAGE NAIC# INSURER INSURER INSURER INSURER ADDITIONAL POLICIES Ifa policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits. I INSR LTR TYPE OF INSURANCE ADDL IVSD SUBR WVD POLICY NUMBER POLICY EFFECTIVE DATE POLICY EXPIRATION DATE LIMITS (MM/DD/YYYY) (MM/DD/YYYY) C WORKERS COMPENSATION N/A WC068022460 01/01/2016 01/01/2017 IL, KY, NC, NH, UT, VT SIR applies per policy to ms & condit ons C WORKERS COMPENSATION N/A WC068022462 01/01/2016 01/01/2017 GA, VA SIR applies per policy to ms & condit ons C WORKERS COMPENSATION N/A WC068022461 01/01/2016 01/01/2017 NJ, PA SIR applies per policy to ms & condit ons C WORKERS COMPENSATION N/A WC068022463 01/01/2016 01/01/2017 CA SIR applies per policy to ms & condit ons C WORKERS COMPENSATION N/A WC068022464 01/01/2016 01/01/2017 FL SIR applies per policy to ms & condit ons C WORKERS COMPENSATION N/A WC068022467 01/01/2016 01/01/2017 NO, OH, WA, WI, WY SIR applies per policy to ms & conditions C WORKERS COMPENSATION N/A 01/01/2016 01/01/2017 I IWCOGS022465 ME SIR applies per policy to ms & condit ons ACORD 101 (2008/01) 'A 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AC'ORO� ADDITIONAL REMARKS SCHEDULE Page of AGENCY Arthur J. Gallagher & co. NAMED INSURED TruGreen Limited Partnership POLICY NUMBER see certificate CARRIER NAIC CODE see certificate EFFECTIVE DATE: 1/1/2016 ADDITIONAL REMARKS ITHISADDITIONAL REMARKS FORM ISA SCHEDULE TO ACORD FORM, I /FORM NUMBER: ACORD 25 FORM TITLE: Certificateof I'ab`__ _y Insurance 1 Additional Description of Operations/ locations l Vehicles; Additional Information *The named insured includes (but is not limited to) : TruGreen Holding corporation FEIN #46-4321581 TruGreen, Inc. FEIN #36-3734601 TruGreen companies LLC FEIN #36-4313320 TruGreen Limited Partnership FEIN #36-3734669 TruGreen Home Landscape services, L.L.C. FEIN #20-5520972 Lake county Partnership FEIN #36-3453078 TruGreen Limited Partnership dba Barefoot Grass FEIN #36-3734669 TruGreen Limited Partnership dba EPM Lawncare FEIN #36-3734669 ACORD 101 (2008/01) 0 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD EXHIBIT C INSURANCE COVERAGES Worker's Compensation & Disability Employer's Liability: Bodily Injury by Accident/Disease: Bodily Injury by Accident/Disease: Bodily Injury by Accident/Disease: Property damage, contractual liability, products -completed operations: General Aggregate Limit (other than Products/Completed Operations): Products/Completed Operations: Personal & Advertising Injury Statutory Limits $100,000 each employee $250,000 each accident $500,000 policy limit $500,000 $500,000 Policy Limit: $500,000 Each Occurrence Limit: $250,000 Fire Damage (any one fire): $250,000 Medical Expense Limit (any one person): $ 50,000 Comprehensive Auto Liability (owned, hired and non -owned) Bodily Single Limit: Injury and property damage: Policy Limit: Umbrella Excess Liability Each occurrence and aggregate: Maximum deductible: $500,000 each accident $500,000 each accident $500,000 $500,000 $ 10,000 EXHIBIT B INVOICE Name of Company: Address & Zip: Telephone No.: Fax No.: Project Name: Invoice No. Purchase Order No: Date: Signature Printed Name Goods Services Person Providing Goods/Services Date Goods/ Service Provided Goods/Services Provided (Describe each good/service separately and in detail) Cost Per Item Hourly Rate/ Hours Worked Total GRAND TOTAL Signature Printed Name 1az BRE CIM TRUGREEN`. COMMERCIAL 860 RIDGE LAKE BLVD MEMPHIS TN 38120 7534 0410 NO RP 02 02022016 YYNNNNNN 0000296 S1 T1 P 300 1 SP 0.485 CITY OF CARMEL DAVE HUFFMAN 3400 W 131ST ST WESTFIELD IN 46074-8267 �I��'111'1111'��Ilrrillrl111r�Il�l�r�l"II�'��III'Illl�l����'I�' Your TruGreen@ Invoice Pay by phone (317)570-2300 Questions (317)570-2300 This invoice reflects payments received by 02/01/16. If payment has already been sent, please disregard. Service i Description of Services Invoice Ch Date 1 & Service Address Number Payments/ I Total Credits I Due 1 00005739 20 070015283029 00000000000426821326 0068550000685500 5 j Ice Melt Pallets 42682132 $6,8`QQJ i 02/01/16 Work Order 1766774007 ! Location: CITY OF CARMEL 3400 W $6,855.00 j 131ST, WESTFIELD IN 46074 I ! Due ®ate: 02%15/2016 1'otaf iJu $6,555.®0 *T Plea-77777-�se make checks; payahle to TruGrean Llmifed Partrifershlp _ F ..............>e..a.., .. ........ a...�_ �_..... r....L.....�......_.._...._�....—xw................�4-..........._..._..�_............�-....9........... ...�...v.�_ --------------------------------------------------------------------- ..._.v.> �..... .�.� '.....-_.....�.. .. � ............. �...._......n...�6....�....m............_...Y..�..t�.,......e._..... wA.....a r...... �k....�..._..._ TRUGRE'EN I Due Date i Total Due 1 Amount Paid— Check # ) COMMERCIAL ! ---_._________._.___._-__._--__- Customer Number: 7001528302 02/15/2016 $6,855.00 I I 1 Branch Number: 5739 -------------- Payment Options: CITY OF CARMEL • Pay online at My Account atTruGreen.com DAVE HUFFMAN • Pay by phone at (317) 570-2300 3400 W. 131ST • Pay by enclosed check (See back of invoice for details) :•--------j WESTFIELD IN 46074 • Credit card payment (Please fill out the following): Check One: Q Q Fl/1 O m Q Ei° ss 0 m Mail to: ; TRUGREEN PROCESSING CENTER Credit Card #: PO BOX 9001033 LOUISVILLE KY 40290-1033 Exp. date: / Name (as it appears on credit card): Authorized Signature: ***REQUIRED*** 1 00005739 20 070015283029 00000000000426821326 0068550000685500 5