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HomeMy WebLinkAboutAl Warren Oil Company, Inc./STREET/$58,690.50/Fuel Storage Tanks and Fuel DocuSign Envelope ID:657F94F3-EFFE-4735-A05E-CDBADFA24E5B APPROVED Al Warren Oil Company,Inc. By Sergey Grechukhin at 12:25 pm,Jul 10,2023 Street Department-2023 Appropriation#s 2201 2201 42-313.00 Motor Vehicle Highway Fund,2201 2201 42-314.00 Motor Vehicle Highway Fund; P.O.#s 109843, 109842 Contract Not To Exceed$58,690.50 AGREEMENT FOR PURCHASE OF GOODS AND SERVICES THIS AGREEMENT FOR PURCHASE OF GOODS AND SERVICES ("Agreement") is hereby entered into by and between the City of Carmel, Indiana, acting by and through its Board of Public Works and Safety ("City"), and Al Warren Oil Company, Inc. an entity duly authorized to do business in the State of Indiana ("Vendor"). TERMS AND CONDITIONS 1. ACKNOWLEDGMENT,ACCEPTANCE: Vendor acknowledges that it has read and understands this Agreement, and agrees that its execution of same constitutes its acceptance of all of the Agreement's terms and conditions. 2. PERFORMANCE: City agrees to purchase the goods and/or services (the "Goods and Services") from Vendor using City budget appropriation number 2201 2201 42-313.00 and 2201 2201 42-314.00 Motor Vehicle Highway funds. Vendor agrees to provide the Goods and Services and to otherwise perform the requirements of this Agreement by applying at all times the highest technical and industry standards. 3. PRICE AND PAYMENT TERMS: 3.1 Vendor estimates that the total price for the Goods and Services to be provided to City hereunder shall be no more than Fifty Eight Thousand Six Hundred Ninety Dollars and Fifty Cents ($58,690.50) (the "Estimate"). Vendor shall submit an invoice to City no more than once every thirty (30) days detailing the Goods and Services provided to City within such time period.City shall pay Vendor for such Goods and Services within thirty-five (35) days after the date of City's receipt of Vendor's invoice detailing same, so long as and to the extent such Goods and Services are not disputed, are in conformance with the specifications set forth in Exhibit A, are submitted on an invoice that contains the information contained on attached Exhibit B, and Vendor has otherwise performed and satisfied all the terms and conditions of this Agreement. 3.2 Vendor agrees not to provide any Goods and Services to City that would cause the total cost of the Goods and Services provided by Vendor to City hereunder to exceed the Estimate, unless City has previously agreed, in writing,to pay an amount in excess thereof.All payments and any late payments fees shall be pursuant to Indiana Prompt Payment Statute; Ind. Code 5-17-5 et al. 4. WARRANTY: Vendor expressly warrants that the Goods and Services covered by this Agreement will conform to those certain specifications, descriptions and/or quotations regarding same as were provided to Vendor by City and/or by Vendor to and accepted by City, all of which documents are incorporated herein by reference, and that the Goods and Services will be delivered in a timely,good and workmanlike manner and free from defect. Vendor acknowledges that it knows of City's intended use and expressly warrants that the Goods and Services provided to City pursuant to this Agreement have been selected by Vendor based upon City's stated use and are fit and sufficient for their particular purpose. 5. TIME AND PERFORMANCE: This Agreement shall become effective as of the last date on which a party hereto executes same ("Effective Date"), and both parties shall thereafter perform their obligations hereunder in a timely manner. Time is of the essence of this Agreement. DocuSign Envelope ID:657F94F3-EFFE-4735-A05E-CDBADFA24E5B Al Warren Oil Company,Inc. Street Department-2023 Appropriation#s 2201 2201 42-313.00 Motor Vehicle Highway Fund,2201 2201 42-314.00 Motor Vehicle Highway Fund; P.O.#s 109843, 109842 Contract Not To Exceed$58,690.50 6. DISCLOSURE AND WARNINGS: If requested by City, Vendor shall promptly furnish to City, in such form and detail as City may direct, a list of all chemicals, materials, substances and items used in or during the provision of the Goods and Services provided hereunder, including the quantity,quality and concentration thereof and any other information relating thereto.At the time of the delivery of the Goods and Services provided hereunder,Vendor agrees to furnish to City sufficient written warning and notice (including appropriate labels on containers and packing) of any hazardous material utilized in or that is a part of the Goods and Services. 7. LIENS: Vendor shall not cause or permit the filing of any lien on any of City's property. In the event any such lien is filed and Vendor fails to remove such lien within ten (10) days after the filing thereof, by payment or bonding, City shall have the right to pay such lien or obtain such bond, all at Vendor's sole cost and expense. 8. DEFAULT: In the event Vendor: (a) repudiates, breaches or defaults under any of the terms or conditions of this Agreement, including Vendor's warranties; (b)fails to provide the Goods and Services as specified herein; (c) fails to make progress so as to endanger timely and proper provision of the Goods and Services and does not correct such failure or breach within five (5) business days (or such shorter period of time as is commercially reasonable under the circumstances) after receipt of notice from City specifying such failure or breach; or (d) becomes insolvent, is placed into receivership, makes a general assignment for the benefit of creditors or dissolves, each such event constituting an event of default hereunder, City shall have the right to (1)terminate all or any parts of this Agreement, without liability to Vendor; and (2) exercise all other rights and remedies available to City at law and/or in equity. 9. INSURANCE AND INDEMNIFICATION: Vendor shall procure and maintain in full force and effect during the term of this Agreement, with an insurer licensed to do business in the State of Indiana, such insurance as is necessary for the protection of City and Vendor from all claims for damages under any workers' compensation, occupational disease and/or unemployment compensation act; for bodily injuries including, but not limited to, personal injury, sickness, disease or death of or to any of Vendor's agents, officers, employees, contractors and subcontractors; and,for any injury to or destruction of property, including, but not limited to, any loss of use resulting therefrom. The coverage amounts shall be no less than those amounts set forth in attached Exhibit C. Vendor shall cause its insurers to name City as an additional insured on all such insurance policies, shall promptly provide City, upon request, with copies of all such policies, and shall provide that such insurance policies shall not be canceled without thirty (30) days prior notice to City. Vendor shall indemnify and hold harmless City from and against any and all liabilities, claims, demands or expenses (including, but not limited to, reasonable attorney fees) for injury, death and/or damages to any person or property arising from or in connection with Vendor's provision of Goods and Services pursuant to or under this Agreement or Vendor's use of City property. Vendor further agrees to indemnify, defend and hold harmless City and its officers, officials, agents and employees from all claims and suits of whatever type, including, but not limited to, all court costs,attorney fees, and other expenses, caused by any act or omission of Vendor and/or of any of Vendor's agents, officers, employees, contractors or subcontractors in the performance of this Agreement. These indemnification obligations shall survive the termination of this Agreement. DocuSign Envelope ID:657F94F3-EFFE-4735-A05E-CDBADFA24E5B Al Warren Oil Company,Inc. Street Department-2023 Appropriation#s 2201 2201 42-313.00 Motor Vehicle Highway Fund,2201 2201 42-314.00 Motor Vehicle Highway Fund; P.O.#s 109843, 109842 Contract Not To Exceed$58,690.50 10. GOVERNMENT COMPLIANCE: Vendor agrees to comply with all federal, state and local laws, executive orders, rules, regulations and codes which may be applicable to Vendor's performance of its obligations under this Agreement, and all relevant provisions thereof are incorporated herein by this reference. Vendor agrees to indemnify and hold harmless City from any loss, damage and/or liability resulting from any such violation of such laws, orders, rules, regulations and codes. This indemnification obligation shall survive the termination of this Agreement. 11. NONDISCRIMINATION: Vendor represents and warrants that it and all of its officers, employees, agents, contractors and subcontractors shall comply with all laws of the United States, the State of Indiana and City prohibiting discrimination against any employee, applicant for employment or other person in the provision of any Goods and Services provided by this Agreement with respect to their hire, tenure, terms, conditions and privileges of employment and any other matter related to their employment or subcontracting, because of race, religion, color, sex, handicap, national origin, ancestry, age, disabled veteran status and/or Vietnam era veteran status. 12. NO IMPLIED WAIVER: The failure of either party to require performance by the other of any provision of this Agreement shall not affect the right of such party to require such performance at any time thereafter, nor shall the waiver by any party of a breach of any provision of this Agreement constitute a waiver of any succeeding breach of the same or any other provision hereof. 13. NON-ASSIGNMENT: Vendor shall not assign or pledge this Agreement, whether as collateral for a loan or otherwise, and shall not delegate its obligations under this Agreement without City's prior written consent. 14. RELATIONSHIP OF PARTIES: The relationship of the parties hereto shall be as provided for in this Agreement, and neither Vendor nor any of its officers, employees, contractors, subcontractors and agents are employees of City. The contract price set forth herein shall be the full and maximum compensation and monies required of City to be paid to Vendor under or pursuant to this Agreement. 15. GOVERNING LAW; LAWSUITS: This Agreement is to be construed in accordance with and governed by the laws of the State of Indiana,except for its conflict of laws provisions. The parties agree that, in the event a lawsuit is filed hereunder, they waive their right to a jury trial, agree to file any such lawsuit in an appropriate court in Hamilton County, Indiana only, and agree that such court is the appropriate venue for and has jurisdiction over same. 16. SEVERABILITY: If any term of this Agreement is invalid or unenforceable under any statute, regulation, ordinance, executive order or other rule of law, such term shall be deemed reformed or deleted, but only to the extent necessary to comply with same, and the remaining provisions of this Agreement shall remain in full force and effect. DocuSign Envelope ID:657F94F3-EFFE-4735-A05E-CDBADFA24E5B Al Warren Oil Company,Inc. Street Department-2023 Appropriation#s 2201 2201 42-313.00 Motor Vehicle Highway Fund,2201 2201 42-314.00 Motor Vehicle Highway Fund; P.O.#s 109843, 109842 Contract Not To Exceed$58,690.50 17. NOTICE: Any notice provided for in this Agreement will be sufficient if it is in writing and is delivered by postage prepaid U.S. certified mail, return receipt requested, to the party to be notified at the address specified herein: If to City: City of Carmel AND City of Carmel Street Department Office of Corporation Counsel 3400 W 131st Street One Civic Square Carmel, Indiana 46074 Carmel, Indiana 46032 If to Vendor: Al Warren Oil Company, Inc. PO Box 2279 Hammond, Indiana 46323 Notwithstanding the above, notice of termination under paragraph 19 hereinbelow shall be effective if given orally, as long as written notice is then provided as set forth hereinabove within five (5) business days from the date of such oral notice. 18. TERMINATION: 18.1 Notwithstanding anything to the contrary contained in this Agreement,City may, upon notice to Vendor, immediately terminate this Agreement for cause, in the event of a default hereunder by Vendor and/or if sufficient funds are not appropriated or encumbered to pay for the Goods and Services to be provided hereunder. In the event of such termination, Vendor shall be entitled to receive only payment for the undisputed invoice amount representing conforming Goods and Services delivered as of the date of termination, except that such payment amount shall not exceed the Estimate amount in effect at the time of termination, unless the parties have previously agreed in writing to a greater amount. 18.2 City may terminate this Agreement at any time upon thirty (30) days prior notice to Vendor. In the event of such termination, Vendor shall be entitled to receive only payment for the undisputed invoice amount of conforming Goods and Services delivered as of the date of termination, except that such payment amount shall not exceed the Estimate amount in effect at the time of termination, unless the parties have previously agreed in writing to a greater amount. 18.3 The City may terminate this Agreement pursuant to Paragraph 11 hereof, as appropriate. 19. REPRESENTATIONS AND WARRANTIES The parties represent and warrant that they are authorized to enter into this Agreement and that the persons executing this Agreement have the authority to bind the party which they represent. 20. ADDITIONAL GOODS AND SERVICES Vendor understands and agrees that City may, from time to time, request Vendor to provide additional goods and services to City.When City desires additional goods and services from Vendor,the City shall notify Vendor of such additional goods and services desired, as well as the time frame in which same are to be provided. Only after City has approved Vendor's time and cost estimate for the provision of such additional goods and services, has encumbered sufficient monies to pay for same, and has authorized Vendor, in writing, to provide such additional goods and services, shall such goods and services be provided by Vendor to City. A copy of the City's authorization documents for the purchase of additional goods and services shall be numbered and attached hereto in the order in which they are approved by City. DocuSign Envelope ID:657F94F3-EFFE-4735-A05E-CDBADFA24E5B Al Warren Oil Company,Inc. Street Department-2023 Appropriation#s 2201 2201 42-313.00 Motor Vehicle Highway Fund,2201 2201 42-314.00 Motor Vehicle Highway Fund; P.O.#s 109843, 109842 Contract Not To Exceed$58,690.50 21. TERM Unless otherwise terminated in accordance with the termination provisions set forth in Paragraph 19 hereinabove, this Agreement shall be in effect from the Effective Date through December 31, 2023 and shall, on the first day of each January thereafter, automatically renew for a period of one (1) calendar year, unless otherwise agreed by the parties hereto. 22. HEADINGS All heading and sections of this Agreement are inserted for convenience only and do not form a part of this Agreement nor limit, expand or otherwise alter the meaning of any provision hereof. 23. BINDING EFFECT The parties, and their respective officers, officials, agents, partners, successors, assigns and legal representatives, are bound to the other with respect to all of the covenants, terms, warranties and obligations set forth in Agreement. 24. NO THIRD PARTY BENEFICIARIES This Agreement gives no rights or benefits to anyone other than City and Vendor. 25. DEBARMENT AND SUSPENSION 25.1 The Vendor certifies by entering into this Agreement that neither it nor its principals nor any of its subcontractors are presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from entering into this Agreement by any federal agency or by any department, agency or political subdivision of the State of Indiana. The term "principal" for purposes of this Agreement means an officer, director, owner, partner, key employee or other person with primary management or supervisory responsibilities, or a person who has a critical influence on or substantive control over the operations of the Vendor. 25.2 The Vendor certifies that it has verified the state and federal suspension and debarment status for all subcontractors receiving funds under this Agreement and shall be solely responsible for any recoupment, penalties or costs that might arise from use of a suspended or debarred subcontractor. The Vendor shall immediately notify the City if any subcontractor becomes debarred or suspended, and shall, at the City's request, take all steps required by the City to terminate its contractual relationship with the subcontractor for work to be performed under this Agreement. 26. IRAN CERTIFICATION Pursuant to I.C. § 5-22-16.5, the Vendor shall certify that, in signing this Agreement, it does not engage in investment activities within the Country of Iran. 27. ADVICE OF COUNSEL: The parties warrant that they have read this Agreement and understand it, have had the opportunity to obtain legal advice and assistance of counsel throughout the negotiation of this Agreement, and enter into same freely, voluntarily, and without any duress, undue influence or coercion. 28. ENTIRE AGREEMENT: This Agreement, together with any exhibits attached hereto or referenced herein, constitutes the entire agreement between Vendor and City with respect to the subject matter hereof, and supersedes all prior oral or written representations and agreements regarding same. Notwithstanding any other term or condition set DocuSign Envelope ID:657F94F3-EFFE-4735-A05E-CDBADFA24E5B Al Warren Oil Company,Inc. Street Department-2023 Appropriation its 2201 2201 42-313.00 Motor Vehicle Highway Fund,2201 2201 42-314.00 Motor Vehicle Highway Fund; P.O.#s 109843. 109842 Contract Not To Exceed$58,690.50 forth herein, but subject to paragraph 16 hereof, to the extent any term or condition contained in any exhibit attached to this Agreement or in any document referenced herein conflicts with any term or condition contained in this Agreement,the term or condition contained in this Agreement shall govern and prevail. This Agreement may only be modified by written amendment executed by both parties hereto,or their successors in interest. IN WITNESS WHEREOF, the parties hereto have made and executed this Agreement as follows: CITY OF CARMEN, INDIANA Al Warren Oil Company, Inc. by and through its Board of Public Works and Safety ll-DocuSigned by: By: ` 97 F821srain8D6 f a James2 ar Presiding Officer Authorized Signature Date: 7/19/2023 DocuSigned by: q� ktli,),L,L.N. y r hob? Q Printed Name 7Ar BEitke, Member Date: 7/19/2023 6AA5,, ijn vkly `l+ n - fir' ' o.,t,k© ' DocuSigned by: Title III [o i ()ba#sain, �r 2 A P,Member FIDITIN: '? — 3 1 G 0 I g 7/19/2023 Date' ATTEST: Date: "1 /(q DocuSigned by: 6W6frpoigFClerk Date: 7/19/2023 DocuSign Envelope ID:657F94F3-EFFE-4735-A05E-CDBADFA24E5B AL r .+H4C i (� CORPORATE OFFICE WA EN OIL Co . TEL 800.327.8903 Specialized Petroleum Marketers 1646 Summer Street-Hammond,IN 46320 www.ALWARRENOIL.com City of Cannel 06/21/23 3400 W. 131st St Cannel, IN 46074 Attn: Jason Armes Please accept this letter as the equipment agreement between Al Warren Oil Company,Inc. (AWOC) and the City of Cannel. AWOC will provide the following equipment at no cost to 3400 W. 131st St Cannel, IN 46074. Equipment - Two (2) 2,500-gallon tanks and related dispensing equipment for On-Road B20 Diesel Fuel and 87octane gas. - Two (2) 560-gallon tanks and related dispensing equipment for Off-Road Diesel Fuel (1 tank goes to 3400 W. 131st St and 1 tank goes to 4915 E. 106th St Carmel, IN 46032 Terms & Conditions 1) The above-listed equipment will remain the property of AWOC. 2) AWOC will be the sole supplier of fuel for these tanks for a minimum period of 4 years. 3) AWOC will provide basic maintenance on the equipment at no cost to the City of Cannel. If the equipment requires repairs or replacement parts due to misuse or abuse, then AWOC will invoice the City of Cannel, accordingly. 4) AWOC will install fuel-level monitoring in order to schedule deliveries based on operational need and market conditions. 5) There is a $1200 delivery and set-up fee for the 4 tanks. Sincerely, Arnie Berg Business Development Manager Acceptance Date DocuSign Envelope ID:657F94F3-EFFE-4735-A05E-CDBADFA24E5B AL A rio.+ ORPORATE OFFICE WA EN QIL INC.C . TEL 800.327.8903 Specialized Petroleum Marketers 1646 Summer Street-Hammond,IN 46320 www.ALWARRENOIL.com City of Carmel 06/22/23 3400 W. 131' St Carmel, IN 46074 Attn: Jason Armes PRICE QUOTE (effective 6/22/23) Total Price Total On-Road B20 Quantity Base Price Tax (per gallon) (dollars) Indiana On-Road B20 7500 $2.6730 .56 $3.2330 $24,247.50 Please call me with any questions. Sincerely, Arnie Berg aberg@alwarrenoil.com DocuSign Envelope ID:657F94F3-EFFE-4735-A05E-CDBADFA24E5B AL A rio.+ ORPORATE OFFICE WA EN QIL INC.C . TEL 800.327.8903 Specialized Petroleum Marketers 1646 Summer Street-Hammond,IN 46320 www.ALWARRENOIL.com City of Carmel 06/22/23 3400 W. 131st St Carmel, IN 46074 Attn: Jason Armes PRICE QUOTE (effective 6/22/23) Total Price Total Unleaded Fuel (87oct) Quantity Base Price Tax (per gallon) (dollars) Indiana Gasoline 87oct 7500 $2.5853 .34 $2.9253 $21,939.75 Please call me with any questions. Sincerely, Arnie Berg aberg@alwarrenoil.com DocuSign Envelope ID:657F94F3-EFFE-4735-A05E-CDBADFA24E5B AL A rio.+ ORPORATE OFFICE WA EN QIL INC.C . TEL 800.327.8903 Specialized Petroleum Marketers 1646 Summer Street-Hammond,IN 46320 www.ALWARRENOIL.com City of Carmel 06/22/23 3400 W. 131' St Carmel, IN 46074 Attn: Jason Armes PRICE QUOTE (effective 6/22/23) Total Price Total Off-Road ULS Fuel Quantity Base Price Tax (per gallon) (dollars) Indiana Off-Road Dyed 4500 $2.7785 $2.7785 $12,503.25 Please call me with any questions. Sincerely, Arnie Berg aberg@alwarrenoil.com DocuSign Envelope ID:657F94F3-EFFE-4735-A05E-CDBADFA24E5B PILL WARLEN_e IL CO., INC. Since 1948 /Nr �s Specialized Petroleum Marketers FUEL EQUIPMENT AGREEMENT THE DESCRIBED EQUIPMENT LISTED BELOW IS LOANED TO CUSTOMER: City of Carmel (BUSINESS NAME) 3400 W. 131st St Carmel, IN 46074 (STREET ADDRESS/CITY/STATE/ZIP CODE) FOR USE IN STORING, HANDLING, DISPENSING AND SELLING BULK PRODUCTS,SUBJECT TO THE TERMS AND CONDITIONS AS SET FORTH BELOW.CUSTOMER ACKNOWLEDGES RECEIPT OF THE BELOW-DESCRIBED EQUIPMENT LOANED TO CUSTOMER BY AL WARREN OIL CO., INC.(AWOC)AND AGREES UPON REQUEST TO RETURN IT TO AWOC AT CUSTOMER'S SOLE EXPENSE IN AS GOOD AS ORIGINALLY RECEIVED CONDITION.CUSTOMERS RETURNING EQUIPMENT WITHIN 12 MONTHS OF INSTALATION ARE LIABLE FOR AN ADDITIONAL$500 RE-STOCKING FEE PER PIECE OF EQUIPMENT.ORDINARY WEAR AND TEAR ACCEPTED.THE EQUIPMENT SHALL REMAIN THE PROPERTY OF AWOC AND AWOC MAY,AT ANY TIME,WITHOUT NOTICE, ENTER UPON THE PREMISES WHERE THE EQUIPMENT SHALL BE LOCATED AND RETAKE POSSESSION OF THE EQUIPMENT WITHOUT LEGAL PROCESS OR LIABILITY.CUSTOMER AGREES THAT THE LOANED EQUIPMENT IS TO BE USED SOLEY FOR THE PRODUCT THAT AWOC SUPPLIES. CUSTOMER AGREES TO PAY AWOC FULL VALUE AMOUNT SHOULD CUSTOMER USE THE EQUIPMENT WITH ANOTHER VENDORS PRODUCT. CUSTOMER AGREES TO MAINTAIN THE EQUIPMENT IN GOOD WORKING CONDITION.CUSTOMER WILL NOTIFY AWOC OF ANY AND ALL DAMAGES AND MAY BE INVOICED FOR THE REPAIRS AND/OR REPLACEMENT OF THE DAMAGED EQUIPMENT.AWOC RESERVES THE RIGHT FOR AN ANNUAL VOLUME REVIEW. UNDER PERFORMING CUSTOMERS COULD RESULT IN A MANDATORY EXTENDED AGREEMENT TO PURCHASE AWOC PRODUCT.SHOULD CUSTOMER TERMINATE AGREEMENT UPON ANNUAL REVIEW, RESTOCKING FEES WILL APPLY. CUSTOMER HAS USE OF THE EQUIPMENT WITHOUT ANY WARRANTY EXPRESSED OR IMPLIED,AND NEITHER AL WARREN OIL CO., INC. NOR ITS ASSIGNS SHALL BE LIABLE TO CUSTOMER FOR ANY LOSS OF MERCHANDISE CAUSED BY DEFECTS THERIN,OR FOR ANY DAMAGE, LOSS OR INJURY OF ANY KIND RESULTING THEREFROM.CUSTOMER ACCEPTS THE EQUIPMENT'AS IS'AND AGREES TO INDEMNIFY AWOC AND ITS ASSIGNS AGAINST ALL CLAIMS OF ALL PERSONS ARISING,DIRECTLY OR INDIRECTLY, FROM CUSTOMER'S USE AND/OR POSSESSION OF THE EQUIPMENT. QTY DESCRIPTON VALUE 1 2500 gal Above Ground Storage Tank with Pump, Hose and Nozzle $15,000.00 1 2500 gal Above Ground Storage Tank with Pump, Hose and Nozzle $15,000.00_ 1 560 gal Above Ground Storage Tank with Pump, Hose and Nozzle $6000.00 1 560 gal Above Ground Storage Tank with Pump, Hose and Nozzle_ I $6000.00 AGREED AND ACCEPTED BY: CUSTOMER AL WARREN OIL CO.,INC. 1 CUSTOMER STATED ANNUAL VOLUME:N/A SIGNATURE: ,1-4.... t. J SIGNATURE: PRINTED NAME:Arnie Berg PRINTED NAME: TITLE:Business Development Manager TITLE: DATE:June 215,2023 DATE: Corporate Office: 1646 Summer Street Hammond, IN 46320 Phone: 800-327-8903 www.alwarrenoil.com DocuSign Envelope ID:657F94F3-EFFE-4735-A05E-CDBADFA24E5B Model Certificate M CERTIFICATE FOR STATE USE OR NONPROFIT EDUCATIONAL ORGANIZATION USE (To support vencipr's claim for a credit or payment unde-§6416(a)(4)of the Internal Revenue Code.) GCa i 3'-t.)-~Y✓1 —(A.v t lz 1116 j r )T'L2-C Name,address,and employer identification number of ultimate vendor The undersigned ultimate purchaser("Buyer")hereby certifies the following under the penalties of perjury: Buyer will use the gasoline or aviation gasoline to which this certificate relates(check one): V For the exclusive use of a state or local government;or For the exclusive use of a nonprofit educational organization. This certificate applies to the following(complete as applicable): This is a single purchase certificate: 1. Invoice or delivery ticket number 2. Number of gallons V This is a certificate covering all purchases under a specified account or order number: 1.Effective date 2.Expiration date (period not to exceed 1 year after the effective date) 3. Buyer's account number Buyer will provide a new certificate to the vendor if any information in this certificate changes. Buyer understands that by signing this certificate,Buyer gives up its right to claim any credit or payment for the gasoline or aviation gasoline to which this certificate relates. Buyer acknowledges that it hasn't and won't claim any credit or payment for the gasoline or aviation gasoline to which this certificate relates. Buyer understands that the fraudulent use of this certificate may subject Buyer and all parties making such fraudulent use of this certificate to a fine or imprisonment,or both,together with the costs of prosecution. Printed or typed name of person signing Matt Higginbotham _ Title of person signing Street Commissioner Name of Buyer Carmel Street Department Employer identification number Address of Buyer 3400 W. 131st Street, Carmel,��// IN 46074 Signature and date signed 7`G �G�G t9tia,m, 6/26/23 Chapter 18 Appendix Page 51 DocuSign Envelope ID:657F94F3-EFFE-4735-A05E-CDBADFA24E5B Model Certificate P CERTIFICATE OF STATE USE (To support vendors claim for credit or payment under section 6427 of the Internal Revenue Code.) (Liz (je ity.€X ).co OO►3 4.1). _rr'1._ 4,x! S tin$101 VY 2V (�,r�t r�1 e.fi4; tJ - 3)0 Name,Address,and Employer Identification Number of Vendor The undersigned buyer("Buyer")hereby certifies the following under penalties of perjury: A. Buyer will use the diesel fuel or kerosene to which this certificate relates for the exclusive use of a state or local government,or the District of Columbia. B. This certificate applies to the following(complete as applicable): 1. If this is a single purchase certificate,check here©and enter: a. Invoice or delivery ticket number b. Number of gallons 2. If this is a certificate covering all purchases under a specified account or order number,check here WI and enter: a. Effective date b, Expiration date (period not to exceed 1 year after effective date) c. Buyer's account or order number • Buyer will provide a new certificate to the vendor if any information in this certificate changes. • If Buyer uses the diesel fuel or kerosene to which this certificate relates for a purpose other than stated in the certificate, Buyer will be liable for any tax. • Buyer acknowledges that it hasn't and won't claim any credit or payment for the diesel fuel or kerosene to which this certificate relates. • Buyer understands that the fraudulent use of this certificate may subject Buyer and all parties making such fraudulent use of this certificate to a fine or imprisonment,or both,together with the costs of prosecution. Printed or typed name of person signing Matt Higginbotham Title of person signing Street Commissioner Name of Buyer Carmel Street Department Employer identification number Address of Buyer 3400 W. 131st Street, Carmel, IN 46074 Signature and date signed ?i`G 7/* ove i a.m., 6/26/23 Page 54 Chapter 18 Appendix DocuSign Envelope ID:657F94F3-EFFE-4735-A05E-CDBADFA24E5B EXHIBIT B Invoice Date: Name of Company: Address &Zip: Telephone No.: Fax No.: Project Name: Invoice No. Purchase Order No: Goods Services Person Providing Date Goods/Services Provided Cost Per Hourly Total Goods/Services Goods/ (Describe each good/service Item Rate/ Service separately and in detail) Hours Provided Worked L. GRAND TOTAL Signature Printed Name DocuSign Envelope ID:657F94F3-EFFE-4735-A05E-CDBADFA24E5B EXHIBIT C INSURANCE COVERAGES Worker's Compensation & Disability Statutory Limits Employer's Liability: Bodily Injury by Accident/Disease: $100,000 each employee Bodily Injury by Accident/Disease: $250,000 each accident Bodily Injury by Accident/Disease: $500,000 policy limit Property damage, contractual liability, products-completed operations: General Aggregate Limit (other than Products/Completed Operations): $500,000 Products/Completed Operations: $500,000 Personal & Advertising Injury 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: $500,000 each accident Injury and property damage: $500,000 each accident Policy Limit: $500,000 Umbrella Excess Liability Each occurrence and aggregate: $500,000 Maximum deductible: $ 10,000 DocuSign Envelope ID:657F94F3-EFFE-4735-A05E-CDBADFA24E5B Page 1 of 1 INDIANA RETAIL TAX EXEMPT g City ®f CIlriTI1e]I CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER FEDERAL EXCISE TAX EXEMPT 109843 ONE CIVIC SQUARE 35-6000972 THIS NUMBER MUST APPEAR ON INVOICES,A/P CARMEL, INDIANA 46032-2584 VOUCHER,DELIVERY MEMO,PACKING SLIPS, SHIPPING LABELS AND ANY CORRESPONDENCE FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL-1997 PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION 6/26/2023 377288 AL WARREN OIL CO INC Street Department VENDOR PO BOX 2279 SHIP 3400 W. 131st Street TO Carmel, IN 46074- HAMMOND, IN 46323- Matt Higginbotham (317)733-2001 PURCHASE ID BLANKET CONTRACT PAYMENT TERMS FREIGHT 78671 QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION Department: 2201 Fund: 2201 Motor Vehicle Highway FND Account: 42-313.00 1 Each Diesel Fuel $36,750.75 $36,750.75 Sub Total $36,750.75 OF CAS' off 111 iv BUN • e 4 1 U i Send Invoice To: Street Department 3400 W. 131st Street Carmel, IN 46074- *b I AO (317)733-2001 PLEASE INVOICE IN DUPLICATE DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT PAYMENT $36,750.75 SHIPPING INSTRUCTIONS *AP VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND VOUCHER HAS THE PROPER SWORN *SHIP PREPAID. AFFIDAVIT ATTACHED. I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN *C.O.D.SHIPMENT CANNOT BE ACCEPTED. THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER. *PURCHASE ORDER NUMBER MUST APPEAR ON ALL SHIPPING LABEL , *THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 X ;s2 +—� AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. ORDERED BY Lee Higginbotham TITLE Commissioner CONTROL NO. 1 09843 CONTROLLER DocuSign Envelope ID:657F94F3-EFFE-4735-A05E-CDBADFA24E5B Page 1 of 1 INDIANA RETAIL TAX EXEMPT g City ®f CIlriTI1e]I CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER FEDERAL EXCISE TAX EXEMPT 109842 ONE CIVIC SQUARE 35-6000972 THIS NUMBER MUST APPEAR ON INVOICES,A/P CARMEL, INDIANA 46032-2584 VOUCHER,DELIVERY MEMO,PACKING SLIPS, SHIPPING LABELS AND ANY CORRESPONDENCE FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL-1997 PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION 6/26/2023 377288 AL WARREN OIL CO INC Street Department VENDOR PO BOX 2279 SHIP 3400 W. 131st Street TO Carmel, IN 46074- HAMMOND, IN 46323- Matt Higginbotham (317)733-2001 PURCHASE ID BLANKET CONTRACT PAYMENT TERMS FREIGHT 78670 QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION Department: 2201 Fund: 2201 Motor Vehicle Highway FND Account: 42-314.00 1 Each Gasoline $21,939.75 $21,939.75 Sub Total $21,939.75 OF CAS' off 111 iv BUN • e 4 1 U i Send Invoice To: Street Department 3400 W. 131st Street Carmel, IN 46074- *b I AO (317)733-2001 PLEASE INVOICE IN DUPLICATE DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT PAYMENT $21,939.75 SHIPPING INSTRUCTIONS *AP VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND VOUCHER HAS THE PROPER SWORN *SHIP PREPAID. AFFIDAVIT ATTACHED. I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN *C.O.D.SHIPMENT CANNOT BE ACCEPTED. THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER. *PURCHASE ORDER NUMBER MUST APPEAR ON ALL SHIPPING LABEL , *THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 X ;s2 +—� AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. ORDERED BY Lee Higginbotham TITLE Commissioner CONTROL NO. 1 09842 CONTROLLER