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Home My WebLink About357006 ALL AMERICAN BACKFLOW - CONTRACT - BID - 5907 BACKFLOW ASSEMBLY TESTING AND REPAIRa SERVICES AGREEMENT WORK ORDER TYPE THIS AGREEMENT made and entered into the day and year set forth below, by and between THE CITY OF FORT COLLINS, COLORADO, a Municipal Corporation, hereinafter referred to as the "City" and Lynnette Keim Doing Business As All American Backflow, hereinafter referred to as "Service Provider". W ITNESSETH: In consideration of the mutual covenants and obligations herein expressed, it is agreed by and between the parties hereto as follows: 1. Services to be Performed. a. This Agreement shall constitute the basic agreement between the parties for services for Back Flow Assembly and Repair. The conditions set forth herein shall apply to all services performed by the Service Provider on behalf of the City and particularly described in Work Orders agreed upon in writing by the parties from time to time. Such Work Orders, a sample of which is attached hereto as Exhibit "A", consisting of one (1) page, and incorporated herein by this reference, shall include a description of the services to be performed, the location and time for performance, the amount of payment, any materials to be supplied by the City and any other special circumstances relating to the performance of services. No workorder shall exceed $50,000. The only services authorized under this agreement are those which are performed after receipt of such Work Order, except in emergency circumstances where oral work requests may be issued. Oral requests for emergency actions will be confirmed by issuance of a written Work Order within two (2) working days. b. The City may, at any time during the term of a particular Work Order and without invalidating the Agreement, make changes within the general scope of the particular services WOSA January 2005 EXHIBIT C INSURANCE REQUIREMENTS The Service Provider will provide, from insurance companies acceptable to the City, the insurance coverage designated hereinafter and pay all costs. Before commencing work under this bid, the Service Provider shall furnish the City with certificates of insurance showing the type, amount, class of operations covered, effective dates and date of expiration of policies, and containing substantially the following statement: "The insurance evidenced by this Certificate will not be cancelled or materially altered, except after ten (10) days written notice has been received by the City of Fort Collins." In case of the breach of any provision of the Insurance Requirements, the City, at its option, may take out and maintain, at the expense of the Service Provider, such insurance as the City may deem proper and may deduct the cost of such insurance from any monies which may be due or become due the Service Provider under this Agreement. The City, its officers, agents and employees shall be named as additional insureds on the Service Provider's general liability and automobile liability insurance policies for any claims arising out of work performed under this Agreement. 2. Insurance coverages shall be as follows: A. Workers' Compensation & Employer's Liability. The Service Provider shall maintain during the life of this Agreement for all of the Service Provider's employees engaged in work performed under this agreement: Workers' Compensation insurance with statutory limits as required by Colorado law. 2. Employer's Liability insurance with limits of $100,000 per accident, $500,000 disease aggregate, and $100,000 disease each employee. B. Commercial General & Vehicle Liability. The Service Provider shall maintain during the life of this Agreement such commercial general liability and automobile liability insurance as will provide coverage for damage claims of personal injury, including accidental death, as well as for claims for property damage, which may arise directly or indirectly from the performance of work under this Agreement. Coverage for property damage shall be on a "broad form" basis. The amount of insurance for each coverage, Commercial General and Vehicle, shall not be less than $500,000 combined single limits for bodily injury and property damage. In the event any work is performed by a subcontractor, the Service Provider shall be responsible for any liability directly or indirectly arising out of the work performed under this Agreement by a subcontractor, which liability is not covered by the subcontractor's insurance. EXHIBIT D SCOPE OF WORK 1. Service Provider to: A. Provide services as described above, as set out in specific work orders. B. Carry insurance levels as required in the attached Services Agreement. C. Clean-up each job site at the end of each day and at work completion. D. Maintain a local phone number, and must be able to be reached by telephone during prescribed business hours. 2. Workmanship and Materials: A. Must provide proof of current Cross -Connection Control Certification issued by the Colorado Dept. of Health. Certification must stay current throughout term of contract. B. All parts and materials used shall be new to represent a quality application in the finished product. C. Must provide proof of calibration of test equipment. Calibration must have been performed within one year and must stay current throughout term of contract. D. Testing and repairs must be performed as per the most currently accepted A.S.S.E. Series 5000 test procedures. E. Work must be completed 30 days after notice to proceed is given or as instructed by City Representative. F. Keys to enclosures will be provided by the City Representative and must be returned at the end of the testing period. G. Backflows must be left in operational mode unless device has failed test and parts are being ordered or if downstream valves were off when tester arrived. In any case where the device is left off, the City Representative must be notified within 24 hours. H. Work must be performed by the holder of the Certificate. 3. Bidder Qualifications A. At least (2) two years consistent, hands on experience in commercial and residential backflow testing. Must be able to demonstrate this through references. B. Must provide list of at least (10) ten jobs completed in Fort Collins which are available for inspection by Owner. 4. Work Order Procedure: A. All job estimates must be submitted on a unit price basis consistent with the prices established in the Bid Schedule section. B. Contractor will invoice for all jobs completed on a unit price basis with the prices established in the Bid Schedule section, including appropriate mark up on materials, if any. Material invoices must be included with the billing invoices. C. Work order number must be included on the billing invoices. 5. Method of Award: A Award will be based upon (1) the most favorable total cost for the various testing categories and labor requirement stated below and (2) the service provider meeting the requirements of the attached Services Agreement. B. Calculate the costs for the work listed below using values shown in Bid Schedule. Work to be done during normal work hours. ACORD. CERTIFICATE OF LIABILITY INSURANCE P4DA 04-20 T2005 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION LEID FINANCIAL GROUP INC/PHS ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 342560 P:(866)467-8730 F:(877)905-0457 ALTER THE COVERAGE AFFORDED BY THE POLICI P. O. BOX 33015 SAN ANTONIO TX 78265 INSURERS AFFORDING COVERAGE MSURED INSURER A:Hartford Casualty Ins Co INSURER B: LYNNETTE KEIM DBA ALL AMERICAN BACKFLOW INSURER C: 820 MERGANSER DRIVE, #2105 INSURER D: CnvFanr,Fc 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, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. AVSR ITR TYPE OF INSURANCE POLICY AMBER PoLKYEFPECTNEDATE WMIDDIVY) PoLKYEXMATION (WA L/M/TS GENERAL L/AR2/TV EACH OCCURRENCE $1 0 0 O O 0 O A COMMERCIAL GENERAL LIABILITY 34 SBA PE5367 05/26/04 05/26/05 FIRE DAMAGE (Any one fire) s300 OOO CLAIMS MADE O OCCUR MED EXP (Any one person) $1 O 0 0 0 PERSONAL B ADV INJURY $1 00O 000 X Business Liab GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2 0 0 0 0 0 0 POLICY PRAT X LOC AUTOMOBILE UARR/TY ANY AUTO COMBINED SINGLE LIMIT (Ea accidenO $ BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accidera) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE UARAfTY AUTO ONLY - EA ACCIDENT S OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGO EXCESS LIABILITY EACH OCCURRENCE S OCCUR F1 CLAIMS MADE AGGREGATE $ _S $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND WC STATU- OTH- UMIT EMPLOYERS' 11AR21TY E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY UMIT $ O TRER OF SCRIP TION OF OPERATIONS/! OCA TIONSNEMCLES/EXCT USIONS ADDED RY END ORSEMENTISPECIA L PROVISIONS Those usual to the Insured's Operations. CtH I IH CA It HULL&H I I ADDLTIONALINSURED;WSURER LETTER: _ CANCLL LA I U N SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL The City of Fort Collins 30 DAYS WRITTEN NOTICE (10 DAYS FOR NON-PAYMENT) TO THE CERTIFICATE Purchasing Dept HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR PO BOX 580 REPRESENTATIVES. Fort Collins CO 80522-0580 A VEHORIZED REPRESENTA TIME ACORD 25-S (7/97) 0ACORD CORPORATION 1988 — Testing and Repair, Inc. Office: 303.537.0126 FAX: 303.537.0129 e-mail: Fred2backflowconsultingcom 15403 E 17tb Ave Unit F, Aurora, CO 80011 Accuracy Certification for Backflow Prevention Assembly Test Equipment Owner of Eauipment Company: All American Backflow Contact: Lynnette Kem /�1p,( Office Phone: 970.493.3546 Address: 820 Merganser Dr #+- Alt. Phone: 970-391-0006 Fort Collins CO 80524 FAX Phone: q %D - y � 3 3 S �% (� I Gauge & Test ICit Information Gauge Make: Orange Research Model: 1516 Kit Make: Watts Kit Model: TK-99E Serial No: 0088332 Certification test results Standard Certification Points are Bolded 7 Manometer Differential Initial Reading Final Reading Readina - PSID Before Calibration After Calibration 15.0 14.0 15,0 15.0 110 12.0 11.0 12.3 11.9 10.0 9.0 8.0 8.9 R-2 7.0 &0 5.0 5.6 5_(L 4.0 3.0 3.2 3.0 2.0 2.2 2.0 1.0 1.2 0.8 0.0 0 0 Pressure Test: Ka: 200 Vaives(gasy 200 Vaives(water): Hoses: 200 Lab conditions during the certification: Temperature: 690F Humidity: 23% Initial Condition: good Comments: See explanation on back of form: 1 ❑ 2 ❑ 3 ❑ 4 ❑ 5)4 6)4 7,0 Hints to Proper Gauge Use • Gauge must be tapped on the side before taking your reading to free linkage. • Test kit should be held in the up -right position during testing. • Leakage through needle valves can cause false passing results. Insure pressure and bleed valves are fully closed before taking gauge readings. • Needle valves should be fully closed when finger tight Stop testing devices and have test kit valves serviced N round to be leaking. Date of Certification: Feb 24.2005 Certification is valid for one year • Calibration was accurate and as stated on this form when test kit left Baddlow Consulting. We are not responsible for damage due to handing during shipment. • Test kit should be handled with care. • Abusive handling or freezing may affed the calibration. • When tester suspects 'readings are ineccurete, test kit should be re-evaluated (Even if less than one year has passed since last certification). Repair Services Performed ComponmYG I Gaua :: e ❑ Sensing tines O Diaphragm ❑ Main Spring ❑ H.P. Housing ❑ L.P. Housing ❑ Movement • Pander ❑ Lens ❑ Scale Plate ❑ Gasket Valves: ❑ High Bleed ❑ Low Bleed O High ❑ Low ❑ By -Pass Hoses: o High ❑ Low ❑ By -Pass ❑ High Bleed ❑ Low Bleed ❑ Filter(s): ❑ Others: ❑ Others: i� ent Calibrated By: Name: Patrick A. Carter Signature: • Gauge is certified to be wi in the tolerances specified by the manufacturer. • The equipment used to test this test kit is a Heise PM certified to the requirements of the National Institute of Standards and Technology. Inquiries should refer to Serial Number A2W57. GAUGE CODE EXPLANATIONS Backflow Consulting Testing & Repair, Inc. (BCTR) attempts to adjust all gauges used to test backflow preventors to meet the manufacturer's tolerances. We try to adjust all differential pressure gauges to read a true 2.0 P.S.I.D. or as close as possible. 1. This gauge is non -linear. We cannot certify this gauge at this time. It must be replaced or returned to a manufacturer's authorized gauge repair center for proper calibration, repair. 2. Although this gauge has been certified to be within the manufacturer's recommended tolerances, this gauge is demonstrating resistance to calibration changes, which indicates early signs of diaphragm hardening due to the composition of water or other internal corrosion issues. You must tap the side of the gauge before recording a reading. We suggest the Technician closely observes the operation of this gauge and have it re -certified if the tests indicate a higher then normal percentage of passing or failing results.. 3. This gauge is non -linear. However, we were able to adjust the gauge to read within manufacturer's tolerance on the low end of the scale between 0 psid — 5 psid. Some administrative authorities will find this gauge unacceptable for use in their jurisdiction. 4. When disassembling this gauge, it was discovered that large amounts of iron debris were attached to the magnet. This debris was affecting the magnetic field that drives the gauge pointer and most likely caused the gauge to read inaccurately. It is recommended that filters (if installed on hoses) be cleaned regularly and proper flushing of test cocks be performed before this gauge is used. 5. This type of gauge must be held in the up -right position when testing backflow preventors. Readings will be different if held flat (horizontally) while testing. The manufacturer wams that because of its magnet movement, this gauge should never be mounted in direct contact with ferrous (steel, cast iron, etc.) surfaces. Contact with ferrous surfaces will cause incorrect readings. 6. Do not lay this gauge on an electrical motor or any other electrical source. Magnetic fields generated by the electrical source will affect gauge readings. 7. Most manufacturers use "soft seated" needle valves because of their high precision control of fluids, normal long life and complete leaktightness. When using soft seated needle valves care should be taken not to over tighten the valves. Valves should be leaktight when slight resistance is felt as the valve is being closed. If it is noticed that increasing force is required to close a needle valve, it is in need of cleaning or replacement of the seat. Do not continue to use a needle valve that requires excessive force to close completely. This action will embed debris in the soft seat and begin to scar the brass housing seat. Continued use may destroy the valve. Debris in valve or scarred and damaged seats will cause leaking of a small amount of water even when valve is closed completely. Use of a gauge with leaking needle valves will result in false passing or failing results when testing a backflow device. Replacement of needle valve stems, soft seats and complete valves are relatively simple repairs. These repairs may be made by the tester or the gauge may be sent Backflow Consulting Testing and Repair, Inc. or returned to the test kit manufacturer. BCTR kit cert form back.doc 2003 Anacn Upper PUrrron rU YUUi � Cl UU�aw Backflow Prevention Assembly Tester Exp Date: 1 /31 /08 Cert No. 06 - 00170 v Administrat r American Backflow Prevention Association �� Backflow Prevention Assembly Tester Exp Date: 1 /31108 Cert No. 06 - 00170 Lynnette R. Keim 820 Merganser Drive #406 Fort Collins, CO 80524 Admini 0 Use lower portion for wallet identification Be sure to keep us up-to-date with your current mailing address it Program Administrator American Backflow Prevention Association Backflow Prevention Assembly Tester P.O. Box 91082 Los Angeles, CA 90009 (323) 776-2764 Phone/Fax Email: ehavlinaxc@aol.com National Office American Backflow Prevention Association P.O. Box 3051 Bryan, TX 77805-3051 (979) 846-7606 Fax (979) 846-7607 www.abpa.org -Sep Ub U4 u-t:5ip W-9 I. Request for Taxpayer Give fort to the (Rev. December 1e Identification IIdentification Number and Certification requester. Do NOT tiasuu Depanl Treasury t0 the IRS. Rewc internal Rerer we Service Ne a (it a joint account or charged your Specific Ironuetions an page 2.)�. grushi name, it differem m •. ( c InstruAtions on page ) L Check ppopdate box: Inldivid alfde proprietor ❑ corporation ❑ Partnership ❑ Other► .................. Addr s (number. street. pt. or state no.) ,r Requester's name and address (opdmap , state, and ZIP ode i taxpayer Idortti (cation Number N) List accoora number(s) here (optionag Enter your TIN in the appropriate box. For individuals, this is your social security number sex al a cur y mrmb.r (SSN). However, if you are a resident alien OR a sole proprietor, see the instructions on page 2. For other entities, it is your employer identification number ( IN). If do not have OR a For Payees Exempt From Badmp you a number, see How To Get a TIN on page 2. Withholding (See the Instructions Note: If the account is in more than one name, Eml "r i ntl a n numb on page 2.) see the chart on page 2 for guidelines on whose I I I number to enter. ■-rrtun■ t.eruncan0rt Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or 1 am waiting for a number to be issued to me), and 2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) 1 have not been notified by the internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report at interest or dividends, or (e) the IRS has notified me that I am no longer subject to backup withholding. Certification Instructions. —You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have felled to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not requited to sign the Certification, but you must provide your correct TIN. (See the instructions on page 2.) Sign Here Signature ► paw ► Purpose of Form. —A person who is required to file an information return with the IRS must get your correct taxpayer Identification number (TIN) to report, for example, income paid to you, real estate transactions, mortgage interest you paid, acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA. Use Form W-9 to give your correct TIN to the person requesting It the requester) and, when applicable, to: 1. Certify the TIN you are giving is correct (or you are waiting for a number to be issued), 2. Certify you are not subject to backup withholding, or 3. Claim exemption from backup withholding if you are an exempt payee. Note: If a requester gives you a form other than a W-9 to request your TIN, you must use the requester's form if it is substantially similar to this Form W-9, What Is Backup Withholding? —Persons making certain payments to you must withhold and pay to the IRS 31 % of such payments under certain conditions. This is called "backup withholding." Payments that may be subject to backup withholding include interest, dividends, broker and - barter exchange transactions, rents, royalties, nonemployee pay, and certain payments from fishing boat operators. Real estate transactions are not subject to backup withholding. If you give the requester your correct TIN, make the proper certifications, and report all your taxable interest and dividends on your tax return, payments you receive wit[ not be subject to backup withholding. Payments you receive will be subject to backup wkhhulding if. 1. You do not furnish your TIN to the requester, or 2. The IRS tells the requester that you furnished an incorrect TIN, or 3. The IRS tells you that you are subject to backup withholding because you did not report all your interest and dividends on your tax return (for reportable interest and dividends only), or 4. You do not certify to the requester that you are not sutiject to backup withholding under 3 above (for reportable interest and dividend accounts opened after 1983 only), or S. You do not certify your TIN when required. See the Part III instructions on page 2 for details. Certain payees and payments are exempt from backup withholding. See the Part II instructions and the separate Instructions for the Requester of Form W-9. Penalties Failure To Furnish TIN. —If you fail to furnish your correct TIN to a requester, you are subject to a penalty of $50 for each such failure unless your failure is due to reasonable cause and not to willful neglect. Civil Penalty for False information With Respect to Withholding. —If you make a false statement with no reasonable basis that results in no backup withholding, you are subject to a $500 penalty. Criminal Penalty for Falsifying Information_ Willfully falsifying certifications or affirmations may subject you to criminal penalties including fine% and/or imprisonment. Meuse of TINs.—If the requester discloses or uses TINS in violation of Federal law, the requester may be subject to civil and criminal penalties. Cat. No, 10231X Form W-9 (Rev. 12-e6) .K 14i4t 8 eil5re '-..o „h'„ �j14j �AU3f11 d li`' °'4i I ot'i�eAti e�°4iL4 �Ipppbb�b+qpl/_ ff+7b11 -. 1 bbi7p _: 0 t 998 GOES GOE— ES 344662634625 All Rights Reserved r AMERICAN BACKFLOW -PREVENTION ASSOCIATION Be it known that Lynnette R. Keim having submitted acceptable evidence of qualification by education, training, and experience is hereby granted this Certificate as a Backflow Prevention Assembly Tester 06-00170 Witness our Hand and Seal, effective 31 January 2005 Administrator, ABPA Tester C rtification Program pl g , y :• 1++ � ++ ,�. I b b p � `l++I+h - - ° d+Hh yb bV __tee .� A+�W .., d l �++ . ::_ + yYi r t,, az 1 3} 6sT �rl h`�,h't< e�?I 1,7�, py � ail. :� y�� h� r. � r. t .�. �•' t re. LITHO. IN U.S.A. t 0 t 998 GOES GOE— ES 344662634625 All Rights Reserved r AMERICAN BACKFLOW -PREVENTION ASSOCIATION Be it known that Lynnette R. Keim having submitted acceptable evidence of qualification by education, training, and experience is hereby granted this Certificate as a Backflow Prevention Assembly Tester 06-00170 Witness our Hand and Seal, effective 31 January 2005 Administrator, ABPA Tester C rtification Program pl g , y :• 1++ � ++ ,�. I b b p � `l++I+h - - ° d+Hh yb bV __tee .� A+�W .., d l �++ . ::_ + yYi r t,, az 1 3} 6sT �rl h`�,h't< e�?I 1,7�, py � ail. :� y�� h� r. � r. t .�. �•' t re. LITHO. IN U.S.A. t ACORDTN CERTIFICATE OF LIABILITY INSURANCE P4DA 04-20AT2005 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION LEID FINANCIAL GROUP INC/PHS ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 342560 P:(866)467-8730 F:(877)905-0457 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P. 0. BOX 33015 SAN ANTONIO TX 78265 INSURERS AFFORDING COVERAGE INSURED INSURER A: Hartford Casualtv Ins Co INSURER B: LYNNETTE KEIM DBA ALL AMERICAN BACKFLOW INSURER C: 820 MERGANSER DRIVE, #2105 INSURER D: 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN TYPE OF INSURANCE PoLICY NLAIRER PoLICY EFFECTNE ATE Y POUCV EXPIRA T/ON O LA ITS GENERAL LIARI/TY EACH OCCURRENCE $1 O O O O O 0 A COMMERCIAL GENERAL LIABILITY 34 SBA PE5367 05/26/04 05/26/05 FIRE DAMAGE (Any mefiire) s300 000 MED EXP (Any one person) $ 1 O O O 0 CLAIMS MADE O OCCUR X Business Liab PERSONAL & ADV INJURY S1,000,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIPROT APPLES PER: PRODUCTS - COMP/OP AGO $ 2 0 0 O 000 1-1 POLICY JEC X LOC AUFOMLIBILE UALILIFV COMBINED SINGLE UMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILYper INJURY $ SCHEDULED AUTOS IPe,person) HIRED AUTOS BODILY INJUdmt) $ NON -OWNED AUTOS IPer acciderrt) PROPERTY DAMAGE $ (Per accidem) GARA GE L/AR/LITV AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGO EXCESS UARRITY EACH OCCURRENCE $ AGGREGATE $ OCCUR CLAIMS MADE $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND WC STATU- OTH- EMPLOYERS'UARI/TY TORY E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LMIT $ O TUER DESCRIP "ON OF OPERATIONS/L OCA TLON$/VER/CLESIEXCL UMONS ADDED RY EMIORSEMENT/SPECIAL PROVISIONS Those usual to the Insured's Operations. The City of Fort Collins Purchasing Dept Po Box 580 Fort Collins CO 80522-0580 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE (10 DAYS FOR NON-PAYMENT) TO THE CERTIFICATE HOLDER NAMED TO THE L. EFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. """" "'J'' ID ACORD CORPORATION 1988 assigned and the Service Provider agrees to perform such changed services. 2. Changes in the Work. The City reserves the right to independently bid any services rather than issuing work to the Service Provider pursuant to this Agreement. Nothing within this Agreement shall obligate the City to have any particular service performed by the Service Provider. 3. Time of Commencement and Completion of Services. The services to be performed pursuant to this Agreement shall be initiated as specified by each written Work Order or oral emergency service request. Oral emergency service requests will be acted upon without waiting for a written Work Order. Time is of the essence. 4. Contract Period, This Agreement shall commence upon signing, and shall continue in full force and effect until April 30, 2006, unless sooner terminated as herein provided. In addition, at the option of the City, the Agreement may be extended for additional one year periods not to exceed four (4) additional one year periods. Renewals and pricing changes shall be negotiated by and agreed to by both parties. The Denver -Boulder -Greeley CPI-U published by the Colorado State Planning and Budget Office will be used as a guide. Written notice of renewal shall be provided to the Service Provider and mailed no later than ninety (90) days prior to contract end. 5. Delay. If either party is prevented in whole or in part from performing its obligations by unforeseeable causes beyond its reasonable control and without is fault or negligence, then the party so prevented shall be excused from whatever performance is prevented by such cause. To the extent that the performance is actually prevented, the Service Provider must provide written notice to the City of such condition within fifteen (15) days from the onset of such condition. 6. Early Termination by City/Notices Notwithstanding the time periods contained herein, the City may terminate this Agreement at any time without cause by providing written notice of termination to the Service Provider. Such notice shall be mailed at least fifteen (15) days prior to the termination date contained in said notice unless otherwise agreed in writing by the parties. All W OSA January 2005 - Testing and Repair, Inc. Office: 303.537.0126 FAX: 303.537.0129 e-mail: Fred2backflowconsultingcom 15403 E 17th Ave Unit F, Aurora, CO 80011 Accuracy Certification for Backflow Prevention Assembly Test Eauioment Owner of Equoment' Company: All American Backflow Conrad: Lynnette Keim fJ/0,6 Office Phone: 970.493.3546 Andress: 820 Merganser Dr #206- Aft. Phone: 970-391-0006 Fort Collins CO 80524 FAx Phone: q 70 41 ! 3 3 s L/.6 Gauge Test IGt Information Gauge Make: Orange Research Mom: 1516 Kit Mee: Watts Kit Mom: TK-99E .Serial No: 0088332 Certification test results standard Certification Paints are Bolded Manometer Differential Initial Reading Final Reading Keaauta - r5tu Betore Calibration After Calibration 15.0 14.0 15.0 15.0 13.0 12.0 11.0 12.3 11.6 10.0 9.0 8.0 8.9 s_2 7.0 5.0 5.0 5.6 5.0 4.0 3.0 3.2 3.0 2.0 2.2 2.0 1.0 1.2 0.8 0.0 0 0 Pressure Ted: Kit: 200 Valves(gas): 200 Vahres(water): Hoses: 200 Lab conditions during the certification: Temperature: 690F Humidity: 23% Initial Condition: good Comments: See smi nation on back of form: 1 ❑ 2 ❑ 3 ❑ 4 ❑ 50 6,0 7 4 Hinds to Proper Gage Use • Gauge must be tapped on the sloe before taking your reading to free linkage. • Test kit should be held in the up -right position during testing. • Leakage through needle valves can cause false passing results. Insure pressure and bleed valves are fully closed before taking gauge readings. • Needle valves should be fully closed when finger tight Stop testing devices and have test kit valves serviced If found to be leaking. Date of Certification: Feb 24,2005 Certification is valid for one year • CafibrM= was accurate and as staled on this form when test kit left Baddlow consulting. we are not respon sbie for damage due to handing during shipment. • Test kit should be handled with care. • Abuswe handling or freezing may affect the cakbration. • When tester suspects readings are inaccurate, test kit should be re-evaluated (Even if less than one year has passed since last certification). Repair Services Performed Conwotnents Inspected 0 Gauge: ❑ Sensing Lines ❑ Diaphragm ❑ Main Spring ❑ H.P. Housing ❑ L.P. Housing ❑ Movement ❑ Pointer ❑ Lens ❑ Scat Plate ❑ Gasket Valves: • High Need ❑ Low Bleed Cl High ❑ Low ❑ By -Pass Hoses: ❑ High ❑ Low ❑ By -Pass ❑ High Bleed ❑ Low Bleed ❑ Fiiter(s): ❑ Others: ❑ Others: Equipment Calibrated Name: Patnick A. Carter .Signature: • Gauge is certified to be wi m the tolerances specified by the manufacturer. • The equipment used to test this test kit is a Heise PM certified to the requimmw is of the National Institute of Standards and Technology. Inquiries should refer to Serial Number A28057. 11I11V 11VU11 VNVI\IIV v• r rvv V�rvrvr�..varvv..r v.v.. Backflow Prevention Assembly Tester Exp Date: 1 /31 /08 cart No. 06 - 00170 Administrat r Aiiacn upper poruvrl W yvul I =I IIII .UtW 0 Use lower portion for wallet identification Be sure to keep us up-to-date with your current mailing address P Program Administrator American Backflow Prevention Association American Backflow Prevention Association — Backflow Prevention Assembly Tester P.O. Box 91082 Los Angeles, CA 90009 Backflow Prevention Assembly Tester (323) 776-2764 Phone/Fax Email: ehavlinaxc@aol.com Exp Date: 1 /31 /08 cert No. 06 - 00170 National Office Lynnette R. Keim American Backflow, Prevention Association 820 Merganser Drive #406 P.O. Box 3051 Fort Collins, CO 80524 ` Bryan, TX 77805-3051 (979)846-7606 Fax(979)846-7607 Administrator www.abpa.org C4 Sep 09 04 07:51p p.10 Farm W-9 Request for Taxpayer Ginn° forrn to the (Rev. December9 IdenIdentification Number and Certification request°' °o NOT 0epannwix of the TreamAsur., y aeMl t0 the IRS. Irxanal Revenue Service N o of a}olnt a=oure or changed your na Spedtle instructions on page 2.)_. e Busineyl name, if different m Insi 'ons on page .) Z 'FLCheck o;i ate box: ndwld aV de propretor ❑ Corporation Cl Partnership ❑ Other ► . . ......... ....._....._._. Addr (number. street. pi. or suite no.) /'1 a Requester's name and address (optional) CRT state, and! Zip ode l 'Taxpa er Identification Number IN List account numbw(s1 Iwro (opti<mdl Enter your Tin the appropriate box. For your social security number nber individuals, tINhis is Soc al w raa (SSNI However, if you are a resident alien OR a sole proprietor, see the instructions on page 2. For Payees Exempt From Badwp For other entities, it is your employer identification do OR number (EIN). If you not have a number, see How To Get a TIN on page 2. Withholding (See the Instructions Note. If the account is in morn than one name, Employ sew tHkaaon nwnbar on page 2.) see the chart on page 2 for guidelines on whose 1 number to enter. gigAsn (:erGflcation Under penalties of perjury, I certify that: 1. The number shown m this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and 2. 1 am not subject to backup withhold" because: (a) I am exempt from backup withholding, or ft I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (e) the IRS has notified me that I am no longer subject to backup withholding. Cortifrcatio n Instructions. —You must cross out item 2 above if you have been nodfled by the IRS that you are currently subject to backup withholding because you have faded to report all interest and dtvidends on your tax return. For real estate trartsactiorls, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property. cancellation of debt contributions to an individual retirement arrangement (IRA), and generally, payments other than Interest and dividends, you are not required to sign the Certification, but you must provide your correct TIN. (See the Instructions on page 2.) Sign Here Skinsture ► Date ► Purpose of Farm. —A person who is required to file an information return with the IRS must get your correct taxpayer identification number (TIN) to report, for example, income paid to you, real estate transactions, mortgage interest you paid, acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA. Use Form W-9 to give your correct TIN to the person requesting It (the requesteo and, when applicable, to: 1. Certify the TIN you are giving is correct (or you are waking for a number to be issued), 2. Certify you are not subject to backup withholding, or 3. Claim exemption from backup withholding if you are an exempt payee. Note. N a requester gives you a form other than a W-9 to request your TIN, you must use the requester's form if it is substantially similar to this Form W-9, Whet Is Backup Withholdin97—Persons making certain payments to you must withhold and pay to the IRS 31 % of such payments under certain conditions. This is called "backup withholding" Payments that may be subject to backup withholding include interest dividends, broker and barter exchange transactions, rents, royalties, nonemployee pay, and certain payments from fishing boat operators. Real estate transactions are not subject to backup withholding. If you give the requester your correct TIN, make the proper certifications, and report all your taxable interest and dividends on your tax return, payments you receive will not be subject to backup withholding. Payments you receive will be subject to backup withholding 8: 1. You do not furnish your TIN to the requester, or 2. The IRS tells the requester that you furnished an incorrect TIN, or 3. The IRS tells you that you are subject to backup withholding because you did not report all your interest and dividends on your tax return (for reportable interest and dividends only), or /. You do not certify to the requester that you are not subject to backup withholding under 3 above (for reportable interest and dividend accounts opened after 1983 only). or S. You do not certify your TIN when required. See the Part III instructions on page 2 for details. Certain payees and payments are exempt from backup withholding. See the Part II instructions and the separate Instructions for the Requester of Form Ill Pendf tills Failure To Furnish TIN. —If you fail to furnish your correct TIN to a requester, you are subject to a penalty of $50 for each such failure unless your failure is due to reasonable cause and not to willful neglect. Civil Penalty for False Information With Respect to Withholding. —If you make a false statement with nn masonable basis that results in no backup withholding, you are subject to a $500 penalty. Crittinat Penalty for Falsifying Information Willfully falsifying certifications or affirmations may subject you to criminal penalties including fines and/or imprisonment. Misuse of TINI If the requester discloses or uses TINS in violation of Federal taw, the requestes may be subject to civil and criminal penalties. Cat. No. 10231X Form W-9 (Rev. 12-96) Fit C P98 GOES 36625 All Rights Reserved AMERICAN BACKFLOW -PREVENTION ASSOCIATION Be it known that Lynnette R. Keim having submitted acceptable evidence of qualification by education, training, and experience is hereby granted this Certificate as a Backflow Prevention Assembly Tester 06 - 00170 -- Witness our Hand and Seal, effective 31 January 2005 Administrator, ABPA Tester C rtification Program �4 vi a �rtll//�/jlllt si1111/11111 '� s ens ;��II'I,I,�11s x =-.� �;;1,11/,11�11 -� t111111�11 ° ...�: tjllllll>F � .� �.cd111111111 `� .�, s 7111 p 1'��.�.1i gV�:i'!�S /1 #1;�� ♦♦ �..�.t, ��,€ 1^ y�s{�r �� t''F ��^I ;,(J�. • ;� ,`�+ a�^4 ,'a +�,1+�yif�?'� ^�&i �:..:��+ �s, ��ie�� ;7y ��It�sy r�i rx'a�°S(�, .,'li�j�, ::� �i�.J�Jh�iA"J{6 f A .Vw,y, .be�U:e'Tit "U. ,A ....�'�t!si,1,.�,1.�'1 �- � �'4h7L�4C�.>t�� .: fii ..Wtw..t�YdF�+, • �I�utii.,,t. �., enV. "^s 9tr;km,.�Ohnnn7.U�,P' : ni.� /✓J,P�'Or i�l t✓{S�/4�„ q�F °t ✓fAY.t�eitY. 3< �L�~� .:: � L! 't.�,(f.%4�d �~ �4S}!!.!✓N i�4 v ` Y!j IA.J t 'F i a..Y tJ 5V LITHO. IN U.S.A. notices provided under this Agreement shall be effective when mailed, postage prepaid and sent to the following address: City Service Provider City of Fort Collins, Purchasing All American Backflow P.O. Box 965 820 Merganser Dr. #406 Ft. Collins, CO 80522 Ft. Collins, CO 80524 In the event of early termination by the City, the Service Provider shall be paid for services rendered to the termination date, subject only to the satisfactory performance of the Service Provider's obligations under this Agreement. Such payment shall be the Service Provider's sole right and remedy for such termination. 7. Contract Sum. This is an open-end indefinite quantity Agreement with no fixed price. The actual amount of work to be performed will be stated on the individual Work Orders. The City makes no guarantee as to the number of Work Orders that may be issued or the actual amount of services which will in fact be requested. No Work Order of $50,000 or more shall be issued. 8. Payments. a. The City agrees to pay and the Service Provider agrees to accept as full payment for all work done and all materials furnished and for all costs and expenses incurred in performance of the work the sums set forth for the hourly labor rate and material costs, with markups, stated within the Bid Schedule Proposal Form, attached hereto as Exhibit "B", consisting of one (1) page, and incorporated herein by this reference. b. Payment shall be made by the City only upon acceptance of the work by the City and upon the Service Provider furnishing satisfactory evidence of payment of all wages, taxes, supplies and materials, and other costs incurred in connection with the performance of such work. 9. City Representative. The City's representative will be shown on the specific Work Order and shall make, within the scope of his or her authority, all necessary and proper decisions with reference to the work requested. All requests concerning this Agreement shall be directed to the City Representative. WOSA January 2005 10. Independent Contractor. It is agreed that in the performance of any services hereunder, the Service Provider is an independent contractor responsible to the City only as to the results to be obtained in the particular work assignment and to the extend that the work shall be done in accordance with the terms, plans and specifications furnished by the City. 11. Personal Services. It is understood that the City enters into the Agreement based on the special abilities of the Service Provider and that this Agreement shall be considered as an agreement for personal services. Accordingly, the Service Provider shall neither assign any responsibilities nor delegate any duties arising under the Agreement without the prior written consent of the city. 12. Acceptance Not Waiver. The City's approval or acceptance of, or payment for any of the services shall not be construed to operate as a waiver of any rights under the Agreement or of any cause of action arising out of the performance of this Agreement. 13. Warranty. (a) Service Provider warrants that all work performed hereunder shall be performed with the highest degree of competence and care in accordance with accepted standards for work of a similar nature. (b) Unless otherwise provided in the Agreement, all materials and equipment incorporated into any work shall be new and, where not specified, of the most suitable grade of their respective kinds for their intended use, and all workmanship shall be acceptable to City. (c) Service Provider warrants all equipment, materials, labor and other work, provided under this Agreement, except City -furnished materials, equipment and labor, against defects and nonconformances in design, materials and workmanship/workwomanship for a period beginning with the start of the work and ending twelve (12) months from and after final acceptance under the Agreement, regardless whether the same were furnished or performed by Service Provider or by any of its subcontractors of any tier. Upon receipt of written notice from City of any such defect or nonconformances, the affected item or part thereof shall be redesigned, repaired or replaced by Service Provider in a manner and at a time acceptable to City. 14. Default. Each and every term and condition hereof shall be deemed to be a material WOSA January 2005 element of this Agreement. In the event either party should fail or refuse to perform according to the terms of this agreement, such party may be declared in default thereof. 15. Remedies. In the event a party has been declared in default, such defaulting party shall be allowed a period of ten (10) days within which to cure said default. In the event the default remains uncorrected, the party declaring default may elect to (a) terminate the Agreement and seek damages; (b) treat the Agreement as continuing and require specific performance; or (c) avail himself of any other remedy at law or equity. If the non -defaulting party commences legal or equitable actions against the defaulting party, the defaulting party shall be liable to the non - defaulting party for the non -defaulting party's reasonable attorney fees and costs incurred because of the default. 16. Binding Effect. This writing, together with the exhibits hereto, constitutes the entire agreement between the parties and shall be binding upon said parties, their officers, employees, agents and assigns and shall inure to the benefit of the respective survivors, heirs, personal representative, successors and assigns of said parties. 17. Indemnity/Insurance. a. The Service Provider agrees to indemnify and save harmless the City, its officers, agents and employees against and from any and all actions, suits, claims, demands or liability of any character whatsoever, brought or asserted for injuries to or death of any person or persons, or damages to property arising out of, result from or occurring in connection with the performance of any service hereunder. b. The Service Provider shall take all necessary precautions in performing the work hereunder to prevent injury to persons and property. c. Without limiting any of the Service Provider's obligations hereunder, the Service Provider shall provide and maintain insurance coverage naming the City as an additional insured under this Agreement of the type and with the limits specified within Exhibit "C", consisting of one (1) page, WOSA January 2005 attached hereto and incorporated herein by this reference. The Service Provider before commencing services hereunder, shall deliver to the City's Director of Purchasing and Risk Management, 250 N. Mason St., Fort Collins, CO 80524, one copy of a certificate evidencing the insurance coverage required from an insurance company acceptable to the city. 18. Entire Agreement. This Agreement, along with all Exhibits and other documents incorporated herein, shall constitute the entire Agreement of the parties. Covenants or representations not contained in this Agreement shall not be binding on the parties. 19. Law/Severability. This Agreement shall be governed in all respect by the laws of the State of Colorado. In the event any provision of this Agreement shall be held invalid or unenforceable by any court of competent jurisdiction such holding shall not invalidate or render unenforceable any other provision of this Agreement. 20. Special Provisions. Special provisions or conditions relating to the services to be performed pursuant to this Agreement are set forth in Exhibit D, consisting of two (2) page, attached hereto and incorporated herein by this reference. WOSA January 2005 CITY OF FORT COLLINS, COLORADO a municipal corporation By: James 'Neill II, CPPO, FNIGP Director of Purchasing and Risk Management Date: Lynnette Keim Doing busi ss as All American Backflow By P RlNT MA Date: _S% - a 0 - D . - WOSA January 2005 EXHIBIT "A" WORK ORDER FORM PURSUANT TO AN AGREEMENT BETWEEN THE CITY OF FORT COLLINS AND DATED: Work Order Number: Purchase Order Number: Project Title: Commencement Date: Completion Date: Maximum Fee: (time and reimbursable direct costs): Project Description: Scope of Services: Service Provider agrees to perform the services identified above and on the attached forms in accordance with the terms and conditions contained herein and in the Services Agreement between the parties. In the event of a conflict between or ambiguity in the terms of the Services Agreement and this work order (including the attached forms) the Services Agreement shall control Service Prov el By_I_— Date: L-- 4/2001 Acceptance User User CC: Purchasing The attached forms consisting of O pages are hereby accepted and incorporated herein by this reference, and Notice to Proceed is hereby given. City of Fort Collins By: Date: Director of Purchasing and Risk Management Over $30,000 J EXHIBIT B BID SCHEDULE — BID #5907 BACKFLOW ASSEMBLY TESTING AND REPAIR Award will be based on lowest total for all phases (1 through 3) of the Bid Schedule. 1. Provide testing of any size PVB $_,,2,�_,6 per test X 76 = $_L2 O 2. Provide testing of any size RP �_per test X 55 = $_ 1 SD 3. Repair labor rates $__0?_SL _O_vper hour X 6 hrs $__ / S0 GRAND TOTAL $ S l0 , O 4. $__ _d ,Minimum charge if any 5. Maximum material mark-up City will pay: p 1) < $500.00 + 10% Bidder's mark-up 2) > $500.00 + 8% Bidder's mark-up Since miscellaneous materials and minimum charge will be a minor factors with this contract in most cases, they will not be calculated in bid method of award, but contractor must honor both mark-up rate and minimum charge. FIRM NAME_A.�_�y✓1 C, i c ry=R 1.0 (-j Are you a Corporation, Partnership, DBA, LLC, or PCB) SIGNATURE_jLeC) J ADDRESS__-9r- _C__e_ r' -1 s 4 �� eQ #�i . ee 11 PHONE/FAX # ? �0 n 9 %Q — S' 3 5