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HomeMy WebLinkAboutPROPOSAL FOR WATER PLANT OPERATION AND LABORATORY SERVICES FOR GRACEWOOD CAMPUS OF THE EAST CENTRAL REGIONAL HOSPITAL• • Proposal for Water Plant Operation and Laboratory Services for the Gracewood Campus of the East Central Regional Hospital The Gracewood Campus of the East Central Regional Hospital owns a private water system consisting of four wells (two active) and one groundwater treatment plant. The system is operated under permit number 121-0008 issued by the Georgia Environmental Protection Division on January 12, 2007. The Augusta Utilities Department is a large public water and wastewater utility whose service area surrounds the Gracewood Campus. The Gracewood Campus has requested that Augusta Utilities provide a proposal to assist in the operation and monitoring of the Gracewood water system. In response to this request Augusta Utilities provides the following proposal. Water Plant Operation Augusta Utilities proposes to check the operation of the water treatment plant three times per day, seven days per week utilizing our operations staff located at the N. Max Hicks Water Treatment Plant. Operators will perform the following activities: 1. Monitor chemical concentrations in water and adjust dosages as needed. 2. Observe the functioning of equipment associated with the plant operations and report issues to appropriate Gracewood staff for action. 3. Assist in the training and oversight of Gracewood staff in performing additional system monitoring as needed. 4. Collect and store data documenting system operation. 5. Prepare and submit Monthly Operating Reports to the Georgia EPD. 6. Prepare an annual Consumer Confidence Report for the Gracewood Campus to reproduce and distribute. laboratory Services Augusta Utilities proposes to provide laboratory services in compliance with the system operating permit. These services will be performed by the Augusta central water quality laboratory and will consist of the following activities: 1. One site visit per month to collect water samples for analysis as required the system operating permit. 2. Analyses will be performed at the Augusta laboratory, the Georgia EPD laboratory or other laboratory as appropriate. 3. Documentation of analysis and results will be provided to the Gracewood Campus. 4. Perform other sampling and analysis as required by regulatory agencies. Attachment number 1 \nPage 1 Item # 32 1 • Cost for Services Augusta Utilities proposes to perform the stated services for a monthly fee of S1,066.82. Details of these costs are provided in Attachment A to this proposal. This fee would be fixed for 3 years at which time the costs will be reevaluated based on current conditions and experience with provision of these services. If a cost adjustment is needed the proposed revised cost will be submitted to the Gracewood Campus for consideration. Agreement Termination Augusta Utilities proposes that the agreement to provide services may be terminated by either party after providing a 60-day notice of intent to do so. Attachment number 1 \nPage 2 Item # 32 Task Rate Monthly Cost Annual Cost One site visit per 8 -hour shift (3 p er day) to sample water for appropriate chemical content as needed to insure high quality drinking water and compliance with Gracewood's water system operating permit number 121 - 0008. 1.5 Hours per day for total of 45 hours per month at $14.20 per hour plus labor overhead of $ 4.97= $19.17 per hour. $862.65 $10,351.80 Preparation and submission of Monthly Operating Report to Georgia EPD, Annual Consumer Confidence Report and other reports /submissions to regulatory agencies. Two microbiological samples at $50.00 each. $75.00 $900.00 Total for Water Plant Operation Services $937.65 $11,251.80 $120.00 Total for AU Services $1,066.82 $12,801.84 Task Rate Monthly Cost Annual Co One site visit per month to collect water samples for analysis as required by Gracewood's water system operating permit number 121 -0008. 1 Hour per month at $14.20 per hour plus labor overhead of $ 4.97= $19.17 per hour. $19.17 $230.04 Cost of monthly analysis at Augusta's Water Quality Laboratory for 2 microbiological samples per month as required by the system operating permit. Two microbiological samples at $50.00 each. $100.00 $1,200.00 Additional analyses as required by the system operating permit. $10.00 $120.00 Total for la boratory Services $129.17 $1,550.04 • Attachment A AUD Cost for Laboratory and Water Plant Operation Services to Gracewood Campus Laboratory Services Water Plant Operation Services Attachment number 1 \nPage 3 Item # 32 Attachment 1: State Entity Contract Terms and Conditions for Services Attachment 2: Proposal from City of Augusta Utilities dated on Thursday, October 25.2012 Attachment 3: Letter of Acceptance of Proposal Attachment 4: Initial Purchase Order with AUD Cost for Laboratory and Water Plant Operation Services to Gracewood Campus, (Attachment A), from original Proposal Attachment 5: Contract Administration Plan and Summary Attachment 6: Tobacco and Smoke Free Environment Compliance / Certificate of Insurance Attachment 7: Immigration and Security Form Attachment 8: Tax Compliance Form Attachment 9: Supplier General Information Worksheet Attachment 10: Vendor Registration Form (PeopleSoft Financials System) Solicitation Title Water Operations and Lab Assistance State of Georgia State Entity Standard Contract Form 1. This Contract is entered into between the State Entity and the Contractor named below: State Entity's Name Department of Behavioral Health & Developmental Disabilities -East Central Regional Hospital (hereafter called State Entity) Contractor's Name City of Augusta - Richmond County, Augusta Water Utilities Department (0000013727) 2. Contract to Begin: Date of Completion: Renewals: 3 Saturday, December 1. 2012 Thursday, December 1. 2016 First: 07.01.2013 — 06.30.2014 (12) Second: 07.01.2014 — 06.30.2015 (12) Third : 07.01.2015 — 12.01.2016 (5) 3. Performance Bond, if any: N/A Other Bonds, if any: N/A 4. Maximum Amount of this Total Financial Obligation of the Total Financial Obligation of the State Entity Contract: State Entity for the First Fiscal for each Renewal Period if Renewed: $38,405.52 Year: $12,801.84 $7467.74 5. Authorized Person to Receive Contract Notices for State Authorized Person to Receive Contract Notices for Contractor: Entity: Alicia Marie Bing, GCPCA 6. The parties agree to comply with the terms and conditions of the following attachments which are by this reference made a part of the Contract: IN WITNESS WHEREOF, this Contract has been executed by the parties hereto. 7. B (_ oo n re) Pnntteedd Name an itle of Person Signing t� �A vyD S . G• ,u4f EN � � Address 360 Bay Street, Suite 180, Augusta, GA 30901 Revised 02/11/11 Solicitation Number Contract Number N/A 44100- 015-00000 -54960 Tom D. Weidmeier, PE, Director Contractor Contractor's Name (If other than an individual, state whether a corporation, partnership, etc.) City of Augusta - Richmond County, Augusta Water Utilities Department (0000013727) Date Signed I( I Zy f��.� (hereafter called Contractor) SPD -SP025 8. State Entity Name Department of Behavioral Health & Developmental Disabilities; East Central Regional Hospital B �. ' ze• ignature) ARAM A Revised 02/11/11 State Entity Date Signed P nted Name and Title of Person Signin, Alicia Marie Bing, GCPCA, Mgr., Procurement & Contract Administration Address 3405 Mike Padgett Highway, Tom Hest Drive, Building 8, Room 11, Augusta, GA 30906 2 11 - 30 -12 08:40 IN SPD -SP025 A. DEFINITIONS AND GENERAL INFORMATION 1. Definitions. The following words shall be defined as set forth below: Revised 02/11/11 STATE OF GEORGIA AGENCY STANDARD CONTRACT Attachment 1 Contract Terms and Conditions for Services (i) "Contractor" means the provider(s) of the Services under the Contract. (ii) "Purchase Instrument" means the documentation issued by the State Entity to the Contractor for a purchase of Services in accordance with the terms and conditions of the Contract. The Purchase Instrument should reference the Contract and may include an identification of the Services to be purchased, the time and location such Services will be utilized, and any other requirements deemed necessary by the State Entity. (iii) "Response ", "Contractor's Response" or "Final Response" means the Contractor's submitted response to the RFX, including any modifications or clarifications accepted by the State Entity. (iv) "RFX" means the Request for Proposal, Request for Bid, or other solicitation document (and any amendments or addenda thereto) specifically identified in the State Entity Standard Contract Form that was issued to solicit the Services that are subject to the Contract. (v) "Services" means the services and deliverables as provided in the RFX and as further described by the Response and the Contract. (vi) "State" means the State of Georgia, the State Entity, and any other authorized state entities issuing Purchase Instruments against the Contract. (vii) "State Entity" means the State of Georgia entity identified in the State Entity Standard Contract Form to contract with the Contractor for the Services identified in the Contract. (viii) "State Entity Standard Contract" or "Contract" means the agreement between the State Entity and the Contractor as defined by the State Entity Standard Contract Form and its incorporated documents. (ix) "State Entity Standard Contract Form" means the document that contains basic information about the Contract and incorporates by reference the applicable Contract Terms and Conditions, the RFX, Contractor's Response to the RFX, the final pricing documentation for Services and any mutually agreed clarifications, modifications, additions and deletions resulting from final contract negotiations. No objection or amendment by a Contractor to the RFX requirements or the Contract shall be incorporated by reference into this Contract unless the State Entity has accepted the Contractor's objection or amendment in writing. The State Entity Standard Contract Form is defined separately and referred to separately throughout the State Entity Standard Contract as a means of identifying the location of certain information. For example, the initial term of the Contract is defined by the dates in the State Entity Standard Contract Form. 3 SPD -SP025 2. Priority of Contract Provisions. Any pre - printed contract terms and conditions included on Contractor's forms or invoices shall be null and void. 3. Reporting Requirements. Contractor shall provide all reports required by the RFX. In addition, unless otherwise provided in the RFX, Contractor shall keep a record of the purchases made pursuant to the Contract and shall submit a quarterly written report to the State Entity. B. DURATION OF CONTRACT 1. Contract Term. The Contract between the State Entity and the Contractor shall begin and end on the dates specified in the State Entity Standard Contract Form unless terminated earlier in accordance with the applicable terms and conditions. Pursuant to O.C.G.A. Section 50 -5 -64, this Contract shall not be deemed to create a debt of the State for the payment of any sum beyond the fiscal year of execution or, in the event of a renewal, beyond the fiscal year of such renewal. 2. Contract Renewal. The State Entity shall have the option, in its sole discretion, to renew the Contract for additional terms as defined in the State Entity Standard Contract Form on a year - to -year basis by giving the Contractor written notice of the renewal decision at least sixty (60) days prior to the expiration of the initial term or renewal term. Renewal will depend upon the best interests of the State, funding, and Contractor's performance. Renewal will be accomplished through the issuance of a Notice of Award Amendment. Upon the State Entity's election, in its sole discretion, to renew any part of this Contract, Contractor shall remain obligated to perform in strict accordance with this Contract unless otherwise agreed by the State Entity and the Contractor. 3. Contract Extension. In the event that this Contract shall terminate or be likely to terminate prior to the making of an award for a new contract for the Services, the State Entity may, with the written consent of Contractor, extend this Contract for such period as may be necessary to afford the State a continuous supply of the Services. C. DESCRIPTION OF SERVICES 1. Specifications in Bidding Documents. All Services shall be provided in accordance with the specifications contained in the RFX, the terms of the Contract, and as further described in Contractor's Response. 2. Product Shipment and Delivery. All products, if any, shall be shipped F.O.B. destination. Destination shall be the location(s) specified in the RFX or any provided Purchase Instrument. All items shall be at the Contractor's risk until they have been delivered and accepted by the receiving entity. All items shall be subject to inspection on delivery. Hidden damage will remain the responsibility of the Contractor to remedy without cost to the State Entity, regardless of when the hidden damage is discovered. 3. Non - Exclusive Rights. The Contract is not exclusive. The State Entity reserves the right to select other contractors to provide services similar to the Services described in the Contract during the term of the Contract. 4. No Minimums Guaranteed. The Contract does not guarantee any minimum level of purchases or use of Services. Revised 02/11/11 4 SPD -SP025 D. COMPENSATION 1. Pricing and Payment. The Contractor will be paid for Services provided pursuant to the Contract in accordance with the RFX and final pricing documents as incorporated into the State Entity Standard Contract Form and the terms of the Contract. Unless clearly stated otherwise in the Contract, all prices are firm and fixed and are not subject to variation. Prices include, but are not limited to freight, insurance, fuel surcharges and customs duties. 2. Billings. If applicable, and unless the RFX provides otherwise, the Contractor shall submit, on a regular basis, an invoice for the Services supplied to the State Entity under the Contract at the billing address specified in the Purchase Instrument or Contract. The invoice shall comply with all applicable rules concerning payment of such claims. The State Entity shall pay all approved invoices in arrears and in accordance with applicable provisions of State law. Unless otherwise agreed in writing by the State Entity and the Contractor, the Contractor shall not be entitled to receive any other payment or compensation from the State Entity for Services provided by or on behalf of the Contractor under the Contract. The Contractor shall be solely responsible for paying all costs, expenses and charges it incurs in connection with its performance under the Contract. 3. Delay of Payment Due to Contractor's Failure. If the State Entity in good faith determines that the Contractor has failed to perform or deliver Services as required by the Contract, the Contractor shall not be entitled to any compensation under the Contract until such Service is performed or delivered. In this event, the State Entity may withhold that portion of the Contractor's compensation which represents payment for Services that were not performed or delivered. To the extent that the Contractor's failure to perform or deliver in a timely manner causes the State Entity to incur costs, the State Entity may deduct the amount of such incurred costs from any amounts payable to Contractor. The State Entity's authority to deduct such incurred costs shall not in any way affect the State Entity's authority to terminate the Contract. 4. Set -Off Against Sums Owed by the Contractor. In the event that the Contractor owes the State Entity and /or the State any sum under the terms of the Contract, pursuant to any judgment, or pursuant to any law, the State Entity and /or the State may set off the sum owed against any sum owed by the State Entity to the Contractor in the State Entity's sole discretion. E. TERMINATION 1. Immediate Termination. Pursuant to O.C.G.A. Section 50 -5 -64, this Contract will terminate immediately and absolutely if the State Entity determines that adequate funds are not appropriated or granted or funds are de- appropriated such that the State Entity cannot fulfill its obligations under the Contract, which determination is at the State Entity's sole discretion and shall be conclusive. Further, the State Entity may terminate the Contract for any one or more of the following reasons effective immediately without advance notice: (i) In the event the Contractor is required to be certified or licensed as a condition precedent to providing the Services, the revocation or loss of such license or certification may result in immediate termination of the Contract effective as of the date on which the license or certification is no longer in effect; Revised 02/11/11 (ii) The State Entity determines that the actions, or failure to act, of the Contractor, its agents, employees or subcontractors have caused, or reasonably could cause, life, health or safety to be jeopardized; 5 SPD -SP025 Revised 02/11/11 (iii) The Contractor fails to comply with confidentiality laws or provisions; and /or (iv) the Contractor furnished any statement, representation or certification in connection with the Contract or the bidding process which is materially false, deceptive, incorrect or incomplete 2. Termination for Cause. The occurrence of any one or more of the following events shall constitute cause for the State Entity to declare the Contractor in default of its obligations under the Contract: (i) The Contractor fails to deliver or has delivered nonconforming Services or fails to perform, to the State Entity's satisfaction, any material requirement of the Contract or is in violation of a material provision of the Contract, including, but without limitation, the express warranties made by the Contractor; (ii) The State Entity determines that satisfactory performance of the Contract is substantially endangered or that a default is likely to occur; (iii) The Contractor fails to make substantial and timely progress toward performance of the Contract; (iv) The Contractor becomes subject to any bankruptcy or insolvency proceeding under federal or state law to the extent allowed by applicable federal or state law including bankruptcy laws; the Contractor terminates or suspends its business; or the State Entity reasonably believes that the Contractor has become insolvent or unable to pay its obligations as they accrue consistent with applicable federal or state law; (v) The Contractor has failed to comply with applicable federal, state and local laws, rules, ordinances, regulations and orders when performing within the scope of the Contract; (vi) The Contractor has engaged in conduct that has or may expose the State Entity or the State to liability, as determined in the State Entity's sole discretion; or (vii) The Contractor has infringed any patent, trademark, copyright, trade dress or any other intellectual property rights of the State Entity, the State, or a third party. 3. Notice of Default. If there is a default event caused by the Contractor, the State Entity shall provide written notice to the Contractor requesting that the breach or noncompliance be remedied within the period of time specified in the State Entity's written notice to the Contractor. If the breach or noncompliance is not remedied within the period of time specified in the written notice, the State Entity may: (I) Immediately terminate the Contract without additional written notice; and /or (ii) Procure substitute services from another source and charge the difference between the Contract and the substitute contract to the defaulting Contractor; and /or, (iii) Enforce the terms and conditions of the Contract and seek any legal or equitable remedies. 4. Termination upon Notice. Following thirty (30) days' written notice, the State Entity may terminate the Contract in whole or in part without the payment of any penalty or incurring any further obligation to the Contractor. Following termination upon notice, the Contractor shall be 6 SPD -SP025 5. Termination Due to Change in Law. The State Entity shall have the right to terminate this Contract without penalty by giving thirty (30) days' written notice to the Contractor as a result of any of the following: 6. Payment Limitation in Event of Termination. In the event of termination of the Contract for any reason by the State Entity, the State Entity shall pay only those amounts, if any, due and owing to the Contractor for the Services actually rendered up to the date specified in the notice of termination for which the State Entity is obligated to pay pursuant to the Contract or Purchase Instrument. Payment will be made only upon submission of invoices and proper proof of the Contractor's claim. This provision in no way limits the remedies available to the State Entity under the Contract in the event of termination. The State shall not be liable for any costs incurred by the Contractor in its performance of the Contract, including, but not limited to, startup costs, overhead or other costs associated with the performance of the Contract. 7. The Contractor's Termination Duties. Upon receipt of notice of termination or upon request of the State Entity, the Contractor shall: Revised 02/11/11 entitled to compensation, upon submission of invoices and proper proof of claim, for Services provided under the Contract to the State Entity up to and including the date of termination. (I) The State Entity's authorization to operate is withdrawn or there is a material alteration in the programs administered by the State Entity; and /or (ii) The State Entity's duties are substantially modified. (i) Cease work under the Contract and take all necessary or appropriate steps to limit disbursements and minimize costs, and furnish a report within thirty (30) days of the date of notice of termination, describing the status of all work under the Contract, including, without limitation, results accomplished, conclusions resulting there from, and any other matters the State Entity may require; (ii) Immediately cease using and return to the State Entity, any personal property or materials, whether tangible or intangible, provided by the State Entity to the Contractor; (iii) Comply with the State Entity's instructions for the timely transfer of any active files and work product produced by the Contractor under the Contract; (iv) Cooperate in good faith with the State Entity and its employees, agents and contractors during the transition period between the notification of termination and the substitution of any replacement contractor(s); and (v) Immediately return to the State Entity any payments made by the State Entity for Services that were not delivered or rendered by the Contractor. 7 SPD -SP025 F. CONFIDENTIAL INFORMATION 1. Access to Confidential Data. The Contractor's employees, agents and subcontractors may have access to confidential data maintained by the State to the extent necessary to carry out the Contractor's responsibilities under the Contract. The Contractor shall presume that all information received pursuant to the Contract is confidential unless otherwise designated by the State. If it is reasonably likely the Contractor will have access to the State's confidential information, then: Revised 02/11/11 (i) The Contractor shall provide to the State a written description of the Contractor's policies and procedures to safeguard confidential information (ii) Policies of confidentiality shall address, as appropriate, information conveyed in verbal, written, and electronic formats (iii) the Contractor must designate one individual who shall remain the responsible authority in charge of all data collected, used, or disseminated by the Contractor in connection with the performance of the Contract; and (iv) the Contractor shall provide adequate supervision and training to its agents, employees and subcontractors to ensure compliance with the terms of the Contract The private or confidential data shall remain the property of the State at all times. Some Services performed for the State Entity may require the Contractor to sign a nondisclosure agreement. Contractor understands and agrees that refusal or failure to sign such a nondisclosure agreement, if required, may result in termination of the Contract. 2. No Dissemination of Confidential Data. No confidential data collected, maintained, or used in the course of performance of the Contract shall be disseminated except as authorized by law and with the written consent of the State, either during the period of the Contract or thereafter. Any data supplied to or created by the Contractor shall be considered the property of the State. The Contractor must return any and all data collected, maintained, created or used in the course of the performance of the Contract, in whatever form it is maintained, promptly at the request of the State. 3. Subpoena. In the event that a subpoena or other legal process is served upon the Contractor for records containing confidential information, the Contractor shall promptly notify the State and cooperate with the State in any lawful effort to protect the confidential information. 4. Reporting of Unauthorized Disclosure. The Contractor shall immediately report to the State any unauthorized disclosure of confidential information. 5. Survives Termination. The Contractor's confidentiality obligation under the Contract shall survive termination of the Contract. G. INDEMNIFICATION 1. Contractor's Indemnification Obligation. The Contractor agrees to indemnify and hold harmless the State and State officers, employees, agents, and volunteers (collectively, "Indemnified Parties ") from any and all costs, expenses, losses, claims, damages, liabilities, settlements and judgments, including reasonable value of the time spent by the Attorney General's Office, related to or arising from: 8 SPD -SP025 Revised 02/11/11 (i) Any breach of the Contract; (ii) Any negligent, intentional or wrongful act or omission of the Contractor or any employee, agent or subcontractor utilized or employed by the Contractor; (iii) Any failure of Services to comply with applicable specifications, warranties, and certifications under the Contract; (iv) The negligence or fault of the Contractor in design, testing, development, manufacture, or otherwise with respect to the Services provided under the Contract; (v) Claims, demands, or lawsuits that, with respect to the goods (if any) or any parts thereof, allege product liability, strict product liability, or any variation thereof; (vi) The Contractor's performance or attempted performance of the Contract, including any employee, agent or subcontractor utilized or employed by the Contractor; (vii) Any failure by the Contractor to comply with the "Compliance with the Law" provision of the Contract; (viii) Any failure by the Contractor to make all reports, payments and withholdings required by federal and state law with respect to social security, employee income and other taxes, fees or costs required by the Contractor to conduct business in the State of Georgia or the United States; (ix) Any infringement of any copyright, trademark, patent, trade dress, or other intellectual property right; or (x) Any failure by the Contractor to adhere to the confidentiality provisions of the Contract. 2. Duty to Reimburse State Tort Claims Fund. To the extent such damage or loss as covered by this indemnification is covered by the State of Georgia Tort Claims Fund ( "the Fund "), the Contractor (and its insurers) agrees to reimburse the Fund. To the full extent permitted by the Constitution and the laws of the State and the terms of the Fund, the Contractor and its insurers waive any right of subrogation against the State, the Indemnified Parties, and the Fund and insurers participating there under, to the full extent of this indemnification. 3. Litigation and Settlements. The Contractor shall, at its own expense, be entitled to and shall have the duty to participate in the defense of any suit against the Indemnified Parties. No settlement or compromise of any claim, Toss or damage entered into by the Indemnified Parties shall be binding upon Contractor unless approved in writing by Contractor. No settlement or compromise of any claim, loss or damage entered into by Contractor shall be binding upon the Indemnified Parties unless approved in writing by the Indemnified Parties. 4. Patent/Copyright Infringement Indemnification. Contractor shall, at its own expense, be entitled to and shall have the duty to participate in the defense of any suit instituted against the State and indemnify the State against any award of damages and costs made against the State by a final judgment of a court of last resort in such suit insofar as the same is based on any claim that any of the Services constitutes an infringement of any United States Letters Patent or copyright, provided the State gives the Contractor immediate notice in writing of the institution of such suit, permits Contractor to fully participate in the defense of the same, and gives Contractor all available information, assistance and authority to enable Contractor to do so. Subject to approval of the Attorney General of the State of Georgia, the State Entity shall 9 SPD -SP025 Revised 02/11/11 tender defense of any such action to Contractor upon request by Contractor. Contractor shall not be liable for any award of judgment against the State reached by compromise or settlement unless Contractor accepts the compromise or settlement. Contractor shall have the right to enter into negotiations for and the right to effect settlement or compromise of any such action, but no such settlement shall be binding upon the State unless approved by the State. In case any of the Services is in any suit held to constitute infringement and its use is enjoined, Contractor shall, at its option and expense: (i) Procure for the State the right to continue using the Services; (ii) Replace or modify the same so that it becomes non - infringing; or (iii) Remove the same and cancel any future charges pertaining thereto. Contractor, however, shall have no liability to the State if any such patent or copyright infringement or claim thereof is based upon or arises out of: (i) Compliance with designs plans or specifications furnished by or on behalf of the State Entity as to the Services; (ii) Use of the Services in combination with apparatus or devices not supplied by Contractor; (iii) Use of the Services in a manner for which the same was neither designed nor contemplated; or (iv) The claimed infringement of any patent or copyright in which the State Entity or any affiliate or subsidiary of the State Entity has any direct interest by license or otherwise. 5. Survives Termination. The indemnification obligation of the Contractor shall survive termination of the Contract. H. INSURANCE Contractor shall provide all insurance as required. 1. BONDS The Contractor shall provide all required bonds in accordance with the terms, should there be any, and as stated in the State Entity Standard Contract Form. 10 SPD -SP025 J. WARRANTIES 1. Construction of Warranties Expressed in the Contract with Warranties Implied by Law. All warranties made by the Contractor and /or subcontractors in all provisions of the Contract and the Contractor's Response, whether or not the Contract specifically denominates the Contractor's and /or subcontractors' promise as a warranty or whether the warranty is created only by the Contractor's affirmation or promise, or is created by a description of the Services to be provided, or by provision of samples to the State shall not be construed as limiting or negating any warranty provided by law, including without limitation, warranties which arise through course of dealing or usage of trade, the warranty of merchantability, and the warranty of fitness for a particular purpose. The warranties expressed in the Contract are intended to modify the warranties implied by law only to the extent that they expand the warranties applicable to the Services provided by the Contractor. The provisions of this section apply during the term of the Contract and any extensions or renewals thereof. 2. Warranty — Nonconforming Services and Goods. All Services and any goods delivered by Contractor to the State Entity shall be free from any defects in design, material, or workmanship. If any Services or goods offered by the Contractor are found to be defective in material or workmanship, or do not conform to Contractor's warranty, the State Entity shall have the option of returning, repairing, or replacing the defective Services or goods at Contractor's expense. Payment for Services and any goods shall not constitute acceptance. Acceptance by the State Entity shall not relieve the Contractor of its warranty or any other obligation under the Contract. 3. Compliance with Federal Safety Acts. Contractor warrants and guarantees to the State that the Services provided under the Contract are in compliance with Sections 5 and 12 of the Federal Trade Commission Act; the Fair Packaging and Labeling Act; the Federal Food, Drug, and Cosmetic Act; the Consumer Product Safety Act; the Federal Environmental Pesticide Control Act; the Federal Hazardous Substances Act; the Fair Labor Standards Act; the Wool Products Labeling Act; the Flammable Fabrics Act; the Occupational Safety and Health Act; the Office of Management and Budget A -110 Appendix A; and the Anti - Kickback Act of 1986. 4. Originality and Title to Concepts, Materials, and Goods Produced. Contractor represents and warrants that all the concepts, materials, goods and Services produced, or provided to the State pursuant to the terms of the Contract shall be wholly original with the Contractor or that the Contractor has secured all applicable interests, rights, licenses, permits or other intellectual property rights in such concepts, materials and works. The Contractor represents and warrants that the concepts, materials, goods and Services and the State's use of same and the exercise by the State of the rights granted by the Contract shall not infringe upon any other work, other than material provided by the Contract to the Contractor to be used as a basis for such materials, or violate the rights of publicity or privacy of, or constitute a libel or slander against, any person, firm or corporation and that the concepts, materials and works will not infringe upon the copyright, trademark, trade name, trade dress patent, literary, dramatic, statutory, common law or any other rights of any person, firm or corporation or other entity. The Contractor represents and warrants that it is the owner of or otherwise has the right to use and distribute the goods and Services contemplated by the Contract. 5. Conformity with Contractual Requirements. The Contractor represents and warrants that the Services provided in accordance with the Contract will appear and operate in conformance with the terms and conditions of the Contract. 6. Authority to Enter into Contract. The Contractor represents and warrants that it has full authority to enter into the Contract and that it has not granted and will not grant any right or Revised 02/11/11 11 SPD -SP025 Revised 02/11/11 interest to any person or entity that might derogate, encumber or interfere with the rights granted to the State and the State Entity. 7. Obligations Owed to Third Parties. The Contractor represents and warrants that all obligations owed to third parties with respect to the activities contemplated to be undertaken by the Contractor pursuant to the Contract are or will be fully satisfied by the Contractor so that the State and the State Entity will not have any obligations with respect thereto. 8. Title to Property. The Contractor represents and warrants that title to any property assigned, conveyed or licensed to the State is good and that transfer of title or license to the State is rightful and that all property shall be delivered free of any security interest or other lien or encumbrance. Title to any supplies, materials, or equipment shall remain in the Contractor until fully paid for by the State Entity. Except as otherwise expressly authorized by the State Entity, all materials produced by Contractor personnel in performance of Services, including but not limited to software, charts, graphs, diagrams, video tapes and other project documentation shall be deemed to be work made for hire and shall be the property of the State of Georgia. 9. Industry Standards. The Contractor represents and expressly warrants that all aspects of the Services provided or used by it shall at a minimum conform to the standards in the Contractor's industry. This requirement shall be in addition to any express warranties, representations, and specifications included in the Contract, which shall take precedence. 10. Contractor's Personnel and Staffing. Contractor warrants that all persons assigned to perform Services under this Contract are either lawful employees of Contractor or lawful employees of a subcontractor authorized by the State Entity as specified in the RFX. All persons assigned to perform Services under this Contract shall be qualified to perform such Services. Personnel assigned by Contractor shall have all professional licenses required to perform the Services. 11. State Security. State Entity requires that a criminal background investigation be made of any and all Contractor personnel utilized to provide Services to the State. Contractor represents and warrants that Contractor shall refrain from assigning personnel to any task under this Contract if such investigation reveals a disregard for the law or other background that indicates an unacceptable security risk as determined by the State. The Contractor's employees, agents and subcontractors may be granted access to state computers, hardware, software, programs and /or information technology infrastructure or operations to the extent necessary to carry out the Contractor's responsibilities under the Contract. Such access may be terminated at the sole discretion of the State. The Contractor shall provide immediate notice to State Entity of any employees, agents and /or subcontractors suspected of abusing or misusing such access privilege. The Contractor represents and warrants that Contractor shall provide notice to State Entity of the changed status of any employee, agent or subcontractor granted access to state computers, hardware, software, programs and /or information technology infrastructure or operations, including, but not limited to, termination or change of the position or contract relationship. 12. Use of State Vehicles. Contractor warrants that no State vehicles will be used by Contractor for the performance of Services under this Contract. Contractor shall be responsible for providing transportation necessary to perform all Services. 12 SPD -SP025 K. PRODUCT RECALL If this Contract includes the provision of goods and in the event that any of the goods are found by the Contractor, the State, any governmental agency, or court having jurisdiction to contain a defect, serious quality or performance deficiency, or not to be in compliance with any standard or requirement so as to require or make advisable that such goods be reworked or recalled, the Contractor will promptly communicate all relevant facts to the State Entity and undertake all corrective actions, including those required to meet all obligations imposed by laws, regulations, or orders, and shall file all necessary papers, corrective action programs, and other related documents, provided that nothing contained in this section shall preclude the State Entity from taking such action as may be required of it under any such law or regulation. The Contractor shall perform all necessary repairs or modifications at its sole expense except to any extent that the Contractor and the State shall agree to the performance of such repairs by the State upon mutually acceptable terms. L. CONTRACT ADMINISTRATION 1. Order of Preference. In the case of any inconsistency or conflict among the specific provisions of the State Entity Standard Contract Terms and Conditions (including any amendments accepted by both the State Entity and the Contractor attached hereto), the RFX (including any subsequent addenda), and the Contractor's Response, any inconsistency or conflict shall be resolved as follows: (i) First, by giving preference to the specific provisions of the State Entity Standard Contract Terms and Conditions. (ii) Second, by giving preference to the specific provisions of the RFX. (iii) Third, by giving preference to the specific provisions of the Contractor's Response, except that objections or amendments by a Contractor that have not been explicitly accepted by the State Entity in writing shall not be included in this Contract and shall be given no weight or consideration. 2. Intent of References to Bid Documents. The references to the parties' obligations, which are contained in this document, are intended to supplement or clarify the obligations as stated in the RFX and the Contractor's Response. The failure of the parties to make reference to the terms of the RFX or the Contractor's Response in this document shall not be construed as creating a conflict and will not relieve the Contractor of the contractual obligations imposed by the terms of the RFX and the Contractor's Response. The contractual obligations of the State Entity cannot be implied from the Contractor's Response. 3. Compliance with the Law. The Contractor, its employees, agents, and subcontractors shall comply with all applicable federal, state, and local laws, rules, ordinances, regulations and orders now or hereafter in effect when performing under the Contract, including without limitation, all laws applicable to the prevention of discrimination in employment and the use of targeted small businesses as subcontractors or contractors. The Contractor, its employees, agents and subcontractors shall also comply with all federal, state and local laws regarding business permits and licenses that may be required to carry out the work performed under the Contract. Contractor and Contractor's personnel shall also comply with all State and State Entity policies and standards in effect during the performance of the Contract, including but not limited to the State Entity's policies and standards relating to personnel conduct, security, safety, confidentiality, and ethics. Further, the provisions of O.C.G.A. Section 45 -10 -20 et seq. have not and must not be violated under the terms of this Contract. Revised 02/11/11 13 SPD -SP025 4. Drug -free Workplace. The Contractor hereby certifies as follows: (i) Revised 02/11/11 Contractor will not engage in the unlawful manufacture, sale, distribution, dispensation, possession, or use of a controlled substance or marijuana during the performance of this Contract; and (ii) If Contractor has more than one employee, including Contractor, Contractor shall provide for such employee(s) a drug -free workplace, in accordance with the Georgia Drug -free Workplace Act as provided in O.C.G.A. Section 50 -24-1 et seq., throughout the duration of this Contract; and (iii) Contractor will secure from any subcontractor hired to work on any job assigned under this Contract the following written certification: "As part of the subcontracting agreement with (Contractor's Name), (Subcontractor's Name) certifies to the contractor that a drug -free workplace will be provided for the subcontractor's employees during the performance of this Contract pursuant to paragraph 7 of subsection (b) of Code Section 50- 24-3." Contractor may be suspended, terminated, or debarred if it is determined that: (i) Contractor has made false certification here in above; or (ii) Contractor has violated such certification by failure to carry out the requirements of O.C.G.A. Section 50- 24 -3(b). 5. Amendments. The Contract may be amended in writing from time to time by mutual consent of the parties. If the contract award exceeds the delegated purchasing authority of the State Entity, then the State Entity must obtain approval of the amendment from the Department of Administrative Services (DOAS). All amendments to the Contract must be in writing and fully executed by duly authorized representatives of the State Entity and the Contractor. 6. Third Party Beneficiaries. There are no third -party beneficiaries to the Contract. The Contract is intended only to benefit the State Entity, the State, and the Contractor. 7. Choice of Law and Forum. The laws of the State of Georgia shall govern and determine all matters arising out of or in connection with this Contract without regard to the choice of law provisions of State law. In the event any proceeding of a quasi-judicial or judicial nature is commenced in connection with this Contract, such proceeding shall solely be brought in a court or other forum of competent jurisdiction within Fulton County, Georgia. This provision shall not be construed as waiving any immunity to suit or liability, including without limitation sovereign immunity, which may be available to the State. 8. Parties' Duty to Provide Notice of Intent to Litigate and Right to Demand Mediation. In addition to any dispute resolution procedures otherwise required under this Contract or any informal negotiations which may occur between the State and the Contractor, no civil action with respect to any dispute, claim or controversy arising out of or relating to this Contract may be commenced without first giving fourteen (14) calendar days written notice to the State of the claim and the intent to initiate a civil action. At any time prior to the commencement of a civil action, either the State or the Contractor may elect to submit the matter for mediation. Either the State or the Contractor may exercise the right to submit the matter for mediation by providing the other party with a written demand for mediation setting forth the subject of the dispute. The parties will cooperate with one another in selecting a mediator and in scheduling 14 SPD -SP025 Revised 02/11/11 the mediation proceedings. Venue for the mediation will be in Atlanta, Georgia; provided, however, that any or all mediation proceedings may be conducted by teleconference with the consent of the mediator. The parties covenant that they will participate in the mediation in good faith and that they will share equally in its costs; provided, however, that the cost to the State shall not exceed five thousand dollars ($5,000.00). All offers, promises, conduct and statements, whether oral or written, made in the course of the mediation by any of the parties, their agents, employees, experts and attorneys, and by the mediator or employees of any mediation service, are inadmissible for any purpose (including but not limited to impeachment) in any litigation or other proceeding involving the parties, provided that evidence that is otherwise admissible or discoverable shall not be rendered inadmissible or non - discoverable as a result of its use in the mediation. Inadmissibility notwithstanding, all written documents shall nevertheless be subject to the Georgia Open Records Act, O.C.G.A. Section 50 -18 -70 et seq. No party may commence a civil action with respect to the matters submitted to mediation until after the completion of the initial mediation session, forty-five (45) calendar days after the date of filing the written request for mediation with the mediator or mediation service, or sixty (60) calendar days after the delivery of the written demand for mediation, whichever occurs first. Mediation may continue after the commencement of a civil action, if the parties so desire. 9. Assignment and Delegation. The Contract may not be assigned, transferred or conveyed in whole or in part without the prior written consent of the State Entity. For the purpose of construing this clause, a transfer of a controlling interest in the Contractor shall be considered an assignment. 10. Use of Third Parties. Except as may be expressly agreed to in writing by the State Entity, Contractor shall not subcontract, assign, delegate or otherwise permit anyone other than Contractor or Contractor's personnel to perform any of Contractor's obligations under this Contract or any of the work subsequently assigned under this Contract. No subcontract which Contractor enters into with respect to performance of obligations or work assigned under the Contract shall in any way relieve Contractor of any responsibility, obligation or liability under this Contract and for the acts and omissions of all subcontractors, agents, and employees. All restrictions, obligations and responsibilities of the Contractor under the Contract shall also apply to the subcontractors. Any contract with a subcontractor must also preserve the rights of the State Entity. The State Entity shall have the right to request the removal of a subcontractor from the Contract for good cause. 11. Integration. The Contract represents the entire agreement between the parties. The parties shall not rely on any representation that may have been made which is not included in the Contract. 12. Headings or Captions. The paragraph headings or captions used in the Contract are for identification purposes only and do not limit or construe the contents of the paragraphs. 13. Not a Joint Venture. Nothing in the Contract shall be construed as creating or constituting the relationship of a partnership, joint venture, (or other association of any kind or agent and principal relationship) between the parties thereto. Each party shall be deemed to be an independent contractor contracting for the Services and acting toward the mutual benefits expected to be derived here from. Neither Contractor nor any of Contractor's agents, servants, employees, subcontractors or contractors shall become or be deemed to become agents, servants, or employees of the State. Contractor shall therefore be responsible for compliance with all laws, rules and regulations involving its employees and any 15 SPD -SP025 Revised 02/11/11 subcontractors, including but not limited to employment of labor, hours of labor, health and safety, working conditions, workers' compensation insurance, and payment of wages. No party has the authority to enter into any contract or create an obligation or liability on behalf of, in the name of, or binding upon another party to the Contract. 14. Joint and Several Liabilities. If the Contractor is a joint entity, consisting of more than one individual, partnership, corporation or other business organization, all such entities shall be jointly and severally liable for carrying out the activities and obligations of the Contract, and for any default of activities and obligations. 15. Supersedes Former Contracts or Agreements. Unless otherwise specified in the Contract, this Contract supersedes all prior contracts or agreements between the State Entity and the Contractor for the Services provided in connection with the Contract. 16. Waiver. Except as specifically provided for in a waiver signed by duly authorized representatives of the State Entity and the Contractor, failure by either party at any time to require performance by the other party or to claim a breach of any provision of the Contract shall not be construed as affecting any subsequent right to require performance or to claim a breach. 17. Notice. Any and all notices, designations, consents, offers, acceptances or any other communication provided for herein shall be given in writing by registered or certified mail, return receipt requested, by receipted hand delivery, by Federal Express, courier or other similar and reliable carrier which shall be addressed to the person who signed the Contract on behalf of the party at the address identified in the State Entity Standard Contract Form. Each such notice shall be deemed to have been provided: (i) at the time it is actually received; or, (ii) within one (1) day in the case of overnight hand delivery, courier or Services such as Federal Express with guaranteed next day delivery; or, (iii) within five (5) days after it is deposited in the U.S. Mail in the case of registered U.S. Mail From time to time, the parties may change the name and address of the person designated to receive notice. Such change of the designated person shall be in writing to the other party and as provided herein. 18. Cumulative Rights. The various rights, powers, options, elections and remedies of any party provided in the Contract shall be construed as cumulative and not one of them is exclusive of the others or exclusive of any rights, remedies or priorities allowed either party by law, and shall in no way affect or impair the right of any party to pursue any other equitable or legal remedy to which any party may be entitled as long as any default remains in any way unresolved, unsatisfied or not discharged. 19. Severability. If any provision of the Contract is determined by a court of competent jurisdiction to be invalid or unenforceable, such determination shall not affect the validity or enforceability of any other part or provision of the Contract. Further, if any provision of the Contract is determined to be unenforceable by virtue of its scope, but may be made enforceable by a limitation of the provision, the provision shall be deemed to be amended to the minimum extent necessary to render it enforceable under the applicable law. Any agreement of the State Entity and the Contractor to amend, modify, eliminate, or otherwise 16 SPD -SP025 change any part of this Contract shall not affect any other part of this Contract, and the remainder of this Contract shall continue to be of full force and effect. 20. Time is of the Essence. Time is of the essence with respect to the performance of the terms of the Contract. Contractor shall ensure that all personnel providing Services to the State are responsive to the State's requirements and requests in all respects. 21. Authorization. The persons signing this Contract represent and warrant to the other parties that: (i) It has the right, power and authority to enter into and perform its obligations under the Contract; and (ii) It has taken all requisite action (corporate, statutory or otherwise) to approve execution, delivery and performance of the Contract and the Contract constitutes a legal, valid and binding obligation upon itself in accordance with its terms. 22. Successors in Interest. All the terms, provisions, and conditions of the Contract shall be binding upon and inure to the benefit of the parties hereto and their respective successors, assigns and legal representatives. 23. Record Retention and Access. The Contractor shall maintain books, records and documents in accordance with generally accepted accounting principles and procedures and which sufficiently and properly document and calculate all charges billed to the State throughout the term of the Contract for a period of at least five (5) years following the date of final payment or completion of any required audit, whichever is later. Records to be maintained include both financial records and service records. The Contractor shall permit the Auditor of the State of Georgia or any authorized representative of the State, and where federal funds are involved, the Comptroller General of the United States, or any other authorized representative of the United States government, to access and examine, audit, excerpt and transcribe any directly pertinent books, documents, papers, electronic or optically stored and created records or other records of the Contractor relating to orders, invoices or payments or any other documentation or materials pertaining to the Contract, wherever such records may be located during normal business hours. The Contractor shall not impose a charge for audit or examination of the Contractor's books and records. If an audit discloses incorrect billings or improprieties, the State reserves the right to charge the Contractor for the cost of the audit and appropriate reimbursement. Evidence of criminal conduct will be turned over to the proper authorities. 24. Solicitation. The Contractor warrants that no person or selling agency (except bona fide employees or selling agents maintained for the purpose of securing business) has been employed or retained to solicit and secure the Contract upon an agreement or understanding for commission, percentage, brokerage or contingency. 25. Public Records. The laws of the State of Georgia, including the Georgia Open Records Act, as provided in O.C.G.A. Section 50 -18 -70 et seq., require procurement records and other records to be made public unless otherwise provided by law. 26. Clean Air and Water Certification. Contractor certifies that none of the facilities it uses to provide the Services are on the Environmental Protection State Entity (EPA) List of Violating Facilities. Contractor will immediately notify the State Entity of the receipt of any communication indicating that any of Contractor's facilities are under consideration to be listed on the EPA List of Violating Facilities. Revised 02/11/11 17 SPD -SP025 27. Debarred, Suspended, and Ineligible Status. Contractor certifies that the Contractor and /or any of its subcontractors have not been debarred, suspended, or declared ineligible by any agency of the State of Georgia or as defined in the Federal Acquisition Regulation (FAR) 48 C.F.R. Ch.1 Subpart 9.4. Contractor will immediately notify the State Entity if Contractor is debarred by the State or placed on the Consolidated List of Debarred, Suspended, and Ineligible Contractors by a federal entity. 28. Use of Name or Intellectual Property. Contractor agrees it will not use the name or any intellectual property, including but not limited to, State trademarks or logos in any manner, including commercial advertising or as a business reference, without the expressed prior written consent of the State. 29. Taxes. The State Entity is exempt from Federal Excise Taxes, and no payment will be made for any taxes levied on Contractor's employee's wages. The State Entity is exempt from State and Local Sales and Use Taxes on the services. If requested, Tax Exemption Certificates is furnished. Contractor or an authorized subcontractor has provided the State Entity with a sworn verification regarding the filing of unemployment taxes or persons assigned by Contractor to perform Services, which verification is incorporated herein by reference. 30. Certification Regarding Sales and Use Tax. By executing the Contract, the Contractor certifies it is either (a) registered with the State Department of Revenue, collects, and remits State sales and use taxes as required by Georgia law, including Chapter 8 of Title 48 of the O.C.G.A.; or (b) not a "retailer" as defined in O.C.G.A. Section 48 -8 -2. The Contractor also acknowledges that the State may declare the Contract void if the above certification is false. The Contractor also understands that fraudulent certification may result in the State Entity or its representative filing for damages for breach of contract. 31. Delay or Impossibility of Performance. Neither party shall be in default under the Contract if performance is delayed or made impossible by an act of God. In each such case, the delay or impossibility must be beyond the control and without the fault or negligence of the Contractor. If delay results from a subcontractor's conduct, negligence or failure to perform, the Contractor shall not be excused from compliance with the terms and obligations of the Contract. 32. Limitation of Contractor's Liability to the State. Except as otherwise provided in this Contract, Contractor's liability to the State for any claim of damages arising out of this Contract shall be limited to direct damages and shall not exceed the total amount paid to Contractor for the performance under this Contract. No limitation of Contractor's liability shall apply to Contractor's liability for loss or damage to State equipment or other property while such equipment or other property is in the sole care, custody, and control of Contractor's personnel. Contractor hereby expressly agrees to assume all risk of loss or damage to any such State equipment or other property in the care, custody, and control of Contractor's personnel. Contractor further agrees that equipment transported by Contractor personnel in a vehicle belonging to Contractor (including any vehicle rented or leased by Contractor or Contractor's personnel) shall be deemed to be in the sole care, custody, and control of Contractor's personnel while being transported. Nothing in this section shall limit or affect Contractor's liability arising from claims brought by any third party. 33. Obligations beyond Contract Term. The Contract shall remain in full force and effect to the end of the specified term or until terminated or canceled pursuant to the Contract. All obligations of the Contractor incurred or existing under the Contract as of the date of Revised 02/11/11 18 SPD -SP025 Revised 02/11/11 expiration, termination or cancellation will survive the termination, expiration or conclusion of the Contract. 34. Counterparts. The State Entity and the Contractor agree that the Contract has been or may be executed in several counterparts, each of which shall be deemed an original and all such counterparts shall together constitute one and the same instrument. 35. Further Assurances and Corrective Instruments. The State Entity and the Contractor agree that they will, from time to time, execute, acknowledge and deliver, or cause to be executed, acknowledged and delivered, such supplements hereto and such further instruments as may reasonably be required for carrying out the expressed intention of the Contract. 36. Transition Cooperation and Cooperation with other Contractors. Contractor agrees that upon termination of this Contract for any reason, it shall provide sufficient efforts and cooperation to ensure an orderly and efficient transition of services to the State or another contractor. The Contractor shall provide full disclosure to the State and the third -party contractor about the equipment, software, or services required to perform the Services for the State. The Contractor shall transfer licenses or assign agreements for any software or third - party services used to provide the Services to the State or to another contractor. Further, in the event that the State has entered into or enters into agreements with other contractors for additional work related to Services rendered under the Contract, Contractor agrees to cooperate fully with such other contractors. Contractor shall not commit any act, which will interfere with the performance of work by any other contractor. 19 SPD -SP025 G E O R G t o Tom D. Wiedmeier, PE Director October 25, 2012 Mr. Mickie Collins, Chief Operating Officer East Central Regional Hospital at Gracewood 100 Myrtle Boulevard Gracewood, GA 30812 Re: Water Operations and Lab Assistance Dear Mr. Collins: Enclosed is a proposal for Augusta Utilities (AU) to provide water plant operations assistance and lab services for East Central Regional Hospital at Gracewood's private water system. This proposal includes three visits to the water treatment plant per day, with chemical dosages being adjusted as necessary. Augusta Utilities will perform required lab testing, prepare and submit monthly operating reports to EPD and prepare an annual Consumer Confidence Report. This proposal does not include maintenance of treatment plant or distribution system components. Augusta Utilities proposes to provide these services at a monthly cost of $1,067. If this proposal is satisfactory to you, we will have a Memorandum of Understanding prepared. We are prepared to begin providing these services on December 1, 2012. Please contact me if you have questions or comments. Very truly yours, Tom D. Wiedmeier, P.E. Director TDW:cjw Enclosures Augusta Utilities 360 Bay Street — Suite 180 — Augusta, GA 30901 (706) 312 -4160 — Fax (706) 312 -4123 www.augustaga.gov AUGUSTA UTILITIES Proposal for Water Plant Operation and Laboratory Services for the Gracewood Campus of the East Central Regional Hospital The Gracewood Campus of the East Central Regional Hospital owns a private water system consisting of four wells (two active) and one groundwater treatment plant. The system is operated under permit number 121 -0008 issued by the Georgia Environmental Protection Division on January 12, 2007. The Augusta Utilities Department is a large public water and wastewater utility whose service area surrounds the Gracewood Campus. The Gracewood Campus has requested that Augusta Utilities provide a proposal to assist in the operation and monitoring of the Gracewood water system. In response to this request Augusta Utilities provides the following proposal. Water Plant Operation Augusta Utilities proposes to check the operation of the water treatment plant three times per day, seven days per week utilizing our operations staff located at the N. Max Hicks Water Treatment Plant. Operators will perform the following activities: 1. Monitor chemical concentrations in water and adjust dosages as needed. 2. Observe the functioning of equipment associated with the plant operations and report issues to appropriate Gracewood staff for action. 3. Assist in the training and oversight of Gracewood staff in performing additional system monitoring as needed. 4. Collect and store data documenting system operation. S. Prepare and submit Monthly Operating Reports to the Georgia EPD. 6. Prepare an annual Consumer Confidence Report for the Gracewood Campus to reproduce and distribute. Laboratory Services Augusta Utilities proposes to provide laboratory services in compliance with the system operating permit. These services will be performed by the Augusta central water quality laboratory and will consist of the following activities: 1. One site visit per month to collect water samples for analysis as required the system operating permit. 2. Analyses will be performed at the Augusta laboratory, the Georgia EPD laboratory or other laboratory as appropriate. 3. Documentation of analysis and results will be provided to the Gracewood Campus. 4. Perform other sampling and analysis as required by regulatory agencies. Cost for Services Augusta Utilities proposes to perform the stated services for a monthly fee of $1,066.82. Details of these costs are provided in Attachment A to this proposal. This fee would be fixed for 3 years at which time the costs will be reevaluated based on current conditions and experience with provision of these services. If a cost adjustment is needed the proposed revised cost will be submitted to the Gracewood Campus for consideration. Agreement Termination Augusta Utilities proposes that the agreement to provide services may be terminated by either party after providing a 60 -day notice of intent to do so. Task Rate Monthly Cost Annual Cost One site visit per 8 -hour shift (3 per day) to sample water for appropriate chemical content as needed to insure high quality drinking water and compliance with Gracewood's water system operating permit number 121- 0008. 1.5 Hours per day for a total of 45 hours per month at $14.20 per hour plus labor overhead of $ 4.97 = $19.17 per hour. $862.65 $10,351.80 Preparation and submission of Monthly Operating Report to Georgia EPD, Annual Consumer Confidence Report and other reports /submissions to regulatory agencies. Two microbiological samples at $50.00 each. $75.00 $900.00 Total for Water Plant Operation Services $937.65 $11,251.80 Task Rate Monthly Cost Annual Cost One site visit per month to collect water samples for analysis as required by Gracewood's water system operating permit number 121 -0008. 1 Hour per month at $14.20 per hour plus labor overhead of $ 4.97 = $19.17 per hour. $19.17 $230.04 Cost of monthly analysis at Augusta's Water Quality Laboratory for 2 microbiological samples per month as required by the system operating permit. Two microbiological samples at $50.00 each. $100.00 $1,200.00 Additional analyses as required by the system operating permit. $10.00 $120.00 Total for Laboratory Services $129.17 $1,550.04 Attachment A AUD Cost for Laboratory and Water Plant Operation Services to Gracewood Campus ory Services Operation Services Total for All Services $1,066.82 $12,801.84 DBHDD ECRH -P &CA -131 Georgia Department of Behavioral Health & Developmental Disabilities Frank W. Bent', Commissioner East Central Regional Hospital Augusta Campus • 3405 Mike Padgett Highway • Augusta, Georgia, 30906. 706 - 792 -7006 Gracewood Campus • 100 Myrtle Boulevard • Gracewood, Georgia, 30812.706- 790 -2011 Procurement & Contract Administration Tom Hester Drive, Building 8, Room 11 Augusta, GA 30906 November 6.2012 Mr. Tom D. Weidmeier, PE Director City of Augusta Utilities , 0000013727 360 Bay Street, Suite 180 Augusta, GA 30901 Re: Water Operations and Lab Assistance Dear Mr. Weidmeier: November 28. 2012 Enclosed is information gathering documentation needed to establish contractual agreement between Department of Behavioral Health; East Central Regional Hospital (ECRH), and City of Augusta Utilities. We have reviewed the proposal to provide water plant operations assistance and lab services for ECRH at Gracewood's private water system. We understand the services to include three visits to the water treatment plant per day, with chemical dosages being adjusted as necessary. We further understand Augusta Utilities will perform required lab testing, prepare and submit monthly operating reports to EPD and prepare an annual Consumer Confidence Report. We do also understand that, the proposal does not include maintenance of treatment plant or distribution system components. We understand this not to include any chemical agents needed; agency will supply. • that your company's legal name and legal address for payment remittance appear correct as presented on the Purchase Order Number. 44100- 015 - 00000 -54960 • that your stated deliverables as stated on the Purchase Order are stated to your understanding, and, • that the payment procedures reflect your understanding and agreement If the items mentioned above are correct, please complete Section 7 of SPD- SP025, State of Georgia State Entity Standard Contract Form. Then please complete documents and date/sign contract and submit applicable annexes. Please return the documents directly to me at the address listed below. An electronic copy of the executed contract will be returned to you for your files. If you would like an original copy of the contract as well, please submit two copies for execution and one will be mailed back to you. In keeping with the department's policy, a signed contract must be in place before service can begin; therefore, I ask you to return the signed contract and applicable annexes as soon as possible to allow for internal processing. A copy of the purchase order is provided for your accounts receivable department. The Purchase Order Number (PO) last five digits only, need to appear on all invoices and correspondence. The Billing address to mail all original invoices to is: DBHDD -East Central Regional Hospital Attn: Accounts Payable Supervisor Administration Bldg 8 Gracewood, GA 30812 1 Please contact me if you have questions or comments. l �. 0 0 4...)„,„14 Alicia Marie Bing, GCPCA Manager Respe Enclosures: (revisions 11.28.2012) cc: Mickie Collins, Chief Operations Officer Candace S. Walker, Financial Services Director Jacqueline M. Walker, Budget & Accounts Payable Lavelle R. Dunnum, Contracts Allen Saxon, Asst Dir, Augusta Utilities 2 Ship To: DBHDD -East Central Regional Hospital 3405 Mike Padgett Highway Property Control / Rec. Warehouse, Bldg 8 Augusta, GA 30906 1 -1 95895 2-1 95895 Svcs; Laboratory, samples, water quality(microbiological), offsite 3-1 95895 Vendor: 0000013727 CITY OF AUGUSTA AUGUSTA MUNICIPAL COURT 401 WALTON WAY AUGUSTA, GA 30901 -2496 Svcs; Laboratory, water sample analysis, site collection Svcs; Laboratory, analysis, miscellaneous, as required 4-1 95895 Svcs; Operations, Water Plant, on Site Purchase Order Purchase Order Type Date Revision 44100 - 015 - 0000054960 AC 11/14/2012 Page 1 Payment Terms Freight Terms Net 30 Destination Ship Via COMMON Buyer /Phone: Latrelle Dunnum 706/792 -7105 BiII To: DBHDD -East Central Regional Hospital Accounts Payable 100 Myrtle Blvd, P 0 Box 1299 Gracewood, GA 30812 I.ine -Sch Item Description Quantity UOM PO Price Extended Amt Due Date The State of Georgia Contract Terms and Conditions are applicable to this order. They can be viewed at: http:// www. doas. georgia. gov/ StateLocal/ SPD/ Docs_ SPD _General/terms- conditions.pdf Class IX - PLANT, PROPERTY, and INFRASTRUCTURE; MATERIALS, SERVICE SUPPLIES, EQUIPMENT, and SERVICES FOR FACILITIES SUPPORT and UPKEEP. T 4 Test, Measurement, and Diagnostic Equip and Services CUSTOMER ID: TERMS: 12 Months CONTRACT / PO: DBH0000028306 / 54960 START DTD: 12.01.2012 END DTD: 12.01.2016 CURRENT PERIOD: 12.01.2012 - 06.30.2013 (I) REPRESENTATIVE: Allen Saxon, Asst Dir, 706.312.4160, asaxon @augustaga.gov Accts Rec: Amy Russell, 706.312.4154, 706.312.4123(F), arussell @augustaga.gov Agency POC: Glenn Aaron, 706.790.2219, Facilities Maintenance, gwaaron@dbhdd.ga.gov Accs Pay: Donald Pyles, 706.790.2044, dlpyles@dbhdd.ga.gov Contract: LaTrelle Dunnum, 706.792.7105, 706.434.4246efax, ldunnum@dbhdd.ga.gov One site visit per month to collect water samples for analysis as required by Gracewood's water system operating permit number 121 -0008. 1 Hr per mon @14.20 per + lab ovhd 4.97. » All shipments, shipping papers, invoices, and correspondence must be identified with our Purchase Order Number. Overshipments will not be accepted unless authorized by Buyer prior to shipment. 7.0000 WHR 19.1700 Item Total 14.0000 EA 50.0000 Two microbiological samples analysis performed as Augusta's Water Quality Laboratory per month » Item Total 7.0000 EA 10.0000 Item Total 315.0000 WHR 19.1700 One site visit per 8 -hour shift(3 per day) to sample water for appropriate chemical content as needed to insure high quality drinking water and compliance with Gracewood's water system operating permit number 121 -0008. 1.5 Hr /day *45 Mon @14.20 per + lab ovhd 4.97 » ut orize Signature 134.19 11/14/2012 134.19 700.00 11/14/2012 700.00 70.00 11/14/2012 70.00 6,038.55 11/14/2012 Ship To: DBHDD -East Central Regional Hospital 3405 Mike Padgett Highway Property Control / Rec. Warehouse, Bldg 8 Augusta, GA 30906 Vendor: 0000013727 CITY OF AUGUSTA AUGUSTA MUNICIPAL COURT 401 WALTON WAY AUGUSTA, GA 30901 -2496 Line -Sch Item Description Quantity UOM PO Price Extended Amt Due Date 5-1 95895 Svcs; Operations, Reports, Preparation and Submission Preparation and submission of Monthly Operating and others. Purchase Order All shipments, shipping papers, invoices, and correspondence must be identified with our Purchase Order Number. Overshipments will not be accepted unless authorized by Buyer prior to shipment. Purchase Order Type Date Revision 44100 - 015 0000054960 AC 11/14/2012 Page 2 Payment Terms Freight Terms Net 30 Destination Ship Via COMMON Buyer /Phone: Latrelle Dunnum 706/792 -7105 Bill To: DBHDD -East Central Regional Hospital Accounts Payable 100 Myrtle Blvd, P O Box 1299 Gracewood, GA 30812 7.0000 EA Item Total Item Total Total PO Amount ut orize Signature 75.0000 6,038.55 525.00 11/14/2012 Report to Georgia EDP, Annual Consumer Confidence Report Agency Agreement established to outsource facility's Water Treatment Services to City of Augusta. City of Augusta proposal that was reviewed by DBHDD's Central Office. 525.00 7,467.741 Contract Administrator: Alicia Marie Bing, P&CA Mgr Email: Ambingl (a�dbadd.ga.gov Phone: 706.771.4803 Contract Number: 44100.015.00000 -54960 Expiration date: Thursday, December 1. 2016 Contract Title: Water Operations and Lab Assistance Renewal options: 2 —12 month / 1 — 5 month Supplier awarded: City of Augusta Utilities, (0000013727) Estimated annual spend: $ 12,801.84 Supplier address: 360 Bay Street, Suite 180 Augusta, GA 30901 Supplier Key Contact(s): Name: Tom D. Weidmeier, PE, Director Or, Mr. Allen Saxon, Asst Dir Address: 360 Bay Street, Suite 180, Augusta, GA 30901 Phone: 706.312.4160 Email: tomw asaxon@augustaga.gov Contract date: Saturday, December 1. 2012 Savings estimate, if any: $20,000.00 yearly Contract Administration Plan Revised 11.28.201 2 -anb Core State Entities and estimated spend, if available: Over the next thirty -six months, $38,405.52. The expectation is that this will become a permanent service. Fixed pricing is partly based on City of Augusta current wage scales. This is subject to change at the three year interval. Contract description: Water plant operations and monitoring of the Gracewood water system. To observe the plant operations and report issues that agency staff will have responsibility to take appropriate actions. Laboratory site and off -site analysis of water collections samples, and documentation of findings as required by regulatory agencies. Key requirements and activities: Observe equipment functioning, assist in the training and oversight of Gracewood staff performance of additional system monitoring, collect and store data documenting system operations, prepare and submit Monthly Reports to Georgia EPD, and to prepare an annual Consumer Confidence Report for Gracewoods's reproduction and distribution. -Letter of Proposal from City of Augusta Utilities -SCOPE - Proposal for Water Plant Operation and Laboratory Services for the Gracewood Campus of the East Central Regional Hospital - Attachment A — AUD Cost for Laboratory and Water Plant Operation Services to Gracewood Campus (all documents attached to SPD- SP025) Revised 02/10/11 SPD -CP016 Renewal Options (if any): Exercised 1 Renewal? ❑ Yes ❑ No Renewal Period: 07.01.2013 through 06.30.2014 Exercised 2nd Renewal? ❑ Yes ❑ No Renewal Period: 07.01.2014 through 06.30.2015 Exercised 3 Renewal? ❑ Yes ❑ No Renewal Period: 07.01.2015 through 12.01.2016 Exercised 4th Renewal? ❑ Yes ❑ No Renewal Period: through State Entity: DBHDD -East Central Regional Hospital Date: 11/2 F /z..® /-).— Supplier Name: City of Augusta Utilities Supplier ID: 0000013727 Contract Number: 44100- 015 -00000 -54960 Award Date: Saturday, 11.30.2012 Contract Title: Water Operations and Lab Assistance NIGP Code(s): 95895, 98991, 96891, 95895 Buyer's Last Name: BING Contract Type: ❑ Open ❑ Fixed Statewide State Entity Address Supplier Address Street: 100 Myrtle Blvd, Bldg 93 Street: 360 Bay Street, Suite 180 City: Gracewood State GA City: Augusta State GA Zip: 30812 Zip: 30901 Effective Date: Reason for Contract Close Out: ❑ Supplier Completed Performance ❑ Terminated for Convenience ❑ Contract Expired ❑ Terminated for Cause ❑ Terminated for Lack of Funding Department of Administrative Services State Purchasing Division CONTRACT ACTION SUMMARY FORM Contract Information: Revised 11.28.2012 math- Revised: 02/11/11 Contact Information: Performance Period: Initial Term: Effective Date: I Saturday, 12.01.2012 Expiration Date: I Sunday, June 30. 2013 Amendment(s): Amendment Number: Effective Date: Brief Description: Contract Close Out: • Georgia SPD -CP007 Department of Administrative Services State Purchasing Division Special Notes 1. Georgia Notes: Revised: 02/11/11 SPD -CP007 c e 0 t; 6 t 1 Donna B. Williams. CGFM Sandra M. Wright, CWCP Director Risk Management Manager November 27, 2012 Alicia M. Bing DBHDD -ECRH, P &CA Agency Procurement Officer 3405 Mike Padgett Hwy, Bldg 8, Rm 11 Augusta, GA 30906 RE: Self - Funding Liabilities Verification Letter Dear Ms. Bing, FINANCE DEPARTMENT RISK MANAGEMENT DIVISION As Augusta - Richmond County, Georgia is a local government pursuant to the "Home Rule Act ", liability claims are handled in -house through the Risk Management Division of the Finance Department and any settlement awards are paid from available Commission funds. Augusta - Richmond County, Georgia does not carry commercial liability insurance coverage on its fleet, equipment/machinery or liability coverage on its operations. Augusta is self insured for its Worker's Compensation liability exposure but does carry excess liability insurance for this area. Damages to property are handled in -house through the Risk Management Division of the Finance Department and available funds are used to repair or replace damaged items. Under contract agreements, the Augusta Commission will fulfill its obligation under the agreement as if there were insurance to cover the loss. Please be advised that Augusta- Richmond County, Georgia is entitled to the defense of sovereign immunity, Sincerely, f Donna Williams Finance Director 530 Greene Street.. Room 217 Augusta. Georgia 30401 (706) 821 -2301 (Office) (706) 821.2502 (Fax) ww,Arta siAtiA.(aov Contractor's Name: City of Augusta - Richmond County, Augusta Water Utilities Department (0000013727) State Entity's Name: Department of Behavioral Health & Developmental Disabilities; East Central Regional Hospital State Solicitation/ Contract No.: 44100.015.00000 -54960 IMMIGRATION AND SECURITY FORM (GEORGIA SECURITY AND IMMIGRATION COMPLIANCE ACT A}I!II)AVIT) By executing this affidavit, the undersigned Contractor verifies its compliance with O.C.G.A. §13-10- 91, stating affirmatively that the Contractor identified above has registered with and is participating in a federal work authorization program *, in accordance with the applicability provisions and deadlines established in O.C.G.A. 13- 10 -91. The undersigned further agrees that, should it employ or contract with any subcontractor(s) in connection with the physical performance of services pursuant to this contract with the State Entity, Contractor will secure from such subcontractor(s) similar verification of compliance with O.C.G.A. § 13 -10 -91 on the attached Subcontractor Affidavit. Contractor further agrees to maintain records of such compliance and provide a copy of each such verification to the State Entity at the time the subcontractor(s) is retained to perform such service. 46923 EEV / E- Verify Company Identification Number BY: Authorized Officer or Agent Date Mit Y. st... Title of Authorized Officer or Agent of Contractor -PA 5 • C AEP k{r Printed Name of Authorized Officer or Agent SUBSCRIBED AND SWORN BEFO ME ON THIS THE DA OF Notary My Commission Expires: 0// air Georgia CONTRACTOR AFFIDAVIT LOZ `L1 'AON sau!dx uo!ss!wwoO AtAl *MOO puotu ! i `oggnd 'LIMN [NOTARY SEAL] *any of the electronic verification of work authorization programs operated by the United States Department of Homeland Security or any equivalent federal work authorization program operated by the United States Department of Homeland Security to verify information of newly hired employees, pursuant to the Immigration Reform and Control Act of 1986 (IRCA), P.L. 99 -603 Revised 11/08/11 SPD -SP054 Contractor's Name: City of Augusta - Richmond County, Augusta Water Utilities Department (0000013727) Subcontractors: None State Solicitation/ Contract No.: 44100.015.00000 -54960 Contractor's Name: City of Augusta - Richmond County, Augusta Water Utilities Department (0000013727) State Entity's Name: Department of Behavioral Health & Developmental Disabilities; East Central Regional Hospital State Solicitation/ Contract No.: 44100.015.00000 -54960 Georgia IMMIGRATION AND SECURITY FORM (GEORGIA SECURITY AND IMMIGRATION COMPLIANCE ACT AFFIDAVIT) ADDITIONAL INSTRUCTIONS TO CONTRACTOR: Identify all subcontractors used to perform under the state contract. In addition, you must attach a signed and notarized affidavit (third page of this form) from each of the subcontractors listed below. The contractor is responsible for providing a signed and notarized affidavit to the State Entity within five (5) days of the addition of any new subcontractor used to perform under the identified state contract. Revised 11/08/11 SPD -SP054 Contractor's Name: City of Augusta - Richmond County, Augusta Water Utilities Department (0000013727) Subcontractor's (Your) Name: None State Entity's Name: Department of Behavioral Health & Developmental Disabilities; East Central Regional Hospital State Solicitation/ Contract No.: 44100.015.00000 -54960 Georgia IMMIGRATION AND SECURITY FORM (GEORGIA SECURITY AND IMMIGRATION COMPLIANCE ACT AFFIDAVIT) By executing this affidavit, the undersigned Subcontractor verifies its compliance with O.C.G.A. §13- 10-91, stating affirmatively that the Subcontractor which is engaged in the physical performance of services under a contract with the Contractor identified above on behalf of the State Entity identified above has registered with and is participating in a federal work authorization program *, in accordance with the applicability provisions and deadlines established in O.C.G.A. 13- 10 -91. EEV / E- Verify Company Identification Number BY: Authorized Officer or Agent Date (Subcontractor Name) Title of Authorized Officer or Agent of Contractor Printed Name of Authorized Officer or Agent SUBSCRIBED AND SWORN BEFORE ME ON THIS THE Notary Public DAY OF , 20 My Commission Expires: (01 SUBCONTRACTOR AFFIDAVIT [NOTARY SEAL] *any of the electronic verification of work authorization programs operated by the United States Department of Homeland Security or any equivalent federal work authorization program operated by the United States Department of Homeland Security to verify information of newly hired employees, pursuant to the Immigration Reform and Control Act of 1986 (IRCA), P.L. 99-603 Revised 11/08/11 SPD -SP054 Georgia TAX COMPLIANCE INSTRUCTIONS TO SUPPLIERS Please complete the following information: • Supplier's Name: City of Augusta - Richmond County, Augusta Water Utilities Department (0000013727) • Physical Location Address: 360 Bay St, Suite 180, Augusta, GA 30901 • Federal Identification Number (FEI): 58- 2204274 • Have you ever been registered in the State of Georgia? No • If so, please provide the following information, if applicable: o State Taxpayer Identification Number (STI): o Sales and Use Tax Number: o Withholding Tax Number: • What type of service will you perform? Water Operations and Laboratory Assistance • Will you sell any tangible personal property or goods? No • Supplier's Affiliate's Name: None o FEI: o STI: o Sales and Use Tax Number: o Withholding Tax Number: If there is more than one affiliate, please attach a separate sheet listing the information above. • Person responsible for handling supplier's tax issues (such as the CFO, the company tax officer, etc.): o Name: Steven Little o Telephone Number: 706 -312 -4124 o E -mail Address: slittle @augustaga.gov NOTICE TO SUPPLIER: In the event the supplier is considered for contract award, the information provided in the form will be submitted by the State Entity to the Georgia Department of Revenue ( "DOR ") for a determination as to whether the supplier is a "prohibited source" (as defined by O.C.G.A. §50 -5 -82) or whether there are any other outstanding tax issues. MISSING, INCOMPLETE, OR ERRONEOUS DATA MAY DELAY OR PROHIBIT VERIFICATION OF YOUR ELIGIBILITY FOR CONTRACT AWARD. NO PROHIBITED SOURCE MAY RECEIVE CONTRACT AWARD; THEREFORE, YOU ARE STRONGLY ENCOURAGED TO CHECK YOUR TAX STATUS NOW AND RESOLVE ANY OUTSTANDING TAX LIABILITIES AND /OR MISSING TAX RETURNS. STATE ENTITY: Please submit this form via email to DOR at tsd- state- contractors@a,dor.ga.gov for processing in accordance with the Georgia Procurement Manual. Revised: 12/22/2010 SPD -SPO45 OF_ 4 E cam: VENDOR MANAGEMENT FORM (PeopleSoft Financial System) The initiating Agency will submit this form to the Vendor Management Group for verification and approval. Agency must complete section 5 of the form to obtain approval. SECTION 1 VENDOR IDENTIFICATION (COMPLETE ALL APPLICABLE FIELDS) VENDOR NUMBER: 13727 FEI /SSN /EMP ID NUMBER: 58- 2204274 VENDOR NAME: Augusta Richmond County PAYMENT ALT NAME: (IF CHECK IS TO BE PAYABLE IN A DIFFERENT NAME) Augusta Utilities Department ADDRESS: Greene Street ADDRESS CONT: CITY: Augusta STATE: GA ZIP CODE: 30901 COUNTRY: USA PHONE NUMBER: (706) 312 -4154 FAX NUMBER: (706) 312 -4123 EMAIL: arussell @augustaga.gov SECTION 2 — BANK ACCOUNT INFORMATION (ATTACH COPY OF VOIDED CHECK) ROUTING # BANK ACCOUNT # Mi = Check here if General Bank Account can be used by ALL State of Georgia agencies making payments Check here if this account can only be used for a SPECIFIC purpose (Indicate specific purpose for which this account can be used) I authorize the State of Georgia to deposit payment for goods or services received into the provided bank account by the Automated Clearing House (ACH). I further acknowledge that this agreement is to remain in full effect until such time as changes to the bank account information are submitted in writing by the vendor or individual named above. I understand it is the sole responsibility of the vendor or individual to notify the State of Georgia of any changes to the bank account information. (Vendor Printed Name) (Vendor Signature) (Date) SECTION 3 — SPECIFY TYPE OF ACTION (CHECK ALL THAT APPLY) MI New Vendor MI Employee M 1099 Code 0 Classification Change IIIII Add address MI FEI/TIN Change** M Name Change** Q Change of Address: Address # • Right of Way Purchase Vendor Deactivation - IM •1111 Bank Account Add Documentation for Vendor Name /TIN changes must include Confirmation from Secretary of State's office of legal name SIC CODES (CHECK ALL THAT APPLY) Small Business E= Women Owned p GA Based Business IO Minority Business Certified Fleet Anywhere Vendor i Other (provide details in Section 4) Bank Account Change — Bank Account Delete at least one of the following: IRS documentation (tax documents, FEI issuance letter, etc); change OR a newly completed W -9 form provided by the vendor. CI Minority Business Enterprise Cl African American 1= Asian American p Hispanic- Latino p Native American p Pacific Islander SECTION 4 — ADDITIONAL COMMENTS SECTION 5 — STATE OF GEORGIA AGENCY CONTACT INFORMATION (OFFICE USE ONLY) Requestor Name: Angela Emerson Agency BUM 44100 Date: Email: anemerson @dhr.state.ga.us Phone: (404) 463 -2740 Fax #: (770) 359 -1818 Form W -9 (Rev. January 2011) Depertment ot the Treasury Hemel Remus Service g Pnrt 1 Sign Here Name (as shown on your income tax return) AUGUSTA - RICHMOND COUNTY (AUGUSTA UTIUTIES is a department of ARC) Bushels s name/disregarded entity name. If different from above AUGUSTA UTILITIES DEPARTMENT OF AUGUSTA - RICHMOND COUNTY GOVERNMENT Check appropriate box for federal tax classification (required): ❑ individual/sole proprietor 0 C Corporation ❑ S Corporation ❑ Partnership 0 Tnantiestate 0 limited iiebiity company. Enter the tax classification (C=C corporation. S=S corporation. P=pa lnerehip) ► © other (see ins uctions)► LOCAL GOVERNMENT Address (number, street, and apt. or suite no.) 530 GREENE STREET City, state. and ZIP code AUGUSTA, GEORGIA 30901 List account numbers) he (optional) Taxpayer Identification Number (TIN) Certification Enter your 11N in the appropriate box. The TIN provided must match the name given on the "Name" line to avoid backup withholding. For individuals, this is your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3. Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose number to enter. Signstuas of U.B. person • Request for Taxpayer Identification Number and Certification 62kAzcaivL General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Purpose of Form A person who is required to file an information return with the IRS must obtain your correct taxpayer identification number (11N) 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 only if you are a U.S. person (including a resident alien), to provide your correct TIN to the person requesting it (the requester) and, when applicable, to: 1. Certify that the TIN you are giving is correct (or you are waiting for a number to be Issued), 2. Certify that you are not subject to backup withholding, or 3. Claim exemption from backup withholding if you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income from a U.S. trade or business is not subject to the withholding tax on foreign partners' share of effectively connected income. Cat. No. 10231X Requester's creme and address florid security ravisher i Give Form to the requester. Do not send to the IRS. D Exempt payee Parr II Employer idsralliestion number TIT 7 4 Under penalties of perjury, 1 certify that 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be rued 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 1 am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup wltrtolding, and 3. I am a U.S. citizen or other U.S. person (defined below). 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 failed to report all interest and dividends on your tax retum. 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 ORA), 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 4. oe»► 1 eD -t2 Note. If a requester gives you a form other than Form W-9 to request your TIN, you must use the requester's form if it is substantially similar to this Form W -9. Definition of a U.S. person. For federal tax purposes, you are considered a U.S. person if you are: • An individual who is a U.S. citizen or U.S. resident alien, • A partnership, corporation, company, or association created or organized in the United States or under the taws of the United States, • An estate (other than a foreign estate), or • A domestic trust (as defined in Regulations section 301 .7701 -7). Special rules for partnerships. Partnerships that conduct a trade or business in the United States are generally required to pay a withholding tax on any foreign partners' shore of income from such business. Further, in certain cases where a Form W -9 has not been received. a partnership is required to presume that a partner is a foreign person, and pay the withholding tax. Therefore, if you are a U.S. person that is a partner in a partnership conducing a trade or business in the United States, provide Form W-9 to the partnership to establish your U.S. status and avoid withholding on your share of partnership income. Form W-9 (Rev. 1-2011) • • • Commission Meeting Agenda 11/20/2012 5:00 PM East Central Georgia Regional Hospital, Water Operations and Lab Assistance Department: Caption: Background: Utilities Approve proposal for Augusta Utilities to provide Water Operations and Lab Assistance to East Central Georgia Regional Hospital at Gracewood (Gracewood). Gracewood currently operates on -site water and wastewater systems, including a well system and wastewater treatment plant. They will soon be decommissioning their wastewater plant and sending their wastewater to our system for treatment. Gracewood has also requested that we evaluate the possibility of providing operational and lab support for their groundwater treatment system. Analysis: Because of the proximity of Gracewood to the Hicks Plant and our Groundwater Treatment Plants, this support can easily be incorporated into the operational rounds of the groundwater plants. We propose providing the services outlined in the attached proposal for a monthly fee of $1,067. Financial Impact: We will realize new sewer revenue of approximately $14,000 per month once Gracewood begins discharging. The fee of $1,067 per month for water and lab assistance will be adequate to cover the cost of this service. Alternatives: The Commission could elect not to approve the attached proposal. Recommendation: We recommend approval of the attached proposal, and authorize execution of a contract with the State subject to approval of the Administrator and City Attorney. Funds are Available in the Following Accounts: Cover Memo Item # 32 • • • REVIEWED AND APPROVED BY: Finance. Procurement. Law. Administrator. Clerk of Commission Cover Memo Item # 32