VENDOR(S): Park Line Asphalt Maintenance Inc

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VENDOR(S): Park Line Asphalt Maintenance Inc.

CONTRACT: 51;...2018

ATTACHMENTS: Award List and TBR#942-2018

DATE: July 10, 2018

INITIAL(S): GJF: ep

LETTER: .AWARD

PRICE CHANGE:

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Elaine Peterson - C#Sl-2018-Removal & Disposal of Diatomaceous Earth ·····.·1:·· ·-· -------· -·- ------ ·==--·-=-===:::::::::======:.::====:::===:.::=====================~==========

From: Elaine Peterson

To: Noreen Murray; Kyle Meegan; Mildred Menendez; Paul Loraso; Nancy Pra ...

Subject: C#Sl-2018-Removal & Disposal ofDiatomaceous Earth

The above contract has been awarded to: Park Line Asphalt Maintenance Inc.

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R~cipients: 6 Response Pending: 6 • I

Annie Curry Response Pending

Kyle Meegan Response Pending

Mildred Menendez

Nancy Pratt

Noreen Murray

Paul Loraso

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- Pagel of l

PURCHASING DIVISION - BIDDERS LIST AND TABULATIONS lu~~~~. _ rJ .

OPENING DATE: ~ ~ ID at g _,,,....,.,,'-'-' .. ______,~~· ~=-~--__ c'\ NO CONCLUSION SHOULD BE DRAWN UPON REVIEWING THIS DOCUMENT · ~~ ~ { _

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NO CONCLUSION SHOULD BE DRAWN UPON REVIEWING THIS DOCUMENT SUBJECT: · -----------

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COliNCIL MEMBERS

DOROTHY L. GOOSBY EDWARD A. AJttBROSINO

BRUCE A. BLAKEMAN ERIN KING SWEENEY

ANTHON~· P. D'ESPOSITO DENNIS DllNNE, SR.

- -TOWN OF HEMPSTEAD

SYLVIA A. CABANA TOWN CLERK

Office of the Comptroller PURCHASING DIVISION

DONALD X. CLAVIN, JR. RECEIVER or TAXES

KEVIN R. CONROY, CPA TOWN COMPTROLLER ·

GORDON J. Fox DIVISION or Pl!RCHASING

Park Line Asphalt Maintenance Inc. Attn: Richard R. Mailand, President 1877 Montauk Highway Brookhaven, New York 11719

350 FRONT STREET, HEMPSTEAD, N.Y. 11550 (516) 489-5000 Fax (516) 483-6353

July 10, 2018

Contract# 51-2018 Term: July 3, 2018 to

June 30, 2021 Yearly Requirements for: Removal & Disposal of Diatomaceous Earth Tel. #631-286-4 726 Fax #631-286-4763

LAURA A. GILLEN SUPERVISOR

E-Mail: [email protected] Fed. I.D. #112810094

To Whom It May Concern:

' The Town of Hempstead Town Board Resolution #942-2018 adopted on July 3, 2018 for the above has been awarded to your firm in accordance with all the specifications and conditions contained therein.

No cash discount is offered.

The list of pools requiring cleaning service with the approximate number required a year and cost per cleaning is attached.

Prices include pick-up at various pool locations in the Town of Hempstead.

All calls for service will be handled through the Department of Parks & Recreation Division of Technical Service at (516) 670-10 I 0, attention Matt Thompson.

Service must be made within forty-eight ( 48) hours notification from the Department of Parks and Recreation.

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-Billing-time is detennined by on-the-job time, not portal to portal. A bill oflading stating location of the disposal is required to be supplied to the Department of Parks and Recreation ..

Prices must remain finn for the entire three (3) year tenn of Contract. There .will be no extensions.

· Bid price includes delivery within the doors of Town of Hempstead Parks and Recreation Department at various · pool locations. Prices also include removal of Diatomaceous earth and water from pits/tanks.

All pits/tanks do not necessarily need to be cleaned at one time.

Payments will be made in the arrears upon the submission of a Town claim and receipts signed by an authorized , department employee receiving the material and/or verifying that the service has been rendered. Enclosed is a supply of claim fonns for your use. No purchase orders will be issued.

It is understood that all specifications and conditions of this Contract remain the same.

GJF: ep Attached-Award List and

T.B. Resolution #942-2018 Enclosed: Claim Forms

AWARD LIST

PARK LINE ASPHALT MAINTENANCE.

Contract No. 51-2018

REMOVAL AND DISPOSAL OF DIA TOMACEOUS EARTH

The following pools will require this service for the approximate stated time per year:

Echo Park Pool Year Round (14 cleanings)

Forest City Pool Summers Only (2 cleanings)

Newbridge Road Pool Summers Only (2 cleanings)

Veterans Memorial Pool ·summers Only (3 cleanings)

Averill Boulevard Pool Summers Only (3 cleanings)

PITS/TANKS PER LOCATION

3

. l

3

3

COSTPER PIT/TANK LOCATION

$ 695.00/each

$ 695.00/each

$ 695.00/each

$ 695.00/each

$ 695.00/each

Approximate yearly total amount ofDiatomaceous Earth to be disposed ofis 18 X 16 ½ cubic yards (all pools included).

NOTE: THE TOWN OF HEMPSTEAD RESERVES THE RIGHT TO ADD OR DELETE LOCATIONS AND THE NUMBER OF CLEANINGS PER LOCATION.

-Case No. 24883 RESOLUTIONNO. 942-2018

Adopted: July 3, 2018 S:enior CoUllcilwoman Goosby offered the following resolution and moved its adoption as follows:

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RESOLUTION ACCEPTING A BID FOR CONTRACT #51-2018 FOR THE REMOVAL AND DISPOSAL OF DIATOMACEOUS EAR1H FOR TIIE DEPARTMENT OF PARKS AND RECREATION . .

WHEREAS, the Department of Purchasing, on behalf of the Department of Parks and Recreation, advertised for bids for the removal.and disposal of diatomaceous earth at several designated pool facilities; and

WHEREAS, the bids submitted pursuant to such advertisement were opened and read in the office of the Director of Purchasing on April 18, 2018 and ·

WHEREAS, this contract may be extended at the discretion of the Director of Purchasing for a period of one year, up to a maximum of three years on the behalf of the Commissioner of Parks and Recreation. Each one-year extension to be upon mutual agreement between the Director of Purchasing and the contractor.

WHEREAS, the following bids were referred to the Department of Parks and Recreation for examination and report cost per pit as follows:

· Park Line Asphalt Maintenance, Inc 1877 Montauk Highway Brookhaven.N.Y.11719

Park Pits/l'anks l2!l!: Location Cost ger git /tank each location Cash.Disc.

Echo Park Pool 3 $.695.00 NIA (Year round 14 cleanings) Forest City Pool $ 695.00 (Swnmers only, 2 cleanings) :Newbridge Road Pool (Swnmers only, 2 cleanings) 3 $ 695.00 Veterans Memorial Pool (Summers only, 3 cleanings) 3 $ 695.00 Averill Boulevard Pool (Summers only, 3 cleanings) 1 $ 695.00

Pal Environmental Safety Corp. d/b/a Pal Environmental Services 1 l-02 Queens Plaza South Long Island City, N.Y. 11101

Park Pits/Tanks R!lf Location Cost Jl!lf !!it /tank each location Cash Disc. Echo Park Pool 3 $3,115.00 2% (Year round 14 cleanings) Forest City Pool 1 $3,115.00 (Summers only, 2 cleanings) Newbridge Road Pool (Summers only,~ cleanings) 3 $3,115.00 Veterans Memorial Pool (Summers only, 3 cleanings) 3 $3,115.00 Averill Boulevard Pool (Summers only, 3 cleanings) 1 $3,115.00

----------------------~--------~. ---·--··~.-~--~

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-AARCO Environmental Services Corp. 50 Gear Avenue Lindenhurst. N. Y. 11757

Park Pits/I'~ ~r Location Echo Park Pool 3 (Year round 14 cleanings) Forest City Pool 1 (Summers only, 2 cleanings) Newbridge Road Pool (Summers only, 2 cleanings) 3 Veterans Memorial Pool (Swnmers only, :J cleanings) 3 Averill Boulevard Pool (Summers only, 3 cleanings)

and

Co~ m;r mt /tank each location Cash~isc. $13,766.00 NIA

$5,300.00

$3,950.00

$8,850.00

$8,850.00

WHEREAS, the Commissioner of the Department of Parks and Recreation has reported that the bid submitted from Park Line Asphalt Maintenance Inc., 1877 Montauk Highway, Brookhaven, N.Y. 11719 was the lowest bidder and has recommended acceptance of said bid to the Town Board and it appears that said bidder is duly qualified;

NOW, THEREFORE, BE IT

RESOLVED, that the bid received from Park Line Asphalt Maintenance Inc. for the removal and disposal of diatomaceous earth, be accepted; and

BE IT FURTHER

RESOLVED, that the .Town Comptroller be and is hereby authorized to make payments from Parks and Recreation Code 400-007-7110-4720-Pool Maintenance.

The foregoing resolution was adopted upon roll call as follows:

A YES: SEVEN (7)

NOES: NONE (0)

J

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- -T.B.R. #942-2018

CC: Parks & Recreation Department E-mail to Noreen Murray and Kyle Meegan

Mildred C. Menendez - Administrative Assistant

Paul J. Lo Raso - Assistant to the Division of Purchasing (26-2015)

Nancy Pratt-Assistant Buyer

Annie Curry - Purchasing Division

Contract#S 1-2018

-CONTRACT NO 51-2018 OPENNG DA TE: AT 11 :00 A. M.

WEDNESDAY- APRIL 18, 2018

-PROPOSALS MUST BE REC~VED IN THE OFFICE OF THE

DIRECTOR OF PURCHASING NO LATER THAN 11:00 A.MON THE OPENING DATE.

LATE PROPOSALS WILL NOT BE CONSIDERED

CONTRACT PROPOSAL TOWN Of HEMPSTEAD - STATE OF NEW YORK FOR BIDS TO BE RECEIVED AND OPENED IN THE OFFICE OF

DIRECTOR OF FINANCE 350 FRONT STREET- ROOM 122

HEMPSTEAD, NEW YORK I 1550-4037

TITLE YEARLY REQUIREMETS FOR: REMOVAL & DISPOSAL OF DIATOMACEOUS EARTH

The undersigned bidder affirms and declares that he/she carefully examined the advertised invitation for bids. the general specifications arid detailed specifications. and certifies that this proposal is signed with full knowledge and acceptance of all the provisions thereof and offers and agrees. if this bid is accepted within ____ days from the date of opening of bids to furnish any or all items upon which prices are hereinafter quoted in the quantities and at the prices bid. All prices must include delivery charges. Delivery to be made within up@Jilil awa ~'s

after receipt of order or orders during the contract period. FROM UPON A WARD TO THREE m YEARS

Cash Discount of ___ ~per cent will be allowed for prompt payment within 20 business days.

BID OF Parkline Asphalt Maintenance~ 1877 Montauk Highway, "Brookhave, N. Y. 11719 (Name of Bidder) (Address)

(Corporate) G) _ /J /V'\ _ ,.. n ) t\ {) f [ l ~ f n ( Seal ) By~~ Title {. ·YI\&) ' Name_~IU>~bO~-r_,~\Ju_~· t"-'--\--'-AN~· .,...Vc---

(Signature of proprietor. partner or officer authorize! to sign for corporation title) · (Print or type name of signe;,-·

Federal I. D.Number_1_1_2_8_1_0_0~9_4 ___________ Telephone No. ___ 6_3_1_-_2_8_6_-_4_7_2_6 ______ _

E-Mail park l i necel ia@optonline. netFax No. _____ 6e,_3.c,__1_-_2_8_6_-_4_7_6_3 _____ _

BIDDER'S SIGNATURE SHOULD BE ACKNOWLEDGED BELOW.

STATE OF COUNTY OF SS.:

On this _____ day of ____ 20 ___ , Before me personally appeared _______ _ To me known and known to be (the individual described in)* (a member of the finn of ___________ _ the finn described in) and who executed the within instrument, and (he/she) (each and everyone of them severally) duly acknowledge that _he/she_executed the same (as and for the act of deed of said finn).

STATE OF \J \.( . . COUNTY OF SS.: 5~.C..

Onthis LO dayofq)~l 20\..Y" , before me, the subscriber, personally came Rt, b .ed- µa_ c ( ~ _____ to me know, who being by a duly sworn ve_, did despose and say that he/she resides in (0). )'GQ>AQ\ ~ @~t-~ud_~ L ; that he/she is the \J, PM-:> of \hl i,_\:J;:'\ the corporation described in and

which executed the above instrument; that he/she knew the seal of said corporation; that the seal affixed to said instrument was said corporate seal; that it was affixed by order of the Board of Directors of said corporation, and that he/she signed his/her name thereto by like order.

*Notary; X out parts of acknowledgement which do not apply.

Notary Public County of State of ~ a, S. u&ac tu 'f

NotaryPubiic, County of . State of

.ep

(FORINDIYIDUAL(S}, FIRM OR PARTNERSHIP) (FOR CORPORATIONS)

BAA8ARA 'ALtO flotll'V Pubf;c, State c,tfj •

t- ~ No ~36 Suffolk Cou-~·"" cXp,re _ , tt h-- 2..- .....

SUPPLY AND DELIVER THE ATTACHED PROPOSAL ACCORD.ING TO THE SPECIFICA TIOHNS AND CONDITIONS

MAIL PROPOSALS EARLY; ALLOW TIME FOR UNA VOIDABLE DELAYS THAT MAY OCCUR.

Copditiop !I) A SUBSTITUTE FOR THE PRODUCT SPECIFIED WILL BE CONSIDERED IN ALL CASES EXCEPT WHEN.OTHERWISE STATED. THE BIDDER MUST SUBMIT WITH THE BID SATISFACTORY PROOF THAT ANY SUBSTITUTE OFFERED IS EQUAL TO THE STANDARD SPECIFIED.

(2) All bid prices must include deliver within doors unless Town specifies otherwise. (3) No charge shall be made for boxing or packing. (4)Use this form. (5)Director of Finance reserves the right to reject any or all bids and to award by items, by groups. or as a whole.( 6 )Issuance of Town Purchase Order constitutes of bid. BIDDERS ARE REQUESTED TO ALSO READ THE TERMS AND CONDITIONS ATTACHED HERETO. IN EXECUTING THIS BID, THE BIDDER WARRANTS THAT THE PRICE SUBMITTED HEREIN ARE NOT HIGHT THAN THOSE OFFERED TO ANY GOYERNMENTL OR COMMERCIAL CONSUMER FOR LIKE DE! IVERIES. PRICES: The provisions of the New York State Fair Trade Law (Fed-Crawford Act) and the federal price discrimination law (Robinson-Patman Act) do not apply to purchase by the Town. DO NOT INCLUDE FEDERAL. ST ATE OR OTHER TAXES IN BID PRICES.

Page of 5 Page

- -W-9 Request for Taxpayer ~

tForn, Give Form to the (Rev. November 2017) Identification Number and Certification requester. Do not Department of the Treasury

► Go to www.irs.gov/FormW9 for instructions and the latest information. send to the IRS.

Internal Revenue Service

1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank.

Park Line Asohalt Maintenance, Inc. 2 Business name/disregarded entity name, if different from above

C') 3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the 4 Exemptions (codes apply only to Q) Ol following seven boxes. certain entities, not individuals; see ro 0. instructions on page 3): C □ Individual/sole proprietor or D C Corporation 0 S Corporation D Partnership D Trust/estate 0

. "' single-member LLC Exempt payee code (if any) Cl) C: a. 0

□ ~~ Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) ►

0 2 Note: Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check Exemption from FATCA reporting t: t, LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is code (if any) •- C another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-member LLC that ,_ _ Q. 0 is disregarded from the owner should check the appropriate box for the tax classification of its owner.

:E 0 □ Other (see instructions) ► (Applies to accounts maintained outside the U.S.) Cl) a. 5 Address (number, street, and apt. or suite no.) See instructions. Requester's name and address (optional) (/) Q)

1877 Montauk Hwv. Q) Cl)

6 City, state, and ZIP code

Brookhaven, NY 11719 Seaford Union Free School Dist. 7 List account number(s) here (optional)

■ ::F.T •• Taxpayer Identification Number (TIN) I Social security number I Enter your TIN in_ the appropriate box. :h~ TIN provided must_ match the name given on line 1 to avoid

backup withholding. For ind1v1duals, this Is generally your social security number (SSN). However, for a [II] DJ I I I I I resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other - -entities, it is your employer identification number (EIN). If you do not have a number, see How to get a . . . . . TIN, later. or Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and r! =e-m-p7lo_y_e_r.,..id-:-e-n...,tic::fi-ca-t-io_n_n_u_m-be_r ___ __, Number To Give the Requester for guidelines on whose number to enter.

11-2810094

Certification Under penalties of perjury, I certify that:

1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and 2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue

Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and

3. I am a U.S. citizen or other U.S. person (defined below); and

4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.

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 return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part 11, later.

Sign Here

Signature of U.S. person ►

General Instructions Section references are to the Internal Revenue Code unless otherwise noted.

Future developments. For the latest information about developments related to Form W-9 and its instructions, such as legislation enacted after they were published, go to www.irs.gov/FormW9.

Purpose of Form An individual or entity (Form w-g requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number {SSN), individual taxpayer identification number (/TIN), adoption taxpayer identification number (ATIN), or employer identification number {EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following.

• Form 1099-INT (interest earned or paid)

Cat. No. 10231X

Date ► Lf /ro rr-• Form 1099-DIV (dividends, including those from stocks or mutual funds)

• Form 1099-MISC (various types of income, prizes, awards, or gross proceeds)

• Form 1099-B {stock or mutual fund sales and certain other transactions by brokers)

• Form 1099-S (proceeds from real estate transactions)

• Form 1099-K {merchant card and third party network transactions) • Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition)

• Form 1099-C (canceled debt) • Form 1099-A (acquisition or abandonment of secured property)

Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN.

If you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding, later.

Form W-9 (Rev. 11-2017)

Toe of Hempstead Purchasing Div-n

CERTIFICATION AFFIDAVIT

Note- The Town of Hempstead is prohibited by Town Code section 62-6 from entering into any

contract with any vendor relating to services, supplies, information technology, or construction

without a sworn certification that the vendor is not engaging, and will not engage during the course of

the contract with the Town of Hempstead, in any economic boycott of an American Allied Nation or

any American Allied Nation controlled territories, as described in Town Code section 62-6. If the vendor

is found by a preponderance of the evidence by the Town Board to have engaged in such a boycott at

the time of the submission of the bid, the signing of the contract, or during the course of the contract,

the contract may be rescinded and the Town shall be entitled reimbursement of all its out of pocket

costs in connection with its dealings with the vendor, as well as any further relief authorized by Town

Code section 62-6. By signing this affidavit, the signor is representing that he or she has fully reviewed

Town Code section 62-6, fully understands it provisions, and will at all relevant times act in compliance

therewith.

I, certify that I am either a vendor to this contract, a representative authorized by lawful resolution to

sign for the vendor, or an officer or member of the vendor of this contract and I attest under penalty of

perjury that upon personal knowledge the subject vendor is not currently engaging in a "Boycott of

American Allied Nation" as that term is used in Town Code section 62-6, nor will the subject vendor

engage in such behavior at the submission of the subject bid, at the signing of the contract, and during

the entire duration of the subject contract with the Town of Hempstead. It is understood by the vendor

that the term American Allied Nation includes any American Allied controlled territory and consists of

any nation that is a member of the North Atlantic Treaty Organization, any country that is a signatory

to the Southeast Asian Treaty Organization, any country, other than Venezuela, that is a signatory to

the RIO Treaty of 1947, as well ,as any of the nations of Ireland, Israel, Japan and the Republic of Korea.

I further certify that the vendor shall comply in all respects with Town Code section 62-6, and I or

anyone involved with the vendor shall immediately notify the Town Attorney upon gaining knowledge

of any such violation by the vendor or any of its agents, employees, or representatives.

I understand that any false statements made herein are punishable as a Class "pt' Misdemeanor

pursuant to Section 210.45 of the Penal Law of the _State of New York.

Signature of Vendor /Officer of Vendor

Sworn to before me this i{) day ofA/'rt ( , 20 ,y

OAR8A~A FA\.CO filott?\f Public, Stnto of NV

r..io 4992536 Suffolk Cou~ ~'Expireo "'l-{_1.,{ { 2,,.l

Notary Public

6~v\,L,~GQ

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CONTRACT PROPOSAL (continued) TOWN OF HEMPSTED

ST A TE OF NEW YORK Contract No. 51-2018

SUPPLY LABOR & EQUIPMENT FOR THE REMOVAL & DISPOSAL OF

DIATOMACEOUS EARTH FROM POOL FILTER TANKS.

SPECIFICATIONS

A- All calls for service will be handled through the Division of Technical Service Department;

· B - Vendor must respond to a service call within 48 hours of notification;

C - Billing time shall be determined by on the job time, not portal to portal;

D - We require a Bill of Lading stating location of the disposal.

THE FOLLOWING POOLS WILL REQUIRE THIS SERVICE FOR THE APPROXIMATE STATED TIME PER YEAR.


ECHO PARK POOL 3 COST PER PIT/TANK EACH LOCATION $ 695.00 YEAR ROUND ( 14 CLEANINGS)

FOREST CITY POOL COST PER PIT/TANK EACH LOCATION $ 695.00 SUMMERS ONLY (2 CLEANINGS)

NEWBRIDGE ROAD POOL 3 COST PER PIT/TANK EACH LOCATION $ 695.00 SUMMERS ONLY (2 CLEANINGS)

VETERANS MEMORIAL POOL 3 COST PER PIT/TANK EACH LOCATION $ 695.00 SUMMERS ONLY (3 CLEANINGS)

AVERILL BOULEY ARD POOL COST PER PIT/TANK EACH LOCATION $ 695.00

SUMMERS ONLY (3 CLEANINGS)

Price to include removal of Diatomaceous Earth and Water from Pit/Tank. All pit/tanks do not necessarily need to be cleaned at one time

Approximate yearly total amount of Diatomaceous Earth to be disposed of is 18 X 16½ cubic yards. (All pools included).

Please call Division of Technical Services for any questions at (516) 670-1010, Attn: Matthew Thompson.

NOTE: The Town of Hempstead reserves the right to add or delete locations and the number of cleanings per location.

.ep Page2

CONDITIONS

-Contract No. 51-2018 Req. No. PD#000 13-20 I 8

Bids shall be accepted only from those having the necessary qualifications to properly execute this bid.

2 No alteration, erasure or addition is to be made in the typewritten or printed matter. -Any corrections made by vendor on bid MUST be initialed.

3 Any deviations from the specifications must be specifically stated at the time of bidding and same shall be made in writing and made a part of the bid;

4 Prices and information required, except signature of bidder, must be typewritten or written in ink. All signatures must be handwritten. Facsimile, printed or typewritten signatures are not acceptable.

5 Bid must be signed in ink by owner, partner or corporate officer.

6 Bid price shall include delivery within doors of: TOWN OF HEMPSTEAD Parks and Recreation - Various Pools.

7 No Federal, State or Municipal Sales & Excise.taxes shall be quoted or charged. The Town is exempt from·such taxes. An exemption certificate will be furnished upon request.

8 Cash discount, if offered, must be for a minimum of 20 business days in order for it to be a determining factor in making the award.

9 The Town Board reserves the right to reject any and all bids, to waive any informality in the bids received, and to accept the bid most favorable to the interest of the Town, after all bids have been examined and checked.

IO Bid shall be submitted in the envelope furnished, and property sealed.

11 Payments will be made monthly in arrears upon the submission of a Town claim and receipt, signed by an authorized Department employee; verifying that the service has been rendered.

12 No Purchase Orders will be issued.

13 This is a three (3) year Contract and will not be extended.

14 Prices must remain firm for the entire term of Contract.

15 All bids may be reviewed at bid opening. Thereafter, no reviews, inquiries, or results of bids will be permitted until Award has been made.

16 Failure to comply with any of the above instructions shall operate as a condition upon which the bid may be rejected .

. . ep Page 5 of 5 '

Contract C51-2018 Removal and Disposal of Diatomaceous Earth Opened 4/18/2018

Cost per tank Cost per tank Cost per tank

Parkline Aarco Pal Enviornment Location # Cleaninru #tanks

Echo Park 14 3 $ 695.00 $ 13,766.00 $ 3,115.00

Forest City 2 1 $ 695.00 $ 5,300.00 $ 3,115.00 -Newbridge 2 3 $ 695.00 $ 3,950.00 $ 3,115.00

Veterans Mem 3 3 $ 695.00 $ 8,850.00 $ 3,115.00

Averill 3 1 $ 695.00 $ 8,850.00 $ 3,115.00

NON-UNION Discount Net Net 2%

-

· PURCHASING DIVISION

Co~tract & Formaflid Review & Recommen, Procedures

CONTRACT /~.fN.oo: __ s1_-_20_1_8 __ _

TITLE: RBIIOVAL & DISPOSAL OF DIATOMACEOUS EARTB

----------------------------RBQN. PD #13-2018.

Number of bids received: THREE (3J -----------• Contract/~ opened and reviewed for adherence to purchasing

guidelines and requirements with recommendation by the Purchasing

Division.

0 _xx __ Town Board Resolution Required *********************************************************************************************************************

• Contract/~ transferred to the Department of __ P_a_r_ks_&_Re_c_r_ea_t:_i_o_n_· _______ _

Attn: Daniel Lino, Commissioner (Ndreen Murray)

s1L ~ ~~p$ ************c.:*****************************************************************************************************

• Contract/fialma/xijja reviewed and recommended by the Department .~ Parks & Recreat:ion . ~----------------

$/ ________ ~--- _/_/_

o . Recommendation Memo Attached ---0 Town Board Resolution Attached

o Contract/Bids Rejec~ed

• Reason for rejection:

• Further action:

• ___ Rebid Contact/Formal Bid-New Specifications

attached.

.. No Further action ---KEEP ENCLOSED COPIES OF BIDS FOR YOUR RECORDS

-PURCHASING DIVISION

350 FRONT STREET, HEMPSTEAD NY 11550 (516) 489-5000

From the desk of: GORDON J. FOX

~7

/b I /}J,.

Director of Finance

/ ~ .£or/> ,m' /44/-_,1

µz, /t>l//f:?W -. fa cc;.,,-,,.,,,- a#~

/f'v!? /f J;:..,41 lf M-'!7 ;e,5~~;. ;/,w~

4~

- - ,_ CONTRACT NO 51-20 I 8 OPENNG DA TE: AT I I :00 A. M.

' ,.. , PROPOSALS MUSi BE RECErVED IN THE OFFICE OF THE

DIRECTOR OF PURCHASING NO LATER THAN 11 :00 A.MON THE OPENING DATE.

WEDNESDAY-APRIL 18, 2018 LATE PROPOSALS WILL NOT BE CONSIDERED

CONTRACT PROPOSAL TOWN OF HEMPSTEAD - STATE OF NEW YORK FOR BIDS TO BE RECEIVED AND OPENED IN THE OFFICE OF

DIRECTOR OF FINANCE 350 FRONT STREET- ROOM 122

HEMPSTEAD, NEW YORK 11550-4037

TITLE YEARLY REQUlREMETS FOR: REMOVAL & DISPOSAL OF DIATOMACEOUS EARTH

The undersigned bidder affirms and declares that he/she carefully examined the advertised invitation for bids. the general specifications and detailed specifications. and certifies that this proposal is signed with full knowledge and acceptance of all the provisions thereof and offers and agrees. if this bid is accepted within ____ days from the date of opening of bids to furnish any or all items upon which prices are hereinafter quoted in the quantities and at the prices bid. All prices must include delivery charges. Delivery to be made within ______ days

after receipt of order or orders during the contract period. FROM UPON A WARD TO THREE (3) YEARS

Cash Discount of ___ ~per cent will be allowed for prompt payment within 20 business days.

BIDOFAarco Environmental Services, 50 Gear Avenue, Lindenhurat, New York 11757 (Name of Bidder) (Address)

(Corporate) QJ j . . . ~ £/ J-- ~ () • / ( Seal ) By ~ • • ~ /~,:,..__I Name 7f:c ,l,.c~ c_);(}AOA, '-Ile.

(Si~proprietor.partner or officer authorized to sign for corporation title) (Print or type name of signer)

BIDDER'S SIGNATURE SHOULD BE ACKNOWLEDGED BELOW.


On this _____ day of ____ 20 ___ , Before me personally appeared _______ _ To me known and known to be (the individual described in)* (a member of the firm of ___________ _ the firm described in) and who executed the within instrument, and (he/she) (each and everyone of them severally) duly acknowledge that

he/she_executed the same (as and for the act of deed of said firm).

ST A TE OF ~.QA.A:> \l:,r~ . COUNTY OF.5"~

On this / 7 day of 4-f.>!;1, l 20 Z.'?5: before me, the subscriber, personally came rz..,·c.ro'icJ <-~Y to me know, who being by a duly sworn did despose and say that he/she resides in .511C.Cb lk....c~~ ~------; that he/she is thef.?re::.rd-tVJ/...of ~ Et,✓ the corporation described in and which executed the above instrument; that he/she knew the seal of said corporation; that the seal affixed to said instrument was said corporate seal; that it was affixed by order of the Board of Directors of said corporation, and that he/she signed his/her name thereto by like order.

·*Notary; X out parts of acknowledgement which do not apply. '-< . -N-ot-ary_P_u-bl-ic_C_o_u_nty_o_f __________ S-ta-te_o_f_____ Notary Public, County of ct:tof : :S

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(FORINDIVIDUAL(S), FIRM OR PARTNERSHIP) (FOR CORPORATIONS)

TARA L. BOGGS NOTARY PUBLIC, State of New Yolk

No. 01806203253 Ouahfied in Suffolk County

Comm,ss1on Expires March 30, 20 "Zi( SUPPLY AND DELIVER THE ATTACHED PROPOSAL ACCORDING TO THE SPECIFICA TIOHNS AND CONDITIONS

MAIL PROPOSALS EARLY; ALLOW TIME FOR UNA VOIDABLE DELAYS THAT MAY OCCUR.

Condition (I) A SUBSTITUTE FOR THE PRODUCT SPECIFIED WILL BE CONSIDERED IN ALL CASES EXCEPT WHEN .OTHERWISE STATED. THE BIDDER MUST SUBMIT WITH THE BID SATISFACTORY PROOF THAT ANY SUBSTITUTE OFFERED IS EQUAL TO THE STANDARD SPECIFIED. (2) All bid prices must include deliver within doors unless Town specifies otherwise. (3) No charge shall be made for boxing or packing. (4)Use this form. (5)Director of Finance reserves the right to reject any or all bids and to award by items, by groups, or as a whole.(6)lssuance of Town Purchase Order constitutes of bid. BIDDERS ARE REQUESTED TO ALSO READ THE TERMS AND CONDITIONS ATTACHED HERETO. IN EXECUTING THIS BID, THE BIDDER WARRANTS THAT THE PRICE SUBMITTED HEREIN ARE NOT HIGHT THAN THOSE OFFERED TO ANY GOVERNMENTL OR COMMERCIAL CONSUMER FOR LIKE DELIVERIES. PRICES: The provisions of the New York State Fair Trade Law (Fed-Crawford Act) and the federal price discrimination law (Robinson-Patman Act) do not apply to purchase by the Town. DO NOT INCLUDE FEDERAL, ST ATE OR OTHER TAXES IN BID PRICES.

Page of 5 Page

• • --• u"_... •-

__________ ..._ __ .... .. Form W-9 Request for Taxpayer Give Form to the (Rev. November 2017) Identification Number and Certification requester. Do not Department of Iha Treasury

► Go to www.irs.gov/FormW9 for instructions and the latest information. send to the IRS.

Internal Revenue Service 1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank.

AARCO Environmental Services Corp. 2 Business name/disregarded entity name, if different from above

C') Gl 3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the 4 Exemptions (codes apply only to Cl following seven boxes. certain entities, not individuals; see a

D C Corporation 0 S Corporation Instructions on page 3):

C □ Individual/sole proprietor or D Partnership D Trust/estate 0

4i ! single-member LLC Exempt payee code (rf any)

_g~ D Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) ►

o 2 Note: Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check Exemption from FATCA reporting c 1ii LLC If the LLC Is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is code (if any) ·c ..5 another LLC that Is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-member LLC that Q. () is disregarded from the owner should check the appropriate box for the tax classification of its owner. !E

()

□ Other (see instructions) ► (App~:s to account! maintllined Of.JU~ the U.S.) QI a. 5 Address (number, street, and apt. or suite no.) See Instructions. Requester's name and address (oplionaQ tn

l 50 Gear Ave 6 City, state, and ZIP code

Lindenhurst, NY 11757 7 List account number(s) here (optionaQ

-~JI •• Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid I Social security number I backup wlthholdlng. For individuals, this Is generally your social security number (SSN). However, for a [ill DJ I I I I I resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other - -entities, it is your employer identification number (EIN). If you do not have a number, see How to get a . . . . . TIN, later. or Note: If the account is in more than one name, see the instructions for line 1. Also see What Name andl ~ -Em-p-lo_y_er-,-d-en-t-ifl_c_a_tlo_n_nu-m-be_r ___ ~ Number To Give the Requester for guidelines on whose number to enter.

81 -055 12

Certification Under penalties of pe~ury, I certify that:

1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and 2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue

Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and

3. I am a U.S. citizen or other U.S. person (defined below); and

4. The FATCA code(s) entered on this form (if any) Indicating that I am exempt from FATCA reporting is correct.

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 return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments o~~ t~a_n lnter~st and dividends, you er ot requl (I to sign the certification, but you must provide your correct TIN. See the Instructions for Part II, later.

Sign Here

Signature of U.S. person ►

/ General Instructions Section references are to the Internal Revenue Code unless otherwise noted.

Future developments. For the latest Information about developments related to Form W-9 and its instructions, such as legislation enacted after they were published, go to www.irs.gov/FormW9.

Purpose of Form An Individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer Identification number (ATIN);or employer Identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns Include, but are not limited to, the following. • Form 1099-INT (Interest earned or paid)

Cat. No. 10231X

Date ►

• Form 1099-DIV (dividends, including those from stocks or mutual funds)

• Form 1099-MiSC (various types of income, prizes, awards, or gross proceeds) • Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) • Form 1099-S (proceeds from real estate transactions) • Form 1099-K (merchant card and third party network transactions) • Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition) • Form 1099-C (canceled debt) • Form 1099-A (acquisition or abandonment of secured property)

Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN.

If you do not retum Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What Is backup withholding, later.

Form W-9 (Rev. 11-2017)

To-of Hempstead Purchasing Divi. ' ... '








the time of the submission of the bid, the signing of the contract, or during the course of the contract,





therewith.










the RIO Treaty of 1947, as well as any of the nations of Ireland, Israel, Japan and the Republic of Korea.




I understand that any false statements made herein are punishable as a Class "A" Misdemeanor

pursuant to Section 210.45 of the Penal Law of the State of New York.

Ok-.?'

Signature of Vendor /Officer of Vendor

Sworn to before me this 17 day of IJ(Jr,/ , 2016

Notary Public

TARA L. BOGGS NOTARY PUBLIC, State of New York

No. 01 BO6203253 Qualified in Suffolk County _. ,

Commission Expires March 30, 20-

- ...

TOWN OF HEMPSTEAD - PURCHASING DIVISION VENDOR'S PUBLIC DISCLOSURE STATEMENT

CONTRACT# __ 5J--2-Q~J8 ______ _ Or

FORMAL BID# _______ _

I) COMPANY NAME: tM't<~.6/Jf.e'~d#ent~ ~V/~ AooREss: SCJ ~ Av'A/1/Pe L/u~#4£Sr ...-vy //~s-.::;z-PHONE(u:,:rpg6 .q~ FAX {f-3~ ~/0 Email Sf'(o1'2>rtittfn:'46,v)~

2) FEDERAL 1.0. IDENTIFICATION: _____ ~_i'_-.... ~--~ ........ 3:-"'/_/;_~ ___ / __________ _ Or

SOCIAL SECURITY NUMBER: ___________________ _

3) TYPE OF BUSINESS: ✓ INDIVIDUAL: _____ CORPORATION: ______ PARTNERSHIP: ____ _

4) TABLE OF ORGANIZATION:

5)

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a) LIST NAMES AND ADDRESSES OF ALL PRINCIPALS, SUCH AS ALL INDIVIDUALS SERVING ON THE BOARD OF DIRECTORS OR CO.MP ARABLE BODY, NAMES AND ADDRESSES OF ALL PARTNERS, NAMES AND ADDRESSES OF ALL CORPORATE OFFICERS. (ATTACH ADDITIONAL PAPER IF REQUIRED)

ADDRESS

/dc4k4 ~#>kt 3 ~06a. ~7? lo£&~~

b) LIST ALL NAMES AND ADDRESSES OF THOSE INDIVIDUAL SHAREHOLDERS HOLDING MORE THAN FIVE (5%) INTEREST IN THE FIRM AND STATE PERCENTAGE(%) FOR EACH INDIVIDUAL. (ATTACH ADDITONAL PAPER IF REQUIRED)

ADDRESS PERCENTAGE

_rs-tp

/

Page 3

TOWN OF HEMPSTED ST A TE OF NEW YORK

-CONTRACT PROPOSAL (continued)

Contract No. 51-2018


DIATOMACEOUS EARTH FROM POOL FILTER TANKS.

SPECIFICATIONS


B - Vendor must respond to a service call within 48 hours of notification;





ECHO PARK POOL 3 YEAR ROUND (14 CLEANINGS)

FOREST CITY POOL SUMMERS ONLY (2 CLEANINGS)

NEWBRIDGE ROAD POOL 3 SUMMERS ONLY (2 CLEANINGS)

VETERANS MEMORIAL POOL 3 SUMMERS ONLY (3 CLEANINGS)

AVERILL BOULEY ARD POOL SUMMERS ONLY (3 CLEANINGS)

COST PER PIT/TANK EACH LOCATION





l!lp,

$ \ 3)-r,,:-t!P

$ 5 300-~

Price to include removal of Diatomaceous Earth and Water from Pit/Tank. All pit/tanks do not necessarily need to be cleaned at one time

Approximate yearly total amount of Diatomaceous Earth to be disposed of is 18 X 16½ cubic yards. (All pools included).

Please call Division of Technical Services for any questions at (516) 670-1010, Attn: Matthew Thompson.


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CONTRACT NO 51-2018 OPENNG DA TE: AT 11 :00 A. M.

WEDNESDAY-APRIL 18, 2018

-CONTRACT PROPOSAL

J

PROPOSALS MUSJ B;,~ RE';EIVED IN THE OFFICE OF THE

DIRECTOR OF PURCHASING NO LATER THAN 11 :00 A.MON THE OPENING DATE.

LATE PROPOSALS WILL NOT BE CONSIDERED

BY: ····················••m

TOWN OF HEMPSTEAD - STATE OF NEW YORK FOR BIDS TO BE RECEIVED AND OPENED IN THE OFFICE OF

DIRECTOR OF FINANCE 350 FRONT STREET - ROOM 122

HEMPSTEAD, NEW YORK 11550-4037

TITLE YEARLY REQUIREMETS FOR: REMOVAL & DISPOSAL OF DIA TOMA CEO US EARTH

The undersigned bidder affirms and declares that he/she carefully examined the advertised invitation for bids. the general specifications and detailed specifications. and certifies that this proposal is signed with full knowledge and acceptance of all the provisions thereof and offers and agrees. if this bid is accepted within ____ days from the date of opening of bids to furnish any or all items upon which prices are hereinafter quoted in the quantities and at the prices bid. All prices must include delivery charges. Delivery to be made within ______ days

after receipt of order or orders during the contract period. FROM liPON A WARD

Cash Discount of Z. per cent will be allowed for prompt payment within 20 business days. TO THREE (3) YEARS

Queens Plaza South, Long Island City, N.Y. 11101 (Address)

Federal I. D.Number-4---'-"'-----''----"''--''---'------~Telephone No._~7,_._1"""'8,___----""f___..'-/_'9_,_· _-_t)_'jL--t!)_Q __ _

E-Mail __ ~........,_;~""----#C~=--.,__,_....e...L-'::.....=..~'---· t1,_#/_Fax No .. __ 7-«----r:-=$'----3----'-1/_'t.,:__-_z_a_o_O_· --


On this _____ day of ____ 20 ___ , Before me personally appeared _______ _ To me known and known tobe (the individual described in)* (a member of the firm of ___________ _ the firm described in) and who executed the within instrument, and (he/she) (each and everyone of them severally) duly acknowledge that

he/she_executed the same (as and for the act of deed of said firm).

*Notary; X out parts of acknowledgement which do not apply.

Notary Public County of State of

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(FOR JNDIVIDUAL(S), FIRM OR PARTNERSHIP)

SUPPLY AND DELIVER THE ATTACHED PROPOSAL ACCORDING TO THE SPECIFICA TIOHNS AND CONDITIONS

MAIL PROPOSALS EARLY; ALLOW TIME FOR UNAVOIDABLE DELAYS THAT MAY OCCUR.

Condition (I) A SUBSTITUTE FOR THE PRODUCT SPECIFIED WILL BE CONSIDERED IN ALL CASES EXCEPT WHEN OTHERWISE STATED. THE BIDDER MUST SUBMIT WITH THE BID SATISFACTORY PROOF THAT ANY SUBSTITUTE OFFERED IS EQUAL TO THE STANDARD SPECIFIED. (2) All bid prices must include deliver within doors unless Town specifies otherwise. (3) No charge shall be made for boxing or packing. (4)Use this form. (5)Director of Finance reserves the right to reject any or all bids and to award by items, by groups, or as a whole.(6)1ssuance of Town Purchase Order constitutes of bid.

BIDDERS ARE REQUESTED TO ALSO READ THE TERMS AND CONDITIONS ATTACHED HERETO. IN EXECUTING THIS BID, THE BIDDER WARRANTS THAT THE PRICE SUBMITTED HEREIN ARE NOT HIGHT THAN THOSE OFFERED TO ANY GOVERNMENTL OR COMMERCIAL CONSUMER FOR LIKE DELIVERIES. PRICES: The provisions of the New York State Fair Trade Law (Fed-Crawford A.ct) and the federal price discrimination law (Robinson-Patman Act) do not apply to purchase by the Town. DO NOT INCLUDE FEDERAL, ST ATE OR OTHER TAXES IN BID PRICES.

Page of 5 Page

. ~ To.f Hempstead Purchasing Divis.








the time .of the submission of the bid, the signing of the contract, or during the course of the contract,





therewith.










the RIO Treaty of 1947, as well as any of the nations of Ireland, Israel, Japan and the Republic of Korea.




I un erstand that any false statements made herein are punishable as a Class "A" Misdemeanor

nt to Section 210.45 of the Penal Law of the State of New York.

, 20

_ MARLEN DAGHER

Notary Public

NOTARY PUBLIC~STATE OF NEW YORK .1 No. 01OA6298'33' ·

Qualified Jn klng-s coJnty My Commission Ex'pires ._M~rch {o, 20Jr-

CONTRACT PROPOSAL (continued) TOWN OF HEMPSTED

ST A TE OF NEW YORK Contract No. 51-2018


DIATOMACEOUS EARTH FROM POOLFILTER TANKS.

SPECIFICATIONS


B - Vendor must respond to a service call within 48 hours of notification;





ECHO PARK POOL 3 COST PER PIT/TANK EACH LOCATION $ 3/IS YEAR ROUND ( 14 CLEANINGS)

FOREST CITY POOL COST PER PIT/TANK EACH LOCATION $ 3,I I~ J

SUMMERS ONLY (2 CLEANINGS)

NEWBRIDGE ROAD POOL 3 COST PER PIT/TANK EACH LOCATION $ '3 I 1S SUMMERS ONLY (2 CLEANINGS)

I

VETERANS MEMORIAL POOL 3 COST PER PIT/TANK EACH LOCATION $ 3 I 15 SUMMERS ONLY (3 CLEANINGS)

AVERILL BOULEVARD POOL 1 COST PER PIT/TANK EACH LOCATION $ J //JS-SUMMERS ONLY (3 CLEANINGS) . . • · . {1 .

;,r,. #o /Yle,fl+ioJV o-F Ut\ 1 ~ 1v / ;i.,.e,l·,4,lt ,._'j //NA.(L t-1,, .e.vt. rdrrL ,-1-w /IJ~ 1 0

u ' /'JtJIV .-u 4 1ollf. ...... . -:::----- . Price to include removal of Diatomaceous Earth and Water from Pit/Tank. All pit/tanks do not necessarily need to be cleaned at one time

Approximate yearly total amount of Diatomaceous Earth to be disposed of is 18 X 16½ cubic. yards. (All pools included).

Please call Division of Technical Services for any questions at (516) 670-10 I 0, Attn: Matthew Thompson.


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I)

2)

3)

- -TOWN OF HEMPSTEAD - PURCHASING DIVISION

VENDOR'S PUBLIC DISCLOSURE STATEMENT

CONTRACT# __ sJ--2-0-18,__ _____ _ Or

FORMAL BID# ______ _

COMPANYNAME, Pe L £11,o1,1110Ntt/t"lto./J $11-ft-1) (l,,,-1 AooREss: JI - o 2,.- &vVt~1t,.s fl,,~lfl S11~r/. LIC, Nf///o/ · PHONE# zct 3l/~ - 0 q~o FAX# 7( f ~<./~ ,zaoo Email:

7e n,'" ".rt..ll@,Leo,tf .e,.,., FEDERAL 1.0. IDENTIFICATION:._ .... 11 __ -__ ,._r_,;w_'l ___ l'_7..,:f _________ _

Or SOCIAL SECURITY NUMBER:. ___________________ _

TYPE OF BUSINESS: __.-INDIVIDUAL:. _____ CORPORATION:. ___ ~ ___ PARTNERSHIP: ____ _

4) TABLE OF ORGANIZATION:

5)

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a) LIST NAMES AND ADDRESSES OF ALL PRINCIPALS, SUCH AS ALL INDIVIDUALS SERVING ON THE BOARD OF DIRECTORS OR COMPARABLE BODY, NAMES AND ADDRESSES OF ALL PARTNERS, NAMES AND ADDRESSES OF ALL CORPORATE OFFICERS. (ATTACH ADDITIONAL PAPER IF REQUIRED)

NAME ADDRESS

b) LIST ALL NAMES AND ADDRESSES OF THOSE INDIVIDUAL SHAREHOLDERS HOLDING MORE THAN FIVE (5%) INTEREST IN THE FIRM AND STATE PERCENTAGE(%) FOR EACH INDIVIDUAL. (ATTACH ADDITONAL PAPER ff REQUIRED)

NAME ADDRESS PERCENT AGE

b"(l1ft4? v.-a~~ 2.JIC(~1ikt.s'l>r1~ 1Ai-.&I- /'1d2o Oc,t!0v11.S1 he t Aly Jtf'7 2-

TITLE:. ___ __,,_ __ --".....,.__ ________ DATE:. __ ~---+-~ 1 __ ,_l+--, -~------\ ~

Page3

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-NOTE: All bidders MUST sign and have notarized Certification Affidavit enclosed.

W-9 Request for taxpayer identification number & certification form (attached) must be filled out and returned with the bid.

Only one bid per bidder will be considered. If multiple bids are received from one bidder, then all bids from that bidder will be considered invalid and unacceptable

Attention Veterans:

You may have certain rights under Section 162 of the New York State Finance Law in connection with public contracts for the purchase of commodities or provision of services. Specifically, this law may authorize acceptance of a bid submitted by a "qualified veteran's workshop" provided that the bid shall not exceed the lowest responsible bid by greater than 15%. It is incumbent on you to submit all required

documentation to the Town, demonstrating your qualification for treatment under that Section. You should consult your attorney to determine your qualification for treatment under the provision.

Page 4

•

CONDITIONS

-· Contract No. 51-2018 Req. No. PD#000 13-2018

Bids shall be accepted only from those having the necessary qualifications to properly execute this bid.

2 No alteration, erasure or addition is to be made in the typewritten or printed matter. Any corrections made by vendor on bid MUST be initialed.

3 Any deviations from the specifications must be specifically stated at the time of bidding and same shall be made in writing and made a part of the bid.

4 Prices and information required, except signature of bidder, must be typewritten or written in ink. All signatures must be handwritten. Facsimile, printed or typewritten signatures are not acceptable.

5 Bid must be signed in ink by owner, partner or corporate officer.

6 Bid price shall include delivery within doors of: TOWN OF HEMPSTEAD Parks and Recreation - Various Pools.

7 No Federal, State or Municipal Sales & Excise taxes shall be quoted or charged. The Town is exempt from-such taxes. An exemption certificate will be furnished upon request.

8 Cash discount, if offered, must be for a minimum of 20 business days in order for it to. be a determining factor in makingthe award.

9 The Town Board reserves the right to reject any and all bids, to waive any informality in the bids received, and to accept the bid most favorable to the interest of the Town, after all bids have been examined and checked.

l 0 Bid shall be submitted in the envelope furnished, and property sealed ..

11 Payments will be made monthly in arrears upon the submission of a Town claim and receipt, signed by an authorized Department employee; verifying that the service has been rendered.

12 No Purchase Orders will be issued.

13 This is a three (3) year Contract and will not be extended.

14 Prices must remain firm for the entire term of Contract.

15 All bids may be reviewed at bid opening. Thereafter, no reviews, inquiries, orresults of bids will be permitted until Award has been made.

16 Failure to comply with any of the above instructions shall operate as a condition upon which the bid may be rejected .

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Documents

VENDOR(S): Park Line Asphalt Maintenance Inc