HomeMy WebLinkAbout2015 CON North State Environmental - Waste DisposalSHORT FORM SERVICES AGREEMENT
BY AND BETWEEN
TIIE CITY OF NATIONAL CITY
AND
NORTH STATE ENVIROMENTAL
THIS AGREEMENT is entered into this 1st day of July, 2015, by and between the CITY
OF NATIONAL CITY, a municipal corporation (the "CITY"), and NORTH STATE
ENVIROMENTAL (the "CONTRACTOR").
NOW, THEREFORE, CITY agrees to engage CONTRACTOR to perform the services
set forth herein in accordance with the following terms and conditions:
I. Description of Services. CONTRACTOR shall provide City -Wide on -site waste
disposal and pick-up/clean-up (Hazmat) as needed for our fiscal year ending June 30, 2016, and
as directed by Rick Hernandez, the City's Facilities, Maintenance Supervisor
2. Length of Agreement. The duration of this agreement is through June 30, 2016.
3. Compensation. The total compensation to CONTRACTOR for providing the
services set forth herein shall not exceed an annual total cost of $ 6,000.00. The compensation
for CONTRACTOR'S work shall be based upon and not exceed the rates given in Exhibit"A"
(the labor rates) without prior written authorization from CITY.
4. Payment Schedule. CITY will make payment within thirty (30) days of receiving
and approving a billing statement for the satisfactorily completed services of CONTRACTOR.
5. Termination. CITY may terminate this Agreement at any time by providing a one
(1) day written notice to CONTRACTOR.
6. Independent Contractor. It is agreed that CONTRACTOR is an independent
Contractor, and all persons working for or under the direction of CONTRACTOR are
CONTRACTOR'S agents, servants and employees, and said persons shall not be deemed agents,
servants, or employees of CITY.
7. Insurance. CONTRACTOR shall obtain:
A. ❑ If checked, Professional Liability Insurance (errors and omissions)
with minimum limits of $1,000,000 per occurrence.
B. Automobile insurance covering all bodily injury and property damage
incurred during the performance of this Agreement, with a minimum coverage of $1,000,000
combined single limit per accident. Such automobile insurance shall include owned, non -owned,
and hired vehicles ("any auto").
C. Commercial general liability insurance, with minimum limits of
$1,000,000 per occurrence/$2,000,000 aggregate, covering all bodily injury and property damage
arising out of its operations under this Agreement.
D. Workers' compensation insurance in an amount sufficient to meet
statutory requirements covering all of CONTRACTOR'S employees and employers' liability
insurance with limits of at least $1,000,000 per accident. In addition, the policy shall be endorsed
with a waiver of subrogation in favor of the City. Said endorsement shall be provided prior to
commencement of work under this Agreement.
E. The aforesaid policies shall constitute primary insurance as to the CITY,
its officers, employees, and volunteers, so that any other policies held by the CITY shall not
contribute to any loss under said insurance. Said policies shall provide for thirty (30) days prior
written notice to the CITY of cancellation or material change.
F. Said policies, except for the professional liability and workers'
compensation policies, shall name the CITY and its officers, agents and employees as additional
insureds, and separate additional insured endorsements shall be provided.
G. If required insurance coverage is provided on a "claims made" rather than
"occurrence" form, the CONTRACTOR shall maintain such insurance coverage for three years
after expiration of the term (and any extensions) of this Agreement. In addition, the "retro date
must be on or before the date of this Agreement.
H. Insurance shall be written with only California admitted companies which
hold a current policy holder's alphabetic and financial size category rating of not less than A VIII
according to the current Best's Key Rating Guide, or a company equal financial stability that is
approved by the City's Risk Manager. In the event coverage is provided by non -admitted
"surplus limes" carriers, they must be included on the most recent California List of Eligible
Surplus Lines Insurers (LESLI list) and otherwise meet rating requirements.
1. This Agreement shall not take effect until certificate(s) or other sufficient
proof that these insurance provisions have been complied with, are filed with, and approved by
the CITY's Risk Manager. If the CONTRACTOR does not keep all of such insurance policies in
full force and effect at all times during the terms of this Agreement, the CITY may elect to treat
the failure to maintain the requisite insurance as a breach of this Agreement and terminate the
Agreement as provided herein.
J. All deductibles and self -insured retentions in excess of $10,000 must be
disclosed to and approved by the CITY.
K. Insurance certificates must specify certificate holder as:
City of National City
AT'IN: Risk Manager
1243 National City Blvd
National City, CA 91950-4301.
8. Hold. Harmless. CONTRACTOR shall defend, indemnify, and hold CITY, its
Officers, employees, and agents harmless from any liability for damage or claims of same,
including but not limited to personal injury, property damage and death, which may arise from
CONTRACTOR, or CONTRACTOR'S subcontractors, agents or employees' operations under
this Agreement. CITY shall cooperate reasonably in the defense of any action, and
CONTRACTOR shall employ competent counsel, reasonably acceptable to the City Attorney.
9. Acceptability of Work. The City shall, with reasonable diligence, determine the
quality or acceptability of the work, the manner of performance, and/or the compensation
payable to the CONTRACTOR.
I O. Business License. CONTRACTOR must possess or shall obtain business license
from National City Finance Department before beginning work.
Revised. August 2014 2
11. Miscellaneous Provisions.
A. Counterparts. This Agreement may be executed in multiple counterparts,
each of which shall be deemed an original, but all of which, together, shall constitute but one and
the same instrument.
B. Captions. Any captions to, or headings of, the sections or subsections of
this Agreement are solely for the convenience of the parties hereto, are not a part of this
Agreement, and shall not be used for the interpretation or determination of the validity of this
Agreement or any provision hereof.
C. No Obligations to Third parties. Except as otherwise expressly provided
herein, the execution and delivery of this Agreement shall not be deemed to confer any rights
upon, or obligate any of the parties hereto, to any person or entity other than the parties hereto.
D. Exhibits and Schedules. The Exhibits and Schedules attached hereto are
hereby incorporated herein by this reference for all purposes.
E. Amendment to this Agreement. The terms of this Agreement may not be
modified or amended except by an instrument in writing executed by each of the parties hereto.
F. Waiver. The waiver or failure to enforce any provision of this Agreement
shall not operate as a waiver of any future breach of any such provision or any other provision
hereof.
G. Applicable Law. This Agreement shall be governed by and construed in
accordance with the laws of the State of California. The CONTRACTOR shall comply with all
laws, including federal, state, and local laws, whether now in force or subsequently enacted.
H. Entire Agreement. This Agreement supersedes any prior agreements,
negotiations and communications, oral or written, and contains the entire agreement between the
parties as to the subject matter hereof. No subsequent agreement, representation, or promise
made by either party hereto, or by or to an employee, officer, agent, or representative of any
party hereto shall be of any effect unless it is in writing and executed by the party to be bound
thereby.
T. Successors and Assigns. This Agreement shall be binding upon and shall
inure to the benefit of the successors and assigns of the parties hereto.
J. Construction. The parties acknowledge and agree that (i) each party is of
equal bargaining strength, (ii) each party has actively participated in the drafting, preparation and
negotiation of this Agreement, (iii) each such party has consulted with or has had the opportunity
to consult with its own, independent counsel and such other professional advisors as such party
has deemed appropriate, relative to any and all matters contemplated under this Agreement, (iv)
any rule or construction to the effect that ambiguities are to be resolved against the drafting party
shall not apply in the interpretation of this Agreement, or any portions hereof, or any
amendments hereto.
IN WITNESS WHEREOF, this Agreement is executed by CITY and by CONTRACTOR
on the date and year first above written.
Revised August 2014 3
CITY OF NATIONAL CITY
By:
APP
Leslie Deese, City Manager
1
Clau•ia Gacitua Silva
VED AS 0 ORM:
ti
0160 tL
City Attorney
CONTACT INFORMATION
CITY OF NATIONAL CITY
1243 National City Boulevard
National City, CA 91950-4301
Phone: (619)336- 4585
Fax: (619)336-4397
Contact: Rick Hernandez
Title: Facilities Supervisor
Dep.: Public Works
Email: rickh@nationalcityca.gov
NORTH STATE ENVIROMENTAL
(Corporation -- signatures of two corporate officers required)
(Partnership — one Signature)
(Sole proprietorship — one signature)
By:
(Na
me
Q-1L01/
(Print) J
By:
ame)
/6'g,JyIak
(Print)
(Title)
NORTH STATE ENVIROMENTAL
Complete Address:
2526 Folex Way, Ste. A,
Spring Valley, CA. 91978
Phone 619-409-9292
Fax 619-409-9290
Contact: Frank Balistreri
Title: Owner
Email: terrines a att.net
Taxpayer 1.D. No 942676644
Revised August 2014 4
Chent#, 659230 NOSTATEN
A CORD, CERTIFICATE OF LIABILITY INSURANCE
SATE IMICKFLYTI0
9/30/2014
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THI
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
4EPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER,
IMPORTANT. If the certificate holder is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder In lieu of such enclotsement(s).
PROou GER
HUB Intl Insurance Sery Inc.
.icense ff0757776
1091 North Shoreline Blvd 200
Mountain View, CA 94043
North State Environmental
P.O. Sox 2148
So. San Francisco, CA 94083-2148
CERTIFICATE NI
THIS iS TO CERTIFY THAT THE POLICIES DE INSURANCE LISTED (ELOW HAVEBEENISSUEO TO THE INSURED NAmED ABOVE OR THE POLICY PERIOD
HaorcATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT CR OTHER DOCUMENT WfTH RESPECT TO INFAir.H THIS
CERTIFICATE MAY BE Isstivn oR mAY' PERTAIN. THE ortGURANCE AEFOHDED 51" THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS,
EXCLUSiONS ANO CONDITIONS OF SUCH POLIC‘Es LiEtiTS SHOWN MAY 1-LAVE eEEN REDUCED BY PAID CLAIMS,
LTA
INSR
TYPE OF INSURANCE lADOL,SUER POLICY EFF , POLICY_ _,ME.
iiNSR 4WD 1 POLICY NUMBER EN,M.Morrero tputliDDrryrr, j Leads
A 1 GENERAL LiAttiuTT ECP0151290015 0/01/2014; 10/01/201 EACH OCCURRENCE
K COmmERCIAL GGNERAL LiAelury
I-7j .RNIA4?Er=rilance, X OCC_ $ 1 oqipoo
cumus.N.ADE 1UR ,
men e&F tArh, one Dellkw01 , I $ 00
X BI/P0 GL DED:$5000 1
PERSONAL & Any INJURY ,LS 1,000,000
X POLUPROF DED ;10000
GENERAL AGGREGATE ' S2,000,000
CiP4iRiE,GArF LIMIT AP ;PUE IS PER,
PRODUCTS ., COMP/OP At,IG $2000,000
X nu
, .,y 1.g.0 i 1 t:OC.
DPLIPL $1,000,000
AUTOMOBILE UABILITY
—..... BAP151280915 0/01/2014 ;10101 ItiOLE Lit,41; "
X ANY AUTO
ALL OWNED SCHEDULED e Ly INJURY (Per polltarq• :"°"°°
! AUTOS 1., , AUTOS BODILY SIA:DRY {PA, art,DR640 $
y NON -OWNED
, XH HIRED AUTOS .^ AUTOS
jenesse,Corcoranahubinternational.Com
INItueEitteiArroarallo co YE 4 ACE` NAIC
INSURER A Nautilus Insurance Company 17370
101 0 Groot Divide insurance 25224
INsuRE,,c Travelers insurance Group Inc 36137
!NSDREN
INSURER E I
SURER F
UMBRELLA LIAO X OCCuR
OFFICERNERBER EXCLUVED? y / A
1 yosi, dosento5 uHr/ele .
nrscmPT/01.4 OF oFp_wnpRs bObvi
C Motor Truck Cargo QT6607444L03 TiL14
bility
FFX151290515
X EXCESS LIAB 2,..L:LAIMS-MADE
Dm 1 X RETENTioNSO
la WORKERS COMPENSA DON
WCA151290715
AND EMPLOYERS' LIABILITY
ANY PRORRIVORIPARTNEREXECUTIVErYll
'Mandatory In Nit
;
NAME
Jenesse Corcoran
{te,N,L, EH) 650 237-3024 i FAX
I vuc, 650 560-6390
0/01 / 014' 10/01/201 ACHOCCURRERCE
ASO:REGIME ' 39,091? 000
,,,...'49.L9tic 000
10/01/2014 10/01/201SX ImEty‘NaS ji16,47.j.is I [2t,LTR'l
Er...LACH ACCIDENT IS toao,poo
oinEaSE-EAtraREOYEE10,000,000
$1,000,000
1401/2 E DISEASE POLICY LIMO 1
$250,000
$2,500 Deductible
DESCRIPTION OF OPERATIONS/ LOCATIONS r VEHICLES IAtisch ACORD 105, Remarks Schedule, lr.o,11Si:wick, tnag oluRI)
Re: SSA# 178 City of National City is additional Insured in regards to General Llabllity per the attached
endorsement form ECP1004 04/10. Waiver of Subrogation applies to General Liability per attached endorsement
m ENV2004 09/06. Additional Insured applies to Automobile Liability per attached endorsement form ENV2223
04108, Automobile Liability Waiver of Subrogation applies per attached enciorcement form CA0444 03/10.
ricers Compensation Waiver of Subrogation applies per mewled endorsment form WC040306 04/84.
TIFICATE H
City of National City
Finance Department
Purchasing Division
1243 National City Blvd.
National City, CA 91950
ACORD 25 12010/05) 1 of 1
dS3103440/M3103059
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES DE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL SE DELIVERED tN
ACCORDANCE WITH THE POLICY PROVISIONS,
AUTHORIZED REPRESENTATIVE
01988-2010 ACORI) CORPORATION, Ail rights reserved.
The ACORD name and logo are registered marks of ACOR
SG42
Policy Number: ECP0151290015
ENDORSEMENT
Th encorsen-eni forms ad of he odic? IC which il is allactied Pionse read 1 ca•efaily
WAIVER OF SUBROGATION
Jr is agreed lhat the C'ic^rpary, in the event of' any paymeri under Ih;s policy, waives r ghl cit recovery againsi any
Phncipal, but only at he spellic written request of the Named Insured &tiler before iaaNerioss, wherein sjcti
waiver has been included hefore os:s as part e( j conicacIL el 4nderlapq by 1-w. tlamed Insueed
This waiver shall apay only with respect to losses occurring due lo oper.al;ons ,:ncarlaken as per the socifie
contract existing oetwitiit:n the NAlincii Insured andSuch Pr,neihal and ghn'i net he ::onstread th r: Naive! with espera in or -ier operations PrIbpaliii vyWch the Named ,insui eta hos no contractile irterest
Ni waive- of subrogation snatt directly or ind rectly eOply to any employee, erholcyces er agents at either he
NRmed nsoreit cf the Prircipal, and the Ccmpany reserves its ngril er lien lc; ieimbu,ser from any recCvery
(lin" ChlAir.ed hv any irij,:red employee
f his wi;i,vo, (toes not apply in p.l.r;•.:4d,clinn or 1I i..0 do where sticn wniver is neio In ho illegai nr aga,nst
policy cr in any situation wherein the Principal o,',Jansi wiwm, subrogo lice is le bu waived i tot.nd to he solely neRti)eni
b,y Utoktoir SOAtritity.th14AVritirt (14).:#1 474` :Kt ti.ku I %....211tAkt41,5,..1i.r..N1";..r•,,n 246.4 01.0 r.v.vierto :yea( 4;43 COol.ame
;i4 irrm.porspq fr,11314141' trio t'N11014r lowy
fl+" za04 ea 06
Policy Number: BAP151260915
COMMERCIAL AUTO
CA 04 44 03 10
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US (WAIVER OF SUBROGATION)
This endorsement modifies Insurance provded under he tollowng,
BUSINESS AUTO COVFRAGF FORM
BustNEss AUTO PHYSICAL DAMAGE COVERAGE FORM
GARAU COVFRAGE FORM
MOTOR CARRIER COVERAGE FORM
TRUCKFRS COVERAGE FORM
Rh respect to coverage preview: oy this enderement, the prov!slons cl he Coverage Form upp'i uness
modified by hi endorser-tient
Its endorsement changeS the VOliCy effective an 0-1C necption ciatc (1-1C; policy unless another date rs ind.coted below.
'Endorsement FirectIve Dato: 10/01/2013
Named Insured: Norge StaIn Envi,-onrre-ita
(..) Of Person(s) Or Organizatlan(s):
SCHEDULE
filariket Coverage suoject to written centred end wntlen agreement
iforrnarion required to compete this Schedule, 1 not shown ,:lbeve, will 1-,e shown the Dec/waters,
f he Transfer Of RIghte Cif Recovery Against
Others To Us Condition does not apply to the
eon) ar oronnizabon(s) shown in the Sciicdule,
etit only to the extent that :•t.ibrogai,on is waned
p,tor to the 'accident" or he 'loss' under a contract
viln trot person or organization
CA 04 44 03 10
CO insurance Se Cr:1fi Offce, nc,, 2009 Page 1 of 1
Policy Number, ECP0151290015
ENDORSEMENT
This endorsement forms a part of the policy to which it is attached, Please read it carefully,
t ADDITIONAL INSURED — BLANKET
rhis eneorsement modifies insurance provided under the foliowing
ENVIRONMENTAL COMBINED POLICY
In consideration of tne premium charged and notwithstanding anything contained in this policy to the contrary, it is hereby
agreed and understood that this endorsement shall apply only to the Coverage Parl(s) corresponding with the box cr
boxes marked below,
0 COVERAGES A AND B - GENERAL LIABILITY
IfY,1 COVERAGE D CONTRACTORS POLLUTION LIABILITY
SECTION III - WHO IS AN INSURED is amended toinclude as an insured, with respect to Coverage A, B anc D, any
person(s) or organization(s) when you and such person(s) or organ zation(s) have agreed in a written contract or written
agreement that such person(s) or organizalion(s) be added as an additional insured on your policy Such written contract
Of written agreement rnust he in effect prior lc the performance of your work which is the subject of Such written contract
or written agreement.
Such additional insured status applies crity,
1, under COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY and COVERAGE B PERSONAL
AND ADVERTISING INJURY LIABILITY for claims or suits resulting froxi
a. Your work performed for such person(s) or organization(s) in the performance of your ongoing
operations for the additional insured, or
b. Your work performed for such person(s) er argana1ions(s) and included in the products-compfeted
operations hazard.
2. Under COVERAGE D CONTRACTORS POLLUTION LIABILITY for claims or suits arising out of pollution
conditions that are the resul ol:
a. Your work performed for such person(s) or organization(s) in the performance of your ongoing
operations for the additional insured; or
b. Your wurk performed for such person(s) or organization s and included in the pi oducls-compleled
operations hazard.
With respect to damages caused by your work, as desurinec above. the coverage provided hereunder shall be primary
and not contributing with any other insurance avaliaole to those oerson(s) or organization(s) with which you hove so
agreed in a written contract or written agreement
ALL OTHER TERMS AND CONDITIONS OF THE POLICY SHALL APPLY AND REMAIN UNCHANGED.
2006 by Berkley Seer:eery ../reer,ereieg Meengets LLC, ineqiliele el hle125kos Maumee CoMpery tI11:1 Omit Divide Mewl:kick Ceerberly. Aleuble ruse. vett.
C. I 9e5-2006hy kmrance Sertir es Mite, ine,, materiel likekl by pereekkier,
ECP 1004 0.4 10
Page 1011
Policy Number: BAP 151260915
ENDORSEMENT
Th3 endorsement forms a part of the policy to which It rs attached. Please read it carefully
BUSINESS AUTO - ADDITIONAL INSURED
WHEN REQUIRED BY CONTRACT OR AGREEMENT
This endorsement modifies insurance prcMdeiJ indcr1he fol ow,ng
BUSINESS AUTO COVERAGE FORM
Section It-. Liability Coverage A. — Coverag•, 1. Who la an Insured, is amended to add:
d. Any person or organ whorl to whom yoJ oecome oellgated to .ncl -Ida as an addllonal insured unthr thIs
policy, as a esulto1arycoro ay -eel -Pont you enter Into, excluding ocntracts or agrocroonts fur
orofess'onEw senvces, whici- reou.'es you to furilsh insurance to that person or orciailizaton of the type
provded by this policy, out only 1.v'th respect to IlaDility alsng out of your opera( ons or prom ses owned by or
rented to you However, the insu-ance provided will not exceed the lesser of:
1. The coverage and/or limits of this policy, or
2. The covertve Emtior IlnJl requ rut, by sad contred c- agreement
ALL OTHER TERMS AND CONDITIONS OF THE POLICY SHALL APPLY AND RE MAJN UNCHANGED.
g.,44040 SIIUday g.31,11tin ir:Lvnrz C417%zny t Up, hmulati ConlioVoidl jils.D4464vud,
4004, ,f6vor ipt) 5,ornir ve with
ENV 2'O23 04 OS Page of
WORKRRS C0NEENBATTON AND EMPtOYaRa 1.111oWLFTY IN9IMAM.7. 1",L7.11'
WC 04 03 06 tiO4-64)
WiTwaR OF OUR 'fur rc iitruvea FROM CTHRRa FeiDOT-clu,le01104
we nAve the rigtt tO recover cur payments from anyone liable for an injury coverY
thi policy. We will not enforce our right against that person or organization nailed
in the 3chedule. (This agreement applies only to the extent that you perform work
under a wrf.t.7en contract that requires you to ootain this agreement ficm us,)
You muet maintain payroll recordo accurately enrov.itin3 the rOrmmeratiOn Ot yOUT
empicyeee while mgaged in thu work described in the Schedule
The addltloria/ premium tor this endoratusant shell De .04 i of the California
WorkOree compenaation prmmium orhmrwiam due, on Aoch remmci-mcion.
&cheduie
Person or CrVaniaation
Any principal wherein w0Gh waiver haa
been included before loss as part of a contractual
undert41,1G9 UY U3..ed
This endo:sement chenges the Polio Go which LE le tached and le Ofl the
date issued unlese othorwioc stated.
(Ma inEormati'on below iv ro,virad only wise this, endorsement lu issued subseque t to
preparation of the policy.)
Endortemant Effective 1041/W4 policy No MA151290715
Ine:Ired Ncrth $tate rrivironmestal,
Ineurance t:ourpany Great Divide ninurana. Convour
Comncersisned by
End.:,,,,ment No.
CoPYri9PIth W�rker's Inwrome Ratiny )wreov Galflerria, ALL rip's oiaervet
THIS DOCUMENT HAS A TRUE DOCUCHECK' WATERMARK AHD VISIBLE FIBERS DISC
77148 CITY OF NATIONAL CITY
BUSINESS LICENSE CERTIFICATE
PURSUANT TO COY ORDINANCE THIS LICENSE /S HEREBY GRANTED FOR THE TERM & PURPOSE STATED
BUS DESCRPTION HAZ MAT DISPOSAL
BUSINESS ADDRESS 2526 FOLEX WAY STE
BUSINESS NAME
ATTN:
FAAILING
ADDRESS
NORTH STATE ENVIRONMENT
2526 FOLEX WAY STE A
SPRING VALLEY, CA 91978-2038
NON TRANSFERABLE POST IN A CONSPICUOUS F'LACE
pate o! Expiration: 12/31/2015
City Manager
Form W-9
2013)
Capartelent of elk,
Internal Revenue Sevire
Request for Taxpayer
IdentJficatjor, Number and Certification
cn yetir income tax return)
Environmental
Bustress nerriedexiso
Give Form to the
requester. Do not
send to the IRS.
ed entity name. if 6nerent rrOn71.-(014“ee
Check appropriate box or federal fax classilleatioLJni
Individual/sole propnefor 12.1 C. Corporation L. S Corporation 0 Partnership rii] Trust/estate
1.n. 1-1
2
larraled liability company Er ter Mc tax classific.etien corporation, S.S. corporation, P.pannerskpj
0 Other (see irertruchons/11`
to Address (number. street, Tar -xi apt. Or suite no.)
ri P.O. Box 2148
City, state. and 7111 code
South San Francisco, CA 94083
List account number(s) hare (optional
Taxpayer Identification Number (TIN)
Enter your TIN in The appropriate box, The TIN provided most (notch the Rama given on the 'Name" Ina
to avoid backup withholding. For individuals. this is your social security number (SSN). Howvever, for a
r,;:sident alien, sole prWrig.t0r, Or disregarded ent ty, see the Part I instructions on page 3. For other
entities, it is your employer i-,)erthficritIon number fEiN). If you do not have e number, sce New to get a
Ti' on page 3.
Note. if the account is in mere than one name, see the chart on page 4 for auttlelines on whose
number to enter.
Exemptions (see instructions):
Exerrpt payee xide f
Exemption tram FATCA reporting
code fif any
Requester's name and address (opoont0
rt U rtification
er 116na111es of perjury. I certify that:
[Social semi ay number
Timployer identi foation number -
g
4
2 6 7 6 6 14 4
1, The number shown on this form Is my caned taxpayer identification number (or I in waiting for a number to be issued to me). and
2. I am rot subject to backup withholding because: (a) I am exempt from backup 'ftithhulding, or (b) I have not been notified by the Internal Revenue
Service ORS) that I am subject to backup withhislrang as a result of a failure to report all Interest or dividends, or (c) tne IRS has notified me that I urn
rib fongor subject to back..ip i.vithhelding, and
3. I ern a US, citizen or other U.S. parson (defined below). end
4. The FATCA coOms) entered on this form tit any) indicating that I arn exerrip
Certification Instructions, You must cross out item 2 above if you have been
because you have !again() report al! interest and dividends on your tax return
interest paid. acquisition or abandoniniant of secured property, cancellation o
genet -rely, payments other than interest and dividends, you are not required to
instructions on page 3_
Sign Signature of
Here u.S. person 0
General Instructions
t irom FATCA reporting is correct.
notified by the iRS that p41.1 are currently subiect to backup withholding
For real estate transactions, item 2 does not apply. For mortgage
f debt, contributions to an individual ,etirement arrangement (IRA), and
sign the certification, but you must provide your Correct TIN. Sao the
O n references are to the enema( Revenue Cute unless otnernose °moo
Future developments The tR5 nas crewed a page on IR13 goy ice information
about Form W-9, at weetvirs,anWw9 Information about any fultre deelleprne,
iu
al'eated) Form 'N.9 (such as legiraation enacted after we release it) will be posted
ex: that page.
Purpose of Form
A per eon lent, is required to Ile an ittormation ore urn with the IRS muse obtain your
correct taxpayer Identifirzton number (TIN} to report. for example, steams paid to
you, oaymentS made to you in settlement or payment Card and third party network
transactions real estate transactions, mortgage interest you paid, acquisition Cr
agnodorment iecurect property, carroetation of debt, or contributions yOu made
to an irta
Use Form W-9 on!11 you are a US person lin‘ludrig a resident alien), to
prorride your =rent TNN to the person requesting it (the recueSted and, %MeV
applicable, kr
1. Corley that the 1114 you doe givalgls correct Or you ars Wading for a number
to be esurca,
2 Certify ram you are not subtect to backup weithholdir,g, or
3. Claim esempllon from backup withholding if you are a U.S +Omega payee. if
applicableyou are Aled certifying Ikat as a US person, your allocable share of
any Partnership income from a U.S. [rodeo business is rot cubatot to the
vicintiording lax on fOraign partners' 'Shore or effectively Connected inrOMe, and
4 Certify that FATCA oude(s) entered on this form Of any) tothcating that yOu are
exempt !torn the FATCA reaortiog, IS correct.
Note, If you are a US. person and a requester caves you a form other Marl 4051
W-9 to request your TI14. you must use the requester's form If it er substanilaily
smiler to this form W-0.
Definttfon of a U,S. person. FM haderaf tax purposesyou ore considered 0.6
Person 11 you are.
• Ail indovIdnat who a US, citizen or U.S resident alien• ,
A partnership, COrpOeRtioni, f„-ofdpany, or association created or orgarmzed to the
I./Meal Stott* Of Under, the laws of the United States,
. An estate (1utber tren a Infedjn estate), or
• A domestic trust (as ciannad in Regulations section 301.7701-1).
Special rules for partnerships. Partnerships that conduct a trade or business ri
the United Slates are generally required to pay a withholding tax under section
1446 on any keeign partnersshare of effectively connected taxable Income term
such business. Fur dee, al certain eases where a Form W-9 etas ran been received,
the rakes under section 1446 (eguire a partnership to presume diet a partner is e
tereqn person, and pay the section 1446 wilhholdIng tax. Therefore, it you are a
U.S, person that is a partner r a partnership conducting a trade or bus -Mass 1 the
United Slaws, univete Fenn W44 to the partnership to establish your U.S, statue
and T.ierod section 14413 witteto;ding on your share or pudnemnip inCome
Cal. No 1C231 X
Poi 1A1-9 trlev. 8-2 13)
City ofNational C'Mm
Contract Pricing 2015
ITEM NO.
DESCRIPTION
UNIT
UNIT PRICE
1
F|smnvmhleo-Liquid:
a)5Gallon Drum
EA
$ 80.00
b) 15 Gallon Dmrn
EA
$ 100,00
d3OGallon Drum
EA
$ 120.00
d)55Gallon Drum
EA
$ 14O.00
e)Lab Pack, 5Gallon
EA
$ 100.00
f)Lab Pack, 15Gallon
EA
$ 175,00
g)Lab Pack, 3OGallon
EA
$ 215.00
h)Lab Pack, 55Gallon
EA
$ 280.00
2
F|amnnmmWwm-Solid:
a)5Gallon Drum
� EA
$ 14U.00
b) 15SaUon Drum
EA
$ 18100
o)3OGallon Drum
EA
$ 30008
d)55Gallon Drum
EA
$ 380.00
e)Lab Pack, 6Gallon
EA
$ 145.00
f) Lab Pack, 15GaUnn
EA
$ 200�00
g)Lab Pack, 3UGallon
EA
$ 300.00
h)Lab Pack, 55Gallon
EA
$ 400.00
3
A|dehydee/Fonno|im:
o)3OGallon Drum
EA
$ 270.00
b)55Gallon Drum
EA
$ 320.00
4
Glycol:
o)3DGallon Drum
E4
$ 145.00
b)55Gallon Drum
EA
$ 185.00
5
Toxic -Liquidm:
a)30Gallon Drum
EA
$ 280.00
h)55Gallon Drum
EA
$ 32&80
u)Lab Pack, 5Gallon
EA
$ 120.00
d) Lab Pack, 15GoUon
EA
$ 200.00
e)Lab Pack, 38Gallon
B\
$ 270.00
f)Lab Pack, 55Gallon
EA
$ 315.00
8
Waste Oil:
a) 15GaUon Drum
EA
$ 98.00
h)3OGallon Drum
EA
$ 100.00
c)55Gallon Drum
EA
$ 120.00
7
Flammable toxic 'Liqukds:
a)3OGallon Drum
EA
$ 300-00
b)55Gallon Drum
EA
$ 350.00
o) Lab Pack, 5GaUon
EA
$ 130.00
d)Lab Pack, 15Gallon
EA
$ 200.00
o)Lab Pack, 3OGallon
EA
G 2K00
f)Lab Pack, 55Gallon
EA
$ 330-00
City of National City
Contract Pricing 2015
ITEM NO.
DESCRIPTION
UNIT
UNIT PRICE
8
Corrosive Liquid:
a) 30 Gallon Drum
EA
$ 240.00
b) 55 Gallon Drum
EA
$ 310.00
c) Lab Pack, 5 Gallon
EA
$ 120.00
d) Lab Pack, 15 Gallon
EA
$ 180.00
e) Lab Pack, 30 Gallon
EA
$ 220.00
f) Lab Pack, 55 Galion
EA
$ 310.00
9
Corrosive Solid:
a) 30 Gallon Drum
EA
$ 200.00
b) 55 Gallon Drum
EA
$ 240.00
c) Lab Pack, 5 Gallon
EA
$ 120.00
(I) Lab Pack, 15 Galion
EA
$ 180.00
e) Lab Pack, 30 Gallon
EA
$ 220.00
f) Lab Pack, 55 Gallon
EA
$ 310.00
10
Oxidizer - Liquid:
a) 30 Gallon Drum
EA
$ 300.00
b) 55 Galion Drum
EA
$ 420.00
c) Lab Pack, 5 Galion
EA
$ 150.00
d) Lab Pack, 15 Gallon
EA
$ 215.00
e) Lab Pack, 30 Gallon
EA
$ 315.00
f) Lab Pack, 55 Gallon
EA
$ 425.00
11
Oxidizer - Solid:
a) 30 Gallon Drum
EA
$ 300.00
b) 55 Gallon Drum
EA
$ 450.00
c) Lab Pack, 5 Gallon
EA
$ 150.00
d) Lab Pack, 15 Gallon
EA
$ 225.00
e) Lab Pack, 30 Gallon
EA
$ 315.00
f) Lab Pack, 55 Gallon
EA
$ 415.00
12
Latex Paint:
a) 30 Gallon Drum
EA
$ 120.00
b) 55 Gallon Drum
EA
$ 140.00
c) Lab Pack, 5 Gallon
EA
$ 60.00
d) Lab Pack, 15 Gallon
EA
$ 80.00
e) Lab Pack, 30 Gallon
EA
$ 120.00
f) Lab Pack, 55 Gallon
EA
$ 150.00
g) Lab Pack, Cubic Yard Box
EA
$ 400.00
13
Oil -Based Paint - >8,000 BTU, <3" Solid:
a) 30 Gallon Drum
EA
$ 140.00
b) 55 Gallon Drum
EA
$ 165.00
c) Lab Pack, 5 Gallon
EA
$ 80.00
d) Lab Pack, 15 Gallon
EA
$ 186.00
e) Lab Pack, 30 Gallon
EA
$ 160.00
f) Lab Pack, 55 Gallon
EA
$ 320.00
g) Lab Pack, Cubic Yard Box
EA
$ 795.00
City of National City
Contract Pricing 2015
ITEM NO.
DESCRIPTION
UNIT
UNIT PRICE
14
Reactive Liquids/Solids:
a) Lab Pack, 5 Gallon
EA
$ 175.00
b) Lab Pack, 15 Gallon
EA
$ 225.00
c) Lab Pack, 30 Gallon
EA
$ 350.00
15
PCB Ballasts:
a) 5 Gallon Drum
EA
$ 80.00
b) 15 Gallon Drum
EA
$ 120.00
c) 30 Gallon Drum
EA
$ 200.00
d) 55 Gallon Drum
EA
$ 320.00
16
Non - PCB Light Ballasts:
a) 5 Gallon Drum
EA
$ 80.00
b) 15 Gallon Drum
EA
$ 150.00
c) 30 Gallon Drum
EA
$ 175.00
d) 55 Gallon Drum
EA
$ 200.00
17
Flammable Aerosols:
a) 5 Gallon Drum
EA
$ 120.00
b) 15 Gallon Drum
EA
$ 185.00
c) 30 Gallon Drum
EA
$ 225.00
d) 55 Gallon Drum
EA
$ 310.00
18
Aerosols (inhalers, pesticides, corrosive):
a) 5 Gallon Drum
EA
$ 165.00
b) 15 Gallon Drum
EA
$ 225.00
19
Batteries - NiCad:
a) 5 Gallon Drum
EA
$ 50.00
b) 15 Gallon Drum
EA
$ 125.00
c) 30 Gallon Drum
EA
$ 200.00
d) 55 Gallon Drum
EA
$ 325.00
20
Batteries - Lithium:
a) 5 Gallon Drum
EA
$ 50.00
b) 15 Gallon Drum
EA
$ 125.00
c) 30 Gallon Drum
EA
$ 250.00
d) 55 Gallon Drum
EA
$ 350.00
21
Batteries - Lead Acid:
a) Bulk - per pound
LB
$ 0.30
22
Batteries - Alkaline (landfill):
a) 5 Gallon Drum
EA
$ 60.00
b) 15 Gallon Drum
EA
$ 100.00
c) 30 Galion Drum
EA
$ 150.00
d) 55 Gallon Drum
EA
$ 200.00
��'�m *�� ����'���G8U ����
City - National ' _'.�
Contract Pricing 2015
ITEM NO,
DESCRIPTION
UNIT
UNIT PRICE
23
RCRAToxic 'Solid:
a
a)30Gallon Drum
EA
220�00
b
b)55Gallon Drum
EA
$ 260.00
u)Lab Pack, 5Gallon
EA
$ 13D.00
d> Lab Pack, 15QuUon
EA
$ 195,00
e
e)Lab Pack, 3DGallon
EA
$ 260.00
f) Lab Pack, 55Ga||on
EA
$ 360.80
24
Mercury ' E/emwnCa|($200.00 min applies):
a
a) Pound
LB
$ 20.00
25
Mercury Cpmnpouud($25O.UOmin app|ims):
a
a)Pound
L8
$ 28.00
26
Class 'Liquid:
8
8) 5G3||on D0n1
EA
$ 88-80
h)15Gallon Drum
EA
$ 140.00
o)3OGallon Drum
EA
o 180.00
d)55Gallon Drum
EA
$ 250.00
e) Lab Pevk, 5 Gallon
EA
$ 100.00
fLaU Pack, 15 Gallon
EA
$ 140.00
g) Lab Pack, 30GaUon
EA
$ 216.00
h) Lab Pack, 55SeUon
EA
$ 280�00
27
Class 9'Solid:
a)30Gallon Drum
EA
$ 200�00
b)55Gallon Drum
EA
8 2K00
v) Lab Pack, 5GaUon
EA
G 1KOO
d)Lab Pack, 15GaUon
EA
$ 140.00
e) Lab Pack, 30Ga||on
EA
$ 215.00
f) Lab Pack, 55GeUon
EA
$ 280.00
2$
Non'RCRALiquid:
a)5Gallon Drum
EA
40.00
b) 15 Gallon Drum
EA
$ 100.00
o)3UGallon Drum
EA
$ 125.00
d)55Gallon Drum
EA
$ 155�00
g) Lab Pack, 5GaUon
EA
$ 60.00
h)Lab Pack, 15Gallon
EA
$ 135.00
ULab Pack, 3OGallon
EA
$ 165.00
j)Lab Pack, 55GaUon
EA
$ 195�80
k)Lab Pack, Cubic Yard Box
EA
$ 52000
|) Bulk 276gallon tote
EA
8430.00
City of National City
Contract Pricing 2015
ITEM NO.
DESCRIPTION
UNIT
UNIT PRICE
29
Non-RCRA Solid:
a) 30 Gallon Drum
EA
$ 125.00
b) 55 Gallon Drum
EA
$ 155.00
c) Cubic Yard Box - Bulk
EA
$ 420.00
e) Lab Pack, 5 Gallon
EA
$ 40.00
f) Lab Pack, 15 Gallon
EA
$ 60.00
g) Lab Pack, 30 Gallon
EA
$ 135.00
h) Lab Pack, 55 Galion
EA
$ 180.00
i) Lab Pack, Cubic Yard Box
EA
$ 500.00
30
Empty Containers(for recycle):
a) 5 Gallon Drum
EA
$ 8.00
b) 15 Gallon Drum
EA
$ 10.00
c) 30 Gallon Drum
EA
$ 20.00
d) 55 Gallon Drum
EA
$ 25.00
31
Electronic Components ($50.00 min applies):
a) Bulk - per pound
LB
$ 0.80
32
Chemist
HR
$ 85.00
33
Technician
HR
$ 59.00
34
Containers:
a) 55 Gallon Drum - Steel
EA
$ 42.00
b) 30 Gallon Drum - Steel
EA
$ 46.00
c) 15 Gallon Drum - Steel
EA
$ 48.00
d) 55 Gallon Drum - Poly
EA
$ 45.00
e) 30 Gallon Drum - Poly
EA
$ 38.00
f) 15 Gallon Drum - Poly
EA
$ 39.00
g) 5 Gallon Drum - Poly
EA
$ 14.00
h) 55 Gallon Lab Pack Container
EA
$ 40.00
i) 30 Gallon Lab Pack Container
EA
$ 30.00
j) 15 Gallon Lab Pack Container
EA
$ 26.00
k) 5 Gallon Lab Pack Container
EA
$ 12.00
I) Cubic Yard Box
EA
$ 70.00
n) Vermiculite - bag
EA
$ 20.00
m) Bio bags
EA
$ 2.00
35
Asbestos
YD
$ 90.00
36
Fluorescent lamps
a) Straight F-tubes (per linear foot)
FT
$ 0.16
b) Biax, "0" °U" lamps
EA
$ 0.95
c) Sodium, Mercury, HID lamps
EA
$ 2.95
City of National City
Contract Pricing 2015
ITEM NO.
DESCRIPTION
UNIT
UNIT PRICE
37
Lead for Recycle:
a) 5Ga|kon Drum
GA
$ 25.0--
b) 15GaUon Drum
EA
$ 90.80
n)3OGallon Drum
EA
$ 180,00
d)55Gallon Drum
�
b4
$ 250�00
38
MAPP Gas Cylinder
EA
3 05.00
39
Organic Peroxide:
a)6Gallon Drum
EA
$ 175.00
40
P|HZone ^A/':
a)5Gallon Drum
E4
$ 2K00
b)15Gallon Drum
EA
$ 275.00
41
P|HZone ~B^:
u) 5Gm||un Drum
EA
$ 20Q.00
b) 15Gallon Drum
EA
$ 300.00
42
PnppaneCy|inmr
G4
$ 40.00
43
Silver Recovery Cartridges:
a)5Gallon Drum
EA
3 100,00
44
Transportation 'Bulk
a)Roll-off with driver
HR
90.00
b) Tanker with driver
HR
90.00
45
Tires
EA
$ 8.00
48
Oily Watmr- Bulk
GAL
$ 0,90
47
Washout
a)Non-hazardous waste washout
EA
$ 200�00
b)Non'RCRAhazardous waste washout
EA
$ 35000
o)RCRAwaste washout
EA
$ 350�00
City of National City
Contract Pricing 2015
ITEM NO.
DESCRIPTION
UNIT
UN[TPR|CIff-
48
Appliances for recycle:
a) Refrigerator
E&
$ 50.00
b)Refrigera0zr/Fnoazer
EA
$ 50.00
c)Microwave oven
EA
$ 50.00
d)Other small appliance
EA
$ 50.00
e)Other large appliance
EA
$ 50.00
49
O|| Filters:
o)5Gallon Drum
EA
$ 40.00
b)16Gallon Drum
EA
$ 40.00
c)30Gallon Drum
EA
$ 40O0
d)56Gallon Drum
E4
S 40.00
SO
Reactive Metals (sodium, lithium):
a)5Gallon Drum
EA
$ 325�00
51
RCRAphanmwaste with sharps:
a)5Gallon Drum
EA
$ 650.00
52
RCRy\Phannwaste without sharps:
o)5Gallon Drum
EA
$ 650�00
53
ERCall-out Services:
a)Tanker
HR
$ 12500
b)Ro||-off
HR
$ 125.00
c)Step deck, other
HR
$ 11500
d)Van Trailer
HR
$ 95.00
e)Service Truck
HR
$ 120,00
0Project Manager
HR
$ 105.00
g)Teohnicien
HR
$ 7500
h)Chemiot
HR
$ 115�00
i)Pressure Washer
Day
$ 250.00
54
Cylinders:
a)Calibration gas - Lecture bottle 2.1
EA
$ 350.80
b)Calibration gas ' Small cylinder 2.1
EA
$ 500.00
o) Calibration gas - Medium cylinder 2.1
EA
$ 850M
d)Calibration gas - Large cylinder 2.1
EA
$ 350.00
e)Compress air Lecture bottle 22
EA
$ 2K00
8 Compress air - Small cylinder 2.2
64
$ 400UO
g)Compress air - Medium cylinder 22
EA
$ 50000
g)Compress air - Large cylinder 22
EA
$ 60000
h>Empty gas ' Lecture bottle 2.3
EA
$ 55000
i) Empty gas - Small cylinder 2 3
EA
$ 700OO
j)Empty gas - Medium cylinder 2.3
EA
$ 850.00
k)Empty gas ' Large cylinder 23
EA
$ 880,00
CITY OF NATIONAL CITY
Office of the City Clerk
1243 National City Blvd., National City, California 91950
619-336-4228 phone / 619-336-4229 fax
Michael R. Dalla, CMC - City Clerk
September 16, 2015
Mr. Frank Balistreri
North State Environmental
2526 Folex Way, Suite A
Spring Valley, CA 91978
Dear Mr. Balistreri,
On July 1st, 2015, an Agreement was entered into between the City of National City and
North State Environmental.
We are enclosing for your records a fully executed original Agreement.
Sincerely,
Michael R. Dalla, CMC
City Clerk
Enclosure