HomeMy Public PortalAbout050-2017 - Metro - Airco - Asbestos AbatementAGREEMENT
THIS AGREEMENT made and entered into this Jp day ofArd , 2017, and referred to as
Contract No. 50-2017 by and between the City of Richmond, Indiana, a municipal corporation
acting by and through its Board of Public Works and Safety (hereinafter referred to as the "City")
and Asbestos Inspections & Removal Company d/b/a Air Co., 4404 N. Franklin Road, Indianapolis,
Indiana, 46226 (hereinafter referred to as the "Contractor").
SECTION I. STATEMENT AND SUBJECT OF WORK
City hereby retains Contractor to provide services in connection with asbestos abatement for certain
properties located in Richmond, Indiana, for the Richmond Blight Elimination Program (Round 1
and Round 2) Project (the "Project"), per Indiana Housing and Community Development ("IHCDA")
Guidelines, which services are more specifically set forth in the Notice to bidders. The structures are
as follows:
Round l:
529 South 7th Street $2,500.00
2303 Glen Court $1,000.00
TOTAL: $3,500.00
Round 2:
220 South 12th Street $1,500.00
300 South 121h Street $1,000.00
325 South 12th Street $3,000.00
2231 Glen Court $500.00
TOTAL: $6,000.00
PROJECT TOTAL: $9,500.00
A request for quotes, dated February 23, 2017, including all addendums, has been made available for
inspection by Contractor, is on file in the office of the Director of the Department of Infrastructure
and Development, is hereby incorporated by reference, and made a part of this Agreement.
Contractor agrees to abide by the same.
The response of Contractor to said Request for Quotes, consisting of two (2) pages, dated March 7,
2017, is attached hereto as Exhibit A, which Exhibit is incorporated by reference and made a part of
this Agreement. Contractor agrees to abide by the same.
Contract No. 50-2017
Page 1 of 9
Should any provisions, terms, or conditions contained in any of the documents attached hereto as
Exhibits, or in any of the documents incorporated by reference herein, conflict with any of the
provisions, terms, or conditions of this Agreement, this Agreement shall be controlling.
The Contractor shall furnish all labor, material, equipment, and services necessary for the proper
completion of all work specified.
No performance of services shall commence until the following has been met:
1. The City is in receipt of any required certificates of insurance;
2. The City is in receipt of any required affidavit signed by Contractor in
accordance with Indiana Code 22-5-1.7-11(a)(2); and
3. A purchase order has been issued by the Purchasing Department.
SECTION II. STATUS OF CONTRACTOR
Contractor shall be deemed to be an independent contractor and is not an employee or agent of the
City of Richmond. The Contractor shall provide, at its own expense, competent supervision of the
work.
SECTION III. COMPENSATION
City shall pay Contractor a sum not to exceed Nine Thousand Five Hundred Dollars and Zero Cents
($9,500.00) for satisfactory completion of the Project.
SECTION IV. TERM OF AGREEMENT
This Agreement shall be effective when signed by all parties and shall continue in effect until
completion of the BEP project, which completion shall be within thirty (30) days from the date of the
Purchase Order.
Notwithstanding the term of this Agreement, City may terminate this Agreement in whole or in part,
for cause, at any time by giving at least five (5) working days written notice specifying the effective
date and the reasons for termination which shall include but not be limited to the following:
a. failure, for any reason of the Contractor to fulfill in a timely manner
its obligations under this Agreement;
b. submission of a report, other work product, or advice, whether oral or written, by the
Contractor to the City that is incorrect, incomplete, or does not meet reasonable
professional standards in any material respect;
c. ineffective or improper use of funds provided under this Agreement;
d. suspension or termination of the grant funding to the City under which this Agreement
is made; or
Page 2 of 9
e. unavailability of sufficient funds to make payment on this Agreement.
In the event of such termination, the City shall be required to make payment for all work performed
prior to the date this Agreement is terminated, but shall be relieved of any other responsibility herein.
This Agreement may also be terminated, in whole or in part, by mutual Agreement of the parties by
setting forth the reasons for such termination, the effective date, and in the case of partial
termination, the portion to be terminated.
SECTION V. INDEMNIFICATION AND INSURANCE
Contractor agrees to obtain insurance and to indemnify the City for any damage or injury to person or
property or any other claims which may arise from the Contractor's conduct or performance of this
Agreement, either intentionally or negligently; provided, however, that nothing contained in this
Agreement shall be construed as rendering the Contractor liable for acts of the City, its officers,
agents, or employees. Contractor shall as a prerequisite to this Agreement, purchase and thereafter
maintain such insurance as will protect it from the claims set forth below which may arise out of or
result from the Contractor's operations under this Agreement, whether such operations by the
Contractor or by any sub -contractors or by anyone directly or indirectly employed by any of them, or
by anyone for whose acts the Contractor may be held responsible.
Coverage Limits
A. Worker's Compensation & Statutory
Disability Requirements
B. Employer's Liability $100,000
C. Comprehensive General Liability
Section 1. Bodily Injury $1,000,000 each occurrence
$2,000,000 aggregate
Section 2. Property Damage $1,000,000 each occurrence
D. Comprehensive Auto Liability
Section 1. Bodily Injury $1,000,000 each person
$2,000,000 each occurrence
Section 2. Property Damage $1,000,000 each occurrence
E. Comprehensive Umbrella Liability $1,000,000 each occurrence
$2,000,000 each aggregate
F. Contractor's Pollution Liability $1,000,000 each occurrence
Page 3 of 9
G. Professional Liability Errors
and Omissions $1,000,000 each occurrence
SECTION VI. COMPLIANCE WITH WORKER'S COMPENSATION LAW
Contractor shall comply with all provisions of the Indiana Worker's Compensation law, and shall,
before commencing work under this Agreement, provide the City a certificate of insurance, or a
certificate from the industrial board showing that the Contractor has complied with Indiana Code
Sections 22-3-2-5, 22-3-5-1 and 22-3-5-2. If Contractor is an out of state employer and therefore
subject to another state's worker's compensation law, Contractor may choose to comply with all
provisions of its home state's worker's compensation law and provide the City proof of such
compliance in lieu of complying with the provisions of the Indiana Worker's Compensation Law.
SECTION VII. COMPLIANCE WITH E-VERIFY PROGRAM REQUIREMENTS
Pursuant to Indiana Code 22-5-1.7, Contractor is required to enroll in and verify the work eligibility
status of all newly hired employees of the contractor through the Indiana E-Verify program.
Contractor is not required to verify the work eligibility status of all newly hired employees of the
contractor through the Indiana E-Verify program if the Indiana E-Verify program no longer exists.
Prior to the performance of this Agreement, Contractor shall provide to the City its signed Affidavit
affirming that Contractor does not knowingly employ an unauthorized alien in accordance with IC
22-5-1.7-11 (a) (2). In the event Contractor violates IC 22-5-1.7 the Contractor shall be required to
remedy the violation not later than thirty (30) days after the City notifies the Contractor of the
violation. If Contractor fails to remedy the violation within the thirty (30) day period provided
above, the City shall consider the Contractor to be in breach of this Agreement and this Agreement
will be terminated. If the City determines that terminating this Agreement would be detrimental to
the public interest or public property, the City may allow this Agreement to remain in effect until the
City procures a new contractor. If this Agreement is terminated under this section, then pursuant to
IC 22-5-1.7-13 (c) the Contractor will remain liable to the City for actual damages.
SECTION VIII. IRAN INVESTMENT ACTIVITIES
Pursuant to Indiana Code (IC) 5-22-16.5, Contractor certifies that Contractor is not engaged in
investment activities in Iran. In the event City determines during the course of this Agreement that
this certification is no longer valid, City shall notify Contractor in writing of said determination and
shall give contractor ninety (90) days within which to respond to the written notice. In the event
Contractor fails to demonstrate to the City that the Contractor has ceased investment activities in Iran
within ninety (90) days after the written notice is given to the Contractor, the City may proceed with
any remedies it may have pursuant to IC 5-22-16.5. In the event the City determines during the
course of this Agreement that this certification is no longer valid and said determination is not
refuted by Contractor in the manner set forth in IC 5-22-16.5, the City reserves the right to consider
the Contractor to be in breach of this Agreement and terminate the agreement upon the expiration of
the ninety (90) day period set forth above.
Page 4 of 9
SECTION IX. PROHIBITION AGAINST DISCRIMINATION
A. Pursuant to Indiana Code 22-9-1-10, Contractor, any sub -contractor, or any person acting on
behalf of Contractor or any sub -contractor shall not discriminate against any employee or
applicant for employment to be employed in the performance of this Agreement, with respect
to hire, tenure, terms, conditions or privileges of employment or any matter directly or
indirectly related to employment, because of race, religion, color, sex, disability, national
origin, or ancestry.
B. Pursuant to Indiana Code 5-16-6-1, the Contractor agrees:
That in the hiring of employees for the performance of work under this Agreement of
any subcontract hereunder, Contractor, any subcontractor, or any person acting on
behalf of Contractor or any sub -contractor, shall not discriminate by reason of race,
religion, color, sex, national origin or ancestry against any citizen of the State of
Indiana who is qualified and available to perform the work to which the employment
relates;
2. That Contractor, any sub -contractor, or any person action on behalf of Contractor or
any sub -contractor shall in no manner discriminate against or intimidate any
employee hired for the performance of work under this Agreement on account of
race, religion, color, sex, national origin or ancestry;
3. That there may be deducted from the amount payable to Contractor by the City under
this Agreement, a penalty of five dollars ($5.00) for each person for each calendar
day during which such person was discriminated against or intimidated in violation of
the provisions of the Agreement; and
4. That this Agreement may be canceled or terminated by the City and all money due or
to become due hereunder may be forfeited, for a second or any subsequent violation
of the terms or conditions of this section of the Agreement.
C. Violation of the terms or conditions of this Agreement relating to discrimination or
intimidation shall be considered a material breach of this Agreement.
SECTION X. ADDITIONAL PROGRAM PROVISIONS
The City of Richmond is entering into this Agreement with Contractor with the understanding that
City has been or will be allocated certain funding from the Indiana Housing and Community
Development Authority ("IHCDA") in order that the City can participate in the IHCDA's Blight
Elimination Program ("BEP"). As a result, the following provisions as applicable to City as the
"Program Recipient" and/or as applicable to Contractor are set forth in this Section. Contractor
agrees that in the event the IHCDA notifies the City and submits any additional applicable laws,
statutes, or guidelines applicable to this Agreement under IHCDA's Program Guidelines for BEP,
said additional provisions shall be attached to this Agreement as an Addendum and executed by the
parties.
Page 5 of 9
A. The Recipient shall carry out the Project in accordance with the conflict of interest provisions
prescribed in 24 CFR 92.356(f).
B. The Recipient and Contractor and any principals of the Recipient and Contractor certify that
(A) it, except for de minimis and nonsystematic violations, has not violated the terms of (i)
IC 24-4.7 (Telephone Solicitation Of Consumers), (ii) IC 24-5-12 (Telephone Solicitations),
or (iii) IC 24-5-14 (Regulation of Automatic Dialing Machines) in the previous three hundred
sixty-five (365) days, even if IC 24-4.7 is preempted by Federal law; and (B) it will not
violate the terms of IC 24-4.7 for the duration of this Agreement, even if IC 24-4.7 is
preempted by Federal law.
C. The Recipient and Contractor and any principals of the Recipient and Contractor certify that
an affiliate or principal of the it and any agent acting on behalf of the it or on behalf of an
affiliate or principal of the Recipient (A) except for de minimis and nonsystematic violations,
has not violated the terms of IC 24-4.7 in the previous three hundred sixty-five (365) days,
even if IC 24-4.7 is preempted by Federal law; and (B) will not violate the terms of IC 24-4.7
for the duration of this Agreement, even if IC 24-4.7 is preempted by Federal law.
D. Meaningful Access for Limited English Proficient Persons. Persons who, as a result of
national origin, do not speak English as their primary language and who have limited ability
to speak, read, write, or understand English ("limited English proficient persons" or "LEP")
may be entitled to language assistance under Title VI of the Civil Rights Act of 1964 ("Title
VI") in order to receive a particular service, benefit, or encounter. In accordance with Title
VI and its implementing regulations, the Recipient and Contractor agree to take reasonable
steps to ensure meaningful access to activities funded with BEP Funds by LEP persons. Any
of the following actions could constitute "reasonable steps", depending on the circumstances:
acquiring translators to translate vital documents, advertisements, or notices, acquiring
interpreters for face to face interviews with LEP persons, placing advertisements and notices
in newspapers that serve LEP persons, partnering with other organizations that serve LEP
populations to provide interpretation, translation, or dissemination of information regarding
the project, hiring bilingual employees or volunteers for outreach and intake activities,
contracting with a telephone line interpreter service, etc.
E. Lobbying Activities. Pursuant to 5 U.S.C. § 1502 and 31 U.S.C. § 1352, as amended from
time to time , and any regulations promulgated thereunder, the Recipient and Contractor
hereby certify that no Federally appropriated funds have been paid or will be paid by or on
behalf of the Recipient or Contractor to any person for influencing or attempting to influence
an officer or employee of any agency, a member of Congress, an officer or employee of
Congress, or an employee of a member of Congress, in connection with the awarding of any
Federal contract, the making of any Federal award, the making of any Federal loan, the
entering into of any cooperative agreement, and the extension, continuation, renewal,
amendment to, or modification of any Federal contract, award, loan, or cooperative
agreement. If any funds other than Federally appropriated funds have been paid or will be
paid to any person for influencing or attempting to influence an officer or employee of any
agency, a member of Congress, an officer or employee of Congress, or an employee of a
member of Congress, the Recipient and/or Contractor shall complete and submit Standard
Form-LLL, "Disclosure Form to Report Lobbying".
Page 6 of 9
F. Non -Discrimination Clause. Pursuant to the Indiana Civil Rights Law, specifically including
Indiana Code § 22-9-1-10, and in keeping with the purposes of the federal Civil Rights Act of
1964, the Age Discrimination in Employment Act, and the American with Disabilities Act,
the Recipient and Contractor covenant that they shall not discriminate against any employee
or applicant for employment relating to this Agreement with respect to hire, tenure, terms,
conditions or privileges of employment or any matter directly or indirectly related to
employment because of the employee or applicant's race, age, color, religion, sex, disability,
national origin, ancestry, or status as a veteran, or any other characteristic protected by
federal, state, or local law ("Protected Characteristics"). Furthermore, the Recipient and
Contractor certify compliance with applicable federal laws, regulations, and executive orders
prohibiting discrimination based on the Protected Characteristics in the provision of services.
Recipient and Contractor understand that IHCDA is a recipient of federal funds, and
therefore, where applicable, the Recipient, Contractor and subcontractors of both agree to
comply with requisite affirmative action requirements, including reporting pursuant to 41
C.F.R. Chapter 60, as amended and Section 202 of Executive Order 11246.
G. Maintaining a Drug -Free Workplace (Executive Order No. 90-5). Pursuant to Executive
Order No. 90-5, April 12, 1994, issued by Governor Evan Bayh, the Indiana Department of
Administration requires the inclusion of this certification in all contracts with and grants from
the State of Indiana in excess of $25,000. No award of a contract or grant shall be made, and
no contract, purchase order or agreement, the total of which amount exceeds $25,000, shall
be valid unless and until this certification has been fully executed by the Recipient and
Contractor and attached to the contract or agreement as part of the contract documents. False
certification or violation of the certification may result in sanctions including, but not limited
to, suspension of contract payments, termination of the contract payments, termination of the
contract or agreement and/or debarment of contracting opportunities with the State for up to
three (3) years.
The Recipient and Contractor certify and agree that each will provide a drug -free workplace
by:
1. Publishing and providing to all of its employees a statement notifying
employees that the unlawful manufacture, distribution, dispensing, possession or use of a
controlled substance is prohibited in the Recipient's and Contractor's workplaces and
specifying the actions that will be taken against employees for violations of such prohibition;
and
2. Establishing a drug -free awareness program to inform employees about (1)
the dangers of drug abuse in the workplace; (2) the Recipient's and Contractor's policies of
maintaining a drug -free workplace; (3) any available drug counseling, rehabilitation, and
employee assistance programs; and (4) the penalties that may be imposed upon an employee
for drug abuse violation occurring in the workplace;
3. Notifying all employees in the statement required by subparagraph (a) above
that as a condition of continued employment the employee will (1) abide by the terms of the
statement; and (2) notify the employer of any criminal drug use conviction for a violation
occurring in the workplace no later than five (5) days after such a conviction;
Page 7 of 9
4. Notifying in writing the contracting State Agency and the Indiana Department
of Administration within ten (10) days after receiving notice from an employee under
subdivision (c)-(2) above, or otherwise receiving actual notice of a conviction;
5. Within thirty (30) days after receiving notice under subdivision (c)-(2) above
of a conviction, imposing the following sanctions or remedial measures on any employee
who is convicted of drug abuse violations occurring in the workplace: (1) take appropriate
personnel action against the employee, up to and including termination; or (2) require such
employee to satisfactorily participate in a drug abuse assistance or rehabilitation program
approved for such purposes by a Federal, State or local health, law enforcement, or other
appropriate agency; and
6. Making a good faith effort to maintain a drug -free workplace through the
implementation of subparagraphs (a) through (e) above.
SECTION XI. RELEASE OF LIABILITY
Contractor hereby agrees to release and hold harmless the City and all officers, employees, or agents
of the same from all liability for negligence which may arise in the course of Contractor's
performance of its obligations pursuant to this Agreement.
SECTION XII. MISCELLANEOUS
This Agreement is personal to the parties hereto and neither party may assign or delegate any of its
rights or obligations hereunder without the prior written consent of the other party. Any such
delegation or assignment, without the prior written consent of the other party, shall be null and void.
This Agreement shall be controlled by and interpreted according to Indiana law and shall be binding
upon the parties, their successors and assigns. This document constitutes the entire Agreement
between the parties, although it may be altered or amended in whole or in part at any time by filing
with the Agreement a written instrument setting forth such changes signed by both parties. By
executing this Agreement the parties agree that this document supersedes any previous discussion,
negotiation, or conversation relating to the subject matter contained herein.
This Agreement may be simultaneously executed in several counterparts, each of which shall be an
original and all of which shall constitute but one and the same instrument.
The parties hereto submit to jurisdiction of the courts of Wayne County, Indiana, and any suit arising
out of this Contract must be filed in said courts. The parties specifically agree that no arbitration or
mediation shall be required prior to the commencement of legal proceedings in said Courts. By
executing this Agreement, Contractor is estopped from bringing suit or any other action in any
alternative forum, venue, or in front of any other tribunal, court, or administrative body other than the
Circuit or Superior Courts of Wayne County, Indiana, regardless of any right Contractor may have to
bring such suit in front of other tribunals or in other venues.
Any person executing this Contract in a representative capacity hereby warrants that he/she has been
duly authorized by his or her principal to execute this Contract.
Page 8 of 9
In the event of any breach of this Agreement by Contractor, and in addition to any other damages or
remedies, Contractor shall be liable for all costs incurred by City in its efforts to enforce this
Agreement, including but not limited to, City's reasonable attorney's fees.
In the event that an ambiguity, question of intent, or a need for interpretation of this Agreement
arises, this Agreement shall be construed as if drafted jointly by the parties, and no presumption or
burden of proof shall arise favoring or disfavoring any party by virtue of the authorship of any of the
provisions of this Agreement.
IN WITNESS WHEREOF, the parties have executed this Agreement at Richmond, Indiana, as of the
day and year first written above, although signatures may be affixed on different dates.
"CITY"
THE CITY OF RICHMOND,
INDIANA by and through its
Board of Public Works and Safety
By: �LA,
Vicki Robinson, President
Richard Foore, Member
an
"CONTRACTOR"
ASBESTOS INSPECTIONS & REMOVAL
COMPANY DB/A AIR CO.
4404 N. Franklin Road
Indianapolis, IN 46226
By:
Printed: 44-14yIle 6rGllC
T
Title: J/l P 7reS",ol".e I —
APPROVED: Date: q- /y— /%
-c-Da-vid- . Snow yo
Date: DL( ( O l
Page 9 of 9
I C- I k-T
CITY OF RICHMOND
50 North Fifth Street
„ Richmond, Indiana 47374
(765)983-7200
Asbstos Inspections & Removal Company
(dba AIR Co)
4404 N. Franklin Road
Indianapolis, IN 46226
PRICE REQUEST
THIS IS NOT AN ORDER
INSTRUCTIONS
This is a request for a price or quote for the services or
materials described below. Any additional
specifications may be attached hereto. This is not an
order and the City reserves the right to accept all or
part, or decline the entire proposal. Please complete
your full name, address, and phone number below with
signature; itemize all prices and charges where
requested; and attach explanation for any substitution to
specifications altered. Please return in care of
Purchasing to the address above by the specified date
and time to be considered unless otherwise specified.
DATE REPLY MUST BE IN
February 23, 2017 March 9 2017 4:59 .m.
DELIVERY REQUIRED
I DELIVERED
PAYMENT TERMS
I UPON RECEIPT OF INVOICE
QUANTITY
CATALOG NO.
DESCRIPTION
UNIT PRICE
TOTAL
BEP Asbestos Abatement
(see attached)
Please include a current certificate of
insurance with your bid, naming the
City of Richmond as the certificate
holder.
Bids must be enclosed in a sealed
envelope with the project name on
the outside.
PRICE REQUEST
BY �/
VICKI ROBINSON
PURCHASING DIRECTOR
* Bids are to be mailed or brought to the
Purchasing Department in the Richmond
Municipal Building at 50 North 5th Street.
State Tax Exemption No. 003121909-001
NAME OF FIRM QUOTING
Asbestos Inspections & Removal
i
BYE
Wayne Gre eAUTHORIZEDBY
Vice President
DATE
March 7, 2017 TITLE
Phone No. 31 7-546-7473
I=XH{BIT -.�4— PAGE '0�
PROPOSAL SHEET
Bid will be awarded based on lump sum bid of each round even though pricing for each address is also
required.
ROUND 1 PROPOSAL
The undersigned Bidder proposes to furnish all necessary labor, machinery, tools, apparatus, materials,
equipment, service and other necessary supplies, and to perform and fulfill all obligations incident thereto in
strict accordancewith and within the time(s) provided by the terms and conditions of the Contract Documents
for the above described Work and Project, including any and all addenda thereto, for the total sum as follows:
1. 529 South 71' Street $1, 5 0 0. 0 0
?. 2303 Glen Court $ 1 , 0 0 0. 0 0
For the total lump sum of three thousand five hundred dollars ($_,1 0. 0().
ROUND 2 PROPOSAL
The undersigned Bidder proposes to furnish all necessary labor, machinery, tools, apparatus, materials,
equipment, service and other necessarysul)plies and to perform and fulfill all obligations ir�eident thereto in
strict accordance with and within the times) provided by the terms and conditions of the Contract Documents
for the above described Work and Project, including any and all addenda thereto, for the total sum as follows:
1. 220 South 12t' Street $ 1 , 5 0 0.0 0
2. 300 South 12"' Street $ 1 _, 0 0 0 , 0 0
3. 325 South 120' Street $ 3, 000.00
4. 2231 Glen Court $ 500.00
For the total lump sum of six thousand dollars ($ 6, 000.0I1
A current certificate of insurance, including Workers' Compensation according to the included coverage Iimits
naming the City of Richmond as the certificate holder, is needed
How soon after a purchase order is issued would the project begin?
Two weeks due to IDEM notification requirements
Number of days to complete each group —
Two days for group one, four days for group two
Signature:t''r
Date: March 7, 2017
F17571T PAGE �OF
Form
ong
Request for Taxpayer
Give Form to the
Identification Number and Certification
requester. Do not
Departmentv.
Department of the Treasury
the
Sena to the IRS.
internal
Reverxre Service
1 Name (as shown on your income tax return). Name is recluired on this line; do not leave this lire blank.
Asbestos Inspections & Removal Company
_
2 Business name/disregarded entity name. H different from above
AIR Co
c
3 Check appropriate box for federal tax classification; check only one of the following seven boxes:
4 Exemptions (codes apply only to
certain entities. not individv�s: sae
°
❑ irdnrtdua(isoie proprietor or ❑ C Corporation Q S Corporation ❑ Partnership ❑ Trustlestate
instructions on page 3):
v
single -member Lt.0
❑ limited liability company. Enter the tax classification (C=C corporation. S=S corporation. P=partnership) 10,
Exempt payee coda (if amyl
p 2
Note. For a single -memo LLC that is disregarded, do not check LLC; check the appropriate box in the tine above for
Exemption from FATCA reporting
rb
the tax classification of the single -member owner.
code (if arty)
`
n. o
❑ i I h oter (see Instructions) ►
rw,iORC la,IC«�M*,r«wO MM �*rreus.i
s Address (number, sleet, and apt. or suite no.)
Requester's name and address (optional)
4404 N Franklin Road
6 City, state, and 21P code
Indianapolis, IN 46226
7 List account numbs qs) here (opliorta6)
Taxpayer Identification Number (TIN)
Enter your TiN in the appropriate box. The TIN provided must match the name given on line 1 to avoid Social security number
backup withholding. For ietor. r ls,die this is d entallyity, your social security number (page however, fora FM — m
resident afiert, sole proprietor, or disregarded entity, seethe Part 1 instructions on page 3. For other
entities, it is your employer identification number (EIN). if you do not have a number, see Flow to get a
77N on page 3. or
Note. If the account is in more than one name, see the instructions for line 1 and the chart on page 4 for W°je Id�"cation number
guidelines on whose number to enter,
3 5— 2 1 d 1 d 1 6 9 2 6
i(M Certification
Under penalties of perjury, I certify that;
1. The number shown on this form is my correct taxpayer identification number (or 1 am waiting for a number to be issued to me): and
2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) 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. 1 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 on page 3.
Sign Signature of
Here U.S. person ► L./WW2n��- gate ► 03 11 f t
General
Section references are to the Internal Revenue Code unless otherwise rioted,
Future di velolmmints, Information about developments affecting Form W-9 (such
as legislation enacted after we release it) is at www,irs.gov1fw9.
Purpose of Form
An individual or entity (Form W-s requester) who is required to rile an information
return with the IRS must obtain your correct taxpayer identt'icatior, number (Till
which may be your social security number (SSN), individual taxpayer identification
number (171141, adoption taxpayer identification number (ATiN), or employer
identification number (EIN), to report on an nfamtaWn return the amount paid to
you, or other amount reportable on an information return, Examples of information
returns inclxde, but are not united to, the following:
• Form 1099-INT (interest eared or paid)
• Form 1099-DFV (dividends, including those from stocks or mutual funds)
• Form 1099-MISC (various types of income, prizes, awards, or gross proceeds)
• Form 1099-B (stack or mutual fund sales and certain other transactions by
brokers)
• Form 1099-S (proceeds from real estate transnVons)
• Form 109g-K (merchant card and third party network transactions)
Form 1098 (home mortgagee interest). 1098-E (student loan interest), IM-T
(turd)
• 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 wittihotdirn, See What is backup wiMnok£ng? on page 2.
By signing the filled -out form, you:
1. Certify that the TIN you are giving is correct (or you are waiting for a number
to be issued),
2. Certify flat you are not subject to backup withholding, or
3_ Clairn exemption from backup withho" if you are a U.S. exempt payee. If
applicable, you are also certifying that as a U.S. person, your aaNw able share of
any partnership income frorn a US. trade or business Is not eject to the
withholding tax on foreign partners, share of effectively corvlected income, and
4, certify that FATCA code(s) entered on this form Cif any) indicating that you are
exempt from the FATCA repoir", is correct. See What is FATCA repo.,TN? on
page 2 for further informi lion.
Cat. No. 10231 x Form W-9 (Rev. 12.2014)
Substitute Form W-9 Taxpayer IdentificationNendor Information
Complete and submit this form to the Purchasing Department of the City of Richmond
Vendor number Address # Vendor Business Contact Contact Phone Number
(Office use only do not fill in)
III Jeff Fox 317-546-7473
Legal Business Name
Asbestos Inspections & Removal, Company
Business Street Address
4404 N Franklin Road
City State Zip Code +4
Indianapolis 46226
Business Phone FAX Number Toll Free Number
317-544-7473 317-546-1272
Company Web Address
www.aircoindv.com
E-mail Address
ieff@aircoindv.com
Tax Payer ID (TIN): Federal EIN: 35 - 2006926
or Soc. Sec. #
Specify 1099 Category if known:
(Fed tax withheld, commissions, healthcare payments, proceeds, CIDT or PPS withholding...)
1099 Address:
Box/Bldg/Suite: same as above - City/State/Zip:
Street: Contact Name:
SECTION A VENDOR MAILING ADDRESS (Please complete if different from business address.)
Does your business accept Purchase Orders: Yes n No
Address
Same as above
City State Zip Code + 4
SECTION B VENDOR REMITTANCE ADDRESS (required to be completed.)
Same as above
City State Zip Code + 4
IN
Accounts Receivable Contact Name Phone Number FAX Number
Wavne Grelle 317-546-7473 1 317-546-1272
SECTION C BUSINESS INFORMATION
Business Type
Consultant Distributor Service Provider X Legal Corporation (Law Firm)
Federal Government State Government Local Government
Ownership Status (Check all that apply.)
Individual Partnership Corporation X Minority Business LLC
Small Business Non -Profit Org. Women -Owned Business Professional Corp.
I HEREBY 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 FOR 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 DIVIENDEDS, OR (c) THE IRS HAS
NOTIFIED ME THAT I AM NO LONGER SUBJECT TO BACKUP WITHHOLDING, AND
3. I AM A U.S. PERSON (INCLUDING A U.S. RESIDENT ALIEN.
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 REALrESTATE TRANSACTIONS, ITEM 2 DOES NOT APPLY.
PRINTED OR TYPED NAME
Jeffrev M Fox
SIGNATURE
This information is needed in order to process a purchase order.
PLEASE RETURN COMPLETED FORM TO:
CITY OF RICHMOND
PURCHASING DEPARTMENT
50 NORTH FIFTH STREET
RICHMOND, IN 47374
Or fax to 765-983-7212
TITLE
General Manaeer
DATE
3/27/2017
ALSO, please note that an original invoice will need to be mailed to
Accounts Payable at the City of Richmond, 50 North 5th Street,
Richmond, IN 47374 with the Purchase Order # referenced on the
invoice in order for payment to be processed. Thank you.
ACRFINS-11
T1TROICF
CORD' CERTIFICATE OF LIABILITY INSURANCE
FDATE(MMIDD/YYYY)
03/10/2017
i1S CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
ERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
FLOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
EPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IPORTANT: if the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
is certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
)UCER
JredPartners of Indiana, LLC
11 N. Meridian Street, Suite #300
Inapolis, IN 46290
CONTAMACT Lisa Becker
PHONE FAX
(AIC. No, Ext):
ED4,&E . lbecker@assuredptrin.com
INSURERS AFFORDING COVERAGE
NAIL 1f
INSURER A: Hamilton Specialty Insurance Company
RED
INSURERS: Cincinnati Insurance Company
10677
INSURER C : Travelers Indemnity Company of America
25666
Asbestos Inspections and Removal Company
DBA Airco
4404 N. Franklin Rd.
INSURER D
INSURER E :
Indianapolis, IN 46226
INSURER F :
r,�arr wwr�rn. RFVICInfJ NI IMRFR'
4IS•IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
DICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
=RTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
(CLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TYPE OF INSURANCE
INSD
BR
wVD
POLICY NUMBER
POLICY EFF
POLICY EXP
12/07/2017
UMITS
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE OCCUR
AHSECC1121600
12/07/2016
EACH OCCURRENCE
1,000,000
DAMAGETORENTED
$ 100,000
10,000
MED EXP one
1,000,000
PERSONAL & ADV INJURY
GENERALAGGREGATE
1 2,000,000
GEWL AGGREGATE LIMIT APPLIES PEP,
PRODUCTS - COMP/OP AGG
$ 2,000,000
POLICY ❑X JECOT- ❑X LOC
POLLUTION
a 1,000,000
OTHER:
SINGLE LIMIT
11W0,000
AUTOMOBILE LIABILITYCOMBINED
BODILY INJURY Per
$
X ANY AUTO
EBA 0375560
03112/2017
03/12/2018
BODILY INJURY Per accident
$
OWNED SCHEDULED
AUTOS ONLY AUTOS
FIR DAMAGE
.pWNEp
AUTOS AUTOS
ONLY ONLY
UMBRELLA LIAR
EXCESS LIAR
X
OCCUR
CLAIMS -MADE
HSEXS1121700
12107/2016
12/07/2017
EACH OCCURRENCE
$ 5,000,000
X
AGGREGATE5,000,000
DED RETENTION E
WORKERS COMPENSATION
ER OTH-
X PSTATUTE
AND EMPLOYERS' LIABILITY Y I N
6JU8-0244N26 6-71
03/29/2017
03/29/2018
E.L. EACH ACCIDENT
E 1,000,000
ANY PROPRIETORIPARTNERIEXECUTWE
OFFICERIMEMBER EXCLUDED?
NIA
E.L. DISEASE - EA EMPLOYE
$ 1,000,000
(Mandatory in NH)
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
It desu8�e under
DESCRIPTION OF OPERATIONS below
PROFESSIONAL LIAB
AHSECC1121600
12/07/2016
12/07/2017
E&O
1,000,000
mPTiON OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached I more space is required)
CITY OF RICHMOND
50 N. 5TH STREET
RICHMOND, IN 47374
ORD 25 (2016103)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED/ REPRESENTATIVE
01988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
J Brian L. Wyndham, Mayor
Karen McQueen, Clerk -Treasurer
Janet McClellan, Plan Administrator
Troy McQueen, Building Inspector
To )Morn It May Concern:
CITY OF BRAZIL
203 East National Avenue
Brazil, Indiana 47834
Phone: (812) 443-2221
Fax: (812) 446-0337
xww. brazil. in. gov
Air Co Asbestos Inspections & Removal removed asbestos out of two homes on Feb. 16, 2017
for the City of Brazil. They removed all asbestos and reported back the results to us with pictures
on the same day. They are very prompt and did a great job of removing the asbestos. I would
highly recommend them for asbestos inspections and removal.
Sincerely,
Janet McClellan
Planning Administrator
City of Brazil
renew
INDIANAPOLIS
a community land bank
March 23, 2017
Tammy Tidrow
Department of Infrastructure & Development
City of Richmond
50 N 5th Street Richmond, IN 47374
Dear Tammy,
I am writing you in regard to the work done by Air Co. for the City of Indianapolis with respect to
environmental remediation for properties demolished under the Blight Elimination Program. We at
Renew Indianapolis are quite satisfied with both the quality and speed of Air Co.'s work and we plan
to continue to use their services in the future.
Sincerely,
Andrew Christenberry
Program Manager
Tammy Tidrow
From:
scasey@caseybertram.com
Sent:
Thursday, March 23, 2017 10:42 AM
To:
ttidrow@richmondindiana.gov
Cc:
jarthur@caseybertram.com
Subject:
Air Co
Tammy,
Air Co. has done all of our pre -demolition asbestos inspections for our projects over the last 10+ years.
We use Air Co. if an owner hasn't already had an inspection completed.
If asbestos is found during the inspection, Air Co. is our first choice for removal.
Casey -Bertram uses Air Co. because they are fast, professional, and we enjoy working with their staff.
Air Co is very knowledgeable about all of the regulations regarding asbestos.
Should you need additional information, please feel free to give me a call.
Scott Casey
President
Casey -Bertram Construction, Inc.
5780 E. 25th Street
Indianapolis, IN 46218
317-546-3366 Office
317-546-6680 Fax
317-281-6843 Cell
email: scasevO)casevbertram.com
website: www.caseybertram.com
rCASEY-SERTRAM