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Home My WebLink About20231358.tiffRESOLUTION RE: APPROVE APPLICATION FOR SUPPLEMENTAL REIMBURSEMENT FOR PETROLEUM STORAGE TANK REMEDIATION AT FUELING FACILITY PERFORMED BY PALMETTO ENVIRONMENTAL GROUP, AND AUTHORIZE CHAIR TO SIGN WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS, the Board has been presented with an Application for Supplemental Reimbursement for Petroleum Storage Tank Remediation at the Fueling Facility with said professional services being performed by the Palmetto Environmental Group from the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Accounting Department and Fleet Services, to the Colorado Department of Labor and Employment, Division of Oil and Public Safety, commencing upon full execution of signatures, with further terms and conditions being as stated in said application, and WHEREAS, after review, the Board deems it advisable to approve said application, a copy of which is attached hereto and incorporated herein by reference. NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County, Colorado, that the Application for Supplemental Reimbursement for Petroleum Storage Tank Remediation at the Fueling Facility with said professional services being performed by the Palmetto Environmental Group from the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Accounting Department and Fleet Services, to the Colorado Department of Labor and Employment, Division of Oil and Public Safety, be and hereby is, approved. BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to sign said application. cc: FT(D5),I cT(cP/cD) 06 /09 /23 2023-1358 FT0003 AC0023 APPLICATION FOR SUPPLEMENTAL REIMBURSEMENT FOR PETROLEUM STORAGE TANK REMEDIATION AT FUELING FACILITY PERFORMED BY PALMETTO ENVIRONMENTAL GROUP PAGE 2 The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 15th day of May, A.D., 2023. BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO ATTEST: ddradA) JC.ltD%ok Mikg.Ereeman, Chair Weld County Clerk to the Board Co n y Attorney Date of signature: 05/30/2 2023-1358 FT0003 AC0023 C�n*ael- tP$i ((nog BOARD OF COUNTY COMMISSIONERS PASS -AROUND REVIEW PASS -AROUND TITLE: Colorado Petroleum Tank Storage Fund Reimbursement DEPARTMENT: Accounting/Fleet Services DATE: May 2, 2023 PERSON REQUESTING: Chris D'Ovidio/David Springer Brief description of the problem/issue: During the recent construction work on the Greeley fuel site there was additional contamination found under the site. The Palmetto Environmental Group was hired to come and clean up additional contamination. All the work has been completed and the services have been paid for. The Palmetto group is now asking for the board's signature on a Colorado Petroleum Storage Tank Fund reimbursement request so the County can be reimbursed the cost of the cleanup. The reimbursement request is $49,169.79, the amount of the environmental services preformed by the Palmetto Group. This is a similar process the board agreed to when Palmetto did some work on the fuel site in 2021. What options exist for the Board? (include consequences, impacts, costs, etc. of options): Signing the request will reimburse the county for the $49,169.79 costs incurred for the cleanup. Recommendation: We recommend the boards sign%the request to receive the reimbursement. Approve Schedule ecommendation Work Session Other/Comments: Perry L. Buck, Pro-Tem Mike Freeman, Chair Scott K. James Kevin D. Ross Lori Saine 2023-1358 5/15 FTOO 3 PtCOOZ3 COLORADO PETROLEUM STORAGE TANK FUND SUPPLEMENTAL REIMBURSEMENT APPLICATION Short Form S (2017) This form should be used, and can only be used, on Supplemental Reimbursement Applications when the Applicant has already established eligibility for reimbursement of remediation costs relative to this occurrence. The nature of this Supplemental Reimbursement Application is: [Select all that apply] Additional costs not previously reimbursed. X Other (Explain): List RAP # of last application previously filed for this remediation: Applicant's Full Legal Name: Weld County Government Social Security # or Federal Tax ID# 84-6000813 Contact Person: Chris D'0vidio Phone 0 970.400.4445 Fax # Mailing Address: Street: 1150 O Street City: Greeley State CO Zip 80631 Email: cdovidio@weldgov.com Reimbursement Mailing Address (if different) : Remit Entity: Street: City: State ID, Zip Email: Applicant is (select one): Government Site Name: Weld County Fueling Facility Site Address: Street: 1113 H Street City: Greeley State CO Zip 80632 6 j11�! T,wan„t„ the re res t, ive to be the t hand Applicant's Representative (if applicable) Name Palmetto Environmental Group Address 4995 York St. Email: mail@palmetto-environmental.com City Denver State CO Zip 80216 Phone 0 303.825.8117 Fax # 303.534.5049 Total from Listing of Costs, last column: $49,169.79 Less reimbursement from any other source (see #5): NET REIMBURSEMENT REQUEST: $49,169.79 Dates of work covered by this application: From: 9/28/21 k- 2/1 4/23 a�¢�fgoiGodii7up,ryp��: ila ii�:ld9li��aww :!g:liw!�Rillil��l 'ua.:.mii:tll'I" ,5illli i 14040,4,1,-.4400:04. i:Fili a'alhllli kfilll :�i:ii r�lurf;�i,�glluliol�a�7iii =Rents - Xt 1,, 'a luui 0 uIn mu REV 8/4/17 *Prior versions of this application will not be accepted Page 1 of 4 REIMBURSEMENT INFORMATION 1 Will there be additional reimbursement applications for this release? Yes 2 Have any of the costs submitted for reimbursement already been submitted with another reimbursement application? If yes, identify these costs and explain why you are resubmitting these costs: No 3 Do any of the costs submitted for reimbursement cover a time period for which you have already received, or requested reimbursement? If yes, identify these costs and explain why you are resubmitting them: No 4 Except for any contractual relationship established in response to this remediation, is there any relationship - personal, financial, or otherwise - between Applicant and any company or person who performed work for which reimbursement is claimed? If yes, explain: No 5 Has Applicant received, or does Applicant expect to receive, compensation for corrective action costs from ANY source other than the Colorado Petroleum Storage Tank Fund, including lawsuits, settlements, judgments, contributions from other parties? If yes, state amount of other reimbursement: $ . Identify source of reimbursement, including court case name and number, No if applicable: Note if the ',ha,beeni any 'n - s' 10 r rvvrance from that submitted with the Grigrna , Applicat ion provide vpdafet t rnft r`rrrati'° t 'wrtkr tfi l'" Ir ° '{gin the s ure farm t as tre C !gin af Applic` ° rvv . '! 6 Do any costs claimed for reimbursement represent work performed by the Applicant or Applicant's employees? If yes, submit the Affidavits Regarding Work Performed by Applicant. No 7 g Has the Legal Name, Remit Entity or Address, Mailing Address or Tax Payer Identification Number changed since the submittal of the Original or last Supplemental Reimbursement Application? If so, please submit a W-9 (scanned signature is acceptable) - see Completing App Instructions tab. NO W-9 - If you answered yes to question 7, attach a W-9 to this application and explain any changes here. REV 8/4/17 *Prior versions of this application will not be accepted Page 2 of 4 By submitting this application, the Applicant affirms and agrees that: 1. The Applicant certifies, under penalty of law, that Applicant is the appropriate person to request reimbursement, and that this document and all attachments were prepared under Applicant's direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. 2. The Applicant is the owner/operator or duly authorized agent of the owner/operator responsible for this Site. The Applicant is and shall be responsible for assuring compliance with all applicable State and federal regulations. 3. The information submitted by the Applicant, to the best of Applicant's knowledge and belief, is true, accurate and complete. Applicant understands that this application will be submitted by the Colorado Department of Labor and Employment (CDLE or State) for consideration by the Petroleum Storage Tank Committee (Committee). Upon demand by the Committee, Applicant agrees to return the entire award Applicant may receive or any other amount the Committee considers appropriate if (a) Applicant misrepresented or omitted any fact, either in writing or orally, relevant to the determinations made by the Committee or the CDLE; or (b) Applicant fails to complete, to the Committee's or the CDLE's satisfaction, the corrective action. 4. The Applicant shall not be entitled to obtain any other reimbursement from any source other than the State for the same costs or work reimbursed by the State. Any reimbursement the Applicant receives or is entitled to receive, including insurance proceeds, is and shall be the property of the State of Colorado to the extent of payment(s) made to the Applicant by the State from the Petroleum Storage Tank Fund. Upon receipt of any such reimbursement from a source other than the State, Applicant shall immediately report and pay such reimbursement to the State. 5. To the extent payment is made from the Petroleum Storage Tank Fund, the Applicant hereby assigns to the State of Colorado any rights the Applicant may have which may allow the Applicant to seek and obtain recovery from any other entity for the costs or work reimbursed by the State, including the right to recover from insurance companies. 6. The Applicant shall not submit any further claims for reimbursement from the State for the Site(s) and work identified in this application, other than an amendment to the application or protest of the Fund Payment Report, if any, for work not heretofore reimbursed. 7. Applicant shall indemnify, save, and hold harmless the State, its employees and agents, and the Committee against any and all claims, damages, liability and court awards including costs, expenses, and attorney fees and related costs, incurred as a result of any act, omission or misrepresentation by the Applicant, or its employees, agents, subcontractors, or assignees pursuant to the terms of this application. As to governmental entity Applicants, no term or condition of this application shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protection, or other provisions, of the Colorado Governmental Immunity Act, CRS 24-10-101 et seq., or the Federal Tort Claims Act, 28 USC 2671 et seq., as applicable, as now or hereafter amended. 8. In addition to any other legal rights the State of Colorado may have, the State shall have audit and on -site inspection rights for 3 years after navmpnt. 9. The remediation services and supplies for which expenses are listed in this application were performed and/or purchased at the most reasonable rates available for compliance. 10. The Applicant shall provide all formal or informal environmental assessment information to any future owner upon request. 11. In the event the Applicant breaches any of the terms, conditions or requirements of this application , the State of Colorado, in addition to any other remedies, at law or equity, shall be entitled to immediate repayment on demand of all amounts paid to the Applicant; and in the event that the State is required to take legal action to enforce any of the provisions contained herein, the State shall be entitled, in addition to damages, to its costs and reasonable attorney fees and related expenses incurred in connection with such enforcement. 12. At all times during the performance of this remediation, the Applicant shall strictly adhere to all applicable federal and state laws, rules and regulations that have been or may hereafter be established, including without limitation 42 USC 6991 and CRS 8-20.5-101, et seq., and associated regulations. 13. The State may allocate more or less funds to the remediation described in this Application than the amount requested by the Applicant. Once the reimbursement request is approved, the State will issue a Fund Payment Report, substantially in the form of Exhibit B, documenting the amount that will be processed and paid. 14. The Committee has the authority and the right to designate funds be paid to Applicants on pro -rata basis when the Petroleum Storage Tank Fund balance prevents payment in full, pursuant to CRS 8-20.5-206(e)(2). 15. Each additional request by Applicant for reimbursement from the Petroleum Storage Tank Fund must be submitted on a new supplemental application. Any additional payment by the State shall be conditioned upon the issuance by the Committee of a new Fund Payment Report for navmpnt. 16. Pursuant to 7 CCR 1101-14, Article 8, the Applicant may file a protest of the Fund Payment Report if the Applicant disputes a decision by the Committee, as stated on the Fund Payment Report. The Applicant may petition the Committee to review its decision. A Protest must be submitted within 60 days of the date of the Fund Payment Report. See 7 CCR 1101-14, 8-6. The Applicant shall use the form of Protest of Fund Payment Report provided by the Division of Oil and Public Safety of the Colorado Department of Labor and Employment. 17. The maximum amount to be paid by the State, if any, in connection with this reimbursement request shall be authorized by the Committee in the Fund Payment Report. 18. The payment by the State and acceptance by the Applicant of any reimbursement amounts requested under this application shall be deemed to be good and sufficient consideration for the promises, certifications and affirmations made by Applicant in this Application. REV 8/4/17 *Prior versions of this application will not be accepted Page 3 of 4 Applicant: Weld County Government Legal Name of Applicant 84-6000813 Social Security Number or FEIN MAY 1 5 2023 Signature of Applicant or Authorized Officer Mike Freeman, Chair - Board of County Commissioners Date Print Name 8 Title of Authorized Officer Complete if this is a replacement signatory page RAP# FACILITY ID# EMAIL TO: cdle PSTReimbursementApps/Ostate.co.us If you have any questions please consult the OPS website and/or contact OPS at (303) 318-8510. OPS website: http://www.colorado.gov/ops REV 8/4/17 *Prior versions of this application will not be accepted Page 4 of 4 020023 %� 52 PALMETTO GNVI20NMRNTAL GROUP LLC .Affidavit: Proof of Payment (Revised 115/2016) • This form should be used when an applicant submits an affidavit as proof of payment for costs claimed for reimbursement. This form €s not required if copies of canceled checks or other bank confirmations of payment are provided. Please note the following requirements. • This form must be reproduced on the company letterhead of the payee (not the applicant's letterhead), o Affidavits that are not on the payee's letterhead will not be accepted. • This form must be signed by the payee, not the applicant. • Use a separate affidavit for each contractor. • Do not use this form if there is any affiliation or relationship between the applicant and the payee. More information €s available In Section 8-2 (b) (2) of the Petroleum Storage Tank Regulations. Applicant Information Applicant Name: Site Name: Weld County Government Weld County Fueling Facility 1113 H Street Site Address: City: I Greeley I State: I CO [ZIP: 180632 Payee Information and' Certification Check the following, as appropriate. N I, being first duly sworn upon oath and being of lawful age, state that the following invoices relative to the referenced application for reimbursement from the Colorado Petroleum Storage Tank Fund have been paid in full by the applicant, O I, being first duly sworn upon oath and being of lawful age, state that the following invoices relative to the referenced application for reimbursement from the Colorado Petroleum Storage Tank Fund will be paid in full by the applicant upon receipt of the reimbursement in accordance with a promissory agreement. o Provide a signed and notarized copy of the agreement. Invoice # Invoice Date Amount Paid Invoice # Invoice Date Amount Paid 18459 3/27/23 $48,688.49 18459Z 3/27/23 $481,30 • I further state that there is no relationship or affiliation between myself and the applicant. • I hereby certify that the foregoing information is correct to the best of my knowledge, information and belief. I understand there are severe civil and/or criminal penalties for any false statement or misrepresentation of a material fact, knowing it to be false, or failing to disclose a material fact with the intent to defraud. Signature: Date: Printed Name: I John D. Drafts I Title: I Principal Company (Payee) Name: I Palmetto Environmental Group Company (Payee) Mailing Address: 14995 York St City: I Denver Phone #: 303.825.8117 State: I Co I ZIP: 180216 Notary Public Certification Subscribed and sworn to before me in the county of this day of Notary Public Printed Name: Signature: My Commission Expires: , State of (303) 825-8117 tl 4995 York Street 4 Denver, Colorado 80216 d mail@palmetto-environmental.com COLORADO PETROLEUM STORAGE TANK FUND Photocopy additional pages as necessary LISTING OF COSTS Primary Invoice #1 Contractor Name Dates of Work2 xx/xx/xx xx/xx/xx Beginning Ending Proof of Payment Invoice Amount Amount Submitted for Reimbursements Canceled Check' Other' Check # Check Amt 18459 Palmetto 9/28/21 2/14/23 AFF $48,688.49 $48,688.49 18459z Palmetto 9/28/21 2/14/23 AFF $481.30 $481.30 TED FOR REIMBURSEMENT CONSIDERATION: $49,169.79 1 List all PRIMARY invoices. If invoice does not clearly identify work performed, add that information to the invoice copy submitted with the application. 2 List invoices in order by the date of work performed. 3 If proof of payment is by canceled check, back of canceled check is also required if the dollar amount is not encoded by the bank on the front of the check. 4 If proof of payment is by payee affidavit or CPA Certification, use following codes: AFF = Affidavit. CPA = CPA Certification of Payment. Use CDLE Forms. 5 List only ALLOWABLE costs. If amount requested differs from invoice amount, identify on the invoice any cost for which reimbursement is NOT requested. Contract Form New Contract Request Entity Information Entity Name* Entity ID* PALMETTO ENVIRONMENTAL GROUP g,000 34965 LLC Contract Name* COLORADO PETROLEUM TANK STORAGE FUND REIMBURSEMENT Contract Status CTB REVIEW ❑ New Entity? Contract ID 6968 Contract Lead CDOVIDIO Contract Lead Email cdovidiogweldgov.com;cpat telli@weldgov.com Parent Contract ID Req YES d Approval Department Project # Contract Description* THE PALMETTO GROUP HAS COMPLETED SOME ENVIROMENTAL CLEAN UP AT THE GREELEY FUEL SITE. THEY ARE NOW ASKING THAT THE BOARD SIGN A REIMBURSEMENT REQUEST FROM THE COLORADO PETROLEUM TANK STORAGE FUND. Contract Description 2 Contract Type. AGREEMENT Amount. 549,169.79 Renewable * NO Automatic Renewal Grant IGA Department ACCOUNTING Department Email CM - Accounting Aweldgov.com Department Head Email CM-Accourtting- DeptHead@weldgov.com County Attorney GENERAL COUNTY ATTORNEY EMAIL County Attorney Email CM- COU NTYATTORN EYA0WELDG OV.COM if this is a renewal enter raevi+ous Contract ID if this is part of a MSA enter MSA Contract ID Requested ROCC Agenda Date* 05.15x2023 Due Date 05111/2023 Will a work session with EOCC be required?* NO Does Contract require Purchasing Dept. to be included? Note: the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts are not in OnBase Contract Dates Effective Date Review Date* 11;082023 Renewal Date Termination Notice Period Contact Information Committed Delivery Date Contact Info Contact Name Contact Type Contact Email Purchasing Purchasing Approver Approval Process Department Head ESTHER GESICK DH Approved Date 05/10,2023 Final Approval BOCC Approved BOCC Signed Date BOCC Agenda Date 05 15/2023 Originator CDOVIDIO Finance Approver CHRIS D'©V'ID1O Expiration Date 12/31/2023 Contact Phone 1 Purchasing Approved Date Finance Approved Date 05110/2023 Tyler Ref # AG 051523 Legal Counsel BRUCE BARKER Contact Phone 2 Legal Counsel Approved Date 05;'10/2023 Hello