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Home My WebLink About20153398Co rkirc a lb M ate BOARD OF COUNTY COMMISSIONERS PASS -AROUND REVIEW RE: 2017 Repair Mastic Material Supply DEPARTMENT: Public Works DATE: 7/6/2017 PERSON REQUESTING: Neal Bowers Brief description of the problem/issue: The original agreement for 2015 Repair Mastic Material Supply (#B1500180) can be extend from October 21, 2017, to October 20, 2018, as permitted by the contract. This extension would be the third year of a possible three- year contract. Denver Industrial Sales and Service Co. did not request an increase in the price per ton. The bid submitted doesn't exceed the 2017 crack filler maintenance budget. What options exist for the Board? (Include consequences, impacts, costs, etc. of options) The Board may either approve or deny the contract extension / renewal. Recommendation: Public Works recommends approval of the renewal for Denver Industrial Sales and Service Co. for Repair Mastic Material Supply. Sean P. Conway Julie A. Cozad, Chair Mike Freeman Barbara Kirkmeyer Steve Moreno, Pro-Tem Anorove Recommendation Schedule Work Session Other/Comments: �`'`,- �-� 4) -7- '` 1-19-17 %Iq-11 G:t DULL ,t0/5--3398 CONTRACT AGREEMENT EXTENSION/RENEWAL BETWEEN THE WELD COUNTY DEPARTMENT OF PUBUC WORKS AND DENVER INDUSTRIAL SALES AND SERVICE CO. This Agreement Extension/Renewal ("Renewal"), made and entered into 5 day of July, 2017, by and between the Board of Weld County Commissioners, on behalf of the Weld County Department of Public Works, hereinafter referred to as the "Department", and Denver Industrial Sales and Service Co., hereinafter referred to as the "Contractor". WHEREAS the parties entered into an agreement (the `Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as document No. 2015-3398 approved on October 21, 2015. WHEREAS the parties hereby agree to extend the term of the Original Agreement in accordance with the terms of the Original Agreement, which is incorporated by reference herein, as well as the terms provided herein. NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: The Original Agreement will end on October 20, 2017. The parties agree to extend the Original Agreement for an additional 365 day period, which will begin October 21, 2017, and will end on October 20, 2018. • The Renewal, together with the Original Agreement, constitutes the entire understanding between the parties. The following change is hereby made to the Contract Documents: 1. The 2015 Bid Schedule of the original contract shall be replaced with the attached 2017 Bid Schedule, which is incorporated herein. 2. The original contract price shall be modified to no more than $12,600.00 for this contract period between October 21, 2017 and October 20, 2018. All other terms and conditions of the Original Agreement remain unchanged. IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. CONTRACTOR: Todd Mellema, President Pdntr me v . Sl ature BOARD OF COUNTY COMMISSIONERS WELD COUNTY. Julie Cozad, Chair \ �l1�L �1 9 2017 ATTEST: Weld BY: Deputy Clerk t./the B. < rd 020/5—c5✓91 Terms and Conditions: The Agreement shall commence approximately November 2015 and continue in full force for one year. At the option of the County, the Agreement may be extended for up to two (2) additional years. Increases in the Cost may be negotiated for subsequent renewal of the second and third additional one-year periods. Cost increase must be consistent with regional trends. Weld County will use the ENR cost index (Paving, PG 58 per ton Denver) to measure the percent of increase from year to year to justly increase in cost. Price adjustment will not be implemented without final approval from Weld County. Ira ITEM QUANTITY UNIT PRICE PER Ati Inclusive 15 Tonfor s of Material SINLI Delivery , Equipment, ETC 408 Repair Mastic and Delivery 10 Ton $1,260.00 $12,600.00 Prices will include all labor and equipment cost necessary to manufacture, load, scale and deliver and pickup material and Equipment to Weld County Public Works facility. The remainder of this page left blank intentionally The undersigned, by his or her signature, hereby acknowledges and represents that 1. The bid proposed herein meets all of the conditions, specifications and special provisions set forth in the request for proposal for Request No. #B1500180 2. The quotations set forth herein are exclusive of any federal excise taxes and all other state and local taxes. 3. He or she is authorized to bind the below -named bidder for the amount shown on the accompanying proposal sheets. 4. The signed bid submitted, all of the documents of the Request for Proposal contained herein (including, but not limited to the product specifications and scope of services), the formal acceptance of the bid by Weld County, and signature of the Chair of the Board of County Commissioners, together constitutes a contract, with the contract date being the date of signature by the Chair of the Board of County Commissioners. 5. Weld County reserves the right to reject any and aN bids, to waive any Informality in the bids, and to accept the bid that, in the opinion of the Board of County Commissioners, is to the best interests of Weld County. The bid(s) may be awarded to more than one vendor. FIRM Denver industrial Sales and Service Co. BUSINESS ADDRESS 85o South Llpan St CITY, STATE, ZIP CODE Denver, CO 80223-2744 TELEPHONE NO 303-935-2485 FAX 303-935-6787 PRINTED NAME AND' TITLE Todd Mellema, Preslcjent• �' SIGNATUR —�� / E-MAIL todd@dissco.net TAX ID 84-1203912 s SA(FS, Sit CORPORATE •+ fn SEAL n DATE July 07, 2017 "THE SUCCESSFUL BIDDER SHALL PROVIDE A W-9 IF NOT ALREADY ONLORPO c f WELD COUNTY IS EXEMPT FROM COLORADO SALES TAXES. THE CERTIFICATE OF EXEMPTION NUMBER IS #98-03551.0000. ACCPR El CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDW lYYI 7/6/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. HOLDER. THIS BY THE POLICIES AUTHORIZED IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(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 endorsement(s). PRODUCER Henry Ham Agency 645 E. Evans AveMAR Denver CO 80250 CONTACT sAmL _._.Romi_S_.Romero ... so. s 303-744-t341 J FAX tAlC. Nor30744-065__ tomiChen fyj]HII7.CIatiY--__--- - INSURERIS) AFFORDING COVERAGE # NAIC M INSys a a AIG Specialty insurance X26883 INSURED DENVE-3 Denver Industrial Sales & Service Co Inc 850 S Li an St Denver CO 80223 nn►ireaPI Inn ��.•.�_- --- .___ INSURERS. rrleBCe & Indugtiy nsuratl10e INSURER C AutQ-OWner$_Insurance Company au INSURER D — - {I} INSURER E : INSURERF: j- 283822018 • THIS INDICATED, CERTIFICATE EXCLUSIONS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTTRR TYPE OP N$URANCE t o POLICY HUMBER POuCYEFP SIIII SYYYTY1 ESP FOIIMM/D�DY1Yrai LIMITS A B[l1E1ALLNBILITY X COMMERCIAL GENERAL LABILITY _ EG4761 198 , 12/10/2018 I 12/10/2017 I EACH OCCURRENCE $1,000,000 TO RENTED PREMISES IER $300,000 J CLAIMS -MADE I " i OCCUR occenengt MED EXP (My one person) $25,000 %t Pollution -dm and PERSONAL BADV INJURY $1,000,000 .-j .. : GENERAL AGGREGATE $2.000,000 GEM. AGGREGATE LIMIT APPLIES PER! !X iPOLICY I 1IIpg L —ILOC PRODUCTS-COMP/OP AGO $2 000000 $ B suro soeILE uABLLIW X ' ANY AUTO 7 X . SCHEDULED AUTOS AUTOS NED AUTOS CA 195-54-96 i 12/10/2016 12/10/2017 !Ear i snaaL! Ussrr ;1,000,000 BODILY INJURY (Per person) $ — AU. VANED AUTOS BODILY INJURY (Peracddenq $ 1 HIRED AUTOS PROPERTY DAMAGE IPlraml tY $ X (Comp/COD Camp/ Coil 52,000 A ---- UMBRELLA UAB I EXCESS LAB OCCUR CLAIMS -MADE EGU5844320 12/10/2016 12/10/2017 EACH OCCURRENCE $1,000,000 AGGREGATE 51.000,000 I PEp X 1 RETENTION $ 10.000 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTNE Y/N OFFICFR/M EMBER EXCLUDED? (Mandatory In NH) III Yyes,, 5r,be under QESCRIPTION OF OPERATIONS Delow NIA; ( I WC STATtI I � 01 _ l TORY LIMITS I ER I - EL EACH ACCIDENT • _ $ EL. DISEASE - EA EMPLOYEEt $ El. DISEASE - POLICY UNIT $ C PROPERTY PROPERTY LEASED AND RENT 74308613 ' 7/1/2016 7/1/2017 'BUILDING 312,400 aPP BB,770 LEAS/RENT 80,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additlonel Remarks Schedule, if more space Is required) LEAS/RENT — DED: $500 NCELLATION Neal Bowers Weld County Public Works 1111 H Street Greeley CO 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 e. ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The A CORD name and logo are registered marks of ACORD ENDORSEMENT NO. 10 This endorsement effective 12:01 AM, December 10. 2015 Forms a part of Policy No: EG 4761196 Issued to: DENVER INDUSTRIAL SALES AND SERVICE COMPANY, INC. By: AG SPECIALTY INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED PRIMARY AND NON-CONTRIBUTORY ENDORSEMENT - OWNERS, LESSEES OR CONTRACTORS - YOUR WORK This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY AND POLLUTION LEGAL LIABILITY POLICY SCHEDULE Name of Additional Insured Person(s) or Organization(s): BLANKET WHERE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT Location(s) of Covered Operation(s): BLANKET WHERE REQUIRED BY WRITTEN CONTRACTOR AGREEMENT I. Solely as respects COVERAGE A - BODILY INJURY AND PROPERTY DAMAGE LIABILITY, COVERAGE B - PERSONAL AND ADVERTISING INJURY LIABILITY, and COVERAGE E - ADDITONAL POLLUTION LEGAL LIABILITY, SECTION II - WHO IS AN INSURED is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for bodily injury, property damage, personal and advertising injury, or environmental damage arising out of your work for the additional insured(s) by or for you at the location(s) designated above. II. As respects the coverage afforded the additional insured(s)scheduled above, this insurance is primary and non-contributory, and our obligations are not affected by any other insurance carried by such additional insured(s) whether primary, excess, contingent, or on any other basis. All other terms, conditions and exclusions shall remain the same. is AUTHORIZED REPRESENTATIVE or countersignature (in states where applicable) 107427 (12/10) PAGE 1 OF 1 CI4835 MEMORANDUM TO: Clerk to the Board DATE: July 15, 2016 FROM: Neal Bowers, Public Works Department SUBJECT: Agenda Item RE: Doc #2015-3398 Bid #B1500180 Renewal/extension of original agreement for the 2015 Repair Mastic Material Supply with Denver Industrial Sales and Service Co. This is the second year of a possible three-year contract from October 21, 2016, to October 20, 2017. Enclosures M:\Francie\AGENDA memos \Agenda-Neal.doe N3z,14.0- /(, c:`�u)�i11B1GL) BOARD OF COUNTY COMMISSIONERS PASS -AROUND REVIEW/ WORK SESSION REQUEST RE: 2016 Repair Mastic Material Supply DEPARTMENT: Public WOrks PERSON REQUESTING: Neal Bowers, Public Works DATE: 7/6/16 Brief description of the problem/issue: The original agreement for 2015 Repair Mastic Material Supply (#B 1500180) can be extend from October 21, 2016, to October 20, 2017, as permitted by the contract. This extension would be the second year of a possible three year contract. Denver Industrial Sales and Service Co. did not request an increase in the price per ton. The bid submitted doesn't exceed the 2016 crack filler maintenance budget. What options exist for the Board? (Include consequences, impacts, costs, etc. of options) The Board may either approve or deny the contract extension / renewal. Recommendation: Public Works recommends approval of the renewal for Denver Industrial Sales and Service Co. for Repair Mastic Material Supply. Mike Freeman, Chair Sean P. ConwayyPro-Tem Julie Cozad Barbara Kirkmeyer Steve Moreno Approve Schedule Recommendation Work Session MP- Other/Comments; CONTRACT AGREEMENT EXTENSION/RENEWAL BETWEEN THE WELD COUNTY DEPARTMENT OF PUBLIC WORKS AND DENVER INDUSTRIAL SALES AND SERVICE CO. This Agreement Extension/Renewal ("Renewal"), made and entered into 27 day of June, 2016, by and between the Board of Weld County Commissioners, on behalf of the Weld County Department of Public Works, hereinafter referred to as the "Department", and Denver Industrial Sales and Service Co. hereinafter referred to as the "Contractor". WHEREAS the parties entered into an agreement (the "Original Agreement") identified by the Weld County Clerk to the Board of County Commissioners as document No. 2015-3398 approved on October 21,2015. WHEREAS the parties hereby agree to extend the term of the Original Agreement in accordance with the terms of the Original Agreement, which is incorporated by reference herein, as well as the terms provided herein. NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: • The Original Agreement will end on October 20, 2016. • The parties agree to extend the Original Agreement for an additional 365 day period, which will begin October 21, 2016, and will end on October 20, 2017. • The Renewal, together with the Original Agreement, constitutes the entire understanding between the parties. The following change is hereby made to the Contract Documents: 1. The 2015 Bid Schedule of the original contract shall be replaced with the attached 2016 Bid Schedule, which is incorporated herein. 2. The original contract price shall be modified to no more than $18,900.00 for this contract period between October 21, 2016 and October 20, 2017. • All other terms and conditions of the Original Agreement remain unchanged. IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. CONTRACTOR: ATTEST: Weld C BY: 416//Pvi-j d' Deputy Clerk the Board APPROjp AS TO FUND NG: Controller APP' ` ED AS TO • RM: County Attorney BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO Mike Freeman, Chair JUL 2 0 2016 - APPROVED AS T -SUBSTANCE: Elect-• Off is or Department Head Director of General Services oZd/5:- 35 9f Terms and Conditions: The Agreement shall commence approximately November 2015 and continue in full force for one year. At the option of the County, the Agreement may be extended for up to two (2) additional years. Increases in the Cost may be negotiated for subsequent renewal of the second and third additional one-year periods. Cost increase must be consistent with regional trends. Weld County will use the ENR cost index (Paving, PG 58 per ton Denver) to measure the percent of increase from year to year to justify increase in cost. Price adjustment will not be implemented without final approval from Weld County. 2016 BID SCHEDULE ITEM# ITEM QUANTITY UNIT PRICE PER All Inclusive Cost for 15 Tons of Material UNIT Delivery, Equipments ETC.* 408 Repair Mastic and Delivery 15 Ton $1,260.00 $18,900.00 *Prices will include all labor and equipment cost necessary to manufacture, load, scale and deliver and pickup material and Equipment to Weld County Public Works facility. The remainder of this page left blank intentionally The undersigned, by his or her signature, hereby acknowledges and represents that: 1. The bid proposed herein meets all of the conditions, specifications and special provisions set forth in the request for proposal for Request No. #61500180 2. The quotations set forth herein are exclusive of any federal excise taxes and all other state and local taxes. 3. He or she is authorized to bind the below -named bidder for the amount shown on the accompanying proposal sheets. 4. The signed bid submitted, all of the documents of the Request for Proposal contained herein (including, but not limited to the product specifications and scope of services), the formal acceptance of the bid by Weld County, and signature of the Chair of the Board of County Commissioners, together constitutes a contract, with the contract date being the date of signature by the Chair of the Board of County Commissioners. 5. Weld County reserves the right to reject any and all bids, to waive any informality in the bids, and to accept the bid that, in the opinion of the Board of County Commissioners, is to the best interests of Weld County. The bid(s) may be warded to mor than one vendor. �' FIRM iritAey "`'LSTc� 3-lst S Gor e--141 Cy' 1 BUSINESS ADDRESS 7 y cr CITY, STATE, ZIP CODE /- `PY�%('/�� Cc) TELEPHONE NQ.� 1 -2,' FAX v TAX ID # PRINTED NAME AND TITLE SIGNATURE �G 2 E-MAIL 1 do l'S C �'� "T 4" DATE el, **THE SUCCE -FUL BIDDER SHALL PROVIDE A W-9 IF NOT ALREADY ON FILE** WELD COUNTY IS EXEMPT FROM COLORADO SALES TAXES. THE CERTIFICATE OF EXEMPTION NUMBER IS #98-03551-0000. • AWRD® CERTIFICATE OF LIABILITY INSURANCE DATE DNYYY) 6/28/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS 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 REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) 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 endorsement(s). PRODUCER CONTACT NAME: Romi S. Romero Henry Ham Agency 645 E. Evans Ave. PHO(A)C,NN . Ext):303-744-1341 I FAX (NC, No):303-744-0654 Denver CO 80250 E-MAIL ADDREss:romi(g henryham.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :AIG Specialty Insurance 26883 INSURED DENVE-3 INSURER B: Commerce & Industry Insurance 19410 Denver Industrial Sales INSURER C Auto -Owners Insurance Company 18988 & Service Co Inc 850 S Lipan St INSURER D Denver CO 80223 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 664196096 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR LTRINSR TYPE OF INSURANCE ADDL SUBR WVD POLICY NUMBER POLICY EFF (MMIDDNYYY) POLICY EXP (MM/DD/YYYY) LIMITS A GENERAL LIABILITY EG4761196 12/10/2015 12/10/2016 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES (Ea occurrence) $300,000 CLAIMS -MADE IX I OCCUR MED EXP (Any one person) $25,000 X Pollution-clm and PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000.000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 X POLICY PRO - X JECT $ B AUTOMOBILE LIABILITY CA195-54-96 12/10/2015 12/10/2016 COMBINED SINGLE LIMIT (EaaccidenU $1,000,000 X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ X HIRED AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ X Comp/Coll Comp/ Coll $2,000 A UMBRELLA UAB X OCCUR EGU5844320 12/10/2015 12/10/2016 EACH OCCURRENCE $1,000,000 EXCESS LIAB CLAIMS -MADE AGGREGATE $1,000,000 j DED IX I RETENT ON $10,000 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY WC STATU- j I OTH- TORY LIMITS ER Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ C PROPERTY 74308613 7/1/2015 7/1/2016 BUILDING 312.400 BPP 98,770 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Weld County is listed as an additional insured on the General Liability Policy per written contract. CERTIFICATE HOLDER CANCELLATION Weld County 1150 0 Street Room #107 Greeley CO 80631 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 v. ,I © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD ENDORSEMENT NO. 10 This endorsement, effective 12:01 AM, December 10, 2015 Forms a part of Policy No: EG 4761196 Issued to: DENVER INDUSTRIAL SALES AND SERVICE COMPANY, INC. By: AIG SPECIALTY INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED PRIMARY AND NON-CONTRIBUTORY ENDORSEMENT - OWNERS, LESSEES OR CONTRACTORS - YOUR WORK This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY AND POLLUTION LEGAL LIABILITY POLICY SCHEDULE Name of Additional Insured Person(s) or Organization(s): BLANKET WHERE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT Location(s) of Covered Operation(s): BLANKET WHERE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT I. Solely as respects COVERAGE A - BODILY INJURY AND PROPERTY DAMAGE LIABILITY, COVERAGE B - PERSONAL AND ADVERTISING INJURY LIABILITY, and COVERAGE E - ADDITONAL POLLUTION LEGAL LIABILITY, SECTION II - WHO IS AN INSURED is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for bodily injury, property damage, personal and advertising injury, or environmental damage arising out of your work for the additional insured(s) by or for you at the location(s) designated above. II. As respects the coverage afforded the additional insured(s)scheduled above, this insurance is primary and non-contributory, and our obligations are not affected by any other insurance carried by such additional insured(s) whether primary, excess, contingent, or on any other basis. All other terms, conditions and exclusions shall remain the same. AUTHORIZED REPRESENTATIVE or countersignature (in states where applicable) 107427 (12/10) PAGE 1 OF 1 C I4$35 WELD COUNTY DEPARTMENT OF PUBLIC WORKS CONTRACT BID DOCUMENTS AND SPECIFICATIONS FOR 2015 Repair Mastic Material Supply & Equipment for Application October 2015 Weld County Public Works Pavement Management Division 1111 H Street P.O. Box 758 Greeley, Colorado 80632 970-304-6496, Ext. 3750 e,onDIAA± 4411,414_ 10-as_c t5 c -e-: Ptd 045/ k,) 2015-3398 r cola, BID REQUEST #B1500180 Page 1 TABLE OF CONTENTS The following provisions take precedence over Specifications or Plans and Supplement the 2011 Edition of the Colorado Department of Transportation "Standard Specifications for Road and Bridge Construction" (Standard Specifications) which is to be used to control material supply for this project. BIDDING REQUIREMENTS Invitation to Bid 3 Instructions to Bid 4-5 General Provisions 5-8 Insurance Requirements . 8-10 Specifications and/or scope of work and proposed pricing 11 Bid Schedule . 12-13 Acknowledgement of Bid Documents 14 IRS Form W-9 15 Anti -Collusion Affidavit 16 CONTRACT FORMS Notice of Award 17 SPECIAL PROVISIONS Project Special Provisions Index 18 Project Special Provisions 19-22 REQUEST FOR BID WELD COUNTY, COLORADO BID REQUEST #61500180 f COUNTY 1150 O STREET GREELEY, CO 80631 DATE: September 29, 2015 BID NUMBER: B1500180 DESCRIPTION: 2015 Repair Mastic Material Supply DEPARTMENT: Public Works BID OPENING DATE: 10/13/15 @ 10:00 am 1. NOTICE TO BIDDERS: The Board of County Commissioners of Weld County, Colorado, by and through its Director of General Services (collectively referred to herein as, "Weld County"), wishes to purchase the following: 2015 Repair Mastic Material Supply & Equipment for Application (with possible two, one year renewals) Bids will be received at the Office of the Weld County Purchasing Department in the Weld County Administrative Building, 1150 0 Street Room #107 Greeley CO 80631 until: (10:00 am) on (October 13, 2015) (Weld County Purchasing Time Clock). PAGES 3 - 10 OF THIS REQUEST FOR BIDS CONTAIN GENERAL INFORMATION FOR THE REQUEST NUMBER REFERRED TO ABOVE. NOT ALL OF THE INFORMATION CONTAINED IN PAGES 3-10 MAY BE APPLICABLE FOR EVERY PURCHASE. BID SPECIFICS FOLLOW PAGE 10. 2. INVITATION TO BID: Weld County requests bids for the above -listed merchandise, equipment, and/or services. Said merchandise and/or equipment shall be delivered to the location(s) specified herein Bids shall include any and all charges for freight, delivery, containers, packaging, less all taxes and discounts, and shall, in every way, be the total net price which the bidder will expect the Weld County to pay if awarded the bid. You can find bid information on the Weld County Purchasing website at http://www.co.weld.co.us/Departments/Purchasing/index.html located under Current Request for Bids. Weld County Government is a member of the Rocky Mountain E -Purchasing System. The Rocky Mountain E -Purchasing System (BidNet®) is an on-line notification system that is being utilized by multiple governmental entities. Participating entities post their bids, quotes, proposals, addendums, and awards on this one centralized system. Bid Delivery to Weld County — 3 methods: 1. Email. Emailed bids are preferred. Bids may be emailed to: bids @ w e I d g o v . c o m . Emailed bids must include the following statement on the email: "I hereby waive my right to a sealed bid". An email confirmation will be sent when we receive your bid/proposal. If more than one copy of the bid is requested, you must submit/mail hard copies of the bid proposal. 2. Facsimile. Bids may be faxed to 970-336-7226 attention "Purchasing". The vendor must include the following statement on the facsimile: "I hereby waive my right to a sealed bid. If BID REQUEST #61500180 Page 3 more than one copy of the bid is requested, you must submit/mail hard copies of the bid proposal. 3. Mail or Hand Delivery. Mailed (or hand delivered) bids should be sent in a sealed envelope with the bid title and bid number on it. Please address to: Weld County Purchasing Department, 1150 O Street, Room #107 Greeley, CO 80631. Please call Purchasing at 970-336-7225 if you have any questions. 3. INSTRUCTIONS TO BIDDERS: INTRODUCTORY INFORMATION Bids shall be typewritten or written in ink on forms prepared by the Weld County Purchasing Department. Each bid must give the full business address of bidder and be signed by him with his usual signature. Bids by partnerships must furnish the full names of all partners and must be signed with the partnership name by one of the members of the partnership or by an authorized representative, followed by the signature and title of the person signing. Bids by corporations must be signed with the legal name of the corporation, followed by the name of the state of the incorporation and by the signature and title of the president, secretary, or other person authorized to bind it in the matter. The name of each person signing shall also be typed or printed below the signature. A bid by a person who affixes to his signature the word "president," "secretary," "agent," or other title without disclosing his principal, may be held to be the bid of the individual signing. When requested by the Weld County Director of General Services, satisfactory evidence of the authority of the officer signing on behalf of a corporation shall be furnished. A power of attorney must accompany the signature of anyone not otherwise authorized to bind the Bidder. All corrections or erasures shall be initialed by the person signing the bid. All bidders shall agree to comply with all of the conditions, requirements, specifications, and/or instructions of this bid as stated or implied herein. All designations and prices shall be fully and clearly set forth. All blank spaces in the bid forms shall be suitably filled in. Bidders are required to use the Proposal Forms which are included in this package and on the basis indicated in the Bid Forms. The Bid Proposal must be filled out completely, in detail, and signed by the Bidder. Late or unsigned bids shall not be accepted or considered. It is the responsibility of the bidder to ensure that the bid arrives in the Weld County Purchasing Department on or prior to the time indicated in Section 1, entitled, "Notice to Bidders." Bids received prior to the time of opening will be kept unopened in a secure place. No responsibility will attach to the Weld County Director of General Services for the premature opening of a bid not properly addressed and identified. Bids may be withdrawn upon written request to and approval of the Weld County Director of General Services; said request being received from the withdrawing bidder prior to the time fixed for award. Negligence on the part of a bidder in preparing the bid confers no right for the withdrawal of the bid after it has been awarded. Bidders are expected to examine the conditions, specifications, and all instructions contained herein, failure to do so will be at the bidders' risk. In accordance with Section 14-9(3) of the Weld County Home Rule Charter, Weld County will give preference to resident Weld County bidders in all cases where said bids are competitive in price and quality. It is also understood that Weld County will give preference to suppliers from the State of Colorado, in accordance with C.R.S. § 30-11-110 (when it is accepting bids for the purchase of any books, stationery, records, printing, lithographing or other supplies for any officer of Weld County). Weld County reserves the right to reject any and all bids, to waive any informality in the bids, to award the bid to multiple vendors, and to accept the bid that, in the opinion of the Board of County Commissioners, is to the best interests of Weld County. The bid(s) may be awarded to more than one vendor. In submitting the bid, the bidder agrees that the signed bid submitted, all of the documents of the Request for Proposal contained herein (including, but not limited to the product specifications and scope of services), the formal acceptance of the bid by Weld County, and signature of the Chair of the Board of County Commissioners, together constitutes a contract, with the contract date being the date of signature by the Chair of the Board of County Commissioners. 4. SUCCESSFUL BIDDER HIRING PRACTICES - ILLEGAL ALIENS BID REQUEST #B1500180 Page 4 Successful bidder certifies, warrants, and agrees that it does not knowingly employ or contract with an illegal alien who will perform work under this contract. Successful bidder will confirm the employment eligibility of all employees who are newly hired for employment in the United States to perform work under this Agreement, through participation in the E -Verify program or the State of Colorado program established pursuant to C.R.S. §8-17.5-102(5)(c). Successful bidder shall not knowingly employ or contract with an illegal alien to perform work under this Agreement or enter into a contract with a subcontractor that fails to certify with Successful bidder that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Agreement. Successful bidder shall not use E -Verify Program or State of Colorado program procedures to undertake pre -employment screening or job applicants while this Agreement is being performed. If Successful bidder obtains actual knowledge that a subcontractor performing work under the public contract for services knowingly employs or contracts with an illegal alien Successful bidder shall notify the subcontractor and County within three (3) days that Successful bidder has actual knowledge that a subcontractor is employing or contracting with an illegal alien and shall terminate the subcontract if a subcontractor does not stop employing or contracting with the illegal alien within three (3) days of receiving notice. Successful bidder shall not terminate the contract if within three days the subcontractor provides information to establish that the subcontractor has not knowingly employed or contracted with an illegal alien. Successful bidder shall comply with reasonable requests made in the course of an investigation, undertaken pursuant to C.R.S. §8-17.5-102(5), by the Colorado Department of Labor and Employment. If Successful bidder participates in the State of Colorado program, Successful bidder shall, within twenty days after hiring a new employee to perform work under the contract, affirm that Successful bidder has examined the legal work status of such employee, retained file copies of the documents, and not altered or falsified the identification documents for such employees. Successful bidder shall deliver to County, a written notarized affirmation that it has examined the legal work status of such employee, and shall comply with all of the other requirements of the State of Colorado program. If Successful bidder fails to comply with any requirement of this provision or of C.R.S. §8-17.5-101 et seq., County, may terminate this Agreement for breach, and if so terminated, Successful bidder shall be liable for actual and consequential damages. Except where exempted by federal law and except as provided in C.R.S. § 24-76.5-103(3), if Successful bidder receives federal or state funds under the contract, Successful bidder must confirm that any individual natural person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. § 24-76.5-103(4), if such individual applies for public benefits provided under the contract. If Successful bidder operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it: (a) is a citizen of the United States or is otherwise lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms of identification required by C.R.S. § 24-76.5-101, et seq., and (c) shall produce one of the forms of identification required by C.R.S. § 24-76.5-103 prior to the effective date of the contract. 5. GENERAL PROVISIONS A. Fund Availability: Financial obligations of Weld County payable after the current fiscal year are contingent upon funds for that purpose being appropriated, budgeted and otherwise made available. By acceptance of the bid, Weld County does not warrant that funds will be available to fund the contract beyond the current fiscal year. B. Confidential Information: Confidential financial information of the bidder should be transmitted separately from the main bid submittal, clearly denoting in red on the financial information at the top the word, "CONFIDENTIAL." However, the successful bidder is advised that as a public entity, Weld County must comply with the provisions of C.R.S. 24-72-201, et seq., with regard to public records, and cannot guarantee the confidentiality of all documents. C. Governmental Immunity: No term or condition of the contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental Immunity Act §§24-10-101 et seq., as applicable now or hereafter amended. D. Independent Contractor: The successful bidder shall perform its duties hereunder as an independent contractor and not as an employee. He or she shall be solely responsible for its acts BID REQUEST #B1500180 Page 5 and those of its agents and employees for all acts performed pursuant to the contract. Neither the successful bidder nor any agent or employee thereof shall be deemed to be an agent or employee of Weld County. The successful bidder and its employees and agents are not entitled to unemployment insurance or workers' compensation benefits through Weld County and Weld County shall not pay for or otherwise provide such coverage for the successful bidder or any of its agents or employees. Unemployment insurance benefits will be available to the successful bidder and its employees and agents only if such coverage is made available by the successful bidder or a third party. The successful bidder shall pay when due all applicable employment taxes and income taxes and local head taxes (if applicable) incurred pursuant to the contract. The successful bidder shall not have authorization, express or implied, to bind Weld County to any agreement, liability or understanding, except as expressly set forth in the contract. The successful bidder shall have the following responsibilities with regard to workers' compensation and unemployment compensation insurance matters: (a) provide and keep in force workers' compensation and unemployment compensation insurance in the amounts required by law, and (b) provide proof thereof when requested to do so by Weld County. E. Compliance with Law: The successful bidder shall strictly comply with all applicable federal and state laws, rules and regulations in effect or hereafter established, including without limitation, laws applicable to discrimination and unfair employment practices. F. Choice of Law: Colorado law, and rules and regulations established pursuant thereto, shall be applied in the interpretation, execution, and enforcement of the contract. Any provision included or incorporated herein by reference which conflicts with said laws, rules and/or regulations shall be null and void. G. No Third Party Beneficiary Enforcement: It is expressly understood and agreed that the enforcement of the terms and conditions of the contract, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties and nothing in the contract shall give or allow any claim or right of action whatsoever by any other person not included in the contract. It is the express intention of the undersigned parties that any entity other than the undersigned parties receiving services or benefits under the contract shall be an incidental beneficiary only. H. Attorney's Fees/Legal Costs: In the event of a dispute between Weld County and the successful bidder, concerning the contract, the parties agree that Weld County shall not be liable to or responsible for the payment of attorney fees and/or legal costs incurred by or on behalf of the successful bidder. I. Disadvantaged Business Enterprises: Weld County assures that disadvantaged business enterprises will be afforded full opportunity to submit bids in response to all invitations and will not be discriminated against on the grounds of race, color, national origin, sex, age, or disability in consideration for an award. J. Procurement and Performance: The successful bidder agrees to procure the materials, equipment and/or products necessary for the project and agrees to diligently provide all services, labor, personnel and materials necessary to perform and complete the project. The successful bidder shall further be responsible for the timely completion, and acknowledges that a failure to comply with the standards and requirements outlined in the Bid within the time limits prescribed by County may result in County's decision to withhold payment or to terminate this Agreement. K. Term: The term of this Agreement begins upon the date of the execution of this Agreement by County, and shall continue through and until successful bidder's completion of the responsibilities described in the Bid. L. Termination: County has the right to terminate this Agreement, with or without cause on thirty (30) days written notice. Furthermore, this Agreement may be terminated at any time without notice upon a material breach of the terms of the Agreement. BID REQUEST #61500180 Page 6 M. Extension or Modification: Any amendments or modifications to this agreement shall be in writing signed by both parties. No additional services or work performed by the successful bidder shall be the basis for additional compensation unless and until the successful bidder has obtained written authorization and acknowledgement by County for such additional services. Accordingly, no claim that the County has been unjustly enriched by any additional services, whether or not there is in fact any such unjust enrichment, shall be the basis of any increase in the compensation payable hereunder. N. Subcontractors: The successful bidder acknowledges that County has entered into this Agreement in reliance upon the particular reputation and expertise of the successful bidder. The successful bidder shall not enter into any subcontractor agreements for the completion of this Project without County's prior written consent, which may be withheld in County's sole discretion. County shall have the right in its reasonable discretion to approve all personnel assigned to the subject Project during the performance of this Agreement and no personnel to whom County has an objection, in its reasonable discretion, shall be assigned to the Project. The successful bidder shall require each subcontractor, as approved by County and to the extent of the Services to be performed by the subcontractor, to be bound to the successful bidder by the terms of this Agreement, and to assume toward the successful bidder all the obligations and responsibilities which the successful bidder, by this Agreement, assumes toward County. County shall have the right (but not the obligation) to enforce the provisions of this Agreement against any subcontractor hired by the successful bidder and the successful bidder shall cooperate in such process. The successful bidder shall be responsible for the acts and omissions of its agents, employees and subcontractors. O. Non -Assignment: The successful bidder may not assign or transfer this Agreement or any interest therein or claim thereunder, without the prior written approval of County. Any attempts by the successful bidder to assign or transfer its rights hereunder without such prior approval by County shall, at the option of County, automatically terminate this Agreement and all rights of the successful bidder hereunder. Such consent may be granted or denied at the sole and absolute discretion of County. P. Interruptions: Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perform any obligation under this Agreement, where such failure is due to any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions. Q. Non -Exclusive Agreement: This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. R. Employee Financial Interest/Conflict of Interest — C.R.S. §§24-18-201 et seq. and §24-50-507. The signatories to this Agreement agree that to their knowledge, no employee of Weld County has any personal or beneficial interest whatsoever in the service or property which is the subject matter of this Agreement. County has no interest and shall not acquire any interest direct or indirect, that would in any manner or degree interfere with the performance of the successful bidder's services and the successful bidder shall not employ any person having such known interests. During the term of this Agreement, the successful bidder shall not engage in any in any business or personal activities or practices or maintain any relationships which actually conflicts with or in any way appear to conflict with the full performance of its obligations under this Agreement. Failure by the successful bidder to ensure compliance with this provision may result, in County's sole discretion, in immediate termination of this Agreement. No employee of the successful bidder nor any member of the successful bidder's family shall serve on a County Board, committee or hold any such position which either by rule, practice or action nominates, recommends, supervises the successful bidder's operations, or authorizes funding to the successful bidder. S. Severability: If any term or condition of this Agreement shall be held to be invalid, illegal, or unenforceable by a court of competent jurisdiction, this Agreement shall be construed and BID REQUEST #61500180 Page 7 enforced without such provision, to the extent that this Agreement is then capable of execution within the original intent of the parties. T. Binding Arbitration Prohibited: Weld County does not agree to binding arbitration by any extra- judicial body or person. Any provision to the contrary in the contract or incorporated herein by reference shall be null and void. U. Board of County Commissioners of Weld County Approval: This Agreement shall not be valid until it has been approved by the Board of County Commissioners of Weld County, Colorado or its designee. V. Compensation Amount: Upon the successful bidder's successful completion of the service, and County's acceptance of the same, County agrees to pay an amount no greater than the amount of the accepted bid. The successful bidder acknowledges no payment in excess of that amount will be made by County unless a "change order" authorizing such additional payment has been specifically approved by the County's delegated employee, or by formal resolution of the Weld County Board of County Commissioners, as required pursuant to the Weld County Code. W. Taxes: County will not withhold any taxes from monies paid to the successful bidder hereunder and the successful bidder agrees to be solely responsible for the accurate reporting and payment of any taxes related to payments made pursuant to the terms of this Agreement. Contractor shall not be entitled to bill at overtime and/or double time rates for work done outside of normal business hours unless specifically authorized in writing by County. 6. INSURANCE REQUIREMENTS General Requirements: Successful bidders must secure, at or before the time of execution of any agreement or commencement of any work, the following insurance covering all operations, goods or services provided pursuant to this request. Successful bidders shall keep the required insurance coverage in force at all times during the term of the Agreement, or any extension thereof, and during any warranty period. The required insurance shall be underwritten by an insurer licensed to do business in Colorado and rated by A.M. Best Company as "A"VIII or better. Each policy shall contain a valid provision or endorsement stating "Should any of the above -described policies by canceled or should any coverage be reduced before the expiration date thereof, the issuing company shall send written notice to the Weld County Director of General Services by certified mail, return receipt requested. Such written notice shall be sent thirty (30) days prior to such cancellation or reduction unless due to non-payment of premiums for which notice shall be sent ten (10) days prior. If any policy is in excess of a deductible or self -insured retention, County must be notified by the Successful bidder. Successful bidder shall be responsible for the payment of any deductible or self -insured retention. County reserves the right to require Successful bidder to provide a bond, at no cost to County, in the amount of the deductible or self -insured retention to guarantee payment of claims. The insurance coverage's specified in this Agreement are the minimum requirements, and these requirements do not decrease or limit the liability of Successful bidder. The County in no way warrants that the minimum limits contained herein are sufficient to protect the Successful bidder from liabilities that might arise out of the performance of the work under this Contract by the Successful bidder, its agents, representatives, employees, or subcontractors. The successful bidder shall assess its own risks and if it deems appropriate and/or prudent, maintain higher limits and/or broader coverages. The successful bidder is not relieved of any liability or other obligations assumed or pursuant to the Contract by reason of its failure to obtain or maintain insurance in sufficient amounts, duration, or types. The successful bidder shall maintain, at its own expense, any additional kinds or amounts of insurance that it may deem necessary to cover its obligations and liabilities under this Agreement. Any modification to these requirements must be made in writing by Weld County. The successful bidder stipulates that it has met the insurance requirements identified herein. The successful bidder shall be responsible for the professional quality, technical accuracy, and quantity of all materials and services provided, the timely delivery of said services, and the coordination of all BID REQUEST #B1500180 Page 8 services rendered by the successful bidder and shall, without additional compensation, promptly remedy and correct any errors, omissions, or other deficiencies. INDEMNITY: The successful bidder shall defend, indemnify and hold harmless County, its officers, agents, and employees, from and against injury, loss damage, liability, suits, actions, or claims of any type or character arising out of the work done in fulfillment of the terms of this Contract or on account of any act, claim or amount arising or recovered under workers' compensation law or arising out of the failure of the successful bidder to conform to any statutes, ordinances, regulation, law or court decree. The successful bidder shall be fully responsible and liable for any and all injuries or damage received or sustained by any person, persons, or property on account of its performance under this Agreement or its failure to comply with the provisions of the Agreement, or on account of or in consequence of neglect of The successful bidder in its methods or procedures; or in its provisions of the materials required herein, or from any claims or amounts arising or recovered under the Worker's Compensation Act, or other law, ordinance, order, or decree. This paragraph shall survive expiration or termination hereof. It is agreed that the successful bidder will be responsible for primary loss investigation, defense and judgment costs where this contract of indemnity applies. In consideration of the award of this contract, the successful bidder agrees to waive all rights of subrogation against the County its associated and/or affiliated entities, successors, or assigns, its elected officials, trustees, employees, agents, and volunteers for losses arising from the work performed by the successful bidder for the County. A failure to comply with this provision shall result in County's right to immediately terminate this Agreement. Types of Insurance: The successful bidder shall obtain, and maintain at all times during the term of any Agreement, insurance in the following kinds and amounts: Workers' Compensation Insurance as required by state statute, and Employer's Liability Insurance covering all of the successful bidder's employees acting within the course and scope of their employment. Policy shall contain a waiver of subrogation against the County. This requirement shall not apply when a successful bidder or subcontractor is exempt under Colorado Workers' Compensation Act., AND when such successful bidder or subcontractor executes the appropriate sole proprietor waiver form. Commercial General Liability Insurance for bodily injury, property damage, and liability assumed under an insured contract, and defense costs, with the minimum limits must be as follows: $1,000,000 each occurrence; $2,000,000 general aggregate; $2,000,000 products and completed operations aggregate; $1,000,000 Personal Advertising injury Automobile Liability: Successful bidder shall maintain limits of $1,000,000 for bodily injury per person, $1,000,000 for bodily injury for each accident, and $1,000,000 for property damage applicable to all vehicles operating both on County property and elsewhere, for vehicles owned, hired, and non -owned vehicles used in the performance of this Contract. Successful bidders shall secure and deliver to the County at or before the time of execution of this Agreement, and shall keep in force at all times during the term of the Agreement as the same may be extended as herein provided, a commercial general liability insurance policy, including public liability and property damage, in form and company acceptable to and approved by said Administrator, covering all operations hereunder set forth in the Request for Bid. Proof of Insurance: County reserves the right to require the successful bidder to provide a certificate of insurance, a policy, or other proof of insurance as required by the County's Risk Administrator in his sole discretion. BID REQUEST #B1500180 Page 9 Additional Insureds: For general liability, excess/umbrella liability, pollution legal liability, liquor liability, and inland marine, Successful bidder's insurer shall name County as an additional insured. Waiver of Subrogation: For all coverages, Successful bidder's insurer shall waive subrogation rights against County. Subcontractors: All subcontractors, subcontractors, independent contractors, sub -vendors, suppliers or other entities providing goods or services required by this Agreement shall be subject to all of the requirements herein and shall procure and maintain the same coverage's required of Successful bidder. Successful bidder shall include all such subcontractors, independent contractors, sub - vendors suppliers or other entities as insureds under its policies or shall ensure that all subcontractors maintain the required coverages. Successful bidder agrees to provide proof of insurance for all such subcontractors, independent contractors, sub -vendors suppliers or other entities upon request by the County. The terms of this Agreement are contained in the terms recited in this Request for Bid and in the Response to the Bid each of which forms an integral part of this Agreement. Those documents are specifically incorporated herein by this reference. SPECIFICATIONS, SCOPE OF WORK AND PROPOSED PRICING: Purpose: The project in general consists of delivery of specified Repair Mastic material and equipment for Weld County 2015 crack seal projects. General Conditions and Information: 1. Weld County will not supply any material for this project. 2. Repair Mastic shall be Crafco Inc. Mastic One or an approved equal. 3. For 2015, the Successful bidder shall supply the following below. a. 200 (gallon) tank Mastic Mixer/melter kettle or equivalent necessary to apply the Mastic martial to the work area. BID REQUEST #B1500180 Page 10 b. 10 ton of Repair Mastic c. Supply material hander cart and all hand tools needed to apply the hot mastic to roadway. d. Eight (8) hours of training for Weld County employees on jobs site in Weld County. e. All material and equipment cost shall be include in the price per ton. f. Equipment shall be provided for a three (3) week period between November 15, 2015 and before December 31, 2015. Vendor will load, scale and deliver all materials and equipment to Weld County Public Works facility at 1111 H Street, Greeley, CO by no later than November 15, 2015. Also pickup all equipment when job is complete. h. Payment shall be made according to the bid price per ton i. Vendor will call 24 hours before delivery of material, delivery will only between 7:00am to 3:00 pm, Monday through Friday. The successful bidder is required to accommodate these situations. j. Weld County will select the bidder based on the lowest cost to the County that meets specifications. 4. For future years 2016-2017 (assuming renewal of contract): a. The amount of material (in tons) needed will be determined on an annual basis and communicated to the successful vendor. b. 200 (gallon) tank Mastic Mixer/melter kettle or equivalent necessary to apply the Mastic martial to the work area. c. Supply material hander cart and all hand tools needed to apply the hot mastic to roadway. d. Eight (8) hours of training for Weld County employees on jobs site in Weld County. e. All material and equipment cost shall be include in the price per ton. f. Equipment shall be provided for a three (3) week period mutually agreed upon by the vendor and Weld County but likely will be in October, November, or December. Vendor will load, scale and deliver all materials and equipment to Weld County Public Works facility at 1111 H Street, Greeley, CO, and will pick up all equipment when job is complete. h. Payment shall be made according to the bid price per ton i. Vendor will call 24 hours before delivery of material, delivery will only between 7:00am to 3:00 pm, Monday through Friday. The successful bidder is required to accommodate these situations. Weld County will select the bidder based on the lowest cost to the County that meets specifications. g. g. The specification for material supply shall be in accordance with the Colorado Department of Transportation, Standard Specification for Road and Bridge Construction 2011, unless otherwise stipulated in this document. The below CDOT specification documents are pertinent to this contract. References to the division shall mean Weld County and all documentation required will be handled through the Weld County Public Works Department. Specifications can be found on pages 18-22 of this document. Section 105.22 Section 106.07 Section 106.08 Section 408.02 Schedule: Dispute Resolution Material Inspection Control of Materials Materials/Joint & Crack Sealant (March 2014) (February 2011) (February 2011) (February 2011) Bid Due to Purchasing: October 13, 2015 Estimated Bid Accepted by BOCC: October 28, 2015 (or before depending on pricing) Weld County Contract: Questions related to the project and procedures should be directed to: Neal Bowers, Pavement Management Supervisor Weld County Public Works 970.304.6496, ext. 3744 nbowersco.weld.co.us BID REQUEST #B1500180 Page 11 Terms and Conditions: The Agreement shall commence approximately November 2015 and continue in full force for one year. At the option of the County, the Agreement may be extended for up to two (2) additional years. Increases in the Cost may be negotiated for subsequent renewal of the second and third additional one-year periods. Cost increase must be consistent with regional trends. Weld County will use the ENR cost index (Paving, PG 58 per ton Denver) to assist in the evaluation of any proposed percent of increase from year to year to justify increase in cost. Price adjustment will not be implemented without final approval from Weld County. 2015 BID SCHEDULE ITEM# ITEM QUANTITY UNIT PRICE PER ALL INCLUSIVE COST FOR 10 TONS OF MATERIAL, UNIT DELIVERY, EQUIPMENT, ETC.* 408 Repair Mastic and Delivery 10 Ton $1,260.00 $12,600.00 *Prices will include all labor and equipment cost necessary to manufacture, load, scale and deliver and pickup material and Equipment to Weld County Public Works facility. PLEASE NOTE: The 200 gallon Mastic Mixer that DISSCO is offering for use with this solicitation is a New 2015 Crafco Patcher II (see attached brochure) that DISSCO received January of this year. This unit is valued at $59.000.00 new. This unit has been rented throughout this year and has been a stellar machine with virtually no operational issues. DISSCO as well as this unit is fully insured thru AIG Specialty Insurance Group with 1M and 2M limits. See attached Certificate. The undersigned, by his or her signature, hereby acknowledges and represents that: 1. The bid proposed herein meets all of the conditions, specifications and special provisions set forth in the request for proposal for Request No. #61500180 2. The quotations set forth herein are exclusive of any federal excise taxes and all other state and local taxes. 3. He or she is authorized to bind the below -named bidder for the amount shown on the accompanying proposal sheets. 4. The signed bid submitted, all of the documents of the Request for Proposal contained herein (including, but not limited to the product specifications and scope of services), the formal acceptance of the bid by Weld County, and signature of the Chair of the Board of County Commissioners, together constitutes a contract, with the contract date being the date of signature by the Chair of the Board of County Commissioners. 5. Weld County reserves the right to reject any and all bids, to waive any informality in the bids, and to accept the bid that, in the opinion of the Board of County Commissioners, is to the best interests of Weld County. The bid(s) may be awarded to more than one vendor. BID REQUEST #61500180 Page 12 FIRM Denver Industrial Sales and Service Co. BUSINESS 850 S Lipan St ADDRESS CITY, STATE, ZIP CODE Denver, CO 80223 TELEPHONE NO 303-935-2485 F i '3 -• TAX ID # 84-1203912 PRINTED NAME AND TITLE Todd Mel SIGNATURE 1. • E-MAIL toddmellema@dissco.net W DATE October 13, 2015 C-1 m n ated in the State of Colorado **THE SUCCESSFUL BIDDER SHALL PRO V?6 (iDA-9 ;IF.A4b LREADY ON FILE** WELD COUNTY IS EXEMPT FROM COLORADO SALES TAXES. THE CERTIFICATE OF EXEMPTION NUMBER IS #98-03551-0000. YOU DO NOT NEED TO SEND BACK PAGES 1 -11. ATTES Weld BY: enB,ard —� ; eputy CI ACKNOWLEDGEMENT OF BID DOCUMENTS BOARD OF COUNTY COMMISSIONERS WF D COUNTY, CQL,6R1DO hair OC7 2 1 ZHS STANCE: Director of General Services Bid Opening Checklist: All of the following pages must be submitted with every bid submittal. Failure to Submit any of these documents will disqualify your bid. Q Receipt of addenda(s), if any, should be signed. Q W-9 (page 15) 0 Anti -Collusion Affidavit. (page 16) 0 Bid Schedule (page 12-13) BID REQUEST #BI 500180 ��_ X39' Page 13 I have initialed each of the above items and have fully executed the corresponding documents. I hereby Acknowledge and understand the above required bid documents. Denver Ind. Sales and Service Co. (Contractor) 12 O Dated this day of Title: 15 ;20 President, in State of Colorado BID REQUEST #61500180 Page 14 COLORADO DEPARTMENT OF TRANSPORTATION ANTI -COLLUSION AFFIDAVIT fil" f r�0180 Weld County I hereby attest that I am the person responsible within my firm for the final decision as to the price(s) and amount of this bid or, if not, that I have written authorization, enclosed herewith, from that person to make the statements set out below on his or her behalf and on behalf of my firm. I further attest that, 1. The price(s) and amount of this bid have been arrived at independently, without consultation, communication or agreement for the purpose or with the effect of restricting competition with any other firm or person who is a bidder or potential prime bidder. 2A. Neither the price(s) nor the amount of this bid have been disclosed to any other firm or person who is a bidder or potential prime bidder on this project, and will not be so disclosed prior to bid opening. 2B. Neither the prices nor the amount of the bid of any other firm or person who is a bidder or potential prime bidder on this project have been disclosed to me or my firm. 3A. No attempt has been made to solicit, cause or induce any firm or person who is a bidder or potential prime bidder to refrain from bidding on this project, or to submit a bid higher than the bid of this firm, or any intentionally high or non- competitive bid or other form of complementary bid. 3B. No agreement has been promised or solicited for any other firm or person who is a bidder or potential prime bidder on this project to submit an intentionally high, noncompetitive or other form of complementary bid on this project. 4. The bid of my firm is made in good faith and not pursuant to any consultation, communication, agreement or discussion with, or inducement or solicitation by or from any firm or person to submit any intentionally high, noncom- petitive or other form of complementary bid. 5. My firm has not offered or entered into a subcontract or agreement regarding the purchase or sale of materials or services from any firm or person, or offered, promised or paid cash or anything of value to any firm or person, whether in connection with this or any other project, in consideration for an agreement or promise by any firm or person to refrain from bidding or to submit any intentionally high, noncompetitive or other form of complementary bid or agreeing or promising to do so on this project. 6. My firm has not accepted or been promised any subcontract or agreement regarding the sale of materials or services to any firm or person, and has not been promised or paid cash or anything of value by any firm or person, whether in connection with this or any other project, in consideration for my firm's submitting any intentionally high. noncompetitive or other form of complementary bid, or agreeing or promising to do so, on this project. 7. I have made a diligent inquiry of all members, officers, employees, and agents of my firm with responsibilities relating to the preparation, approval or submission of my firm's bid on this project and have been advised by each of them that he or she has not participated in any communication, consultation, discussion, agreement, collusion, or other conduct inconsistent with any of the statements and representations made in this affidavit. 8. I understand and my firm understands that any misstatement in this affidavit is and shall be treated as a fraudulent concealment from the Colorado Department of Transportation, of the true facts relating to submission of bids for this contract. I DECLARE UNDER PENALTY OF PERJURY IN THE SECOND DEGREE, AND ANY OTHER APPLICABLE STATE OR ,- FEDERAL LAWS, THAT THE STATEMENTS MADE ON THIS DOCUMENT ARE TRUE AND COMP TO,TFIE.,,BES1 OF MY KNOWLEDGE. . s'`: Confraciors r,nn or company Nana Denver Industrial Sales and Service Co. dl. 1f0-12-2015 P 2nd contractors Inn or companynam• p+ror^..-r _ cal,. Sworn to before me thisA...--. �f. October 2015 of ry blic�ar�C Schonack�my MA K MO$ NOTARY PUBLIC STATE OF COLORADO NOTARY ID 20104042!53 comm,an,dn em+ras NOTE: This document must be signed in ink. 8cc404Yr NOTICE OF AWARD 2015 Repair Mastic Material Supply &Equipment For Application .806 1102 BID REQUEST #B1500180 Page 16 Ferro W-9 (Hex. August 2013) Department of the Treasury Infernal Revenue Server Request for Taxpayer Identification Number and Certification Give Form to the requester. Do not send to the IRS. Print or type See Specific Instructions on page 2 Name (as shown an you income tax return) Denver Industrial Sales and Service Co. (3usitess name/disregarded entity name, if different from above Chock appropiat° bent for fesderal tax classification: ❑ Individual/sole proprietor ID Corporation ❑ S Corporation ❑ Partnership Li ❑ Limited liability company. Enter the lax classification (CeC corporation. S -S orporatdn, Pepartnership) LJ Other (see instructions) le - Trust/estate In Exemptions Exempt payee Exemphon code (rf any) (see tare uctiorrr): code (deny) front FATCA reporting Address (number, street. arid apt. or suite no.) 850 S. Lipan St. Requester's name and address (optional) Weld County Crty,state. and ZIP code Denver, CO 80223 list account number(s) here (optional) Part I Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on the "Name" brie to avoid backup withholding. For individuals, this is your social security number (SSN). However, for a resident alien, sole propnetor or disregarded entity, see the Part I instructions on page 3. For other entities, it is your employer identification number (FIN). ft you do not have a number, see How to get e TIN on page 3 Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose number to enter. Social security manlier Employer identification number J 8 4 1 2 0 3 9 1 2 Part II Certification Under penalties of perjury, I certify that: 1_ The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and 2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and 3. I am a U.S. citizen or other U.S. person (defined below), and 4. The FATCA code(s) entered on this form Of any) indicating that I am exempt Certification instructions. You must cross out item 2 above if you have been because you have failed to report all interest and dividends on your tax return. interest paid, acquisition or abandonment of secured property, Cancellation of generally, payments other than interest and dividends instructions on page 3. Sign Signature Here us. pens xi' General Instructions Sa:tnan rotes WC!. are to the Internal Rov nue Cad° unless otherwise noted. Future developments. the IRS has aeatol a patµ: on IRS.gov for information about Form W-0, at vwnv.vs.gov/w9- Information about any future developnronts affecting Form W-9 (such as legislation enacted after we release it) will be posted on that page. Purpose of Form A person wino ins rimmed to tile an nlomatron return with the IRS must obtain your correct taxpayer rdentitication number (tiN) to report, tor example, income paid to you, payments made to you in settlement of payment card and nod party network transactions, real estate transactions. mortgage interest you paid. aimesition of abandonment of seared property, cancellation of debt, or contnbutiors you made to an IRA. Use Form W-9 only if you are a U.S. person (including it resident alien), to provide your correct TV') to the person requesting it (the requester) and, when applicable, to: 1. Certify that the TIN you are giving is correct (or you are,v�(afting for a number tube ).,.i -11 ..,!0 2. Certify to Yj�r t 3. Clam ex jppplicable, �an xr y part, dump' or are a U.S. exempt payee. If en, your alld.cable share of is not sarbyct to the from FATCA reporting is correct. notified by the IRS that you are currently subject to backup withholding For real estate transactions, item 2 does not apply. For mortgage dQbtc'contnbutions to an individual retirement arrangement (IRA). and ilgn the certification, but you must provide your correct TIN. See the Dab ► /e' 'o withholdevj tax on foreign partners' share at effeciwey connected income, and 4. Certify that FATCA colon) entered on this form (if any) indicating that you we exempt tan the FATCA reporting, is correct. Nob. II you are a U.S. person and a requester gives you a form other than Form W-9 to request your TIN, you must use the requester's form it it is substantially similar to this Form W-9. Definition of a U.S. parson For federal tax purposes, you arc considered a U.S. pescxn d you are: • An individual who is a U.S. citizen or U.S. resident alien, • A partnership, corporation, company, or association created or organized in the United States or under the laws of the lkited States, • An estate (other then a Ioreiyn estate), or • A domestic trust (as defined in Regulations section 301.7/01-i). Spacial rules for partruerships. Partnerships that conduct a trade or business in the United States are genrxally required to pay a withholding tax under section 144(1 on any foreign partners' share of effectively connected taxable income from such business. Further, in certain cases where a Form W-9 has not been received, the; rules undo section 1446 require a painershp to presume that a paints us a foreign person, and pay the section 1446 withholding tax. Therefore, if you are a U.S. person that is a partner in a partnership conducting a trade or business in the lJrxted States, provide Fans W-9 to the partnership to establish your U.S. status and avoid section 1446 withholding on you share of partnership income. Cat. No. 10231X Form W-9 (Rev. 8.2013) BID REQUEST #61500180 Page 15 To: Denver Ind Sales and Service Co 850 S Lipan St Denver, CO 80223 Project Description: The project in general consists delivery and pickup of specified repair Mastic material and equipment for the 2015 crack seal projects in Weld County. The Owner has considered the Bid submitted by you for the above described Work in response to its Invitation for Bids and Instructions to Bidders. You are hereby notified that your Bid has been accepted in the amount of $ or as shown in the Bid Schedule. You are required by the Instructions to Bidders to respond within ten (10) calendar days from the date of this Notice to you. You are required to return an acknowledged copy of this Notice of Award to the Owner. Dated this day of , 2015. Weld County, Colorado, Owner By Neal Bowers, Pavement Management Supervisor ACCEPTANCE OF NOTICE Receipt of the above Notice of Award is hereby acknowledged by (Contractor) Dated this day of , 2015. By: Title: WELD COUNTY PUBLIC WORKS DEPARTMENT SPECIAL PROVISIONS The Colorado Department of Transportation 2011 Standard Specifications for Road and Bridge Construction controls BID REQUEST #B1500180 Page 17 construction of this project. The following special provisions supplement or modify the Standard Specifications and take precedence over the Standard Specifications and plans. PROJECT SPECIAL PROVISIONS Index Page Revision of Section 105.22 Revision of Section 106.07 Revision of Section 106.08 Revision of Section 408.02 — Dispute Resolution — Material Inspection — Control of Materials — Materials/Joint & Crack Sealant (March 2014) (February 2011) (February 2011) (February 2011) The remainder of this page left blank intentionally Page 18 19 20 21 22 BID REQUEST #61500180 Page 18 REVISION OF SECTION 105 DISPUTE RESOLUTION Section 105 — Definition and Terms is hereby revised for this project as follows: Subsection 105.22 shall be revised as follows: The Colorado department of Transportation will not participate in the resolution process for any claims filed by the Contractor. Contract claims will follow the appropriate procedures for Subsection 105.17 except that all claims reviews will be handled by Weld County or its duly authorized representative. The following terms of this subsection shall be defined as follows: Project Engineer shall be Weld County Public Works. District Engineer shall mean the Weld County Public Works Department of its duly authorized representative. Chief Engineer shall mean the Weld County Public Works Department of its duly authorized representative. For this project the Weld County Duly Authorized Representatives are: Project Manager: Neal Bowers, Pavement Management Supervisor Project Engineer: Don Dunker, County Engineer Project Inspector: Josh Holbrook, Construction Inspection Supervisor The remainder of this page left blank intentionally BID REQUEST #61500180 Page 19 REVISION OF SECTION 106 MATERIAL INSPECTION Section 106.07 of the Standard Specifications is hereby revised for this project as follows: When the department inspects the material at the plant the following conditions will be met: (1) The department shall have the cooperation and assistance of the Contractor and the materials producer. (2) The department shall have access to all parts of the plant necessary for the manufacture or production of the materials being furnished. Test on the material shall be witnessed by a representative of Weld County for specification compliance. No material will be accepted if associated batch and lot numbers do not match previously approved material. Weld County reserves the right to select random samples from the job in progress for retesting. The retesting may be prior to or after incorporation of materials into the work. Those materials sampled and tested after delivery on the project or after incorporation into the work that do not meet the requirements of the contract will be rejected. The remainder of this page left blank intentionally REVISION OF SECTION 106 CONTROL OF MATERIAL BID REQUEST #B1500180 Page 20 Section 106 of the Standard Specifications is hereby revised for this project as follows: Subsection 106.08 shall be revised to include the following: Packaging, Marking and Storage. Sealant material shall be supplied pre -blended, pre -reacted, and pre-packaged. If supplied in solid form, the blocks of completed material shall be cased in a plastic or other dissolvable liner having the capability of becoming part of the crack sealing liquid. Each container shall be legibly marked with the manufacturer's name, the trade name of the sealer, the manufacturer's batch or lot number the application temperature range, the recommended application temperature, and the safe heating temperature. The material will be stockpiled at the Engineering Department, 1111 "H" Street, Greeley, Colorado. It is the sole responsibility of the supplier to coordinate delivery times. The remainder of this page left blank intentionally REVISION OF SECTION 408 MATERIALS/JOINT & CRACK SEALANT Section 408.02 of the Standard Specifications is hereby revised for this project as follows: BID REQUEST #B1500180 Page 21 PROPERTIES: Properties of the binder, aggregate and appropriately blended and heated Mastic One are as follows: Property Requirement POLYMER MODIFIED BINDER Cone Penetration, 77°F (25°C) (ASTM D5329) Cone Penetration, 122°F (50°C) (ASTM D5329) Softening Point (ASTM D36) Flexibility (1"[25.4 mm], 180', 10 sec) (ASTM D3111 modified) AGGREGATE Abrasion Resistance (ASTM C131) BLENDED PRODUCT Flexibility, 32°F (0°C) (PTM 3) Adhesion, 77°F (25°C) (PTM 4) Specific Gravity Minimum Applica© on Temperature Maximum Applica© on Temperature 60 max 120 max 200°F (93°C) min Pass at 32°F (0°C) 35% max Pass 25 PSI (172 KPA) min 1.7 — 2.0 375°F (190°C) 400°F (204°C) The remainder of this page left blank intentionally BID REQUEST #61500180 Page 22 1 ® ACCQRL7 CERTIFICATE OF LIABILITY INSURANCE DATE (MMlD DlYYYYJ 1011 (MMID THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS 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 REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) 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 endorsement(s). PRODUCER Henry Ham Agency 645 E. Evans Ave. Denver CO 80250 CONTACT NAME: Romi S. Romero PHONE .Ext):303 744 1341 (AIC, No):303-744-0654 A ADOREss:romi@henryham.com INSURER(S) AFFORDING COVERAGE NAIC all INSURER A :AIG Specialty Insurance 26883 INSURED DENVE-3 Denver Industrial Sales & Service Co Inc 850 S Lipan St Denver CO 80223 INSURER B:Commerce & Industry Insurance 19410 INSURER C :Chartis Risk Specialists 2349 INSURER D Auto -Owners Insurance Company 18988 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 2O65783935 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL-SUBR INSR WVD POLICY NUMBER POLICY EFF (MM!DDIYYYY) POLICY EXP (MM!DDIYYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY EG4761196 12/10/2014 12/10/2015 EACH OCCURRENCE $1,000,000 DAMAGE TO REN TED PREMISES (Ea occurrence) $300,000 MED EXP (Any one person) $25,000 CLAIMS -MADE X OCCUR PERSONAL & ADV INJURY $1,000,000 X Pollution-clm and GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG $2,000,000 GEN'L AGGREGATE POLICY LIMIT APPLIES JEOCT PER. LOC $ B AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED X SCHEDULED AUTOS NED NON-OWNED CA195-54-96 12/10/2014 12/10/2015 C.OMBINtD SINGLt LIMI I (Ea accident) $1,000,000 BODILY INJURY Per person) $ BODILY INJURY Per accident) $ PROPERT (PerraccidentDAMAGE $ C UMBRELLA LIAB EXCESS LIAB X O OCCUR CLAMS -MADE EGU5844320 12/10/2014 12/10/2015 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 $ DED IX RETENT ON $10,000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (MandatorylnNH) If yes, describe under DESCRIPTION OF OPERATIONS below N /A WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ D PROPERTY 74308613 7/1/2015 7/1/2016 BUILDING 31Z400 BPP 98,770 DESCRIPTION OF OPERATIONS! LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) EQUIPMENT: 2015 Crafco pathcher II - serial # 8064 value: $60,000 CERTIFICATE HOLDER CANCELLATION Weld County 1150 O Street Room #107 Greeley CO 80631 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 ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD RAFc°K PATCHER Available in one ton and two ton capacity. Specifically designed to melt and prepare PolyPatch and TechCrete pavement patching materials for application. The diesel Crafco Patcher II is a double boiler that is digitally controlled to assure that material temperatures are held within specification ranges at all times. A swivel material delivery chute makes placing material fast and easy. To clean out, load the machine with dry aggregate - run agitator and empty - it's that easy. All machines are equipped with a safety shutoff on the lid to prevent injury during operation. Available in a one ton (Patcher I) and two ton (Patcher II). For more information on this equipment or TechCrete and PolyPatch patching materials, contact your authorized Crafco representative. FEATURES: • Diesel powered • Digital temp controls • Swivel chute • Easy clean out • Safety shut off lid • Curb side controls • Double boiler • Multi material use design TECHCRETE >,4' the superior solution for conr_rary/_, Crafco TechCrete is the long-term solution for distressed concrete pavement preservation. Spatted concrete caused by fatigue, freeze/thaw cycles, warping stress, ingress of water, or substrate problems can lead to costly reconstruction. Due to its flexibility, high tensile strength, ability to bridge joints and high compressive resistance, TechCrete creates a long lasting concrete repair. TechCrete repair system has excellent adhesion and has a high friction surface ideally suited for Thin Bond Repair (TBR), multi corner slab repair, joint intersection repairs and recessed applications. POLYPATCH H / MASTIC O N E the cost effective, permanent repair for distressed concrete and asphalt pavements Crafco PolyPatch has been specifically designed for cracks too large for crack sealing and distressed surfaces that are too small for re -paving. It is a versatile hot -applied, pourable, self-adhesive polymer modified asphalt binder containing selected aggregate to ensure good load bearing and skid resistant characteristics. Available in several grades for various applications. PolyPatch is effectively used to level high manhole risers, drop inlets, bridge deck approaches, elevation discrepancies, utility cuts and more. For detailed product properties refer to the Crafco PolyPatch Product Data Sheet and Installation Instructions or call your local Crafco Distributor. Mastic One has the same great properties of PolyPatch only with a standard weight aggregate. For more information on Crafco products contact your local Crafco Distributor or call: Cnikarim www.crafco.com nmINC 800-528-8242 Your local Crafco Representative: 420 N. Roosevelt Ave.. Chandler, Arizona 85226 • Phone 1-602-276-04061 Fax: 1-480-961-0513 © 2010, Crafco, Inc., All Rights Reserved 7-10 Asph epoir roc' wits PolyPatch & Mastic One For cracks too large for crack sealing and too small for repaving a - J • Flexible • Durable (supports heavy loads) • Waterproof • Bonds to AC & PCC pavement • Long-term solution (5 years + performance) • Engineered design in premeasured package for consistency and maximum performance; no field blending • Easy installation • Reduce crew and equipment, and no compaction compared to hot mix asphalt PRESERVATION PRODUCTS PAVEMENT Delivering Confidence Through Innovation, Quality and Value Since 1976 Crafco PolyPatch & Mastic One are the right products for the job! & pothole repair For more Information on Crafco products contact your local Crafco Distributor or call: Longltu mal crac s (>1.5") Leveling manhole covers O INC PRESERVATION PRODUCTS Delivering Confidence Through Innovation, Quality and Value Since 1976 Crafco PolyPatch products are hot -applied, pourable, self-adhesive patching materials used for preservation, maintenance and repair of asphalt and portland cement concrete pavements and bridge deck surfaces. PolyPatch products are composed of highly modified polymer asphalt binder and durable lightweight construction aggregate. These products are formulated for distresses larger than those typically repaired by crack or joint sealing , but smaller than those requiring remove and replace patching procedures. The unique design features of PolyPatch products produce materials which are adhesive, flexible, and resistant to vehicle loadings. PolyPatch products are produced in 2 grades: PolyPatch and PolyPatch Fine Mix. PolyPatch has larger aggregate for use in deeper installations. PolyPatch Fine Mix uses smaller aggregate for thinner repairs and feathered edges. PolyPatch products are supplied in solid form in 30 lb. (approx.. weight) boxes containing pre -measured binder and aggregate. PolyPatch and PolyPatch Fine Mix have been quality Crafco products for over 15 years. Crafco Mastic One is similar to PolyPatch Fine Mix but is compounded with standard weight aggregate and packaged in 40 lb boxes. eck approach Crack patching Repairs prior to surface treatment Leveling utility cuts Ideally used for: • Filling wide cracks and joints • Filling potholes • Sealing utility cuts • Leveling depressed thermal cracks • Repairing deteriorated longitudinal joints • Skin patch repairs • Leveling manhole covers • Leveling bridge deck approaches • Pretreatment of fatigue cracked areas prior to surface treatments • Filling spalls, popouts, and corner breaks Your local Crafco Representative: +1 800 528 8242 / www.crafco.com 420 N. Roosevelt Ave., Chandler, Arizona 85226 • Phone +1 602 276 0406 / Fax: +1 480 961 0513 © 2014, Crafco, Inc. August #A1026 lakR100 PRODUCT DATA SHEET INC PRESERVATION PRODUCTS PAVEMENT Delivering Confidence Through Innovation, Quality and Value Since 1976 420 N. Roosevelt Ave. • Chandler, AZ 85226 1-800-528-8242 • 1-602-276-0406 • FAX 1-480-961-0513 www.Crafco.com MASTIC ONE PART NO. 33339 READ BEFORE USING THIS PRODUCT GENERAL Mastic One is a hot applied, pourable, aggregate filled, black color, polymer modified asphalt pavement repair mastic. Mastic One is used for sealing, filling and repairing many distresses in both asphalt concrete and portland cement concrete pavements and bridge deck surfaces that are larger than those typically repaired by crack or joint sealing, but smaller than repairs requiring remove and replace patching procedures. Typical uses include sealing, filling and leveling of wide transverse or longitudinal cracks and joints, filling potholes and utility cuts, localized skin patch repairs, repairs prior to surface treatments, and leveling bridge approaches or faulted areas. When properly applied, Mastic One forms a well bonded, flexible, durable, traffic resistant repair. To use, Mastic One is placed into an appropriate melter (Crafco Patcher I or II), mixed and heated until application temperature is reached, poured into the prepared repair area and then leveled. Mastic One is formu- lated to provide neat feathered edge installation. Mastic One is then ready for traffic when it has cooled and solidified. VOC = 0 g/l. PROPERTIES Properties of the binder, aggregate and appropriately blended and heated Mastic One are as follows: Property Requirement POLYMER MODIFIED BINDER Cone Penetration, 77°F (25°C) (ASTM D5329) Cone Penetration, 122°F (50°C) (ASTM D5329) Softening Point (ASTM D36) Flexibility (1"[25.4 mm], 180°, 10 sec) (ASTM D3111 modified) AGGREGATE Abrasion Resistance (ASTM C131) BLENDED PRODUCT Flexibility, 32°F (0°C) (PTM 3) Adhesion, 77°F (25°C) (PTM 4) Specific Gravity Minimum Application Temperature Maximum Application Temperature 60 max 120 max 200°F (93°C) min Pass at 32°F (0°C) 35% max Pass 25 PSI (172 KPA) min 1.7 — 2.0 375°F (190°C) 400°F (204°C) Note: Due to unique properties of Mastic One, modified test procedures are required. Test methods PTM 3, 4 are available from Crafco. INSTALLATION The density of Mastic One is 116 pcf ( +/- 3%) and the weight per gallon is 15.5 lbs/gal (1.86 kg/I) at 60°F (15.5°C). Prior to use, the user must read and follow Installation Instructions for Mastic One to verify proper product selection, heating methods, pavement preparation procedures, application geometry, usage precautions and safety procedures. These instructions are available at www.crafco.com and provided with each pallet of Mastic One. PACKAGING Mastic One can be supplied in either standard cardboard boxes, or in meltable, boxless PLEXI-melt packaging. Each package contains premeasured poly- mer modified binder and aggregate. Both packaging types are labeled in accordance with OSHA and GHS requirements; include Installation Instructions; are sold by net weight; are supplied interlock stacked on 48 by 40 inch 4 -way pallets; can be stored outside; and are covered with a weather resistant pallet cover and 2 layers of UV protected stretch wrap. Box packaging consists of cardboard boxes containing 40 lb of product with 60 boxes per pallet. Boxes contain a quick melting release film enabling easy removal of product from the box. Boxes are tape closed, without any staples. PLEXI-melt packaging consists of blocks containing 25 lb of product with 80 packages per pallet. To use, the pallet wrapping is removed, and the individual blocks are placed in the melter. There are no cardboard boxes to open, empty, or dispose of. The PLEXI-melt wrapping quickly melts into the product without affecting proper- ties. WARRANTY CRAFCO, Inc. warrants that CRAFCO products meet applicable ASTM, AASHTO, Federal or State specifications at time of shipment. Techniques used for the preparation of the cracks and joints prior to sealing or filling are beyond our control as are the use and application of the products; therefore, Crafco shall not be responsible for improperly applied or misused products. Remedies against Crafco, Inc., as agreed to by Crafco, are limited to replacing nonconforming product or refund (full or partial) of purchase price from Crafco, Inc. All claims for breach of this warranty must be made within three (3) months of the date of use or twelve (12) months from the date of delivery by Crafco, Inc. whichever is earlier. There shall be no other warranties expressed or implied. For optimum performance, follow Crafco recommendations for product installation. ©2014 Crafco, Inc. November RAO® INC PRESERVATION PRODUCTS PAVEMENT Delivering Confidence Through Innovation, Quality and Value Since 1976 420 N. Roosevelt Ave. • Chandler, AZ 85226 1-800-528-8242. 1-602-276-0406 • FAX 1-480-961-0513 www.Crafco.com INSTALLATION INSTRUCTIONS MASTIC ONE PART NO. 33339 READ BEFORE USING THIS PRODUCT GENERAL: These installation instructions are for Crafco Mastic One, which is a hot -applied, single component, pourable, aggregate filled, polymer modified asphalt mastic used for maintenance, repair, and preservation of pavement and bridge surfaces. Mastic One is used for sealing, filling and repairing many distresses in both asphalt concrete and portland cement concrete pavements that are larger than those typically repaired by crack or joint sealing, but smaller than repairs requiring remove and replace patching procedures. Typical uses include sealing, filling and leveling of wide transverse or longitudinal cracks and joints, filling potholes and utility cuts, localized skin patch repairs and leveling bridge approaches or faulted areas. When properly applied, Mastic One forms a well bonded, flexible, durable, traffic resistant repair. To use, Mastic One is placed in an appropriate melter, mixed and heated until application temperature is reached, and then poured into the prepared repair area and leveled. Mastic One is formulated to provide neat feathered edge installation. Mastic One is then ready for traffic when it has cooled to solidify. MELTING. HEATING AND AGITATING: Mastic One is supplied in solid form in a meltable plastic bag in a cardboard box or in boxless meltable PLEXI-melt packaging. The aggregate and polymer modified binder are pre -measured and contained in the package, but are not pre -mixed. To use, Mastic One is placed in a Crafco Patcher I or II or other approved melter to mix and heat to the proper installation temperature. If inappropriate melters are used, application difficulties, pump system damage, and extreme wear can result. The melter must be equipped with an effective horizontal agitator system that is able to maintain a uniformly mixed product, have a thermostatically controlled hot oil jacketed heating system, and have an effective means of dispensing product. During heating, the heat transfer oil should be heated to between 450 and 525°F (323 - 274°C). Agitation should begin as soon as the Mastic One has melted sufficiently for the agitator shaft to turn. Additional Mastic One can then be added to the melter. Heating and agitation should continue until all added material has been thoroughly mixed and the product application temperature range of 375 - 400°F (190 - 204°C) has been reached. At application temperature, Mastic One is a thick, grainy appearing mastic. Additional Mastic One can be added as product is used and quantity in the melter decreases. When adding additional Mastic One, the agitator must be stopped. After the additional Mastic One is added, agitation is to be immediately resumed and application should not resume until required temperatures are reached and all added material has melted, becoming well mixed into the product with no uncoated aggregate present. During application and while product is hot, agitation should be continuous, except for when additional product is being added to guard against aggregate settlement. If aggregate settles in the melter, it may be difficult to agitate product. For best performance, it is recommended that the melter be emptied, or only small amounts of Mastic One be left in the melter at the end of each work day. PAVEMENT TEMPERATURES: Apply Mastic One when pavement temperature exceeds 40°F (4°C). Lower temperature may result in reduced adhesion due to presence of moisture or ice. If pavement temperature is less than 40°F (4°C), it may be warmed with a heat lance that puts no direct flame on the pavement (Crafco Part No. 45650). If installing at night, assure that dew is not forming on the pavement surface. Applied product shall be checked by qualified personnel to assure that adhesion is adequate. TRAFFIC CONTROLS: Place appropriate traffic controls in accordance with part 6, Temporary Controls, of the FHWA Manual on Uniform Traffic Control devices (MUTCD) to protect the work site for the duration of the repairs. RECOMMENDED INSTALLATION PROCEEDURES: 1. Only apply Mastic One to clean, sound, dry surfaces. Avoid highly distressed areas in need of reconstruction. All areas must be clean from dust and debris. All areas to be repaired shall be blown with clean, dry, oil free compressed air at 90 psi (620 kpa) minimum. If compressed air does not sufficiently remove all debris or dust coatings, additional cleaning procedures such as sweeping with a stiff or wire bristle broom, sandblasting or routing are recommended. (If sealant won't adhere, neither will Mastic One). PCCP shall be abrasive cleaned to achieve maximum adhesion performance. 2. The minimum pavement temperature for installation of Mastic One is 40°F (4°C). If the pavement temperature is less than 40°F (4°C), it can be warmed by heating with a heat lance. Asphalt concrete pavement should be heated so a slight bleeding effect occurs. This bleeding brings some of the asphalt binder from the pavement to the surface, which will enhance the adhesive bond between the Mastic One and road surface. However, caution should be taken to prevent overheating/oxidizing the asphalt brought to the surface as this could be detrimental to adhesion performance. Heating the pavement will also remove moisture assuring a dry surface. Mastic One should be applied within 10 minutes of warming the pavement area. 3. Mastic One that has been mixed and heated to installation temperature is poured from the melter and immediately applied to the prepared pavement area. Mastic One can be poured from the melter directly into the repair area, poured into an appropriate bucket such as the Crafco TechCrete Bucket (Part No. 32263) and then applied, or poured into the Crafco Material Handler (Part No. 57650) and then installed. For placing Mastic One in wide cracks, Crafco Shoebox Applicators (Part Nos. 32350-32353, 32255, 32250, 32252, or 32253) can be used. 4. Immediately following application to the pavement surface, Mastic One shall be leveled and smoothed to the desired level using a straight metal or rubber squeegee. If necessary for deep installations, to limit settling and to produce a level finished surface, Mastic One can be applied in layers with a cooling and solidifying time period between applications. Minimum installed thickness is 3/8 in (1 cm). The aggregate portion of Mastic One is selected to allow feathered edge type ©2014 Crafco, Inc. November CRAFCO MASTIC ONE I INSTALLATION INSTRUCTIONS installations when required. The finished Mastic One installation should be applied smooth and level with the pavement surface. 5. When installing over a distressed pavement surface, Mastic One should be applied at least 6 in (15 cm) beyond the distressed area onto sound pavement surfaces. 6. Mastic One cools quickly after installation and is ready for traffic when it has solidified sufficiently to support loads. Apply Crafco Detack to reduce surface tack and allow quicker opening of the area to traffic. USES AND INSTALLATION CONFIGURATIONS: The general use of Mastic One is to repair pavement deficiencies which are larger than those that can be appropriately addressed with pavement sealants, but smaller than those where conventional remove and replace patching procedures are used. Typical uses include (but are not limited to): 1) Sealing and filling pavement cracks or joints over 1.5 in (3.8cm) wide, 2) Filling potholes, 3) Leveling depressed thermal cracks, 4) Sealing and repairing deteriorated longitudinal joints, 5) Skin patching, 6) Pretreatment of cracked areas prior to surface treatments, 7) Repairs prior to surface treatments 8) Leveling manhole covers, bridge deck approaches, or other settlement at structures, 9) Capping settled utility cuts, 10) Filling spalls, popouts, and corer breaks Note: Mastic One shall not be used for surface skin patch repairs at intersections, unless followed by a surface treatment. Mastic One binder is self-adhesive and develops a strong bond to the pavement. Shrinkage of approximately 5% occurs as Mastic One cools from application temperature to ambient. No compaction is required. After application, time must be given for the product to cool before opening the area to traffic. Cooling time will vary depending on the size of the application and ambient temperature. Generally allow approximately 30 to 60 minutes of cooling for each 1 in (2.5cm) of material depth. For installations of Mastic One deeper than 2.5 in (6.3cm), product should be installed in layers not exceeding 2.5 in thick (6.3cm) with cooling to 200F (93C) maximum before applying the next layer. The final layer to the pavement surface level should be 1/2 to 1 in (1.2 to 2.5cm) thick. This layering process reduces material shrinkage during product cooling. Installations over 2 in (5cm) deep can be bulked by adding up to 25% by volume of Crafco Structural Aggregate (Part No. 34033) to the patch in layers for improved stability and quicker cooling. Roofing felt or other similar strips can be used along the work area boundaries to create neat, well defined edges. The strips should be removed immediately after application before material cools. APPLICATION LIFE: Application life at application temperatures is approximately 12 to 15 hours. Application life may be extended by adding fresh material as quantity in the applicator decreases. Mastic One must be agitated while being applied. The material may be reheated to application temperature once, after the initial heat up. Additional reheating of the material may result in degradation of properties. At the end of the installation day, it is recommended that the melter be as empty as possible. Product volume of no more than 25% of melter capacity should be left in the melter for reheating. When reheating, a volume of Mastic One equal to or greater than the amount being reheated should be added to the melter for the next installation. When the application life has been exceeded, Mastic One will begin to thicken, become "stringy" and may then gel. If this should occur, the material should immediately be removed from the melter and discarded. PRECAUTIONS: Mastic One will soften, become sticky, and track if exposed to fuel or oil spillage, therefore, it should not be used in areas subject to fuel or oils. STORAGE: Pallets of packaged product are protected with a weather resistant covering. During storage, the protective wrap must be kept on the pallets to maintain pallet stability. If rips in the pallet covering occur during handling, they should be repaired to help maintain packaging integrity. Pallets should be stored on a level surface which is dry and has good drainage. Pallets should not be stacked because crushing of bottom layers may occur. Mastic One material properties are not affected by packaging deterioration. SAFETY PRECAUTIONS: Since Mastic One is heated to elevated temperatures, it is essential that operations be conducted in manners which assure safety of personnel. All associated with use of the material need to be aware of the hazards of using hot applied materials and safety precautions. Before use, the crew should read and understand product use, safety information and the product SDS. This sheet which is supplied with each shipment, describes the characteristics of the product as well as any potential health hazards and precautions for safe handling and use. User should check D.O.T. requirements for transportation of product at elevated temperatures (above 212°F (100°C)). HAZARDS ASSOCIATED WITH HOT APPLIED MATERIALS: Skin contact with hot applied materials causes burns. Over exposure to fumes may cause respiratory tract irritation, nausea, or headaches. Appropriate precautions need to be taken to prevent contact with the hot material and to avoid inhalation of fumes for everyone in the vicinity of the work area operation. Safety precautions should include: 1. Protective clothing to prevent skin contact with hot material. 2. Care when adding product to melters to reduce splashing. 3. Careful operation and control of tools which are used to apply product. 4. Traffic and pedestrian control measures which meet or exceed MUTCD requirements to prevent access to work areas while product is still in a molten state. 5. Avoidance of material fumes. 6. Proper application configurations with a minimum amount of excesses of material. 7. Appropriate clean up of excessive applications or product spills. ADDITIONAL INFORMATION: Additional information regarding these products is available by contacting your distributor or Crafco, Inc. This information includes 1) Product Data Sheets, 2) Safety Data Sheets, 3) Equipment Safety Manual ©2014 Crafco, Inc. November CluumN INC AN RR60N■ COMPANY SAFETY DATA SHEET 1. Identification Product identifier Crafco Mastic, Polypatch and Matrix Products Other means of identification Not available. Recommended use Pavement Patching and Repair Recommended restrictions None known. Manufacturer/Importer/Supplier/Distributor information Manufacturer Manufacturer: Crafco, Inc. Address: 6165 West Detroit St. Chandler, AZ 85226 USA Contact Name: Jim Chehovits Telephone: 602-276-0406 E-mail: jim.chehovits@crafco.com CHEMTREC: 800-424-9300 (North America) + 1-703-527-3887 (International) 2. Hazard(s) identification Physical hazards Not classified. Health hazards Not classified. Environmental hazards Not classified. OSHA defined hazards Not classified. *Hazards not stated here are "Not classified", "Not applicable" or "Classification not possible". Label elements Hazard symbol None. Signal word Not applicable. Hazard statement Not applicable. Prevention Not applicable. Response Not applicable. Storage Not applicable. Disposal Not applicable. Hazard(s) not otherwise None known. classified (HNOC) Supplemental information None. 3. Composition/information on ingredients Mixtures Chemical name Common name and synonyms CAS number 0/0 DISTILLATES (PETROLEUM), HYDROTREATED HEAVY NAPHTHENIC 64742-52-5 0-10 QUARTZ 14808-60-7 0 - 75 ASPHALT 8052-42-4 10 - 40 CALCIUM CARBONATE 471-34-1 0-10 Other components below reportable levels 0 - 75 4. First -aid measures Inhalation Skin contact If breathing is difficult, remove to fresh air and keep at rest in a position comfortable for breathing. Get medical attention, if needed. Call a physician if symptoms develop or persist. In case of contact, immediately flush skin with plenty of water for at least 15 minutes while removing contaminated clothing and shoes. Thoroughly wash (or discard) clothing and shoes before reuse. Material name: Crafco Mastic, Polypatch and Matrix Products 5013 Version #: 01 Issue date: 02-27-2015 SDS US 1/7 Eye contact Ingestion Most important symptoms/effects, acute and delayed Indication of immediate medical attention and special treatment needed General information 5. Fire -fighting measures Suitable extinguishing media Unsuitable extinguishing media Specific hazards arising from the chemical Special protective equipment and precautions for firefighters Fire -fighting equipment/instructions Specific methods Immediately flush eyes with plenty of water for at least 15 minutes. If a contact lens is present, DO NOT delay irrigation or attempt to remove the lens. Get medical attention if irritation develops and persists. Rinse mouth. Do not induce vomiting. Do not use mouth-to-mouth method if victim ingested the substance. Call a POISON CENTER or doctor/physician if you feel unwell. Not available. In case of ingestion, the decision of whether or not to induce vomiting should be made by the attending physician. Certain pre-existing conditions may make workers particularly susceptible to the effects of this chemical: asthma, allergies, impaired pulmonary function. If you feel unwell, seek medical advice (show the label where possible). Ensure that medical personnel are aware of the material(s) involved, and take precautions to protect themselves. Show this safety data sheet to the doctor in attendance. Discard any shoes or clothing items that cannot be decontaminated. Water fog. Foam. Dry chemical powder. Carbon dioxide (CO2). Addition of water or foam to the fire may cause frothing. Do not use a solid water stream as it may scatter and spread fire. Fire may produce irritating, corrosive and/or toxic gases. Development of hazardous combustion gases or vapours possible in the event of a fire. The following may develop: Acrolein. Firefighters must use standard protective equipment including flame retardant coat, helmet with face shield, gloves, rubber boots, and in enclosed spaces, SCBA. Firefighters should wear full protective clothing including self contained breathing apparatus. Structural firefighters protective clothing will only provide limited protection. In case of fire and/or explosion do not breathe fumes. Firefighters must use standard protective equipment including flame retardant coat, helmet with face shield, gloves, rubber boots, and in enclosed spaces, SCBA. ALWAYS stay away from tanks engulfed in flame. Fight fire from maximum distance or use unmanned hose holders or monitor nozzles. In the event of fire, cool tanks with water spray. By fire, toxic gases may be formed (COx, NOx). Keep run-off water out of sewers and water sources. Dike for water control. In the event of fire and/or explosion do not breathe fumes. In the event of fire, cool tanks with water spray. Use water spray to cool unopened containers. 6. Accidental release measures Personal precautions, protective equipment and emergency procedures Methods and materials for containment and cleaning up Environmental precautions 7. Handling and storage Precautions for safe handling Conditions for safe storage, including any incompatibilities Keep unnecessary personnel away. Wear appropriate protective equipment and clothing during clean-up. Ventilate closed spaces before entering them. Do not touch or walk through spilled material. ELIMINATE all ignition sources (no smoking, flares, sparks or flames in immediate area). Dike far ahead of spill for later disposal. Following product recovery, flush area with water. Never return spills in original containers for re -use. Prevent further leakage or spillage if safe to do so. Runoff or release to sewer, waterway or ground is forbidden. The product is non-combustible. If heated, irritating vapors may be formed. Do not use in area≤ without adequate ventilation. Wash hands thoroughly after handling. Wash hands after handling. Observe good industrial hygiene practices. Prevent electrostatic charge build-up by using common bonding and grounding techniques. Store in a well -ventilated place. Keep the container tightly closed and dry. Store in a closed container away from incompatible materials. Keep out of the reach of children. 8. Exposure controls/personal protection Occupational exposure limits US. OSHA Table Z-1 Limits for Air Contaminants (29 CFR 1910.1000) Components Type Value Form CALCIUM CARBONATE (CAS PEL 471-34-1) 5 mg/m3 Respirable fraction. 15 mg/m3 Total dust. Material name: Crafco Mastic, Polypatch and Matrix Products 5013 Version #: 01 Issue date: 02-27-2015 SDS US 2/7 US. OSHA Table Z-1 Limits for Air Contaminants (29 CFR 1910.1000) Components Type Value Form DISTILLATES PEL (PETROLEUM), HYDROTREATED HEAVY NAPHTHENIC (CAS 64742-52-5) US. OSHA Table Z-3 (29 CFR 1910.1000) Components Type 5 mg/m3 Mist. Value Form QUARTZ (CAS 14808-60-7) TWA US. ACGIH Threshold Limit Values Components Type 0.3 mg/m3 Total dust. 0.1 mg/m3 Respirable. 2.4 mppcf Respirable. Value Form ASPHALT (CAS 8052-42-4) TWA QUARTZ (CAS 14808-60-7) TWA US. NIOSH: Pocket Guide to Chemical Hazards Components Type 0.5 mg/m3 0.025 mg/m3 Inhalable fraction. Respirable fraction. Value Form ASPHALT (CAS 8052-42-4) CALCIUM CARBONATE (CAS 471-34-1) DISTILLATES (PETROLEUM), HYDROTREATED HEAVY NAPHTHENIC (CAS 64742-52-5) Ceiling TWA STEL 5 mg/m3 Fume. 5 mg/m3 Respirable. 10 mg/m3 Total 10 mg/m3 Mist. TWA 5 mg/m3 Mist. QUARTZ (CAS 14808-60-7) TWA 0.05 mg/m3 Respirable dust. Biological limit values No biological exposure limits noted for the ingredient(s). Appropriate engineering Good general ventilation (typically 10 air changes per hour) should be used. Ventilation rates should controls be matched to conditions. If applicable, use process enclosures, local exhaust ventilation, or other engineering controls to maintain airborne levels below recommended exposure limits. If exposure limits have not been established, maintain airborne levels to an acceptable level. Ensure adequate ventilation, especially in confined areas. Individual protection measures, such as personal protective equipment Eye/face protection Wear safety glasses; chemical goggles (if splashing is possible). Wear chemical goggles; face shield (if handling molten material). Hand protection Chemical resistant gloves are recommended. If contact with forearms is likely wear gauntlet style gloves. Other Wear suitable protective clothing and eye/face protection. Use of an impervious apron is recommended. Skin protection Respiratory protection When workers are facing concentrations above the exposure limit they must use appropriate certified respirators. Thermal hazards During product use, there is a risk of thermal burns. General hygiene considerations When using do not smoke. Avoid contact with eyes. Avoid contact with skin. Keep away from food and drink. Handle in accordance with good industrial hygiene and safety practice. 9. Physical and chemical properties Appearance Physical state Form Color Odor Odor threshold pH Solid. Solid. Solid. Black. Dark brown Product is a black, semi -solid with a burnt tar odor. Not available. Not available. Material name: Crafco Mastic, Polypatch and Matrix Products 5013 Version #: 01 Issue date: 02-27-2015 SDS US 3/7 Melting point/freezing point 150 - 250 °F (65.56 - 121.11 °C) ASTM D36 Softening Point Initial boiling point and > 800 °F (> 426.67 °C) boiling range Flash point > 400.0 °F (> 204.4 °C) Evaporation rate Not available. Flammability (solid, gas) Not available. Upper/lower flammability or explosive limits Flammability limit - lower Not available. (%) Flammability limit - upper (%) Explosive limit - lower Not available. (%) Explosive limit - upper Not available. (%) Not available. Vapor pressure Vapor density Relative density Solubility(ies) Solubility (water) Partition coefficient (n-octanol/water) Auto -ignition temperature Decomposition temperature Viscosity Other information Density Percent volatile Specific gravity 2.04 hPa estimated Not available. Not available. Not available. Not available. > 700 °F (> 371.11 °C) Not available. Not available. Not Available 0% 1-2.2 10. Stability and reactivity Reactivity Not available. Chemical stability Material is stable under normal conditions. Hazardous polymerization does not occur. Possibility of hazardous reactions Conditions to avoid Incompatible materials Hazardous decomposition products Strong oxidizing agents. Incompatible with oxidizing agents. Upon decomposition, product emits acrid dense smoke with carbon dioxide, carbon monoxide, trace oxides of nitrogen and sulfur, and water. 11. Toxicological information Information on likely routes of exposure Ingestion May cause discomfort if swallowed. However, ingestion is not likely to be a primary route of occupational exposure. Inhalation Skin contact Eye contact Symptoms related to the physical, chemical and toxicological characteristics Information on toxicological effects Acute toxicity Product May cause irritation to the respiratory system. Irritating to skin. Causes eye irritation. Molten material will produce thermal burns. Not available. Species Test Results Crafco Mastic, Polypatch and Matrix Products (CAS Mixture) Acute Oral LD50 Mouse 17340.7969 mg/kg estimated Material name: Crafco Mastic, Polypatch and Matrix Products 5013 Version #: 01 Issue date: 02-27-2015 SDS US 4/7 Product Species Test Results Components Rat Species 18934.6973 mg/kg estimated Test Results CALCIUM CARBONATE (CAS 471-34-1) Acute Oral LD50 Mouse Rat * Estimates for product may be based on additional component data not shown. Skin corrosion/irritation Defats the skin. Causes irritation. Serious eye damage/eye irritation Irritating to eyes. Respiratory or skin sensitization 6450 mg/kg 6450 mg/kg Respiratory sensitization Not available. Skin sensitization Irritating to skin. Germ cell mutagenicity No data available to indicate product or any components present at greater than 0.1% are mutagenic or genotoxic. Carcinogenicity This product is not considered to be a carcinogen by IARC, ACGIH, NTP, or OSHA. US. OSHA Specifically Regulated Substances (29 CFR 1910.1001-1050) Not listed. Reproductive toxicity Contains no ingredient listed as toxic to reproduction Specific target organ toxicity - single exposure Specific target organ toxicity -repeated exposure Aspiration hazard Not available. Not available. Not available. Chronic effects Prolonged inhalation may be harmful. May cause eczema -like skin disorders (dermatitis). 12. Ecological information Ecotoxicity This product has no known eco-toxicological effects. Not expected to be harmful to aquatic organisms. Components Species Test Results CALCIUM CARBONATE (CAS 471-34-1) Aquatic Fish LC50 Western mosquitofish (Gambusia affinis) > 56000 mg/I, 96 hours * Estimates for product may be based on additional component data not shown. Persistence and degradability Bioaccumulative potential Mobility in soil Other adverse effects Not available. Not available. Not available. Not available. 13. Disposal considerations Disposal instructions Dispose of contents/container in accordance with local/regional/national/international regulations. When this product as supplied is to be discarded as waste, it does not meet the definition of a RCRA waste under 40 CFR 261. Hazardous waste code Not applicable. Waste from residues / Dispose of in accordance with local regulations. unused products Contaminated packaging Offer rinsed packaging material to local recycling facilities. 14. Transport information DOT Not regulated as dangerous goods. IATA Not regulated as dangerous goods. Material name: Craft() Mastic, Polypatch and Matrix Products 5013 Version #: 01 Issue date: 02-27-2015 SOS US 5/7 IMDG Not regulated as dangerous goods. Transport in bulk according to Not available. Annex II of MARPOL 73/78 and the IBC Code Further information If the product is shipped at temperatures below 212°F (100°C), it is not regulated for transport by ground, air or vessel. If shipped above 212 deg F: "UN3257, Elevated Temperature Liquid, n.o.s. (Asphalt mixture), 9, PG III" 15. Regulatory information US federal regulations All components are on the U.S. EPA TSCA Inventory List. TSCA Section 12(b) Export Notification (40 CFR 707, Subpt. D) Not regulated. CERCLA Hazardous Substance List (40 CFR 302.4) Not listed. US. OSHA Specifically Regulated Substances (29 CFR 1910.1001-1050) Not listed. Superfund Amendments and Reauthorization Act of 1986 (SARA) Hazard categories Immediate Hazard - No Delayed Hazard - No Fire Hazard - No Pressure Hazard - No Reactivity Hazard - No SARA 302 Extremely hazardous substance Not listed. SARA 311/312 No Hazardous chemical SARA 313 (TRI reporting) Not regulated. Other federal regulations Clean Air Act (CAA) Section 112 Hazardous Air Pollutants (HAPs) List Not regulated. Clean Air Act (CAA) Section 112(r) Accidental Release Prevention (40 CFR 68.130) Not regulated. Safe Drinking Water Act Not regulated. (SDWA) US state regulations WARNING: This product contains a chemical known to the State of California to cause cancer. US. Massachusetts RTK - Substance List ASPHALT (CAS 8052-42-4) CALCIUM CARBONATE (CAS 471-34-1) QUARTZ (CAS 14808-60-7) US. New Jersey Worker and Community Right -to -Know Act Not regulated. US. Pennsylvania RTK - Hazardous Substances ASPHALT (CAS 8052-42-4) CALCIUM CARBONATE (CAS 471-34-1) QUARTZ (CAS 14808-60-7) US. Rhode Island RTK Not regulated. US. California Proposition 65 US - California Proposition 65 - CRT: Listed date/Carcinogenic substance ASPHALT (CAS 8052-42-4) QUARTZ (CAS 14808-60-7) International Inventories Country(s) or region Australia Canada Listed: January 1, 1990 Listed: October 1, 1988 Inventory name Australian Inventory of Chemical Substances (AICS) Domestic Substances List (DSL) On inventory (yes/no)* Yes Yes Material name: Crafco Mastic, Polypatch and Matrix Products 5013 Version #: 01 Issue date: 02-27-2015 SOS US 6/7 Country(s) or region Canada China Europe Europe Japan Korea New Zealand Philippines United States & Puerto Rico *A "Yes" indicates that all compon A "No" indicates that one or more country(s). Inventory name On inventory (yes/no)* Non -Domestic Substances List (NDSL) No Inventory of Existing Chemical Substances in China (IECSC) Yes European Inventory of Existing Commercial Chemical Substances Yes (EINECS) European List of Notified Chemical Substances (ELINCS) No Inventory of Existing and New Chemical Substances (ENCS) Yes Existing Chemicals List (ECL) Yes New Zealand Inventory Yes Philippine Inventory of Chemicals and Chemical Substances Yes (PICCS) Toxic Substances Control Act (TSCA) Inventory Yes ents of this product comply with the inventory requirements administered by the governing country(s) components of the product are not listed or exempt from listing on the inventory administered by the governing 16. Other information, including date of preparation or last revision Issue date Version # Further information References Disclaimer Revision Information 02-27-2015 01 HMIS® is a registered trade and service mark of the NPCA. ACGIH EPA: AQUIRE database US. IARC Monographs on Occupational Exposures to Chemical Agents HSDB® - Hazardous Substances Data Bank IARC Monographs. Overall Evaluation of Carcinogenicity National Toxicology Program (NTP) Report on Carcinogens ACGIH Documentation of the Threshold Limit Values and Biological Exposure Indices The information in the sheet was written based on the best knowledge and experience currently available. The information provided in this Safety Data Sheet is correct to the best of our knowledge, information and belief at the date of its publication. The information given is designed only as a guidance for safe handling, use, processing, storage, transportation, disposal and release and is not to be considered a warranty or quality specification. The information relates only to the specific material designated and may not be valid for such material used in combination with any other materials or in any process, unless specified in the text. Product and Company Identification: Product and Company Identification Composition / Information on Ingredients: Ingredients Physical & Chemical Properties: Multiple Properties Transport Information: Material Transportation Information Transport information: Further information Regulatory Information: Risk Phrases - Class. Material name: Crafco Mastic, Polypatch and Matrix Products 5013 Version #: 01 Issue date: 02-27-2015 SDS US 7/7 Hello