Contract 2020-016A#2020-16-A
SUPPLIER AGREEMENT FOR
NEPTUNE WATER METERS AND EQUIPMENT
THIS AGREEMENT, made and entered into this 20 day of May 2020, A.D., by and between the City of
Clermont 685 West Montrose Street, Clermont, Florida (hereinafter referred to as "CITY"), and
SUNSTATE METER & SUPPLY, INC., 14001 W. Newberry Road, Newberry, FL 32669, (hereinafter
referred to as "SUPPLIER").
WHEREAS, CITY has utilized Neptune Water Meters & R450 Systems (herein referred to as Neptune
Meters) for potable and irrigation meters;
WHEREAS, Neptune Meters is a proprietary product and is only available from SUPPLIER; and
WHEREAS, the City Council has determined that there is only one source for the required product in
accordance with City of Clermont Purchasing Policy, Section E.B.
WITNESSETH: That the parties hereto, for the consideration hereinafter set forth, mutually agree as
follows:
ARTICLE I — SCOPE OF WORK
The SUPPLIER shall furnish Neptune Meters in such quantities as requested by CITY and as set forth in
a purchase order as provided in writing by CITY. Provided, however, that nothing herein shall require
CITY to purchase or acquire any items or services from SUPPLIER.
ARTICLE II — THE CONTRACT SUM
CITY shall pay SUPPLIER, for the faithful performance of the Agreement as set forth in the Unit Price
Schedule set forth in Exhibit 'A', attached hereto and incorporated herein. The CITY understands that the
unit price in Exhibit `A' may change on an annual basis based on consumption and market price. Use of
a lesser or higher quantities or market price will become a factor in annual price adjustment negotiations.
ARTICLE III — TERM AND TERMINATION
1. This Agreement is to become effective upon execution by both parties, and shall remain in
effect for the initial term of two (2) year, unless terminated as provided for herein.
2. Prior to, or upon completion, of the initial term of this contract, the City shall have the option
to renew this contract for three (3) additional twelve (12) month period(s) subject to a price
adjustment at SUPPLIER's option. Prior to completion of the contract term, the City may
consider an adjustment to price based the SUPPLIER's responsibility to request in writing any
price adjustment under this provision. The SUPPLIER's written request for adjustment shall
be submitted sixty (60) days prior to the termination of the initial or any renewal term of this
Agreement. If no adjustment request is received from the contractor, CITY shall be entitled to
assume that the SUPPLIER has agreed that the optional term may be exercised without price
adjustment. Any adjustment request received after the commencement of a new option period
shall not be considered. The City reserves the right to reject any written price adjustments
submitted by the contractor and/or to not exercise any otherwise available option period based
on such price adjustments. Continuation of the contract beyond the initial period, and any
option subsequently exercised, is a City prerogative, and not a right of the SUPPLIER. This
prerogative will be exercised only when such continuation is clearly in the best interest of the
City.
Notwithstanding any other provision of this Agreement, CITY or SUPPLIER may, upon
written notice to SUPPLIER or CITY, terminate this Agreement if: a) without cause and for
convenience upon sixty (60) days written notice to SUPPLIER or CITY b) SUPPLIER or
CITY is adjudged to be bankrupt; c) SUPPLIER or CITY makes a general assignment for the
benefit of its creditors; d) SUPPLIER or CITY fails to comply with any of the conditions of
provisions of this Agreement; or e) SUPPLIER or CITY is experiencing a labor dispute, which
threatens to have a substantial, adverse impact upon performance of this Agreement, without
prejudice to any other right or remedy CITY may have under this Agreement. In the event of
such termination, CITY shall be liable only for the payment of all unpaid charges, determined
in accordance with the provisions of this Agreement, for work, properly performed and
accepted prior to the effective date of termination.
ARTICLE IV — COMMENCEMENT AND COMPLETION OF WORK
The SUPPLIER shall provide all items only upon issuance of an authorized and approved purchase order
and in the timeframe as set forth in the applicable purchase order.
ARTICLE V — PAYMENTS
In accordance with the provisions fully set forth in the General Conditions, SUPPLIER shall submit a
payment request by the third (3rd) day of each calendar month for items provided during the preceding
calendar month. CITY shall make payment to the SUPPLIER, within thirty (30) calendar days, on the
basis of a duly certified and approved payment invoice by the CITY for items provided and accepted by
the CITY.
ARTICLE VI — DISPUTE RESOLUTION - MEDIATION
1. Any claim, dispute or other matter in question arising out of or related to this Agreement shall
be subject to mediation as a condition precedent to voluntary arbitration or the institution of legal
or equitable proceedings by either party.
The CITY and SUPPLIER shall endeavor to resolve claims, disputes and other matters in
question between them by mediation.
3. The parties shall share the mediator's fee and any filing fees equally. The mediation shall be
held in Clermont, Lake County, Florida, unless another location is mutually agreed upon.
Agreements reached in mediation shall be enforceable as settlement agreements in any court
having jurisdiction thereof.
ARTICLE VII — INDEMNIFICATION RIDER
To cover to the fullest extent permitted by law, the SUPPLIER shall indemnify and hold harmless the
CITY and its agents and employees from and against all claims, damages, losses and expenses, including
but not limited to attorney's fees, arising out of or resulting from the performance of the Work, provided
that any such claim, damage, loss or expense (1) is attributable to bodily injury, sickness, disease or death,
or to injury to or destruction of tangible property (other than the Work itself) , and (2) is caused in whole
or in part by any negligent act or omission of the SUPPLIER or anyone directly or indirectly employed by
any of them or anyone for whose acts any of them may be liable. Such obligation shall not be construed
to negate, abridge, or otherwise reduce any other right to obligation of indemnity which would otherwise
exist as to any party or person described in this Article. The SUPPLIER hereby acknowledges receipt of
ten dollars and other good and valuable consideration from the CITY for the indemnification provided
herein.
ARTICLE VIII - NOTICES
All notices shall be in writing and sent by United States mail, certified or registered, with return receipt
requested and postage prepaid, or by nationally recognized overnight courier service to the address of the
party set forth below. Any such notice shall be deemed given when received by the party to whom it is
intended.
SUPPLIER: Sunstate Meter & Supply, Inc.
14001 W. Newberry Road
Newberry, FL 32669
Attn: Keith Ellenburg, President
CITY: City of Clermont
Attn: Darren Gray, City Manager
685 W. Montrose Street
Clermont, FL 34711
ARTICLE IX — MISCELLANEOUS
1. Attorneys' Fees. In the event a suit or action is instituted to enforce or interpret any provision
of this agreement, the prevailing party shall be entitled to recover such sum as the Court may
adjudge reasonable as attorneys' fees at trial or on any appeal, in addition to all other sums
provided by law.
2. Waive . The waiver by city of breach of any provision of this agreement shall not be
construed or operate as a waiver of any subsequent breach of such provision or of such provision
itself and shall in no way affect the enforcement of any other provisions of this agreement.
Severability. If any provision of this agreement or the application thereof to any person or
circumstance is to any extent invalid or unenforceable, such provision, or part thereof, shall be
deleted or modified in such a manner as to make the agreement valid and enforceable under
applicable law, the remainder of this agreement and the application of such a provision to other
persons or circumstances shall be unaffected, and this agreement shall be valid and enforceable to
the fullest extent permitted by applicable law.
4. Amendment. Except for as otherwise provided herein, this agreement may not be modified or
amended except by an agreement in writing signed by both parties.
5. Entire Agreement. This agreement including the documents incorporated by reference contains
the entire understanding of the parties hereto and supersedes all prior and contemporaneous
agreements between the parties with respect to the performance of services by SUPPLIER.
6. Assignment. This agreement is personal to the parties hereto and may not be assigned by
SUPPLIER, in whole or in part, without the prior written consent of city.
7. Venue. The parties agree that the sole and exclusive venue for any cause of action arising out
of this agreement shall be Lake County, Florida.
8. Applicable Law. This agreement and any amendments hereto are executed and delivered in the
State of Florida and shall be governed, interpreted, construed and enforced in accordance with the
laws of the State of Florida.
9) Public Records. CONTRACTOR expressly understands records associated with this project
are public records and agrees to comply with Florida's Public Records law, to include, to:
(a) Keep and maintain public records that ordinarily and necessarily would be required
by the CITY in order to perform the services contemplated herein.
(b) Provide the public with access to public records on the same terms and conditions
that the CITY would provide the records and at a cost that does not exceed the cost
provided in this Florida's Public Records law or as otherwise provided by law.
EXHIBIT A
S Sunstate Meter & Supply, Inc. Phone: 352.332.7106
�i � PP Y�
W. Newberry Road, Newberry, FL 32669 Fax: 352.332.5604
l 14001 Wym "Florida's LeadingDistributor o Automated Meter Reading Systems "
� Y
Feb. 3, 2020
Mr. Freddy L. Suarez, MPA, CPPB
Purchasing Director
City of Clermont
685 W. Montrose St.
Clermont, Fl. 34711
RE: NEPTUNE WATER METERS & EQUIPMENT — 2020-22
Listed below are the prices you have requested:
Neptune R450 System
Description
Unit Price
5/8"x3/4" T10 PB Meter Complete W/Ecoder/ProCoder Pit Gallon Register
$85.65
5/8"0/4" T10 PB Meter Complete W/Ecoder/ProCoder R450i Pit Gallon Register
$203.40
5/8"x3/4" MACH 10 R450i Pit Gallon Meter
$290.00
%" Short Lay MACH 10 R450i Pit Gallon Meter
$299.50
1" T10 BB Meter Complete W/Ecoder/ProCoder Pit Gallon Register
$163.00
1" T10 BB Meter Complete W/Ecoder/ProCoder R450i Pit Gallon Register
$288.00
1" MACH 10 R450i Pit Gallon Meter
$355.00
1 %:" T10 Flanged Meter Complete W/Ecoder/ProCoder Pit Gallon Register
$322.75
1 %" T10 Flanged Meter Complete W/Ecoder/ProCoder R450i Pit Gallon Register
$455.75
1 1/2" MACH 10 R450i Pit Gallon Meter
$687.50
2" T10 Flanged Meter Complete W/Ecoder/ProCoder Pit Gallon Register
$475.00
2" T10 Flanged Meter Complete W/Ecoder/ProCoder R450i Pit Gallon Register
$607.50
2" MACH 10 R450i Pit Gallon Meter
$812.50
1 ''/2" HP Turbine Meter Complete W/Ecoder/ProCoder Pit Gallon Register
$635.75
1 ''/2" HP Turbine Meter Complete W/Ecoder/ProCoder R450i Pit Gallon Register
$785.75
2" HP Turbine Meter Complete W/Ecoder/ProCoder Pit Gallon Register
$645.00
2" HP Turbine Meter Complete W/Ecoder/ProCoder R450i Pit Gallon Register
$795.00
3" HP Turbine Meter Complete W/Ecoder/ProCoder Pit Gallon Register
$1,121.00
3" HP Turbine Meter Complete W/Ecoder/ProCoder R450i Pit Gallon Register
$1,263.00
3" MACH 10 Stand Alone Gallon Meter
$2,564.00
4" HP Turbine Meter Complete W/Ecoder/ProCoder Pit Gallon Register
$1,248.00
4" HP Turbine Meter Complete W/Ecoder/ProCoder R450i Pit Gallon Register
$1,380.00
4" MACH 10 Stand Alone Gallon Meter
$3,257.00
6" HP Turbine Meter Complete W/Ecoder/ProCoder Pit Gallon Register
$2,172.00
6" HP Turbine Meter Complete W/Ecoder/ProCoder R450i Pit Gallon Register
$2,288.00
6" MACH 10 Stand Alone Gallon Meter
$5,300.00
Sunstate Meter & Supply, Inc. Phone: 352.332.7106
pp y,
414001 W. Newberry Road, Newberry, FL 32669 Fax: 352.332.5604
- "Florida's Leading Distributor o Automated Meter Reading Systems"
3" Tru Flo Compound Meter Complete W/Ecoder/ProCoder Gal. Registers $2,674.00
4" Tru Flo Compound Meter Complete W/Ecoder/ProCoder Gal. Registers $2,930.00
6" Tru Flo Compound Meter Complete W/Ecoder/ProCoder Gal. Registers $4,568.00
4"xl" HPPIIIS FS Compound Meter Complete W/Ecoder/ProCoder Pit Gal. Registers
$7,172.00
6"xl 1/2" HPPI19S FS Compound Meter Complete W/Ecoder/ProCoder Pit Gal. Registers
$10,409.00
8"x2" HPPIIIS FS Compound Meter Complete W/Ecoder/ProCoder Pit Gal. Registers
$13,520.00
10"x2" HPPIIIS FS Compound Meter Complete W/Ecoder/ProCoder Pit Gal. Registers
$19,088.00
2" DI Coated Flanged Meter Strainer
$263.00
3" DI Coated Flanged Meter Strainer
$375.00
4" DI Coated Flanged Meter Strainer
$572.00
6" DI Coated Flanged Meter Strainer
$795.00
Any Size/Model Ecoder/ProCoder Register Only
$77.00
Ecoder/ProCoder V2 Register Mount F/Wall MIU
$9.00
Any Size/Model Ecoder/ProCoder R450i Register Only
$174.00
R450 Wall MIU
$110.00
R450 High Power Wall MIU
$120.00
R450 Pit MIU Only
$110.00
R450 Pit MIU Antenna Assy. Only
$40.00
R450 V2 Fixed Based Rack Mount Data Collector (Includes UPS Assy.)
$25,000.00
R450 Fixed Based Data Collector Antenna
$1,490.00
Neptune 360 Advanced Software Set -Up Fee (one-time fee)
$3,700.00
Neptune 360 Advanced Additional Remote Training
$852.00
Neptune 360 Advanced On -Site Training (8 hours)
$1,704.00
Neptune 360 Advanced Professional Services (per hour fee)
$433.00
Neptune 360 Advanced Subscription Fee — AMI Software Annual SaaS
Connected Customers 10,000-20,000 (per endpoint/per year)
$2.06
Connected Customers 20,000-50,000 (per endpoint/per year)
$1.89
Shipping Terms: Freight Allowed
Payment Terms: Net 30 Days — Check or ACH Only
Delivery: 2 — 4 weeks ARO
Pricing Term: May 26, 2020 — May 25, 2022
Respectfully submitted,
JqffKun&vu#h-
Director of Sales
Sunstate Meter & Supply, Inc.
Phone: 352-516-9791
Email: jefi@kimbroughsales.com
(c) Ensure that public records that are exempt or confidential and exempt from public
records disclosure requirements are not disclosed except as authorized by law.
(d) Meet all requirements for retaining public records and transfer, at no cost, to the
CITY all public records in possession of CONTRACTOR upon termination of the contract
and destroy any duplicate public records that are exempt or confidential and exempt from
public records disclosure requirements. CONTRACTOR shall use reasonable efforts to
provide all records stored electronically must be provided to the CITY in a format that is
compatible with the information technology systems of the CITY.
(e) IF CONTRACTOR HAS QUESTIONS REGARDING THE APPLICATION OF
CHAPTER 119, FLORIDA STATUTES, TO THE CONTRACTOR'S DUTY TO
PROVIDE PUBLIC RECORDS RELATING TO THIS CONTRACT, CONTRACTOR
SHALL CONTACT THE CITY'S CUSTODIAN OF PUBLIC RECORDS AT CITY
CLERK'S OFFICE, (352) 241-7331.
IN WITNESS WHEREOF, the parties hereto have executed this Agreement on this JD day of
(NAa [ �— .2020.
City o lermont
4
ail L. Ash, Mayor
Attevt:
racy ` City
4
..• fir.
Sunstate Meter & Supply, Inc.
By:
Keith Ellenburg-President
Printed Name and Title
Attest:
Corporate Secretary
Karen Whittle
(Name Printed or Typed)
W-9
Request for Taxpayer
Form
(Rev. October2018)
Identification Number and Certification
Give Form to the
requester. Do not
Department of the Treasury
Internal Revenue Service
► Go to www.1rs.gov1FormW9 for instructions and the latest information.
send to the IRS.
1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank.
SUNSTATE METER & SUPPLY, INC.
2 Business name/disregarded entity name, if different from above
m3
Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the
4 Exemptions (codes apply only to
following seven boxes,
certain entities, not Individuals; see
a
p
❑ C Corporation
❑ Individual/sole proprietor or poration ❑ S Corporation ❑ Partnership ❑ Trust/estate
instructions on page 3):
W
ai a
single -member LLC
Exempt payee code (if any)
0 2
4 t
❑ Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) It-
8 2
Note: Check the appropriate box in the line above for the tax classification of the single -member owner. Do not check
Exemption from FATCA reporting
v
LLC if the LLC is classified as a single -member LLC that is disregarded from the owner unless the owner of the LLC Is
a cS
another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single -member LLC that
code (if any)
.2
is disregarded from the owner should check the appropriate box for the tax classification of its owner.
❑ Other (see instructions) ►
IAppflu to =c nts malnUdned w,tside the U.S.)
W
5 Address (number, street, and apt. or suite no.) See instructions.
Requester's name and address (optional)
14001 WEST. NEWBERRY ROAD
6 City, state, and ZIP code
NEWBERRY, FLORIDA 32669
7 List account number(s) here (optional)
I axpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid Social security number
backup withholding. For individuals, this is generally your social security number (S. However, for a — m —
resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other
entities, it is your employer identification number (EIN). If you do not have a number, see How to get a
TIN, later.
or
Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and I Employer identification number
Number To Give the Requester for guidelines on whose number to enter.
5 9 F— 2 1 0 1 0 1 1 1 2 1 8 1 5
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. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue
Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am
no longer subject to backup withholding; and
3. 1 am a U.S. citizen or other U.S. person (defined below); and
4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because
you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid,
acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments
other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part 11, later.
Sign I Signature of vj 1 �/
Here U.S. person ►yl)l/11,,,�,,,�' Il1.w.Xr, Date► 2, 12b t2.d2,[D
General Instructions
Section references are to the Internal Revenue Code unless otherwise
noted.
Future developments. For the latest information about developments
related to Form W-9 and its instructions, such as legislation enacted
after they were published, go to www.irs.gov1FormW9.
Purpose of Form
An individual or entity (Form W-9 requester) who is required to file an
information return with the IRS must obtain your correct taxpayer
identification number (TIN) which may be your social security number
(SSN), individual taxpayer identification number (ITIN), adoption
taxpayer identification number (ATIN), or employer identification number
(EIN), to report on an information return the amount paid to you, or other
amount reportable on an information return. Examples of information
returns include, but are not limited to, the following.
• Form 1099-INT (interest earned or paid)
• Form 1099-DIV (dividends, including those from stocks or mutual
funds)
• Form 1099-MISC (various types of income, prizes, awards, or gross
proceeds)
• Form 1099-B (stock or mutual fund sales and certain other
transactions by brokers)
• Form 1099-S (proceeds from real estate transactions)
• Form 1099-K (merchant card and third party network transactions)
• Form 1098 (home mortgage interest), 1098-E (student loan interest),
1098-T (tuition)
• Form 1099-C (canceled debt;.
• Form 1099-A (acquisition or abandonment of secured property)
Use Form W-9 only if you are a U.S. person (including a resident
alien), to provide your correct TIN.
If you do not return Form W-9 to the requester with a TIN, you might
be subject to backup withholding. See What is backup withholding,
later.
Cat. No. 10231X Form W-9 (Rev. 10-2018)
Form W-9 (Rev. 10-2018)
By signing the filled -out form, you:
1. Certify that the TIN you are giving is correct (or you are waiting for a
number to be issued),
2. Certify that you are not subject to backup withholding, or
3. Claim exemption from backup withholding if you are a U.S. exempt
payee. If applicable, you are also certifying that as a U.S. person, your
allocable share of any partnership income from a U.S. trade or business
is not subject to the withholding tax on foreign partners' share of
effectively connected income, and
4. Certify that FATCA code(s) entered on this form (if any) indicating
that you are exempt from the FATCA reporting, is correct. See What is
FATCA reporting, later, for further information.
Note. If 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 if
it is substantially similar to this Form W-9.
Definition of a U.S. person. For federal tax purposes, you are
considered a U.S. person if 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 United States;
• An estate (other than a foreign estate); or
• A domestic trust (as defined in Regulations section 301.7701-7).
Special rules for partnerships. Partnerships that conduct a trade or
business in the United States are generally required to pay a withholding
tax under section 1446 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 under section 1446
require a partnership to presume that a partner is 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
United States, provide Form W-9 to the partnership to establish your
U.S. status and avoid section 1446 withholding on your share of
partnership income.
In the cases below, the following person must give Form W-9 to the
partnership for purposes of establishing its U.S. status and avoiding
withholding on its allocable share of net income from the partnership
conducting a trade or business in the United States.
• In the case of a disregarded entity with a U.S. owner, the U.S. owner
of the disregarded entity and not the entity;
• In the case of a grantor trust with a U.S. grantor or other U.S. owner,
generally, the U.S. grantor or other U.S. owner of the grantor trust and
not the trust; and
• In the case of a U.S. trust (other than a grantor trust), the U.S. trust
(other than a grantor trust) and not the beneficiaries of the trust.
Foreign person. If you are a foreign person or the U.S. branch of a
foreign bank that has elected to be treated as a U.S. person, do not use
Form W-9. Instead, use the appropriate Form W-8 or Form 8233 (see
Pub. 515, Withholding of Tax on Nonresident Aliens and Foreign
Entities).
Nonresident alien who becomes a resident alien. Generally, only a
nonresident alien individual may use the terms of a tax treaty to reduce
or eliminate U.S. tax on certain types of income. However, most tax
treaties contain a provision known as a "saving clause." Exceptions
specified in the saving clause may permit an exemption from tax to
continue for certain types of income even after the payee has otherwise
become a U.S. resident alien for tax purposes.
If you are a U.S. resident alien who is relying on an exception
contained in the saving clause of a tax treaty to claim an exemption
from U.S. tax on certain types of income, you must attach a statement
to Form W-9 that specifies the following five items.
1. The treaty country. Generally, this must be the same treaty under
which you claimed exemption from tax as a nonresident alien.
2. The treaty article addressing the income.
3. The article number (or location) In the tax treaty that contains the
saving clause and its exceptions.
4. The type and amount of income that qualifies for the exemption
from tax.
5. Sufficient facts to justify the exemption from tax under the terms of
the treaty article.
Pan. 2
Example. Article 20 of the U.S.-China income tax treaty allows an
exemption from tax for scholarship income received by a Chinese
student temporarily present in the United States. Under U.S. law, this
student will become a resident alien for tax purposes if his or her stay in
the United States exceeds 5 calendar years. However, paragraph 2 of
the first Protocol to the U.S.-China treaty (dated April 30, 1984) allows
the provisions of Article 20 to continue to apply even after the Chinese
student becomes a resident alien of the United States. A Chinese
student who qualifies for this exception (under paragraph 2 of the first
protocol) and is relying on this exception to claim an exemption from tax
on his or her scholarship or fellowship income would attach to Form
W-9 a statement that includes the information described above to
support that exemption.
If you are a nonresident alien or a foreign entity, give the requester the
appropriate completed Form W-8 or Form 8233.
Backup Withholding
What is backup withholding? Persons making certain payments to you
must under certain conditions withhold and pay to the IRS 24% of such
payments. This is called "backup withholding." Payments that may be
subject to backup withholding include interest, tax-exempt interest,
dividends, broker and barter exchange transactions, rents, royalties,
nonemployee pay, payments made in settlement of payment card and
third parry network transactions, and certain payments from fishing boat
operators. Real estate transactions are not subject to backup
withholding.
You will not be subject to backup withholding on payments you
receive if you give the requester your correct TIN, make the proper
certifications, and report all your taxable interest and dividends on your
tax return.
Payments you receive will be subject to backup withholding IF.
You do not furnish your TIN to the requester,
2. You do not certify your TIN when required (see the instructions for
Part II for details),
3. The IRS tells the requester that you fumished an incorrect TIN,
4. The IRS tells you that you are subject to backup withholding
because you did not report all your interest and dividends on your tax
return (for reportable interest and dividends only), or
5. You do not certify to the requester that you are not subject to
backup withholding under 4 above (for reportable interest and dividend
accounts opened after 1983 only).
Certain payees and payments are exempt from backup withholding.
See Exempt payee code, later, and the separate Instructions for the
Requester of Form W-9 for more information.
Also see Special rules for partnerships, earlier.
What is FATCA Reporting?
The Foreign Account Tax Compliance Act (FATCA) requires a
participating foreign financial institution to report all United States
account holders that are specified United States persons. Certain
payees are exempt from FATCA reporting. See Exemption from FATCA
reporting code, later, and the Instructions for the Requester of Form
W-9 for more information.
Updating Your Information
You must provide updated information to any person to whom you
claimed to be an exempt payee if you are no longer an exempt payee
and anticipate receiving reportable payments in the future from this
person. For example, you may need to provide updated information if
you are a C corporation that elects to be an S corporation, or if you no
longer are tax exempt. In addition, you must furnish a new Form W-9 if
the name or TIN changes for the account; for example, if the grantor of a
grantor trust dies.
Penalties
Failure to furnish TIN. If you fail to furnish your correct TIN to a
requester, you are subject to a penalty of $50 for each such failure
unless your failure is due to reasonable cause and not to willful neglect.
Civil penalty for false information with respect to withholding. If you
make a false statement with no reasonable basis that results in no
backup withholding, you are subject to a $500 penalty.
Form W-9 (Rev. 10-2018)
Criminal penalty for falsifying information. Willfully falsifying
certifications or affirmations may subject you to criminal penalties
including fines and/or imprisonment.
Misuse of TINS. If the requester discloses or uses TINs in violation of
federal law, the requester may be subject to civil and criminal penalties.
Specific Instructions
Line 1
You must enter one of the following on this line; do not leave this line
blank. The name should match the name on your tax return.
If this Form W-9 is for a joint account (other than an account
maintained by a foreign financial institution (FFI)), list first, and then
circle, the name of the person or entity whose number you entered in
Part I of Form W-9. If you are providing Form W-9 to an FFl to document
a joint account, each holder of the account that is a U.S. person must
provide a Form W-9.
a. Individual. Generally, enter the name shown on your tax return. If
you have changed your last name without informing the Social Security
Administration (SSA) of the name change, enter your first name, the last
name as shown on your social security card, and your new last name.
Note: ITIN applicant: Enter your individual name as it was entered on
your Form W-7 application, line 1a. This should also be the same as the
name you entered on the Form 1040/1040A/1040EZ you filed with your
application.
b. Sole proprietor or single -member LLC. Enter your individual
name as shown on your 1040/104OA/1040EZ on line 1. You may enter
your business, trade, or "doing business as" (DBA) name on line 2.
c. Partnership, LLC that Is not a single -member LLC, C
corporation, or S corporation. Enter the entity's name as shown on the
entity's tax return on line 1 and any business, trade, or DBA name on
line 2.
d. Other entities. Enter your name as shown on required U.S. federal
tax documents on line 1. This name should match the name shown on the
charter or other legal document creating the entity. You may enter any
business, trade, or DBA name on line 2.
e. Disregarded entity. For U.S. federal tax purposes, an entity that is
disregarded as an entity separate from its owner is treated as a
"disregarded entity." See Regulations section 301.7701-2(c)(2)(iii). Enter
the owner's name on line 1. The name of the entity entered on line 1
should never be a disregarded entity. The name on line 1 should be the
name shown on the income tax return on which the income should be
reported. For example, if a foreign LLC that is treated as a disregarded
entity for U.S. federal tax purposes has a single owner that is a U.S.
person, the U.S. owner's name is required to be provided on line 1. If
the direct owner of the entity is also a disregarded entity, enter the first
owner that is not disregarded for federal tax purposes. Enter the
disregarded entity's name on line 2, "Business name/disregarded entity
name." If the owner of the disregarded entity is a foreign person, the
owner must complete an appropriate Form W-8 instead of a Form W-9.
This is the case even if the foreign person has a U.S. TIN.
Line 2
If you have a business name, trade name, DBA name, or disregarded
entity name, you may enter it on line 2.
Line 3
Check the appropriate box on line 3 for the U.S. federal tax
classification of the person whose name is entered on line 1. Check only
one box on line 3.
Page 3
IF the entity/person on line 1 is
THEN check the box for ...
a(n) ...
• Corporation
Corporation
• Individual
Individual/sole proprietor or single-
• Sole proprietorship, or
member LLC
• Single -member limited liability
company (LLC) owned by an
individual and disregarded for U.S.
federal tax purposes.
• LLC treated as a partnership for
Limited liability company and enter
U.S. federal tax purposes,
the appropriate tax classification.
• LLC that has filed Form 8832 or
(P= Partnership; C= C corporation;
2553 to be taxed as a corporation,
or S= S corporation)
or
• LLC that is disregarded as an
entity separate from its owner but
the owner is another LLC that is
not disregarded for U.S. federal tax
purposes.
• Partnership
Partnership
• Trust/estate
Trust/estate
Line 4, Exemptions
If you are exempt from backup withholding and/or FATCA reporting,
enter in the appropriate space on line 4 any code(s) that may apply to
you.
Exempt payee code.
• Generally, individuals (including sole proprietors) are not exempt from
backup withholding.
• Except as provided below, corporations are exempt from backup
withholding for certain payments, including interest and dividends.
• Corporations are not exempt from backup withholding for payments
made in settlement of payment card or third party network transactions.
• Corporations are not exempt from backup withholding with respect to
attomeys' fees or gross proceeds paid to attorneys, and corporations
that provide medical or health care services are not exempt with respect
to payments reportable on Form 1099-MISC.
The following codes identify payees that are exempt from backup
withholding. Enter the appropriate code in the space in line 4.
1—An organization exempt from tax under section 501(a), any IRA, or
a custodial account under section 403(b)(7) if the account satisfies the
requirements of section 401(f)(2)
2—The United States or any of its agencies or instrumentalities
3—A state, the District of Columbia, a U.S. commonwealth or
possession, or any of their political subdivisions or instrumentalities
4—A foreign government or any of its political subdivisions, agencies,
or instrumentalities
5—A corporation
6—A dealer in securities or commodities required to register in the
United States, the District of Columbia, or a U.S. commonwealth or
possession
7—A futures commission merchant registered with the Commodity
Futures Trading Commission
8—A real estate investment trust
9—An entity registered at all times during the tax year under the
Investment Company Act of 1940
10—A common trust fund operated by a bank under section 584(a)
11—A financial institution
12—A middleman known in the investment community as a nominee or
custodian
13—A trust exempt from tax under section 664 or described in section
4947
Form W-9 (Rev. 10-2018) Page 4
The following chart shows types of payments that may be exempt
from backup withholding. The chart applies to the exempt payees listed
above, 1 through 13.
IF the payment is for ...
THEN the payment is exempt
for...
Interest and dividend payments
All exempt payees except
for 7
Broker transactions
Exempt payees 1 through 4 and 6
through 11 and all C corporations.
S corporations must not enter an
exempt payee code because they
are exempt only for sales of
noncovered securities acquired
prior to 2012.
Barter exchange transactions and
Exempt payees 1 through 4
patronage dividends
Payments over $600 required to be
Generally, exempt payees
reported and direct sales over
1 through 52
$5,0001
Payments made in settlement of
Exempt payees 1 through 4
payment card or third party network
transactions
1 See Form 1099-MISC, Miscellaneous Income, and its instructions.
2 However, the following payments made to a corporation and
reportable on Form 10J9-MISC are not exempt from backup
withholding: medical and health care payments, attorneys' fees, gross
proceeds paid to an attorney reportable under section 6045(f), and
payments for services paid by a federal executive agency.
Exemption from FATCA reporting code. The following codes identify
payees that are exempt from reporting under FATCA. These codes
apply to persons submitting this form for accounts maintained outside
of the United States by certain foreign financial institutions. Therefore, if
you are only submitting this form for an account you hold in the United
States, you may leave this field blank. Consult with the person
requesting this form if you are uncertain if the financial institution is
subject to these requirements. A requester may indicate that a code is
not required by providing you with a Form W-9 with "Not Applicable" (or
any similar indication) written or printed on the line for a FATCA
exemption code.
A —An organization exempt from tax under section 501(a) or any
individual retirement plan as defined in section 7701(a)(37)
B—The United States or any of its agencies or instrumentalities
C—A state, the District of Columbia, a U.S. commonwealth or
possession, or any of their political subdivisions or instrumentalities
D—A corporation the stock of which is regularly traded on one or
more established securities markets, as described in Regulations
section 1.1472-1(c)(1)(i)
E—A corporation that is a member of the same expanded affiliated
group as a corporation described in Regulations section 1.1472-1(c)(1)()
F—A dealer in securities, commodities, or derivative financial
instruments (including notional principal contracts, futures, forwards,
and options) that is registered as such under the laws of the United
States or any state
G—A real estate investment trust
H—A regulated investment company as defined in section 851 or an
entity registered at all times during the tax year under the Investment
Company Act of 1940
I —A common trust fund as defined in section 584(a)
J—A bank as defined in section 581
K—A broker
L—A trust exempt from tax under section 664 or described in section
4947(a)(1)
M—A tax exempt trust under a section 403(b) plan or section 457(g)
plan
Note: You may wish to consult with the financial institution requesting
this form to determine whether the FATCA code and/or exempt payee
code should be completed.
Line 5
Enter your address (number, street, and apartment or suite number).
This is where the requester of this Form W-9 will mail your information
returns. If this address differs from the one the requester already has on
file, write NEW at the top. If a new address is provided, there is still a
chance the old address will be used until the payor changes your
address in their records.
Line 6
Enter your city, state, and ZIP code.
Part I. Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. If you are a resident alien and
you do not have and are not eligible to get an SSN, your TIN is your IRS
individual taxpayer identification number (ITIN). Enter it in the social
security number box. If you do not have an ITIN, see How to get a TIN
below.
If you are a sole proprietor and you have an EIN, you may enter either
your SSN or EIN.
If you are a single -member LLC that is disregarded as an entity
separate from its owner, enter the owner's SSN (or EIN, if the owner has
one). Do not enter the disregarded entity's EIN. If the LLC is classified as
a corporation or partnership, enter the entity's EIN.
Note: See What Name and Number To Give the Requester, later, for
further clarification of name and TIN combinations.
How to get a TIN. If you do not have a TIN, apply for one immediately.
To apply for an SSN, get Form SS-5, Application for a Social Security
Card, from your local SSA office or get this form online at
www.SSA.gov. You may also get this form by calling 1-800-772-1213.
Use Form W-7, Application for IRS Individual Taxpayer Identification
Number, to apply for an ITIN, or Form SS-4, Application for Employer
Identification Number, to apply for an EIN. You can apply for an EIN
online by accessing the IRS website at www.irs.gov/Businesses and
clicking on Employer Identification Number (EIN) under Starting a
Business. Go to www.irs.gov/Forms to view, download, or print Form
W-7 and/or Form SS-4. Or, you can go to www.irs.gov/OrderForms to
place an order and have Form W-7 and/or SS-4 mailed to you within 10
business days.
If you are asked to complete Form W-9 but do not have a TIN, apply
for a TIN and write "Applied For" in the space for the TIN, sign and date
the form, and give it to the requester. For interest and dividend
payments, and certain payments made with respect to readily tradable
instruments, generally you will have 60 days to get a TIN and give it to
the requester before you are subject to backup withholding on
payments. The 60-day rule does not apply to other types of payments.
You will be subject to backup withholding on all such payments until
you provide your TIN to the requester.
Note: Entering "Applied For" means that you have already applied for a
TIN or that you intend to apply for one soon.
Caution: A disregarded U.S. entity that has a foreign owner must use
the appropriate Form W-8.
Part II. Certification
To establish to the withholding agent that you are a U.S. person, or
resident alien, sign Form W-9. You may be requested to sign by the
withholding agent even if item 1, 4, or 5 below indicates otherwise.
For a joint account, only the person whose TIN is shown in Part I
should sign (when required). In the case of a disregarded entity, the
person identified on line 1 must sign. Exempt payees, see Exempt payee
code, earlier.
Signature requirements. Complete the certification as indicated in
items 1 through 5 below.
Form W-9 (Rev. 10-2018)
1. Interest, dividend, and barter exchange accounts opened
before 1984 and broker accounts considered active during 1983.
You must give your correct TIN, but you do not have to sign the
certification.
2. Interest, dividend, broker, and barter exchange accounts
opened after 1983 and broker accounts considered inactive during
1983. You must sign the certification or backup withholding will apply. If
you are subject to backup withholding and you are merely providing
your correct TIN to the requester, you must cross out item 2 in the
certification before signing the form.
3. Real estate transactions. You must sign the cert;fication. You may
cross out item 2 of the certification.
4. Other payments. You must give your correct TIN, but you do not
have to sign the certification unless you have been notified that you
have previously given an incorrect TIN. "Other payments" include
payments made in the course of the requester's trade or business for
rents, royalties, goods (other than bills for merchandise), medical and
health care services (including payments to corporations), payments to
a nonemployee for services, payments made in settlement of payment
card and third party network transactions, payments to certain fishing
boat crew members and fishermen, and gross proceeds paid to
attorneys (including payments to corporations).
5. Mortgage interest paid by you, acquisition or abandonment of
secured property, cancellation of debt, qualified tuition program
payments (under section 529), ABLE accounts (under section 529A),
IRA, Coverdell ESA, Archer MSA or HSA contributions or
distributions, and pension distributions. You must give your correct
TIN, but you do not have to sign the certification.
What Name and Number To Give the Requester
For this type of account: I Give name and SSN of:
1. Individual I The individual
2. Two or more individuals (joint
The actual owner of the account or, if
sccount) other than an account
combined funds, the first individual on
maintained by an FFI
the account'
3. Two or more U.S. persons
Each holder of the account
Qoint account maintained by an FFI)
4. Custodial account of a minor
The minor2
(Uniform Gift to Minors Act)
5. a. The usual revocable savings trust
The grantor -trustee'
(grantor is also trustee)
b. So-called trust account that is not
The actual owner'
a legal or valid trust under state law
6. Sole proprietorship or disregarded
The owner3
entity owned by an individual
7. Grantor trust filing under Optional
The grantor'
Form 1099 Filing Method 1 (see
Regulations section 1.671-4(b)(2)()
(A))
For this type of account:
Give name and EIN of:
8. Disregarded entity not owned by an
The owner
individual
9. A valid trust, estate, or pension trust
10. Corporation or LLC electing
corporate status on Form 8832 or
Form 2553
11. Association, club, religious,
charitable, educational, or other tax-
exempt organization
Legal entity°
The corporation
The organization
12. Partnership or multi -member LLC The partnership
13. A broker or registered nominee The broker or nominee
Pane 5
For this type of account: Give name and EIN of:
14. Account with the Department of The public entity
Agriculture in the name of a public
entity (such as a state or local
government, school district, or
prison) that receives agricultural
program payments
15. Grantor trust filing under the Form The trust
1041 Filing Method or the Optional
Form 1099 Filing Method 2 (see
Regulations section 1.6714(b)(2)(1)(B))
' List first and circle the name of the person whose number you furnish.
If only one person on a joint account has an SSN, that person's number
must be furnished.
2 Circle the minor's name and furnish the minor's SSN.
3 You must show your individual name and you may also enter your
business or DBA name on the "Business name/disregarded entity"
name line. You may use either your SSN or EIN (if you have one), but the
IRS encourages you to use your SSN.
° List first and circle the name of the trust, estate, or pension trust. (Do
not furnish the TIN of the personal representative or trustee unless the
legal entity Itself is not designated In the account title.) Also see Special
rules forpartnerships, earlier.
*Note: The grantor also must provide a Form W-9 to trustee of trust.
Note: If no name is circled when more than one name is listed, the
number will be considered to be that of the first name listed.
Secure Your Tax Records From Identity Theft
Identity theft occurs when someone uses your personal information
such as your name, SSN, or other identifying information, without your
permission, to commit fraud or other crimes. An identity thief may use
your SSN to get a job or may file a tax return using your SSN to receive
a refund.
To reduce your risk:
* Protect your SSN,
• Ensure your employer is protecting your SSN, and
• Be careful when choosing a tax preparer.
If your tax records are affected by identity theft and you receive a
notice from the IRS, respond right away to the name and phone number
printed on the IRS notice or letter.
If your tax records are not currently affected by identity theft but you
think you are at risk due to a lost or stolen purse or wallet, questionable
credit card activity or credit report, contact the IRS Identity Theft Hotline
at 1-800-908-4490 or submit Form 14039.
For more information, see Pub. 5027, Identity Theft Information for
Taxpayers.
Victims of identity theft who are experiencing economic harm or a
systemic problem, or are seeking help in resolving tax problems that
have not been resolved through normal channels, may be eligible for
Taxpayer Advocate Service (TAS) assistance. You can reach TAS by
calling the TAS toll -free case intake line at 1-877-777-4778 or TTY/TDD
1-800-829-4059.
Protect yourself from suspicious emails or phishing schemes.
Phishing is the creation and use of email and websites designed to
mimic legitimate business emails and websites. The most common act
is sending an email to a user falsely claiming to be an established
legitimate enterprise in an attempt to scam the user into surrendering
private information that will be used for identity theft.
Form W-9 (Rev. 10-2018)
The IRS does not initiate contacts with taxpayers via emails. Also, the
IRS does not request personal detailed information through email or ask
taxpayers for the PIN numbers, passwords, or similar secret access
information for their credit card, bank, or other financial accounts.
If you receive an unsolicited email claiming to be from the IRS,
forward this message to phishing@irs.gov. You may also report misuse
of the IRS name, logo, or other IRS property to the Treasury Inspector
General for Tax Administration (11GTA) at 1-800-366-4484. You can
forward suspicious emails to the Federal Trade Commission at
spam@uce.gov or report them at www.ftc.gov/complaint. You can
contact the FTC at www.ftc.gov/idtheft or 877-IDTHEFT (877-438-4338).
If you have been the victim of identity theft, see www.ldentityTheft.gov
and Pub. 5027.
Visit www.irs.govIldentityTheft to learn more about identity theft and
how to reduce your risk.
Privacy Act Notice
Section 6109 of the Internal Revenue Code requires you to provide your
correct TIN to persons (including federal agencies) who are required to
file information returns with the IRS to report interest, dividends, or
certain other income paid to you; mortgage interest you paid; the
acquisition or abandonment of secured property; the cancellation of
debt; or contributions you made to an IRA, Archer MSA, or HSA. The
person collecting this form uses the information on the form to file
information returns with the IRS, reporting the above information.
Routine uses of this information include giving it to the Department of
Justice for civii and criminal litigation and to cities, states, the District of
Columbia, and U.S. commonwealths and possessions for use in
administering their laws. The information also may be disclosed to other
countries under a treaty, to federal and state agencies to enforce civil
and criminal laws, or to federal law enforcement and Intelligence
agencies to combat terrorism. You must provide your TIN whether or
not you are required to file a tax return. Under section 3406, payers
must generally withhold a percentage of taxable interest, dividend, and
certain other payments to a payee who does not give a TIN to the payer.
Certain penalties may also apply for providing false or fraudulent
information.
SUNSMET-01 NERC
ACORD' CERTIFICATE OF LIABILITY INSURANCE UATE(M1 J27120202020
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 CQNTRAQT 09TVVCLN THE 109YING INMER(s)) AUTHORIZED
REPRESENTATIVE OR PROOUCER• ANO THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or 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
Hub International Florida
2811 NW 41at Street
Gainesville, FL 32606
INSURED--- ------------ ----------
Sunstate Meter & Supply Co, Inc .
14001 W Newberry Rd
Newberry, FL 32669
COVERAGES CERTIFICATE aulea000.
CERTIFICATE
(A , No, Ext): (352) 377-2002 1 iA e. Ner(352) 376-8393 1
INSURER A._ United Fire & Indemnity Company _
INSURER B: Transportation Insurance Company
INSURER C :
INSURER D- _
INSURER E :
Riavwlvry I UMBCK:
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.
L TYPE OF INSURANCE I� POLICY NUMBER POLICY EFF (POLICY EXP
INSR ADDL SUBRhMYY)
i LIMITS
--
i
A X I COMMERCIAL GENERAL LIABILITY I I
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1,000,000
- _ CLAIMS -MADE I X 'OCCUR j X I 160611489 1/1/2020 IM/2021
A3EEa ccoreESo
100,000
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— -
_ .... _ ......... ----- - -- -. _-.
_MED EXP (Any one Gerson)
5,000
--- - - -- -- -
PERSONAL & ADV INJURY $
1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
�—
i X ` POLICY I � jECT LOC
GENERAL AGGREGATE j $
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_
LRODUCTS -COMP/OP AGG $
2,000,006
OTHER:
is
AUTOMOBILE LIABILITY I fi I
-
AUTO
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(Ea arc IsleeqANY T$
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OWNED i SCHEDULED
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AUTOS ONLY
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INJURY fPPr arson --
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PROPERTY DAMAGE
AUTOS ONLY I f
Per accident $
-
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EXCESS LIAB i CLAIMS-MADE
�650511489 1/1/2020
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1/1/2021 I
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$
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AND EMPLOYERS' LIABILITY
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ANY PROPRIETOR/PARTNER/EXECUTIVE
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(Mandatory In NH) '---
9/21 /2019
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912112020
L. EACH ACCIDENT i $
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I
i
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E.L. DISEASE - EA EMPLOYEE $
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If yea, describe under j
DESCRIPTION OF OPERATIONS below
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E.L. DISEASE -POLICY LIMIT
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I
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule maybe attached If more space Is required)
City of Clermont is included as an Additional Insured as respects to General Liability as required by written
contract. 2015-40/NEPTUNE WATER METERS AND EQUIPMENT
City of Clermont
685 West Montrose St
Clermont, FL 34711
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
t, I Vtit3-ZU75 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD