Agenda 06/14/2022 Item #16C7 (Award ITB #22-7975 to Indusco Environmental Services & DeLoach Industries)06/14/2022
EXECUTIVE SUMMARY
Recommendation to award Invitation to Bid (“ITB”) No. 22-7975, "Tower Packing Media
Replacement for Water Treatment Plants", to Indusco Environmental Services, Inc., and DeLoach
Industries, Inc., for the purchase of replacement degasification and odor control tower packing
media at the North and South County Regional Water Treatment Plants on a primary/secondary
per line-item basis.
OBJECTIVE: To maintain degasification and odor control towers at the North and South County
Regional Water Treatment Plants by issuing an award to purchase certified tower packing media, as
needed.
CONSIDERATIONS: As part of an ongoing cost-containment effort, the Public Utilities Department
continues to analyze all areas of greatest cost-improvement potential to ensure that it provides best value
to its customers. One such cost-containment area is the purchase of tower packing media that the Collier
County Water-Sewer District utilizes in its treatment processes to produce potable water successfully,
compliantly, and reliably.
Tower packing is a critical component of dissolved gas removal and odor control during the treatment and
production of drinking water at the North and South County Regional Water Treatment Plants. The
existing packing gets aged and fouled and needs to be replaced on a recurring basis. The packing is
essential to maintaining an optimized treatment process and preventing degraded water quality by
providing an increased surface area to enhance mass transfer through air -stripping (degasification) and
scrubbing (odor control). Public Utilities operates sixteen towers at the South Collier Regional Water
Treatment Plant (SCRWTP) utilizing 1,600 ft3 per tower, or 25,600 ft3 total, and twelve towers at the
North Collier Regional Water Treatment Plant (NCRWTP) utilizing eight at 600 ft3 and four at 1,800 ft3
for a total of 12,000 ft3. The scope of this project includes the purchase of replacement tower packing.
The new packing shall conform to NSF/ANSI Standard 61: Drinking Water System Components as
adopted in Rule 62-555, Fla. Admin. Code.
On March 3, 2022, the Procurement Services Division released notices for ITB No. 22 -7975, Tower
Packing Media Replacement for Water Treatment Plants. The County received two bids by the April 5,
2022, deadline as follows.
Respondents:
Company Name City County State Bid Amount Responsive/
Responsible
Indusco Environmental Services, Inc. Daphne Baldwin AL See Tabulation Yes/Yes
DeLoach Industries, Inc. Sarasota Sarasota FL See Tabulation Yes/Yes
Staff recommends awarding this ITB to Indusco Environmental Services, Inc. and DeLoach Industries,
Inc. on a primary/secondary per line-item basis in accordance with the attached bid tabulation, and
requests authorization to open Standard County Purchase Orders to procure goods for this award on an as-
needed basis.
Both companies being recommended are manufacturing companies focused on water/wastewater air
pollution and odor control services and are leaders in the industry.
16.C.7
Packet Pg. 1269
06/14/2022
Indusco Environmental Services, Inc. has been in business since the mid-1970’s, has a 40-year history in
odor control and chemical process equipment, and Collier County has successfully used Indusco for tower
packing media materials on and off since 2013.
Deloach Industries, Inc. is a Florida-based company that has been in business since 2013 and specializes
in the design, manufacturing, operations & maintenance of water, wastewater, and odor control systems.
The company has experience working with and meeting the needs of municipal and industrial
applications, but this will be the first time working with Collier County.
FISCAL IMPACT: Funds are available in the Collier County Water-Sewer District Operating Fund
(408). Purchase orders will be issued on an as-needed basis. The facilities that will use this award
include the North County Regional Water Treatment Plant and the South County Regional Water
Treatment Plant. Historically, annual spending is approximately $300,000; however, this may not be
indicative of future buying patterns.
LEGAL CONSIDERATIONS: This item is approved as to form and legality, and requires majority
vote for Board approval.-SRT
GROWTH MANAGEMENT IMPACT: This project meets current Growth Management Plan
standards to ensure the adequacy and availability of viable public facilities.
RECOMMENDATION: That the Board of County Commissioners, Ex-officio the Governing Board of
the Collier County Water-Sewer District, awards ITB No. 22-7975 to Indusco Environmental Services,
Inc., and DeLoach Industries, Inc., on a primary/secondary per line-item basis in accordance with the
attached bid tabulation, and requests authorization to open Standard County Purchase Orders to procure
goods for this award on an as-needed basis.
Prepared by: Howard Brogdon, Director, Water Division
ATTACHMENT(S)
1. 22-7975 - NORA Executed (PDF)
2. 22-7975 Bid Tabulation (PDF)
3. 22-7975 Indusco Combined Bid Package (PDF)
4. 22-7975 DeLoach Combined Bid Package (PDF)
5. 22-7975 Solicitation (PDF)
16.C.7
Packet Pg. 1270
06/14/2022
COLLIER COUNTY
Board of County Commissioners
Item Number: 16.C.7
Doc ID: 22320
Item Summary: Recommendation to award Invitation to Bid (“ITB”) No. 22-7975, "Tower
Packing Media Replacement for Water Treatment Plants", to Indusco Environmental Services, Inc., and
DeLoach Industries, Inc., for the purchase of replacement degasification and odor control tower packing
media at the North and South County Regional Water Treatment Plants on a primary/secondary per line -
item basis.
Meeting Date: 06/14/2022
Prepared by:
Title: Plant Manager – Water
Name: Howard Brogdon
05/24/2022 8:53 AM
Submitted by:
Title: Plant Manager – Water
Name: Howard Brogdon
05/24/2022 8:53 AM
Approved By:
Review:
Procurement Services Ana Reynoso Level 1 Purchasing Gatekeeper Completed 05/24/2022 10:07 AM
Procurement Services Sue Zimmerman Additional Reviewer Completed 05/24/2022 10:56 AM
Procurement Services Cynthia McCanna Additional Reviewer Completed 05/24/2022 11:56 AM
Procurement Services Sandra Herrera Additional Reviewer Completed 05/24/2022 4:41 PM
Public Utilities Operations Support AmiaMarie Curry Additional Reviewer Completed 05/25/2022 9:16 AM
Public Utilities Department Drew Cody Level 1 Division Reviewer Completed 05/25/2022 5:05 PM
Public Utilities Department George Yilmaz Level 2 Division Administrator Review Completed 05/27/2022 11:30 AM
County Attorney's Office Scott Teach Level 2 Attorney Review Completed 05/31/2022 2:18 PM
Office of Management and Budget Debra Windsor Level 3 OMB Gatekeeper Review Completed 05/31/2022 2:44 PM
County Attorney's Office Jeffrey A. Klatzkow Level 3 County Attorney's Office Review Completed 05/31/2022 3:33 PM
Growth Management Operations Support Christopher Johnson Additional Reviewer Completed 06/01/2022 11:45 AM
County Manager's Office Dan Rodriguez Level 4 County Manager Review Completed 06/08/2022 8:11 AM
Board of County Commissioners Geoffrey Willig Meeting Pending 06/14/2022 9:00 AM
16.C.7
Packet Pg. 1271
Notice of Recommended Award
Solicitation: 22-7975 Title: Tower Packing Media Replacement for Water Treatment Plants
Due Date and Time: April 5, 2022, at 3:00PM
Respondents:
Company Name City County State Bid Amount Responsive/
Responsible
Indusco Environmental Services, Inc. Daphne Baldwin AL See Tabulation Yes/Yes
DeLoach Industries, Inc. Sarasota Sarasota FL See Tabulation Yes/Yes
Utilized Local Vendor Preference: Yes No
Recommended Vendor(s) For Award:
On March 3, 2022, the Procurement Services Division released notices for Invitation to Bid #22-7975 Tower
Packing Media Replacement for Water Treatment Plants. Eight thousand seven hundred sixty (8,760)
notifications were sent, forty-one (41) vendors viewed, and two (2) bids were submitted on April 5, 2022.
Additional outreach was conducted.
Intent of the award was to identify a Primary/Secondary vendor based on the Lowest Price Per Line Item. Staff
recommends Indusco Environmental Services, Inc. to be awarded as the primary vendor, and DeLoach
Industries, Inc. as the secondary vendor.
Contract Driven Purchase Order Driven
Required Signatures
Project Manager:
Procurement Strategist:
Procurement Services Director:
__________________________________ _________________
Sandra Herrera Date
DocuSign Envelope ID: 1AD3B0CD-C42E-4FDA-89DF-58482729D543
4/12/2022
4/12/2022
4/12/2022
16.C.7.a
Packet Pg. 1272 Attachment: 22-7975 - NORA Executed (22320 : Tower Packing Media Replacement for Water Treatment Plants)
Bid Due Date: April 5, 2022 Notices Issued: 8,760Procurement Strategist: Cynthia McCannaPackages Viewed: 41Project Manager: Howard BrodgonSubmittals: 2PrimarySecondaryIndusco Environmental Services, Inc. DeLoach Industries, Inc. Item # Item Description Unit of Measure Unit Price Unit Price1 NSF/ANSI 61 Certified 3 1/2" Spheres Cubic Feet (ft3)$15.45 $18.002 NSF/ANSI 61 Certified 2" Barrels Cubic Feet (ft3)$16.10 $30.00Yes/No Yes/NoForm 1: Vendor Declaration Statement Yes YesForm 2: Conflict of Interest Certification Affidavit Yes YesForm 3: Immigration Affidavit Certification Yes YesForm 4: Local Vendor Preference Tax Receipt (if applicable) N/A N/AForm 5: ReferencesN/A YesForm 6: Grant Forms (if applicable) N/A N/AInsurance RequirementsN/A N/AW-9Yes YesSun Biz/Division of Corp. Yes YesAddendumN/A N/AE-VerifyYes YesBid ScheduleYes YesDaphne, AL SarasotaBaldwin SarasotaOpended by: Cynthia McCannaWitnessed by: Ana ReynosoVendor ChecklistPlace of Business County#22-7975 Tower Packing Media Replacement for Water Treatment PlantsBid Tabulation16.C.7.bPacket Pg. 1273Attachment: 22-7975 Bid Tabulation (22320 : Tower Packing Media Replacement for Water Treatment
16.C.7.cPacket Pg. 1274Attachment: 22-7975 Indusco Combined Bid Package (22320 : Tower Packing Media Replacement for
STATE OF GEORGIA
Secretary of State
Corporations Division
313 West Tower
2 Martin Luther King, Jr. Dr.
Atlanta, Georgia 30334-1530
ANNUAL REGISTRATION *Electronically Filed*
Secretary of State
Filing Date: 2/22/2022 2:24:43 PM
BUSINESS INFORMATION
CONTROL NUMBER K311535
BUSINESS NAME INDUSCO ENVIRONMENTAL SERVICES INC.
BUSINESS TYPE Domestic Profit Corporation
EFFECTIVE DATE 02/22/2022
ANNUAL REGISTRATION PERIOD 2022
PRINCIPAL OFFICE ADDRESS
ADDRESS P.O. Box 790, Daphne, AL, 36526, USA
REGISTERED AGENT
NAME ADDRESS COUNTY
EDGAR DANIEL VAUGHAN III 909 CLAY ROAD, MABLETON, GA, 30126, USA Cobb
OFFICERS INFORMATION
NAME TITLE ADDRESS
EDGAR DANIEL VAUGHAN, III CEO 909 CLAY ROAD, MABLETON, GA, 30126, USA
EDGAR DANIEL VAUGHAN, III SECRETARY 909 CLAY ROAD, MABLETON, GA, 30126, USA
EDGAR DANIEL VAUGHAN, III CFO 909 CLAY ROAD, MABLETON, GA, 30126, USA
AUTHORIZER INFORMATION
AUTHORIZER SIGNATURE Jennifer McRee
AUTHORIZER TITLE Authorized Person
16.C.7.c
Packet Pg. 1275 Attachment: 22-7975 Indusco Combined Bid Package (22320 : Tower Packing Media Replacement for Water Treatment Plants)
Form W-9
(Rev. October 2018)
Department of the Treasury
Internal Revenue Service
Request for Taxpayer
Identification Number and Certification
a Go to www.irs.gov/FormW9 for instructions and the latest information.
Give Form to the
requester. Do not
send to the IRS.Print or type. See Specific Instructions on page 3.1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank.
2 Business name/disregarded entity name, if different from above
3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the
following seven boxes.
Individual/sole proprietor or
single-member LLC
C Corporation S Corporation Partnership Trust/estate
Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) a
Note: Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check
LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is
another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-member LLC that
is disregarded from the owner should check the appropriate box for the tax classification of its owner.
Other (see instructions) a
4 Exemptions (codes apply only to
certain entities, not individuals; see
instructions on page 3):
Exempt payee code (if any)
Exemption from FATCA reporting
code (if any)
(Applies to accounts maintained outside the U.S.)
Requester’s name and address (optional)
7 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 line 1 to avoid
backup withholding. For individuals, this is generally your social security number (SSN). However, for a
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.
Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and
Number To Give the Requester for guidelines on whose number to enter.
Social security number
––
or
Employer identification number
–
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 (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 II, later.
Sign
Here
Signature of
U.S. person a Date a
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.gov/FormW9.
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)
ns. You must cross out item 2 above if you have been notified by the IRS that you
all interest and dividends on your tax return. For real estate transactions, item 2
ent of secured property, cancellation of debt, contributions to an individual retire
ividends, you are not required to sign the certification, but you must provide you
a D
ructions
to the Internal Re en e Code nless other ise
• Form 1099-DIV (div
funds)
January 02, 2022
Indusco Environmental Services Inc
✔
5 Address (number, street, and apt. or suite no.) See instructions.
PO Box 790
6 City, state, and ZIP code
Daphne, AL 36526
58 2051685
16.C.7.c
Packet Pg. 1276 Attachment: 22-7975 Indusco Combined Bid Package (22320 : Tower Packing Media Replacement for Water Treatment Plants)
Form W-9 (Rev. 10-2018)Page 2
By signing the filled-out form, you:
1. Certify that the TIN you are giving is correct (or you are waiting for a
number to be issued),
2. Certify 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.
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 party 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:
1. 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 furnished 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.
16.C.7.c
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Form W-9 (Rev. 10-2018)Page 3
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 FFI 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 1040/1040A/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.
IF the entity/person on line 1 is
a(n) . . .
THEN check the box for . . .
• Corporation Corporation
• Individual
• Sole proprietorship, or
• Single-member limited liability
company (LLC) owned by an
individual and disregarded for U.S.
federal tax purposes.
Individual/sole proprietor or single-
member LLC
• LLC treated as a partnership for
U.S. federal tax purposes,
• LLC that has filed Form 8832 or
2553 to be taxed as a 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.
Limited liability company and enter
the appropriate tax classification.
(P= Partnership; C= C corporation;
or S= S corporation)
• 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
attorneys’ 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
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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
patronage dividends
Exempt payees 1 through 4
Payments over $600 required to be
reported and direct sales over
$5,0001
Generally, exempt payees
1 through 52
Payments made in settlement of
payment card or third party network
transactions
Exempt payees 1 through 4
1 See Form 1099-MISC, Miscellaneous Income, and its instructions.
2 However, the following payments made to a corporation and
reportable on Form 1099-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)(i)
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.
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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 certification. 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:Give name and SSN of:
1. Individual The individual
2. Two or more individuals (joint
account) other than an account
maintained by an FFI
The actual owner of the account or, if
combined funds, the first individual on
the account1
3. Two or more U.S. persons
(joint account maintained by an FFI)
Each holder of the account
4. Custodial account of a minor
(Uniform Gift to Minors Act)
The minor2
5. a. The usual revocable savings trust
(grantor is also trustee)
b. So-called trust account that is not
a legal or valid trust under state law
The grantor-trustee1
The actual owner1
6. Sole proprietorship or disregarded
entity owned by an individual
The owner3
7. Grantor trust filing under Optional
Form 1099 Filing Method 1 (see
Regulations section 1.671-4(b)(2)(i)
(A))
The grantor*
For this type of account:Give name and EIN of:
8. Disregarded entity not owned by an
individual
The owner
9. A valid trust, estate, or pension trust Legal entity4
10. Corporation or LLC electing
corporate status on Form 8832 or
Form 2553
The corporation
11. Association, club, religious,
charitable, educational, or other tax-
exempt organization
The organization
12. Partnership or multi-member LLC The partnership
13. A broker or registered nominee The broker or nominee
For this type of account:Give name and EIN of:
14. Account with the Department of
Agriculture in the name of a public
entity (such as a state or local
government, school district, or
prison) that receives agricultural
program payments
The public entity
15. Grantor trust filing under the Form
1041 Filing Method or the Optional
Form 1099 Filing Method 2 (see
Regulations section 1.671-4(b)(2)(i)(B))
The trust
1 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.
4 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 for partnerships, 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.
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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 (TIGTA) 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.IdentityTheft.gov
and Pub. 5027.
Visit www.irs.gov/IdentityTheft 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 civil 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.
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Page 1 of 17 E-Verify MOU for Employers | Revision Date 06/01/13
Company ID Number:
THE E-VERIFY
MEMORANDUM OF UNDERSTANDING
FOR EMPLOYERS
ARTICLE I
PURPOSE AND AUTHORITY
E-Verify is a program that electronically confirms an employee’s eligibility to work in the United States
after completion of Form I-9, Employment Eligibility Verification (Form I-9). This Memorandum of
Understanding (MOU) explains certain features of the E-Verify program and describes specific
responsibilities of the Employer, the Social Security Administration (SSA), and DHS.
Authority for the E-Verify program is found in Title IV, Subtitle A, of the Illegal Immigration Reform and
Immigrant Responsibility Act of 1996 (IIRIRA), Pub. L. 104-208, 110 Stat. 3009, as amended (8 U.S.C.
§ 1324a note). The Federal Acquisition Regulation (FAR) Subpart 22.18, “Employment Eligibility
Verification” and Executive Order 12989, as amended, provide authority for Federal contractors and
subcontractors (Federal contractor) to use E-Verify to verify the employment eligibility of certain
employees working on Federal contracts.
ARTICLE II
RESPONSIBILITIES
A. RESPONSIBILITIES OF THE EMPLOYER
1.The Employer agrees to display the following notices supplied by DHS in a prominent place that is
clearly visible to prospective employees and all employees who are to be verified through the system:
a.Notice of E-Verify Participation
b.Notice of Right to Work
2.The Employer agrees to provide to the SSA and DHS the names, titles, addresses, and telephone
numbers of the Employer representatives to be contacted about E-Verify. The Employer also agrees to
keep such information current by providing updated information to SSA and DHS whenever the
representatives’ contact information changes.
3.The Employer agrees to grant E-Verify access only to current employees who need E-Verify access.
Employers must promptly terminate an employee’s E-Verify access if the employer is separated from
the company or no longer needs access to E-Verify.
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The parties to this agreement are the Department of Homeland Security (DHS) and the
DeLoach Industries, Inc (Employer). The purpose of this agreement is to set forth terms and
conditions which the Employer will follow while participating in E-Verify.
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Company ID Number:
4. The Employer agrees to become familiar with and comply with the most recent version of the
E-Verify User Manual.
5. The Employer agrees that any Employer Representative who will create E-Verify cases will
complete the E-Verify Tutorial before that individual creates any cases.
a. The Employer agrees that all Employer representatives will take the refresher tutorials when
prompted by E-Verify in order to continue using E-Verify. Failure to complete a refresher tutorial
will prevent the Employer Representative from continued use of E-Verify.
6. The Employer agrees to comply with current Form I-9 procedures, with two exceptions:
a. If an employee presents a "List B" identity document, the Employer agrees to only accept "List
B" documents that contain a photo. (List B documents identified in 8 C.F.R. § 274a.2(b)(1)(B)) can
be presented during the Form I-9 process to establish identity.) If an employee objects to the photo
requirement for religious reasons, the Employer should contact E-Verify at
888-464-4218.
b. If an employee presents a DHS Form I-551 (Permanent Resident Card), Form I-766
(Employment Authorization Document), or U.S. Passport or Passport Card to complete Form I-9,
the Employer agrees to make a photocopy of the document and to retain the photocopy with the
employee’s Form I-9. The Employer will use the photocopy to verify the photo and to assist DHS
with its review of photo mismatches that employees contest. DHS may in the future designate
other documents that activate the photo screening tool.
Note: Subject only to the exceptions noted previously in this paragraph, employees still retain the right
to present any List A, or List B and List C, document(s) to complete the Form I-9.
7. The Employer agrees to record the case verification number on the employee's Form I-9 or to print
the screen containing the case verification number and attach it to the employee's Form I-9.
8. The Employer agrees that, although it participates in E-Verify, the Employer has a responsibility to
complete, retain, and make available for inspection Forms I-9 that relate to its employees, or from other
requirements of applicable regulations or laws, including the obligation to comply with the
antidiscrimination requirements of section 274B of the INA with respect to Form I-9 procedures.
a. The following modified requirements are the only exceptions to an Employer’s obligation to not
employ unauthorized workers and comply with the anti-discrimination provision of the INA: (1) List B
identity documents must have photos, as described in paragraph 6 above; (2) When an Employer
confirms the identity and employment eligibility of newly hired employee using E-Verify procedures,
the Employer establishes a rebuttable presumption that it has not violated section 274A(a)(1)(A) of
the Immigration and Nationality Act (INA) with respect to the hiring of that employee; (3) If the
Employer receives a final nonconfirmation for an employee, but continues to employ that person,
the Employer must notify DHS and the Employer is subject to a civil money penalty between $550
and $1,100 for each failure to notify DHS of continued employment following a final
nonconfirmation; (4) If the Employer continues to employ an employee after receiving a final
nonconfirmation, then the Employer is subject to a rebuttable presumption that it has knowingly
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employed an unauthorized alien in violation of section 274A(a)(1)(A); and (5) no E-Verify participant
is civilly or criminally liable under any law for any action taken in good faith based on information
provided through the E-Verify.
b. DHS reserves the right to conduct Form I-9 compliance inspections, as well as any other
enforcement or compliance activity authorized by law, including site visits, to ensure proper use of
E-Verify.
9. The Employer is strictly prohibited from creating an E-Verify case before the employee has been
hired, meaning that a firm offer of employment was extended and accepted and Form I-9 was
completed. The Employer agrees to create an E-Verify case for new employees within three Employer
business days after each employee has been hired (after both Sections 1 and 2 of Form I-9 have been
completed), and to complete as many steps of the E-Verify process as are necessary according to the
E-Verify User Manual. If E-Verify is temporarily unavailable, the three-day time period will be extended
until it is again operational in order to accommodate the Employer's attempting, in good faith, to make
inquiries during the period of unavailability.
10. The Employer agrees not to use E-Verify for pre-employment screening of job applicants, in
support of any unlawful employment practice, or for any other use that this MOU or the E-Verify User
Manual does not authorize.
11. The Employer must use E-Verify for all new employees. The Employer will not verify selectively
and will not verify employees hired before the effective date of this MOU. Employers who are Federal
contractors may qualify for exceptions to this requirement as described in Article II.B of this MOU.
12. The Employer agrees to follow appropriate procedures (see Article III below) regarding tentative
nonconfirmations. The Employer must promptly notify employees in private of the finding and provide
them with the notice and letter containing information specific to the employee’s E-Verify case. The
Employer agrees to provide both the English and the translated notice and letter for employees with
limited English proficiency to employees. The Employer agrees to provide written referral instructions
to employees and instruct affected employees to bring the English copy of the letter to the SSA. The
Employer must allow employees to contest the finding, and not take adverse action against employees
if they choose to contest the finding, while their case is still pending. Further, when employees contest
a tentative nonconfirmation based upon a photo mismatch, the Employer must take additional steps
(see Article III.B. below) to contact DHS with information necessary to resolve the challenge.
13. The Employer agrees not to take any adverse action against an employee based upon the
employee's perceived employment eligibility status while SSA or DHS is processing the verification
request unless the Employer obtains knowledge (as defined in 8 C.F.R. § 274a.1(l)) that the employee
is not work authorized. The Employer understands that an initial inability of the SSA or DHS automated
verification system to verify work authorization, a tentative nonconfirmation, a case in continuance
(indicating the need for additional time for the government to resolve a case), or the finding of a photo
mismatch, does not establish, and should not be interpreted as, evidence that the employee is not work
authorized. In any of such cases, the employee must be provided a full and fair opportunity to contest
the finding, and if he or she does so, the employee may not be terminated or suffer any adverse
employment consequences based upon the employee’s perceived employment eligibility status
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(including denying, reducing, or extending work hours, delaying or preventing training, requiring an
employee to work in poorer conditions, withholding pay, refusing to assign the employee to a Federal
contract or other assignment, or otherwise assuming that he or she is unauthorized to work) until and
unless secondary verification by SSA or DHS has been completed and a final nonconfirmation has
been issued. If the employee does not choose to contest a tentative nonconfirmation or a photo
mismatch or if a secondary verification is completed and a final nonconfirmation is issued, then the
Employer can find the employee is not work authorized and terminate the employee’s employment.
Employers or employees with questions about a final nonconfirmation may call E-Verify at 1-888-464-
4218 (customer service) or 1-888-897-7781 (worker hotline).
14. The Employer agrees to comply with Title VII of the Civil Rights Act of 1964 and section 274B of
the INA as applicable by not discriminating unlawfully against any individual in hiring, firing,
employment eligibility verification, or recruitment or referral practices because of his or her national
origin or citizenship status, or by committing discriminatory documentary practices. The Employer
understands that such illegal practices can include selective verification or use of E-Verify except as
provided in part D below, or discharging or refusing to hire employees because they appear or sound
“foreign” or have received tentative nonconfirmations. The Employer further understands that any
violation of the immigration-related unfair employment practices provisions in section 274B of the INA
could subject the Employer to civil penalties, back pay awards, and other sanctions, and violations of
Title VII could subject the Employer to back pay awards, compensatory and punitive damages.
Violations of either section 274B of the INA or Title VII may also lead to the termination of its
participation in E-Verify. If the Employer has any questions relating to the anti-discrimination provision,
it should contact OSC at 1-800-255-8155 or 1-800-237-2515 (TDD).
15. The Employer agrees that it will use the information it receives from E-Verify only to confirm the
employment eligibility of employees as authorized by this MOU. The Employer agrees that it will
safeguard this information, and means of access to it (such as PINS and passwords), to ensure that it
is not used for any other purpose and as necessary to protect its confidentiality, including ensuring that
it is not disseminated to any person other than employees of the Employer who are authorized to
perform the Employer's responsibilities under this MOU, except for such dissemination as may be
authorized in advance by SSA or DHS for legitimate purposes.
16. The Employer agrees to notify DHS immediately in the event of a breach of personal information.
Breaches are defined as loss of control or unauthorized access to E-Verify personal data. All
suspected or confirmed breaches should be reported by calling 1-888-464-4218 or via email at
E-Verify@dhs.gov. Please use “Privacy Incident – Password” in the subject line of your email when
sending a breach report to E-Verify.
17. The Employer acknowledges that the information it receives from SSA is governed by the Privacy
Act (5 U.S.C. § 552a(i)(1) and (3)) and the Social Security Act (42 U.S.C. 1306(a)). Any person who
obtains this information under false pretenses or uses it for any purpose other than as provided for in
this MOU may be subject to criminal penalties.
18. The Employer agrees to cooperate with DHS and SSA in their compliance monitoring and
evaluation of E-Verify, which includes permitting DHS, SSA, their contractors and other agents, upon
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reasonable notice, to review Forms I-9 and other employment records and to interview it and its
employees regarding the Employer’s use of E-Verify, and to respond in a prompt and accurate manner
to DHS requests for information relating to their participation in E-Verify.
19. The Employer shall not make any false or unauthorized claims or references about its participation
in E-Verify on its website, in advertising materials, or other media. The Employer shall not describe its
services as federally-approved, federally-certified, or federally-recognized, or use language with a
similar intent on its website or other materials provided to the public. Entering into this MOU does not
mean that E-Verify endorses or authorizes your E-Verify services and any claim to that effect is false.
20. The Employer shall not state in its website or other public documents that any language used
therein has been provided or approved by DHS, USCIS or the Verification Division, without first
obtaining the prior written consent of DHS.
21. The Employer agrees that E-Verify trademarks and logos may be used only under license by
DHS/USCIS (see M-795 (Web)) and, other than pursuant to the specific terms of such license, may not
be used in any manner that might imply that the Employer’s services, products, websites, or
publications are sponsored by, endorsed by, licensed by, or affiliated with DHS, USCIS, or E-Verify.
22. The Employer understands that if it uses E-Verify procedures for any purpose other than as
authorized by this MOU, the Employer may be subject to appropriate legal action and termination of its
participation in E-Verify according to this MOU.
B. RESPONSIBILITIES OF FEDERAL CONTRACTORS
1. If the Employer is a Federal contractor with the FAR E-Verify clause subject to the employment
verification terms in Subpart 22.18 of the FAR, it will become familiar with and comply with the most
current version of the E-Verify User Manual for Federal Contractors as well as the E-Verify
Supplemental Guide for Federal Contractors.
2. In addition to the responsibilities of every employer outlined in this MOU, the Employer understands
that if it is a Federal contractor subject to the employment verification terms in Subpart 22.18 of the
FAR it must verify the employment eligibility of any “employee assigned to the contract” (as defined in
FAR 22.1801). Once an employee has been verified through E-Verify by the Employer, the Employer
may not create a second case for the employee through E-Verify.
a. An Employer that is not enrolled in E-Verify as a Federal contractor at the time of a contract
award must enroll as a Federal contractor in the E-Verify program within 30 calendar days of
contract award and, within 90 days of enrollment, begin to verify employment eligibility of new hires
using E-Verify. The Employer must verify those employees who are working in the United States,
whether or not they are assigned to the contract. Once the Employer begins verifying new hires,
such verification of new hires must be initiated within three business days after the hire date. Once
enrolled in E-Verify as a Federal contractor, the Employer must begin verification of employees
assigned to the contract within 90 calendar days after the date of enrollment or within 30 days of an
employee’s assignment to the contract, whichever date is later.
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b. Employers enrolled in E-Verify as a Federal contractor for 90 days or more at the time of a
contract award must use E-Verify to begin verification of employment eligibility for new hires of the
Employer who are working in the United States, whether or not assigned to the contract, within
three business days after the date of hire. If the Employer is enrolled in E-Verify as a Federal
contractor for 90 calendar days or less at the time of contract award, the Employer must, within 90
days of enrollment, begin to use E-Verify to initiate verification of new hires of the contractor who
are working in the United States, whether or not assigned to the contract. Such verification of new
hires must be initiated within three business days after the date of hire. An Employer enrolled as a
Federal contractor in E-Verify must begin verification of each employee assigned to the contract
within 90 calendar days after date of contract award or within 30 days after assignment to the
contract, whichever is later.
c. Federal contractors that are institutions of higher education (as defined at 20 U.S.C. 1001(a)),
state or local governments, governments of Federally recognized Indian tribes, or sureties
performing under a takeover agreement entered into with a Federal agency under a performance
bond may choose to only verify new and existing employees assigned to the Federal contract. Such
Federal contractors may, however, elect to verify all new hires, and/or all existing employees hired
after November 6, 1986. Employers in this category must begin verification of employees assigned
to the contract within 90 calendar days after the date of enrollment or within 30 days of an
employee’s assignment to the contract, whichever date is later.
d. Upon enrollment, Employers who are Federal contractors may elect to verify employment
eligibility of all existing employees working in the United States who were hired after November 6,
1986, instead of verifying only those employees assigned to a covered Federal contract. After
enrollment, Employers must elect to verify existing staff following DHS procedures and begin
E-Verify verification of all existing employees within 180 days after the election.
e. The Employer may use a previously completed Form I-9 as the basis for creating an E-Verify
case for an employee assigned to a contract as long as:
i. That Form I-9 is complete (including the SSN) and complies with Article II.A.6,
ii. The employee’s work authorization has not expired, and
iii. The Employer has reviewed the Form I-9 information either in person or in
communications with the employee to ensure that the employee’s Section 1, Form I-9
attestation has not changed (including, but not limited to, a lawful permanent resident alien
having become a naturalized U.S. citizen).
f. The Employer shall complete a new Form I-9 consistent with Article II.A.6 or update the
previous Form I-9 to provide the necessary information if:
i. The Employer cannot determine that Form I-9 complies with Article II.A.6,
ii. The employee’s basis for work authorization as attested in Section 1 has expired or
changed, or
iii. The Form I-9 contains no SSN or is otherwise incomplete.
Note: If Section 1 of Form I-9 is otherwise valid and up-to-date and the form otherwise complies with
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Article II.C.5, but reflects documentation (such as a U.S. passport or Form I-551) that expired after
completing Form I-9, the Employer shall not require the production of additional documentation, or use
the photo screening tool described in Article II.A.5, subject to any additional or superseding instructions
that may be provided on this subject in the E-Verify User Manual.
g. The Employer agrees not to require a second verification using E-Verify of any assigned
employee who has previously been verified as a newly hired employee under this MOU or to
authorize verification of any existing employee by any Employer that is not a Federal contractor
based on this Article.
3. The Employer understands that if it is a Federal contractor, its compliance with this MOU is a
performance requirement under the terms of the Federal contract or subcontract, and the Employer
consents to the release of information relating to compliance with its verification responsibilities under
this MOU to contracting officers or other officials authorized to review the Employer’s compliance with
Federal contracting requirements.
C. RESPONSIBILITIES OF SSA
1. SSA agrees to allow DHS to compare data provided by the Employer against SSA’s database. SSA
sends DHS confirmation that the data sent either matches or does not match the information in SSA’s
database.
2. SSA agrees to safeguard the information the Employer provides through E-Verify procedures. SSA
also agrees to limit access to such information, as is appropriate by law, to individuals responsible for
the verification of Social Security numbers or responsible for evaluation of E-Verify or such other
persons or entities who may be authorized by SSA as governed by the Privacy Act (5 U.S.C. § 552a),
the Social Security Act (42 U.S.C. 1306(a)), and SSA regulations (20 CFR Part 401).
3. SSA agrees to provide case results from its database within three Federal Government work days of
the initial inquiry. E-Verify provides the information to the Employer.
4. SSA agrees to update SSA records as necessary if the employee who contests the SSA tentative
nonconfirmation visits an SSA field office and provides the required evidence. If the employee visits an
SSA field office within the eight Federal Government work days from the date of referral to SSA, SSA
agrees to update SSA records, if appropriate, within the eight-day period unless SSA determines that
more than eight days may be necessary. In such cases, SSA will provide additional instructions to the
employee. If the employee does not visit SSA in the time allowed, E-Verify may provide a final
nonconfirmation to the employer.
Note: If an Employer experiences technical problems, or has a policy question, the employer should
contact E-Verify at 1-888-464-4218.
D. RESPONSIBILITIES OF DHS
1. DHS agrees to provide the Employer with selected data from DHS databases to enable the
Employer to conduct, to the extent authorized by this MOU:
a. Automated verification checks on alien employees by electronic means, and
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b. Photo verification checks (when available) on employees.
2. DHS agrees to assist the Employer with operational problems associated with the Employer's
participation in E-Verify. DHS agrees to provide the Employer names, titles, addresses, and telephone
numbers of DHS representatives to be contacted during the E-Verify process.
3. DHS agrees to provide to the Employer with access to E-Verify training materials as well as an
E-Verify User Manual that contain instructions on E-Verify policies, procedures, and requirements for
both SSA and DHS, including restrictions on the use of E-Verify.
4. DHS agrees to train Employers on all important changes made to E-Verify through the use of
mandatory refresher tutorials and updates to the E-Verify User Manual. Even without changes to
E-Verify, DHS reserves the right to require employers to take mandatory refresher tutorials.
5. DHS agrees to provide to the Employer a notice, which indicates the Employer's participation in
E-Verify. DHS also agrees to provide to the Employer anti-discrimination notices issued by the Office of
Special Counsel for Immigration-Related Unfair Employment Practices (OSC), Civil Rights Division,
U.S. Department of Justice.
6. DHS agrees to issue each of the Employer’s E-Verify users a unique user identification number and
password that permits them to log in to E-Verify.
7. DHS agrees to safeguard the information the Employer provides, and to limit access to such
information to individuals responsible for the verification process, for evaluation of E-Verify, or to such
other persons or entities as may be authorized by applicable law. Information will be used only to verify
the accuracy of Social Security numbers and employment eligibility, to enforce the INA and Federal
criminal laws, and to administer Federal contracting requirements.
8. DHS agrees to provide a means of automated verification that provides (in conjunction with SSA
verification procedures) confirmation or tentative nonconfirmation of employees' employment eligibility
within three Federal Government work days of the initial inquiry.
9. DHS agrees to provide a means of secondary verification (including updating DHS records) for
employees who contest DHS tentative nonconfirmations and photo mismatch tentative
nonconfirmations. This provides final confirmation or nonconfirmation of the employees' employment
eligibility within 10 Federal Government work days of the date of referral to DHS, unless DHS
determines that more than 10 days may be necessary. In such cases, DHS will provide additional
verification instructions.
ARTICLE III
REFERRAL OF INDIVIDUALS TO SSA AND DHS
A. REFERRAL TO SSA
1. If the Employer receives a tentative nonconfirmation issued by SSA, the Employer must print the
notice as directed by E-Verify. The Employer must promptly notify employees in private of the finding
and provide them with the notice and letter containing information specific to the employee’s E-Verify
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case. The Employer also agrees to provide both the English and the translated notice and letter for
employees with limited English proficiency to employees. The Employer agrees to provide written
referral instructions to employees and instruct affected employees to bring the English copy of the letter
to the SSA. The Employer must allow employees to contest the finding, and not take adverse action
against employees if they choose to contest the finding, while their case is still pending.
2. The Employer agrees to obtain the employee’s response about whether he or she will contest the
tentative nonconfirmation as soon as possible after the Employer receives the tentative
nonconfirmation. Only the employee may determine whether he or she will contest the tentative
nonconfirmation.
3. After a tentative nonconfirmation, the Employer will refer employees to SSA field offices only as
directed by E-Verify. The Employer must record the case verification number, review the employee
information submitted to E-Verify to identify any errors, and find out whether the employee contests the
tentative nonconfirmation. The Employer will transmit the Social Security number, or any other
corrected employee information that SSA requests, to SSA for verification again if this review indicates
a need to do so.
4. The Employer will instruct the employee to visit an SSA office within eight Federal Government work
days. SSA will electronically transmit the result of the referral to the Employer within 10 Federal
Government work days of the referral unless it determines that more than 10 days is necessary.
5. While waiting for case results, the Employer agrees to check the E-Verify system regularly for case
updates.
6. The Employer agrees not to ask the employee to obtain a printout from the Social Security
Administration number database (the Numident) or other written verification of the SSN from the SSA.
B. REFERRAL TO DHS
1. If the Employer receives a tentative nonconfirmation issued by DHS, the Employer must promptly
notify employees in private of the finding and provide them with the notice and letter containing
information specific to the employee’s E-Verify case. The Employer also agrees to provide both the
English and the translated notice and letter for employees with limited English proficiency to
employees. The Employer must allow employees to contest the finding, and not take adverse action
against employees if they choose to contest the finding, while their case is still pending.
2. The Employer agrees to obtain the employee’s response about whether he or she will contest the
tentative nonconfirmation as soon as possible after the Employer receives the tentative
nonconfirmation. Only the employee may determine whether he or she will contest the tentative
nonconfirmation.
3. The Employer agrees to refer individuals to DHS only when the employee chooses to contest a
tentative nonconfirmation.
4. If the employee contests a tentative nonconfirmation issued by DHS, the Employer will instruct the
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employee to contact DHS through its toll-free hotline (as found on the referral letter) within eight
Federal Government work days.
5. If the Employer finds a photo mismatch, the Employer must provide the photo mismatch tentative
nonconfirmation notice and follow the instructions outlined in paragraph 1 of this section for tentative
nonconfirmations, generally.
6. The Employer agrees that if an employee contests a tentative nonconfirmation based upon a photo
mismatch, the Employer will send a copy of the employee’s Form I-551, Form I-766, U.S. Passport, or
passport card to DHS for review by:
a. Scanning and uploading the document, or
b. Sending a photocopy of the document by express mail (furnished and paid for by the employer).
7. The Employer understands that if it cannot determine whether there is a photo match/mismatch, the
Employer must forward the employee’s documentation to DHS as described in the preceding
paragraph. The Employer agrees to resolve the case as specified by the DHS representative who will
determine the photo match or mismatch.
8. DHS will electronically transmit the result of the referral to the Employer within 10 Federal
Government work days of the referral unless it determines that more than 10 days is necessary.
9. While waiting for case results, the Employer agrees to check the E-Verify system regularly for case
updates.
ARTICLE IV
SERVICE PROVISIONS
A. NO SERVICE FEES
1. SSA and DHS will not charge the Employer for verification services performed under this MOU. The
Employer is responsible for providing equipment needed to make inquiries. To access E-Verify, an
Employer will need a personal computer with Internet access.
ARTICLE V
MODIFICATION AND TERMINATION
A. MODIFICATION
1. This MOU is effective upon the signature of all parties and shall continue in effect for as long as the
SSA and DHS operates the E-Verify program unless modified in writing by the mutual consent of all
parties.
2. Any and all E-Verify system enhancements by DHS or SSA, including but not limited to E-Verify
checking against additional data sources and instituting new verification policies or procedures, will be
covered under this MOU and will not cause the need for a supplemental MOU that outlines these
changes.
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B. TERMINATION
1. The Employer may terminate this MOU and its participation in E-Verify at any time upon 30 days
prior written notice to the other parties.
2. Notwithstanding Article V, part A of this MOU, DHS may terminate this MOU, and thereby the
Employer’s participation in E-Verify, with or without notice at any time if deemed necessary because of
the requirements of law or policy, or upon a determination by SSA or DHS that there has been a breach
of system integrity or security by the Employer, or a failure on the part of the Employer to comply with
established E-Verify procedures and/or legal requirements. The Employer understands that if it is a
Federal contractor, termination of this MOU by any party for any reason may negatively affect the
performance of its contractual responsibilities. Similarly, the Employer understands that if it is in a state
where E-Verify is mandatory, termination of this by any party MOU may negatively affect the
Employer’s business.
3. An Employer that is a Federal contractor may terminate this MOU when the Federal contract that
requires its participation in E-Verify is terminated or completed. In such cases, the Federal contractor
must provide written notice to DHS. If an Employer that is a Federal contractor fails to provide such
notice, then that Employer will remain an E-Verify participant, will remain bound by the terms of this
MOU that apply to non-Federal contractor participants, and will be required to use the E-Verify
procedures to verify the employment eligibility of all newly hired employees.
4. The Employer agrees that E-Verify is not liable for any losses, financial or otherwise, if the Employer
is terminated from E-Verify.
ARTICLE VI
PARTIES
A. Some or all SSA and DHS responsibilities under this MOU may be performed by contractor(s), and
SSA and DHS may adjust verification responsibilities between each other as necessary. By separate
agreement with DHS, SSA has agreed to perform its responsibilities as described in this MOU.
B. Nothing in this MOU is intended, or should be construed, to create any right or benefit, substantive
or procedural, enforceable at law by any third party against the United States, its agencies, officers, or
employees, or against the Employer, its agents, officers, or employees.
C. The Employer may not assign, directly or indirectly, whether by operation of law, change of control or
merger, all or any part of its rights or obligations under this MOU without the prior written consent of
DHS, which consent shall not be unreasonably withheld or delayed. Any attempt to sublicense, assign,
or transfer any of the rights, duties, or obligations herein is void.
D. Each party shall be solely responsible for defending any claim or action against it arising out of or
related to E-Verify or this MOU, whether civil or criminal, and for any liability wherefrom, including (but
not limited to) any dispute between the Employer and any other person or entity regarding the
applicability of Section 403(d) of IIRIRA to any action taken or allegedly taken by the Employer.
E. The Employer understands that its participation in E-Verify is not confidential information and may be
disclosed as authorized or required by law and DHS or SSA policy, including but not limited to,
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Congressional oversight, E-Verify publicity and media inquiries, determinations of compliance with
Federal contractual requirements, and responses to inquiries under the Freedom of Information Act
(FOIA).
F. The individuals whose signatures appear below represent that they are authorized to enter into this
MOU on behalf of the Employer and DHS respectively. The Employer understands that any inaccurate
statement, representation, data or other information provided to DHS may subject the Employer, its
subcontractors, its employees, or its representatives to: (1) prosecution for false statements pursuant to
18 U.S.C. 1001 and/or; (2) immediate termination of its MOU and/or; (3) possible debarment or
suspension.
G. The foregoing constitutes the full agreement on this subject between DHS and the Employer.
To be accepted as an E-Verify participant, you should only sign the Employer’s Section of the
signature page. If you have any questions, contact E-Verify at 1-888-464-4218.
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Approved by:
Employer
Name (Please Type or Print) Title
Signature Date
Department of Homeland Security – Verification Division
Name (Please Type or Print) Title
Signature Date
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DeLoach Industries, Inc
Patricia DeYoe
Electronically Signed 04/05/2022
USCIS Verification Division
Electronically Signed 04/05/2022
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Company ID Number:
Information Required for the E-Verify Program
Information relating to your Company:
Company Name
Company Facility Address
Company Alternate Address
County or Parish
Employer Identification Number
North American Industry
Classification Systems Code
Parent Company
Number of Employees
Number of Sites Verified for
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DeLoach Industries, Inc
6389 Tower Lane
Sarasota, FL 34233
SARASOTA
352470120
332
5 to 9
1
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Are you verifying for more than 1 site? If yes, please provide the number of sites verified for in
each State:
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FLORIDA 1 site(s)
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Company ID Number:
Information relating to the Program Administrator(s) for your Company on policy questions or
operational problems:
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Name Patricia L DeYoe
Phone Number (941) 371 - 4995
Fax Number (941) 677 - 2649
Email Address patty@deloachindustries.com
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16.C.7.dPacket Pg. 1334Attachment: 22-7975 DeLoach Combined Bid Package (22320 : Tower Packing Media Replacement for Water Treatment Plants)
16.C.7.dPacket Pg. 1335Attachment: 22-7975 DeLoach Combined Bid Package (22320 : Tower Packing Media Replacement for Water Treatment Plants)
Document Number
FEI/EIN Number
Date Filed
State
Status
Department of State /Division of Corporations /Search Records /Search by Entity Name /
Detail by Entity Name
Florida Profit Corporation
DELOACH INDUSTRIES INC
Filing Information
P13000017073
35-2470120
02/21/2013
FL
ACTIVE
Principal Address
6389 TOWER LANE
SARASOTA, FL 34240
Changed: 04/29/2020
Mailing Address
6389 TOWER LANE
SARASOTA, FL 34240
Changed: 04/29/2020
Registered Agent Name & Address
DELOACH, ANTHONY
6389 TOWER LANE
SARASOTA, FL 34240
Name Changed: 02/03/2021
Address Changed: 03/21/2018
Officer/Director Detail
Name & Address
Title President
DELOACH, ANTHONY
6389 TOWER LANE
SARASOTA, FL 34240
Title Secretary
D5657589 8: C8;<8;=>5897Florida Department of State
Detail by Entity Name https://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?...
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16.C.7.d
Packet Pg. 1336 Attachment: 22-7975 DeLoach Combined Bid Package (22320 : Tower Packing Media Replacement for Water Treatment Plants)
DELOACH, TRAVIS
6389 TOWER LANE
SARASOTA, FL 34240
Annual Reports
Report Year Filed Date
2020 04/29/2020
2021 02/03/2021
2022 01/27/2022
Document Images
01/27/2022 -- ANNUAL REPORT View image in PDF format
02/03/2021 -- ANNUAL REPORT View image in PDF format
04/29/2020 -- ANNUAL REPORT View image in PDF format
03/06/2019 -- ANNUAL REPORT View image in PDF format
03/21/2018 -- ANNUAL REPORT View image in PDF format
04/13/2017 -- ANNUAL REPORT View image in PDF format
03/18/2016 -- ANNUAL REPORT View image in PDF format
02/23/2015 -- ANNUAL REPORT View image in PDF format
02/27/2014 -- ANNUAL REPORT View image in PDF format
02/21/2013 -- Domestic Profit View image in PDF format
Florida Department of State, Division of Corporations
Detail by Entity Name https://search.sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?...
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16.C.7.d
Packet Pg. 1337 Attachment: 22-7975 DeLoach Combined Bid Package (22320 : Tower Packing Media Replacement for Water Treatment Plants)
16.C.7.dPacket Pg. 1338Attachment: 22-7975 DeLoach Combined Bid Package (22320 : Tower Packing Media Replacement for Water Treatment Plants)
16.C.7.dPacket Pg. 1339Attachment: 22-7975 DeLoach Combined Bid Package (22320 : Tower Packing Media Replacement for Water Treatment Plants)
COLLIER COUNTY
BOARD OF COUNTY COMMISSIONERS
INVITATION TO BID (ITB)
FOR
TOWER PACKING MEDIA REPLACEMENT FOR WATER
TREATMENT PLANTS
SOLICITATION NO.: 22-7975
CYNTHIA MCCANNA, PROCUREMENT STRATEGIST
PROCUREMENT SERVICES DIVISION
3295 TAMIAMI TRAIL EAST, BLDG C-2
NAPLES, FLORIDA 34112
TELEPHONE: (239) 252-8992
Cynthia.McCanna@colliercountyfl.gov (Email)
This solicitation document is prepared in a Microsoft Word format. Any alterations to this
document made by the Bidder may be grounds for rejection of the bid, cancellation of any
subsequent award, or any other legal remedies available to the Collier County Government.
16.C.7.e
Packet Pg. 1340 Attachment: 22-7975 Solicitation (22320 : Tower Packing Media Replacement for Water Treatment Plants)
SOLICITATION PUBLIC NOTICE
INVITATION TO BID (ITB) NUMBER: 22-7975
PROJECT TITLE: TOWER PACKING MEDIA REPLACEMENT FOR WATER TREATMENT
PLANTS
DUE DATE: Tuesday April 5, 2022 at 3:00 PM EST
PLACE OF BID OPENING: PROCUREMENT SERVICES DIVISION
3295 TAMIAMI TRAIL EAST, BLDG C-2
NAPLES, FL 34112
All bids shall be submitted online via the Collier County Procurement Services Division Online Bidding System:
https://www.bidsync.com/bidsync-cas/
INTRODUCTION
As requested by the Water Division (hereinafter, the “Division or Department”), the Collier County Board of County Commissioners
Procurement Services Division (hereinafter, “County”) has issued this Invitation to Bid (hereinafter, “ITB”) with the intent of
obtaining bid submittals from interested and qualified vendors in accordance with the terms, conditions and specifications stated or
attached. The vendor, at a minimum, must achieve the requirements of the Specifications or Scope of Work stated.
The results of this solicitation may be used by other County departments once awarded according to the Board of County
Commissioners Procurement Ordinance.
Media has become fouled and aged and needs to be replaced to maintain an optimized treatment process. Historically, County
departments have spent approximately $300,000 annually related to this process; however, this may not be indicative of future buying
patterns.
BACKGROUND
Raw water from the well field contains entrapped hydrogen sulfide gas (H2S) and during treatment carbon dioxide gas (CO2) is
released from the chemical breakdown of dissolved calcium bicarbonate. For improved water quality, these gases need to be removed
during the water production process.
Tower packing is a critical component of dissolved gas removal and odor control during the treatment and production of drinking
water. The existing packing has become fouled and aged and needs to be replaced to maintain an optimized treatment process and to
prevent degraded water quality. Packing material is a hollow, geometrical shape constructed of a network of ribs, struts and drip rods
for the purpose of providing increased surface area to enhance mass transfer through air-stripping (degasification) and scrubbing (odor
control). Collier County Public Utilities operates sixteen towers at the South Collier Regional Water Treatment Plant (SCRWTP)
utilizing 1,600 ft3 per tower, or 25,600 ft3 total, and twelve towers at the North Collier Regional Water Treatment Plant (NCRWTP)
utilizing eight at 600 ft3 and four at 1,800 ft3 for a total of 12,000 ft3. Each location utilizes NSF 61 certified tower packing in the
towers.
TERM OF CONTRACT
The contract term, if an award(s) is/are made is intended to be for one (1) year with four (4) one (1) year renewal options.
Prices shall remain firm for the initial term of this contract.
Surcharges will not be accepted in conjunction with this contract, and such charges should be incorporated into the pricing structure.
The County Manager, or designee, may, at his discretion, extend the Agreement under all of the terms and conditions contained in this
Agreement for up to one hundred eighty (180) days. The County Manager, or designee, shall give the Contractor written notice of the
County's intention to extend the Agreement term not less than ten (10) days prior to the end of the Agreement term then in effect.
All goods are FOB destination and must be suitably packed and prepared to secure the lowest transportation rates and to
comply with all carrier regulations. Risk of loss of any goods sold hereunder shall transfer to the COUNTY at the time and
place of delivery, provided that risk of loss prior to actual receipt of the goods by the COUNTY nonetheless remain with
VENDOR.
16.C.7.e
Packet Pg. 1341 Attachment: 22-7975 Solicitation (22320 : Tower Packing Media Replacement for Water Treatment Plants)
AWARD CRITERIA
ITB award criteria are as follows:
The County’s Procurement Services Division reserves the right to clarify a vendor’s submittal prior to the award of the
solicitation.
It is the intent of Collier County to award to the lowest, responsive and responsible vendor(s) that represents the best value to
the County.
For the purposes of determining the winning bidder, the County will select the vendor with the lowest price, lowest discount,
or criteria established in the solicitation as outlined below:
• Lowest Price Per Line Item
Collier County reserves the right to select one, or more than one suppliers, award on a line item basis, establish a pool for
quoting, or other options that represents the best value to the County; however, it is the intent to:
• Identify Primary and Secondary Awardees.
The County reserves the right to issue a formal contract or standard County Purchase Order for the award of this solicitation.
DETAILED SCOPE OF WORK
The scope of this project includes the purchase of NSF certified, geometrical shaped tower packing.
Newly installed public water system (PWS) components, like tower packing, that come into contact with drinking water or drinking
water treatment chemicals shall conform to National Sanitation Foundation/American National Standards Institute (NSF/ANSI)
Standard 61: Drinking Water System Components as adopted in Rule 62-555 Florida Administrative Code.
Submittals need to be received for the procurement of NSF/ANSI 61 certified tower packing in either 3 ½” spheres and/or 2” barrels
size/shape. The packing needs to be shipped in 60 ft3 Super sacks. Unit prices are inclusive of shipping costs.
VENDOR CHECKLIST
***Vendor should check off each of the following items as the necessary action is completed (please see, Vendor Check List)***
16.C.7.e
Packet Pg. 1342 Attachment: 22-7975 Solicitation (22320 : Tower Packing Media Replacement for Water Treatment Plants)