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Agenda 01/13/2026 Item #16C 3 (Award Invitation to Bid No. 25-8392 to Universal Controls Instrument Services, Inc and terminate agreement #20-7750 with Universal Controls Instrument Services Inc, Trinova Inc, and Benro Enterprises Inc)
1/13/2026 Item # 16.C.3 ID# 2025-4925 Executive Summary Recommendation that the Board of County Commissioners, as the ex-officio Governing Board of the Collier County Water-Sewer District, award Invitation to Bid No. 25-8392 to Universal Controls Instrument Services, Inc., for Instrument Calibration, Repair, and Replacement Services, terminate for convenience agreement #20-7750 with Universal Controls Instrument Services, Inc., Trinova Inc., and Benro Enterprises Inc., and authorize the Chair to sign the attached Agreement. OBJECTIVE: The public purpose is to maintain various types of instrumentation throughout the Collier County Water Sewer District (“CCWSD”) for the Water, Wastewater and Irrigation Quality (IQ) facilities, including plants, booster stations, well fields, master pumps, and lift stations. This action is to procure a vendor to maintain the integrity and continuous operations of the various instruments by providing instrument calibration, repairs, and replacement services for planned and emergency work. CONSIDERATIONS: CCWSD is responsible for providing the continuous operation of its Public Utilities systems. Instrument calibration, repair, and replacement services for utility control systems are required to maintain facilities in regulatory compliance with the Florida Department of Environmental Protection. On July 10, 2024, the Procurement Services Division released notices for Invitation to Bid (ITB) No. 25-8392, Instrument Calibration, Repair, and Replacement Services. Notifications were sent to 3,270 vendors; 451 viewed the bid information; and one bid was submitted by the August 25, 2024, submission deadline. The solicitation deadline was extended twice for a total of 14 days, during which time staff conducted additional vendor outreach. Staff reviewed the bid received and determined Universal Controls Instrument Services, Inc., to be responsive and responsible, with minor irregularities. A fair, open, and transparent competitive process was conducted. The attached proposed agreement will become effective upon Board approval and provides for a three-year term, with two one-year renewal options. This agreement will replace existing agreements #20-7750 with Universal Controls Instrument Services, Inc., Trinova Inc., and Benro Enterprises Inc., which will terminate upon execution of the new agreement into the financial system. Even with two extensions to the submission deadline, only one proposal was received in response to this solicitation. This item is consistent with the Collier County strategic plan objective to maintain public infrastructure and facilities to effectively, efficiently, and sustainably meet the needs of our community. It further supports the Infrastructure and Asset Management Strategic Focus Area’s objectives to optimize the useful life of all public infrastructure resources through proper planning and preventative maintenance. FISCAL IMPACT: The source of funding is the Collier County Water-Sewer Operating Fund (4008). GROWTH MANAGEMENT IMPACT: There are no Growth Management impacts associated with this action. LEGAL CONSIDERATIONS: This item has been reviewed by the County Attorney, is approved as to form and legality and requires a majority vote for approval. -JAK RECOMMENDATION(S): To award Invitation to Bid No. 25-8392 to Universal Controls Instrument Services, Inc., Page 8643 of 14062 1/13/2026 Item # 16.C.3 ID# 2025-4925 for Instrument Calibration, Repair, and Replacement Services, terminate for convenience agreement #20-7750 with Universal Controls Instrument Services, Inc., Trinova Inc., and Benro Enterprises Inc., and authorize the Chair to sign the attached Agreement. PREPARED BY: Robert Von Holle, Director, Wastewater Division ATTACHMENTS: 1. 25-8392 Bid Tabulation 2. 25-8392 NORA 3. 25-8392 Solicitation 4. 25-8392 Universal Controls Contract VS 5. 25-8392 Universal Controls Proposal 6. 25-8392 Universal Controls COI exp 11.30.26 (GL, Auto, Umbrella, WC) 7. Benro Notice to Terminate Letter 8. Trinova Notice to Terminate Letter 9. Universal Controls Notice to Terminate Page 8644 of 14062 ITEM NO. DESCRIPTION UNIT QTY UNIT PRICE TOTAL COST 1 Analyzer Calibration / Revalidation Each 103 135.00$ 13,905.00$ 2 Confined Space Entry Fee Each 1 595.00$ 595.00$ 3 Repair and Replacement Labor Rate - Normal Business Hours M-F , 7:00am - 5:00pm Except for County Observed Holidays Hour 192 115.00$ 22,080.00$ 4 Repair and Replacement Labor Rate - Urgent Outside of Normal Business Hours Hour 30 195.00$ 5,850.00$ 42,430.00$ ITEM NO. DESCRIPTION UNIT QTY UNIT PRICE TOTAL COST 1 Flow Meters Calibration / Revalidation Each 274 135.00$ 36,990.00$ 2 Confined Space Entry Fee Each 1 595.00$ 595.00$ 3 Repair and Replacement Labor Rate - Normal Business Hours M-F , 7:00am - 5:00pm Except for County Observed Holidays Hour 32 115.00$ 3,680.00$ 4 Repair and Replacement Labor Rate - Urgent Outside of Normal Business Hours Hour 10 195.00$ 1,950.00$ 43,215.00$ ITEM NO. DESCRIPTION UNIT QTY UNIT PRICE TOTAL COST 1 Level Control Calibration / Revalidation Each 23 135.00$ 3,105.00$ 2 Confined Space Entry Fee Each 1 595.00$ 595.00$ 3 Repair and Replacement Labor Rate - Normal Business Hours M-F , 7:00am - 5:00pm Except for County Observed Holidays Hour 40 115.00$ 4,600.00$ 4 Repair and Replacement Labor Rate - Urgent Outside of Normal Business Hours Hour 10 195.00$ 1,950.00$ 10,250.00$ ITEM NO. DESCRIPTION UNIT QTY UNIT PRICE TOTAL COST 1 Pressure Calibration / Revalidation Each 39 135.00$ 5,265.00$ 2 Confined Space Entry Fee Each 1 595.00$ 595.00$ 3 Repair and Replacement Labor Rate - Normal Business Hours M-F , 7:00am - 5:00pm Except for County Observed Holidays Hour 40 115.00$ 4,600.00$ 4 Repair and Replacement Labor Rate - Urgent Outside of Normal Business Hours Hour 10 195.00$ 1,950.00$ 12,410.00$ Opened By: Rita Iglesias Witnessed By: Andres Fuentes Date: August 25, 2025, 3:00 PM EST Project Manager: Donna Deeter Procurement Strategist: Rita Iglesias Notifications Sent: 3,270 Viewed: 447 Bids Received: 1 CATEGORY A: ANALYZER *Quanties are used for evaluation purposes only. Bid Tabulation ITB No. 25-8392 Instrument Calibration, Repairs and Replacement Services Universal Controls Instrument Services, Inc. Category A Total Line Item: Category B Total Line Item: Category C Total Line Item: CATEGORY B: FLOW METERS CATEGORY C: LEVEL CONTROL Category D Total Line Item: Universal Controls Instrument Services, Inc. CATEGORY D: Pressure Calibration REQUIRED FORMS AND DOCUMENTS YES/NO Bid Schedule YES Bid Response Form (Form 1)YES Contractors Key Personnel Assigned to Project - (Form 2)YES Immigration Affidavit Certification (Form 3)YES Reference Questionaire - at least 3 *YES Business Tax Receipt YES W-9 YES SunBiz YES Insurance Requirements YES Addenda (2)YES E-Verify YES Page 8645 of 14062 Notice of Recommended Award Solicitation: 25-8392 Title: Instrument Calibration, Repair, and Replacement Services Due Date and Time: August 25, 2025 at 3:00 PM EST Respondents: Company Name City County State Bid Amount Responsive/Responsible Universal Controls Instrument Services, Inc. New Port Richey Citrus FL Category A: $42,430.00 Category B: $43,215.00 Category C: $10,250.00 Category D: $12,410.00 Yes/Yes Utilized Local Vendor Preference: Yes No N/A Recommended Vendor(s) For Award: On July 10, 2024, the Procurement Services Division released notices for Invitation to Bid (ITB) No. 25-8392, Instrument Calibration, Repair, and Replacement Services. Three thousand, two hundred and seventy (3,270) notifications were sent, four hundred and fifty-one (451) vendors viewed the bid information, and one (1) bid was submitted by August 25, 2024, the submission deadline. The solicitation deadline was extended two (2) times for a total of fourteen (14) days, during which time staff conducted additional vendor outreach. Staff reviewed the bid received and determined Universal Controls Instrument Services, Inc. to be responsive and responsible, with minor irregularities. A fair, open, and transparent competitive process was conducted. Staff recommends awarding all categories to Universal Controls Instrument Services, Inc. Contract Driven Purchase Order Driven Required Signatures Project Manager: Procurement Strategist: Procurement Services Director: __________________________________ _________________ Sandra Srnka Date Docusign Envelope ID: 36AB28F5-3372-4ED7-B800-211376407124 9/16/2025 9/16/2025 9/16/2025 Page 8646 of 14062 COLLIER COUNTY BOARD OF COUNTY COMMISSIONERS INVITATION TO BID (ITB) FOR INSTRUMENT CALIBRATION, REPAIR, AND REPLACEMENT SERVICES SOLICITATION NO.: 25-8392 RITA IGLESIAS, PROCUREMENT STRATEGIST PROCUREMENT SERVICES DIVISION 3295 TAMIAMI TRAIL EAST, BLDG C-2 NAPLES, FLORIDA 34112 TELEPHONE: (239) 252-1033 Rita.Iglesias@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. Docusign Envelope ID: 35887CEC-618E-4F3D-8F1A-E3250C25A43C Page 8647 of 14062 SOLICITATION PUBLIC NOTICE INVITATION TO BID (ITB) NUMBER: 25-8392 PROJECT TITLE: INSTRUMENT CALIBRATION, REPAIR, AND REPLACEMENT SERVICES PRE- BID MEETING: N/A LOCATION: N/A DUE DATE: August 8, 2025, 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://procurement.opengov.com/portal/collier-county-fl. INTRODUCTION As requested by the Public Utilities 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 Contractors in accordance with the terms, conditions and specifications stated or attached. The Contractor, at a minimum, must achieve the requirements of the Specifications or Scope of Work stated. BACKGROUND Collier County Public Utilities Department is responsible for maintaining various types of instrumentation throughout the County for Water, Wastewater and Irrigation Quality (IQ) facilities, including but not limited to, plants, booster stations, well fields, master pump and lift stations. In order to maintain the integrity and continuous operations of these various instruments, the County is soliciting Contractors to provide instrument calibration (or revalidation), repairs and replacement services for planned and urgent work. Historically, the County has spent approximately $100,000 annually; however, this may not be indicative of future buying patterns. TERM OF CONTRACT The contract term, if an award(s) is/are made is intended to be for three (3) years with two (2) one (1) year renewal options. Prices shall remain firm for the initial term of this contract. Surcharges and/or travel expenses 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 her 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. AWARD CRITERIA ITB award criteria are as follows: The County’s Procurement Services Division reserves the right to clarify a Contractor’s submittal prior to the award of the solicitation. It is the intent of the County to award to the lowest, responsive and responsible Contractor(s) that represents the best value to the County. Docusign Envelope ID: 35887CEC-618E-4F3D-8F1A-E3250C25A43C Page 8648 of 14062 For the purposes of determining the winning bidder, the County will select the Contractor with the lowest Total Line Item cost for each Category listed below: Contractors may bid on one or multiple Categories. o CATEGORY A - Analyzers o CATEGORY B - Flow Meters o CATEGORY C - Level Control o CATEGORY D – Pressure Calibration The County reserves the right to select one, or more suppliers, award on a Total Line Item per category basis, establish a pool for quoting, or other options that represent the best value to the County; however, it is the intent to: o Award a Primary and Secondary Contractor per Category The County reserves the right to issue a formal contract, standard County Purchase Order, or utilize the County Purchasing Card for the award of this solicitation. DETAILED SCOPE OF WORK This solicitation seeks to establish Contractor(s) to provide instrument calibration (or revalidation), repair and replacement services for planned and urgent work. Provided in this solicitation is a reference Exhibit A “Instrument Manufacturer List” for a list of manufacturers currently being used at the County. This list is for reference only and may change as the utility system evolves. Should the Primary Contractor not be able to perform the services or fails to under the resultant contract requirements, the County may move to the Secondary Contractor. Secondary Contractor shall assume all duties and responsibilities of the Primary Contractor. The County reserves the right at any time to use other Contractors for the services described by requesting additional quotes from other Contractors, per the Procurement Ordinance, as amended. The Contractor and employees shall comply with all Occupational Safety and Health Administration (OSHA) safety standards, rules and regulations, as well as all applicable Federal, State and local laws and regulations. The Contractor will supply all required safety equipment and employees who have completed a training class conforming to OSHA Confined Space Standard 29 CFR 1910.146 for performing work in confined space areas where applicable. The Contractor and employees shall keep the work site area free of debris and trash. 1. Calibration/Revalidation Services The Contractor(s) shall be required to provide annual, biannual, monthly, weekly and as-needed instrument calibrations, to be performed per the manufacturer and industry specifications for the instruments that will be calibrated. The table below is provided herein as a reference and includes the quantity, category of instrument, and frequency of calibration required for the instruments. The quantities and categories are subject to change as the utility system evolves. The County will provide updated information to the Contractor as required. After the award is made, the Contractor shall submit its proposed calibration schedule to the County for approval. Line Item Category Annual As Needed Monthly Quarterly Semi-Annual Weekly Grand Total 1 Analyzer 30 6 20 20 12 15 103 2 Flow Meter 27 215 32 274 3 Level Control 7 16 23 4 Pressure 13 26 39 77 221 20 20 86 15 439 Calibration Frequency - total number per Category Grand Total Docusign Envelope ID: 35887CEC-618E-4F3D-8F1A-E3250C25A43C Page 8649 of 14062 The Contractor shall ensure that a certified calibration technician performs the calibration services. The Contractor shall furnish proof of the technician’s certification upon the request of the County. After the award is made, the Contractor will submit, example(s) of their calibration form(s) for each of the four (4) categories of instruments as listed above. The calibration forms should meet or exceed State and local requirements for validation. The Contractor shall report any instrument performance issues immediately to the appropriate County Representative. The report shall be in writing describing the issue and digital images shall be included to support the issue as appropriate. The Contractor shall provide within fourteen (14) calendar days after the service, a calibration certificate with each calibration to include the following information: serial number, manufacturer, location and all valid National Institute of Standards and Technology (NIST) traceable documentation concerning the measurement and test equipment used in the instrument calibration. 1.1 Price Methodology and Invoicing for Calibration/Revalidation The calibration and revalidation will be performed at the Unit Price submitted on the Bid Schedule. The Unit Price for Calibration /Revalidation will be inclusive of labor, materials parts, equipment, travel and all necessary resources needed and any required certification reports. A confined space entry fee may be added in addition to the Unit Price for calibration/revalidation services, as appropriate. The invoice shall reference Purchase Order number, facility, instrument location, category of the instrument and unit price (as referenced on the Bid Schedule), date the calibration / revalidation was completed. 2. Repairs and Replacement Installation Services The Contractor shall provide all labor, tools, materials, travel, equipment, and safety items necessary to perform repairs and replacements of various types of instruments. This includes compliance with all confined space requirements, as applicable. Repair and replacement services may include, but are not limited to: on-site repairs, removal, pick-up and delivery, replacement, disassembly, provision of loaner equipment, inspections, condition reports, failure analysis, equipment start-up and training, and calibration or revalidation with factory-approved certification documentation, including test results and the inspection and reporting requirements described below. Specifications for any loaner equipment must be submitted with the quote and approved in writing by the appropriate County Representative. Inspection The Contractor shall inspect and test the instruments and related components for electrical, mechanical, and physical defects. This includes checking support structures, conduits, grounding, electrical panels, cabinet locks, paint condition, and any other issues that may affect equipment reliability. Reporting The Contractor shall identify the cause of failure and provide a written report detailing findings, test results, and measurements. A formal repair quote must be submitted using the pricing in the Bid Schedule. This quote must include a written recommendation, with justification, on whether the equipment should be repaired or replaced. This information must be submitted to the appropriate County Representative. Within five (5) business days of installation the Contractor must provide all manufacturer documentation related to installation, maintenance, programming, specifications, testing, OEM and calibration certifications. Start-Up and Training Start-up and training must be provided upon request by the County following the initial inspection. Repair Timeline . All repairs must be completed within the timeframes outlined in Section 3 (Response Time), unless a written extension is granted by the appropriate County Representative. This written approval must be signed, dated, and submitted with the invoice. Docusign Envelope ID: 35887CEC-618E-4F3D-8F1A-E3250C25A43C Page 8650 of 14062 Parts and Calibration All replacement parts must meet or exceed OEM specifications. Calibration or revalidation must be completed and results provided to the County within five (5) business days after each repair or replacement. 2.1 Price Methodology and Invoicing for Repairs and Replacement Services The repairs and replacement work shall be quoted per the pricing structure on the Bid Schedule. Markup for equipment, parts, and supplies shall not exceed 15%. Copies of purchase receipts for individual items exceeding $500.00 must accompany the Contractor’s invoice submitted to the County for payment. A confined space entry fee may be added to the quote for repairs and replacements, as appropriate. The markup shall be limited to 10% for subcontractor fees. Subcontractor fees must be in accordance with the Bid Schedule or lower. A copy of the subcontractor quote or invoice must accompany the Contractor’s invoice submitted to the County for payment. The invoice shall reference the Purchase Order number, facility, instrument location, and category of the instrument (as listed on the Bid Schedule). The date of completion and whether the service was for a repair and/or replacement instrument(s). If the work was requested as urgent, this should be noted on the invoice. The invoice should clearly show costs as well as total hours multiplied by the hourly rate as listed on the Bid Schedule. Documentation supporting the invoice charges such as receipts/subcontractor invoices or quotes, proof of list price, County signed and dated approvals for urgent work shall be attached to the invoice. 3. Response Time: Normal business hours: Monday-Friday, 7:00 am-5:00 pm, except for County observed holidays. Non-Urgent (during normal business hours) • The Contractor shall respond via phone call and/or email within two (2) hours after the request from the County has been sent. • An inspection and written repair estimate/quote report shall be provided to the County within three (3) business days after the initial request from the County was sent. • Repairs shall be completed within three (3) business days after the issuance of an approved Purchase Order unless additional time is approved in writing. Urgent (outside of normal business hours) • Awarded Contractor(s) shall provide an urgent phone number to the County. The Contractor(s) shall update the County if this phone number should change. An employee of the Contractor(s) shall be available to return urgent calls 24 hours per day, 365 days per year. • The Contractor shall respond via phone call and/or email within thirty (30) minutes after the request from the County has been sent. • An inspection and written repair estimate report shall be provided to the County within twenty-four (24) hours after the request from the County was sent. A notation shall be made on the report clearly stating “Urgent” work. • Repairs shall be completed within twenty-four (24) hours after the issuance of an approved Purchase Order unless additional time is approved in writing. 4. Warranty: The Contractor shall warranty all repairs/replacements performed by the Contractor, including material and workmanship, to operate within acceptable levels (as determined by the County) for a period of at least one (1) year from the date of the completed repair/replacement. Any repaired/replaced equipment by the Contractor that fails to operate accordingly for the duration of the warranty period shall be repaired or replaced by the Contractor without any additional cost to the County. The Contractor shall furnish, without cost to the County, all parts and labor necessary to complete a warranty repair. 5. Assignment of Work: The County will issue a Purchase Order (or blanket purchase order). No work shall be performed until the Contractor is in receipt of an approved Purchase Order. Docusign Envelope ID: 35887CEC-618E-4F3D-8F1A-E3250C25A43C Page 8651 of 14062 A Purchase Order shall survive the Contract expiration to allow work to be completed. Blanket Purchase orders do not survive the Contract. No new services will be requested after the expiration of the Contract. VENDOR CHECKLIST ***Vendor should check off each of the following items as the necessary action is completed (please see, Vendor Check List) *** The County requests that the vendor submits no fewer than three (3) and no more than ten (10) completed reference forms from clients (during which period of time, eg. 5 years) whose projects are of a similar nature to this solicitation as a part of their proposal. Provide information on the projects completed by the vendor that best represent projects of similar size, scope and complexity of this project using Form 5 provided in OpenGov as part of the Required Forms. Vendors may include two (2) additional pages for each project to illustrate aspects of the completed project that provide the information to assess the experience of the Proposer on relevant project work. Docusign Envelope ID: 35887CEC-618E-4F3D-8F1A-E3250C25A43C Page 8652 of 14062 Page 8653 of 14062 Page 8654 of 14062 Page 8655 of 14062 Page 8656 of 14062 Page 8657 of 14062 Page 8658 of 14062 Page 8659 of 14062 Page 8660 of 14062 Page 8661 of 14062 Page 8662 of 14062 Page 8663 of 14062 Page 8664 of 14062 Page 8665 of 14062 IN WITNESS WHEREOF, the parties hereto, by an authorized person or agent, have executed this Agreement on the date and year first written above. ATTEST: Crystal K. Kinzel, Clerk of the Circuit Court and Comptroller By: Dated: --------(SEAL) Contractor's Witnesses: ;1t'� Contractor's First Witness m!Jsr�w;s tType/print w �,.,_ � ritrcfc;r•s Second Witness , )O\enc S, 1�f✓ tType/print witnessamet J BOARD OF COUNTY COMMISSIONERS COLLIER COUNTY, FLORIDA By: , Chairman -----------Burt L. Saunders Universal Controls Instrument Services, Inc. Contractor By: Ju� S1 (\/ Cfol��r tt �,0 , , Jt-''"'' t-'""' sigln�ture and titlet Page 14 of 18 Fixed Tenn Service Agreement [2025 _ ver.2] ·§ Page 8666 of 14062 Page 8667 of 14062 Page 8668 of 14062 Page 8669 of 14062 Page 8670 of 14062 Page 8671 of 14062 Page 8672 of 14062 Page 8673 of 14062 Page 8674 of 14062 County of Collier, FL Procurement Sandra Srnka, Procurement Director 3299 Tamiami Trail, East Naples, FL 34112 [UNIVERSAL CONTROLS INSTRUMENT SERVICES,] RESPONSE DOCUMENT REPORT GEN No. 25-8392 Instrument Calibration, Repair, and Replacement Services RESPONSE DEADLINE: August 25, 2025 at 3:00 pm Report Generated: Tuesday, August 26, 2025 Universal Controls Instrument Services, Response CONTACT INFORMATION Company: Universal Controls Instrument Services, Email: bob@universalcontrols.net Contact: Bob Schwenneker Address: 4925 Cross Bayou Blvd. New Port Richey, FL 34652 Phone: (352) 427-2621 Website: https://universalcontrols.net Submission Date: Aug 4, 2025 4:26 PM (Eastern Time) Page 8675 of 14062 [UNIVERSAL CONTROLS INSTRUMENT SERVICES,] RESPONSE DOCUMENT REPORT GEN No. 25-8392 Instrument Calibration, Repair, and Replacement Services [UNIVERSAL CONTROLS INSTRUMENT SERVICES,] RESPONSE DOCUMENT REPORT undefined - Instrument Calibration, Repair, and Replacement Services Page 2 ADDENDA CONFIRMATION Addendum #1 Confirmed Aug 11, 2025 2:56 PM by Bob Schwenneker Addendum #2 Confirmed Aug 19, 2025 5:52 AM by Bob Schwenneker QUESTIONNAIRE 1. I certify that I have read, understood and agree to the terms in this solicitation, and that I am authorized to submit this r esponse on behalf of my company.* Confirmed 2. ALL DOCUMENTS REQUIRING EXECUTION SHOULD BE EITHER BY WET SIGNATURES OR VERIFIABLE ELECTRONIC SIGNATURES. FAILURE TO PROVIDE THE APPLICABLE DOCUMENTS MAY DEEM YOU NON-RESPONSIVE/NON-RESPONSIBLE. Confirmed 3. Invitation to Bid (ITB) Instructions Form* Invitation to Bid (ITB) Instructions have been acknowledged and accepted. Confirmed 4. Collier County Purchase Order Terms and Conditions.* Collier County Purchase Order Terms and Conditions have been acknowledged and accepted. Confirmed Page 8676 of 14062 [UNIVERSAL CONTROLS INSTRUMENT SERVICES,] RESPONSE DOCUMENT REPORT GEN No. 25-8392 Instrument Calibration, Repair, and Replacement Services [UNIVERSAL CONTROLS INSTRUMENT SERVICES,] RESPONSE DOCUMENT REPORT undefined - Instrument Calibration, Repair, and Replacement Services Page 3 5. Insurance Requirements* Vendor Acknowledges Insurance Requirement and is prepared to produce the required insurance certificate(s) within five (5) da ys of the County's issuance of a Notice of Recommended Award. Confirmed 6. Bid Schedule * Please upload the completed bid schedule in Microsoft Excel format. 25-8392_-_BID_SCHEDULE.xlsx 7. County Required Forms VENDOR DECLARATION STATEMENT (FORM 1)* Vendor,_declaration_statement.pdf CONFLICT OF INTEREST AFFIDAVIT (FORM 2)* Conflict_of_interest,_certification,_affidavit.pdf IMMIGRATION AFFIDAVIT CERTIFICATION (FORM 3)* Immigration_affidavit_certification.pdf LOCAL VENDOR PREFERENCE (IF APPLICABLE FORM 4) Include a copy of the business tax receipt. No response submitted REFERENCE QUESTIONNAIRE (IF APPLICABLE FORM 5) All forms must be completed. References_1.docx References_2.docx Page 8677 of 14062 [UNIVERSAL CONTROLS INSTRUMENT SERVICES,] RESPONSE DOCUMENT REPORT GEN No. 25-8392 Instrument Calibration, Repair, and Replacement Services [UNIVERSAL CONTROLS INSTRUMENT SERVICES,] RESPONSE DOCUMENT REPORT undefined - Instrument Calibration, Repair, and Replacement Services Page 4 References_3.docx References_4.docx References_5.docx GRANT PROVISIONS (IF APPLICABLE FORM 6) All forms must be completed No response submitted PROOF OF STATUS FROM DIVISION OF CORPORATIONS - FLORIDA DEPARTMENT OF STATE (SUNBIZ)** http://dos.myflorida.com/sunbiz/ should be attached with your submittal. 2025_Annual_report.sunbiz.pdf E-VERIFY - MEMORANDUM OF UNDERSTANDING* Vendor MUST be enrolled in the E-Verify - https://www.e-verify.gov/ at the time of submission of the proposal/bid. E-Verify Memorandum of Understanding or Company Profile page should be attached with your submittal. UCIS_MOU.pdf W-9 FORM* W9_2025_Signed_UCIS_KA.pdf SIGNED ADDENDUMS (IF APPLICABLE) No response submitted ANY REQUIRED LICENSES. No response submitted MISCELLANEOUS DOCUMENTS No response submitted Page 8678 of 14062 Page 8679 of 14062 Page 8680 of 14062 Page 8681 of 14062 Page 8682 of 14062 Rev. 1 2025 Procurement Services Division Form 5 Reference Questionnaire (USE ONE FORM FOR EACH REQUIRED REFERENCE) Solicitation: INSTRUMENT CALIBRATION, REPAIR, AND REPLACEMENT SERVICES SOLICITATION NO.: 25-8392 Reference Questionnaire for: Universal Controls Instrument Services, Inc (Name of Company Requesting Reference Information) Bob Schwenneker (Name of Individuals Requesting Reference Information) Name: Chris Saliba (Evaluator completing reference questionnaire) Company: U.S. Water Services Corp. (Evaluator’s Company completing reference) Email: csaliba@uswatercorp.net FAX: Telephone: 813-416-3992 Collier County has implemented a process that collects reference information on firms and their key personnel to be used in the selection of firms to perform this project. The Name of the Company listed in the Subject above has listed you as a client for which t hey have previously performed work. Please complete the survey. Please rate each criteria to the best of your knowledge on a scale of 1 to 10, with 10 representing that you were very satisifed (and would hire the firm/individual again) and 1 representing that you were very unsatisfied (and would never hire the firm/indivdiual again). If you do not have sufficient knowledge of past performance in a p articular area, leave it blank and the item or form will be scored “0.” Project Description: ___________________________ Completion Date: _____________________________ Project Budget: _______________________________ Project Number of Days: _______________________ Item Criteria Score (must be completed) 1 Ability to manage the project costs (minimize change orders to scope). 2 Ability to maintain project schedule (complete on-time or early). 3 Quality of work. 4 Quality of consultative advice provided on the project. 5 Professionalism and ability to manage personnel. 6 Project administration (completed documents, final invoice, final product turnover; invoices; manuals or going forward documentation, etc.) 7 Ability to verbally communicate and document information clearly and succinctly. 8 Abiltity to manage risks and unexpected project circumstances. 9 Ability to follow contract documents, policies, procedures, rules, regulations, etc. 10 Overall comfort level with hiring the company in the future (customer satisfaction). TOTAL SCORE OF ALL ITEMS Page 8683 of 14062 Rev. 1 2025 Procurement Services Division Form 5 Reference Questionnaire (USE ONE FORM FOR EACH REQUIRED REFERENCE) Solicitation: INSTRUMENT CALIBRATION, REPAIR, AND REPLACEMENT SERVICES SOLICITATION NO.: 25-8392 Reference Questionnaire for: Universal Controls Instrument Services, Inc (Name of Company Requesting Reference Information) Bob Schwenneker (Name of Individuals Requesting Reference Information) Name: Chris Cavaleri (Evaluator completing reference questionnaire) Company: Palm Beach County (Evaluator’s Company completing reference) Email: ccavaleri@pbcwater.com FAX: Telephone: 561-493-6107 Collier County has implemented a process that collects reference information on firms and their key personnel to be used in the selection of firms to perform this project. The Name of the Company listed in the Subject above has listed you as a client for which t hey have previously performed work. Please complete the survey. Please rate each criteria to the best of your knowledge on a scale of 1 to 10, with 10 representing that you were very satisifed (and would hire the firm/individual again) and 1 representing that you were very unsatisfied (and would never hire the firm/indivdiual again). If you do not have sufficient knowledge of past performance in a p articular area, leave it blank and the item or form will be scored “0.” Project Description: ___________________________ Completion Date: _____________________________ Project Budget: _______________________________ Project Number of Days: _______________________ Item Criteria Score (must be completed) 1 Ability to manage the project costs (minimize change orders to scope). 2 Ability to maintain project schedule (complete on-time or early). 3 Quality of work. 4 Quality of consultative advice provided on the project. 5 Professionalism and ability to manage personnel. 6 Project administration (completed documents, final invoice, final product turnover; invoices; manuals or going forward documentation, etc.) 7 Ability to verbally communicate and document information clearly and succinctly. 8 Abiltity to manage risks and unexpected project circumstances. 9 Ability to follow contract documents, policies, procedures, rules, regulations, etc. 10 Overall comfort level with hiring the company in the future (customer satisfaction). TOTAL SCORE OF ALL ITEMS Page 8684 of 14062 Rev. 1 2025 Procurement Services Division Form 5 Reference Questionnaire (USE ONE FORM FOR EACH REQUIRED REFERENCE) Solicitation: INSTRUMENT CALIBRATION, REPAIR, AND REPLACEMENT SERVICES SOLICITATION NO.: 25-8392 Reference Questionnaire for: Universal Controls Instrument Services, Inc (Name of Company Requesting Reference Information) Bob Schwenneker (Name of Individuals Requesting Reference Information) Name: Deborah Houghton (Evaluator completing reference questionnaire) Company: Sarasota County Public Utilities (Evaluator’s Company completing reference) Email: dhoughto@scgov.net FAX: Telephone: 941-716-3997 Collier County has implemented a process that collects reference information on firms and their key personnel to be used in the selection of firms to perform this project. The Name of the Company listed in the Subject above has listed you as a client for which t hey have previously performed work. Please complete the survey. Please rate each criteria to the best of your knowledge on a scale of 1 to 10, with 10 representing that you were very satisifed (and would hire the firm/individual again) and 1 representing that you were very unsatisfied (and would never hire the firm/indivdiual again). If you do not have sufficient knowledge of past performance in a p articular area, leave it blank and the item or form will be scored “0.” Project Description: ___________________________ Completion Date: _____________________________ Project Budget: _______________________________ Project Number of Days: _______________________ Item Criteria Score (must be completed) 1 Ability to manage the project costs (minimize change orders to scope). 2 Ability to maintain project schedule (complete on-time or early). 3 Quality of work. 4 Quality of consultative advice provided on the project. 5 Professionalism and ability to manage personnel. 6 Project administration (completed documents, final invoice, final product turnover; invoices; manuals or going forward documentation, etc.) 7 Ability to verbally communicate and document information clearly and succinctly. 8 Abiltity to manage risks and unexpected project circumstances. 9 Ability to follow contract documents, policies, procedures, rules, regulations, etc. 10 Overall comfort level with hiring the company in the future (customer satisfaction). TOTAL SCORE OF ALL ITEMS Page 8685 of 14062 Rev. 1 2025 Procurement Services Division Form 5 Reference Questionnaire (USE ONE FORM FOR EACH REQUIRED REFERENCE) Solicitation: INSTRUMENT CALIBRATION, REPAIR, AND REPLACEMENT SERVICES SOLICITATION NO.: 25-8392 Reference Questionnaire for: Universal Controls Instrument Services, Inc (Name of Company Requesting Reference Information) Bob Schwenneker (Name of Individuals Requesting Reference Information) Name: Lyndsey Austin (Evaluator completing reference questionnaire) Company: Toho Water Authority (Evaluator’s Company completing reference) Email: laustin@tohowater.com FAX: Telephone: 407-485-2837 Collier County has implemented a process that collects reference information on firms and their key personnel to be used in the selection of firms to perform this project. The Name of the Company listed in the Subject above has listed you as a client for which t hey have previously performed work. Please complete the survey. Please rate each criteria to the best of your knowledge on a scale of 1 to 10, with 10 representing that you were very satisifed (and would hire the firm/individual again) and 1 representing that you were very unsatisfied (and would never hire the firm/indivdiual again). If you do not have sufficient knowledge of past performance in a p articular area, leave it blank and the item or form will be scored “0.” Project Description: ___________________________ Completion Date: _____________________________ Project Budget: _______________________________ Project Number of Days: _______________________ Item Criteria Score (must be completed) 1 Ability to manage the project costs (minimize change orders to scope). 2 Ability to maintain project schedule (complete on-time or early). 3 Quality of work. 4 Quality of consultative advice provided on the project. 5 Professionalism and ability to manage personnel. 6 Project administration (completed documents, final invoice, final product turnover; invoices; manuals or going forward documentation, etc.) 7 Ability to verbally communicate and document information clearly and succinctly. 8 Abiltity to manage risks and unexpected project circumstances. 9 Ability to follow contract documents, policies, procedures, rules, regulations, etc. 10 Overall comfort level with hiring the company in the future (customer satisfaction). TOTAL SCORE OF ALL ITEMS Page 8686 of 14062 Rev. 1 2025 Procurement Services Division Form 5 Reference Questionnaire (USE ONE FORM FOR EACH REQUIRED REFERENCE) Solicitation: INSTRUMENT CALIBRATION, REPAIR, AND REPLACEMENT SERVICES SOLICITATION NO.: 25-8392 Reference Questionnaire for: Universal Controls Instrument Services, Inc (Name of Company Requesting Reference Information) Bob Schwenneker (Name of Individuals Requesting Reference Information) Name: Preston Collum (Evaluator completing reference questionnaire) Company: Volusia County (Evaluator’s Company completing reference) Email: pcollum@volusia.org FAX: Telephone: (386) 804-7786 Collier County has implemented a process that collects reference information on firms and their key personnel to be used in the selection of firms to perform this project. The Name of the Company listed in the Subject above has listed you as a client for which t hey have previously performed work. Please complete the survey. Please rate each criteria to the best of your knowledge on a scale of 1 to 10, with 10 representing that you were very satisifed (and would hire the firm/individual again) and 1 representing that you were very unsatisfied (and would never hire the firm/indivdiual again). If you do not have sufficient knowledge of past performance in a p articular area, leave it blank and the item or form will be scored “0.” Project Description: ___________________________ Completion Date: _____________________________ Project Budget: _______________________________ Project Number of Days: _______________________ Item Criteria Score (must be completed) 1 Ability to manage the project costs (minimize change orders to scope). 2 Ability to maintain project schedule (complete on-time or early). 3 Quality of work. 4 Quality of consultative advice provided on the project. 5 Professionalism and ability to manage personnel. 6 Project administration (completed documents, final invoice, final product turnover; invoices; manuals or going forward documentation, etc.) 7 Ability to verbally communicate and document information clearly and succinctly. 8 Abiltity to manage risks and unexpected project circumstances. 9 Ability to follow contract documents, policies, procedures, rules, regulations, etc. 10 Overall comfort level with hiring the company in the future (customer satisfaction). TOTAL SCORE OF ALL ITEMS Page 8687 of 14062 4925 CROSS BAYOU BOULEVARD NEW PORT RICHEY, FL 34652 Current Principal Place of Business: Current Mailing Address: 4925 CROSS BAYOU BOULEVARD NEW PORT RICHEY, FL 34652 US Entity Name: UNIVERSAL CONTROLS INSTRUMENT SERVICES, INC. DOCUMENT# P20000080081 FEI Number: 85-3537810 Certificate of Status Desired: Name and Address of Current Registered Agent: DEREMER, GARY 4925 CROSS BAYOU BOULEVARD NEW PORT RICHEY, FL 34652 US The above named entity submits this statement for the purpose of changing its registered office or registered agent, or both, in the State of Florida. SIGNATURE: Electronic Signature of Registered Agent Date Officer/Director Detail : I hereby certify that the information indicated on this report or supplemental report is true and accurate and that my electronic signature shall have the same legal effect as if made under oath; that I am an officer or director of the corporation or the receiver or trustee empowered to execute this report as required by Chapter 607, Florida Statutes; and that my name appears above, or on an attachment with all other like empowered. SIGNATURE: Electronic Signature of Signing Officer/Director Detail Date FILED Feb 12, 2025 Secretary of State 7411097187CC GARY DEREMER CEO 02/12/2025 2025 FLORIDA PROFIT CORPORATION ANNUAL REPORT Yes Title CEO, P Name DEREMER, GARY A Address 4925 CROSS BAYOU BOULEVARD City-State-Zip:NEW PORT RICHEY FL 34652 Title VP Name SALIBA, CHRISTOPHER Address 4925 CROSS BAYOU BOULEVARD City-State-Zip:NEW PORT RICHEY FL 34652 Title CFO Name RUPE, KAYCEE Address 4925 CROSS BAYOU BOULEVARD City-State-Zip:NEW PORT RICHEY FL 34652 Title VP Name SCHWENNEKER, ROBERT Address 4925 CROSS BAYOU BOULEVARD City-State-Zip:NEW PORT RICHEY FL 34652 Page 8688 of 14062 THE E-VERIFY MEMORANDUM OF UNDERSTANDING FOR EMPLOYERS USING AN E-VERIFY EMPLOYER AGENT ARTICLE I PURPOSE AND AUTHORITY The parties to this agreement are the Department of Homeland Security (DHS), the UNIVERSAL CONTROLS INSTRUMENT SERVICES (Employer), and the E-Verify Employer Agent. The purpose of this agreement is to set forth terms and conditions which the Employer and the E-Verify Employer Agent will follow while participating in E-Verify. 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 E-Verify Employer Agent, 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. Section 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 shall become familiar with and comply with the most recent version of the E-Verify User Manual. The Employer will obtain the E-Verify User Manual from the E-Verify Employer Agent. 4. 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 1-888-464-4218. 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 I-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. 5. 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. Company ID Number:143162 Client Company ID Number:1665528 Page 1 of 13 | E-Verify MOU for Employers Using an E-Verify Employer Agent | Revision Date 06/01/13 Page 8689 of 14062 6. 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 5 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 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. 7. 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. 8. 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. 9. The Employer must use E-Verify (through its E-Verify Employer Agent) 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. 10. 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. 11. 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. Section 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 (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 Company ID Number:143162 Client Company ID Number:1665528 Page 2 of 13 | E-Verify MOU for Employers Using an E-Verify Employer Agent | Revision Date 06/01/13 Page 8690 of 14062 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). 12. 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). 13. The Employer agrees that it will use the information it receives from E-Verify (through its E-Verify Employer Agent) 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. 14. 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 a E-Verify@uscis.dhs.gov. Please use "Privacy Incident - Password" in the subject line of your email when sending a breach report to E-Verify. 15. The Employer acknowledges that the information it receives through the E-Verify Employer Agent from SSA is governed by the Privacy Act (5 U.S.C. Section 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. 16. The Employer agrees to cooperate with DHS and SSA in their compliance monitoring and evaluation of E- Verify (whether directly or through their E-Verify Employer Agent), which includes permitting DHS, SSA, their contractors and other agents, upon 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. 17. 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. 18. 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. 19. 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. 20. 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. 21. The Employer agrees that it will notify its E-Verify Employer Agent immediately if it is awarded a federal contract with the FAR clause. Your E-Verify Employer Agent needs this information so that it can update your company's E-Verify profile within 30 days of the contract award date. B. RESPONSIBILITIES OF E-VERIFY EMPLOYER AGENT 1. The E-Verify Employer Agent agrees to provide to the SSA and DHS the names, titles, addresses, and telephone numbers of the E-Verify Employer Agent representatives who will be accessing information under E-Verify and shall update them as needed to keep them current. 2. The E-Verify Employer Agent agrees to become familiar with and comply with the E-Verify User Manual and provide a copy of the most current version of the E-Verify User Manual to the Employer so that the Employer Company ID Number:143162 Client Company ID Number:1665528 Page 3 of 13 | E-Verify MOU for Employers Using an E-Verify Employer Agent | Revision Date 06/01/13 Page 8691 of 14062 can become familiar with and comply with E-Verify policy and procedures. The E-Verify Employer Agent agrees to obtain a revised E-Verify User Manual as it becomes available and to provide a copy of the revised version to the Employer no later than 30 days after the manual becomes available. 3. The E-Verify Employer Agent agrees that any person accessing E-Verify on its behalf is trained on the most recent E-Verify policy and procedures. 4. The E-Verify Employer Agent agrees that any E-Verify Employer Agent Representative who will perform employment verification cases will complete the E-Verify Tutorial before that individual initiates any cases. A. The E-Verify Employer Agent agrees that all E-Verify Employer Agent representatives will take the refresher tutorials initiated by the E-Verify program as a condition of continued use of E-Verify, including any tutorials for Federal contractors, if any of the Employers represented by the E-Verify Employer Agent is a Federal contractor. B. Failure to complete a refresher tutorial will prevent the E-Verify Employer Agent and Employer from continued use of E-Verify. 5. The E-Verify Employer Agent agrees to grant E-Verify access only to current employees who need E-Verify access. The E-Verify Employer Agent must promptly terminate an employee's E-Verify access if the employee is separated from the company or no longer needs access to E-Verify. 6. The E-Verify Employer Agent agrees to obtain the necessary equipment to use E- Verify as required by the E-Verify rules and regulations as modified from time to time. 7. The E-Verify Employer Agent agrees to, consistent with applicable laws, regulations, and policies, commit sufficient personnel and resources to meet the requirements of this MOU. 8. The E-Verify Employer Agent agrees to provide its clients with training on E-Verify processes, policies, and procedures. The E-Verify Employer Agent also agrees to provide its clients with ongoing E-Verify training as needed. E-Verify is not responsible for providing training to clients of E-Verify Employer Agents. 9. The E-Verify Employer Agent agrees to provide the Employer with the notices described in Article II.B.1 below. 10. The E-Verify Employer Agent agrees to create E-Verify cases for the Employer it represents in accordance with the E-Verify Manual, the E-Verify Web-Based Tutorial and all other published E-Verify rules and procedures. The E-Verify Employer Agent will create E-Verify cases using information provided by the Employer and will immediately communicate the response back to the Employer. If E-Verify is temporarily unavailable, the three-day time period will be extended until it is again operational in order to accommodate the E-Verify Employer Agent's attempting, in good faith, to make inquiries on behalf of the Employer during the period of unavailability 11. When the E-Verify Employer Agent receives notice from a client company that it has received a contract with the FAR clause, then the E-Verify Employer Agent must update the company's E-Verify profile within 30 days of the contract award date. 12. If data is transmitted between the E-Verify Employer Agent and its client, then the E-Verify Employer Agent agrees to protect personally identifiable information during transmission to and from the E-Verify Employer Agent. 13. The E-Verify Employer Agent 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@uscis.dhs.gov. Please use "Privacy Incident - Password" in the subject line of your email when sending a breach report to E-Verify. 14. The E-Verify Employer Agent agrees to fully cooperate with DHS and SSA in their compliance monitoring and evaluation of E-Verify, including permitting DHS, SSA, their contractors and other agents, upon reasonable notice, to review Forms I-9, employment records, and all records pertaining to the E-Verify Employer Agent's use of E-Verify, and to interview it and its employees regarding the use of E-Verify, and to respond in a timely and accurate manner to DHS requests for information relating to their participation in E- Verify. 15. The E-Verify Employer Agent 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 E-Verify Employer Agent 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 Employer Agent services and any claim to that effect is false. 16. The E-Verify Employer Agent 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 Company ID Number:143162 Client Company ID Number:1665528 Page 4 of 13 | E-Verify MOU for Employers Using an E-Verify Employer Agent | Revision Date 06/01/13 Page 8692 of 14062 prior written consent of DHS. 17. The E-Verify Employer Agent agrees that E-Verify trademarks and logos may be used only under license by DHS/USCIS (see ) and, other than pursuant to the specific terms of such license, may not be used in any manner that might imply that the E-Verify Employer Agent's services, products, websites, or publications are sponsored by, endorsed by, licensed by, or affiliated with DHS, USCIS, or E-Verify. 18. The E-Verify Employer Agent understands that if it uses E-Verify procedures for any purpose other than as authorized by this MOU, the E-Verify Employer Agent may be subject to appropriate legal action and termination of its participation in E-Verify according to this MOU. C. RESPONSIBILITIES OF FEDERAL CONTRACTORS The E-Verify Employer Agent shall ensure that the E-Verify Employer Agent and the Employers represented by the E- Verify Employer Agent carry out the following responsibilities if the Employer is a Federal contractor or becomes a federal contractor. The E-Verify Employer Agent should instruct the client to keep the E-Verify Employer Agent informed about any changes or updates related to federal contracts. It is the E-Verify Employer Agent's responsibility to ensure that its clients are in compliance with all E-Verify policies and procedures. 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 reverify 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. 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 anE-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, Company ID Number:143162 Client Company ID Number:1665528 Page 5 of 13 | E-Verify MOU for Employers Using an E-Verify Employer Agent | Revision Date 06/01/13 Page 8693 of 14062 ii. The employee's work authorization has not expired, and iii. The Employer has reviewed the information reflected in the Form I-9 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 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. D. RESPONSIBILITIES OF SSA 1. SSA agrees to allow DHS to compare data provided by the Employer (through the E-Verify Employer Agent) 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 the E-Verify Employer Agent) 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. Section 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 E-Verify Employer Agent. 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 E-Verify Employer Agent. Note: If an Employer experiences technical problems, or has a policy question, the employer should contact E-Verify at 1-888-464-4218. E. RESPONSIBILITIES OF DHS 1. DHS agrees to provide the Employer with selected data from DHS databases to enable the Employer (through the E-Verify Employer Agent) to conduct, to the extent authorized by this MOU: A. Automated verification checks on alien employees by electronic means, and B. Photo verification checks (when available) on employees. 2. DHS agrees to assist the E-Verify Employer Agent with operational problems associated with its participation in E-Verify. DHS agrees to provide the E-Verify Employer Agent names, titles, addresses, and telephone numbers of DHS representatives to be contacted during the E-Verify process. 3. DHS agrees to provide to the E-Verify Employer Agent with access to E-Verify training materials as well as Company ID Number:143162 Client Company ID Number:1665528 Page 6 of 13 | E-Verify MOU for Employers Using an E-Verify Employer Agent | Revision Date 06/01/13 Page 8694 of 14062 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 E-Verify Employer Agents 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 E-Verify Employer Agents to take mandatory refresher tutorials. 5. DHS agrees to provide to the Employer (through the E-Verify Employer Agent) 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 E-Verify Employer Agent's E-Verify users a unique user identification number and password that permits them to log in to E-Verify. 7. HS agrees to safeguard the information the Employer provides (through the E-Verify Employer Agent), 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 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 Company ID Number:143162 Client Company ID Number:1665528 Page 7 of 13 | E-Verify MOU for Employers Using an E-Verify Employer Agent | Revision Date 06/01/13 Page 8695 of 14062 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 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. 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. In addition, any Employer represented by the E-Verify Employer Agent may voluntarily terminate this MOU upon giving DHS 30 days' written notice. 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 Company ID Number:143162 Client Company ID Number:1665528 Page 8 of 13 | E-Verify MOU for Employers Using an E-Verify Employer Agent | Revision Date 06/01/13 Page 8696 of 14062 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. 5. Upon termination of the relationship between an Employer and their E-Verify Employer Agent, E-Verify cannot provide the Employer with its records. The Employer agrees to seek its records from the E-Verify Employer Agent. 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, 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, the E-Verify Employer Agent, 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, the Employer, and the E-Verify Employer Agent. UNIVERSAL CONTROLS INSTRUMENT SERVICES (Employer) hereby designates and appoints Tiara James (E- Verify Employer Agent), including its officers and employees, as the E-Verify Employer Agent for the purpose of carrying out (Employer) responsibilities under the MOU between the Employer, the E-Verify Employer Agent, and DHS. Company ID Number:143162 Client Company ID Number:1665528 Page 9 of 13 | E-Verify MOU for Employers Using an E-Verify Employer Agent | Revision Date 06/01/13 Page 8697 of 14062 If you have any questions, contact E-Verify at 1-888-464-4218. Approved by: Employer UNIVERSAL CONTROLS INSTRUMENT SERVICES Name (Please Type or Print) Kaycee Rupe Title Signature Electronically Signed Date April 07, 2021 E-Verify Employer Agent Paycom Name (Please Type or Print) Tiara James Title Signature Electronically Signed Date April 07, 2021 Department of Homeland Security - Verification Division Name USCIS Verification Division Title Signature Electronically Signed Date April 07, 2021 Company ID Number:143162 Client Company ID Number:1665528 Page 10 of 13 | E-Verify MOU for Employers Using an E-Verify Employer Agent | Revision Date 06/01/13 Page 8698 of 14062 Information Required for the E-Verify Program Information relating to your Company: Company Name UNIVERSAL CONTROLS INSTRUMENT SERVICES Company Facility Address 4925 Cross Bayou Boulevard New Port Richey, FL 34652 Company Alternate Address 4925 Cross Bayou Boulevard New Port Richey, FL 34652 County or Parish Pasco Employer Identification Number 85-3537810 North American Industry Classification Systems Code Heavy And Civil Engineering Construction (237) Parent Company Number of Employees 1 to 4 Number of Sites Verified for 1 Company ID Number:143162 Client Company ID Number:1665528 Page 11 of 13 | E-Verify MOU for Employers Using an E-Verify Employer Agent | Revision Date 06/01/13 Page 8699 of 14062 Are you verifying for more than 1 site? If yes, please provide the number of sites verified for in each State: Florida 1 Company ID Number:143162 Client Company ID Number:1665528 Page 12 of 13 | E-Verify MOU for Employers Using an E-Verify Employer Agent | Revision Date 06/01/13 Page 8700 of 14062 Information relating to the Program Administrator(s) for your Company on policy questions or operational problems: Name Kaycee Rupe Phone Number (727) 848-8292 Fax Number Email Address krupe@uswatercorp.net Company ID Number:143162 Client Company ID Number:1665528 Page 13 of 13 | E-Verify MOU for Employers Using an E-Verify Employer Agent | Revision Date 06/01/13 Page 8701 of 14062 Form W-9 (Rev. March 2024) Request for Taxpayer Identification Number and Certification Department of the Treasury Internal Revenue Service Go to www.irs.gov/FormW9 for instructions and the latest information. Give form to the requester. Do not send to the IRS. Before you begin. For guidance related to the purpose of Form W-9, see Purpose of Form, below.Print or type. See Specific Instructions on page 3.1 Name of entity/individual. An entry is required. (For a sole proprietor or disregarded entity, enter the owner’s name on line 1, and enter the business/disregarded entity’s name on line 2.) 2 Business name/disregarded entity name, if different from above. 3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1. Check only one of the following seven boxes. Individual/sole proprietor C corporation S corporation Partnership Trust/estate LLC. Enter the tax classification (C = C corporation, S = S corporation, P = Partnership) .... Note: Check the “LLC” box above and, in the entry space, enter the appropriate code (C, S, or P) for the tax classification of the LLC, unless it is a disregarded entity. A disregarded entity should instead check the appropriate box for the tax classification of its owner. Other (see instructions) 3b If on line 3a you checked “Partnership” or “Trust/estate,” or checked “LLC” and entered “P” as its tax classification, and you are providing this form to a partnership, trust, or estate in which you have an ownership interest, check this box if you have any foreign partners, owners, or beneficiaries. See instructions ......... 4 Exemptions (codes apply only to certain entities, not individuals; see instructions on page 3): Exempt payee code (if any) Exemption from Foreign Account Tax Compliance Act (FATCA) reporting code (if any) (Applies to accounts maintained outside the United States.) 5 Address (number, street, and apt. or suite no.). See instructions. 6 City, state, and ZIP code 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. See also 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 Date 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. What’s New Line 3a has been modified to clarify how a disregarded entity completes this line. An LLC that is a disregarded entity should check the appropriate box for the tax classification of its owner. Otherwise, it should check the “LLC” box and enter its appropriate tax classification. New line 3b has been added to this form. A flow-through entity is required to complete this line to indicate that it has direct or indirect foreign partners, owners, or beneficiaries when it provides the Form W-9 to another flow-through entity in which it has an ownership interest. This change is intended to provide a flow-through entity with information regarding the status of its indirect foreign partners, owners, or beneficiaries, so that it can satisfy any applicable reporting requirements. For example, a partnership that has any indirect foreign partners may be required to complete Schedules K-2 and K-3. See the Partnership Instructions for Schedules K-2 and K-3 (Form 1065). Purpose of Form An individual or entity (Form W-9 requester) who is required to file an information return with the IRS is giving you this form because they Cat. No. 10231X Form W-9 (Rev. 3-2024) Kristie Anker Page 8702 of 14062 Form W-9 (Rev. 3-2024)Page 2 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-NEC (nonemployee compensation). • 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), and 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. Caution: If you don’t return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding, later. 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; and 4. Certify to your non-foreign status for purposes of withholding under chapter 3 or 4 of the Code (if applicable); and 5. 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). Establishing U.S. status for purposes of chapter 3 and chapter 4 withholding. Payments made to foreign persons, including certain distributions, allocations of income, or transfers of sales proceeds, may be subject to withholding under chapter 3 or chapter 4 of the Code (sections 1441–1474). Under those rules, if a Form W-9 or other certification of non-foreign status has not been received, a withholding agent, transferee, or partnership (payor) generally applies presumption rules that may require the payor to withhold applicable tax from the recipient, owner, transferor, or partner (payee). See Pub. 515, Withholding of Tax on Nonresident Aliens and Foreign Entities. The following persons must provide Form W-9 to the payor for purposes of establishing its non-foreign status. • In the case of a disregarded entity with a U.S. owner, the U.S. owner of the disregarded entity and not the disregarded 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 grantor trust. • In the case of a U.S. trust (other than a grantor trust), the U.S. trust and not the beneficiaries of the trust. See Pub. 515 for more information on providing a Form W-9 or a certification of non-foreign status to avoid withholding. 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 (under Regulations section 1.1441-1(b)(2)(iv) or other applicable section for chapter 3 or 4 purposes), do not use Form W-9. Instead, use the appropriate Form W-8 or Form 8233 (see Pub. 515). If you are a qualified foreign pension fund under Regulations section 1.897(l)-1(d), or a partnership that is wholly owned by qualified foreign pension funds, that is treated as a non-foreign person for purposes of section 1445 withholding, do not use Form W-9. Instead, use Form W-8EXP (or other certification of non-foreign status). 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 their 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 their 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, but are not limited to, 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, as described in item 4 under “By signing the filled- out form” above (for reportable interest and dividend accounts opened after 1983 only). Page 8703 of 14062 Form W-9 (Rev. 3-2024)Page 3 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. See also Establishing U.S. status for purposes of chapter 3 and chapter 4 withholding, earlier. What Is FATCA Reporting? The Foreign Account Tax Compliance Act (FATCA) requires a participating foreign financial institution to report all U.S. account holders that are specified U.S. 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 are no longer 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. 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. • 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 for 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 you filed with your application. • Sole proprietor. Enter your individual name as shown on your Form 1040 on line 1. Enter your business, trade, or “doing business as” (DBA) name on line 2. • Partnership, C corporation, S corporation, or LLC, other than a disregarded entity. 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. • 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. Enter any business, trade, or DBA name on line 2. • Disregarded entity. In general, a business entity that has a single owner, including an LLC, and is not a corporation, is disregarded as an entity separate from its owner (a disregarded entity). See Regulations section 301.7701-2(c)(2). A disregarded entity should check the appropriate box for the tax classification of its owner. Enter the owner’s name on line 1. The name of the owner 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. 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, enter it on line 2. Line 3a Check the appropriate box on line 3a for the U.S. federal tax classification of the person whose name is entered on line 1. Check only one box on line 3a. IF the entity/individual on line 1 is a(n) . . . THEN check the box for . . . • Corporation Corporation. • Individual or • Sole proprietorship Individual/sole proprietor. • LLC classified as a partnership for U.S. federal tax purposes or • LLC that has filed Form 8832 or 2553 electing to be taxed as a corporation 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 3b Check this box if you are a partnership (including an LLC classified as a partnership for U.S. federal tax purposes), trust, or estate that has any foreign partners, owners, or beneficiaries, and you are providing this form to a partnership, trust, or estate, in which you have an ownership interest. You must check the box on line 3b if you receive a Form W-8 (or documentary evidence) from any partner, owner, or beneficiary establishing foreign status or if you receive a Form W-9 from any partner, owner, or beneficiary that has checked the box on line 3b. Note: A partnership that provides a Form W-9 and checks box 3b may be required to complete Schedules K-2 and K-3 (Form 1065). For more information, see the Partnership Instructions for Schedules K-2 and K-3 (Form 1065). If you are required to complete line 3b but fail to do so, you may not receive the information necessary to file a correct information return with the IRS or furnish a correct payee statement to your partners or beneficiaries. See, for example, sections 6698, 6722, and 6724 for penalties that may apply. 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 on 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). Page 8704 of 14062 Form W-9 (Rev. 3-2024)Page 4 2—The United States or any of its agencies or instrumentalities. 3—A state, the District of Columbia, a U.S. commonwealth or territory, 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 territory. 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 as defined under section 581. 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. 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 5.2 • Payments made in settlement of payment card or third-party network transactions Exempt payees 1 through 4. 1 See Form 1099-MISC, Miscellaneous Information, 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) entered 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 territory, 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, enter “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 ITIN. Enter it in the entry space for the Social security number. 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). 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 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/EIN. 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 Form SS-4 mailed to you within 15 business days. If you are asked to complete Form W-9 but do not have a TIN, apply for a TIN and enter “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, you will generally 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. See also Establishing U.S. status for purposes of chapter 3 and chapter 4 withholding, earlier, for when you may instead be subject to withholding under chapter 3 or 4 of the Code. Caution: A disregarded U.S. entity that has a foreign owner must use the appropriate Form W-8. Page 8705 of 14062 Form W-9 (Rev. 3-2024)Page 5 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. 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) The grantor-trustee1 b. So-called trust account that is not a legal or valid trust under state law The actual owner1 6. Sole proprietorship or disregarded entity owned by an individual The owner3 7. Grantor trust filing under Optional 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 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 Form 1041 or under the Optional Filing Method 2, requiring Form 1099 (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 on line 1, and enter your business or DBA name, if any, on line 2. 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.) * Note: The grantor must also provide a Form W-9 to the trustee of the trust. ** For more information on optional filing methods for grantor trusts, see the Instructions for Form 1041. 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 return 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 a questionable credit report, contact the IRS Identity Theft Hotline at 800-908-4490 or submit Form 14039. For more information, see Pub. 5027, Identity Theft Information for Taxpayers. Page 8706 of 14062 Form W-9 (Rev. 3-2024)Page 6 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 877-777-4778 or TTY/TDD 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. 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 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. Go to 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 territories for use in administering their laws. The information may also 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, payors must generally withhold a percentage of taxable interest, dividends, and certain other payments to a payee who does not give a TIN to the payor. Certain penalties may also apply for providing false or fraudulent information. Page 8707 of 14062 ITEM NO. DESCRIPTION UNIT UNIT PRICE QTY TOTAL COST 1 Analyzer Calibration / Revalidation Each 135.00$ 103 13,905.00$ 2 Confined Space Entry Fee Each 595.00$ 1 595.00$ 3 Repair and Replacement Labor Rate - Normal Business Hours M-F , 7:00am - 5:00pm Except for County Observed Holidays Hour 115.00$ 192 22,080.00$ 4 Repair and Replacement Labor Rate - Urgent Outside of Normal Business Hours Hour 195.00$ 30 5,850.00$ 42,430.00$ ITEM NO. DESCRIPTION UNIT UNIT PRICE QTY TOTAL COST 1 Flow Meters Calibration / Revalidation Each 135.00$ 274 36,990.00$ 2 Confined Space Entry Fee Each 595.00$ 1 595.00$ 3 Repair and Replacement Labor Rate - Normal Business Hours M-F , 7:00am - 5:00pm Except for County Observed Holidays Hour 115.00$ 32 3,680.00$ 4 Repair and Replacement Labor Rate - Urgent Outside of Normal Business Hours Hour 195.00$ 10 1,950.00$ 43,215.00$ ITEM NO. DESCRIPTION UNIT UNIT PRICE QTY TOTAL COST 1 Level Control Calibration / Revalidation Each 135.00$ 23 3,105.00$ 2 Confined Space Entry Fee Each 595.00$ 1 595.00$ 3 Repair and Replacement Labor Rate - Normal Business Hours M-F , 7:00am - 5:00pm Except for County Observed Holidays Hour 115.00$ 40 4,600.00$ 4 Repair and Replacement Labor Rate - Urgent Outside of Normal Business Hours Hour 195.00$ 10 1,950.00$ 10,250.00$ ITEM NO. DESCRIPTION UNIT UNIT PRICE QTY TOTAL COST 1 Pressure Calibration / Revalidation Each 135.00$ 39 5,265.00$ 2 Confined Space Entry Fee Each 595.00$ 1 595.00$ 3 Repair and Replacement Labor Rate - Normal Business Hours M-F , 7:00am - 5:00pm Except for County Observed Holidays Hour 115.00$ 40 4,600.00$ 4 Repair and Replacement Labor Rate - Urgent Outside of Normal Business Hours Hour 195.00$ 10 1,950.00$ 12,410.00$ Category D Total Line Item: Instrument Calibration, Repairs and Replacement Services ITB No. 25-8392 Bid Schedule CATEGORY B: FLOW METERS CATEGORY A: ANALYZER Category B Total Line Item: CATEGORY C: LEVEL CONTROL Category A Total Line Item: *Quanties are used for evaluation purposes only. Category C Total Line Item: CATEGORY D: Pressure Calibration Page 8708 of 14062 Page 8709 of 14062 Page 8710 of 14062 Page 8711 of 14062 Rev. 1 2025 Procurement Services Division Form 5 Reference Questionnaire (USE ONE FORM FOR EACH REQUIRED REFERENCE) Solicitation: INSTRUMENT CALIBRATION, REPAIR, AND REPLACEMENT SERVICES SOLICITATION NO.: 25-8392 Reference Questionnaire for: Universal Controls Instrument Services, Inc (Name of Company Requesting Reference Information) Bob Schwenneker Company: U.S. Water Services Corp. (Evaluator’s Company completing reference) Collier County hasimplementeda process that collects reference information on firms and their key personnel to be used in the selection of firms to perform this project. The Name of the Company listed in the Subject above has listed you as a client for which they have previously performed work. Please complete the survey. Please rate each criteria to the best of your knowledge on a scale of 1 to 10, with 10 representing that you were very satisifed (and would hire the firm/individual again) and 1 representing that you were very unsatisfied (and would never hire the firm/indivdiual again). If you do not have sufficient knowledge of past performance in a particular area, leave it blank and the item or form will be scored “0.” Completion Date: _____________________________Project Description: ___________________________ Project Budget: _______________________________Project Number of Days: _______________________ Item Criteria Score (must be completed) 1 Ability to manage the project costs (minimize change orders to scope). 2 Ability to maintain project schedule (complete on-time or early). 3 Quality of work. 4 Quality of consultative advice provided on the project. 5 Professionalism and ability to manage personnel. 6 Project administration (completed documents, final invoice, final product turnover; invoices; manuals or going forward documentation, etc.) 7 Ability to verbally communicate and document information clearly and succinctly. 8 Abiltity to manage risks and unexpected project circumstances. 9 Ability to follow contract documents, policies, procedures, rules, regulations, etc. 10 Overall comfort level with hiring the company in the future (customer satisfaction). TOTAL SCORE OF ALL ITEMS (Name of Individuals Requesting Reference Information) Name: Hope Smith (Evaluator completing reference questionnaire) Email: hsmith@uswatercorp.net FAX: Telephone: 352-236-2444 x 102 10 10 10 10 10 10 10 10 10 10 Page 8712 of 14062 Rev. 1 2025 Procurement Services Division Form 5 Reference Questionnaire (USE ONE FORM FOR EACH REQUIRED REFERENCE) Solicitation: INSTRUMENT CALIBRATION, REPAIR, AND REPLACEMENT SERVICES SOLICITATION NO.: 25-8392 Reference Questionnaire for: Universal Controls Instrument Services, Inc (Name of Company Requesting Reference Information) Bob Schwenneker (Name of Individuals Requesting Reference Information) Name: Preston Collum (Evaluator completing reference questionnaire) Company: Volusia County (Evaluator’s Company completing reference) Email: pcollum@volusia.org FAX: Telephone: (386) 804-7786 Collier County hasimplementeda process that collects reference information on firms and their key personnel to be used in the selection of firms to perform this project. The Name of the Company listed in the Subject above has listed you as a client for which they have previously performed work. Please complete the survey. Please rate each criteria to the best of your knowledge on a scale of 1 to 10, with 10 representing that you were very satisifed (and would hire the firm/individual again) and 1 representing that you were very unsatisfied (and would never hire the firm/indivdiual again). If you do not have sufficient knowledge of past performance in a particular area, leave it blank and the item or form will be scored “0.” Project Description: ___________________________Completion Date: _____________________________ Project Budget: _______________________________Project Number of Days: _______________________ Item Criteria Score (must be completed) 1 Ability to manage the project costs (minimize change orders to scope). 2 Ability to maintain project schedule (complete on-time or early). 3 Quality of work. 4 Quality of consultative advice provided on the project. 5 Professionalism and ability to manage personnel. 6 Project administration (completed documents, final invoice, final product turnover; invoices; manuals or going forward documentation, etc.) 7 Ability to verbally communicate and document information clearly and succinctly. 8 Abiltity to manage risks and unexpected project circumstances. 9 Ability to follow contract documents, policies, procedures, rules, regulations, etc. 10 Overall comfort level with hiring the company in the future (customer satisfaction). TOTAL SCORE OF ALL ITEMS 10 10 10 10 10 10 10 10 10 10 100 Page 8713 of 14062 Rev. 1 2025 Procurement Services Division Form 5 Reference Questionnaire (USE ONE FORM FOR EACH REQUIRED REFERENCE) Solicitation: INSTRUMENT CALIBRATION, REPAIR, AND REPLACEMENT SERVICES SOLICITATION NO.: 25-8392 Reference Questionnaire for: Universal Controls Instrument Services, Inc (Name of Company Requesting Reference Information) Bob Schwenneker (Name of Individuals Requesting Reference Information) Name: Deborah Houghton (Evaluator completing reference questionnaire) Company: Sarasota County Public Utilities (Evaluator’s Company completing reference) Email: dhoughto@scgov.net FAX: Telephone: 941-716-3997 Collier County hasimplementeda process that collects reference information on firms and their key personnel to be used in the selection of firms to perform this project. The Name of the Company listed in the Subject above has listed you as a client for which they have previously performed work. Please complete the survey. Please rate each criteria to the best of your knowledge on a scale of 1 to 10, with 10 representing that you were very satisifed (and would hire the firm/individual again) and 1 representing that you were very unsatisfied (and would never hire the firm/indivdiual again). If you do not have sufficient knowledge of past performance in a particular area, leave it blank and the item or form will be scored “0.” Project Description: ___________________________Completion Date: _____________________________ Project Budget: _______________________________Project Number of Days: _______________________ Item Criteria Score (must be completed) 1 Ability to manage the project costs (minimize change orders to scope). 2 Ability to maintain project schedule (complete on-time or early). 3 Quality of work. 4 Quality of consultative advice provided on the project. 5 Professionalism and ability to manage personnel. 6 Project administration (completed documents, final invoice, final product turnover; invoices; manuals or going forward documentation, etc.) 7 Ability to verbally communicate and document information clearly and succinctly. 8 Abiltity to manage risks and unexpected project circumstances. 9 Ability to follow contract documents, policies, procedures, rules, regulations, etc. 10 Overall comfort level with hiring the company in the future (customer satisfaction). TOTAL SCORE OF ALL ITEMS Calibration service 9 9 9 9 Yearly 3 year contract 9 9 Initial contract term $169,245.00 Page 8714 of 14062 Rev. 1 2025 Procurement Services Division Form 5 Reference Questionnaire (USE ONE FORM FOR EACH REQUIRED REFERENCE) Solicitation: INSTRUMENT CALIBRATION, REPAIR, AND REPLACEMENT SERVICES SOLICITATION NO.: 25-8392 Reference Questionnaire for: Universal Controls Instrument Services, Inc (Name of Company Requesting Reference Information) Bob Schwenneker (Name of Individuals Requesting Reference Information) Company: Palm Beach County (Evaluator’s Company completing reference) Collier County hasimplementeda process that collects reference information on firms and their key personnel to be used in the selection of firms to perform this project. The Name of the Company listed in the Subject above has listed you as a client for which they have previously performed work. Please complete the survey. Please rate each criteria to the best of your knowledge on a scale of 1 to 10, with 10 representing that you were very satisifed (and would hire the firm/individual again) and 1 representing that you were very unsatisfied (and would never hire the firm/indivdiual again). If you do not have sufficient knowledge of past performance in a particular area, leave it blank and the item or form will be scored “0.” Project Description: ___________________________Completion Date: _____________________________ Project Budget: _______________________________Project Number of Days: _______________________ Item Criteria Score (must be completed) 1 Ability to manage the project costs (minimize change orders to scope). 2 Ability to maintain project schedule (complete on-time or early). 3 Quality of work. 4 Quality of consultative advice provided on the project. 5 Professionalism and ability to manage personnel. 6 Project administration (completed documents, final invoice, final product turnover; invoices; manuals or going forward documentation, etc.) 7 Ability to verbally communicate and document information clearly and succinctly. 8 Abiltity to manage risks and unexpected project circumstances. 9 Ability to follow contract documents, policies, procedures, rules, regulations, etc. 10 Overall comfort level with hiring the company in the future (customer satisfaction). TOTAL SCORE OF ALL ITEMS Name:Vincent Guierl (Evaluator completing reference questionnaire) Email: vjguiel@pbcwater.com FAX: Telephone: 10 10 10 10 10 10 10 10 10 10 561-452-3600 Plantwide Instrument Calibrations May 2025 $ 19,000.00 Approx. 15 days 100 Page 8715 of 14062 Rev. 1 2025 Procurement Services Division Form 5 Reference Questionnaire (USE ONE FORM FOR EACH REQUIRED REFERENCE) Solicitation: INSTRUMENT CALIBRATION, REPAIR, AND REPLACEMENT SERVICES SOLICITATION NO.: 25-8392 Reference Questionnaire for: Universal Controls Instrument Services, Inc (Name of Company Requesting Reference Information) Bob Schwenneker (Name of Individuals Requesting Reference Information) Name: Lyndsey Austin (Evaluator completing reference questionnaire) Company: Toho Water Authority (Evaluator’s Company completing reference) Email: laustin@tohowater.com FAX: Telephone: 407-485-2837 Collier County hasimplementeda process that collects reference information on firms and their key personnel to be used in the selection of firms to perform this project. The Name of the Company listed in the Subject above has listed you as a client for which they have previously performed work. Please complete the survey. Please rate each criteria to the best of your knowledge on a scale of 1 to 10, with 10 representing that you were very satisifed (and would hire the firm/individual again) and 1 representing that you were very unsatisfied (and would never hire the firm/indivdiual again). If you do not have sufficient knowledge of past performance in a particular area, leave it blank and the item or form will be scored “0.” ProjectDescription:Ann.calibration.repairs(alllocations )Project.Budget: _______________________________ Completion.Date:9/30/2027_____________________ Project Number of Days: __3 years_________ Item Criteria Score (must be completed) 1 Ability to manage the project costs (minimize change orders to scope). 2 Ability to maintain project schedule (complete on-time or early). 3 Quality of work. 4 Quality of consultative advice provided on the project. 5 Professionalism and ability to manage personnel. 6 Project administration (completed documents, final invoice, final product turnover; invoices; manuals or going forward documentation, etc.) 7 Ability to verbally communicate and document information clearly and succinctly. 8 Abiltity to manage risks and unexpected project circumstances. 9 Ability to follow contract documents, policies, procedures, rules, regulations, etc. 10 Overall comfort level with hiring the company in the future (customer satisfaction). TOTAL SCORE OF ALL ITEMS 10 10 10 9 10 9 10 10 10 10 Page 8716 of 14062 INSURANCE REQUIREMENTS COVERSHEET Project Name Vendor Name Solicitation/Contract No. Attachments Risk Approved Insurance Requirements Risk Approved Insurance Certificate(s) Comments Attachments Approved by Risk Management Division Approval: Instrument Calibration, Repair, and Replacement Services Universal Controls 25-8392 Please review and approve. Thank you ✔ DareusHeidi Digitally signed by DareusHeidi Date: 2025.12.08 10:34:36 -05'00' Page 8717 of 14062 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2016 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY Willis Towers Watson Southeast, Inc. c/o 26 Century Blvd P.O. Box 305191 Nashville, TN 372305191 USA Universal Controls Instrument Services, Inc. 4939 Cross Bayou Blvd New Port Richey, FL 34652 RE: Any and All Work Performed on behalf of Collier County Collier County Board of County Commissioners, OR, Board of County Commissioners in Collier County, OR, Collier County Government, OR, Collier County are included as an Additional Insureds as respects to General Liability and Auto Liability. General Liability and Auto Liability policies shall be Primary and Non-contributory with any other insurance in force Collier County Board of County Commissioners 3295 Tamiami Trail E. Naples, FL 34112 11/24/2025 1-877-945-7378 1-888-467-2378 certificates@wtwco.com Philadelphia Indemnity Insurance Company 18058 Great American Alliance Insurance Company Westfield Specialty Insurance Company 26832 16992 W41902141 A 1,000,000 1,000,000 10,000 1,000,000 3,000,000 3,000,000 Y PHPK2629384-008 11/30/2025 11/30/2026 A 1,000,000 11/30/202611/30/2025YPHPK2629391-008 A 5,000,000 0 PHUB891163-008 11/30/2025 11/30/2026 5,000,000 WC E546162-06 B 1,000,000No10/31/2025 10/31/2026 1,000,000 1,000,000 C Professional Insuring Each Claim/AggregateCPP-455074Q-01 11/30/2025 11/30/2026 421923628908987SR ID:BATCH: $1,000,000 WTW Certificate Center Page 1 of 2 Page 8718 of 14062 ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved. THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: FORM TITLE: ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE Page of AGENCY CUSTOMER ID: LOC #: AGENCY CARRIER NAIC CODE POLICY NUMBER NAMED INSURED EFFECTIVE DATE: Universal Controls Instrument Services, Inc. 4939 Cross Bayou Blvd New Port Richey, FL 34652 for or which may be purchased by Additional Insureds. 22 Willis Towers Watson Southeast, Inc. See Page 1 See Page 1 See Page 1 See Page 1 25 Certificate of Liability Insurance W41902141CERT:4219236BATCH:28908987SR ID:Page 8719 of 14062 Page 8720 of 14062 Page 8721 of 14062 Procurement Services Division – 3295 Tamiami Trail East – Naples, Florida 34112-4901 www.colliercountyfl.gov/procurementservices November 12, 2025 Attn: Raymond Rocha Benro Enterprises, DBA Rocha Controls. 5025 W Rio Vista Ave Tampa, Florida 33634 Via Email: rrocha@rochacontrols.com, Mtyl@rochacontrols.com RE: Agreement No. 20-7750 Instrumentation Calibration, Repair and Replacement Services (the “Agreement”) Notice to Terminate for Convenience Dear Raymond Rocha: Staff is recommending to the Board of County Commissioners (the “Board”) at its next available meeting that it approve terminating for convenience Agreement No. 20-7750, as permitted under Section 10 of the Agreement. Subject to the Board’s approval, this letter will serve as the County’s thirty-day written Notice to Terminate for Convenience. Should you have any questions please contact Donna Deeter at (239) 252-2622. Respectfully, Viviana Giarimoustas Procurement Manager cc: Donna Deeter Donna.Deeter@collier.gov Page 8722 of 14062 Procurement Services Division – 3295 Tamiami Trail East – Naples, Florida 34112-4901 www.colliercountyfl.gov/procurementservices November 12, 2025 Attn: Robert Watson Trinova, Inc. 2401 Drane Field Road Lakeland, Florida 33811 Via Email: robbie@trinovainc.com , Debra.Kent@trinovainc.com RE: Agreement No. 20-7750 Instrumentation Calibration, Repair and Replacement Services (the “Agreement”) Notice to Terminate for Convenience Dear Robet Watson: Staff is recommending to the Board of County Commissioners (the “Board”) at its next available meeting that it approve terminating for convenience Agreement No. 20-7750, as permitted under Section 10 of the Agreement. Subject to the Board’s approval, this letter will serve as the County’s thirty-day written Notice to Terminate for Convenience. Should you have any questions please contact Donna Deeter at (239) 252-2622. Respectfully, Viviana Giarimoustas Procurement Manager cc: Donna Deeter Donna.Deeter@collier.gov Page 8723 of 14062 Procurement Services Division – 3295 Tamiami Trail East – Naples, Florida 34112-4901 www.colliercountyfl.gov/procurementservices November 10, 2025 Attn: Gary Deremer Universal Controls Instrument Services 4925 Cross Bayou Boulevard New Port Richey, Florida 34652 Via Email: gary@universalcontrols.net RE: Agreement No. 20-7750 Instrumentation Calibration, Repair and Replacement Services (the “Agreement”) Notice to Terminate for Convenience Dear Gary Deremer: Staff is recommending to the Board of County Commissioners (the “Board”) at its next available meeting that it approve terminating for convenience Agreement No. 20-7750, as permitted under Section 10 of the Agreement. Subject to the Board’s approval, this letter will serve as the County’s thirty-day written Notice to Terminate for Convenience. Should you have any questions please contact Donna Deeter at (239) 252-2622. Respectfully, Viviana Giarimoustas Procurement Manager cc: Donna Deeter Donna.Deeter@collier.gov Page 8724 of 14062