WRITTEN CONSENT OF DUBOIS CHEMICALS, INC.
(THE "CORPORATION")
The undersigned, serving as Vice President, Secretary and Treasurer who has been authorized by the Board of Directors of DuBois Chemicals, Inc. to sign, adopt and consent on behalf of the Board of Directors to the following action and resolution:
1. DuBois employs Laura Lanthier, Manager FSA & Municipal Bids of the Corporation as well as Andrew Paulson and Angela Degeyter as Municipal Bids Specia I ists.
2. Laura Lanthier, Andrew Paulson and Angela Degeyter are authorized to execute, for and on behalf of this Corporation, all bid documents and instruments as may be necessary to complete and enter into Governmental Contracts or Agreements.
Eric M. Dill Date
Vice President, Secretary and Treasurer
3630 East Kemper Road • Cincinnati, OH 45241
Phone: 800.438.2647 • Fax: 513-326-8320 • www.duboischemicals.com
Rev. 2026-01-26
ATTACHMENT A
NORTH BAY AGENCY CHEMICAL POOL
INSURANCE and INDEMNITY CERTIFICATION AGREEMENT FY26/27 NBACP discontinued using insurance to disqualify any bidder during the bid process. You are required to acknowledge and accept the insurance and indemnity terms below by certifying your company will comply with all the requirements. It is highly recommended that you provide this to your insurance producer to ensure your company’s insurance program can meet the requirements below before certifying compliance. If you are the successful bidder, you will have 15 business days to provide NBACP with all the necessary insurance certificates and endorsements. If they are not received and approved by the 15th day after you have been notified of your successful bid, NBACP will award to the next bidder.
INSURANCE
The successful Bidder shall not commence work under the Agreement until Bidder has obtained all the insurance(s) required under this paragraph and such insurance(s) has been approved by the individual Agency. All requirements herein provided shall appear either in the body of the insurance policies or as endorsements and shall specifically bind the insurance carrier.
Bidder shall procure and maintain for the duration of the contract all necessary insurance against claims for injuries to persons or damages to property which may arise from or in connection with the performance of the work hereunder by the Bidder, the Bidder’s agents, representatives, employees or subcontractors.
Minimum Scope of Insurance:
1. Insurance shall be at least as broad as:
a. Personal injury
b. Contractual liability
c. Contractor’s broad form pollution liability
d. Product liability
2. Insurance Services Office form covering Automobile Liability, code 1 (any auto)
3. Workers’ Compensation insurance as required by the State of California and Employer’s Liability Insurance
Rev. 2026-01-26
Bidder shall maintain limits no less than:
TYPE OF INSURANCE MINIMUM LIMITS OF LIABILITY
Standard Workers'
Compensation & Employer's
Liability Including Occupations
Disease Coverage
Statutory limits as required by the State of California including $1 million Employers’ Liability per accident,per employee for bodily injury or disease. If Bidder is self-insured, provide a certificate of Permission to Self-Insure, signed by the California Department of Industrial Relations and Self-Insurance.
Comprehensive General
Liability Insurance
$5,000,000 per occurrence for bodily injury, personal injury, property damage and products and completed operations;
product liability, contractor’s pollution liability. If Commercial General Liability Insurance orother form with a general aggregate liability is used, either the general aggregate limit shall apply separately to this product or the minimum required aggregate limit or be twice the required occurrence limit. Policy shall be endorsed to name the Agency as an additional
insured per the conditions detailed below.
ISO Form CG 20 10 (1/85) or its equivalent is required. The endorsement must not exclude products and completed
operations coverage. If it does, then CG 20 37 (10/01) is also required.
Comprehensive
Automobile Liability
Insurance
$5,000,000 per accident for bodily injury and property damage, to include automobile pollution liability. If the Bidder is subject to the Motor Carrier Act of 1980, Automobile Liability Policy must be endorsed to include MCS-90 Endorsement for
transportation of hazardous materials/waste/substances. If not, the policy shall be endorsed to include Transportation Pollution Liability Coverage to cover the materials
transported by the Bidder.
Umbrella/Excess Liability
Coverage
If an Umbrella or Excess Liability Policy is used to meet the liability limits, coverage shall be as broad as specified for underlying coverages and policies.
Broad Form Contractors
Pollution Liability
Insurance
Same limits as Commercial General Liability.
Rev. 2026-01-26
Deductibles and Self-Insured Retentions
Any deductibles or self-insured retentions must be declared to and approved by each Agency. At the option of each Agency, either: the insurer shall reduce or eliminate such deductibles or self-insured retentions as respects the Agency, its officers, officials, employees, and volunteers; or the Bidder shall procure a bond guaranteeing payment of losses and related investigations, claim administration and defense expenses. Bidder is responsible for satisfaction of the deductible and/or self-insured retention for each los
Other Insurance Provisions
The required general liability and automobile liability policies are to contain, or be endorsed to contain the following provisions:
1. The Agency, its officers, officials, employees, agents and volunteers are to be covered as additional insureds as respects: liability arising out of activities performed by or on behalf of the Bidder; products and completed operations of the Bidder; premises owned, occupied or used by the Bidder; or automobiles owned, leased, hired or borrowed by the Bidder. The coverage shall contain no special limitations on the scope of protection afforded to the Agencies, its officers, officials, employees, agents or volunteers.
2. For any claims related to this project, the Bidder’s insurance coverage shall be primary insurance as respects the Agencies, its officers, officials, employees, agents and volunteers.
Any insurance or self- insurance maintained by the Agencies, its officers, officials, employees, agents or volunteers shall be excess of the Bidder’s insurance and shall not contribute with it and in no way relieves the Bidder from its responsibility to provide insurance.
3. Any failure to comply with reporting or other provisions of the policies including breaches of warranties shall not affect coverage provided to the Agencies, its officers, officials, employees, agents or volunteers.
4. The Bidder’s insurance shall apply separately to each insured against whom claim is made or suit is brought except, with respect to the limits of the insurer’s liability.
5. Each insurance policy required by this clause not be suspended, voided, canceled by either party, reduced in coverage or limits except after thirty (30) days’ prior written notice by certified mail, return receipt requested, has been given to the Agencies individually. Failing to do so could subject the Bidder to breach of contract.
6. Any available insurance proceeds in excess of the specified minimum insurance coverage requirements and limits shall be available to the Agency. Furthermore, the requirements for coverage and limits shall be (1) the minimum coverage and limits specified in the Agency Agreement or (2) the full coverage and maximum limits of any insurance proceeds available to the Bidder, whichever is greater.
7. If an umbrella or excess insurance policy is used to satisfy the required limits of insurance, it shall be endorsed to contain a provision that such coverage shall also apply on a primary and non-contributory basis for the benefit of each Agency before the Agency’s own insurance shall be called upon to protect it as a named insured.
Rev. 2026-01-26
Acceptability of Insurers
Insurance is to be placed with insurers with a current A.M. Best’s rating of no less than A:VII.
Verification of Coverage
Bidder shall furnish the Agencies with endorsements effecting coverage required by this clause.
The endorsements are to be signed by a person authorized by that insurer to bind coverage on its behalf. All endorsements are to be received and approved by each individual Agency before work commences.
INDEMNIFICATION
To the maximum extent permitted by law, the successful Bidder shall, at its own expense, indemnify, defend with counsel acceptable to each North Bay Agency Chemical Pool participating Agency listed on the Standard Agreement for chemical requirements, (which acceptance will not be unreasonably withheld), and hold harmless each such participating Agency and its officers, officials, employees, agents and volunteers ("Indemnities") from and against any and all liability, loss, damage, claims, suits, actions, arbitration proceedings, administrative proceedings, regulatory proceedings, civil penalties and fines, expenses and costs (including, without limitation, claims expenses, attorney's fees and costs and fees of litigation) (collectively, "Liability") of every nature, whether actual, alleged or threatened, arising out of or in connection with the furnishing of chemicals by the successful Bidder pursuant to the Standard Agreement or the successful Bidder’s failure to comply with any of the terms of the Standard Agreement, regardless of any fault or alleged fault of the Indemnitees.
The successful Bidder’s obligation to indemnify, defend and hold harmless under this provision shall not be excused because of the successful Bidder’s inability to evaluate Liability, or because the successful Bidder evaluates Liability and determines that the successful Bidder is not or may not be liable. The successful Bidder must respond within 30 calendar days to any tender for defense and indemnity by any participating Agency, unless the time for responding has been extended by an authorized representative of the participating Agency in writing. If the successful Bidder fails to accept tender of defense and indemnity within 30 calendar days, in addition to any other remedies authorized by law, so much of the money due or that may become due the successful Bidder under the Standard Agreement as shall reasonably be considered necessary by the participating Agency may be retained by the participating Agency until disposition has been made of the matter subject to tender, or until the successful Bidder accepts the tender, whichever occurs first.
The successful Bidder waives any and all rights to express or implied indemnity against the Indemnitees concerning any Liability of the successful Bidder arising out of or in connection with the furnishing of chemicals by the successful Bidder pursuant to the Standard Agreement or the successful Bidder’s failure to comply with any of the terms of the Standard Agreement.
- -
Subject: Product Information - Fluoride
To Whom It May Concern,
The Fluorosilicic Acid is manufactured by J.R. Simplot Company, located in Rock Springs, WY.
The product then will be shipped via dedicated rubber-lined tanker truck to delivery locations.
The manufacturing process is in accordance with AWWA Standard Specifications and is ANSI/ NSF 60 Standard Certified. During the production of phosphoric acid fluoride gases are produced that are recovered as fluorosilicic acid (FSA or H2SiF6).
Fluorosilicic Acid is used to treat potable water to reduce the incidence of dental caries. Please see attached Certificate of Analysis and Product Data sheets as well as NSF Certifications.
DuBois Chemicals appreciates your business and looks forward to continuing to supply your chemical requirements. Please contact me if you need further clarification regarding this letter.
Sincerely,
Laura Lanthier
Manager, Municipal Bids & Contracts
Email: [email protected]
Office: (208) 932-6615
February 6, 2026
Certificate of Authorization
This is to certify that DuBois Chemical is the exclusive distributor authorized by the J. R. Simplot Company to sell Fluorosilicic Acid (FSA). This further will certify that the FSA manufactured by the J. R.
Simplot Company is produced in accordance with AWWA standard B703a-19 and ANSI/NSF 60 standard specifications.
Sincerely,
J. R. Simplot Company
Jon Davidson
Sr. Director of Industrial, Silica, and Feed Ingredients
DATE:
TO:
Product: Fluorosilicic Acid (FSA)
Shipper Number SH-10708155
Rail Car Number GATX 72730
Date Analyzed:
Other Information: Release #: 5856781.5
Analysis Name Analysis
Max Min
% Assay (H2SiF6) 25% 23% 23.57 . % HF 1.0% 0.49
% P2O5 0
Specific gravity @ 60oF 1.220
Lead (Pb) ppm 0.75
Arsenic ppm 5.87
Color (APHA) 200 5
Visible Suspended Matter none
Quentin Hardesty, Lab Supervisor
Meets ANSI / AWWA B703-19
Rock Springs, WY 82901
Specification
February 18, 2025
Wednesday, February 19, 2025
Certificate of Analysis (COA)
SIMPLOT PHOSPHATES LLC
515 South Hwy 430
Certified to Max. use:
NSF/ANSI/CAN 60 5 mg/L
Fluorosilicic Acid (FSA)
Safety Data Sheet
according to Federal Register / Vol. 77, No. 58 / Monday, March 26, 2012 / Rules and Regulations Issue date: 3/25/2021 Revision date: 3/24/2025 Supersedes: 3/25/2021 Version: 2.0 3/24/2025 (Revision date) US - en 1/11
SECTION 1 Identification
1.1. Product identifier
Product form : Substance
Substance name : Fluorosilicic Acid (FSA)
Chemical name : Hydro Fluorosilicic Acid (HSA)
Product code : M17200
1.2. Other means of identification
No additional information available
1.3. Recommended use of the chemical and restrictions on use No additional information available
1.4. Supplier's details
JR Simplot Company
P.O. Box 70013
Boise, ID, 83707
T 1-208-336-2110
1.5. Emergency phone number
Emergency number : CHEMTREC 1-800-424-9300
SECTION 2 Hazard Identification
2.1. Classification of the substance or mixture
GHS US classification
Corrosive to metals, Category 1 H290 May be corrosive to metals.
Acute toxicity (oral), Category 4 H302 Harmful if swallowed.
Skin corrosion/irritation, Category 1 H314 Causes severe skin burns and eye damage.
Full text of H statements : see section 16
2.2. Label elements
GHS US labeling
Hazard pictograms (GHS US) : Signal word (GHS US) : Danger Hazard statements (GHS US) : H290 - May be corrosive to metals H302 - Harmful if swallowed
H314 - Causes severe skin burns and eye damage
Precautionary statements (GHS US) : P234 - Keep only in original packaging.
P260 - Do not breathe dusts or mists.
P264 - Wash hands, forearms and face thoroughly after handling.
P270 - Do not eat, drink or smoke when using this product.
P280 - Wear protective gloves, protective clothing, eye protection, face protection, and hearing protection.
P301+P312 - If swallowed: Call a poison center or doctor if you feel unwell.
P301+P330+P331 - If swallowed: rinse mouth. Do NOT induce vomiting.
Fluorosilicic Acid (FSA)
Safety Data Sheet
according to Federal Register / Vol. 77, No. 58 / Monday, March 26, 2012 / Rules and Regulations 3/24/2025 (Revision date) US - en 2/11
P303+P361+P353 - If on skin (or hair): Take off immediately all contaminated clothing. Rinse skin with water/shower.
P304+P340 - If inhaled: Remove person to fresh air and keep comfortable for breathing.
P305+P351+P338 - IF IN EYES: Rinse cautiously with water for several minutes. Remove contact lenses, if present and easy to do. Continue rinsing.
P310 - Immediately call a poison center or doctor.
P321 - Specific treatment (see supplemental first aid instruction on this label).
P330 - Rinse mouth.
P363 - Take off immediately all contaminated clothing and wash it before reuse.
P390 - Absorb spillage to prevent material-damage.
P405 - Store locked up.
P501 - Dispose of contents and/or container to hazardous or special waste collection point, in accordance with local, regional, national and/or international regulations.
2.3. Hazards associated with known or reasonably anticipated uses No additional information available
2.4. Hazards not otherwise classified
No additional information available
2.5. Unknown acute toxicity
No additional information available
SECTION 3 Composition/information on ingredients
3.1. Substances
Name : Fluorosilicic Acid (FSA)
Name Product identifier % GHS US classification
Water CAS-No.: 7732-18-5 75 78 Not classified
hexafluorosilicic acid CAS-No.: 16961-83-4 23 25 Skin Corr. 1B, H314 Full text of hazard classes and H-statements : see section 16
3.2. Mixtures
Not applicable
SECTION 4 First aid measures
4.1. Description of necessary first-aid measures
First-aid measures general : If you feel unwell, seek medical advice. Never give anything by mouth to an unconscious person.
If you feel unwell, seek medical advice (show the label where possible). Call a physician immediately.
First-aid measures after inhalation : Remove person to fresh air and keep comfortable for breathing. Allow affected person to breathe fresh air. Allow the victim to rest.
First-aid measures after skin contact : Remove affected clothing and wash all exposed skin area with mild soap and water, followed by warm water rinse. Rinse skin with water/shower. Remove/Take off immediately all contaminated clothing. Call a physician immediately.
First-aid measures after eye contact : Rinse immediately with plenty of water. Obtain medical attention if pain, blinking or redness persists. Rinse cautiously with water for several minutes. Remove contact lenses, if present and easy to do. Continue rinsing. Call a physician immediately.
Fluorosilicic Acid (FSA)
Safety Data Sheet
according to Federal Register / Vol. 77, No. 58 / Monday, March 26, 2012 / Rules and Regulations 3/24/2025 (Revision date) US - en 3/11
First-aid measures after ingestion : Do NOT induce vomiting. Obtain emergency medical attention. Call a POISON CENTER or doctor/physician if you feel unwell. Rinse mouth. Do not induce vomiting. Call a physician immediately.
4.2. Most important symptoms/effects, acute and delayed Potential Adverse human health effects and
symptoms
: Based on available data, the classification criteria are not met. Harmful if swallowed.
Symptoms/effects after inhalation : None under normal conditions.
Symptoms/effects after skin contact : Burns.
Symptoms/effects after eye contact : Serious damage to eyes.
Symptoms/effects after ingestion : Swallowing a small quantity of this material will result in serious health hazard. Harmful if swallowed. Burns.
4.3. Indication of immediate medical attention and special treatment needed, if necessary Other medical advice or treatment : Treat symptomatically.
SECTION 5: Fire-fighting measures
5.1. Suitable (and unsuitable) extinguishing media
Suitable extinguishing media : Sand. Water spray. Dry powder. Foam. Carbon dioxide.
Unsuitable extinguishing media : Do not use a heavy water stream.
5.2. Specific hazards arising from the chemical
Fire hazard : No fire hazard.
Explosion hazard : No direct explosion hazard.
Hazardous decomposition products in case of fire : Toxic fumes may be released.
5.3. Special protective equipment and precautions for fire-fighters Firefighting instructions : Use water spray or fog for cooling exposed containers. Exercise caution when fighting any chemical fire. Prevent fire-fighting water from entering environment. Do not enter fire area without proper protective equipment, including respiratory protection.
Protection during firefighting : Do not enter fire area without proper protective equipment, including respiratory protection. Do not attempt to take action without suitable protective equipment. Self-contained breathing apparatus. Complete protective clothing.
SECTION 6 Accidental release measures
6.1. Personal precautions, protective equipment and emergency procedures General measures : Stop leak if safe to do so. Notify authorities if product enters sewers or public waters. Absorb spillage to prevent material-damage.
For non-emergency personnel
Protective equipment : Wear recommended personal protective equipment.
Emergency procedures : Ventilate spillage area. Evacuate unnecessary personnel. Avoid contact with skin and eyes. Do not breathe dust/fume/gas/mist/vapors/spray.
For emergency responders
Protective equipment : Do not attempt to take action without suitable protective equipment. Equip cleanup crew with proper protection. For further information refer to section 8: "Exposure controls/personal protection".
Emergency procedures : Ventilate area. Evacuate unnecessary personnel. Stop leak if safe to do so.
Fluorosilicic Acid (FSA)
Safety Data Sheet
according to Federal Register / Vol. 77, No. 58 / Monday, March 26, 2012 / Rules and Regulations 3/24/2025 (Revision date) US - en 4/11
Environmental precautions : Avoid release to the environment. Prevent entry to sewers and public waters. Notify authorities if liquid enters sewers or public waters.
6.2. Methods and materials for containment and cleaning up For containment : Absorb spilled material with sand or earth. Contain any spills with dikes or absorbents to prevent migration and entry into sewers or streams. Stop leak, if possible without risk.
Methods for cleaning up : Take up liquid spill into absorbent material. Soak up spills with inert solids, such as clay or diatomaceous earth as soon as possible. Collect spillage. Store away from other materials.
Absorb spillage to prevent material-damage.
Other information : Dispose of materials or solid residues at an authorized site.
See Heading 8,Exposure controls and personal protection,For further information refer to section 13 SECTION 7 Handling and storage
7.1. Precautions for safe handling
Precautions for safe handling : Ensure good ventilation of the work station. Wash hands and other exposed areas with mild soap and water before eating, drinking or smoking and when leaving work. Provide good ventilation in process area to prevent formation of vapor. Avoid contact with skin and eyes. Do not breathe dust/fume/gas/mist/vapors/spray. Wear personal protective equipment.
Hygiene measures : Wash hands, forearms and face thoroughly after handling. Wash contaminated clothing before reuse. Do not eat, drink or smoke when using this product. Always wash hands after handling the product.
Additional hazards when processed : May be corrosive to metals.
7.2. Conditions for safe storage, including incompatibilities Technical measures : Keep in a cool, well-ventilated place away from heat.
Storage conditions : Keep only in the original container in a cool, well ventilated place away from : Keep container closed when not in use. Store in corrosive resistant container with a resistant inner liner. Keep only in original container. Store locked up.
Incompatible products : Strong bases. Strong acids.
Incompatible materials : Sources of ignition. Direct sunlight. Metals.
Packaging materials : Store in corrosive resistant container with a resistant inner liner. Store always product in container of same material as original container.
SECTION 8 Exposure controls/personal protection
8.1. Control parameters
No additional information available
8.2. Appropriate engineering controls
Appropriate engineering controls : Ensure good ventilation of the work station.
Environmental exposure controls : Avoid release to the environment.
8.3. Individual protection measures, such as personal protective equipment Personal protective equipment:
Avoid all unnecessary exposure.
Materials for protective clothing:
Use chemically protective clothing
Fluorosilicic Acid (FSA)
Safety Data Sheet
according to Federal Register / Vol. 77, No. 58 / Monday, March 26, 2012 / Rules and Regulations 3/24/2025 (Revision date) US - en 5/11
Hand protection:
Acid proof gloves should be worn to prevent contact
Eye protection:
Splash proof goggles and full-face shield should be worn at all times. Safety glasses
Skin and body protection:
Wear suitable protective clothing
Respiratory protection:
Wear appropriate mask
Personal protective equipment symbol(s):
Other information:
Do not eat, drink or smoke during use.
SECTION 9 Physical and chemical properties
9.1. Basic physical and chemical properties
Physical state : Liquid
Appearance : Clear, colorless to pale straw liquid.
Color : Colorless
Odor : characteristic
Odor threshold : No data available
pH : 1
Melting point : Not applicable
Freezing point : No data available
Boiling point : 105 °C
Flash point : No data available
Flammability (solid, gas) : Non flammable.
Vapor pressure : No data available
Relative vapor density at 20°C : No data available
Relative density : No data available
Solubility : Soluble.
Partition coefficient n-octanol/water (Log Pow) : No data available Auto-ignition temperature : No data available
Decomposition temperature : No data available
Viscosity, kinematic : No data available
Explosion limits : No data available
Particle characteristics : No data available
Water
Particle characteristics No data available
hexafluorosilicic acid
Particle characteristics No data available
Fluorosilicic Acid (FSA)
Safety Data Sheet
according to Federal Register / Vol. 77, No. 58 / Monday, March 26, 2012 / Rules and Regulations 3/24/2025 (Revision date) US - en 6/11
9.2. Data relevant with regard to physical hazard classes (supplemental) No additional information available
SECTION 10 Stability and reactivity
10.1. Reactivity
The product is non-reactive under normal conditions of use, storage and transport.
10.2. Chemical stability
Stable. Not established.
10.3. Possibility of hazardous reactions
Not established.
10.4. Conditions to avoid
Extremely high temperatures. Direct sunlight. Extremely high or low temperatures.
10.5. Incompatible materials
Alkalis. Chlorites. Combustible solids and organic peroxides. Strong acids. Strong bases. May be corrosive to metals. metals.
10.6. Hazardous decomposition products
Corrosive fumes of fluorides. fume. Carbon monoxide. Carbon dioxide.
SECTION 11 Toxicological information
11.1. Information on toxicological effects
Acute toxicity (oral) : Harmful if swallowed.
Acute toxicity (dermal) : Not classified
Acute toxicity (inhalation) : Not classified
Fluorosilicic Acid (FSA)
LD50 oral rat 430 mg/kg
ATE US (oral) 430 mg/kg body weight
Water (7732-18-5)
LD50 oral rat 90000 mg/kg
ATE US (oral) 90000 mg/kg body weight
Skin corrosion/irritation : Causes severe skin burns.
pH: 1
Water (7732-18-5)
pH 7
Serious eye damage/irritation : Assumed to cause serious eye damage pH: 1
Water (7732-18-5)
pH 7
Respiratory or skin sensitization : Not classified
Fluorosilicic Acid (FSA)
Safety Data Sheet
according to Federal Register / Vol. 77, No. 58 / Monday, March 26, 2012 / Rules and Regulations 3/24/2025 (Revision date) US - en 7/11
Germ cell mutagenicity : Not classified
Carcinogenicity : Not classified
Reproductive toxicity : Not classified
STOT-single exposure : Not classified
STOT-repeated exposure : Not classified
Aspiration hazard : Not classified
Fluorosilicic Acid (FSA)
Viscosity, kinematic No data available
Water (7732-18-5)
Viscosity, kinematic No data available
hexafluorosilicic acid (16961-83-4)
Viscosity, kinematic No data available
Potential Adverse human health effects and
symptoms
: Based on available data, the classification criteria are not met. Harmful if swallowed.
Symptoms/effects after inhalation : None under normal conditions.
Symptoms/effects after skin contact : Burns.
Symptoms/effects after eye contact : Serious damage to eyes.
Symptoms/effects after ingestion : Swallowing a small quantity of this material will result in serious health hazard. Harmful if swallowed. Burns.
SECTION 12 Ecological information
12.1. Ecotoxicity
Ecology - general : The product is not considered harmful to aquatic organisms or to cause long-term adverse effects in the environment. Before neutralisation, the product may represent a danger to aquatic organisms.
Hazardous to the aquatic environment, short term
(acute)
: Not classified
Hazardous to the aquatic environment, long term
(chronic)
: Not classified
hexafluorosilicic acid (16961-83-4)
LC50 - Fish [1] > 10 mg/l (96 h, Brachydanio rerio, Static system)
12.2. Persistence and degradability
Fluorosilicic Acid (FSA)
Persistence and degradability Not established.
Water (7732-18-5)
Persistence and degradability Not established.
hexafluorosilicic acid (16961-83-4)
Persistence and degradability Biodegradability: not applicable, Reacts with water: release of toxic/harmful substances, No (test)data on mobility of the components available, Not established.
Chemical oxygen demand (COD) Not applicable
ThOD Not applicable
BOD (% of ThOD) Not applicable
Fluorosilicic Acid (FSA)
Safety Data Sheet
according to Federal Register / Vol. 77, No. 58 / Monday, March 26, 2012 / Rules and Regulations 3/24/2025 (Revision date) US - en 8/11
12.3. Bioaccumulative potential
Fluorosilicic Acid (FSA)
Bioaccumulative potential Not established.
Water (7732-18-5)
Partition coefficient n-octanol/water (Log Pow) -1.38
Bioaccumulative potential Not established.
hexafluorosilicic acid (16961-83-4)
Bioaccumulative potential Not bioaccumulative. Not established.
12.4. Mobility in soil
hexafluorosilicic acid (16961-83-4)
Ecology - soil No (test)data on mobility of the component(s) available.
12.5. Other adverse effects
Ozone : Not classified
Fluorinated greenhouse gases : No
Other information : Avoid unintentional release to the environment.
SECTION 13 Disposal considerations
Regional waste regulation : Disposal must be done according to official regulations.
Waste treatment methods :
Sewage disposal recommendations : Disposal must be done according to official regulations.
Product/Packaging disposal recommendations : Dispose in a safe manner in accordance with local/national regulations. Dispose of contents/container to hazardous or special waste collection point, in accordance with local, regional, national and/or international regulation. Disposal must be done according to official regulations.
Additional information : Do not re-use empty containers.
Ecological waste information : Avoid unintentional release to the environment.
SECTION 14 Transport information
14.1. UN number
Not regulated for transport
14.2. UN Proper Shipping Name
Proper Shipping Name (DOT) : Fluorosilicic acid
Proper Shipping Name (TDG) : Not applicable
Proper Shipping Name (IMDG) : Not applicable
Proper Shipping Name (IATA) : Not applicable
14.3. Transport hazard class(es)
DOT
Transport hazard class(es) (DOT) : 8
Hazard labels (DOT) : 8
Fluorosilicic Acid (FSA)
Safety Data Sheet
according to Federal Register / Vol. 77, No. 58 / Monday, March 26, 2012 / Rules and Regulations 3/24/2025 (Revision date) US - en 9/11
TDG
Transport hazard class(es) (TDG) : Not applicable
IMDG
Transport hazard class(es) (IMDG) : Not applicable
IATA
Transport hazard class(es) (IATA) : Not applicable
14.4. Packing group
Packing group (DOT) : II
Packing group (TDG) : Not applicable
Packing group (IMDG) : Not applicable
Packing group (IATA) : Not applicable
14.5. Environmental hazards
Other information : No supplementary information available.
14.6. Transport in bulk
Not applicable
14.7. Special precautions for user
DOT
UN-No. (DOT) : UN1778
DOT Special Provisions (49 CFR 172.102) : A6 - For combination packaging, if plastic inner packaging are used, they must be packed in tightly closed metal receptacles before packing in outer packaging.
A7 - Steel packaging must be corrosion-resistant or have protection against corrosion.
B2 - MC 300, MC 301, MC 302, MC 303, MC 305, and MC 306 and DOT 406 cargo tanks are not authorized.
B15 - Packaging must be protected with non-metallic linings impervious to the lading or have a suitable corrosion allowance.
IB2 - Authorized IBCs: Metal (31A, 31B and 31N); Rigid plastics (31H1 and 31H2); Composite (31HZ1). Additional Requirement: Only liquids with a vapor pressure less than or equal to 110 kPa at 50 C (1.1 bar at 122 F), or 130 kPa at 55 C (1.3 bar at 131 F) are authorized.
N3 - Glass inner packaging are permitted in combination or composite packaging only if the hazardous material is free from hydrofluoric acid.
N34 - Aluminum construction materials are not authorized for any part of a packaging which is normally in contact with the hazardous material.
T8 - 4 178.274(d)(2) Normal............. Prohibited
TP2 - a. The maximum degree of filling must not exceed the degree of filling determined by the following: (image) Where: tr is the maximum mean bulk temperature during transport, tf is the temperature in degrees celsius of the liquid during filling, and a is the mean coefficient of cubical expansion of the liquid between the mean temperature of the liquid during filling (tf) and the maximum mean bulk temperature during transportation (tr) both in degrees celsius. b. For liquids transported under ambient conditions may be calculated using the formula: (image) Where: d15 and d50 are the densities (in units of mass per unit volume) of the liquid at 15 C (59 F) and 50 C (122 F), respectively.
TP12 - This material is considered highly corrosive to steel.
DOT Packaging Exceptions (49 CFR 173.xxx) : None
DOT Packaging Non Bulk (49 CFR 173.xxx) : 202
DOT Packaging Bulk (49 CFR 173.xxx) : 242
Fluorosilicic Acid (FSA)
Safety Data Sheet
according to Federal Register / Vol. 77, No. 58 / Monday, March 26, 2012 / Rules and Regulations 3/24/2025 (Revision date) US - en 10/11
DOT Quantity Limitations Passenger aircraft/rail (49
CFR 173.27)
: 1 L
DOT Quantity Limitations Cargo aircraft only (49
CFR 175.75)
: 30 L
DOT Vessel Stowage Location : A -
passenger vessel.
TDG
No data available
IMDG
No data available
IATA
No data available
SECTION 15 Regulatory information
15.1. Federal regulations
All components of this product are present and listed as Active on the United States Environmental Protection Agency Toxic Substances Control Act (TSCA) inventory
15.2. International regulations
CANADA
Water (7732-18-5)
Listed on the Canadian DSL (Domestic Substances List)
hexafluorosilicic acid (16961-83-4)
Listed on the Canadian DSL (Domestic Substances List)
EU-Regulations
No additional information available
National regulations
Water (7732-18-5)
Listed on INSQ (Mexican National Inventory of Chemical Substances)
15.3. State regulations
California Proposition 65 - This product does not contain any substances known to the state of California to cause cancer, developmental and/or reproductive harm
Component State or local regulations
hexafluorosilicic acid(16961-83-4) U.S. - Massachusetts - Right To Know List; U.S. - New Jersey - Right to Know Hazardous Substance List
SECTION 16 Other information
according to Federal Register / Vol. 77, No. 58 / Monday, March 26, 2012 / Rules and Regulations Revision date : 3/24/2025
Fluorosilicic Acid (FSA)
Safety Data Sheet
according to Federal Register / Vol. 77, No. 58 / Monday, March 26, 2012 / Rules and Regulations 3/24/2025 (Revision date) US - en 11/11
Issue date : 3/25/2021
Other information : None.
Full text of hazard classes and H-statements
H290 May be corrosive to metals
H302 Harmful if swallowed
H314 Causes severe skin burns and eye damage
NFPA health hazard : 3 - Materials that, under emergency conditions, can cause serious or permanent injury.
NFPA fire hazard : 0 - Materials that will not burn under typical fire conditions, including intrinsically noncombustible materials such as concrete, stone, and sand.
NFPA reactivity : 0 - Material that in themselves are normally stable, even under fire conditions.
Hazard Rating
Health : 3 Serious Hazard - Major injury likely unless prompt action is taken and medical treatment is given
Flammability : 0 Minimal Hazard - Materials that will not burn Physical : 0 Minimal Hazard - Materials that are normally stable, even under fire conditions, and will NOT react with water, polymerize, decompose, condense, or self-react. Non-Explosives.
Safety Data Sheet (SDS), USA
Disclaimer: This information relates to the specific material designated and may not be valid for such material used in combination with any other materials or in any process. Such information is to the best of our knowledge and belief, accurate and reliable as of the date compiled. However, no representation, warranty or guarantee is made as to its accuracy, reliability or completeness. NO WARRANTY OF MERCHANTABILITY, FITNESS FOR
ANY PARTICULAR PURPOSE, OR ANY OTHER WARRANTY, EXPRESS OR IMPLIED, IS MADE CONCERNING THE INFORMATION HEREIN PROVIDED. It is the user's responsibility to satisfy himself as to the suitability and completeness of such information for his own particular use. We do not accept liability for any loss or damage that may occur from the use of this information nor do we offer warranty against patent infringement.
- -
Subject: Product Information - Fluoride
To Whom It May Concern,
The Fluorosilicic Acid is manufactured by J.R. Simplot Company, located in Rock Springs, WY.
The product then will be shipped via dedicated rubber-lined tanker truck to delivery locations.
The manufacturing process is in accordance with AWWA Standard Specifications and is ANSI/ NSF 60 Standard Certified. During the production of phosphoric acid fluoride gases are produced that are recovered as fluorosilicic acid (FSA or H2SiF6).
Fluorosilicic Acid is used to treat potable water to reduce the incidence of dental caries. Please see attached Certificate of Analysis and Product Data sheets as well as NSF Certifications.
DuBois Chemicals appreciates your business and looks forward to continuing to supply your chemical requirements. Please contact me if you need further clarification regarding this letter.
Sincerely,
Laura Lanthier
Manager, Municipal Bids & Contracts
Email: [email protected]
Office: (208) 932-6615
February 6, 2026
Certificate of Authorization
This is to certify that DuBois Chemical is the exclusive distributor authorized by the J. R. Simplot Company to sell Fluorosilicic Acid (FSA). This further will certify that the FSA manufactured by the J. R.
Simplot Company is produced in accordance with AWWA standard B703a-19 and ANSI/NSF 60 standard specifications.
Sincerely,
J. R. Simplot Company
Jon Davidson
Sr. Director of Industrial, Silica, and Feed Ingredients
DATE:
TO:
Product: Fluorosilicic Acid (FSA)
Shipper Number SH-10708155
Rail Car Number GATX 72730
Date Analyzed:
Other Information: Release #: 5856781.5
Analysis Name Analysis
Max Min
% Assay (H2SiF6) 25% 23% 23.57 . % HF 1.0% 0.49
% P2O5 0
Specific gravity @ 60oF 1.220
Lead (Pb) ppm 0.75
Arsenic ppm 5.87
Color (APHA) 200 5
Visible Suspended Matter none
Quentin Hardesty, Lab Supervisor
Meets ANSI / AWWA B703-19
Rock Springs, WY 82901
Specification
February 18, 2025
Wednesday, February 19, 2025
Certificate of Analysis (COA)
SIMPLOT PHOSPHATES LLC
515 South Hwy 430
Certified to Max. use:
NSF/ANSI/CAN 60 5 mg/L
Fluorosilicic Acid (FSA)
Safety Data Sheet
according to Federal Register / Vol. 77, No. 58 / Monday, March 26, 2012 / Rules and Regulations Issue date: 3/25/2021 Revision date: 3/24/2025 Supersedes: 3/25/2021 Version: 2.0 3/24/2025 (Revision date) US - en 1/11
SECTION 1 Identification
1.1. Product identifier
Product form : Substance
Substance name : Fluorosilicic Acid (FSA)
Chemical name : Hydro Fluorosilicic Acid (HSA)
Product code : M17200
1.2. Other means of identification
No additional information available
1.3. Recommended use of the chemical and restrictions on use No additional information available
1.4. Supplier's details
JR Simplot Company
P.O. Box 70013
Boise, ID, 83707
T 1-208-336-2110
1.5. Emergency phone number
Emergency number : CHEMTREC 1-800-424-9300
SECTION 2 Hazard Identification
2.1. Classification of the substance or mixture
GHS US classification
Corrosive to metals, Category 1 H290 May be corrosive to metals.
Acute toxicity (oral), Category 4 H302 Harmful if swallowed.
Skin corrosion/irritation, Category 1 H314 Causes severe skin burns and eye damage.
Full text of H statements : see section 16
2.2. Label elements
GHS US labeling
Hazard pictograms (GHS US) : Signal word (GHS US) : Danger Hazard statements (GHS US) : H290 - May be corrosive to metals H302 - Harmful if swallowed
H314 - Causes severe skin burns and eye damage
Precautionary statements (GHS US) : P234 - Keep only in original packaging.
P260 - Do not breathe dusts or mists.
P264 - Wash hands, forearms and face thoroughly after handling.
P270 - Do not eat, drink or smoke when using this product.
P280 - Wear protective gloves, protective clothing, eye protection, face protection, and hearing protection.
P301+P312 - If swallowed: Call a poison center or doctor if you feel unwell.
P301+P330+P331 - If swallowed: rinse mouth. Do NOT induce vomiting.
Fluorosilicic Acid (FSA)
Safety Data Sheet
according to Federal Register / Vol. 77, No. 58 / Monday, March 26, 2012 / Rules and Regulations 3/24/2025 (Revision date) US - en 2/11
P303+P361+P353 - If on skin (or hair): Take off immediately all contaminated clothing. Rinse skin with water/shower.
P304+P340 - If inhaled: Remove person to fresh air and keep comfortable for breathing.
P305+P351+P338 - IF IN EYES: Rinse cautiously with water for several minutes. Remove contact lenses, if present and easy to do. Continue rinsing.
P310 - Immediately call a poison center or doctor.
P321 - Specific treatment (see supplemental first aid instruction on this label).
P330 - Rinse mouth.
P363 - Take off immediately all contaminated clothing and wash it before reuse.
P390 - Absorb spillage to prevent material-damage.
P405 - Store locked up.
P501 - Dispose of contents and/or container to hazardous or special waste collection point, in accordance with local, regional, national and/or international regulations.
2.3. Hazards associated with known or reasonably anticipated uses No additional information available
2.4. Hazards not otherwise classified
No additional information available
2.5. Unknown acute toxicity
No additional information available
SECTION 3 Composition/information on ingredients
3.1. Substances
Name : Fluorosilicic Acid (FSA)
Name Product identifier % GHS US classification
Water CAS-No.: 7732-18-5 75 78 Not classified
hexafluorosilicic acid CAS-No.: 16961-83-4 23 25 Skin Corr. 1B, H314 Full text of hazard classes and H-statements : see section 16
3.2. Mixtures
Not applicable
SECTION 4 First aid measures
4.1. Description of necessary first-aid measures
First-aid measures general : If you feel unwell, seek medical advice. Never give anything by mouth to an unconscious person.
If you feel unwell, seek medical advice (show the label where possible). Call a physician immediately.
First-aid measures after inhalation : Remove person to fresh air and keep comfortable for breathing. Allow affected person to breathe fresh air. Allow the victim to rest.
First-aid measures after skin contact : Remove affected clothing and wash all exposed skin area with mild soap and water, followed by warm water rinse. Rinse skin with water/shower. Remove/Take off immediately all contaminated clothing. Call a physician immediately.
First-aid measures after eye contact : Rinse immediately with plenty of water. Obtain medical attention if pain, blinking or redness persists. Rinse cautiously with water for several minutes. Remove contact lenses, if present and easy to do. Continue rinsing. Call a physician immediately.
Fluorosilicic Acid (FSA)
Safety Data Sheet
according to Federal Register / Vol. 77, No. 58 / Monday, March 26, 2012 / Rules and Regulations 3/24/2025 (Revision date) US - en 3/11
First-aid measures after ingestion : Do NOT induce vomiting. Obtain emergency medical attention. Call a POISON CENTER or doctor/physician if you feel unwell. Rinse mouth. Do not induce vomiting. Call a physician immediately.
4.2. Most important symptoms/effects, acute and delayed Potential Adverse human health effects and
symptoms
: Based on available data, the classification criteria are not met. Harmful if swallowed.
Symptoms/effects after inhalation : None under normal conditions.
Symptoms/effects after skin contact : Burns.
Symptoms/effects after eye contact : Serious damage to eyes.
Symptoms/effects after ingestion : Swallowing a small quantity of this material will result in serious health hazard. Harmful if swallowed. Burns.
4.3. Indication of immediate medical attention and special treatment needed, if necessary Other medical advice or treatment : Treat symptomatically.
SECTION 5: Fire-fighting measures
5.1. Suitable (and unsuitable) extinguishing media
Suitable extinguishing media : Sand. Water spray. Dry powder. Foam. Carbon dioxide.
Unsuitable extinguishing media : Do not use a heavy water stream.
5.2. Specific hazards arising from the chemical
Fire hazard : No fire hazard.
Explosion hazard : No direct explosion hazard.
Hazardous decomposition products in case of fire : Toxic fumes may be released.
5.3. Special protective equipment and precautions for fire-fighters Firefighting instructions : Use water spray or fog for cooling exposed containers. Exercise caution when fighting any chemical fire. Prevent fire-fighting water from entering environment. Do not enter fire area without proper protective equipment, including respiratory protection.
Protection during firefighting : Do not enter fire area without proper protective equipment, including respiratory protection. Do not attempt to take action without suitable protective equipment. Self-contained breathing apparatus. Complete protective clothing.
SECTION 6 Accidental release measures
6.1. Personal precautions, protective equipment and emergency procedures General measures : Stop leak if safe to do so. Notify authorities if product enters sewers or public waters. Absorb spillage to prevent material-damage.
For non-emergency personnel
Protective equipment : Wear recommended personal protective equipment.
Emergency procedures : Ventilate spillage area. Evacuate unnecessary personnel. Avoid contact with skin and eyes. Do not breathe dust/fume/gas/mist/vapors/spray.
For emergency responders
Protective equipment : Do not attempt to take action without suitable protective equipment. Equip cleanup crew with proper protection. For further information refer to section 8: "Exposure controls/personal protection".
Emergency procedures : Ventilate area. Evacuate unnecessary personnel. Stop leak if safe to do so.
Fluorosilicic Acid (FSA)
Safety Data Sheet
according to Federal Register / Vol. 77, No. 58 / Monday, March 26, 2012 / Rules and Regulations 3/24/2025 (Revision date) US - en 4/11
Environmental precautions : Avoid release to the environment. Prevent entry to sewers and public waters. Notify authorities if liquid enters sewers or public waters.
6.2. Methods and materials for containment and cleaning up For containment : Absorb spilled material with sand or earth. Contain any spills with dikes or absorbents to prevent migration and entry into sewers or streams. Stop leak, if possible without risk.
Methods for cleaning up : Take up liquid spill into absorbent material. Soak up spills with inert solids, such as clay or diatomaceous earth as soon as possible. Collect spillage. Store away from other materials.
Absorb spillage to prevent material-damage.
Other information : Dispose of materials or solid residues at an authorized site.
See Heading 8,Exposure controls and personal protection,For further information refer to section 13 SECTION 7 Handling and storage
7.1. Precautions for safe handling
Precautions for safe handling : Ensure good ventilation of the work station. Wash hands and other exposed areas with mild soap and water before eating, drinking or smoking and when leaving work. Provide good ventilation in process area to prevent formation of vapor. Avoid contact with skin and eyes. Do not breathe dust/fume/gas/mist/vapors/spray. Wear personal protective equipment.
Hygiene measures : Wash hands, forearms and face thoroughly after handling. Wash contaminated clothing before reuse. Do not eat, drink or smoke when using this product. Always wash hands after handling the product.
Additional hazards when processed : May be corrosive to metals.
7.2. Conditions for safe storage, including incompatibilities Technical measures : Keep in a cool, well-ventilated place away from heat.
Storage conditions : Keep only in the original container in a cool, well ventilated place away from : Keep container closed when not in use. Store in corrosive resistant container with a resistant inner liner. Keep only in original container. Store locked up.
Incompatible products : Strong bases. Strong acids.
Incompatible materials : Sources of ignition. Direct sunlight. Metals.
Packaging materials : Store in corrosive resistant container with a resistant inner liner. Store always product in container of same material as original container.
SECTION 8 Exposure controls/personal protection
8.1. Control parameters
No additional information available
8.2. Appropriate engineering controls
Appropriate engineering controls : Ensure good ventilation of the work station.
Environmental exposure controls : Avoid release to the environment.
8.3. Individual protection measures, such as personal protective equipment Personal protective equipment:
Avoid all unnecessary exposure.
Materials for protective clothing:
Use chemically protective clothing
Fluorosilicic Acid (FSA)
Safety Data Sheet
according to Federal Register / Vol. 77, No. 58 / Monday, March 26, 2012 / Rules and Regulations 3/24/2025 (Revision date) US - en 5/11
Hand protection:
Acid proof gloves should be worn to prevent contact
Eye protection:
Splash proof goggles and full-face shield should be worn at all times. Safety glasses
Skin and body protection:
Wear suitable protective clothing
Respiratory protection:
Wear appropriate mask
Personal protective equipment symbol(s):
Other information:
Do not eat, drink or smoke during use.
SECTION 9 Physical and chemical properties
9.1. Basic physical and chemical properties
Physical state : Liquid
Appearance : Clear, colorless to pale straw liquid.
Color : Colorless
Odor : characteristic
Odor threshold : No data available
pH : 1
Melting point : Not applicable
Freezing point : No data available
Boiling point : 105 °C
Flash point : No data available
Flammability (solid, gas) : Non flammable.
Vapor pressure : No data available
Relative vapor density at 20°C : No data available
Relative density : No data available
Solubility : Soluble.
Partition coefficient n-octanol/water (Log Pow) : No data available Auto-ignition temperature : No data available
Decomposition temperature : No data available
Viscosity, kinematic : No data available
Explosion limits : No data available
Particle characteristics : No data available
Water
Particle characteristics No data available
hexafluorosilicic acid
Particle characteristics No data available
Fluorosilicic Acid (FSA)
Safety Data Sheet
according to Federal Register / Vol. 77, No. 58 / Monday, March 26, 2012 / Rules and Regulations 3/24/2025 (Revision date) US - en 6/11
9.2. Data relevant with regard to physical hazard classes (supplemental) No additional information available
SECTION 10 Stability and reactivity
10.1. Reactivity
The product is non-reactive under normal conditions of use, storage and transport.
10.2. Chemical stability
Stable. Not established.
10.3. Possibility of hazardous reactions
Not established.
10.4. Conditions to avoid
Extremely high temperatures. Direct sunlight. Extremely high or low temperatures.
10.5. Incompatible materials
Alkalis. Chlorites. Combustible solids and organic peroxides. Strong acids. Strong bases. May be corrosive to metals. metals.
10.6. Hazardous decomposition products
Corrosive fumes of fluorides. fume. Carbon monoxide. Carbon dioxide.
SECTION 11 Toxicological information
11.1. Information on toxicological effects
Acute toxicity (oral) : Harmful if swallowed.
Acute toxicity (dermal) : Not classified
Acute toxicity (inhalation) : Not classified
Fluorosilicic Acid (FSA)
LD50 oral rat 430 mg/kg
ATE US (oral) 430 mg/kg body weight
Water (7732-18-5)
LD50 oral rat 90000 mg/kg
ATE US (oral) 90000 mg/kg body weight
Skin corrosion/irritation : Causes severe skin burns.
pH: 1
Water (7732-18-5)
pH 7
Serious eye damage/irritation : Assumed to cause serious eye damage pH: 1
Water (7732-18-5)
pH 7
Respiratory or skin sensitization : Not classified
Fluorosilicic Acid (FSA)
Safety Data Sheet
according to Federal Register / Vol. 77, No. 58 / Monday, March 26, 2012 / Rules and Regulations 3/24/2025 (Revision date) US - en 7/11
Germ cell mutagenicity : Not classified
Carcinogenicity : Not classified
Reproductive toxicity : Not classified
STOT-single exposure : Not classified
STOT-repeated exposure : Not classified
Aspiration hazard : Not classified
Fluorosilicic Acid (FSA)
Viscosity, kinematic No data available
Water (7732-18-5)
Viscosity, kinematic No data available
hexafluorosilicic acid (16961-83-4)
Viscosity, kinematic No data available
Potential Adverse human health effects and
symptoms
: Based on available data, the classification criteria are not met. Harmful if swallowed.
Symptoms/effects after inhalation : None under normal conditions.
Symptoms/effects after skin contact : Burns.
Symptoms/effects after eye contact : Serious damage to eyes.
Symptoms/effects after ingestion : Swallowing a small quantity of this material will result in serious health hazard. Harmful if swallowed. Burns.
SECTION 12 Ecological information
12.1. Ecotoxicity
Ecology - general : The product is not considered harmful to aquatic organisms or to cause long-term adverse effects in the environment. Before neutralisation, the product may represent a danger to aquatic organisms.
Hazardous to the aquatic environment, short term
(acute)
: Not classified
Hazardous to the aquatic environment, long term
(chronic)
: Not classified
hexafluorosilicic acid (16961-83-4)
LC50 - Fish [1] > 10 mg/l (96 h, Brachydanio rerio, Static system)
12.2. Persistence and degradability
Fluorosilicic Acid (FSA)
Persistence and degradability Not established.
Water (7732-18-5)
Persistence and degradability Not established.
hexafluorosilicic acid (16961-83-4)
Persistence and degradability Biodegradability: not applicable, Reacts with water: release of toxic/harmful substances, No (test)data on mobility of the components available, Not established.
Chemical oxygen demand (COD) Not applicable
ThOD Not applicable
BOD (% of ThOD) Not applicable
Fluorosilicic Acid (FSA)
Safety Data Sheet
according to Federal Register / Vol. 77, No. 58 / Monday, March 26, 2012 / Rules and Regulations 3/24/2025 (Revision date) US - en 8/11
12.3. Bioaccumulative potential
Fluorosilicic Acid (FSA)
Bioaccumulative potential Not established.
Water (7732-18-5)
Partition coefficient n-octanol/water (Log Pow) -1.38
Bioaccumulative potential Not established.
hexafluorosilicic acid (16961-83-4)
Bioaccumulative potential Not bioaccumulative. Not established.
12.4. Mobility in soil
hexafluorosilicic acid (16961-83-4)
Ecology - soil No (test)data on mobility of the component(s) available.
12.5. Other adverse effects
Ozone : Not classified
Fluorinated greenhouse gases : No
Other information : Avoid unintentional release to the environment.
SECTION 13 Disposal considerations
Regional waste regulation : Disposal must be done according to official regulations.
Waste treatment methods :
Sewage disposal recommendations : Disposal must be done according to official regulations.
Product/Packaging disposal recommendations : Dispose in a safe manner in accordance with local/national regulations. Dispose of contents/container to hazardous or special waste collection point, in accordance with local, regional, national and/or international regulation. Disposal must be done according to official regulations.
Additional information : Do not re-use empty containers.
Ecological waste information : Avoid unintentional release to the environment.
SECTION 14 Transport information
14.1. UN number
Not regulated for transport
14.2. UN Proper Shipping Name
Proper Shipping Name (DOT) : Fluorosilicic acid
Proper Shipping Name (TDG) : Not applicable
Proper Shipping Name (IMDG) : Not applicable
Proper Shipping Name (IATA) : Not applicable
14.3. Transport hazard class(es)
DOT
Transport hazard class(es) (DOT) : 8
Hazard labels (DOT) : 8
Fluorosilicic Acid (FSA)
Safety Data Sheet
according to Federal Register / Vol. 77, No. 58 / Monday, March 26, 2012 / Rules and Regulations 3/24/2025 (Revision date) US - en 9/11
TDG
Transport hazard class(es) (TDG) : Not applicable
IMDG
Transport hazard class(es) (IMDG) : Not applicable
IATA
Transport hazard class(es) (IATA) : Not applicable
14.4. Packing group
Packing group (DOT) : II
Packing group (TDG) : Not applicable
Packing group (IMDG) : Not applicable
Packing group (IATA) : Not applicable
14.5. Environmental hazards
Other information : No supplementary information available.
14.6. Transport in bulk
Not applicable
14.7. Special precautions for user
DOT
UN-No. (DOT) : UN1778
DOT Special Provisions (49 CFR 172.102) : A6 - For combination packaging, if plastic inner packaging are used, they must be packed in tightly closed metal receptacles before packing in outer packaging.
A7 - Steel packaging must be corrosion-resistant or have protection against corrosion.
B2 - MC 300, MC 301, MC 302, MC 303, MC 305, and MC 306 and DOT 406 cargo tanks are not authorized.
B15 - Packaging must be protected with non-metallic linings impervious to the lading or have a suitable corrosion allowance.
IB2 - Authorized IBCs: Metal (31A, 31B and 31N); Rigid plastics (31H1 and 31H2); Composite (31HZ1). Additional Requirement: Only liquids with a vapor pressure less than or equal to 110 kPa at 50 C (1.1 bar at 122 F), or 130 kPa at 55 C (1.3 bar at 131 F) are authorized.
N3 - Glass inner packaging are permitted in combination or composite packaging only if the hazardous material is free from hydrofluoric acid.
N34 - Aluminum construction materials are not authorized for any part of a packaging which is normally in contact with the hazardous material.
T8 - 4 178.274(d)(2) Normal............. Prohibited
TP2 - a. The maximum degree of filling must not exceed the degree of filling determined by the following: (image) Where: tr is the maximum mean bulk temperature during transport, tf is the temperature in degrees celsius of the liquid during filling, and a is the mean coefficient of cubical expansion of the liquid between the mean temperature of the liquid during filling (tf) and the maximum mean bulk temperature during transportation (tr) both in degrees celsius. b. For liquids transported under ambient conditions may be calculated using the formula: (image) Where: d15 and d50 are the densities (in units of mass per unit volume) of the liquid at 15 C (59 F) and 50 C (122 F), respectively.
TP12 - This material is considered highly corrosive to steel.
DOT Packaging Exceptions (49 CFR 173.xxx) : None
DOT Packaging Non Bulk (49 CFR 173.xxx) : 202
DOT Packaging Bulk (49 CFR 173.xxx) : 242
Fluorosilicic Acid (FSA)
Safety Data Sheet
according to Federal Register / Vol. 77, No. 58 / Monday, March 26, 2012 / Rules and Regulations 3/24/2025 (Revision date) US - en 10/11
DOT Quantity Limitations Passenger aircraft/rail (49
CFR 173.27)
: 1 L
DOT Quantity Limitations Cargo aircraft only (49
CFR 175.75)
: 30 L
DOT Vessel Stowage Location : A -
passenger vessel.
TDG
No data available
IMDG
No data available
IATA
No data available
SECTION 15 Regulatory information
15.1. Federal regulations
All components of this product are present and listed as Active on the United States Environmental Protection Agency Toxic Substances Control Act (TSCA) inventory
15.2. International regulations
CANADA
Water (7732-18-5)
Listed on the Canadian DSL (Domestic Substances List)
hexafluorosilicic acid (16961-83-4)
Listed on the Canadian DSL (Domestic Substances List)
EU-Regulations
No additional information available
National regulations
Water (7732-18-5)
Listed on INSQ (Mexican National Inventory of Chemical Substances)
15.3. State regulations
California Proposition 65 - This product does not contain any substances known to the state of California to cause cancer, developmental and/or reproductive harm
Component State or local regulations
hexafluorosilicic acid(16961-83-4) U.S. - Massachusetts - Right To Know List; U.S. - New Jersey - Right to Know Hazardous Substance List
SECTION 16 Other information
according to Federal Register / Vol. 77, No. 58 / Monday, March 26, 2012 / Rules and Regulations Revision date : 3/24/2025
Fluorosilicic Acid (FSA)
Safety Data Sheet
according to Federal Register / Vol. 77, No. 58 / Monday, March 26, 2012 / Rules and Regulations 3/24/2025 (Revision date) US - en 11/11
Issue date : 3/25/2021
Other information : None.
Full text of hazard classes and H-statements
H290 May be corrosive to metals
H302 Harmful if swallowed
H314 Causes severe skin burns and eye damage
NFPA health hazard : 3 - Materials that, under emergency conditions, can cause serious or permanent injury.
NFPA fire hazard : 0 - Materials that will not burn under typical fire conditions, including intrinsically noncombustible materials such as concrete, stone, and sand.
NFPA reactivity : 0 - Material that in themselves are normally stable, even under fire conditions.
Hazard Rating
Health : 3 Serious Hazard - Major injury likely unless prompt action is taken and medical treatment is given
Flammability : 0 Minimal Hazard - Materials that will not burn Physical : 0 Minimal Hazard - Materials that are normally stable, even under fire conditions, and will NOT react with water, polymerize, decompose, condense, or self-react. Non-Explosives.
Safety Data Sheet (SDS), USA
Disclaimer: This information relates to the specific material designated and may not be valid for such material used in combination with any other materials or in any process. Such information is to the best of our knowledge and belief, accurate and reliable as of the date compiled. However, no representation, warranty or guarantee is made as to its accuracy, reliability or completeness. NO WARRANTY OF MERCHANTABILITY, FITNESS FOR
ANY PARTICULAR PURPOSE, OR ANY OTHER WARRANTY, EXPRESS OR IMPLIED, IS MADE CONCERNING THE INFORMATION HEREIN PROVIDED. It is the user's responsibility to satisfy himself as to the suitability and completeness of such information for his own particular use. We do not accept liability for any loss or damage that may occur from the use of this information nor do we offer warranty against patent infringement.
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-MAIL ADDRESS:
PRODUCER
(A/C, No, Ext): PHONE
INSURED
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
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 WVDADDL
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
AUTOS ONLY AUTOS NON-OWNED OWNED SCHEDULED
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 EMPLOYEEE.L. EACH ACCIDENT EROTH- STATUTE PER
(MM/DD/YYYY) LIMITS POLICY EXP(MM/DD/YYYY) POLICY EFFLTR TYPE OF INSURANCE POLICY NUMBER INSR
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)
© 1988-2015 ACORD CORPORATION. All rights reserved.
CERTIFICATE HOLDER
The ACORD name and logo are registered marks of ACORD
HIRED
AUTOS ONLY
4/17/2026
HUB International Insurance Services Inc.
9855 Scranton Road
Suite 100
San Diego CA 92121
Sally Walter 858-373-4969 619-393-0484 [email protected] License#: 0757776 AIG Specialty Insurance Company 26883 DUBOCHE-01 Starr Indemnity and Liability 38318 DuBois Chemicals, Inc.
3630 East Kemper Road
Sharonville OH 45241
Starr Surplus Lines Insurance Company 13604 Everest National Insurance Company 10120 1629304490 A X 1,000,000 X 300,000 25,000 1,000,000 2,000,000 X
Y Y EG 14260787-05 10/1/2025 10/1/2026
2,000,000
B
B
1,000,000 X
Y Y 1000635945251
1000635946251
10/1/2025
10/1/2025
10/1/2026
10/1/2026
A X 10,000,000 XY Y EGU 14260788-05 10/1/2025 10/1/2026 10,000,000
B
B
X
N
Y 100 0004358
100 0004359
10/1/2025
10/1/2025
10/1/2026
10/1/2026
1,000,000 1,000,000 1,000,000
A
C
D
Pollution Liability
Excess Liability
Cyber Liability
Y
Y Y
Y
Y Y
EG 14260787-05
1000337865251
CYBP001653-251
10/1/2025
10/1/2025
4/1/2025
10/1/2026
10/1/2026
10/1/2026
Aggregate Limit
Aggregate Limit
Aggregate Limit
2,000,000
10,000,000
5,000,000
Jobs: City of Vallejo, Fleming Hill WTP 202 Fleming Hill Road, Vallejo, 94590 and Travis AFB WTP 383 Fairchild Drive, Travis AFB 94535, City of Vallejo, the Agency, its officers, officials, employees, agents and volunteers are listed as Additional Insureds per the attached endorsements when required by written contract. Coverage is Primary and Non-Contributory when required by written contract.
City of Vallejo
555 Santa Clara Street
Vallejo CA 94590
FORM MCS-90 OMB No.: 2126-0008 Expiration: 06/30/2027
USDOT Number: ___________ Date Received: _____________
Please note, the expiration date as stated on this form relates to the process for renewing the Information Collection Request for this form with the Office of Management and Budget. This requirement to collect information as requested on this form does not expire. For questions, please contact the Office of Registration and Safety Information, Registration, Licensing, and Insurance Division.
A Federal Agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a current valid OMB Control Number. The OMB Control Number for this information collection is 2126-0008. Public reporting for this collection of information is estimated to be approximately 2 minutes per response, including the time for reviewing instructions, gathering the data needed, and completing and reviewing the collection of information. All responses to this collection of information are mandatory. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, Federal Motor Carrier Safety Administration, MCRRA, Washington, D.C. 20590.
Endorsement for Motor Carrier Policies of Insurance for Public Liability under Sections 29 and 30 of the Motor Carrier Act of 1980 FORM MCS-90
Issued to DUBOIS CHEMICALS, INC. ET. AL. of OH
(Motor Carrier Name) (Motor Carrier state or province)
Dated at 12:01 am on this 29th day of October 2025
Amending Policy Number: 1000635945251 Effective Date: 10/01/2025 Name of Insured Company: Starr Indemnity & Liability Company Countersigned by: __________________________________
(authorized company representative)
The policy to which this endorsement is attached provides primary or excess insurance, as indicated for the limits shown (check only one): This insurance is primary and the company shall not be liable for amounts in excess of $1,000,000 for each accident.
This insurance is excess and the company shall not be liable for amounts in excess of for each accident in excess of the underlying limit of for each accident.
Whenever required by the Federal Motor Carrier Safety Administration (FMCSA), the company agrees to furnish the FMCSA a duplicate of said policy and all its endorsements. The company also agrees, upon telephone request by an authorized representative of the FMCSA , to verify that the policy is in force as of a particular date. The telephone number to call is: (866) 519-2522. Cancellation of this endorsement may be effected by the company or the insured by giving (1) thirty-five (35) days notice in writing to the other party (said 35 days notice to commence from the date the notice is mailed, proof of mailing shall be sufficient proof of notice), and (2) if the insured is subject to the FMCSA’s registration requirements under 49 U.S.C. 13901, by providing thirty (30) days notice to the FMCSA (said 30 days notice to commence from the date the notice is received by the FMCSA at its office in Washington, DC).
Filings must be transmitted online via the Internet at https://portal.fmcsa.dot.gov/UrsRegistrationWizard/. Rev 5/26/2023 (continued on next page)
United States Department of Transportation
Federal Motor Carrier Safety Administration
FORM MCS-90 OMB No.: 2126-0008 Expiration: 06/30/2027
FORM MCS-90 Page 2 of 3
DEFINITIONS AS USED IN THIS ENDORSEMENT
Accident includes continuous or repeated exposure to conditions or which results in bodily injury, property damage, or environmental damage which the insured neither expected nor intended.
Motor Vehicle means a land vehicle, machine, truck, tractor, trailer, or semitrailer propelled or drawn by mechanical power and used on a highway for transporting property, or any combination thereof.
Bodily Injury means injury to the body, sickness, or disease to any person, including death resulting from any of these.
Property Damage means damage to or loss of use of
tangible property.
The insurance policy to which this endorsement is attached provides automobile liability insurance and is amended to assure compliance by the insured, within the limits stated herein, as a motor carrier of property, with Sections 29 and 30 of the Motor Carrier Act of 1980 and the rules and regulations of the Federal Motor Carrier Safety Administration (FMCSA).
In consideration of the premium stated in the policy to which this endorsement is attached, the insurer (the company) agrees to pay, within the limits of liability described herein, any final judgment recovered against the insured for public liability resulting from negligence in the operation, maintenance or use of motor vehicles subject to the financial responsibility requirements of Sections 29 and 30 of the Motor Carrier Act of 1980 regardless of whether or not each motor vehicle is specifically described in the policy and whether or not such negligence occurs on any route or in any territory authorized to be served by the insured or elsewhere. Such insurance as is afforded, for public liability, does not apply to injury to or death of the insured’s employees while engaged in the course of their employment, or property transported by the insured, designated as cargo. It is understood and agreed that no condition, provision, stipulation, or limitation contained in the policy, this endorsement, or any other endorsement thereon,
Environmental Restoration means restitution for the loss, damage, or destruction of natural resources arising out of the accidental discharge, dispersal, release or escape into or upon the land, atmosphere, watercourse, or body of water, of any commodity transported by a motor carrier. This shall include the cost of removal and the cost of necessary measures taken to minimize or mitigate damage to human health, the natural environment, fish, shellfish, and wildlife.
Public Liability means liability for bodily injury, property damage, and environmental restoration.
or violation thereof, shall relieve the company from liability or from the payment of any final judgment, within the limits of liability herein described, irrespective of the financial condition, insolvency or bankruptcy of the insured. However, all terms, conditions, and limitations in the policy to which the endorsement is attached shall remain in full force and effect as binding between the insured and the company. The insured agrees to reimburse the company for any payment made by the company on account of any accident, claim, or suit involving a breach of the terms of the policy, and for any payment that the company would not have been obligated to make under the provisions of the policy except for the agreement contained in this endorsement.
It is further understood and agreed that, upon failure of the company to pay any final judgment recovered against the insured as provided herein, the judgment creditor may maintain an action in any court of competent jurisdiction against the company to compel such payment.
The limits of the company’s liability for the amounts prescribed in this endorsement apply separately to each accident and any payment under the policy because of anyone accident shall not operate to reduce the liability of the company for the payment of final judgments resulting from any other accident.
(continued on next page
FORM MCS-90 OMB No.: 2126-0008 Expiration: 06/30/2027
FORM MCS-90 Page 3 of 3
SCHEDULE OF LIMITS — PUBLIC LIABILITY
Type of carriage Commodity transported January 1, 1985
(1) For-hire (in interstate or foreign commerce, with a Property (nonhazardous) $750,000 gross vehicle weight rating of 10,001 or more pounds).
(2) For-hire and Private (in interstate, foreign, or
intrastate commerce, with a gross vehicle weight rating of 10,001 or more pounds).
Hazardous substances, as defined in 49 CFR 171.8, transported in cargo tanks, portable tanks, or hoppertype vehicles with capacities in excess of 3,500 water gallons; or in bulk Division 1.1, 1.2, and 1.3 materials, Division 2.3, Hazard Zone A, or Division 6.1, Packing
Group I, Hazard Zone A material; in bulk Division 2.1 or
2.2; or highway route controlled quantities of a Class 7 material, as defined in 49 CFR 173.403. (3) For-hire and Private (in interstate or foreign Oil listed in 49 CFR 172.101; hazardous waste, $1,000,000 commerce, in any quantity; or in intrastate commerce, hazardous materials, and hazardous substances in bulk only; with a gross vehicle weight rating of defined in 49 CFR 171.8 and listed in 49 CFR 172.101, 10,001 or more pounds). but not mentioned in (2) above or (4) below. (4) For-hire and Private (In interstate or foreign
commerce, with a gross vehicle weight rating of less
than 10,001 pounds).
Any quantity of Division 1.1, 1.2, or 1.3 material; any quantity of a Division 2.3, Hazard Zone A, or Division
6.1, Packing Group I, Hazard Zone A material; or
highway route controlled quantities of a Class 7
material as defined in 49 CFR 173.403.
* The schedule of limits shown does not provide coverage. The limits shown in the schedule are for information purposes only $5,000,000
$5,000,000
1 Approved as to form:
By: for
Veronica Nebb, City Attorney
CHEMICAL SUPPLIES PURCHASE AGREEMENT
This Chemical Supplies Purchase Agreement ("Agreement") is made and entered into this 1st day of July, 2026, by and between the City of Vallejo, a municipal corporation ("City"), and LINDE INC., a Delaware corporation, hereinafter referred to as “Vendor,” who agree as follows:
1. Vendor shall provide City, and deliver to Fleming Hill, Travis, and Green Valley Water Treatment Plants, as required by the Vallejo Municipal Water System, the following:
Chemical: Liquid Oxygen
Quantity: 240,000 ccf
Unit Price: $1.45/ccf
Chemical Cost: $348,000.00
(Three Hundred Forty-Eight Thousand Dollars
and Zero Cents)
Contingency for Misc. Surcharges (10%): $34,800.00
(Thirty-Four Thousand Eight Hundred Dollars
and Zero Cents)
Agreement Not to Exceed Amount: $382,800.00
(Three Hundred Eighty-Two Thousand Eight
Hundred Dollars and Zero Cents)
The foregoing quantity(ies) is/are an approximation only, and are the quantities estimated as required by the Water System for the Agreement term. City does not expressly or by implication warrant that the actual quantities ordered during the Agreement term will correspond therewith, and reserves the right to increase or decrease the quantity of chemical ordered, at the bid price, as may be necessary or advisable.
2. Vendor hereby agrees that all chemicals and/or materials furnished shall be in accordance with the terms and conditions of each and every provision as set forth in those specifications entitled “NORTH BAY AGENCY CHEMICAL POOL CHEMICAL REQUIREMENTS,” referenced herein and made a part hereof as though attached or recited in their entirety herein.
3. Vendor further agrees that all chemicals and/or materials furnished and delivered shall be in conformity with its bid proposal and per specifications of the North Bay Agency Chemical Pool Bid opened on April 15, 2026.
4. Vendor further agrees that all chemicals and/or materials to be furnished and
2 delivered shall be strictly in accordance with said specifications, except that the City reserves the right to accept material other than that called forth in said specifications provided the Water Director approves in writing such other chemical/material as equal or better prior to Vendor furnishing or delivering the same.
5. Vendor has obtained or agrees to apply, prior to performance under this Agreement, to City’s Finance Department for a business license, pay the applicable business license tax and maintain said business license during the term of this Agreement. The failure to obtain such license shall be a material breach of this Agreement and grounds for termination by City. No payments shall be made to Vendor until such business license(s) has been obtained.
6. Vendor shall be fully informed of all Federal, State, County or Municipal laws, statutes, ordinances, codes and regulations which may in any manner apply to or otherwise have effect on the material to be furnished and shall at all times abide by all such rulings, orders and decrees of those agencies, bodies or tribunals having any jurisdiction or authority over the same.
7. City hereby agrees to pay to Vendor, in lawful money of the United States of America, at the time and in accordance with the provisions set forth in said specifications the price(s) set forth above.
8. The term of this Agreement is for Fiscal Year 2026-2027, shall commence upon execution of the contract by the City Manager, and shall continue in full force and effect until June 30, 2027. If the term of this Agreement extends into fiscal years subsequent to that in which it is approved, such continuation of the Agreement is contingent on the appropriation of funds for such purpose by the City Council of the City of Vallejo.
9. The parties hereto shall have the right by mutual consent to extend this Agreement on a month-to-month basis, notwithstanding the termination date specified above herein.
Any such agreed extension may include a revision of the unit price herein recited and such revised price shall then prevail over the unit price recited herein for the term of such extension. In the event City desires to extend this Agreement, the Water Director shall so notify the Vendor, who shall promptly accept or reject such extension in writing.
10. All notices or instruments required to be given or delivered by law or this Agreement shall be in writing and shall be effective upon receipt thereof and shall be by personal service or delivered by depositing the same in any United States Post Office, registered or certified mail, postage prepaid, addressed to:
If to City: Beth Schoenberger, Water Director
City of Vallejo Water Department
202 Fleming Hill Road
Vallejo, CA 94589
If to Vendor: Holly O’Donnell, Dir. of Government & Aerospace Programs
3 Linde, Inc.
7000 High Grove Blvd.
Burr Ridge, IL 60527
Any party may change its address for receiving notices by giving written notice of such change to the other party in accordance with this section.
11. The City Representative shall administer this Agreement for the City, and routine administrative communications shall be made to the City Representative, or the representative's designee:
Nicholas Rolley, Water Operations Superintendent
City of Vallejo Water Department
202 Fleming Hill Road
Vallejo, CA 94589
[email protected]
12. This Agreement, including all attachments, contains the entire agreement between the parties and supersedes whatever oral or written understanding they may have had prior to the execution of this Agreement. This Agreement shall not be amended or modified except by a written agreement executed by each of the parties hereto.
13. This Agreement shall in all respects be governed by the law of the State of California without regard to its conflicts of law rules. Litigation arising out of or connected with this Agreement shall be instituted and maintained in the courts of Solano County in the State of California or in the United States District Court, Eastern District of California, Sacramento, California, and the parties consent to jurisdiction over their person and over the subject matter of any such litigation in such courts, and consent to service of process issued by such courts.
14. The following Exhibits are attached hereto and incorporated herein by reference:
Exhibit A: NBACP “Standard Agreement” & Bid Form
Exhibit B: NBACP Insurance and Indemnity Certification Agreement Exhibit C: NBACP Bid Award Documents
Exhibit D: NBACP Bid Packet
Exhibit E: Manufacturer Chemical Information
Exhibit F: Insurance and Endorsements (including any attachments) Exhibit G: City of Vallejo Business License
[SIGNATURES ON FOLLOWING PAGE]
4 IN WITNESS WHEREOF, the parties have executed this Agreement on the day and year shown below the name of each of the parties.
LINDE INC.,
a Delaware corporation
By:
Holly O’Donnell
Sales Director
DATE:
11706591
Vallejo Business License No.
(City Seal)
CITY OF VALLEJO,
a municipal corporation
By:
Harry Black
Interim City Manager
DATE:
ATTEST:
By:
Dawn Abrahamson
City Clerk
APPROVED AS TO CONTENT:
By:
Beth Schoenberger
Water Director
APPROVED AS TO FORM:
By:
Veronica A.F. Nebb
City Attorney
APPROVED AS TO INSURANCE:
By:
Armond Sarkis
Risk Manager
5 Exhibit A
NBACP Standard Agreement & Bid
6 Exhibit B
NBACP Insurance and Indemnity Certification
Agreement
7 Exhibit C
NBACP Bid General Requirments
8 Exhibit D
NBACP Bid Packet
9 Exhibit E
Manufacturer Chemical Information
(Including Any Attachments)
10 Exhibit F
Insurance and Endorsements
11 Exhibit G
City of Vallejo Business License
- 4 -
NORTH BAY AGENCY CHEMICAL POOL (NBACP)
FOR FISCAL YEAR 2026 – 2027
STANDARD AGREEMENT
c/o: Orlando Cortez
NBACP Chair
Vallejo Flood and Wastewater District
450 Ryder Street
Vallejo, CA 94590
Dear Mr. Cortez:
I hereby agree to furnish the chemicals identified in the attached bid form(s), as solicited by the NBACP, for the following NBACP agencies:
1. City of American Canyon 2. City of Benicia 3. City of Calistoga
4. City of Davis 5. City of Fairfield 6. City of Napa
7. City of Petaluma 8. City of St. Helena 9. City of Vacaville
10. City of Vallejo 11. City of West Sacramento 12. Solano Irrigation District
13. Township of Yountville 14. Vallejo Flood and Wastewater District and in accordance with the prices, specifications, terms and conditions as stated in the bid packet.
Company:
Address:
City, State, Zip:
Phone: Email:
Authorized Representative:
Signature: Date:
WE ACKNOWLEDGE ADDENDUM/ADDENDA NUMBER THROUGH .
SPECIFIC DEVIATIONS:
- 5 -
NORTH BAY AGENCY CHEMICAL POOL
FOR FISCAL YEAR 2026 – 2027
BID FORM
CHEMICAL PRODUCT
CONCENTRATION COST UNIT DELIVERY DESCRIPTION
COST PER
UNIT
Aluminum Sulfate 48% Dry Ton Full Load (~ 45,000 lb)
Aluminum Sulfate 35% (acid alum) Dry Ton Full Load (~ 45,000 lb) Sodium Hydroxide 50% Dry Ton Full Load (~ 45,000 lb)
Sodium Hydroxide 50% Dry Ton Short Load (< 30,000 lb)
Sodium Hydroxide 25% Dry Ton Full Load (~ 45,000 lb)
Sodium Hydroxide 25% Dry Ton Short Load (< 30,000 lb)
Liquid Oxygen (Gas) 100% CCF Full Load (280-460 CCF)
Carbon Dioxide (Gas) 100% Pounds Full Load (~ 18,000 lb) Carbon Dioxide (Gas) 100% Pounds Short Load (< 2,000 lb) Liquid Chlorine (Cl2 Gas) 100% Ton Short Load (< 4 cylinders) Sodium Hypochlorite 12.5% Gallons Full Load (> 4,000 gal) Sodium Hypochlorite 12.5% Gallons Sodium Hypochlorite 12.5% Gallons 55-gallon drum Ferric Chloride 43% Dry Ton Full Load (~ 45,000 lb)
Sodium Bisulfite 25% Gallons Full Load (> 1000 gal)
Sodium Bisulfite 40% Gallons Full Load (> 1000 gal)
Fluorosilicic Acid 24% Dry Ton Full Load (~ 45,000 lb)
Ortho-Polyphosphate 17 – 19% (as Ortho)
Gallons
Pound
Pound
250-gal tote
Short Load (~20,000 lb)
Full Load (~45,000 lb)
SUBMISSION CONTACT INFORMATION:
Company:
Address:
City, State, Zip:
Phone: Email:
Authorized Representative:
Signature: Date:
April 14, 2026
City of Vallejo
FLEMING HILL WTP
202 Fleming Hill Road
Vallejo, CA 94590
RE: NORTH BAY AGENCY CHEMICAL POOL REQUIREMENTS FOR FISCAL YEAR 2026 – 2027 DUE WEDNESDAY, APRIL 15, 2026 @ 2:00 PM
To Whom It May Concern:
We are pleased to submit our proposal for your Liquid Oxygen requirements for the period of July 1, 2026 through June 30, 2027 as listed below:
Location Customer Owned Tank Volume/Year
Fleming Hill WTP 11,000 gallon 240,000 ccf
MODIFICATIONS TO BID SPECIFICATIONS
If legally allowed by the bidding process, Linde’s Sales, Legal, and Risk Management groups are available for further discussion on any of the modifications, additions or clarifications provided below.
NORTH BAY AGENCY CHEMICAL POOL FOR FISCAL YEAR 2026 – 2027 General Requirements
liability and automobile liability policies shall include the City, its elected and appointed officers, directors, and employees as additional insured per ISO Endorsement Number CG 20 10 12 19. Such additional insured coverage shall be limited to the extent liability arises from Seller’s negligence in connection with the work or operations performed by or on behalf of Contractor pursuant to this Agreement and subject to the contractual limitations in this Agreement notwithstanding any language to the contrary in any insurance document issued or received by either party.
Health Safety and Liability below. If the indemnification language as contained in this Section is not acceptable, upon mutual agreement the contract could be silent as to liability and indemnity
Pages 14-15 15. Delivery Requirements Note: Linde will load and invoice on a meter ticket. We will not supply a weight ticket with the delivery. Product is offloaded into the storage tank through a calibrated meter on the rear of our trailers. Beginning and ending meter weights are recorded on the delivery ticket and the delta is the amount that will be invoiced.
If this practice is not acceptable for the City, Linde can provide this service, but there will be an additional charge for doing so. If awarded the business, we can provide this information.
If through any cause other than a force majeure event, the successful Bidder fails to fulfill in a timely and proper manner its material obligations or if the successful Bidder shall violate any of the material covenants, agreements, general requirements, or stipulations of the Award, and such Bidder has not cured that violation upon reasonable notice and reasonable opportunity to cure same by the relevant Agency, each Agency shall have the right to unilaterally terminate the contract by giving written notice to the successful Bidder of such termination and specifying the effective date of termination. Notwithstanding the above, the successful Bidder shall not be relieved of liability to the Agency for direct damage sustained by the Agency by virtue of breach of the award by the successful Bidder and the Agency may withhold any payments to the successful Bidder for the purpose of set-off until such time as the exact amount of direct damages due the Agency from the successful Bidder is determined
Generation for Water, Wastewater, and Reclaimed Water Systems.
numbers, driver’s license numbers, etc. Upon arrival to your facility, the driver will show this identification as well as a photo ID.
ATTACHMENT A - INSURANCE and INDEMNITY CERTIFICATION AGREEMENT 2026 Pages 35-39 Insurance We will include with this bid a sample COI that evidences what we can provide.
Pages 35-39 Insurance Regarding all references to Additional Insured, Contractor’s commercial general liability and automobile liability policies shall include the City, its elected and appointed officers, directors, and employees as additional insured per ISO Endorsement Number CG 20 10 12 19. Such additional insured coverage shall be limited to the extent liability arises from Seller’s negligence in connection with the work or operations performed by or on behalf of Contractor pursuant to this Agreement and subject to the contractual limitations in this Agreement notwithstanding any language to the contrary in any insurance document issued or received by either party.
Health Safety and Liability below. If the indemnification language as contained in this Section is not acceptable, upon mutual agreement the contract could be silent as to liability and indemnity
In addition to the above, the following terms and conditions are hereby incorporated into the bid documents and confirm the agreement of Buyer (defined below) to purchase Buyer’s total requirements, in gaseous and liquid form, of Product (defined below) for use at Buyer's Locations(s) (defined below) for the period of the Basic Term (defined below) and the agreement of Linde, Inc. (“Seller”) to deliver Product to Buyer pursuant to these terms and conditions. The terms and conditions set forth below are incorporated into the bid documents and these terms and conditions together with the bid documents as modified by the above letter are collectively referred to as the “Agreement”. Payment terms are net thirty (30) days from date of invoice.
For purposes of this letter the terms "Buyer”, “Buyer's Location”, “Basic Term”, "Prices", "Product," "Specifications", and “Product Storage System” will have the respective meanings set forth below:
“Buyer” means City of Vallejo having an address at 202 Fleming Hill Road, Vallejo, CA 94590 “Buyer's Location(s)” means Vallejo, CA
“Basic Term” means July 1, 2026 through June 30, 2027
“Prices” means $1.45/ccf
“Product” means Liquid Oxygen
“Product Storage System” means Buyer’s owned 11,000-gallon storage tank “Specifications” means ≥ 99.5% assay
Linde’s plant is NSF 60 certified by WQA. Evidence of certification can be found by going to the following website:
www.wqa.org.
You will find a list of all the Linde plants that are NSF-60 certified for oxygen. Supply to your facility will be shipping from our Pittsburg, CA plant. Attached is a copy of the paperwork that you will receive with each shipment to your facility indicating that the product is certified by WQA to the ANSI/NSF Standard 60, Drinking Water Treatment Chemicals – Health Effects.
Also attached for your reference is a copy of our Sustainable Development web page. Detailed information can be found by going to www.lindeus.com.
1. BUYER’S STORAGE SYSTEM: Buyer, at its expense, will maintain the Product Storage System (“Product Storage System”) and the site on which the Product Storage System is located. Seller will have the right, without any liability hereunder, to refuse to deliver Product into the Product Storage System if Seller reasonably determines that the Product Storage System or Product Storage System site is unfit for the storage or delivery of Product or the site on which the Product Storage System is located is not safe as determined by Seller for the delivery of Product.
2. SPECIFICATIONS. Product delivered hereunder will meet the Specifications. Buyer may reject any Product which does not meet the Specifications and no charge will be made for Product so rejected. Since Buyer may obtain devices which have the capability of testing whether Product meets the Specifications, no claim of any kind with respect to the conformance of Product to the foregoing Specifications, whether or not based on negligence, warranty, strict liability or any other theory of law, will be greater than the price of the quantity of nonconforming Product in respect to which such claim is made. The foregoing constitutes Buyer's exclusive remedy and Seller's sole obligation with respect to any such claim. THERE ARE NO EXPRESS WARRANTIES BY SELLER OTHER THAN THOSE SPECIFIED IN THIS ARTICLE 2. NO WARRANTIES BY SELLER
(OTHER THAN WARRANTY OF TITLE AS PROVIDED IN THE UNIFORM COMMERCIAL CODE) WILL BE IMPLIED
OR OTHERWISE CREATED UNDER THE UNIFORM COMMERCIAL CODE INCLUDING, WITHOUT LIMITATION, WARRANTY OF MERCHANTABILITY AND WARRANTY OF FITNESS FOR A PARTICULAR PURPOSE.
3. CONTINGENCIES. Neither party hereto will be liable to the other for default or delay in the performance of any of its obligations hereunder (except any obligation to make payments when due) due to act of God, accident, fire, flood, storm, riot, war, act of terrorism, sabotage, explosion, strike, concerted acts of workers, national defense requirements, governmental law, ordinance, rule or regulation, whether valid or invalid, extraordinary failure of equipment or apparatus, inability to obtain electricity or other type of energy, feedstock, raw or finished material from normal sources of supply, labor, equipment or transportation, or any similar or different contingency beyond its reasonable control which would prevent or delay performance or make performance commercially impracticable whether or not the contingency is of the same class as those enumerated above, it being expressly agreed that such enumeration is non-exclusive; provided, however, that neither business downturn nor economic conditions will qualify as a contingency within the meaning of this Article 3. In the event any such contingency affects only a part of Seller's capability to produce and/or deliver Product, Seller will allocate production and/or deliveries among the requirements of all its affected customers and Seller's own requirements in a fair and reasonable manner. Buyer will pay or reimburse Seller for any additional costs incurred relating to the delivery of any Product to Buyer during a contingency. In the event that a contingency event prevents Seller from delivering Product or requires Buyer to pay any additional costs for Product then Buyer shall be allowed to seek Product from alternative sources during the period of the contingency. In the event that a contingency event prevents Seller from delivering Product or requires Buyer to pay any additional costs for Product then Buyer shall be allowed to seek Product from alternative sources during the period of the contingency.
4. HEALTH AND SAFETY. Buyer acknowledges that there are hazards associated with Product, including the storage, use and handling thereof, and Buyer agrees that its employees, agents, contractors, and others concerned with Product are aware of such hazards. Buyer assumes all responsibility for the suitability and the results of using Product alone or in combination with other articles or substances and in any manufacturing, medical, or other process or procedures. Buyer will notify Seller of any hazards and safety procedures at Buyer’s Location(s) and Buyer will notify Seller in advance of any anticipated construction, renovation, or change in operations in the area of any Product Storage System site so that any hazards associated with same can be minimized. Buyer will be responsible for complying with (i) all relevant reporting obligations under all applicable laws, including the Emergency Planning and Community Right-to-Know Act of 1986, 42 U.S.C. Sections 11001-11049 (EPCRA, also commonly known as Title III of the Superfund Amendments and Reauthorization Act of 1986 (SARA Title III)), and (ii) process safety management and risk management programs that in either case result from the presence at Buyer’s Location(s) of Product supplied under this Agreement. Buyer will warn and protect its employees, contractors and others exposed to the hazards posed by Buyer’s storage, use and handling of Product. Seller will provide documents to Buyer containing Seller’s safety and health information pertaining to Product, including Seller’s Safety Data Sheet(s), and Buyer will incorporate such information into Buyer’s safety program.
5. LIMITATION OF LIABILITY. Seller will not be liable to Buyer for any incidental, consequential, indirect, special or exemplary damages (including loss of biological material or scientific research, lost profits, sales or other similar damages) arising in connection with this Agreement without regard to the nature of the claim or the underlying theory or cause of action (whether in contract, tort, strict liability, equity or any other theory of law) on which such damages are based. In addition, subject to the limitations in this Agreement, Seller’s total liability over the Basic Term and any Renewal Term(s) for any and all claims of Buyer shall not exceed under any theory of law, the amount received from Buyer under the Agreement at the Buyer Location for the three-month period prior to the date such claim first arises.
Buyer will warn and protect its employees, contractors and others exposed to the hazards posed by Buyer's storage, use and handling of Product. Seller will provide documents to Buyer containing Seller's safety and health information pertaining to Product, including Seller's Material Safety Data Sheet(s), and Buyer will incorporate such information into Buyer's safety program. Buyer hereby waives any right of subrogation that Buyer, any insurer of Buyer or any third party making a claim through Buyer, may have under this Agreement. Seller will not be liable to Buyer for any incidental, consequential, indirect, special or exemplary damages (including lost profits, sales or other similar damages) arising in connection with this Agreement without regard to the nature of the claim or the underlying theory or cause of action (whether in contract, tort, strict liability, equity or any other theory of law) on which such damages are based.
Buyer will pay Seller a Transportation Charge for each delivery of Product. The current Transportation Charge is set forth in the chart below and may be adjusted quarterly based on the average of the previous quarter’s Weekly U.S. No. 2 Diesel Retail Prices (Dollars per Gallon) as published by the US Energy Information Administration and as otherwise determined by Seller. The diesel prices can be found at www.eia.gov. The chart below shows how the charge varies with diesel price changes. The Transportation Charge for Diesel Fuel Prices not shown will increase or decrease in the same increments reflected on the chart.
The above referenced charges or surcharges will be in addition to the Prices and will be invoiced by Seller’s standard billing methods.
Linde will follow the guidelines of the Compressed Gas Association CGA M-1, 2013; 13.1.2 for systems inspections. Buyer shall be responsible for all costs associated with such work. Billing will be based on the Price Schedule for Supply System Service in effect at that time of the work (current schedule attached).
Please indicate your acceptance by signing below that the above provisions are included and made a part of the Agreement between the parties. A signed copy will be returned to you for your records. This document becomes a part of the contract documents for Liquid Oxygen.
Our proposal is valid for thirty (30) days and is subject to the above terms and conditions. I hope that Linde can serve your industrial gas needs in the near future. If you have any questions, please feel free to contact me on (630) 320-4231.
Sincerely,
LINDE INC.
Account Manager
AGREED AND ACCEPTED THIS _____ DAY OF ______________, 2026 CITY OF VALLEJO, CA LINDE INC.
Signature: ________________________ Signature: ________________________ Name: ________________________ Name: ________________________ Title: ________________________ Title: ________________________ Date: ________________________ Date: ________________________
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CERTIFICATION
By signing the below, your company acknowledges and accepts the insurance and indemnity terms set forth above. You also certify that you have communicated with your insurance producer to ensure your company can meet the above criteria. If you are the successful bidder and you fail to supply NBACP with the required insurance certificates and endorsements within 15 days, the bid will be awarded to the next qualifying bidder.
Date of Certification
Company Name
Print Name of Authorized Agent
Signature of Authorized Agent
April 23, 2026
To: North Bay Agency Chemical Pool (NBACP) Members
CC: Chemical Suppliers
Re: Recommendation for Fiscal Year (FY) 2026-2027 Chemical Purchases Please find enclosed the bid summary of the FY 2026-2027 chemical bid solicitations for the NBACP.
Based on a meeting of NBACP members, the award of bids for the various chemicals for FY 2026-2027 is as follows providing the selected chemical supplier submits the appropriate insurance documents that meet the NBACP minimum insurance requirements by May 8, 2026:
Aluminum Sulfate, 48% Chemtrade Chemicals $589.87/DT
Aluminum Sulfate (Acid), 35% Chemtrade Chemicals $789.54/DT Sodium Hydroxide, 50% (Full Load) Univar Solutions $823.49/DT Sodium Hydroxide, 50% (Short Load) Univar Solutions $865.87/DT Sodium Hydroxide, 25% (Full Load) Univar Solutions $1,028.81/DT Sodium Hydroxide, 25% (Short Load) Univar Solutions $1,127.20/DT Sodium Bisulfite, 25% Univar Solutions $1.45/Gal
Sodium Bisulfite 40% Thatcher Co. of CA Inc. $2.595/Gal Liquid Chlorine Gas (1-ton Cylinder) Thatcher Co. of CA Inc. $3,265.00/ton Sodium Hypochlorite, 12.5% (Full load) Univar Solutions $3.90/Gal Sodium Hypochlorite, 12.5% (Short load) Univar Solutions $4.35/Gal Sodium Hypochlorite, 12.5% (55 gal Drum) No Bid ---
Hydrofluorosilicic acid, 100% Dubois $3,178.26/DT
Hydrofluorosilicic acid, 24% No Bid ---
Ferric Chloride, 43% Thatcher Co. of CA Inc. $1,153.00/DT Liquid Oxygen, 100% Linde Inc. $1.45/CCF
Carbon Dioxide Linde Inc. $0.184/lb.
Orthopolyphosphate (Full load) Sterling Water Tech $0.7400/lb.
Orthopolyphosphate (Short Load) Carus $0.80/lb.
Orthopolyphosphate (Tote) Sterling Water Tech $11.1500/Gal.
NBACP Members
April 23, 2026
NBACP members will present these bids to their managers for acceptance. Purchase orders and contracts will be processed by each individual agency member to the respective chemical vendor prior to the onset of FY 2026-2027. If you have any further questions, please contact my office at (707) 558- 3408.
Sincerely,
Orland Cortez
NBACP Chairman 2026-2027
NORTH BAY AGENCY CHEMICAL POOL (NBACP) - PRIMARY CHEMICAL BID RESULTS APRIL 15, 2026 FY 2026 - 2027
ALUM ACID ALUM
LOX
(Liquid
Oxygen)
CO2 FERRIC
25%
SODIUM
BISULFITE
40%
SODIUM
BISULFITE
(Dry Ton) (Dry Ton) (Dry ton) (Dry ton) (Dry Ton) (Dry Ton) (CCF) lb (gallon) (gallon) (Dry Ton) (gallon) (gallon) (Dry Ton) (adjusted) Lb. Lb. (gallon) Full Full Full Short Full Short 100% 100% Full Short Full Short Full Full Full 100% 24% Full short tote Brenntag Pacific, Inc. $1,170.00 $1,965.00 $1,450.00 $2,850.00 Dubois $3,178.26
Chemtrade Chem $589.87 $789.54
Kemira $1,407.67
Pencco $1,189.00 $5,550.00
Carus $0.76 $0.80 $12.5400
Nalco
Linde Inc. $1.45 $0.184
Olin Corporation $4.02 $4.72
Heimburger & Company $2.1370 $2.669
Sterling Water Tech $0.7400 $0.8400 $11.1500
Thatcher Co.of CA Inc $3,265.00 $1,153.00 $2.28 $2.595
Univar Solutions $823.49 $865.87 $1,028.81 $1,127.20 $3.90 $4.35 $1.45 $2.600
FISCAL YEAR
FY 25-26 $372.00 $574.00 $662.02 $1,000.00 $774.81 $1,050.00 $1.38 $0.18 $3,050.00 $3.09 $3.49 $8.29 $1,478.00 $1.92 $2.54 $2,079.00 $498.96 $0.72 $0.80 $10.59 FY 24-25 $299.00 $499.00 $711.00 $960.00 $869.78 $1,015.00 $1.38 $0.160 $3,050.00 $2.49 $2.89 $7.89 $1,440.00 $2.400 $2.640 $2,475.00 $594.00 $0.7800 $0.8000 $11.2000 FY 23-24 $304.00 $508.00 $868.00 $868.00 $1,008.00 $1,840.00 $1.38 $0.160 $2,650.00 $1.82 $2.79 $7.75 $1,397.00 $2.450 $2.845 $2,487.50 $597.00 $0.9384 $1.0279 $12.4721 FY 22-23 $386.00 $550.00 $742.12 $1,086.33 $885.70 $1,319.67 $1.15 $0.140 $1,800.00 $1.62 $1.80 $1,195.00 $1.795 $2,333.33 $560.00 $0.9900 $1.0900 $13.5600 FY 21-22 $266.00 $450.00 $402.99 $499.90 $1.05 $0.090 $1,185.00 $0.69 $0.8027 $900.00 $1.12 $2,226.09 $534.26 $0.4488 $0.4491 $27.0545 FY 20-21 $285.00 $375.00 $443.00 $567.00 $1.00 $0.070 $1,140.00 $0.70 $0.82 $810.00 $1.09 $1,604.35 $385.04 $5.5000 $5.7500 $6.5000 FY 19-20 $255.00 $297.70 $674.60 $762.55 $0.56 $0.260 $0.00 $850.00 $0.65 $0.65 $840.00 $1.05 $1,352.17 $325.50 FY 18-19 $255.00 $297.70 $674.60 $762.55 $0.26 $0.050 $0.00 $850.00 $0.65 $0.65 $756.00 $1.05 $1,352.17 $325.50 FY 17-18 $232.00 $257.00 $538.22 $630.88 $0.28 $0.049 $0.00 $800.00 $0.53 $0.59 $500.00 $1.03 $1,421.74 $341.22 FY 16-17 $229.00 $229.00 $395.00 $444.06 $0.27 $615.00 $645.00 $0.47 $0.57 $438.78 $0.94 $1,661.00 $398.64 FY 15-16 $204.00 $204.00 $399.13 $463.26 $0.28 $459.00 $462.00 $0.50 $0.57 $493.70 $0.89 $1,789.83 $429.56 FY 14-15 $184.00 $184.00 $445.00 $483.80 $0.27 $519.00 $555.00 $0.51 $0.58 $517.00 $0.91 $2,065.21 $495.65 FY 13-14 $277.60 $277.60 $452.00 $479.00 $0.24 $565.00 $540.00 $0.62 $0.50 $597.00 $0.75 $2,480.39 $595.29 FY 12-13 $398.00 $398.00 $475.00 $505.00 $0.21 $565.00 $540.00 $0.58 $0.48 No Bid $0.75 $2,550.00 $612.00
CHEMICAL VENDOR
LIQUID Cl2 (GAS)
(Chlorine)
(1-ton Cylinder)
12.5% NaOCl
(Sodium Hypochlorite)
55 gal drum
FLUORIDE Orthopolyphosphate 25% NaOH
(Sodium Hydroxide)
50% NaOH
(Sodium Hydroxide)
April 14, 2026
City of Vallejo
FLEMING HILL WTP
202 Fleming Hill Road
Vallejo, CA 94590
RE: NORTH BAY AGENCY CHEMICAL POOL REQUIREMENTS FOR FISCAL YEAR 2026 – 2027 DUE WEDNESDAY, APRIL 15, 2026 @ 2:00 PM
To Whom It May Concern:
We are pleased to submit our proposal for your Liquid Oxygen requirements for the period of July 1, 2026 through June 30, 2027 as listed below:
Location Customer Owned Tank Volume/Year
Fleming Hill WTP 11,000 gallon 240,000 ccf
MODIFICATIONS TO BID SPECIFICATIONS
If legally allowed by the bidding process, Linde’s Sales, Legal, and Risk Management groups are available for further discussion on any of the modifications, additions or clarifications provided below.
NORTH BAY AGENCY CHEMICAL POOL FOR FISCAL YEAR 2026 – 2027 General Requirements
liability and automobile liability policies shall include the City, its elected and appointed officers, directors, and employees as additional insured per ISO Endorsement Number CG 20 10 12 19. Such additional insured coverage shall be limited to the extent liability arises from Seller’s negligence in connection with the work or operations performed by or on behalf of Contractor pursuant to this Agreement and subject to the contractual limitations in this Agreement notwithstanding any language to the contrary in any insurance document issued or received by either party.
Health Safety and Liability below. If the indemnification language as contained in this Section is not acceptable, upon mutual agreement the contract could be silent as to liability and indemnity
Pages 14-15 15. Delivery Requirements Note: Linde will load and invoice on a meter ticket. We will not supply a weight ticket with the delivery. Product is offloaded into the storage tank through a calibrated meter on the rear of our trailers. Beginning and ending meter weights are recorded on the delivery ticket and the delta is the amount that will be invoiced.
If this practice is not acceptable for the City, Linde can provide this service, but there will be an additional charge for doing so. If awarded the business, we can provide this information.
If through any cause other than a force majeure event, the successful Bidder fails to fulfill in a timely and proper manner its material obligations or if the successful Bidder shall violate any of the material covenants, agreements, general requirements, or stipulations of the Award, and such Bidder has not cured that violation upon reasonable notice and reasonable opportunity to cure same by the relevant Agency, each Agency shall have the right to unilaterally terminate the contract by giving written notice to the successful Bidder of such termination and specifying the effective date of termination. Notwithstanding the above, the successful Bidder shall not be relieved of liability to the Agency for direct damage sustained by the Agency by virtue of breach of the award by the successful Bidder and the Agency may withhold any payments to the successful Bidder for the purpose of set-off until such time as the exact amount of direct damages due the Agency from the successful Bidder is determined
Generation for Water, Wastewater, and Reclaimed Water Systems.
numbers, driver’s license numbers, etc. Upon arrival to your facility, the driver will show this identification as well as a photo ID.
ATTACHMENT A - INSURANCE and INDEMNITY CERTIFICATION AGREEMENT 2026 Pages 35-39 Insurance We will include with this bid a sample COI that evidences what we can provide.
Pages 35-39 Insurance Regarding all references to Additional Insured, Contractor’s commercial general liability and automobile liability policies shall include the City, its elected and appointed officers, directors, and employees as additional insured per ISO Endorsement Number CG 20 10 12 19. Such additional insured coverage shall be limited to the extent liability arises from Seller’s negligence in connection with the work or operations performed by or on behalf of Contractor pursuant to this Agreement and subject to the contractual limitations in this Agreement notwithstanding any language to the contrary in any insurance document issued or received by either party.
Health Safety and Liability below. If the indemnification language as contained in this Section is not acceptable, upon mutual agreement the contract could be silent as to liability and indemnity
In addition to the above, the following terms and conditions are hereby incorporated into the bid documents and confirm the agreement of Buyer (defined below) to purchase Buyer’s total requirements, in gaseous and liquid form, of Product (defined below) for use at Buyer's Locations(s) (defined below) for the period of the Basic Term (defined below) and the agreement of Linde, Inc. (“Seller”) to deliver Product to Buyer pursuant to these terms and conditions. The terms and conditions set forth below are incorporated into the bid documents and these terms and conditions together with the bid documents as modified by the above letter are collectively referred to as the “Agreement”. Payment terms are net thirty (30) days from date of invoice.
For purposes of this letter the terms "Buyer”, “Buyer's Location”, “Basic Term”, "Prices", "Product," "Specifications", and “Product Storage System” will have the respective meanings set forth below:
“Buyer” means City of Vallejo having an address at 202 Fleming Hill Road, Vallejo, CA 94590 “Buyer's Location(s)” means Vallejo, CA
“Basic Term” means July 1, 2026 through June 30, 2027
“Prices” means $1.45/ccf
“Product” means Liquid Oxygen
“Product Storage System” means Buyer’s owned 11,000-gallon storage tank “Specifications” means ≥ 99.5% assay
Linde’s plant is NSF 60 certified by WQA. Evidence of certification can be found by going to the following website:
www.wqa.org.
You will find a list of all the Linde plants that are NSF-60 certified for oxygen. Supply to your facility will be shipping from our Pittsburg, CA plant. Attached is a copy of the paperwork that you will receive with each shipment to your facility indicating that the product is certified by WQA to the ANSI/NSF Standard 60, Drinking Water Treatment Chemicals – Health Effects.
Also attached for your reference is a copy of our Sustainable Development web page. Detailed information can be found by going to www.lindeus.com.
1. BUYER’S STORAGE SYSTEM: Buyer, at its expense, will maintain the Product Storage System (“Product Storage System”) and the site on which the Product Storage System is located. Seller will have the right, without any liability hereunder, to refuse to deliver Product into the Product Storage System if Seller reasonably determines that the Product Storage System or Product Storage System site is unfit for the storage or delivery of Product or the site on which the Product Storage System is located is not safe as determined by Seller for the delivery of Product.
2. SPECIFICATIONS. Product delivered hereunder will meet the Specifications. Buyer may reject any Product which does not meet the Specifications and no charge will be made for Product so rejected. Since Buyer may obtain devices which have the capability of testing whether Product meets the Specifications, no claim of any kind with respect to the conformance of Product to the foregoing Specifications, whether or not based on negligence, warranty, strict liability or any other theory of law, will be greater than the price of the quantity of nonconforming Product in respect to which such claim is made. The foregoing constitutes Buyer's exclusive remedy and Seller's sole obligation with respect to any such claim. THERE ARE NO EXPRESS WARRANTIES BY SELLER OTHER THAN THOSE SPECIFIED IN THIS ARTICLE 2. NO WARRANTIES BY SELLER
(OTHER THAN WARRANTY OF TITLE AS PROVIDED IN THE UNIFORM COMMERCIAL CODE) WILL BE IMPLIED
OR OTHERWISE CREATED UNDER THE UNIFORM COMMERCIAL CODE INCLUDING, WITHOUT LIMITATION, WARRANTY OF MERCHANTABILITY AND WARRANTY OF FITNESS FOR A PARTICULAR PURPOSE.
3. CONTINGENCIES. Neither party hereto will be liable to the other for default or delay in the performance of any of its obligations hereunder (except any obligation to make payments when due) due to act of God, accident, fire, flood, storm, riot, war, act of terrorism, sabotage, explosion, strike, concerted acts of workers, national defense requirements, governmental law, ordinance, rule or regulation, whether valid or invalid, extraordinary failure of equipment or apparatus, inability to obtain electricity or other type of energy, feedstock, raw or finished material from normal sources of supply, labor, equipment or transportation, or any similar or different contingency beyond its reasonable control which would prevent or delay performance or make performance commercially impracticable whether or not the contingency is of the same class as those enumerated above, it being expressly agreed that such enumeration is non-exclusive; provided, however, that neither business downturn nor economic conditions will qualify as a contingency within the meaning of this Article 3. In the event any such contingency affects only a part of Seller's capability to produce and/or deliver Product, Seller will allocate production and/or deliveries among the requirements of all its affected customers and Seller's own requirements in a fair and reasonable manner. Buyer will pay or reimburse Seller for any additional costs incurred relating to the delivery of any Product to Buyer during a contingency. In the event that a contingency event prevents Seller from delivering Product or requires Buyer to pay any additional costs for Product then Buyer shall be allowed to seek Product from alternative sources during the period of the contingency. In the event that a contingency event prevents Seller from delivering Product or requires Buyer to pay any additional costs for Product then Buyer shall be allowed to seek Product from alternative sources during the period of the contingency.
4. HEALTH AND SAFETY. Buyer acknowledges that there are hazards associated with Product, including the storage, use and handling thereof, and Buyer agrees that its employees, agents, contractors, and others concerned with Product are aware of such hazards. Buyer assumes all responsibility for the suitability and the results of using Product alone or in combination with other articles or substances and in any manufacturing, medical, or other process or procedures. Buyer will notify Seller of any hazards and safety procedures at Buyer’s Location(s) and Buyer will notify Seller in advance of any anticipated construction, renovation, or change in operations in the area of any Product Storage System site so that any hazards associated with same can be minimized. Buyer will be responsible for complying with (i) all relevant reporting obligations under all applicable laws, including the Emergency Planning and Community Right-to-Know Act of 1986, 42 U.S.C. Sections 11001-11049 (EPCRA, also commonly known as Title III of the Superfund Amendments and Reauthorization Act of 1986 (SARA Title III)), and (ii) process safety management and risk management programs that in either case result from the presence at Buyer’s Location(s) of Product supplied under this Agreement. Buyer will warn and protect its employees, contractors and others exposed to the hazards posed by Buyer’s storage, use and handling of Product. Seller will provide documents to Buyer containing Seller’s safety and health information pertaining to Product, including Seller’s Safety Data Sheet(s), and Buyer will incorporate such information into Buyer’s safety program.
5. LIMITATION OF LIABILITY. Seller will not be liable to Buyer for any incidental, consequential, indirect, special or exemplary damages (including loss of biological material or scientific research, lost profits, sales or other similar damages) arising in connection with this Agreement without regard to the nature of the claim or the underlying theory or cause of action (whether in contract, tort, strict liability, equity or any other theory of law) on which such damages are based. In addition, subject to the limitations in this Agreement, Seller’s total liability over the Basic Term and any Renewal Term(s) for any and all claims of Buyer shall not exceed under any theory of law, the amount received from Buyer under the Agreement at the Buyer Location for the three-month period prior to the date such claim first arises.
Buyer will warn and protect its employees, contractors and others exposed to the hazards posed by Buyer's storage, use and handling of Product. Seller will provide documents to Buyer containing Seller's safety and health information pertaining to Product, including Seller's Material Safety Data Sheet(s), and Buyer will incorporate such information into Buyer's safety program. Buyer hereby waives any right of subrogation that Buyer, any insurer of Buyer or any third party making a claim through Buyer, may have under this Agreement. Seller will not be liable to Buyer for any incidental, consequential, indirect, special or exemplary damages (including lost profits, sales or other similar damages) arising in connection with this Agreement without regard to the nature of the claim or the underlying theory or cause of action (whether in contract, tort, strict liability, equity or any other theory of law) on which such damages are based.
Buyer will pay Seller a Transportation Charge for each delivery of Product. The current Transportation Charge is set forth in the chart below and may be adjusted quarterly based on the average of the previous quarter’s Weekly U.S. No. 2 Diesel Retail Prices (Dollars per Gallon) as published by the US Energy Information Administration and as otherwise determined by Seller. The diesel prices can be found at www.eia.gov. The chart below shows how the charge varies with diesel price changes. The Transportation Charge for Diesel Fuel Prices not shown will increase or decrease in the same increments reflected on the chart.
The above referenced charges or surcharges will be in addition to the Prices and will be invoiced by Seller’s standard billing methods.
Linde will follow the guidelines of the Compressed Gas Association CGA M-1, 2013; 13.1.2 for systems inspections. Buyer shall be responsible for all costs associated with such work. Billing will be based on the Price Schedule for Supply System Service in effect at that time of the work (current schedule attached).
Please indicate your acceptance by signing below that the above provisions are included and made a part of the Agreement between the parties. A signed copy will be returned to you for your records. This document becomes a part of the contract documents for Liquid Oxygen.
Our proposal is valid for thirty (30) days and is subject to the above terms and conditions. I hope that Linde can serve your industrial gas needs in the near future. If you have any questions, please feel free to contact me on (630) 320-4231.
Sincerely,
LINDE INC.
Account Manager
AGREED AND ACCEPTED THIS _____ DAY OF ______________, 2026 CITY OF VALLEJO, CA LINDE INC.
Signature: ________________________ Signature: ________________________ Name: ________________________ Name: ________________________ Title: ________________________ Title: ________________________ Date: ________________________ Date: ________________________
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NORTH BAY AGENCY CHEMICAL POOL (NBACP)
FOR FISCAL YEAR 2026 – 2027
STANDARD AGREEMENT
c/o: Orlando Cortez
NBACP Chair
Vallejo Flood and Wastewater District
450 Ryder Street
Vallejo, CA 94590
Dear Mr. Cortez:
I hereby agree to furnish the chemicals identified in the attached bid form(s), as solicited by the NBACP, for the following NBACP agencies:
1. City of American Canyon 2. City of Benicia 3. City of Calistoga
4. City of Davis 5. City of Fairfield 6. City of Napa
7. City of Petaluma 8. City of St. Helena 9. City of Vacaville
10. City of Vallejo 11. City of West Sacramento 12. Solano Irrigation District
13. Township of Yountville 14. Vallejo Flood and Wastewater District and in accordance with the prices, specifications, terms and conditions as stated in the bid packet.
Company:
Address:
City, State, Zip:
Phone: Email:
Authorized Representative:
Signature: Date:
WE ACKNOWLEDGE ADDENDUM/ADDENDA NUMBER THROUGH .
SPECIFIC DEVIATIONS:
- 5 -
NORTH BAY AGENCY CHEMICAL POOL
FOR FISCAL YEAR 2026 – 2027
BID FORM
CHEMICAL PRODUCT
CONCENTRATION COST UNIT DELIVERY DESCRIPTION
COST PER
UNIT
Aluminum Sulfate 48% Dry Ton Full Load (~ 45,000 lb)
Aluminum Sulfate 35% (acid alum) Dry Ton Full Load (~ 45,000 lb) Sodium Hydroxide 50% Dry Ton Full Load (~ 45,000 lb)
Sodium Hydroxide 50% Dry Ton Short Load (< 30,000 lb)
Sodium Hydroxide 25% Dry Ton Full Load (~ 45,000 lb)
Sodium Hydroxide 25% Dry Ton Short Load (< 30,000 lb)
Liquid Oxygen (Gas) 100% CCF Full Load (280-460 CCF)
Carbon Dioxide (Gas) 100% Pounds Full Load (~ 18,000 lb) Carbon Dioxide (Gas) 100% Pounds Short Load (< 2,000 lb) Liquid Chlorine (Cl2 Gas) 100% Ton Short Load (< 4 cylinders) Sodium Hypochlorite 12.5% Gallons Full Load (> 4,000 gal) Sodium Hypochlorite 12.5% Gallons Sodium Hypochlorite 12.5% Gallons 55-gallon drum Ferric Chloride 43% Dry Ton Full Load (~ 45,000 lb)
Sodium Bisulfite 25% Gallons Full Load (> 1000 gal)
Sodium Bisulfite 40% Gallons Full Load (> 1000 gal)
Fluorosilicic Acid 24% Dry Ton Full Load (~ 45,000 lb)
Ortho-Polyphosphate 17 – 19% (as Ortho)
Gallons
Pound
Pound
250-gal tote
Short Load (~20,000 lb)
Full Load (~45,000 lb)
SUBMISSION CONTACT INFORMATION:
Company:
Address:
City, State, Zip:
Phone: Email:
Authorized Representative:
Signature: Date:
- 35 -
ATTACHMENT A
NORTH BAY AGENCY CHEMICAL POOL
INSURANCE and INDEMNITY CERTIFICATION AGREEMENT FY26/27 NBACP discontinued using insurance to disqualify any bidder during the bid process. You are required to acknowledge and accept the insurance and indemnity terms below by certifying your company will comply with all the requirements. It is highly recommended that you provide this to your insurance producer to ensure your company’s insurance program can meet the requirements below before certifying compliance. If you are the successful bidder, you will have 15 business days to provide NBACP with all the necessary insurance certificates and endorsements. If they are not received and approved by the 15th day after you have been notified of your successful bid, NBACP will award to the next bidder.
INSURANCE
The successful Bidder shall not commence work under the Agreement until Bidder has obtained all the insurance(s) required under this paragraph and such insurance(s) has been approved by the individual Agency. All requirements herein provided shall appear either in the body of the insurance policies or as endorsements and shall specifically bind the insurance carrier.
Bidder shall procure and maintain for the duration of the contract all necessary insurance against claims for injuries to persons or damages to property which may arise from or in connection with the performance of the work hereunder by the Bidder, the Bidder’s agents, representatives, employees or subcontractors.
Minimum Scope of Insurance:
1. Insurance shall be at least as broad as:
a. Personal injury
b. Contractual liability
c. Contractor’s broad form pollution liability
d. Product liability
2. Insurance Services Office form covering Automobile Liability, code 1 (any auto)
3. Workers’ Compensation insurance as required by the State of California and Employer’s Liability Insurance
Bidder shall maintain limits no less than:
TYPE OF INSURANCE MINIMUM LIMITS OF LIABILITY
Standard Workers'
Compensation & Employer's
Liability Including Occupations
Disease Coverage
Statutory limits as required by the State of California including $1 million Employers’ Liability per accident, per employee for bodily injury or disease. If Bidder is self-insured, provide a certificate of Permission to Self-Insure, signed by the California Department of Industrial Relations and Self-Insurance.
- 36 -
Comprehensive General
LiabilityInsurance
$5,000,000 per occurrence for bodily injury, personal injury, property damage and products and completedoperations;
product liability, contractor’s pollution liability. If Commercial General Liability Insurance orother form with a general aggregate liability is used, either the general aggregate limit shall apply separately to this product or the minimum required aggregate limit or be twice the required occurrence limit. Policy shall be endorsed to name the Agency as an additional
insured per the conditions detailed below.
ISO Form CG 20 10 (1/85) or its equivalent is required. The endorsement must not exclude products and completed
operations coverage. If it does, then CG 20 37 (10/01) is also required.
Comprehensive
Automobile Liability
Insurance
$5,000,000 per accident for bodily injury and property damage, to include automobile pollution liability. If the Bidder is subject to the Motor Carrier Act of 1980, Automobile Liability Policy must be endorsed to include MCS-90 Endorsement for
transportation of hazardous materials/waste/substances. If not, the policy shall be endorsed to include Transportation Pollution Liability Coverage to cover the materials
transported by the Bidder.
Umbrella/Excess Liability
Coverage
If an Umbrella or Excess Liability Policy is used to meet the liability limits, coverage shall be as broad as specified for underlying coverages and policies.
Broad Form Contractors
Pollution Liability
Insurance
Same limits as Commercial General Liability.
Deductibles and Self-Insured Retentions
Any deductibles or self-insured retentions must be declared to and approved by each Agency. At the option of each Agency, either: the insurer shall reduce or eliminate such deductibles or self-insured retentions as respects the Agency, its officers, officials, employees, and volunteers; or the Bidder shall procure a bond guaranteeing payment of losses and related investigations, claim administration and defense expenses. Bidder is responsible for satisfaction of the deductible and/or self-insured retention for each loss.
Other Insurance Provisions
The required general liability and automobile liability policies are to contain, or be endorsed to contain the following provisions:
1. The Agency, its officers, officials, employees, agents and volunteers are to be covered as additional insureds as respects: liability arising out of activities performed by or on behalf of the Bidder; products and completed operations of the Bidder; premises owned, occupied or used
- 37 -
by the Bidder; or automobiles owned, leased, hired or borrowed by the Bidder. The coverage shall contain no special limitations on the scope of protection afforded to the Agencies, its officers, officials, employees, agents or volunteers.
2. For any claims related to this project, the Bidder’s insurance coverage shall be primary insurance as respects the Agencies, its officers, officials, employees, agents and volunteers.
Any insurance or self- insurance maintained by the Agencies, its officers, officials, employees, agents or volunteers shall be excess of the Bidder’s insurance and shall not contribute with it and in no way relieves the Bidder from its responsibility to provide insurance.
3. Any failure to comply with reporting or other provisions of the policies including breaches of warranties shall not affect coverage provided to the Agencies, its officers, officials, employees, agents or volunteers.
4. The Bidder’s insurance shall apply separately to each insured against whom claim is made or suit is brought except, with respect to the limits of the insurer’s liability.
5. Each insurance policy required by this clause not be suspended, voided, canceled by either party, reduced in coverage or limits except after thirty (30) days’ prior written notice by certified mail, return receipt requested, has been given to the Agencies individually. Failing to do so could subject the Bidder to breach of contract.
6. Any available insurance proceeds in excess of the specified minimum insurance coverage requirements and limits shall be available to the Agency. Furthermore, the requirements for coverage and limits shall be (1) the minimum coverage and limits specified in the Agency Agreement or (2) the full coverage and maximum limits of any insurance proceeds available to the Bidder, whichever is greater.
7. If an umbrella or excess insurance policy is used to satisfy the required limits of insurance, it shall be endorsed to contain a provision that such coverage shall also apply on a primary and non-contributory basis for the benefit of each Agency before the Agency’s own insurance shall be called upon to protect it as a named insured.
Acceptability of Insurers
Insurance is to be placed with insurers with a current A.M. Best’s rating of no less than A:VII.
Verification of Coverage
Bidder shall furnish the Agencies with endorsements effecting coverage required by this clause.
The endorsements are to be signed by a person authorized by that insurer to bind coverage on its behalf. All endorsements are to be received and approved by each individual Agency before work commences.
- 38 -
INDEMNIFICATION
To the maximum extent permitted by law, the successful Bidder shall, at its own expense, indemnify, defend with counsel acceptable to each North Bay Agency Chemical Pool participating Agency listed on the Standard Agreement for chemical requirements, (which acceptance will not be unreasonably withheld), and hold harmless each such participating Agency and its officers, officials, employees, agents and volunteers ("Indemnities") from and against any and all liability, loss, damage, claims, suits, actions, arbitration proceedings, administrative proceedings, regulatory proceedings, civil penalties and fines, expenses and costs (including, without limitation, claims expenses, attorney's fees and costs and fees of litigation) (collectively, "Liability") of every nature, whether actual, alleged or threatened, arising out of or in connection with the furnishing of chemicals by the successful Bidder pursuant to the Standard Agreement or the successful Bidder’s failure to comply with any of the terms of the Standard Agreement, regardless of any fault or alleged fault of the Indemnitees.
The successful Bidder’s obligation to indemnify, defend and hold harmless under this provision shall not be excused because of the successful Bidder’s inability to evaluate Liability, or because the successful Bidder evaluates Liability and determines that the successful Bidder is not or may not be liable. The successful Bidder must respond within 30 calendar days to any tender for defense and indemnity by any participating Agency, unless the time for responding has been extended by an authorized representative of the participating Agency in writing. If the successful Bidder fails to accept tender of defense and indemnity within 30 calendar days, in addition to any other remedies authorized by law, so much of the money due or that may become due the successful Bidder under the Standard Agreement as shall reasonably be considered necessary by the participating Agency may be retained by the participating Agency until disposition has been made of the matter subject to tender, or until the successful Bidder accepts the tender, whichever occurs first.
The successful Bidder waives any and all rights to express or implied indemnity against the Indemnitees concerning any Liability of the successful Bidder arising out of or in connection with the furnishing of chemicals by the successful Bidder pursuant to the Standard Agreement or the successful Bidder’s failure to comply with any of the terms of the Standard Agreement. ///
///
///
- 39 -
CERTIFICATION
By signing the below, your company acknowledges and accepts the insurance and indemnity terms set forth above. You also certify that you have communicated with your insurance producer to ensure your company can meet the above criteria. If you are the successful bidder and you fail to supply NBACP with the required insurance certificates and endorsements within 15 days, the bid will be awarded to the next qualifying bidder.
Date of Certification
Company Name
Print Name of Authorized Agent
Signature of Authorized Agent
LINDE INC.
ASSISTANT SECRETARY'S CERTIFICATE
I, Anthony M. Pepper, Assistant Secretary of LINDE INC., a corporation organized and existing under the laws of the State of Delaware (the “Corporation”), DO HEREBY CERTIFY that the following are true and correct resolutions adopted by the Board of Directors of said Corporation in a Unanimous Consent of Directors dated June 24, 1992, and that said resolutions are still in full force and effect:
RESOLVED, that the general enabling resolutions adopted by the Board on November 8, 1988 are amended and restated in their entirety as follows:
"RESOLVED, that the Chairman, the Chief Executive Officer, the President, any VicePresident, the Chief Financial Officer, the Treasurer, the Secretary, any Assistant Treasurer or any Assistant Secretary of the Corporation is authorized, in the name and on behalf of the Corporation, to execute and deliver any contract, agreement or document, to enter into any commitment or obligation, or to take or do or cause to be taken or done any action or thing, for the conduct of the business of the Corporation in the ordinary course thereof; and be it further RESOLVED, that the Chief Executive Officer or the President of the Corporation is authorized to appoint executives of a business, division or department of the Corporation, to designate their titles, to fix their compensation, and to prescribe their duties; and be it further RESOLVED, that the President, or any Vice-President of the Corporation responsible for a business, division or department of the Corporation is authorized to appoint other agents and employees for such component, to designate their titles, if any, to fix their compensation, and to prescribe their duties; and be it further
RESOLVED, that any officer or manager referred to above is authorized to designate in writing one or more employees or representative to do any act or thing which said officer or manager is authorized to do pursuant to the foregoing resolutions; and be it further RESOLVED, that any person dealing with the Corporation may conclusively rely on a certificate from the Secretary or an Assistant Secretary of the Corporation or on an opinion from an attorney employed by or otherwise representing the Corporation that an officer, manager or other person is authorized to act for the Corporation in a particular matter.” IN WITNESS WHEREOF, I have hereunto set my hand this 25th day of February 2026. _______________________
Anthony M. Pepper
Assistant Secretary
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-MAIL ADDRESS:
PRODUCER
(A/C, No, Ext): PHONE
INSURED
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
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 WVDADDL
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
AUTOS ONLY AUTOS NON-OWNED OWNED SCHEDULED
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 EMPLOYEEE.L. EACH ACCIDENT EROTH- STATUTE PER
(MM/DD/YYYY) LIMITS POLICY EXP(MM/DD/YYYY) POLICY EFFLTR TYPE OF INSURANCE POLICY NUMBER INSR
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
of Marsh USA LLC X
2,000,000 24147 A
10/01/2026 X
CN102547296-STND-GAW-25-26 1,000,000 ¿
NYC-011999814-08 10/01/2025 X
2,000,000 09/22/2025
5 1,000,000 1,000,000 1,000,000 A
10/01/2026 MWTB-313505-25 10/01/2025 10,000 MWC-313504-25 1,000,000
Evidence of Insurance.
10 Riverview Drive
Linde Inc.
Danbury, CT 06810
1,000,000
Old Republic Insurance Company X
1166 Avenue of the Americas
MARSH USA, LLC.
Attn: [email protected] Fax: 212-948-0500
New York, NY 10036
MWZY-313507-25 N
Danbury, CT 06810
Linde Inc.
10 Riverview Drive
10/01/2025
A
1,000,000
X
10/01/2026 Page 328 of 2762
Water Quality Association
Gold Seal Certificate
175 East Park Drive
Certification Date:
Authorized By:
Caren L. Settler
Process Improvement Manager
Water Quality Association
2375 Cabot Drive
Lisle, IL 60532, USA
Products are evaluated according to Product Certification Scheme Type 5, as defined in ISO/IEC 17067 (current version).
This Certificate, or any part thereof, may not be used in a misleading manner and validation of its use is contingent upon the Official WQA web -listing.
Revision: 09/27/2021 FORM.12046
Linde Inc
January 09, 2023
Tonawanda, New York United States
Facility: Linde Pittsburg
Please contact your Account Representative for product expiration terms . All Standards referenced in the Product Certification Schemes by Standard Name.
Water Quality Association Official Gold Seal Listing
Granted to the following company:
Linde Inc
175 East Park Drive
Tonawanda, New York 14150 United States
For the Facility Located at: 2000 Loveridge Road
Pittsburg, California 94565 United States
Linde Pittsburg
The WQA Gold Seal Certification Department has issued certification for the following model(s) to the standard(s) below. Only models that appear in the official listing are authorized to bear the WQA Gold Seal.
NSF/ANSI/CAN 60 - 2021: Drinking Water Treatment Chemicals - Health Effects Oxygen
Notice: To request any changes to the certified model(s), please request a Change to Certified Product (CCP) form. Examples include any change to the wetted parts or formulations such as supplier or material types, literature, or a change in company name. This list is not all inclusive. Failure to submit documentation regarding changes may result in non-compliance with the standard(s) as well as de- listing of the affected models.
April 28, 2025
City of Vallejo
Fleming Hill WTP
202 Fleming Hill Road
Vallejo, CA 94590
Dear Customer:
Please be advised that all liquid oxygen delivered to you by Linde Inc. will meet or exceed industrial grade, AWWA B304-13 Liquid Oxygen guidelines and the specifications below:
COMPONENT SPECIFICATION
Assay 99.50%
Moisture 6.0 PPM
Odor None Detected
Total Hydrocarbons 25.0 PPM
A dewpoint of ≤ -80 dF is equal to 6.0 ppm
Liquid oxygen supplied is certified to the NSF-60 standard for treatment of drinking water.
Sincerely,
Eric Hein
Quality Engineer
Praxair, Inc.
LINDE INC.
Certificate of Analysis - COA
Customer Name
Customer Address
Linde Number:
Product Label:
Lot Number:
Liquid Oxygen
Component Specification Analytical Result Analytical Method Assay >= 99.5 % Servomex 4100
H2O <= 6 PPM Analyzer
Odor Is None Detected Organoleptic
Total Hydrocarbons <= 25 PPM Analyzer
LDL = Lower Detection Limit of Analyzer
Authorized Linde Representative
Route #:
Tractor #:
Trailer #:
Service Agreement #: Location: Carrier: Well Number:
Liquid Delivery
Delivery Volume:
Driver 1:
Driver 2:
Date/Time Arrived: Date/Time Depart:
Meter
Finish: Gross Weight:
Start: Tare Weight:
Net Weight:
Scale Ticket #:
U/M Scale U/M
Linde #:
Customer:
Measurement Site:
Customer Prod ID:
LINDE INC
Delivered by:
Liquid Oxygen Air Liquefaction
Produced by the air liquefaction process
PO#:
Release #:
Product Label: Liquid Oxygen
Lot Number:
Date 123-45678
Proof of Delivery
Order #: 12345678
*22279310*
NSF-ANSI-CAN 60 by WQA
MAXIMUM USE: N/A
Order contact:
Driver or Deputy
Weighmaster:
Date 123-45678
Proof of Delivery
Order #: 12345789
*22279310*
Commitment to
Excellence
Price Schedule for Supply System Service
→ Customer-requested tank
painting
→ Relocation of equipment
(permanent or temporary)
→ Modifications to existing
equipment
→ Installation of accessory
equipment
→ Vaporizer de-icing
→ Repair of customer-caused
damage
→ Pressure washing
→ Services on customer-owned
tanks
→ Annual tank inspection
→ Pressure adjustment
→ Piping work
→ Repairs associated with
improper use of Supply
System
→ Installation, relocation, or
removal of permanent or
temporary Supply System
→ Custom services completed
on site
→ Trailer purge
Linde is focused on helping our customers obtain the products and services needed to help ensure that their facilities operate as efficiently and safely as possible, with minimum interruptions. As part of our commitment, Linde offers special services and support.
If any of the services listed are needed, please contact us at 1-844-44LINDE (1-844-445-4633) and a member of our Customer Service team will provide you with next steps.
Price Schedule for Supply System Service 2 of 2
© Copyright 2024. Linde plc. Linde, and Making our world more productive are trademarks of Linde plc. The information contained herein is offered for use by technically qualified personnel at their discretion and risk without warranty of any kind. P-40-4702B 01/2024
Labor, portal-to-portal, weekdays $260/hour, $1,000 minimum charge Labor, portal-to-portal, weekends & holidays $395/hour, $1,500 minimum charge Travel, portal-to-portal $2.75 per mile
Warm Tank Fill $1,950/tank (including labor and miles)
Customer Owned Tank Inspection $1,450/supply system (including labor and miles) Extra charges may apply if additional work is required during a technician visit, including parts, crane or freight charges (e.g. during Supply System installations, removals, relocations), and other miscellaneous expenses.
Customer Service Technician
Rates for All Services
The following charges apply to services performed on Linde or customer owned Supply Systems for Argon, Carbon Dioxide, Helium, Hydrogen, Nitrogen, and Oxygen. If you are unsure if services performed on your Supply System will be billed to you, please contact your Account Manager. Billable services performed will be invoiced per charges in the schedule and are subject to change.
Small Trailer/ISO $2,500 / trailer
Nitrogen/Oxygen $2,500 / trailer
Argon $6,000 / trailer
Hydrogen $10,000 / trailer
Carbon Dioxide $2,500 / trailer
Trailer Purging
A purchase order number is required before any services are performed. Please be prepared to provide a purchase order number when calling 1-844-44LINDE (1-844-445-4633) for service requests.
Water Quality Association
Gold Seal Certificate
175 East Park Drive
Certification Date:
Authorized By:
Caren L. Settler
Process Improvement Manager
Water Quality Association
2375 Cabot Drive
Lisle, IL 60532, USA
Products are evaluated according to Product Certification Scheme Type 5, as defined in ISO/IEC 17067 (current version).
This Certificate, or any part thereof, may not be used in a misleading manner and validation of its use is contingent upon the Official WQA web -listing.
Revision: 09/27/2021 FORM.12046
Linde Inc
January 09, 2023
Tonawanda, New York United States
Facility: Linde Pittsburg
Please contact your Account Representative for product expiration terms . All Standards referenced in the Product Certification Schemes by Standard Name.
Water Quality Association Official Gold Seal Listing
Granted to the following company:
Linde Inc
175 East Park Drive
Tonawanda, New York 14150 United States
For the Facility Located at: 2000 Loveridge Road
Pittsburg, California 94565 United States
Linde Pittsburg
The WQA Gold Seal Certification Department has issued certification for the following model(s) to the standard(s) below. Only models that appear in the official listing are authorized to bear the WQA Gold Seal.
NSF/ANSI/CAN 60 - 2021: Drinking Water Treatment Chemicals - Health Effects Oxygen
Notice: To request any changes to the certified model(s), please request a Change to Certified Product (CCP) form. Examples include any change to the wetted parts or formulations such as supplier or material types, literature, or a change in company name. This list is not all inclusive. Failure to submit documentation regarding changes may result in non-compliance with the standard(s) as well as de- listing of the affected models.
April 28, 2025
City of Vallejo
Fleming Hill WTP
202 Fleming Hill Road
Vallejo, CA 94590
Dear Customer:
Please be advised that all liquid oxygen delivered to you by Linde Inc. will meet or exceed industrial grade, AWWA B304-13 Liquid Oxygen guidelines and the specifications below:
COMPONENT SPECIFICATION
Assay 99.50%
Moisture 6.0 PPM
Odor None Detected
Total Hydrocarbons 25.0 PPM
A dewpoint of ≤ -80 dF is equal to 6.0 ppm
Liquid oxygen supplied is certified to the NSF-60 standard for treatment of drinking water.
Sincerely,
Eric Hein
Quality Engineer
Praxair, Inc.
LINDE INC.
Certificate of Analysis - COA
Customer Name
Customer Address
Linde Number:
Product Label:
Lot Number:
Liquid Oxygen
Component Specification Analytical Result Analytical Method Assay >= 99.5 % Servomex 4100
H2O <= 6 PPM Analyzer
Odor Is None Detected Organoleptic
Total Hydrocarbons <= 25 PPM Analyzer
LDL = Lower Detection Limit of Analyzer
Authorized Linde Representative
Route #:
Tractor #:
Trailer #:
Service Agreement #: Location: Carrier: Well Number:
Liquid Delivery
Delivery Volume:
Driver 1:
Driver 2:
Date/Time Arrived: Date/Time Depart:
Meter
Finish: Gross Weight:
Start: Tare Weight:
Net Weight:
Scale Ticket #:
U/M Scale U/M
Linde #:
Customer:
Measurement Site:
Customer Prod ID:
LINDE INC
Delivered by:
Liquid Oxygen Air Liquefaction
Produced by the air liquefaction process
PO#:
Release #:
Product Label: Liquid Oxygen
Lot Number:
Date 123-45678
Proof of Delivery
Order #: 12345678
*22279310*
NSF-ANSI-CAN 60 by WQA
MAXIMUM USE: N/A
Order contact:
Driver or Deputy
Weighmaster:
Date 123-45678
Proof of Delivery
Order #: 12345789
*22279310*
Commitment to
Excellence
Price Schedule for Supply System Service
→ Customer-requested tank
painting
→ Relocation of equipment
(permanent or temporary)
→ Modifications to existing
equipment
→ Installation of accessory
equipment
→ Vaporizer de-icing
→ Repair of customer-caused
damage
→ Pressure washing
→ Services on customer-owned
tanks
→ Annual tank inspection
→ Pressure adjustment
→ Piping work
→ Repairs associated with
improper use of Supply
System
→ Installation, relocation, or
removal of permanent or
temporary Supply System
→ Custom services completed
on site
→ Trailer purge
Linde is focused on helping our customers obtain the products and services needed to help ensure that their facilities operate as efficiently and safely as possible, with minimum interruptions. As part of our commitment, Linde offers special services and support.
If any of the services listed are needed, please contact us at 1-844-44LINDE (1-844-445-4633) and a member of our Customer Service team will provide you with next steps.
Price Schedule for Supply System Service 2 of 2
© Copyright 2024. Linde plc. Linde, and Making our world more productive are trademarks of Linde plc. The information contained herein is offered for use by technically qualified personnel at their discretion and risk without warranty of any kind. P-40-4702B 01/2024
Labor, portal-to-portal, weekdays $260/hour, $1,000 minimum charge Labor, portal-to-portal, weekends & holidays $395/hour, $1,500 minimum charge Travel, portal-to-portal $2.75 per mile
Warm Tank Fill $1,950/tank (including labor and miles)
Customer Owned Tank Inspection $1,450/supply system (including labor and miles) Extra charges may apply if additional work is required during a technician visit, including parts, crane or freight charges (e.g. during Supply System installations, removals, relocations), and other miscellaneous expenses.
Customer Service Technician
Rates for All Services
The following charges apply to services performed on Linde or customer owned Supply Systems for Argon, Carbon Dioxide, Helium, Hydrogen, Nitrogen, and Oxygen. If you are unsure if services performed on your Supply System will be billed to you, please contact your Account Manager. Billable services performed will be invoiced per charges in the schedule and are subject to change.
Small Trailer/ISO $2,500 / trailer
Nitrogen/Oxygen $2,500 / trailer
Argon $6,000 / trailer
Hydrogen $10,000 / trailer
Carbon Dioxide $2,500 / trailer
Trailer Purging
A purchase order number is required before any services are performed. Please be prepared to provide a purchase order number when calling 1-844-44LINDE (1-844-445-4633) for service requests.
5,000,000
MWZY-313507-25
NYC-009099297-50
1,000,000
X
N/A
Attn: [email protected] Fax: 212-948-0500
N
X
10/01/2025
24 10/01/2026
10/01/2025
MWTB-313505-25
POLLUTION LIABILITY
A
5,000,000
5,000,000
N/A
1,000,000
X
A
X
09/18/2025
10/01/2025
5,000,000
The City, its officers, officials, employees, agents and volunteers are included as additional insured (except Workers' Compensation and Pollution) where required by written contract. This insurance is primary and non-contributory over any existing insurance and limited to liability arising out of the operations of the named insured and where required by written contract.
X
Vallejo, CA 94589-2337
City of Vallejo
A
Limit:
10,000
10/01/2026
5,000,000
5,000,000
24147
5,000,000
1,000,000
10/01/2026
MWC-313504-25
1166 Avenue of the Americas
MARSH USA, LLC.
New York, NY 10036
10 Riverview Dr.
Linde Inc.
Danbury, CT 06810
MWZZ-313509-25
10/01/2025
202 Fleming Hill Road
A
.
10/01/2026
Old Republic Insurance Company
POLICY NUMBER: COMMERCIAL GENERAL LIABILITY
CG 20 26 12 19
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CG 20 26 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 ADDITIONAL INSURED – DESIGNATED
PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s) Or Organization(s):
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section II – Who Is An Insured is amended to
include as an additional insured the person(s) or
organization(s) shown in the Schedule, but only
with respect to liability for "bodily injury", "property damage" or "personal and advertising injury"
caused, in whole or in part, by your acts or
omissions or the acts or omissions of those acting
on your behalf:
1. In the performance of your ongoing operations;
or
2. In connection with your premises owned by or
rented to you.
However:
1. The insurance afforded to such additional
insured only applies to the extent permitted by
law; and
2. If coverage provided to the additional insured is
required by a contract or agreement, the
insurance afforded to such additional insured
will not be broader than that which you are
required by the contract or agreement to
provide for such additional insured.
B. With respect to the insurance afforded to these
additional insureds, the following is added to
Section III – Limits Of Insurance:
If coverage provided to the additional insured is
required by a contract or agreement, the most we
will pay on behalf of the additional insured is the
amount of insurance:
1. Required by the contract or agreement; or
2. Available under the applicable limits of
insurance;
whichever is less.
This endorsement shall not increase the
applicable limits of insurance.
MWZY 313507 25 Linde Inc. 10/01/25 - 10/01/26
As required by written contract or agreement.
PCA 048 09 19 Page 1 of 1
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
IL 10 (12/06) OLD REPUBLIC INSURANCE COMPANY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED AND PRIMARY AND
NON-CONTRIBUTORY ENDORSEMENT
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
SCHEDULE
Designated Person(s) or Organization(s):
A. SECTION II – COVERED AUTOS LIABILITY COVERAGE, paragraph 1. Who Is An Insured is amended to include the person(s) or organization(s) shown in the above Schedule as an additional “insured”, but only with respect to "accidents" arising out of your work while being performed for such person(s) or organization(s).
B. The following is added to the Other Insurance Condition in the Business Auto Coverage Form and the Other Insurance – Primary And Excess Insurance Provisions in the Motor Carrier Coverage Form and supersedes any provision to the contrary:
This policy's Covered Autos Liability Coverage is primary to and will not seek contribution from any other insurance available to the “insured” person(s) or organization(s) shown in the above Schedule provided that:
1. Such “insured” is a Named Insured under such other insurance; and
2. You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to such "insured".
MWTB 313505 25 Linde Inc. 10/01/25 - 10/01/26
All persons or organizations where required by written contract.
COMMERCIAL GENERAL LIABILITY
CG 20 01 12 19
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CG 20 01 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 PRIMARY AND NONCONTRIBUTORY –
OTHER INSURANCE CONDITION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
LIQUOR LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
The following is added to the Other Insurance
Condition and supersedes any provision to the
contrary:
Primary And Noncontributory Insurance
This insurance is primary to and will not seek
contribution from any other insurance available to
an additional insured under your policy provided
that:
(1) The additional insured is a Named Insured
under such other insurance; and
(2) You have agreed in writing in a contract or
agreement that this insurance would be
primary and would not seek contribution
from any other insurance available to the
additional insured.
MWZY 313507 25 Linde Inc. 10/01/25 - 10/01/26
POLICY NUMBER: COMMERCIAL GENERAL LIABILITY
CG 20 26 12 19
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CG 20 26 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 ADDITIONAL INSURED – DESIGNATED
PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s) Or Organization(s):
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section II – Who Is An Insured is amended to
include as an additional insured the person(s) or
organization(s) shown in the Schedule, but only
with respect to liability for "bodily injury", "property damage" or "personal and advertising injury"
caused, in whole or in part, by your acts or
omissions or the acts or omissions of those acting
on your behalf:
1. In the performance of your ongoing operations;
or
2. In connection with your premises owned by or
rented to you.
However:
1. The insurance afforded to such additional
insured only applies to the extent permitted by
law; and
2. If coverage provided to the additional insured is
required by a contract or agreement, the
insurance afforded to such additional insured
will not be broader than that which you are
required by the contract or agreement to
provide for such additional insured.
B. With respect to the insurance afforded to these
additional insureds, the following is added to
Section III – Limits Of Insurance:
If coverage provided to the additional insured is
required by a contract or agreement, the most we
will pay on behalf of the additional insured is the
amount of insurance:
1. Required by the contract or agreement; or
2. Available under the applicable limits of
insurance;
whichever is less.
This endorsement shall not increase the
applicable limits of insurance.
MWZY 313507 25 Linde Inc. 10/01/25 - 10/01/26
As required by written contract or agreement.
POLICY NUMBER: COMMERCIAL GENERAL LIABILITY
CG 24 04 12 19
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CG 24 04 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US (WAIVER OF SUBROGATION)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
ELECTRONIC DATA LIABILITY COVERAGE PART
LIQUOR LIABILITY COVERAGE PART
POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES
POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
RAILROAD PROTECTIVE LIABILITY COVERAGE PART
UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS
SCHEDULE
Name Of Person(s) Or Organization(s):
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
The following is added to Paragraph 8. Transfer Of
Rights Of Recovery Against Others To Us of
Section IV – Conditions:
We waive any right of recovery against the person(s)
or organization(s) shown in the Schedule above
because of payments we make under this Coverage
Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against
such person(s) or organization(s) prior to loss. This
endorsement applies only to the person(s) or
organization(s) shown in the Schedule above.
MWZY 313507 25 Linde Inc. 10/01/25 - 10/01/26
As Required by Written Contract or Agreement
THIS BUSINESS LICENSE DOES NOT PERMIT A
BUSINESS THAT IS OTHERWISE PROHIBITED.
Business Name
Business Location
Business Owner(s) License Number
Effective Date
Expiration Date
CITY OF VALLEJO
BUSINESS LICENSE
10 RIVERVIEW DR
LINDE, INC.
PO BOX 44
TONAWANDA, NY 14151-0001
For all inquiries regarding this license, contact HdL
Business Support Center at 707-302-6074.
"For Services Provided in the City of Vallejo, California Only"
STEVE ANGEL
LINDE, INC.
July 01, 2025
June 30, 2026
11706591
LINDE, INC. :
Thank you for your payment on your City of Vallejo Business License. ALL LICENSES MUST BE AVAILABLE FOR INSPECTION UPON REQUEST. If you have questions concerning your business license, contact the Business Support Center via email at: [email protected] or by telephone at: (707) 302-6074.
Keep this portion for your license separate in case you need a replacement for any lost, stolen, or destroyed license. A fee may be charged for a replacement or duplicate license.
This certificate does not entitle the holder to conduct business before complying with all requirements of the Vallejo Municipal code and other applicable laws, nor to conduct business in a zone where conducting such business violates law.
If you have a fixed place of business within the City of Vallejo please display the Business License above in a conspicuous place at the premises. Otherwise, every Business License holder not having a fixed place of business in the City shall keep the Business License upon his or her person, or affixed in plain view any cart, vehicle, van or other movable structure or device at all times if required by the Collector.
Starting January 1, 2021, Assembly Bill 1607 requires the prevention of gender-based discrimination of business establishments. A full notice is available in English or other languages by going to: https://www.dca.ca.gov/publications/ City of Vallejo
BUSINESS LICENSE
BUSINESS LICENSING
8839 N CEDAR AVE #212
FRESNO, CA 93720-1832
Date of Issue: 07/01/2025
LINDE, INC. License Number: 11706591
PO BOX 44
TONAWANDA, NY 14151-0001
TO BE POSTED IN A CONSPICUOUS PLACE
AND
NOT TRANSFERABLE OR ASSIGNABLE.
2025 - 2026
TAX COLLECTOR’S OFFICE, City Hall, 555 Santa Clara St., Vallejo, CA. This certificate is evidence that the person(s), firm, or corporation named hereon has paid the tax required by Chapter 5.04 of the City of Vallejo Municipal Code for the type of business, the business address and for the period indicated hereon. This certificate is issued without verification that the taxpayer is subject to or exempted from licensing by local, state, Federal or other agencies. Issuance of this certificate is not an endorsement, nor a certificate of compliance with other ordinances or laws, nor an assurance that the proposed use is in conformance with the City’s building / Fire / Zoning regulations.
Business Type Truck or Wagon Delivery
1 Approved as to form:
By: for
Veronica Nebb, City Attorney
CHEMICAL SUPPLIES PURCHASE AGREEMENT
This Chemical Supplies Purchase Agreement ("Agreement") is made and entered into this 1st day of July, 2026, by and between the City of Vallejo, a municipal corporation ("City"), and NALCO, An Ecoland Company, a Delaware Corporation, hereinafter referred to as “Vendor,” who agree as follows:
1. Vendor shall provide City, and deliver to Fleming Hill, Travis, and Green Valley Water Treatment Plants, as required by the Vallejo Municipal Water System, the following:
a) Chemical: CatFloc 8102 Plus
b) Quantity: 9 totes
c) Unit Price: $5,220 per tote
d) Chemical Cost: $46,980.00
(Fourty-Six Thousand Nine Hundred
Eighty Dollars and Zero Cents)
Contingency for Misc Surcharges (10%) $4,698.00
(Four Thousand Six Hundred NinetyEight Dollars and Zero Cents) Agreement Not to Exceed Amount: $51,678.00
(Fifty-One Thousand Six Hundred
Seventy-Eight Dollars and Zero Cents)
The foregoing quantity(ies) is/are an approximation only, and are the quantities estimated as required by the Water System for the Agreement term. City does not expressly or by implication warrant that the actual quantities ordered during the Agreement term will correspond therewith, and reserves the right to increase or decrease the quantity of chemical ordered, at the bid price, as may be necessary or advisable.
2. Omitted.
3. Omitted.
4. Vendor further agrees that all chemicals and/or materials to be furnished and delivered shall be strictly in accordance with said specifications, except that the City reserves the right to accept material other than that called forth in said specifications provided the Water Director approves in writing such other chemical/material as equal or better prior to Vendor furnishing or delivering the same.
2 5. Vendor has obtained or agrees to apply, prior to performance under this Agreement, to City’s Finance Department for a business license, pay the applicable business license tax and maintain said business license during the term of this Agreement. The failure to obtain such license shall be a material breach of this Agreement and grounds for termination by City. No payments shall be made to Vendor until such business license(s) has been obtained.
6. Vendor shall be fully informed of all Federal, State, County or Municipal laws, statutes, ordinances, codes and regulations which may in any manner apply to or otherwise have effect on the material to be furnished and shall at all times abide by all such rulings, orders and decrees of those agencies, bodies or tribunals having any jurisdiction or authority over the same.
7. City hereby agrees to pay to Vendor, in lawful money of the United States of America, at the time and in accordance with the provisions set forth in said specifications the price(s) set forth above.
8. The term of this Agreement is for Fiscal Year 2026-2027, shall commence upon execution of the contract by the City Manager, and shall continue in full force and effect until June 30, 2027. City shall, at its discretion, have the right to extend the term of this Agreement for 90 days by written notice to Vendor. The total duration of this Agreement, including the exercise of any options under this section, shall not exceed September 30, 2026. If the term of this Agreement extends into fiscal years subsequent to that in which it is approved, such continuation of the Agreement is contingent on the appropriation of funds for such purpose by the City Council of the City of Vallejo.
9. The parties hereto shall have the right by mutual consent to extend this Agreement on a month-to-month basis, notwithstanding the termination date specified above herein.
Any such agreed extension may include a revision of the unit price herein recited and such revised price shall then prevail over the unit price recited herein for the term of such extension. In the event City desires to extend this Agreement, the Water Director shall so notify the Vendor, who shall promptly accept or reject such extension in writing.
10. All notices or instruments required to be given or delivered by law or this Agreement shall be in writing and shall be effective upon receipt thereof and shall be by personal service or delivered by depositing the same in any United States Post Office, registered or certified mail, postage prepaid, addressed to:
If to City: Beth Schoenberger, Water Director
City of Vallejo Water Department
202 Fleming Hill Road
Vallejo, CA 94589
If to Vendor: Julian L. Smith (Account Manager)
Nalco, an Ecolab Company
2111 E. Dominguez Street
3 Long Beach, CA 90810
Any party may change its address for receiving notices by giving written notice of such change to the other party in accordance with this section.
11. The City Representative shall administer this Agreement for the City, and routine administrative communications shall be made to the City Representative, or the representative's designee:
Nicholas Rolley, Water Operations Superintendent
City of Vallejo Water Department
202 Fleming Hill Road
Vallejo, CA 94589
[email protected]
12. INSURANCE
Vendor shall procure and maintain for the duration of the contract all necessary insurance against claims for injuries to persons or damages to property which may arise from or in connection with the performance of the work hereunder by the Vendor, the Vendor’s agents, representatives, employees or subcontractors.
13. MINIMUM SCOPE OF INSURANCE
1. Insurance shall be at least as broad as:
a. Standard Workers’ Compensation & Employer’s Liability Including Occupations Disease Coverage
b. Comprehensive General Liability Insurance
c. Comprehensive Automobile Liability Insurance
d. Umbrella/Excess Liability Coverage
e. Broad Form Contractors Pollution Liability Insurance
2. Insurance Services Office form covering Automobile Liability, code 1 (any auto)
3. Worker’s Compensation insurance as required by the State of California and Employer’s Liability Insurance.
14. VENDOR SHALL MAINTAIN LIMITS NO LESS THAN:
TYPE OF INSURANCE MINIMUM LIMITS OF LIABILITY
4 Standard Workers'
Compensation & Employer's
Liability Including Occupations
Disease Coverage
Statutory limits as required by the State of California including $1 million Employers’ Liability per accident, per employee for bodily injury or disease. If Vendor is self-insured, provide a certificate of Permission to
Self-Insure, signed by the California Department of
Industrial Relations and Self-Insurance.
Comprehensive General
Liability Insurance
$5,000,000 per occurrence for bodily injury, personal
injury, property damage and products and completed
operations, product liability, contractor’s pollution
liability. If Commercial General Liability Insurance or other form with a general aggregate liability is used,
either the general aggregate limit shall apply
separately to this product or the minimum required
aggregate limit or be twice the required occurrence
limit. Policy shall be endorsed to name the City as an
additional insured per the conditions detailed below.
ISO Form CG 20 10 (1/85) or its equivalent is
required.
Comprehensive Automobile
Liability Insurance
$5,000,000 per accident for bodily injury and property
damage, to include automobile pollution liability. If the Vendor is subject to the Motor Carrier Act of 1980,
Automobile Liability Policy must be endorsed to
include MCS-90 Endorsement for transportation of
hazardous materials/waste/substances. If not, the
policy shall be endorsed to include Transportation
Pollution Liability Coverage to cover the materials
transported by the Vendor.
Umbrella/Excess Liability
Coverage
If an Umbrella or Excess Liability Policy is used to
meet the liability limits, coverage shall be as broad as specified for underlying coverages and cover those
insured in the underlying policies.
Broad Form Contractors
Pollution Liability Insurance
Same limits as Commercial General Liability
insurance. Time Element Sudden and Accidental
coverage and/or any Blended Pollution
Endorsements on General Liability and Auto Liability
policies and/or Pollution Liability policies will not be accepted.
15. DEDUCTIBLES AND SELF-INSURED RETENTIONS
5 Any deductibles or self-insured retentions must be declared to and approved by Cityy. At the option of City, either: the insurer shall reduce or eliminate such deductibles or self-insured retentions as respects the City, its officers, officials, employees, and volunteers; or the Vendor shall procure a bond guaranteeing payment of losses and related investigations, claim administration and defense expenses. Vendor is responsible for satisfaction of the deductible and/or self-insured retention for each loss.
16. OTHER INSURANCE PROVISIONS
The required general liability and automobile liability policies are to contain, or be endorsed to contain the following provisions:
1. The City, its officers, officials, employees, agents and volunteers are to be covered as additional insureds as respects: liability arising out of activities performed by or on behalf of the Vendor; products and completed operations of the Vendor; premises owned, occupied or used by the Vendor; or automobiles owned, leased, hired or borrowed by the Vendor. The coverage shall contain no special limitations on the scope of protection afforded to the Agencies, its officers, officials, employees, agents or volunteers.
2. For any claims related to this project, the Vendor’s insurance coverage shall be primary insurance as respects the City, its officers, officials, employees, agents and volunteers. Any insurance or self-insurance maintained by the City, its officers, officials, employees, agents or volunteers shall be excess of the Vendor’s insurance and shall not contribute with it and in no way relieves the Vendor from its responsibility to provide insurance.
3. Any failure to comply with reporting or other provisions of the policies including breaches of warranties shall not affect coverage provided to the City, its officers, officials, employees, agents or volunteers.
4. The Vendor’s insurance shall apply separately to each insured against whom claim is made or suit is brought except, with respect to the limits of the insurer’s liability.
5. Each insurance policy required by this clause shall be endorsed to state that coverage shall not be suspended, voided, canceled by either party, reduced in coverage or limits except after thirty (30) days’ prior written notice by certified mail, return receipt requested, has been given to the City.
6. Any available insurance proceeds in excess of the specified minimum insurance coverage requirements and limits shall be available to the City.
Furthermore, the requirements for coverage and limits shall be (1) the minimum coverage and limits specified in the City’s Agreement or (2) the full coverage and maximum limits of any insurance proceeds available to the Vendor, whichever is greater.
6 7. If an umbrella or excess insurance policy is used to satisfy the required limits of insurance, it shall be endorsed to contain a provision that such coverage shall also apply on a primary and non-contributory basis for the benefit of City before the City’s own insurance shall be called upon to protect it as a named insured.
8. The workers’ compensation policy required hereunder shall be endorsed to state that the workers' compensation carrier waives its right of subrogation against City, its officers, officials, employees, agents and volunteers, which might arise by reason of payment under such policy in connection with Bidder’s performance under this Agreement. The waiver of subrogation rights endorsement in favor of the City of Vallejo shall be attached to the Certificate of Insurance.
Acceptability of Insurers
Insurance is to be placed with insurers with a current A.M. Best’s rating of no less than A: VII.
Verification of Coverage
Vendor shall furnish the Agencies with original endorsements effecting coverage required by this clause. The endorsements are to be signed by a person authorized by that insurer to bind coverage on its behalf. The endorsements are to be on forms provided by the City. All endorsements are to be received and approved by City before work commences. As an alternative to City forms, the Vendor’s insurer may provide complete, certified copies of all required insurance policies, including endorsements affecting the coverage required by the City.
17. INDEMNIFICATION
To the maximum extent permitted by law, the Vendor shall, at its own expense, indemnify, defend with counsel acceptable to City listed on the Standard Agreement for chemical requirements, (which acceptance will not be unreasonably withheld), and hold harmless the City and its officers, officials, employees, agents and volunteers ("Indemnities") from and against any and all liability, loss, damage, claims, suits, actions, arbitration proceedings, administrative proceedings, regulatory proceedings, civil penalties and fines, expenses and costs (including, without limitation, claims expenses, attorney's fees and costs and fees of litigation) (collectively, "Liability") of every nature, whether actual, alleged or threatened, arising out of or in connection with the negligent acts or omissions, or willful misconduct of the Vendor pursuant to the Standard Agreement or the Vendor’s failure to comply with any of the terms of the Standard Agreement. The Vendor shall not be required to indemnify an Indemnitee for the Indemnitee’s own negligence or willful misconduct.
The Vendor’s obligation to indemnify, defend and hold harmless under this provision shall not be excused because of the Vendor’s inability to evaluate Liability, or because the Vendor evaluates Liability and determines that the Vendor is not or may not be liable. The
7 Vendor must respond within 30 calendar days to any tender for defense and indemnity by City, unless the time for responding has been extended by an authorized representative of the City in writing. If the Vendor fails to accept tender of defense and indemnity within 30 calendar days, in addition to any other remedies authorized by law, so much of the money due or that may become due the Vendor under the Standard Agreement as shall reasonably be considered necessary by the City may be retained by the City until disposition has been made of the matter subject to tender, or until the Vendor accepts the tender, whichever occurs first.
The Vendor waives any and all rights to express or implied indemnity against the Indemnitees concerning any Liability of the Vendor arising out of or in connection with the furnishing of chemicals by the Vendor pursuant to the Standard Agreement or the Vendor’s failure to comply with any of the terms of the Standard Agreement.
18. This Agreement, including all attachments, contains the entire agreement between the parties and supersedes whatever oral or written understanding they may have had prior to the execution of this Agreement. This Agreement shall not be amended or modified except by a written agreement executed by each of the parties hereto.
19. This Agreement shall in all respects be governed by the law of the State of California without regard to its conflicts of law rules. Litigation arising out of or connected with this Agreement shall be instituted and maintained in the courts of Solano County in the State of California or in the United States District Court, Eastern District of California, Sacramento, California, and the parties consent to jurisdiction over their person and over the subject matter of any such litigation in such courts, and consent to service of process issued by such courts.
20. The following Exhibits are attached hereto and incorporated herein by reference:
Exhibit A: Chemical Quote
Exhibit B: Manufacturer Chemical Information
Exhibit C: Insurance and Endorsements (including any attachments) Exhibit D: City of Vallejo Business License
[SIGNATURES ON FOLLOWING PAGE]
8 IN WITNESS WHEREOF, the parties have executed this Agreement on the day and year shown below the name of each of the parties.
NALCO, an Ecolab Company
a Delaware corporation
By:
Julian L. Smith
Account Manager
DATE:
11711486
Vallejo Business License No.
(City Seal)
CITY OF VALLEJO,
a municipal corporation
By:
Harry Black
Interim City Manager
DATE:
ATTEST:
By:
Dawn Abrahamson
City Clerk
APPROVED AS TO CONTENT:
By:
Beth Schoenberger
Water Director
APPROVED AS TO FORM:
By:
Veronica A.F. Nebb
City Attorney
APPROVED AS TO INSURANCE:
By:
Armond Sarkis
Risk Manager
9
10 Exhibit A
Chemical Quote
11 Exhibit B
Manufacture’s Information for Chemical
12 Exhibit C
Insurance and Endorsements
(including any attachments)
13 Exhibit D
City of Vallejo Business License
July 1, 2025
Josh Manrique
Administrative Manager
Travis Air Force Base Facility
383 Fairchild Dr
Fairfield, CA 94535
805-897-2621
Mr. Galtere
In response to your request for pricing for Cat-Floc 8102 PLUS, Nalco Company offers the following price quote.
Product: CatFloc®8102 PLUS
Package: 250 GAL tote - 2251 LBS
Price: $2.15/LB
Total: $5,220 EA
Your annual spend, based on proposed usage will be the following:
QTY: 10 Totes
Annual Cost: $ 52,200
The pricing includes delivery to the Travis Air Force Base Plant, Fairfield, CA 94535 Above pricing is effective 2025-JUL-01 and our intent is to hold the pricing through 2026-JUN-30. Nalco reserves the right to renegotiate the price should there be excessive increase to raw material or fuel cost.
Pricing does not include any temporary energy surcharges (8% as of 4/15/23).
If you have concerns regarding the information above, please feel free to callme directly, 310-924-5669, or email me whenever you have time,
Sincerely,
Julian L Smith
DISTRICT MANAGER – MU101
NALCO Water | An Ecolab Company 10521 HUMBOLT ST, LOS ALAMITOS, CA 90720 M 310.924.5669 E [email protected]
1601 W. DIEHL ROAD
NAPERVILLE, ILLINOIS 60563-1198
(630) 305-1000
Regulatory Certifications & Registrations: North America Product: CAT-FLOC 8102 PLUS
Created:12/05/2020
US FOOD AND DRUG ADMINISTRATION (FDA)
FDA Compliance status Maximum dosage Limitation
21 CFR 176.170 Components of
paper and paperboard in contact
with aqueous and fatty foods and
21 CFR 176.180 Components of
paper and paperboard in contact
with dry foods.
If applicable, see below. If applicable, see below.
Limitation: For use only as a flocculant employed prior to the sheet-forming operation in the manufacture of paper and paperboard, and used at a level not to exceed 10 mg/L (10 ppm) of influent water.
176.170 Limitation: The final food contact surface must comply with the extractives limitations as outlined in 176.170(c).
FDA Compliance status Maximum dosage Limitation
This product has been affirmed as
GRAS (Generally Recognized as
Safe) under 21 CFR 570.30 for
use in animal feed, when used
according to the following
limitations:
If applicable, see below. If applicable, see below.
Limitation: When used in DAF only applications for meat or fruit/vegetable applications, product use level may not exceed 1,000 ppm (actives).
Limitation: When used in DAF/centrifuge or DAF/press F&B applications, product use level may not exceed 600 ppm in the DAF and 500 ppm in the centrifuge or press application.
Limitation: When used in DAF only applications for dairy applications, product use level may not exceed 2,000 ppm (actives).
CANADIAN FOOD INSPECTION AGENCY (CFIA)
Authorized use is under category: W1
LABEL INSTRUCTIONS at time of printing:
1601 W. DIEHL ROAD
NAPERVILLE, ILLINOIS 60563-1198
(630) 305-1000
Regulatory Certifications & Registrations: North America Product: CAT-FLOC 8102 PLUS
Created:12/05/2020
DIRECTIONS FOR USE: This product is to be used only as directed by a Nalco representative. For use in potable water systems. The residual monomer content of the polymer should not exceed 0.05% by weight. FOR FOOD PLANTS AND OTHER INDUSTRIAL USES ONLY 50 ppm NOTICE TO USER: This product has received acceptance for use in registered food establishments provided that they are used in keeping with the instructions outlined on the label.
HEALTH CANADA
NOTICE TO USER: This product has received acceptance for use in registered food establishments provided that they are used in keeping with the instructions outlined on the label.
GERMAN FEDERAL INSTITUTE FOR RISK ASSESSMENT (BFR)
This product is In compliance with recommendation BfR XXXVI Dosage Limit (%) Dosage Limit (mg/dm2) Limitation Qualifier 0,80 % Not applicable product based on dry fiber
NSF/ANSI STANDARD 60 - DRINKING WATER TREATMENT CHEMICALS This product has received NSF/International certification under NSF/ANSI Standard 60 in the coagulation and flocculation category. The official name is "Poly (Diallyldimethylammonium Chloride) (pDADMAC)." Maximum product application dosage is : 50 mg/l.
PRODUCT STEWARDSHIP ASSESSMENT
HUMAN HAZARD AND EXPOSURE CHARACTERIZATION:
Based on our hazard characterization, the potential human hazard is: Low Based on our recommended product application and personal protective equipment, the potential human exposure is: Low
ENVIRONMENTAL HAZARD AND EXPOSURE CHARACTERIZATION:
Based on our hazard characterization, the potential environmental hazard is: Moderate Based on our recommended product application and the product's characteristics, the potential environmental exposure is: Moderate
1601 W. DIEHL ROAD
NAPERVILLE, ILLINOIS 60563-1198
(630) 305-1000
Regulatory Certifications & Registrations: North America Product: CAT-FLOC 8102 PLUS
Created:12/05/2020
Due to our commitment to Product Stewardship, we have evaluated the human and environmental hazards and exposures of this product. Based on our recommended use of this product, we have characterized the product's general risk. This information should provide assistance for your own risk management practices. We have evaluated our product's risk as follows:
* The human risk is: Low
* The environmental risk is: Moderate
Any use inconsistent with our recommendations may affect the risk characterization. Our sales representative will assist you to determine if your product application is consistent with our recommendations. Together we can implement an appropriate risk management process.
FEDERAL WATER POLLUTION CONTROL ACT, CLEAN WATER ACT, 40 CFR 401.15 / formerly Sec. 307, 40 CFR 116.4 / formerly Sec. 311
Substances listed under this regulation are not intentionally added or expected to be present in this product. Listed components may be present at trace levels.
CLEAN AIR ACT, Sec. 112 (Hazardous Air Pollutants, as amended by 40 CFR 63), Sec. 602 (40 CFR 82, Class I and II Ozone Depleting Substances)
Substances listed under this regulation are not intentionally added or expected to be present in this product. Listed components may be present at trace levels.
Regulatory Affairs
CAT-FLOC 8102 PLUS
Coagulant
Product Bulletin
PRODUCT DESCRIPTION AND APPLICATION
CAT-FLOC 8102 PLUS is a medium low molecular weight, liquid cationic polyelectrolyte. It is used as a primary coagulant or coagulant aid in water and wastewater clarification. It is highly effective as a replacement for, or can be used in conjunction with, inorganic coagulants such as ferric salts or alum.
CAT-FLOC 8102 PLUS is chlorine resistant and effective over a broad pH range.
Features Benefits
Liquid polymer
NSF International certified
Easy to feed
Acceptable for use in drinking water applications
Unique high charge, medium low molecular
weight cationic polymer
Effective in a wide range of wastewater and
water clarification applications
Forms a strong floc Improved finished water quality
May reduce or replace inorganic coagulants Reduce sludge generation
PHYSICAL & CHEMICAL PROPERTIES
These properties are typical. Refer to the Safety Data Sheet (SDS) for the most current data.
Form Liquid
Appearance Viscous, clear, pale yellow to amber
Specific Gravity @77oF [25oC] 1.05
pH (Neat) @ 77oF [25oC] 5 – 8
Freeze Point (°F/°C) 30/-1
Freeze-Thaw Recovery Complets. May stratify upon freezing - Agitate to make uniform
Viscosity @ 77oF [25oC] 25 – 200 cP
Flash Point (PMCC) >200o
F [>93oC]
ACTIVE CONSTITUENTS
Considered Proprietary
REGULATORY APPROVALS
Refer to the product SDS and Regulatory Certifications & Registrations (RCR) document for most recent information on approvals.
MATERIALS OF COMPATIBILITY
Material compatibility data are only valid for product storage and feed systems.
CAT-FLOC 8102 PLUS polymer is moderately corrosive to iron and copper, including their alloys.
Storage tanks, chemical feed systems, and piping should be constructed of high density (HDPE) or crosslinked (XLPE) polyethylene, fiberglass (FRP) with polyester or vinylester resins, epoxy- or vinylesterlined steel.
Compatible Not Compatible
Polyethylene - High Density Carbon Steel
Polypropylene Brass
Polyethylene - Crosslinked Aluminum
PVC, CPVC
TEFLONTM
Kynar®
Viton® synthetic rubber
FRP (bisphenol)
FRP (isophthalic)
Plasite 7122 (epoxy)
Plasite 4100 (vinyl ester)
Stainless Steel 304 & 316
Buna-N Rubber
Neoprene
DOSAGE AND FEEDING
CAT-FLOC 8102 PLUS should be fed via a closed feed system. A closed feed system is defined as a system in which fluid is moved from a closed storage vessel into a treated media without exposure to the atmosphere except through normal venting or pressure relief devices.
CAT-FLOC 8102 PLUS polymer may be fed neat as long as in-line dilution is provided. However, dilution to 1% as product is recommended to assure better contact of the coagulant with the impurities in the water. Neat polymer feed systems should be capable of handling 1,000 cps viscosity material.
Product feed rate will be site and application specific, and may vary as conditions change. Product demand may be determined by a bench test using Jar Test procedures.
The dosage of CAT-FLOC 8102 PLUS will be determined based on the required clarity of the effluent water from the clarification equipment. Typically optical turbidity units such as the NTU or JTU are measured using a turbidimeter. Dosage control should be based on meeting required turbidity specifications.
ENVIRONMENTAL AND TOXICITY DATA
Refer to the product Safety Data Sheet and RCR for all aquatic and mammalian toxicity information.
SAFETY AND HANDLING
Read SDS and RCR for specific personal protective equipment (PPE) recommendations and for health effects information.
As part of good industrial and personal hygiene and safety procedure, avoid all unnecessary exposure to the product and ensure prompt removal from eyes, skin and clothing. Wash thoroughly after handling.
Keep container closed when not in use.
STORAGE
Product should be maintained at 38°F (3°C) or higher. Protect from low temperatures as the product may become viscous and may cause pumping problems. It is best to avoid stainless steel bulk tanks as the product will cause corrosion over a longer period of time.
Recommended limit for in plant storage is 1 year in an unopened container.
REMARKS
If you need assistance or more information on this product, please call your nearest Nalco representative.
For more news about Nalco, an Ecolab company, visit our website www.nalco.ecolab.com For Medical and Transportation Emergencies involving Nalco products, please see the Safety Data Sheet for the phone number.
ADDITIONAL INFORMATION
CAT-FLOC, Ecolab, Nalco and the logo are trademarks of Ecolab USA Inc.
All other trademarks are the property of their respective owners. ©2015 Ecolab USA Inc. All Rights Reserved.
Nalco An Ecolab Company
Subsidiaries and Affiliates in Principal Locations Around the World ©2015 Ecolab USA, Inc. All Rights Reserved
SAFETY DATA SHEET
CAT-FLOC 8102 PLUS
1 / 8
Section: 1. PRODUCT AND COMPANY IDENTIFICATION
Product name : CAT-FLOC 8102 PLUS
Other means of identification : Not applicable.
Recommended use : FLOCCULANT
Restrictions on use : Refer to available product literature or ask your local Sales Representative for restrictions on use and dose limits.
Company : Nalco Company
1601 W. Diehl Road
Naperville, Illinois 60563-1198
USA
TEL: (630) 305-1000
Emergency telephone
number
: (800) 424-9300 (24 Hours) CHEMTREC
Issuing date : 01/17/2020
Section: 2. HAZARDS IDENTIFICATION
GHS Classification
Not a hazardous substance or mixture.
GHS Label element
Precautionary Statements : Prevention:
Wash hands thoroughly after handling.
Response:
Specific measures: consult SDS Section 4.
Storage:
Store in accordance with local regulations.
Other hazards : None known.
Section: 3. COMPOSITION/INFORMATION ON INGREDIENTS
No hazardous ingredients
Section: 4. FIRST AID MEASURES
In case of eye contact : Rinse with plenty of water. Get medical attention if symptoms occur.
In case of skin contact : Wash off with soap and plenty of water. Get medical attention if symptoms occur.
If swallowed : Rinse mouth. Get medical attention if symptoms occur.
If inhaled : Get medical attention if symptoms occur.
Protection of first-aiders : In event of emergency assess the danger before taking action. Do not put
SAFETY DATA SHEET
CAT-FLOC 8102 PLUS
2 / 8
yourself at risk of injury. If in doubt, contact emergency responders. Use personal protective equipment as required.
Notes to physician : Treat symptomatically.
Most important symptoms
and effects, both acute and
delayed
: See Section 11 for more detailed information on health effects and symptoms.
Section: 5. FIREFIGHTING MEASURES
Suitable extinguishing media : Use extinguishing measures that are appropriate to local circumstances and the surrounding environment.
Unsuitable extinguishing
media
: None known.
Specific hazards during
firefighting
: Not flammable or combustible.
Hazardous combustion
products
: Decomposition products may include the following materials: Carbon oxides nitrogen oxides (NOx) Sulphur oxides Oxides of phosphorus Special protective equipment
for firefighters
: Use personal protective equipment.
Specific extinguishing
methods
: Fire residues and contaminated fire extinguishing water must be disposed of in accordance with local regulations.
Section: 6. ACCIDENTAL RELEASE MEASURES
Personal precautions,
protective equipment and
emergency procedures
: Refer to protective measures listed in sections 7 and 8.
Environmental precautions : No special environmental precautions required.
Methods and materials for
containment and cleaning up
: Stop leak if safe to do so. Contain spillage, and then collect with noncombustible absorbent material, (e.g. sand, earth, diatomaceous earth, vermiculite) and place in container for disposal according to local / national regulations (see section 13). For large spills, dike spilled material or otherwise contain material to ensure runoff does not reach a waterway. Flush away traces with water.
Section: 7. HANDLING AND STORAGE
Advice on safe handling : For personal protection see section 8. Wash hands after handling.
Conditions for safe storage : Keep out of reach of children. Keep container tightly closed. Store in suitable labelled containers.
Suitable material : Keep in properly labelled containers.
Unsuitable material : not determined
SAFETY DATA SHEET
CAT-FLOC 8102 PLUS
3 / 8
Section: 8. EXPOSURE CONTROLS/PERSONAL PROTECTION
Components with workplace control parameters
Contains no substances with occupational exposure limit values.
Engineering measures : Good general ventilation should be sufficient to control worker exposure to airborne contaminants.
Personal protective equipment
Eye protection : Safety glasses
Hand protection : Wear protective gloves.
Gloves should be discarded and replaced if there is any indication of degradation or chemical breakthrough.
Skin protection : Wear suitable protective clothing.
Respiratory protection : No personal respiratory protective equipment normally required.
Hygiene measures : Wash hands before breaks and immediately after handling the product.
The Personal Protective Equipment (PPE) recommendations provided above have been made in good faith based on typical expected conditions of use. PPE selection should always be completed in conjunction with a proper risk assessment and in accordance with a PPE management program.
Section: 9. PHYSICAL AND CHEMICAL PROPERTIES
Appearance : Liquid
Colour : light yellow
Odour : odourless
Flash point : > 93.3 °C
pH : 5.0 - 8.0,(100 %), (25 °C)
Odour Threshold : no data available
Melting point/freezing point : Freezing Point: -3 °C
Initial boiling point and boiling
range
: 100 °C
Evaporation rate : no data available
Flammability (solid, gas) : Not applicable.
Upper explosion limit : no data available
Lower explosion limit : no data available
Vapour pressure : similar to water
Relative vapour density : no data available
Relative density : 1.02 - 1.06,
Density : 8.5 - 8.8 lb/gal
SAFETY DATA SHEET
CAT-FLOC 8102 PLUS
4 / 8
Water solubility : completely soluble
Solubility in other solvents : no data available
Partition coefficient: noctanol/water: no data available Auto-ignition temperature : no data available
Thermal decomposition : no data available
Viscosity, dynamic : 30 - 160 mPa.s (25 °C)
Viscosity, kinematic : no data available
Molecular weight : no data available
VOC : 0 %, EPA Method 24
Section: 10. STABILITY AND REACTIVITY
Reactivity : No dangerous reaction known under conditions of normal use.
Chemical stability : Stable under normal conditions.
Possibility of hazardous
reactions
: No dangerous reaction known under conditions of normal use.
Conditions to avoid : Freezing temperatures.
Incompatible materials : Strong oxidizing agents
Hazardous decomposition
products
: Decomposition products may include the following materials:
Carbon oxides
nitrogen oxides (NOx)
Sulphur oxides
Oxides of phosphorus
Section: 11. TOXICOLOGICAL INFORMATION
Information on likely routes of
exposure
: Inhalation, Eye contact, Skin contact
Potential Health Effects
Eyes : Health injuries are not known or expected under normal use.
Skin : Health injuries are not known or expected under normal use.
Ingestion : Health injuries are not known or expected under normal use.
Inhalation : Health injuries are not known or expected under normal use.
Chronic Exposure : Health injuries are not known or expected under normal use.
Experience with human exposure
Eye contact : No symptoms known or expected.
SAFETY DATA SHEET
CAT-FLOC 8102 PLUS
5 / 8
Skin contact : No symptoms known or expected.
Ingestion : No symptoms known or expected.
Inhalation : No symptoms known or expected.
Toxicity
Product
Acute oral toxicity : LD50 rat: 14,600 mg/kg
Test substance: Product
Acute inhalation toxicity : no data available
Acute dermal toxicity : LD50 rabbit: > 20,000 mg/kg
Test substance: Similar Product
Skin corrosion/irritation : Species: Rabbit
Result: 1.0
Method: Draize Test
Test substance: Similar Product
Serious eye damage/eye
irritation
: Species: rabbit
Result: 8.0
Method: Draize Test
Test substance: Similar Product
Respiratory or skin
sensitization
: no data available
Carcinogenicity : no data available
Reproductive effects : no data available
Germ cell mutagenicity : no data available
Teratogenicity : no data available
STOT - single exposure : no data available
STOT - repeated exposure : no data available
Aspiration toxicity : no data available
Section: 12. ECOLOGICAL INFORMATION
Ecotoxicity
Environmental Effects : Harmful to aquatic life with long lasting effects.
Product
Toxicity to fish : LC50 Oncorhynchus mykiss (rainbow trout): 0.74 mg/l Exposure time: 96 hrs
Test substance: Product tested in clean water
LC50 Zebra Danio: 10 - 100 mg/l
Exposure time: 96 hrs
Test substance: Representative polymer tested in water with DOC
SAFETY DATA SHEET
CAT-FLOC 8102 PLUS
6 / 8
Toxicity to daphnia and other
aquatic invertebrates
: LC50 Daphnia magna (Water flea): 1.8 mg/l
Exposure time: 48 hrs
Test substance: Product tested in clean water
LC50 Daphnia magna (Water flea): 10 - 100 mg/l
Exposure time: 48 hrs
Test substance: Representative polymer tested in water with DOC
Persistence and degradability
The organic portion of this preparation is expected to be poorly biodegradable.
Mobility
The environmental fate was estimated using a level III fugacity model embedded in the EPI (estimation program interface) Suite TM, provided by the US EPA. The model assumes a steady state condition between the total input and output. The level III model does not require equilibrium between the defined media. The information provided is intended to give the user a general estimate of the environmental fate of this product under the defined conditions of the models.
If released into the environment this material is expected to distribute to the air, water and soil/sediment in the approximate respective percentages;
Air : <5%
Water : 30 - 50%
Soil : 50 - 70%
The portion in water is expected to be soluble or dispersible.
Bioaccumulative potential
This preparation or material is not expected to bioaccumulate.
Other information
The hazard characterization is based on the tests or potential hazard in the clean water.
Section: 13. DISPOSAL CONSIDERATIONS
Disposal methods : The product should not be allowed to enter drains, water courses or the soil. Where possible recycling is preferred to disposal or incineration. If recycling is not practicable, dispose of in compliance with local regulations. Dispose of wastes in an approved waste disposal facility.
Disposal considerations : Dispose of as unused product. Empty containers should be taken to an approved waste handling site for recycling or disposal. Do not re-use empty containers.
Section: 14. TRANSPORT INFORMATION
The shipper/consignor/sender is responsible to ensure that the packaging, labeling, and markings are in compliance with the selected mode of transport.
SAFETY DATA SHEET
CAT-FLOC 8102 PLUS
7 / 8
Land transport (DOT)
Proper shipping name : PRODUCT IS NOT REGULATED DURING TRANSPORTATION Air transport (IATA)
Proper shipping name : PRODUCT IS NOT REGULATED DURING TRANSPORTATION Sea transport (IMDG/IMO)
Proper shipping name : PRODUCT IS NOT REGULATED DURING TRANSPORTATION Section: 15. REGULATORY INFORMATION
TSCA list : No substances are subject to a Significant New Use Rule.
No substances are subject to TSCA 12(b) export notification requirements.
EPCRA - Emergency Planning and Community Right-to-Know Act SARA 304 Extremely Hazardous Substances Reportable Quantity This material does not contain any components with a section 304 EHS RQ.
SARA 311/312 Hazards : No SARA Hazards
SARA 302 : No chemicals in this material are subject to the reporting requirements of SARA Title III, Section 302.
SARA 313 : This material does not contain any chemical components with known CAS numbers that exceed the threshold (De Minimis) reporting levels established by SARA Title III, Section 313.
California Prop. 65
This product does not contain any chemicals known to State of California to cause cancer, birth defects, or any other reproductive harm.
INTERNATIONAL CHEMICAL CONTROL LAWS :
United States TSCA Inventory
On or in compliance with the active portion of the TSCA inventory Australia. Industrial Chemical (Notification and Assessment) Act All substances in this product comply with the National Industrial Chemicals Notification & Assessment Scheme (NICNAS).
Canadian Domestic Substances List (DSL)
The substance(s) in this preparation are included in or exempted from the Domestic Substance List (DSL).
Japan. ENCS - Existing and New Chemical Substances Inventory All substances in this product comply with the Law Regulating the Manufacture and Importation Of Chemical Substances and are listed on the Existing and New Chemical Substances list (ENCS).
Korea. Korean Existing Chemicals Inventory (KECI)
SAFETY DATA SHEET
CAT-FLOC 8102 PLUS
8 / 8
All substances in this product comply with the Chemical Control Act (CCA) and are listed on the Existing Chemicals List (ECL)
Philippines Inventory of Chemicals and Chemical Substances (PICCS) All substances in this product comply with the Republic Act 6969 (RA 6969) and are listed on the Philippines Inventory of Chemicals & Chemical Substances (PICCS).
China Inventory of Existing Chemical Substances
All substances in this product comply with the Provisions on the Environmental Administration of New Chemical Substances and are listed on or exempt from the Inventory of Existing Chemical Substances China (IECSC).
New Zealand. Inventory of Chemicals (NZIoC), as published by ERMA New Zealand All substances in this product comply with the Hazardous Substances and New Organisms (HSNO) Act 1996,and are listed on or are exempt from the New Zealand Inventory of Chemicals.
Taiwan Chemical Substance Inventory
All substances in this product comply with the Taiwan Existing Chemical Substances Inventory (ECSI).
Section: 16. OTHER INFORMATION
NFPA: HMIS III:
Revision Date : 01/17/2020
Version Number : 1.1
Prepared By : Regulatory Affairs
REVISED INFORMATION: Significant changes to regulatory or health information for this revision is indicated by a bar in the left-hand margin of the SDS.
The information provided in this Safety Data Sheet is correct to the best of our knowledge, information and belief at the date of its publication. The information given is designed only as a guidance for safe handling, use, processing, storage, transportation, disposal and release and is not to be considered a warranty or quality specification. The information relates only to the specific material designated and may not be valid for such material used in combination with any other materials or in any process, unless specified in the text.
For additional copies of an SDS visit www.nalco.com and request access.
Flammability
Health
Instability
0 1
0 FLAMMABILITY
PHYSICAL HAZARD
HEALTH
1 0
0 Special hazard. 0 = not significant, 1 = Slight,
2 = Moderate, 3 = High
4 = Extreme, * = Chronic
EACH OCC-PRODUCTS
C
12/01/2025
Ecolab
X
N
12/01/2024
5,000,000
(incl Stop Gap ND,WA,WY)
12/01/2025
Y
19445
XWC018017439 (OH)
10,000,000
12/01/2025
A
Y
B
SEE ABOVE
12/01/2025 X
AIU Insurance Company
OH XS Workers Compensation
12/01/2024
Y
2,000,000
1120187
Marsh | U.S. Operations.
12/01/2025
CHI-011002086-01
12/01/2024
X
15,000,000
09/24/2025
12/01/2025
X
1 A
Y
12/01/2024
212-948-5382
018017433 (Products)
& Employers Liability
2,000,000
2,000,000
2,000,000
A
[email protected]
12/01/2025
12/01/2024
5,000,000
12/01/2024
X
19399
018017429 (AOS)
LIMIT
0 12/01/2024
WC018017437 (AOS)
WC018017438 (WI)
62785848
Limits apply excess of $1M SIR
500,000
that may apply, where required by written contract. All endorsements are issued on a blanket basis without having to specifically name individual customers or others on an endorsement.
The Certificate Holder and any other persons or organizations are included as additional insured on the auto liability, general / product liability and umbrella liability policies, where required by written contract executed prior to loss. Refer to the attached page "Additional Remarks Schedule" for the applicable additional insured, insurance as primary, waiver of subrogation, notice of cancellation and other endorsements Nalco Company LLC
Ecolab Inc.
St. Paul, MN 55102
1 Ecolab Place
2,000,000
National Union Fire Ins Co Pittsburgh PA
X
333 South 7th Street, Suite 1400
MARSH USA LLC
Minneapolis, MN 55402-2400
A
018017431
American International Group UK Limited
N
Fairfield, CA 94535
CITY OF VALLEJO
383 Fairchild Drive
12/01/2024
017737354 (MA)
C
Y 5,000,000
Y
866-966-4664
X
A
10,000,000
12/01/2025
Y
MARSH USA LLC
Lobster Ink US, Inc
St. Paul, MN 55102 Naperville, IL 60563
Named Insured: coverage under the policies shown above apply to Ecolab Inc., its subsidiaries, and business units including but not limited to the following:
1 Ecolab Place 1601 West Diehl Road
Ecolab Inc. Nalco Company LLC
Ecolab Inc.
Additional Insured-Where Required Under Contract or Agreement 87950 December 1, 2024-2025
Additional Insured-Where Required Under Contract or Agreement 94954 Ecovation, Inc. Nalco Production LLC
Additional Insured-Owners, Lessees or Contractors-Automatic Status When Requirement in Construction Agreement with You CG 20 33 Ecolab USA Folttec, LLC
Swisher
Bioquell Inc. Abednego Environmental Services, LLC
Pest Management Services, Inc.
liability, general liability and umbrella liability policies. The following endorsements are attached to the policies shown above:
Kay Chemical Barclay Water Management, Inc.
umbrella
Additional Insured: Where required by written contract executed prior to loss, the certificate holder and any person or organization are included as additional insured on the auto Pest Elimination
Lessor-Additional Insured and Loss Payee CA 20 01
Additional Insured-Owners, Lessees or Contractors - Scheduled Person or Organization CG 20 10 Food Protection Services LLC Nalco U.S. 1 LLC
Additional Insured-Owners, Lessees or Contractors-Automatic Status for Other Parties When Required in Written Construction Agreement CG 20 38 Ecolab U.S. 2 Inc. Nalco Holding Company
Purolite LLC
General Liability (Premises/Ongoing Operations)
Research Fumigation Co., LLC
General Liability (Premises/Ongoing Operations) and General Liability (Products/Completed Operations) Insurance Primary as to Certain Additional Insureds 74445 Chemstar Cascade Water
Food Safety Specialists, Inc. Nalco U.S. 2 LLC
Additional Insured-Designated Person or Organization CG 20 26 Additional Insured-Owners, Lessees or Contractors-Completed Operations CG 20 37 Additional Insured-Managers or Lessors of Premises CG 20 11 Additional Insured-Vendors CG 20 15
Certificate Description of Operations Language
Automobile Liability
General Liability (Products/Completed Operations)
EcoSure Nalco Industrial Outsourcing
Ecolab Production LLC ChemStaff
Nalco Company LLC
Ecolab Inc.
Waiver of Subrogation: Where required by written contract executed prior to loss, waiver of subrogation is granted on the auto liability, general liability, workers’ compensation, and 1 Ecolab Place
FPS Region 3 LLC Nalco Water Nalco Water Pretreatment Solutions, LLC Additional Insured-Lessor of Leased Equipment Automatic Coverage CG 20 34 St. Paul, MN 55102
Additional Insured-State of Governmental Agency or Subdivision or Political Subdivision-Permits or Authorizations CG 20 12 Royal Pest Solutions, Inc.
Additional Insured-Primary Insurance 74434 (Premises/Ongoing Operations); 94955 (Products/Completed Operations)
MARSH USA LLC
Blended Pollution Endorsement is attached to the general liability (premises) policy shown above Pesticide or Herbicide Applicator Coverage is attached to the general liability (premises) liability policy shown above General Liability (Premises/Ongoing Operations), General Liability (Products/Completed Operations) and Automobile Liability: Limited Advice of Cancellation to Scheduled Entities Notice of Cancellation: The following endorsements are attached to the policies shown above:
Workers’ Compensation & Employers Liability: Limited Advice of Cancellation Provided Via Email to Entities Other Than the Named Insured 108538
General Liability (Premises/Ongoing Operations) and General Liability (Products/Completed Operations): Waiver of Transfer of Rights of Recovery Against Others to Us CG 24 04 liability policies. The following endorsements are attached to the policies shown above:
Automobile Liability: Waiver of Transfer of Rights of Recovery Against Others to Us 62897 Commercial General Liability policy includes ISO standard Separation of Insureds clause.
Longshore and Harbor Workers’ Compensation Act Coverage Endorsement WC 00 01 06 A is attached to the workers’ compensation policies shown above Waiver of Governmental Immunity Endorsement CG 24 14 is attached to the general liability (premises) policy shown above indemnification obligations or at law.
Umbrella policy territory is WORLDWIDE. Coverage applies excess of retained amounts. This retained limit can be satisfied either through insurance or paid by Ecolab.
Maritime Coverage Endorsement WC 00 02 01 B (Jones Act) is attached to the workers’ compensation policies shown above.
Alternate Employer Endorsement WC 00 03 01, WC 00 03 01 A are attached to the workers’ compensation policies shown above Limits shown are in US Dollars (USD)
Workers’ Compensation & Employers Liability: Waiver of Our Right to Recover from Others WC 04 03 61 Outer Continental Shelf Lands Act Coverage Endorsement WC 00 01 09 C is attached to the workers’ compensation policies shown above.
Nalco Company LLC
Ecolab Inc.
1 Ecolab Place
The insurance evidenced herein and in the referenced policies is not intended to provide coverage beyond that required by written contract, beyond the Named Insured’s St. Paul, MN 55102
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11711486 NALCO COMPANY LLC 2/1/2020 6/30/2026 1601 W DIEHL RD, NAPERVILLE, IL 60563- 0130
Total records found: 1
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City of Vallejo
Processing Center
1 Approved as to form:
By: for
Veronica Nebb, City Attorney
CHEMICAL SUPPLIES PURCHASE AGREEMENT
This Chemical Supplies Purchase Agreement ("Agreement") is made and entered into this 1st day of July, 2026, by and between the City of Vallejo, a municipal corporation ("City"), and SNF Polydyne, Inc. dba Polydyne, Inc., a Delaware Corporation, hereinafter referred to as “Vendor,” who agree as follows:
1. Vendor shall provide City, and deliver to Fleming Hill, Travis, and Green Valley Water Treatment Plants, as required by the Vallejo Municipal Water System, the following:
Chemical: CLARIFLOC A-6360
Quantity: 23,000 lbs
Unit Price: $1.55 per lb
Chemical Cost: $35,650.00
(Thirty-Five Thousand Six Hundred
Fifty Dollars and Zero Cents)
Contingency for Misc Surcharges (10%) $3,565.00
(Three Thousand Five Hundred SixtyFive Dollars and Zero Cents) Agreement Not to Exceed Amount: $39,215.00
(Thirty-Nine Thousand Two Hundred
Fifteen Dollars and Zero Cents)
The foregoing quantity(ies) is/are an approximation only, and are the quantities estimated as required by the Water System for the Agreement term. City does not expressly or by implication warrant that the actual quantities ordered during the Agreement term will correspond therewith, and reserves the right to increase or decrease the quantity of chemical ordered, at the bid price, as may be necessary or advisable.
2. Omitted.
3. Omitted.
4. Vendor further agrees that all chemicals and/or materials to be furnished and delivered shall be strictly in accordance with said specifications, except that the City reserves the right to accept material other than that called forth in said specifications provided the Water Director approves in writing such other chemical/material as equal or better prior to Vendor furnishing or delivering the same.
2 5. Vendor has obtained or agrees to apply, prior to performance under this Agreement, to City’s Finance Department for a business license, pay the applicable business license tax and maintain said business license during the term of this Agreement. The failure to obtain such license shall be a material breach of this Agreement and grounds for termination by City. No payments shall be made to Vendor until such business license(s) has been obtained.
6. Vendor shall be fully informed of all Federal, State, County or Municipal laws, statutes, ordinances, codes and regulations which may in any manner apply to or otherwise have effect on the material to be furnished and shall at all times abide by all such rulings, orders and decrees of those agencies, bodies or tribunals having any jurisdiction or authority over the same.
7. City hereby agrees to pay to Vendor, in lawful money of the United States of America, at the time and in accordance with the provisions set forth in said specifications the price(s) set forth above.
8. The term of this Agreement is for Fiscal Year 2026-2027, shall commence upon execution of the contract by the City Manager, and shall continue in full force and effect until June 30, 2027. City shall, at its discretion, have the right to extend the term of this Agreement for 90 days by written notice to Vendor. The total duration of this Agreement, including the exercise of any options under this section, shall not exceed September 30, 2026. If the term of this Agreement extends into fiscal years subsequent to that in which it is approved, such continuation of the Agreement is contingent on the appropriation of funds for such purpose by the City Council of the City of Vallejo.
9. The parties hereto shall have the right by mutual consent to extend this Agreement on a month-to-month basis, notwithstanding the termination date specified above herein.
Any such agreed extension may include a revision of the unit price herein recited and such revised price shall then prevail over the unit price recited herein for the term of such extension. In the event City desires to extend this Agreement, the Water Director shall so notify the Vendor, who shall promptly accept or reject such extension in writing.
10. All notices or instruments required to be given or delivered by law or this Agreement shall be in writing and shall be effective upon receipt thereof and shall be by personal service or delivered by depositing the same in any United States Post Office, registered or certified mail, postage prepaid, addressed to:
If to City: Beth Schoenberger, Water Director
City of Vallejo Water Department
202 Fleming Hill Road
Vallejo, CA 94589
If to Vendor: Rawlin Castro, Regional Sales Manager
SNF Polydyne, Inc.
1 Chemical Plant Road
3 Riceboro, GA 31323
Any party may change its address for receiving notices by giving written notice of such change to the other party in accordance with this section.
11. The City Representative shall administer this Agreement for the City, and routine administrative communications shall be made to the City Representative, or the representative's designee:
Nicholas Rolley, Water Operations Superintendent
City of Vallejo Water Department
202 Fleming Hill Road,
Vallejo, CA 94589
[email protected]
12. INSURANCE
Vendor shall procure and maintain for the duration of the contract all necessary insurance against claims for injuries to persons or damages to property which may arise from or in connection with the performance of the work hereunder by the Vendor, the Vendor’s agents, representatives, employees or subcontractors.
13. MINIMUM SCOPE OF INSURANCE
1. Insurance shall be at least as broad as:
a. Standard Workers’ Compensation & Employer’s Liability Including Occupations Disease Coverage
b. Comprehensive General Liability Insurance
c. Comprehensive Automobile Liability Insurance
d. Umbrella/Excess Liability Coverage
e. Broad Form Contractors Pollution Liability Insurance
2. Insurance Services Office form covering Automobile Liability, code 1 (any auto)
3. Worker’s Compensation insurance as required by the State of California and Employer’s Liability Insurance.
14. VENDOR SHALL MAINTAIN LIMITS NO LESS THAN:
TYPE OF INSURANCE MINIMUM LIMITS OF LIABILITY
4 Standard Workers'
Compensation & Employer's
Liability Including Occupations
Disease Coverage
Statutory limits as required by the State of California including $1 million Employers’ Liability per accident, per employee for bodily injury or disease. If Vendor is self-insured, provide a certificate of Permission to
Self-Insure, signed by the California Department of
Industrial Relations and Self-Insurance.
Comprehensive General
Liability Insurance
$5,000,000 per occurrence for bodily injury, personal
injury, property damage and products and completed
operations, product liability, contractor’s pollution
liability. If Commercial General Liability Insurance or other form with a general aggregate liability is used,
either the general aggregate limit shall apply
separately to this product or the minimum required
aggregate limit or be twice the required occurrence
limit. Policy shall be endorsed to name the City as an
additional insured per the conditions detailed below.
ISO Form CG 20 10 (1/85) or its equivalent is
required.
Comprehensive Automobile
Liability Insurance
$5,000,000 per accident for bodily injury and property
damage, to include automobile pollution liability. If the Vendor is subject to the Motor Carrier Act of 1980,
Automobile Liability Policy must be endorsed to
include MCS-90 Endorsement for transportation of
hazardous materials/waste/substances. If not, the
policy shall be endorsed to include Transportation
Pollution Liability Coverage to cover the materials
transported by the Vendor.
Umbrella/Excess Liability
Coverage
If an Umbrella or Excess Liability Policy is used to
meet the liability limits, coverage shall be as broad as specified for underlying coverages and cover those
insured in the underlying policies.
Broad Form Contractors
Pollution Liability Insurance
Same limits as Commercial General Liability
insurance. Time Element Sudden and Accidental
coverage and/or any Blended Pollution
Endorsements on General Liability and Auto Liability
policies and/or Pollution Liability policies will not be accepted.
15. DEDUCTIBLES AND SELF-INSURED RETENTIONS
5 Any deductibles or self-insured retentions must be declared to and approved by Cityy. At the option of City, either: the insurer shall reduce or eliminate such deductibles or self-insured retentions as respects the City, its officers, officials, employees, and volunteers; or the Vendor shall procure a bond guaranteeing payment of losses and related investigations, claim administration and defense expenses. Vendor is responsible for satisfaction of the deductible and/or self-insured retention for each loss.
16. OTHER INSURANCE PROVISIONS
The required general liability and automobile liability policies are to contain, or be endorsed to contain the following provisions:
1. The City, its officers, officials, employees, agents and volunteers are to be covered as additional insureds as respects: liability arising out of activities performed by or on behalf of the Vendor; products and completed operations of the Vendor; premises owned, occupied or used by the Vendor; or automobiles owned, leased, hired or borrowed by the Vendor. The coverage shall contain no special limitations on the scope of protection afforded to the Agencies, its officers, officials, employees, agents or volunteers.
2. For any claims related to this project, the Vendor’s insurance coverage shall be primary insurance as respects the City, its officers, officials, employees, agents and volunteers. Any insurance or self-insurance maintained by the City, its officers, officials, employees, agents or volunteers shall be excess of the Vendor’s insurance and shall not contribute with it and in no way relieves the Vendor from its responsibility to provide insurance.
3. Any failure to comply with reporting or other provisions of the policies including breaches of warranties shall not affect coverage provided to the City, its officers, officials, employees, agents or volunteers.
4. The Vendor’s insurance shall apply separately to each insured against whom claim is made or suit is brought except, with respect to the limits of the insurer’s liability.
5. Each insurance policy required by this clause shall be endorsed to state that coverage shall not be suspended, voided, canceled by either party, reduced in coverage or limits except after thirty (30) days’ prior written notice by certified mail, return receipt requested, has been given to the City.
6. Any available insurance proceeds in excess of the specified minimum insurance coverage requirements and limits shall be available to the City.
Furthermore, the requirements for coverage and limits shall be (1) the minimum coverage and limits specified in the City’s Agreement or (2) the full coverage and maximum limits of any insurance proceeds available to the Vendor, whichever is greater.
6 7. If an umbrella or excess insurance policy is used to satisfy the required limits of insurance, it shall be endorsed to contain a provision that such coverage shall also apply on a primary and non-contributory basis for the benefit of City before the City’s own insurance shall be called upon to protect it as a named insured.
8. The workers’ compensation policy required hereunder shall be endorsed to state that the workers' compensation carrier waives its right of subrogation against City, its officers, officials, employees, agents and volunteers, which might arise by reason of payment under such policy in connection with Bidder’s performance under this Agreement. The waiver of subrogation rights endorsement in favor of the City of Vallejo shall be attached to the Certificate of Insurance.
Acceptability of Insurers
Insurance is to be placed with insurers with a current A.M. Best’s rating of no less than A: VII.
Verification of Coverage
Vendor shall furnish the Agencies with original endorsements effecting coverage required by this clause. The endorsements are to be signed by a person authorized by that insurer to bind coverage on its behalf. The endorsements are to be on forms provided by the City. All endorsements are to be received and approved by City before work commences. As an alternative to City forms, the Vendor’s insurer may provide complete, certified copies of all required insurance policies, including endorsements affecting the coverage required by the City.
17. INDEMNIFICATION
To the maximum extent permitted by law, the Vendor shall, at its own expense, indemnify, defend with counsel acceptable to City listed on the Standard Agreement for chemical requirements, (which acceptance will not be unreasonably withheld), and hold harmless the City and its officers, officials, employees, agents and volunteers ("Indemnities") from and against any and all liability, loss, damage, claims, suits, actions, arbitration proceedings, administrative proceedings, regulatory proceedings, civil penalties and fines, expenses and costs (including, without limitation, claims expenses, attorney's fees and costs and fees of litigation) (collectively, "Liability") of every nature, whether actual, alleged or threatened, arising out of or in connection with the negligent acts or omissions, or willful misconduct of the Vendor pursuant to the Standard Agreement or the Vendor’s failure to comply with any of the terms of the Standard Agreement. The Vendor shall not be required to indemnify an Indemnitee for the Indemnitee’s own negligence or willful misconduct.
The Vendor’s obligation to indemnify, defend and hold harmless under this provision shall not be excused because of the Vendor’s inability to evaluate Liability, or because the
7 Vendor evaluates Liability and determines that the Vendor is not or may not be liable. The Vendor must respond within 30 calendar days to any tender for defense and indemnity by City, unless the time for responding has been extended by an authorized representative of the City in writing. If the Vendor fails to accept tender of defense and indemnity within 30 calendar days, in addition to any other remedies authorized by law, so much of the money due or that may become due the Vendor under the Standard Agreement as shall reasonably be considered necessary by the City may be retained by the City until disposition has been made of the matter subject to tender, or until the Vendor accepts the tender, whichever occurs first.
The Vendor waives any and all rights to express or implied indemnity against the Indemnitees concerning any Liability of the Vendor arising out of or in connection with the furnishing of chemicals by the Vendor pursuant to the Standard Agreement or the Vendor’s failure to comply with any of the terms of the Standard Agreement.
18. This Agreement, including all attachments, contains the entire agreement between the parties and supersedes whatever oral or written understanding they may have had prior to the execution of this Agreement. This Agreement shall not be amended or modified except by a written agreement executed by each of the parties hereto.
19. This Agreement shall in all respects be governed by the law of the State of California without regard to its conflicts of law rules. Litigation arising out of or connected with this Agreement shall be instituted and maintained in the courts of Solano County in the State of California or in the United States District Court, Eastern District of California, Sacramento, California, and the parties consent to jurisdiction over their person and over the subject matter of any such litigation in such courts, and consent to service of process issued by such courts.
20. The following Exhibits are attached hereto and incorporated herein by reference:
Exhibit A: Chemical Quote
Exhibit B: Manufacturer Chemical Information
Exhibit C: Insurance and Endorsements (including any attachments) Exhibit D: City of Vallejo Business License
[SIGNATURES ON FOLLOWING PAGE]
8 IN WITNESS WHEREOF, the parties have executed this Agreement on the day and year shown below the name of each of the parties.
SNF Polydyne, Inc. dba Polydyne, Inc.,
a Delaware corporation
By:
Boyd Stanley
Senior Vice President
DATE:
11710989
Vallejo Business License No.
(City Seal)
CITY OF VALLEJO,
a municipal corporation
By:
Harry Black
Interim City Manager
DATE:
ATTEST:
By:
Dawn Abrahamson
City Clerk
APPROVED AS TO CONTENT:
By:
Beth Schoenberger
Water Director
APPROVED AS TO FORM:
By:
Veronica A.F. Nebb
City Attorney
APPROVED AS TO INSURANCE:
By:
Armond Sarkis
Risk Manager
9
10 Exhibit A
Chemical Quote
11 Exhibit B
Manufacture’s Information for Chemical
12 Exhibit C
Insurance and Endorsements
(including any attachments)
13 Exhibit D
City of Vallejo Business License
polydyneinc.com
Polydyne Inc. • 1 Chemical Plant Road • Riceboro, GA 31323 USA • Tel 800.848.7659 May 13, 2026
John Manrique
City of Vallejo
Administrative Manager
111 Amador Street
Vallejo, CA 94590
RE: Contract Renewal Proposal for CLARIFLOC A-6360 Product Dear Mr. Manrique,
Polydyne Inc. values the opportunity to renew the referenced contract and looks forward to continuing our partnership. In connection with this renewal, we respectfully request a price adjustment to account for the sustained cost increases we have absorbed over the past year. For your review, we have attached supporting documentation to substantiate the requested price increase. Effective July 1, 2026, through June 30, 2027, Polydyne Inc. proposes to supply as follows:
PRODUCT PACKAGE CURRENT PRICE PROPOSED PRICE
CLARIFLOC A-6360 2300 LB. TOTE $1.43/LB. DELIVERED $1.55/LB. DELIVERED Please be assured that we are closely monitoring all aspects of our business and are working to remain the low-cost polymer supplier.
We greatly value our ongoing partnership and look forward to supporting you in the upcoming contract term. If the proposed renewal is agreeable, kindly confirm in writing by emailing [email protected].
If you have any questions or need any additional information, please feel free to contact Cathy Huynh, Technical Service Representative at (916) 200-6465 or by email to [email protected], or Rawlin Castro, West Region Sales Manager, at (415) 218-6089 or by email to [email protected].
Best regards,
Boyd Stanley
Sr. Vice-President Attachments
U.S. On-Highway Diesel
+38%
As published by the U.S. EIA
Mixture.
Processing aid for industrial applications.
None.
Not classified.
None.
None.
None.
None.
Spills produce extremely slippery surfaces.
Not applicable, this product is a mixture.
For explanation of abbreviations see section 16
< 5%
64742-47-8
69011-36-5
Acute Tox. 4;H302, Eye Dam. 1;H318
Asp. Tox. 1;H304
Does not result in classification of the mixture if the kinematic viscosity is greater than 20.5 mm²/s measured at 40°C. 20 - 45%
Poly(oxy-1,2-ethanediyl), a-tridecyl-w-hydroxy-, branched
SAFETY DATA SHEET
Distillates (petroleum), hydrotreated light
Move to fresh air. No hazards which require special first aid measures.
Wash off immediately with soap and plenty of water while removing all contaminated clothes and shoes. In case of persistent skin irritation, consult a physician.
Rinse immediately with plenty of water, also under the eyelids, for at least 15 minutes. Alternatively, rinse immediately with Diphoterine ®. Get prompt medical attention.
Rinse mouth with water. Do NOT induce vomiting. Call a physician or poison control centre immediately.
None under normal use.
None reasonably foreseeable.
None.
Water. Water spray. Foam. Carbon dioxide (CO2). Dry powder.
Warning! Spills produce extremely slippery surfaces.
None known.
Thermal decomposition may produce: nitrogen oxides (NOx), carbon oxides (COx). Ammonia (NH3). Hydrogen cyanide (hydrocyanic acid) may be produced in the event of combustion in an oxygen deficient atmosphere.
Wear self-contained breathing apparatus and protective suit.
Spills produce extremely slippery surfaces.
SAFETY DATA SHEET
Avoid contact with skin and eyes. Spills produce extremely slippery surfaces. Do not touch or walk through spilled material.
Wear adequate personal protective equipment (see Section 8 Exposure Controls/Personal Protection).
Keep people away from spill/leak. Prevent further leakage or spillage if safe to do so.
As with all chemical products, do not flush into surface water.
Small spills:
Do not flush with water.Soak up with inert absorbent material. Sweep up and shovel into suitable containers for disposal.
Large spills:
Do not flush with water.Dam up. Soak up with inert absorbent material. Clean up promptly by scoop or vacuum.
Residues:
After cleaning, flush away traces with water.
SECTION 7: Handling and storage; SECTION 8: Exposure controls/personal protection; SECTION 13: Disposal considerations;
Avoid contact with skin and eyes. Renders surfaces extremely slippery when spilled. When using, do not eat, drink or smoke.
Keep away from heat and sources of ignition. Freezing will affect the physical condition and may damage the material.
Incompatible with oxidizing agents.
This information is not available.
SAFETY DATA SHEET
Use local exhaust if misting occurs. Natural ventilation is adequate in absence of mists.
Safety glasses with side-shields. Use equipment for eye protection tested and approved under appropriate government standards such as NIOSH (US) or EN 166 (EU).
PVC or other plastic material gloves. Be aware that liquid may permeate gloves, frequent change is advised. Suitable gloves can be recommended by the glove supplier. The selected protective gloves have to satisfy the specifications of EU Directive 89/689/EEC and the standard EN 374 derived from it.
Wear coveralls and/or chemical apron and rubber footwear where physical contact can occur. The type of protective equipment must be selected according to the concentration and amount of the dangerous substance at the specific workplace.
Breathing apparatus needed only when aerosol or mist is formed. Use respirators and components tested and approved under appropriate government standards such as NIOSH (US) or CEN (EU).
Wash hands before breaks and at the end of workday. Wash hands before breaks and immediately after handling the product. Handle in accordance with good industrial hygiene and safety practice.
Do not allow uncontrolled discharge of product into the environment.
Viscous liquid, Milky.
Aliphatic.
No data available.
Not applicable.
< 5°C
> 100°C
Does not flash.
SAFETY DATA SHEET
Distillates (petroleum), hydrotreated light
200 mg/m3 (8 hours) (vapors)
No data available.
Not applicable.
Not expected to create explosive atmospheres.
2.3 kPa @ 20°C
0.804 g/L @ 20°C
1.0 - 1.2 (See Technical Bulletin or Product Specifications for a more precise value, if available)
Completely miscible.
Not applicable.
No data available.
> 150°C
No data available.
> 20.5 mm²/s @40°C
Not expected to be explosive based on the chemical structure.
Not expected to be oxidising based on the chemical structure.
Not applicable.
None.
Stable under recommended storage conditions.
Stable under recommended storage conditions.
None known.
Protect from frost, heat and sunlight.
SAFETY DATA SHEET
Incompatible with oxidizing agents.
Thermal decomposition may produce: nitrogen oxides (NOx), carbon oxides (COx). Ammonia (NH3). Hydrogen cyanide (hydrocyanic acid) may be produced in the event of combustion in an oxygen deficient atmosphere.
LD50/oral/rat > 5000 mg/kg (Estimated)
LD50/dermal/rat > 5000 mg/kg. (Estimated)
The product is not expected to be toxic by inhalation.
Non-irritating to skin.
Not irritating. (OECD 437)
Not sensitizing.
Not mutagenic.
Not carcinogenic.
Not toxic for reproduction.
No known effects.
No known effect.
Due to the viscosity, this product does not present an aspiration hazard.
LD50/oral/rat > 5000 mg/kg (OECD 401)
Distillates (petroleum), hydrotreated light
Not irritating. (OECD 404)
Repeated exposure may cause skin dryness or cracking.
SAFETY DATA SHEET
LD50/dermal/rabbit > 5000 mg/kg (OECD 402)
LC0/inhalation/4 hours/rat >= 4951 mg/m3 (vapors) (OECD 403) (Based on results obtained from tests on analogous products)
LD50/oral/rat = 500 - 2000 mg/kg
By analogy with similar products, this product is not expected to be sensitizing. (OECD 406)
LD50/dermal/rabbit > 2000 mg/kg
By analogy with similar substances, this substance is not expected to be toxic for reproduction.
NOAEL/rat = 300 ppm. (OECD 421)
Not irritating. (OECD 405)
No data available.
Not irritating. (OECD 404)
No known effects.
Causes serious eye irritation. (OECD 405)
Not mutagenic. (OECD 471, 473, 474, 476, 478, 479)
The results of testing on guinea pigs showed this material to be non-sensitizing.
Based on available data, product is not expected to demonstrate chronic toxic effects.
NOAEL/oral/rat/90 days >= 3000 mg/kg/day (OECD 408) (Based on results obtained from tests on analogous products)
In vitro tests did not show mutagenic effects. In vivo tests did not show mutagenic effects.
Based on the absence of mutagenicity, it is unlikely that the substance is carcinogenic.
May be fatal if swallowed and enters airways.
Carcinogenicity study in rats (OECD 451): Negative.
Poly(oxy-1,2-ethanediyl), a-tridecyl-w-hydroxy-, branched
SAFETY DATA SHEET
LC50/Danio rerio/96 hours > 100 mg/L (Estimated)
LC50/Oncorhynchus mykiss/96 hours > 100 mg/L (Estimated) EC50/Daphnia magna/48 hours > 100 mg/L (Estimated)
IC50/Algae/72 hours > 100 mg/L (Estimated)
No data available.
No data available.
No data available.
No data available.
No data available.
LC0/Oncorhynchus mykiss/96 hours > 1000 mg/L (OECD 203) Based on available data, product is not expected to be toxic for reproduction.
Two-Generation Reproduction Toxicity (OECD 416)
- NOAEL/rat > 250 mg/kg/day
Prenatal Development Toxicity Study (OECD 414)
- NOAEL/Maternal toxicity/rat > 50 mg/kg/day
- NOAEL/Developmental toxicity/rat > 50 mg/kg/day
EC0/Daphnia magna/48 hours > 1000 mg/L (OECD 202)
Based on available data, product is not expected to demonstrate chronic toxic effects.
NOAEL/oral/rat/600 days = 50 mg/kg/day
IC0/Pseudokirchneriella subcapitata/72 hours > 1000 mg/L (OECD 201) NOEC/Oncorhynchus mykiss/28 days > 1000 mg/L
No known effects.
SAFETY DATA SHEET
Distillates (petroleum), hydrotreated light
No known effects.
Not readily biodegradable.
Does not hydrolyse.
No data available.
EC10/activated sludge/17 hours > 10000 mg/L (DIN 38412-8) No data available.
Poly(oxy-1,2-ethanediyl), a-tridecyl-w-hydroxy-, branched EC50/Tetrahymena pyriformis/ 48h > 1000 mg/L.
No data available.
LC50/Cyprinus carpio/96 hours = 1 - 10 mg/L (OECD 203)
EC50/Daphnia/48 hours = 1 - 10 mg/L (OECD 202)
No data available.
IC50/Desmodesmus subspicatus/72 hours = 1 - 10 mg/L (OECD 201) Distillates (petroleum), hydrotreated light
NOEC/Daphnia magna/21 days > 1000 mg/L
Readily biodegradable. 67.6% / 28 days (OECD 301 F) ; 68.8% / 28 days (OECD 306) ; 61.2% / 61 days (OECD 304 A)
No data available.
SAFETY DATA SHEET
NOEC/Daphnia magna/21 days > 1 mg/L (OECD 202)
No data available. Readily biodegradable, exposure to sediment is unlikely.
The product is not expected to bioaccumulate.
Not applicable.
No data available.
No data available.
No data available.
Poly(oxy-1,2-ethanediyl), a-tridecyl-w-hydroxy-, branched Poly(oxy-1,2-ethanediyl), a-tridecyl-w-hydroxy-, branched > 3
No data available.
Readily biodegradable. > 60% / 28 days (OECD 301 B)
SAFETY DATA SHEET
No data available.
Does not hydrolyse.
Distillates (petroleum), hydrotreated light
Does not hydrolyse.
Distillates (petroleum), hydrotreated light
3 - 6
No data available.
None known.
Dispose in accordance with local and national regulations.
Rinse empty containers with water and use the rinse-water to prepare the working solution. If recycling is not practicable, dispose of in compliance with local regulations. Can be landfilled or incinerated, when in compliance with local regulations.
In accordance with local and national regulations.
Not classified.
Not classified.
Not classified.
All components of this product are either listed as active on the inventory or are exempt from listing. > 5000
No data available.
SAFETY DATA SHEET
Poly(oxy-1,2-ethanediyl), a-tridecyl-w-hydroxy-, branched
Not concerned.
Not concerned.
Not concerned.
Not concerned.
Not concerned.
Not concerned.
Not concerned.
Not RCRA hazardous.
WARNING! This product contains a chemical known to the State of California to cause cancer and birth defects or other reproductive harm, Acrylamide, Ethylene oxide, 1,4-Dioxane Health: 0
Flammability: 1
Instability: 0
SAFETY DATA SHEET
Health: 0
Flammability: 1
Physical Hazard: 0
PPE Code: B
SECTION 1. Identification of the substance/mixture and of the company/undertaking, SECTION 15. Regulatory information, SECTION 16. Other Information.
STOT = Specific target organ toxicity
Acute Tox. 4 = Acute toxicity Category Code 4
Asp. Tox. 1 = Aspiration hazard Category Code 1
Eye Dam 1 = Serious eye damage/eye irritation Category Code 1 H302 - Harmful if swallowed
H304 - May be fatal if swallowed and enters airways
H318 - Causes serious eye damage
Do not handle until all safety precautions have been read and understood.
U.S. Code of Federal Regulations 29 CFR 1910.1200
Version: 25.01.a
ENAC001A
SAFETY DATA SHEET
The information provided in this Safety Data Sheet is correct to the best of our knowledge, information and belief at the date of its publication. The information given is designed only as a guidance for safe handling, use, processing, storage, transportation, disposal and release and is not to be considered a warranty or quality specification. The information relates only to the specific material designated and may not be valid for such material used in combination with any other materials or in any process, unless specified in the text.
SAFETY DATA SHEET
•
CERTIFICATE OF LIABILITY INSURANCE
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR TYPE OFINSURANCE ADDL
INSD
SUBR
WVD POLICYNUMBER
POLICY EFF
(MM/DD/YYYY)
POLICY EXP
(MM/DD/YYYY) LIMITS
A X
COMMERCIAL GENERAL LIABILITY Y IEPICB5ZFB006 12/31/2025 12/31/2026 EACH OCCURRENCE $1,000,000
CLAIMS-MADE X OCCUR
DAMAGE TO RENTED
PREMISES (Ea occurrence) $500,000
MED EXP (Any one person) $25,000
PERSONAL & ADV INJURY $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
X POLICY PRO-
JECT LOC
OTHER:
PRODUCTS - COMP/OP AGG $2,000,000
$
B AUTOMOBILE LIABILITY Y 10ABR30602 12/31/2025 12/31/2026 COMBINED SINGLE LIMIT (Ea accident) $1,000,000
X ANY AUTO BODILY INJURY (Per person) $
ALL OWNED
AUTOS
HIRED AUTOS
SCHEDULED
AUTOS
NON-OWNED
AUTOS
BODILY INJURY (Per accident) $
X X PROPERTY DAMAGE
(Per accident) $
$
A UMBRELLA LIAB
EXCESSLIAB
X OCCUR
CLAIMS-MADE
Y IEELCASB5ZFD006 12/31/2025 12/31/2026 EACH OCCURRENCE $5,000,000 X AGGREGATE $5,000,000
DED RETENTION$ $
B WORKERS COMPENSATION
ANDEMPLOYERS'LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N / A
10WNR30600 12/31/2025 12/31/2026 X PER
STATUTE
OTHER
E.L. EACH ACCIDENT $1,000,000
E.L. DISEASE - EA EMPLOYEE $1,000,000
E.L. DISEASE - POLICY LIMIT $1,000,000
A POLLUTION LIABILITY Y IEPICB5ZFB006 12/31/2025 12/31/2026 LIMIT: $1,000,000 DEDUCTIBLE; $250,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Vallejo, The Agency, its officers, officials, employees, agents and volunteers are included as Additional Insured where required by written contract with respects to liability arising out of activities performed by the Named Insured per terms and conditions of the policies. Insurance coverage applies on a primary and non-contributory basis where required by written contract per terms and conditions of the policies. Excess Liability provides additional limits over General Liability, Pollution Liability, and Automobile Liability. 30 DAY CANCELLATION CLAUSE INCLUDED
EXCESS LIABILITY POLICY PROVIDES ADDITIONAL EXCESS LIMITS OVER THE PRIMARY $1M POLLUTION LIABILITY POLICY.
CERTIFICATE HOLDER CANCELLATION
ACORD 25 (2014/01)
© 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks ofACORD
City of Vallejo
202 Fleming Hill Road
Vallejo, CA 94589
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE 14
DATE (MM/DD/YYYY)
12/29/2025
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER
EPIC Insurance Brokers & Consultants
1140 Avenue of the Americas – 8
th Floor
New York, NY 10036
CONTACT Andrea Kim
NAME:
PHONE 212.293-6203
(A/C, No, Ext):
FAX 212.488.0220
(A/C, No):
E-MAIL [email protected]
ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #
INSURER A: IRONSHORE SPECIALTY INSURANCE COMPANY 25445
INSURED
Polydyne Inc.
One Chemical Plant Road
PO Box 250
Riceboro GA 31323
INSURER B: HARTFORD FIRE INSURANCE COMPANY 19682
INSURER C:
INSURER D:
INSURER E:
INSURER F:
COMMERCIAL AUTOMOBILE
HA 99 16 12 21
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
Form HA 99 16 12 21 Page 1 of 5
© 2021, The Hartford
(Includes copyrighted material of Insurance Services Office, Inc. with its permission.)
COMMERCIAL AUTOMOBILE BROAD FORM
ENDORSEMENT
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
To the extent that the provisions of this endorsement provide broader benefits to the "insured" than other provisions of the Coverage Form, the provisions of this endorsement apply.
1. BROAD FORM INSURED
Paragraph .1. - WHO IS AN INSURED - of
Section II - Liability Coverage is amended to
add the following:
d. Subsidiaries and Newly Acquired or
Formed Organizations
The Named Insured shown in the
Declarations is amended to include:
(1) Any legal business entity other than a
partnership or joint venture, formed as a
subsidiary in which you have an
ownership interest of more than 50% on
the effective date of the Coverage Form.
However, the Named Insured does not
include any subsidiary that is an
"insured" under any other automobile
policy or would be an "insured" under
such a policy but for its termination or
the exhaustion of its Limit of Insurance.
(2) Any organization that is acquired or
formed by you and over which you
maintain majority ownership. However,
the Named Insured does not include any
newly formed or acquired organization:
(a) That is a partnership or joint
venture,
(b) That is an "insured" under any other
policy,
(c) That has exhausted its Limit of
Insurance under any other policy, or
(d) 180 days or more after its
acquisition or formation by you,
unless you have given us notice of
the acquisition or formation.
Coverage does not apply to "bodily
injury" or "property damage" that results
from an "accident" that occurred before
you formed or acquired the organization.
e. Employees as Insureds
(1). Any "employee" of yours while using a
covered "auto" you don't own, hire or
borrow in your business or your
personal affairs.
f. Lessors as Insureds
(1). The lessor of a covered "auto" while the
"auto" is leased to you under a written
agreement if:
(a) The agreement requires you to
provide direct primary insurance for
the lessor and
(b) The "auto" is leased without a
driver.
Such a leased "auto" will be considered a
covered "auto" you own and not a covered
"auto" you hire.
g. Additional Insured if Required by Contract
(1) When you have agreed, in a written
contract or written agreement, that a
person or organization be added as an
additional insured on your business auto
policy, such person or organization is an
"insured", but only to the extent such
person or organization is liable for
"bodily injury" or "property damage"
caused by the conduct of an "insured"
under paragraphs a. or b. of Who Is An
Insured with regard to the ownership,
maintenance or use of a covered "auto."
The insurance afforded to any such
additional insured applies only if the
"bodily injury" or "property damage"
occurs:
(a) During the policy period, and
(b) Subsequent to the execution of such
written contract, and
(c) Prior to the expiration of the period
of time that the written contract
requires such insurance be provided
to the additional insured.
(2) How Limits Apply
If you have agreed in a written contract
or written agreement that another
person or organization be added as an
additional insured on your policy, the
most we will pay on behalf of such
additional insured is the lesser of:
(a) The limits of insurance specified in
the written contract or written
agreement; or
(b) The Limits of Insurance shown in
the Declarations.
Such amount shall be a part of and not
in addition to Limits of Insurance shown
in the Declarations and described in this
Section.
(3) Additional Insureds Other Insurance
If we cover a claim or "suit" under this
Coverage Part that may also be covered
by other insurance available to an
additional insured, such additional
insured must submit such claim or "suit"
to the other insurer for defense and
indemnity.
However, this provision does not apply
to the extent that you have agreed in a
written contract or written agreement
that this insurance is primary and noncontributory with the additional insured's own insurance.
(4) Duties in The Event Of Accident, Claim,
Suit or Loss
If you have agreed in a written contract
or written agreement that another
person or organization be added as an
additional insured on your policy, the
additional insured shall be required to
comply with the provisions in LOSS
CONDITIONS 2. - DUTIES IN THE
EVENT OF ACCIDENT, CLAIM , SUIT
OR LOSS – OF SECTION IV –
BUSINESS AUTO CONDITIONS, in the
same manner as the Named Insured.
2. Primary and Non-Contributory if
Required by Contract
Only with respect to insurance provided to
an additional insured in A.1.g. - Additional
Insured If Required by Contract, the
following provisions apply:
(1) Primary Insurance When Required By
Contract
This insurance is primary if you have
agreed in a written contract or written
agreement that this insurance be
primary. If other insurance is also
primary, we will share with all that other
insurance by the method described in
Other Insurance 5.d.
(2} Primary And Non-Contributory To Other
Insurance When Required By Contract
If you have agreed in a written contract
or written agreement that this insurance
is primary and non-contributory with the
additional insured's own insurance, this
insurance is primary and we will not
seek contribution from that other
insurance.
Paragraphs (1) and (2) do not apply to other
insurance to which the additional insured
has been added as an additional insured.
When this insurance is excess, we will have
no duty to defend the insured against any
"suit" if any other insurer has a duty to
defend the insured against that "suit". If no
other insurer defends, we will undertake to
do so, but we will be entitled to the insured's
rights against all those other insurers.
When this insurance is excess over other
insurance, we will pay only our share of the
amount of the loss, if any, that exceeds the
sum of:
(1) The total amount that all such other
insurance would pay for the loss in the
absence of this insurance; and
(2) The total of all deductible and selfinsured amounts under all that other insurance.
We will share the remaining loss, if any, by
the method described in SECTION IVBusiness Auto Conditions, B. General Conditions, Other Insurance 5.d.
3. AUTOS RENTED BY EMPLOYEES
Any "auto" hired or rented by your "employee"
on your behalf and at your direction will be
considered an "auto" you hire.
The SECTION IV- Business Auto Conditions, B.
General Conditions, 5. OTHER INSURANCE
Condition is amended by adding the following:
e. If an "employee’s" personal insurance also
applies on an excess basis to a covered
"auto" hired or rented by your "employee" on
your behalf and at your direction, this
insurance will be primary to the
"employee’s" personal insurance.
Form HA 99 16 12 21 Page 3 of 5
4. AMENDED FELLOW EMPLOYEE EXCLUSION
EXCLUSION 5. - FELLOW EMPLOYEE - of
SECTION II - LIABILITY COVERAGE does not
apply if you have workers' compensation
insurance in-force covering all of your
"employees".
Coverage is excess over any other collectible
insurance.
5. HIRED AUTO PHYSICAL DAMAGE COVERAGE
If hired "autos" are covered "autos" for Liability
Coverage and if Comprehensive, Specified
Causes of Loss, or Collision coverages are
provided under this Coverage Form for any
"auto" you own, then the Physical Damage
Coverages provided are extended to "autos" you
hire or borrow, subject to the following limit.
The most we will pay for "loss" to any hired
"auto" is:
(1) $100,000;
(2) The actual cash value of the damaged or
stolen property at the time of the "loss"; or
(3) The cost of repairing or replacing the
damaged or stolen property,
whichever is smallest, minus a deductible. The
deductible will be equal to the largest deductible
applicable to any owned "auto" for that
coverage. No deductible applies to "loss"
caused by fire or lightning. Hired Auto Physical
Damage coverage is excess over any other
collectible insurance. Subject to the above limit,
deductible and excess provisions, we will
provide coverage equal to the broadest
coverage applicable to any covered "auto" you
own.
We will also cover loss of use of the hired "auto"
if it results from an "accident", you are legally
liable and the lessor incurs an actual financial
loss, subject to a maximum of $1000 per
"accident".
This extension of coverage does not apply to
any "auto" you hire or borrow from any of your
"employees", partners (if you are a partnership),
members (if you are a limited liability company),
or members of their households.
6. PHYSICAL DAMAGE - ADDITIONAL
TEMPORARY TRANSPORTATION EXPENSE
COVERAGE
Paragraph A.4.a. of SECTION III - PHYSICAL
DAMAGE COVERAGE is amended to provide a
limit of $50 per day and a maximum limit of
$1,000.
7. LOAN/LEASE GAP COVERAGE
Under SECTION III - PHYSICAL DAMAGE
COVERAGE, in the event of a total "loss" to a
covered "auto", we will pay your additional legal
obligation for any difference between the actual
cash value of the "auto" at the time of the "loss"
and the "outstanding balance" of the loan/lease.
"Outstanding balance" means the amount you
owe on the loan/lease at the time of "loss" less
any amounts representing taxes; overdue
payments; penalties, interest or charges
resulting from overdue payments; additional
mileage charges; excess wear and tear charges;
lease termination fees; security deposits not
returned by the lessor; costs for extended
warranties, credit life Insurance, health, accident
or disability insurance purchased with the loan
or lease; and carry-over balances from previous
loans or leases.
8. AIRBAG COVERAGE
Under Paragraph B. EXCLUSIONS - of
SECTION III - PHYSICAL DAMAGE
COVERAGE, the following is added:
The exclusion relating to mechanical breakdown
does not apply to the accidental discharge of an
airbag.
9. ELECTRONIC EQUIPMENT - BROADENED
COVERAGE
a. The exceptions to Paragraphs B.4 -
EXCLUSIONS - of SECTION III - PHYSICAL
DAMAGE COVERAGE are replaced by the
following:
Exclusions 4.c. and 4.d. do not apply to
equipment designed to be operated solely by
use of the power from the "auto's" electrical
system that, at the time of "loss", is:
(1) Permanently installed in or upon the
covered "auto";
(2) Removable from a housing unit which is
permanently installed in or upon the
covered "auto";
(3) An integral part of the same unit housing
any electronic equipment described in
Paragraphs (1) and (2) above; or
(4) Necessary for the normal operation of the
covered "auto" or the monitoring of the
covered "auto's" operating system.
b. Section III, Physical Damage Coverage,
Limit of Insurance, Paragraph C.2. is
amended to add the following:
$1,500 is the most we will pay for "loss" in
any one "accident" to all electronic
equipment (other than equipment designed
solely for the reproduction of sound, and
accessories used with such equipment) that
reproduces, receives or transmits audio,
visual or data signals which, at the time of
"loss", is:
(1) Permanently installed in or upon the
covered "auto" in a housing, opening or
other location that is not normally used
by the "auto" manufacturer for the
installation of such equipment;
(2) Removable from a permanently installed
housing unit as described in Paragraph
2.a. above or is an integral part of that
equipment; or
(3) An integral part of such equipment.
c. For each covered "auto", should loss be
limited to electronic equipment only, our
obligation to pay for, repair, return or replace
damaged or stolen electronic equipment will
be reduced by the applicable deductible
shown in the Declarations, or $250,
whichever deductible is less.
10. EXTRA EXPENSE - BROADENED
COVERAGE
Under Paragraph A. - COVERAGE - of SECTION
III - PHYSICAL DAMAGE COVERAGE, we will
pay for the expense of returning a stolen covered
"auto" to you.
11. GLASS REPAIR - WAIVER OF DEDUCTIBLE
Under Paragraph D. - DEDUCTIBLE - of
SECTION III - PHYSICAL DAMAGE COVERAGE,
the following is added:
No deductible applies to glass damage if the
glass is repaired rather than replaced.
12. TWO OR MORE DEDUCTIBLES
Under Paragraph D. - DEDUCTIBLE - of
SECTION III - PHYSICAL DAMAGE COVERAGE,
the following is added:
If another Hartford Financial Services Group,
Inc. company policy or coverage form that is not
an automobile policy or coverage form applies to
the same "accident", the following applies:
(1) If the deductible under this Business Auto
Coverage Form is the smaller (or smallest)
deductible, it will be waived;
(2) If the deductible under this Business Auto
Coverage Form is not the smaller (or
smallest) deductible, it will be reduced by
the amount of the smaller (or smallest)
deductible.
13. AMENDED DUTIES IN THE EVENT OF
ACCIDENT, CLAIM, SUIT OR LOSS
The requirement in LOSS CONDITIONS 2.a. -
DUTIES IN THE EVENT OF ACCIDENT,
CLAIM, SUIT OR LOSS - of SECTION IV -
BUSINESS AUTO CONDITIONS that you must
notify us of an "accident" applies only when the
"accident" is known to:
(1) You, if you are an individual;
(2) A partner, if you are a partnership;
(3) A member, if you are a limited liability
company; or
(4) An executive officer or insurance manager, if
you are a corporation.
14. UNINTENTIONAL FAILURE TO DISCLOSE
HAZARDS
If you unintentionally fail to disclose any hazards
existing at the inception date of your policy, we
will not deny coverage under this Coverage
Form because of such failure.
15. HIRED AUTO - COVERAGE TERRITORY
SECTION IV, BUSINESS AUTO CONDITIONS,
PARAGRAPH B. GENERAL CONDITIONS, 7. -
POLICY PERIOD, COVERAGE TERRITORY -
is added to include the following:
(6) For short-term hired "autos", the coverage
territory with respect to Liability Coverage is
anywhere in the world provided that if the
"insured's" responsibility to pay damages for
"bodily injury" or "property damage" is
determined in a "suit," the "suit" is brought in
the United States of America, the territories
and possessions of the United States of
America, Puerto Rico or Canada or in a
settlement we agree to.
16. WAIVER OF SUBROGATION
Paragraph 5. TRANSFER OF RIGHTS OF
RECOVERY AGAINST OTHERS TO US - of
SECTION IV - BUSINESS AUTO CONDITIONS
A. Loss Conditions is amended by adding the
following:
We waive any right of recovery we may have
against any person or organization with whom
you have a written contract that requires such
waiver because of payments we make for
damages under this Coverage Form.
17. RESULTANT MENTAL ANGUISH COVERAGE
The definition of "bodily injury" in SECTION VDEFINITIONS, C. is replaced by the following:
"Bodily injury" means bodily injury, sickness or
disease sustained by any person, including
mental anguish or death resulting from any of
these.
18. EXTENDED CANCELLATION CONDITION
Paragraph 2. of the COMMON POLICY
CONDITIONS - CANCELLATION - applies
except as follows:
If we cancel for any reason other than
nonpayment of premium, we will mail or deliver
to the first Named Insured written notice of
cancellation at least 60 days before the effective
date of cancellation.
Form HA 99 16 12 21 Page 5 of 5
19. HYBRID, ELECTRIC, OR NATURAL GAS
VEHICLE PAYMENT COVERAGE
In the event of a total loss to a "non-hybrid" auto
for which Comprehensive, Specified Causes of
Loss, or Collision coverages are provided under
this Coverage Form, then such Physical
Damage Coverages are amended as follows:
a. If the auto is replaced with a "hybrid" auto or
an auto powered solely by electricity or
natural gas, we will pay an additional 10%,
to a maximum of $2,500, of the "non-hybrid"
auto’s actual cash value or replacement
cost, whichever is less,
b. The auto must be replaced and a copy of a
bill of sale or new lease agreement received
by us within 60 calendar days of the date of
"loss,"
c. Regardless of the number of autos deemed
a total loss, the most we will pay under this
Hybrid, Electric, or Natural Gas Vehicle
Payment Coverage provision for any one
"loss" is $10,000.
For the purposes of the coverage provision,
a. A "non-hybrid" auto is defined as an auto
that uses only an internal combustion engine
to move the auto but does not include autos
powered solely by electricity or natural gas.
b. A "hybrid" auto is defined as an auto with an
internal combustion engine and one or more
electric motors; and that uses the internal
combustion engine and one or more electric
motors to move the auto, or the internal
combustion engine to charge one or more
electric motors, which move the auto.
20. VEHICLE WRAP COVERAGE
In the event of a total loss to an "auto" for which
Comprehensive, Specified Causes of Loss, or
Collision coverages are provided under this
Coverage Form, then such Physical Damage
Coverages are amended to add the following:
In addition to the actual cash value of the "auto",
we will pay up to $1,000 for vinyl vehicle wraps
which are displayed on the covered "auto" at the
time of total loss. Regardless of the number of
autos deemed a total loss, the most we will pay
under this Vehicle Wrap Coverage provision for
any one "loss" is $5,000. For purposes of this
coverage provision, signs or other graphics
painted or magnetically affixed to the vehicle are
not considered vehicle wraps.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF OUR RIGHT TO RECOVER FROM
OTHERS ENDORSEMENT - CALIFORNIA
Policy Number: Endorsement Number:
Effective Date: Effective hour is the same as stated on the Declarations of the policy.
Named Insured and Address:
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule.
The additional premium for this endorsement shall be
otherwise due on such remuneration.
% of the California workers’ compensation premium
SCHEDULE
Person or Organization Job Description
Countersigned by
Authorized Representative
Form WC 04 03 06 Printed in U.S.A.
IE.END.EPIC.012 (07/22) Includes copyrighted material of Insurance Services Offices, Inc. with its permission Page 1 of 2
IRONSHORE SPECIALTY INSURANCE COMPANY
175 Berkeley Street
Boston, MA 02116
Toll Free: (877) IRON411
Endorsement # 16
Policy Number: IEPICB5ZFB006 Effective Date of Endorsement: December 31, 2025 Insured Name: SNF Holding Company
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
SPECIFIED ADDITIONAL INSURED(S) PRIMARY AND NON-CONTRIBUTORY This endorsement modifies insurance provided under the following:
ENVIRONMENTAL PROTECTION INSURANCE COVERAGE PACKAGE (EPIC PAC) In consideration of the premium paid, the policy to which this Endorsement is attached is amended as follows:
SCHEDULE
Name of Additional Insured Person(s) Or Organization(s)
1. Blanket where required by written contact
A. SECTION II – WHO IS AN INSURED, Paragraph 4.e. is amended to specify the entity indicated in the Schedule above as:
e. Any person or organization, other than a third party carrier, you agree to include as an insured in a written contract, written agreement or permit, but only with respect to bodily injury, property damage, environmental damage, or personal and advertising injury caused, in whole or in part, by your operations, your work, equipment or premises leased or rented by you, or your products which are distributed or sold in the regular course of a vendor’s business, however:
(1) A vendor is not an insured as respects bodily injury, property damage, environmental damage or personal and advertising injury:
(a) For which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement except that which the vendor would have in the absence of the contract or agreement; (b) Arising out of any express warranty unauthorized by you; (c) Arising out of any physical or chemical change in the product made intentionally by the vendor; (d) Arising out of repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from you, and then repackaged in the original container;
(e) Arising out of any failure to make inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products;
(f) Arising out of demonstration, installation servicing or repair operations, except such operations performed at the vendor’s location in connection with the sale of the product; or