HomeMy WebLinkAboutAgreement_Water Service_6/9/2022_Airgas, IncAirgas,Inc.,
on behalf of its subsidiaries and
affiliates
Account Application
* Required
❑ Individual ❑ Partnership ra Corporation
• Name: Village of Tequesta
* Billing Address: 136 Bridge goad
* City: Tequesta *State: Fl- *Zip: 33469
* Phone #: (!1 ) 768 _ 0482 Fax #:(
* Mobile #: Other #: �)
* Shipping Name: Village or Tequesta
* Shipping Address: '136 Bridge Road
* City: Tequeste *State: FL * Zip: 33469
* Phone #: ( 561) 768 - 0482 Fax #:�)
' County, Parish, or Province: Palm Beach County
• Is Ship To Location w/in City Limits? Yes
Number of Locations (Non -administrative): 2
Web Address: w .teauesta.org DUNS #:
Parent Company Name: village of Tequesta
Parent Company DUNS #:
$ Credit Limit Requested:
Check One if Applicable: ❑ COD w/ Lease ❑ COD w/Rent
* Email Address: Imccorkle@tequesta.org
Purchasing Information
Purchasing Contact Name: Janet Mccorkle
Purchasing Contact Phone #:( 561 ) 768 0482
Purchasing Contact Email: imccorkle@tequesta.org
Is a Purchase Order Required? Product ❑ Rental/Lease c
If yes, when is the purchase order supplied:
At time of order ❑ At time of delivery ❑
Partnership: Partner/Officer Information
Name 1:
Jeremy Alien
Last 4 digits of SS# l:
Title 1:
village Manager
Address 1:
345 Teauesta Drive
City:
Tequesta
State: FL Zip: 33469
Name 2:
Last 4 digits of SS# 2:
Title 2:
Address 2:
City:
State: Zip:
Name 3:
Last 4 digits of SS# 3:
Title 3:
Address 3:
City:
State: Zip:
Trarta Rafaranrae IA1Il
Approved By:
S Amount:
Account #:
Salesman #:
Branch:
Territory:
Date approved:
Individual Information
Employer.
Length of Employment (# yrs):
Employer Phone #: ( ) - DOB:
Last 4 Digits of Social Security #:
Do you own your primary residence? D Yes ❑ No
Landlords Name:
Have you ever filed for bankruptcy'? ❑ Yes ❑ No
If yes, what type of bankruptcy? Date Filed:
Nearest Relative (not living with you):
Phone Number:
Corporation/Partnership: General Information
Buyer Name:
Buyer Phone # (_) - # Years in Business:
$ Credit Limit Requested:
Check One if Applicable: o COD w/ Lease ❑ COD w/Rent
Type of Business:
Annual Sales $: Number of employees:
Controller Name:
Controller Phone #: (�
Accounts Payable Contact Name:
Accounts Payable Contact Phone
Accounts Payable Email Address:
Has your company ever filed for bankrtptcy9 ❑ Yes ❑ No
If yes, what type of bankruptcy? Date Filed:
Sales Tax Information
** indicate either subject to or not subject to Sales Tax
* required unless subject to Sales Tax
*■ ❑ We are subject to payment of Sales Tax
•* rx We are tax-exempt (exemption certificate must be furnished and list items for
which you are exempt to receive exemption)
' Exemption Certificate #: 85-8015833079C-7
'Tax Contact Name:
'Tax Contact Phone #: ( )
' Tax Contact Email:
Bank Information (All)
Bank Reference Name: TD Bank
Bank Account #:
Phone #: ( 561 ) 838 - 2245
Fax #:(_) -
Name: Advantage Bundling
phi # ( ) - 866-286-3546
Fax #(
( )
Acct. r-:
Address: 2228 Page Road, St 103
City: Durham, NC 27703
State:
Zip:
Name: Nozzle Nolen
Phone # ) - 561-746-3928
Fax #( -
Acct #:
Address: 341 Old Dixie Hwy
City: Tequesta, FL 33469
State:
Zip:
Name: Publix Super Market, Inc.
Phone # - 877-333-7585
Fax #(
Acet #:
Address: P.O. Box 32009
1 City: Lakeland, FL 33802
State:
zip:
Airgas, Inc., on behalf of its subsidiaries and affiliates
Terms of Sale
Terms of Sale refers to the terms and conditions contained herein and on Seller's website at www.aireas.com. "Seller" refers to Airgas, inc., on behalf of its
subsidiaries and affiliates. "Buyer" refers to the applicant in the account application to which these Terms of Sale are affixed. Each sale of Goods or services by an
Airgas company shall be governed by the Terms of Sale. Each contract for the sale of Goods or services between Seller and Buyer ("Contract") shall include the
Terms of Sale, together with any other terms describing the Goods or services being sold, their price, delivery terms, and all other special provisions. "Goods" refers to
any items of tangible personal property described in any Contract, or otherwise provided by Seller to Buyer.
1. Deliverv. Seller may deliver the Goods or ship the Goads by a carrier of Seller's selection, F.O.B. shipping point to the Buyers address in the Contract, unless the
Contract provides otherwise. Delivery date(s) are determined from the date of each Contract and are estimates of approximate dates of delivery, not a guarantee of a
particular day of delivery.
2. Buyer's Delay of Acceptance. 1f Buyer delays acceptance of the Goods when delivered or ready for shipment, Buyer shall forthwith pay to Seller the full
price of the Goods and shall also pay Seller such warehousing and pier charges and other expenses as Seller may incur as a result of Buyers delay.
3. Terms of Payment. Unless otherwise specified in a Contract, Buyer shall make payment in full within 30 days after the date of Seller's invoice. A late payment
charge of 1.5% on the unpaid, past due balance, will be assessed monthly (minimum two dollars ($2.00), or the maximum lawful rate allowable in the state
where the Goods are delivered, whichever is less. If a Contract provides for payment other than cash immediately or cash on delivery (COD), Buyer represents
that the goods are being purchased for business, commercial or agricultural purposes and not for personal, household, or family use. Buyer
represents and warrants that Buyer is and shall remain solvent until Seller receives payment in full for the goods. Buyer shall be in default
hereunder and Seller may cancel any Contract without liability to Buyer upon Buyer's failure to make payment as required herein or upon Buyer's
failure to comply with any of the terms and conditions contained herein or upon the institution of any voluntary or involuntary bankruptcy,
insolvency, receivership or debtor relief processing by or against Buyer or upon Buyer's making of an assignment for the benefit of creditors. If
Seller employs any collection agency or attorney to collect any amount due Seller, and/or to repossess any goods, Buyer shall pay all collection fees, attomeys'
fees, and court costs, in addition to the amount otherwise unpaid. Seller may bring suit for the collection of any such amount in any jurisdiction or venue
Seller may select.
4. Taxes. Any taxes imposed by federal, state, or other governmental authority on the sale or use of Goods or the sale or performance of services by an Airgas
company shall be paid by Buyer in addition to the purchase price.
5. Title to Equipment. Title to all rental equipment shall remain in Seller's name. Buyer shall not cover, modify, remove or otherwise disturb any
identification or other indicia of Seller's ownership on any rental equipment.
6. Security for Goods. Until Buyer pays Seller in full for any Goods purchased, title to the Goods shall remain in Seller's name and Seller shall have a purchase
money security interest in the Goods. If Buyer shall default in any payments, Seller shall have all the rights as holder of such title or as such secured party under the
Uniform Commercial Code and/or any other law then in force; and Seller may, in addition, retain as rental any payments received by Seller on account of the purchase
price of the Goods, whether Buyer's default shall have occurred before or after delivery. If Seller repossesses the Goods, Seller may resell the Goods after 10 days'
prior written notice to Buyer. Seller may file one or more financing statements to perfect such security interests. If necessary, Buyer shall execute such financing
statements upon the request of Seller.
7. Warranty. All products, other items of sale, cylinders and other containers furnished by an Airgas company shall conform to the description thereof published by the
manufacturer at the time of sale and will meet Seller's purity specifications for all gas products. SELLER SPECIFICALLY DISCLAIMS ANY OTHER EXPRESS OR
IMPLIED STANDARDS, GUARANTEES, OR WARRANTIES, INCLUDING ANY WARRANTIES OF MERCHANTABILITY, FITNESS FOR A
PARTICULAR PURPOSE OR NON4NFRINGEMENT AND ANY WARRANTIES THAT MAY BE ALLEGED TO ARISE AS A RESULT OF CUSTOM OR
USAGE.
8. Limitation oj' Liability. SELLER SHALL BE LIABLE ONLY FOR THE REPAIR OR REPLACEMENT OF DEFECTIVE GAS CYLINDERS AND
PRODUCTS, INCLUDING THE REPLACEMENT OF GASES THAT DO NOT MEET ITS PURITY SPECIFICATIONS WITH GASES THAT DO MEET
SUCH SPECIFICATIONS. BUYER KNOWINGLY AND FULLY ASSUMES THE RISKS OF TRANSPORTING AND USING COMPRESSED GASES.
SELLER SHALL NOT BE LIABLE FOR ANY DIRECT (EXCEPT AS EXPRESSLY PROVIDED HEREM INDIRECT, SPECIAL, INCIDENTAL,
CONSEQUENTIAL AND/OR PUNITIVE DAMAGES, ARISING OR ALLEGED TO ARISE OUT OF OR IN CONNECTION WITH ITS PERFORMANCE OF
ANY OBLIGATIONS OR ANY PRODUCT, OTHER ITEMS OF SALE, OR EQUIPMENT SOLD OR LEASED BY SELLER, WHETHER SUCH DAMAGE
RESULTS FROM ANY NEGLIGENT ACT OR OMISSION OR IS RELATED TO STRICT LIABILITY, OR OTHERWISE.
9. Period of Limitation of Action. No action shall be brought by Buyer for any breach of Contract or otherwise in connection with any Goods or services provided or to be
provided by Seller more than one year after the cause of action therefore accrues.
10. Force Majeure. Service and deliveries by Seller are subject to and contingent upon floods, strike or other labor disturbances, fire, accidents, war, delays of carriers,
inability to obtain raw materials, failures of normal sources of supply, restraints of government (whether or not it later proves to be invalid), or any other similar or dissimilar
cause beyond Seller's reasonable control. Seller shall advise Buyer in writing of the reason for and anticipated length of any such delay. If any such cause affects only a part
of Seller's capacity to perform, Seller will allocate production and deliveries among its customers in a fair and reasonable manner.
11. Amendments; Entire Agreement; No Variations Permitted. The Terms of Sale and any Contract executed by Buyer and Seller represent the entire agreement of Buyer
and Seller with respect to the sale or rental of Goods and services and supersede all prior agreements, promises, conditions, arrangements, communications, representations
and warranties, including, but not limited to, any purchase order, acceptance or other document of Buyer, even if the same is signed or acted upon by Seller. The Terms of
Sale and any Contract may be agreed to, amended or supplemented only in a writing executed by authorized representatives of Buyer and Seller. No person other than an
authorized representative of Seller has any authority to agree on Seller's behalf to any terms of sale not set forth herein or in a Contract.
The undersigned Buyer, to induce Airgas, Inc., on behalf of its subsidiaries and affiliates, to open an account for Buyer, and in consideration of each sale of Goods
which Seller hereafter makes to Buyer, hereby agrees as follows: (1) All such sales shall be governed by the Airgas Terms of Sale; (2) Buyer has examined and
understands such Terms of Sale; (3) Seller shall have the right to make such investigation of Buyer as Seller may deem appropriate in its discretion, which
shall include, without limitation, checking credit, business and personal references; and (4) Seller shall have no obligation to extend credit to Buyer, and Seller
may, in its discretion, terminate, at any time, any credit theretofore extended by Seller to Buyer.
Buyer Signature:
Jeremy Allen Wte: 022.01S1ned by Jeremy Allen
Date: 2022.0425 14:ST.35
-04'W Date:
Buyer Name (Print
• Jeremy Allen
Buyer Title: Village Manager
Witness Name:
l.L
Witness Title: Eve [ ,/j /r
As-y4,
Notice: The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national
origin, sex, marital status, age (provided the applicant has the capacity to enter into a binding contract): because all or part of th a applicants income derives from
any public assistance program; or because the applicant has, in good faith, exercised any right under the Consumer Credit Protection Act. The federal agency that
administers compliance with the law concerning this credit is the Federal Trade Commission, Division of Credit Practices, 6e and Pennsylvania Avenue, NW,
Washington, DC 20580.
PUBLIC RECORDS. In accordance with Sec. 119.0701, Florida Statutes, CONTRACTOR must keep
and maintain this Agreement and any other records associated therewith and that are associated
with the performance of the work described in the Proposal or Bid. Upon request from the
Village's custodian of public records, CONTRACTOR must provide the Village with copies of
requested records, or allow such records to be inspected or copied, within a reasonable time in
accordance with access and cost requirements of Chapter 119, Florida Statutes. A CONTRACTOR
who fails to provide the public records to the Village, or fails to make them available for
inspection or copying, within a reasonable time may be subject to attorney's fees and costs
pursuant to Sec. 119.0701, Florida Statutes, and other penalties under Sec. 119.10, Florida
Statutes. Further, CONTRACTOR shall ensure that any exempt or confidential records associated
with this Agreement or associated with the performance of the work described in the Proposal
or Bid are not disclosed except as authorized by law for the duration of the Agreement term, and
following completion of the Agreement if the CONTRACTOR does not transfer the records to the
Village. Finally, upon completion of the Agreement, CONTRACTOR shall transfer, at no cost to
the Village, all public records in possession of the CONTRACTOR, or keep and maintain public
records required by the Village. If the CONTRACTOR transfers all public records to the Village
upon completion of the Agreement, the CONTRACTOR shall destroy any duplicate public records
that are exempt or confidential and exempt from public records disclosure requirements. If the
CONTRACTOR keeps and maintains public records upon completion of the Agreement, the
CONTRACTOR shall meet all applicable requirements for retaining public records. Records that
are stored electronically must be provided to the VILLAGE, upon request from the Village's
custodian of public records, in a format that is compatible with the Village's information
technology systems.
IF CONTRACTOR HAS QUESTIONS REGARDING THE APPLICATION OF CHAPTER
119, FLORIDA STATUTES, TO CONTRACTOR'S DUTY TO PROVIDE PUBLIC RECORDS
RELATING TO THIS AGREEMENT, PLEASE CONTACT THE VILLAGE CLERK, RECORDS
CUSTODIAN FOR THE VILLAGE, AT (561) 768-0440, OR AT
Imcwilliams@teguesta.org, OR AT 345 TEQUESTA DRIVE, TEQUESTA, FLORIDA
33469.
Pursuant to Article XII of the Palm Beach County Charter, the Office of the Inspector General has
jurisdiction to investigate municipal matters, review and audit municipal contracts and other
transactions, and make reports and recommendations to municipal governing bodies based on
such audits, reviews, or investigations. All parties doing business with the Village shall fully
cooperate with the inspector general in the exercise of the inspector general's functions,
authority, and power. The inspector general has the power to take sworn statements, require
the production of records, and to audit, monitor, investigate and inspect the activities of the
Village, as well as contractors and lobbyists of the Village in order to detect, deter, prevent, and
eradicate fraud, waste, mismanagement, misconduct, and abuses.
"The Village of Tequesta strives to be an inclusive environment. As such, it is the Village's policy
to comply with the requirements of Title II of the American with Disabilities Act of 1990 ("ADA")
by ensuring that the Contractor's [ agreement /bid documents and specifications ) are accessible
to individuals with disabilities. To comply with the ADA, the Contractor shall provide a written
statement indicating that all [ agreement /bid documents and specifications), from Contractor,
including files, images, graphics, text, audio, video, and multimedia, shall be provided in a format
that ultimately conforms to the Level AA Success Criteria and Conformance Requirements of the
Web Content Accessibility Guidelines 2.0 (Dec. 11, 2008) ("WCAG 2.0 Level AA"), published by
the World Wide Web Consortium ("WK"), Web Accessibility Initiative ("WAI"), available at
www.w3.org/TR/WCAG/."