HomeMy WebLinkAboutSafety Department (BPW Approved 2/14/24) City of Jeffersonville
Government Contract Coversheet
Please note: All information MUST be completely filled out and submitted to Clerk's Office
within 48 hrs of execution.
Date Submitted to Clerk: ZI ZI I2.`1
Department: -y
Vendor Name: Wall 6113
Sign Date: 2! Zo/v.(
Ending Date: +af 3( 12�
Amount of Original Contract: O it 1S 3s
Is this an amendment or change order
to original contract? Yes or NO
Amended Contract Amount:
Purpose: Nib 4MSDS Pfalic,iwti
For Clerk's Office to fill out
Date uploaded to Gateway:
DocuSign Envelope ID:AB4E482E-6290-41F7-B68A-99E1A56CCF67
m r C`
V' cityE CUSTOMER ORDER FORM
222 Merchandise Mart Plaza,Suite 1750 Contract Number, Q-155210
Chicago,IL 60654 Issued Date: 9/6/2022
Ph:312.881.2000 Issued By: Bernard Siliezar
Fax:866.320. 021 Offor Valid Through: 11/1/2022
Tax ID*.04-3826478 g
Customer Information
Customer: City of Jeffersonville Attn: Brian Smith
D-U-N-S®Number: 071320964 Address: 500 Quartermaster Ct Ste
300,Jeffersonville,IN United
States
Terms &Conditions _.
Related Contract: Payment Terms: Net 30
Contract Start Date: 1/1/2023 Billing Frequency: Annual
Contract End Date: 12/31/2025 Annual Price Adjustment: 3.00%
Initial Term: 36 Months
` _' ,,,y, *!.4 rrpfions t4 Servrce-
( Itern` I Type Q;y r ) _ soy to` , .:0120•to
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.-' .. ._ - =1��3 z ,12/_311202.4, r:;4?J31/2o25 `>�
Chemical Management Annual 1
HQ _ _ Annual 1 _ _�.
__� �-I $2,521.44 I $2,597.09 ' $2,675.00
Included Site Administrator - - �- 1 Annual 1 I'- -._
— --- _
I
1 Additional Site Administrators ? Annual 4 j I $309.00 $318,27 T $327,82 j
Fax Sack Service-Domestic I Annual 1 I Included Inctuded� included
7, _.._Tptal $2,830 44 $2 91535 $3 002 8 '.
This Custorre;Order Form,ixluding ell Exhibits,and ire Services provided hereunder are governed by the terms and conditions et the VeloctyEHS Master Subscription and Services Agreement,as posted en-L
ss:ttnww.el Nip which Is hereby incorporated into this Customer Order Form(the'Agreement").By ageing hakfe,Customer agreos to be bound by such terms and conditions as of the date of signing,
1
VltetedtyEHS may deem Oita Customer OrderFe null and void if the executed agreement la not received by b'elocityOHS by the'OfferVafId Through'date listed above,or if the document is rationed with
nendwriden changes
cubigned
City of Jeffersonvi e / /l VelocityEHS� _1 I �¢
\ / U,c.A.t.t,
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------
Signature: kJ V 85CD60D0Al2E46E .
-�1,rU--- � v;!'1�--� Signature:
Name: \ \''��1L MOO�A- Name: rill chael Bruffey
Title: ci.h i ( Title:
Date: a,- 114-'dt" Date: 2/20/2024
Contract#:a-1652(0 0 2001-2022 VeiorityEHS.Aiirightsreserved_vatocityEHS®,MsnSaniine-,Hurnanlecht.and Cher*an are proprietary trademarks of Ve;acily®NS. Page I of 2
DocuSign Envelope ID:AB4E482E-6290-41F7-B68A-99E1A56CCF67
1eIoCItyLH! ° CUSTOMER ORDER FORM
Exhibit A
HQ:(M)SDS Management Sass subscription pricing Includes:
• One annual HQ subscrlpfon(s)for the Customer and up to 200 employees.
• Two Account Administrators.Addttbr.e Administrators may be purchased for en adeitional annue'fee per license.
• Unlimited MSDS database searches,views and eacltions to the eSInder.
• Access to sEnder end MSDSonllne database eearoh from the SOS/Chemical Management mobito eppiloetion.
• Access to the MSP6onlIno Desktop Application,which allows edmin strafor(s)to print SDSe,and dvwnioad en electronic backup of their SDSs end basic
Information.
• Animal allotment of S0 MSDS Requests and 100 MSD$Uploads.Additional MSDS Requests may be purchased In bur des of fitly(60)for$200;additional MSDS
Uploads may be purchased In bundles of(100)for$200.
a Technical&Customer Support.
• Additional Terms and Conditions apply,To learn more,click la.
Additional Site Administrators pricing includes:
• Annual subscription for 4 Additional Adndnietator(a),
• Additional Administrators may be purchased for an additional an nun'fee nor license,
• Impiemsntafon Services end Technical 8 Customer Support
Fax-Back Service—Domestic:This 24(7 Service provides ail Customer employees Included within tho Coverage of this agreement access to a toll-free telephone number In
order to request en SDS to he supplied eta facsimile,receive chemical exposure support,or medical Information.
• Customer Is allowed up to 1 fax events on an annual basis.
• Chemical exoceura support or medics)Information calls will be counted as five(6)fax events.
• Initial purchase Includes allotment of ten(10)6.6 x 11 Posters and tidy(60)1-800-Number Stickers to communlcute the program.
• Additional fax events may be purchased In bundles of ten(10)fcr$200.00.
a Additional matedets are available upon request at$2,60 per Poster end$0.10 per Sticker(minimum$26.00 order).
• DISCLAIMER-THE FAX-BACK SERVICE CONSISTS OF CUSTOMER RECEIVING REQUESTED COPIES OF SDS DOCUMENTS VIA FAX.CUSTOMER
ACKNOWLEDGES THAT THE FAX-BACK SERVICE IS PROViDED THROUGH THIRD PARTY CONTRACTORS RETAINED BY VELOCRYEHS AND THAT
SUCH CONTRACTORS MAY PROVIDE OR OFFER TO PROVIDE ADDITIONAL SERVICES,ADVICE,REPORTS OR RECOMMENDATIONS TO CUSTOMER,
INCLUDING BUT NOT LIMITED TO MEDICAL,HEALTH CARE OR EMERGENCY INFORMATION ABOUT OR PERTAINING TO EXPOSURE TO OR
TRF-ATNENT FOR EXPOSURE TO CHEMICALS,THAT ARE NOT PART OF THE FAX-BACK SERVICE COTHER SERVICES OR ADVICE').IN NO EVENT
SHALL VELocfryEF1S BE LIABLE TO CUSTOMER OR TC ANY THIRD PARTY FOR ANY LOSS,DAMAGE,OR EXPENSE RELATING TO SUCH OTHER
SERVICES OR ADVICE OR CUSTOMER'S RSUANCETHEREON,AND CUSTOMER AGREES TO HOLD VE:OCITYEHS HARMLESS FROM SAME.
All lees are In.USD and,unless otherwise noted,are due en the Contract Start Date,as noted on pane one(1)of this agreement. The Contract End Date reflects the subscription
^anniversary date';subsequent year's fees will be Invoiced between 46 and 80 days before each anniversary date,with payments due prior to each anniversary dale,Sales tax
associated to this Order vAll appear on the Invoice,where appleable.
Colored 0:Q-186210 0 2001-2022 VeJoel(yEHS,At righle reserved.VelocityEHSC,MS!JSonfne®d,Hurnenteeh4,and Chemtote are proprietary trademarks of VetocifyEllS, Pane 2 of 2