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BCRUA-2025-023 - 6/25/2025 RESOLUTION NO. BCRUA-2025-023 WHEREAS, the Brushy Creek Regional Utility Authority, Inc. ("BCRUA") has duly advertised for bids to purchase water treatment chemicals and for related goods and services; and WHEREAS, Polydyne, Inc. has submitted the lowest responsible bid for Aqua Hawk 9937 (Tote), herein "Water Treatment Chemicals"; and WHEREAS, the BCRUA wishes to accept the bid of Polydyne, Inc. for Water Treatment Chemicals, Now Therefore BE IT RESOLVED BY THE BOARD OF DIRECTORS OF THE BRUSHY CREEK REGIONAL UTILITY AUTHORITY: That the Board President is hereby authorized and directed to execute on behalf of the BCRUA an Agreement Between the BCRUA and Polydyne, Inc. for the purchase of Water Treatment Chemicals, a copy of said Agreement being attached hereto as Exhibit"A" and incorporated herein. The Board of Directors hereby finds and declares that written notice of the date, hour, place and subject of the meeting at which this Resolution was adopted was posted and that such meeting was open to the public as required by law at all times during which this Resolution and the subject matter hereof were discussed, considered and formally acted upon, all as required by the Open Meetings Act, Chapter 551, Texas Government Code, as amended. RESOLVED this 25th day of June, 2025. NA'COLE THOMPSO , President Brushy Creek Regional Utility Authority ATTEST: RE FLORES, S 0330.4634-A:4906-2948-4878 EXHIBIT A a | Brushy Creek Regional Utility Authority A Partnership of Cedar Park, Leander and Round Rock IFB # 04-29-225-BC-370 Subj ect: Water Treatment Chemicals Due: May 16, 2025 at 2:00 PM Central Submit Bids to: Brushy Creek Regional Utility Authority c/o City of Cedar Park Purchasing Department 450 Cypress Creek Road, Bldg. 2 Cedar Park, Texas 78613 450 Cypress Creek Rd. Bldg. 1 * Cedar Park, Texas 78613 * www.cedarparktexas.gov * (512) 401-5000 « Fax: (512) 258-6083 -1- EXHIBIT A BCRUA 450 Cypress Creek Rd. Bldg. 1 Cedar Park Texas 78613 Table of Contents 1. BIDDER’S CHECKLIST oo... ccccccccccsesssesescssecscecsescsssessscscessescscssscssscscanscavssscecscevavavevaavanaeeseress 3 2. STANDARD TERMS AND CONDITIONS. .......ccccccccccssscsssscscscscscescssssscescscscscscsevsvsvacaeeavsnavanseeeeees 4 3. SPECTAL CONDITIONS wo. ccccccccsesesessseseccsesesesevsescseescscscscssvscsusseseesscscasscssevacaeuaveacseasacaeaneaes 9 3.1 TMSUY ANCE 0... cee eseenecesescseseecesesesseeacscsenessesessesesseseusssecsesassassesscassusecscsssesesvessasacnavavaetatacuasas 9 3.2 Damage Provision .........0ccc cc ccsesescseescsetsesesssssesscsesecsessesesseeceessessesscssessesavsusevacecseevateceevaces 10 3.3 Bid Terms ..........cccccccccccsecsceeresseneesseeseeseesescssssssessesessesscssesesesscsesecsuessusessuessaneevaeavaceetareetevaters 10 4, SPECTFICATIONS 0... ccccccccccccesesesseseessesssnenessssssuesesesevssevasavsvssevevsveusvsvsvsvevssesesusesesesteesueererevees 12 5S. BID ccccccccccccccsscsssssssscsecsesesesseenscseeessesessesesessesesesasesecseseseusessassssaseceusausesauacesvaceasaceutaracatatescarsecas 15 6. DEMONSTRATION OF EXPERIENCE ......ccccccccccccscscssscsscsescscscscsesessscscscarscscessvevsesseseteveveeserens 18 7. LIST OF MACHINERY AND EQUIPMENT .......ccccscscccscscsessscssessescsesescssssesecscsersecucscaceveceresees 20 8. VENDOR PROFILE oo.cccccccccccceesssssesssesessesnscsesssesesacsesesscscsesesevscscsesevesssarsuseseessavavaseaecstaraceeeeens 21 9, BID RESPONSE FORM 0... ccccccsessesssssssssssesesssesesssescsesessecsesesescscscsessscssscacacecsvavacevavarevevenenarsereas 22 10. REFERENCES 000... ccccccccsssssesssssessessesssnsnscsnecssessesvsesevavssasscesevscscscscecscscscscssscscscansesvavsesesrenseeetaes 23 11. DEVIATION OR COMPLIANCE FORM........cccccsccccsssesccscscssescssscsccsrsescasscscecnavsvscacacueeceresaceeeees 24 12, RELEASE AND INDEMNIFICATION uc cccccccccscssssscsesesssesessscsessscscscscscsuscssecscsesvsvevsnsvevanseeecers 25 13. NON-COLLUSION ACKNOWLDGEMENT .......cccccscccssssssescscscsescsessscsescsssssesssesecsseseatsasenanenanees 26 14. SUSPENSION OR DEBARMENT CERTIFICATE ..........cccccccccccccccscscssssscsecsesssseeseseseetscesereneees 26 15. COOPERATIVE PURCHASING Qu... ccccccccssesstsssssessesecscsesecscscsssesevsvecscsussesessavseacteesasacaceeeusaeesees 27 16. CONFLICT OF INTEREST AND QUESTIONAIRE ........ccccccccccscscscsssssesesssssstsesssseseeeeseeteeees 28 17. DISCLOSURE OF INTERESTED PARTIES ......ccccccccccsccsescsesesessescssscscsesscssssssececesesesvesseeaeeees 29 18. W-9 FORM oo .ccccccccccccccccseesscsesseesenenessesesssenesssacsssesesessesesesessenssevecessessesssvsuecscesescevasaceaeaeeverenacatenes 30 450 Cypress Creek Rd. Bldg. 1 * Cedar Park, Texas 78613 * www.cedarparktexas.gov * (512) 401-5000 * Fax: (512) 258-6083 -2- N/A 1. BIDDER’S CHECKLIST [a Provided Pricing. [¥ Demonstration of Experience form filled in. CL] List of Machinery and Equipment form filled in, if applicable. J Vendor Profile form filled in. [x] Bid Response Form **IMPORTANT** Failure to sign and return this form may result in disqualification. Cl Provided Safety Data Sheets (SDS) for all chemicals bid. [x] References provided. [4 Deviation or Compliance form filled in. [x] Release and Indemnification form filled and signed. Non-Collusion Acknowledgement form filled and signed. [X] Suspension or Debarment Certificate filled and signed. [x] Cooperative Purchasing form filled and signed. [x] Access latest Conflict of Interest Questionnaire here. Please fill out and return with submission. If no conflicts exist, write N/A on the “Name of Officer” line. [x] Access latest W-9 form here. Please fill out, and return with your submission. Important Notes: Question deadline is May 2, 2025 at 5:00 PM. Any questions submitted after this time will not be answered. Questions should be submitted in writing via email to Andy Portillo at andy.portillo@cedarparktexas.gov. Submissions will be submitted electronically on BidNet Direct: https://www.bidnetdirect.com/texas/Authority-of-cedar-park Persons signing subsequent sections of the Bid shall have the authority to sign the Bid on Bidder’s behalf and shall be an officer or person authorized to bind the entity they represent to this Bid. Award of Contract(s) will be made based on Best Value as permitted by Section 252.043 of Texas Local Government Code. 450 Cypress Creek Rd. Bldg. 1 * Cedar Park, Texas 78613 * www.cedarparktexas.gov ¢ (512) 401-5000 ¢ Fax: (512) 258-6083 -3- This is an Invitation for Bid Date Issued: April 16, 2025 Subject: Water Treatment Chemicals IFB. No.: 04-29-225-BC-370 Due Date: Time Due: Tentative Award Date: May 16, 2025 2:00 PM Central June 2025 2.1 2.2 2.3 2.4 2.5 2. STANDARD TERMS AND CONDITIONS General Description of Work - The Brushy Creek Regional Utility Authority ("BCRUA") is in need of water treatment chemicals for the Water Plant located at 1906 Hur Industrial, Cedar Park, TX 78613. The intent of this solicitation is to allow BCRUA to enter into a contract or multiple contracts for the procurement of the products specified in Section 5 of this IFB at a fixed price for a twelve (12) month period. This Invitation to Bid (“IFB”) shall be on file in the BCRUA Finance Department, from 8:00 a.m. until 5:00 p.m., Monday through Friday, and available to interested individuals and entities (“Bidders”) from the date issued until the due date and time. All general information questions should be directly emailed to Andy Portillo at andy.portillo@cedarparktexas.gov. Bidders are expected to examine all documents that make up this IFB. Bidders shall promptly notify the Authority of any omission, ambiguity, inconsistency, or error that they may discover upon examination of the IFB. The Authority assumes no responsibility for errors or misrepresentations that result from the use of incomplete Bids. READ THIS IFB FULLY AND CAREFULLY. BIDS SHALL BE COMPLETE UPON SUBMISSION, INCLUDING ALL FORMS AND ATTACHMENTS REQUIRED HEREIN. FAILURE TO STRICTLY COMPLY WITH THESE STATED TERMS OF SUBMISSION MAY RESULT IN REJECTION OF THE BID. All responses to this IFB shall be submitted on the attached response forms. Bids must be received at BCRUA Finance Department at or before 2:00 PM Central on May 16, 2025. Each Bid must be properly identified with the subject title and date and time due. Bidders shall electronically submit through the Texas BidNetDirect website. PHYSICAL BIDS, FAXED BIDS, AND E-MAILED BIDS AND/OR LATE SUBMISSIONS 2.6 2.7 WILL NOT BE ACCEPTED. All Bids shall be addressed as shown below: Invitation to Bid: Water Treatment Chemicals Reference Number: 04-29-225-BC-370 Due Date and Time: May 16, 2025 at 2:00 PM Central During the pendency of this IFB, Bidder shall not contact any Authority staff except those designated herein this IFB or subsequent addendums or correspondence. Any questions or concerns should be addressed in writing to Andy Portillo at andy.portillo@cedarparktexas.gov at 450 Cypress Creek Rd. Bldg. 1 « Cedar Park, Texas 78613 * www.cedarparktexas.gov * (512) 401-5000 * Fax: (512) 258-6083 -4- 2.8 2.9 2.10 2.11 2.12 2.13 2.14 2.15 2.16 least 14 days prior to the due date of May 16, 2025. Please reference the above-designated IFB number and the line number being referenced. Non-compliance with this provision may result in rejection of the Bid. No phone calls related to IFB will be accepted. Any material information provided one Bidder concerning this IFB shall be provided to all Bidders via the Texas BidNet Direct website. An addendum will be issued if necessary. Bidders that have not registered with Texas BidNet Direct will be responsible for checking for new information or addendums on the website. All information required of the Bidder, unless otherwise specified, must be completed on the forms provided by the Authority. Failure to sign the Bid Response Form will disqualify Bidder. Persons signing the Bid shall have the authority to sign the Bid on Bidder’s behalf and shall be an officer or person authorized to bind the entity they represent to this Bid. Each and every deviation from the terms, conditions, specifications, or performance requirements of this IFB shall be listed on the Deviation Form upon submission of your Bid. Listing of deviations is an integral and required part of your Bid. Any deviations not listed on the Deviation Form upon submission of your Bid will not become part of the contract awarded by the Authority pursuant to this IFB. Bids will be opened on May 16, 2025 at 2:00 PM Central at the BCRUA Finance Department. Bids cannot be altered or amended after the deadline. Alterations made before opening must be signed by the Bidder or Bidder’s agent. No Bid may be withdrawn after the date and time of opening without approval of the Purchasing Manager. The Authority, in its sole discretion, may negotiate changes to any submitted Bid, including price, after submitted Bids have been opened. The Authority reserves the right to accept and/or reject any and all submitted Bids or any part thereof, waive immaterial errors, and award the contract in the best interest of the Authority. The Authority shall be sole interpreter of the terms, conditions, specifications, and performance requirements of this IFB. In case of a discrepancy between the unit price and the extended total for an item, the figure that is most advantageous to the Authority will apply. An opened Bid may not be changed to correct any error by the Bidder or Bidder’s agent. It is not the policy of the Authority to award a contract on the basis of price alone. The Authority reserves the right to award the contract to the lowest responsible Bidder who provides the specified goods and services at the best value to the Authority. To determine best value to the Authority, the Authority may, in accordance with Texas Local Government Code Section 252.043, consider: the purchase price; reputation of the Bidder and of the Bidder’s goods and services; the quality of the Bidder’s goods or services; the extent to which the goods or services meet the Authority’s needs; the Bidder’s past relationship with the Authority; the impact on the ability of the Authority to comply with laws and rules relating to contracting with historically underutilized businesses and nonprofit organizations employing persons with disabilities; the total long-term cost to the Authority; and any other relevant criteria specifically listed, herein. 450 Cypress Creek Rd. Bldg. 1 + Cedar Park, Texas 78613 * www.cedarparktexas.gov * (512) 401-5000 * Fax: (512) 258-6083 -5- 2.17 If, at any time, the successful Bidder fails to fulfill or abide by the terms, conditions, specifications, or performance requirements of this IFB, or any contract awarded and entered pursuant thereto, the Authority reserves the right to: 2.17.1 Purchase Water Treatment Chemicals services on the open market and charge Bidder the difference between its contract price and new contractor’s price; 2.17.2. Deduct charges from the successful Bidder the difference between its contract price and new contractor’s price; 2.17.3 Terminate any awarded contract without penalty on the Authority, by furnishing written notice of termination to Bidder, and select another Bidder and award a contract to its Bidder pursuant to the terms thereof. 2.18 At the Authority’s sole discretion and convenience, the Authority may terminate any awarded contract without regard to cause without penalty, and pay for the authorized services provided to the date of termination. 2.19 Ifit is determined that any benefit to secure favorable treatment was offered, elicited, or provided by Bidder or Bidder’s employee, affiliate, representative, partner, subcontractor, or agent, to any officer or employee of the Authority, Bidder will be disqualified from consideration and/or the awarded contract will be terminated. 2.20 All goods, raw materials, and products provided pursuant to the awarded contract must be new and not used, shop worn, or reconditioned. 2.21 All work must be in compliance with and conform to any and all applicable state or local laws, ordinances, regulations, codes, rules, policies, and interpretations thereof. 2.22 Once a Bid has been selected, items or processes may be substituted only by furnishing an equal or superior quality and/or grade product or process than originally specified at no additional cost to the Authority. Any such substitution shall be pre-approved by the Authority, and the acceptance of any such substitution shall be in the Authority’s sole discretion. 2.23. Any contract awarded pursuant to this IFB is only assignable, upon written consent of both parties, which consent shall not be unreasonably withheld. 2.24 The Authority is tax exempt under Tax Code, Subtitle E. SALES, EXCISE, AND USE TAXES, CHAPTER 151, section 151.309, as amended. 2.25 Invoices for partial payment must be approved in advance by the Purchasing Manager. 2.26 Bidder shall include a Safety Data Sheet (SDS). 2.27 Undisputed payments will be submitted to Bidder within thirty (30) days from receipt of original invoice. 2.28 Any contract awarded pursuant to this IFB shall be governed by the Uniform Commercial Code, if applicable. Wherever the “Uniform Commercial Code” is used, it shall be construed as meaning the Uniform Commercial Code as adopted in the State of Texas effective and in force on the date of any such agreement between the Authority and Bidder. 450 Cypress Creek Rd. Bldg. 1 + Cedar Park, Texas 78613 * www.cedarparktexas.gov * (512) 401-5000 * Fax: (512) 258-6083 -6- 2.29 2.30 2.31 2.32 2.33 2.34 Trade secrets and confidential information contained in a Bid are subject to the Texas Public Information Act. Pricing is not confidential information. Bidders who include information in a Bid that is legally protected as a trade secret or confidential information must clearly indicate the specific protected information by highlighting that information and marking it “Trade Secret” or “Confidential” at the appropriate place. The Authority will not be responsible for any public disclosure of the trade secret or confidential information if it is not marked as provided above. An awarded Bid in its entirety is not confidential. If a request is made under the Texas Public Information Act to inspect information designated as trade secret or confidential in a Bid, Bidder shall, upon notification by the Authority, immediately furnish sufficient written reasoning as to why the information should be protected from disclosure in a timely manner to the Texas Attorney General for final determination at the address below: Office of the Attorney General Open Records Division P.O. Box 12548 Austin, TX 78711 Fax 512-463-2092 The obligations of the parties under a contract awarded through this IFB are primarily performable in Williamson County, Texas. Exclusive venue shall be Williamson County, Texas, and any contract awarded under this IFB shall be governed by the laws of the State of Texas. The Authority may, at its option, offset any amounts due and payable under a contract awarded under this IFB against any debt (including taxes) lawfully due to the Authority from the successful Bidder, regardless of whether the amount due arises pursuant to the terms of the contract or otherwise, and regardless of whether or not the debt due to the Authority has been reduced to judgment by a court. No member of the Authority Board or any Authority employee shall have any financial interests in the profits of any contract, service or other work performed by the Bidder(s) or personally profit directly or indirectly from any contract, purchase, sale or service between the Authority and any person or company. TEXAS GOVERNMENT CODE/PROHIBITION OF BOYCOTT ISRAEL: Bidder verifies that it does not Boycott Israel and agrees that during the term of this Agreement will not Boycott Israel as that term is defined in Texas Government Code Section 808.001/2270.001, as amended. By signing a Bid, the Bidder certifies that it does not boycott Israel and will not boycott Israel during the term of this contract. TEXAS GOVERNMENT CODE/PROHIBITION OF BOYCOTT FIREARMS AND AMMUNITION INDUSTRIES: Senate Bill 19, Effective September 1, 2021, amended Subtitle F, Title 10 of the Texas Government Code to add Chapter 2274 which prohibits. a political subdivision of the State of Texas from entering into a contract with a company that discriminates against the firearms and ammunition industries. By signing below, Bidder certifies that it does not have a practice, policy, guidance, or directive that discriminates against a firearm entity or firearm trade association as defined by Chapter 2274 of the Texas Government Code, and will not so discriminate during the term of the contract. 450 Cypress Creek Rd. Bldg. 1 * Cedar Park, Texas 78613 * www.cedarparktexas.gov * (512) 401-5000 * Fax: (512) 258-6083 -7- 2.35 2.36 TEXAS GOVERNMENT CODE/PROHIBITION OF BOYCOTT ENERGY COMPANIES: Senate Bill 13, effective September 1, 2022, amended Subtitle F, Title 10 of the Texas Government Code to add Section 2274.002 which prohibits a political subdivision of the State of Texas from entering into a contract with a company that discriminates against energy companies. By signing a Bid, the Bidder certifies that it does not boycott energy companies and will not boycott energy companies during the term of this contract. The awarded contract is subject to the appropriation of funds by the Authority Board in the Authority’s budget adopted for any fiscal year for the specific purpose of making payments pursuant to the awarded contract for that fiscal year. The obligation of the Authority pursuant to the awarded contract in any fiscal year for which the awarded contract is in effect shall constitute a current expense of the Authority for that fiscal year only, and shall not constitute an indebtedness of the Authority of any monies other than those lawfully appropriated in any fiscal year. In the event of non-appropriation of funds in any fiscal year to make payments pursuant to the awarded contract, the awarded contract may be terminated. 450 Cypress Creek Rd. Bldg. 1 + Cedar Park, Texas 78613 * www.cedarparktexas.gov + (512) 401-5000 « Fax: (512) 258-6083 -8- 3. SPECIAL CONDITIONS 3.1 Insurance The successful Bidder shall procure and maintain in force during the terms of any contract awarded pursuant to this IFB, at its own cost, the following minimum insurance coverage: A. Workers’ Compensation and Employer’s Liability: a. State of Texas: $1,000,000 Each Accident b. Employer’s Liability: $100,000 Each Accident $500,000 Disease-Policy Limit $100,000 Disease-Each Employee c. Waiver of Subrogation B. Commercial General Liability: a. Bodily Injury and Property Damage General Aggregate Limit: $1,000,000 b. Personal and Advertising Injury Limit: $500,000 c. Each Occurrence Limit: $1,000,000 The policy shall be on an Occurrence Form and include the following coverage: Premises Operations; Personal and Advertising Injury; Medical Payments; Liability assumed under an Insured Contract; Independent Contractors; and Broad Form Property Damage. Coverage provided should be at least as broad as found in Insurance Services Office (ISO) form CG0001. C. Commercial Automobile Liability Limits: a. Bodily Injury and Property Damage General Aggregate Limit: $1,000,000 b. Medical Payments: $5,000 Per Person c. Uninsured/Underinsured Motorist: $100,000 Prior to the execution of any awarded contract by the Authority, the successful Bidder shall forward Certificates of Insurance to the Purchasing Manager. The required insurance policies shall be procured and maintained in full force and effect for the duration of the awarded contract. Certificate Holder shall be the BCRUA at 450 Cypress Creek Rd., Cedar Park, Texas 78613. 450 Cypress Creek Rd. Bldg. 1 + Cedar Park, Texas 78613 * www.cedarparktexas.gov * (512) 401-5000 * Fax: (512) 258-6083 -9- 3.2 Damage Provision If in performance pursuant to an awarded contract, successful Bidder, or Bidder’s employee, affiliate, representative, partner, subcontractor, or agent, damages the Authority’s real or personal property, Bidder shall compensate the Authority for the cost of repair or replacement, whichever the Authority determines is appropriate under the circumstances. In such event, the Authority will provide to successful Bidder an invoice stating the actual cost of repairing or replacing the damaged property. Successful Bidder shall provide payment of the invoiced amount within thirty (30) days of its receipt of said invoice. Should successful Bidder refuse to compensate the Authority for the damage incurred, said invoiced amount shall be withheld from the amount payable to successful Bidder for services rendered pursuant to the awarded contract. This provision does not waive or diminish the Authority’s right to pursue any and all legal remedies to collect for damages caused by Bidder, or Bidder’s employee, affiliate, representative, partner, subcontractor, or agent. 3.3 Bid Terms By signing and submitting a Bid, Bidder agrees: 3.3.1 To hold this Bid open for one hundred twenty (120) days after the Due Date for review of the Bid. 3.3.2 That orders will be delivered, “F.O.B. Destination, Inside Delivery” within the time specified in the Bid after receipt of order by fax, in-person, or by mail. 3.3.3 To furnish goods and services in strict compliance with the terms, conditions, specifications, and performance requirements of this IFB. 3.3.4 That payment(s) will only be made from an original invoice, not from any statement, and invoices for payment shall be submitted via e-mail to accounts.payable@cedarparktexas.gov or via mail, courier, or personal delivery to: BCRUA Attn: Accounts Payable 450 Cypress Creek Rd. Bldg. 1 Cedar Park, Texas 78613 3.3.5 Invoices shall not include Federal Excise, State, or Authority sales taxes, as the Authority shall furnish a tax exemption certificate. 3.3.6 The Authority shall notify the successful Bidder of any contested invoice(s) in writing, and the Authority and successful Bidder shall mutually resolve such disputed invoice(s) within sixty (60) days of successful Bidder’s receipt of said notice of dispute. 3.4 The term of contract shall be for one year, beginning on the date of execution of the contract, and shall automatically renew for up to four (4) additional one (1) year periods. 450 Cypress Creek Rd. Bldg. 1 * Cedar Park, Texas 78613 * www.cedarparktexas.gov * (512) 401-5000 ¢ Fax: (512) 258-6083 -10- 3.5 Limit Award The Authority reserves the right to award multiple contracts for portions of this work to others, based on the Bids submitted, if it is in the best interest of the BCRUA. Alternatively, the Authority may, at its option, award by line item as opposed to awarding the entire Bid to the same vendor. 450 Cypress Creek Rd. Bldg. 1 * Cedar Park, Texas 78613 * www.cedarparktexas.gov * (512) 401-5000 * Fax: (512) 258-6083 -11- 4. SPECIFICATIONS 4.1 General Conditions 4.1.1 Certified Analysis: Each bid shall be accompanied by an affidavit stating the purity of the product to be provided and its suitability for the intended uses of BCRUA. During the bid evaluation process, BCRUA may require Bidders to submit samples and specifications of each chemical to be tested to determine the accuracy of the Bidders’ stated purity, chemical validity, and compatibility to operating equipment. Analysis of the sample shall be performed in a laboratory of BCRUA’s choice. If the sample purity is less than the stated purity, the cost of the analysis shall be paid by the Bidder. BCRUA reserves the right to have each shipment analyzed and to reject the shipment if it does not meet AWWA and NSF/ANSI standards. If Bidder needs to test polymer chemicals (Aqualum, Hypert+lon, Aqua Hawk) in order to provide an accurate bid, they may do so ONLY between the hours of 10 AM and 2 PM on April 29" & 30" at: BCRUA Water Treatment Plant 1906 Hur Industrial Blvd. Cedar Park, Tx. 78613 Orders shall be placed as required. After award of bid, the contact will be BCRUA Water Treatment Plant Superintendents or a designee. Contact the superintendent or the designee twenty-four (24) hours prior to delivery or with any technical questions you may have. Sampling and Testing Prior to Unloading: BCRUA reserves the right to subject samples of the chemicals to complete analyses to ensure that it meets specifications. Any load tested by BCRUA that fails to comply with the Specification shall constitute grounds for rejection of that load. No payment shall be made for chemicals that are rejected. In the event that the load is rejected, the Vendor shall have twenty-four (24) hours to supply another shipment. In the event that the Vendor is unable or unwilling to supply another shipment within this time period, BCRUA has the right to procure a shipment from another source and charge the Vendor the price difference, if any. Three rejections of a load or shipment during any period of this agreement may constitute automatic termination of the Vendor’s agreement with BCRUA. Sampling and Test of Shipment after Unloading: BCRUA reserves the right to subject samples of the chemicals to complete analyses to ensure that it meets specifications. Three failures during any period of this purchase order may constitute automatic termination of the Vendor’s agreement from BCRUA. 450 Cypress Creek Rd. Bldg. 1 * Cedar Park, Texas 78613 * www.cedarparktexas.gov * (512) 401-5000 + Fax: (512) 258-6083 -12- 4.2 Delivery 4.2.1. BCRUA may request the successful Bidder (“Vendor”) to email a Certificate of Analysis (COA) of the product lot to be delivered. 4.2.2 Packaging and shipment of chemicals shall conform to all current regulations of the State of Texas, the United States Department of Transportation (DOT) and all other applicable regulatory agencies. 4.2.3 BCRUA reserves the right to change quantities and delivery dates at its discretion with a 24-hour notice before scheduled delivery. 4.2.4 Before unloading and upon arrival to the site, the driver shall notify Operations, and present the Bill of Lading, the Certificate, and any other applicable order/delivery documents to the Operations representative. After review and approval of the delivery documents, Operations staff will then escort the driver to the appropriate unloading station. BCRUA reserves the right to reject the delivery based on inadequate or nonconforming information in these documents. All other documentation prescribed by DOT, ICC, other regulatory bodies and statutes must be provided when the chemical is delivered. 4.2.5 The Vendor will be required to transport the shipments to the site and unload the product in an area designated by BCRUA. All labor and equipment costs required for the loading and unloading of the product shall be borne by the vendor. Vendor shall bear all expenses associated with any chemical removal, site cleaning and material disposal due to an error on Vendor’s or their subcontractors’ part to transfer the chemical into the correct storage area. 4.2.6 The transporting equipment shall be clean and free of residue that may contaminate the Vendor’s product or impede the unloading process. It is the Vendor’s responsibility to verify the cleanliness of the transporting equipment before loading. BCRUA may reject a load if the equipment is not properly cleaned. 4.2.7 All delivery vehicle drivers shall have a proper commercial driver’s license with a Hazardous Material endorsement. BCRUA reserves the right to check driver’s license. 4.2.8 Vendor is fully responsible for delivering the chemicals to the designated location without impacting the facility operation and/or condition. The Vendor shall be responsible for any spillage or leakage resulting from the failure of Vendor’s or its subcontractor’s delivery equipment or from failure of attendant delivery personnel in the proper performance of their duties. Proper performance shall require delivery personnel’s constant inspection and observation of unloading operations and knowledgeable response to problems and emergencies, which would most commonly be expected to occur. 450 Cypress Creek Rd. Bldg. 1 * Cedar Park, Texas 78613 » www.cedarparktexas.gov * (512) 401-5000 * Fax: (512) 258-6083 -13- 4.2.9 BCRUA reserves the right to refuse any and all deliveries made with equipment that is poorly maintained and/or leaking chemical. The Vendor shall observe the entire unloading operation and shall immediately report any spills caused during operations. 4.2.10 The Vendor shall indemnify and hold BCRUA harmless for any failure to properly report and/or comply with Federal and State rules/regulations regarding vendor caused spills or releases. The Vendor shall take immediate and appropriate actions to clean up any spilled/leaked liquid chlorine. 4.2.11 All delivery vehicles shall be fully equipped with all necessary container repair kits and self-contained breathing apparatus to properly respond to an emergency arising from uncontrolled discharge of the material provided. 4.2.12 Vendor shall provide an emergency response crew at no cost to BCRUA. Bidders shall state what emergency response crew will be used and a separate emergency telephone list. The emergency response crew must be capable of responding to an emergency within two (2) hours of notification that an emergency exists. If the spill is not cleaned up in a timely fashion, BCRUA will hire a qualified company to clean up the spill, and the cost of such service will charged to the Vendor and deducted from the amount due to the Vendor. 450 Cypress Creek Rd. Bldg. 1 * Cedar Park, Texas 78613 * www.cedarparktexas.gov * (512) 401-5000 + Fax: (512) 258-6083 -14- --FORMS TO BE RETURNED WITH BID— 5. BID The undersigned hereby declares: to have carefully examined the contract documents, including all addenda; have a clear understanding of said documents and premises; propose to provide the necessary tools, machinery, apparatus and other means of maintenance; and to furnish all labor, materials and services specified in the contract or called for in the contract documents for the prices as indicated below. BCRUA is in need of water treatment chemicals for BCRUA’s Water Plant located at 1906 Hur Industrial Blvd, Cedar Park, TX 78613. The intent of this solicitation is to allow the BCRUA to enter into a contract or multiple contracts for the procurement of the products specified on the following page at a fixed price for a twelve (12) month period. BCRUA will make award(s) based on Best Value as permitted in Section 252.043 of Texas Local Government Code. BCRUA will accept partial bids. Bidder shall submit pricing for any and all chemicals they wish to be considered for. If multiple Bidders bid on the same chemical, BCRUA reserves the right to award a primary vendor for each chemical (lowest bid) and one or more back up vendors in ascending bid order. PRICE INCREASE: Agreement prices for chemicals shall remain firm throughout the first twelve (12) month period of the Agreement. A price increase to the Agreement may be considered at renewal time each year thereafter and shall be equal to the lesser of: 1) consumer price index for that year, or 2) 5%. And at no time can the total increase be greater than 25% of the original unit price. CONSUMER PRICE INDEX (CPI): Price adjustments will be made in accordance with the percentage change in the U.S. Department of Labor Consumer Price Index for all Urban Consumers (CPI-U), All Items. The Price adjustment rate will be determined by comparing the percentage difference between: (a) the six month average unadjusted CPI using the most recent six months of available data at time of request, and (6) the six month average unadjusted CPI for the same six month period in the preceding year. The percentage difference between (a) and (b) will be the maximum allowable price adjustment rate. Please see the example provided below. No retroactive Agreement price adjustments will be allowed. CPI data can be found at the Bureau of Labor Statistics, Consumer Price Index website here: http://www.bls.gov/cpi/ PROCEDURE TO REQUEST INCREASE: Email the written price increase request with the rate detail comparison and comprehensive calculation to BCRUA's Purchasing Department a minimum of 30 days, but no sooner than 60 days, prior to each renewal period. The detailed written calculation will be verified and confirmed. All written requests for increases must include the BCRUA contract number, solicitation reference information, and contact information for the authorized representative requesting the increase. Price increase requests shall be sent by mail to: BCRUA Attn: Purchasing Department 450 Cypress Creek Rd, Bldg 1 Cedar Park, TX 78613 purchasing@cedarparktexas.gov 450 Cypress Creek Rd. Bldg. 1 * Cedar Park, Texas 78613 * www.cedarparktexas.gov * (512) 401-5000 * Fax: (512) 258-6083 -15- Upon receipt of the request, BCRUA reserves the right to either accept the escalation and make changes to the Agreement within 30 days of the request, negotiate with the Vendor, or cancel the Agreement if an agreement cannot be reached on the value of the increase. Example Scenario and Calculation: 1. 2. 3. 4, 5. a ve Agreement renewal date of December 1, 2024. Price increase request due by: November 1, 2024. Current period six month average will be calculated using unadjusted CPI data from May — October 2024. Previous period six month average will be calculated using unadjusted CPI data from May — October 2023. Current period six month average = 314.758 Previous period six month average = 306.236 Calculate % difference: (314.758 - 306.236) / 306.236 x 100 = 2.782 Max allowable price increase at renewal is 2.8% CONTRACT TIME: The Bidder agrees, if awarded the Contract, to commence work within ten (10) calendar days after receipt of a notice of award or in accordance with the schedule provided by owner. The term of this agreement shall be for one (1) year, beginning on the date of the execution of the agreement, and shall automatically renew for up to four (4) additional one (1) year periods. DOCUMENTS: Each Bidder by submittal of their IFB response represents and warrants that they are satisfied as to the requirements and provisions of the IFB for this project and the documents describing the scope of work. Barkly Boyd Stanley Title: Sr. Vice-President Date: 05/14/2025 450 Cypress Creek Rd. Bldg. 1 » Cedar Park, Texas 78613 * www.cedarparktexas.gov * (512) 401-5000 « Fax: (512) 258-6083 -16- PRICING SHEET *** BIDDER MUST ATTACH SAFETY DATA SHEETs (SDS) FOR ALL CHEMICALS BID *** Chemical Approximate Delivery Quantity Approximate Delivery Frequency Delivery Location Approximate Annual Quantity Unit Unit Price (delivered) Can you deliver within 5 business days? (Y or N) Sodium Hypochlorite - 12% Bleach 5000Gal Every 1-2 weeks 1906 Hur Industrial Blvd Cedar Park Texas 78613 195,000 Gallons No Bid Liquid Ammonium Sulfate 48,000lbs Every 4-6 weeks 1906 Hur Industrial Blvd Cedar Park Texas 78613 936,000 Pounds No Bid CLARIFLOC C-378 Aqualum 3003 35,200Ibs Every 10-12 weeks 1906 Hur Industrial Blvd Cedar Park Texas 78613 176,000 Pounds $0.82/LB. Yes CLARIFLOC C-378 Aqualum 3003 6 totes Every 4-6 months 1906 Hur Industrial Blvd Cedar Park Texas 78613 28,584 Pounds $0.82/LB. Yes Aluminum Chlorohydrate + 4% LCS 48,000Ibs Every 3-4 weeks 1906 Hur Industrial Blvd Cedar Park Texas 78613 624,000 Pounds No Bid CLARIFLOC C-6240 Aqua Hawk 9937 6 totes Every 4-6 months 1906 Hur Industrial Blvd Cedar Park Texas 78613 32,410 Pounds $1.50/LB. Yes Fluorosilic Acid 23% 35,200 Every 6-8 weeks 1906 Hur Industrial Blvd Cedar Park Texas 78613 211,200 Pounds No Bid Sodium Permanganate 3000 4-6 months 1906 Hur Industrial Blvd Cedar Park Texas 78613 6000 Gallons No Bid 450 Cypress Creek Rd. Bldg. 1 * Cedar Park, Texas 78613 * www.cedarparktexas.gov ¢ (512) 401-5000 « Fax: (512) 258-6083 -17- 6. DEMONSTRATION OF EXPERIENCE Years in business under present business name: 30+ Years Total years of experience in work of the type called for in this contract: 30+ Years List in table below the contracts of similar scope and scale to the Authority’s IFB has your organization completed. List most recent FIRST: and Anionic Emulsion Contract Amount | Type of Work Date Completed | Owner’s Name & Contact Info ‘ . Urbana Champaign S.D. $351,000.00 Supply and Delnery ° wae 04/30/25 100 E. University Avenue Urbana, IL 61801 Pol astewater *reaimen Jackie Christensen,(217) 367-3409 ext. 1128 olymer. ‘ Lafourche Parish Water District South Plant $259,000.00 Supply and Delivery of 5753 Highway 308 Lockport, LA 70374 Dadmac 12/31/24 p Jenny Robichaux, (985) 532-6924 Supply and Delivery of Water cay ot Cincinnati Cincinnati. OH 4523 . 12/31/24 ellogg Avenue, Cincinnati, $153,200.00 Pobmen Treatment /3u James Springer, (513) 624-5624 Supply of Dadmac Pol City of Oshkosh $117,500.00 ae Oe | 12/31/2024 1495 Lake Shore Drive, Oshkosh, WI 54901 Brad Rockus, (920) 236-5164 List in the table below what contracts your organization currently has: Contract Amount | Type of Work Projected Owner’s Name & Contact Info Date of Completion INew Orleans Sewerage and Water Board $1,400,000.00 Supply of Dadmac 10/31/2025 8800 South Claiborne Street, INew Orleans, LA 70615 Kenneth Hopel, (504) 585-2356 ‘ Los Angeles County Sanitation $4,000,0000.00 Supply of Emulsion Polymer 07/31/2025 District 24501 South Figueroa Street, Whitter, CA 90601 Malika Jones, (310) 830-2401 . City of Cincinnati $2,0000,000.00 Supply of Emulsion Polymer | 06/30/2025 1600 Cest Street, Cincinnati, OH 45202 Larry Scanlon, (513) 352-4921 Gulf Coast Water Authority $900,000.00 Supply of Dadmac 06/30/2025 4001 5th Avenue North, Texas City, TX 77591 Drew Hutto, (281) 488-4115 If you have any additional experience or work that you would like to submit, please provide separate additional documentation upon submittal. 450 Cypress Creek Rd. Bldg. 1 * Cedar Park, Texas 78613 * www.cedarparktexas.gov * (512) 401-5000 * Fax: (512) 258-6083 - 18 - Have you ever failed to complete any contract awarded to you? [] Yes [&£ No If “Yes”, state where and why. Click or tap here to enter text, Are you at present in any major litigation or lawsuits involving work of any type? [}Yes [No If “Yes”, explain: Click or tap here to enter text. Explain in detail the manner in which you have inspected the work proposed in this contract: Click or tap here to enter text. 450 Cypress Creek Rd. Bldg. 1 * Cedar Park, Texas 78613 * www.cedarparktexas.gov * (512) 401-5000 + Fax: (512) 258-6083 -19- Not Applicable 7, LIST OF MACHINERY AND EQUIPMENT It is required that a Contractor be able to perform the requested services. It is represented as part of this Bid that the below listed equipment is available for use on the work covered by the Scope of Work. As a part of the Bid evaluation BCRUA may inspect the availability and capability of the equipment of the Contractor submitting the winning Bid. Units Types of Equipment Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text. 450 Cypress Creek Rd. Bldg. 1 * Cedar Park, Texas 78613 * www.cedarparktexas.gov * (512) 401-5000 * Fax: (512) 258-6083 -20- 8. VENDOR PROFILE Company Name: Polydyne Inc. and D/B/A:Polydyne Inc. Telephone Numbers: Phone: (800) 848-7659 Option 2 Fax: (912) 880-2078 If there is no toll free number, does the company accept collect calls? 0 Yes K] No Contacts: Corporate Contact for this Bid: Name: Boyd Stanley, Sr. Vice-President Address: One Chemical Plant Road Authority, State, Zip: Riceboro, GA 31323 Phone: (800) 848-7659 Option 2. Fax: (912) 880-2078 E-mail: bids@polydyneinc.com Website: polydyneinc.com If local contact is the same as corporate contact, check here Local Contact for this Bid: Name: Brent SoRelle, Sr. Technical Sales Representative Address: 961 Copper Canyon Drive Authority, State, Zip: Prosper, TX 75078 Phone:(682) 216-5062 Fax: (912) 880-2078 E-mail: bsorelle@polydyneinc.com Number of years the company has been in business under this name: 30 Years Other company names used with dates, from/to: Not Applicable 450 Cypress Creek Rd. Bldg. 1 * Cedar Park, Texas 78613 * www.cedarparktexas.gov * (512) 401-5000 ¢ Fax: (512) 258-6083 -21- 9. BID RESPONSE FORM By signing and submitting this Bid, Bidder acknowledges that they have inspected the specifications, are capable and willing to perform and/or provide the required services and/or products, and shall complete this project within the amount of time and dollar amount specified. The undersigined certifies that the prices contained in this Bid have been carefully checked and submitted as correct and final. All unit prices include the cost of delivery. The undersigned is authorized to bind themselves or the entity they represent to a contract. C1 An individual proprietorship C1 A partnership A corporation chartered under the laws of the State of Delaware, acting by its officers pursuant to its by-laws or a resolution of its Board of Directors Signature: 7 Printed Name: Boyd Stanley Title: Sr. Vice-President Date: 05/14/2025 450 Cypress Creek Rd. Bldg. 1 * Cedar Park, Texas 78613 * www.cedarparktexas.gov * (512) 401-5000 ° Fax: (512) 258-6083 -22- 10. REFERENCES Bidder shall submit a list of at least three (3) references for which Bidder has provided like products or services. References will include contact name and telephone number. Bids submitted without three references may be disqualified from consideration. Cedar Park/Austin area references are preferred. Company: Los Angeles County Sanitation District Contact name: Malika Jones Phone number: (310) 830-2400 EXT. 5249 Email: mjones@lacsd.org Company: City of Cincinnati Contact name: Larry Scanlan Phone number: (513) 244-5178 Email: larry.scanlan@cincinnati-oh.gov Company: Lafourche Parish Water District Contact name: Jenny Robichaux Phone number: (985) 532-6924 Email:jennyr@lpwdla.com Company: Click or tap here to enter text. Contact name: Click or tap here to enter text. Phone number: Click or tap here to enter text. Email: Click or tap here to enter text. Company: Click or tap here to enter text. Contact name: Click or tap here to enter text. Phone number: Click or tap here to enter text. Email: Click or tap here to enter text. 450 Cypress Creek Rd. Bldg. 1 + Cedar Park, Texas 78613 » www.cedarparktexas.gov « (512) 401-5000 © Fax: (512) 258-6083 -23- 11. DEVIATION OR COMPLIANCE FORM DEVIATIONS: In the event the undersigned Bidder intends to deviate from the general terms, conditions, special conditions or specifications contrary to those listed in the “Terms and Conditions” and other information attached hereto, all such deviations must be LISTED ON THIS PAGE, with complete and detailed conditions and information also being attached (attach additional pages as necessary). NO DEVIATIONS: In the absence of any deviation entry on this page, Bidder assures the Authority of Bidder’s compliance with the Terms, Conditions, Specifications, and information contained in this IFB. Deviation | Deviation TEB Reference . (related to the Detailed Deviation Description # Title deviation) No Deviations 450 Cypress Creek Rd. Bldg. 1 + Cedar Park, Texas 78613 * www.cedarparktexas.gov * (512) 401-5000 + Fax: (512) 258-6083 -24- 12. RELEASE AND INDEMNIFICATION TO THE MAXIMUM EXTENT PERMITTED BY LAW, BIDDER HEREBY AGREES AND CONSENTS FOR ITSELF, INDIVIDUALLY, AND ON BEHALF OF THE BUSINESS ENTITY, TO FULLY AND UNCONDITIONALLY RELEASE, INDEMNIFY, DEFEND, AND HOLD HARMLESS THE BCRUA, TEXAS, INCLUDING ITS OFFICERS, AGENTS AND EMPLOYEES, AND TO DEFEND AND HOLD IT HARMLESS FROM AND AGAINST ANY AND ALL COSTS, EXPENSES, ATTORNEY FEES, CLAIMS, SUITS, DEMANDS, LOSSES, OR LIABILITY FOR INJURIES TO REAL OR PERSONAL PROPERTY AND INJURIES TO PERSONS INCLUDING DEATH, INCLUDING BIDDER’S EMPLOYEES, AFFILIATES, REPRESENTATIVES, PARTNERS, AGENTS, OR THOSE WORKING ON BIDDER’S BEHALF, FROM ANY AND ALL OTHER COSTS, EXPENSES, ATTORNEY FEES, CLAIMS, SUITS, DEMANDS, LOSSES OR LIABILITIES OF ANY AND EVERY NATURE WHATSOEVER ARISING IN ANY MANNER, DIRECTLY OR INDIRECTLY, OUT OF OR IN CONNECTION WITH ANY CONTRACT AWARDED PURSUANT TO THIS IFB AND IN THE PERFORMANCE THEREOF, REGARDLESS OF CAUSE OR OF THE SOLE, JOINT, COMPARATIVE OR CONCURRENT NEGLIGENCE OR GROSS NEGLIGENCE, SAVE AND EXCEPT THE SOLE AND EXCLUSIVE NEGLIGENCE OF THE AUTHORITY. THIS PROVISION SHALL APPLY TO ALL IMPUTED OR ACTUAL JOINT ENTERPRISE AND JOINT VENTURE LIABILITY, IF ANY. Printed Name: Boyd Stanley Title: Sr. Vice-President Date: 05/14/2025 450 Cypress Creek Rd. Bldg. 1 » Cedar Park, Texas 78613 » www.cedarparktexas.gov « (512) 401-5000 « Fax: (512) 258-6083 -25- 13. NON-COLLUSION ACKNOWLDGEMENT The undersigned Bidder affirms that they are duly authorized to execute this Bid, that this company, corporation, firm, partnership or individual has not prepared this Bid in collusion with any other Bidder, and that the contents of this Bid as to prices, terms and conditions thereof have not been communicated by the undersigned Bidder, nor by Bidder’s employee, affiliate, representative, partner, subcontractor, or agent, to any other individual or entity engaged in this type of business prior to the official opening of this IFB. Company Name: Polydyne Inc. Signature of Company Officer: poy hb feat Company Officer Printed Name: Boyd Stanley Title: Sr. Vice-President Date: 05/14/2025 14. SUSPENSION OR DEBARMENT CERTIFICATE Non-Federal entities are prohibited from contracting with or making subcontract awards under covered transactions to parties that are suspended or debarred or whose principals are suspended or debarred. Covered transactions include procurement for goods or services equal to or in excess of $100,000.00. Contractors receiving individual awards for $100,000.00 or more and all subcontract recipients must certify that the organization and its principals are not suspended or debarred. By submitting this offer and signing this certificate, Bidder certifies that no suspension or disbarment is in place, which would preclude receiving a federally funded contract under the Federal OMB, A-102, Common Rule, as may be amended. Company Name: Polydyne Inc. Many Signature of Company Officer: Pods poly Company Officer Printed Name: Boyd Stanley Title: Sr. Vice-President Date: 05/14/2025 450 Cypress Creek Rd. Bldg. 1 ¢ Cedar Park, Texas 78613 www.cedarparktexas.gov * (512) 401-5000 ¢ Fax: (512) 258-6083 -26- 15. COOPERATIVE PURCHASING Interlocal Cooperative Contracting/Purchasing: Authority for local governments to contract with one another to perform certain governmental functions and services, including but not limited to purchasing functions, is granted under Government Code, Title 7, Chapter 791 Interlocal Cooperation Contracts, Subchapter B and Subchapter C, and Local Government Code, Title 8, Chapter 271, Subchapter F, Section 271.101 and Section 271.102. Other governmental entities within the State of Texas may be extended the opportunity to purchase off of the BCRUA’s IFB, with the consent and agreement of the successful Bidder(s) and the BCRUA. Such consent and agreement shall be conclusively inferred from lack of exception to this clause in Bidder’s Bid. However, all parties indicate their understanding and all parties hereby expressly agree that the BCRUA is not an agent of, partner to, or representative of those outside agencies or entities and that the BCRUA is not obligated or liable for any action or debts that may arise out of such independently-negotiated cooperative procurements. Other governmental entities utilizing Interlocal agreements with the BCRUA, may desire, but are not obligated, to purchase goods and services defined in this Bid from the successful Bidder. All purchases by governmental entities, other than the BCRUA, will be billed directly to and paid by that governmental entity. The BCRUA will not be responsible for other governmental entities debts. Each governmental entity will place their own orders with the successful Bidder and be responsible for ensuring full compliance with the specifications. Prior to other governmental entities placing orders, the BCRUA will notify the successful Bidder of their intent. Please indicate below if you will permit other governmental entities to purchase from your agreement with the BCRUA. x] Yes, others can purchase; L] No, only the BCRUA can purchase. Signature: Fad Printed Name: Boyd Stanley Title: Sr. Vice-President Date: 05/14/2025 450 Cypress Creek Rd. Bldg. 1 * Cedar Park, Texas 78613 * www.cedarparktexas.gov ° (512) 401-5000 ¢ Fax: (512) 258-6083 -27- 16. CONFLICT OF INTEREST AND QUESTIONAIRE Please sign, if applicable The Texas Ethics Commission adopted the attached Conflict of Interest Questionnaire (Form CIQ) pursuant to Texas Local Government Code Chapter 176, as amended. For questions about these forms, please see the Texas Ethics Commission at: https://www.ethics.state.tx.us/data/forms/conflict/CIO.pdf Bidder shall answer each question in the attached Form CIQ in relation to the following individuals and submit a completed form with its Bid: Local Government Local Government Officer Jie Officer ue Na?Colé ‘Thompson President of Posrd of Anne Duffy Vice President of Board of Directors Directors Rene Flores Secretary Jason Anderson Citizen Director Assistant Hilda Montgomery Citizen Director Mel Kirkland Citizen Director Sam Roberts General Manager Christian Culver Superintendent Jennifer Baumeister Administrative Support Ryan Manilla Supervisor 450 Cypress Creek Rd. Bldg. 1 * Cedar Park, Texas 78613 * www.cedarparktexas.gov ¢ (512) 401-5000 « Fax: (512) 258-6083 - 28 - CONFLICT OF INTEREST QUESTIONNAIRE FORM CIQ For vendor doing business with local governmental entity This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. OFFICE USE ONLY This questionnaire is being filed in accordance with Chapter 176, Local Government Code, by a vendor who has a business relationship as defined by Section 176.001(1-a) with a local governmental entity and the vendor meets requirements under Section 176.006(a). Date Received By law this questionnaire must be filed with the records administrator of the local governmental entity not later than the 7th business day after the date the vendor becomes aware of facts that require the statement to be filed. See Section 176.006(a-1), Local Government Code. A vendor commits an offense if the vendor knowingly violates Section 176.006, Local Government Code. An offense under this section is a misdemeanor. 1 | Name of vendor who has a business relationship with local governmental entity. Polydyne Inc. Bl Check this box if you are filing an update to a previously filed questionnaire. (The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 7th business day after the date on which you became aware that the originally filed questionnaire was incomplete or inaccurate.) 3 | Name of local government officer about whom the information is being disclosed. None Name of Officer 14] Describe each employment or other business relationship with the local government officer, or a family member of the officer, as described by Section 176.003(a)(2)(A). Also describe any family relationship with the local government officer. Complete subparts A and B for each employment or business relationship described. Attach additional pages to this Form CIQ as necessary. A. Is the local government officer or a family member of the officer receiving or likely to receive taxable income, other than investment income, from the vendor? — [| Yes [| No B. Is the vendor receiving or likely to receive taxable income, other than investment income, from or at the direction of the local government officer or a family member of the officer AND the taxable income is not received from the local governmental entity? [| Yes [| No 15! Describe each employment or business relationship that the vendor named in Section 1 maintains with a corporation or other business entity with respect to which the local government officer serves as an officer or director, or holds an ownership interest of one percent or more. Check this box if the vendor has given the local government officer or a family member of the officer one or more gifts as described in Section 176.003(a)(2)(B), excluding gifts described in Section 176.003(a-1). f Boyd Stanley Sr. Vice-President 05/14/2025 Signature of vendor doing\blisiness with the governmental entity Date Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 1/1/2021 CONFLICT OF INTEREST QUESTIONNAIRE For vendor doing business with local governmental entity Acomplete copy of Chapter 176 of the Local Government Code may be found at http://www.statutes.legis.state.tx.us/ Docs/LG/htm/LG.176.htm. For easy reference, below are some of the sections cited on this form. Local Government Code § 176.001(1-a): "Business relationship" means a connection between two or more parties based on commercial activity of one of the parties. The term does not include a connection based on: (A) a transaction that is subject to rate or fee regulation by a federal, state, or local governmental entity or an agency of a federal, state, or local governmental entity; (B) a transaction conducted at a price and subject to terms available to the public; or (C) a purchase or lease of goods or services from a person that is chartered by a state or federal agency and that is subject to regular examination by, and reporting to, that agency. Local Government Code § 176.003(a)(2)(A) and (B): (a) Alocal government officer shall file a conflicts disclosure statement with respect to a vendor if: RK (2) the vendor: (A) has an employment or other business relationship with the local government officer or a family member of the officer that results in the officer or family member receiving taxable income, other than investment income, that exceeds $2,500 during the 12-month period preceding the date that the officer becomes aware that (i) a contract between the local governmental entity and vendor has been executed: or (ii) the local governmental entity is considering entering into a contract with the vendor; (B) has given to the local government officer or a family member of the officer one or more gifts that have an aggregate value of more than $100 in the 12-month period preceding the date the officer becomes aware that: (i) a contract between the local governmental entity and vendor has been executed; or (ii) the local governmental entity is considering entering into a contract with the vendor. Local Government Code § 176.006(a) and (a-1) (a) Avendor shall file a completed conflict of interest questionnaire if the vendor has a business relationship with a local governmental entity and: (1) has an employment or other business relationship with a local government officer of that local governmental entity, or a family member of the officer, described by Section 176.003(a)(2)(A); (2) has given a local government officer of that local governmental entity, or a family member of the officer, one or more gifts with the aggregate value specified by Section 176.003(a) (2)(B), excluding any gift described by Section 176.003(a-1); or (3) has a family relationship with a local government officer of that local governmental entity. (a-1) The completed conflict of interest questionnaire must be filed with the appropriate records administrator not later than the seventh business day after the later of: (1) the date that the vendor: (A) begins discussions or negotiations to enter into a contract with the local governmental entity; or (B) submits to the local governmental entity an application, response to a request for proposals or bids, correspondence, or another writing related to a potential contract with the local governmental entity; or (2) the date the vendor becomes aware: (A) of an employment or other business relationship with a local government officer, or a family member of the officer, described by Subsection (a); (B) that the vendor has given one or more gifts described by Subsection (a); or (C) of a family relationship with a local government officer. Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 1/1/2021 17. DISCLOSURE OF INTERESTED PARTIES Prior to entering into a contract that is at least $1 million in value, the Bidder must submit a “Certificate of Interested Parties” Form, in accordance with Texas Government Code Section 2252.908, as amended. Within 30 days of receipt of the form, the Authority must submit a copy to the Texas Ethics Commission. 450 Cypress Creek Rd. Bldg. 1 + Cedar Park, Texas 78613 * www.cedarparktexas.gov « (512) 401-5000 + Fax: (512) 258-6083 -29- 18. W-9 FORM 450 Cypress Creek Rd. Bldg. 1 + Cedar Park, Texas 78613 * www.cedarparktexas.gov « (512) 401-5000 * Fax: (512) 258-6083 -30- Request for Taxpayer Identification Number and Certification Go to www.irs.gov/FormW49 for instructions and the latest information. Form W-9 (Rev. March 2024) Department of the Treasury Internal Revenue Service Before you begin. For guidance related to the purpose of Form W-9, see Purpose of Form, below. 1 Name of entity/individual. An entry is required. (For a sole proprietor or disregarded entity, enter the owner's name on line 1, and enter the business/disregarded entity’s name on line 2.) Give form to the requester. Do not send to the IRS. Polydyne Inc. 2 Business name/disregarded entity name, if different from above. 3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1. Check only one of the following seven boxes. C corporation im Partnership CL] LLC. Enter the tax classification (C = C corporation, S = S corporation, P = Partnership) Note: Check the “LLC” box above and, in the entry space, enter the appropriate code (C, S, or P) for the tax classification of the LLC, unless it is a disregarded entity. A disregarded entity should instead check the appropriate box for the tax classification of its owner. [_] Other (see instructions) 4 Exemptions (codes apply only to certain entities, not individuals; see instructions on page 3): im Individual/sole proprietor oO S corporation oO Trust/estate Exempt payee code (if any) Exemption from Foreign Account Tax Compliance Act (FATCA) reporting code (if any) Print or type. See Specific Instructions on page 3. 3b If on line 3a you checked “Partnership” or “Trust/estate,” or checked “LLC” and entered “P” as its tax classification, and you are providing this form to a partnership, trust, or estate in which you have an ownership interest, check this box if you have any foreign partners, owners, or beneficiaries. See instructions . (Applies to accounts maintained outside the United States.) 5 Address (number, street, and apt. or suite no.). See instructions. One Chemical Plant Road 6 City, state, and ZIP code Riceboro, GA 31323 7 List account number(s) here (optional) Part I Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid Requester’s name and address (optional) Social security number backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN, later. = Employer identification number Note: If the account is in more than one name, see the instructions for line 1. See also What Name and Number To Give the Requester for guidelines on whose number to enter. 3/4)/-)]1])/8]1)/0)2)8)3 Part Il Certification Under penalties of perjury, | certify that: 1. The number shown on this form is my correct taxpayer identification number (or | am waiting for a number to be issued to me); and 2.1 am not subject to backup withholding because (a) | am exempt from backup withholding, or (b) | have not been notified by the Internal Revenue Service (IRS) that | am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that | am no longer subject to backup withholding; and 3.lama U.S. citizen or other U.S. person (defined below); and 4. The FATCA code(s) entered on this form (if any) indicating that | am exempt from FATCA reporting is correct. Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and, generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part Il, later. Sign Signature of Boyd Stanley 05/14/2025 Here | U.S. person Sr. Vice-President pate ere = a General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Future developments. For the latest information about developments related to Form W-9 and its instructions, such as legislation enacted after they were published, go to www.irs.gov/FormW9. What’s New Line 3a has been modified to clarify how a disregarded entity completes this line. An LLC that is a disregarded entity should check the appropriate box for the tax classification of its owner. Otherwise, it should check the “LLC” box and enter its appropriate tax classification. New line 3b has been added to this form. A flow-through entity is required to complete this line to indicate that it has direct or indirect foreign partners, owners, or beneficiaries when it provides the Form W-9 to another flow-through entity in which it has an ownership interest. This change is intended to provide a flow-through entity with information regarding the status of its indirect foreign partners, owners, or beneficiaries, so that it can satisfy any applicable reporting requirements. For example, a partnership that has any indirect foreign partners may be required to complete Schedules K-2 and K-3. See the Partnership Instructions for Schedules K-2 and K-3 (Form 1065). Purpose of Form An individual or entity (Form W-9 requester) who is required to file an information return with the IRS is giving you this form because they Cat. No. 10231X Form W-9 (Rev. 3-2024) Form W-9 (Rev. 3-2024) Page 2 must obtain your correct taxpayer identification number (TIN), which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following. * Form 1099-INT (interest earned or paid). * Form 1099-DIV (dividends, including those from stocks or mutual funds). * Form 1099-MISC (various types of income, prizes, awards, or gross proceeds), * Form 1099-NEG (nonemployee compensation). ¢ Form 1099-B (stock or mutual fund sales and certain other transactions by brokers). * Form 1099-S (proceeds from real estate transactions). ¢ Form 1099-K (merchant card and third-party network transactions). * Form 1098 (home mortgage interest), 1098-E (student loan interest), and 1098-T (tuition). * Form 1099-C (canceled debt). * Form 1099-A (acquisition or abandonment of secured property). Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN. Caution: If you don’t return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding, later. By signing the filled-out form, you: 1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued); 2. Certify that you are not subject to backup withholding; or 3. Claim exemption from backup withholding if you are a U.S. exempt payee; and 4. Certify to your non-foreign status for purposes of withholding under chapter 3 or 4 of the Code (if applicable); and 5. Certify that FATCA code(s) entered on this form (if any) indicating that you are exempt from the FATCA reporting is correct. See What Is FATCA Reporting, later, for further information. Note: If you are a U.S. person and a requester gives you a form other than Form W-9 to request your TIN, you must use the requester’s form if it is substantially similar to this Form W-9. Definition of a U.S. person. For federal tax purposes, you are considered a U.S. person if you are: ¢ An individual who is a U.S. citizen or U.S. resident alien; ¢ A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States; ¢ An estate (other than a foreign estate); or * A domestic trust (as defined in Regulations section 301.7701-7). Establishing U.S. status for purposes of chapter 3 and chapter 4 withholding. Payments made to foreign persons, including certain distributions, allocations of income, or transfers of sales proceeds, may be subject to withholding under chapter 3 or chapter 4 of the Code (sections 1441-1474). Under those rules, if a Form W-9 or other certification of non-foreign status has not been received, a withholding agent, transferee, or partnership (payor) generally applies presumption rules that may require the payor to withhold applicable tax from the recipient, owner, transferor, or partner (payee). See Pub. 515, Withholding of Tax on Nonresident Aliens and Foreign Entities. The following persons must provide Form W-9 to the payor for purposes of establishing its non-foreign status. ¢ In the case of a disregarded entity with a U.S. owner, the U.S. owner of the disregarded entity and not the disregarded entity. * In the case of a grantor trust with a U.S. grantor or other U.S. owner, generally, the U.S. grantor or other U.S. owner of the grantor trust and not the grantor trust. * In the case of a U.S. trust (other than a grantor trust), the U.S. trust and not the beneficiaries of the trust. See Pub. 515 for more information on providing a Form W-9 or a certification of non-foreign status to avoid withholding. Foreign person. If you are a foreign person or the U.S. branch of a foreign bank that has elected to be treated as a U.S. person (under Regulations section 1.1441-1(b)(2)(iv) or other applicable section for chapter 8 or 4 purposes), do not use Form W-9., Instead, use the appropriate Form W-8 or Form 8233 (see Pub. 515). If you are a qualified foreign pension fund under Regulations section 1.897(I)-1(d), or a partnership that is wholly owned by qualified foreign pension funds, that is treated as a non-foreign person for purposes of section 1445 withholding, do not use Form W-9. Instead, use Form W-8EXP (or other certification of non-foreign status). Nonresident alien who becomes a resident alien. Generally, only a nonresident alien individual may use the terms of a tax treaty to reduce or eliminate U.S. tax on certain types of income. However, most tax treaties contain a provision known as a saving clause. Exceptions specified in the saving clause may permit an exemption from tax to continue for certain types of income even after the payee has otherwise become a U.S. resident alien for tax purposes. If you are a U.S. resident alién who is relying on an exception contained in the saving clause of a tax treaty to claim an exemption from U.S. tax on certain types of income, you must attach a statement to Form W-89 that specifies the following five items. 1. The treaty country. Generally, this must be the same treaty under which you claimed exemption from tax as a nonresident alien. 2. The treaty article addressing the income. 3. The article number (or location) in the tax treaty that contains the saving clause and its exceptions. 4. The type and amount of income that qualities for the exemption from tax. 5. Sufficient facts to justify the exemption from tax under the terms of the treaty article. Example. Article 20 of the U.S.-China income tax treaty allows an exemption from tax for scholarship income received by a Chinese student temporarily present in the United States. Under U.S. law, this student will become a resident alien for tax purposes if their stay in the United States exceeds 5 calendar years. However, paragraph 2 of the first Protocol to the U.S.-China treaty (dated April 30, 1984) allows the provisions of Article 20 to continue to apply even after the Chinese student becomes a resident alien of the United States. A Chinese student who qualifies for this exception (under paragraph 2 of the first Protocol) and is relying on this exception to claim an exemption from tax on their scholarship or fellowship income would attach to Form W-9 a statement that includes the information described above to support that exemption. lf you are a nonresident alien or a foreign entity, give the requester the appropriate completed Form W-8 or Form 8233. Backup Withholding What is backup withholding? Persons making certain payments to you must under certain conditions withhold and pay to the IRS 24% of such payments, This is called “backup withholding.” Payments that may be subject to backup withholding include, but are not limited to, interest, tax-exempt interest, dividends, broker and barter exchange transactions, rents, royalties, nonemployee pay, payments made in settlement of payment card and third-party network transactions, and certain payments from fishing boat operators. Real estate transactions are not subject to backup withholding. You will not be subject to backup withholding on payments you receive if you give the requester your correct TIN, make the proper certifications, and report all your taxable interest and dividends on your tax return. Payments you receive will be subject to backup withholding if: 1. You do not furnish your TIN to the requester; 2. You do not certify your TIN when required (see the instructions for Part Il for details); 3. The IRS tells the requester that you furnished an incorrect TIN; 4. The IRS tells you that you are subject to backup withholding because you did not report all your interest and dividends on your tax return (for reportable interest and dividends only); or 5. You do not certify to the requester that you are not subject to backup withholding, as described in item 4 under “By signing the filled- out form” above (for reportable interest and dividend accounts opened after 1983 only). Form W-9 (Rev. 3-2024) Page 3 Certain payees and payments are exempt from backup withholding, See Exempt payee code, later, and the separate Instructions for the Requester of Form W-9 for more information. See also Establishing U.S. status for purposes of chapter 3 and chapter 4 withholding, earlier. What Is FATCA Reporting? The Foreign Account Tax Compliance Act (FATCA) requires a participating foreign financial institution to report all U.S. account holders that are specified U.S. persons. Certain payees are exempt from FATCA reporting. See Exemption from FATCA reporting code, later, and the Instructions for the Requester of Form W-9 for more information. Updating Your Information You must provide updated information to any person to whom you claimed to be an exempt payee if you are no longer an exempt payee and anticipate receiving reportable payments in the future from this person. For example, you may need to provide updated information if you are a C corporation that elects to be an S corporation, or if you are no longer tax exempt. In addition, you must furnish a new Form W-9 if the name or TIN changes for the account, for example, if the grantor of a grantor trust dies. Penalties Failure to furnish TIN. If you fail to furnish your correct TIN to a requester, you are subject to a penalty of $50 for each such failure unless your failure is due to reasonable cause and not to willful neglect. Civil penalty for false information with respect to withholding. If you make a false statement with no reasonable basis that results in no backup withholding, you are subject to a $500 penalty. Criminal penalty for falsifying information. Willfully falsifying certifications or affirmations may subject you to criminal penalties including fines and/or imprisonment. Misuse of TINs. If the requester discloses or uses TINs in violation of federal law, the requester may be subject to civil and criminal penalties. Specific Instructions Line 1 You must enter one of the following on this line; do not leave this line blank. The name should match the name on your tax return. lf this Form W-9 is for a joint account (other than an account maintained by a foreign financial institution (FFI)), list first, and then circle, the name of the person or entity whose number you entered in Part | of Form W-9. If you are providing Form W-9 to an FFI to document a joint account, each holder of the account that is a U.S. person must provide a Form W-9. ¢ Individual. Generally, enter the name shown on your tax return. If you have changed your last name without informing the Social Security Administration (SSA) of the name change, enter your first name, the last name as shown on your social security card, and your new last name. Note for ITIN applicant: Enter your individual name as it was entered on your Form W-7 application, line 1a. This should also be the same as the name you entered on the Form 1040 you filed with your application. * Sole proprietor. Enter your individual name as shown on your Form 1040 on line 1. Enter your business, trade, or “doing business as” (DBA) name on line 2. * Partnership, C corporation, S corporation, or LLC, other than a disregarded entity. Enter the entity’s name as shown on the entity’s tax return on line 1 and any business, trade, or DBA name on line 2. ¢ Other entities. Enter your name as shown on required U.S. federal tax documents on line 1. This name should match the name shown on the charter or other legal document creating the entity. Enter any business, trade, or DBA name on line 2. * Disregarded entity. In general, a business entity that has a single owner, including an LLC, and is not a corporation, is disregarded as an entity separate from its owner (a disregarded entity). See Regulations section 301.7701-2(c)(2). A disregarded entity should check the appropriate box for the tax classification of its owner. Enter the owner's name on line 1. The name of the owner entered on line 1 should never be a disregarded entity. The name on line 1 should be the name shown on the income tax return on which the income should be reported. For example, if a foreign LLC that is treated as a disregarded entity for U.S. federal tax purposes has a single owner that is a U.S. person, the U.S. owner's name is required to be provided on line 1. If the direct owner of the entity is also a disregarded entity, enter the first owner that is not disregarded for federal tax purposes. Enter the disregarded entity’s name on line 2. If the owner of the disregarded entity is a foreign person, the owner must complete an appropriate Form W-8 instead of a Form W-9. This is the case even if the foreign person has a U.S. TIN. Line 2 If you have a business name, trade name, DBA name, or disregarded entity name, enter it on line 2. Line 3a Check the appropriate box on line 3a for the U.S. federal tax classification of the person whose name is entered on line 1. Check only one box on line 3a. IF the entity/individual on line 1 is a(n)... THEN check the box for... * Corporation Corporation. © Individual or © Sole proprietorship Individual/sole proprietor. ¢ LLC classified as a partnership for U.S. federal tax purposes or ¢ LLC that has filed Form 8832 or 2553 electing to be taxed as a corporation Limited liability company and enter the appropriate tax classification: P = Partnership, C = C corporation, or S = S$ corporation. * Partnership Partnership. * Trust/estate Trust/estate. Line 3b Check this box if you are a partnership (including an LLC classified as a partnership for U.S. federal tax purposes), trust, or estate that has any foreign partners, owners, or beneficiaries, and you are providing this form to a partnership, trust, or estate, in which you have an ownership interest. You must check the box on line 3b if you receive a Form W-8 (or documentary evidence) from any partner, owner, or beneficiary establishing foreign status or if you receive a Form W-9 from any partner, owner, or beneficiary that has checked the box on line 3b. Note: A partnership that provides a Form W-9 and checks box 3b may be required to complete Schedules K-2 and K-3 (Form 1065). For more information, see the Partnership Instructions for Schedules K-2 and K-3 (Form 1065). If you are required to complete line 3b but fail to do so, you may not receive the information necessary to file a correct information return with the IRS or furnish a correct payee statement to your partners or beneficiaries. See, for example, sections 6698, 6722, and 6724 for penalties that may apply. Line 4 Exemptions If you are exempt from backup withholding and/or FATCA reporting, enter in the appropriate space on line 4 any code(s) that may apply to you. Exempt payee code. ¢ Generally, individuals (including sole proprietors) are not exempt from backup withholding. « Except as provided below, corporations are exempt from backup withholding for certain payments, including interest and dividends. ¢ Corporations are not exempt from backup withholding for payments made in settlement of payment card or third-party network transactions. ¢ Corporations are not exempt from backup withholding with respect to attorneys’ fees or gross proceeds paid to attorneys, and corporations that provide medical or health care services are not exempt with respect to payments reportable on Form 1099-MISC. The following codes identify payees that are exempt from backup withholding. Enter the appropriate code in the space on line 4. 1—An organization exempt from tax under section 501 (a), any IRA, or a custodial account under section 403(b)(7) if the account satisfies the requirements of section 401(f)(2). Form W-9 (Rev. 3-2024) Page 4 2—The United States or any of its agencies or instrumentalities. 3—A state, the District of Columbia, a U.S. commonwealth or territory, or any of their political subdivisions or instrumentalities. 4—A foreign government or any of its political subdivisions, agencies, or instrumentalities. 5—A corporation. 6—A dealer in securities or commodities required to register in the United States, the District of Columbia, or a U.S. commonwealth or territory. 7—A futures commission merchant registered with the Commodity Futures Trading Commission. 8—A real estate investment trust. 9—An entity registered at all times during the tax year under the Investment Company Act of 1940. 10-—A common trust fund operated by a bank under section 584(a). 11—A financial institution as defined under section 581. 12—A middleman known in the investment community as a nominee or custodian. 13—A trust exempt from tax under section 664 or described in section 4947. The following chart shows types of payments that may be exempt from backup withholding. The chart applies to the exempt payees listed above, 1 through 13. IF the payment is for... THEN the payment is exempt for... * Interest and dividend payments | All exempt payees except for 7. ¢ Broker transactions Exempt payees 1 through 4 and 6 through 11 and all C corporations. S corporations must not enter an exempt payee code because they are exempt only for sales of noncovered securities acquired prior to 2012. ¢ Barter exchange transactions and patronage dividends Exempt payees 1 through 4. * Payments over $600 required to be reported and direct sales over $5,000' Generally, exempt payees 1 through 52 * Payments made in settlement of Exempt payees 1 through 4. payment card or third-party network transactions 1See Form 1099-MISC, Miscellaneous Information, and its instructions. ? However, the following payments made to a corporation and reportable on Form 1099-MISC are not exempt from backup withholding: medical and health care payments, attorneys’ fees, gross proceeds paid to an attorney reportable under section 6045(f), and payments for services paid by a federal executive agency. Exemption from FATCA reporting code. The following codes identify payees that are exempt from reporting under FATCA. These codes apply to persons submitting this form for accounts maintained outside of the United States by certain foreign financial institutions. Therefore, if you are only submitting this form for an account you hold in the United States, you may leave this field blank. Consult with the person requesting this form if you are uncertain if the financial institution is subject to these requirements. A requester may indicate that a code is not required by providing you with a Form W-9 with “Not Applicable” (or any similar indication) entered on the line for a FATCA exemption code. A-—An organization exempt from tax under section 501(a) or any individual retirement plan as defined in section 7701 (a)(87). B—The United States or any of its agencies or instrumentalities. C—A state, the District of Columbia, a U.S. commonwealth or territory, or any of their political subdivisions or instrumentalities. D—A corporation the stock of which is regularly traded on one or more established securities markets, as described in Regulations section 1.1472-1(c)(1)(i). E—A corporation that is a member of the same expanded affiliated group as a corporation described in Regulations section 1.1472-1(c)(1)(i). F—A dealer in securities, commodities, or derivative financial instruments (including notional principal contracts, futures, forwards, and options) that is registered as such under the laws of the United States or any state. G—A real estate investment trust. H—A regulated investment company as defined in section 851 or an entity registered at all times during the tax year under the Investment Company Act of 1940. |—A common trust fund as defined in section 584(a). J—A bank as defined in section 581. K—A broker. L—A trust exempt from tax under section 664 or described in section 4947(a)(1). M—A tax-exempt trust under a section 403(b) plan or section 457(g) plan. Note: You may wish to consult with the financial institution requesting this form to determine whether the FATCA code and/or exempt payee code should be completed. Line 5 Enter your address (number, street, and apartment or suite number). This is where the requester of this Form W-9 will mail your information returns. If this address differs from the one the requester already has on file, enter “NEW” at the top. If a new address is provided, there is still a chance the old address will be used until the payor changes your ~ address in their records. ; Line 6 Enter your city, state, and ZIP code. Part I. Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. If you are a resident alien and you do not have, and are not eligible to get, an SSN, your TIN is your IRS ITIN. Enter it in the entry space for the Social security number. If you do not have an ITIN, see How to get a TIN below. If you are a sole proprietor and you have an EIN, you may enter either your SSN or EIN. If you are a single-member LLC that is disregarded as an entity separate from its owner, enter the owner’s SSN (or EIN, if the owner has one). If the LLC is classified as a corporation or partnership, enter the entity’s EIN. Note: See What Name and Number To Give the Requester, later, for further clarification of name and TIN combinations. How to get a TIN. If you do not have a TIN, apply for one immediately. To apply for an SSN, get Form SS-5, Application for a Social Security Card, from your local SSA office or get this form online at www.SSA.gov. You may also get this form by calling 800-772-1213, Use Form W-7, Application for IRS Individual Taxpayer Identification Number, to apply for an ITIN, or Form SS-4, Application for Employer Identification Number, to apply for an EIN. You can apply for an EIN online by accessing the IRS website at www.irs.gov/EIN. Go to www.irs.gov/Forms to view, download, or print Form W-7 and/or Form SS-4. Or, you can go to www.irs.gov/OrderForms to place an order and have Farm W-7 and/or Form SS-4 mailed to you within 15 business days. If you are asked to complete Form W-9 but do not have a TIN, apply for a TIN and enter “Applied For” in the space for the TIN, sign and date the form, and give it to the requester. For interest and dividend payments, and certain payments made with respect to readily tradable instruments, you will generally have 60 days to get a TIN and give it to the requester before you are subject to backup withholding on payments. The 60-day rule does not apply to other types of payments. You will be subject to backup withholding on all such payments until you provide your TIN to the requester. Note: Entering “Applied For” means that you have already applied for a TIN or that you intend to apply for one soon. See also Establishing U.S. status for purposes of chapter 3 and chapter 4 withholding, earlier, for when you may instead be subject to withholding under chapter 3 or 4 of the Code. Caution: A disregarded U.S. entity that has a foreign owner must use the appropriate Form W-8. Form W-9 (Rev. 3-2024) Page 5 Part Il. Certification To establish to the withholding agent that you are a U.S. person, or resident alien, sign Form W-9. You may be requested to sign by the withholding agent even if item 1, 4, or 5 below indicates otherwise. For a joint account, only the person whose TIN is shown in Part | should sign (when required). in the case of a disregarded entity, the person identified on line 1 must sign. Exempt payees, see Exempt payee code, earlier. Signature requirements. Complete the certification as indicated in items 1 through 5 below. 1. Interest, dividend, and barter exchange accounts opened before 1984 and broker accounts considered active during 1983. You must give your correct TIN, but you do not have to sign the certification. 2. Interest, dividend, broker, and barter exchange accounts opened after 1983 and broker accounts considered inactive during 1983. You must sign the certification or backup withholding will apply. If you are subject to backup withholding and you are merely providing your correct TIN to the requester, you must cross out item 2 in the certification before signing the form. 3. Real estate transactions. You must sign the certification. You may cross out item 2 of the certification. 4, Other payments. You must give your correct TIN, but you do not have to sign the certification unless you have been notified that you have previously given an incorrect TIN. “Other payments” include payments made in the course of the requester’s trade or business for rents, royalties, goods (other than bills for merchandise), medical and health care services (including payments to corporations), payments to a nonemployee for services, payments made in settlement of payment card and third-party network transactions, payments to certain fishing boat crew members and fishermen, and gross proceeds paid to attorneys (including payments to corporations). 5. Mortgage interest paid by you, acquisition or abandonment of secured property, cancellation of debt, qualified tuition program payments (under section 529), ABLE accounts (under section 529A), IRA, Coverdell ESA, Archer MSA or HSA contributions or distributions, and pension distributions. You must give your correct TIN, but you do not have to sign the certification. What Name and Number To Give the Requester For this type of account: Give name and SSN of: — . Individual The individual ny wo Fal oa for] ~N . Two or more individuals (joint account) other than an account maintained by an FFI . Two or more U.S, persons (joint account maintained by an FFI) Custodial account of a minor (Uniform Gift to Minors Act) . a, The usual revocable savings trust (grantor is also trustee) b. So-called trust account that is not a legal or valid trust under state law . Sole proprietorship or disregarded entity owned by an individual . Grantor trust filing under Optional Filing Method 1 (see Regulations section 1.671-4(b)(2)(I)(A))** The actual owner of the account or, if combined funds, the first individual on the account? Each holder of the account The minor? The grantor-trustee! The actual owner’ The owner The grantor* Give name and EIN of: The owner For this type of account: 8, Disregarded entity not owned by an individual oO Legal entity? The corporation . A valid trust, estate, or pension trust 10, Corporation or LLC electing corporate status on Form 8832 or Form 2553 . Association, club, religious, charitable, educational, or other tax-exempt organization { prs The organization nm 12, Partnership or multi-member LLC 13. A broker or registered nominee 14. Account with the Department of Agriculture in the name of a public entity (such as a state or local government, school district, or prison) that receives agricultural program payments 15. Grantor trust filing Form 1041 or under the Optional Filing Method 2, requiring Form 1099 (see Regulations section 1.671-4(b)(2)()(B)** The partnership The broker or nominee The public entity The trust ‘List first and circle the name of the person whose number you furnish. If only one person on a joint account has an SSN, that person’s number must be furnished. ? Circle the minor’s name and furnish the minor’s SSN. ’You must show your individual name on line 1, and enter your business or DBA name, if any, on line 2. You may use either your SSN or EIN (if you have one), but the IRS encourages you to use your SSN. ‘List first and circle the name of the trust, estate, or pension trust. (Do not furnish the TIN of the personal representative or trustee unless the legal entity itself is not designated in the account title.) *Note: The grantor must also provide a Form W-9 to the trustee of the trust. “For more information on optional filing methods for grantor trusts, see the Instructions for Form 1041. Note: If no name is circled when more than one name is listed, the number will be considered to be that of the first name listed. Secure Your Tax Records From Identity Theft Identity theft occurs when someone uses your personal information, such as your name, SSN, or other identifying information, without your permission to commit fraud or other crimes. An identity thief may use your SSN to get a job or may file a tax return using your SSN to receive a refund. To reduce your risk: * Protect your SSN, ¢ Ensure your employer is protecting your SSN, and ¢ Be careful when choosing a tax return preparer. !f your tax records are affected by identity theft and you receive a notice from the IRS, respond right away to the name and phone number printed on the IRS notice or letter. If your tax records are not currently affected by identity theft but you think you are at risk due to a lost or stolen purse or wallet, questionable credit card activity, or a questionable credit report, contact the IRS Identity Theft Hotline at 800-908-4490 or submit Form 14039. For more information, see Pub. 5027, Identity Theft Information for Taxpayers. Form W-9 (Rev. 3-2024) Page 6 Victims of identity theft who are experiencing economic harm or a systemic problem, or are seeking help in resolving tax problems that have not been resolved through normal channels, may be eligible for Taxpayer Advocate Service (TAS) assistance. You can reach TAS by calling the TAS toll-free case intake line at 877-777-4778 or TTY/TDD 800-829-4059, Protect yourself from suspicious emails or phishing schemes. Phishing is the creation and use of email and websites designed to mimic legitimate business emails and websites. The most common act is sending an email to a user falsely claiming to be an established legitimate enterprise in an attempt to scam the user into surrendering private information that will be used for identity theft. The IRS does not initiate contacts with taxpayers via emails. Also, the IRS does not request personal detailed information through email or ask taxpayers for the PIN numbers, passwords, or similar secret access information for their credit card, bank, or other financial accounts. If you receive an unsolicited email claiming to be from the IRS, forward this message to phishing@irs.gov. You may also report misuse of the IRS name, logo, or other IRS property to the Treasury Inspector General for Tax Administration (TIGTA) at 800-366-4484. You can forward suspicious emails to the Federal Trade Commission at spam@uce.gov or report them at www.ftc.gov/complaint. You can contact the FTC at www.ftc.gov/idtheft or 877-IDTHEFT (877-438-4338). If you have been the victim of identity theft, see www./dentityTheft.gov and Pub. 5027. Go to www.irs.gov/IdentityTheft to learn more about identity theft and how to reduce your risk. Privacy Act Notice Section 6109 of the Internal Revenue Code requires you to provide your correct TIN to persons (including federal agencies) who are required to file information returns with the IRS to report interest, dividends, or certain other income paid to you; mortgage interest you paid; the acquisition or abandonment of secured property; the cancellation of debt; or contributions you made to an IRA, Archer MSA, or HSA. The person collecting this form uses the information on the form to file information returns with the IRS, reporting the above information. Routine uses of this information include giving it to the Department of Justice for civil and criminal litigation and to cities, states, the District of Columbia, and U.S. commonwealths and territories for use in administering their laws. The information may also be disclosed to other countries under a treaty, to federal and state agencies to enforce civil and criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism. You must provide your TIN whether or not you are required to file a tax return. Under section 3406, payors must generally withhald a percentage of taxable interest, dividends, and certain other payments to a payee who does not give a TIN to the payor. Certain penalties may also apply for providing false or fraudulent information. POLYDYNE INC CERTIFICATE OF RESOLUTIONS |, Christopher J, Gannon, Secretary of Polydyne Inc., a Delaware corporation (the “Company”), do hereby certify that at a duly called meeting of the Board of Directors of the Company, held on January 8, 2020, the Board of Directors unanimously approved the following Resolutions: RESOLVED, that Boyd Stanley, René Pich, John Pittman, Mark Schlag, Bobby Wise and Ken Luke be and hereby are authorized, empowered and directed to bid, in the name of and on behalf of the Corporation, upon such municipal projects as he may deem appropriate; and further RESOLVED, that Boyd Stanley, René Pich, John Pittman, Mark Schlag, Bobby Wise and Ken Luke be and hereby are authorized and empowered to execute and deliver, in the name of and on behalf of the Corporation, all documents, instruments, certificate, agreements and papers as he may deem advisable or necessary or proper to effect the Corporation's municipal bids or the transactions contemplated thereby; and further RESOLVED, that any Officer of the Corporation be and hereby is authorized and empowered, and to the extent necessary or advisable, directed, to attest the execution of any document executed pursuant to these resolutions, and to affix the seal of the Corporation thereto, and to certify under seal to any municipality the adoption of these resolutions; and further RESOLVED, that the authorizations granted under these Resolutions shall continue ‘in full force and effect until successors to the foregoing representatives of the Corporation shall have been duly appointed or until the death, resignation or removal of each such representative. IN WITNESS WHEREOF, the undersigned has signed this Certificate of Resolutions with effect this 8" day of January 2020. aver J. Gantfon, Secretary ie él ticity of this copy of the Resolution of the Board of Directors. This resolution is still valid and in efféct as of date signed. Mark Schlag ] pe Vice President Finance, Assistant-Secretary & Treasurer Date: 05/14/25 Federal Identification No. State of Incorporation: Date of Incorporation: Administrative Offices: Polydyne Inc. General Information 34-1810283 Delaware August 21, 1995 P.O. Box 279, 1 Chemical Plant Road Riceboro, GA 31323 Payment Address: P.O. Box 404642 Atlanta, GA 30384-4642 Board of Directors | John Pittman Officers President John Pittman Secretary Christopher Gannon VP-Finance, CFO, Treasurer & Assistant Secretary Mark Schlag Senior Vice President Boyd Stanley Vice President Ken Luke *Authorized Signers-Non Officers | Bobby Wise | Controller Ownership Disclosure Corporation Percent Ownership Owner Polydyne Inc. 100 SNF Holding Company SNF Holding Company 100 SPCM SA SPCM SA 100 Mr. René PICH holds and/or controls 100% of the shares of SPCM SA, a company duly organized and existing under the laws of France, whose registered office is in ZAC de Milieux, Andrézieux, (42163), FRANCE, registered under the number 312 327 737 in the Commercial Registry of the town of Saint-Etienne (42000), FRANCE. Rey. 11/2022 SNF WATER SCIENCE polydyneinc.com AFFIDAVIT OF PRODUCT PURITY AND SUITABILITY State of GEORGIA County of LIBERTY Before me, the undersigned authority, personally appeared Boyd Stanley who, being by me duly sworn, deposed as follows: My name is Boyd Stanley and | am the Sr. Vice-President of Polydyne Inc. Located at One Chemical Plant Road, Riceboro, GA 31323. 1am authorized to make this affidavit on behalf of the company in connection with our bid submission to the Brushy Creek Regional Utility Authority (BCRUA). The products to be supplied under this bid are Clarifloc C-378, a cationic flocculant intended for potable water clarification, and Clarifloc C-6240, a cationic polymer designed for sludge dewatering using a belt filter press. Clarifloc C-378 is certified by NSF International under NSF/ANSI Standard 60 for use in drinking water treatment, with a maximum approved dosage of 50 mg/L. Clarifloc C-6240 is manufactured to meet high-quality standards and is widely used in municipal and industrial applications for effective sludge dewatering. Clarifloc C-378 is suitable for use by BCRUA in potable water clarification processes, where it aids in the aggregation and removal of suspended solids. Clarifloc C-6240 is appropriate for use in sludge dewatering operations utilizing a belt filter press, offering efficient performance and compatibility with standard treatment systems. Attached to this affidavit are supporting documents, including the NSF certification for Clarifloc C-378 and technical data sheets for both products, verifying their purity and suitability for the intended applications. Boyd Stanley Sr. Vice-President Polydyne Inc. Subscribed and sworn to before me this 15" day of May, 2025. ’ Notary Public Signature [Notary Seal] ? My commission expires: ___.s* & = Os “\gSION ly, S = os TES oan a7 e TUVIO CU Tae = oO oS a 0 3 o = =O3 iG zsh Cup ses SB ndy iy SES gyro seer, OS e, 40'F Cords Polydyne Inc. « 1 Chemfd4! ®Ent Road « Riceboro, GA 31323 USA °« Tel 800.848.7659 SNF WATER SCIENCE polydyneinc.com STATEMENT OF EXPERIENCE POLYDYNE INC. (“POLYDYNE”) is a wholly owned subsidiary of SNF HOLDING COMPANY (“SNFHC”). POLYDYNE is the largest supplier of water-soluble polymers to the municipal market in the United States. In addition to POLYDYNE, SNFHC operates nine manufacturing plants in the United States. We are a fully integrated manufacturing company and produce several of our key raw materials. POLYDYNE is also the only polymer supplier that offers a full range of polymers, i.e. powders, emulsions and solutions. Worldwide our company has been in operation for over 30 years. POLYDYNE’S exclusive charter is to be the direct marketing organization for all SNFHC-produced products, to the municipal market, in the United States, particularly those requiring “Manufacturer Only”. Polydyne Inc. Contact Information: Bids and Contracts Information: Boyd Stanley, Sr. Vice-President PH: (800) 848-7659 Option 2 FX: (912) 880-2078 EM: bids@polydyneinc.com Sales and Technical Support: Brent SoRelle, Sr. Technical Sales Representative Rick Johnson, Regional Sales Manager PH: (682) 216-5062 PH: (281) 630-4591 FX: (912) 880-2078 FX: (912) 880-2078 EM: bsorelle@polydyneinc.com EM: rjohnson@polydyneinc.com Froud Mink, 7 Boyd Stanley = Sr. Vice-President POLYDYNE INC. Date: May 14, 2025 Polydyne Inc. « 1 Chemical Plant Read * Riceboro, GA 31323 USA « Tel 800.848.7659 5/14/25, 3:13 PM Listing Category Search Page | NSF International The Public Health and Safety Organization NSF Product and Service Listings These NSF Official Listings are current as of Wednesday, May 14, 2025 at 12:15 a.m. Eastern Time. Please contact NSF to confirm the status of any Listing, report errors, or make suggestions. Alert: NSF is concerned about fraudulent downloading and manipulation of website text. Always confirm this information by clicking on the below link for the most accurate information: http://info.nsf.org /Certified/PwsChemicals/Listings.asp? CompanyName=polydyne&TradeName=c%2D378& NSF/ANSI/CAN 60 Drinking Water Treatment Chemicals - Health Effects Polydyne Incorporated P.O. Box 279 Riceboro, GA 31323 United States 800-848-7659 Visit this company's website (http://www.polydyneinc.com), Facility : Los Angeles, CA Poly (Diallyldimethylammonium Chloride)(pDADMAC) Trade Designation Product Function Max Use Clarifloc® C-378 Coagulation & Flocculation 50m¢g/L Facility : Riceboro, GA https://info.nsf.org/Certified/PwsChemicals/Listings.asp? CompanyName=polydyne&TradeName=c-378&ChemicalName=&ProductFunction=&PlantSta... 1/2 5/14/25, 3:13 PM Listing Category Search Page | NSF International Poly (Diallyldimethylammonium Chloride)(pDADMAC) Trade Designation Product Function Max Use Clarifloc® C-378 Coagulation & Flocculation 50mg/L Facility : Dolton, IL Poly (Diallyldimethylammonium Chloride)(pDADMAC) Trade Designation Product Function Max Use Clarifloc® C-378 Coagulation & Flocculation 50m¢g/L Facility : Pearlington, MS Poly (Diallyldimethylammonium Chloride)(pDADMAC) Trade Designation Product Function Max Use Clarifloc® C-378 Coagulation & Flocculation 50m¢/L Number of matching Manufacturers is 1 Number of matching Products is 4 Processing time was 1 seconds https://info.nsf.org/Certified/PwsChemicals/Listings.asp? CompanyName=polydyne& TradeName=c-378&ChemicalName=&ProductFunction=&PlantSta... 2/2 CERTIFICATE Polydyne Inc. 5 N F OF 3080 PORT & HARBOR DRIVE POLYDYNE ANALYSIS INDUSTRIAL PARK ROAD D PEARLINGTON MS 39572 CUSTOMER NAME : SAMPLE OA#: SAMPLE POLYDYNE PRODUCT NAME : CLARIFLOC C-378 PURCHASE ORDER NR: SAMPLE DATE: — 02/09/2025 AMOUNT : SAMPLE QUALITY CONTROL QC BATCH NUMBER UNIT SPECIFICATION PPDD/49746 TEST NON VOLATILE SOLIDS % 19.0 - 22.0 20.2 3100 A pH on solution 5.0 - 7.0 5.7 3130A BROOKFIELD VISCOSITY cps 1000 - 3000 1520 3420 A (LV3, 30 rpm) Date: 02/09/2025 Signature Darryl Matranga If the # symbol appears in the QC-TEST column, then the data on that line is given for information only, and does not constitute a specification. If ND appears in the result column, that means under the limit of detection. For Personal Care ingredients, the generic name is corresponding to the INCI name. SUP NR: OG-0098 REVISION: 04 SNF WATER SCIENCE POLYDYNE CLARIFLOC C-378 POLYMER CHARACTERISTICS CLARIFLOC C-378 polymer isa high molecular weight, homopolymer of diallyldimethylammonium chloride. It is an effective organic coagulant for water clarification ina wide variety of municipal applications. CLARIFLOC C-378 can partially or totally replace alum, ferric, lime and other inorganic coagulants, thereby reducing sludge volume. Unlike inorganics, it is effective over very wide pH ranges. CLARIFLOC C-378 is NSF certified for clarification of potable water at dosages up to 50 mg/L. TYPICAL PROPERTIES Physical Form Amber Liquid Density 8.5 - 8.9 Ibs/gal Freezing Point -3C. Solubility Totally Water Soluble PREPARATION AND FEEDING CLARIFLOC C-378 isasolution polymer which can be diluted to any convenient concentration for feeding. No special make- down or activation procedures are necessary. The polymer can be diluted in-line using a static mixer or in a stirred vessel. Diluting to 1-10% product is highly recommended for all clarification application because the coagulant will be distributed more efficiently into the system with less chance of overdose. MATERIALS OF CONSTRUCTION Crosslinked polyethylene, fiberglass, stainless steel and lined mild steel are the preferred materials of construction for bulk tanks. Unlined mild steel, black iron, galvanized steel, or copper are not recommended in any part of the polymer feed system. Stainless steel or PVC are the best choice for pump heads and feed lines. MANUFACTURING SPECIFICATIONS Specific Gravity 1.02- 1.05 % Active 19.0-22.0 Product Viscosity 1,000 - 3,000 cPs Product pH 5.0-7.0 HANDLING AND STORAGE CLARIFLOC C-378 has asuggested in-plant storage life of six months in unopened drums. For best results, store at 40-90 F. Protect from freezing. Ifthe product freezes, allow itto warm up in a heated area and thaw thoroughly before attempting to use it. For spills of CLARIFLOC C-378, sprinkle sawdust or vermiculite over the spill area and sweep the material into approved chemical disposal containers. PRODUCT SAFETY INFORMATION CLARIFLOC C-378 is amildly acidic product that can irritate the skin and eyes, so gloves, rubber apron and goggles should be worn during the handling of this product. Anyone responsible for the procurement, use or disposal of this product should familiarize themselves with the appropriate safety and handling information outlined inthe POLYDYNE Material Safety Data Sheet. Inthe event ofan emergency with CLARIFLOC C-378, contact Chemtrec anytime day or night at (800) 424-9300. SHIPPING CLARIFLOC C-378 Polymer is shipped in 55 gallon drums containing 450 pounds net and in 275 gallon totes containing 2300 pounds net. Bulk quantities are also available. ADDITIONAL INFORMATION To place an order or obtain technical information from any location in the continental United States, call toll free: (800) 848-7659 For additional information, please refer to the Safety Data Sheet (SDS) All statements, information and data given herein are believed to be accurate, but are presented without warranty, expressed or implied. Statements concerning possible use are made without representation or warranty that any such use is free of patent infringement, and is not a recommendation to infringe on any patent. The user should not assume that all safety measures are indicated or that other measures may not be required. Any determination of the suitability of a particular product for any use contemplated by the user is the sole responsibility of the user. © 2023 POLYDYNE INC. | 0323 Polydyne Inc. ¢ 1 Chemical Plant Road « Riceboro, GA 31323 « Tel 800.848.7659 * Fax 912.880.2078 * www.polydyneinc.com Heaith-safety | f Environment : SAFETY DATA SHEET According to U.S. Code of Federal Regulations 29 CFR 1910.1200, Hazard Communication. SECTION 1: Identification of the substance/mixture and of the company/undertaking 1.1. Product identifier Product name: CLARIFLOC™ C-378 Type of product: Mixture. 1.2. Relevant identified uses of the substance or mixture and uses advised against Identified uses: Processing aid for industrial applications. Uses advised against: None. 1.3. Details of the supplier of the safety data sheet C POLYDYNE INC may 1 Chemical Plant Road PO BOX 279 Riceboro, GA 31323 Telephone: 1-800-848-7659 Telefax: (912)-884-8770 E-mail address: 7 1.4. Emergency telephone number 24-hour emergency number: 1-800-424-9300 SECTION 2: Hazards identification 2.1. Classification of the substance or mixture Classification according to paragraph (d) of 29 CFR 1910.1200: Not classified. 2.2. Label elements Labelling according to paragraph (f) of 29 CFR 1910.1200: Print Date: 05/14/2025 Revision date: 11/08/2024 Page: 1/10 SAFETY DATA SHEET CLARIFLOC™ C-378 Hazard symbol(s): None. Signal word: None. Hazard statement(s): None. Precautionary statement(s): None. 2.3. Other hazards Spills produce extremely slippery surfaces. SECTION 3: Composition/information on ingredients 3.1. Substances Not applicable, this product is a mixture. 3.2. Mixtures Hazardous components Contains no reportable hazardous substances. SECTION 4: First aid measures 4.1. Description of first aid measures Inhalation: Move to fresh air. No hazards which require special first aid measures. Skin contact: 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. Eye contact: Rinse immediately with plenty of water, also under the eyelids, for at least 15 minutes. Alternatively, rinse immediately with Diphoterine ®. Get prompt medical attention. Ingestion: Rinse mouth with water. Do NOT induce vomiting. Get medical attention immediately if symptoms occur. 4.2. Most important symptoms and effects, both acute and delayed None under normal use. 4.3. Indication of any immediate medical attention and special treatment needed None reasonably foreseeable. Other information: None. Print Date: 05/14/2025 Revision date: 11/08/2024 Page: 2/10 SAFETY DATA SHEET CLARIFLOC™ C-378 SECTION 5: Firefighting measures 5.1. Extinguishing media Suitable extinguishing media: Water. Water spray. Foam. Carbon dioxide (CO2). Dry powder. Warning! Spills produce extremely slippery surfaces. Unsuitable extinguishing media: None known. 3.2. Special hazards arising from the substance or mixture Hazardous decomposition products: Thermal decomposition may produce: hydrogen chloride gas, nitrogen oxides (NOx), carbon oxides (COx). Hydrogen cyanide (hydrocyanic acid) may be produced in the event of combustion in an oxygen deficient atmosphere. 5.3. Advice for firefighters Protective measures: Wear self-contained breathing apparatus and protective suit. Other information: Spills produce extremely slippery surfaces. SECTION 6: Accidental release measures 6.1. Personal precautions, protective equipment and emergency procedures Personal precautions: Do not touch or walk through spilled material. Spills produce extremely slippery surfaces. Protective equipment: Wear adequate personal protective equipment (see Section 8 Exposure Controls/Personal Protection). Emergency procedures: Keep people away from spill/leak. Prevent further leakage or spillage if safe to do so. 6.2. Environmental precautions Do not contaminate water. 6.3. Methods and material for containment and cleaning up 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. 6.4. Reference to other sections Print Date: 05/14/2025 Revision date: 11/08/2024 Page: 3/10 SAFETY DATA SHEET CLARIFLOC™ C-378 SECTION 7: Handling and storage; SECTION 8: Exposure controls/personal protection; SECTION 13: Disposal considerations; SECTION 7: Handling and storage 7.1. Precautions for safe handling Avoid contact with skin and eyes. Renders surfaces extremely slippery when spilled. When using, do not eat, drink or smoke. 7.2. Conditions for safe storage, including any incompatibilities Keep away from heat and sources of ignition. Freezing will affect the physical condition and may damage the material. 7.3. Specific end use(s) This information is not available. SECTION 8: Exposure controls/personal protection 8.1. Control parameters Occupational exposure limits: None known. 8.2. Exposure controls Appropriate engineering controls: Use local exhaust if misting occurs. Natural ventilation is adequate in absence of mists. Individual protection measures, such as personal protective equipment: a) Eye/face protection: 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). b) Skin protection: i) Hand protection: 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. ii) Other; 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. c) Respiratory protection: No personal respiratory protective equipment normally required. d) Additional advice: 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. Print Date: 05/14/2025 Revision date: 11/08/2024 Page: 4/10 SAFETY DATA SHEET CLARIFLOC™ C-378 Environmental exposure controls: Do not allow uncontrolled discharge of product into the environment. SECTION 9: Physical and chemical properties 9.1. Information on basic physical and chemical properties a) Appearance: b) Odour: c) Odour Threshold: d) pH: e) Melting point/freezing point: f) Initial boiling point and boiling range: g) Flash point: h) Evaporation rate: i) Flammability (solid, gas): J) Upper/ower flammability or explosive limits: k) Vapour pressure: |) Vapour density: m) Relative density: n) Solubility(ies): 0) Partition coefficient n-octanol/water (log value): p) Autoignition temperature: q) Decomposition temperature: r) Viscosity: s) Kinematic viscosity: t) Explosive properties: u) Oxidizing properties: v) Particle characteristics: 9.2. Other information Clear to slightly yellow liquid. None. Not applicable. 3 - 7 (See Technical Bulletin or Product Specifications for a more precise value, if available) <5°C > 100°C Does not flash. 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 in water. <0 Does not self-ignite (based on the chemical structure). > 150°C See Technical Bulletin. No data available. Not expected to be explosive based on the chemical structure. Not expected to be oxidising based on the chemical structure. Not applicable. Print Date: 05/14/2025 Revision date: 11/08/2024 Page: 5/10 SAFETY DATA SHEET CLARIFLOC™ C-378 None. SECTION 10: Stability and reactivity 10.1. Reactivity Stable under recommended storage conditions. 10.2. Chemical stability Stable under recommended storage conditions. 10.3. Possibility of hazardous reactions None known. 10.4. Conditions to avoid Protect from frost, heat and sunlight. 10.5. Incompatible materials None known. 10.6. Hazardous decomposition products Thermal decomposition may produce: hydrogen chloride gas, nitrogen oxides (NOx), carbon oxides (COx). Hydrogen cyanide (hydrocyanic acid) may be produced in the event of combustion in an oxygen deficient atmosphere. SECTION 11: Toxicological information 11.1. Information on toxicological effects Information on the product as supplied: Acute oral toxicity: Acute dermal toxicity: Acute inhalation toxicity: Skin corrosion/irritation: Serious eye damage/eye irritation: Respiratory/skin sensitisation: Mutagenicity: Carcinogenicity: LD50/oral/rat > 5000 mg/kg LD50/dermal/rat > 5000 mg/kg. Testing by the inhalation route is inappropriate because exposure of humans via inhalation is unlikely: the substance has no vapour pressure and there is practically no exposure to inhalable aerosols. Not irritating. Slightly irritating. Not sensitizing to skin. No respiratory sensitization has been observed in the workplace. Not mutagenic. By analogy with similar substances, this substance is not expected to be carcinogenic. Print Date: 05/14/2025 Revision date: 11/08/2024 Page: 6/10 SAFETY DATA SHEET CLARIFLOC™ C-378 Reproductive toxicity: By analogy with similar substances, this substance is not expected to be toxic for reproduction. STOT - Single exposure: No known effects. STOT - Repeated exposure: No known effect. Aspiration hazard: No hazards resulting from the material as supplied. SECTION 12: Ecological information 12.1. Toxicity Information on the product as supplied: Acute toxicity to fish: LC50/Danio rerio/96 hours > 100 mg/L Acute toxicity to invertebrates: EC50/Daphnia magna/48 hours > 100 mg/L Acute toxicity to algae: Algal inhibition tests are not appropriate. The flocculation characteristics of the product interfere directly in the test medium preventing homogenous distribution which invalidates the test. Chronic toxicity to fish: No data available. Chronic toxicity to invertebrates: No data available. Toxicity to microorganisms: EC0/activated sludge/0.5 hours = 1000 mg/L (OECD 209) Effects on terrestrial organisms: Exposure to soil is unlikely. Sediment toxicity: Exposure to sediment is unlikely. 12.2. Persistence and degradability Information on the product as supplied: Degradation: Not readily biodegradable. Hydrolysis: Does not hydrolyse. Photolysis: No data available. 12.3. Bioaccumulative potential Information on the product as supplied: Not bioaccumulating. Print Date: 05/14/2025 Revision date: 11/08/2024 Page: 7/10 SAFETY DATA SHEET CLARIFLOC™ C-378 Partition co-efficient (Log Pow): <0 Bioconcentration factor (BCF): ~0 12.4. Mobility in soil Information on the product as supplied: Exposure to soil is not to be expected. Koc; ~0 12.5. Other adverse effects None known. SECTION 13: Disposal considerations 13.1. Waste treatment methods Waste from residues/unused products: Dispose in accordance with local and national regulations. Contaminated packaging: 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. Recycling: Store containers and offer for recycling of material when in accordance with the local regulations. SECTION 14: Transport information Land transport (DOT) Not classified. Sea transport (IMDG) Not classified. Air transport (IATA) Not classified. SECTION 15: Regulatory information Print Date: 05/44/2025 Revision date: 11/08/2024 Page: 8/10 SAFETY DATA SHEET CLARIFLOC™ C-378 SECTION 15: Regulatory information 15.1. Safety, health and environmental regulations/legislation specific for the substance or mixture Information on the product as supplied: TSCA Chemical Substances Inventory: All components of this product are either listed as active on the inventory or are exempt from listing. US SARA Reporting Requirements: SARA (Section 311/312) hazard class: Not concerned. SARA Title ill Sections: Section 302 (TPQ) - Reportable Quantity: Not concerned. Section 304 - Reportable Quantity: Not concerned. Section 313 (De minimis concentration): Not concerned. Clean Water Act Section 311 Hazardous Substances (40 CFR 117.3) - Reportable Quantity: Not concerned. Clean Air Act Section 112(r) Accidental release prevention requirements (40 CFR 68) - Reportable Quantity: Not concerned. CERCLA Hazardous Substances List (40 CFR 302.4) - Reportable Quantity: Not concerned. RCRA status : Not RCRA hazardous. California Proposition 65 Information: Not concerned. SECTION 16: Other information NFPA and HMIS Ratings: Print Date: 05/14/2025 Revision date: 11/08/2024 Page: 9/10 SAFETY DATA SHEET CLARIFLOC™ C-378 NFPA: Health: Flammability: Instability: HMIS: Health: Flammability: Physical Hazard: PPE Code: oo wooo This data sheet contains changes from the previous version in section(s): SECTION 12. Ecological information, SECTION 16. Other Information. Key or legend to abbreviations and acronyms used in the safety data sheet: Acronyms STOT = Specific target organ toxicity Training advice: Do not handle until all safety precautions have been read and understood. This SDS was prepared in accordance with the following: U.S. Code of Federal Regulations 29 CFR 1910.1200 Version: 24.01.a LDCC010A 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. Print Date: 05/14/2025 Revision date: 11/08/2024 Page: 10/10 5/14/25, 3:14 PM Listing Category Search Page | NSF International The Public Health and Safety Organization NSF Product and Service Listings These NSF Official Listings are current as of Wednesday, May 14, 2025 at 12:15 a.m. Eastern Time. Please contact NSF to confirm the status of any Listing, report errors, or make suggestions. Alert: NSF is concerned about fraudulent downloading and manipulation of website text. Always confirm this information by clicking on the below link for the most accurate information: http://info.nsf.org/Certified/PwsChemicals/Listings.asp? CompanyName=polydyne&TradeName=c%2D6240& NSF/ANSI/CAN 60 Drinking Water Treatment Chemicals - Health Effects Polydyne Incorporated P.O. Box 279 Riceboro, GA 31323 United States 800-848-7659 Visit this company's website (http://www.polydyneinc.com) Facility : Riceboro, GA Polyacrylamide[PC] Trade Designation Product Function Max Use Clarifloc®) C-6240 Coagulation & Flocculation 3 mg/L [PC] Polyacrylamide Products Certified by NSF International comply with 40 CFR 141.111 requirements for percent monomer and dose. https://info.nsf.org/Certified/PwsChemicals/Listings.asp? CompanyName=polydyne&TradeName=c-6240&ChemicalName=&ProductFunction=&PlantSt... 1/2 5/14/25, 3:14 PM Listing Category Search Page | NSF International Number of matching Manufacturers is 1 Number of matching Products is 1 Processing time was 1 seconds https://info.nsf.org/Certified/PwsChemicals/Listings.asp? CompanyName=polydyne&TradeName=c-6240&ChemicalName=&ProductFunction=&PlantSt... 2/2 CERTIFICATE Polydyne Inc, S N F OF 3929 MEDFORD STREET CUSTOMER NAME : SAMPLE LOS ANGELES CA 90063 OA#: SAMPLE POLYDYNE PRODUCT NAME : CLARIFLOC C-6240 PURCHASE ORDER NR: SAMPLE DATE: 01/07/2025 AMOUNT : SAMPLE QUALITY CONTROL ac BATCH NUMBER UNIT SPECIFICATION RC32/4186M TEST BULK VISCOSITY cps 500 - 2000 1560 1010A NON VOLATILE SOLIDS % 43.0 - 50.0 46.6 1050 A UL BROOKFIELD VISCOSITY cps 4.30 - 5.30 4.81 1019A RESIDUAL ACRYLAMIDE ppm 0 - 499 30 1001 A Date: 01/07/2025 Signature Kimberly Fitch If the # symbol appears in the QC-TEST column, then the data on that line is given for information only, and does not constitute a specification. If ND appears in the result column, that means under the limit of detection. For Personal Care ingredients, the generic name is corresponding to the INCI name. SUP NR: OG-0098 REVISION: 04 WATER SCIENCE POLYDYNE CLARIFLOC C-6240 POLYMER PRINCIPAL USES CLARIFLOC C-6240 is a medium charge cationic polyacrylamide in emulsion form that is used as a flocculant in a wide variety of municipal and industrial wastewater treatment applications. It has been success- fully applied in all liquid/solids separation systems including clarifica- tion, thickening, and dewatering. Clarifloc C-6240 is NSF certified for clarification of potable water at dosages up to 3.0 mg/L. TYPICAL PROPERTIES Physical Form Clear to Milky White Liquid Density 8.6 - 8.7 lbs/gal Cationicity 40 % Active Polyacrylamide Min. 39% Freezing Point 7F.(-14C,) PREPARATION AND FEEDING CLARIFLOC C-6240 is a single component emulsion polymer that must be pre-diluted in water before use. In most cases, this product should not be applied neat. One method for dilution is adding the neat polymer into the vortex of a mixed tank at a concentration between 0.25-1.0% polymer (0.5% is optimum) by weight. The polymer can also be injected through a number of commercially available systems that provide in-line mechanical mixing. The best feed systems use initial high energy mixing (>1000 rpm) for a short time (<30 sec) to achieve good dispersion followed by low energy mixing (<400 rpm) fora longer time (10-30 min). Polymer solutions should be aged for 15-60 minutes for best results. Solution shelf life is 8-16 hours. MATERIALS OF CONSTRUCTION Cross-linked polyethylene, fiberglass, stainless steel or lined steel are the preferred materials of construction for bulk tanks. Avoid natural rubber and Buna-N gaskets as these materials swell when placed in contact with neat polymer. Unlined mild steel, black iron, galvanized steel, copper or brass are not recommended in any part of the feed system. Stainless steel, Viton or Teflon are the best choices for pump heads. For feed lines, use PVC or reinforced Tygon tubing. MANUFACTURING SPECIFICATIONS Total Solids 43-50% Residual AcAm < 500 ppm Neat Viscosity 500 - 2000 cPs UL Viscosity 4.3 -5.3 cPs HANDLING AND STORAGE Suggested in-plant storage life is 6 months in unopened drums. For best results, store at 50-80 F. Bulk tanks should be mixed by periodically recirculating the contents bottom to top. Bulk tanks can also be fitted with an agitator type mixer that reaches the bottom 2 feet of the tank. Drums and bins should be mixed very well before first use and weekly after that. Do not allow emulsion polymers to freeze. Should freezing } occur, allow the product to thaw thoroughly in a heated area and mix | well before attempting to use it. For spills of CLARIFLOC C-6240, | sprinkle vermiculite or equivalent absorbant over the spill area and | sweep the material into approved chemical disposal containers. Do | not spray water onto a spill because the resulting gel is very difficult | to clean up. SAFETY INFORMATION CLARIFLOC C-6240 is a mildly acidic product that can irritate the | skin and eyes and should be handled accordingly. Gloves, goggles and apron are highly recommended. Anyone responsible for the procure- | H ment, use or disposal of this product should familiarize themselves with | the appropriate safety and handling precautions involved. Such | information is outlined inthe POLYDYNE Material Safety Data Sheet. | In the event of an emergency with this product, contact Chemtrec | anytime day or night at (800) 424-9300. SHIPPING CLARIFLOC C-6240 Polymer is shipped in 55 gallon drums containing 450 pounds net orin 275 gallon totes containing 2300 poundsnet. Bulk quantities are also available. ADDITIONAL INFORMATION To place an order or obtain technical information from anywhere in the continental United States, call toll free: (800) 848-7659 For additional information, please refer to the Safety Data Sheet (SDS) All statements, information and data given herein are believed to be accurate, but are presented without warranty, expressed or implied. Statements concerning possible use are made without representation or warranty that any such use is free of patent infringement, and is not a recommendation to infringe on any patent. The user should not assume that all safety measures are indicated or that other measures may not be required. Any determination of the suitability of a particular product for any use contemplated by the user is the sole responsibility of the user. © 2023 POLYDYNE INC. | 0323 Polydyne Inc. © 1 Chemical Plant Road « Riceboro, GA 31323 « Tel 800.848.7659 * Fax 912.880.2078 * www.polydyneinc.com SAFETY DATA SHEET According to U.S. Code of Federal Regulations 29 CFR 1910.1200, Hazard Communication. SECTION 1: Identification of the substance/mixture and of the company/undertakin 7.1. Product identifier Product name: CLARIFLOC™ C-6240 Type of product: Mixture. 1.2. Relevant identified uses of the substance or mixture and uses advised against Identified uses: Processing aid for industrial applications. Uses advised against: None. 1.3. Details of the supplier of the safety data sheet C . POLYDYNE INC» ompee 1 Chemical Plant Road PO BOX 279 Riceboro, GA 31323 Telephone: 1-800-848-7659 Telefax: (912)-884-8770 E-mail address: ” 1.4. Emergency telephone number 24-hour emergency number: 1-800-424-9300 SECTION 2: Hazards identification 2.1. Classification of the substance or mixture Classification according to paragraph (d) of 29 CFR 1910.1200: Not classified. 2.2. Label elements Labelling according to paragraph (f) of 29 CFR 1910.1200: Print Date: 05/14/2025 Revision date: 12/06/2024 Page: 1/15 SAFETY DATA SHEET CLARIFLOC™ C-6240 Hazard symbol(s): None. Signal word: None. Hazard statement(s): None. Precautionary statement(s): None. 2.3. Other hazards Spills produce extremely slippery surfaces. For explanation of abbreviations see Section 16. SECTION 3: Composition/information on ingredients 3.1, Substances Not applicable, this product is a mixture. 3.2, Mixtures Hazardous components Distillates (petroleum), hydrotreated light Concentration/ -range: 20 - 30% CAS Number: 64742-47-8 Classification according to paragraph (d) Asp. Tox. 1;H304 of 29 CFR 1910.1200: Notes Does not result in classification of the mixture if the kinematic viscosity is greater than 20.5 mm?/s measured at 40°C. Poly(oxy-1,2-ethanediyl), a-tridecyl-w-hydroxy-, branched Concentration/ -range: <5% CAS Number: 6901 1-36-5 Classification according to paragraph (d) Acute Tox. 45H302, Eye Dam. 1;H318 of 29 CFR 1910.1200: For explanation of abbreviations see section 16 SECTION 4: First aid measures Print Date: 05/14/2025 Revision date: 12/06/2024 Page: 2/15 SAFETY DATA SHEET CLARIFLOC™ C-6240 SECTION 4: First aid measures 4.1, Description of first aid measures Inhalation: Move to fresh air. No hazards which require special first aid measures. Skin contact: 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. Eye contact: Rinse immediately with plenty of water, also under the eyelids, for at least 15 minutes. Get medical attention immediately. Ingestion: Rinse mouth with water. Do NOT induce vomiting. Call a physician or poison control centre immediately. 4.2. Most important symptoms and effects, both acute and delayed None under normal use. 4.3. Indication of any immediate medical attention and special treatment needed None reasonably foreseeable. Other information: None. SECTION 5: Firefighting measures 5.1, Extinguishing media Suitable extinguishing media: Water. Water spray. Foam. Carbon dioxide (CO2). Dry powder. Warning! Spills produce extremely slippery surfaces. Unsuitable extinguishing media: None known. 5.2. Special hazards arising from the substance or mixture Hazardous decomposition products: Thermal decomposition may produce: hydrogen chloride gas, 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. 5.3, Advice for firefighters Protective measures: Wear self-contained breathing apparatus and protective suit. Other information: Spills produce extremely slippery surfaces. Print Date: 05/14/2025 Revision date: 12/06/2024 Page: 3/15 SAFETY DATA SHEET CLARIFLOC™ C-6240 SECTION 6: Accidental release measures 6.1. Personal precautions, protective equipment and emergency procedures Personal precautions: Do not touch or walk through spilled material. Spills produce extremely slippery surfaces. Protective equipment: Wear adequate personal protective equipment (see Section 8 Exposure Controls/Personal Protection). Emergency procedures: Keep people away from spill/leak. Prevent further leakage or spillage if safe to do so. 6.2. Environmental precautions As with all chemical products, do not flush into surface water. 6.3. Methods and material for containment and cleaning up 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. 6.4. Reference to other sections SECTION 7: Handling and storage; SECTION 8: Exposure controls/personal protection; SECTION 13: Disposal considerations; SECTION 7: Handling and storage 7.1. Precautions for safe handling Avoid contact with skin and eyes. Renders surfaces extremely slippery when spilled. When using, do not eat, drink or smoke. 7.2. Conditions for safe storage, including any incompatibilities Keep away from heat and sources of ignition. Freezing will affect the physical condition and may damage the material. Incompatible with oxidizing agents. 7.3. Specific end use(s) This information is not available. SECTION 8: Exposure controls/personal protection 8.1. Control parameters Occupational exposure limits: Print Date: 05/14/2025 Revision date: 12/06/2024 Page: 4/15 SAFETY DATA SHEET CLARIFLOC™ C-6240 Distillates (petroleum), hydrotreated light ACGIH: 200 mg/m3 (8 hours) (vapors) 8.2. Exposure controls Appropriate engineering controls: Ensure adequate ventilation, especially in confined areas. Use local exhaust if misting occurs. Natural ventilation is adequate in absence of mists. Individual protection measures, such as personal protective equipment: a) Eye/face protection: 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). b) Skin protection: i) Hand protection: 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. ii) Other: 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. c) Respiratory protection: No personal respiratory protective equipment normally required. d) Additional advice: Wash hands before breaks and immediately after handling the product. Wash hands before breaks and at the end of workday. Handle in accordance with good industrial hygiene and safety practice. Environmental exposure controls: Do not allow uncontrolled discharge of product into the environment. SECTION 9: Physical and chemical properties 9.1. Information on basic physical and chemical properties a) Appearance: Viscous liquid, Milky. b) Odour: Aliphatic. c) Odour Threshold: No data available. d) pH: Not applicable. é) Melting point/freezing point: <S°C ) Initial boiling point and boiling range: > 100°C Print Date: 05/14/2025 Revision date: 12/06/2024 Page: 5/15 SAFETY DATA SHEET CLARIFLOC™ C-6240 g) Flash point: h) Evaporation rate: i) Flammability (solid, gas): |) Upper/ower flammability or explosive limits: k) Vapour pressure: !) Vapour density: m) Relative density: n) Solubility(ies): 0) Partition coefficient n-octanolWwater (log value): p) Autoignition temperature: q) Decomposition temperature: r) Viscosity: s) Kinematic viscosity: t) Explosive properties: u) Oxidizing properties: Vv) Particle characteristics: 9.2, Other information None. SECTION 10: Stability and reactivity 10.1. Reactivity Stable under recommended storage conditions. 10.2. Chemical stability Stable under recommended storage conditions. 10.3. Possibility of hazardous reactions Oxidizing agents may cause exothermic reactions. 10.4. Conditions to avoid Protect from frost, heat and sunlight. 10.5. Incompatible materials Does not flash. 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. Not applicable. > 150°C > 20.5 mm?/s @ 40°C No data available. Not expected to be explosive based on the chemical structure. Not expected to be oxidising based on the chemical structure. Not applicable. Print Date: 05/44/2025 Revision date: 12/06/2024 Page: 6/15 SAFETY DATA SHEET CLARIFLOC™ C-6240 Oxidizing agents. 10.6. Hazardous decomposition products Thermal decomposition may produce: hydrogen chloride gas, 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. SECTION 11: Toxicological information 11.1. Information on toxicological effects Information on the product as supplied: Acute oral toxicity: LD50/oral/rat > 5000 mg/kg (Estimated) Acute dermal toxicity: LDS50/dermal/rat > 5000 mg/kg. (Estimated) Acute inhalation toxicity: The product is not expected to be toxic by inhalation. Skin corrosion/irritation: Non-irritating to skin. Serious eye damage/eye irritation: Not irritating. (OECD 437) Respiratory/skin sensitisation: Not sensitizing. Mutagenicity: Not mutagenic. Carcinogenicity: Not carcinogenic. Reproductive toxicity: Not toxic for reproduction. STOT - Single exposure: No known effects. STOT - Repeated exposure: No known effect. Aspiration hazard: Due to the viscosity, this product does not present an aspiration hazard. Relevant information on the hazardous components: Distillaies (petroleum), hydrotreated light Acute oral toxicity: LD50/oral/rat > 5000 mg/kg (OECD 401) Acute dermal toxicity: LD50/dermal/rabbit > 5000 mg/kg (OECD 402) Acute inhalation toxicity: LCO/inhalation/4 hours/rat >= 4951 mg/m3 (vapors) (OECD 403) (Based on results obtained from tests on analogous products) Skin corrosion/irritation: Not irritating. (OECD 404) Repeated exposure may cause skin dryness or cracking. Print Date: 05/14/2025 Revision date: 12/06/2024 Page: 7/15 SAFETY DATA SHEET CLARIFLOC™ C-6240 Serious eye damage/eye irritation: Respiratory/skin sensitisation: Mutagenicity: Carcinogenicity: Reproductive toxicity: STOT - Single exposure: STOT - Repeated exposure: Aspiration hazard: Not irritating. (OECD 405) By analogy with similar products, this product is not expected to be sensitizing. (OECD 406) Not mutagenic. (OECD 471, 473, 474, 476, 478, 479) Carcinogenicity study in rats (OECD 451): Negative. By analogy with similar substances, this substance is not expected to be toxic for reproduction. NOAEL/rat = 300 ppm. (OECD 421) No known effects. 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) May be fatal if swallowed and enters airways. Poly(oxy-L,2-ethanediyl), a-tridecyl-w-hydroxy-, branched Acute oral toxicity: Acute dermal toxicity: Acute inhalation toxicity: Skin corrosion/irritation: Serious eye damage/eye irritation: Respiratory/skin sensitisation: Mutagenicity: Carcinogenicity: LD50/oral/rat = 500 - 2000 mg/kg LD50/dermal/rabbit > 2000 mg/kg No data available. Not irritating. (OECD 404) Causes serious eye irritation. (OECD 405) The results of testing on guinea pigs showed this material to be non-sensitizing. 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. Print Date: 05/14/2025 Revision date: 12/06/2024 Page: 8/15 SAFETY DATA SHEET CLARIFLOC™ C-6240 Reproductive toxicity: STOT - Single exposure: STOT - Repeated exposure: Aspiration hazard: SECTION 12: Ecological information 12.1. Toxicity Information on the product as supplied: Acute toxicity to fish: Acute toxicity to invertebrates: Acute toxicity to algae: Chronic toxicity to fish: Chronic toxicity to invertebrates: Toxicity to microorganisms: Effects on terrestrial organisms: Sediment toxicity: 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 No known effects. Based on available data, product is not expected to demonstrate chronic toxic effects. NOAEL/oral/rat/600 days = 50 mg/kg/day No known effects. LC50/Fish/96 hours = 10 - 100 mg/L (Estimated) EC50/Daphnia magna/48 hours = 10 - 100 mg/L (Estimated) Algal inhibition tests are not appropriate. The flocculation characteristics of the product interfere directly in the test medium preventing homogenous distribution which invalidates the test. No data available. No data available. No data available. No data available. No data available. Relevant information on the hazardous components: Distillates (petroleum), hydrotreated light Acute toxicity to fish: Acute toxicity to invertebrates: Acute toxicity to algae: LC0/Oncorhynchus mykiss/96 hours > 1000 mg/L (OECD 203) EC0/Daphnia magna/48 hours > 1000 mg/L (OECD 202) IC0/Pseudokirchneriella subcapitata/72 hours > 1000 mg/L (OECD 201) Print Date: 05/14/2025 Revision date: 12/06/2024 Page: 9/15 SAFETY DATA SHEET CLARIFLOC™ C-6240 Chronic toxicity to fish: Chronic toxicity to invertebrates: Toxicity to microorganisms: Effects on terrestrial organisms: Sediment toxicity: NOEC/Oncorhynchus mykiss/28 days > 1000 mg/L NOEC/Daphnia magna/21 days > 1000 mg/L ~ ECS50/Tetrahymena pyriformis/ 48h > 1000 mg/L. No data available. No data available. Readily biodegradable, exposure to sediment is unlikely. Poly(oxy-1,2-ethanediyl), a-tridecyl-w-hydroxy-, branched Acute toxicity to fish: Acute toxicity to invertebrates: Acute toxicity to algae: Chronic toxicity to fish: Chronic toxicity to invertebrates: Toxicity fo microorganisms: Effects on terrestrial organisms: Sediment toxicity: 12.2. Persistence and degradability Information on the product as supplied: Degradation: Hydrolysis: Photolysis: LC50/Cyprinus carpio/96 hours = | - 10 mg/L (OECD 203) ECS50/Daphnia/48 hours = 1 - 10 mg/L (OECD 202) IC50/Desmodesmus subspicatus/72 hours = | - 10 mg/L (OECD 201) No data available. NOEC/Daphnia magna/21 days > 1 mg/L (OECD 202) EC10/activated sludge/17 hours > 10000 mg/L (DIN 38412-8) No data available. No data available. Based on the degradability data of the components, this product is expected to be readily (bio)degradable according to OECD criteria. At natural pHs (>6) the polymer degrades due to hydrolysis to more than 70% in 28 days. The hydrolysis products are not harmful to aquatic organisms. No data available. Relevant information on the hazardous components: Distillates (petroleum), hydrotreated light Print Date: 05/14/2025 Revision date: 12/06/2024 Page: 10/15 SAFETY DATA SHEET CLARIFLOC™ C-6240 Degradation: Readily biodegradable. 67.6% / 28 days (OECD 301 F) ; 68.8% / 28 days (OECD 306) ; 61.2% / 61 days (OECD 304 A) Hydrolysis: Does not hydrolyse. Photolysis: No data available. Poly(oxy-1,2-ethanediyl), a-tridecyl-w-hydroxy-, branched Degradation: Readily biodegradable. > 60% / 28 days (OECD 301 B) Hydrolysis: Does not hydrolyse. Photolysis: No data available. 12.3. Bioaccumulative potential Information on the product as supplied: The product is not expected to bioaccumulate. Partition co-efficient (Log Pow): Not applicable. Bioconcentration factor (BCF): No data available. Relevant information on the hazardous components: Distillates (petroleum), hydrotreated light Partition co-efficient (Log Pow): 3-6 Bioconcentration factor (BCF): No data available. Poly(oxy-1,2-ethanediyl), a-tridecyl-w-hydroxy-, branched Partition co-efficient (Log Pow): > 3 Bioconcentration factor (BCF): No data available. 12.4, Mobility in soil Information on the product as supplied: No data available. Print Date: 05/14/2025 Revision date: 12/06/2024 Page: 11/15 SAFETY DATA SHEET CLARIFLOC™ C-6240 Relevant information on the hazardous components: Distillates (petroleum), hydrotreated light Koc: No data available. Poly(oxy-1,2-ethanediyl), a-tridecyl-w-hydroxy-, branched Koc: > 5000 12.5. Other adverse effects None known. SECTION 13: Disposal considerations 13.1. Waste treatment methods Waste from residues/unused products: Dispose in accordance with local and national regulations. Contaminated packaging: 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. Recycling: Store containers and offer for recycling of material when in accordance with the local regulations. SECTION 14: Transport information Land transport (DOT) Not classified. Sea transport (IMDG) Not classified. Air transport (IATA) Not classified. SECTION 15: Regulatory information 15.1. Safety, health and environmental regulations/legislation specific for the substance or mixture Information on the product as supplied: Print Date: 05/14/2025 Revision date: 12/06/2024 Page: 12/15 SAFETY DATA SHEET CLARIFLOC™ C-6240 TSCA Chemical Substances Inventory: All components of this product are either listed as active on the inventory or are exempt from listing. US SARA Reporting Requirements: SARA (Section 311/312) hazard class: Not concerned. SARA Title Ill Sections: Section 302 (TPQ) - Reportable Quantity: Not concerned. Section 304 - Reportable Quantity: Not concerned. Section 313 (De minimis concentration): Not concerned. Clean Water Act Section 311 Hazardous Substances (40 CFR 117.3) - Reportable Quantity: Not concerned. Clean Air Act Section 112(r) Accidental release prevention requirements (40 CFR 68) - Reportable Quantity: Not concerned. CERCLA Hazardous Substances List (40 CFR 302.4) - Reportable Quantity: Not concerned. RCRA status : Not RCRA hazardous. California Proposition 65 Information: 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 SECTION 16: Other information NFPA and HMIS Ratings: NFPA: Print Date: 05/14/2025 Revision date: 12/06/2024 Page: 13 / 15 SAFETY DATA SHEET CLARIFLOC™ C-6240 Health: Flammability: Instability: oreo HMIS: Health: Flammability: Physical Hazard: PPE Code: mors This data sheet contains changes from the previous version in section(s): SECTION 15. Regulatory information, SECTION 16. Other Information. Key or legend to abbreviations and acronyms used in the safety data sheet: Acronyms STOT = Specific target organ toxicity Abbreviations Acute Tox. 4 = Acute toxicity Category Code 4 Asp. Tox. 1 = Aspiration hazard Category Code 1| Eye Dam | = Serious eye damage/eye irritation Category Code | Hazard statements H302 - Harmful if swallowed H304 - May be fatal if swallowed and enters airways H318 - Causes serious eye damage Training advice: Do not handle until all safety precautions have been read and understood. This SDS was prepared in accordance with the following: U.S. Code of Federal Regulations 29 CFR 1910.1200 Version: 24.01.b ENCC046 Print Date: 05/14/2025 Revision date: 12/06/2024 Page: 14/15 SAFETY DATA SHEET CLARIFLOC™ C-6240 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. Print Date: 05/14/2025 Revision date: 12/06/2024 Page: 15/15