BCRUA-2025-023 - 6/25/2025 AGREEMENT BETWEEN THE
BRUSHY CREEK REGIONAL UTILITY AUTHORITY,INC.
AND POLYDYNE,INC.
FOR THE PURCHASE OF
WATER TREATMENT CHEMICALS
This Agreement for the purchase of Water Treatment Chemicals is made and entered
into on this the 25th day of June, 2025, by and between the BRUSHY CREEK REGIONAL
UTILITY AUTHORITY, INC., whose offices are located at 1906 Hur Industrial Blvd., Cedar
Park, Texas referred to herein as the"BCRUA," and POLYDYNE, INC., whose office is located
at One Chemical Plant Road, Riceboro, GA 31323, referred to herein as"Vendor."
RECITALS:
WHEREAS, BCRUA desires to purchase certain Water Treatment Chemicals (defined
below); and
WHEREAS, BCRUA has issued its Invitation for Bid, ("IFB") No. 04-29-225-BC-370
for the provision of said Water Treatment Chemicals; and
WHEREAS, BCRUA has determined that the bid submitted by Vendor is the lowest
responsible bid for Aqua Hawk 9937 (Tote), herein "Water Treatment Chemicals"; and
WHEREAS, the parties desire to enter into this Agreement to set forth in writing their
respective rights, duties, and obligations;
NOW,THEREFORE,
in consideration of the mutual promises contained herein and other good and valuable
consideration, the receipt and sufficiency of which are hereby acknowledged, the parties
mutually agree as follows:
1.0 DEFINITIONS
A. Agreement means this binding legal contract between BCRUA and Vendor
whereby BCRUA is authorized to buy Water Treatment Chemicals, and Vendor is
obligated to sell same. The Agreement includes the following: (a) BCRUA's
Invitation for Bid, designated Solicitation Number 04-29-225-BC-370 dated May
16, 2025; (b) Vendor's Response to IFB ("Bid"); and (c) any exhibits and/or
addenda thereto. Any inconsistencies or conflicts in the contract documents shall
be resolved by giving preference in the following order:
Invitation for Bid Agreement.Treatment Chemicals.Aqua Hawk 9937.Polydyne,Inc.06.16.25 4925-4029-7294 v.1
gaa,\- ZS -023
(1) This Agreement;
(2) Vendor's Response to IFB ("Bid");
(3) BCRUA's IFB,Addenda, exhibits, and attachments.
B. BCRUA means the Brushy Creek Regional Utility Authority, Inc..
C. Effective Date means the date set out in the introductory paragraph above.
D. Goods and Services mean the Water Treatment Chemicals and any other
specified services, supplies, materials, commodities, or equipment, as described in the IFB.
E. Vendor means POLYDYNE, INC, or any successors or assigns.
2.0 EFFECTIVE DATE AND TERM
A. This Agreement shall remain in full force and effect until it expires as indicated
herein or is terminated in accordance with Section 16.0.
B. The term of this Agreement shall be for one (1) year from the Effective Date, and
shall automatically renew for up to four (4) additional one (1) year periods, unless either party
provides written notice to the other at least sixty (60) days prior to the end of the then current
term of its intent not to renew.
3.0 CONTRACT DOCUMENTS AND EXHIBITS
BCRUA selected Vendor to supply the Goods and Services as outlined in the IFB; any
Addenda to IFB; and the Bid submitted by Vendor, all as contained in Exhibit"A," incorporated
herein by reference for all purposes. The intent of these documents is to formulate an Agreement
listing the responsibilities of both parties as outlined in the IFB and any Addenda to IFB and as
offered by Vendor in its Bid.
The Goods and Services which are the subject matter of this Agreement are described in
Exhibit "A" and, together with this Agreement, comprise the total Agreement and Exhibit "A"
is a part of this Agreement as if repeated herein in full.
4.0 ITEMS AWARDED; SCOPE OF WORK
A. The following Water Treatment Chemicals items set out in the "Pricing Sheet" on
page 17 of Exhibit"A" are awarded to Vendor: Aqua Hawk 9937 (Tote).
B. Vendor shall satisfactorily provide all Goods and Services described in Exhibit
"A," attached hereto, within the contract term specified in Section 2.0. Vendor's undertakings
shall be limited to Goods and Services for BCRUA and/or advising BCRUA concerning those
matters on which Vendor has been specifically engaged. Vendor shall provide its Goods and
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Services in accordance with this Agreement and Exhibit "A" and with due care, and in
accordance with prevailing industry standards for comparable Goods and Services.
5.0 COSTS
In consideration for the Goods and Services to be provided by Vendor, BCRUA agrees to
pay Vendor the amounts set forth in the above-described Pricing Sheet of Exhibit "A." Provided
however, at the beginning of each renewal period, the parties may mutually agree to adjust the
above amount based on the increase in the U.S. Department of Labor Consumer Price Index
(CPI-U) for all Urban Consumers.
6.0 INVOICES
All invoices shall include, at a minimum,the following information:
1. Name and address of Vendor;
2. Purchase Order Number;
3. Description and quantity of items received; and
4. Delivery dates.
7.0 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 bid, with the consent and agreement of the Vendor and the
BCRUA. Such agreement shall be conclusively inferred for the Vendor from lack of exception to
this clause in the service provider's response. However, 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"piggyback"procurements.
8.0 NON-APPROPRIATION AND FISCAL FUNDING
This Agreement is a commitment of BCRUA's current revenues only. It is understood
and agreed that BCRUA shall have the right to terminate this Agreement if the governing body
of BCRUA does not appropriate funds sufficient to purchase the Goods and Services as
determined by BCRUA's budget for the fiscal year in question. BCRUA may affect such
termination by giving the Vendor written notice of termination.
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9.0 PROMPT PAYMENT POLICY
In accordance with Chapter 2251, V.T.C.A., Texas Government Code, any payment to be
made by BCRUA to Vendor will be made within thirty (30) days of the date BCRUA receives
Goods and Services under this Agreement, the date the performance of the services under this
Agreement are completed, or the date BCRUA receives a correct invoice for the Goods and
Services, whichever is later. Vendor may charge interest on an overdue payment at the rate in
effect on September 1 of the fiscal year in which the payment becomes overdue, in accordance
with V.T.C.A., Texas Government Code, Section 2251.025(b). This Prompt Payment Policy
does not apply to payments made by BCRUA in the event:
1. There is a bona fide dispute between BCRUA and Vendor, a contractor,
subcontractor, or supplier about the goods delivered or the service performed that
cause the payment to be late; or
2. There is a bona fide dispute between Vendor and a subcontractor or between a
subcontractor and its supplier about the goods delivered or the service performed
that causes the payment to be late; or
3. The terms of a federal contract, grant, regulation, or statute prevent BCRUA from
making a timely payment with federal funds; or
4. The invoice is not mailed to BCRUA in strict accordance with any instruction on
the purchase order relating to the payment.
10.0 GRATUITIES AND BRIBES
BCRUA may, by written notice to Vendor, cancel this Agreement without liability to
Vendor if it is determined by BCRUA that gratuities or bribes in the form of entertainment, gifts,
or otherwise were offered or given by Vendor or its agents or representatives to any BCRUA
officer, employee or elected representative with respect to the performance of this Agreement. In
addition, Vendor may be subject to penalties stated in Title 8 of the Texas Penal Code.
11.0 TAXES
BCRUA is exempt from Federal Excise and State Sales Tax; therefore, tax shall not be
included in Vendor's charges.
12.0 INSURANCE
Vendor shall meet all BCRUA insurance requirements set forth in paragraph 3.1 the IFB.
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13.0 BCRUA'S REPRESENTATIVE
BCRUA hereby designates the following representative authorized to act in its behalf
with regard to this Agreement:
Sam Roberts, General Manager
Brushy Creek Regional Utility Authority
1906 Hur Industrial Blvd.
Cedar Park, Texas 78613
14.0 RIGHT TO ASSURANCE
Whenever either party to this Agreement, in good faith, has reason to question the other
party's intent to perform hereunder, then demand may be made to the other party for written
assurance of the intent to perform. In the event that no written assurance is given within the
reasonable time specified when demand is made, then and in that event the demanding party may
treat such failure as an anticipatory repudiation of this Agreement.
15.0 DEFAULT
If Vendor abandons or defaults under this Agreement, Vendor shall be declared in default
of this Agreement if it does any of the following and fails to cure the issue within ten (10) days
of receipt of written notice:
1. Fails to fully, timely and faithfully perform any of its material obligations under
this Agreement;
2. Becomes insolvent or seeks relief under the bankruptcy laws of the United States
and is unable to perform its material obligations under the Agreement.
16.0 TERMINATION AND SUSPENSION
A. BCRUA has the right to terminate this Agreement, in whole or in part, for
convenience and without cause, at any time upon written notice to Vendor, the "Date of
Termination."
B. In the event of any default by Vendor, BCRUA has the right to terminate this
Agreement for cause, as set forth in Section 15.0.
C. Vendor has the right to terminate this Agreement only for cause, that being in the
event of a material and substantial breach by BCRUA, which is not cured within ten(10) days of
written notice of said breach, or by mutual agreement to terminate evidenced in writing by and
between the parties.
D. In the event BCRUA terminates under subsections (A) or (B) of this section, the
following shall apply: Upon BCRUA's delivery of the referenced notice to Vendor, Vendor shall
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discontinue all services in connection with the performance of this Agreement and shall proceed
to cancel promptly all existing orders and contracts insofar as such orders and contracts are
chargeable to this Agreement. Within thirty (30) days after the Date of Termination, Vendor
shall submit a statement showing in detail the goods and/or services satisfactorily performed
under this Agreement up to the date of termination. BCRUA shall then pay Vendor that portion
of the charges, if undisputed. The parties agree that Vendor is not entitled to compensation for
services it would have performed under the remaining term of the Agreement except as provided
herein.
17.0 INDEMNIFICATION
Vendor shall defend (at the option of BCRUA), indemnify, and hold BCRUA, its
successors, assigns, officers, employees and elected officials harmless from and against all suits,
actions, legal proceedings, claims, demands, damages, costs, expenses, attorney's fees, and any
and all other costs or fees arising out of, or incident to, concerning or resulting from the fault of
Vendor, or Vendor's agents, employees or subcontractors, in the performance of Vendor's
obligations under this Agreement, no matter how, or to whom, such loss may occur. Nothing
herein shall be deemed to limit the rights of BCRUA or Vendor(including, but not limited to the
right to seek contribution)against any third party who may be liable for an indemnified claim.
18.0 COMPLIANCE WITH LAWS AND REGULATIONS
A. Vendor, its agents, employees, and subcontractors shall use best efforts to comply
with all applicable federal and state laws, and with all applicable rules and regulations
promulgated by local, state, and national boards, bureaus, and agencies.
B. In accordance with Chapter 2271, Texas Government Code, a governmental entity
may not enter into a contract with a company for goods or services unless the contract contains
written verification from the company that it: (1)does not boycott Israel; and (2)will not boycott
Israel and will not boycott Israel during the term of this contract. The signatory executing this
Agreement on behalf of Vendor verifies Vendor does not boycott Israel and will not boycott
Israel during the term of this Agreement.
C. In accordance with Chapter 2274, Texas Government Code, a governmental entity
may not enter into a contract with a company with at least ten (10) full-time employees for a
value of at least One Hundred Thousand and No/100 Dollars ($100,000.00) unless the contract
has a provision verifying that it: (1) does not have a practice, policy, guidance, or directive that
discriminates against a firearm entity or firearm trade association; and (2) will not discriminate
during the term of the contract against a firearm entity or firearm trade association. The signatory
executing this Agreement on behalf of Vendor verifies Vendor does not have a practice, policy,
guidance, or directive that discriminates against a firearm entity or firearm trade association, and
it will not discriminate during the term of this Agreement against a firearm entity or firearm trade
association.
D. In accordance with Chapter 2274, Texas Government Code, a governmental entity
may not enter into a contract with a company with at least ten (10) full-time employees for a
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value of at least One Hundred Thousand and No/100 Dollars ($100,000.00) unless the contract
has a provision verifying that it: (1) does not boycott energy companies; and (2) will not boycott
energy companies during the term of this Agreement. The signatory executing this Agreement on
behalf of Vendor verifies Vendor does not boycott energy companies, and it will not boycott
energy companies during the term of this Agreement.
19.0 ASSIGNMENT AND DELEGATION
The parties hereby bind themselves, their successors, assigns and legal representatives to
each other with respect to the terms of this Agreement. Neither party shall assign, sublet, or
transfer any interest in this Agreement without prior written authorization of the other party.
20.0 NOTICES
A. All notices and other communications in connection with this Agreement shall be
in writing and shall be considered given as follows:
1. When delivered personally to recipient's physical or email address as stated in
this Agreement; or
2. Three (3) days after being deposited in the United States mail, with postage
prepaid to the recipient's address as stated in this Agreement.
Notice to Vendor:
Brent SoRelle, Sr.
961 Copper Canyon Drive
Prosper,TX 75078
bsorelle@polydyneinc.com
Notice to BCRUA:
Sam Roberts, General Manager
Brushy Creek Regional Utility Authority
1906 Hur Industrial Blvd.
Cedar Park, Texas 78613
sroberts@bcrua.com
AND TO
Stephen L. Sheets
General Counsel
309 E. Main St.
Round Rock, Texas 78664
steve@scrrlaw.com
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B. Nothing contained herein shall be construed to restrict the transmission of routine
communications between representatives of BCRUA and Vendor.
21.0 APPLICABLE LAW, ENFORCEMENT, AND VENUE
This Agreement shall be enforceable in Cedar Park, Texas, and if legal action is necessary
by either party with respect to the enforcement of any or all of the terms or conditions herein,
exclusive venue for same shall lie in Williamson County, Texas. This Agreement shall be
governed by and construed in accordance with the laws and court decisions of the State of Texas.
22.0 EXCLUSIVE AGREEMENT
This document, and all appended documents, constitutes the entire Agreement between
Vendor and BCRUA. This Agreement may only be amended or supplemented by mutual
agreement of the parties hereto in writing.
23.0 DISPUTE RESOLUTION
BCRUA and Vendor hereby expressly agree that no claims or disputes between the
parties arising out of or relating to this Agreement, or a breach thereof shall be decided by any
arbitration proceeding, including without limitation, any proceeding under the Federal
Arbitration Act(9 USC Section 1-14)or any applicable state arbitration statute.
24.0 SEVERABILITY
The invalidity, illegality, or unenforceability of any provision of this Agreement or the
occurrence of any event rendering any portion or provision of this Agreement void shall in no
way affect the validity or enforceability of any other portion or provision of this Agreement. Any
void provision shall be deemed severed from this Agreement, and the balance of this Agreement
shall be construed and enforced as if this Agreement did not contain the particular portion or
provision held to be void. The parties further agree to amend this Agreement to replace any
stricken provision with a valid provision that comes as close as possible to the intent of the
stricken provision. The provisions of this section shall not prevent this entire Agreement from
being void should a provision which is of the essence of this Agreement be determined void.
25.0 MISCELLANEOUS PROVISIONS
A. Standard of Care. Vendor represents that it employs trained, experienced, and
competent persons to perform all of the services, responsibilities and duties specified herein and
that such services, responsibilities, and duties shall be performed in a manner according to
generally accepted industry practices.
B. Time is of the Essence. The parties agree that, from time to time, certain unique
transactions may have special requirements relative to timing and, accordingly, the parties will
identify those transactions and exercise best efforts to accomplish those transactions within the
stated timeframe. Other timing requirements will be met in a commercially reasonable manner.
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Where damage is caused to BCRUA due to Vendor's failure to perform in the special timing
requirement circumstances, BCRUA may pursue any remedy available without waiver of any of
BCRUA's additional legal rights or remedies.
C. Orders Placed With Alternate Vendors. In order to protect the health, safety,
and welfare of the public, if Vendor cannot provide the Goods and Services as specified herein,
BCRUA reserves the right and option to obtain the products from another supplier or suppliers.
D. Binding Agreement. This Agreement shall extend to and be binding upon and
inure to the benefit of the parties' respective heirs, executors, administrators, successors, and
assigns.
E. Multiple Counterparts. This Agreement may be executed in multiple
counterparts, any one of which shall be considered an original of this document; and all of
which,when taken together, shall constitute one and the same instrument.
[Signatures on the following page.]
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IN WITNESS WHEREOF, BCRUA Mid Vendor have executed this Agreement on the
dates indicated.
POI
M
Date
BRUSHY CREEK REGIONAL UTILITY AUTHORITY
By:
Na'cole Thompson, President
Date Signed: � 12612-S
Attest:
By: !J .ice..
Rene loxes, BCRUA ary
Approved a to {or•m:
By:
Stephen L. Sheets, General Counsel
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EXHIBIT A
Brushy Creek Regional Utility Authority
F,, ' A Partnership of Cedar Park,Leander and Round Rock
IFB # 04-29-225-BC-370
Subject: Water Treatment Chemicals
Due: May 16,2025 at 2:00 PM Central
Submit Bids to:
Brushy Creek Regional Utility Authority
do 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
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BCRUA
450 Cypress Creek Rd.Bldg. 1
Cedar Park Texas 78613
Table of Contents
1. BIDDER'S CHECKLIST 3
2. STANDARD TERMS AND CONDITIONS 4
3. SPECIAL CONDITIONS 9
3.1 Insurance 9
3.2 Damage Provision 10
3.3 Bid Terms 10
4. SPECIFICATIONS 12
5. BID 15
6. DEMONSTRATION OF EXPERIENCE 18
7. LIST OF MACHINERY AND EQUIPMENT 20
8. VENDOR PROFILE 21
9. BID RESPONSE FORM 22
10. REFERENCES 23
11. DEVIATION OR COMPLIANCE FORM 24
12. RELEASE AND INDEMNIFICATION 25
13. NON-COLLUSION ACKNOWLDGEMENT 26
14. SUSPENSION OR DEBARMENT CERTIFICATE 26
15. COOPERATIVE PURCHASING 27
16. CONFLICT OF INTEREST AND QUESTIONAIRE 28
17. DISCLOSURE OF INTERESTED PARTIES 29
18. W-9 FORM 30
450 Cypress Creek Rd.Bldg.1 •Cedar Park,Texas 78613•www.cedarparktexas.gov•(512)401-5000•Fax:(512)258-6083
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1. BIDDER'S CHECKLIST
El Provided Pricing.
IN Demonstration of Experience form filled in.
N/A ❑ List of Machinery and Equipment form filled in, if applicable.
® Vendor Profile form filled in.
M Bid Response Form **IMPORTANT** Failure to sign and return this form may result in
disqualification.
[El Provided Safety Data Sheets(SDS)for all chemicals bid.
IX References provided.
® Deviation or Compliance form filled in.
M Release and Indemnification form filled and signed.
®Non-Collusion Acknowledgement form filled and signed.
® Suspension or Debarment Certificate filled and signed.
® Cooperative Purchasing form filled and signed.
® 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.
® 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
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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. STANDARD TERMS AND CONDITIONS
2.1 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.
2.2 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.
2.3 All general information questions should be directly emailed to Andy Portillo at
andy.portillo@cedarparktexas.gov.
2.4 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.
2.5 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
WILL NOT BE ACCEPTED.
2.6 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
2.7 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
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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.
2.8 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.
2.9 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.
2.10 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.
2.11 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.
2.12 The Authority,in its sole discretion,may negotiate changes to any submitted Bid,including price,
after submitted Bids have been opened.
2.13 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.
2.14 The Authority shall be sole interpreter of the terms, conditions, specifications, and performance
requirements of this IFB.
2.15 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.
2.16 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
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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 If it 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
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2.29 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
2.30 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.
2.31 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.
2.32 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.
2.33 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.
2.34 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
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2.35 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.
2.36 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
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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
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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(cr),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
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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
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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.
4.1.2 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.
4.1.3 BCRUA reserves the right to have each shipment analyzed and to reject the shipment if it
does not meet AWWA and NSF/ANSI standards.
4.1.4 If Bidder needs to test polymer chemicals(Aqualum,Hyper+Ion,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 29th&30th at:
BCRUA Water Treatment Plant
1906 Hur Industrial Blvd.
Cedar Park,Tx.78613
4.1.5 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.
4.1.6 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.
4.1.7 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
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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
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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
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--FORMS TO BE RETURNED WITH BID-
-. 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
(b) 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
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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. Agreement renewal date of December 1,2024.
2. Price increase request due by:November 1,2024.
3. Current period six month average will be calculated using unadjusted CPI data from May—
October 2024.
4. Previous period six month average will be calculated using unadjusted CPI data from May
—October 2023.
5. Current period six month average=314.758
6. Previous period six month average=306.236
7. Calculate%difference:
(314.758-306.236)/306.236 x 100=2.782
8. 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.
Signature:e /0(
//aK
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
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PRICING SHEET
*** BIDDER MUST ATTACH SAFETY DATA SHEETs(SDS) FOR ALL CHEMICALS BID***
Approximate Approximate Can you deliver
Approximate Unit Price
Chemical Delivery Delivery Location Annual Unit within S business
Delivery Quantity Frequency Quantity (delivered) days?(Y or N)
1906 Hur Industrial Blvd
Cedar Park Texas 78613 No Bid
Sodium Hypochlorite-12%Bleach 5000Gal Every 1-2 weeks 195,000 Gallons
1906 Hur Industrial Blvd
Liquid Ammonium Sulfate 48,0001bs Every 4-6 weeks Cedar Park Texas 78613 936,000 Pounds No Bid
CLARIFLOC C-378 1906 Hur Industrial Blvd
Every 10-12 $0.82/LB. Yes
Aqualum 3003 35,2001bs weeks Cedar Park Texas 78613 176,000 Pounds
CLARIFLOC C-378 1906 Hur Industrial Blvd
Every 4-6 $0.82/LB. Yes
Aqualum 3003 6 totes months Cedar Park Texas 78613 28,584 Pounds
1906 Hur Industrial Blvd
No Bid
Cedar Park Texas 78613
Aluminum Chlorohydrate+4%LCS 48,0001bs Every 3-4 weeks 624,000 Pounds
CLARIFLOC C-6240 1906 Hur Industrial Blvd
Every 4-6 $1.50/LB. Yes
Aqua Hawk 9937 6 totes months Cedar Park Texas 78613 32,410 Pounds
1906 Hur Industrial Blvd
Cedar Park Texas 78613 No Bid
Fluorosilic Acid 23% 35,200 Every 6-8 weeks 211,200 Pounds
1906 Hur Industrial Blvd
Cedar Park Texas 78613 No Bid
Sodium Permanganate 3000 4-6 months 6000 Gallons
450 Cypress Creek Rd.Bldg. 1 •Cedar Park,Texas 78613•www.cedarparktexas.gov•(512)401-5000•Fax:(512)258-6083
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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:
Contract Amount Type of Work Date Completed Owner's Name&Contact Info
Supply and Delivery of Water Urbana Champaign S.D.
$351,000.00 and Wastewater Treatment 04/30/25 100 E.University Avenue Urbana,IL 61801
Jackie Christensen,(217)367-3409 ext. 1128
Polymer.
Supply and Delivery of Lafourche Parish Water District South Plant
$259,000.00 Dadmac 12/31/24 5753 Highway 308 Lockport,LA 70374
Jenny Robichaux,(985)532-6924
Supply and Delivery of Water City of Cincinnati
$153,200.00 and Wastewater Treatment 12/31/24 5651 Kellogg Avenue,Cincinnati,OH 4523(
Polymer. James Springer,(513)624-5624
Supply of Dadmac Polymer 12/31/2024 City of Oshkosh
$117,500.00 and Anionic Emulsion 425 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
New Orleans Sewerage and Water Board
$1,400,000.00 Supply of Dadmac 10/31/2025 8800 South Claiborne Street,
New Orleans,LA 70615
Kenneth Hopei,(504)585-2356
Supply of Emulsion Polymer Los Angeles County Sanitation
$4,000,0000.00 PP Y Y 07/31/2025 District 24501 South Figueroa Street,
Whitter,CA 90601
Malika Jones,(310)830-2401
City of Cincinnati
S2,0000,000.00 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
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Have you ever failed to complete any contract awarded to you?
❑Yes lX 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?
El Yes lXNo
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
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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
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450 Cypress Creek Rd.Bldg. 1 •Cedar Park,Texas 78613•www.cedarparktexas.gov•(512)401-5000•Fax:(512)258-6083
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8. VENDOR PROFILE
Company Name: Polydyne Inc.
and DB/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 M 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 El
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
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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 undersigned 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.
❑An individual proprietorship
0 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: J
Printed Name: oyd 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
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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
Emaikjennyr@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
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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
IFB Reference
Title (related to the Detailed Deviation Description
deviation)
No Deviations
450 Cypress Creek Rd.Bldg. 1 •Cedar Park,Texas 78613•www.cedarparktexas.gov•(512)401-5000•Fax:(512)258-6083
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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.
Signature: A
lPic
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
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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: G46 "X
Company Officer Printed Name: Boyd Stanley UU
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. �%�
Signature of Company Officer:
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
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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.
® Yes,others can purchase; ❑ No,only the BCRUA can purchase.
Signature: 72#.09(j$W
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
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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 Title Local Government Title
Officer Officer
Na'Cole Thompson President of Board of Anne Duffy Vice President of Board of
Directors Directors
Rene Flores Secretary Jason Anderson Citizen Director
Hilda Montgomery Citizen Director Mel Kirkland Citizen Director
Sam Roberts General Manager Christian Culver Superintendent
Jennifer Baumeister Administrative Support Ryan Manilla Supervisor
Assistant
450 Cypress Creek Rd.Bldg.1•Cedar Park,Texas 78613•www.cedarparktexas.gov•(512)401-5000•Fax:(512)258-6083
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CONFLICT OF INTEREST QUESTIONNAIRE FORM CIO
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 Date Received
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).
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.
J Name of vendor who has a business relationship with local governmental entity.
Polydyne Inc.
J n
I I Check this box if you are filing an update to a previously flied questionnaire.(The law requires that you file an updated
f 1 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.)
11 Name of local government officer about whom the information is being disclosed.
None
Name of Officer
J 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
CIO 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?
n Yes n No
J 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.
flCheck 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).
Boyd Stanley
Sr. Vice-President 05/14/2025
Signatureof vendor doin sii3.1riess 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
A complete 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) A local government officer shall file a conflicts disclosure statement with respect to a vendor if:
(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) A vendor 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
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18. W-9 FORM
450 Cypress Creek Rd.Bldg.1•Cedar Park,Texas 78613•www.cedarparktexas.gov•(512)401-5000•Fax:(512)258-6083
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Form
Request for Taxpayer Give form to the
(Rev.March2024) Identification Number and Certification requester.Do not
Department of the Treasury Go to www.irs.gov/FormW9 for instructions and the latest information. send to the IRS.
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.)
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 4 Exemptions(codes apply only to
m only one of the following seven boxes. certain entitles,not Individuals;
see instructions on page 3):
co ❑ Individual/sole proprietor ✓❑ C corporation ❑ S corporation ❑ Partnership ❑ Trust/estate
ai c ❑ LLC.Enter the tax classification(C=C corporation,S=S corporation,P=Partnership) . . . . Exempt payee code(If any)
o Note:Check the"LLC"box above and,in the entry space,enter the appropriate code(C,S,or P)for the tax
c"i classification of the LLC,unless it Is a disregarded entity.A disregarded entity should instead check the appropriate Exemption from Foreign Account Tax
o box for the tax classification of its owner. Compliance Act(FATCA)reporting
❑ Other(see Instructions) code(if any)
O. V
!� 3b if on line 3a you checked"Partnership"or"Trust/estate,"or checked"LLC"and entered"P"as its tax classification,
y and you are providing this form to a partnership,trust,or estate in which you have an ownership interest,check (Applies to accounts maintained
to this box if you have any foreign partners,owners,or beneficiaries.See instructions ❑ outside the United States.)
te
• 5 Address(number,street,and apt.or suite no.).See instructions. Requester's name and address(optional)
co
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 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 or
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 II Certification
Under penalties of perjury,I certify that:
1.The number shown on this form is my correct taxpayer identification number(or I am waiting for a number to be issued to me);and
2.I am not subject to backup withholding because(a)I am exempt from backup withholding,or(b)I have not been notified by the Internal Revenue
Service(IRS)that I am subject to backup withholding as a result of a failure to report all interest or dividends,or(c)the IRS has notified me that I am
no longer subject to backup withholding;and
3.I am a U.S.citizen or other U.S.person(defined below);and
4.The FATCA code(s)entered on this form(if any)Indicating that I am exempt from FATCA reporting Is correct.
Certification instructions.You must cross out Item 2 above if you have been notified by the IRS that you are currently subject to backup withholding
because you have failed to report all interest and dividends on your tax return.For real estate transactions,item 2 does not apply.For mortgage Interest paid,
acquisition or abandonment of secured property,cancellation of debt,contributions to an individual retirement arrangement(IRA),and,generally,payments
other than interest and dividends,you are of req 'red to sign the certification,but you must provide your correct TIN.See the instructions for Part II,later.
Sign Signature of Boyd Stanley
Here U.S.person Y 05/14/2025
Sr.Vice-President Date
General Instructions 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
Section references are to the Internal Revenue Code unless otherwise foreign partners,owners,or beneficiaries when it provides the Form W-9
noted. to another flow-through entity in which It has an ownership interest.This
Future developments.For the latest information about developments change is intended to provide a flow-through entity with Information
related to Form W-9 and its instructions,such as legislation enacted regarding the status of Its indirect foreign partners,owners,or
after they were published,go to www.lrs.gov/FormW9. beneficiaries,so that it can satisfy any applicable reporting
requirements.For example,a partnership that has any indirect foreign
What's New 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).
Line 3a has been modified to clarify how a disregarded entity completes
this line.An LLC that is a disregarded entity should check the Purpose of Form
appropriate box for the tax classification of its owner.Otherwise,it
should check the"LLC"box and enter its appropriate tax classification. 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 Foreign person.If you are a foreign person or the U.S.branch of a
may be your social security number(SSN),individual taxpayer foreign bank that has elected to be treated as a U.S.person(under
identification number(ITIN),adoption taxpayer identification number Regulations section 1.1441-1(b)(2)(1v)or other applicable section for
(ATIN),or employer identification number(EIN),to report on an chapter 3 or 4 purposes),do not use Form W-9.Instead,use the
Information return the amount paid to you,or other amount reportable appropriate Form W-8 or Form 8233(see Pub.515).If you are a
on an information return.Examples of information returns include,but qualified foreign pension fund under Regulations section 1.897(I)-1(d),or
are not limited to,the following. a partnership that is wholly owned by qualified foreign pension funds,
•Form 1099-INT(interest earned or paid), that Is treated as a non-foreign person for purposes of section 1445
Form 1099-DIV(dividends,including those from stocks or mutual withholding,do not use Form W-9.Instead,use Form W-8EXP(or other
•uFos). certification of non-foreign status).
f•Form 1099-MISC(various types of income,prizes,awards,or gross Nonresident alien who becomes a resident alien.Generally,only a
proceeds). 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
•Form 1099-NEC(nonemployee compensation). treaties contain a provision known as a saving clause.Exceptions
•Form 1099-B(stock or mutual fund sales and certain other specified in the saving clause may permit an exemption from tax to
transactions by brokers). continue for certain types of income even after the payee has otherwise
•Form 1099-S(proceeds from real estate transactions). become a U.S.resident alien for tax purposes.
If you are a U.S.resident alien who Is relying on an exception
•Form 1099-K(merchant card and third-party network transactions). contained in the saving clause of a tax treaty to claim an exemption
•Form 1098(home mortgage interest),1098-E(student loan interest), from U.S.tax on certain types of income,you must attach a statement
and 1098-T(tuition), to Form W-9 that specifies the following five items.
•Form 1099-C(canceled debt). 1.The treaty country.Generally,this must be the same treaty under
•Form 1099-A(acquisition or abandonment of secured property). which you claimed exemption from tax as a nonresident alien.
Use Form W-9 only if you are a U.S.person(including a resident 2.The treaty article addressing the income.
alien),to provide your correct TIN. 3.The article number(or location)in the tax treaty that contains the
Caution:If you don't return Form W-9 to the requester with a TIN,you saving clause and Its exceptions.
might be subject to backup withholding.See What is backup 4.The type and amount of income that qualifies for the exemption
withholding,later. from tax.
By signing the filled-out form,you: 5.Sufficient facts to justify the exemption from tax under the terms of
1.Certify that the TIN you are giving is correct(or you are waiting for a the treaty article.
number to be issued); Example.Article 20 of the U.S.-China Income tax treaty allows an
2.Certify that you are not subject to backup withholding;or exemption from tax for scholarship income received by a Chinese
Claim exemption from backup withholding If you are a U.S.exempt student temporarily present in the United States.Under U.S.law,this
3.
paeCl and 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
4.Certify to your non-foreign status for purposes of withholding under first Protocol to the U.S.-China treaty(dated April 30,1984)allows the
chapter 3 or 4 of the Code Of applicable);and provisions of Article 20 to continue to apply even after the Chinese
5.Certify that FATCA code(s)entered on this form(if any)indicating student becomes a resident alien of the United States.A Chinese
that you are exempt from the FATCA reporting Is correct.See What Is student who qualifies for this exception(under paragraph 2 of the first
FATCA Reporting,later,for further information. Protocol)and is relying on this exception to claim an exemption from tax
Note:If you are a U.S.person and a requester gives you a form other on their scholarship or fellowship income would attach to Form W-9 a
statement that Includes the information described above to support that
than Form W-9 to request your TIN,you must use the requester's form If exemption.
it is substantially similar to this Form W-9.
Definition of a U.S.person.For federal tax purposes,you are If you are a nonresident alien or a foreign entity,give the requester the
appropriate completed Form W-8 or Form 8233.
considered a U.S.person if you are:
•An individual who is a U.S.citizen or U.S.resident alien; Backup Withholding
•A partnership,corporation,company,or association created or What is backup withholding?Persons making certain payments to you
organized in the United States or under the laws of the United States; must under certain conditions withhold and pay to the IRS 24%of such
•An estate(other than a foreign estate);or payments.This is called"backup withholding."Payments that may be
•A domestic trust(as defined in Regulations section 301.7701-7). subject to backup withholding Include,but are not limited to,Interest,
tax-exempt interest,dividends,broker and barter exchange
Establishing U.S.status for purposes of chapter 3 and chapter 4 transactions,rents,royalties,nonemployee pay,payments made in
withholding.Payments made to foreign persons,including certain settlement of payment card and third-party network transactions,and
distributions,allocations of income,or transfers of sales proceeds,may certain payments from fishing boat operators.Real estate transactions
be subject to withholding under chapter 3 or chapter 4 of the Code are not subject to backup withholding.
(sections 1441-1474).Under those rules,if a Form W-9 or other You will not be subject to backup withholding on payments you receive
certification of non-foreign status has not been received,a withholding If you give the requester your correct TIN,make the proper certifications,
agent,transferee,or partnership(payor)generally applies presumption and report all your taxable interest and dividends on your tax return.
rules that may require the payor to withhold applicable tax from the
recipient,owner,transferor,or partner(payee).See Pub.515, Payments you receive will be subject to backup withholding if:
Withholding of Tax on Nonresident Aliens and Foreign Entities. 1.You do not furnish your TIN to the requester;
The following persons must provide Form W-9 to the payor for 2.You do not certify your TIN when required(see the instructions for
purposes of establishing its non-foreign status. Part II for details);
•In the case of a disregarded entity with a U.S.owner,the U.S.owner 3.The IRS tells the requester that you furnished an incorrect TIN;
of the disregarded entity and not the disregarded entity. 4.The IRS tells you that you are subject to backup withholding
•In the case of a grantor trust with a U.S.grantor or other U.S.owner, because you did not report all your Interest and dividends on your tax
generally,the U.S.grantor or other U.S.owner of the grantor trust and retum(for reportable interest and dividends only);or
not the grantor trust. 5.You do not certify to the requester that you are not subject to
•In the case of a U.S.trust(other than a grantor trust),the U.S.trust backup withholding,as described In Item 4 under"By signing the filled-
and not the beneficiaries of the trust. out form"above(for reportable interest and dividend accounts opened
See Pub.515 for more information on providing a Form W-9 or a after 1983 only).
certification of non-foreign status to avoid withholding.
Form W-9(Rev.3-2024) Page 3
Certain payees and payments are exempt from backup withholding. example,if a foreign LLC that is treated as a disregarded entity for U.S.
See Exempt payee code,later,and the separate Instructions for the federal tax purposes has a single owner that is a U.S.person,the U.S.
Requester of Form W-9 for more information, owner's name is required to be provided on line 1.If the direct owner of
See also Establishing U.S.status for purposes of chapter 3 and the entity is also a disregarded entity,enter the first owner that is not
chapter 4 withholding,earlier, 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,
What Is FATCA Reporting? 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.
The Foreign Account Tax Compliance Act(FATCA)requires a Line 2
participating foreign financial institution to report all U.S.account
holders that are specified U.S.persons.Certain payees are exempt from If you have a business name,trade name,DBA name,or disregarded
FATCA reporting.See Exemption from FATCA reporting code,later,and entity name,enter it on line 2.
the Instructions for the Requester of Form W-9 for more information.
Line 3a .
Updating Your Information Check the appropriate box on line 3a for the U.S.federal tax
You must provide updated information to any person to whom you classification of the person whose name is entered on line 1.Check only
claimed to be an exempt payee if you are no longer an exempt payee one box on line 3a.
and anticipate receiving reportable payments in the future from this IF the entity/individual on line 1 THEN check the box for...
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 is a(n)...
no longer tax exempt.In addition,you must furnish a new Form W-9 if • Corporation Corporation.
the name or TIN changes for the account,for example,If the grantor of a • Individual or Individual/sole proprietor.
grantor trust dies.
• Sole proprietorship
Penalties • LLC classified as a partnership Limited liability company and
Failure to furnish TIN.If you fall to furnish your correct TIN to a for U.S.federal tax purposes or enter the appropriate tax
requester,you are subject to a penalty of$50 for each such failure • LLC that has flied Form 8832 or classification:
unless your failure is due to reasonable cause and not to willful neglect. 2553 electing to be taxed as a P=Partnership,
Civil penalty for false information with respect to withholding.If you corporation C=C corporation,or
make a false statement with no reasonable basis that results in no S=S corporation.
backup withholding,you are subject to a$500 penalty. • Partnership Partnership.
Criminal penalty for falsifying information.Willfully falsifying • Trust/estate Trust/estate.
certifications or affirmations may subject you to criminal penalties
including fines and/or imprisonment. Line 3b
Misuse of TINs.If the requester discloses or uses TINS in violation of Check this box If you are a partnership(including an LLC classified as a
federal law,the requester may be subject to civil and criminal penalties. partnership for U.S.federal tax purposes),trust,or estate that has any
foreign partners,owners,or beneficiaries,and you are providing this
Specific Instructions 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
Line 1 (or documentary evidence)from any partner,owner,or beneficiary
You must enter one of the following on this line;do not leave this line establishing foreign status or if you receive a Form W-9 from any
blank.The name should match the name on your tax return. partner,owner,or beneficiary that has checked the box on line 3b.
If this Form W-9 is for a joint account an Note:A partnership that provides a Form W-9 and checks box 3b may
maintained thi nFo by a-9rsifn financial institution(other(F than,list first,accountaun then be required to complete Schedules K-2 and K-3(Form 1065).For more
circle,the name of the person or entity whose number you entered In Form 1065,see the Partnership Instructions for Schedules K-2 and K-3
(Form
Part I of Form W-9.If you are providing Form W-9 to an FFI to document ( 1065).
a joint account,each holder of the account that is a U.S.person must If you are required to complete line 3b but fail to do so,you may not
provide a Form W-9. receive the information necessary to file a correct Information return with
•Individual.Generally,enter the name shown on your tax return.If you the IRS or furnish a correct payee statement to your partners or
have changed your last name without informing the Social Security penaltiespena that
See,for example,sections 6698,6722,and 6724 for
hat may apply.
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. Line 4 Exemptions
Note for ITIN applicant:Enter your individual name as it was entered If you are exempt from backup withholding and/or FATCA reporting,
on your Form W-7 application,line 1 a.This should also be the same as enter in the appropriate space on line 4 any code(s)that may apply to
the name you entered on the Form 1040 you filed with your application. you.
•Sole proprietor.Enter your individual name as shown on your Form Exempt payee code.
1040 on line 1.Enter your business,trade,or"doing business as"(DBA) • Generally,individuals(including sole proprietors)are not exempt from
name on line 2. backup withholding.
•Partnership,C corporation,S corporation,or LLC,other than a • Except as provided below,corporations are exempt from backup
disregarded entity.Enter the entity's name as shown on the entity's tax withholding for certain payments,including Interest and dividends.
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 •• Corporations are not exempt from backup withholding for payments
documents on line 1.This name should match the name shown on the made In settlement of payment card or third party network transactions.
charter or other legal document creating the entity.Enter any business, • Corporations are not exempt from backup withholding with respect to
trade,or DBA name on line 2. attorneys'fees or gross proceeds paid to attorneys,and corporations
•Disregarded entity.In general,a business entity that has a single that provide medical or health care services are not exempt with respect
owner,including an LLC,and is not a corporation,Is disregarded as an to payments reportable on Form 1099-MISC.
entity separate from its owner(a disregarded entity).See Regulations The following codes identify payees that are exempt from backup
section 301.7701-2(c)(2).A disregarded entity should check the withholding.Enter the appropriate code in the space on line 4.
appropriate box for the tax classification of its owner.Enter the owner's 1—An organization exempt from tax under section 501(a),any IRA,or
name on line 1.The name of the owner entered on line 1 should never a custodial account under section 403(b)(7)if the account satisfies the
be a disregarded entity.The name on line 1 should be the name shown requirements of section 401(0(2).
on the income tax return on which the income should be reported.For
Form W-9(Rev.3-2024) Page 4
2—The United States or any of its agencies or instrumentalities. F—A dealer in securities,commodities,or derivative financial
3—A state,the District of Columbia,a U.S.commonwealth or territory, Instruments(including notional principal contracts,futures,forwards,
or any of their political subdivisions or instrumentalities. and options)that is registered as such under the laws of the United
4—A foreign government or any of Its political subdivisions,agencies, States or any state.
or instrumentalities. G—A real estate investment trust.
5—A corporation. H—A regulated investment company as defined In section 851 or an
6—A dealer in securities or commodities required to register in the entity registered at all times during the tax year under the Investment
United States,the District of Columbia,or a U.S.commonwealth or Company Act of 1940.
territory. I—A common trust fund as defined in section 584(a).
7—A futures commission merchant registered with the Commodity J—A bank as defined In section 581.
Futures Trading Commission. K—A broker.
8—A real estate investment trust. L—A trust exempt from tax under section 664 or described in section
9—An entity registered at all times during the tax year under the 4947(a)(1).
Investment Company Act of 1940. M—A tax-exempt trust under a section 403(b)plan or section 457(g)
10—A common trust fund operated by a bank under section 584(a). plan.
11—A financial institution as defined under section 581. Note:You may wish to consult with the financial institution requesting
this form to determine whether the FATCA code and/or exempt payee
12—A middleman known in the investment community as a nominee or
code should be completed.
custodian.
13—A trust exempt from tax under section 664 or described in section Line 5
4947. Enter your address(number,street,and apartment or suite number).
The following chart shows types of payments that may be exempt This is where the requester of this Form W-9 will mail your information
from backup withholding.The chart applies to the exempt payees listed returns.If this address differs from the one the requester already has on
above,1 through 13. 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
IF the payment is for... THEN the payment is exempt address in their records.
for...
• Interest and dividend payments All exempt payees except Line 6
for 7. Enter your city,state,and ZIP code.
• Broker transactions Exempt payees 1 through4and6 Part I. Taxpayer Identification Number (TIN)
through 11 and all C corporations.
S corporations must not enter an Enter your TIN in the appropriate box.If you are a resident alien and
exempt payee code because they you do not have,and are not eligible to get,an SSN,your TIN Is your
are exempt only for sales of IRS iTIN.Enter It In the entry space for the Social security number.If you
noncovered securities acquired do not have an ITIN,see How to get a TIN below.
prior to 2012. If you are a sole proprietor and you have an EIN,you may enter either
• Barter exchange transactions Exempt payees 1 through 4. your SSN or EIN.
and patronage dividends If you are a single-member LLC that is disregarded as an entity
• Payments over$600 required to Generally,exempt payees separate from Its owner,enter the owner's SSN(or EIN,if the owner has
be reported and direct sales over 1 through 5.2 one).If the LLC is classified as a corporation or partnership,enter the
$5,000' entity's EIN.
• Payments made in settlement of Exempt payees 1 through 4. Note:See What Name and Number To Give the Requester,later,for
payment card or third-party further clarification of name and TIN combinations.
network transactions How to get a TIN.If you do not have a TIN,apply for one immediately.
1See Form 1099-MISC,Miscellaneous Information,and Its instructions. To apply for an SSN,get Form SS-5,Application for a Social Security
2 Card,from your local SSA office or get this form online at
However,the following payments made to a corporation and www.SSA.gov.You may also get this form by calling 800-772-1213.Use
reportable on Form 1099-MISC are not exempt from backup Form W-7,Application for IRS Individual Taxpayer Identification
withholding:medical and health care payments,attorneys'fees,gross Number,to apply for an ITIN,or Form SS-4,Application for Employer
proceeds paid to an attorney reportable under section 6045(f),and Identification Number,to apply for an EIN.You can apply for an EIN
payments for services paid by a federal executive agency. online by accessing the IRS website at www.irs.gov/EIN.Go to
Exemption from FATCA reporting code.The following codes identify www.irs.gov/Forms to view,download,or print Form W-7 and/or Form
payees that are exempt from reporting under FATCA.These codes SS-4.Or,you can go to www.irs.gov/OrderForms to place an order and
apply to persons submitting this form for accounts maintained outside have Form W-7 and/or Form SS-4 mailed to you within 15 business
of the United States by certain foreign financial institutions.Therefore,if days.
you are only submitting this form for an account you hold in the United if you are asked to complete Form W-9 but do not have a TIN,apply
States,you may leave this field blank.Consult with the person for a TIN and enter"Applied For"in the space for the TIN,sign and date
requesting this form if you are uncertain If the financial institution is the form,and give it to the requester.For interest and dividend
subject to these requirements.A requester may indicate that a code is payments,and certain payments made with respect to readily tradable
not required by providing you with a Form W-9 with"Not Applicable"(or instruments,you will generally have 60 days to get a TIN and give It to
any similar Indication)entered on the line for a FATCA exemption code, the requester before you are subject to backup withholding on
A—An organization exempt from tax under section 501(a)or any payments.The 60-day rule does not apply to other types of payments.
individual retirement plan as defined In section 7701(a)(37). You will be subject to backup withholding on all such payments until
B—The United States or any of its agencies or instrumentalities. you provide your TIN to the requester.
C—A state,the District of Columbia,a U.S.commonwealth or Note:Entering"Applied For"means that you have already applied for a
territory,or any of their political subdivisions or Instrumentalities. 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
D—A corporation the stock of which is regularly traded on one or when you may Instead be subject to withholding under chapter 3 or 4 of
more established securities markets,as described in Regulations the Code.
section 1.1472-1(c)(1)(i). Caution:A disregarded U.S.entity that has a foreign owner must use
E—A corporation that is a member of the same expanded affiliated the appropriate Form W-8.
group as a corporation described in Regulations section 1.1472-1(c)(1)(1).
Form W-9(Rev.3-2024) Page 5
Part II. Certification For this type of account: Give name and EIN of:
To establish to the withholding agent that you are a U.S.person,or 8.Disregarded entity not owned by an The owner
resident alien,sign Form W-9.You may be requested to sign by the Individual
withholding agent even if item 1,4,or 5 below indicates otherwise. 9.A valid trust,estate,or pension trust Legal entity,
For a joint account,only the person whose TIN is shown in Part I 10.Corporation or LLC electing corporate The corporation
should sign(when required).In the case of a disregarded entity,the status on Form 8832 or Form 2553
person identified on line 1 must sign.Exempt payees,see Exempt payee 11.Association,club,religious,charitable, The organization
code,earlier. educational,or other tax-exempt
Signature requirements.Complete the certification as indicated in organization
items 1 through 5 below. 12.Partnership or multi-member LLC The partnership
1.Interest,dividend,and barter exchange accounts opened 13.A broker or registered nominee The broker or nominee
before 1984 and broker accounts considered active during 1983. 14.Account with the Department of The public entity
You must give your correct TIN,but you do not have to sign the Agriculture in the name of a public
certification. entity(such as a state or local
2.Interest,dividend,broker,and barter exchange accounts that receivess a agg governmenthoricuu lturall p dist pr,grrogra mson)
m
opened after 1983 and broker accounts considered inactive during payments
1983.You must sign the certification or backup withholding will apply.If 15.Grantor trust filing Form 1041 or The trust
you are subject to backup withholding and you are merely providing under the Optional Filing Method 2,
your correct TIN to the requester,you must cross out item 2 In the requiring Form 1099(see Regulations
certification before signing the form. section 1.671-4(b)(2)f)(B)}'•
3.
cross out item 2 of the certReal estate iificationu must sign the certification.You may I 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
4.Other payments.You must give your correct TIN,but you do not must be furnished.
have to sign the certification unless you have been notified that you
have previously given an incorrect TIN."Other payments"include Circle the minor's name and furnish the minor's SSN.
payments made in the course of the requester's trade or business for 3You must show your Individual name on line 1,and enter your business
rents,royalties,goods(other than bills for merchandise),medical and or DBA name,if any,on line 2.You may use either your SSN or EIN Of
health care services(including payments to corporations),payments to you have one),but the IRS encourages you to use your SSN.
a nonemployee for services,payments made in settlement of payment 'List first and circle the name of the trust,estate,or pension trust.(Do
card and third-party network transactions,payments to certain fishing not furnish the TIN of the personal representative or trustee unless the
boat crew members and fishermen,and gross proceeds paid to legal entity itself is not designated in the account title.)
attorneys(including payments to corporations).
5.Mortgage interest paid by you,acquisition or abandonment of *Note:The grantor must also provide a Form W-9 to the trustee of the
secured property,cancellation of debt,qualified tuition program trust. •
payments(under section 529),ABLE accounts(under section 529A), ""For more information on optional filing methods for grantor trusts,see
IRA,Coverdeii ESA,Archer MSA or HSA contributions or the Instructions for Form 1041.
distributions,and pension distributions.You must give your correct Note:If no name is circled when more than one name is listed,the
TIN,but you do not have to sign the certification. number will be considered to be that of the first name listed.
What Name and Number To Give the Requester Secure Your Tax Records From Identity Theft
For this type of account: Give name and SSN of: Identity theft occurs when someone uses your personal information,
1.Individual The individual such as your name,SSN,or other Identifying information,without your
2.Two or more individuals(joint account) The actual owner of the account or, permission to commit fraud or other crimes.An identity thief may use
other than an account maintained by if combined funds,the first Individual your SSN to get a job or may file a tax return using your SSN to receive
an FFI on the account, a refund.
3.Two or more U.S.persons Each holder of the account To reduce your risk:
(joint account maintained by an FFI) •Protect your SSN,
4.Custodial account of a minor The minor2 •Ensure your employer Is protecting your SSN,and
(Uniform Gift to Minors Act)
5.a.The usual revocable savings trust The grantor-trustees •Be careful when choosing a tax return preparer.
(grantor is also trustee) If your tax records are affected by Identity theft and you receive a
b.So-called trust account that Is not The actual owner' notice from the IRS,respond right away to the name and phone number
a legal or valid trust under state law printed on the IRS notice or letter.
6.Sole proprietorship or disregarded The owner3 If your tax records are not currently affected by identity theft but you
entity owned by an Individual 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
7.Grantor trust filing under Optional The grantor' Identity Theft Hotline at 800-908-4490 or submit Form 14039.
Filing Method 1(see Regulations
section 1.671-4(b)(2)(i)(A)) 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 Privacy Act Notice
systemic problem,or are seeking help In resolving tax problems that
have not been resolved through normal channels,may be eligible for Section 6109 of the Internal Revenue Code requires you to provide your
Taxpayer Advocate Service(TAS)assistance.You can reach TAS by correct TIN to persons(including federal agencies)who are required to
calling the TAS toll-free case Intake line at 877-777-4778 or TTY/TDD file information returns with the IRS to report interest,dividends,or
800-829-4059. certain other income paid to you;mortgage interest you paid;the
Protect yourself from suspicious smalls or phishing schemes. acquisition or abandonment of secured property;the cancellation of
Protecg is the creation and use of email and websites designed to debt;or contributions you made to an IRA,Archer MSA,or HSA.The
mimic legitimate business emails and websites.The most common act personormcollectingnr thisth the form uses the reportingt th Information o the form to file
Is sending an email to a user falsely claiming to be an established information returns with IRS, the above Information.
legitimate enterprise in an attempt to scam the user into surrendering Routine uses of this information include giving it to the Department of
private information that will be used for identity theft. Justice for civil and criminal litigation and to cities,states,the District of
Columbia,and U.S.commonwealths and territories for use In
The IRS does not Initiate contacts with taxpayers via emails.Also,the administering their laws.The information may also be disclosed to other
IRS does not request personal detailed Information through email or ask countries under a treaty,to federal and state agencies to enforce civil
taxpayers for the PIN numbers,passwords,or similar secret access and criminal laws,or to federal law enforcement and Intelligence
information for their credit card,bank,or other financial accounts. agencies to combat terrorism.You must provide your TIN whether or not
If you receive an unsolicited email claiming to be from the IRS, you are required to file a tax return.Under section 3406,payors must
forward this message to phishing@irs.gov.You may also report misuse generally withhold a percentage of taxable interest,dividends,and
of the IRS name,logo,or other IRS property to the Treasury Inspector certain other payments to a payee who does not give a TIN to the payor.
General for Tax Administration(TIGTA)at 800-366-4484.You can Certain penalties may also apply for providing false or fraudulent
forward suspicious emails to the Federal Trade Commission at information.
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.ldentityTheft.gov
and Pub.5027.
Go to www.lrs.gov/ldentkyTheft to learn more about identity theft and
how to reduce your risk.
POLYDYNE INC
CERTIFICATE OF RESOLUTIONS
I, 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, Rene 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, Rene 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 8th day of January 2020.
41114..R'/i ..fit
r' a J. Gan i on, Secretary
SEAL
1995
I : -$t t*alit) ticity of this copy of the Resolution of the Board of Directors. This resolution is still valid
and in e ect as of date signed.
Mark Schlag
Vice President Finance,Assistant-Secretary&Treasurer
Date:05/14/25
Polydyne Inc.
General Information
Federal Identification No. 34-1810283
State of Incorporation: Delaware
Date of Incorporation: August 21,1995
Administrative Offices: 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.Rene 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,
Andrezieux,(42163),
FRANCE,registered under
the number 312 327 737 in
the Commercial Registry of
the town of Saint-Etienne
(42000),FRANCE.
Rev.11/2022
SPIF
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 I am the Sr.Vice-President of Polydyne Inc. Located at One Chemical Plant
Road, Riceboro,GA 31323. I am 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 15th day of May,2025.
Notary Public Signature & r [Notary Seal]
o11
My commission expires: �,� P J MCOF,9�./e
OTARY
• jOUMP
-cool
Polydyne Inc. • 1 Chemfalt-rantRoad • 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
Boyd Stanley
Sr. Vice-President
POLYDYNE INC.
Date: May 14, 2025
Polydyne Inc. • 1 Chemical Plant RQ\ad • Riceboro, GA 31323 USA•Tel 800.848.7659
5/14/25,3:13 PM Listing Category Search Page I NSF International
NSF
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 6o
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
thttp://www.polydyneinc.coml
Facility : Los Angeles, CA
Poly(Diallyldimethylammonium Chloride)(pDADMAC)
Trade Designation Product Function Max Use
Clarifloc®C-378 Coagulation&Flocculation 5omg/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 I NSF International
Poly(Diallyldimethylammonium Chloride)(pDADMAC)
Trade Designation Product Function Max Use
Clarifloc® C-378 Coagulation &Flocculation 5omg/L
Facility : Dolton, IL
Poly(Diallyldimethylammonium Chloride)(pDADMAC)
Trade Designation Product Function Max Use
Clarifloc® C-378 Coagulation &Flocculation 5omg/L
Facility : Pearlington, MS
Poly(Diallyldimethylammonium Chloride)(pDADMAC)
Trade Designation Product Function Max Use
Clarifloc® C-378 Coagulation & Flocculation 5omg/L
Number of matching Manufacturers is i
Number of matching Products is 4
Processing time was i seconds
https://info.nsf.org/Certified/PwsChemicals/Listings.asp?CompanyName=polydyne&TradeName=c-378&ChemicalName=&ProductFu notion=&PlantSta... 2/2
CERTIFICATE Polydyne Inc.
SNF O F 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 3130 A
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-3 78 POLYMER
CHARACTERISTICS HANDLING AND STORAGE cy',.
CLARIFLOC C-378 polymer is a high molecular weight, CLARIFLOC C-378 has a suggested in-plantstoragelifeofsix
homopolymer of diallyldimethylammonium chloride. It is an months in unopened drums. For best results,store at 40-90 F. _"3
effective organic coagulant for water clarification in a wide Protect from freezing.Ifthe product freezes,allow it to warm up t`'
variety ofmunicipal applications.CLARIFLOC C-378 can in a heated area and thaw thoroughly before attempting to use
w:=;
partiallyortotallyreplacealum,ferric,lime and other inorganic it. For spills of CLARIFLOC C-378, sprinkle sawdust or r <,
coagulants,thereby reducing sludge volume.Unlike vermiculite over the spill area and sweep the material into F,
inorganics,it is effective over very wide pH ranges. approved chemical disposal containers.
CLARIFLOC C-378 is NSF certified for clarification of
potable water at dosages up to 50 tng/L.
PRODUCT SAFETY INFORMATION
TYPICAL PROPERTIES CLARIFLOC C-378 is a mildly acidic product that can irritate
the skin and eyes,so gloves,rubber apron and goggles should
Physical Form AmberLiquid be worn during the handling ofthis product.Anyone responsible
Density 8.5-8.9 lbs/gal for the procurement, use or disposal of this product should
Freezing Point -3 C. familiarize themselves with the appropriate safety and handling
Solubility Totally Water Soluble information outlined in the POLYDYNE Material Safety Data
Sheet. In the event ofan emergency with CLARIFLOC C-378,
PREPARATION AND FEEDING contact Chemtrec anytime day or night at(800)424-9300.
CLARIFLOC C-378 is a solution polymer which can be diluted SHIPPING
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. CLARIFLOC C-378 Polymer is shipped in 55 gallon
Diluting to 1-10% product is highly recommended for all drums containing 450 pounds net and in 275 gallon
clarification application because the coagulant will be distributed totes containing 2300 pounds net. Bulk quantities are
more efficiently into the system with less chance of overdose. also available.
MATERIALS OF CONSTRUCTION ADDITIONAL INFORMATION
Crosslinked polyethylene,fiberglass,stainless steel and lined To place an order or obtain technical information from any
mild steel are the preferred materials of construction for bulk location in the continental United States,call toll free:
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 18881 848-7858
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
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 mode 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. I 0323
Polydyne Inc. • 1 Chemical Plant Road • Riceboro,GA 31323 • Tel 800.848.7659 • Fax 912.880.2078 • www.polydyneinc.com
NF HeaIth•Safety
Envlronmeni
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: CLARIFLOCTM 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
POLYDYNE INC
Company: 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:0511412025 Revision date:1110812024 Page: 1/10
SAFETY DATA SHEET CLARIFLOCTM 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 S. 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:0511412025 Revision date:11108/2024 Page: 2/10
SAFETY DATA SHEET CLARIFLOCTM 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.
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). 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:0511412025 Revision date:1110812024 Page: 3/10
SAFETY DATA SHEET CLARIFLOCTm 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:0511412025 Revision date:11108/2024 Page: 4/10
SAFETY DATA SHEET CLARIFLOCTM 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: Clear to slightly yellow liquid.
b)Odour: None.
c)Odour Threshold: Not applicable.
d)pH: 3 -7 (See Technical Bulletin or Product Specifications for a
more precise value, if available)
e)Melting point/freezing point: <5°C
t)Initial boiling point and boiling range: > 100°C
g)Flash point: Does not flash.
h)Evaporation rate: No data available.
i)Flammability(solid,gas): Not applicable.
j) Upper/lower flammability or explosive limits: Not expected to create explosive atmospheres.
k) Vapour pressure: 2.3 kPa @ 20°C
I) Vapour density: 0.804 gIL @ 20°C
m)Relative density: 1.0- 1.2(See Technical Bulletin or Product Specifications
for a more precise value, if available)
n)Solubility(ies): Completely miscible in water.
o)Partition coefficient n-octanol/water(log value): <0
p)Autoignition temperature.' Does not self-ignite(based on the chemical structure).
q)Decomposition temperature: > 150°C
r) Viscosity: See Technical Bulletin.
s)Kinematic viscosity: No data available.
t)Explosive properties: Not expected to be explosive based on the chemical structure.
u)Oxidizing properties: Not expected to be oxidising based on the chemical structure.
v)Particle characteristics: Not applicable.
9.2. Other information
Print Date:0511412025 Revision date:1110812024 Page: 5/10
SAFETY DATA SHEET CLARIFLOCTM 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: LD50/oral/rat>5000 mg/kg
Acute dermal toxicity: LD50/dermal/rat> 5000 mg/kg.
Acute inhalation toxicity: 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.
Skin corrosion/irritation: Not irritating.
Serious eye damage/eye irritation: Slightly irritating.
Respiratory/skin sensitisation: Not sensitizing to skin. No respiratory sensitization has been observed in the
workplace.
Mutagenicity: Not mutagenic.
Carcinogenicity: By analogy with similar substances,this substance is not expected to be carcinogenic.
Print Date:0511412025 Revision date:11/0812024 Page: 6/10
SAFETY DATA SHEET CLARIFLOCTM 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: ECO/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:0511412025 Revision date:11/0812024 Page: 7/10
SAFETY DATA SHEET CLARIFLOCTM 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:0511412025 Revision date:11/08/2024 Page: 8/10
SAFETY DATA SHEET CLARIFLOCTM 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:0511412025 Revision date:1110812024 Page: 9/10
SAFETY DATA SHEET CLARIFLOCTM C-378
NFPA:
Health: 0
Flammability: 0
Instability: 0
a
0
A.
Irr
HMIS:
Health: 0
Flammability: 0
Physical Hazard: 0
PPE Code: B
This data sheet contains cha ges 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
LDCCO1OA
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:0511412025 Revision date:1110812024 Page:10/10
5/14/25,3:14 PM Listing Category Search Page I NSF International
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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.nsforg/Certified/PwsChemicals/Listings.asp?
CompanyName=polydyne&TradeName=c%2D624o&
NSF/ANSI/CAN 6o
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-624o Coagulation&Flocculation 3 mg/L
[PC] Polyacrylamide Products Certified by NSF International comply with 40 CFR 141.111
requirements for percent monomer and dose.
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SIVF CERTIFICATE Polydyne Inc.
O F 3929 MEDFORD STREET
POLYDYNE ANALYSIS
LOS ANGELES CA 90063
CUSTOMER NAME:
SAMPLE
OA#: SAMPLE
POLYDYNE PRODUCT NAME: CLARIFLOC C-6240
PURCHASE ORDER NR: SAMPLE DATE: 01/07/2025
AMOUNT: SAMPLE QUALITY CONTROL QC
BATCH NUMBER
UNIT SPECIFICATION RC32/4186M TEST
BULK VISCOSITY cps 500-2000 1560 1010 A
NON VOLATILE SOLIDS % 43.0-50.0 46.6 1050 A
UL BROOKFIELD VISCOSITY cps 4.30-5.30 4.81 1019 A
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
StIF
WATER SCIENCE POLYDYNE
CLARIFLOC C-6240 POLYMER
PRINCIPAL USES MANUFACTURING SPECIFICATIONS
CLARIFLOC C-6240 is a medium charge cationic polyacrylamide
in emulsion form that is used as a flocculant in a wide variety ofmunicipal Total Solids 43-50%
and industrial wastewater treatment applications. It has been success- Residual AcAm <500 ppm
fully applied in all liquid/solids separation systems including clarifica- Neat Viscosity 500-2000 cPs , 5
tion,thickening,and dewatering. Clarifloc C-6240 is NSF certified UL Viscosity 4.3-5.3 cPs
for clarification of potable water at dosages up to 3.0 mg/L. (I`:'..„
HANDLING AND STORAGE F 141
TYPICAL PROPERTIES
Suggested in-plant storage life is 6 months in unopened drums.For best
Physical Form Clear to Milky White Liquid results,store at 50-80 F. Bulk tanks should be mixed by periodically
Density 8.6-8.7 lbs/gal recirculating the contents bottom to top.Bulk tanks can also be fitted
Cationicity 40% with an agitator type mixer that reaches the bottom 2 feet of the tank.
Active PolyacrylaniideMin. 39% Drums and bins should be mixed very well before first use and weekly
Freezing Point 7 F.(-14 C.) 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,
PREPARATION AND FEEDING 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
CLARIFLOC C-6240 is a single component emulsion polymer that to clean up.
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 SAFETY INFORMATION
polymer i nto the vortex of a mixed tank at a concentration between CLARIFLOC C-6240 is a mildly acidic product that can irritate the
0.25-1.0%polymer(0.5%is optimum)by weight. The polymer can
also be injected through a number of commercially available systems
skin and eyes and should be handled accordingly. Gloves,goggles and
that provide in-line mechanical mixing.The best feed systems use initial apron are highly recommended. Anyone responsible for the procure-
high energy mixing(>1000 rpm)for a short time(<30 sec)to achieve ment,use or disposal ofthis product should familiarize themselves with
dis dispersionlowmixing(<400t to for alon longer
the appropriate safety and handling precautions involved. Such
goodp byenergy rpm) g information is outlined in the POLY DYNE Material Safety Data Sheet.
time(10-30 min). Polymer solutions should be aged for 15-60 minutes
for best results. Solution shelf life is 8-16 hours. In the event of an emergency with this product, contact Chemtrec
anytime day or night at(800)424-9300.
MATERIALS OF CONSTRUCTION SHIPPING
CLARIFLOC C-6240 Polymer is shipped in 55 gallon drums
containing 450 pounds net or in 275 gallon totes containing 2300
Cross-linked polyethylene,fiberglass,stainless steel or lined steel are pounds net. Bulk quantities are also available.
the preferred materials of construction for bulk tanks. Avoid natural
rubber and Buna-N gaskets as these materials swell when placed in ADDITIONAL INFORMATION
contact with neat polymer. Unlined mild steel,black iron,galvanized To place an order or obtain technical information from anywhere in the
steel,copper or brass are not recommended in any part of the feed continental United States,call toll free:
system. Stainless steel.Viton or Teflon are the best choices for pump
heads. For feed lines,use PVC or reinforced Tygon tubing. 848-/858
For additional information, please refer to the Safety Data Sheet (SDS)
All statements,information and data given herein ore 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. 10323
Polydyne Inc. • 1 Chemical Plant Road • Riceboro,GA 31323 • Tel 800.848.7659 • Fax 912.880.2078 • www.polydyneinc.com
SNF Health-Safety
__.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: CLARIFLOCTM 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
POLYDYNE INC
Company: 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 CLARIFLOCTM 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 mm2/s measured at 40°C.
Poly(oxy-1,2-ethanediyl), a-tridecyl-w-hydroxy-, branched
Concentration/-range: < 5%
CAS Number: 69011-36-5
Classification according to paragraph(d) Acute Tox. 4;H302, Eye Dam. I;H318
of 29 CFR 1910.1200:
For explanation of abbreviations see section 16
SECTION 4: First aid measures
Print Date:05/1412025 Revision date:12106/2024 Page: 2115
SAFETY DATA SHEET CLARIFLOCTM 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:05/1412025 Revision date:12/0612024 Page: 3/15
SAFETY DATA SHEET CLARIFLOCTM 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:
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SAFETY DATA SHEET CLARIFLOCTM 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.
e)Melting point/freezing point: <5°C
f) Initial boiling point and boiling range: > 100°C
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SAFETY DATA SHEET CLARIFLOCTM C-6240
g)Flash point: Does not flash.
h)Evaporation rate: No data available.
i)Flammability(solid,gas): Not applicable.
j)Upper/lower flammability or explosive limits: Not expected to create explosive atmospheres.
k) Vapour pressure: 2.3 kPa @ 20°C
1) Vapour density: 0.804 g/L @ 20°C
m)Relative density: 1.0 - 1.2 (See Technical Bulletin or Product Specifications
for a more precise value, if available)
n)Solubility(ies): Completely miscible.
o)Partition coefficient n-octanol/water(log value): Not applicable.
p)Autoignition temperature: Not applicable.
q)Decomposition temperature: > 150°C
r) Viscosity: >20.5 mm2/s @ 40°C
s)Kinematic viscosity: No data available.
t)Explosive properties: Not expected to be explosive based on the chemical structure.
u) Oxidizing properties: Not expected to be oxidising based on the chemical structure.
v)Particle characteristics: Not applicable.
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
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SAFETY DATA SHEET CLARIFLOCTM 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: LD50/dermaUrat> 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:
Distillates (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.
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SAFETY DATA SHEET CLARIFLOCTM C-6240
Serious eye damage/eye irritation: Not irritating. (OECD 405)
Respiratory/skin sensitisation: By analogy with similar products,this product is not expected to be sensitizing.
(OECD 406)
Mutagenicity: Not mutagenic. (OECD 471,473,474,476,478,479)
Carcinogenicity: Carcinogenicity study in rats (OECD 451):Negative.
Reproductive toxicity: By analogy with similar substances,this substance is not expected to be toxic for
reproduction.
NOAEL/rat=300 ppm. (OECD 421)
STOT-Single exposure: No known effects.
STOT-Repeated exposure: 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)
Aspiration hazard: May be fatal if swallowed and enters airways.
Poly(oxy-1,2-ethanediyl), a-tridecyl-w-hydroxy-, branched
Acute oral toxicity: LD50/oral/rat=500-2000 mg/kg
Acute dermal toxicity: LD50/dermal/rabbit>2000 mg/kg
Acute inhalation toxicity: No data available.
Skin corrosion/irritation: Not irritating. (OECD 404)
Serious eye damage/eye irritation: Causes serious eye irritation. (OECD 405)
Respiratory/skin sensitisation: The results of testing on guinea pigs showed this material to be non-sensitizing.
Mutagenicity: In vitro tests did not show mutagenic effects. In vivo tests did not show mutagenic
effects.
Carcinogenicity: Based on the absence of mutagenicity,it is unlikely that the substance is carcinogenic.
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SAFETY DATA SHEET CLARIFLOCTM C-6240
Reproductive 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/Matemal toxicity/rat>50 mg/kg/day
-NOAEL/Developmental toxicity/rat>50 mg/kg/day
STOT-Single exposure: No known effects.
STOT-Repeated exposure: Based on available data,product is not expected to demonstrate chronic toxic effects.
NOAEL/oral/rat/600 days=50 mg/kg/day
Aspiration hazard: No known effects.
SECTION 12: Ecological information
12.1. Toxicity
Information on the product as supplied:
Acute toxicity to fish: LC50/Fish/96 hours= 10- 100 mg/L(Estimated)
Acute toxicity to invertebrates: EC50/Daphnia magna/48 hours= 10- 100 mg/L(Estimated)
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: No data available.
Effects on terrestrial organisms: No data available.
Sediment toxicity: No data available.
Relevant information on the hazardous components:
Distillates(petroleum), hydrotreated light
Acute toxicity to fish: LCO/Oncorhynchus mykiss/96 hours> 1000 mg/L(OECD 203)
Acute toxicity to invertebrates: ECO/Daphnia magna/48 hours> 1000 mg/L(OECD 202)
Acute toxicity to algae: IC0/Pseudokirchneriella subcapitata/72 hours> 1000 mg/L(OECD 201)
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SAFETY DATA SHEET CLARIFLOCTM C-6240
Chronic toxicity to fish: NOEC/Oncorhynchus mykiss/28 days> 1000 mg/L
Chronic toxicity to invertebrates: NOEC/Daphnia magna/21 days> 1000 mg/L
Toxicity to microorganisms: EC50/Tetrahymena pyriformis/48h> 1000 mg/L.
Effects on terrestrial organisms: No data available.
Sediment toxicity: No data available. Readily biodegradable,exposure to sediment is unlikely.
Poly(oxy-1,2-ethanediyl), a-tridecyl-w-hydroxy-, branched
Acute toxicity to fish: LC50/Cyprinus carpio/96 hours= 1 - 10 mg/L(OECD 203)
Acute toxicity to invertebrates: EC50/Daphnia/48 hours= 1 - 10 mg/L(OECD 202)
Acute toxicity to algae: IC50/Desmodesmus subspicatus/72 hours= 1 - 10 mg/L(OECD 201)
Chronic toxicity to fish: No data available.
Chronic toxicity to invertebrates: NOEC/Daphnia magna/21 days> 1 mg/L(OECD 202)
Toxicity to microorganisms: EC10/activated sludge/17 hours> 10000 mg/L(DIN 38412-8)
Effects on terrestrial organisms: No data available.
Sediment toxicity: No data available.
12.2. Persistence and degradability
Information on the product as supplied:
Degradation: Based on the degradability data of the components, this product is expected to be
readily(bio)degradable according to OECD criteria.
Hydrolysis: 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.
Photolysis: No data available.
Relevant information on the hazardous components:
Distillates(petroleum), hydrotreated light
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SAFETY DATA SHEET CLARIFLOCTM 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.
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SAFETY DATA SHEET CLARIFLOCTM 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:
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SAFETY DATA SHEET CLARIFLOCTM 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 III 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-Dioxanc
SECTION 16:Other information
NFPA and HMIS Ratings:
NFPA:
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SAFETY DATA SHEET CLARIFLOCTM C-6240
Health: 0
Flammability: 1
Instability: 0
1
OA.
VP'
HMIS:
Health: 0
Flammability: 1
Physical Hazard: 0
PPE Code: B
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 1 =Serious eye damage/eye irritation Category Code 1
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
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SAFETY DATA SHEET CLARIFLOCTM 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.
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