CM-12-06-103NTASERVIRONPIENTAL SERVICES L.P.
3929 Caifomia Parkway E.
Fort Worth, Texas 76119 (Tarrant County)
Ph. 817.535.7222
WORK AUTHORIZATION
Fax back to
817.535.8187
COMPANY (hereafter 'Customer) NAME: Gj y el ac9.tA Rock Purchase Order #
Date: 6/7/20/2,
COMPANY Physical Address (hereafter 'Customer): a 2/ 4 P-,,,, .$1-- STATE OF INCORPORATION: lX FEIN:
BILLING ADDRESS (If Different from Above): 9a/ s /"!4, n S
Company/Customer Contact: CAA,/es A%S & o// Telephone#: /- ? 71` Pager/ Mobile#:S/2 ?"/R- 3 5-3p
Job Location: 270/ N N41r57' Job Description: Ca.,. Igor on-i-ekvns.rfo.c) DOT#:
License Plate#:
I, (print name) A.-& .r, t Ifizi/ty (print title) Ass ;s,4,yrGtyyt1 hk n4 Driver License # (include State) of the above
mentioned CUSTOMER, hereby authorize TAS Environmental Services, LP (hereafter ?AS1) to provide services, labor,
contain, dean -up and/or provide related services in connection with the equipment, supthe and schedule
to nonned
in TAS's project described above according to the terms and conalliorhs and the pricing schedule contained
Response Rate Schedule in effect at the time that services are performed. I hereby represent that I am authorized to contractually bind Customer this
matter, and I have personal knowledge of the applicable TAS current Response Rates Schedule. Customer regarding
suppies and materials as TAS deems necessary to property complete the work requested, and Customer a9 last TAS may fully cooperate with TAS
e such services, riance labor, of the work
to coon• My signature appearing below signifies that I have read, understand and agree to al terms and �conditio' n Work Authorization. of the wale
1. Customer acknowledges and agrees that (a) TAS maintains a current Response Rate Schedule for the Services
Customer agrees to pay to TAS all charges in accordance with the Responserequested, and (b) CustomerdChas a copy of same.
such Rate Schedule in effect at the time that work is perbrmed, and Customer agrees to make
rees
that transportation
3929 California Parkway E, Fort Worth, Texas 76119 mately upon receipt by Customer of TAS's invoice(s). Customer
charges and decontanwnaton and/or disposal charges may appear in one or more invoices. Customer agrees to pay a finance or any
porton of the charges not timely paid at the rate of 1-112% per month (18% per annum) for each month a payment is in arrears beginning on the first day of the first month
following any delinquency. Customer agrees to pay al attorneys fees and costs incurred if Customer's account is referred to any attorney for collection. Customer agrees
that Customer is responsible and liable ler paying TAS for the charges incurred. Customer guarantees timely payment to TAS
regardless may contend that any third -party person or entity is responsible or liable, in whole or inofwhethero us omer contends or
Part, induding but not linked to any insurance artier of Customer. Customer
assumes full responsibility for communicating with Customer's insurance carrier and hereby releases and holds harmless TAS from communicating in any manner with
Customer's insurance carrier. Customeragrees that
any Partial Payment to TAS for the charges incurred, inckding from a third -party person or entity such as Customer's
insurance carrier, MI not relieve Customer of the obligation to pay the full balance due, including finance charges accrued,
attomeys fees
immediately notify TAS of any changes to Customer's name and/or addresses and/or phone numbers. a• Customer agrees to
2. Customer shall be requiredproperly execute a TAS Work Authorization at the time services are requested in order for work to begin. Failure to properly execute hs
Work Authorization or pay pranptly for services upon receipt of any invoice may be considered reasonable rause b suspend operations if
require a retainer in an amount to be determined during the initial response or at an time subsequent begun. TAS reservesmy snipe d
operations until such retainer has been provided. Y baequent to commencement of operations and, m its disaebon, may suspend
3. INDEMNIFICATION. REGARDLESS OF CAUSE AND N CONSIDERATION FOR TAS PROVIDING RESPONSE SERVICES IN CONNECTION WITH ACTMTIES ENGAGED
IN BY CUSTOMER OR ITS AGENTS, ASSIGNS, EMPLOYEES AND REPRESENTATIVES, CUSTOMER AGREES TO I DEMN IFYAND HOLD HARMLESS TAS FROM AND
AGAINST ANY AND ALL CLAIMS OR CAUSES OF ACTION OF ANY KIND WHATSOEVER BROUGHT OR ASSERTED IN ANY MANNER AGAINST TAS BY ANY PERSON
OR ENTRY (WHETHER BY THIRD PARTES AND/OR BY CUSTOMER AND CUSTOMER'S AGENTS, REPRESENTATIVES, OFFICERS, EMPLOYEES AND ASSIGNS) THAT
ARISES DIRECTLY OR INDIRECTLY OUT OF TAS'S PERFORMANCE OF TIE WORK AND/OR PRESENCE AT THE NIORKSRE WHICH CLAWS SHALL INCLUDE, BY WAY
OF EXAMPLE BUT NOT BY WAY OF LWRATION, LOSSES, DAMAGES, COSTS AND EXPENSES INCLUDING ATTORNEYS FEES AND WHETHER SOUNDING IN
CONTRACT, TORT OR OTHERWISE AND WHETHER FOR TRESPASS, DAMAGE OR INJURY TO PROPERTY OR INJURY OR DEATH OF PERSONNEL (INCLUDING
SUBSURFACE AND EASEMENT), AND NCLUDNG FOR VIOLATIONS BY THE CUSTOMER OF THE RESOURCE CONSERVATION AND RECOVERY ACT, AS AMENDED,
THE COMPREHENSIVE ENVIRONMENTAL RESPONSE, COMPENSATION AND UABILITYACT, AS AMENDED, THE TOXIC SUBSTANCES CONTROL ACT, AS AMENDED,
AND OTHER ENVIRONMENTAL LAWS, RULES AND REGULATIONS RELATING TO THE MERE EXISTENCE, GENERATION OR PAST, CURRENT OR FUTURE
OWNERSHIP OF HAZARDOUS OR NONHAZARDOUS SUBSTANCES, WASTES OR MATERIALS RELATING TO SERVICES PROVIDED UNDER THIS AGREEMENT.
CUSTOMER AGREES TO DEFEND ALL ASSERTED CLAIMS AGAINST TAS REGARDLESS OF CAUSE OR ALLEGED NEGUGENCE OF TAS OR CUSTOMER, AT
CUSTOMER'S EXPENSE. CUSTOMER HEREBY REPRESENTS THAT CUSTOMER CARRIES INSURANCE N SUFFICIENT AMOUNTS IN ORDER TO SATISFY
CUSTOMER'S DEFENSE AND I DEMNRY OF TAS AND AGREES TO PROVIDE A CERTIFICATE OF INSURANCE TO TAS UPON REQUEST.
4. Customer fully agrees that: this authorization in no way obligates TAS to satisfy any local, state or federal
regulaby reporting requirements any provision herein deemed to be Invalid or unenforceable for any reason shall not affect the legality,ot to Ude evert
pronouns shad not affect the substance herein. The parties agree that venue in Tarrant County, Texas is proper and the validly, interpretation and other forcement of this
Agreement and the contents herein are to be ' pursuant to the kava of the Stale of Texas (without reference to the laws of another stale
this agreement shall be in Tarrant Te .) and any suit regarding
Customer Sig Print Name: 4--l/(.l!'i `e
7 //ll -e/ Date:
Accounts Payable contact Name: �l, �u k.i /t.j r r% Phoned: ' f 2 �7 1- 27'7 /
f
TAS Signature: Print Name: Date: 6
btk, 1'- Ota -103
Rev. January/2010
CUSTOMER NAME:
JOB NUMBER:
GENERATOR NAME:
PROJECT LOCATION:
MAILING ADDRESS:
CONTACT PERSON:
DISPOSAL AUTHORIZATION
THIS IS NOT AN INVOICE, ESTIMATE ONLY
DATE:
Rot ' /2c-4 Contractor: TAS Environmental Services, LP.
( , I)e(on re,-1/.14.>/eti 3929 California Parkway East
�'��%✓ /�'l�l�i rl� Fort Worth, TX 76119
02'20/ /V,frikr r Toll Free 1-888-654-0111
,22 / .nwK S Facsimile (817) 535-8187
TELEPHONE / FAX NUMBER: T (c/1) - 0.7),
F (s7) ) 02/(— SS S ce•
IS MATERIAL RCRA HAZARDOUS? YES
*Generator's US EPA ID Number:
NO
*Generator's US EPA Waste Code(s) (D,U,P,K,F):
*Generator's Texas Waste Code Number of the above material:
* WASTE DESCRIPTION:
* DISPOSAL METHOD:
* DISPOSAL FACILITIES:
* ESTIMATED DISPOSAL COST:
* ESTIMATED TOTAL VOLUME:
Customer understands that Customer may arrange for another entity to provide transportation and disposal services. However, in the event
Customer requests TAS, LP to provide transportation and disposal services and TAS, LP agrees by providing same, then Customer
understands, acknowledges and agrees that Customer is providing AUTHORIZATION AS AGENT FOR WASTE DISPOSAL as follows:
Customer authorizes TAS, LP to provide for transportation and disposal of the waste (including but not limited to material provided by TAS,
LP which may become contaminated by reason of the spill clean up) which result from the spill or job description referred to above. In the
event TAS, LP performs such disposal work, Customer acknowledges that Customer will incur additional charges including but not limited to
sample analysis fees, transportation fees, roll -off box rentals and dumping fees and Customer agrees to pay such fees pursuant to the terms of
payment as set forth above. Further, Customer understands and agrees that Customer is the responsible party for the spill or damage and is
therefore liable for the disposal of any and all hazardous or non -hazardous commodities and/or waste. Customer understands, acknowledges
and agrees that title to waste materials resulting from the cleanup of hazardous and/or non -hazardous materials will not be transferred to TAS,
LP. Customer hereby indemnifies and holds harmless TAS, LP from any damages of whatever nature in acting on behalf of the Customer as
Agent in the proper management of the disposal and transportation of any wastes generated during this project, including but not limited to
properly characterizing the nature and extent of any contamination, determining appropriate waste codes, completing required disposal facility
profile and disposal restriction forms, generating waste manifest(s), and completing any other documentation related to the proper disposition
of waste that may ' local, state and federal regulations.
Signature:
in by applicabl
rr//,,ttibif
Print
Title: ,IS_. / i-4:,7 Ci. �'[ahr�Rr•
Company:
Date:
P.O #
c,11(0 RPUBLIC
SERVICES, INC.
THIRD PARTY SIGNATURE AUTHORIZATION
for Special Waste Disposal
Date: -2/20/2-
This
-2/20/ZThis Authorization is only valid for 3 years
from the above date.
To Whom It May Concern:
Please be advised that the following company/individual has been appointed to work as our agent
for purposes of managing waste materials that we may generate.
Name of Authorized Agent
Lisa Colon
Name of Company
TAS Environmental Services
Title
Disposal Coordinator
Telephone Number
210.496.5310
The above broker/individual is authorized to act as our authorized agent for the following purposes:
® Complete and sign Special Waste Profile.
® Complete and sign Special Waste Profile -Recertification.
• Authorize amendments to Special Waste Profile.
® Sign contracts to dispose and/or transport material.
® Sign certifications necessary to comply with landfill requirements.
® Sign manifests to initiate shipment to disposal facilities.
Our authorized agent will notify us prior to any action stated above, and will provide us with
copies of any documents bearing our name.
Name of Company
GeneratorContact (Print Name)
a6a,uu /#dr
Mailing Address
Title h /1,11/0 ST
4.5)/sTe' -r carr14,,,
Telephone Number
5/Z o2/ k-Sy3o
Courtney Nielson
Subject: RE: Car Decontamination
From: Cheryl Delaney
Sent: Friday, June 08, 2012 2:30 PM
To: Monique Adams
Subject: FW: Car Decontamination
Hi Monique/Courtney
This is the City Manager item we had lauire sign —this is regarding the expenses related to the suicide incident. Since we
went out of the process, we wanted to be sure you had a copy of the documents.
Let me know if you have any questions.
Thanks!
Cheryl
From: Charles Meserole
Sent: Friday, June 08, 2012 10:59 AM
To: Cheryl Delaney
Cc: Barry L. Becker
Subject: FW: Car Decontamination
Good Morning Cheryl,
Attached are the signed TAS contracts. They pick up the car this morning. Thanks for all your help.
Best Regards,
Charles
Charles H. Meserole
Administrative Manager
Round Rock Fire Dept.
PH# (512) 671-2779
Cell (512) 748-9539
Fax (512) 218-5594
From: Charles Meserole
Sent: Thursday, June 07, 2012 5:12 PM
To: 'austinadmin'
Cc: Bobby McCullough; Manny Martinez; David Coatney
Subject: Car Decontamination
Good Afternoon Stephanie,
Attached are the contracts signed by the Assistant City Manager. Please proceed with the car decontamination.
Thanks,
Charles
1
Charles H. Meserole
Administrative Manager
Round Rock Fire Dept.
PH# (512) 671-2779
Cell (512) 748-9539
Fax (512)218-5594
From: austinadmin [mailto:austin@taslp.com]
Sent: Thursday, June 07, 2012 3:50 PM
To: Charles Meserole
Cc: Bobby McCullough
Subject:
Charles,
Please fill out and sign the attached forms and resend to me at your earliest
convenience. We will need these forms in order to have disposal completed.
If you have additional questions, please contact Bobby McCullough at
bmccullough@taslp.com or at 512-853-0923 or 512-990-9903.
Thank you,
TAS Environmental Services
13720 Immanuel Rd.
Pflugerville, TX 78660
Phone: (512) 990-9903
Fax: (512) 990-0033
austinAtaslp.com