FERGUSON ENTERPRISES, LLC - UNDERGROUND UTILITY PIPE, PARTS & MAT.A CONTRACT AWARD SHEET INSTRCUTIONAL GUIDE TO ASSIST YOU WITH THE INFORMATION CONTACINED HEREIN IS AVAILABLE IN THE
PURCHASING SECTION OF OUR WEBPAGE AT:
www.hialeahfl.gov
CITY OF HIALEAH
CONTRACT AWARD
PURCHASING DEPARTMENT
CITY OF HIALEAH CONTRACT: UNDERGROUND UTILITY PIPE, PARTS AND MATERIALS
DESCRIPTION: COLLIER COUNTY UNDERGROUND UTILITY PARTS SUPPLIER CONTRACT # 17-7176
CONTRACT PERIOD: APRIL 26, 2022 THROUGH APRIL 01, 2024
SECTION #1 – VENDOR AWARD
Name: FERGUSON ENTERPRISES, LLC Name:
Contact: JoDerek Adams Contact:
Phone: 239-643-4970 Phone:
Fax: Fax:
E-mail: joderek.adams@ferguson.com E-mail:
Name: Name:
Contact: Contact:
Phone: Phone:
Fax: Fax:
E-mail: E-mail:
SECTION #2 – AWARD/BACKGROUND INFORMATION/APPLICABLE ORDINANCES/NOTES
CITY COUNCIL APPROVED ON: 04/26/2022, ITEM D AMENDED AMOUNT:
RESOLUTION NO: INSURANCE REQUIREMENTS:
ANNUAL CONTRACT AMOUNT: $100,000.00 PERFORMANCE BOND:
APPLICABLE ORDINANCES:
Notes:
SECTION #3 – REQUESTING DEPARTMENT
CITY OF HIALEAH, DEPARTMENT OF PUBLIC WORKS
Contract Administrator: Armando Vidal
Phone: 305-556-3800
SECTION #4 – PROCURING AGENCY
CITY OF HIALEAH, DEPARTMENT OF PUBLIC WORKS
Contract Administrator: Armando Vidal
Phone: 305-556-3800
Prepared by: Carmen Escalera
RECEIVED
APR 2 1 2022 RECEIVED
By. B. . it.a .. \ ............ _ . . . ....
APR 1 4 2022
COUNCIL AGENDA ITEM REQUEST FOi .M OFFICE OF
MANAGE MENT & BUDGET
This form, letter from the department head addressed to the Mayor and City Council, as well as
supporting documents are due the Monday of the week prior t o the City Council Meeting.
Date of Request: April 8, 2022
Requesting City Department: Department of Public Works
Requested Council Meeting April 26,2022
Date :
Action Requested from the x Issue a purchase order
City Council:
0 Increase a purchase order
0 Award a bid
ITE M# D 0 Bid No. -
APR 2 6 2022
0 Reject a bid
0 Bid No .
0 Special Events Permit
0 Street Closure
x Other:
Department is reque sting to piggyback contract #17 -7176
between Collie r Count y and Ferguson to iss ue a Purcha se
Order for Qarts and materials
Scope of service(s) or Inventory Parts and materials
product(s):
Vendor: Ferg uson Enterprises (D BA ) Pollard W ater
10810 S.W . 184 St.
M iami, FL 33157
Expenditure Amount : $100,000.00
Funding So urce (i.e., account W ater and Sewer Rev enues
f unding the expenditure): 450.0000 .141001
Purchasing Process: 0 Competitive Bidding
Ferguson Enterprises
ITB #17-716
0 An exception to competitive bidding applies:
0 Professional services in the nature of
consultants, accountants and attorneys
0 Sole source provider
0 Emergency based on object facts
0 Credit facilities
X Competitive bidding is not required because the
City is utilizing a bid that has been awarded or under
contract by state, county or other governmental
agencies.
0 Title of state, county or other governmental
agencies contract:
X Piggy-back contract expiration date:
4/01/2024 Collier County Contract No.#17-7176
0 Waive Competitive Bidding
D Reason(s) it is not advantageous to the City to
utilize competitive bidding:
2
Signatures:
L
Ruth Rubi, Assistant Director of Financial M
Esteban Bovo, Jr., Mayor
Ferguson Enterprises
ITB #17-716
MEMORANDUM
DATE: April 8, 2022
CITY OF HIALEAH
DEPARTMENT OF PUBLIC WORKS
3700 W 4™ AVENUE, HIALEAH, FL 33012
TO: Esteban Bovo, Jr., Mayor
FROM: Armando Vidal, P.E., Directo
SUBJECT: Ferguson Enterprises (DBA) Pollard Water-Parks and Materials
RECOMMENDATION;
The Department is requesting authority to "Piggyback" Collier County Underground Utility
Parts Supplier Contract# 17-7176 with Ferguson Enterprises (DBA) Pollard Water and
issue a Purchase Order in the amount of $100,000.00 for parts and materials. The
Department spent $222,038.51 with this supplier on Fiscal Year 2020-2021.
PROJECT NAME; Department of Public Works -Inventory
PROJECT LOCATION; 3700 W. 4th Ave
PROJECT DESCRIP'[ION/EXPLANATION: Ferguson Enterprises provides the Department
with Pipe, Parts and Materials
MANAGING DEPARTMENT: Department of Public Works
FISCAL IMPACT/FUNDING SOURCE: Fiscal Impact an expenditure of $100,000.00
Account No. 450.000.141001
12/01/2020
col.'Ner County
Administrative Services Department
Procurement Services Division
Mark McFalls, General Manager
Ferguson Enterprises Inc. dba Fe rguson Waterworks
3801 ProspectAvenue
Naples, Florida 34104
Via Email: joderek.adarnsC@ferguson .co m
RE: Contract Renewal for# 17 -7176 "UNDERGROUND UTILITY PARTS SUPPLIER"
Dear Mr. McFalls:
Collier County would like to renew the above contract unde r the same terms and conditions for
an additional Three (3) year period in accordance with the renewal clause in the contract.
If you are agreeable please indicate your intentions by providing the information requ e sted below
and executing the acceptance section:
~ I am agreeable to renewing the above referenced contract under the
same terms, conditions, and pricing as the existing contract.
I a m not agreea bl e to the rene wal of this contract.
By executing the section below, this contract will be in effect from 4/02/2021 until 4/01/2024.
C ompany Name
C ompany
Signature
Print Na m e
S ig nature Da t e
fVl A 12-';(__ M c:-e ~ LLS
Marc 1 9, 2 0 2 1 ----------------;
ProoJrement 8€1\<ices Dviskl!l • 3295 Tamiami Trai l Eas t • Naples , Florida 34112-4901 • 1ww.coll ierg ov.net/p rocuremen lserv ices
Page 2 of 2
RE: Contract Renewal for# 17-7176 "UNDERGROUND UTILITY PARTS SUPPLIER"
Telephone
Number
FAX Number
Email Address
Collier County Procurement Services is pleased to announce, it has pmtnered with BidSync to
provide Free web-based Bidding services to its vendors, suppliers and contractors.
N¢;:~_te-l.l~}q:ix~:.&biJij~)\i'~W~~i"~{~Jili1f~'tfQ!'.i:P:. Register today at www.bidsy nc.com.
For Registration Assistance, please contact BidSync customer service at
800-990-9339 Or email: su12port@biclsync.com.
Please return this letter to the Procurement Services Division with your response no later than
12/812020. You may email your response to email Renewals@colliercountyfl.gov. If you have
any questions you may contact me at 239-252-8407.
Respectfully,
Zimmerman Suef.,Dlgllully slgnod by Zlmmor111~11Sua
~ .. o n10: 2020.1 2 m rn:3 5:s1.os•oo'
.. :>
Sue Zimmerman, CPM
Contract Manager -Procurement Services Divi sion
C: Kevin Anderson, PUD: Operations Support
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COLLIER COUNTY
BOARD OF COUNTY COMMISSIONERS
REQUEST FOR PROPOSAL (RFP)
FOR
UNDERGROUND UTILITY PARTS SUPPLIER
SOLICITATION NO.: 17-7176
VIVIANA GIARIMOUST AS , PROCUREMENT STRA TEGlST
PROCUREMENT SER VICES DIVISION
3295 TAMIAMI TRAIL EAST, BLDG C-2
NAPLES, FLORIDA 34 112
TELEPHONE: (239) 252-83 75
VivianaGialimoustas@colli ergov .n et (Email )
This so licitation d ocum ent is prepar ed in a Microsoft Word fo rnrnt. Any altera ti ons to this
document made by the Vendor may be grounds for rej ection of proposal, cancella ti on of any
s ub se qu e nt award, or a ny other l egal re medi es available to the Colli er County Governm ent.
. ,.c~· ...
CoJfJi-!V Count.v --------.... _ ·----..
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Form 1: V endor's Non-Response Statement
T h e so le intent of th e Coll ier Cou nty Procmerne n t Services Division. is to iss u e soli c itati ons that are c lea r, concise and o p e nl y
co mpetiti ve. T h ere fore, we are interested in ascertaining reaso ns for prospective Vendors not wishing to respond to th is soli ci t ation.
If your ·fim1 is not re s ponding to this RF P, p le ase indicate the rea son(s) by checki ng the item (s) li sted below an d ret urn this f'o rn1 v ia
emai l note d on th e cove r page, o r ma il to Col li er County Governm e nt, P rocurement Servi c es Di vision., 3295 Tamiami T rai l Eas t.
BLDG C-2, Napl es, F L 34 1 12.
We are not responding to Solicitation 17-7176 Underground Utility P arts Supplier for the following reaso n(s):
D Servi ces requested no t available throug h o ur company.
D O ur firm could not meet specifi cati ons/scope of work.
D Specificati ons/scope of work no t clearly unde rstood or applicabJ e (too vague, ri gid , et c .)
D P roject is too s mall.
D Insufficient time allowed fo r pre paration o f response .
D Incorrect address used . P lease correct m ai li ng address :
D Othe r reaso n(s):
Name of Fim1 :
Address :
C ity, State, Z ip :
Telephone:
E mail:
Re presen tative S ig nature:
R e prese nta ti ve Name:
NA.
i\Jm1niS'! :1~.i.·e Scrv:ccs. Oepanfr1£:nt
?m•.<:r~r·)l;-:nl t.;:::1 .ce~ .. :ii'·;:.: c;n
Form 2: Vendor Check List
IMPORTANT: THIS SHEET MUST BE SIGNED. Please read carefull y, sign in the spaces indicated and return with your
Prnposal.
Vendor s hould check off each of the fo ll owing items as the necessary action is comp leted :
IZJ The Proposal ha~ be e n s igned.
[XJ All applicable forms have been signed and included, along with licenses to comp le te the require ments of the project.
!ZJ Any addenda ha ve been signe d and included .
ALL PROPOSALS MUST HAVE THE RFP NUMBER AND TITLE
N a me of.Fim1 : Ferguson Enterprises INC
Address: 3801 Prospect Avenu e
City, S tate, Zip: Napl es , Flori da, 34104
Telephone: 239-643-4970
Email: joderek.adams@fergu son.com
Representative S igna ture:
Representative Name: J o Derek Adams
· ·1'·r\· -, ,u _1e.r L.:11 1 u1 ry
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Fo rm 3: Conflict of Interest Affi davi t
The Venuor ce1i ifi es th at, to the hest o f il s know led ge and belief th e pa st a nd current work on any Colli e r County project a ffi liated
w ith : 17-7176 Underground Utility Parts Supp li.er d o cs no t pose an organi z ational conflict as described by one of the three
ca tegori es below:
Biased ground rnles-The lirm ha s no t set the "ground rul es" for affi li ated pas t or cun ent Collie r County proj ect identifi e d
above (e.g., w ritin g a procure ment's s ta te m e nt of woi-1<. specifications, o r p erforming syste ms e n ginet::ring a nd tec hnical
directi on for th e p rocurem e n t) whi c h appe ars to skew the com petit io n in favor of my fim1.
Impaired objectivity -The tirrn ha s not performed work o n a n af.fil ia tctl past or c urrent Coll ie r County proj ect ide ntified
above to e va luate proposa ls I past performance of itself or a competi tor, w hi c h calls into question the contractor's ab ility to
render impartial advice to the go vernment.
U n equal access to information -T he finn h as not hatl access to nonpublic information as part of its p erfo1ma nce of a
Colli e r C ounty proj ect id entifi e d above whi c h may ha ve provide d the contractor (o r an affiliate) with an un fai r competitive
advantage in c urre nt or future so licitations and contracts.
In addition to this signed affidavit, the contractor I vendor must provide the following :
1. All documents produced as a res ult of the work completed in the past or currently being worked on for the above mentioned
project; and,
2. [ndicate if the information produced was obta in e d as a matter of public re cord (in the "sunshine") or through non-public (not in
t he "sunshine") co nversation (s), m eeting (s), doc ume nt(s) a nd/o r other means.
Failure to di sclos e all material or having an organizational conflic t in one or mo re of the three categories above be identifie d, may
result in the disqualitication fo r future soli c itations affiliated wi th the above referenced projec t(s).
By the s ignature below, the firm (employees, officers and/or agents) certifie s , and hereby disclose s , tha t, to the best of their knowledge
and b e li e f, a ll r elevant facts concerni ng p ast, pres ent, o r c urrently planne d interest or activity (financial, contractual , organizational,
or otherwise) which relates to th e projec t ide ntified a bove has been fully di sclosed and doe s not pose an org anizational confli c t.
F inn: Ferguson E nt e rpri ses INC ,
Signature and Date: ~();::;:l M\·;:::,._ 11/1 472017
Print Name: JoDerek Ad e ms
Title of Signatory : Outs id e Sales Rep resentative
S tate of ------
F lo rid a ------------C o unt y o f __ L_e_e _______________ _
SUBSCRIBED A ND SWORN to before m e thi s Fourtee nth __ d ay of Novembe r , 20 _1_7 __ _
by JoDerek Adam s
f Out ~id e Sales Representative
__________ , w ho is p e rson ally known to m e to be t he
for th e Firm, OR w ho prodpced the followin g identification
'/\_.,·),,· (' ) I -r··' r \ I I ' .~. ) (.)J j
(:o rnrni~s ion Expira ti o n
~~rs License \
-Jf . \ ·\
N ot<i~, l >'ublic
\
BOA RD OF COUNTY COMM ISS IONERS
Col li e r County Govern me nt C ompl ex
Nap les, F lor ida 341 12
c~H1'e t' Cmrnty ---~--..._........__ __
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Form 4: Ven dor Declarntion Stateme n t
RE: S oli c itation: 17-7 176 Under g round Utility Parts Supplier
De ar C ommiss i oners:
T he unders ign e d , as Ve nd o r d ecl ares that thi s prop osal is ma de without connection or arrange ment with any o th er person and thi s
proposal is in ever y respec t fair and mad e in goo d faith , without collus ion or fra ud.
T he Ve nd o r agrees, i f thi s p ro posa l is a ccepted, to ex ecut e a Collier Co unty docum ent fo r the p urpose of establi shing a fo rm al
co ntractual re latio11ship betw een th e firm and Col li er C ounty , for the perfom1ance of all requirements to whi ch the proposal pe rta in s.
The Vendor st ates that the proposal is based upon the propo sa l documents li sted by the above re fe re nced Sol icitation. F urther, the
''end or agrees that if awarded a contract for these services, the vendor will not be eligible to compete, submit a proposal, be
aw iu·ded, or perform as a s ub-vendor fur any future services associated with work that is a result of this award ed contract.
TN WITNESS W HEREOF, WE have h ere unto s ubscri bed our nam es on th is 14th day of Nov e mb e r
Co lli er , in the State of Florida --
Firm 's Legal Na me:
Address:
C ity, S tat e , Z ip Co de:
Fl orida Ce rtifi cate of
Auth orit y Docum ent
Numbe r
Ferguson Enterprises INC
3801 Prospect Avenue
Napl es, Fl orida , 34104
02 1785 21-801 24 22862-0
, 20]2 in t he County of
Federal Tax 5"-Ll..:._,--'-1=2--'-1 --'-17'-7'-'-1 -------------------------
Ide ntifi cat ion N um ber
*CC R # o r CAGE Code N/ A
*Onl y i f Gra nt F un ded
Tele p ho ne:
S ignature by:
(Type d and writte n)
Tit le :
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
23 9-6 4 3-4970 -Office
239-280-8219 -Ce ll
Jo Derek Ada ms
Outside Sales R eprese ntative
Send payments to:
(required if different from
above)
Contact name:
Title:
Address :
C ity, State, ZI P
Telephone:
Emai l:
Office servicing Collier
County to place orders
(required if di fferent from
above)
Contact name:
Title:
Address:
City, State, ZIP
Tele phone:
Email :
Ad d ition al C ontact I nformation
Ferguson Enterprises INC
Company na me used as payee
Jim La brasciano
D istri~t Cred it M anaaer
7816 Professional Place
Tampa, FL, 33637
813-280-8600
jim,labrasciano@ferguson .com
joderek.adams@ferguson.com
Ferguson Waterworks
JoDerek Adams
Outside Sales Representative
3801 Prospect Avenue
Naples, Florida. 34104
2 39-643-4970
joderek.adams @ferguson.com
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Cn[/il .t C~u1111 1.y
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Form 5: Immigratio n Affidavit Ce.-tilicat.ion
Solic itation : 17-7176 Underground Uti lity Parts Supplier
Thi s Affida vit i s required and s hould be sig ned, notari ze d by an authori zed prin cipal of th e fim1 an d s ubmitt ed with form <i l R e qu e~t
for for Proposals(.RFP) submittal s . Further, Ve ndor s are required to e nr o ll in tb e £-Ve rify program , a nd provid e accep tabl e ev id e nce
of th eir enroll m e n!'. at th e tim e of th e submi ss io n of th e Ve ndo r's prop osal. Accept abl e ev i.de nce crmsists o f u co py o f the p ro pe rl y
comp le ted E-V e rify Compa ny Profile pag e ur a copy of the fully e xe cul eu E-Veri ly Memorand um of Und ers ta mli ng for th e co mp a ny.
Fai lure to include. this Affidavit and acceptab le evidence of' e nrollment in the E-Verifv program nrnv deem the Vendor 's
proposal as n011 -r cspo nsive.
Collier County wil l not inte nti o nall y award C o11n1 y co ntracts to any Vendor who knowing ly emplo y~ unauthori zed al ie n work e rs ,
con s tituting a violatio n or lhe •!mploy1111~11t pro vision co nla in ed in 8 U.S.C. Se ction 1324 a(e) Section 274 A(c) of Lhc l mmi g rnlion
and Nationality Act ("fNA ").
Collier Co un ty may co nsider the empl oy ment by a ny Vendor of unauthori ze d <ii i.en s a vio latio n of Section 2 74A (e) of the fNA. Suc h
Violation by the recipient of the E mployment Pro visions contai ned in Se ction 274A (e) of th e fN A shall be g round s fo.r un il ateral
te1mi nation of the co ntract by Colli er County.
Vendor attes ts that they are full y comp lianl with all appli cabl e immi gration laws (specifi c all y to th e 19 86 lmmi gra ti on Act and
s ub sequent Amendme nt(s)) and ag ree s to comp ly wi t h the pro vision s o f th e Memo randum of Und erstanding with E -Verify an<l to
provide proof of enrollm ent in T he E mploym e nt Eli g ibility V erifi cation Sys tem (E-Verify), o perated by the Departm ent of Home land
Secu1it y in partnership with th e S oc ial Sec urity Admini st ration at the time of subm ission of the Vend or 's proposal.
Company Name Ferguson Enterprises INC
Print Name JoDerek Adams Title Outside Sales Representative
Signature Date 11 /14/20 17
I
State of F lo rid a
Co unty of Lee
~~~~~~~~
'I~h e foreg oing inst r ument wa s si g ne d and acknowl e d ged before me this 1:!.!b___day of Novembe r , 201Z_. b y
(:J ~me r@ k Adam s who ha s produ ced Drive rs Li cens e as ide ntifi cati o n.
(rl Hnt or Type N <!!~~:). (T y pe of fdent ifi cati on a nd Number)
/ /\ _. .'-r V -~:l \ ,,,,11111,111
N-0 t<fry Pub lic Si gnature ,•''1 ~'C,WSA A ~1111
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,''oy ,o;1$SIO/y'·., 11
, Carole A Newsam ' ·· ~,,, · ,
; O::'t ~~t,;~~'Q'b \Jt ~ PrintedName ofNotaryPubli c .• "{.u 1''\.$~'0 :;·~:0; 'i''i' s~-~~ o :·is: I · --. :: · ~\:i'·'l) t>:cz: ::
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T he signec of this Affi<l a vit guaranl ees , as cv1de nc cd by the swo rn ar{i'L1lN II 11~(11~mc d he re 1 ll, the ti ut h and a ccu1 acy 0 f this affid ,1v1 I
to interroga to ri es he rein afte r ma de .
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Form 6: Vendo r Substitute W -9
Reque st fo r Tax p aye r I dent ifi ca tion Numbe r and Certifi c a tion
In acc ord anc e with the In te rnal Reve nue Ser vice reg ul<i.ti o ns, Co lli e r Co un ty is requi n :d to co ll ect th e fo ll owing in fo rma ti on
fo r tax re p o1t ing pu rposes fro m indi vidual s an d com panies w ho do bus ine ss wi t h the Co un ty (i nc lud i ng soc ial s ecurity num be rs
if use d b y th e indi vidual or. co mp an y n.>r tax re po ni ng purp oses). Fl orid a St atut e 119.07 1(5 ) req u ires th at tl1e co un ty
noti ly yo u in writing o f t he rea so n for colkcti ng thi s informat ion , w hi c h will be used for no o th e r pu rpose tha n he 1•e i11 sla ted.
Ple ase co mp lete all informati o n that a ppl ies to yo ur bus in ess a nd return wi th you r q uo le or pro posal.
I. G en crnl Infor mation (prov ide all inforn1al ion)
Ta x paye r Name Ferguson t:.nterpn ses I N(.;
(as shown on in co m e tax return) Fe rgu so n Waterworks
Busi ness Name (if different from taxpayer 11a111 e)
Address 3801 Prospect Avenue City _N __ a~p_le_s __________________ _
Stat e Florida Zip_3_4_1_0_4 ____ ---------------
...Icleplwn, 239-643-4970 i:; ,.,,,,; 1 jodere k.adams@fergus on .com
Order lnformation Remit I Payment I nformatio n
Addres s 3801 Prosp e ct Avenue Add ress PO Box 100286
Cit y Naples State Florida Z ip 34104 Ci ty Atlanta State _G_A ___ Zip 30384-0286
Email joderek.adams@ferguson.com
Emai l jim.lab rasciano@ferquson.co m
2 . C ompany Status (c h e ck o nly one)
__ lndividual I So le Proprietor I X Corporat io n 1 --Paitnership
L Tax Exempt (Fe dera l inC0 rnc ta x-exe mpt entity __ Limited Liability Co mpa 11y
under lnl e t na l Reve nue Servic e guid e lin e s IRC
50 1 (c) 3) __ C __ E n ter the t ax cl a s sification
~-------------------~-~li~D~=~Di.,~f.i:pnrded E11.litv C = Comora1io11
3. T axpayer Identification N um ber Ohr tax r ep o rt ing purposes only)
Federal Tax Id entifi cat ion Numbe r (TIN) 54-12117 __ 7_1 ________________ _
(V e nd o rs who do not have a T lN , wi ll be reL uireJ to , rnv id e a social sec urit numb e r pri or to an award).
4. S ig n and Date Fo rm: C ertificatio n :
Und e I . 1 .. I I r /11!1/CT ti es o/ 11er1111 y, cprll/Y I 1at t 1e in/o m wti<111 s w w11 on I is . ,,,.,,, is correct to !Ill' (/10 \V u< g c. h ~· I I
signature (Z /2 j l ( { Date
-(7 ,.,...... ''"""--../' J oD ere k Adams 11 /14/2017
/I
Titl e Phone Number
O uts ide Sal e s Rep res e nta tiv e 239-2 80-82 19 ---
Insurance I Bond Type
l . ~ Worker 's Compen sation
2 . ~Emp lo yer's Liability
3. [8J Commerc ial General
Liability (O ccurre nce
Form) patterned after t he
current ISO fom1
4 . [8J Indemnification
5. ~Auto m ob ile Liability
Form 7: Insurance and Bonding Requirements
Required Li mits
Statutory Lim it s of F lorida Statut es, C hapt er 440 and all Federal Gov ernme nt
St atutory Limits and Re quirem ents
$100,000 single limit per occurrence
Bodily li~ury and Prop erty Damage
$ l,000,000 singl e limit per occurrence, $2,000,000 agg regate for Bodily Injury
Liability and Prop c1iy D ama ge Lia bility . This shaJI incl ude Premises and
Operations; Independent Co ntractors; Produc ts and Co mp le ted Operatio ns and
Co ntra ctual Liability.
To the maximum extent permitted by Florida law , the
Contractor/Vendor/Vendor s hall defend , indemnify and hold harmless Collier
Co unty, it s officers and employees from any and all lia bi liti es, damages , losses
and costs, including , but not I imited to, rea sonable attorneys' fees and
paralegal s' fees, to the ex ten t caused by th e negligence, re cklessness, or
intentionally wron gful co ndu ct of the Co ntra ctor/Vendor/Vendor or anyone
emp loyed or utili zed by th e Contra c tor/Vendor/Vendor in the per.fonn ance of
this Agreement.
$1,000,000 Each Occurrence; Bodily Injury & Property Damage.
Owned/Non-owned/Hired; Automob il e Inc lud e d
6. 0 Oth er insurance as D Watercraft $ _____ Per Occurrence
noted :
7 . 0 B id bond
D United States Longshoreman 's and Harb orworker's Ac t coverage s hall be
maintained whe re app li cab le to th e comp letion o f the work .
$ Per Occurre nce
D Maritime Coverage (Jon es Act) shall be maintain ed whe re app li cabl e to the
co mpl etion of the wo rk.
$ _____ Pe r Occ urrenc e
D Aircraft Liability coverag e sha.JI be carr ie d in li mits of n ot less than
$5,000,000 each occ urrence if appl ica ble to the co mpl etion of th e Services
under thi s Ag re e me nt.
$ _____ Per Occ urrence
D Pollution $ _____ Per Occ urre nce
D Proj e ct Professiona l Liab ili ty$ _____ Pe r Occurren ce
D Va lu ab le Papers Ins urance $ _____ Per Occ urrenc e
S ha ll be subm itted with proposal res pons e in th e form of ce1i i fietl fund s,
cas hi e rs ' c heck or an irrevo cabl e lett e r of c redit , a cash bo nd po sted wi th the
Co unt y C lerk, or propo sal bon d in a sum eq ua l to 5% of th e co st propo sa l. All
ch ecks s h a ll be made p ayable to the Collie r Cou nty Board of Co unty
Co mmi ssion e rs on a b a nk o r trust company located in the S tate of Florida a nd
insured by the Federa l Depos it In surance Corporati on.
8. 0 .Perfom1ance and
Payment B o nd s
For proj e cts in exce ss of $200,000, bonds s hall b e s ubmit te d w ith the executed
contrac t b y Proposers receiving a wa rd, and w ritte n for 100% of the Contract
award amount, t he cost borne by the Proposer recei ving an award . T he
Performance and Paym e nt Bonds s ha ll be underwritten by a su rety authorized
to d o business in the State of Florida a nd otherwise acceptable to O'A-ner:
prov ide d , howeve r, the s ure ly shall b e rated as "A-" or better as lo general
policy h older s rating and Class V o r hi g her rating as to financial s i ze catego ry
and the amount req uire d s hall not exceed 5% of the reported policy hold e rs '
surplus, all as reported in the most current Best Key Rating Guide, published
by A.M. Best Company , In c. of75 F ulton Street, New York, New York 10038.
9. [g) Vendor sha ll ensur e that a ll subcontrac tors co mp.ly w ith the s ame i nsurance r equirements th at he is requi red to
meet. The s ame Vendor shall provide County w it h certifi cates of i ns urance m eeting t h e required in surance
prov1s10 ns.
I 0. ~ Collier County must be named as "ADDITIONAL INSURED" on the Insurance Certificate for Commercial
General Liability where required. Th.i s ins urance s hall be primary and .non-contributory with respect to any other
insurance maintained by, or available for the benefit of, the Additional fnsured and the V endor's policy shall be
endorsed accordingly.
11 . ~ The Certificate Holder s h a U be named as Collier County Board of County Commissioners, OR, Board of
C ounty Commi ssion ers in Colli er County, O R C ollier County Government, OR Collier County. The Certifi cat es
of Ins urance mus t st ate the Contract Number, or Projec t Number, or s p ecifi c Proj ect descrip tion, o r must re<1d: For
any and all work perfom1ed on behalf of Collier County.
12. [g) Thirty (30) Days Cancellation Notice required.
RLC 9/26/2 01 7
Vend or's Insurance Statement
We unde rstand the ins ura n ce re quire m e nts of these s pec ifi cations and tha t the evi dence of ins ura bility m ay be
required within fi ve (5) days of the award of this sol ic itation.
Name o f Firm
Vendor
S ignature
Print Name
Ins u rance
Agency
Agent Nam e
Ferguson Enterprise;::; INC Date 11 /14/2017
I , .
JoDere k Adams
Willis of M a~l and l_N_C __________________ _
Pablo Rios Telephone Number 6 10-2 60-4335
Form 8: Refen•nce Questionnaire
Solicitation: 17-7176 Undergro und Utility Parts Su pplier
Reference Q uestio nna ire for:
(Name o r Co mpa n y R e questing Reference Informatio n)
(N ame orlndividuals Req u esti ng Refere nce In fo nnation)
Name: Company:
(Evaluator com pleting referen ce questi onna ire) (Evaluator's Compa ny co mpleting referen ce)
Ema il : FAX: Tdephonc:
Colli er County is impl ementing a process that collects re fe rence information on firm s and their key p e rsonnel to be used
in tbe sele c ti on of fim1 s to perform this proj ect. T he Name of the Company li s ted in th e S u bject' above ha s li s ted yo u
as a client for w hic h th ey have previous ly p e r formed work. Please comple te the survey. Pleas \: rate e ach crite ria to t he
best of your knowledge on a scale of I t o 10 , w ith 10 representing that you were ve1:y sai:isi le d (allll would hire l'hc
firm/i ndi vidual again) and 1 repr esenting that you we re very ·unsatisfi e d (and would never hire the firm/indivdiual.
again). If you do not have su fficient knowledge of pas t pe rformance in a partic ul ar a rea , leave it blank and the item or
fo rm w ill be scored "O." (Pleasu not.e, references rrom Colli e r County staff w ill not be accep te d .)
Project Description: Completion Date:-------------
PrajectBudgct: _____________ ~ Proj e ct Number of Days:-----------
Hem Citeria Score
I Ability to manage the project costs (minimize c hange orders t o scope).
2 Ability to mai ntain project schedul e (comple te on-time or early).
J Quality of wor k .
4 Quality of consultative advice prov ide d on the project.
5 Profession ali sm a nd abi li ty to ma n age pe r som1 e l.
6 Project admin is tra tion (compl eted documents, fin a l invoice, fin al product turnover;
invoices; manual s or going forward d ocumentation , e tc .)
7 Ab ility to verball y communi cate and document information c le arl y an d s u ccim:tl y .
8 Abi ltity to manage ri s ks an d un expected project c ircums tances .
9 Ab ility to fo ll ow contract documents, po li c ie s, procedures, rul es, regu l atio n s, etc .
10 Overa ll comfon level w ith hi r in g the co mp any in the future (cu s tome r satisfaction).
TOTAL SCO HE OF ALL I TEMS (M:1xi11111111 100 Points)
;\i~~
Cn'llie r-(_:.0H11 y -... ~ -
' 1-,·-1 ·---~.' ~;·:·-~ ~~-. i' ,;~ ::-~ [<·f:.:-:1\•~"''-;;·i;
• •""'I ;.• ' •• •
Attac hment 9: Vendor Submittal -Local V<'llllor Preference Affid;nit
So lici tation: .17-7176 Un derground Utility Parts Supplier (Ch eck Approp1i ate F:lo .xes Below)
State o f l<'lor ida (Select Co unty if Vendor is described as a Local Busi ness
IX] Collier Cou n ty
0 Lee Co unty
Ven dor affi1111s that it is a local business as dcfini:d by the Procurement O rdin uncc of the Coll ie r County Board of
Cou nty Commi ss ioners and the Regulations T hereto . As defined in Sect io n Xf of th e Co.llicr Cou nty Procu rement
O rdi nance:
Local business means the vendor has a current Bu s iness Tax Receipt issued by the Coll ier C ounty Tax Collector
for at least one year prior to bid o r proposa l submissio n to do bus iness w ith i n Coll ier Cou nty, and that identifies
the busin ess with a p ermunent phys ica l busine ss address located within th e limit s of Collier Co unty from whi c h
th e vend or's s taff operates and perfom1s business in a n a r ea z oned fo r th e c onduct of s uc h business. A Post Office
.Box or a facility that r eceives ma il , or a non-permanent struc ture such as a c onstruction tra iler, s tornge s hed, or
othe r n on-permanent structure s hall n ot be use<l for th e purpose of establi s hing said p hysical addr ess. In addition
to the forego ing, a vendor shall not be considered a "local business" unless it contributes to the economi c
d evel opment and we ll-being of Collier County in a verifiable and me asurabl e way. This may include, but n ot be
limited to, the rete nti on a nd expansion of employment oppo ttuni ties, s upport and increas e to t he County's tax bas e,
and residency of e mployees and princ ipals of the bus iness within Collier Co u nty. Vendo rs s ha ll affirm in writing
th e ir co mpliance with th e foregoing at t h e time nf s ubmitting their bid or propos al to be eli g ible for consideration
as a "l ocal business" under thi s secti on. A vendor who misrepresents t he Loca l Preference s tatus of its firm in a
propos al or bid s ubmitted to th e County wil l lose the privilege to c laim Loc a l Preference statu s for a period of up
t o one year under this section.
V e ndo r mus t complete the follow ing infomiation:
Year B u siness Established in [X]C o lli e r County or 0 Lee Co unty: 1989 __
Number of Employees (1 ncluding Owner(s) or Corporate O fficcrs): 3 0 ,000
N umber of E mployees Li v ing in IZJ Colli er Cuunly or IZJ Lee (lJ1cluding Ow1icr(s) or Corporate Office r s):~_
lf requested by the County , vend o r w ill be required t o provide documentation s u bstanti ating the information g iven in
thi s affidavit. Fail ure to do so will res ult in vendor 's s ubmissi on being d ee m ed not applicable .
Ve nd or Name: Ferqu son Wat erworks Date: 11 /14/2 017
Address in Co lli e_~-?" L ee lun.ty {.31~~1 Prospec t Ave nu e , Naples Flo ri da 34 104
S ig na ture : u.U(/ ;)v~~ T itl e : O u ts id e S ales Rep resentative
STAT E OF FLORlDA
[~fcOUJER COUNTY 0 LEE C OUNTY
~~on i~tp a nd Subscribe d Before Me, a Nota r y Publi c , for the abo ve S tate a11d C o u nt y, on th1s _1_4_t_h ___ Day of
~ye 1i~ r , 20~,: . . __ , ,
' i1 '\ ( \ ' }' '\1 --
---.-·' ,( t.. -------·
Notary P ll ll li c
M y Commis sio n Ex p ires: /j. i ~) t
~--~-
I
I I -j ( ! { ) / .-'i .'I
·~··I
(AFFI X OFFIC IAL SEAL)
ACOl~d"' CERTIFICATE OF LIABILITY INSURANCE Page I DATE (MMIDDIYYYY)
~ 1 of 2 11/14/201 7
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If t he certifica t e holder i s a n ADDITIONAL INSURED, the polic y(ie s) m ust hav e ADDITIONAL INSURED prov isions o r be endorsed .
If SUBROGATION IS WAIVED, subjec t to the term s and condit i ons of the policy, ce rtain policies may require an endors ement.A statem e nt
on this certific ate does not c onfer rights t o t h e certificate holder In lie u of such endorse me nt(s).
l'RODUC ER CONTACT
Wi l l is o f Marylan d , Inc . Ni:IME: __ _ ---___
1
------
PfiONE l'llX ~-C::.NO.E4t)· 6 1 0 -96 4-8 7 00 (NC.NO):__Q._10-254.::-5 600 c/o 2 6 Centur y B lvd . -
P . 0 . B o x 305 1 9 1 A~~1~ss . ___g§rtifica te s @w·i llis~J;;Q.1!!.__ ___ --Nashville , TN 3 7230-5 1 91
INSURER(S)llF FOROIN G_COVERllGE NAICll
IN SURER A: Na tio nal Union F ire Ins . Co . of Pittsburg 19445 -002
INSLiilfo. --------
INSURERS: National Un i o n Fire Ins . Co. of Pitts bur g 19445-000
Ferguson En t erprises, Inc . a nd Sub s idiaries --
(See Attached Named Insu red Sche d ule) IN SURE RC: Na tio n al Un ion F i r e Ins . Co. o f Pittsburg 1 944 5 -001
1 2500 Jefferson Avenue \ 1N SUR ER O: New Hampshi re I nsur ance Company 23841-001
Newport News, VA 23602
INSURERE : -----
I INSURERF :
C OV ERAGES CERTIFICATE NUMBER· 2 5798004 REVISION NUMB ER·
TH IS IS T O CERTIFY THAT THE POL ICIES OF IN S URANCE LISTED BELOW HAVE BEE N ISSUED TO T HE IN SU RED NAM ED AB OVE FOR THE POLIC Y PER IOD
INDIC ATED. NOTWITH STANDIN G AN Y RE QU IREM ENT , T ER M OR CO ND ITION OF ANY CONT RACT OR OTH ER DOCUMENT WITH RESPECT TO WH ICH THIS
CERT IFICATE MAY BE ISS UED OR MAY PERTAIN. TH E INSURANCE AFFORDE D BY T HE POLI CIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TER MS,
EXC LUSIONS AND CONDITIONS OF SUCH PO LIC IES. LI MITS SHOWN MAY HAVE BE EN REDUCE D BY PA ID CLAI MS.
\N:: I TYPE oF--;;:;;ANCE---~~H:,~f---;;;L1cY N u ~;R --~?.;)g 6,VriY.:i.· -l--tpMoMLt01c0Yet.E:x:P~~~~~-------~u~M;1T;s~----------=--=-==~
A X I '0j~""'~"~""'"" Y GL 712 -9880 5/1/2 0 1 7 5/1 /2 018 ,__,E_A_C_H _o_cc_u_R~R~E=NC=E-_ _,
1
$ 2 OQ.Q_,_Qfill__ =--CLAIMS-MADEW OCCUR Eti._~_ffi_~-~-~-n_'k_l'l,_Ju_~~~"~e"~')--t~__J,_,__9..Q.Q_,.QQQ_
MED EX P ~.n..i_o_n •~' P_<l!_rso_n~>--1-• ____ !l,,.Q_,_QQQ_
___ ___ PERSONAL &ADV INJU RY ~ .• Q.Q.Q..,_Q.Q_Q
B
B
c
D
GE N'L AGGREGATE 1.IMIT APP LI ES PER:
-i POI.ICY r~;LI j~Wf 1 ~: 1 LOC
-1 OTl-IER
A UTOMOB ILE LIABILI TY
x ANY AUTO -OWNED -SCHED ULED
AUTOS ONLY AUTOS
Hlr<ED X NON-b WNEO
~~~ON LY /IUTQSO NLY
Ins u red X ~!~~al
x
Jx
UMBRELLA LIAB H OCC UR
EXCES S LIAB CLA IMS -MADE
I OE D I !RETENTI ON$
WORKE RS COMPENSAT ION
AND EMP LOYE RS' LIABILITY y /N
ANY PROPRIETOR/PARTNER/EXECUTIVE I N I
OFF ICE R/MEMBER EXCLUDED? _
f ~~,~~~!~~;b~ ~1m1 e r
Dl:SC NIPTION OF OPERATIONS below
NIA
AOS 1 9 2192 7
MA 1921928
VA 1921929
023102 5 16
5 /1/2017
5/1 /2017
5 /1/2017
5/1/201 7
5/1 /2 0 1 8
5 /1 /2 018
5/1 /20 1 8
5/1/2 0 18
GENERAL AGGREGATE S 5 1 . .PJULJ)_QQ,_
PRODUCTS · COMP/OP ~§_g__ !l_.? , QQ_Q_,, QQ. Q_
$
COMBI NED SIN GLE LIMIT 5 0 0 0 0 0 0 µ(=EE•~·~~a~ld~"~"'~l _____ 1s 1 1
BODILY INJU RY (Perperson) $
1-
BODILY INJURY(Per accident) S
-P r1t:!mr-vlThM'1'e5E~--1--------i
(Per occlde nl) S ___ _
$
EACH OCC URRENC E S
v I PEI~ : I 10 1H t ~-srt1nJTI~J_ , ER ----
~~<:J·1 11cc 10ENT $ 2 _, 00 0 .~
E.L DISEASE· EA EMPLOY EE S 2 _, 0 0 0 1 0 QQ__ _
E.L DISE AS E -PO LI CY LIMIT S 2 , 000, 000
I~· I DESC RIPTION OF OPERATI ONS I LO CATIONS I VEtil CLES (ACOR D 1 Of , Additi ona l Romork!l Schedule, ma y be ottnc hotl If more space Is roq ulrod )
Workers Compe nsation Pol i c y #WC 0 2 310 2516 p rovid es c o ver age for AL, AR, CO, C T, DC, DE, GA , HI , I A ,
ID , I N, K S , LA, MD , MI , MN , M O, MS , MT, N E, NM , NV, NY , OK , OR , S C , SD , T N , T X , WV .
See A ttached f o r Additi o n a l Wo rke rs ' Compensation Pol icies:
C ollie r Count y is i n c lude d as a n Addi tio n a l I n s ure d under General L iabil ity as required by w r i tten
c ontract but only with respec t t o l iab i l i ty arising out o f Named Insured 's operation s .
C E RTIFICA TE HOL DER
Collier County
C AN CELLA T ION
SHO ULD ANY OF TH E ABOV E DESCRIBED POLI CIES BE CANCELLED BEFORE
TH E EXP IRAT ION DATE THEREOF, NOTICE W ILL BE DE LI VERED IN
A CCORDANCE WITH TH E PO LI CY PRO V ISIONS .
AUTHORIZE D REPRESE NTATI VE
AGENCY CUSTOMER ID: 0.~3=1~4=1=9 __ _
LOC#: ____ _
ADDITIONAL REMARKS SCHEDULE P a ge _2 . of 2 _ ..
AGENCY NAMED INSURED
and Subsidiaries
Willis of Maryland, Inc .
Ferguson Enterprises, Inc.
(See Attached Named Insured Schedule) -12500 Jefferson Avenue POLICY NUMBER Newport News, VA 23602
See First Page
CARRIER I NAIC CODE ---
See First Paae EFFECTIVE DATE: See First Paqe
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE
General Li.ability policy shall be Primary and Non-contributory with any other insurance in force
for or which may be purchased by Additional Insured.
ADDITIONAL COVERAGE SCHEDULE
COVERAGE LIMITS
POLICY TYPE: Workers' Compensation & Employers Per Statute
Liability-ME E.L. Each Accident: $2,000,000
CARRIER: New Hampshire Insurance Company E.L. Disease-Policy Limit: $2,000,000
POLICY TERM: 05/01/2017 -05/01/2018 E.L. Disease-Each Employee: $2 ,000,000
POLICY NUMBER: WC023102515
POLICY TYPE: Workers' Compensation & Employers Liability Per Statute
-CA E.L. Each Accident: $2,000 ,000
CARRIER: American Home Assurance Company E.L. Disease-Policy Limit: $2,000,000
POLICY TERM: 05/01/2017 -05/01/2018 E.L. Disease-Each Employee: $2,000,000
POLICY NUMBER: WC023102514
POLICY TYPE: Workers' Compensation & Employers Liability Per Statute
-FL E.L. Each Accident: $2,000,000
CARRIER : Illinois National Insurance Company E.L. Disease-Policy Limit: $2,000,000
POLICY TERM: 05/01/2017 -05/01/2018 E.L. Disease-Each Employee: $2,000 ,000
POLICY NUMBER: WC023102513
POLICY TYPE: Workers' Compensation & Employers Liability Per Statute
-MA& WI E.L. Each Accident: $2,000,000
CARRIER: New Hampshire Insurance Company E.L. Disease-Policy Limit: $2,000,000
POLICY TERM: 05/01/2017 -05/01/2018 E.L. Disease-Each Employee: $2,000,000
POLICY NUMBER: WC023102518
POLICY TYPE : Workers' Compensation & Employers Liability Per Statute
-AK,AZ,IL,KY,NC,NH,NJ,PA,UT,VA,VT E.L. Each Accident: $2,000,000
CARRIER: New Hampshire Insurance Company E.L. Disease-Policy Limit: $2,000,000
POLICY TERM: 05/01/2017 -05/01/2018 E.L. Disease-Each Employee: $2,000,000
POLICY NUMBER: WC023102517
W1ll1s
Ferguson Enterprises, Inc. and Subsidiaries.
List of Named Insureds
Air Cold Supply
Air Cold Supply/Webb Distributors
Alamo Pipe & Supply
Alaska Pipe & Supply
Andrews Li g hting Gallery, Inc. (dba
Andrews Lighting & Hardware Gallery)
Arkansas Supply, Inc.
Ar-Jay Building Products, Inc. (dba
The Ar-Jay Center)
Atlantic American Fire Equipment Company
Arkansas Supply
The Bath + Beyond
Bruce-Rogers Company
Build.com, Inc.
Builders Appliance Center, LLC
CAL-STEAM, a Wolseley Company
Camellia Valley Supply
Castle Supply Company, Inc.
CastleN01th
Central Pipe & Supply
CFP
Chadwick
City Lights Design Showroom
Clawfoot Supply, LLC
Clay ton Group, Inc.
Clayton International, LLC
C line Contract Sales
Co lgan Cabinets
Colgan Distributors
Crow Company
Custom Lighting Incorporated
Custom Hardware and Accessories, Inc.
D & C Plumbing & Heating Supply
Davis & Warshow, Inc.
Davidson Electric Wholesale Supply
The Davidson Corporation, a Delaware
Corporation
The Davidson Group Co mp a ni es , In c
Davidson Group Leasing
Davidson P ipe Company In c ., a New York
Corporation
Davidson Pipe Supply Company, Inc.
Davies Water
Dealemet, LLC db a Dealernet
Decorative Product Source , In c.
E & J Plumbing & Heating Supply Co.
Economy Plumbing and Heating Supply Co.
Energy & Process Corporation
Equarius, Inc . clba Equarius Waterworks,
Meter & Automation Group
Factory Direct Appliance
Ferguson Bath Kitchen and Lighting Gallery
Ferguson Enterprises IV, Inc.
Ferguson Enterprises of Montana, Inc.
Ferguson Enterprises of Virginia, Inc.
Ferguson Enterprises V, Tnc.
Ferguson Enterprises, Inc.
Ferguson Enterprises, Inc. dba WPCC
Forwarding
Ferguson Enterprises, Inc. A Corp of Virginia
Ferguson Enterprises NY -Metro , Inc .
Ferguson Fire & Fabrication, Inc.
Ferguson Fire & Fabrication, Inc. (fka Action
Fire Fab & Supply, Inc.)
Ferguson Fire & Fabrication, Inc . (fka Sierra
Craft, lnc.)
Ferguson Full Service Supply
Ferguson Heating & Cooling
Ferguson Holdings, Inc .
Ferguson Hospitality Sales
Ferguson Industrial Plastics and Pump
Division
Ferguson Integrated Systems Division, Inc.
Ferguson Intennountain Piping
Ferguson Internati onal
Ferguson Process Services
Ferguson Valve & Automation
Ferguso n W atcrworks
Ferguson Waterworks -Midw es t Pipe
Ferguson Waterworks -Municipal Pipe
Ferguson Waterworks -Red H ed
Ferguson Waterworks EPPCO
Ferguson Waterworks International
Frischkorn , In c.
Gabrie l Sc ientifi c & Machine, LLC
Galleria Bath & Kitchen Showplace
G ilmour Supp ly Company, In c.
Global HY AC Distributors, Inc.
Fergu son En terprises , In c . dba Gro eniger
& Company
Ferguson Enterprises, Inc. and Subsidiaries.
List of Named Insureds
Gulf Refrigeration Supply
High Country Plumbing Supply
Home Equipment Company, Inc.
HP Products Corporation
HP Logistics, Inc .
Indiana Plumbing Supply Co., Inc .
Industrial Hub of the Carolinas
J&G Products
J.D. Daddario Company
Joseph G. Pollard Co., Inc.
Kandall Fabricating
Karl's Appliances, A Ferguson Enterprise
Lane Piping Co.
Lawrence Plumbing Supply Co.
Lighting Unlimited, LLC
Lincoln Products
Linwood Pipe and Supply
Living Direct, Inc.
Louisiana Utilities Supply Company
Louisiana Chemical Pipe, Valve & Fitting,
Inc . dba Wolseley Industrial Group
LUSCO
Lyon Conklin & Co., Inc.
Mastercraft Cabinets
Matera Paper Company, Inc.
McFarland Supply Co., Inc.
Michigan Meter Technology
Michigan Pipe &Valve-Flint, b1c.
Michigan Pipe &Valve-Lansing, lnc.
Monotube Pile Corporation
Northern W ater Works Supply, Inc.
Onda-Lay Pipe and Rental, In c .
Page's Appliances
Palermo Supply
Park Supply
P CS Industries d/b/a HP Products Co rp.
Pipe Products
Plumbing Decor
Plumb Source
Powell Pipe & Supp ly Company
Power Equipment Direct Inc.
P .V. Sullivan Supply Co., Inc.
R Supply Company
Ramapo Wholesalers
R ecord S uppl y Company
Redlon & Johnson
Reese Kitchen, Bath & Lighting Gallery
RenWes Sales
S.G. Supply Company
S .G . Supply Company dba SG Supply Co.,
a Ferguson Enterprise
Siena Craft, Inc.
Signature Hardware
Ship-Pac, Inc. d/b/a HP Products Corp.
SOS Sales
Specialty Pipe & Tube, Inc.
Specialty Pipe & Tube of Texas, Inc .
Stock Loan Services LLC
Summer & Dunbar
Supply North Central Group
Tarpon Wholesale Supplies
T & A Valve Industries, Inc.
The Parnell-Martin Companies LLC
The Plumbers W arehouse
The Plumbing Source In c .
The Stock Market
Tubeco Fabrication, Inc .
Underground Pipe & Valve Inc.
United A utomatic
W ater Works Supplies
Webb Distributors
Western Air Systems and Contro ls, Inc.
Westfield Lighting
Wholesale Group, Inc.
WIA of California, In c .
Wolseley Industria l Group
Wolseley Industria l Plastics
Wolseley Investments Acq ui s it ions , Inc.
Wolseley Inves tments, Inc.
Wolseley NA Construction Services, LLC
Wolseley North America, Inc.
Wolseley North American Consulting, LLC
Wolseley North American Services, Inc .
WPCC Forward in g
ENDORSEMENT #
T his endorsement , effective 1 2:01 A.M. 05i0112017 forms a p art o f
Po lic y N o . GL 712-9880 issued to W o lseley Inve stments, Inc .
By N a tional Union Fire Insurance Company of Pittsbu1gh, Pa.
THIS ENDORS EM ENT CHANGES T HE PO LICY . PLEASE REA D IT CAREFU LL Y.
LIMITED ADVICE OF CANCELLATION PROVIDED VIA E-MAIL
TO ENTITIES OTHER THAN THE FIRST NAMED INSURED
T h is policy is am ended as follows:
In the event that the Insurer cane-e ls this po licy for any reason other than non-p a yment of premium,
a nd
1. the can cella tio n effective date i s p rior t o this policy's expirat ion date;
2. th e First N a med Insured i s under an exi s ting contractua l obligation to notify a c ertificate
holder when this policy is c a nceled (he r eina fte r , the "Certificate Holder(s)") and has
provide d to the Ins urer, either directly or through its broker of record , the e mail address
o f a contact a t each such entity; and
3. t he Insure r received this informatio n aft e r the First Named In sured receives n otice of
ca n cellation of this po lic y and prior to this po licy's can cellati on effective d ate , via a n
e lectronic spreads h eet that is accept able t o the Ins ure r,
the Insurer will provide advice of cancellation (the "Advice") via e-mail to each such Certificate
Holde r s within 30 days after the Fir st Named Insured provides such infor mation to the In s urer;
provided, however, that if a specific n umber of days is not stated above, the n the Advice will be
p rovided to s u c h Certificate H o lde rl s ) as soon as reasonably practicable after the First Named
In sured provides such information to the Ins urer.
Proof of t h e In s ure r emailing the Advic e , u s ing the information provided by the First Named In sured ,
will serve as proo f that t h e Ins ure r h as fully sa t isfie d its obligations under this en d orsement.
T his endorsement d oes n ot affect, in any way, cove r age provided under this policy o r the
ca n ce lla tion o f this po li c y o r th e effective date ther eof , nor shall this endor sement invest any rights
in any entity no t insured under t his policy.
T h e fo llowing Definitions app ly to this e ndorse m ent:
1. Firs t N am e d Insured m ean s the N amed In s u re d s h o wn on the Dec larations Page o f this
po li c y .
2. In surer means the insurance company s h own in th e h eader on the Declarations page of this
policy.
A ll othe r terms, condit i ons and exclusions sha ll remain th e same.
107414 (03/11) Pa9a 1
~,/.75. ···,_"., y · /-~ .r""-~.
Autho ri zed Re presen t ative
ENDORSEMENT #
This endorsement, etfective 1 2:0 1 A.M. 5 /1 /2 017 forms a par t of
Policy No. C A 1921927 issued to Wolseley Investments, Inc.
By National Union Fire Insurance Company of Pitts burgh, Pa .
TH IS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT C AREFULLY .
LIMITED ADVICE OF CANCELLATION PROVIDED VIA E-MAIL
TO ENTITIES OTHER THAN THE FIRST NAMED INSURED
This policy i s amended a s follows:
In the event that the Insurer c ancels this pol icy for any reason other than non-payment o f pre mium,
and
1. the cance ll a tio n effective date is prior to this policy's e xpiration d ate;
2. the First Named Ins ured is under an existing contractua l obligation to notify a certifica te
holder when this policy is c ance led (hereinafte r, the "Certificate Holder(s)") and has
provided to the Ins urer , either directly or through it s broker of record, the email add r ess
of a contact a t each s uch entity ; and
3. the Ins ure r r e c e ived this intorma tion a tter the First Named Insure d r eceives notice of
cance llation of this polic y a nd prior to this polic y's cance llatio n eff ective date, vi a an
e lectronic spreadsh eet th a t i s aci;ept a ble to th e Insure r,
the Insurer will provide advice of cancellation (t he "Advice") via e-mail to each such Certificate
Holde rs within 30 days a fter the First N amed Insure d provid es such information to the Insurer;
provided, h o wever , that if a specific m11nber of days is n o t stated above, then t h e Advi ce will b e
provided t o such Certificate Holder(s) as soo n as reason ab ly practicable after the Firs t. Named
Ins ured provides s u c h information to the In s ure r.
Proof of the In s urer e mailing th e Advic e , usi ng the inform atio n provided by the Firs t Named Ins u red ,
will serv e a s proof th at the In sure r h a s fully sati sfied its obligation s under this endorsement.
T his endorsement does not a ffect, in a ny way, covera g e provide d under this polic y or the
can cella tion of thi s po l icy o r the eff ective date thereof, nor s hall this e ndorse m e nt invest a ny rights
in a ny e ntity not insured under this policy.
T he following Definition s apply to this e nd orsem e nt :
1 . Firs t N ame d Ins ured m ean s the N a m ed Ins ured s hown on the D e c la ra t ions Page of t his
p o li c y.
2 . In surer means th e insu rance company sh o wn in the h ea d e r on the D ec larations p age of this
po l i c y.
All oth e r te rm s , c o nd it i ons a n d e x c lus ions s ha ll r e m ain t h e s am e .
A u thori ze d R epresenta tive
107 414 (03 /11) Page 1
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different
elate is indicated below
(The following" atlacl1·1n9 clause· need be compreled only whoo this endorsement is issued subsequent to prep;:irJtion of the policy).
This endorsement, effective 12:0·1 AM 5/1/2017 forms a part of Policy No. WC 023102516
Issued to Wolseley Investments, Inc.
By New Hampshire lnsumnce Company
LIMITED ADVICE OF CANCELLATION PROVIDED VIA E-MAIL
TO ENTITIES OTHER THAN THE NAMED INSURED
(WORKERS' COMPENSATION ONLY)
This policy is amended as follows:
In ll1 e event U1 at the Insurer cancels thi s policy for any reason 0U1er than non-payment of premium , <.ind
·1. lhe c<incellation effective date is prior to this policy's e xpiration date ;
2. lhe N amed Insured or, if applicable, any other employers named in Item ·1 of the Information Page is under an
existing contrnctual obligation to notify a certificate holder when this policy is canceled (hereinafter, the
"Certificate Holder(s)") and the Named Insured has provided to the Insurer, either directly or through its
broker of record , the email address of a contact at each such e ntity; and
3 . the In s urer received this information after the Named In s ured receives notice of cancellation of this policy and
prio r to this policy's cancellation effective date , via an electronic spreadsheet that is acceptable to thmsure r,
the In surer will provide advice of cancellation (the " Advice" ) vi a e-mail to each such Certificate Holders within 30
days after the Named Insured provides such information to the Insurer; provided, however, that if a specific number of
days is not stated above, th en the Advice will be provided to such Certificate Holder(s) as soon <is reasonably
practica ble after the Narn ed In s ured provides such i nformation to thelnsurer.
Proof of th e In s urer em;:iiling the Advice, using th e infom1ation provided by the First N am ed Insured, will serve as
proof that the In surer has fully satisfied its ob ligations und er this endorsement .
This endorsement does not affect, in any way, coverage provid ed under this poli cy or the cancellation of this policy or
lhe effective date thereof, nor sh;:ill this enciorsement invest any rights in any entity not insured under thi s policy
The following definitions apply to this endorsement:
·1. Named Insured means the insu red first named employer in Item 1 o f th e lnform ntion Page o f thi s policy.
2 In s urer mea ns th e in s urance comp;:rny shown in the header on th e Informati on Page of this poli cy
A ll other terms, conditions and exc lu s ion s shall remain th e sam e.
WC 99 00 56
iEd . 04/1 'I)
AUTHORIZED REPRESENTAT IVE
Company ID Number: 1205487
THE E-VERIFY
MEMORANDUM OF UNDERSTANDING
FOR WEB SERVICES EMPLOYERS
ARTICLE I
PURPOSE AND AUTHORITY
The parties to this Agreement are the Department of Homeland Security (DHS) and Ferguson
Enterprises, Inc. (Web Services Employer). The purpose of this agreement is to set forth terms and
conditions which the Web Services Employer will follow while participating in E-Verify.
A Web Services Employer is an Employer who verifies employment authorization for its newly hired
employees using a Web Services interface.
E-Verify is a program that electronically confirms a newly hired employee's authorization to work in the
United States after comp letion of the Form 1-9, Employment Eligibility Verifi cat ion (Form 1-9). This
MOU explains certain features of the E-Verify program and describes specific responsibilities of the
Web Services Employer, OHS, and the Social Security Administration (SSA).
For purposes of this MOU, the "E-Verify browser" refers to the website that provid e s direct access to
the E-Verify system : https:/J.e~v erify .usci s .gov/emp/. You may access E-Verify directly free of charge
via the E-Verify browse r.
Authority for the E-Verify program is found in Title IV , Subtitle A, of the Illegal Immigration Reform and
Immigrant Responsibility Act of 1996 (llRIRA), Pub. L. 104-208 , 110 Stat. 3009, as amended (8 U.S.C.
§ 1324a note). The Federal Acquisition Regulation (FAR) Subpart 22.18 , "Employment Eligibility
Verifi ca tion " and Executive Order 12989, as amended, provide authority for Federa l contractors and
subcontractors (F edera l contractor) to use E-Verify to verify the employment eligibility of certain
employees working on Federal contracts.
Before accessing E-Verify using Web Services access, the Web Services Employer must meet certain
technical requirements . This will require the investment of significant amounts of resources and tim e.
If th e W eb Services Employer is required to use E-Verify prior to completion and accept ance of its Web
Services interface, then it mu st us e th e E-V erify browser until it is abl e to use its Web Services
interface. The W eb Services E mployer mu st also maintain ongoing techni ca l compatibility with
E-V erify.
DHS accepts no liability relating to the W eb Services Employe r's development or maintenance of any
W eb Services access system.
D ~n o 1 n f ?'l l=_\/p r;f" Mnl I fnr Wr-•h SP.rvices Emol overs I Revision Da l e 06/0 "1/13
Company ID Number: 1205487
ARTICLE II
RESPONSIBILITIES
A. RESPONSIBILITIES OF THE WEB SERVICES EMPLOYER
1. By enrolling in E-Verify and signing the applicable MOU, the Web Services Employer asserts that it
is a legitimate company which intends to use E-Verify for legitimate purposes only and in accordance
with the laws, regulations, and OHS policies and procedures relating to the use of E-Verify.
2. The Web Services Employer agrees to display the following notices supplied by OHS in a prominent
place that is clearly visible to prospective employees and all employees who are to be verified through
the system :
a. Notice of E-Verify Participation
b. Notice of Right to Work
3. The Web Services Employer agrees to provide to the SSA and OHS the names, titles, addresses ,
and telephone numbers of the Web Services Employer representatives to be conta cted about E-Verify.
The Web Services Employer also agrees to keep s uch information current by providing updated
information to SSA a nd OHS when e ver the representatives ' contact inform at ion changes.
4 . The Web Services Employer agrees to grant E-Verify access only to current employees who need
E-Verify access. Web Services Employers must promptly terminate an employee's E-Verify access if
the employer is separated from the company or no longer needs access to E-Verify.
5. The Web Servi ces Employer agrees to become famili ar with and comply with the mo st recent
version of the E-Verify User Manu al. Th e Web Servic es Employer will ensure th at outdat ed manu als
are promptly replaced with the new version of the E-Verify User Manual when it becomes available .
6. The Web Services Employer agrees that a ny person accessing E-Verify on its behalf is trained on
the most rec e nt E-Verify policy and proce dures.
7. Th e W eb Servi ces Emp loyer ag rees th at a ny of its representa tives wh o will creat e E-V erify cases
will complete the E-Verify Tutorial before creating any cases.
a. The Web Services Employer agrees th at all of its represe ntatives will take the refresh er t utorials
wh en prompted by E-Ve rify in ord e r to con tinu e using E-Ve rify . Failure t o comp let e a refres he r
tutoria l will prevent th e Employer Represe ntativ e from cont inu ed use of E-Verify .
8. The W eb Services E-Ve rify Employer Ag en t ag rees to ob tain th e necessa ry equ ip ment to use
E-Verify as required by the E-Verify rule s and regulations as modified from tim e to time .
9. The W eb Se rvic es E-V erify Employer Ag ent agrees to , consistent with applicable laws, regulations,
and polici es, co mmit suffi cient pe rson nel a nd reso urces to meet th e requirements of this MOU .
10 . The W e b Servi ces Emp loyer ag rees t o comply with curre nt Fo rm 1-9 procedures , with tw o
PAa P. 2 nf 23 E-VP.rifv MOU for W eb Servi ces Emolovers I Revision Dat e 06/01/1 3
Company ID Number: 1205487
exceptions :
a. If an employee presents a "List B" identity document, the Web Services Employer agrees to
only accept "List B" documents that contain a photo. (List B documents identified in 8 C.F .R. §
274a.2(b)(1 )(B)) can be presented during the Form 1-9 process to establish identity.) If an
employee objects to the photo requirement for religious reasons, the Web Services Employer
should contact E-Verify at 888-464-4218.
b . If an employee presents a OHS Form 1-551 (Permanent Resident Card), Form 1-766
(Employment Authorization Document), or U.S. Passport or Passport Card to complete Form 1-9 ,
the Web Services Employer agrees to make a photocopy of the document and to retain the
photocopy with the employee's Form 1-9. The Web Services Employer will use the photocopy to
verify the photo and to assist OHS with its review of photo mismatches that employees contest.
OHS may in the future designate other documents that activate the photo screening tool.
Note: Subject only to the exceptions noted previously in this paragraph, employees still retain the right
to present any List A, or List B and List C, document(s) to complete the Form 1-9.
11 . The Web Services Employer agrees to record the case verification number on the employee's
Form 1-9 or to print the screen containing the case verification number and attach it to th e employee's
Form 1-9.
12. The Web Services Employer agrees that, although it participates in E-Verify, the Web Services
Employer has a responsibility to complete, retain, and make available for inspection Forms 1-9 that
relate to its employees, or from other requirements of applicable regulations or laws, including the
obligation to comply with the antidiscrimination requirements of section 2748 of the INA with respect to
Form 1-9 procedures.
a . The following modified requirements are the only exceptions to a Web Services Employer's
obligation to not employ unauthoriz ed workers and comply with the anti-discrimination provision of
the INA: (1) List B identity documents must have photos , as described in paragraph 6 above ; (2)
Wh en a Web Services Employer confirms the identity and employment e li g ibility of newly hired
employee using E-V e rify procedures, it es tabli s hes a rebuttable presumption th at it has not violated
section 27 4A(a)(1 )(A) of th e Immigration a nd Nation ality Act (INA) with respect to th e hiring of th at
employee ; (3) If the Web Se rvices Employer receives a fin al non co nfirmation f or an employee, but
continues to employ that person, the Web Services Em p loyer must notify OHS and the Web
Servi ces Employer is subject to a civil mon ey penalty between $550 and $1, 100 for each failure to
notify OHS of continued em ploym e nt following a fin al nonco nfirmation; (4) If the W eb Se rvi ces
Emp loye r co ntinu es to employ an emp loyee aft er receivin g a fin al no nco nfirma tion, th e n th e W eb
Services Employer is s ubj ect to a rebutta ble presum ption that it has knowingly e mployed a n
un authorized ali e n in vi o lation of section 27 4A(a)(1 )(A); a nd (5) no E-V e rify participant is civilly or
criminally li able unde r any law for any action t ak en in good fa ith based on in fo rm ation provided
throu g h th e E-Verify.
b. OHS rese rv es th e right to conduct Fo rm 1-9 compli a n ce in specti ons, as we ll as an y oth e r
e nforcement or co mpliance activity a uth o ri ze d by law , including site vi sits, to en sure prop e r use of
Page 3 of 23 E-Verify MOU for W eb Servi ces Empl oyers I Revision Da l e 06/01/13
Company ID Number: 1205487
E-Verify.
13. The Web Services Employer is strictly prohibited from creating an E-Verify case before the
employee has been hired, meaning that a firm offer of employment was extended and accepted and
Form 1-9 was completed . The Employer agrees to create an E-Verify case for new employees within
three Employer business days after each employee has been hired (after both Sections 1 and 2 of
Form 1-9 have been completed), and to co mplete as many steps of the E-Veri fy process as are
necessary according to the E-Verify User Manu al. If E-Verify is temporarily unavailable , the three-day
time period will be extended until it is again operational in order to accommodate the Employer's
attempting, in good faith, to make inquiries during the period of unavailability. If, however, the Web
Services interface is unavailable due to no fault of E-Verify, then the three day time period is not
extended. In such a case, the Web Services Employer must use the E-Verify browser during the
outage.
14. The Web Services Employer agrees not to use E-Verify for pre-employment screening of job
applicants , in support of any unlawful employment practice , or for any other use that this MOU or the
E-Verify User Manual does not authorize .
15. The Web Services Employer must use E-Verify for all new employees. The Web Services
Employer will not verify selectively and will not verify employees hired before the effective date of this
MOU. Employers who are Federal contractors may qualify for exceptions to this requirement as
described in Article 11.B of this MOU .
16. The Web Services Employer agrees to follow appropriate procedures (s ee Article Ill below)
regarding tentative nonconfirmations. The W eb Servic es Emp loyer must promptly notify employees in
private of th e finding and provide them with th e notice and letter containing information specific to th e
employee's E-Ve rify case. The W eb Services Employer agrees to provide both the Engli sh and the
tran slated notice and letter far employees with limited English proficiency to employees . The Web
Services Employer agrees to provide written referral instructions to employees and instruct affected
employees to bring the English copy of the letter to the SSA. The W eb Services Employer must allow
employees to contest the finding, and not take adverse action aga in st employees if th ey choose to
co ntes t the finding, while th eir case is still pending. Fu rth er, when employee s contest a tent ative
nonconfirmation based upon a photo mismatch, the Em ployer must tak e add itional steps (see Articl e
111.B below) to contact OHS with information necessa ry to reso lve the challenge.
17. The Web Services Employer agrees not to take any adverse action against an employee based
upon th e emp loye e's perceived employment e li gibility s tatus while SSA or OHS is processing the
verification requ es t unl ess the Employe r obtain s knowledge (as d efin e d in 8 C.F.R. § 274a.1(1)) that th e
e mployee is not work authorized. The W eb Se rvic es Emp loyer und ers ta nds th at an initial in ability of th e
SSA or OHS automated verification system to verify wo rk authorization, a tentative nonconfirmation, a
case in continuance (indicating the need for add ition al time for the government to resolve a case), or
the finding of a photo mismatch, does not es tablish, and should not be interpreted as, e vid ence th at the
e mployee is not work authorized . In any of such cases , th e em ployee must be provided a fu ll and fair
opportunity to co ntes t th e finding, a nd if he or she c;loes so, the employee may not be termin ated or
s uffer a ny ad verse employme nt con se quences ba se d upon the emp loyee's perceived employment
Page 4 or 23 E-Verify MOU for Web Se rvi ces Employers/ Revision Date 06/01/13
Company ID Number: 1205487
eligibility status (including denying, reducing, or extending work hours, delaying or preventing train ing ,
requiring an employee to work in poorer conditions, withholding pay, refusing to assign the employee to
a Federal contract or other assignment, or otherwise assuming that he or she is unauthorized to work)
until and unless secondary verification by SSA or OHS has been completed and a final nonconfirmation
has been issued. If the employee does not choose to contest a tentative nonconfirmation or a photo
mismatch or if a secondary verification is completed and a final nonconfirmation is issued , then the
Web Services Employer can find the employee is not work authorized and term inate the employee's
employment. Employers or employees with questions about a final nonconfirmation may call E-Verify at
1-888-464-4218 (customer service) or 1-888-897-7781 (worker hotline).
18. The Web Services Employer agrees to comply with Title VII of the Civil Rights Act of 1964 and
section 2748 of the INA as applicable by not discriminating unlawfully against any individual in hiring,
firing, employment eligibility ve rification , or recruitment or referral practices. because of hi ~ or her
national origin or citizenship statu s , or by committing discriminatory docume ntary pra c tic es. The Web
Services Employer understands that such illega l practices can include selective verification or use of
E-Verify except as provided in part D below, or discharging or refusing to hire employees because they
appear or sound "foreign" or have received tentative noricohfirmations. The Web Services Employer
furth er understands that any violation of the immigration-re lated unfair employment practices provisions
in section 2748 of the INA could subject the Web Services Employer to civil penalties, back pay
awards , and oth e r sanctions, and violations of Title VII could subject th e Web Services Employer to
back pay awards, compensatory and punitive damages. Violations of either section 2748 of the INA or
Title VII may also le<;id to the termination of its participation in E-Verify. If the Web Services Employer
has any questions relating to the anti-discrimination provision , it should contact OSC at 1-800-255-8155
or 1-800-237-25 15 (TDD).
19. The W eb Services Employe r ag ree s th at it will use the information it rece ives from E-V erify only to
confirm the employment eligibility of employees as authorized by this MOU. T he Web Services
Employer agrees that it will safeg uard this information, and means of access to it (su c h as PINS and
passwords), to ensure th at it is not used for any other purpose and as necessary to protect its
confidentia lity, including ensuring tha t it is not di sse min ated to any pe rso n other than employees of th e
W e b Se rvic es Employer who are auth ori ze d to perform the W eb Se rvi ces Employer's res pon sib ili ties
unde r thi s MOU , exce pt for such dissemination as may be au thorize d in ad vance by SSA or OHS for
legitim ate purpose s.
20. Th e W eb Servi ces Emp loyer agrees to notify OHS immediately in th e event of a breach of personal
inform ation. Breaches are defin ed as los s of co ntrol or un au thori ze d access to E-V erify perso nal da ta .
All suspected or confirm ed breac he s should be repo rt ed by ca lling 1-888-464-4218 or vi a ema il
at E-V erify@d hs.gov. Please us e "Priv ac y In cide nt -Password" in th e su bj ect lin e of your ema il
wh en sending a breach report to E-Verify .
21 . The Web Services Employer ac kn owl edges that th e inform ation it rece ives from SSA is governed
by the Privacy Act (5 U.S.C . § 552a(i)(1) an d (3)) a nd th e Socia l Security Act (4 2 U.S.C. 1306(a)). Any
perso n who obtain s this information un der fa lse preten ses or uses it for any purpos e oth er th an as
provid e d for in thi s MOU may be s ubj ect to crimin al penalties.
PaQe 5 of 23 E-Verify MO U for Web Services Employe rs I Revi sion Da te 06/01/13
e:-verify ___________ :,~1: etit~
Company ID Number: 1205487
22. The Web Services Employer agrees to cooperate with OHS and SSA in their compliance
monitoring and evaluation of E-Verify, which includes permitting OHS, SSA, their contractors and other
agents, upon reasonable notice, to review Forms 1-9 and other employment records and to interview it
and its employees regarding the Employer's use of E-Verify, and to respond in a prompt and accurate
manner to OHS requests for information relating to their participation in E-Verify.
a. The Web Services Employer agrees to cooperate with OHS if OHS requests information about
the Web Services Employer's interface, including requests by OHS to view the actual interface
operated by the Web Services Employer as well as related business documents. The Web
Services Employer agrees to demonstrate for OHS the functionality of its interface to E-Verify upon
request.
23. The Web Services Employer shall not make any false or unauthorized claims or references about
its participation in E-Verify on its website, in advertising materials, or other media. The Employer shall
not describe its services as federally-approved, federally-certified, or federally-recognized, or use
language with a similar intent on its website or other materials provided to the public. Entering into this
MOU does not mean that E-Verify endorses or authorizes your E-Verify services and any claim to that
effect is false.
24. The Web Services Employer shall not state in its website or other public documents that any
language used therein has been provided or approved by OHS, USCIS or the V erification Division,
without first obtaining the prior written consent of OHS .
25. The Web Services Employer agrees that E-Verify trademarks and logos may be used only under
license by OHS/USCIS (see M-795 (Web)) and, other than pursuant to the specific terms of such
license, may not be used in any manner that might imply that the Employer's services, products,
websites, or publications are sponsored by, endorsed by, licensed by, or affiliated with OHS, USCIS, or
E-Verify.
26. The Web Services Employer agrees to complete its Web Services interface no later than six
months after the date the Web Services Employer signs this MOU. E-Verify considers the interface to
be comp lete once it has been built pursuant to the Interface Control Agreem ent (ICA), submitted to
E-Verify for testing, and approved for sys tem acces s.
27 . The Web Services Employer agrees to perform sufficient maintenance on the Web Services
interfa ce in accordance with the requirements listed in the ICA. These requirements include, but are
not limited to , updating the Web Services interface to ensure that any updates or enhancements are
in corpo rat ed no late r th an six months after the issuance of an ICA. W eb Servi ce s Employers should be
aware th at thi s will require th e inves tm ent of tim e and reso urces. Compli ance with th e requirem ents of
th e ICA must be ca rri ed out to th e sa ti sfaction of OH S and or its assig nees.
28. The W eb Services Employer agrees that a ny system or interface it develops will follow the ste ps
for creati ng E-Verify cases and processing tentative nonconfirmations, as laid out in th e ICA, this MOU
and th e Use r Manu al, including but not limited to all o wing an e mployer to clo se an invalid case where
approp ri ate, all owing a n employer to refe r a tentativ e non co nfirmation on ly wh en a n employee choo ses
to co nt es t a tentativ e nonconfirm ation (no a utomati c refe rra ls), and referring a ten tativ e non c onfirm ation
Paae 6 of 23 E-Verifv MOU for W eb Servi ces Employe rs I Revi s io n Da te 0610 111 3
E ,.. -f -~:.:.!~. ·•''·· . -ver1 y _________ :~t :o~~
Company ID Number: 1205487
to the appropriate agency at the time the employer prints the referral letter and provides the letter to the
employee. The Web Services Employer understands tl1at any failure to make its system or interface
consistent with proper E-Verify procedures can result in OHS terminating the Web Services Employer's
agreement and access.
29. The Web Services Employer understands that if it uses E-Verify procedures for any purpose other
than as authorized by this MOU, the Web Services Employer may be subject to appropriate legal action
and termination of its participation in E-Verify according to this MOU.
B. EMPLOYERS THAT ARE FEDERAL CONTRACTORS WITH THE FAR E-VERIFY CLAUSE
NOTE: ff you do not have any Federal contracts at this time , this section does not apply to your
company. In the future , if you are awarded a Federal contract that contains the FAR E-Verify clause,
then you must comply with each provision in this Section . See 48 C.F.R. 52.222.54 for the text of the
FARE-Verify clause and the E-Verify Supplemental Guide for Feder;;tl Contractors for complete
information.
1. If the Web Services Employer is a Federal contractor with the FARE-Verify clause subject to the
employment verification terms in Subpart 22.18 of the FAR, it will become familiar with and comply with
the most current version of the E-Verify User Manual for Federal Contractors as well as the E-Verify
Supplemental Guide for Federal Contractors.
2 . In addition to the responsibilities of every employer outlined in this MOU , the Web Services
Employer understands that if it is a Federal contractor subject to the employment verification terms in
Suppart 22.18 of the FAR it must verify the employment eligibility of any "employee assigned to the
contract" (as defined in FAR 22.1801 ). Once an employee has been verified through E-V erify by the
Web Services Employer, the Employer may not create a second case for the employee through
E-Verify.
a. A Web Services Employer that is not enrolled in E-Verify as a Federal contractor at the time of a
contract award must enroll as a Federal contractor in the E-Verify program within 30 calendar days
of contract award and, within 90 d ays of enrollment, begih to verify employment eligibility of new
hires using E-V erify. The Web Services Employer must verify tho se employees who are working in
th e United St ates, whether or not th ey are ass ign ed to the contract. Once the W eb Services
Employer begins verifying new hires , such verification of new hires must be initiated within three
business days after th e hire date. On ce enrolled in E-Verify as a Federal contractor, the Web
Services Employer must begin verificatio n of employees ass igned to th e contract within 90
calendar days after the date of e nrollm ent or within 30 days of an employee's ass ignm en t to the
contract, whi cheve r date is later.
b. W eb Services Empl oyers enrolled in E-Verify as a Fede ra l co ntractor for 90 days or more at the
time of a contract award must use E-Verify to begin verifi ca tion of employment eligibility for new
hires of the Employer who are working in the United States, whether or not ass igned to the
contract, within three business days after th e date of hire. If the W eb Services Employe r is e nroll ed
in E-Verify as a Fede ral co ntractor for 90 ca lenda r days or less at the time of contract award, the
W eb Servic es Employer must, within 90 days of enrollm ent, beg in to use E-Verify to initi ate
Paae 7 of 23 E-Verify MOU for Web Se rvi ces E mployers I Revision Date 06/01/13
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verification of new hires of the contractor who are working in the United States, whether or not
assigned to the contract. Such verification of new hires must be initiated within three business days
after the date of hire. A Web Services Employer enrolled as a Federal contractor in E-Verify must
begin verification of each employee assigned to the contract within 90 calendar days after date of
contract award or within 30 days after assignment to the contract, whichever is later.
c. Federal contractors that are institutions of higher education (as defined at 20 U.S.C. 1001 (a)),
state or local governments, governments of Federally recognized Indian tribes, or sureties
performing under a takeover agreement entered into with a Federal agency under a performance
bond may choose to only verify new and existing employees assigned to the Federal contract. Such
Federal contractors may, however, elect to verify all new hires, and/or all existing employees hired
after November 6, 1986. Web Services Employers in this category must begin verification of
employees assigned to the contract within 90 calendar days after the date of enrollment or with in 30
days of an employee's assignment to the contract, whichever date is later.
d. Upon enrollment, Web Services Employers who are Federal contractors may elect to verify
employment eligibility of all existing employees working in the United States who were hired after
November 6, 1986, instead of verifying only those employees assigned to a covered Federal
contract. After enrollment, Web Services Employers must elect to verify existing staff following OHS
procedures and begin E-Verify verification of all existing employees w ithin 180 days after the
election.
e . The Web Services Employer may use a previously completed Form 1-9 as the basis for creating
an E-Verify case for an employee assigned to a contract as long as:
i. That Form 1-9 is complete (including the SSN) and complies with Article 11.A.6,
ii. The employee's work authorization has not expired, and
iii. The Web S ervices Employer has review ed the Form 1-9 inform ation either in person or in
communications with the employee to ensure that the employee's Section 1, Form 1-9
attestation has not changed (including, but not limited to , a lawful permanent resid ent ali en
having become a naturalized U.S. citizen).
f . The W eb Services Employe r s hall com pl ete a new Form 1-9 consistent with Articl e II.A. 10 or
upd at e th e previous Form 1-9 to provide th e necess ary inform a tion if:
i. The Web Services Employer cannot determine that Form 1-9 complies with Article
11.A.10 ,
ii. Th e e mpl oyee's bas is for work authori z ation as attes ted in Section 1 has exp ired or
ch ang ed , or
iii. T he Fo rm 1-9 co nta in s no SS N or is oth erwi se incomplete.
Note: If Section 1 of Form 1-9 is otherwise valid and up-to-d ate and th e form otherwise co m pl ie s wit h
Articl e 11.A.10 , but reflects documentation (such as a U.S. passport or Form 1-551) that expi re d after
co mpl eting Form 1-9, th e W eb Se rvi ces Emp loye r shall not require th e production of add itiona l
docum en t ation, o r u se the photo screen in g tool de scrib e d in Article 11.A.5, subject to any ad diti onal or
superse ding in struction s that may be provid ed on thi s subj ect in th e E-V erify Use r Manu al.
Page 8 of 23 E-Verify MO U fo r W eb Se rv ices Empl oyers I Revision Da te 06/01/13
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g. The Web Services Employer agrees not to require a second verification using E-Verify of any
assigned employee who has previously been verified as a newly hired employee under this MOU or
to authorize verification of any existing employee by any Web Services Employer that is not a
Federal contractor based on this Article.
3. The Web Services Employer understands that if it is a Federal contractor, its compliance with this
MOU is a performance requirement under the terms of the Federal contract or subcontract, and the
Web Services Employer consents to the release of information relating to compliance with its
verification responsibilities under this MOU to contracting officers or other officials authorized to review
the Employer's compliance with Federal contracting requirements.
C. RESPONSIBILITIES OF SSA
1. SSA agrees to allow OHS to compare data provided by the Web Services Employer against SSA's
database. SSA sends OHS confirmation that the data sent either matches or does not match the
information in SSA's database.
2. SSA agrees to safeguard the information the Web Services Employer provides through E-Verify
procedures. SSA also agrees to limit access to such information, as is appropriate by law, to
individuals responsible for the verification of Social Security numbers or responsible for evaluation of
E-Verify or such other persons or entities who may be authorized by SSA as governed by the Privacy
Act (5 U.S.C. § 552a), the Social Security Act (42 U.S.C. 1306(a)), and SSA regulations (20 CFR Part
401 ).
3. SSA agrees to provide case results from its database within three Federal Government work days of
the initial inquiry. E-Verify provides the information to the Web Services Employer.
4. SSA agrees to update SSA records as necessary if the employee who contests the SSA tentative
nonconfirmation visits an SSA field office and provides the required evidence. If the employee visits an
SSA field office within the eight Federal Government work days from the date of referral to SSA, SSA
agrees to update SSA records, if appropriate, within the eight-day period unless SSA determines that
more than eight days may be necessary. In such cases, SSA will provide additional instructions to the
em ployee. If th e employee does not vi s it SSA in th e time allowed, E-V erify may provide a fin a l
nonconfirmation to the employer.
Note: If a Web Services Employer experiences technical probl e ms , or has a policy question, the Web
Services Employer should contact E-Verify at 1-888 -464-42 18.
D. RESPONSIBILITIES OF OHS
1. After SSA veri f ies th e accuracy of S SA records for employees throu gh E-V erify , OHS agrees to
provide the Web Services Employer access to selected data from OHS databases to enable th e W eb
Servi ces Employer to conduct, to the extent authorized by thi s MOU :
a . Autom ated verifi cation checks on employees by electronic mea ns , and
b . P hoto veri f ica tion c h ec k s (wh en av ail abl e) on employees .
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Company ID Number: 1205487
2. OHS agrees to provide to the Web Services Employer appropriate assistance with operational
problems that may arise during the Web Services Employer's participation in the E-Verify program .
OHS agrees to provide the Web Services Employer names, titles, addresses, and telephone numbers
of DHS representatives to be contacted during the E-Verify process.
3. OHS agrees to make available to the Web Services Employer at the E-Verify Web site
(www.dhs.gov/E-Verify) and on the E-Verify Web browser (https://e-verify .uscis.gov/emp/), instructional
materials on E-Verify policies, procedures and requirements for both SSA and DHS, including
restrictions on the use of E-Verify. DHS agrees to provide training materials on E-Verify .
4 . OHS agrees to provide to the Web Services Employer a notice that indicates the Web Services
Employer's participation in the E-Verify program. OHS also agrees to provide to the Web Services
Employer anti-discrimination notices issued by the Office of Special Counsel for Immigration-Related
Unfair Employment Practices (OSC), Civil Rights Division, U.S. Department of Justice.
5 . OHS agrees to issue the Web Services Employer a user identification number and password that
permits the Employer to verify information provided by its employees with OHS .
6 . DHS agrees to safeguard the information provided to OHS by the Web Services Employer, and to
limit access to such information to individuals responsible for the verification of employees' employment
eligibility and for evaluation of the E-Verify program, or to such other persons or entities as may be
authorized by applicable law. Information will be used only to verify the accuracy of Social Security
Numbers and employment eligibility, to enforce the Immigration and Nationality Act (INA) and Federal
criminal or anti-discrimination laws, and to administer Federal contracting requirements.
7. DHS agrees to provide a means of automated verification that is designed (in conjunction with SSA
verification procedures) to provide confirmation or tentative no nconfirmation of employees' employment
eligibility within three Federal Government work days of the initial inquiry.
8. DHS agrees to provide a means of secondary verification (including updating OHS records as
necessary) for employees who contest OHS tentative nonconfirmations and photo non-match tentative
nonconfirmations that is designed to provide fin a l confirmation or nonconfirm ation of the employe es'
employm ent eligibility within 10 Federal Government w ork days of th e dat e of referral to DHS, unl es s
OHS determines that more than 1 O days may be necessary. In such cases, DHS will provide additional
verification instructions.
9. OHS agrees to provid e th e W eb Services Employ er with an Interface Control Agree ment (ICA). This
do cument will provide technical req uire ments th a t the W eb Services Employer must me et to crea te and
maintain a W eb Servi ces inte rface to the V erifi cation Information Syst e m (VIS). VIS is a composite
information system that provides immigration status verification for government agencies and
verifi cation of employm ent a uthorization for employers particip ating in E-Verify.
10. DHS ag re es to provide periodic sy ste m e nhancements to improve th e ease and accuracy of
E-Verify , as needed . OHS will also provide E-Ve rify enhancements to co mpl y with app licab le laws and
reg ul ations . As e nh ancem e nts occur, W eb Se rvi ce s Employers mu st upd ate their W eb Servi ces
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Company ID Number: 12054 87
interface to reflect system changes within the timelines specified in Article V.A.1. DHS will provide the
Web Services Employer with an ICA to support the E-Verify release whenever system enhancements
are required.
11 . DHS agrees to provide to the Web Services Employer guidance on breach notification and a
means by which the Web Services Employer can report any and all suspected or confirmed breaches
of owned or used systems or data spills related to E-Verify cases. At this time , if the Employer
encounters a suspected or confirmed breach or data spill, it should contact E-Verify at 1-888-464-4218.
12. In the event the Web Services Employer is subject to penalties , OHS will issue a Notice of Adverse
Action that describes the specific viola ti ons if it intends to suspend or term in ate the employer's W eb
Services interface access. The Web Services Employer agrees that OHS sha ll not be liable fo r an y
financial losses to the Web Services Employer, its employees, or any other party as a result of your
account suspension or termination and agrees to hold DHS harmless from any such claims .
ARTICLE Ill
REFERRAL OF INDIVIDUALS TO SSA AND OHS
A. REFERRAL TO SSA
1. If the Web Services Employer receives a tentative nonconfirmation issued by SSA, the Web
Services Employer must print the notice and promptly provide it to the employee so that the employee
may determine whether he or she will contest the tentative nonconfirmation. Th e Web Services
Employer must review the tentative non co nfirmation with the employee in private . After the notice has
been signed , the Web Services Employer must give a copy of the sign e d notice to the employee and
attach a copy to the employee 's Form 1-9.
2. The Web Services Employer will refer employees to SSA field offices only as directed by the
automated system based on a tentative nonconfirmation , and only after the Web Services Emp lo yer
records the case verification number, reviews the input to detect any transactio n errors , and determines
that the employee co ntests the tentative no nconfirmation. The W eb Services Employer wi ll trans mit the
Social Security Number to SSA for verifica tion again if t his review indica te s a need to do so. The W eb
Services Employer will determine wh ether the empl oyee con tests the tentative nonconfirmatio n as soon
as possible after the Employer receives it.
3. If the employee contests an SSA tentative nonconfirmation, the Web Serv ices Emplo yer will provide
the employee with a system-generated refe rral letter and instruct the employee to visi t an SSA office
within eight Federal Governm e nt w ork da ys . SSA will electronically transmit the res ult of the referral t o
th e W eb Se rvi ces Employer within 10 Fede ra l Gove rnm ent work days of th e referra l unless it
determines th at more than 10 days is necessary. The Employer ag rees to check th e E-Verify system
regularly for case upd at es .
4. Th e W eb Servi ce s Employe r agrees not to ask the employee to obta in a pri ntout from th e Socia l
Secu rity Num ber database (the Numident) or other wri tten verification of th e Socia l Security Number
from th e SSA.
P "n" 11 of 2 3 E-Verify MOU for Web Services Employe rs I Revi sion D ate 06/01/1 3
Company ID Number: 1205487
B. REFERRAL TO OHS
1. If the Web Services Employer receives a tentative nonconfirmation issued by DHS, the Web
Services Employer must promptly notify employees in private of the finding and provide them with the
notice and letter containing information specific to the employee's E-Verify case . The Web Services
Employer also agrees to provide both the English and the translated notice and letter for employees
with limited English proficiency to employees. The Web Services Employer must allow employees to
contest the finding, and not take adverse action against employees if they choose to contest the
finding, while their case is still pending.
2. The Web Services Employer agrees to obtain the employee's response about whether he or she will
contest the tentative nonconfirmation as soon as possible after the Web Services Employer receives
the tentative nonconfirmation. Only the employee may determine whether he or she will contest the
tentative nonconfirmation.
3. The Web Services Employer agrees to refer individuals to OHS only when the employee chooses to
contest a tentative nonconfirmation .
4. If the employee contests a tentative nonconfirmation issued by DHS, the Web Services Employer
will instruct the employee to contact OHS through its toll-free hotline (as found on the referral letter)
within eight Federal Government work days .
5. If the Web Services Employer finds a photo mismatch, the Web Services Employer must provide the
photo mismatch tentative nonconfirmation notice and follow the instructions outlined in paragraph 1 of
this section for tentative nonconfirmations, generally.
6. The Web Services Employer agrees that if an employee contests a tentative nonconfirmation based
upon a photo mismatch, the Web Services Employer will send a copy of the employee's Form 1-551,
Form 1-766, U.S. Passport, or passport card to OHS for review by:
a. Scanning and uploading the document, or
b. Sending a photocopy of the document by express mail (furnished and paid for by the employer).
7. Th e Web Services Employer understands that if it cannot determine whether there is a photo
match/mismatch, the Employer must forward the employee's documentation to DHS as described in
the preceding paragraph. The Employer agrees to resolve the case as specified by the OHS
representative who will determine the photo match or mismatch.
8. DHS will electronically transmit th e res ult of the ref e rral to the W eb Services Employer within 10
Federal Government work days of th e referra l unless it determines th at more than 10 days is
necessary.
9. Whil e waiting for case res ults, the Web Services Employer agrees to check the E-Verify system
regu larly for case updates.
10 . DHS agrees to provide th e W eb Services Employ e r with an Interfac e Con trol Agree me nt (ICA).
Paoe 12 o f 23 E-Verify MOU for W eb Servi ces Empl oyers I Revi s ion Date 06/01/1 3
Company ID Number: 1205487
This document will provide technical requirements that the Web Services Employer must meet to
create and maintain a Web Services interface to the Verification Information System (VIS). VIS is a
composite information system that provides immigration status verification for government agencies
and verification of employment authorization for employers participating in E-Verify.
11. DHS agrees to provide periodic system enhancements to improve the ease and accuracy of
E-Verify, as needed. DHS will also provide E-Verify enhancements to comply with applicable laws and
regulations . As enhantements occur, Web Services Employers must update their Web Services
interface to reflect system changes within the timelines specified in Article V.A.1. DHS will provide the
Web Services Employer with an ICA to support the E-Verify release whenever system enhancements
are required.
A. NO SERVICE FEES
ARTICLE IV
SERVICE PROVISIONS
1. SSA and DHS will not charge the Employer or the Web Services E-Verify Employer Agent for
verification services performed under this MOU. The Employer is responsible for providing equipment
needed to make inquiries. To access E-Verify, an Employer will need a personal computer with Internet
access .
ARTICLE V
SYSTEM SECURITY AND MAINTENANCE
A. DEVELOPMENT REQUIREMENTS
1. Software developed by Web Services Employers must comply with federally-mandated information
security policies and industry security standards to include but not limited to:
a. Public Law 107-347, "E-Government Act of 2002, T itle Ill, Federal Information Security
Management Act (FISMA)," December 2002 .
b. Office of Management and Budget (OMB) Memorandum (M-10-15), "FY 2010 Reporting
Instructions for the Federal Information Security Management Act and Agency Privacy
Management," April 2010.
c. National Institute of Standards and Technology (NIST) Special Publication (SP) and Federal
Information Process ing Standards Publication (FIPS).
d. Internation al Organization for Stand ardi zati on /Intern ational Electrotechni ca l Comm iss ion
(ISO/IEC) 27002, Information Technology -Security Te chniques -Code of Practice for
Information Security Management.
2 . The Web Services Employer agrees to update its W eb Services interface to th e sa tisfaction of OHS
or its assignees to reflect system enh a ncements within six months from the date OHS notifies the Web
Servic es User of th e syst e m upd at e . The W eb Servi ces Use r will rece iv e notice from OHS in th e fo rm
Page 13 of 23 E-Ve rify MOU for W e b Se rvi ces Employe rs I Revision Date 06/01/13
Company ID Number: 1205487
of an Interface Control Agreement (ICA). The Web Services Employer agrees to institute changes to
its interface as identified in the ICA, including all functionality identified and all data elements detailed
therein.
3 . The Web Services Employer agrees to demonstrate progress of its efforts to update its Web
Services interface if and when OHS requests such progress reports.
4. The Web Services Employer acknowledges that if its system enhancements are not completed to
the satisfaction of DHS or its assignees within six months from the date DHS notifies the Web Services
Employer of the system update, then the Web Services Employer's E-Verify account may be
suspended , and support for previous releases of E-Verify may no longer be available to the Web
Services Employer. The Web Services Employer also acknowledges that DHS may suspend its
account after the six-month period has elapsed.
5. The Web Services Employer agrees to incorporate error handling logic into its development or
software to accommodate and act in a timely fashion should an error code be returned.
6 . The Web Services Employer agrees to complete the technical requirements testing which is
confirmed upon receiving approval of test data and connectivity between the Web Services Employer
and DHS .
7. OHS will not reimburse any Web Services Employer or software developer who has expended
resources in the development or maintenance of a Web Services interface if that party is unable , or
becomes unable, to meet any of the requirements set forth in this MOU.
8. Housing, development, infrastructure, maintenance, and testing of the Web Services applications
m a y take place outside the United States and its territories, but testing must be conducted to ensure
that the code is correct and secure.
9. Tf the Web Services Employer includes an electronic Form 1-9 as part of its inte rface, then it must
comply with the standards for electronic retention of Form 1-9 found in 8 CFR 274a.2(e).
B. INFORMATION SECURITY REQUIREMENTS
Web Services Employers performing verification services under this MOU must ensure that information
that is shared between the Web Services Employer and DHS is appropriately protected comparable to
the protection provided wh e n the information is within the DHS environment [OMB Circular A -130
Appendix Ill].
To achi e ve thi s level of informa tion security, the W eb Services Employer agrees to in stitute the
following procedures:
1. Conduct periodic assessments of risk, including the magnitude of harm that could result from the
unauthorize d access, use , disclosure, disruption, modification, or destruction of information and
information systems that support the operations and assets of the DHS, SSA, and th e W eb Services
E mploye r ;
Pag e 14 o f 23 E-Verify MO U for W e b Servi ces Employers I Re vision D ate 06/01 /13
Company ID Number: 1205487
2. Develop policies and procedures that are based on risk assessments, cost-effectively reduce
information security risks to an acceptable level, and ensure that information security is addressed
throughout the life cycle of each organizational information system;
3. Implement subordinate plans for providing adequate information security for networks, facilities,
information systems, or groups of information systems, as appropriate;
4. Conduct security awareness training to inform the Web Services Employer's personnel (including
contractors and other users of information systems that support the operations and assets of the
organization) of the information security risks associated with their activities and their responsibilities in
complying with organizational policies and procedures designed to reduce these risks;
5. Develop periodic testing and evaluation of the effectiveness of information security policies ,
procedures, practices, and security controls to be performed with a frequency depending on risk, but no
less than once per year;
6. Develop a process for planning, implementing, evaluating, and documenting remedial actions to
address any deficiencies in the information security policies, procedures, and practices of the
organization;
7. Implement procedures for detecting, reporting, and responding to security incidents;
8. Create plans and procedures to ensure continuity of operations for informatio n systems that support
the operations and assets of the organization;
9 . In information-sharing environments, the information owner is responsible for establishing th e rules
for appropriate use and protection of th e subject information and retains th at responsibility even wh en
the information is shared with or provided to other organizations [NIST SP 800-37].
10. DHS reserves the right to restrict Web Services calls from certain IP addresses.
11. OHS res erves the right to audit the Web Services Employer's application.
12. W eb Services Employers ag re e to cooperat e willingly with th e OHS ass essment of information
security and privacy practices used by the company to develop and maintain the software .
C. DATA PROTECTION AND PRIVACY REQUIREMENTS
1. Web Se rvic es Employers must practice proper Intern et se curity; this mea ns using HTTP ov er
SS L/TLS (also kn own as HTTPS) wh en accessin g OHS information reso urces such as E-Ver ify [NIST
SP 800 -95]. Intern e t secu r ity practi ces lik e thi s a re necessa ry beca u se Simple Obj ect Acces s Protoc ol
(SOAP), which provides a basic messaging framework on which Web Services can be built, allows
mess ages to be viewed or modified by attacker s as mess ages traverse the Intern et and is not
indepe nd ently designed w ith all th e necessa ry security protocols for E-Verify us e .
2. In accorda nce with OHS stand ard s , th e W eb Servi ces Employe r agrees to maintain physica l,
elec troni c, and proced ura l sa fegu a rd s t o appropria tely protect the in forma ti on shared und er thi s MOU
Page 15 of 23 E-Verify MOU for W e b Servi ces Employers I Re vi s ion Da te 06/01/1 3
Company ID Number: 1205487
against loss, theft, misuse, unauthorized access, and improper disclosure, copying use, modification or
deletion.
3. Any data transmission requiring encryption shall comply with the following standards:
• Products using FIPS 197 Advanced Encryption Standard (AES) algorithms with at least 256-bit
encryption that has been validated under FIPS 140-2.
• NSA Type 2 or Type 1 encryption.
4. User ID Management (Set Standard): All information exchanged between the parties under this
MOU will be done only through authorized Web Services Employer representatives identified above.
5. The Web Services Employer agrees to use the E-Verify browser instead of its own interface if it has
not yet upgraded its interface to comply with the Federal Acquisition Regulation (FAR) system changes.
In addition, Web Services Employers whose interfaces do not support the Form 1-9 from 2/2/2009 or
8/7/2009 agree to use the E-Verify browser until the system upgrade is completed.
6. The Web Services Employer agrees to use the E-Verify browser instead of its own interface if it has
not completed updates to its system to the satisfaction of OHS or its assignees within six months from
the date DHS notifies the Web Services Employer of the system update. The Web Services Employer
can resume use of its interface once it is up-to-date, unless the Web Services Employer has been
suspended or terminated from continued use of the system.
D. COMMUNICATIONS
1. The Web Services Employer agrees to develop an electronic system that is not subject to any
agreement or other requirement that would restrict access and use by an agency of the United States.
2. The Web Services Employer agrees to develop effective contro ls to ensure the integrity, accuracy
and reliabil ity of its electronic system .
3. The Web Services Employer agrees to develop an inspection and quality assurance program that
regularly (at least once per year) eva lu ates the electronic system, and includes periodic checks of
electronically stored information . The W eb Services Employer agrees to share th e results of its regular
in spection a nd qu ality assurance program with DHS upon request.
4. The Web Services Employer agrees to develop an electronic system with the abi lity to produce
legible copies of appli cable notices , letters, and other written, photographic and graphic materials .
5. All inform ation exc hanged between th e parties und er thi s MOU will be in accordance with applica ble
law s, regulation s , and policies, including but not limited to, information security guidelin es of the
sending party with respect to any information that is deemed Personally Identifiable Information (Pll),
includ in g but not limited to the employee or a pplicant's Social Security number, ali e n numb e r, date of
birth, or other information that may be us ed to identify the individua l.
6. Suspected a nd co nfirm e d inform ati on security breach es must be reported to DHS according to
Articl e V .C .1. Rep orting s u c h breaches do es not reli ev e th e W e b Se rvi ces Employe r from furthe r
Paae 16 of 23 E-Verifv MOU for Web Services Empl oyers I Revision Date 06/01/1 3
Company ID Number: 1205487
requirements as directed by state and local law. The Web Services Employer is subject to applicable
state laws regarding data protection and incident reporting in addition to the requirements herein.
E. SOFTWARE DEVELOPMENT RESTRICTIONS
1. DHS reserves the right to terminate the access of any software developer with or without notice who
creates or uses an interface that does not comply with E-Verify procedures.
2. Employers are prohibited from Web Services Software development unless they also create cases
in E-Verify to verify their new hires' work authorization. Those pursuing software development without
intending to use E-Verify are not eligible to receive an ICA. At this time, E-Verify does not permit Web
Services software development without also being a Web Services Employer or Web Services E-Verify
Employer Agent.
F. PENALTIES
1. The Web Services Employer agrees that any failure on its part to comply with the terms of the MOU
may result in account suspension, termination, or other adverse action.
2. DHS is not liable for any financial losses to Web Services Employer, its clients, or any other party as
a result of account suspension or termination .
A. MODIFICATION
ARTICLE VI
MODIFICATION AND TERMINATION
1. This MOU is effective upon the signature of all parties and shall continue in effect for as long as the
SSA and DHS operates the E-Verify program unless modified in writing by the mutual consent of all
parties.
2 . Any and all E-Verify system enhancements by DHS or SSA , including but not limited to E-Verify
checking ag ain st additional d at a sourc es and instituting new verifi cation policies or procedures, will be
cov ered und er this MOU and will not caus e th e need for a supplem ent al MOU th at outlin es these
changes.
B. TERMINATION
1. Th e W eb S ervic es Employer m ay t ermin at e thi s MOU and its particip ation in E-V erify at any tim e
upon 30 d ays prior written noti ce to th e oth er parti es.
2 . Notwithstanding Articl e V , part A of this MOU, DHS may terminate this MOU , and thereby the Web
Services Employer's parti c ipation in E-V erify, with or without notice at any tim e if deem ed necessary
becaus e of the requirem ents of law or policy, or upon a det ermination by SSA or OHS that th ere has
be en a breach of sy st em integrity or sec urity by the W eb Services Empl oye r, or a failu re on the part of
eith er p arty to c omply with est abli shed E-Verify procedures and/or l eg al requirem ents. Th e W eb
Servi ces Em p loye r und ers t ands th at if it is a Federal contractor, termin ation of thi s MOU by any party
Page 17 of 23 E-Verify M OU fo r W eb Services Emplo yers I Revisio n Dale 06/01/13
Company ID Number: 1205487
for any reason may negatively affect the performance of its contractual responsibilities. Similarly, the
Web Services Employer understands that if it is in a state where E-Verify is mandatory, termination of
this by any party MOU may negatively affect the Web Services Employer's business.
3. A Web Services Employer that is a Federal contractor may terminate this MOU when the Federal
contract that requires its participation in E-Verify is terminated or completed . In such cases, the Web
Services Employer must provide written notice to OHS. If the Web Services Employer fails to provide
such notice, then that Web Services Employer will remain an E-Verify participant, will remain bound by
the terms of this MOU that apply to non-Federal contractor participants, and will be required to use the
E-Verify procedures to verify the employment eligibility of all newly hired employees.
4. The Web Services Employer agrees that E-Verify is not liable for any losses, financial or otherwise,
if the Web Services Employer or the Employer is terminated from E-Verify.
ARTICLE VII
PARTIES
A. Some or all SSA and OHS responsibilities under this MOU may be performed by contractor(s), and
SSA and OHS may adjust verification responsibilities between each other as necessary. By separate
agreement with OHS, SSA has agreed to perform its responsibilities as described in this MOU.
B. Nothing in this MOU is intended, or should be construed, to create any right or benefit, substantive
or procedural, enforceable at law by any third party against the United States, its agencies, officers, or
employees, or against the Web Services Employer, its agents, officers, or employees.
C. The Web Services Employer may not assign, directly or indirectly, whether by operation of law,
change of control or merger, all or any part of its rights or obligations under this MOU without the prior
written consent of OHS, which consent shall not be unreasonably withheld or delayed. Any attempt to
sublicense, assign, or transfer any of the rights, duties, or obligations herein is void.
D. Each party shall be solely responsible for defending any claim or action against it arising out of or
related to E-Verify or this MOU, whether civil or criminal, and for any liability wherefrom, including (but
not limited to) any dispute between the Web Services Employer and any other person or entity
regarding the applicability of Section 403(d) of llRIRA to any action taken or allegedly taken by the Web
Services Employer.
E. Th e Web Services Employer understands that its participation in E-Verify is not confidential
information and may be disclosed as authorized or required by law and OHS or SSA policy, including
but not limited to, Congression al overs ight, E-Verify publicity and media inquiries, determinations of
compli anc e with Fede ral contractu al re quirem ents, and responses to inquiries under the Freedom of
Information Act (FOIA).
F. Th e individuals whose signatures appear below represent th at they are auth ori z ed to enter into this
MOU on behalf of the Web Services Employer and OHS respectively. The Web Servic es Employer
understand s th at any in accurate statement, repre se ntation , data or oth er inform ation provid ed to OHS
Page 18 o F 23 E-VeriFy M O U For W e b Se rvi ces Employers I Revisio n Da t e 06/0 1/13
Company ID Number: 1205487
may subject the Web Servi c es Employ er , its subcontra ctors, its employe es , or its representatives to : (1)
prosecution for false statements pursuant to 18 U.S.C. 1001 and/or; (2) immedia te terminatio n of its
MOU and/or; (3) possible debarment or suspension.
G . The foregoing constitutes the full agreement on this subject between OHS and the Web Se rvices
Employer.
Approved by:
Web Services Employer
Ferguson Enterprises, Inc.
Name (Please Type or Print) Title
Julie A Yutesler
Si![Jnature Da te
Electron ically Signed 06/0 9/2017
Department of Homeland Security -Verification Division
Na me (Pleas e Type or Print) Titl e
US CI S V erifi ca ti on Divi sion
Signature Date
Electro nica lly Signed 06 /0 9/20 17
Pag e 19 o f 23 E-Verify MOU for W eb Serv ices Employer s I Rev ision D al e 06/01/13
Company ID Number: 1205487
Information Required for the E-Verify Program
Information relating to your Company:
Ferguson Enterprises, Inc .
Company Name
12500 Jefferson Avenue
Newport News, VA 23602
Company Facility Address
Company Alternate Address
County or Parish NEWPORT NEWS CITY
Employer Identification Number 54121 1771
North American Industry 423 Classifi cation Systems Code
Parent Company
Number of Employees 10 ,000 and over
Numb er of Sites V erified for 1,24 0
Page 20 of 23 E-V erify MOU for W e b Serv ices Employe rs I Re vi sion Date 06/01/13
5 -Verify __________ ;r~t :d:®~
Company ID Number: 1205487
Are you verifying for more than 1 site? If yes, please provide the number of sites verified for in
each State:
ALASKA 5 site(s) WASHINGTON 40 site(s)
ALABAMA 23 site(s) WISCONSIN 19 site(s)
ARKANSAS 11 site(s) WEST VIRGINIA 11 site(s)
ARIZONA 29 site(s) WYOMING 5 site(s)
CALIFORNIA 164 site(s)
COLORADO 24 site(s)
CONNECTICUT 2 site(s)
DIST OF COL 1 site(s)
DELAWARE 5 site(s)
FLORIDA 70 site(s)
GEORGIA 29 site(s)
HAWAII 9 s ite(s)
IOWA 10 site(s)
IDAHO 11 site(s)
ILLINOIS 22 site(s)
INDIANA 28 site(s)
KANSAS 12 s ite(s)
KENTUCKY 18 site(s)
LOUI S IANA 7 si te(s)
MASSACHUSETIS 18 site(s)
MARYLAND 33 site(s)
MAINE 8 site(s)
MICHIGAN 30 site(s)
MINNESOTA 24 si te(s)
MISSOURI 13 site(s )
MI SSISSI PP I 10 site(s)
MONTANA 8 site(s)
NORTH CAROLINA 74 site(s)
NORTH DAKOTA 8 site(s)
NEBRASKA 6 s ite(s)
N EW HAMPSHIRE 9 site (s)
NEW JERSEY 33 site(s )
NEW MEXICO 8 site(s)
N EVADA 13 site (s)
NEW YORK 29 site(s)
OHIO 26 site(s)
OKLAHOMA 12 site(s )
OREGON 24 site(s)
PE NN SYLVANI A 32 site(s)
RHODE I SLA ND 1 site(s)
SO UT H CAROLIN A 29 site(s)
SOUTH DAKOTA 4 site(s)
TENN ESSEE 29 site(s)
TEXAS 111 site(s )
UTAH 16 site(s)
VI RG INI A 74 site(s)
V ER MO NT 3 site (s )
Page 2 1 of 2 3 E-Verify MOU for W e b Servi ces Employe r s I Revi sion D ate 06/0 1/13
Company ID Number: 1205487
Information relating to the Program Administrator(s) for your Company on policy questions or
operational problems:
Name Cynthia Pena
Phone Number (757) 223 -6305
Fax Number
Email Address cynthia.pena@ferguson.com
Name Julie A Yutesle r
Phone Number (757) 223 -6340
Fax Number
Email Address julie.yutesler@fe rguson .com
Pag e 22 of 23 E-V eri fy MOU for W eb Se rvices Em ploye rs I Revision Date 0610 111 3
Company ID Number: 1205487
Page intentionally left blank
Pag e 23 of 23 E-V erify MO U for W eb Se rvices Emp loyers I Revi sion Da te 06/01/1 3
3/16/22, 12:10 PM Detail by Entity Name
I . I ." !' , 'l/
I ( :, I )( >I '['I (,, .. ,
,I ) ) I .} t · , / ~ .J
); -<-' 11'· .·<,, '·
Qllpmlm'.l l\I of Swlu I Divis in11 of r.or!)oralio ns I Su mrh R11cnrdr; I Su11ro1L!J1• Enli ly.J':l.illu.Q I
Detail by Entity Name
Foreign Limited Liability Company
FERGUSON ENTERPRISES, LLC
Filing Information
Document Number
FEl/EIN Number
Date Filed
State
Status
Principal Address
M19000003601
54-1211771
04/09/2019
VA
ACTIVE
12500 JEFFERSON AVE.
NEWPORT NEWS, VA 23602
Mil.iling Address
12500 JEFFERSON AVE.
NEWPORT NEWS, VA 23602
Registered Agent Name & Addrelili
CORPORATE CREATIONS NETWORK, INC .
801 US HIGHWAY 1
NORTH PALM BEACH, FL 33408
Address Changed : 03/25/2020
Authorized Pers on(~) Detail
Name & Address
Title MGR
BRUNDAGE, WILLIAM S
12500 J EFFERSON AV E .
NEW PORT NEWS, VA 23602
Titl e MG R
HUTCHERSO N, ALE X B
12 500 J EFFERSON AV E.
N EW PORT NEWS, VA 2360 2
3/16/22, 12 :10 PM
MURPHY, KEVIN M
12500 JEFFERSON AVE .
NEWPORT NEWS, VA 23602
Title MGR
Graham, Ian T
12500 JEFFERSON AVE.
NEWPORT NEWS, VA 23602
Title Treasurer
Crowder , Brenda L.
12500 JEFFERSON AVE .
NEWPORT NEWS, VA 23602
Title Assistant Sec retary
Cooper , James L.
12500 JEFFERSON AVE .
NEWPORT NEWS, VA 23602
Title Ass istant Se c retary
Gallo, Eric A.
12500 JEFFERSON AVE .
NEWPORT NEWS, VA 2 3602
Titl e A ssist ant Secretary
Rice, Wesley E.
12500 JEFFERSON AVE .
NEWPORT NEWS, VA 236 02
Titl e A ss istant Secretary
Yutesler, Julie A.
12500 JEFF ERSON AV E .
NEWPORT NEWS , VA 2360 2
Re port Yea r
2 020
202 1
Fil ed D ate
02/22/202 0
03/29/2021
Docu m ent Ima ges
iJ:\129/20::''1 --il.r-1 1-JIJl\L HCPQl<l" View imngo H1 PDF fo nrmt
Det ai l by Entity Nam e
3/16/22, 12:10 PM Detail by Entity Name
-;· .. ~ I /II
City of Hialeah -General Ledger
450 Water & Sewers Division Fund
Account
450.0000.141001
INVENTORY -PIPES , VALVES & FITTINGS
Total >As-sets for iFi und 1'50
450
Water & Sewers Division Fund
Fiscal Year: 2022
Fund Totals
$0.00
Balance
127,879.54
577,158.43
iJ21/879.54
577,!158.43
$577,158.43
Revenue/Expenses Ba lance: $0.00
iEncumber.ed
264,596.61
264,596.61
$264,596.61
Trial Balance
through
04 /14/2022
Trial Balance -
IJast iDate
4/14/2022
Assets
($841,755.04)