Document D4RaXoXNZb3rJ2VnbKqygp2B
I. Contract Identification
File No.:
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:File Name
Location(s):
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Work Description:
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Dates: (1) General: /z/ir [H-- n-jz-Lj^
(2) Specific (on-site):
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Amount! 2,^00 -
Contractor:
Reviewer: Date:
Ill. Employees
A. Employees/Workers
B. Days worked
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"CERTIFIC/ ""E OF INSURANCE ___________________________________________
I ISSUE DATE (MMp/vy}_~
' 12-12-fc.:^l
PRODUCER ' '
.
Li Small I nsu r.ance -'^genby/
60 Boa rdman-Cah f.j e l d Road P. 0.Box 3 408 Boardman, Ohio 44512
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND.OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
COMPANIES. AFFORDING COVERAGE
COMPANY LETTER
^West
Arne rican
Insurance Company
INSURED
Tasco Insulat ions, Inc. 120 East Woodland Avenue Youngstown, Ohio 44502
COMPANY LETTER
B Oh i 0
Casualty
Insurance
Company
COMPANY LETTER
C Fide I
ity
S Gua ranty
Ins,
Under.
DCOMPANY
LETTER
COVERAGES
ECOMPANY
LETTER
THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS, AND CONDI TIONS OF SUCH POLICIES.
CO
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE POLICY EXPIRATION DATE (MM/DD/YY) DATE (MM/DO/YY)
GENERAL LIABILITY
A COMPREHENSIVE FORM
PREMISES/OPERATIONS UNDERGROUND EXPLOSION S COLLAPSE HAZARD PRODUCTS/COMPLETED OPERATIONS
CONTRACTUAL
INDEPENDENT CONTRACTORS
BROAD FORM PROPERTY DAMAGE
PERSONAL INJURY
XPW (84) 1 4 21 . 22
2-31-83 12-31-8
AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS (PRIV. PASS.) ALL OWNED AUTOS (^Rp^N)
HIRED AUTOS N0N-0WNED AUTOS GARAGE LIABILITY
XAW (84) 14 21 22
2-31-83 12-31-84^
EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM
XB0 (84) 14 21 22
2-31-83 12-
WORKERS' COMPENSATION AND
EMPLOYERS' LIABILITY
OTHER
I ns ta11 a tion
Floater
sp 028105187
2-31-83 12-31 - 8^
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS
Applying insulation consisting of fiberglass, silicate and other similar
non-conducting materials to piping and equipment.
Job - Water 1ines at scrubber
CERTIFICATE HOLDER
CANCELLATION-
81 aw Knox Rolls Wheeling, W. Va
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE I PIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 1 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY. ITS AGENTS OR REPRESENTATIVES.
[ AUTHORIZED REPRESSNTA
fLcb ij
<Tblawknox:
A'Division o/.
insofidated Industries, Inc. -
98 PENINSULA ST. WHEELING, WV 26003
AN EQUAL OPPORTUNITY EMPLOYER
PilKCf-iiiSK tiwet'tt-u
-r^or v .
.
BLANKETORDfR RELEASE
NUMBERS BELOW MUST APPEAR ONJLALL. INVOICES*. PACKAGES. SHIPPING PAPERS AND CORRE SPONDENCE.
REFERENCE NO.'
ConT^ln9
DATE
Greg Femberg - -216-744-2145
N AM 6
-
12-7-84
Net 30 Days
Buyers Plant
oeuVERY REQ.
OEUVERY PROM.
SHIP VIA
11-26-84
12-10-84
Seller's Delivery
lrt*ICKT FOR Acer. OF
OTXBR see
BELOV**
XX
BILL SALSS OR USB
TAX
VBS NO
0
Dept. #13
AFE 33-167-11
PURCHASE XJORDER
BLANKET ORDER RELEASE
PURCHASE ORDER NO.
53-10017
RELEASE .NUMBER
TO
Tasco Insulations, Inc. P. 0. Box 1167 Youngstown, OH 44501
SHIP TO
INVOICING INSTRUCTIONS
SHIP TO LOCATIONS
0 Wheeling Works Wheeling, W,, Va. 26003 .--. Warwood Works 2 Warwood '--' Wheeling, W. Va. 26003 ryi Other L2J (See Below)
jr-! Same as XJ Ship To
| |- See Below
YES
NO
Partial Shipment Acceptable
West Virginia Sales or Use Tax License No. 34-061-7695-002M
Item
Quantity
Description
Commodity Code
Account No.
Price
List of Materials for Insulation of Water Lines on our Scrubber Unit *As per TAsco Letter DAted 11-8-84
553.35
Labor to Install this Material
(48 hrs. + O.C. Tax) Hourly Rate
$ 1,846.65 38.50
Attached Find one (1) copy each of the following forms which are part of the Terms and Conditions of this Purchase Order:
FORM E-3701-General Conditions Covering Work on Owner Premises, pages 1 thru 6
FORM E-3702-Plant Regulations and Safety Rules Covering Work on Owner Premises, pages 1 thru 3.
FORM E-3703-Release and Waiver of Liens, which are to be properly executed in duplicate and attached to final invoice. If properly executed forms do not accompany final invoice, it will be returned to you.
NOTE: Seller's Insurance Certificate must be in Buyer's file before Seller's Personnel enters premises.
PRICE IS FIRM AND NOT SUBJECT TO ESCALATION
TOTAL $ 2,400.00
vDraaOO/cc
Di,eclor of Purchasing
jS* EXACT QUANTITIES REQUIRED - OVER SHIPMENTS
LJ WILL BE RETURNED AT SELLERS EXPENSE
SIGNED
BLA W-KNOX ROLLS
Acceptance of this Purchase Order constitutes acceptance of the terms and conditions below and on reverse side her Acknowledgment copy must be completed and returned promptly to the purchasing department.
1. MARKINGS: EACH PIECE. PACKAGE AND CONTENTS MUST BE MARKED WITH OUR REFERENCE NO.. PURCHASE ORDER NO.. AND RELEASE NO.
PACKING LIST MUST ITEMIZE ALL PIECES IN EACH PACKAGE AND SHIPMENT SHQWING REFERENCE NO.. PURCHASE ORDER NO.. AND RELEASE NO.
IF THE ABOVE IS NOT FOLLOWED. OUR COST TO COMPLY WILL BE DEDUCTED FROM YOUR INVOICE.
2. INVOICES: SEPARATE INVOICES IN TRIPLICATE. ACCOMPANIED BY BILL OF LADING FOR EACH SHIPMENT MUST BE MAILED ON DAY OF SHIPMENT TO ADDRESS NOTED ABOVE. THE INVOICES MUST CERTIFY THAT "ALL PRICES CHARGED 8Y SELLER ARE IN COM PLIANCE WITH THE ECONOMIC STABILIZATION ACT OF 1970 AS AMENDED. AND ALL EXECUTIVE ORDERS. REGULATIONS. GUIDELINES AND RULINGS ISSUED PURSUANT THERETO".
3. LOADINGS: ALL SHIPMENTS WEIGHING OVER 200 LBS PER PIECE MUST BE DELIVERED IN OPEN TOP OR FLAT BEO TRUCK.
4. RECEIVING HOURS: WHEELING PLANT -- 7 AM TO 1:30 PM MONDAY THRU FRIDAY WARWOOD PLANT -- 7 AM TO 2:00 PM MONDAY THRU THURSDAY
5. IF FREIGHT IS FOR ACCOUNT OF BLAW-KNOW ROLLS -- PREPAID -- IT IS REQUESTED YOU PREPAY THE FREIGHT CHARGES ON THE MATERIAL COVERED BY THIS ORDER ADDING THEM TO YOUR INVOICE. ATTACHING A COPY OF THE PAI0 FREIGHT BILL.
6. ON THE DATE SHIPMENT IS MADE A COPY OF THE SHIPPING MEMORANDUM MUST BE MAILED TO BLAW-KNOW ROLLS PURCHASING DEPARTMENT. 98 PENINSULA STREET. WHEELING. WV 26003.
I
QUANTITY QUANTITY ITEM SHIPPED ORDERED
DESCRIPTION OF MATERIAL
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TOTAL
57 /o 01 5/
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RECEIVED
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DATE
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Contract No. or
/&)?>Mdse. Sale No..
SHIP TO
TASCO INSULATIONS, INC
P.0. Box 1167
120 E. Woodland Avenue
YOUNGSTOWN, OHIO 44501
Phone (2j) 744-214^
0740
DATE. /2 ~/2 -
VIA
WHEN
BILL TO
QUANTITY QUANTITY ITEM SHIPPED ORDERED
DESCRIPTION OF MATERIAL
2LPER.
<01-------------------------------------------------
*/</ EXTENSION
TOTAL
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Contract No.
_-
or
</Of)Mdse. Sale No
/
SHIP TO
TASCO INSULATIONS, INC
P.O. Box 1167
120 E. Woodland Avenue-
YOUNGSTOWN, OHIO 44501
Phone (2*$) 744-2145^
/// /
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/1___________
WHEN
BILL TO
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____________________________PER.
(J N^srry/------------------------
QUANTITY QUANTITY ITEM SHIPPED ORDERED
DESCRIPTION OF MATERIAL
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PRICE /ex/ension
TOTAL
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--
RECEIVED
'
DATE
-
ITEM QSUHAIPNPTEITDY QOUROANERTIETOY
DESCRIPTION OF MATERIAL
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UNIT PRICE EXTENSION
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7 11
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TOTAL
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