Bid Notice.pdf

Town of Mamaroneck Highway Department

740 West Boston Post Road Mamaroneck, New York 10543

(914) 381-7825

Highway Department Yard Waste Disposal

Years 2026, 2027 & 2028 Contract TA-26-01A

Bid Opening: Thursday, September 17th, 2026

10:00 AM E.S.T.

Town Center Offices Conference Room “C”

TOWN OF MAMARONECK

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P a g e

WESTCHESTER COUNTY, NEW YORK

NOTICE TO BIDDERS

CONTRACT TA-26-01A Town of Mamaroneck Highway Department Yard Waste Disposal

YEARS 2026, 2027 & 2028

Sealed proposals for Town of Mamaroneck Highway Department Yard Waste Disposal will be received by the Town of Mamaroneck in the Town Offices at 740 West Boston Post Road, Mamaroneck, New York until 10:00 a.m., E.S.T., Thursday, September 17th, 2026 at which time and place the proposals will be publicly opened and read.

The Information for Bidders, Form of Proposal and Contract, and Specifications of this project are available for examination. Free online access to documents can be obtained by viewing the solicitation posting on the Empire State Purchasing Group website:

https://www.bidnetdirect.com/new-york. Paper bid documents can also be viewed at the Town Administrator’s Office in the Town of Mamaroneck, Town Center at 740 West Boston Post Road, Mamaroneck, NY, 10543. Questions pertaining to this contract, including scheduling a site visit, shall be directed to Town Engineer Robert Wasp at (914) 381-7835; or by email at RWasp@townofmamaroneckny.gov

All bids must be submitted in sealed envelopes plainly marked:

"BID FOR CONTRACT # TA-26-01 TOWN OF MAMARONECK HIGHWAY

DEPARTMENT YARD WASTE DISPOSAL - YEARS 2026 & 2027”

The Town of Mamaroneck reserves the right to reject any or all proposals, or to waive any informality in the proposal, as deemed advisable in the interest of the Town.

By Order of the Town Board of the Town of Mamaroneck, NY Meredith Robson Town Administrator

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GENERAL INFORMATION TO BIDDERS

TITLE: TOWN OF MAMARONECK HIGHWAY DEPARTMENT YARD WASTE

DISPOSAL 2026, 2027 & 2028– CONTRACT TA-26-01A

SCOPE OF SERVICE:

The Contract requires an acceptance facility to dispose of wood, and brush materials from the Town Highway Department. The Vendor must be in close proximity to the Town and be able to accept materials multiple times a day during normal conditions and during high volume storm events.

Vendors submitting proposals must respond in writing to all of the requirements of this Request for Proposal.

Acceptance of materials under this contract is to be performed daily as required by the town through December 31, 2026. An option for extension for additional contract years 2027 & 2028 is included on the Form of Proposal and may be offered at the Town’s sole discretion.

GENERAL REQUIREMENTS:

1. Definitions of Terms:

The words “Town” & “Owner” and “Bid” & “Proposal” are used synonymously in these specifications.

2. Proposal Compliance:

All proposals shall be submitted in a sealed envelope clearly labeled with the name of the bidder containing the identifying words “BID FOR CONTRACT – Town of Mamaroneck Highway Department Yard Waste Disposal TA-26-01A.” All proposals must be addressed and submitted to the Office of the Town Administrator no later than 10:00 a.m., E.S.T., Thursday, September 17th, 2026. Proposals submitted in unmarked envelopes may not be accepted. However, time permitting, the Town will accept resubmitted proposals granted they are properly labeled prior to the scheduled bid opening.

Proposals can be submitted at the main security desk located on the first floor of the Town Center.

Prospective bidders are requested to contact the Town Engineer at (914)-381-7835 to confirm receipt of their proposal prior to the time of opening.

Public bid opening is scheduled for Thursday, September 17th – 10:00 AM. Those wishing to attend should expect to wait at the Town Center entrance. Town staff will meet bidders at 10:00 AM and will escort those in attendance to the bid opening location.

3. Proposal Form:

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Each bid submitted must be written or typed on the attached “Form of Proposal.” Failure to do so will cause grounds for disqualification. All blank spaces must be filled in with unit costs expressed in both words and figures.

4. Withdrawal of Bids & Proposals:

Bids may be withdrawn in person or writing by the vendor provided that notice is given during normal business hours up to two hours before the scheduled bid opening time. Once the bids and proposals are opened, prices shall remain in effect for the duration of the contract. However after the “opening” of bids, vendors submitting a bid proposal may withdraw their proposal if a “no award” of contract is made within 45 days upon submission of such bid.

5. Acceptance or Rejection:

The Town of Mamaroneck reserves the right to reject any or all proposals or to waive any informality in the proposal, as deemed advisable in the interest of the Town. The Town also reserves the right to award the contract in whole or in part. All unit prices and alternate prices shall remain valid for the contract period and the Town of Mamaroneck may elect to accept or reject any item.

Bids will not be accepted from firms which have pleaded guilty to or, otherwise, been convicted of bid rigging or related criminal charges. Nor will bids be accepted from firms which include a principal or an officer who has pleaded guilty to or, otherwise been convicted of a bid rigging or related criminal charges. Such bidders are disqualified from bidding on this project

6. Bidders Qualification:

Each bidder shall complete and return with his bid the Contractor’s prequalification form(s) attached. No bids will be considered from bidders who are unable to show that they regularly provide service of the type herein called for. The Town of Mamaroneck may make any investigations it deems necessary to determine the ability of the bidder to perform the specified work. The bidder shall furnish to the Town all such information for this purpose as the Town may request.

Selection shall be based on possession of the necessary proximity, availability of service, and demonstration to provide a satisfactory record of cost effective service.

7. Familiarity with Bid Documents, Site Conditions, and Governing Law:

Each bidder is required to be familiar with all of the bid documents terms and conditions in addition to understanding all federal, state and locals laws, regulations and ordinances regarding performing the service in accordance to this contract.

Failure of the bidder to fully familiarize himself with conditions related to these specifications for which the service is to be performed, shall not relieve any bidder from any obligation set forth in this contract.

8. Term of Contract:

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The contract work shall be completed within the time limits set forth; from contract award to end of the calendar year December 31, 2026; with an optional extension for service years 2027 & 2028.

Brush, large wood debris, branches, and tree stumps must be accepted by the Vendor. The Town of Mamaroneck Highway Department must be able to dispose of debris multiple times a day.

Vendor must be able to accept debris during normal conditions and during high volume storm events.

9. Errors, Interpretations, and Addenda:

Should bidders find any omissions, discrepancies or errors in the contract documents or should any bidder have doubt to the clarity of meaning of any written language, they should immediately notify the Town of Mamaroneck Engineering Department and request an addendum or an RFI response.

Questions regarding these bid specifications shall be directed to Town Engineer, Robert Wasp, at

(914) 381-7835 and (914) 381-8473 (Fax) or by e-mail: rwasp@townofmamaroneckNY.gov

10. Payment:

Payment for service shall be based on a per yard basis.

All requisitions for payment shall be submitted to the Highway Department for approval.

Requisitions shall consist of an invoice submitted on company letterhead.

The fee schedule shown on the “Form of Proposal” shall dictate the basis of payment.

11. Termination by the Owner:

If the Contractor defaults or neglects to carry out the service in accordance with the contract documents or fails to perform any provision of the contract, the Town of Mamaroneck may, after seven days written notice to the Contractor and without prejudice to any other remedy he may have, make good such deficiencies and may deduct the cost thereof from the payment then or thereafter due the Vendor.

12. Inspection Procedure and Basis of Payment:

Actual monetary payment shall be made as per the contract’s schedule of unit bid prices.

13. Contact Information:

TOWN OF MAMARONECK KEY PERSONNEL:

John Barreto (**) General Foreman Town Yard Facility………………………………………………(914) 834-8325

Robert Wasp, P.E.

Town Engineer

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Town Offices……..………………………………………………(914) 381-7835

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SPECIFICATIONS FOR

HIGHWAY DEPARTMENT YARD WATER DISPOSAL

CONTRACT TA 26-01A

GENERAL:

Review all sections of the specification for provisions therein affecting the work of this section.

SCOPE OF WORK:

It is the intent of the Town of Mamaroneck to enter into a maximum of a three-year contract with a qualified organization for the acceptance of Town Highway Department’s wood, and brush yard waste. Disposal may take place multiple times per day.

It is the vendor’s responsibility to maintain compliance with all applicable approvals & permits for operation of the receiving waste transfer and disposal facility. Documentation of valid permit coverage for the vendor’s facility must be provided to the Town upon request.

A per yard rate is requested based on the information contained herein. The defined waste must be accepted daily during normal conditions and during high volume storm events.

Prospective bidders shall have seven (7) working days prior to the bid opening date to bring to the attention of the Town of Mamaroneck Town Administrator or his designee any errors or defects in these specifications which would prevent them from providing a responsive bid.

BASIS OF PAYMENT:

Work under this contract shall be paid under the unit prices shown on the fee schedule of the Form of Proposal.

All requisitions for payment shall be submitted to the Highway Department for review and approval. Requisitions shall consist of an invoice submitted on company letterhead.

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CONTRACT TA-26-01A

HIGHWAY DEPARTMENT YARD WASTE DISPOSAL

Form of Proposal (page 1 of 3)

To the Town Board of the Town of Mamaroneck Mamaroneck, NY 10543

Gentlemen/Ladies:

The undersigned as Bidder, declares that the only persons interested in this Proposal, or the Contract proposed to be made, as principals, are as stated; that he has carefully examined the Information for Bidders and the Specifications pertaining thereto; and he proposes and agrees, if this Proposal is accepted that he will enter into a Contract with the Town of Mamaroneck to provide the service called for in the Specifications in the manner and with the time prescribed for the following prices:

Schedule of Unit Prices - YEAR 2026:

Item Description & Quantity Unit Bid Cost

1. Wood Materials Disposal Acceptance and disposal of wooden yard waste, logs and brush from the Highway Department.

@_______________PER YARD

Unit Bid in Words:

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Form of Proposal (page 2 of 3)

Schedule of Unit Prices - YEAR 2027 (Town Option):

Item Description & Quantity ______________________Unit Bid Cost

1. Wood Materials Disposal and brush from the Highway Department.

@_______________PER YARD

BIDDER'S FIRM NAME:_____________________________________________________________

ADDRESS OF FIRM:________________________________________________________________

TELEPHONE:____________________________ EMAIL:___________________________________

SIGNED:________________________________ DATE:__________________________________

PRINTED:_______________________________ TITLE:__________________________________

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Form of Proposal (page 3 of 3)

Schedule of Unit Prices - YEAR 2028 (Town Option):

Item Description & Quantity ______________________Unit Bid Cost

2. Wood Materials Disposal and brush from the Highway Department.

@_______________PER YARD

BIDDER'S FIRM NAME:_____________________________________________________________

ADDRESS OF FIRM:________________________________________________________________

TELEPHONE:____________________________ EMAIL:___________________________________

SIGNED:________________________________ DATE:__________________________________

PRINTED:_______________________________ TITLE:__________________________________

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Highway Department Materials Disposal

ARTICLES OF AGREEMENT

________________________________________________________________(Name of Bidder)

_____________________________________________________________(Name of Company) hereby agrees to provide services to the Town of Mamaroneck, Westchester County, New York in accordance with the Proposal, Information for Bidders, and Specifications, which are attached to these Articles of Agreement and hereby made a part of this contract (all of which contract documents the Contractor acknowledges he has read and examined) and to accept in full payment for the services listed in the Proposal, accepted by the Town of Mamaroneck at the unit bid prices.

The Town of Mamaroneck, Westchester County, New York agrees to make payment in full for services delivered, within the time period specified, and satisfactory demonstration to appropriate Town officials and upon the Contractor’s providing the standard manufacturer’s warranty against defective materials and workmanship for a period of not less than one year after date of services.

Upon the failure of the Contractor to perform in any manner, in accordance with the Proposals, Information for Bidders and Specifications, the Town has the right to cancel this contract and in such event, the bid security shall be considered as liquidated damages and shall be forfeited to the Town.

IN WITNESS WHEREOF, the Town of Mamaroneck has caused this contract to be executed by its duly authorized officers, who, however, incur no possible liability by reason of the execution thereof or of anything herein contained, and has hereunto set his hand and seal this _________ day of ___________________, TOWN OF MAMARONECK

ATTEST: __________________________ By:___________________________ Town Clerk Town Administrator

ATTEST: __________________________ By: __________________________ Contractor

Contract # TA-26-01A

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740 WEST BOSTON POST ROAD

MAMARONECK, NY 10543

APPLICATION FOR PREQUALIFICATION

1. Name of Vendor: ______________________________________________________

Business Address: ______________________________________________________

City, State and Zip Code

2. Federal ID Number: ______________________ Telephone #: __________________

Fax #: ________________________

3. Please indicate all classes of work for which your company is experienced. Show the percentage of the amount of work performed for each class. Do not include any work subcontracted out to another company.

Trucking, Materials Transport ( %) Material Separation/Disposal ( %)

Landscaping & Beautification ( %) Other____________________( %)

If a Corporation, provide the following:

State of incorporation:______________________________________________________

President:___________________________ Number of Years:_____________________

Treasurer:___________________________ Number of Years:_____________________

Secretary:___________________________ Number of Years:_____________________

4. If a Partnership, provide the following:

Name of Partner:___________________________ Number of Years:_______________

Residence:_______________________________________________________________

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5. If a Joint Venture, provide the following for each company:

Name of Company:________________________________________________________

Address:________________________________________________________________

Name of Company:________________________________________________________

Address:________________________________________________________________

Name of Company:________________________________________________________

Address:________________________________________________________________

For Prequalification as a Joint Venture, each company must be prequalified with Town of Mamaroneck and the additional items must be submitted:

A. A notarized letter signed by an officer of each company authorizing one individual to sign all Bid Documents, Request for Proposals, Contracts, Payment Requisitions and any other related documents while conducting work for the Town.

B. A certified copy of Power of Attorney from each partnering company in the Joint Venture.

6. Other form of business organization:__________________________________________

7. Attach to this application any additional information regarding key personnel employed or associated with your firm such as resumes, letters of recommendation, a statement from a certified public accountant or any other information demonstrative to the firm’s experience, employee skills, financial capacity and managerial abilities.

List below the names of all personnel & titles for which attached supporting documents are submitted:

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8. Has your firm or any key party employed by your firm failed to complete any work awarded or has any municipality/owner ever found your firm or key party thereof to be in default?

YES / NO

If yes, provide the following:

NAME OF PROJECT:_____________________________________________________

WORK LOCATION:______________________________________________________

DESCRIPTION OF WORK:________________________________________________

OWNER:_______________________________________________________________

OWNER’S REP.:________________________ TELEPHONE #:___________________

ARCH./ENG’R:_________________________ TELEPHONE #:___________________

CONTRACT AMOUNT:___________________________________________________

START DATE:_________________________ COMP. DATE:____________________

Reasons for failure to complete work or contract default:

(Attach additional sheets if necessary)

9. For the past five years, list below any of the following:

A. Any litigation in which your firm, or any partner or employee was a defendant.

B. Any civil, criminal or administrative proceedings involving public contracts, safety or environmental laws or regulations including those of OSHA, NYSDOT, NYSDEC, EPA, DEP or any other similar agency of any state.

C. Any civil, criminal or administrative proceedings involving payment of minimum wage, prevailing wages, affirmative action or equal opportunity for any municipality, county or state which you have performed work.

D. Any deaths or injuries that occurred in connection with any project your firm or employee of your firm has undertaken.

E. Any municipal code violations or citations for traffic law infractions for which your firm or any party employed by your firm has received in connection with the course of work.

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F. Any projects for which there have been liens placed upon. State all relevant information included dollar amount of lien and all parties associated with the lien.

(Attach additional sheets if necessary)

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Contract # TA-26-01A

PREQUALIFICATION FORM AFFIRMATION

The Town of Mamaroneck reserves the right to request at any time, additional information regarding the Applicant’s experience, manpower, equipment, safety records, procedures, both financial and bonding capacity, completed projects, work currently under contract, and any information pertinent to the Applicant’s skill, ability and integrity to perform work for the Town.

The undersigned, on behalf of the Applicant, hereby certifies that the foregoing information is true and complete. The undersigned further certifies that he or she is authorized to sign this affirmation on behalf of the Applicant.

Dated this _________________ day of _________________, 20______.

Name of Applicant / Bidder

By ___________________________________

Title__________________________________

State of ________________________)

County of ______________________)

_______________________________________________being duly sworn deposes and says that he or she is ___________________________________of____________________________

(Name of Organization) and that the foregoing questions and all statements and information provided therein contained are true and correct.

Subscribed and sworn to before me this ________ day of _________________ , 20_____.

(Notary Public)

My commission expires ________________, 20_____.

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NON COLLUSION AFFIDAVIT

This Affidavit must be completed, notarized and included in your bid proposal submission. Failure to do so will result in the rejection of your bid proposal. A separate Affidavit must be submitted by each principal of any joint venture.

PROJECT: Town of Mamaroneck – 2026&2027 Highway Department Materials Disposal, Contract TA-26-01A

I, __________________________________, acting on behalf of (Name of Person)

(Person, Company, Corporation, Firm or Organization)

Of which I am _____________________________________, submitting a bid request for proposal (Title of Person) f\or the abovementioned project certify and affirm that

(Person, Company, Corporation, Firm or Organization) has neither directly or indirectly entered into any agreements, conferred with any other vendor(s) or participated in any “collusion” or otherwise taken any action to compromise the process of open competitive bidding in connection with the aforementioned project. False statements made herein may be subject to any criminal prosecution and disbarment from bidding future Town projects.

Name of Company or Firm

Signature and Title of Official Making Affidavit

Subscribed and sworn to before me this ________ day of _________________, 20_____.

(Notary Public)

My commission expires ________________, 20_____.

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Minimum Insurance Requirements for Town of Mamaroneck

Contractors

Prior to commencement of any work under this Contract and until completion and final acceptance of the work, the Contractor/Provider shall, at its sole expense, maintain the following insurance on its own behalf, and furnish to the Town of Mamaroneck certificates of insurance evidencing same and reflecting the effective date of such coverage as follows:

The term “Contractor/Provider” as used in this indemnification agreement shall mean and include Subcontractors of every tier.

1) Commercial General Liability Policy, with limits of no less than $1,000,000 Each Occurrence/$2,000,000 Aggregate limits for Bodily Injury and Property Damage, and shall include coverage for:

A. Premises & Operations B. Products/Completed Operations;

C. Independent Contractors;

D. Personal & Advertising Injury E. Blanket Contractual Liability

F. XCU

G. Town of Mamaroneck and their assigns, officers, employees, representatives and agents should be named as an “Additional Insured” on the policy using ISO Additional Insured Endorsement CG 20 10 11/85 or an endorsement providing equivalent or broader coverage and shall apply on a primary and non-contributory basis, including any self-insured retentions. The Certificate of Insurance should show this applies to the General Liability coverage on the certificate, and Additional Insured Endorsement shall be attached.

H. To the extent permitted by New York law, the Contractor/Provider waives all rights of subrogation or similar rights against Town of Mamaroneck, assigns, officers, employees, representatives and agents.

I. General Aggregate shall apply separately to each project (must be on an occurrence form).

J. Cross Liability coverage (Commercial General Liability and Business Automobile Liability policies only).

K. General Liability policy must NOT contain any coverage exclusions or restrictions related to the scope of work being performed as well as injuries to employees, subcontractors, or employees of subcontractors (i.e. labor law).

L. Products/Completed Operations: coverage to remain in force for (2) years following completion of the project.

2) Worker’s Compensation and Employers Liability Policy, covering operations in New York State. Evidence must be provided on a C-105.2. Waiver of Subrogation to be included in favor of the Town of Mamaroneck.

3) N.Y.S. Disability, covering all employees. Evidence must be provided on a DB 120.1.

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4) Comprehensive Automobile Policy, with limits no less than $1,000,000 Bodily Injury and Property Damage liability including coverage for owned, non-owned, and hired private passenger and commercial vehicles.

A. Town of Mamaroneck and their assigns, officers, employees, representatives and agents should be named as an “Additional Insured” on the policy on a primary, non-contributory basis. The Certificate of Insurance should show this applies to the Automobile Liability coverage on the certificate, and Additional Insured Endorsement shall be attached.

B. To the extent permitted by New York law, the Contractor/Provider waives all rights of subrogation or similar rights against the Town of Mamaroneck, assigns, officers, employees, representatives and agents.

C. If motor vehicles are used for transporting hazardous materials, the Contractor shall Provide pollution liability broadened coverage (ISO endorsement CA 9948) as well as proof of MCS 90.

5) Umbrella Liability, with limits of no less than $5,000,000 Each Occurrence/$5,000,000 Aggregate, including coverage for General Liability, Automobile, and Workers Compensation and Professional Liability (if applicable) & Pollution Liability (if applicable). Waiver of Subrogation to be included in favor of the Town of Mamaroneck.

Coverage for the additional insured, the Town of Mamaroneck, shall apply on a primary and non-contributory basis, including any self- insured retentions.

6) Contractors Pollution Liability (if applicable), with limits of no less than $2,000,000 Per Claim / $2,000,000 Aggregate. Contractor shall maintain and cause its Subcontractors doing such work to maintain Contractors Pollution Liability Insurance including coverage for third-party liability claims covering any environmental claims, liabilities, loss or damage, including property damage, bodily injury, disease, transporter liability and properties contaminated during transportation caused by pollution conditions that arise from the operations of the Contractor and its Subcontractors of every tier. Such insurance shall provide coverage for actual, alleged or threatened emission, discharge, dispersal, seepage, release or escape of pollutants (including asbestos), including any loss, cost or expense incurred as a result of any cleanup of pollutants (including asbestos), or in the investigation, settlement or defense of any claim, action, or proceedings arising from the operations under the Contract. Such insurance shall be in the Contractor’s name and name the Town of Mamaroneck as an additional insured on a primary, non-contributory basis including a Waiver of Subrogation in favor of the Town of Mamaroneck. Additional Insured coverage shall be at least as broad as provided to the Contractor for this Project. If such insurance is written on a claims-made policy, such policy shall have a retroactive date on or before the effective date of this Contract, and continuous coverage shall be maintained, or an extended discovery period exercised, for a period of not less than three (3) years from the time the Work under this Contract is completed.

7) Owners & Contractors Protective Liability: $2,000,000 Per Occurrence / $2,000,000 Aggregate with the Town of Mamaroneck as the named insured, and maintained during the life of this contract which will protect the Town of Mamaroneck from claims for damages for personal injury, liability, accidental or wrongful death, as well as property damage which may arise from operations under this contract whether such operations be

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by himself or by any subcontractor or by anyone directly or indirectly employed by either party.

8) Certificates shall provide that thirty (30) days written notice prior to cancellation or expiration be given to the Town of Mamaroneck. Policies that lapse and/or expire during term of work shall be recertified and received by the Town of Mamaroneck no less than thirty (30) days prior to expiration or cancellation.

The Contractor/Provider shall furnish to the Town of Mamaroneck Certificates of Insurance as evidence of coverage prior to commencement of work and naming the Town of Mamaroneck as an Additional Insured by endorsement. The Contractor/Provider acknowledges that failure to obtain such insurance on behalf of the Town of Mamaroneck Constitutes a material breach of contract and subjects it to liability for damages, indemnification and all other legal remedies available to the Town of Mamaroneck. The failure of the Town of Mamaroneck to object to the contents of the certificate or absence of same shall not be deemed a waiver of any and all rights held by the Town of Mamaroneck.

The cost of furnishing the above insurance shall be borne by the Contractor/Provider, there will be no direct payment for this work. Cost will be deemed to have been included in the price bid for all scheduled items.

All carriers listed in the certificates of insurance shall be A.M. Best Rated A VII or better and be licensed in the State of New York.

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Indemnification and Hold Harmless Agreement

To the fullest extent permitted by law, Contractor/Subcontractor will indemnify and hold harmless the Town of Mamaroneck, it’s officers, representatives, agents and employees from and against any and all claims, suits, liens, judgments, damages, losses and expenses, including reasonable legal fees and all court costs and liability (including statutory liability) arising in whole or in part and in any manner from injury and/or death of person or damage to or loss of any property resulting from the acts, omissions, breach or default of Contractor/Subcontractor, it’s officers, directors, agents, employees and subcontractors, in connection with the performance of any work by or for Contractor/Subcontractor pursuant to any contract, Purchase Order and/or related Proceed Order. Contractor/Subcontractor will defend and bear all costs of defending any actions or proceedings brought against the Town of Mamaroneck, their officers, representatives, agents and employees, arising in any employee of the Contractor/Subcontractor and shall not be limited in any way by an amount or type of damage, compensations, or benefits payable under any applicable workers’ compensation, disability benefits or other similar employees benefit act.

The Contractor/Subcontractor hereby expressly permits the Town of Mamaroneck to pursue and assert claims against the Contractor/Subcontractor for indemnity, contribution and common law negligence arising out of claims for damages for death and personal injury.

Company Title/Name: _________________________________________________________

Name: _______________________________ Signature: _____________________________

Date: ________________________________

Nature/Scope of Work Being Performed: ___________________________________________

Please sign, date and return to:

Town of Mamaroneck Town Center – 740 West Boston Post Road

Mamaroneck, NY 10543