SWAN_ANALYTICAL_SOLE_SOURCE_PACKET.pdf

SINGLE SOURCE

CERTIFICATE OF CONDITIONS AND CIRCUMSTANCES

Instructions: The purpose of this form is to certify conditions and circumstances for the purchase of goods and services under the single source exception to the competitive bid process. This request is to be executed by the Department Director and submitted to the Purchasing Department for consideration and approval/disapproval.

Item or Services Required:

Name of Company considered Single Source:

Conditions and special circumstances for the Single Source. Please be specific:

Requesting Department Director’s Signature Date of Request

Requisition Number Buyer Name Purchasing Department Action:

Signature Date

Quotation/Documentation attached

Original to Purchasing

Copy to Mayor’s Office by Requesting Department

ANALYTICAL INSTRUMENTS

www.swan-analytical-usa.com · SWAN ANALYTICAL USA INC. · WHEELING, IL 60090 · PHONE 847 229 1290 · FAX 847 229 1320

July 14, 2025

To Whom it may concern, Swan Analytical USA is the sole manufacturer of its products. All Swan Analytical USA products are manufactured by Swan Analytical USA.

Swan Analytical USA is the sole source in the state of Florida. No other representatives in Florida can sell Swan products, OEM repair/replace parts, maintenance, repair/replace service, field service and technical support for Swan Analytical USA.

If you have questions regarding this issue, please contact the office at 847-229-1290 or Shaun Sharrett directly at 262-880-8995.

Sincerely, Shaun Sharrett VP of Sales Swan Analytical USA 390 Holbrook Drive Wheeling, IL 60090

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

ACCORDANCE WITH THE POLICY PROVISIONS.

INSURER(S) AFFORDING COVERAGE

INSURER F :

INSURER E :

INSURER D :

INSURER C :

INSURER B :

INSURER A :

NAIC #

NAME:

CONTACT

(A/C, No):

FAX

E-MAIL

ADDRESS:

PRODUCER

(A/C, No, Ext):

PHONE

INSURED

REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES

IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.

If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).

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.

OTHER:

(Per accident)

(Ea accident)

N / A

SUBR

WVD

ADDL

INSD

THIS IS TO CERTIFY THAT THE 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 CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.

$PROPERTY DAMAGE

BODILY INJURY (Per accident)

BODILY INJURY (Per person)

COMBINED SINGLE LIMIT

AUTOS ONLY

AUTOSAUTOS ONLY

NON-OWNED

SCHEDULEDOWNED

ANY AUTO

AUTOMOBILE LIABILITY

Y / N

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY

OFFICER/MEMBER EXCLUDED?

(Mandatory in NH)

DESCRIPTION OF OPERATIONS below If yes, describe under

ANY PROPRIETOR/PARTNER/EXECUTIVE

E.L. DISEASE - POLICY LIMIT

E.L. DISEASE - EA EMPLOYEE

E.L. EACH ACCIDENT

ER

OTH-

STATUTE

PER

LIMITS(MM/DD/YYYY)

POLICY EXP

(MM/DD/YYYY)

POLICY EFF

POLICY NUMBERTYPE OF INSURANCELTR

INSR

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

EXCESS LIAB

UMBRELLA LIAB $EACH OCCURRENCE

$AGGREGATE

OCCUR

CLAIMS-MADE

DED RETENTION $

$PRODUCTS - COMP/OP AGG

$GENERAL AGGREGATE

$PERSONAL & ADV INJURY

$MED EXP (Any one person)

$EACH OCCURRENCE

DAMAGE TO RENTED

$PREMISES (Ea occurrence)

COMMERCIAL GENERAL LIABILITY

CLAIMS-MADE OCCUR

GEN'L AGGREGATE LIMIT APPLIES PER:

POLICY

PRO-

JECT LOC

CERTIFICATE OF LIABILITY INSURANCE

DATE (MM/DD/YYYY)

CANCELLATION

AUTHORIZED REPRESENTATIVE

ACORD 25 (2016/03)

© 1988-2015 ACORD CORPORATION. All rights reserved.

CERTIFICATE HOLDER

The ACORD name and logo are registered marks of ACORD

HIRED

AUTOS ONLY

1/16/2025

AssuredPartners of Illinois, LLC 4350 Weaver Pkwy Warrenville IL 60555

Certificate Team 630-355-2077 630-355-7996 certs.apil@assuredpartners.com

XL Insurance America, Inc. 24554 SWANANA-01 Hartford Accident and Indemnity Company 22357

Swan Analytical USA, Inc.

390 Holbrook Drive Wheeling IL 60090

Hartford Underwriters Insurance Company 30104

1442290243

A X 1,000,000 X 100,000

5,000

1,000,000

2,000,000 X

US00136349LI24A 1/1/2025 1/1/2026

2,000,000

B 1,000,000

X

X X

83UECAA5990 11/30/2024 11/30/2025

A X 10,000,000 X

US00136349LI24A 1/1/2025 1/1/2026

10,000,000 X N/A

C X

N

83WECBU0053 10/26/2024 10/26/2025

1,000,000

1,000,000

1,000,000

Excess Liability Limits: This liability insurance forms part of a global program of insurance for which XL Insurance Company SE, London, Zurich Branch, has issued a Master policy covering the above insured and its group of companies as follows: Policy ref. (US00136349LI24A) Effective (01/01/25-01/01/26). Master policy limit is at least USD 10 million. Conversion Rate will be stated if applicable.

City of Tampa 7125 N. 30th Street Tampa FL 33610

12 month cost estimate ___$25K________SW