02-28-2007 HUCMRegular Meeting
February 28, 2007
Members present: President Donald Walser; Secretary Dwight Bordson; Commissioner
Craig Lenz; Commissioner Robert Hantge; General Manager Michael Kumm; Attorney
Marc Sebora.
Member absent: Vice President David Wetterling
President Walser called the meeting to order at 3:00 pm.
Commissioner Hantge made a motion to approve the minutes of the January 31, 2007
Regular Meeting. Secretary Bordson seconded the motion and it passed unanimously.
Commissioner Lenz made a motion to ratify the payment of bills in the amount of
$3,971,932.53 (detailed listing in payable book). Secretary Bordson seconded the
motion and it passed unanimously.
GM Kumm discussed the plans for developing an investment policy for HUC funds.
Commissioner Lenz made a motion to approve financial statements/budget year to
date. Secretary Bordson seconded the motion and it passed unanimously.
GM Kumm presented R. W. Becks Feasibility Study for the biomass project.
Commissioner Hantge reported on the decision of the committee that met on February
22, 2007. Its the consensus of the committee to approve Task 1: Characterize Biomass
Feedstocks. After discussion Commissioner Hantge made a motion to approve engineer
Agreement with R. W. Beck to conduct feasibility study for biomass project (tabled from
January 31, 2007), task 1 at a cost estimate of $3,250. Commissioner Lenz seconded
the motion and it passed unanimously.
Brenda Ewing presented the job evaluation and compensation study. Five firms
submitted proposals. Based on cost, timeline and experience, it is the recommendation
of staff to award the study to Laumeyer and Associates. Commissioner Lenz made a
motion to award job evaluation and compensation study to Laumeyer and Associates.
Secretary Bordson seconded the motion and it passed unanimously.
Dan Lang presented the capacity sale contract. We have 20 megawatts for sale in 2007
and Xcel has entered into a contract with us to buy that capacity. Commissioner Lenz
made a motion to approve capacity sale contract. Secretary Bordson seconded the
motion and it passed unanimously.
GM presented the contract with Medica Insurance Company. The contract has been
approved; asking for authorization to sign it. Commissioner Hantge made a motion
authorizing staff to sign and approve contract with Medica Insurance Company.
Commissioner Lenz seconded the motion and it passed unanimously.
Jan Sifferath presented the contract with Cintas. They supply uniforms with OSHA
required fire retardant material. They also launder the uniforms according to OSHA
standards. Two other suppliers were contacted to submit bids but neither returned
phone calls or proposals. This will be a 5-year contract with Cintas. Commissioner Lenz
made a motion to approve contract with Cintas. Commissioner Hantge seconded the
motion and it passed unanimously.
Commissioner Hantge made a motion to approve requisition #002448 to Arjay
Automation for an electric meter tester. Secretary Bordson seconded the motion and it
passed unanimously.
Commissioner Lenz made a motion to approve requisition #002464 to Crysteel Truck
Equipment for utility/service body. Secretary Bordson seconded the motion and it
passed unanimously.
Secretary Bordson made a motion to approve requisition #002466 to GE Aeroderivative
& Package Services for generator inspection and trim balance. Commissioner Lenz
seconded the motion and it passed unanimously.
GM Kumm discussed the organization of Municipal Gas Agency. At the March meeting
representatives from MMUA will be here to discuss the value of this joint action agency.
Division reports
Business Jan Sifferath
Rebate program starts March 1, 2007
HUC had a spot at the Home & Garden Show
Jon Guthmiller attended a CIP seminar to qualify for home energy audits-
part 1. Part 2 will be in May.
Inventory is moving along software installed and tested
Electric Steve Lancaster
New lineman starts next Monday
nd
Held the 2 annual safety & trade show huge success
Will meet with city personnel regarding the architect for downtown plant
Gas John Webster
Offer of employment extended today for gas welder/serviceperson
Contractor damaged gas line litigation possible
GM Kumm handed out a comparison of monthly residential bills 800 KWH. Of eleven
communities, Hutchinson falls in the middle.
Legal report
None
Old Business
Discussed budget payment plans for commercial customers. No action was
taken.
President Walser appointed David Wetterling and Dwight Bordson to serve as
committee members for labor relation negotiations.
Jan Sifferath mentioned the CIP duplications report.
New Business
Discussed MAPP splitting because of reliability actions and the possibility of
MAPP being absolved eventually.
Secretary Bordson made a motion to adjourn the meeting at 4:14 p.m. Commissioner
Hantge seconded the motion and it passed unanimously.
_________________________________
Dwight Bordson, Secretary
ATTEST________________________________
Donald Walser, President
(D3
Regular Meeting
February 28, 2007
Members present: President Donald Walser; Secretary Dwight Bordson; Commissioner
Craig Lenz; Commissioner Robert Hantge; General Manager Michael Kumm; Attorney
Marc Sebora.
Member absent: Vice President David Wetterling
President Walser called the meeting to order at 3:00 pm.
Commissioner Hantge made a motion to approve the minutes of the January 31, 2007
Regular Meeting. Secretary Bordson seconded the motion and it passed unanimously.
Commissioner Lenz made a motion to ratify the payment of bills in the amount of
$3,971,932.53 (detailed listing in payable book). Secretary Bordson seconded the
motion and it passed unanimously.
GM Kumm discussed the plans for developing an investment policy for HUC funds.
Commissioner Lenz made a motion to approve financial statements /budget year to
date. Secretary Bordson seconded the motion and it passed unanimously.
GM Kumm presented R. W. Beck's Feasibility Study for the biomass project.
Commissioner Hantge reported on the decision of the committee that met on February
22, 2007. It's the consensus of the committee to approve Task 1: Characterize Biomass
Feedstocks. After discussion Commissioner Hantge made a motion to approve engineer
Agreement with R. W. Beck to conduct feasibility study for biomass project (tabled from
January 31, 2007), task 1 at a cost estimate of $3,250. Commissioner Lenz seconded
the motion and it passed unanimously.
Brenda Ewing presented the job evaluation and compensation study. Five firms
submitted proposals. Based on cost, timeline and experience, it is the recommendation
of staff to award the study to Laumeyer and Associates. Commissioner Lenz made a
motion to award job evaluation and compensation study to Laumeyer and Associates.
Secretary Bordson seconded the motion and it passed unanimously.
Dan Lang presented the capacity sale contract. We have 20 megawatts for sale in 2007
and Xcel has entered into a contract with us to buy that capacity. Commissioner Lenz
made a motion to approve capacity sale contract. Secretary Bordson seconded the
motion and it passed unanimously.
GM presented the contract with Medica Insurance Company. The contract has been
approved; asking for authorization to sign it. Commissioner Hantge made a motion
authorizing staff to sign and approve contract with Medica Insurance Company.
Commissioner Lenz seconded the motion and it passed unanimously.
24
Jan Sifferath presented the contract with Cintas. They supply uniforms with OSHA
required fire retardant material. They also launder the uniforms according to OSHA
standards. Two other suppliers were contacted to submit bids but neither returned
phone calls or proposals. This will be a 5 -year contract with Cintas. Commissioner Lenz
made a motion to approve contract with Cintas. Commissioner Hantge seconded the
motion and it passed unanimously.
Commissioner Hantge made a motion to approve requisition #002448 to Arjay
Automation for an electric meter tester. Secretary Bordson seconded the motion and it
passed unanimously.
Commissioner Lenz made a motion to approve requisition #002464 to Crysteel Truck
Equipment for utility /service body. Secretary Bordson seconded the motion and it
passed unanimously.
Secretary Bordson made a motion to approve requisition #002466 to GE Aeroderivative
& Package Services for generator inspection and trim balance. Commissioner Lenz
seconded the motion and it passed unanimously.
GM Kumm discussed the organization of Municipal Gas Agency. At the March meeting
representatives from MMUA will be here to discuss the value of this joint action agency.
Division reports
Business — Jan Sifferath
• Rebate program starts March 1, 2007
• HUC had a spot at the Home & Garden Show
• Jon Guthmiller attended a CIP seminar to qualify for home energy audits -
part 1. Part 2 will be in May.
• Inventory is moving along — software installed and tested
Electric — Steve Lancaster
• New lineman starts next Monday
• Held the 2nd annual safety & trade show — huge success
• Will meet with city personnel regarding the architect for downtown plant
Gas — John Webster
• Offer of employment extended today for gas welder /serviceperson
• Contractor damaged gas line — litigation possible
GM Kumm handed out a comparison of monthly residential bills — 800 KWH. Of eleven
communities, Hutchinson falls in the middle.
Legal report
None
Old Business
Discussed budget payment plans for commercial customers. No action was
taken.
President Walser appointed David Wetterling and Dwight Bordson to serve as
committee members for labor relation negotiations.
Jan Sifferath mentioned the CIP duplications report.
New Business
Discussed MAPP splitting because of reliability actions and the possibility of
MAPP being absolved eventually.
Secretary Bordson made a motion to adjourn the meeting at 4:14 p.m. Commissioner
Hantge seconded the motion and it passed unanimously.
ATTEST
Donald Walser, resident
II
/.1.: Ed Me'.
:v • •
0-s-
CITY OF HUTCHINSON, MN
BIOMASS ENERGY PROJECT
A. Project Feasibility Review
The role of R. W. Beck, Inc. (the Consultant) during the feasibility review is to perform a preliminary
assessment of the potential of the City of Hutchinson's biomass energy recovery project (the Project).
The goal of the review is to determine the potential inputs, outputs, appropriate technologies and
conceptual level costs and benefits of converting the City's biosolids and compost biomass into a
recoverable energy product. The review will also recommend whether or not to proceed further with
regard to developing the Project. The Project is to be located in Hutchinson, Minnesota and is sponsored
by Hutchinson Utilities (HU) with the goal of ultimately producing electric power for the benefit of HU.
and it's customers.
The tasks of the review are to identify the likely biomass inputs including but not limited to the City's
treatment plant biosolids and biomass currently processed at the City's Composting Facility; identify and
describe appropriate conversion technologies; estimate the potential costs for development, construction
and operation of an energy recovery facility; and provide a recommendation on the Project's technical
and economic viability. This review is not intended to be at a level of detail sufficient for Project
financing. An additional, more in -depth review would be required for this, as described in the Additional
Services section of this Scope of Services.
The Consultant will review the principal technical elements of the Project to identify issues presenting
notable risk to Project viability. This may include proposing an approach to address those issues which
are within the Consultant's area of expertise and working with HU (the Client) to help resolve each issue.
In general, the Consultant will work closely with HU staff to quantify and characterize the biomass
inputs and understand the power generation goals and constraints. This Scope of Services does not
include any assessment, evaluation, review, testing, or discussion of facility security issues, including but
not limited to protection from terrorist acts, that may impact Client's facilities, systems, or human life or
those of other entities with which the Client has business or operational relations.
Task 1: Characterize Biomass Feedstocks
The Consultant will perform a high level review of the Hutchinson WWTP biosolids production to
characterize both fuel value and quantities. The acceptance and availability of compost biomass will also
be characterized with regard to the City's internal quantities and expected receipts from external sources
including the Minneapolis /St. Paul metro area. The goal will be to provide a combined estimate of
annual feedstock quantity and fuel value for input to the Project.
Task 1 Cost Estimate: $3,250
Task 2: Review Energy Conversion Technologies
The Consultant will review the principal elements of both traditional and new processes associated with
generating power from solid biomass fuels. The objective of the assessment is to provide a preliminary
screening of appropriate technologies such as direct combustion, gasification and anaerobic digestion.
Screening criteria will include potential environmental impacts, past commercial success, reference
projects and vendor business qualifications as demonstrated by number of projects and references. With
input from the HU staff, RWB will provide a recommendation for further consideration of the most
promising technology. The Consultant will characterize the principal technology - related risks,
City of Hutchinson, MN
CITY OF HUTCHINSON, MN BIOMASS ENERGY PROJECT
concentrating on an evaluation of the extent of the Project's commercial operating experience,
technology and O &M considerations, and fuel- specific issues.
Task 2 Cost Estimate: $9,080
Task 3: Estimate Conceptual Project Costs
The Consultant will conduct a broad review of the Project's conceptual costs based on those of similar
type projects and information submitted through technology vendors and reference projects. A
conceptual pro forma spreadsheet will be prepared indicating the projects capital and O &M costs with
potential revenue from the generation of electric power as directed by HU staff. The Consultant will
provide a discussion of the reasonableness of the Project financial feasibility, as reflected in a conceptual
Project pro forma. Project siting, interconnection, permitting, contract issues and externalities will be
outside the scope of this review.
Task 3 Cost Estimate: $4,220
Task 4: Risk Discussion Summary
Dependent upon available information and the time allotted, the Consultant will provide a discussion of
the principal risks of the Project including technology, fuel supply, capital and O &M cost uncertainty,
etc.
Task 4 Cost Estimate: $2,880
Task 5: Recommendations
Based on the technical and financial analyses described above, the Consultant will provide the Client
with recommendations regarding further consideration of the Project, if warranted. The
recommendations will include a list of items requiring more detailed evaluation including technical,
operational, environmental, and financial considerations.
Task 5 Cost Estimate: $2,880
Note that the suggested Task cost estimates assume a maximum of two meetings with HU staff.
B. Services Furnished by Client
The Client will assist the Consultant in obtaining the following, as applicable:
• Identification of and access to the Project participants' biomass quantity and characterizations as
available.
• Copies of engineering information related to the Project.
• Assistance as required to ascertain HU goals, limitations and preferences regarding the Project.
C. Additional Services Available from the Lender's Consultant
The services under this section are in addition to the typical services provided by the Consultant in a
preliminary project feasibility study as described in Section A. Such services will be provided at the
request of the Client. At the time of a request by the Client for additional services, the Consultant will
provide a time and cost estimate to complete the requested services.
City of Hutchinson, MN
%5�
CITY OF HUTCHINSON, MN BIOMASS ENERGY PROJECT
Perform Project Technical Review (Phase I Services)
The Consultant, during the technical due diligence review of the Project, will evaluate the principal
aspects of the Project's engineering design, cost and scheduling estimates and the technical provisions in
the principal Project contracts and permits. Areport will be prepared summarizing the review's findings.
Perform Construction Monitoring (Phase II Services)
The Consultant, during the engineering, procurement and construction phase of the Project, will review
the execution of the EPC Contract and report to the Client on the construction progress of the Project.
Perform Start -Up and Testing (Phase III Services)
The Consultant, during the start-up and performance testing phase of the Project, will provide an
independent assessment of:
■ The degree of satisfaction of the performance guarantees specified in the EPC Contract.
• The initial operation of the Project.
• Substantial completion.
• The completion of the EPC Contract.
Provide Commercial Operation Monitoring (Phase IV Services)
The Consultant, during general commercial operation, will monitor the overall operation and
maintenance (O &M) of the Project for the purpose of assessing its ongoing capability to meet its future
debt - service obligations.
D. Limits of Authority
The Consultant's comments, opinions and recommendations are solely in connection with its duties as a
consultant to the Client. The overall responsibility for design and construction of the Project rests with
the contractor, and the Consultant is not responsible for the acts or omissions of the Client or any
contractor. Employees of the Consultant will not:
• Undertake any of the responsibilities of the Client, contractor, subcontractor or of the contractor's
superintendent.
• Expedite work for the Client nor Contractor, unless the Client requests and reimburses the Lender's
Consultant for costs associated with specific expediting functions.
• Advise the Client nor contractor on, nor issue directions as to, safety precautions and programs in
connection with the work.
R. W. Beck, Inc. 3
IMemorandum
TO: Hutchinson Utilities Commission
FROM: Brenda Ewing, Human Resources Director
RE: Recommendation for Consultant for Job Evaluation and Compensation System
DATE: February 23, 2007
Per Commission approval, Hutchinson Utilities solicited proposals from a number of consultants
for job evaluations and a compensation system. A total of five proposals were received.
Attached is a matrix indicating the components of the job evaluation and compensation study
project and the consultants' ability to meet the various requirements.
From the information on the matrix, all of the proposals received appear to meet the general
requirements. In regards to cost and project timelines, Employers Association Inc. (EA),
Laumeyer and Associates (LA), and Riley, Dettmann & Kelsey (RDK) are the firms that are
closest to meeting our requirements. It should, however, be noted that the EA Option A and
RDK proposals do not include employee interviews, and the lowest cost alternative is Laumeyer
and Associates.
Each of these three consulting firms has completed work for municipalities and/or utilities and
have favorable references noted. The City of Hutchinson did employ the services of Laumeyer
and Associates for our most recent job evaluation and compensation system project in 2005.
It is requested that you consider these proposals your meeting of February 28, 2007. Based on
project cost and timelines, it is the recommendation of staff to accept the proposal from
Laumeyer and Associates.
If you have any questions regarding this information, I will be in attendance at the meeting.
Encl.
cc: Mike Kumm, General Manager
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1
CONFIRMATION AGREEMENT
This Confirmation Agreement ( "Agreement ") shall confirm the agreement reached on
2007, by and between Northern States Power Company ( "NSP ") and Hutchinson Utilities
Commission ( "HUC "), hereinafter NSP and HUC are sometimes referred to singly as "Party" and
collectively as "Parties ", with respect to the purchase of Capacity and associated Energy under the
terms and conditions as follows:
Seller: HUC
Buyer: NSP
Governing Agreement: Mid - Continent Energy Marketers Association ( "MEMA ") Capacity and
Energy Tariff, effective December 2, 2003 (for energy supply
arrangements) and the Midwest Independent System Operator ("MISO-)
Transmission and Energy Markets Tariff ("TEMT'), effective March 1,
2005 (for delivery arrangements).
Contract Term: June 1, 2007 through August 31, 2007
Commodity: Deliverable MISO Capacity per MISO TEMT Module E with a Day Ahead
Call on Energy, settled with MISO at the applicable Day -Ahead Locational
Marginal Price ( "LMP ").
Contract Quantity: 20 MW. The Contract Quantity of capacity is as listed, without reserves.
Designated
Network Resource: The Designated Network Resource ( "dNR') shall be GRE.HUTGREI
Delivery Point: GRE.HUTGRE L The Parties may use an alternate delivery point for energy,
by mutual agreement.
Capacity Price: $2.25 per kW per month. Total capacity charges for the term of this
Agreement are $135,000.
Energy Scheduling: All schedules for energy under this Agreement shall be made in the MISO
Day Ahead Energy Market. When energy is requested by NSP, the Parties
shall arrange a Financial Bilateral Transaction at the Delivery Point using
standard MISO Day Ahead scheduling practices.
Energy Pricing: Energy shall be priced at the MISO Day Ahead nodal price determined at the
Delivery Point plus $100.00 per MWh. The Parties may also develop
alternate Energy Scheduling and Pricing by mutual agreement.
Offering of dNR: Seller shall comply with the MISO TEMT when offering the dNR into the
MISO Energy Market, subject to dNR availability. The Seller, prior to any
applicable MISO scheduling deadline, shall submit dNR offer curves to the
MISO or self - schedule the dNR for operation.
Transmission and Losses: NSP shall be responsible for any and all applicable charges MISO
may assess at the Delivery Point or at any agreed upon alternate
delivery point associated with delivery of energy under this
Agreement.
Conditions Precedent: This Agreement is contingent upon the Commodity purchased and
sold hereunder being approved as Accredited Capacity in accordance
with MAPP procedures governing the accreditation of capacity.
The Parties will be responsible for submitting all necessary
documentation to MAPP for accreditation. If for any reason any of
the Conditions Precedents are not satisfied before April 1, 2007 then
this Agreement, in its entirety, shall automatically terminate as to the
Parties' commitments hereunder without liability of either Party.
Each Party agrees to use commercially reasonable efforts to cause the
Conditions Precedent to be satisfied.
The terms and conditions and the rates for service specified in this Agreement shall remain in effect
for the term of the transaction described herein. Absent the Parties' written agreement, this
Agreement shall not be subject to change by application of either Party pursuant to Section 205 or
206 of the Federal Power Act. Absent the agreement of both Parties to the proposed change, the
standard of review for changes to this Agreement whether proposed by a Party, a non -party or the
Federal Energy Regulatory Commission acting sua sponte shall be the "public interest" standard of
review set forth in United Gas Pipe Line v. Mobile Gas Service Corp., 350 U.S. 332 (1956) and
Federal Power Commission v. Sierra Pacific Power Co., 350 U.S. 348 (1956) (the "Mobile- Sierra
doctrine ").
Each Party acknowledges that the other Party's responsibilities and obligations under the Governing
Agreement and any Confirmation Agreement are those of that Party's merchant function, not of its
transmission function, and that neither this Governing Agreement nor any Confirmation Agreement
imposes any responsibilities or obligations on the other Party's transmission function.
NORTHERN STATES POWER COMPANY
By: Date:
Name: Todd Hegwer
Title: Director, Origination, Xcel Energy Services Inc. as agent for
Northern States Power Company
HUTC ON UTII (TIES COMMIIS�SION
By: Date:' 2 0
Name: Donald Wals r
Title: President
HUTCHINSON UTILITIES COMMISSION
By: �< ,/ Date: Z zel Y?
Name: Mike Kumm
Title: General Manager
MEDICA INSURANCE COMPANY ( "MIC")
PLAN
MASTER GROUP CONTRACT
Employer Name: Hutchinson Utilities
Employer Group #: 48963
Effective Date: January 1, 2007
Contract #: MIC300 -15 BPL #: 76003
Amendment(s) #: Amendments attached is applicable for benefit package log (BPL) as listed
above.
ARTICLE 1
INTRODUCTION
This Master Group Contract ( "Contract ") is entered into by and between Medica Insurance
Company ( "MIC ") and the employer group named above ( "Employer "), an employer under
Minnesota law and other applicable law. This Contract includes the Eligibility Appendix, the
Enrollment Appendix, the Certificate of Coverage ( "Certificate ") and any Amendments. This
Contract is delivered in the state of Minnesota.
If this Contract is purchased by Employer to provide benefits under an employee welfare benefit
plan governed by the Employee Retirement Income Security Act, 29 U.S.C. 1001, et seq.
("ERISA"), this Contract is governed by ERISA and, to the extent state law applies, the laws of
the State of Minnesota. If this Contract is not governed by ERISA, it is governed by the laws of
the State of Minnesota. If this Contract is governed by ERISA, any legal action arising out of or
relating to this Contract shall be brought in the federal district court for the district of Minnesota.
If this Contract is not governed by ERISA, any legal action arising out of or relating to this
Contract shall be brought in state court in Hennepin County, Minnesota.
In consideration of payment of the Premiums by the Employer and payment of Copayments and
Coinsurance by or for Members, MIC will provide coverage for the Benefits set forth in the
Certificate and any amendments, subject to all terms and conditions, including limitations and
exclusions, in this Contract.
This Contract replaces and supersedes any previous agreements between Employer and MIC
relating to Benefits.
MIC shall not be deemed or construed to be an employer for any purpose with respect to the
administration or provision of benefits under Employer's welfare benefit plan. MIC shall not be
responsible for fulfilling any duties or obligations of Employer with respect to Employer's benefit
plan.
MIC MGC [99] Page 1 2/8/2007
MIC MGCLGSTD
The terms used in this Contract have the same meanings given those terms defined in the
Certificate, unless otherwise specifically defined in this Contract.
ARTICLE 2
TERM OF CONTRACT
Section 2.1 Term and Renewal. This Contract is effective from January 1 2007, ( "Effective
Date ") to December 31, 2007, ( "Expiration Date "). All coverage under this Contract begins at
12:01 a.m. Central Time.
At least 30 days before each Expiration Date, MIC shall notify Employer of any modifications to
this Contract, including Premiums and Benefits for the next term of this Contract ( "Renewal
Terms "). If Employer accepts the Renewal Terms or if Employer and MIC agree on different
Renewal Terms, this Contract is renewed for the additional term, unless MIC terminates this
Contract pursuant to Section 2.2.
Section 2.2 Termination of This Contract. Employer may terminate this Contract after at
least 30 days written notice to MIC. This Contract is guaranteed renewable and will not be
terminated by MIC except for the following reasons and will be effective as stated below.
Terminations for the reasons stated below require at least 30 days written notice from MIC:
(a) Upon notice to an authorized representative of the Employer when Employer does not
pay the required Premium when due, provided, however, that this Contract can be
reinstated pursuant to Section 4.2;
(b) On the date specified by MIC because Employer provided MIC with false information
material to the execution of this Contract or to the provision of Benefits under this
Contract. MIC has the right to rescind this Contract back to the effective date;
(c) On the date specified by MIC due to Employer's violation of the participation or
contribution rules as determined by MIC;
(d) Automatically on the date Employer ceases to do business pursuant to 11 U.S.C.
Chapter 7;
(e) On the date specified by MIC, after at least 90 days prior written notice to Employer, that
this Contract is terminated because MIC will no longer issue this particular type of group
health benefit plan within the applicable employer market;
(f) On the date specified by MIC, after at least 180 days prior written notice to the
applicable state authority and Employer, that this Contract will be terminated because
MIC will no longer renew or issue any employer health benefit plan within the applicable
employer market;
(g) If this Contract is made available to Employer only through one or more bona fide
associations, on the date specified by MIC after Employer's membership in the
association ceases.
(h) Any other reasons or grounds permitted by the licensing laws and regulations governing
MIC.
Notwithstanding the above, MIC may modify the Premium rate and /or the coverage at renewal.
Nonrenewal of coverage as a result of failure of MIC and the Employer to reach agreement with
MIC MGC [991 Page 2 2/812007
MIC MGCLGSTD
1
respect to modifications in the Premium rate or coverage shall not be considered a failure of
MIC to provide coverage on a guaranteed renewable basis.
Section 2.3 Notice of Termination.
MIC will notify Employer and Subscribers in writing if MIC terminates this Contract for any
reason. Employer will provide timely written notification to Subscribers in all circumstances for
which MIC does not provide written notification to Subscribers.
Section 2.4 Effect of Termination. In the event of termination of this Contract:
(a) All Benefits under this Contract will end at 12:00 midnight Central Time on the effective
date of termination;
(b) MIC will not be responsible for any Claims for health services received by Members after
the effective date of the termination; and
(c) Employer shall be and shall remain liable to MIC for the payment of any and all
Premiums that are unpaid at the time of termination.
ARTICLE 3
ENROLLMENT AND ELIGIBILITY
Section 3.1 Eligibility. The Eligibility Appendix to this Contract governs who is eligible to
enroll under this Contract. The eligibility conditions stated in the Eligibility Appendix are in
addition to those specified in the Certificate.
Section 3.2 Enrollment. The Enrollment Appendix to this Contract governs when eligible
employees and eligible dependents may enroll for Benefits under this Contract, including the
Initial Enrollment Period and any applicable Special Enrollment Periods. Employer shall
conduct the Initial Enrollment Period. Employer shall cooperate with MIC in the event of a
Special Enrollment Period.
Section 3.3 Qualified Medical Child Support Orders. Employer will establish, maintain and
enforce all written procedures for determining whether a child support order is a qualified
medical child support order as defined by ERISA. Employer will provide MIC with notice of such
determination and a copy of the order, along with an application for coverage, within the greater
of 30 days after issuance of the order or the time in which Employer provides notice of its
determination to the persons specified in the order.
When and if Employer receives notice that the child has designated a representative, or of the
existence of a legal guardian or custodial parent of the child, Employer shall promptly notify MIC
of such person(s).
MIC shall have no responsibility for:
(i) establishing, maintaining or enforcing the procedures described above;
(ii) determining whether a support order is qualified; or
(iii) providing required notices to the child or the designated representative.
MIC MGC [991 Page 3 2/8/2007
MIC MGCLGSTD
Section 3.4 Eligibility and Enrollment Decisions Subject to applicable law and the terms of
this Contract, Employer has sole discretion to determine whether employees and their
dependents are eligible to enroll for Benefits. MIC shall rely upon Employer's determination
regarding an employee's and /or dependent's eligibility to enroll for Benefits. The Employer will
be responsible for maintaining information verifying its continuing eligibility and the continuing
eligibility of its eligible Subscribers and eligible Dependents. This information shall be provided
to MIC as reasonably requested by MIC. The Employer shall also maintain written
documentation of a waiver of coverage by an eligible Subscriber or eligible Dependent and
provide this documentation to MIC upon reasonable request.
ARTICLE 4
PREMIUMS
The monthly Premiums for this Contract are:
Subscriber Classifications
Monthly Premium
Monthly Employer Contribution
Rate
Class 1
Employer shall contribute a
(Subscriber Only)
$ 464.45
minimum of 50% towards the
single monthly premium rate.
Class 4
(Family)
$1,177.53
The Premiums are due on the first day of each calendar month. Employer shall pay the
Premiums to MIC at the billing address stated in the Acceptance of Contract.
Employer shall notify MIC in writing:
(a) each month of any changes in the coverage classification of any Subscriber; and
(b) within 30 days after the effective date of enrollments, terminations or other changes
regarding Members.
Section 4.2 Grace Period and Reinstatement. Employer has a grace period of 10 days after
the due date stated in Section 4.1 to pay the monthly Premiums. If Employer fails to pay
Premium, the Contract will be terminated in accordance with Section 2.2(a). This Contract will
be reinstated if Employer pays all of the Premiums owed on or before the end of the grace
period. In the event this Contract is not reinstated pursuant to this Section, MIC will not be
responsible for any Claims for health services received by Members after the effective date of
the termination.
Section 4.3 Premium Calculation. The monthly Premiums owed by Employer shall be
calculated by MIC using the number of Subscribers in each coverage classification according to
MIC's records at the time of the calculation. Employer may make adjustments to its payment of
Premiums for any additions or terminations of Members submitted by Employer but not yet
reflected in MIC's calculations.
A full calendar month's Premiums shall be charged for Members whose effective date falls on
or before the 15th day of that calendar month. No Premium shall be charged for Members
whose effective date falls after the 15th day of that calendar month. With the exception of
MIC MGC [991 Page 4 2/8/2007
MIC MGCLGSTD
1
termination of coverage due to a Member's death, a Member's Benefits may be terminated only
at the end of a calendar month and a full Premium rate for that month will apply.. In the case of
a Member's death, that Member's Benefits will be terminated on the date of death.
Section 4.4 Retroactive Adjustments. In accordance with applicable law, retroactive
adjustments may be made for any additions or terminations of Members or changes in
coverage classifications not reflected in MIC's records at the time the monthly Premiums were
calculated by MIC. However, no retroactive credit will be granted for any month in which a
Member received Benefits. No retroactive adjustments to enrollment or Premium refund shall
be granted for any change occurring more than 60 days prior to the date MIC received
notification of the change from Employer.
Regardless of the preceding, Employer shall pay a Premium for any month during which a
Member received Benefits.
Section 4.5 Premium Changes. MIC may change the Premiums after 30 days prior written
notice to Employer.
Section 4.6 Employer Fees. MIC may charge Employer:
(a) a late payment charge in the form of a finance charge of 12% per annum for any
Premiums not received by the due date; and
(b) a service charge for any non - sufficient -fund check received in payment of the
Premiums.
ARTICLE 5
INDEMNIFICATION
MIC will hold harmless and indemnify Employer against any and all claims, liabilities, damages
or judgments asserted against, imposed upon or incurred by Employer, including reasonable
attorney fees and costs, that arise out of MIC's grossly negligent acts or omissions in the
discharge of its responsibilities to a Member.
Employer will hold harmless and indemnify MIC against any and all claims, liabilities, damages
or judgments asserted against, imposed upon or incurred by MIC, including reasonable attorney
fees and costs, that arise out of Employer's or Employer's employees', agents', and
representatives' grossly negligent acts or omissions in the discharge of its or their
responsibilities under this Contract.
Employer and MIC shall promptly notify the other of any potential or actual claim for which the
other party may be responsible under this Article 5.
ARTICLE 6
ADMINISTRATIVE SERVICES
The services necessary to administer this Contract and the Benefits provided under it will be
provided in accordance with MIC's or its designee's standard administrative procedures. If
Employer requests such administrative services be provided in a manner other than in
MIC MGC [99] Page 5 2/8/2007
MIC MGCLGSTD
accordance with these standard procedures, including requests for non - standard reports, and if
MIC agrees to provide such non - standard administrative services, Employer shall pay for such
services or reports at MIC's or its designee's then - current charges for such services or reports.
ARTICLE 7
CLERICAL ERROR
A Member will not be deprived of coverage under the Contract because of a clerical error.
Furthermore, a Member will not be eligible for coverage beyond the scheduled termination date
because of a failure to record the termination.
ARTICLE 8
ERISA
When this Contract is entered into by Employer to provide benefits under an employee welfare
benefit plan governed by ERISA, MIC shall not be named as and shall not be the plan
administrator of the employee welfare benefit plan, as that term is used in ERISA. MIC shall
only be considered a named fiduciary for purposes of claims adjudication.
The parties agree that MIC has sole, final, and exclusive discretion to:
(a) interpret and construe the Benefits under the Contract;
(b) interpret and construe the other terms, conditions, limitations and exclusions set out in
the Contract;
(c) change, interpret, modify, withdraw or add Benefits without approval by Members; and
(d) make factual determinations related to the Contract and the Benefits.
For purposes of overall cost savings or efficiency, MIC may, in its sole discretion, provide
services that would otherwise not be Benefits. The fact that MIC does so in any particular case
shall not in any way be deemed to require it to do so in other similar cases.
MIC may, from time to time, delegate discretionary authority to other persons or entities
providing services under this Contract.
ARTICLE 9
DATA OWNERSHIP AND USE
Information and data acquired, developed, generated, or maintained by MIC in the course of
performing under this Contract shall be MIC's sole property. Except as this Contract or
applicable law requires otherwise, MIC shall have no obligation to release such information or
data to Employer. MIC may, in its sole discretion, release such information or data to
Employer, but only to the extent permitted by law and subject to any restrictions determined by
MIC.
MIC MGC (99] Page 6 2/8/2007
MIC MGCLGSTD
ARTICLE 14
DISPUTE RESOLUTION
In the event that any dispute, claim or controversy of any kind or nature relating to this Contract
arises between the parties, the parties agree to meet and make a good faith effort to resolve
the dispute. The party requesting the meeting shall provide the other, in advance of the
meeting, with written notice of the claimed dispute. Upon receipt of the written notice,
representatives for each party shall meet promptly to attempt to resolve the dispute. If a
mutually agreeable resolution is not reached within thirty (30) days following receipt of the
written notice, either party may pursue legal action in accordance with the terms of this
Contract. The parties may mutually agree to waive the informal dispute resolution process set
forth herein. Any such waiver must be in writing and executed by both parties.
ARTICLE 15
TIME LIMIT ON CERTAIN DEFENSES
No statement made by Employer, except a fraudulent statement, shall be used to void this
Contract after it has been in force for a period of 2 years.
ARTICLE 16
RELATIONSHIP BETWEEN PARTIES
The relationship between Employer and any Member is that of Employer and Subscriber,
Dependent or other coverage classification as defined in this Contract.
The relationships between MIC and Network Providers and the relationship between MIC and
Employer are solely contractual relationships between independent contractors. Network
Providers and Employer are not agents or employees of MIC. MIC and its employees are not
agents or employees of Network Providers or Employer.
The relationship between a Network Provider and any Member is that of provider and patient
and the Network Provider is solely responsible for the services provided to any Member.
ARTICLE 17
EMPLOYER RECORDS
Employer shall furnish MIC with all information and proofs that MIC may reasonably require with
regard to any matters pertaining to this Contract. MIC may at any reasonable time inspect all
documents furnished to Employer by an individual in connection with the Benefits, Employer's
payroll records, and any other records pertinent to the Benefits under this Contract.
MIC MGC [991 Page 8 2/8/2007
MIC MGCLGSTD
I
Unless Employer provides the appropriate written assurances required by 45 CFR 164.504,
MIC will only provide Employer with summary health information (for the purposes of obtaining
premium bids or for modifying, amending or terminating the group health plan only) and
information on whether individuals are participating in the group health plan, or is enrolled in or
has disenrolled from the health plan as provided in 45 CFR 164.504 (f)(1) and the minimum
necessary information for purposes of auditing MIC's operations or services.
ARTICLE 18
MEMBER RECORDS
By accepting Benefits under this Contract, each Member, including Dependents, whether or not
such Dependents have signed the Subscriber's application, authorizes and directs any person
or institution that has provided services to the Member to furnish MIC or any of MIC's designees
at any reasonable time, upon its request, any and all information and records or copies of
records relating to the Benefits provided to the Member. In accordance with applicable law,
MIC and any of MIC's designees shall have the right to release any and all records concerning
health care services: (i) as necessary to implement and administer the terms of this Contract; or
(ii) for appropriate medical review or quality assessment. Such Member information and
records shall be considered confidential medical records by MIC and its designees.
ARTICLE 19
NOTICE
Except as provided in Article 2, notice given by MIC to an authorized representative of
Employer will be deemed notice to all Members.
All notices to MIC shall be sent to the address stated in the Acceptance of Contract. All notices
to Employer shall be sent to the persons and addresses stated in Employer's Application. All
notices to MIC and Employer shall be deemed delivered:
(a) if delivered in person, on the date delivered in person;
(b) if delivered by a courier, on the date stated by the courier;
(c) if delivered by an express mail service, on the date stated by the mail service vendor; or
(d) if delivered by United States mail, 3 business days after date of mailing.
A party can change its address for receiving notices by providing the other party a written notice
of the change.
ARTICLE 20
COMMON LAW
No language contained in the Contract constitutes a waiver of MIC's rights under common law.
MIC MGC [991 Page 9 2/8/2007
MIC MGCLGSTD
ACCEPTANCE OF CONTRACT
This Contract is deemed accepted by Employer upon the earlier of MIC's receipt of Employer's
first payment of the Premium or upon Employer's execution of this Contract by its duly
authorized representative. This Contract is deemed accepted by MIC upon MIC's deposit of
Employer's first payment of ,the Premium. Such acceptance renders all terms and provisions
herein binding on MIC and the Employer.
IN WITNESS WHEREOF, Medica has caused this Contract to be executed on this February 8,
2007, to take effect on the Effective Date stated in the Contract.
MEDICA INSURANCE COMPANY
401 Carlson Parkway
Minnetonka, MN 55305
(952) 992 -2200
Billing Address:
NW 7105
P.O. Box 1450
Minneapolis, MN
Mailing Address:
P.O. Box 9310
Minneapolis, MN
EMPLOYER
Hutchinson Utilities
Address:
225 Michigan St SE
Hutchinson, MN 55350
Telephone: 30) 587 -4746
55485 -5442 By: gt�� j
Title:
Employer Representative:
55440
By:
.mac!
Tom Henke
Senior Vice President, Commercial Markets
By:
James P. Jacobson
Senior Vice President and Assistant Secretary
Jan Sifferat
m-
MIC MGC [99] Page 10 2/8/2007
MIC MGCLGSTD
LJ
ELIGIBILITY APPENDIX
Employer Name: Hutchinson Utilities
Employer Group #: 48963
Section 1 Eligibility to Enroll. A Subscriber, and his or her Dependents, as defined below,
who satisfies the eligibility conditions stated in this Contract are eligible to enroll for coverage
under this Contract. Any person who does not satisfy the definition of Subscriber or Dependent
is not eligible for coverage under this Contract.
A Subscriber and his or her Dependents must meet the eligibility requirements described below
and in the entire Contract.
If there is a conflict between the Certificate and this Eligibility Appendix, this Eligibility Appendix
governs.
Section 2 Subscriber Definition.
The term "Subscriber" as used in the Contract will include the types of employees and
conditions identified below:
Classifications
Employer Hours: Full -time employees
working a minimum of 40 hours /week
Applicable Waiting Periods and Effective Dates
New Hires: First of month following date of hire
Status Change: First of month following date of
change
Return: First of month following date of return
The definition of Subscriber may also include a child for whom an employee is required to
provide health coverage through a qualified medical child support order. Such a child is
considered a Subscriber only if:
(1) the Employer has determined and notified MIC that the support order is effective and
meets all criteria of a qualified medical child support order, as that term is used in the
Employee Retirement Income Security Act ( "ERISA "); and
(2) the relevant employee is eligible to enroll for coverage according to the terms of the
Contract.
MIC MGC [99] Page 11 2/8/2007
MIC MGCLGSTD
When the Subscriber is a child who is eligible for coverage as a result of a qualified medical
child support order, certain rights and obligations pertaining to other Subscribers are modified
according to the terms of the Contract.
A Subscriber who is a child entitled to receive coverage through a qualified medical child
support order is not subject to any waiting periods, except to the extent that such waiting
periods apply to the employee who is ordered by the qualified medical child support order to
provide coverage.
Section 3 Dependent Definition. The term "Dependent" as used in this Contract includes the
following:
The Subscriber's spouse.
2. The following dependent children:
(a) Subscriber's unmarried natural or adopted child;
(b) an unmarried child Placed For Adoption with the Subscriber;
(c) a child for whom the Subscriber or the Subscriber's spouse has been appointed
legal guardian, however, upon request by MIC, the Subscriber must provide
satisfactory proof of dependency;
(d) Subscriber's or Subscriber's spouse's unmarried grandchild who, from the date
of birth, resides with and is dependent upon the Subscriber or Subscriber's
spouse for support and;
(e) Subscriber's stepchild.
A Dependent child must be under 19 years of age if s /he is not a student and must be
under 25 years of age if s /he is a student. A Dependent child is eligible as a student if
s /he is enrolled full -time in a recognized high school, college, university, trade or
vocational school. If the student is unable to carry a full -time course load due to illness,
injury, or a physical or mental disability, as documented by a Physician, full -time student
status will be granted if the student carries at least 60% of a full -time course load, as
determined by the educational institution.
3. The Subscriber's handicapped Dependent. The handicapped Dependent must be:
(a) incapable of self- sustaining employment by reason of mental retardation,
mental illness, mental disorder or physical handicap; and
(b) chiefly dependent upon the Subscriber for support and maintenance.
The handicapped Dependent shall be eligible for coverage as long as he or she continues to be
handicapped and satisfies the requirements of (a) and (b) above, unless coverage otherwise
terminates under this Contract. MIC may require annual proof of handicap and dependency.
An illness will not be considered a physical handicap.
A child who is the subject of a qualified medical child support order is not a Dependent, but is
considered a Subscriber as defined above, and may not enroll Dependents for coverage. See
Section 2.
MIC MGC [991 Page 12 2/8/2007
MIC MGCLGSTD
1
�l
'.1
Any person who does not satisfy the terms listed above will not be eligible for coverage under
the Contract.
MIC MGC [99] Page 13 21812007
MIC MGCLGSTD
ENROLLMENT APPENDIX
Employer Name: Hutchinson Utilities
Employer Group #: 48963
INITIAL ENROLLMENT
"Initial Enrollment Period" is a 30 day time period starting with the date an eligible Subscriber
and his or her eligible Dependents are first eligible to enroll for coverage under this Contract.
An eligible Subscriber must apply within this period for coverage to begin the date he or she
was first eligible to enroll. (The 30 day time period does not apply to newborn Dependents; see
Special Enrollment, (item 4).) An eligible Subscriber who enrolls during the Initial Enrollment
Period is accepted without application of health screening or affiliation periods. An eligible
Subscriber and his /her Dependents who do not enroll during the Initial Enrollment Period may
enroll for coverage during any applicable Special Enrollment Periods as described below.
A Subscriber who is a child entitled to receive coverage through a qualified medical child
support order is not subject to any Initial Enrollment Period restrictions, except as noted in the
Eligibility Appendix.
NOTIFICATION
Subscribers must notify Employer within 30 days of the effective date of any change of address
or name, addition or deletion of Dependents, or other facts identifying the Subscriber or the
Subscriber's Dependents.
The Employer must notify MIC within 30 days of the effective date of the Member's initial
enrollment application, changes to the Member's name or address, or changes to enrollment,
including if a Member is no longer eligible for coverage.
SPECIAL ENROLLMENT
A. Special Enrollment Periods. The following "Special Enrollment Periods" are available
in addition to the Initial Enrollment Period.
A Special Enrollment Period will apply to an eligible employee and Dependent if:
(1) the eligible employee or Dependent:
a. was covered under Qualifying Coverage at the time the eligible employee
or Dependent was first eligible to enroll under the Contract, and
b. declined coverage for that reason, and
C. presents to MIC either (i) evidence of the loss of prior coverage due to
loss of eligibility for that coverage, or (ii) evidence that employer
contributions toward the prior coverage have terminated, and
MIC MGC [991 Page 14 2/8/2007
MIC MGCLGSTD
d. maintains Continuous Coverage, and
e. requests enrollment in writing within 30 days of the date of the loss of
coverage or the date the employer's contribution toward that coverage
terminates;
For purposes of this item:
a. prior coverage does not include continuation coverage required under federal
law;
b. loss of eligibility includes loss of eligibility as a result of legal separation,
divorce, death, termination of employment, or reduction in the number of
hours of employment;
c. loss of eligibility does not include a loss due to failure of the eligible employee
or Dependent to pay Premiums on a timely basis or termination of coverage
for cause;
(2) the eligible employee or Dependent:
a. was covered under benefits available under (i) the Consolidated Omnibus
Budget Reconciliation Act of 1985 ( "COBRA "), Public Law Number 99-
272, as amended, or (ii) any state continuation laws applicable to the
employer or MIC, and
b. declined coverage for that reason, and
C. the eligible employee or Dependent presents to MIC evidence that the
eligible employee or Dependent has exhausted such COBRA or state
continuation coverage and has not lost such coverage due to either
failure of the eligible employee or Dependent to pay Premiums on a
timely basis or for cause, and
d. maintains Continuous Coverage, and
e. requests enrollment in writing within 30 days of the loss of coverage;
(3) the Dependent is a new spouse of the Subscriber or eligible employee, provided
that the marriage is legal, enrollment is requested in writing within 30 days of the
marriage, and the eligible employee also enrolls during this Special Enrollment
Period;
(4) the Dependent is a new Dependent child of the Subscriber or eligible employee,
provided that enrollment is requested in writing within 30 days of the Subscriber
or eligible employee acquiring the Dependent (the notification period is not
limited to 30 days for newborn Dependents), and provided the eligible employee
also enrolls during this Special Enrollment Period;
(5) the Dependent is the spouse of the Subscriber or eligible employee through
whom the Dependent child described in item #4 above claims Dependent status
and:
a. that spouse is eligible for coverage; and
b. is not already enrolled under the Contract; and
MIC MGC [99] Page 15 2/8/2007
MIC MGCLGSTD
C. enrollment is requested in writing within 30 days of the Dependent child
becoming a Dependent, provided the eligible employee also enrolls
during this Special Enrollment Period;
(6) the Dependents are eligible Dependent children of the Subscriber or eligible
employee and enrollment is requested in writing within 30 days of a Dependent,
as described in items #3 or #4 above, becoming eligible to enroll under the
coverage, provided the eligible employee also enrolls during this Special
Enrollment Period.
Additionally, when Employer provides MIC with notice of a qualified medical child
support order and a copy of the order, MIC will provide such eligible dependent child
with a Special Enrollment Period. Employer will provide MIC with such notice, along with
an application for coverage, within the lesser of 30 days or the time in which Employer
provides notice of its determination to the persons specified in the order.
B. Effective Dates of Coverage. Coverage shall become effective:
(1) in the case of paragraphs (A)(1) or (2) above, the day after the date the other
coverage ended;
(2) in the case of paragraph (A)(3) above, the date of the marriage;
(3) in the case of paragraph (A)(4) above, the date of birth, date of adoption, or date
of placement for adoption. In all other cases, the date the Subscriber acquires
the Dependent child.
(4) in the case of paragraph (A)(5) above, the date the Subscriber acquires the Dependent
Child; and
(5) in the case of (A)(6) above, the first day of the first calendar month beginning after the
date the completed request for enrollment is received by MIC.
(6) in the case of a qualified medical child support order, the first day of the first calendar
month beginning after the date the completed request for enrollment is received by MIC.
OFF -CYCLE ENROLLMENT
NO OFF -CYCLE ENROLLMENT FOR LATE ENTRANTS WITHOUT
CONTINUOUS COVERAGE
An eligible Subscriber or an eligible Subscriber and his or her Dependents who do not enroll for
coverage offered through Employer during the Initial Enrollment Period or any applicable
Special Enrollment Period will be considered Late Entrants.
(1) Late Entrants who have maintained Continuous Coverage may enroll and coverage will
be effective the first day of the month following date of approval by MIC. Continuous
Coverage will be determined to have been maintained if the Late Entrant requests
enrollment within 63 days after prior Qualifying Coverage ends.
(2) Late Entrants who have not maintained Continuous Coverage may not enroll off - cycle.
MIC MGC [991 Page 16 2/8/2007
MIC MGCLGSTD
r
An eligible Subscriber or Dependent who:
(1) does not enroll during the Initial Enrollment Period or any applicable Special Enrollment
period; and
(2) is an enrollee of the Minnesota Comprehensive Health Association ( "MCHA ") at the time
MIC offers or renews coverage with Employer, provided the eligible Subscriber or
Dependent maintains Continuous Coverage,
will not be considered a Late Entrant and will be allowed to enroll. Coverage will be effective as
determined by MIC.
MIC MGC [99] Page 17 2/8/2007
MIC MGCLGSTD
CINEASO
STANDARD UNIFORM RENTAL SERVICE AGREEMENT
Customer
4- 44,,,Aso�a AU4
New Renewal
Location No. A-? 0
Contract No. ZJ t 0
Customer No. ?J_45 0
Date /
Phonef 320) S-43 77 — A-) 4 b
Address 2Z-S 1� c��c S'N�e '� City State M/v Zip��
UNIFORM PRICING:
• This agreement is effective as of the date of execution for a term of 60 months from date of installation.
• The additional charges listed below are subject to adjustment by Company effective upon notice to Customer, which notice may be in
the form of an invoice.
• Name Emblem $ a/� oo ea . Company Emblem $ �. S'—� ea
• Custom Emblem $ /• Sb ea • Embroidery $ NA ea
• COD Terms $ "— per week charge for prior service (if Amount Due is Carried to Following Week)
• Credit Terms - Charge Payments Due 10 Days After End of Month
• Automatic Lost Replacement Charge: Item % of Inventory $ Ea.
• Automatic Lost Replacement Charge: Item % of Inventory $ Ea.
• Weekly Minimum Charge $ Sb.oO per week
• Make -Up Charge $ I .Z.S' per garment.
• Non- Standard/Special Cut Garment (i.e., non- standard, non - stocked, unusually small or large sizes, unusually short or long sleeve or
length, etc.) premium $ . % O per garment per week.
• Seasonal Sleeve Change $ 00- per change per week.
• Under no circumstances will the Company accept textiles bearing free liquid. Shop towels may not be used to clean up oil or solvent spills.
Shop towel container $ h% C per week.
• Artwork Charge for LogoMat $ _/V 0-
• Uniform Storage Lockers: $ N A ea/week, Laundry Lock -up: $ •ZS- ea/week Shipping: $ I`i C
• Service Charge $ 9.9 s per week.
This Service Charge is used to help Company pay various fluctuating current and future costs including, but not limited to, costs directly
or indirectly related to the environment, energy issues, service and delivery of goods and services, in addition to other miscellaneous
costs incurred or that may be incurred in the future by Company.
• Size Change: CustomeX agrees to have employees measured by a Cintas representative using garment "size samples ". A charge
of $ per garment will be assessed for employees size changed within 4 weeks of installation.
• Other
FACILITY SERVICES PRODUCTS PRICING:
Item #
Rental Freq.
Inventory
Unit Price
Rm-
e O
C 8
• This agreement is effective as of the date of execution for a term of 60 months from date of installation.
• The additional charges listed below are subject to adjustment by Company effective upon notice to Customer, which notice may be in
the form of an invoice.
• Name Emblem $ a/� oo ea . Company Emblem $ �. S'—� ea
• Custom Emblem $ /• Sb ea • Embroidery $ NA ea
• COD Terms $ "— per week charge for prior service (if Amount Due is Carried to Following Week)
• Credit Terms - Charge Payments Due 10 Days After End of Month
• Automatic Lost Replacement Charge: Item % of Inventory $ Ea.
• Automatic Lost Replacement Charge: Item % of Inventory $ Ea.
• Weekly Minimum Charge $ Sb.oO per week
• Make -Up Charge $ I .Z.S' per garment.
• Non- Standard/Special Cut Garment (i.e., non- standard, non - stocked, unusually small or large sizes, unusually short or long sleeve or
length, etc.) premium $ . % O per garment per week.
• Seasonal Sleeve Change $ 00- per change per week.
• Under no circumstances will the Company accept textiles bearing free liquid. Shop towels may not be used to clean up oil or solvent spills.
Shop towel container $ h% C per week.
• Artwork Charge for LogoMat $ _/V 0-
• Uniform Storage Lockers: $ N A ea/week, Laundry Lock -up: $ •ZS- ea/week Shipping: $ I`i C
• Service Charge $ 9.9 s per week.
This Service Charge is used to help Company pay various fluctuating current and future costs including, but not limited to, costs directly
or indirectly related to the environment, energy issues, service and delivery of goods and services, in addition to other miscellaneous
costs incurred or that may be incurred in the future by Company.
• Size Change: CustomeX agrees to have employees measured by a Cintas representative using garment "size samples ". A charge
of $ per garment will be assessed for employees size changed within 4 weeks of installation.
• Other
FACILITY SERVICES PRODUCTS PRICING:
Item #
Description
Rental Freq.
Inventory
Unit Price
-
2-140
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Cintas Loc. No.` Please Sign Name X �� \�LZit"l
By Please Print Name X, vy e 5
Title !�Gf sJ'tc-p_ Please Print Title 1C DO ti fA tiA, 5 v
Accepted - GM:
Form Distribution: (1) White - Office (2) Canary- Customer (3) Pink - Corporate Office
R -2100A (4MS) Page t of 2
Tj-tKl,Np4
I B3 U
1 Prepared for: Jan Sifferath
February 19th, 2007
M U I F O R M P'E 0 P L E ":�
Rental Uniforms
ApX employees in an inventory of 9 (4 changes) Indura U1traSoft Shirts/Indura Jeans $7.95 /employee /week
Any employees in an inventory of 9 (4 changes) Cotton Shirts/Denim Jeans $& /employee /week
Facility Service Items
Red Shop Towels
Soil Lock Up Lockers
Service Charge
Other Items
Replacement Rate for Indura Ultra Soft Shirt
Replacement Rate for Indura Jean
Replacement Rate for Cotton Shirt
Replacement Rate for Denim Jeans
Make Up Charges
Emblem Charges
$0.08 per item
$1.25 per item
$9.95 per item
$25.00 per item
$50.00 per item
$16.00 per item
$20.00 per item
$1.25 per item
$1.50 per item
F,11
0
1
Prepared for Hutchinson Utility
Rem S
Description
Quantity
invoiced
Current
Prices
Current
Bulk Rem
Price Total
Quoted
Prices
Quoted
Bulk Item
Price Total
Variance
106
Service Charge
1
$17.26
$17.26
$9.95
$9.95
-$7.31
8004
Sal Lock Up Lockers
2
$1.42
$2.84
$1.25
$2.50
-$0.34
2160
Red Shop Towels
200
$0.085
$17.00
$0.08
$16.00
-$1.00
6605
1 Flame Resistans Shirts/Jeans
17
$13.38
$227.46
$7.95
$135.15
- $92.31
1125
100% Coition Shirts/Jeans
17
$7.67
$130.39
$5.25
$89.25
T $41.14
Weekly Volume For Total Account $394.85 $282.96 - $142.10
Average Weekly Savings: $142.10
Average Yearly Savings: $7389.20
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