HomeMy WebLinkAbout279-19 RESOLUTIONOF FAYEr,
9RkANSPS
113 West Mountain Street
Fayetteville, AR 72701
(479) 575-8323
Resolution: 279-19
File Number: 2019-0790
OZARK DUMPSTER SERVICE, LLC:
A RESOLUTION TO APPROVE A TWO YEAR AGREEMENT WITH OZARK DUMPSTER SERVICE,
LLC FOR THE HAULING AND DISPOSAL OF SOLID WASTE AND RECYCLABLE MATERIAL IN
THE CITY OF FAYETTEVILLE WITH AUTOMATIC RENEWALS FOR TWO ADDITIONAL TWO
YEAR TERMS
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF FAYETTEVILLE,
ARKANSAS:
Section 1: That the City Council of the City of Fayetteville, Arkansas hereby approves a two year agreement
with Ozark Dumpster Service, LLC, a copy of which is attached to this Resolution, for the hauling
and disposal of solid waste and recyclable material in the City of Fayetteville with automatic
renewals for two additional two year terms.
PASSED and APPROVED on 12/3/2019
Attest: %A-( CLERk
Kara Paxton, City Clerk Treasure20'76.zo
SAS
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Page 1 Printed on 1215119
I
City of Fayetteville, Arkansas
s J=' Text File
File Number: 2019-0790
Agenda Date: 12/3/2019
In Control: City Council Meeting
Agenda Number: A. 21
OZARK DUMPSTER SERVICE, LLC:
113 West Mountain Street
Fayetteville, AR 72701
(479) 575-8323
Version: 1 Status: Passed
File Type: Resolution
A RESOLUTION TO APPROVE A TWO YEAR AGREEMENT WITH OZARK DUMPSTER
SERVICE, LLC FOR THE HAULING AND DISPOSAL OF SOLID WASTE AND RECYCLABLE
MATERIAL IN THE CITY OF FAYETTEVILLE WITH AUTOMATIC RENEWALS FOR TWO
ADDITIONAL TWO YEAR TERMS
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF FAYETTEVILLE, ARKANSAS:
Section 1: That the City Council of the City of Fayetteville, Arkansas hereby approves a two year agreement
with Ozark Dumpster Service, LLC, a copy of which is attached to this Resolution, for the hauling and disposal
of solid waste and recyclable material in the City of Fayetteville with automatic renewals for two additional two
year terms.
City of Fayetteville, Arkansas Paye 1 Printed on 12/4/2019
City of Fayetteville Staff Review Form
2019-0790
Legistar File ID
12/3/2019
City Council Meeting Date - Agenda Item Only
N/A for Non -Agenda Item
Shannon Newman 11/13/2019 RECYCLING/TRASH COLLECTION (750)
Submitted By Submitted Date Division / Department
Action Recommendation:
A resolution to approve an agreement between the City of Fayetteville, Arkansas and Ozark Dumpster Service, LLC
to haul and dispose of solid waste in the City of Fayetteville
Budget Impact:
Account Number
Project Number
Budgeted Item? NA Current Budget
Funds Obligated
Does item have a cost? NA
Budget Adjustment Attached? NA
Current Balance
Item Cost
Budget Adjustment
Fund
Project Title
I$ I
Remaining Budget $ -
V20180321
Purchase Order Number: Previous Ordinance or Resolution #
Change Order Number: Approval Date:
Original Contract Number:
Comments:
CITY OF
FAYETTEVILLE
ARKANSAS
MEETING OF DECEMBER 3, 2019
TO: Mayor Jordan and City Council
CITY COUNCIL MEMO
THRU: Peter Nierengarten, Environmental Director
Jeff Coles, Recycling and Trash Collections Director
FROM: Shannon Newman, Financial Analyst - Recycling and Trash Collections
DATE: November 13, 2019
SUBJECT: A resolution to approve an agreement between the City of Fayetteville,
Arkansas and Ozark Dumpster Service, LLC to haul and dispose of solid waste in the
City of Fayetteville
RECOMMENDATION:
Staff recommends City Council approval of a resolution with Ozark Dumpster Service, LLC for
the hauling and disposal of solid waste in the City of Fayetteville.
BACKGROUND:
City Code 50.29 - Private Collectors; Contract With City Required
No person, except a duly authorized agent or employee of the city, shall empty garbage or trash
receptacles, or convey or transport garbage or trash on the streets or public thoroughfares of
the city, without a written contract with the city. (Code 1965, §10-46; Ord. No. 1194, 4-6-59;
Code 1991, §50.29)
In accordance with this City Code, Ozark Dumpster Service has submitted a request for contract
to haul solid waste within,the city limits of Fayetteville.
There are currently 10 approved franchise haulers operating in the city of Fayetteville. Attached
is a list of these haulers and the materials they are approved to haul.
DISCUSSION:
The hauling contract will permit Ozark Dumpster Service to collect and haul Class 1 and Class 4
solid waste using open -top roll -off style containers with capacities of 20 cubic yards or greater,
or roll -off style compactors with capacities of 20 cubic yards or greater. No unseparated
recyclables, with the exception of construction/demolition waste, shall be hauled from any
customer within the corporate limits of the City of Fayetteville.
The agreement requires Ozark Dumpster Service to pay a monthly fee to the City of Fayetteville
of 10% of the gross revenue received for providing solid waste hauling services and 5% of the
gross revenue received for providing the hauling of construction/demolition waste to a permitted
construction and demolition waste sorting facility.
Mailing Address:
113 W. Mountain Street www.fayetteville-ar.gov
Fayetteville, AR 72701
The term of the agreement will be 2 years with automatic renewals for 2 additional 2 -year terms.
Staff proposes approval for Ozark Dumpster Service, LLC to haul and dispose of solid waste
within the City of Fayetteville per the terms of the attached agreement.
BUDGET/STAFF IMPACT:
None
Attachments:
Franchise Haulers
Ozark Dumpster Service, LLC Agreement to Haul and Dispose of Solid Waste in the City of
Fayetteville
City of Fayetteville Franchise Haulers
Business
DBA
city
Activity
Hauling and disposal of solid waste and
recyclable material within the city limits of
Eco Vista Waste Management
Waste Management
Tontitown Ar.
Fayetteville.
Hauling and disposal of solid waste and
recyclable material within the city limits of
Hogeye Mfg. Co. Inc
Hogbox
Fayetteville Ar.
Fayetteville.
Hauling and disposal of solid waste and
recyclable material within the city limits of
Allied Waste Services
Republic
Bella Vista Ar.
Fayetteville.
Hauling and disposal of solid waste and
recyclable material within the city limits of
Central Arkansas Recycling & Disposal
CARDS
Little Rock Ar.
Fayetteville.
Hauling and disposal of solid waste and
recyclable material within the city limits of
Waste -Away
Whiteline Waste
Hiwassee Ar.
Fayetteville.
Organic waste hauling and composting
Food Loops
Rogers Ar.
within the city limits of Fayetteville.
Hauling and disposal of solid waste and
recyclable material within the city limits of
Marck Recycling
Rogers Ar.
Fayetteville.
Hauling and disposal of solid waste and
recyclable material within the city limits of
Windstar Investments LLC
Roll Off Dumpsters
Rogers Ar.
Fayetteville.
Organic waste hauling and composting
Food Recycling Solutions, LLC
Rogers Ar.
within the city limits of Fayetteville
Hauling and disposal of solid waste and
recyclable material within the city limits of
Inland Waste Solutions
Orion Waste Solutions
Bethel Heights Ar.
Fayetteville.
AGREEMENT TO HAUL AND DISPOSE OF
SOLID WASTE IN THE CITY OF FAYETTEVILLE
This Agreement3r1— (the "Agreement"), is entered into on this day of eUm 6f-2019, between
the City of Fayetteville, Arkansas, a municipal corporation (the "City"), and Ozark Dumpster Service,
LLC (the "Hauler"), and shall be .in full force and effect on the date first written above, City and Hauler
agree as follows:
The term of this Agreement shall be for two (2) years, with automatic renewals for two (2)
additional two (2) year terms, unless otherwise terminated pursuant to the terms hereof. Notice of
non -renewal by either City or Hauler shall be given at least thirty days prior to the end of the
current term_
2. Hauler agrees that from and after the original date of this Agreement, all customer service
Agreements for facilities within the corporate limits of the City, excluding residential areas,
entered into before or after the effective date of this Agreement, or renewed shall have terms of no
more than one (1) year and any subsequent extensions shall be for terms of no more than one (1)
year. No customer service Agreement shall extend the terms of this Agreement.
3. Hauler agrees and understands that it may only collect and haul Class 1 and Class 4 Solid Waste
and/or Recyclables using the type equipment commonly referred to as open -top roll -off style
containers with capacities of twenty (20) cubic yards or greater, or roll -off style compactor
containers with capacities of twenty (20) cubic yards or greater, containing waste generated from
industrial, large commercial or construction/demolition activities, or which is classified as Special
Waste, Hazardous Waste, grease or any other type Solid Waste which requires special handling or
disposal. Hauler shall not collect any Class 1 or Class 4 material in other containers. No
unseparated recyclables, with the exception of construction/demolition waste, shall be hauled from
any customer within the corporate limits of the City of Fayetteville.
4. In consideration of the right to provide the hauling of solid waste and/or recyclables described in
Item 43 above, Hauler agrees and understands that it shall be required to pay a monthly fee of-
ten (10%) percent (the "Solid Waste Fee") of the gross revenue .received for providing solid waste
hauling services and five (5%) percent (the "Recycling Fee") of the gross revenue received for
providing the hauling of recyclables or construction/demolition waste to a permitted construction
and demolition waste sorting facility. Any construction/demolition waste that is not hauled to and
accepted by a permitted construction and demolition waste sorting facility or any recyclables not
accepted by a recycling facility or recycling broker shall be subject to the 10% Solid Waste Fee.
5. Hauler agrees and understands that it shall deliver all Class I waste to a properly Licensed landfill
facility and all Class 4 waste to a properly licensed landfill facility or a properly licensed
construction and demolition waste sorting facility. Hauler shall pay all tip fees to the construction
and demolition waste sorting facility operator, transfer station fees to the transfer station operator
and all landfill fees to the landfill operator, as they may be established and amended, from time to
time.
6. Hauler shall pay all fees due hereunder, along with submitting "Attachment A: Solid Waste
Documentation", or page 1 of Attachment Ain conjunction with an agreed upon vendor generated
report, on or before the 15' of each calendar month for the immediately preceding calendar month.
Payments of fees received after the due date shall be assessed a 10% penalty per month. If Hauler
Page l of 6
fails to pay the fees within forty-five (45) days of the due date, the City may terminate this
Agreement upon delivery of one (1) written notice to the Hauler. The supporting information shall
be sufficient to demonstrate the accuracy of the fee calculation, and shall include the following
information: (i) Hauler's worksheet calculating the fees .remitted; (ii) a list of payments received
from customers within the City; (iii) such list shall clearly indicate whether each payment was
from a permanent or temporary customer, and (iv) the fee shall be based upon all activity from
each customer account within the City, and shall include the normal billing charges for all free or
discounted services (including those for non-profit organizations) including but not limited to
delivery, pull charges, disposal charges, transportation charges, final pull charges, and return
charges. With payment remittance, the City will review and obtain certain trade secret
information, including rates, frequency of service, customer lists, and other customer information
("Confidential Information"). The City asserts this information is exempt from disclosure under
the Arkansas Freedom of Information Act as the information meets the exemption for records that
"'if disclosed would give advantage to competitors." This information will only be reviewed by
City financial staff, and will not be made available to City Recycling and Trash Collection staff.
7. Hauler shall pay all fees due hereunder, along with submitting "Attachment B: Recycling
Documentation", on or before the 15' of each calendar month for the immediately preceding
calendar. month. .Payments of fees received after the due date shall be assessed a 10% penalty per
month. If Hauler fails to pay the fees within forty-five (45) days of the due date, the City may
terminate this Agreement upon delivery of one (1) written notice to the Hauler. The supporting
information shall be sufficient to demonstrate the accuracy of the fee calculation, and shall include
the following information: (i) volumes of recycling collected, in tons, by commodity, with
disposition by destination market, for all recycling; (ii) volumes of construction and demolition
waste delivered to permitted construction and demolition waste sorting facility and percentage of
material recovered. With payment remittance, the City will review and obtain certain trade secret
information, including rates, frequency of service, customer lists, other customer information, and
contracts with recyclers and processing mills ("Confidential Information"). The City asserts this
information is exempt from disclosure under the Arkansas Freedom of Information Act as the
information meets the exemption for records that "if disclosed would give advantage to
competitors." This information. will only be reviewed by City financial staff, and will not be made
available to City Recycling and Trash Collection staff.
The City shall have the right to conduct an audit of Hauler's customer files and records for all
customers located within the City, provided that such audit privilege shall be limited to once per
calendar quarter. If such audit reveals the Hauler should have paid at least 5% more than reported,
the cost of the audit shall be paid by the Hauler to the City. During such audit, the City may review
and obtain certain trade secret information, including rates, frequency of service, customer lists,
and other customer information ("Confidential Information"). This infonnation shall not be
divulged to any third party by the City, its employees, officers, or elected officials without the
express written consent of the Hauler, or as otherwise required by law. The City asserts this
infonnation is exempt from disclosure under the Arkansas Freedom of Information Act as the
information meets the exemption for records that "if disclosed would give advantage to
competitors." This information will only be reviewed by City financial staff, and will not be made
available to City solid waste staff.
9. The City will advise Hauler of any request for information which the City, at the City's sole
discretion; determines to be non -disclosable or otherwise subject to an exemption from disclosure
under the Arkansas Freedom of Information Act. If a court of competent jurisdiction determines
Page 2 of 6
that said requested information is disclosable or otherwise is not exempt from disclosure under the
Arkansas Freedom of Information. Act, the City will comply with said .finding and notify Hauler.
Discovery requests made to the City during the course of any litigation, or any other subpoena or
court order issued to the City for information or records related to Hauler and this Agreement, shall
be promptly made known to Hauler.
10. Hauler agrees and understands that it shall submit to the City by June 30' on an annual basis: (i)
a list of all commercial vehicles used to provide services in the City; (ii) proof of appropriate
vehicle registration; (iii) and proof of the insurance required in the Agreement.
11. Hauler agrees and understands that it shall provide by June 30th on an annual basis: (i) a list of
vehicle operators collecting and hauling waste in the City of Fayetteville; (ii) proof of their valid
and appropriate commercial drivers' licenses; (iii) and the provision, maintenance, and
implementation of a plan to ensure that the vehicle operators maintain their commercial driver's
licenses in accordance with applicable federal and state laws.
12. Hauler agrees that it shall provide by June 30th on an annual basis copies of valid and current
hauling and disposal permits from the Arkansas Department of Environmental Quality, the Solid
Waste District with jurisdiction, and any local permitting agency.
13. Hauler agrees that it shall comply with all federal, state and local laws applicable to the safety,
environmental and transportation matters related to providing solid waste collection services under
this Agreement. Hauler agrees that all open -top roll -off style containers will be properly covered
during transit on streets and highways within Fayetteville.
14. The City reserves the right to inspect all vehicles and containers to ensure compliance with
approved materials and to ensure that the vehicles are safe and well-maintained and that all
containers are well-maintained and water tight, if necessary.
15. If Hauler utilizes the City's transfer station, Hauler agrees and understands that it shall be required
to establish an individual credit or service relationship with the City of Fayetteville transfer station
operator. Hauler agrees that it shall comply with all practices, policies and procedures as
established by the transfer station operator from time to time. Any tipping fee deposits required by
the transfer station or landfill operators shall be refunded, less any unpaid tipping fees, when the
Hauler ceases hauling activities governed by this Agreement.
16. This Agreement .has been entered into freely and voluntarily by Hauler which agrees to abide by
all of the terms and conditions as a matter of contractual obligation pursuant to applicable City
ordinances. This is a contractual Agreement and is not intended to be part of or relate in any way
to any license or ordinance created pursuant to A.C.A. §26-77-102.
17. Neither this Agreement, nor any rights or obligations hereunder may be assigned or transferred to
any third part or affiliate.
18. For the purpose of this contract, the Point of Contact for the City of Fayetteville shall be the City's
Environmental Director. The Points of Contact for the Hauler shall be Alexandra Hoilenbeck.
Communications pertaining to day-to-day aspects of this contract shall be through these
individuals. Either party may change its designated Point of Contact upon ten (10) days prior
written notice to the other party.
Page 3 of 6
19. Hauler agrees to protect, indemnify, defend and save harmless the City, its officials, officers,
employees, agents, subcontractors, representatives and assigns from any loss, claim liability,
penalty, fine, forfeiture, demand cause of action, suit and costs and expenses incidental thereto
(including costs of defense, settlement and reasonable attorneys' fees), to the extent caused by (i)
Hauler's breach of any term, condition, covenant or warranty contained in this Agreement, or (ii)
Hauler's negligent act or omission or willful misconduct related to the delivery of waste to the
City transfer station or a properly licensed landfill facility.
20. Insurance: Hauler shall maintain the following insurance coverage during the term of this
Agreement:
a) Hauler shall provide and maintain, during the term of this Agreement,
comprehensive general liability insurance, to protect against all claims arising out
of the performance of its services hereunder that result in bodily injury, death or
property damage. The policy or policies shall contain a clause that the insurer will
not cancel. or decrease the insurance coverage without first giving the City sixty
(60) days notice in writing.
b) Upon written request, Hauler shall furnish the City with evidence that the insurance
required of it is in force,
C) City will be added as an additional insured on General Liability and Auto Liability
policies.
d) The types of coverage and limits of liability of all insurance required herein shall
be a follows:
COVERAGE
LIMITS OF LIABILITY
Worker's Compensation
Statutory
Employer's Liability
$500,000
Bodily Injury Liability except
Automobile
$1,000,000
each occurrence
Property Damage Liability Except
Automobile
$1,000,000
each a e ate
Automobile Bodily In'
$1,000,000 each person
Comprehensive General
Liability
$1,000,000
each occurrence
Automobile Property
Dama e Liability
$1,000,000
each occurrence
Excess Umbrella
Liability
$1,000,000
each occurrence
21. Termination:
a) Except as otherwise provided herein, if Hauler breaches this Agreement or defaults
in the performance of any of the requirement or conditions contained herein, and
such breach continues for fifteen (15) days after the City has given the Hauler
written notice of such breach or default, the City may: (i) terminate this Agreement
no sooner than thirty (30) days after the date of written notice of such breach or
Page 4 of 6
default; (ii) cure the breach or default at the expense of the Hauler; and/or (iii)
exercise any right or remedy to which it may be entitled by law.
b) The City may terminate this Agreement upon written notice to the Hauler if the
Hauler makes an assignment for the benefit of creditors, or files a voluntary petition
in bankruptcy, receivership or insolvency, or files an answer in any involuntary
proceeding of that nature admitting the material allegations of the petition, or if a
proceeding in bankruptcy, receivership or insolvency shall be instituted and such
proceeding is not dismissed within sixty (60) days.
c) In the event that this Agreement is terminated for any reason, any amounts payable
to the City by Hauler for services rendered for any reason whatsoever shall become
immediately due and payable as of the date of such termination.
22. All notices required or permitted under this contract shall be submitted in writing to the other party
of this contract by electronic mail, return receipt requested, and by U.S. Mail, which notice shall
be effective three (3) days after deposit therein addressed to the following:
City of Fayetteville Ozark Dumpster Service, LLC
Environmental Director Attn: Alexandra Hollenbeck
113 West Mountain Street 2128 Cheyenne Trail
Fayetteville, AR 72701 Springdale, AR 72762
23. Hauler agrees and understands that this Agreement and documents submitted to the City pursuant
hereto are subject to the Arkansas Freedom of Information Act. If a Freedom of Information .Act
request is presented to the City of Fayetteville requesting such non-exempt documents, such non-
exempt documents shall be provided in a prompt and timely manner as prescribed in the Arkansas
Freedom of Information Act (Ark. Code Ann. § 25-19-101 et seq.). Only legally authorized
photocopying costs may be assessed for this compliance.
24. This Agreement shall be interpreted according to and enforced under the laws of the State of
Arkansas. Capitalized terms herein shall have the same meaning as set forth in ADEQ Reg. No.
22.
25. A waiver by either party of any of the terms or conditions herein shall be limited to that particular
instance, and shall not be construed as a general waiver of either party's right to seek appropriate
remedies for any other breaches by either party.
26. Each paragraph of the Agreement is severable from all other paragraphs. In the event any court of
competent jurisdiction determines that any paragraph or subparagraph is invalid or unenforceable
for any reason, all remaining paragraphs and subparagraphs shall remain in full force and effect.
27. This contract constitutes the entire understanding of the parties and no Notification or variation of
the terms of this contract shall be valid unless made in writing and signed by the duly authorized
agents of the City of Fayetteville and the Hauler.
28. Each of the undersigned warrants that he or she has the full right, power, and authority to execute
this contract on behalf of the party indicated for the purposes herein contained.
Page 5 of 6
29. To the extent a definition or a specific term is not provided herein but is nonetheless required by
the context, it is the intention of the parties to incorporate herein the definitions contained in
applicable law and regulation in effect as the date hereof, except to the extent subsequent law or
regulation shall expressly or implicitly mandate a revised definition.
30. The obligations of the parties to this Agreement, which by their nature would continue beyond the
termination, cancellation or expiration of this Agreement, shall survive the termination (for any
reason), cancellation or expiration of this Agreement.
IN WITNESS WHEREOF, we have hereunto set our hands on the date first written above.
CITY OF FAYETTEV.ILLE
to
ATTEST:
OZARK DUMPSTER SERVICE, LLC
By:�t,ULiYWi}�.f�1'�
NAMIE, Title
WITNESS:
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Page 6 of 6
Attachment A: Solid Waste Documentation
Required Supporting Information For Monthly Payment of Fees
Due on or before the 15th of each calendar month for the immediately
preceding calendar month. Payments of the fees received after the due
date shall be assessed a 10% penalty per month.
Hauler:
Month:
1. Please give the number of permanent customer accounts you have within the
corporate limits of the City of Fayetteville for the month reported.
2. Please give the number of temporary customer accounts you have within the
corporate limits of the City of Fayetteville for the month reported.
3. Please give the total number of containers placed with all your customer
accounts within the corporate limits of the City of Fayetteville for the month reported.
4. For each account identified above, please complete the attached form showing your unique
account identifier which is blind to the City, the account type, the total number of containers with
that account, the total number of pulls with that account, and the monthly revenues collected by
container for that account. (A form is required for each customer account identified in item #1
and item #2. The container total from all the forms should equal the container total specified
in item #3.)
5. The forms completed for item #4 above should include all normal billing charges for free, donated,
or discounted services. These normal billing charges should include but not be limited to
delivery, pull charges, disposal charges, transportation charges, final pull charges, and
return charges. Only donated or discounted services to non-profit organizations may be
excluded.
6. Total fee remitted to the City of Fayetteville for the month reported.
(This should equal the total of all the account fees calculated on the attached forms.)
I swear or affirm that all of the information provided above and on all attached forms is true,
correct, and complete to the best of my knowledge and belief.
Printed Name
Signature
Title
Phone #
Date
Customer Account Identifier
(use your unique identifier that is blind to the City)
Customer Account Type
(permanent or temporary)
Total containers with account
Total number of pulls with account
Container # Monthly Revenues
1
2
3
4
5
6
7
8
9
10
Total:
Donated or
Discounted Normal
Container # Billing Charge
1
2
3
4
5
Tota I:
Grand Total:
10% of Grand Total: Fee to be remitted to City
for this account
Attachment B: Recycling Documentation
Note: This form should also be used for reporting Construction & Demolition Waste
that is taken to a permitted Construction and Demolition Waste sorting facility
Required Supporting Information For Monthly Payment of Fees
Due on or before the 15th of each calendar month for the immediately
preceding calendar month. Payments of the fees received after the due
date shall be assessed a 10% penalty per month.
Hauler:
Month:
1. Please give the number of permanent customer accounts you have within the
corporate limits of the City of Fayetteville for the month reported.
2. Please give the number of temporary customer accounts you have within the
corporate limits of the City of Fayetteville for the month reported.
3. Please give the total number of containers placed with all your customer
accounts within the corporate limits of the City of Fayetteville for the month reported.
4. For each account identified above, please complete the attached form showing your unique
account identifier which is blind to the City, the account type, the total number of containers with
that account, the total number of pulls with that account, and the monthly revenues collected by
container for that account. (A form is required for each customer account identified in item #1
and item #2. The container total from all the forms should equal the container total specified
in item #3.)
5. The forms completed for item #4 above should include all normal billing charges for free, donated,
or discounted services. These normal billing charges should include but not be limited to
delivery, pull charges, disposal charges, transportation charges, final pull charges, and
return charges. Only donated or discounted services to non-profit organizations may be
excluded.
6. Total fee remitted to the City of Fayetteville for the month reported.
(This should equal the total of all the account fees calculated on the attached forms.)
I swear or affirm that all of the information provided above and on all attached forms is true,
correct, and complete to the best of my knowledge and belief.
Printed Name
Signature
Title
Phone #
Date
Customer Account Identifier
(use your unique identifier that is blind to the City)
Customer Account Type
(permanent or temporary)
Total containers with account
Total number of pulls with account
Container # Monthly Revenues
1
2
3
4
5
6
7
8
9
10
Total:
Donated or
Discounted Normal
Container # Billing Charge
1
2
3
4
5
Total:
Grand Total:
5% of Grand Total:
Fee to be remitted to City
for this account