Additional State of Emergency Related Instructions

State of Florida Contractor Information Worksheet

Contract No. 390-000-13-1: Potable Water and Food-grade Ice for Emergency Operations Contractor Information Contractor Name: Consolidated Disaster Services, LLC Respondent FEID 46-1396771 No.: MFMP Vendor No.: 001 (FEID-3 digit Seq.) Street Address: 101 Harrison Avenue City, State and Zip: Panama City, FL 32401

Internet Address: www.consolidateddisasterservices.com Telephone No.: (850) 767-5955 Toll-Free No.: N/A Fax No.: (850) 769-7715 Contract Administrator Name: Bo Rivard Title: Manager Street Address: 101 Harrison Avenue City, State and Zip: Panama City, FL 32401 E-Mail Address: [email protected] Telephone No.: (850) 767-5955 Toll-Free No.: N/A Cell Phone No.: (850) 819-1317 Fax No.: (850) 769-7715 Emergency Contact Yes Alternate Contract Administrator Name: William Harrison Title: Manager Street Address: 101 Harrison Avenue City, State and Zip: Panama City, FL 32401 E-Mail Address: [email protected] Telephone No.: (850) 767-5955 Toll-Free No.: N/A Cell Phone No.: (850) 832-9377 Fax No.: (850) 769-7715 Emergency Contact Yes Ordering: Please provide information where Customers should direct orders. You must provide a regular mailing address and e-mail address. If equipped to receive purchase orders electronically, you may also provide an Internet Address. If there is additional information you can provide to facilitate ordering during a declared state of emergency, please add the information at the bottom of this page.

SP #410 (02/2013) Page 1 of 2 Ordering Contact Name: Zenia Moran Title: Office Manager Street Address: 101 Harrison Avenue City, State and Zip: Panama City, FL 32401 E-Mail Address: [email protected] Telephone No.: (850) 767-5955 (850) 769-7714 Toll-Free No.: N/A Cell Phone No.: N/A Emergency No: (850) 819-1317 Fax No.: (850) 769-7715 Remit-To Information Remit-To Name: Zenia Moran

Remit-To Street 101 Harrison Avenue Address:

Remit-To City, State Panama City, FL 32401 And Zip:

Remit-To Email And/Or Internet [email protected] Address: Note: Please make sure the Ordering Instructions & Remit-To information provided above matches the MyFloridaMarketPlace ("MFMP") Vendor Registration account information: https://vendor.myfloridamarketplace.com/ PLEASE DUPLICATE DOCUMENT AS NEEDED.

Additional State of Emergency related instructions:

 Additional Emergency Contact Information: o William Harrison – cell (850) 832-9377 o Jay Trumbull – cell (850) 258-1226

SP #410 (02/2013) Page 2 of 2