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2012-078 Notice to Proceed - Ausland - Fire Station 2
CITY OF ASHLAND May 1, 2012 Aaron Ausland, President Ausland Builders,Inc. 3935 Highland Avenue Grants Pass, OR 975126 Project: City of Ashland Fire Station#2 Architect's Project# 1107.00 i Aaron, In accordance with the provisions of contract documents and the signed Owner-Contractor agreement, you are hereby authorized to proceed with the Work as defined in the agreement. This document constitutes your Notice-to-Proceed(as referenced in that agreement). We look forward to working with you on this project. John Karns Fire Chief Ashland Fire&Rescue Ashland Fire and Rescue Tel:(541)482-2770 455 and, r Blvd. Fax:((80) 735-29 8 Ashland,Oregon 97520 TTY:(800)135-2900 w .ashland.or.us 1 19 9 7 ED IT I ON i I AIA DOCUMENT A101-1997 ■ Standard Form of Agreement Between Owner and Contractor where the basis of payment is a STIPULATED SUM This document has important legal consequences. A G R E E M E N T made as of the Eighteenth day of April Consultation with an in the year two Thousand Twelve (In words,indicate day,inonmh and year) attorney is encouraged with respect to its BETWEEN -the Owner. completion or modification. (Name,address and other information) City of Ashland AIA Document A201-1997, 20 East Main Street Ashland,OR 97520-1849 General Conditions of the Contract for Construction,is adopted in this document by reference.Do not use with other general conditions and the Contractor: unless this document is (Name,address and other information) modified. Auhland Gr6up 3935 Highland Avenue Grants Pass OR 97526 This document has been approved and endorsed by The Associated General Contractors of America. The Project is: (Name and Imation) Ashland Fire Station 2 1860 Ashland Street Ashland,Oregon 97520 The Architect is: (Name,address and other information) Peck SmileyEttlin Architects,Inc. 4412 5W Corbett Avenue �•�� Portlarid,OR 97239 - 01997 AIA® Tel(503)248-9170 AIA DOCUMENT AIOI-1997 Fax(503)248-0223 OWNER-CONTRACTOR AGREEMENT The Owner and Contractor-agree as follows. The American Institute of Architects 1735 New York Avenue, N.W. Copyright 1915,1918,1925,1937,1951,1958, 1961, 1963,1967,1974,1977,1987,0 1997 by The American Institute of Washington,D.C.20006-5292 Architects. Reproduction of the material herein or substantial quotation of its provisions without permission of the AIA violates the copyright laws of the United States and will subject the violator to legal prosecution. WARNING:Unlicensed photocopying violates U.S.copyright laws and will subject the violator to legal prosecution. ARTICLE 1 THE CONTRACT DOCUMENTS The Contract Documents consist of this Agreement, Conditions of the Contract (General, Supplementary and other Conditions), Drawings, Specifications, Addenda issued prior to execution of this Agreement,other documents listed in this Agreement and Modifications issued after execution of this Agreement;these form the Contract,and are as fully a part of the Contract as if attached to this Agreement or repeated herein. The Contract represents the entire and integrated agreement between the parties hereto and supersedes prior negotiations, representa- tions or agreements,either written or oral.An enumeration of the Contract Documents,other than Modifications,appears in Article 8. ARTICLE 2 THE WORK OF THIS CONTRACT The Contractor shall fully execute the Work described in the Contract Documents,except to the extent specifically indicated in the Contract Documents to be the responsibility of others. ARTICLE 3 DATE OF COMMENCEMENT AND SUBSTANTIAL COMPLETION 3.1 The date of commencement of the Work shall be the date of this Agreement unless a different date is stated below or provision is made for the date to be fixed in a notice to proceed issued by the Owner. (Insert the date of commencement if it differs from the date of this Agreement or,if applicable,state that the date will be fixed in d notice to proceed.) - Ten calender days from the Notice to Proceed from the Owner. If,prior to the commencement of the Work,the Owner requires time to file mortgages,mechan- ic's liens and other security interests,the Owner's time requirement shall be as follows: 3.2 The Contract Time shall be measured from the date of commencement. 3.3 The Contractor shall achieve Substantial Completion of the entire Work not later than 240 days from the date of commencement,or as follows: (Insert number of calendar days.Alternatively,a calendar date may be used when coordinated with the date of commencement. Unless stated elsewhere in the Contract Documents, insert any requirements for earlier Substantial Completion olrcertain portions of the Work.) subject to adjustments of this Contract Time as provided in the Contract Documents. (Insert provisions,if any,for liquidated damages relating to failure to complete on time or for bonus payments for early completion of the Work.) Liquidated Damages are$500.00 per day as listed in A201 General Conditions 9.11.1. jlll o a 0 01997 AIA® AIA DOCUMENT A101-1997 OWNER-CONTRACTOR AGREEMENT The American Institute of Architects 1735 New York Avenue,N.W. Washington,D.C.20006-5292 WARNING:Unlicensed photocopying violates U.S.copyright laws and will subiect the violator to legal prosecution. - f i I 1 i I ARTICLE 4 CONTRACT SUM 4.1 The Owner shall pay the Contractor the Contract Sum in current funds for the Contractor's performance of the Contract.The Contract Sum shall be two million one hundred eighty four thousand four hundred Dollars(s 2,184,400.00 ), subject to additions and deductions as provided in the Contract Documents. 4.2 The Contract Sum is based upon the following alternates,if any,which are described in the Contract Documents and are hereby accepted by the Owner: (State the numbers or other identification of accepted alternates.If decisions on other alternates are to he made by the Owner subsequent'.to the execution of this Agreement,attach a schedule of such other alternates showing the amount for each and the date when that amount expires.) Alternate No.t: $97,000 Add Truck Exhaust Alternate No.S:$1,400 Add Room Signage Alternate No.6: $67,000 Add Oxygen Generator The amounts are Included in the total In section 4.1 above. 4.3 Unit prices,if any,areas follows: Rock Removal:$250 per cubic yard Additional Excavation/Engineered Fill:$40 per cubic yard. ARTICLE 5 PAYMENTS 5.1 PROGRESS PAYMENTS 5.1.1 Based upon Applications for Payment submitted to the Architect by the Contractor and Certificates for Payment issued by the Architect,the Owner shall make progress payments on account of the Contract Sum to the Contractor as provided below and elsewhere in the Contract Documents. 5.1.2 The period covered by each Application for Payment shall be one calendar month ending on the last day of the month,or as follows: 5.1.3 Provided that an Application for Payment is received by the Architect not later than the last day of a month,the Owner shall make payment to the Contractor not later than the thirtieth(30th) day of the following month. If an Application for Payment is received by the Architect after the application date fixed above,pay- , ment shall be made by the Owner not later than thirty(30) days after the Architect receives the Application for Payment. 5.1.4 Each Application for Payment shall be based on the most recent schedule of values submit- c°Oc ted by the Contractor in accordance with the Contract Documents.The schedule of values shall 01997 A I A allocate the entire Contract Sum among the various Portions of the Work.The schedule of values AIA DOCUMENT A101-1997 shall be prepared in such form and supported by such data to substantiate its accuracy as the OWNER-CONTRACTOR Architect may require. This schedule,unless objected to by the Architect,shall be used as a basis AGREEMENT .,for reviewing the Contractor's Applications for Payment. The American Institute of Architects 1735 New York Avenue, N.W. Washington,D.C.20006-5292 WARNING:Unlicensed photocopying violates U.S.copyright laws and will subject the violator to legal prosecution. i I 5.1.5 Applications for Payment shall indicate the percentage of completion of each portion of the Work as of the end of the period covered by the Application for Payment. 5.1.6 Subject to other provisions of the Contract Documents,the amount of each progress pay- ment shall be computed as follows: .1 Take that portion of the Contract Sum properly allocable to completed Work as deter- mined by multiplying the percentage completion of each portion of the Work by the share of the Contract Sum allocated to that portion of the Work in the schedule of val- ues,less retainage of five I percent(5.00 %). Pending final determi- nation of cost to the Owner of changes in the Work, amounts not in dispute shall be included as provided in Subparagraph 7.3.8 of AIA Document A201-1997; .2 Add that poi-tion of the Contract Sum properly allocable to materials and equipment delivered and suitably stored at the site for subsequent incorporation in the completed construction (or, if approved in advance by the Owner,suitably stored off the site at a location agreed upon in writing),less retainage of five percent(5.00 s Subtract the aggregate of previous payments made by the Owner;and .4 Subtract amounts,if any, for which the Architect has withheld or nullified a Certificate for•Payment as provided in,Paragraph 9.5 of AIA Document A201-1997. 5.1.7 The progress payment amount determined in accordance with Subparagraph 5.1.6 shall be further modified under the following circumstances: .1 Add,upon Substantial Completion of the Work,a sum sufficient to increase the total pay- merits to the full amount of the Contract Sum,less such amounts as the Architect shall determine for incomplete Work,retainage applicable to such work and unsettled claims; and(Subparagraph 0.5 of AIA Document A201-1997 requires release of applicable relainage upon Substantial Completion of Work with consent of surety,if any) .2 Add,if final completion'of the Work is thereafter materially delayed through no fault of the Contractor,any additional amounts payable in accordance with Subparagraph 9.10.3 of AIA Document A2o1-1997. 5.1.9 Reduction or limitation of relainage,if any,shall be as follows: (If it is intended,prior to Substantial Completion of the entire Work,to reduce or limit the retainage resulting from the percentages inserted in Clauses 5.1.6.1 and 5.1.6.2 above,and this is not explained elsewhere in the Contract Documents,insert here provisions for such reduction or limitation.) III 5.1.9 Except with the COwner's prior approval,the Contractor shall not make advance payments to suppliers for materials or equipment which have not been delivered and stored at the site. O 51 FINAL PAYMENT 01997 AIA® 511 Final payment;constituting the entire unpaid balance of the Contract Sum,shall be made AIA DOCUMENT A101-1997 by the Owner to the Contractor when: OWNER-CONTRACTOR .1 the Contractor'has fully performed the Contract except for the Contractor's responsibil- AGREEMENT ity to correct Work as provided in Subparagraph 12.2.2 of AIA Document A2ol-1997,and The American Institute to satisfy other re uirements,if any,which extend beyond final payment;and of Architects .2 a final Certificate for Payment has been issued by the Architect. 1735 New York Avenue,N.W. Washington,D.C.20006-5292 WARNING:Unlicensed photocopying violates U.S.copyrlght laws and will subject the violator to legal prosecution. I 5.2.2 The Owner's final payment to the Contractor shall be made no later than 3o days after the issuance of the Architect's final Certificate for Payment,or as follows: ARTICLE 6 TERMINATION OR SUSPENSION 6.1 The Contract may be terminated by the Owner or the Contractor as provided in Article 14 of AIA Document A2o1-r997. 6.2 The Work may be suspended by the Owner as provided in Article 14 of AIA Document A2o1-1997. ARTICLE 7 MISCELLANEOUS PROVISIONS 7.1 Where reference is made in this.Agreement to a provision of AIA Document A201-1997 or another Contract Document,the reference refers to that provision as amended or supplemented by other provisions of the Contract Documents. 7.2 Payments due and "unpaid under the Contract shall bear interest from the date payment is due at the rate stated below,or in the absence thereof,at the legal rate prevailing from time to time at the place where the Project is located. (Insert rate of interest agreed upon,if any.) (Usury laws and requirements under the Federal Truth in Lending Act,similar state and local consumer credit ' .laws and other regulations at the Owners and Contractor's principal places of business, the location of the Project and elsewhere may affect the validity of this provision. Legal advice should be obtained with respect to deletions or modifications,and also regarding requirements such as written disclosures or waivers.) 7.3 The Owner's representative is: (Name,address and other information) John Karns (or Jim MacNamara) Ashland Fire and Rescue 455 Siskiyou Boulevard Ashland,OR 97520 7.4 The Contractor's representative is: (Name,address and other information) Zack Secrest Ausland Group 3935 Highland Avenue Grants Pass OR 97526 p 7.5 Neither the Owner's nor the Contractor's representative shall be changed without ten days' written notice to the other party. 7.6 Ot her provisions: lll� 7.6.1 The contractor is to comply with ORS 279C.580(10 day payment to subcontractors and interest penalties after 30 days). ° o. o 7.6.2 The contractor shall not allow any lien or claim to be filed against the City on account of �Oo any labor or material furnished. 01997 AIA® 7.6.3 All references to the General Conditions in this contract are to the AIA A201 2007 and AIA DOCUMENT AIOI-1997 its edits as included in the Project Specification manual. OWNER-CONTRACTOR AGREEMENT The American Institute of Architects 1735 New York Avenue,N.W. Washington,D.C.20006-5292 WARNING:Unlicensed photocopying violates U.S.copyright laws and will subject the violator to legal prosecution. ARTICLE 8 ENUMERATION OF CONTRACT DOCUMENTS 8.1 The Contract Documents, except for Modifications issued after execution of this Agreement,are enumerated as follows: 8.1.1 The Agreement is this executed 1997 edition of the Standard Form of Agreement Between Owner and Contractor,AIA Document Aim-1997. 8.1.2 The General Conditions are the 1997 edition of the General Conditions of the Contract for Construction,AIA Document A2o1-1997 8.1.3 The Supplementary and other Conditions of the Contract are those contained in the Project Manual dated March 2012 and are as follows: Document Title Pages AIA AMI-'2007 General Conditions 43 8.1.4 The Specifications are those contained in the Project Manual dated as in Subparagraph 8.1.3, and are as follows: (Either list the Specifications here or refer to an exhibit attached to this Agreement.) Section Title Pages Sections 00010 through Advertisement For Bids to Sound 791 17716 Reinforcement &Soils Report Appendix 1:Soils Report 8.1.5 The Drawings are as follows,and are dated 3-09-2012 unless a different dale is shown below: (Either list the Drmvinis here or refer to an exhibit attached to this Agreement.) Number Title Date Section 01050 List of Drawings 3-9-2102 811.1 o O 01997 AIA® AIA DOCUMENT A101-1997 OWNER-CONTRACTOR AGREEMENT The American Institute of Architects 1735 New York Avenue,N.W. Washington,D.C.20006-5292 WARNING:.Unlicensed photocopying violates U.S.copyright laws and will subject the violator to legal prosecution. •4 I The Addenda,if any,are as follows: Number Date Pages No.1 3-23-2012 26 No.2 3-29-2012 37 No.3 4-02-2012 13 This Agreement is entered into as of the day and ye first wr tten above and is executed in at least three original copies,of which one is to be delive d to the C tractor,one to the Architect for use in the administratiLolthe tr act,and the emainder to O ner. OWNER(Signature T R A C T O R(Signature) . David Kanner,City AdministratorC�NCrV� —�US�Cu/L� (printed name and title) (Printed name and title) O CAUTION:you should sign an original AIA document or a licensed reproduction.Originals contain the AIA logo printed in red;licensed reproductions are those produced in accordance with the Instructions to this document. 01997 AIA® AIA DOCUMENT A101.1997 OWNER-CONTRACTOR AGREEMENT 8d as to farm The American Institute - of Architects 1735 New York Avenue, N.W. Washington, D.C.20006-5292 ...............:._____'_`_•____.,__..,_:_._.Ile ___...:_...:_...._..a-All...:,:....w...,i.a........I...i....,.e...«.,., e Document A312T"' - 2010 Performance Bond Bond#929524702 CONTRACTOR: SURETY: (Name,legal status and address) (Name, legal status andprincipal place Ausland Builders, Inc. of business) 3935 Highland Avenue Western Surety Company This document has important legal Grants Pass, OR 97526 12909 SW 68th Parkway, Suite 200 consequences.Consultation with Portland, OR 97223 an attorney is encouraged with OWNER: respect to Its completion or (Name,legal status and address) modification. City of Ashland 455 Slskiyou Blvd. Any singular reference to Ashland, OR 97520 Contractor,Surety,owner or other party shall be considered CONSTRUCTION CONTRACT plural where applicable. AIA Document A312-2010 Date: A P,^t \ l$ I a,�1 y combines two separate bonds,a Amount: .Performance Bond and a Two Million, One Hundred Eighty-Four Thousand, Four Hundred and No/l00ths Dollars- Payment Bond,into one form. Description: ($2,1$4,400.00) This Is not a single combined (Name and location) Performance and Payment Bond. Ashland Fire & Rescue, Fire Station 2 1860 Ashland Street Ashland, OR 97520 BOND Date. ' Pr' 1 -2-D%Z (Not earlier than Construction Contract Date) Amount: Two Million, One Hundred Eighty-Four Thousand, Four Hundred and No/100ths Dollars---- ($2,184,400.00) ry Modifications to this Bond: ffNone 0 See Section 16 CONTRACT A PRINCIPAL SURETY Company: (Corporate Seal) Company: (Corporate Seal) Ausland B ild 1 c. Western SuCompany Signature: Signature: r "� Name 1A tCt,n A Name Ruby . Haskell and Title: P1.e51L\gy�'� and Title: Attorney-in-Fact (Any additional signatures appear on the last page of this Performance Bond.) (FOR INFORMATION ONLY—Name,address and telephone) AGENT or BROKER: OWNER'S REPRESENTATIVE: Ward Insurance Agency Inc. (Architect, Engineer or other parry.) P O Box 10167 Eugene OR 97440-2167 (541) 687-1117 Init. AIA Document A312--2010.The American Imblute ofArchltec%. auiu 1 ! §I no Contractor and Surety,jointly and severally,bind themselves,their heirs,executors,administrators,successors and assigns to the Owner for the performance of the Concoction Contract,which is incorporated herein by reference. §2 If the Contractor performs the Construction Contract,the Surety and the Contractor shall have no obligation under this Bond,except when applicable to participate in a conference as provided in Section 3. §3 If there is no Owner Default under the Construction Contract,the Surety's obligation under this Bond shall arise after 1 the Owner first provides notice to the Contractor and the Surety that the Owner is considering declaring a Contractor Default.Such notice shall indicate whether the Owner is requesting a conference among the Owner,Contractor and Surety to discuss the Contractor's performance.If the Owner does not request a conference,the Surety may,within five(5)business days after receipt of the Owner's notice, request such a conference.If the Surety timely requests a conference,the Owner shall attend.Unless the Owner agrees otherwise,any conference requested under this Section 3.1 shall be held within ten (10)business days of the Surety's receipt of the Owner's notice.If the Owner,the Contractor and the Surety agree,the Contractor shall be allowed a reasonable time to perform the Construction Contract, but such an agreement shall not waive the Owner's right,if any,subsequently to declare a Contractor Default; .2 the Owner declares a Contractor Default,terminates the Construction Contract and notifies the Surety; and .3 the Owner has agreed to pay the Balance of the Contract Price in accordance with the terms of the Construction Contract to the Surety or to a contractor selected to perform the Construction Contract. §4 Failure on the part of the Owner to comply with the notice requirement in Section 3.1 shall not constitute a failure to comply with a condition precedent to the Surety's obligations,or release the Surety from its obligations,except to the extent the Surety demonstrates actual prejudice. §5 When the Owner has satisfied the conditions of Section 3,the Surety shall promptly and at the Surety's expense take one of the following actions: §51 Arrange for the Contractor,with the consent of the Owner,to perform and complete the Construction Contract; §5.2 Undertake to perform and complete the Construction Contract itself,through its agents or independent contractors; §5.3 Obtain bids or negotiated proposals from qualified contractors acceptable to the Owner for a contract for performance and completion of the Construction Contract,arrange for a contract to be prepared for execution by the Owner and a contractor selected with the Owner's concurrence,to be secured with performance and payment bonds executed by a qualified surety equivalent to the bonds issued on the Construction Contract,and pay to the Owner the amount of damages as described in Section 7 in excess of the Balance of the Contract Price incurred by the Owner as a result of the Contractor Default;or §5.4 Waive its right to perform and complete,arrange for completion,or obtain a new contractor and with reasonable promptness under the circumstances: .1 After investigation,determine the amount for which it may be liable to the Owner and,as soon as practicable after the amount is determined,make payment to the Owner;or .2 Deny liability in whole or in part and notify the Owner,citing the reasons for denial. §6 If the Surety does not proceed as provided in Section 5 with reasonable promptness,the Surety shall be deemed to be in default on this Bond seven days after receipt of an additional written notice from the Owner to the Surety demanding that the Surety perform its obligations under this Bond,and the Owner shall be entitled to enforce any remedy available to the Owner.If the Surety proceeds as provided in Section 5.4,and the Owner refuses the payment or the Surety has denied liability,in whole or in part,without further notice the Owner shall be entitled to enforce any remedy available to the Owner. Init. AIA Document A312°—2010.The American Institute of Architects. 2 §7 If the Surety elects to act under Section 5.1,52 or 5.3,then the responsibilities of the Surety to the Owner shall not be greater than those of the Contractor under the Construction Contract,and the responsibilities of the Owner to the Surety shall not be greater than those of the Owner under the Construction Contract.Subject to the commitment by the Owner to pay the Balance of the Contract Price,the Surety is obligated,without duplication,for .1 the responsibilities of the Contractor for correction of defective work and completion of the Construction Contract; .2 additional legal,design professional and delay costs resulting from the Contractor's Default,and resulting from the actions or failure to act of the Surety under Section 5;and ,3 liquidated damages,or if no liquidated damages are specified in the Construction Contract,actual damages caused by delayed performance or non-performance of the Contractor: §81f the Surety elects to act under Section'5,1,5.3 or 5.4,the Surety's liability is limited to the amount of this Bond. §9 The Surety shall not be liable to the Owner or others for obligations of the Contractor that are unrelated to the Construction Contract,and the Balance of the Contract Price shall not be reduced or set off on account of any such unrelated obligations.No right of action shall accrue on this Bond to any person or entity other than the Owner or its heirs,executors,administrators,successors and assigns. §10 The Surety hereby waives notice of any change,including changes of time,to the Construction Contract or to related subcontracts,purchase orders and other obligations. §11 Any proceeding,legal or equitable,under this Bond may be instituted in any court of competent jurisdiction in the location in which the work or part of the work is located and shall be instituted within two years after a declaration of Contractor Default or within two years after the Contractor ceased working or within two years after the Surety refuses or fails to perform its obligations under this Bond,whichever occurs first.If the provisions of this Paragraph are void or prohibited by law,the minimum period of limitation available to sureties as a defense in the jurisdiction of the suit shall be applicable. §12 Notice to the Surety,the Owner or the Contractor shall be mailed or delivered to the address shown on the page on which their signature appears. §13 When this Bond has been furnished to comply with a statutory or other legal requirement in the location where the construction was to be performed,any provision in this Bond conflicting with said statutory or legal requirement shall be deemed deleted herefrom and provisions conforming to such statutory or other legal requirement shall be deemed incorporated herein.When so furnished,the intent is that this Bond shall be construed as a statutory bond and not as a common law bond. §14 Definitions §14.1 Balance of the Contract Price.The total amount payable by the Owner to the Contractor under the Construction Contract after all proper adjustments have been made,including allowart"to the Contractor of any amounts received or to be received by the Owner ht settlement of insurance or other claims for damages to which the Contractor is entitled,reduced by all valid and proper payments made to or on behalf of the Contractor under the Construction Contract. §14,2 Construction Contract,The agreement between the Owner and Contractor identified on the cover page, including all Contract Documents and changes made to the agreement and the Contract Documents. §14,3 Contractor Default.Failure of the Contractor,which has not been remedied or waived,to perform or otherwise to comply with a material term of the Construction Contract. §14.4 Owner Default Failure of the Owner,which has not been remedied or waived,to pay the Contractor as required under the Construction Contract or to perform and complete or comply with the other material terms of the Construction Contract. §14.5 Contract Documents.All the documents that comprise the agreement between the Owner and Contractor. §151f this Bond is issued for an agreement between a Contractor and subcontractor,the term Contractor in this Bond shall be deemed to be Subcontractor and the term Owner shall be deemed to be Contractor. Init. ALA Document Aal2--2010.The Amedc lro0tute or Architects. 3 §16 Modifications to this bond are as follows: (Space is provided below ,for additional signatures ofadded parlies,other than those appearing on the cover page.) CONTRACTOR AS PRINCIPAL SURETY Company: (Corporate Seal) Company: (C»Porate Sect) Signature: Signature: Name and Title: Name and Title:" Address Address CAUTION:You should sign an original AIA Contract Document,on which this text appears In RED.An original assures that changes will not be obscured. Init. AIA OOcan•ent A312°-260.The Arrrericen lnsfitufe of Amldteets. 4 1A Document A312 TM . 2010 Payment Bond Bond #929524702 CONTRACTOR: SURETY: (Name,legal status and address) (Name,legal status and principal place Ausland Builders Inc. of business) 3935 Highland Avenue Western Surety Company This document has Important legal Grants Pass, OR 97526 12909 SW 68th Parkway, Suite 200 consequences.Consultation with Portland, OR 97223 an anomey is encouraged with - OWNER: respect to Its completion or (Name, legal status and address) modification. City of Ashland Any singular reference to 455 Siskiyou Blvd. Contractor,Surety,Owner or Ashland, OR 97520 other party shall be considered CONSTRUCTION CONTRACT plural where applicable. Date: . r,`1 \ I aO 1y AIA Document A312-2010 Pcombines two separate bonds,a Amount: Performance Bond and a Two Million, One Hundred Eighty-Four Thousand, Four Hundred and No/100ths Dollars-- Payment Bond,Into one form. Description: ($2,184,400.00) This is not a single combined• (Name and location) Performance and Payment Bond. Ashland Fire & Rescue, Fire Station 2 1860 Ashland Street Ashland, OR 97520 BOND Date:la p+=+ \ \ q =x 1'y (Not earlier than Construction Contract Date) Amount:Two Million, One Hundred Eighty-Four_Thousand, Four Hundred and No/100ths Dollars ---- ($2,184,400.00) Modifications to this Bond: CKNone 0 See Section 18 CONTRACT R AS RINCIPAL SURETY Company: (Corporate Seal) Company: (Corporate Seal) Ausland B 'Ides I estern S ty Company %��� Signature: Signature: f• AA& l Name r1-pvc�n ya-U S'VAV-16\ Name Rublr . Haskell and Tide: Qre.�is•\E�'�' and Title: Attorney-in-Fact (Any additional signatures appear on the last page of this Payment Bond.) (FOR INFORMA TION ONL Y—Name,address and telephone) AGENT or BROKER: OWNER'S REPRESENTATIVE: Ward Insurance Agency, Inc. (Architect,Engineer orotherparty) P0 Box 10167 Eugene OR 97440-2167 (541) 687-1117 Init. AIA Document A312--2010.The American Institute of Architects. anr+o 5 i §1 The Contractor and Surety,jointly and severally,bind themselves,their heirs,executors,administrators,successors and assigns to the Owner to pay for labor,materials and equipment furnished for use in the performance of the Construction Contract,which is incorporated herein by reference,subject to the following terms. §2lfthe Contractor promptly makes payment of all sums due to Claimants,and defends,indemnifies and,holds harmless the Owner from claims,demands,liens or suits by any person or entity seeking payment for labor,materials or equipment furnished for use in the performance of the Construction Contract,then the Surety and the Contractor shall have no obligation under this Bond. . §3 If there is no Owner Default under the Construction Contract,the Surety's obligation to the Owner under this Bond shall arise after the Owner has promptly notified the Contractor and the Surety(at the address described in Section 13) of claims,demands, liens or suits against the Owner or the Owner's property by any person or entity seeking payment for labor,materials or equipment furnished for use in the performance of the Construction Contract and tendered defense of such claims,demands,liens or suits to the Contractor and the Surety. §d When the Owner has satisfied the conditions in Section 3,the Surety shall promptly and at the Surety's expense defend,indemnify and hold harmless the Owner against a duly tendered claim,demand, lien or suit. §5 The Surety's obligations to a Claimant under this Bond shall arise after the following: §5.1 Claimants,who do not have a direct contract with the Contractor, .1 have furnished a written notice of non-payment to the Contractor,stating with substantial accuracy the amount claimed and the name of the party to whom the materials were,or equipment was,furnished or supplied or for wham the labor was done or performed,within ninety(90)days after having last performed labor or last furnished materials or equipment included in the Claim;and .2 have sent a Claim to the Surety(at the address described in Section 13). §5.2 Claimants,who are employed by or have a direct contract with the Contractor,have sent a Claim to the Surety(at the address described in Section 13). §6 If a notice of non-payment required by Section 5.1.1 is given by the Owner to the Contractor,that is sufficient to satisfy a Claimant's obligation to famish a written notice of non-payment under Section 5.1.1. §7 When a Claimant has satisfied the conditions of Sections 5.1 or 5.2,whichever is applicable,the Surety shall promptly and at the Surety's expense take the following actions: §71 Send an answer to the Claimant,with a copy to the Owner,within sixty(60)days after receipt of the Claim, stating the amounts that are undisputed and the basis for challenging any amounts that are disputed;and §7.2 Pay or arrange for payment of any undisputed amounts. §7.3'fhe Surety's failure to discharge its obligations under Section 7.1 or Section 7.2 shall not be deemed to uonstilulc a waiver of defenses the Surety or Contractor may have or aequiro as to a Claim,except as to undisputed amounts for which the Surety and Claimant have reached agreement.If,however,the Surety fails to discharge its obligations under Section 7.1 or Scction 7.2,the Surety shall indemnify the Claimant for the reasonable attorney's fees the Claimant incurs thereafter to recover any sums found to be due and owing to the Claimant. §8 The Surety's total obligation shall not exceed the amount of this Bond,plus the amount of reasonable attorney's fees provided under Section 7.3,and the amount of this Bond shall be credited for any payments made in good faith by the Surety. §9 Amounts owed by the Owner to the Contractor under the Construction Contract shall be used for the performance of the Construction Contract and to satisfy claims, if any,under any construction pcdormanee bond.By the Contractor furnishing and the Owner accepting this Bond,they agree that all funds earned by the Contractor in the performance of the Construction Contract are dedicated to satisfy obligations of the Contractur and Surely under this Bond,subject to the Owner's priority to use the funds for the completion of the work. Init. AIA Document A312--2010,The American tnstltule of AmNlects. s I §10 The Surety shall not be liable to the Owner,Claimants or others for obligations of the Contractor that are unrelated to the Construction Contract.The Owner shall not be liable for the payment of any costs or expenses of any Claimant under this Bond,and shall have under this Bond no obligation to make payments to,or give notice on behalf of,Claimants or otherwise have any obligations to Claimants under this Bond. §11 The Surety hereby waives notice of any change,including changes of time,to the Construction Contract or to related subcontracts,purchase orders and other obligations. §12 No suit or action shall be commenced by a Claimant under this Bond other than in a court of competent jurisdiction in the state in which the project that is the subject of the Construction Contract is located or after the expiration of one year frbmthe date(1)on which the Claimant sent a Claim to the Surety pursuant to . Section 5.1.2 or 5.2,or(2)on which the last labor or service was performed by anyone or the last materials or equipment were furnished by anyone under the Construction Contract,whichever of(1)or(2)first occurs.If the provisions of this Paragraph are void or prohibited by law,the minimum period of limitation available to sureties as a defense in the jurisdiction of the suit shall be applicable. §13 Notice and Claims to the Surety,the Owner or the Contractor shall be mailed or delivered to the address shown on the page on which their signature appears.Actual receipt of notice or Claims,however accomplished,shall be sufficient compliance as of the date received. §14 When this Bond has been furnished to comply with a statutory or other legal requirement in the location where the construction was to be performed,any provision in this Bond conflicting with said statutory or legal requirement shall be deemed deleted herefrom and provisions conforming to such statutory or other legal requirement shall be deemed incorporated herein.When so furnished,the intent is that this Bond shall be construed as a statutory bond and not as a common law bond. §15 Upon request by any person or entity appearing to be a potential beneficiary of this Bond,the Contractor and Owner shall promptly furnish a copy of this Bond or shall permit a copy to be made. §16 Definitions §16.1 Claim.A written statement by the Claimant including at a minimum: .1 the name of the Claimant; .2 the name of the person for whom the labor was done,or materials or equipment furnished; .3 a copy of the agreement or purchase order pursuant to which labor,materials or equipment was furnished for use in the performance of the Construction Contract; .4 a brief description of the labor,materials or equipment furnished; .5 the date on which the Claimant last performed labor or last furnished materials or equipment for use in the performance of the Construction Contract; .6 the total amount earned by the Claimant for labor,materials or equipment furnished as of the date of the Claim; .7 the total amount of previous payments received by the Claimant;and .8 the total amount due and unpaid to the Claimant for labor,materials or equipment furnished as of the date of the Claim. §16.2 Claimant.An individual or entity having a direct contract with the Contractor or with a subcontractor of the Contractor to furnish labor,materials or equipment for use in the performance of the Construction Contract.The term Claimant also includes any individual or entity that has rightfully asserted a claim under an applicable mechanic's lien or similar statute against the real property upon which the Project is located.The intent of this Bond shall be to include without limitation in the terms"labor,materials or equipment"that part of water,gas,power,light,heat,oil, gasoline,telephone service or rental equipment used in the Construction Contract,architectural and engineering services required for performance of the work of the Contractor and the Contractor's subcontractors,and all other items for which a mechanic's lien may be asserted in the jurisdiction where the labor,materials or equipment were furnished. §16.3 Construction Contract.The agreement between the Owner and Contractor identified on the cover page, including all Contract Documents and all changes made to the agreement and the Contract Documents. [nit. ALA,OOCumant A313°-2010.The Amariwn InatituM Of Are111190ra. 7 I §16.4 Owner Default,Failure of the Owner,which has not been remedied or waived,to pay the Contractor as required under the Construction Contract or to perform and complete or comply with the other material terms of the Construction Contract. §16.6 Contract Documents.All the documents that comprise the agreement between the Owner and Contractor. §17 If this Bond is issued for an agreement between a Contractor and subcontractor,the term Contractor in this Bond shall be deemed to be Subcontractor and the term Owner shall be deemed to be Contractor. §18 Modifications to this bond are as follows: (Space is provided below for additional signatures of added parties, other than those appearing on the cover page.) CONTRACTOR AS PRINCIPAL SURETY Company: (Corporate Seal) Company: (Corporate Seal) Signature: Signature: Name and Title: Name and Title: Address Address CAUTION:You should sign an original AIA Contract Document,on which this text appears in RED.An original assures that changes will not be obscured. Init. AIA Document A31I°-2010.The Aierben Institute of Architects. 8 Western Surety Company POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY-IN-FACT Know All Men By These Presents,That WESTERN SURETY COMPANY,a South Dakota corporation,is a duly organized and existing corporation having its principal office in the City of Sioux Falls, and Slate of South Dakota,and that it does by virtue of the signature and seal herein affixed hereby make,constitute and appoint Ruby M Haskell, Larry C Buck, Paul Jensen, Kristen McGillvrey, Robert A Harvey, Margaret Hargett, Steven J Hanson, Catherine L Gomes,Individually of Eugene,OR,its true and lawful Attomey(s)-in-Fact with full power and authority hereby conferred to sign,seal and execute for and on its behalf bonds, undertakings and other obligatory instruments of similar nature - In Unlimited Amounts - and to bind it thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of the corporation and all the acts of said Attorney,pursuant to the authority hereby given,are hereby ratified and confirmed. This Power of Attorney is made and executed pursuant to and by authority of the Bylaw printed on the reverse hereof,duly adopted,as indicated,by the shareholders of the corporation. In Witness Whereof,WESTERN SURETY COMPANY has caused these presents to be signed by its Senior Vice President and its corporate seal to be hereto affixed on this 7th day of October,2011. _..gjE7 WESTERN SURETY COMPANY C PAP Nbig 04 Paul VrBruflat,Senior Vice President State of South Dakota l JT County of Minnehaha ss , On this 7th day of October,2011,before me personally came Paul T.Brunat,to me known,who,being by me duly sworn,did depose and say: that he resides in the City of Sioux Falls,State of South Dakota;that he is the Senior Vice President of WESTERN SURETY COMPANY described in and which executed the above instrument;that he knows the seal of said corporation;that the seal affixed to the said instrument is such corporate seal;that it was so affixed pursuant to authority given by the Board of Directors of said corporation and that he signed his name thereto pursuant to like authority, and acknowledges same to be the act and deed of said corporation. My commission expires ♦4"`•`44944444449494++�'+■ +' D. KRELL ; November 30,2012 ±�NOTABY PUBLIC OUTH DAKOTA ^ + sEAL S SEAL s .44444444444444994444494 P D.Krell,No,ry Public CERTIFICATE I,L. Nelson, Assistant Secretary of WESTERN SURETY COMPANY do hereby certify that the Power of Attorney hereinabove set forth is still in force,and further certify that the By-Law of the corporation printed on the reverse hereof is still in force. In testimony whereof I have hereunto subscribed my name and affixed the seal of the said corporation this 1 R day of �T if'% \. 2012 . T "� "•E.YO# WESTERN SURETY COMPANY e�ja+(•AV Yr_ L.Nelson,Assistant Secretary Form F4280-09-06 ,aco CERTIFICATE OF LIABILITY INSURANCE DATE(MM DDIV 4/16/2012 2 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER NAME: Kim Schnetzky Ward Insurance Agency ac°tea E . (541)687-1117 NC Noll (541)342-8280 P 0 Box 10167 INSURERS)AFFORDING COVERAGE NAICi Eugene OR 97440 INSURERA:Continental Western Ins. Co. 10804 INSURED INSURER B: Ausland Builders Inc INSURER C: DBA: Ausland Group INSURERD: 3935 Highland Avenue INSURER E: Grants Pass OR 97526 INSURERF: COVERAGES CERTIFICATE NUMBER:CL1213015819 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS. INSR rypE OF DLS POLICY BEE POLICY EXP LTR POLICY NUMBER MMIODIYYYV MMIDDIY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Eaocalnence $ 300,000 A CLAIMSWADE QOCCUR X 2967760 /1/2012 /1/2013 MED EXP Hoy one person) $ 10,000 X $1,000 PD DIED PERSONAL B ADV INXRY $ 1,000,000 PER OCCURRENCE GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY X PR0. LOC $ AUTOMOBILE LIABILITY (CEOe ecadent IMI 1,000,000 A X MY AUTO BODILY Nd1RY(Per person) $ ALL O`ANED SCHEDULED 2967760 /1/2012 /1/2013 BODILY PJJURY(Per eccidend) $ ALTOS AUTOS X HIRED AUTOS X NON MED PPROPERdO WAGE $ Uninsumdmotonstcom Nned $ X UMBRELLA LAB [XI OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAMS ADE AGGREGATE $ DED I I RETENTION$ 02967761 /1/2012 /1/2013 $ WOWERSCOMPENSATION RCSTATU- OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETORIPARTNERIE%ECUTIVE E.L.EACH ACCIDENT $ OFFICERIMEMBE EXCLUDED? NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ II YYee tleecn euntler DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Limited Pollution 2967760 /1/2012 /1/2013 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(Attach ACORD 101,Adddlonal Remarks Schedule,If more space Is required) CITY OF ASHLAND, THE ARCHITECT, THEIR E14PLOYEES AND AGENTS ARE NAMED AS ADDITIONAL INSUREDS AS RESPECTS WORK PERFORMED BY NAMED INSURED UNDER WRITTEN CONTRACT AGREEMENT S PER ATTACHED CLCGO020 S CLCG2016. COVERAGE IS PRIMARY S NON-CONTRIBUTORY. WAIVER OF SUBROGATION IS APPLICABLE PER ATTACHED CLCGO020. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF ASHLAND ACCORDANCE WITH THE POLICY PROVISIONS. 455 SISKIYOU BOULEVARD ASHLAND, OR 97520 AUTHORIZED REPRESENTATIVE Paul Jensen/CLYNN ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005).01 The ACORD name and logo are registered marks of ACORD , NAMED INSURED:AUSLANG BUILDERS INC DBA:AUSLAND GROUP POLICY#CWP2967760 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS' COMMERCIAL GENERAL LIABILITY ENHANCEMENT ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. MEDICAL PAYMENTS (b) That is Fire, Lightning, Explosion or If SECTION I— COVERAGE C MEDICAL PAY- Sprinkler Leakage insurance for prem- MENTS is not otherwise excluded from this ises rented to you or temporarily occu- Coverage Part: pied by you with the permission of the owner; 1. The Medical Expense Limit provided by.this 4. Paragraph 9.a. of SECTION V — DEFINI- LIMITS OF INSURANCE,, shall be the policy, subject to the terms SECTION III - TIONS is deleted and replaced by the follow- greater of: ing: a. $10,000; or a. A contract for a lease of premises. However, that portion of the contract for b. The Medical Expense Limit shown in the a lease of premises that indemnifies any Declarations of this Coverage Part. person or organization for damage by B. FIRE, LIGHTNING, EXPLOSION, SMOKE AND fire, lightning, explosion or sprinkler SPRINKLER LEAKAGE DAMAGE TO PREM- leakage premises while rented to you ISES YOU RENT or temporarily occupied by you with permission of the owner is not an "in- If damage to premises rented to you under Cov- sured contract!'; erage A. is not otherwise excluded from this pol- C. NON-OWNED WATERCRAFT icy,the following applies: 1. The last paragraph of SECTION 1 — COW 1. Paragraph g.(2) of SECTION I — COVER- ERAGE A.2. Exclusions is deleted and re- AGE A.2. Exclusions is deleted and re- placed by the following: placed by the following: Exclusions c. through n. do not apply to A watercraft you do not own that is: damage by fire, lightning, explosion or sprin- (a) Less than 51 feet long; and kler leakage to premises while rented to your (b) Not used to carry persons or property for or temporarily occupied by you with permis- a charge, sion of the owner. A separate limit of insur- ance applies to this coverage as described D. SUPPLEMENTARY PAYMENTS in SECTION III--LIMITS OF INSURANCE. SECTION I — SUPPLEMENTARY PAYMENTS 2. Paragraph 6. of SECTION III — LIMITS OF — COVERAGES A AND B is amended as fol- INSURANCE is deleted and replaced by the lows: following: 1. The limit of insurance in paragraph 1.b. is 6. Subject to 5. above,the greater of: increased from$250 to$2,500;and a. $300,000; or 2. The limit of insurance in paragraph 1.d. is b. the Damage To Premises Rented increased from $250 to$500. To You Limit shown in the Declare- E. AUTOMATIC ADDITIONAL INSURED — tions; SPECIFIED RELATIONSHIPS Is the most we will pay under COVER- The following is added to Paragraph 2. of SEC- AGE A for damages because of "prop- TION II -WHO IS AN INSURED: erty damage"to any one premises,while e. Any person or organization described in rented to you, or temporarily occupied by paragraph f. below,whom you and such per you with the permission of the owner son or organization have agreed in writing in arising out of any one fire, lightning, ex- a contract or agreement that such person or plosion or sprinkler leakage incident. organization be added as an additional in- 3. Paragraph 4.b.(1)(b) Other Insurance of sured on your policy. SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS is deleted and re- placed by the following: CL CG 00 20 03 07 Includes copyrighted materiel of Insurance Services Page 1 of 6 Orrico,[tic.,with Its permission Such person or organization is an insured (c) The ownership, maintenance,or use provided: I of any elevators. (1) The written or oral contract or agree- F. ADDITIONAL INSURED—OWNERS, LESSEES ment is: OR CONTRACTORS—AUTOMATIC STATUS (a) Currently in effect or becomes effec- 1. SECTION It — WHO IS AN INSURED is live during the policy period;and amended to include as an additional insured (b) Executed prior to an"occurrence"or any person or organization for whom you are offense to which this insurance performing operations when you and such would apply. person or organization have agreed in writ- ing in a contract or agreement that such per- (2) They are not specifically designated as son or organization be added as an addi- an additional insured under any other tional insured on your policy. Such person or provision of, or endorsement added to, organization is an additional insured only this policy. with respect to liability for "bodily injury", f. Only the following persons or organizations "property damage" or "personal and adver- are additional insureds under this endorse- tising injury'caused,in whole or in part, by. ment, and coverage provided to such addi- a. Your acts or omissions;or tional insureds is limited as provided herein: b. The acts or omissions of those acting on (1) The manager or lessor of a premise your behalf; leased to you, but only with respect to li- ability arising from the ownership, main- in the performance of your ongoing opera- tenance or use of that part of the prem- tions for the additional insured, ises leased to you and subject to the fol- A person's or organization's status as an ad- lowing additional exclusions: ditional insured under this policy ends when This insurance does not apply to: your operations for that additional Insured (a) Any "occurrence"which takes place are completed. after you cease to be a tenant of that 2. With respect to the insurance afforded to premises. these additional insureds,the following addi- (b) Structural alterations, new construc- tional exclusions apply: tion or demolition operations per- This insurance does not apply to: formed by or on behalf of the man- ager 'Bodily injury",or lessor. Y 1 ry", "property damage" or "personal and advertising injury" arising (2) Any person or organization from whom out of the rendering of, or the failure to .you lease equipment, but only with re- render, any professional architectural, spect to liability for"bodily injury', prop- engineering or surveying services, in- erty damage" or "personal and advertis• cluding: ing injury'caused, in whole or in part, by your maintenance, operation or use of (1) The preparing, approving, or failing equipment leased to you by such per- to prepare or approve, maps, shop son(s)or organizat on(s). drawings,opinions, reports, surveys, field orders, change orders or draw- However, this insurance does not apply ings and specifications;or to any "occurrence" which takes place after the equipment lease expires. (2) Supervisory, inspection, arohitec- (3) Any state or political subdivision, subject turai or engineering activities, to the fallowing additional provision: b. "Bodily injury" or "property damage" This insurance applies only with respect occurring after; to the following hazards for which the (1) All work, including materials, parts slate or political subdivision has issued a or equipment furnished in connec- permit in connection with premises you Lion with such work, on the project own,rent, or control and to which this in- (other than service, maintenance or surance applies: repairs) to be performed by or On (a) The existence, maintenance, repair, behalf of the additional insured(s) al construction, erection, or removal of the location the covered opera- advertising signs, awnings, cano- pies, cellar entrances, coal holes, (2) That portion of "your work" out of driveways, manholes, marquees, which the injury or damage arises hoist away_ openings, sidewalk has been put to its intended use by vaults, street banners, or decors- any person or organization other tions and similar exposures;or than another contractor or subcon- (b) The construction, erection, or re- tractor engaged in performing op- moval of elevators;or erations for a principal as a part of the same project. CL CG 00 20 03 07 Includos copydghtod material of Insurance services Page 2 of 6 Office.Inc.,with its permission 3. The insurance provided by this endorsement c. We may pay any part or all of the de- is primary insurance and we will not seek ductible amount to effect settlement of contribution under any insurance policy un- any claim or suit and, upon notification der which such additional insured is a of the action taken; you shall promptly named insured, if such policy was procured reimburse us for such part of the de- and paid for by such additional insured, or a ductible amount as we have paid. parent or related entity of such additional in- H. BROADENED NAMED INSURED sured. 4. With respect to the insurance afforded to Paragraph 3. of SECTION II - WHO IS AN IN- these additional insureds, SECTION III — SURED is deleted and replaced by the following: LIMITS OF INSURANCE is amended as fol- Any organization, other than a joint venture, over lows: which you maintain ownership or majority inter- est applicable of more than 50%will be a Named Insured if pp there is no other similar insurance available to sured are those specified in the written con- that organization. However: tract or agreement or the limits stated in the Declarations, whichever is less. If no limits a. Coverage under this provision is afforded are specified in the written contract or only until the 180th day after you acquire or agreement, the limits applicable to the addi- form the organization or the end of the policy tional insured are those specified in the Dec- period,whichever is earlier. larations. The limits of insurance are inclu- b. COVERAGE A does not apply to "bodily in- sive of and not in addition to the limits of in- jury" or"property damage" that occurred be- surance shown in the Declarations. fore you acquired or formed the organiza- G. PROPERTY DAMAGE TO BORROWED tion. EQUIPMENT c. COVERAGE B does not apply to "personal 1. Paragraph 2.j. of SECTION I - COVER- and advertising injury" arising out of an of- AGES, COVERAGE A. BODILY INJURY fense committed before you acquired or AND PROPERTY DAMAGE LIABILITY is formed the organization. amended as follows: I. CONSTRUCTION PROJECT GENERAL AG- Paragraphs (3) and (4) of this exclusion do GREGATE LIMIT not apply to tools or equipment loaned to 1. For all sums which the insured becomes you, provided they are not being used to per- legally obligated to pay as damages caused form operations at the time of loss. by "occurrences" under COVERAGE A 2. SECTION III — LIMITS OF INSURANCE Is (SECTION 1), and for all medical expenses deleted and replaced by the following: caused by accidents under COVERAGE C (SECTION 1),which can be attributed only to The most we will pay In any one "occur- ongoing operations at a single construction renee" for "property damage" to borrowed project away from premises owned by or equipment is $15,000. This limit of inuur- rented to the insured: ance is the most we will pay regardless of a. A Single Construction Project General the number of Aggregate Limit applies to each Ion- a. Insureds; struction project away from premises b. Claims mach or"suits" brought;or owned by or rented to the insured, and that limit is equal to the amount of the c. Persons or organizations making claims General Aggregate Limit shown in the or bringing"suits". Declarations. 3. Deductible b. The Single Construction Project General Aggregate Limit is the most we will pay .a. Our obligation to pay damages on behalf for the sum of all damages under COV- of the insured applies only to the amount ERAGE A, except damages because of of damages in excess of$250 as appli- "bodily injury" or "property damage" in- cable to"property damage" as the result cluded in the "Products-completed op- of any one "occurrence', regardless of erations hazard', and for medical ex- the number of persons or organizations penses under COVERAGE C regardless who sustain damages because of that of the number of: "occurrence (1) Insureds; b. The terms of this insurance, including those with respect to our right and duty (2) Claims made or"suits" brought; or to defend the insured against any"suits" (3) Persons or organizations making seeking those damages;and your duties claims or bringing"suits". in the event of an"occurrence",claim, or suit"apply Irrespective of the application of the deductible amount. CL CG 00 20 03 07 Includes copyrighted material of Insurance services Page 3 of 6 Office,Inc.,will,Its permission c. Any payments made under COVERAGE J. KNOWLEDGE OF OCCURRENCE A for damages or under COVERAGE C The following is added to paragraph 2. Duties In for medical expenses shall reduce the The Event Of Occurrence, Offense, Claim Or Single Construction Project General Ag- Suit of SECTION IV — COMMERCIAL GEN- gregate Limit for that construction pro- ERAL LIABILITY CONDITIONS- ject away from premises owned by or rented to the insured. Such payments e. A report of an "occurrence", offense, claim shall not reduce the General Aggregate or"suit"to: Limit shown in the Declarations nor shall (1) You,if you are an individual, they reduce any other Single Construc- tion Project General Aggregate Limit for (2) A partner, if you are a partnership, any other separate construction project away from premises owned by or rented (3) An executive officer, if you are a to the insured. corporation, or d. The limits shown in the Declarations for (4) A manager, if you are a limited liability Each Occurrence, Fire Damage and company: Medical Expense continue to apply. is considered knowledge and requires you to However, instead of being subject to the notify us of the"occurrence", offense, claim, General Aggregate Limit shown in the or"suit"as soon as practicable. Declarations, such limits will be subject to the applicable Single Construction f. We are considered on notice of an Project General Aggregate Limit. occurrence", offense, claim or "suit" that is 2. For all sums which the insured becomes reported to your Workers' Compensation legally obligated hi a as damages caused insurer for an event which later develops into by "occurrences" under COVERAGE A an "occurrence", offense, claim or "suit" for Y which there is coverage under this policy. (Sr CTION 1), and for all medical expenses However, we will only be considered on caused by accidents under COVERAGE C notice if you notify us as soon as you know (SECTION I), which cannot be attributed the claim should be addressed by this policy only to ongoing operations at a single desig- rather than your Workers' Compensation noted construction project away from prem- policy. ises owned by or rented to the insured: K. UNINTENTIONAL OMISSIONS a. Any payments made under COVERAGE A for damages or under COVERAGE C The following is added to paragraph 6. Repre- for medical expenses shall reduce the sentations of SECTION IV - COMMERCIAL amount available under the General Ag- GENERAL LIABILITY CONDITIONS: gregate Limit or the Products-Completed d. If you unintentionally fail to disclose any ex- Operations Aggregate Limit, whichever posures existing at the inception date of your is applicable; and policy, we will not deny coverage under this b. Such payments shall not reduce any Coverage Part solely because of such failure Single Construction Project General Ag- to disclose, However, this provision does gregate Limit. not affect our right to collect additional pre- mium or exercise our right of cancellation or 3. When coverage for liability arising out of the non-renewal. "products-completed operations hazard" is This provision does not apply to an known provided, any payments for damages be P ppY Y cause of"bodily injury" or"property damage" injury or damage which is excluded under included in the "products-completed opera- any other provision of this policy. tions hazard" will reduce the Products- L. MENTALANGUISH Completed Operations Aggregate Limit, and not reduce the General Aggregate Limit nor Paragraph 3, of SECTION V— DEFINITIONS is the Single Construction Project General Ag- deleted and replaced by the following: gregate Limit. 3. `Bodily injury" means bodily injury, sickness 4. If the applicable construction project away or disease sustained by a person, Including from premises owned by or rented to the in- mental anguish or death resulting from any sured has been abandoned, delayed, or of these at anytime. abandoned and then restarted, or if the au- M. WAIVER OF TRANSFER OF RIGHTS OF RE- thorized contracting parties deviate from COVERY AGAINST OTHERS plans, blueprints, designs, specifications or paragraph 8. Transfer Of Rights Of Recovery timetables, the project well still be deemed to Against Others To Us of SECTION IV— COM- MERCIAL GENERAL LIABILITY CONDITIONS 5. The provisions of Limits Of Insurance is amended by the addition of the following: (SECTION 111) not otherwise modified by this endorsement shall continue to apply as stipulated. CL CG 00 20 0307 Indudos copyrighted material or Insurance SeMues Page 4 of 6 Office,Inc.,with its permission We waive any right of recovery we may have be- the premises, site or loca- cause of payments we make for injury or dam- tion in connection with such age arising out of your ongoing operations or operations by such insured, "your work" done under a contract requiring such contractor or subcontractor. waiver with that person or organization and in- cluded in the "products-completed operations hazard". apply to "bodily injury' or "property damage" arising However, our rights may only be waived prior to out of heat, smoke or fumes the"occurrence"giving rise to the injury or dam- from a"hostile fire". age for which we make payment under this Cov- erage Part. The insured must do nothing after a (2) Any loss, cost or expense aris- loss to impair our rights. At our request, the in- ing out of any: sured will bring "suit" or transfer those rights to (a) Request, demand, order or us and help us enforce those rights. statutory or regulatory re- N. LIMITED JOB SITE POLLUTION quirement issued or made e A pursuant to t i any e env- 1. Exclusion f. under Section 1 — Coverage mental protection or env- is replaced by the following: ronmental liability statutes or 2. Exclusions regulations that any insured test for, monitor, clean up, This insurance does not apply to: remove, contain, treat, de- toxify or neutralize, or in any way respond to, or assess (1) "Bodily injury' or "property dam- the effects of, "pollutants"; age"arising out of the actual, al- or leged or threatened discharge, (b) Claim or suit by or on behalf dispersal, seepage, migration, of a governmental authority release or escape of "pollut- for damages because of ants": testing for, monitoring, (a) At or from any premises, cleaning up, removing, con- site or location on which any taining, treating, detoxifying insured or any contractors or neutralizing or in any way or subcontractors working responding to or assessing directly or indirectly on any' the effects of, "pollutants". insured's behalf are per- However, this paragraph does forming operations if the not apply to liability for those operations are to test for, sums the insured becomes le- monitor, clean up, remove, gally obligated to pay as dam- contain, treat, detoxify or ages because of"property dam- neutralize, or in any way re- age" that the insured would spond to, or assess the er- have in the absence of such re- facts of,"pollutants";or quest, demand, order or statu- (b) At or from a storage tank or tory or regulatory requirement, other container, ducts or or such claim or "suit" by or an piping which is below or par- behalf of a governmental author- tially below the surface of ity the ground or water or 2. With respect to "bodily injury' or "property which, at any time, has been damage"arising out of the actual, alleged or buried under the surface of threatened discharge, dispersal, seepage, the ground or water and d then subsequently exposed migration, release or escape of"pollutants": by erosion, excavation or a. The "Each Occurrence Limit" shown in any other means if the ac- the Declarations does not apply_ tual, alleged or threatened discharge, dispersal, seep- b. Paragraph 7. of Limits Of Insurance age, migration, release or (Section III)does not apply. escape of"pollutants"arises c. Paragraph 1. of Section III — Limits Of at or from any premises, site Insurance is replaced by the following: or location which any in- sured or any contractors or The Limits Of Insurance shown in this subcontractors working di- endorsement, or in the Declarations and rectly or indirectly on any in- the rules below fix the most we will pay sured's behalf are perform- regardless of the number of: ing operations if the "pollut- (1) Insureds; ants"are brought on or to CL CG 00 20 03 07 Includes copyrighted materiel of Insurance Services Page 5 of 6 Offica,Inc.,with Its pormisslon (2) Claims made or"suits"brought;or 9. Subject to 8. above, the Medical 3 Persons or organizations making Expense Limit is the most we will ( ) g pay under Coverage C for all medi- claims oP bringing"suits". cal expenses because of"bodily in- d. The following are added to Section III'— jury' sustained by any one person Limits Of Insurance: arising out of the actual, alleged or threatened discharge, dispersal, B. Subject to 2. or 3. above, whichever seepage, migration, release or es- applies, the most we will pay for the cape of"pollutants". sum of: O. OTHER INSURANCE a. Damages under Coverage A; and If this policy includes a Coverage Form or an Endorsement which provides coverage for loss b. Medical expenses under Cover- or damage-covered by one or more of the Ex- age C tensions of this endorsement, the limit and the because of "bodily injury" or "prop- coverage provided by this endorsement are de- erry damage" arising out of the ac- leted and replaced by the limit and coverage tual, alleged or threatened dis- provided by that Coverage Form or Endorse- charge, dispersal, seepage, migra- ment. lion, release or escape of "pollut- ants"is$100,000. CL CG 00 20 03 07 Includes copyrighted material orinsurance Services Page 6 of$ Office,Inc.,with its permissian ReferenceConnect Page I of 1 CWG I General Liability 101/01/07 THIS ENDORSEMENT CHANGES THE POLICY.'PLEASE READ IT CAREFULLY. CL CG 20 16 0107 OREGON ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS - AUTOMATIC STATUS WHEN REQUIRED BY WRITTEN CONTRACT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Section II—Who Is An Insured is amended to include as an additional insured any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured only to the extent that the liability for"bodily injury" or"property damage" is caused by "your work" performed for that additional insured at locations specified in the written contract or agreement and included in the"products-completed operations hazard". With respect to the insurance afforded to these additional insureds, this insurance does not apply to "bodily injury" or"property damage" that occurs prior to the execution of, or subsequent to the expiration of, the contract or agreement in which you agreed that such person or organization be added as an additional insured on your policy. CDContinental Western Group 02012 Vertafore; Inc.All Rights Reserved. littps://wwv.silvei plume.com/sponline/SP SAGE.ASP?cmd=doc&id=cwi47543&fed=14100... 1/9/2012 www,salf.com OREGON WORKERS COMPENSATION + saiF CERTIFICATE OF INSURANCE 0 corporation MAIL TO: CERTIFICATE HOLDER: AUSLAND BUILDERS INC CITY OF ASHLAND AUSLAND GROUP ASHLAND FIRE & RESCUE 3935 HIGHLAND AVE 455 SISKYOU BLVD GRANTS PASS, OR 97526 ASHLAND, OR 97520 The policy of insurance listed below has been issued to the insured named below for the policy period indicated. The insurance afforded by the policy described herein is subject to all the terms, exclusions and conditions of such policy. POLICY NO. - POLICY PERIOD ISSUE DATE 756372 07/01/2011 to 07/01/2012 04/16/2012 INSURED: BROKER OF RECORD: AUSLAND BUILDERS INC WARD INSURANCE AGENCY INC AUSLAND GROUP PO BOX 10167 3935 HIGHLAND AVE EUGENE, OR 97440 GRANTS PASS, OR 97526 LIMITS OF LIABILITY: Bodily Injury by Accident $500,000 each accident Bodily Injury by Disease $500,000 each employee Body Injury by Disease $500,000 policy limit DESCRIPTION OF OPERATIONS/LOCATIONS/SPECIAL ITEMS: Fire Station #2 IMPORTANT: The coverage described above is in effect as of the issue date of this certificate. It is subject to change at any time in the future. This certificate is issued as a matter of information only and confers no rights to the certificate holder. This certificate does not amend, extend or alter the coverage afforded by the policies above. CANCELLATION: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL MAIL 30 DAYS' WRITTEN NOTICE TO THE ABOVE NAMED CERTIFICATE HOLDER. AUTHORIZED REPRESENTATIVE 3rgr r President and CEO 400 High Street SE Salem,OR 97312 P:800.285.8525 F:503.373.8020 i o F CONTRACT.FEE SECTION PREVAILING WAGE RATE UNIT F : c BUREAU OF LABOR AND INDUSTRIES m 800 N.E.OREGON ST.,#1045 PORTLAND,OR 97232-2180 •'j869• PHONE- (971)673-0852 i FAX: (971)673-0769 For Office Use Only: Project DB#: lfU/'7 3 PUBLIC WORKS FEE INFORMATION FORM For use by public agencies that have contracted with a contractor on a public works project regulated by ORS 279C.800 to 279C.870,in compliance with ORS 279C.825. Also for use by public agencies that are a party to a public works project pursuant to ORS 279C.800(6)(a)(B)or(C). PUBLIC AGENCIES: Please complete and mail this form to BOLI at the above address, along with the public works fee of one-tenth of one percent of the contract price (contract amount x .001), payable to BOLI. The minimum fee is $250.00; the maximum fee is $7,500.00. Without the following completed information, the bureau may be unable to properly credit you for payment received. PUBLIC AGENCY: Ashland Fire and Rescue/City of Ashland AGENCY#: AGENCY MAILING ADDRESS: 455 Siskiyou Blvd. CITY,STATE,ZII'Ashland.Oregon 97520 AGENCY CONTACT PERSON:John Karns PHONE: (541)482-2770 PROJECT MANAGER NAME:James A.Mc Namara PHONE: (541)482-0346 PROJECT NAME: Building of Fire Station 2 CONTRACT NAME(if part of larger project):Ashland Fire&Rescue Fire Station 2 Replacement PROJECT LOCATION: 1860 Ashland Street:Ashland,Oregon 97520 PROJECT NO: DATE CONTRACT FIRST ADVERTISED: 03-09-2012 DATE CONTRACT AWARDED: 4" Ig IZ CONTRACT ORCCB#: I'77-33' CONTRACTOR BUSINESS NAME(DBA): L uo i\(� CONTRACTOR ADDRESS: CITY,STATE ZIP l/�1 CONTRACT AMOUNT: $ i I o—Av q OU FEE AMOUNT DUE/PAID: $ $y O If less than$50K is it part of a larger project? ❑yes[]no Contract amount x.001=fee due (Please duplicate this form for future use.) VM-39(Rev.03/09) r.., BUREAU OF LABOR AND INDUSTRIES NOTICE OF PUBLIC WORKS (For use by public agencies in complying with ORS 279C.835 for public works awarded after January 1,2008) NOTE: ORS 279C.835 requires that public contracting agencies include with this form a copy of the disclosure of first-tier subcontractors submitted pursuant to ORS 279C.370. PUBLIC AGENCY INFORMATION � Agency Name:Ashland Fire and Rescue/City of Ashland Agency Number(if known):J Address:455 Siskivou Blvd- Agency Division:FIRE City,State,Zip:Ashland.Oregon 97520 Agency Representative:John Kams Phone: 541482-2770 SECTION A: To be completed when a public agency awards a contract ton contractor for a public works project,including CWGC projects. (See reverse for public works projects in which no public agency awards a contract to a contractor.) CONTRACT INFORMATION: Project Name:Disposal of Asbestos Containing Materials Project Number: Contract Name(if part of larger project):Ashland Fire&Rescue Fire Station 2 Replacem Contract Number: Project Manager Name:James A.Mc Namara Phone#: 541482-0346 Fax#: 541482-2101 Project Location(Street(s),City); 1860 Ashland Street,Ashland,Oregon 97520 Project County: Jackson Contract Amount: $ it 2 J g!1 00.O O If under$50,000,is this contract part of a larger project?YES—NO If yes,total project amount: $ Mill project use federal funds that require compliance with the Davis-Bacon Act? YESNO Date Contract Specifications First Advertised for Bid(if not advert ised,date of RFP or first contact with contractor): 3-9-2012 If CM/GC Contract,Date Contract Became a Public Works Contract(see OAR 839-025-0020(7)): Date Contract Awarded: q- 8' �'Z Date Work Expected to Begin: "a - Date Work Expected to be Complete: 0 M -) PRIME CONTRACTOR INFORMATION: Name:(x,11 n n n A r Address: 3 �/' ry� City, State Zip: ��5��0 Phone:51 -Arl fo-2 J 792) Construction Contractors Board Registration Number: 19 2 333 Name of Bonding Company: Address: Agent Name and Phone Number: Bond Number: ❑ Copy.of first-tier subcontractors attached(see NOTE above). THIS FORM WILL BE RETURNED TO THE PUBLIC AGENCY FOR CORRECTION AND RESUBMITTAL IF INCOMPLETE. WH-81(Rev 03-08) Notice of Public Works—Page 2 SECTION B: To be completed when a project is a public works pursuant to ORS 279C.800(6)(a)(B)(a project for the construction, reconstruction,major renovation or painting of a privately owned road,highway,building, structure or improvement of any type that uses funds of a private entity and$750,000 or more of funds of a . public agency)and no public agency awards a contract to a contractor. CONTRACT INFORMATION: Name of Project Owner: Phone#: Fax#: Project Name: Project Number: Project Location(Street(s),City): Project County: Total Project Amount: $ Amount of Public Funds Provided for the project:$ Name(s)of Public Agency(ies)Providing Public Funds: Date the public agency or agencies commit to the provision of funds for the project: Will project use federal funds that require compliance with the Davis-Bacon Act? YES❑NO❑ Date Work Expected to Begin: Date Work Expected to be Complete: SECTION C: To be completed when a project is a public works pursuant to ORS 279C.800(6)(a)(C)(a project for the construction of a privately owned road,highway,building,structure or improvement of any type that uses funds of a private entity and in which 25 percent or more of the square footage of the completed project will be occupied or used by a public agency)and no public agency awards a contract to a contractor. CONTRACT INFORMATION: Qame of Project Owner: Phone#: Fax#: Project Name: Project Number: Project Location(Street(s),City): Project County: Total Project Amount: $ Amount of Public Funds Provided for the project:$ Name(s)of Public Agency(ies)Providing Public Funds: Total square footage of privately owned road,highway,building,structure or improvement: Percent of total square footage of the completed project that will be occupied or used by a public agency: Date the public agency or agencies entered into an agreement to occupy or use the completed project: Will project use federal funds that require compliance with the Davis-Bacon Act? YES❑NO❑ Date Work Expected to Begin: Date Work Expected to be Complete: THIS FORM WILL BE RETURNED TO THE PUBLIC AGENCY FOR CORRECTION AND RESUBMITTAL IF INCOMPLETE. Signature of agency representative completing form: Printed Name: 11 i )11/J'P1�I PLf �l(J/)-)m (f S Phone#: 1 5552-,22/6 Date:S —Q -J 2 RETURN THIS COMPLETED FORM TO: Prevailing Wage Rate Unit•Bureau of Labor and Industries•800 NE Oregon Street,111045•Portland,OR 97232-2180 Telephone(971)673-0852•FAX(971)673-0769 WB-81(Rev 03-08) 0 CITY OF ASHLAND Today's Date: 5/2/2012 Requested Check Issue Date 5/10/2012 Please note Vendors are paid Net 30 (30days)from today's date if not otherwise specified. Request(s) must be in Accounts Payable Inbox by 5:00pm Friday to be issued the following Friday. Request for Check To be used for the following: • Rebates, Refunds or Reimbursements (not employees) • Advanced payments for Books/Schools/Registration/Hotels (attach documentation) • State/County Assessments • Grants and Debt Services • Membership Dues Payee: Bureau of Labor and Industries 800 NE Oregon Street #1045 Portland, Oregon 97232-2180 Description Prevailing Wage Rate Unit- Bureau of Labor and Industries 800 NE Oregon Street #1045, Portland, Oregon 97232 Ausland Group Station 2 Account Number Amount Account Number' Amount 410.08.24.00.704200 2,184.40 Project# 000175.999 Total .2,184.40 Requested by: Kimberley Summers Return check to: Send check with Approved by: attachment YES i GAfre\KSUMMERS\Month End Spread Sheets\Monthly Letters-Check Request\Check RequeshRequest for check.docUpdated on:05/02/12 OF regon Bureau of Labor and Industries ^ z Brad Avakian Commissioner 6 . April 26, 2012 ASHLAND FIRE AND RESCUE 455 SISKIYOU BLVD ATTN: KIMBERLEY SUMMERS ASHLAND, OR 97520 PAYMENT RECEIPT FOR PUBLIC WORKS FEE (OAR 839-025-0210) Name of Project Contract: FIRE STATION 2/DISPOSAL OF ASBESTOS CONTAINING MATERIALS Project/Contract/Check No: CK#93381 BOLI Assigned Database No: 66723 This certificate is proof that ASHLAND FIRE AND RESCUE made a fee payment of$250 for the public works project named above, based on the contract awarded to BELFOR ENVIRONMENTAL INC (CCB#:126132) on 22-MAR-12, leaving a balance of$0 for this contract. As required by ORS 279C.825 and OAR 839-025-0210, the agency shall, upon completion of the contract, determine the final contract price, including change orders and adjustments to the contract. If the final contract price vanes by$100,000 or more, the agency shall submit any additional payment or request for refund of fees, using form WH-40, to the bureau within 39 days of final payment to the contractor by the agency. PORTLAND EUGENE BEND MEDFORD 800 NE Oregon St.Suite 1045 1400 Executive Parkway,Suite 200 Apprenticeship and Training Apprenticeship and Training Portland,OR 97232-2180 Eugene,OR 97401-7103 Worksource Bend 119 N Oakdale Ave. (971)673-0761 (541)686-7623 1645 NE Forbes Rd,Ste 106 Medford,OR 97501-2629 Fax(971)673-0762 FAX(541)686-7980 Bend,OR 97701-4990 (541)776-6201 (541)322-2435 FAX(541)776-6284 FAX(541)389-8265 SALEM PENDLETON 3865 Wolverine St.NE;E-1 Oregon Relay f rY:711 Civil Rights Salem,OR 97305-1268 1327 SE 3'a St. (503)378-3292 www.oregon.gov/boli Pendleton,OR 97801-4101 �tl' FAx(503)373x636 AN EQUAL OPPORTUNITY EMPLOYER FA(X(541)276-5767 BUREAU OF LABOR AND INDUSTRIES NOTICE OF PUBLIC WORKS (For use by public agencies in complying with ORS 279C.835 for public works awarded after January 1,2008) NOTE: ORS 279C.835 requires that public contracting agencies include with this form a copy of the disclosure of first-tier subcontractors submitted pursuant to ORS 279C.370. PUBLIC AGENCY INFORMATION Agency Name:Ashland Fire and Rescue/City of Ashland Agency Number(if known):244 Address:455 Siskivou Blvd, Agency Division FIRE City, State,Zip:Ashland,Oregon 97520 Agency Representative:John Kams Phone:541.482-2770 SECTION A: To be completed when a public agency awards a contract to a contractor for a public works project,including CM/GC projects. (See reverse for public works projects in which no public agency awards a contract to a contractor.) CONTRACT INFORMATION: Project Name:Disposal of Asbestos Containing Materials Project Number: Contract Name(if part of larger project):Ashland Fire&Rescue Fire Station 2 Replacem Contract Number: Project Manager Name:Janies A.Mc Namara Phone#:541-482-0346 Fax#: 541482-2101 Project Location(Street(s),City): 1860 Ashland Street,Ashland,Oregon 97520 Project County:Jackson Contract Amount: $2367.00 If under$50,000,is this contract part of a larger project?YES X NO If yes,total project amount: $ Will project use federal funds that require compliance with the Davis-Bacon Act? YESNO_ Date Contract Specifications First Advertised for Bid(if not advertised,date of RFP or first contact with contractor): 3-1-2012 If CM/GC Contract,Date Contract Became a Public Works Contract(see OAR 839-025-0020(7)): Date Contract Awarded:03-22-2012 Date Work Expected to Begin:4-19-2012 Date Work Expected to be Complete: 5-30-2012 PRIME CONTRACTOR INFORMATION: Name:_ (31Q� A)�nof) 'jv1r%01\�, Address: q F.�� (P ' City,State Zip: C9ntr\00, kt Ax5� i nfZ Phone: )(l1 - lo(Ot. -5P-OI Construction Contractors Board Registration Number: 12 3 Name of Bonding Company: Address: Agent Name and Phone Number: Bond Number: ❑ Copy of first-tier subcontractors attached(see NOTE above). THIS FORM WILL BE RETURNED TO THE PUBLIC AGENCY FOR CORRECTION AND RESUBMITTAL IF INCOMPLETE. WH-81(Rev 03.08) Notice of Public Works—Page 2 SECTION B: To be completed when a project is a public works pursuant to ORS 279C.800(6)(a)(B)(a project for the construction,reconstruction,major renovation or painting of a privately owned road,highway,building, structure or improvement of any type that uses funds of a private entity and$750,000 or more of funds of a public agency)and no public agency awards a contract to a contractor. CONTRACT INFORMATION: Name of Project Owner: Phone#: Fax#: Project Name: Project Number: Project Location(Street(s),City): Project County: Total Project Amount:$ Amount of Public Funds Provided for the project:$ Name(s)of Public Agency(ies)Providing Public Funds: Date the public agency or agencies commit to the provision of funds for the project: Will project use federal funds that require compliance with the Davis-Bacon Act? YES ❑NO❑ Date Work Expected to Begin: Date Work Expected to be Complete: SECTION C: To be completed when a project is a public works pursuant to ORS 279C.800(6)(a)(C)(a project for the construction of a privately owned road,highway,building,structure or improvement of any type that uses funds of a private entity and in which 25 percent or more of the square footage of the completed project will be occupied or used by a public agency)and no public agency awards a contract to a contractor. CONTRACT INFORMATION: Name of Project Owner: Phone#: Fax#: Project Name: Project Number: Project Location(Street(s),City): Project County: Total Project Amount:$ Amount of Public Funds Provided for the project:$ Name(s)of Public Agency(ies)Providing Public Funds: Total square footage of privately owned road,highway,building,structure or improvement: Percent of total square footage of the completed project that will be occupied or used by a public agency: Date the public agency or agencies entered into an agreement to occupy or use the completed project: . Will project use federal funds that require compliance with the Davis-Bacon Act? YES ❑NO❑ Date Work Expected to Begin: v Date Work Expected to be Complete: THIS FORM WILL BE RETURNED TO THE PUBLIC AGENCY FOR CORRECTION AND RESUBMITTAL IF INCOMPLETE. Signature of agency representative completing form: ���)� Printed Name: IfilmbPt/`�eu ` (/6'� nelkS Phone#:/`f�S52a2iL Date4 �6_ J RETURN THIS COMPLETED FORM TO: Prevailing Wage Rate Unit•Bureau of Labor and Industries•800 NE Oregon Street,#1045•Portland,OR 97232-2180 Telephone(971)673-0852•FAX(971)673-0769 WH-81(Rev 03-08) i o CONTRACT FEE SECTION PREVAILING WAGE RATE UNIT N : 0 BUREAU OF LABOR AND INDUSTRIES m : 800 N.E.OREGON ST.,#1045 PORTLAND,OR 97232-2180 85: PHONE: (971)673-0852 FAX: (971)673-0769 For Office Use Only: Project DB#: PUBLIC WORKS FEE INFORMATION FORM For use by public agencies that have contracted with a contractor on a public works project regulated by ORS 279C.800 to 279C.870,in compliance with ORS 279C.825. Also for use by public agencies that are a party to a public works project pursuant to ORS 279C.800(6)(a)(B)or(C). PUBLIC AGENCIES: Please complete and mail this form to BOLI at the above address, along with the public works fee of one-tenth of one percent of the contract price (contract amount x .001), payable to BOLI. The minimum fee is $250.00; the maximum fee is $7,500.00. Without the following completed information, the bureau may be unable to properly credit you for payment received. PUBLIC AGENCY: Ashland Fire and Rescue/City of Ashland AGENCY#: 2g4q AGENCY MAILING ADDRESS: 455 Siski ou Blvd. CITY,STATE,ZIP Ashland Oregon 97520 AGENCY CONTACT PERSON:John Karns PHONE: (541)482-2770 PROJECT MANAGER NAME:James A.Mc Namara PHONE: (541)482-0346 PROJECT NAME:Disposal of Asbestos Containing Materials CONTRACT NAME (if part of larger project):Ashland Fire&Rescue Fire Station 2 Replacement PROJECT LOCATION: 1860 Ashland Street,Ashland,Oregon 97520 PROJECT NO: DATE CONTRACT FIRST ADVERTISED: 03-01-2012 DATE CONTRACT AWARDED: 3/22/2012 CONTRACTOR CCB#: 126132 CONTRACTOR BUSINESS NAME(DBA):Belfor Environmental Inc. CONTRACTOR ADDRESS: 12821 NE Airport Way CITY,STATE ZIP Portland,Oregon 97230 CONTRACT AMOUNT: $2367.00 FEE AMOUNT DUE/PAH): $250.00 If less than$50K is it part of a larger project? Eyes Ong Contract amount x.001 fee due (Please duplicate this form for future use.) WH-39(Rev. 03/09)