HomeMy WebLinkAbout2012-243 Contract - Hays Oil Contract for Fuel — Ashland Parks & Recreation
C I T Y OF CONTRACTOR: Hays Oil Company
-4S H LAND
20 East Main Street CONTACT: Steven Hays
Ashland, Oregon 97520 ADDRESS: 1890 So. Pacific Hwy, Medford, OR 97501
Telephone: 541/488-6002
Fax: 541/488-5311 TELEPHONE: 541-772-2053, Ext. 1009
DATE AGREEMENT PREPARED:September 10,2012 FAX: 541-779-2602
BEGINNING DATE: September 10, 2012 COMPLETION DATE: June 30, 2013
COMPENSATION: Fuel to be priced using the "Eugene AM OPIS (Oil Price Index Service) rack average", plus
applicable taxes and markup as follows: Regular Unleaded 10% Ethanol $0.181, Dyed B5 Biodiesel $0.181
GOODS AND SERVICES TO BE PROVIDED: Fuel to be delivered bi-weekly and/or as needed to the fuel tank
located at the Ashland Park Shop (Next to Oak Knoll Course) 3070 Hwy 66, Ashland, OR, 97520. Per
proposal attached as Exhibit C. Types of fuel: Regular Unleaded 10% Ethanol and Dyed B-5 Biodiesel;
Fuel tank: 1,500 Gallons - 500 Gallons/Bio-Diesel, 1,000 Gallons/Unleaded
ADDITIONAL TERMS: This contract may be extended for one additional year (July 1, 2013 to June 30, 2014).
NOW THEREFORE, pursuant to AMC 2.50.090 and after consideration of the mutual covenants contained herein the
CITY AND CONTRACTOR AGREE as follows:
1. All Costs by Contractor: Contractor shall, provide all goods as specified above and shall at its own risk and
expense, perform any work described above and, unless otherwise specified, furnish all labor, equipment and
materials required for the proper performance of such work.
2. Qualified Work: Contractor has represented, and by entering into this contract now represents, that any personnel
assigned to the work required under this contract are fully qualified to perform the work to which they will be assigned _
in a skilled and'worker-like manner and, if required to be registered, licensed or bonded by the State of Oregon, are
so registered, licensed and bonded. Contractor must also maintain a current City business license.
3. Completion Date: Contractor shall provide all goods in accordance with the standards and specifications, no later
than the date indicated above and start performing the work under this contract by the beginning date indicated
above and complete the work by the completion date indicated above.
4. Compensation: City shall pay Contractor for the specified goods and for any work performed, including costs and
expenses, the sum specified above. Payments shall be made within 30 days of the date of the invoice. Should the
contract be prematurely terminated, payments will be made for work completed and accepted to date of termination.
Compensation under this contract, including all costs and expenses of Contractor, is limited to$25,000.00, unless a
separate written contract is entered into by the City.
5. Ownership of Documents: All documents prepared by Contractor pursuant to this contract shall be the property of
City.
6. Statutory Requirements: ORS 2796.220, 27913.225, 2796.230, 279B.235, ORS Chapter 244 and ORS 670.600 are
made part of this contract.
7. Living Wage Requirements: If contractor is providing services under this contract and the amount of this contract
is $19,494 or more, Contractor is required to comply with chapter 3.12 of the Ashland Municipal Code by paying a
living wage, as defined in this chapter, to all employees performing work under this contract and to any subcontractor
who performs 50% or more of the work under this contract. Contractor is also required to post the notice attached
hereto as Exhibit B predominantly in areas where it will be seen by all employees.
8. Indemnification: Contractor agrees to defend, indemnify and save City, its officers, employees and agents harmless
from any and all losses, claims, actions, costs, expenses,judgments, subrogations, or other damages resulting from
injury to any person (including injury resulting in death), or damage (including loss or destruction)to property, of
whatsoever nature arising out of or incident to the performance of this contract by Contractor(including but not limited
to, Contractor's employees, agents, and others designated by Contractor to perform work or services attendant to this
contract). Contractor shall not be held responsible for any losses, expenses, claims, subrogations, actions, costs,
judgments, or other damages, directly, solely, and proximately caused by the negligence of City.
9. Termination:
a. Mutual Consent. This contract may be terminated at any time by mutual consent of both parties.
b. Cites Convenience. This contract may be terminated at any time by City upon 30 days' notice in writing
and delivered by certified mail or in person.
C. For Cause. City may terminate or modify this contract, in whole or in part, effective upon delivery of
written notice to Contractor, or at such later date as may be established by City under any of the following
Contract for Fuel-Ashland Parks 8 Recreation, Page 1 of 5
1
conditions:
i. If City funding from federal, state, county or other sources is not obtained and continued at levels
sufficient to allow for the purchase of the indicated quantity of services;
ii. If federal or state regulations or guidelines are modified, changed, or interpreted in such a way
that the services are no longer allowable or appropriate for purchase under this contract or are
no longer eligible for the funding proposed for payments authorized by this contract; or
iii. If any license or certificate required by law or regulation to be held by Contractor to provide the
services required by this contract is for any reason denied, revoked, suspended, or not renewed.
d. For Default or Breach.
i. Either City or Contractor may terminate this contract in the event of a breach of the contract by
the other. Prior to such termination the party seeking termination shall give to the other parry
written notice of the breach and intent to terminate. If the party committing the breach has not
entirely cured the breach within 15 days of the date of the notice, or within such other period as
the party giving the notice may authorize or require, then the contract may be terminated at any
time thereafter by a written notice of termination by the party giving notice.
ii. Time is of the essence for Contractor's performance of each and every obligation and duty under
this contract. City by written notice to Contractor of default or breach, may at any time terminate
the whole or any part of this contract if Contractor fails to provide services called for by this
contract within the time specified herein or in any extension thereof.
iii. The rights and remedies of City provided in this subsection (d)are not exclusive and are in
addition to any other rights and remedies provided by law or under this contract.
e. Obligation/Liability of Parties. Termination or modification of this contract pursuant to subsections a, b, or
c above shall be without prejudice to any obligations or liabilities of either party already accrued prior to such
termination or modification. However, upon receiving a notice of termination (regardless whether such notice is
given pursuant to subsections a, b, c or d of this section, Contractor shall immediately cease all activities under
this contract, unless expressly directed otherwise by City in the notice of termination. Further, upon termination,
Contractor shall deliver to City all contract documents, information, works-in-progress and other property that are
or would be deliverables had the contract been completed. City shall pay Contractor for work performed prior to
the termination date if such work was performed in accordance with the Contract.
10. Independent Contractor Status: Contractor is an independent Contractor and not an employee of the City.
Contractor shall have the complete responsibility for the performance of this contract.
11. Non-discrimination Certification: The undersigned certifies that the undersigned Contractor has not discriminated
against minority, women or emerging small businesses enterprises in obtaining any required subcontracts.
Contractor further certifies that it shall not discriminate in the award of such subcontracts, if any. The Contractor
understands and acknowledges that it may be disqualified from bidding on this contract, including but not limited to
City discovery of a misrepresentation or sham regarding a subcontract or that the Bidder has violated any
requirement of ORS 279A.110 or the administrative rules implementing the Statute.
12. Asbestos Abatement License: If required under ORS 468A.710, Contractor or Subcontractor shall possess an
asbestos abatement license.
13. Assignment and Subcontracts: Contractor shall not assign this contract or subcontract any portion of the work
without the written consent of City. Any attempted assignment or subcontract without written consent of City shall be
void. Contractor shall be fully responsible for the acts or omissions of any assigns or subcontractors and of all
persons employed by them, and the approval by City of any assignment or subcontract shall not create any
contractual relation between the assignee or subcontractor and City.
14. Use of Recyclable Products: Contractor shall use recyclable products to the maximum extent economically feasible `
in the performance of the contract work set forth in this document.
15. Default. The Contractor shall be in default of this agreement if Contractor: commits any material breach or default of
any covenant, warranty, certification, or obligation it owes under the Contract; if it loses its QRF status pursuant to
the QRF Rules or loses any license, certificate or certification that is required to perform the work or to quality as a
QRF if Contractor has qualified as a QRF for this agreement; institutes an action for relief in bankruptcy or has
instituted against it an action for insolvency; makes a general assignment for the benefit of creditors; or ceases doing
business on a regular basis of the type identified in its obligations under the Contract; or attempts to assign rights in,
or delegate duties under, the Contract.
16. Insurance. Contractor shall at its own expense provide the following insurance:
a. Worker's Compensation insurance in compliance with ORS 656.017, which requires subject employers to
provide Oregon workers'compensation coverage for all their subject workers
b. General Liability insurance with a combined single limit, or the equivalent, of not less than Enter one:
$200,000, $500,000, $1,000,000, $2,000,000 or Not Applicable for each occurrence for Bodily Injury and Property
Damage. It shall include contractual liability coverage for the indemnity provided under this contract.
C. Automobile Liability insurance with a combined single limit, or the equivalent, of not less than Enter one:
$200,000, $500,000, $1,000,000,or Not Applicable for each accident for Bodily Injury and Property Damage,
including coverage for owned, hired or non-owned vehicles, as applicable.
Contract for Fuel—Ashland Parks 8 Recreation, Page 2 of 5
i
d. Notice of cancellation or change. There shall be no cancellation, material change, reduction of limits or
intent not to*renew the insurance coverage(s)without 30 days' written notice from the Contractor or its insurer(s)to
the City.
e. Additional Insured/Certificates of Insurance. Contractor shall name The City of Ashland, Oregon, and its
elected officials, officers and employees as Additional Insureds on any insurance policies required herein but only
with respect to Contractor's services to be provided under this Contract. As evidence of the insurance coverages
required by this Contract, the Contractor shall furnish acceptable insurance certificates prior to commencing work
under this contract.The contractor's insurance is primary and non-contributory. The certificate will specify all of the
parties who are Additional Insureds. Insuring companies or entities are subject to the City's acceptance. If
requested, complete copies of insurance policies, trust agreements, etc. shall be provided to the City. The
Contractor shall be financially responsible for all pertinent deductibles, self-insured retentions and/or self-
insurance.
17. Governing Law; Jurisdiction; Venue: This contract shall be governed and construed in accordance with the laws
of the State of Oregon without resort to any jurisdiction's conflict of laws, rules or doctrines. Any claim, action, suit or
proceeding (collectively, "the claim")between the City(and/or any other or department of the State of Oregon)and
the Contractor that arises from or relates to this contract shall be brought and conducted solely and exclusively within
the Circuit Court of Jackson County for the State of Oregon. If, however, the claim must be brought in a federal
forum, then it shall be brought and conducted solely and exclusively within the United States District Court for the
District of Oregon filed in Jackson County, Oregon. Contractor, by the signature herein of its authorized
representative, hereby consents to the in personam jurisdiction of said courts. In no event shall this section be
construed as a waiver by City of any form of defense or immunity, based on the Eleventh Amendment to the United
States Constitution, or otherwise, from any claim or from the jurisdiction.
18. THIS CONTRACT AND ATTACHED EXHIBITS CONSTITUTE THE ENTIRE AGREEMENT BETWEEN THE
PARTIES. NO WAIVER, CONSENT, MODIFICATION OR CHANGE OF TERMS OF THIS CONTRACT SHALL
BIND EITHER PARTY UNLESS IN WRITING AND SIGNED BY BOTH PARTIES. SUCH WAIVER, CONSENT,
MODIFICATION OR CHANGE, IF MADE, SHALL BE EFFECTIVE ONLY IN THE SPECIFIC INSTANCE AND FOR
THE SPECIFIC PURPOSE GIVEN. THERE ARE NO UNDERSTANDINGS,AGREEMENTS, OR
REPRESENTATIONS, ORAL OR WRITTEN, NOT SPECIFIED HEREIN REGARDING THIS CONTRACT.
CONTRACTOR, BY SIGNATURE OF ITS AUTHORIZED REPRESENTATIVE, HEREBY ACKNOWLEDGES THAT
HE/SHE HAS READ THIS CONTRACT, UNDERSTANDS IT,AND AGREES TO BE BOUND BY ITS TERMS AND
CONDITIONS.
19. Nonappropriations Clause. Funds Available and Authorized: City has sufficient funds currently available and
authorized for expenditure to finance the costs of this contract within the City's fiscal year budget. Contractor
understands and agrees that City's payment of amounts under this contract attributable to work performed after the
last day of the current fiscal year is contingent on City appropriations, or other expenditure authority sufficient to allow
City in the exercise of its reasonable administrative discretion, to continue to make payments under this contract. In
the event City has insufficient appropriations, limitations or other expenditure authority, City may terminate this
contract without penalty or liability to City, effective upon the delivery of written notice to Contractor, with no further
liability to Contractor.
20. Prior Approval Required Provision. Approval by the City of Ashland Council or the Public Contracting Officer is
required before any work may begin under this contract.
21. Certification. Contractor shall sign the certification attached hereto as Exhibit A and herein incorporated by
refere e.
Contractor ,,\\ ' City of Ash/l]a�
By U ill By �l!�
Sign turelI Department Head
Print Name Print Name
I s,>E14 , °i(Wk_
Title Date
W-9 One copy of a W-9 is to be submitted with
the signed contract. Purchase Order No. ��-
Contract for Fuel–Ashland Parks&Recreation, Page 3 of 5
EXHIBIT A
CERTIFICATIONS/REPRESENTATIONS: Contractor, under penalty of perjury, certifies that (a) the
number shown on the attached W-9 form is its correct taxpayer ID (or is waiting for the number to be
issued to it and (b) Contractor is not subject to backup withholding because (i) it is exempt from
backup withholding or(ii) it has not been notified by the Internal Revenue Service (IRS) that it is
subject to backup withholding as a result of a failure to report all interest or dividends, or (iii) the IRS
has notified it that it is no longer subject to backup withholding. Contractor further represents and
warrants to City that (a) it has the power and authority to enter into and perform the work, (b) the
Contract, when executed and delivered, shall be a valid and binding obligation of Contractor
enforceable in accordance with its terms, (c) the work under the Contract shall be performed in
accordance with the highest professional standards, and (d) Contractor is qualified, professionally
competent and duly licensed to perform the work. Contractor also certifies under penalty of perjury
that its business is not in violation of any Oregon tax laws, and it is a corporation authorized to act on
behalf of the entity designated above and authorized to do business in Oregon or is an independent
Contractor as defined in the contract documents, and has checked four or more of the following
criteria:
X (1) 1 carry out the labor or services at a location separate from my residence or is in a s
specific portion of my residence, set aside as the location of the business.
(2) Commercial advertising or business cards or a trade association membership are
purchased for the business.
(3) Telephone listing is used for the business separate from the personal residence listing.
(4) Labor or services are performed only pursuant to written contracts.
(5) Labor or services are performed for two or more different persons within a period of one
year.
(6) 1 assume financial responsibility for defective workmanship or for service not provided
as evidenced by the ownership of performance bonds, warranties, errors and omission
insurance or liability insurance relating to the labor or services to be provided.
Contractor (Date)
'Contract for Fuel—Ashland Parks&Recreation, Page 4 of 5
�l�lYS
. .
PO BOX 1220 Medford OR 97501
(800)-452-6555
August 29,2012
City of Ashland
90 N. Mountain Avenue
Ashland OR 97520.
Fax:541-488-5320
Attn: Purchasing Representative, Karl Olson
Re: Fuel Bid for Ashland Parks Shop
The pricing for this bid offering will be based on the following. The prices are quoted without any tax for bid
purposes only. The applicable taxes will be applied a;the time of delivery/invoice:
• Eugene Oregon OPIS Average 09:00 AM EDT report.
• Deliveries to Ashland are made on a weekly basis.
• The fuels available for delivery are those that are provided at the Eugene Oregon fuel terminal.
• Regular Unlead 30%Ethanol
• 85 biodiesel Dyed
Price of fuel and markup.
• Regular Unlead
OPIS Price 3.3081, Markup .181, Total extax 3.4891
• Dyed BS Biodiesel
a OPIS Price- 3.4701, Markup .181, Total ex tax 3.6511
If you have any questions,contact Steven Hays,541-772-2053 ex 1009 or email shays @haysoil.com.
Thanks you for the opportunity to bid on your fuel needs.
Sincerely;
Steven Hays
1890 So.Pacific Hwy. 529 NE F Street 191 Bateman Drive 829014`"Street
Medford OR 97501 Grants Pass OR 97526 Central Point OR 97502 White City OR 97503
541-772-2053 541-476.2218 541-664-6640 541-826-5550
Fax 541-779-2602 Fax 541-476-9936 Fax 541-664-1364 Fax 541-826-3864 .
www saifxom
OREGON WORKERS COMPENSATION sal f
CERTIFICATE OF INSURANCE 10Pcorporation
CERTIFICATE HOLDER:
CITY OF ASHLAND
90 N. MOUNTAIN AVENUE
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
480084 07/01/2012 to 07/01/2013 06/21/2012
INSURED: BROKER OF RECORD:
R W HAYS CO
PO BOX 1220
MEDFORD, OR 97501-0091
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:
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. This
certificate does not constitute a contract between the issuing insurer, authorized representative or
producer and the certificate holder..
CANCELLATION:
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE
THEREOF, NOTICE WILL BE DELIVERED TO THE POLICYHOLDER AND CERTIFICATE HOLDER IN
ACCORDANCE WITH THE POLICY PROVISIONS AND OREGON LAW. SAIF WILL ENDEAVOR TO
PROVIDE WRITTEN NOTICE WITHIN 30 DAYS WHENEVER POSSIBLE.
AUTHORIZED REPRESENTATIVE
President and CEO
400 High Street SE
Salem,OR 97312
P:800.285.8525
F:503.373.8020
Policy_Batch CertlflcateOHnsumnce .t
JUN-27-2012 13:44 ELLIOTT POWELL BRDEN BAKE P.01
DATE(MWDWTTYT)
o CERTIFICATE OF LIABILITY INSURANCE 6/22/2012
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(ies)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 endorsemenUs • NTACr
RODUDER N Pam Wimmer
PHONE (503)227-1771 -TG64
Illiott Powell Baden and Baker Inc. E-MIUL
.pwimmar @epbb.com
.521 S.W. Salmon street NALCa
INSURER$ AFFORDING COVERAGE
>ortland OR 97205-1783 INSURERA:COntinental Wasters 111SUrazlCe
ISURED INSURER 6
tw Hays Co, DBA: Hays Oil Company INSURER C1
?O BOX 1220 NSURER D:
INSURER E
Redford OR 97501 INSURER F:
:OVERAGES CERTIFICATE NUMBER:12-13 GL, Auto, Umb 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..NOTWIITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
NSR U P�pY EFF MPMUCY OF LIMITS
rn TYPE OF INSURANCE POUCYN MBER EACH OCCURR 1,000,000
ENCE S
CENERALDASILITY DANA T
0
MI , S , 0
X COMMERCIALGENERALUABIU II /1/2012 /1/2013
5,000
A CLAIMS-MADE 7 OCCUR DP2930039 APED one parson S
PERSONAL 8ADV INJURY S 1.000,000
GENERAL AGGREGATE S 2,000,OOO
PRODUCTS.COMPIOP AGG s 2,000,000
GENL AGGREGATE LIMIT APPLIES PER: _
X POLICY PRO-. LOC COMBINED SINGLE LIMB
accident) 1,000,000
AUTOMOBILE UABILIYY
BODILY INJURY(Poi pesos) S
A X ANYAUTO
AUTOS AUTOS 42938039 /3/2012 /1/2013 SODM1Y INJURY(Per acrldam) $
PROPERTY DAMAGE $
NON-OWNED tP.r ecqlftnt)
MIRED AUTOS AUTOS
UnlASared molodsl combined 5 1 000 000
EACH OCCURRENCE S 10,000,000
UMBRELLA DAB X OCCUR 10,000,000
AGGREGATE s
A X EXCESS DAB CLAIMS-MADE
938040 /1/2012 11/2019 S
LIED X RETENTION S WC STATU• OTN•
WORKERS COMPENSATION
AND EMPLOYERS'DABIDIT TIN E.4 EACH ACCIDENT S
ANY PR RIETO A OFFIGSR/ME MEMBER EXCLUDOFAT ECUTNE❑ N/A
(Mandatory In NH) E DISEASE-EA EMPLOY
.DISEASE-POLICY LIMB S
S
It ycs.deacnbe Ynder E.L.
DESCRIPTION OF OPERATIONS below
DFSGRIpnDN OF OPERATIONS 1 LOCATWNS I VEHICLES(Attach ACORD 101,Additional RAmAns Schedule,M Mon apace is n0ulnd)
Ra: Delivery of Fuel. Paz £ozms CW 3130 (09 06) and CW 1054 (01 90) attached.
CERTIFICATE HOLDER CANCELLATION -
(541)488-5320 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCE4LED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Ashland
Issued by Fadarated AVTHORXZED ROARESENTATIVE
90 N Mountain Ave
Ashland, OR 97520
Earn Wimmer/PW
ACORD 25(201 0105) ®1988.2010 ACORD CORPORATION. All rights reserved.-
INSn25=10oM).01 The ACORD name and logo are registered marks of ACORD
JUN-27-2012 13:44 ELLIOTT POWELL HRDEN HRKE P.03
CW 31 s0 09 06
. Trzs MWMSEb=qT =agGSB T8& POLICY. PLmss Z= IT CAS$MMZY.
ADDITIOML ZXSMMD - ERIBMRY COVERAGE - SCHEDULED PERSON OR
ORQMIZA7=0 f
This endorsement modifies insurance provided uader the. following:
COMMZFECIAIr GENERAL L-*ABILITY CD RAGE PART
6CRIMM3
Names .og Additional Insu=ed Person(c) or orga .satioz(s)r
Slankee Additional Insured per Forms
cr.2026. CW313.0 MIOSA
c/o RW Hays Co Inc
PO 30X 1220
Medford, OR 97501
Locatioa(s) of covered operations:
As agreed to in writing in the contract or agreement requiring the person or-
crganizatiod to be added' as an additional insured on your.policy.
Information required to complete this schsdule,, if riot shown above, will be shown iri
the Declaracioms.
A. Section II r Yho 'Ia An Znsured is amended to include am an additional iasured the
gersons) or organization(s) shown in the. Schediale, Sut. only with respect to lia-
ili:cy for "bodily injury" °property damage! or "personal and advertising inju-
ry" caused„ in whole or in pest, by:
1. Your acts or' 'omissidas; or
2. The act, or emissions of those acting on your behalf. iq the performaocet of
our bagomag operations. for the. additional insureds) at the locations)
esigntted above:
V, With respect to the insurance afforded to these additional insureds, the fol-
lowing additional exclus_oZS applyi
This insurance. doe's nbt apply to "bodily injury!' or "property damage- occurring
after:
I_ A11 work, including materials,, parts,or equipment furnished in connection. with
such work, , on the project (otrier than service, maintenance or repairsl . to be
performed byaeoro habehalf een fthe
completed,additional. insured(s) at the location of the or
covered:i- That. portion of "you= work" out of which the injury or damage. arises has been
put to its intended use by any person or organization other than another
contractor or subcontractor engaged in performing operations for a orineipal
as part of the same project.
C'. with respect to the insurance afforded to these additional insureds, the
following applies:
The insurance provided by this endorsement is primary insurance and we will not
seek contribution under any insurance policy under which such additional inauzed
is a named insured, if such policy was procured and paid for by such additional
insured, or a parent or related entity of such additional insured..
Cw 31 30 09 06 includes cooppyrighted material of 2nsuranee services
office, Inc., with its permission Page 1
TOTRL P.03
JUN-27-2012 13:44 ELLIOTT POWELL BRDEN BAKE P.02
POLICY NURSER! 2936039
THIS ENDORSEMENT CKmas3 THE POLICY. PLEASE READ IT. CAREFULLY
MANUSCRIPT MIDORSEME.NT
This endorsement modifies instiirarnce provided under the following:
COMMERCIAL PROPER'T'Y COVERAGE PART
SUSINESSOWNSRS
INLAND MARINE .
CRIME COVERAGE PART
Q COMMERCIAL AUTO COVERAGE PART
COMMERCIAL GENERAL LIASnjTY COVERAGE PART
CD PRODUCTS COMPLETED OPERATIONS LIABILITY COVERRRE. PART
❑ OWNERS An. CONTyA=R5 PROTECTIVE LIABILITY COVERAGE; PART.
COMMERCIAL UMBRELLA POLICY
WORXERS•COMPENSATION POLTCY .
ADDITICNAL INSURED DESIGNATED PERSON OR,ORGANIZATION (continued)-
rff#.ffi.f4fffrffR4•itfrfierffrrrf.f trriRf 4rf Mfr rf�<errfferrRferffff of rfR
Name of Additional Insured Persoa(s) Or Organization lei':
Any person or organization wnon'you are required to name as an
addieional insured on this policy undez, a written contract or
agreement_ Such written contract or agreement must be executed
Prior to the,-bodily injury° Or °.Property damage".
No such person or:organizacion is an insured with respect to any
occurence that takes place after expiration of the written contract
or agreement between You and such person or organization.
CW 10 54 91 90
CITY i 11ECORIDE 1 Page 1 / 1
Ashland Park Commission I DATEe PO NUMBER
20 E MAIN ST. 8/1512012 00132
ASHLAND, OR 97520
(541)488-5300 -
VENDOR: 000414 SHIP TO:
HAYS OIL COMPANY, RW HAYS OIL COMPANY D
PO BOX 1220
MEDFORD, OR 97501
FOB Point: Req.No.:
Terms: net Dept.:
Req.Del. Date: Contact: Bruce Dickens
Special Inst: Confirming? NO
'-
Quantity - Unit:. - - Description - ' Unit Price. Ext.Price '
THIS IS A REVISED PURCHASE ORDER
Fuel to be delivered as needed to the 4,000.00
Oak Knoll Shop- FY 2013 - NOTE:
Pending RFQ and successful contract ;
award.
New contract awarded to Hays Oil Co 7,000.00
UNLEADED FUEL- Mark up$0.181 per
qallon
B5 BIO-DIESEL-Mark up$0.181 per 7,000.00
gallon
I
Contract for Fuel (Ashland Parks& Rec)
Beqinninq date: September 10, 2012 i
Completion date: June 30, 2013
Insurance required/On file
I
i
i
SUBTOTAL 18 000.00
BILL TO: - TAX 0.00
FREIGHT 0.00
TOTAL 18.000.00
I
Account Number Project Number Amount Account Number Project Number-. .:Amount
E 211.12.04.00.602120 18 000.00
I
Auttforized Signature VENDOR COPY ;.
FORM #3 CITY OF
�t� � SH LAN D
;'�aV N-
A
REQUISITION Date of request:
Required date for delivery:
Vendor Name
Address,City,State,Zip
Contact Name&Telephone Number
Fax Number
SOURCING METHOD
❑ Exempt from Competitive Bidding ❑ Emergency
❑ Reason for exemption:_ ❑ Invitation to Bid (Copies onfile) ❑ Form#13,Written findings and Authorization
❑ AMC 2.50 Date approved by Council:_ ❑ Written quote or proposal attached
❑ Written quote or proposal attached
❑ Small Procurement Cooperative Procurement
-m —
Less than$5.00 r Request for Proposal (Copies on file) ❑I State of Oregon
❑ Direct Award Date approved by Council: Contract#
❑ Verbal/Written quote(s)or proposal(s) ❑ State of Washington
-Intermediate Procurement I I Sole Source Contract
GOODS&SERVICES �-! rk,b"I
ce'�'e6� � I Applicable Form(#5,6,7 or 8) ❑ Other goviimment agency contract
000 �f ❑
Written quote or proposal attached Agency
L,;1W%0Wr11t—t1e1r1 quotes a It acred''"-"�.-
M;- ❑ Form#4, Personal Services$5K to$75K Contract 4
PERSONAL SERVICES L_J Special Procuremen lbternovemmental Aareement
$5,000 to$75,000 ❑ Form#9,Request for Approval ❑ Agency
❑ Less than$35,000,by direct appoint nt ❑ Written quote or proposal attached Date original contract approved by Council:
F-1 (3)Written proposals attached Date approved by Council: (Date)
❑ Form K Personal Services$5K to$75K I Valid until: (Date)
Description of SERVICES Total Cost.
$
Item # Quantity Unit Description of MATERIALS Unit Price Total Cost
F-7 Al
E-1 Per attached quotelproposal 's T0tAl'C'0ST
Project Number---------- Account Number ----------------
Account Number----_-------------- Account Number ----------------
*Expenditure must be charged to the appropriate account numbers for the financials to accurately reflect the actual expenditures.
IT Director in collaboration with department to approve all hardware and software purchases:
ITDirector Date Support-Yes/No
By signing this requisition form,l certify that the City's public contracting requirements have b.0 ff tied.
sais
Employee Signature: Department Head Signature:
(Equal to or greater than$5,000)
Additional signatures(if applicable):
Funds appropriated for current fiscal year., (ES NO 1012el
Finance Director-(Equal too(olealerfhan$5,000) Date
Comments:
Form#3•Requisition