HomeMy WebLinkAbout2012-266 Contract - ModSpace
Contract for GOODS AND SERVICES Less than $25,000
CITY OF CONTRACTOR: ModSpace
.-ASHLAND CONTACT: Brandon Statton
20 East Main Street
Ashland, Oregon 97520 ADDRESS: 13132 N. Woodrush Way,'Portland, OR
Telephone: 541/488-6002
Fax: 5411488-5311 TELEPHONE: 866-322-0120
DATE AGREEMENT PREPARED: FAX: 610-232-1210 e
BEGINNING DATE: -9-012 COMPLETION DATE:
COMPENSATION: See Exhibit B, herein incorporated.
GOODS AND SERVICES TO BE PROVIDED:
ADDITIONAL TERMS: Goods, services, and price schedule are as provided in Exhibit B, and except as
otherwise specifically provided herein, terms and conditions of Exhibit B will govern.
NOW THEREFORE, pursuant to AMC 2.50 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 279B.220, 279B.225, 279B.230, 2798.235, 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 $18,890 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. City's 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
conditions:
Contract for Goods and Services Less than $25,000, Revised 06/3012011, Page 1 of 5
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 party
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 bylaw 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 qualify 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. Workers 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.
d. Notice of cancellation or than e. There shall be no cancellation material change, reduction of limits or
Contract for Goods and Services Less than $25,000, Revised 06/3012011, Page 2 of 5
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
reference.
Contractor: Nopvcat.S~Rz..rr Ci hIand
By qjdA~ By
Si aturee D partment Head
/y. 4 vLt.o7.r r ORJ& I<Q N h]`G2
Print Name Print Name
~fC/1 COA1 Ti44c-TS- to 125 l 17.
Title Date
W-9 One copy of a W-9 is to be submitted with
the signed contract. Purchase Order No.
Contract for Goods and Services Less than $25,000, Revised 06130/2011, 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:
(1) 1 carry out the labor or services at a location separate from my residence or is in a
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.
MoyvLoNt sPi ~2~0 io - r Z
Contractor (Date)
Conlract for Goods and Services Less than $25,000, Revised 06130/2011, Page 4 of 5
- ~ tXh 1 ~ I ~ 4/
This Quote Created For: 10/03/2012
M c Ashland Parks & Recreation Quote 007458
pafie Quote Expires: 11/02/2012
866-322-0120
Customer Details: Branch Details: Delivery Details:
Ashland Parks & Recreation Portland Or Winburn Way & Nutley
340 S Pioneer St 13132 N. Woodrush Way ASHLAND, OR 97520
Ashland, OR 97520-2729 Portland, OR
Contact: Dan Merrill Contact: Brandon Station
Phone: 541-488-5340 Phone: 866-322-0120
merrilld@ashland.or.us FAX: 610-232-1210
Bra ndon. Statton@ modspace.com
10'X 32' - SINGLE WIDE 10"
Quote Type: Operating Lease
Monthly"~,Charges
pry... -Term Monthly Rental Total Mouthy Rate
1 3 Months $239.00 $239.00
One Time Charges
Setup and Delivery Charges -Billed with First Invoice
Qty Installation Charges Each Total Prim
1 Building Delivery $1,300.00 $1,300.00
1 Delivery Fuel Surcharge $65.00 $65.00
1 Block And Level $66.00 $66.00
1 Remove Tires $60.00 $60.00
Setup and Delivery Total $1,491.00
Dismantle and Return Charges - Billed with Last Invoice
Qty Dismantle and Return Charge Each Total Price
1 Building Return $1,300.00 $1,300.00
1 Return Fuel Surcharge $65.00 $65.00
1 Unblock $66.00 $66.00
Dismantle and Return Total $1,431.00
Billed at Current Rate at time of Termination Total Requested One Time Charges $2,922.00
Yo~u'Aiso Requested '
Qty Monthly Rental Total Monthly Rate
Additional Items(Mordhly Charge)
2 Steps 2@ $5.00 $10.00
Additional Value Added Products Total $10.00
Tax rates will vary with delivery address. Taxes are subject to change by tax authorities without notice.
Property Expense per month $14.34
qq, provide you with these es avingiop0ons. k,M~,° + *y
We aal ggest Vague=Added Products. Let Mods-,'
innialun th_e box to the leR of the item; enter quantity if needed; and let us In re of the rest:
ljiltijI77-77 Qty y Rate (each) Intial;: Qy Rate.(each) ,r rr t
0 Ahchor/Tle Down 6 $69.00 ~ QRemove AnchorsTedowns V,'~ $69 00aiB
!
QDamage,Waiver 1 $75.017°"ia°'~ QGeneral Liatitliy In`surande 1 x;$,19 50°°
Satisfies your leesa oDigatian for canmerdal pmperlrlMUrama. I Safisfies`your lease obligation fw k'ommpdel liaC~Lty mwrance - I
QStack/Folding Chair (Ea.) 3 $3.00°°""'""' [::]Folding Table (Ea.) 1 $10.00°°'"°""'.
Page I
Visit us on the web at www.modspaCe.com
MWSpaee
Contractual Insurance Requirements for Mobile and Modular Buildings (US ONLY)
Per Section 9(a) of the Modular Space Corporation lease agreement, you must provide insurance for all units leased from
Modular Space Corporation with the foltowing coverage:
1. Commercial General Liability insurance with a rninhwm combined single limit of $1,000,000 per occurrence,
written In an occurrence form, including coverage for premises, operations, contractual liablgty, broad form property
damage, Independent contractors and personal Injury liability, naming Modular Space Corporation as an additional
Insured.
2. Commerclal Property Insurance protecting against all loss and damages. at fug replacement cost, sustained or
suffered due to the loss of or damage to the Equipment as a result of collision, fire, lightening, theft, food, windstorm,
_ explosion or any other casualty, naming Modular Space Corporation and Bank of America, N.A. as a loss payees.
Please Indicate how you will be meeting the Modular Space Corporation lease requirements and send
back with lease documents:
OPTION 1 - select one or both of the ModSpace's convenient and cost-effective programs:
❑ Commercial General Llabll ty Program ❑ Damage Waiver Program
This program satisfies the lease requirement for Commercial General This program satisfies the lease requirements for
Liability Insurance. Commercial Properly Insurance.
Under this pr am, you receive insurance coverage offered by With this program we waive, for a fee, (a) your
American So%u am Insurance Co and administered by Allen obligation under the Lease agreement to carry
Insurance Group. The Insurer will defend you and pay those Commercial Property Insurance and (b) your
amounts that you are legally obligated to pay due to bodily tipury and liability to us for repair or replacement of the
property damage arising from the proper use and occupancy of a building structure for loss or damage as specified
modular unit leased from Modular Space Corporation up to the policy in Section 9(a)00 of the Lease Agreement. The
limits. Steps, stairs, and ramps are also covered when they are used waiver is effective only If Ore Lessee does riot
in cormectim with a modular unit leased from Modular Space violate any other provision of the Lease
Corporation. An ouigne of cover Is available upon request. Agreement. You will remain liable to us for the
Coverage is subject to underwriting and specific terms and conditions first $1000 of damage per unit. This waiver Is
set tot in your policy. not insurance coverage.
OPTION 2- I will be providing my own insurance for the leased units:
1 (the lessee) have insurance in accordance with Section 9 of the lease agreement with respect to all requirements
except as elected in Option 1 above. I will deliver a certificate of Insurance no later than 14 days after equipment delivery
as required by Section g(b) of the lease agreement. If I fail to delver the insurance certificate within lie 14 days I
understand that Modular Space Corporation has the right to Wnpose an insurance processing fee as well as an uninsured
lessee fee as ou0trued In section 9(c) of the lease agreement:
Agency Name: Agent Name:
Agency Address: Agency Phone a:
Agency Far a:
X Signature Of Lessee Print Name Date
TO BE FILLED OUT BY MODSPACE BRANCH PERSONNEL:
Customer Account Name: Customer Number
Lease Agreement Number Unit Numbeds):
Manufacturer. Unit(s) Serial Number.
Equipment Value: Model Year:
IF OPTION 21s selected please fax torn to 888.204-0015 or email mode1axWmrance0m2ds2aee.eom
Corporate Headquarters - 1200 Swedesford Road, Berwyn, PA 19312 www.modapeoacom
C This Quote Created For: 10/03/2012
M~ c Ashland Parks & Recreation Quote 007458
panp Quote Expires: 11/02/2012
866-322-0120
Only ModSpace Offers Our Exclusive, No-Hassle "On-Time Guarantee' If your Singlewide with a term of 6 months or greater is not delivered
on the date promised, your first month's rent is absolutely hee. If it is not removed on the date promised, ModSpace will rebate one month's
rent. No arguments. No hassle
Quote is based on customer signing a ModSpace Lease Agreement, Sale Agreement, or Finance Lease Agreement.
All transactions are subject to credit approval
All buildings are subject to availability and actual 6oorplans may vary.
Scope of work and material provided are indicated herein. Any additional work performed and material provided are subject to additional costs.
Modular Space Corporation does not warrant that equipment meets any local or state code not specifically listed.
Customer-is responsible for all occupancy and utility permits, fees, licenses, and utility connections, including watensewer. ModSpace can quote
prices to obtain permits and handle all utility connections upon request.
The Lessee is responsible for providing a level site capable of minimum 1,000 psf soil bearing capacity that is accessible to standard mobile
transport equipment. Unlevel sites may increase blocking charges.
Standard electrical requirements for temporary power are single phase, 100 amp, 110-240 volts for singlewides, complexes may vary. Electrical
supply, permit and hookup supplied by others.
For leases over six months, all return charges will be charged at the current rate at time of unit return.
Units with restrooms are not self-contained; they require either plumbing into water/sewer or the use of holding tanks. Goth plumbing hookup
and leasing of holding tanks or portable toilets can be provided by ModSpace - prices available upon request.
Wad time or additional site time will be charged at $95.00 per hour.
Pilot cars will be billed as required by ODOT and WADOT at $99 each for all 12' wide and 14' wide units. Pilot cars with over a 25 mile radius
will be charged an additional $1.99 per mile on a per mile basis. Amount may vary based on route.
Installation/set-up charges does not include anchorsNedowas and skirting which maybe required by City, County, and/or State. Anchors4wowns
and skirting costs can be provided upon request.
ModSpace will not be responsible for damage to underground utilities that are not marked at time of install when anchorsmedowns are used.
Blue Stake Locator call in center for OR: 800-332-2344 and for WA: 8004245555.
Property tax and/or sales tax will be charged additionally on all buildings located in Oregon and Washington.
fffYflfffffiffYeffYRf1111ffffifififYMfff1111fffiHffiffYfff1111f111ffffllffitf4fffftYYffYYf1111ff111ff M111ffitYYfffffYfifllflf111f
This Quotation is subject to ModSpace's credit approval of Customer. ModSpace does not warrant that the equipment meets any local or state
• code not specifically listed herein. Pricing quoted herein is open for Customers acceptance for thirty (30) days from the date of this Quotation and
excludes all state and local taxes, fees, permits and utility connections (unless specifically stated otherwise). Equipment is subject to availability.
Any Value Added Products or Services ('VAPS"), including, without limitation, storage containers, sanitary holding tanks, water delivery systems,
portable toilets, wash stations, toilet trailers, septic tanks, generators, furnishings, security systems, steps or ramps quoted by ModSpace are
provided strictly as a matter of convenience to the Customer. The Customer understands and agrees that ModSpace only serves as a billing agent
for the third party vendor of the VAPS and assumes no liability therefor. By signing below, customer accepts the terms of this quotation, leases or
purchases (as applicable) the equipment identified herein, and agrees that such signature constitutes customers acceptance of and agreement
to the ModSpace Lease or Sale Agreement. Such lease or sale, and customers agreement thereto, is subject to ModSpace's standard terms
and conditions located at http:/twww.modspace.com/resourcesidorument-library. Customer may request a copy of the terms and conditions from
a ModSpace representative. If customer has previously executed a master agreement with ModSpace, those terms and mnditions shall govern
the transaction. Such terms and conditions are incorporated as if fully set forth herein. Any customer purchase order or other customer-provided
document purporting to replace, supersede or supplement the terms and conditions of the Modspace Lease or Sale Agreement shall carry no
force or effect except as an instrument of billing.
Customer Approval Signature Date
Print Name Lease prepared by
Print Title Print Reps Name here
V®t~ 88 to form
Page 2
Visit us on the web at www.modspace.com
N
AC" 'CERTIFICATE OF LIABILITY INSURANCE Pagel of ~0/26/202
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 endorsement(s).
PRODUCER 'CONTACT
'
Willis of Paneeylvenie. Ind. ..NAME; _
;PHONE WAX
N4E%Il:_877_9}$-7.79 __-_tqC-NO ..y,,, _88 677.217
8 _
c/o 26 Century Blvd. L+NG.IL
E-MA
P. O. Box 304191 :ADDREBS._.._.9~_L.53..kr.4.@.~Y?1..3..a_-0AF1_
.
Nashville. TN 3'1230-5191
INSURERIS)AFFORDING COVERAGE NAICa
INSURERA: National Union Fire Ins. Co. of PSttsburg'19445-001
_
IN$VREO INSURFRE Ircnahora Indemnity led. .23647-001
Modular Space Corporation
1200 Swedestord Road INSURFRC New Rempah.ira In¢uranam company ,23941 001
Berwyn, PA 15312-1076 INSURERD,.New Nampehira Insurance Company
.23841 U50
. . _
INGURERE: Insurance Company of the State of Pannsyl!19420-002
INRURER F,
COVERAGES CERTIFICATE NUMBER: 18772675 REVISION NUMBER:
THIS IS TO CERTIFY THAT TH6 POLICIES Or INSURANCE LISTED BELOW HAVE BEEN ISSUED I'D THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMEN'1- 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:
INSR _ ...OA' $IIRR..... ...1, EC EPP POLICY EXP..
TYPE OP INSURANCE POLICY NU M980. LIMITS
WVD A GENERAL !LIABILITY Y 4406348 3/30/2012 13/30/2013 EACH OCCURRENCE.._,,,,,,,,,,,,,, $ 1,,,000,...0.00....
DAMAO TO'ENTFD
CIALGEE UABILITY PRFMI F.V,Iktl( II Y^.J:41 $ ~.i 0_0_0 QO Q__
COMMERCIAL GENERAL XL OCCUR j MED EXP(Am w,PerMip $ 10,000
CLAI ,
,
PERSONAL A ADV INJURY 1., 000,.0_0 0
- .
GENERALACOREOArE ;S OD0, 000
_ .
GEN'L AGGREGATE LIMIT APPLES PER: PROLNICT$-COMPIOP AOO , 000, 000
PRO
POLICY - Lr- LOC :f
A auTOMO91LE UAaam Y :4695608 :3/30/2012 13/30/2013 fE88s0swGLE LIMIT
1f 2, OO D, 000
A X ANV AUTO Y :4695609 13/30/2012 13/3D/2013 BODILY INJURYIPer pemm) $
ALLOWNED 1SCHEDUL,FD Y 4695610 3/30/2012 3/30/2013 BODILY INJLIRYLPo lnidem l) S
A AU109 :AUTOS
- :NON-OWNED Pii ERTV LIAMAOF
HIRED A4'I'PS AUI'OF 8r aae.I), f
g X UMBRELLA UAB X =Xk y 000202602 ;3/30/2012 3/30/2013 EACH OCCURRENCE f 5,000,,00.0
EXCESS UAO CLAIMS-MAPU AGGREGATE_ f 510001000_
OED i (RETENTIONS I$
C• WORKERSCOMPENSATION ;ADS 033464467 13/30/2012 i3 130/2013 iX
ANOEMPLOYER$'LIABILTY TORYIIMIT$ ER..
D ANY PROPRIETOR/ ARTNERIEXECUTIVE NN ;NAT 033464466 13/30/2012 13/30/2013 E.L. EACH ACCIDENT _ f 1 000 000
E MFIGIn ~EeR MEMIB~ER EXCLUDED? -j NIA CA 033464464 13/30/2012 ,3/30/2013 F. DISEME EAEMPI,OYEE $ 1,000, 000
& Dtv.R1PTI/JN OF OPERATIONS neww (MA 0334644653 /30/2012 '1,3/30/2013E.L. DISEASE-POLICY UMn' 1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Aaach ATOM lei"Addiledel Ramat ke 3clla,wls, If meet spice is"ulad)
He: Lease #190179
See Attached:
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Ashland Parks and Recreation AUTHORIZED REPRESENTATIVE
Attnf Rari Olson
90 N. Mountain Ave.
Ashland, OR 97520 _w::2 c.7
Co11:3903543 Tpl:1423550 Oartr18772675 07988-2010ACORDCORPORATION. All rights reserved.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
Why We Are.Using he Latest ACORD Certificate.of..Insuranee and.
Evidence of Insurance'forms?::
In septernber 2009, ACORD revised the ACORt724 Certificate of Property Insurance and'the;25 Certifcate.of
.
Llabllity Insurance form..Also'rln December 2009 they revised the ACORD 27 Evidence of Property insurance and
the 28 Evidence of Commercial,Property Insurance., One of the major changes on all the forms was the removal
of the cancellation'notlce,provislon. For the following reasons,.we are unable to Issue'an older.edltlon of these
forms;.modifythe current form,. or complete a proprietary form•you.provide:
"Notice of canceltation'is a:policy right; not an unregulated service: No insurer shown'on this certificate' is able to
,-..provide the cancellation notice you desire by endorsement. For example, the•lnsured can cancel. lmmedlately,
so it would be.impossible for the insurer to give you the notice you request. State law also grants the insurer the
right to cancel for reasons such as nonpayment with.less notice than you require.
For the'reason just cited, if our agency was to Issue.a certificate that provides the cancellatioi notlce you
request,. we would doso with the full knowledge that it would be impossible to actually give that amount of
..notice under certain circumstances. As such, the certificate could be alleged to constitute a' misrepresentation
or fraud which could subject our agency and staff to serious,civil.and criminal penalties
if a certificate purports to provides policy right different from that provided by the policy Itself then the
certificate'eff ectively purports to be a policy form-Policy forms must be filed and approved bybur state
'department of insurance. Use of non-filed policy forms is illegal and could result in legal sanction's distinctfrom'
the assertion that the certificate is fraudulent..
iJdderthe ACORD Corporation's lieensing.agreement the prior editions of superseded forms can be'used for
one year from the time.the.new, forms are introduced. This is another reason we cannot use an older edition of
the ACORD forms:.Doing so would.violate ACORD's llcensing agreement and, as a copyrighted document,.,.
federalcopyright.law.
,Likewise, we are unable to:mod'ifythe new certificate to.add a notice of cancellatlon.ACORD forms are
designed to be completed,: not altered: ACORD's Forms Instruction Guide says that a.certificate.should not be '
used "To waive' rights...To quote wording from a contract:,.To quote any wording which amends a policy unless.
the policy itself has.been amended.".In addition, our insurance' company contracts only allow us to.issue
'unaltered ACORDforms.....: i.;...;..:•...;...:.....
We are'often:asked to issue:p'ropriefary certificates provided by the certificate" requestor:'Again, our insurance
company contracts only allow us to issue.unaltered ACORD forms. Many proprietary certificates include broad;
`vague or ambiguous language that may or may not be incompliance. with state laws, regulations, and insurance.
department directives. Therefore, we cannot Issue any proprietary certificates that have not been.revlewed by
our state, Insurance department
If you have received prior versiofisledifions of the ACORb Certificate or Evidence fotmst being advised that
priorversions/editions areunacceptable; a risk of being out of regulatory and/or statutory compliance ls;hlghly '
plausible.,,.
We appreciate yourundersianding of the legal restrictions on our ability to fully complywith your request,
AGENCY CUSTOMER ID: 220111.01._..._.__,._.........__
LOCH:
ADDITIONAL REMARKS SCHEDULE Page ....2_of .2.........
AGENCY NAMED INSURED
Modular space corporation
Willis of Pennsylvania Inc. 1200 Swadesford Road
ROIICY NUMDEN Berwyn, PA 19312-1078
See First Page
CARRIER i NAIC CODE
i .
Bee First Pa a EFOeCTIyeDAYe: $ee First Page
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: ZS FORM TITLE: CERTIFICATE OF LIABILITY INSDRANC$
Workers Compensation-Florida
Policy #033464463
Policy Term: 03/30/2012 - 03/30/2013
Carrier: New Rempshire Insurance Company
Limits: WC Statutory Limits
EL Each Accident : 11000,000
EL Disease - Each Ere lo as : 1,000,000
EL Disease - Policy Limyit : 1,000,000
Subject to their terms and conditions, the above referenced liability policies (excluding Workers'
Compensation and Emp loyers Liability) include Ashland Parka and Recreation as Additional insured in
regards to work pert ad by employees, agents and subcontractors of MSC in the course of
delivering, installing, repairing and/or removal of modular buildings leased or purchased from MSC.
ACORD 101 (2008/01) Co110003543 Tp1:1423550 Cart:18772675 (0 2000 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
Willis
Fax
Date/Time: Fri, Oct 26 2012 12:38:34 PM EST
Pages: 4
To: Kari Olson
Fax: 541-488-5320
From: Willis North America, Inc.
Fax: 888-467-2378
Voice: 877-945-7378
Email: certificates@willis.com
Subject: Your Certificate Request for Modular Space Corporation -
Willis:-6058229-
we trust this document is issued in compliance with your needs.
However, if you have any questions or wish to discuss it in any way,
please do not hesitate to contact us.
Thank you,
Please contact sender if you do not receive the number of pages stated or have difficulty with legibility. Please be
aware that this facsimile is confidential. If you are not the intended recipient, please notify us immediately. You
should not copy it or use it for any purpose, nor disclose its contents to any other person.
CITY RECORDER Page 1 / 1
Ashland Park Commission DATE PO NUMBER
10/31/2012 00169
20 E MAIN ST.
ASHLAND, OR 97520
(541) 488-5300
VENDOR: 004077 SHIP TO:
MODULAR SPACE CORPORATION
1200 SWEDESFORD ROAD
BERWYN, PA 19312
FOB Paint: Req. No.:
Terms: net Dept.:
Req. Del. Date: Contact: Rachel Dials
Special Inst: Confirming? NO
Quantity Unit Description Unit Price Ext. Price
4.00 MO Modular Office Building Rental 239.00 956.00
Ice Skating Rink
November 2012 to February 2013
Delivery and Set up 1,491.00
Dismantle and Return 1,431.00
Per attached contract and quotation
Quotation 007458
Contract for Goods and Services
Beginning date: November, 2012
Completion date: February, 2013
SUBTOTAL 3,878.00;
BILL TO: TAX 0.00
FREIGHT 0.00
TOTAL 3,878.00.
Account Number Project Number Amount Account Number Project Number Amount
E 211.12.03.02.60691 E 000007.999 3,878.00
~ Zo/L
e 7 /03/
VENDOR
A orized Signature COPY
I
FORM,#3 CITY OF
-taco -ASHLAND ej~
REQUISITION Date of request:
Required date for delivery:
Vendor Name l/~ X711 "r ~e--
Address, City, State, Zip
Contact Name & Telephone Number
Fax Number
I
SOURCING METHOD
❑ Exempt from Competitive Bidding ❑ Ememencv
❑ Reason for exemption: ❑ Invitation to Bid (Copies on file) ❑ Form #13, Written findings and Authorization
❑ AMC 2.50 Date approved by Council: ❑ Written quote or proposal attached
❑ C ten quote or proposal attached
Small Procurement Cooperative Procurement
Less than 5 000 El Request for Proposal (Copies on file) ❑ State of Oregon
t Award Date approved by Council: Contract #
erbal/Wdtten quote(s) or proposal(s) ❑ State of Washington
Intermediate Procurement ❑ Sole Source Contract #
GOODS & SERVICES ❑ Applicable Form (#5,6, 7 or 8) ❑ Other government agency contract
$5,000 to $100.000 ❑ Written quote or proposal attached Agency
❑ (3) Written quotes attached ❑ Form #4, Personal Services $5K to $75K Contract It
PERSONAL SERVICES ❑ Special Procurement Intergovernmental Agreement
$5.000 to $75,000 ❑ Agency
❑ Form #g, Request for Approval
❑ Less than $35,000, by direct appointment ❑ Written quote or proposal attached Date original contract approved by Council:
❑ (3) Written proposals attached Date approved by Council: (Dale)
❑ Form #4, Personal Services $5K to $75K Valid until: Date
Description of SERVICES Total Cost
I
Item # Quantity Unit Description of MATERIALS Unit Price Total Cost
-2x:19 -Le ~;W 10-C
I
- "TOTALCOST
Per attached quotelproposal $
i..
elf ~O ,
ProjectNumbeQQUJ -9`t~ AccountNumber___•__-_ • -
-
Account NumberqL-I--Q}(('2--_(~(C-f-Il3 AccountNumber___•__-__•__-______
'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 hav been se
Employee Signature: Department Head Signature
(Equal to orgre to than $5,000)
Additional signatures (if applicable):
i
Funds appropriated for current fiscal year., YES / NO
Finance Director- (Equal to orgreaterthan $5,000) Date
Comments:
Form #3 - Requisition