HomeMy WebLinkAbout2012-280 Contract - Upper Limb It
Contract for GOODS AND SERVICES Less than $25,000
CITY OF CONTRACTOR: Upper Limb It Tree Service
'ASHLAND CONTACT: Randolph P. Mason
20 East Main Street
Ashland, Oregon 97520 ADDRESS: 77 Manzanita Street #3, Ashland, OR 97520
Telephone: 541/488-6002
Fax: 541/488-5311 TELEPHONE: 541-601-6324
DATE AGREEMENT PREPARED: 11/08/2012 FAX:
BEGINNING DATE: 11/14/2012 COMPLETION DATE: January 31, 2012
COMPENSATION: $5,950.00 per proposal attached as Exhibit C.
GOODS AND SERVICES TO BE PROVIDED: Hazard Tree Removal - Six (6) dead trees on City of Ashland
property in three (3) locations as follows: one dead Oak tree @ 440 Normal St; four dead Douglas Fir @ end
of Terrace St; and one dead Ponderosa Pine @ end of Liberty St. Includes clean-up of all firewood, limbs and
debris.
ADDITIONAL TERMS:
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 2798.220, 27913.225, 27913.230, 27913.235, 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. 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 b City under an of the following
Contract for Goods and Services Less than $25,000, Revised 06/30/2012, Page 1 of 5
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 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 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 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. 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 Goods and Services Less than $25,000, Revised 06/30/2012, Page 2 of 5
s
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.
Contrac r: City of Ashland
BYE By
ignature Department Head
NV4VQAI.A.t Q.
~~gW4
lint Name Print Name
)nee - kI 1,1( col 2
Title Date
W-9 One copy of a W-9 is to be submitted with
the signed contract. Purchase Order No.
a
Contract for Goods and Services Less than $25,000, Revised 06/30/2012, Page 3 of 5
i
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.
&1 i
O8
Contractor (Date
Contract for Goods and Services Less than $25,000, Revised 06/30/2012, Page 4 of 5
Qr L, - l l ~Qe ~~rolce
kaA OA99M
\
n ~ Q,~ ZG V1 ! - /
q(o
Z)o
utw
Nov. 9. 2012 1:05PM Farmerl-5- 5--b"d-0 No. 4221 P. 1
ACORbP CERTIFICATE OF LIABILITY INSURANCE 11M/201"a "
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER- THIS
CERTFlCATE DOES NOT AFFIRMATIVELY OR NEOATTVELY 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: I the certificate holder Is an ADDITIONAL INSURED, the pollcy(les) must be endorsed, If SUBROGATION IS WAIVED, subject to
the (arms and conditions of the policy, certain policies may require an endorsement, A statement on this ceAlncele does not confer rights to the
certificate holder In I(aD of such endamemenl s .
mowosa care
Michael A, Rush PHONE FAX
.1361 Center Dr, Suite 100 AD ss.
Medford, OR 97501
Mtsu a AFWRDaO COYERAeE MAICs
DIVINER A: First Financial Insurance Company
uMURED IMGURERa:
Randolph P Meson erauwt C:
77 Manzanlta St MSUaER b:
Ashland, OR 97520 M INUM F!
Oa F:
COVERAGES CERTIFICATE NUMBER: 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 MAY HAVE BEEN REDUCED BY PAID CLAIMS.
La"
1e WO Type FDISuRssca ffl~
0011nuL wRILM 54OF-000579 31102012 3/1W013 Fpm DO~var~R~ s 1,000,000.00
OWAAAM To RENTED
EMSEa )E& m s 100,000,00
X CommmcIAL OBeRa Lwam PR
A Cl NSIOADE X❑ OCCUR uln F (I•V em pwww) s -5,00-0-0-0
YENSONALILADVODURY s 1,000,0110.00
GENERAL AOOPEGATE s 2,000,000.00
GrKLAGGREOATFUSRTAVAJEaPFx PROOIICrs•COMPIOPAGO s 2,000,000.00
X paler Pao roc s
auraroehLE LI.seLTn saecl,r UTAT
ANY AUTO BODILY IMAIar (Par P~) T
ALL OWNED aCrEnam BOOLY IN.URY (Fir Anuawq 1
AUTOS AUTOS
PEO.uros A~ O P.e~I.nTM Oawr'E y
f
UYaeel.lA!JAS OCCUR FACM OCCUAREND 3
EECE9e Los CLADL44IADE AGCREGATF T
DIED RETENTION s
OIT+
WORIOERSCOIPENEATMTII WC aTAIU- m
ANDEMPIDTEWLUUIa III
MY PROPRIEI I ORTNERbECUTNE YIN EL EACM A--Wr S
OFFr ROMEMr1Fe UCLL0907 ~ MIA
(Yw,d"y in MH) ELOISEAM-BRENMO 3
Uya~ sas w.
OE&OUPTOewleM OFOPERATIONe blwr EL MSFASE-POUCYLWIT $
DECCArTIOM OF OPERATIOMe I UDCAVOMe I MHOCIES (AIneA ACORD 101, AMOMMI FwW&A OrfMMAO. Mm ape N hydrae
Evidence of Insurance
CERTIFICATE HOLDER CANCELLATION
City of Ashland SHOULDANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
90 N Mountain Ave THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN.
Ashland, OR 97520 ACCORDANCEWITITHEPOUCYPROVISIONS.
AuTMOp@OpEPREaPJRA7fYE
F~
k
®1999-2010 ACORD CORPORATION. All rights reserved.
ACORD 2512010105) The ACORD name and logo are registered marks of ACORD ,
SAIF Corporation 11/9/2012 10:54:46 AM PAGE 1/001 Fax Server
www.seif.com
OREGON WORKERS COMPENSATION
CERTIFICATE OF INSURANCE Sa~f
Jcorporation
CERTIFICATE HOLDER:
CITY OF ASHLAND
ATTN: KAREN OLSON
90 NORTH MOUNTAIN AVE
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
741742 04/01/2012 to 04/01/2013 11/09/2012
INSURED: BROKER OF RECORD:
RANDOLPH MASON
UPPER LIMB IT TREE SERVICE
77 MANZANITA ST
ASHLAND, OR 97520-2640
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:
All Operations
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
3rg? . r Rq4. 1
President and CEO
400 High Street SE
Salem, OR 97312
P: 800.285.8525
F: 503.373.8020
Pallcy_B tch_CertiOCate rlnsumote
BUSINESS AUTO
DECLARATIONS FARMERS INSURANCE EXCHANGE
D POLICY MEMBERS OF FARMERS INSURANCE GROUP OF COMPANIES
❑ COVERAGE PART HOME OFFICE: 4680 WILSHIRE BLVD., LOS ANGELES, CALIFORNIA 90010
ITEM ONE
NAMED MASON, RANDY
INSURED UPPER LIMB-IT TREE SERVICE Account Number Prod, Count
MAILING 77 MANZANITA ST #3 73-01-363 60472-31-75
ADDRESS gent ouy um er
ASHLAND OR 97520
Type of
The named insured is an individual ❑ Partnership ❑ Corp. Business LANDSCAPE GARDENING
unless otherwise stated: ❑ joint Venture ❑ Organization (Other than Partnership or joint venture)
Policy Period from 03/12/12 (not prior to time applied for) to 03/12/13 12:01 AM Standard Time
If this policy replaces other coverages that end at noon standard time on the same day this policy begins, this policy will not
tape effect until the other coverage ends. This policy will continue for successive policy periods as follows: If we elect to
continue this insurance, we will renew this policy if you pay the required renewal premium for each successive policy period
subject to our premiums, rules and forms then to effect.
REM TWO SCHEDULE OF COVERAGES AND COVERED AUTOS
*This policy provides only those coverages where a charge is shown in the premium column below. Each of these coverages
will apply only to those autos shown as covered "autos'. Autos" are shown as covered autos for a particular coverage by
the entry of one or more of the symbols from the COVERED AUTO Section of the Business Auto Coverage Form nest to
the name of the coverage.
'COVERED AUTOS THE MOST WLIMIT
E WILL PAY FOR
COVERAGES ANY ONE ACCIDENT OR LOSS PREMIUM
(LIMITS SHOWN IN THOUSANDS)
LIABILITY 7 $ 250/500/100 862.00
PERSONAL INJURY PROTECTION SEPARATELY STATED IN EACH PIP ENDORSEMENT
(or equivalent No-Fqu t (overage)
ADDED PERSONAL INJURY PROTECTION SEPARATELY STATED IN EACH ADDED PIP ENDORSEMENT
(or equivalent added no-fault cov.)
PROPERTY PROTECTION INSURANCE SEPARATELY STATED IN THE P.P.I. ENDORSEMENT MINUS
(Michigan only) S DEDUCTIBLE FOR EACH ACCIDENT
AUTO MEDICAL PAYMENTS 7 $ SEE SCHEDULE 17.00
UNINSURED MOTORIST 7 $ SEE SCHEDULE 51.00
UNINSURED MOTORIST $
PROPERTY DAMAGE
UNDERINSURED MOTORISTS (When not S
incl. in Uninsured Motorists Coverage)
Actual Cash Value or Cost of Repair, whichever is
PHYSICAL DAMAGE less minus S SEE SCHEDULE Ded. for EE ch Covered
COMPREHENSIVE (OVERAGE 7 Auto. But no Deductible Applles to Loss Caused~y fire or 143.00
Lightning.. See Item Four or hired or borrowed "autos".
PHYSICAL DAMAGE SPECIFIED pctua cash value o cost of a1~ air, w is ever i
CAUSES OF LOSS (OVERAGE 7 Less us$25 Ded. for E c . (overe Auto our
a~sed~Fy Mjlchiefpr Van~a ism. See Item Four for hired
Or orrowea Autos .
PHYSICAL DAMAGE Actual (ash Value or Cost of Repair whichever is
COLLISION COVERAGE 7 less minus $ SEE SCHEDULE Ded. for Each Covered 240.00
Auto. See item four for hired or borrowed "Autos".
HYSI L AGE 7 $ 500 for each disablement of a covered
TOWING AND LABOR auto. (ACTUALLIMIT)
PREMIUM NO DORSEMENTS
ESTIMATETAL PREMIUM 1,313.06
FARMERS'
56-5190 6TH EDMON 3-10 (5190601 PAGE 1 OF 3
r
60472-31-75
Po iry Num er
BBUSSITHS AUTO DECLARATIONS (Continued)
SCHEDULE OF COVERED AUTOS YOU OWN TERRITORY
DESCRIPTION PURCHASED
Yipr, Model Tr~qde, jaMe Bpdy Type. Town & State where Covered
4overed Serial Num er (5 Ve ~u N) ent ication Number Ops~i'~w Act BI & Auta will be principally garaged
auto No. RE(D)
OR 203
1 96 INTERNATIONAL. F4900 12500 ASHLAND
1HTFDAAMXTH294617
2 06 TORNADO 15 27000 ASHLAND OR 203
4S8S216105WO24284
CLASSIFICATION
Radius o usiness use ize , go rimary econ ary o e ExcepT for towing, all physical damage
Operation s - serve a G(W or Veh. Group acing ating loss is payable to you and the loss
actor payee named belowas interests
r retaif Seating Factor
~ vend c - commercial Capacity is . Y. may appear at the time of the loss.
uto No. Dam.
50, C 22000 7 1;6000 .5000 68199
2 50 C
cti a entry in IT
Bence o a e ucti a or limit entry in any column De low means t T me imii Or a u
corres on in ITEM TIN column a lies instead
LIABILf(Y PERSONAL INJURY PROTECTION ADDED P.I.P. PROP. PROT. Mi . on
C *imii remium if sEEtat in ea remium Icode~tPti i fn~c en~t minus a act. Premium
Auto No. dudible ss own~%W remium shown be ow
2 250%500%100 44.00
ota 862.00
Premium
Bence o a e udi a or emit entry in any column a ow means t at t e emit or a ucti a entry in t
corresponding ITEM TWO column a lies instead)
AUTO MED. PAY U SURED 0 0 ISIS I RED OTOR T U D INS TO S S
Covered PROPERTY DAMAGE
* imii remium
Auto No. * imit remium * emit remium * imit remrum
2
Ota
Premium 17.00 51.00
sence o a e ucti a or mut entry in any column below means i at t e imii or a ucti a entrym
corres ondin ITEM TWb column applies instead) O I O BOR
COLLIS 0
COP ARM IVE SPECIFIED US 5 0 O SS
im t state n Premium imii sta e i i it state in ITEM remium Disa~ement Premium
Covered Wile 1Minus ~e uc- TWQ !no d dud.
Auto o. s own eow Premium shown~rei0
1 500 71.00 500 131.00
2 500 72.00
ota 143.00 240.00
Premium
*(LIMITS sHOWN IN THOUSANDS)
05190602 PAGE
mromnu vm
CfTY RECD^ DER Page 1 / 1
ASHLAND CITY OF
, DATE PO NUMBER
20 E MAIN ST. 11/14/2012 11293
ASHLAND, OR 97520
(541) 488-5300
VENDOR: 001127 SHIP TO: Safety
UPPER LIMB IT (541) 488-5358
77 MANZANITA STREET #3 90 N MOUNTAIN
ASHLAND, OR 97520 ASHLAND, OR 97520
FOB Point: Req. No.:
Terms: Net Dept.:
Req. Del. Date: Contact: Stu Wilkie
Special Inst: Confirming? No
Quanti Unit Description Unit Price Ext. Price
Hazard Tree Removal 5,950.00
Six (6) trees C@ 3 locations
(1) dead Oak Tree 440 Normal St.
(4) dead Douqlas Fir @ end of Terrace St
(1) dead Ponderosa Pine a end of Liberty
Includes clean-up of all firewood,
limbs and debris
Contract for Goods and Services
Beginninq date: 11/14/2012
Completion date: January 31, 2012
Insurance required/On file
SUBTOTAL 5.950.001
BILL TO: Account Payable TAX 0.00
20 EAST MAIN ST FREIGHT 0.00
541-552-2010 TOTAL 5,950.00
ASHLAND, OR 97520
Account Number Project Number Amount Account Number Project Number Amount
E 110.08.14.00.60235 800.00
E 410.08.24.00.60240 5,150.00
VENDOR COPY
Authorize ignature/
FORM#3 CITY OF
ASHLAND
REQUISITION Date of request: 11/6/12
Required date for delivery:
Vendor Name Upper Limb-it
Address, City, State, Zip 77 Manzanita St. #3
Contact Name & Telephone Number Ashland, Or. 97520
Fax Number Contact Randy Mason (541)-601-6324
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: ❑ Wdtlen quote or proposal attached
❑ Written quote or proposal attached
❑ Small Procurement Cooperative Procurement
Less than $5,000 ❑ Request for Proposal (Copies on file) ❑ State of Oregon
❑ Direct Award Dale approved by Council: Contract #
❑ VerballWritten 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 00 to 100 000 ❑ Written quote or proposal attached Agency
(3) Wntten quotes attached ❑ Form #4, Personal Services $5K to $75K Contract #
PERSONAL SERVICES ❑ Special Procurement Intergovernmental Agreement
$5,000 to $75,000 ❑ Form #9, Request for Approval ❑ Agency
❑ 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: (Date)
❑ Form #4, Personal Services $5K to $75K Valid until: Date
Description of SERVICES Total Cost
Hazard Tree Removal of 6 Dead Trees on City of Ashland Property (3) Locations
(1) One Dead Oak tree @440 Normal St.
(2) Four Dead Douglas Fir @ End of Terrace St. $5,950.00
(3) One Dead Ponderosa Pine @ End of Liberty St. -
4 Includes Clean-upof all Firewood, Limbs and Debris
Item # Quantity Unit Description of MATERIALS Unit Price Total Cost
TOTAL COST
Per attached quotelproposal $5,950.00
Project Number Account Number 7ZO-vo-zy-Co-,i;_v2-}a' $S r5~,`
Account Number- Account Number_L'L2•o8•LY c_`6 -°?3S_3
*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 re isition form, I certify that the City's public contracting requirements have been satisfied.
Employee Signature: Department Head Signature: w ,R-2
(Equal to or greater th. n $5,000)
Additional signatures (if applicable):
Funds appropriated for current fiscal year: CE3 / NO
Finance Director- (Equal to orgy ter than $5,000) Date
Form #3 - Requisition