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HomeMy WebLinkAbout2013-006 Contract - Polaris Land Surveying Contract for PERSONAL SERVICES less than $35,000 CITY OF CONSULTANT: Polaris Land Surveying, LLC ASHLAND CONTACT: Shawn Kampmann 20 East Main Street Ashland, Oregon 97520 ADDRESS: P.O. Box 459, Ashland, OR 97520 Telephone: 541/488-6002 Fax: 5411488-5311 TELEPHONE: (541) 482-5009 DATE AGREEMENT PREPARED: FAX: (541) 488-0797 December 21, 2012 BEGINNING DATE: December 24, 2012 COMPLETION DATE: February 28, 2013 COMPENSATION: Not to Exceed $2,500 SERVICES TO BE PROVIDED: Surveying services related to a property line adjustment for 430 N. Main Street. See attached proposal ADDITIONAL TERMS: FINDINGS: Pursuant to AMC 2.50.120, after reasonable inquiry and evaluation, the undersigned Department Head finds and determines that: (1) the services to be acquired are personal services; (2) the City does not have adequate personnel nor resources to perform the services; (3) the statement of work represents the department's plan for utilization of such personal services; (4) the undersigned consultant has specialized experience, education, training and capability sufficient to perform the quality, quantity and type of work requested in the scope of work within the time and financial constraints provided; (5) the consultant's proposal will best serve the needs of the City; and (6) the compensation negotiated herein is fair and reasonable. NOW THEREFORE, in consideration of the mutual covenants contained herein the CITY AND CONSULTANT AGREE as follows: 1. Findings I Recitations. The findings and recitations set forth above are true and correct and are incorporated herein by this reference. 2. All Costs by Consultant: Consultant shall, at its own risk and expense, perform the personal services described above and, unless otherwise specified, furnish all labor, equipment and materials required for the proper performance of such service. 3. Qualified Work: Consultant has represented, and by entering into this contract now represents, that all personnel assigned to the work required under this contract are fully qualified to perform the service 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. 4. Completion Date: Consultant shall start performing the service under this contract by the beginning date indicated above and complete the service by the completion date indicated above. 5. Compensation: City shall pay Consultant for service 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. 6. Ownership of Documents: All documents prepared by Consultant pursuant to this contract shall be the property of City. 7. Statutory Requirements: ORS 279C.505, 279C.515, 279C.520 and 279C.530 are made part of this contract. 8. Living Wage Requirements: If the amount of this contract is $19,494 or more, Consultant 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 service work under this contract. Consultant is also required to post the notice attached hereto as Exhibit B predominantly in areas where it will be seen by all employees. 9. Indemnification: Consultant 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 Consultant (including but not limited to, Consultant's employees, agents, and others designated by Consultant to perform work or services attendant to this contract). Consultant 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. 10. Termination: a. Mutual Consent. This contract may be terminated at an time b mutual consent of both artiest Wpulo w*s\eng\12-30 Alley Extension - N Main to LonlA_Admin\Eng Vendo2 (Polaris Land Surveying)\Contracl Documents\Final Cony Docs\12-30 Polaris -Contract for Personal Services Less than $35K - Revised o6 30 2012.docx b. Citv'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 whale or in part, effective upon delivery of written notice to Consultant, or at such later date as may be established by City under any of the following 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 Consultant 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 Consultant 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 Consultant's performance of each and every obligation and duty under this contract. City by written notice to Consultant of default or breach may at any time terminate the whole or any part of this contract if Consultant fails to provide services called for by this contract within the time specked 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, Consultant shall immediately cease all activities under this contract, unless expressly directed otherwise by City in the notice of termination. Further, upon termination, -Consultant 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 Consultant for work performed prior to the termination date if such work was performed in accordance with the Contract. 11. Independent Contractor Status: Consultant is an independent contractor and not an employee of the City. Consultant shall have the complete responsibility for the performance of this contract. Consultant shall provide workers' compensation coverage as required in ORS Ch 656 for all persons employed to perform work pursuant to this contract. Consultant is a subject employer that will comply with ORS 656.017. 12. Assignment and Subcontracts: Consultant 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. Consultant 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. 13. Default. The Consultant shall be in default of this agreement if Consultant: commits any material breach or default of any covenant, warranty, certification, or obligation it owes under the Contract; its QRF status pursuant to the QRF Rules or loses any license, certificate or certification that is required to perform the Services or to qualify as a QRF if consultant 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. 14. Insurance. Consultant 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. Professional Liability insurance with a combined single limit, or the equivalent, of not less than . 1 000 000 for each claim, incident or occurrence. This is to cover damages caused by error, omission or negligent acts related to the professional services to be provided under this contract. C. General Liability insurance with a combined single limit, or the equivalent, of not less than 1 000 000 for each occurrence for Bodily Injury and Property Damage. It shall include contractual liability coverage for the indemnity provided under this contract. d. Automobile Lia6ility insurance with a combined single limit, or the equivalent, of not less than $1.000.000 for each accident for Bodily Injury and Property Damage, including coverage for owned, hired or non-owned vehicles, as applicable. e. 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 Consultant or its insurers to G:\pub-vvrks\eng\12-30 Alley Extension - N Main to LOMA Admin\Eng Vendo2 (Polaris Land Surveying)\Contract Documents\Finai Contr Docs172-30 Polaris - Contract for Personal Services Less than $35K - Revised 06 3o 2012.docx the City. f. Additional Insured/Certificates of Insurance. Consultant 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 Consultant's services to be provided under this Contract. The consultant's insurance is primary and non-contributory. As evidence of the insurance coverages required by this Contract, the Consultant shall furnish acceptable insurance certificates prior to commencing work under this contract. 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 Consultant shall be financially responsible for all pertinent deductibles, self-insured retentions and/or self- insurance. 15. 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 Consultant 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. Consultant, 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. 16. 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. CONSULTANT, 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. 17. 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. Consultant 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 Consultant, with no further liability to Consultant. Certification. Consultant shall sign the certification attached hereto as Exhibit A and herein incorporated b reference. Consultant: City of Ashland By 5 0,.-ti By \ -Sigma Department HXad Print Na Print Name MA (2`2! //Z itle e Date W-9 One copy of a W-9 is to be submitted with the signed contract. Purchase Order No. G:kpub- Askeng\12-30 Alley Extension - N Main to Lon1A_AdminlEng Vendo2 (Polaris Land Surveying)\Contract Documents\Fnal Contr Dors112-30 Polaris - Contract for Personal Services Less than $35K - Revised 06 30 201 2.docx 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) I 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. Contractor (Date) GApub- vrks\eng\12-30 Alley Extension - N Main to LoriW_Admin\Eng Vendo2 (Polaris Land Surveying)\Contract DocumentsTinal Cony Docs\12-30 Polaris - Contract for Personal Services Less than $35K - Revised 06 3o 20 t 2.docx CITY OF ASHLAND, OREGON EXHIBIT B City of Ashland LIVING WAGE hour effective June 30, 2012 (Increases annually every June 30 by the Consumer Price Index) • . . portion of business of their cafeteria plans (including employer, if the employer has childcare) benefits to the ten or more employees, and amount of wages received by has received financial the employee. assistance for the project or For all hours worked under a business from the City of ➢ Note: °Employee" does not service contract between their Ashland in excess of $19,494. include temporary or part-time employer and the City of employees hired for less than Ashland if the contract L If their employer is the City of 1040 hours in any twelve- exceeds $19,494 or more. Ashland including the Parks month period. For more For all hours worked in a and Recreation Department. details on applicability of this policy, please see Ashland month if the employee spends In calculating the living wage, Municipal Code Section 50% or more of the employers may add the value 3.12.020. employee's time in that month of health care, retirement, working on a project or 401 K and IRS eligible For additional information: Call the Ashland City Administrator's office at 541488-6002 or write to the City Administrator, City Hall, 20 East Main Street, Ashland, OR 97520 or visit the city's website at www.ashland.or.us. Notice to Employers: This notice must be posted predominantly in areas where it can be seen by all employees. CITY O F ASHLAND G:\pub-wrWeng\12-30 Alley Extension - N Main to LonW_Admin\Eng Vendor2 (Polaris Land Surveying)\Contract DocumenIffinal Cony Docs\12-30 Polaris - Contract for Personal Services Less than $35K - Revised 06 30 2012.docx. PA0 LAND 0URVEYIN0, LLC {1 Y R A R u R December 12, 2012 City of Ashland Public Works Department 51 Winbum Way Ashland, Oregon 97520 Attn: Scott Fleury Re: Land Partition Survey Proposal 430 North Main Street - City Parking Lot ADwssoea Map No. 391E 05 DA, Tax Lot 2700 Dear Scott, Per your request based on our meeting yesterday, the following Is a proposal for surveying services to perform a Land Partition of the above referenced city owned parcel being utilized as a public parking lot adjacent parcels owned by Colwell 8 Lombardi 's per the following scope of services. it Is understood that the Property Line Adjustment with the Lombardi property at 431 Lori Lane will get recorded first and the remaining City parcel with then be partitioned with a 25 foot wide strip with an 8 foot flag pole to be sold as surplus property. 5L0_~ 0_ F SFQVICE5: 4 Field survey to re-establish project survey control and to locate and tie additional topographic features necessary to update data to reflect current Oita conditions per Ashland Planning Department requirements for the Preliminary Map submittal. 4 Office computations and analysis of field survey data and preparation of the Preliminary Partition Map for the application submittal to city Planning Department. 4 Field survey to establish permanent monuments at all new parcel property corners, as necessary. 4 Prepare and file the final Property Line Adjustment plat with the office of the Jackson County Surveyor to conform with Oregon Revised Statutes (O.-5.) 209.250 and 92.060 and City of Ashland Land Use Ordinance 18.76.110. FEES Fees will be paid on a Tim and Materials, Not to Exceed Basis according to the attached hourly rate schedule enclosed as Exhibit A, which is valid until December 31, 2013. All additional work F. O. Boa 459. Ashland: Oregon 97520 • Phone,: (541) 492.5009 a Fsa: (541) 499.0797 y Mobile: (541) 6013000 • wwrv.Poler/s Survy y.cam Scott Fleury December 12, 2012 Page 2 that is outside the scope of eervicea as described will also be paid at said described hourly rates. Polarie Land Surveying LLC will endeavor to keep the actual cost of the work as low as may be consistent with the purpose of the project and with proper workmanship and materials. The cost to perform the surveying servicee as outlined in the Scope of Services above is as follows: Not to Exceed Twenty Five Hundred Dollars ($2,500.00) Any fees required by Jackson County, title companies, or other quasi-governmental agencles are not included in the surveying costs outlined above and shall be the responsibility of the City of Ashland for the city required fees and be reimbursed to Polaris Land Surveying LLC for the Jackson County and title company fees. As compensation for services rendered, an invoice will be sent on the 20th day of each month, or at the conclusion of the project, showing the hours and rates of the various claeol leatlons of personnel working on the project. It is agreed that the payment of our invoice amount will be due upon receipt of your receipt of payment from the City of Ashland. In the event suit or action is Instituted to enforce this agreement or any terms hereof, or in the event of an appeal from suit, action or proceeding, the prevailing party shall be entitled to such sums as the court may adjudge reasonable as attorneys fees in such suit, action or appeal. This letter is written as a Surveying Proposal and Agreement. An acceptance line Is provided for your signature if you wish to engage us to perform the aforementioned services. Please return one aigned copy for our files. If you have any questions, please don t hesitate to call. Yours, truly, Shawnp~ Professional Land Surveyor CC: Brad Barber, Karl Johnson 5:\survey0\662-11\430 North Main Partition survey proposal.doc AUTHORIZATION Approved e \ Date,z~IOJ Iz P. O. 0ax 439, r 97520 n Phone: (541) 4925009 + Fax: (541) 406.0797 Mobile: (541) Sol- 3000 a www.polerle our ve y.cem P'O L A ATI O LAND SURVEYING, LLC t i R {i A Si sY ~ th EXHIBIT "A" POLAR15 LAND SURVEYING LLC F_F_F ~)rHFDI II F (EFFECTIVE JANUARY 1, 2012) PRINCIPAL LAND SURVEYOR ................................$120.00 / hour PROFEE75IONAL LAND SURVEYOR ..........................$100.00 / hour SENIOR 5URVEY TECHNICIAN $ 80.00 / hour SURVEY TECHNICIAN $ 75.00 / hour DRAFTING TECHNICIAN $ 70.00 / hour SURVEY FIELD CREW (STANDARD) $135.00 / hour SURVEY FIELD CREW (w/ GP5) $150.001 hour DOCUMENT PFOCEE5ING $ 60.00 / hour MILEAGE (out of tam projects) $ 0.55 / mile OUT-OF-POCKET EXPENSES .................................ACTUAL CAST i~ P. O. 60. 459, Ashland, OreOaa 97520 u Phone: (541J 462.5009 • F4a: (541) 466.0797 Mohlle: (541) 601-3000 n wx w.p4leriseurve y.e4w t~~ ~ ' DATE (MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 8/29/2012 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 F 1ESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. 11,. iRTANT: 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 endorsemenL A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 2ODUCER CONTAME: ACT Sarah Qua9liaroli N - .ssurance Risk Managers; Inc. PHONE . (303) 454-9562 aC Na.(303)454-9564 851 S. Parker Road Aoo eSs.squagliaroli@a=-i.com Mite 760 INSURERS AFFORDING COVERAGE NAIC$ nrora CO 80014 INSURER A:Beazle Insurance 7540 !SURED INSURER B: 'olaris Land Surveying, LLC INSURER C: 1.0. BOX 459 INSURER D: ' INSURER E .shland OR 97520 INSURER F: OVERAGES CERTIFICATE NUMBER:CL12B2915340 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. SR ADD S BR POLICY EFF POLICY EXP LIMITS FIR TYPE OF INSURANCE POLICY NUMBER MMIDD/YYYY MWDD/YYYY IM MD GENERAL LIABILITY EACH OCCURRENCE $ DAMA ORE ED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE ❑ OCCUR MED EXP (Any ona person) $ PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ G 1- AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ _ P°LICY PRO- LOG $ ,,T r TOMOBILE LIABILITY COMBINED SINGLE UNIT Ea accident $ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Par accident) $ AUTOS NONOOYJNED PROPERTY AMPGE $ HIRED AUTOS AUTOS Pare. d MID $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DIED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY YIN ANY PROPRI£7OR/PARTNER1EXECU lVE EL EACH ACCIDENT $ OFFlCERrMEMBER EXCLUDED/ NIA IMandat., Ie NH) EL DISEASE - EA EMPLOYE $ i(Yesclescnbeunder EL DISEASE -POLICY LIMB $ DESCRIPTION OF OPERATIONS bebw A Professional Liability 5139A120601 6/28/2012 /28/2013 per Clain $1,000,000 Claims Made Policy General Aggregate $2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) :ERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. Dept. of Public Works Attn: Scott Fleury AUTHORIZED REPRESENTATIVE 20 E. Main Street Ashland, OR 97520 - Lisa Isom/SARAH ACORD 25 (2010/OS) ©1988-2010 ACORD CORPORATION. All rights reserved. IN502512D1005101 The ACORD name and loan are reaistered marks of ACORD A OC R°® DATE (MM DD YOYY CERTIFICATE OF LIABILITY INSURANCE 08/29/2012 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 endorsement(s). PRODUCER COTACT Jon Snowden, Agent NANME: Jon Snowden PH E _T 541.482.2461 ac Na:541.482.4957 En, 420 Bridge Street WE o Ashland, OR 97520 ADDRESS, ion 'onsnowden.com INSURER(S) AFFORDING COVERAGE NAIC Y INSURER A: State Farm Fire and Casual COm an 25143 INSURED Polaris Land Surveying, LLC INSURER B: PO Box 459 NSURER c Ashland, OR 97520 INSURERD: INSURER E : INSURER 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. NSR LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MMIDDY EFF MMI:DD/YYYY LIMITS tYY A GENERAL LIABILITY ❑ 97-131K-11164-1 0510712012 05107/2013 EACH OCCURRENCE $ 1,000,000 FI DIUVAGE 10 RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence$. 300,000 CLAIMS-MADE I-XI OCCUR MED EXP(Any an a Person) $ 5,000 PERSONAL S ADV INJURY $ GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $ 1,000,000 X POLICY PRO- LOC E JECT F-] AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT- ' A El 090 4953-BO9-37C 0810912012 0210912013 Ea accident $ ANY AUTO BODILY I NJURY(Per Person) $ 11000,000 AUTOS X AUTOSULED BODILY INJURY (Par accident) $ -1,000,000 NON-OWNED PROPERTY DAMAGE $ 1,000,000 Per acridenl ' HIRED AUTOS AUTOS $ UMBRELLA LIAB OCCUR ❑ EACH OCCURRENCE E EXCESS LIAB CLAIMS-MADE AGGREGATE $ LIED RETENnON$ $ A WORKERS COMPENSATION WC STATU- OTH- ANDEMPLOYERS' LIABILITY YIN 97-BK-R148-8 0510512012 05105/2013 TORY LIMITS ft ANY PROPRIETOWPARTNERIEXECUTIVE E.L. EACH ACCIDENT E 500,000 OFFICE/MEMBER EXCLUDED? N❑ NIA ❑ (Mandatory I. NH) E.L. DISEASE - EA EMPLOE $OO, 500,000 D00 DESCRIPTION OF OPERATIONS thel, If yes, describe under - EL DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) _and surveying - 151 Clear Creek Dr. Ste. 101 Ashland, OR 97520 CERTIFICATE HOLDER CANCELLATION City of Ashland Dept. of Public Works SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 E Main St. ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520 AUTHORIZED REPRESENTATNE Attn: Scott Fleury 01988-2010 ACORD CORPORATION. All rights reserved. - ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD 1001486 132849.7 03-01-2012 Page 1 / 1 l`Y RECORDER CITY OF _ 3)c ' ASHLAND DATE '.,C PO NUMBER i.: 20 E MAIN ST. 1/412013 11383 i ASHLAND, OR 97520 (541) 488-5300 VENDOR: 008064 SHIP TO: Ashland Public Works POLARIS LAND SURVEYING INC (541) 488-5587 PO BOX 459 51 WINBURN WAY ASHLAND, OR 97520 ASHLAND, OR 97520 FOB Point: - Req. No.: Terms: Net Dept.: Req. Del. Date: Contact: Karl Johnson Special Inst: Confirming? No 3; Quanti llnit Descri tibni ` .'Unit Price Ext. Prim, Surveying services related to a 2,500.00 property line adiustment for 430 N. Main Street and 431 Lori Lane. Contract for Personal Services Beginning date: December 24, 2012 Completion date: February 28, 2013 SUBTOTAL 2,500.00 BILL TO: Account Payable TAX 0.00 20 EAST MAIN ST FREIGHT 0.00 541-552-2010 TOTAL 2,500.00 ASHLAND, OR 97520 _ Account Number .)r ` roje`ct Nu_mber_ Amount, +Acc-ounENumber_„ Project Number„ A`inount E 260.08.12.00.70420 E 201230.120 2,500.00 Ze) Autho, d signature VENDOR COPY I FORM #3 CITY OF A request for a Purchase Order ASHLAND REQUISITION Date of request: 12/21/12 Required date for delivery: ASAP Vendor Name Polaris Land Surveying, LLC Address, City, State, Zip P.O. Box 459. Ashland. OR 97520 Contact Name & Telephone Number Shawn Kampmann (541) 482.5009 Fax Number (541) 488.0797 SOURCING METHOD ❑ Exempt from Competitive Bidding ❑ Emergency ❑ 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 ❑ Written quote or proposal attached ❑ Small Procurement Cooperative Procurement Less than $5.000 ❑ Request for Proposal (Copies on file) ❑ State of Oregon ❑ Direct Award Date approved by Council: Contract # ❑ VerbalMritten 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 # 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 Surveying services related to a property line adjustment for 430 N. Main Street & 431 Lori Lane. $2,500 Item # Quantity Unit Description of MATERIALS Unit Price ' Total Cost TOTALCOST ❑ Per attached quote/proposal Project Number 201230.120 Account Number 260.08.12.00.704200 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 s'g i a is r isition f I cerh that the City's public contracting requirements have been satisfie . Employee Signature: Department Head Signature: Cc`~~ ~US1 Q J~G r> (Equal to or greater than $5,000) Additional signatures (if ap cab Funds appropriated for current fiscal year. YES / NO Finance Director- (Equal to orgreater than $5,000) Date Comments: Form #3-Requisition -