HomeMy WebLinkAbout2013-078 Contract - Green Meadows Building
Contract for GOODS AND SERVICES Less than $25,000
CITY O F CONTRACTOR: Green Meadows Building Co.
ASHLAND CONTACT: Jim Green
20 East Main Street
Ashland, Oregon 97520 ADDRESS: 5313 Highway 66, Ashland, OR 97520
Telephone: 541/488-6002
Fax: 541/488-5311 TELEPHONE: 541-201-0095, Cell 541-840-5848
DATE AGREEMENT PREPARED: April 1, 2013 FAX: 541-482-8914
BEGINNING DATE: April 1, 2013 COMPLETION DATE: April 30, 2013
COMPENSATION: $2,435.00 per proposal #143 attached as Exhibit C.
GOODS AND SERVICES TO BE PROVIDED: Remove HVAC and patch CMU wall, construct 7' x 12' 3" wall
in reception area, install pocket door, install display units, and complete finish trim on cabinets per proposal
#143 attached as Exhibit C. Location: Cemetery
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 27913.220, 279B.225, 27913.230, 279B.235, ORS Chapter 244 and ORS 670.600 are
made part of this contract.
7. Living Wage Requirements: If contractor is providing services under this contract and the amount of this contract
is $19,494 or more, Contractor is required to comply with chapter 3.12 of the Ashland Municipal Code by paying a
living wage, as defined in this chapter, to all employees performing work under this contract and to any subcontractor
who performs 50% or more of the work under this contract. Contractor is also required to post the notice attached
hereto as Exhibit B predominantly in areas where it will be seen by all employees.
8. Indemnification: Contractor agrees to defend, indemnify and save City, its officers, employees and agents harmless
from any and all losses, claims, actions, costs, expenses, judgments, subrogations, or other damages resulting from
injury to any person (including injury resulting in death), or damage (including loss or destruction) to property, of
whatsoever nature arising out of or incident to the performance of this contract by Contractor (including but not limited
to, Contractor's employees, agents, and others designated by Contractor to perform work or services attendant to this
contract). Contractor shall not be held responsible for any losses, expenses, claims, subrogations, actions, costs,
judgments, or other damages, directly, solely, and proximately caused by the negligence of City.
9. Termination:
a. Mutual Consent. This contract may be terminated at any time by mutual consent of both parties.
b. 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 06130/2012, 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 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.
d. Notice of cancellation or change. There shall be no cancellation, material change, reduction of limits or
Contract for Goods and Services Less than $25,000, Revised 06/30/2012, Page 2 of 5
intent hot 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 sfiall sign the certification attached hereto as Exhibit A and herein incorporated by
reference.
Contra tor: City of Ashland
G R.,.-.
BY ^ By lfyluk
Signature Departmen d
J) ~ 6:~Pe-nJ yVl t r, h," / P T2!r~F
Print Name Print Name
i j>C/J T Lf /V,(?
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 06/3012012, 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) 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)
Contract for Goods and Services Less than $25,000, Revised 06/30/2012, Page 4 of 5
Green Meadows Building Co,
Highway Ashland. Estimate
OR OR 97520
Office:541-201-0095 Cell:541-840-5848
Fax:541-482-8914 Date Estimate #
Email:greenmeadows(a`gwestoffice.net
CCB# 132551 3/20/2013 143
Name /Address
City ofAshland-
20 E. Main Street
Ashland, OR 97520
Project
Cemetary Office
Description Qty Rate
At cemetery office building on Normal St.: Remove wall mounted heater and patch in with CMU blocks. 2,435.00 2,435.00
then stucco on outside and plaster inside. Properly dispose of heater unit. Build 7' high by 12'-3" wall at
front room with drywall on both sides. Provide and install 3'-0' X 6'-8" Flush. hollow core paint grade
pocket door in this new wall. Cut down and install display units on one side of new wall and trim ends.
Build and install panel at dishwasher to hide end of dishwasher. Install hood or microwave hood
(provided by City) without venting at existing hood cabinet space (wiring and painting be others). Fix new
bathroom threshold (no charge).
Pre-renovation asbestos survey for waste products going to landfill to be provided by City of Ashland. 0.00 0.00
remrmed and re-instaII'dhy ~'h"r FI""n'",91 d",t and '„ct,n a -&A J)y gt6"r" City to prol, de any
bdditienal siding-materials.
. 00
Total $5.285.00
12:113 APR 05, 2013 FAX NO: 772-8235 #95273 PAGE: 414
Aco CERTIFICATE OF LIABILITY INSURANCE ' DP ID DR OATEIMMDDYVYY)
04 02 13
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW- THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE UR PRODUCEIR, ANU'IHC CEHI'IF'ICAIE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject 1:67
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate dean not confer rights to the
certificate holder In lieu of such endorsement(s).
PRODUCER NAME;
Insurance Marketplace, Inc. PHONE NnEet: nlc,-
1998 Skypark Dr Suite 100 ADDRESS:
Medford OR 97504 PHOUICER
CUSTOMERIDO: GREEN-7
Phone:541-779-0177 FaDC:FAX 772-8235 INSURERIS) AFFORDING COVERAGE NAIC0
INSURED INSURER A: 6aif Corporation
Green Meadows Building Cc INSURER B:
Jim Green
5313 Hwy 66 INSURER C:
Ashland OR 97520
INSURER D
INSURER E
INSURER P
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE. POI ICIF.S OF INSURANCE LiSTEn nn OW I AVE DCGN ISSUCD TO TI IC INSURED NAMED AOOVC FOR TI IR POLICY PERIOD
INDICATrn, NOTW ITI MTANDINC ANY RCOl11RCMCNT, TERM OR CONDITION OP ANY CONTRACT On OTHER DOCUMENT WITH RESPCCT TO W HICI IT[ II$
CER'I IYICA•I E MA? BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POI.ICIFS DPSCRIRFD HFRF..IN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS St IOW N MAY I IAVD nrrN RCDI ICCD BY PAID CLAIMS.
LTR TYPE OFINSURARCE INBR WVU POUCYNUMBER MMnIDY EFF MMIDDIYBYXP UNITS YY) GENERAL LIABILITY EACHOL`CUHHENCE $
fiWGETa RENTED -
COMMEHOIAL GENERAL LIABILITY fT2EMISES Ee acrurrenceL $ _
1 CLAIMS-MADE F7 OCCUR MED EXP (My one PWP
' PEHSONALBAUV INJURY $
GENERAL AGOREDAI E $ _
GCNL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AEG $
I'ULICY .PICrT LUC $
AUTOMOBILE LIABILITY M DOMDINCD SINRI.D UNIT T
' (Cu :ranadmd)
ANY ALIT? BODILY INJURY (Per Peroun) $
AI.L OW NCD AIITOS - -
BODILY INJURY (I`eremlUenl) $
SCHEDULED AUTOS
PRUI'ER1Y DAMAGE
HIHto AU I OS (Pal' aaalCenQ $
NON-OWNED AUTOS $
UMBRELLA LIAB OCCUR'- FAGH OOCURRENCE $
EXCESS LIAR CLAIMS.MADC ACCRrOATF.
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RETENTIDN $ - $
A WORKERS COMPENSATION 71 01/01/13 01/ill/1<
AND EMPLOYERS'LIABILTTY YIN TORY LIMITS _ ER
ANY PRnPRITTDRIPARTNRRICXCCITIVC0 IA E.L. EACH ACCIDENT $500000
OFFICLR1MEMBEH EXCLUDED? IL~1I
(Mandatary in NH) EL DISLASE - EA EMPLOYE' $ 500000
1 II yy , deacnbe under
DESCRIPTION OF OPERATIONS W. 51„DISFA5F-POI.IGYLIMD IS 500000
DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (Apace ACORD 101, AddlU°Ual Release S°DeUUle, If more aPece la required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OR THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFOkE
CITYOFA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS,
City of Ashland AUTHORIZED REPRESENTATIVE,
20 E Main St
Ashland OR 66520 R. Scott Weaver, CIC
@11988.2009 ACORD CORPORATION. All rights rosorved.
ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD
12:17 APR 05, 2013 FAX NO: 772-8235 #95273 PAGE: 2/4
° CERTIFICATE OF LIABILITY INSURANCE 4/2/2013 vvr)
gC'OItU
THIS CERTIFICATE 13 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($), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER,
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(les) must be endorsed, If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, eertaln policies may requiro an endorsement, A statement on this certificate does not confer lights to the
certificate holder In Ileu of such endorsement(s).
PHUUUCEH NAME:
INSURANCE MARKETPLACE, INC. PiIONE AN
Inrt:, rval:...._
p -
PO BOX 278
MEDFORD, OR 975010019 INSnRER(s) AFFORDING CUVEKAIA Nluco
INSURER A: Conlracfnra Bonding and Ins'urahea Oompiny 37200
IUSUHlU INSURER B:
GRCEN MEADOWS BUILDING COMPANY wwnER C:
5313 HWY 66 NsuneR D:,_,_„-_
ASfiLAND, OR 97520 INSURER E:
INSIIRF.R F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOVII I LAVE RF.F.N ISSUED TO 114L INSURED NAMED ABOVE FOR 'I HE POLICY I'CRIOD
INDI CATEU. NDTVATHRTANDING ANY HkOUIREMFNT, TERM OR CUNUITION OF ANY COINTRAC"I' CAR OTIICR DOCUMENT VMTH RESPECT TO WI IICI1 7HI9
CEFn IFICATE MAY DE ISSUED ON MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIDED HEREIN IS SUBJL(cf TO ALL 1116 TERMS,
D CLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOVMI MAY I IAVE BEEN REDUCED BY PAID CLAIMS,
WSN '**OCrcY EFF P Ilo g I.Nff&
TYRE OF INSURANCE POLKY NUMBER 11
[am
A GENERAL LIABILRY EACH OCOURRF.NOE. i 1,000,00
X coMMSRC1AL OOaERx tIAtlLITY D11PGO629 1(0/2013 1/612014 EMac WR BCCenencR i 300,00
(:I AIM6M G OCCUH MED Mr (Anyone Perwn) S 5,OD
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GPNRPR !.AGGREGATE F 1,000,00
GE1V'L AM RE OAT E LIMTAPFJ F.6 PWR'. PHODUOTR- 00M,JCPA00 i 1,000,000
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UESCHIVIIIIN OF OPGRATDlNS ILOCnTR1N614ENKLFS(ARR[H aLORD 101, AdUNHxN R,m91ks SQIedIIM,RIndre RpemixnryuipU)
CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED PER FORM CBGLOO51 ATTACHED.
Products and completed operations coverage is included according to the terms of the policy and subject to applicable policy
exclusions.
CERTIFICATE HOLDP32 CANCELLATION
CITY OF ASHLAND SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
20 E MAIN ST
AIITIIORIZCD REPRESEteI RflVi 1 ~ZX
ASHLAND, OR 97520 41 5390 t/,^,J
V1089-2010 ACORD CORPORAYItlN. All rights reserved.
ACORO 25 (2010106) The ACORD norm and logo are registered marks of ACORD
12:18 APR 05, 2013 FAX NO: 772-8235 #95273 PAGE: 3/4
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - SCHEDULED PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Person or organization:
CITY OF ASHLAND
(If no entry appears above, information required to complete this endorsement will be shown in the Decla-
rations or Supplemental Schedule as applicable to this endorsement.)
A. Section 11 - Who Is An Insured Is amended to include as an additional insured the person(s) or or-
ganization(s) shown in the Schedule. Such person or organization is an additional insured only with
respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused by
your negligence in the performance of your ongoing operations performed for that additional insured.
A person's or organization's status as an additional insured under this endorsement ends when your
operations for that additional insured are completed.
8. With respect to the insurance afforded to these additional insureds, the following additional exclusions
apply:
This Insurance does not apply to:
1. "Bodily injury", "property damage", or "personal and advertising injury" arising out of the rendering
of, or the failure to render, any professional architectural, engineering or surveying services, in-
cluding but not limited to:
a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions,
reports, surveys, field orders, change orders or drawings and specifications; or
b. Supervisory, inspection, architectural or engineering activities.
2. "Bodily injury" or "property damage" occurring after:
a. All work, including materials, parts or equipment furnished In connection with such work; on
the project (other than service, maintenance or repairs) to be performed by or on behalf of the
additional insured(s) at the location of the covered operations has been completed; or
b. That portion of "your work" out of which the injury or damage arises has been put to its in-
tended use by any person or organization other than another contractor or subcontractor en-
gaged in performing operations for a principal as a part of the same project.
3. "Bodily injury" or "property damage" occurring or commencing before:
a. Execution of the written contract or agreement that such person or organization be added as
an additional insured on your policy.
CBGL 00 51 06 OB Contains Copyrighted Material of Page 1 of 1
ISO Properties, Inc., with permission
03/11/2020 05:50 FAX 16001
.acoR&
VEHICLE OR EQUIPMENT CERTIFICATE OF INSURANCE DALE (MLVOO YY YY)
W1012013
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.
This form is used to report coverages provided to a single specific vehicle or equipment Do not use this form to report liability coverage
provided to mutOplo vehicles under a single policy. Use ACORD 25 fur that purpose.
PRODUCER - NCONTACT ONE. SANDY
RateFann BRIAN CONRAD STATE FARM INSURANCE PuNDC xA EM . 541 482-8470
a : 541 482E956
~0 1806 ASHLAND ST Eamon seridy@dearlyconrad.com
ASHLAND, OR 97520 CUSTOMER NSUR S)AFFORDNG COVERAGE RAICS
INSURED INSURER A: State Fann Mutual Automobile Insurance Company 25178
JAMES B DONNA GREEN INSURER e:
dba GREEN MEADOWS BUILDING COMPANY INSURER C:
5313 HWY 66 INSURER D: _
ASHLAND, OR 97520 INSURER
DESCRIPTION OF VEHICLE OR EQUIPMENT
YEAR MAKE/MANUFACTURER MODEL BODY TYPE VEHICLE IDENTIFICATION NUMBER
2DO3 CHEVT EXPRESS VAN IGCFH25T531151965
DESCRIPTION SERWLNUMBER
2013 GRIFFIN DUMP TRAILER 4C9BU1ZZ5DE020098
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICY(IES) OF INSURANCE LISTED BELOW HAS/HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY
PERIOD(S) 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 POUCY(IES) DESCRIBED HEREIN IS/ARE SUBJECT TO
ALL THE TERMS, EXCLUSIONSAND CONDITIONS OF SUCH POLICY IES).
INSR ADDL POIIICYEFFBCTNE POLICYESNRATION
LTR NSRD TYPE OF INSURANCE POLICYNUMBER DATE(MMNBIYYYY) OATE(M MUYYYI) LIM S
X VEHICLE LIABILITY COMBINED SINGLEUMIT S
1583944-EOI-37 11/0112012 1110112013 GODLY IWURY(Perpaw,) S 250000
BODILY INJURY (PR sv*Wd) S 500000
PROPERTY DAMAGE S 100000
GENERAL LIABILITY EACH OCCURENCE S
OCCURRENCE - GENERALAGGREGATE $
CLAIMS MADE S
INSR LOW POLICY EFFECTIVE PODGY EMRATION -
LTR AY TYPE OF INSURANCE POLICY NUMBER DATE(MMOOYYYYY) DATE (NU&DDnYYY)
X VEH COLLISION LOSS 1583944-ED1-37 11/0112012 11101/2019 El ACV ❑AGREED AMT f LSNT
❑ ❑ STATED MIT $500 DED
X VEHCOMP VEH OTC I] ACV ❑AGREED AMT S LIMIT
158 3944-E01-37 11010112012 11101/2013
❑ ❑ STATED AMT ! O O®
PROPERTY ❑ ACV ❑ AGREEDAMT
f LW7
BASIC BROAD ❑ RC ❑ STATED AMT
f DED
SPECIAL ❑
REMARKS INCLUONIG 81ECML CONDITIONS I OTHER COVERAGES (ARMI, ACORD 101, AOlRDnel Runt. Scbedme, It more wecef Muted)
2001 HONDA CRV - POL #139 7347-C07-37A SAME COVERAGES AS NOTED ABOVE
ADDITIONAL INTEREST CANCELLATION
Select one of the following: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
the eddilloneliMalast aeuraed helm Ms been Added lD Dn pd yliea) timed NIsin by policy n mor(e). BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE
A moveM bW DeenaanlMalD Add the additional WO.QW dee~ beam m Ow polcy(les) DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
Y Dare'nb a .
VEHICLE I EOUIPMERT INTEREST: LEASED FINANCED DESCRIPTION OF THEAODITIOP ALNTEREST
RAKE AND ADDRESS OF ADDITIONAL INTEREST AUDITIONALNSUREO LOSS PAYEE
LSINER'S LOSS PAYEE
LOANILEASENUMSER
RE NTA77VE
LS /I C5
®1997-2010 ACORD CORPORATION. All rights reserved.
ACORD 23 (2010105) The ACORD name and logo are registered marks of ACORD
1004381 1429872 01-28-2013
Page 111
L ! RECORDER
n '
DATE PO NUMBER'
A, CITY OF.
ASHLAND
20 E MAIN ST. 4/5/2013 11521
ASHLAND, OR 97520
(541) 488-5300
VENDOR: 005955 SHIP TO: Ashland Building Maintenance
GREEN MEADOWS BUILDING CO. (541) 488-5358
5313 HIGHWAY 66 90 N MOUNTAIN AVENUE
ASHLAND, OR 97520 ASHLAND, OR 97520
FOB Point: Req. No.: .
Terms: Net Dept.:
Req. Del. Date: contact: Dale Peters
Special Inst: Confirming? No
. Quantity Unit Description - Unit Price Ext. Price
Remove and patch CMU wall, construct 7' 2,435.00
x 12'3" wall in reception area, install
pocket door, install dispaly units,
complete finish trim on cabinets.
Contract for Goods & Services
Beginning date: April 1, 2013
Completion date: April 30, 2013
SUBTOTAL 2,435.00
BILL TO: Account Payable TAX 0.00
20 EAST MAIN ST FREIGHT 0.00
541-552-2010 TOTAL 2,435.00
ASHLAND, OR 97520
Account Number Project Number Amount Account Number, Project Number- Amount
E 410.08.24.00.70420 E 000277.999 2,435.00
Authorized Signature VENDORCOPY
FORM #3 CITY OF
A reOues for a Purchase Order ASHLAND
REQUISITION Date of request: z6tvlARts
Required date for delivery:
Vendor Name GREEN MFAnnwR Rl In niNr, rn
Address, City, State, Zip 5317 HIC HWAV fifi
Contact Name & Telephone Number
Fax Number ASHLAND. OR 97520
541 201 0095 CELL 541 840 5948 JIM QR N
SOURCING METHOD
❑ Exempt from Competitive Bidding ❑ Emergency
❑ Reason for exemption: ❑ Invitation to Bid (Copies on file) ❑ Farm #13, Written findings and Authorization
❑ AMC 2.50 Date approved by Council: ❑ Written quote or proposal attached
❑ Written uote or proposal attached
Small Procurement Cooperative Procurement
Less than $5,000 ❑ Request for Proposal (Copies on file) ❑ State of Oregon
Z Direct Award Date approved by Council: Contract #
❑ Verbal/Written quote(s) or proposal(s) ❑ State of Washington
Intermediate Procurement ❑ Sole Source Contract #
GOODS 8 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: (Dale)
❑ Form #4, Personal Services $5K to $75K Valid until: Date
Description of SERVICES Total Cost
~iarr~v.S.N~.hr+' :raA- d-MLk t.~w~-~ Ce,~,s r
Ie-'3" X(1 r+ rzCac-p ro aYtca ItiSTpr_` o~4E lec2
T)ISP a l uM,+•~s,/~~•ri e5~-E2: a,,. e.z1E,i,.r~s~
$ 2435.00
Y IcEE 5r t_ ..e9ricH LED
Item # Quantity Unit Description of MATERIALS Unit Price Total Cost
C l` C/ Y Sam
❑ Per attached quotelproposal $ TOTAL COST
Project Number _000277.999 Account Number 410.08.24.00.704200
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:
IT Director Date Support -Yes/No
By signing this r uisition form, l certify that the City's public contracting requirements have been satisfied.
Employee Signature: Department Head Signature: `my oQDi 0
(Equal to or greater than $5,000)
Additional signatures (if applicable):
Funds appropriated for current fiscal year (9 / No 47(- G(, lot w~
Final Director-(Equaltoorgreaterthan$5,000) Date
Comments:
Form #3 - Requisition