HomeMy WebLinkAbout2013-079 Contract - Green Meadows Building
Contract for GOODS AND SERVICES Less than $25,000
CITY OF 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: $3,911.00 per proposals #142 and #144 attached as Exhibits C and D.
GOODS AND SERVICES TO BE PROVIDED: Repair walls, install new door, construct wall at opening, and
install new T-Bar ceiling per proposals #142 and #144 attached as Exhibits C and D. Location: WWTP
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 2796.220, 279B.225, 2796.230, 2798.235, ORS Chapter 244 and ORS 670.600 are
made part of this contract.
7. Living Wage Requirements: If contractor is providing services under this contract and the amount of this contract
is $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:
i. If City funding from federal, state, count or other sources is not obtained and continued at levels
Contract for Goods and Services Less than $25,000, Revised 06/30/2012, Page 1 of 5
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 maybe 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 ORF 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 Liabilitv 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
intent not to renew the insurance coverage(s) without 30 days' written notice from the Contractor or its insurers to
Contract for Goods and Services Less than $25,000, Revised 06130/2012, Page 2 of 5
the City.
,e. Additional Insured/Certificates of Insurance. Contractor shall name The City of Ashland, Oregon, and its
elected officials, officers and employees as Additional Insureds on any insurance policies required herein but only
with respect to Contractor's services to be provided under this Contract. As evidence of the insurance coverages
required by this Contract, the Contractor shall furnish acceptable insurance certificates prior to commencing work
under this contract. The contractor's insurance is primary and non-contributory. The certificate will specify all of the
parties who are Additional Insureds. Insuring companies or entities are subject to the City's acceptance. If
requested, complete copies of insurance policies, trust agreements, etc. shall be provided to the City. The
Contractor shall be financially responsible for all pertinent deductibles, self-insured retentions and/or self-
insurance.
17. Governing Law; Jurisdiction; Venue: This contract shall be governed and construed in accordance with the laws
'of the State of Oregon without resort to any jurisdiction's conflict of laws, rules or doctrines. Any claim, action, suit or
proceeding (collectively, "the claim") between the City (and/or any other or department of the State of Oregon) and
the Contractor that arises from or relates to this contract shall be brought and conducted solely and exclusively within
the Circuit Court of Jackson County for the State of Oregon. If, however, the claim must be brought in a federal
forum, then it shall be brought and conducted solely and exclusively within the United States District Court for the
District of Oregon filed in Jackson County, Oregon. Contractor, by the signature herein of its authorized
representative, hereby consents to the in personam jurisdiction of said courts. In no event shall this section be
construed as a waiver by City of any form of defense or immunity, based on the Eleventh Amendment to the United
States Constitution, or otherwise, from any claim or from the jurisdiction.
18. THIS CONTRACT AND ATTACHED EXHIBITS CONSTITUTE THE ENTIRE AGREEMENT BETWEEN THE
PARTIES. NO WAIVER, CONSENT, MODIFICATION OR CHANGE OF TERMS OF THIS CONTRACT SHALL
BIND EITHER PARTY UNLESS IN WRITING AND SIGNED BY BOTH PARTIES. SUCH WAIVER, CONSENT,
MODIFICATION OR CHANGE, IF MADE, SHALL BE EFFECTIVE ONLY IN THE SPECIFIC INSTANCE AND FOR
THE SPECIFIC PURPOSE GIVEN. THERE ARE NO UNDERSTANDINGS, AGREEMENTS, OR
REPRESENTATIONS, ORAL OR WRITTEN, NOT SPECIFIED HEREIN REGARDING THIS CONTRACT.
CONTRACTOR, BY SIGNATURE OF ITS AUTHORIZED REPRESENTATIVE, HEREBY ACKNOWLEDGES THAT
HE/SHE HAS READ THIS CONTRACT, UNDERSTANDS IT, AND AGREES TO BE BOUND BY ITS TERMS AND
CONDITIONS.
19. Nonappropriations Clause. Funds Available and Authorized: City has sufficient funds currently available and
authorized for expenditure to finance the costs of this contract within the City's fiscal year budget. Contractor
understands and agrees that City's payment of amounts under this contract attributable to work performed after the
last day of the current fiscal year is contingent on City appropriations, or other expenditure authority sufficient to allow
City in the exercise of its reasonable administrative discretion, to continue to make payments under this contract. In
the event City has insufficient appropriations, limitations or other expenditure authority, City may terminate this
contract without penalty or liability to City, effective upon the delivery of written notice to Contractor, with no further
liability to Contractor.
20. Prior Approval Required Provision. Approval by the City of Ashland Council or the Public Contracting Officer is
required before any work may begin under this contract.
21. Certification. Contractor shall sign the certification attached hereto as Exhibit A and herein incorporated by
reference.
Contract r: * City of Ashland
By By SZ.
-T, Signature Department Head
M \1y\wi4 v{~ 1 P. tea, ll~
Print Name Print Name
p ~ + bEaT L4 (z(r-r
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 06/30/2012, 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/:
V (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.
~Zl L740 / 77
Contractor (Date)
Contract for Goods and Services Less than $25,000, Revised 06/3012012, Page 4 of 5
Green Meadows Building Co.
Highway 66
Ashland. Estimate
OR 975 520
OlTice:541-201-0095 Cell: 541-840-5848
Pax:541-482-8914 Date Estimate #
Gnan NaaCOrn Enrail: reennrcadows~ westoffice.net
CCB# 132551 3/19/2013 142
Name / Address
City of Ashland-
20.E. Main Street
Ashland, OR 97520
Project
Wastewater Tx. Plant
Description Qty Rate Total
Work at Wastewater treatment building; Materials, labor and tools to cut in doorway (3-0 X 6-8) then 2.999.00 2,999.00
install header. patch drywall and hang door provided by others. Frame in 4'X T-7" opening in 2X4 wall,
apply 5/8" dnivall to both sides, apply 5/8" plywood to one side and 1/2" finished Masonite to other side
with special grommet fasteners and screws.(Masonite provided by others). Drywall patches where walls
were removed with one,of(set to remain where walls do not match (We will provide vertical corner bead
at offset). Patch and smooth finish to all walls to make ready for painting by others. Painting and any
electrical work to be completed by City personnel. Waste products to be transported to landfill.
Pre-renovation asbestos survey for drywall and ceiling tiles to be provided by City of Ashland. 0.00 0.00
Remove and replace existing dropped ceiling with similar style grid and tiles and relocate I IVAC supplies 0.00 0.00
to adjacent spaces. Quote pending.
Total $2,999.00
Green Meadows Building Co. }
Highway 66
`
Ashland. ES}Ima e
OR 975 520
Office:541-201-0095 Cell:541-840-5848
Fax:541-482-8914 Date Estimate #
erecn Meadows Email:greenmeadowsngwestofiice.net
CCB4132551 - 3/22/2013 144
Name /Address
City of Ashland-
20 E. Main Street _
Ashland, OR 97520
Project
Stucco & Ceiling
Description Qty Rate Total
So-- P`IIGh A@ 2Ad ;QpaiFS a! C;@M@!@F)'9ff4e9 an Name! 9&. (S669 less Wysu %kant;a G8GFdiA8Ie, 1,960.00 9,960.00
Remove existing and replace dropped ceiling at Wastewater Treatment office in room 9'-6" X 16-10". 912.00 912.00
Tiles to match existing. ($152 less if you want to coordinate, schedule and oversee the work yourself then
bill Harrington Acoustical direct.)
Total $4,872.00
1Z: 1C HYK I~br GL'lld 'r I-In IYV- rrc-ocao tr~.~cro rnw v1ti
® DATE (MMIOD%YYY)
A~ CERTIFICATE OF LIABILITY INSURANCE DPID DR 04 02 is
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'I'HE CER'TIF'ICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(iesI must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and condltlons of the pollcy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder In lieu of such endorsernon((s). -
PRODUCER NAME:
PHONE
Insurance Marketplace, Inc. AIG Nu E.t: - AIC Nak
1998 Skypark Dr Suite 100 ADDRESS:
Medford OR 97504 CPRODUCER GREEN-7
Phone:541-779-0177 Fax:FAX 772-8235 INSURER(S) AFFORDING COVERAGE NAIL 11
INSURED INSURER A: Saif corporation
Green Meadows Building CO INSURER B:
Jim Green -
5313 Hwy 66 INBURERC:
Ashland OR 97520
INSURER D
INSURER E
INSURER r:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE. POI,ICJPS OF INSURANCE I.ISTGD AGLOW I IAVG MEN IFAUCO TO TI IC INSURED NAMED ABOVE_ FOR TI M. POLICY PERIOD '
INDICATED, NOTV ITI ISTANDING ANY RCOIIIrCMENT, TERM OR CONDITION Or ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO W HIC.I I TI IIS
CEKI'IF'ICA'I E MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIRED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POI.K.IFS. LIMITS 5I ]OWN MAY IIAVE nrCN R[DUCED BY PAID CLAIMS.
TYPE OF IN ADD SUB POLICY EFP POLICY EXP
LTR INSR WVU POLICY NUMBER MM/DD/V MMIUUIYYYY _ LIMITS -
GENERALLIA8ILITY ERCHOCCURHENCE $
l3ETOREMEO
COMMERCIAL GENERAL LIABILITY rREMISEO Ee acrurrenceZ_ $ _
1CLAIMS-MADE nOCCUR NEDEXP(Anyonep.am) $
PEXSONAL 8 ADV INJURY $
GENERAL AGGREGATE $
GBNL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMR'OP AGG S
PRO-
POLICY F_1JrCT 71 LUG m $
AUTOMOBILE LIABILITY COMBINCDSINGIF UNIT $
' (Co urciJ~a,p
ANY AUTO - BUD ILYIN.IURY(Parpemr n) $
ALL OWNED AUTOS - BODILY INJUPY(i,et accident) $
SCHEDULED AUTOS _PRWE "
!'IiUI'ERTY DAMAGE. $
HIHEU AU IOS (reraccldenQ .
NON-OWNED AUTOS $
UMBRELLA LIAR OCCUR - _FACH OCCURRENCE S
EXCESS I.IA9 CLAIMSMAOr. AGORrCATE.
DEDUCTIBLE
RETENTION $ _ $
WGISTAT,
A WORKERR COMPENSATION 947188 a1/o1/~s Da/n1/1a -
ANDEMPLOYERS'LIABILIrY YIN TORY LIMITS r.R
ANY PROPRIITnRryARTNBRICXCCITV E.L.EACHACCIDENT $ 500000
OFHC'EWMEMBER EXCLUDED? CEI /A -
(Mandatoryin NH) EL. DISEASE - to EMPLOYE- $ 500000
II yyea, descdba under - -
DCSCRIPTIONOFOPERATIONS belOW f-.I„DISFA5E-POI.ICY Um' $ 500000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remark. Schedule, If more space Isrcyulreri)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
CITYOFA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POUCYPROVISIDNG.
City of Ashland AUTHORIZED REPRESENTATIVE
20 F Main St
Ashland OR 86520 R. Scott Weaver, CIO
@J 1988.2009 ACORD CORPORATION. All rights rosorved. '
ACORD 25 (2009100) The ACORD name and logo are registered marks of ACORD
1G•Lf MrrC ✓JJ, cello - ,n.,
DATE
.41C'~RU
CERTIFICATE OF LIABILITY INSURANCE 41212013nrrrt
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 It on ADDITIONAL INSURED, the pollcy(les) mutt be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the polity, cartaln policies may require an endorsement. A statement on this certlfcate does not eonfer rights to the
certificate holder In Ileu of such endonsement(s).
" PRODUCER xnrnE:
INSURANCE MARKETPLACE, INC. PUONE TAX
n,L Ne):
PO BOX 27E FHt0.1L
MEDFORD,OR975010019 INSIIaER(sl drportDlnc cove xneA NAlcp
VISURER n: cgnVadnm Bondina and InsuraOw co 37206
INSUNkU INSURER a
GREEN MEADOWS BUILDING COMPANY INSURER C:
5313 HWY 66 INSURER
ASHLAND, OR 97520 Ixsussrs E:
1tN IRF.NH
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF IN9URANCE LISTED BELCAN I IAVC RF.F.N ISSUED TO IHL INSURED NAMED ABOVE FOR•'I HE POUCY PERIOD
INDICATED. NOTVATHRTANDIING ANY RLOUIREM FNT, TERM OR CONDITION OF ANY C0117RAC"I" OR OTHER DOCUMENT MATH RESPLCT TO 1M IICH THIS
CERI I-ICATE MAY DE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HRRFIIV IS SUEJEC'f TO ALL THE TERMS,
Ek: CLUSiONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOVA MAY I-IAVC BEEN REDUCED BY PAID CLAIMS,
ouar e V I
IN6Ft r e
WTI of INSURANCE POLICY NUMBER n mrnn LUpRS UIM A GENERAL LIABII.rrY - EAcH OCOURREMOR• F 1,000,00
X OOMMERCIALCONCRALLIAldLITY D11PGO629 116/2013 1/,/2074 P FMlstc Dapcm~Mnce s 300,000
CI AIMS MME DCCUk ME O EXP CAny ono Down) F 5,00
Y PFR xNF A. YIIVJURY F 1,000,00
nFNFRALAGGROGATE 1 1,000,000
GfiN'LAOOREOATBLIMT APPN FE PCR PHODUCTR- cONP/OP AIJO 1 1,000,000
X POLICY Ph(J I.Oc E
CONIDIINED 91NOLE UMI I'
AUTUMII HILH IId Nd.ITY Ea apddenl 1
RODILYINJURY(Per perwn) F
o
ANr IA fA:
AIIHCDULED Rf1DILVIWURY(IRr ecddenl) i
AI R09 OS NNO"M PROPERTY DAMAOE ..8
HIRMALT09 Aimee _ e¢NdeM
i
UMDRCLLIILIna OUCUR EACH occunrO.ICC F
F.XCCSSLIFD CWM!'iNNDC- AaGRPiiATE $
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WUHNE KKC0h PE NSATION di fAlTfl ._.rCP
AND EMPLOYCRS'LIAUILII'f Y/N
ANY 'HO PRIF.TORIPA mNCrJCFEcImVE❑ NIA EL.e GH AUCURNT
OFRCFRIMEM DGR EXCWDEU'.I
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If Yea, dewdpe dndnr EL GIDfJ+.4E-PODUYIIMJI S
- DESCRIPTION Ce CF' A'110NR h:pw
UE5CHIP11Or1 nF OPFRATIONG ILOCATIt1NN1~'F.HIf.LES(dNAen ACORD tat, AdnlOu,d Rcrddlks StTedllla,RlnorB [peen ir.rnq,lifetl)
CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED PER FORM CBGLOOS1 ATTACHED.
Products and completed operations coverage is included according to the terms of the policy and subject to applicable policy
exclusions.
CERTIFICATE HOLDER CANCELLATION
CITY OF ASHLAND SHOULDANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVI51ONS.
20 E MAIN ST
AurnonRCO navnasem n"nvc.\~~
ASHLAND, OR 97520 GlSJb! ~ 39D
@P'1099-213110 ADORE CORPORATION. All rights reserved.
ACORO 25 (20'10/06) The ACORD name and logo are registered marks of ACORD
1G• to nrr~ n.» ~oi~+ • -
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 Organisation:
CITY OF ASHT,AND
(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 II - 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.
13, With respect to the insurance afforded to these additional insureds, the following additional exclusions
apply
This Insurance does nut 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 projcct (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 06 Contains Copyrighted Matanal of Page 1 of 1
ISO Propnrties, Inc., with permission
03/11/2020 05:50 FAX Z001
CAN CM
Ac®~ VEHICLE OR EQUIPMENT CERTIFICATE OF INSURANCE
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THIS CERTIFICATE M 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 tom to report liability coverage
provided to multiple vehicles under a single policy. Use ACORD 28 for that purpose.
PRODUCER
Me: SANDY
Sfateiann BRIAN CONRAD STATE FARM INSURANCE 541 482-8470 541 482-6956
1 SO6 ASHLAND ST e'er s"y@ciearlycorwad.com
ASHLAND, OR 97520 or
LNSUREFtlgl AFFORONS COVERAGE NAIC a
INSURED INSURER A : State Famed Mutual Automobile Insurance Company 25178
JAMES & DONNA GREEN INSURER B:
dba GREEN MEADOWS BUILDING COMPANY NNREac:
5313 HWY 66 NNBER O:
ASHLAND, OR 97520 INSURER 9:
DESCRIPTION OF VEHICLE OR EQUIPMENT
YEAR MMIMANUFACnMR MODEL BODY TITS VEHICLE IDENTIFICATION NUMBER
2003 CHEVT EXPRESS VAN IGCFH25T531151965
DESCRIPTION BERILL NUMBER
2013 GRIFFIN DUMP TRAILER 4C9BU1ZZ5DE02009S
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(IFS) DESCRIBED HEREIN ISfARE SUBJECT TO
ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICY(IES).
INSIR aoRL POUCYEFPECTNE POLCYnPIRA
Lin wRn TYPEGFINWRANCE POLICY NUfAMM DATE(MMIDWVYM NITE(MWDDIYYYY) LMSB
X VENLLE LIABILITY COMBINED SINGLE LIMIT S
1583944-X01-37 11101/2012 1110112013 BOO LY INJURY (PM P~) S 250DO0
eoDLr lFUURr (Pr emdMn) s 500000
PROPERTY DAMAGE f 100000
GENERAL UABLLITY EACH OCCURENCE S
OCCURRENCE GENERALAGGREGATE S
CLAIMS MADE i
RISK LOIN POUCYEFFEC11VE POLICY EXPIRATION
LTR A TYPE OF INSURANCE POLICY NUMBER DATE IMMONYVYIT DATE MVAMf"YY) LMITBIMDWrBLE
x VEM COLLISION LOSS G1 ACv ❑ AGREED AMT f LIMIT
158 3944-ED1-37 11f0112012 11I01n013
❑ ❑ STATED AMT A 5W Do
x VEHCOMP VEH OTC ❑ ACV ❑AGREEDAMT S UINr
158 3944-X01-37 1101012012 111012013
❑ ❑ STATED AMT S Q OFD
PROPERTY ❑ ACY ❑ AGREEDAMT
f WT
BASIC R BROAD ❑ NC ❑ STATED ANT
f OED
SPECIAL ❑
REMARKS INCLUDING SPEDALCONIKOONSI OTHER COVERAGeN IAMa ACORD M. AddAbnM ROMMb Sd0a A, N men SPNe N required)
2001 HONDA CRV - POL N139 7347-C07-37A SAME COVERAGES AS NOTED ABOVE
ADDITIONAL INTEREST CANCELLATION
Select am of the following: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
TM Waigwr inblAs dnatod balm has Men added m ft pakytin) IUNd hMMn by pact xviWei. BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE
A fw Men eDnRMd re add oe ed 111wal Trowel dwaeMd balm m ft Pary(les) DELIVEAEO IN ACCORDANCE WITH THE POLICY PROVISIONS.
1 e.
VEHICLE I EOUIPIENT INrmar. LEASED RNANCEO DESCRIPTION OF" MAOD710NA4.NTEMT
RAEE AM ADDRESS OF ADDITIONIS INTEREST Ap0RI0NAL MSIRED LOSS PAYEE
LENDERS LOSS PAYEE
I F1
LOAN I LEAS! NUMBER
A71VE
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4D 1897-2010 ACORD CORPORATION. AH fights reserved.
ACORD Z3 (2010!06) The ACORD nerve and logo are registered marks of ACORD
1004381 142987.2 01-28-2013
Page 1 / 1
CITY O F RLVtii'iu
DATE PO NUMBER
A C H F AND
20 E MAIN ST. 4/5/2013 11522
1 ASHLAND, OR 97520
(541) 488-5300
VENDOR: 005955 SHIP TO: Ashland WWTP
GREEN MEADOWS BUILDING CO. (541) 488-5348
5313 HIGHWAY 66 1295 OAK STREET
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
Repair walls, install new door, 3,911.00
construct wall at openinq, and install
new T-bar ceilinq (o? WWTP.
Contract for Goods & Services
Beqinninq date: April 1, 2013
Completion date: April 30, 2013
SUBTOTAL 3 911.00
BILL TO: Account Payable TAX 0.00
20 EAST MAIN ST FREIGHT 0.00
541-552-2010 TOTAL 3,911.00
ASHLAND, OR 97520
Account Number Project Number- Amount Account Number Project Number Amount
E 410.08.24.00.70420 E 000338.999 3,911.00
Authorized Signature VENDOR COPY
FORM #3 1 CITY OF
A requesi Fir a Purchase Order ASHLAND
REQUISITION Date of request: 26 MAR 13
Required date for delivery:
Vendor Name GRFFN MFAnnwc RI III DING. cn
Address, City, State, Zip 5313 HIGHWAY 66
Contact Name & Telephone Number
ASHLAND OR 97520
Fax Number
541 201 0095 CFLL 541 840 5848 JIM GREEN
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 uote or proposal attached
Small Procurement Cooperative Procurement
ess than $5,000 ❑ Request for Proposal (Copies on file) ❑ State of Oregon
Direct Award Date approved by Council: Contract #
❑ Verbal/Written quote(s) or proposal(s) ❑ Stale 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 ❑ Agency
❑ Form #9, Request for Approval
❑ Less than $35,000, by direct appointment ❑ Written quote or proposal attached Date original contract approved by Council:
❑ (3) Written proposals attached Date approved by Council: (Date)
❑ Form #4, Personal Services $5K to $75K Valid until: Date
Description of SERVICES Total Cost
rt ~aI s tiws w~~ Ncw D~rt2 Con~6TZ~+cr
la a~~ R~ e~o-..^. ~..q r .d ..-+p rr•+s'T-ea~``~. T-HWYt
Cr.~ r_r ru~ SEF- tArrwcr-r ED / lif.~ Gt'~~/~ $ 3911.00
Item # Quantity Unit Description of MATERIALS Unit Price Total Cost
D -2 /
TOTAL COST
❑ Per attached quotelproposal $
Project Number 000338.999 _ 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:
ITDirector Date Support -Yes/No
By signing th isition form, I certify that the City's public contracting requirements have been satisfied.
Employee Signature: Department Head Signature: I~~1?
(Equalto or Greater ra $5,000)
Additional signatures (if applicable):
Funds appropriated for current fiscal year.., YES / NO
Finance Director- (Equal to orgreaterthan $5,ooo) Date
Comments:
Form #3 - Requisition