HomeMy WebLinkAbout2013-106 Contract - Simpson & Associates
Contract for GOODS AND SERVICES Less than $25,000
CITY OF CONTRACTOR: 5 r V" f s an. /"J SSOG%a s
ASHLAND CONTACT: T . r~ Sl wr jD So h
20 East Main Street
~ ~Cx 7 b fvt~ Dl~
Ashland, Oregon 97520 ADDRESS: f , t7, 130,< W C>
Telephone: 541/488-6002 g 7 S p l
Fax: 541/488-5311 TELEPHONE: 3q- qgq `j
DATE AGREEMENT PREPARED: FAX: 5q(-73q 3
BEGINNING DATE: COMPLETION DATE: J,b ~QJ 15
COMPENSATION: 1 2567
GOODS AND SERVICES TO BE PROVIDED: 5 p et c ,e cz r c.v e, Po b r gal I,;~
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 279B.220, 279B.225, 279B.230, 27913.235, ORS Chapter 244 and ORS 670.600 are
made part of this contract.
7. Living Wage Requirements: If contractor is providing services under this contract and the amount of this contract
is $19,494 or more, Contractor is required to comply with chapter 3.12 of the Ashland Municipal Code by paying a
living wage, as defined in this chapter, to all employees performing work under this contract and to any subcontractor
who performs 50% or more of the work under this contract. Contractor is also required to post the notice attached
hereto as Exhibit B predominantly in areas where it will be seen by all employees.
8. Indemnification: Contractor agrees to defend, indemnify and save City, its officers, employees and agents harmless
from any and all losses, claims, actions, costs, expenses, judgments, subrogations, or other damages resulting from
injury to any person (including injury resulting in death), or damage (including loss or destruction) to property, of
whatsoever nature arising out of or incident to the performance of this contract by Contractor (including but not limited
to, Contractor's employees, agents, and others designated by Contractor to perform work or services attendant to this
contract). Contractor shall not be held responsible for any losses, expenses, claims, subrogations, actions, costs,
judgments, or other damages, directly, solely, and proximately caused by the negligence of City.
9. Termination:
a. Mutual Consent. This contract may be terminated at any time by mutual consent of both parties.
b. City's Convenience. This contract may be terminated at any time by City upon 30 days' notice in writing
and delivered by certified mail or in person.
C. For Cause. City may terminate or modify this contract, in whole or in part, effective upon delivery of
written notice to Contractor, or at such later date as may be established 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 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 Liabilit insurance with a combined single limit, or the equivalent, of not less than Enter one:
$200,00 500,000 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, 50 ,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 06/30/2012, 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.
Con City of Ashla
By By bl
nature Department Head
Print Name Print Name
yq(~ s h(Q
Title Date
W-9 One copy of a W-9 is to be submitted with
the signed contract. Purchase Order No.
AP(ROV D S~FORM
ig a ure
S-C=~
Date
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) 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.
Contractor (Date)
Contract for Goods and Services Less than $25,000, Revised 06/30/2012, Page 4 of 5
SIMPSON
f P.O. Box 8270
and Medford, OR 97501
ASSOCI ES INC. Ph. 541-734-9849
Concrete Repair 6 Induetrtd Coatings Fax 541-734-2223
°Co,RWn9 Am Hc. 91. 197'1°
OR License #104632 • ID License #R[526611 www.simpassoc.com
Concrete Prep
Grinding April 16th 2013
Polishing
Shotblasting TO: Lonny Flora / City of Ashland
Scarify Re: Quotation - Daniel Meyer Pool
Concrete Repairs;
Crack Repair We propose to furnish labor, materials & equipment adequate to complete the
Spalls following described work:
Slab Carl Section of Work
Trip Hamnls ollOtatlOn
structural Paintine $ 2,867.
Carbon Fiber Includes:
Crack injection
1. Spot Prime and apply 2 coats of Finish to Interior T-111 Siding (Currently
Concrete Finishes Dark Blue).
Hardeners
Densihers
Sealers This work will take 4 days to complete - If we have a start Date of Monday May
Moisture Vapor Control 13th we would be complete C.O.B. Thursday May 16th
joint Sealants
Joint Repair ClarilCations:
Wall Joints
Floor Joints 1. We have included the use of Sherwin Williams Paints.
Pre-Forrned 2. We have NOT included BOLI Prevailing Wages.
Resinous Flooring 3. This work will take approx. 4 Days to complete. We can start within 5 days of
Epoxy your directive to proceed.
Urethane 4. Please review the attached Standard Bid Clarifications Attachment.
Polyureu
MMA Please call me with any questions. Phone 541-944-9539.
Submitted By: .
Special Coatings
ConminnR:nl TzfM P S.w~ Ja
Tank
❑o version Tim P. Simpson Jr.,CSI
Conductive Simpson & Associates, Inc.
Dissipative Oregon Emerging Small Business Cert # 5837
Waterproofing American Concrete Institute Member # 1137848
Elastonneric
Fluid Applied
Sheet Membrane
Itenionite
Sihme
Trowel On
Decorative
Facilities Served
Manufacturing
Ford Service
Pulp Paper
Chemical
Warehouse
ReMil
Correctional
Educational
Transportation InEaaEx rF
I N T NMA 1 ca
ErRNT10NAL ruxrso
CrFCOR1rYq
CONCRETE REPAIR xmRmeRa
I N S T I T U T E ° Raesd AmMren Cen[9te InstlMe•
"~'a Adtsxvg mRrere
I
Standard Resin / Concrete Repair/Waterproofing/Sealants/Painting Clarifications
. Attachment: Project Name: Daniel Meyer Pool
Clarifications to our quotation;
Temporary Heat and Enclosures:
Unless specifically included in our quotation language we have not considered or included any
temporary heat or temporary enclosures to facilitate work on this project.
Power. Temp Liahtina. Water& Waste Disposal:
Unless specifically included in our quotation language we have not considered or included any
temporary power, Temp Lighting or water to facilitate work on this project. Waste disposal
facilities provided and maintained by others.
Sequencing of Work
All scheduling to be in accordance with PDCA Standard P7-99 "Job Sequencing". All quotes
subject to Engineering/Architectural approval and our interpretations of specifications of
Specifications and Drawings.
Damage To our Finished Work
We have not included any costs associated with repairing damage caused to our work by other
trades. Any costs associated with having to re-prep or refinishing damaged surfaces will be
charged to the general contractor/ or owner who can distribute the charges to others. As a General
Contractor or owner you may wish to include a contingency fund in your job costs to cover any
damage repairs. Damage repairs will not proceed without a written Change Order authorizing
such repairs from the General Contractor or owner to our firm. Our rates for damage repair for
straight time are at $ 45.50 hr. plus materials, equipment, travel, Lodging & Per Diem at cost plus
10%. Overtime is calculated at 1 & %z times the straight time rate. Any jobsite cleanup of
finished, repaired or otherwise prepared surfaces at end of project prior to acceptance of work by
General Contractor, Owner or other Installers to be by others.
Acceptance of Substrates
We make every effort to point out deficiencies in substrates prior to beginning our s work so that
other trades such as cement masons can properly complete their work prior to our beginning work.
We do not approve or accept the work of others. Moisture Vapor Transmission Issues of any kind
are the responsibility of the General Contractor/ Owner. We have not included, unless specifically
included above, any MVT Testing or remediation. -
Other Trades sometimes attempt to utilize our prime coats as a surface to more readily
identify repairs to their work. This is considered to be damage to our finish & you may wish to
advise them that we will bill you on a back charge basis for having to re-prime/re-Vowel surfaces
they repair. We typically do not proceed on any work until we are requested to by your field
supervision after they have had an opportunity to inspect and approve substrates with or without
the architect.
Collection If any payment by Client is not received in a Timely manner or in accordance with any
clarifications listed above, then interest shall accrue at the rate of 1.5% per month on all unpaid
amounts. In addition, Client shall pay all collection costs and attorney's fees incurred in collecting
past-due accounts, including costs and fees incurred at mediation, trial or appeal.
Submitted By,
T«,. S:..ya.
OP 10: KIY
CERTIFICATE OF LIABILITY INSURANCE °aH2'Ma~z013
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 pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms said conditions; of tho.pollcy,. certain Policies may reyuke an endorsement- A statement on this certificate does not corder rights to the
certificate holder in Beu of such endorsement s
PRODUCER Phone.541-7735358 Kendall'Yeaw
Protectors Insurance; LLC fax: 541-772-1906PHONE PAx
PBW Rock Iris Agency LLC ICA) 'uo E .541-842-2963 N,541
72-1906
PO Box 4669 'ADDRESS kentlail 8BW RtaII.COin
Medford, OR;.97501
ANX.Modre6. : SIMP&2•
wauREpw AFFDROMG COVERAGE NMCP
INSURED, Simpson & Associates Inc INSURERA: Starr Surplus Lines Insurance 13604
PO Box. 8270- wsu m B : North Pacific Insurance. Co: 23892
Medford, OR 97501 we1r mc:Commerce Commerce& Industry-ins Co
eWURERD:
wsURER£:
'wsuRERF:
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. NOTWriHSTANDINC ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER'. DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE 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 RAVE BEEN REDUCED BY PAID. CLAIMS.
TYPE OF INBURNICE' POLICY NUMBER : MIKIDDOYM 1.IIeTI1
'cENta+aLLUep:RY EACH OCCURENCE s 11000,0
A TXC~~RCIAI- cETERAL LIABILITY X SLPOOL0061002 02123)2013 :O21232014 PREASSES Ee ocwrcenco $ Koo(
CLA1MGLlADE F;17
O OCCUR MEDENP(Anymiip6r.) f 5,DIX
PERSONAL 6 AOV INlIF2Y f 1,000,
OFJERAL AGGREGATE f 2,000,OOC
6ENL AGGREGATE LIWTAPPLIESPER: PRODUCTS-CO4wOF ACG F 2,000;
X POLICY- ,Pr F~ LOC f
AUIOMOeaE LUasIrY - - X, COMBINED SINGLE LIMB
IEe eca6inl f 1000.
B ANY AUTO 04173626 05/0112013 05101f2014 .SODILYIKWY(Pxoxc ) s
ALL ONTED AUTOS BODILY INi-RY„(Per Xcidrry) f
X SUED-LEDPUf0S' PROPERTY DAMAGE
X : . (Parattl0air) f
HIRED AUTOS
X w"YMED AUTOS
i
-UWRELLALMB .X OCCUR EACH OCCURRENCE f 2,000,
f 2000,
X EI(CESSUAS CWM610ADE AGGREGATE C EBU01 1660693 on312013 02m2014
DebucrlBLE
RErENT1ON ':s s
YIDRI(ER9 COMPENaATION WCSTATU-. OTtt
AND EMPLOYERT LIABILITY YIN MY LIMIT
ANYPROPRETORPARTNER(FJtECUINE E. L. EACH ACCIDENT i
OFFICENAEMS:R EXCLUDED? ~ NIA
/Mmeeory ln'. NMI E. L: DISEASE - EA ENPLOY f
II Y", Wswb..6vI
DESCRJPTIONOF OPERATO. Wm E.L, DIS&&-POLICY LIMIT' f
DESCRIPTION OF OPERATIONS I LOCATIONSI NEHICLE9 DadoN ACOAO 101, A q.W R. . esMJtl., enian rpiu N r Wo,a
Project: Pool Bldg L,Interior Wood Paznting~Goeting
City of Ashland 'and its elected n££icials, e. 10yec9 ang a4ents 'acting
Rithin the scope ,CAof their, duties as such are listed as. additional insureds
er policy forms''20GS:(9299), pnd CG2010(1001). Primary and Hon-
contributory coverage is an 000001(1204).
CERTIFICATE HOLDER ' CANCELLATION
CITYAS2
SHOULD ANY OP'THB'ABDVE'DEBCRISW'.POLICIES BE CANCELLED BEFORE
City of Ashland THE EXPIRATION DATE THEREOF, NOTICE RILL BE. OELNERED IN
ACCORDANCE WITH THE POLICY PROVISIONAL
20E-Main St.
Ashland, OR 97520 AUMMORIZED MPFAIRWArN6'
Alex Modrell
®1996.2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09) T.he:ACORD name and'logo are registered marks of ACORD
POLICY NUMeEEt; 004173826 COMMERCIAL-AULO
Cll. 204a=02I'99
THIS ENDORSEMENT CHANGES' THEPOLI.CY. PLEASE READ IT CAREFULLY.
'dESICNATED ~N$U,RED
This endorsement modlfles.insurance providemunder the following:
8VOINE$$AUTO COVERAQ'F FORM
GARAGECOVERAQ FORM,
MOTOR ARRIER COVERAGE FORM
7RUCKES COVERAGE FORM
With respect;to.coverage provided by,lhisendorsement,Jthe provisions. of the coverage For6Apply unless.modl-
ftedby th ls.endorsement.
This, endorsement idontifioa pomon(s) or orgonizution(s) whb ;dre "Inegreds" under the Who IgAn Ioaui*0 ProU-
51on of the C,overage Form. This endorsement doesinot alter coverage proAded in the:COverage Form:
This endorsementchanges the pollcyeffective,op: die inception date of the policy unless another date is Indoited
below.
Endorseinent, Effecfive:. Countersigned, By
05/01/201 3
Namedfnsured: Simpson & Associates Inc
r uthorized'Re resentatlve '
SCHEDULE
`Wine of Pars&h1q) or O'rganaadon(g)i
City of Ashland
(If no entry appears above, infonnatlon:required to complete this eniorserrient,will he shown in the Declarations
as a plicablelo:the endorsement!)'
Each person or organizadon shown in the 6chedule is an '9nsured" for Llabilty Coverage, but;only to the, extent
that person or. organization qualifies as an "insured" under the Who Is An Insured Provision contained
.In Section II of the Coverage Form.
f}3~28f9;2
CA; 20 48,02 09 Copyright, Insurance Servlces:Office, Inc:; 1988 Page 1: of 1'
r erooi
201'20403.pdf
COMMERCIAL
OENERAGCIABILITY
CG 20510/001
THIS ENDORSEMENT CHANOESTNE POLICY. PLEASE READ IT cAREPULLY.
ADDITIONAL INSURED - OWNERS,, LESSEES OR
CONTRACTORS --.SCHEOULEp :PERSON OR.
ORGANIZATION
This endorsernent;modifies insurance provided uhder'the following:
COMMERCIAL GENERAL LIABILMY COVERAQE,PART
SCHEDULE
ame of Personior Organization
lanket.as;required "by wntten;contract on a,pnmary 8:non-contributor
ybass.
(If no entry appears above, information required to :complete this endorsement will.be shown in the
;Declarations as applicable tothis endorsemeint.)
A Section II -Who Is An Insured is amended to; include as an'insured the person oforganizaton.
shown in the Scliedule, butonly with respect to Ilab tityansing:out of your ongoing operations
performed for that insured.
B. With raspedto the insurance afforded'to these-additional insureds, the.follgwing exclusion is
added:
-2;- Exclusions
This insurance doesnot,apply:to "bodily, injury" or 1'propertyd'amage" occurring after:
(1) All work including materials, parts or equipmentfuniished in conneGtionwith such
work, -on the project (other than ser ice, maintenance;or repairs) to be performed.: by or
on behalf of the additlonal msured(s) at the site of the covered operations has been
completed; or
(2) That porlionof'yourworl' out ofwhich the injury orrdamage anises has been put to
its intended use by any person or organization other:than anothercontractor or
subcontractor engaged in palformirig operations for.a'principal:as a part ofthe'seme
project
CO 20 10.10'01
CG0001 12-01
a. Primary Insurance
This insurance is primary except when b. below applies. If this insurance is primary, our obligations are not
affected unless any of the other insurance is also primary. Then, we will share with all that other insurance
by the method described in c. below.
b. Excess Insurance
This insurance is excess over:
(1) Any of the other insurance, whether primary, excess, contingent or on any other basis:
(a) That is Fire, Extended Coverage, Builder's Risk, Installation Risk or similar coverage for "your work";
(b) That is Fire Insurance for premises rented to you or temporarily occupied by you with permission of
the owner;
(c) That is insurance purchased by you to cover your liability as a tenant for "property damage" to
premises rented to you or temporarily occupied by you with permission of the owner; or
(d) If the loss arises out of the maintenance or use of aircraft, "autos" or watercraft to the extent not
subject to Exclusion g. of Section I - Coverage A - Bodily Injury And Property Damage Liability.
(2) Any other primary insurance available to you covering liability for damages arising out of the premises
or operations, or the products and completed operations, for which you have been added as an additional
insured by attachment of an endorsement.
When this insurance is excess, we will have no duty under Coverages A or B to defend the insured against
any "suit" if any other insurer has a duty to defend the insured against that "suit". If no other insurer
defends, we will undertake to do so, but we will be entitled to the insureds rights against all those other
insurers.
When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if
any, that exceeds the sum of:
(1) The total amount that all such other insurance would pay for the loss in the absence of this insurance;
and
(2) The total of all deductible and self-insured amounts under all that other insurance.
We will share the remaining loss, if any, with any other insurance that is not described in this Excess
Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in
the Declarations of this Coverage Part.
c. Method Of Sharing
If all of the other insurance permits contribution by equal shares, we will follow this method also. Under this
approach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none
of the loss remains, whichever comes first.
If any of the other insurance does not permit contribution by equal shares, we will contribute by limits.
Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total
applicable limits of insurance of all insurers.
5. Premium Audit
a. We will compute all premiums for this Coverage Part in accordance with our rules and rates.
b. Premium shown in this Coverage Part as advance premium is a deposit premium only. At the close of each
audit period we will compute the earned premium for that period and send notice to the first Named Insured.
The due date for audit and retrospective premiums is the date shown as the due dale on the bill. If the sum of
the advance and audit premiums paid for the policy period is greater than the earned premium, we will return
the excess to the first Named Insured.
c. The first Named Insured must keep records of the information we need for premium computation, and send
us copies at such times as we may request.
6. Representations
By accepting this policy, you agree:
a. The statements in the Declarations are accurate and complete;
b. Those statements are based upon representations you made to us; and
y c. We have issued this policy in reliance upon your representations.
7. Separation Of Insureds
Except with respect to the Limits of Insurance, and any rights or duties specifically assigned in this Coverage
Part to the first Named Insured, this insurance applies:
Simpson & Associates, Inc. Transmittal
Y.O. Box 8270 DATE: 4-25-13
Medford, Oregon 97504 Job No:
(541) 734-9849 RE: CITY OF ASHLAND DANIEL
FAX (541) 734-2223 MEYER POOL PAINTING
CCB: 104632
TO:
City of Ashland X Lonny Flora
20 East Main St Recreation Coordinator
Ashland, OR 97520 PH 541-552-2250
FAX 541488-5314
We are sending you, X attached _ under separate cover via the following items:
_ Submittals X Paint Drawdowns -Specifications _ Other
Samples -Copy of Letter
COPIES DATE DESCRIPTION
1 4/25/13• Signed Contract ready for counter-signature.
1 4/24/13 General Liability, Automobile Liability & Umbrella Liability
Insurance certificate & endorsements.
THESE ARE TRANSMITTED as checked below:
-For Approval -For Your Use XXAS Requested -For Review and Comment
Thanks
Copy To: FILE Signed: QALL
lwm T M Bain
Page 1 / 1
Ashland Park Commission DATE PO NUMBER.
20 E MAIN ST. 5/10/2013 00222
ASHLAND, OR 97520
(541) 488-5300
VENDOR: 004161 SHIP TO:
SIMPSON & ASSOCIATES INC
PO BOX 8270
MEDFORD, OR 97501
FOB Point: Req. No.:
Terms: net Dept:
Req. Del. Date: Contact: Rachel Dials
Special Inst: Confirming? No
Quantity Unit Description Unit Price EA Price
Spot prime and apply 2 coats of finish . 2,867.00
to interior T-111 siding (currently
dark blue)
LocatioN; Daniel Meyer Pool
Contract for Goods and Services
Beginning date: May 13, 2013
Completion date: May 16, 2013
SUBTOTAL 2,867.00
BILL TO: TAX 0.00
FREIGHT 0.00
TOTAL 2,867.00 .
Account Number Project Number Amount Account Number Project Number Amount
E 211.12.03.02.60691 E 000008.999 2,867.00
Authori2" 7 ignature VENDOR COPY
pd-s
FORM#3 CITY OF
A request for a Purchase Order ASHLAND
REQUISITION Date of request: 13
Required date for delivery: G;(
Vendor Name l Yl(1 Q ~0 A 0.1 tO
Address, City, State, Zip X2-70 kW ty a b
Contact Name & Telephone Number TiM514f1 ~R l
F'794 -M9
ax Number ( 7N1
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 #
Verbal/Written 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 #g, Request for Approval ❑ Agency
❑ Less than $35,000, by direct appointment ❑ Written quote or proposal attached Dale 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
_ &MAX a VkV ~ Total Cost
frr/r W~ trAA `N &MAX S4NJ f~lV '~VI` "1~r1 ~lh
C' ` V1 qd' ,y r
h L(u erg u t rL ~~.b'I <
$
Item # Quantity Unit escri tion of MATERIALS Unit Price Total Cost
TOTAL COST
] Per attached quotelproposal;
Project NumberC)L•) L)K-9~6 Account Number2k-LZ-Q.3-C~---UiAP1(-9
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
~y signing(th requisition form, l certify that the City's public contracting requirements have bee afisfled.
Employee Signature: ' WJIrnSLI/1-) Department Head Signature:
(Equal to or greater than $5,000)
City Administrator:
Funds appropriated for current fiscal year., YES / NO (Equal to or greater than $25,000)
Finance Director- (Equal to or greater than 55,000) Date
Comments:
Form #3 - Requisition