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Home My WebLink About2013-130 CONT AMND - Liquid Engineering Additional Work Authorization Liquid Engineering Corporation P.O. Box 80230 Billings, MT 59108 (800) 438-2187 Client - Date ASHLAND WATER DEPARTMENT 04-24-2013 Address LECJob 90 N MOUNTAIN AVE Number #45022 City State Reservoir ASHLAND - OR - Name CLEAR WELL Phone Date of 5414885345 contract 04-02-2013 You are authorized to perform the following specifically described additional work: MERCURY REMOVAL FROM CLEAR WELL AT A4 HOUR MINIMUM FOR 1900.00 ADDITIONAL HOUR AT 425.00 RECEIVED MAY 01 2013 ACCOUNTS PAYABLE Approved for Payment ❑ Do Not Pay Signature Account # Date 4 - 2S- )3 PLEASE RETURN TO PAYABLES ADDITIONAL CHARGE FOR ABOVE WORK IS: $2,353.00 Payment will be made as follows: Net 30 Above additional work to be performed under same conditions as specified in original contract unless otherwise stipulated. Date: Authorizing Signature: Print Name: (Client signs here) We hereby agree to furnish labor and materials - complete in accordance with the above specifications, at above stated price. Authorized Signature: Date: 04-24-2013 (Contractor signs here) ROBERT HEATON THIS IS CHANGE ORDER NO. 01 Note: This revision becomes part of, and in conformance with, the existing contract. 0 Copy-Ighi Ins 2005:ipuid "cngineer~ng carpancion-All righn --d Liquid Engineering Corporation Potable Water Reservoir Supplemental Report Job Number: #45022 Utility: ASHLAND WATER DEPARTMENT Tank: CLEARWELL Inspector: p. BIELEK Dive Controller: R. HEATON Date: 04-24-2013 S when the diver entered the water he discovered 2 large pools of mercury about 1.5 tbls we did remove them and there was some minor staining left on the floor. he also found small amount of mercury though out the floor panels and we removed that as well the expansion joints did have a lot of mercury infused in them we removed as much as we could we do recommend that the tank be drained so the expansion joint could be replaced l DISCLAIMER Liquid Engineering does not provide consulting engineering services. unless otherwise noted, the findings contained in this report were neither prepared nor reviewed by a licensed Professional Engineer, but are based on experience, training and visual examination of the Dive Maintenance Technician DCopyright 1998 - 2009 Liquid Engineering corporation - All rights reserved Client#: 7082 LIQUIDEN ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 5/06/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE,DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s)- - PRODUCER CONTACT - NAME: Payne West Insurance, Inc.' PHONE _ F N No Eat: AIC No: P.O. Box 30638 EM . , ADDRESS: Billings, MT 59107-0638 INSURER(S) AFFORDING COVERAGE NAICIT 406 238-1900 INSURERA, Westchester Surplus Lines lnsur INSURED INSURERS: Ace American Insurance Company Liquid Engineering Corporation P.O. Box 80230 INSURER C Billings, MT 59108-0230 INSURER D INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS !S T CERTIFY THAT, THE POLICIES Cc •SL'Ra.NCE LISTED ° HAVE BEEN ISSUED TO THE INSURED NAMED ROVE FOR THE POLICY oER!OD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUB POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD/YYYY [MM/DDJYYYY) A GENERALLIABILfTY X G24280792002 5/0112013 05/01/201 opEAICN,I1H0E00URRENCE 110-0-0-100-0 X COMMERCIAL GENERAL LIABILITY PREAGJTO RENTante $50000 FxI Ea CLAIMS-MADE OCCUR MED EXP (Any one person) s5,000 X BI/PD Ded:2,500 PERSONAL B AIV INJURY $1000000 _ GENERAL AGGREGATE 52,000,000 GEN`L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGO 52,000,000 POLICY X PRO-. 1 LOC f B AUTOMOBILE LIABILITY CALHO8415717007 5/01/2013 05/01/201 COMBINED SINGLE LIMIT 1,000,000 Ea accident BODILY INJURY (Per person) $ ANY AUTO ALL OWNED X SCHEDULED BODILY INJURY(Peraccident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE S AUTOS Per accident $ A X UMBRELLA LIAB X OCCUR G2428105AO02 5101/2013 05/011201 EACH OCCURRENCE - $2000000 EXCESS LIAB CLAIMS-MADE AGGREGATE 112,000,000 DED X RETENTION $0 S WORKERS COMPENSATION WC STATU- 10TH-1 AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOP/PARTNEPJEXECUTIVE E.L. EACH ACCIDENT $ OFFICEWMEMBER EXCLUDED? N/A (Mandatory In NH) E.L. DISEASE - FA EMPLOYEE S If yes, describe under CESCRIPTIGN OF OPERATIONS Selo. E.L. DISEASE- POLICY LIMIT S A Professional G24280792002 - 5/01/2013 05101/201 $1,000,000/$1,000,000 A Pollution G24280792002 5/01/2013 05101/201 $1,000,000/$1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) CERTIFICATE HOLDER CANCELLATION Ashland Water Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 90 N. Mountain Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520 AUTHORIZED REPRESENTATNE J t7 }41J r ~~OtS'[ © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 1 of l The ACORD name and logo are registered marks of ACORD #S910329/M909911 CT1 Client#: 7082 LIQUIDEN FATE (MMIDD)YYYY) 5106/20/3 0 ACORD.e CERTIFICATE OF LIABILITY INSURANCE 5106/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER - CONTACT NAME: Payne West Insurance,, Inc. PHONE - A% AIC No Ezl : AIC No : P.O. Box 30638 I nooaess: Billings, MT 59107-0638 INSURER(S) AFFORDING COVERAGE NAIC0 406 238-1900 I INSURER A: Montana State Fund INSURED INSURER B: Zurich AmericanInsurance Co. Liquid Engineering Corporation INSURER C P.O. Box 80230 INSURER D Billings, MT 59108-0230 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES Cr'INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABQVEFORTUC POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITIONOF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE NADDLSUBR SR MD POLICY NUMBER MM/DDMYYYY MM/DDV.E%P LIMITS GENERAL LIABILITY EACH ~~OEECCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISESOE. occu nce $ CLAIMS-MADE r7 OCCUR MED EXP (Any one person) $ PERSONAL B ADV INJURY $ GENERAL AGGREGATE S GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG S POLICY PRa LOC S AUTOMOBILE LABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per accitlenl UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ OED RETENTION S $ A WORKERS COMPENSATION 032521526 5/01/2013 05/011201 X WCSTATU- OTH- AND EMPLOYERS' LIABILITY B ANY PROPRIETOR/PARTNER/EXECUTIVEO WC959746702 - - 5/01/2013 051011201 E.L. EACH ACCIDENT $1,000,000 OFFICERIMEMBER EXCLUDED? y NIA (Mandatory In NHl E.L.DISEASE-EAEMPLOVEE $1 000000 If yes, describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT 51,000 OOD DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is requlmd) All operations performed by the above insured. Proprietors/Partners/Executive Officers/Members Excluded: Liz Dykstra, Secretaryfrreasurer CERTIFICATE HOLDER CANCELLATION Ashland Water Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 90 N. Mountain Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S9100471M909253 CT1 Page 1 / 1 J~ CITY OF ASHLAND DATE -PO NUMBER 20 E MAIN ST. 4/5/2013 11528 ASHLAND, OR 97520 (541) 488-5300 VENDOR: 017658 SHIP TO: Ashland Water Treatment Plant LIQUID ENGINEERING CORP (541) 488-5345 PO BOX 80230 ASHLAND, OR 97520 BILLINGS, MT 59108 FOB Point: Req. No.: Terms: Net - Dept: Req. Del. Date: Contact: Greg Hunter Special Inst: - Confirming? No , Quantity Unit Description ' Unit Price' Ext. Price F THIS IS A REVISED PURCHASE ORDER Remove elemental mercury from clearwell 1,900.00 Contract for Goods and Services Completion date: 04/17/2013 Processed chanqe order 05124/2013 425.00 Addtional services required from on-site contractor ~~13-adz SUBTOTAL 2.325.00 BILL TO: Account Payable TAX 0.00 20 EAST MAIN ST FREIGHT 0.00 541-552-2010 TOTAL 2,325.00 ASHLAND, OR 97520 Account Number;? Project Number Amount Account Number Project Number - Amount E 670.08.19.00.60240 2,325.00 ,lax S/Ly~Z~/ 3 Author' d signature VENDOR COPY FORM#1o C1TY OF CONTRACT AMENDMENT APPROVAL REQUEST FORM ASHLAND Request for a Change Order Name of Supplier I Contractor I Consultant: LIQUID ENGINEERING Total amount of this Purchase Order Number: 11528 contract amendment $,42&00 Title I Description: REMOVE ELEMENTAL MERCURY FROM CLEARWELL > ❑ Per attached contract amendment Contract Amendment Original contract amount $1900 100 % of original contract Total amount of previous contract amendments $0.00 0.00 % of original contract Amount of this contract amendment $425.00 22.368 % of original contract TOTAL AMOUNT OF CONTRACT $2325.00 122.368 % of original contract In accordance with OAR 137-047-0800: 1) The amendment is within the since of procurement as described in the solicitation documents, Sole Source notice or approval of Special Procurement 2) The amendment is necessary to comply with a change in law that affects performance of the contract 3) The amendment results from renegotiation of the terms and conditions, including the contract price, of a contract and the amendment is advantageous to the City of Ashland, subject to all of the following conditions: a) goods and services to be provided under the amended contract are the same as the goods and services to be provided under the unamended contract; b) The City determines that, with all things considered, the amended contract is at least as favorable to the City as the unamended contract; c) The amended contract does not have a total tens greater than allowed in the solicitation document, contract or approval of a Special Procurement An amendment is not within the scope of the procurement if the City determines that if it had described the changes to be made by the amendment in the procurement documents, it would likely have increased competition or affected award of contract. ' Contract amendment is within the scope of procurement: YES YES NO' (If "NO", requires Council approval I Attach copy of CC.) Sourcing Method: SMALL PROCUREMENT - Less than 85.000 INVITATION TO BID or COOPERATNE PROCUREMENT, QRF or 9'YES*, the total amount of contract and cumulative REQUEST FOR PROPOSAL EXEMPTION PURSUANT TO AMC 2.50 amendments s $6,000. ❑ 'YES', the total amount of cumulative amendments ❑'YES', the total amount of original contract and ❑ If'NO', amount exceeding authority requires s 25% of original contract amount or $250,000 cumulative amendments s $100K for Goods 8 Services, s Council approval. Attach copy of Council whichever is less. $75K for Personal Services, <$50K forAttomey Fees. Communication. ❑ If "NO*, amount exceeding authority requires ❑ If "NO', amount exceeding authority requires Council ❑ Exempt-Reason: - Council approval. Attach copy of Council approval. Attach copy of Council Communication. PERSONAL SERVICES Communication. ❑ Exempt-Reason: ❑ -YES', Direct appointment 5$35,000 ❑ Exempt-Reason: ❑ If'NO', requires approval. INTERMEDIATE PROCUREMENT SOLESOURCE EMERGENCY PROCUREMENT Goods a Services - $5.000 to $100.000 ❑ 'YES", the total amount of cumulative amendments ❑ Written Findings: Document the nature of the Personal Services - $5.000 to $75.000 s 25% of original contract amount or $250,000 emergency, including necessity and circumstances ❑ 'YES', the total amount of cumulative whichever is less. requiring the contract amendment amendments 5 25% of original contract amount ❑ If ❑ If 'NO', amount exceeding authority requires ❑ Obtain direction and written approval from City 'NO', amount exceeding authority requires Council Council approval. Attach copy of Council Administrator approval. Attach copy of Council Communication. Communication. ❑ If applicable, attach copy of Council Communication ❑ Exem t-Reason: ❑ Exem t-Reason: ❑ Exem t-Reason: SPECIAL PROCUREMENT INTERGOVERNMENTAL AGREEMENT ❑'YES', the total amount of original contract and cumulative amendments are ❑'YES', the original contract was approved by City Council. within the amount and terms initially approved by Coundl as a Special Provide date approved by City Council: (Date) Procurement. If'NO', Council approval is required. Attach copy of Council Communication. ❑ If'NO', amount exceeding authority requires Coundl approval. ❑ Contract amendment approved and signed by City Administrator. Attach copy of Council Communication. Project Number Account Number Account Number 670.08.19.00.602400 'Expenditure must be charged to the appropriate account numbers for the financials to reflect the actual expenditures accurately. Attach e a pages rf needed. Employee Signature: ~e/r/f'J Department Head Signature: .x(~/~` (Equal,toor greater than $5,000) City Administrator: _ (Equal fo or greater rhar 825, 00 or f0Y) Funds appropriated for current fiscal year: YES / NO ; z3 , 3 Finance Director (Equalto orgmaterthan $5,000) Dale Comments: PROCESS WITHOUT CONTRACT ADDENDUM Form #10 - Contract Amendment Approval Request Form, Request for a Change Order, Page 1 of 1, 5/23/2013