HomeMy WebLinkAbout2013-354 Contract - Roxy Ann Rock a
Contract for GOODS AND SERVICES Less than $25,000
CITY OF CONTRACTOR: Roxy Ann Rock
ASHLAND CONTACT: Wes Norton
20 East Main Street
Ashland, Oregon 97520 ADDRESS: P.O. Box 4488 Medford, OR 97501
Telephone: 541/488-6002
Fax: 541/488-5311 TELEPHONE: 541-601-7451
DATE AGREEMENT PREPARED: October 14, 2013 FAX: 541-855-6051
BEGINNING DATE: October 21, 2013 COMPLETION DATE: January 30, 29430p1~-
COMPENSATION: $21,970.00
GOODS AND SERVICES TO BE PROVIDED:
Demolition, Site Work, New Utilities, Work at new Restroom Building at Lithia Park as noted and specified in
the request for quote Lithia Park Restroom Replacement Document Project # 000034.999
ADDITIONAL TERMS: BT?_ OLI may apply to this project based on combined costs of project if total exceeds
$50,000.00 ('eJa,('.. WZy_ M44
d t
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, 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 $19,825 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 b City under an of the following
Contract for Goods and Services Less than $25,000, Revised 06/13/2013, Page 1 of 7
conditions:
i. If City funding from federal, state, county or other sources is not obtained and continued at levels
sufficient to allow for the purchase of the indicated quantity of services;
ii. If federal or state regulations or guidelines are modified, changed, or interpreted in such a way
that the services are no longer allowable or appropriate for purchase under this contract or are
no longer eligible for the funding proposed for payments authorized by this contract; or
iii. If any license or certificate required by law or regulation to be held by 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 Li b, , nsn a with a combined single limit, or the equivalent, of not less than Enter one:
$200,000, $500,0 $1,000,00 2,000,000 or Not Applicable for each occurrence for Bodily Injury and Property
Damage. It shall inc ractual liability coverage for the indemnity provided under this contract.
C. Automobile Li bili m ance with a combined single limit, or the equivalent, of not less than Enter one:
$200,000, $500,00 1,000,0 or Not Applicable for each accident for Bodily Injury and Property Damage,
including coverage for o ned, hired or non-owned vehicles, as applicable.
Contract for Goods and Services Less than $25,000, Revised 06113/2013, Page 2 of 7
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 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 shall sign the certification attached hereto as Exhibit A and herein incorporated by
reference.
Contractor: City of Ashland
By By
Signature _ -Department Head
/ff
Print Name Print Name
d 1y e 2_ (4 ((K 11
Title Date p
W-9 One copy of a W-9 is to be submitted with
the signed contract. Purchase Order Nc~_
-AshlWaAsst CttyAt may
Data 0 1
Contract for Goods and Services Less than $25,000, Revised 06/13/2013, Page 3 of 7
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 06/13/2013, Page 5 of 7
CITY OF ASHLAND, OREGON
EXHIBIT B
City of Ashland
LIVING
WAGE
nmper hour effective June 30, 2013
(Increases annually every June 30 by the
Consumer Price Index)
portion of business of their cafeteria plans (including
employer, if the employer has childcare) benefits to the
ten or more employees, and amount of wages received by
has received financial the employee.
assistance for the project or
For all hours worked under a business from the City of Note: "Employee" does not
service contract between their Ashland in excess of $19,825. include temporary or part-time
employer and the City of employees hired for less than
Ashland if the contract If their employer is the City of 1040 hours in any twelve-
exceeds $19,825 or more. Ashland including the Parks month period. For more
and Recreation Department. details on applicability of this
➢ For all hours worked in a policy, please see Ashland
month if the employee spends i In calculating the living wage, Municipal Code Section
50% or more of the employers may add the value 3.12.020.
employee's time in that month of health care, retirement,
working on a project or 401 K and IRS eligible
For additional information:
Call the Ashland City Administrator's office at 541-488-6002 or write to the City Administrator, City Hall,
20 East Main Street, Ashland, OR 97520 or visit the city's website at www.ashland.or.us.
Notice to Employers: This notice must be posted predominantly in areas where it can be seen by all
employees.
CITY OF
ASHLAND
Contract for Goods and Services Less than $25,000, Revised 06/13/2013, Page 6 of 7
Ashland Parks and Recreation
Lithia Park Restroom Replacement
Project #0000034.999
10/09/13 Bid:
Base Bid: Hours Rate Gross Burden G&A Total Gross Wages
Cement Mason 80 20.00 1600 400 300 $ 2,300
Laborer 40 20.00 800 200 150 1,150
Operator 160 20.00 3200 800 600 4,600
Carpenter 20 20.00 400 100 75 575
Total Man Hours 300
Alternate:
Operator 30 20.00 600 150 112 862
Cement Mason 30 20.00 600 150 113 863
Total $ 10,350
Bid Detail for Prevailing Wage:
Base Bid: +
Hours Fringe Gross Burden G&A Total Gross Wages
Cement Mason 80 38.48 3,078 769 577 $ 4,424
Laborer 40 34.26 1,370 342 257 1,969
Operator 160 46.76 7,481 1,870 1,402 10,753
Carpenter 20 38.93 779 194 145 1,118
Total Man Hours 300
Alternate:
Operator 30 46.76 1,403 350 262 2,015
Cement Mason 30 38.48 1,154 288 216 1,658
Bid Detail for Prevailing Wage: $ 21,937
Less 10/09/13 Bid $ , 0)
Wage Adjustment $ 11,587
REQUEST FOR QUOTATIONS
LITHIA PARK RESTROOM REPLACEMENT
Project #
Project is located in the south portion of Lithia Park, at 418 Granite Street. See attached pages for the
site location, proposed schedule, electric trench requirements, drawings of the new prefabricated
restroom and site plans. The project includes the following:
1. Demolition:
a. Demolish existing restroom building.
b. Removal of existing utilities serving existing restroom building.
c. Removal of existing sidewalk.
2. Site Work:
a. Preparation of pad for new prefabricated restroom building.
b. Supply and install 12" of compacted'/<-0.
c. Replace existing concrete curb and gutter along north edge of parking lot (add alternate
#1).
3. New Utilities:
a. 36" deep x 12" wide electrical service trench with 2" conduit with pull wire, per
attached electric trench requirements.
b. Installation of owner-supplied AFN blue flex conduit on top of sand above electrical
conduit.
c. Supply and install 4" sewer line.
d. 36" deep x 12" wide First User Station water service trench with sanded bottom,'/o"-0
fill to within 12" of finished grade.
e. Supply and install 1/4" Type K Annealed soft copper water line in same trench as First
User Station water service.
4. Work at New Building:
a. Supply and install 2" thick ASJ Faced CertaPro Board (CB 600) on walls and ceiling of
Utility Room. Attach to concrete with zinc-plated Titen HD Anchors with 2" diameter
washers.
b. Supply and install '/4" fire-rated plywood on north and east walls of Utility Room.
c. Supply and install weatherstripping at Utility Room door.
d. Supply and install flashing boots at 1 '/2" Irrigation roof penetration and 2" First User
Station roof penetration.
e. Supply and install 750 watt QMark electric wall heater (GFR1500T2 with GFRSM
surface mounting frame) on west wall of Utility Room.
f Supply and install duplex receptacle at north wall of Utility Room for AFN.
g. Supply and install 4-gang receptacle at east wall of Utility Room for First User Station.
h. Supply and install power from 150 amp breaker panel to heater and receptacles outlined
above.
The schedule for this project is outlined on the attached Proposed Schedule.
Bidder hereby proposes to furnish all materials, labor, equipment, tools, transportations, services,
licenses, fees, permits, etc., required by the bid documents to complete the work for the lump-sum base
bid of Dollars
CEV3TMCA E OF LMLI` Y INSURANCE 6/14/ `AT4 ~I2013
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THIS CERTIFICATE IS ISSUED AS A MATT ER 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 cartlficate holder Is an ADDITIONAL INSURED, the policy(les) 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 Rim Sch_ etZ.z
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Ward Insurance Agency ANON= (541)687-1 117 Farc C, lrtl. (543)342-8280
PO Box 10167 .kimOvardinscrance. net
]INSURER(S) AFFCROINC COVERAGE NAIC0
Eugene OR 97440 INSURER A:Ateeri can States Insurance Co 19704
INSURED INSURERS: -
Wesley Reed Norton INSURER C:
DIEN: Rory Ann ROCIC ENSURER O:
PO BOX 4488 wSUReRF.
Medford OR 97501 svRERr:
COVERAGES CERTIFICATE NUMBER:13/14 GL/1:t-SCHZD EQUIP REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAFAED ABOVE FOR THE POLICY PERIOD
INDICATED. FOI WIT'r'STANOING ANDY REQUIREIAENT, TERM OR CONOMOP! OF ANY CONTRACT OR OTHER OCCUMAENT WITH RESPECT TO 4LHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE A.FFO.RDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONCIT ICIIIS OF SUCH POLICIES. LIMITS SHOWN M.AYHAVE BEEN P,E DUCED BY PAID CL AI.-AS.
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GENLAGGREGATE LLVIT nPPLIES? R[ - PRODUCTS - COCEP/OP AGG I i 2,000,000
POLICY X I PR T Lc:, f 5-
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DESCRIPTION OF OPERATIONS I LOCATIONS 'VEHICLES (A1.&ACORDI01,Addleonal Remarks SChedu!q lfnwre Bp0c4 is repulrMl
Re: Enders Memorial Shelter
City of Ashland and its acents, officers and employees are named as additional inscreds, cut only with
respects to cc-:tractor's services to be provided •mder this contract and per attached. CGS674.
CERTIFICATE HOLDER_ CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE MJILL BE DELIVERED IN
City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS.
Ashland Park & Recreation
340 S. Pioneer St. AUTHORzsDa=_PRESSVrATIVE
Ashland, OR 97520
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ACORD 25 (2010105) - a 1988.2010 ACORD CORPORATION. All rights reserved.
INS0251mir..6).6f The ACORO name and logo are registered marks of ACORD
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<1CERIIRICA T E OF L-,IAL~ ~tl~iSl~Jll~b'=StlV'ICE 6/14/2013
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THICERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYIAND 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 DET'NEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. 1
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(es) 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 eertifleale does not confer rights to the
certlffcate holder In lieu of such endorsement(s)
PRODUCER ".uAmE: BCi;, *e Watts
Ward Insurance Agency li °YR- (541) 687-iii? ralc Net. (343)343-8480
E0 Box 10167 'E"'AS. noHbie:r@.:ardis•Arance, net
WSL'RER(5 AFFORDINGCOVERAGE - NAICV
Eugene OR 97440 IiNSURERA:Travelers-7iTC (ARP)
INSURED (INSURER B : _
?~TeEley Reed VOrton INSURERC:
PO Box 4488 - IINSUR-n _
IINS URE_R E_<
Medford OR 97501 11\SLRERP:
COVERAGES CERTIFICATE NUMBER:13/14 Trorl- COMM REVISION NU6113ER: _
THIS IS TO CERTIFY THAT THE FOIJCIES Or INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TILE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOT flTHSTANOING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO !!¢HICH THIS 1
CERTIFICATE MAY BE ISSLIEO OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HERE6N IS SUEJECT TO ALL THE TERM IS,
EXCLUSIONS AND C0,40ITiC,N5 OF SUCH POLICIES, LIMITS SH.VAM 61AY HAVE BEEN REDUCED BY PAID CLAIMS. -
MSR ADCL SU_. POUCY EFF PO!ICY-=xP LIMITS
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AND dPLOYER$ LABILITY YIN
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OFIC RIN we= RXG 1JE7+ NIA 5/12/2013 6/iP/90'_G
IVandearyln NH) IESUB44539C63 DI A,E-EAEGFICYEEi 500 C'OC
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DESCRIPTION OF ore=.AnONS eEIO„ I .CL.DISEASE-Prn!cY L!Mlr ; 500 A00
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DESC,MP.IONOFOPERATIONSILOCATIONSIVEHICLaS Ahaeh ACCRD 101, Add tonalRtrarNs Sci:edula, Ifmoro space is reau'red).
RE: Enders :Seacrial Shelter
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CERTIFICATE HOLDER 'CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
j THE EXPIRATION DATE THEREOF, NOTICII WILL BE DELIVERED IN
City Oi Ashland I ACCORDANCE WITH THE POLICY PROVISIONS.
Ashland Parks & Recreation
'AUT'r:ORIiED REPRES-eNTATiW
340 S. Pioneer Street
Ashland, OR 97520 i
C Ch IStens en/BOBB?E Gam-
ACORD 25 (2010105) 01988-2010ACORD CORPOPATION. All rights reserved.
INS025 (zm°csJ.O+ The ACORD name and logo are registered marks of ACORD
/
CITY RECORDER Page 1 1
Ashland Park Commission DATE PO NUMBER
, 10/21/2013 00299
20 E MAIN ST
ASHLAND, OR 97520
(541) 488-5300
VENDOR: 004105 SHIP TO:
ROXY ANN ROCK
PO BOX 4488
MEDFORD, OR 97501
FOB Point: Req. No.:
Terms: net Dept.:
Req. Del. Date: Contact: Bruce Dickens
Special Inst. Confirming? NO
Quantity Unit - Description Unit Price - Ext. Price
Site prep work, demolition, new 21,970.00
utilities at Lithia Park Restrooms
i
Contract for Goods and Services
Beqinninq date: October 21, 2013
Completion date: January 30,-2#fi320J
SUBTOTAL 21 970.00
BILL TO: TAX 0.00
FREIGHT 0.00
TOTAL 21,970.00
Account Number Project Number Amount Account Number Project Number :Amount .
E 411.12.00.00.70420 E 000034.999 21 970.00
Authorized Signature 63 VENDOR COPY
FORM #3 CITY OF
A request for a Purchase Order ASHLAND
REQUISITION Date of request: io f~ /3
Required date for delivery:
Vendor Name flA(-IJ c C.' I We,-, rJ2 RV ) Address, City, State, Zip pt) boo yLli l,1,--%D96 n&
Contact Name & Telephone Number 541 _ &o I _ -7~A- y
Fax Number 5"`f r- 55~- /^6 /
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 Dale 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
❑ Direct Award Date approved by Council: Contract #
❑ VerbaliWritfen 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 and solicitation attached ❑ Form 94, Personal Services $5K to $75K Contract #
PERSONAL SERVICES El Special Procurement Intergovemmental Agreement
$5.000 to $75,000 [1 Form #9, 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/writien solicitation Dale approved by Council: (Date)
❑ Form 44, Personal Services $5K to $75K Valid until: (Date) I
Description of SERVICES Total Cost
Item At Quantity Unit Description of MATERIALS Unit Price Total Cost
TOTAL COST
❑ Per attached quote/p'roppo/saall~ $
Project Number~~3j-'!=i`~1 AccountNumber
AccountNumber'#/ • l_Z-~A-Q~70~2~0 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 requisi ' n form, i certify that the City's public contracting requirements hay bee satisfied.
Employee Signature e 1 04C.,~O Department Head Signature:
(Equal to or greater than $5,000)
City Administrator:
(Equaltoorgreater than$25, 00)
Funds appropriated for current fiscal year. h ES / NO Zr. c Qs^ t 0'/7-z4'43
lV/ Finance Director- (Equal to orgre rthan $5,000) Date
Comments:
Form #3 - Requisition