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HomeMy WebLinkAbout2014-003 Contract - Rogue Valley Heating i Contract for GOODS AND SERVICES Less than $25,000 CITY OF CONTRACTOR: Rogue Valley Heating ASHLAND CONTACT: Eric Armstrong 20 East Main Street Ashland, Oregon 97520 ADDRESS: 2820 Foothill Blvd, Grants Pass, OR 97526 Telephone: 541/488-6002 Fax: 541/488-5311 TELEPHONE: (541)476-3211 DATE AGREEMENT PREPARED: 11/14/2013 FAX: (541)476-2964 BEGINNING DATE: 12/1/2013 COMPLETION DATE: 12/18/2013 COMPENSATION: $6,251.00 GOODS AND SERVICES TO BE PROVIDED: Remove and replace rooftop HVAC system. See proposal for details. 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, 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 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 06/13/2013, 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. J. Time is of the essence for Contractor's performance of each and every obligation and duty under this contract. City by written notice to Contractor of default or breach, may at any time terminate the whole or any part of this contract if Contractor fails to provide services called for by this contract within the time specified herein or in any extension thereof. iii. The rights and remedies of City provided in this subsection (d) are not exclusive and are in addition to any other rights and remedies provided by law or under this contract. e. Obligation/Liability of Parties. Termination or modification of this contract pursuant to subsections a, b, or c above shall be without prejudice to any obligations or liabilities of either party already accrued prior to such termination or modification. However, upon receiving a notice of termination (regardless whether such notice is given pursuant to subsections a, b, c or d of this section, Contractor shall immediately cease all, activities under this contract, unless expressly directed otherwise by City in the notice of termination. Further, upon termination, Contractor shall deliver to City all contract documents, information, works-in-progress and other property that are or would be deliverables had the contract been completed. City shall pay Contractor for work performed prior to the termination date if such work was performed in accordance with the Contract. 10. Independent Contractor Status: Contractor is an independent Contractor and not an employee of the City. Contractor shall have the complete responsibility for the performance of this contract. 11. Non-discrimination Certification: The undersigned certifies that the undersigned Contractor has not discriminated against minority, women or emerging small businesses enterprises in obtaining any required subcontracts. Contractor further certifies that it shall not discriminate in the award of such subcontracts, if any. The Contractor understands and acknowledges that it may be disqualified from bidding on this contract, including but not limited to City discovery of a misrepresentation or sham regarding a subcontract or that the Bidder has violated any requirement of ORS 279A.110 or the administrative rules implementing the Statute. 12. Asbestos Abatement License: If required under ORS 468A.710, Contractor or Subcontractor shall possess an asbestos abatement license. 13. Assignment and Subcontracts: Contractor shall not assign this contract or subcontract any portion of the work without the written consent of City. Any attempted assignment or subcontract without written consent of City shall be void. Contractor shall be fully responsible for the acts or omissions of any assigns or subcontractors and of all persons employed by them, and the approval by City of any assignment or subcontract shall not create any contractual relation between the assignee or subcontractor and City. 14. Use of Recyclable Products: Contractor shall use recyclable products to the maximum extent economically feasible in the performance of the contract work set forth in this document. 15. Default. The Contractor shall be in default of this agreement if Contractor: commits any material breach or default of any covenant, warranty, certification, or obligation it owes under the Contract; if it loses its QRF status pursuant to the QRF Rules or loses any license, certificate or certification that is required to perform the work or to qualify as a QRF if Contractor has qualified as a QRF for this agreement; institutes an action for relief in bankruptcy or has instituted against it an action for insolvency, makes a general assignment for the benefit of creditors; or ceases doing business on a regular basis of the type identified in its obligations under the Contract; or attempts to assign rights in, or delegate duties under, the Contract. 16. Insurance. Contractor shall at its own expense provide the following insurance: a. Worker's Compensation insurance in compliance with ORS 656.017, which requires subject employers to provide Oregon workers' compensation coverage for all their subject workers b. General Liability insurance with a combined single limit, or the equivalent, of not less than Enter one: $200,000, $500,000, $1,000,000, $2,000,000 or Not Applicable for each occurrence for Bodily Injury and Property Damage. It shall include contractual liability coverage for the indemnity provided under this contract. C. Automobile Liability insurance with a combined single limit, or the equivalent, of not less than Enter one: $200,000, $500,000, $1,000,000, or Not Applicable for each accident for Bodily Injury and Property Damage, including coverage for owned, hired or non-owned vehicles, as applicable. d. Notice of cancellation or change. There shall be no cancellation, material change, reduction of limits or 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 06/13/2013, 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. 17.1 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. Nona ppropriations 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 (AU~ - Signature Department Head Print Name Print Name Title Date W-9 One copy of a W-9 is to be submitted with ~l D h the signed contract. Purchase Order No. d~ I n Contract for Goods and Services Less than $25,000, Revised 06/13/2013, Page 3 of 5 i 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. l~ (3) Telephone listing is used for the business separate from the personal residence listing. C (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. Co ractor (Date) Contract for Goods and Services Less than $25,000, Revised 06/13/2013, Page 4 of 5 OGUE HVAC BID-PROPOSAL fI'MALLEY • Heating & Air Conditioning 2820 Foothill Blvd. Grants Pass, OR 97526 turn t0 the expertSo 541-476-3211, 541-779-8333 Fax 541-476-2964 CCB 114839 DATE PROPOSAL NO. www.roquevall6yheat-air.com 11/5/13 COA008 OWNERMUYER NAME OWNER'S City of Ashland 20 E. Main Street OWNER'S CITY, STATE 8 POSTAL CODE OWNER'S HOME PHONE OWNER'S WORK PHONE Ashland OR 97520 541-552-2292 PROJECT NAME I PROJECT ADDRESS Heat Pump replacement 403 Dead Indian Memorial Rd PROJECT CITY. STATE 8 POSTAL CODE PROJECT PHONE FAX Ashland Or. 97520 CONSTRUCTION TO BEGIN CONrRACT COMPLETION DATE DATE OF PLANS ESTIMATOR Rick We hereby propose to furnish the following work: Remove and dispose of existing heat pump. Provide and install a new Puron heat pump by Carrier including an adapter curb. We will reconnect to existing line and low voltage electrical, condensate drain, and duct system A crane will be used for rigging the old unit off, and the new unit in place. Includes complete equipment startup and operational check Equipment: Carrier model 50EZA48-3 with 10 kw strip heater and 0-25%,OSA damper, compressor hard start kit and 240v compressor crankcase heater J ~ Cost: $5,995.00 Option: Replace existing thermostat with a new Carrier commercial thermostat model 33CS2PP2S-03 Cost:$256.00 1 t~ U i PROPOSED PAYMENT: Owner agrees to pay Contractor a PROPOSED total cash price of $ f3 251 00 Dollars. OWNER represents that this agreement is a cash transaction wherein no financing is contemplated and contractor acts in reliance on said representation. THE PAYMENT SCHEDULE WILL BE AS FOLLOWS: 1. Down payment of $ 2. Payment schedule as follows: In full upon comoletion 3/2013 2: S8 :11 L'M h'bI (tr I -cl emI lvv.. ® ►i a' CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) L 512 AI?n 13 FHIS 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 :he terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the zertificate holder in lieu of such endorsement(s). ODUCER Beecher 911 Tennyson Ave. ,u Nancy, ncy, LLC PHONE NT(AAC ACT N.NAME: (EjI a ake No), 54 1 -?94 -3196 Eugene, OR 97408 E-MAIL ADDRESS: u8 noa~e2@beechercarlson.com INSURERS AFFORDING COVERAGE NAIC k / W.beechercadson.com INSURER A: Amer'cao Hallmark Ins (-.o of IeAas 43424 'URED INSURER B Roggue Valley Heating-& Air Conditioning Co. uvsuRERC: ?820 Foothill Blvd. Grants Pass OR 97526 - INSURER D: INSURERS INSURE0. F OVERAGES CERTIFICATE NUMBER: 16490165 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. 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 POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL TIE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. R ADOL SUBR POLICYEFF POLICY EXP LIMITS R TYPE OF INSURANCE INSR MD POLICY NUMBER MMMDIYYYY MM/e01YYYY GENERALLIABILITY J J 44CL465175 7/1/2013 7/1/2014 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 100,000 J COMMERCIAL GENERAL LABILITY PREMISES Ea ocartrence $MED EXP(Any one Person) $1 5'000 CLAIMsMADE OCCUR PERSONAL&ADV INJURY $ 1,000000 GENERAL AGGREGATE $ 2,000000 PRODUCTS-COMPIOP AGO E' 2,000,000 GEN'L AGGREGATE LIMB APPLIES PER POLICY J PRO LOC $ i F-] 44CL465175 7/1/2013 7/112014 COM(EaBINED SINGLE LIMIT AUTOMOBILE LIABILITY accltlenp E 1,O00,000 BODILY INJURY (Per person) A § J ALL AUTO OWNED e SCHEDULED BODILY INJURY (Par accident) $ AUTOS S AUTOS PROPERT AUTOSNON-OWNED Per acatlenq § J HIRED At TITS Y DAMAGE J 5 8 UMBRELLA LIAR J OCCUR EACH OCCURRENCE E 1,000,000 J 44CU465176 7/1/2013. 7/1/2014 EXCESS LIAR GLAIMS-MADE AGGREGATE 1,000000 OEO J RETENTION$ 10,000 8 b g WC STATU- H. AND . WORKERS COMPENSATION TORY LIMITS E AND EMPLOYERS' LIABILITY TNEFU YIN E.L. EACHACCIDENT $ ANVPROPRIETORIPARTNDED? CUTNE❑ N/A . OFFICE or, in N NHER EXCLUDED] E. L. DISEASE -EA EMPLOYEE E IMantlalory in ) II yas, dasua undeE.L. DISEASE - POLICY LIMIT $ DESCRIPTIO bN OF 0'P ERATIONS Bebw ESCRIPTION OF OPERATIONS !LOCATIONS! VEHICLES (AIIOCM1 AC ORD 101, Additional Remarke Schedule, it more epace le mpulmtl) ;eneral Liability Policy provides Additional Insured on a Primary and Non Contributory basis per the attached MP9767 10/10 endorsement ;eneral Liability policy also provides Waiver of Subrogation per the attached MP9767 16/10 endorsement. -his form is subject to policy terms, conditions and exclusions. :ERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 90 N Mountain Ave. ACCORDANCE WITH THE POLICY PROVISIONS. Ashland OR 97520 AUTHORIZED REPRESENTATIVE EUG Sue Noakes © 1988-2010 ACORD CORPORATION. All rights reserved. %CORD 25 (2010105) The ACORD name and logo are registered marks of ACORD 11 NO.: 16490,65 (EUG) Sue Noakes 5/2a/2013 2:57:11 PN Page L of 6 /2011 9:2'.i:Lb AN Yb;1' (.111 n cr~v.. i~..~ „ DATE (Mm/DDrryrrl a -j® CERTIFICATE OF LIABILITY INSURANCE 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 endorsements . RODUCER Beecher Carlson Insurance Agency, LLC CONTACT NAME: EU Jer I Colernao 2911 Tenn-,son Ave., Suite 304 _ PHONE 1. - -30 ac No : - - Eugene, OR 97408 E-MAIL ADDRESS: LOIE an corn INSURER 5 AFFORDING COVERAGE NAIC M W W.bee Chercarts On.LOm OISURER A : 5 . 2412 ISURED INSURER B ROgue'Valley Heating & Air Conditioning Co. INSURER C: 2820 Foothill Blvd. Grants Pass OR 97526 INSURERO: INSURERE: INSURERF: :OVERAGES CERTIFICATE NUMBER: 17514664 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. 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 POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.- ISR ADUL SURR POLICY NUMBER POLICYIEFF MMIDUYIYYYY TR LIMITS TYPE OF INSURANCE INSR MD GENERALLIABIUTY J J EA 3 TORENTE NTER $ P REM MA G ED ' PREMISES (En ocnarance $ COMMERCIAL GENERAL LIABILITY EXP CIAIMS-MADE O OCCUR MED (Anyone person) $ PERSON ALB ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGE $ GEN'L AGGREGATE LI MR APPLIES PER: ' POLICY PRO LOC ~ E $ (EenalccNdenISINGL LIMIT $ AUTOMOBILE LIABILITY BODILY INJURY (Per person) $ ANY AUTO $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) AIITOS AUTOS PROPERTY AMAGE NON-OWNED - Pe,.catlenl $ HIRED AlIT05 AUTOS $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMSMADE AGGREGATE $ g DED RETENTIONS $ WORKERS COMPENSATION 520190 10/1/2013 101112014 J TORY LIIMITS. ER _ A AND EMPLOYERS' DAWLITY Y I N ANY PROPRIETOMPARTNERIEXECUTIVE E.L. EACH ACCIDENT $ 1 000,000 E.L. DISEASE . EA EMPLOYEE S 1 000 000 OFFICERIMEMBER EXCLUDED? N I A (Mantlamry in NH) If yes, d_a ,Id. under E.L. DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS heb. DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IAlbch ACORD 101, Addillorlal Remarks Sehedula, if mom space Is requiretl) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland _ THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 90 N )Mountain Ave. ACCORDANCE WITH THE POLICY PROVISIONS. Ashland OR 97520 n^ AUTHORIZED REPRESENTATIVE EUG.Je (Coleman O 1988-2010 ACORD CORPORATION. It rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD CRT Nn.: 1]510a" MUG) deryL c,le- 9/3/2011 9:2-':15 .V1 Page 1 of 1 BATE IMMmon'rn') A CERTIFICATE OF LIABILITY INSURANCE 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 Beecher Carlson Insurance Agency, LLC CONTACT NAME: (EUM I in 2911 Tenn son Ave., Suite 304 PHONE 1 N Extl~ 541-284-31)82 ° AIL No : 2- Eugene, OK 97408 EMAIL ADDRESS: INSURERS AFFORDING COVERAGE NAICN NNJVJ.beechercarlson.COm INSURERA: AI 2 INSURED INSURER B Rogue Valley Heating & Air Conditioning Co. INSURERS: 2820 Foothill Blvd. Grants Pass OR 97526 INSURER D: ' INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: 17661223 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. 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 POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADDL SUER POLICYEFF POLICY EXP LIMITS INSR LTR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY MWDDA` Y _bm GENERAL LIABILITY EACH OCCURRENCE $ - DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Eaccainence S CLAIMS-MADE OCCUR MED EXP (Any one person) $ PERSONAL B ADV INJURY S GENERAL AGGREGATE S' GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ s C POLICY PRO- LOC - ESM itlent51NGLE LIMIT f AUTOMOBILE LIABILITY BODILY INJURY (Per person) f ANY AUTO A OMED SCHEDULED BODILY INJURY (Per acdtlent) f DAMAGE AUTOS S B AUTOS PROPE ciRTYdent $ NON-0WNED Per ac HIRED AUTOS AUTOS S Y UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE 3 DED 11 RETENTIONS f ' f WORKERS COMPENSATION 620190 10f1/2012 10/1/2013 TORY LAMITS OER A AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1000000 OFFICERIMEMBER EXCLUDED? N/A EL DISEASE:EA EMPLOYEE f 1000000 (Mandatory in NH) Ifyes, describe under E. L. DISEASEPOLICY LIMIT. $ 1,000,00 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (At .h ACORD 101, Additional Remarks Schedule, if more space Is required) CERTIFICATE HOLDCANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 90 N Mountain ACCORDANCE WITH THE POLICY PROVISIONS. Ashland OR 9752n^ AUTHORIZED REPRESENTATIVE 4ti~ EUG Je I Coleman ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD CERT NO.: 17661223 (EOG) Jeryl Colman 9/17/2013 3:09:26 PM Page 1 of 1 3/2013 2:58:17 Ph1 PST (GMT-U) exuh: 1 uuuD rU: 1: eleno ARTISANS ADVANTAGE ENHANCED COVERAGE ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUILDING AND PERSONAL PROPERTY COVERAGE FORM CAUSES OF LOSS - SPECIAL FORM COMMERCIAL PROPERTY CONDITIONS COMMERCIAL GENERAL LIABILITY COVERAGE FORM When this endorsement is attached to the policy, insurance under the Building and Personal Property Coverage Form, the Causes of Loss- Special Form, the Commercial Property Conditions and the-Commercial General Liability Coverage Form is enhanced to provide the coverages described in this endorsement. All other conditions of the policy continue to apply. This coverage is subject to the provisions applicable to the Building and Personal Property Coverage Form, Causes of Loss- Special Form, the Commercial Property Conditions and the General Liability Coverage Form. SCHEDULE Coverage Enhancements Limits of Insurance Each Location Property Coverage Premises Boundary 1,000 feet Property Coverage Extensions - Newly Acquired or Constructed Property Buildings $500,000. at Each Building Business Personal Property $250,000. at Each Building Personal Effects and Property of Others $ 25,000. at Replacement Cost Valuable Papers and Records (Other than Electronic Data) $ 25,000. Property Off-Premises (Including Laptops and Other Electronic Equipment) $/15,000. per tree/shrub, max, limit $25,000. Outdoor Property (Named Perils) Non-Owned Detached Trailers $ 10,000. Accounts Receivable $ 50,000. Property in Transit (Including Laptops and Other Electronic Equipment) $ 15,000. Fine Arts $ 25,000. Property Additional Coverages $ 25,000. Debris Removal $ 5,000. Fire Department Service Charge Pollutant Clean-up and Removal $ 15,000. Electronic Data $ 25,000. Interruption of Computer Operations $ 15,000. Arson Reward $ 5,000. Water Back-Up and Sump Overflow $ 25,000. Brands and Labels $ 25,000. Employee Theft $ 10,000. Business Income Including Extra Expense. $ 25,000. Business Income from Dependent Properties $ 10,000. Claims Expenses $ 10,000. Inventory or Appraisal Cost $ 5,000. Money and Securities $ 10,000. Inside Outside $ 5,000. Off Premises Power Failure - Direct Damage $ 10,000. Ordinance or Law Coverage Coverage A Included within Building Limit. Coverages B and C Combined 25% of Bldg. Limit, $150,000. maximum Outdoor Signs $ 10,000. Recharging of Fire Extinguishers $ 5,000. Unauthorized Business Card Use $ 5,000. Forgery or Alteration $ 10,000. Salespersons Samples $ 2,500. material of Insurance Services Office, Inc, and 9e MP 97 67 10 10 Includes copyrighted Pa 1 of 25 American Association of Insurance Services, Inc., with their permission fiS NQ.: 16490165 (EUGI Sue Noakes 5/20/2013 2:51:11 FM Page 2 of 6 3/2013 2:58:.17 PM PST (GI'IT-8) FROM: iUU1UO tv: i~xlxoo✓ocv _ Inland Marine Coverages $ 10,000. Installation Coverage Contractors Equipment Coverages: Small Tools $ 5,000. (Maximum limit per item $1,000) Employee Small Tools $ 1,000. (Maximum limit per item $250) Leased and Rented Equipment 5,000. Rental Reimbursement $ 1,000. General Liability Additional Coverages I Blanket Additional Insured (Including Primary Non-Contributing Coverage) Included in Each Occurrence Limit Mobile Equipment Broadened Coverage Included in Each Occurrence Limit . Aggregate Limit Per Project Included in Each Occurrence Limit Blanket Waiver -Mcluded in Each Occurrence Limit Voluntary Property Damage Coverage $ 2,500. The following applies to coverages under this endorsement only.. Property Coverage The phrase 'within 100 feet of the described premises' used in Paragraphs a.(5)(b), b. and c.(2) under A.1. Covered Property of the BUILDING AND PERSONAL PROPERTY COVERAGE FORM and Paragraph 2.c.(1) under C. Limitations of the CAUSES OF LOSS - SPECIAL FORM is replaced by the phrase 'within 1,000 feet of the described premises'. 1 Property Coverage Extensions Paragraph A.5. Coverage Extensions of the BUILDING AND PERSONAL PROPERTY COVERAGE FORM is deleted in its entirety and replaced by the following: 5. Coverage Extensions Except as otherwise provided, the following Extensions apply to property located in or on the building described in the Declarations or in the open (or in a vehicle) within 1,000 feet of the described premises. If a Coinsurance percentage of 80% or more or, a Value Reporting period symbol, is shown in the Declarations, you may extend the insurance provided by this Coverage Part as follows: a. Newly Acquired Or Constructed Property (1) Buildings If this policy covers Building, you may extend that insurance to apply to: (a) Your new buildings while being built on the described premises; and (b) Buildings you acquire at locations, other than the described premises, intended for: (i) Similar use as the building described in the Declarations; or (it) Use as a warehouse. The most we will pay for loss or damage under this Extension is $500,000 at each building. (2) Your Business Personal Property (a) If this policy covers Your Business Personal Property, you may extend that insurance to apply to: (i) Business personal property, including such propertythat you newly acquire, at any location you acquire, at any location you acquire other than at fairs, trade shows or exhibitions; (ii) Business personal property, including such property that you newly acquire, located at your newly constructed or acquired buildings at the location described in the Declarations; or (iii) Business personal property that you newly acquire, located at the described premises. The most we will pay for loss or damage under this Extension is $250,000 at each building. (b) This Extension does not apply to: Page 2 of 25 Includes copyrighted material of Insurance Services Office, Inc. and MP 97 67 10,10 American Association of Insurance Services, Inc., with their permission 3ei n0.'. 16490165 IEUGI Sue Noakes 5/=0/=013 2:5%:11 111 rage 3 or 6 ?/2013 2:58:17 FM PST (GMT-6) FROM: 100005 TU: 1a4i4mbD SGu _ _•-n (5) Vandalism and malicious mischief; or (6) Theft. c. The following is added to A.2. Property Not Covered of the BUILDING AND PERSONAL PROPERTY COVERAGE FORM: r. Property while stored or operated underground in connection with any mining operations. d. The following is added to Paragraph 2. of B. Exclusions of the CAUSES OF LOSS - SPECIAL FORM: n, We will not pay for loss or damage caused by puncture, blowout and road damage to tires and tubes mounted on vehicles. However, we do pay for puncture, blowout or road damage caused by a specified peril. o. We will not pay for loss caused by humidity, dampness, dryness or changes in or extremes of temperature. p. We will not pay for loss caused by the weight of a load which, under the operating conditions at the time of a loss, exceeds the registered lifting capacity of any equipment or machine. q. We will not pay for loss due to theft or mysterious disappearance from any vehicle or attached container. We will pay for loss due to burglary when there are signs of forcible entry to a locked vehicle or container, e. E.7. Valuation of the BUILDING AND PERSONAL PROPERTY COVERAGE FORM is deleted and replaced bythe following: 7. Valuation We will determine the value of covered property in the event of loss or damage as follows: a. At actual cash value at the time of the loss (with a deduction for depreciation) except as provided in Paragraphs b. and c. following. b. Pair or Set. The value of a lost or damaged article which is part of a pair or set is based on a reasonable proportion of the value of the entire pair or set. The loss is not considered a total loss of the pair or set. , c. Loss to Parts. The value of a lost or damaged part of an item that consists of several parts when it is complete is based on the value of only the lost or damaged part or the cost to repair or replace it. 2. Rental Reimbursement In the event of loss by a covered peril to covered contractors' equipment that you own, we will reimburse you for your expense to rent similar equipment while your equipment is inoperable. The.most we will reimburse you for rental reimbursement expenses is $1,000. We will continue to reimburse you for the rental of equipment after the expiration date of this coverage provided the loss occurred before the expiration date. We will not reimburse you: a. If you can continue or resume your operations with similar equipment that is available to you at no additional expense to you; or b. For the rental expense of any equipment unless you make every reasonable effort to repair, replace or rebuild the inoperable equipment after the covered loss occurs. 3. With respect to this Additional Coverage, Contractors Equipment Coverage, Section D. Deductible of the BUILDING AND PERSONAL PROPERTY COVERAGE FORM is deleted and replaced by the following: D. Deductible We will not pay for loss or damage in anyone occurrence until the amount of loss or damage exceeds $500. We will then pay the amount of loss or damage in excess of $500 up to the applicable limit of insurance. We will not reimburse you for the rental of equipment until after 72 hours have passed since the covered property was rendered inoperable. After 72 hours have passed, we will only reimburse you for the rental expense that you actually incur. The deductible of $500 does not apply to rental reimbursement expenses. General Liability Additional Coverages The following Additional Coverages are added to the COMMERCIAL GENERAL LIABILITY COVERAGE FORM. A. Blanket Additional Insured Coverage 1. SECTION II -WHO IS'AN INSURED of the COMMERCIAL GENERAL LIABILITY COVERAGE FORM is amended to include as an insured any person or organization (referred to as Additional Insured) whom you are required to add as an Additional Insured on this policy under: a. A written contract or agreement; and b. Where a certificate of insurance showing that person or organization as an additional insured has been issued; and Page 20 of 25 Includes copyrighted material of Insurance Services Office, Inc. and MP 97 67 10 10 American Association of Insurance Services, Inc., with their permission sr NO.'. 1o4901E5 (EVG) Sve N"ke5 5/30/2013 ~.57:11 PN vage 4 of 5 8/2013 2:58:17 PM PST (GMT-8) FROM: 100005 '1'O: 1S9i4db1 U •^7 c. When the written contract or agreement and certificate of insurance are currently in effect or becoming in effect during the term of the policy and executed prior to the "bodily injury," "property damage," or'"personal and advertising injury." 2. The insurance provided to the Additional Insured is limited as follows: a. The Additional Insured is only an additional insured for: (1) "Bodily injury," "property damage," or "personal and advertising injury" caused in whole or in part by negligent acts or omissions of the Named Insured or anyone directly or indirectly employed bythe Named Insured orfor whose acts a Named Insured may be liable. (2) Liability arising out of your ongoing operations for the Additional Insured by or for you. A person's or organization's status as an insured under this coverage ends. when your operations for that insured are completed. b. The Limits of Insurance applicable to the Additional Insured are those specified in the written contract or agreement but not more than the Limits of Insurance specified in the Declarations for this policy. The Limits of Insurance applicable to the Additional Insured are inclusive of and not in addition to the Limits of Insurance shown in the Declarations for the Named Insured. 3. In addition to the other exclusions applicable to Section I, Coverages A., B. and C. of the COMMERCIAL GENERAL LIABILITY COVERAGE FORM, the insurance provided to the Additional Insured does not apply to: a. "Property damage" to: (1) Property owned, used, occupied by, loaned or rented to the Additional Insured; (2) Property in the care, custody or control of the Additional Insured or over which the Additional Insured are for any purpose exercising physical control; or (3) "Your work" performed for the Additional Insured, b. "Bodily injury," "property damage," or "personal and advertising injury" arising out of an architect's, engineer's or surveyor's rendering or failure to render any professional services for you, for the Additional Insured or for others, including, but not limited to: (1) The preparing, approving or failure to prepare or approve maps, drawings, opinions, reports, surveys, change orders, designs or specifications; or (2) Supervisory, inspection or engineering services. c. "Bodily injury" or "property damage" occurring after: (1) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by ar on behalf of the additional insured at the site of the covered operations has been completed; or (2) That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. 4. - SECTION IV -COMMERCIAL GENERAL LIABILITY CONDITIONS, Paragraph 4. Other Insurance, is amended to add the following subparagraph: d. Additional Insured's Other Insurance As Excess Insurance To the extent required by an "insured contract," this insurance is primaryon behalf of the Additional Insured; and any other insurance maintained by the Additional Insured is excess and not contributory with this insurance' If the "insured contract" does not require this provision, then Paragraph a. above will apply. B. Mobile Equipment Broadened Coverage V.12J.(1) of the COMMERCIAL GENERAL LIABILITY COVERAGE FORM is replaced by the following: (1) Equipment designed primarily for: (a) Snow Removal; (b) Road maintenance, but not construction or resurfacing; or (c) Streetcleaning. Except the above provisions do not apply to self-propelled vehicles of less than 1,000 pounds gross vehicle weight which are not intended for use on a highway. C. Aggregate Limit Per Project - The General Aggregate Limit under SECTION III - LIMITS OF INSURANCE of the COMMERCIAL GENERAL LIABILITY COVERAGE FORM applies separately to each of your projects away from premises owned by or rented to you. MP 97 67 10 10 Includes copyrighted material of Insurance Services Office, Inc. and Page 21 of 25 American Association of Insurance Services, Inc., with their permission SFT NG.: 16430L65 IEUGI Sue Noakes 5/2e/2C13 2:57:11 Fn Fi9e 5 Of 6 ;/2013 2:58:17 PM PST (GMT-8) FROM: lUUUU.) '1'V: LJYlvoao cv _ D. Blanket Waiver Of Transfer Of Rights Of Recovery Against Others To Us The Transfer Of Rights Of Recovery Against Others To Us Condition (SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of the following: We waive any right of recovery we may have against any person or organization to whom you by written contract or written agreement have waived your own right or recovery for loss caused by that person or organization because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a written contract or written agreement with that person or organization and included in the "products-completed operations hazard." I This provision does not apply unless the written contract or written agreement has been executed prior to the ',Occurrence" or offense giving rise to the "bodily injury" or "property damage." E. Voluntary Property Damage Coverage 1. We will, at your request, pay but not defend any claim for "property damage" to the propertyof others otherwise excluded under A.2.j.(4), (5) and (6) of the COMMERCIAL GENERAL LIABILITY COVERAGE FORM provided that; a. Such "property damage" takes place while such property is in your care, custody or control, or is property of others over which you, for any purpose, are exercising or have exercised physical control; and b. Such "property damage" takes place away from any premises you own, rent or lease; and c. Such "property damage" takes place within the "coverage territory" and during the policy term; and d. Such "property damage" takes place only during your operations that are known to us, are scheduled on the policy and for which a premium has been charged. 2. The insurance under this additional coverage does not apply to "property damage" to property: a. Held by you for servicing, repair, storage or sale at premises owned by, rented or leased to you; b. While being transported by or caused bythe ownership, maintenance, operation, use, "loading or unloading" of any "auto," watercraft or aircraft; or c. Owned or occupied by or rented to you. 3. Deductible This additional coverage will apply only to that amount of any loss in each "occurrence" that exceeds $500. The terms of the policy with respect to your duties in the event of "occurrence," claim or "suit' and the Companys rightto investigate, negotiate and settle any claim or "suit" apply irrespective of the application of the deductible amount of $500. We may pay any part or all of the deductible amount of $500 to effect settlement of any claim or "suit." Upon notification of the action taken, you must promptly reimburse us for such part of the deductible amount as has been paid by us. 4. Limits of Liability The Limit of Liability for this additional coverage shall not exceed $2,500 for each "occurrence" and is the limit of the Company's liability for all damages on account of each claim or "suit" covered herein. The annual aggregate Limit of Liability is $2,500 and is, subject to the above provisions respecting each claim, the total limit of the Company's liability for all damages. 5. Settlement In the event of loss covered bythis additional coverage, you shall, if requested by us, replace the property or furnish the labor and materials necessaryfor repairs thereto at actual cost to you, excluding prospective profit or overhead charges , of any nature. Any property so paid for or replaced shall, at our option, become the property of the Company. Payment hereunder shall not constitute an admission of liability of you or, except as stated herein, of the Company. Additional Conditions A. Insurance Under Two Or More Coverages The following is added to Paragraph C. Insurance under Two or More Coverages of the COMMERCIAL PROPERTY _ CONDITIONS: If a Coverage Form is attached to this policy that provides a limit for any coverage provided by this endorsement; the limit shown in the SCHEDULE and the coverage provided by this endorsement are deleted and replaced by the limit and coverage provided by the Coverage Form. B. Limits Of Insurance Regardless of the number of buildings at a location covered by this endorsement, the most we will pay under this Coverage Enhancement endorsement in any one occurrence is the applicable Limits of Insurance shown in the SCHEDULE on page 1 of this endorsement. I Page 22 of 25 Includes copyrighted material of Insurance Services Office, Inc. and MP 97 67 10 10 American Association of Insurance Services, Inc., with their permission ,RT NO.: 16490165 IEUG1 Sue Noakes 5128/2013 Pn Page 6 of 6 I QI1 T RECORDER ~ Page 1 / 1 CITY OF ASHLAND DATE _ PO NUMBER 20 E MAIN ST. 1/9/2014 12042 ASHLAND, OR 97520 (541) 488-5300 VENDOR: 001239 SNIP TO: Ashland Building Maintenance ROGUE VALLEY HEATING & AIR (541) 488-5358 2820 FOOTHILL BLVD 90 N MOUNTAIN AVENUE GRANTS PASS, OR 97526 ASHLAND, OR 97520 FOB Point: Req. No.: Terms: Net Dept.: Req. Del. Date: Contact: Dale Peters Special Inst: Confirming? No Quanti : Unit Description Unit Price 'r Ext. Price Remove and replace rooftop HVAC system 6,251.00 at Ashland Airport. Contract for Goods and Services Beqinninq date: 12/01/2013 Completion date: 12/18/2013 SUBTOTAL 6 251.00 BILL TO: Account Payable TAX 0.00 20 EAST MAIN ST, FREIGHT 0.00 541-552-2010 TOTAL 6,251.00 ASHLAND, OR 97520 Account Number. Project Number Amount Account Number. ProjectNumber - .-Amount E 410.08.24.00.70420 E 000105.999 6,25-1.0- 0 Q y(~ 1/ILG~t Auth Zed Signature VENDORCOPY FORM'#3 c I T ;v OF A request for a Purchase Order 1"~S H LAN D REQUISITION Date of request: '14NOV 13 Required date for delivery: _ Vendor Name Real IF VAS I Ey HEATING Address, City, State, Zip 2820 FOOTHU I BI Vn Contact Name & Telephone Number Fax Number GRANTS PASS. OR 97526 541 779 8333 FAX 541 476 2964 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 H 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/Wmten quote(s) or proposal(s) ❑ State of Washington Intermediate Procurement DD Contract # GOODS & SERVICES Applicable Form (#5,6, 7 or 8) El Other government agency contract 5 0 "to 100 0 eiv4e- nt a uote or proposal attached Agency (3) Written quotes d solicitation ached ❑ Form #4, Personal Services $5K to $75K Contract # rPERSONAL SERVICES ❑ Special Procurement Intergovernmental Agreement $5.000 to $75.000 ❑ Form #9, Request for Approval ❑ Agency ❑ Less than $35,000, by direct appointment ❑ Written quote or proposal attached Date original contract approved by Council: ❑ (3) Written proposals/written solicitation Date approved by Council: (Date) ❑ Form #4, Personal Services $5K to $75K Valid until: Date Description of SERVICES Total Cost 1Z) aqua /W-a 7gnc /P f'><09 GYSTAFm SSE -~32o 4S'AL- FO20"~7'fig2z-s $ 6251.00 Item # Quantity Unit Description of MATERIALS Unit Price Total Cost L'~ ~j O~ /~i✓ 6 y~ F1 Per attached quote/proposal $TOTAL COST Project Number B~~jO Account NumberyID - bB~ -OD- DY?oo Account Number Account Number 'Expenditure must be charged to the appropriate account numbers for the financials to accurately reflect the actual expenditures. IT Director in collaboration with department to approve all hardware and software purchases: IT Director Date Support -Yes /No By signing this requisition form i that the City's public contracting requirements have been satisfied. Employee Department Head: UIJQL r2 (Equal to or greater than $5,_000) Department Manager/Supervisor: City Administrator: I (Equaltoorgreaterthan$25,00 ) Funds appropriated for current fiscal year., YE / NO U Finance Director- (Equaltoorgaterthan$5,000) Date Comments: - i . Form #3 - Requisition