HomeMy WebLinkAbout2014-018 Contract - Bartlett Tree Service
Contract for GOODS AND SERVICES Less than $25,0001
CITY OF CONTRACTOR: Bartlett Tree Service
ASHLAND CONTACT: Mike Bartlett
20 East Main Street
Ashland, Oregon 97520 ADDRESS: 2288 Old Stage Road, Central Point, OR 97502
Telephone: 541/488-6002
Fax: 541/488-5311 TELEPHONE: 541-779-6067, 541-601-678
DATE AGREEMENT PREPARED: January 31, 2014 FAX:
BEGINNING DATE: January 31, 2014 COMPLETION DATE: February 28, 2014
COMPENSATION: $2,350.00 per bid attached as Exhibit C.
GOODS AND SERVICES TO BE PROVIDED: Tree pruning, clean-up and removing mistletoe per ITB
attached as Exhibit D. Site location: Oak Knoll Golf Course
ADDITIONAL TERMS: 1
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. 1
2. Qualified Work: Contractor has represented, and by entering into this contract now represents, that any personnel
assigned to the work required under this contract are fully qualified to perform the work to which they will be assigned
in a skilled and worker-like manner and, if required to be registered, licensed or bonded by the State of Oregon, are
so registered, licensed and bonded. Contractor must also maintain a current City business license)
3. Completion Date: Contractor shall provide all goods in accordance with the standards and specifications, no later
than the date indicated above and start performing the work under this contract by the beginning date indicated
above and complete the work by the completion date indicated above.
4. Compensation: City shall pay Contractor for the specified goods and for any work performed, including costs and
expenses, the sum specified above. Payments shall be made within 30 days of the date of the invoice. Should the
contract be prematurely terminated, payments will be made for work completed and accepted to date of termination.
Compensation under this contract, including all costs and expenses of Contractor, is limited to $25,000.00, unless a
separate written contract is entered into by the City.
5. Ownership of Documents: All documents prepared by Contractor pursuant to this contract shall be the property of
City.
6. Statutory Requirements: ORS 2796.220, 2796.225, 279B.230, 2796.235, 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.
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 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. i
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. 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 r~-
Department Head
Signature
T-7 of-7-
Print Name Print Name
Title Date
W-9 One copy of a W-9 is to be submitted with
the signed contract. Purchase Order No.
Contract for Goods and Services Less than $25,000, Revised 06/1312013, Page 3 of 5
EXHIBIT A
CERTIFICATIONS/REPRESENTATIONS: Contractor, under penalty of perjury, certifies that (a) the
number shown on the attached W-9 form is its correct taxpayer ID (or is waiting for the, number to be
issued to it and (b) Contractor is not subject to backup withholding because (i) it is exempt from
backup withholding or (ii) it has not been notified by the Internal Revenue Service (IRS) that it is
subject to backup withholding as a result of a failure to report all interest or dividends, or (iii) the IRS
has notified it that it is no longer subject to backup withholding. Contractor further represents and
warrants to City that (a) it has the power and authority to enter into and perform the work, (b) the
Contract, when executed and delivered, shall be a valid and binding obligation of Contractor
enforceable in accordance with its terms, (c) the work under the Contract shall be performed in
accordance with the highest professional standards, and (d) Contractor is qualified, professionally
competent and duly licensed to perform the work. Contractor also certifies under penalty of perjury
that its business is not in violation of any Oregon tax laws, and it is a corporation authorized to act on
behalf of the entity designated above and authorized to do business in Oregon or is an independent
Contractor as defined in the contract documents, and has checked four or more of the following
criteria:
(1) 1 carry out the labor or services at a location separate from my residence or is in a
,S~ecific 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.
y (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
of
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.
- 2S/Zri
Contractor (Date)
Contract for Goods and Services Less than $25,000, Revised 06/13/2013, Page 4 of 5
"Leaf it to us"
BARnETT (541) 779-6067 or(541)601-6780
TREE SERVICE LLC Certified Arborists on staff
Licensed • Bonded • Insured J
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Client Signature
Ashland Parks and Recreation Department
340 So. Pioneer St.
Ashland, OR. 97520
Phone (541) 488-5340
Fax (541).488-5314
PRICE QUOTATION
SPECIFICATIONS & PROPOSAL FORM
for
OAK KNOLL GOLF COURSE TREE PRUNING
2014
Instruction to Vendors Pg. 2-3
Specifications Pg. 4-6
Sample Price Quotation Form Pg. 6-7
Tree List
E. Proposal Acceptance or Resection
The Ashland Parks and Recreation Department reserves the right to accept or reject
any or all proposals deemed in its best interest. Without limiting the generality of the
foregoing, any proposal which is incomplete, obscure, or irregular may be rejected.
The acceptance of the proposal will be a notice in writing signed by a duly authorized
representative of the Department. The acceptance of the proposal shall bind the
successful vendor to execute a contract and to be responsible for liquidated damages
as provided or execution of contract and damages for failure to execute.
The rights and obligations provided for in the contract shall become effective and upon
the parties only within its formal execution by the Department Director or his delegated
representative.
F. Time Frame
The vendor shall commence the work after receiving a notice to proceed, and shall
complete the Oak Knoll work no later than February 28, 2014. The vendor shall be
accessed $75.00 per day for work not completed by the deadlines, until the entire
project is accomplished.
The completion date will be extended for those days deemed unsafe to work due to
adverse weather conditions. This decision must be agreed upon between the
Contractor and Park Horticulturist, and decided by Friday at the end of each week.
Notice will be by telephone and then by mail.
G. References and Qualifications
The vendor is.required to submit proof of International Society of Arboriculture
certification.
The vendor is required to submit a city business license from the City of Ashland.
The vendor is required to submit proof of auto insurance.
All vendors who have not previously performed pruning work for Ashland Parks & Rec.
Dept. shall submit a minimum of three (3) references from previous work performed
within the last two (2) years in the Medford-Ashland area.
Additionally, all vendors who have not previously performed pruning work for Ashland
Parks & Rec. Dept. shall submit a.list containing a minimum of three (3) former job sites
where work was performed within the last two (2) years within the Medford-Ashland area
that can be visually inspected by the Department.
Both the reference list and work list shall be attached to the proposal at the time it is
submitted.
PROPOSAL AND SPECIFICATIONS PAGE 3
Tree Pruning in Lithia Park 12/16/2013
Contractor's Insurance and Indemnity
All persons performing work must be covered by Contractor's insurance and indemnity
plan. Contractor shall, at Contractor's own expense, at all times during the term of this
agreement, maintain in force a comprehensive or commercial general liability policy
including coverage for contractual liability for obligations assumed under this Contract,
blanket contractual liability, products and completed operations, Owner's and
Contractor's protective insurance and comprehensive automobile liability including
owned and non-owned automobiles. The liability under each policy shall be a minimum
of $500,000.00 per occurrence (combined single limit for bodily injury and property
damage claims) or $500,000.00 per occurrence for bodily injury and $100,000.00 per
occurrence for property damage.
Liability coverage shall be provided on an occurrence not claims basis. The Ashland
Parks and Recreation Department, its officers, employees and agents shall be
named as additional insured.
Certificates of insurance acceptable to the Ashland Parks and Recreation
Department shall be filed with the Department prior to the commencement of any
services by Contractor under this agreement. These certificates shall contain
provision that coverage afforded under the policies can not be canceled and
restrictive modifications cannot be made until at least thirty (30) days prior written
notice has been given to the Department. A certificate which states merely that the
issuing company "will endeavor to mail" written notice is unacceptable.
The Contractor, its Sub-contractors, if any, and all employers providing work, labor,
or materials under this contract are subject employers under the Oregon Workers'
Compensation Law and shall comply with O.R.S. 656.017, which requires them to
provide workers' compensation coverage that satisfies Oregon Law for all their
subject works. This shall include Employer's Liability Insurance with coverage limits
of not less. than $100,000.00 each accident. Contractors who perform the work
without the assistance or labor of any employee need not obtain such coverage.
Insurance carried by Contractor under this Contract shall be the primary coverage,
and the Ashland Parks and Recreation Department's insurance is excess and
solely for damages or losses for which the City is responsible.
Contractor agrees to defend, indemnify and save Ashland Parks and Recreation
Department, its officers, employees and agents harmless from any and all losses,
claims, actions, costs, expenses, judgments, subornation, 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 agreement by Contractor (including, but not
limited to, Contractor's employees, agents, and other designated by Contractor to
perform work or services attendant to this agreement). Contractor shall not be held
responsible for damages caused by the negligence of the Ashland Parks and
Recreation Department. The Contractor agrees that Contractor will be solely
PROPOSAL AND SPECIFICATIONS PAGE 5
Tree Pruning in Lithia Park 12/16/2013
3. The vendor shall commence the work after receiving a notice to proceed, no earlier than January
30, 2014, and shall complete all work no later than February 28, 2014.
4. The Ashland Parks and Recreation Department reserves the right to accept or reject any or all
proposals deemed in its best interest. Without limiting the generality of the foregoing, any
proposal which is incomplete, obscure, or irregular may be rejected.
5. Please attach proposal estimates for 2014 Oak Knoll Contracted Pruning on a Letterhead
from your business by 1:00 p.m. Thursday January 23, 2014.
The foregoing price includes all labor, materials, equipment, overhead, profit, insurance and all other
incidental expenses to cover the finished work of the several kinds called for. The price quotation is to
be shown in both words and figures.
PROPOSAL AND SPECIFICATIONS PAGE 7
Tree Pruning in Lithia Park 12/16/2013
January 7, 2014
Oak Knoll Pruning List
Note: All trees requiring work marked with white dote at base
Deadwood 1" or greater required to be pruned out. Clearance over
parking lot and driveway 13' or higher depending on visible damage to
limbs. All mistletoe shall be removed from trees on list.
1. Black Oak: (Parking Lot near clubhouse) Mistletoe removal, deadwood removed entire
tree, clearance over parking lot.
2. Oak Mistletoe removal and clearance of parking lot.
3. Shumard? Oak (Planter within parking lot) mistletoe removal, deadwood and clearance.
4. Oak (Planter within parking lot) mistletoe removal, deadwood and clearance.
5. (3) Shumard Oaks: Mistletoe removal, road clearance
6. (2) Shumaid Oaks: mistletoe, deadwood and clearance
7. South of #9: Black Oak: Road Clearance
8. Oak (across from above)Clearance and deadwood
9. (2) Black Oaks along putting green: Mistletoe, deadwood and clearance.
10. Black Oak (in grove along drive) Clearance
11. Black Oak (by 7h hole) Clearance, remove leader with wounds.
12. Black Oak (path to clubhouse from drive) Remove leader over drive.
13.Black Walnut (Entrance from Highway)Raise canopy for machine clearance, prune
deadwood, poor cuts/stubs, prune for structure.
14. Black Locusts (3) ( Entrance from Highway)Prune for semi Clearance
Ii
i
(AI Y RECORDER
/ ' ® DATE (NWDD/YYYY)A ° CERTIFICATE OF LIABILITY INSURANCE 12i5i2D13
THIS CERTIFICATEAS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND ORALTER 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 - CgINATACT part Breazeale
Brown & Brown Northwest MONNE. per, (541)494-2655 rVC A541)494-2]55
3256 Hillcrest Park Drive _ EatA1L S:pam.breazeale®beechercarlson.com
INSURER(S) AFFORDING COVERAGE NAIC 0
Medford OR 97504 INSURER AAmerican Fire & Casualty Co 24066
INSURED - INSURER B:
Bartlett Tree Service LLC INSURER C:
2288 Old Stage Road INSURER D:
INSURER E
Central Point OR 97502 INSURER F:
COVERAGES CERTIFICATE NUMBER:13-14 GL BA 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.
INSR TYPEOFINSURANCE A UBR POLICYNUMBER MWDDNYYV MMIO~YYYV LIMITS
TR
GENERAL LIABILITY EACH OCCURRENCE S 11000,000
X. COMMERCIAL GENERAL LIABILITY PREMISES ! N Rene $ 1,000,000
A CLAIMS-MADE FO OCCUR X RA54106717 2/21/201312/21/2014 MEDEXP(Anycne person) $ 15,000
PERSONAL S ADV INJURY S 1,000,000
GENERAL AGGREGATE $ 2,000,000
GENL AGGREGATE UMIT APPLIES PER: PRODUCTS -COMMP AGG S 2,000,000
X POLICY F1 JF~.T PRO, LOC S
AUTOMOBILE LIABIUTY E. Enl IN LE LIMIT
11000,000
ANY AUTO BODILY INJURY (Per Parson) S
A ALL OWNED X SCHEDULED AA54106717 12121/2013 2/21/2014 BODILY INJURY(Paramdert) $
AUTOS AUTOS
NONOWNED PR P R DAMAGE S
Ix HIRED AUTOS X AUTOS Pere dent
Medical payrnerva S $000
UMBRELLA LIAR OCCUR - EACH OCCURRENCE S
EXCESS LIAR CLM MS-MADE AGGREGATE S
OED RETENTIONS S
WORKERS COMPENSATION WC STATU- 0TH-
AND EMPLOYERS' LIABILI TY
ANY PROPRIETORlPARTNERIEXECUTIVE~ NIA E.L. EACH ACCIDENT S
OFFICERILIEMBER EXCLUDED?
(Mandatory in NH) E.L. DISEASE - EA EMPLOYE S
II vas. deSCn under
OE SCRIPTIONOFOPERATIONSbelow E.L. DISEASE - POLICY UMIT S
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AKach ACORD 101, Additional Rename Schedule, if mom apace le required)
General Liability policy includes Blanket Additional Insured coverage as required by written contract per
form # CG8811 (10109).
This form is subject to policy terms, conditions, and exclusions.
CERTIFICATE HOLDER CANCELLATION
(541)488-5320 kari.olson®ashland.or.us SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS.
Xari Olson
20 E Main Street AUTHORD:ED REPRESENTATIVE
Ashland, OR 97520 .
Pam Breazeale/PAMBRE ~~TasA ~1'~`"
COMMERCIAL GENERAL LIABILITY
CG 8811 1009
THIS ENDORSEMENT CHAN4ES THE POLICY. PLEASE READ IT CAREFULLY.
COMMERCIAL GENERAL LIABILITY EXTENSION
(Oregon)
This endorsement modifies Insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
INDEX
SSUUBJECT
PAGE
NON-OWNED AIRCRAFT 2
NON-OWNED WATERCRAFT 2
PROPERTY DAMAGE LIABILITY-ELEVATORS 2
EXTENDED DAMAGE TO PROPERTY RENTED TO YOU (Tenant's Property Damage) 2
MEDICAL PAYMENTS. EXTENSION 3
EXTENSION OF SUPPLEMENTARY PAYMENTS - COVERAGES A AND B 3
ADDITIONAL INSUREDS- BY CONTRACT. AGREEMENT OR PERMIT 3
PRIMARY AND NON-CONTRIBUTORY- ADDITIONAL INSURED EXTENSION 5
ADDITIONAL INSUREDS- EXTENDED PROTECTION OF YOUR "LIMITS OF INSURANCE" 5
WHO IS AN INSURED - INCIDENTIAL MEDICAL ERRORSIMALPRACTICE AND WHO IS AN INSURED - B
FELLOW EMPLOYEE EXTENSION - MANAGEMENT EMPLOYEES
NEWLY FORMED OR ADDITIONALLY ACQUIRED ENTITIES 8
FAILURE TO DISCLOSE HAZARDS AND PRIOR OCCURRENCES 7
KNOWLEDGE OF OCCURRENCE, OFFENSE, CLAIM OR SUIT 7
LISERALUATION CLAUSE 7
BODILY INJURY REDEFINED 7
EXTENDED PROPERTY DAMAGE 7
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US - 7
WHEN REQUIRED IN A CONTRACT OR AGREEMENT WITH YOU
♦ 02010 Liberty Mutual Insurance Company. All rights reae"ad.
CG Be 11 10 09 Includes copyrighted material of Insurance Services Office Inc., with its permission. Page 1 of 7
With respect to coverage afforded by this endorsement, the provisions of the policy apply unless modified by
the endorsement.
A. NON-OWNEDAIRCRAFF
I
Under Paragraph 2. Exclusions of Section I - Coverage A - Bodily Injury And Property Damage Liability,
exclusion g. Aircraft, Auto Or Watercraft does not apply to an aircraft provided:
1. It is not owned byany insured;
2. Ills hired, chartered or loaned with a trained paid crew;
3. The pilot In command holds a currently effective certificate, Issued by the duly constituted authority of
the United States of America or Canada, designating her or him a commercial or airline pilot; and
4. It Is not being used to carry persons or property for a charge.
However, the insurance afforded by this provision does not apply if there is available to the insured other
valid and collectible insurance, whether primary, excess (other than insurance written to apply specifically
In excess of this pollcy), contingent or on any other basis, that.would also apply to the loss covered under
this provision.
B. NON•OWNEDWATERCRAFr
Under Paragraph 2. Exclusions of Section 1- Coverage A- Bodily Injury And Property Damage Liability,
Subparagraph (2) of exclusion g. Aircraft, Auto Or Watercraft is replaced by the following:
This exclusion does not apply to:
(2) A watercraft you do not own that is:
(a) Less than 52 feet long; and
(b) Not being used to carry persons or property for a charge;
C. PROPERTY DAMAGE LIABILITY -ELEVATORS
1. Under Paragraph 2. Exclusions of Section i - Coverage A - Bodily Injury And Property Damage Usbil-
1t.y Subparegraphs (3), (4) and (6) of exclusion j. Damage To Property do not apply If such "property
damage" results from the use of elevators. For the purpose of this provision, elevators do no Include
vehicle lifts. Vehicle lifts are lifts or hoists used in automobile service or repair operations.
2. The following Is added to Section IV - Commercial General Liability Conditions, Condition 4. Other
Insurance, Paragraph b. Excess Insurance: '
The insurance afforded by this provision of this endorsement is excess over any property Insurance,
whether primary, excess, contingent or on any othor basis.
D. EXTENDED DAMAGE TO PROPERTY RENTED TO YOU (Tenarrt's Property Damage)
If Damage To Premises Rented To You is not otherwise excluded from thls.Covarage Part:
1. Under Paragraph 2. Exclusions of Section I - Coverage A -Bodily Injury and Property Damage Liability:
a. The fourth from the last paragraph of exclusion J. Damage To Property is replaced by the follow-
ing:
Paragraphs (1), (3) and (4) of this exclusion do not sooty to "property damage", other than damage
by fire, lightning, explosion, smoke or leakage from automatic fire protection system) to:.
(1) Premises rented to you for a period of 7 or fewer consecutive days; or
(ii) Contents that you rent or lease as part of a promises rental or lease agreement for a period of
more than 7 days.
Paragraphs (1), (3) and (4) of this exclusion do not apply to "property damage" to contents of
ti premises rented to you fors period of 7 or fewer consecutive days.
02010 Liberty Mutual Insurance Company. All riahts reserved.
CG.88 11 logo Includes copyrighted material of Insurance Services Office Inc:, with Its permission Page 2 of 7
A separate limit of insurance applies to this coverage as. described in Section 111 - Limits. of
Insurance.
b. The lest paragraph of subsection 2. Exclusions is replaced by the following:
Exclusions c. through, n, do not apply to damage by fire; lightning, explosion, smoke; or leakage
from automatic tire protection systems to premises while rented to you or temporarily-occupied by
you with permission of the owner. A separate limit of insurance applies to Damage To Premises
Rented To You as described in Section III - Limits of insurance.
2. Paragraph 9. under Section III -Limits of Irisiurance Is replaced by the following:
6. Subject to Paragraph 5. above, the Damage To Premises Rented To You Limit is the most we will
pay under Coverage A for damages because of "property damage" to:
a. Any one premise:
(1) While rented to you; or
(2) While rented to you or temporarily occupied by you with. permission. of the-owner for
damage. by fire, lightning, exploiion, smoke or leakage from automatic protection sys-
tems; or
b. Contents that you rent or tease as part of a premises rental or lease agreement.
As regards coverage provided by this provision D. EXTENDED DAMAGE TO PROPERTY RENTED TO YOU
(Tenant`s Property Damage)- Paragraph 9.a. of Definitions Is replaced with the following:
9.a. A contract for a lease of premises. However, that portion of the contract for a lease of premises
that indemnifies any person or organization for damage by fire, lightning, explosion, smoke, or
leakage from automatic fire protection systems to premises while rented to you or temporarily
occupied by you with the permission of the owner, or for damage to contents of such premises
that are included in your premises rental or lease agreement, is not an "insured contract".
E. MEDICAL PAYMENTS EXTENSION
If Coverage C Medical Payments Is not otherwise excluded, the Medical Payments provided by this policy
are amended as follows:
Under Paragraph 1. Insuring Agreement of Section 1- Coverage C - Medical Payments, Subparagraph
(b) of Paragraph a. Is replaced by the following:
(b) The expenses are incurred and reported within three years of the date of the accident; and
F. EXTENSION OF SUPPLEMENTARY PAYMENTS - COVERAGES A AND B
1. Under Supplementary Payments -Coverages A and B, Paragraph 1.b. Is replaced by the following:
b. Up to $3,000 for cost of ball bonds requited because of accidents or traffic law violations arising
out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have
to furnish these bonds.
2. Paragraph 1.d. Is replaced by the following:,
d. All reasonable expenses Incurred by the insured at our request to assist us in the Investigation or
defense of the claim or "suit", including actual loss of earnings up to $500 a day because of time
off from work.
G. ADDITIONAL INSUREDS - BY'CONTRACT, AGREEMENT OR PERMIT
1. Paragraph 2. under Section 11 - Who Is An Insured is amended to Include es on insured any person or
organization whom you have agreed. to.add as an additional Insured In a written contract, written
agreement or permit. Such person or organization is an additional insured but only with, respect to i
liability for "bodily Injury", "property damage" or "personal and advertising injury" caused by:
02010 Liberty Mutual insurance Company. NI rights racurvud.
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a. Your acts or omissions, or the acts or omissions of those acting on your behalf, lit the performance
of your on going operations for the additional insured that are the subject of the written contract or
written agreement provided that the "bodily injury" or "property damage" occurs, or the "per-
sonal and advertising injury" is committed, subsequent to the signing of such written contract or
1 written agreement; or
b. Promises or facilities rented by you or used by you; or
c: The maintenance, operation or use by you of equipment rented or leased to you by such person or
organization; or ,
d. Operations performed by you or on your behalf for which the state or political subdivision has
issued a permit subject.to the following additional provisions:
(1) This insurance does not apply to "bodily Injury", "property damage'% or "personal and ad-
vertising Injury" arising out of the operations performed for the state or political subdivision;
(2) This insurance does not apply to "bodily injury" or "property damage" included within the
- • "completed operations hazard".
(3) Insurance applies to premises you own, rent, or control but only with respect to the following
hazards:
(a) The existence, maintenance, repair, construction, erection, or removal of advertising
signs, awnings, canopies, caller entrances, coal holes, driveways, manholes, marquees,
hoist away openings, sidewalk vaults, street banners, or decorations and similar expo-
sures; or
(b) The construction, erection, or removal of elevators; or
(c) The ownership, maintenance, or use of any elevators covered by this insurance.
With respect to Paragraph 1.e. above, a person's or organization's status' es an additlonal Insured
under this endorsement ends when:
(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 or on behalf of the
additional Insured(s) at the location of the covered operations has been completed; or
M 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 some project,
With respect to Paragraph 1.b-above, a person's or organization's status as an additional insured under
this endorsement ends when their written contract or written agreement with you for such premises or
faci titles end's.
With respects to Paragraph t.a above, this insurance does not apply to any "occurrence" which takes
place after the equipment rental or lease agreement hes.expired or you have returned such equipment
to the lessor.
The insurance provided by this endorsement applies only if the written contract or written agreement
is signed prior to the "bodily Injury" or "property damage".
We have no duty to defend an additional Insured under this endorsement until we receive, written
notice of a "suit" by the additional Insured as required In Paragraph b. of Condition 2, Duties in the
Event Of Occurrence, Offense, Claim Or Suit under Section IV - Commercial General Liability Condi-
tions.
I 2. With respect to the Insurance provided by this endorsement, the following are added to'Paragraph 2-
Exciusions under Section I.• Coverage A - Nodity Injury And Property Damsge Liability:
02010 Liberty Mutual Incuranos Company. All rights rasomed.
Ce 8811 10 09 Includes copyrighted materlal of Insurance Services Office Inc., with its permission. Page 4 of 7
This insurance does not apply to:
A. "Bodily injury" or "property damage" arising from the sate negligence of the additional insured.
ti. "Bodily injury" or "property damage" that occurs prior to you commencing operations at the.
location where such "bodily Injury" or "property damage" occurs:
c. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the render-
ing of, or the failure to render, any professional architectural, engineering or surveying services,
including;
11) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions,
reports, surveys, field orders, chenge orders or drawingsand specifications; or
(2) Supervisory, inspection, architectural or engineering activities.
d. "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 or on behalf of the
additional insured(s) atthe location 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.
e. Any person or organization specifically designated as an additional Insured for ongoing operations
by a separate ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS endorsement is-
sued by us and made a partof this policy.
H. PRIMARY AND NON-CONTRIBUTORY ADDITIONAL INSURED EXTENSION
This provision applies to any person or organization who qualifies as an additional insured under any form t
or endorsement under this policy.
Condition 4. Other Insurance of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS is amend-
ed asfollows:
a. The following is added to Paragraph e. Primary Insurance:
If an additional insured's policy has an Other insurance provision making Its policy excess, and you
have agreed in a written contract or written agreement to provide the additional insured coverage on a
primary and noncontributory basis, this policy shall be primary and we will not seek contribution from
the additional Insured's policy for damages we cover.
b. The following Is added to Paragraph b. Excess Insurance:
When a written contract or written agreement, other then a premises lease, facilities rental contract or
agreement, an equipment rental or lease contractor agreement, or permit Issued by a state or political
subdivision between you and an additional Insured does not require this Insurance to be primary or
primary and non-contributory, this Insurance is excess over any other Insurance for which the addi-
tional insured is designated as a Named Insured.
Regardless of the writt an agreement between you and an additional insured, this insurance is excess
over any other Insurance whether primary, excess, contingent or on any other basis for which the
additional insured has been added as an additional insured on other policies.
1. ADDITIONAL INSUREDS- EXTENDED PROTECTION OF YOUR "LIMITS OF INSURANCE"
This provision applies to any person or organization who qualifies as an additional insured under any
form or endorsement under this policy.
1. The following is added to Condition 2. Duties In The Event Of Occurrence, Offense, Claim or Suit
02010 Liberty Mutual Insurance Company. All rights reserved.
CG 88 11 10 09 Includes copyrighted material of Insurance Services Mee Inc., with its permission. Page_5-of 7
An additional Insured under this endorsementwill as soon as practicable:
a. Give written notice of an "occurrence" or an offense, that may result'In a claim or "suit" under
. this insurance to us;
b. Tender the defense and indemnity of any claim or "suit" to all insurers whom also have
insurance available to the additional insured; and
c. Agree to make available any other insurance which the additional insured has for a loss we
cover under this Coverage Part.
d. We have no duty to defend or indemnify an additional insured under this endorsement until
we receive written notice of a "suit" by the additional Insured.
2. The limits of insurance applicable to the additional insured are.those specified in a written contract
or written agreement or the limits of insurance as stated In the Declaration of this policy and
defined in Section III - limits of Insurance of this policy, wiilchever are less. These limits are
Inclusive of and not in addition to the limits of insurance available under this policy.
J. WHO IS AN INSURED- INCIDENTM MEDICAL ERRORS,/ MALPRACi1CE I.
WHO IS AN INSURED -FELLOW EMPLOYEE EXTENSION- MANAGEMENT EMPLOYEES
Paragraph 2a.(1) of Section 11- Who Is An Insured is replaced with the following:
(1) "Bodily injury" or "personal and advertising Injury":
(a) To you, to your partners or members Of you area partnership or joint venture), to your members (if
you are a limited liability company), to a co-"employee" while In the course of his or her employ-
ment or performing duties related to the conduct of your business, or to your other "volunteer
workers" while performing duties related to the conduct of your business;
(b) To the spouse, child, parent, brother or sister of that co-"employee" or "volunteer worker" as a
consequence of Paragraph (1) (a) above;
(c) For which there is any obligation to share damages with or repay someone else who must pay
damages because of the Injury described in Paragraphs (1) (a) or (b) above; or
(d) Arising out of his or het providing or failing to provide professional health care services. However,
if you are not in the business of providing professional health care services or providing profes.
sional health care personnel to others, or if coverage for providing professional health care ser-
vices Is not otherwise excluded by separate endorsement, this provision (Paragraph (d)) does not
apply:
Paragraphs (a) and (b) above do not apply to "bodily Injury" or "personal and advertising injury" caused by
an "employee" who is acting in a supervisory capacity for you, Supervisory capacity as used herein means
the "employee's" job responsibilities assigned by you, Includes the direct supervision of other "employ-
ass" of yours. However; none of these "employees" are Insureds for "bodily injury" or "personal end
advertising injury" arising out of their willful conduct, which Is defined asthe purposeful or willful intentto
cause "bodily injury" or "personal and advertising injury", or caused in whole or In part by their Intoxica-
tion by liquor or controlled substances.
The coverage provided by provision J. Is excess over any other valid and collectable insurance available to
your "employee".
K. NEWLY FORMED OR ADDITIONALLY ACQUIRED ENTITIES
Paragraph 9: of Section II - Who Is An Insured is replaced by the following:
3. Any organization you newly acquire or form and over which you maintain ownership or majority
interest, will qualify as a Named Insured 1f there Is no other similar insurance available to that
organization. However:
a. Coverage under this provision is afforded only until the expirstion of the policy period in
which the entity was acquired or formed by you:
b. Coverage A does not apply to "bodily Injury" or "property damage" that occurred before you
acquired or formed the organization;-and
02010 Libany Mutual Insurance Company. All rights reserved.
CO as 11 10 08 includes oopynomed materiel of insurance Services Office Ina, with its permission. Page S of 7
c. Coverage B does not apply to "personal and advertising injury" arising out of an offense
committed before you acquired or formed the organization.
d. Records and descriptions otoperations must be maintained by the first Named Insured.
No person or organization'is an insured with respect to the.conduct bf any current or past partnership, joint 1
venture or limited liability company that is not shown as a Named Insured in the Declarations or qualifies
for as an insured under.this provision
L.. FAILURE TO DISCLOSE HAZARDS AND PRIOR OCCURRENCES '
Under Section IV - Commercial General Liability Conditions, the following 1s added to Condition 0. Repre-
sentations:
Your failure to disclose all hazards or prior "occurrences" existing as of the inception date of the policy
shall not prejudice the coverage afforded by this.polioy provided such failure to disclose all hezarda or
prior "occurrences" Is.not intentional.
M. KNOWLEDGE OF OCCURRENCE, OFFENSE, CLAIM OR SUIT
i
Under Section IV - Commercial General.Uability Conditions, the following is added to Condition 2. Duties
In The Event of Occurrence; Offense, Claim Oi Suit: - 1'
Knowledge of an "occurrence", offense, claim or "suit" by an agent, servant or "employee" of any
insured shall not in itself constitute knowledge of the insured unless an insured listed under Paragraph
1. of Section II - Who Is An Insured or a person who has been designated by them to receive reports of
"occurrences", offenses, claims or "suits" shall h ' aye received such notice from the agent, servant or
"employee".,
N. LIBERALIZATION CLAUSE
If we revise this Commercial General Liability Extension Endorsement to provide more coverage without
additional premium charge, your policy will automatically provide the coverage as of the day the revision is
effective in your state.
0. BODILY INJURY REDEFINED 1
Under Section V - Definitions, Definition 3. is replaced by the following:
3. "Bodily Injury" means physical injury, sickness or disease sustained by a person. This includes
mental anguish, mental Injury, shock, fright or death that results from such physical Injury, sick-
ness or disease.
P. EXTENDED PROPERTY DAMAGE
Exclusion a. of COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY is replaced by the
following:
a. Expected Or Intended Injury
"Bodily Injury" or "property damage" expected or intended from the standpoint of the insured.
This exclusion does not apply to "bodily injury" or "property damage" resulting from the use of
reasonable force to protect persons or property. .
O. WAIVER OF TRANSFER. OF RIGHTS OF RECOVERY AGAINST OTHERS TO US - WHEN REQUIRED IN A
CONTRACT OR AGREEMENT WITH YOU
Under Section IV . Commercial General Liability Conditions, the following Is added to Condition 8. Trans-
fer Of Rights Of Recovery Against Others To Us:
We waive any right of recovery we may have against a person or organization because of payments we
make for injury or damage arising out of your ongoing operations or "your work" done under a
contract with that person or organization and included in the "products-completed operations hazard"
provided:
1. You and that person or organization' have agreed In writing in a contract or agreement that you
waive such rights against that person or organization; and •
2. The injury or damage. occurs subsequentto the execution of the written contract or written agree=
ment.
02010 Liberty Mutual Insurance Company. All ddhts reserved.
CG 08 11 10 09 Includes copyrighted material of Insurance Services Office Inc- with its permission. Page 7 of 7
SAIF Corporation 1/23/2014 4:03:35 PM PAGE 1/001 Fax Server
w W.saifxom i
A 'A
OREGON WORKERS COMPENSATION S11f
CERTIFICATE OF INSURANCE Jcorporation
The policy of Insurance listed below has been issued to the insured named below for the
policy period indicated. The Insurance afforded by the policy described herein Is subject to
all the terms, exclusions and conditions of such policy.
POLICY NO. POLICY PERIOD ISSUE DATE
733779 01/01/2014 to 01/01/2015 01/23/2014
INSURED: BROKER OF RECORD:
BARTLETT TREE SERVICE LLC
2288 OLD STAGE RD
CENTRAL POINT, OR 97502-1352
LIMITS OF LIABILITY:
Bodily Injury by Accident $500,000 each accident
Bodily Injury by Disease $500,000 each employee
Body Injury by Disease $500,000 policy limit
DESCRIPTION OF OPERATIONS/LOCATIONS/SPECIAL ITEMS:
All Operations
IMPORTANT:
The coverage described above is in effect as of the issue date of this certificate. It is subject to change
at any time in the future.
This certificate is issued as a matter of information only and confers no rights to the certificate holder.
This certificate does not amend, extend or alter the coverage afforded by the policies above. This
certificate does not constitute a contract between the Issuing insurer, authorized representative or
producer and the certificate holder.
AUTHORIZED REPRESENTATIVE
!~rg -c!p jr
President and CEO
400 High Street SE
Salem, OR 77312
P: 800.285.8525
F: 503.373.8020
Pulicy_Batth_Certn oteofinsu rance
CITY RECORDER Page 1 /1
Ashland Park Commission DATE PO NUMBER
20 E MAIN ST. 2/11/2014 00326
ASHLAND, OR 97520
.(541) 488-5300
VENDOR: 004091 SHIP TO:
BARTLETT TREE SERVICE
2288 OLD STAGE ROAD
CENTRAL POINT, OR 97502
FOB Point: Req. No.:
Terms: net Dept.:
Req. Del. Date: Contact: Anne Thayer
Special Inst: Confirming? NO
quanti Unit Description - Unit Price Ext. Price
Pruning 20 trees Oak Knoll Golf Course 2,350.00
Contract for Goods and Services
Beginning date: January 31, 2014
Completion date: February 28, 2014
SUBTOTAL 235000
31LL TO: TAX 0.00
FREIGHT 0.00
TOTAL 2,350.00
Account Number:.... 'Project Number . Amount:. Account Number Project Number Amount
E 211.12.04.00.60235 2,350.00
i
i
Auth rzed Signature VENDOR COPY
FARM#3 CITY OF
A request for a Purchase Order ASHLAND
REQUISITION Date of request:
Required date for delivery:
Vendor Name -FrrL'&y1' fCU
Address, City, State, Zip QM9 Oki) 6~ t~a 1g T G!
Contact Name & Telephone Number I ray' . (®6 - SCE biz// • 7~ ° ~o,~~o:~
Fax Number 1 +
SOURCING METHOD
❑ Exempt from Competitive Bidding ❑ Emergency
❑ Reason for exemption: ❑ Invitation to Bid (Copies on file) ❑ Form #13, Written findings and Authorization
❑ AMC 2.50 Date approved by Council: ❑ Written quote or proposal attached
❑ Written uote or proposal attached
Small Procurement Cooperative Procurement
Less than $5,000 ❑ Request for Proposal (Copies on file) ❑ State of Oregon
❑ Direct Award Dale approved by Council: Contract #
❑ Verbal/Written quote(s) or proposal(s) ❑ Stale of Washington
Intermediate Procurement ❑ Sole Source Contract #
GOODS & SERVICES ❑ Applicable Form (#5,6, 7 or 8) ❑ Other government agency contract
$5,000 to $100,000 ❑ Written quote or proposal attached Agency
❑ (3) Written quotes and solicitation attached ❑ Form #4, Personal Services $5K to $75K Contract #
PERSONAL 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 Dale original contract approved by Council:
❑ (3) Written proposalslwritten solicitation Date approved by Council: (Date)
❑ Form #4, Personal Services $5K to $75K Valid until: (Date) I
Description of SERVICES Total Cost
prLSI~ ine,, a0 ~✓'e e,S C~k.kl-t~l, ~ ~dl~ ~iJ)-.~-e.,
Item Al Quantity Unit Description of MATERIALS Unit Price Total Cost
TOTAL COST
❑ Per attached quotelproposal $
Project Number Account Number o? 36D
Account NumberZll -12 btlbN53 AccountNumber___-__-__-__-______
'Expenditure must be charged to the appropriate account numbers for the financials to accurately reflect the actual expenditures.
IT Director in collaboration with department to approve all hardware and software purchases:
ITDirector Date Support-Yes/No
By signing this requisition form, I certify that the City's public contracting requirements have bee ~ isfied.
Employee Signature: Department Head Signature:
( ual to or greater than $5,000)
City Administrator:
(Equal to or greater than $25,000)
Funds appropriated for current fiscal year YES / NO
Finance Director- (Equalto or greater than $5,000) Date
Comments:
Form #3-Requisition