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HomeMy WebLinkAbout2014-066 Contract - Integrity Pest & Home Repair Contract for GOODS AND SERVICES Less than $25,000 C I T Y OF CONTRACTOR: Integrity Pest & Home Repair ASHLAND 20 East Main Street CONTACT: Randy Baldwin, Owner/Operator Ashland, Oregon 97520 ADDRESS: 548 Hogan Ave, Medford, OR 97504 Telephone: 541/488-6002 Fax: 541/488-5311 TELEPHONE: 541-613-7311 DATE AGREEMENT PREPARED: March 11, 2014 FAX: BEGINNING DATE: January 1, 2014 COMPLETION DATE: December 31, 2014 COMPENSATION: $95.00. per month per bid attached as Exhibit C. (Parks & Recreation Shop $45/Mo and Maintenance Building $50/Mo GOODS AND SERVICES TO BE PROVIDED: Pest control services to be provided at the Ashland Parks & Recreation shop and maintenance buildings located at 307 H 66 once per month for 12 months. ADDITIONAL TERMS: Workers' Compensation is being i because the owner/operator has no employees and will be performing the work himself. Contractor's initials NOW THEREFORE, pursuant to AMC 2.50 090 and after ons' eration 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, 2798.225, 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: . 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. 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 referenc Contractor City of Ashlla d By By Signa re Department Head 474bdoq I~Htinw~ n~ ~~?o~ Pri Name Print Name g~NRJc~ ~rl~l, y Title Date W-9 One copy of a W-9 is to be submitted with OD / the signed contract. Purchase Order No. Contract for Goods and Services Less than $25,000, Revised 06/13/2013, Page 3 of 5 EXHIBIT A CERTIFICATIONS/REPRESENTATIONS: Contractor, under penalty of perjury, certifies that (a) the number shown on the attached W-9 form is its correct taxpayer ID (or is waiting for the number to be issued to it and (b) Contractor is not subject to backup withholding because (i) it is exempt from backup withholding or (ii) it has not been notified by the Internal Revenue Service (IRS) that it is subject to backup withholding as a result of a failure to report all interest or dividends, or (iii) the IRS has notified it that it is no longer subject to backup withholding. Contractor further represents and warrants to City that (a) it has the power and authority to enter into and perform the work, (b) the Contract, when executed and delivered, shall be a valid and binding obligation of Contractor enforceable in accordance with its terms, (c) the work under the Contract shall be performed in accordance with the highest professional standards, and (d) Contractor is qualified, professionally competent and duly licensed to perform the work. Contractor also certifies under penalty of perjury that its business is not in violation of any Oregon tax laws, and it is a corporation authorized to act on behalf of the entity designated above and authorized to do business in Oregon or is an independent Contractor as defined in the contract documents, and has checked four or more of the following criteria: (1) 1 carry out the labor or services at a location separate from my residence or is in a specific portion of my residence, set aside as the location of the business. (2) Commercial advertising or business cards or a trade association membership are purchased for the business. (3) Telephone listing is used for the business separate from the personal residence listing. (4) Labor or services are performed only pursuant to written contracts. (5) Labor or services are performed for two or more different persons within a period of one year. (6) 1 assume financial responsibility for defective workmanship or for service not provided as evidenced by the ownership of performance bonds, warranties, errors and omission insurance or liability insurance relating to the labor or services to be provided. Contractor (Date) Contract for Goods and Services Less than $25,000, Revised 06/13/2013, Page 4 of 5 CITY OF ASHLAND TAX REGISTRATION (FOR REVENUE PURPOSES ONLY) BUSINESS LOCATION INFORMATION REGISTRATION NO. STREErADDREW: 548 HOGAN AVE BL-008026 PHONE: (541) 613-7311 OWNER INFORMATION NAME: RANDY BALDWIN TL Barbara Christensen CRY RECORDERRREASURER REGISTRATION EXPIRES JUNE 30. INTEGRITY PEST & HOME REPAIR yi 548 HOGAN AVEi MEDFORD, OR 97504 e ` ;i 2014 TO BE POSTED IN A CONSPICUOUS PLACE. Corm I U 14 xev U4lUts OREGON DEPARTMENT OF AGRICULTURE 635 CAPITOL ST NE Printed: 01110/2014 SALEM. OR 97301-2532 (503) 9861550 POST IN A CONSPICUOUS PLACE BUSINESS LOCATION INTEGRITY PEST & HOME REPAIR INTEGRITY PEST & HOME REPAIR RANDALL L BALDWIN 548 HOGAN AVE 548 HOGAN AVE MEDFORD OR 97504 MEDFORD OR 97504 CATEGORIES OF LICENSES LICENSE NUMBER DATE ISSUED DATE EXPIRES INS - General Pests INS - Structure] Pests AG-L1018497CP0 01/09/2014 12/31/2014 Commercial Pesticide Operator Pesticide Phone Numbers Form 4124 Rev 11/12 OREGON DEPARTMENT OF AGRICULTURE 635 CAPITOL ST NE Printed: 01/10/2014 SALEM, OR 97301-2532 POST THIS LICENSE IN A CONSPICUOUS PLACE SEAN COYLE 548 HOGAN AVE MEDFORD OR 97504 LICENSE NUMBER DATE ISSUED DATE EXPIRES LICENSE AG-LI027335APL 01/09/2014 12/31/2014 Pesticide Apprentice License Pesticide Phone Numbers 1 ODA Pesticide Website 1 Emergency Services Dial 911 1 -Get this information- National Poison Center 1 (800) 222-1222 ° Regulation Updates Treatment information for pesticide poisoning. 1 ° On-line Newsletter CD OERS ....................................1 (800).452-0311:.,, ( Search Registered Pesticides Emergency information for spills. 1 1 ° Report Pesticides Used NPIC 1(800) 858-7378 Licensing Requirements ° General and toxicological information on pesticides 1 ° Testing Locations o ODA Pesticides Division .........1 (503) 986-4635 1 ° Look Up Test Scores Information on pesticide regulations. 1 ° Search Recertification Classes Dupont WA 98327-5000 DECLARATIONS PAGE . NAMED INSURED Art 37-2194-1 B a POLICY NUMBER 145 5228-A13-378 oorzm POLICY PERIOD JAN 16 2014 to JUL 13 2014 548 HOGAN AVE RANDY & MICHELLE 12:01 A.M. Standard Time 548 HOG MxMi MEDFORD OR 97504-4303 STATE FARM PAYMENT PLAN NUMBER 1133915915 AGENT I"I~~I~II~~'~IIIIII~II~'I'I~III'll~'I~"I111~111'Il~l~lllll~l~ RUSS WIMMER 2936 E BARNETT RD STE 101 MEDFORD, OR 97504-8309 n'e PHONE: (541)776-7877 DO NOT PAY PREMIUMS SHOWN ON THIS PAGE. IF AN AMOUNT IS DUE, THEN A SEPARATE STATEMENT IS ENCLOSED. YOUR CAR z M 2003 CHEVROLET 01500 PICKUP 1 GCEC14X03Z286376 603H60A000 .~^S~."~: ' ' K+' v~rsv"`~..s+ritr~'P'1+'L~S7~'~~r3'~`4aee'Ua4•'~.a.:• ~ ~ r. . ,y..3~. - .;~,ir r';^1s~". A Liability Coverage Each Person, Each Accident Property Damage Limy ~ $100 000 (See Policy Schedule for Limds G Collision Covera e - $500 Deductible $48.92 - R1 Car Rental and Travel Ex enses Coverage $9.04 s Each Da , Each Loss U1 Uninsured Motor Veh c e poverage $22.96 Each Person, Each Accident Pro a Dama a Limit 20,000 TotaLprerniimF#or5ANi1OM#o'JULh13?2014r l i a~1r 3 "$279''51~~7h~s~s'notiabill ~ 1MPQ)TANT'~MES$AGES i' r~r~r, il5l r-,ti 4, rr h Y~~i , . ~r;,~i~ti~~l;~i+9ti~n,~ ry~yls «i ti '~l ~tit\rhlll A kli ~ IOiI ~"Ron"12.F~rII ~~U rci Iiil ~r 14r NO Replaced policy number 1455228-37A. Your total renewal premium for JAN 13 2014 to JUL 13 2014 is $284.35. MY - TI.IYVnIIR PrAlciCTC nG rurc nrri nnnrrnnic onr_r Tur nnl rr•v n.,nvr ~r D pont 5000 8327-5000 DECLARATIONS PAGE PAGE 1 OF 2 NAMED INSURED AT3 37-2194-1 M A POLICYNUMBER 2637835-A16-37 001132 0053 BALDWIN, RANDY 8 MICHELLE POLICY PERIOD JAN 16 2014 to JUL 16 2014 548 HOGAN AVE 12:01 A.M. Standard Time MEDFORD OR 97504-4303 STATE FARM PAYMENT PLAN NUMBER' 1133915915 AGENT If~llll'1~,1,,111~~111~1~111111~~111~1'l~l~l~'~IIII~II~11111~1,I1 RUSS WIMMER 3 2936 E BARNETT RD STE 101 MEDFORD, OR 97504-8309 sg PHONE: (541)776-7877 DO NOT PAY PREMIUMS SHOWN ON THIS PAGE. IF AN AMOUNT IS DUE, THEN A SEPARATE STATEMENT IS ENCLOSED. YOUR CAR Aillt3 Et _ MAIN= 2012 CHEVROLET C1500 PICKUP 1GCNCPEX4CZ127877 603H60A000 Wes.. [~i4$15,%,u{4T.Q1 ~ N4 YtiKS%SX' A Fr Liability- Coverage Each Person, Each Accident Pr rty Damage Limit $100,000 P-- IjAM (See Polic Schedule for Limits. G Collision Coverage - $SOO Deductible $85.76 R1 Car Rental and Travel Ex enses Coverage $9.20 Each Da , Each Loss U7 Uninsured Motor Vehicle Covera a $23.36 Each Person, Each Accident z w : _D' _Q~QO Pro Damage Limit CSti 21 1:1 RM: 1, gligimig,gi M;:; 0 2182 WE Ri:1, gggg Emil: 2111 $20.000 T- otial° remr'uM10tJAfY 18.,201;4ato,JUL a1&.:207.4 u " $352' 37 w , Th1s 1s!,r16t a btlL„ L Replaced policy number 1455227-37. New Policy Form State Farm works hard to offer you the best combination of price, service, and protection. The amount you pay for automobile insurance is determined by many factors such as the coverages you have, where you live, the kind of car you drive, how your car is used, who drives the car, and information from consumer reports. ,seDZT CERTIFICATE OF LIABILITY INSURANCE DA 8/13no 3m THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE gOES 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 N TACT Centralized Service Unit Commercial Lines - (415) 541-7900 PHONE 415.541-7900 FAX NI: 866.930.6996 Wells Fargo Insurance Services USA, Inc. - CA Lic#. OD08408 E-^ Rif: Wmilmncisco.certs@wellsfargo.com 45 Fremont Street, Suite 800 INSURERS AFFORDING COVERAGE NAIC% San Francisco, CA 94105-2259 INSURERA: Impedum Insurance Company 35408 INSURED INSURER B : Randy Baldwin ribs Integrity Pest & Home Repair INSURER C: 548 Hogan Avenue - INSURER D: INSURER E: Medford OR 97504 INSURER F COVERAGES CERTIFICATE NUMBER: 6451611 REVISION NUMBER: See below THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED :FO 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. INTSnR TYPE OF INSURANCE AVOL SU POLCY EFF POLICY EXP POLICY NUMBER MIDI MMMDIYVVYI LIMITS A GENERAL LIABILITY IICGL0180700 8/12/2013 8/12/2014 EACH OCCURRENCE S 1,000,000 EWAGE TO X COMMERCLALGENERALUABIUTY P REMISE nce E 100,00° CLAIMS.MADE LKOCCUR MED EXP (Arty one pemon) E 5,000 PERSONAL &ADV INJURY $ 1,000.000 GENERAL AGGREGATE S 2,000.00 GENL AGGREGATE UMR APPLES PER PRODUCTS -COMP/OPAGG E 2.000,000 X POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LpermIMIT tlent ANY AUTO BODILY INJURY (Per ) E ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (POT actiderrt) E HIRED AUTOS No WNED PROPERTYDAMAGE. f amides E UMBRELLA WAB OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE AGGREGATE S DED RETENTIONS E WORKERS COMPENSATION X WC STATU- OTH- A AND EMPLOYERS' LIABILITY y/N IICW00025500 06112/2013 06/1212014 ANY PROPRIErOMPARTNER/EXECUTIVE E- EACH ACCIDENT 11000,000 OFFICER/MEMSER EXCLUDED? F-1 NIA f (Mandatory in NN) FI DISEASE - EA EMPLO E I.ODO.000 DYyaess tlasmbeuntler DESCRIPTION OF OPERATIONS below E.L DISEASE-PODGY UMR E 1,000,000 DESCM"ON OF OPERATIONS I LOCATIONS I VEHICLES (ADach ACORD 101, Additional Remarks Schedule, N mom apace Is mqulred) PROOF OF INSURANCE CERTIFICATE HOLDER CANCELLATION Randy Baldwin dba Integrity Pest & Repair SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 548 Hogan Avenue THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Medford, OR 97504 AUTHORED REPRESENTATIVE The ACORD name and logo are registered marks of ACORD ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD25 (2010105) ~1,/amMUb~adOml cAW W a11tlAl met m M1mHaI CITY RECORDER Page 1 / 1 CITY OF ASHLAND : DATE:=s=: PO NUMBER 20 E MAIN ST. > 414/2014 00340 ASHLAND, OR 97520 (541) 488-5300 VENDOR: 004103 SHIP TO: INTEGRITY PEST & HOME REPAIR 548 HOGAN AVENUE MEDFORD, OR 97504 FOB Point: Req. No.: Terms: net Dept: Req. Del. Date: Contact: Bruce Dickens Special Inst: Confirming? NO Quanti - unit ; ° Deeori hon - Unit Price: - Ext' Price 12.00 Mo Pest Control - $45.00/Month 45.00 540.00 Parks & Recreation Shop 12.00 Mo Pest Control - $50.00/Month 50.00 600.00 Maintenance Buildinq Location: Oak Knoll Golf Course Contract for Goods and Services Beqinninq date: January 1, 2014 Completion date: December 31, 2014 BILL TO: SUBTOTAL 1,140.00 TAX 0.00 FREIGHT 0.00 TOTAL 1,140.00 ':Account Number,..,., „Pro1'ectNumbero,. 6L ;t~.:AccountNiirnber <<, :proecbNumber, ;Arrint-.~.„, / Amount E 211.12.02.06.60410 1 140.00 A 'zed Signature VENDOR COPY I FORM#3 CITY OF A request for a Purchase Order ASHLAND REQUISITION Date of request: ET zJ 4 Required date for delivery: Vendor Name TN ~y~r r ft e~~ d AbAtA- ~A r(' Address, City, State, Zip f~13 µa4,+ 0.J¢ (f~,t( 6f& 9"7s-.6 1 Contact Name & Telephone Number Fax Number Qa^ fSpldw+n s +11- r3- 7 If SOURCING METHOD ❑ Exempt from Competitive Bidding ❑ Ememencv ❑ Reason for exemption: ❑ Invitation to Bid (Copies on file) ❑ Form #13, Written findings and Authorization ❑ AMC 2.50 Date approved by Council: ❑ Written quote or proposal attached ❑ Written quote or proposal attached ❑ Small Procurement Cooperative Procurement Less than $5,000 ❑ Request for Proposal (Copies on file) ❑ State of Oregon Direct Award Date approved by Council: Contract # ❑ Verballhritten quote(s) or proposal(s) ❑ State of Washington Intermediate Procurement ❑ Sole Source Contract # GOODS & SERVICES ❑ Applicable Form (#5,6, 7 or 8) ❑ Other government agency contract $5.000 to $100,000 ❑ Written quote or proposal attached Agency ❑ (3) Written quotes and solicitation attached ❑ Form #4, Personal Services $5K to $75K Contract # PERSONAL SERVICES t Intergovernmental Agreemen PEES to $75 ER ❑ Special Procurement ❑ Form#g,RequestforApproval ❑ Agency ❑ Less than $35,000, by direct appointment ❑ Written quote or proposal attached Date original contract approved by Council: ❑ (3) Written proposalsAvritten solicitation Date approved by Council: (Date) ❑ Form #4, Personal Services $5K to $75K Valid until: Date Description of SERVICES I_ I 1 Total Cost P,&4 e ox~rd eA. kvuAt W-[ -%4c. &AcA, 5G, )o Atwi x sa k j'Y "33 Item # quantity Unit Description of MATERIALS Unit Price Total Cost ~,wd s yS>ttz sUv.~ TOTA&cost' El Per attached quotelproposal $ Project Number--------__ Account Number -_--~r~yG ' Account Nuni It .IZ-67--e4.6011101) 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 sofAvare purchases: ITUrector Date Support-Yes/No By signing this requis#ton orm, I certify that the City's public contracting requirements have been satisfied. Employee: Department Head: Department ana9erISUPervisor: City - Administrator: (Equal to or greater than $5,000) (Equal to or greater than $25,000) Funds appropriated for current fiscal year., YES / NO • Finance Director-(Equal to orgreater than s5,ooo) Date Comments: Form #3 - Requisition