HomeMy WebLinkAbout2014-185 Contract - Ellen Falkner
CITY Of
ASHLAND INDEPENDENT CONTRACTOR:
CONTACT: Ellen Falkner
20 East Main Street ADDRESS: 240 Orange Ave., Ashland OR 97520
Ashland, Oregon 97520 TELEPHONE: 541-482-3110
Telephone: 541/488-6002
Fax: 541/488-5311 FAX: efalkner@gwest.net
DATE CONTRACT FULLY EXECUTED:
BEGINNING DATE: Ju 17 2014 COMPLETION DATE: August 17 2014
COMPENSATION: $250 plus $50 for paint
SCOPE OF WORK: PainUrepair damage to art work on utility box on Calle Guanajuato
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 have a current City business license.
3. Indemnification: Contractor agrees to defend, indemnify and save City, its officers, employees and agents harmless against and
from losses, expenses, or other damages resulting from injury to any person or damage to property arising out of or incident to the
negligent performance of this contract by Contractor, its employees, or agents. Contractor shall not be held responsible for any
losses, expenses, or other damages, directly, solely, and proximately caused by the negligence of City.
4. Termination: CCi rs Convenience. This contract may be terminated at any time by the City.
5. Independent Contractor Status and Other Representations: Contractor is an Independent Contractor and not an employee of
the City. Contractor shall have the complete responsibility for the performance of this contract. Contractor certifies the accuracy of
the representations in attached Exhibit A.
6. 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. See Exhibit B (Back of Page). Worker's compensation insurance is
required if work is performed by employees, subcontractors, or volunteers.
BY INITIALING THE BLANK AT THE END OF THIS SENTENCE, CONTRACTOR CERTIFIES UNDER PENAL F LAW
THE WORK REQUIRED BY THIS CONTRACT SHALL BE PERFORMED SOLELY BY THE UNDERSIGNED:
7. Statutory Requirements: ORS 279B.220, 279B.225, 2798.230, 279B.235, ORS Chapter 244 and ORS 670.600 are made part of
this contract.
8. Asbestos Abatement License: If required under ORS 468A.710, Contractor or Subcontractor has an asbestos abatement license.
9. 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.
10. Non-discrimination Certification: The undersigned certifies that Contractor has not discriminated against minority, women or
emerging small business enterprises in obtaining any required subcontracts. Contractor further certifies that it shall not
discriminate in the award of such subcontracts, if any.
11. Governing Law; Jurisdiction; Venue: This contract shall be governed and construed in accordance with the laws of the State of
Oregon .
12. 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.
Contractor off' ty o shland
m f
By By S~n
W-9 -One copy of W-9 is to be submitted with the signed contract.
~d. l90 36 s-
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 (a) its business is not in violation of any Oregon tax laws; (b) if it is a corporation or limited liability company, it
is in good standing under state and federal laws and the undersigned is authorized to act on behalf of the entity; (c) it is an
independent Contractor as defined in ORS 670.600; (d) Contractor meets at least four of the criteria listed below and
so Indicates by placing Contractor's initials in the blanks before all the criteria Contractor meets:
(1) Contractor carries out the provided labor or services at a location separate from Contractor's residence or
in a specific portion of its 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) The telephone listing used for the business is separate from the telephone listing for Contractor's personal
residence.
(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) Contractor assumes 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.
7/27//
Contractor (Date)
EXHIBIT B
CITY OF ASHLAND
WORKERS' COMPENSATION INSURANCE CERTIFICATION
CERTIFICATION OF COVERAGE:
Contractor will maintain Workers' Compensation insurance coverage for the term of the contract and
will provide Certificate of Workers' Compensation Insurance before
Project Beginning Date.
CERTIFICATION OF EXEMPTION FROM COVERAGE:
Contractor is exempt from the requirement to obtain workers compensation insurance under ORS
Chapter 656 for the following reason (initial the appropriate box).
SOLE PROPRIETOR
• Contractor is a sole proprietor, and
• Contractor has no employees, and
• Contractor will not hire employees or subcontractors to perform this contract.
CORPORATION - FOR PROFIT
• Contractor's business is incorporated; and
• All employees of the corporation are officers and directors and have a substantial ownership
interest* in the corporation, and
• All work will beperformed by the officers and directors; Contractor will not hire other employees or
subcontractors to perform this contract.
CORPORATION - NONPROFIT
Contractor's business is incorporated as a nonprofit corporation, and
Contractor has no employees; all work is performed by volunteers, and
- Contractor will not hire employees or subcontractors to perform this contract.
PARTNERSHIP
Contractor is a partnership, and
Contractor has no employees, and
- All work will be performed by the partners; Contractor will not hire employees or subcontractors to perform this
contract, and
Contractor is not engaged in work performed in direct connection with the construction, alteration, repair, improvement,
moving or demolition of an improvement to real property or appurtenances thereto.**
LIMITED LIABILITY COMPANY
- Contractor is a limited liability company, and
- Contractor has no employees, and
All work will be performed by the members; Contractor will not hire employees or subcontractors to perform this
contract, and
If Contractor has more than one member, Contractor is not engaged in work performed in direct connection with the
construction, alteration, repair, improvement, moving or demolition of an improvement to real property or
appurtenances thereto. * *
*NOTE: Under OAR 436-50-050 a shareholder has a "substantial ownership" interest if the shareholder owns 10% of the
corporation, or if less than 100/6 is owned, the shareholder has ownership that is at least equal to or greater than the average
percentage of ownership of all shareholders.
**NOTE: Under certain circumstances partnerships and limited liability companies can claim an exemption even when performing
construction work. The requirements for this exemption are complicated. Consult with City Attorney's Office before an exemption
request is accepted from a contractor who will perform construction work.
G:llegailCOTITRACTStContracting WORKSHOP 2013113raft Personal Services Contract - Low Risk - Public Art 5-8-14.docx
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1 CORIDER Page 1 / 1
ASHLAND PARK COP II SSII U
20 E MAIN ST. 1.~PO NUMBER
ASHLAND, OR 97520 7/17/2014 00365
(541) 488-5300
VENDOR: 004056 SHIP TO:
FALKNER, ELLEN S
240 ORANGEAVENUE
ASHLAND, OR 97520
FOB Point: Req. No.:
Terms: net Dept:
Req. Del. Date: contact: Ann Seltzer
Special Inst: Confirming? No
Quanta `Umt . Description, ' :r.:UniNPrice -'Ext. Price
Artist to touch up and paint electric 300.00
box on Calle
Contract for Independent Contractor
Beginninq date: JuIV 17, 2014
Completion date: Auqust 17, 2014
SUBTOTAL 300.00
BILL TO: TAX 0.00
FREIGHT 0.00
TOTAL 300.00
Account. Number- -Project Number` 'Amount ""Account Number ' 'Project Number " 'AmouW
E 411.12.00.00.70420 E 000053.999 300.00
Autho d sign. VENDOR COPY
FORM #3 CITY OF
A request for a Purchase Order ASHLAND
REQUISITION Date of request: aQ/
Required date for delivery:
Vendor Name a
Address, City, State, Zip J u/J Pa/1c 1 Ad-
Contact Name & Telephone Number /~Pa ( Ct 701 0
Fax Number pub
SOURCING METHOD
❑ Exempt from Competitive Bidding ❑ Emeraencv
❑ Reason for exemption: ❑ Invitation to Bid (Copies on file) ❑ Form #13, Witten 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 ❑ Reauest for Proposal (Copies on file) ❑ State of Oregon
❑ DirectAward Date approved by Council: Contract #
❑ Verbal/Written 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 ❑ 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)
El Form 94, Personal Services $5K to $75K Valid until: Date
Description of SERVICES boy, 0/) Total Cost
NA 4~aW ~1~ OP JP ~'t VYW~/ V•~t.+ boh Y/ ~ ntl~,h LR~~p<`is
Y
Item Al Quantity Unit Description of MATERIALS Unit Price Total Cost
~/OTAL^YCUST''
El Per attached quotelpro osal J t
OOm~~.999 C' y ;s~~' ''aUr~' s
Project Number n~4t9~
1 Account NumberYff-11 -0.09-10 A a
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 testify that the City's public contracting requirements have been sat'
EmployeeQ4,l,0 Department Head:~'C 2
(Equal to or greater than $5,000)
Department ManagerlSupervisor: City Administrator:
(Equal to or greater than $25,000)
Funds appropriated for current fiscal year., YES / NO
Finance Director- (Equarto orgreaterthan $5,000) Date
Comments:
Form #3 - Requisition