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HomeMy WebLinkAbout2014-235 Contract - Rubensteins Contract Carpet Contract for GOODS AND SERVICES Less than $25,000 CITY OF CONTRACTOR: Rubenstein's ASHLAND CONTACT: Greg Graham 20 East Main Street Ashland, Oregon 97520 ADDRESS: P.O. Box 500 Gold Hill, OR 97525 Telephone: 541/488-6002 Fax: 541/488-5311 TELEPHONE: (541) 550-6522 DATE AGREEMENT PREPARED: Jul 21, 2014 FAX: (541) 341-3754 BEGINNING DATE: Jul 28, 2014 COMPLETION DATE: August 20,2014 COMPENSATION: $4191.69 Installation, removal and disposal of carpet at Oak Knoll Club House. $1428.45 Installation, removal, and disposal of carpet at 340 South Pioneer Street Ashland OR 97520. GOODS AND SERVICES TO BE PROVIDED: Labor to install new carpet and remove old carpet at two locations: Oak Knoll Golf Course 3070 Hwy. 66 Ashland Oregon and 340 South Pioneer St. Ashland Oregon. ADDITIONAL TERMS: Carpet purchase and installation pricing through Interface Services Oregon Price Agreement #258. NOW THEREFORE, pursuant to AMC 2.50.090 and after consideration of the mutual covenants contained herein the CITY AND CONTRACTOR AGREE as follows: 1. All Costs by Contractor: Contractor shall, provide all goods as specified above and shall at its own risk and expense, perform any work described above and, unless otherwise specified, furnish all labor, equipment and materials required for the proper performance of such work. 2. Qualified Work: Contractor has represented, and by entering into this contract now represents, that any personnel assigned to the work required under this contract are fully qualified to perform the work to which they will be assigned in a skilled and worker-like manner and, if required to be registered, licensed or bonded by the State of Oregon, are so registered, licensed and bonded. Contractor must also maintain a current City business license. 3. Completion Date: Contractor shall provide all goods in accordance with the standards and specifications, no later than the date indicated above and start performing the work under this contract by the beginning date indicated above and complete the work by the completion date indicated above. 4. Compensation: City shall pay Contractor for the specified goods and for any work performed, including costs and expenses, the sum specified above. Payments shall be made within 30 days of the date of the invoice. Should the contract be prematurely terminated, payments will be made for work completed and accepted to date of termination. Compensation under this contract, including all costs and expenses of Contractor, is limited to $25,000.00, unless a separate written contract is entered into by the City. 5. Ownership of Documents: All documents prepared by Contractor pursuant to this contract shall be the property of City. 6. Statutory Requirements: ORS 2796.220, 27913.225, 2796.230, 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 $20,142.20 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 b certified mail or in person. Contract for Goods and Services Less than $25,000, Revised 07/08/2014, Page 1 of 6 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, county or other sources is not obtained and continued at levels sufficient to allow for the purchase of the indicated quantity of services; ii. If federal or state regulations or guidelines are modified, changed, or interpreted in such a way that the services are no longer allowable or appropriate for purchase under this contract or are no longer eligible for the funding proposed for payments authorized by this contract; or iii. If any license or certificate required by law or regulation to be held by Contractor to provide the services required by this contract is for any reason denied, revoked, suspended, or not renewed. d. For Default or Breach. i. Either City or Contractor may terminate this contract in the event of a breach of the contract by the other. Prior to such termination the party seeking termination shall give to the other party written notice of the breach and intent to terminate. If the party committing the breach has not entirely cured the breach within 15 days of the date of the notice, or within such other period as the party giving the notice may authorize or require, then the contract may be terminated at any time thereafter by a written notice of termination by the party giving notice. ii. Time is of the essence for Contractor's performance of each and every obligation and duty under this contract. City by written notice to Contractor of default or breach, may at any time terminate the whole or any part of this contract if Contractor fails to provide services called for by this contract within the time specified herein or in any extension thereof. iii. The rights and remedies of City provided in this subsection (d) are not exclusive and are in addition to any other rights and remedies provided by law or under this contract. e. Obligation/Liability of Parties. Termination or modification of this contract pursuant to subsections a, b, or c above shall be without prejudice to any obligations or liabilities of either party already accrued prior to such termination or modification. However, upon receiving a notice of termination (regardless whether such notice is given pursuant to subsections a, b, c or d of this section, Contractor shall immediately cease all activities under this contract, unless expressly directed otherwise by City in the notice of termination. Further, upon termination, Contractor shall deliver to City all contract documents, information, works-in-progress and other property that are or would be deliverables had the contract been completed. City shall pay Contractor for work performed prior to the termination date if such work was performed in accordance with the Contract. 10. Independent Contractor Status: Contractor is an independent Contractor and not an employee of the City. Contractor shall have the complete responsibility for the performance of this contract. 11. Non-discrimination Certification: The undersigned certifies that the undersigned Contractor has not discriminated against minority, women or emerging small businesses enterprises in obtaining any required subcontracts. Contractor further certifies that it shall not discriminate in the award of such subcontracts, if any. The Contractor understands and acknowledges that it may be disqualified from bidding on this contract, including but not limited to City discovery of a misrepresentation or sham regarding a subcontract or that the Bidder has violated any requirement of ORS 279A.110 or the administrative rules implementing the Statute. 12. Asbestos Abatement License: If required under ORS 468A.710, Contractor or Subcontractor shall possess an asbestos abatement license. 13. Assignment and Subcontracts: Contractor shall not assign this contract or subcontract any portion of the work without the written consent of City. Any attempted assignment or subcontract without written consent of City shall be void. Contractor shall be fully responsible for the acts or omissions of any assigns or subcontractors and of all persons employed by them, and the approval by City of any assignment or subcontract shall not create any contractual relation between the assignee or subcontractor and City. 14. Use of Recyclable Products: Contractor shall use recyclable products to the maximum extent economically feasible in the performance of the contract work set forth in this document. 15. Default. The Contractor shall be in default of this agreement if Contractor: commits any material breach or default of any covenant, warranty, certification, or obligation it owes under the Contract; if it loses its QRF status pursuant to the QRF Rules or loses any license, certificate or certification that is required to perform the work or to qualify as a QRF if Contractor has qualified as a QRF for this agreement; institutes an action for relief in bankruptcy or has instituted against it an action for insolvency; makes a general assignment for the benefit of creditors; or ceases doing business on a regular basis of the type identified in its obligations under the Contract; or attempts to assign rights in, or delegate duties under, the Contract. 16. Insurance. Contractor shall at its own expense provide the following insurance: a. Worker's Compensation insurance in compliance with ORS 656.017, which requires subject employers to provide Oregon workers' compensation coverage for all their subject workers b. General 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 Liabilit insurance with a combined single limit, or the equivalent, of not less than Enter one: Contract for Goods and Services Less than $25,000, Revised 07/08/2014, Page 2 of 6 $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 insurer(s) to the City. e. Additional Insured/Certificates of Insurance. Contractor shall name The City of Ashland, Oregon, and its elected officials, officers and employees as Additional Insureds on any insurance policies required herein but only with respect to Contractor's services to be provided under this Contract. As evidence of the insurance coverages required by this Contract, the Contractor shall furnish acceptable insurance certificates prior to commencing work under this contract. The contractor's insurance is primary and non-contributory. The certificate will specify all of the parties who are Additional Insureds. Insuring companies or entities are subject to the City's acceptance. If requested, complete copies of insurance policies, trust agreements, etc. shall be provided to the City. The Contractor shall be financially responsible for all pertinent deductibles, self-insured retentions and/or self- insurance. 17. Governing Law; Jurisdiction; Venue: This contract shall be governed and construed in accordance with the laws of the State of Oregon without resort to any jurisdiction's conflict of laws, rules or doctrines. Any claim, action, suit or proceeding (collectively, "the claim") between the City (and/or any other or department of the State of Oregon) and the Contractor that arises from or relates to this contract shall be brought and conducted solely and exclusively within the Circuit Court of Jackson County for the State of Oregon. If, however, the claim must be brought in a federal forum, then it shall be brought and conducted solely and exclusively within the United States District Court for the District of Oregon filed in Jackson County, Oregon. Contractor, by the signature herein of its authorized representative, hereby consents to the in personam jurisdiction of said courts. In no event shall this section be construed as a waiver by City of any form of defense or immunity, based on the Eleventh Amendment to the United States Constitution, or otherwise, from any claim or from the jurisdiction. 18. THIS CONTRACT AND ATTACHED EXHIBITS CONSTITUTE THE ENTIRE AGREEMENT BETWEEN THE PARTIES. NO WAIVER, CONSENT, MODIFICATION OR CHANGE OF TERMS OF THIS CONTRACT SHALL BIND EITHER PARTY UNLESS IN WRITING AND SIGNED BY BOTH PARTIES. SUCH WAIVER, CONSENT, MODIFICATION OR CHANGE, IF MADE, SHALL BE EFFECTIVE ONLY IN THE SPECIFIC INSTANCE AND FOR THE SPECIFIC PURPOSE GIVEN. THERE ARE NO UNDERSTANDINGS, AGREEMENTS, OR REPRESENTATIONS, ORAL OR WRITTEN, NOT SPECIFIED HEREIN REGARDING THIS CONTRACT. CONTRACTOR, BY SIGNATURE OF ITS AUTHORIZED REPRESENTATIVE, HEREBY ACKNOWLEDGES THAT HE/SHE HAS READ THIS CONTRACT, UNDERSTANDS IT, AND AGREES TO BE BOUND BY ITS TERMS AND CONDITIONS. 19. Nona ppropriations Clause. Funds Available and Authorized: City has sufficient funds currently available and authorized for expenditure to finance the costs of this contract within the City's fiscal year budget. Contractor understands and agrees that City's payment of amounts under this contract attributable to work performed after the last day of the current fiscal year is contingent on City appropriations, or other expenditure authority sufficient to allow City in the exercise of its reasonable administrative discretion, to continue to make payments under this contract. In the event City has insufficient appropriations, limitations or other expenditure authority, City may terminate this contract without penalty or liability to City, effective upon the delivery of written notice to Contractor, with no further liability to Contractor. 20. Prior Approval Required Provision. Approval by the City of Ashland Council or the Public Contracting Officer is required before any work may begin under this contract. 21. Certification. Contractor shall sign the certification attached hereto as Exhibit A and herein incorporated by reference. Contract for Goods and Services Less than $25,000, Revised 07/08/2014, Page 3 of 6 Contractor: Qp City =Z, By By Signature Department Head -v5(2R t~m ~ er-fASA f, 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. GV C- S Cl a-r,~ e APPRpV_ D AS TO FORM YTrV--IL Aahlan ast. hY homey Data14L /fL Contract for Goods and Services Less than $25,000, Revised 07/08/2014, Page 4 of 6 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. I - Z~ 1 4 Contractor ~"4d5 6h~*O)et Cvrk (Date) Contract for Goods and Services Less than $25,000, Revised 07/08/2014, Page 5 of 6 OP ID: NS ,d►~oR° CERTIFICATE OF LIABILITY INSURANCE 07/30/2014 DA Y) 07/30/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER C NAME: ONTACT Beckie Graves Alfred J. Davis Company PHONE FAX P.O. Box 1776 AIC No EXt :503-226-3801 AIC No : 503-226-0376 Portland, OR 97207 E-MAIL N. Dickson Davis ADDRESS: beckie@alfredjdavis.com PRODUCER RUBEN-1 CUSTOMER ID INSURER(S) AFFORDING COVERAGE NAIC # INSURED Rubenstein's Contract INSURERA:Valley Forge Insurance Company 20508 Carpet LLC INSURER B: Continental Insurance Company 35289 Attn: Stephanie Everett PO Box 10637 INSURER C: Continental Casualty Company 20443 Eugene, OR 97440-2637 INSURER D : Liberty Northwest 41939 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 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. ILTR TYPE OF INSURANCE POLICY NUMBER MMIDDY /YYYY MMIDD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY X 5083126517 03/15/2014 03/15/2015 PDAMAGE TO RENTED REMISES Ea occurrence $ 100,000 CLAIMS-MADE Fx_]OCCUR MED EXP (Any one person) $ 5,000 PERSONAL BADVINJURY $ 1,000,000 GENERALAGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY X PJECT RO LOC Stop Gap $ 1,000,000 AUTOMOBILE LIABILITY X COMBINED SINGLE LIMIT $ 1,000,000 B X ANY AUTO 5083126503 03/15/2014 03/1512015 (Ea accident) BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULEDAUTOS PROPERTY DAMAGE $ HIRED AUTOS (PER ACCIDENT) NON-OWNED AUTOS $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 EXCESS LAB CLAIMS-MADE AGGREGATE $ 10,000,000 C X 5083126498 03/15/2014 03/15/2015 DEDUCTIBLE $ X RETENTION $ Nil $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS' LIABILITY TORY LIMITS ER D ANY PROPRIETOR/PARTNER/EXECUTIVEY NIA WC4-1NC-820245-013 10/01/2013 10/01/2014 E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,00 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,000 A Installation 5083126517 03/15/2014 03/15/2015 Limit 2,000,000 Floater Storage 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) re: All Operations see notes attached for additional insured wording Installation Floater includes coverage for materials in storage. CERTIFICATE HOLDER CANCELLATION CITYASH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN y ACCORDANCE WITH THE POLICY PROVISIONS. 20 East Main Street Ashland, OR 97520 AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD NOTEPAD. HOLDER CODE CITYASH RUBEN-1 PAGE 2 INSURED-S NAME Rubenstein's Contract OP ID: NS Date 0713012014 The City of Ashland, and its elected officials officers and employees are named as additional insured per attached G140331C and CA2048. Coverage afforded shall be primaryy and non-contributory when required by written contract per attached G140331C. Rubenstein's Contract Carpet LLC G-140331-C • CNA Policy Number: 5083126517 (Ed. 10/10) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - WITH PRODUCTS-COMPLETED OPERATIONS COVERAGE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE (OPTIONAL) Name of Additional Insured Persons Or Organizations (As required by "written contract" per Paragraph A. below.) Locations of Covered Operations (As per the "written contract," provided the location is within the "coverage territory" of this Coverage Part.) A. Section II - Who Is An Insured is amended to 2. We will not provide the additional insured any include as an additional insured: broader coverage or any higher limit of 1. Any person or organization whom you are insurance than the least that is: required by "written contract" to add as an a. Required by the "written contract"; additional insured on this Coverage Part; and b. Described in 13.1. above; or 2. The particular person or organization, if any, c. Afforded to you under this policy. scheduled above. B. The insurance provided to the additional insured is 3. This insurance is excess of all other insurance limited as follows: available to the additional insured whether on a primary, excess, contingent or any other basis. 1. The person or organization is an additional But if required by the "written contract," this insured only with respect to liability for "bodily insurance will be primary and non-contributory injury," "property damage," or "personal and relative to insurance on which the additional advertising injury" caused in whole or in part by: insured is a Named Insured. a. Your acts or omissions; or 4. The insurance provided to the additional insured does not apply to "bodily injury," "property b. The acts or omissions of those acting on damage," or "personal and advertising injury your behalf arising out of: in the performance of your ongoing operations a. The rendering of, or the failure to render, specified in the "written contract"; or any professional architectural, engineering, c. "Your work" that is specified in the "written or surveying services, including: contract" but only for "bodily injury" or " (1) The preparing, approving, or failing to property damage" included in the prepare or approve maps, shop "products-completed operations hazard," drawings, opinions, reports, surveys, and only if: field orders, change orders or drawings (1) The "written contract" requires you to and specifications; and provide the additional insured such (2) Supervisory, inspection, architectural or coverage; and engineering activities; or (2) This Coverage Part provides such coverage. G-140331-C Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 1 of 2 (Ed. 10/10) Ru NuContract Carpet LLC G-14 Policy 10/10) Policy Number: 5083126517 (Ed. 10/1 U) b. Any premises or work for which the We have no duty to defend or indemnify an additional insured is specifically listed as an additional insured under this endorsement until additional insured on another endorsement we receive from the additional insured written attached to this Coverage Part. notice of a claim or "suit." C. SECTION IV - COMMERCIAL GENERAL 2. With respect only to the insurance provided by LIABILITY CONDITIONS is amended as follows: this endorsement, the first sentence of 1. The Duties In The Event of Occurrence, Paragraph 4.a. of the Other Insurance Condition Offense, Claim or Suit condition is amended to is deleted and replaced with the following: add the following additional conditions 4. Other Insurance applicable to the additional insured: a. Primary Insurance An additional insured under this endorsement This insurance is and non- will as soon as practicable: primary contributory except when rendered (1) Give us written notice of an "occurrence" or excess by endorsement G-140331-C, an offense which may result in a claim or or when Paragraph b. below applies. "suit" under this insurance, and of any claim D. Only for the purpose of the insurance provided by or suit that does result; this endorsement, SECTION V - DEFINITIONS is (2) Except as provided in Paragraph B.3 of this amended to add the following definition: endorsement, agree to make available any "Written contract" means a written contract or other insurance the additional insured has written agreement that requires you to make a for a loss we cover under this Coverage Part; person or organization an additional insured on this Coverage Part, provided the contract or agreement: (3) Send us copies of all legal papers received, 1. Is currently in effect or becomes effective during and otherwise cooperate with us in the the term of this policy; and investigation, defense, or settlement of the claim or "suit"; and 2. Was executed prior to: (4) Tender the defense and indemnity of any a. The "bodily injury" or "property damage"; or claim or "suit" to any other insurer or self insurer whose policy or program applies to a b The offense that caused the "personal and loss we cover under this Coverage Part. advertising injury" if the "written contract" requires this for which the additional insured seeks coverage insurance to be primary and non- under this Coverage Part. contributory, this provision (4) does not apply to insurance on which the additional insured is a Named Insured. G-140331-C Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 2 of 2 (Ed. 10/10) POLICY NUMBER: 5083126517 COMMERCIAL AUTO CA 20 48 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Endorsement Effective: 3/15/14 Countersigned By: Named Insured: Rubenstein's Contract Carpet LLC SCHEDULE Name of Person(s) or Organization(s): Any person or organization which is required To be named as a result of written contract (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section II of the Coverage Form. CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 InterfaceSERVICES- PROPOSAL 106 Northpoint Parkway, Suite 300 >w Acworth, GA 30102 Ashland Parks Department 108418 800.336.0225 / fax 770.975.1799 . - r ti s -a Penny Spencer 8003360225 x4836 7/18/2014 ra 4' Price good for 90 days s • s s s - , • unless noted below Bruce Dickens Ashland Parks Department Offices Rubensteins Ashland County 340 S Pioneer St Ashland, OR 97520 OR 7~ 9, 77 7-1 95.68 sq yd Cubic 6393 Height $22.69 $2,170.98 85 sq yd Carpet Installation $8.93 $759.05 85 sq yd Carpet removal, recycling, disposal, Prevailing $5.98 $508.30 Wage 2 ea Floor Prep, man hours, Prevailing Wage $68.67 $137.34 1 ea Prep Material $23.76 $23.76 Pricing based on State of Oregon Price Agreement #258, good Jul 1, 2014 to June 30, 2015. I . 0 . $2,170.98 . • • $1,428.45 $0.00 t $0.00 $3,599.43 Signature Date 7/18/2014 InterfaceSERVICESTM PROPOSAL 106 Northpoint Parkway, Suite 300 Acworth, GA 30102 IOak Knoll Golf Club : 108417 800.336.0225 / fax 770.975.1799 IMP Penny Spencer 8003360225 x4836 7/18/2014 Price good for 90 days s s ; rs s s f' 'r s s unless noted below Bruce Dickens Oak Knoll Golf Club Rubensteins Ashland County 3070 HW 66 Ashland, OR 97520 OR ONOMMMMI,". Flom 191.36 sq yd Cubic Vertical $22.69 $4,341.96 185 sq yd Carpet Installation $8.93 $1,652.05 185 sq yd Carpet removal, recycling, disposal, Prevailing $5.98 $1,106.30 Wage 6 ea Floor Prep, man hours, Prevailing Wage $68.67 $412.02 360 In ft 4" cove base, supply and install $1.56 $561.60 360 In ft Base removal, recycling, disposal, Prevailing $0.38 $136.80 Wage 36 In ft Premium Transitions $5.01 $180.36 6 ea Prep Material $23.76 $142.56 Pricing based on State of Oregon Price Agreement #258, good Jul 1, 2014 to June 30, 2015. • • $4,341.96 $4,191.69 • $0.00 ` $0.00 $8,533.65 Signature Date 7/18/2014 Page 1 / 1 ASHLAND PARK COMMISSION 20 E MAIN ST. DATE FPO NUMBER ASHLAND, OR 97520 8/20/2014 00386 (541) 488-5300 VENDOR: 004518 SHIP TO. RUBENSTEINS CONTRACT CARPET LL PO BOX 10637 EUGENE, OR 97440-2637 FOB Point: Req. No.: Terms: net Dept.: Req. Del. Date: Contact: Bruce Dickens Special Inst: Confirming? No Quantity Unit - Descri tion Unit Price " Ext. Price THIS IS A REVISED PURCHASE ORDER State of Oreqon Price Aqreement #2583 4,191.69 Oak Knoll Golf Course Pro Shop Quote 108417 - Carpet installation only Ashland Park Shop Office 1,428.45 340 S. Pioneer Quote 108418 - Carpet installation only Note: Separate PO is beinq issued for carpet purchase to Interface Services. This purchase is placed aqainst State of Oreqon Price Aqreement #2583. The contract terms and conditions, special contract terms and conditions (T's & C's) contained in the price aqreement are hereby incorporated by reference and shall apply to this purchase and shall take precedence over all other conflictinq T's & C's expressed or implied. SUBTOTAL 5.620.14 BILL TO: TAX 0.00 FREIGHT 0.00 TOTAL 5,620.14 Account Number Project Number Amount Account Number Project Number Amount E 211.12.02.06.70400 5,620.14 Authorized Signatur ~ VENDOR COPY FORM#3 CITY OF ASHLAND REQUISITION Date of request: Required date for delivery: Vendor Name 1. be,05J-e i l) S Address, City, State, Zip PD f) Ok- . 60117 Mil. 0P- 225 - Contact Name & Telephone Number C-1&9Aft-1-k1 65Cri ) _ &Sa Fax Number SOURCING METHOD ❑ Exempt from Competitive Bidding ❑ Emergency ❑ Reason for exemption: ❑ Invitation to Bid (Copies on file) ❑ Form #13, Written findings and Authorization ❑ AMC 2.50 Date approved by Council: ❑ Written quote or proposal attached ❑ Written quote or proposal attached ❑ Small Procurement Cooperative Procurement Less than $5.000 ❑ Request for Proposal (Copies on file) ® State of Oregon ❑ Direct Award Date approved by Council: Contract # ❑ Verbal/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 Intergovern mental Agreement $5,000 to $75,000 ❑ Agency ❑ Form #g, Request for Approval ❑ Less than $35,000, by direct appointment ❑ Written quote or proposal attached Date original contract approved by Council: ❑ (3) Written proposals/written solicitation Date approved by Council: (Date) ❑ Form #4, Personal Services $5K to $75K Valid until: Date Description of SERVICES _ Total Cost ( Jbt 6`( L~l ~ i' vtDL~%t A-NP DISp~ $ , Item # Quantity Unit Description of MATERIALS Unit Price Total Cost ❑ Per attached quotelproposal TOTAL COST Project Number Account Number - AccountNumber2_l _ f 0& Account Number *Expenditure must be charged to the appropriate account numbers for the financials to accurately reflect the actual expenditures. IT Director in collaboration with department to approve all hardware and software purchases: IT Director Date Support -Yes/ No By signing this requisition form, 1 certify that the City's public contracting requirements have been satisfied. Employee:`L L&L ~lJtilV; ~ l Department Head: L (Equal to or greater than $5,000) Department Manager/Supervisor: City Administrator: (Equal to or greater than $25,000) Funds appropriated for current fiscal year NO a Z6 / Finance Director- (Equal to o~t$5,000) Date Comments: Form #3 - Requisition