HomeMy WebLinkAbout2014-272 Contract - Apache Metal
Contract for GOODS AND SERVICES Less than $25,000
CITY OF CONTRACTOR: John Gorevin (Apache Metal)
-AS H LAND CONTACT: John Gorevin
20 East Main Street
Ashland, Oregon 97520 ADDRESS: 3935 Coleman Creek Rd, Medford, OR 97501
Telephone: 541/488-6002
Fax: 541/488-5311 TELEPHONE: 541-535-6784
DATE AGREEMENT PREPARED: 10/02/2014 FAX: 541-535-9495
BEGINNING DATE: 10/06/2014 COMPLETION DATE: 10/31/2014
COMPENSATION: $2,469.00
GOODS AND SERVICES TO BE PROVIDED: Custom fabricate painted steel flashing and install on exposed
beams on building exterior per bid attached as Exhibit C. Location: Fire Station #2
ADDITIONAL TERMS:
Workers' Compensation is b i w i4l because the owner/operator has no employees and will be
performing the work himself. Contaptor's initials)
In the event of conflicts or discrepancie among the contract documents, the City of Ashland Contract for Goods and Services will be primary and take
precedence, and any exhibits or ancillary contracts or agreements having redundant or contrary provisions will be subordinate to and interpreted in a
manner that will not conflict with the said primary City of Ashland Contract.
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 27913.220, 27913.225, 27913.230, 27913.235, 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 an time b City upon 30 days' notice in writing
Contract for Goods and Services Less than $25,000, Revised 07/08/2014, Page 1 of 5
and delivered by certified mail or in person.
C. Por 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 O ompensation coverage for all their subject workers
b. Gerieral Liabilit' in rance 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.
Contract for Goods and Services Less than $25,000, Revised 07/08/2014, Page 2 of 5
C. Automobile' bilit insurance with a combined single limit, or the equivalent, of not less than Enter one:
$200, , $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. 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.
Co tra tor: City of Ashlan
By ~~4----~' By
gnature Depart ent Head
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 07/08/2014, 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.
16- `7
Con A~tor (Date)
Contract for Goods and Services Less than $25,000, Revised 07/08/2014, Page 4 of 5
CITY OF ASHLAND, OREGON
EXHIBIT B
City of Ashland
LIVING
WAGE
•
per hour effective June 30, 2014
R (Increases annually every June 30 by the
Consumer Price Index)
• - • - portion of business of their 401 K and IRS eligible
_ employer, if the employer has cafeteria plans (including
ten or more employees, and childcare) benefits to the
has received financial amount of wages received by
For all hours worked under a assistance for the project or the employee.
➢ business from the City of
service contract between their Ashland in excess of ➢ Note: "Employee" does not
employer and the City of $20,142.20. include temporary or part-time
Ashland if the contract employees hired for less than
exceeds $20,142.20 or more. ➢ If their employer is the City of 1040 hours in any twelve-
Ashland including the Parks month period. For more
➢ For all hours worked in a and Recreation Department. details on applicability of this
month if the employee spends policy, please see Ashland
employee's or more of the ➢ In calculating the living wage, Municipal Code Section
employee's time in that month employers may add the value 3.12.020.
working on a project or of health care, retirement,
For additional information:
Call the Ashland City Administrator's office at 541-488-6002 or write to the City Administrator, City Hall,
20 East Main Street, Ashland, OR 97520 or visit the city's website at www.ashland.or.us.
Notice to Employers: This notice must be posted predominantly in areas where it can be seen by all
employees.
CITY OF
ASHLAND
Contract for Goods and Services Less than $25,000, Revised 07/08/2014, Page 5 of 5
3935 Coleman Creek Rd.
Apache METAL Medford, Oregon
JOHN GOREVIN
Phone: 541-535-6784
Fax: 541-535-9495
Pager: 773-0990
X71°nJ° 4 ~ N-c P~VQ F ffz +'o OSE ,V, 07 ' "
7'CC N /Al Be-
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---wool GOREV-1 OP ID: TF
ACRD CERTIFICATE OF LIABILITY INSURANCE x10107
THIS CERTIFIPATE 13 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: N the certificate holier Is an ADDITIONAL INSURED, the poifcy(les) must be endorsed ff SUBROGATION IS WANED, 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 Neu of such endorsement(s).
PRODUCER R. Joe Hubbard
Protectors Insurance, LLC ri FAX
Ipa E :541-7T3-5358 JAC, No): 541-772-1906
Pilot Rock Ins Agency LLC (CA)
PO Box 4669 SS: joeh@protectorsins.com
Medford, OR 97501
R. Joe Hubbard INSURER(S) AFFORDING COVERAGE NAIC 0
INSURER A:CBIC -Portland an RLI Company 37206
INSURED John C Gorevin INSURERB:
Apache Metal Construction
3935 Coleman Creek Rd INS"~RQC
Medford, OR 97501 INSURER D
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.
LTR TYPE OF INSURANCE POLICY NUMBER-- (MMIDO(YYYY) LIMITS
A X COMMERCIAL GENERAL LMBti-rIY EACH OCCURRENCE = 1,000,00 -0A0%MHtNItL) 00
CLAWS-MADE occuR X D11 HA3257 04/03/2014 04/03/2015 PREMISES Es occurrence $ 300,
WED EXP (Any one person) $ 5,00
PERSONAL & ADV INJURY f 1,000,00
GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00
POLICY JECT F-] LOC PRODUCTS - COMP/OP AGG t 2,000,
OTHER: $
AUTOMOBILE LIABILITY ECOMBINED a accident SINGLE LIMIT =
ANY AUTO BODILY INJURY (Per person) ;
ALL OWNED SCHEDULED BODILY INJURY (Per sccldent) $
AUTOS AUTOS FM DAMAGE
HIRED AUTOS SOS WNED Per accident =
i
UMBRELLA LM OCCUR EACH OCCURRENCE _
EXCESS LM CLAIMS-MADE AGGREGATE S
DED RETENTION $
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN A R
ANY PROPRIETORIPARTNERIEXECUTIVE E.L. EACH ACCIDENT I$
OFFICERMIEMBER EXCLUDED? F-] NIA
(Mandatory M NH) E. L. DISEASE - EA EMPLOYEE _
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks SchedWe, may be attached If more span In required)
Certificate holder is listed as additinal insured per form CBGLOO41 0606
CERTIFICATE HOLDER CANCELLATION
0000000
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Ashland Fire 8 Rescue THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
455 Slskiyou Blvd
Ashland, OR 97520 AUTHORIZED REPRESENTATIVE
R. Joe Hubbard
®1888-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
BLANKET ADDITIONAL INSURED
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
A. Section II - Who Is An Insured is amended drawings, opinions, reports, surveys,
to include as an additional insured any per- field orders, change orders or draw-
son or organization for whom you are per- ings and specifications; or
forming operations when you and such per- b. Supervisory, inspection, architectural
son or organization have agreed in writing in or engineering activities.
a contract or agreement that such person or
organization be added as an additional in- 2. "Bodily injury" or "property damage" oc-
sured on your policy. Such person or organi- curring after:
zation is an additional insured only with re- a. All work, including materials, parts or
spect to liability for "bodily injury", "property
damage" or "personal and advertising injury" equipment famished in connection
caused by your negligence in the perform- with such work, on the project (other
ance of your ongoing operations performed than service, maintenance or re-
for that additional insured. A person's or or- pairs) to be performed by or on be-
for
status as an additional insured half of the additional insured(s) at
under this endorsement ends when your op- the location of the covered opera-
under
for that additional insured are com-
pleted. b. That portion of "your work" out of
B. With respect to the insurance afforded to which the injury or damage arises
these additional insureds, the following addi- has been put to its intended use by
tional exclusions apply: any person or organization other
than another contractor or subcon-
This insurance does not apply to: tractor engaged in performing opera-
1. "Bodily injury", "property damage" or tions for a principal as a part of the
"personal and advertising injury" arising same project.
out of the rendering of, or the failure to 3. "Bodily injury" or "property damage" oc-
render, any professional architectural, curring or commencing before:
engineering or surveying services, in- a. Execution of the written contract or
cluding but not limited to: agreement that such person or or-
a. The preparing, approving, or failing ganization be added as an additional
to prepare or approve, maps, shop insured on your policy.
CBGL 00 41 06 06 Contains Copyrighted Material of Page 1 of 1
ISO Properties, Inc., with permission
OP ID: HL
E (MM/DD/YYYY)
A~ Ro- VEHICLE OR EQUIPMENT CERTIFICATE OF INSURANCE DAT 10ro7/2014
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.
This form Is used to report coverages provided to a single specific vehicle or equipment. Do not use this form to report liability coverage
provided to multiple vehicles under a single policy. Use ACORD 25 for that purpose.
PRODUCER 541-773-5358 COM ACT R. Joe Hubbard
N,;541-772-1906
Protectors Insurance, LLC 541-772-1906 PHONE .541-773-5358 FAX
Pilot Rock Ins Agency LLC (CA) IA/C. No. tw. PO Box 4669 E.MAa :Joeh@protectorains.com
ADDRZjj
Medford, OR 97501 PRODUCER
GOREJ01
R. Joe Hubbard CUSTOMER ID*:
INS S AFFORDING COVERAGE N=#
INSURED John Jane orev n INSURER A:Safeco Insurance Company 24740
3935 Coleman Creek Rd
Medford, OR 97501 INSURER B
INSURER C :
INSURER D :
INSURER E :
DESCRIPTION OF VEHICLE ORE UIPMENT
YEAR MAKE I MANUFACTURER MODEL BODY TYPE VEHICLE IDENTIFICATION NUMBER
1991 FORD ECONOLIN IPP IFTGS24HOMHAO9065
DESCRIPTION SERIAL NUMBER
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICY(IES) OF INSURANCE LISTED BELOW HAS/HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY
PERIOD(S) 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 POLICY(IES) DESCRIBED HEREIN IS/ARE SUBJECT TO
ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICY(IES).
INSR ADD•L POLICY EFFECTIVE POLICY EXPIRATION
LTR 013RD TYPE OF INSURANCE POLICY NUMBER DATE (MMA)OrYYYY) DATE (MMMOMYY) LIMITS
A VEHICLE LIABILITY COMBINED SINGLE LIMIT t 600,000
P5488135 04112/2014 10/1212014 BODILY INJURY (Per person) $
BODILY INJURY (Per soeident) $
PROPERTY DAMAGE $
GENERAL LIABILITY EACH OCCURENCE $
OCCURRENCE GENERAL AGGREGATE $
CLAIMS MADE $
INSR Loss POLICY EFFECTIVE POLICY EXPIRATION
LTR PAYE TYPE OF INSURANCE POLICY NUMBER DATE (MMDOIYYYY) DATE (MMMD/YYYY) LIMITS I DEDUCTIBLE
A X VEH COLLISION LOSS P5488135 1011212014 0411212015 ❑ ACV ❑ AGREED AMT III LIMIT
❑ ❑ STATED AMT S 500 DED
A X VEH COMP VEH OTC P5488135 10/12/2014 0411212015 C3 ACV ❑ AGREED AMT $ LIMIT
STATED AMT 111 250 DED
PROPERTY ❑ ACV ❑ AGREED AMT
LIMIT
BASIC BROAD ❑ RC ❑ STATED AMT =
DED
SPECIAL 0 t
REMARKS (INCLUDING SPECIAL CONDITIONS I OTHER COVERAGES) (Attach ACORD 101, Additional Remarks Schedule, U more space is required)
ADDITIONAL INTEREST CANCELLATION
Select one of the following: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
The additional interest described below has been added to the poky(is) listed herein by policy nurnber(s). BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE
A nest has been submlted to add the additional Interest described below to the policy(ies) DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
VEHICLE I EQUIPMENT INTEREST: LEASED FINANCED DESCRIPTION OF THE ADDITIONAL INTEREST
NAME AND ADDRESS OF ADDITK)NAL INTEREST ADDITIONAL INSURED H LOSS PAYEE
Ashland Fire and Rescue LENDERS LOSS PAYEE
455 Siskiyou Blvd LOAN I LEASE NUMBER
Ashland, OR 97520
AUTHORIZED REPRESENTATIVE
R. Joe Hubbard
®1997-2010 ACORD CORPORATION. All rights reserved.
ACORD 23 (2010/05) The ACORD name and logo are registered marks of ACORD
L 3935 Coleman Creek Rd.
Apache METAL Medford, Oregon
JOHN' GOREVIN
Phone: 541-535-6784
Fax: 541-535-9495
Pager: 773-0990
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CITY OF
. ASHLAND DATE. PO NUMBER
20 E MAIN ST. 10/8/2014 12547
ASHLAND, OR 97520
(541}.48.8-5300
VENDOR: 019023 SHIP To: Ashland Fire Department
APACH METAL (541) 482-2770
3935 COLEMAN CREEK ROAD 455 SISKIYOU BLVD
ASHLAND, OR 97520
FOB Point: Req. No.:
Terms: Net C9 Dept.:
Req. Del. Date: Contact: Scott Hollinqsworth
Special Insthh~_~'. Confirming? NO
' v LGC..~ G U
Quantity Unit Description ' Unit Price Ext. Price
Custom fabricate painted steel flashinq 2,469.00
and install on exposed beams on
buildinq exterior of Fire Station #2
Contract for Goods and Services
Beqinninq date: 10/06/2014
Completion date: 10/31/2014
SUBTOTAL 2.469.00.
BILL TO: Account Payable TAX 0.00
20 EAST MAIN ST FREIGHT 0.00
541-552-2010 TOTAL 2,469.00
ASHLAND, OR 97520
Account Number Project Number Amount Account Number Project Number Amount
E 110.07.12.00.60222 2,469.00
Authorized Signature / VENDOR COPY
FORM #3 CITY OF
A regUeSf for a'Purchase Order ASHLAND
REQUISITION Date of request:
Required date for delivery:
Vendor Name L~ ~C c o r, \
Address, City, State, Zip C J Q 75 Z d
Contact Name & Telephone Number
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
PS-Lmall 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 Inter -governmental Agreement
❑ Special Procurement 9 $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 r--iptio[ n of SERVICES Total Cost
S-✓~.S~ ~~ti },.._1~ O ~ fvC C ` ~G G~ V `'.l ~.:Jo•~ ~
Item # Quantity Unit Description of MATERIALS Unit Price Total Cost
f~ TOTAL COST
O-Per attached quotelproposal $
Project Number - Account Number---. - -
AccountNumber___-_ 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:
IT Director Date Support -Yes /No
By signing this requisitio formal certifjb#hat hPCity's public contracting requirements have been satisfied.
Employee: 7, / DePartment Head:
v V (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: OYES % NO
Finance Director- (Equal to or greater than $5,000) Date
Comments:
Form #3 - Requisition