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HomeMy WebLinkAbout2015-052 Contract - Pacific Electrical Contractors Contract for GOODS AND SERVICES Less than $25,000 ASHY y CONTRACTOR: Pacific Electrical Contractors 10 CONTACT: Joe Myers, Vice President (Attn: Terry R. Partsafas - main contact) IS Q RECR~P°~ ADDRESS: 920 S. Grape St., Medford, OR 97501 340 S. Pioneer Street Ashland, Oregon 97520 TELEPHONE: 541-773-7751 Telephone: 541/488-5340 FAX: 541-779-2072 ORIGINAL Fax: 541/488-5314 DATE AGREEMENT PREPARED February 11, 2015 BEGINNING DATE: 2/19/15 COMPLETION DATE: 3/20/15 COMPENSATION: Not to exceed $4,345.00 GOODS AND SERVICES TO BE PROVIDED: Install 14 Lithium LVMS232-MDR-DLS-Mvolt-GEB101S as described in the request for quotation. See Exhibit C ADDITIONAL TERMS: In the event of conflicts or discrepancies among the contract documents, the City of Ashland Parks and Recreation Commission 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 prima City of Ashland Parks and Recreation Commission 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 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, 27913.225, 2798.230, 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 /Commission. Contract for Goods and Services Less than $25,000, Revised 07/08/2014, Page 1 of 6 9. Termination: a. Mutual Consent. This contract may be terminated at any time by mutual consent of both parties. b. City's Convenience. This contract may be terminated at any time by City upon 30 days' notice in writing and delivered by certified mail or in person. C. For Cause. City may terminate or modify this contract, in whole or in part, effective upon delivery of written notice to Contractor, or at such later date as may be established by City under any of the following conditions: i. If City funding from federal, state, 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 Contract for Goods and Services Less than $25,000, Revised 07/08/2014, Page 2 of 6 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 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. Contract for Goods and Services Less than $25,000, Revised 07/08/2014, Page 3 of 6 Contractor: City of Ashland Parks and Recreation Commission r By )AA By -A j1AA Department Head Ilb 34P erg, Y\&t 1,0 rin~t1 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 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. X (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. X (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. 2 l3 ~ Contractor (Date) Contract for Goods and ices Less than $25,000, Revised 07/08/2014, Page 5 of 6 • ASHLAND, OREGON L CITY EXHIBIT B City of Ashland LIVING ALL employers described below must comply with of WAGE Ashland laws regulating payment of a living wage. per hour effective June 30, 2014 (Increases annually every June 30 by the ~r 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 tot the has received financial amount of wages received by assistance for the project or the employee. ➢ For all hours worked under a 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 50% 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 '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 07108/2014, Page 6 of 6 PACIFIC ELECTRICAL CONTRACTORS CCB #3651 BCD #15-100 PROPOSAL AND ACCEPTANCE SUBMITTED TO Ashland Parks and Recreation PHONE 541-488-5340 DATE 12/11/2014 ATTENTION Rachel Dials FAX 541-488-5314 STREET 340 S. Pioneer St. JOB NAME Install lighting at Skating Ring CITY, STATE, zip Ashland, Or. 97520 SITE LOCATION 90 Windward Way, Ashland, Or. EMAIL rachel.dials(cDashland.or.us SITE CONTACT: Bill Miller JOB PHONE 541-951-0510 We hereby submit specifications and estimates for: Mount (4) metal halide fixtures in the center of the roof (mounting hardware provided by the city of Ashland) Mount (6) metal halide emergency fixtures (3) on each side (mounting hardware provided by the city of Ashland) Install cord caps on all SO cords in ceiling (10 total) (cord caps provided by The City of Ashland) Make up SO cords in their respective underground boxes Labor and materials provided during normal business hours Price excludes City of Ashland Electrical Permit (Permit to be handled by the city of Ashland) Scissor lift to be on site, and provided by the City of Ashland All SO cords to be installed in the air, and in their respective underground box before PEC is on site All existing wiring underground and at the panel is assumed to be complete and in serviceable condition We Propose hereby to furnish material and labor - complete in accordance with the above specifications, for the sum total of Eight Hundred Seventy-Five Dollars and No/100's $875.00 Payment to be made as follows: Within 10 days of receipt of invoice All material is guaranteed to be as specified. All work to be completed in a workmanlike manner Authorized according to standard practices. Any alteration or deviation from the above specifications involving extra costs will be executed only upon written order, and will become an extra charge over and above Signature , the estimate. This proposal is contingent upon strikes, accidents, delays or price increases of necessary Terry R Partsafas-Project Manager commodities such as wire and steel exceeding 10%; therefore, increases are possible beyond the # of days shown at the right. Owner to carry fire, tornado and other necessary insurance. Our workers are fully covered by Workmen's Compensation Insurance. Note: This proposal may be withdrawn by us if not accepted within 30 days. Acceptance of Proposal - The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payments will be made as outlined above. Date of Acceptance Signature CAPABLE. COMPETITIVE. GUARANTEED. 920 South Grape Street • Medford, Oregon 97501 - Phone 541-773-7751 • Fax 541-779-2072 • www.PacificElectrical.cam www.saif.com Oregon Workers' Compensation saif Certificate of Insurance (corporation Certificate holder: CITY OF ASHLAND PARKS & RECREATION 340 S. PIONEER ST ASHLAND, OR 97520-2729 The policy of insurance listed below has been issued to the insured named below for the policy period indicated. The insurance afforded by this policy is subject to all the terms, exclusions and conditions of such policy; this policy is subject to change or cancellation at any time. Insured Producer/contact Pacific Electrical Contractors Inc SAIF Corporation 920 S Grape St Phil L Swinford Medford, Or 97501-3631 541.672.4422 phiswi@saif.com Issued 02/13/2015 Limits of liability Policy 811124 Bodily Injury by Accident $500,000 each accident Period 10/01/2014 to 10/01/2015 Bodily Injury by Disease $500,000 each employee Body Injury by Disease $500,000 policy limit Description of operations/locations/special items Important This certificate is issued as a matter of information only and confers no rights to the certificate holder. This certificate does not amend, extend or alter the coverage afforded by the policies above. This certificate does not constitute a contract between the issuing insurer, authorized representative or producer and the certificate holder. CANCELLATION: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED TO THE POLICYHOLDER AND CERTIFICATE HOLDER IN ACCORDANCE WITH THE POLICY PROVISIONS AND OREGON LAW. SAIF WILL ENDEAVOR TO PROVIDE WRITTEN NOTICE WITHIN 30 DAYS WHENEVER POSSIBLE. Authorized representative r b /L; '--7 I John D. Gilkey Interim President and CEO 400 High Street SE Salem, OR 97312 P: 800.285.8525 F: 503.584.9812 Pol icy_OLCA_CertificateOfl nsu ra nce PAC107C OP ID: MAJ 2015 Y) ACORO CERTIFICATE OF LIABILITY INSURANCE rATE02/ 131 3//2015 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 NCONTACT AME: Marcia Aho United Risk Solutions, Inc. PHONE 541-245-1111 AX No:541-245-1112 PO Box 936 A/c No Ext Medford, OR 97501-0067 E-MAIL SS: marcia.aho@unitedrisk.com INSURERS AFFORDING COVERAGE NAIC # INSURER A: Cincinnati Insurance Company 10677 INSURED Pacific Electrical INSURER B : Contractors, Inc. 920 S. Grape St. INSURER c Medford, OR 97501-3631 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. INSR TYPE OF INSURANCE ADDL UB POLICY NUMBER MM DD YYYY MM/DD Y YY LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 DAMA TO REMISES S ( Ea RENTED occurrence $ 500,000 A X COMMERCIAL GENERAL LIABILITY X EPP0260135 07/01/2014 07/01/2015 P PREM CLAIMS-MADE Fx_]OCCUR MED EXP (Any one person) $ 10,00 PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,00 POLICY X PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1 000,000 Ea accident A X ANY AUTO EBA0260135 07/01/2014 07/01/2015 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS PER ACCIDENT $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,00 A EXCESS LIAB CLAIMS-MADE EPP0260135 07/01/2014 07/01/2015 AGGREGATE $ 5,000,00 DED RETENTION $ Incl EL $ WORKERS COMPENSATION WTATU- OTH- AND EMPLOYERS' LIABILITY Y/ N C RY S L M T E E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ NIA OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) RE: Install 14 Lithium LVMS232-MDR-DLS-Mvolt-GEB101S The City of Ashland, Oregon, and its elected officials, officers and employees are listed as Additional Insureds as provided by endt #GA 233 OR 09-10 on any insurance policies required herein but only with respect to Contractors services provided under this contradt. SEE NEXT PAGE CERTIFICATE HOLDER CANCELLATION CITAS04 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. Parks & Recreation 340 S. Pioneer St. AUTHORIZED REPRESENTATIVE Ashland, OR 97520-2729 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD NOTEPAD. HOLDER CODE CITAS04 PAC107C PAGE 2 INSURED'S NAME Pacific Electrical OP ID: MAJ Date 02/13/2015 Coverage is Primary and Non-Contributoryy as provided by endt #GA 233 OR 09-10. Cancellation clause as provided by endt. #IA4374 OR 04-14. . THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OREGON CONTRACTORS' COMMERCIAL GENERAL LIABILITY BROADENED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Endorsement - Table of Contents: Coverage: Begins on Page: 1. Employee Benefit Liability Coverage ...............2 2. Unintentional Failure to Disclose Hazards .........................................................................................8 3. Damage to Premises Rented to You 8 4. Supplementary Payments ..................................................................................................................9 5. Medical Payments ............................................................................................................................10 6. Voluntary Property Damage (Coverage a.) and Care, Custody or Control Liability Coverage (Coverage b.) ......................................................................................................10 7. 180 Day Coverage for Newly Formed or Acquired Organizations ...................................................10 8. Waiver of Subrogation .....................................................................................................................10 9. Automatic Additional Insured - Specified Relationships: I I x Managers or Lessors of Premises; x Lessor of Leased Equipment; x Vendors; X State or Political Subdivisions - Permits Relating to Premises; X State or Political Subdivisions - Permits; and x Contractors' Operations 10. Broadened Contractual Liability -Work Within 50' of Railroad Property ..........................................16 11. Property Damage to Borrowed Equipment ......................................................................................16 12. Employees as Insureds - Specified Health Care Services: 16 x Nurses; x Emergency Medical Technicians; and X Paramedics 13. Broadened Notice of Occurrence .....................................................................................................16 B. Limits of Insurance: The Commercial General Liability Limits of Insurance apply to the insurance provided by this endorsement, except as provided below: 1. Employee Benefit Liability Coverage Each Employee Limit: $ 1,000,000 Aggregate Limit: $ 3,000,000 Deductible: $ 1,000 3. Damage to Premises Rented to You The lesser of: a. The Each Occurrence Limit shown in the Declarations; or b. $500,000 unless otherwise stated $ 4. Supplementary Payments a. Bail bonds: $ 1,000 b. Loss of earnings: $ 350 5. Medical Payments Medical Expense Limit: $ 10,000 Includes copyrighted material of Insurance GA 233 OR 0910 Services Office, Inc., with its permission. Page 1 of 16 6. Voluntary Property Damage (Coverage a.) and Care, Custody or Control Liability Coverage (Coverage b.) Limits of Insurance (Each Occurrence) Coverage a. $1,000 Coverage b. $5,000 unless otherwise stated $ Deductibles (Each Occurrence) Coverage a. $250 Coverage b. $250 unless otherwise stated $ COVERAGE PREMIUM BASIS RATE ADVANCE PREMIUM (a) Area (For Limits in Excess of (For Limits in Excess of (b) Payroll $5,000) $5,000) (c) Gross Sales (d) Units e Other b. Care, Custody $ or Control TOTAL ANNUAL PREMIUM 11. Property Damage to Borrowed Equipment Each Occurrence Limit: $ 10,000 Deductible: $ 250 C. Coverages: 2) Our right and duty to 1. Employee Benefit Liability Coverage defend ends when we ance a. The following is added to SECTION I cable have limit o of f used the insurance - COVERAGES: Employee Benefit in the payment of Liability Coverage. judgments or settle- (1) Insuring Agreement ments. (a) We will pay those sums that No other obligation or liabil- the insured becomes legally ity to pay sums or perform obligated to pay as dam- acts or services is covered ages caused by any act, er- unless explicitly provided for ror or omission of the in- under Supplementary Pay- sured, or of any other per- ments. son for whose acts the in- (b) This insurance applies to sured is legally liable, to damages only if the act, er- which this insurance ap- ror or omission, is negli- plies. We will have the right gently committed in the and duty to defend the in- "administration" of your sured against any "suit" "employee benefit program"; seeking those damages. and However, we will have no duty to defend against any 1) Occurs during the pol- "suit" seeking damages to icy period; or which this insurance does not apply. We may, at our 2) Occurred prior to the discretion, investigate any effective date of this report of an act, error or endorsement provided: omission and settle any a) You did not have claim or ,suit that may re- knowledge of a sult. But: claim or "suit" on 1) The amount we will pay or before the ef- for damages is limited fective date of this as described in SEC- endorsement. TION III - LIMITS OF You will be INSURANCE; and deemed to have Includes copyrighted material of Insurance GA 233 OR 09 10 Services Office, Inc., with its permission. Page 2 of 16 knowledge of a 1) Failure of any invest- claim or "suit" ment to perform; when any "author- • ized represents- 2) Errors in providing in- tive' ; formation on past per- formance of investment i) Reports all, or vehicles; or any part, of the ad, error or 3) Advice given to any omission to us person with respect to or any other that person's decision insurer; to participate or not to participate in any plan ii) Receives a included in the "em- written or ver- ployee benefit pro- bal demand or gram". claim for dam- ages because (f) Workers' Compensation of the act, error and Similar Laws or omission; Any claim arising out of your and failure to comply with the b) There is no other mandatory provisions of any applicable insur- workers' compensation, un- ance. employment compensation insurance, social security or (2) Exclusions disability benefits law or any similar law. This insurance does not apply to: (a) Bodily Injury, Property (g) ERISA Damage or Personal and Damages for which any in- Advertising Injury sured is liable because of li- ability imposed on a fiduci- "BodilY in1 N "property ary by the Employee Re- damage" or "personal and tirement Income Security advertising injury". Act of 1974, as now or (b) Dishonest, Fraudulent, hereafter amended, or by Criminal or Malicious Act any similar federal, state or local laws. Damages arising out of any (h) Available Benefits intentional, dishonest, fraudulent, criminal or mali- Any claim for benefits to the cious act, error or omission, extent that such benefits are committed by any insured, available, with reasonable including the willful or reck- effort and cooperation of the less violation of any statute. insured, from the applicable (c) Failure to Perform a Con- funds accrued or other col- tract lectible insurance. Damages arising out of fail- (i) Taxes, Fines or Penalties ure of performance of con- Taxes, fines or penalties, tract by any insurer. including those imposed (dj Insufficiency of Funds under the Internal Revenue Code or any similar state or Damages arising out of an local law. insufficiency of funds to meet any obligations under Q) Employment-Related any plan included in the Practices "employee benefit program". Any liability arising out of (e) Inadequacy of Perform- any: ance of Investment / Ad- (1) Refusal to employ; vice Given With Respect to Participation (2) Termination of em- ployment; Any claim based upon: Includes copyrighted material of Insurance GA 233 OR 09 10 Services Office, Inc., with its permission. Page 3 of 16 (3) Coercion, demotion, tors are insureds, but only evaluation, reassign- with respect to their duties ment, discipline, defa- as your officers or directors. mation, harassment, Your stockholders are also humiliation, discrimina- insureds, but only with re- tion or other employ- spect to their liability as ment related practices, stockholders. acts or omissions; or (e) A trust, you are an insured. (4) Consequential liability Your trustees are also in- as a result of (1), (2) or sureds, but only with respect (3) above. to their duties as trustees. This exclusion applies (2) Each of the following is also an whether the insured may be insured: held liable as an employer or in any other capacity and (a) Each of your "employees" to any obligation to share who is or was authorized to damages with or repay administer your "employee someone else who must benefit program". pay damages because of (b) Any persons, organizations the injury or "employees" having (3) Supplementary Payments proper temporary authoriza- tion to administer your "em- SECTION I - COVERAGES, ployee benefit program" if SUPPLEMENTARY PAY- you die, but only until your MENTS - COVERAGES A AND legal representative is ap- B also apply to this Coverage. pointed. b. Who is an Insured (c) Your legal representative if you die, respects Employee Benefit Liabil- but only with re- As sped to duties as such. . ity Coverage, SECTION II - WHO IS That representative will AN INSURED is deleted in its entirety have all your rights and du- and replaced by the following: ties under this Coverage (1) If you are designated in the Dec- Part. larations as: (3) Any organization you newly ac- (a) An individual, you and your quire or form, other than a part- spouse are insureds, but nership, joint venture or limited only with respect to the con- liability company, and over which duct of a business of which you maintain ownership or ma- you are the sole owner. jority interest, will qualify as a Named Insured if no other simi- (b) A partnership or joint ven- lar insurance applies to that or- ture, you are an insured. ganization. However, coverage Your members, your part- under this provision: ners, and their spouses are also insureds but only with (a) Is afforded only until the respect to the conduct of 180th day after you acquire your business. or form the organization or the end of the policy period, (c) A limited liability company, whichever is earlier; and you are an insured. Your members are also insureds, (b) Does not apply to any act, but only with respect to the error or omission that was conduct of your business. committed before you ac- Your managers are insur- quired or formed the organi- eds, but only with respect to zation. their duties as your manag- c. Limits of Insurance ers. As respects Employee Benefit Liabil- (d) An organization other than a ity Coverage, SECTION III - LIMITS partnership, joint venture or OF INSURANCE is deleted in its en- limited liability company, you tirety and replaced by the following: are an insured. Your ex- ecutive officers" and direc- Includes copyrighted material of Insurance GA 233 OR 09 10 Services Office, Inc., with its permission. Page 4 of 16 (1) The Limits of Insurance shown in amount stated in the Decla- Section B. Limits of Insurance, rations as applicable to 1. Employee Benefit Liability Each Employee. The limits Coverage and the rules below of insurance shall not be re- fix the most we will pay regard- duced by the amount of this less of the number of deductible. (a) Insureds; (b) The deductible amount stated in the Declarations (b) Claims made or "suits" applies to all damages sus- brought; tained by any one "em- (c) Persons or organizations ployee", including such making claims or bringing "employee's" dependents "suits"; and beneficiaries, because of all acts, errors or omis- (d) Acts, errors or omissions; or sions to which this insur- (e) Benefits included in your ance applies. "employee benefit program". (c) The terms of this insurance, (2) The Aggregate Limit shown in tnocluding those with respect Section B. Limits of Insurance, 1. Employee Benefit Liability 1) Our right and duty to Coverage of this endorsement is defend the insured the most we will pay for all dam- against any "suits" ages because of acts, errors or seeking those dam- omissions negligently committed ages; and in the "administration" of your "employee benefit program". 2) Your duties, and the duties of any other in- (3) Subject to the limit described in volved insured, in the (2) above, the Each Employee event of an act, error or Limit shown in Section B. Limits omission, or claim, of Insurance, 1. Employee Benefit Liability Coverage of apply irrespective of the ap- this endorsement is the most we pli amount. of the deductible will pay for all damages sus- tained by any one "employee", (d) We may pay any part or all including damages sustained by of the deductible amount to such "employee's" dependents effect settlement of any and beneficiaries, as a result of: claim or "suit" and, upon no- (a) An act, error or omission; or tification of the action taken, you shall promptly reim- (b) A series of related acts, er- burse us for such part of the rors or omissions, regard- deductible amount as we less of the amount of time have paid. that lapses between such d. Additional Conditions acts, errors or omissions, negligently committed in the As respects Employee Benefit Li- "administration" Coverage, SECTION IV - ployee oyee beenefi snefit n of program". em- COMMERCIAL GENERAL LIABIL- ITY CONDITIONS is amended as fol- However, the amount paid under lows: this endorsement shall not ex- (1) Item 2. Duties in the Event of ceed, and will be subject to the limits and restrictions that apply Occurrence, Offense, Claim or to the payment of benefits in any Suit is deleted in its entirety and plan included in the "employee replaced by the following: benefit program". 2. Duties in the Event of an (4) Deductible Amount Act, Error or Omission, or Claim or Suit (a) Our obligation to pay dam- - a. You must see to it that ages on behalf of the in- we are noted as soon sured applies only to the as practicable of an ad, cess amount of of the damages in ex deductible - error or omission which Includes copyrighted material of Insurance GA 233 OR 09 10 Services Office, Inc., with its permission. Page 5 of 16 may result in a claim. surance may also To the extent possible, apply. notice should include: • d. No insured will, except (1) What the act, error at that insured's own or omission was cost, voluntarily make a and when it oc- payment, assume any curred; and obligation, or incur any expense without our (2) The names and consent. addresses of any- one who may suf- (2) Item 5. Other Insurance is de- fer damages as a leted in its entirety and replaced result of the act, by the following: error or omission. 5. Other Insurance b. If a claim is made or "suit" is brought against If other valid and collectible any insured, you must: insurance is available to the insured for a loss we cover (1) Immediately re- under this Coverage Part, cord the specifics our obligations are limited of the claim or as follows: "suit" and the date received; and a. Primary Insurance (2) Notify us as soon This insurance is Ari- as practicable. mary except when c. below applies. If this in- You must see to it that surance is primary, our we receive written no- obligations are not af- tice of the claim or fected unless any of the "suit" as soon as practi- other insurance is also cable. primary. Then, we will share with all that other c. You and any other in- insurance by the volved insured must: method described in b. (1) Immediately send below. us copies of any b. Method of Sharing demands, notices, summonses or le- If all of the other insur- gal papers re- ance permits contribu- ceived in connec- tion by equal shares, tion with the claim we will follow this or "suit"; method also. Under this approach each insurer (2) Authorize us to ob- contributes equal tain records and amounts until it has other information; paid its applicable limit (3) Cooperate with us of insurance or none of in the investigation the loss remains, or settlement of whichever comes first. the claim or de- If any of the other in- fense against the surance does not per- "suit"; and mit contribution by (4) Assist us, upon equal shares, we will our request, in the contribute by limits. enforcement of Under this method, any right against each insurer's share is any person or or- based on the ratio of its ganization which applicable limit of in- may be liable to surance to the total ap- the insured be- plicable limits of insur- cause of an act, ance of all insurers. error or omission c. No Coverage to which this in- Includes copyrighted material of Insurance GA 233 OR 09 10 Services Office, Inc., with its permission. Page 6 of 16 This insurance shall not providing some or all of the cover any loss for following benefits to "em- which the insured is en- ployees", whether provided titled to recovery under through a "cafeteria plan" or any other insurance in otherwise: force previous to the ef- fective date of this a. Group life insurance; Coverage Part. group accident or health insurance; den- e. Additional Definitions tal, vision and hearing As respects Employee Benefit Li- plans; and flexible spending accounts; ability Coverage, SECTION V - provided that no one DEFINITIONS is amended as fol- other than an "em- lows: ployee" may subscribe (1) The following definitions are to such benefits and added: such benefits are made generally available to 1. "Administration" means: those "employees" who satisfy the plan's eligi- a. Providing information to bility requirements; "employees", including their dependents and b. Profit sharing plans, beneficiaries, with re- employee savings spect to eligibility for or plans, employee stock scope of "employee ownership plans, pen- benefit programs"; sion plans and stock subscription plans, pro- b. Interpreting the "em- vided that no one other ployee benefit pro- than an "employee' grams"; may subscribe to such c. Handling records in benefits and such connection with the benefits are made gen- "employee benefit pro- erally available to all grams"; or "employees who are eligible under the plan d. Effecting, continuing or for such benefits; terminating any "em- ployee's" participation c. Unemployment insur- in any benefit induced ante, social security in the "employee bene- benefits, workers' com- ft programp pensation and disability benefits; and However, "administration" does not include: d. Vacation plans, induc- ing buy and sell pro- a. Handling payroll deduc- grams; leave of ab- tions; or sence programs, in- cluding military, mater- b. The failure to effect or nity, family, and civil maintain any insurance leave; tuition assistance or adequate limits of plans; transportation coverage of insurance, and health club subsi- induding but not limited dies. to unemployment in- surance, social security (2) The following definitions are de- benefits, workers' com- leted in their entirety and re- pensation and disability placed by the following: benefits. 21. 'Suit" means a civil pro- 2. "Cafeteria plans" means ceeding in which money plan authorized by applica- damages because of an act, ble law to allow "employees" error or omission to which to elect to pay for certain this insurance applies are benefits with pre-tax dollars. alleged. "Suit" includes: 3. "Employee benefit pro- a. An arbitration proceed- grams" means a program ing in which such dam- Includes copyrighted material of Insurance GA 233 OR 09 10 Services Office, Inc., with its permission. Page 7 of 16 ages are claimed and The exclusions under SECTION to which the insured I - COVERAGES, COVERAGE must submit or does A. BODILY INJURY AND submit with our con- PROPERTY DAMAGE LIABIL- sent; ITY, 2. Exclusions, other than I. b. Any other alternative War and the Nuclear Energy Y Liability Exclusion, are deleted dispute resolution pro- and the following are added: ceeding in which such damages are claimed This insurance does not apply to: and to which the in- sured submits with our (a) "Property damage": consent; or 1) Assumed in any con- c. An appeal of a civil pro- tract; or ceeding. 2) Loss caused by or re- 8. "Employee" means a person sulting from any of the actively employed, formerly following: employed, on leave of ab- a) Wear and tear; sence or disabled, or re- tired. "Employee" includes a b) Rust, corrosion, 'leased worker". "Employee" fungus, decay, de- does not include a "tempo- terioration, hidden rary worker". or latent defect or 2. Unintentional Failure to Disclose Haz- any quality in property that Ards causes it to dam- SECTION IV - COMMERCIAL GENERAL age or destroy it- LIABILITY CONDITIONS, 7. Represen- self; tations is hereby amended by the addi- c) Smog; tion of the following: d) Mechanical break- Based on our dependence upon your rep- break Y° down including resentations as to existing hazards, if un- rupture or bursting intentionally you should fail to disclose all caused by cen- such hazards at the inception date of your trifugal force; policy, we will not reject coverage under this Coverage Part based solely on such e) Settling, cracking, failure. shrinking or ex- 3. Damage to Premises Rented to You pansion; or a. The last Subparagraph of Paragraph f) Nesting or char 2. SECTION I - COVERAGES, or release discharge e of waste COVERAGE A. - BODILY INJURY or AND PROPERTY DAMAGE, 2. LI- products or r secr secre- ABILITY Exclusions is hereby bird de- birdss, insects, , rodents or leted and replaced by the following: other animals. Exclusions c. through q. do not apply (b) Loss caused directly or indi- to damage by fire, explosion, light- rectly by any of the follow- ning, smoke or soot to premises in while rented to you or temporarily oc- cupied by you with permission of the 1) Earthquake, volcanic owner. eruption, landslide or any other earth move- b. The insurance provided under SEC- ment; TION I - COVERAGES, COVERAGE A. BODILY INJURY AND PROP- 2) Water that backs up or ERTY DAMAGE LIABILITY applies overflows from a sewer, to "property damage" arising out of drain or sump; water damage to premises that are both rented to and occupied by you. 3) Water under the ground surface pressing on, or (1) As respects Water Damage Le- flowing or seeping gal Liability, as provided in Para- through: graph 3.b. above: Includes copyrighted material of Insurance GA 233 OR 09 10 Services Office, Inc., with its permission. Page 8 of 16 a) Foundations, one "occurrence" to which walls, floors or this insurance applies. paved surfaces; • (3) The amount we will pay is limited b) Basements, as described in Section B. Lim- whether paved or its of Insurance, 3. Damage to not; or Premises Rented to You of this endorsement. c) Doors, windows or other openings. 4. Supplementary Payments (c) Loss caused by or resulting Under SECTION I - COVERAGE, SUP- from water that leaks or PLEMENTARY PAYMENTS - COVER- flows from plumbing, heat- AGES AAND B: ing, air conditioning, or fire protection systems caused a. Paragraph 2. is replaced by the fd- by or resulting from freezing, lowing: unless: Up to the limit shown in Section B. 1) You did your best to Limits of Insurance, 4.a. Bail Bonds maintain heat in the of this endorsement for cost of bail building or structure; or bonds required because of accidents or traffic law violations arising out of 2) You drained the equip- the use of any vehicle to which the ment and shut off the Bodily Injury Liability Coverage ap- water supply if the heat plies. We do not have to furnish was not maintained. these bonds. (d) Loss to or damage to: b. Paragraph 4. is replaced by the foi- l ) Plumbing, heating, air lowing: conditioning, fire pro- All reasonable expenses incurred by tection systems, or the insured at our request to assist us other equipment or ap- in the investigation or defense of the pliances; or claim or "suit', including actual loss of earnings up to the limit shown in Sec- 2) The interior of any tion B. Limits of Insurance, 4.b. building or structure, or Loss of Earnings of this endorsement to personal property in per day because of time off from the building or structure work. caused by or resulting from rain, snow, sleet 5. Medical Payments or ice, whether driven by wind or not. The Medical Expense Limit of Any One Person as stated in the Declarations is c. Limit of Insurance amended to the limit shown in Section B. The Damage to Premises Rented to Limits of Insurance, 5. Medical Pay- 9a ments of this endorsement. You Limit as shown in the Declara- tions is amended as follows: 6. Voluntary Property Damage and Care, (2) Paragraph 6. of SECTION III - Custody or Control Liability Coverage LIMITS OF INSURANCE is a. Voluntary Property Damage Cov- hereby deleted and replaced by erage the following: We will pay for "property damage" to 6. Subject to 5. above, the property of others arising out of op- Damage to Premises erations incidental to the insured's Rented to You Limit is the business when: most we will pay under COVERAGE A. BODILY (1) Damage is caused by the in- INJURY AND PROPERTY sured; or DAMAGE LIABILITY, for (2) Damage occurs while in the in- damages because of "prop- sured's possession. erty damage" to premises while rented to you or tem- With your consent, we will make porarily occupied by you these payments regardless of fault. with permission of the owner, arising out of any Includes copyrighted material of Insurance GA 233 OR 09 10 Services Office, Inc., with its permission. Page 9 of 16 b. Care, Custody or Control Liability deductible amount as has been Coverage paid by us. SECTION 1 - COVERAGES, COV- 7. 180 Day Coverage for Newly Formed or ERAGE A. BODILY INJURY AND Acquired Organizations PROPERTY DAMAGE LIABILITY, 2. Exclusions, j. Damage to Property, SECTION II -WHO IS AN INSURED is Subparagraphs (3), (4) and (5) do not amended as follows: apply to "property damage" to the Subparagraph a. of Paragraph 4. is property of others described therein. hereby deleted and replaced by the fol- With respect to the insurance provided by lowing: this section of the endorsement, the fol- a. Insurance under this provision is af- lowing additional provisions apply: forded only until the 180th day after a. The Limits of Insurance shown in the you acquire or form the organization Declarations are replaced by the lim- or the end of the policy period, its designated in Section B. Limits of whichever is earlier; Insurance, 6. Voluntary Property 8. Waiver of Subrogation Damage and Care, Custody or Control Liability Coverage of this SECTION IV - COMMERCIAL GENERAL endorsement with respect to cover- LIABILITY CONDITIONS, 9. Transfer of age provided by this endorsement. Rights of Recovery Against Others to These limits are inclusive of and not Us is hereby amended by the addition of in addition to the limits being re- the following: placed. The Limits of Insurance shown in Section B. Limits of Insur- We waive any right of recovery we may ante, 6. Voluntary Property Dam- have because of payments we make for age and Care, Custody or Control injury or damage arising out of your ongo- Liability Coverage of this endorse- ing operations or "your work" done under ment fix the most we will pay in any a written contract requiring such waiver one "occurrence" regardless of the with that person or organization and in- number of: cluded in the "products-completed opera- tions hazard". However, our rights may (1) Insureds; only be waived prior to the "occurrence" Claims made or "suits" brought; giving rise to the injury or damage for (2) which we make payment under this Cov- or erage Part. The insured must do nothing (3) Persons or organizations making after a loss to impair our rights. At our re- claims or bringing "suits". trquest, ans- fer those eriinsured ghts to us will anbring d help pus enforce b. Deductible Clause those rights. (1) Our obligation to pay damages 9. Automatic Additional Insured - Speci- on your behalf applies only to the fied Relationships amount of damages for each a. The following is hereby added to occurrence' which are in excess SECTION 11-WHO IS AN INSURED: of the deductible amount stated in Section B. Limits of Insur- (1) Any person or organization de- ance, 6. Voluntary Property scribed in Paragraph 9.a.(2) be- Damage and Care, Custody or low (hereinafter referred to as Control Liability Coverage of additional insured) whom you are this endorsement. The limits of required to add as an additional insurance will not be reduced by insured under this Coverage Part the application of such deducti- by reason of: ble amount. A w (2) Condition 2. Duties in the Event (a) me ttto~ contract or agree- of Occurrence, Offense, Claim or Suit, applies to each claim or (b) An oral agreement or con- "suit" irrespective of the amount. tract where a certificate of insurance showing that per- (3) We may pay any part or all of the son or organization as an deductible amount to effect set- additional insured has been tlement of any claim or "suit" issued, and, upon notification of the ac- tion taken, you shall promptly re- is an insured, provided: imburse us for such part of the Includes copyrighted material of Insurance GA 233 OR 09 10 Services Office, Inc., with its permission. Page 10 of 16 (a) The written or oral contract or use of equipment leased or agreement is: to you by such person(s) or 1 Currently in effect or organizations(s). However, y this insurance does not ap- becomes effective dur- ply to any "occurrence" ing the policy period; which takes place after the and equipment lease expires. 2) Executed prior to an (c) Any person or organization "occurrence" or offense (referred to below as ven- to which this insurance dor) with whom you have would apply; and agreed per Paragraph (b) They are not specifically 9.a.(1) above to provide in- named as an additional in- surance, but only with re- sured under any other pro- spect to "bodily injury' or vision of, or endorsement "property damage" arising added to, this Coverage out of 'your products" which Part. are distributed or sold in the regular course of the ven- (2) Only the following persons or or- does business, subject to ganizations are additional insur- the following additional ex- eds under this endorsement, and clusions: insurance coverage provided to such additional insureds is lim- 1) The insurance afforded ited as provided herein: the vendor does not apply to: (a) The manager or lessor of a „ premises leased to you with a) Bodily injury" whom you have agreed per "property damage" for which the ven- Paragraph 9.a.(1) above to dor is obligated to provide insurance, but only with respect to liability aris- pay damages s- ing out of the ownership, reason n the as- maintenance or use of that sumptio of liability part of a premises leased to a contract s you, subject to the following agreement. This additional exclusions: exclusion does not apply to liability for This insurance does not ap- damages that the ply to: vendor would have in the absence of 1) Any "occurrence" which the contract or takes place after you agreement; cease to be a tenant in that premises. b) Any express war- ranty unauthorized 2) Structural alterations, by you; new construction or demolition operations c) Any physical or performed by or on be- chemical change half of such additional in the product insured. made intentionally by the vendor; (b) Any person or organization from which you lease d) Repackaging, ex- equipment with whom you cept when un- have agreed per Paragraph packed solely for 9.a.(1) above to provide in- the purpose of in- surance. Such person(s) or spection, demon- organization(s) are insureds, stration, testing, or but only to the extent that the substitution of the liability for "bodily injury", parts under in- "property damage" or "per- structions from the sonal and advertising injury" manufacturer, and is caused by your negli- then repackaged gence, acts or omissions in in the original con- the maintenance, operation tainer; Includes copyrighted material of Insurance GA 233 OR 09 10 Services Office, Inc., with its permission. Page 11 of 16 e) Any failure to Part with respect make such inspec- to such products. tions, adjustments, tests or servicing (d) Any state or political subdi- as the vendor has vision with which you have agreed to make or agreed per Paragraph normally under- 9.a.(1) above to provide in- takes to make in surance, subject to the fol- the usual course of lowing additional provision: business, in con- This insurance applies only nection with the with respect to the following distribution or sale hazards for which the state of the products; or political subdivision has f) Demonstration, in- issued a permit in connec- stallation, servicing tion with premises you own, or repair opera- rent or control and to which tions, except such this insurance applies: operations per- 1) The existence, mainte- formed at the ven- nance, repair, construc- does premises in tion, erection, or re- connection with moval of advertising the sale of the signs, awnings, cano- product; pies, cellar entrances, g) Products which, coal holes, driveways, after distribution or manholes, marquees, sale by you, have hoist away openings, been labeled or re- sidewalk vaults, street labeled or used as banners, or decorations a container, part or and similar exposures; ingredient of any or other thing or sub- 2) The construction, erec- stance by or for tion, or removal of ele- the vendor; or vators; or h) "Bodily injury" or 3) The ownership, main- "property damage" tenance, or use of any arising out of the elevators covered by negligence, acts or this insurance. omissions of the vendor, its em- (e) Any state or political subdi- ployees or anyone vision with which you have else acting on its agreed per Paragraph behalf. 9.a.(1) above to provide in- surance, subject to the fol- 2) This insurance does not lowing provisions: apply to any insured person or organization: 1) This insurance applies only with respect to op- a) From whom you erations performed by have acquired you or on your behalf such products, or for which the state or any ingredient, political subdivision has part or container, issued a permit. entering into, ac- companying or 2) This insurance does not containing such apply to "bodily injury", products; or „property damage" or personal and advertis- b) When liability in- ing injury" arising out of cluded within the operations performed "products- for the state or political completed opera- subdivision. tions hazard" has been excluded un- (f) For "your work" performed der this Coverage in Oregon, any person or Includes copyrighted material of Insurance GA 233 OR 09 10 Services Office, Inc., with its permission. Page 12 of 16 organization with which you (a) Subparagraphs (e), (f) and have agreed per Paragraph (g) do not apply to "bodily in- 9.a.(1) above to provide in- jury" or "property damage" surance, but only to the ex- included within the "prod- tent that the liability is ucts-completed operations caused by 'your work" per- hazard"; formed for that additional in- sured and only to the extent (b) Subparagraphs (a), (d), (e) that such liability is caused and (g) do not apply to "bod- by your negligence or the ily injury", "property dam- negligence of those acting age" or "personal and ad- on your behalf. A person or of the ng inj sole ury'arising out organization's status as an of th negligence or insured under this provision willful misconduct of the ad- insured or its "em- of this endorsement contin- ployeales'; or of for only the period of loye time required by the written (c) Subparagraph (f) and (g) do contract or agreement, but not apply to "bodily injury", in no event beyond the expi- "property damage" or "per- ration date of this Coverage sonal and advertising injury" Part. If there is no written arising out of: contract or agreement, or if no period of time is required 1) The rendering of, or by the written contract or failure to render, any agreement, a person or or- professional services ganization's status as an in- by you or on your be- sured under this endorse- half, but only with re- ment ends when your op- spect to either or both erations for that insured are of the following opera- completed. tions: (g) For "your work" performed a) Providing engi- in the "coverage territory" neering, architec- but not in Oregon, any per- tural or surveying son or organization with services to others; which you have agreed per and Paragraph 9.a.(1) above to provide insurance, but only b) Providing, or hiring with respect to liability aris- independent pro- ing out of "your work" per- fessionals to pro- formed for that additional in- vide, engineering, sured by you or on your be- architectural or half. A person or organiza- surveying services tion's status as an insured connection with under this provision of this construction work endorsement continues for you perform. only the period of time re- 2) Subject to Paragraph 3) quired by the written con- below, professional tract or agreement, but in no services include: event beyond the expiration date of this Coverage Part. a) Preparing, approv- If there is no written contract ing, or failing to or agreement, or if no period prepare or ap- of time is required by the prove, maps, shop written contract or agree- drawings, opin- ment, a person or organiza- ions, reports, sur- tion's status as an insured veys, field orders, under this endorsement change orders, or ends when your operations drawings and for that insured are com- specifications; and pleted. b) Supervisory or in- (3) Any insurance provided to an spection activities additional insured designated performed as part under Paragraph 9.a.(2): of any related ar- Includes copyrighted material of Insurance GA 233 OR 09 10 Services Office, Inc., with its permission. Page 13 of 16 chitectural or engi- primary to other insurance neering activities. available to the additional 3) Professional services insured except: do not include services 1) As otherwise provided within construction in SECTION IV - means, methods, tech- COMMERCIAL GEN- niques, sequences and ERAL LIABILITY procedures employed CONDITIONS, 5. by you in connection Other Insurance, b. with construction work Excess Insurance; or you perform. 2) For any other valid and (d) Subparagraphs (f) and (g) collectible insurance do not apply to "bodily in- available to the addi- jury" or "property damage" tional insured as an ad- arising out of "your work" for ditional insured by at- which a consolidated (wrap- tachment of an en- up) insurance program has dorsement to another been provided by the prime insurance policy that is contractor / project manager written on an excess or owner of the construction basis. In such case, the project in which you are in- coverage provided un- volved. der this endorsement shall b. Only with regard to insurance pro- vided to an additional insured desig- (2) Condition 11. Conformance to nated under Paragraph 9.a.(2) Sub- Specific Written Contract or paragraphs (f) and (g) above, SEC- Agreement is hereby added: TION III - LIMITS OF INSURANCE is amended to include: 11. Conformance to Specific Written Contract or The limits applicable to the additional Agreement insured are those specified in the written contract or agreement or in a. With respect to addi- the Declarations of this Coverage tional insureds de- Part, whichever are less. If no limits scribed in Paragraph are specified in the written contract or 9.a.(2)(f) above only: agreement, or if there is no written If a written contract or contract or agreement, the limits ap- agreement between plicable to the additional insured are you and the additional those specified in the Declarations of insured specifies that this Coverage Part. The limits of in- coverage for the addi- surance are inclusive of and not in tional insured: addition to the limits of insurance shown in the Declarations. (1) Be provided by the Insurance Ser- c. SECTION IV - COMMERCIAL GEN- vices Office addi- ERAL LIABILITY CONDITIONS is tional insured form hereby amended as follows: number CG 32 61, (1) Condition 5. Other Insurance is CG 32 62 or CG amended to include: 32 63; or (a) Where required by a written (2) Include coverage contract or agreement, this for completed op- insurance is primary and / or erations; or noncontributory as respects (3) Include coverage any other insurance policy for "your work"; issued to the additional in- sured, and such other in- and where the limits or surance policy shall be ex- coverage provided to cess and / or noncontribut- the additional insured is ing, whichever applies, with more restrictive than this insurance. was specifically re- quired in that written (b) Any insurance provided by contract or agreement, this endorsement shall be the terms of Para- Includes copyrighted material of Insurance GA 233 OR 09 10 Services Office, Inc., with its permission. Page 14 of 16 graphs 9.a.(3)(a) or 9.b. agreement specifies above, or any combina- the Insurance Services tion thereof, shall be in- Office additional in- terpreted as providing sured form number CG the limits or coverage 20 10 but does not required by the terms of specify which edition, or the written contract or specifies an edition that agreement, but only to does not exist, Para- the extent that such lim- graphs 9.a.3.b. and its or coverage is in- 9.b. of this endorse- cluded within the terms ment shall not apply of the Coverage Part to and Paragraph which this endorsement 9.a.(3)(a) of this en- is attached. dorsement shall apply. b. With respect to addi- 10. Broadened Contractual Liability -Work tional insureds de- Within 50' of Railroad Property scribed in Paragraph 9.a.(2)(g) above only: It is hereby agreed that Paragraph f.(1) of Definition 12. "Insured contract" (SEC- If a written contract or TION V - DEFINITIONS) is deleted. agreement between you and the additional 11. Property Damage to Borrowed Equip- insured specifies that ment coverage for the addi- a. The following is hereby added to Ex- tional insured: clusion j. Damage to Property of a. Be provided by the Paragraph 2., Exclusions of SEC- Insurance Ser- TION I - COVERAGES, COVERAGE vices Office addi- A BODILY INJURY AND PROP- tional insured form ERTY DAMAGE LIABILITY: number CG 20 10 Paragraphs (3) and (4) of this exclu- or CG 20 37 sion do not apply to tools or equip- (where edition ment loaned to you, provided they are specified); or not being used to perform operations b. Include coverage at the time of loss. for completed op- b. With respect to the insurance pro- erations; or vided by this section of the endorse- c. Include coverage ment, the following additional provi- for "your work"; sions apply: and where the limits or (1) The Limits of insurance shown in coverage provided to the Declarations are replaced by the additional insured is the limits designated in Section more restrictive than B. Limits of Insurance, 11. of was specifically re- this endorsement with respect to quired in that written coverage provided by this en- contract or agreement, dorsement. These limits are in- the terms of Para- clusive of and not in addition to graphs 9.a.(3)(a), the limits being replaced. The 9.a.(3)(b) or 9.b. above, Limits of Insurance shown in or any combination Section B. Limits of Insurance, thereof, shall be inter- 11. of this endorsement fix the preted as providing the most we will pay in any one "oc- limits or coverage re- currence" regardless of the quired by the terms of number of: the written contract or (a) Insureds; agreement, but only to the extent that such lim- (b) Claims made or "suits" its or coverage is in- brought; or cluded within the terms of the Coverage Part to (c) Persons or organizations which this endorsement making claims or bring is attached. If, however, "suits". the written contract or Includes copyrighted material of Insurance GA 233 OR 09 10 Services Office, Inc., with its permission. Page 15 of 16 (2) Deductible Clause a. Nurses; (a) Our obligation to pay dam- b. Emergency Medical Technicians; or ages on your behalf applies only to the amount of dam- c. Paramedics, ages for each "occurrence" in the jurisdiction where an "occurrence" which are in excess of the or offense to which this insurance applies Deductible amount stated in takes place. Section B. Limits of Insur- ance, 11. of this endorse- 13. Broadened Notice of Occurrence ment. The limits of insur- ance will not be reduced by Paragraph a. of Condition 2. Duties in the application of such De- the Event of Occurrence, Offense, ductible amount. Claim or Suit (SECTION IV - COMMER- CIAL GENERAL LIABILITY CONDI- (b) Condition 2. Duties in the TIONS) is herebydeleted and replaced by Event of Occurrence, Of- the following: fense, Claim or Suit, ap- plies to each claim or "suit" a. You must see to it that we are notified irrespective of the amount. as soon as practicable of an "occur- rence" or an offense which may result (c) We may pay any part or all in a claim. To the extent possible, no- of the deductible amount to tice should include: effect settlement of any claim or "suit" and, upon no- (1) How, when and where the "oc- tification of the action taken, currence,, or offense took place; you shall promptly reim- (2) The names and addresses of burse us for such part of the any injured persons and wit- deductible amount as has nesses; and been paid by us. 12. Employees as Insureds - Specified (3) T u nature and locati nn out any inj or Health Care Services ry damage g the "occurrence" or offense. It is hereby agreed that Paragraph This requirement applies only when 2.a.(1)(d) of SECTION II - WHO IS AN the "occurrence" or offense is known INSURED, does not apply to your „em- to an "authorized representative". ploWes" who provide professional health care services on your behalf as duly li- censed: Includes copyrighted material of Insurance GA 233 OR 09 10 Services Office, Inc., with its permission. Page 16 of 16 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OREGON CHANGES - CANCELLATION AND NONRENEWAL This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE PART CHEMICAL APPLICATION LIMITED LIABILITY COVERAGE PART CLAIMS-MADE EXCESS LIABILITY COVERAGE PART COMMERCIAL AUTO COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL OUTPUT POLICY COMMERCIAL PROPERTY COVERAGE PART COMMERCIAL UMBRELLA LIABILITY COVERAGE PART CONTRACTOR'S ERRORS AND OMISSIONS COVERAGE PART - CLAIMS-MADE CONTRACTORS' LIMITED POLLUTION LIABILITY COVERAGE PART CRIME AND FIDELITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART EMPLOYEE BENEFIT LIABILITY COVERAGE PART EMPLOYMENT PRACTICES LIABILITY COVERAGE PART EXCESS LIABILITY COVERAGE PART FARM COVERAGE PART GARAGE COVERAGE PART GOLF COURSE CHEMICAL APPLICATION LIMITED LIABILITY COVERAGE PART HOL.EAN-ONE COVERAGE PART INTERNET LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART MACHINERY AND EQUIPMENT COVERAGE PART MANUFACTURER'S ERRORS AND OMISSIONS COVERAGE PART - CLAIMS-MADE OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCT WITHDRAWAL COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART PROFESSIONAL LIABILITY COVERAGE PART PROFESSIONAL UMBRELLA LIABILITY COVERAGE PART PROFESSIONAL UMBRELLA LIABILITY COVERAGE PART - CLAIMS-MADE SEPTIC SYSTEMS DESIGN AND INSPECTION ERRORS AND OMISSIONS COVERAGE PART SINGLE INTEREST AUTOMOBILE PHYSICAL DAMAGE INSURANCE POLICY A. Paragraph 2. of the Cancellation Common Pol- continuing the policy or in present- icy Condition is replaced by the following: ing a claim under the policy, 2. if this policy has been in effect for: (3) Substantial increase in the risk of loss after insurance coverage has a. Fewer than 60 days and is not a re- been issued or renewed, including newal policy, we may cancel for any but not limited to an increase in reason. exposure due to rules, legislation b. 60 days or more or is a renewal policy, or court decision; we may cancel only for one or more of (4) Failure to comply with reasonable the following reasons: loss control recommendations; (1) Nonpayment of premium; (5) Substantial breach of contractual (2) Fraud or material misrepresenta- duties, conditions or warranties; tion made by you or with your (6) Determination by the commis- knowledge in obtaining the policy, sioner that the continuation of a line of insurance or class of busi- Includes copyrighted material of ISO IA 4374 OR 0414 Properties, Inc., with its permission. Pape 1 of 3 ness to which the policy belongs (1o) above, cancellation will not be ef- will jeopardize our solvency or will fective until at least: place us in violation of the insur- ance laws of Oregon or any other (1) 10 days after the first Named In- state; or sured receives our notice, if we cancel for nonpayment of pre- (7) Loss or decrease in reinsurance mium; or covering the risk. (2) 30 days after the first Named In- c. 60 days or more or is a renewal policy, sured receives our notice, if we we may cancel for any other reason cancel for any other reason. approved by the commissioner by rule, but only with respect to insurance pro- D. Paragraph 6. of the Cancellation Common Pol- vided under the following: icy Condition does not apply. (1) A package policy that includes E. The following are added and supersede any commercial property and com- provision to the contrary. mercial liability insurance; 1. Nonrenewal (2) Commercial Automobile Coverage We may elect not to renew this policy by Part; mailing or delivering to the first Named In- (3) Commercial General Liability sured, at the last mailing address known to Coverage Part; us, written notice of nonrenewal before the: (4) Commercial Property Coverage a. Expiration date of the policy; or Part - Legal Liability Coverage b. Anniversary date of the policy if the Form; polity is written for a term of more than (5) Commercial Property Coverage one year or without a fixed expiration Part - Mortgage Holder's Insur- date. ance Coverage Form; However, if this policy is issued for a term (6) Employment Practices Liability of more than one year and for additional Coverage Part; consideration the premium is guaranteed, we may not refuse to renew the policy at its (7) Farm Coverage Part - Farm Liabi- anniversary date. ity Coverage Form; Nonrenewal will not be effective until at (8) Liquor Liability Coverage Part; least 45 days after the first Named Insured (9) Products/Completed Operations receives our notice. Liability Coverage Part; or 2. Mailing Of Notices (1o) Professional Liability Coverage a. If notice of cancellation or nonrenewal Part. is mailed, a post office certificate of mailing will B. Paragraph 3, of the Cancellation Common Pol- be conclusive proof that the first Named Insured received the no- icy Condition is amended by the addition of the tice on the third calendar day after the following: date of the certificate of mailing. 3. We will mail or deliver to the first Named b. The following provision applies with re- insured written notice of cancellation, stat- spect to coverage provided under the ing the reason for cancellation. Farm Coverage Part: C. The following is added to the Cancellation If the first Named insured has affirma- Common Policy Condition: tively consented to our use of an elec- 7. Number Of Days' Notice Of Cancella- tronic record to deliver notice of can- tion: cellation or nonrenewal and has not withdrawn such consent, then the elec- a. With respect to insurance provided tronic record delivering notice of can- under z.c.(1) through (10) above, can- cellation or nonrenewal satisfies the cellation will not be effective until at requirement that the notice of cancella- least 10 working days after the first tion or nonrenewal be provided, or Named insured receives our notice. made available, to the first Named In- sured in writing if we send the first b. With respect to insurance other than Named Insured the electronic record that provided under 2.c.(1) through Includes copyrighted material of ISO IA 4374 OR 0414 Properties, Inc., with its permission. Page 2 of 3 with a request for a return receipt and ter providing or delivering the notice of we receive the return receipt. If we do cancellation or nonrenewal to the first not receive the return receipt, we may Named Insured in writing, subject to cancel or nonrenew the policy only af- Paragraph 2.a. above. Includes copyrighted material of ISO IA 4374 OW0414 Properties, Inc., with its permission. Page 3 of 3 PACIFIC ELECTRICAL CONTRACTORS CCB #3651 BCD #15-10C PROPOSAL AND ACCEPTANCE SUBMITTED TO Ashland Parks and Recreation PHONE 541-552-2252 DATE 12/5/2014 ATTENTION Bruce Dickens FAX 541-488-5314 STREET 340 S. Pioneer St. JOB NAME Ashland P&R Lighting Retrofit CITY, STATE, zip Ashland, Or. 97520 JOB LOCATION 340 S. Pioner St, Ashland, Or. EMAIL bruce.dickens cDashland.or.us JOB PHONE 541-552-2252 We hereby submit specifications and estimates for: Remove (14) existing surface fixtures Provide and install (14) surface Lithonia AVSM 2 32 MDR DLS MVOLT GEB101S Dispose of removed fixtures, ballasts, and lamps Labor and materials provided during normal business hours Price included City of Ashland Electrical Permit Item number 6, 7, and 8 are already T-8 strip fixtures, and will not be replaced or relamped Delivery of the fixtures will be after the December 30, 2014 deadline We Propose hereby to furnish material and labor - complete in accordance with the above specifications, for the sum total of: Four Thousand Three Hundred Forty-Five Dollars and Noll 00's $4,345.00 Payment to be made as follows: Within 10 days of receipt of invoice All material is guaranteed to be as specified. All work to be completed in a workmanlike manner Authorized _ according to standard practices. Any alteration or deviation from the above specifications involving Signature extra costs will be executed only upon written order, and will become an extra charge over and above the estimate. This proposal is contingent upon strikes, accidents, delays or price increases of necessary Terry R. Partsafas-Project Manager commodities such as wire and steel exceeding 10%; therefore, increases are possible beyond the # of days shown at the right. Owner to carry fire, tomado and other necessary insurance. Our workers are fully covered by Workmen's Compensation Insurance. Note: This proposal may be withdrawn by us if not accepted within 30 days. Acceptance of Proposal - The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payments will be made as outlined above. Date of Acceptance Signature CAPABLE. COMPETITIVE. GUARANTEED. 920 South Grape Street - Medford, Oregon 97501 • Phone 541-773-7751 • Fax 541-779-2072 • www.PacificElectrical.com nPage 1/1 ASHLAND PARK COMMISSION 20 E MAIN ST. DATE FPO NUMBER ASHLAND, OR 97520 2/19/2015 00433 (541) 488-5300 VENDOR: 004559 SHIP TO: PACIFIC ELECTRICAL CONTRACTORS 920 S GRAPE STREET MEDFORD, OR 97501 FOB Point: Req. No.: Terms: net Dept.: Req. Del. Date: contact: Bruce Dickens Special Inst: Confirming? NO Quantity Unit Description Unit Price - Ext. Price Remove and replace 14 liqht fixtures, 4,345.00 includes disposal, per attached contract. Contract for Goods and Services Beqinninq date: 02/1912015 Completion date: 03/20/2015 SUBTOTAL 4.345.001 BILL TO: TAX 0.00 FREIGHT 0.00 TOTAL 4,345.001 Account Number Project Number Amount Account Number Project Number Amount E 411.12.00.00.70420 E 000056.999 4,345.00 Authori ed Signature VENDOR COPY FORM #3 CITY OF 0 4" y ASHLAND REQUISITION Date of request: I I f Required date for delivery: Vendor Name ci)/~J~~ h-)0-2-5 Address, City, State, Zip .ST tO Cf ' b ) Contact Name & Telephone Number -T~ 7.7S 1 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 23 Small Procurement Cooperative Procurement Less than $5,000 ❑ Request for Proposal (Copies on file) ❑ State of Oregon ❑ Direct Award Date approved by Council: Contract # iJ 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) ❑ Form #4, Personal Services $5K to $75K Valid until: Date Description of SERVICES _ Total- Cost PCiM D 1/ - P- (!Ip ! ft-c~ i 4-1 l-I V- T- F-) >C- tvra~-S rg/-~ V I I~ c Sr>~ I J 1 42) yc u s fps S,p~ L I ej] ' Item # Quantity Unit Description of MATERIALSUnit-PriceTotal Cost ® Per attached quotelproposal TOTAL COST Sys; If Project Number qC0 Account Number _ _ _ - _ _ - _ _ / Account NumberL`1( _ - _ i? 6t OD-~~vq~7 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 certify that the City's public contracting requirements have been satisfied. Employee: '11 Al ,Q ti Department Head: (Equal to or greater than $5,000) Department ManagerlSupervisor: City Administrator: (Equal to or greater than $25,000) Funds appropriated for current fiscal year: NO Finance Director- (Equal to orgreaterthan $5,000) Date Comments: Form #3 - Requisition Lighting Upgrade for Lithia Park Offices Bid Tab Contractors Bids Comments Pacific Electrical $4,345.00 Apparent Low Bid Welbum Electric, Inc. $4,734.00 Ashland Electric Chose not to bid CITY OF -ASHLAND A request for authorization SURPLUS PROPERTY DISPOSAL DATE: TO: Lee Tuneberg, Public Contracting Officer PREPARED BY: CONTENTS APPROVED BY (Department Head): 1. Description of Surplus Property by: Description Quantity Identification Current Value Dept and Year Number 2. Disposal Method - j Public Agency or School District Name: ❑ Direct Sale - Price/Offer $ ❑ Direct Transfer l a Non-profit Corporation Name: ❑ Direct Sale - Price/Offer $ ❑ Direct Transfer Method: Comments: APPROVED BY: Date: Lee Tuneberg Finance Director Revenue fund to be credited with proceeds from the disposal of surplus property: _ _ _ _ _ _ _ _