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Home My WebLink About2015-167 Contract - William Olsen Designs Contract for GOODS AND SERVICES Small Procurement Less than $5,000 CITY OF INDEPENDENT CONTRACTOR: Vi`( t i a M O 15 C ASHLAND CONTACT: V/~ t ~ ` 6L O 20 East Main Street ADDRESS: 1-~`"`Sr 1 S 13 Ashland, Oregon 97520 G Lp Telephone: 541/488-6002 ~t h 1 '0 2 Fax: 541/488-5311 TELEPHONE: C~yi X2(0 - ( toSZ FAX: BEGINNING DATE: f 7L-a I S COMPLETION DATE: J _L, 3 A 2 0 I'; COMPENSATION: 65 GOODS AND SERVICES TO BE PROVIDED: SgL X{~; f In the event of conflicts or discrepancies among Contract Documen s, this standard form of the City of Ashland Contract 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 this standard form 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. Ownership of Production: All documents, materials or items produced by Contractor pursuant to this contract shall be the property of City. 4. Statutory Requirements: ORS 279B.220, 279B.225, 279B.230, 279B.235, ORS Chapter 244 and ORS 670.600 are made part of this contract. 5. Indemnification: Contractor agrees to defend, indemnify and save City, its officers, employees and agents harmless from those losses, expenses, or other damages resulting from injury to any person or damage to property arising out of or incident to the negligent performance of this contract by Contractor its employees, or agents. Contractor shall not be held responsible for any losses, expenses, or other damages, directly, solely, and proximately caused by the negligence of City. 6. Termination: City's Convenience. This contract may be terminated at any time by the City. 7. 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. 8. 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. 9. Asbestos Abatement License: If required under ORS 468A.710, Contractor or Subcontractor shall possess an asbestos abatement license. 10. Assignment and Subcontracts: Contractor shall not assign this contract or subcontract any portion of the work. 11. 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. 12. 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. 13. Insurance. Contractor shall at its own expense provide the following insurance: a. 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. Worker's compensation insurance is required if work is performed by employees, subcontractors, or volunteers. BY INITIALING THIS SENTENCE, CONTRACTOR CERTIFIES UNDER PENA} TY OF LAW THAT THE WORK REQUIRED BY THIS CONTRACT SHALL BE PERFORMED SOLELY BY THE UNDERSIGNED: tr . -f~D General Liability insurance with a combined single limit, or the equivalent, of not less than $1,000,000 for each occurrence for Bodily Injury Perty Damage. It shall include contractual liability coverage for the indemnity provided under this contract. " Automobile Liability insurance with a combined single limit, or the equivalent, of not less than $1,000,000 for each accident for Bodily ry an d Property Damage, including coverage for owned, hired or non-owned vehicles, as applicable. 14. Governing Law; Jurisdiction; Venue: This contract shall be governed and construed in accordance with the laws of the State of Oregon 15. 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. Certification. Contractor shall sign the certification attached hereto as Exhibit A and herein incorporated by reference. Cont tor: City of Ashland: By By ature a rtme t ~ead Print Name Prin Na e o w n c /8 9 Title Date W-9 One copy of a W-9 is to be submitted with the signed contract. Purchase Order No. Cave ~ ~ ' Alt V-N C.,e 6(o-~ n f h AfA--I . Revised 10-28-14 r O fi 1 Page of VJ 0 I 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. 1'vn`tract6r (Date) Revised 10-28-14 Page 2 of 2 My O 3 O x o 3 ° 3 m i Y~° a N 1'V _ ro c ~ ? A O = 7 O= x< - - m a` - v H v o ~ ox 3 s o V ID -t o~ 3 _ o`a v p.i rho 3 d ti a vii T 3 _ w \/1 o a w lr^ c e n m > °m ^ T 3 0 0 O p E S O Z - i A c 8 m O x m n ~ D N n 3 a °c 1 bd 9WILLOL OP ID: PS ACORL7 DATE (MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 05/13/2015 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 polfcy(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 endorsements . PRODUCER Phone: 541-7794232 NAME: T Hart Insurance _NAME: PHONE FA-2---- 1123 Royal Ave. Fax: 541-772-3963 1AICNo. E9i: . Medford, OR 97604 E•N Arc No Hart Insurance / Medford aDPRESS: INSURERIS AFl FORDING COVERAGE NAIC# _INSURER A Liberty Northwest Ins. Corp 41939 INSURED Witiliam Olsen Designs INSURER B: 280 East Hersey St Unit 13 - - - - Ashland, OR 97520 INSURERC 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. INTER TYPE OF INSURANCE AM~ OLICY EFF Y EXP IN, WyD I POLICY NUMBER MMlDD Y MM1D JYY Y LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A ' X COMMERCIAL GENERAL LIABILITY X 8KA55855232 01124/2015 DAMAGj=fo RERTEU- ' 01/24/2016 PREMISES (Eag cunence $ 1,000,00 CLAIMS-MADE U OCCUR j MED EXP (Any one person) $ 13100 r PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000 00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,00 PRO- POLICY , LOC ! g AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT , a ~ccWeni) ANY AUTO BODILY INJURY (Per person) S ALL OWNED SCHEDULED AUTOS F AUTOS BODILY INJURY (Per accident)! $ HIRED AUTOS NON-OWNED P£RTY DAMA AUTOS P¢r cc dent $ UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LU18 LAIMS•MADE ; AGGREGATE $ - - ~---DED RETENTION WORKERS COMPENSATION WC STATU• OTH- AND EMPLOYERS' LIABILITY YIN LIMITS..-, ANY PROPRIETORIPARTNERIEXECUTWE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) I E.L. DISEASE -EA EMPLOYE S If yes, describe under t__ DESCRIPTION OF OPERATIONS pelow E.L. DISEASE -.POLICY LIMIT $ i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if mom space Is required) Certificate Holder is an additional insured per form # CG8810 (4/13) CERTIFICATE HOLDER CANCELLATION ASHLPA1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Ashland Parks and Recreation ACCORDANCE WITH THE POLICY PROVISIONS. 340 S Pioneer Street Ashland, OR 97520 AUTHORIZED ESENTATIVE Hart Insurn e I Me rd (D 1988.2010 ACORD CO ORATION. All rights reserved. ACORD 26 (2010/05) The ACORD name and logo are registered marks of ACORD GEICO GEICO CASUALTY COMPANY Washington DC VERIFICATION OF COVERAGE (SEE BELOW UNDER CAUTIONARY NOTE) INSURED Policy Number: 424805 5131 Effective Date: 04-27-15 WILLIAM MARTIN OLSEN Expiration Date: 10-27-15 108 E HERSEY ST Registered State: OREGON UNIT 5 ASHLAND- OR 47520-1363 To whom it may concern: This letter is to verify that we have issued the policyholder coverage under the above policy number for the dates indicated in the effec- tive and expiration date fields for the vehicle listed. This should serve as proof that the below mentioned vehicle meets or exceeds the financial responsibility requirement for your state. This verification of coverage does not amend, extend or alter the coverage afforded by this policy. Vehicle Year: 2015 Make: M BENZ Model: SPRINTER VIN: WD4PE7DCOF5946419 COVERAGES LIMITS DEDUCTIBLES BODILY INJURY LIABILITY $25,000/$50,000 PROPERTY DAMAGE LIABILITY $20,000 COMPREHENSIVE $500 DED COLLISION $500 DED _y Lienholder Additional Insured Interested Party CITY ASHLAND CITY OF ASHLAND ASHLAND OR 97520-0000 Additional Information: Ts-uPd 05/20/2015 If you have any additional questions, please call 1-800-841-3000. CAUTIONARYNOTE: THE CURRENT COVERAGES, LIMITS, AND DEDUCTIBLES MAY DIFFER FROM THE COVERAGES, LOHTS, AND DEDUCTIBLES INEFFECT AT OTHER TIMES DURING THE POLICYPERIOD. THIS VERIFICATION OF COVERAGE REFLECTS THE COVERAGES, LIMITS AND DEDUCTIBLES AS OF THE ISSUED DATE OF THIS DOCUMENT WHICH IS SHOWN UNDER "ADDITIONAL INFORMATION" OR IF AN ISSUED DATE IS NOT SHOWN, THE DATE OF THIS FACSOULE. U-3310-07 GEICO, Oregon Insurance Identification Card Important Information gei co. com 1-800-841-3000 Here are your Policy Identification Cards. Please destroy your GEICO CASUALTY COMPANY old cards when the new cards become effective. PO BOX 509090 SAN bf%O, CA 92150-9090 Policy Number Effective DateExpiration Date Due to space limitations on the ID card, only the Named Insured and 4248055131 04-27-15 10-27-15 the Co-insured are listed. For a full list of drivers covered under this Year Make Model vehicle ID No. policy, please reference the Drivers section of your Declarations 2015 M BENZ SPRIN ER WD4PE7DCOF5946419 Page, which is included With your Insurance packet. Insured: WILLIAM MARTIN oLSEN Please notify us promptly of any change in your address to be sure you receive all Important policy documents. Prompt notification Will This policy provides coverage as prescribed by law. enable us to service you batter. Your policy is recorded under the name and policy number shown on the card. If you would like additional ID cards, you can go online to gelco.com or call us at 1-800-841-3000. What to do at the time of an accident. • Do not admit fault. - Do not reveal the limits of your liability coverage to anyone. • Exchange contact information; get year, make, model, plate number, insurance carrier and policy number of all involved. Also, identify witnesses and collect contact information. • Contact the police or 911 if applicable. • Contact GEICO by calling 1-800-841-3000 or visit gelco.com to report the accident. U-4-OR (12-09) Page 1 / 1 ASHLAND PARK COMMISSION 20 E MAIN ST. DATE FP0 NUMBER ASHLAND, OR 97520 6/19/2015 00456 (541) 488-5300 VENDOR: 004041 SHIP TO: WILLIAM OLSEN DESIGNS 280 E HERSEY #13 ASHLAND, OR 97520 FOB Point: Ashland, Oreqon Req. No.: Terms: net Dept.: Req. Del. Date: Contact: Bruce Dickens Special Inst: Confirming? No Quantity Unit Description Unit Price Ext. Price Mill, size and sand rouqh wood boards 1,965.00 for Ashland Parks and Recreation wood workinq projects. Mortise placks, dock and router larqe timbers as needed. $100.00 per hour, Not to exceed $1,965.00, One hour minimum Contract for Goods and Services Small Procurement Less than $5,000 Beqinninq date: May 11, 2015 Completion date: June 30, 2015 SUBTOTAL 1965.00 BILL TO: TAX 0.00 FREIGHT 0.00 TOTAL 1,965.00 Account Number Project Number Amount Account Number Project Number Amount E 211.12.02.06.60211 1,965.00 Authorized rTgnature VENDOR COPY FORM #3 m ~(3ro5 'ICITY OF (WSH LAN D G REQUISITION D to of request: 4/27/15 5 ~~uikjG dr delivery: 6/30/15 60-,t e C4- _ Vendor Name William Olsen Designs Address, City, State, Zip Contact Name & Telephone Number 280 E. Hersey #13, Ashland, OR 97520 1541-326-1652 / willolsentlesigns(7aol.com Fax Number We site: i iam sen esigns,com SOURCING METHOD ❑ Exempt from Competitive Bidding ❑ Emergency ❑ Reason for exemption: ❑ Invitation to Bid (Copies on file) ❑ Form #13, Written findings and Authorization ❑ AMC 2.50 Date approved by Council: ❑ Written quote or proposal attached ❑ Written quote or proposal attached ❑ Small Procurement Cooperative Procurement Less than $5,000 ❑ Request for Proposal (Copies on file) ❑ State of Oregon ® Direct Award Date approved by Council: Contract # ❑ Verbal/Written quote(s) or proposal(s) ❑ State of Washington Intermediate Procurement ❑ Sole Source Contract # GOODS & SERVICES ❑ Applicable Form (#5,6, 7 or 8) ❑ Other government agency contract $5,000 to $100,000 ❑ Written quote or proposal attached Agency ❑ (3) Written quotes and solicitation attached ❑ Form #4, Personal Services $5K to $75K Contract # PERSONAL SERVICES ❑ Special Procurement 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) I Description of SERVICES Total Cost N-L) - ?kce a- Mill, size and sand rough wood boards for Ashland Parks and Recreation woodworking projects. $ 1,965.00 Mortise placks, dock and router large timbers as needr Rate = $100 / hour One-hour minimum for labor. ~ ~g - G cr-~ Item # Quantity Unit Description of MATERIALS Unit Price Total Cost TOTAL COST ® Per attached quotelproposal $ -1,965.00 Project Number _ _ _ _ _ _ - _ _ _ Account Number _211 _ - 12 - 02 - 06 602118 Account Number___-__-__- Account Number___-__-__- - 'Expenditure must be charged to the appropriate account numbers for the financials to accurately reflect the actual expenditures. IT Director in collaboration with department to approve all hardware and software purchases: IT Director Date Support -Yes /No By signing t uisi . ti on form, I certify thafithe City's public contracting requirements have been satisfied. Em p to v 2 a - . ~ Department Head: (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. YES / NO Finance Director- (Equal to or greater than $5,000) Date Comments: Form #3 - Requisition