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HomeMy WebLinkAbout2016-023 Contract - California Health & Rescue Training Contract for GOODS AND SERVICES Less than $25,000 CITY OF CONTRACTOR: California Health & Rescue Training -ASHLAND CONTACT: Kent L. Freeman 20 East Main Street Ashland, Oregon 97520 ADDRESS: PO Box 88, Roseville, CA 95678 Telephone: 541/488-6002 Fax: 541/488-5311 TELEPHONE: 530-367-3770 DATE AGREEMENT PREPARED: January 6, 2016 FAX: BEGINNING DATE: May 16, 2016 COMPLETION DATE: May 31, 2016 COMPENSATION: $7,575.00 per proposal attached as Exhibit C. GOODS AND SERVICES TO BE PROVIDED: Trench Rescue Training (didactic and manipulative training) per proposal attached as Exhibit C. ADDITIONAL TERMS: In the event of conflicts or discrepancies among the contract documents, the City of Ashland Contract for Goods and Services will be primary and take precedence, and any exhibits or ancillary contracts or agreements having redundant or contrary provisions will be subordinate to and interpreted in a manner that will not conflict with the said primary City of Ashland Contract. NOW THEREFORE, pursuant to AMC 2.50.090 and after consideration of the mutual covenants contained herein the CITY AND CONTRACTOR AGREE as follows: 1. All Costs by Contractor: Contractor shall, provide all goods as specified above and shall at its own risk and expense, perform any work described above and, unless otherwise specified, furnish all labor, equipment and materials required for the proper performance of such work. 2. Qualified Work: Contractor has represented, and by entering into this contract now represents, that any personnel assigned to the work required under this contract are fully qualified to perform the work to which they will be assigned in a skilled and worker-like manner and, if required to be registered, licensed or bonded by the State of Oregon, are so registered, licensed and bonded. Contractor must also maintain a current City business license. 3. Completion Date: Contractor shall provide all goods in accordance with the standards and specifications, no later than the date indicated above and start performing the work under this contract by the beginning date indicated above and complete the work by the completion date indicated above. 4. Compensation: City shall pay Contractor for the specified goods and for any work performed, including costs and expenses, the sum specified above. Payments shall be made within' 30 days of the date of the invoice. Should the contract be prematurely terminated, payments will be made for work completed and accepted to date of termination. Compensation under this contract, including all costs and expenses of Contractor, is limited to $25,000.00, unless a separate written contract is entered into by the City. 5. Ownership of Documents: All documents prepared by Contractor pursuant to this contract shall be the property of City. 6. Statutory Requirements: ORS 27913.220, 27913.225, 27913.230, 27913.235, ORS Chapter 244 and ORS 670.600 are made part of this contract. 7. Living Wage Requirements: If contractor is providing services under this contract and the amount of this contract is $20,142.20 or more, Contractor is required to comply with chapter 3.12 of the Ashland Municipal Code by paying a living wage, as defined in this chapter, to all employees performing work under this contract and to any subcontractor who performs 50% or more of the work under this contract. Contractor is also required to post the notice attached hereto as Exhibit B predominantly in areas where it will be seen by all employees. 8. Indemnification: Contractor agrees to defend, indemnify and save City, its officers, employees and agents harmless from any and all losses, claims, actions, costs, expenses, judgments, subrogations, or other damages resulting from injury to any person (including injury resulting in death), or damage (including loss or destruction) to property, of whatsoever nature arising out of or incident to the performance of this contract by Contractor (including but not limited to, Contractor's employees, agents, and others designated by Contractor to perform work or services attendant to this contract). Contractor shall not be held responsible for any losses, expenses, claims, subrogations, actions, costs, judgments, or other damages, directly, solely, and proximately caused by the negligence of City. 9. Termination: a. Mutual Consent. This contract may be terminated at any time by mutual consent of both parties. b. City's Convenience. This contract may be terminated at 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 b City under an of the following Contract for Goods and Services Less than $25,000, Revised 06/02/2015, Page 1 of 5 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 ht1~ t } 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. 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 Contract for Goods and Services Less than $25,000, Revised 06/02/2015, Page 2 of 5 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 nor-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. Contractor: City of Ashland By By t,,i G✓ Signature Department Head Print Name Print Name Title Date W-9 One copy of a W-9 is to be submitted with the signed contract. Purchase Order No. AP -Q AS TO FOR( Ashland Asstty ttom.. 4 Contract for Goods and Services Less than $25,000, Revised 06/02/2015, Page 3 0 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 tract documents, and has checked four or more of the following criteria: Z ; r (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. l~ (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. Contractor (Date) Contract for Goods and Services Less than $25,000, Revised 06/02/2015, Page 4 of 5 CITY • ASHLAND, OREGON EXHIBIT B City of Ashland LIVING WAGE per hour effective June 30, 2015 (Increases annually every June 30 by the Consumer Price Index) portion of business of their 401 K and IRS eligible employer, if the employer has cafeteria plans (including ten or more employees, and childcare) benefits to the has received financial amount of wages received by assistance for the projector 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 city's website at www.ashland.or.us. Notice to Employers: This notice must be posted predominantly in areas where it can be seen by all employees. CITY OF ASHLAND Contract for Goods and Services Less than $25,000, Revised 06/02/2015, Page 5 of 5 oqq Po 13ox 88 "),os'-\8 fro A 1 1 j California Health & Rescue Training October 3, 2015 Ashland Fire & Rescue 455 Siskiyou Blvd. Ashland, OR 97520 Chief Karns, Please find enclosed a proposal for providing Trench Rescue Technician training for your personnel in Ashland. The document outlines what we will provide for the training and what we will need Ashland to provide. Unlike many trainers we will provide the bulk of the technical equipment but will work with any of the equipment you already possess and want to use in the training. We will also be glad to work with other personnel that you may want to include in the training, such as public works personnel that may serve as a valuable resource to you in a trenching incident. The instructors that will be providing this training is Stan Klopfenstein and myself, Kent Freeman. We were both on the working group that wrote this curriculum for California State Fire Training as well as the text book that we will be providing to each of your students. We have enjoyed working with you in the past at Beverly Hills Fire Department and would be privileged to work with you again. If you should have any questions regarding the enclosed proposal feel free to contact me at calrescue a gmail.com or 530-367-3770 (office) or 916-838-9922 (cell) Than you in advance for taking time to review this material and considering us to provide valuable training to your personnel. Kent L. Freeman wv✓w.calrescue.cem CALIFORNIA T R A 1 N I N G (3>0 . 530-367-3770 www.calrescue.com Box 88, Roseville, CA 95678 October 3, 2015 Ashland Fire & Rescue 455 Siskiyou Blvd Ashland, OR 97520 Attention: Fire Chief John Karns QUOTATION FOR SERVICES, PREPARED FOR: Ashland Fire & Rescue CONDITIONS: 1. California Health and Rescue Training (C.H.A.R.T.) to provide program of instruction in Trench Rescue Technician. (didactic and manipulative training) 2. Program to be approximately 24 hours in length and follow all of the guidelines set forth by OSHA 1926 P, NFPA 1006 and 1670, as well as California State Fire Marshal's Office Division of Training. 3. Trench Rescue Technician manual to be provided to each student. Certificates of completion shall be provided by California Health & Rescue Training or California State Fire Training (FSTEP program). See payment section for difference in cost. 4. Equipment required for the program to be provided by C.H.A.R.T. with the exception of equipment and materials listed in #5 and materials highlighted in yellow on resource list, which shall be provided by Ashland Fire & Rescue. 5. Ashland Fire & Rescue to provide classroom, LCD projector, screen, and chalk or dry erase board. Ashland Fire & Rescue to provide trenches as diagrammed on drawings included with this document, as well as back hoe and operator. 6. Class size to be no more than 24 for complete program. Course content to include didactic and manipulative training on the hazards of trenching operations and rescues, case histories of trench incidents, soil classification, ventilation procedures, victim packaging techniques, personnel requirements, responsibilities and safety, use of timber shores, air shores, hydraulic shores and improvised shores, use and interpretation of tabulated data specifically developed for Trench Rescue etc. PAYMENT: A total paymelf $7575.00 to be paid upon receipt of invoice following completion of project for class size up to 24 with certificates issued by California Health & Rescue Training. A total payment of $,8060.00 to be paid upon receipt of invoice following completion of project for class size up to 24 with certificates issued by California State Fire Training FSTEP (Fire Service Training & Education Program) Class dates projected to be after May 16, 2016 with dates to be confirmed and agreed upon by C.H.A.R.T. and Ashland Fire and Rescue personnel. CONTRACT APPROVED BY: Nrepresentative) NAME (Ashland Fire & Rescue representative) date date Please sign and return one copy of this contract to confirm program scheduling. i Trench Rescue Resource List Plywood 4'x8'x3/4" 32 each 2x 12x 10' 32 each 2x4x8' 12 each 4x4x 12' 10 each 4x4x 16' 4 each 4x4x8' 36 each 18" 4x4 Wedges 24 pair Finland Form (sheeting) optional item 2 each provided by chart Hydraulic Speed shores w/ extensions, pump & t-handle 2 each provided by chart Pneumatic shores (with controller & regulator) Paratech (with extensions) 2 each provided by chart Air Shore 2 each provided by chart Air bag (with controller & regulator) low, medium or high press. 1 each provided by chart SCBA Cylinders (low or high pressure) 2 each Pipe screw jacks (with pipe cutter and pipe wrench) 6 each provided by chart Pipe (Schedule 40 1 '/z" Galvanized, 8' or 10' lengths) 4 each provided by chart Ellis Post Screw Jacks (4x4) 6 each provided by chart Rope 50' 6 each provided by chart Webbing (20' lengths) 6 each provided by chart 10 1/4" circular saw (with extension cord) 1 each provided by chart Gasoline chain saw (with fuel & oil) 1 each Generator (minimum 2.5 kw with extension cords) 1 each provided by chart Crow bars 4 each provided by chart Shovels (round point, long handle) 4 each provided by chart Shovels (round point, short handle) 2 each provided by chart Framing hammers 8 each provided by chart Single Jacks (short handle sledge hammer) 6 each provided by chart Tape measure (25') 8 each provided by chart Ladders (straight or roof) 4 each 16D Duplex Nails 25 lbs 5 gallon buckets 6 each provided by chart Wood pallet (for cutting station) 1 each provided by chart Atmospheric Monitor 1 each provided by chart Ventilation fan 1 each provided by chart Manikins (hose or regular) 2 each Backboard with straps 1 each provided by chart Carpenters pencils 8 each provided by chart Speed Square 1 each provided by chart Duct Tape 1 each provided by chart Back Hoe & Operator Trench Rescue Class - Training Trenches 24' 36" 8' Deep 36" 14 8,6„ s 8,6„ 60" • Dig trenches a minimum of 20' 8' Deep apart if possible 12' • Square corners 3671 and bottom if possible. 8' Deep 20' 36" 10' Deep (minimum) 20' OP ID: TA 016 Y) CERTIFICATE OF LIABILITY INSURANCE 0 F D1/14//22016 01 /14 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 CONTACT Aschwanden-Grayberg Ins. Serv. NHONr: James Gra ber FAX 13 - --Y---..~__ - Licence No. 0524744 (A/C, No. Ext): 916-685-0770 (A/C, No): 916-685-0772 9727 Elk Grove-Florin RD. #130 E-MAIL Elk Grove, CA 95624 ADDRESS: _ PRODUCER James F. Grayberg CUSTOMER ID is: CALIF-2 INSURER(S) AFFORDING COVERAGE Y NAIC # INSURED California Health & Rescue INSURER A : HISCOX USA Training INSURER B : Llyods London Reference Num: 106 ` - Kent Freeman INSURER c - - PO BOX 88 INSURER D : Roseville, CA 95678 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 AOOL SUER' POLICY EFF POLICY EXP LTR r_-IYPE OF INSURANCE INSR WVD POLICY NUMBER 1MMIDDIYYYY MMIDDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE 5 1,000,00 - 11 A X COMMERCIAL GENERAL LIABILITY ME01356051.15 07/11/20151 07111/2016 pH~SES EaEwc rfenca S 50,00 CLAIMS-MADE F ; OCCUR MF1) EXP IAny one person) S 5,00 PERSONAL & ADV INJURY $ 1,000,00 l GENERAL AGGREGATE S 3,000,00 GENT AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ 1,000,00 X POLICY FjRO LO(, $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY (Per person) S ALL OWNED AUTOS BODILY INJURY (Per accident) 5 SCHEDULED AUTOS PROPERTY DAMAGE 3 HIRED AUTOS (PER ACCIDENT) NON-OWNED AUT OS S UMBRELLA LIAR OCCUR EACH OCCURRENCE I $ EXCESS LIAB Cl AIMS-MADE AGGREGATE OIDUCIIBLF ; S ttl'LNI ION S OTH- WORKERS COMPENSATION T JCY LIMITS ER , AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETORfPARTNER/EXECUTIVE EL EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? N I A (Mandatory in NH) - E" 1- DISEASE EA f-MPLOYEE S if yes. cesc ibe under I) SCRIPT 'ION OF OPERATIONS beicA EL DISEASE - POLICY LIMIT S B Llyod's of London MEO1356051.15 07/1112015 07/11/2016 E&O Ins 3,000,00 Claim Lim 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101. Additional Remarks Schedule, if more space is required) The City of Ashland and its elected officials off icers,employees and volunteers are to be covered as insured with respect arising out of work or operations performed by or on behalf of the contractor including materials parts or equipment furnished in connection with work or operations. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN y ACCORDANCE WITH THE POLICY PROVISIONS. 20 East Main Street Ashland, OR 94520 AUTHORIZED REPRESENTATIVE James F ralyberg ©1988-2009 ACORD COR ORAT 0 All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD CALIFORNIA m, 1 ©✓„E3 'To 1 R A It - N I N G 530-367-3770 www.caIrescue.com P.O. Box 88, Roseville, CA 95678 January 15, 2016 City of Ashland 20 East Main Street Ashland, Oregon 97520 To Whom It May Concern: Please be advised that California Health & Rescue Training as a company owns no vehicles. In addition no vehicles will be needed in the performance of our contracted work and the use of personal vehicles will be limited to transportation to the parking lot. I have enclosed proof of personal vehicle insurance on my vehicles that will be utilized for transportation to the parking lot. If there are further questions regarding this matter, please do not hesitate to contact me at 530-367-3770. Sincerely, e Kent L. Freeman CSAA Insurance Exchange Automobile Policy Declarations r# PO Box 22221 Y Insurance Oakland, CA 94623-2221 Please keep with your policy. See Important Notice on reverse. For questions or changes call: (800) 922-8228 Page 1 of 1 1. Name and Address of Insured Declarations Process O Type Amended Declarations Date 12-29-2015 i= r~ EVA FREEMAN Q I'd icy CAAS100188056 Since ince 1989 Io~E1e KENT FREEMAN s 324 COPE RIDGE COURT 0 From 12:01 A.M. Standard Time at the address of the ROSEVILLE CA 95747-8055 ? Named Insured, but not prior to the time applied Your 12-28-2015 for or, if this is a replacement declarations, not V policy prior to the time coverage change was requested. Period To O 12:01 A.M. Standard Time at the address of the a 08-25-2016 Named Insured. Alternate Address Occupation Alternate Number Telephone Number Other (916) 740-3258 Item Make Model Yr Body Type Vehicle Identification No. Name to 1 Item Eliminated Drivers KENT to N do not J 2 TOYOTA 2014 CREW PICKUP 5TFBY5F1XEX404159 W necessarily EVA u > correspond L 3 TOYOTA 2015 WAGON 4 DOOR 2T3DFREVXFW394166 FE to principally p operated vehicles. Liability Limits Item I Item 2 Item 3 Coverage . Person Each Occurrence Deductible Premium Deductible Pre . mium . Deductible Premium . . Deductible Premium.... Each . Bodily Injury 100,000 300,000 No Cov E $196 $168 $137 Medical Payments No Coverage No Coverage No Coverage No Coverage Uninsured Motorists 100,000 300,000 No Cov ; $49 $49 $34 Property Damage 100,000 No Cov $126 $130 $126 Cr Comprehensive Actual Cash Value Less Deductible No Cov ? $301 100 $191 100 $116 a Lnn Collision Actual Cash Value Less Deductible No Cov $410 500 $484 500 $300 W Enhanced Transportation Expense INCL $28 W O All Risks Actual Cash Value Less Deductible No Coverage No Coperage No Coverage TOTAL PREMIUM PER VEHICLE ➢ $1,082 $1,050 $737 *Automobile Death Benefits $15,000 per deceased insured person Premium $6 Premium Summary CA Surcharge: $0 Total Return Premium: $613.00- This is not a bill. Schedule of Changes W Maintain Vehicle(s) 113 Z a u Item Rated Driver Driv Safety Record Yrs Driv Exp Est Ann Mi Driven Veh Garage Zip Vehide Usage Gender Marital 2 KENT FREEMAN 0 Pt 39 15,000 Mi 95747 Pleasure M M LU See reverse for Q 3 EVA FREEMAN 0 Pt 42 6,000 Mi 95747 Pleasure F M explanation of LA Ln codes. W 2 N z Discounts: Mature Driver: None. Multi Car: Item(s) 2, 3. U Good Driver: Item(s) 2, 3. New Driver: None. Multi Policy: None. Good Student: None. You may qualify for other products LU and discounts. For more info } a call your insurance Agent N Ken B Palmer 0 (530) 886-2546 55 1500 0414 08-25-1989 00623 0100 CALIFORNIA O T R A i N i N G 530-367-3770 www.calrescue.com P.O. Box 88, Roseville, CA 95678 January 15, 2016 City of Ashland 20 East Main Street Ashland, Oregon 97520 To Whom It May Concern: Please be advised that California Health & Rescue Training is operated as a Sole Proprietor company, as such I employ no personnel and am subject to no Workers Compensation insurance requirements. I do understand that if I do employ any personnel in the future that California Health & Rescue Training will be subject to all of the requirements of Workers Compensation. Please find with this document a copy of my Medical Insurance Card, covering my medical liability. If there are further questions regarding this matter, please do not hesitate to contact me at 530-367-3770. Sincerely, Kent L. Freeman IAA ISM PERMANENTS NORTHERN CAUFORN A REGION ru KEG REEKAF SIRTHDA T E S" MEDICAL O-k *:I NUWER U11,830q lf For Information About Your Health Flan Benefits (800) 464-4000 For Appointments and Medical Advice, check your local telephone directory. M Page 1 / 1 CITY OF DATE PO NUMBER ASHLAND 20 E MAIN ST. 1/26/2016 13343 W ASHLAND, OR 97520 (541) 488-5300 VENDOR: 020013 SHIP T(.,,: Ashland Fire Department CALIFORNIA HEALTH & RESCUE TRN (541) 482-2770 PO BOX 88 455 SISKIYOU BLVD ROSEVILLE, CA 97547 ASHLAND, OR 97520 FOB Point: Req. Nc : Terms: Net Depi:.: Req. Del. Date: Contac`:: John Karns Special Inst: Confirming? No Quantity Unit Description Unit Price Ext. Price Trench Rescue Traininq 7,575.00 Traininq scheduled in Mav, 2016 Departments: Fire & Public Works Contract for Goods and Services Beqinninq date: Mav 16, 2016 Completion date: May 31, 2016 SUBTOTAL 7,575.00 BILL TO: Account Payable TAX 0.00 20 EAST MAIN ST FREIGHT 0.00 541-552-2010 TOTAL 7, 575.00 ASHLAND, OR 97520 Account Number Project Number Amount Account Number Project Number Amount E 110.07.12.00.60640 E 000496.999 5,375.00 E 410.08.24.00.61040 2,200.00 Authorjred Signature VENDOR COPY FORM 93 CITY OF r,J ' v4 ~ ASHLAND REQUISITION Date of request: Required date for delivery: Vendor Name Y: , Address, City, State, Zip Contact Name & Telephone Number c~ 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 Attach co of council communication If council approval required, attach co of CC ❑ Small Procurement Cooperative Procurement Less than $5,000 ❑ Request for Proposal (Copies on file) E] Direct Award Date approved by Council: Contract # ❑ Verbal/Written quote(s) or proposal(s) -(Attach copy of council communication) ❑ 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 0 ess 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 - (Attach copy of council communication) Description of SERVICES Total Cost CZ~ Item # Quantity Unit Description of MATER6X4S Unit Price Total Cost TOTAL COST ❑ Per attached quotelproposal Project Number- Account Numbe' r f Account Number - - - - - - - - - - Account Number -~_r----_--- *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 s9tisfied. /'~GcvS~Lt~ Employee: Department Head: J (Equafto or greater than $5,000) Department Manager/Supervisor: City Administrator: (Equal to or greater than $25,000) Funds appropriated for current fiscal year: Gy';'~ / NO ~ ~ 7 Finance Director- (Equal to orgreaterthan $5,000) Date Comments: Form #3 - Requisition