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HomeMy WebLinkAbout2016-055 Contract - Ashland Medford Plumbing Contract for GOODS AND SERVICES Less than $25,000 CITY OF CONTRACTOR: Ashland Medford Plumbing Inc. -A5 H LAND CONTACT: Jon Janakes 20 East Main Street Ashland, Oregon 97520 ADDRESS: PO Box 8494, Medford, OR 97501 Telephone: 541/488-6002 Fax: 541/488-5311 TELEPHONE: 541-734-3236 DATE AGREEMENT PREPARED: 03/03/2016 FAX: 541-732-0092 BEGINNING DATE: 03/03/2016 COMPLETION DATE: 03/16/2016 COMPENSATION: $2,177.20 per bid attached as Exhibit C. GOODS AND SERVICES TO BE PROVIDED: Facilities Maintenance Shop - Remove and replace Water Heater 20 Gallon - $821.20 and Community Development Center - Remove and replace Water Heat 50 Gallon - $1,356.00. Includes permit fees. Per bid 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 b certified mail or in person. Contract for Goods and Services Less than $25,000, Revised 06/02/2015, Page 1 of 5 C. For Cause. City may terminate or modify this contract, in whole or in part, effective upon delivery of written notice to Contractor, or at such later date as may be established by City under any of the following conditions: i. If City funding from federal, state, county or other sources is not obtained and continued at levels sufficient to allow for the purchase of the indicated quantity of services, ii. If federal or state regulations or guidelines are modified, changed, or interpreted in such a way that the services are no longer allowable or appropriate for purchase under this contract or are no longer eligible for the funding proposed for payments authorized by this contract; or iii. If any license or certificate required by law or regulation to be held by Contractor to provide the services required by this contract is for any reason denied, revoked, suspended, or not renewed. d. For Default or Breach. i. Either City or Contractor may terminate this contract in the event of a breach of the contract by the other. Prior to such termination the party seeking termination shall give to the other party written notice of the breach and intent to terminate. If the party committing the breach has not entirely cured the breach within 15 days of the date of the notice, or within such other period as the party giving the notice may authorize or require, then the contract may be terminated at any time thereafter by a written notice of termination by the party giving notice. ii. Time is of the essence for Contractor's performance of each and every obligation and duty under this contract. City by written notice to Contractor of default or breach, may at any time terminate the whole or any part of this contract if Contractor fails to provide services called for by this contract within the time specified herein or in any extension thereof. iii. The rights and remedies of City provided in this subsection (d) are not exclusive and are in addition to any other rights and remedies provided by law or under this contract. e. Obligation/Liability of Parties. Termination or modification of this contract pursuant to subsections a, b, or c above shall be without prejudice to any obligations or liabilities of either party already accrued prior to such termination or modification. However, upon receiving a notice of termination (regardless whether such notice is given pursuant to subsections a, b, c or d of this section, Contractor shall immediately cease all activities under this contract, unless expressly directed otherwise by City in the notice of termination. Further, upon termination, Contractor shall deliver to City all contract documents, information, works-in-progress and other property that are or would be deliverables had the contract been completed. City shall pay Contractor for work performed prior to the termination date if such work was performed in accordance with the Contract. 10. Independent Contractor Status: Contractor is an independent Contractor and not an employee of the City. Contractor shall have the complete responsibility for the performance of this contract. 11. Non-discrimination Certification: The undersigned certifies that the undersigned Contractor has not discriminated against minority, women or emerging small businesses enterprises in obtaining any required subcontracts. Contractor further certifies that it shall not discriminate in the award of such subcontracts, if any. The Contractor understands and acknowledges that it may be disqualified from bidding on this contract, including but not limited to City discovery of a misrepresentation or sham regarding a subcontract or that the Bidder has violated any requirement of ORS 279A.110 or the administrative rules implementing the Statute. 12. Asbestos Abatement License: If required under ORS 468A.710, Contractor or Subcontractor shall possess an asbestos abatement license. 13. Assignment and Subcontracts: Contractor shall not assign this contract or subcontract any portion of the work without the written consent of City. Any attempted assignment or subcontract without written consent of City shall be void. Contractor shall be fully responsible for the acts or omissions of any assigns or subcontractors and of all persons employed by them, and the approval by City of any assignment or subcontract shall not create any contractual relation between the assignee or subcontractor and City. 14. Use of Recyclable Products: Contractor shall use recyclable products to the maximum extent economically feasible in the performance of the contract work set forth in this document. 15. Default. The Contractor shall be in default of this agreement if Contractor: commits any material breach or default of any covenant, warranty, certification, or obligation it owes under the Contract; if it loses its QRF status pursuant to the QRF Rules or loses any license, certificate or certification that is required to perform the work or to qualify as a QRF if Contractor has qualified as a QRF for this agreement, institutes an action for relief in bankruptcy or has instituted against it an action for insolvency; makes a general assignment for the benefit of creditors; or ceases doing business on a regular basis of the type identified in its obligations under the Contract; or attempts to assign rights in, or delegate duties under, the Contract. 16. Insurance. Contractor shall at its own expense provide the following insurance: a. Worker's Compensation insurance in compliance with ORS 656.017, which requires subject employers to provide Oregon workers' compensation coverage for all their subject workers b. General Liability insurance with a combined single limit, or the equivalent, of not less than Enter one, $200,000, $500,000, $1,000,000, $2,000,000 or Not Applicable for each occurrence for Bodily Injury and Property Damage. C. Automobile Liability insurance with a combined single limit, or the equivalent, of not less than Enter one: Contract for Goods and Services Less than $25,000, Revised 06/02/2015, Page 2 of 5 $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,. r: City of Ashland By, By S~ Signature Department Head k~4 Print Name Print Name r~qki 31711(, Title Date W-9 One copy of a W-9 is to be submitted with the signed contract. Purchase Order No. l Contract for Goods and Services Less than $25,000, Revised 06/02/2015, Page 3 of 5 EXHIBIT A CERTIFICATIONS/REPRESENTATIONS: Contractor, under penalty of perjury, certifies that (a) the number shown on the attached W-9 form is its correct taxpayer ID (or is waiting for the number to be issued to it and (b) Contractor is not subject to backup withholding because (i) it is exempt from backup withholding or (ii) it has not been notified by the Internal Revenue Service (IRS) that it is subject to backup withholding as a result of a failure to report all interest or dividends, or (iii) the IRS has notified it that it is no longer subject to backup withholding. Contractor further represents and warrants to City that (a) it has the power and authority to enter into and perform the work, (b) the Contract, when executed and delivered, shall be a valid and binding obligation of Contractor enforceable in accordance with its terms, (c) the work under the Contract shall be performed in accordance with the highest professional standards, and (d) Contractor is qualified, professionally competent and duly licensed to perform the work. Contractor also certifies under penalty of perjury that its business is not in violation of any Oregon tax laws, and it is a corporation authorized to act on behalf of the entity designated above and authorized to do business in Oregon or is an independent Contractor as defined in the contract documents, and has checked four or more of the following criteria: ,0' (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. 40- (2) Commercial advertising or business cards or a trade association membership are purchased for the business. 4Q7 (3) Telephone listing is used for the business separate from the personal residence listing. _VZY (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. 3 L' _ 0 Contractor (Date) Contract for Goods and Services Less than $25,000, Revised 06/02/2015, Page 4 of 5 CITY OF 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 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 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 t ~~62 0 AS ASHLAND MEDFORD PLUMBING INC. PO Box 8494; Medford, OR 97501 • Phone: 541-734-3236 Fax: 541-732-0092 OR CCB 164934 / CA CCB 891355 City of Ashland Facilities Maintenance & In Community Development Center March 1, 2016 SCOPE OF WORK: PLUMBING, WATER HEATER REMOVAL & REPLACEMENT We here by submit an estimate for Facilities Maintenance & In Community Development Center- Facilities Maintenance-In Shop We Shall- o Remove & Replace shop Water Heater 20 Gallon o We shall remove all excess piping and install new Stainless Steel Flex connectors and T & P extended into existing Water Heater Pan o Permit Fee ADD PERMIT FE6-4 & 0 ___._>r.... ADD 10 Year Warranty $a 58'60 [0`_:-$765.20---N Initial to Accept * Community Development Center- o We shall remove and replace 50 Gallon gas Water Heater in Attic o We shall utilize pull downstairs with assistance of winch system to install Water Heater o We shall replace Water Heat Flex Line with Stainless Steel Flex Lines o Permit Fee ADD PERMIT FEK$56.00 ADD 10 Year Warranty $1P:00 (BID: $1,300.00~~ "Initial to Accept Exclusions: Bonds, permits and fees, sewer and water fees, electrical and controls. Hazardous Materials Disclaimer: Ashland Medford Plumbing will be held harmless in the discovery and manipulation of any and all hazardous materials. It is the job owner's responsibility to meet all requirements in handling such materials at no cost to Ashland Medford Plumbing. Ashland Medford Plumbing will go on standby time or redirect work until such situation is resolved. Owner will be responsible for all cost involved, including wages and equipment rental. Ashland Medford Plumbing will not lose work time due to delays generated by such discoveries. All materials are guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements are contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado, flood and other necessary insurance. Our workers are fully covered by Workman's Compensation Insurance. A late payment service charge of 2% per month will be charged on accounts 30 days past due from date of billing. The service charge is an annual percentage rate of 24%. Minimum service charge is $100.00, plus the reasonable cost of collection, including but not limited to attorney and legal fees. I agree that my liability for the charges is not waived and I agree to be held personally liable for such charges. Authorized Signature %~n I -nakeS Date March 1, 2016 Acceptance of Proposal/Contract - The above price, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payments to be made within 30 days of submission of Progress Billing. Signature Date of Acceptance Spec irdiaing iii Plnntbing, I /echnnical, Hydronie s, Radiant. Geothermal and Fisll Service Escarrrlion 304350 A Human Resource Management Company March 02, 2016 ASHLAND MEDFORD PLUMBING INC 5555 N MEDFORD INDUSTRIAL RD CENTRAL POINT, OR 97502-9400 Re: Barrett Business Services, Inc. ("BBSI") Letter of Self-Insurance for Workers' Compensation Coverage As the named addressee of this Letter, your company's required workers' compensation coverage is provided through BBSI's state approved Self-Insured Workers' Compensation Plan by way of your co-employment contract with BBSI. Additional information is as follows: State: Oregon Workers' Compensation Limits: Employer Liability Limits: Self Insurance Certification 1068 Statutory $5,000,000.00 Each Accident $5,000,000.00 Disease Coverage Limit by Client $5,000,000.00 Disease; Each Employee Other Comments (place an "X" if applicable): Named "Letter Holder": City of Ashland 20 East Main St Ashland, OR 97520 MX Other: Contract effective 9/17/12, renewed through 9/30/16. Subject to 30 days' notice of cancellation. Additionally, BBSI's self-insured program is further supported by an excess workers' compensation insurance policy with ACE American Insurance Co.. Copy of certificate is available upon request. For additional information, please contact your local BBSI office at: MEDFORD (541) 772-5469 3512 Excel Drive Suite 107 Very truly yours, Medford, OR 97504 Michael L. Elich President and Chief Executive Officer doc: LOST A R ® DATE (MM/DDNYYY) CERTIFICATE OF LIABILITY INSURANCE 03/032016 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 endorsements . PRODUCER CONTACT NAME: CENTER CLIENT CONTACT FEDERATED MUTUAL INSURANCE COMPANY HOME OFFICE: P.O. BOX 328 A CNNo Ext : 888-333-4949 F ✓XC No : 507-446-4664 OWATONNA, MN 55060 E-MAIL ADDRESS: CLIENTCONTACTCENTER FEDINS.COM INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 358-611-2 INSURER B: ASHLAND MEDFORD PLUMBING INC INSURER C: PO BOX 8494 MEDFORD, OR 97501 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 124 REVISION NUMBER: 0 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 DL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD MM/DDIYYYY MMIDDIYYYY GENERAL LIABILITY EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED $100 000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrenceCLAIMS-MADE FxIOCCUR MED EXP (Any one person) EXCLUDED A N N 9337481 03/20/2015 03/20/2016 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEWL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 X POLICY JEC LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 Ea acciden X ANY AUTO BODILY INJURY (Per person) ALL OWNED SCHEDULED A AUTOS AUTOS N N 9337481 03/20/2015 03/20/2016 BODILY INJURY (Per accident) NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $2,000,000 A EXCESS LIAB CLAIMS-MADE N N 9337482 03/20/2015 03/20/2016 AGGREGATE $2,000,000 DED RETENTION WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY Y / N TORY LIMITS ER ANY PROPRIETORIPARTNERIEXECUTIVE E.L. EACH ACCIDENT OFFICERIMEMBER EXCLUDED? ❑N / A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE If yes, describe under E.L DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION 358-611-2 1240 CITY OF ASHLAND SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 20 E MAIN ST THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ASHLAND, OR 97520-1814 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD FEDEMTED INSURANCE7@) Dear Policyholder, Thank you for choosing Federated Insurance to handle your insurance and risk management needs. The attached certificate document(s) have been issued or updated. Please feel free to contact us with any additional changes, additions or deletions that may be needed by contacting the Federated Client Contact Center at: Phone: 1-888-3334949 Fax: 507-446-4664 E-mail: clientcontactcenter@fedins.com Thank you for your business! Client Contact Center Enclosed: Certificate Document(s) MISC-0829 (04-13) . z Page 1 / 1 CITY OF DATE PO NUMBER ASHLAND 20 E MAIN ST. 3/9/2016 13416 ASHLAND, OR 97520 (541) 488-5300 VENDOR: 002537 SHIP TO: Ashland Building Maintenance ASHLAND MEDFORD PLUMBING (541) 488-5358 P 0 BOX 8494 90 N MOUNTAIN AVENUE MEDFORD, OR 97504 ASHLAND, OR 97520 FOB Point: Ashland, Oreqon Req. No.: Terms: Net Dept.: Req. Del. Date: Contact: Wes Hoadley Special Inst: Confirming? No Quantity Unit Description Unit Price Ext. Price Facilities Maintenance Shop (Street 2,177.20 Dept) Remove and replace 20 qallon water heater $821.20 Community Development Remove and replace 50 gallon water heater $1,356.00 Includes permit fees Contract for Goods and Services Beginninq date: 03/03/2016 Completion date: 03/16/2016 SUBTOTAL 2177.20 BILL TO: Account Payable TAX 0.00 20 EAST MAIN ST FREIGHT 0.00 541-552-2010 TOTAL 2,177.20 ASHLAND, OR 97520 Account Number Project Number Amount Account Number Project Number Amount E 410.08.24.00.60240 E 000069.999 821.20 E 410.08.24.00.60240 E 000067.999 1,356.00 Authori Signature VENDOR COPY FORM #3 CITY OF _ vrII ASHLAND REQUISITION Date of request: 2 March 2016 Required date for delivery: 16 March 2016 Vendor Name Ashland Marifnrrl Pliimhinn Mr. Address, City, State, Zip PO Rnx 8494 Medford nR 97501 Contact Name & Telephone Number Fax Number Jon Janakes 541-734-3236 541-732-0092 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) ❑ State of Oregon Date approved by Council: ❑ Direct Award -(Attach copy of council communication) 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 - (Attach copy of council communication) Description of SERVICES Total Cost Remove, replace, and dispose of existing water heaters; expenses detailed below $ a~ Item # Quantity Unit Description of MATERIAL Unit Price Total Cost 1 Ea. 20 gallon electric water heater, plus removal and disposal of existing 765.20 765.20 1 Ea. 50 gallon gas water heater, plus removal and disposal of ex' tiri 1300.00 1300.00 1 9 2 Ea. Permit fee 56.00 112.00 TOTAL COST ® Per attached quote/proposal ~2168:2U Project Number oocc-; -Z J S~ ~L Account Number 410 - 08 - 24 - 00 - 602400 loco~,7 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 this requisition form, I certify that the City's public contracting requirements have been satisfied. Employee: ,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 orgreaterthan $5,000) Date Comments: Form #3 - Requisition