HomeMy WebLinkAbout2016-115 Contract - Workplace Resource of Oregon
Contract for GOODS AND SERVICES Less than $25,000
C I T Y OF CONTRACTOR: Workplace Resource of Oregon j
-ASHLAND
CONTACT: Chad Pitman, Account Manger
20 East Main Street
Ashland, Oregon 97520 : ADDRESS: 29 S. Grape St. Medford OR 97501
Telephone: 541/488-6002
Fax: 541%488-5311 TELEPHONE: 541-245-1681
DATE AGREEMENT PREPARED: 51/17/16 FAX: - i
BEGINNING DATE: 5/30/16 COMPLETION DATE: 7_/22/16 I
COMPENSATION: Not to exceed $2360.00
GOODS AND SERVICES TO BE PROVIDED:
Provide and install cubical panels and auxiliary components to expand existing single desk workspace into two
work spaces. Full details are provided in Exhibit C (quote).
ADDITIONAL TERMS:
In the event of conflicts or discrepancies among the contract documents, the Citv of Ashland Ccntract 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 nlerpreted in a
manner that will not conflict with the said primary City of Ashland Contract. _ j
NOW THEREFORE, pursuant to AMC 2.50.090 and after consideration of the mutual covenants contained herein the CITY
AND CONTRACTOR AGREE as follows:
E
1. All Costs by Contractor: Contractor shall, provide all goods as specified above and shall at its own risk and f
expense, perform any work described above and, unless otherwise specified. furnish all labor, equipment and
I 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. 1
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
i 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 2798.220, 2798.225, 27913.230. 2798.235, 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 i
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. f
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.
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
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 I
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 j
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. j
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
E 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, $1,000,0M $2.000,000 or Not Applicable for each occurrence for Bodily Injury and Property I
Damage.
Contract for Goods and Services Less than $25.000, Revised 06`0212015, F'age 2 of 5
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 I
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 j
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 I
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 j
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 l
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. j
21. Certification. Contractor shall sign the certification attached hereto as Exhibit A and herein incorporated by j
reference. f
I Contractor: City of Ashland
f
1By
Signature Department Head I
r~
Print Name Print Name
I
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 06='02.'2015, Page 3 of 5
EXHIBIT A
CERTIFICATIONWREPRESENTATIONS: 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:
✓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.
V/'*" (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.
t/ (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.
Van
Contractor (Date)
4th--,
Contract for Goods and Services Less than $25,000. Revised 06"021,2015, Page 4 of 5
CITY • ASHLAND9 OREGON
EXHIBIT B
City of Ashland
LIVING
comply ALL employers
WA E
described below must
payment Ashland laws regulating
of
living
per hour effective June 30,
wage.
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 . 10, 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-
For all hours worked in a Ashland including the Parks month period. For more month if the employee spends
and Recreation Department. details on applicability oil this
50% or more of the policy, please see Ashland
In calculating the living wage, Municipal Code Section
employee's time in that month employers may add the value 3.?202C.
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 vv,,vw.ashland.orjus.
Notice to Employers: This notice must be posted predominantly in areas where it can be seen by all
employees. C I T Y OF
-.SH LAN D
Contract for Goods and Services Less than $25,000, Revised 06102:2015, Page 5 of 5
Chad Pitman Exhibit
'W'orkplace Resource of Oregon HermanNlittet'WorkpiaceResource
29 S. Grape St.
Medford, OR 97501 lap
Phone: 541-245-1681
FAX: 541-245-1656
Email: chad_pitmanfuEwroregonxorn City of Ashland (i ayloa Kathol)
Tuesday, :May 17, -1016
b
C'it~ ofAshl,und Citti of.Ashland 0%, of'Ashland
20 I . Main 20 F. Main 20 F. Main
:Ashland. OR 97520 Ashland. OR 97520 ;Ashland. 012 97.i-10
All iterns on this quote are being purchased from the State of Oregon pricing agreement.
State of Oregon Contract #9727, Price Agreement #9722
Total Sell ''rice: $2,355.62 4 - weeks
Customer Si-nature-9.
Terms:
City of Ashland (Kaylea Kathol) 1 of 2
Item; ! Mtg ; Cat Oty Part Number Part Description Sell
_ S Ext Sell S
1 f HMI i HAO ! 1 ! A1355.48E +Base Pwr Adapter,W/0 Covers 4-Ciro 48W S 51.24 3 51.24
r
i
2 ;HMI ; HAO; 1 All 125.6724J +Panel,Tack Ac-aa-._-__...__...
i rrNpwr WlRcplCom Lc 67H 24W 193.76' S 193.76
JT +just tan (nonstandard)
I MT +medium tone 1
17J ; +avalon-Pr Cat 2
'01 +avalon beothuk
7.1 +avalon-Pr Cat 2
01 '+avalon beothuk
- - - L
3 FHMI , MAO I All 125.6736G '+Panel,Tack Ac-Barr Pwr 4-Circ W/Com Lc 67H 36W ; S 280.84' S 280.84
JT +just tan (nonstandard)
MT +medium tone
i 7J +avalon-Pr Cat 2
01 +avalon beothuk
i 71 ; +avalon-Pr Cat 2
I
01 +avalon beothuk
4 T HMI HAO 1 - A1230.67H +Conn,3-INay 90 Deg Hard 67H S 72.52 S 72.52
i
JT +just tan (nonstandard)
MT +medium tone
5 ' HMI ' HAO 1 A1271.67H +Fin End 67H S 18.20 ; S 18.20
JT ;+justtan (nonstandard)
MT +medium tone
6 ; HMI HC2 1
Z2WLA +Sq-Edge Vinyl Cnr WS.Winged,Lam Top 5 155.68 S 155.68
2448 i C24" deep x 48" wide left
2442 Q24" deep x 42" wide right
'S7 *7/8" gap (std AO 2 gap)
LT +light tone
i LT +light tone
I
I ,
light tone
~ -
7 HMI HC2 I
J i Z2RLA :+Sq-Edge Vinyl Rect WS,Lam Top $ 87.921 S 87.92
'24 -24" deep
40 +24" deep x 39.5' wide
S7 ; +718" gap (std AO 2 gap)
LT +light tone
LT +light tone j
LT +light tone i
J. 1_____ 1 _ _ _ -1-1--.111- _
HMl HAO 1 A2310.3072L +Work Surf,Sq Edge Rect Lam 30D 72W -.f •-_S 181.44: $ 181.44
LT +light tone
LT i +light tone
9 ✓ ; HMI HAO' f 'A3220.i348 ;+Shelf,SkaragelDisplay B-Style 13D 48W 5 54.68 j S 54.88
JT +just tan (nonstandard)
10 ~ HMI MER 1 ' M16-1522-13BF +Ped,Moblte,Std Puli,BiB/F 15W 22D $ 325.26' $ 325.26
TS +smooth paint on textured steel
JT ; +just tan (nonstandard) '
T2 +1 114"-high painted metal top with squared edge
KD +keyed differently. black
HN +no hand grip or transit handle
DC -hanging rail, no compressor
C:ktlserslcpitmanlDocumentstCAPlProjectslCity of AshlandlCity of Ashland (Kaylea Kathol) reconfig.sp4 5/17/2016 7:10:21 AM
City of Ashland (Kaylea Kafhol) 2 of 2
lterrl •1 Mfg! Cat ; 9t r ; Part Number i Part Description Sell S Ext Sell S
71 J HMI ` MER 1 M16-1522-FF +Ped,Mobllo,Std Pull,FtF 16W 22D S 308.88 ` S 308.88
TS +smooth paint on textured steel
JT ;-#-just tan (nonstandard)
T2 :+1 1/4"-high painted metal top with squared edge
KD !+keyed differently, black
HN +no hand grip or transit handle
i DC ! +hanging rail, no compressor
12 Vol 1 rLABDR__.__.._... Installation costs _ . _ _ _ , 5 625.00 S 625.0
0
10 I
Grand Total S 2,355.62
C:1UserslcpitmanlDocumentslCAPlProjects\City of AshlandlCity of Ashland (Kaylea Kathol) reconfig.sp4 511712016 7:10:21 AM
HMIOR-1 OP ID: CW
ACOR[7 DATE (MMIDDNYYY)
CERTIFICATE OF LIABILITY INSURANCE 05/17/2016
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 NAMEACT Richard Biggs
Biggs Insurance Services PHONE
P.O. Box 189 Ar-.111, E1,1 1J.- 360-695-3301 Arc, No : 360-696-2232
916 Main Street ADDPXSS: Rich.Bi 5 Bi sinsurance.com
Vancouver, WA 98666
Richard Biggs INSURER(S AFFORDING COVERAGE NAIL #
INSURER A:American Fire and Casual Co 24066
INSURED HMI Oregon Dealership, Inc. INSURER 13: Ohio Casualty Insurance Co 24074
dba: Workplace Resource of OR INSURER c : Ohio Security Insurance Co 24082
700 NE Multnomah, Ste 100
Portland, OR 97232 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 POLICY EFF POLICY EXP LIMITS
LTR INSD WVD POLICY NUMBER MMIDDIYYYY MMIDDIYYYY
A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
TO RENTED
DAMAG
_7 CLAIMS-IAADE PCIOCCUR X X BKA55589489 06/01/2015 06/01/2016 PREMISES Ea occurrence/ $ 1,000,000
MED EXP (Any one person) $ 115,000
PERSONAL a ADV INJURY $ 1,000,1300
GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000
POLICY D J CT- F7 LOC PRODUCTS - COMPIOP AGG $ 2,000,000
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1 000 000
Ea accident > >
A X ANY AUTO BAA55589489 06/01/2015 06/01/2016 BODILY INJURY (Per person) $
ALL OWNED SCHEDULED BODILY INJURY (Per accdent) $
AUTOS AUTOS
X NON-
X HIRED AUTOS PROPERTY DAMAGE $
AUTOS OWNED Per accident
X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000
B EXCESS LIAB CLAIMS-MADE US055589489 06/01/2015 06101/2016 AGGREGATE $ 5,000,000
DIED X RETENTION $ 10,00D $
WORKERS COMPENSATION X PER OTH-
AND EMPLOYERS' LIABILrrY STATUTE ER
C ANY PROPRIETORtPARTNERIEXECUIIVE YIN NIA WS55589489 06/01/2015 06101/2016 E.L. EACH ACCIDENT $ 500,000
OFFICERIMEMBER EXCLUDED?
(Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $ 500,000
If yes; describe under
DESCRIPTION OF OPERATIONS belcrw E.L. DISEASE - POLICY LIMIT $ 5'500,000
A Auto Hired BAA55589489 06/01/2015 06/01/2016 100 500
Physical Damage Comp Collision
DESCRIPTION OF OPERATIONS ! LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
The City of Ashland, Oregon, and its elected officials, off icersm and
employees are named additional insured as required by written contract per
attached endorsement CG881 0 04113.
CERTIFICATE HOLDER CANCELLATION
CITYALI
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.
20 East Main Street
Ashland, OR 975520 AUTHORIZED REPRESENTATIVE
O 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
Page 1 / 1
CITY OF
ASHLAND DATE PO NUMBER
20 E MAIN ST. 5/31/2016 13552
ASHLAND, OR 97520
(541) 488-5300
VENDOR: 004095 SHIP TO: Ashland Public Works
WORKPLACE RESOURCE OF OREGON (541) 488-5587
825 NE MULTNOMAH 51 WINBURN WAY
SUITE 270 ASHLAND, OR 97520
PORTLAND, OR 97232
FOB Point: Ashland, Oregon Req. No.:
Terms: Net 15 days Dept.:
Req. Del. Date: Contact: MICHAEL FAUGHT
Special Inst: Confirming? No
Quantity Unit Description Unit Price Ext. Price
THIS IS A REVISED PURCHASE ORDER
CONTRACTOR TO PROVIDE AND INSTALL 2,360.00
CUBICAL PANELS AND AUSILIARY COMPONE=NTS
TO EXPAND EXISTING SINGLE DESK
WORKSPACE INTO TWO WORKSPACES
CONTRACT FOR GOODS AND SERVICES LESS
THAN $25,000
BEGINNING 05/30/16
COMPLETION 07/22/16
SUBTOTAL 2,360.00
BILL TO: Account Payable TAX 0.00
20 EAST MAIN ST FREIGHT 0.00
541-552-2010 TOTAL 2,360.00
ASHLAND, OR 97520
Account Number Project Number Amount Account Number Project Number Amount
E 410.08.24.00.60240 2,360.00
~/rte
Aut ized Sign ure VENDOR COPY
FORM #3 CITY OF
ASHLAND
REQUISITION Date of request: 5/19/2016
Required date for delivery: 5/16/2016
Vendor Name Workplace Resources of Oregon
Address, City, State, Zip 825 NE Multnomah, Portland, OR 97232 (local :29 S Grape St, 97501)
Contact Name & Telephone Number Chad Pitman, (541) 245-1681
Fax Number
SOURCING METHOD
❑ Exempt from Corn etitia Bidding El Ernergenc
❑ Reasonjor exemptio ❑ Invitation to Bid (Copies on file) ❑ Form #13, Written findings and Authorization
❑ AMC 2.5Q ' Date approved by Council: Written-quote or proposal-attachpd ~
Written uQte or ro osal attached Attach co of council communication If council a roval re uired, atta co -
❑
® Small Procur ent Coo ve Procurement
Less than VAd ❑ Request for Proposal (Copies on file) tate of Oregon
® Direct Date approved by Council: Contract # gyiZ-7 tzlnd'- q-7~
❑ Verbal ote(s) or proposal(s) -(Attach copy of council communication) hin ton
Intermed' to Procure nt ❑ Sole Source Contract #
GOOD SERVICES ❑ Applicable Form (#5,6, 7 or 8) ❑ Other government agency contract
5 00 0 $100,000 ❑ Written quote or proposal attached Agency
❑ ( Written quotes and solicitation attached ❑ Form #4, Personal Services $5K to $75K Contract #
PERSONAL SERVICES 171 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
Contractor to provide and install cubical panels and auxiliary
components to expand existing single desk workspace into two $2360.00
workspaces.
Item # Quantity Unit Description of MATERIALS Unit Price Total Cost
xxx
xxx
xxx
TOTAL COST
® Per attached quote/proposal
Project Number 2016-18 Account Number _ 410.08.24.00.602400
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 requisitio form, I certify that the City's public c tracting requirements have been satisfied.
Employee: Department Head:
(Equal to or g eat n $5,000)
Department Manager/Supervisor: City Administrator:
(Equal to or greater than $25,000)
Funds appropriated for current fiscal year:
Finance Director (Equal to or greater than $5,000) Date
Comments:
Form #3 - Requisition