HomeMy WebLinkAbout2016-142 Contract - Gerlitz Engineering
Contract for PERSONAL SERVICES less than $35,000
A S #14(
CONSULTANT: Gerlitz Engineering Consultants
CONTACT: Justin Gerlitz, PE
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~S a REGR P'l ADDRESS: 1867 Williams Highway, Suite 201,
Grants Pass, OR 97527
340S. Pioneer Street
Ashland, Oregon 97520 TELEPHONE: 541-244-2617
Telephone: 541/488-5340
Fax: 541/488-5314 EMAIL: justin@gerlitzengineering.com
DATE AGREEMENT PREPARED: 5/24/16
BEGINNING DATE: 6/3/2016 COMPLETION DATE: 12/31/2017
COMPENSATION: As per Exhibit C, not to exceed $10,000.
SERVICES TO BE PROVIDED: Provide engineering services as 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 Personal 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.
FINDINGS:
Pursuant to AMC 2.50.120, after reasonable inquiry and evaluation, the undersigned Department Head finds and
determines that: (1) the services to be acquired are personal services; (2) the City does not have adequate personnel nor
resources to perform the services; (3) the statement of work represents the department's plan for utilization of such
personal services; (4) the undersigned consultant has specialized experience, education, training and capability sufficient
to perform the quality, quantity and type of work requested in the scope of work within the time and financial constraints
provided; (5) the consultant's proposal will best serve the needs of the City; and (6) the compensation negotiated herein
is fair and reasonable.
NOW THEREFORE, in consideration of the mutual covenants contained herein the CITY AND CONSULTANT AGREE as
follows:
1. Findings / Recitations. The findings and recitations set forth above are true and correct and are incorporated herein
by this reference.
2. All Costs by Consultant: Consultant shall, at its own risk and expense, perform the personal services described
above and, unless otherwise specified, furnish all labor, equipment and materials required for the proper performance
of such service.
3. Qualified Work: Consultant has represented, and by entering into this contract now represents, that all personnel
assigned to the work required under this contract are fully qualified to perform the service 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.
4. Completion Date: Consultant shall start performing the service under this contract by the beginning date indicated
above and complete the service by the completion date indicated above.
5. Compensation: City shall pay Consultant for service 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.
6. Ownership of Documents: All documents prepared by Consultant pursuant to this contract shall be the property of
City.
7. Statutory Requirements: ORS 279C.505, 279C.515, 279C.520 and 279C.530 are made part of this contract.
8. Living Wage Requirements: If the amount of this contract is $20,142.20 or more, Consultant 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 service work under
this contract. Consultant is also required to post the notice attached hereto as Exhibit B predominantly in areas where
it will be seen by all employees.
9. Indemnification: Consultant 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 Consultant (including but not
limited to, Consultant's employees, agents, and others designated by Consultant to perform work or services
attendant to this contract). Consultant shall not be held responsible for an losses, expenses, claims, subro ations,
Contract for Personal Services, Revised 06102/2015, Page 1 of 5
actions, costs, judgments, or other damages, directly, solely, and proximately caused by the negligence of City.
10. 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 Consultant, 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 Consultant 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 Consultant 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 Consultant's performance of each and every obligation and duty under
this contract. City by written notice to Consultant of default or breach may at any time terminate
the whole or any part of this contract if Consultant 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, Consultant shall immediately cease all activities under
this contract, unless expressly directed otherwise by City in the notice of termination. Further, upon termination,
Consultant 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 Consultant for work performed prior to
the termination date if such work was performed in accordance with the Contract.
11. Independent Contractor Status: Consultant is an independent contractor and not an employee of the City.
Consultant shall have the complete responsibility for the performance of this contract. Consultant shall provide
workers' compensation coverage as required in ORS Ch 656 for all persons employed to perform work pursuant to
this contract. Consultant is a subject employer that will comply with ORS 656.017.
12. Assignment and Subcontracts: Consultant 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. Consultant 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.
13. Default. The Consultant shall be in default of this agreement if Consultant: commits any material breach or default
of any covenant, warranty, certification, or obligation it owes under the Contract; its QRF status pursuant to the QRF
Rules or loses any license, certificate or certification that is required to perform the Services or to qualify as a QRF if
consultant 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.
14. Insurance. Consultant 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. Professional 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 claim, incident or occurrence. This is to
cover damages caused by error, omission or negligent acts related to the professional services to be provided
under this contract.
C. 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.
d. Automobile Liabilit insurance with a combined single limit, or the equivalent, of not less than Enter one:
Contract for Personal Services, Revised 06/02/2015, Page 2 of 5
$200,000, $500,000, $1,000,000, o Not Applicable or each accident for Bodily Injury and Property Damage,
including coverage for owned, hired or non-o e vehicles, as applicable.
e. 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 Consultant or its insurer(s) to
the City.
f. Additional Insured/Certificates of Insurance. Consultant 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 Consultant's services to be provided under this Contract. The consultant's insurance is primary and
non-contributory. As evidence of the insurance coverages required by this Contract, the Consultant shall furnish
acceptable insurance certificates prior to commencing work under this contract. 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
Consultant shall be financially responsible for all pertinent deductibles, self-insured retentions and/or self-
insurance.
15. 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 Consultant 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. Consultant, 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.
16. 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.
CONSULTANT, 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.
17. 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. Consultant
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 Consultant, with no further
liability to Consultant.
Certification. Consultant shall sign the certification attached hereto as Exhibit A and herein incorporated b reference.
Consultant: City of Ashlpnd
r _
By By Sig 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.
Contract for Personal Services, 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:
(1) 1 carry out the labor or services at a location separate from my residence or is in a
specific portion of my residence, set aside as the location of the business.
(2) Commercial advertising or business cards or a trade association membership are
purchased for the business.
(3) Telephone listing is used for the business separate from the personal residence listing.
(4) Labor or services are performed only pursuant to written contracts.
(5) Labor or services are performed for two or more different persons within a period of one
year.
(6) 1 assume financial responsibility for defective workmanship or for service not provided
as evidenced by the ownership of performance bonds, warranties, errors and omission
insurance or liability insurance relating to the labor or services to be provided.
- 11,6
r or (Date)
Contract for Personal Services, Revised 06/02/2015, Page 4 of 5
CITY OF ASHLAND, OREGON
EXHIBIT B
City Ashland
of LIVING
WA E
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
For all hours worked under a assistance for the project or the employee.
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
50% month or if the more of the employee spends Policy' Please see Ashland
➢ 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 Personal Services, Revised 06/02/2015, Page 5 of 5
EXHIBIT C
G F R L I TZ/-,;;~
EngineerConsultants
May 24, 2016
Jason Minica, Planning and Development Manager
Ashland Parks & Recreation
1195 E. Main Street
Ashland, OR 97520
RE: Garfield Park/General Services Proposal
Jason,
Based on our recent discussions, the Ashland Parks & Recreation Department is in the process
of reconstructing a portion of Garfield Park with a new water feature, basketball courts,
volleyball courts, hardscape improvements, and landscaping. You are currently working with
Laurie Sager and Associates and Thornton Engineering to complete the design documents which
are in the final approval process.
Gerlitz Engineering Consultants (GEC) has been approached to assist the design team with the
public bidding process. This includes, but is not limited to preparing a formal bid schedule and
construction cost estimate for the proposed improvements. This includes both the site design
elements as well as the specialized equipment and site amenities that will be installed as part of
the project.
In addition to the services listed above, it is our understanding that you would like us to also be
available for additional bidding and construction administration for the Garfield Park project as
well as other design and construction management services for upcoming/ongoing projects.
Based on this, we have prepared the following general services scope:
Task "X'- Garfield Park Bid Assistance
• Project administration (meetings, research, design coordination, etc.)
• Coordination with design team to procure plans, specifications, specialized
equipment/surfacing costs, and equipment details.
• Prepare detailed bid item list for public bidding process.
• Prepare construction cost estimate for overall project.
Task "A" Estimate: $2,100 (T&M)
Task "B" - General Design, Bid Assistance, and Construction Administration
• Project administration (meetings, research, design coordination, etc.)
• Ongoing bid and construction administration for the Garfield Park project and other
Ashland Parks & Recreation projects.
• Ongoing planning, design, and project management services for upcoming/ongoing
Ashland Parks & Recreation projects.
Task "B" Estimate: $7,900 (T&M)
1867 Williams Highway, Suite 201, Grants Pass, OR 97527
Office: 541-244-2617 www.gerlitzengineering.com - Page 1
Exclusions:
• Project planning, application, permit, plan production, and subconsultant fees (by APR)
• Bid packet printing and distribution (by APR)
Please review this information and let us know if you have any questions or comments. Based
on our long standing history of completing similar projects in the local area and working
relationships with the design team and City of Ashland, we are confident that we can complete
this project efficiently within the schedule provided. We look forward to working with you on
this and upcoming projects.
Sincerely,
Justin Gerlitz, P.E.
Principal Engineer
1867 Williams Highway, Suite 201, Grants Pass, OR 97527
Office: 541-244-2617 • www.gerlitzengineering.com - • Page 2
___"Maa`4 9GERLEN OP ID: MO
CERTIFICATE OF LIABILITY INSURANCE DA061MMIDD ~ )
ik~ 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).
NTACT
PRODUCER Phone: 541-479-5521 NAM
E:
Hart Insurance PHONE FAX
P. O. Box 1240 Fax: 541-474-1890 o Exth A/c No :
Grants Pass, OR 97528 E-MAIL
Mark O'Hara ADDRESS:
INSURERS AFFORDING COVERAGE NAIC a
INSURER A : Hanover American
INSURED Gerlitz Engineering INSURER B : AIX Specialty
Consultants, LLC. INSURER C: SAIF Corporation
1867 Williams Hwy., Suite 201
Grants Pass, OR 97527 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. EXP
AT R LIMITS
INSR TYPE OF INSURANCE ADDL SUER INSR POLICY NUMBER MMIDDYIYYYY M~MIADIYYYY
GENERAL LIABILITY EACH OCCURRENCE $ 2,000,0 DAMAGE TO RFffTED__
A COMMERCIAL GENERAL LIABILITY X OZ2A83525100 02/08/2016 02/08/2017 PREMISES Ea occurTenoe $ 300,0
CLAIMS-MADE ~ OCCUR MED EXP (An one person) $ 5,0
X Business Owners PERSONAL & ADV INJURY $ MN 2,000,00
i GENERAL AGGREGATE $ 4,000,00
GEN'L AGGREGATE LIMIT APPLIES PER: j PRODUCTS - COMPIOP AGG $ 4,000,00
F-] JFCT F7 PRO LOC 3 $
POLICY
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
Ea accident $
ANY AUTO i BODILY INJURY (Per person) $
s ALL OWNED SCHEDULED
AUTOS AUTOS BODILY INJURY (Per accident) S
X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $
AUTOS Per accident
UMBRELLA LIAR E OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DED RETENTION $ $
WORKERS COMPENSATION X WC STATU- OTH-
AND EMPLOYERS' LIABILITY TO ER
C ANY PROPRIETOR/PARTNER/EXECUTIVE Y NIA 862187 05/19/2016 06/1912097 E.L. EACH ACCIDENT $ 500,00
OFFICERIMEMBER EXCLUDED? j
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 600,0001
If yes, describe under I E.L. OiSEASE -POLICY LIMIT S 500,00
DESCRIPTION OF OPERATIONS below
B Architects & Eng. LH2 A839262 00 02/0812016 02108/2017 Per Claim 2,000,00
Professional Liab. Aggregate 2,000,00
k
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD ,Ot, Additional Remarks Schedule, If more space Is required)
The City of Ashland, Oregon, its elected officials, officers and employees
are included as Additional Insured with respect to Consultant's service
provided by written contract. Coverage is Primary & Non Contributory.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Ashland Parks and Recreation ACCORDANCE WITH THE POLICY P VISIONS.
Commission
AUTHORIZED REPRESENTATIVE
340 S. Pioneer Street
Ashland, OR 97520 Mark O'Hara
01988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
H Fht
Anover
Insurance Group_
OZ2 A836251 0901601
BUSINESSOWNERS LIABILITY SPECIAL BROADENING ENDORSEMENT
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies Insurance provided under the following:
BUSINESSOWNERS COVERAGE FORM
SUMMARY OF COVERAGES Limits Page
1. Additional Insured by Contract, Agreement or Permit 1
2. Additional Insured - Broad Form Vendors 2
3. Alienated Premises 2
4. Bodily Injury Redefined 2
5. Broad Form Property Damage - Borrowed Equipment, Customers 2
Goods and Use of Elevators
6. Incidental Malpractice (Employed Nurses, EMT's and Paramedics) 3
7. Personal and Advertising Injury - Broad Form 3
8. Product Recall Expense $25,000 Occurrence
$50,000 Aggregate 3
9. Unintentional Failure to Disclose Hazards 5
10. Unintentional Failure to Notify 5
This endorsement amends coverages provided under the Businessowners Coverage Form through new
coverages and broader coverage grants. This coverage is subject to the provisions applicable to the
Businessowners Coverage Form, except as provided below.
1. A dtioml Insured by Contract, Agreement or This insurance applies on a primary basis if
Permit that is required by the written contract,
Under SECTION it - LIABILITY, C. Ynio, Is An agreement or permit.
Insured, Paragraph 4, is added as follows: b. This provision does not apply:
a. Any person or organization for whom you (1) Unless the written contract or written
are performing operations when you and agreement has been executed or permit
such person or organization have agreed in has been issued prior to the "bodily
writing in a contract, agreement or permit injury", "property damage" or "personal
that such person or organization be added and advertising Injury";
as an additional Insured on your policy. Such
person or organization is an additional (2) To any person or organization included
as an insured by an endorsement
insured only with respect to liability for Issued by us and made part of this
"bodily Injury", "property damage" or
"personal and advertisin Policy;
g injury" caused, in
whole or in part, by: (3) To any person or organization included
as an insured under Item 1.a.2. of this
(1) Your acts or omissions; or endorsement;
(2) The acts or omissions of those acting
on your behalf, (4) To any lessor of equipment:
but only with respect to; (a) After the equipment lease expires;
or
(3) "Your work" for the additional Insured(s) (b) If the "bodily injury", "property
at the location designated in the damage" or "personal and
contract, agreement or permit; or advertising injury" arises out of the
(4) Premises you own, rent, lease, control or sole negligence of the lessor;
occupy.
391-1006 06 09 Includes copyrighted material of Insurance Services Office, Inc- Page 1 of 5
13,183
(5) To any: demonstration. testing, or the
(a) Owners or other interests from substitution of parts under instruction
whom land has been leased which from the manufacturer, and then
takes place after the lease for that repackaged in the original container;
land expires; or Q. Any failure to make such inspection.
(b) Managers or lessors of premises if. adjustments, tests or servicing as the
vendor has agreed to make or normally
G) The occurrence takes place after undertakes to make in the usual course
you cease to be a tenant in that of business In connection with the
premises; or distribution or sale of the product;
(ii) The "bodily injury". "property f. Demonstration, installation, servicing or
damage" or "personal and repair operations, except such
advertising injury" arises out of operations performed at the vendor's
structural alterations, new premises in connection with the sale of
construction or demolition the product;
operations performed by or on
behalf of the manager or lessor; g- Products which, after distribution or sale
or by you, have been labeled or relabeled
or used as a container, part or
(6) To "bodily injury", "property damage" or ingredient of any thing or substance by
"personal and advertising injury" arising or for the vendor; or
out of the rendering of or the failure to h. '"Bodily injury" or "property damage"
render any professional services. arising out of the sole negligence of the
c. Additional insured coverage provided by vendor for its own acts or omissions or
this provision will not be broader than those of its employees or anyone else
coverage provided to any other insured. acting on its behalf. However, this
d. All other Insuring agreements, exclusions, exclusion does not apply to:
and conditions of the policy apply. (1) The- exceptions contained in
2. Additional Insured - Broad Form Vendors paragraphs 5.d. or 51; or
Under SECTION II - LIABILITY, C. Who Is An (2) Such inspections, adjustments, test
Insured, paragraph S. is added as follows: or servicing as the vendor has
5. Any person or organization with whom you agreed to make or normally
agreed, because of a written contract or undertakes to make in the usual
written agreement to provide insurance, but course of business, in connection
only with respect to "bodily Injury" or with the distribution or sale of the
"property damage" arising out of "your products.
products" which are distributed or sold In This insurance does not apply to any
the regular course of the vendor's business. insured person or organization, from whom
The insurance afforded the vendor does not you have acquired such products, or any
apply to: ingredient, part or container, entering into,
accompanying or containing such products.
a. "Bodily injury" or "property damage" for
which the vendor is obligated to pay 3. Alienated Premises
damages by reason of the assumption of Under SECTION II - LIABILITY, B. Exclusions,
liability in a contract or agreement. This paragraph 1X(2) is replaced in its entirety with
exclusion does not apply to liability for the following:
damages that the vendor would have in (2) Premises you sell, give away or abandon. If
the absence of the contract or the "property damage" arises out of any part
agreement; of those premises and occurred from
b. Any express warranty unauthorized by hazards that were known by you, or should
you; have reasonably been known by you, at the
c. Any physical or chemical change in the time the property was transferred or
product made intentionally by the abandoned.
vendor; 4. Bodily Injury Redefined
d. Repackaging, unless unpacked solely Under SECTION II • LIABILITY, F. Liability and
for the purpose of inspection, Medical Expenses Definitions, definition 4. is
replaced In its entirety by the following:
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4. "Bodily injury" means bodily Injury, (a) The insured; or
disability, sickness or disease sustained by (b) Any officer of the corporation,
a person, including death resulting from any director, stockholder, partner or
of these at any time. Bodily Injury" includes member of the insured; and
mental anguish or other mental iniurv
resulting from "bodily injury"'. (2) Not directly or indirectly related to an
5. Broad Form Property Damage - Borrowed "employee", nor to the employment,
Equipment, Customers Goods, Use of Elevators Prospective employment or termination of
any person or persons by an insured.
a. Under SECTION 11 - LIABILITY, S. 8. Product Recall Expense
Exclusions, paragraph 1.k., the following is
added: a. Under SECTION Il - LIABILITY, B.
Paragraph (4) does not apply to "property Exclusions, Paragraph 1. o. is replaced in its damage" to borrowed equipment while at a entirety by the following:
jobsite and not being used to perform o. Recall of Products. Work or Impaired
operations. Property
Paragraph (3), (4) and (6) do not apply to Damages claimed for any loss, cost or
"property damage" to "customers goods" expense incurred by you or others for
while on your premises nor to the use of the loss of use, withdrawal, recall,
elevators. inspection, repair, replacement,
b. Under SECTION 11 - LIABILITY, F. Liability adjustment, removal or disposal of:
and Medical Expenses Definitions, the (1) "Your product";
following additional definition is added: (2) "Your work"; or
"Customers goods" means property of your (3) "Impaired property";
customer on your premises for the purpose If such
of being: product, work or property is
withdrawn or recalled from the market
a. Worked on: or or from use by any person or
b. Used in your manufacturing process. organization because of a known or
c. The insurance afforded under this provision suspected defect deficiency, inadequacy is excess over any other valid and or dangerous condition
in it, but this
collectible property insurance (including exclusion does"not apply to "product
deductible) available to the Insured whether recall expenses that you incur for the
covered recall of your product". The
primary, excess, contingent or on any other exception to the exclusion does not
basis. apply to "product recall expenses"
6. Incidental Malpractice - Employed Nurses, resulting from:
EhWs and Paramedics
(1) Failure of any products to
Under SECTION 11 - LIABILITY, C. Who Is An accomplish their intended purpose;
Insured, paragraph 2.a.(1)(d) does not apply to a (2) Breach of warranties of fitness,
nurse, emergency medical technician or
paramedic employed by you if you are not quality, durability or performance;
engaged in the business or occupation of (3) Loss of customer approval, or any
providing medical, paramedical, surgical, cost incurred to regain customer
dental, x-ray or nursing services. approval;
7. Personal and Advertising Injury - Broad Form (4) Redistribution or replacement of
Under SECTION 11 • LIABILITY, F. Liability and "your product" which has been
Medical Expenses Definitions, definition 15, recalled by like products or "Personal and Advertising Injury", paragraph h. substitutes;
is added as follows: (5) Caprice or whim of the insured;
h. Discrimination or humiliation (unless (6) A condition likely to cause loss of
insurance thereof is prohibited by law) that which any insured knew or had
results in injury to the feelings or reputation reason to know at the inception of
of a natural person, but only if such this insurance;
discrimination or humillation is: (7) Asbestos, including loss, damage
(1) Not done intentionally by or at the or clean up resulting from asbestos
direction of: or asbestos containing materials; or
5914006 06 09 includes copyrighted material of Insurance Services Office, Inc. Page 3 of 6
13,185
MW Recall of "your products" that have printed advertisements including
no known or suspected defect stationary, envelopes and
solely because a known or postage;
suspected defect in another of (2) Shipping the recalled products
"your products" has been found. from any purchaser, distributor
b. Under SECTION II - LIABILITY, C. Who or user to the place or places
Is An Insured, paragraph 4.c. is added designated by you;
as follows: (3) Remuneration paid to your
c. "Bodily injury" or "property damage" regular "employees" for
do not apply to "product recall necessary overtime;
expense" arising out of any (4) Hiring additional persons, other
withdrawal or recall that occurred than your regular "employees";
before you acquired or formed the
organi2ation. (5) Expenses incurred by
"employees" including
c. Under SECTION II - LIABILITY, E. transportation and
Liability and (Medical Expense General accommodations;
Conditions, 2. Duties in the Event of
Occurrence, Offense, Claim or Suit, (6) Expenses to rent additional
paragraph e. is added as follows: warehouse or storage space;
e. You must see to it that the following (7) Disposal of "your product", but
are done in the event of an actual or only to the extent that specific
anticipated "covered recall" that methods of destruction other
may result In "product recall than those employed for trash
expense": discarding or disposal are
required to avoid "bodily injury"
(1) Give us prompt notice of any or "property damage" as a result
discovery or notification that of such disposal,
"your product" must be
withdrawn or recalled. Include a you incur exclusively for the purpose
description of "your product" of recalling your product"; and
and the reason for the b. Your lost profit resulting from such
withdrawal or recall; "covered recall".
(2) Cease any further release, e. Under SECTION 11 - LIABILITY, D.
shipment, consignment or any Liability and Medical Expenses Limits of
other method of distribution of Insurance, the following is added:
like or similar products until it 5. The Limits of insurance and rules
has been determined that all stated below fix the most that we
such products are free from will pay under this Product Recall
defects that could be a cause of Expense Coverage-
loss under this insurance.
d. Under SECTION II - LIABILITY, F. The Aggregate Limit is the most
that we will reimburse you for
Ualbility and Medical Expenses the sum of all "product recall
(Definitions, the following additional expenses" incurred for all
definitions are added: "product recall expenses"
"Covered recall" means a recall made initiated during the policy period,
necessary because you or a government (2) The Occurrence Limit shown on
body has determined that a known or the Summary of Coverages is
suspected defect, deficiency, the most we will pay in
inadequacy, or dangerous condition in connection with any one defect
"your product" has resulted or will result or deficiency.
in "bodily injury" or "property damage". (a) All "product recall
"Product recall expense(s)" means: expenses" in connection
with substantially
a. Necessary and reasonable expenses the same
general harmful condition
for: will be deemed to arise out
(1) Communications, including radio of the same defect or
or television announcements or deficiency and considered
one "occurrence".
391-1006 as 09 Includes copyrighted material of Insurance Services Office, Inc. Page 4 of 6
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(b) Any amount reimbursed
for "product recall
expenses" in connection
with any one "occurrence"
will reduce the amount of
the Aggregate Limit
available for
reimbursement of "product
recall expenses" in
connection with any other
defect or deficiency.
(c) If the Aggregate Limit has
been reduced by
reiriibursement of "product
recall expenses" to an
amount that is less than
the Occurrence Limit, the
remaining Aggregate Limit
is the most that will be
available for
reimbursement of "product
recall expenses" in
connection with any other
defect or deficiency.
& A deductible of $500 applies per
each "Occurrence".
9. Unintentional Failure to Disclose Hazards
Under SECTION 11 - LIABILITY, E. Liability and
Medical Expenses General Conditions,
paragraph 6. is added as follows:
Representations
We will not disclaim coverage under this
Coverage Form if you fail to disclose all
hazards existing as of the inception date of
the policy provided such failure is not
intentional.
10. Unintentional Failure to Notify
Under SECTION II - LIABILITY, E. Liability and
Medical Expenses General Conditions, 2. Duties
in the Event of Occurrence, Offense, Claim or
Suit, paragraph f. is added as follows.
f. Your rights afforded under this Coverage
Form shall not be prejudiced if you fall to give
us notice of an "occurrence", offense, claim
or "suit", solely due to your reasonable and
documented belief that the "bodily injury" or
"property damage" is not covered under this
Policy.
391.1006 06 09 Includes copyrighted material of insurance Services Office, Inc. Page 5 of 6
13,187
,nnnw.saif.com saiFcorporation
May 18, 2016
MARK O'HARA
GERLITZ ENGINEERING CONSULTANTS, LLC. HART INSURANCE AGEN Y HJ
1867 WILLIAMS HWY., SUITE 201 PO BOX 1240
GRANTS PASS, OR 97527 GRANTS PASS, OR 97528
Policy Number: 862187
Effective Date of Coverage: May 19, 2016
Dear Policyholder:
Thank you for selecting SAIF Corporation as your workers' compensation provider. As the
leading workers' compensation insurance company in Oregon, our goals are to provide you
exceptional service at an affordable price, and to help you make your workplace as safe as
possible.
Included with this letter is a policy information page that shows your estimated payroll, premium
modifiers, and estimated premium amount. You also will find an explanation of your classifications
and the endorsements that apply to your policy.
We've also provided some key information below. You'll find everything else you need to know
about your policy, workplace safety, filing and managing a claim, and more in the easy-to-use
Employer Guide on our website. Just go to saif.com and click "Employer Guide." You can
request printed information on topics of interest to you and your workers by calling us at
503.373.8000 or 800.285.8525, or by emailing uwpayroll@saif.com.
Payroll reporting At the end of each annual reporting period, we'll send you a form to report
the actual payroll for your covered workers for that period.
For more on payroll reporting, see these key pages on saif.com:
- Learn how to complete your payroll report: saif.com/instructions
- View details on the requirements for reporting your payroll by class:
saif.com/class
- See an explanation of who is covered (also called "subject workers") and who is
not: saif.com/whomiscovered
- Learn when to report a worker in multiple classifications: saif.com/vtr
For your convenience, you can report your payroll and make your payments online.
Go to the Employer Guide on saif.com and log into (or register for) Business Online.
Your premium I Payment options based on your estimated premium of $250.57 are
listed below.
Installment Payment Plan
Due Date Amount
05/18/2016 $250.57
400 High St SE i Salem, OR 97312P: 800.285.8525
Policy No: 862187 saifcorporation
Page 2
Important: Changes in your payroll, classifications, or number of locations during the
policy year can result in an adjustment to your installment amounts. Please notify us
right away of any changes in your business.
Premium audits I Our goal is to ensure accurate payroll reporting we want you to pay only
what you're required to pay. Premium auditors verify that you have reported the correct payroll
in the proper classification. Learn more about the premium audit process at saif.com/premiumaudit.
Nondisabling claim reimbursement I This program could help you reduce or eliminate
costs that are considered when determining your future experience rating modification factors.
Learn more about the program and billing options at saif.com/ndr.
Managed care organizations (MCOs) I Majoris Health Systems is the registered managed care
provider in your area. If you need to find a doctor or medical facility for an injured worker, you'll
find MCO directories at saif.com/supportingworker.
Workplace safety and health I You may request workplace safety and industrial hygiene
assistance by contacting our team of safety and health experts at 877.242.5211 or by email at
SafetyServices@saif.com. Safety professionals will assist you in analyzing your operations,
hazards, injury records, and management controls.
In addition, they will help you:
- Learn how to conduct onsite health and safety surveys
- Assess your safety and health programs
- Learn to identify and evaluate safety training requirements, best practices, and
available resources
- Understand your responsibilities and the rules which pertain to your workplace under
the Oregon Safe Employment Act (OSEA) and the Oregon Occupational Safety and Health
Division. (OR-OSHA). OSEA and OR-OSHA require employers to provide a safe and
healthful workplace and to do everything reasonably necessary to protect the life,
health, and safety of their employees. Learn more at www.orosha.org or 800.922.2689.
You also can find expert workplace safety information in the comprehensive safety section
on our website by going to saif.com and clicking "Safety and health." Note: You have the right
to contact OR-OSHA if we fail to provide loss prevention services as offered or requested.
If you have any questions or need assistance, please contact MARK O'HARA
at 541.479.5521. We look forward to working with you.
Sincerely,
Service Center
P: 971.242.5001 or 888.598.5880
F: 971.242.5353
servicecenter@saif.com
Enclosures
c: MARK O'HARA - HART INSURANCE AGENCY
NBi 400 High St SE I Salem, OR 973121 P; 800.285.8525
saiFcorpora ion Information Page Carrier No: 20001
Policy No: 862187
Employer Identification No: 81-1188082
NCCI Risk ID No:
Item 1. The Insured: Entity Type:
GERLITZ ENGINEERING CONSULTANTS, LLC. LIMITED LIABILITY COMPANY
Mailing address: Agency:
GERLITZ ENGINEERING CONSULTANTS, LLC. MARK O'HARA
1867 WILLIAMS HWY., SUITE 201 HART INSURANCE AGENCY
GRANTS PASS, OR 97527 PO BOX 1240
GRANTS PASS, OR 97528
Other workplaces not shown above:
NONE
Item 2. The policy period is from 05-19-2016, 12:01 A.M. to 06-01-2017, 12:01 A.M. at the insured's mailing
address
Item 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers
Compensation Law of the states listed here: OREGON
B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in
item 3.A. The limits of our liability under Part Two are:
Bodily Injury by Accident $500,000 each accident
Bodily Injury by Disease $500,000 each employee
Bodily Injury by Disease $500,000 policy limit
C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here:
NONE
D. This policy includes these endorsements and schedules:
WC360601 E Oregon Cancellation Endorsement
W0000421 D Catastrophe (other than Certified Acts of Terrorism) Premium End
W0000422B Terrorism Risk Insurance Prog Reauthorization Act Disclosure End
W0000414 Notification of Change in Ownership Endorsement
W0000406A Premium Discount Endorsement
WC360406 Premium Due Date Endorsement
WC990309C SAIFPlus Endorsement
WC360301 Oregon Unsafe Equipment Exclusion Endorsement
WC990616 Confidentiality Endorsement
Item 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating
Plans. The premium and rates and the experience rating modification factor, if any, may change on
your anniversary rating date of 06-01-2017. All information required below is subject to verification and
change by audit.
Policy No: 862187 sai f corpo ra t i on
Page 2
Information Page
Estimated Rate Per
Policy Period $100 of Estimated
Class -Description Payroll Pa roll Premium
Period: 05/19/2016 - 05131/2017
Gerlitz Engineering Consultants, Llc.
8601 14 Architect Or Engineer Firm-Sales/Dr __$49,71 0 0.36 $178.96
Total Payroll $49,710
Manual Premium $178.96
Estimated Premium $178.96
Total Estimated Premium $178.96
SAIFPIus Credit (2% to a $600 maximum) $3.58
Balance of Policy Minimum Premium (excludes Part Two Premium) + $50.62
Estimated Standard Premium $226.00
Terrorism Premium + $4.97
Catastrophe Premium + $4.97
Estimated Policy Period Premium $235.94
DCBS Assessment @ 6.20% on $235.94 (excludes Part Two & Federal Premium) + $14.63
Total Estimated Policy Premium Including DCBS Assessment $250.57
Policy Minimum Premium: $226
Your policy premium is based on your current estimated premium and may be prorated for
policies in effect for less than a full year or adjusted based on actual payroll by classification.
The SAIFPIus discount applies only to premium paid prior to the end of the policy period.
Terrorism Premium is in addition to Policy Minimum Premium.
Catastrophe Premium is in addition to Policy Minimum Premium.
Payroll Reporting Frequency: Annual
This information page is part of your policy.
Countersigned on 05-18-2016 at Salem, Oregon
Ker arnett4.1 ent
W0000001 A and Chief Executive Officer
CITY OF
ASHLAND
FORM #4
DETERMINATIONS TO PROCURE
PERSONAL SERVICES
$5,000 to $75,000
To: Dave Kanner, Public Contracting Officer
From: Michael Black, Ashland Parks and Recreation Director
Date: June 21, 2016
Re: DETERMINATIONS TO PROCURE PERSONAL SERVICES
In accordance with AMC 2.50.120(A), for personal services contracts greater than $5,000, but less
than $75,000, the Department Head shall make findings that City personnel are not available to
perform the services, and that the City does not have the personnel or resources to perform the
services required under the proposed contract. However, the City Attorney, the Public Contracting
Officer, or Local Contract Review Board, can require a formal solicitation for bids to ensure that
the purposes of this chapter are upheld.
Background
The Parks Commission intent is to hire professional engineering services for Garfield Park and future
upcoming and ongoing projects.
Gerlitz Engineering will provide an engineer's estimate and bid list for the Garfield Park project. They
will also provide various planning and design aspects to upcoming and ongoing projects.
Estimated cost for Garfield Park Project is $2,100. Budgeted amount is $10,000 with a difference of
$7,900 to be used for ongoing and upcoming projects.
The timeline is through December 31, 2017.
Pursuant to AMC 2.50.120(A), has a reasonable inquiry been conducted as to the availability of
City personnel to perform the services, and that the City does not have the personnel and resources
to perform the services required under the proposed contract?
Ashland Parks and Recreation Commission does not have personnel to perform the duties as outlines
above.
Form #4 - Department Head Determinations to Procure Personal Services, Page 1 of 1, 6/22/2016
Kristy Blackman
From: Kristy Blackman
Sent: Thursday, June 23, 2016 11:07 AM
To: Betsy Harshman
Subject: RE: Requisition for Eng Servs for Garfield Park
We just put the whole thing for this year and then unpaid balances will be entered for next year. I just need to know if
ANY work will be done, and it sounds like it will so I'll enter it for this year O
Thanks Betsy O
From: Betsy Harshman
Sent: Thursday, June 23, 2016 11:03 AM
To: Kristy Blackman <kristy.blackman@ashland.or.us>
Subject: RE: Requisition for Eng Servs for Garfield Park
I think you could safely put $2,000 in this FY and the remaining $8,000 in FY 17. Does that work?
Thank you!
O Betsy
From: Kristy Blackman
Sent: Thursday, June 23, 2016 10:53 AM
To: Betsy Harshman
Subject: Requisition for Eng Servs for Garfield Park
Hi Betsy,
Can you tell me if any of this work for this PO will happen before the end of this month? I need to determine if we need
to enter it in this or next FY.
Thanks0
5;~'Tedo
Administrative Assistant
City of Ashland/Administrative Services/Finance
20 East Main Street, Ashland, OR 97520
541-552-2012 direct/voice, TTY 800-735-2900
541-552-2059 fax
OF
This email transmission is official business of the City of Ashland, and it is subject to Oregon Public Records Law for
disclosure and retention. If you have received this message in error, please contact me at (541) 552-2012
1
Page 1 / 1
ASHLAND PARK COMMISSION
20 E MAIN ST. DATE PO NUMBER
ASHLAND, OR 97520 6/23/2016 00569
(541) 488-5300
VENDOR: 004826 SHIP TO:
GERLITZ ENGINEERING
1867 WILLIAMS HWY SUITE 201
GRANTS PASS, OR 97527
FOB Point: Req. No.:
Terms: net Dept.:
Req. Del. Date: Contact: BETSY HARSHMAN
Special Inst: Confirming? NO
Quantity Unit Description Unit Price Ext. Price
PROVIDE ENGINEERING SERVICES FOR 10,000.00
GARFIELD PARK WATER PARKAS PER PROPOSAL
CONTRACT FOR PERSONAL SERVICES LESS
THAN $35,000
BEGINNING: 06103/16
COMPLETION: 12/31/17
SUBTOTAL 10 000.00
BILL TO: TAX 0.00
FREIGHT 0.00
TOTAL 10,000.00
Account Number Project Number Amount Account Number Project Number Amount
E 411.12.00.00.70420 E 000060.999 10 000.00
Authoriz Signature VENDOR COPY
- a Ar
1111 - CITY OF
FORM #3
ASHLAND
'~'Olj Ei y-it 1-
REQUISITION Date of request: " f
Required date for delivery:
Vendor Name Gjerlh FnninPPrinn ('nnsultnnts
Address, City, State, Zip 1867 Williamson NinhwaV, Suite 01, Grants Pass, OR 97527
Contact Name & Telephone Number Justin Gerlitz' 541-244-2617
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) ❑ 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
Provide engineering services for Garifled Water Park as per proposal. $ 10,000
Item # Quantity Unit Description of MATERIALS Unit Price Total Cost
TOTAL COST
® Per attached quote/proposal $
Project Number 000060 Account Number 411.12.00.00.704200
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:
lT Director Date Support -Yes /No
By signing this requisition form, 1 certify that the City's public contracting requirements have been satisfied.
9 a
a _ r = Department Head:
Employee: (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 ES / NO = el z X
Finance Director- (Equal to A greater than $5,000) Date
Comments:
Form #3 - Requisition