Loading...
HomeMy WebLinkAbout2016-150 Contract - Bertocchi Builders Contract for GOODS AND SERVICES CITY OF CONTRACTOR: Bertocchi Builders, Inc. ASHLAND CONTACT: Mark Bertocchi 20 East Main Street Ashland, Oregon 97520 ADDRESS: 1860 Gabriel Way, Medford, OR 97501 Telephone: 541/488-6002 Fax: 541/488-5311 TELEPHONE: (541) 944-7137 DATE AGREEMENT PREPARED: 5-11-2016 FAX: BEGINNING DATE: 5-18-2016 COMPLETION DATE: 6-27-16 COMPENSATION: Not to exceed $1400 GOODS AND SERVICES TO BE PROVIDED: Contractor shall provide all requisite goods for the following selected services from Exhibit C (proposal): City Hall - Repair two areas of soft sub floor in Finance Department* 1. Remove carpet squares to expose soft sub floor 2. Cut out and replace damaged sub floor 3. Prep and reinstall carpet squares 4. Clean site and dispose of all waste *Client to remove any and all furniture and filing cabinets Ashland Police Department - Install shelving unit 1. Install one shelve unit in southwest corner of room 136 2. Install laminate countertops, in kind with existing 3. Install rubber wall base where missing below cabinet, in kind with existing Pioneer Hall - Install stainless steel plate to cover damaged area on counter top 1. Sand down burned area 2. Clean and prep surface 3. Install 18"x20" stainless steel plate: glue in place, seal edge with silicone. 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 b the City. Contract for Goods and Services, Page 1 of 9 5. Ownership of Documents: All documents prepared by Contractor pursuant to this contract shall be the property of City. 6. Statutory Requirements: ORS 279B.220, 279B.225, 279B.230, 279B.235, ORS Chapter 244 and ORS 670.600 are made part of this contract. 7. Living Wage Requirements: If contractor is providing services under this contract and the amount of this contract is $20,142.20 or more, Contractor is required to comply with chapter 3.12 of the Ashland Municipal Code by paying a living wage, as defined in this chapter, to all employees performing work under this contract and to any subcontractor who performs 50% or more of the work under this contract. Contractor is also required to post the notice attached hereto as Exhibit B predominantly in areas where it will be seen by all employees. 8. Indemnification: Contractor agrees to defend, indemnify and save City, its officers, employees and agents harmless from any and all losses, claims, actions, costs, expenses, judgments, subrogations, or other damages resulting from injury to any person (including injury resulting in death), or damage (including loss or destruction) to property, of whatsoever nature arising out of or incident to the performance of this contract by Contractor (including but not limited to, Contractor's employees, agents, and others designated by Contractor to perform work or services attendant to this contract). Contractor shall not be held responsible for any losses, expenses, claims, subrogations, actions, costs, judgments, or other damages, directly, solely, and proximately caused by the negligence of City. 9. Termination: a. Mutual Consent. This contract may be terminated at any time by mutual consent of both parties. b. City's Convenience. This contract may be terminated at any time by City upon 30 days' notice in writing and delivered by certified mail or in person. C. For Cause. City may terminate or modify this contract, in whole or in part, effective upon delivery of written notice to Contractor, or at such later date as may be established 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 an portion of the work Contract for Goods and Services, Page 2 of 9 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: $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 b the City of Ashland Council or the Public Contracting Officer is Contract for Goods and Services, Page 3 of 9 required before any work may begin under this contract. 21. Certification. C ctor shall sign the certification attached hereto as Exhibit A and herein incorporated by referen Contr City of Ashland B B, ---"Signature Department Head ac, j 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 Goods and Services, Page 4 of 9 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. ~f (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. r Contractor (Date) Contract for Goods and Services, Page 5 of 9 • ASHLAND, OREGON EXHIBIT B City of Ashland LIVING WAGE per hour effective June 30, 2015 R (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, • 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, Page 6 of 9 Exhibit C From Bertocchi Builders Inc Proposal Dated 4-23-2014 1860 Gabriel Way Medford Or 97501 541-944-7137 CCB # 181329 To: City of Ashland cc Wes Hoadley, Dave Arnold 90 N. Mountain Ave Ashland Or 97520 Proposal regarding: Two areas of soft sub floor, in City Hall building Finance Dept. 5. Remove carpet squares to expose soft sub floor 6. Cut out and replace damaged sub floor 7. Prep and reinstall carpet squares 8. Clean up remove debris from site Total cost $375.00 r'1 rr i T'P"Y"g A ~V Ll.`CG.1_ ca, rV,+;t -e . }i re- ro C:1 'l..k"!J.a (l~a t~ S.. C~"~11`l,~Y~ Y:.:."~.".'i✓'\:7,"'ti1 r i , U L X 77 t'i' .,L -1"S„ 11 ..__..~Ji -i ti-U..o.. C., r;"f'1 r, rrr• r' i. ? r s - -air -_vv L r°t L Slc G; P 15IC3 iA ,r NOTE: Client to move any and all furnisher, filling cabinets, refrigerators and vending machines In order to perform the work stated above Contract for Goods and Services, Page 7 of 9 From Bertocchi Builders Inc Proposal Dated 5-3-2016 1860 Gabriel Way Medford Or 97501 541-944-7137 CCB # 181329 To: City of Ashland cc Wes Hoadley, Dave Arnold 90 N. Mountain Ave Ashland Or 97520 Proposal regarding: Pioneer Hall 1. Provide and install stainless steel plate to cover over damaged area 2. Sand down burned area 3. clean and prep surface 4. Install 18" X 20" stainless steel plate glue in place seal edge with silicone Total cost $135.00 Contract for Goods and Services, Page 8 of 9 From Bertocchi Builders Inc Proposal Dated 4-26-2016 1860 Gabriel Way Medford Or 97501 541-944-7137 CCB # 181329 To: City of Ashland cc Wes Hoadley, Dave Arnold 90 N. Mountain Ave Ashland Or 97520 Proposal regarding: Shelve unit work for the police department. Provide and install one shelve unit, match Formica counter top if still available. Install new rubber cove base. Total cost $820.00 Contract for Goods and Services, Page 9 of 9 EXHIBIT Q CITY OF ASHLAND WORKERS' COMPENSATION INSURANCE CERTIFICATION Unless an exemption under ORS Chapter 656 applies, Contractor must maintain Workers' Compensation insurance coverage for the duration of this Agreement and ensure that any subcontractor also meets the requirements of ORS Chapter 656. If the Contractor or any of its subcontractors fail to meet the requirements of ORS Chapter 656 or if any worker as a result of this Agreement claim Workers' Compensation coverage, Contractor agrees to indemnify and hold harmless the City for any penalties; costs, including defense costs; and financial obligations for 0 Z:1 injury to the worker(s) the State deems are covered workers under its law and rules regulating Workers' Compensation benefits. By placing the initials of Contractor's authorized representative in the applicable blank below and the signature of Contractor's authorized representative on page no. 2, Contractor certifies that Workers' Compensation coverage will be maintained for the term of the Agreement or that Contractor is exempt from the requirement to obtain Workers' Compensation insurance. CERTIFICATION OF COVERAGE: Contractor will maintain Workers' Compensation insurance coverage for the term of the contract and will provide Certificate of Workers' Compensation Insurance before Project Beginning Date. CERTIFICATION OF EXEMPTION FROM COVERAGE: Contractor is exempt from the requirement to obtain workers compensation insurance under ORS Chapter 656 or the following reason (initial the appropriate box). SOLE PRIETOR Contractor zs a sole proprietor, and Contractor has no employees, and • Contractor will not hire employees or subcontractors to perform this contract. A it CORPORATION - FOR PROFI'T' Contractor's business is incorporated; and • All employees of the corporation are officers and directors and have a substantial ownership interest* in the corporation, and w All work will be performed by the officers and directors; Contractor will not hire other employees or subcontractors to perform this contract- CORPORATION - NONPROFIT contractor's business is incorporated as a nonprofit corporation, and Contractor has no employees; all work is performed by volunteers, and Contractor will not hire employees or subcontractors to perform this contract. PARTNERSHIP 0O.O, • Contractor is a partnership, and Contractor has no employees, and - All work will be performed by the partners; Contractor will not hire employees or subcontractors to perform this contract, and • Contractor is not engaged in work performed in direct connection with the construction, alteration, repair, improvement, moving or demolition of an improvement to real property or appurtenances thereto. * * Paoe 1 of 2 EXHIBIT D CITY. OF ASHLAND WORKERS' COMPENSATION INSURANCE CERTIFICATION LIMITED LIABILITY COMPANY - Contractor is a limited liability company, and - Contractor has no employees, and All work will be performed by the members; Contractor will not hire employees or subcontractors to perform this contract, and • If Contractor has more than one member, Contractor is not engaged in work performed in direct connection with the construction, alteration, repair, improvement, moving or demolition of an i rovem o real pr rty or appurtenances thereto. (Signor ontractor's Authorized Representative) (Date) t Ir (Print Name - Contra - is Authorized Representative) (Title - Contractor's Authorized Representative) *NOTE: Under OAR 436-50-050 a shareholder has a "substantial ownership" interest if the shareholder owns 10% of the corporation, or if less than 10% is owned, the shareholder has ownership that is at least equal to or greater than the average percentase of ownership of all shareholders. **NOTE: Under certain circumstances partnerships and limited liability companies can claim an exemption even when perforrning construction work. The requirements for this exemption are complicated. Consult with City Attorney's Office before an exemption request is accepted from a contractor who will perform construction work. Page 2 of'? AC"RO® DATE (MM/DD/YYYlf7 CERTIFICATE OF LIABILITY INSURANCE 05/25/2016 PF47DUCER (925) 674-1755 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Ferrante Insurance Services, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1401 Willow Pass Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 105 Concord CA 94520- INSURERS AFFORDING COVERAGE NAIC # INSURED Bertocchi Builders Inc. INSURER A Security National Ins. Comp. 1860 Gabriel Way INSURER B INSURER C: INSURER D: Medford OR 97501- INSURER E: - COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTAN DING 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR !ADD'L POLICY NUMBER POLICY EFFECTIVE I POLICY EXPIRATION LIMITS LTR N RD PE F INSURANCE DATE MM/DD DATE (MWDDfYYYY) AI X GENERAL LIABILITY ! NA115205200 ;!03/23/2016 03/23/2017 EACH OCCURRENCE $ 1,000,000 - X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED ' MADE X OCCUR''I PREMISES (Ea occurrence~__ $ 100,000 MED EXP (Any one person) $ 5,000 CLAIMS PERSONAL & ADV INJURY I $ 1r000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG L $ 2 , 000, 000 - X POLICY PRO- ' LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO - - f - - ' ALL OWNED AUTOS BODILY INJURY (Per person) $ SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC / AUTO ONLY: AGG $ EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE I RETENTION $ $ WC STATU- - WORKERS COMPENSATION TO RY LIMITS OTHER !I AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) I E.L DISEASE - EA EMPLOYEE:, If yes, describe under - SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ OTHER ! DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Certificate holder to be named as additional insured per attached endorsement form #49-0108 07 11. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL City of Ashland IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 90 N. Mountain REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Ashland OR 97520-evv_ 1 ACORD 25 (2009/01) ©1988-2009 ACORD CORPORATION. All rights reserved. INS025 (200901) The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BLANKET ADDITIONAL INSUREDS - OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Policy Number: NA115205200 Endorsement Effective: 5/25/2016 12:01 a.m. Named Insured Countersigned T BERTOCCHI BUILDERS INC F + BERTOCCHI BUILDERS INC 1 ti SCHEDULE Name of Person or Organization: Any person or organization that the named insured is obligated by virtue of a written contract or agreement to provide insurance such as is afforded by this policy. Location: (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. Section II - Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only to the extent that the person or organization shown in the Schedule is held liable for your acts or omissions arising out of your ongoing operations performed for that insured. B. With respect to the insurance afforded to these additional insureds, the following exclusion is added: 2. Exclusions This insurance does not apply to "bodily injury" or "property damage" occurring after: (1) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the site of the covered operations has been completed; or (2) That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. The words "you" and "your" refer to the Named Insured shown in the Declarations. D. "Your work" means work or operations performed by you or on your behalf; and materials, parts or equipment furnished in connection with such work or operations. Primary Wording If required by written contract or agreement: Such insurance as is afforded by this policy shall be primary insurance, and any insurance or self-insurance maintained by the above additional insured(s) shall be excess of the insurance afforded to the named insured and shall not contribute to it. Waiver of Subrogation If required by written contract or agreement: We waive any right of recovery we may have against an entity that is an additional insured per the terms of this endorsement because of payments we make for injury or damage arising out of "your work" done under a contract with that person or organization. 49-0108 07 11 May Include Copyrighted Material of Insurance Services Offices, Inc. Page 1 of 1 Used with permission Jun 02 16 01:24p Jon Snowden State Farm 5414824957 p.2 AC~ ~ VEHICLE OR EQUIPMENT CERTIFICATE OF INSURANCE DAo6roTE TE (MM(MMfDD/YYYY) 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. THJS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. This form is used to report coverages provided to a single specific vehicle or equipment Do not use this form to report liability coverage provided to multiple vehicles under a single policy. UseACORD 25 for that purpose. PRODUCER CONTACT NAME: Jon Snowden 5#alri°FaJ"i71 Jon Snowden PAIc N Ezt : (541) 482-2461 n/c No - (541) 482-4957 420 Bride St E-MAIL g ADDRESS: jen@jonsnowden.com Ashland, OR 97520 PRODUCER C TOMER ID INSURER(S) AFFORDING COVERAGE NAIC a rNSURED INSURERA: State Farm MUtUaIAutomobile Insurance Company 25178 Bertocchi, Mark INSURER B: DBA Bertocchi Builders INSURERC: 1860 Gabriel Way INSURER D : Medford, OR 97501 INSURER E : DESCRIPTION OF VEHICLE OR EQUIPMENT YEAR MAKE / MANUFACTURER MODEL BODY TYPE VEHICLE IDENTIFICATION NUMBER 2005 Chevy K2500 Pickup 1 GCHK23235FB47007 DESCRIPTION SERIAL NUMBER COVERAGES CERTIFICATE NUMBER: REVISION NUMBER. THIS IS TO CERTIFY THAT THE POLICY;IES) OF INSURANCE LISTED BELOW HASIHA.VE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD{S) INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICY(IES) DESCRIBED HEREIN IS/ARE SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICY(IES). INSR AWL POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE (MM/DCNYYY) DATE (MMIDD/YYYY) LIMITS X VEHICLE LIABILITY COMBINED SINGLE LIMIT S Y 002 6612-F22-37N 12/22/2015 0612212016 60D:LY INJURY (Per person) S 100,000 IPODILY INJURY (Per accident: $ 300,000 j PROPERTY DAMAGE $ 50,000 GENERAL LIABILITY EACH OCCURENCE S OCCURRENCE GENERAL AGGREGATE $ CLAIMS MADE $ NSR Loss POLICY EFFECTIVE POLICY EXPIRATION LTR PAYEE TYPE OF INSURANCE POLICY NUMBER DATE (MMIDDIYYYII) DATE (MM/DD/YYYY) LIMITS I DEDUCTIBLE ❑ AGREED AMT S LIMIT Y X VEH COLLISION LOSS 002 6612-F22-37N 12/22/2015 0612212016 ❑ ACV ❑ ❑ STATED AMT S 1000 DIED X VEH COMP VEH OTC ❑ ACV ❑ AGREED AMT S LIMIT 002 6612-F22-37N 12!2212015 06/2212016 ❑ ❑ STATED AMT S 250 DED PROPERTY ❑ ACV ❑ AGREEG AMT BASIC R BROAD 5 LIMIT ❑ RG ❑ STATED AMT SPECIAL ❑ $ DED tEMARKS (INCLUDING SPECIAL CONDITIONS f OTHER COVERAGES) (Attach ACORD 101, Addrtlonal Remarks Schedule, If more space Is required) %DDITIONAL INTEREST CANCELLATION )elect one of the following: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED The add tional interest described below has been added to the policy;ies) listed herein by policy number(s). BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE A request has been submitted to add the additional interest described below to the pclicy(i--s) DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. listed nereirt 7iv., nu'rIb s . 'EHICLE I EQUIPMENT INTEREST: LEASED FINANCED DESCRIPTION OF THE ADDITIONAL INTEREST IAME AND ADDRESS OF ADDITIONAL INTEREST X ADDITIONAL INSURED LOSS PAYEE City OF Ashland LENDER'S LOSS PAYEE 2C E Main St LOAN I R Ashland, OR 97520 AU ORIZED RES NT, I VE 1997.2ACO COR ORATION. All rights reserved. (CORD 23 (2010105) The ACORD name and logo are registered marks 46f AC 1004361 142987.2 01-28-2013 Page 1 / 1 CITY OF ASHLAND DATE PO NUMBER ALI 20 E MAIN ST. 6/16/2016 13566 IrAft ASHLAND, OR 97520 (541) 488-5300 VENDOR: 013674 SHIP TO: Ashland Public Works BERTOCCHI BUILDERS INC (541) 488-5587 1860 GABRIEL WAY 51 WINBURN WAY MEDFORD, OR 97501 ASHLAND, OR 97520 FOB Point: Ashland, Oreqon Req. No.: Terms: Net Dept.: Req. Del. Date: Contact: KAYLEA KATHOL Special Inst: Confirming? No Quantity Unit Description Unit Price Ext. Price CONTRACTOR TO PROVIDE AND INSTALL 1,330.00 (A) A SHELF IN ASHLAND POLICE DPT RM 136; (B) STAINLESS STEEL CUTTING BOARD OVER DAMAGED COUNTER PIONEER HALL (C) MATERIALS AND LABOR FOR FLOOR REQAIRS IN CITY HALL CONTRACT FOR GOODS AND SERVICES BEGINNING 05/11/16 COMPLETION 05/18/16 SUBTOTAL 1,330.00 BILL TO: Account Payable TAX 0.00 20 EAST MAIN ST FREIGHT 0.00 541-552-2010 TOTAL 1,330.00 ASHLAND, OR 97520 Account Number Project Number Amount Account Number Project Number Amount E 110.06.12.00.60140 824.60 E 410.08.24.00.60240 505.40 Ai ifhn prl Rinnaf irp VENDOR COPY CITY OF ASHLAND NOTICE OF TRANSMITTAL TO: Kari Olson DATE: 3-June-2016 PROJECT: Minor Facility Repairs JOB NO.: SUBJECT: Requisition THE FOLLOWING ITEMS ARE BEING SENT TO YOU: (a) Executed contract with Bertocchi Builders (b) Certification of exemption frorr. workers' compensation coverage (c) Insurance documents ENCLOSED UNDER SEPARATE COVER " REMARKS : I had a conversation with Miranda Iwamoto last week, during which she confirmed that the City has a W9 on file for Bertocchi Builders. Department of Public Works By: Kaylea Kathol Title: Project Manager - Facilities PUBLIC WORKS Tel: 541488-5587 20 E. Main Street Fax: 541-488-6006 Ashland, Oregon 97520 TTY: 800-735-2900 www.ash~and.or.us /r FORM #3 CITY OF ASHLAND REQUISITION Date of request: 6/2/2016 Required date for delivery: 6/14/2016 Vendor Name Bertocchi Builders, Inc. Address, City, State, Zip 1860 Gabriel Way, Medford, OR 97501 Contact Name & Telephone Number Mark Bertocchi, (541) 944-7137 Fax Number SOURCING METHOD ❑ Exempt from Competitive Bidding ❑ EmergencX ❑ 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 ® Direct Award Date approved by Council: Contract # ❑ Verbal/Written quote(s) or proposal(s) -(Attach copy of council communication) ❑ State of Washington Intermediate Procurement ❑ Sole Source Contract # GOODS & SERVICES ❑ Applicable Form (#5,6, 7 or 8) ❑ Other government agency contract $5,000 to $100,000 ❑ Written quote or proposal attached Agency ❑ (3) Written quotes and solicitation attached ❑ Form #4, Personal Services $51K 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 Contractor to provide and install (a) a shelf in Ashland Police Department room 136; (b) a stainless steel cutting board over $1330.00 damaged countertop in Pioneer Hall; and (c) materials and labor for floor repairs in City Hall. Item # Quantity Unit Description of MATERIALS Unit Price Total Cost XXX xxx XXX TOTAL COST ® Per attached quote/proposal Project Number Account Number 110-06-12-00-601400 (62%) Account Number Account Number 410-08-24-00-602400 (38%) *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 12ublic contracting requirements have been satisfied.' Employee: Department Head: _~7 (Equal to or greater than $5,000) Department Manager/Supervisor: City Administrator: a (Equal to or greater than $25,000) Funds appropriated for current fiscal year: Finance Director- (Equal to or greater than $5, 000) Date Comments: Fnrm 93 - Renuisition