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HomeMy WebLinkAbout2016-239 Contract - Polaris Land Surveying Contract for Personal Services less than $35,000,00 CITY OF CONSULTANT: Polaris Land Surveying -.5 H LA N D CONTACT: Shawn Kampmann 20 East Main Street Ashland, Oregon 97520 ADDRESS: P.O. Box 459 Ashland, OR 97520 Telephone: 541/488-6002 Fax: 541/488-5311 TELEPHONE: 541-482-5009 DATE AGREEMENT PREPARED: 8/24/2016 EMAIL: BEGINNING DATE: 8/24/2016 COMPLETION DATE: 06/30/2017 COMPENSATION: Not to exceed $16,900; see exhibit C SERVICES TO BE PROVIDED: Surveying services to research and analyze existing multiple deed titles for possible street right-of-way dedication of Mistletoe Road between Tolman Creek and Siskiyou Blvd, along with a property line adjustment survey to reconfigure Tax Lot 1800; see exhibit C. E 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 rims 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: y 1. Findings ! Recitations. The findings and recitations set forth above are true and correct and are incorporated herein ~I 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 $20,283.20 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 i 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 less than $35,000.00, Page 1 of 5 0 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 l 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: $250,000, $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 Liability insurance with a combined single limit, or the equivalent, of not less than Enter one: Contract for Personal Services less than $35,000.00, Page 2 of 5 II $100,000, $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. 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, excluding Professional Liability and Workers' Compensation, 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 h rein incorporated b reference. Consul nt: City of Ashland By By ` j Signature Department ead Print Name Print Name T Title Date W-9 One copy of a W-9 is to be submitted with the signed contract. Purchase Order No. G Contract for Personal Services less than $35,000.00, 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. X' (3) Telephone listing is used for the business separate from the personal residence listing. X (4) Labor or services are performed only pursuant to written contracts. X (5) Labor or services are performed for two or more different persons within a period of one i/ year. (6) 1 assume financial responsibility for defective workmanship or for service not provided as evidenced by the ownership of performance bonds, warranties, errors and omission insurance or liability insurance relating to the labor or services to be provided. Contractor (Date) Contract for Personal Services less than $35,000.00, Page 4 of 5 CITY OF ASHLAND, OREGON EXHIBIT B City of Ash land LIVING per hour effective June 30, 2016 (Increases annually every June 30 by the %all Consumer Price Index) portion of business of their 401 K and IRS eligible employer, if the employer has cafeteria plans (including ten or more employees, and childcare) benefits to the has received financial amount of wages received by assistance for the projector the employee. ➢ For all hours worked under a business from the City of service contract between their Ashland in excess of ➢ Note: "Employee" does not employer and the City of $20,283.20. include temporary or part-time Ashland if the contract employees hired for less than exceeds $20,283.20 or more. ➢ If their employer is the City of 1040 hours in any twelve- Ashland including the Parks month period. For more ➢ For all hours worked in a and Recreation Department. details on applicability of this month if the employee spends policy, please see Ashland 50% or more of the ➢ In calculating the living wage, Municipal Code Section employee's time in that month employers may add the value 3.12.020. working on a project or of health care, retirement, For additional information: Call the Ashland City Administrator's office at 541-488-6002 or write to the City Administrator, City Hall, 20 East Main Street, Ashland, OR 97520 or visit the city's website at www.ashland.or.us. Notice to Employers: This notice must be posted predominantly in areas where it can be seen by all employees. CITY OF ASHLAND Contract for Personal Services less than $35,000.00, Page 5 of 5 EXH I BIT C r m r L ANO URVEY1NG, LLC r August 8, 2016 City of Ashland Engineering Department 51 Winburn Way Ashland, Oregon 97520 Attn: Brad Barber PLS, City Surveyor Re: Mistletoe Road Deed Research Analysis & Right-of-Way Status Report for a future Street Dedication and a Property Line Adjustment Survey reconfiguring Tax Lot 1800 Assessor's Map No. 391E 14 AC, Tax Lots 1300,1400,1500,1600 & 1800 Assessor's Map No. 391E 14 D, Tax Lots 1200,1201,1300,1301 & 2490 Dear Brad, Based on our recent correspondence regarding this project, the following is a proposal for surveying services to research & analyze existing multiple deed titles for a possible street right- of-way dedication of Mistletoe Road between Tolman Creek Road and Siskiyou Boulevard, along with a Property Line Adjustment (PLA) survey to reconfigure Tax Lot 1800 separating the existing improved area currently leased to Oregon Department of Forestry (ODF) from the portion currently utilized as access for Mistletoe Road, per the following scope of services: SCOPE OF SERVICES: Research of deeds, surveys, rights of way and easements of thirteen (13) subject properties and adjoiners based on current title reports to be ordered by Polaris. Field survey to re-establish project survey control network from previous surveys in this area performed by this office and to locate and tie existing survey monuments established in 2002 along Mistletoe Road by George Burrell's Survey No. 17207. Also to map existing improvements within said properties to determine potential prescriptive rights, possible encroachments and extents of existing improvements of the ODF leased land in Tax Lot 1800 to determine the adjusted easterly parcel line. Office computations and analysis of field survey data necessary to map current street alignment for dedication, and to prepare the Preliminary PLA Map for the planning application submittal packet for Tax Lot 1800 and consolidation of Tax Lots 1300,1400,1500 & 1600. Prepare Legal Descriptions, Map Exhibits & Findings Report for future dedications. Prepare and file the Final PLA Plat with the office of the Jackson County Surveyor to conform with Oregon Revised Statutes (O.R.S.) 209.250 and 92.060(7) and City of Ashland Land Use Ordinance 18.76.110. P. 0. Sox 459, Ashland, Oregon 97520 Phone: (541) 482-5009 - Fax: (541) 488-0797 Mobile: (541) 601-3000 www.polarisrurvev.com Brad Barber PLS August 8, 2016 Page 2 FEES: Fees will be paid on a Tim and Materials Not to Exceed Basis to include a 20% contingency fee if needed, according to the attached hourly rate schedule enclosed as Exhibit A, which is valid until December 31, 2016. All additional work that is outside the scope of services as described will also be paid at said described hourly rates Polaris Land Surveying LLC will endeavor to keep the actual cost of the work as low as may be consistent with the purpose of the project and with proper workmanship and materials. The cost to perform the surveying services as outlined in the Scope of Services above is as follows: PLA Survey: A range between Fifty Four Hundred Dollars ($5,400.00) and Fifty Eight Hundred Dollars ($5,800.00), Not to Exceed $5,800.00. R/W Dedication Survey: A range between Seventy Two Hundred Dollars ($7,200.00) and Seventy Six Hundred Dollars ($7,600.00), Not to Exceed $7,600.00. Title Reports: Estimated cost of Thirty Five Hundred Dollars ($3,500.00). Any fees required by City of Ashland, Jackson County, or other quasi-governmental agencies are not included in the surveying costs outlined above and shall be the responsibility of the client. As compensation for services rendered, an invoice will be sent on the 20th day of each month, or at the conclusion of the project, showing the hours and rates of the various classifications of personnel working on the project. In the event suit or action is instituted to enforce this agreement or any terms hereof, or in the event of an appeal from suit, action or proceeding, the prevailing party shall be entitled to such sums as the court may adjudge reasonable as attorney's fees in such suit, action or appeal. This letter is written as a Surveying Proposal and Agreement. An acceptance line is provided for your signature if you wish to engage us to perform the aforementioned services. Please return one signed copy for our files. Yours truly, Shawn Kampmann Professional Land Surveyor CC: Scott Fleury PE, Engineering Services Manager S:\surveys\1064-16\Mist1etoe Road RW-PLA survey proposal.docx AUTHORIZATION Approved By Date P. 0. Sox 459, Ashland, Oregon 97520 Phone: (541) 482-5009 Fax: (541) 488-0797 Mobile: (541) 601-3000 www.polarissurvey.com m a LANs OUIZYEYINCF, LLC EXHIBIT "A" POLARIS LAND SURVEYING LLC FEE SCHEDULE (EFFECTIVE JANUARY 1, 2016) PRINCIPAL LAND SURVEYOR ................................$120.00 / hour PROFESSIONAL LAND SURVEYOR ..........................$100.00 / hour SENIOR SURVEY TECHNICIAN $ 80.00 / hour SURVEY TECHNICIAN $ 75.00 / hour DRAFTING TECHNICIAN $ 75.00 / hour SURVEY FIELD CREW (STANDARD) $ 135.00 / hour SURVEY FIELD CREW (w/ GPS) $ 150.00 / hour DOCUMENT PROCESSING $ 60.00 /hour MILEAGE (out of town projects) $ 0.575 /mile OUT-OF-POCKET EXPENSES .................................ACTUAL COST P. o. Sax 459, A5hland, Oregon 97520 Phone: (541) 462-5009 - Fax. (541) 488-0797 Mobile: (541) 601-3000 www.polari55urvey.eom Saco oR CERTIFICATE OF LIABILITY INSURANCE °07/20 016 NYYY) 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). NA Jon Snowden : PRODUCER Jon Snowden, Agent NAME: PHONE FAX 420 Bridge Street ~A c No ExtI; 541.482.2461 541.482.4957 E-MAIL Ashland, OR 97520 ADDRESS: jon@jonsnowden.com O INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : State Farm Fire and Casualty Company 25143 _ INSURED Polaris Land Surveying, LLC INSURER B : State Farm Mutual Automobile Insurance Company 25178 PO Box 459 INSURER C _ Ashland, OR 97520 INSURER D__ INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MMIDD EFF MWDD/YYYY LIMITS LTR GENERAL LIABILITY A Y 97-B2-R503.2 0510712016 0510712017 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence $ 300,000 CLAIMS-MADE E OCCUR MED EXP (Any one person) $ 5,000 X Non-Owned Auto PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPlOP AGG $ RO LOC $ POLICY P JECT _1 A AUTOMOBILE LIABILITY a COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED X SCHEDULED BODILY INJURY (Per accident) $ _ AUTOS AUTOS $ 1,000,000 NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR -1 F1 EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION X TOWC STATU- RY LIMITS ER AND EMPLOYERS' LIABILITY YIN 97-132-.1160-0 05105/2016 05/05/2017 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 500,000 OFFICFJMEMBER EXCLUDED? N❑ N/A ❑ " (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ 500,000 If yes, describe under E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Land surveying - 151 Clear Creek Dr. Ste. 101 Ashland, OR 97520 CERTIFICATE HOLDER CANCELLATION CITY OF ASHLAND OREGON AND ITS ELECTED SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN OFFICIALS, OFFICERS & EMPLOYEES ACCORDANCE WITH THE POLICY PROVISIONS. 20 E MAIN ST AUTHORIZED REPRESENTATIVE ASHLAND, OR 97520 5 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD 1001486 132849.7 03-01-2012 Y► (MM/ ACS D® CERTIFICATE OF LIABILITY INSURANCE 6/2DATE7/220016 16 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Barr Blinderman Assurance Risk Managers, Inc. NAME: Y A/1 C.N .EXt): (303) 454-9562 AC, No)•cso3>4s4-9s64 - - 10651 East Bethany Drive ADDRESS: barrY.blinderman@arm-i.com Suite 300 INSURER(S) AFFORDING COVERAGE NAIC # Aurora CO 80014-2688 INSURERA:Hanover Insurance Company 22292 INSURED INSURER B Polaris Land Surveying LLC INSURER C : P O BOX 459 INSURER D: INSURER E Ashland OR 97520-0016 INSURER F COVERAGES CERTIFICATE NUMBER:16-17 E&O 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. MISR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE E OCCUR PREMISES Ea_occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN1 AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO- CT FJ LOC PRODUCTS - COMP/OP AGG $ POLICY n E - OTHER. $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident _ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ _ AUTOS AUTOS PROPERTY DAMAGE $ HIRED AUTOS NON-OWNED Per accident - - - UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DIED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY Y I N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E L. EACH ACCIDENT $ _ - - OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ A Professional Liabiilty LH4 A349055 02 6/28/2016 6/28/2017 Per Claim $1,000,000 Claims Made Form Annual Aggregate $2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland, Oregon and It's THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Elected Officials, Officers & Employees ACCORDANCE WITH THE POLICY PROVISIONS. 20 E. Main St. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE Lisa Isom/BARRY ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 rgni4m ~ OVA& Purchase Order Fiscal Year 2017 Page: 1 of: 1 WA 0 = EE[fi- - B City of Ashland ATTN: Accounts Payable Purchase ~ 20 E. Main Order # 135 Ashland, OR 97520 T Phone: 541/552-2010 O Email: payable@ashland.or.us V POLARIS LAND SURVEYING LLC H C/O Public Works Department E I 51 Winburn Way N PO BOX 459 p Ashland, OR 97520 D ASHLAND, OR 97520 Phone: 541/488-5347 R O Fax: 541/488-6006 541 482-5009 Michael Fau ht ZE K_ 09/01/2016 604 FOB ASHLAND OR City Accounts Pa able Surveying Services 1 Surveying services to research and analyze existing multiple deed 1 $16,900.0000 $16,900.00 titles for possible street right-of-way dedication of Mistletoe Road between Tolman Creek and Siskiyou Blvd., along with a property line adjustment survey to reconfigure Tax Lot 1800; see Exhibit C. Contract for Personal Services less than $35,000 Beginning date: 08/24/2016 Completion date: 06/30/2017 GL SUMMARY 081100 - 604100 $16,900.00 Y 5 By:Date: Authorized Signature $16,900.00 F® #3 CITY OF ASHLAND REQUISITION Date of request: 08/24/2016 Required date for delivery: ASAP Vendor Name PnlariS I and gijryeVinq Address, City, State, Zip P.O. Box 459 Ashland OR 97520 Contact Name & Telephone Number Shawn Kampmann 541-482-5009 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 ❑ Direct Award Date approved by Council: Contract # ❑ Verbal/Written quote(s) or proposal(s) -(Attach copy of council communication) ❑ State of Washington Intermediate Procurement ❑ Sole Source Contract # GOODS & SERVICES ❑ Applicable Form (#5,6, 7 or 8) ❑ Other government agency contract $5,000 to $100,000 ❑ Written quote or proposal attached Agency ❑ (3) Written quotes and solicitation attached ❑ Form #4, Personal Services $5K to $75K Contract # PERSONAL SERVICES ❑ Special Procurement Intergovernmental Agreement $5,000 to $75,000 ❑ Form #9, Request for Approval ❑ Agency ® 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 Surveying services to research and analyze existing multiple deed titles for possible street right-of-way dedication of Mistletoe Road between Tolman Creek and Siskiyou Blvd, along with a property line $16,900.00 adjustment survey to reconfigure Tax Lot 1800; see exhibit C. Item # Quantity Unit Description of MATERIALS Unit Price Total Cost TOTAL COST ❑ Per attached quotelproposal $ Project Number Account Number 1~-00~~~-- Account Number Account Number - - - - - - _ - - - *Expenditure must be charged to the appropriate account numbers for the financials to accurately reflect the actual expenditures. IT Director in collaboration with department to approve all hardware and software purchases: IT Director Date Support' -Yes /No By signing this r, quisition form, I certify that the City's public contracting requirements have been satisfied. Employee: Department Head: mL~ C l r 3 (Equal to or greate $5,000) Department Manager/Supervisor: City Administrator: (Equal to or greater than $25,000) Funds appropriated for current fiscal year: YES I ND.. Finance Director- (Equal to or greater than S5, 000) Date Comments: Form #3 - Requisition