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HomeMy WebLinkAbout2016-301 Contract - Pacific Mobile Structures Contract for GOODS AND SERVICES less than $25,000 CITY OF CONTRACTOR: Pacific Mobile Structures -ASHLAND CONTACT: Amy Hartnell 20 East Main Street Ashland, Oregon 97520 ADDRESS: 13970 Fir St. Oregon City, OR 97045 Telephone: 541/488-6002 Fax: 541/488-5311 TELEPHONE: 503-722-2988 DATE AGREEMENT PREPARED: 10-13-2016 FAX: 503-722-2988 BEGINNING DATE: 11-7-2016 COMPLETION DATE: 3-6-2017 COMPENSATION: Not to exceed $6,000 GOODS AND SERVICES TO BE PROVIDED: One 10' x 30' mobile office rental including delivery, setup, tear down, pickup, and PPT 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 prima City of Ashland Contract. NOW THEREFORE, pursuant to AMC 2.50.090 and after consideration of the mutual covenants contained herein the CITY AND CONTRACTOR AGREE as follows: 1. All Costs by Contractor: Contractor shall, provide all goods as specified above and shall at its own risk and expense, perform any work described above and, unless otherwise specified, furnish all labor, equipment and materials required for the proper performance of such work. 2. Qualified Work: Contractor has represented, and by entering into this contract now represents, that any personnel assigned to the work required under this contract are fully qualified to perform the work to which they will be assigned in a skilled and worker-like manner and, if required to be registered, licensed or bonded by the State of Oregon, are so registered, licensed and bonded. Contractor must also maintain a current City business license. 3. Completion Date: Contractor shall provide all goods in accordance with the standards and specifications, no later than the date indicated above and start performing the work under this contract by the beginning date indicated above and complete the work by the completion date indicated above. 4. Compensation: City shall pay Contractor for the specified goods and for any work performed, including costs and expenses, the sum specified above. Payments shall be made within 30 days of the date of the invoice. Should the contract be prematurely terminated, payments will be made for work completed and accepted to date of termination. Compensation under this contract, including all costs and expenses of Contractor, is limited to $25,000.00, unless a separate written contract is entered into by the City. 5. Ownership of Documents: All documents prepared by Contractor pursuant to this contract shall be the property of City. 6. Statutory Requirements: ORS 27913.220, 27913.225, 27913.230, 27913.235, ORS Chapter 244 and ORS 670.600 are made part of this contract. 7. Living Wage Requirements: If contractor is providing services under this contract and the amount of this contract is $20,283.20 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 b City under an of the following Contract for Goods and Services Less than $25,000, 06/30/2016, Page 1 of 5 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 ice n-qp- If mQuirinri i inrisar ORS 468A 710, Contractor or SubCnntractor shall possess an cense. NMA, 911/ 13. Assignment and Subcontracts: Contractor shall not assign this contract or subcontract any portion of the work without the written consent of City. Any attempted assignment or subcontract without written consent of City shall be void. Contractor shall be fully responsible for the acts or omissions of any assigns or subcontractors and of all persons employed by them, and the approval by City of any assignment or subcontract shall not create any contractual relation between the assignee or subcontractor and City. 14. Use of Recyclable Products: Contractor shall use recyclable products to the maximum extent economically feasible in the performance of the contract work set forth in this document. 15. Default. The Contractor shall be in default of this agreement if Contractor: commits any material breach or default of any covenant, warranty, certification, or obligation it owes under the Contract; if it loses its QRF status pursuant to the QRF Rules or loses any license, certificate or certification that is required to perform the work or to qualify as a QRF if Contractor has qualified as a QRF for this agreement; institutes an action for relief in bankruptcy or has instituted against it an action for insolvency; makes a general assignment for the benefit of creditors; or ceases doing business on a regular basis of the type identified in its obligations under the Contract; or attempts to assign rights in, or delegate duties under, the Contract. 16. Insurance. Contractor shall at its own expense provide the following insurance: a. Worker's Compensation insurance in compliance with ORS 656.017, which requires subject employers to provide Oregon workers' compensation coverage for all their subject workers b. General Liability insurance with a combined single limit, or the equivalent, of not less than Enter one: $200,000, $500,000, $1,000,000, $2,000,000 or Not Applicable for each occurrence for Bodily Injury and Property Damage. C. Automobile Liability insurance with a combined single limit, or the equivalent, of not less than Enter one: $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. Contract for Goods and Services Less than $25,000, 06/30/2016, Page 2 of 5 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, excluding Workers' Compensation, 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. Nona ppropriations Clause. Funds Available and Authorized: City has sufficient funds currently available and authorized for expenditure to finance the costs of this contract within the City's fiscal year budget. Contractor understands and agrees that City's payment of amounts under this contract attributable to work performed after the last day of the current fiscal year is contingent on City appropriations, or other expenditure authority sufficient to allow City in the exercise of its reasonable administrative discretion, to continue to make payments under this contract. In the event City has insufficient appropriations, limitations or other expenditure authority, City may terminate this contract without penalty or liability to City, effective upon the delivery of written notice to Contractor, with no further liability to Contractor. 20. Prior Approval Required Provision. Approval by the City of Ashland Council or the Public Contracting Officer is required before any work may begin under this contract. 21. Certification. Contractor shall sign the certification attached hereto as Exhibit A and herein incorporated by reference. Contractor: a6~~; (p 5~ Tn.C . City of Ashl nd By By Signature Department Head v-t~c&?o 4t 4 A Print Name Print Name S e- C, / zr,~,- a - S ///0/ Title Date W-9 One copy of a W-9 is to be submitted with the signed contract. Purchase Order No. Contract for Goods and Services Less than $25,000, 06/30/2016, 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: V (1) 1 carry out the labor or services at a location separate from my residence or is in a specific portion of my residence, set aside as the location of the business. V (2) Commercial advertising or business cards or a trade association membership are / purchased for the business. (3) Telephone listing is used for the business separate from the personal residence listing. (4) Labor or services are performed only pursuant to written contracts. (5) Labor or services are performed for two or more different persons within a period of one / year. V1 (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. iG a i Sfr~~~ureS ,Lr1C. ld Contractor (Date) Contract for Goods and Services Less than $25,000, 06/30/2016, Page 4 of 5 ADDENDUM TO CITY OF ASHLAND CONTRACT FOR GOODS AND SERVICES LESS THAN $25,000 Addendum made this 25 day of October, 2016, between the City of Ashland ("City") and PACIFIC MOBILE STRUCTURES ("Contractor"). Recitals: A. On November 7, 2016, City and Contractor entered into a "City of Ashland Contract for Goods and Services Less than $25,000" (further referred to in this addendum as "the agreement"). B. The parties desire to amend the agreement to (e.g. "extend the date of completion" or "increase the compensation to be paid to Contractor" or "modify the ro'ect" . City and Consultant agree to amend the agreement in the following manner: 1. "Additional Terms" are amended to read as follows: `City approves Pacific Mobile Structures' use of subcontractor Field Transportation and approves automobile insurance in the amount of $1,000,000, naming the City of Ashland as an additional insured, as approved by their individual insurance policies for business usefor delivery of the mobile offices to the City of Ashland 2. Except as modified above the terms of the agreement shall remain in full force and effect. CONT TOR: CITY OF ASHLAND: .00 B BY D a ent Head Its r Date DATE " 0 S+C-tkA(,, C '7 Purchase Order # ` Acct. No.: (For City purposes only) D~d 6 /Cl - APPROVED A870 FORM Ashland City Attorney r 1- CITY OF ASHLAND, ADDENDUM TO CONTRACT FOR GOODS AND SERVICES <$25,000 Client#: 704959 PACIFMOB ,tCORD,, CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 1/26/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: USi Northwest CL1 APHONE A/C, No, Ext : 503 224-8390 610 362-8130 700 NE Multnomah, Suite 1300 E-MAIL an ela.christiansen usi.biz ADDRESS. g Portland, OR 97232 INSURER(S) AFFORDING COVERAGE NAIL # 503 224-8390 INSURER A : American Economy Insurance Comp 119690 INSURED INSURERS: American Insurance Company 21857 Pacific Mobile Structures Inc INSURER C : Liberty Northwest Insurance Cor 141939 P.O. Box 1404 INSURER D : Lloyds of London 185202 Chehalis, WA 98532 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 CONTRACTOR 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 ADDL UBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE fNSR WVD POLICY NUMBER MM/DD/YYYY MMIDD A X COMMERCIAL GENERAL LIABILITY 01 C131839060 01131/2016 01131/2017 EACH OCCURRENCE $1,000,000 CLAIMS-MADE D OCCUR PRAEMITo . Q, Drrence s200 000 X WA Stop Gap $1 M MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 62,000,000 (~_!X 1 PRO I POLfCY~ PRODUCTS - COMPIOP AGG s2,000,000 I LOC - JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO 1 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED i BODILY INJURY (Per accident) $ AUTOS AUTOS j T NON-OWNED j PROPERTY DAMAGE $ HIRED AUTOS AUTOS 1 Per accident S B UMBRELLA LIAB ?t X OCCUR F SU032180838 1/31/2016 011311201 EACH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 IDED i RETENTION 5 $ C WORKERS COMPENSATION WC41 NC018531 113112016 011311201 X f PER STATUT oTH- AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNEPJEXECUTIVE - E.L. EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N N I A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $1,0001000 If yes, describe under _ DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 D Pollution Liab PGIARK0455500 1131/2016 01/311209 $1 M occ/$2M agg A Installation 01C131839060 1131/2016 01/31/201 $1M;$1000 Ded DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of Ashland, Oregon, and its elected officials, officers and employees are additional insured as respects the operations of the named insured. CERTIFICATE HOLDER CANCELLATION City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE tY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 East Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) 1 of 1 The ACORD name and logo are registered marks of ACORD #S17134142/M17129054 BVSZP PACIF35 OP ID: RS DATE (MM/DD/YYYY) ,~coizn CERTIFICATE OF LIABILITY INSURANCE 01/18/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Nicholson & Associates PHONE FAX 118 W. Pine Street A/c No Ext): - AIC, No): Centralia, WA 98531-4290 E-MAIL Todd Working ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : American States Insurance Co. 19704 INSURED Pacific Mobile Structures Inc INSURER B : Attn: Nick Ververis - - P.O. Box 1404 INSURER C : _ Chehalis, WA 98532 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 ADDLPUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSR1WVD POLICY NUMBER (MMIDD/YYYY) (MMIDDIYYYY) GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE RENT D COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrences $ _ r $ CLAIMS-MADE El, OCCUR ME D EXP (Any one person) PERSONAL & ADV INJURY $ GENERAL AGGREGATE GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ POLICY PRO- LOC $ JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,00 Ea accident $ A X ANY AUTO X 01C13162927 01/3112016 01/3112017 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS NAUTOS ON--OWNED PROPERTY DAMAGE PER ACCIDENT) $ 1 ~000,00 HIRED AUTOS AUTOS - $ UMBRELLA LIAB OCCUR EACH OCCURRENCE _ $ _ EXCESS LIAB AGGREGATE $ CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION WC STATU- 09TH- AND EMPLOYERS' LIABILITY TORY LIMITS _ ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y - N / A E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ ! I DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of Ashland, Oregon, and its elected officials, officers and employees as additional insured with respects to auto liability. Coverage is primary and non contributory. Job located at 95 Winburn Way Ashland, OR 97520 CERTIFICATE HOLDER CANCELLATION CITY059 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. 20 East Main St Ashland, OR 97520 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD 10/31/2016 09i5 l Page 1/1 ACC OR" CERTIFICATE OF LIABILITY INSURANCE 10/31/20 6 10/31/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Customer Service Team Choice One Insurance AHCNNo Ex : (503) 387-5211 (AIC No: (503)387-5750 9111 SE Saint Helens St E-MAIL customerservice@choiceoneinsuranceinc.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC Clackamas OR 97015 INSURERA:United States Liability Ins Co 25895 INSURED INSURER B :Northland Insurance Company 24015 Field Transportation, Inc INSURER C 10815 SW 135th INSURER D INSURER E Beaverton OR 97008 INSURER F COVERAGES CERTIFICATE NUMBER:AL/GL/MTC 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS. INSR I A I POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSO POLICY NUMBER MMIODIYYW MMIDDIYY X I COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE g 1,000,000 DAMAGE N A I CLAIMS-MADE X OCCUR I PREMISES Ea occurrence S 100,000 j INS2726525 j 3/15/2016 3/15/2017 MED EXP (Any one person) 5,000 I PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE Li,,/,IT APPLIES PER GENERAL AGGREGATE $ 2,000,000 PRO ❑ LOC PRODUCTS - COMP/OP AGG $ Included POLICY X ACT E11 - OTHER I s AUTOMOBILE LIABILITY COMBI*JED SINGLE LiM1i y 1,000,000 f Ea zccident ANY AUTO BODILY INJURY (Per person) S B ALL OWNED SCHEDULED ~ IINIO5050 3/15/2016 3/15/2017 80Dil- iNJURY (Peraccadent) AUTOS X I UTOS NON-0VV,'ED PROPERTY DAMAGE 17 ] HIRED AUTOS AUTOS ~ (Per acrdent I Unnsured motonst cornb ned ( 100 , 000 I H UMBRELLA LIAR i OCCUR I EACH OCCURRENCE 5 EXCESS LIAR I I CLAI;~S ,M,E' AGGREGATE C, ED I RETENTIO6;.r WORKERS COMPENSATION P'R 0TH- AND EMPLOYERS' LIABILITY Y I N i I STATUTE ER ANY FROPRIETOR!?ARTP:_Rl=::`rUTIVE , E L EACH ACCIDENT $ OFFICERIMEM ER E;:cLUDED^ I N I A (mandatory in NH) EL DISEASE - EA EMPLOYEd 5 It es d?scrbe ur;d?r ~DEsc.RiPi i0 r: 0, OPERATIONS helpr~ EL DISEASE- POLICY LIMIT Is B Motor Truck Cargo WN185050 3/15/2016 3/1512017 SineleConveyar ee/$i5,000 Deduct/1, 000 DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 East Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE Anclre r Shulik/PAiy V O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INS025 (201401) CERTIFICATE OF COVERAGE Agent This certificate is issued as a matter of information only DIRECT and confers no rights upon the certificate holder other than those provided in the coverage document. This certificate does not amend, extend or alter the coverage afforded by the coverage documents listed herein. cityycounty insurance services Named Member or Participant Companies Affording Coverage City of Ashland COMPANY A -CIS COMPANY B - National Union Fire Insurance Company of Pitts, PA 20 East Main Street COMPANY C - RSUI Indemnity Ashland, OR 97520 COMPANY D - Torus National Insurance Company LINES OF COVERAGE This is to certify that coverage documents listed herein have been issued to the Named Member herein for the Coverage period indicated. Not withstanding any requirement, term or condition of any contract or other document with respect to which the certificate may be issued or may pertain, the coverage afforded by the coverage documents listed herein is subject to all the terms, conditions and exclusions of such coverage documents. Type of Coverage Company Certificate Effective Termination Date Coverage Limit Letter Number Date General Liability A 16LASH 7/1/2016 7/1/2017 General Aggregate: $15,000,000 X Commercial General Liability Each Occurrence: $5,000,000 X Public Officials Liability X Employment Practices X Occurrence Auto Liability A 16LASH 7/1/2016 7/1/2017 General Aggregate: None X Scheduled Autos Each Occurrence: $5,000,000 X Hired Autos X Non-Owned Autos Auto Physical Damage A 16APDASH 7/1/2016 7/1/2017 X Scheduled Autos X Hired Autos X Non-Owned Autos X Property A 16PASH 7/1/2016 7/1/2017 Per Filed Values X Boiler and Machinery A 16BASH 7/1/2016 7/1/2017 Per Filed Values Excess Liability X Excess Crime B 16ECASH 7/1/2016 7/1/2017 Per Loss: $250,000 X Excess Earthquake C 16EQASH 7/1/2016 7/1/2017 Each Occurrence: $5,000,000 X Excess Flood C 16FASH 7/1/2016 7/1/2017 Each Occurrence: $5,000,000 X Excess Cyber Liability A 16ECLASH 7/1/2016 7/1/2017 Occurrence/Aggregate: $500,000 Workers' Compensation Description: Per contract for rental of one 10' x 30' mobile office for use by the City of Ashland Parks and Recreation Department at 95 Winbum Way, in Ashland, Oregon. Certificate Holder: CANCELLATION: Should any of the coverage documents herein be cancelled before the expiration date thereof, CIS will provide 30 days written notice to the certificate holder named herein, but failure to mail such Pacific Mobile Structures notice shall impose no obligation or liability of any kind upon CIS, its agents or representatives, or the issuer 13970 Fir Street of this certificate. Oregon City, OR 97045 Date: October 28, 2016 RENTAL QUOTE PACIFIC Date: 9/19/2016 Quote Number: 109975 Lease Term: 4 Months Sales Consultant: Ron Young City of Ashland SITE ADDRESS P (503) 722-2998 F (503) 722-2988 20 East Main Street Ashland Rotary Centennial Ice Rink in ron@pacificmobile.com Ashland, OR 97520 Lithia Park Lonny Flora 541-552-2250 95 Winburn Way Ionny.flora@ashland.or.us Ashland, OR 97520 Lonny Flora 541-552-2250 ~ Description Please check your desired unit(s) and options ® 10x30 _ - Rental Rate 1 Q $299.00 _ Steps -OSHA Compliant 2 Q $0.00 - _ _ Personal Property Taxes 1 F47 $10.75 - - - - Total monthly rental cost (checked items only) $309.75 W _ Deliverer Freiqht Pilots not Included 1 Q $1,500.00 Drop Set includes Tires, axles, & hitch removed 1 Q $520.00 Custom Modifications 10' Counter w/back spalsh 2 ❑ $930_00 Custom Modifications Metal Door Guards 2 ❑ $197.00 Total setup cost (checked items only) $2,020.00 - _ _ Return Freight Pilots not Included 1 $1,500.00 - Tear down of drop set includes Tires, axles, & hitch install 1 Q $520.00 - - - - - - Total return cost (checked items only) $2,020.00 Damage Waiver ❑ $26.91 - Monthly property damage waiver cost (checked items only) **All charges for the Term of 4 Months $5,279.00 "R.I.E. = Rate In Effect at Term End e Note: Items manually checked will be reflected on your Order Confirmation. Two weeks no ce equired for pick p of building. "Pricing does not include applicable sales tax, personal property tax, pilot cars and special permits unless otherwise n ed included. Quote is ga for 30 days and limited to availability of stock on hand. By signing the customer is authorizing Pacific Mobile Structures to process the order for the selected equipm n an services upon a oval credit. Th s authorization will convert this quotat,e into an Operating Lease Agreement bound by the Terms and Condition on Page Three 13) of this quotation, An rder firmation will be t to dasgna` e-mail address on file. UA C sto er Authorized Representative Date Page 1 of 2 P.O. Box 1404 Chehalis. VVA 98532 800.225.6539. pacificrnobile.corn PACIFiC 9/19/2016 City of Ashland 20 East Main Street Ashland, OR 97520 RE: Quote 109975 Lonny Flora: Thank you for giving us the opportunity to provide you with a quote. We appreciate your business and look forward to being of further service to you and your company. ORDERING PROCESS: To schedule delivery, please check the box next to the unit and any additional items you wish to order and simply fax or e-mail the signed quote back to us. Upon receipt of the signed quote, an order confirmation will be sent to you summarizing your order and confirming your delivery date. Sincerely, Amy Hartnell = i 13970 Fir St. Oregon City, OR 503.722.2998 pacifici-nobile.com Floor Plan: 10'x30' Office - Two Rooms Floor plans may vary according to building model, size and specifications. Interior partitioning is optional and fully customizable. i k i. Optional interior walls shown and may include additional costs. SPECIFICATIONS: • Ducted heating and air conditioning • Metal entry doors with deadbolts • Commercial grade carpet and tile floors • Acoustical sound dampening ceilings • Vinyl wrap interior walls 0 Built to the state commercial building code Purchase Order 9 0 :F ~ RE Fiscal Year 2017 Page: 1 of: 1 I1tN1PP~AIlALC= - B Ashland Parks Commission ~ - - I ATTN: Accounts Payable L 20 E. Main Purchase 405 L Ashland, OR 97520 Order # T Phone: 541/552-2010 0 Email: payable@ashland.or.us V PACIFIC MOBILE STRUCTURES INC H C/O Recreation Division (Grove E PO BOX 1404 I 1195 East Main Street N P Ashland, OR 97520 D CHEHALIS, WA 98532 Phone: 541/488-5340 R O Fax: 541/488-5314 ffi-Ep enr PhQnfU~mbr 13, 503 722-2998 Lonn Flores .11/07/2016 1988 FOR ASHLAND OR Parks Accounts Pa able MMW P-11 Mobile Office Trailer 1 Mobile office trailer, includes delivery, setup and takedown. NTE 1 EACH $6,000.0000 $6,000.00 $6,000.00, Project 000007.999 Contract for Goods and Services less than $25,000 Beginning date: 11/07/2016 Completion date: 03/06/2017 GL SUMMARY 125302 610210 $6,000.00 B " r ,1/ Date: Authorizedfinature $6,000.001 FORM # CITY OF ASHLAND REQUISITION Date of request: as Required date for delivery: 1° 1-1 11 Vendor Name I f Address City, State Zip /7il,pae Contact Name & Telephone Number, 47 a 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 Vie- of )0c e ~3 ub)DD- Item # Quantity Unit Description of MATERIALS Unit Price Total Cost TOTAL COST Per attached quote/proposal $ 1 Project Number Account Number 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: /T Director Date Support -Yes / No By signing this requisition form, I certify that the City's public contracting requirements have been satisfied. Employee: F- a Department Head: (Equal to or greater than $5,000) Department Manager/Supervisor:City Administrator: r` (Equal to or greater than $25,000) Funds appropriated for current fiscal year: YES / NO tnance DireCtor~ (Equal to or greater than $5,000) Date Comments: Form #3 - Requisition