HomeMy WebLinkAbout2016-310 Contract - Jonathan Lange PHD
Independent Contractor: Jon Lange
CITY OF
-ASHLAND CONTACT: Jon Lange
20 East Main Street
Ashland, Oregon 97520 ADDRESS: 2345 Blue Sky Lane, Ashland OR
Department: Fire
Telephone: 5411482-2770 TELEPHONE: (541) 778-4072
EMAIL: info@jonlangeconsulting.com
PROTECT CAPTION: Ashland Forest Resiliency Community Engagement Meeting Facilitation
BEGINNING DATE: November 14, 2016 COMPLETION DATE: November l8th, 2016
COMPENSATION: Not to exceed $500
GOODS OR SERVICES TO BE PROVIDED:
Meeting facilitation for Ashland Forest Resiliency Community Engagement meeting November 17th and associated meeting preparation
with City staff.
Worker's com sation will be waived due to work being performed only by the contractor and no employees.
Initialed:
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Page 1 of 3 Contract for Goods and Services - Small Procurement Less than $5,000 LR Revised 2-13-15
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. Ownership of Production: All documents, materials or items produced by Contractor pursuant to this contract shall be the property of City.
4. Statutory Requirements: ORS 279B.220, 27913.225, 27913.230, 279B.235, ORS Chapter 244 and ORS 670.600 are made part of this contract.
5. Indemnification: Contractor agrees to defend, indemnify and save City, its officers, employees and agents harmless from those losses,
expenses, or other damages resulting from injury to any person or damage to property arising out of or incident to the negligent performance of
this contract by Contractor its employees, or agents. Contractor shall not be held responsible for any losses, expenses, or other damages,
directly, solely, and proximately caused by the negligence of City.
6. Termination: City's Convenience. This contract may be terminated at any time by the City.
7. 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. Contractor certifies the accuracy of the representations in attached Exhibit A.
8. Asbestos Abatement License: If required under ORS 468A.710, Contractor or Subcontractor shall possess an asbestos abatement license.
9. Assignment and Subcontracts: Contractor shall not assign this contract or subcontract any portion of the work.
10. 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.
11. Workers' Compensation Insurance: BY INITIALING THIS SENTENCE, CONTRACTOR CERTIFIES THAT THE WORK REQ
1 BY THIS CONTRACT WILL BE PERFORMED SOLELY BY THE UNDERSIGNED AND NOT BY ANY EMPLOYEES,
SUBCONTRACTORS OR VOLUNTEERS SUBJECT TO WORKERS' COMPENSATION COVERAGE UNDER ORS 656.017
12. Liability Insurance. Contractor shall at its own expense provide the following insurance:
a. General Liability insurance with a combined single limit, or the equivalent, of not less than $ Waived for each occurrence
for Bodily Injury and Property Damage. It shall include contractual liability coverage for the indemnity provided under this contract.
b. Automobile Liability insurance with a combined single limit, or the equivalent, of not less than $ tai Lx'~ for each accident for
Bodily Injury and Property Damage, including coverage for owned, hired or non-owned vehicles, as applicable.
13. Governing Law; Jurisdiction; Venue: This contract shall be governed and construed in accordance with the laws of the State of Oregon.
14. THIS CONTRACT AND ATTACHED EXHIBITS CONSTITUTE THE ENTIRE AGREEMENT BETWEEN THE PARTIES. NO
WAIVER, CONSENT OR MODIFICATION OF THIS CONTRACT SHALL BIND EITHER PARTY UNLESS IN WRITING AND
SIGNED BY BOTH PARTIES. IN THE EVENT OF CONFLICTS OR DISCREPANCIES AMONG CONTRACT DOCUMENTS, THIS
STANDARD FORM CITY OF ASHLAND CONTRACT 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 THIS SIGNED DOCUMENT.
Contractor: City of Ashland:
By By
Sigutur Signature
Print Name Print Name
Title Date
is
W-9 One copy of a W-9 is to be submitted with the signed contract. Purchase Order No.
AFB ov FORM
G
Ashland City Attorney
Date 1
Page 2 of 3 Contract for Goods and Services - Small Procurement Less than $5,000 LR Revised 2-13-15
i
A
EXHIBIT A F
r
CERTIFICATIONSMEPRESENTATIONS: Contractor, under penalty of perjury, certifies that (a) the number shown on the
I
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 k
i
subject to backup withholding. Contractor further represents and warrants to City that (a) it has the power and authority to enter into
and perform the work, (b) the Contract, when executed and delivered, shall be a valid and binding obligation of Contractor enforceable
in accordance with its terms, (c) the work under the Contract shall be performed in accordance with the highest professional standards,
and (d) Contractor is qualified, professionally competent and duly licensed to perform the work. Contractor also certifies under penalty
of perjury that its business is not in violation of any Oregon tax laws, and it is a corporation authorized to act on behalf of the entity
designated above and authorized to do business in Oregon or is an independent Contractor as defined in the contract documents, and
has checked four or more of the following criteria:
(1) 1 carry out the labor or services at a location separate from my residence or is in a specific portion of my residence, set aside
as the location of the business.
(2) Commercial advertising or business cards or a trade association membership are purchased for the business.
❑ (3) Telephone listing is used for the business separate from the personal residence listing.
(4) Labor or services are performed only pursuant to written contracts. _
❑ (5) Labor or services are performed for two or more different persons within a period of one year.
❑ (6) 1 assume financial responsibility for defective workmanship or for service not provided as evidenced by the ownership of
performance bonds, warranties, errors and omission insurance or liability insurance relating to the labor or services to be
provided.
~l7 7LI - ~d
Contracto (Date)
41
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Page 3 of 3 Contract for Goods and Services - Small Procurement Less than $5,000 LR Revised 2-13-15
Purchase Order
Fiscal Year 2017 Page: 1 of: 1
E TM
B City of Ashland
ATTN: Accounts Payable Purchase
~ 20 E. Main Order # 418
Ashland, OR 97520
T Phone: 541/552-2010
O Email: payable@ashland.or.us
V H C/O Fire and Rescue Department
E LANGE, PHD, JONATHAN I I 455 Siskiyou Blvd
N 2345 BLUE SKY LANE p Ashland, OR 97520
D ASHLAND, OR 97520 Phone: 541/482-2770
R O Fax: 541/488-5318
541 552-6425 Chris Chambers
= - o o---=
I a Ord r~s~= / n_d -Q~-_dmbe~ a M HE
11/19/2016 308 FOB ASHLAND OR City Accounts Pa able
Engagement Meeting Facilitatio
1 Ashland Forest Resiliency Engagement Meeting Facilitation, 1 $500.0000 $500.00
Project 000199.400 _
Contract for Goods and Services Small Procurement Less than
$5,000
Beginning date: 11/14/2016
Completion date: 11/18/2016
GL SUMMARY
072900 - 604160 $500.00
A
` ~ _ ate:
Authorize Signature - - = $500.00
#3 CITY F
SHLAND
REQUISITION Date of request: 11/15/2016
Required date for delivery: 11/22/2016
Vendor Name Jon Lange
Address, City, State, Zip 2345 Blue Sky Lane
Contact Name & Telephone Number 541.778.4072
Fax Number info@jonlangeconsulting.com
SOURCING METHOD
❑ Exempt from Competitive Bidding ❑ Emergency
❑ Reason for exemption; ❑ Invitation to Bid (Copies on file) ❑ Form #13, Written findings and Authorization
❑ AMC 2.50 Date approved by Council: ❑ Written quote or proposal attached
❑ Written quote or proposal attached _ Attach co of council communication -(If council approval required, attach co of CC
® Small Procurement Cooperative Procurement
Less than $5,000 ❑ Request for Proposal (Copies on file) ~ State of Oregon
Date approved by Council;
® Direct Award 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 ❑ Agency
❑ Form #9, Request for Approval
❑ Less than $35,000, by direct appointment El 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
Ashland Forest Resiliency Community Engagement Meeting Facilitation $ 500.00
Item # Quantity Unit Description of MATERIALS Unit Price Total Cost
TOTAL COST
❑ Per attached quote/proposal ' g $ 500.00
Project Number 000199.400 Account Number 110.07 - 29 - 00.604160
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 requisition form, I certify that the City's public contracting requirements have been satisfied.
Employee: Department Head:
(Equal to or greater than $5,000)
Department ManagerlSupervisor: City Administrator:
(Equal to or greater than $25,000)
Funds appropriated for current fiscal year YES / NO
Finance Director- (Equal to or greater than $5,000) Date
Comments:
Form #3 - Requisition