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HomeMy WebLinkAbout2016-313 Contract - Table Rock Custom Masonry Contract for GOODS AND SERVICES CITY OF CONTRACTOR: TABLE ROCK HOMES & MASONRY -ASHLAND CONTACT: EFREN REGALADO 20 East Main Street Ashland, Oregon 97520 ADDRESS: 7782 HARLAN DR, WHITE CITY, OR 9 7 5 0 3 Telephone: 541/488-6002 Fax: 541/488-5311 TELEPHONE: 541-301-2171 DATE AGREEMENT PREPARED: 11-22-16 FAX: TABLE ROCKMAS ONRY @ HOTMAI L. COM BEGINNING DATE: 11/28/16 COMPLETION DATE: 2/28/17 COMPENSATION: Not to exceed $46,750. Compensation includes the proposed cost of services 42,500) plus a 10% contingency used only to accommodate unanticipated circumstances unearthed during excavation that were unobservable during the bidding process. GOODS AND SERVICES TO BE PROVIDED: Contractor to provide hardscaping services at pioneer hall courtyard per Exhibit C (request for quote/bid sheet). 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 $46,750.00, 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, 279B.225, 27913.230, 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 $20,283.20 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 an time b City upon 30 days' notice in writing Contract for Goods and Services, Page 1 of 5 • 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 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 Liabilit insurance with a combined single limit, or the equivalent, of not less than Enter one: $200,000, $500)000, . , $2,000,000 or Not Applicable for each occurrence for Bodily Injury and Property Damage. Contract for Goods and Services, Page 2 of 5 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, 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. 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 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: Ci~-of Ashland a, By By Signature Department Head 4 ct C, (c, J C) I& i,3 o C_--, Pri Name Print Name re-5 i'~ C LA. Title Date W-9 One copy of a W-9 is to be submitted with AP OVERAS P FORM the signed contract. Purchase Order No. 't UN I ~c Ashi nd City Attomey Data_2TZ Contract for Goods and Services Less thall $25,000, , Page 3 of 5 p- 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 (1) 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 fiu-ther 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) I 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. Vl (2) Commercial advertising or business cards or a trade association membership are purchased for the business. V' (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. L111- (6) I 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. V i- t,-- A C- C'-~ 0- ~ ~3 /0 --/(.1 - iG Contractor (Date) (2- tA, LLC- Contract for Goods and Services Less than $25,000, 0613012016, Page 7 of 9 CITY OF ASHLAND, OREGON EXHIBIT B City of Ash land employers LIVING ALL below must comply with City of Ashland laws regulating payment of a living wage. per hour effective June 30, 2016 (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 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 Goods and Services Less +h $25,000, 06/3W2916Page 5 of 5 Exhibt C CITY OF ASHLAND October 10, 2016 Efr en Regalado 7782 Harlan Drive White City, OR, 97503 Phone: 541-301-2171 RE: REQUEST FOR QUOTE: PIONEER HALL COURTYARD HARDSCAPE EVIPROVE ME NTS The City of Ashland 1s accepting bid quotations for the installation of hardscaping in the Pioneer Hall courtyard at 73 Winburn Way. As detailed in the enclosed plans, work will consist of installing drainage features that connect to existing stolen drain lines; clay brick unit pavers; masonry and dry-set stone walls (constructed, in part, of stones salvaged from the existing hardscape); a concrete planter curb; a concrete ramp and steel handrail; and a concrete staircase and steel handrail. The contractor will provide both handrails. All work is to be performed in accordance with the enclosed plans, details and specifications. Pre-bid inquiries and clarifications regarding the project plans/details/specs for the Pioneer Hall courtyard s project are to be directed to Greg Covey, Covey Pardee Landscape Architects, at 541-552-1015. All costs associated with complete installation of the project items are to be included in the Total Bid Amount. All work is to be completed by November 30, 2016. If interested in submitting a bid for this work, please complete the attached "Request for Quote" form. I Potential bidders are invited to attend a non-mandatory pre-bid meeting on October 13, 2016, at 1:30 PM at 51 Winburn Way prior to submitting a bid. The completed/signed bid may be returned to me by mail at the City of Ashland Public Works/Engineering, 20 E. Main Street, Ashland OR 97520 or in person at 51 Winburn Way. You may also send a bid electronically to kaylea.kathol@ashland.or.us. However; upon notification, the winning original hard copy bid document must be submitted to this office for contract purposes. Bids must be received by 2:00 PM on October 19, 2016. This project will be subject to the enclosed City of Ashland Contract for Goods and Services and current Living Wage j Ordinance (Contract Exhibit B). Contractor to warranty craftsmanship for a minimum of 1 year from the date of installation acceptance. If you have any questions regarding this request, I may be contacted at (541) 552-2419. Sincerely, 1 Kaylea Kathol, Project Manager j City of Ahhland, Public Works - Engineering (541) 552-2419, kaylea.kathol@ashland.or.us a I i l Public WorlmTngineering Department Tel: (541) 488-5347 20 E. Main Street Fax: (541) 488-6006 Ashland, Oregon 97520 TTY: (800) 735-2900 w«w.ashland.or.us I REQUEST FOR QUOTE QUOTE: PIONEER HALL COURTYARD HARDSCAPING IMPROVEMENTS Description Quantity Unit Item Total 1. General Conditions Mobilization 1 LS $ Const. supervision, temp. facilities 1 LS $ f ,1 Final grading (laborer) 1 LS $ Excavator & operator 1 LS $ 0 U t3 Haul-off & disposal 30 CY $ 3,00 wg- Area drains 2 LS $ 7 ~C) Drainage pipe, rock for 48 LF seat wall 1 LS $ 4. Concrete Concrete paving w/ color San Diego buff 170 SF $ 2 y°cv Concrete planter curb (6" wide) 22 LF $ Z Concrete stairs 15 LF $ G 0 Concrete footing 48 LF $ -7 S G Stone seat wall 48 LF $ Z Y rr v Dry-stack stone wall 30 FF $ f~ ~y 12 6. Pavers Aggregate base & setting bed 20 CY $ 600 Clay brick pavers (Pacific Clay's Bear Path in 915 SF $ v "Red Flashed" or similar) S i s y ~ . ~ , ice-- %j Y ~ may` y ~~~✓j ~ ~ ~ ~ s~~, 7. Handrails Ramp handrail (w/ black powder coat) 37 LF $"O Stair handrail (w/ black powder coat) 10 LF $ -700 TOTAL BID $ 11 2-t S` v o Not included: Irrigation, imported topsoil, soil preparation, and planting (to be provided by Ashland Parks & Recreation Department) -T 0. CL I- L C_ 3ei- Public Works/Engineering Department Tel: (541) 488-5347 20 E. Main Street Fax: (541) 488-6006 Ashland, Oregon 97520 TTY: (800) 735-2900 www.ashland.or.us kyr PLEASE RETURN QUOTE BY: 2:00 PM, Friday, October 21, 2016 Date: /0 By: ~(rcvk K-C ll~t~~ Signature i i Address: `7 `7 cu ck Y ( Y c I"' e-cj Printed Name 1 f t S i A t tom- ~ ~.w k t T t't' 0 a~ Title `Tob1c eGj-k~16,"Irl LLL Company Phone: 3 61 ` T I Public Norks/Enginccring Department Tel: (541) 488-5347 20 E. Main Street Fax: (541) 488-6006 Ashland, Oregon 97520 TTY: (800) 735-2900 %v,c,v.ashland.or.us ~r (MMIDDNYYY) 66. CERTIFICATE OF LIABILITY INSURANCE D1112212016 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 have ADDITIONAL INSURED provisions or 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 Juan NAME: WORLD OF INSURANCE LLC AICNo Ext : (541)770-3383 1 A/c No : (541)772-8945 1091 MEDFORD CENTER ADDRESS: woi@worldofinsurancemedford.com MEDFORD, OR 97504 INSURER(S) AFFORDING COVERAGE NAIC# INSURER A : Coml. Auto INSURED INSURER B EFREN REGALADO - INSURER C : LAURA FLETES 7782 Harlan Dr INSURER D: White City, OR 97503 INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: 00000000-205765 REVISION NUMBER: 2 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 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 $ CLAIMS-MADE Ej OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY 71 PROT F~ LOC PRODUCTS -COMP/OP AGG $ OTHER: $ A AUTOMOBILE LIABILITY 03976300 11/04/2016 05/04/2017 (Ea acccidentSINGLE LIMIT $ IM ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY X AUTOS HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY Y / N _ STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N / A (Mandatory in NH) E. L. DISEASE- EA EMPLOYE S If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ I 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 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. 20 E Main Ashland, OR 97520 AUTHORIZED REPRESENTATIVE (JPS) ©1988-20 ACORD CO PORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registe rks of ORD Printed by JPS on November 22, 2016 at 02:20PM Application for Insurance PROMfUllIE~ COMMZ-RC14Z Please review, sign where indicated, and return Policy number: 03976300-0 Named Insured: EFREN REGALADO DBA: TABEL ROCK MASONRY November 4, 2016 Page 1 of 5 Policy and premium information for policy number 03976300-0 Insurance company: Artisan and Truckers Casualty Co P.O. BOX 94739 Cleveland, OH 44101 Agent: DANIEL PULIDO WORLD OF INS LLC 1091 MEDFORD CENTER MEDFORD, OR 97504 68299 1-541-770-3383 Named Insured: EFREN REGALADO DBA: TABEL ROCK MASONRY 7782 HARLAN DR WHITE CITY, OR 97503 e-mail address: NONE Phone Number: 1-541-301-2171 Financial responsibility vendor: EXPERIAN 1-888-397-3742 Policy period: Nov 4, 2016 - Nov 4, 2017 Effective date and time: Nov 4, 2016 at 03:5 ET ~....~b.D.,.....V16,1 Total policy premium: $1,019.00 1 Initial payment required: $254.75 Initial payment received: $254.75 Payment plan: 4 payments Rated drivers The insured declares that no persons other than those listed in t-iis application regularly operate the vehicle(s) described in this application. Date Driver's Original of Marital license Additional year Name birth Age status number State Points information CDL CDL issued EFREN REGALADO 04/02/1976 40 Married "''6339 OR 2 No Continued Policy number: 03976300-0 EFREN REGALADO Page 2 of 5 Driving history Please review the following information carefully because driving history, including driving convictions as indicated on your motor vehicle report, is used to determine your rate. All accidents are considered at-fault and chargeable unless the accident is under an applicable payment threshold or we receive additional information from you or another source that proves the accident was not-at-fault. We use convictions from your motor vehicle report. Please notify Customer Service if you were not convicted of a violation listed below. If our review of your driving history indicates that this violation did not result in a conviction, we will reevaluate your policy without that violation. We obtain driving history from the following sources: • Your application (APP) • Progressive claims history (PROG) • Motor Vehicle Reports and/or court data (MVR) - provided by a consumer reporting agency • Comprehensive Loss Underwriting Exchange (CLUE) - provided by a consumer reporting agency Driver and Description Date Source/Consumer reporting agency EFREN REGALADO Disregard Traffic Device 05/06/2014 MVR/LexisNexis EFREN REGALADO Speeding 11/11/2014 MVR/LexisNexis Outline of coverage Description Limits Deductible Premium . . . . . . . . . . . . . . . . Liability To Others $673 Bodily Injury and Property Damage Liability $1,000,000 combined single limit . Uninsured Motorist Bodily injury $1,000,000 combined single limit 58 Uninsured Motorist Property Damage $20,000 each accident $200 19 $300 hit & run Medical Payments $10,000 each person 38 33 Comprehensive See Auto Coverage Schedule Limit of liability less deductible . . . . . . . . . . . . . . . . . . . . . . . Collision 198 See Auto Coverage Schedule Limit of liability less deductible Total 12 month policy premium $1,019 Auto coverage schedule 1. 2007 Ford F550 SUPER DUTY Stated Amount:'` $10,000 (including Permanently Attached Equip) VIN: 1FDAF56P27EA87199 Garaging Zip Code: 97503 Territory: 8 Radius: 100 miles Personal use: N Body type: Dump Truck Use class: C Liability Liability UM/UIM .131 . UM PD Med Pay Premium $673 $58 $19 $38 Comp Comp Collision Collision Auto Total Physical Damage Deductible Premium Deductible Premium Premium $500 $33 $500 $198 1,019 Vehicle questions NONE Continued PROGATU/ME~ COMMfRC/AL Policy number: 03976300-0 Policyholder: EFREN REGALADO November 4, 2016 Policy period: Nov 4, 2016 - Nov 4, 2017 Page 1 of 1 Payment schedule Due date Amount Feb 4, 2017 .........................$260.75 May 4, 2017 ........................$260.75 Aug 4, 2017 ........................$260.75 Total Premium; $1,019.00 Payment Option: 4 payments An installment fee of $6.00 has been included in each payment. You may avoid paying installment fees by paying your premium in full. You may reduce the amount you pay in installment fees by paying your premium in larger amounts and fewer installments. Form Z159 (05/06) DANIEL PUILIDO PR49jGREff111f VvORLD OF INS LLC 1091 MEDFORD CENTER COMMERC/AL MEDFORD, OR 97504 Policy number: 03976300-0 Underwritten by: Artisan and Truckers Casualty Co EFREN REGALADO November 4, 2016 DBA: TABEL ROCK MASONRY Policy Period: Nov 4, 2016 - Nov 4, 2017 7782 HARLAN DR WHITE CITY, OR 97503 Online Service progressiveagent.com Customer Service 1-800-444-4487 Payment Receipt for commercial auto insurance initial payment Payment information Receipt for your initial payment Amount: $254,75 Payment Method: Credit Card Card Type: Credit Account number: ' 7953 Merchant ID: Artisan and Truckers Casualty Co Form Payrec (08/09) Policy number: 03976300-0 EFREN REGALADO Page 1 of 1 Agent compensation disclosure The insurance producer that sold you this policy is a licensed independent insurance agent authorized by Artisan and Truckers Casualty Co and by other insurance companies to solicit business on their behalf. We believe that independent agents who represent more than one company can better assist you in finding the combination of coverage, price and service that meets your needs. We will pay your agent a commission for placing your policy with us. We may also help your agent pay for advertising and marketing that is designed to attract new customers. Your agent may also be eligible for additional compensation, based upon the volume and profitability of certain business he or she places with us. Form 2181 (05105) Policy number: 03976300-0 EFREN REGALADO Page 1 of 1 Important Notice Federal, state and local laws may require you to carry higher limits of liability insurance based on your business or vehicle type. It's your responsibility to comply with these laws, Please contact the state department of transportation, your employer, or the city and municipalities where you operate, to determine if you're required to carry higher limits. Form A107 (03/13) ACO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 161~ 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 have ADDITIONAL INSURED provisions or 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: Belem Montes Clear Choice Insurance LLC A/c, No Ext): (503)601-0350 (FAX, No): (503)619-0880 11000 SW Barbur Blvd # 100 E-MAIL Portland, OR 97219 ADDRESS: belem@insurancecci.com License 100210477 INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Arch Specialty Insurance Co _ INSURED INSURER B : Table Rock Custom Masonry LLC INSURER C : 7782 Harlan Dr INSURER D: White City, OR 97503 INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: 00000000-66275 REVISION NUMBER: 5 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 EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DDNYYY A X COMMERCIAL GENERAL LIABILITY Y AG L003530600 03/2212016 03/22/2017 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RETED CLAIMS-MADE 7 OCCUR PREMISES (Ea occurrence $ 100 000 MED EXP (Any one person) $ 10,000 _ PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY JECOT LOC PRODUCTS - COMP/OP AGG s_______2,000_1000 -I OTHER: $ AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY Y / N STATUTE ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) E.L. DISEASE- EA EMPLOYE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Ashland is added as additional insured to the general liability policy. CERTIFICATE HOLDER CANCELLATION 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 Ashland, OR 97520 AUTHORIZED REPRESENTATIVE Os ~D[ (BMC) ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Printed by BMC on October 31, 2016 at 04:16PM Kaylea Kathol From: Cecilia De La Rosa <cecilia@insurancecci.com> Sent: Tuesday, November 22, 2016 10:52 AM To: Kaylea Kathol Cc: Belem Montes Subject: Re: Table Rock Masonry LLC - Certificate of Insurance Hello Kaylea, I finally heard back from the underwriter on this endorsement request. I was told that this carrier does not allow to increase limits midterm. Since his policy is renewing in a few weeks they would need to cancel the current policy and issue a new one. Our office will be in contact with Efren to process the payment on the new Gl. I am currently out o town but monitoring my emails today and tomorrow. thanks On Nov 22, 2016, at 10:09 AK Kaylea Kathol <kaylea.katholkashland.or.us> wrote: Hello Cecilia,. Today Efren Regalado (Table Rock Masonry) brought a COI dated 10/11/2016 to me for a project he's been awarded with the City of Ashland (attached). Unfortunately, it doesn't look like any of his insurance limits have been increased as he had requested earlier this month (attached). I understand he asked that the Each Occurrence limit be increased to $2,000,000, but it still is only $1,000,000. Maybe we've had a misunderstanding. Is there a chance that the updated policy request is still being processed and hasn't been issued yet? Thank you for all your help, Kaylea Kathol, Project Manager City of Ashland - Public Works/Engineering 51 Winburn Way, Ashland OR 97520 C: (541) 331-1144 1 0: (541) 552-2419 NOTICE: This email transmission is official business of the City of Ashland, and is subject to the Oregon Public Records Law for disclosure and retention. If you have received this message in error, please contact me at 541-552-2419. Thank you. From: Cecilia De La Rosa [mailto:cecilia@insurancecci.com] Sent: Wednesday, November 09, 2016 10:53 AM To: Kaylea Kathol 1 11/23/2016 Proof of Coverage Search - Results Proof of Coverage Search - Policy Search Results Displaying 1 - 1 (1 total) 1< Prev Next >1 07/28/2016 to 06/01/2017 Insurer: SAIF CORPORATION Policy C752264R166 Policy Status: ACTIVE Policy Holder: TABLE ROCK CUSTOM MASONRY, LLC 7782 HARLAN DR WHITE CITY, OR 97503-1419 Covered Employer Locations Claims Processing Information TABLE ROCK CUSTOM MASONRY, LLC 07/28/2016 to 06/01/2017 7782 HARLAN DR WHITE CITY OR Displaying 1 - 1 (1 total) 1< Prev I Next >1 Return to the search page Request Coverage Search Assistance Search hints: • The search return is proof of coverage for carrier-insured, self-insured, or worker leasing arrangements. Self- insurance was added in October 2011, eliminating the need for a separate search for that coverage and worker-leasing coverage is also included in the same search form. • The search tool is sensitive to exact spelling, based on the spelling used by the insurer, and considers only whole words. If you are unsure of a spelling or just want to search quickly, start the word and then use a % sign as a wild card to complete the word. The % symbol must be the last entry if you are using it as a wild card for any particular word. • First, try searching with fewer words of the employer's legal name (perhaps just one unique word or portion of a word ending in a % symbol). • If the screen shows too many results, then add another element such as the city or one known piece of the street address (even just the address number without the street name). • If the results are still too many, add another data element. • If you use the back arrow to get back to the search page, click on the "Reset Search Fields" button to clear the form. Shortcut to this site: Work CompCoverage. wcd.oregon.gov 1 /1 http://www4.cbs.state.or.us/ex/wcd/cov/ Purchase Order Fiscal Year 2017 Page: 1 of: 1 CONBAL E-TS B City of Ashland I ATTN: Accounts Payable Purchase ~ 20 E. Main Order # 425 Ashland, OR 97520 T Phone: 541/552-2010 O Email: payable@ashland.or.us V TABLE ROCK CUSTOM MASONRY H C/O Public Works Department E 7782 HARLAN DR I 51 Winburn Way N P Ashland, OR 97520 D WHITE CITY, OR 97503 Phone: 541/488-5347 O TO Fax: 541/488-6006 541 301-2171 Ka lea Kathol DafQrder~rra~Numr= _ aFFquirgl° :Br - _ _ 11/28/2016 958 FOB ASHLAND OR City Accounts Payable Hardscaping Pioneer Hall 1 Contractor to provide hardscaping services in Pioneer Hall 1 $46,750.0000 $46,750.00 courtyard Contract for Goods and Services Beginning date: 11/28/2016 Completion date: 02/28/2017 GL SUMMARY 082400 - 704200 $46,750.00 f t S ~f Date: uthorizetl Signature - - $46,750.00 FORM #3.._ - CITY OF ASHLAND REQUISITION ; r Date of request: 11/28/16 Required date for delivery: 11/30/16 Vendor Name TABLE ROCK MASONRY Address, City, State, Zip 7782 HARLAN DRIVE, WHITE CITY, OR 97503 Contact Name & Telephone Number EFREN REGALADO (541) 301-2171 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 cop of council communication _(If council approval required, attach cop 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 Intergovernmental Agreement ❑ Special Procurement ❑ Agency $5,000 to $75,000 ❑ Form #9, Request for Approval Date original contract approved by Council: ❑ Less than $35,000, by direct appointment ❑ Written quote or proposal attached (Date) ❑ (3) Written proposals/written solicitation Date approved by Council: _ (Attach copy of council communication) ❑ Form #4, Personal Services $5K to $75K Valid until: Date Description of SERVICES Total Cost CONTRACTOR TO PROVIDE HARDSCAPING SERVICES IN PIONEER HALL COURTYARD, PER EXHIBIT C. $46,750.00 Item # Quantity Unit Description of MATERIALS Unit Price Total Cost XXX XXX XXX y TOTAL COST ® Per attached quote/proposal Project Number Account Number 410.08,6'15.00.704200 Account Number Account Number *Expenditure must be charged to the appropriate account numbers for the financials to accurately reflect the actual expenditures. IT Director in collaboration 'th department to approve all hardware and software purchases: I T Director Date Support-Yes / No By signing this requisit orm I certify t at f e City' ublic contracting requirements have been satisfied. Emp to Department Head: Egaar $5,000) Department Manager/Supervisor City Administrator: 4-, m (Equal to or greater than $25,000) Q - T , Funds appropriated for current fiscal year:'ES / NO ~nance.DlreCtbr= (Equal to or greater than S5,000) Date Comments: Form #3 - Requisition