Loading...
HomeMy WebLinkAbout2017-195 Contract Rogue Valley Backflow Service Contract for GOODS AND SERVICES less than $25,000 n C1 T V OF CONTRACTOR: Rogue Valley Backflow Service -ASHLAND CONTACT: Erin Akers 20 East Main Street Ashland, Oregon 97520 ADDRESS: 717 West l s' Street, Phoenix, OR 97535 Telephone: 541/488-6002 Fax: 541/488-5311 TELEPHONE: 541-482-9464 DATE AGREEMENT PREPARED: 8/31/17 FAX: N/A BEGINNING DATE: 7/1/2017 COMPLETION DATE: 6/30/2018 COMPENSATION: Per fee schedule attached as Exhibit C. GOODS AND SERVICES TO BE PROVIDED: Perform backflow assembly tests as per Exhibit C. ADDITIONAL TERMS: In the event of conflicts or discrepancies among the contract documents, the City of Ashland Contract for Goods and Services will be primary and take precedence, and any exhibits or ancillary contracts or agreements having redundant or contrary provisions will be subordinate to and interpreted in a manner that will not conflict with the said primary City of Ashland Contract. NOW THEREFORE, pursuant to AMC 2.50.090 and after consideration of the mutual covenants contained herein the CITY AND CONTRACTOR AGREE as follows: 1. All Costs by Contractor: Contractor shall, provide all goods as specified above and shall at its own risk and expense, perform any work described above and, unless otherwise specified, furnish all labor, equipment and materials required for the proper performance of such work. 2. Qualified Work: Contractor has represented, and by entering into this contract now represents, that any personnel assigned to the work required under this contract are fully qualified to perform the work to which they will be assigned in a skilled and worker-like manner and, if required to be registered, licensed or bonded by the State of Oregon, are so registered, licensed and bonded. Contractor must also maintain a current City business license. 3. Completion Date: Contractor shall provide all goods in accordance with the standards and specifications, no later than the date indicated above and start performing the work under this contract by the beginning date indicated above and complete the work by the completion date indicated above. 4. Compensation: City shall pay Contractor for the specified goods and for any work performed, including costs and expenses, the sum specified above. Payments shall be made within 30 days of the date of the invoice. Should the contract be prematurely terminated, payments will be made for work completed and accepted to date of termination. Compensation under this contract, including all costs and expenses of Contractor, is limited to $25,000.00, unless a separate written contract is entered into 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, 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 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. i 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. Non appropriations 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: City of Ashland LJ" By By ~j Signature V.(/V- partment Head C-!1~ V ~ --a < - P44) !--A- C_ _ fb2--------- Print Name Print Name ----~Yl ~~!L_------ 21 SEP zo/ Title Date W-9 One copy of a W-9 is to be submitted with ;Z,0, tl i~ 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: -,A2A. _ (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. ?sue (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. J I ` --1-- - Contractor (Date) Contract for Goods and Services Less than $25,000, 06/30/2016, Page 4 of 5 www saif.com Oregon Workers' Compensation Sa i f Certificate of Insurance rovo* corporation Mail to: Certificate holder: ROGUE VALLEY BACKFLOW SERVICE LLC CITY OF ASHLAND ROGUE VALLEY BACKFLOW SERVICE 20 E MAIN 717 W 1ST ST ASHLAND, OR 97520 PHOENIX, OR 97535-9787 The policy of insurance listed below has been issued to the insured named below for the policy period indicated. The insurance afforded by this policy is subject to all the terms, exclusions and conditions of such policy; this policy is subject to change or cancellation at any time. Insured Producer/contact Rogue Valley Backflow Service LLC United Insurance Agencies Rogue Valley Backflow Service United Insurance Agencies 717 W 1st St 541.242.6464 kellyc@uiaoregon.com Phoenix, Or 97535-9787 Issued 09/06/2017 Limits of liability Policy 875425 Bodily Injury by Accident $500,000 each accident Period 09/01/2017 to 09/01/2018 Bodily Injury by Disease $500,000 each employee Body Injury by Disease $500,000 policy limit Description of operations/locations/special items Important This certificate is issued as a matter of information only and confers no rights to the certificate holder. This certificate does not amend, extend or alter the coverage afforded by the policies above. This certificate does not constitute a contract between the issuing insurer, authorized representative or producer and the certificate holder. Authorized representative ) 6~,- wz-- Kerry Barnett President and CEO 400 High Street SE Salem, OR 97312 P 800.285.8525 F: 503.584.9812 P oli cy_O L CA_C ertifi cate Ofln s u ran ce A~~ ® DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 09106/2017 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 NCONTACT AME: JUSTIN WOODSIDE Focusl Insurance Group, Inc PHONE FAX 720 E Jackson St (A/C, No, Ext): 541-772-3120 (AIC, No): 541-772-7900 E-MAIL Medford, OR 97504 ADDRESS: justin@focuslins.com License 100171325 INSURER(S) AFFORDING COVERAGE - NAIC # INSURER A. Builders 8r Tradesmen's Ins Ser 178007 INSURED - - - - INSURER B ROGUE VALLEY BACKFLOW SERVICE LLC DBA ROGUE VALLEY BACKFLOW SERVICE INSURER C 717 W FIRST ST INSURER D: PHOENIX, OR 97535 INSURERE INSURER F COVERAGES CERTIFICATE NUMBER: 00000000-0 REVISION NUMBER: 1 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. R LTR ADDLISUB D R POLICY EFF POLICY EXP LIMITS ILT TYPE OF INSURANCE ' IN D WV POLICY NUMBER MM/OD/YYYY MM/DD/YYYY A X f COMMERCIAL GENERAL LIABILITY Y XN107621000 . 08128/2017 08/28/2018 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR DAMAGE PREMISES PREMISES (RENTED occurrence) j $ 100,000 I MED EXP (Any. one person) _ $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEN-L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2,000,000 X POLICY I JECT LOC PRODUCTS -_COMP/OP AGG 2,000,000 OTHER' r AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ TEa accident)__. ANY AUTO I BODILY INJURY (Per person) $ OWNED ISCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS _ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONI. V _ AUTOS ONLY TPer accident) _ $ UMBRELLA LIAB -i OCCUR MADE EACH OCCURRENCE EXCESS LIAB AGGREGATE - $ DED RETENTION $ - - - $ WORKERS COMPENSATION PER OTH- :AND EMPLOYERS' LIABILITY STATUTE_ ER YIN ANY PROPRIETORWARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N I A _ - - - _ - - - (Mandatory in NH) E.L. DISEASE EA EMPLOYEE! $ If yes, describe under -t - DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ I. DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Each Occurrence CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The City of Ashland, Oregon ACCORDANCE WITH THE POLICY PROVISIONS. 20 East Main St ASHLAND, OR 97520 AUTHQRIZED REPRESENTATIVE 11' © 19158- 015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Printed by JJW On September 06, 2017 at 04:23PM STATE OF OREGON LANDSCAPE CONTRACTORS BOARD $ 20,000.00 SURETY BOND LCB License # (il'already issued) Surety Company's Bond # I-SM0966184 ROGUE VALLEY BACKFLOW SERVICE LLC DBA ROGUE VALLEY BACKFI-MA' SERVICE (the "Principal") is (or seeks to be) a landscape contracting business as defined by ORS 671.520. The Principal is applving for a license from the Landscape Contractors Board ("LCB") of the State of Oregon, or for renewal of its license, and as a condition of the license is required by ORS 671.690 to furnish a bond issued by a corporation authorized to do business in the State of Oregon, sutjcct to the conditions stated in this bond. RLI Insurance Company (the "Surety") hereby binds itself, its respective heirs, personal representatives, administrators, successors and assigns to pay to the State of Oregon the sum of S 20.000.00 The obligation of the Surety under this bond is void if, in accordance with ORS Chapter 671.690 through ORS 671.710 and OAR Chapter 808, the Principal pays all amounts as determined by the LCB to be paid by the Principal, otherwise this obligation remains in full force and effect. This bond is for the exclusive purpose of ensuring payment of determination orders of the LCB in accordance with ORS 671.690 through ORS 671.710. This bond is one continuing obligation, and the liability of the Surety for the aggregate of all claims which may arise under this bond may in no event exceed the amount of the penal sum of this bond. This bond is effective on the 28th day of August 2017 , and remains in force until depleted by claims paid under ORS 671, unless the Surety sooner cancels the bond. The Surety may cancel this bond and be relieved of fimher liability for work on contracts entered after cancellation by giving 30 days written notice to the principal and the LCB of the State of Oregon. Cancellation shall not limit the responsibility of the surety for determination orders relating to wort: performed or contracted to perform prior to the cancellation. This bond shall not be valid for purposes of licensing in accordance with ORS chapter 671 unless tiled with the [-CB within sixty (60) days of the date show above. Surety represents and warrants that it is authorized to transact surety business in the State of Oregon. Dated this 24th day of Aui-,ust 2017 Surety Name: RLI Insurance Company PN~EJustin Woodside CO % Printed Nome o1 ,Horner In Fa(l or I,eenl =a G0i1P0Rg2-F •:9t Si,Enntttre SE A Ij Attorney In Fact Title L IN p\5 "''"f1111110" 720 E Jackson Street [541) 772-3120 iddre s Plume Medford, OR 97504 On State 7ilt 10/20/5 R3643015-30,30 RIF Insurance ComPan} POWER OF ATTORNEY RU"' P.O. Box 3967 Pcoria IL 61612-3967 Phone: (309)692-1000 Fax: (309)683-1610 RLI Insurance Company Bond No. LSM0966184 Know All Men bh These Presents: That the RLI Insurance Company a corporation organized and existing under the laws of the State of Illinois and authorized and licensed to do business in all states and the District of Columbia does hereby make, constitute and appoint: Justin Woodside in the City of Medford State of Oregon as Attorney In Fact with full power and authority hereby conferred upon him/her to sign, execute, acknowledge and deliver for and on its behalf as Surety, in general, any and all bonds, undertakings, and rccognizances in an amount not to exceed Two Hundred Fifty Thousand and 00/100 Dollars ( $ 250,000.00 ) for any single obligation, and specifically for the following described bond. Principal: ROG1LVAI_.i-FY BACKFL.OW SERVICE LL.C DBA_ROCUT VALLEY BACKFLOW SERVICE Obligee: Oregon Landscape Contractors Board Type Bond: Landscape Contractor _ Bond Amount: $ 20,000.00 Effective Date: August 28, 2017 The RLI Insurance Company further certifies that the following is a true and exact copy of a Resolution adopted by the Board of Directors of RLI Insurance Company and now in force to-wit: All bonds, policies, undertakings, Powers of Attorney or other obligations of the corporation shall be executed in the corporate name of the Company by the President, Secretary, any Assistant Secretary, Treasurer, or any Vice President, or by such other officers as the Board of Directors may authorize. The President, any Vice President, Secretary, any Assistant Secretary, or the Treasurer may appoint Attorneys in Fact or Agents who shall have authority to issue bonds, policies or undertakings in the name of the Company. The corporate seal is not necessary for the validity of any bonds, policies, undertakings, Powers of Attorney or other obligations of the corporation. The signature of any such officer and the corporate seal may be printed by facsimile." IN WITNESS WHEREOF, the RLI Insurance Company has caused these presents to be executed by its Vice President with its corporate seal affixed this 24th day of August 2017 ONCE c ATTEST: RLI Insurance Company a: GOPPORq TF •:9 ~ SEAI, . dy. OWJ-L Cherie L. Montgomery ssistant Secretary 5+++,0`' Barton W. Davis Vice President CCINO\,a mm~u0 On this 24th day of August 2017 before me, a Notary Public, personally appeared Barton W. Davis and Cherie L. Montgomery who being by me duly sworn, acknowledged that they signed the above Power of Attorney as Vice President and Assistant Secretary , respectively, of the said RLI Insurance Company and acknowledged said instrument to be the voluntary act and deed of said corporation. a. C)FFICIAL SEAL 14 _'QU !Nf. ;M, BO ' : k I: Jac cline M. Rock r Notary Public corerrissioNexPiPes0114118 ~mzm~m~~~rmnm~~rmr'! A0006104 GEICO GEICO CASUALTY COMPANY Washington DC VERIFICATION OF COVERAGE (SEa_ BLLOW UNDERCAUITIONARY NO`IE) INSURED Policy Number: 4382 99 57 38 Effective Date: 09-12-17 ERIN COVINGTON AND BRIAN Expiration Date: 02-13-18 JEFFREY AKERS Registered State: OREGON 717 W 1ST ST PHOFNTX, OR 97535-9787 To whom it may concern; This letter is to verify that we have issued the policyholder coverage under the above policy number for the dates indicated in the effec- tive and expiration date fields for the vehicle listed. This should serve as proof that the below mentioned vehicle meets or exceeds the financial responsibility requirement for your state. This verification of coverage does not amend, extend or alter the coverage afforded by this policy. Vehicle Year' 2002 Make: TOYOTA Model: RAV4 VIN: 3TEHH2Ov926068313 COVERAGES LIMITS DEDUCTIBLES BODILY INJURY LIABILITY $100,000/$300,000 PROPERTY DAMAGE LIABILITY $100,000 PERSONAL INJURY PROTECTION NON-DED UNINSURED MOTORIST BODILY IN] $100,000/$300,000 UNINSURED MOTORIST PROPERTY DAMAGE $20,000 _ Lienholder Additional Insured I11terested ]'arty Additional Information: Issued 09/11/2017 If you have any additional questions, please call 1-800-841-3000. CAUTIONARY NOTE: TIIF, C"CrRRE1'T CgVE,R,A.C>FS, i,Il~1ITS„1NJ) DEDUC'TUILES NIW DIFFFR FROM TIII'- Ct?VFRAC;ES, IdhRTS,A.ND DEPUCTIBL.ES IN EFFECT AT OTIIF.R TIMES DURING TIFF. POLICY PERIOD. TILTS VERIFICATION OF COVERAGE REFIX.C.`TS TIFF CONFERAGES, L [NIFFS AND DEDUCTIBLES AS OF TUFF: ISSUED DATA; OF THIS DOCUITENT WHIC'14 IS SILOWN I WDER -ADDITIONAL INFORRSAI ]ON" OR IF AN ISSU iED DAIV IS V01` SFIOWN. "IIIF. DATE. OF THIS FACSIMILE. U-33 10-07 GEICO GEICO CASUALTY COMPANY Washington DC VERIFICATION OF COVERAGE (SET BE' OW UNDE12 CAUTIONARY NtYCL) INSURED Policv Number: 4382995738 Effective Date: 09-12-17 ERIN COVINGTON AND BRIAN Expiration Date: 02-13-18 JEFFREY AKERS Registered State: OREGON 717 W 1ST ST PHOENIX. OR 97535-9787 To whom it may concern: This letter is to verify that we have issued the policyholder coverage under the above policy number for the dates indicated in the effec- tive and expiration date fields for the vehicle listed. This should serve as proof that the below mentioned vehicle meets or exceeds the financial responsibility requirement for your state. This verification of coverage does not amend, extend or alter the coverage afforded by this policy. Vehicle Year: 2003 Make: FORD Model: WINDSTAR VIN:2FMZA57493BB02292 COVERAGES LIMIT'S DEDUCTIBLES BODILY INJURY LIABILITY $100,000/$300,000 PROPERTY DAMAGE LIABILITY $100,000 PERSONAL INJURY PROTECTION NON-DED UNINSURED MOTORIST BODILY INJ $100,000/$300,000 UNINSURED MOTORIST PROPERTY DAMAGE $20,000 _ Lienholder _ Additional Insured Interested Party Additional Information: Issued 09/11/2017 If you have any additional questions, please call 1-800-841-3000. CAUrI07V:1RI NIM E: THE CVRRENT ('OA'FR.AGFS. LIA111S. AND DEDUCTIBLES MAY DIFFER FROM MY, C'OVERAC.'ES, 1,11MITS, AND DEDUCTIBLES UN F,FFFCT AT OTLIFR TIMES DURING TILE POLICY PERIOD. THIS VERIFLCA'IION OF COVERAGE REFI.F..CTS TH.F ('OVERNGES. LINIIIS AND DEDUCTIBLES AS OF THE ISSUE t) DATE OF THIS DOCUMENT' WHICH IS KNOWN UNDER *vDDLTt(,)NAI,INFORM1IATION" OR WAN ISSUED I)MY 19 NOT SNOUT:. 111F DATE OFTIILS FACSIMILE. U-3310-07 GEICO GEICO CASUALTY COMPANY Washington DC VERIFICATION OF COVERAGE (SEE BELOW UNDER CAUTIONARY NOTE..) INSURED Policv Number: 4382995738 Effective Date: 09-12-17 ERIN COVINGTON AND BRIAN Expiration Date: 02-13-18 JEFFREY AKERS Registered State: OREGON 717 W 1sT ST PHOENIX. OR 97535-9787 To whum it may concern: This letter is to verify that we have issued the policyholder coverage under the above policy number for the dates indicated in the effec- tivo and expiration date fields for the vehicle listed. This should serve as proof that the below mentioned vehicle meets or exceeds the financial responsibility requirement for your state. I 'his verification of coverage does not amend, extend or alter the coverage afforded by this policy. Vehicle Year: 1999 Make: FORD Model: EXPLORER VIN: IFMDU34E2XZB85912 (;OVERAGES LIMITS DEDUCTIBLES BODILY INJURY LIABILITY $100,000/$300,000 PROPERTY DAMAGE LIABILITY $100,000 PERSONAL INJURY PROTECTION NON-DED UNINSURED MOTORIST BODILY IN] $100,000/$300,000 UNINSURED MOTORIST PROPERTY DAMAGE $20,000 _ Lienholder _ Additional Insured Interested I'arty Additional Information: Issued 0911112017 If you have any additional questions, please call 1-800-841-3040. Caiil[O.1`.-1R] NOTE: "[HE CURRENT COVERAGES. LIMITS. AND DEDUCTIBLES 1NIAYDIFFER FROM THE COVERAGES, hIRNIITS,A,'VD DEDUCTIBLES UN EFFFCTAT OTHER T"IINFS DURING THE POLICYPF:RIOD.'11118 VERIFIC'A'TION OFC'OV'F'RAGF. RF.FIFC'IS ]ITY COVERAGES. TANIITSAND DEDI.K'11:BLES AS OF THF.ISSUED DAIF, OF THIS DOCUMENT' ]]IIK'H IS MIO]V'.V 1.'N DF;R ^ADDrCIONAI,ItiT'OIZ11Ar10N" OR IF AN ISSUED DATE IS NOT SFIO]VN. 111E DAIF OF THIS FACSINHLF.. U-3310-07 Purchase Order Fiscal Year 2018 Page: 1 of: 1 IHIS PO NUMBER MUST APPEAR ON ALL B City of Ashland INVOICES- AND SHIPPING DOCUMENTS. - L ATTN: Accounts Payable Purchase L 20 E. Main Order# 20181032 Ashland, OR 97520 T Phone: 541/552-2010 0 Email: payable@ashland.or.us V S C/O Facilities Maintenance Div E ROGUE VALLEY BACKFLOW SERVICE, MARK H N JAMIESON 90 North Mountain Ave D 1151 REITEN DR P Ashland, OR 97520 O ASHLAND, OR 97520 Phone: 541/488-5358 R O Fax: 541/552-2304 Vendor Phone Number -Vendor 'Fax=Number -Requisition Number Delivery Reference 541 482-9464 David Arnold Date Ordered= Vendor Number -Date Required right--Mdthadams - `QepartmentlLocation 09/26/2017 633 FOB ASHLAND OR City Accounts Payable Item# Descri tion/PartNo it Price Extended Price Backflow assembly tests 1 Perform backflow assembly tests for FY18 as described in Exhibit 1 $2,000.0000 $2,000.00 C. Contract for Goods and Services less than $25,000 Beginning date: 07/01/2017 Completion date: 06/30/2018 Project Account: GL SUMMARY 082400 - 602400 $2,000.00 By: Date: - A orized S ature PO=Total = $2,000.00, FORM #3 CITY OF ASHLAND REQUISITION Date of request: 9/21/17 Required date for delivery: Vendor Name Roque Valley Backflow Service Address, City, State, Zip 717 West 1st Street, Phoenix, OR 97535 Contact Name & Telephone Number Erin Akers (541)482-9464 Fax Number SOURCING METHOD ❑ Exempt from Competitive Bidding ❑ Emergency ❑ Reason for exemption: ❑ Invitation to Bid (Copies on file) ❑ Form #13, Written findings and Authorization Date approved by Council: ❑ Written quote or proposal attached ❑ AMC 2.50 ❑ Written quote or proposal attached ® 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) ❑ State of Washington Contract # Intermediate Procurement ❑ Sole Source ❑ Other government agency contract GOODS & SERVICES ❑ Applicable Form (#5,6, 7 or 8) Agency $5,000 to $100,000 ❑ Written quote or proposal attached Contract # ❑ (3) Written quotes and solicitation ❑ Form #4, Personal Services $5K to $75K Intergovernmental Agreement attached ❑ Agency PERSONAL SERVICES ❑ Special Procurement Date original contract approved by Council: $5,000 to $75,000 ❑ Form #9, Request for Approval (Date) ❑ Less than $35,000, by direct ❑ Written quote or proposal attached appointment Date approved by Council: ❑ (3) Written proposals/written solicitation ❑ Form #4, Personal Services $5K to $75K Valid until: (Date) Description of SERVICES Total Cost Perform backflow assembly tests for FY18 as described in Exhibit C $ 2,000.00 Item # Quantity Unit Description of MATERIALS Unit Price Total Cost TOTAL COST ® Per attached quote/proposal Project Number _ _ _ _ _ _ - _ _ _ Account Number 082400-602400 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 re r1 cert th the City's public contracting requirements have be n satisfied. Employee Signature: Department Head Signature: qual to or greater than $5,000) 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