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HomeMy WebLinkAbout2018-002 - Contract for Goods and Services Contract for GOODS AND SERVICES Small Procurement Less than $5,000 CITY OF INDEPENDENT CONTRACTOR: Pro Kleen Inc. ASHLAND CONTACT: Rusty Lowery, Project Manager 20 East Main Street ADDRESS: 646 West Dutton Road, Eagle Point, OR 97524 Ashland, Oregon 97520 Telephone: 541/488-6002 TELEPHONE: 541-857-1818 Fax: 541/488-5311 EMAIL: resotration@getprokleen.com BEGINNING DATE: December 20, 2017 COMPLETION DATE: January 15, 2018 COMPENSATION: As per attached Exhibit B, not to exceed $2,240.48. GOODS AND SERVICES TO BE PROVIDED: Provide mold mitigation and restoration services in the basement of the administration building located at 340 S. Pioneer, as per attached Exhibit B. In the event of conflicts or discrepancies among Contract Documents, this standard form of the 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 standard form 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. 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, 279B.225, 279B.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. 8. 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. 9. Asbestos Abatement License: If required under ORS 468A.710, Contractor or Subcontractor shall possess an asbestos abatement license. 10. Assignment and Subcontracts: Contractor shall not assign this contract or subcontract any portion of the work. 1 1 . 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. 12. 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. 13. Insurance. Contractor shall at its own expense provide the following insurance: a. 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. Worker's compensation insurance is required if work is performed by employees, subcontractors, or volunteers. BY INITIALING THIS SENTENCE, CONTRACTOR CERTIFIES UNDER PENALTY OF LAW THAT THE WORK REQUIRED BY THIS CONTRACT SHALL BE PERFORMED SOLELY BY THE UNDERSIGNED: b. General Liability insurance with a combined single limit, or the equivalent, of not less than $1,000,000 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 $1,000,000 for each accident for Bodily Injury and Property Damage, including coverage for owned, hired or non-owned vehicles, as applicable. 14. Governing Law; Jurisdiction; Venue: This contract shall be governed and construed in accordance with the laws of the State of Oregon 15. 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. Certification. Contract s all sign the certification attached hereto as Exhibit A and herein incorporated by reference. Contractor: City of Ashland: By 1o ig ture ep rtment Head V Print Name Print Name ~ v` 4 f~ GG P.( Title Date n f L, r W-9 One copy of a W-9 is to be submitted with the signed contract. Purchase Order NO. Revised 10-28-14 Page 1 of 2 EXHIBIT A CERTIFICATIONS/REPRESENTATIONS: Contractor, under penalty of perjury, certifies that (a) the number shown on the attached W-9 form is its correct taxpayer ID (or is waiting for the number to be issued to it and (b) Contractor is not subject to backup withholding because (i) it is exempt from backup withholding or (ii) it has not been notified by the Internal Revenue Service (IRS) that it is subject to backup withholding as a result of a failure to report all interest or dividends, or (iii) the IRS has notified it that it is no longer subject to backup withholding. Contractor further represents and warrants to City that (a) it has the power and authority to enter into and perform the work, (b) the Contract, when executed and delivered, shall be a valid and binding obligation of Contractor enforceable in accordance with its terms, (c) the work under the Contract shall be performed in accordance with the highest professional standards, and (d) Contractor is qualified, professionally competent and duly licensed to perform the work. Contractor also certifies under penalty of perjury that its business is not in violation of any Oregon tax laws, and it is a corporation authorized to act on behalf of the entity designated above and authorized to do business in Oregon or is an independent Contractor as defined in the contract documents, and has checked four or more of the following criteria: (1) 1 carry out the labor or services at a location separate from my residence or is in a specific portion of my residence, set aside as the location of the business. (2) Commercial advertising or business cards or a trade association membership are purchased for the business. Ow" (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 ownership of performance bonds, warranties, errors and omission insurance or liability insurance relating Jtohe the labor or services to be provided. ~QC ryn bcf 13 r ?_B(~ Contr ct (Date) i I Revised 10-28-14 Page 2 of 2 PRoKLEEm Pro HIeen Inc. 646 West Dutton Rd. Eagle Point OR 97524 541-857-1818 Client: Ashland Parks & Rec (Jeff) Home: (541) 601-3926 Property: 340 S Pioneer St Ashland, OR 97520 Operator: RESTORAT Estimator: Rusty Lowery Business: (541) 890-8353 Position: Project Manager E-mail: restoration@getprokleen.com Company: ProKleen Cleaning & Restoration Business: 646 W Dutton Rd Eagle Point, OR 97524 Type of Estimate: Mold Date Entered: 12/5/2017 Date Assigned: 12/1/2017 Price List: ORME8X_NOV17 Labor Efficiency: Restoration/Service/Remodel Estimate: 2017-12-APR-MLD-MIT File Number: Self Pay pRo m -K-"4 Pro Kleen Inc. 646 West Dutton Rd. Eagle Point OR 97524 541-857-1818 2017-12-APR-MLD-MIT Main Level Main Level DESCRIPTION QTY REMOVE REPLACE TAX O&P TOTAL 1. Haul debris - per pickup truck load - 0.25 EA 119.34 0.00 0.00 6.26 36.10• including dump fees 6. Add for personal protective 1.00 EA 0.00 18.41 0.00 3.87 22.28 equipment - Heavy duty 7. Respirator - Full face - multi- 1.00 DA 0.00 7.61 0.00 1.60 9.21 purpose resp. (per day) 8. Personal protective gloves - Heavy 1.00 EA 0.00 4.30 0.00 0.90 5.20 duty (per pair) 9. Personal protective gloves - 2.00 EA 0.00 0.33 0.00 0.14 0.80 Disposable (per pair) 10. Respirator cartridge - HEPA & 1.00 EA 0.00 36.00 0.00 7.56 43.56 vapor & gas (per pair) 2. Contamination - air or surface 1.00 EA 0.00 85.00 0.00 0.00 85.00 testing & lab analysis Tape Lift 5. Contamination - air or surface 1.00 EA 0.00 325.00 0.00 68.25 393.25 testing & lab analysis Third Party Clearance 23. Negative air fan/Air scrubber (24 1.00 DA 0.00 71.28 0.00 14.97 86.25 hr period) - No monit. 24. Add for HEPA filter (for negative 0.25 EA 0.00 187.68 0.00 9.85 56.77 air exhaust fan) 26. Commercial Supervision / Project 2.00 HR 0.00 59.19 0.00 24.86 143.24 Management - per hour Total: Main Level 0.00 138.26 881.66 Basement Stora 4• a ge Height: 8 -Map Room 365.33 SF Walls 77.51 SF Ceiling °ments[: ^ 442.84 SF Walls & Ceiling 77.51 SF Floor I ' T 8.61 SY Flooring 45.67 LF Floor Perimeter ~9 1 45.67 LF Ceil. Perimeter DESCRIPTION QTY REMOVE REPLACE TAX O&P TOTAL 19. Tear out baseboard and bag for 12.00 LF 0.73 0.00 0.00 1.84 10.60 disposal - up to Cat 3 20. Tear out wet drywall, cleanup, bag, 12.00 LF 5.62 0.00 0.00 14.16 81.60 perLF-to4'-Cat3 2017-12-APR-MLD-MIT 12/7/2017 Page:2 PRoK~mr=w Pro Kleen Inc. 11 646 West Dutton Rd. Eagle Point OR 97524 541-857-1818 CONTINUED - Basement Storage DESCRIPTION QTY REMOVE REPLACE TAX O&P TOTAL 21. Apply anti-microbial agent to the 48.00 SF 0.00 0.27 0.00 2.73 15.69 surface area 22. Seal the surface area w/anti- 48.00 SF 0.00 1.06 0.00 10.69 61.57 microbial coating - one coat 25. HEPA Vacuuming - hourly charge 0.50 HR 0.00 64.93 0.00 6.82 39.29 Totals: Basement Storage 0.00 36.24 208.75 _8' lo' Map Room Height: 8' 3' 4" r 239.94 SF Walls 47.38 SF Ceiling I 1 Map Room 287.32 SF Walls & Ceiling 47.38 SF Floor 5' 12•4 1 5.26 SY Flooring 29.99 LF Floor Perimeter asemcnt $torl 29.99 LF Ceil. Perimeter 9"r DESCRIPTION QTY REMOVE REPLACE TAX O&P TOTAL 11. Tear out baseboard and bag for 10.00 LF 0.73 0.00 0.00 1.53 8.83 disposal - up to Cat 3 12. Tear out wet drywall, cleanup, bag, 10.00 LF 5.62 0.00 0.00 11.80 68.00 perLF-to4'-Cat3 13. Apply anti-microbial agent to the 40.00 SF 0.00 0.27 0.00 2.27 13.07 surface area 16. Seal the surface area w/anti- 40.00 SF 0.00 1.06 0.00 8.90 51.30 microbial coating - one coat Totals: Map Room 0.00 24.50 141.20 Total: Main Level 0.00 199.00 1,231.61 Labor Minimums Applied DESCRIPTION QTY REMOVE REPLACE TAX O&P TOTAL 15. Hazardous waste/mold rem. labor 1.00 EA 0.00 99.31 0.00 20.85 120.16 min 18. Painting labor minimum 1.00 EA 0.00 106.56 0.00 22.38 128.94 Totals: Labor Minimums Applied 0.00 43.23 249.10 Line Item Totals: 2017-12-APR-MLD-MIT 0.00 242.23 1,480.71 2017-12-APR-MLD-MIT 12/7/2017 Page:3 ®-.a F3RoKLEEni Pro HIeen Inc. 646 West Dutton Rd. Eagle Point OR 97524 541-857-1818 Grand Total Areas: 605.27 SF Walls 124.89 SF Ceiling 730.16 SF Walls and Ceiling 124.89 SF Floor 13.88 SY Flooring 75.66 LF Floor Perimeter 0.00 SF Long Wall 0.00 SF Short Wall 75.66 LF Ceil. Perimeter 124.89 Floor Area 145.67 Total Area 605.27 Interior Wall Area 435.00 Exterior Wall Area 48.33 Exterior Perimeter of Walls 0.00 Surface Area 0.00 Number of Squares 0.00 Total Perimeter Length 0.00 Total Ridge Length 0.00 Total Hip Length 2017-12-APR-MLD-MIT 12/7/2017 Page:4 PRoKt_EEni Pro Kleen Inc. 646 West Dutton Rd. Eagle Point OR 97524 541-857-1818 Summary Line Item Total 1,238.48 Overhead 115.36 Profit 126.87 Replacement Cost Value $1,480.71 Net Claim $1,480.71 Rusty Lowery Project Manager 2017-12-APR-MLD-MIT 12/7/2017 Page:5 PR°KL.EEiu Pro Kleen Inc. 646 West Dutton Rd. Eagle Point OR 97524 541-857-1818 Recap of Taxes, Overhead and Profit Overhead (10%) Profit (10%) None (0%) Line Items 115.36 126.87 0.00 Total 115.36 126.87 0.00 2017-12-APR-MLD-MIT 12/7/2017 Page:6 PROKL-mmm Pro Kleen Inc. 646 West Dutton Rd. Eagle Point OR 97524 541-857-1818 Client: Ashland Parks & Rec (Jeff) Home: (541) 601-3926 Property: 340 S Pioneer St Ashland, OR 97520 Operator: RESTORAT Estimator: Rusty Lowery Business: (541) 890-8353 Position: Project Manager E-mail: restoration@getprokleen.com Company: ProKleen Cleaning & Restoration Business: 646 W Dutton Rd Eagle Point, OR 97524 Type of Estimate: Mold Date Entered: 12/5/2017 Date Assigned: 12/1/2017 Price List: ORMEBX_NOV 17 Labor Efficiency: Restoration/Service/Remodel Estimate: 2017-12-APR-MLD-REB File Number: Self Pay PRoKLEEtu Pro Kleen Inc. 646 West Dutton Rd. Eagle Point OR 97524 541-857-1818 2017-12-APR-MLD-REB Main Level Main Level DESCRIPTION QTY REMOVE REPLACE TAX O&P TOTAL 26. Haul debris - per pickup truck load 0.25 EA 119.34 0.00 0.00 6.26 36.10 - including dump fees 27. Commercial Supervision/ Project 1.00 HR 0.00 59.19 0.00 12.43 71.62 Management - per hour Total: Main Level 0.00 18.69 107.72 f3' 10" "P Basement Storage Height: 8' Flap Room 365.33 SF Walls 77.51 SF Ceiling ~ °montst6~^„ ' I 442.84 SF Walls & Ceiling 77.51 SF Floor 8.61 SY Flooring 45.67 LF Floor Perimeter 8'9' 1 45.67 LF Ceil. Perimeter 1---9'"-~ T' DESCRIPTION QTY REMOVE REPLACE TAX O&P TOTAL 31. Replace Cove base molding - 12.00 LF 0.00 1.76 0.00 4.43 25.55 rubber or vinyl, 4" high 28. Replace 5/8" - drywall per LF - up 12.00 LF 0.00 10.95 0.00 27.59 158.99 to 4' tall Totals: Basement Storage 0.00 32.02 184.54 a' 10"-, Map Room Height: 8' 239.94 SF Walls 47.38 SF Ceiling 1 Map Room 287.32 SF Walls & Ceiling 47.38 SF Floor ^S. 12 ,4 1 5.26 SY Flooring 29.99 LF Floor Perimeter nscmen[Smrl 29.99 LF Ceil. Perimeter 9"t DESCRIPTION QTY REMOVE REPLACE TAX O&P TOTAL 35. Replace 5/8" - drywall per LF - up 10.00 LF 0.00 10.95 0.00 23.00 132.50 to 4' tall 36. Replace Door opening trim - 1.00 EA 0.00 81.41 0.00 17.10 98.51 Detach & reset 34. Replace Cove base molding - 10.00 LF 0.00 1.76 0.00 3.70 21.30 rubber or vinyl, 4" high Totals: Map Room 0.00 43.80 252.31 2017-12-APR-MLD-REB 12/7/2017 Page:2 pROKLEEIII Pro Kleen Inc. 646 West Dutton Rd. Eagle Point OR 97524 541-857-1818 Total: Main Level 0.00 94.51 544.57 Labor Minimums Applied DESCRIPTION QTY REMOVE REPLACE TAX O&P TOTAL 30. Drywall labor minimum 1.00 EA 0.00 123.96 0.00 26.04 150.00 37. Finish carpentry labor minimum 1.00 EA 0.00 53.88 0.00 11.32 65.20 Totals: Labor Minimums Applied 0.00 37.36 215.20 Line Item Totals: 2017-12-APR-MLD-REB 0.00 131.87 759.77 Grand Total Areas: 605.27 SF Walls 124.89 SF Ceiling 730.16 SF Walls and Ceiling 124.89 SF Floor 13.88 SY Flooring 75.66 LF Floor Perimeter 0.00 SF Long Wall 0.00 SF Short Wall 75.66 LF Ceil. Perimeter 124.89 Floor Area 145.67 Total Area 605.27 Interior Wall Area 435.00 Exterior Wall Area 48.33 Exterior Perimeter of Walls 0.00 Surface Area 0.00 Number of Squares 0.00 Total Perimeter Length 0.00 Total Ridge Length 0.00 Total Hip Length 2017-12-APR-MLD-REB 12/7/2017 Page:3 PROK~EE~u Pro Kleen Inc. 646 West Dutton Rd. Eagle Point OR 97524 541-857-1818 Summary Line Item Total 627.90 Overhead 62.79 Profit 69.08 Replacement Cost Value $759.77 Net Claim $759.77 Rusty Lowery Project Manager 2017-12-APR-MLD-REB 12/7/2017 Page:4 PROKLEEM Pro Meen Inc. 646 West Dutton Rd. Eagle Point OR 97524 541-857-1818 Recap of Taxes, Overhead and Profit Overhead (10%) Profit (10%) None (0%) Line Items 62.79 69.08 0.00 Total 62.79 69.08 0.00 2017-12-APR-MLD-REB 12/7/2017 Page:5 Client: 177066 PROKLEE ACORD_ CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 9/11/2017 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 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 Thomas Hart iNAM_E: Pro el Insurance p AMC, 0. 541-245-7755 (A , No): 541-245-1112_ Medford Commercial Insurance E-MAIL ADDRESS: thomas.hart@Propelinsurance.com - P O BOX 936 INSURER(S) AFFORDING COVERAGE NAIC # Medford, OR 97501 INSURER A: Tokio Marine Specialty Ins. Co. 53850 INSURED I INSURER B: Philadelphia Indemnity Ins Co. 18058 Pro Kleeninc. - 646 W. Dutton Rd. MSURERC INSURER D : Eagle Point, OR 97524-6589 INSURER E - i 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 INSR WV POLICY NUMBER MM/DDffYYY) MM1DD A X COMMERCIAL GENERAL LIABILITY PPK1632982 10112017 04101/201 EACH OCCURRENCE $1 000,000 ET (Ea RENTED CLAIMS-MADE L-F7v ^ RMAG I OCCUR AMAGE TO RENTED X PD Ded $1,000 MED_EXP(Anyouneperson) $5,000 PERSONAL 8 ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY [-1 JE C F] LOC PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY PHPK1632940 4/0112017 04/01/201 COMBINED SINGLE LIMIT Ea accident 1,000,000 X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS Per accident A UMBRELLA LIAB X OCCUR PUB578579 4/0112017 041011201 EACH OCCURRENCE $1 OOO OOO Xi EXCESS UTAB CLAIMS-MADE AGGREGATE $1,000.000 DED 1 RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY T ANY PROPRIETOR/PARTNEPJEXECUTIVE Y I -I E.L. EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? ❑ N I A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ A Envir - Prof Liab PPK1637549 4101/2017 041011201 Per Incid. $2,000,000 Claims Made Aggregate $2,000,000 Ded $2,500 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION For Evidence Only SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 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 #S2851061/M2677508 ANH01 Client#: 177066 PROKLEE ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 12/13/2017 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 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: Thomas Hart Propel Insurance PHONE 541-245-7755 FAX 541-245-1112 (A/C, No, Ex); A/C, No): Medford Commercial Insurance E-MAIL ADDRESS: thomas.hart@ProPelinsurance.com P O Box 936 INSURER(S) AFFORDING COVERAGE NAIC # Medford, OR 97501 INSURER A : Tokio Marine Specialty Ins. Co. 53850 INSURED INSURER B : Philadelphia Indemnity Ins Co. 18058 Pro Kleen Inc. INSURER C 646 W. Dutton Rd. INSURER D : Eagle Point, OR 97524-6589 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. LT LIMITS INSR TYPE OF INSURANCE ADDLSUBRJ POLICY NUMBER MM/DD/YYYYY MMIDDfyYYY LTR INSR WVD WVD A X COMMERCIAL GENERAL LIABILITY PK1632982 4/01/2017 04101/201 EACH OCCURRENCE $1,000,000 CLAIMS-MADE 4 OCCUR DAMAGE TO RENTED (Ea R occurrence $100,000 PREMISES X PD Ded $1,000 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 PRO- LOC PRODUCTS - COMP/OP AGG $2,000,000 OTHER: $ B AUTOMOBILE LIABILITY PHPK1632940 4/01/2017 04/01/201 EOa acc.'d.ntslNGLE LIMIT $1,000,000 X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PerOaE dRTY ent DAMAGE $ AUTOS A UMBRELLA LIAB X OCCUR PUB536466 4/01/2017 041011201 EACH OCCURRENCE $11000000 tDED CESS LIAB CLAIMS-MADE AGGREGATE $1 000 00 RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N I A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ A Envir - Prof Liab PPK1637549 4/01/2017 04/01/201 Per Incid. $2,000,000 Claims Made Aggregate $2,000,000 Ded $2,500 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION Ashland Parks and Recreation SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 340 South Pioneer Street ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE I IA. 1( ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) 1 of l The ACORD name and logo are registered marks of ACORD #S2983113/M2677508 ANH01 I Client#: 177067 PROKINC ACORDru CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 1011012017 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 cert ificate 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: Therese Pritchett Propel Insurance M, Et): 800 499-0933 866 577-1326 Medford Workers Compensation E-MAIL P O Box 936 ADDRESS: Therese.Pritchett@propelinsurance.com - INSURER(S) AFFORDING COVERAGE NAIC # Medford, OR 97501 INSURER A : SAIF Corporation 136196 INSURED INSURERS: Pro Kleen, Inc. - 646 W. Dutton Road INSURERC: Eagle Point, OR 97524 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 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. IN SR ADDL,SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR ! D POLICY NUMBER MMIDDIYYYY MM/DDIYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAG=~O RENTED REMI3S~.. Ea occurrence S - MED EXP (Any one person) s PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE j s PRO- POLICY 1:1 JECT U LOC PRODUCTS - COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON-OWNED ' PROPERTY DAMAGE AUTOS $ Per accident i s UMBRELLA LIAR OUEACH OCCURRENCE is EXCESS LIAR LAGGREGATE $ DED RETENTIONS i- f s - A WORKERS COMPENSATION 7$343$ 8I0112017 081012011# X PER OTH- AND EMPLOYERS' LIABILITY TAT TE FIR ANY PROPRIETOR/PARTNER/EXECUTIVE Y I N i E.L. EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? ❑ NIA (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $500,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT , $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION To Whom It May Concern SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE RI C~ ✓41P'Ll 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) 1 of l The ACORD name and logo are registered marks of ACORD #S2911440/M2758608 LAH00 ti 'ASH`S Purchase Order a 9P~ ,J Fiscal Year 2018 Page: 1 of: 1 9 $ R E G FEo d`5 _ ' THIS PO NUMBER MUST APPEAR ON ALL INVOICES AND SHIPPING-DOCUMENTS B Ashland Parks Commission I ATTN: Accounts Payable L Purchase X0181153 L 20 E. Main Order # Ashland, OR 97520 T Phone: 541/552-2010 O Email: payable@ashland.or.us V S C/O Parks Department E PRO-KLEEN INC H Admin Office N 646 WEST DUTTON RD P 340 South Pioneer D EAGLE POINT, OR 97524 Ashland, OR 97520 O T Phone: 541/488-5340 R O Fax: 541/488-5314 RRwin~l a-m ffa - _ f3 1Hesr n _ - Bets Harshman ~Qr M~aa e - vir _ = 1 H= FiQ _ - Qe q: r e 7n Eratlorrid 12/26/2017 3926 Parks Accounts Pa able Mold Restoration Services 1 Provide mold mitigation and restoration services in the basement 1 $2,240.4800 $2,240.48 of the Parks Administration building located at 340 S. Pioneer as per attached Exhibit B. Contract for Goods and Services Small Procurement Less than $5,000 Beginning date: December 20, 2017 Completion date: January 15, 2018 Project Account: $2,240.48 GL SUMMARY 121200 - 602220 $2,240.48 f By. Date. uthorized Signature I PO Total $2,240.48 CITY OF FORM #3 -ASHLAND REQUISITION date of request: 1 ~.119/~(117 r Required date for delivery: Vendor Name Prn KlaPn Inr. Address, City, State, zip 646 West Dutton Road Eagle Point, OR. Contact Name & Telephone Number Rusty Lowery, Project Manager - 541-857-1818 Email address restoration@getprokleen.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: ED Direct Award -(Attach copy of council communication) Contract # ❑ Verbal/Written quote(s) or proposal(s) ❑ 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 Provide mold mitigation and restoration services in the basement of the Parks administration building located at 340 S. Pioneer as per attached Exhibit B. 2,240.48 Item # Quantity Unit Description of MATERIALS Unit Price Total Cost TOTAL COST ® Per attached quotelproposal $ Project Number _ _ _ Account Number 121200.602220 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: G~ Department Head: (Equal to or gre ter than $V60) Department Manager/Supervisor: City Admini ra dr: (Equal to or greater than $25,000) Funds appropriated for current fiscal year., YES / NO Finance Director- (Equal to orgreaterthan $5,000) Date Comments: Form #3 - Requisition