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HomeMy WebLinkAbout2018-024-Contract for Goods and Services-AMPS Contract for GOODS AND SERVICES less than $25,000 CITY OF CONTRACTOR: AMPS -AS H LA N D CONTACT: Jon Janakes 20 East Main Street Ashland, Oregon 97520 ADDRESS: PO Box 8494, Medford, OR 97501 Telephone: 541/488-6002 Fax: 541/488-5311 TELEPHONE: 541-734-3236 DATE AGREEMENT PREPARED: 12/28/2017 FAX: BEGINNING DATE: 7/1/2017 COMPLETION DATE: 6/30/2018 COMPENSATION: Per fee schedule attached as Exhibit C. y GOODS AND SERVICES TO BE PROVIDED: Maintenance and services of plumbing systems and related equipment on an as-needed basis for FY18. 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 I 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, 2798.230, 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 $20,688.86 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 i 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 Contract for Goods and Services Less than $25,000, 06/19/2017, 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 j 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 j 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 ~I persons employed by them, and the approvai by City of ai y 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 i the QRF Rules or loses any license, certificate or certification that is required to perform the work or to qualify as a QRF if Contractor has qualified as a QRF for this agreement; institutes an action for relief in bankruptcy or has instituted against it an action for insolvency; makes a general assignment for the benefit of creditors; or ceases doing business on a regular basis of the type identified in its obligations under the Contract; or attempts to assign rights in, or delegate duties under, the Contract. 16. Insurance. Contractor shall at its own expense provide the following insurance: a. Worker's Compensation insurance in compliance with ORS 656.017, which requires subject employers to provide Oregon workers' compensation coverage for all their subject workers b. General Liability insurance with a combined single limit, or the equivalent, of not less than Enter one: $200,000, $500,000, $1,000,000, $2,000,000 or Not Applicable for each occurrence for Bodily Injury and Property Damage. C. Automobile Liability insurance with a combined single limit, or the equivalent, of not less than Enter one: $200,000, $500,000, $1,000,000, or Not Applicable for each accident for Bodily Injury and Property Damage, including coverage for owned, hired or non-owned vehicles, as applicable. Contract for Goods and Services Less than $25,000, 06/19/2017, 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 I 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"' City of Ashland By Signature epartment Head L~~ f-41 t[.a- G 6rLo w.J Print Name Print Name ~r 9 J4-,J Zo t e Title Date W-9 One copy of a W-9 is to be submitted with ~D l l~ the signed contract. Purchase Order No. J Contract for Goods and Services Less than $25,000, 06/19/2017, 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, it is an independent Contractor as defined in the contract documents, it is authorized to do business in Oregon, it is authorized to act on behalf of the City, and Contractor has checked four or more of the following criteria that apply to its business. (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. X (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. ontractor (Date) Contract for Goods and Services Less than $25,000, 06/19/2017, Page 4 of 5 CITY OF ASHLAND, OREGON EXHIBIT B City of Ashland LIVING WAGE Iola A per hour effective June 30, 2017 (Increases annually every June 30 by the Consumer Price Index) • • . business of their and IRS eligible cafeteria employer, if the employer plans (including has ten or more childcare) benefits to the employees, and has amount of wages received financial received by the ➢ For all hours worked assistance for the project employee. under a service contract or business from the City between their employer of Ashland in excess of ➢ Note: "Employee" does and the City of Ashland if $20,688.86. not include temporary or the contract exceeds part-time employees $20,688.86 or more. ➢ If their employer is the hired for less than 1040 City of Ashland including hours in any twelve- ➢ For all hours worked in a the Parks and Recreation month period. For more month if the employee Department. details on applicability of spends 50% or more of this policy, please see the employee's time in ➢ In calculating the living Ashland Municipal Code that month working on a wage, employers may Section 3.12.020. project or portion of add the value of health care, retirement, 401 K additional For 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 Contract for Goods and Services Less than $25,000, 06/19/2017, Page 5 of 5 -AS H LA N D Page 1 0{ Z Ashland Medford Plumbing and Excavation Services PO Box 8494; Medford, OR 97501 • Phone: 541-734-3236 • Fax: 541-732-0092 City of Ashland As Need Contract Fiscal Year 2018 Rate Sheet Attention: David Arnold Via Email: david.arnold@ashland.or.us December 19, 2017 Billing on a Time and Material Basis - to be paid within 30 days of billing. Plumbing Service Rate Sheet Labor Rates (Plus Materials) PER HOUR 1 Plumber $95 1 Plumber and 1 Helper $150 2 Plumbers $175 Camera Lines $250 (1 hr max) Jetter Lines $250 (1 hr max) Excavation Service Rate Sheet MACHINE WITH OPERATOR PER HOUR EX LG EXCAVATOR $120 MINI EXCAVATOR W/HAMMER $125 MINI EXCAVATOR $85 DUMP TRUCK $85 SKID STEER $85 BACK HOE $85 BULL DOZER $95 ROLLER $85 LABORER $65 LABOR PER HOUR FOREMAN $85 LABOR CLASS 1 $75 LABOR CLASS 2 $65 ROCK PER TON 3/4" ROCK $10.50 4" SHALE / ROCK $9.50 RIP RAP $13.50 Specializing in Pinnabin , Merheinicai, dronies, Rodiant. Geothernted and Fnii See-riee E.venn•ation EX~`b't G Page 2 of 2 Ashland Medford Plumbing and Excavation Services PO Box 8494; Medford, OR 97501 • Phone: 541-734-3236 • Fax: 541-732-0092 Exclusions: Bonds, permits and fees, site security, dumpsters, crane, forklift, saw cutting and concrete removal, concrete pour back, items not identified on plans, responsibility for damage to installed materials. No surveying is included - All surveying required for grid line installation is the responsibility of the general contractor. No footings shall be installed before rough in plumbing. All installed footings that are damaged due to the underground plumbing shall be the responsibility of the general contractor. Escalator Clause: Due to the recent fluctuation in commodity pricing AMP can only hold this price for 15 days. Material pricing may increase without a notification within that time. Hazardous Materials Disclaimer: Ashland Medford Plumbing will be held harmless in the discovery and manipulation of any and all hazardous materials. It is the job owner's responsibility to meet all requirements in handling such materials at no cost to Ashland Medford Plumbing. Ashland Medford Plumbing will go on standby time or redirect work until such situation is resolved. Owner will be responsible for all cost involved, including wages and equipment rental. Ashland Medford Plumbing will not lose work time due to delays generated by such discoveries. All materials are guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements are contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado, flood and other necessary insurance. Our workers are fully covered by Workman's Compensation Insurance. A late payment service charge of 2% per month will be charged on accounts 30 days past due from date of billing. The service charge is an annual percentage rate of 24%. Minimum service charge is $100.00, plus the reasonable cost of collection, including but not limited to attorney and legal fees. I agree that my liability for the charges is not waived and I agree to be held personally liable for such charges. Authorized Signature Ion lanakes Date December 19, 2017 Acceptance of Proposal/Contract - The above price, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payments will be made 20% Down and Final Payment Upon Completion. Signature Date of Acceptance S ieeio/iain in P/tunbin , i►It~tletoeita/, Ro dronies, Rndinn4 Ctothernttd and F►d/ Serrire Eveartttion A~~ ® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 12292017 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 endorsements . PRODUCER CONTACT NAME: CLIENT CONTACT CENTER FEDERATED MUTUAL INSURANCE COMPANY HOME OFFICE: P.O. BOX 328 (A/C. Ext : 888-333-4949 Fo/c No : 507-446-4664 OWATONNA, MN 55060 A E-MAIL INSURER(S) AFFORDING COVERAGE NAIC N INSURER A: FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 358-611-2 INSURER B: ASHLAND MEDFORD PLUMBING INC INSURER C: PO BOX 8494 MEDFORD, OR 97501-0894 INSURER D: - INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 175 REVISION NUMBER: 0 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 NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD MMIDDIYYYY MM/DDIYYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED $100,000 CLAIMS-MADE OCCUR PREMISES Ea ocwrrenceMED EXP (Any one person) EXCLUDED A Y N 9337481 03/20/2017 03/20/2018 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY ❑ PRO ❑ LOC OTHER: JECT PRODUCTS - COMPIOP AGG $2,000,000 X AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea ccident $1,000,000 a _ X ANY AUTO BODILY INJURY (Per person) OWNED AUTOS ONLY SCHEDULED A AUTOS Y N 9337481 03120/2017 03/20/2018 BODILY INJURY (Per accident) NON-OWNED PROPERTY DAMAGE HIRED AUTOS ONLY AUTOS ONLY Per accident) _ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $2,000,000 A EXCESS LIAB CLAIMS-MADE N N 9337482 03/2012017 03/20/2018 AGGREGATE $2,000,000 DED RETENTION WORKERS COMPENSATION PER STATUTE 7 O ER R _ AND EMPLOYERS' LIABILITY Y / N E.L. EACH ACCIDENT ANY OR I EXCLUDED? (EXEC UTIVE ❑ NIA OFFICER MEMB (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE If yes, describe under E.L DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required) SEE ATTACHED PAGE CERTIFICATE HOLDER CANCELLATION 358-611-2 175 0 CITY OF ASHLAND SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 20 E MAIN ST THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ASHLAND, OR 97520-1814 ACCORDANCE WITH THE POLICY PROVISIONS... AUTHORIZED REPRESENTATIVE O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 358-611-2 r~ LOC _ ACOR ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMEDINSURED FEDERATED MUTUAL INSURANCE COMPANY ASHLAND MEDFORD PLUMBING INC PO BOX POLICY NUMBER 8494 SEE CERTIFICATE # 175.0 MEDFORD, OR 97501-0894 CARRIER 74~E SEE CERTIFICATE # 175.0 EFFECTIVE DATE: SEE CERTIFICATE # 175.0 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE INSURANCE PROVIDED BY THE GENERAL LIABILITY COVERAGE IS PRIMARY AND NONCONTRIBUTORY OVER OTHER INSURANCE. THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU ENDORSEMENT FOR GENERAL LIABILITY. THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED BY CONTRACT ENDORSEMENT FOR BUSINESS AUTO LIABILITY. INSURANCE PROVIDED BY THE BUSINESS AUTO LIABILITY IS PRIMARY AND NONCONTRIBUTORY OVER OTHER INSURANCE. FOR REASONS OTHER THAN NON-PAYMENT OF PREMIUM, 30 DAYS NOTICE WILL BE PROVIDED TO THE CERTIFICATE-HOLDER IN THE EVENT THAT THE ISSUING COMPANY CANCELS THE POLICY BEFORE THE EXPIRATION DATE OF THE POLICY. CITY OF ASHLAND AND ITS ELECTED OFFICIALS, OFFICERS, EMPLOYEES, ARE LISTED AS ADDITIONAL INSURED ON ANY INSURANCE POLICES EXCLUDING WORKERS COMPENSATION REQUIRED HEREIN BUT ONLY WITH RESPECT TO CONTRACTORS SERVICES TO BE PROVIDED UNDER THIS CONTRACT ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Y SEE/ 304350 A Human Resource Alanagement CompM December 29, 2017 ASHLAND MEDFORD PLUMBING INC 5555 N MEDFORD INDUSTRIAL RD CENTRAL POINT, OR 97502-9400 Re: Barrett Business Services, Inc. ("BBSI") Letter of Self-Insurance for Workers' Compensation Coverage As the named addressee of this Letter, your company's required workers' compensation coverage is provided through BBSI's state approved Self-Insured Workers' Compensation Plan by way of your co-employment contract with BBSI. Additional information is as follows: State: Oregon Workers' Compensation Limits: Employer Liability Limits: Self Insurance Certification 1068 Statutory $5,000,000.00 Each Accident $5,000,000.00 Disease Coverage Limit by Client $5,000,000.00 Disease; Each Employee Other Comments (place an "X" if applicable): EVINamed "Letter Holder": City of Ashland 20 East Main St Ashland, OR 97520 0 Other: Contract effective 9/17/12, renewed through 9/30/18. Subject to 30 days' notice of cancellation. Additionally, BBSI's self-insured program is further supported by an excess workers' compensation insurance policy with ACE American Insurance Co.. Copy of certificate is available upon request. For additional information, please contact your local BBSI office at: MEDFORD (541) 772-5469 3512 Excel Drive Suite 107 Very truly yours, Medford, OR 97504 X44L6& Michael L. Elich President and Chief Executive Officer doc: LOSS-2 C1TY BEC®RE") FE Purchase Order Fiscal Year 2018 Page: 1 of: 1 €3~P_1--k~4M6E&-fNllSr~£eE11i.~-0r~AL ~r~r~7~ESN~-SPIPP-~t~G~]QG➢t~lEt1'ES-~_ B City of Ashland _ ATTN: Accounts Payable Purchase 2~ Q V 11L 20 E. Main Order# CJ Ashland, OR 97520 T Phone: 5411552-2010 O Email: payable@ashland.or.us E H C/O Public Works Department AMPS, ASHLAND MEDFORD PLUMBING 1 51 Wnburn Way P O BOX 8494 p Ashland, OR 97520 D MEDFORD, OR 97504 Phone: 541/488-5347 O TO Fax: 541/488-6006 Q _ _ o ~_ms~t°rarrlma5e ffi e = _ e of ~T? - Paula Brown ~~r~e~ -.eerJ~mEe_~ fir - ~.n r -fie ok~~ _ ~~--•art~a~t(~tiocL 01111/2018 372 1 "1: FOB ASHLAND OR Cit Accounts Pa able Maintenance and services of plumbing sylsttems and related 1 $4,000.0000 $4,000.00 7Complefion Wrr ----On-call Plumbing Services equipment on an as needed basis forFYY Contract for Goods and Services less than $25,000 Beginning date: 07/01/2017 date: 06/30/2018 Project Account: GL SUMMARY 082400 - 602400 $4,000.00 By v Date: ti? uthod ed signature ~fifil_ - = $4,000.00 FORM #3 CITY OF -ASHLAND REQUISITION n "I .I:', r x Date of request: 1/9/2018 Required date for delivery: Vendor Name AMPS Address, City, State, Zip PO Box 8494, Medford, OR 97501 Contact Name & Telephone Number Jon Janakes (541)734-3236 Fax Number SOURCING METHOD ❑ Emergency ❑ Exempt from Competitive Bidding ❑ 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 Cooperative Procurement ❑ Small Procurement ❑ Less than $5.000 Request for Proposal (Copies on file) El State of Oregon ® Direct Award Date approved by Council: Contract # ❑ State of Washington ❑ Verbal/Written quote(s) or proposal(s) 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 El Special Procurement Date original contract approved by Council: ❑ Form #9, Request for Approval (Date) $5,000 to $75.000 ❑ Written quote or proposal attached ❑ Less than $35,000, by direct Date approved by Council: appointment ❑ (3) Written proposals/written solicitation Valid until: (Date) ❑ Form #4, Personal Services $5K to $75K Total Cost Description of SERVICES Maintenance and services of plumbing systems and related equipment on an as- $ 4,000 needed basis for FY18. 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 requisition form, I certify that the City's public contracting requirements a een satisfied. Employee Signature:`~vrkN' 11Department 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: