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HomeMy WebLinkAbout2018-049-Contract for Safety Training Contract for Safe Training Onsite for Public Works & Electric Utility De arty ents CONSULTANT: Evergreen Job & Safety Training, Inc. CITY OF ASHLAND CONTACT: Jesse Langslet, Owner/Trainer 20 East Main Street ADDRESS: 1352 Palmerston Loop, Roseville, CA 95678 Ashland, Oregon 97520 Telephone: 541/488-6002 TELEPHONE: 916-742-1811 Fax: 541/488-5311 FAX: 916-742-1852 EMAIL: evergreenjobandsafety@gmail.com EFFECTIVE DATE: March 1, 2018 COMPLETION DATE: February 28, 2023 COMPENSATION: FIVE (5) YEAR CONTRACT ELECTRIC UTILITY PUBLIC WORKS (16 Employees) (60 Employees) YEAR 1 $21377.28/Month $28,527.36 $2,434.24/Month $29,210.88 March 2018 - February 2019 YEAR 2 $2,472.37/Month $29,668.44 $2,531.61/Month $30,379.32 March 2019 - February 2020 (+4% increase/Year 2) (+4% increase/Year 2) YEAR 3 $2,472.37/Month $29,668.44 $2,531.61/Month $30,379.32 March 2020 - February 2021 YEAR 4 $2,571.27/Month $30,855.24 $2,632.87/Month $31,594.44 March 2021- February 2022 (+4% increase/Year 4) (+4% increase/Year 4) YEAR 5 $2,571.27/Month $30,855.24 $2,632.87/1\4onth $31,594.44 March 2022 - February 2023 ELECTRIC PUBLIC Total amount for 5-year contract: WORKS $149.574.72 $153.158.40 SERVICES TO BE PROVIDED: SAFETY TRAINING'- Cost per month includes monthly safety training classes (one per department each month), job observations (two per department each month), administration, training materials, record keeping, program development, insurance, travel, lodging, meals, and any other expenses required to facilitate the required safety trainings and job observations per the City's RFP and Contractor's proposal dated 01/18/2018. Approved by City Council on February 6, 2018. ADDITIONAL TERMS: In the event of a conflict or discrepancy among the contract documents, this City of Ashland Contract for Personal Services will be primary and take precedence, and any exhibits or ancillary agreements having redundant or contrary provisions will be subordinate to and interpr6ted in a manner that will not conflict with the said rims City of Ashland Contract. FINDINGS: Pursuant to AMC 2.50.120, after reasonable inquiry and evaluation, the 'undersigned Department Head finds and determines that: (1) the services to be acquired are personal services; (2) the City does not have adequate personnel nor resources to. perform the services; (3) the statement of work represents the department's plan for utilization of such personal services; (4) the undersigned consultant has specialized experience, education, training and capability sufficient to perform the quality, quantity and type of work requested in the scope of work within the time and financial constraints provided; (5) the consultant's proposal will best serve the needs of the City; and (6) the compensation negotiated herein is fair and reasonable. NOW THEREFORE, in consideration of the mutual covenants contained herein the CITY AND CONSULTANT AGREE as Contract for Safety Training (Onsite for Public Works & Electric Utility Departments), Page 1 of 6 follows: 1. Findings 7 Recitations. The findings and recitations set forth above are true and correct and are incorporated herein by this reference. 2. All Costs by Consultant: Consultant shall, at its own risk and expense, perform the personal services described above and, unless otherwise specified, furnish all labor, equipment and materials required for the proper performance of such service. 3. Qualified Work: Consultant has represented, and by entering into this contract now represents, that all personnel assigned to the work required under.this contract are fully qualified to perform the service 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. 4. Completion Date: Consultant shall start performing the service under this contract by the beginning date indicated above and complete the service by the completion date indicated above. 5. Compensation: City shall pay Consultant for service 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. 6. Ownership of Documents: All documents prepared by Consultant pursuant to this contract shall be the property of City. 7. 'Statutory Requirements: ORS 279C.505, 279C.515, 279C.520 and 279C.530 are made part of this contract. 8. Living Wage Requirements: If the amount of this contract is $20,688.86 or more, Consultant 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 service work under this contract. Consultant is also required to post the notice attached hereto as Exhibit B predominantly in areas where it will be seen by all employees. 9. Indemnification: Consultant 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 Consultant (including but not limited to, Consultant's employees, agents, and others designated by Consultant to perform work or services attendant to this contract). Consultant 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. 10. '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 Consultant, or at such later date as may be established by City under any of the following. conditions: . i. If City funding from federal, state, county or other sources is not obtained and continued at levels sufficient to allow for the purchase of the indicated quantity of services; ii. If federal or state regulations or guidelines are modified, changed, or interpreted in such a way that the services are no longer allowable or appropriate for purchase under this contract or are no longer eligible for the funding proposed for payments authorized by this contract; or iii. If any license or certificate required by law or regulation to be held by Consultant 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 Consultant 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 Consultant's performance of each and every obligation and duty under this contract. City by written notice to Consultant of.default or breach may at any time terminate the whole or any part of this contract. if Consultant 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, Consultant shall immediately cease all activities under this contract, unless expressly directed otherwise by City in the notice of termination. Further, upon termination, Consultant shall deliver to City all contract documents, information, works-in-progress and other property are Contract for Safety Training (Onsite for Public Works & Electric Utility Departments), Page 2 of 6 or would be deliverables had the contract been completed. City shall pay Consultant for work performed prior to the termination date if such work was performed in accordance with the Contract. 11. Independent Contractor Status: Consultant is an independent contractor and not an employee of the City. Consultant shall have the complete responsibility for the performance of this contract. Consultant shall provide workers' compensation coverage as required in ORS Ch 656 for all persons employed to perform work pursuant to this contract. Consultant is a subject employer that will comply with ORS 656.017. 12. Assignment and Subcontracts: Consultant 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. Consultant 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. 13. Default. The Consultant shall be in default of this agreement if Consultant: commits any material breach or default of any covenant, warranty, certification, or obligation it owes under the Contract; its QRF status pursuant to the QRF Rules or loses any license, certificate or certification that is required to perform the Services onto qualify as a QRF if consultant has qualified as a QRF for this agreement; institutes an action for relief in bankruptcy or has instituted against it an action for insolvency; assignment for the benefit of creditors; or ceases doing business akes a general , 9 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. 14. Insurance. Consultant 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. Professional Liability insurance with a combined single limit, or the equivalent, of not less than $2',000,000 for each claim, incident or occurrence. This is to cover damages caused by error, omission or n gli ent acts related to the professional services to be provided under this contract. c ( General Liability insurance with a combined single limit, or the equivalent, of not lel s than $2,000_,Q00 for ch ccuurence for Bodily Injury and Property Damage. ---Ajutomobile Liability insurance with a combined single limit, or the equivalent, of not less than Enter one: $100,000, 500,000„ $1,000,000, or Not Applicable for each accident for Bodily Injury and Property Damage, inc uding coverage for owned, hired or non-owned vehicles, as applicable. e. 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 Consultant or its insurer(s) to the City. f. Additional Insured/Certificates of Insurance. Consultant shall name The City of Ashland, Oregon, and its elected officials, officers and employees as Additional Insureds on any insurance policies, excluding Professional Liability and Workers' Compensation, required herein, but only with respect to Consultant's services to be provided under this Contract. The consultant's insurance is primary and non-contributory. As evidence of the insurance coverages required by this Contract, the Consultant shall furnish acceptable insurance certificates prior to commencing work under this contract. 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 Consultant shall be financially responsible for all pertinent deductibles, self-insured retentions and/or self-insurance. 15. 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 Consultant 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. Consultant, 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. 16. 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. CONSULTANT, 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. 17. 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. Consultant understands and agrees that City's payment of amounts under this contract attributable to work performed after the Contract for Safety Training (Onsite for Public Works & Electric Utility Departments), Page 3 of 6 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 Consultant, with no further liability to Consultant.. Certification. Consultant shall sign the certification attached hereto as Exhibit A and herein incorporated by reference. Consultant: City of Ashland By , Z By Signature epartmd'nt Head Print Names Print Name /I er Title Date (W-9 is to be submitted with the signed contract. Purchase Order No. PT,OVEV, AS a FORM Ashlg -Ast.'CZY-4xz~;rney Date' 1 4 - Contract for Safety Training (Onsite for Public Works & Electric Utility Departments), Page 4 of 6 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) [.carry out the labor or services at a location separate from my residence or is in.a specific portion of my residence, set aside as the location of the business. ® (2) Commercial advertising or business cards or a trade association membership are purchased for the business. - (3) Telephone listing is used for the business separate from the personal residence listing. (4) Labor or services are performed only pursuant to written contracts. (5) Labor or services are performed for two or more different persons within a period of one year. (6) 1 assume financial responsibility. for defective workmanship or for service not provided as evidenced by the ownership of performance bonds, warranties, errors and omission insurance or liability insurance relating to the labor or services to be provided. -/e, PJ Co tractor (Date). Contract for Safety Training (Onsite for Public Works & Electric Utility Departments), Page 5 of 6 \ , EXHIBIT B City of Ashland LIVING W GE per hour effective June 30, 2017 (Increases annually every June 30 by the Consumer Price Inde)t) portion of business of their 401 K and IRS eligible employer, if the employer has cafeteria plans (including ten or more employees, and childcare) benefits to the has received financial amount of wages received by assistance for the project or the employee. . ➢ For all hours worked under a business from the City of service contract between their Ashland in excess of ➢ Note: "Employee" does not employer and the City of $20,688.86. include temporary or part-time Ashland if the contract employees hired for less than exceeds $20,688.86 or more. ➢ If their employer is the City of 1040 hours in any twelve- Ashland including the Parks month period. For more ➢ For all hours worked in a and Recreation Department. details on applicability of this month if the employee spends policy, please see Ashland 50% or more of the ➢ In calculating the living wage, Municipal Code Section employee's time in that month employers may add the value 3.12.020. working on a project or of health care, retirement, For- a'dditional information: Call the Ashland City Administrator's office at 541-488-6002 or write to the City Administrator, City Hall, 20 East Main Street, Ashland, OR 97520 or visit the city's website at www.ashland.or.us. Notice to Employers: This notice must be posted predominantly in areas where it can be seen by all employees. CITY OF -ASHLAND Contract for Safety Training (Onsite for Public Works & Electric Utility Departments), Page 6 of 6 CERTIFICATION OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE REQUIREMENTS Contractor is exempt from the requirement to obtain workers compensation insurance under ORS Chapter 656 for the following reason. Contractor is to initial the appropriate box as follows: SOLE PROPRIETOR (Initials) w Contractor is a sole proprietor, and ■ Contractor has no employees, and p ■ Contractor will not hire employees or subcontractors to perform this contract. ~rlir CORPORATION - FOR PROFIT (Initials) N Contractor's business is incorporated; and ■ All employees of the corporation are officers and directors and have a substantial ownership interest" in the corporation, and ■ All work will be performed by the officers and directors; Contractor will not hire other employees or subcontractors to perform this contract. CORPORATION - NONPROFIT (Initials) ■ Contractor's business is incorporated as a nonprofit corporation, and ■ Contractor has no employees; all work is performed by volunteers, and ■ Contractor will not hire employees or subcontractors to perform this contract. PARTNERSHIP (Initials) ■ Contractor is apartnership, and ■ Contractor has no employees, and ■ All work will be performed by the partners; Contractor will not hire employees or subcontractors to perform this contract, and ■ Contractor is not engaged in work performed in direct connection with the construction, alteration, repair, improvement, moving or demolition of an improvement to real property or appurtenances thereto." LIMITED LIABILITY COMPANY (Initials) ■ Contractor is a limited liability company, and ■ Contractor has no employees, and . ■ All work will be performed by the members; Contractor will not hire employees or subcontractors to perform this contract, and ■ If Contractor has more than one member, Contractor is not engaged in work performed in direct connection with the construction, alteration, repair, improvement, moving or demolition of an improvement to real property or appurtenances thereto.' (Signature orAuthorized Signer) (Date) %x/117 (f - r (Signer'sTitle *NOTE: Under OAR436-50-050 a shareholder has a "substantial ownership" interest if the shareholder owns 10% of the corporation, or if less than 10% is owned, the shareholder has ownership that is at least equal to or greater than the average percentage of ownership of all shareholders. **NOTE: Under certain circumstances partnerships and limited liability companies can claim an exemption even when performing construction work. The requirements for this exemption are complicated. Consult with City Attorney's Office before an exemption request is accepted from a contractor who will perform construction work. ACORD-. CERTIFICATE OF.LIABILITY INSURANCE DATE(MM/DD/YY) 1 01/24/2018 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE Hays Companies DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE 80 S 8th Street, Suite 700 POLICIES BELOW. Minneapolis, MN 55402 INSURERS AFFORDING COVERAGE NAIC # Email: programs@hayscompanies.com INSURERA: Certain Underwriters at Lloyds PHONE NO. 1-888-767-2159 FAX NO. 612-373-7270 INSURER B: INSURED INSURER C: Evergreen Job & Safety Training, Inc. 1352 Palmerston Loop INSURER D: Roseville, CA 95678 INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSR ICY ILTR NSRD TYPE OF INSURANCE POLICY NUMBER PDAT (MM/DD/YY) PDATE (MWDD/Y) LIMITS GENERAL LIABILITY EACH OCCURRENCE 2000000 DA TO EMI ESES S (EaREMED occurrence 100000 X X COMMERCIAL GENERAL LIABILITY PR PREMI X CLAIMS MADE F__j OCCUR MED EXP (Any one person) 2500 A General Liability 1802MFA004067 02/0512018 0210512019 PERSONAL & ADV INJURY 2000000 GENERAL AGGREGATE 4000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG EXCLUDED X POLICY PROJECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea Accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per Person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per Accident) PROPERTY DAMAGE (Per Accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT ANY AUTO OTHER THAN EA ACC AUTO ONLY: AGG EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE OCCUR F-1 CLAIMS MADE AGGREGATE DEDUCTIBLE RETENTION WC STAN- OTH- WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS' LIABILITY E.L. EACH ACCIDENT ANY PROPRIETORIPARTNER/EXECUTNE OFFICER/MEMBER EXCLUDED? E.L. DISEASE- EA EMPLOYEE If yes, describe under SPECIAL PROVISION BELOW E.L. DISEASE- POLICY LIMIT OTHER A Professional (E&0) Liability 1802MFA004067 02/05/2018 02/05/2019 Each Claim 12000000 Aggregate 4000000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS THIS CERTIFICATE OF INSURANCE SERVES ONLY AS EVIDENCE OF COMBINED PROFESSIONAL AND GENERAL LIABILITY COVERAGE. CERTIFICATE HOLDER IS ADDITIONAL INSURED PER THE FOLLOWING ENDORSEMENT. CERTIFICATE HOLDER ADDITIONAL INSURED; INSURER LETTER: CANCELLATION City of Ashland 90 N. Mt Avenue SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Ashland, OR 9Y520 EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POICY PROVISIONS. AUTHORIZED SIGNATURE © ACORD CORPORATION 1988-2009 ACORD 25 (2001/08) ADDITIONAL INSURED ENDORSEMENT I Insured: Evergreen Job & Safety Training, Inc. Policy Number: 1802MFA004067 Effective Date: 02/05/2018 at 12:01 a.m. standard time It is hereby understood and agreed that for the additional premium charged, the following is added to the policy as an Additional Insured with respect to claims arising out of services performed by the insured on their behalf: City of Ashland 90 N. Mt. Avenue Ashland, OR 97520 ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. 1 Date: January 24, 2018 BY: HAYS AFFINITY A MEMBER OF HAYS COMPANIES L - Customer Copy - JESSE LANGSLET Page 1 of 2 Customer name:JESSE LANGSLET Company: SF Mutual Address: 1352 PALMERSTON LOOP Servicing Agent: BRIAN WILSON ROSEVILLE, CA 95678-1176 Eff date: 10-26-2017 to 04-26-2018 Policy: 428 1456-D26-55 Description: 2014 TOYOTA CAMRY 4DR Status: PAID.ON SFPP VIN: 4T1 BF1 FK3EU871086 SFPP 0359985612 Coverage Details The premium amounts shown reflect a six-month policy term. Code Description Amount A Liability Coverage .246.86 Bodily Injury Limits Each Person, Each Accident $100,000 $300,000 Property Damage Limit Each Accident $100,000 C Medical Payments Coverage 18.63 Limit - Each Person $5,000 D Comprehensive Coverage - $250 Deductible 39.78 G Collision Coverage - $1,000 Deductible 127.07 H Emergency Road Service Coverage 5.66 R1 Car Rental and Travel Expenses Coverage 12.48 Limit - Car Rental Expense Each Day, Each Loss , 80%$500 U Uninsured Motor Vehicle Coverage 36.84 Bodily Injury Limits Each Person, Each Accident $100,000 $300,000 U1 Uninsured Motor Vehicle Property Damage Coverage 3.99 Total: 491.31 Vehicle Details Year: 2014 Make: TOYOTA Model: CAMRY Body Style: 4DR VIN: 4T1 BF1 FK3EU871086 MSRP base: 0.00 MSRP additional equip: 0.00 https://sfnet.opr.statefann.org/sysapv/printOptionsAction.do 2/15/2018 - Customer Copy - JESSE LANGSLET Page 2 of 2 Odometer Information Odometer reading: 33,000 Odometer date: 04-2017 Vehicle Usage Annual miles: 7,501 Use of vehicle: PLSRMK/SCH Household Driver Details JESSE LANGSLET Birth date: 12-03-1977 Occupation: LINEMAN Gender: MALE Marital Status: MARRIED License: XXXX5642 State/Prov: CA JOLYNNLANGSLET Birth date: 04-19-1972 Gender: FEMALE Marital Status: MARRIED License : XXXX2357 State/Prov: CA The information on this document is presented for general informational purposes only and is not intended to serve as a declaration page or policy. State Farm Mutual Automobile Insurance Company, Bloomington, Illinois https:Hsfnet.opr.statefarm.org/sysapv/printOptionsAction.do 2/15/2018 Purchase Order Fiscal Year 2018 Page: 1 of 1 THIS PO NUMBER MUST APPEAR ON ALL B City of Ashland INVOICES, AND SHIPPING DOCUMENTS. - I L 20 E. ATTN: Accounts Payable Purchase L Ashland, Main 20181234 Aand, OR 97520 Order # T Phone: 541/552-2010 O Email: payable@ashland.or.us V H C/O Purchasing Division E EVERGREEN JOB & SAFETY TRAINING 1 90 North Mountain Ave N 1352 PALMERSTON LOOP P Ashland, OR 97520 D ROSEVILLE, CA 95678 Phone: 541/488-5354 O T Fax: 541/488-5320 R O a-nor=P :'ane= unifier = _enda =~tr~ Kari Olson Date Ordered =_Vendor Number E7e_te Requ[r~ - _ _Qepame'ILocation=T_ 03/06/2018 1076 FOB ASHLAND OR/NET30 Cit Accounts Pa able J>i P~i~~ :Exten`de f r . - Safety Training - Public Works 1 Safety Training (New Contract) 4 MO $2,434.2400 $9,736.96 Public Works De artment March - June 2018 $2,434.24 per month Contract for Safety Training (Onsite for Public Works & Electric Utility Departments) Effective date: Mary 1, 2018 Completion date: February 28, 2023 Project Account: GL SUMMARY 082400 - 610400 $9,736.96 By: Date. C Authorized Signature $9,736.96 k C I T Y OF T1 ~#3 FORM #3 ASHLAND REQUISITION Date of request: 2/27/18 Required date for delivery: Vendor Name Evergreen Job & Safety Training Inc. Address, City, State; Zip 1352 Palmerston Loop, Roseville, CA 95678 Contact Name & Telephone Number Jesse Langslet (916)742-1811 FAX: (916)742-1852 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 uote or proposal attached Cooperative Procurement 171 Small Procurement Less than $5.000 ® Reauest for Proposal (Copies on file) ❑ State of Oregon ❑ Direct Award Date approved by Council: Contract # ❑ VerbaWllritten 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 [1 (3) Written quotes and solicitation ❑ Form #4, Personal Services $51K to $75K Intergovernmental Agreement attached El Agency PERSONAL SERVICES ❑ Special Procurement Date original contract approved by Council: $5,000 to $75.000 [I 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 Valid until: (Date) ❑ Form #4, Personal Services $5K to $75K Description of SERVICES Total Cost Monthly Safety Training for Public Works Employees (March 1, 2018 - June 30, 9,7.36 9T' 2018) Item # Quantity Unit Description of MATERIALS Unit Price Total Cost 'TO'TAL .COST' ® Per attached quotelproposal : Project Number Account Number 082400-610400 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 is requisitio f rm, 1 ce ily that the City's public contracting requirements have been satisfied Employee Signature: Department Head Signature: (Equal to or greater than $5,000) City Administrator: (Equal to or greater than $25,000) Funds appropriated for current fiscal year' YE 7 NO narnce Dir or- (Equal to or greater than $5,000) Date Comments: