HomeMy WebLinkAbout2019-030 20190275 Kellington, Michael PC 1 A
PERSONAL SERVICES AGREEMENT
PROVIDER: MICHAEL KELLINGTON,
ATTORNEY AT LAW
C I T Y OF ADDRESS: 116 MISTLETOE STREET
ASHLAND MEDFORD, OREGON 97501
20 East Main Street
Ashland, Oregon 97520 TELEPHONE: 541-779-8267
Telephone: 541/488-5305
Fax: 541/552-2080 FAX: 541-779-3430
EMAIL: kellingtonlaw a,gmail.com
This Personal Services Agreement (hereinafter "Agreement") is entered into by and between the City of
Ashland, an Oregon municipal corporation (hereinafter "City"), and Michael Kellington, Attorney-at-Law,
(hereinafter "Provider"), for court-appointed legal services in the Ashland Municipal Court.
NOW THEREFORE, in consideration of the mutual covenants contained herein, the City and Provider
I
hereby agree as follows:
1. Effective Date and Duration: This Agreement shall become effective on September 18, 2018 (the
"Effective Date"), and unless sooner terminated as specifically provided herein, shall continue in full
force and effect until March 18, 2019.
2. Scope of Work: Provider will provide court-appointed legal services for indigent persons appearing in
the Ashland Municipal Court as set forth in Ashland Municipal Code Chapter 2.32. Provider's services
are collectively referred to herein as the "Work."
3. Supporting Documents/Conflicting Provisions: This Agreement and any exhibits or other supporting
documents shall be construed to be mutually complementary and supplementary wherever possible. In
the event of a conflict which cannot be so resolved, the provisions of this Agreement itself shall control
over any conflicting provisions in any of the exhibits or supporting documents.
4. All Costs Borne By Provider: Provider shall, at Provider's own risk and expense, perform the Work
described above and, unless otherwise specified in this Agreement, furnish all labor, equipment, and
materials required for the proper performance of such Work.
5. Qualified Work: Provider has represented that he is a member in good standing of the Oregon State
Bar, and by entering into this Agreement now represents, that he and all personnel assigned to the Work
to be performed under this Agreement 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.
Page 1 of 6: Personal Services Agreement with Michael Kellington
6. Compensation: City shall pay Provider a flat fee of $750.00 (seven hundred and fifty dollars) per
month as compensation under this Agreement. In no event shall Provider's total of all compensation and
reimbursement under this Agreement exceed the sum of $750.00 (seven hundred and fifty dollars) per
month without the express, written approval from the City official whose signature appears below, or
such official's successor in office. Payments shall be made within thirty (30) days of the date of receipt
by the City of Provider's invoice. Should this Agreement be terminated prior to completion of all Work,
payments will be made for any phase of the Work completed and accepted as of the date of termination.
7. Statutory Requirements: The following laws of the State of Oregon are hereby incorporated by
reference into this Agreement: ORS 279B.220, 27913.230 and 27913.235.
8. Indemnification: Provider hereby agrees to defend, indemnify, save, and hold the 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 Agreement by Provider (including but not limited to, Provider's employees,
agents, and others designated by Provider to perform Work or services attendant to this Agreement).
However, Provider shall not be held responsible for any losses, expenses, claims, subrogations, actions,
costs, judgments, or other damages, caused solely by the negligence of City.
9. Termination:
a. Mutual Consent. This Agreement may be terminated at any time by the mutual consent of both
parties.
b. City's Convenience. This Agreement may be terminated by City at any time upon not less than
thirty (30) days' prior written notice delivered by certified mail or in person.
C. For Cause. City may terminate or modify this Agreement, in whole or in part, effective upon
delivery of written notice to Provider, 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
Agreement or are no longer eligible for the funding proposed for payments authorized by this
Agreement; or
Page 2 of 6: Personal Services Agreement with Michael Kellington
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iii. If any license or certificate required by law or regulation to be held by Provider to provide
the services required by this Agreement is for any reason denied, revoked, suspended, or not
renewed.
d. For Default or Breach.
i. Either City or Provider may terminate this Agreement in the event of a breach of the
Agreement by the other. Prior to such termination the party seeking termination shall give to
the other party written notice of the breach and its intent to terminate. If the party
committing the breach has not entirely cured the breach within fifteen (15) days of the date of
the notice or within such other period as the ivin the notice may party g g Y authorize in writing,
then the Agreement 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 Provider's performance of each and every obligation and duty
under this Agreement. City by written notice to Provider of default or breach may at any
time terminate the whole or any part of this Agreement if Provider fails to provide services
called for by this Agreement within the time specified herein or within 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 Agreement.
e. Obligation/Liability of Parties. Termination or modification of this Agreement 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 Subsection a, b, c, or d
of this section, Provider shall immediately cease all activities under this Agreement, unless
expressly directed otherwise by City in the notice of termination. Further, upon termination,
Provider shall deliver to City all Agreement documents, information, works-in-progress and
other property that are or would be deliverables had the Agreement been completed. City shall
pay Provider for Work performed prior to the termination date if such Work was performed in
accordance with this Agreement.
10. Independent Contractor Status: Provider is an independent contractor and not an employee of the
City for any purpose. Provider shall have the complete responsibility for the performance of the Work
pursuant to this Agreement.
11. Assignment: Provider shall not assign this Agreement 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. Provider 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 of the Work shall not create any contractual relation between the assignee or subcontractor
and City.
12. Default. The Provider shall be in default of this Agreement if Provider: commits any material breach
or default of any covenant, warranty, certification, or obligation under the 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 Agreement; or attempts to assign rights in, or delegate duties under, this
Agreement.
Page 3 of 6: Personal Services Agreement with Michael Kellington
13. Insurance. Provider shall, at Provider's own expense, maintain 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
$300,000 (three hundred thousand dollars) per occurrence. This is to cover any damages caused by
error, omission or negligent acts related to the professional services to be provided under this
Agreement.
c. 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' prior written notice from the
Provider or its insurer(s) to the City.
d. Certificates of Insurance. Provider 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 Provider's services to be provided under this Agreement. The Provider's insurance is
primary and non-contributory. As evidence of the insurance coverages required by this Agreement,
the Provider shall furnish acceptable insurance certificates prior to commencing the Work under this
Agreement. 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
Provider shall be financially responsible for all pertinent deductibles, self-insured retentions, and/or
self-insurance.
14. Nondiscrimination: Provider agrees that no person shall, on the grounds of race, color, religion, creed,
sex, marital status, familial status or domestic partnership, national origin, age, mental or physical
disability, sexual orientation, gender identity or source of income, suffer discrimination in the
performance of any Work under this Agreement when employed by Provider. Provider agrees to comply
with all applicable requirements of federal and state civil rights and rehabilitation statutes, rules and
regulations. Further, Provider agrees not to discriminate against a disadvantaged business enterprise,
minority-owned business, woman-owned business, a business that a service-disabled veteran owns or an
emerging small business enterprise certified under ORS 200.055, in awarding subcontracts as required by
ORS 279A.I 10.
15. Provider's Compliance With Tax Laws:
15.1 Provider represents and warrants to the City that:
15. 1.1 Provider shall, throughout the term of this Agreement, including any extensions hereof,
comply with:
(i) All tax laws of the State of Oregon, including but not limited to ORS 305.620 and ORS
Chapters 316, 317, and 318;
(ii) Any tax provisions imposed by a political subdivision of the State of Oregon applicable
to Provider; and
(iii) Any rules, regulations, charter provisions, or ordinances that implement or enforce any
of the foregoing tax laws or provisions.
15.1.2 Provider, for a period of no fewer than six (6) calendar years preceding the Effective Date of
this Agreement, has faithfully complied with:
(i) All tax laws of the State of Oregon, including but not limited to ORS 305.620 and ORS
Chapters 316, 317, and 318;
Page 4 of 6: Personal Services Agreement with Michael Kellington
(ii) Any tax provisions imposed by a political subdivision of the State of Oregon applicable
to Provider; and
(iii) Any rules, regulations, charter provisions, or ordinances that implement or enforce any
of the foregoing tax laws or provisions.
16. Governing Law; Jurisdiction; Venue: This Agreement 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 the
Provider that arises from or relates to this Agreement 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. Provider, by
its signature hereon of its authorized representative, hereby consents to the in personam jurisdiction of
said courts.
17. THIS AGREEMENT AND THE ATTACHED EXHIBITS CONSTITUTE THE ENTIRE
UNDERSTANDING AND AGREEMENT BETWEEN THE PARTIES. NO WAIVER, CONSENT,
MODIFICATION OR CHANGE OF TERMS OF THIS AGREEMENT 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 AGREEMENT. PROVIDER, BY SIGNATURE OF ITS AUTHORIZED
REPRESENTATIVE, HEREBY ACKNOWLEDGES THAT HE/SHE HAS READ THIS
AGREEMENT, UNDERSTANDS IT, AND AGREES TO BE BOUND BY ITS TERMS AND
CONDITIONS.
18. Amendments. This Agreement may be amended only by written instrument executed by both parties
with the same formalities as this Agreement.
19. Non-appropriations Clause. Funds Available and Authorized: City has sufficient funds currently
available and authorized for expenditure to finance the costs of this Agreement within the City's fiscal
year budget. Provider understands and agrees that City's payment of amounts under this Agreement
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 Agreement. In the event City has
insufficient appropriations, limitations or other expenditure authority, City may terminate this
Agreement without penalty or liability to City, effective upon the delivery of written notice to Provider,
with no further liability to Provider.
Page 5 of 6: Personal services Agreement with Michael Kellington
20. Certification. Provider shall sign the certification attached hereto as "Exhibit A" and incorporated
herein by this reference.
CITY OF ASHLAND: MICHAEL KE I G N, ATTORNEY-AT-LAW
(PROV ER):
By: By.
City Admi ator Sig ature
Printed Name Printed Name
o 'Z 3 Ica A #w-r1 ey
Date Title
lD /l 8-
Date
Purchase Order No.t,~ ~(W-9-9 is to be submitted with this signed Agreement)
APPROVED AS TO FORM:
Assistant City Attorney
Date
Page 6 of 6: Personal Services Agreeme^!
I
EXHIBIT A
CERTIFICATIONS/REPRESENTATIONS: Provider, by and through its authorized representative, 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) Provider 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. Provider further represents and warrants to City
that: (a) it has the power and authority to enter into and perform the Work, (b) the Agreement, when executed
and delivered, shall be a valid and binding obligation of Provider enforceable in accordance with its terms, (c)
the work under the Agreement shall be performed in accordance with the highest professional standards, and (d)
Provider is qualified, professionally competent, and duly licensed (if applicable) to perform the Work. Provider
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 Agreement, it is authorized to do business in the State of Oregon, and
Provider has checked four or more of the following criteria that apply to its business.
(1) Provider carries out the work or services at a location separate from a private residence or is in a
specific portion of a private 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.
X (4) Labor or services are performed only pursuant to written contracts.
X (5) Labor or services are performed for two or more different persons within a period of one year.
(6) Provider assumes financial responsibility for defective workmanship or for service not provided
as evidenced by the ownership of performance bonds, warranties, errors and omission (professional
bility) insurance or liability insurance relating to the Work or services to be provided.
lb~lb l/S
Provider Date
Page I of I EXHIBIT A
ASHLAND MUNICIPAL CODE
Section 2.50.110 Electronic Advertisement of Public Contracts
The City may publish the advertisement for Offers by posting it on the website of the city, or if
applicable, another governmental entity as long as the content required by the Model Rules and Oregon
Public Contracting Code is available. Individuals that obtain the solicitation materials electronically are
responsible for regularly checking for instructions, addenda, and related materials.
(Ord 3013, added, 05/18/2010)
Section 2.50.120 Personal Services Contracts
A. A personal service contract that does not exceed $35,000 may be awarded by direct appointment.
Personal Services Contracts that are for contract amounts greater than $35,000, but less than $75,000
shall follow the process for Intermediate Procurements as outlined above. In addition, for personal
services contracts greater than $5,000, but less than $75,000, the Public Contracting Officer shall
make findings that City personnel are not available to perform the services, and that the City does not
have the personnel or resources to perfom-t- ttre-'gervices requ d-unde the proposed contract.
However, the City Attorney the~ic Contracting Officer, or Loca ontr it
w Board, can
require a formal soli 'tarn for bids to ensure that the purposes of this chapter are u h
1. Class Exe ion - Attorney Services. Personal service contracts for legal Sul,'legal
servic expert witnesses, court-appointed attorneys, stenographers and other legal service are
ex pt from the competitive procurement requirements of this section and may be entered into
sed upon the judgment of the City Attorney. The City Attorney shall obtain City C uncil
pproval of any expenditure for legal services paid to a single legal services provider that is
xpected to exceed $50,000 prior to entering into the contract. In addition, exc~pf for legal
c nsel hired by the City to provide legal services to indigent criminal defcndaq~s /prosecuted by
the the City Attorney shall select and retain all outside legal cou hired by the City
subject to t al of the City Council.
2. Pre-qualified Pool Exemption. e i y may irectly award a personal services contract that does
not exceed $100,000 to a provider that has been selected to be on a list of:
a. The City's current list of qualified providers through a formal process; or
b. From another public contracting agency' s current list of qualified providers as long as the
public contracting agency uses a process substantially similar to the City's to derive the list.
3. Continuation of Work Exemption. Personal service contracts of not more than $100,000 for the
continuation of work by a contractor who preformed preliminary studies, analysis or planning for
the work under a prior contract may be awarded without competition if the prior contract was
awarded under a competitive process and the Public Contracting Officer determines that use of
the original contractor will significantly reduce the costs of, or risks associated with, the work.
B. The Local Contract Review Board is hereby opting out of OAR 137-048 regarding architectural,
engineering, and land surveying services.
C. The standard procurement rules adopted above shall apply to such contracts, as well as the following
personal services selection criteria:
1. Specialized experience in the type of work to be performed;
2. Capacity and capability to perform the work, including any specialized services within the time
limitations for the work;
3. Educational and professional record, including past record of performance on contracts with
governmental agencies and private parties with respect to cost control, quality of work, ability to
meet schedules, and contract administration where applicable;
4. Availability to perform the assignment and familiarity with the area in which the specific work is
located, including knowledge of designing or techniques peculiar to it, where applicable;
5. Cost of the services; and
6. Any other factors relevant to the particular contract.
(Ord 3039, amended, 11/07/2010; Ord 3013, added, 05/18/2010; Ord 2934, Replaced, 11/21/2006)
Page 6 of 7
Michael ]Kellington 116 Mistletoe Street
Attorney at Law Medford, OR 97501
Criminal Defense Sarah Smith Phone: 541,779.8267
Legal AssistaPt Fax: 541.779.3430
kelIingtonlaiv@ IlaiLcom
December 4, 2018
City of Ashland
20 East Main Street
Ashland, OR 97520
RE: Municipal Court Contract
Public Defense Services
To Whom it May Concern:
t
Enclosed please find the executed services agreement, together with a business license
application and a check for $90. Finally, please find my PLF assessment form from the most
current period.
I have been working now for the City in court since September. I would appreciate a payment,
including back-payment for the months of September, October, November and this month.
I
I look forward to working with the court in my capacity as municipal public defender.
Sincer
Mich Kellington
MEK/kem
Enclosures
I
3
a
WARNING: THIS DOCUMENT HAS SECURITY FEATURES IN THE PAPER
Washington Federal A-7098/3250
Michael Kellington 600 Biddle Rd ff
116 Mistletoe St Medford OR 97504 l~1 12018
Medford OR 97501 60
Pay to the Order of
iii Y. "«77 , \ i JL64N ccwcA- DOLLARS
rv
Memo:
IP002018no 1:3 2 50 709801: 2 79 700L746its
I
1
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CITY OF
i
ASHLAND
BUSINESS REGISTRATION APPLICATION
As required under Ashland Municipal Cade Chapter 6.04
n I
l
Ap lication Received Date Customerit
New Registration (Issued within 14 business days)
e pplicalion fee for a business registration is based on the fiscal year of July 1 to June 30. Non Profits are exempt
from the fee If 601(c)(3) proof of Non Profit status Is provided.
O Expedited Registration (Issued after start of business or approval needed within 3 business days)
t
O Change of Ownership
i
O Temporary Registration (issued Immediately)
The fee for a Tem ora Business Re istralion Is $26.00 and valid for 30 da
Business Name (Please Include all names associated wpqJJth he business (I.e. corporations, OBA, etc.))
'V1~L'KCUL~. r 1`~2~1`( /+MZ Ar t_.A /.v !
i
Businf4s Street Address Business Mailing Address (if different) ;
( G-"MI s`Ft~f.
z
city, /glqt ate, ZrICity, State, Zip
1~lz~it7s'r (lac-~~O{ .
Business Tolophone: (C:~t) Email
Websile - }
Do you own or rent this location: Own ent ;
Anticipated Start Dale of Business: I 1 -r ±
Type of Business: p601(c)(3) O Corporation ( Limited Liability Corporation
p Llmlted Liability Partnership M Partnership O Sole Proprietorship
If Contractor: CCB# Expires
r
LCB# Expires
WE ROWN
Principal Owner Name (or corporation name and contact person as appropriate)
5An+4...ec. '
Principal Owner Mailing Address City, Slate, Zip i
r
Owner Home Phone ( ) Owner Call Phone ( )
i
Additional Owner Name, Address and Phone
Emergency Contact Person and Relationship ( o•owner Property Manager, Leasing Agent, etc.)
Scir<-k S~t•rf.~ >Y~-'7~R-,~"Z+s~=f
Emergency Contact Phone number ( t
5~t .'772- fvj2 i
Application continues on the following page.
{t .
4
1
3
I
i
Detailed description of Business Activity
S t
LP-9 e, II Se-" e.,< ~ K a C,;Z •f eat c z
Business Activity Is defined as conducting any occupation, calling, trade, profession, rental activity, or other s
transactional activities, Including rental of two (2) or more dwelling unite and rental of any transient lodgings,
with the Intent of receiving payment or other valuable consideiation. i
Dwelling Unli Is defined as one or more rooms designed for occupancy by one (1) family and not having more I
then one (1) kitchen or cooking facility. I
Kitchen Is defined as an area, any part of which Is designed, built, used or Intended to be used for food
preparation and cooking or which contains a sink along with a refrigerator and a range, stove, or microwave. !
List number of Dwelling Units;
Federal Tax IDISSN Number of Individuals working In Ashland
Oregon Secretary of State Registry No. Building Square Footage
Is this a home business located within the city limits? Yes/No
If Yes, please complete Home Occupation Permit Application
Does this building have fire sprinklora? e o
Is this business planning to discharge Industrial wastewater Into the City's wastewater system? Ye o
If Yes, you may need an Industrial Wastewater Discharge Permit. (Pick up an application at City Hall or contact t
the Wastewater Department at (641) 552-2335. After the application Is reviewed, you will be notified If a permit is ;
i
required or not. There Is no fee required with this process.
Upon Initial approval, the subsequent fiscal years will be billed unless the City is notified in writing of
cancelation of registration.
There will not be a partial refund for businesses that cease operation within the fiscal year. P
Registrant shall pay a prorated fee of $10 for each Prorated amount plus $5 for each additional employee
month, or portion of a month, remaining In the fiscal after the first two.
year from the date of the application, with a
minimum fee of $26
Late Application Fee (Expedited Process) $26.00 ,
Temporary Business Registration Application Fee 6.00 1
Renewal Fee $76 for rst 2 employees` plus $10 for each additional
e p oyee
Late Renewal Fee (paid 30 days after the due date) 10% with a minimum of $25.00
Rental Property Fees Same as above for activity Including six or more
properties
"Pursuant to AMC 6.04.020.E an employee Is an Individual who performs service for another Individual or '
organization. The number of employees reported shall be the number of employees as of the date the new
application or renewal will become effective If approved. It does not matter whether an individual Is a full, part- I.
time, or temporary employee for business license purposes.
I hereby certify the contents of this piic n to be correct to the best of my knowledge, and furthermore, that I have
read, understood and agreed that re o sibility for complying with all applicable federal, state, or local laws,
applicant. `
ordinances, or reguletl s rests sot 1 . hel'
Applicants signature -Title )r YL
Print name Today's date f!Z T O
l
Please submit the completed registration to the City of Ashland at 20 E. Main St, Ashland, OR 97520, or fax to
(541) 552-2059. For questions, please call (541) 488-6004.
i
)
i
(ry 7IB Michael Kellington <kellingtonlaw@gmail.com>
PLF 2019 ASSESSMENT (971900 Mr. Michael E Kellington)
1 message
PLF Notices <notices@osbplf.org> Thu, Nov 15, 2018 at 3:40 AM
Reply-To: remind@osbplf.org
To: kellingtonlaw@gmail.com
Professional
d Liability Fund
Mr. Michael F, Kellington 971900 November 14, 2018
DISCLAIMER: Please note that the PLF will never contact you by phone or email asking for
credit card information.
Attached is your PLF assessment and request for exemption for Plan Year 2019. You may
complete and mail either form, or you can go to the PLF website to pay your assessment or
request an exemption from the Assessment & Exemption page.
The deadline for submission of your primary assessment payment or exemption request is
Jamiary 10, 201.9.
Attorneys must do ONE of the following Up January 10, 2019:
1. Pay the assessment in full. It 1~0
2. Pay the first installment including the service charge. -Lo
3. Submit a Request for Exemption. k1
Late charges will be assessed if payment or exemption is not received.
Anew method for paying is now available! Visit the PLF website and choose PLF QUICK
PAY from the ASSESSMENTS &C EXEMPTIONS menu. Alternatively, click the following link:
PLF Quick Pay.
More information about the assessment and exemption guidelines can be found on the Billing
& Exemption Information page.
The 2019 Primary Coverage Plan is available here.
If you have questions, please contact Kathy Medford, Assessment Coordinator, at.(503) 639_
69~ 1.
Professinnal Liatulity fund
16037 SW Upper Boones Ferry Road, Suite 300, Tigard, OR 97224
131") t? ox 231600. 1 i~jard, OIL 97281 -1600
7
3
OSS Professio al Liabili Fund 12/1/2018
Record of Payment C~teck:2614 Payee: 875.00
WA Fed 1746 875.00
Kellington Checking Account
REORDER 140.5104 FORM #7200
Purchase Order
Fiscal Year 2019 Page: 1 of: 1
THI a P£~ NUMBER M-USTAPPEAR ON ALL
iNVQICES, AND SHIPPING DOCUMENTS.B City of Ashland
ATTN: Accounts Payable Purchase
L 20 E. Main 20190275
Ashland, OR 97520 Order #
T Phone: 541/552-2010
O Email: payable@ashland.or.us
V H C/O Human Resources Division
E KELLINGTON, MICHAEL E. PC 1 20 East Main Street
N 116 MISTLETOE STREET P Ashland, OR 97520
D MEDFORD, OR 97501 Phone: 541/552-2110
O T Fax: 541/488-5311
R O
Tina Gra
12/14/2018 4251 FOB ASHLAND OR/NET30 Cit Accounts Pa able
-Ili Extende = = _
Legal Services
1 Provide legal services for indigent persons appearing in Ashland 1 $4,500.0000 $4,500.00
Municipal Court per Charter/AMC 2.32
Personal Services Agreement
Completion date: 03718/2019
Project Account:
GL SUMMARY******,.*,**,
010400 - 604140 $4,500.00
y. Date:
/Authorized ignature - - - $4,500.00
FORM#3 Ilk V ~ CITY OF
ASHLAND
et-7
REQUISITION Date of request: 10 Z5
Required date for delivery:
Vendor Name ellt
Address, City, State, Zip ) I M511e-foe ee
Contact Name & Telephone Number p q79,91 17
Email address kif
SOURCING METHOD t
❑ Exempt from Competitive Bidding ❑ Emergency r
F1 Reason for exemption: ❑ Invitation to Bid ❑ Farm #13, Written findings ad Aupb9y,,,
❑ AMC 2.50 Date approved by Council: ❑ Written quote or proposal attached
❑ Written quote or proposal attached Attach co of council communication If council a roval re uired„attach co f ,
Small Procurement ❑ Request for Proposal Cooperative Procurement V
Not exceeding $5,000 Date approved by Council: El State of Oregon
LiPbirect Award _(Attach copy of council communication) Contract #
Verbal/Written quote(s) or proposal(s) ❑ Request for Qualifications (Public Works) ❑ State of Washington
j4 C' ICCi lOQ Cv069/e jpitr, Date approved by Council: Contract #
Attach co of council communication ❑ Other government agency contract
Intermediate Procurement ❑ Sole Source Agency
GOODS & SERVICES ❑ Applicable Form (#5, 6, 7 or 8) Contract #
Greater than $5,000 and less than $100.000 ❑ Written quote or proposal attached Intergovernmental Agreement
❑ (3) Written quotes and solicitation attached ❑ Farm #4, Personal Services >$5K & <$75K Agency
PERSONAL SERVICES ❑ Special Procurement ❑ Annual cost to City does not exceed $25,000.
Greater than $5,000 and less than $75.000 ❑ Form #g, Request for Approval Agreement approved by Legal and approved/signed by
❑ Direct appointment not to exceed $35,000 ❑ Written quote or proposal attached City Administrator. AMC 2.50.070(4)
❑ (3) Written proposals/written solicitation Date approved by Council: ❑ Annual cost to City exceeds $25,000, Council
❑ Form #4, Personal Services >$5K & <$75K Valid until: Dale approval required. (Attach copy of council communication)
Description of SERVICES Total Cost
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Item # Quantity Unit Description of MATERIALS Unit Price Total Cost
❑ Per attached quotelproposal TOTAL COST
$ ~f 500
Project Number _ Account Number D 1 Q~QQ• ~DI I SID
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. q
/I
Employee: Department Head:
(Equal to or g eater than $5,000)
Department Manager/Supervisor: City Administrator:
(Equal to or greater than $25,000)
Funds appropriated for current fiscal year (fE3) / NO
ante Dire - (Equal to orgreater than $5,000) Date
Comments:
Form #3 - Requisition