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HomeMy WebLinkAbout2019-126 20190434 Rogue Valley Dust Control SERVICES AGREEMENT PROVIDER: Rogue Valley Dust Control CITY OF PROVIDER'S CONTACT: Mike Falco ASHLAND 20 East Main Street ADDRESS: 2744 Howard Ave. Ashland, Oregon 97520 Medford, OR 97501 Telephone: 541/488-5587 PHONE: 541-631-0067 Fax: 541/488-6006 This Services Agreement(hereinafter"Agreement") is entered into by and between the City of Ashland, an Oregon municipal corporation(hereinafter "City") and Rogue Valley Dust Control, an assumed business name ("hereinafter "Provider"), to treat up to 9,600 square feet for dust control at$0.11 per square foot, as shown on Exhibit A. 1. PROVIDER'S OBLIGATIONS 1.1 Provide treatment up to 9,600 square feet for dust control at $0.11 per square foot as set forth in the "SUPPORTING DOCUMENTS" attached hereto and, by this reference, incorporated herein. Provider expressly acknowledges that time is of the essence of any completion date set forth in the SUPPORTING DOCUMENTS, and that no waiver or extension of such deadline may be authorized except in the same manner as herein provided for authority to exceed the maximum compensation. The services defined and described in the "SUPPORTING DOCUMENTS" shall hereinafter be collectively referred to as "Work." 1.2 Provider shall obtain and maintain during the term of this Agreement and until City's final acceptance of all Work received hereunder, a policy or policies of liability insurance including commercial general liability insurance with a combined single limit, or the equivalent, of not less than $2,000,000 (two million dollars) per occurrence for Bodily Injury and Property Damage. 1.2.1 The insurance required in this Article shall include the following coverages: • Comprehensive General or Commercial General Liability, including personal injury, contractual liability, and products/completed operations coverage; and • Automobile Liability. 1.2.2 Each policy of such insurance shall be on an "occurrence" and not a "claims made" form, and shall: • Name as additional insured "the City of Ashland, Oregon, its officers, agents and employees" with respect to claims arising out of the provision of Work under this Agreement; • Apply to each named and additional named insured as though a separate policy had been issued to each, provided that the policy limits shall not be increased thereby; • Apply as primary coverage for each additional named insured except to the extent that two or more such policies are intended to "layer" coverage and, taken together, they provide total coverage from the first dollar of liability; • Provider shall immediately notify the City of any change in insurance coverage • Provider shall supply an endorsement naming the City, its officers, employees and agents as additional insureds by the Effective Date of this Agreement; and Page 1 of 5: Agreement between the City of Ashland and Rogue Valley Dust Control 1 • • Be evidenced by a certificate or certificates of such insurance approved by the City. 1.3 Provider shall,at its own expense,maintain Worker's Compensation insurance in compliance with ORS 656.017, which requires subject employers to provide workers' compensation coverage for all of its subject workers. 1.4 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 P erformance of 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.110. 1.5 In all solicitations either by competitive bidding or negotiation made by Provider for work to be performed under a subcontract, including procurements of materials or leases of equipment, each potential subcontractor or supplier shall be notified by the Providers of the Provider's obligations under this Agreement and Title VI of the Civil Rights Act of 1964 and other federal nondiscrimination laws. 1.6 Living Wage Requirements: If the amount of this Agreement is $21,127.46 or more, Provider is required to comply with Chapter 3.12 of the Ashland Municipal Code by paying a living wage,as defined in that chapter, to all employees performing Work under this Agreement and to any Subcontractor who performs 50% or more of the Work under this Agreement. Consultant is also required to post the notice attached hereto as "Exhibit A"predominantly in areas where it will be seen by all employees. 2. CITY'S OBLIGATIONS 2.1 City shall pay Provider the sum of$1,056.00 as provided herein as full compensation for the Work as specified in the SUPPORTING DOCUMENTS. 2.2 In no event shall Provider's total of all compensation and reimbursement under this Agreement exceed the sum of$1,056.00 without express, written approval from the City official whose signature appears below, or such official's successor in office. Provider expressly acknowledges that no other person has authority to order or authorize additional Work which would cause this maximum sum to be exceeded and that any authorization from the responsible official must be in writing. Provider further acknowledges that any Work delivered or expenses incurred without authorization as provided herein is done at Provider's own risk and as a volunteer without expectation of compensation or reimbursement. 3. GENERAL PROVISIONS 3.1 This is a non-exclusive Agreement. City is not obligated to procure any specific amount of Work from Provider and is free to procure similar types of goods and services from other providers in its sole discretion. 3.2 Provider is an independent contractor and not an employee or agent of the City for any purpose. 3.3 Provider is not entitled to, and expressly waives all claims to City benefits such as health and disability insurance, paid leave, and retirement. Page 2 of 5: Agreement between the City of Ashland and Rogue Valley Dust Control 3.4 This Agreement embodies the full and complete understanding of the parties respecting the subject matter hereof. It supersedes all prior agreements, negotiations, and representations between the parties, whether written or oral. 3.5 This Agreement may be amended only by written instrument executed with the same formalities as this Agreement. 3.6 The following laws of the State of Oregon are hereby incorporated by reference into this Agreement: ORS 279B.220, 279B.230 and 279B.235. 3.7 This Agreement shall be governed by the laws of the State of Oregon without regard to conflict of laws principles. Exclusive venue for litigation of any action arising under this Agreement shall be in the Circuit Court of the State of Oregon for Jackson County unless exclusive jurisdiction is in federal court, in which case exclusive venue shall be in the federal district court for the district of Oregon. Each party expressly waives any and all rights to maintain an action under this Agreement in any other venue, and expressly consents that, upon motion of the other party, any case may be dismissed or its venue transferred, as appropriate, so as to effectuate this choice of venue. 3.8 Provider shall defend,save,hold harmless and indemnify the City and its officers, employees and agents from and against any and all claims, suits, actions, losses, damages, liabilities, costs, and expenses of any nature resulting from, arising out of, or relating to the activities of Provider or its officers, employees, contractors, or agents under this Agreement. 3.9 Neither party to this Agreement shall hold the other responsible for damages pr delay in performance caused by acts of God, strikes, lockouts, accidents, or other events beyond the control of the other or the other's officers, employees or agents. 3.10 If any provision of this Agreement is found by a court of competent jurisdiction to be unenforceable, such provision shall not affect the other provisions, but such unenforceable provision shall be deemed modified to the extent necessary to render it enforceable, preserving to the fullest extent permitted the intent of Provider and the City set forth in this Agreement. 4. SUPPORTING DOCUMENTS The following documents are,by this reference,expressly incorporated in this Agreement,and are collectively referred to in this Agreement as the "SUPPORTING DOCUMENTS:" • The Provider's complete written 2019 Quote 2. 5. REMEDIES 5.1 In the event Provider is in default of this Agreement, City may, at its option, pursue any or all of the remedies available to it under this Agreement and at law or in equity, including, but not limited to: 5.1.1 Termination of this Agreement; 5.1.2 Withholding all monies due for the Work that Provider has failed to deliver within any scheduled completion dates or any Work that have been delivered inadequately or defectively; 5.1.3 Initiation of an action or proceeding for damages, specific performance, or declaratory or injunctive relief; 5.1.4 These remedies are cumulative to the extent the remedies are not inconsistent,and City may pursue any remedy or remedies singly, collectively, successively or in any order whatsoever. Page 3 of 5: Agreement between the City of Ashland and Rogue Valley Dust Control 1 5.2 In no event shall City be liable to Provider for any expenses related to termination of this Agreement or for anticipated profits. If previous amounts paid to Provider exceed the amount due, Provider shall pay immediately any excess to City upon written demand provided. 6. TERM AND TERMINATION 6.1 Term This Agreement shall be effective from the date of execution on behalf of the City as set forth below (the"Effective Date"), and shall continue in full force and effect until September 1, 2019,unless sooner terminated as provided in Subsection 6.2. 6.2 Termination 6.2.1 The City and Provider may terminate this Agreement by mutual agreement at any time. 6.2.2 The City may, upon not less than thirty (30) days' prior written notice, terminate this Agreement for any reason deemed appropriate in its sole discretion. 6.2.3 Either party may terminate this Agreement, with cause, by not less than fourteen (14) days' prior written notice if the cause is not cured within that fourteen (14) day period after written notice. Such termination is in addition to and not in lieu of any other remedy at law or equity. 7. NOTICE Whenever notice is required or permitted to be given under this Agreement, such notice shall be given in writing to the other party by personal delivery, by sending via a reputable commercial overnight courier, or by mailing using registered or certified United States mail, return receipt requested, postage prepaid, to the address set forth below: If to the City: City of Ashland—Public Works Department • Attn: Kaylea Kathol 20 E. Main Street Ashland, Oregon 97520 Phone: (541) 488-5587 With a copy to: City of Ashland—Legal Department 20 E. Main Street Ashland, OR 97520 - Phone: (541) 488-5350 If to Provider: Rogue Valley Dust Control Attn: Mike Falco 2744 Howard Ave. Medford, OR 97501 8. WAIVER OF BREACH One or more waivers or failures to object by either party to the other's breach of any provision,term,condition, or covenant contained in this Agreement shall not be construed as a waiver of any subsequent breach,whether or not of the same nature. 9. PROVIDER'S COMPLIANCE WITH TAX LAWS Page 4 of 5: Agreement between the City of Ashland and Rogue Valley Dust Control 9.1 Provider represents and warrants to the City that: 9.1.1 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. 9.1.2 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; (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. 9.2 Provider's failure to comply with the tax laws of the State of Oregon and all applicable tax laws of any political subdivision of the State of Oregon shall constitute a material breach of this Agreement. Further, any violation of Provider's warranty, as set forth in this Article 9, shall constitute a material breach of this Agreement. Any material breach of this Agreement shall entitle the City to terminate this Agreement and to seek damages and any other relief available under this Agreement,at law,or in equity. IN WITNESS WHEREOF the parties have caused this Agreement to be signed in their respective names by their duly authorized representatives as of the dates set forth below. CITY OF ASHLAND: ROGUE VALL Y DUST CONTROL (P.' -i IISER): By: By: r Signature Signature yA-14 L• - c #relyp✓.J / " i / C Ci Printed Name Printed Name 10;4./ Fi rm (' `✓ r-t e �_. Title Title Date ate (W-9 is to be submitted with this signed Agreement) Purchase Order No. ( 0 Page 5 of 5: Agreement between the City of Ashland and Rogue Valley Dust Control Dust Suppression Treatment Area Shown in Red - approx. 900-1000 linear feet, 12 feet wide \} Business owner may contact you about applying dust suppressant to this road. We would prefer that this I road get treated at the same time as the areas identified by the City in red to save on moblization costs. i However,if this road does get treated;it will be seperate from the City's contract I I 464 ft x 22 ft 10,228 sf Cx .. 6DO ft x��2 _ er :�i :$- . . ii 4. LE end uti St rm Drain Inlets • Drains to Stream +, [� "Za.' • Drains to Swale 14 O ® #■ 1 NorthEastAccessRoad p 4r Na e dust suppression 1 1 ROGUE VALLEY 2019 QUOTE 2 DUST CON r TO: City of Ashland 2744 Howard Avenue 51 Winburn Way, Medford, OR 97501 Ashland, OR roguevalleydustcontrol @gmail.com 541-331-1144 Website: roguevalleydustcontrol.com i I JOB LOCATION . _ JOB DATE . Lr Ashland Airport-403 Dead Indian Rd. 2019 DESCRIPTION PRICE % Dust abatement on 9600 sq ft total .11/sq ft j $1056* i Chem-Shield additive(n/c for 2019 season) $52.80 n/c *Included in this price are two separate applications. First treatment at be.innin. of season and a retreat later in the season around August 1st. RVDC will guarantee results.Please notify if additional retreats are needed. If the initial application process takes place with Brim Aviation's application ( .10/sq ft $960* Chem-Shield included n/c Subtotal Sales Tax Total Make checks payable to: Mike Falco. Payment is due upon completion of job. Mike 541-613-0067 THANK YOU FOR YOUR BUSINESS! Rose 541-531-8383 `;j ATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE D4/11/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME. PROTECTORS INSURANCE LLC PO BOX 4669 PHONE FAX MEDFORD, OR 97501 (A/C,No.Ext): (A/C,No.): E-MAIL ADDRESS: PHONE NO. (541)773-5358 INSURER(S)AFFORDING COVERAGE NAIL# INSURED MICHAEL FALCO INSURER A: RED SHIELD INSURANCE COMPANY 41580 DBA: ROGUE VALLEY DUST CONTROL INSURER B: 2744 HOWARD AVE INSURER C: MEDFORD, OR 97501 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY 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 (MM/DD/YYYY) (MM/DD/YYYY) GENERAL LIABILITY EACH OCCURRENCE 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES 100,000 A (Ea occurrence) ICLAIMS-MADE ©OCCUR X CLP 024987 10/14/2018 10/14/2019 MED EXP(Any one person) 5,000 PERSONAL&ADV INJURY 1,000,000 GENERAL AGGREGATE 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG EXCLUDED POLICY ri PROJECT n LOC COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY (Ea accident) ANY AUTO BODILY INJURY(Per person) —OWNED —SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) —HIRED —NON-OWNED PROPERTY DAMAGE(Per accident) AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE .AGGREGATE DED I I RETENTION WORKERS COMPENSATION 1WC STATUTORY I 'OTHER AND EMPLOYERS'LIABILITY Y/N 'LIMITS ANY PROPRIETOR PARTNER/EXECUTIVE N/A E.L. EACH ACCIDENT OFFICER MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE-EA EMPLOYEE If yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space is required) ROADWAY DUST CONTROL SPRAYING The Certificate Holder is included as an additional insured pursuant to ISO form GL 1115(11/15)a copy of which is attached hereto for informational purposes. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, CITY OF ASHLAND NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE PUBLIC WORKS DEPARTMENT POLICY PROVISIONS. 20 E MAIN ST AUTHORIZED REPRESENTATIVE ASHLAND,OR 97520 ( /" 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD • This page intentionally left blank POLICY NUMBER: CLP 024987 COMMERCIAL GENERAL LIABILITY GL 11 15 11 15 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: CITY OF ASHLAND PUBLIC WORKS DEPARTMENT 20 E MAIN ST ASHLAND, OR 97520 A. Section II — Who Is An Insured is amended to 4. The person or organization are not additional include as an additional insured the additional insureds for liability arising out of their own insured(s) shown in the Schedule, when you and negligence, or the "products completed such person or organization have agreed in writing operations hazard". in a contract or agreement that such person or organization you are contracting with be added as C. With respect to the insurance afforded to the an additional insured on your policy. Such person or additional insureds the following limitations and organization is an additional insured only with exclusions apply: respect to "bodily injury" or "property damage" This insurance does not apply to, and the additional occurring subsequent to execution of the written insureds are not insureds for: contract or agreement, while you are performing your ongoing operations at the person's or 1. "Bodily injury", "property damage" or "personal organization's premises, and caused only by your and advertising injury" arising out of the negligence in the performance of those operations. rendering of, or the failure to render, any The person's or organization's status as an professional architectural, engineering or additional insured ends when your personnel are no surveying services, including: longer present at the premises of the person or organization. a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, B. The insurance provided to the additional insureds is opinions, reports, surveys, field orders, limited as follows: change orders or drawings and specifications; and 1. Any insurance afforded to such additional insureds by this endorsement only applies to the b. Supervisory, inspection, architectural or extent permitted by law; and engineering activities. This limitation and exclusion applies even if the 2. If coverage provided to the additional insured is claims against an insured allege negligence or other required by a contract or written agreement, the wrongdoing in the supervision, hiring, employment, insurance afforded to such additional insured training or monitoring of others by that insured, if will not be broader than that which you are the "occurrence" which caused the "bodily injury" or required by the contract or written agreement to "property damage", or the offense which caused the provide for such additional insured; and "personal and advertising injury", involved the 3. The person or organization is an additional rendering of or the failure to render any professional insured only for vicarious liability resulting from architectural, engineering or surveying services. your negligent acts; and GL 11 15 11 15 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 1 of 2 2. "Bodily injury", "property damage" or "personal and advertising injury" occurring after: a. All work, including materials, parts or equipment furnished in connection with such work, or the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or b. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as part of the same project. D. Coverage afforded to the additional insured is no greater than that provided to you and is subject to all policy terms, conditions, and exclusions, including those applicable to other insurance, to the same extent they are applicable to you. E. The following duties are added to the Duties in Event of Occurrence, Offense, Claim or Suit Condition of this policy: Additional insureds under this endorsement shall tender any claim or "suit" to all available insurance and shall give written notice to us of any "occurrence" which may result in a claim or "suit" under this insurance. F. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the written contract or agreement you have entered into with the additional insured; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. GL 11 15 11 15 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. Page 2 of 2 PROGREll///E` • Policy number: 037830625 Underwritten by: 38-United Financial Casualty Co. • Certificate of Insurance Certificate Holder Insured Agent Additional Insured CITY OF ASHLAND PUBLIC WORKS DEPT. MIKE FALCO PROTECTORS INS LLC 20 EAST MAIN ST. PO BOX 4669 ASHLAND,OR 97520 2744 HOWARD ST MEDFORD OR97501 MEDFORD OR 97501 (541)773-5358 • • This document certifies that insurance policies identified below have been issued by the designated insurer to the insured named above for the period(s)indicated.This certificate is issued for information purposes only. It confers no rights upon the certificate holder and does not change, alter,modify, or extend the coverages afforded by the policies listed below.The coverages afforded by the policies listed below are subject to all the terms,exclusions, limitations,endorsements,and conditions of these policies. Policy Effective Date: Policy Expiration Date: 11/16/2018 05/16/2019 insurance coverane(s) Limits Bodily Injury Property Damage(BIPD)Liability $500,000 COMBINED SINGLE LIMIT Uninsured/Underinsured Motorist Coverage $500,000 COMBINED SINGLE LIMIT • Uninsured/Underinsured Motorist Property Damage $20,000 W/$200 DED Medical Payment Coverage $10,000 r • • Description of Location/Vehicles/Special Items Scheduled autos only 1979 FORD F7000 R70BVEG7282 COMPREHENSIVE$500 DED COLLISION $500 DED 1988 FORD F8F 1 FDXK84A5JVA06810 COMPREHENSIVE$500 DED COLLISION $500 DED 1993 FORD MEDIUM HEAVY F7 1FDNK74P1PVA10304 COMPREHENSIVE$500 DED COLLISION $500 DED Certificate number 10119M2E062 l Please be advised that additional insureds and lienholders will be notified in the event of a mid-term cancellation. Form 5241(10/02) 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) • Contractor is a sole proprietor,and • Contractor has no employees,and • Contractor will not hire employees or subcontractors to perform this contract. ILL Y1- —FOR PROFIT (Initials) a 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 a partnership,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 purtenances thereto.** (Signature of Authorized Si ( gner} ((Date) G Wi 'l. y- (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 Iiability 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. • • Kariann Olson From: • Sheryl Wirts<SherylW @protectorsins.com> Sent: Wednesday, April 17, 2019 1:34 PM To: roguevalleydustcontrol @gmail.com; Tami Campos; Kariann Olson Subject: RE: Received original copies of Rogue Valley Dust Control Attachments: City of Ashland GL Certificate.pdf; Auto certificate.pdf Hi Mike, Tami and Kari I sent both the Auto &the General Liability Certificates on 04/11/18 as two separate attachments to Mike & Tami. Here they are again. We don't have any Workers Cornp as Mike has no employees. Thanks, Sheryl Sheryl Wirts, CISR Customer Service Representative • 514 Crater Lake Avenue P.O. Box 4669 Medford, OR 97501 Phone (541)773-5358 Fax (541)772-1906 shervlweorotectorsins.com/www.protectorsins.com Protectors Insurance LLC "Coverage is not bound, altered or amended until confirmation is provided to you in writing." Confidentiality Notice:This communication including any attachments may contain privileged or confidential information.If you are not the intended recipient,or believe that you received this communication in error,please advise the sender immediately and delete or destroy the communication you received without copying or disclosing the contents. - • From: roguevalleydustcontrol @gmail.com [mailto:roguevalleydustcontrol©gmail.com] Sent: Wednesday, April 17, 2019 12:36 PM To: Sheryl Wirts Subject: Fwd: Received original copies of Rogue Valley Dust Control What do we need to do with the auto? Mike Begin forwarded message: From: Kaylea Kathol<kaylea.kathol @ashland.or.us> Date:April 17,2019 at 12:02:28 PM PDT To: Michael Falco<roguevalleydustcontrol @gmail.com> Cc:Tami Campos<tami.campos @ashland.or.us> Subject: FW: Received original copies of Rogue Valley Dust Control Hi Mike, 1 Thanks for sending the general liability insurance certificate to the City. We are still missing the auto insurance certificate (with City named as additional insured) and worker's comp (if applicable). Please feel free to call or email if you have any questions. Thanks! Kaylea Kathol, Project Manager City of Ashland -Public Works/Engineering 51 Winburn Way,Ashland OR 97520 C: (541) 3314144 I 0: (541) 552-2419 , , NOTICE: This email transmission is official business of the City of Ashland, and is subject to the Oregon Public Records Law for disclosure and retention. If you have received this message in error, please contact me at 541-552-2419. Thank you. On Apr 17, 2019 at 9:26 AM,<Kariann Olson>wrote: Received original copy in inter-office mail today 04/17/2019. Only General Liability is attached. Still missing Auto and Workers'Comp • Will scan/post on PO spreadsheet. Thank you. Kariann Olson Purchasing Representative City of Ashland 90 N. Mountain Ave. Ashland, Oregon 97520 . Tel 541-488-5354 Fax 541-488-5320 TTY 800-735-2900 kari.olson(dashland_or.us Visit the City's web site at: www.ashland.or.us' This email transmission is official business of the City of Ashland,and it is subject to Oregon Public Records law for disclosure and retention. If you have received this message in error, please contact me at(541)488-5354.Thank you. • 2 • Kariann Olson From: Tami Campos Sent: Friday, April 19, 2019 7:55 AM To: Kariann Olson Cc: Kaylea Kathol Subject: Fwd: FW: Received original copies of Rogue Valley Dust Control Attachments: Ashland WC Cert 2019.pdf This goes with the rest of the contract paperwork.Thanks Kari, happy Friday! Begin forwarded message: From: Michael Falco<roguevalleydustcontrol @gmail.com> Date:Apr 19, 2019 at 7:38 AM To:Tami Campos<tami.campos @ashland.or.us> Subject: Re: FW: Received original copies of Rogue Valley Dust Control Good morning, Please see the attached signed form you requested. Have a great day! On Thu,Apr 18, 2019 at 9:42 AM Tami Campos<tami.campos@ashland.or.us>wrote: Good morning Mike, Could you please complete the attached workers compensation exemption form? Thank you! raww De/M 61,1e/-Cawpos, Administrative Analyst City of Ashland, Public Works Department 20 East Main Street,Ashland,OR 97520 541-552-2420 Fax:541-488-6006,TTY: 1-800-735-2900 1 itiLike Public Works on Facebook for updates and information! Like Ashland Water Conservation on Facebook for updates and information! This email transmission is official business of the City of Ashland, and it is subject to Oregon Public Records law for disclosure and retention. If you have received this message in error,please contact me at 541-552-2420. Thank you. From:Sheryl Wins<SherylW @protectorsins.com> Sent:Wednesday,April 17, 2019 1:34 PM To: roguevallevdustcontrol @gmail.com;Tami Campos<tami.campos @ashland.or.us>; Kariann Olson <kari.olson @ashland.or.us> Subject: RE: Received original copies of Rogue Valley Dust Control Hi Mike,Tami and Kari I sent both the Auto &the General Liability Certificates on 04/11/18 as two separate attachments to Mike & Tami. Here they are again. We don't have any Workers Comp as Mike has no employees. Thanks, Sheryl Sheryl Wirts, CISR Customer Service Representative 514 Crater Lake Avenue P.O. Box 4669 Medford, OR 97501 Phone (541)773-5358 I Fax (541)772-1906 shervlwOorotectorsins.com/www.orotectorsins.com 2 • Protectors Insurance LLC "Coverage is not bound, altered or amended until confirmation is provided to you in writing." Confidentiality Notice:This communication including any attachments may contain privileged or confidential information.If you are not the intended recipient,or believe that you received this communication in error,please advise the sender immediately and delete or destroy the communication you received without copying or disclosing the contents. From: roguevalleydustcontrol @gmail.com [mailto:roguevalleydustcontrol@ gmail.com] Sent: Wednesday, April 17, 2019 12:36 PM To: Sheryl Wirts Subject: Fwd: Received original copies of Rogue Valley Dust Control What do we need to do with the auto? Mike Begin forwarded message: From: Kaylea Kathol<kaylea.kathol @ashland.or.us> Date:April 17, 2019 at 12:02:28 PM PDT To: Michael Falco<roguevallevdustcontrol @gmail.com> Cc:Tami Campos<tami.camr os @ashland.or.us> Subject: FW: Received original copies of Rogue Valley Dust Control Hi Mike, Thanks for sending the general liability insurance certificate to the City. We are still missing the auto insurance certificate (with City named as additional insured) and worker's comp (if applicable). Please feel free to call or email if you have any questions. Thanks! 3 Kaylea Kathol, Project Manager City of Ashland - Public Works/Engineering 51 Winburn Way, Ashland OR 97520 C: (541) 331-1144 I 0: (541) 552-2419 I! NOTICE:This email transmission is official business of the City of Ashland, and is subject to the Oregon Public Records Law for disclosure and retention. If you have received this message in error, please contact me at 541-552-2419. Thank you. £}F± On Apr 17, 2019 at 9:26 AM, <Kariann Olson>wrote: Received original copy in inter-office mail today 04/17/2019. Only General Liability is attached. Still missing Auto and Workers'Comp. Will scan/post on PO spreadsheet. Thank you. Kariann Olson Purchasing Representative City of Ashland 90 N. Mountain Ave. Ashland, Oregon 97520 Tel 541-488-5354 4 Fax 541-488-5320 TTY 800-735-2900 kari.olson(alashland.or.us Visit the City's web site at: www.ashland.or.us This email transmission is official business of the City of Ashland, and it is subject to Oregon Public Records law for disclosure and retention. If you have received this message in error, please contact me at(541)488-5354.Thank you. -- Mike Falco 541-613-0067 Rose Hillburn 541-531-8383 ROGUE VALLEY DUST CONT OL 5 Kariann Olson From: Kariann Olson Sent: Friday, April 12, 2019 3:11 PM To: Kaylea Kathol j Cc: Tami Camp. , •ann Olson Subject: RE: Emailing: RVDus ontrol requisition packet 3.25.19.pdf ssing insurance certificates for this contract. l 7 IP/ank you. j Z Kariann Olson 6. Purchasing Representative //AA C City of Ashland 90 N. Mountain Ave. p4 / Ashland, Oregon 97520 / n , � Tel 541-488-5354 (�/" Fax 541-488-5320 TTY 800-735-2900 kari.olson @ashland.or.us Visit the City's web site at: www.ashland.or.us This email transmission is official business of the City of Ashland, and it is subject to Oregon Public Records law for disclosure and retention. If you have received this message in error, please contact me at(541)488-5354.Thank you. Original Message From: Kaylea Kathol Sent: Monday,April 08, 2019 8:12 AM To: Kariann Olson<kari.olson @ashland.or.us> Cc:Tami Campos<tami.campos @ashland.or.us> Subject: FW: Emailing: RVDust Control requisition packet 3.25.19.pdf Hi Kari, Do you know if the attached contract/requisition has come across your desk? Thanks! Kaylea Original Message From:Taina Glick Sent: Monday, March 25, 2019 2:13 PM To:Tami Campos<tami.campos @ashland.or.us> Cc: Kaylea Kathol<kaylea.kathol @ashland.or.us> Subject: Emailing: RVDust Control requisition packet 3.25.19.pdf Just a status update... The signed requisition and services agreement was sent to Kari this afternoon. See attached. Taina Glick Administrative Assistant City of Ashland, Public Works Department 51 Winburn Way 1 V FrAi Purchase Order ,� �°- -� Fiscal Year 2019 Page: 1 of: 1 B City of Ashland I ATTN: Accounts Payable Purchase L 20 E. Main Order# 20190434 Ashland, OR 97520 T Phone: 541/552-2010 0 Email: payable @ashland.or.us V H C/O Public Works Department E ROGUE VALLEY DUST CONTROL I 51 Winburn Way N 2744 HOWARD AVENUE p Ashland, OR 97520 MEDFORD, OR 97501 Phone: 541/488-5347 O T Fax: 541/488-6006 R O Paula Brown Brown ai —41=-61. de-l-ere=slap=trQR '•;_. - I 04/09/2019 4504 FOB ASHLAND OR/NET30 City Accounts Payable Dust Control Ashland Airport 1 Dust control treatment at the Ashland Municipal Airport 1 $1,056.0000 $1,056.00 Services Agreement Completion date: 09/01/2019 Project Account: GL SUMMARY 085700-704100 $1,056.00 By: Date: LI t 1 Aut oriized Signature I =—= $1,056.00 i ,27�� — 7 FORM #3 b7 ,21,, 'A— l� E.. CITY OF 7 � k e kiNSHLAND A request for a Purchase Order I t L4.c . ' e,- REQUISITION Date of request: - --03/13/2019- Vendor Name - Rogue Valley Dust Control Address,City,State,Zip - 2744 Howard Ave.Medford,OR 97501 Contact Name Mike Falco Telephone Number 541-631-0067 Email address C -6 . 4/14--(--- SOURCING METHOD d� ` n 2 ❑ Exempt from Competitive Bidding /� 3 ��' ` ❑ Invitation to Si Bid ❑ Reason for exemption: Date approved by Council: £ cicj 1�, r ❑ AMC 2.50 _(Attach copy of council communication) E \ j �j VA ❑ Written quote or proposal attached - ' /` `# ✓-' ❑ Small Procurement ❑ Request for Proposal C A r .7 , Not exceeding$5,000 Date approved b Council: ❑ Direct Award (Attach copy of council communication) `or / ❑ Verba1Written quote(s)or proposals) D Request for Qualifications(Public Works) C \ 1� Intermediate Procurement Date approved by Council: ` GOODS&SERVICES (Attach copy of council communication) C�I ` j 4;1-1`" Greater than$5,000 and less than$100,000 ❑ Sole Source \(�\ ../// 1///`�/ ❑ (3)Written quotes and solicitation attached ❑Applicable Form(#5,6,7 or 8) a 1/ PERSONAL SERVICES • ❑Written quote or proposal attached Form In1 /////`� Greater than$5,000 and less than$75,000 ❑ Form#4, Personal Services 45K&<$75K Agi L ❑Direct appointment not to exceed$35,000 ❑ ❑ Special Procurement roved by Legal and approved/signed ❑(3)Written proposals/written solicitation ❑ Form#9,Request for Approval Agreement approved y b ❑Form#4,Personal Services>$5K&<$75K ❑ Written quote or proposal attached City Administrator.AMC 2.50.070(4) Date approved by Council: ❑Annual cost to City exceeds$25,000,Council Valid until: (Date) approval required.(Attach copy of council communication) Description of SERVICES Total Cost Dust control treatment at the Ashland Municipal Airport $,1,0,56.09 ' - - -- item# - Quantity ' • Unit---- - -- -Description of-MATERIALS- --Unit Price - Total Cost-- - - Per attached quotelproposal , TUTAL-:EOS—t- -.E x p e n d i t u r e must.be-chargedto the.appropdate a c c o u n t n u m b e r s.f o r.!h e i n a n r i a l s tole fleet.the actual expendifures accurately. _ _. --_--- Project Number - - - - _ _ Account Number 085700 - 704100 $ 1,056:00 .Project Number _ _ _ Account Number - $ , ,— _ _• Projectl'umber -_ _ _ Account Number - IT Director in collaboration with department to approve all hardware and software purchases: By signing this requisition form,I cedifythat the City's public contracting requirements have been satisfied. IT Director Date Support-Yes/No Employee: 0illT, R'VI).(` -. r ii 11, Department Head: /14 1-5-1t44ttzof1 (Equal to or greater than$5,000) Department Manager/Supervisor: City Administrator: (Equal to or greater than$25,000) Funds appropriated for current fiscal year YES / NO Finance Director-(Equal to or greater than$5,000) Date Comments: Form#3-Requisition