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HomeMy WebLinkAbout2019-241 20200130 Star Collision Centers Inc. . GOODS & SERVICES AGREEMENT PROVIDER: Star 24-Hour Towing CITY OF PROVIDER'S Deanna Lopez ASHLAND CONTACT: 20 East Main Street Ashland, Oregon 97520 ADDRESS: 1024 Summit Avenue Telephone: 541/488-5587 Medford, OR 97501 Fax: 541/488-6006 PHONE: 541-772-3908 This Goods and Services Agreement (hereinafter "Agreement") is entered into by and between the City of Ashland, an Oregon municipal corporation (hereinafter "City") and Star 24-Hour Towing, a domestic business corporation ("hereinafter "Provider"), for fleet services. 1. PROVIDER'S OBLIGATIONS 1.1 Provide fleet services for FY20 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 goods and 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 • Be evidenced by a certificate or certificates of such insurance approved by the City. Pagc 1 of 5: Agreement between the City of Ashland and Star 24-Hour Towing 1.3 All subject employers working under this Agreement are either employers that will comply with ORS 656.017 or employers that are exempt under ORS 656.126. 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 performance 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.1 10. 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. 2. CITY'S OBLIGATIONS 2.1 City shall pay Provider the sum of $4,500 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 $4,500 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. 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 27913.220, 27913.230 and 27913.235. Page 2 of 5: Agreement between the City of Ashland and Star 24-Hour Towing 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 or 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 Rate Sheet effective July 2019. 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. 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 June 30, 2020, unless sooner terminated as provided in Subsection 6.2. Page 3 of 5: Agreement between the City of Ashland and Star 24-Hour Towing I~ 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 Attn: Wes Hoadley 90 North Mountain Avenue Ashland, Oregon 97520 Phone: (541) 552-2355 With a copy to: City of Ashland - Legal Department 20 E. Main Street Ashland, OR 97520 Phone: (541) 488-5350 If to Provider: Star 24-Hour Towing Attn: Deanna Lopez 1024 Summit Avenue Medford, OR 97501 541-772-3908 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 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. Page 4 of 5: Agreement between the City of Ashland and Star 24-Hour Towing 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: Star 24-Hour owing (P VIDER): By: L1~ By: Signature Sign ur ~yKla G ij~2.~r~✓•J Printed Name Printed Name ?R, Title Title g4.441G 7v / 9 Date Date (W-9 is to be submitted with this signed Agreement) Purchase Order No. Page 5 of 5: Agreement between the City of Ashland and Star 24-Hour Towing 24 F H Towing Service GOLO 772-3908 CL ASS ® PROFE$$ION~ E%CELLENCETHROUGHTRAINING Complete Body Coll»slo Centers Repair & Painting City of Ashland Contracted Rates Effective July 2019 • Towing Fees Light Duty Hook-up $75.00 Includes 10 free miles, after that each mile is $3.00 Dolly Fee if needed is $25.00 Medium Duty is $125.00 Per Hour Heavy Duty is $200.00 Per Hour Light Duty Equipment Hauling is $85.00 Per Hour Heavy Duty Equipment Hauling is $110.00 Per Hour Recovery Fees Light Duty Winching $95.00 Per Hour Medium Duty Winching $125.00 Per Hour Heavy Duty Winching $200.00 Per Hour Service Calls $60.00 Per Hour Medford Ashland Rogue River 541-779-5621 541-535-9003 541-582-0754 Fax: 541-779-4685 Fax; 541-535-5886 Fax: 541-582-2574 1024 Summit Ave. 1119 S. Pacific Hwy. 210 Gilmore ACORD® DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 08108/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND 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: Randy Walker _ Randy Walker(7371338) PHONE FAX 1339 Commerce Ave Ste 106 (A/C, NO, EXT): 360-200-5287 360-846-1036 E-MAIL Longview WA 98632-3739 ADDRESS: rwalker3@farmersagent.com INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURERA: Truck Insurance Exchange 21709 INSURERB: Farmers Insurance Exchange 21652 STAR COLLISION CENTERS, INC dba INSURER C: Mid Century Insurance Company 21687 Star Body Works, Star 24 hour Towing INSURER D: 1024 Summit Ave INSURER E: MEDFORD OR 97501 I NSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME ABOVE FOR TH E POLICY PERIOD INDICATED- NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WH ICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE I NSU RANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDTL SUBR POLICY EFF POLICY EXP LTR TYPEOFINSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,00 CLAIMS-MADE ❑ OCCUR DAMAGE TO RENTED $ PREMISES (Ea Occurrence) 100,00 MED EXP (Anyone person) $ 15,000 C _ Y Y 606742303 05101/2019 05/01/2020 PERSONAL& ADV INJURY $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 X POLICY ❑ PROJECT ❑ LOC PRODUCTS - COMP/OPAGG $ 4,000,000 OTHER: $ _ AUTOMOBILE LIABILITY COMBINED SINGLELlM1T $ 2,000,000 (Ea accident) BODILY INJURY (Per person) $ ANY AUTO OWNEDAUTOS SCHEDULED I BODILY INJURY (Per accident) $ C ONLY X AUTOS Y 606742303 05/0112019 05101/2020 HIREDAUTOS X NON-OWNED PROPERTY DAMAGE $ ONLY AUTOS ONLY (Peraccident) GAR LIAB GAR AGGREGATE $ 4,000,000 UMBRELLALIAB X OCCUR EACH OCCURRENCE C EXCESS LIAB CLAIMS-MADE Y 604506605 05/01/2019 05/01/2020 AGGREGATE $ 3,000,000 DED RETENTION $ 1$ WORKERS COMPENSATION PER OTHER $ AND EMPLOYERS' LIABILITY STATUTE ANY PROPRIETOR/PARTNER/ Y/N E.L-EACH ACCIDENT $ EXECUTIVE OFFICER/MEMBER N/A E.L. DISEASE - EA EMPLOYEE EXCLUDED? (Mandatory in NH) Ifyes, describe under DESCRIPTION OF E.L. DISEASE -POLICY LIMIT $ OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if morespace is required) Named Insured Continued: Star Collision Center of Ashland Inc dba Star Body Works - Ashland, Star Collision Center of Rogue River, dba Star Body Works - Rogue River Star Collision Center of Grants Pass LLC, dba Star Body Works - Grants Pass Garage Keepers Limit - Continued on Accord 101 CERTIFICATE HOLDER CANCELLATION e Ityo s an regon, itso cers, agents SHOULDANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION and employees DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 20 East Main Street AUTHORIZED REPRESENTATIVE Ashland C n 97 ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All Rights Reserved 31-1769 11-15 The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC III: AC R ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NMIED INSURED K R CONSULTANTS LLC Star Collision Centers, Inc POLICY NUMBER DBA Star Body Works, Star 24 Hour Towing 606742303 1024 Summit Ave CARRIER NAIC CODE Medford OR 97501 Mid Century Insurance Company EFm--,E DATE: 51112019 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Garage Keepers Coverage lJmtis by Location 210 GILMORE ST, ROGUE RIVER, OR 97537 - Garage Keepers Coverage $50,000 930 SUMMIT AVE, MEDFORD, OR 97501 - Garage Keepers Coverage $20,000 1024 SUMMIT AVE, MEDFORD, OR 97501 - Garage Keepers Coverage $200,000 609 W MCANDREWS RD, MEDFORD, OR 97501 - Garage Keepers Coverage $50,000 1355 SAGE RD, MEDFORD, OR 97501 Garage Keepers Coverage $200,000 210 GILMORE ST, ROGUE RIVER, OR 97537 - Garage Keepers Coverage $15,000 1119 S PACIFIC HWY, TALENT, OR 97540 - Garage Keepers Coverage $500,000 715 UNION AVENUE, GRANTS PASS, OR 97527 - Garage Keeper; Coverage $1,000,000 200 GILMORE ST, ROGUE RIVER, OR 97537 - Garage Keepers Coverage $15,000 1111 OAK ST, MEDFORD, OR 97501- Garage Keepers Coverage $200,000 SW N CENTRAL, MEDFORD, OR 97501 - Garage Keepers Coverage $800,000 610 N CENTRAL AVE, MEDFORD, OR 97501- Garage Keepers Coverage $200,000 620 N CENTRAL AVE, MEDFORD, OR 97501-Garage Keepers Coverage $200,000 600 W MCANDREWS ROAD, MEDFORD, OR 97501 - Garage Keepers Coverage $200,000 ON HOOK COVERAGE IS AS FOLLOWS: $250,000 - $1000 deductible 2017 FORD F650 1 FDNXGDC9HDB08948 2006 PETERBILT 335 2NPLHDBX76M631124 2007 FORD FSSO 1FOAF561277EA90311 2008 GMC 5900 1 GDE5E1 OW402543 19W INTERNATIONAL 43001HTSCAAMSWN52"a 2000 FREIGHTLINER FLAG 1 FV3GFBCeYHG191e9 2011 FORD F650 3FRWFOFCOBV552689 2005 INTERNATIONAL 4300 IHTMMAAl-SM121932 2005 INTERNATIONAL 4300 1HTMMAALISH121930 1984 PETERBILT 3591XP9D29X4EP16W" 2017 FORD F550 1FD0X5HT9HEF01930 1999 FORD F450 1 FDXF47S5XEB67479 2008 FORD F550 1FOAFSSRBBE831001 2007 FORD F550 1FDAF571317EB19996 2012 KENWORTH T3001XK0049XOCR302244 2012 PETERBILT 3671XPTD4=CD140S70 1997 4V TRAILER TRAILEZE 1 DA72T974VP013245 5500,000 - $1,000 deductible 2001 PETERBILT 3791XPSDB9XX1N551206 2012 PETERBILT 3671XPTD40)C=161622 2013 Wa1WORTH T800INKDX4EXIDJ316024 30 Days Notice of Cancellation applies to the Commercial General Liability coverage part ACORD 101 (2008/01) ® 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD say Fcorpora t I OI I Information Page Carrier No: 20001 Policy No: 480082 Employer Identification No: 93-1027262 NCCI Risk ID No: 360212971 Item 1. The Insured: Entity Type: STAR COLLISION CENTERS INC CORPORATION Mailing address: Agency: STAR COLLISION CENTERS INC CINDI JAYUBO PO BOX 8300 PROPEL INSURANCE MEDFORD, OR 97501-0600 PO BOX 936 MEDFORD, OR 97501 Other workplaces not shown above: 1024 SUMMIT AVE, MEDFORD, OR 97501-2364 600 N CENTRAL AVE, MEDFORD, OR 97501 STAR 24 HOUR TOWING STAR BODY WORKS Item 2. The policy period is from 01-01-2019, 12:01 A.M. to 01-01-2020, 12:01 A.M. at the insured's mailing address Item 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: OREGON B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident $1,000,000 each accident Bodily Injury by Disease $1,000,000 each employee Bodily Injury by Disease $1,000,000 policy limit C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: NONE D. This policy includes these endorsements and schedules: WC360601 E Oregon Cancellation Endorsement W0000421 D Catastrophe (other than Certified Acts of Terrorism) Premium End W0000422B Terrorism Risk Insurance Prog Reauthorization Act Disclosure End W0000414 Notification of Change in Ownership Endorsement W0000406A Premium Discount Endorsement WC360406 Premium Due Date Endorsement WC990602 Subject Officer Payroll Requirement - Corporation W0000424 Audit Noncompliance Charge Endorsement WC360304 Oregon Amendatory Endorsement WC990616 Confidentiality Endorsement Item 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. The experience rating modification factor and other rating plan factors, if any, may change on your rating effective date of 01-01-2020. All information required below is subject to verification and change by audit. sai Fcorpora t i on Information Page Carrier No: 20001 Policy No: 480082 Employer Identification No: 93-1027262 NCCI Risk ID No: 360212971 Item 1. The Insured: Entity Type: STAR COLLISION CENTERS INC CORPORATION Mailing address: Agency: STAR COLLISION CENTERS INC CINDI JAYUBO PO BOX 8300 PROPEL INSURANCE MEDFORD, OR 97501-0600 PO BOX 936 MEDFORD, OR 97501 Other workplaces not shown above: 1024 SUMMIT AVE, MEDFORD, OR 97501-2364 600 N CENTRAL AVE, MEDFORD, OR 97501 STAR 24 HOUR TOWING STAR BODY WORKS Item 2. The policy period is from 01-01-2019, 12:01 A.M. to 01-01-2020, 12:01 A.M. at the insured's mailing address Item 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: OREGON B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident $1,000,000 each accident Bodily Injury by Disease $1,000,000 each employee Bodily Injury by Disease $1,000,000 policy limit C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: NONE D. This policy includes these endorsements and schedules: WC360601E Oregon Cancellation Endorsement W0000421D Catastrophe (other than Certified Acts of Terrorism) Premium End W0000422B Terrorism Risk Insurance Prog Reauthorization Act Disclosure End W0000414 Notification of Change in Ownership Endorsement W0000406A Premium Discount Endorsement WC360406 Premium Due Date Endorsement WC990602 Subject Officer Payroll Requirement - Corporation W0000424 Audit Noncompliance Charge Endorsement WC360304 Oregon Amendatory Endorsement WC990616 Confidentiality Endorsement Item 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. The experience rating modification factor and other rating plan factors, if any, may change on your rating effective date of 01-01-2020. All information required below is subject to verification and change by audit. Purchase Order ,`E e✓.° ►v':' Fiscal Year 2020 Paae: 1 of 1 j 11-IIS E'J ~V?Ji41~3E.r~iv1U5TAf'P~h C?~v ~'tLL I woi( ES m D SHIPPING DOCUMENTS. B City of Ashland ATTN: Accounts Payable 20 E. Main Purchase 20200130 Ashland, OR 97520 Order # T Phone: 541/552-2010 O Email. payable@ashland.or.us V H C/O Fleet/Shop Division E STAR COLLISION CENTERS INC 1 90 North Mountain Ave N PO BOX 8300 P Ashland, OR 97520 D MEDFORD, OR 97501 Phone: 541/488-5358 O T Fax: 541/552-2304 R O 541 772-3908 5sH dle 09/ 05/2019 212 FOB ASHLAND OR Accounts PTowing Services 1 On-call towing services for FY 20 1 $4,500.0000 $4,500.00 Goods & Services Agreement Completion date: 06/30/2020 Project Account: GL SUMMARY 086500 - 602223 $4,500.00 By: Date: 5 '1 Authorized Signature $4,500.00] 4.f ~-max FORM#3 CITY OF ASHLAND REQUISITION - Date of request: 8/22/2019 Required date for delivery: Vendor Name Star 24-Hour Towing Address, City, State, Zip 1024 Summit Avenue Medford OR 97501 Contact Name & Telephone Number Deanna Lopez 541-772-3908 Email address SOURCING METHOD ❑ Exempt from Competitive Bidding ❑ Emergency ❑ Reason for exemption: ❑ Invitation to Bid ❑ Form #13, Written findings and Authorization ❑ AMC 2,50 Date approved by Council: ❑ Written quote or proposal attached ❑ Written quote or proposal attached Attach co of council communication _(If council approval required, attach co of CC ® Small Procurement ❑ Request for Proposal Cooperative Procurement Not exceeding $5,000 Date approved by Council: ❑ State of Oregon ® Direct Award -(Attach copy of council communication) Contract # ❑ Verbal/Written quote(s) or proposal(s) ❑ Request for Qualifications (Public Works) ❑ State of Washington 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 ❑ Form #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 #9, 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: Date approval required. (Attach copy of council communication) Description of SERVICES Total Cost FFY2OTowing services as needed $ 4,500.00 Item # Quantity Unit Description of MATERIALS Unit Price Total Cost ❑ Per attached quotelproposal TOTAL COST Project Number _ _ _ _ _ _ • _ _ _ Account Number 086500-602223 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 req 'sition f rm, I cert' I hat the City's public contracting requirements have been satisfied. 1~11 M ?=9 Employee: Department Head: (Equal to or grea er than $5,000) Department ManagerlSupervis r: City Administrator: (Equal to or greater than $25,000) Funds appropriated for current fiscal year YES / NO Deputy Finance Director- (Equal to or greater than $5,000) Date Comments: Form #3 - Requisition