HomeMy WebLinkAbout2019-259 20200208 Andy Dwyer
PERSONAL SERVICES AGREEMENT ($25,000.00 or less)
CONSULTANT: ANDY DWYER
C I T Y OF ADDRESS: 1361 QUINCY STREET
ASHLAND ASHLAND, OREGON 97520
20 East Main Street
Ashland, Oregon 97520 TELEPHONE: (971) 713-1323
Telephone: 541/552-2218
Fax: 541/552-5318 EMAIL: dwyera@sou.edu
This Personal Services Agreement (hereinafter "Agreement") is entered into by and between the City of
Ashland, an Oregon municipal corporation (hereinafter "City") and Andy Dwyer, an individual/sole proprietor
("hereinafter "Consultant"), for education consultation services related to a fire education curriculum.
NOW THEREFORE, in consideration of the mutual covenants contained herein, the City and
Consultant hereby agree as follows:
1. Effective Date and Duration: This Agreement shall become effective on the date of execution on
behalf of the City, as set forth below (the "Effective Date"), and unless sooner terminated as specifically
provided herein, shall terminate upon the City's affirmative acceptance of Consultant's Work as
complete and Consultant's acceptance of the City's final payment therefore, but not later than January
31, 2020.
2. Scope of Work: Consultant shall provide fire education consultation services to evaluate existing fire
and wildlife ecology curricula, make recommendations on such curricula, and compile resources to
create a fire education database as more fully set forth in the Consultant's Proposal entitled "Proposed
Fire Curriculum Database for Ashland Forest Resiliency" dated September 25, 2019, which is attached
hereto as "Exhibit A" and incorporated herein by this reference. Consultant'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 Consultant: Consultant shall, at its own risk, 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: Consultant has represented, and by entering into this Agreement now represents, that
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 5: Personal Services Agreement with Andy Dwyer.
6. Compensation: City shall pay Consultant the sum of $3,000 (three thousand dollars) as full
compensation for Consultant's performance of all Work under this Agreement. In no event shall
Consultant's total of all compensation and reimbursement under this Agreement exceed the sum of
$3,000 (three thousand dollars) 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 Consultant'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. Ownership of Work/Documents: All Work, work product, or other documents produced in
furtherance of this Agreement belong to the City, and any copyright, patent, trademark proprietary or
any other protected intellectual property right shall vest in and is hereby assigned to the City.
8. Statutory Requirements: The following laws of the State of Oregon are hereby incorporated by
reference into this Agreement: ORS 27913.220, 279B.230 and 27913.235.
9. Living Wage Requirements: If the amount of this Agreement is $21,127.46 or more, Consultant 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 B" predominantly in areas where it will be seen
by all employees.
10. Indemnification: Consultant hereby agrees to defend, indemnify, save, and hold City, its officers,
employees, and agents harmless from any and all losses, claims, actions, costs, expenses, judgments, 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 Consultant (including but not limited to, Consultant's employees,
agents, and others designated by Consultant to perform Work or services attendant to this Agreement).
However, Consultant shall not be held responsible for any losses, expenses, claims, subrogations,
actions, costs, judgments, or other damages, caused solely by the negligence of City.
11. 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 Consultant, or at such later date as may be established by City under
any of the following conditions:
i. If City funding from federal, state, county or other sources is not obtained and continued at
levels sufficient to allow for the purchase of the indicated quantity of services;
ii. If federal or state regulations or guidelines are modified, changed, or interpreted in such a
way that the services are no longer allowable or appropriate for purchase under this
Agreement or are no longer eligible for the funding proposed for payments authorized by this
Agreement; or
Page 2 of 5: Personal Services Agreement with Andy Dwyer.
iii. If any license or certificate required by law or regulation to be held by Consultant 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 Consultant 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 parry
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 party giving the notice may 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 Consultant's performance of each and every obligation and duty
under this Agreement. City, by written notice to Consultant of default or breach, may at any
time terminate the whole or any part of this Agreement if Consultant fails to provide the
Work 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.
12. Independent Contractor Status: Consultant is an independent contractor and not an employee of the
City for any purpose.
13. Assignment: Consultant 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.
14. Default. The Consultant shall be in default of this Agreement if Consultant: commits any material
breach or default of any covenant, warranty, certification, or obligation 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.
15. Insurance. Consultant shall, at its own expense, maintain the following insurance:
a. Workers' Compensation. Consultant shall obtain and maintain Workers' Compensation insurance in
compliance with ORS 656.017, which requires subject employers to provide Oregon Workers'
Compensation coverage for its subject workers, unless such employers are exempt under ORS
656.126. If exempt under ORS 656.126, Consultant shall certify such exemption to the City.
b. Professional Liability insurance with a combined single limit, or the equivalent, of not less than
$2,000,000 (two million dollars) per occurrence. This is to cover any damages caused by error,
omission or negligent acts related to the Work to be provided under this Agreement. This insurance
requirement is being waived by City for this Agreement. O v to Ili
c. 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, Death, and Property Damage.
This insurance requirement is being waived by City for this Agreement. L.~,'14
Page 3 of 5: Personal Services Agreement with Andy Dwyer.
d. Automobile Liability insurance with a combined single limit, or the equivalent, of not less than
$500,000 (five hundred thousand dollars) for each accident for Bodily Injury and Property Damage,
including coverage for owned, hired or non-owned vehicles, as applicable. This reduced coverage is
approved by City for this Agreement.
e. Notice of cancellation or change. There shall be no cancellation, material change, reduction of limits
or intent not to renew the insurance coverage(s) without thirty (30) days' prior written notice from
the Consultant or its insurer(s) to the City.
f. Additional Insured/Certificates of Insurance. Consultant shall name the City of Ashland, Oregon,
and its elected officials, officers and employees as Additional Insureds on any insurance policies,
excluding Professional Liability and Workers' Compensation, required herein, but only with
respect to Consultant's services to be provided under this Agreement. The consultant's insurance is
primary and non-contributory. As evidence of the insurance coverages required by this Agreement,
the Consultant shall furnish acceptable insurance certificates and endorsements prior to commencing
the Work under this Agreement.
16. Nondiscrimination: Consultant 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 Consultant. Consultant agrees to
comply with all applicable requirements of federal and state civil rights and rehabilitation statutes, rules
and regulations. Further, Consultant 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.
17. Consultant's Compliance With Tax Laws:
17.1 Consultant represents and warrants to the City that:
17. 1.1 Consultant 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 Consultant; and
(iii) Any rules, regulations, charter provisions, or ordinances that implement or enforce any
of the foregoing tax laws or provisions.
17.1.2 Consultant, 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 Consultant; 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: Personal Services Agreement with Andy Dwyer.
18. Governing Law; Jurisdiction: This Agreement shall be governed and construed in accordance
with 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.
19. Amendments. This Agreement may be amended only by written instrument executed by both parties
with the same formalities as this Agreement.
20. THIS AGREEMENT AND THE ATTACHED EXHIBITS CONSTITUTE THE ENTIRE
UNDERSTANDING BETWEEN THE PARTIES. THERE ARE NO UNDERSTANDINGS,
AGREEMENTS OR REPRESENTATIONS, EITHER ORAL OR WRITTEN, NOT SPECIFIED
HEREIN REGARDING THIS AGREEMENT. CONSULTANT, 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.
21. Certification. Consultant shall execute the certification attached hereto as "Exhibit C" and incorporated
herein by this reference.
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: ANDY DWYER (CONSULTANT):
By: By: A~J ' 'U
Signature Signature
t r i-r A • 11*tuo r r~ r,t 1-, D r
AA Printed Name d~ Printed Name
tTT Title Title
Date Dat
(W-9 is to be submitted with this signed Agreement)
Purchase Order No.
Page 5 of 5: Personal Services Agreement with Andy Dwyer.
i
EXHIBIT B
CITY OF ASHLAND, OREGON
City of Ashland
LIVING
ALL employers • • WAGE
below comply of Ashland laws regulating
payment of a living wage.
per hour, effective June 30, 2019.
The Living Wage is adjusted annually every
W June 30 by the Consumer Price Index.
. , portion of business of their 401 K and IRS eligible
employer, if the employer has cafeteria plans (including
ten or more employees, and childcare) benefits to the
has received financial amount of wages received by
assistance for the project or the employee.
For all hours worked under a business from the City of
service contract between their Ashland in excess of ➢ Note: For temporary and
employer and the City of $21,507.75. part-time employees, the
Ashland if the contract Living Wage does not apply
exceeds $21,507.75 or more. y If their employer is the City of to the first 1040 hours worked
Ashland, including the Parks in any calendar year. For
For all hours worked in a and Recreation Department. more details, please see
month if the employee spends Ashland Municipal Code
50% or more of the ➢ In calculating the living wage, Section 3.12.020.
employee's time in that month employers may add the value
working on a project or of health care, retirement,
additional For Call the Ashland City Administrator's office at 541-488-6002 or write to the City Administrator,
City Hall, 20 East Main Street, Ashland, OR 97520, or visit the City's website at www.ashland.or.us.
(Notice to Employers: This notice must be posted predominantly in areas where it can be
seen by all employees.
CITY OF
-ASH LAN D
Page I of I EXHIBIT B
EXHIBIT C
CERTIFICATIONS/REPRESENTATIONS: Consultant, 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) Consultant
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. Consultant further represents and warrants
to City that: (a) it has the power and authority to enter into this Agreement and perform the
Work, (b) the Agreement, when executed and delivered, shall be a valid and binding obligation
of Consultant enforceable in accordance with its terms, (c) the work under the Agreement shall
be performed in accordance with the highest professional standards, and (d) Consultant is
qualified, professionally competent, and duly licensed (if applicable) to perform the Work.
Consultant 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 Consultant has checked four or more of the following
criteria that apply to its business.
(1) Consultant 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.
4 (2) Commercial advertising or business cards or a trade association membership are
purchased for the business.
(3) Telephone listing is used for the business separate from the personal residence
A listing.
(4) Labor or services are performed only pursuant to written contracts.
~y- (5) Labor or services are performed for two or more different persons within a period
of one year.
(6) Consultant assumes financial responsibility for defective workmanship or for
service not provided as evidenced by the ownership of performance bonds,
warranties, errors and omission (professional liability) insurance or liability insurance
relating to the Work or services to be provided.
Consultant's signature
s
~p 1
Date
Page I of I EXHIBIT C
Proposed Fire Curriculum Database for Ashland Forest Resiliency
SOU Graduate Intern: Andy Dwyer
Academic Advisor: Arielle Halpern
Organization: Ashland Forest Resiliency Project
Term: TBD, Possibly Fall
Objectives:
The purpose of this project is to survey existing curriculum that relates to fire education. The
objective is to create a database that hosts applicable fire lessons that aim to educate on
wildfire ecology and fire use as a valuable tool for forest restoration. Regional and Nation-wide
curriculum will be surveyed in order to attain the most appropriate material that can be used
outside and inside the classroom - to have readily available lessons manageable on a four-
season schedule. Material within the finalized database will be modeled to fit southwestern
Oregons dry forest and the surrounding ecoregion. The idea is to see what fire curriculum is
available, so that we can have access to modern fire education lesson planning that local and
regional educators can draw from and spread fire restoration awareness.
Phase One Deliverables:
1. A list of specific, regionally appropriate fire curriculum.
2. Evaluation of current curriculum that matches AFR philosophy, common core, and
NGSS state standards.
3. Curriculum and resources organized into a google document.
Goals & Schedule:
• My goal for career-related experience as an SOU EE graduate student for this project is
to refine coordination skills, act as a project lead for AFR, and gain experience
evaluating curriculum from regional and national organizations to bring ecologically
wise material in a collection for educator use.
• Work with ScienceWorks to collaborate on fire and forest lesson planning.
• Reach out to USFS FireWorks education program leaders on a possible workshop event
where their trainers train Rogue Valley organizations on creative fire lessons.
• Strategies to include internet research, calling to speak with education coordinator's at
desired organizations, Collaborating with AFR, SOU, and Outdoor School extension on
high quality material, organizing community events, budgeting for training workshops,
bringing educators in the field to run fire education lessons, and serve as the point-
person for distribution of regionally innovative curriculum.
• Time allocation: The full 2 credits (30 hours per credit), 60 hours total will be allocated
towards this project. Completion time within 3 weeks.
Timeframe and Cost
October 151- December 3111
Cost of contracted service: $3,000.00 (included in the cost is the 60-hour internship and
additional time to complete phase one deliverables)
Summary
As a graduate student in EE at SOU, it would be an outstanding opportunity for me to be able to
work with Ashland Forest Resiliency partners on bringing in quality fire curriculum to Rogue
Valley schools and organizations. I believe this project aligns well with my future career goals,
as I'd like to strengthen leadership and coordination skills. As a past business owner working in
the field of restoration, I bring experience in coordinating with organizations, landowners,
homeowners, and volunteer groups on restoration projects in ecology-based planning using
native plants as a catalyst.
Growing awareness on innovative methods like fire restoration education is critical in today's
threat of climate change and I can't think of a better chance to learn about fire use as a growing
tool in the forest landscape. I'm driven to help community members and organizations come
together on this subject, one in which I would like to gain more knowledge with myself. If
chosen for this project, I hope to serve well as the SOU representative on current and future
AFR operations.
Andy Dwyer
dwyera@sou.edu
(971) 713-1323
1361 Quincy St.
Ashland, OR 97520
CENTURY INS GRP PROGRFff1YE
572 SW BLUFF DR, #100
BEND, OR 97702 AUTO
Policy Number: 926381293
Underwritten by:
Progressive Classic Insurance Co
T DWYER September 10, 2019
ANDY
T D Y STREET Policy Period: Dec 21, 2018 - Dec 21, 2019
1361 QUlNC
ASHLAND, OR 97520 Page 1 of 2
1-541-382-4211
CENTURY INS GRP LLC
Contact your agent for personalized service.
progressiveagent.com
Auto Insurance Online Service
aim.
update
Coverage Summary Make payments, billing activity,
policy information or or check status of a claim.
This is your Declarations Page 1-800-274-4499
To report a claim.
Your policy information has changed
Your coverage began on December 21, 2018 at the later of 12:01 a.m. or the effective time shown on your application. This policy
period ends on December 21, 2019 at 12:01 a.m.
This coverage summary replaces your prior one. Your insurance policy and any policy endorsements contain a full explanation of your
coverage. The policy contract is form 9611A OR (08/15). The contract is modified by forms 4884 (10/08) and Z445 OR (11/17).
Policy changes effective September 9, 2019
Changes requested on: Sep 10, 2019 02:39 p.m.
Requested by: Andy T Dwyer
Premium change: -$134.23
Changes: The 2003 NISSAN FRONTIER has been removed.
The address for your 2007 HONDA CR-V has changed.
The Multi-Car discount has been removed from your policy.
Drivers and resident relatives Additional informafion
Andy.. Dwyer Named insured
Ca
lina A Dwyer
Form 6489AA OR (11/17) comi
i
Policy Number: 926381293
Andy T Dwyer
Paget of 2
Outline of coverage
2007 HONDA CR-V 4 DOOR WAGON
VIN: 5J6RE48557L004774
Garaging ZIP Code: 97520
Primary use of the vehicle: Business
Length of vehicle ownership when policy started or vehicle added: Less than 1 month
Limits Deductible Premium
Liability To Others $489
Bodily Injury and Property Damage Liability $500,000 combined single limit each accident
Personal Injury Protection $15,000 $0 87
Uninsured/Underinsured Motorist $500,000 combined single limit each accident 97
Uninsured Motorist Proper t y Damage $50,000 each accident $200 11
$300 hit & run
Comprehensive Actual Cash Value $250 68
Collision Actual Cash Value $250 243
...en...t al..Re..i........mburse..m......ent.......................................... u.P.t.... $40... .u..m ...30..... das .'y"s'-..................................................
each d..Y /maxi m 21
R
Roadside Assistance 10
Total premium for 2007 HONDA ( business use ) $1,026
Total 12 month policy premium $1,026.00
Premium discounts
Polity
926381293 Five-Year Accident Free, Continuous Insurance: Gold, Paperless, Paid in Full and
Three-Year Safe Driving
Form 8489AA OR (11/17)
CERTIFICATION OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE REQUIREMENTS
Contractor is exempt from the requirement to obtain workers compensation insurance pursuant to 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.
CORPORATION - FOR PROFIT
(initials) ■ 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
appurtenances thereto.**
,4- , Wl/ 1 o y l A
Signature of Authorized Signer) (Dat )
AVLC, ,+1-0 1 S. e- Cl ct
(Authorized Signer's Title)
*NOTE: Under OAR436-50-050 a shareholder has a "substantial ownership" interest if the shareholder owns 10% of the
corporation, or if less than 10% is owned, the shareholder has ownership that is at least equal to or greater than the average
percentage of ownership of all shareholders.
**NOTE: Under certain circumstances partnerships and limited liability companies can claim an exemption even when performing
construction work. The requirements for this exemption are complicated. Consult with City Attorney's Office before an exemption
request is accepted from a contractor who will perform construction work.
2INS GRP LLC
57 PROGREGIME`
572 SW SW BLUFF DR DR, #100
BEND, OR 97702 AUTO
Policy Number: 926391293
Underwritten by.
Progressive Classic Insurance Co
ANDY T DWYER September 1 D, 2019
AN
AN T D Policy Period: Dec 21, 2018 - Dec 21, 2019
1361 Y STREET
ASHLAND, OR 97520 Page 1 of 2
1-541-382.4211
CENTURY INS GRP LLC
Contact your agent for personalized service.
progresslveagent.com
Auto Insurance online service
usofaclaim.
itdormapformattion or information or dhwdcckngstatus of a claim.
Coverage Summary policy Make
This is your Declarations Page 1To report a a dal-800-2744499m.
Your policy information has changed
Your coverage began on December 21, 2018 at the later of 12:01 a.m. or the effective time shown on your application. This policy
period ends on December 21, 2019 at 12:01 a.m.
This coverage summary replaces your prior one. Your insurance policy and any policy endorsements contain a full explanation of your
coverage. The policy contract Is form 9611A OR (08/15), The contract is modified by forms 4884 (10/08) and Z445 OR (11/17).
Policy changes effective September 9, 2019
...ang n-g* . es..............requestedon"'o'n-: .............................................Sep ....10.•,...2019....... 02:39........p..,m....................
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Requested by: Andy T Dwyer
' Premlumchange: -E134.23
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Changes: 2-0-0,3",
The address for your 2007 HONDA CR-V has changed.
The Multi-Car discount has been removed from your policy.
i
Drivers and resident relatives AdditonallnlmmaBun
AndyT Dwyer Named insured
Canna A Dwyer
Form6469AA0R(I7) Core
Policy Number: 926381293
Andy T Dwyer
Paget of 2
Outline of coverage
2007 HONDA CR•V 4 DOOR WAGON
VIN: SJ6RE48557L004774
Garaging ZIP Code: 97520
Primary use of the vehicle: Business
Length of vehicle ownership when policy started or vehicle added: Less than 1 month
0mils Deductible Premium
Liability To Others $489
Bodily Injury and Property Damage Liability $500,000 combined single limit each accident
.0....00
$15..., i6 87
PersonallnJuryProtectlon
Uninsured)Underlnsured Motorist $500,000 combined single limit each accident 97
Uninsur. ...e M.ot..or..ist... P........D..am.....age.. $50.........................000 ...cid c......ent f~66 1 . 1
rop.... erty, ~ eacfi a
$300 hit & run
Comprehensive Actual Cash Value $250 68
Collision Actual Cash Value $250 ....................243
.............................ximum ii
Rental Reimbursement up to $4D each daylma 3.. days 2
Roadside Assistance ""j p
....2 0 7 H .........................use........................................................................................................ $1........026..
for
Total premium
h 0ONDA (business ) ,
polic....y. p.. r rem'e"m- iu.. in, m................................
Tota112 mont $1,026.00
Premium discounts
Policy
926381293 Flve-Year Accident Free, Con Onuous Insurance: Gold, Paperless, Pald.. In.. *F' u-
Three-Year Safe Driving
Form 6489AA OR 01117)
Purchase Order
Fiscal Year 2020 Page: 1 of: 1
W
THIS PG NUMBER MUS APPEAR ON ALL
B City of Ashland INVOKES `AND SHIPPING, DOCUMENTS. I
s
ATTN: Accounts Payable - -
L 20 E. Main Purchase 2020020
L Ashland, OR 97520 Order # T Phone: 541/552-2010
O Email: payable@ashland.or.us
V H C/O Fire and Rescue Department
E DWYER, ANDREW T 1 455 Siskiyou Blvd
N 1361 QUINCY ST 15H
D P ,Ashland, OR 97520
O ASHLAND, OR 97520 Phone: 541/482-2770
R T Fax: 541/488-5318
O
Chris Chambers
10/15/2019 4986 FOB ASHLAND OR/NET30 Cit Accounts Pa able
Fire Ecology Curriculum
1 List of regionally specific curriculum on fire ecology, evaluation of 1 $3,000.0000 $3,000.00
current curriculum and organization of curriculum evaluation in
easy to follow format.
Personal Services Agreement $25,000.00 or less)
Completion date: January 31, 020
Project Account: E-000199-400
GL SUMMARY
. 072900 - 606100 $3,000.00
By: L o" Date: g
Authorized Signature $3,000.00
FARM #3 l~ CITY OF
A request rta;a 'Pumhase rde-r ASHLAND
REQUISITION Date of request: 10/07/2019
Vendor Name Andrew And Dwyer
Address, City, State, Zip 1361 Quincy Street, Ashland, OR 97520
Contact Name And Dwyer L/
Telephone Number 971 713-1323 /v
Email address dwyera(a)sou.edu
SOURCING METHOD
❑ Exempt from Competitive Bidding ❑ Emercency
❑ Reason for exemption: ❑ Invitation to Bid (Copies on file) ❑ 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 a roval required, attach co of CC
❑ Small Procurement Cooperative Procurement
Less than $5,000 ❑ Request for Proposal (Copies on file) ❑ State of Oregon
❑o Orect Award Date approved by Council: Contract #
❑ Verbal(Written quote(s) or proposal(s) -(Attach copy of council communication) ❑ Stale of Washington
Intermediate Procurement ❑ Sole Source Contract#
GOODS & SERVICES ❑ Applicable Form (#5,6, 7 or 8) ❑ Other government agency contract
$5,000 to $100.000 ❑ Written quote or proposal attached Agency
❑ (3) Written quotes and solicitation attached ❑ Form #4, Personal Services $5K to $75K Contract #
PERSONAL SERVICES ❑ Special Procurement Intergovernmental Agreement
$5,000 to $75,000 ❑ Form #9, Request for Approval ❑ Agency
❑ Less than $35,000, by direct appointment ❑ Written quote or proposal attached Date original contract approved by Council:
❑ (3) Written proposalsAWtten solicitation Date approved by Council: (Date)
❑ Form #4, Personal Services $5K to $75K Valid until: Date -(Attach copy of council communication)
Description of SERVICES Total Cost
List of regionally specific curriculum on fire ecology, evaluation of current curriculum and
organization of curriculum evaluation in easy to follow format.
$ 3;000:00
Item # Quantity Unit Description of MATERIALS Unit Price Total Cost
TOTAL COST
❑ Per attached quotelproposal $
Project Number 0 0 0 1 9 a. 4 0 0 Account Number 0 7 2 9 0 0.6 0 e 1 0 o
Project Number Account Number
Project Number Account Number
'Expenditure mustbe charged to the appropriate account numbers forthe financials to accurately reflect the actual expenditures.
IT Directorin collaboration with department to approve all hardware and software purchases:
ITDirector Date Support-Yes/No
By signing this requisition form, I ce ify that the City's public contracting requirements have been satisfied.
Employee: Department Head: (Equal to or greater than $5,000)
Department ManagerlSupervisor: tyxCom`mistrator:
(Equal to or greater than $25,000)
Funds appropriated for current fiscal year., YES/NO
Deputy Finance Director-(Equalto orgreaterthan$5,000) Date
Comments:
Form #3 - RequiSilion
Legal Department Review
DOCUMENT TRANSMITTAL AND CONTROL
This form will accompany the document through the drafting, review, and signature processes, and will
be kept with the City's final executed copy of the document.
Document: w r-to it Cy~ its ► ~~V~cu -7
(I cl de names of parties to the document)
Type of Document: Contract Lease ❑ Easement ❑ Deed ❑ IGA ❑
Other (Specify)
Dept Contact: Sao, ~--Toycs ACTION REQUESTED:
Dept: 110FE Phone: ❑ Review Draft
Date submitted to Legal: ~I 2e~ 1 ❑ Approve final and forward to:
Draft due by: P) V (Unless indicated, Legal will return document to you)
Return Requested by: AW
Complete this section ONLY the first time this form is filled out:
Has this document been previously worked on by the Legal Department staff? ❑ No ❑ Yes
If yes, by whom?
LEGAL DEPT First Date Received by Legal Date: Byf -
USE ONLY Returned to Dept. for Revision Date: By.
Received for additional review by Legal Date: _ By:
Returned to Dept. for Revision Date: By:
Received for additional review by Legal Date: By:
Returned to Dept. for Revision Date: By:
Received for Additional Review by Legal Date: By:
Returned to Dept for Revision Date: By:_
Final Logged out by Le al Date : if) By:
Comments from LEGAL to DEPARTIIIENT: Comments from D PA TMENT to LE A
See Attached.,
y. t-
lee;,
f f i
i
Return original executed document to the City Does this document need to be recorded?
Recorder for safekeeping? ❑ No 0,, Yes No ❑ Yes
CITY ADMINISTRATOR / DEPARTMENT HEAD
Please do not sign the attached document until this form has been approved by the Legal Department.
FINAL LEGAL DEPARTTNIENT APPROVAL: - Date: i
G:Alegal\DEPARTMENTS\Contracting\FORMS\Legal Doc Transmittal - KLB.doex