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HomeMy WebLinkAbout2019-267 20200084 Pump Pipe& Tank Services AMENDMENT NO. 1 to GOODS AND SERVICES AGREEMENT between THE CITY OF ASHLAND, an Oregon municipal corporation, ("City") and PUMP, PIPE AND TANK SERVICES, LLC, a domestic limited liability company, ("Provider") for Fuel System Management and Repairs RECITALS A. The City and Provider previously entered into a Goods and Services Agreement effective August 6, 2019, (the "Agreement") to provide fuel system management and repair services; and B. The Parties wish to amend the terms of the Agreement to reflect the hourly rates of compensation to be paid to Provider as set forth in the SUPPORTING DOCUMENTS. AGREEMENT NOW THEREFORE, in consideration of the mutual benefits and obligations set forth herein, the parties agree as follows: 1. Amend Section 2.1 as follows, with strikeout wording deleted and underscored wording added: 2.1 City shall pay Provider at the hourly rates the ° of $10,000 aprovided herein as full eempe safie for- the Work as specified in the SUPPORTING DOCUMENTS for any Work performed pursuant to this Agreement. 2. This Amendment No. 1 is effective retroactively to the Effective Date of August 6, 2019. 2. Except as specifically modified by this Amendment No. 1, the terms and conditions of the Agreement remain in full force and effect. Page 1 of 2: Amendment No. 1 to Goods and Services Agreement between the City of Ashland and Pump, Pipe and Tank Service LLC IN WITNESS WHEREOF the parties have caused this Amendment No. 1 to be signed in their respective names by their duly authorized representatives as of the dates set forth below: CITY OF ASHLAND, OREGON PUMP, , AND TANK SERVICES,. LLC By: By: aula C. Brown, Public Works Director Printed Name: v, .n ~ enca Date: A0 kre Zo ! 9 Title: ~5 U' C Date: LZ6 t~ 1 Page 2 of 2: Amendment No. 1 to Goods and Services Agreement between the City of Ashland and Pump, Pipe and Tank Service LLC GOODS & SERVICES AGREEMENT PROVIDER: Pump, Pipe and Tank Services, LLC CITY OF PROVIDER'S Ryan McHenry ASHLAND CONTACT: 20 East Main Street Ashland, Oregon 97520 ADDRESS: PO Box 146 Telephone: 541/488-5587 Talent, OR 97540 Fax: 541/488-6006 PHONE: 541-535-6542 This Goods and Services Agreement (hereinafter "Agreement") is entered into by and between the City of Ashland, an Oregon municipal corporation (hereinafter "City") and Pump, Pipe and Tank Services, LLC, a domestic business corporation ("hereinafter "Provider"), for fuel system management and repairs. 1. PROVIDER'S OBLIGATIONS 1.1 Provide fuel system management and repairs 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. Page 1 of 5. Agreement between the City of Ashland and Pump, Pipe and Tank Services, LLC 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.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. 2. CITY'S OBLIGATIONS 2.1 City shall pay Provider the sum of $10,000 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 $10,000 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 Pump, Pipe and Tank Services, LLC 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 dated February 1, 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 Pump, Pipe and Tank Services, LLC 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 - Facilities Maintenance Department Attn: David Arnold 90 North Mountain Avenue Ashland, Oregon 97520 Phone: (541) 552-2292 With a copy to: City of Ashland - Legal Department 20 E. Main Street Ashland, OR 97520 Phone: (541) 488-5350 If to Provider: Pump, Pipe and Tank Services, LLC Attn: Ryan McHenry PO Box 146 Talent, OR 97540 541-535-6542 8. WAIVER OF BREACH One or more waivers or failures to object by either parry 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 Pump, Pipe and Tank Services, LLC 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: (1) 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: Pump, P' nd Tank Services, LLC (PROVIDER): By: By: Signature Sign ture C ~q kf C Printed Name Printed Name Title itle G ~ r7 1 0 11 ate Date is to be submitted with this signed Agreement) Purchase Order No. Page 5 of 5: Agreement between the City of Ashland and Pump, Pipe and Tank Services, LLC I Pump P~pe & Tank Services L CCB # 197390, CA# 569114 • PO Box 146 Talent, OR 97540"~' E-mail: servicerequest@puinppipetank.com Phone: 541-535-6542 or Toll Free: 1-844-450-2503 Fax: 541-535-5557 To whom it may concern, Below is a table showing Pump Pipe & Tank Services, LLC company rates. Please note that if the service is located in the Rogue Valley area (Medford, Ashland, White City, Central Point, Jacksonville) we do not charge a mileage or travel rate fee. If service is located outside of the area, then mileage and travel will apply. CUSTOMER RATES 2/1/2019 Labor hourly rate $85.00 Travel hourly rate $85.00 Overtime $127.50 Overtime Travel $127.50 Weekend Rate $170.00 Weekend Travel $170.00 Holiday Rate $255.00 Holiday Travel $255.00 Mileage $1.00 Phone Support $42.50 i Sincerely, I Ryan McHenry - Service Manager/Owner Pump Pipe & Tank Services, LLC I David Arnold From: David Arnold Sent: Thursday, July 25, 2019 12:34 To: David Arnold Subject: Contract/PP&T/Rate Sheet/Comparison/Results Hi Below is a description of the Fuel Management and Service companies that we requested Rate Sheets from and the results: Pipe, Pump and Tank: 25 Jun Received During in Person Meet and Greet SME Solutions: 2 May Submitted/Compared Rates and Service Carson 14 May Request I No Response 27 Jun Request 11 No Response Dave Dave Arnold, Facility Maintenance City of Ashland - Public Works 90 North Mountain Ave Ashland, OR 97520 541 552 2292 FAX: 541 552 2304 david.arnold@ashland.or.us This email transmission is official business of the City of Ashland, 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 2292. Thank you. PUMPP-1 A~ RQ DATE (NM/DD/YYYI) /R CERTIFICATE OF LIABILITY INSURANCE 07126/2019 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(iss) 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 endorsements . PRODUCER 817-640-5035 CONTACT Jim Beam, CIC NAME Monroe & Monroe Insurance PHONE 817-640-5035 FAX N,) 817-640-0131 Agency, Ltd. AIC, No, Ext): _ : 2921 Gallerla Dr., Suite 102 E-MAIL Arlington, TX 76011 IADDRES NSURER S AFFORDING COVERAGE NAIL Jim Beam, CIC 23418 f1NS.URER URER A: Mid-ContinentCasuaiCo. INSURED URER B : The Hanover Insurance Group 22292 Pup Pie ank e~1►Ices LLC C Robert McHenry dbSa ump Pipe & - Tank Services INSURER D Petroleum Pump Supply PO Box 146 INSURER E : Talent, OR 97540 INSURER F R 1 E' VERAGES CERTIFICATE 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 ADDL SUB POLICY NUMBER POLICY EFF POLICY EXP LIMITS TYPE OF INSURANCE 1 000 000 A X COMMERCIAL GENERAL LIABk.n'Y EACH OCCURRENCE CLAIMS-MADE ❑X OCCUR 04GL1014977 11/1512018 11/15/2019 DAMAGETORENTED 100,000 -0- X Pollution Liab MED EXP An one n X ProfessionalLiab PERSONAL 6ADV_INJURY 1,000,000 GENERAL AGGREGATE 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: $~QQQ~QQQ POLICY ❑ PRO ❑ LOC PRODUCTS -COMP/OP AGG JECT OTHER: COMBINED SINGLE LIMIT 1,000,000 B AUTOMOBILE LIABILITY X ANY AUTO WDA75436203 10115/2018 10/15/2019 BODILY INJURY Perperson AUTOS ONLY AUTOSULED BODILY INJURY Per acddent TYt AMAGE ~R ~N yy Ep PPPOPERcciden X AUTOS ONLY X AUTO ONNLY EACH OCCURRENCE 1,(100'000 A UMBRELLALIAB X OCCUR X EXCESS LIAB CLAIMS-MADE XS207529 11/15/2018 11115/2019 AGGREGATE 1,000,000 DED X RETENTION E 10,000 PER OTH WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORM'ARTNER/EXECUTNE E.L. EACH ACCIDENT pFFICERIMEMBEER EXCLUDED? NIA (Mandatory Yt NH) E.L. DISEASE - EA EMPLOYEE If es, describe underP T 1NS below - T 04CRA5129 11/1512018 11115/2019 Owned Equ 4,900 A Equipment Floater DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached H more space is required) The General Liability and Commercial Auto policies include a blanket additional insured and waiver of subrogation endorsement which provides additional insured and waiver of subrogation status to the City of Ashland, Oregon, its officers, agents and employees only when there isa written "insured contract" as defined by the SEE NOTES; ER NCELLATION CITASH1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. Facility Maintenance Dept. 90 North Mountain Ave. AUTHORIZED REPRESENTATIVE Ashland, OR 97520 ACORD 25 (2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Request for Taxpayer Give Form to the Form 9 Identification Number and Certification requester. Do not (Rev. Octobe the Revof the he Tre Service p. send to the IRS. pepert asury Oo to www.1rs9 . ov1ForynM for instrvctbrts and the latest information. Internal Rev 1 Name (as stumm on your Income tax rstum). Name is required on this fine; do not leave this lane blank. Ptm1 Pipe & Tank Services LLC 2 Business nama/dleregardad entity name. If dlMerent from above Punt Pipe & Tank Services LLC t° 3 Check appropriate box for federal tau classification of the person whose name is entered on tine 1. check one of the 4 FxempUona (codes apply only to certain 7 on rentitks, not endrAduals; see m following seven boxes. m fie) c ❑ Individual/sole prophets or ❑ c corporation ❑ S Corporation ❑ Partnership Q Tmstlestate o i Exempt payee code fif any) single-member LLC Q Limited liability company. Enter tax classification (C=c corporation, S=S corporation, P=Pertne(shlp) ► S `o t? Note: Check the appropriate box' One above for the tax classification of the single-memberowner. Do not check Exemption from FATCA reporting n LLC If the LLC is classified m a sing mbar LLC that is disregarded from the owner unless 0* owner of the LLC Is code (a any) u another LLC that is not disregarded the owner for uS. federal tax purposes. Otherwise -a single-member LLC 66 is disregarded from the owner should the appropriate box for the tax classification of ,N owner. g Other (see instructions) ► t^Cnn•r m cmi.us mr•rr+od ass usl y 6 Address (number, street, and apt. or state noJ insinj ttons. Requesters name and address (optionall vo Pf) Box 146 B City, stele, and 21P code Tale OR 97540 7 List aGeount numberls) here (optionap • Taxpayer Identification Number (TI sew seeeritr reorresr r---r~ Enter your TIN the appropriate box. The TIN provided must m ch the a given on line 1 avoid backup withholding. For individuals, this is generally generally your social s lY n leer (SSN). However, for e resident alien, sole proprietor, or disregarded entity, see the instru ions r Part I, later. For otter entities, it is your employer identification number (EIM. If you do not av a number, see Haw to get a or T7N, later. Note: if the account is in more than one name, see the instructions f 'no 1. Also see Whet Name Certification Under penalties of perjury, I certify that 1. The number shown on this form is my, correct taxpayer id tlflcation numb (or I am waiting for a number to be issued to me); and 2. 1 am not subject to backup withholding because: (a) I a empt from backu withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding a result of a failure to eport all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and 3. 1 am a U.S. citizen or other U.S. person (defiled ben and 4. The FATCA code(s) entered on this form of any) i ting that I em exempt from TCA reporting is correct. Certification instructions. You must cross out item 2 ve if you have been notified by IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on our tax return. For real estate his ions, item 2 does not apply. For mortgage Interest paid, acquisition or abandonment of secured property, collation of debt, contributions to an in ' 'dual retirement arrangement (IRA), and generally, payments other than interest and dividends, ou are not u to sign the certification, but you must 'der your correct TIN. Seethe instructions for Part 11, later. Sign signamro of Date ► Here U.S. Pesaro ► Fo 9- N (dividends, including those from stocks or mutual General Instructions n Section references are to the Intemal Rev nue Code unless otherwise Fo 1099-M (various types of income, prizes, awards, or gross noted. P eeds) Future developments. For the latest i ormation about developments • Form 1099-B is Gk or mutual fund sales and certain other related to Forth W-9 and its fast uctic such as legislation enacted transactions by br ers) after they were published, go to www rrs.govIFormIN9. - Forth 1099-5 (pro Beds from real estate transactions) Purpose of Form • Form 1099-K inner ant card and third party network transactions) • Forth 1098 (home gage interest), 1098-E (student ban Interest), An individual or entity (Forth W-9 ester) who Is required to file an 1098_T (tuition) information rotten with IRS rot t ote ,your correct taxpayer . Forth 1099-C (canceled debt) y be you social seam number identification number r (TIN) which a b (SSN), Individual taxpayer iden ' tion number (f TIN), adoption . Form 1099-A (acquisition or abandonment of secured property) taxpayer identification number TIN). or employer Identification number Use Forth W3 only if you are a U.S. parson (knciudrn9 a resident (EIN), to report on an irdormaboh return the amount paid to you, or other alien) to provide your correct TIN. amount reportable on an Info etion return. Examples of Information with riot return Farm W-9 to the requester returns include, but are not li L bon folowing. ~ to backup withholding. See What backup a TIN, you withholding, t • Farm 1099-INT (interest red or thr paid) low. Form W-9 (Rev. 10-2019) Cat. No. 10231X B~~I 90062, A H. Res "Mmag aW Cm*" August 01, 2019 PUMP PIPE & TANK SERVICES LLC 5446 S PACIFIC HWY PHOENIX, OR 97535-6608 Re: Barrett Business Services, Inc. ("BBSI") Letter of Self-Insurance for Workers' Compensation Coverage As the named addressee of this Letter, your company's required workers' compensation coverage is provided through BBSI's state approved Self-Insured Workers' Compensation Plan by way of your co-employment contract with BBSI. Additional information is as follows: State: Oregon Workers' Compensation Limits: Employer Liability Limits: Self Insurance Certification 1068 Statutory $5,000,000.00 Each Accident $5,000,000.00 Disease Coverage Limit by Client $5,000,000.00 Disease; Each Employee Other Comments (place an "X" if applicable): ~X Named "Letter Holder": City of Ashland 20 E Main St Ashland, OR 97520 ~X Other: Contract effective 5/112012, renewed through 4/30/2020. Subject to 30 days' notice of cancellation. Additionally, BBSI's self-insured program is further supported by an excess workers' compensation insurance policy with ACE American Insurance Co.. Copy of certificate is available upon request. For additional Information, please contact your local BBSI office at: MEDFORD (541) 772-5469 3512 Excel Drive Suite 107 Very truly yours, Medford, OR 97504 ftz-e& Michael L. Elich President and Chief Executive Officer doc: Los[-2 HOLOEROOOE CRASH? PUMPP-1 PAGE2 NOTEPAD: INSUREO•s HAVE Pump Pipe & Tank Services LLC OP ID: AD sam 0 712 612 01 9 policy, between the named insured and the certificate holder which requires such status. The General Liability policy contains a special endorsement with primary and noncontributory" wording. i I Purchase Order Fiscal Year 2020 Page: 1 of 1 THIS PO NUN16ER MUST APPEAR ON ALL INVOICES, AND SHIPPING DOCUMENTS,B City of Ashland I ATTN: Accounts Payable L L 20 E. Main Purchase 20200084 Ashland, OR 97520 Order # T Phone: 541/552-2010 O Email: payable@ashland.or.us V H C/O Facilities Maintenance Div E PUMP PIPE & TANK SERVICES, LLC 1 90 North Mountain Ave N PO BOX 146 p Ashland, OR 97520 D TALENT, OR 97540 Phone: 541/488-5358 O T Fax: 541/552-2304 R O 541 535-6542 David Arnold .08/1312019 468 FOB ASHLAND OR Cit Accounts Pa able 7 1 Fuel System Maintenance Fuel system maintenance and repairs for FY 20 1 $10,000.0000 $10,000.00 Goods & Services Agreement Completion date: June 30, 2020 Project Account: GL SUMMARY 082400 - 602400 $10,000.00 By: c Date Authorized Signature PO Total _ $10,000.00 CITY OF FORM ASHLAND + v oft'le-sty iFor '21 L'=UUA2'Mscr 0trdet'l, REQUISITION zi G zig Date of request: 8/6/2019 ~ Required date for delivery: Vendor Name Pump Pipe & Tank Services LLC Address, City, State, Zip PO Box 146, Talent OR 97540 Contact Name & Telephone Number Ryan McHenry 541-535-6542 Fax Number SOURCING METHOD ❑ Exempt from Competitive Bidding ❑ Emergency ❑ Reason for exemption: ❑ Invitation to Bid (Copies on file) ❑ Form #13, Written findings and Authorization Date approved by Council: ❑ Written quote or proposal attached ❑ AMC 2.50 ❑ Written quote or ro osal attached ❑ Small Procurement Cooperative Procurement Less than $5.000 ❑ Request for Proposal (Copies on file) ❑ State of Oregon ❑ Direct Award Date approved by Council: Contract # ❑ VarbalNVdtten quote( or propo E] State of Washington Contract # Intermediate Procurem ❑ Sole Source ❑ Other government agency contract GOODS & SERVICES , ,r[] Applicable Form (#5,6, 7 or 8) Agency $5.000 to $100.000 Written quote or proposal attached Contract # ® (3) Written quotes and s Ii i ❑ Form #4, Personal Services $5K to $75K Intergovernmental Agreement attached b ❑ Agency PERSONAL SERVICES g ❑ Special Procurement Date.original contract approved by Council: $5.000 to $75,000 ❑ Form #9, Request for Approval (Date) ❑ Less than $35,000, by direct ❑ Written quote or proposal attached appointment Date approved by Council: ❑ (3) Written proposals/written solicitation ❑ Form #4, Personal Services $5K to $75K Valid until: (Date) Description of SERVICES Total Cost Fuel system maintenance and repairs for FY20 $ 10,000:00 Item # Quantity Unit Description of MATERIALS Unit Price Total Cost TOTAL COST ® Per attached quote/proposal Project Number Account Number 082400-602400 *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: ITDirector Date Support-Yes/No By signing thi isiff fo m Fihat the City's public contracting requirements have been satisfied. Employee Signature: Department Head Signature: G (Equal o or greater than $5,h ) City Administrator: (Equal to or greater than $25,000) Funds appropriated for current fiscal year. Y FS / NO C0~ 1. A 161710 Finance Director- (Equal to or greater than $5,000) Date Comments: Form #3 - Requisition ,