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HomeMy WebLinkAbout2019-273 20200183 West Coast Pipeline CITY OF OF ASHLAND sir PUBLIC IMPROVEMENT CONTRACT FOR OAK STREET WATERLINE REPLACEMENT PROJECT NO. 2018-32 This Public Improvement Contract (hereinafter "Contract") is entered into by and between the CITY OF ASHLAND, an Oregon municipal corporation (hereinafter "City"), and West Coast Pipeline LLC (hereinafter "Contractor"). NOW THEREFORE, for good and valuable consideration, the sufficiency of which is hereby acknowledged, the parties mutually covenant and agree as follows: 1. PROJECT MANAGER: The City's Project Manager for this Contract is: Chance MetcalL City of Ashland Public Works Engineering Department. 2. WORK: 2.1. The Work under this Contract is for the Oak Street Waterline Replacement Project No. 2018-32 as more fully described in the Contract Documents listed in Section 5 of EXHIBIT A, STANDARD TERMS AND CONDITIONS FOR PUBLIC IMPROVEMENT CONTRACTS. Contractor shall complete all Work as specified in the Contract Documents. The Work is generally described as follows: The installation of approximately 2628 linear feet of 8-inch ductile iron waterline along with related fittings and appurtenances. The Statement of Work, including the delivery schedule for the Work, is contained in the Contract Documents. 2.2. Contractor shall, at its own risk and expense, perform the Work described in the Contract Documents and furnish all permits, labor, tools, machinery, materials, transportation, equipment and services of all kinds required for, necessary for, or reasonable incidental to, performance of the Work, that is, the construction of the Oak Street Waterline Replacement Project No. 2018-32. Contractor shall secure all municipal, County, State, or Federal Permits or licenses including payment of permit fees, license fees, and royalties necessary for or incidental to the performance of the Work. The risk of loss for such Work shall not shift to the City until written acceptance of the Work by the City. 3. EFFECTIVE DATE AND DURATION: 23 1 This Contract is effective as of the date of execution by the City (the "Effective Date"). All Work under this Contract shall, unless otherwise terminated or extended, be completed by November 22, 2019 following Contractor's receipt of the written Notice to Proceed. 4. CONSIDERATION 4.1. City agrees to pay Contractor, at the times and in the manner provided in the Contract Documents, the sum of $346,462.50 for performing the Work required by this Contract, including allowable expenses. This sum cannot be modified except by Change Order approved in writing by the City. Any progress payments to Contractor shall be made only in accordance with the schedule and the requirements as set forth in the Standard Terms and Conditions. 4.2. City certifies that sufficient funds have been appropriated to make payments required by this Contract during the current fiscal year. Contractor understands and agrees that City's payment of amounts under this Contract attributable to Work performed after the last day of the current fiscal year is contingent upon City appropriations, or other expenditure authority sufficient to allow City in the exercise of its reasonable discretion, to continue to make payments under this Contract. In the event City has insufficient appropriations, limitations or other expenditure authority, City may terminate this Contract without penalty or liability to City, effective upon the delivery of written notice to Contractor, with no further liability to Contractor. 5. CONTRACTOR'S REPRESENTATIONS In order to induce City to enter into this Contract, Contractor makes the following representations: 5.1. Contractor has examined and carefully studied the Contract Documents, and any data and reference items identified in the Contract Documents. 5.2. Contractor has visited the Site, conducted a thorough, alert visual examination of the Site and adjacent areas, and become familiar with and is satisfied as to the general, local, and Site conditions that may affect cost, progress, and performance of the Work. 5.3. Contractor is familiar with and is satisfied as to all laws and regulations that may affect cost, progress, and performance of the Work. 5.4. Contractor has carefully studied all drawings of physical conditions relating to existing surface or subsurface structures at the Site that have been identified in the Supplementary Conditions, especially with respect to Technical Data in such reports and drawings, and reports and drawings relating to Hazardous Environmental Conditions, if any, at or adjacent to the Site that have been identified in the Supplementary Conditions, especially with respect to Technical Data in such reports and drawings. 5.5. Contractor has considered the information known to Contractor itself, information commonly known to contractors doing business in the locality of the Site; information and observations obtained from visits to the Site; the Contract Documents; and the Site-related reports and drawings identified in the Contract Documents, with respect to the effect of such information, observations, and documents on (1) the cost, progress, and performance of the Work; (2) the means, methods, techniques, sequences, and procedures of construction to be employed by Contractor; and (3) Contractor's safety precautions and programs. 5.6. Based on the information and observations referred to in the preceding paragraph, Contractor agrees that no further examinations, investigations, explorations, tests, studies, or data are 24 necessary for the performance of the Work at the Contract Price, within the Contract Times, and in accordance with the other terms and conditions of the Contract. 5.7. Contractor is aware of the general nature of work to be performed by City and others at the Site that relates to the Work as indicated in the Contract Documents. 5.8. Contractor has given City written notice of all conflicts, errors, ambiguities, or discrepancies that Contractor has discovered in the Contract Documents, and the written resolution thereof by City is acceptable to Contractor. 5.9. The Contract Documents are generally sufficient to indicate and convey understanding of all terms and conditions for performance and furnishing of the Work. 6. GOVERNING LAW The provisions of this Contract shall be construed in accordance with the laws of the State of Oregon. Any action or suits involving any question arising under this contract must be brought in the appropriate court in Jackson County, Oregon. If the claim must be brought in a federal forum, then it shall be brought and conducted in the United States District Court for the District of Oregon. Contractor, by the signature herein of its authorized representative, hereby consents to the in persona jurisdiction of said courts. In no event shall this section be construed as a waiver of the City of any form of defense or immunity. 25 CONTRACTOR DATA, CERTIFICATION, AND SIGNATURE / S j t`(n G Business Name (please print): L Contact Name: Phone: ~ 1// 4P? x: S'~yl 6S ~a ~-3 Address - l Gm- Y15-6 Do Not Write Federal and State Tax ID Numbers on this Agreement: One copy of W-9 is to be submitted with the signed contract to be kept on file in the City ofAshland Finance Department. Ashland Business License 47 ~ Construction Contractors Board #~f(c" Citizenship: Nonresident alien Yes ✓ No Business Designation (check one): Individual Sole Proprietorship Partnership Corporation Govemment/Nonprofit The above information must be provided prior to contract approval. Payment information will be reported to the Internal Revenue Service (IRS) under the name and taxpayer I.D. number provided above. (See IRS 1099 for additional instructions regarding taxpayer ID numbers.) Information not matching IRS records could subject you to 31 percent backup withholding. I, the undersigned, understand that the Standard Terms and Conditions For Public Improvement Contracts (Exhibit A) together with Exhibits B through J together with all other Contract Documents as described in Standard Terms and Conditions Section 5 below, and the separately bound Oregon 2018 Standard Specifications for Construction, as amended by the City of Ashland's most recent Addenda to the 2018 Standard Specifications are an integral part of this contract and agree to perform the work described in the Contract Documents, including Exhibit A, in accordance with the terms and conditions of this contract. I further understand the City is prohibited from entering into a contract when the contractor has neglected or refused to file any return, pay any tax, or properly contest a tax, pursuant to ORS 305.385; I hereby certify, under penalty of perjury and false swearing, that I/my business am/is not in violation of any Oregon tax laws; I further certify that the certification and representations in Standard Term and Condition # 16 [CCB Registration Requirements] are true and correct, and further I certify that I am an independent contractor as defined in ORS 670.600. 26 CONTRACTOR: Signatu /Title VV4 Printed name / L-2 Date NOTICE TO CONTRACTOR: This contract does not bind the City of Ashland unless and until it has been executed by the Public Contracting Officer or designee. CITY OF ASHLAND SIGNATURE CITY: City Administrator, City of Ashland CA I-:~ oIIg Date ATTACHMENTS: Certificate of Representation Standard Terms & Conditions Bid Schedule Insurance Requirements 27 CERTIFICATE OF REPRESENTATION Contractor, under penalty of perjury, certifies that: (a) The number shown on this form is its correct taxpayer ID (or is waiting for the number to be issued to it; and (b) Contractor 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. Contractor further represents and warrants to City that (a) it has the power and authority to enter into and perform the work, (b) the Contract, when executed and delivered, shall be a valid and binding obligation of Contractor enforceable in accordance with its terms, and (c) The work under the Contract shall be performed in accordance with the highest professional standards, and (d) Contractor is qualified, professionally competent and duly licensed to perform the work. Contractor also certifies under penalty of perjury that its business is not in violation of any Oregon tax laws, and it is a corporation authorized to act on behalf of the entity designated above and authorized to do business in Oregon or is an independent contractor as defined in the contract documents, and has checked four or more of the following criteria: (1) I carry out the labor or services at a location separate from my residence or is in a specific portion of my residence, set aside as the location of the business. V (2) Commercial advertising or business cards or a trade association membership are purchased / for the business. i/ (3) Telephone listing is used for the business separate from the personal residence listing. -4) Labor or services are performed only pursuant to written contracts. i/ (5) Labor or services are performed for two or more different persons within a period of one year. V/--(6) 1 assume financial responsibility for defective workmanship or for service not provided as evidenced by the ownership of performance bonds, warranties, errors and omission insurance or liability insurance relating to the labor or services to be provided. Con rac or Dat 28 PERFORMANCE BOND The undersigned as principal further referred to in this bond as Contractor, and as surety, further referred to in this bond as Surety, are jointly and severally bound unto City of Ashland as obligee further referred to in this bond as City, in the sum of Dollars $ Contractor and City have entered into a written contract dated for the following proiect• Oak Street Waterline Replacement No. 2018-32. This contract is further referred to in this bond as the Contract and is incorporated into this bond by this reference. The conditions of this bond are: 1. If Contractor faithfully performs the Contract in accordance with the plans, specifications and conditions of the contract within the time prescribed by the Contract, as required by ORS 279C 380 through 279C 385 then this obligation is null and void; otherwise it shall remain in full force and effect. 2. If Contractor is declared by City to be in default under the Contract, the Surety shall promptly remedy the default perform all of Contractor's obligations under the contract in accordance with its terms and conditions and pay to City all damages that are due under the Contract. 3. This bond is subject to claims under ORS 279C.380 through 279C.390. 4. This obligation jointly and severally binds Contractor and Surety and their respective heirs, executors, administrators, successors. 5. Surety waives notice of modification of the Contract or extension of the Contract time. 6. Nonpayment of the bond premium shall not invalidate this bond. 7. The bond number and the name address and telephone number of the agent authorized to receive notices concerning this bond are as follows. Bond Number: Bond Agent: Address: Telephone: SIGNED this day of 20 56 • PERFORMANCE BOND Page 2 WITNESS: CONTRACTOR: By: (Corporate Seal) Title: Legal Address: Attest: Corporate Secretary WITNESS: SURETY: By: (Corporate Seal) Title: Legal Address: Attest: Corporate Secretary 57 PAYMENT BOND The undersigned as principal further referred to in this bond as Contractor, and as surety, further referred to in this bond as Surety, are jointly and severally bound unto City of Ashland as obligee further referred to in this bond as City, in the sum of Dollars Contractor and City have entered into a written contract dated for the following project: Oak Street Waterline Replacement No. 2018-32. This contract is further referred to in this bond as the Contract and is incorporated into this bond by this reference. The conditions of this bond are. 1. If Contractor faithfully performs the Contract within the time prescribed by the Contract, and promptly makes payment to all claimants as defined in ORS 279C.600 through 2790.620, then this obligation is null and void otherwise it shall remain in full force and effect. 2. If Contractor is declared by City to be in default under the Contract, the Surety shall promptly remedy the default perform all of Contractor's obligations under the contract in accordance with its terms and conditions and pay to City all damages that are due under the Contract. 3. This bond is subject to claims under ORS 279C.600 through 279C.620. 4. This obligation jointly and severally binds Contractor and Surety and their respective heirs, executors, administrators, successors. 5. Surety waives notice of modification of the Contract or extension of the Contract time. 6. Nonpayment of the bond premium shall not invalidate this bond. 7. The bond number and the name address and telephone number of the agent authorized to receive notices concerning this bond are as follows: Bond Number: Bond Agent: Address: Telephone: SIGNED this day of 20 58 PAYMENT BOND Page 2 WITNESS: CONTRACTOR: By: (Corporate Seal) Title: Legal Address: Attest: Corporate Secretary WITNESS: SURETY: By: (Corporate Seal) Title: Legal Address: Attest: Corporate Secretary 59 CITY OF ASHLAND Orti BID AND BID SCHEDULE TO FURNISH ALL PERMITS, LABOR, TOOLS, MACHINERY, MATERIALS, TRANSPORTATION, EQUIPMENT AND SERVICES OF ALL KINDS REQUIRED FOR THE CONSTRUCTION OF THIS PROJECT FOR THE CITY OF ASHLAND, JACKSON COUNTY, OREGON, AS STATED IN THE COMPLETED BID SCHEDULE, ALL IN ACCORDANCE WITH THE CONTRACT DOCUMENTS, PLANS, SPECIFICATIONS, AND DRAWINGS WHICH ARE ON FILE AT THE CITY OF ASHLAND, CITY HALL, 20 EAST MAIN STREET, ASHLAND, OREGON 97520. NAME OF BIDDER ll t r CONTACT ADDRESS CITY W STATE -e ZIP TELEPHONE NO. _ / f L a 5924 Zt+roa ,~'d FAX NO. -66s- -0~3 ~"naG ~°wt 0~' 9750-9 sir-941-6070 EMAIL ADDRESS UV To the Honorable Mayor and City Council City Hall City of Ashland 20 East Main Street Ashland, Oregon 97520 In response to the City of Ashland's Invitation to Bid, this Bid is submitted as an offer by the undersigned to enter into a contract with the City of Ashland for furnishing all permits, labor, tools, machinery, materials, transportation, equipment and services of all kinds required for, necessary for, or reasonable incidental to, the construction of the Oak Street Waterline Replacement Project No 2015-32 (hereinafter "Project") for the City of Ashland, Oregon, as shown in the contract documents on file at City Community Development Building, which are a condition of this Bid as though they were attached. This offer is subject to the following declarations as to the acts, intentions and understandings of the undersigned and the agreement of the City of Ashland to the terms and prices herein submitted. 1. The undersigned has familiarized itself with the nature and extent of the Contract Documents, the project work, the site, the locality, the general nature of work to be performed by the City or others at the site that relates to the project work required by the Contract Documents, local conditions, and federal, state, and local Laws and Regulations that in any manner may affect cost, progress, performance, or furnishing of the project work. 12 1. The undersigned has obtained and carefully studied for assumes responsibility for obtaining and carefully studying) examinations, investigation, exploration, tests, and studies which pertain to the conditions (subsurface or physical) at or contiguous to the site or otherwise and which may affect the cost, progress, performance, or furnishing of the project work as Contractor deems necessary for the performance and furnishing of the project work at the Contract Price, within the Contract Times, and in accordance with the other terms and conditions of the Contract Documents; and no additional or supplementary examinations, investigations, explorations, tests, reports, or similar information or data are or will be required by Contractor for such purposes. 3. It is understood that the City shall investigate and determine the qualifications of the apparent low responsive bidder prior to awarding the contract. The City shall reject any bid by a nonqualified or disqualified bidder. The City of Ashland reserves the right to reject for any good cause any or all bids, waive formalities, or to accept any bid which appears to serve the best interests of the City. The City reserves the right to reject any bid not in compliance with all prescribed public bidding procedures and requirements and may reject all bids for good cause upon a finding that it is in the public interest to do so. Evaluation of bids will be based on minimum requirements established by the specifications and compliance with conditions of the Notice to Contractors and Invitation to Bid, and compliance with City public contracting rules. Additional evaluation criteria are as follows: None. 4. The deadline to file a written protest or request, pursuant to the Instructions to Bidders to change contract terms, conditions or specifications is not less than ten 10 calendar days prior to bid. opening. Bid closing may be extended by the City to consider a protest or request. 5. All of the contract documents, including all plans, specifications, and drawings have been examined and an examination of the site of the proposed work, together with such investigations as are necessary to determine the conditions to be encountered have been made by the undersigned and the terms and conditions of the contract and solicitation documents are hereby accepted, and that if this Offer is accepted, the undersigned will contract with the City of Ashland, Oregon, in a form substantially similar to that attached Agreement and agree to be bound to the terms and conditions of said contract and solicitation documents. 6. It is understood that the contract drawings may be supplemented by additional drawings and specifications in explanation and elaboration thereof and, if they are not in conflict with those referred to in paragraph 1 above, they shall have the saine force and effect as though they were attached, and they shall be accepted as part of the contract when issued. 7. The undersigned agrees that upon written acceptance of this bid s/he will, within ten working days, of receipt of such notice, execute a formal contract agreement with the City. The undersigned further agrees that s/he will provide the following in order to execute the contract: Performance Bond and Corporate Surety Payment Bond, both in the amount equal to 100% of the awarded contract; Certificates of Insurance for Liability and property damage coverage; Certificates of Coverage for Workman Compensation and unemployment insurance; All other bonds, permits, licenses, etc. as required in the contract documents. 8. It is understood that all the work will be performed under a lump sum or unit price basis and that for the lump sum or unit price all services, materials, labor, equipment, and all work necessary to complete the project in accordance with the plans and specifications shall be furnished for the said lump sum or unit price named. It is understood that the quantities stated in connection with the price schedule for the contract are approximate only and payment shall be made at the unit prices mined for the actual quantities 13 incorporated in the completed work, If there shall be an increase in the amount of work covered by the lump sum price, it shall be computed on a basis of "extra work" for which an increase in payment will have been earned and if there be a decrease in the lump sum payment, it shall be made only as a result of negotiation between the undersigned and the Owner. Furthermore, it is understood that any estimate with respect to time, materials, equipment, or service which may appear on the plans or in the specifications is for the sole purpose of assisting the undersigned in checking the undersigned's own independent calculations and that at no time shall the undersigned attempt to hold the Owner, the Engineer, or any other person, ft-m or corporation responsible for any errors or omissions that may appear in any estimate. 9. The undersigned submits the unit prices as those at which he will perform the work involved. The extensions of the column headed "ITEM TOTAL" are made for the sole purpose of facilitating bid comparisons and if there are any discrepancies between the unit prices and the total amount shown, the unit prices shall govern. 10. The undersigned agrees to furnish labor, tools, machinery, materials, transportations, equipment and services of all kinds required for, necessary for, or reasonably incidental to, construction of this Project with all appurtenant work as required by the plans and specifications of this Offer for the unit or lump sum prices in the "BID SCHEDULE". 11. In stating prices, it is understood that the prices include all materials and work required to complete the project in accordance with the Contract Documents, the plans and the specifications. If any material, item, or service required by the plans and specifications has not been mentioned specifically in the "BID SCHEDULE," the same shall be furnished and placed with the understanding that the full cost to the City has been merged with the several prices stated in the "BID SCHEDULE." 12. The City reserves the right to cancel this solicitation or to reject any and all bids in whole or in part when the cancellation or rejection is in the best interests of the City as detennined by the City in accordance with ORS 279B.100 13. The foregoing prices shall include all labor, materials, equipment, overhead, profit, insurance, and all other incidental expenses to cover the finished work of the several kinds called for. Unit prices are to be shown in both words and figures. In case of any discrepancy, the amounts shown in words shall govern. 14. Upon receipt of written notice of the acceptance of its bid, Bidder shall execute a formal contract with the City within ten (10) days, deliver surety bond or bonds as required, and deliver required proof of insurance. The bid security attached in the sum of five percent (5%) of the total price for the bid or combination of bids is to become the property of the Owner in the event the contract and bond are not executed within the time above set forth as liquidated damages for the delay and additional expense to the Owner caused thereby. 15. If the proposed bid price will exceed $50,000.00 the undersigned, as bidder, acknowledges that provisions of ORS 279C.800 to 279C.870 relating to workers on public works to be paid not less than prevailing rate of wage shall be included in the contract, or in the alternative, if the project is to be funded with federal fiords and is subject to the Davis-Bacon Act (40 U.S.C. §276a) bidder agrees to comply with the Davis- Bacon Act requirements. "Prevailing Wage Rates for Public Works Contracts in Oregon," which are incorporated herein by reference, and can be accessed at: htlps://www oregon aov/boli/WHD/PWR/Pages_/nwr state.aspx 16. The undersigned shall furnish bonds required by the specifications and comply with the laws of the Federal Government, State of Oregon and the City of Ashland which are pertinent to construction contracts of this nature even though such laws may not have been quoted or referred to in the specifications. 14 17. Accomp hying this Offer is a certified check, cashier's check or a QbonD for the sum of 611, , payable to the City of Ashland, Oregon, this being an amount for ten percent (10%) of the total bid based upon the estimate of quantities at the above price according to the conditions of the advertisement. If this Offer is accepted by the City and the undersigned fails to execute a satisfactory contract and bonds as stated in the Advertisement within ten (10) working days from the date of notification, then the City may, at its option, determine that the undersigned has abandoned the contract and there upon this Offer shall be considered null and void, and the bid security accompanying this Offer shall be forfeited to and become the property of the City of Ashland. If the bid is not accepted, the bid security accompanying this Offer shall be returned to the undersigned. 18. The undersigned agrees to comply with the provisions of ORS 279C.800 to 279C.870, the Oregon Prevailing Wage law. The undersigned, as bidder, acknowledges that provisions of ORS 279C.800 to 279C.870 relating to workers on public works to be paid not less than prevailing rate of wage shall be included in the contract, or in the alternative, if the project is to be funded with federal funds and is subject to the Davis-Bacon Act (40 U.S.C. §276a), bidder agrees to comply with the Davis-Bacon Act requirements. The undersigned Contractor agrees to be bound by and will comply with the provisions of ORS 279C.838, 279C.840 or 40 U.S.C. 3141 to 3148. [OAR 137-049-0200(1)(a)(J)]. 19. The undersigned certifies that the undersigned Contractor is not ineligible to receive a contract for a public work pursuant to ORS 279C.860. Bidder further agrees, if awarded a contract, that every subcontractor will be eligible to receive a contract for a public work pursuant to ORS 279C_860. 20. The undersigned certifies that the undersigned Contractor has not discriminated against minority, women or emerging small businesses enterprises in obtaining any required subcontracts. The bidder understands and acknowledges that it may be disqualified from bidding on this public improvement project as set forth in OAR 137-049-0370, including but not limited to City discovery a misrepresentation or sham regarding a subcontract or that the Bidder has violated any requirement of ORS 279A.110 or the administrative rules implementing the Statute. 21. The undersigned agrees that the time of completion shall be defined in the specifications, and further, the undersigned agrees to initiate and complete this Project by the date stated below. • The work shall be commenced within ten (10) business days after receipt of the written Notice to Proceed. • The work shall be completed in all respects by November 22, 2019 after Notice to Proceed. • The undersigned agrees that the "Time of Completion" shall be as defined in the specifications and that the bidder will complete the work within the number of consecutive calendar days stated for each schedule after "Notice to Proceed" has been issued by the Owner. Bidder furthermore agrees to pay as liquidated damages, for each calendar day thereafter, the amounts shown in Standard Conditions, for each day the project remains incomplete. 22. The undersigned bidder is registered with the Oregon Construction Contractors Board (CCB), the registration is current and valid, and the bidder's registration number is stated below. [OAR 137-049- 0230(1)] Bidder understands that failure to have a current CCB license shall result in rejection of this bid. 23. The undersigned bidder is licensed. by the State Landscape Contractors Board, if applicable, the license is current and valid, and the bidder's registration number is stated below. [OAR 137-049-0200(1)(a)(K)] Bidder understands that failure to have a current LCB license shall result in rejection of this bid. 15 24. In determining the lowest responsible bidder, City shall, for the purpose of awarding the contract, add a percent increase on the bid of a non-resideut bidder equal to the percent, if any, of the preference given to that bidder in the state in which the bidder resides. "Resident bidder" of Oregon means a bidder that has paid unemployment taxes or income taxes in this state during the 12 calendar months immediately preceding submission of the bid, has a business address in this state and has stated in the bid that the bidder is a "resident bidder" of the State of Oregon. The undersigned represents him/her self in this bid to be either a Resident or a Nonresident bidder by completing the appropriate blank below. The Bidder is U or is not a Resident Bidder as defined in ORS 279A.120. 25. The undersigned hereby represents that no Councilor, Commissioner, officer, agency or employee of the City of Ashland is personally interested directly or indirectly in this Contract or the compensation to be paid hereunder and that no representation, statement or statements, oral or in writing, of the City, its Councilors, Commissioners, officers, agents or employees had induced him/her to enter into this Contract, and the papers made a part of its terms; 26. The undersigned has not directly or indirectly induced or solicited any person to submit a false or sham bid or refrain from bidding. The undersigned certifies that this bid has been arrived at independently and submitted without connection with any person, finn or corporation making a bid for the same material and is, in all respects, fair and without collusion or fraud. 27. The undersigned confirms that this firm has a Qualified Drug Testing Program for employees in place and will demonstrate this prior to award of contract. [OAR 137-049-0200(1)(c)(B)J 28. The undersigned confirms that if this contract involves asbestos abatement or removal, the bidder is licensed under ORS 468A.710 for asbestos removal. Asbestos abatement is not implicated in this contract. 29. The City of Ashland may waive minor informalities, reject any bid not in compliance with all prescribed public bidding procedures and requirements, and may reject for good cause any or all bids upon a finding that it is in the public interest to do so. 30. The rmdersigned confirms that this offer is not contingent upon City's acceptance of any terms and conditions other than those contained in this Solicitation and the Contract Documents. 31. The bidder understands that the City reserves the right to make changes to the Notice to Contractors Invitation to Bid and the resulting contract by written addenda, prior to the closing time and date. The City will transmit addenda to registered plan holders but shall publish notice of any addenda on City's website (www.ashland.or.us) at the Public Works page. The addenda may be downloaded or picked up at the Department of Public Works, 51 Winburn Way, Ashland, Oregon. The bidder must check the website and Public Works bulletin board frequently until closing. The bidder acknowledges that the Addendum(s) listed below have been reviewed online or a copy obtained and considered as part of the submittal of this Offer and Bid Schedule. ADDENDUM NUMBER I THROUGH 9- HAVE BEEN REVIEWED ~ 32. The bidder understands that the City will be awarding the contract to the Respo 'ble Bidder 4 with the lowest Responsive Bid. OAR 137-049-0200(1)(b)(C). Whether a bidder is responsible will be determined by ORS 279C.375 and the City's completion of the attached Bidder Responsibility Determination Form. 16 33. Instructions for First-Tier Subcontractors Disclosure. Bidders are required to disclose information about certain first-tier subcontractors (those subcontractors contracting directly with the bidder) when the contract price exceeds $100,000 (see ORS 279C.370). Specifically, when the contract amount of a first-tier subcontractor is greater than or equal to: (i) 5% of the project bid, but at least $15,000, or (ii) $350,000 regardless of the percentage, you must disclose the following information about that subcontract within two working hours of bid closing: The subcontractor's name and address; • The subcontractor's Construction Contractor Board registration number, if one is required, and; • The subcontract dollar value. If you will not be using any subcontractors that are subject to the above disclosure requirements, you are required to indicate "NONE" on the form. Failure to submit this form by the disclosure deadline will result in a non-responsive bid. A non-responsive bid will not be considered for award. THE CITY MAY REJECT A BID IF THE BIDDER FAILS TO SUBMIT THE DISCLOSURE FORM WITH THIS INFORMATION WITHIN TWO HOURS OF BID CLOSING. THIS DOCUMENT SHALL NOT BE FAXED. IT IS THE RESPONSIBILITY OF BIDDERS TO SUBMIT THIS DISCLOSURE FORM AND ANY ADDITIONAL SHEETS BY THE DEADLINE. SEE INSTRUCTIONS TO BIDDERS. The disclosure should be submitted on the First-Tier Subcontractor Disclosure Form attached to this Invitation to Bid. 34. Bidder Information and Signature wzq }5~ i (mot wti 2 Firm Name of Bidder~&at Signat IofCBid Printed Name of Bidder 5g24 ZtiW x11502 / ~ Fw ` y4l,6070 Official Title State of Inco1 ration CCB Number cf 20 Dated this day of Naive of Bidder l t! h 4!l 'l/ ` ~ / L Address l,,. / oye j T'S0 2 Telephone No, 17 BID SCHEDULE Oak Street Waterline Replacement 542°~ 099 e11509, ProiectNo. 2018-32 It'd , 541 . ~r•?~ ' Spec. Unit Price No. Description # Q Unit Bid Total Price Bid I Mobilization (Not to Exceed 8%) 00210 1 Lump ~ioc> 4--- Sum lC~ V d 2 Construction Survey Work 00305 1 Lump 1 ~6 e-V 6 Z9 3 Temporary Work Zone Traffic Control, 00225 1 Lump Complete Sum 0c, d ~JJU 4 Erosion Control 00280 1 Sum /00 2/~0 5 Rock Excavation 00330 1 YCubic ard 6 Trench, Level 3,1/7.-0" HMAC 4" Thickness 00495 311 yard 60bz c L' . cw 7 Cold Plane Pavement Removal 00620 1826 Square Yard 8 Aggregate Shoulders, Parking, Staging area 00640 833 Square ard '/Z Street Inlay Level 3, 3/4"-0" HMAC 2" 00744 Square / p~ p f 9 Thickness 1826 Yard J_ 10 Bollard 00815 1 Each Y'' T. 11 Force Balanced Flex-Tend Coupler 01140 2 Each '00o /-OG 00 8-inch Class 54 Ductile Iron Pipe, Fittings Linear 12 and Couplings with Restrained Joints and 01140 2673 Foot C ~t,AS, E 3~Ct`F i L t. 13 Ductile Iron Pipe Elbow 11. 5, 22.5, and 90 01140 15 Each 14 Ductile Iron Pipe Tees, 8" x 8" x 8" 01140 2 Each l oc;« 15 Ductile Iron Pipe Tees, 8" x 6" x 8" 01140 3 Each 5 16 8-inch Gate Valve 01150 6 Each l0 O SJc~ o 17 6-inch Gate Valves 01160 3 Each 18 Hydrant Assemblies 01160 3 Each 55<xt . l - ;S 19 Polyethylene Encasement 100 Linear Foot e 20 90 Degree Pipe Supports 4 Each goo - - - - - - - - / Total Nance of Authorized Representative r Total ritten it/bolla'rs A orized Re pr sentative ignature Date 18 FIRST-TIER SUBCONTRACTOR DISCLOSURE FORM INSTRUCTIONS instructions for Submitting Form Submit the First-Tier Subcontractor Disclosure form in any of the following manners: • Not later than two working hours after the ti2ne set for opening Bids. (For example, before 11:00 a.m. after a 9:00 ami. Bid Opening.) Submit according to one of the following methods: • Print the form fiom the Bid Booklet, till it in, and either: o Deliver to the following address where it can be time and date stamped City of Ashland Community Development and Engineering Services Building 51 Winburn Way Ashland, OR 97520, or o FAX it to (541) 488-6005. The Agency is not responsible for partial, failed, illegible, or partially legible FAX transmissions or electronic submissions. Instructions for First-Tier:SuhconXraglgr Disclosure Without regard to the amount of a Bidder's Bid, if the Agency's cost range for a public improvement project in the "Notice to Contractors", or in other advertisement or solicitation documents is greater than $100,000, bidders are required to disclose information about first-tier subcontractors that will furnish labor or labor and materials (See ORS 279C370). Specifically, when the contract amount of a first-tier subcontractor is greater than or equal to: (1) 5% of the total project Bid, but at least $15,000, or (2) $350,000 regardless of the percentage of the total project Bid, you must disclose the followuig information about that subcontractor not later than two working hours after the time set for opening Bids: • The name of the subcontractor • The category of work that the subcontractor will be performing • The dollar amount of the subcontract If the Agency's cost range is greater than $100,000 and you will not be using any first-tier subcontractors, you are still required to submit the form, with the appropriate box checked or enter "NONE" on the first line. If the Agency's cost range is greater than $100,000 and you are not subject to the above disclosure requirements, you are still required to submit the form, with the appropriate box checked or enter "NONE" on the first line. THE AGENCY MUST REJECT BIDS if the Bidder fails to submit the disclosure form with this information by the stated deadline. 19 To determine disclosure requirements, the Agency recommends that you disclose subcontract information for any subcontractor as follows: 1) Determine the lowest possible prime contract price. That will be the base Bid amount less all alternate deductive Bid amounts (exclusive of any options that can only be exercised after Bid award). 2) Provide the required disclosure information for any fast-tier subcontractor whose potential contract services are greater tlam or equal to: (1) 5% of the lowest contract price, but at least $15,000, or (2) $350,000 regardless of the percentage. Total all possible work for each subcontractor in snaking this determination, (for example, if a subcontractor will provide $15,000 worth of services on the base Bid and $40,000 on an additive alternate, then the potential amount of the subcontractor's services is $55,000. Assuming that $55,000 exceeds 5% of the lowest contract price, provide the disclosure for both the $15,000 services and the $40,000 services). 20 FIRST-TIER SUBCONTRACTOR DISCLOSURE FORM Project Name Oak Street Waterline Replacement Project Number 2018-32 Bid Opening Date`` / Q °O tfy Name of Bidding Contractor ❑ CHECK THIS BOXIF YOU 1"LL NOT BE USING ANY FIRST-77ER SUBCONTRACTORS OR IF YOUARE NOT SUBJECTTO THE DI.SCLOSUREREQUIREMENTS (SEE INSTRUCTIONS) Firm Name ~~/j ? Dollar Amount Category of Work /7 t. VJ~ CJCSe) Firm Name 'ti Cam'" Dollar Amount Cate go of Work r : er+~~ Sd Ofit~ Firm Name t., ft, t AV Dollar Amount Category of Work 4O-6 GY/r+ r 50co ir- Firm Name V" 4' t `t Cx Y Dollar Amount Category of Work /acv O Firm Name Dollar Amouat Category of Work Finn Name Dollar Amormt Category of Work Firm Name Dollar Amount Category of Work (Attach additional sheets as necessary) 21 This ime intentionally left blank 22 EXHIBIT E BONDS CITY OF ASHLAND STANDARD PUBLIC IMPROVEMENT CONTRACT BID BOND We, West Coast Pipeline, LLC. a corporation or partnership duly organized under the laws of the State of Oregon and authorized to transact business in the State of Oregon, as "PRINCIPAL," and, We, Merchants National Bonding, Inc. a corporation partnership duly organized under the laws of the State of Iowa and authorized to transact business in the State of Oregon, as "SURETY," hereby jointly and severally bind ourselves, our respective heirs, executors, administrators, successors and //assigns firmly by these presents to pay unto the City of Ashland, Oregon, (OBLIGEE) the sum of l7 1Cx of total artinurr bio ) Ten percent of total amount bid Dollars. The condition of the obligation of this bond, is that the PRINCIPAL herein has in response to City's Notice to Cartractum and Invitation to Bid, submitted its Offer for the Oak Sheet Water-line Replacement No 2018- L2 , which Offer is incorporated herein and made a part hereof by this reference, and Principal is required to furnish bid security in an amount equal to ten (10%) percent of the total amount of the bid pursuant to ORS 279C.365 and the City's public contracting rules and contract documents. NOW THEREFORE, If the Offer, submitted by PRINCIPAL, is accepted, and if the Contract pursuant to the Offer is awarded to the PRINCIPAL, and if the PRINCIPAL executes such contract and furnishes such good and sufficient Performance and Payment Bonds as required by the Bidding and Contract documents within the time specified and fixed by the Documents, then this obligation shall be void; otherwise it shall remain in full force and effect. If the PRINCIPAL shall fail to execute the proposed Contract and to furnish the Performance and Payment Bonds, the SURETY hereby agrees to pay the OBLIGEE the surety bond sum as liquidated damages within ten (10) days of such failure. IN WITNESS WHEREOF, we have caused this instrument to be executed and sealed by our duly authorized legal representatives this 15 th day of _ Auuc u s t ZO 19. Merchants National West Coast Bonding, Inc. Pipeline, LLC. Surety Principal iaa~e [_~~s nwe:nr A sn~rp 5925 Upton Rd C~ntrai ec:nr_, c'F. - Address Address B By. :.ni`e hlc. vrmic Attorney -in-Fact [A certified copy of the Agent's Power of Attorney must be attached hereto.] 54 ' MERCHANTS BONDING COMPANY. POWER OF ATTORNEY Know All Persons By These Presents, that MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC., both being corporations of the State of Iowa (herein collectively called the "Companies") do hereby make, constitute and appoint, Individually, Conor Davidson; James S Ewald; Jeanette Simmons; Jenifer McCormick; Marc Baker; Wolter VanDoorninck their true and lawful Attorney(s)4n-Fact, to sign its name as surety(ies) and to execute, seal and acknowledge any and all bonds, undertakings, contracts and other written Instruments In the nature thereof, on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. This Power-of-Attomey is granted and is signed and sealed by facsimile under and by authority of the following By-Laws adopted by the Board of Directors of Merchants Bonding Company (Mutual) on April 23, 2011 and amended August 14, 2015 and adopted by the Board of Directors of MerchantsNatlonal Bonding, Inc., on October 18, 2015. "The President, Secretary, Treasurer, or any Assistant Treasurer or any Assistant Secretary or any Vice President shall have power and authority to appoint Atlomeys-In-Fed, and to authorize them to execute on behalf of the Company, and attach the seal of the Company thereto, bonds and undertakings, recognizances, contracts of Indemnity and other writings obligatory in the nature thereof." 'The signature of any authorized officer and the seal of the Company may be affixed by facsimile or electronic transmission to any Power of Attorney or Certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligations of the Company, and such signature and seal when so used shall have the same force and effect as though manually fixed' In connection with obligations In favor of the Florida Department of Transportation only, It Is agreed that the power and out hority hereby given to the Aftomey-in-Fact Includes any and all consents for the release of retained percentages and/or final estimates on engineering and construction contracts required by the State of Florida Department of Transportation. It Is fully understood that consenting to the State of Florida Department of Transportation making payment of the final estimate to the Contractor and/or its assignee, shall not relieve this surety company of any of its obligations under its bond. In connection with obligations in favorof the Kentucky Department of Highways only, It is agreed that the power and authority hereby given to the Atomey-in-Fact cannot be modified or revoked unless prior written personal notice of such Intent has been given to the Commissioner- Department of Highways of the Commonwealth of Kentucky at least thirty (30) days prior to the modification or revocation. In Witness Whereof, the Companies have caused this instrument to be signed and sealed this 5th day of February , 2018 ~•~pf~PO Ae.~. a~.NG CQA• MERCHANTS BONDING COMPANY (MUTUAL) 'A4-•G~~ A4!•'*yC : m~yO4 *-.A~; MERCHANT NATIONAL BONDING, INC. 01 2003 ; j*; 1933 By 's~d••. ,...;lac: : vdg •ac. .•/(r ~ ~1 President ' STATE OF IOWA COUNTY OF DALLAS as. On this this 5th day of February 2018 , before me appeared Larry Taylor, to me personally known, who being by me duly sworn did say that he is President of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC.; and that the seals affixed to the foregoing Instrument are the Corporate Seals of the Companies; and that the said instrument was signed and sealed in behalf of the Companies by authority of their respective Boards of Directors. IA4 i.VSL - s ALICIA K. GRAM v Commission Number 767430 , My Commission bVires , April 1, 2020 O' Notary Public (Expiration of rotary's commission does not Invalidate this instrument) I, William Warner, Jr., Secretary of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC., do hereby certify that the above and foregoing Is a true and correct copy of the POWER-OF-ATTORNEY executed by said Companies, which is still in full force and effect and has not been amended or revoked. In Witness Whereof, I have hereunto set my hand and affixed the seal of the Companies on this 15th day of August , 2015 . 0pg49% 'p~~'QpQA hy-GOP Rq~;.Oa: : 0:v0 'I.(•yc~ h/..G~v'rr ~J . aF2 -o- aloe ~Yz _o_ o; 6s2.•x~ p. 2003 :gym - ; y 1933 Secretary :°d ac:• POA 0018 (3117) ® DATE (MMIDDNYYY) A~~ o CERTIFICATE OF LIABILITY INSURANCE 9118/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Brown & Brown Northwest NCONTACT AME: Susan Wilson 3256 Hillcrest Park Drive PHONE 541 494-2658 ac No: 541-494-2758 Medford, OR 97504 E-MAIL ADDRESS: swilsan bbnw.com INSURERS AFFORDING COVERAGE NAIC p www.bbnw.com INSURERA: Ohio Secud Insurance Company 24082 INSURED INSURER B: SAIF West Coast Pipeline LLC 5924 Upton Road INSURER C: Travelers Casualty and Sure Co America 31194 Central Point OR 97502 INSURER D: Ohio Casualty Insurance Company 24074 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 51199650 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. MEN ADDLSUBR POLICY EFF POLICY UP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER (MMIDDNYYYI MMIDD/YY1'Y WSO 2= A COMMERCIAL GENERAL LIABILITY ✓ ✓ BKS58627297 5/9/2019 5/9/2020 EACH OCCURRENCE $100000 0 DAMAGE TO CLAIMS-MADE M OCCUR PREMISES E.Eoccu ante $100,000 MED UP (Any one person) $5000 PERSONAL &ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE 52,000,000 POLICY F,/ I IRI F-1 LOG PRODUCTS -COMPIOPAGG s2,000,000 OTHER: $ A AUTOMOBILE LIABILITY ✓ ✓ BA558627297 5/912019 5/9/2020 COMBINED SINGLE LIMIT $1,000,000 Ea accident ✓ ANYAUTO BODILY INJURY (Per person) $ OWNED H SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident S D UMBRELLA LIAB ✓ OCCUR US058627297 519/2019 5/9/2020 EACH OCCURRENCE $3000000 EXCESS LIAB CLAIMS-MADE AGGREGATE $3,000,000 DIED RETENTIONS $ B WORKERS COMPENSATION 866776 5/1/2019 5/1/2020 ✓ PER ✓ ERH Exceeds Statute AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNETEXECUTIVE YIN NIA EL EACH ACCIDENT $1000000 OFFICER/MEMBEREXCLUDED7 (Mandatory In NH) E.L. DISEASE-EA EMPLOYE $1 000000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE-POLICY LIMIT $1000000 G Motor Truck Cargo QT6609J965726TIL18 5/912019 5/9/2020 Limit: $1,000,000 - Deductible $5,000 Rented/Leased Equipment Limit: $200,000 - Deductible $2,500 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Sehedule, maybe attached if more space is required) General Liability and Auto Liability include Additional Insured coverage including Primary & Non-contributory, Waiver of Subrogation & Per Project Aggregate per attached endorsements CG88100413, CG88701208 & AC85010618 when required by written contract. Subject to policy terms, limits, conditions and exclusions. Re: Oak Street Waterline Replacement CERTIFICATE HOLDER CANCELLATION SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 East Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Ashland OR 97520 AUTHORIZED REPRESENTATNE Susan Wilson ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 51199650 1 044263 1 19-20 GL/AUTO/OMB/WC I Suean Wilson 19/18/2019 9:52:06 AM (PUT) I Page 1 of 17 COMMERCIAL GENERAL LIABILITY CG 88 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL GENERAL LIABILITY EXTENSION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART INDEX SUBJECT PAGE NON-OWNED AIRCRAFT 2 NON-OWNED WATERCRAFT 2 PROPERTY DAMAGE LIABILITY - ELEVATORS 2 EXTENDED DAMAGE TO PROPERTY RENTED TO YOU (Tenant's Property Damage) 2 MEDICAL PAYMENTS EXTENSION 3 EXTENSION OF SUPPLEMENTARY PAYMENTS - COVERAGES A AND B 3 ADDITIONAL INSUREDS - BY CONTRACT, AGREEMENT OR PERMIT 3 PRIMARY AND NON-CONTRIBUTORY - ADDITIONAL INSURED EXTENSION 5 ADDITIONAL INSUREDS - EXTENDED PROTECTION OF YOUR "LIMITS OF INSURANCE" 6 WHO IS AN INSURED - INCIDENTAL MEDICAL ERRORS/MALPRACTICE AND WHO IS AN INSURED - 6 FELLOW EMPLOYEE EXTENSION - MANAGEMENT EMPLOYEES NEWLY FORMED OR ADDITIONALLY ACQUIRED ENTITIES 7 FAILURE TO DISCLOSE HAZARDS AND PRIOR OCCURRENCES 7 KNOWLEDGE OF OCCURRENCE, OFFENSE, CLAIM OR SUIT 7 LIBERALIZATION CLAUSE 7 BODILY INJURY REDEFINED 7 EXTENDED PROPERTY DAMAGE 8 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US - 8 WHEN REQUIRED IN A CONTRACT OR AGREEMENT WITH YOU 2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Pagel of 8 5'_1956`,0 1 04.1.:63 19 2 ; G_/AU I,' W_:i WSt Say n,I I, I 9/Ia/2 C19 ',2 .,t L. _E 2 1 . With respect to coverage afforded by this endorsement, the provisions of the policy apply unless modified by the endorsement. A. NON-OWNED AIRCRAFT Under Paragraph 2. Exclusions of Section I - Coverage A - Bodily Injury And Property Damage Liability, exclusion g. Aircraft, Auto Or Watercraft does not apply to an aircraft provided: 1. It is not owned by any insured; 2. It is hired, chartered or loaned with a trained paid crew; 3. The pilot in command holds a currently effective certificate, issued by the duly constituted authority of the United States of America or Canada, designating her or him a commercial or airline pilot; and 4. It is not being used to carry persons or property for a charge. However, the insurance afforded by this provision does not apply if there is available to the insured other valid and collectible insurance, whether primary, excess (other than insurance written to apply specifically in excess of this policy), contingent or on any other basis, that would also apply to the loss covered under this provision. B. NON-OWNED WATERCRAFT Under Paragraph 2. Exclusions of Section I - Coverage A- Bodily Injury And Property Damage Liability, Subparagraph (2) of exclusion g. Aircraft, Auto Or Watercraft is replaced by the following: This exclusion does not apply to: (2) A watercraft you do not own that is: (a) Less than 52 feet long; and (b) Not being used to carry persons or property for a charge. C. PROPERTY DAMAGE LIABILITY-ELEVATORS 1. Under Paragraph 2. Exclusions of Section I - Coverage A- Bodily Injury And Property Damage Liability, Subparagraphs (3), (4) and (6) of exclusion j. Damage To Property do not apply if such "property damage" results from the use of elevators. For the purpose of this provision, elevators do not include vehicle lifts. Vehicle lifts are lifts or hoists used in automobile service or repair operations. 2. The following is added to Section IV - Commercial General Liability Conditions, Condition 4. Other Insurance, Paragraph b. Excess Insurance: The insurance afforded by this provision of this endorsement is excess over any property insurance, whether primary, excess, contingent or on any other basis. D. EXTENDED DAMAGE TO PROPERTY RENTED TO YOU (Tenant's Property Damage) If Damage To Premises Rented To You is not otherwise excluded from this Coverage Part: 1. Under Paragraph 2. Exclusions of Section I - Coverage A - Bodily Injury and Property Damage Liability: a. The fourth from the last paragraph of exclusion j. Damage To Property is replaced by the following: Paragraphs (1), (3) and (4) of this exclusion do not apply to "property damage" (other than damage by fire, lightning, explosion, smoke, or leakage from an automatic fire protection system) to: (i) Premises rented to you for a period of 7 or fewer consecutive days; or (ii) Contents that you rent or lease as part of a premises rental or lease agreement for a period of more than 7 days. Paragraphs (1), (3) and (4) of this exclusion do not apply to "property damage" to contents of premises rented to you for a period of 7 or fewer consecutive days. A separate limit of insurance applies to this coverage as described in Section III - Limits of Insurance. © 2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 8 51199650 1 044263 1 19-20 GL/AM/UMB/WC I Susan Wilson 1 9/16/2019 9:52:06 A (PDT) I Page 3 of 17 b. The last paragraph of subsection 2. Exclusions is replaced by the following: , Exclusions c. through n. do not apply to damage by fire, lightning, explosion, smoke or leakage from automatic fire protection systems to premises while rented to you or temporarily occupied by you with permission of the owner. A separate limit of insurance applies to Damage To Premises Rented To You as described in Section III - Limits Of Insurance. 2. Paragraph 6. under Section III - Limits Of Insurance is replaced by the following: 6. Subject to Paragraph 5. above, the Damage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of "property damage" to: a. Any one premise: (1) While rented to you; or (2) While rented to you or temporarily occupied by you with permission of the owner for damage by fire, lightning, explosion, smoke or leakage from automatic protection systems; or b. Contents that you rent or lease as part of a premises rental or lease agreement. 3. As regards coverage provided by this provision D. EXTENDED DAMAGE TO PROPERTY RENTED TO YOU (Tenant's Property Damage) - Paragraph 9.a. of Definitions is replaced with the following: 9.a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, lightning, explosion, smoke, or leakage from automatic fire protection systems to premises while rented to you or temporarily occupied by you with the permission of the owner, or for damage to contents of such premises that are included in your premises rental or lease agreement, is not an "insured contract". E. MEDICAL PAYMENTS EXTENSION If Coverage C Medical Payments is not otherwise excluded, the Medical Payments provided by this policy are amended as follows: Under Paragraph 1. Insuring Agreement of Section I - Coverage C - Medical Payments, Subparagraph (b) of Paragraph a. is replaced by the following: (b) The expenses are incurred and reported within three years of the date of the accident; and F. EXTENSION OF SUPPLEMENTARY PAYMENTS - COVERAGES A AND B 1. Under Supplementary Payments - Coverages A and B, Paragraph 1.b. is replaced by the following: b. Up to $3,000 for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds. 2. Paragraph 1.d. is replaced by the following: d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or "suit", including actual loss of earnings up to $500 a day because of time off from work. G. ADDITIONAL INSUREDS - BY CONTRACT, AGREEMENT OR PERMIT 1. Paragraph 2. under Section II - Who Is An Insured is amended to include as an insured any person or organization whom you have agreed to add as an additional insured in a written contract, written agreement or permit. Such person or organization is an additional insured but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused in whole or in part by: a. Your acts or omissions, or the acts or omissions of those acting on your behalf, in the performance of your on going operations for the additional insured that are the subject of the written contract or written agreement provided that the "bodily injury" or "property damage" occurs, or the "personal and advertising injury" is committed, subsequent to the signing of such written contract or written agreement; or © 2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 3 of 8 r.~i_.,~ 16 _ T,._ _ 2 7 b. Premises or facilities rented by you or used by you; or c. The maintenance, operation or use by you of equipment rented or leased to you by such person or organization; or d. Operations performed by you or on your behalf for which the state or political subdivision has issued a permit subject to the following additional provisions: (1) This insurance does not apply to "bodily injury", "property damage", or "personal and advertising injury" arising out of the operations performed for the state or political subdivision; (2) This insurance does not apply to "bodily injury" or "property damage" included within the "completed operations hazard". (3) Insurance applies to premises you own, rent, or control but only with respect to the following hazards: a) The existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, street banners, or decorations and similar exposures; or (b) The construction, erection, or removal of elevators; or (c) The ownership, maintenance, or use of any elevators covered by this insurance. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. With respect to Paragraph 1.a. above, a person's or organization's status as an additional insured under this endorsement ends when: (1) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or (2) That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. With respect to Paragraph 1.b. above, a person's or organization's status as an additional insured under this endorsement ends when their written contract or written agreement with you for such premises or facilities ends. With respects to Paragraph 1.c. above, this insurance does not apply to any "occurrence" which takes place after the equipment rental or lease agreement has expired or you have returned such equipment to the lessor. The insurance provided by this endorsement applies only if the written contract or written agreement is signed prior to the "bodily injury" or "property damage". We have no duty to defend an additional insured under this endorsement until we receive written notice of a "suit" by the additional insured as required in Paragraph b. of Condition 2. Duties In the Event Of Occurrence, Offense, Claim Or Suit under Section IV - Commercial General Liability Conditions. © 2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 4 of 8 51199650 1 044263 1 19-20 GL/A=/OMB/WC I Susan Wilson 1 9/18/2019 9:52:06 AM (PG) I Page 5 of 17 2. With respect to the insurance provided by this endorsement, the following are added to Paragraph 2. Exclusions under Section 1 - Coverage A - Bodily Injury And Property Damage Liability: This insurance does not apply to: a. "Bodily injury" or "property damage" arising from the sole negligence of the additional insured. b. "Bodily injury" or "property damage" that occurs prior to you commencing operations at the location where such "bodily injury"or "property damage" occurs. C. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: (1) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (2) Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury' or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of, or the failure to render, any professional architectural, engineering or surveying services. d. "Bodily injury" or "property damage" occurring after: (1) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or (2) That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. e. Any person or organization specifically designated as an additional insured for ongoing operations by a separate ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS endorsement issued by us and made a part of this policy. 3. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: a. Required by the contract or agreement; or b. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. H. PRIMARY AND NON-CONTRIBUTORY ADDITIONAL INSURED EXTENSION This provision applies to any person or organization who qualifies as an additional insured under any form or endorsement under this policy. Condition 4. Other Insurance of SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: a. The following is added to Paragraph a. Primary Insurance: If an additional insured's policy has an Other Insurance provision making its policy excess, and you have agreed in a written contract or written agreement to provide the additional insured coverage on a primary and noncontributory basis, this policy shall be primary and we will not seek contribution from the additional insured's policy for damages we cover. © 2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 5 of 8 51199650 1 044263 1 19-20 GL/AVID/OMB/WC I Susan Wilson 1 9/18/2019 9:52:06 AM (PUT) I Page 6 of 17 b. The following is added to Paragraph b. Excess Insurance: When a written contract or written agreement, other than a premises lease, facilities rental contract or agreement, an equipment rental or lease contract or agreement, or permit issued by a state or political subdivision between you and an additional insured does not require this insurance to be primary or primary and non-contributory, this insurance is excess over any other insurance for which the additional insured is designated as a Named Insured. Regardless of the written agreement between you and an additional insured, this insurance is excess over any other insurance whether primary, excess, contingent or on any other basis for which the additional insured has been added as an additional insured on other policies. 1. ADDITIONAL INSUREDS - EXTENDED PROTECTION OF YOUR "LIMITS OF INSURANCE" This provision applies to any person or organization who qualifies as an additional insured under any form or endorsement under this policy. 1. The following is added to Condition 2. Duties In The Event Of Occurrence, Offense, Claim or Suit: An additional insured under this endorsement will as soon as practicable: a. Give written notice of an "occurrence" or an offense that may result in a claim or "suit" under this insurance to us; b. Tender the defense and indemnity of any claim or "suit" to all insurers whom also have insurance available to the additional insured; and c. Agree to make available any other insurance which the additional insured has for a loss we cover under this Coverage Part. d. We have no duty to defend or indemnify an additional insured under this endorsement until we receive written notice of a "suit" by the additional insured. 2. The limits of insurance applicable to the additional insured are those specified in a written contract or written agreement or the limits of insurance as stated in the Declarations of this policy and defined in Section 111- Limits of Insurance of this policy, whichever are less. These limits are inclusive of and not in addition to the limits of insurance available under this policy. J. WHO IS AN INSURED - INCIDENTAL MEDICAL ERRORS / MALPRACTICE WHO IS AN INSURED - FELLOW EMPLOYEE EXTENSION - MANAGEMENT EMPLOYEES Paragraph 2.a.(1) of Section II - Who Is An Insured is replaced with the following: (1) "Bodily injury" or "personal and advertising injury": (a) To you, to your partners or members (if you are a partnership or joint venture), to your members (if you are a limited liability company), to a co-"employee" while in the course of his or her employment or performing duties related to the conduct of your business, or to your other "volunteer workers" while performing duties related to the conduct of your business; (b) To the spouse, child, parent, brother or sister of that co-"employee" or "volunteer worker" as a consequence of Paragraph (1) (a) above; (c) For which there is any obligation to share damages with or repay someone else who must pay damages because of the injury described in Paragraphs (1) (a) or (b) above; or (d) Arising out of his or her providing or failing to provide professional health care services. However, if you are not in the business of providing professional health care services or providing professional health care personnel to others, or if coverage for providing professional health care services is not otherwise excluded by separate endorsement, this provision (Paragraph (d)) does not apply. © 2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 6 of 8 51199650 1 044263 1 19-20 GL/AUTO/LMB/WC I Susan Wilson 1 9/18/2019 9:52:06 AM (PM) I Page 7 of 17 Paragraphs (a) and (b) above do not apply to "bodily injury" or "personal and advertising injury" caused by an , "employee" who is acting in a supervisory capacity for you. Supervisory capacity as used herein means the "employee's" job responsibilities assigned by you, includes the direct supervision of other "employees" of yours. However, none of these "employees" are insureds for "bodily injury" or "personal and advertising injury" arising out of their willful conduct, which is defined as the purposeful or willful intent to cause "bodily injury" or "personal and advertising injury", or caused in whole or in part by their intoxication by liquor or controlled substances. The coverage provided by provision J. is excess over any other valid and collectable insurance available to your "employee". K. NEWLY FORMED OR ADDITIONALLY ACQUIRED ENTITIES Paragraph 3. of Section II - Who Is An Insured is replaced by the following: 3. Any organization you newly acquire or form and over which you maintain ownership or majority interest, will qualify as a Named Insured if there is no other similar insurance available to that organization. However: a. Coverage under this provision is afforded only until the expiration of the policy period in which the entity was acquired or formed by you; b. Coverage A does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed the organization; and c. Coverage B does not apply to "personal and advertising injury" arising out of an offense committed before you acquired or formed the organization. d. Records and descriptions of operations must be maintained by the first Named Insured. No person or organization is an insured with respect to the conduct of any current or past partnership, joint venture or limited liability company that is not shown as a Named Insured in the Declarations or qualifies as an insured under this provision. L. FAILURE TO DISCLOSE HAZARDS AND PRIOR OCCURRENCES Under Section IV - Commercial General Liability Conditions, the following is added to Condition 6. Representations: Your failure to disclose all hazards or prior "occurrences" existing as of the inception date of the policy shall not prejudice the coverage afforded by this policy provided such failure to disclose all hazards or prior "occurrences" is not intentional. M. KNOWLEDGE OF OCCURRENCE, OFFENSE, CLAIM OR SUIT Under Section IV - Commercial General Liability Conditions, the following is added to Condition 2. Duties In The Event of Occurrence, Offense, Claim Or Suit: Knowledge of an "occurrence", offense, claim or "suit" by an agent, servant or "employee" of any insured shall not in itself constitute knowledge of the insured unless an insured listed under Paragraph 1. of Section II - Who Is An Insured or a person who has been designated by them to receive reports of "occurrences", offenses, claims or "suits" shall have received such notice from the agent, servant or "employee". N. LIBERALIZATION CLAUSE If we revise this Commercial General Liability Extension Endorsement to provide more coverage without additional premium charge, your policy will automatically provide the coverage as of the day the revision is effective in your state. 0. BODILY INJURY REDEFINED Under Section V - Definitions, Definition 3. is replaced by the following: 3. "Bodily Injury" means physical injury, sickness or disease sustained by a person. This includes mental anguish, mental injury, shock, fright or death that results from such physical injury, sickness or disease. © 2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 7 of 8 51199650 1 044263 1 19-20 GL/AUTO/UMB/WC i Susan Wilson 1 9/18/2019 9:52:06 AM (PDT) i Page 6 of 17 P. EXTENDED PROPERTY DAMAGE Exclusion a. of COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY is replaced by the following: a. Expected Or Intended Injury "Bodily injury" or "property damage" expected or intended from the standpoint of the insured. This exclusion does not apply to "bodily injury" or "property damage" resulting from the use of reasonable force to protect persons or property. Q. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US - WHEN REQUIRED IN A CONTRACT OR AGREEMENT WITH YOU Under Section IV - Commercial General Liability Conditions, the following is added to Condition 8. Transfer Of Rights Of Recovery Against Others To Us: We waive any right of recovery we may have against a person or organization because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products-completed operations hazard" provided: 1. You and that person or organization have agreed in writing in a contract or agreement that you waive such rights against that person or organization; and 2. The injury or damage occurs subsequent to the execution of the written contract or written agreement. © 2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance services Office, Inc., with its permission. Page 8 of 8 51199650 1 044263 1 19-20 GL/AUTO/MB/WC I Suean Wilson 1 9/16/2019 9:52:06 AM (POT) I Page 9 of 17 COMMERCIAL GENERAL LIABILITY CG 88 70 12 08 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONSTRUCTION PROJECT(S) - GENERAL AGGREGATE LIMIT (PER PROJECT) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under Section I - Coverage A - Bodily Injury And Property Damage Liability, and for all medical expenses caused by accidents under Section I - Coverage C Medical Payments, which can be attributed only to ongoing operations at a single construction project away from premises owned by or rented to you: 1. A separate Construction Project General Aggregate Limit applies to each construction project, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2. The Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under Coverage A, except damages because of "bodily injury" or "property damage" included in the "products-completed operations hazard", and for medical expenses under Coverage C regardless of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits". 3. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the Construction Project General Aggregate Limit for that construction project. Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Construction Project General Aggregate Limit for any other construction project. 4. The limits shown in the Declarations for Each Occurrence, Fire Damage and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Construction Project General Aggregate Limit. B. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under Section 1- Coverage A - Bodily Injury And Property Damage Liability, and for all medical expenses caused by accidents under Section I - Coverage C Medical Payments, which cannot be attributed only to ongoing operations at a single construction project away from premises owned by or rented to you: 1. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products-Completed Operations Aggregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Construction Project General Aggregate Limit. C. When coverage for liability arising out of the "products-completed operations hazard" is provided, any payments for damages because of "bodily injury" or "property damage" included in the "products- completed operations hazard" will reduce the Products-Completed Operations Aggregate Limit, and not reduce the General Aggregate Limit nor the Construction Project General Aggregate Limit. D. If the applicable construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project. E. The provisions of Section III - Limits Of Insurance not otherwise modified by this endorsement shall continue to apply. CG 88 70 12 08 Includes copyrighted material of ISO Properties, Inc., with its permission. Page 1 of 1 51199650 1 044263 1 19-20 GL/AUTO/OMB/WC I Susan Wilson 1 9/10/2019 9:52:06 AM (POT) I Page 10 of 17 COMMERCIAL AUTO AC 85 01 06 18 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO COVERAGE ENHANCEMENT ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage afforded by this endorsement, the provisions of the policy apply unless modified by the endorsement. If the policy to which this endorsement is attached also contains a Business Auto Coverage Enhancement Endorsement with a specific state named in the title, this endorsement does not apply to vehicles garaged in that specified state. COVERAGEINDEX SUBJECT PROVISION NUMBER ACCIDENTAL AIRBAG DEPLOYMENT 13 ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT 4 AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS 21 AMENDED FELLOW EMPLOYEE EXCLUSION 6 AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE 15 BODILY INJURY REDEFINED 25 EMPLOYEES AS INSUREDS (Including Employee Hired Auto) 3 EXTRA EXPENSE - BROADENED COVERAGE 11 GLASS REPAIR -WAIVER OF DEDUCTIBLE 17 HIRED AUTO COVERAGE TERRITORY 23 HIRED AUTO PHYSICAL DAMAGE (Including Employee Hired Auto) 7 LOAN / LEASE GAP (Coverage Not Available In New York) 16 NEWLY FORMED OR ACQUIRED SUBSIDIARIES 2 PARKED AUTO COLLISION COVERAGE (WAIVER OF DEDUCTIBLE) 18 PERSONAL EFFECTS COVERAGE 12 PHYSICAL DAMAGE - ADDITIONAL TRANSPORTATION EXPENSE COVERAGE 9 PHYSICAL DAMAGE DEDUCTIBLE -VEHICLE TRACKING SYSTEM 14 PRIMARY AND NON-CONTRIBUTORY -WRITTEN CONTRACT OR WRITTEN AGREEMENT 24 RENTAL REIMBURSEMENT 10 SUPPLEMENTARY PAYMENTS 5 TOWING AND LABOR 8 TRAILERS - INCREASED LOAD CAPACITY 1 s TWO OR MORE DEDUCTIBLES 19 UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS 20 WAIVER OF TRANSFER OF RIGHTS OF RECOVERYAGAINST OTHERS TO US 22 x SECTION I - COVERED AUTOS is amended as follows: 1. TRAILERS - INCREASED LOAD CAPACITY The following replaces Paragraph C.1. Certain Trailers, Mobile Equipment And Temporary Substitute Autos of SECTION I - COVERED AUTOS: "Trailers" with a load capacity of 3,000 pounds or less designed primarily for travel on public roads. © 2017 Liberty Mutual Insurance AC 85 01 06 18 Includes copyrighted material of Insurance Services Office Inc.,with its Permission. Page 1 of 7 51199650 1044263 19-20 GL/AUTO/OMB/WC Susan Wilson 19/10/2019 9:53:06 AM (PDT) I Page 11 of 17 SECTION II - LIABILITY COVERAGE is amended as follows: 2. NEWLY FORMED OR ACQUIRED SUBSIDIARIES SECTION II - LIABILITY COVERAGE, Paragraph A.I. - Who Is An Insured is amended to include the following as an "insured": d. Any legally incorporated subsidiary of which you own more than 50 percent interest during the policy period. Coverage is afforded only for 90 days from the date of acquisition or formation. However, "insured" does not include any organization that: (1) Is a partnership or joint venture; or (2) Is an "insured" under any other automobile policy except a policy written specificall y to apply in excess of this policy; or (3) Has exhausted its Limit of Insurance or had its policy terminated under any other automobile policy. Coverage under this provision d. does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed the organization. " 3. EMPLOYEES AS INSUREDS SECTION II - LIABILITY COVERAGE, Paragraph A.1. Who Is An Insured is amended to include the following as an "insured": e. Any "employee" of yours while using a covered "auto" you do not own, hire or borrow but only for acts within the scope of their employment by you. Insurance provided by this endorsement is excess over any other insurance available to any "employee". f. Any "employee" of yours while operating an "auto" hired or borrowed under a written contract or agreement in that "employee's" name, with your permission, while performing duties related to the conduct of your business and within the scope of their employment. Insurance provided by this endorsement is excess over any other insurance available to the "employee". 4. ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT SECTION II - LIABILITY COVERAGE, Paragraph A.1. Who Is An Insured is amended to include the following as an "insured": g. Any person or organization with respect to the operation, maintenance or use of a covered "auto", provided that you and such person or organization have agreed in a written contract, written agreement, or permit issued to you by governmental or public authority, to add such person, or organization, or governmental or public authority to this policy as an "insured". However, such person or organization is an "insured": (1) Only with respect to the operation, maintenance or use of a covered "auto"; (2) Only for "bodily injury" or "property damage" caused by an "accident" which takes place after you executed the written contract or written agreement, or the permit has been issued to you; and (3) Only for the duration of that contract, agreement or permit. The "insured" is required to submit a claim to any other insurer to which coverage could apply for defense and indemnity. Unless the "insured" has agreed in writing to primary noncontributory wording per enhancement number 24, this policy is excess over any other collectible insurance. 5. SUPPLEMENTARY PAYMENTS SECTION II - LIABILITY COVERAGE, Coverage Extensions, 2.a. Supplementary Payments, Paragraphs (2) and (4) are replaced by the following: (2) Up to $3,000 for cost of bail bonds (including bonds for related traffic violations ) required because of an "accident" we cover. We do not have to furnish these bonds. (4) All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $500 a day because of time off from work. © 2017 Liberty Mutual Insurance AC 85 01 06 18 Includes copyrighted material of Insurance Services Office Inc., with its Permission. Page 2 of 7 51199650 1044263 119-20 GL/AUTO/UMB/WG I Susan Wilson 19/18/2019 9:52:06 AM (PUT) Page 12 of 17 6. AMENDED FELLOW EMPLOYEE EXCLUSION In those jurisdictions where, by law, fellow "employees" are not entitled to the protection afforded to the employer by the workers compensation exclusivity rule, or similar protection, the following provi- sion is added: SECTION II - LIABILITY, Exclusion B.5. Fellow Employee does not apply if the "bodily injury" results from the use of a covered "auto" you own or hire if you have workers compensation insurance in force for all of your "employees" at the time of "loss". This coverage is excess over any other collectible insurance. SECTION III - PHYSICAL DAMAGE COVERAGE is amended as follows: 7. HIRED AUTO PHYSICAL DAMAGE Paragraph A.4. Coverage Extensions of SECTION III - PHYSICAL DAMAGE COVERAGE, is amended by adding the following: If hired "autos" are covered "autos" for Liability Coverage, and if Comprehensive, Specified Causes of Loss or Collision coverage are provided under the Business Auto Coverage Form for any "auto" you own, then the Physical Damage coverages provided are extended to "autos": a. You hire, rent or borrow; or b. Your "employee" hires or rents under a written contract or agreement in that "employee's" name, but only if the damage occurs while the vehicle is being used in the conduct of your business, subject to the following limit and deductible: a. The most we will pay for "loss" in any one "accident" or "loss" is the smallest of: (1) $50,000; or (2) The actual cash value of the damaged or stolen property as of the time of the "loss"; or (3) The cost of repairing or replacing the damaged or stolen property with other property of like kind and quality, minus a deductible. b. The deductible will be equal to the largest deductible applicable to any owned "auto" for that coverage. c. Subject to the limit, deductible and excess provisions described in this provision, we will provide coverage equal to the broadest coverage applicable to any covered "auto" you own. d. Subject to a maximum of $1,000 per "accident", we will also cover the actual loss of use of the hired "auto" if it results from an "accident", you are legally liable and the lessor incurs an actual financial loss. e. This coverage extension does not apply to: (1) Any "auto" that is hired, rented or borrowed with a driver; or (2) Any "auto" that is hired, rented or borrowed from your "employee" or any member of your "employee's" household. Coverage provided under this extension is excess over any other collectible insurance available at the time of "loss". 8. TOWING AND LABOR SECTION 111 - PHYSICAL DAMAGE COVERAGE, Paragraph A.2. Towing, is amended by the addition of the fallowing: We will pay towing and labor costs incurred, up to the limits shown below, each time a covered "auto" classified and rated as a private passenger type, "light truck" or "medium truck" is disabled: a. For private passenger type vehicles, we will pay up to $75 per disablement. b. For "light trucks", we will pay up to $75 per disablement. "Light trucks" are trucks that have a gross vehicle weight (GVVV) of 10,000 pounds or less. c. For "medium trucks" , we will pay up to $150 per disablement. "Medium trucks" are trucks that have a gross vehicle weight (GVV\o of 10,001 - 20,000 pounds. However, the labor must be performed at the place of disablement. © 2017 Liberty Mutual Insurance AC 85 01 06 18 Includes copyrighted material of Insurance Services Office Inc.,with its Permission. Page 3 of 7 51199650 1 044263 119-20 GL/A=/9 /WC Susan Wilson 9/16/2019 9:52:06 AM (PVT) I Page 13 of 17 9. PHYSICAL DAMAGE -ADDITIONAL TRANSPORTATION EXPENSE COVERAGE , Paragraph A.4.a. Coverage Extensions, Transportation Expenses of SECTION III - PHYSICAL DAMAGE COVERAGE, is amended to provide a limit of $50 per day and a maximum limit of $1,500. 10. RENTAL REIMBURSEMENT SECTION III - PHYSICAL DAMAGE COVERAGE, A. Coverage, is amended by adding the following: a. We will pay up to $75 per day for rental reimbursement expenses incurred by you for the rental of an "auto" because of "accident" or "loss", to an "auto" for which we also pay a "loss" under Comprehensive, Specified Causes of Loss or Collision Coverages. We will pay only for those ex- penses incurred after the first 24 hours following the "accident" or "loss" to the covered "auto." b. Rental Reimbursement requires the rental of a comparable or lessor vehicle, which in many cases may be substantially less than $75 per day, and will only be allowed for the period of time it should take to repair or replace the vehicle with reasonable speed and similar quality, up to a maximum of 30 days. c. We will also pay up to $500 for reasonable and necessary expenses incurred by you to remove and N replace your tools and equipment from the covered "auto". This limit is excess over any other collectible insurance. d. This coverage does not apply unless you have a business necessity that other "autos" available for your use and operation cannot fill. e. If "loss" results from the total theft of a covered "auto" of the private passenger type, we will pay ° under this coverage only that amount of your rental reimbursement expenses which is not already provided under Paragraph 4. Coverage Extension. f. No deductible applies to this coverage. g. The insurance provided under this extension is excess over any other collectible insurance. If this policy also provides Rental Reimbursement Coverage you purchased, the coverage provided by this Enhancement Endorsement is in addition to the coverage you purchased. For the purposes of this endorsement provision, materials and equipment do not include "personal effects" as defined in provision 12.13. 11. EXTRA EXPENSE - BROADENED COVERAGE Under SECTION III - PHYSICAL DAMAGE COVERAGE, A. Coverage, we will pay for the expense of returning a stolen covered "auto" to you. The maximum amount we will pay is $1,000. 12. PERSONAL EFFECTS COVERAGE A. SECTION III - PHYSICAL DAMAGE COVERAGE, A. Coverage, is amended by adding the following: If you have purchased Comprehensive Coverage on this policy for an "auto" you own and that "auto" is stolen, we will pay, without application of a deductible, up to $600 for "personal effects" stolen with the "auto." The insurance provided under this provision is excess over any other collectible insurance. B. SECTION V - DEFINITIONS is amended by adding the following: For the purposes of this provision, "personal effects" mean tangible property that is worn or carried by an "insured." "Personal effects" does not include tools, equipment, jewelry, money or securi- ties. 13. ACCIDENTAL AIRBAG DEPLOYMENT SECTION III - PHYSICAL DAMAGE COVERAGE, B. Exclusions is amended by adding the following: If you have purchased Comprehensive or Collision Coverage under this policy, the exclusion for "loss" relating to mechanical breakdown does not apply to the accidental discharge of an airbag. Any insurance we provide shall be excess over any other collectible insurance or reimbursement by manufacturer's warranty. However, we agree to pay any deductible applicable to the other coverage or warranty. © 2017 Liberty Mutual Insurance AC 85 01 06 18 Includes copyrighted material of Insurance Services Office Inc., with its Permission. Page 4 of 7 51199650 044263 19-20 GL/AUTO/UMS/WC Susan Wilson 19/18/2019 9:52:06 AM (PDT) Page 14 of 17 14. PHYSICAL DAMAGE DEDUCTIBLE - VEHICLE TRACKING SYSTEM SECTION III - PHYSICAL DAMAGE COVERAGE, D. Deductible, is amended by adding the following: Any Comprehensive Deductible shown in the Declarations will be reduced by 50% for any "loss" caused by theft if the vehicle is equipped with a vehicle tracking device such as a radio tracking device or a global position device and that device was the method of recovery of the vehicle. 15. AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE SECTION III - PHYSICAL DAMAGE COVERAGE, B. Exclusions, Paragraph a. of the exception to exclu- sions 4.c. and 4.d. is deleted and replaced with the following: Exclusions 4.c. and 4.d. do not apply to: a. Electronic equipment that receives or transmits audio, visual or data signals, whether or not de- signed solely for the reproduction of sound, if the equipment is: (1) Permanently installed in the covered "auto" at the time of the "loss" or removable from a housing unit that is permanently installed in the covered "auto"; and (2) Designed to be solely operated by use from the power from the "auto's" electrical system; and (3) Physical damage coverages are provided for the covered "auto". If the "loss" occurs solely to audio, visual or data electronic equipment or accessories used with this equipment, then our obligation to pay for, repair, return or replace damaged or stolen property will be reduced by a $100 deductible. 16. LOAN / LEASE GAP COVERAGE (Not Applicable In New York) A. Paragraph C. Limit Of Insurance of SECTION III - PHYSICAL DAMAGE COVERAGE is amended by adding the following: The most we will pay for a "total loss" to a covered "auto" owned by or leased to you in any one "accident" is the greater of the: 1. Balance due under the terms of the loan or lease to which the damaged covered "auto" is subject at the time of the "loss" less the amount of., a. Overdue payments and financial penalties associated with those payments as of the date of the "loss"; b. Financial penalties imposed under a lease due to high mileage, excessive use or abnormal wear and tear; c. Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insur- ance purchased with the loan or lease; d. Transfer or rollover balances from previous loans or leases; e. Final payment due under a "Balloon Loan"; f. The dollar amount of any unrepaired damage which occurred prior to the "total loss" of a covered "auto"; g. Security deposits not refunded by a lessor; h. All refunds payable or paid to you as a result of the early termination of a lease agreement or as a result of the early termination of any warranty or extended service agreement on a covered "auto"; I. Any amount representing taxes; j. Loan or lease termination fees; or 2. The actual cash value of the damage or stolen property as of the time of the "loss". An adjustment for depreciation and physical condition will be made in determining the actual cash value at the time of the "loss". This adjustment is not applicable in Texas. B. Additional Conditions This coverage applies only to the original loan for which the covered "auto" that incurred the "loss" serves as collateral, or lease written on the covered "auto" that incurred the "loss". © 2017 Liberty Mutual Insurance AC 85 01 06 18 Includes copyrighted material of Insurance Services Office Inc.,with its Permission. Page 5 of 7 51199650 1 044263 1 19-20 GL/AUT0/➢M3/WC I SU6dn Wilson 19/18/2019 9:52:06 AM (PDT) I Page 15 of 17 C. SECTION V - DEFINITIONS is changed by adding the following: As used in this endorsement provision, the following definitions apply: "Total loss" means a "loss" in which the cost of repairs plus the salvage value exceeds the actual cash value. A "balloon loan" is one with periodic payments that are insufficient to repay the balance over the term of the loan, thereby requiring a large final payment. 17. GLASS REPAIR- WAIVER OF DEDUCTIBLE Paragraph D. Deductible of SECTION 111 - PHYSICAL DAMAGE COVERAGE is amended by the addition of the following: No deductible applies to glass damage if the glass is repaired rather than replaced. ° 18. PARKED AUTO COLLISION COVERAGE (WAIVER OF DEDUCTIBLE) Paragraph D. Deductible of SECTION III - PHYSICAL DAMAGE COVERAGE is amended by the addition of the following: The deductible does not apply to "loss" caused by collision to such covered "auto" of the private _ passenger type or light weight truck with a gross vehicle weight of 10,000 lbs. or less as defined by the manufacturer as maximum loaded weight the "auto" is designed to carry while it is: a. In the charge of an "insured"; b. Legally parked; and c. Unoccupied. The "loss" must be reported to the police authorities within 24 hours of known damage. The total amount of the damage to the covered "auto" must exceed the deductible shown in the Declarations. This provision does not apply to any "loss" if the covered "auto" is in the charge of any person or a organization engaged in the automobile business. 19. TWO OR MORE DEDUCTIBLES Under SECTION III - PHYSICAL DAMAGE COVERAGE, if two or more company policies or coverage forms apply to the same "accident", the following applies to Paragraph D. Deductible: a. If the applicable Business Auto deductible is the smaller (or smallest) deductible, it will be waived; or b. If the applicable Business Auto deductible is not the smaller (or smallest) deductible , it will be reduced by the amount of the smaller (or smallest) deductible; or c. If the "loss" involves two or more Business Auto coverage forms or policies, the smaller (or smallest) deductible will be waived. For the purpose of this endorsement, company means any company that is part of the Liberty Mutual Group. a SECTION IV - BUSINESS AUTO CONDITIONS is amended as follows: 20. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS SECTION IV- BUSINESS AUTO CONDITIONS, Paragraph B.2. is amended by adding the following: " If you unintentionally fail to disclose any hazards, exposures or material facts existing as of the incep- tion date or renewal date of the Business Auto Coverage Form, the coverage afforded by this policy will not be prejudiced. However, you must report the undisclosed hazard of exposure as soon as practicable after its discovery, and we have the right to collect additional premium for any such hazard or exposure. © 2017 Liberty Mutual Insurance AC 85 01 06 18 Includes copyrighted material of Insurance Services Office Inc., with its Permission. Page 6 of 7 51199650 1 044263 1 19-20 GL/AOTO/U /WC I Susan Wilson 9/18/2019 9:52:06 AM (POT) Page 19 of ll 21. AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT, OR LOSS SECTION IV - BUSINESS AUTO CONDITIONS, Paragraph A.2.a. is replaced in its entirety by the follow- ing: a. In the event of "accident", claim, "suit" or "loss", you must promptly notify us when it is known to: (1) You, if you are an individual; (2) A partner, if you are a partnership; (3) Member, if you are a limited liability company; (4) An executive officer or the "employee" designated by the Named Insured to give such notice, if you are a corporation. To the extent possible, notice to us should include: (a) How, when and where the "accident" or "loss" took place; (b) The "insureds" name and address; and (c) The names and addresses of any injured persons and witnesses. 22. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US SECTION IV - BUSINESS AUTO CONDITIONS, Paragraph A.S. Transfer Of Rights Of Recovery Against Others To Us, is amended by the addition of the following: If the person or organization has in a written agreement waived those rights before an "accident" or "loss", our rights are waived also. 23. HIRED AUTO COVERAGE TERRITORY SECTION IV - BUSINESS AUTO CONDITIONS, Paragraph B.7. Policy Period, Coverage Territory, is amended by the addition of the following: f. For "autos" hired 30 days or less, the coverage territory is anywhere in the world, provided that the "insured's" responsibility to pay for damages is determined in a "suit", on the merits, in the United States, the territories and possessions of.the United States of America, Puerto Rico or Canada or in a settlement we agree to. This extension of coverage does not apply to an "auto" hired, leased, rented or borrowed with a driver. 24. PRIMARY AND NON-CONTRIBUTING IF REQUIRED BY WRITTEN CONTRACT OR WRITTEN AGREE- MENT The following is added to SECTION IV - BUSINESS AUTO CONDITIONS, General Conditions, B.S. Other Insurance and supersedes any provision to the contrary: This Coverage Form's Covered Autos Liability Coverage is primary to and will not seek contribution from any other insurance available to an "insured" under your policy provided that: 1. Such "insured" is a Named Insured under such other insurance; and 2. You have agreed in a written contract or written agreement that this insurance would be primary and would not seek contribution from any other insurance available to such "insured". SECTION V - DEFINITIONS is amended as follows: 25. BODILY INJURY REDEFINED Under SECTION V - DEFINITIONS, Definition C. is replaced by the following: "Bodily injury" means physical injury, sickness or disease sustained by a person, including mental anguish, mental injury, shock, fright or death resulting from any of these at any time. © 2017 Liberty Mutual Insurance AC 85 01 06 18 Includes copyrighted material of Insurance Services Office Inc., with its Permission. Page 7 of 7 51199650 044293 1 19-20 GL/AUTO1UM9/WC Susan Wilson 9/16/2019 9:52:06 AM (POT) I Page 17 of 17 Council Business Meeting September 17, 2019 Agenda Item Approval of a Construction Contract with West Coast Pipeline, for the Oak Street Waterline Replacement Project (PW 2018-32) From Paula C. Brown, PE Public Works Director Chance Metcalf Project Manager Contact Paul a.brown (c_ashland.or.us; (541) 552-2411 chance.metcalf6a~ashland. or.us; (541) 552-2448 SUMMARY Before Council, acting as the Local Contract Review Board, is approval of a construction contract with West Coast Pipeline, for the Oak Street Waterline Replacement Project with a total contract amount of $346,462.50. POLICIES, PLANS & GOALS SUPPORTED City Council Goals (supported by this project): Goal 1: Develop current and long-term budgetary resilience Evaluate revenue streams Goal 2: Analyze City departments/programs to gain efficiencies, reduce costs and improve services Goal 3: Enhance and improve transparency and communication - Develop a robust program to engage with Ashland citizens about City priorities and our progress on those priorities... Maintain Essential Services - Drinking Water System Continue to leverage resources to develop and/or enhance Value Services - Water Conservation Department Goals: • Maintain existing infrastructure to meet regulatory requirements and minimize life-cycle costs • Deliver timely life cycle capital improvement projects • Maintain and improve infrastructure that enhances the economic vitality of the community • Evaluate all city infrastructure regarding planning management and financial resources PREVIOUS COUNCIL ACTION Council approved the Capital Improvements Program (CIP) on April 2, 2019. The CIP includes the construction of Oak Street Waterline Replacement in the 2019-21 biennium. Likewise, the 2019-21 Biennial Budget (BN) included this project in the Water fund for $400,000 in the first year (2019-20). BACKGROUND AND ADDITIONAL INFORMATION The City of Ashland released the Invitation to Bid (ITB) documents resulting in a public improvement contract for supplying all labor, equipment, and materials necessary to construct the Oak Street Waterline Replacement Project No. 2018-32. This project includes, but is not limited to the following major work items: earthwork, replacement of waterline infrastructure, and asphalt concrete paving. The ITB was posted on the Oregon Procurement Information Network (ORPIN) on August 6, 2019, and documents were also on file at the City in the Community Development Building at 51 Winburn Way. Bids were received and opened on September 3, 2019. Five bids were received from Brittania Excavation, Kogap Enterprises, Knife River Page 1 of 2 CITY OF ASHLAND Materials, Central Pipeline, and West Coast Pipeline, all deemed responsive. West Coast Pipeline provided the lowest bid. Oak Street Waterline Replacement Project (2018-32) West Coast Central Knife River Kogap Britannia Pipeline Pipeline Materials Enterprises Excavation $346,462.50 $347,151.00 $404,757.00 $417,858.00 $503,938.69 FISCAL IMPACTS The 2019-21 Water Division BN includes funds for contracted services (capital improvement program) in the amount of $400,000 for this project. The Oak Street Waterline Replacement Project was designed in-house. Staff's construction estimate for the Oak Street Waterline Replacement Project was $404,225. The bid amount is $57,762 below the engineer's estimate and well within the budgeted amount. STAFF RECOMMENDATION Staff recommends approval of a construction contract with West Coast Pipeline for the Oak Street Waterline Replacement Project for a contract amount of $346,462.50. ACTIONS, OPTIONS & POTENTIAL MOTIONS Council, acting as the Local Contract Review Board, has the option to approve this contract or refer action back to staff to rebid the project or request that the project not be constructed. Potential motions include: 1. I move to approve the construction contract with West Coast Pipeline for the Oak Street Waterline Replacement Project for a contract amount of $346,462.50. 2. I move to direct staff to develop a new solicitation and construction bid for this project. 3. I move that Council remove this priority project from the current Capital Improvements Project list and not make the improvements to the Oak Street Waterline Replacement Project. REFERENCES & ATTACHMENTS Attachment 1: Public Improvement Contract Between the City and West Coast Pipeline Page 2 of 2 CITY OF -ASHLAND CITY OF ASHLAND %hi A PUBLIC IMPROVEMENT CONTRACT FOR OAK STREET WATERLINE REPLACEMENT PROJECT NO. 2018-32 This Public Improvement Contract (hereinafter "Contract") is entered into by and between the CITY OF ASHLAND, an Oregon municipal corporation (hereinafter "City"), and West Coast Pipeline LLC (hereinafter "Contractor"). NOW THEREFORE, for good and valuable consideration, the sufficiency of which is hereby acknowledged, the parties mutually covenant and agree as follows: 1. PROJECT MANAGER: The City's Project Manager for this Contract is: Chance Metcalf City o Ashland Public Works En inQ eerie Department. 2. WORK: 2.1. The Work under this Contract is for the Oak Street Waterline Replacement Project No. 2018-32 as more fully described in the Contract Documents listed in Section 5 of EXHIBIT A, STANDARD TERMS AND CONDITIONS FOR PUBLIC IMPROVEMENT CONTRACTS. Contractor shall complete all Work as specified in the Contract Documents. The Work is generally described as follows: The installation of approximately 2628 linear feet of 8-inch ductile iron waterline along with related fittings and appurtenances. The Statement of Work, including the delivery schedule for the Work, is contained in the Contract Documents. 2.2. Contractor shall, at its own risk and expense, perform the Work described in the Contract Documents and furnish all permits, labor, tools, machinery, materials, transportation, equipment and services of all kinds required for, necessary for, or reasonable incidental to, performance of the Work, that is, the construction of the Oak Street Waterline Replacement Project No. 2018-32. Contractor shall secure all municipal, County, State, or Federal Permits or licenses including payment of permit fees, license fees, and royalties necessary for or incidental to the performance of the Work. The risk of loss for such Work shall not shift to the City until written acceptance of the Work by the City. 3. EFFECTIVE DATE AND DURATION: 23 This Contract is effective as of the date of execution by the City (the "Effective Date"). All Work under this Contract shall, unless otherwise terminated or extended, be completed by November 22, 2019 following Contractor's receipt of the written Notice to Proceed. 4. CONSIDERATION 4.1. City agrees to pay Contractor, at the times and in the manner provided in the Contract Documents, the sum of $346,462.50 for performing the Work required by this Contract, including allowable expenses. This sum cannot be modified except by Change Order approved in writing by the City. Any progress payments to Contractor shall be made only in accordance with the schedule and the requirements as set forth in the Standard Terms and Conditions. 4.2. City certifies that sufficient funds have been appropriated to make payments required by this Contract during the current fiscal year. Contractor understands and agrees that City's payment of amounts under this Contract attributable to Work performed after the last day of the current fiscal year is contingent upon City appropriations, or other expenditure authority sufficient to allow City in the exercise of its reasonable discretion, to continue to make payments under this Contract. In the event City has insufficient appropriations, limitations or other expenditure authority, City may terminate this Contract without penalty or liability to City, effective upon the delivery of written notice to Contractor, with no further liability to Contractor. 5. CONTRACTOR'S REPRESENTATIONS In order to induce City to enter into this Contract, Contractor makes the following representations: 5.1. Contractor has examined and carefully studied the Contract Documents, and any data and reference items identified in the Contract Documents. 5.2. Contractor has visited the Site, conducted a thorough, alert visual examination of the Site and adjacent areas, and become familiar with and is satisfied as to the general, local, and Site conditions that may affect cost, progress, and performance of the Work. 5.3. Contractor is familiar with and is satisfied as to all laws and regulations that may affect cost, progress, and performance of the Work. 5.4. Contractor has carefully studied all drawings of physical conditions relating to existing surface or subsurface structures at the Site that have been identified in the Supplementary Conditions, especially with respect to Technical Data in such reports and drawings, and reports and drawings relating to Hazardous Environmental Conditions, if any, at or adjacent to the Site that have been identified in the Supplementary Conditions, especially with respect to Technical Data in such reports and drawings. 5.5. Contractor has considered the information known to Contractor itself; information commonly known to contractors doing business in the locality of the Site; information and observations obtained from visits to the Site; the Contract Documents; and the Site-related reports and drawings identified in the Contract Documents, with respect to the effect of such information, observations, and documents on (1) the cost, progress, and performance of the Work; (2) the means, methods, techniques, sequences, and procedures of construction to be employed by Contractor; and (3) Contractor's safety precautions and programs. 5.6. Based on the information and observations referred to in the preceding paragraph, Contractor agrees that no further examinations, investigations, explorations, tests, studies, or data are 24 necessary for the performance of the Work at the Contract Price, within the Contract Times, and in accordance with the other terms and conditions of the Contract. 5.7. Contractor is aware of the general nature of work to be performed by City and others at the Site that relates to the Work as indicated in the Contract Documents. 5.8. Contractor has given City written notice of all conflicts, errors, ambiguities, or discrepancies that Contractor has discovered in the Contract Documents, and the written resolution thereof by City is acceptable to Contractor. 5.9. The Contract Documents are generally sufficient to indicate and convey understanding of all terms and conditions for performance and furnishing of the Work. 6. GOVERNING LAW The provisions of this Contract shall be construed in accordance with the laws of the State of Oregon. Any action or suits involving any question arising under this contract must be brought in the appropriate court in Jackson County, Oregon. If the claim must be brought in a federal forum, then it shall be brought and conducted in the United States District Court for the District of Oregon. Contractor, by the signature herein of its authorized representative, hereby consents to the in persona jurisdiction of said courts. In no event shall this section be construed as a waiver of the City of any form of defense or immunity. 25 CONTRACTOR DATA, CERTIFICATION, AND SIGNATURE Business Name (please print): Contact Name: Phone: Fax: Address Do Not Write Federal and State Tax ID Numbers on this Agreement: One copy of W-9 is to be submitted with the signed contract to be kept on file in the City ofAshland Finance Department. Ashland Business License # Construction Contractors Board # Citizenship: Nonresident alien Yes No Business Designation (check one): Individual Sole Proprietorship Partnership Corporation Government/Nonprofit The above information must be provided prior to contract approval. Payment information will be reported to the Internal Revenue Service (IRS) under the name and taxpayer I.D. number provided above. (See IRS 1099 for additional instructions regarding taxpayer ID numbers.) Information not matching IRS records could subject you to 31 percent backup withholding. I, the undersigned, understand that the Standard Terms and Conditions For Public Improvement Contracts (Exhibit A) together with Exhibits B through J together with all other Contract Documents as described in Standard Terms and Conditions Section 5 below, and the separately bound Oregon 2018 Standard Specifications for Construction, as amended by the City of Ashland's most recent Addenda to the 2018 Standard Specifications are an integral part of this contract and agree to perform the work described in the Contract Documents, including Exhibit A, in accordance with the terms and conditions of this contract. I further understand the City is prohibited from entering into a contract when the contractor has neglected or refused to file any return, pay any tax, or properly contest a tax, pursuant to ORS 305.385; I hereby certify, under penalty of perjury and false swearing, that I/my business am/is not in violation of any Oregon tax laws; I further certify that the certification and representations in Standard Term and Condition # 16 [CCB Registration Requirements] are true and correct, and further I certify that I am an independent contractor as defined in ORS 670.600. 26 CONTRACTOR: Signature/Title Printed name Date NOTICE TO CONTRACTOR: This contract does not bind the City of Ashland unless and until it has been executed by the Public Contracting Officer or designee. CITY OF ASHLAND SIGNATURE CITY: City Administrator, City of Ashland Date ATTACHMENTS: Certificate of Representation Standard Terms & Conditions Bid Schedule Insurance Requirements 27 CERTIFICATE OF REPRESENTATION Contractor, under penalty of perjury, certifies that: (a) The number shown on this form is its correct taxpayer ID (or is waiting for the number to be issued to it; and (b) Contractor 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. Contractor further represents and warrants to City that (a) it has the power and authority to enter into and perform the work, (b) the Contract, when executed and delivered, shall be a valid and binding obligation of Contractor enforceable in accordance with its terms, and (c) The work under the Contract shall be performed in accordance with the highest professional standards, and (d) Contractor is qualified, professionally competent and duly licensed to perform the work. Contractor also certifies under penalty of perjury that its business is not in violation of any Oregon tax laws, and it is a corporation authorized to act on behalf of the entity designated above and authorized to do business in Oregon or is an independent contractor as defined in the contract documents, and has checked four or more of the following criteria: (1) I carry out the labor or services at a location separate from my residence or is in a specific portion of my residence, set aside as the location of the business. (2) Commercial advertising or business cards or a trade association membership are purchased for the business. (3) Telephone listing is used for the business separate from the personal residence listing. (4) Labor or services are performed only pursuant to written contracts. (5) Labor or services are performed for two or more different persons within a period of one year. (6) I assume financial responsibility for defective workmanship or for service not provided as evidenced by the ownership of performance bonds, warranties, errors and omission insurance or liability insurance relating to the labor or services to be provided. Contractor Date 28 PERFORMANCE BOND The undersigned , as principal, further referred to in this bond as Contractor, and as surety, further referred to in this bond as Surety, are jointly and severally bound unto City of Ashland, as obligee, further referred to in this bond as City, in the sum of Dollars Contractor and City have entered into a written contract dated for the following project: Oak Street Waterline Replacement No. 2018-32. This contract is further referred to in this bond as the Contract and is incorporated into this bond by this reference. The conditions of this bond are: 1. If Contractor faithfully performs the Contract in accordance with the plans, specifications and conditions of the contract within the time prescribed by the Contract, as required by ORS 279C. 380 through 279C.385, then this obligation is null and void: otherwise it shall remain in full force and effect. 2. If Contractor is declared by City to be in default under the Contract, the Surety shall promptly remedy the default, perform all of Contractor's obligations under the contract in accordance with its terms and conditions and pay to City all damages that are due under the Contract. 3. This bond is subject to claims under ORS 279C.380 through 279C.390. 4. This obligation jointly and severally binds Contractor and Surety and their respective heirs, executors, administrators, successors. 5. Surety waives notice of modification of the Contract or extension of the Contract time. 6. Nonpayment of the bond premium shall not invalidate this bond. 7. The bond number and the name, address, and telephone number of the agent authorized to receive notices concerning this bond are as follows. Bond Number: Bond Agent: Address: Telephone: SIGNED this day of 20. 56 PERFORMANCE BOND Page 2 WITNESS: CONTRACTOR: By: (Corporate Seal) Title: Legal Address: Attest: Corporate Secretary WITNESS: SURETY: By: (Corporate Seal) Title: Legal Address: Attest: Corporate Secretary 57 PAYMENT BOND The undersipned as principal further referred to in this bond as Contractor, and as surety further referred to in this bond as Surety, are jointly and severally bound unto City of Ashland as obligee further referred to in this bond as City, in the sum of Dollars $ Contractor and City have entered into a written contract dated for the following project: Oak Street Waterline Replacement No. 2018-32. This contract is further referred to in this bond as the Contract and is incorporated into this bond by this reference. The conditions of this bond are: 1. If Contractor faithfully performs the Contract within the time prescribed by the Contract, and promptly makes payment to all claimants as defined in ORS 279C.600 through 279C.620 then this obligation is null and void; otherwise it shall remain in full force and effect. 2. If Contractor is declared by City to be in default under the Contract, the Surety shall promptly remedy the default perform all of Contractor's obligations under the contract in accordance with its terms and conditions and pay to City all damages that are due under the Contract. 3. This bond is subiect to claims under ORS 279C.600 through 279C.620. 4. This obligation jointly and severally binds Contractor and Surety and their respective heirs, executors, administrators, successors. 5. Surety waives notice of modification of the Contract or extension of the Contract time. 6. Nonpayment of the bond premium shall not invalidate this bond. 7. The bond number and the name address and telephone number of the agent authorized to receive notices concerning this bond are as follows: Bond Number: Bond Agent: Address: Telephone: SIGNED this day of 20-.--. ~ SR PAYMENT BOND Page 2 WITNESS: CON'T'RACTOR: By: (Corporate Seal) Title: Legal Address: Attest: Corporate Secretary WITNESS: SURETY: By: (Corporate Seal) Title: Legal Address: Attest: Corporate Secretary I 59 CITY OF ASHLAND BID AND BID SCHEDULE TO FURNISH ALL PERMITS, LABOR, TOOLS, MACHINERY, MATERIALS, TRANSPORTATION, EQUIPMENT AND SERVICES OF ALL KINDS REQUIRED FOR THE CONSTRUCTION OF THIS PROJECT FOR THE CITY OF ASHLAND, JACKSON COUNTY, OREGON, AS STATED IN THE COMPLETED BID SCHEDULE, ALL IN ACCORDANCE WITH THE CONTRACT DOCUMENTS, PLANS, SPECIFICATIONS, AND DRAWINGS WHICH ARE ON FILE AT THE CITY OF ASHLAND, CITY HALL, 20 EAST MAIN STREET, ASHLAND, OREGON 97520. 1- \ , NAMEOF BIDDER ULST 1 O ~Y~t l) Y, CONTACT ADDRESS Cn-y -YL ~o~rol STATE -e ZIP TELEPHONE NO. 7 ~t 9J/-66110 9a4u,~ ~d FAXNO. s T 0 re;'°d OR 97509 541-941-6070 EMAH. ADDRESS ~/1~ • w To the Honorable Mayor and City Council CityHall City of Ashland 20 East Main Street Ashland, Oregon 97520 In response to the City of Ashland's Invitation to Bid, this Bid is submitted as an offer by the undersigned to enter into a contract with the City of Ashland for furnishing all permits, labor, tools, machinery, materials, transportation, equipment and services of all kinds required for, necessary for, or reasonable incidental to, the construction of the Oak Street Waterline Replacement Project No 2018-32 (hereinafter "Project") for the City of Ashland, Oregon, as shown in the contract documents on file at City Community Development Building, which are a condition of this Bid as though they were attached. This offer is subject to the following declarations as to the acts, intentions and understandings of the undersigned and the agreement of the City of Ashland to the terms and prices herein submitted. 1. The undersigned has familiarized itself with the nature and extent of the Contract Documents, the project work, the site, the locality, the general nature of work to be performed by the City or others at the site that relates to the project work required by the Contract Documents, local conditions, and federal, state, and local Laws and Regulations that in any manner may affect cost, progress, performance, or furnishing of the project work. 12 1. The undersigned has obtained and carefully studied (or assumes responsibility for obtaining and carefully studying) examinations, investigation, exploration, tests, and studies which pertain to the conditions (subsurface or physical) at or contiguous to the site or otherwise and which may affect the cost, progress, performance, or furnishing of the project work as Contractor deems necessary for the performance and furnishing of the project work at the Contract Price, within the Contract Times, and in accordance with the other terms and conditions of the Contract Documents; and no additional or supplementary examinations, investigations, explorations, tests, reports, or similar information or data are or will be required by Contractor for such purposes. 3. It is understood that the City shall investigate and determine the qualifications of the apparent low responsive bidder prior to awarding the contract. The City shall reject any bid by a nonqualified or disqualified bidder. The City of Ashland reserves the right to reject for any good cause any or all bids, waive formalities, or to accept any bid which appears to serve the best interests of the City. The City reserves the right to reject any bid not in compliance with all prescribed public bidding procedures and requirements and may reject all bids for good cause upon a finding that it is in the public interest to do so. Evaluation of bids will be based on minimum requirements established by the specifications and compliance with conditions of the Notice to Contractors and Invitation to Bid, and compliance with City public contracting rules. Additional evaluation criteria are as follows: None. 4. The deadline to file a written protest or request, pursuant to the Instructions to Bidders to change contract terns, conditions or specifications is not less than ten 10 calendar days prior to bid opening. Bid.closing may be extended by the City to consider a protest or request. 5. All of the contract documents, including all plans, specifications, and drawings have been examined and an examination of the site of the proposed work, together with such investigations as are necessary to determine the conditions to be encountered have been made by the undersigned and the terms and conditions of the contract and solicitation documents are hereby accepted, and that if this Offer is accepted, the undersigned will contract with the City of Ashland, Oregon, in a form substantially similar to that attached Agreement and agree to be bound to the terms and conditions of said contract and solicitation documents. 6. It is understood that the contract drawings maybe supplemented by additional drawings and specifications in explanation and elaboration thereof and, if they are not in conflict with those referred to in paragraph 1 above, they shall have the same force and effect as though they were attached, and they shall be accepted as part of the contract when issued. 7. The undersigned agrees that upon written acceptance of this bid s/he will, within ten working days, of receipt of such notice, execute a formal contract agreement with the City. The undersigned further agrees that s/he will provide the following in order to execute the contract: Performance Bond and Corporate Surety Payment Bond, both in the amount equal to 100% of the awarded contract; Certificates of Insurance for Liability and property damage coverage; Certificates of Coverage for Workman Compensation and unemployment insurance; All other bonds, permits, licenses, etc. as required in the contract documents. 8. It is understood that all the work will be performed under a lump sum or unit price basis and that for the lump sum or unit price all services, materials, labor, equipment, and all work necessary to complete the project in accordance with the plans and specifications shall be furnished for the said lump sum or unit price named. It is understood that the quantities stated in connection with the price schedule for the contract are approximate only and payment shall beinade at the unitprices named forthe actual quantities 13 incorporated in the completed work. If there shall be an increase in the amount of work covered by the lump sum price, it shall be computed on a basis of "extra work" for which an increase in payment will have been earned and if there be a decrease in the lump sum payment, it shall be made only as a result of negotiation between the undersigned and the Owner. Furthermore, it is understood that any estimate with respect to time, materials, equipment, or service which may appear on the plans or in the specifications is for the sole purpose of assisting the undersigned in checking the undersigned's own independent calculations and that at no time shall the undersigned attempt to hold the Owner, the Engineer, or any other person, film or corporation responsible for any errors or omissions thatmay appear in any estimate. 9. The undersigned submits the unit prices as those at which he will perform the work involved. The extensions of the column headed "ITEM TOTAL" are made for the sole purpose of facilitating bid comparisons and if there are any discrepancies between the unit prices and the total amount shown, the unit prices shall govern. 10. The undersigned agrees to furnish labor, tools, machinery, materials, transportations, equipment and services of all kinds required for, necessary for, or reasonably incidental to, construction of this Project with all appurtenant work as required by the plans and specifications of this Offer for the unit or lump sum prices in the "BID SCHEDULE". 11. In stating prices, it is understood that the prices include all materials and work required to complete the project in accordance with the Contract Documents, the plans and the specifications. If any material, item, or service required by the plans and specifications has not been mentioned specifically in the "BID SCHEDULE," the same shall be furnished and placed with the understanding that the full cost to the City has been merged with the several prices stated in the "BID SCHEDULE." 12. The City reserves the right to cancel this solicitation or to reject any and all bids in whole or in part when the cancellation or rejection is in the best interests of the City as determined by the City in accordance with ORS 279B.100 13. The foregoing prices shall include all labor, materials, equipment, overhead, profit, insurance, and all other incidental expenses to cover the finished work of the several kinds called for. Unit prices are to be shown in both words and figures. In case of any discrepancy, the amounts shown in words shall govern. 14. Upon receipt of written notice of the acceptance of its bid, Bidder shall execute a formal contract with the City within ten (10) days, deliver surety bond or bonds as required, and deliver required proof of insurance. The bid security attached in the sum of five percent (51/o) of the total price for the bid or combination of bids is to become the property of the Owner in the event the contract and bond are not executed within the time above set forth as liquidated damages for the delay and additional expense to the Owner caused thereby. 15. Ifthe proposed bid price will exceed $50,000.00 the undersigned, as bidder, acknowledges that provisions of ORS 279C.800 to 279C.870 relating to workers on public works to be paid not less than prevailing rate of wage shall be included in the contract, or in the alternative, if the project is to be funded with federal finds and is subject to the Davis-Bacon Act (40 U.S.C. §276a) bidder agrees to comply with the Davis- Bacon Act requirements. "Prevailing Wage Rates for Public Works Contracts in Oregon," which are incorporated herein by reference, and can be accessed at: bgps•//www oie2on eov/boli/WED/PWR/Paees/pwr state.asnx 16. The undersigned shall furnish bonds required by the specifications and comply with the laws of the Federal Government, State of Oregon and the City of Ashland which are pertinent to construction contracts of this nature even though such laws may not have been quoted or referred to in the specifications. 14 17. Accompanying this Offer is a certified check, cashier's check or a 'd bond for the sum of (51~71 - payable to the City of Ashland, Oregon, this being an amount for ten percent (10%) of the total bid based upon the estimate of quantities at the above price according to the conditions of the advertisement. If this Offer is accepted by the City and the undersigned fails to execute a satisfactory contract and bonds as stated in the Advertisement within ten (10) working days from the date of notification, then the City may, at its option, determine that the undersigned has abandoned the contract and there upon this Offer shall be considered null and void, and the bid security accompanying this Offer shall be forfeited to and become the property of the City of Ashland. If the bid is not accepted, the bid security accompanying this Offer shall be returned to the undersigned. 18. The undersigned agrees to comply with the provisions of ORS 279C.800 to 279C.870, the Oregon Prevailing Wage law. The undersigned, as bidder, acknowledges that provisions of ORS 279C.800 to 279C.870 relating to workers on public works to be paid not less than prevailing rate of wage shall be included in the contract, or in the alternative, if the project is to be funded with federal funds and is subject to the Davis-Bacon Act (40 U.S.C. §276a), bidder agrees to comply with the Davis-Bacon Act requirements. The undersigned Contractor agrees to be bound by and will comply with the provisions of ORS 2790.838, 279C.840 or 40 U.S.C. 3141 to 3148. [OAR 137-049-0200(1)(a)(J)]. 19. The undersigned certifies that the undersigned Contractor is not ineligible to receive a contract for a public work pursuant to ORS 279C.860. Bidder further agrees, if awarded a contract, that every subcontractor will be eligible to receive a contract for a public work pursuant to ORS 279C_8% 20. The undersigned certifies that the undersigned Contractor has not discriminated against minority, women or emerging small businesses enterprises in obtaining any required subcontracts. The bidder understands and acknowledges that it may be disqualified from bidding on this public improvement project as set forth in OAR 137-049-0370, including but not limited to City discovery a misrepresentation or sham regarding a subcontract or that the Bidder has violated any requirement of ORS 279A. f 10 or the administrative rules implementing the Statute. 21. The undersigned agrees that the time of completion shall be defined in the specifications, and further, the undersigned agrees to initiate and complete this Project by the date stated below. • The work shall be commenced within ten (10) business days after receipt of the written Notice to Proceed. • The work shall be completed in all respects by November 22, 2019 after Notice to Proceed. • The undersigned agrees that the "Time of Completion" shall be as defined in the specifications and that the bidder will complete the work within the number of consecutive calendar days stated for each schedule after "Notice to Proceed" has been issued by the Owner. Bidder furthermore agrees to pay as liquidated damages, for each calendar day thereafter, the arnounts shown in Standard Conditions, for each day the project remains incomplete. 22. The undersigned bidder is registered with the Oregon Construction Contractors Board (CCB), the registration is current and valid, and the bidder's registration number is stated below. [OAR 137-049- 0230(1)] Bidder understands that failure to have a current CCB license shall result in rejection of this bid. 23. The undersigned bidder is licensed by the State Landscape Contractors Board, if applicable, the license is current and valid, and the bidder's registration number is stated below. [OAR 137-049-0200(I)(a)(K)] Bidder understands that failure to have a current LCB license shall result in rejection of this bid. 15 24. In determining the lowest responsible bidder, City shall, for the purpose of awarding the contract, add a percent increase on the bid of a non-resident bidder equal to the percent, if any, of the preference given to that bidder in the state in which the bidder resides. 'Resident bidder' of Oregon means a bidder that has paid unemployment taxes or income taxes in this state during the 12 calendar months immediately preceding submission of the bid, has a business address in this state and has stated in the bid that the bidder is a "resident bidder" of the State of Oregon. The undersigned represents him/her self in this bid to be either a Resident or a Nonresident bidder by completing the appropriate blank below. The Bidder is t or is not a Resident Bidder as defined in ORS 279A.120. -XJ 25. The undersigned hereby represents that no Councilor, Commissioner, officer, agency or employee of the City of Ashland is personally interested directly or indirectly in this Contract or the compensation to be paid hereunder and that no representation, statement or statements, oral or in writing, of the City, its Councilors, Commissioners, officers, agents or employees had induced him/her to enter into this Contract, and the papers made a part of its terms; 26. The undersigned has not directly or indirectly induced or solicited any person to submit a false or sham bid or refrain from bidding. The undersigned certifies that this bid has been arrived at independently and submitted without connection with any person, firm or corporation making a bid for the same rnaterial and is, in all respects, fair and without collusion or fraud. 27. The undersigned confirms that this firm has a Qualified Drug Testing Program for employees in place and will demonstrate this prior to award of contract. (OAR 137-049-0200(1)(c)(B)] 28. The undersigned confirms that if this contract involves asbestos abatement or removal, the bidder is licensed under ORS 468A.710 for asbestos removal. Asbestos abatement is not implicated in this contract. 29. The City of Ashland may waive minor informalities, reject any bid not in compliance with all prescribed public bidding procedures and requirements, and may reject for good cause any or all bids upon a finding that it is in the public interest to do so. 30. The undersigned confirms that this offer is not contingent upon City's acceptance of any terms and conditions other than those contained in this Solicitation and the Contract Documents. 31. The bidder understands that the City reserves the right to make changes to the Notice to Contractors / Invitation to Bid and the resulting contract by written addenda, prior to the closing time and date. The City will transmit addenda to registered plan holders but shall publish notice of any addenda on City's website (www.ashland.or.us) at the Public Works page. The addenda may be downloaded or picked up at the Department of Public Works, 51 Winbum Way, Ashland, Oregon. The bidder must check the website and Public Works bulletin board frequently until closing. The bidder acknowledges that the Addendum(s) listed below have been reviewed online or a copy obtained and considered as part of the submittal of this Offer and Bid Schedule. ADDENDUM NUMBER THROUGH d- HAVE BEEN REVIEWED ~1 32. The bidder understands that the City will be awarding the contract to the Respoble Bidder with the lowest Responsive Bid. OAR 137-049-0200(1)(b)(C). Whether a bidder is responsible will be determined by ORS 279C.375 and the City's completion of the attached Bidder Responsibility Determination Form. 16 33. Instructions for First-Tier Subcontractors Disclosure. Bidders are required to disclose information about certain first-tier subcontractors (those subcontractors contracting directly with the bidder) when the contract price exceeds $100,000 (see ORS 279C370). Specifically, when the contract amount of a first-tier subcontractor is greater than or equal to: (i) 5% of the project bid, but at least $15,000, or (ii) $350,000 regardless of the percentage, you must disclose the following information about that subcontract within two working hours of bid closing: • The subcontractor's name and address; • The subcontractor's Construction Contractor Board registration number, if one is required, and; • The subcontract dollar value. If you will not be using any subcontractors that are subject to the above disclosure requirements, you are required to indicate "NONE" on the form. Failure to submit this form by the disclosure deadline will result in a non-responsive bid_ A non-responsive bid will not be considered for award. THE CITY MAY REJECT A BID IF THE BIDDER FAILS TO SUBMIT THE DISCLOSURE FORM WITH THIS INFORMATION WITHIN TWO HOURS OF BID CLOSING. THIS DOCUMENT SHALL NOT BE FAXED. IT IS THE RESPONSIBILITY OF BIDDERS TO SUBMIT THIS DISCLOSURE FORM AND ANY ADDITIONAL SHEETS BY THE DEADLINE. SEE INSTRUCTIONS TO BIDDERS. The disclosure should be submitted on the First-Tier Subcontractor Disclosure Form attached to this Invitation to Bid. 34. Bidder Information and Signature W?, )(I 15- ( i - 2b Vti6 ' Firm Name of Bidder ~dA c~e4,, Signat of Bid t Printed Name of Bidder ~ 59ItY 11502 Official Title 7r0 State of Incoi ration CCB Number Dated this Z8 day of GI lcf r 2 0 ff. Naine of Bidder y Address Ag , C w< Telephone No. Y/ 17 BID SCHEDULE Oak Street Waterline Replacement ygg417502 Proiect No. 2018-32 y4t. J.it- Spec. Unit Price No. Description # Q Unit Bid Total Price Bid 1 Mobilization (Not to Exceed 8%) 00210 1 Lump Sum I'd, v00U e,00 ~ 2 Construction Survey Work 00305 1 Lump D6 r , C O Jv Sum 3 Temporary Work Zone Traffic Control, 00225 1 Lump Complete Sum ~000-4~ ,0 a b~ U 4 Erosion Control 00280 1 Lump 210C) 5 Rock Excavation 00330 1 Cubic ~ 7, Yard 6 Trench, Level 3, %2-0" HMAC 4" Thickness 00495 311 Squrarre 7 Cold Plane Pavement Removal 00620 1826 Square yard ~312 7 o f 8 Aggregate Shoulders, Parking, Staging area 00640 833 Square Yard '/2 Street Inlay Level 3, 3/4"-0" HMAC 2" Square 9 Thickness 00744 1$26 Yard r 10 Bollard 00815 1 Each %A30' 11 Force Balanced Flex-Tend Coupler 01140 2 Each Doc" kV 00 8-inch Class 54 Ductile Iron Pipe, Fittings Linear vv`' o 12 and Couplings with Restrained Joints and 01140 2673 Foot C CLhba E SP,(-tLPILL. 13 Ductile Iron Pi Elbow 11. 5, 22.5, and 90 01140 15 Each pct o ~~p v 14 Ductile Iron Pipe Tees, 8" x 8» x 01140 2 Each 15 Ductile Iron Pipe Tees, 8" x 6" x 8" 01140 3 Each 00 16 8-inch Gate Valve 01150 6 Each U Sfc~ 0 a l, 1N17 6-inch Gate Valves 01160 3 Each f p p o'_`' ' t~ •tNa 18 Hydrant Assemblies 01160 3 Each 5~;-O(j (6,,5 700 19 Polyethylene Encasement 100 Linear Foot 5 20 90 Degree Pipe Supports 4 Each 6900 Total ~J 6 41 4y4VS;)(#1A5C6-V1 -4TA4 Name ofAuthorized Representative r Total 47ritten i DollarsslW/ j 77~~ A orized Re pr sentative ignature Date C- 18 FIRST-TIER SUBCONTRACTOR DISCLOSURE FORM INSTRUCTIONS Instructions for Submitting Form Submit the First-Tier Subcontractor Disclosure form in any of the following manners: • Not later than two working hours after the time set for opening Bids. (For example, before 11:00 a.m. after a 9:00 a.m. Bid Opening.) Submit according to one of the following methods: • Print the form from the Bid Booklet, fill it in, and either: a o Deliver to the #'ollowinb address where it can be time and date stamped City of Ashland Community Development and Engineering Services Building 51 Winburn Way Ashland, OR 97520, or o FAX it to (541) 488-6006. The Agency is not responsible for partial, failed, illegible, or partially legible FAX transmissions or electronic submissions. Instructions for First-Tier Subcontractor Disclosure Without regard to the amount of a Bidder's Bid, if the Agency's cost range for a public improvement project in the "Notice to Contractors", or in other advertisement or solicitation documents is greater than $ 100,000, bidders are required to disclose information about first-tier subcontractors that will furnish labor or labor and materials (See ORS 279C.370). Specifically, when the contract amount of a first-tier subcontractor is greater than or equal to: (1) 5% of the total project Bid, but at least $15,000, or (2) $350,000 regardless of the percentage of the total project Bid, you trust disclose the following information about that subcontractor not later than two working hours after the time set for opening Bids: • The name of the subcontractor • The category of work that the subcontractor will be performing • The dollar amount of the subcontract If the Agency's cost range is greater than $100,000 and you will not be using any first-tier subcontractors, you are still required to submit the form, with the appropriate box checked or enter "NONE" on the first line. If the Agency's cost range is greater than $100,000 and you are not subject to the above disclosure requirements, you are still required to submit the form, with the appropriate box checked or enter "NONE" on the first line. THE AGENCY MUST REJECT BIDS if the Bidder fails to submit the disclosure form with this information by the stated deadline. 19 To determine disclosure requirements, the Agency recommends that you disclose subcontract information for any subcontractor as follows: 1) Detennine the lowest possible prime contract price. That will be the base Bid amount less all alternate deductive Bid amounts (exclusive of any options that can onlybe exercised after Bid award). 2) Provide the required disclosure information for any first-tier subcontractor whose potential contract services are greater than or equal to: (1) 5% of the lowest contract price, but at least $15,000, or (2) $350,000 regardless of the percentage. Total all possible work for each subcontractor in making this determination, (for example, if a subcontractor will provide $15,000 worth of services on the base Bid and $40,000 on an additive alternate, then the potential amount of the subcontractor's services is $55,000. Assuming that $55,000 exceeds 5% of the lowest contractprice, provide the disclosure for both the $15,000 services and the $40,000 services). 20 FIRST-TIER SUBCONTRACTOR DISCLOSURE FORM Project Name Oak Street Waterline Replacement Project Number 2018-32 Bid Opening Date / s, ~fJ / Q = dO t" Name of Bidding Contractor /J( ❑ CBECK THIS BOX IF YOU YVILL NOT BE USING ANY FIRST-TIER SUBCONTRACTORS OR IF YOUARE NOT SUBJECT TO THE DISCLOSURE REQUIREMENTS (SEE INSTRUCTIONS) Firm Name ~Y "laih - DolllaarAntotmt Catepr of Work f4 C- (/~~1 Z / CX'>•v C_ Firm Name Dollar Amount Category of Work f t P t !'Sp 0, Finrr Name GL/~ICc ~J~~t bjR'v / Dollar Amount Category of Work ol (~6'Yy! , 0cc- Finu Name L `L CYLr " (r Dollar Amount V- 4' Category of Work /alt/ O lee- Firm Name Dollar Amount Category of Work Firm Name Dollar Amount Cateoo of Work Firm Name Dollar Amount Category of Work (Attach additional sheets as necessary) 21 This page intentionally left blank 22 EXHIBIT E BONDS CITY OF ASHLAND STANDARD PUBLIC IMPROVEMENT CONTRACT BID BOND We, West Coast Pipeline, LLC. organized under the laws of the State of Oregon a corporation or partnership duly and authorized to transact business in the State of Oregon, as "PRINCIPAL," and, We, Merchants National Bonding, Inc, a corporation or partnership duly organized under the laws of the State of Iowa , and authorized to transact business in the State of Oregon, as "SURETY," hereby jointly and severally bind ourselves, our respective heirs, executors, administrators, successors and a44s++signs firmly by these presents to pay unto the City of Ashland, Oregon, (OBLIGEE) the sum of (~7 10a of total amount bid Ten percent of total amount bid Dollars. The condition of the obligation of this bond, is that the PRINCIPAL herein has in response to City's Notice to Conn-actors and Invitation to Bid, submitted its Offer for the Oak Street Waterline Replacement No 2018 32 , which Offer is incorporated herein and made a part hereof by this reference, and Principal is required to furnish bid security in an amount equal to ten (10%) percent of the total amount of the bid pursuant to ORS 279C.365 and the City's public contracting riles and contract documents. NOW THEREFORE, If the Offer, submitted by PRINCIPAL, is accepted, and if the Contract pursuant to the Offer is awarded to the PRINCIPAL, and if the PRINCIPAL executes such contract and furnishes such good and sufficient Performance and Payment Bonds as required by the Bidding and Contract documents within the time specified and fixed by the Documents, then this obligation shall be void; otherwise it shall remain in full force and effect. If the PRINCIPAL shall fail to execute the proposed Contract and to furnish the Performance and Payment Bonds, the SURETY hereby agrees to pay the OBLIGEE the surety bond sum as liquidated damages within ten (10) days of such failure. IN WITNESS WHEREOF, we have caused this instrument to be executed and sealed by our duly authorized legal representatives this 15th day of August , 20 19. Merchants National West Coast Bonding, Inc. Pipeline, LLC. Surety Principal "I 90..1 I'll, o-s o-Tlilr a 10 5929 Upton Rd Central Point, OR 97502 Address Address - By: B94 rmic Attorney -in-Fact [A certified copy of the Agent's Power of Attorney must be attached hereto.] 54 MERCHANTS BONDING COMPANY.. POWER OF ATTORNEY Know All Persons By These Presents, that MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC., both being corporations of the State of Iowa (herein collectively called the "Companies") do hereby make, constitute and appoint, individually, Conor Davidson; James S Ewald; Jeanette Simmons; Jenifer McCormick; Marc Baker; Walter VanDoorninck their hue and lawful Attorney(s)-in-Fact, to sign its name as surety(les) and to execute, seal and acknowledge any and all bonds, undertakings, contracts and other written Instruments In the nature thereof, on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. This Power-of-Atomey is granted and is signed and sealed by facsimile under and by authority of the following By-Laws adopted by the Board of Directors of Merchants Bonding Company (Mutual) on April 23, 2011 and amended August 14, 2015 and adopted by the Board of Directors of Merchants National Bonding. Inc„ on October 16, 2015. 'The President, Secretary, Treasurer, or any Assistant Treasurer or any Assistant Secretary or any Vice President shall have power and authority to appoint AUomeys-In-Fact, and to authorize them to execute on behalf of the Company, and attach the seal of the Company thereto, bonds and undertakings, recognizances, contracts of Indemnity and other writings obligatoryin the nature thereof.' 'The signature of any authorized officer and the seal of the Company may be affixed by facsimile or electronic transmission to any Power of Attorney or Certification thereof authorizing the execution and delivery of any band, undertaking, recognizance, or other suretyship obligations of the Company, and such signature and seal when so used shall have the some force and effect as though manually fixed.' In connection with obligations in favor of the Florida Department of Transportation only, it Is agreed that the power and aut hority hereby given to the Attorney-in-Fact Includes any and all consents for the release of retained percentages andfor final estimates on engineering and construction contracts required by the State of Florida Department of Transportation. It Is fully understood that consenting to the Stale of Florida Department of Transportation making payment of the final estimate to the Contractor and/or Its assignee, shall not relieve this surety company of any of its obligations under Its bond. In connection with obligations in favor of the Kentucky Department of Highways only, It is agreed that the power and authority hereby given to the Attorney-in-Fact cannot be modified or revoked unless prior written personal notice of such Intent has been given to the Commissioner- Department of Highways of the Commonwealth of Kentucky at least thirty (30) days prior to the modification or revocation. In Wilness Whereof, the Companies have caused this instrument to be signed and sealed this 5th day of February , 2018 :Jtl G4 LP 0R4~'-. 0, MERCHANTS BONDING COMPANY . '3--'I, UR•9.~9yc; MERCHANTS NATIONAL NCTUAL) 2003 1933 c: By 7,7x, " President STATE OF IOWA COUNTY OF DALLAS ss. On this this 5th day of February 2018 , before me appeared Larry Taylor, to me personally known, who being by me duly sworn did say that he is President of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC.; and that the seals affixed to the foregoing instrument are the Corporate Seals of the Companies; and that the said instrument was signed and sealed in behalf of the Companies by authority of their respective Boards of Directors. IN s ALICIA K. GRAM OAS Commission Number 767430 f iMy Commission Expires 1 N _ ' r April 1, 2020 VC~7 e Notary Public (Expiration of notary's commission does not invalidate this instrument) I, William Warner, Jr., Secretary of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC., do hereby certify that the above and foregoing Is a true and correct copy of the POWER-OF-ATTORNEY executed by said Companies, which is still in full force and effect and has net been amended or revoked. In Witness Whereof, I have hereunto set my hand and affixed the seal of the Companies on this 15th day of August , 2019 A 'O~~'pP0 O~Oq'. -0- Vt s S i` ' Z ° y 1933 Secretary 2003 POA 0018 (3117) PERFORJLaWE 13011) The undersigned West Coast Pipeline, LLC. , as principal further referred to in this bond as Contractor, and Merchants National Bonding Inc., as surety, further referred to in this bond as Surety, are jointly and severally boundhunto City of Ashland, as obligee further referred to in this bond as City, in the sum of Hundred Siw Twn: d5Qzlw Centt Dollars ($346,462.50)_ Contractor and City have entered into a written contract dated for the following project: Oak Street Waterline Replacement No. 2018-32. This contract is further referred to in this bond as the Contract and is incorporated into this bond by this reference. The conditions of this bond are: 1. If Contractor faithfully performs the Contract in accordance with the plans specifications and conditions of the contract within the time prescribed by the Contract as required by ORS 2790 380 through 279C.385, then this obligation is null and void; otherwise it shall remain in full force and effect. 2. If Contractor is declared by City to be in default under the Contract, the Surety shall promptly remedy the default, perform all of Contractor's obligations under the contract in accordance with its terms and conditions and pa to City all damages that are due under the Contract. 3. This bond is subiect to claims under ORS 2790.380 through 279C.390. 4. This obligation jointly and severally binds Contractor and Surety and their respective heirs, executors. administrators, successors. 5. Surety waives notice of modification of the Contract or extension of the Contract time 6. Nonpayment of the bond premium shall not invalidate this bond 7. The bond number and the name, address, and telephone number of the agent authorized to receive notices concerning this bond are as follows. Bond Number: NOR1251 Bond Agent: Elliott, Powell, Baden and Baker, Inc. Address: 1521 SW Salmon Street Portland, Oregon 97205 Telephone: 503-227-1771 SIGNED this 18th day of September 2019. ~r v~ a ' W CJ I ~ o . -o a Cg o' ° a° y 3 1J y U Q ~ Q i0 o u ~ I w 0 0 `W~ o ~W o Z U Z ~ Y PAYMENT BOND The undersigned West Coast Pipeline, ine, LLC , as principal, further referred to in this bond as Contractor, and Merchants National Bonding. Inc. , as surety, further referred to in this bond as Surety. are jointly and severally bbound untorCity of Ashland as obligee, further referred to in this bond as City in the sum of ThrttnundraM Su Thousand Fou ,T1 Sixty Two and 5011W Crn, Dollars ($346,462.50 Contractor and City have entered into a written contract dated for the following project: Oak Street Waterline Replaeenwat No. 2018-32. This contract is furfher referred to in this bond as the Contract and is incorporated into this bond by this reference. The conditions of this bond are: 1. If Contractor faithfully performs the Contract within the time prescribed by the Contract and promptly makes payment to all claimants, as defined in ORS 2790.600 through 279C.620, th en this obligation is null and void: otherwise it shall remain in full force and effect 2. If Contractor is declared by City to be in default under the Contract, the Surety shall promptly 'remedy the default perform all of Contractor's obligations-under the contract in accordance with'its terns and conditions and pay to City all damages that are due under the Contract 3. This bond is subject to claims under ORS 279C.600 through 279C.620. 4. This obligation jointly and severally binds Contractor and Surety and their respective heirs executors, "administrators, successors. 5. Surety waives notice of modification of the Contract or extension of the Contract time. 6. NonpaMent of the bond premium shall not invalidate this bond. 7. The bond number and the name, address, and telephone number of the agent authorized to receive notices concerning this bond are as follows: Bond Number: NOR1251 Bond Agent: Elliott, Powell, Baden and Baker, Inc. Address: 1521 SW Salmon Street Portland, Oregon 97205 Telephone: 503-227-1771 SIGNED this 18th day of September 2019. 58 PAYMENT BOND Page 2 WITNESS: CONTRACTOR: West Coast Pipeline, LLC. By: LLL (Corporate Sea]) Title: L G/kGv Legal Address: 5924 Upton Road Central Point. eon 97502 Attest: ~t Corpo e Secretary WITNESS .,t~ .ox- SURETY: Merchants National Bonding, Inc. By: (Corporate Seal) Title: Lyndsav C. Warren, Attomey-in-Fact Legal Address: PO Box 14498 Des Moin s. lowa-5W06-3499 Attest: Corporate Secretary MERCHAN~ BONDING COMPANY. POWER OF ATTORNEY Know All Persons By These Presents, that MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC., both being corporations of the State of Iowa (herein collectively called the "Companies") do hereby make, constitute and appoint, individually, Conor Davidson; James S Ewald; Jeanette Simmons; Jenifer McCormick; Lyndsay C Warren; Marc Baker; Wolter VanDoorninck their true and lawful Attorney(s)-in-Fact, to sign its name as surety(ies) and to execute, seal and acknowledge any and all bonds, undertakings, contracts and other written instruments in the nature thereof, on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. This Power-of-Attomey is granted and is signed and sealed by facsimile under and by authority of the following By-Laws adopted by the Board of Directors of Merchants Bonding Company (Mutual) on April 23, 2011 and amended August 14, 2015 and adopted by the Board of Directors of Merchants National Bonding, Inc., on October 16, 2015. "The President, Secretary, Treasurer, or any Assistant Treasurer or any Assistant Secretary or any Vice President shall have power and authority to appoint Attomeys-in-Fact, and to authorize them to execute on behalf of the Company, and attach the seal of the Company thereto, bonds and undertakings, recognizances, contracts of indemnity and other writings obligatory in the nature thereof." "The signature of any authorized officer and the seal of the Company may be affixed by facsimile or electronic transmission to any Power of Attorney or Certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligations of the Company, and such signature and seal when so used shall have the same force and effect as though manually fixed." In connection with obligations in favor of the Florida Department of Transportation only, it is agreed that the power and aut hority hereby given to the Attomey-in-Fact includes any and all consents for the release of retained percentages and/or final estimates on engineering and construction contracts required by the State of Florida Department of Transportation. It is fully understood that consenting to the State of Florida Department of Transportation making payment of the final estimate to the Contractor and/or its assignee, shall not relieve this surety company of any of its obligations under its bond. In connection with obligations in favor of the Kentucky Department of Highways only, it is agreed that the power and authority hereby given to the Attomey-in-Fact cannot be modified or revoked unless prior written personal notice of such intent has been given to the Commissioner- Department of Highways of the Commonwealth of Kentucky at least thirty (30) days prior to the modification or revocation. In Witness Whereof, the Companies have caused this instrument to be signed and sealed this 30th day of August , 2019 .•'.t10N4..."••. •'~P'(LPOgt epS, 'p~~'PpQ o~'O.y• MERCHANTS BONDING COMPANY (MUTUAL) e/.y: ~0 ql~;.:y :•m:r, 99A*.;4. MERCHANTS NATIONAL BONDING, INC. . r-.. -o- :Qi~ :Z: •z: 2003 1933 : •ti ; By %dJ~••.....: ~~1~,•' ~Jd~i * •\1a~: President STATE OF IOWA COUNTY OF DALLAS ss. On this this 30th day of August 2019 , before me appeared Larry Taylor, to me personally known, who being by me duly sworn did say that he is President of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC.; and that the seals affixed to the foregoing instrument are the Corporate Seals of the Companies; and that the said instrument was signed and sealed in behalf of the Companies by authority of their respective Boards of Directors. ALICIA K. GRAM Commission Number 767430 r My Commission Expires owP April 1, 2020 110 Notary Public (Expiration of rotary's commission does not invalidate this instrument) I, William Warner, Jr., Secretary of MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC., do hereby certify that the above and foregoing is a true and correct copy of the POWER-OF-ATTORNEY executed by said Companies, which is still in full force and effect and has not been amended or revoked. In Witness Whereof, I have hereunto set my hand and affixed the seal of the Companies on this 18th day of September , 2019 ~Pt,FOA~e' ~0POO~Oq'. ~h~;GOR A9% :gym; 94~ 4" 'A L./iL~.s+r/ G✓ ~l . -0- ON - 2: •z: :3; 2003 4) • a• 1933 Secretary • y: P,OA 0018 (3117) Purchase Order Fiscal Year 2020 Page: 1 of: 1 THIS PO NUMBER MUST APPEAR ON ALL B City of Ashland INVOICES, AND SHIPPING DOCUMENTS. . I ATTN: Accounts Payable ~ 20 E. Main Purchase 20200183 Ashland, OR 97520 Order # T Phone: 541/552-2010 O Email: payable@ashland.or.us V H C/O Public Works Department E WEST COAST PIPELINE LLC 1 51 Winburn Way N 5924 UPTON RD p Ashland, OR 97520 D CENTRAL POINT, OR 97502 Phone: 541/488-5347 O T Fax: 541/488-6006 R O Vendor--Phone Number Vendor Fax Number ` Requisition Number = Delivery Reference , Chance Mecalf Date Ordered Vendor Number Date Required Freight Method/Terms Department/Lb catlon. 09/26/2019 4961 FOB ASHLAND OR City Accounts Payable Item# Descri tion/ParENo - QTY' UOM. Unit'Price -Extended Pri_ Oak Street Water Replacement 1 Description of Services: 1 346,462.5000 $346,462.50 Oak Street Waterline Replacement Contract Name: Public Improvement Contract For Oak Street Waterline Replacement Project No. 2018-32 Terms of Contract: Effective Date: 9/20/19 Completion Date: 11/22/19 Project Account: E-201832-999 GL SUMMARY 081800 - 704200 $346,462.50 By:~ (A Date t e' { Authorized Signature PO Total $346,462.50 FORM#3 P"_rd"Q). 00 l8)3lTY OF A request for s Purchase Order ASHLAND 09/19/2019 REQUISITION Date of request: Vendor Name West Coast Pipeline LLC Address, City, State, Zip 5924 Upton Road Central Point OR 97502 Contact Name Justin Aplin Telephone Number 541-665-0243 Email address justin(G)wcpipe.com SOURCING METHOD ❑ Exempt from Competitive Bidding ❑ Emergency ❑ Reason for exemption: ❑ Invitation to Bid (Copies on file) ❑ Form #13, Written findings and Authorization ❑ AMC 2.50 Date approved by Council: 09/17/2019 ❑ 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 Cooperative Procurement Less than $5,000 ❑ Request for Proposal (Copies on file) ❑ Stale of Oregon ❑ Direct Award Date approved by Council: Contract # ❑ VerbaVWritten quote(s) or proposal(s) -(Attach copy of council communication) ❑ State of Washington Intermediate Procurement ❑ Sole Source Contract# GOODS & SERVICES ❑ Applicable Farm (#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 A, 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 proposals/written solicitation Date approved by Council: (Date) ❑ Form A, Personal Services $5K to $75K Valid until: Date -(Attach copy of council communication) Description of SERVICES Total Cost Oak Street Waterline Replacement $14 6;462.50 Item # Quantity Unit Description of MATERIALS Unit Price Total Cost TOTAL- COST-0 Per attached quotelproposal Project Number? 0 1 8 3 2. _ Account Number g e l e o 0. r 0 a 2 0 0 3 4 6 4 6 2, 5 0 Project Number _ _ _ _ _ _ _ Account Number _ _ _ _ _ _ _ _ _ _ _ _ _ Project 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: ITDirector Date Support-Yes/No By signing this requisition form, I certify that the City's public contracting requirements have been satisfied. Employee: lki ftz Dew 11~ V ~ Department Head: u S4%1) / Department Manager/Supervisor: City Administrate goa ltoor greaterthan $5,000) / (Equal to or greater than $25,000) Funds appropriated for current fiscal year: I ES I NQ Deputy Finance Director-(Equal to orgreater than $5,000) Date Comments: Form #3 - Requisition