HomeMy WebLinkAbout2023-023 PO 20230266- Evergreen Job & Safety Training Purchase Order
nil
' no CMS " ri' t 'e ,D ei [Fiscal Year 2023 Page: 1 of: 1
B City of Ashland ._ _ _
LATTN: Accounts Payable Purchase
L 20 E. Main
20230266
Ashland, OR 97520 Order#
T Phone: 541/552-2010
O Email: payable@ashland.or.us
V H C/O Electric Department
E EVERGREEN JOB &SAFETY TRAINING I 90 North Mountain Ave
N 1352 PALMERSTON LOOP p Ashland, OR 97520
D ROSEVILLE, CA 95678 Phone: 541/488-5357
R T Fax: 541/552-2436
ze. 11Ctiili:e = ilirrEl [ a] 7-D linq € oe lala�Irt IIe�EE iii I€ 1}*�I��ii1 =r _,___ ..1
____ ___ _ ]elk[
_ _ Thomas McBartlett III
_
ft—W 1§'M—_'_` el k®BA e1 I® E_ �k=1( ilal 1 drzrAl IoiRE--c „ iE el_ar ly k a e
03/16/2023 1076 FOB ASHLAND O R/NET30Cit Accounts Pa able
4�i@ L _- �$ - Bl' i-j- ®194 11 - =AE--3aaC _ PiMg4a°QEM gi t®To=m
Safety Training Electric Dept A
1 Safety Training -Electric Utility Department 12.0 MO $2,699.00 $32,388.00
Five(5)Year Agreement(Mar 2023 -Feb 2028).
Approved by the City Council March 15, 2023
YEAR
March 2023 - February 2024 $2,699.00/Month
Project Account:
3 YEAR 2 12.0 MO $0.01 $0.12
March 2024 —February 2025 $2,699.00/Month
Project Account:
4 YEAR 3 12.0 MO $0.01 $0.12
March 2025 -February 2026 $2,834.00/Month
Project Account: .
5 YEAR 4 • 12.0 MO $0.01 $0.12
March 2026 - February 2027$2,834.00/Month
Project Account: ,
6 YEAR 5 • 12.0 MO $0.01 $0.12
March 2027 - February 2028 $2,834.00/Month
Project Account: . -
*************** GL SUMMARY*************** .
111800-606400 $32,388.48 I I I 1
By: A 1) fiY Date: 'y
Au'o ' 7T i•nature o - e.14Ts a $32 388.4
t
•FORM #3 al � .D � • � CITY OF .
A � � �e~ ct'l ��t�l��� ��." .� ASHLAND
REQUISITION •
Date of request: 03/1612023 •
. Required date for delivery:
.Vendor Name EVERGREEN JOB&SAFETY TRAINING INC. '
Address,City,State,Zip
Contact Name&Telephone Number •
• Email address
SOURCING METHOD
❑ Exempt from Competitive Bidding ❑ Invitation to Bid ❑ Emergency •
❑ Reason for exemption: Date approved by Council: CI Form#13,Written findings and Authorization
❑ AMC 2.50 _ _(Attach copy of council communication) ❑ Written quote or proposal attached
❑ Written quote or proposal attached _(If council approval required,attach copy of CC)
El Small Procurement 0 Request for Proposal Cooperative Procurement
Not exceeding$5,000 Date approved by Council: 03/15/2023 ❑ State of Oregon
❑ Direct Award ■ (Attach copy of council communication) Contract#
❑ Verbal/Written bid(s)or proposal(s) ❑ Request for Qualifications(Public Works) 0 State of Washington
Date approved by Council:_ Contract#
_(Attach copy of council communication) 0 Other government agency contract
Intermediate Procurement ❑ Sole Source Agency
GOODS&SERVICES 0 Applicable Form(#5,6,7 or 8) Contract#
Greater than$5,000 and less than$100,000 ❑ Written quote or proposal attached Intergovernmental Agreement
❑ (3)Written bids&solicitation attached ❑ Form#4,Personal Services$51(to$75K Agency
PERSONAL SERVICES Date approved by Council:_ 0 Annual cost to City does not exceed$25,000.
Greater than$5,000 and less than$75,000 Valid until: (Date) Agreement approved by Legal and approved/signed by
❑ Less than$35,000,by direct appointment ❑ Special Procurement City Administrator.AMC 2.50.070(4)
❑ (3)Written proposals&solicitation attached ❑ Form#9,Request for Approval ❑ Annual cost to City exceeds$25,000,Council
❑ Form#4,Personal Services$5K to$75K 0 Written quote or proposal attached approval required.(Attach copy of council communication)
Date approved by Council: .
Valid until: (Date)
Description of SERVICES
Safety Training-Electric Utility Department-5 Year Contract-March 2023 thru February 2028 TOTAL:COST .. `
Year 1-$2,699/Mo,Year 2-$2,699/Mo,Year 3-$2,834/Mo,Year 4-$2834/Mo,Year 5-$2834/Mo
$ 166,'8OQ:00
Item# Quantity Unit Description of MATERIALS Unit Price Total Cost
•
•
❑. Per attached quotelproposal . 0 : TOTAL,COST'
Project Number Account Number 1 1 1e 0 0.6 0 6 4 0 0
Account Number - Account Number • -
*Expenditure must be charged to the appropriate account numbers for the financials to accurately reflect the actual expenditures.
IT Director in collaboration with department to approve all hardware and software purchases:
IT Director Date Support-Yes/No
By signing this requisition form,i certify that the City's public contracting requirements have been satisfied.
Employee: • Department Head ,23A /7 Z3
r (Equal o or atert an$5,000)
Department ManagerlSupervisor: City Manage,, j I f
dr/
/ (Greater than:: ,0'i •
Funds appropriated for current fiscal year: lip NO �% /,IIFA /F�" O
F'1 a 1/r-7.r-( qual to or greater than$5,000) Da
Comments: S
•
\ 'in#3-Requisition
SAFETY TRAINING FOR THE ELECTRIC UTILITY DEPARTMENT
CONSULTANT: Evergreen Job & Safety Training, Inc.
CITY 'O F CONTACT: Jesse Langslet, Owner/Instructor
ASHLAND
Electric Department ADDRESS: 1352 Palmerston Loop,Roseville, CA.95678
90 N.Mountain
Ashland, Oregon 97520 TELEPHONE: 916.-742-1811 •
Telephone: 541-488-5357
FAX: 916-742-1852
EMAIL: evergreenjobandsafety@gmail.com
This Personal Services Agreement (hereinafter"Agreement") is entered into by and between the
City of Ashland, an Oregon municipal corporation'(hereinafter "City") and Evergreen Job & Safety
Training,Inc. ("hereinafter"Consultant"), for Safety Training for the Electric Utility Department.
NOW.THEREFORE, in consideration of the mutual covenants contained herein,the City and
Consultant hereby agree as follows: '
1. Effective Date and Duration: This Agreement shall become effective on the date of execution
on behalf of the City, as set forth below(the "Effective Date"), and unless sooner terminated as
specifically provided herein, shall terminate upon the City's affirmative acceptance of
• Consultant's.Work as complete and Consultant's acceptanceof the City's final payment therefore,
but not later than February 28, 2028. . .
2. Scope of Work: Consultant will provide Safety Training for the Electric Utility Department
as more fully set forth in the Consultant's Proposal dated 12/16/2022,which is attached hereto
• as "Exhibit A" and incorporated herein by this reference. Consultant's services are collectively
referred to in this Agreement as the"Work." •
3. Compensation: City shall pay Consultant the following cost per month as follows'as full
compensation for Consultant's performance of all Work under this Agreement.
5-YEAR CONTRACT Firm Cost Per Month(All Inclusive) Annual Cost
Year 1 March 2023—February 2024 $2,699.00 $32,388.00
• Year 2 . March 2024—February 2025 $2,699,00 $32,388.00
Year 3 ' . March 2025—February 2026 $2,834.00 $34,008.00
Year 4. March 2026—February 2027 $2,834.00. $34.008.00
Year 5 March 2027—February 2028 $2,834.00 $34,008.00
TOTAL COST(5-Years) $166,800.00
•
•
•
In no event shall Consultant's total of all compensation and reimbursement under this Agreement
exceed the sum of$166,800.00 (one hundred sixty-six thousand eight hundred dollars) •
without the express, written approval from the City official whose signature appears below, or
•
such official's successor in office. Payments shall be made within thirty (30) days of the date of
r
Page 1 of 7: PERSONAL SERVICES AGREEMENT BETWEEN THE CITY OF ASHLAND AND EVERGREEN JOB&SAFETY TRAINING,INC.
•
{
receipt by the City of Consultant's invoice. Should this Agreement be terminated prior to •
completion of all Work,payments will be made for any phase of the Work completed and
accepted as of the date of termination.
4. Supporting Documents/Conflicting Provisions: This Agreement and any exhibits or other
• supporting documents shall be construed to be mutually complementary and supplementary
wherever possible. In the event of a conflict which cannot be so resolved,the provisions of this
Agreement itself-shall control over any conflicting provisions in any of the exhibits or supporting
documents.
5. All Costs Borne by Consultant: Consultant shall, at its own risk,perform the Work described
above and,unless otherwise specified in this Agreement, furnish all labor, equipment, and "
materials required for the proper performance of such Work.
6. Qualified Work: Consultant has represented, and by entering into this Agreement now
represents,that all personnel assigned to the Work to be performed under this Agreement are
fully qualified to perform the services to which they will be assignedin a skilled manner and, if
required to be registered, licensed, or bonded by the State of Oregon, are so registered, licensed,
or bonded.
7. Ownership of Work/Documents: All Work,work product, or.other documents produced in
furtherance of this Agreement belongto the City, and any copyright,patent,trademark
proprietary or any other protected intellectual property right shall vest in and is hereby assigned
to the City.
8. Statutory Requirements: The following laws of the State of Oregon are hereby incorporated
by reference into this Agreement: ORS 279B.220, 279B.230 and 279B.235.
9. Living Wage Requirements: If the amount of this Agreement is $24,050.68 or more,
Consultant is required to comply with Chapter 3.12 of the Ashland Municipal Code by paying a
living wage, as defined in that chapter,to all employees performing Work under this Agreement
"and to any Subcontractor who performs 50% or more of the Work under this Agreement.
' Consultant is also required to post the notice attached hereto as "Exhibit B"predominantly in
areas where it will be seen by all employees. •
10. Indemnification: Consultant hereby agrees to defend, indemnify, save, and hold City, its
officers, employees, and agents harmless from any and all losses, claims, actions, costs,
expenses,judgments, or other damages resulting from injury to any person(including injury
. resulting in death), or.damage (including loss or destruction)to property, of whatsoever nature .
arising out of or incident to the performance of this Agreement by Consultant(including but not
limited to, Consultant's employees, agents, and others designated by Consultant to perform Work
or services attendant to this Agreement). However, Consultant shall not be held responsible for •
-
any losses, expenses, claims, costs,judgments, or other damages, caused solely by the gross
negligence of City. • •
11. Termination: .
a. Mutual Consent. This Agreement may be terminated at any time by the mutual consent
of both parties.
b. City's Convenience. This Agreement may be terminated by.City at any time upon not
less than thirty (30) days' prior written notice delivered by certified mail or in person.
c. For Cause. City may terminate or modify this Agreement, in whole or in part, effective
•
Page 2 of 7: PERSONAL SERVICES AGREEMENT BETWEEN THE CITY OF ASHLAND AND EVERGREEN JOB&SAFETY TRAINING,INC.
•
upon delivery of written notice.to Consultant, or at such later date as may be established
by City under any of the following conditions:
i. If City funding from federal, state, county or other sources is not obtained and
• continued at levels sufficient to allow for the purchase of the indicated quantity of
services;
• ii. If federal or state regulations or guidelines are modified, changed, or interpreted in
such a way that the services are no longer allowable or appropriate for purchase under
this Agreement or are no longer eligible for the funding proposed for payments
authorized by this Agreement; or
iii. If any license or certificate required by law or regulation to be held by Consultant to
provide the services required by this Agreement is for any reason denied,revoked,
suspended, or not renewed.
d. For Default or Breach.
i. Either City or Consultant may terminate this Agreement in the event of a breach of
the Agreement by the other. 'Prior to such termination the party seeking termination
shall give to the other party written notice of the breach and its intent to terminate. If
the party committing the breach has not entirely cured the breach within fifteen(15)
days of the date of thenotice, or within such other period as the party giving the
notice may•authorize in writing,then the Agreement may be terminated at any time
thereafter by a written notice of termination by the party giving notice.
ii. Time is of the essence for Consultant's performance of each and every obligation and
duty under this Agreement. City,by written notice to Consultant of default or breach,
may at any time terminate the whole or any part of this Agreement if Consultant fails
to provide the Work called for by this Agreement within the time specified herein or
within any extension thereof.
iii. The rights and remedies of City provided in this subsection(d) are not exclusive and
are in addition to any other rights and remedies provided by law or under this
Agreement.
e. Obligation/Liability of Parties. Termination or modification of this Agreement pursuant
to subsections a, b,or c above shall be without prejudice to any obligations or liabilities
of either party already accrued prior to such termination or modification. However,,upon
receiving a notice of termination(regardless whether such notice is given pursuant.to
Subsection a,.b, c, or d of this section, Consultant shall immediately cease all activities
under this Agreement,lmless expressly directed otherwise by City in the notice of
termination. Further,upon termination, Consultant shall deliver to City all documents,
information,works-in-progress and other property that are or would be deliverables had
the Agreement been completed. City shall.pay Consultant for Work performed prior to
the termination date if such Work was performed in accordance with this Agreement.
12. Independent Contractor Status: Consultant is an independent contractor and not an employee
of the City for any purpose. Consultant shall have the complete responsibility for the
performance of this Agreement. Consultant shall provide workers' compensation coverage as
required in ORS Chapter 656 for all persons employed to perform Work pursuant to this
Agreement. Consultant is a subject employer that will comply with ORS 656.017.
• Page 3 of 7: PERSONAL SERVICES AGREEMENT BETWEEN THE CITY OF ASHLAND AND EVERGREEN JOB&SAFETY TRAINING,NC.
13. Assignment: Consultant shall not assign this Agreement or subcontract any portion of the Work
• without the written consent of City. Any attempted assignment or subcontract without written
consent of City shall be void. Consultant shall be fully responsible for the acts or omissionsof
any assigns or subcontractors and of all persons employed by them, and the approval by City of
•
any assignment or subcontract of the Work shall not create any contractual'relation between the
assignee or subcontractor and City.
14. Default. The Consultant shall be in default of this Agreement if Consultant: commits any
material breach or default of any covenant, warranty, certification, or obligation under the
Agreement; institutes an action for relief in bankruptcy or has instituted against it an action for
• insolvency; makes a general assignment for the benefit of creditors; or ceases doing business on
a regular basis.of the type identified in its obligations under the Agreement; or attempts to assign
rights in, or delegate duties under,this Agreement. '
15. Insurance. Consultant shall, at its own expense, maintain the following insurance:
a. Worker's Compensation insurance in compliance with ORS 656.017, which requires subject
employers to provide Oregon workers' compensation coverage for all their subject workers
•
b. Professional Liability insurance with a combined single limit, or the equivalent, of not less
than$2,000,000 (two million dollars)per occurrence. This is to cover any damages caused
by error, omission or negligent acts related to the Work to be provided under this Agreement.
c. General Liability insurance with a combined single limit, or the equivalent, of not less than
$2,000,000 (two million dollars)per occurrence for Bodily Injury, Death, and Property
Damage.
d. Automobile Liability insurance with a combined single limit, or the equivalent, of not less
than$1,000,000 (one million dollars) for each accident for Bodily Injury and Property
Damage, including coverage for owned,hired or non-owned vehicles, as applicable.
e. Notice of cancellation or change. There shall be no cancellation, material change, reduction '
of limits or intent not to renew the insurance coverage(s) without thirty (30) days' prior
written notice from the Consultant or its insurer(s)to the City.
f. Additional Insured/Certificates of Insurance. Consultant shall name the City of Ashland,
'Oregon, and its elected officials, officers and employees as Additional Insureds on any
insurance policies, excluding Professional Liability and Workers' Compensation, required
•herein,but only with
respect to Consultant's services to be provided under this Agreement. The consultant's
insurance is primary and non-contributory. As evidence of the insurance coverages required
by-this Agreement,the Consultant shall furnish acceptable insurance certificates prior to
commencing the Work under this Agreement. The certificate will specify all of the parties
• who are Additional Insureds.. Insuring companies.or entities are subject to the City's
acceptance. If requested, complete copies of insurance policies; trust agreements, etc. shall
be provided to the City. The Consultant shall be financially responsible for all pertinent
deductibles, self-insured retentions, and/or self-insurance.
16. Nondiscrimination: Consultant agrees that no person shall, on the grounds of race, color,
religion, creed, sex,marital status, familial status or domestic partnership, national origin, age,
mental or physical disability, sexual orientation, gender identity or.source of income, suffer
discrimination in the performance of any Work under this Agreement when employed by
Page 4 of 7: PERSONAL SERVICES AGREEMENT BETWEEN THE CITY OF ASHLAND AND EVERGREEN JOB&SAFETY TRAINING,INC.
• •
•
is
Consultant. Consultant agrees to comply with all applicable requirements of federal and state
civil rights and rehabilitation statutes,rules and regulations. Further, Consultant agrees not to
discriminate against a disadvantaged business enterprise, minority-owned business, woman-
owned business, a business that a service-disabled veteran owns or an emerging small business •
enterprise certified under ORS 200.055, in awarding subcontracts as required by ORS 279A.1.10.
17. Consultant's Compliance with Tax Laws:
17.1 Consultant represents and warrants to the City that: •
17.1.1 Consultant shall,throughout the term of this Agreement, including any extensions
hereof, comply with:
(i) All tax laws of the State of Oregon, including but not limited to ORS 305.620 and
ORS Chapters 316, 317, and 318;
(ii) Any tax provisions imposed by a political subdivision of the State of Oregon
applicable to Consultant; and
(iii) Any rules,regulations, charter provisions, or ordinances that implement or
enforce any of the foregoing tax laws or provisions.
17.1.2 Consultant, for a period of no fewer than six (6) calendar years preceding the Effective
Date of this Agreement, has faithfully complied with:
(i) All tax laws of the State of Oregon, including but not limited to ORS 305.620 and
ORS Chapters 316, 317, and 318;
(ii) Any tax provisions imposed by a political subdivision of the State of Oregon
applicable to Consultant; and
(iii) Any rules, regulations, charter provisions, or ordinances that implement or
enforce any of the foregoing tax laws or provisions.
•
18. Notice. Whenever notice is required or permitted to be given under this Agreement, such notice
shall be given in writing to the other party by personal delivery,by sending via a reputable
commercial overnight courier, by mailing using registered or certified United States mail,return
receipt requested,postage prepaid, or by electronically confirmed at the address or facsimile
number set forth below:
If to the City:
Electric Department
Attention: Thomas McBartlett III
Address: 90 N. Mountain
Ashland, Oregon 97520
Telephone: 541-488-5387
Email: Thomas.mcbartlett@ashland.or.us
With a copy to:
City of Ashland—Legal Department • •
20 E. Main Street
Ashland, Oregon 97520
Phone: (541) 488-5350 .
Page 5 of 7: PERSONAL SERVICES AGREEMENT BETWEEN THE CITY OF ASHLAND AND EVERGREEN JOB&SAFETY TRAINING,INC.
J
If to Consultant:
Evergreen Job & Safety Training, Inc.
Attention: Jesse Langslet, Owner/Instructor
Address: 1352 Palmerston Loop
•
Roseville, CA 95678
•
Telephone: 916-742-1811
Email: evergreenjobandsafety@gmail.com • .
19. Governing Law. This Agreement shall be governed by the laws of the State of Oregon without
regard to conflict of laws principles. Exclusive venue for litigation of any action arising under
this Agreement shall be in the Circuit Court of the.State of Oregon for Jackson County unless
• exclusive jurisdiction is in federal court, in which case exclusive venue shall be in the federal
district court for the district of Oregon. Each party expressly waives any and all rights to
• maintain an action under•this Agreement in any other venue, and expressly consents that,upon
motion of the other party, any case may be dismissed or its venue transferred, as appropriate, so
as to effectuate this choice of venue.
20. Amendments. This Agreement may be amended only by written instrument executed by both
•
parties with the same formalities as this Agreement.
21. Nonappropriations Clause. Funds Available and Authorized: City has sufficient funds
currently available and authorized for expenditure to finance the costs of this:Agreement within
the City's fiscal year budget. Consultant understands and agrees that City's payment of amounts
under this Agreement attributable to Work performed after the last day of.the current fiscal year
is contingent on City appropriations, or other expenditure authority sufficient to allow City in the
•
exercise of its reasonable administrative discretion,to continue to make payments under this
Agreement. Iri the event City has insufficient appropriations, limitations or other expenditure
authority, City may terminate this Agreement without penalty or liability to City, effective upon
• ,the delivery of written notice to Consultant,with no further liability to Consultant.
22. THIS AGREEMENT AND THE ATTACHED EXHIBITS CONSTITUTE THE ENTIRE
• UNDERSTANDING AND AGREEMENT BETWEEN THE PARTIES. NO WAIVER,
• CONSENT, MODIFICATION OR CHANGE OF TERMS OF THIS AGREEMENT SHALL
BIND EITHER PARTY UNLESS'IN WRITING AND SIGNED BY BOTH PARTIES. SUCH
WAIVER, CONSENT, MODIFICATION OR CHANGE, IF MADE, SHALL BE EFFECTIVE •
ONLY IN THE SPECIFIC INSTANCE AND FOR THE SPECIFIC PURPOSE GIVEN.
THERE ARE NO.UNDERSTANDINGS,AGREEMENTS, OR REPRESENTATIONS, ORAL
OR WRITTEN,NOT SPECIFIED HEREIN REGARDING THIS AGREEMENT.
CONSULTANT,BY SIGNATURE OF ITS AUTHORIZED REPRESENTATIVE, HEREBY
ACKNOWLEDGES THAT HE/SHE HAS READ THIS AGREEMENT, UNDERSTANDS IT,
AND AGREES TO BE BOUND BY ITS TERMS AND CONDITIONS.
23. Certification. Consultant agrees to and shall sign the certification attached hereto as "Exhibit
C" and incorporated herein by this reference.
•
Page 6 of 7: PERSONAL SERVICES AGREEMENT BETWEEN THE CITY OF ASHLAND AND EVERGREEN JOB&SAFETY TRAINING,INC.
,
IN WITNESS WHEREOF the parties have caused this Agreement to be signed in their respective names
by their duly authorized representatives as of the dates set forth below.
CITY OF ASHLAND: EVERGREEN JOB & SAFETY TRAINING,INC.
By: e°i f By: 7/420.--/ ----
sep
"141
Lrd, City Manager Sir
0/7. 43 . e se Lv5 late Printed Ne
£pera rr- b w ter—
Title
Purchase Order No. 3� 6 02-'Z3—"2
Date
(W-9 is to be submitted with this signed Agreement)
APPROVED AS TO FORM:
co.4./\_______
City Attorney
03/20 ,
Dae
Page 7 of 7: PERSONAL SERVICES AGREEMENT BETWEEN THE CITY OF ASHLAND AND EVERGREEN JOB&SAFETY TRAINING,INC.
•
• ,
•
•
•
EXHIBIT B •
CITY OF ASHLAND, OREGON
•
`° y wCit . of Ashland •.
• ,
LIVING
. .
ALL employers described WAG E
below must comply with City
of Ashland laws regulating • •
•
•a ment of a livin• wase.
$17.02'per hour;;effective June;;30;.'2022.
The. Living_Wage is adjusted 'annually every:
wall' June 30.by the Consumer Price,Index.
Employees must be paid a portion of business of their 401K and IRS eligible
living wage: employer, if the employer has cafeteria plans (including '
ten or more employees, and childcare) benefits,tb the
has received financial amount of wages received by
' assistance for the project or the employee.
For all hours worked under a business from the City of
service contract between their Ashland in excess of > Note: For temporary and
• •
employer and the City of $24,050.68. part-time employees, the
Ashland if the contract • Living Wage does not apply
exceeds $24,050.68 or more. > If their employer is the City of to the first 1040 hours worked
Ashland, including the Parks in any calendar year. For
> For all hours worked in a and Recreation Department. more details, please see
month if the employee spends Ashland Municipal Code
50% or more of the • ➢ In calculating the living wage, Section.3.12.020.
employee's time in that month employers may add the value
working on a projector of health care, retirement,
For additional information:
Call the Ashland City Administrator's office at 541-488-6002 or write to the City Administrator,.
City Hall, 20 East Main Street, Ashland, Oregon 97520, or visit the City's website at www.ashland.or.us.
Notice to Employers: This notice must be posted predominantly in areas where it can be
seen by all employees. CITY OF
•
• ASH LAN D
Page 1 of 1: EXHIBIT B
1 j
EXHIBIT C
CERTIFICATIONS/REPRESENTATIONS: Consultant,by and through its authorized "
representative,under penalty of perjury, certifies that(a)the number shown on the attached W-9
form is,its correct taxpayer ID (or is waiting for the number to be issued to it and(b) Consultant
• is not subject to backup'withholding because: (i) it is exempt from backup withholding, or (ii) it
has not been notified by the Internal Revenue Service (IRS)that it is subject to backup .
withholding as a result of a failure to report all interest or dividends, or (iii)the IRS has notified
it that it is no longer subject to backup withholding. Consultant further represents and warrants
to.City that: (a) it has the power and authority to•enter into this Agreement and perform the
Work, (b)the Agreement, when executed and delivered, shall be a valid and binding obligation
• of Consultant enforceable in accordance with its terms, (c)the work under the Agreement shall
be performed in accordance with the highest professional standards, and (d) Consultant is
qualified,professionally competent, and duly licensed (if applicable)to perform the Work..
Consultant also"certifies under penalty of perjury that its business is not in violation of any
Oregon tax laws, it is an independent contractor as defined in the Agreement, it is authorized to
do business in the State of Oregon, and Consultant has checked four or more of the following
criteria that apply to its business.
• (1) Consultant carries out the work or services at a location separate from a private
residence or is in.a specific portion of a private residence, set aside as the location of
the business.
(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.
(5) Labor or services are performed for twoor more different persons within'a period
of one year. .
(6) Consultant assumes financial responsibility for defective workmanship or for
service not provided as evidenced by the ownership of performance bonds,
warranties, errors and omission(professional liability) insurance or liability insurance
relating to the.Work or services to be provided.
•
/ •
Con-o ltant's s' ature . •
0 ---23--907-3 5 . • .
Date
Page 1 of 1: EXHIBIT C • • S .
1
• CERTIFICATION OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE REQUIREMENTS
Contractor is exempt from the requirement to obtain workers compensation insurance pursuant to ORS •
Chapter 656 for the following reason. Contractor is to initial the appropriate box as follows:
SOLE PROPRIETOR
(-I als) ■ Contractor is a sole proprietor,and
■ Contractor has no employees,and
• Contractor will not hire employees or subcontractors to perform'this contract.
1. CORPORATION—FOR PROFIT
(I vials). .■ Contractor's business is incorporated;and
■. All employees of the corporation are officers and directors and have a substantial ownership interest*in the
corporation,and
■ All work will be performed by the officers and directors;Contractor will not hire other employees or subcontractors '
to perform this contract.
CORPORATION-NONPROFIT
(nitials) • Contractor's business is incorporated as a nonprofit corporation, and
■ Contractor has no employees; all work is performed by volunteers,and
• Contractor will not hire employees or subcontractors to performthis contract.
PARTNERSHIP '
- itials) • Contractor is a partnership,and
• Contractor has no employees,and •
• All work will be performed by the partners;Contractor will not hire employees or subcontractors to perform this
contract,and
■ Contractor is not engaged in work performed.in direct connection with the construction,alteration,repair,
improvement,moving or demolition of an improvement to real property or appurtenances thereto.**
LIMITED LIABILITY COMPANY
( itials) • Contractor is•a limited liability company, and
• Contractor has no employees,and
• All work will be performed by the members;Contractor will not hire employees or subcontractors to perform this
contract,and
• If Contractor has more than one member, Contractor is not engaged in work performed in direct connection with the
construction,alteration,repair,improvement,moving or demolition of an improvement to real property or
appurtenances thereto.**
•
igna Authorized Signer) (Date)
0Per r 0lit)
(Authorized igner's Title) •
•
*NOTE: Under OAR436-50-050 a shareholder has a"substantial ownership"interest if the shareholder owns 10%of the
corporation,or if less than 10%is owned,the shareholder has ownership that is at least equal to or greater than the average
percentage of ownership of all shareholders.
•
**NOTE: Under certain circumstances partnerships and limited liability companies can claim an exemption even when performing
construction work. The requirements for this exemption are complicated. Consult with City Attorney's Office before an exemption
request is accepted from a contractor who will perform construction work.
3/4., .
t
•
• 5.
'i,
�t
4 i .. I
•
ACO CERTIFICATE CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
`..*''' •
03/09/2023
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES,
• BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. .
IMPORTANT: If the certificate holder is.an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may.require an endorsement A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER ---CONTACT Nekiesha Hale • •
. NAME: •
Cook,Disharoon&Greathouse,Inc. PHONE (510)437-1900 FAX (510)437-1979
(Ale,No,Ext): (A/C,No):
16 Bryson Drive E-MAADDRESS: certificates@cdginsurance.com
INSURERS)AFFORDING COVERAGE NAIC#
Sutter Creek • CA 95685 INSURERA: LandmarkAmerican Ins Co 33138
•INSURED INSURER B:
Evergreen Job and Safety,Incorporated - INSURER C: '
• • 1352 Palmerston Loop INSURER D: ' •
•
INSURER E:
• Roseville . -• CA 95678-1176 INSURER F:
. COVERAGES CERTIFICATE NUMBER: CL233916645 . REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED By THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADDLSUBR POLICY EFF POLICY EXP
LTR TYPEOFINSURANCE INSD WVD POLICY NUMBER (MM/DD1YYYY) (MMIDD/YYYY) • LIMITS
X COMMERCIAL GENERAL LIABILITY •
EACH OCCURRENCES 1,000,000
• DAMAGE TO RENTED
• CLAIMS-MADE n OCCUR .. • PREMISES Ea occu ence) $ 50,000
MED EXP(Any one person) $ 10,000
A • .Y Y LHC801898 03/14/2023 03/14/2024• PERSONAL SADVINJURY $ 1,000,000
GEN'LAGGREGATE LIMITAPPLIES PER: GENERALAGGREGATE $ 2,000,000
X POLICY n jEC n LOC PRODUCTS-COMP/OPAGG $ 2,000,000
JCI OTHER: Professional Liability •
PL EACH CLAIM $ 1,000,000
AUTOMOBILE LIABILITY • COMBINED SINGLE LIMIT $
_ (Ea accident)
ANY AUTO BODILY INJURY(Per person) $
OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
• HIRED NON-OWNED PROPERTY DAMAGE • $
AUTOS ONLY _ AUTOS ONLY • (Per accident)
. • $
UMBRELLA LIAB — OCCUR -$
EACH OCCURRENCE
. EXCESS LIABCLAIMS-MADE AGGREGATE • $
DED RETENTION$ $
WORKERS COMPENSATION
OTH-
AND EMPLOYERS'LIABILITY YIN •
PER
ER •
ANY PROPRIETOR/PARTNER/EXECUTIVE N!A E.L EACH ACCIDENT $
.OFFICER/MEMBER EXCLUDED?
(Mandatory In NH) E.L DISEASE-EA EMPLOYEE $
If yes,describe under
DESCRIPTION OF OPERATIONS below • E.L.DISEASE-POLICY LIMIT $
• DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required)
THIS CERTIFICATE SERVES AS PROOF OF COMBINED PROFESSIONAL AND GENERAL LIABILITY COVERAGE. •
Additional Insured per RSG 550050710 . "
Waiver of Subro per RSG 54078 0310 •• .
Primary and Noncontributory per RSG 54155 0816 '
•
CERTIFICATE HOLDER - • ' CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
•
• THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
• • City of Ashland • ACCORDANCE WITH THE POLICY PROVISIONS.,
90 N.Mt Avenue, "
AUTHORIZED REPRESENTATIVE '
• Ashland OR 97520 kik 74,k
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
• r
•
LANDMARK AMERICAN INSURANCE COMPANY
This Endorsement Changes The Policy, Please Read It Carefully.
WAIVER OF TRANSFER OF RIGHTS OF
•
RECOVERY AGAINST OTHERS TO US
This endorsement modifies insurance provided under the following: -
COMMERCIAL GENERAL LIABILITY COVERAGE PART
•
SCHEDULE
Name of Person or Organization:
Any Person or Organization As Required By Written:Contract
The following is added to SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, 8. •
TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US:
We waive any right of recovery we may have against the person,or organization shown in the SCHEDULE
• above because of payment we make for injury or damage arising out of your ongoing operations, •"your
product or "your work" done under a written contract with that person or organization and included in the
"product-completed operations hazard". This waiver applies only, to the person or organization shown in
the SCHEDULE above.
•
•
•
•
•
•
•
•
This endorsement effective 3/14/2022
• • Forms part of Policy Number LHC845567 •
• Issued to EVERGREEN JOB AND•SAFETY TRAINING INC •
by Landmark American Insurance Company
Endorsement No.: 15
RSG 54078 0310 Includes copyrighted material of Insurance Services Office, Inc.,with its permission.
Copyright, Insurance Services:Office, Inc.,2009 •
LANDMARKAMERICAN INSURANCE COMPANY
This Endorsement Changes The Policy. Please Read it Carefully.
ADDITIONAL INSURED
• BLANKET
This endorsement modifies insurance provided.under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
•
SCHEDULE •
Name of Person or Organization:. • .
Any person or organization to whom or to which you are.obligated by virtue of a Written contract or by the
issuance or existence of a written permit,to provide insurance such as is afforded.by this policy.
•
•. A. SECTION II - WHO IS AN INSURED is amended to include as an additional insured the person(s) or
organization(s) shown on the SCHEDULE, but only with respect to liability for "bodily injury", "property
damage" or"personal and advertising injury"caused, inwhole or in part, by:
. 1. Your acts or omissions;or
2., The acts or omissions of those acting.on your behalf; •
•
in the performance of your ongoing operations for,the additional insured(s) at the location(s) designated
above.
B. With respect to the insurance afforded to these additional insured, the following.addiitional exclusions apply:
This insurance does not apply to "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.
•
•
•
•
•
•
This endorsement effective 3/14/2022 ,
forms part of Policy Number LHC845567
issued to EVERGREEN.JOB AND SAFETY TRAINING INC
by Landmark American Insurance Company
Endorsement No.: 01
RSG 55005 0710 • Includes copyrighted material of Insurance Services Office, Inc.
With its permission. •
LANDMARK.AMERICAN INSURANCE COMPANY
This Endorsement Changes The Policy, Please Read It Carefully.
PRIMARY AND NONCONTRIBUTORY -
OTHER INSURANCE CONDITION (SPECIFIC)
This endorsement modifies insurance provided under the following: •
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
SCHEDULE
Name of Additional Insured
Where required by written contract
The following is added to the Other Insurance Condition and supersedes any provision to the contrary:
Primary And Noncontributory Insurance •
This insurance is primary to and will not seek contribution from any other insurance available to the additional
insured listed in the SCHEDULE above provided that:
(1) The additional insured is a Named Insured under such other insurance; and.
(2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not
seek contribution from any other insurance available tothe additional insured.
•
•
•
•
•
This endorsement effective 3/14/2022 '
forms part of Policy Number LHC845567
issued to EVERGREEN JOB AND SAFETY TRAINING INC
by Landmark American Insurance Company
Endorsement No.: 11
RSG 54155 0816 Includes copyrighted material of Insurance Services Office, Inc.
with its permission.
EXHIBIT A
•
Viil4 -
ft
&aeof3peen 006 $$ifQEgg '7vetinin j, .,enc.
1352 Palmerston Loop-Roseville,CA 95678
Office:(916)742-1811
Fax: (916)742-1852
evergreenjobandsafety@gmail.com
•
City of Ashland—Electric Department 12/16/2022
Attn: Thomas McBartlett III
Director of Electric Utility
90 N.Mountain Ave.
•Ashland, OR 97520
COST PROPOSAL
5-Year Service Contract: March,2023—February,2028
Dear Mr.McBartlett III,
I appreciate the opportunity to present this Cost Proposal.As your job and safety
training instructor,I will be dedicated to providing the best possible service to meet the
specific needs of the City of Ashland Electric Department through providing quality
training on OSHA and other job and technical topics for your employees.I feel very
competent to provide the scope of services you are requesting based on 26 years of
experience in the trade as a Journeyman Lineman,Line Crew Foreman and Safety
Consultant.This cost for training is as follows, and includes all of my expenses,
including administration,training materials,record keeping,program development,
insurance,travel,lodging,meals, etc.Here is the breakdown of fees:
5-Year Contract Cost Per Month Annual Cost
Year 1—March 2023—February 2024 $2,699.00 $32,388.00
Year 2—March 2024—February 2025 $2,699.00 - $32,388:00
Year 3—March 2025—February 2026 $2,834.00 $34,008.00
Year 4 March 2026-February 2027 $2,834.00 $34,008.00
Year 5—March 2027-February 2028 $2,834.00 $34,008.00
Total Cost(5 years) $16(69800.00 -
o '
,
1
1
-
If this proposal meets your approval,I will proceed with addressing the contractual terms
you are requesting and will comply fully with the insurance requirements for the City of
Ashland.Thank you for considering Evergreen Job&Safety TrRining,Inc. for your training
• provider.I hope to have the opportunity to serve you in this capacity.Please reach out if you
have any questions and thank you again for your consideration.
•
Sincerely, •
Jesse Langslet
Owner/Instructor
/2-—
Jesse Langslet/Owner Date
•
•
•
7 7
-41
•
•
Jab 4-407u,RC2/nS` 2;
�u�s�9i$een /job A. $a6eltt rtstainino, Ossc.
1352 Palmerston Loop-Roseville,CA 95678
Office:(916)742-1811
Fax:(916)742-1852
evergreenjobandsafety@gmail.com •
City of Ashland—Electric Department 12/16/2022
Attn: Thomas McBartlett III
Director of Electric Utility
90 N.Mountain Ave. •
Ashland, OR 97520 •
Dear Mr. McBartlettIII,
I.appreciate the opportunity to introduce this proposal for onsite safety training
for the City of Ashland Electric Utility Department. This proposal contains an overview
of my qualifications and experience, along with my certifications and credentials.I feel
very competent to provide the scope of services you are requesting based on 26 years of
experience in the trade as a Journeyman Lineman, Line Crew Foreman and Safety
Consultant. I have included references for your review.
As your job and safety training instructor, I will be dedicated to providing the
best possible service to meet the specific needs of the City of Ashland through providing
quality training on OSHA and other job and technical topics for your employees.This
proposal outlines my training methods practices and includes a list with descriptions of
the 57 courses my company offers. .
If this proposal meets your approval,I will proceed with addressing the contractual terms
you are requesting and will comply fully with the insurance requirements for the City of
Ashland. Thank you for considering Evergreen Job&Safety Training,Inc. for your training •
provider.I hope to have the opportunity to serve you in this capacity.Please reach out if you
have any questions and thank you again for your review.
Sincerely,
•
•
Jesse Langslet
Owner/Instructor
t ,
j
� '
'�eeus IPI yl.
lob
&aergreen 01)6 do $a6eiy crgaininq, Dote.
1352 Palmerston Loop-Roseville,CA 95678
Office: (916) 742-1811
Fax: (916) 742-1852
evergreenjobandsafety@gmail.coam •
Owner/Trainer:
Jesse Langslet
CITY OF ASHLAND
SAFETY TRAINING PROPOSAL
ELECTRIC UTILITY DEPARTMENT
Due 1/1912023
•
• )•
„1.
b et• •,:
J,(1'31!.1F*:-14 601,aPiNalastRiebs4,
Table of Contents •
•
Qualifications & Experience • 1
• Company Overview
• Personal Experience
• Certifications&Credentials
•
. Tnstructional Methods
• Job Observations&Substation Inspections •
Safety Training Classes •. • 3 •
• Proposed Safety Training Classes
• Example of 12-Month Schedule
•
References • 4
Contractual Terms & Conditions 5
Cost Proposal (submitted separately)
•
Appendix A: Proposal Form(Exhibit A)
Appendix B: Evergreen Course Offerings (with descriptions) •
Appendix C: Evergreen Track Sheet •
Appendix D: Evergreen Job Observation Form
Appendix E: Evergreen Substation Inspection Form , •
Appendix F: Certificate of Compliance (Exhibit B)
• Appendix G:Acceptance of City's contract provisions (Exhibit D) .
•
Qualifications & Prior Experience •
•
Company Overview
•
Evergreen Job & Safety Training, Inc.has been providing safety training for the past 28 years to
electrical utilities and municipalities throughout California, Oregon&Nevada. In April 2013,I
took Over the company from the previous owner,retaining all contracts and clients. In the past
five years asowner and instructor for my company, I have provided training for more than 20
utilities in California, Oregon and Nevada.I am the sole trainer for my company. This training
includes both classroom and hands-on/field experiences,job observations, and substation
inspections, encompassing all OSHA 1910269 regulations and technical content. Classroom
training involves power point instruction, discussion, safety videos, and exams:Field experience
includes hands-on training using all tools and equipment used on the job. Forms used for
classroom training,job observations and substation inspections are included in this proposal.
•
Currently,we offer more than 57 courses in the areas of general safety and technical training,
including all 23 topics in the OSHA 1910.269 regulations, as well as Cal-OSHA Title 8
regulations. We offer training on a monthly basis, semi-annually, and also as a one-time service,
all at competitive pricing to our clients. We are dedicated to educating our clients on the most
up-to-date safety requirements and regulations in order to promote safe work practices for all
employees in the industry. A list of course offerings with descriptions is included in
Appendix B.
•
•
Personal Experience •
My qualifications for being an instructor/safety trainer for the City of Ashland Electric
Department include the following: I have worked in the electrical line,trade for more than 26
years.I have a broad range of experience as a journeyman lineman/line foreman including
employment for both outside line contractors and utilities all across the United States. I have
experience working under a vast variety of safety regulations and standards within the trade. My
personal experience as a journeyman drives my commitment to providing exceptional education
to all line workers in order to maintain respect of the trade, improve the quality of work, and
ensure a'safe working environment. •
Certifications & Credentials
• Certified CPR,First Aid,A.E.D. Trainer
• Certified Forklift Instructor
• • Certified Occupational Hearing Conservationist
• Certified Work Zone Temporary Traffic Control &Flagging
Instructor
• Certified NCCO Crane Operator
• Class A- Commercial Driver's License,(CDL)
• OSHA 20 Certification
1
• IBEW Local 1245 Journeyman Lineman Card#D930056
• • HAZMAT Certification •
• Certified Energized Primary Voltage Rubber Glove Instructor
Instructional Methods
As the company's owner and sole trainer, I incorporate various types if instructional methods
into my training.For classroom settings,I utilize the following methods for content delivery and
knowledge assessment;Power Point presentations, safety training videos,interactive DVD
instruction,hands-on simulations, small and large.group discussion, and written exams. For
instruction in a field setting,I utilize hands-on instruction and practice using a variety of tools,
machinery and equipment that simulates actual on the job experiences. Trainings consist of either
a half day or full day schedule, depending on the topics covered.A list of course offerings with
descriptions is included in Appendix B. :
All trainings and participants are recorded on a company form known as a Track Sheet..
'Employees who participate in the training sign and print their names on the Track Sheet.The
trainer summarizes the topic(s) covered during the session on the Track Sheet,which are then
photo-copied for company record keeping.An original copy is provided to the supervisor
following the session. A copy of the company Track Sheet isincluded in Appendix C.
Job Observations and Substation Inspections
Job Observations and Substation Inspections are conducted as requested by the client and/or
required by law. The length of time of each observation and/or inspection varies due to the type
of job observed and size and condition of the facility inspected.
For job observations,the certified instructor/trainer will observe and report on various work
conditions in the field regarding safety,use of equipment and work methods. A company Job.
Observation Form is used to note job conditions,work methods and equipment used.Names of
crew leader and crew members are recorded and recommendations of work procedures are
provided including suggestions for improvement.All formal observations are provided by the
instructor/trainer in a written report:Photos and copies of all written job observations are
recorded and provided-to the supervisor. A copy of the Job Observation form is included in
Appendix D. . . .
For substation inspections, a company form is used that includes 10 topic areas of inspection
including; safety,high side buss and switches, circuit switchers, circuit breakers,power
transformers,voltage and voltage regulators, OCR's and oil switches,miscellaneous electrical
equipment, control house, and departure.Notes are recorded that may include recommendations
for improvement. All formal inspections are completed by the trainer/observer in a written
report. Photos and copies of all written inspections are recorded and provided to the supervisor.
A copy of the Substation Inspection form is included in Appendix E.
2
Safety Training Classes
Proposed Safety Training Classes
The complete list of 18 topics included in the City of Ashland RFP on page 11 are topics that are
covered in Evergreen's training schedule.For each of my client's training needs,I typically
alternate the training topics over a two year period in order for all of the necessary topics to be
covered. A list of training topics with descriptions is included in Appendix B.
•
Example of 12-Month Schedule
The following schedule is the actual topical training schedule that was executed for the
2022 training year for the City of Ashland—Electric Department.Days of the week,
start times for training sessions,length of training courses and proposed job observations
have been added as requested:
DATE OSHA 1910269 ToPics
PARAGRAPHS
JANUARY 14 B CPR, FIRST AID & AED
Friday
Start Time: 7:00 am
Course Length:4.5 hours 0
Job Observation: 1 hour
FEBRUARY 11 F EXCAVATIONS
•
Friday •
Start Time: 7:00 am
Course Length:4.5 hours
Job Observation: 1 hour
MARCH 11 E ENCLOSED SPACES &
Friday P MECHANICAL EQUIPMENT • •
Start Time: 7:00 am
Course Length:4.5 hours
Job Observation: 1 hour
APRIL 08 N GROUNDING
Friday .
Start Time: 7:00 am •
Course Length:4.5 hours •
Job Observation: 1 hour
MAY 06 BURN CENTER PRESENTATION
Friday
Start Time:7:00 am
Course Length:4.5 hours
Job Observation: 1 hour
JUNE 03 Q OVERHEAD LINES &
Friday HEAT ILLNESS
Start Time: 7:00 am
3
f
Course Length:4.5 hours
Job Observation: 1 hour
JULY 01 L ENERGIZED PARTS
Friday
Start Time: 7:00 am
Course Length:4.5 hours
•
Job Observation: 1 hour
JULY 29 FLAGGING & TRAFFIC CONTROL
Friday
Start Time: 7:00 am
Course Length:4.5 hours
Job Observation: 1 hour 0
AUGUST 26 TRANSFORMERS
Friday
Start Time:7:00 am -
Course Length:4.5 hours
Job Observation: 1 hour
SEPTEMBER 23 EMERGENCY RESPONSE PROCEDURES,
Friday POLE-TOP RESCUE &
• Start Time: 7:00 am BUCKET TRUCK RESCUE
Course Length:4.5 hours
Job Observation: 1 hour
NOVEMBER 10 C JOB BRIEFINGS &
Friday H LADDER SAFETY
Start Time:7:00 am
Course Length:4.5 hours
Job Observation: 1 hour
DECEMBER 16 J LIVE LINE TOOLS & GROUNDS TESTING
Friday
Start Time: 7:00 am
Course Length:4.5 hours
Job Observation: 1 hour
References
Jason Harston
(530) 249-4605
Plumas-Sierra Rural Electric Cooperative
Portola, CA
jharston@psrec.coop
Service provided: OSHA technical & safety training for the electric department
Andy Lethbridge•
(530) 598-4766.
Trinity Public Utilities District
4
Weaverville, CA
alethbridge@trinitypud.com
Service provided: OSHA technical&safety training for the electric department
Todd Woolman
(707)480-6485
City of Healdsburg—Electric Department
Healdsburg, CA
twoolman@ci.healdsburg.ca.us
Service provided: OSHA technical&safety training for the electrical department •
Contractual Terms & Conditions
If this proposal meets your approval, I will proceed with addressing any contract requirements
you are requesting.Evergreen will provide the following job training and/or safety training
services including job observations to the customer's employees:A total of twelve (12)programs •
for the Electric Department to be presented during the course of each year of the agreement
period.Upon agreement to this contract. By consent of both parties,the program schedule is to
be considered tentative arid,therefore, is subject to change by mutual agreement between both
parties during the course of the Agreement period.
Invoices for training sessions are sent to the client within 7 days of the completed
training.Payment for training and other services is expected within 30 days of receiving •
the invoice. The company keeps both electronic and paper records of all trainings,
invoices,Track Sheets, Job Observation forms, Substation Inspection forms, employee
exams, and employee certifications that are provided through the services of the
company and.the instructor/trainer. This proposal is a firm,irrevocable offer for 90 days.
Furthermore,I will comply with the insurance requirements for the City of Ashland.
• The Proposal Submission Form (Exhibit A) is included in Appendix A.
• The Certificate of Compliance(Exhibit B)is included in Appendix F.
• Acceptance of the City's contract provisions (Exhibit D)is included in Appendix.G.
•
•
•
•
•
• 5
•
•
•
•
•
•
•
•
•
•
. Appendix A . .
•
Proposal Form •
•
(Exhibit A)
1
` 4 '
• EXHIBIT A
Request for Proposals
SAFETY TRAINING
(Onsite for Public Works&Electric Utility Departments)
December 5,2022
•
Proposal Submission Form
The undersigned proposer submits.this proposal in response to the City's Request for Proposals(RFP) for
• SAFETY TRAINING,released on December 5,2022.The proposer warrants that proposer has carefully
reviewed the RFP and that this proposal represents proposer's full response to the requirements described
in the RFP. The proposer further warrants that if this proposal is accepted,the proposer will contract with
the City, agrees to the terms and conditions found in the attached contract and RFP or has submitted terms
and conditions acceptable to the City, and will provide all necessary labor,materials,equipment, and
other means required to complete the work in accordance with the requirements of the RFP and contract'
documents. . . • -
The proposer hereby acknowledges the requirement to carry or indicates the ability to obtain the;assurance
required in the contract. Indicate in the affirmative by initialing here:
•
The proposer hereby acknowledges receipt of Addendum Nos.A,B, C, and D to this RFP.
Full legal name of company: Evergreen job&Safety Training,Inc.
Principle owner's name: •
Jesse Langslet •
•
Business Address: 1352 Palmerston Loop
Roseville,CA 85678
State and location of .
•
company headquarters: California-Roseville
Year business established: 2013 •
Telephone Number: (916)742-1811 •
Fax Number: •(916)742-1852
•
Email Address: EvergreenJobandSafety@gmail.coan
Authorized Signature:
Printed/Typed Name: Jesse Langslet
•
Title: Owner/Operator
Date: 12/16/2022
RFP—Safety Training,Page 19 of 29
I
' 1
•••
•
•
•
•
•
•
•
1014 "„Abla.
•
•
•
• Appendix B
•
•
Evergreen Course Offerings.
• (with descriptions) •
I
t
,
t
• • EVERGREEN JOB & SAFETY TRAINING, INC.
LIST OF TRAINING COURSES W/ DESCRIPTIONS
•
• GENERAL SAFETY
• FIRST AID & CPR:
InstructionAnd discussion on Basic Plus CPR,First Aid,&A.E.D.View Basic Plus Medic First
Aid Videos.Perform hands-on CPR procedures and A.E.D.operation.Inspected all company
A.E.D.'s and familiarize all employees with,the operation of their company's specific A.E.D.
model.Instruction on basic First Aid:including how to assess an injured person,how to protect
yourself in a first aid emergency,and basic first aid treatment for the following conditions: •
choking,bleeding,shock,head/neck/back injury,spinal motion restriction,broken limbs,stroke,
diabetes,seizures,asthma,severe allergic reactions,cardiac arrest,poisoning,heat exhaustion,
heat stroke,hypothermia and frostbite.
• • AUTOMATED EXTERNAL.DEFIBRILLATION (AED):
Instruction and discussion on the Automated External Defibrillator(A.E.D.).Perform hands-on
A.E.D.operation.Inspect all company A.E.D.'s and familiarize all employees with the operation
of their company's specific A.E.D.model.
•
• EMERGENCY RESPONSE PROCEDURES:
Instruction and discussion on Emergency Response Procedures including mayday radio calls and
communications with E.M.S.Instruction on Pole-Top&Bucket Truck Rescue.Perform hands-on
pole-top rescue using cross-arm and screwdriver methods.Perform hands-on Bucket Truck
rescue using rescue blocks and bucket dump method.Instruction on steps to take to provide
proper medical care in the event of an electrical injury.Inspection of all company A.E.D.'s.
Review Rubber Glove principles and safe work practices.
• BLOOD-BORNE PATHOGENS:.
Instruction and discussion on blood-borne pathogens:identifying different types,why they are
harmful,how to prevent exposure and minimize and eliminate exposure and risks,methods of
transmission,effects on health,signs and symptoms after contact,and review of exposure control
plan.Instruction on proper P.P.E.to protect against blood-borne pathogens.View training video
on blood-borne pathogens.
•
• ELECTRICAL BURNS:
Presentation by Curtis Ryun of the Oregon Burn Center:Burn prevention&burn care.Discussion
on types of burns,ways to protect from burns using safety measures and proper P.P.E.,care for •
burns,and proper ways to care for a burn victim.Videos and photos of burn accidents and burn
victims are included during instruction.
° p
• HEARING CONSERVATION PROGRAM/HEARING TESTING:
Instruction and discussion on when to wear hearing protection,what type of protection,how to
properly use and maintain hearing protection,and the limitations of different types of hearing
protection.Discussion on how noise can damage the ear in different ways.Perform hearing tests
on all employees affected by/exposed to loud noise.
• WORK ZONE,TRAFFIC CONTROL & FLAGGING:
• Instruction and discussion on temporary traffic control and flagger safety including control of
traffic flow and safety measures for flaggers,workers,vehicles and pedestrians.Discussion on
traffic control set-ups and responsibilities of flaggers including ways to avoid potential
hazardous situations involving flagging and traffic control.View traffic control and flagger •
training videos.Written exam on flagger duties and temporary traffic control plans.
•
• CHAINSAW SAFETY:
Instruction and discussion on proper chainsaw operation,maintenance,storage,fueling,
operations and handling.Instruction on proper Personal Protective Equipment(PPE)to ufiii7e
while operating a chainsaw.View training Video:Chainsaw Safety.Discussion on near miss
chainsaw accidents and how to prevent such accidents. '
•
• DEFENSIVE DRIVING:
Instruction and discussion on basic defensive driving techniques including,inspection of vehicle
condition,awareness of blind spots,understanding the two-second rule,proper use and
maintenance of seat belts,and hazards of driving while under the influence/intoxicated&
distracted driving.View Defensive Driving training videos.
• ' DOG BITE PREVENTION:
Instruction and discussion on hazards associated with dogs while reading meters and entering
customers'properties including reading body language of the animal to prevent being bitten,
ways to avoid dog encounters,and how to protect yourself during a dog attack.Discussion on
proper ways to introduce yourself while approaching a customer's property.
• FORKLIFT CERTIFICATIONS:
Instruction and discussion on basic forklift principles and safe working rules.Discussion on basic
principles of a forklift including the stability triangle,picking and moving loads,load charts,tail
swing,crushing hazards,and other possible hazards while operating a forklift.Written Exam:
Forklift safe working rules.Hands-on skills test using company forklift. '
• HEAT ILLNESS AWARENESS & PREVENTION:
Instruction and discussion on symptoms of heat-related injuries and/or illness/exhaustion,
• proper care for victims of heat stress/illness,and prevention for heat-related injuries and/or
illness includingproper hydration and how to acclimate to working in hot conditions.View
training video on heat stress/illness awareness and prevention.
• SAFETY DATA SHEETS: '
Instruction and discussion on how to properly locate,read and follow safety data sheets.
Discussion on the use of chemicals in the workplace;properties of each chemical;the physical,
health,and environmental health hazards;protective measures;and safety precautions for
handling,storing,and transporting of chemicals.
•
•
• JOB OBSERVATIONS:
Observe and report on various work conditions in the field regarding safety,use of equipment
and work methods.A company Job Observation Form is used to.note job conditions,work
methods and equipment used.Names of crew leader and crew members are recorded and
recommendations of work procedures are provided including suggestions for improvement.All
formal observations are provided by the trainer/observer in a written report.Photos and copies
of all written job observations are recorded and provided to the supervisor.
•
OSHA 1910269 PARAGRAPHS (23 ToPIcs)
•
•
• GENERAL (A):
Instruction and discussion on the general operation and maintenance of electric power
generation,control,transformation,transmission,and distribution lines and equipment.
• MEDICAL SERVICES & FIRST AID (B):
Instruction and discussion on Basic Plus CPR,First Aid,&A.E.D.View Basic Plus Medic First
• Aid Videos.Perform hands-on CPR procedures and A.E.D.operation.Inspected all company •
A.E.D.'s and familiarize all employees with the operation of their company's specific A.E.D.
model.Instruction on basic First Aid:including how to assess an injured person,how to protect
yourself in a first aid emergency,and basic first aid treatment for the following conditions:
choking,bleeding,shock,head/neck/back injury,spinal motion restriction,.broken limbs,stroke,
diabetes,seizures,asthma;severe allergic reactions,cardiac arrest,poisoning,heat exhaustion,
heat stroke,hypothermia and frostbite. .
• JOB BRIEFINGS (C): • .
Instruction and discussion on required job briefing topics,procedures,and the importance of
having a thorough tailboard meeting before the start of each job.Briefings include discussions on
hazards associated with the job,work procedures involved,special precautions,energy source
controls,and personal protective equipment requirements.
•
• HAZARDOUS ENERGY CONTROL PROCEDURES (LOCK-OUT/TAG-OUT) (D):
Instruction and discussion on the importance of using lock-out/tag-out procedures while
working on conductors or electrical equipment,including related equipment for communication
or metering.Discussion on the importance of using locks and tags in conjunction with written
switching procedures.View Lock-Out/Tag-Out training video.
• ENCLOSED SPACES (E): •
Instruction and discussion on safe work practices,determination of required permit status,rescue
equipment,proper P.P.E.and rescue devices needed,evaluation of potential hazards,removal of
covers,hazardous atmospheres,attendants,calibration of test instruments,testing for oxygen
deficiency,testing for'flammable gases and vapors,ventilation and monitoring,entrant&
attendant communication,and air supply.
• EXCAVATIONS (F):
Instruction and discussion on identifying soil classifications,proper use of benching and sloping
systems,and proper use of shoring to protect against cave-ins while working in excavations.
` i y
•
View training video on soil classifications.View slope&bench angle charts for soil
classifications.
• PERSONAL PROTECTIVE EQUIPMENT (G):.
Instruction and discussion on Personal Protective Equipment(P.P.E)requirements,proper use
and benefits of basic electrical P.P.E.such as:F.R.clothing,hard hats,safety glasses&hearing
protection.Discussion on proper protection of head,eye,face,hand,foot,and full body.
Discussion on arc flash hazards.Discussion on when to wear PPE,what type of PPE is necessary,
and the limitations of different types of PPE.Inspection,cleaning and testing of all company
• overhead and underground personal protective grounds.Discussion on the importance of a
good,clean,tight connection.Inspection of all company fall protection devices.
• LADDERS, PLATFORMS, STEPBOLTS & MANHOLE STEPS (H):
Instruction and discussion on proper ladder selection,inspection,set-up&storage;discussion on
different types of ladders and the proper use of each type;discussion arid review of common
ladder accidents and how to prevent injury.Discussion on safety measure tobe take when
, encountering platforms,stepbolts and manholes while on the job.
• HAND & PORTABLE POWER TOOLS (I):
Instruction and discussion on proper use,care,maintenance and storage of hand tools and '
portable power tools connected by cord and plug.Discussion on types of hand and portable tools
used including vehicle mountedgenerators,hydraulic and pneumatic tools.
• LIVE LINE TOOLS (T): . •
Instruction and discussion on basic care,maintenance and storage of live line tools and personal
protective grounds.Discussion on the importance of proper,good,clean connections while using
personal protective grounds.Inspection,cleaning and testing of all company live line tools using
Chance wet-dry hot stick tester.Inspection,cleaning and testing of all company overhead and
underground personal protective grounds.
• MATERIAL HANDLING & STORAGE (K):
Instruction and discussion on how to properly handle, use, store and maintain all workplace
materials.
• WORKING ON OR NEAR EXPOSED ENERGIZED PARTS (L):
Instruction and discussion on minimum approach distances,types of insulation,working '
position,making connections,proper apparel,fuse handling,non-current carrying metal parts,
tail-boards,qualified employees and opening circuits under load. •
• DE-ENERGIZING LINES & EQUIPMENT (M):
Instruction and discussion on how to properly identify,isolate,and test&ground a circuit or
piece of equipment. Discussion on remote switches and breakers.Instruction on proper
switching procedures and working under a clearance. •
• GROUNDING FOR THE PROTECTION OF THE EMPLOYEES (N):
Instruction and discussion on different grounding hazards and procedures including;proper
identification,isolation,testing&grounding of distribution and transmission systems,
establishing an equa-potential zone,order of connection&removal of grounds,and step&touch
• potential.View training video:Chance E.P.Z.Grounding
1 1
i f C
•1. '
•
•
• TESTING & TEST FACILITIES (0): •
Instruction and discussion on underground thumper fault locating and proper grounding and
•
protection in a test environment. •
• MECHANICAL• EQUIPMENT (P):
Instruction and discussion on the importance of outriggers,load charts,boom angles,and having
a safety watch when working near energized lines.Discussion on safe work habits while working
around all types of line equipment
• OVERHEAD LINES (Q):
Instruction and discussion on testing wood poles,stringing conductors and grounding pulling
equipment View safety video on conductor stringing.
•
• LINE CLEARANCE TREE TRIMMING OPERATIONS (R):
. Instruction and discussion on electrical hazards,brush chippers,gasoline engine power saws,
minimum approach distances,instruction on proper chain saw operation,starting procedures,
handling,refueling&storage.View safety training video:Chainsaw Safety.
• • COMMUNICATIONS (S):
Instruction and discussion on precautions to take,regarding exposure while working near
electromagnetic radiation levels.Discussion on proper steps to take regarding•exposure including
the understanding of warning signs and symbols related to levels of hazardous exposure.
•
•. UNDERGROUND ELECTRICAL INSTALLATIONS (T): ,
Instruction and discussion on basic safe work practices while working on or near underground
conductors.Instruction on oxygen testing in vaults,moving energized cable,basic underground
switching,cable identification,terminations,excavations,lock-out/tag-out procedures,proper
grounding of primary underground conductors,working around utilities such as gas,water,
sewer&communications,underground trouble-shooting methods,and rescue procedures.
• SUBSTATIONS (U):
Instruction and discussion on signs,working space,minimum approach distances,clearances,
ground connections,entry,qualified employees,step potential,fence bonding,tagging&
switching procedures.Instruction on substation equipment such as switchers,transformers,
voltage regulators,distribution breakers and protective relays.Written reports and photos for all
substation inspections are recorded and copies are given to the supervisor.
• 'POWER GENERATION (V); •
Instruction and discussion on various types of power generation and how to protect against
back-feed.View safety training video:Power Generation.
• SPECIAL CONDITIONS (W):
hnstruction and discussion on the requirements pertaining to the de-energizing and grounding of
capacitor installations.Discussion on proper handling of capacitors banks,terminals and racks.
4
•
•
❖ TECHNICAL TRAINING
• HOT STICK/LIVE LINE TOOLS TESTING:
Instruction and discussion on basic care,maintenance and storage of live line tools and personal
protective grounds.Discussion on the importance of proper,good,clean connections while using
personal protective grounds.Inspection,cleaning and testing of all company live line tools using
Chance wet-dry hot stick tester.Inspection,cleaning and testingof all company overhead and
underground_personal protective grounds.
• PERSONAL PROTECTIVE GROUNDS TESTING:
Instruction and discussion on the importance of sizing grounds for maximum available fault
current;discussion on basic grounding procedures.Inspect,clean&test all company overhead&
underground personal protective grounds.
• POLE-TOP/BUCKET TRUCK/VAULT RESCUE:
Instruction and discussion on Pole-Top&Bucket Truck Rescue.Perform hands-on pole-top
rescue using cross-arm and screwdriver methods.Perform hands-on Bucket Truck rescue using
rescue blocks and bucket dump method.Instruction on how to properly test for oxygen levels in
vaults and methods for proper and safe vault rescue.
• RUBBER GLOVE CERTIFICATION COURSE & RE-CERTIFICATION:
Instruction and discussion on principles of insulate and isolate;second point of contact;
importance of protection against second point of contact;proper testing,use and care of tools and
equipment;instruction on proper type,class,rating,testing,inspection,use,care and
maintenance of all rubber goods,minimum approach distances,proper covering of energized
parts,and crew make-up.Instruction on all proper,safe rubber glove practices,procedures,
communication and tailboards.Rubber Glove written test.Cover-Up Interactive Training
Program:Instruction on`proper use of rubber goods used for personal protection during rubber
glove procedures.
• TRANSFORMER THEORY, APPLICATION & CONNECTIONS:
Instruction and discussion on transformer theory,banking,paralleling,basic hook-ups,how to
fuse and install transformers,Wye&Delta connections for primary and secondary sides,single
phase and three phase connections,phase rotation and,paralleling single transformers and three
phase banks&ground reference,vectoring&voltage checks;Discussion on how to trouble-shoot
• various situations.Discussion on phase angle&angular displacement,instruction on fuse sizing
&overloading conditions.
• VOLTAGE REGULATORS:
Instruction and discussion on proper volt meter operation.Instruction on down guy and screw
anchor installation.Discussion on proper Johnny Ball position and proper anchor lead.Perform
hands-on guy wire installation and anchor rod installation.Instruction on how to pull down guy ,
for proper strain on pole to achieve a plumb pole.Discussion on proper underground locates and
. digging around underground utilities.View volt meter training videos.
• CAPACITORS:
Instruction and discussion on basic capacitor theory and operation.Discussion on hazards
associated with working with distribution capacitors.Instruction on power correction,power
t a ,
•
factor and inductive and capacitive circuits.Discussion on capacitor sizing and proper fusing.
Discussion on the difference between inductive and capacitive circuits.Instruction on the
importance of using a load break device for de-energizing capacitors and the importance of
shunting after de-energizing.
• RIGGING:
Instruction and discussion on basic rigging techniques including rope breaking strength,knots,
weights of poles&material,sling angles&tension,parted blocks,mechanical advantage,
calculating haul line tension&hook strain,shock loading,figuring snatch block tensions&
friction,safe working loads of slings&chokers,capstans,fall line tensions,staying out of the bite
• while rigging,and calculating rigging for setting poles,hanging transformers and sagging wire.
• CONFINED SPACE:
Instruction and discussion on confined space permit,required confined space&confined space
rescue procedures.Instruction on how to classify confined spaces,oxygen testing,equipment
testing,rescue equipment,and roles and responsibilities of the entry supervisor,attendant and
entrant.View training video:Confined Space.
• METER SETTING & INSTALLATION:
Instruction and discussion on basic metering principles with setting and installation,and safety
concerns while performingmeter disconnects and re-connects.Discussion on how to properly
approach customers with caution.Discussion of physical and electrical hazards employees may
encounter while working on meter installations,proper P.P.E.while working on various voltages
in meter panels,safety procedures for voltage checks,procedures for checking for back-feed,
continuity tests,meter nameplate information and how to identify proper meter application,
discussion on meter connectionsfor single phase,three phase and demand meters.
• SUBSTATION SAFETY/INSPECTIONS:
Instruction and discussion on signs,working space,minimum approach distances,clearances,
ground connections,entry,qualified employees,step potential,fence bonding,tagging&
• switching procedures..Instruction on substation equipment such as switchers,transformers,
voltage regulators,distribution breakers and protective relays.A company Substation Inspection
Form is used that includes 10 topic areas of inspection.Notes are recorded that may include
recommendations for improvement.All formal inspections are completed by the
trainer/observer in a written report.Photos and copies of all written inspections are recorded
and provided to the supervisor.
• LIVE LINE TOOL APPLICATION & MAINTENANCE:
Inspect,clean and test all company live line tools using Chance wet-dry hot stick tester.
Instruction on basic care and maintenance of live line tools and personal protective grounds.
•
1t
f
EVERGREEN JOB & SAFETY TRAINING, INC.
LIST OF_TRAINING COURSES
• GENERAL SAFETY:
• FIRST AID & CPR
• AUTOMATED EXTERNAL DEFIBRILLATION (AED)
• EMERGENCY RESPONSE PROCEDURES
• BLOOD-BORNE PATHOGENS
• ELECTRICAL BURNS
• HEARING CONSERVATION PROGRAM/HEARING TESTING
• WORK ZONE TRAFFIC CONTROL & FLAGGING
• BACK SAFETY & ERGONOMICS
• Loss CONTROL
• CHAINSAW SAFETY
• DEFENSIVE DRIVING
• FORKLIFT CERTIFICATIONS
• HEAT ILLNESS AWARENESS & PREVENTION
• VIOLENCE IN THE WORKPLACE
• SAFETY DATA SHEETS -
• JOB OBSERVATIONS
❖ OSHA 1910269 PARAGRAPHS (23 TOPICS):
• GENERAL
• MEDICAL SERVICES & FIRST AID
• JOB BRIEFINGS .
• HAZARDOUS ENERGY CONTROL PROCEDURES (LOCK-OUT/TAG-OUT)
• ENCLOSED SPACES
• EXCAVATIONS
• PERSONAL PROTECTIVE EQUIPMENT (PPE)
• LADDERS, PLATFORMS, STEPBOLTS & MANHOLE STEPS
• HAND & PORTABLE POWER TOOLS
• LIVE LINE TOOLS
• MATERIAL HANDLING & STORAGE
• WORKING ON OR NEAR EXPOSED ENERGIZED PARTS
• DE-ENERGIZING LINES & EQUIPMENT
• TESTING & TEST FACILITIES
• MECHANICAL EQUIPMENT •
• OVERHEAD LINES
• LINE CLEARANCE TREE TRIMMING OPERATIONS •
• GROUNDING FOR THE PROTECTION OF THE EMPLOYEES
• UNDERGROUND ELECTRICAL INSTALLATIONS
• COMMUNICATIONS
• SUBSTATIONS
,
•
• POWER GENERATION
• SPECIAL CONDITIONS
•
• TECHNICAL TRAINING:
• HOT STICK/LIVE LINE TOOLS TESTING
• PERSONAL PROTECTIVE GROUNDS TESTING
• POLE-TOP/BUCKET TRUCK/VAULT RESCUE
. • RUBBER GLOVE CERTIFICATION COURSE & RE-CERTIFICATION
• TRANSFORMER THEORY, APPLICATION & CONNECTIONS
• • VOLTAGE REGULATORS
• ,CAPACITORS
• RIGGING •
• SYSTEM PROTECTION
• CONFINED SPACE •
• ,QUALIFIED WORKER (NON-JOURNEYMAN)
• METER SETTING & INSTALLATION
• ARC FLASH/FR APPAREL
• OVERHEAD. & UNDERGROUND SWITCHING PROCEDURES
• LIGHTNING ARRESTORS
• FAULT CURRENT
• SUBSTATION SAFETY/INSPECTIONS
• LIVE LINE TOOL APPLICATION &.MAINTENANCE
�k
•
•
•
•
�JfJ\
•
. f17° D:b� b.yg
`4n 'UAN, 5t
tan 5afgV T.01#14,Y
•
Appendix C
Evergreen Track Sheet
i
eoese9YQew Oen ifk $a hi 7mining, -One.
Jot
Aig fgRf ikI f ;lid', -•
Company Name: Date:
Training/Course Provided:
Employee Name Employee Signature TraininWCourse Objectives:
(please print)
1
I 1
1 •
i •
f
1
f !^
I
I P
I
i
1 I
itt
i
i
Instructor Name: Company Representative Signature:
Instructor Signature: Date Signed:
I
•
•
•
•
NA X0411 4:1,41 Rj � .
, 5 ey 74wu 4 •
•
•
•
•
•
•
•
Appendix.D
•
Evergreen Job Observation Form
,J
c!vesreen 006 A $a6ety (Training, ..One.
JOB OBSERVATION FORM
Company Name: •
Observer: . .
•
Date: Time: • Weather: •
Crew Leader:
Crew Members:
Job Location:
•
Job Task: •
Job Briefing: Was a Job Briefing conducted? YES NO
If so,by whom?
• • Energy Source Controls:
• Hazardous Conditions:
• Special Precautions:
• Personal Protective Equipment:
•
• Are proper tools &equipment in use? YES NO
• Are necessary traffic control devices being used? YES NO
Safety Notes: .
Observer Signature
1
.
•
•
•
•
•
•
•
•
•
•
•
•
•
t
N'AV ru. • rs— • v-1°7
17;47_, 4
Safety 7 ��`
Job a •
' ;lid•,;y'
•
•
•
•
•
•
•
Appendix E .
•
•
•
Evergreen Substation Inspection Form •
1
SUBSTATION & SWITCHING STATION MONTI- Y INSPECTION WORKSHEET
EVERGREEN JOB & SAFETY TRAINING, INC. STATION:
1.352 Palmerston Loop DATE'
Roseville,CA 95678 •
Office: (916) 742-1811 INSPECTOR:
•
. Fax: (916) 742-1852 TIME:
• Cell: (916) 224-0395
evergreenjobandsafety@gmail.com TEMPERATURE: '
• . ; YES No. I . - j YES _No
A.•SAFETY J 27. FREE FROM Ou. LEAKS ! i 'J
1. GATES PROPERLY LOCKED ! I J 28. THERMOMETERS OK/MAXIMUMS RESET
2. SUITABLE WARNING SIGNS ON FENCES ; 1 29. AUXILIARY COOLING EQUIPMENT
3. FENCES & GATES GROUNDED i - � - I, 30. GAS PRESSiIItE
---
4. Exrrs, WALKWAYS & DRIVEWAYS CLEAR : �^-�! F. VOLTAGES & VOLTAGE REGULATORS -1 - -
5. SUBSTATION ENCLOSURE FREE OF STORED l ! 31 VOLTAGES i .
MATERIAL & EQUIPMENT__ 1 I I •
I _
6. EQUIPMENT GROUNDS 1 32. BUSHINGS CLEAN, GOOD CONDITION •
B. HIGH SIDE BUSS & SWITCHES • i 1- ' 33. OIL LEVELS & GAUGES J
7. AIR BREAK & DISCONNECT SWITCHES APPEARANCE s . J 1 34. FREE FROM OIL LEAKS •
8. GROUND CONNECTION TO HANDLE ! • ! 1 35. INDICATING LIGHTS -
•
9. BYPASS SWITCHES APPEARANCE ; • ( 36. INDICATING GLASS COVERS • .
10. INSULATORS 37. CABINET GASKETS WEATHER TIGHT
11. BUSS APPEARANCE ' ' G. OCR's AND OIL SWITCHES •
C. CIRCUIT SWITCHERS i ' 35. APPEARANCE • I I --
' 12. APPEARANCE39. BUSHINGS CLEAN, GOOD CONDITION i- . '
13. GLASS/PORCELAIN CLEAN, GOOD CONDITION j I 4 40. FREE FROM OIL LEAKS
•
s 14. CONTROL POWER ' ' 41. BYPASS SWITCHES APPEARANCE "
j • •
'
. .... .. . . . . . . . . .
• D. CIRCUIT BREAKERS i ; IL MISCELLANEOUS ELECTRICAL EQUIPMENT '
• 16. APPEARANCE . i .43. ARRESTORS: APPEARANCE & CONNECTIONS I {
17. BUSHINGS CLEAN,GOOD CONDITION ' ! 44. FUSES & CONNECTIONS
18. OIL LEVELS & GAUGES -- - f 45. STATION LIGHTS -_----- ------
19. FREE FROM OIL LEAKS . ; 46. OVERHEAD GROUND WIRE . 7
20. SPACE HEATERS OPERATIVEI L CONTROL HOUSE 1_'
-- !
2L RELAY TARGETS RESET, CONTROL POWER 47. CONTROL HOUSE SECURE ' j i
22 INDICATING LIGHTS • -1-
I48. CLEAN I j 1
, 23. CONTROL CABINETS & GASKETS { I_- 1 49. EYEWASH ! l -{i
E. POWER TRANSFORMERS I f 50. FIRE EXTINGUISHER • I 1
•
' 24. APPEARANCE ' r- i 51 BATTERY CHECK_ --- --� -` -I
i---..- - - -_.._
Ii
25. BUSHINGS CLEAN, GOOD CONDITION � J
i i J. DEPARTURE � � � I
26. OIL LEVELS & GAUGES • 52 STATION LOCKED & SECURE •
�+ t
NOTES/COMMENTS: •
r
a
+ t1 p/1
ndiSi �
l
�.c;eiF.j�:.'.,};}r,:Lr.n-,.j
.:.;_.;x11.
h ..
Appendix F
Certificate of Compliance
(Exhibit B)
EXHIBIT B
Certificate of Compliance .
Compliance with Oregon Tax Laws:
In compliance with OAR 137-047-0260(2)(e),I hereby attest or affirm under penalty of perjury: That I am
authorized to act on behalf of the proposer in this matter,that I have authority and knowledge regarding the
payment of taxes, and that contractor is,to the best of my knowledge,not in violation of any Oregon Tax
Laws,as defined in ORS 305.380.
Compliance with Nondiscrimination Laws:
•
In compliance with ORS 279A.110(4), OAR 137-046-0210(2) and OAR 137-047-0260(2)(a)(E),I hereby
attest or affirm under penalty of perjury that I am authorized to act on behalf of proposer in this matter,and
to the best of my knowledge the proposer has not discriminated and will not discriminate, in violation of
ORS 279A.110(1),.against a minority,women or emerg ng small business enterprise certified under ORS
200.055 or against a business enterprise that is owned or controlled by or that employs a disabled veteran
as defined in ORS 408.225 in obtaining a required subcontract. •
•
•
Corporate Officer:
By:• /
. Si i?;
Jesse Langslet
Print Name •
•
Title: Owner/Operator
•
Date: 12/16/2022 •
•
•
•
•
•
RFP—Safety Training,Page 20 of29 •
•
•
•
•
•
•
•
•
wnbASfiF !' �.
•
• bLafety T. � " �
•••19- S 0.9.44.'.
•
Appendix .G
Acceptance of City's contract provisions •
• (Exhibit D) •
Ja rua,'S4fal°o' t+1-%
• eoe o reen jo6 A Ser{gtlt '3'glni,9, Jne.
1352.Palmerston Loop-Roseville,CA 95678
Office:(916)742-1811
• Fax:(916).742-1852 .
• evergreenjobardsafety@gmail.com
•
Re: 5-Year Service Contract:March,2023—February,2028
City of Ashland—Electric Utility Department
• I,Jesse Langslet,do hereby indicate acceptance and agreement with the City of Ashland's contract
provisions as presented in the Goods and Services Agreement found in Exhibit D of the City of
Ashland Request for Proposals for Onsite Safety Training for the Electric Utility Department;
released on December 5,2022.In the event that I shall enter into a contractual agreement with the
City of Ashland for such training services, I will fully comply with the contract provisions as
presented.
•
12— 1(D--2.022
•
Jesse Langslet Date Signed
Owner/Instructor
Y
t '