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HomeMy WebLinkAbout2022-099 PO 20230161- Carlson Corp. • Purchase Order ,a cry ECORDp Fiscal Year 2023 Page:p1 of: 1 RECORDER+uR' g=-.-1D ,711;1 a F 5 `i 1.= D ER*41 B City of Ashland t, E�r�1i 1 f' �[ } [+a�[�i ��rfa��4 t I ATTN: Accounts PayableL Purchase L 20 E. Main 20230161 Ashland, OR 97520 Order# -r Phone: 541/552-2010 O Email: payable@ashland.or.us • VCARLSON CORP H C/O Electric Department N 4932 FERN VALLEY RD I 90 North Mountain Ave • D PO BOX 1503 P Ashland, OR 97520 R• MEDFORD, OR 97501 Phone: 541/488-5357 T Fax: 541/552-2436 •.S :§ a-elf '-I34§i=��f=1F [=1: J I� _ 2n5:71:1. =i Rick Barton FI 10/12/2022 . 1669 FOB ASHLAND OR/NET30 Ci Accounts Pa able !—� — � _..i-1�'�'-es[MI=.IE=��'=a — -_ _- __—_ = aL=3h�.=��I€ xa �� — ma=r ! � � , ,, € �� �_C- i* � -d~-§het's=ur[t-C Directional Drill Streetlight • 1 Directional drill for streetlight power 1.0 $4,950.00 $4,950.00 Goods and Services Agreement(Less than $35,000) Completion date: 01/31/2023 Project Account: E-000815-999 . ***************GL SUMMARY*************** 111800-602400 $4,950.00 • BY �1� . Al Date:. r Au •rize• ignature � z $4 950.00 FORM #3 _ CITY of A {• itc..<-A. f NI VChaS0 i'r,°.:r 0 ( ( ASHLAND REQUISITION ' Date of request: 10104/2022 • Required date for delivery: Vendor Name CARLSON CONSTRUCTION Address,City,State;Zip PO BOX 1503,1234 CORONA AVENUE MEDFORD,OR 97504 Contact Name&Telephone Number Brent Carlson,541.773.3035 cell:541.601.3849 Email address bcarlsonconstruction@hotmail.com •SOURCING METHOD ❑ Exempt from Competitive Bidding ❑ Invitation to Bid ❑ Emergency ❑ Reason for exemption:. •Date approved by Council: 0 Form#13,Written findings and Authorization , ❑ AMC 2.50 • _(Attach copy of council communication) 0 Written quote or proposal attached ❑ Written quote or proposal attached • - _(If council approval required,attach copy of CC) ❑ Small Procurement ❑ Request for Proposal Cooperative Procurement Not exceeding$5,000 Date approved by Council: 0 State of Oregon NI Direct Award _(Attach copy of council communication) - • Contract# • ' ❑ VerballWritten bid(s)or proposal(s) 0 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 0 Written quote or proposal attached Intergovernmental Agreement ❑ (3)Written bids&solicitation attached 0 Form#4,Personal Services$5K to$75K Agency - • PERSONAL SERVICES Date approved by Council: ❑ 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 ❑ Written quote or proposal attached approval required.(Attach copy of council communication) Date approved by Council: Valid until: Date Description of SERVICES , "`TOTALCOST: Per Carlson bid proposal,dated 10103122:provide directional drill for street light power per map, exhibit B,includingremove two(2)concretepanels and install conduit.COA toprovide all materials. O '4;950:00: ,-' ��' Item# Quantity 'Unit Description of MATERIALS Unit Price Total Cost . (COA to provide all material potholing of utilities,street repair,. sidewalk repairs,installing of wire into streetlights and ground • boxes.) [=I Per attached quotelproposal ;`.TOTAL`COST` Project Number o 0 0 8 1 5. 9 9 9 Account Number h 1 1 _ 0 0.6 a 2 4 0 0 $4 95D:O:Q'. 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 requisit' rm,I certifyth City's public contracting requirements have been satisfied. Z2.-- Employee" �� ) Department Head: Y (Equa o or greater than$5,0 0) Department Manager/Supervisor: City Manager: (Greater than$35,000) Funds appropriated for current fiscal year: YES /NO Finance Director-(Equal to orgreaterthan$5,000) Date Comments: - - • Form#3-Requisition • • • CARLSON CONTRACT N MAIN & CENTRAL • • PROVIDER: CARLSON CONTSTRUCTION CITY O F PROVIDER'S CONTACT: Brent Carlson ASHLAND 20 East Main Street ADDRESS: PO Box 1503, 1234 Corona Ave. Medford Ashland,Oregon 97520 Oregon, 97504 . Telephone: 541/488-5587 Fax: 541/488-6006 PHONE: 541.773.3035, cell: 541.601.3849 bcarlsonconstruction a hotmaiLcom This Goods and Services Agreement (hereinafter "Agreement") is entered into by and between the City of Ashland, an Oregon municipal corporation (hereinafter "City") and CARLSON CONTSTRUCTION, (a domestic/foreign business corporation) ("hereinafter"Provider"), for directional drill for streetlight power. • 1. PROVIDER'S OBLIGATIONS • 1.1 Provide directional drill for streetlight power per bid proposal as set 'forth in the "SUPPORTING DOCUMENTS" attached hereto and, by this reference, incorporated herein. Provider expressly acknowledges that time is of the essence of any completion date set forth in the SUPPORTING DOCUMENTS, and that no waiver or extension of such deadline may be authorized except in the same • manner as herein provided for authority to exceed the maximum compensation. The services defined and described in the "SUPPORTING DOCUMENTS",shall hereinafter be collectively referred to as "Work." 1.2 Provider shall obtain and maintain during the term of this Agreement and until City's final acceptance of all Work received.hereunder,a policy or policies of liability insurance inchiding commercial general • liability insurance with a combined single limit, or the equivalent, of not less than $2,000,000 (two million dollars) per occurrence for Bodily Injury and Property Damage. 1.2.1 The insurance required in this Article shall include the following coverages: • • Comprehensive General or Commercial General "Liability, including personal injury, • contractual liability, and products/completed operations coverage; and • Automobile Liability; and • Workers' Compensation. • 1.2.2 Each policy of such insurance shall be on an "occurrence" and not a"claims made" form, and shall: • Name as additional insured "the City of Ashland, Oregon, its officers, agents and • employees" with respect to claims arising put of the, provision of Work under this Agreement; • Apply to each named and additional named insured as'though a separate policy had been issued to each,provided that the policy limits shall not be increased thereby; • Apply as primary coverage for each additional named insured except to the extent that two or more such policies are intended to "layer' coverage and, taken together, they provide total coverage from the first dollar of liability; • Provider shall immediately notify the City of any change in insurance coverage • • Provider shall supply an endorsement naming the City, its officers, employees and'agents .as additional insureds by the Effective Date of this Agreement; and Page I of 5: Goods and Services Agreement between the City of Ashland and Carlson Construction • Be evidenced by a certificate or certificates of such insurance approved by the City. • 1.3 Provider shall,at its own expense,maintain Worker's Compensation Insurance in compliance with ORS 656.017, which requires subject employers to provide workers' compensation coverage for all of its subject workers. • 1.4 Provider agrees that no person shall, on the grounds of race, color, religion, creed, sex, marital status, . familial status or domestic partnership, national origin, age, mental or physical disability, sexual orientation, gender identity or source of income, suffer discrimination in the 'performance of this . Agreement when employed by Provider. Provider agrees to comply with all applicable requirements of federal and state civil rights and rehabilitation statutes, rules and regulations. Further, Provider agrees not to discriminate against a disadvantaged business enterprise,minority-owned business,woman-owned business, a business that a service-disabled veteran owns or an emerging small business enterprise certified under ORS 200.055,in awarding subcontracts as required by ORS 279A.110. 1.5 In all solicitations either by competitive bidding or.negotiation made by Provider for work to be performed under a subcontract, including procurements of materials or leases of equipment, each potential subcontractor or supplier shall be notified by the Providers of the Provider's obligations under this Agreement and Title VI of the Civil Rights Act of 1964 and other federal nondiscrimination laws. 1:6 Living Wage Requirements: If the amount of this Agreement is $24,050.68 or more, Provider -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. Provider is also required to post the notice attached hereto as "Exhibit A"predominantly in areas where it will be seen by all employees. 1.7 Assignment: Provider shall not assign this Agreement or subcontract any portion of the Work to be provided hereunder without the prior written consent of the City. Any attempted assignment or .subcontract without written consent of the City shall be void. Provider shall be fully responsible for the acts or omissions of any assigns or subcontractors and of all persons employed by them,andthe approval by the City of any assignment or subcontract shall not create any contractual relation between the assignee or subcontractor and the City, 2. CITY'S OBLIGATIONS • • 2.1 City shall pay Provider the sum of$4,950.00 as provided herein as full compensation for the Work as specified in the SUPPORTING DOCUMENTS. 2.2 In no event shall Provider's total of all compensation and reimbursement under this Agreement exceed the sum of$4,950.00 without express, written approval from the City official whose signature appears below,or such official's successor in office. Provider expressly acknowledges that no other person has • authority to:order or authorize additional Work which would cause this maximum sum to be exceeded and that any authorization from the responsible official must be in writing. Provider further acknowledges that any Work delivered or expenses incurred without authorization as provided herein is done at Provider's own risk and as a volunteer without expectation of compensation or reimbursement. 3. GENERAL PROVISIONS 3.1 This is a non-exclusive Agreement. City is not obligated to procure any specific amount of Work from Provider and is free to procure similar types of goods'and services from other providers in its sole discretion. • 3.2 Provider is an independent contractor and not an employee or agent of the City for any purpose. Page 2 of 5: Goods and Services Agreement between the City of Ashland and Carlson Construction • • 3.3 Provider is not.entitled to, and expressly waives all claims to City benefits such as health and disability . insurance,paid leave, and retirement. 3:4 This Agreement embodies the full and complete understanding of the parties respecting the subject matter hereof. It supersedes all prior agreements,negotiations;and representations between the parties, whether written or oral. • 3.5 This'Agreement may be amended only by written instrument executed with the same formalities as this Agreement. 3.6 The following laws of the State of Oregon are hereby incorporated by reference into.this Agreement: ORS 27.9B.220, 279B.230 and 279B.235. • 3.7 This Agreement shall be governed by the laws of the State of Oregon Without regard to conflict of laws • principles. Exclusive venue for litigation of any action arising under this Agreement shall be in the Circuit Court of the State of Oregon for Jackson County unless exclusive jurisdiction is in federal court, in which case exclusive venue shall be in the federal district court for the district of Oregon. Each party expressly waives any and all rights to maintain an action under this Agreement in any other venue, and expressly consents that, upon motion of the other party, any case may be dismissed or its venue • transferred, as appropriate, so as to effectuate this choice of venue. 3.8 Provider shall defend,save,hold harmless and indemnify the City and its officers,employees and agents from and against any and all claims, suits, actions, losses, damages, liabilities, costs, and expenses of any nature resulting from, arising out of, or relating to the activities of Provider or its officers, employees,contractors, or agents under this Agreement. 3.9 Neither party to this Agreement shall hold the other responsible for damages or delay in performance . caused by acts of God,strikes,lockouts, accidents, or other events beyond the control of the other or the. other's officers, employees or agents. • 3.10 If any provision of this Agreement is found by a court of competent jurisdiction to be unenforceable, such.provision shall not affect the other provisions, but such unenforceable provision shall be deemed. • modified to the extent necessary to render it enforceable,preserving to the fullest extent permitted the intent of Provider and the City set forth in this Agreement. • 3.11 Deliveries will be F.O.B destination. Provider shall pay all transportation and handling charges for the Goods.Provider is responsible and liable for loss or damage until final inspection and acceptances of the Goods,by the City. Provider remains liable for latent defects, fraud, and warranties. • 3.12 The City may inspect and test the Goods. The City may reject non-conforming Goods and require Provider to correct them without charge or deliver them at a reduced price, as negotiated. If Provider does not cure any defects within a reasonable time, the City may reject the Goods and cancel this Agreement in whole or in part. This paragraph does not affect or limit the City's rights, including its rights under the Uniform Commercial Code, ORS Chapter 72 (UCC). 3.13 Provider represents and 'warrants that the Goods are.new, current, and fully warranted by the manufacturer. Delivered Goods will comply with SUPPORTING DOCUMENTS and be free from defects in labor, material and manufacture. Provider shall transfer all warranties to the City. Page 3 of 5: Goods and Services Agreement between the City of Ashland and Carlson Construction • • 4. SUPPORTING DOCUMENTS , • 4.1 The. following documents are, by this reference, expressly incorporated in this Agreement, and are collectively referred to in this Agreement as the "SUPPORTING DOCUMENTS:" • Exhibit B -2022-09-28 N Main and Central Street Light Circuit Exhibit C—Bid Proposal Exhibit D—Right-of-way closure permit • .4.2 This Agreement and the SUPPORTING DOCUMENTS shall be construed to be mutually ,complimentary 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 SUPPORTING DOCUMENTS. In the event of conflict.between provisions of two S of the SUPPORTING DOCUMENTS,the several supporting documents shall be given precedence in the order. listed in Article 4.1. 5. REMEDIES . 5.1 In the event Provider is in default of this Agreement, City may, at its option, pursue any or all of the remedies available to it under this Agreement and at law or in equity, including,but not limited to: 5.1.1 Termination of this Agreement; 5.1.2 Withholding all monies due for the Work that Provider has failed to deliver within any scheduled completion dates or any Work that have been delivered inadequately or defectively; 5.1.3 Initiation. of an action or proceeding for damages, specific performance, or declaratory or injunctive relief; 5.1.4 These remedies are cumulative to the extent the remedies are.not inconsistent,and City may pursue any remedy or remedies singly, collectively, successively or in any order whatsoever. 5.2 In no event shall City be liable to Provider for any expenses related to termination of this.Agreement or for anticipated profits. If previous amounts paid to Provider exceed the amount due,Provider shall pay immediately any excess to City upon written demand provided. • 6. TERM AND TERMINATION 6.1 Term This Agreement shall be effective from the date of execution on behalf of the City as set forth below . (the "Effective Date") and shall continue in full force and effect until January 31, 2023, unless sooner terminated as provided in Subsection 6.2. 6.2 Termination 6.2.1 The City and Provider may terminate this Agreement by mutual agreement at any time. • 6.2.2 The City may, upon not less than thirty (30) days' prior written notice, terminate this Agreement for any reason deemed appropriate in its sole discretion. • 6.2.3 Either party may terminate this Agreement, with cause,by not less than fourteen(14) days' prior written notice if the cause is not cured within that fourteen (14) day period after written notice. • Such termination is in addition to and not in lieu of any other remedy'at law or equity. 7. NOTICE • • Whenever notice is required or permitted to be given under this Agreement, such notice shall be given in writing to the other party by personal delivery, by sending via a reputable commercial overnight courier, or by mailing using registered or certified United States mail, return receipt requested,.postage prepaid, to the • address.set forth below: Page 4 of 5: Goods and Services Agreement between the City of Ashland and Carlson Construction r , If to the City: . - City of Ashland—Electric Department • Attn: Rick Barton • 20 E. Main Street Ashland, Oregon 97520 • Phone: (541) 488-5357 • With a copy to: City of Ashland—Legal Department 20 E. Main Street • • Ashland, OR 97520 Phone: (541) 488-5350 • If to Provider: • Carlson Construction Attn: Brent Carlson • 8. WAIVER OF BREACH • One or.more waivers or.failures to object by either party to the other's breach of any provision,term,condition, or covenant contained in this Agreement shall not be construed as a waiver of any 'subsequent breach,whether or not of the same nature. 9. PROVIDER'S COMPLIANCE WITH TAX LAWS • 9.1 Provider represents and warrants to the City that: 9.1.1 Provider shall, throughout the term of this Agreement, including any extensions hereof, comply with: (i) All tax laws of-the State of Oregon, including but not limited to ORS 305.620 and ORS chapters 316,317, and 318; (ii) Any tax provisions imposed by a political subdivision of the State of Oregon applicable to Provider; and . • (iii) Any rules, regulations, charter provisions, or ordinances that implement or enforce any of the foregoing tax laws or provisions. • 9.1.2 Provider, for a period of no fewer than six (6) calendar,years preceding the Effective Date of this Agreement, has faithfully complied with: (i) All tax laws of the State of Oregon,. including but not limited to ORS 305.620 and ORS . chapters 316, 317, and 318; , (ii) Any tax provisions imposed by a political subdivision of the State of Oregon applicable to Provider; and (iii) Any rules,regulations, charter provisions, or ordinances that implement or enforce any of • the foregoing tax laws or provisions. • 9.2 Provider's failure to comply with the tax laws of the State of Oregon and all applicable tax laws of any political subdivision of the State of Oregon shall constitute a material breach of this Agreement. Further, any violation of Provider's warranty, as set forth in this Article 9, shall.constitute a.material breach of this Agreement. Any material breach of this Agreement shall entitle the City to terminate this Agreement and to seek damages and any.other relief available under this Agreement, at law,or in equity. • Page 5 of 5: Goods and Services Agreement between the City of Ashland and Carlson Construction • 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: CARLSON ONST CT By:( //,� By: Signature ignature COSTAVN Thomas McBartlett Brent Carlson GOA%b11 Electric Director, City of Ashland Owner 0//(/2_0e?__ 0°'° Date Date (W-9 is to be submitted with this signed Agreement) Purchase Order No. • • • Page 6 of 5: Goods and Services Agreement between the City of Ashland and Carlson Construction • EXHIBIT A ' CITY OF ASHLAND, OREGON • • City of Ashland LIVING ALL employers described WAGE below must comply will City of Ashland laws regulating • • .'y'i g wage_ • $17.0 -4 per hours effective June 30.r 2022 . • PPIEFL-4, The Living Wage is adjusted annually every rift June 30 by the Cons firmer Price Index. • Employees must be paid a portion of the business of of health care,retirement, their employer,if the 401K,and IRS eligible living wage: employer has ten or more cafeteria plans(including employees,and has received childcare)benefits to the • For all hags worked under a financial assistance for the employee's amount of wages. service contract between their projec t or br ;iea;ss from the . employer and the City of City of Ashland over > Note: For temporary and Ashland if-the contact $24,0511.60; part-time employees,the Living Wage does not apply exceeds$24,05O.68 or more. ).. If their employer is the City of to the first 1040 hours worked ▪ For all bows worked in a Ashland,including the Parks in anycefendaryear. For month,ifthe employee and Recreation Department mare details,please see spends 50%or more of the Ashland Municipal Code employee's time in that month • r In calculating the living wage, • S ion3.12.020. working air a project or employers may add the value For additional information= Call the Ashland City Manager's office at 541-488-60D2 or write to the City Manager, . City Hail,20 East Main Street,Ashland, OR 97520,or visit the City's website at www.ashland.ar.us. Notice to Employers: This notice must be posted.in areas where it can be seen by all employees_ . • • C Tv 01 • ASHLAND Page 7 of 5 Goods and Services Agreement between the City of Ashland and Carlson Construction - - \ - \, , I :k: ;_290 \ . ZP / 2 \ P 'a 0 =M `�� N �� • 159: t < A, ` P5041254 :.. °} \ ,� is v Intereept:existing,conduit; \' plumb into:new,handhol0. `` ff, Vii, \% New Harhole; ' P041106 4 ' `0 °� �,� H5058128° 147 .:. / - °• :ODOT specs. �; . '_ ;Small HH,in sidewalk. - o- - °t ' , 139 / � / t:` �2a.P\/�C Bore / �2 "opt . , P5.0411Q_1 . / / / 35 �! _ \ / • / .. ` - ,? Intercept existing. nduit, / .‘ :, plumb into;hew;handhdle�. " New 15 LB-Ashland '---,..New Handhole: ° N _ :P504:1.1.02 preast�:footing for t'V H5058127 i �. H[gh:L:ights�. �� �` ODOTspecs'., % 196 0 25 50 c.' • 100'Feet $mall 'H HF`� ,` %` in sidewalk° -b C Project# 000 815.999 , S k. ` .9/ %` S5041103 i/T� North Main St and Central Av q 2 . L - Street Light Circuit H5058126 (II �� •. - Print Date:9/29/2022 • FXHIRIT R V Carlson Construction Mailing: PO Box 1503 Medford OR 97501 Office: 1234 Corona Avenue Medford, OR 97504. 541-773-3035 Cell: 541-601-3849 CCB# 173889 Email: bcarlsonconstruction@hotmail.com • BID PROPOSAL DATE SUBMITTED: 10/3/2022. CONTRACT AMOUNT:$4,950.00 Required Deposit: $ PROPOSAL SUBMITTED TO: WORK TO BE PERFORMED AT: Customer: City of Ashland Address: N Main and Central Address: City:Ashland City: Phone: Phone: Rick Email: • Thank you for allowing Carlson Construction the opportunity to bid this project for you. Our estimate is based on your plans and specifications. Please feel free to call and discuss this quote at any time. Bid is to directional drill for streetlight power.We will saw cut and remove two concrete panels for our entrance and exit holes,we will install conduit provided by COA. COA is to provide all material, potholing of utilities,street repairs, sidewalk repairs, installing of wire into streetlights,and ground boxes. - *Note:The prices quoted above are subject to change after 14 days of this proposal. Delinquent accounts will be charged a minimum of 3%per week on all past due invoices. Payment is due within 14 days of invoice date.All material is guaranteed to be as specified.Any alteration or deviation from above specifications involving additional extra costs will be executed only upon additional written orders and will become an additional extra on the project.All agreements are contingent upon accidents or delays beyond our control,this includes all city and or county inspection requirements. Liability Disclaimer:Carlson Construction is not responsible for unmarked utilities, irrigation, private water, private power, landscape repairs, and/or unforeseens. Repairs will be completed at the owner's expense and billed at time and material rates. Reasonable access to be provided for equipment unless discussed prior to job. Extra cost to complete job • due to verbal changes, adverse weather,ground condition, rock, and/or unforeseens will be billed at time and material • rates. ACCEPTANCE OF PROPOSAL The above prices,specifications,and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Signature Date of Acceptance • • Page 1 of i EXHIBIT C. • EXHIBIT D . CITY OF • Permit Fee* ASHLAND Cost Sidewalk/Parking<72 hrs $1• 6 • F/. Sidewalk>72 hrs $74 • /r, Parking>72 hrs $74 Application For: Street/Alley $225 • Permit# •• .... Right-of-Way Closure Permit . x Acceptance of fee does not deem the permit approved. • This permit covers the temporary closure of sidewalks,streets,alleys,parking spaces and paths within'the City of Ashland public right-of-way. Closures on federal highways, state highways or county roads may require additional permits through ODOT or Jackson County.The applicant must submit this application along with the written temporary traffic control plan at least 48 hours prior to the proposed closure.All traffic control plans shall conform to the ODOT Temporary Traffic Control Handbook, City of Ashland Engineering Standards and the Ashland Municipal Code. The applicant is responsible for notifying the Fire Department 541-482-2770,the Police Department 541-482-5211,911 Dispatch 541-488-2211 and the Ashland School District Transportation Department 541-482-3174 of all street closures.For more information call 541-488-5587. Owner Information Contractor Information • Owner's Name Brent Carlson Contractor's Name Carlson Construction Mailing Address P.O. Box 1503 Medford, OR 97501 Mailing Address P.O. Box 1503 Medford,OR 97501 Phone Number 1-541-601-3849 Office/Cell Phone Number 1-541-773-3035 CCB Number 173889 Applicant shall,at the Applicant's own expense,at all times during the term of this Permit,maintain in force a comprehensive or commercial general liability policy including coverage for contractual liability for obligations assumed under this Permit. Applicant shall defend, indennrify and save City, its officers, agents, and employees harmless from anyand all claims, actions, costs,judgments, damages or other expenses resulting from injury to any person (including it jury resulting in dealt,)or damage to property(including loss or destruction), of whatsoever nature arising old of or incident to the negligent activities covered under the terms of this Permit. Digitally signed by Rick Barton Rick Barton Rick Barton-0�oo o�.10.0508:20:12 10/05/2022 Applicant Name Applicant Signature Date • t baronr ashland.or.us Applicant email bartonr@ashland.or.us Information . Site Address'Central av and N.. Main St. Block(between X&Y Streets) Estimated Start Date/Time 10/18/2022 Estimated Closure Duration 8 Hrs. Project Information • • • 0 Street 1=1 Sidewalk 8 Parking Space 0 Alley ❑Path ❑Other • Purpose: Directional Drill 2" pvc for Street Light circuit. • :For.:S aff.Use,O to n1 '••Re .e :A' •.,i eyed b ecu db v .4: i• - uali e.: fie`•: 't'o 't' royal: •I�Pr aa� > nai co••a,ronsofAtl: �.A a p• :P.rovide Ela rc conirol lart er.MUTCD•standards. ? ;.'i`• ', '':'':` ``''[1 Active•;Business.License';;::;;: ::: • DEPARTMENT OF • PUBLIC WORKS 20 East Main St Fax:541-488.6006 .r, Ashland,Oregon 97520 TTY: 800-735-2900 �G�wv.ashland.or.us G:1pub-wrksleng\01A Blank Forms\Current Permit Forms1July 2021 .;�ker�'D CERTIFICATE OF LIABILITY INSURANCE • DATE(MM1°DIYYYY) 2/17/2022 THIS CERTIFICATES ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOE 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 bertificate 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 of confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Protectors Insurance]LLC PHONE: John Eliot P.O.Box 4669 I A/C,No.Ext):541-842-2970 FAX No):541-772-1906 Medford OR 97504 ADDRESS: johneeprotectorsins.com • INSURER(S)AFFORDING COVERAGE NAIC# - INSURERA:SAIF Corporation 524113 INSURED CARLS-6 INSURER B: •Brent Axel Carlson • Carlson Construction INSURER C: PO Box 1503 INSURER D: Medford OR 97501 INSURERE: I INSURER F: COVERAGES I CERTIFICATE NUMBER:797586690 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 I ASDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE ' 1NSD•WV° POLICY NUMBER (MM/DDIYYYY) (MM/DD/YYYY) LIMITS COMMERCIAL GEI�ERALLIABILITY EACHOCCURRENCE $ f DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ 1 MED EXP(Any one person) $ ' PERSONAL&ADV INJURY _ $ • GENII AGGREGATE LIMIT APPLIES PER: • GENERAL AGGREGATE $ POLICY JEpT LOC PRODUCTS-COMP/OPAGG $ OTHER: II $ AUTOMOHILELIABILITY • 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) i $ UMBRELLA.LIABI _ OCCUR EACH OCCURRENCE $ EXCESS LIAR 1 CLAIMS-MADE AGGREGATE $ DED RETE(STION$ • $ A WORKERS COMPENSATION Y 878937 s AT 12/1/2021 12/1/2022 X UTE OTH- ER TTH- • AND EMPLOYERS'LIABILITY ' Y/N ANYPROPRIETORIPARTNERIEXECUTIVE EL.EACH ACCIDENT $1,000,000 OFFICER/MEMBEREXCLUDED? ' NIA ' (Mandatory In NH) E.L DISEASE_EA EMPLOYEE $1,000,000 'ryes,describe under • DESCRIPTION OF OPERNTIONS below E.L DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATION'!LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) .i { CERTIFICATE.HOLDBR • . . • CANCELLATION • SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL 'BE DELIVERED IN i ACCORDANCE WITH THE POLICY PROVISIONS. City of Ashland 90 N Mountain Ave AUTHORIZED REPRESENTATIVE Ashland OR 97520 i ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) i The ACORD name and logo are registered marks of ACORD • • CORD y A ® I CERTIFICATE OF LIABILITY INSURANCE . . DATE0(Y f2 . THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOEIS 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 ISI WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does noconfer rights to the certificate holder in lieu of such endorsement(s). PRODUCER* CONTACT FEDERATED MUTUAL INSURANCE COMPANY NAME: CLIENT CONTACT CENTER HOME OFFICE:P.0.111 QX 328 (PsIC,No, Ext):888-333-4949 FAX,No):507-446-4664 OWATONNA,MN 55060 • ADDRESS:CLIENTCONTACTCENTER(a)FEDINS.COM • • INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:FEDERATED RESERVE INSURANCE COMPANY 16024 INSURED i 184-0974 INSURER B: • CARLSO'N CONSTRUCTION INSURER C: • ' PO BOX 1503 INSURER 0: MEDFORD,OR 97501/0112 • INSURER E: 1INSURER F: COVERAGES I CERTIFICATE NUMBER:S • REVISION NUMBER:0 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 BEENREDUCED BY PAID CLAIMS. ITR TYPE 09 INSURANCE 'NSR SUERwPOLICY NUMBER POLICY EFF POLICY EXP YY (MMIDp/VYYY) (MMIDD/YYYY) • LIMITS X COMMERCIAL.GENERAL LIABILITY • EACH OCCURRENCE •$1,000,000 • DAMAGE TO RENTED $100,000 CLAIMS-MA{E FIX OCCUR. PREMISES(Ea occurrence) • MED EXP(Any one person) EXCLUDED i A 1 N N 9837473 10/06/2022 10/06/2023 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE • $2,000,000 POLICY. PRO- LOC . JECT PRODUCTS-COMP/OP AGG $2,000,000 OTHER: AUTOMOBILE LIABILITY . COMBINED SINGLE LIMIT • ( (Ea accident) $1,000,000 X ANY' AUTO 1 BODILY INJURY(Per person) — A OWNED AUTOS ONLY _AUTOS N N 9837473 10/05/2022 10/06/2023 BODILY INJURY(Per accident) HIRED AUTOS ONLY NON-OWNED AUTOS ONLY PROPERTY DAMAGE (per accident) X UMBRELLA LIAR X OCCUR EACH OCCURRENCE' $5,000,000 A EXCESS LIAB ; CLAIMS-MADE N N 9837474 10/06/2022 10/06/2023 AGGREGATE $5,000,000 DEO RETENTION • WORKERS COMPENSATION - • OTH- AND EMPLOYERS'LIABILITY Y 1 N PER STATUTE ER ANY PROPRIETORIPPRTNERIEXECUTIVE E.L EACH ACCIDENT OFFICER/MEMBER EXCLUDED? N./A (Mandatory in NH) ? • E.L.DISEASE-EA EMPLOYEE • II yes,describe under I - - ' DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT t I i DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) . 1 CERTIFICATE HOLDER CANCELLATION 184-0974 i 8 0 CITY OF ASHLAND '• SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 20 E MAIN ST . • THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ASHLAND,OR 97520-1814 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE K I - • © 1988-2015 ACORD CORPORATION.All rights reserved. ACORD 26(2016103) The ACORD name and logo are registered marks of ACORD