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HomeMy WebLinkAbout2023-129 PO 20240110- Civil West Engineering Service PUrcI,ase Order =, CM' REco-iDE• • Fiscal Year 2024 Page: 1 of: 1 B City of Ashland __ ATTN: Accounts Payable Purchase L 20 E_ Main Order�e 20240110 Ashland, OR 97520 T Phone: 541/552-2010 O Email: payable@ashland.or.us V H C/O Public Worlcs department N CIVIL WEST ENGINEERING SERVW ICE 1 51 inburn Way ID 486 E STREET P Ashland, OR 97520 O COOS BAY, OR 97420 T PhoFax: 54'1/ 488 600647 R O 541 266-8601 08/30/2023 Ci .,. able Update Industrial User Survey 1 Update City of Ashland Wastewater Industrial User Survey 1.0 $13,984.00 $13,984.00 Personal Services Agreement (Less than $35,000.00) Completion date: 12/31/2023 Project Account: GL SUMMARY 086100- -04100 ••13 984.00 By: �y t��. Uate: a-6 Las-112�� Authorized Sig natu '13 984.00 *,�/ ft. "' / ( O CITY OF FORM #3 / � D / : ' : : � . : ASHLAND .€ REQUISITION Date of request: 08/22/2023 Required date for delivery: Vendor Name CMI West Engineering Inc. Address,City,State,Zip 830 O'Hare Pkwy Ste 102 Medford,OR 97504 Contact Name&Telephone Number Manny Ramos 541-266-8601 Email address SOURCING METHOD ❑ Exempt from Competitive Bidding ❑ Invitation to Bid ❑ Emergency ❑ Reason for exemption: Date approved by Council: ❑ 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) ❑ Small Procurement ❑ Request for Proposal Cooperative Procurement Not exceeding$5,000 Date approved by Council: ❑ State of Oregon ❑ Direct Award _(Attach copy of council communication) Contract# ❑ Verbal/Written bid(s)or proposal(s) ❑ Request for Qualifications(Public Works) ❑ State of Washington Date approved by Council: Contract# _(Attach copy of council communication) ❑ Other government agency contract Intermediate Procurement ❑ Sole Source Agency GOODS&SERVICES ❑ 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$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 tI 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 Update City of Ashland Wastewater Industrial User Survey TOTAL COST $ 13,984;00 Item # Quantity Unit Description of MATERIALS Unit Price Total Cost a Per attached quote/proposal TOTAL COST $, Project Number Account Number 0 8 6 1 0 0.6 0 4 1 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 requisition046#0 form,I certify that the City's publiccontractingrangrequirements have been satisfied. Employee: I jyt i"'theCi - (4/ j - Department Hea . S•Z 2. 23 to or greater than$5,000) Department Manager/Supervisor: City Manager: \nn (Greater than$35, 00) j Funds appropriated for current fiscal year: ®/ NO Y V V\ �1 L Finance Director-(Equal to eater than$5,000) Date Comments: Form#3-Requisition • PERSONAL SERVICES AGREEMENT (LESS THAN $35,000.00) CONSULTANT: Civil West Engineering Services, Inc. CITY OF ASH LAND CONSULTANT'S CONTACT: Manny Ramos 20 East Main Street Ashland, Oregon 97520 ADDRESS: 830 O'Hare Parkway Ste 102 Telephone: 541/488-5587 Medford, OR 97504 Fax: 541/488-6006 TELEPHONE: 541-326-4828 This Personal Services Agreement(hereinafter"Agreement") is entered into by and between the City of Ashland, an Oregon municipal corporation (hereinafter "City") and Civil West Engineering Services Inc, a foreign limited liability company ("hereinafter"Consultant"), to update City of Ashland Wastewater Industrial User Survey. NOW THEREFORE, in consideration of the mutual covenants contained herein, the City and Consultant hereby agree as follows: 1. Effective Date and Duration: This Agreement shall become effective on the date of execution on behalf of the City, as set forth below(the "Effective Date"), and unless sooner terminated as specifically provided herein, shall terminate upon the City's affirmative acceptance of Consultant's Work as complete and Consultant's acceptance of the City's final payment therefore, but not later than December 31, 2023. 2. Scope of Work: Consultant will provide on-call inspection services for public works permits and special projects as more fully set forth in the Consultant's Proposal dated August 7, 2023, 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 sum of$13,984.00 (thirteen thousand nine hundred eighty-four dollars) as full compensation for Consultant's performance of all Work under this Agreement. In no event shall Consultant's total of all compensation and reimbursement under this Agreement exceed the sum of$13,984.00 (thirteen thousand nine hundred eighty-four dollars)without the express, written approval from the City official whose signature appears below, or such official's successor in office. Payments shall be made within thirty (30) days of the date of receipt by the City of Consultant's invoice. Should this Agreement be terminated prior to completion of all Work, payments will be made for any phase of the Work completed and accepted as of the date of termination. Page 1 of 7: PERSONAL SERVICES AGREEMENT BETWEEN THE CITY OF ASHLAND AND CIVIL WEST ENGINEERING SERVICES,INC. 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 assigned in 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 belong to the City, and any copyright, patent, trademark proprietary or any other protected intellectual property right shall vest in and is hereby assigned to the City. 8. Statutory Requirements: The following laws of the State of Oregon are hereby incorporated by reference into this Agreement: ORS 279B.220, 279B.230 and 279B.235. 9. Living Wage Requirements: If the amount of this Agreement is $25,335.05 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 CIVIL WEST ENGINEERING SERVICES,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 the notice, or within such other period as the party giving the notice may authorize in writing, then the Agreement may be terminated at any time thereafter by a written notice of termination by the party giving notice. ii. Time is of the essence for Consultant's performance of each and every obligation and duty under this Agreement. City, by written notice to Consultant of default or breach, may at any time terminate the whole or any part of this Agreement if Consultant fails to provide the Work called for by this Agreement within the time specified herein or within any extension thereof. iii. The rights and remedies of City provided in this subsection (d) are not exclusive and are in addition to any other rights and remedies provided by law or under this Agreement. 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, unless 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 Page 3 of 7: PERSONAL SERVICES AGREEMENT BETWEEN THE CITY OF ASHLAND AND CIVIL WEST ENGINEERING SERVICES,INC. 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. 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 omissions of 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 Page 4 of 7: PERSONAL SERVICES AGREEMENT BETWEEN THE CITY OF ASHLAND AND CIVIL WEST ENGINEERING SERVICES,INC. 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 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.110. 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: Public Works Attn: Chance Metcalf 20 East Main Street Ashland, Oregon 97520 Page 5 of 7: PERSONAL SERVICES AGREEMENT BETWEEN THE CITY OF ASHLAND AND CIVIL WEST ENGINEERING SERVICES,INC. With a copy to: City of Ashland—Legal Department 20 E. Main Street Ashland, Oregon 97520 Phone: (541) 488-5350 If to Consultant: Civil West Engineering Services, Inc. Manny Ramos 830 O'Hare Parkway Ste 102 Medford, OR 97504 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. In 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 Page 6 of 7: PERSONAL SERVICES AGREEMENT BETWEEN THE CITY OF ASHLAND AND CIVIL WEST ENGINEERING SERVICES,INC. 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. 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: CIVIL WEST ENGINEERING (CONSULTANT): By: By: Signature SCOTT' C�.FU2y Manny Ramos Printed Name Printed Name Principle (hut...-.1C_ wo2rs lot urc_a. __ Title Title 9 •22• ?3 8/18/2023 Date Date ;, / 7/ /C0 Purchase Order No. (W-9 is to be submitted with this signed Agreement) Page 7 of 7: PERSONAL SERVICES AGREEMENT BETWEEN THE CITY OF ASHLAND AND CIVIL WEST ENGINEERING SERVICES,INC. Rogue Valley Office Coos Bay Office 830 O'Hare Parkway Ste 102 486'E'Street Civil West � Medford,OR 97501 Coos Bay,OR 97420 �I�I 4 541-326-4828 541-266-8601 .. Engineering Services,Inc. Albany Office Newport Office 945 SE Geary Street 609 SW Herbert Street Albany,OR 97321 Newport,OR 97366 541-223-5130 541-264-7040 ENGINEERING SCOPE OF SERVICES Date: August 7, 2023 To: Chance Metcalf, PMP City of Ashland 20 East Main St. Ashland, OR 97520 From: Manny Ramos, Rogue Valley Manager, Civil West Engineering Services, Inc. RE: City of Ashland—Industrial User Survey Background Summary The City of Ashland is periodically required to produce an updated Industrial User Survey as required by DEQ.This proposal will describe the necessary Scope of Services for an updated Industrial User Survey. Part A: Scope of Work The tasks identified and listed below are critical to ensure successful completion of the updated Industrial User Survey. Civil West Engineering shall herein after being identified as "Consultant" and The City of Ashland shall be known as the "Client." I. Proposed Civil Engineering Scope of Services Task 1—Project Management/Administration-Consultant will provide project management and administrative efforts related to all the tasks below. Included in this task is correspondence between Civil West and the project team, coordination with sub-consultants for the tasks noted below. Task 2—Compile Master List Industrial Users—Consultant will work in collaboration with the Client to prepare an updated master list of industrial users.The list will be compiled from existing record data and input from the building departments issued permits. Task 3—Survey of existing Industrial Users—Consultant will work with the client to prepare the survey/ questionnaire to be mailed to all the users. Consultant will monitor responses and provide a final report to the Client depicting the percentage received.At this time secondary efforts will be made to connect with users that did not respond to the mailer.With the final response tally completed and reviewed task 4 will be initiated. Task 4—Follow up activities—Consultant will prepare a follow up list of users that did not have a completed response or were deemed to be high risk users. Consultant will confer with the Client to finalize a list of users that will receive an onsite visit for reporting of operations and potential pretreatment requirements. 1 Task 5—Survey Results—Consultant will prepare summarized Survey results provide responses to RFI's, RFC's and one (1)final Site Walk to determine substantial completion. Meetings will be held with the City for acceptance of the IU survey data. Results will be organized and stored in an easy access format for future monitoring programs. Task 6—Program Submission—Consultant will Summarize survey results, including a list of IUs subject to pretreatment program requirements,a classification of these users (either by NAICs code, industrial category, or other appropriate scheme), and a list of pollutants known or suspected to be discharged from each IU. Where available, information on the concentrations of these pollutants should also be presented. Task 7—Reimbursables—Will include allowances for project costs related to reimbursable expense items as follows:copies of any plans, reports, reproduction, mailing fees, including digital deliverables. Exclusions- Any service not specifically listed above. Assumptions: Client to provide necessary support for data that originates from within various City Departments. B: Estimated Engineering Budget The following summary/proposed fee schedule is provided below: The budget depicted below is considered a "Not to Exceed format". Civil West reserves the right to adjust costs between categories,as necessary to accomplish the work; but will not exceed the Total Proposed Budget without written consent of the Client. Task Summary of Proposed Engineering Budget: Budget 1 Project Management $1,200.00 2 Compile Master List of Industrial Users $2,344.00 3 Survey of existing Industrial Users $3,160.00 4 Follow up Activities $3,164.00 5 Survey Results $2,344.00 6 Program Submission $1,272.00 7 Reimbursables-Allowance $500.00 Total Proposed Engineering Budget $13,984.00 Civil West Engineering Services appreciates this opportunity to provide the above engineering services. We are prepared to begin work immediately, as soon as we are authorized to do so. If this proposed approach is acceptable, please sign below and return a copy to our office for our records. Sincerely, , Civil West Engineering Services, Inc. Manny Ram , Rogue Valley Manager Authorized Representative Signature Accepting Fee & Scope of Services Date 2 EXHIBIT B CITY OF ASHLAND, OREGON City of Ashland LIVING ALL employers described WAG E below must comply with City of Ashland laws regulating payment of a living wage. $18.12 per hour,effective June 30, 2023. �� The Living Wage is adjusted annually every June 30 by the Consumer Price Index. Employees must be paid a portion of the business of of health care.retirement living wage: their employer,if the 401K,and IRS eligible employer has ten or more cafeteria plans(Muting employees,and has received childcare)benefits to the Fa all hours worked urnder a financial assistance for the employees amount of wages. service contract between their project or business from the c employer and the City of City of Ashland over Note: For temporary and Ashland if the control $25,335.05; part-time employees,the exceeds$25,335.05 or more. Living Wage does not apply If their employer is the City of to the first 1040 hours worked r Fa all hours worked in a Ashland;including the Parks in any calendar year. For month.if the employee and Recreation Department more demils,please see spends 50%or more of die +Mand Municipal Code enployee time in that month ' In calculating the living wage, Section 3.12.020_ working on a project or employers may add the value For additional information: Call the Ashland City Manager's office at 541-488-6002 or write to the City Manager, City Hall_20 East Main Street,Ashland,OR 97520,or visit the City's website at www_ashland.or.us_ Notice to Employers: This notice must be posted in areas where it can be seen by all employ. CITY OF ASHLAND 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. x (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. x (2) Commercial advertising or business cards or a trade association membership are purchased for the business. x (3) Telephone listing is used for the business separate from the personal residence listing. x (4)Labor or services are performed only pursuant to written contracts. x (5) Labor or services are performed for two or more different persons within a period of one year. x (6) Consultant assumes financial responsibility for defective workmanship or for service not provided as evidenced by the ownership of performance bonds, warranties, errors and omission (professional liability) insurance or liability insurance relating to the Work or services to be provided. Consultant's signature 8/18/2023 Date • ® ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 12/16/2022 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 Grenfell Insurance&Financial Services, Inc. NAME: Corey Johnson NE A P 0 Box 191 /ac.No.Ext): (406)363-0430 FAX No): (406)363-0432 Hamilton, MT 59840 E-MAILE-MAIL : Corey@grenfellinsurance.com License#: 0022631 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: AM Trust E&S Insurance Services INSURED INSURER B: Liberty Mutual Insurance Company 24082 Civil West Engineering Services Inc INSURER C: AIG PO Box 1589 INSURER D: AmTrust Financial Services Inc. Coos Bay, OR 97420 INSURERE: Texas Insurance Company INSURER F: Great Midwest Insurance Company COVERAGES CERTIFICATE NUMBER: 00002178-1143783 REVISION NUMBER: 13 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD hWD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY AES122534200 12/02/2022 09/01/2023 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence)_ $ 100 000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY JEC I- J LOC IIS PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY BAS60246738 09/01/2022 09/01/2023 COMBINEDaacc NGLE LIMIT $ {Eident)SI1,000,000 ANY AUTO BODILYINJURY(Per person) $ OWNEDSCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY X AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ X AUTOS ONLY X AUTOS ONLY (Per accident) C X UMBRELLA LIAB X OCCUR EBU 049702559 09/01/2022 09/01/2023 EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED RETENTION$ $ D WORKERS COMPENSATION SWC1401792 09/01/2022 09/01/2023 X STATUTE EORH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A' (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 E Professional Liabili BFLPMLTOR01120002077601 09/01/2022 09/01/2023 Professional 3,000,000 F Excess E&O HPRO-CX-GM-0000346-00 09/01/2022 09/01/2023 Professional 3,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Civil West Engineering Services,Inc.has granted the officers and employees as additional insureds for ongoing operation, coverage is primary and non-contributory,A waiver of subrogation is granted in favor of additional insureds on a contractual basis. Additional)Insured on going CG 20 10 07 04 Blanket Additional Insured for Completed operation CG 20 37 07 04 Blanket Waiver of Subrogation CG 20 01 0413 (continued on ACORD 101 Additional Remarks Schedule) 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. 20 East Main Street Ashland, OR 97520 AUTHO ED REPRESENTATI (CSJ) ©19 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Printed by CSJ on December 16,2022 at 12:51 PM • AGENCY CUSTOMER ID: 00002178 LOC#: A/CO/ AGENCY ® ADDITIONAL REMARKS SCHEDULE Page 2 of 2 v NAMED INSURED Grenfell Insurance&Financial Services,Inc. Civil West Engineering Services Inc POLICY NUMBER N/A CARRIER NAIC CODE Multiple Carriers EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance (continued from Description of Operations) Blanket Primary&Non-Contributor NX GL 009 08 09 ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Printed by CSJ on December 16,2022 at 12:51 PM