HomeMy WebLinkAbout2024-148 AGRMT - Adkins Engineering & Surveying OFPersonal Services Agreement
LAND
City Information Consultant Information
City of Ashland Firm Name: Adkins Engineering &Surveying
Attn: Kevin Caldwell Contact: Dan Scalas, P.E.
20 East Main Street Address: 1435 Esplanade Ave
Ashland, Oregon 97520 Klamath Falls, OR 97601
Phone:(541) 488-5340 Phone: 541-884-4666
Email: kevin.caldwell@ashland.or.us Email: DScalas@adkinsengineering.com
Contract Summary
Procurement Method: Small Procurement
Completion Date: 06/30/2025
Contract Amount: $ 12,800.00 Twelve thousand eight hundred dollars.
Description of Services: Lithia Park ADA Improvements
Supporting Documents: Proposal Dated: 11/7/24
Dated:
Dated:
Dated:
This Personal Services Agreement (hereinafter"Agreement") is entered into by and between the
City of Ashland, an Oregon municipal corporation (hereinafter "City") and the Consultant listed
under Consultant Information above, ("hereinafter "Consultant"), for the services listed under
Description of Services and Supporting Documents as noted in the Contract Summary above. In
the event of conflict between provisions of the Supporting Documents, the Supporting Documents
shall be given precedence in the order listed above.
This Agreement, the Exhibits and the 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. The Consultant's initials [ herein signify
acknowledgment and agreement to this provision, if applicable, or if not sign "N/A".
Consultant's services are collectively referred to in this Agreement as the "Work."
Page 1 of 8 Personal Services Agreement Between the City of Ashland and Adkins Eng. &Surveying
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 the Completion Date listed under the Contract Summary in the
table one page one of this agreement.
1.1. Time is of the essence. 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.
2. Compensation: City shall pay Consultant the sum listed as the "Contract Amount" under the
Contract Summary on page one of this document 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 Contract Amount without
the express, written approval from the appropriate Department Head or City Manager.
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.
3. Consultant Obligations:
3.1. 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.
3.2. 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.
3.3. 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.
Page 2 of 8 Personal Services Agreement Between the City of Ashland and Adkins Eng.&Surveying
3.4. Work Performance Obligation. Consultant shall, at its own risk, perform the Work
described in the Description of Services and in the Supporting Documents and, unless
otherwise specified in this Agreement, furnish all labor, equipment, and materials required
for the proper performance of such Work.
3.5. Certification. Consultant agrees to and shall sign the certification attached hereto as
"Exhibit C" and incorporated herein by this reference.
4. Insurance: Consultant shall, at its own expense, maintain the following insurance:
4.1. Worker's Compensation. 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.
4.2. Workers' Compensation Exemption. If applicable, Consultant affirms and certifies that
it is exempt from providing Workers' Compensation per ORS 656.027.
Exemption criteria: Enter criteria here or delete if not applicable.
Consultant initials if exempt: Date:
4.3. 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 damage
caused by error, omission or negligent acts related to the Work to be provided under this
Agreement.
4.4. 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.
4.5. Automobile Liability insurance with a combined single limit, or the equivalent, of not less
than $2,000,000 (two million dollars) for each accident for Bodily Injury and Property
Damage, including coverage for owned, hired or non-owned vehicles, as applicable.
4.6. 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.
4.7. 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
Page 3 of 8 Personal Services Agreement Between the City of Ashland and Adkins Eng.&Surveying
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.
5. Termination:
5.1. Mutual Consent. This Agreement may be terminated at any time by the mutual consent
of both parties.
5.2. 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.
5.3. For Cause. City may terminate or modify this Agreement, in whole or in part, effective
upon delivery of written notice to Consultant, or at such later date as may be established
by City under any of the following conditions:
• 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; or
• 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
• 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.
5.4. For Default or Breach. 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.
5.4.1. 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.
Page 4 of 8 Personal Services Agreement Between the City of Ashland and Adkins Eng.&Surveying
5.5. Obligation/Liability of Parties. Termination or modification of this Agreement pursuant
to subsections 5.1, 5.2, or 5.3 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 of whether such notice
is given pursuant to subsection 5.1, 5.2, 5.3, or 5.4 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.
5.6. The rights and remedies of City provided in this subsection are not exclusive and are in
addition to any other rights and remedies provided by law or under this Agreement.
6. 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 third-party claims for injury to any
person (including injury resulting in death), or damage (including loss or destruction) to
property, to the extent caused by the willful misconduct or negligent act, error omission of
Consultant and 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
by the negligence of City.
7. Consultant's Compliance with Tax Laws: Consultant represents and warrants to the City
that: Consultant shall comply with all Oregon tax laws, including but not limited to ORS
305.620, ORS 305.380(4), and ORS Chapters 316, 317, 318, in addition to any rules,
regulations, charter provisions, or ordinances that implement or enforce any of the foregoing
tax laws or provisions and any tax provisions imposed by a political subdivisions of the State
of Oregon.
8. Living Wage Requirements: If the amount of this Agreement is $26,429.65 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.
9. 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
addresses set forth on page one of this agreement with a copy to:
Page 5 of Personal Services Agreement Between the City of Ashland and Adkins Eng.&Surveying
City of Ashland—Legal Department
20 E. Main Street
Ashland, Oregon 97520
Phone: (541) 488-5350
10. General Provisions:
10.1. 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 upon payment to Consultant in accordance with this
Agreement. City agrees to indemnify, defend and hold the Consultant harmless from and
against any claims or damages that may result from the subsequent use, reuse, transfer
or modification of Consultant's drawings and specifications, except on projects where the
Consultant has been retained to provide services.
10.2. Non-appropriations 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.
10.3. Statutory Requirements: The following laws of the State of Oregon are hereby
incorporated by reference into this Agreement: ORS 27913.220, 27913.230 and
27913.235.
10.4. 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.
10.5. 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
Page 6 of 8 Personal Services Agreement Between the City of Ashland and Adkins Eng.&Surveying
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.
11. Merger: 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.
12. Limitation of Liability. Except for claims covered by Consultant's applicable policies of
insurance, to the fullest extent permitted by law, the total liability, in the aggregate, of
Consultant and its officers, directors, partners, employees, agents, and subconsultants to City
and anyone claiming through or under City, for any claims, losses, costs, or damages
whatsoever arising out of, resulting from or in any way relating to this Project or Contract, from
any cause or causes, including but not limited to tort (including negligence and professional
errors and omissions), strict liability, breach of contract, or breach of warranty shall not exceed
the total compensation received by Consultant or$100,000, whichever is greater.
13. Mutual Waiver of Consequential Damages. Except for claims covered by Consultant's
applicable policies of insurance, Consultant and City waive all consequential or special
damages, including, but not limited to, loss of use, profits, revenue, business opportunity, or
production, for claims, disputes, or other matters arising out of or relating to the Contract or
the services provided by Consultant, regardless of whether such claim or dispute is based
upon breach of contract, willful misconduct or negligent act or omission of either of them or to
their employees, agents, subconsultants, or other legal theory, even if the affected party has
knowledge of the possibility of such damages. This mutual waiver shall survive termination
or completion of this Contract.
Page 7 of 8 Personal Services Agreement Between the City of Ashland and Adkins Eng.&Surveying
i
WITNESS WHEREOF, the parties have executed this Agreement in their respective names by
their duly authorized representatives as of the dates indicated below. This Agreement may be
executed in two counterp s, each of which shall be deemed an original, with equal force and
effect as if exgcute°di'n ngle document.
City of Ashland: Adkins Eng.&Surveying (Consultant)
By:
Digitally signed by Daniel Scalas
Daniel S c a l a s Date:2024.11 22 08:51 12-08'00'
Signature
Daniel Scalas
Date
Printed Name
Principal/Project Manager
Title
Purchase Order No.
11/22/24
Date
(L--9 is to be submitted with this signed Agreement)
APPROVED AS TO FORM:
City Attorney
11/21/24
Date
r
Page 8 of 8 Personal Services Agreement Between the City of Ashland and Adkins Eng.&Surveying
A Lmn,
0KINS
ENGINEERING & SURVEYING
November 7, 2024
Kevin Caldwell
Ashland Parks & Recreation Commission
340 S. Pioneer Street
Ashland, Oregon 97520
RE: Lithia Park ADA Improvements
Engineering Scope & Fee proposal
Dear Mr. Caldwell:
Thank you for the opportunity to propose engineering services to the Ashland Parks & Recreation
Commission for the design of ADA parking and path upgrades. It is our understanding from previous
conversations that the design shall include two parking stalls (one ADA accessible) parallel to the
existing curb and an ADA compliant path from the proposed parking stalls, connecting to the existing
path leading to the Japanese Garden.The existing path will be replaced from the proposed path to the
limits of where it meets ADA compliance with the existing path. No stormwater connections will be
proposed for this project.
For this project, Adkins will deliver to the Ashland Parks & Recreation Commission a complete Bid
Document Package consisting of Construction Drawings, Boiler Plate General Conditions,Technical
Special Provisions (APWA), Bid Item Schedule, Construction Cost Estimate and Limited Construction
Support. Adkins proposes to complete the project according to the following Tasks and Scope:
Task I .- Tolpogiralphic Surveying
Task 1 consists of mapping of existing site features and public utilities above and below ground as
located by 8-1-1. We will utilize our in-house survey department to streamline mapping and minimize
costs in the field-to-finish process.
For Task 1,we assume that utility potholing(or other means of locating) will be performed by City staff
or by a City hired Contractor and that 48-hour notification will be provided to Adkins in order to
schedule a technician to document depths, sizes, and material of exposed utilities. Locating of any
privately owned utilities will be the responsibility of the owner. We don't anticipate that utility potholing
will be required for this project.
For Task 2,Adkins will prepare design plans for the ADA upgrades and prepare a preliminary estimate of
probable construction costs to be submitted and reviewed at the 30%design stage.
For the 90%design stage,Adkins will complete a full set of construction drawings, updated estimate of
probable construction costs, a list of Oregon Standard Specifications applicable to the project, and draft
Special Provisions applicable to the project. We assume that the City will complete the front end
specifications and invitation to bid. Construction drawings for this stage will include a Cover Sheet,
Existing Conditions Topographic Survey, Site Plan, Grading Plan, Details,Traffic Control Plan/Details and
1435 Esplanade Ave, Klamath Falls, OR 97601
o 541.884.4666 1 t' 541.884.5335 1 w Adkins ineeri .c®
erosion and sediment control plan.The 30%and 90%design stage will conclude with a design review
meeting between the Ashland Parks & Recreation Commission and Adkins.
For the 100%stage, Adkins will deliver final Construction Drawings, a Construction Cost Estimate, and
final Special Provisions to the 2024 Oregon Standard Specifications for Construction, and a final
Schedule of Bid Items in accordance with the Special Provisions.
During construction,we assume that the Ashland Parks & Recreation Commission will perform the
primary construction management duties and that Adkins will provide assistance in a limited technical
support role. Adkins will: attend the pre-construction conference, provide responses to the Ashland
Parks & Recreation Commission for clarification of design documents and technical specifications,
attend up to two construction meetings and site visits.
We propose to perform Tasks 1 &2 for the Scopes listed above on a Fixed Fee basis for$11,700 and
Task 3 on a Time-and-Materials Basis with an estimated budget of$1,100. A budgetary number will be
provided for testing, i.e. concrete, asphalt and compaction.
Additional work requested by the Ashland Parks& Recreation Commission and not described herein will
be performed on a Time and Materials basis according to our 2024 Standard Fee Schedule. Prior to
performing any additional work Adkins will notify the Ashland Parks & Recreation Commission Project
Manager that work has been requested outside the scope of the proposed Tasks and Scope and will only
perform the additional work once approval has been issued by the Ashland Parks & Recreation
Commission in writing.Additional work explicitly excluded from the scope described herein includes but
is not limited to utility potholing, right-of-way or easement development and negotiations, soils
investigation and report, environmental or cultural investigations, permitting and construction
monitoring, public involvement, and Owner directed design modifications during construction.
Thank you for this opportunity to provide you with this proposal and we look forward to working with
the Ashland Parks& Recreation Commission on this project. Please contact me if you have any questions
or would like to discuss any details of this proposal.
Sincerely,
Dan Scalas, P.E.
Project Manager/Principal
jlDKINS o 541.884.4666 1,F 1. /w Adkins ineeri .c®
r�c'NEERINc&SURVEYING 1435 Esplanade Ave, Klamath Falls, OR 97601
Request for Taxpayer Give Form to the
Form 9
(Rev.October2018) Identification Number and Certification requester.Do not
Department of the Treasury send to the IRS.
Internal Revenue Service ►Go to www.irs.gov/FormW9 for instructions and the latest information.
1 Name(as shown on your income tax return).Name is required on this line;do not leave this line blank.
Adkins Engineering and Surveying, Inc.
2 Business name/disregarded entity name,if different from above
M 3 Check appropriate box for federal tax classification of the person whose name is entered on line 1.Check only one of the 4 Exemptions(codes apply only to
rofollowing seven boxes. certain entities,not individuals;see
a instructions on page 3):
o [IIndividual/sole proprietor or ElC Corporation ❑✓ S Corporation ❑ Partnership ElTrust/estate
N single-member LLC Exempt payee code(if any)
ti c
u ❑ Limited liability company.Enter the tax classification(C=C corporation,S=S corporation,P=Partnership)►
`p ;? Note:Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check Exemption from FATCA reporting
c LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is code(if any)
m — another LLC that is not disregarded from the owner for U.S.federal tax purposes.Otherwise,a single-member LLC that
a is disregarded from the owner should check the appropriate box for the tax classification of its owner.
y ❑ Other(see instructions)► Applies to accounts maintained outside the U.S.)
N5 Address(number,street,and apt.or suite no.)See instructions. Requester's name and address(optional)
an 1435 Esplanade Ave.
6 City,state,and ZIP code
Klamath Falls, OR 97601
7 List account number(s)here(optional)
Taxpayer Identification Number(TIN)
Enter your TIN in the appropriate box.The TIN provided must match the name given on line 1 to avoid Social security number
backup withholding. For individuals,this is generally your social security number(S However,for a FM _T _
resident alien,sole proprietor,or disregarded entity,see the instructions for Part I,later. For other
entities,it is your employer identification number(EIN).If you do not have a number,see How to get a
TIN, later. or
Note:If the account is in more than one name,see the instructions for line 1.Also see What Name and I Employer identification number
Number To Give the Requester for guidelines on whose number to enter.
M92 -FO 8 2 8 5 5 9
Certification
Under penalties of perjury,I certify that:
1.The number shown on this form is my correct taxpayer identification number(or I am waiting for a number to be issued to me);and
2.I am not subject to backup withholding because:(a)I am exempt from backup withholding,or(b)I have not been notified by the Internal Revenue
Service(IRS)that I am subject to backup withholding as a result of a failure to report all interest or dividends,or(c)the IRS has notified me that I am
no longer subject to backup withholding;and
3.1 am a U.S.citizen or other U.S.person(defined below);and
4.The FATCA code(s)entered on this form(if any)indicating that I am exempt from FATCA reporting is correct.
Certification instructions.You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because
you have failed to report all interest and dividends on your tax return.For real estate transactions,item 2 does not apply.For mortgage interest paid,
acquisition or abandonment of secured property,cancellation of debt,contributions to an individual retirement arrangement(IRA),and generally,payments
other than interest and dividends,you are not required to sign the certification,but you must provide your correct TIN.See the instructions for Part II,later.
Sign Signature of
Here U.S.person► Date�Xa ►
General Instructions • Form 1099-DIV(dividends,including those from stocks or mutual
funds)
Section references are to the Internal Revenue Code unless otherwise .Form 1099-MISC(various types of income,prizes,awards,or gross
noted. proceeds)
Future developments.For the latest information about developments •Form 1099-B(stock or mutual fund sales and certain other
related to Form W-9 and its instructions,such as legislation enacted transactions by brokers)
after they were published,go to www.irs.gov/FormW9. •Form 1099-S(proceeds from real estate transactions)
Purpose of Form •Form 1099-K(merchant card and third party network transactions)
An individual or entity(Form W-9 requester)who is required to file an • Form 1098(home mortgage interest), 1098-E(student loan interest),
information return with the IRS must obtain your correct taxpayer 1098-T(tuition)
identification number(TIN)which may be your social security number •Form 1099-C(canceled debt)
(SSN),individual taxpayer identification number(ITIN),adoption •Form 1099-A(acquisition or abandonment of secured property)
taxpayer identification number(ATIN),or employer identification number
(EIN),to report on an information return the amount paid to you,or other Use Form W-9 only if you are a U.S.person(including a resident
amount reportable on an information return.Examples of information alien),to provide your correct TIN.
returns include,but are not limited to,the following. If you do not return Form W-9 to the requester with a TIN,you might
•Form 1099-INT(interest earned or paid) be subject to backup withholding.See What is backup withholding,
later.
Cat.No.10231X Form W-9(Rev.10-2018)
711/12/2024
E(MM/DD/YYYY)
ACCORD® CERTIFICATE OF LIABILITY INSURANCE
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
NAME: Janke Sharp
Great Basin Insurance, Inc. PHONE FAX
2300 Madison Street A/C No Ext: 541-882-5507 A/C,No:541-884-0052
Klamath Falls OR 97603 ADDE-MRESS: Janice.Sharp@gr8basin.com
INSURER(S)AFFORDING COVERAGE NAIC#
INSURERA: Employers Mutual Casualty Company 21415
INSURED ADKIENG-01 INSURER B: EMC Property&Casualty Company 25186
Adkins Engineering and Surveying, Inc.
1435 Esplanade Ave. INsuRERc: SAIF Corporation 36196
Klamath Falls OR 97601 INSURERD:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:1296728430 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS
LTR INSD WVD POLICYNUMBER MM/DD MM/DD
B X COMMERCIAL GENERAL LIABILITY Y 6D23786 8/1/2024 8/1/2025 EACH OCCURRENCE $1,000,000
CLAIMS-MADE OCCUR DAMAGE TO RENTED
PREMISES Ea occurrence $1,000,000
MED EXP(Any one person) $10,000
PERSONAL&ADV INJURY $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
PRO-
POLICY� ECT1:1 LOC PRODUCTS-COMP/OP AGG $2,000,000
OTHER: $
B AUTOMOBILE LIABILITY Y 6E23786 8/1/2024 8/1/2025 COMBINED SINGLE LIMIT $1,000,000
Ea accident
X ANY AUTO BODILY INJURY(Per person) $
OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
X HIRED X NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY Per accident
A X UMBRELLALIAB X OCCUR 6J23786 8/1/2024 8/1/2025 EACH OCCURRENCE $2,000,000
EXCESS LAB CLAIMS-MADE AGGREGATE $2,000,000
DED X RETENTION$1 n nnn $
C WORKERS COMPENSATION 773481 8/1/2024 8/1/2025 X PER OTH-
AND EMPLOYERS'LIABILITY Y/N STATUTE ER
ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $500,000
OFFICER/MEMBER EXCLUDED? ❑ N/A
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500,000
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required)
The City of Ashland Oregon and its elected officials,officer and employees are additional insureds per the attached policy endorsement forms but only with
respects to Consultant's services to be provided under this Agreement.Coverage is Primary and Non Contributory.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Ashland
20 East Main St. AUTHORIZED REPRESENTATIVE
Ashland OR 97520
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
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 professional skill and care ordinarily provided by firms practicing in the same
or similar locality under the same or similar circumstances (the "Standard of Care")with, 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.
(3) Telephone listing is used for the business separate from the personal residence
listing.
(4) Labor or services are performed only pursuant to written contracts.
(5) Labor or services are performed for two or more different persons within a period
of one year.
_F-1 (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
Date
Page 1 of 1: Exhibit C
CITY OF OREGON
City of Ashland
LIVING
• • • • WAGE
per hour, effective June 30, 2024.
1 � The Living Wage is adjusted annually every
June 30 by the Consumer Price Index.
• - - , , portion of the business of of health care, retirement,
their employer, if the 401 K, and IRS eligible
employer has ten or more cafeteria plans(including
employees, and has received childcare) benefits to the
➢ For all hours worked under a financial assistance for the employee's amount of wages.
service contract between their project or business from the
employer and the City of City of Ashland over y Note: For temporary and
Ashland if the contract $26,429.65; part-time employees, the
exceeds$26,429.65 or more. Living Wage does not apply
If their employer is the City of to the first 1040 hours worked
➢ For all hours worked in a Ashland, including the Parks in any calendar year. For
month, if the employee and Recreation Department. more details, please see
spends 50%or more of the Ashland Municipal Code
employee's 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 vvvvvv.ashl nd.or.us.
Notice to Employers: This notice must be posted in areas where it can be seen by all employees.
17 Y 0 F