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Home My WebLink About2006-019 CONT Chg Order - Key Line Construction CI T Y OF CONTRACTOR: Key Line Construction ASHLAND CONTACT: Steve Colson 20 East Main Street ADDRESS: 6687 Tolo Road, Central Point, OR 97502 Ashland, Oregon 97520 Telephone: (541) 488-6002 TELEPHONE: (541) 665-5415 FAX: (541) 488-5311 FAX: (541) 665-5418 DATE AGREEMENT PREPARED: March 8, 2006 BEGINNING DATE: March 8, 2005 COMPLETION DATE: March 31, 2006 COMPENSATION: $8,207.44, Per proposal dated 02/24/2006 SERVICES TO BE PROVIDED: Contractor will bore in approximately 260 feet of 3" conduit from power pole to transformer. Conduit and sweeps to be provided by contractor. Job Location: Quincy Street ADDITIONAL TERMS: Contract for WORK less than $25,000 CITY AND Contractor AGREE: 1. All Costs bv Contractor: Contractor shall, at its own risk and expense, perform the work described above and, unless otherwise specified, furnish all labor, equipment and materials required for the proper performance of such work. 2. Qualified Work: Contractor has represented, and by entering into this contract now represents, that all personnel assigned to the work required under this contract are fully qualified to perform the work to which they will be assigned in a skilled and workerlike manner and, if required to be registered, licensed or bonded by the State of Oregon, are so registered, licensed and bonded. Contractor must also maintain a current City business license. 3. Completion Date: Contractor shall start performing the work under this contract by the date indicated above and complete the work by the completion date indicated above. 4. Compensation: City shall pay Contractor for work performed, including costs and expenses, the sum specified above. Once work commences, invoices shall be prepared and submitted by the tenth of the month for work completed in the prior month. Payments shall be made within 30 days of the date of the invoice. Should the contract be prematurely terminated payments will be made for work completed and accepted to date of termination. Compensation under this contract, including all costs and expenses of Contractor, is limited to $25,000.00 and City shall not be obligated to pay any sum in excess of $25,000.00 unless a separate written contract is entered into by City. 5. Ownership of Documents: All documents prepared by Contractor pursuant to this contract shall be the property of City. 6. Statutory Reauirements: ORS 279C.505, 279C.515, 279C.520, and 279C.530 are made part of this contract. 7. Livina Waae Reauirements: If the amount of this contract is $15,964 or more, and Contractor is not paying prevailing wage for the work, Contractor must comply with chapter 3.12 of the Ashland Municipal Code by paying a living wage, as defined in this chapter, to all employees performing work under this contract and to any subcontractor who performs 50% or more of the work under this contract. Contractor must post the attached notice predominantly in areas where it will be seen by all employees. 8. Indemnification: Contractor agrees to defend, indemnify and save City, its officers, employees and agents harmless from any and all losses, claims, actions, costs, expenses, judgments, subrogations, 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 contract by Contractor (including but not limited to, Contractor's employees, agents, and others designated by Contractor to perform work or services attendant to this contract.) Contractor shall not be held responsible for any losses, expenses, claims, subrogations, actions, costs, judgments, or other damages, directly, solely, and approximately caused by the negligence of City. 9. Termination: This contract may be terminated by City by giving ten days written notice to Contractor and may be terminated by Contractor should City fail substantially to perform its obligations through no fault of Contractor. 10. Independent Contractor Status: Contractor is an independent contractor and not an employee of the City. Contractor shall have the complete responsibility for the performance of this contract. Contractor shall provide workers' compensation coverage as required in ORS Ch 656 for all persons employed to perform work pursuant to this contract and prior to commencing any work, Contractor shall provide City with adequate proof of workers' compensation coverage. Contractor is a subject employer that will comply with ORS 656.017. 11. Insurance: Contractor shall, at its own expense, at all times during the term of this agreement, maintain in force a comprehensive general liability policy including coverage for contractual liability for obligations assumed under this Contract, blanket contractual liability, products and completed operations, owner's and contractor's protective insurance and comprehensive automobile liability including owned and non-owned automobiles. The liability under each policy shall be a minimum of $500,000 per occurrence (combined single limit for bodily injury and property damage claims) or $500,000 per occurrence for bodily injury and $100,000 per occurrence for property damage. Liability coverage shall be provided on an "occurrence" not "claims" basis. The City of Ashland, its officers, employees and agents shall be named as additional insureds. Contractor shall submit certificates of insurance acceptable to the City with the signed contract prior to the commencement of any work under this agreement. These certificates shall contain provision that coverages afforded under the policies cannot be canceled and restrictive modifications cannot be made until at least 30 days prior written notice has been given to City. Each certificate of insurance shall provide proof of required insurance for the duration of the contract period. 12. Assianment and Subcontracts: Contractor shall not assign this contract 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. Contractor 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 shall not create any contractual relation between the assignee or subcontractor and City. CONTRACTOR:Q BY~\\ -,,\l~ , Si,gnature ~ \ ~~'le,_ C J["~~,\---.., \:~',-}&c:~ '\- Print Name TITLE \~<<L~"-C~ \:- , CITY OF ASHLAND: BY 4fy( ~ FINANCE DIR TOR OR BY DATE CITY ADMINISTRATOR 3/1/0' DATE0-~ -Db FederallD# -sc~ -(>c ~ 5 lY (, CCB Name ~e. y \, ~- Co '0- ~ \- '\ C)'<', CCB# /'563 _I C CONTENT REVIEW CITY DATE ,1 ~ IOh I t ACCOUNT # IF' l' // / I / & d? tfJ 7 ttJ .r;:? I' ~-c' PURCHASE ORDER # tf? P tt5 7 ( (for City purposes only) City of Ashland - Business License # * Insurance Certificates and a completed IRS W-9 form must be submitted with signed contract. Revised 4-27-05 CITY OF ASHLAND REQUISITION FORM Date of Request: I ~ - ~- (;)~ THIS REQUEST IS A: o Change Order(existing PO # Required Date of Delivery/Service: . ~ L,~ C~llll"'l&--. {n(" '1 IbLD en r ~'4aAt . prv AT. f..-'i2. q-, S-o ~ . (S"&t0lo\o5 -S4rs- ' ~ L t;;th) "....5'- 9-.(l f L 9-{\) /70 - 0 i'1g- (r~scr) Vendor Name Address .CIty, State, Zip Telephone Number Fax Number contact Name SOLICITATION PR0CE88 SmIII Proc:uNment o Less thai $5,000 o Quotes (Optional) rlall Procullllllllt (3) Written Quotes (Copies attached) o Copy of contract attached o Contract # InvItIItIon to BId (Copies on file) ReaUllt for ProDOIII (Copies on file) SaecIIII Exemat o Written findings attached Qucie or attached Emeraencv o Written findings attached Qucie or attached D..crlptlon of _RVlCBS ~lOf'\ OF ~~ t<.Y'OtA..lT r~Cd.l.l~ (). t W- ~ pflM~ ~ ~ ~4u; ~ attached PROPOSAL Total Cost $ .~ ','2..0'1. qq Item , Quantity Unit Description of IlATI!RIALS Unit PrIce Total Coat 0 Per attached QUOTE _...... Project Number -- - -- - . - - - $ t,101..t/iJ '10 t( (00 Account Number~~.!~. ~~. ~. _~ e · Items and seNices must be charged to the appropriate account numbers for the financia/s to reflect the actual expenditures accurately. By signing this requisition form, I certify that the information provided above meets the City of AshIEJ1d public contracting requirements, Md the docmJentaIioo can be provided I4lOO 1lIqUflSt. ~ .' Employee S1gllllulll: j11.o v., jI1 r(.ct; SU~ .- SIgnaIure: J' '" 1 FIiB-:M-06 Pa (541) 665-541' Papr (541) 7'70-0791 CELL (541) e6O-OI72 CCM 150310. Job ~stimate JOB LOCAnON~ CITY OF ASHLAND QUINCY STREET ASHLAND OIl WOl2006-1000 ppaWO'IN/A ItI:J ,.. ,..........~ ia rJ--' ... ........ 1M.... ~ .......~........ . arwnz., APJt. ~.-.n'CW. """111'~"'" ....'10.....- lYWiI1I1rT ANn BWImPB Ad...-r J-.n ..._.."11 ~ __..- ....IIA..AIm J""'1YUV.ft ~.'M JlR.1lODl'. 1ub will.. doIaM .. lID ...... job ........ All primIry, IDIIa line, ~..... 101' .va &&up willi.. Cbe ~.., f:4tbo GIIIo-' to tll." witbtheir IoaII uIiIiIia. Aay mek.......... thIt~" bend ar ~~ wII be... with... time IIId ___ .... ADy lIMn thm ttIo plow ripI wiD wiII.be ... CQIt oajab. nil pJOpOIII may be witbdra. by.. ifDIlX..-s wkID :40 .,.. IqIdp...t, Aad Labor: ""'.80- sn &WBPS AND CONDUIT UOJ.64 \\ ~ TOTAL-8207.44 -../"-.; WlTHPAVU'RNTTOBBUA.n'RASFOLLOWS: /t/~-~ ~/l (j~~/ ~ AT STAaT Of JOB AND 1dNAINBaBUB l:JP8N C9MPY1'ION. OOBS NO'I' M.'PLY TO HOFIC POWEa AII-W-....... to.......... AI WOJk;.~ ia IL WlQIIn......... ........ .oco." to It....... pndka. Ally ........ or.... hill tile Ibove ~ "iDI -- calli. will be tuaJIed 0JIlJ... wiitlm onIIn. ... wIl ==.==:,;."!.~~~ - . ImVBtu.-r "~mrDYLINB;~ ~RPTANCE OF R.-nuATB 1'Iac a-..e ......1pedIicatIoIII... ..jltl.. .... .t~ ... an ......, Ilf.UIDL Y.. an........ ........ wwk It lp.dIIed. ..,.... willie.... ---..... ...... SJGNA1URB DATE. ~,-~A.~Lt!. >4-:~~ 'r~/ -~6r--~6tg3- r I ACORD. CERTIFICATE OF LIABiliTY INSURANCE OP ID 1~ DAlE (1olIWD/YYYY) KBYLI-l 03/09/06 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE cramer ~ Gile. ID.uraDce, IDC. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 945 ~OWD CeDtre Dr. Suite A ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Medford Oil 97504 PhoDe:541-772-9600 INSURERS AFFORDING COVERAGE NAIe #I I\ISURED INSUlER A. riDaDcial Pacific ID. IN~B: Kel LiDe COD.tructioD, IDC. INS~C: 66 7 !rolo ~ INSUlER D: CeDtral P01Dt Oil 97502 INSUlER E: COVERAGES TtE POLICIES OF INSlJW,ICE LISTED BELOW HAVE BEEN ISSUED TO TtE INSURED NAAED POOVE FOR THE POLICY PERIOD INDICAlED. NOTWllHSTANOING />NY REQUIREr.ENT. TERM OR CONDITION OF />NY CONTRACT OR OTtER DOClJt.ENT WITH RESPECT TO milCH THIS CERTIFICAlE MAY BE ISSLeD OR MAY PERTAIN. TtE 1NSl.JRHlCE AFFORDED BY THE POLICIES DESCRIBED fEREIN IS SUB,ECT TO ALL THE TERMS. EXCLUSIONS />ND CONDITIONS OF SUCH POLICIES. AGGREGAlE LIMITS SHOVVN MAY HAVE BEEN REDUCED BY PAID CLAIMS. L TR IN8RI: lYPE OF INlIURAHCE POLICY NUIIIlER ~ DAlE LIMITS GENERAL LIAIllLITY EACH OCCUlRENCE $ 1,000,000 f-- A X X COMr.ERCIAL GeERAL LIABILITY 173496A 11/22/05 11/22/06 PREMISES (Ea occurenco) $100,000 - ~ CLAIMS MADE ~ ~ MED EXP (!lily one pen;on) $ 5,000 - PERSONAL & PDV INJUlY $1,000,000 - $2,000,000 GENERAL AGGREGAlE - GEN\. AGGREGAlE LIMIT .APPLIES PER: PRODUCTS - COMPIOP AGG $ 2,000,000 I POLICY n ~ n LOC AUTOMOBILE UAIllUTY COMBINED SINGLE LIMIT r-- $1,000,000 A />NY ALlTO 173496A 11/22/05 11/22/06 (Ea accidanl) r-- ALL OWNED ALlTOS BODILY IN.lJRY f-- $ ~ SCHEDULED ALlTOS (Por person) ~ HIRED ALlTOS BODIL Y I~Y $ X NO~OWNED AUTOS (Per accidert) - - PROPERTY DAMAGE $ (por accidert) caARAGE UAIllUTY ALlTO ONLY - EA ACCIDENT $ R />NY ALlTO OTHER THAA EA ACC $ AUTO ONLY: AGG $ EXCE881U1lBREU..A LIAIILl1Y EACHOC~E $ 2,000,000 A ~OC~ D CLAIMS MADE 173496A 11/22/05 11/22/06 AGGREGAlE $2,000,000 $ R DEDUCTIBLE $ RETENTION $ $ WOR1<ER8 COMPENSAnON AND Ir;;'y tiMI'ffi I .tiR EMPLOYERS' LIAIlLITY E.L EACH ACCIDENT $ />NY PROPRIETORIPARThERIEXECLlTIVE OFFICERMeJBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ If yes. describe l.nder E.L DISEASE - POLICY LIMIT $ SPECIAL PROVISIONS ~ OTHER DES RPTION OF OPERATION8/ LOCATION8/ VEHICLES 1 EXCLUSIOH8 ADDEO BY ENCIORSEMENT / SPECW.. PROVISIONS TO CITY or ASHLAND, I~S ORICZ1\S Am) J:MPLOYDS SHALL U NAMED AS ADDI~IONAL INSURBD AS DSPZC!I!S GDBRAL LIABILITY PD TO M!':I!ACHZD ZNDORSJDmN'J!. U: QUINCY ST1UU:~ PllDAJlY rAIJL~ UPAlll PRO.JECT '000085 *10 DAYS NO'1'ICII: rOll NONP.ADa:N'1'* CERTIFICATE HOLDER CI'l'YASH CANCELLATION SHOULD Nti OF 1M! ABOVE DE8CRI8EO POLICIES BE CANCB.LED BEFORE 1M! EXPIRATION DATE llEREOF, 1M! ISstaG INSURER WLL ENDEAVOR TO IIIAL ~ DAYS WRITTEN NOllCE TO THE CERTFlCAlE HOLDER NAIlEO TO 1M! LEFT, BUT FALlJRE TO DO so IHALL IMPOSE NO OBLIGATION OR LlABLl1Y OF Nti KIND UPON llE INSURER, ITS AGENTS OR REPRESENTATIVES. REPlIESENTATIYE RD CORPORATION 1988 CITY 01' ASHLAND 90 N. NOUN'1'AIN AVBNUB ASHLAND Oil 97520 ACORD 25 (2001/08) POLICY NUMBER: 173496A COMMERCIAL GENERAL LIABILITY CG 20 10 1093 Modified THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS (FORM B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: CITY OF ASHlAND, ITS OFFICERS AND EMPLOYEES 90 N. MOUNTAIN AVENUE ASHLAND, OR. 97520 RE: QUINCY STREET PRIMARY FAULT REPAIR PROJECT #??oo85 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement). WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule, but only to the extent that the person or organization is held liable for your acts or omissions for your ongoing operations performed for that insured. CG 20 10 10 93 Modified Page 1 of 1 Includes copyrighted material on Insurance Services Office, Inc., with its permission. SAIF corporation ;j/.l;j/ZUUb ~:ZZ 1J1\U~ ~/~ Ol\lr \JU,[VU,[a.I.~Ull IIIFCCJRJRAIDN 400 High St SE Salem, OR 97312-1000 Toll Free 1-800-285-8525 OREGON WORKERS. COMPENSATION CERTIFICATE OF INSU RANCE CER11f1CA TE HOLDER: CTY OF ASHLAND 90 N. MOUNTAIN AVE. ASHLAND, OR 97520 The policy of insurance listed below has been issued to the insured named below for the policy period Indicated. The insurance afforded by the policy described herein Is subject to all the terms, exclusions and conditions of such policy. POUCY NO. POUCY PERIOD 937629 01/01/2006 TO 01/01/2007 INSURED: BROKER OF RECORD: KEY UNE CONSTRUCTION INC CONTRACTORS INSURANCE SERVICES PO BOX 4410 TUALATIN, OR 97062 ISSUE DATE 03/13/2006 6687 TOLO RD CENTRAL POINT, OR 97502-9350 UMIlS OF LIABIU1Y: Bodily Injury by Accident $500,000 each accident Bodily Injury by Disease $500,000 each employee Bodily Injury by Disease $500,000 policy limit DESCRlP110N 0' OPERA 110NS/ LOCA110NS/SPIClAL InNS: ALL OPERATIONS IMPORTANT: The coverage described above is in effect as of the issue date of this certificate. It is subject to change at any time in the future. This certificate Is issued as a matter of information only and confers no rights to the certificate holder. This certificate does not amend, extend or alter the coverage afforded by the policies above. AUTHORIZED REPRESENTATIVE r T~ it.,~.~ ~J~" ~.' r~' CITY RECORDER~S COpy CITY OF ASHLAND 20 E MAIN ST. ASHLAND, OR 97520 (541) 488-5300 Page1/1 06671 VENDOR: 008877 KEY LINE CONSTRUCTION, INC 6687 TOLO ROAD CENTRAL POINT, OR 97502 SHIP TO: Ashland Electric Department (541) 488-5354 90 N MOUNTAIN ASHLAND, OR 97520 FOB Point: Tenn8: Net Req. Del. Date: Speclallnst: Req. No.: Dept.: ELECTRIC Contact: Scott Johnson Conflnnlng? No THIS IS A REVISED PURCHASE ORDER Contractor to bore approximately 260 feet of 4. conduit from power pole to transformer. Conduit and sweeps to be provided by contractor. Per proposal dated 02124/2006. 8,207.44 Contract for Work BeginninQ date: 0310812006 Completion date: 03131/2006 Insurance certificates required/On file *** This is a chan!:le order. *** BILL TO: Account Payable 20 EAST MAIN ST 541-552-2028 ASHLAND, OR 97520 SUBTOTAL TAX FREIGHT TOTAL - VENDOR COPY