HomeMy WebLinkAbout2008-222 Contract - Key Line Construction
Contract for GOODS AND SERVICES Less than $25,000
CITY OF
ASHLAND
20 East Main Street
Ashland, Oregon 97520
Telephone: 541/488-6002
Fax: 541/488-5311
CONTRACTOR: Keyline Construction
CONTACT: Steve Colson
ADDRESS: 6687 Tolo Road, Central Point, OR 97502
TELEPHONE: 541-665-5415
DATE AGREEMENT PREPARED: November 18, 2008 FAX: 541-665-5418
BEGINNING DATE: December 22,2008 COMPLETION DATE: December 31,2008
COMPENSATION: Not to exceed $5,321.00 to bore the entire project, Not to exceed $8,558.55 to saw cut
asphalt and trench the entire project. Efforts will be made to bore the entire project. If contractor is unable to
bore due to excessive rocks, then the will saw cut as halt and trench. Per attached bids dated 10/06/2008.
GOODS AND SERVICES TO BE PROVIDED: Borerrrench 130 feet and pull in 4" conduit. Sweep into switch, core drill and
swee into concrete ad at transformer. Location: 705 Helman Street Helman Elementa School
ADDITIONAL TERMS: Full a ment u on com letion.
NOW THEREFORE, pursuant to AMC 2.50.090 and after consideration of the mutual covenants contained herein the
CITY AND CONTRACTOR AGREE as follows:
1. All Costs by Contractor: Contractor shall, provide all goods as specified above and shall at its own risk and
expense, perform any 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 any 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 worker-like 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 provide all goods in accordance with the standards and specifications, no later
than the date indicated above and start performing the work under this contract by the beginning date indicated
above and complete the work by the completion date indicated above.
4. Compensation: City shall pay Contractor for the specified goods and for any work performed, including costs and
expenses, the sum specified above. Goods shall be paid for within 30 days of an invoice after delivery of goods
conforming to the standards and specifications. 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, unless a separate written contract is entered into by the City.
5. Ownership of Documents: All documents prepared by Contractor pursuant to this contract shall be the property of
City.
6. Statutory Requirements: ORS 2798.220, 2798.225, 2798.230, 2798.235, ORS Chapter 244 and ORS 670.600 are
made part of this contract.
7. Living Wage Requirements: If contractor is providing services under this contract and the amount of this contract
is $18,088 or more, Contractor is required to 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 500/0 or more of the work under this contract. Contractor is also required to post the notice attached
hereto as Exhibit B 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 proximately caused by the negligence of City.
9. Termination:
a. Mutual Consent. This contract may be terminated at any time by mutual consent of both parties.
b. Citvs Convenience. This contract may be terminated at any time by City upon 30 days' notice in writing
and delivered by certified mail or in person. .
c. For Cause. Cit ma terminate or modif this contract, in whole or in
Contract for Goods and Services Less than $25,000, Revised 06/30/2008, Page 1 of 9
-- -~~-,
written notice to Contractor, or at such later date as may be established by City under any of the following
conditions:
i. If City funding frofTl 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 contract or are
no longer eligible for the funding proposed for payments authorized by this contract; or
iii. If any license or certificate required by law or regulation to be held by Contractor to provide the
services required by this contract is for any reason denied, revoked, suspended, or not renewed.
d. For Default or Breach.
i. Either City or Contractor may terminate this contract in the event of a breach of the contract by
the other. Prior to such termination the party seeking termination shall give to the other party
written notice of the breach and intent to terminate. If the party committing the breach has not
entirely cured the breach within 15 days of the date of the notice, or within such other period as
the party giving the notice may authorize or require, then the contract 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 Contractor's performance of each and every obligation and duty under
this contract. City by written notice to Contractor of default or breach, may at any time terminate
the whole or any part of this contract if Contractor fails to provide services called for by this
contract within the time specified herein or in 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 contract.
e. Obliaation/Liabilitvof Parties. Termination or modification of this contract 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 subsections a, b, c or d of this section, Contractor shall immediately cease all activities under
this contract, unless expressly directed otherwise by City in the notice of termination. Further, upon termination,
Contractor shall deliver to City all contract documents, information, works-in-progress and other property that are
or would be deliverables had the contract been completed. City shall pay Contractor for work performed prior to
the termination date if such work was performed in accordance with the Contract.
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.
11. Non-discrimination Certification: The undersigned certifies that the undersigned Contractor has not discriminated
against minority, women or emerging small businesses enterprises in obtaining any required subcontracts.
Contractor further certifies that it shall not discriminate in the award of such subcontracts, if any. The Contractor
understands and acknowledges that it may be disqualified from bidding on this contract, including but not limited to
City discovery of a misrepresentation or sham regarding a subcontract or that the Bidder has violated any
requirement of ORS 279A.11 0 or the administrative rules implementing the Statute.
12. Asbestos Abatement License: If required under ORS 468A.710, Contractor or Subcontractor shall possess an
asbestos abatement license.
13. Assignment 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.
14. Use of Recyclable Products: Contractor shall use recyclable products to the maximum extent economically feasible
in the performance of the contract work set forth in this document.
15. Default. The Contractor shall be in default of this agreement if Contractor: commits any material breach or default of
any covenant, warranty, certification, or obligation it owes under the Contract; if it loses its ORF status pursuant to
the ORF Rules or loses any license, certificate or certification that is required to perform the work or to qualify as a
ORF if Contractor has qualified as a ORF for this 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 Contract; or attempts to assign rights in,
or delegate duties under, the Contract.
16. Insurance. Contractor shall at its own expense provide the following insurance:
a. Worker's Comoensation insurance in compliance with ORS 656.017, which requires subject employers to
provide Oregon workers' compensation coverage for all their subject workers
b. General Liabilitv insurance with a combined single limit, or the equivalent, of not less than Enter one:
$200,000, $500,000, $1,000,000, $2,000,000 or Not Applicable for each occurrence for Bodily Injury and Property
Damage. It shall include contractual liability coverage for the indemnity provided under this contract.
c. Automobile Liabilitv insurance with a combined single limit, or the equivalent, of not less than Enter one:
$200,000, $500,000, $1,000,000, or Not A Iicable for each accident for Bodil In.u and Pro ert Dama e,
Contract for Goods and Services Less than $25,000, Revised 06/30/2008, Page 2 of 9
including coverage for owned, hired or non-owned vehicles, as applicable.
d. Notice of cancellation or chanae. There shall be no cancellation, material change, reduction of limits or
intent not to renew the insurance coverage(s) without 30 days' written notice from the Contractor or its insurer(s) to
the City.
e. Additional Insured/Certificates of Insurance. Contractor shall name The City of Ashland, Oregon, and its
elected officials, officers and employees as Additional Insureds on any insurance policies required herein but only
with respect to Contractor's services to be provided under this Contract. As evidence of the insurance coverages
required by this Contract, the Contractor shall furnish acceptable insurance certificates prior to commencing work
under this contract. The certificate will specify all of the parties who are Additional Insureds. Insuring companies
or entities are subject to the City's acceptance. If requested, complete copies of insurance policies, trust
agreements, etc. shall be provided to the City. The Contractor shall be financially responsible for all pertinent
deductibles, self-insured retentions and/or self-insurance.
17. Governing Law; Jurisdiction; Venue: This contract shall be governed and construed in accordance with the laws
of the State of Oregon without resort to any jurisdiction's conflict of laws, rules or doctrines. Any claim, action, suit or
proceeding (collectively, lithe claim ") between the City (and/or any other or department of the State of Oregon) and
the Contractor that arises from or relates to this contract shall be brought and conducted solely and exclusively within
the Circuit Court of Jackson County for the State of Oregon. If, however, the claim must be brought in a federal
forum, then it shall be brought and conducted solely and exclusively within the United States District Court for the
District of Oregon filed in Jackson County, Oregon. Contractor, by the signature herein of its authorized
representative, hereby consents to the in personam jurisdiction of said courts. In no event shall this section be
construed as a waiver by City of any form of defense or immunity, based on the Eleventh Amendment to the United
States Constitution, or otherwise, from any claim or from the jurisdiction.
18. THIS CONTRACT AND ATTACHED EXHIBITS CONSTITUTE THE ENTIRE AGREEMENT BETWEEN THE
PARTIES. NO WAIVER, CONSENT, MODIFICATION OR CHANGE OF TERMS OF THIS CONTRACT 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 CONTRACT.
CONTRACTOR, BY SIGNATURE OF ITS AUTHORIZED REPRESENTATIVE, HEREBY ACKNOWLEDGES THAT
HE/SHE HAS READ THIS CONTRACT, UNDERSTANDS IT, AND AGREES TO BE BOUND BY ITS TERMS AND
CONDITIONS.
19. Nonappropriations Clause. Funds Available and Authorized: City has sufficient funds currently available and
authorized for expenditure to finance the costs of this contract within the City's fiscal year budget. Contractor
understands and agrees that City's payment of amounts under this contract 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 contract. In
the event City has insufficient appropriations, limitations or other expenditure authority, City may terminate this
contract without penalty or liability to City, effective upon the delivery of written notice to Contractor, with no further
liability to Contractor.
20. Prior Approval Required Provision. Approval by the City of Ashland Councilor the Public Contracting Officer is
required before any work may begin under this contract.
21. Certification. Contractor shall sign the certification attached hereto as Exhibit A and herein incorporated by
reference.
CONTRACTOR (\ \ ..
BY~~
. V~ Signa
Print Nam~
-PreS\our
I \ \z.Y-/ 0 5
CITY OF ASHLAND:
BY
TITLE
DATE
11-/2- ,,~
FederallD#
30- OO~SIL(O
I I /)
~ If t1 /1 [~ tfJ IJ -r tf}~/ t:9 ~
(For City purposes only)
PURCHASE ORDER # 0 tJ 6 '1 ~
DATE
ACCOUNT #
*Completed W9 form must be submitted with contract
Contract for Goods and Services Less than $25,000, Revised 06/30/2008, Page 3 of 9
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EXHIBIT A
CERTIFICATIONS/REPRESENTATIONS: Contractor, under penalty of perjury, certifies that (a) the
number shown on the attached W-9 form is its correct taxpayer 10 (or is waiting for the number to be
issued to it and (b) Contractor 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. Contractor further represents and
warrants to City that (a) it has the power and authority to enter into and perform the work, (b) the
Contract, when executed and delivered, shall be a valid and binding obligation of Contractor
enforceable in accordance with its terms, (c) the work under the Contract shall be performed in
accordance with the highest professional standards, and (d) Contractor is qualified, professionally
competent and duly licensed to perform the work. Contractor also certifies under penalty of perjury
that its business is not in violation of any Oregon tax laws, and it is a corporation authorized to act on
behalf of the entity designated above and authorized to do business in Oregon or is an independent
Contractor as defined in the contract documents, and has checked four or more of the following
cri7
(1) I carry out the labor or services at a location separate from my residence or is in a
_. / specific portion of my 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.
V (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.
V (6) I assume financial responsibility for defective workmanship or for service not provided
as evidenced by the ownership of performance bonds, warranties, errors and omission
insurance or liability insurance relating to the labor or services to be provided.
-Kc~ un~ ~{JflJ 111~~l)5
Contractor ~~~ (Date)
Contract for Goods and Services Less than $25,000, Revised 06/30/2008, Page 4 of 9
-------T
Fonn W-9
Request for Taxpayer
Identification Number and Certification
Give fonn to the
..quester. Do not
send to the IRS.
(Rev. October 2007)
Dep~rlment of the Treasury
Internlll Reyenue S.erVlce
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ent from above
Corporation 0 Partnerahip
reg.arded entity, C=corporation, P::partnership) II-- __ _ ____
Enter your TIN in the appropriate box. The TIN provided must match the name given on Une 1 to avoid
backup withholcling. For individuals, this is your social security number (SSN). However. for a resident
alien. sole proprietor, or disregarded entity, see the Part I Instructions on page 30 For other entities, it is
your employer identification number (EIN). If you do not have a number, see How to get s TIN on page 3.
Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose
number to enter.
Certification
Under penalties of perjury, I certify that
1. The humber 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 b&en 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 lam no longer subject to backup withholding, and
3. I am a U.S. citizen or other U.S. person (defined below).
Certlficatlon.lnstrucUons. 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 int&rest 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 on page 4.
~~';, I~..:.~ ~ ~C ~ --'. --J
Llstaccount nunber(a) here (optionaQ
Taxpayer Identification Number (TIN)
General Instructions
Section references are to the Internal Revenue Code unless
otherwise noted.
Purpose of Form
A person who is required to file an information return with the
IRS must obtain your correct taxpayer identification number (TIN)
to report, for example; income paid to you. real estate
transactions, mortgage interest you paid, acquisition or
abandonment of secured property. cancellation of debt, or
contributions you made to an IRA
Use Form W~9 only if you are a U.So person (including a
resident alien), to provide your correct TIN to the person
requesting it (the requester) and. when applicable. to:
1. ~rtify that the llN you are giving is correct (Or you are
waiting for a number to be issued),
20 Certify that you are not subject to backup withholding, or
3. Claim exemption from backup withholding if you are a U.S.
eX$mpt payee. If applicable, You are also certifying that as a
U.S. perSon, your allocable share of any partnership income from
a U.S. trade or business is not subject to the withholding tax on
foreign partners' share of effectively connected income.
Note. If a requester gives you a formotherthan Form W-9 to
request your TIN, you must use the requester's form if it is
substantially siinilar to this Form W~9.
D EXempt
payee
Requester's name and address (optionaQ
GliSO 2.
\SOcial..! num!'
or
0..1Ilo-
, ) J~LJ JOB
DeftnlUon of a U.S. person. For federal tax purposes, you are
considered a U.S. person if you are:
. An individual who is a UoS. citizen or U.S. resident alien,
. A partnership, corporation, company, or association created or
organized in the United States or under the laws of the United
States,
. An estate (other than a foreign estate), or
. A domestic trust (as defined in Regulations section
301 .7701-7).
SpecIal rules for ~nershlps. Partnerships that condllct a
trade or business in the United States are generally required to
pay a withholding tax on any foreign partners' share of income
from such businesso Further, in certain cases where a Form W-9
has not been received, a partnership is required to presume that
a partner isa foreign person, and pay the withholding tax.
Therefore, if you are a U.So personthat is a partner ina
partnership conducting a trade or busin$ss in the Unite(l States,
provide Form W-9 to the partnership to establish your UoS.
status and avoid withholding on your share of partnership
income.
The person who gives Form W-9 to the partnership for
purposes of establishing its UoS. status and avoiding withholding
on its. allocable share of net income from the partnership
conducting a trade or business in the United States is in the
follOWing cases:
. The U.S. owner of a disregarded entity and not the entity,
Cat. No. 10231X Form W-9 (Rev. 10-2007)
Contract for Goods and Services Less than $25,000, Revised 06/30/2008, Page 5 of 9
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Spft:iJ:iII,: ... lJrtdcoQ(""'" C_Il'lICfilNr Cdtl~ rJuwm,:
6687 ToIo Rd.
Centra' Point OR 97502
Office: (541) 665-5415 Fax: (541) 665-5418
E-mal: klcinc@ccountry.net
CCBl150310 CCUI837678
10/6/2008
Job Estimate
aty of Ashland.
90 n. Mountain Ave.
Ashland Or.
Job Location: 705 Helman St
~e\f Une Corlst(lrl:iorI is p1~ to ~bmit the followillQ CXl5t estimate:
Bore 130 feet and pullIn 4" CXll1dult. 9lrieeP Into switch, oore drill and sweep into
concrete pad at transformer.
Job will be deaned up to normal job s\:lIndards. All primary, main line, sec:ondary cables and/or selVlc:e
droP wireS are \be responslblllty of the QJStDmef to arrange with their Ioc.aI utilllies. My rock
encountered that cannot be plowed wm be dealt with on a time and material basis.
EQUIPMENT, MATERIAL, AND LABOR: 5,321.00
WITH PAYMENLTO BE MADE AS FOLLOWS:
SooA, AT START OF JOB AND REMAINDER DUE UPON COMPLETION.
All material Is guaranteed to be as >opcCified. All work is compIeI.ed In a WQrkmanship manner acxxxding
to star1daRI prlIdIc:eS. Arft alteraliOns or dev\atiOn from \be above specificatIonS involving extra msts,
wII be elleQIted only upon wriUen ordeIS, and wII becllI1Ie an extra charge ewer and abcwe \be estIrnate.
This proposal may be withdrawn by us if not accepted within 30 days.
AlITHORIZED SIGNAlURE:
~~
Steve Colson - President
ACC1::/YTANCE DE EST1J4ATE
The aIJot,e priceS, specificatiOfIS and contJiI;ionS are satIsfadDtY and are herebY
aa;.epted. You are authorlzed tD do the work as spedfied. PaymelIt wITl be made as
outlined above.
ACCEPTED: SIGNA7VRE
OATE:
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MtAJ C u'r r -r~H
.
tey~
Sprc._i~r ill Vrt*'II"""'" C_'",,'fMr1l Cubl.. """rillS
.6687 To&o Rd.
Centra' Point OR 97502
Office: (541) 665-5415 Fax: (541) 665-5418
E-mal: kldnc@coountJ'y.net
CC~ 150310 CClJI837e78
10/6/2008
Job Estimate
aty Of Ashland
90 N. Mountain Ave.
Ashland Or.
Job Location: 705 Helman St
Kev Line Construction is pleased to submit the following cost estimate:
Saw cut asphalt. trench 130 feet and place 4" conduit. Sweep into switch. Core drill
concrete pad and sweep Into transformer. Remove and replace asphalt.
Job will be deaned up to normal job standards. All primary, main line, seoondary cables and/or servicE
drop wires are the responsibility of the customer to arrange with their local utilities. Any rock
enaultered that cannot be plowed will be dealt with on a time and material basis.
EQUIPMENT, MATERIAl, AND lABOR: 8,558.55
wrn-t PAYMENT TO BE MADE AS FOI LOWS:
50% AT START OF JOB AND REMAINDER DUE UPON COMPlETION.
All inateria\ is guaranteed to be as spedfied. All work is mmp1eted in a workmanship manner according
to ~dard pradices. Arrv alterations or devfation from the above specificationS invoMng extra msts,
wil be executed only upon wriUen orders, and wil become an extriJ charge over and above ttle estimate.
This proposal may be wlhdrawn by us if not accepted within 30 days.
AUTHORIZED SIGNATURE:
~ QJ.~
Steve Colson - President
ACu:fJrANCE OFESTIMATE
The above prices, specificationS and conditions ate satisfactoly and are hereby
accepted. You are authorized to do the work as specified. Payment will be made as
outlined above.
ACCEPTED: SIGNAnJRE
DATE:
--r -- -
ACORDm CERTIFICA TE OF LIABILITY INSURANCE I DATE (MMDDIYYYY)
11/12/2008
PRODUCER (541)772-1111 FAX: (541)772-3785 THIS CER11F1CATE IS ISSUED AS A MATTER OF INFORMA110N
Beecher carlson XDsurance Agency LLC ONL Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CER11F1CATE DOES NOT AMEND, EXTEND OR
707 Mu.z:phy ad AL TER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Medford OR 97504 INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURER A Financial Pacific XDs CO
Key Line COnstruction, :Inc. INSURER B
6687 Tolo Road INSURER C
INSURER D
Central Point OR 97502 INSURER E
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 w-tICH 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.
AGGREGATE LIMITS SHOVVN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR AOO'L TYPE OF INSURANCE POLICY NUMBER ~~~ Pg'tfJ(~~~~ L1MrTS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
- ~~~~~J?E~~~i>ence) 100,000
X ~MERCIAL GENERAL LIABILITY $
- CLAIMS MADE ~ OCCUR 11/22/2008 11/22/2009 5,000
A 113496D MED EXP (Anv one oerson) $
PERSONAL &ADV INJJRY $ 1,000,000
- 2,000,000
GENERAL AGGREGATE $
- 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER PR()nllrT~ _ (",f'lUDK'lD lJ.{";.{";. $
Xl nPRO- n
X POLICY .Fl'T LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
I--- (Ea accident) $
ANY AUTO
I--- 11/22/2009
A ALL OIJl.oNED AUTOS 173496D 11/22/2008 BODIL Y fNJJRY
I--- (Per person) $
~ SCHEDULED AUTOS
X HIRED AUTOS BODIL Y INJJRY
- (Per acddent) $
X NON-Ow.lED AUTOS
-
- PROPERTY DAMAGE $
(Per acddent)
GARAGE LIABILITY AUTO ONLY - EAACCIDENT $
~ ANY AUTO OTHER THAN EA ACC $
AUTO ONL Y AGG $
EXCESSlUMBRELLA LIABILITY FAC:H $ 5,000,000
:=J OCCUR o CLAIMS MADE AGGREGATE $ 5,000,000
$
A ~ DEDUCTIBLE 922533D 11/22/2008 11/22/2009 $
X RETENTION $ 0 $
WORKERS COMPENSATION AND I T~~T -;U/ts I IOJ~-
EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNERIEXECUTIVE EL EACH ACCIDENT $
OFFICERIMEMBER EXCLUDED? EL DISEASE - EA EMPlOYEE $
If yes. describe under $
SPECIAL PROVISIONS below EL DISEASE - POLICY LIMIT
A OTHER Leased or Rented 173496D 11/22/2008 11/22/2009 Limit $100,000
Equipment Deductible $1,000
DESCRIPTION OF OPERATIONSA.OCATIONSNEHlCLESA:XCLUSIONS ADDED BY ENOORSEMENTISPECIAL ~SIONS
lie: Qu.i.ft~ St~~8. l?~illla.y FaJl1.' a8pai~ Pr9j9gt '99888& ltb} fl"' ~.
The City of Ashland, its officers, and employees shall be named as Additional Insured as respects to General
Liabili ty . 10 Day Notice of Cancellation for Non-Payment of Premium. Subject to Policy Limits, Terms Conditions and
I!::I:clusions.
CER11FICATE HOLDER
CANCELLA nON
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
Ci ty of Ashland EXPIRATION DATE THEREOF, THE ISSUING INSURER WLL ENDEAVOR TO MAIL
90 N Mountain Avenue 30 DAYS WVTTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
Ashland, OR 97520 -
FAILURE TO DO so SHALL IMPOSE NO OBLIGATION OR L1ABlLrTY OF ANY KIND UPON THE
INSURER. rrs AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE -~-4-
Darrin Godfrey/KRISMA ~
ACORD 25 (2001108)
INS025 (0108).08a
@ ACORD CORPORA 110N 1988
Page 1 of 2
r.,
crrv RECORDER
Page 1 / 1
CITY OF
ASHLAND
20 E MAIN ST.
ASHLAND. OR 97520
(541) 488-5300
rlllll~
12/1/2008
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:
Tenns: Net
Req. Del. Date:
Speciallnst:
Req. No.:
Depl: ELECTRIC
Contact: Scott Johnson
Confinning? No
Boreffrench 130 feet and pull 4 H conduit
Location: 705 Helman Street (Helman
Elementary School)
8,558.55
Compensation:
Not to exceed $5,321.00 to bore entire
project
Not to exceed $8,558.55 to saw cut
asphalt and trench the entire project
Efforts will be made to bore the entire
project. If contractor is unable to
bore due to excessive rocks, then they
will saw cut asphalt and trench.
BILL TO: Account Payable
20 EAST MAIN ST
541-552-2028
ASHLAND, OR 97520
SUBTOTAL
TAX
FREIGHT
TOTAL
8558.55
0.00
0.00
8.558.55
.~ J. .~ "~F-
Auth zed Slpnature
VENDOR COpy
--------- ~--T- -
!~ reQuest f:or a
REQUISITION FORM
CITY OF
ASHLAND
Date of Request:
11\12\08
THIS REQUEST IS A:
D Change Order( existing PO #
Required Date of Delivery/Service:
12\30\08
Vendor Name
Address
City, State, Zip
Telephone Number
Fax Number
Contact Name
KPI IIN~ r.ON~TRI ir.TION
RRR7 TOI 0 ROAn
CENTRAl POINT OR 97520
541-665 - 5415
541-66~5418
STEVE COLSON
{pRO I=r.T~ Mn1AO)
SOLICITAnON PROCESS
Small Procurement o Sole SOlI'ce o Invitation to Bid
o Less than $5,000 o Written finclngs attached (Copies on file)
o Quotes (Not requi"ed)
Coooerative Procll'ement 0 Reauest for Prooosal
o State of OFWJA con1ract (Copies on file)
Intermeclate Procurement o Other government agency con1ract 0 Soeciall ExemDt
XD (3) Written Quotes o C~ of contract attached 0 Written findings attached
(Copies attached) o Emeraencv
n-coofiaCt# o Written findings attached
Description of SERVICES
XO Per attached PROPOSAL BORE 130' AND INSTAlL 4" CONDUIT @ 705
HELMAN ST. ( HELMAN ELEMENTRY SCHOOL)
Item # Quantity Unit
Description of MATERIALS
Unit Price
Total Cost
KI Per attached QUOTE
~ - J,)-~d - oB
h,",l~ - 'd-~'- 08
Project Number 000140.~~
Account Number 690.11.18.00.704100
* Items and services must be charged to the appropriate account numbers for the financials to reflect the actual expenditures accurately.
By signing this requisition form, I certify that the information provided above meets the City of Ashland public contracting requirements,
and the documentation can be provided upon request.
X1b.n~ ~ltl.
~
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