HomeMy WebLinkAbout2011-072 Contract - Marco Fontana Roofing
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: Marco Fontana Roofing Inc.
CONTACT: Marco Fontana, 541-944-5386
ADDRESS: 600 W. Dutton Rd" #1, Eagle Point, OR 97524
TELEPHONE: 541-770-9439.
DATE AGREEMENT PREPARED: 5/16/11 FAX:
BEGINNING DATE: After 5/16/11 COMPLETION DATE: Before June 15, 2011
COMPENSATION: $4,794 per proposal attached as Exhibit C
GOODS AND SERVICES TO BE PROVIDED: Removal of existing roof at YMCA restroom facility, Inspect
sheathing for damage and make repairs if necessary. Install new 30 year shingles to include 15# felt
underlayment, new painted metalflashing on eaves, vent pipes, skylights, continuous ridge ventilation with
high profile ridge cap. Debris removed from job site. Area surrounding job site magnet swept for nail and left
clean and undamaged. Gutters cleaned and secured. Per proposal attached as Exhibit C.
ADDITIONAL TERMS: Damage to existing sheathing or any other damage in need of repair may be additional
cost 20-Year workmanship guarantee from Marco Fontana Roofing, Inc.
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 b.eginning 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. 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 279B.220, 279B.225, 279B.230, 279B.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 $18,703 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 50% 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. Citv's Convenience. This contract may be terminated at any time by City UDon 30 davs' notice in writino
Contract lor Goods and Services Less than $25,000, Revised 12/20/2010, Page 1016
and delivered by certified mail or in person.
c. For Cause. City may terminate or modify this contract, in whole or in part, effective upon delivery of
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 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 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/Liabilitv of 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 iicense.
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 Compensation insurance in compliance with ORS 656.017, which requires subject employers to
provide Oregon workers' compensation coverage for all their subject workers .
b. General Uabilitv 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
Damaoe. It shall include contractualliabilitv coveraoe for the indemnity provided under this contract.
Contract for Goods and Services Less than $25,000, Revised 12/20/2010, Page 2 of6
c. Automobile Uabilitv insurance with a combined single limit, or the equivalent, of not less than Enter one:
$200,000: $500,000, $1,000,000, or Not Applicable for each accident for Bodily Injury and Property Damage,
including coverage for owned, hired or non-owned vehicles, as applicable.
d. Notice of cancellation or chanCle. There shall be no cancellation, material change, reduction of limits or
intent not to renew the insurance CQverage(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 Ashiand, 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 contractor's insurance is primary and non-contributory. 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, "the 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
coniract 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.
Contract for Goods and Services Less than $25,000, Revised 12/2012010, Page 3 of6
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:;ntrafh- 6\
Signature
(Yl",,,,c.o \-o",,~"~
Pririt Name
~l<l..<;,,>l."""
Title
By
W-9 One copy of a W-9 is to be submitted with
the signed contract.
Department Heac
::RtlCht/'DUlLS
Print Name
5 L 11/1)
ate
CCt::J?6
Purchase Order No.
Contract for Goods and Services Less than $25,000, Revised 12/20/2010, Page 4 of 6
i
EXHIBIT A
CERTIFICATIONS/REPRESENTATIONS: Contractor, under Renalty of ReriUlY, 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) 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) ttlat 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, a~d (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
criteria:
v
v'
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(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.
(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.
(6) I assume financial responsibility for defective workmanshiJ) 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.
77L-cJ,
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Contractor
(Date)
Contract for Goods and Services Less than $25,000, Revised 12/20/2010, Page 5 of 6
From:UNITED RISK SOLUTIONS
5412451112
05/11/201111:55
#746 P.002/008
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OP 10: DT
AC~RD' CERTIFICATE OF LIABILITY INSURANCE I DATE (MMJDDIVYYY)
"---"" 05/11/11
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER,
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(los) .must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy. certain policies may require an endorsement A statement on thfa certificate does not confer rights to the
certificate holder in lieu of such endorseme~~_
PRODUCER 541-245-1111 ~~T Dlallil M. Thomas
United Risk Solutions. Inc. I rM! N.oJ;, 541.245-1112
PO Box 936 541-245-1112 :;::g>'E. _..541-245-1111
Medford, OR 97501-0067 1=~~IliI.thoma~uAltedrlSk'COm
Michael L. Sellers ~~oouc FONT01C
INSURERlSI AFFORDING COVERAGe: NAlc.
INSURED Fontana Roofing, Inc. INSU.ER A, First Mercury Insurance Co.
530 Bell Rd. ",SU.ER s, Nationwide Insurance 19100
Talent, OR 97540-9749 INSURER C :
INSURER 0 :
INSURER E :
. INSURER':
COVERAGES
CERTIFICATE NUMBER'
REVISION NUMBER'
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED AeOVE FOR THE POLICY PERIOD
INDICATED. NOTWlTHSTANOING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN 1$ SUBJECT TO AlL THE TERMS.
EXCLUSIONS AND CONOITlONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAlO CLAIMS.
I~.f: lYPEOFIN$URANCe ~ POUCYNUMBER ~ MMJO ~I UMITS
GENERAL UABIUTY _UMENCE $ 1,000,00
A X COMMERCIAl-GENERAl LIABILITY X FMTX006990 02117/11 02117/12 MI Eo""" $ 50,001
'CLAIMS-MADE 00 OCCUR MEDEXP(Anyonepersonl $ 6,OO!
- PERSONAL & ADV INJURY $ 1,000,001
- GENERAL AGGREGATE $ 2,000,001
~'LAGG:mE LIMIT APnSPER: PRODUCTS-COMPKWAGG $ 2,000,001
POLlCY X. ~~ LOC Oed. $ 5,001
AUTOMOBILE UABfLn'Y X COMBINED SINGLE LIMIT $ 1,000,001
X (Eaaccklenl)
B ANY AUTO "CP BA 7514351311 02117/11 02117/12
.:.:.. BODILY INJURY.{Pw peraoo) $
I- ALL OWNED AUTOS BODILY INJURY (Per accident) $
I- SCHEDULED AUTOS PROPERlYOAMAGiE
$
I- HIRED AUTOS (Peraccident)
NON...()WNEDAUTOS $
I-
Oed. $1,000 $
UMBREl.LA UAB H OCCUR EACH OCCURRENCE $
,- EXCESS LIAB
ClAIMS-MADE AGGREGATE $
1-- DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION I.,WC STATU-II i'm;'-
AND EMPLOYERS' LIABIUTY Y' N
ANY PROPRIETORJPARTNER/EXECUTlVE D .fA E.L EACH ACCIDENT $
OFFlCER/MEMBER EXCLUDED?
(Mandatory In NHt E.l. DISEASE. EA EMPLOYEE S
g~c::~o~ ~~PERATlONS below . E.L OrsEASE ~ POlICY LIMIT $
DESCRIPTtON OF OPERATIONS I LOCATIONS J VEHICLES (Attach ACORD 101, A<klIUonal Remarks SchedUle, If more apace Ia required)
Ce,rtificate Holder Is Named Insured Per fonn Auto Policy Fonn #AC01020309
and General Liability Policy form #CG2037 Attached.
CERTIFICATE HOLDER
CANCELLATION
CITAS04
SHOUlD ANY OF THE AeOVE DESCRIBED POLICIES BE CANCEllED BEFORE
City of Ashland THE EXPiRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Parks & Recreation ACCORDANCE WITH THE POUCY PROVISIONS.
340 S. Pioneer
Ashland, OR 97520 AUTHORIZED REPRESENTATIVE
I ~~
ACORD 2S (2009/09)
Cl1998-2009 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are ....gl.tsred marks of ACORD
Frorn:UNITEO RISK SOLUTIONS
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1 POLICY NUMBER: FMTXD0B616
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5412451112
05/10/2011 15:52
#739 P.003/003
COMMERCIAL GENERAL LlA8ILrrv
CO 20 17 07 04
THIS ENDORSEMENT CHANGES THE POUCY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - COMPLETED OPERATIONS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL L1ABlUTY COVERAGE PART
SCHEDULE
location And Desc:rI or d 0 ons
his endorsemert applies only to Commercial
nations within the "Coverage Territory".
esldentlal Operations are excluded.
ealdenllal Openatlons are defined as work on or
lated to any reeldenUal etruoture Includl~ but not
Imlled to work perfom led on any part of 61ngle family
sllings, conclominluma, duplexes or townhouaes, end
noludes their common areas anellor appurtenant
ruoturea.
e Insurance affOrded to these addltlonal insureds '
s not apply to "bodily Injury" or ''property damage"
risI~ out of ''Yourworit''thatha& beencompJeted by ,
r for you prtorto 021171.2010.
IntOlTllBUon u1red to co etelhle Sohedule If not shown above wID be shown In the Declarations,
Section n - Who Is An Insured is amended to
include as an addltionai insured the person(a) or
orgsnization(s) shown in the Schedule, but only wfth
respact to liability for 'bodily Injl61' or "property dam-
age" caueed, in whole or In pert, by "your work" at
the location designated and de8cribed In the echecf..
ule of this endorsement performed for that Ilddltlonel
insured and Included In the "~mpleted
operations hazard"
CB 20 37 07 04
C ISO Properties, Inc., 2004
Page 1 of1
",tC~Rd I CA TE (MMiOO/YY'YY)
. CERTIFICATE OF LIABILITY INSURANCE 5/10/2011
THIS CERTlFlCAT! IS ISSueD AS A MAT'TliR. 0,. INFOIUM.T10N ONL.'Y AND CO~FER9 NO 5ij<;ilH1'S UPON -mE. CERTIFICATE HOlOER. THl5
CERTIFICATE DOES NOT AFFfRMATIVELY OR NEGAnVELY AMEND, EXTENO OR ALTER ll-IE cOVERAGE AfFORDED BY THE POLICI6.S
BELOW. Tl1IS CEJmFlCA n; OF INSURANCE DOES NOT CONSTtTUTE Po CONTRACT BETWEEN TI-lE ISSUNG INSURER(SI, AUlHOR:lZED
REPR.E!lENTAl1~ OR: pRODUCER,. AND tHE CERTIFICATE l<<)LDER.
IMPORTANT: If the certJ1k:0lI.b! holdH i$;!In ADQ'ftONA.L INSUR.EO, 1M policy(itsJ must bel I!f1lJor$e:d. If SuBROGATION IS WAIVED, subject to
the terms and coru:UdOl'1S of tI'1. lXI11ey, c.l'tilln pclkiee 1tIfl)' require aI\ ."do~nt. jJ.~nt on this certJ1k:lI.tR doe. "001: cCI1far rtgtlts to me
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PROOOCEFI - !IIANlE:
A'l'lAS SUSINESS & EMPLOYEE SERVICES ;.':gN~o.c.,,, /503\ 1235-1986 li~ No),(503) 232-7355
700 N Hayden Island Dr #2~0 , ~~~~t~atlasb8s,com
--
portland, OR 97217 GlI13iOMER 10~
JN8URER(9) AFFORDING COVERAOE NA~"
IN:;ur:l:EO Fontana Roofing, :Inc INSURER A: Dallas National Insuranc:e Co 32271
INSURER B.:
530 Bell Road INSURI:R c:
Talent, OR 97540 IN~UR'Q 0:
INSURER 1::
INsuRER F:
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COVERAGES
CERTIFICATE NUMBER'
REVISION NUMRER.
THIS H:;' TO CERTIFY 'fHAT TriE POLICies OF INSURANCE LISTED BELOYI HAVE BEEN ISSUED TO THE INSUREO NAMED A.BOVE FO~ THE POLICY PERIOD
INDICATED. NOTWlTJoIST.AJI40lNG ANY REQUIRedSNf, TERM OR CONDITION OF ANY CONT~t OR OTHER DOCUMENT WITH RESPECT. TO voA-llCH THIS
ceRTIFICATE MAY BE ISSUED OR. MAY pERTAIN. THE INSURANCE AfFORDED BY THE pOuCIES DESCRIBED HEREIN 1$ SUBJECT TO ALL Ti-l6 TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SH()INN MAY HAVE BEEN REDUCED BY PAlO ~
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,A.uTOM06ILE UABtl.JTY COM61NEC SINGlE LIMIT .
- (Eo~oenl)
I- "NY AUTO
BODILY INJURY (Par pe"r:Pl) ,
f- ALLOVoINED"l.JT08 BODILY INJURY {Per lIel::iden\J . _.-
f- SClolEOULED "UTOiI pROPERTY (),lWAGe:
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f- HIREO AUTOS (Pllr,cQclml)
I- NO~O'M'lEO AUTOS ,
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UMBRELLA UA6 ~I~CUR e/lCH CXX;VRRENC~ ,
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exCESS LlAB CLAIM~~A,oe AooRe:GATE ,
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AND EMPlOYER" UABIUri ViN
A /'HJ ~OPR'STORIPAfl:TNEM;>(EQJTrve 0 Ni, e.L. !:I'.CH ACCIDENT . 500,000
OFFICEltI~~ E;:C.CUJDED?
(~.n".."'ry inNH) WCORl.0715 /1/2010 7/1/2011 500,000
lf~6,<te~b'1JfItW E.L. DISEASE - EA EMPLOYEE ,
OESCRIPTlON O~ OPERATIONS below E.L OlSE,t.,SE. POUCY LIMrr , 500 000
DESCRIPT10N OF OPERATIONS IlOC\T1QNS ;VEfiICLEO (Ah;::t1ACORD 101.AOditlonil RlIlITl.lIrksStMdul".i/ l'J\Oft811sce Ie 1lIQ1.l!n::11) ,.,
CERTIFICATE HOLDER
City of Ashland
Parks & Recreation
340 south Pioneer
~$hl.andi OR 97520
541-488-5314 Fax
CANCELLA nON
S~OULD ANY OF iHE ABOVE DESCRIBED POLICIES BE CANCELLEO BEFORE
THE EXPIFl,ATION DATE THEREOF. NOTICE: WILL BE DELIVERED IN
ACCORDANCE 'Mill T~E POLICY PROVISIONS.
ACOR025 (2000100)
01988-2009 ACORD CORPOIVIIION.A11 "9n15 reseNeO.
The ACORD name and logo are registered marks of ACORD
CITY RECORDER
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'..
,Ashland Park Commission
. DATE
5/19/2011
PO NUMBER
00046
20 E MAIN ST.
ASHLAND, OR 97520
(541) 488-5300
VENDOR: 003754
. MARCO FONTANA ROOFING
530 BELL ROAD
TALENT, OR 97540
SHIP TO:
FOB Point:
Terms: net
Req. Dei. Date:
Speciallnst:
Req. No.:
Dept.:
Contact: Brenda Hammers
Confirming? No
. Quantltv ,. I. Unit'. I. , . . . ' DescriDtion . Unit Price EXt.' Price:
Remove and replace roof shingles, 4,794.00
fiashin!1, etc. on YMCA restroom facility
Contract for Goods & Services
Beginning date: May 16, 2011
Completion date: June 15, 2011
Insurance required/On file
.
SUBTOTAL 4 794.00
BILL TO: TAX 0.00
FREIGHT , 0.00
TOTAL 4.794.00
Account Number . Project Number :'. .. . Amount Account Number" 'Project'Number Amount .
E 211.12.02.06.60211 4 794.00
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AuthO~d Signature
VENDOR COPY
FORM #3
'E';: i ,...l _
",~ ~.];
CITY OF
ASHLAND
REQUISITION
Date of request:
Required date for delivery:
$'
Vendor Name
Address, City, State, Zip
Contact Name & Telephone Number
Fax Number
M/wu.o .~OA.i,4-j'lJ'" ILoOFoJG. ..rAit..
(poo LJ, Clv-.-I4on aJ., "*/ E~~ f.;,,+ OR <;75,).'-/
.(;J"'vro Fon+iLnll. I '>'-/1 - 'I-fI,-S3g-t.
SOLICITATION PROCESS
o ExemDt from ComDetitive BiddinQ 0 Emeraencv
Reason for exemption: o Invital10n to Bid (Copies on file) 0 Written findings attached
Date approved by Council: o Quale or Proposal attached
lit!" Small Procurement CooDeratlve Procurement
Less than $5.000 o Request for ProDosal (Copies on file) o State of Oregon
Note: To1al contract amount, including any Date approved by Council: Contract #
amendments may not exceed $6,000 o State of Washington
Intermediate Procurement 0 Sole Source Contract #
GOODS & SERVICES 0 Written findings attached o Other government agency contract
$5,000 to $100.000 0 Quote or Proposal attached Agency
o (3) Written quotes attached Contract #
PERSONAL SERVICES 0 SDecial Procurement 0 Intergovemmen1al Agreement
$5.000 to $75.000 0 Written findings attached Agency
o Less than $35,000, by direcl appointmenl .0 Quote or Proposal attached Contract #
o (3) Written proposais attached Date annroved bv Council: Date approved by Council:
Description of SERVICES
'R".,.,.,.v",- 4- ~),.e.l'\ll.<-<' roO ~ ",~~".o, , ~"-$I-;"'S...A-c.. 0'"
YIM.LI\ os.\-.-col'Y' kc.; \,'~
Item # Quantity Unit Description of MATERIALS
Total Cost
$
cb
'4,'79'1-
Unit Price
Total Cost
[j Per attached QUOTE
TOTAL COST
$
Project Number ____~_. ___
Account Number ~11. L-2:. {!~ Pk.k.{!i!,lLe Account Number
- . . .
--- -- -- -- ------
Account Number ___' __' __' __' ______ Account Number _~_' __' __' __ - ______
'Expend"ure must be charged to the appropriate account numbers for the financials to reflect the ectual expenditures accurately. Attach extra pages if needed.
By signing this requisffion fOI11l, I cerrify that the infol11lation provided above meets the City's public contracting requirements, and the documentation can be provided
upon request. ~ 0 ~
Employee Signature: ~ Department Head Signature: d.I.
Additional signatures (if applicable):
Funds appropriated for current fiscal year: @/ NO
#~
Finance DIrector
Date
Comments:
G: Finance\Procedure\AP\Forms\Form_3_ -_ReQuisition[1 ).doc
Updated on: 5/1712011