HomeMy WebLinkAbout2012-022 Contract - Rogue Valley Heating & Air Contract for GOODS AND SERVICES Less than $25,000
CITY OF CONTRACTOR: Rogue Valley Heating
ASHLAND CONTACT: Eric Armstrong
20 East Main Street
Ashland, Oregon 97520 ADDRESS: 2820 Foothill Blvd, Grants Pass, OR 97526
Telephone: 5411488-6002
Fax: 5411488-5311 TELEPHONE: 541-476-3211
DATE AGREEMENT PREPARED:January 25,20V FAX: 541-779-8333
BEGINNING DATE: January 31 2012 COMPLETION DATE: March 22, 2012
COMPENSATION: $7,226.00—Per proposal attached as Exhibit C.
GOODS AND SERVICES TO BE PROVIDED: Contractor to provide and install HVAC system per plans and
proposal attached as Exhibit C. Location: Mountain View Cemetery
ADDITIONAL TERMS:
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. 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, 279U30, 2796.235, 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$18,890 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 8 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. City's 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. 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
Contract for Goods and Services Less than$25,000,Revised 06/3012011, Page 1 of 6
sufficient to allow for the purchase of the indicated quantity of services;
it. 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
M. 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.
!it. 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. Obligation/Liability 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.110 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 QRF status pursuant to
the QRF Rules or loses any license, certificate or certification that is required to perform the work or to qualify as a
QRF if Contractor has qualified as a QRF 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 Liability 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 Liability 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 chance. 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 insurers to
Contract for Goods and Services Less than$25,000, Revised 06/30/2011, Page 2 of 5
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 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 clalm 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 Council or 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 incorp led by
reference.
Contractor, _ — City of AShia
By
Signature
QNam / riot Na e
Title I D e
W-9 One copy of a W-9 is to be submitted with
the signed contract. Purchase Order No.
Contract for Goods and Services Less than$25,000,Revised 06/30/2011, Page 3 of 5
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 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) 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
criteria:
_ (1) 1 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.
X (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) 1 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.
L4 Wt A
Cc actor (Date)
Contract for Goods and Services Less than$25,000,Revised 06/3012011,Page 4 of 6
OGLE F VAC BID-PROPOSAL
ZWO LLEY �-
Heating&Air Conditioning
2820 Foothill Blvd.Grants Pass,OR 97526 turn to the experts/"
541-476-3211,541-779-8333
Fax 541-476-2964 CCB 114839 DATE PROPOSAL NO.
)A .mouevallevheat-air.com 1/31/2012 COA003
OWNE.MBRNAME OWNER'b
City of Ashland Attn: Dale Peters 20 E. Main Street
OWNER'S CITY,STATE B POSTAL CODE OWNERS HOME PHONE OWNER'S WORN PHONE
Ashland OR 97520 541-552-2292
PROJECT NAME PROJECTADORESS
Temporary Fire Quarters 440 Normal Street
PROJECT CITY.STATE B POSTAL CODE PROJECTPHONE FM
Ashland OR 97520
CONSTRUCTION TO BEGIN CONTRACT COMPLETION DATE DATE OF PLANS ESTIMATOR
12120/11 Eric
We hereby propose to furnish the following work:
Install one complete Panasonic 2 ton duct free heat pump system to serve temporary fire quarters.System to consist of
outdoor section and 3 high wall indoor sections. One in 9,000 BTU indoor to be installed in Office,one 12,000 BTU indoor
to be mounted in the living area,one 12,000 BTU indoor to be delivered to customer for use in future sleeping area(future
installation labor not included). Includes refrigerant piping,condensate pumps and pad for outdoor section
Unit is rated 18 SEER and 8.5 HSPF.
Electrical to be supplied by others.
Note:Access holes and carpentry work will be performed by others.
PROPOSED PAYMENT:Owner agrees to pay Contractor a PROPOSED total cash price of$ 7 22600 Dollars.
OWNER represents that this agreement is a cash transaction wherein no financing is contemplated and contractor acts in reliance.on said
representation.
THE PAYMENT SCHEDULE WILL BE AS FOLLOWS-
1.Down payment of$ 2.Payment schedule as follows:
Due Lue in full upon completion
Express Limited Warranty One Year Parts and Labor Compressor Warranty Five Years Part Only
Manufacture's Parts Warranty Five Years
NOTE:This proposal may be withdrawn by us if not accepted within 30 days.
ACCEPTANCE OF PROPOSAL
You are hereby authorized to accomplish the work described in the above proposal,for which the undersigned agrees to pay the amount
staled in said proposal and according to the terms thereof. Customer acknowledges receiving: Consumer Protection Notice, Notice of
Procedure an Info rnation Not a to Owner about Construction Liens
com oe/Sel IPywr. Dale OPRIIBUycr AUNO+aeo SlRnelmn Odle
ew:Vaaursellw slpne+ore D.I. ownens.,r AUNOnmo SI,r.W,v Cale
C:ab'-fl+O6rereFOP4Smn WV+64V.0 tVbPropa4
01/31/2012 15:21 5414762964 ROGUE VALLEY HEAT AP PAGE 03/04
A CERTIFICATE OF LIABILITY INSURANCE DArE(M""D°"""'
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: N the certificate h0de,Is Nn ADGTIONAL INSURED,"Peliey(NS)must be andoraad. If SUBROCATION IS WAIVED,subject to
the terms and conditions of the policy.certain policies may require an Endorsement A Statement on this corlMTate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER Beecher Carlson Insurance Agency,LLC OONYAGrmE1EUG18ue.Noskes,.-
59 East 11th Avenue PNONE(A,-r.-ESq�Sa— DQB Ifaz JAM.NO): 541.284,3196
Eugene, OR 97401
EuAAn AoonRgB;_syle.0.gakR5@beechel3si Asan.corn
INSURMRISI AFFORDING COVERAGE —, NAIC0
wwW:bcOChercatlson.LOm -- - --
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RC ue Valley Heating S Air Conditioning, Inc. NpuREn e:.__
20?0 Foothill Blvd. INSURER 01 --
Grants Pass OR 97526 INSURER O: ....
INBURen E: ....
WsuREA F: .. .... --.— .__
COVERAGES CERTIFICATE NUMBER: 111 g2gee 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 VVHICH 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 'ryyg OFNSURANee LM:Y QP ... .._
LTR POLM:YNLPANR YMIDDIWW LIMITS
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PERSONAL S ADV IN JURY_ 3 _
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LOYEE 3 DESCRIPTION OF OPERATIONS bIaw E.L aIBE LIMIT 3 10 ODOR
DESCRIPTION OF WERATIONS I—L0?;W3M-1%'W'3M3 IAO.: ACORD 101,AddIIlonim Remarin 9eNa0.�N,F mom s,,Im is mquInUp
CeRKCate holder Included as additional Insured as resparts general*ability where MgUiMd by wri0en Contract. This form is subject to policy
la"s,conolpons.and exclusions.
CERTIFICATE HOLDER_ 9AAKELLATION
SHOULD ANY OF THE ABOVE DESCRIBED pOLIctES BE CANCELLED BEFORE
City of Ashland THE EMRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
90 N Mountain Ave. ACCORDANCE WITH THE POLICY k6VISIONS.
Ashland OR 97520
AUTHORIRD REPRESENTATIn
EUG Sue Noakes
01988-2010 ACORD CORPORATION. All rights Reserved.
ACORD 25(2010105) The ACORD name and logo are registered marks or ACORD
VEP.T PO.: 133e29Ga IsUn) ..0 N IkCC 9/2213011 11:311:02 AN e99c 1 03 1
01/31/2012 15:21 5414762964 ROGUE VALLEY HEAT AP PAGE 02/04
A°R�' CERTIFICATE OF LIABILITY INSURANCE DATE(MMADD YYVY)
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 INSURERIS), AUTHORIZED
REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER
IMPORTANT: If the eerUfrcate holder ls an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION M WAIVED,subpd to
the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certifleate does not confer rights to the
certificate holder in aeu of such endorsement(s).
PRODUCER Beecher Carlson Insurance Agency, LLC CONTACT NAMe EUG Sue Noakes
59 East 11th Avenue _P wOmEfpiq,tNjSor S41_264-3096 fIAIC,Nol: 541.284.3196
Eugene, OR 97401 E-MIL ADMI , sue.noekes@beechprcoNson,com
INSURFRt31 AFFORDING COVERAGE NAICA _
www.beecharcadwn.com INSURERA: American Hallmark Ina Co,of Texas 43494
INSURED INSURER e:
Rogue Valley Heating&Air Conditioning, Inc. - ° -°------ ----
2620 Foothill Blvd. INSURER O:
Grants Pass OR 97526 INSUFI _
INSURERS:
NSURERFt
COVERAGES CERTIFICATE NUMBER: ituly 54 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.
Wall TYPE 6VSURANCE ��` POLICYEFF POLICY EIP
LTR POLICY NUMBER M M LIMITS
A OIHERALLIABILITr 44CL465175 711/2011 71112012
✓ EACH OCCURRENCE f 1,000,000
EpMOCOMMERC4ILGENERALUABRnY EA Oce
Is 100.000
CLAIMS.MAOE n OCCUR MED—E XP anc Pvmnl__ S 5,000
PERSONAL f ACV INJURY f I,IM0,000
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GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIDPAGG S 2.000,000
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A AUTOMOBILE LIABILITY 44CL455175 7/112011 7-1/2012 I€niryaydnnia L°'- ' f 1000000
✓ ANY AUTO BODILY INJURY(Per penim)
ALL OWNED SCHEDULED . ._.._.._ ......_._ ...f... . ..... __ ....
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✓ HIRED AUTOS ✓ Atn06 HED OFERb AMnGe f
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ANY EMPLOY91a'LJABILITY Yip I TORYLIM 73
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OFFiCER/MBM6eR a%CLUDeO! � — ....._ $.
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0111_SCRIPTO OPGRATI6018 ILOCATION 1 1-0 Es[AI h A.I.A anaAO pedalo,U PCT NSA N r9qukFd)
Certificate holder included ee additional insured as respects general liability where required by written contract, This form is Subject to policy
leans,conditions,and exclusion.
-CERIIFICATE HOLDEg CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CAROM I W BEFORE
City of Ashland THE 0PIRATION DATE THEREOF, NOTICE WILL BE DELWERfiD IN
90 N Mountain Ave. ACCORDANCE WITH THE POLICY PROVISIONS.
Ashland OR 97520
AUTHORIZED REPRESENTATIVE
a�
EUG Sue Noakes
®1968,2010 ACORD CORPORATION. All rights reserved,
ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD
'19l'I NO., 10+60431 IVA, Sut Basktu 6/221,1011 6:59:55 Art Papn 1 At 6
Page 1 / 1
ASHLAND OFRI RECOeFOE
�. ASH LAND �s DATE �':.PO NUMBER':-'
20 E MAIN ST. 2/13/2012 10675
ASHLAND, OR 97520
(541)488-5300
VENDOR: 001239 SNIP TO: Ashland Building Maintenance
ROGUE VALLEY HEATING &AIR (541)488-5358
2820 FOOTHILL BLVD 90 N MOUNTAIN AVENUE
GRANTS PASS, OR 97526 ASHLAND, OR 97520
FOB Point: Req.No.:
Terms: Net Dept.:
Req.Del.Date: Contact: Dale Peters
Special Inst: Confirming? No
'`Quariti
unit" Description :'.'Unit'Ptice , Ezt.Price.:.. .
HVAC System -Temporary Fire Station#2 7,226.00
Per attached proposal and contract
Contract for Goods and Services
Beginning date: January 31, 2012
Completion date: March 22, 2012
Insurance required/On file
i
SUBTOTAL 7,226.00
BILL TO:Account Payable TAX 1 0.00
20 EAST MAIN ST FREIGHT 1 0.00
541-552-2028 TOTALI 7,226.00
ASHLAND, OR 97520
Accourif Number Project'Number � � _ �. ��.°Amount Account Number Projec[Number - Amount
E 410.08.24.00.70420 E 000278.120 7,226.00
AutFrorized Signature VENDOR COPY -
FORM #3 CITY OF
A s"r?t:'i.;?�i ASHLAND
REQUISITION Date of request: ZSJvrN
Required date for delivery: 4E �e
Vendor Name Z°gtiG V���c� ����• g
Address,City,State,Zip
Contact Name&Telephone Number GrZ wf tqb S , IZ S 2
Fax Number
S'V ( 4 'g-033 rZ.
SOLICITATION PROCESS
❑ Exempt from Competitive Bidding ❑ Emergency
❑ Written Findings(Form attached) ❑ Invitation to Bid (Copies on file) ❑ Written findings attached
1Y Quote or Proposal attached Date approved by Council: ❑ Quote or Proposal attached
❑ Small Procurement Cooperative Procurement
Less than$5.000 ❑ Request for Proposal (Copies on f le) ❑ State of Oregon
Note:Total contract amount,including any Dale approved by Council: Contract#
amendments may not exceed$6,000 ❑ Stale of Washington
Intermediate Procurement ❑ Sole Source Contract#
GOODS&SERVICES ❑ Written Findings(Form attached) ❑ Other government agency contract
5 000 to 100 000 El Quote or Proposal attached Agency
(3)Wntten quotes attached Contract#
PERSONAL SERVICES F1 Special Procurement ❑ intergovernmental Agreement
$5.000 to$75,000 ❑ Written Findings(Form attached) Agency
❑ Less than$35,000,by direct appointment ❑ Quote or Proposal attached Contract#
❑ (3)Written proposals attached Date approved by Council: Date approved by Council:
Description of SERVICES v 1 Total Cost
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wwta ��s $ C2� I Co
Item # Quantity Unit Description of MATERIALS Unit Price Total Cost
TOTAL COST
❑ Per attached QUOTE $
ProjectNumber_Z �-12U AccountNumber��� 6� 2' .E10.'4ZODAccountNumber___-__-__- .
Account Number _ _ Account Number_ _ _
'Expenditure must be charged to the appropriate account numbers for the financials to reflect the actual expenditures accurately. Attach extra pages if needed.
By signing this requisition form,l certify that the information provided above meets the City's public contracting requirements,and the documentation can be provided
upon request.
Employee Signature: Department Head Signature: C ESL
Additional signatures(if applicable):
i
Funds appropriated for current fiscal year. ty—a / NO
Finance Director Date
Comments:
G FinancelProcedureVAPTormslForm#3-Requisition.doc Updated on:1/26/2012