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HomeMy WebLinkAbout2012-052 Contract - Belfor Environmental Contract for GOODS AND SERVICES Less than $25,000 C I t Y OF CONTRACTOR: Belfor Environmental -AS H LA N D CONTACT: Ray Greb, Sid Pacheco 20 East Main Street Ashland, Oregon 97520 ADDRESS: 449 Pech Road, Central Point, OR 97502 Telephone: 541/488-6002 Fax: 5411488-5311 TELEPHONE: 541-665-5201, 541-664-5454 DATE AGREEMENT PREPARED: 03/15/2012 FAX: 541-665-5203 BEGINNING DATE: April 1, 2012 COMPLETION DATE: May 30, 2012 COMPENSATION: $2,367.00 per proposal attached as Exhibit C GOODS AND SERVICES TO BE PROVIDED: Abatement of approximately 168 sq ft of asbestos texture and joint compound and approximately 58 sq ft of gray roofing sealant. Price includes DEQ permit/notificatioh, equipment, materials, labor and disposal. Third party air clearance to be provided by owner. Includes BOLI prevailing wage. Per proposal attached as Exhibit C. ADDITIONAL TERMS: This contract is subject to BOLT prevailing wage. 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 279B.220, 279B.225, 279B.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$18,890 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 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. 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 Contract for Goods and Services Less than$25,000, Revised 06/30/2011, Page 1 of 5 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. 1. 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. 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. Contract for Goods and Services Less than$25,000, Revised 06/30/2011,Page 2 of 5 d. . Notice of cancellation or change. There shall be no cancellation, material change, reduction of limits or intent not to renew the insurance coverage(s)without 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 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 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 incorporated by reference. Contractor: City of Ashland By By Signature Departmen Head G" T N N VA-4., s c Print Name Print Name �forc T VI ""Linn 3 —I 14 Title Date 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 06/3012011, 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. (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. 3 --a lZ Contractor (Date) Contract for Goods and Services Less than$25,000,Revised 06130/2011, Page 4 of 5 BELFOR 0) ENVIRONMENTAL CCB# 126132 REVISED PROPOSAL DEQ#FSC718 449 Pech Road Central Point, OR 97502 (541) 665-5201 FAX: (541) 665-5203 Proposal Submitted To: Phone Fax Date Ashland Fire and Rescue 541-552-2216 541488-5318 3-14-12 Street 455 Siskiyou Blvd Attn:John Kams City, State,and Zip Code Ashland,OR 97520 Job Location Ashland Fire Station#2, 1860 Ashland St. Architect Date of Plans Job Phone W/&gzapa8whereby to furnish material and labor—complete in accordance with specifications below, for the sum of: $2,367.00 Payment to be made as follows: Upon Completion All materials are guaranteed to be as specified. All work to be completed in a workmanlike Manner according to standard practices. Any alteration or deviation from specifications Authorized Below involving extra costs will be executed only upon written orders and will become a Signature: Extra charge over and above the estimate. All agreements contingent upon strikes,accidents Or delays beyond our control. Owner to carry fire,tomado,and other necessary Insurance. Our workers are fully covered by Workmen's Compensation Insurance. We hereby submit specifications and estimates for: Abatement of approx. 168 sq It of asbestos texture and joint compound and approx. 58 sq It of gray roofing sealant. Price includes DEQ notification/permit,equipment,materials,and disposal. Third party air clearance to be provided by the owner. Belfor acknowledges this as a prevailing wage project. ----------------------------------------------------------—--------------------------------------------------------------------------—---------- ---------------------=------------—----------------------------------—------—-------------------------------------------—------——-------—-- Mcceizt 4 9ropasat-The above prices,specifications, And conditions are satisfactory and are hereby accepted. You are Signature 4MA4 Authorized to do the work as specified. Payment will be made as Outlined above. Signature Date of acceptance: DATE(MMIO.r-) CERTIFICATE OF LIABILITY INSURANCE Da,42D,2 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT:If the certificate holder Is an ADDITIONAL INSURED,the policy(les)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 this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 9 Aon Risk Services Central, Inc. NE (866) 283-]122 FAX (847) 953-5390 `m Southfield mT office I=ft Ea: AIC.NO.: v 3000 Town Center Ex Suite 3000 ADDRESS: 2 Southfield MI 48075 USA INSURER(S)AFFORDING COVERAGE NAIC0 INSURED INSURER A: National Union Fire Ins CO Of Pittsburgh 19445 Belfor Environmental, Inc. INSURERS: 449 Pech Road Central Point OR 97502 USA NSURER c: nNSURER o: NSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:570045550764 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. Limits shown are as requested LTR TYPE OF NSURANCE INSR MAID PMICY NUNSER MRS GENERAL UABelrY GL EACH OCCURRENCE 51,000,000 X COMMERCIAL GENERAL LABILITY SIR applies per policy terns & Condl ions $1,000,000 PREMISES Ea 000arence CLUMS4.IADE X occuR MED EXP(An one person) $100.000 PERSONAL&ADV WARY 51,000,000 GENERAL AGGREGATE $2,000,000 N GENt AGGREGA IIMIr APPLIES PER PRODUCTS-COM AGO $2,000,000 POLICY '71E PRO X LOC °o n A AUTOe00eELJASBI7Y CA - -2 0410112011 COMBINED SINGLE UnQ S1,000,O0O H X ANYAUIO BODILYIWURY(Perperspn) 0 ALL OWNED nx SCHEDULED BODILY1WURY(Rvr enl) AIRED NON4)WNED PROPERTY DAMAGE U AUTOS 2 X HIRED AUTOS AUTOS Peramtlenl X GnlpOtl$I.= W,DM si.m _V m A % IaIBRCII•NAB X OCCUR 9788925 04/01/201104/01/2012 EgCH OCCURRENCE 55,000,000 V EXCESS LAB CLUMS#ADE AGGREGATE $5,000,000 DED RETENOON • WORKERS COIaENSATION AND WCO 35379 04/01/2011 04 O1 1 X WC STATLL OTH- EIO'LDYEP5LNB61rY YIN OR TORY LIMBS ER ANY PROPRIETOR/PARrNERIEKECUIWE E.L.EACH ACGDENT S1,000,005 • OHICETLMEMBER IXQUOED7 N NIA wCO20635377 04/01/2011 04/01/2012 pkind"m MIq ADS E.L.MSEASEFAE OYEE 51,000,000 DrRIPTIONOFOPERATIONS� E.L.OISEASZ4 CY LIMB $1,000,000 DESCWPIION OF OPERATIDNS I LOCATXXNS I VFJYCLES IAffic11 ALORD 101,ABSitlonal ReTmM1A Sena4e4,H mwa epw Y ngWrM) RE: Asbestos Abatement. Ashland Fire & Rescue is included as additional insured with respect to general liability where required by written contract. See attached Endts. t. CERTIFICATE HOLDER CANCELLATION _ SHOULD ANY OF THE ABOVE DESCRIBED PoLIOIBS RE CANCELLED BEFORE TIC EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED N ACCORDANCE WRN THE POLICY PROVISIONS Ashland Fire & Rescue AUTHORED REPRESENTATAfE Attn: Kimberly 455 OR Blvd. 4Ashland OR 97520 USA 01988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: GL 487-08-86 COMMERCIAL GENERAL LIABILITY CG 2010 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(a): Locations Of Covered Operations WHERE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional exclu- organization(s) shown in the Schedule, but only sions apply: with respect to liability for "bodily injury", "property This insurance does not apply to "bodily injury" or damage" or "personal and advertising injury° "property damage"occurring after: caused, in whole or in part, by: 1. All work, including materials, parts or equip- 1. Your acts or omissions; or ment furnished in connection with such work, 2. The acts or omissions of those acting on your on the project (other than service, maintenance behalf; or repairs) to be performed by or on behalf of in the performance of your ongoing operations for the additional insured(s) at the location of the the additional insured(s) at the location(s) desig- covered operations has been completed; or nated above. 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or Subcontractor engaged in performing operations for a princi- pal as a part of the same project. CG 20 10 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 0 POLICY NUMBER: GL 487-08.86 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Location And Description Of Completed Opera- Or Or anizatlon s : tions WHERE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT Information required to complete this Schedule, if not shown above will be shown in the Declarations. Section 11 — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the "products- completed operations hazard". CG 20 37 07 04 ©ISO Properties, Inc., 2004 Page 1 of t O FULL SCALE ASBESTOS ABATEMENT CONTRACTOR LICENSE Department of Environmental Quality 1550 N.W. Eastman Parkway, Suite 290 Gresham, OR 97030 Telephone: (503) 667-8414 ext. 55022 Issued in Accordance with the Provisions of ORS 468A.710 ISSUED TO: LICENSE NUMBER: BELFOR ENVIRONMENTAL INC FSC718 12821 NE AIRPORT WAY PORTLAND OR 97230 EXPIRATION DATE: JANUARY 1, 2013 INFORMATION RELIED UPON: Asbestos Abatement Contractor License Application submitted November 21, 2011 ISSUED BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY David Monro Air Quality Manager Date Northwest Region/Gresham Office The contractor named above is herewith authorized to conduct asbestos abatement in the State of Oregon subject to the terms and conditions of Oregon Administrative Rules (OAR) Chapter 340 Division 248, including the conditions listed below. 1. The contractor shall ensure that each worker performs asbestos abatement work in compliance with OAR 340-248-0010 through 340-248-0290 and other applicable state and federal asbestos abatement regulations. regon Construction Contractors Board www.oreQon.eov/ccb John A. K¢zhaber,MD, Governor Mailing Address: PO Box 14140 Salem,OR 97309-5052 Street Address: 700 Summer St NE Suite 300 503-3784621 FAX 503-373-2007 CCB LICENSE DETAIL REPORT Oregon Relay 7-1-1 LICENSE: 126132 GENERAL INFORMATION BELFOR ENVIRONMENTAL INC LICENSE STATUS: Active 12821 NE AIRPORT WAY FIRST LICENSED: 11/12/1997 PORTLAND OR 97230 LICENSE EXPIRES: 11/12/2013 503-408-7404 ENTITY: Corporation IND. CONT. STATUS: Nonexempt ENDORSEMENTS ADDITIONAL CERTIFICATES/LICENSES COMMERCIAL: CGC1 -General Contractor 1 CERTIFIED HOME INSPECTOR: NO RESIDENTIAL: RGC-General Contractor LICENSED LEAD BASED PAINT: NO ASSOCIATED NAMES JOE CIOLINO, Corporate Officer SHELDON YELLEN, Corporate Officer RESIDENTIAL BOND INFORMATION COMPANY: HARTFORD FIRE INS CO AMOUNT $ 20,000 EFFECTIVE TO: 11/12/2013 COMMERCIAL BOND INFORMATION COMPANY: HARTFORD FIRE INS CO AMOUNT: $ 75,000 EFFECTIVE TO: 11/12/2013 INSURANCE INFORMATION COMPANY: NATIONAL UNION FIRE INS CO OF PITTSBURG OCCURANCE/AGGREGATE AMOUNT: $1,000,000/$2,000,000 CANCELLATION DATE: 04/01/2012 OTHER LICENSE NUMBERS 93876 124137 126121 126132 146044 146973 This report was generated by the CCB on: November 15, 2011, 10:20 am Avr• 13. 2012 10:45AM Ashland Fire Rescule No, 1022 P. 1 7 -7 5 -� CERTIFICATE OF LIABILITY INSURANCE DATEmMW012 l THIS CERTIFICATE 13 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 e MPORTAN I! If me cerUheate holtler is an ADDiTlQNAL INSURED,the po oy(ies)must be endorsed.If SUBROGATION 3 WAIVED, Sub act to the terms and conditions of the policy,certain policies may require an endorsement,A statement an this certificate does not confer rights to the d ceRlOcate holder in lieu of such endorsement(s). PRODUCER OmmAcT Aon Risk Services Central, Inc. (a6h) 2a3-7122 P (SO) 9$3-5390 Southfield NI office AIG NU EOn A/CNe.: 3000 Town center PIIeLL o Suite 3000 ADDRESS: x Southfield MI 48075 USA INSURERISI AFfORINN6 COVfiRAOfi NAlCR wSORED INSURERA: National Union Fire Ins Co of Pittsburgh 19445 selfor Env1r0nm8htal. Inc. wouRERa Insurance Company of the State of PA 19429 449 Pech Road central Point OR 97502 USA weurmaQ DR:UREA M INSURER E: INeUREq P; COVERAGES CERTIFICATE NUMBER:570045806922 REVISION NUMBER; THIS IS TO CERTIFY THAT THE POUCIES 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. Limits ahovm are ae re ueated 7R TTPEK INSURANCE POLICYNUMEPn UNwe aeNERUU.entry GL EACH aCCIIanENCE 51,000,000 SIR applies per policy term & condi :ions 31,000,000 % eofAAERC1Al GEId:RAL 11APol11Y PREN aES Ea ouanena cuMle.woE orcuR NPL E%P(Aryl arse Neon) $100,000 PERSONAL&WVIWUiY $1,000,000 ¢, GENERALAGGREGATf $2.000.000 yl GEM.AGGREGATE IEAT APPL�s PER PROOLIOIs•COMPIOP AGO 12,00D,000 P= K MIL K Lac CA - - AUTOMOBILE--am IY COMBINEDSINOtI!UMIT 51,000,000 d. k <N+'AUro BOMLYIWURY(PN person) _ x AU.OHTED x "AuiLDD6 U LE GPOeNr wLY d MaenUl RY(Pere adeN) AU curo D HIRED AUr06 NOWNED PROPERTY WOE L a •t, % Cary Dl4 n.mn A top pee ft,00n L w Y UmaReLla We x OcDVR 23102109 04/01/2012 O4 01/2013 EAni OCCURRENCE 15,000,000 U excIRM LM tUWe•WGE AGGREGATE 35,000,000 DED I er frnoN e WORAERS COMPENSATION ANO WCO21417814 04707176-12 04 01 2013 X OTOT�LP9T8 Ea ENPLOYEAg'LmBlltt Mf/IMPWeIORrPwmERI EN!1:1111VE YIN E.L FACH AedDP1R 31.000,000 QF IGORMBISEMExCt1AED1 N NIA 11yyaaee�� E.L p6EAS6EA EMPLOYEE 51,000,000 IOLSCRI�T AI OP OPERATom hepw E.L OIBEA6EPOLICT LPwr 11,000,000_ OESCRIPTbN or OPEw1bNa I LDeATloae r vErpdEe PeeM ACORO 101,A4Rllenel RemeMa 9cNedefe,if more ewoe tr maaUed) tee RE: Asbestos Abatement. Ashland Fire & Rescue is included as additional insured with respect to general liability where a� required by written.contract. See attached Endts. ��•" v?ITY RECORDER Sin CERTIFICATE HOLDER CANCELLATION 6HoULO ANr oP r,m ABOVE DESCRIBED PWQES BE CM1CeU-ED BEFORE THE eKPIMVON V&7 THEREOF, NOTICE V BE PELNERED IN ACCORDANCE HIM THE POl1G1'PRalgalONa. Ashland Fire & Rescue nuiHGRVFn REpRE9EMA7PrE Attn: Kimberly Ass ou Blvd. Ashlanand d OR OR 97520 USA (Y/ �YioA 01980.2010 ACORD CORPORATION.All rights reserved. ACORD 26(2010106) The ACORD name and logo are registered marks of ACORD • I Apr. 13. 2012 10:46AM Ashland Fire Rescue No. 1022 P. 3 �tf - POLICY NUMBER: GL 696-65-77 COMMERCIAL GENERAL LIABIL" CO 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Addilional Insured Person(s) Location And Description Of Completed Opera- Or Or anizaiion s : Ilona WHERE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT Information required to complete this Schedule,if not shown above,will be shown In the Declarations_ Section II — Who Is An Insured Is amended to include as an additional Insured the person($) or organizations) shown in the Schedule, but only with respect to liability for "bodlly Injury" or "properly damage"caused. in whole or in part, by"your work" at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the "products- completed operations hazard`, CG 20 37 07 04 ®ISO Properties, Inc.,2004 Page f of 1 ❑ Apr. 13. 2012 10:45AM Ashland Fire Rescue No. 1022 P. 2 POLICY NUMBER:GL 698-95-77 COMMERCIAL GENERAL LIABILITY CG 2010 07 04 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHE13ULE Name Of Additional Insured Parson(s) Or Or anization s : Locations Of Covered Operations WHERE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT Information required to complete this Schedule If not shown above will be shown In the Declaralions. A. Section It = Who is An Insured is amended to B. With respect to the insurance afforded to these Include as an additional Insured the person(s) or additional insureds, the following additional exclu- organizallon(s) shown In the Schedule, but only sions apply: with respect to liability for "bodily Injury', "property This Insurance does not apply to "bodily injury' or damage or personal and advertising injury" "property damage'occurring after. caused, in whole or in part,by: 1. Your acts or omissions;or 1. All work, including materials, parts equtp- mentfurnished in connection with such work, 2. The acts or omissions of those acting on your on the project(other than service,maintenance behalf; or repairs) to be performed by or on behalf of in the performance of your ongoing operations for the additional Insured(s) at the location of the the addlllonal Insured(s) at the location(s) desig- covered operations has been completed;or nated above. 2. That portion of 'youf work" out of which the Injury or damage arises has been put to its In- tended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a princl- pal as a part of the some project. CG 20 10 07 04 0 ISO Properties,,Inc.,2004 Page 1 of 1 ❑ CITY RECORDER Page 1 /1 CI.TY OF �. ASHLAND DATE > - PO NUMBER ,� 20 E MAIN ST. 3/27/2012 10775 ASHLAND, OR 97520 (541)488-5300 VENDOR: 016817 SHIP TO: Ashland Fire Department BELFOR ENVIRONMENTAL (541) 482-2770 449 PECH ROAD 455 SISKIYOU BLVD CENTRAL POINT, OR 97502 ASHLAND, OR 97520 FOB Point: - Req.No.: " Terms: Net Dept.: " Req.Del.Date: Contact: Greg Case - Kimberley Summers Special Inst: Confirming? No :,QUanti .::.Unit ;.: ., Description v- .< ` . " -Unit Price E xt..price.':. Disposal of asbestos material, includesr 2,367.00 material, labor, equipment, transport and disposal, and DEQ Permit Fee. Subject to BOLI Previaling Wage. Location: Ashland Fire Station#2 Per attached contract and proposal Contract for Goods and Services Beginning date: April 1, 2012 Completion date: May 30, 2012 Insurance required/On file SUBTOTAL 2,367.00 TILL TO:Account Payable TAX 0.00 20 EAST MAIN ST FREIGHT 0.00 541-552-2028 TOTAL 2,367.00 ASHLAND, OR 97520. Account Number'. I ProJect Number. Amount Account Number Project Number:• -Amount 410.08.24.00.70420 E 000175.999 2,367.00 n 3 ZT/Zo/L thorized"Signature VENDOR COPY VORM #3 CITY OF A; tG' CFci for ^ GOi Gei ASHLAND REQUISITION Date of request: Pffl Required date for delivery: Vendor Name Address,City,State,Zip 4A 11 � Ck 0 9 f7 50Z Contact Name&Telephone Number �41 _ lc(o ci _cv 2 Fax Number 5�y _In(015 - 6 q6'3 . SOURCING METHOD ❑ Exempt from Competitive Bidding ❑ Emeroencv ❑ Reason for exemption: ❑ Invitation to Bid (Copies on Ole) ❑ Written findings attached ❑ AMC 2.50 Date approved by Council: ❑ Written quote or proposal attached Written quote or pro sal attached ❑ Small Procurement Cooperative Procurement Less than$5,000 ❑ Request for Proposal (Copies on file) ❑ State of Oregon ❑ Direct Award Date approved by Council: Contract# JK Verbal/Written quote(s)or proposal(s) ❑ State of Washington Intermediate Procurement ❑ Sole Source Contract# GOODS&SERVICES ❑ Written Findings(Form attached) ❑ Other government agency contract . $5.000 to$100.000 ❑ Written guote or proposal attached Agency M (3)Written quotes attached ❑ Special Procurement Contract# PERSONAL SERVICES ❑ Written Findings(Form #9 attached) Intergovernmental Agreement $5.000 to$75.000 ❑ Written quote or proposal attached ❑ Agency ❑ Less than$35,000,by direct appointment Date approved by Council: Date original contract approved by Council: [1 (3)Written proposals attached Valid until: (Date) (Date) Description of SERVICES Total Cost t�CtfQVf Ct �dPa � �(�t'�,"' `�` �( $ item # Quantity Unit Description of MATERIALS -- Unit Price Total Cost TOTAL COST ❑ Per attache dquotelproposal v $ 2 6700 Project Number( 00-i`75pg� Account Number910 • z n Account Number------------------- Account Number------------------- *Expenditure must be charged to the appropriate account numbers for the financials to accurately reflect the actual expenditures. IT Director in collaboration with department to approve all hardware and software purchases: ITDirector Date Support-Yes/No By signing is requisition form,I certify that the City's public contracting requirements have been satisfie Employee Signature: '��'ti �r Department Head Signature: It , �� (Equa oor greaterthan 55,000) Additional signatures(if applicable) A Q Funds appropriated for current fiscal year. YES NO 7 Finance Director-(Equal to orgre han S5,000) Date Comments: Form#3-Requisition