HomeMy WebLinkAbout2012-068 Contract - SOS Plumbing Contract for GOODS AND SERVICES Less than $25,000
CITY OF CONTRACTOR: S.O.S Plumbing Inc.
ASHLAND CONTACT: Scott Turrell
20 East Main Street
Ashland, Oregon 97520 ADDRESS: 206 S. Pacific Hwy, Talent, OR 97540
Telephone: 541/488-6002
Fax: 541/488-5311 TELEPHONE: 541-488-2680
DATE AGREEMENT PREPARED: April 4, 2012 FAX: 541-535-3964
BEGINNING DATE: April 9, 2012 COMPLETION DATE: April 24, 2012
COMPENSATION: $9,850.00 per proposal attached as Exhibit C.
GOODS AND SERVICES TO BE PROVIDED: Contractor to excavate and install PVC conduits and vaults per
City of Ashland drawings and specifications attached as Exhibit D. All required work permits, materials and
labor to be provided by contractor.
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 27913.220, 27913.225, 27913.230, 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 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
conditions:
Contract for Goods and Services Less than$25,000, Revised 06/30/2011, Page 1 of 5
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. 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 change. There shall be no cancellation, material change, reduction of limits or
Contract for Goods and Services Less than$25,000, Revised 06/30/2011, Page 2 of 5
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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: l City of Ashland
Signature Department Head
/SON 1), A ek;s Gi<'E Tun/•F..9��26
Print Name Print Name
Title Date
W-9 One copy of a W-9 is to be submitted with /6-9g /1
the signed contract. Purchase Order No. l �J
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.
✓ (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.
/
Contractor (Date)
Contract for Goods and Services Less than$25,000, Revised 06/30/2011, Page 4 of 5
Proposal
S.O.S. plumbing Inc. March 29,2012
206 S. Pacific Hwy.
Talent, Or 97540 Reference#J 1321-47938
541779-3472 641488-2680 Fax 541-535-3964 Due Date_ 4/28/2012
'Job Name:...;
City of Ashland Electric Dept.-1963 Mae Street
20 E Main Eledtric Dept.-1963 Mae Street
Ashland,OR 97520 Ashland
541-488-5345 541-488-6006
We Hereby Submit Specifications And Estimates For:
This proposal is for an excavation project located at 1963 Mae Street
for the City of Ashland Electric Department.
The scope of work was described in a four page document supplied
by the Electric Department at the mandatory pre-bid jobsite
inspection on March 27, 2012 . The document included a request for
quotation, a project map and two pages of vault details.
The project involves the installation of one new concrete transformer
vault, the installation of roughly 465 ' of 3" Schedule 40 electrical
conduit, and the excavation and backfill of one splice pit to
intercept an existing 3" PVC conduit.
As required in the Scope of Services, all required work permits,
materials and labor are included in this proposal.
We propose hereby to furnish material and labor-complete in accordance with the above specifications,for the
sum of: $9,850.00
All material Is guaranteed to be as specified. All work to be completed in a professional manner according to standard practices. Any alteration or
deviation from above specifications involving extra costs will be executed only upon written orders and will become an extra charge over and above
the estimate. All agreements contingent upon delays beyond our control. Purchaser agrees to pay all costs of collection,including attorney's fees.
This proposal may be withdrawn by us if not accepted by the above due date.
Authorized Acceptance
Signature Signature Date
CITY OF
FORM #2
ASHLAND
REQUEST FOR QUOTATION—TRADE SERVICES
INTERMEDIATE PROCUREMENT
Release date: March 27,2012
Requested by(name/dept/telephone/fax/email): Dave Tygerson,Electric Department Estimator
Tel:5.11-552-2389
Faz: 511-552-2436
Dave.tygerson(dashland.orms
Quotes are due be(time/day/date): 10:OOAM,Tuesday,April 3,2012
Project completion required by(date): Tuesday,April 24,2012
Job site location(name/address): 1963 Mae Street
Preferred method of shipment for materials/equipment(if applicable): FOR Ashland—Freight Prepaid
Quotes/Proposals may be f coed.emailed or hand delivered. Conttuctors shall submit quote/proposal on their compan}
letterhead. Informal email quotes and/or late quotes will not be accepted. Terms or discounts Which are conditioned upon
payment within a certain time will not be considered for purposes of comparison of bids.
The successfiil contractor will be required to enter into a contract with the City for the services and provide insurance
certificates in their own name for General Liability,Automobile and Workers'Compensation. Subcontracting will not be
permitted.
"OR EQUAL":Any brand name listed in the specifications as"m equal"or"m equivalent"shall establish the minimum requirements for quality,utility,
durability,function,purpose,etc.Other product brands may be offered that are equal to or better than the product brand name.Bidder may show cost
difference,alternates and options in the space provided in the quote.This clause is not meant to be restrictive,but to set the minimum standard.THE CITY
SHALL DETERMINE,IN ITS SOLE DISCRETION,WHETHER A PRODUCT OFFERED IS"EQUAL."When the designation is"or equal"or
"equivalent"City shall make its decision after Bid Closing.
SCOPE OF SERVICES
Excavation Proiect
Location: 1963 Mae Street
Excavation and installation of PVC conduits and vaults to be installed per City of Ashland,
Electric Department per attached drawings and specifications. All required work permits,
materials and labor to be provided by licensed contractor.
Mandatory pre-bid jobsite inspection scheduled for 9:OOAM, Tuesday,March 27,2012. All
bidders must be in attendance at the jobsite inspection located at 1963 Mae Street.
All Pricing Must Be Held Firm For 30 Days
Mothod of Award:ORS 27913.07O Wermediate Procurements. (4)If a contract is awarded, the contracting agency shall award the
contract to the offeror whose quote orproposal will best serve the interests of the contracfing agency, tatting into account price as well as
considerations including, but not limited to,a.Veiience,expertise,product tuncfiona#ly, suitability for a particular purpose and contractor
responsibility under ORS 279B.110,
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PO Box 323,WilsomrMs,Oregon 97070-0323 Issue Date:2012 CITY OF ASHLAND
Tel:(503)682-2844 Fax:(503)682-2657 oldcastleprecasteom/wllsonvnle
CERTIFICATE OF LIABILITY INSURANCE °/11/ °"col
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COVERAGES CERTIFICATE:NUMBER:C11.23513209 REVISION NUMBER;
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D1ffiLrrP110N of OPERATIDNa l LerJTIONa l Y@9tlea (q®tll L�701,AddQioeN fbnMrks echrWr,ilnwre Rrrr is,cq,glae)
Ike: Electric Department at 1963 Mae Street- Certificate holder included as additional insured per
attached andorsement ftW97670408 where required by written aontract, This form is subject to policy
terms, conditions, and exclusions-
CERTIFICATE HOLDER CANCELLATION
MOULD ANY OF THE ABOVE DEBCW BED POLICES BE CANCELLPD BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN,
Adii Olson ACCORDANCE WITH THE POLICY PROViBoNe.
Purchasing Representative
City of Ashland AUh10RIIEDREPRESRVTATIVE
90 H Mountain avenue
Ashland, OR 97520 �p
S Ni1scn, AAI, AFC/Su
ACORD 25(2010105) ®1588-2010 ACORD CORPORATION- All rights rresrwed.
INS026 fzmoosLOl The ACORD name and logo are registered marks of ACORD
04/13/2012 08 : 21 FAX 5418579883 ASHLAND INS-MEDFORD 001/001
AC RO L> CERTIFICATE OF LIABILITY INSURANCE /1 IMHWO12
4/13/2012
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(ies) 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 CONTACT Thomas Wilson
NAME:
Ashland Insurance Inc PHONE ($41)857-0679 FA% I$dll SS]-99e3
AIL Na:
801 O'Hare Parkway, Ste 101 E-MAIL ,twilson@ ashlandinsurance.com
INSURER(S)AFFORDING COVERAGE NAIC N
Medford OR 97504 INSURERA•SAIF Corporation
INSURED
INSURER B
SOS Plumbing and Drain Service, Inc. INSURER C:
206 S Pacific Hwy. INSURER 0
INSU RER B
Talent OR 97540 INSURER F:
COVERAGES CERTIFICATE NUMBER:CL111215 0 3 3 4 9 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,
INSR LTR TYPE OF INSURANCE POLICYNUMBER MMME"YYYY MMIDDDITYTY LIMITS
GENERAL LIABILITY EACH OCCURRENCE 5
COMMERCIAL GENERAL LIABILITY PREMISES Ee occurrmcel .5
CLAIMS-MADE ❑OCCUR MED EXP(My ens anon) S
PERSONAL 6 ADV INJURY 5
GENERAL AGGREGATE 5
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPMP AGO 5
POLICY F7 PRO LOC S
AUTOMOBILE LIABILITY COMBINEV SINGLE LIMIT
ANY AUTO BODILY INJURY(Per pc San) 5
ALL OWNED SCHEDULED 8001LY INJURY Per a<POcnU E
AUTOS AUTOS 1
NON-OWNED PR PERTY DAMAGE 5
HIRED AUTOS AUTOS Per acid^rd
S
UMBRELLA LIAR OCCUR EACH OCCURRENCE S
EXCESS LIAB CLAIMS-MADE AGGREGATE S
DED I I RETENTION S S
A WORKERS COMPENSATION WCSTATU- OTH-
AND EMPLOYERS'LIAaILITT VIM M
ANY PROPRIETORIPARTNERIEXECUTIVE E L EACH ACCIDENT S 500,000
CFFICEWMEMBER EXCLUDED? NIA
(Mandatory in NH) 754526 0/1/2011 0/1/2012 EL.DISEASE-EA EMPLOYEE 5 500,000
If ins',devolDeunder
DESCRIPTION OF OPERATIONS belay E.L.DISEASE-POLICY LIMIT 5 500,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Ranar4s Schedule,N mots space is required)
CERTIFICATE HOLDER CANCELLATION
(541) 488-5320 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Kari Olson, Purchasing Rep. ACCORDANCE WITH THE POLICY PROVISIONS.
City of Ashland
90 N Mountain Ave AUTHORIZED REPRESENTATIVE
Ashland, OR 97520
1 1. is
Jeffrey Wilson/MARL
ACORD 25(2010/05) m 1888.2010 ACORD CORPORATION. All rights reserved.
A`�°® CERTIFICATE OF LIABILITY INSURANCE 4/11/2o�
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($), 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 CONTACT Susan Wilson, AAI, AIC
NAME.Beecher Carlson Insurance Agency LLC PHONE (541)772-1111 FAC Nq:(541)772-3785
707 Murphy Rd .susan.wilson@beechercarl son.com
INSURER(S) AFFORDING COVERAGE NAICi
Medford OR 97504 INSURERA T1meZlCan Hallmark Ins Cc of TX 43494
INSURED INSURERS:
SOS Plumbing & Drain Service Inc INSURERC:
206 South Pacific Hwy INSURER0
INSURER E
Talent OR 97540 INSURERF:
COVERAGES CERTIFICATE NUMBER:CL123513209 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 WMICH 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF INSURANCE POLICY NUMBER MMICDY EFF MMIICYE%P OMITS
LTR
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL LIABILITY PREMISES Ea oxurrence $ 100,000
A CI-AIMS-MADE OCCUR 4CL44337606 /11/2012 /11/2013 MED EXP(Any one parson) $ 5,000
PERSONAL&ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GENL AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 2,000,000
X1 POLICY 7 PRO LOC $
AUTOMOBILE LIABILITY Ea aaiden[ 1,000,000
ANY AUTO BODILY INJURY(Per person) $
A ALL OWNED SCHEDULED 4CL44337606 /11/2012 /11/2013
AUTOS X AUTOS BODILY INJURY(Per aai0errt) $
Ix X NON-OWNED PROPERTY DAMAGE $
HIRED AUTOS AUTOS Pereoddent
Undennsumd motorist $
X UMBRELLA LIAR
4 OCCUR EACH OCCURRENCE $ 1,000,000
A EXCESS UAB C.ccu, MADE AGGREGATE $ 1,000,000
DED I X I RETENTION 101000 14CU44337706 /11/2012 /11/2013 $
WORKERS COMPENSATION WC STATU- OTH-
AND EMPLOYERS'LMBILITY YIN Y LIMITS ER
ANY PROPRIETORIPARTNERI ECUTIVE E.L.EACH ACCIDENT $
OFRCEI/MEMEER E UDED'I NIA
(Mandatory In NH) E.L.DISEASE-EA EMPLOYE
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
DES CR"ON OF OPERATIONS I LOCATIONS I VEHICLES (AMch ACORD 101,Addebnal Remarks Schedule,If more smote is required)
Re: Electric Department at 1963 Mae Street. Certificate holder included as additional insured per
attached endorsement #MP97670408 where required by written contract. This form is subject to policy
terms, conditions, and exclusions.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Hari Olson ACCORDANCE WITH THE POLICY PROVISIONS.
Purchasing Representative
City of Ashland AUTHORIZED REPRESENTATIVE
90 N Mountain Avenue
Ashland, OR 97520 '� s
S Wilson, AAI, AIC/SU
ACORD 25(2010105) ®1998-2010 ACORD CORPORATION. All rights reserved.
INS025(201005).01 The ACORD name and logo are registered marks of ACORD
c. The following is added to A.2.Property Not Covered of the BUILDING AND PERSONAL PROPERTY COVERAGE
FORM:
It. Property while stored or operated underground in connection with any mining operations.
d. The following is added to Paragraph 2.of B.Exclusions of the CAUSES OF LOSS-SPECIAL FORM:
n. We will not pay for loss or damage caused by puncture,blowout and road damage to tires and tubes mounted
on vehicles. However,we do pay for puncture, blowout or road damage caused by a specified peril.
o. We will not pay for loss caused by humidity,dampness,dryness or changes in or extremes of temperature.
p. We will not pay for loss caused by the weight of a load which,under the operating conditions at the time of a loss,
exceeds the registered lifting capacity of any equipment or machine.
q. We will not pay for loss due to theft or mysterious disappearance from any vehicle or attached container. We
will pay for loss due to burglary when there are signs of forcible entry to a locked vehicle or container.
e. E.7.Valuation of the BUILDING AND PERSONAL PROPERTY COVERAGE FORM is deleted and replaced by the
following:
7. Valuation
We will determine the value of covered property in the event of loss or damage as follows:
a. At actual cash value at the time of the loss (with a deduction for depreciation) except as provided in
paragraphs b.and c.following.
b. Pair or Set. The value of a lost or damaged article which is part of a pair or set is based on a reasonable
proportion of the value of the entire pair or set. The loss is not considered a total loss of the pair or set.
c. Loss to Parts. The value of a lost or damaged part of an item that consists of several parts when it is
complete is based on the value of only the lost or damaged part or the cost to repair or replace ft.
2. Rental Reimbursement
In the event of loss by a covered peril to covered contractors'equipment that you own,we will reimburse you for your
expense to rent similar equipment while your equipment is inoperable. The most we will reimburse you for rental
reimbursement expenses is$1,000. We will continue to reimburse you for the rental of equipment after the expiration
date of this coverage provided the loss occurred before the expiration date.
We will not reimburse you:
a. If you can continue or resume your operations with similar equipment that is available to you at no additional expense
to you;or
b. For the rental expense of any equipment unless you make every reasonable effort to repair, replace or rebuild the
inoperable equipment after the covered loss occurs.
3. With respect to this Additional Coverage,Contractors Equipment Coverage,Section D.Deductible of the BUILDING
AND PERSONAL PROPERTY COVERAGE FORM is deleted and replaced by the following:
D. Deductible
We will not pay for loss or damage in any one occurrence until the amount of loss or damage exceeds$500.We will
then pay the amount of loss or damage in excess of$500 up to the applicable limit of insurance.
We will not reimburse you for the rental of equipment until after 72 hours have passed since the covered property
was rendered inoperable. After 72 hours have passed,we will only reimburse you for the rental expense that you
actually incur.
The deductible of$500 does not apply to rental reimbursement expenses.
General Liability Additional Coverages
The following Additional Coverages are added to the COMMERCIAL GENERAL LIABILITY COVERAGE FORM.
A. Blanket Additional Insured Coverage
1. SECTION 11—WHO IS AN INSURED of the COMMERCIAL GENERAL LIABILITY COVERAGE FORM is amended to
include as an Insured any person or organization(referred to as Additional Insured)whom you are required to add as an
Additional Insured on this policy under:
a. A written contract or agreement;and
b. Where a certificate of insurance showing that person or organization as an additional insured has been issued;and
c. When the written contractor agreement and certificate of insurance are currently in effector becoming in effect during
the term of the policy and executed prior to the"bodily injury,""property damage,"or"personal and advertising injury."
Page 14 of 18 Includes copyrighted material of ISO Properties,Inc.and MP 97 87 04 08
American Association of Insurance Services,Inc.,used with their permission
2. The insurance provided to the Additional Insured is limited as follows:
a. The Additional Insured is only an additional insured for:
(1) "Bodily injury,""property damage,"or"personal and advertising injury"caused in whole or in part by negligent
acts or omissions of the Named Insured or anyone directly or indirectly employed by the Named Insured or for
whose acts a Named Insured may be liable.
(2) Liability arising out of your ongoing operations for the Additional Insured by or for you. A person's or
organization's status as an insured under this coverage ends when your operations for that insured are
completed.
b. The Limits of Insurance applicable to the Additional Insured are those specified in the written contract or agreement
but not more than the Limits of Insurance specified in the Declarations for this policy. The Limits of Insurance
applicable to the Additional Insured are inclusive of and not in addition to the Limits of Insurance shown in the
Declarations for the Named Insured.
3. In addition to the other exclusions applicable to Section I,Coverages A., B.and C.of the COMMERCIAL GENERAL
LIABILITY COVERAGE FORM,the insurance provided to the Additional Insured does not apply to:
a. "Property damage"to:
(1) Property owned, used,occupied by,loaned or rented to the Additional Insured;
(2) Property in the cars,custody or control of the Additional Insured or over which the Additional Insured are for any
purpose exercising physical control;or
(3) "Your work"performed for the Additional Ensured.
b. "Bodily injury," "property damage,"or"personal and advertising injury" arising out of an architect's, engineer's or
surveyor's rendering or failure to render any professional services for you, for the Additional Insured or for others,
including, but not limited to:
(1) The preparing,approving or failure to prepare or approve maps, drawings, opinions, reports,surveys,change
orders,designs or specifications;or
(2) Supervisory,inspection or engineering services.
c. °Bodily injury'or"property damage"occurring after:
(1) All work,including materials, parts or equipment furnished in connection with such work, on the project(other
than service,maintenance or repairs)to be performed by or on behalf of the additional insured at the site of the
covered operations has been completed; or
(2) That portion of"your work"out of which the injury or damage arises has been put to its intended use by any
person or organization other than another contractor or subcontractor engaged in performing operations for a
principal as a part of the same project.
4. SECTION IV—COMMERCIAL GENERAL UABIL ITY CONDITIONS,paragraph 4.Other Insurance,is amended to add
the following subparagraph:
d. Additional Insured's Other Insurance As Excess Insurance
To the extent required by an"insured contract;this insurance is primary on behalf of the Additional Insured;and any
other insurance maintained by the Additional Insured is excess and not contributory with this insurance.If the Insured
contract"does not require this provision,then paragraph a.above will apply.
B. Mobile Equipment Broadened Coverage
V.12.f.(1)of the COMMERCIAL GENERAL LIABILITY COVERAGE FORM is replaced by the following:
(1) Equipment designed primarily for:
(a) Snow Removal;
(b) Road maintenance, but not construction or resurfacing;or
(c) Streetcleaning.
Except the above provisions do not apply to self-propelled vehicles of few than 1,000 pounds gross vehicle weight which
are not intended for use on a highway.
C. Aggregate Limit Per Project
The General Aggregate Limit under SECTION III—LIMITS OF INSURANCE of the COMMERCIAL GENERAL LIABILITY
COVERAGE FORM applies separately to each of your projects away from premises owned by or rented to you.
MP 97 67 04 08 Includes copyrighted material of ISO Properties,Inc.and Page 15 of 18
American Association of Insurance Services,Inc.,used with their permission
QTY RECt "IDER Page 1 / 1
�. CITY O F
ASHLAND � DATE �:'- � '. � PO NUMBER.
20 EMAAINST 4/13/2012 10818
ASHLAND, OR 97520
(541)488-5300
VENDOR: 001052 SNIP TO: Ashland Electric Department
SOS PLUMBING (541) 488-5354
206 S PACIFIC HWY 90 N MOUNTAIN
TALENT, OR 97540 ASHLAND, OR 97520
FOB Point: Req.No.:
Terms: Net Dept.: --
Req.Del.Date: contact: Dave Tygerson
Special Inst: Confirming? No
Quantity .Unit -- - - - 'Description Unit Price Ext.Price
Excavation and installaton of PVC 9,850.00
conduits and vaults per City provided
drawings and specification. Per
attached RFQ and proposal submitted bV
SOS Plumbinq.
Contract for Goods and Services
Beginning date: April 9, 2012
Completion date: April 24, 2012
Insurance required/On file
SUBTOTAL 9,850.00
BILL TO:Account Payable TAX 0.00
20 EAST MAIN ST FREIGHT 0.00
541-552-2028 ' TOTAL 9,850.00
ASHLAND, OR 97520
Account Number Project Number -Amount Account Number Project Number Amount
E 690.11.18.00.70410 E 000284.999 9,850.00
Authdrized Signature 2___ VENDOR COPY
FORM0 CITY OF
-ASH LAN D
REQUISITION Date of request;
Required date for delivery:
Vendor Name 5-0,S. PLUtnh C
Address,City,State,Zip 2 0/ S !D x/F/c4 HwY % e/,/-F DR 275-,f0
Contact Name&Telephone Number &Ott TUAAELL
Fax Number
n oNe :mil-kRB -26F30 F,4k ,5-4//-5-35-3961-1
SOURCING METHOD
❑ Exempt from Competitive Bidding ❑ Emergency
❑ Reason for exemption: ❑ Invitation to Bid (Copies on ffie) ❑ Form#13,Written findings and Authorization
❑ AMC 2.50 Date approved by Council: ❑ Written quote or proposal attached
❑ Written quote or proposal 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#
❑ Verbal/Written quote(s)or proposal(s) ❑ State of Washington
Intermediate Procurement ❑ Sole Source Contract#
GOODS&SERVICES ❑ Applicable Form(#5,6,7 or 8) ❑ Other government agency contract
5 OOA to 100 000 ❑ Written quote or proposal attached Agency
(3)Wrnen quotes attached ❑ Special Procurement Contract#
PERSONAL SERVICES ❑ Form#0,Request for Approval 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:
❑ (3)Written proposals attached Valid unfit: ate (Date)
Description of SERVICES Total Cost
j9-*YC61V1q7701V 6719or 11l/s7W1AT'101/ OF ,DVC CoAldal'1Y
Qno( I 1'4L1-7-!5 der provrded D aUilp?s and 5pocIF,Caticvr5
Item# Quantity Unit Description of MATERIALS Unit Price Total Cost
TOTAL COST
❑ Per attached quote/proposal $-
Project Number 00028E/ 9f 4 Account Number 69Q-1 9185 UO
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:
1T Director Date Support-Yes/No
_
�By signing this requisition form,l certify that the City's public contracting requirements have been saUsfied.
-I
Employee Signature: , )(I k(Q —J 1QQI71aJ Department Head Signature: _ 1(Equ
• al to or greater n$5,000)
Additional signatures(if applicable):
Funds appropriated for current fiscal yeay / NO
Finance Director-(Equar!o etc sate t ro : ,oeo; Date
Comments: