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HomeMy WebLinkAbout2012-069 Contract - JB Steeling ��� CITY OF ASHLAND PUBLIC Of' �: �SHLANQ` PUBLIC IMPROVEMENT CONTRACT BLUEBIRD PARK STAIRWAY REPLACEMENT Project No. 2011-32 This Contract is between the CITY OF ASHLAND, a municipal corporation of the State of Oregon (hereinafter "City") and J.B. Steel. Inc. (Hereinafter "Contractor"). The City's Project Manager for this Contract is Morgan Wayman, Proiect Manager City of Ashland Public Works Department. WHEREAS, City caused to be prepared a certain bound Project Manual or Bid Package (including but not limited to Invitation to Bid, Bid Schedule, Bid forms, Bid, Performance and Payment Bonds, as applicable, Public Improvement Contract, Contract Standard Terms and Conditions, Conditions, General Provisions, Technical Specifications, Drawings, and Addenda No. 1 through No. 2, more particularly described in Standard Condition 5, (hereinafter referred to as "Contract Documents') for its project entitled Bluebird Park Stairway Replacement and WHEREAS, Contractor did on the 29th day of March, 2012, file with City a bid to furnish equipment, labor, material, and appurtenances for construction of said project as set forth in the Contract Documents and agreed to accept as payment therefore the sums fully stated and set forth in the bid; and WHEREAS, the Contract Documents and bid fully and accurately set forth and describe the terms and conditions upon which the Contractor proposes to furnish said equipment, labor, material and appurtenances and perform said work, together with the manner and time of furnishing same; and NOW THEREFORE, for good and valuable consideration the parties mutually covenant and agree as follows: 1. Recitals. These recitals set forth above are true and correct and are incorporated herein by this reference. 2. Effective Date and Duration This contract is effective on April 6, 2012 or on the date at which every party has signed this contract, whichever is later. The work under this contract shall, unless otherwise terminated or extended, be completed on or before May 18, 2012. 3. Statement of Work The work under this contract is for Bluebird Park Stairway Replacement as is more fully described in the Contract Documents, incorporated herein and made a part hereof by this reference. The statement of work, including the delivery schedule for the work, is contained in the Contract Documents. Contractor acknowledges receipt of all Contract Documents in existence at the date the Contract is signed and further acknowledges Contractor has read and G:\pub-wrks\eng\11-32 Bluebird Park Stair ReplacementU.B.Steel,Inc.4 03 2012 fully understands the Contract Documents, and understands that in signing this Agreement contractor waives all rights to plead misunderstandings regarding the same. Contractor shall, at its own risk and expense, perform the work described in the Contract Documents and furnish all permits, labor, tools, machinery, materials, transportation, equipment and services of all kinds required for, necessary for, or reasonable incidental to, performance of the work, that is, the construction of this Bluebird Park Stainvay for the City of Ashland, Oregon, as shown in the Contract Documents. Contractor shall secure all Municipal, County, State, or Federal Permits or licenses including payment of permit fees, license fees and royalties necessary or incident to performance of the work on this contract. The risk of loss for such work shall not shift to the City until written acceptance of the work by the City. 4. Consideration a. City agrees to pay Contractor, at the times and in the manner provided in the Contract Documents, a sum not to exceed: $48,767.00 for accomplishing the work required by this contract, including allowable expenses. This fixed sum cannot be modified except by Change Order approved in writing by City. Any progress payments to Contractor shall be made only in accordance with the schedule and requirements in Section 21, Standard Terms and Conditions. b. City certifies that sufficient funds have been appropriated to make payments required by this contract during the current fiscal year. 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. CONTRACTOR DATA, CERTIFICATION, AND SIGNATURE Business Name (please print): S. h. T.7G. Contact Name: L.u14, Gvt Phone Fax: SS�/-7�3-GSa3 Address: 1cP0 oss at- CV � 0 w/ Do Not Write Federal and State Tax ID Numbers on this Agreeme t. One copy of W-9 is to be submitted with the signed contract to be kept on file in the City of Ashland Finance Department. Ashland Business License # r)o033o-j L1 Construction Contractors Board z sc `9 Citizenship: Nonresident alien Yes L.1' No Business Designation (check one): Individual Sole Proprietorship Partnership Corporation Government/Nonprofit The above information must be provided prior to contract approval. Payment information will be reported to the Internal Revenue Service (IRS) under the name and taxpayer I.D. number provided above. (See IRS 1099 for additional instructions regarding taxpayer ID numbers.) Information not matching IRS records could subject you to 31 percent backup withholding. G:\pub-wrks\eng\11-32 Bluebird Park Stair Replacement\J.B.Steel,Inc.4 03 2012 I, the undersigned, understand that the Standard Terms and Conditions For Public Improvement Contracts together with Exhibits A through E together with all other, as are an integral part of this contract and agree to perform the work described in the Contract Documents, in accordance with the terms and conditions of this contract. I further understand the City is prohibited from entering into a contract when the contractor has neglected or refused to file any return, pay any tax, or properly contest a tax, pursuant to ORS 305.385; 1 hereby certify, under penalty of perjury and false swearing; that I/my business am/is not in violation of any Oregon tax laws; I further certify that the certification and representations in Standard Term and Condition # 16 [CCB Registration Requirements] are true and correct, and further I certify that I am an independent contractor as defined in ORS 670.600. Signed by Contractor: <T' &4= - i nature/Titl ate Pri nted Name: Ro AKd^cw Qa�4zc NOTICE TO CONTRACTOR: This contract does not bind the City of Ashland unless and until it has been executed by the Public Contracting Officer or designee as well as City Finance and Legal Department representatives. CITY OF ASHLAND SIGNATURE Approve on Robertson, Ashland Parks & Recreation Director Date -Authorized by Ordinance 3013 and Delegation Order dated June 22, 2010 Coding: Reviewed: Reviewed: David Lohman, City Attorney (approved as to legal form) Date G:\pub-wrks\eng\11-32 Bluebird Park Stair Replacementu.B.Steel,Inc.4 03 2012 EXHIBIT A CERTIFICATIONS OF REPRESENTATION Contractor, under penalty of perjury, certifies that: (a) The number shown on this 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, and (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: JZ(1) I carry out the labor or services at a location separate from my residence or is in a ecific portion of my residence, set aside as the location of the business. (2) Commercial advertising or business cards or a trade association membee hip are purchased for the business. I/ (3) Telephone listing is used for the business separate from the personal residen a listing. 7(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 Iiabili insurance relating to the labor or services to be provided. Gw 4111611 Z ontractor Dat G:\pub-wrks\eng\11-32 Bluebird Park Stair Replacement\J.B.Steel,Inc.4 03 2012 EXHIBIT B COMPLIANCE WITH APPLICABLE LAW PUBLIC IMPROVEMENT CONTRACT This exhibit contains the requirements for public contracting as set forth in ORS Chapter 279C.360 through and including 279C.800 and is available through the City Engineering Office at 51 Winburn Way, Ashland, Oregon or online at www.leg.state.or.us/ors EXHIBIT C PUBLIC IMPROVEMENT CONTRACT INSURANCE REQUIREMENTS To: Insurance Agent. Please provide Certificates of Insurance to the Project Manager. During the term of the contract, please provide Certificates of Insurance prior to each renewal. Insurance shall be without prejudice to coverage otherwise existing. During the term of this contract, Contractor shall maintain in force at its own expense all insurance noted below: Workers Compensation insurance in compliance with ORS 656.017. All employers, including Contractor and any subcontractors, that employ subject workers who work under this Contract in the State of Oregon shall comply with ORS 656.017 and provide the required Workers' Compensation coverage, unless such employers are exempt under ORS 656.126. Contractor shall ensure that each of its subcontractors complies with these requirements. Commercial General Liability insurance on an occurrence basis, with a combined single limit of not less than ■ $1,000,000 or ❑ $3,000,000 for each occurrence of bodily injury, personal injury and property damage. It shall include coverage for broad form contractual liability; broad form property damage; personal and advertising injury; owners and contractor protective; premises/operations; and products/completed operations. Coverage shall not exclude excavation, collapse, underground, or explosion hazards. Aggregate limits shall apply on a per- project basis. ■ Required by City ❑ Not required by City Commercial Automobile Liability insurance with a combined single limit, or the equivalent of not less than ■ $1,000,000 or 0 $3,000,000 for each accident for Bodily Injury and Property Damage, including coverage for owned, hired and non-owned vehicles. "Symbol One" coverage shall be designated. ■ Required by City ❑ Not required by City O Builders Risk (Check here if required) insurance during construction to the extent of 100 percent of the value of the work for the benefit of the parties to the Contract as their interest may appear. Coverage shall also include: (1) formwork in place; (2) form lumber on site; (3) temporary structures; (4) equipment; and (5) supplies related to the work while at the site. 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. This notice provision shall be by endorsement physically attached to the certificate of insurance. G:\pub-wrks\eng\11-32 Bluebird Park Stair Replacement\J.B.Steel,Inc.4 03 2012 Additional Insured. For general liability insurance and automobile liability insurance the City, and its agents, officers, and employees will be Additional Insureds, but only with respect to Contractor's services to be provided under this contract. This coverage shall be by endorsement physically attached to the certificate of insurance. The Contractor shall defend, indemnify, and hold harmless, the City and the City's officers, agents, and employees against any liability that may be imposed upon them by reason of the Contractor's or subcontractor's failure to provide workers' compensation and employers liability coverage. Certificates of Insurance. Contractor shall furnish insurance certificates acceptable to City prior to commencing work. The certificate will include the deductible or retention level and required endorsements. Insuring companies or entities are subject to City approval. If requested, copies of insurance policies shall be provided to the City. Contractor shall be responsible for all deductibles, self-insured retention's, and/or self- insurance. EXHIBIT D CERTIFICATION STATEMENT FOR CORPORATION OR INDEPENDENT CONTRACTOR ' t � 1 �ul �F^T 5 Hi I '' y � a AGO. k ti�I�sNTRACTORISACORPORATIO CORPORATION CERTIFICATION: I am authorized to act on behalf of the entity named below, and certify under penalty of perjury that it ' a corporation. e3e, s6d, 1Zc . /-///0//2-- Entity Sign ture I I Date 1iBp,TdONTRACTORJS`INDEPENDENT. Independent Contractor Standards. As used in various provisions of ORS Chapters including but not limited to 316, 656, 657, and 701, an individual or business entity that performs labor or services for remuneration shall be considered to perform the labor or services as an "independent contractor" if the standards of ORS 670.600 are met. Contractor and Project Manager certifies that the Contractor meets the following standards: 1. Contractor is free from direction and control over the means and manner of providing the labor or services, subject only to the specifications of the desired results. 2. Contractor is responsible for obtaining all assumed business registrations or professional occupation licenses required by state law or local ordinances. 3. Contractor furnishes the tools or equipment necessary for the contracted labor or services. G:\pub-wrks\eng\11-32 Bluebird Park Stair ReplacementUB.Steel,Inc.4 03 2012 s 4. Contractor has the authority to hire and fire employees to perform the labor or services. 5. Payment to the Contractor is made upon completion of the.performance or is made on the basis of a periodic retainer. 6. Contractor is registered under ORS chapter 701, if the Contractor provides labor or services for which such registration is required. 7. Contractor has filed federal and state income tax returns in the name of the business or a business Schedule C as part of the personal income tax return, for the previous year, for labor or services performed as an independent contractor in the previous year. 8. Contractor represents to the public that the labor or services are to be provided by an independently established business as four or more of the following circumstances exist. (Check four or more of the following:) A. The labor or services are primarily carried out at a location that is separate from Contractors residence or is primarily carried out in a specific portion of Contractors residence, which is set aside as the location of the business. B. Commercial advertising or business cards are purchased for the business, or Contractor has a trade association membership. C. Telephone listing is used for the business that is separate from the personal residence listing. D. Labor or services are performed only pursuant to written contracts. E. Labor or services are performed for two or more different persons within a period of one year. F. Contractor assumes 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. If any action is taken by a person or enforcement agency relating to Contractor's independent contractor status in connection with this contract, Contractor shall defend, hold harmless and indemnify the CITY of ASHLAND , its elected and appointed officials, employees, volunteers and agents from any such action, claim, judgment, fine, penalty, or order to pay. Contractor shall pay any additional costs incurred by the City in defending such action or incurred as a result of such action. This indemnification is in addition to any indemnification otherwise in this agreement. Contractor Signature Date Project Manager Signature Date G:\pub-wrks\eng\11-32 Bluebird Park Stair ReplacementU.B.Steel,Inc.4 03 2012 EXHIBIT E City OF. j ASHLAND REQUEST FOR OUO.TATIONS i BLUEBIRD PARK STAIRWAY REPLACEMENT PROJECT NO.2011-32 Bluebird Park is located at the comer ofNorth Main and Water.Street in Ashland. The lump . sum bid must contain all elements of constnjction including manufacturing,placement.crane rental,and concrete landings and footings.'Construction of the sidewalk connection at the bottom of the stairway and the re-construction of the.existing wooden handrails and fencing will be'done by others. The-City.of Ashland Living Wage requiremeut will apply to the project. (See attached Exhibit E) Please return yourpmposal no later than 2:00 pm.,Thursday,March 29, 2012. I PROPOSE TO COMPLETE THE BLUEBIRD PARK STAIRWAY PROJECT FOR *"Forty-eight thousand seven hundred sixty seven......................Dollars is 48,767.00 j I ..i'Adjusted Quote: Includes additional price for Boli Prevailing Wage Rates. Date: April 9, 2012• By Address: J_B. Steel,-Inc. f Signature 190 N. Ross Lane Ts pping PO Box 4460 (mailing) Robert-Andrew Batzer Medford, OR 97501 Printed Name President . 541-773-8325 I Title Phone andrewrux @jbsteelinc.com j Email I I Engineering Tel:54114SM347 20 E nd Orregon Fax 541./48&8006 . Ashland,Oregon 97520 77Y: 800!/354900 wxw.aShiand.er.un I ` I I • 1 ACKNOWLEDGEMENT OF ADDENDUM(S) - I The bidder acknowledges that the Addendum(s) listed below have been reviewed and considered as part of the submittal of this project Bid. i ADDENDUM NUMBER 1 THROUGH - HAVE BEEN REVIEWED April 9th, 2012 Authorized Co is Signature Date i i • I I I � Engineering Tat:5411486.5347 20 l Main Street Fax 541-1488-MB 735.29 Ashland,Oregon 97520 TTY: 800!135.2900 • www-ashland.or-us OP ID:SL A�Ro CERTIFICATE OF LIABILITY INSURANCE oA 10/07/11 W) 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 INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the pollcy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terns 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 503.224-2500 CONTACT Anchor Insurance&Surety NAME:Inc 503-224-9830 PHONE ac No:. 1201 SW 12th Ave.,Suite 500 Portland,OR 97205-2030 E-MAIL John D.Klump ADDRESS:PRODUCEE-RRID .BATZE-1 INSURER(S) AFFORDING COVERAGE NAICX INSURED J.B.Steel,Inc. INSURERA:Bituminous Casualty Corp. PO BOX 4460 INSURER B: Medford,OR 97501 INSURER C: NSURER D NSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 rypE OF INSURANCE L POLICY EFF POLICY EXP LIMITS LTR POLICYNUMBER MMMD MM,DDIYYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 • X COMMERCIAL GENERAL LIABILITY X CLP 3553270 05101/11 05101/12 PREMISES Ea occurrence $ 100,00 CLAIMS-MADE ❑X OCCUR MED EXP(Any cne person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,00 GENERALAGGREGATE $ 2,000,00 GENL AGGREGATE U MIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 POLICY X PRO- LOC $ JECT AUTOMOBILE LIABILITY X COMBINED SINGLE LIMIT $ 1,000,00 (Ea accident) • X ANY AUTO CAP 3553269 05/01/11 05/01/12 BODILY INJURY(Per person) $ ALLOWNEDAUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE X HIREDAUTOS (Per acacerl) $ X NON-OWNEDAUTOS $ S J( UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,00 EXCESS LIAB CIAIMSWADE AGGREGATE $ 5,000,00 • CUP 2590309 05101111 05101112 DEDUCTIBLE $ X RETENTION $ 10,000 $ WORKERS COMPENSATION WC STATU- OTH- ANDEMPLOYERTUABILIry YIN TORY ANY PROPRIETOWPARTNERIEXECUTIVE❑ E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? NIA (Mandatory in NH) EL DISEASE-FA EMPLOYEE $ I1 yes,descrOe urWer DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Rama6m Schedule,K mare space is required) RE:BLUEBIRD PARK STAIRWAY REPLACEMENT-PROJECT NO.2011-32 CITY OF ASHLAND&ITS AGENTS,OFFICERS&EMPLOYEES ARE ADDITIONAL INSUREDS PER TERMS&CONDITIONS OF ATTACHED GENERAL LIABILITY ENDTS GL4667-0111, GL-4665-0111 &AUTO ENDT A-2931-1199. 30 DAYS NOTICE OF CANCELLATION EXCEPT 10 DAYS FOR NON-PAYMENT OF PREMIUM. CERTIFICATE HOLDER CANCELLATION ASHLA-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF ASHLAND ACCORDANCE WITH THE POLICY PROVISIONS. 20 EAST MAIN ST. ASHLAND,OR 97520 AUTHORIZEDQREPRE�SENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 26(2009/09) The ACORD name and logo are registered marks of ACORD POLICY N0. CLP 3553270 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY ADDITIONAL INSURED — OWNERS, LESSEES OR CONTRACTORS This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II — Who Is An Insured is amended to include as an additional insured any person or organization who is required by written contract to be an additional insured on your policy, but only with respect to liability for 'bodily injury', 'property damage' or 'personal and advertising Injury' caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the project(s) designated in the written contract. B. With respect to the insurance afforded to these additional Insureds, the Jollowing additional exclusions apply: This insurance does not apply to"bodily Injury' or'property damage' occurring alter: 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(s) at the location 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. This insurance is excess of all other insurance available to the additional insured, whether primary, excess, contingent or on any other basis, unless the written contract requires this Insurance to be primary. In that event, this insurance will be primary relative to insurance policy(s) which designate the additional Insured as a Named Insured in the Declarations and we will not require contribution from such insurance if the written contract also requires that this insurance be non-contributory. But with respect to all other insurance under which the additional insured qualifies as an insured or additional Insured,this Insurance will be excess. GL-4667 (01/11) Includes Copyrighted Material of Insurance Services Office With Its Permission COMMERCIAL AUTO POLICY NO.: CAP 3553269 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED— SPECIFIC ENTITIES This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM: WHO IS AN INSURED is amended to include as an"Insured"the person or organization named in this endorsement. However, the additional insured is an "Insured"only for"bodily injury"or"property damage" arising out of work or operations performed by you or on your behalf for the additional insured and resulting from the ownership, maintenance or use of a"covered auto", by: 1. You, or 2. Any of your employees or agents; or 3. Anyone other than the additional insured or any employee or agent of the additional insured, while using with your permission a covered"auto"you own, hire or borrow. ADDITIONAL INSURED: Any person or organization for whom the named insured has agreed by written contract(insured contract) to designate as an additional insured, subject to all provisions and limitations of this policy. A-2931 (11/99) POLICY NO. 3553270 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 Section II — Who Is An Insured Is amended to include as an additional insured any person or organization who is required by written contract to be an additional insured on your policy for completed operations, but only with respect to liability for 'bodily injury' or 'property damage' caused, In whole or In part, by 'your work' at the project designated in the contract, performed for that additional Insured and Included in the products-completed operations hazard'. This insurance is excess of all other insurance available to the additional insured, whether primary, excess, contingent or on any other basis, unless the written contract requires this insurance to be primary. In that event, this insurance will be primary relative to insurance policy(s) which designate the additional insured as a Named Insured in the Declarations and we will not require contribution from such insurance if the written contract also requires that this insurance be non-contributory. But with respect to all other insurance under which the additional insured qualifies as an insured or additional insured, this insurance will be excess. GL-4665 (01/11) Includes Copyrighted Material of Insurance Services Office With Its Permission �. CITY OF ASHLAND OFFICIAL RECEIPT 20 East Main Street Ashland, Oregon 97520 � p 00027985 (541)488-6004 Receipt date 4111/2012 Payee name JB STEEL, INC. Tender type Check Customer NO: 1019871 Check number 25485 Activity# Description Amount--, 00033084 Application 25.00 License type Temporary License Receiptarnount 2 5.00 www.saif.com OREGON WORKERS COMPENSATION SaIF CERTIFICATE OF INSURANCE 0,corporation CERTIFICATE HOLDER: CITY OF ASHLAND 20 E MAIN ST ASHLAND, OR 97520 - The policy of insurance listed below has been issued to the insured named the policy period indicated. The insurance afforded by the policy describe is s o all the terms, exclusions and conditions of such policy. I i POLICY NO. POLICY PERIOD ISSUE DATE 518502 10/01/2011 to 10/01/2012 04/20/2012 INSURED: BROKER OF REC 3 B STEEL INC WARD INSURANCE AGENCY INC PO BOX 4460 PO BOX 10167 MEDFORD, OR 97501-0267 EUGENE, OR 97440 LIMITS OF LIABILITY: Bodily Injury by Accident $500,000 each accident Bodily Injury by Disease $500,000 each employee Body Injury by Disease $500,000 policy limit DESCRIPTION OF OPERATIONS/LOCATIONS/SPECIAL ITEMS: Bluebird Park Stairway Replacement IMPORTANT: The coverage described above is in effect as of the issue date of this certificate. It is subject to change at any time in the future. This certificate is issued as a matter of information only and confers no rights to the certificate holder. This certificate does not amend, extend or alter the coverage afforded by the policies above. AUTHORIZED REPRESENTATIVE 3rg If> K t�� President and CEO 400 High Street SE SaLem,OR 97312 P:800.285.8525 F:503.373.8020 Pohcy_Batch_certiFimteonnsurance CITY RECORDER Page 1 1 CITY O F AS H LA N D DATE - ;. PO NUMBER 20 E MAIN ST. 4124/2012 10836 ASHLAND, OR 97520 (541)488-5300 VENDOR: 016882 SHIP TO: Ashland Public Works JB STEEL INC (541) 488-5587 PO BOX 4460 51 WINBURN WAY MEDFORD, OR 97501 ASHLAND, OR 97520 FOB Point: Req.No.: Terms: Net Dept.: Req.Del.Date: contact: Bruce Dickens- Morgan Wayman Special Inst: Confirming? No . Quahti - Unit -' - ._ i. Description :.:_Unit Price.; Ext.Price.. Construction of stairs and sidewalk at 48,767.00 Bluebird Park, including landings, footings, crane and placement of stairs. Public Improvement Contract Effective date: April 6, 2012 Completion date: May 18, 2012 Insurance required/On file SUBTOTALl 48 767.00 BILL TO:Account Payable TAX 0.00 20 EAST MAIN ST FREIGHT 0.00 541-552-2028 TOTAL 48,767.00 ASHLAND, OR 97520 'Account Number :,, .Project Number Amount -Account Numbei' '.Project Number Amount.: -_ E 410.03.22.00.704200 E 201132.999 48 767.00 VENDOR COPY Autho ized Signature FORM #3 CITY O F ASHLAND A 1equest for a Purchas-o Order REQUISITION Date of request: ` biz Required date for delivery: Vendor Name n�,, Address,City,State,Zip (ol U N. PC �-- Contact Name&Telephone Number - P0 f JD X (PO Fax Number McDr=O2i�. O(Z 9�6b1 11aYITf�� RoP�e2rI�Ik��j25�F1-77�3z SOLICITATION PROCESS ❑ Exempt from Competitive Bidding ❑ Emeroencv ❑ Written Findings(Form attached) ❑ Invitation to Bid (Copies on file) ❑ Written findings attached ❑ Quote or Proposal attached Date approved by Council: ❑ Quote or Proposal attached ❑ Small Procurement Cooperative Procurement Less than$5,000 ❑ Reauest for Proposal (Copies on file) ❑ State of Oregon Note:Total contract amount,including any Date approved by Council: Contract# amendments may not exceed$6,000 ❑ State of Washington Intermediate Procurement ❑ Sole Source Contract# GOODS&SERVICES ❑ Written Findings(Form attached) ❑ Other government agency contract $5,000 to$100,000 ❑ Quote or Proposal attached Agency (3)Written quotes attached Contract# PERSONAL SERVICES ❑ 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# p - Date approved y ❑ 3 Written.proposals attached Dale a rovedb--Councl:— - - - PP ed b Council:----- -------- - Description of SERVICES Total Cost eem`b ma c i I D,fo D f STINKS rVN D S i iJj Gl1 I. i?,[--I.IE�IRD ) ArIZK iN_Ci1,U0tI�1�lulYlutNL� FA0riJ�Yf�iC1219ov� r. .��„ �_ - x":� [�.� y�/'� �^{� �j t f �'x� Fr iO�„hk r rNr '7�r1�- - r ,GNT�l' ✓i r `t its �A�� r4 ttr Y�j p,'v^rot 9r Item# Quantity Unit Description of MATERIALS Unit Price Total Cost 1­1 Per attached quotelproposal .Y.ROTAL*COST ''z Project Number OjJ7yJ Q_L Account Number - • - Account Nuinber`!(n a_3. �,g0. 7try,-�,W AccountNum bar ___-__-__ '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: IT Director Date By signing this requisition form, I certify that the information provided above satisfies the City's public contracting requirement sra d the documentation can be provided upon request. C/ Employee Signature �1���,�r� Department Head Signature: Additional signatures(if applicable): Funds appropriated for current fiscal year. ES NO �7 Finance Director Date Comments: 05 �. 6� �s-"c_- C`y/�ujrac. G:FinanceTrooedurelARFormsTorm#3-Requisition.doc Updated on:8124/2011