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HomeMy WebLinkAbout2012-113 Contract - Gage It Construction 17 12 08:30a Gage It Construction 5417797227 p.1 Contract for GOODS AND SERVICES Less than $26,000 C IT Y OF CONTRACTOR: Gage It Construction ASHLAND CONTACT: Jon DeBendetti 20 East Main Street Ashland, Oregon 97520 ADDRESS: 4778 Airway Drive, Central Point OR, 97502 Telephone: 5411488-6002 Fax: 541/488-5311 TELEPHONE: 541-779-7007 DATE AGREEMENT PREPARED: 5-15-2012 FAX: BEGINNING DATE: 5-21-2012 COMPLETION DATE: 6-21-2012 COMPENSATION: 2895.00 GOODS AND SERVICES TO BE PROVIDED: Reference Exhibit C:Scope of Installation for Guardrail at North Main Pump Station. ADDITIONAL TERMS:None 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 underthis 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 dale indicated above and start performing the work under this contract by the beginning date indicated above and complete the work by the completion date indicated above. 4. Compensation: City shall pay Contractor for the specified goods and for any work performed, including costs and ,expenses, the sum specified above. Payments shall be made within 30 days of the date of the invoice. Should the contract be prematurely terminated, payments will be made for work completed and accepted to date of termination. Compensation under this contract, including all costs and expenses of Contractor, is limited to $25,000.00, unless a separate written contract is entered Into by the City. 5. Ownership of Documents:All documents prepared by Contractor pursuant to this contract shall be the property of City. 6. Statutory Requirements: ORS 2798.220, 2796.225,279B.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, indemnity and save City, its officers, employees and agents harmless from any and all losses, claims, actions,costs, expenses,judgments, subrogations, or other damages resulting from injury to any person (including injury resulting in death), or damage(including loss or destruction)to property, of whatsoever nature arising out of or incident to the performance of this contract by Contractor(including but not limited to, Contractor's employees, agents,and others designated by Contractor to perform work or services attendant to this contract). Contractor shall not be held responsible for any losses, expenses, claims, subrogations, actions, costs, judgments, or other damages, directly, solely, and proximately caused by the negligence of City. 9. Termination: a. Mutual Consent This contract may be terminated at any time by mutual consent of both parties. b. Citv's Convenience. This contract may be terminated at any time by City upon 30 days' notice in writing and delivered by certified mail or in person. C. For Cause. City may terminate or modify this contract, in whole or in part, effective upon delivery of written notice to Contractor,or at such later date as may be established by City under any of the following conditions: i. If City funding from federal state, county or other sources is not obtained and continued at levels Contract for Goods and Services Less than$25,000, Revised 06/3012011,Page 1 of 5 May 17 12 08:31a Gage It Construction 5417797227 p.2 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 duly under this contract Clty 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. 110. 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 ORF 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 It. 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 intent not to renew the insurance coverage(s)without 30 days' written notice from the Contractor or its insurer(s) to Contract for Goods and Services Less than $25,000, Revised 06/3012011,Page 2 of 5 May 17 12 08:31a Gage It Construction 5417797227 p.3 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 noncontributory. The certificate will specify all of the parties who are Addilional 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 Stales Constitution,or otherwise, from any claim or from thejurisdiction. 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. Contralztor* City of Ashland 13 By Signature Department Head p-. Print Name' Print Name l .d A -)k S/��( 11 Z Title Date W-9 One copy of a W-9 is to be submitted with the signed contract. Purchase Order No. v Contract for Goods and Services Less than$25,000,Revised 06/3012011,Page 3 of 5 May 17 12 08:31a Gage It Construction 5417797227 p.4 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: �c (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. x _ (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. c) Contr for / (Date) Contract for Goods and Services Less than$25,000, Revised 0 613 02 0 1 1, Page 4 of 5 May 17 12 08:31a Gage It Construction 5417797227 p.5 Scott Fleury From: Steve Burkhalter[burkhals @ashland.or.us] Sent: Tuesday, May 15, 2012 6:32 AM To: Sharlene Stephens; Scott Fleury; John Peterson Subject; Fwd: City Of Ashland Guardrail Sharlene, here is the quote for the guardrail replacement on N Main St From Gage It construction. Thanks Steven From: "Jon debenedetti" <jond @gageit.org>� To: "Steve Burkhalter" <burkhals @ashland.or.us> Cc: "Brian Bowman" <brianb @gageit.org>, "Christy Bowman" <christyg @gageit.org> Sent: Monday, May 14, 2012 10:24:57 AM Subject: Re: City Of Ashland Guardrail Good morning Steve. Guardrail repair(NMain St Ashland Or.) JWobilization = $750.00 31.25'type 2a guardraiI @ $28.00 per ft = $875.00 2 type 1 modified anchors @ $S5o.00 ea = $11oo.00 type B end pieces @ $85.00 = $170.00 TOTAL = $2895.00 Lzcludes traffic control Any vacuum excavation for utility conjlicts will be at additional cost. UP to 14 days needed to aquire radius rail. (appoximately t6' radius) Gage It Construction Jon DeBenedetti Supervisor Cell - 541-210-2631 Office - 541-779-7007 On Fri, May 11, 2012 at 1:54 PM, Steve Burkhalter <burkhals @ashland.or.us> wrote: Jon, I have attached a photo of the N Main St guardrail, the area marked in red is where the original railing was. If you have any questions give a call. If you want to email the quote that would be fine or you fax it to 541-552-2304. Thanks Steven i May 17 12 08:32a Gage It Construction 5417797227 P.6 Steven Burkhalter CITY OF ASHLAND Public Works Asset Management (541) 552-2347 (541) 552-2304 fax This email transmission is official business of the City of Ashland, and it is subject to Oregon Public Records law for disclosure and retention. If you have received this message in error, please contact me. Thank you. 2 OP ID: SHJ IN CERTIFICATE OF LIABILITY INSURANCE DAT05/23/12"IDDIYYYY) 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 641.245-1111 CONTACT Nikki Russell UUC NAME United Risk Solutions,Inc. 541-245-1112 PHO"E .541-245-1111 Ac No: 541-245-1112 PO Box 936 Medford,OR 97501-0067 aI DRIESS: nikki.russell@unitedrisk.com PRODUCER C .GAGEOIC INSURER(S) AFFORDING COVERAGE NAIC0 INSURED Gage It Construction LLC INSURER A:Western National Assurance Co P.O.Box 3483 INSURER B: Central Point,OR 97502-0018 INSURER C: NSURER D INSURER 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 I TYPE OF INSURANCE NSR UB POLICY NUMBER PoDDYEFF PO�CY EXP LIMITS L R GENERAL LIABNTY EACH OCCURRENCE E 1,000,00 A X COMMERCIALGENERALLIARILITY X CPPI03830001 03/09112 03109113 PREMISES -RENTmelxe E 300,00 CLAIMSWADE OCCUR NED EXP(My one person) $ 10,00 PERSONALBADVINJURY S 1,000,00 GENERAL AGGREGATE $ 2,000,00 _GE]" AGGREGATE LIMIT APPUESPER: PRODUCTS-COMPIOP AGG $ 2,000,00 X POLICY PRO- L� E JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT E 1,000,00 • X ANY AUTO CPP103829901 03109112 03/09113 (Ea accident) BODILY INJURY(Per person) S ALLOMEDAUTOS BODILY INJURY(Per accident) E SCHEDULEDAUTOS PROPERTY DAMAGE X HIREDAUTOS (Per accident) $ X NONOWNEDAUTOS $ b X UMBRELLALIAB X OCCUR EACH OCCURRENCE S 1,000,00 EXCESS LIAR CLAIMS-MADE AGGREGATE $ 1,000,00 • UM6100639001 03109112 03109113 DEDUCTIBLE $ X RETENTION E 10,000 $ WORKERS COMPENSATION WCSTATU- OTH- AND EMPLOYERS'LIABILITY YIN OFFICER/MEMBER PROPRIETORIPARTNER/EXECUTIVE❑ NIA E.L.EACH ACCIDENT E EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE E Ifyea,desw under DESCRIPTION OF OPERATIONShelmv E.L.DISEASE-POLICY LIMIT E DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Sign Erection,Installation or repair.Subject to policy terms,conditions, limitations,and exclusions. JOB:Guardrail City of Ashland is Additional Insured per form WNGL52 01109,attached. CERTIFICATE HOLDER CANCELLATION CITAS03 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 E Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Ashland,OR 97520 AUTHORIZED R_EEPPREESENTATNE v^ �' ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD Beecher Carlson 5/24/2012 1 : 12 : 49 PM PAGE 2/002 Fax Server �'•� a plwODmvv7. CERTIFICATE OF LIABILITY INSURANCE 50aTF 124lz0l2 THIS CERTIFICATE IS ISSUED,AS:A.MATTER.OF.INFORMATON ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATNELY OR NEGATIVELY AMEND; EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE 00 INSURANCE DOES NOT CONSTITUTE.A CONTRACT'BETWEEN:THE ISSUING:INSURERIS), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER - IMPORTANT: If the cenlBCate holder Is an ADDITIONAL INSURED;the pollcy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to. the terms afid'tondltlons ofthe:policy,Certain pollras may require an endorsement. A statement On this'mtlfloate does net Center nghtS tOahe, ceniffaAs holder) Alau ofsu:h andorsement{s). PRODUCER. NAMEA Larry' Thompson Beecher Carlson Insurance Agency LLC P11Of'E ..1541)772-1111 FAr k1: (541)192-3985 707' Murphy Rd _ _E .larry:thoaq�s�Ti @beeoheroail�on:oom IN$LRE 'APFORUWGCOVERAG['. NA1C,* Medford. OR 97504. INSURERa SPSE 52412 INSURED - INSURERS: Gagc It Construction LLC 114URER C: PO 'BoX 3463 INSl1R51i Dn . . . . . . . . . INSURER E Central Point OR 97S02 1 tWUAsR : COVERAGES CERTIFICATE.NUMBER:2012-13 WC. Cert's- REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED.BELOW HAVE BEEN ISSUED TO THE INSURED-NAMED.ABOVE FOR THE POLICY.PLE1RIOD INDICATED. NOTWITHSTANDING ISSUEING.ANY Y REOUIREMENT IN..TH,TERM OR CONDITION OF ANY E POL4GT OR DESCRIBED D HEREIN I SUB ECT RESPECT ALL VHE T MS. rER7IFICATE MAYBE ISSUED CR MAY P OLICIE.:TNE:MS HOM AFFORDED.BY THE POLICIES IDCL IBED'HER'cIN IS SUBJECT TO ALL THE'TERMS EXCLUSION SAND CONDITIONS'CFSUCH POLICIES:lIMrrS SHOVNJ MAY HAVE BEEN REDUCED BY PAID CLAIMS: - LTR 'IYPE'OF WSURAN( POLICY NDABER MI1M1 F MHUCY�V -IJMTS R GENEMAL 1JAStLfrV EACH OCCURRENCE $ >.. i ^pM!AFPCU; f.FNFTik.PB:,f�l'I'rY 'PREMF.;E5 - $ -OLAIMO-MAO.:❑GCWR MCDC P(My..P.n o' $ P£RSUNIt-SAD✓IN;1Jn $ G4M1!l.�L;v,G BEG AT E $ OENL 46GkEGATE.LNIR A'PJES PEF: PRODCCTC+'-COMFNP AGE. ; FALIC9- PRG L5C $ AJYPUTO' BI:D10 NJUKY,P„,.,,-,) $ ALL OWNED T­ SCHEDLI-5D 41TOo BCDIL'r IN,IURW iPSrn_itlanQ $ '. .HREPA TO S AUTOn ior;--Mrinarc t UMBRELLA LA6' - OcCUF. E> ,HDCCLRPENCE $ EACESSVAB' - C{:JfAS#IAJE" A,CPE,-ATE $ UEE - FE'ZVIIONk $ A WDWERSCOMPENSATION NC STATU-. OT£: .ANDEMPLOY4S LIABILITT " ` e ANY vRewlETr vnR raRlor�c,l VE YIN E EA`r ACCDENT $ 1 1 000 DOO UFFICE�,613FP EXC UDE31 '� N/A (1/2012 /nd.N 10NH) S62c O E Dl, Ax-tA FMPI 01t d S d. 000 000 O:F V,MScrON OF yr DEb_RIPTION DECPERAT kiR5ha,x EL.GIStiaz..POUCY UMp' $ 1000 DGO O..9CRIPnONOFOPE MONSILOCAMDNSt%SHICLES (Almch ACORD IW,Addltl.n4R..k.SeNddulgA+moie ryecelda'dqulied) Re'. Verif-ication of Insurance This fora is subject tc poliay.'temns, c..iditi-ons, and oscSu'sioiis. CERTIFICATE H Q L ER. . . . . . . . . . . . . . . . . . . . . . . . . . C NCE l MON (541)408-6006: SHOULD ANY OF THE ABOVE DESCRIBED POLICIESME CANCELLED BEFORE. THE EXPIRATION -DATE THEREOF, NOTICE. BE DELIVERED ff. City Of AShland ACCORDARCE:WITH THE POLICY;PROVISION& 20 East. Main 9t ,Ashland, OR 97520 Aurtpra2BU Re?!?ESeNrnnvE arrf'T1t'onl[isoT./LARRY i�� > rta.3ai.-» ACORD 25(2010/05). 01988-2010ACORDCORPORATION. Allrights.reserved. INS025(nim,01. The ACORD name and logo are registered marks of ACORD. '.�! Y RECORDED Page 1 / 1 CITY O F DATE ASHLAND ' . PO NUMBER'. 20 E MAIN ST. 6/1/2012 10894,� .:. ASHLAND, OR 97520 (541)488-5300 VENDOR: 005867 SHIP TO: Ashland Public Works GAGE IT CONSTRUCTION, LLC (541)488-5587 P O BOX 3483 51 WINBURN WAY. CENTRAL POINT, OR 97502 ASHLAND, OR 97520 FOB Point: Req.No.: Terms: Net Dept.: Req.Del.Date: Contact: Scott Fluery Special Inst: Confirming? No Ouanb Unit Description - Unit Price. Ext.Prlce Guardrail Installation 2,895.00 (M North main Pump Station Contract for Goods &Services Beginning date: 05/21/12 Completion date: 06/21/12 Insurance required/On file SUBTOTAL 2,895.06 BILL TO:Account Payable TAX 0.00' 20 EAST MAIN ST FREIGHT 0.00 541-552-2028 TOTAL 2,895.00 ASHLAND, OR 97520 .Account Number -: _.Project Number. Amourit Account Number - • Project Number _ . =Amount E 260.08.12.00.704200 E 201207.999 2,895.00 2e/L Au waed Signature VENDOR COPY ' FORM #3 CITY OF A request for a Purchase Order ASHLAND REQUISITION Date of request: S ta(ze tz Required date for delivery: AsoP Vendor Name ( E =t CONISMUcnor­A Address,City,State,Zip gg7i3 d QLL, r>¢ ice. Contact Name&Telephone Number T� �s3�H of iiltl - ��9 -7co7 Fax Number SOURCING METHOD ❑ Exempt from Competitive Bidding ❑ Emergency ❑ Reason for exemption: ❑ Invitation to Bid (Copies on file) ❑ Form#13,Witten 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 V1 Direct Award Date approved by Council: Contract It ❑ VerbalMritten 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 $5.000 to$100 000 ❑ W tten quote or proposal attached Agency ❑ (3)Written quotes attached ❑ Special Procurement Contract# PERSONAL SERVICES ❑ Form#g,Request for Approval Intergovernmental Agreement $5.000 to$75,000 El Written quote or proposal attached ❑ Agency ❑ Less than$35,000,by direct appointment Date approved by Council: Date original contract approved by Council: ❑ 3 Wdtten proposals attached Valid until: Date (Date) Description of SERVICES Total Cost ' (ouA�p2s�i�. .7_rcSt'A c.l_,F�a—r cr1 �. tJoaxtA Wary Duun,p � �1 $ 7SR S .CZ Item # Quantity Unit Description of MATERIALS Unit Price Total Cost ® Per attached quotelproposal TOTAL COST Project Number Z o_ui _- 64 Account Number AccountNumberZl�b_-o9-!?-CO - 704l00 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: IT Director Date Support-Yes/No By 4signin ' reu isiton form,l certify that the City's public contracting requirements have been satisfied. Employee Signatu Department Head Signature: (Equal to of greater than$5,000) Additional signatures(If applicable): Funds appropriated for current fiscal year: YES / NO Finance Director-(Equaltoorgreaterthan$5,000) Date Comments: Form#3-Requisition