HomeMy WebLinkAbout2012-140 Contract - Marquess & Associates Contract for PERSONAL SERVICES less than $35,000
CITY OF CONSULTANT: Marquess &Associates Inc.
ASHLAND CONTACT: Rick Swanson, P.E., G.E.
20 East Main Street
Ashland, Oregon 97520 ADDRESS: 1120 East Jackson, PO Box 490,
Telephone: 541/488-6002 I Medford, Oregon 97501
Fax: 541/488-5311
TELEPHONE: 541-772-7115
DATE AGREEMENT PREPARED: May 25, 2012 FAX: 5411,779-4079
BEGINNING DATE: May 22, 2012 COMPLETION DATE: December 31, 2012
COMPENSATION: Not to exceed $5,000.00 per the proposed estimate attached as Exhibit C.
SERVICES TO BE PROVIDED: Special inspections and materials testing services for the Fire Station 2
construction project per the proposal attached as Exhibit C.
ADDITIONAL TERMS:
FINDINGS:
Pursuant to AMC 2.50.120, after reasonable inquiry and evaluation, the undersigned Department Head finds and
determines that: (1) the services to be acquired are personal services; (2) the City does not have adequate personnel nor
resources to perform the services; (3) the statement of work represents the department's plan for utilization of such
personal services; (4) the undersigned consultant has specialized experience, education, training and capability sufficient
to perform the quality, quantity and type of work requested in the scope of work within the time and financial constraints
provided; (5) the consultant's proposal will best serve the needs of the City; and (6) the compensation negotiated herein
is fair and reasonable.
NOW THEREFORE, in consideration of the mutual covenants contained herein the CITY AND CONSULTANT AGREE as
follows: 0
1. Findings/Recitations. The findings and recitations set forth above are true and correct and are incorporated herein
by this reference.
2. All Costs by Consultant: Consultant shall, at its own risk and expense, perform the personal services described
above and, unless otherwise specified, furnish all labor, equipment and materials required for the proper performance
of such service.
3. Qualified Work: Consultant has represented, and by entering into this contract now represents, that all personnel
assigned to the work required under this contract are fully qualified to perform the service 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.
4. Completion Date: Consultant shall start performing the service under this contract by the beginning date indicated
above and complete the service by the completion date indicated above.
5. Compensation: City shall pay Consultant for service 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.
6. Ownership of Documents: All documents prepared by Consultant pursuant to this contract shall be the property of
City.
7. Statutory Requirements: ORS 279C.505, 279C.515, 279C.520 and 279C.530 are made part of this contract.
8. Living Wage Requirements: If the amount of this contract is $18,890 or more, Consultant 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 service work under
this contract. Consultant is also required to post the notice attached hereto as Exhibit B predominantly in areas where
it will be seen by all employees.
9. Indemnification: Consultant 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 Consultant(including but not
limited to, Consultant's employees, agents, and others designated by Consultant to perform work or services
attendant to this contract). Consultant 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.
10. Termination:
a. Mutual Consent. This contract may be terminated at any time by mutual consent of both parties.
Contract for Personal Services,Revised 06/30/2011, Page 1 of 5
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 Consultant, or at such later date as may be established by City under any of the following
conditions: I T.,
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 Consultant 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 Consultant 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 Consultant's performance of each and every obligation and duty under
this contract. City by written notice to Consultant of default or breach may at any time terminate
the whole or any part of this contract if Consultant 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, Consultant shall immediately cease all activities under
this contract, unless expressly directed otherwise by City in the notice of termination. Further, upon termination,
Consultant 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 Consultant for work performed prior to
the termination date if such work was performed in accordance with the Contract.
11. Independent Contractor Status: Consultant is an independent contractor and not an employee of the City.
Consultant shall have the complete responsibility for the performance of this contract. Consultant shall provide
workers'compensation coverage as required in ORS Ch 656 for all persons employed to perform work pursuant to
this contract. Consultant is a subject employer that will comply with ORS 656.017.
12. Assignment and Subcontracts: Consultant 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. Consultant 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.
1.1 Default. The Consultant shall be in default of this agreement if Consultant: commits any material breach or default
of any covenant, warranty, certification, or obligation it owes under the Contract; its QRF status pursuant to the QRF '-
Rules or loses any license, certificate or certification that is required to perform the Services or to qualify as a QRF if
consultant 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.
14. Insurance. Consultant 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. Professional 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 claim, incident or occurrence. This is to
cover damages caused by error, omission or negligent acts related to the professional services to be provided
under this contract.
C. 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.
d. 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.
e. Notice of cancellation or chan e. There shall be no cancellation, material change, reduction of limits or
Contract for Personal Services, Revised 06/30/2011, Page 2 of 5
intent not to renew the insurance coverage(s)without 30 days' written notice from the Consultant or its insurer(s) to
the City.
f. • Additional Insured/Certificates of Insurance. Consultant 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 Consultant's services to be provided under this Contract. The consultant's insurance is primary and
non-contributory. As evidence of the insurance coverages required by this Contract, the Consultant shall furnish
acceptable insurance certificates prior to commencing work under this contract. 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
Consultant shall be financially responsible for all pertinent deductibles, self-insured retentions and/or self-.
insurance.
15. 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 Consultant 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. Consultant, 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.
16. 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.
CONSULTANT, 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.
17. 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. Consultant
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 Consultant, with no further
liability to Consultant.
Certification. Consultant shall sign the certification attached hereto as Exhibit A and herein incorporated by reference.
onsultannl: City of Ashland
By *S-- ' " ( ;K, By
Signature Depairtment Head
ArC* (r rey, 1-J-01`1'00 K,+A"s
Print Name Print Name
Ile Cr4_ w�? ✓ttf i � _ l q /Z
Title S Q c Date
W-9 One copy of a W-9 is to be submitted with
the signed contract. Purchase Order No.
Contract for Personal Services, 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.
/ r S- 3/-/Z
Contractor (Date)
Contract for Personal Services, Revised 06/30/2011, Page 4 of 5
S:
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• u 11 ` E V ✓ P 541-772-711YOUR PROFESSINAL ENGINEERING TEAM 5 F 541,779-4079 •120 FAST JACKSON PO BOX 490'MEDFORD, OR 97501
& ASSOCIATES INC
EMAIL:infoCmarquess.com WEB:www.marquess.com
May 16, 2012
Jim McNamara
McNamara Engineering
1007 Ashland Street
Ashland, Oregon 97520
RE: PROPOSAL FOR SPECIAL INSPECTION AND
MATERIALS TESTING SERVICES
ASHLAND FIRE STATION#2
ASHLAND, OREGON
MAI PROPOSAL NO. P12-9076
Dear Mr. McNamara:
We are pleased to provide this proposal to perform special inspections and materials testing
services for the above project. The special inspections and testing will be for concrete, rebar and
steel. Our structural steel inspection services will be limited to inspection at the construction site
(we will not budget for shop inspections, but can arrange for these inspections by a firm local to
Redmond on your behalf).
Arrangements
Based on our understanding of the scope of work, we estimate the total cost of our services will
be on the order of$5,000.00. Our breakdown of the costs is shown on the attached estimate.
Our budget is based on 12 visits for concrete inspection/testing.and 4 visits for on-site structural
steel inspection. Our actual cost would be based on the number of pours and callouts to the site
and these visits would be under the control of the Project Superintendent.
We propose our fees for the work be based on actual time and materials spent on behalf of the
project. Our fees would be based on the rate and materials costs shown on the attached Schedule
of Charges. The rates shown on both the estimate and Schedule of Charges are based on
standard time. Premium time at 1.5x the standard rate would apply if work occurs on weekends
or holidays, or if on-site field work starts before 7:00 a.m. or extends beyond 5:00 p.m., or if
field time exceeds 8 hours per day of the project.
All services rendered by us consist of professional tests and inspections made in accordance with
generally accepted principles and practices in Southern Oregon. This warranty is in lieu of all
other warranties, expressed or implied.
Jim McNamara
McNamara Engineering
May 16, 2012
Page 2
Under no circumstances is it our intent to directly control the physical activities of the contractor
or the contractor's workmen's accomplishment of work on the project. Our field representative's
presence on the site is to provide the owner an on-going source of professional opinions based on
the field representative's tests and inspections of the work and does not include any
superintending, supervision, or direction of the actual work of the contractor.
When you are ready to authorize the work, please either sign and return a copy of this proposal
to us or send your contract to us for signature. If you have any questions, please call.
Very truly yours,
MARQUESS &ASSOCIATES, INC.
Rick Swanson, P.E., G.E.
RS/rlo
Addressee: email
Jim McNamara(mcnamara a.mind.net)
Attachments: Estimate
Schedule of Charges
AUTHORIZATION
Approved By Date
7
MARCUL ✓ ✓, P 541-772-7115 F'541-779-4079 1 120 EAST JACKSON PO BOX 490 'MEDFORD, OR 97501
& ASSOCIATES I N C EMAIL:info @marquess.com WEB:www.marquess.com
SCHEDULE OF CHARGES
Special Inspection and Materials Testing
May 2012
Concrete and Masonry Field Testing Technician ............................................................$50/hr
Welding, Bolting, and Epoxy Bolting Special Inspection ...............................................$55/hr
Fireproofing Special Inspection and Testing...................................................................S55/hr
FillCompaction Testing..................................................................................................S55/hr
Concrete and Prestressed Concrete Special Inspection....................................................S55/hr
Masonry Special Inspection.............................................................................................$55/hr
Rebar Special Inspection..................................................................................................$55/hr
Footing Observation by Principal Geotechnical Engineer...............................................$145/hr
Laboratory Technician, including testing and reporting..................................................$42/hr
Concrete Cylinder Compressive Strength, including curing............................................$17/ea
Masonry Mortar Cylinder Compressive Strength, including curing................................$17/ea
Masonry Grout Compressive Strength, including curing ................................................$17/ea
Masonry Block Strength, including curing......................................................................$32/ea
PrismCompressive Strength............................................................................................$125/ea
Nuclear Field Density Gauge(equipment charge)...........................................................$25/visit
VehicleMileage...............................................................................................................$.65/mi
Masonry In-Place Shear Testing......................................................................................$300/ea
Anchor Bolt and Rebar Pull Testing(equipment charge)................................................$25/visit
BoltTorque Testing ........................................................................................................$10/visit
BoltTesting(Skidmore) ..................................................................................................$25/visit
Masonry Moisture Content Testing.................................................................................Hourly
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06-19-12; 11 :44AM; )5417794079 # 1/ t
OP ID:SAW
CERTIFICATE OF LIABILITY INSURANCE °"01I6,19/12 '
-
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: H the certificate holder Is an ADDITIONAL INSURED,the pollCy(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 endomement(s.
PRODUCER 541-773.5358 NAM T" She I Wlrts
Protectors Insurance,LLC
Pilot Rock Ins Agency LLC(CA) 541-772-1906 PHONE .541-842-2968 Fac N,:541.772-1906
Me Box'OR "� s,she w rotectorsins.com
Medford,OR 97501 vR ceR
Karel M.ISOM B •MAROU-1
INSURERS AFFORDING COVERAGE
INSURED Marquess&Associates Inc INSURER A:SAIF CO oration NAICa
PO Box 490 IxwRER e,
Medford,OR 97501
wsuaeR c
,,so RD:
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.
R TYPE OF INSURANCE �� EF PoLVO P LIMITS
POIICV NUMBER
GENERAL IIABIL1iY'
EACH OCCURRENCE S
COMMERCIAL GENERAL LIABILITY PREMISES fEa oc S
CLAIMS4AADE O OCCUR MEDEXP(An ene parson) S
PERSONALSADV INJURY S
GENERAL AGGREGATE S
GEHL AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AGG $
POLICY PRO- LOC S
AUTOMOBILE UAB1u TY
COMBINED SINGLE LIMIT S
I]ANY AUTO (Ea awdM)
ALLOWNEDAUTOS BODILY NJURY(Per person) S
SCHEDULED AUTOS BODILY INJURY(Peraxidad) S
HIREDAUTOS PROPERTY DAMAGE S
(Per acddenl)
NONOYMED AUTOS $
S
UMBRELLAUA OCCUR EACH OCCURRENCE S
=
BXCESS LUU] .u;R ADE AGGREGATE S
DEDUCTIBLE
S
RETENTION S S
WORKERSCOMPENSATION WC STATU- OTH-
AND EMPLOYERS'LIABILITY X
A OFFlP MEMMBERR EXCCLUDED ECG Y� NIA 913785 01/01112 01101113 E.L EACH ACCIDENT S 1,D6D,D8
(aaotlamry ln NMI EL DISEASE-EA EMPLOYE S 11000,0D
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0 SCWPTON OF OPERATIONS below E.L.DISEASE-POLICY UMIT I S 1,000,00
DESCMPTNJN OF OPERATIONS I LOCATIONS I VEHICLES(AMM ACORD 101,AW[Ilona]R.MRe"Schadul0.R more space is m4Wrad)
Fax to 6414885318
CERTIFICATE HOLDER CANCELLATION
CITVASH
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Ashland Fire Department ACCORDANCE WITH THE POLICY PROVISIONS.
Atten Kimberly Summers
455 Slskiyou Blvd AUTHORIZED REPRESENTATIVE
Ashland,OR 97520 WA--
®1988.2009 ACORD CORPORATION. All rights reserved.
ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD
Jun. 19. 2012 1 : 06PM HALL & COMPANY No, 0219 P. 1
Shelbv Pod
From: Shelby Pod [spod@hallandcompany.com]
Sent: Not Sent
To: Robin Otis [rotis @marquess.com]
Subject: Certificate-City of Ashland Fire Department
Attached is the requested certificate of insurance.
Certificate has been faxed to: 541-488-5318
If you have questions or need a change please give me a call at 360-626-2957.
Thank you and have a nice day.
Shelby Pod
Customer Service Agent
Certificate of Insurance Department
Phone: 360-626-2957
Email: Certs @hallandoompany.com
Important Announcement regarding Certificates
( ttn://www.hallandcompany.com/certificate-uodate.oho)
1
Jun. 19. 2012 1 : 06PM HALL & COMPANY No. 0219 P. 2
ACC L7R ' CERTIFICATE OF LIABILITY INSURANCE DATE ,MW 012
08119/2012
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 la an ADDITIONAL INSURED, the pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
the tome and conditions of the policy,certain policies may require an endorsement. Astatement on this certificate does not canter rights to the
certificate holder In lieu of such endorsemem(a).
PROax.ER PhI (580)999.3700 Fa: (360)69"703 C0Np1cT Alma Carroll
MICHAEL J.HALL 6 COMPANY p1jON` 360 588-3700 ° N,; (3 60)698.3703
18660 10TH AVENUE N.E. `
HALL 8 COMPANY =L acafrollehallandcompany.com
POULSBO WA 88370 INSUMNS) AFFORDING COVERAGE NAIC9
INSURER : Travelers Casualty and Surety Co of America 31194
Marquess&Associates Inc INauREaa : The Travelers Indemnity Company of America 25868
PO Box 490 [NSURERC : The Traveleralndemnity,Company 25658
Medford,OR 97601-0033
INauRFA o:
INSUREAE
INSURER F
COVERAGES CERTIFICATE NUMBER: 161969 REVISION NUMBER:
THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOWHAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CON131TION 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.
INS TYPE OF INSURANCE AOUI EUER POLICY NUMBER vaUmJt✓% I Pita Vfw DSmS
IS srraaAL UABILITY 68061481,183A 05/28/12 05129113 EACH OCCURRENCE s 11000,000
X COMMERCIAL GENERAL LIABILITY pR SDE � 1 E 3gg,gOg
CAMS-MADE I XICCCUR I MED.EXP(Anyonape2on) S 5,000
X XCU/OCPGFPD PERSONAL 6 ADV INJURY E 11000,000
X SepBredpn or lneulode GENERALAGGREGATE $ 2,000,000
GEN'L AGGREGATE UMIT APPLIES PER: PRODUCTS-COMP/OP AGG E 2,000.00D
POLICY FXJ PRO- 7 LOC I E
JECT
C AUTOMOBIU-e I--.UTT BA614e14401 06129112 05128113 cmJiilNEO SINeL9 UNIT 1,Oa0,000
Its mdaeno S
ANY AUTO S
BODILY INJURY(For portion) E
AOYdED SCHEDULED
AUTOS AUTOS BODILY INJURY(Pmaoddent) e
HIRED AUTOS NOWOVJED DGE
OS eaI X
i
C uneRaaA UAe X OCCUR CUP3196T698 05129112 05129/13 EACH OCCURRENCE s S,01110,000"aw rs
e s CLAIMS-LADE AGGREGATE s 5,000,000
DED I X RETENnONS 10,000 '7
PARCERe COMPENeATON TORY UM I ER 3
AND 6NPLOYERF NABd1rT
ANY PROPwEroRrvaRrNEwEgcurnE Yin E.L EACH ACCIDENT I S
onNXRM9be[51 rxauxnT a NIA E.L.DISEA66SA EMPLOYEE ' s
tN.d.r.y F NIP)
DESC TI.,�nW E.L DISEASE-POLICY UMIT s
DEecrupilON OF ODFAAnoNS nee. I
A ProreowanM umnny sauna Made Farm 105320166 07/26111 07126112 $1,000,000 Per Claim
DESCFUP 104 OF OPERATIONS I LOCATIONS/VEHICLES(AOrdt ACORD 101,AdOtionsl Remsdrs Sd,eduls,It men spew Is mulred)
City of Ashland Fire Department is an Additional Insured on the Commercial General Liability and Auto Liability when required by written
contract or agreament regarding actIvitles by or on behalf of the Named Insured,The Commercial General Llabllity Insurance Is primary
Insurance and arty other insurance maintained by the Additional Insured shall be exons;only and non-oonVlbuting with this Insuranca.A
walvar of Subrogation applies to the Commercial General Liability,Auto Liability,Umbrella I Excess Liability and Workers Compensation I
Employers Liability in favor of the Additional Insured.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Ashland Fire Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
455 Siskiyou Blvd. ACCORDANCE WITH THE POLICY PROVISIONS.
Ashland,OR 97520 AurHOwgD REpREAENTAnv9 //,�
Attenllon: Kimberly Bummers
Aims Carroll
ACORD 25(2010105) O 1988-20 RPORATIO All rights reserved.
The ACORD name and logo are registered marks of ACORD
Jun. 19, 2012 1 : 06PM HALL & COMPANY No. 0219 P. 3
COMMERICAL,GENERAL LIABILITY
THIS ENf30FtSt bitEN:TGHAHGf 5rTFiE::PGLIGY,PLEAISE.F EP(fJ:IT CAReF V.;
BLANKET ADIDMON 4L 'I!NSU.RED,
(,4R.H17`E�TS, EN0INE,R$. AND SURVEYE?RS}
Thfs and arsemQntirwifevi Pao.WC. „pruaidedunderlhe.tollowtng;
CC'fN}tyIERCIAL GENERAL LIliB1LiTV'COVERiK�E FART
A The follow ng ra added to 1NH.0, I,$ AN INSURED I;N3ul2A NCE (Setltion III) for this Coverage,
Any ,person or orS.grn2! flon itiat yvo agree in 'a B The following is added to Paragraph s,, of d,
oontraet.dr agreem,'eni rAqutnn�lrisurancg"
to ire- tither Insurance i'n COMMpk,0AL"0EISIMAL
crude as arf,aGltlltfohal 'In54red 4P thiS :Covers a LIi�BILITY pi*W 'IONS(Seat on'IV:)
part but dnfy wrih:rdspe4t to liability for"bold in-
y However,:if you specif!Caily agree Ini a :OrilraCl Or
t}(ry pro,petty da„rnaga of "personal InJury. agreement requ!rinq.insuraicethattheliisylranee
darned in WhOB,or in earl, by your ads or:prnis provjded to an,addffonal.hisur9il under Biie'Cov-
slons o[the acts or om!sslo s uf4hose:eaing"on: erggp. Part musk:apply on 'a•piirnary basis, dr a
YOU fi'eitalF primary and norr soniributotY basis, this lnsumw
.a; .tit tha paffbrthanGe:of your ongoing were- is prifiiary to ether insurance P1811s.2vallapl'e•to
lions; such_:addiflonal?insured' blt[eh:roVers such' eddi
b in :ipn Y 1iop with pr.&rL-S o+Ameil by yak tionei insured:a§8sriafTred'insured sort we yp11i sot
Yented'tn°you,:of sf ore With rite other insurance, pymi.040 that-
.
z to cerijjeetlon {4iih u'r *&1k' and.:Lncluded' (ll The lbodily injiury!` or "{iroperty damage% for
wiffii t ;the. "yraduefs romp.1gtefd :operaNtSns wfth..coverage.ls eought;occurs;and
f1g7_ptEl°; (2) The "personal '.ojury, for which.covaraya is
Duch:.person br`sor,'gafiizetldn dgt!i, not,quali y as' wught arises dut ofan:offense comrrked'
an adifitfooal lhsured for bodily iFilufy" •p.foperty after yGu have .entered Into Ihet "contradt or
damage"'or personal nyury" for wfifch that,par- agre0ment requiring insurance". Bt!1 We Insur-
sdnaor'org MnoonhasassU.gted.l3ablQty.44'a.cbn- antegollis'excess:over wi�dslidcollec5bla%har
iract;oragreeit,ant;. Inievarice,wh'etlier prlMary excess, 'cunt ingefil br
TheJlosuranee pi vl imd'to stith a00 onal:impiod an any ether bass(A,tftat iB Qveilablq-to the ii6sueed.
is.NtnUad ae foilgVrs; when•tho Insured f5:an arldiGonal fasu ti :under
d. Thts:i,su[ancfl doe's not ap'pl'y on any;ba81's tq any olher'lnsuranCe,
any.peison or argantza;ion for which ooven 1,. The following i9 added to Paragiaph $; Transfer
Age as an adtiiUuiral insuhed specifically is or Righto Of Recovery Against Others To 1!s
sdtleti.by another endorsement to ilifs Saver-. n OpM.MERCrAL GENERAL LIABILITY C,ON•
age Part. 6i'n S(Sect ken lY)
a,. Ciiis;itsurdnb ..rJee§
not..epply.fb'ths::rerideF We waive any.rlgtlSS of racoVery,ive .rney,have
(ng':of gr PallUre to render any prpfr'sstbriaf agatnsf arty per a dfganl�aGQn be�ilse of
aerUices'.! payments Nre.make•for "bo!d!ly.inlut�!";. `'propbffy
$ The hrrilts of ihsurance affbrdetl tp.tTte,sdtl)+ dama�P•`'or aper=sons. inlury ati$!Og out.dfi 1ol)r
tfonal:ihsured .s6h be.ifre liitvts which yop Work":pefiormed,by;you or on your .:oh f;:u( far
pgryed In- ar"icontrad orligreeorien( iepuir- a w4att or 44re?]Went regllirJtiq fnsurahci"
ing insl3r3nco' to'ertwlde'fpr f t additrlal first, person or organlaatlon: We wOva Itfresa
fnsgred', or the:ljntlts e1 oWn m till Rr d(srp, n6. :drily where you ,have':'agreed to Bo so as
tfons.for (firs Coverage:Part. afilchever are, par,of'tha"Cpfttrad:or agreernent faqulring•:t[isur-
Iewl -this eridois'i ant does:nett increase.410 ariW .Willi such. person or orgarittatlbn Atite(ed
rlmtls:4f insurance gfl#ed in the LCIW is OF into,by you.betoro, end In effo(t wmri,the%aoily'.
CG:03 B7 OtFDT etzoarinm•Treaer�'s:comaamea.inc, 'Page,j oL2
lFli3WB56re capytreriled material,al:7frsuraaCe•St',lrica5.ijfflc4'Ine wl!M.ilt pa"irt9slcVi+.
Jun. 19. 2.012 1 : 06PM HALL & COMPANY No. 0219 P. 4
Cb IVIERICAL Ggk,4,F A�:UAB,ILITY
njury"or '(teoperty damage" oca ia; or Ilia "per- eiage. Karl, .provided'that the "bodlty IhJury' end.
sonal injury"offens@iSCOmmtted, property`.dornage' ozvum. and:the pem'6nsIin
D:; The (pllowlr�q daflnhipd is added Yo DEFINITIONS joy. Ig oaused,by an offense committed:.
(39,00on,vi: a. Aftd'r you.have entered:into ihat.cori„traat or
"Contract. pr' 'agreement reQUinng .in'surance" agree;mertt;
meanstHat pall of any conttaci;Qt egr'9e7T erif till b. While thaj Pate,of the,coritradt or agre*ent is
der;lvkd pis'are requlred'to'Include a,person:or in effect,and
pfganiiation as ar addibpnal ln„stired on thl$Cov- e. Before the end:of the policy,periCO.
Paga2'of 2 m2o0Y3AeTr8yeleis.CoQpaniag,lnc. CG D&8S O9.07
Includes,lha•copYri9„fed material;of Insurance 5emkexv6ce;`Ina.Wlh.(is permission.
Jun. 19. 2012 1 :06PM HALL & COMPANY No. 0219 P. 5
qQW4,ERC1ALAU1T0
THIS ENDORSEMENT PHANGFS THt POLICY. PLEASE READ IT CAREFULLY.
AUTO TO COVERAGE PLUS ENDORSEMENT
diP ovided,under the fbiibwln
Th m
Iteodbehientimo esinsurancepr
BLisi:N.Eq8.AUT'Q COVERAGE FbRM
Wilh.regoect to cove*6 ptovIdSd.�b this 6b4orsEinmnl;.the:provtsichs..of the Coverage Form apply unlessjbodi-
PSI.by the oer)dbrsemenl..
btcfadleng.cdviardge. However, abOreog for any
Ii.ljij ry.,dAmA& oe,rn0qicW. . ..expenses. d Sol #ndorso 9x
rl*rd may b;% &id4d or
lthiiedbyqnclth&endorsement to ihe 0.0irOgO:Parij,and thes.e.tovetage br.cade.hihg§r.qvNlchs do not apply to
ihe extent I.Jhaifcoveraga.A§ excjudeOor Jlrni60.y.such an and, oft. em dril(;Jh The following IiMlnq Is!a genor-Al 0 1 0,;W-
age description anly unnittitlons end 61461usioris may apply to the prj)'yisfdns'of tNp en-
dorsementurd.-M,e:rest of-your.po1.1iayoardfujIytqdoWmifne rights, Odes., prid, what mend to not covered;
A. SLAWti-A00TIONAL,114SURED H. AUDID, VISUAL AND DATA, ELECTRONIC
9. EmmbytP HiRiffnAUTO EQUIPMENT—INCREASED LIMIT
C: f MPLdV-,EES.ASIOSURED I. WAIVIEROF DeDucTielim—GLAss
Q. SUPPLEMENTARY. PAYMENTS INCREASED J. PER9bINAL EFFECTS
umn's K. AIRBAGS
E. '.TRAILERS'—INCREAS
E151DAO'CAPAcrm L AUTO LOAN LEASE GAP'
F. HIREVAU.-TO PHYSICAL DAM.AGE. K BLANKET WAIVER:0F%mR,()GATION
G� PmysitAL uAmAde " TRANSPORTATION
EXPENSE$ INCREASED LIMTr
A. BI.AkKETADDITIONAL.INSURED; per.f.brriniOg duties elated to zhA conduct of
Thefollbwiriqls..added dd,to PardgrapfiA_1,'Wh9 Is yourbusilhetA'.
Ail InSd.Vad I Of SECTIO N
t — LIABILITY C614 2,, The follp"rig replaces Nr6gegph b, In
ERAGE ottbr lnsui"ca:
ofSE67IIiONN' — SUSI.
Any person or orgenlzetlon W hq.:!p required under NESS.:A.UTQ CONDITIONS:,
a W6tteln r0tltad or Sgreernertt.betwftri.YoLt an bi For Hired Auto.Physicel Damage cover-
that pers0ni or brgapIzation, Inat Is siw* end. age i the following pre,deemecj 40 15e:cow
0 i!d tly
xe, e 1'dutoA°you,,Qy4v::
yQij before 1he. "bodily InjQry�,:of ered
occurs and that is In.effpcs.
(j). Ar,%y wvered "auto" y6b lea4aj, hire,
d . bo�naned�s 6).4ddl-
h
eertor borrow and
tional.InSurbd-is an "insUP60 ior Lability cov.e.r
a0ei b4bn*for damaget,io.whlch:ihlt:tnsuratice (2) Any,covered"autd-hired of rented by
spp M
a ,ority-to,She� extent that person or or- your 'employee under a mr,&act in
that Individual employee's" name.
n idni qolltiog as An:"Insured" under the. yeels"
VAh yodr.. permission; Whlid perfibrmi,
160. duties related to the co ridact. of
y6urlbudlrjess.
9. VMPLQYE01iRED AUTO:_ .
However,any'"auto.0 ihait is leaised,.hirdd;
The' followilmig added to Paragraph. AA.,
rented or borrowed iovfth a anver Is not.a
Who IS;An Insurddi Of Sr=,QTION. 11 =,L(- covered '!aU0.
41 ? ITY COVERAGE
Art ernp)oy.oq`of i your.9�Is.,an 'InWrW while C. EMP I LOYEES A$INSURED.
'Thel.followng lsdclded.to.Paragrap�:A.1., Wh
opera0rig a �qovd]TO, aditcl" hired or rked is
under a. contraO* qrpqr�4rnerit 16 that "enl� An filauted, of SECTION II:—LIABILITY Cov-
pioyeo' �i ; �, r ERAGE!
:a name, Wt your;perm
0A,T4 to.07'10 kl 0-rho Trplleri Inamydity Ooavany.AJI 6hta romivaa; Pa04 I of 3
WoyAghted.n)2tqK.o11,. I a 6,with iiMpe"sim.
Jun. 19. 2012 1 : 06PM HALL & COMPANY No. 0219 P. 6
CQF4MFRCiAL,AVT0
Amy. `.e'rnployee",gf yours is ab insureda'While use (3) .11 a repeh or replaCament results In hatter
140 a covered"a[iTa": c u do l omi Tt hire or:borruw than like.:kind or qualify, We.Will not'p'syfor the
1rt
D, yggr buslhess:od you :peroal:effalm ®rount:of belterFnr.
UgN '
P'LEARY PAMENTS
– INCREpSEp (a) A:dedttctjble equal zo the :highest Physical
LIMITS lbatnage dedudlble.applldabte,to. arly owned
1 Yho Toilounhg.repeces Paragraph A4 0,(2) of coverod:"auto":
SEC{lON IF=LIA61L4TY CAVERAGE:, (5) `f iC tegslat does hot PE ply la;
(2) 00. to 2.3* for cai;t i5f.ball.•honds.((er (a) Any "atitq that 'is fiiied,. :rented or bar--
:c3ud,1'no bands W ralatad treffrc law-viola= rowed Will a.driver or
tlonsj requteed. because of an `acciddne (b) Any"660 that is hired rented' or b; r
we rover We do:not. have 16 fur#ilsh rowed front your"employee',:
these bonds.. G, .PHYSICAL DAMAGE – TRANSPORTAT IOW
2 The.followingreplacesParsgraphiA2:a;(4).oF Ej(gENSE'S–INCREASED LIMIT
SECTION If LIiB1L1T`If'COVERAGE:
(4),*1 reasoPebte expenses lneutr„gd.'by the The:following:repleoes the�first sentence In Para.
°areured of our r @glt Sl Ihcludirlg`:a'ctftal graph A 4:a., T.Panspoifa#brl EXPensas of
SECTION. 111 – PHYSICAL :DAMAGE COVER'+
loss of:earning"s; up.t6 060 d day tie= AGE6
cause oftirrb off fie Wbrk.
E. TRAILERS—MCREASED,LGAD CAPACITY' We Will f ay'4p to 350'Per t to a mexlmum of
$1,$DO' (or teniporaTytrartispoftation.ezpenge in.
The follvwptg replaces Paregca—h :0-1,..of SEC. carted byyou:6eeawe 0(the total:theftof a cpv-
TION I—COVERE D,At1T0$,I Bred'"auto°of'the:pr&ate.passenger type.
1C. "Tralfep5 'With, a load eapnefty of S;gF1Q H. A, U,DIE3, VISUAL. AND DATA ,ELEGTRONI.0
p'bwhds' or less dealgned printarlly for #gvel: EQIRPMENT'—:INCRFAtiSED.LIMIT
on.pybllgroads, Paregrapk C:Z. LIInR OF Insurance, of SEC'•
.F. HIRED'.AUTO PHYSICAL DAMA40E TEON 0 PHYSICAL DAMAGE COVERAGE: is
Thefbll4Wlnit( adijad to
agB EXtQ Para).E,aph A.4. tt deleted ot
nsrads otM. 6N11 1
'PHYSfC;L I,, WAIVER OFt]EDUCTIBL,E–GLASS"
dAfl1gGE COVERAIGE;.. Tlie following 19',added:fe.Paragrapft Deductl-
Hlred.Autq 0."1"1 DamageCoyeiage ble'. of AECTLON 111 PHYSICAL UAP/IAGE
ff.hired 'autos' ere covered.'autos"for. Liability COVERAGE:.
Gavel'aoe but not covered `autos` for Physieat No'deductible.':for a:covered:"auto will apply to.
Darrmj Coverage:and thls;Policy also,provides glass:deri5'age ff'lhe glass is repalred:rather.than
Physiaaf Demege Goverage.:for:en pWned."auv!', replaced:
them the•Physical'Nrnage�Coverage is extended J. PERSONA.L ERFEC.S
tovaufos'thatyouhlro„.tenvoriborrow'subjjecttq �efolla trg;is.edrledavPatro ra hA4 Coyei-
the idAoviing.. g P
(1) The.most we;will pay for: "jpss” ky:an one aga EZtanaioha, of SECTION III – PHYSICAL
Any,. DAMAGE COVERAGE:
'accident".to :a:hired, Tented or bgrri wed parabEff9eta Coverage
'��utcy 9s,the;l'eSSeC.PPI gph
(a) $50 000; Wg y ill pay up.W.4400'for 'loss" to wearing ap.
(b} The aGUal cacti valtte of the darrlaged:pr parel;and other personal bffems Whlch'ate:
stolen propertyi as of The tl'rne of the f1) OWn.A by art"Insured and
. "loss.,oe (2) :1n,OrQp,youf:CoYered'"atho",,.
(c 7hQ cast' of repai flhg,or replacing the Thig::coVetage only appltes in the.eyebt d a total
ffalnaged o'r stolen,prorrertty.Q 4 etn;el' theft:of Your coVered'Iauto">
pfoportY 6f.'IIRe k nd andiqualtty, No 'deductibles,apply. to- P;ersgnal,Effe* rover.
;) Aq adjustment for depreciation arldl:physical age:
c4ndtpon wlfl.bO M'061: In Aeterrrilfyjny adual
t h;valuer it it*eu2nt'of'Ootallow..
Page2`pf.3: 6201s;fieTrdviOrmjtki tnitycompany,Allri"resmad. CAT490'0.7 10.
lnr<(u{1ds:Wppdphted'rr�atorial
l6 .. easeruiaes.cl(rr ,lri' wrm Its.'pertnisgim
Jun. 19. 2012 1 : 07PM HALL & COMPANY No. 0219 P. 7
COMMERCIAL AUTO
K. AIRBAGS (2)..An
The foil=is added to.Paragraph ft&, Exclu- (i) Overdue lease or loan payments at the
Sion, C-1110N III: - PHYSICAL. IJAMAGIE tirne-6f the "loss."
I;GvEkAde
(b) Finah.clal pensitiesi imposed under a
Euctusion la,doss:not apply to loss" to ona or Jesse for excessive
sasive U e, abriorMW wear
more qjtbn'gfi in.6 coveted:"auto"you oWti.Ahot.i ri= and-teat or high mileage;
flats due:to cause.other.than a cause;of.4JQ94" .(r) Secuilty deoosRs not,returned py the Jes-
set f6eitt :In paragraphs ,A.11,4. and, but
ohlyr
(0) costs ir�r e.XteR0ed:werrantlaa,, Credit Life
p;,, If that 'auto"It.a 66.ver6d:'vautw forc'ornped- Insurance, Health,.Aeddent Or DisabjItty
k4nWa CoVdjjgd Jfidar this polldyi
Insurance purchased whii. She,' lop n or
b. The airbags are not covered under any Warn lease;and
(a) Qarry-over bafahces from previous loang
hotjnAsntf
c_ The qIr.hag§,*erd orleases.
.We YAII pay up to e.maximum of I 1,00a for any M. BLANKET WAIVER OF SUBROGATION
one The following replaces Paragraph k&, transfer
L. AUTO LOAN LEASE GAP Of Rjgh(s Of Recovery Agains •Others To Us,
of SECTION. —
The,f0owlhO is added to PersorsphA4., Cover- IV :BUSINESS :AUTO t;.0N1D(.
eae Ejfthsloris. of SEVnON 1,11 — PHYSICAL PHYSICAL TIONS:
DAMAGE COVE"GE: 61 Transfer.Of Rights Of li Against
Apto Loan Loate Gap Covered# for PrIvata Others To Us
Passenger Ty.paVehlcles Wi3 waive any right of recovery we may have
In the eov sr)t-of 4.io t6l*.Iosso t:o,a co vere d.:uAdto'of agatnAl!ahy person-Gr,organization to the ex-
the priva le pagabrgar type shown I n th e Schedule lent reiluired of you by 6 written.contract-exe-
I)arna cuted prior to arty uac4dent'! or 1OW" pro-
or e COY. vided that the"Acciclanf'or"IoW arises,out of
sraoe Is prbvided,.w6:.\A1I):payany unpaidarnoq0t
d
due pry the leas'a or Idan.for such covered..7autd' the operations contemplated by such icon-
lessthefdlbWlhgt treat.The Walver,ap pl 1"ordy to theperson or
orgianizatiory deslgnated In w6h.contract,
(1) T.Ij&:4*iJht paid driderthia P1hys1dAI'I)6rjjftd
C00tage S00106 df Ih a 0blIcy'for'thaI'weut6w;
and
CA T4','20'4710 Q-20.10'iihe.Trayelers Indemniiy Company.All.eightgrosamad. Page 3 of 3
Jun. 19. 2012 1 : 07PM HALL & COMPANY No. 0219 P. 8
WBRELLA
THIS END01118EMENT CHA:NiM ES THE POLICY. PLEASE READ IT CAREFULLY.
.WAIVER OF OUR RIGHT TO RECOVER FROM, OTHERS
this undee:the 1`011QWihg
C Mx.4tRi0AL tkO, Ett LIABILITY(W(4F ECLA) JNSUFRANCE
The:follow7ho Ws lidded ftzibrap.h il., OUR RIGHT
T6 ex a, Todifylqfuryl or"property damage!' caused by an
COVtFt.'.FKOM OTHERS , of.SECTION IV:
occmrence"thattakes place,or
CONDITT
If tilemsurg'd ha$;!a.'jR*ree iei a.contract or.aq,reement anloffense�'lhavis comrrotte&
to ,ed?s' right povg'y
,4% LAdy
subsequOAt'fp,th e execution.a. fthe
,o corita&or agree=
against such I fi: p—e, Mdri Merit.
or rqahqq_on, b4i only r
p4ymept*we make beca05e',of'
QM 0490;07"08 1.Of I
lWadat 1ha•.66pj4q.h6bd m.aliWel of Ofta,lnci�Wth N.pemisaion.
c CITY RECORDER Page 1 / 1
�. CITY OF
A C LI 7 A 1�T D DATE... _'.:_. PO NUMBER:
AS -
'� 20 E MAIN ST. 6/20/2012 1 10925
ASHLAND, OR 97520
(541)488-5300
VENDOR: 000575 SHIP To: Ashland Fire Department
MARQUESS &ASSOCIATES, INC. (541)482-2770
1120 E JACKSON 455 SISKIYOU BLVD
J.
MEDFORD, OR 97501 ASHLAND, OR 97520
FOB Point: Req.No.:
Terms: Net - Dept:
Req.Del.Date: contact: John Karns- Kimberley Summers
Special Inst: Confirming? No
Description. .__._ = Unit Price - ''Ext;Price._.
MAI Proposal#P12-9076 Ashland fire 5,000.00
Station 2 Materials Testing Services- '
Per attached proposal and contract
Contract for Personal Services
Beginning date: May 22, 2012
Completion date: December 31, 2012
Insurance required/On file
SUBTOTAL 000.00
BILL To:Account Payable TAX 0.00
20 EAST MAIN ST FREIGHT 0.00
541-552-2028 TOTAL 5,000.00
ASHLAND, OR 97520
'Account Number Project Number - Amount' - Account Number- -P.rcject Number .Amount
E 410.08.24.00.704200 E 000175.999 5,000.00
FORM #3 CITY OF
:� , r rn{ ASHLAND
REQUISITION Date of request: 5/21/2012
Required date for delivery:
Vendor Name NINOCiates Tnc
Address,City,State,Zip 1120 East Jackson PO Box 490 Medford Oregon 97501
Contact Name&Telephone Number
Fax Number 541-772-7115
Fax 541-779-4079
SOURCING METHOD
❑ Exempt from Competitive Bidding ❑ Emergency
❑ Reason for exemption: ❑ Invitation to Bid (Copies on file) ❑ Written findings attached
❑ AMC 2.50 Date approved by Council: ❑ Written quote or proposal attached
❑ Written quote or oral attached
❑ Small Nocurethent Cooperative Procurement
Less than ❑ Request for Proposal (Copies on file) ❑ State of Oregon
❑ Direct Aw Date approved by Council: Contract#
ID Verbal itle quote(s)or proposal(s) ❑ State of Washington
Intermedia a Proc rement ❑ Sole S re Convacl#
GOODS&SERVIC S ❑ Written ings(Form attached) ❑ Other government agency contract
$5.000 to$100.000 Writhe ote or ro osal attached Agency
❑ (3)Written quotes attached ❑ Spectal Pr curement Contract#
PERSONAL SERVICES ❑ Written Findings(Form #9 attached) Intergovernmental Agreement
00 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 until: Date (Date)
Description of SERVICES Total Cost
MAI Proposal#P12-9076 Ashland Fire Station 2 Materials Testing Services 5,000.00
Item# Quantity Unit Description of MATERIALS Unit Price Total Cost
® Per attached quotelproposal TOTAL COST
$5,000.00
Project Number 000175.999 Account Number 410.08.24.00-704200
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:
IT Director Date Support-Yes/No
By signing this requis' n form,l certify that the City's public contracting requirements have been satisfied.
Employee Signature: A/h lU (,r1ryvrr 1J Department Head Signature: e a""M
I
Additional signatures(if applicable): qual to or greater than$5,000)
Funds appropriated for current fiscal year �/ NO �
Finance Director-(Equal to or gre er than$5,000) Date
Comments: