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HomeMy WebLinkAbout2012-152 Contract - Pilot Rock Excavation CITY OF ASHLAND ASHLAND.; PUBLIC IMPROVEMENT CONTRACT N. Main/Wimer/Hersev Intersection Realignment Project No. 2002-05 This Contract is between the CITY OF ASHLAND, a municipal corporation of the State of Oregon (hereinafter"City")and PILOT ROCK EXCAVATION,INC. (Hereinafter "Contractor"). The City's Project Manager for this Contract is Karl Johnson, Associate Engineer 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.I through No.1, more particularly described in Standard Condition 5, (hereinafter referred to as "Contract Documents") for its project entitled "N. Main/WimerXersey Intersection Reali-nmene'and WHEREAS, Contractor did on the 7th day of June, 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 July 9, 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 September 4. 2012 or before 58 calendar days following Contractor's receipt of the Notice to Proceed, whichever is earlier. 3. Statement of Work The work under this contract is for N Main/Wimer/Hersey Intersection Realignment, including street improvements, curb and gutter, sidewalks driveways and other improvements 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 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 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 N. Main/Wimer/Hersey Intersection Realignment 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. t 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: Five Hundred Eighty Thousand, Five Hundred forty Five Dollars ($580,545.00) 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): Pilot Rock Excavation,Inc. Contact Name: Rand LeBaron Phone: (541) 664-9288 Fax: (541) 664-9218 Address: 650 E.Pine Street, Suite 102B,Central Point,OR 97502 Do Not Write Federal and State Tax ID Numbers on this Agreement: 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#�I_-btY7 Z. Construction Contractors Board#157139 Citizenship: Nonresident alien No i i Business Designation(check one): Individual _Sole Proprietorship Partnership X_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. I, the undersigned, understand that the Standard Terms and Conditions For Public Improvement Contracts (Exhibit A) together with Exhibits B through J together with all other Contract Documents as described in Standard Terms and Conditions Section 5 below, and the separately bound Oregon 2008 Standard Specifications for Construction, as amended by the City of Ashland's most recent Addenda to the 2008 Standard Specifications are an integral part of this contract and agree to perform the work described in the Contract Documents, including Exhibit A, 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; I 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 ac/tor/: ignature/fitle ate Printed Name: 7?=Ai!4 p LZ&?zepN 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 Approved: Mike Faught, Director bf Public Works, City of Ashland Date -Authorized by Ordinance 3013 and Delegation Order dated June 22, 2010 Coding: Reviewed:` JtE %vRr> IZ ermcfHz (funds appropriated current fiscal year) Date Reviewed. 7 1 / Z � N _David ohm , Cit Attorney (approved as t legal form) Date AAC60r7 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: ✓ (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. ' V/ (2) Commercial advertising or business cards of a trade association membership are tli purchased for the business. (3)Telephone listing is used for the business separate from the personal residence listing. V (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. V (6) I 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. 7//Z ontractor Date Bond premium based on final contract amount. Bond LAX750419 PAYMENT BOND The undersigned Pilot Rock Excavation Inc. as rvincipal further referred to in this bond as Contractor.and American Safety Casualty Insurance Company as surety, further referred to in this bond as Suretv,are iointiv and severally bound unto City of Ashland as obligee further referred to in this bond as City in the sum of Five Hundred Eighty Thousand Five Hundred Fnrty-Flva Dollars Dollars($580.545,00 1. Contractor and City have entered into a"Titten contract dated for the following proiecT N Main/Wimer/Hersev Intersection Realignment. This contract is further referred to in this bond as the Contract and is incorporated into this bond by this reference. The conditions of this bond are: I. If Contractor faithfully performs the Contract within the time prescribed by the Contract and promLv rriakespavment to all claimants as defined in ORS 279C.600 through 279C.620,then this obligation is null and void:otherwise it shall remain in full force and effect. 2. if Contractor is declared by City to be in default under the Contract. the Surety shall promptly remedv the default perform all of Contractor's obligations under the contract in accordance with its terms and conditions and pay to City all damages that are due under the Contract. 3. This bond is subject to claims under ORS 279C.600 through 279C.620. 4. This obligation jointly and severally binds Contractor and Surety and their respective heirs,executors, administrators, successors. 5. Suretv waives notice of modification of the Contract or extension of the Contract time. 6. Nonpayment of the bond premium shall not invalidate this bond. 7. The bond number and the name,address,and telephone number of the agent authorized to receive notices conceming this bond are as follows: Bond Number: LAX750419 Bond Agent: Bond Experts 11, Ltd. Address: 4850 SW Scholls Ferry Rd. Suite 204, Portland, OR 97225 Telephone: 503.292.2582 SIGNED this 9th day of July 2012• PAYMENT BOND Paee 2 WITNESS: CONTRACTOR: PHQ3oc A Excav/lion Inc. By: Ti (Corporate Sea]) Title: /;�acSfPeLJT Legal Address: 5o e pf w t--- sT SrE l `�Q Ga?,J-TMA—Y— Fb I "T, 6YC �75'D Z Attest: Corporate Secretary WITNESS: SURETY: American Safety asualt Insurance Company (Corporate Seal) By- Title: ney-in-Fact Legal Address: 100 Galleria Parkway, Suite 700, Atlanta, GA 30339 i Attest: Corpora Secretary 1 1 i 1( f r Bond premium based on final contract amount. Bond LAX750419 PERFORMANCE BOND The undersigned Pilot Rock Excavation, Inc. as principal further referred to in this bond as Contractor.and American Safety Casualty Insurance Company .as surety, further referred to in this bond as Suretv.are iointly and severally bound unto Citv of Ashland,as obligee, further referred to in this bond as City in the sum of Five Hundred Eighty Thousand Five Hundred Forty-Five Dollars Dollars($580.545.00 Contractor and City have entered into a written contract dated . for the following project: N.MainAVimer/Hersev Intersection Realignment. This contract is further referred to in this bond as the Contract and is incorporated into this bond by this reference The conditions of this bond are: I. If Contractor faithfulh,performs the Contract in accordance with the plans specifications and conditions of the contract within the time prescribed by the Contract as required by ORS 279C 380 through 279C.385.then this obligation is null and void:otherwise it shall remain in full force and effect. 2. If Contractor is declared by City to be in default under the Contract.the Surety shall promptly remedy the default, perform all of Contractors obligations under the contract in accordance with its terms and conditions and nav to City all damages that are due under the Contract 3. This bond is subject to claims under ORS 279C.380 through 279C.390. 4. This obligation iointty and severally hinds Contractor and Surety and their respective heirs executors,administrators.successors. 5. Surety waives notice of modification of the Contract or extension of the Contract time 6. Nonpayment of the bond premium shall not invalidate this bond 7. The bond number and the name address and telephone number of the agent authori7.ed to receive notices concernine this bond are as follows. Bond Number: LAX750419 Bond Agent: Bond Experts II, Ltd. Address: 4850 SW Scholls Ferry Rd. Suite 204 Portland, OR 97225 Telephone: 503.292.2582 SIGNED this 9th dad of July 2012. PERFORMANCE BOND Paee 2 WITNESS: CONTRACTOR: Pilo cavation, Inc. By (Corporate Seal) Title: pn-t;;�rj f G'" { � TJ Legal Address: I~ r 714E sr v { E:IQ ZX CEniTO/A-L Rb IN`f", 632 -75a 7 Attest: Corporate Secretary WITNESS: SURETY: American Safe asualty Insurance Company (Corporate Seal) By: ` Title: orney-in-Fact Legal Address: 100 Galleria Parkway, Suite 700, Atlanta, GA 30339 Attest: Corpor Vlecretary I NUMIRRW LAX750419 A+t�IrfafrsatFrrglr�aevra POWER OF ATTORNEY - ,.. KNOW ALL MEN BY THESE PRESENTS that American Safety..Casualty Insurance.Company has made,constituted and appointed, and by these oo ,., presents does make.constitute andaomts } - - , I Tyler Running:" e its true and lawful attorneyAn-fact,for it and its name, place,and stead to execute on behalf of the said Company,as surety, bonds,undertaking and contracts of suretyship to be given to . - ALL OBLIGEES provided that no bond or undertaking or contract of suretyship executed under this authority shall exceed in amount the sum of Five Hundred Eighty Thousand Five Hundred Forty Five Dollars($580,545.00) This Power of Attorney Is granted and Is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of - f Directors of the Company of the 8'"day of August,200. - RESOLVED,that the President In conjunction with the Secretary or any Assistant Secretary may appoint attorneys-in-fact or agents with aufhorily,as defined or limited in the instrument evidencing the appointment in each case,for and on behalf of the Company,to execute and deliver and affix the seal of the Company to bands,undertakings,recognitances,and Suretyship obligations of all kinds;and said officers may remove any such attomey-bt- fact or agent and revoke arty power of attorney previously granted to such persons. RESOLVED FURTHER,that any bond,undertaking,recognizance,or suretyship obligation shall be valid and binding upon the company when: ()when signed by the President or any Vice-president and attested and sealed (if a seal is required) by any Secretary or Assistant Secretary or 01) when signed by the President or any Vice-President or Secretary or Assistant Secretary,and countersigned and sealed(d a seal is required)by a duly authorized aftorney-in-fact or agent.or(a)when duly executed and sealed(If a seal is required)by orre or more attorney-io-fad or agents pursuant to and within the units of the authority evidenced by the power of attorney Issued by the Company to such person or persons. RESOLVED FURTHER,that the signature of any authorized officer and the seal of the Company may be affixed by facsimile to any power of attorney or certification thereof authortaft the execution and delivery of any bond, undertaking,recognizance,or other suretyship obligations of the Company; and such signature and seal when to used shall have the same force and effects as though manually affixed. IN WITNESS WHEREOF,American Safety Casualty Insurance Company has caused Its offclet'seal to be hereunto affixed,and these presents to be ' signed by Its President and attested by its Secretary this a day of August,2009 ` �l Gar- • .� CiCC�an fA s. Ambuj Jain "' .3 7'r 1, Joseph D. r. 1581 v , l STATE OF GEORGIA COUNTY OF COBB On this Cb day of August,2009,before me personally came Joseph D.Scollo,Jr.,to me'known.-who,:being by me duly swom,did depose and say he Is the President of American Safety Casualty Insurance Company,the corporation described in and which soaacuted the above instrument:that he knows the seal of the said corporation;that the seal affixed to the said Instrument is such corporate seal;that is was so affixed by order of the Board of Directors of said corporation and that he signed his name thereto by like order. JAMI BAILEY , Notary Pubin,Hall Co.,GA L1 My Cgmmission,Expiree Aug. 13,2012 - is i alley,, Gary Publiftc I,the undersigned.Secretary of American Safety Casualty Insurance Company,an Oklahoma corporation,DO HEREBY"CERTIFY,that the foregoing and attached Power of Attorney remains in full force and has not been revoked;and furthermore that the Resolution of the Board of Directors,set forth in the said Power of Attorney,is now In force. . Signed and sealed in the City of Atlanta,in the State of Geor is Dated thla jdayof V Lei`C4 2,012-- � ��'T '�f��- e� r • _ .. �[^I h 7 Ambuj Jain a %yy a 11c •• 4111bu111Y1 - ORIGINALS OF THIS POWER OF ATTORNEY ARE PRINTED WITH RED NUMERICAL NUMBERS DUPLICATES:SHALL HAVE T14EtSAME FORCE AND EFFECT AS AN ORIGINAL ONLY WHEN ISSUED IN.CONJUCTION WITH THE ORIGINAL EXHIBIT D CERTIFICATION STATEMENT FOR CORPORATION OR INDEPENDENT CONTRACTOR 'A'-CONTRACTORIS,ACORPORATION, CORPORATION CERTIFICATION: I am autho ' to act on behalf of the entity named below,and certify under penalty of perjury that it is a co n. Pilot Rock Excavation, In 171z- iZ Entity nature Date B-:1, C- ONiRACfOR IS(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. 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 represent 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. V C. Telephone listing is used for the business that is separate from the personal residence listing. V 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 agree Contractor Signature Date Project Manager Signature Date 1 t i ,s 9PILORO OP ID:JS AC DATE(MMIDDIYYYY) 1..�JA✓ CERTIFICATE OF LIABILITY INSURANCE 07102/12 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: If the certificate holder is an ADDITIONAL INSURED,the policy(ins) 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 541-779-4232 NAMEACT CONT Hart Insurance 541-7723963 PHONE FAX No: 1123 Royal Ave. a N EM Medford,OR 97504 ADDRIESS, Hart Insurance/Medford INSURERS AFFORDING COVERAGE NAICO INSURER A:Ohio Security Ins Co 41939 INSURED Pilot Rock Excavation Inc INSURER B:Western American Ins Co 41939 650 E Pine St Ste 102b INSURER C Central Point, OR 97502 INSURER 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 POUCY 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 S POLICY NUMBER MM/DDIYYYY MOMILDDIYE LTR YYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY X BKS64855191 07120/11 07120112 PREMISES Ea ce.,nmce 8 1,000,000 CLAIMS-MADE IK OCCUR MEDEXP(Anymm rson) $ 15,000 PERSONAL S ADV INJURY S 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO- LOC $ IECT AUTOMOBILE LIABILITY - (Ea.ca vit) LE LIMIT 1,000,000 B ANY AUTO BAW64866191 07/20/12 07/20/13 BODILY INJURY(Per person) $ ALLOWNED X SCHEDULED - BODILY INJURY(Per accident) $ AUTOS N AUTOS NOWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS Per accident g X UMBR ELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS—MADE US054856191 07/20/11 07/20112 AGGREGATE $ 1,000,000 DED I X I RETENTION S 10,000 $ WORKERS COMPENSATION WCSTATrU OTH- T AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNEWEXECUTIVE YIN❑ NIA E.L EACH ACCIDENT $ OFFICER/MEMBER E%CLUDED't (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DYSCRIPTION OF OPERATIONSbelm E.L.DISEASE-POLICY LIMIT $ A Lease/Rented Equip BKS64866191 07120111 07/20112 Limit 25,00 Ded. 5 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,AEERlotnl Remarks Schedule,N more apace Is required) City of Ashland and its employees,officers and agents are included as ad itional insured as respects to general Ilabllity perform CG8583 10109 attached. ' CERTIFICATE HOLDER CANCELLATION CITYASH 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 E. Main Street Ashland,OR 97520 Hart Insurance I Medford Hart lnsurancel Medford ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CG 85 83 10 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED CONTRACTORS - PRODUCTS/COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Paragraph 2. under Section 11—Who Is An Insured is amended to include as an insured any person or organization whom you have agreed to add as an additional insured in a written contract or written agreement. Such person or organization is an additional insured but only with respect to liability for"bodily injury" or"property damage": 1. Caused by"your work" performed for that additional insured that is the subject of the written contract or written agreement; and 2.. Included in the "products-completed operations hazard". The insurance provided by this endorsement applies only if the written contract or written agreement is signed prior to the "bodily injury' or''property damage". We have no duty to defend an additional insured under this endorsement until we receive written notice of a"suit" by the additional insured as required in Paragraph b. of Condition 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit under Section IV—Commercial General Liability Conditions. B. With respect to the insurance provided by this endorsement, the following are added to Paragraph 2. Exclusions under Section I—Coverage A—Bodily Injury And Property Damage Liability: This insurance does not apply to: 1. "Bodily injury" or"property damage"that occurs prior to you commencing operations at the location where j such"bodily injury" or"property damage" occurs. 2. "Bodily injury" or"property damage" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services including: a. The preparing, approving or failure to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawing and specifications; and b. Supervisory, inspection, architectural or engineering activities. 02010 Liberty Mutual Insurance Company. Al rights reserved. CG 86 83 10 09 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. Page 1 of 2 C. With respect to the insurance afforded by this endorsement, exclusion 1. Damage To Your Work of Paragraph 2. Exclusions under Section I —Coverage A—Bodily Injury And Property Damage Liability is replaced by the following: 1. Damage To Your Work 'Property damage"to"your work' arising out of it or any part of it and included in the"products-completed operations hazard". D. The limits of insurance applicable to the additional insured are those specified in a written contract or written agreement or the limits of insurance as stated in the Declarations of this policy and defined in Section III—Limits Of Insurance of this policy, whichever are less. These limits are inclusive of and not in addition to the limits of insurance available under this policy. E. With respect to the insurance afforded by this endorsement, Section IV—Commercial General Liability Conditions is amended as follows: 1. The following is added to Paragraph 2. Duties In The Event Of Occurrence, Offense,Claims Or Suit: An additional insured under this endorsement will as soon as practicable: a. Give written notice of an "occurrence"or an offense that may result in a claim or"suit" under this insurance to us; b. Tender the defense and indemnity of any claim or"suit"to all insurers whom also have insurance available to the additional insured; and C. Agree to make available any other insurance which the additional insured has for a loss we cover under this Coverage Part_ d. We have no duty to defend or indemnify an additional insured under this endorsement until we receive written notice of a "suit" by the additional insured. 2. Paragraph 4. of Section IV—Commercial General Liability Conditions is amended as follows: a. The following is added to Paragraph a. Primary Insurance: If an additional insured's policy has an Other Insurance provision making its policy excess, and you have agreed in a written contract or written agreement to provide the additional insured coverage on a primary and noncontributory basis, this policy shall be primary and we will not seek contribution from the additional insured's policy for damages we cover. b. The following is added to Paragraph b. Excess Insurance: When a written contract or written agreement, other than a premises lease, facilities rental contract or agreement, an equipment rental or lease contract or agreement, or permit issued by a state or political subdivision between you and an additional insured does not require this insurance to be primary or primary and non-contributory, this insurance is excess over any other insurance for which the additional insured is designated as a Named Insured. Regardless of the written agreement between you and an additional insured,this insurance is excess over any other insurance whether primary, excess, contingent or on any other basis for which the additional insured has been added as an additional insured on other policies. ©2010 Liberty Mutual Insurance Company. All rights reserved. CG 85 83 10 09 Includes copyrighted material of Insurance services office, Inc.,with its permission. Page 2 of 2 A Nmm Reamm elmepemmt G�gmr PILOT ROCK EACAVATION INC 650 E PINE ST STE 1028 CENTRAL POINT, OR 97502-2482 Re: Barrett Business Services, Inc. ("BBSI") Letter of Self-Insurance for Workers'Compensation Coverage As the named addressee of this Letter, your company's required workers'compensation coverage is provided through BBSI's state approved Self-Insured Workers'Compensation Plan by way of your co-employment contract with BBSI. BBSI's California customers can also verify BBSI's state certification at http://www.dir.ca.aov./SIP/sip.htmi; next, click on"Self Insured Employers"; then"Rosters"; then scroll down to Barrett(the list is alphabetical by company name). Additional information is as follows: Self Insurance Certification Number: California: 2246 Oregon: 1068 Washington: 706, 116 Delaware: 152 Maryland: 11365 Colorado: 463 Other Comments(place an"X"if applicable): �X Named "Letter Holder': City of Ashland North Main/Wimer/Hersey Intersection Re-Alignment(2002-05) , 0 Other: Additionally, BBSI's self-insured program is further supported by an excess workers'compensation insurance policy with National Union Fire Insurance Company of Pittsburgh, PA. Copy of certificate is available upon request For additional information, please contact your local BBSI office at: (541) 772-5469 . Very truly yours, Michael L. Elich BBSI Office: MEDFORD President and Chief Executive Officer dm:IOSI-2 8100 HE Parkway Drive,Suite 200 Vancouver,Washington 98662 800.494.5669 360.828.0700 Fox 360.828.0701 www.barrefibusiness.com PARTNERS IN PROFITABILITY 07/11/2012 11:06 5416649218 PILOT ROCK EXCAVATIO PAGE 02/03 business re o ® ® n® January 31, 2012 CONFIRMATION of CERTIFICATION REVIEW RAND LEBARON PILOT ROCK EXCAVATION, INC. 650 E PINE ST STE 102B CENTRAL POINT OR 97502-2482 RE: TIER-2 EMERGING SMALL BUSINESS Mr. LEBARON. We are pleased to inform you that the Oregon Office of Minority, Women and Emerging Small Business has reviewed your certification as an Emerging Small Business (ESB)- Your firm continues to meet.the requirements in State regulation ORS 200-005 and OAR 445-050-0115. ;,•,:.. ;; ; - .. ,F.IRM'S,CERTIFICATION#: 5688 ..• : . :.:CEF( ;ICATION,.EXPIRES;: January 27.;201.5:;::.,:,;';.; As a certified business, your firm will be listed in the State of Oregon, Office of Minority, Women & Emerging Small Business certified Firm information which is available through the Internet. This electronic directory is,available to local and state agencies, as well as private industry and prime contractors. Your ESB certification status is maintained for three years. At least one month prior to the expiration date listed above, you will be sent information regarding your certification review. NOTE: Firms may only be certified in the ESB program for a period of six years as tier-1 and another 6 years as tier-2. If the expiration date listed above is less than three years from the date of this letter your firm will reach the 12 year certification limit by the date and graduate from the ESB program. Changes in business ownership, control,operational management, address or telephone number must be provided to this office within 30 days of the change. Failure to do so may result in de-certification of your firm: The following description table indicates the areas (in the form of NAIC codes) in which your firm has been approved to perform,work Please note that there:may.be.some changes to the NAIC's codes which designate your firm's capability description(s)- Also, OMWESB has recently included new (NIGP and ODOT) codes designating your certified capabilities which are consistent with your firm's eligibility requirements. These codes were added to assure that anyone using the OMWESB directory information is aware of your capabilities for potential contracting purposes. We recommend you view your firm's information on the Internet under 775 Summer St,NE,Suite 200•Salem,OR 97301-1280 503-986-0123•fax 503-581-5115-TTY 800-735-2900•www.oregon4biz.com 4 01/11/2012 11:06 5416649218 PILOT ROCK EXCAVATIO PAGE 03/03 1 your certification number at: http://www4.cbs.state.or.us/ex/dir/omwesb. Please review the information to be sure the codes/descriptions accurately describe your business. If you have questions or suggested changes regarding your capabilities and the codes assigned, or if you do not have access to the Internet, please contact the Certification Specialist named at the bottom of.this letter and they will assist you. Firm's capabilities: NAICS NAICS description and, if present, firm's capability description 236220 COMMERCIAL AND INSTITUTIONAL BUILDING CONSTRUCTION HEAVY AND CIVIL ENGINEERING CONSTRUCTION 237110 WATER AND SEWER LINE AND RELATED STRUCTURES CONSTRUCTION WATER, SEWER LINE AND RELATED STRUCTURES Sincerely, SHEILA HAYWOOD, CERTIFICAltl0t`y SPECIALIST (503) 986-0060 v 1 �i 1 R.:6686.Page 18,Cv Rec ..ESB,ES0215RP / CITY Rte;; ;DER Page 1 1 OW. ASCITY O F ASHLAND DATE PO NUMBER '% 20 E MAIN ST. 7/18/2012 10993 HLAND, OR 97520 _ (541)488-5300 VENDOR: 010462 SHIP TO: Ashland Public Works PILOT ROCK EXCAVATION (541) 488-5587 650 E PINE STREET SUITE 102B 51 WINBURN WAY CENTRAL POINT, OR 97502 ASHLAND, OR 97520 FOB Point: Req.No.: Terms: Net Dept.: Req.Del. Date: Contact: Mike Fauqht- Karl Johnson Special Inst: Confirming? NO Quantity Unit Description Unit Price Ext.Price N. Main/Wimer/Hersey Intersection 581],545.00 Realiqnment Project-Contractor will complete all work associated work involved with the completion of this Project includinq but not limited to concrete work, asphalt pavinq, electrical conduit installation, etc. COA Public Improvement Contract Effective date: July 9, 2012 Completion date: September 4, 2012 Insurance/Bonds required/On file i i I j I i I I I 1 SUBTOTAL 580 545.00 BILL TO:Account Payable TAX 0.00 20 EAST MAIN ST FREIGHT 0.00 j 541-552-2028 TOTAL 580,545.00 ASHLAND, OR 97520 Account Number I Project 0020 .12 Amount Account Number Project Number Amount E 260.08.12.00.70420 E 200205.120 580 545.00 j i I I AuthontWd Sian ature VENDOR COPY FOfit #3 CITY OF ASHLAND REQUISITION Date of request: 06/16/2012 Required date for delivery: ASAP Vendor Name Pilot Rock Excavation, Inc. Address,City,State,Zip 650 E.Pine Street,Suite 102B,Central Point,OR 97502 Contact Name&Telephone Number Rand LeBaron,(541)664-9288 Fax Number (5411)664-9218 SOURCING METHOD ❑ Exempt from Competitive Bidding ❑ Emergency ❑ Reason for exemption:_ Z invitation to Bid (Copies on file) ❑ Form#13,Written findings and Authorization ❑ AMC 2.50 Date approved by Council:06-19-2012 ❑ Written quote or proposal attached ❑ Written quote or pro osal attached Council Communication Attached ❑ Small Procurement Cooperative Procurement Less than$5,00 ❑ Request for Proposal (Copies on file) Slate of Oregon ❑ Direct Award Date approved by Council: Contract# ❑ Verbal/Writtenquote(s)or proposal(s) ❑ State of Washington Intermediate Procurement ❑ Sole Source Contract# GOODS&SERVICES ❑ Applicable Form(#5,6,7 or 8) F-1 Other government agency contract $5,000 to$100,000 0 Written quote or proposal attached Agency El (3)Written quotes attached ❑ Special Procurement Contract# PERSONAL SERVICES ❑ Form#9,Request for Approval Ittergovernmental 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)Written proposals attached Valid until: (Date (Date) _ ) Description of SERVICES Total Cost N.MainMimer[Hersey Intersection Realignment Project-Contractor will complete all work associated work involved with the completion of this project including but not limited to $ 580,545.00 concrete work,asphalt paving,electrical conduit installation,etc. Item # Quantity Unit Description of MATERIALS Unit Price Total Cost ❑ Per attached quotelproposal $TOTAL COST Project Number 200205.120 Account Number 260.08.12.00.704200 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 B this requisition form,I certify that the City's public contracting requirements have been satisfied. 09 Employee Signature: Department Head Signature: -7 3 :2-- Additional signatures(if app iic�able)�� (Equal to or greater tfian$5,000) Funds appropriated for current fiscal year. YES / NO IGK 41 Z-- Finance Director-(Equal to or greater than$5,000) Date Comments: Form#3-Requisition