HomeMy WebLinkAbout2012-155 Contract - Pacific Fire Sprinklers Contract for GOODS AND SERVICES Less than $25,000
C I T Y OF CONTRACTOR: Pacific Fire Sprinklers
ASHLAND CONTACT: Tony Cook
20 East Main Street
Ashland, Oregon 97520 ADDRESS: 5592 Table Rock Road, Central Point, OR 97502
Telephone: 541/488-6002
Fax: 541/488-5311 TELEPHONE: 541-664-6651
DATE AGREEMENT PREPARED: July 9, 2012 FAX: 541-664-7967
BEGINNING DATE: July 17, 2012 COMPLETION DATE: July 20, 2012
COMPENSATION: $4,206.00 per proposal attached as Exhibit C.
GOODS AND SERVICES TO BE PROVIDED: Contract to provide and install new fire sprinkler compressor
and replace recalled sprinkler heads per proposal attached as Exhibit C. Includes all materials, freight and
labor.
ADDITIONAL TERMS:
NOW THEREFORE, pursuant to AMC 2.50.090 and after consideration of the mutual covenants contained herein the
CITY AND CONTRACTOR AGREE as follows:
1. All Costs by Contractor: Contractor shall, provide all goods as specified above and shall at its own risk and
expense, perform any work described above and, unless otherwise specified, furnish all labor, equipment and
materials required for the proper performance of such work.
2. Qualified Work: Contractor has represented, and by entering into this contract now represents, that any personnel
assigned to the work required under this contract are fully qualified to perform the work to which they will be assigned
in a skilled and worker-like manner and, if required to be registered, licensed or bonded by the State of Oregon, are
so registered, licensed and bonded. Contractor must also maintain a current City business license.
3. Completion Date: Contractor shall provide all goods in accordance with the standards and specifications, no later
than the date indicated above and start performing the work under this contract by the beginning date indicated
above and complete the work by the completion date indicated above.
4. Compensation: City shall pay Contractor for the specified goods and for any work performed, including costs and
expenses, the sum specified above. Payments shall be made within 30 days of the date of the invoice. Should the
contract be prematurely terminated, payments will be made for work completed and accepted to date of termination.
Compensation under this contract, including all costs and expenses of Contractor, is limited to$25,000.00, unless a
separate written contract is entered into by the City.
5. Ownership of Documents:All documents prepared by Contractor pursuant to this contract shall be the property of
City.
6. Statutory Requirements: ORS 279B.220, 279B.225, 2796.230, 279B.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$19,494 or more, Contractor is required to comply with chapter 3.12 of the Ashland Municipal Code by paying a
living wage, as defined in this chapter, to all employees performing work under this contract and to any subcontractor
who performs 50%or more of the work under this contract. Contractor is also required to post the notice attached
hereto as Exhibit B predominantly in areas where it will be seen by all employees.
8. Indemnification: Contractor agrees to defend, indemnify and save City, its officers, employees and agents harmless
from any and all losses, claims, actions, costs, expenses,judgments, subrogations, or other damages resulting from
injury to any person(including injury resulting in death), or damage(including loss or destruction)to property, of
whatsoever nature arising out of or incident to the performance of this contract by Contractor(including but not limited
to, Contractor's employees, agents, and others designated by Contractor to perform work or services attendant to this
contract). Contractor shall not be held responsible for any losses, expenses, claims, subrogations, actions, costs,
judgments, or other damages, directly, solely, and proximately caused by the negligence of City.
9. Termination:
a. Mutual Consent. This contract may be terminated at any time by mutual consent of both parties.
b. City's Convenience. This contract may be terminated at any time by City upon 30 days' notice in writing
and delivered by certified mail or in person.
C. For Cause. City may terminate or modify this contract, in whole or in part, effective upon delivery of
written notice to Contractor, or at such later date as may be established by City under any of the following
conditions:
Contract for Goods and Services Less than$25,000, Revised 06/30/2012, Page 1 of 5
i. If City funding from federal, state, county or other sources is not obtained and continued at levels
sufficient to allow for the purchase of the indicated quantity of services;
ii. If federal or state regulations or guidelines are modified, changed, or interpreted in such a way
that the services are no longer allowable or appropriate for purchase under this contract or are
no longer eligible for the funding proposed for payments authorized by this contract; or
iii. If any license or certificate required by law or regulation to be held by Contractor to provide the
services required by this contract is for any reason denied, revoked, suspended, or not renewed.
d. For Default or Breach.
i. Either City or Contractor may terminate this contract in the event of a breach of the contract by
the other. Prior to such termination the party seeking termination shall give to the other party
written notice of the breach and intent to terminate. If the party committing the breach has not
entirely cured the breach within 15 days of the date of the notice, or within such other period as
the party giving the notice may authorize or require, then the contract may be terminated at any
time thereafter by a written notice of termination by the party giving notice.
ii. Time is of the essence for Contractor's performance of each and every obligation and duty under
this contract. City by written notice to Contractor of default or breach, may at any time terminate
the whole or any part of this contract if Contractor fails to provide services called for by this
contract within the time specified herein or in any extension thereof.
iii. The rights and remedies of City provided in this subsection (d)are not exclusive and are in
addition to any other rights and remedies provided by law or under this contract.
e. Obligation/Liability of Parties. Termination or modification of this contract pursuant to subsections a, b, or
c above shall be without prejudice to any obligations or liabilities of either party already accrued prior to such
termination or modification. However, upon receiving a notice of termination (regardless whether such notice is
given pursuant to subsections a, b, c or d of this section; Contractor shall immediately cease all activities under
this contract, unless expressly directed otherwise by City in the notice of termination. Further, upon termination,
Contractor shall deliver to City all contract documents, information, works-in-progress and other property that are
or would be deliverables had the contract been completed. City shall pay Contractor for work performed prior to
the termination date if such work was performed in accordance with the Contract.
10. Independent Contractor Status: Contractor is an independent Contractor and not an employee of the City.
Contractor shall have the complete responsibility for the performance of this contract.
11. Non-discrimination Certification: The undersigned certifies that the undersigned Contractor has not discriminated
against minority, women or emerging small businesses enterprises in obtaining any required subcontracts.
Contractor further certifies that it shall not discriminate in the award of such subcontracts, if any. The Contractor
understands and acknowledges that it may be disqualified from bidding on this contract, including but not limited to
City discovery of a misrepresentation or sham regarding a subcontract or that the Bidder has violated any
requirement of ORS 279A.110 or the administrative rules implementing the Statute.
12. Asbestos Abatement License: If required under ORS 468A.710, Contractor or Subcontractor shall possess an
asbestos abatement license.
13. Assignment and Subcontracts: Contractor shall not assign this contract or subcontract any portion of the work
without the written consent of City. Any attempted assignment or subcontract without written consent of City shall be
void. Contractor shall be fully responsible for the acts or omissions of any assigns or subcontractors and of all
persons employed by them, and the approval by City of any assignment or subcontract shall not create any
contractual relation between the assignee or subcontractor and City.
14. Use of Recyclable Products: Contractor shall use recyclable products to the maximum extent economically feasible
in the performance of the contract work set forth in this document.
15. Default. The Contractor shall be in default of this agreement if Contractor: commits any material breach or default of
any covenant, warranty, certification, or obligation it owes under the Contract; if it loses its QRF status pursuant to
the QRF Rules or loses any license, certificate or certification that is required to perform the work or to qualify as a
QRF if Contractor has qualified as a QRF for this agreement; institutes an action for relief in bankruptcy or has
instituted against it an action for insolvency; makes a general assignment for the benefit of creditors; or ceases doing
business on a regular basis of the type identified in its obligations under the Contract; or attempts to assign rights in,
or delegate duties under, the Contract.
16. Insurance. Contractor shall at its own expense provide the following insurance:
a. Worker's Compensation insurance in compliance with ORS 656.017,which requires subject employers to
provide Oregon workers'compensation coverage for all their subject workers
b. General Liability insurance with a combined single limit, or the equivalent, of not less than Enter one:
$200,000, $500,000, $1,000,000, $2,000,000 or Not Applicable for each occurrence for Bodily Injury and Property
Damage. It shall include contractual liability coverage for the indemnity provided under this contract.
C. Automobile Liability insurance with a combined single limit, or the equivalent, of not less than Enter one:
$200,000, $500,000, $1,000,000, or Not Applicable for each accident for Bodily Injury and Property Damage,
including coverage for owned, hired or non-owned vehicles, as applicable.
d. Notice of cancellation or change. There shall be no cancellation, material change, reduction of limits or
Contract for Goods and Services Less than$25,000, Revised 06/30/2012, Page 2 of 5
1
intent not to renew the insurance coverage(s)without 30 days'written notice from the Contractor or its insurer(s)to
the City.
e. Additional Insured/Certificates of Insurance. Contractor shall name The City of Ashland, Oregon, and its
elected officials, officers and employees as Additional Insureds on any insurance policies required herein but only
with respect to Contractors services to be provided under this Contract.As evidence of the insurance coverages
required by this Contract, the Contractor shall furnish acceptable insurance certificates prior to commencing work
under this contract. The contractor's insurance is primary and non-contributory. The certificate will specify all of the
parties who are Additional Insureds. Insuring companies or entities are subject to the City's acceptance. If
requested, complete copies of insurance policies, trust agreements, etc. shall be provided to the City. The
Contractor shall be financially responsible for all pertinent deductibles, self-insured retentions and/or self-
insurance.
17. Governing Law; Jurisdiction; Venue: This contract shall be governed and construed in accordance with the laws
of the State of Oregon without resort to any jurisdiction's conflict of laws, rules or doctrines. Any claim, action, suit or
proceeding (collectively, "the claim") between the City(and/or any other or department of the State of Oregon)and
the Contractor that arises from or relates to this contract shall be brought and conducted solely and exclusively within
the Circuit Court of Jackson County for the State of Oregon. If, however, the claim must be brought in a federal
forum, then it shall be brought and conducted solely and exclusively within the United States District Court for the
District of Oregon filed in Jackson County, Oregon. Contractor, by the signature herein of its authorized
representative, hereby consents to the in personam jurisdiction of said courts. In no event shall this section be
construed as a waiver by City of any form of defense or immunity, based on the Eleventh Amendment to the United
States Constitution,or otherwise, from any claim or from the jurisdiction.
18. THIS CONTRACT AND ATTACHED EXHIBITS CONSTITUTE THE ENTIRE AGREEMENT BETWEEN THE
PARTIES. NO WAIVER, CONSENT, MODIFICATION OR CHANGE OF TERMS OF THIS CONTRACT SHALL
BIND EITHER PARTY UNLESS IN WRITING AND SIGNED BY BOTH PARTIES. SUCH WAIVER, CONSENT,
MODIFICATION OR CHANGE, IF MADE, SHALL BE EFFECTIVE ONLY IN THE SPECIFIC INSTANCE AND FOR
THE SPECIFIC PURPOSE GIVEN. THERE ARE NO UNDERSTANDINGS,AGREEMENTS, OR
REPRESENTATIONS, ORAL OR WRITTEN, NOT SPECIFIED HEREIN REGARDING THIS CONTRACT.
CONTRACTOR, BY SIGNATURE OF ITS AUTHORIZED REPRESENTATIVE, HEREBY ACKNOWLEDGES THAT
HE/SHE HAS READ THIS CONTRACT, UNDERSTANDS IT,AND AGREES TO BE BOUND BY ITS TERMS AND
CONDITIONS.
19. Nonappropriations Clause. Funds Available and Authorized: City has sufficient funds currently available and
authorized for expenditure to finance the costs of this contract within the City's fiscal year budget. Contractor
understands and agrees that City's payment of amounts under this contract attributable to work performed after the
last day of the current fiscal year is contingent on City appropriations, or other expenditure authority sufficient to allow
City in the exercise of its reasonable administrative discretion, to continue to make payments under this contract. In
the event City has insufficient appropriations, limitations or other expenditure authority, City may terminate this
contract without penalty or liability to City, effective upon the delivery of written notice to Contractor, with no further
liability to Contractor.
20. Prior Approval Required Provision. Approval by the City of Ashland Council or the Public Contracting Officer is
required before any work may begin under this contract.
21. Certification. Contractor shall sign the certification attached hereto as Exhibit A and herein incorporated by
referen
Contracto : City of Ashl
By By
Sign re�j De rtment Head
vT IC /Z L6 L �) P_ b'(y_(,/b_
Print lame / Print Name
TitI4 Date
W-9 One copy of a W-9 is to be submitted with O Q �7
the signed contract. Purchase Order No.
Contract for Goods and Services Less than$25,000, Revised 06/30/2012, 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:
iN y&t_ (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
JUU441- purchased for the business.
441 (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.
u- (5) Labor or services are performed for two or more different persons within a period of one
n year.
(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.
Contractor (Date)
Contract for Goods and Services Less than$25,000, Revised 06/30/2012, Page 4 of 5
�� V
UN-13-2012 WED 02, 11 Pt4 G// P. 001 �
AC1FIC FIRE
SPRINKLERS
DIY.OFAPROFESSIONAL FIRE SYSTEM88
T0:ASHLAND PARKS&RECREATION
I 340 S.PIONEER STREET
i ASHLAND,OREGON 97520
I
Attention: BILL MILLER
j Project:REPLACEMENT OF EXISTING RECALLED SPRINKLER HEADS AND EXISTING AIR
COMPRESSOR
Location:Above
Date: 6/13/2012
Spec,Section: None—Fire Sprinklers
Quotation Amount. $4,206.00
Addendugi:None
Alternates: None
SCOPE OF WORK:
j REPLACE EXISTING FIRE SPRINKLER COMPRESSORTHAT IS NOT UP TO CODE WITH NEW LISTED COMPRESSOR.
THE NEW COMPRESSOR WILL BE A RISER MOUNTED COMPRESSOR THAT IS WL LISTED FOR FIRE PROTECTION
SERVICE,YOU WILL NEED TO PROVIDE THE ELECTRICAL.HOOKUP FORTHE NEW COMPRESSOR;
THIS SECTION OF THE QUOTE COVERS THE REPLACEMENT OF EXISTING FIRE SPRINKLER HEADS THATAT ONE
TIME WERE ON CENTRAL SPRINKLERS RECALL LIST BECAUSE OF POSSIBLY NOTACTIVATING PROPERLY IN CASE
OF A FIRE.THE RECALL PROGRAM WAS nI6CUNUE11 APPROXIMATELYTHREE YEARS AGO,
WE WILL REPLACE ALL RECAL)_Eb SPRYNI(LER HRADS LISTED IN AREAS BELOW:
BASEMENT LEVEL OF MAIN DUMVINGI TOTAL 10 SPRINKLER HEADS
MAIN LEVEL OF THE MAIN DUILDINGI TOTAL 6 SPRINKLER HEADS
ADDITION KUILDINGI TOTAL 9 SPRINKLER HEADS
THE SPRINKLER HEADS THAT COVER THE REAR EXTERIOR WALK WAY I BELIEVE.ARENT ON THE RECALL AND
SHOULD DE FINE,
INCLUUM9 ALL MATERIALS,FREIGHT,AND LABOR,
QUALIFICATIONS.
There will be adequate heat to prevent freezing of a wet system.
• Structure will support a sprinklsrsystent. J
• All work Is based on being done during our nor Furs of work Monday through Friday.
■ This quote remains In effect for thlrty(30�1a s from the above date.
�exc�us)(Oft
• Priming or painting of sprinkler systems)Components, p ® �
• Electrical or alarm work of any kind. ( aC�Fre ir/�/�ria
i
Thank you for the opportunity to submit this Proposal. If you have any questions, please co !C
Respectfully submitted,
Tony Cook
5592 Table Rock Road * Central Point, Oregon 97502 * CCB#41650
Phone (541) 664-6651 * Fax (541) 664-7967 * mtate @aproFlre.com
www.saif.com
OREGON WORKERS COMPENSATION
CERTIFICATE OF INSURANCE ,salf
corporation
CERTIFICATE HOLDER:
CITY OF ASHLAND
ATTEN: KARIANN OLSON
20 EAST MAIN STREET
ASHLAND, OR 97520
The policy of insurance listed below has been issued to the insured named below for the
policy period indicated. The insurance afforded by the policy described herein is subject to
all the terms, exclusions and conditions of such policy.
POLICY NO, POLICY PERIOD ISSUE DATE
445016 10/01/2011 to 10/01/2012 07/10/2012
INSURED: BROKER OF RECORD:
A-PROFESSIONAL FIRE SYSTEMS CO -
PACIFIC FIRE SPRINKLERS
17273 S STEINER RD
BEAVERCREEK, OR 97004-7666
LIMITS OF LIABILITY:
Bodily Injury by Accident $500,000 each accident
Bodily Injury by Disease $500,000 each employee
Body Injury by Disease $500,000 policy limit
DESCRIPTION OF OPERATIONS/LOCATIONS/SPECIAL ITEMS:
All Operations
IMPORTANT:
The coverage described above is in effect as of the issue date of this certificate. It is subject to change
at any time in the future.
This certificate is issued as a matter of information only and confers no rights to the certificate holder.
This certificate does not amend, extend or alter the coverage afforded by the policies above. This
certificate does not constitute a contract between the Issuing insurer, authorized representative or
producer and the certificate holder.
AUTHORIZED REPRESENTATIVE
3rd�.IP lzl�i
President and CEO
J
400 High Street SE
Salem,OR 97312
P:800.285.8525
F:503.373.8020
Policy_ceniricates cemflcateOtInsurance
CERTIFICATE OF LIABILITY INSURANCE oArE,MLaDO YYY)
a7/10/aolz
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 Ileu of such endorsement a.
PRODUCER 801384 1-503-274-6511 AM,A Holly Nev111e
Fullerton a Company Insurance PHONE , 503-790-9322 FAX No: 503-774-6524
PO Box 29018 -MALL mnevilledfullertonco.com
ADDREIEJ;Portland, OR 97296-0018 INSURERS AFFORDING COVERAGE NAICa
Tim Nielson INSURER A: EVEREST IND INS M 10851
INSURED INSURER 8: AMERICAN CAS 00 OF READING PA 20427
A Professional Fire Systems
BEA Pacific Fire Sprinkler Sys INSURER C: TRANSPORTATION INS CO 20494
17273 S Steiner Road INSURER D:
Baavercreek, OR 97004 INSUR E:
INSURER ER F:
COVERAGES CERTIFICATE NUMBER: 28237722 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW RAVE 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.
IL 9R TYPEOFINSURANCE ADUL6 VD POLICY NUMBER POLICY EFF IWIDDYEXP LIMITS
A GENERAL LIABILITY X X 51OLOO2454111 04/01/1 04/01/13
EACH OCCURRENCE $1,000,000
9RTff
%tcW011 MERCIAL GENERAL LIABILITY 50,000
PREMISES(Ea attvrreace E
CIAIMS4XDE M OCCUR MED EXP one raon $5,000
% stop Gap PERSONAL S ADV INJURY S 1,000,000
OENERALAGGREGATE r 2,000,000
O 1 AGGREGATE LIMIT APPLIES PER: PRODUCTS.COMPIOPAOG 52,000,000
POLICY X PRO LCC WA Stop Gap E 1,000,000
B AUTOMOBILE LIABILITY X X C10309 2 49 0 MBINEO SINGL
d LIMIT 1,000,000
X ANY AUTO BODILY INJURY(Perperson) S
ALL OWNED SCHEDULED BODILY INJURY(Perecddenq E
AUTOS AUTOS
X HIREDAUTOS X AUTNOSWNED PROPERTY DAMAGE $
E
A UMBRELLA Me X OCCUR 51CC000759121 04/01/1 04/01/13 EACH OCCURRENCE 32,°00,000
EXCESS LIAR CLAIMSfMADE AGGREGATE $2,000,000
DED I X I RETENTION$10,000 E
WORKERS COMPENSATION WC STATU OT1
AN D EMPLOYERS'LIABILITY YIN TORY I IMIfi ER
ANY PROPRIETORIPARTNERIEXECUTIVE E.L.FACH ACCIOEM E
NIA
OFFICERIMEMSEREXCLUDE01
(Mandatary In NH) • E.L.DISEASE-EA EMPLOYE $
Nya dasmite.wl, �.
DE SCR IPTIONOFOPERATIONSbebw E.L.DISEASE-POIICYLIMIT E
C Laaead a Ranted Equipment C1010912221 04/01/1 04/01/13 Dad $1,0DO 50,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORO 101,AUEItional Ramatka achodulo,If more apace b n9ullad)
The City of Ashland, Oregon and its elected officials, officers and employees
are named as additional insured with regard to operations of the nomad insured in
accordance with the policy terms, conditions and exclusions per the attached endorsement.
Coverage afforded shall be primary and non-contributory when required by written contract per the attached endorsement.
Waiver of subrogation applies to general liability when required by written contract per the attached endorsement.
Additional insured statue 6 waiver of subrogation also applies to auto liability when required by written contract.
CERTIFICATE HOLDER CANCELLATION
Re,All Operations
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Karlann Olson
20 Beat Main Street AUTHORIZED REPRESENTATNE
Ashland, OR 97520 *C�GJ
USA J
®1988-2010 ACORD CORPORATION. All rights reserved.
_ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD
aprofire }
28237777�� 17 ''
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POUCYNUMBER: C1010912249 COMMERCIAL AUTO
CA 20 48 02 99
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
DESIGNATED INSURED
This endorsement modifies Insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
GARAGE COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
TRUCKERS COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by
this endorsement.
This endorsement Identifies person(s)or organlzation(s)who are'Insureds'under the Who Is An Insured Provision of the
Coverage Form.This endorsement does not after coverage provided In the Coverage Form.
This endorsement changes the policy effective on the inception data of the policy unless another date Is Indicated below.
Endorsement Effective: j Countersigned By:
Named Insured:
Authorized Representative)
SCHEDULE
Name of Persons)or Orgenization(a):
Any person or organization as required by written contract.
i
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(If no entry appears above, information required to complete this endorsement will be shown In the Declarations as
a applicable to the endorsement.)
s Each person or organization shown in the Schedule Is an"Insured'for Liability Coverage,but only to the extent that person
or organization qualifies as an "Insured" under the Who Is An Insured Provision contained in Section II of the Coverage
Form.
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OVA POLICY NUMBER: 010 10 912 24 9 (Ed.305/8)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF TRANSFER RIGHTS OF RECOVERY AGAINST OTHERS
This endorsement modifies Insurance provided under the fallowing:
BUSINESS AUTO COVERAGE FORM
GARAGE COVERAGE FORM
TRUCKERS COVERAGE FORM
SCHEDULE
Name of Person or Organization:
Any person or organization ae required
by written contract.
i
(If no entry appears above, Information required to complete this endorsement will be shown in the Declarations as
applicable to this endorsement.) j
We waive any right of recovery we may have against the damage must arise out of your activities under a contract %.
person or organization shown In the Schedule because of with that person or organization.The waiver applies only to
(` payments we make for the Injury or damage.This injury or the person or organization shown In the Schedule.
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POLICY NUMBER: 51 G L002454-1 1 1 COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS
This endorsement modifies Insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART.
SCHEDULE
Name of Person or Organization:
BLANKET WHERE REQUIRED BY WRITTEN CONTRACT
is
I
(If no entry appears above,Information required to complete this endorsement will be shown In the Declarations as
applicable to this endorsement.)
WHO IS AN INSURED(Section II)is amended to include as an insured the person or organization shown In the
Schedule,but only with respect to liability arising out of"your work"for that Insured by or for you. i
The Insurance afforded to the additional insured shall only Include the insurance required by the terms of the writ-
ten agreement and shall not be broader than the coverage provided within the terms of the Coverage Part.
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Includes copyrightod material of Insurance Services Office,
Inc., used with its permission
04/19/to SOLART13
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51GL002454-111
COMMERCIAL GENERAL LIABILITY
ECG 24 520 08 05
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
AMENDMENT- OTHER INSURANCE
(PRIMARY NONCONTRIBUTORY)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
Condition 4. Other Insurance of SECTION IV (2) Any other primary Insurance available to
COMMERCIAL GENERAL LIABILITY CONDITIONS you covering liability for damages arising
is replaced by the following: out of the promises.or operations, or the i
products and completed operations, for i
a, Primary Insurance which you have been added as an addi-
This insurance Is primary except when b. be- tional insured by attachment of an en-
low applies. If this insurance is primary, our ob- dorsement.
ligations are not affected unless any of the When this insurance is excess,we will have no
other insurance is also primary. Then, we will duty under Coverages A or B to defend the in-
share with all that other insurance by the sured against any"suit"if any other insurer has
In-
method described in c. below, except that we a duty to defend the Insured against that`suit".
will not seek contribution from any party with y g
whom you have agreed in a written contract or If no other Insurer defends, we will undertake
agreement that this insurance will be primary to do so, but we will be entitled to the insured's
and noncontributory, if the written contract or rights against all those other insurers,
agreement was made prior to the subject "oc- When this insurance is excess over other in-
currence"or offense. surance, we will pay only our share of the
b. Excess Insurance amount of the loss, if any, that exceeds the
sum of:
This insurance is excess over: (1) The total amount that all such other insur-
(1) Any of the other insurance, whether pri- ance would pay for the loss In the absence
mary, excess, contingent or on any other of this insurance; and
basis:
(2) The total of all deductible and self-insured I
(a) That is Fire, Extended Coverage, amounts under all that other insurance.
Builder's Risk, Installation Risk or simi-
lar coverage for"your work"; We will share the remaining loss, if any, with
b That is Fire insurance for remises any other Insurance that is not described in this
(b) P Excess Insurance provision and was not
rented to you or temporarily occupied by bought specifically to apply In excess of the
you with permission of the owner; Limits of Insurance shown in the Declarations
(c) That is Insurance purchased by you to of this Coverage Part,
cover your liability as a tenant for"prop- c. Method Of Sharing
erty damage" to premises rented to you
or temporarily occupied by you with If all of the other insurance permits contribu-
permission of the owner;or tion by equal shares,we will follow this method
also. Under this approach each insurer con-
(d) If the loss arises out of the maintenance tributes equal amounts until It has paid its ap-.
or use of aircraft, "autos" or watercraft plicable limit of Insurance or none of the boss
to the extent not subject to Exclusion g. remains,whichever comes first.
of Section I — Coverage A — Bodily In-
jury And Property Damage Liability.
ECG 24 520 08 05 Includes copyrighted material of Insurance Services Office, Page 1 of 2 ❑
Inc.,with its permission.
If any of the other insurance does not
permit contribution by equal shares, we
will contribute by limits. Under this
method, each insurer's share is based
on the ratio of its applicable limit of in-
surance to the total applicable limits of
insurance of all insurers.
i
i
i
II.
i
:i
it
9
it
ii
li
ECG 24 520 08 05 Includes copyrighted material of Insurance Services Office, Inc. page 2 of 2 ❑
Used with its permission.
51GL002454-111
COMMERCIAL GENERAL LIABILITY
ECG 24 522 04 02
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
ffpp oo tt�� SCHEDULE
N�C4RJP(ET ���E°�Eb B��ONTRACT
ij
i!
ij
I '
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations
as applicable to this endorsement.)
The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV —
COMMERCIAL GENERAL LIABILITY CONDITIONS)is amended by the addition of the following:
We waive any right of recovery we may have against the person or organization shown in the Schedule above
because of payments we make for injury or damage arising out of your operations or"your work"done under a
written agreement that requires you to waive your rights of recovery, The written agreement must be made prior
to the date of the "occurrence". This waiver applies only to the person or organization shown In the Schedule
above. 'I
ii
ECG 24 522 04.02 Includes copyrighted material.of.losurence Services Office,- - Page 7 of 1 0.
Inc,.,with its permission. . , ..
f
51GL002454-111
COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
i
AMENDMENT - AGGREGATE LIMITS OF INSURANCE
(PER PROJECT)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART.
The General Aggregate Limit under LIMITS OF INSURANCE (SECTION Ili) applies separately to each of your
projects away from premises owned by or rented to you.
Ili
CG 25 031186 Copyright, Insurance Services Office, Inc., 1984 Pago 1 of 1 13
Page 1 / 1
CITY RECORDER
Ashland Park Commission I DATE I F--P0—NUMB—ER---1
20 E MAIN ST. 7/13/2012 00117-
ASHLAND, OR 97520 -
(541)488-5300
VENDOR: 003884 SHIP TO:
PACIFIC FIRE SPRINKLERS, A PROF FIRE SYSTE
17273 S STEINER RD
BEAVERCREEK, OR 97004
FOB Point: Req.No.:
Terms: net Dept.:
Req.Del.Date: Contact: Bruce Dickens
Special Inst: Confirming? NO
Quanti Unit Description Unit Price Ext.Price
Contractor to provide and install new 4,206.00
compressor for fire suppression system
and replace recalled sprinklers
Contract for Goods & Services
Beqinninq date: July 9, 2012
Completion date: July 20, 2012
Insurance required/On file
SUBTOTAL 4,206.00
BILL TO: TAX 0.00
FREIGHT 0.00
TOTAL 4,206.00
Account Number Project Number Amount Account Number Project Number Amount
E 211.12.02.06.60211 4,206.00
Authorized Signature VENDOR COPY
I
FORM #3 CITY OF
Y ASHLAND
A rrMcluest tar a PurchaseO de � -7- /- I z
REQUISITION Date otrequest:
Required date for delivery.
Vendor Name FI62-e `CCL),r )k-leaCS
Address,City,State,Zip 55 Mn go(/<— FA, 00141 pj+ pc;t I rf
Contact Name&Telephone Number
Fax Number TfSYI���El�IO l r-(1'�°U
5q I - (OG q—`7Df 62 -7
SOLICITATION PROCESS
❑ Exempt from Competitive Bidding ❑ Entergencv
❑ Written Findings(Farm attached) ❑ Invitation to Bid (Copies on file) ❑ Written findings attached
❑ Quote or Proposal attached Dale approved by Council: ❑ Quote or Proposal attached
Small Procurement Cooperative Procurement
Less than$5.000 ❑ Reguest for Proposal (Copies on file) ❑ State of Oregon
Note:Total contract amount,including any Date approved by Council: Contract#
amendments may not exceed$6,000 ❑ State of Washington
Intermediate Procurement ❑ Sole Source Contract#
GOODS&SERVICES ❑ Wdlten Findings(Form attached) ❑ Other government agency contract
$5.000 to$100.000 ❑ Quote or Proposal attached Agency
❑ (3)Written quotes attached Contract#
PERSONAL SERVICES ❑ Special Procurement ❑ Intergovernmental Agreement
$5.000 to$75.000 ❑ Written Findings(Form attached) Agency
❑ Less than$35,000,by direct appointment" ❑ Quote or Proposal attached Contract#
" 3 Written sots attached Date a roved b—Council:— - Date approved by Council:--
Description of SERVICES Total Cost
�PhlaC cL- CtOYYt ✓PCftT1 (M 5 /3t+IIDijLIb F0 PI
5 tPP✓ear S stem . �/« c� Ck ([erg gp✓cn9klP/z S a? .�' , rU R f"f ".!
1 1
Item# Quantity Unit Description of MATERIALS Unit Price Total Cost
TOTAI,.'COSTr,
❑ Per attached quote/proposal $ ti
Project Number
______- Account Number___-
Account Number 21 . IZ-(:)Z. C!o- /10 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
By signing this requisition form,I certify that the information provided above satisfies the City's public contracting requirements,and the documentation can be
provided upon request,
Employee Signaturest�J 6G Department Head Signature:
Additional signatures(if applicable):
Funds appropriated forcurrent fiscal year: YES / NO
Finance Director Date
Comments:
G:FlnanceTrooedure%APIFormsTorm#3-Requisition.doc Updated on:8/24/2011