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HomeMy WebLinkAbout2012-217 Contract - Polaris Land Surveying Contract for PERSONAL SERVICES less than $35,000 CITY OF CONSULTANT: Polaris Land Surveying, LLC ASHLAND CONTACT: Shawn Kampmann 20 East Main Street Ashland, Oregon 97520 ADDRESS: P.O. Box 459, Ashland, OR 97520 Telephone: 541/488-6002 Fax: 541/488-5311 TELEPHONE: (541) 482-5009 DATE AGREEMENT PREPARED: FAX: (541) 488-0797 August 27, 2012 BEGINNING DATE: August 27, 2012 COMPLETION DATE: December 31, 2012 COMPENSATION: Not to Exceed $3,500 SERVICES TO BE PROVIDED: Surveying services related to a property line adjustment for 430 N. Main Street & 431 Lori Lane. See attached proposal 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: 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$19,494 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. G:\pub-wrks\eng\02-05 N. Main Hersey Wimer Intersection Realign\A_Adrn n\Eng Vendor4 (Polaris Land Surveying)\Contract Documents\Final Contr Docs\02-05 Polaris-Contract for Personal Services Less than$35K-Revised 06 30 2012.docx 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. 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. 13. 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 Liabilitv insurance with a combined single limit, or the equivalent, of not less than $1,000,000 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 Liabilitv insurance with a combined single limit, or the equivalent, of not less than$1.000,000 for each occurrence for Bodily Injury and Property Damage. It shall include contractual liability coverage for the indemnity provided under this contract. d. Automobile Liabilitv insurance with a combined single limit, or the equivalent, of not less than $1,000,000 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 change. There shall be no cancellation, material change, reduction of limits or intent not to renew the insurance coverage(s)without 30 days' written notice from the Consultant or its insurers to G:\pub-wrks\eng\02-05 N. Main Hersey Wimer Intersection RealignW_Admin\Eng Vendor4 (Polaris Land Surveying)\Contract Documents\Final Contr Docs\02-05 Polaris-Contract for Personal Services Less than$35K-Revised 06 30 2012.docz 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. Consultant: ' City of Ashland n By —(�wf. By WS2 nC sS Q Sig�e Department Head .Shwa �A�ewta�h Mt�h^r4-� (Z• t�c� Print Na a Print Name tf 2 itle Date W-9 One copy of a W-9 is to be submitted with the signed contract. Purchase Order No. Wpub-wrks\eng\02-05 N. Main Hersey winner Intersection RealignW_Admin\Eng Vendor4 (Polaris Land Surveying)\Contract Documents\Final Contr Docs\02-05 Polaris-Contract for Personal Services Less than$35K-Revised 06 30 2012.docx 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. _X (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. —1,/, .,.1 6-ZS - Zel,L- Contractor (Date) G:\pub-wrks\eng\02-05 N. Main Hersey Wimer Intersection Realign\A_Admin\Eng Vendor4 (Polaris Land Surveying)\Contract Documents\Final Contr Docs\02-05 Polaris-Contract for Personal Services Less than$35K-Revised 06 30 2012.docx EXHIBIT C l` ,' r� L .4 iT tr LAND 0 Ut2YEY1NG , LLC i II R n F F A H F August 24,2012 City of Ashland Public Works Department 51 Winburn Way Ashland,Oregon 97520 Attn: 5cott Fleury Re: Lombardi Property Line Adjustment Survey 430 North Main Street&431 Lori Lane Assessor's Map No.391E 05 DA,Tax Lots 2700&2701 Dear Scott, Per your request based on our meeting yesterday,the following is a proposal for surveying services to perform a Property Line Adjustment(FLA)between the city owned parcel being proposed for a public parking lot and the adjacent parcel to the south owned by Robert.&Corinne Lombardi appurtenant to the City's street re-alignment project located at North Main Street and Hersey Street for a public access easement,per the following scope of services: SLOPE OF SFRVICFS: 4 Field survey to re-establish project survey control recently destroyed by on-site construction activities and to locate and tie additional topographic features necessary to update data to reflect current site eonditione per Ashland Planning Department requirements for the Preliminary Map submittal. 4 Office computations and analysis of field survey data and preparation of the Property Line Adjustment Preliminary Map for the application submittal to city Planning Department. 4 Field survey to establish permanent monuments at all parcel and adjusted property corners,as necessary. 4 Prepare and file the final Property Line Adjustment plat with the office of the Jackson County 5urveyor to conform with Oregon Revised Statutes(O.R.S.) 209.250 and 92.060 and City of Ashland Land Use Ordinance 18.76.110. FFFS• Fees will be paid on a Tim and Materials, Not to Exceed Basis according to the attached hourly rate schedule enclosed as Exhibit A,which is valid until December 31,2012. All additional work P. 0. box 459. Ashland, Oregon 97520 • Phone: (541) 452.5009 . Fax: (541) 466.0797 Mobile: (541) 9013000 . ww w.polarlaeurve y.eom 5cott Fleury August 24,2012 Page 2 that is outside the scope of services as described will also be paid at said described hourly rates. Polaris Land Surveying LLC will endeavor to keep the actual cost of the work as low as may be consistent with the purpose of the project and with proper workmanship and materials. The cost to perform the surveying services as outlined in the 5cope of Services above is as follows: Not to Exceed Thirty Five Hundred Dollars ($3,500.00) Any fees required by Jackson County,title companies,or other quasi-governmental agencies are not included in the surveying costs outlined above and shall be the responsibility of the City of Ashland for the city required fees and be reimbursed to Polaris Land Surveying LLC for the Jackson County and title.company fees. As compensation for services rendered,an invoice will be sent on the.20th day of each month,or at the conclusion of the project, showing the hours and rates of the various classifications of personnel working on the project. It is agreed that the payment of our invoice amount will be due upon receipt of your receipt of payment from the City of Ashland. In the event suit or action is instituted to enforce this agreement or any terms hereof,or in the event of an appeal from suit,action or proceeding,the prevailing party shall be entitled to such sums as the court may adjudge reasonable as attorney's fees in such suit,action or appeal. This letter is written as a 5urveying Proposal and Agreement. An acceptance line is provided for your signature if you wish to engage us to perform the aforementioned services. Please return one signed copy for our files. If you have any questions, please don't hesitate to call. Yours truly, 5 5hawn Kampmarm Professional Land Surveyor CC:Brad.Barber, Karl Johnson 5:\5urvey6\662-11\Lombardi-Lori Lanc FLA survey proposal.doc AUTHORIZATION q Approved By^� � 0.� Date 1 J7 P. O. Sax 459, Ashland, Oregon 97520 s Phone: (540 462-5009 Far: (541) 458 .0797 Mobile: (541) 601-3000 s. www,polarloeovvc.v.r OM L A LAND SURVEYING , LLC VT . U a l; a a a u a EXHIBIT"A" POLARI5 LAND 5URVEYING LLG FEE SCHEDULE (EFFECTIVE JANUARY 1,2012) PRINCIPAL LAND 5URVEYOK................................$120.00/hour PROFE55IONAL LAND 5URVEYOR..........................$100.00/hour 5ENIOR 5URVEY TECHNICIAN ...............................$80.00/hour 5URVEY TECHNICIAN ........................................$75.00/hour DRAFTING TECHNICIAN .....................................$70.00/hour 5URVEY FIELD CREW(5TANDARD) .......................$135.00/hour 5URVEY FIELD GREW(w/GP5) ............................$150.00/hour DOCUMENT PKOCE551NG.................................... $ 60.00/hour MILEAGE(out of town projects)............................ $ 0.55/mile OUT-OF-POCKET EXPEN5E5 .................................ACTUAL C05T P. O. Do. 459, Ashland, Oregon 97520 Phone: (541) 462-5009 x Fax: (541) 466-0797 Mobile: (541) 601-3000 • ww w.Po/arlse urve y.cam "c RO ° CERTIFICATE OF LIABILITY INSURANCE 8/29/20112) 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: N the certificate holder is an ADDITIONAL INSURED,the policy(ies) 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 NAME:CONTACT Sarah Q14agliaroli Assurance Risk Managers, Inc. PHONE (303)459-9562 ac No: (303)454-9564 2851 S. Parker Road A"DDREss,squagliaroli @arm-i.com Suite 760 INSURERS AFFORDING COVERAGE NAIC# Aurora CO 80014 INSURER A:Beazley Insurance 37540 INSURED INSURER a Polaris Land Surveying, LLC INSURER C: P.O. BOX 459 INSURER D: INSURER E: Ashland OR 97520 INSURER F: COVERAGES CERTIFICATE NUMBER CL1282915340 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR rypE OF INSURANCE AD POLICY EFF POLICY EXP LIMBS LTR POLICY NUMBER MMIDDA'YYY MMIDD/YYW GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence)$ CLAIMS-MADE ❑OCCUR MED EXP(Any ana person) S PERSONAL 8 ADV INJURY E GENERAL AGGREGATE $ GEITL AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG S EcT POLICY PRO- LOC S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea arsident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accWent) $ AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS H AUTOS Per accident UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION E I$ WORKERS COMPENSATION WC STATU- OTH LI -IE AND EMPLOYERS' ABILITY YIN ANY PROPRIETOWARTNERIEXECUTIVE E.1-EACH ACCIDENT $ OFFICE UMEMBER EXCLUDED? N/A (Mandatory in NH) E.1-DISEASE-EA EMPLOYE $ X yes,describe under DESCRIPTION OF OPERATIONS tss r E.L.DISEASE-POLICY LIMIT 1 $ A Professional Liability V15U9A120601 8/28/2012 x/28/2013 per Cleim $1,000,000 Claims Made Policy General Aggregate $2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION 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. Dept. of Public Works Attn: Scott Fleury AUTHORIZED REPRESENTATIVE 20 E. Main Street Ashland, OR 97520 Lisa Isom/SARAH ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(2010051.01 The ACORD name and loco are registered marks of ACORD '�� CERTIFICATE OF LIABILITY INSURANCE °08/29/2012) 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 is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Jon Snowden, Agent NAME: Jon Snowden 420 Bridge Street PHONE Exit,541.482.2461 aC No:541.482.4957 E#1AIL Ashland, OR 97520 ADDRESS:'ono onsnowden.com O INSURERS AFFORDING COVERAGE NAIC# INSURER A:State Farm Fire and Casualty Company 25143 INSURED Polaris Land Surveying, LLC INSURER B: PO Box 459 INSURER C: Ashland, OR 97520 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 POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN Is SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DD NYYY) fMM/DDfYYYYI LIMITS A GENERAL LIABILITY ❑❑ 97-BK-R164-1 05/07/2012 05/07/2013 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY REMAM SES(Ed occurrence) $ 300,000 CLAIMS-MADE FX-1 OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000 X POLICY PRO LOG $ A AUTOMOBILE LIABILITY ❑❑ 090 4953-609J7C 08/09/2012 02/09/2013 EOa amd.nt SINGLE LIMIT S ANY AUTO BODILY INJURY(Per person) $ 1,000,000 ALL OWNED X SCHEDULED BODILY INJURY(Per accident)AUTOS AUTOS $ 1,000,000 NON-OWNED PROPERTY DAMAGE 1,000,000 HIREDAUTOS AUTOS Peracddent $ $ UMBRELLA LAB OCCUR ❑ EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION WG STATU- OTM- AND EMPLOYERS'LIABILITY YIN 97-BK-R148-8 05105/2012 05105/2013 TORY LIMITS ER ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICEIMEMBER EXCLUDED? N] NIA ❑ (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 500,000 If Yes.dear ius under QFSCRlP]7lON OF OPERATIONS belm E.L.DISEASE-POLICY LIMIT I S 500,000 FI FI DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ANach ACORD 101,Additional Remarks Schedule,if more space is required) Land Surveying-151 Clear Creek Dr. Ste. 101 Ashland,OR 97520 CERTIFICATE HOLDER CANCELLATION City of Ashland Dept. of Public Works SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 E Main St. ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE Attn: Scott Fleury ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD 1001486 132849.7 03-01-2012 CITY RECORDER Page 1 / 1 �. CITY OF ASHLAND I PO NUMBER 20 E MAIN ST. 9/12/2012 11168 ASHLAND, OR 97520 (541)488-5300 VENDOR: 008064 SHIP TO: Ashland Public Works JI: POLARIS LAND SURVEYING INC (541)488-5587 PO BOX 459 51 WINBURN WAY ASHLAND, OR 97520 ASHLAND, OR 97520 FOB Point: . Req.No.: Terms: Net Dept.: Req.Del.Date: - Contact: Karl Johnson Special Inst: Confirming? NO Quanti ty Unit � � � � �f. �Description ,`. .' Unit Price Ext.Price Surveying services related to a 3,500.00 Property line adjustment for 430 N. Main Street and 431 Lori Lane Contract for Personal Services Beginning date: August 27, 2012 Completion date: December 31, 2012 Insurance required/On file SUBTOTALI 3,50R. BILL TO:Account Payable TAX 20 EAST MAIN ST FREIGHT 0.00 541-552-2010 TOTAL 3,500.00 ASHLAND, OR 97520 ;.,.Account Number Project Number Amount Account Number ,.Project Number - Amount E 260.08.12.00.704200 E 200205.120 3,500.00 z- AuthO d Signature VENDOR COPY 'S 1 FORM #3 CITY OF A request for a Purchase Order ASHLAND REQUISITION Date of request: 09/07/12 Required date for delivery: ASAP Vendor Name Polaris Land Surveying,LLC Address,City,State,Zip P.O.Box 459,Ashland OR 97520 Contact Name&Telephone Number Shawn Kampmann(541)482.5009 Fax Number (541)488-0797 SOURCING METHOD ❑ Exempt from Competitive Bidding ❑ Emergency ❑ Reason for exemption: ❑ Invitation to Bid (Copies on file) ❑ Form#13,Written findings and Authorization ❑ AMC 2.50 Date approved by Council: ❑ Written quote or proposal attached ❑ Written quote or proposal attached ❑ Small Procurement Cooperative Procurement Less than$5,000 ❑ Request for Proposal (Copies on file) ❑ State of Oregon ❑ Direct Award Dale approved by Council: Contract# ❑ VerbalMrilten quote(s)or proposal(s) ❑ State of Washington Intermediate Procurement ❑ Sole Source Contract# GOODS&SERVICES ❑ Applicable Form(#5,6,7 or 8) ❑ Other government agency contract $5,000 to$100,000 ❑ Written quote or proposal attached Agency ❑ (3)Written quotes attached ❑ Form#4, Personal Services$5K to$75K Contract# PERSONAL SERVICES ❑ Special Procurement Intergovernmental Agreement $5,000 to$75,000 ❑ Form#g,Request for Approval ❑ Agency M Less than$35,000,by direct appointment ❑ Written quote or proposal attached Date original contract approved by Council: ❑ (3)Written proposals attached Date approved by Council: (Date) ❑ Form#4, Personal Services$5K to$75K Valid until: Date Description of SERVICES Total Cost Surveying services related to a property line adjustment for 430 N.Main Street&431 Lori Lane. $3,500 Item # Quantity Unit Description of MATERIALS Unit Price Total Cost TOTAL COST ❑ Per attached quotelproposal $ 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 By si s rip ro for ,J ceRifyl at the City's public contracting requirements have been satisfied. Employee Signature: / Department Head Signature: //•Z (Equal to or greater than$5,000) Additional signatures(if appl• le): l Funds appropriated for current fiscal year. YES / NO Finance Director-(Equal to orgreater than$5,000) Date Comments: Form#3-Reg6isi0on