HomeMy WebLinkAbout2012-255 Contract - Valley Electrical Contractors Contract for GOODS AND SERVICES Less than $25,000
CITY OF CONTRACTOR: Valley Electrical Contractors
-ASHLAND CONTACT: Terry Partsafas
20 East Main Street
Ashland, Oregon 97520 ADDRESS: PO Box 1555, Medford, Oregon 97501
Telephone: 541/488-6002
Fax: 541/488-5311 TELEPHONE: 541-773-1405
DATE AGREEMENT PREPARED: 9/25/12 FAX: 541-770-2819
BEGINNING DATE: 9/25/12 COMPLETION DATE: 12/1/12
COMPENSATION: $ 5,670 per proposal attached as Exhibit C
GOODS AND SERVICES TO BE PROVIDED: Misc Electrical work at the Daniel Meyer Pool Facility. Service
panel replacement and cleanup. Replace 8 Amerlite pool lights, provided by parks. Remove and replace 2
lights with 50W HPS wall packs. Install 2250W heater w/thermostat in Pool Mechanical room. GFCI outlets,
repair, investigation, and new circuit to vending machine. Electrical Permit. Per proposal attached as Exhibit
C.
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 2798.220, 279B.225, 279B.230, 2796.235, ORS Chapter 244 and ORS 670.600 are
made part of this contract.
7. Living Wage Requirements: If contractor is providing services under this contract and the amount of this contract
is $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.
Contract for Goods and Services Less than$25,000, Revised 06/30/2012, Page 1 of 6
C. For Cause. City may terminate or modify this contract, in whole or in part, effective upon delivery of
written notice to Contractor, or at such later date as may be established by City under any of the following
conditions:
i. If City funding from federal, state, county or other sources is not obtained and continued at levels
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 Liabilit insurance with a combined single limit, or the equivalent, of not less than Enter one:
Contract for Goods and Services Less than $25,000, Revised 06/30/2012, Page 2 of 6
$200,000, $500,000, $1,000,000, or Not Applicable for each accident for Bodily Injury and Property Damage,
including coverage for owned, hired or non-owned vehicles, as applicable.
d. Notice of cancellation or change. There shall be no cancellation, material change, reduction of limits or
intent not to renew the insurance coverage(s) without 30 days' written notice from the Contractor or its insurer(s)to
the City.
e. Additional Insured/Certificates of Insurance. Contractor shall name The City of Ashland, Oregon, and its
elected officials, officers and employees as Additional Insureds on any insurance policies required herein but only
with respect to Contractor's services to be provided under this Contract. As evidence of the insurance coverages
required by this Contract, the Contractor shall furnish acceptable insurance certificates prior to commencing work
under this contract. The contractor's insurance is primary and 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
reference.
Contract for Goods and Services Less than$25,000, Revised 06/30/2012, Page 3 of 6
Contractor: City of As nd
By /�j�S//Z By
ZI Signature \ Department Head
Terry R. Partsafas
Print Name Print Name
Proiect Manager/Estimator (O Z
Valley Electrical Contractors, Inc. Date
Title
W-9 One copy of a W-9 is to be submitted with Purchase Order No. e�5,-7 l
the signed contract.
Contract for Goods and Services Less than$25,000, Revised 06/30/2012, Page 4 of 6
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:
_X_ (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.
_X (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.
_X (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.
Valley Electrical Contractors 10/04/12
Contractor (Date)
Contract for Goods and Services Less than $25,000, Revised 06/30/2012, Page 5 of 6
Mike Hamilton ALLEY ELECTRICAL P.O. Box 1555
Medford, OR 97501
CCB#55415 CONTRACTORS, INC. Tel#(541)773-1405
Fax#(541)770-2819
PROPOSAL
To:Ashland Parks and Recreation
340 S.Pioneer Street
Ashland.Or.97520
Attn:Brenda Hammers
Valley Electrical Contractors, Inc.proposes to fiunish the labor and materials to accomplish the following:
(General Description of Work)
Misc Electrical Work at the Daniel Meyer Pool Facility
At 1075 Homes Ave,Ashland Oregon 97520(Site of Work)
For the compensation as follows:
1. Service Panel Replacement&Clean up $1,780.00
2. Replace Pool Lights $1,040.00
3. Remove and Replace(2)Lights with 50W HPS Wall Packs $ 480.00
4. Install 225OW Heater WiThermostat in Pool Mechanical Room $ 650.00
5. GFCI outlets,Repair,investigation,and New Circuit to Vending Machine $1,720.00
6. Electrical Permit(varies depending on options selected) See Special Conditions Below
The proposal is based upon estimated quantities for the work as follows:
See Attached Scope Letter
In the event the project shall require work in excess of the quantities above set out,and if this is a lump sum proposal,extra charges shall
be made for such additional work at the rates then being regularly charged by the undersigned for such items.
Payment shall be due on or before 10 days after billing.The party prevailing in any litigation arising out of the work,or this agreement,
shall be entitled to recover such as the court may adjudge reasonable as attorney's fees in litigation.
Late charges of I '%%per month(18%annual percentage rate)will be charged on past due accounts. Past due accounts are invoices not
paid within 30 days of billing.
Notwithstanding any provision herein to the contrary,in the event that,during the performance of this agreement,the price of steel
raceways,copper wire and/or any other necessary commodities significantly increases,through no fault of Valley Electrical Contractors,
the price of any materials,components,or goods to he furnished under this agreement shall be equitably adjusted by an amount
reasonably necessary to cover any such significant price increases. As used herein,a significant price increase shall mean any increase in
price exceeding five percent 5%experienced by Valley Electrical Contractors from the date of the execution of this agreement.
Price is subject to a mutually acceptable contract.
Special Conditions:
1. Labor and material will be provided during normal working hours. Building will be without power when
panel is being changed out.
2. Electrical permit will vary with the items of work selected between$60.00 and$90.00
3. Deduct$320.00 from total price of all items are selected,$240.00if 4 items are selected,$160.00 if 3 items
are selected,and$80.00 if 2 items are selected,
This proposal is made for acceptance within ACCEPTANCE
30 days only of the date hereof The foregoing proposal is accepted this
Dated this 6th day of September,2012
Valley Electrical Contractors,Inc. day of Scp .6er .20 17_
By: TerryR
Terry R.Partsaf is—Estimator/Project Manager
Page 1 of 2
Valley Electrical Contractors
A NECA/IBEW electrical industry drug-fire workplace
Mike Hamilton ALLEY ELECTRICAL P.O. Box 1555
' CONTRACTORS, OR 97501
C
OCB#55415 ONTRACTORS, INC. Tel#(541)773-1405
Fax#(541)770.2819
September 6, 2012
Scope Letter for the Daniel Meyer Pool Electrical work
Included in our quote will be the following items
• Item #1. A: Wire brush conduits at ground level, and apply new cold zinc
coating on them.
B: Remove and replace 200 amp panel, and new breakers
C: Remove 220V outlet and timer
• Item #2. A: Remove existing pool lights, and install customer provided pool
lights. Price assumes the new lights can be installed by slightly
modifying the existing conditions.
• Item #3. A: Remove (2) existing outside lights, provide and install (2) new 50
watt BPS lights in their place
• Item #4. A: Provide and install (1) 2,250W heater inside pool /boiler room near
electrical panel
• Item #5. A: Change (11) existing receptacles to weather proof GFCI receptacles
B: Convert (2) existing boxes to GFCI receptacles
C: Replace corroded flex and box with PVC box and non metallic flex
in muriatic acid room
D: Provide and install (1) 20 amp, dedicated receptacle for vending
machines in lobby
• Item #6. A: Provide permit for electrical work
Thank you for the opportunity to give your company a quote on this project. If
you have any questions or concerns please feel free to call any time.
Sincerely
Term f artsa�as
Terry R. Partsafas—Estimator/Project Manager
Valley Electrical Contractors, Inc.
terryp @valleyelectricalcontractors.com
Office 541-773-1405
Fax 541-770-2819
Page 2 of 2
Valley Electrical Contractors, Inc
A NECA/IBEW electrical industry drug free workplace
CITY OF ASHLAND TAX REGISTRATION
(FOR REVENUE PURPOSES ONLY)
BUSINESS LOCATION INFORMATION REGISTRATION NO,
STREETADDRESS: PO BOX 1555
BL-001370
OWNER INFORMATION PHONE: (541) 773-1405
NAME: HAMILTON
Barbara Christensen
- CITY RECORDER/TREASURER
REGISTRATION EXPIRES JUNE 30.
VALLEY ELECTRICAL CONTRACTORS
PO BOX 1555
MEDFORD, OR 97501 2013
TO BE POSTED IN A CONSPICUOUS PLACE.
STATE OF OREGON
CONSTRUCTION CONTRACTORS BOARD j
LICENSE CERTIFICATE
LICENSE NUMBER: 55415
This document certifies that:
I{ VALLEY ELECTRICAL CONTRACTORS INC
PO BOX 1555
MEDFORD OR 97501-0117
is licensed in accordance with Oregon Law as a Residential General Contractor and a Commercial General
Contractor Level 1.
License Details: '
EXPIRATION DATE: 01/14/2014
ENTITY TYPE: Corporation
INDEP. CONT. STATUS: NONEXEMPT
RESIDENTIAL BOND: $20,000
COMMERCIAL BOND: $75,000
INSURANCE: $1,000,000/$2,000,000
RMI: MICHAEL J HAMILTON
HOME INSPECTOR CERTIFIED: NO
OP ID: KIY
CERTIFICATE OF LIABILITY INSURANCE °"� 10511 Y"'
10/05/12
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 pollcy(les) must be endorsed. N.SUBROGATION IS WANED, 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 endorsements.
PRODUCER 541-773-5358 Kendall Yeaw
Protectors Insurance, LLC 541-772-190 PHONE EA:541-7735358 No: 541-772-1906
Pilot Rock Ins Agency LLC (CA)
PO Box 4669 ° .kendall rotectorsins.com
Medford, OR 97501 .VALLE-1
R.Joe Hubbard
INSURER(S)AFFORDING COVERAGE NAIC 11
INSURED Valley Electrical Contractors INSURERA:Liberty Northwest Insurance 41939
Inc- INSURER B:
PO Box 1555
INSURER c:
Medford,OR 97501-0117
INSURER O:
INSURERE:
ERAGES 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.
Jam TYPE OF INSURANCE POLICYNUMBER LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00
A X CON V&-RCIPL GENERAL LIABILITY X 017136775 01124112 01/24/13 PREMISES Ee occurrence $ 100,00
CLAIMS-FADE [K]OCCUR MED EXP(Any one person) $ 5,00
PERSONAL 8 ADV INJURY $ 1,000,00
GENERAL AGGREGATE $ 2,000,00
GENL AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMP/OP AGG $ 2,000,00
POLICY X PRO- LOC I $
AUTOMOBILE WIBLRY COMBINED SINGLE LIMIT $ 1,000,00
(Ea eccidern)
A X my AUTO 017136775 0124!12 0124113 BODILY INJURY(Per person) $
ALL OWNED AUTOS BODILY INJURY(Per eccidern) $
SCHEDULED AUTOS PROPERTY DAMAGE
X HIRED AUTOS (Per eccidert) $
X NON-OWED NJTOS $
$
UMBRELLA UAB OCCU2 EACH OCCURRENCE $
IXCESS LIMB CLA!MSMADE AGGREGATE E
DF.Dl1CTIBLE $
RETENTION
WORKERS COMPENSATION
AND EMPLOYERS'LIABILITY YIN
ANY PROPRITORPARTNERFXECURVE ❑ NIA E.L.EACH ACCIDENT $
OFFICERA.EFEEIt EXCLUDED?
( amfidary M NH) E.L.DISEASE-EA EMPLOYE $
If yes.deeginl9 Under
I EL DISEASE-POLICY LIMIT 1$
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,a mom apace In required)
s additional insured per policy endorsement CG8579(0505):
CITYAS2
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
20 E Mahn Sir ACCORDANCE yitTH THE POLICY PROVISIONS.
Ashland,OR 97520
AIrrHOPJMD REPRESENTATIVE
R.Joe Hubbard
O 1988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD
www.saif.mm
OREGON WORKERS COMPENSATION
CERTIFICATE OF INSURANCE
Q,saif
corporation
CERTIFICATE HOLDER:
CITY OF ASHLAND
20 E 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
468688 04/01/2012 to 04/01/2013 10/09/2012
INSURED: BROKER OF RECORD:
VALLEY ELECTRICAL CONTRACTORS INC
PO BOX 1555
MEDFORD, OR 97501-0117
LIMITS OF LIABILITY:
Bodily Injury by Accident $1,000,000 each accident
Bodily Injury by Disease $1,000,000 each employee
Body Injury by Disease $1,000,000 policy limit
DESCRIPTION OF OPERATIONS/LOCATIONS/SPECIAL ITEMS:
Daniel Meyer Pool Project
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.
CANCELLATION:
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE
THEREOF, NOTICE WILL BE DELIVERED TO THE POLICYHOLDER AND CERTIFICATE HOLDER IN
ACCORDANCE WITH THE POLICY PROVISIONS AND OREGON LAW. SAIF WILL ENDEAVOR TO
PROVIDE WRITTEN NOTICE WITHIN 30 DAYS WHENEVER POSSIBLE.
AUTHORIZED REPRESENTATIVE
3r6qC!P, 1P aq441--�
President and CEO
600 High Street SE
Salem,OR 97312
P:800.285.8525
F:503.373.8020
Polity—Batch—Certlficate0nnsurance
CITY RECORDER Page 1 / 1
Ashland Park Commission DATE PO NUMBER
20 E MAIN ST. 10/23/2012 1 00168
ASHLAND, OR 97520
(541)488-5300 !�{
VENDOR: 004039 SHIP TO:
VALLEY ELECTRICAL CONTRACTORS
PO BOX 1555
MEDFORD, OR 97501
FOB Point: Req.No.:
Terms: net Dept.:
Req.Del. Date: _ Contact: Brenda Hammers
Special Inst: Confirming? No
.,r
Quantity Unit Description Unit Price Ext.Price
Provide miscellaneous electrical work 5,670.00.
at the Daniel Meyer Pool Facility
Contract for Goods and Services
Beqinninq date: 09/25/2012
Completion date: 12/01/2012
Insurance required/On file
SUBTOTAL 5,670.00
31LL TO: TAX 0.00
FREIGHT 0.00
TOTAL 5,670.00
Account Number Project Number Amount .Account Number Project Number Amount
E 211.12.02.06.60211 Q 5-16-70-0-0-
/e
Autho ized Signature VENDOR COPY
FORM CITY OF
ASHLAND
REQUISITION Date of request:
Required date for delivery: rp ra/,
Vendor Name VALLC ��ec'r2rcati Laarruac.ro2s
Address,City,State,Zip po &�K isss
Contact Name&Telephone Number rEen 4 py�rsN errs Shc - 7 3 -i1l0 s'
Fax Number - �
SOURCING METHOD
❑ Exempt from Competitive Bidding ❑ Emergency
❑ Reason for exemption: ❑ Invitation to Bid (Copies on file) ❑ Written findings attached
❑ Quote or Proposal attached Date approved by Council: ❑ Quote or Proposal attached
❑ Small Procurement Cooperative Procurement
Less than$5,000 ❑ Request 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 If
GOODS&SERVICES ❑ Written Findings(Form attached) ❑ Other government agency contract
$5,000 to$100,000 ❑ Quote or Proposal attached Agency
I(0�(3)Written quotes attached Contract If
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 proposals attached I Date approved by Council: Date approved by Council:
Description of SERVICES Total Cost
pi^oa(cle it-kISC , E(e�l-r-lccJ Wo:K
Item # Quantity Unit Description of MATERIALS Unit Price Total Cost
TOTAL COST
❑ Per attached quotelproposal $
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Project Number----------- Account Number?!/ -ia-az- oh• o�uo
Account Number Account Number-------------------
'Expenditure must be charged to the appropriate account numbers for the financials to accurately reflect the actual expenditures.
IT Director in collaboration with department to approve all hardware and software purchases:
IT Director Date Support(Yes/ No)
By signing this requisition form,I certify that the information provided above satisfies the City's public contracting requirements n the documentation can be
provided upon request.
Employee Signature: � , Its Department Head Signature: "
Additional signatures(if applicable):
Funds appropriated for current fiscal year YES / NO
Finance Director Date
Comments:
G FinanceTrocedure%APlFonnsVorm#3-Requisition.doer Updated on:91252012