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HomeMy WebLinkAbout2012-296 Contract - Osmose Utilities v Contract for Utility Wood Pole Inspections and Remedial Treatment CITY OF CONTRACTOR: Osmose Utilities Services, Inc. ASHLAND CONTACT: Michael W. Groves, Jr. 20 East Main Street Ashland, Oregon 97520 ADDRESS: 215 Greencastle Road, Tyrone, GA 30290-2944 Telephone: 541/488-6002 Fax: 541/488-5311 TELEPHONE: 770-632-6700 DATE AGREEMENT PREPARED: November 28, 2012 FAX: 678-364-0844 BEGINNING DATE: December 10, 2012 COMPLETION DATE: December 9, 2017 COMPENSATION: Fee Schedule (Unit Descriptions & Prices) is attached as Exhibit D. GOODS AND SERVICES TO BE PROVIDED: Utility wood pole inspections and remedial treatment services asspecified in the RFP released on September 28, 2012. ADDITIONAL TERMS: This contract incorporates Request for Proposal (RFP) released on September 28, 2012, and unless specifically provided otherwise, takes precedence over all other contract documents. Contract includes Exhibits A-D. 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 contracture 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 amount specified above, 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 2796.220, 279B.225, 2796.230, 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. 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 Utility Wood Pole Inspections and Remedial Treatment, Page 1 of 7 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, 1100 00 00 $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 00 000 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 Utility Wood Pole Inspections and Remedial Treatment, Page 2 of 7 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. The status shall not apply to those claims resulting from the sole negligence of the City of Ashland. Oregon, and ffs elected officials, officers and employees as Additional Insureds shall not apply to the negliaence of the City of Ashland. Oregon, and its elected officials, officers and emplovees. 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. ontractor shal certification attached hereto as Exhibit A and herein incorporated by reference. Contractor: City land By gy o 6 Signature De a entt Head David R. Hagley Da ✓ t i k o N N to- l~ Print Name Print Name Vice President-Operations & Contracts [~4-- Title Date' W-9 One copy of a W-9 is to be submitted with the signed contract. Purchase Order No. A VDTO FORM Signature Contract for Utility Wood Pole Inspections and Remedial Treatment, Page 3 of 7 j 2 /may A Z Date EXHIBIT A CERTIFICATIONS/REPRESENTATIONS: Contractor, under penalty of perjury, certifies that (a) the number shown on the attached W-9 form is its correct taxpayer ID (or is waiting for the number to be issued to it and (b) Contractor is not subject to backup withholding because (i) it is exempt from backup withholding or (ii) it has not been notified by the Internal Revenue Service (IRS) that it is subject to backup withholding as a result of a failure to report all interest or dividends, or (iii) the IRS has notified it that it is no longer subject to backup withholding. Contractor further represents and warrants to City that (a) it has the power and authority to enter into and perform the work, (b) the Contract, when executed and delivered, shall be a valid and binding obligation of Contractor enforceable in accordance with its terms, (c) the work under the Contract shall be performed in accordance with the highest professional standards, and (d) Contractor is qualified, professionally competent and duly licensed to perform the work. Contractor also certifies under penalty of perjury that its business is not in violation of any Oregon tax laws, and it is a corporation authorized to act on behalf of the entity designated above and authorized to do business in Oregon or is an independent Contractor as defined in the contract documents, and has checked four or more of the following criteria: (1) 1 carry out the labor or services at a location separate from my residence or is in a specific portion of my residence, set aside as the location of the business. (2) Commercial advertising or business cards or a trade association membership are purchased for the business. (3) Telephone listing is used for the business separate from the personal residence listing. (4) Labor or services are performed only pursuant to written contracts. (5) Labor or services are performed for two or more different persons within a period of one year. (6) 1 assume financial responsibility for defective workmanship or for service not provided as evidenced by the ownership of performance bonds, warranties, errors and omission insurance or liability insurance relating to the labor or services to be provided. ( ;4'e~a 4~2 /Vat/CM1999 Z 9 2fl t z Contractor (Date) Contract for Utility Wood Pole Inspections and Remedial Treatment, Page 4 of 7 EXHIBIT C WAGES AND LABOR STATE OF OREGON PREVAILING WAGE LAW 279C.840 Payment of prevailing rate of wage; posting of rates and fringe benefit plan provisions. (1) The hourly rate of wage to be paid by any contractor or subcontractor to workers upon all public works shall be not less than the prevailing rate of wage for an hour's work in the same trade or occupation in the locality where the labor is performed. (6)(a) "Public works" includes, but is not limited to: (A) Roads, highways, buildings, structures and improvements of all types, the construction, reconstruction, major renovation or painting of which is carried on or contracted for by any public agency to serve the public interest. 279C.810 Exemptions; rules. (2) ORS 279C.800 to 279C.870 do not apply to: (a) Projects for which the contract price does not exceed $50,000. In determining the price of a project, a public agency: (A) May not include the value of donated materials or work performed on the project by individuals volunteering to the public agency without pay; and (B) Shall include the value of work performed by every person paid by a contractor or subcontractor in any manner for the person's work on the project. For those aspects of the project that qualify as a "public works", the following provisions apply: 1 MINIMUM WAGE RATES ON PUBLIC WORKS Contractor shall comply fully with the provisions of ORS 279C.800 through 279C.870. Documents establishing those conditions, as determined by the Commissioner of the Bureau of Labor and Industries (BOLI), are included as attachments to or are incorporated by reference in the Contract Documents. Contractor shall pay workers at not less than the specified minimum hourly rate of wage, and shall include that requirement in all subcontracts. 2 PAYROLL CERTIFICATION; ADDITIONAL RETAINAGE; FEE REQUIREMENTS 2.1 In accordance with ORS 279C.845, the Contractor and every Subcontractor shall submit written certified statements to the City, on the form prescribed by the Commissioner of the Bureau of Labor and Industries, certifying the hourly rate of wage paid each worker which the Contractor or the Subcontractor has employed on the project and further certifying that no worker employed on the project has been paid less than the prevailing rate of wage or less than the minimum hourly rate of wage specified in the Contract, which certificate and statement shall be verified by the oath of the Contractor or the Subcontractor that the Contractor or Subcontractor has read the certified statement, that the Contractor or Subcontractor knows the contents of the certified statement and that to the Contractor's or Subcontractor's best knowledge and belief the certified statement is true. The certified statements shall set out accurately and completely the payroll records for the prior week including the name and address of each worker, the worker's correct classification, rate of pay, daily and weekly number of hours worked, deductions made and actual wages paid. Certified statements for each week during which the Contract for Utility Wood Pole Inspections and Remedial Treatment, Page 6 of 7 Contractor or Subcontractor has employed a worker on the project shall be submitted once a month, by the fifth business day of the following month. The Contractor and Subcontractors shall preserve the certified statements for a period of ten (10) years from the date of completion of the Contract. 2.2 Pursuant to ORS 279C.845(7),the City shall retain 25 percent of any amount earned by the Contractor on this public works project until the Contractor has filed the certified statements required by section 2.1. The City shall pay to the Contractor the amount retained under this subsection within 14 days after the Contractor files the required certified statements, regardless of whether a Subcontractor has failed to file certified statements. 2.3 Pursuant to ORS 279C.845(8), the Contractor shall retain 25 percent of any amount earned by a first-tier Subcontractor on this public works project until the first-tier Subcontractor has filed with the City the certified statements required by 2.1. Before paying any amount retained under this subsection, the Contractor shall verify that the first-tier Subcontractor has filed the certified statement, Within 14 days after the first-tier Subcontractor files the required certified statement the Contractor shall pay the first-tier Subcontractor any amount retained under this subsection. 2.4 In accordance with statutory requirements, and administrative rules promulgated by the Commissioner of the Bureau of Labor and Industries, the fee required by ORS 279C.825(1) will be paid by City to the Commissioner. Contract for Utility Wood Pole Inspections and Remedial Treatment, Page 7 of 7 Utility Wood Pole Inspections & Remedial Treatment Unit Descriptions & Prices 7 1, INSPECTIONS Unit Price/Per Pole Visual Inspection Report $5.00 Sound & Bore 7/8" Inspection $11.51 Sound & Bore 7/8" REJECT $11.51 Partial Excavate Inspection $23.04 Partial Excavate REJECT $23.04 Additional inspection services can be listed below TREATMENTS I FLURODS 1/2" X 3" Per Rod $3.75 COBRAHEADS 1/2" X 3" Per Rod I Addttiono treatments can be listed below: f pI f I POLE MARKING.& CATEGORIZING pI DATA COLLECTION & DELIVERABLES (As. outlined. in Exhibit A, Section 8.0), `I EXPENSES FOR TRAVEL, LODGING. &.MEALS I Please note: Proposers may also submit supplemental fee schedules for additional services. RFP - Utility Wood Pole Inspections and Remedial Treatment, Unit Descriptions and Prices, Page 1 of 1 A ® DALE (MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 11/29/2Dl2 III - 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(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). cAME:oNTACT Shannon Simon PRODUCER N First Niagara Risk Management, Inc PHONE (716)819-5500 FAX 0.(716)819-5140 726 Exchange Street Suite 900 EbmA,'L,,,.Shannon.Simon@fn=.com INSURERS AFFORDING COVERAGE NAIO/I Buffalo NY 14210 INSURER A:Hartford Fire Insurance Company 9662 INSURED INSURERB:Natll Union Fire Ins CO Of PA 19445 Osmose Utilities Services Inc INSURER C:Travelers Pro Cas CO Of Am 1027 980 Ellicott Street INSURER D: NSURER E: Buffalo NY 14209-2398 INSURER F: COVERAGES CERTIFICATE NUMBER:12-13 OUS - 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 A01 SUER POLICY EFF POMILDS J(P LIMITS Lny TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY MDTY1'YY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 AMA RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occunerlce $ 500,000 A CLAIMS-MADE 10 OCCUR 1 UEN OR 2007 /1/2012 /1/2013 MED EXP Any one person $ 10,000 PERSONAL a ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENL AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGO $ 2,000,000 POLICY X PR0. X LOC $ ECT AUTOMOBILE LIABILITY CE Madent INGLE LIMIT S 1,000,000 A X ANY AUTO BODILY INJURY (Per person) $ ALLO`INED SCHEDULED 1 UEN OH2008 /1/2012 /1/2013 BODILY INJURY (Per accident) 5 AUTOS AUTOS PROPERTY DAMAGE X HIRED AUTOS X AUTOS ED Per accident $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 25,000,000 B EXCESS LIAB CLAIMS-MADE E 44196565 AGGREGATE $ 25,000,000 DIED X RETENTION$ 10!000 1 /1/2012 /1/2013 $ A WORKERS COMPENSATION X NCSTATLL OTH-LIM AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERI~(ECUTIVE N NIA E.L EACH ACCIDENT S 1 000 000 OndatoME Nh)EXCLUDED9 1 WE OR 2006 /1/2012 /1/2013 E.L. DISEASE - EA EMPLOYE $ 1,000,000 (Mandatory in n NH) If SS,RIPTIOe N O OFF OPERATIONS W. DESCRIPTIO EL DISEASE - POLICY LIMIT S 1.000.000 C Leased/Rented Equipment T660342OP452TIL12 /1/2012 /1/2013 Umit $1,400,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) The City of Ashland, Oregon, and its elected officials, officers and employees are Additional Insured on a primary and non-contributory basis in regard to the above Liability policies when required by executed written contract. A Waiver of Subrogation is included when required by executed written contract. Workers Compensation coverage is extended to the state of Oregon. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Ashland 90 N. Mountain Avenue Ashland, OR 97520 AUTHORIZED REPRESENTATIVE Bruce Rogers/SVIKSJ ACORD 25 (2010105) ©1986-2010 ACORD CORPORATION. All rights reserved. INS025 (201005)DI The ACORD name and logo are registered marks of ACORD EXTENSION OF THE INFORMATION PAGE - ITEM 1 - OTHER WORKPLACES d ° Policy Number: 01 WE OH2006 Endorsement Number. Effective Date: 07/01/12 Effective hour Is the same as stated on the Information Page of the policy. Named Insured and Address: OSMOSE HOLDINGS, INC. 0 980 ELLICOTT STREET a BUFFALO, NY 14209 0 Item t of the Information Page is completed to include other workplaces of the named insured: 0 0 0 v NO SPECIFIC LOCATION IN STATE OF AL AL NO SPECIFIC LOCATION IN STATE OF AZ AZ NO SPECIFIC LOCATION IN STATE OF AR AR NO SPECIFIC LOCATION IN THE STATE OF CA 90211 CA e 6560 S. GREENWOOD PLAZA GREENWOOD VILLAGE CO 60111 CO r~ 2 CORPORATE DR., STE. 209 TRUMBULL CT 06611 CT NO SPECIFIC LOCATION IN STATE OF DE DE z= NO SPECIFIC LOCATION IN STATE OF DC DC NO SPECIFIC LOCATION IN STATE OF FL FL 1016 EVEREE INN RD. GRIFFIN GA 30224 GA ° 1142 ANNE ST. GRIFFIN GA 30224 GA 1141 ANNE ST. GRIFFIN GA 30224 GA 215 GREENCASTLE RD. TYRONE GA 30263 GA 57 B JEFFERSON PARKWAY NfiWMAN GA 30265 GA NO SPECIFIC LOCATION IN STATE OF ID ID E=- NO SPECIFIC LOCATION IN STATE OF IL IL e i= s= e O p_B O a B Form WC 99 03 66 Printed in U.S.A. Process Date: 06/27/12 Policy Expiration Date: 07/01/13 EXTENSION OF THE INFORMATION PAGE - ITEM 1 - OTHER WORKPLACES 0 N a ° Policy Number. 01 WE OH2006 Endorsement Number. Effective Date: 07/01/12 Effective hour is the same as stated on the information Page of the policy. Named Insured and Address: OSMOSE HOLDINGS, INC. 0 e ~ 980 ELLICOTT STREET p BUFFALO, NY 14209. 0 Item 1 of the Information Page is completed to include other workplaces of the named insured: 0 0 0 NP NO SPECIFIC LOCATION IN STATE OF IN IN NO SPECIFIC LOCATION IN STATE OF IA IA NO SPECIFIC LOCATION IN STATE OF RS RS NO SPECIFIC LOCATION IN THE STATE OF KY 42130 KY 201 HOLIDAY BLVD. COVINGTON - LA 70433 LA NO SPECIFIC LOCATION IN STATE OF ME ME NO SPECIFIC LOCATION IN STATE OF MD MD r= NO SPECIFIC LOCATION IN STATE OF MA MA 52430 DUNCAN AVE HUBBELL MI 49934 MI 99~ NO SPECIFIC LOCATION IN STATE OF MN MN ° NO SPECIFIC LOCATION IN STATE OF MS MS 100 NEW HERMITAGE DR. HERMITAGE MO 65668 MO 302 PLATTE CLAY WAY, STE. 110 & 112 KEARNEY MO 64060 MO 300 20TH AVE. GREENWOOD MO 64034 MO a NO SPECIFIC LOCATION IN THE STATE OF MT 59001 MT i- NO SPECIFIC LOCATION IN STATE OF NE NE 0 f= Q E~ c f= e e C Form WC 99 03 66 Printed in U.S.A. Process Date: 06/27/12 Policy Expiration Date: 07/01/13 EXTENSION OF THE INFORMATION PAGE - ITEM 1 - OTHER WORKPLACES N N V ° Policy Number: 01 WE OH2006 Endorsement Number: Effective Date: 07/01/12 Effective hour Is the same as stated on the information Page of the policy. Named Insured and Address: OSMOSE HOLDINGS, INC. 0 e 0 980 ELLICOTT STREET N BUFFALO, NY 14209 0 Item 1 of the Information Page is completed to include other workplaces of the named insured: 0 0 0 a # NO SPECIFIC LOCATION IN STATE OF NV NV NO SPECIFIC LOCATION IN STATE OF NH NH NO SPECIFIC LOCATION IN STATE OF NJ NJ NO SPECIFIC LOCATION IN STATE OF NM NM = 251 MOUNTAINVIEW AVE. NYACK NY 10960 NY s- 261 MOUNTAINVIEW AVE. NYACK NY 10960 NY ° 964-966 ELLICOTT ST. BUFFALO NY 14209 NY t= 980 ELLICOTT ST. BUFFALO NY 14209 NY 5703 ENTERPRISE PKWY. E. SYRACUSE NY 13057 NY 200 N. MAIN ST. MOUNT AIRY NC 27030 NC NO SSIPIECIEICLOCATION TW STATE OF OK OK LOCATION IN STATE OF OR OR NU 5LI&SUIrlu L&A;Xr1UDj IN STATE OF PA PX NO SPECIFIC LOCATION IN STATE OF RI RI 103 ROBERTSON ROCK HILL SC 29730 SC NO SPECIFIC LOCATION IN STATE OF SD SD 0 0 c c c i~ Form WC 99 03 66 Printed in U.SA. Process Date: 06/27/12 Policy Expiration Date: 07/01113 EXTENSION OF THE INFORMATION PAGE - ITEM 1 - OTHER WORKPLACES N N ° Policy Number: 01 WE OH2006 Endorsement Number. Effective Date: 07/01/12 Effective hour Is the same as stated on the Information Page of the policy. Named Insured and Address: OSMOSE HOLDINGS, INC. 0 ~o 980 ELLICOTT STREET O BUFFALO, NY 14209 item 1 of the Information Page is completed to include other workplaces of the named insured: 0 0 0 v 3450 FITE RD. MILLINGTON TN 38053 TN w 5151 S. LOOP EAST HOUSTON TX 77033 TX Q NO SPECIFIC LOCATION IN STATE OF UT UT NO SPECIFIC LOCATION IN STATE OF VT VT NO SPECIFIC LOCATION IN STATE OF VA VA s= NO SPECIFIC LOCATION IN STATE OF WA WA e NO SPECIFIC LOCATION IN STATE OF WV WV C 4546 TOMPKINS MADISON WI 53716 WI NO SPECIFIC LOCATION IN STATE OF AX AX B NO SPECIFIC LOCATION IN STATE OF FL FL NO SPECIFIC LOCATION IN STATE OF GA GA r~ NO SPECIFIC LOCATION IN STATE OF MI MI NO SPECIFIC LOCATION IN STATE OF MN MN 980 ELLICOTT STREET BUFFALO NY 14209 NY NO SPECIFIC LOCATION DALLAS TX 75201 TX NO SPECIFIC LOCATION IN STATE OF WV WV f= i= e t- 0 c e 0 ME Form WC 99 03 66 Printed in U.S.A. Process Date: 06127/12 Policy Expiration Date: 07/01/13 EXTENSION OF THE INFORMATION PAGE - ITEM 1 - OTHER WORKPLACES C N M ° Policy Number. 01 WE OH2006 Endorsement Number: Effective Date: 07/01/12 Effective hour Is the same as stated on the Information Page of the policy. Named Insured and Address: OSMOSE HOLDINGS, INC. 0 0 980 ELLICOTT STREET O BUFFALO, NY 14209 0 Item 1 of the Information Page is completed to include other workplaces of the named insured: 0 0 0 v NO SPECIFIC LOCATION IN STATE OF GA GA 980 ELLICOTT STREET BUFFALO NY 14209 NY 980 ELLICOTT STREET BUFFALO NY 14209 NY e 980 ELLICOTT STREET BUFFALO NY 14209 NY 980 ELLICOTT STREET BUFFALO NY 14209 NY tB NO SPECIFIC LOCATION IN STATE OF NH NH e 980 ELLICOTT STREET BUFFALO NY 14209 NY NO SPECIFIC LOCATION IN STATE OF OR OR 980 ELLICOTT STREET BUFFALO NY 14209 NY NO SPECIFIC LOCATION IN STATE OF MI MI NO SPECIFIC LOCATION IN STATE OF NH NH NO SPECIFIC LOCATION IN STATE OF NJ NJ 980 ELLICOTT ST, BUFFALO NY 19209 NY NO SPECIFIC LOCATION IN STATE OF OR OR 980 ELLICOTT ST, BUFFALO NY 14209 NY NO SPECIFIC LOCATION IN STATE OF NV NV ; r- c i= c c Form WC 99 03 66 Printed in U.SA. Process Date: 06/27/12 Policy Expiration Date: 07/01/13 EXTENSION OF THE INFORMATION PAGE - ITEM 1 - OTHER WORKPLACES N ° PolicyNumber. 01 WE OH2006 Endorsement Number: Effective Date: 07/01/12 Effective hour Is the same as stated on the Information Page of the policy. ° Named lnsuredand Address: OSMOSE HOLDINGS, INC. 0 0 980 ELLICOTT STREET x BUFFALO, NY 14209 o Item 1 of the Information Page is completed to include other workplaces of the named insured: 0 0 0 v # NO SPECIFIC LOCATION IN STATE OF NY NY NO SPECIFIC LOCATION IN STATE OF NY NY NO SPECIFIC LOCATION IN STATE OF NY NY c NO SPECIFIC LOCATION IN STATE OF NY NY 980 ELLICOTT STREET BUFFALO NY 14209 NY 980 ELLICOTT STREET BUFFALO NY 14209 NY 980 ELLICOTT STREET BUFFALO NY 14209 NY NO SPECIFIC LOCATION IN THE STATE OF MT 59001 MT 980 ELLICOTT STREET BUFFALO NY 14209 NY NO SPECIFIC LOCATION IN STATE OF AR AR NO SPECIFIC LOCATION IN STATE OF RS RS 1621 KENTUCKY ROUTE 40 WEST STAFFORDSVILLE KY 41256 KY NO SPECIFIC LOCATION IN STATE OF MS MS 1639 MEDICAL CENTER PARKWAY, SUITE 305 MURFREESBORO TN 37129 TN 815 HOGAM ROAD, SUITE 8 CONWAY AR 72034 AR 7340 EAST CALEY AVE, SUITE 240W CENTENNIAL CO 80111 CO C C D C a n~ C C Form WC 99 03 66 Printed in U.S.A. Process Date: 06/27/12 Policy Expiration Date: 07/01/13 EXTENSION OF THE INFORMATION PAGE - ITEM 3.A - STATES COVERED N m w ° Policy Number. 01 WE OH2006 Endorsement Number .-1 Effective Date: 07 /01 /12 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: OSMOSE HOLDINGS, INC. 0 e 0 980 ELLICOTT STREET x BUFFALO, NY 14209 Item 3A. of the Information Page is completed to include the following states: 0 ° MARYLAND MD ( )PENNSYLVANIA PA ( ) MASSACHUSETTS MA ( )RHODE ISLAND RI ( ) • MICHIGAN MI ( )SOUTH CAROLINA SC ( ) MINNESOTA MN ( )SOUTH DAKOTA SO ( 10-0 ) MISSISSIPPI MS ( )TENNESSEE TN ( ) 1= MISSOURI MO ( )TEXAS TX ( ) MONTANA MT ( )UTAH UT ( ) i~ NEBRASKA NE ( )VERMONT VT ( ) 0022 NEVADA NV ( )VIRGINIA VA ( ) o NEW HAMPSHIRE NH ( )WEST VIRGINIA WV ( ) NEW JERSEY NJ ( )WISCONSIN WI ( ) NEW MEXICO NM ( )ALASKA AK ( ) NEW YORK NY ( ) NORTH CAROLINA NC ( ) OKLAHOMA OK ( ) s= OREGON OR ( ) f= C - C 0 C C Form WC 99 03 67 Printed in U.S.A. Process Date: .06/27/12 Policy Expiration Date: 07/01/13 CITY RECD 11DER Page 1 CITY OF F~~ ASHLAND CITY R l~li L3 !l DATE : BO NUMBER 20 E MAIN ST. 12/7/2012 11331 ASHLAND, OR 97520 (541) 488-5300 VENDOR: 006890 SHIP To: Ashland Electric Department OSMOSE UTILITIES SERVICES INC (541) 488-5354 M & T LOCK BOX DEPT # 560 90 N MOUNTAIN PO BOX 8000 ASHLAND, OR 97520 BUFFALO, NY 14267 FOB Point: Req. No.: Terms: Net Dept.: Req. Del. Date: Contact: Mark Holden - Warren DiNapoli Special Inst: Confirming? NO Ouanti Unit - Description. Unit Price Ext. Price, Utility Wood Pole Inspections and 20,000.00 Remedial Treatment RFP/Contract approved by Council November 20, 2012 Contract for Utility Wood Pole Inspections Beginninq date: December 10, 2012 Completion date: December 9, 2017 Term: 5-Years SUBTOTAL 20 000.00 BILL To: Account Payable TAX 0.00. 20 EAST MAIN ST FREIGHT TOTAL 541-552-2010 TOTAL 20,000.00 ASHLAND, OR 97520 Account Number Project Number Amount Account Number • Project.Number.. - Amount. , E 690.11.18.00.60240 20 000.00 VENDOR COPY Auth ized Signal re FORM43 CITY OF A request for a Purchase Order ASHLAND REQUISITION Date of request: Required date for delivery: Vendor Name " GCc lj7co G~rriG Address, City, State, Zip Contact Name & Telephone Number Fax Number SOURCING METHOD ❑ Exempt from Competitive Bidding ❑ Emeraencv ❑ Reason for exemption: ❑ Invitation to Bid (Copies on file) ❑ Form 413, Written findings and Authorization ❑ AMC 2.50 Dale approved by Council: ❑ Written quote or proposal attached ❑ Written uote or ro osal attached ❑ Small Procurement Cooperative Procurement Less than $5;000 guest for Proposal (Copies on file) ❑ State of Oregon ❑ Direct Award Date approved by Council: Contract # ❑ Verbal/ Written quote(s) or proposal(s) ❑ State of Washington Intermediate Procurement ❑ Sole Source Contract # GOODS & SERVICES ❑ Applicable Form (#5,6,7 or 8) ❑ Other govemment agency contract $5.000 to $700.000 ❑ W tten quote or proposal attached Agency ❑ (3) Written quotes attached ❑ Form #4, Personal Services $51K to $75K Contract # PERSONAL SERVICES ❑ Special Procurement Intergovernmental Agreement $5,000 to $75,000 ❑ Form #9, Request for Approval ❑ Agency ❑ Less than $35,000, by direct appointment ❑ Written quote or proposal attached Dale original contract approved by Council: ❑ (3) Written proposals attached Date approved by Council: (Date) ❑ Form #4, Personal Services $5K to $75K Valid until: Dale Description of SERVICES Tottael cost (r ylz o°y Ge 'C.o o ~Pr~ ~hs~~ c on~ 0+`i. a e. ~eE 6 rte. 0 c~a-i e. AL if r_e , ~P 9~ ~s a 21 $ D O~i~•e Item # Quantity Unit description of MATERIALS Unit Price Total Cost i i ❑ Per attached quote/proposal TOTAL COST Project Number Account Numbertit)- 1S 4~t^ _ Ico 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, l certify that the City's public contracting requirements have been sat' tied. , J Employee Signature: Department Head Signature: (Equal to dr ieaterll an 5,000) Additional signatures (if applicable): Funds appropriated for current fiscal year WE / NO Finance Director- (Equal to orgreate n $5,000) Date Comments: Form #3 - Requisition