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HomeMy WebLinkAbout2015-018 Contract - HAZMATIQ Federal Resources • Contract for PERSONAL SERVICES less than $35,000 CITY OF CONSULTANT: HAZMATIQ Federal Resources ASHLAND 20 East Main Street CONTACT: C. Gorman Ashland, Oregon 97520 ADDRESS: 377 Log Canoe Circle, Stevensville, MD 21666 Telephone: 541/488-6002 Fax: 541/488-5311 TELEPHONE: 800-518-9895 DATE AGREEMENT PREPARED: January 12, 2015 FAX: 540-665-4440 BEGINNING DATE: February 23, 2015 COMPLETION DATE: February 27, 2015 COMPENSATION: $17,850.00 per quotation attached as Exhibit C. SERVICES TO BE PROVIDED: HazMatlQ First Responder Offensive Training, (3) 8-Hour Training Days, Dates of classes: February 23, 24 and 26, 2015, Cost: (1 Day) $6,450.00, (1) Day $5,950.00, and (1 Day) $5,450.00 for a total of $17,850.00 ADDITIONAL TERMS: In the event of conflicts or discrepancies among the contract documents, the City of Ashland Contract for Personal Services will be primary and take precedence, and any exhibits or ancillary contracts or agreements having redundant or contrary provisions will be subordinate to and interpreted in a manner that will not conflict with the said rims City of Ashland Contract. 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 thelscope 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 $20,142.20 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 an losses, expenses, claims, subro ations, Contract for Personal Services, Revised 07/08/2014, Page 1 of 5 . 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. 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 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 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 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. d. Automobile Liability insurance. with a combined single limit, or the equivalent, of not less than Enter one: Contract for Personal Services, Revised 07/08/2014, Page 2 of 5 $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. 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 insurer(s) to 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 b reference. onsult City of Ashland c By L. r By Sig at a Department Head Print Nam - Print Name Title Date W-9 One copy of a W-9 is to be submitted with the signed contract. Purchase Order No. Contract for Personal Services, Revised 07/08/2014, Page 3 of 5 EXHIBIT A CERTIFICATIONS/REPRESENTATIONS: Contractor, under penalty of perjury, certifies that (a) the number shown on the attached W-9 form is its correct taxpayer ID (or is waiting for the number to be issued to it and (b) Contractor is not subject to backup withholding because (i) it is exempt from backup withholding or (ii) it has not been notified by the Internal Revenue Service (IRS) that it is subject to backup withholding as a result of a failure to report all interest or dividends, or (iii) the IRS has notified it that it is no longer subject to backup withholding. Contractor further represents and warrants to City that (a) it has the power and authority to enter into and perform the work, (b) the Contract, when executed and delivered, shall be a valid and binding obligation of Contractor enforceable in accordance with its terms, (c) the work under the Contract shall be performed in accordance with the highest professional standards, and (d) Contractor is qualified, professionally competent and duly licensed to perform the work. Contractor also certifies under penalty of perjury that its business is not in violation of any Oregon tax laws, and it is a corporation authorized to act on behalf of the entity designated above. and authorized to do business in Oregon or is an independent Contractor as defined in the contract documents, and has checked four or more of the following criteria: (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. X (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. Frank Guglielmo, President &n/tractor (Date) Federal Resources Supply Company, A Maryland Corporation. Contract for Personal Services, Revised 07/08/2014, Page 4 of 5 CITY OF ASHLAND, OREGON EXHIBIT B` City of Ashland LIVING WAGE . • per hour effective June 30, 2014 ~F (Increases annually every June 30 by the ~r Consumer Price Index) • - • - • , portion of business of their 401 K and IRS eligible • _ employer, if the employer has cafeteria' plans (including ten or more employees, and childcare) benefits to the has received financial amount of wages received by ➢ For all hours worked under a assistance for the project or the employee. business from the City of service contract between their Ashland in excess of ➢ Note: "Employee" does not employer and the City of . $20,142.20. include temporary or part-time Ashland if the contract employees hired for less than exceeds $20,142.20 or more. ➢ If their employer is the City of 1040 hours in any twelve- Ashland including the Parks month period. For more and Recreation Department. details on applicability of this month if the employee spends policy, lease see Ashland 50% or more of the ➢ In calculating the living wage Municipal Code Section employee's time in that month employers may add the value 3.12.020. working on a project or of health care, retirement, • additional Call the Ashland City Administrator's office at 541-488-6002 or write to the City Administrator, City Hall, 20 East Main Street, Ashland, OR 97520 or visit the city's website at www.ashland.or.us. Notice to Employers: This notice must be, posted predominantly in areas where it can be seen by all employees. CITY OF ASHLAND Contract for Personal Services, Revised 07/08/2014, Page 5 of 5 ' Q►~' 9~, ~l ~ ~ /z~ ,cz c ~ C~ J 9c 3 HAZMATI what ~Q By FEDERAL RESOURCES TM HazMatlQ 2014 - 2015 Class Intake Form PO Number _TBA Course: HazMatlQ First Responder Offensive (if applicable, please include PO) Point of Contact: Marshall Rasor Email Address: rasorm@ashland.or.us Phone number: 541-482-2770 Dates of Class: February 23,24, and 26-2015 Starting Time: 0830-1630 Training Address: 1760 East Main St Ashland, Oregon 97520 Name of Training Building/Room#: Grace Point Nazarene Church Shipping Address: 455 Siskiyou BLVD Billing Information: Ashland Fire and Rescue Attn: Kimberly Summers Phone #:541-552-2216 Email Address: summersk@ashland.or.us Address: 455 Siskiyou BLVD Ashland Oregon 97520 Funding Source: ❑ UASI X HMEP 0SHSGP Other 1. Service: HazMat/Q LLC agrees to deliver HazMat/Q Training as outlined in submitted proposal. 2 Rate of Payment for Services.' Agreed upon price listed on most recent proposal 3. Payment Terms: Full payment /s expected 30 days after training /s delivered. (Net130) 4. There will be a 10% cancelat/on fee for any class cancelled/rescheduled 30 days or less before class, due to travel related expenses. 5 HazMatlQ Training requires the host location provide a powerpoint projector, along with up to (5) extra seats for invited guests from local agencies. By completing this form, l agree that materials and training provided by HazMattQ are proprietary. Any use other than as specifically legitimated by HazMat/Q In writing is not permitted and /s illegal. We do not condone any attempt by others to provide training or explanations of the materials and charts without our direct involvement. Because of the potential consequences of use not in accordance with our training, pub//c safety could be compromised, and so appropriate training by our authonzed personnel is the only training permitted. HazMat/Q is not responsible or Liable for any unauthorized training or use of our materials. C~G~ta ~ Marshall Rasor Printed Name Signed Name Please return via email cgorman@hazmatiq. com. 49 ,to Official Quotation 3 HAZMATIQ DATE: 2/24/14 ~t azMat QUOTE NO: jQ BY F E D E R A L R E S O U R C E S Federal Resources Minimum Order $250 377 Log Canoe Circle Stevensville, MD 21666 TELE:80G-518-9895 FAX: 540-665-4440 CONTRACT # TAX ID # SALES PERSON Terms QUOTE VALID 52-2133636 HazMat IQ Net 30 FY 2015 DUNS # CAGE CODE FOB DELIVERY ARO 80-664-7801 1 Q3Z9 Marshall Rasor - marshall.rasor&ashland.or.us Course Requested: (3) Training Days 8-Hour HazMatlQ First Responder Offensive Training Training Cost: Line Description cost 1 HazMatlQ First Responder Offensive Training (1 DAY) $6,450.00 2 HazMatlQ First Responder Offensive Training (1 DAY) $5,950.00 3 HazMatlQ First Responder Offensive Training (1 DAY) $5,450.00 Total $17,850.00 The training cost listed above includes class materials for (30) students per session. travel expenses and instructor fees. Course Description: HazMatlQ First Responder Offensive training incorporates the "Above the line /Below the Line" size-up system, while instructing First Responders on whether they can safely enter the Hot Zone to attempt a rescue. This is accomplished by the use of HazMatlQ FRO Smart Charts, which aid in the decision making process of whether or not it is safe to make a rescue. This 4-hour FRO training emphasizes understanding the uses of the Stay Alive Five Meters (Radiation meter, 4-gas meter and Temperature Gun) and Reagent Papers (pH and F papers). to assure their safety when choosing to enter the hot zone. 1. Provides training on transportation containers, for both highway and railway. 2. Trains First Responders on the HazMatlQ FRO charts (cheat sheets) 3. Provides training on the meters and reagent papers that are required to incorporate this life saving system. a. These meters will also provide invaluable information to your responders who routinely respond to emergencies involving, flammable liquids and gases, oxygen deficient environments, corrosive materials, carbon monoxide, and chemical reactions. If your department responds to Hazardous materials incidents, these tools are essential to both the safety of your department members and the safety of your community. 4. Equips and trains your responders on the use of the NIOSH pocket guide. Currently First Responders are trained only on the DOT Emergency Response Guidebook (ERG) that provides limited on information needed to make a "Go or No Go" decision. Response Scenarios: Students will participate in on-screen scenarios and tabletop exercises. The 8 hour course allows the students to gain additional confidence using the HazMatlQ system and practice tactical decision making. 235 G Log Canoe Cir A cFS HAZMATIQ Stevensville, MD 21666 3 Tel: 800.518.9895 Fax: 540.665.4440 i y IQ B Y FEDERAL RESOURCES Email: cgorman hazmatiq.com TM Website: www.hazmatiq.com Updated: 24 September 2013 Sole Source Justification The HazMatlQ 4-Step System delivers training using a patented (US 12/349.384) hazard and risk assessment system, and is only delivered by an elite cadre of HazMatlQ Certified Trainers. The HazMatlQ 4-Step System is a response tool that incorporates a series of easy to understand and copyrighted "smart charts" which act as job aids. These job aids enable responders to quickly assess risks and make proper decisions on how to best mitigate a hazardous materials/WMD incident. This system coaches responders through the process that virtually eliminates "information overload" "The HazMatlQ 4-Step System is available exclusively from HazMatlQ By Federal Resources which simplifies the competitive bid process and permits "sole source" bids. * HazMatlQ has sole proprietary rights to the 4-Step Training System, Smart Charts used for this system and all other intellectual property used during training. The HazMatlQ 4-Step System consists of: * Step 1) 10-Second "Above the Line - Below the Line" Chemical Size-Up * Step 2) Streamlined Chemical Research Process * Step 3) Selection of appropriate meters * Step 4) Selection of proper personal protective equipment The HazMatlQ System is used in all HazMatlQ Courses. Signed 24 September 2013 HAZMATIQ ®~~,►Q~` „ FEDERAL RESOURCES ' YOU ARE INVITED TO ATTEND A ONE DAY HAZMATIQ TRAINING COURSE • • HazMatlQ is an international training company based in the United States that has trained thousands of emergency responders on how to respond safely and effectively to hazardous materials incidents. Course: Classroom Feb. 23, 24 Or 26 First Responder Offensive Description: Training 0830 - 1630 HazMatlQ First Responder Offensive training for Rea' incorporates the "Above the line /Below the Line" Location: size-up system, while instructing First Responders World on whether they can safely enter the Hot Zone to U.S Fish and Wildlife attempt a rescue. This is accomplished by the use Responses of HazMatlQ FRO Smart Charts, which aid in the Service Forensics Lab decision making process of whether or not it is 1490 E Main St safe to make a rescue. This 4-hour FRO training 9 ~r~ ' Ashland, OR 97520 emphasizes understanding the uses of the Stay Alive Five Meters (Radiation meter, 4-gas meter and Temperature Gun) and Reagent Papers (pH and F papers). to assure their safety when choosing to enter the hot zone. To reserve your spot or for more information, please contact: Provides training on transportation containers, for Marshall R a S 0 C both highway and railway. City of Ashland/Ashland Fire & Rescue Trains First Responders on the HazMatlQ FRO charts (cheat sheets) • Provides training on the meters and reagent 541-482-2770 papers that are required to incorporate this life saving system. ra s o rm @ a s h /and . or. us These meters will also provide invaluable information to your responders who routinely respond to emergencies involving, flammable liquids and gases, oxygen deficient environments, corrosive materials, carbon monoxide, and chemical reactions. If your department responds to Hazardous materials incidents, these tools are essential to both the safety of your department members and the safety of your community. • Equips and trains your responders on the use of the NIOSH pocket guide. Currently First Responders are trained only on the DOT Emergency Response Guidebook (ERG) that provides limited on information needed to make a "Go or No Go" decision. 800.518.9895 www.hazmatiq.com C(MMI A~ L7® ERTIFICATE OF LIABILITY INSURANCE DATE D/YYYY) 0111131 /13/2015 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). PRODUCER GUNTACT NAME: Automatic Data Processing Insurance Agency, Inc. A CONK Ext : ac No : 1 Adp Boulevard ADDDRIESS: Roseland, NJ 07068 INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Rated by Multiple Companies INSURED FEDERAL RESOURCES SUPPLY COMPANY INSURER B : DBA: FRS Holdings Inc. INSURER C : 235-g Log Canoe Circle INSURER D : Stevensville, MD 21666- INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 299910 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. LTR TYPE OF INSURANCE IN SD WVD POLICY NUMBER MMI (MM/DDfYYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE 0 RENTED CLAIMS-MADE F1 OCCUR PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY ~ PRO JECT - ❑ LOC PRODUCTS - COMP/OP AGG $ 1~ OTHER: $ AUTOMOBILE LIABILITY ECOMBINED a accident SINGLE LI I $ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS NON-OWNED PROPER DAMAGE $ NON-OWNED Per F HIRED AUTOS AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION X AND EMPLOYERS' LIABILITY STATUTE YIN ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 A OFFICERIMEMBER EXCLUDED? N / A N 76WBGDZ2480 0211612014 0211612015 (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ 1,000,000 If yes, describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached H more space is required) OR is a covered state under 3C all states coverage 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. 20 East Main Street Ashland, OR 97520 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26 (2014101) The ACORD name and logo are registered marks of ACORD 186023 A`C ® DATE(YYYY) CERTIFICATE OF LIABILITY INSURANCE 1/13/2013/2015 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). PRODUCER CONTACT Debbie Archimbaud NAME: E: Commercial Lines - (919) 676-8834 PHONE FAX Ic a . 919-334-2605 A/C No Wells Fargo Insurance Services USA, Inc. E-MAIL ADDRESS: debbie.archimbaudGwellsfar9o.com 8540 Colonnade Center Drive, Suite 111 INSURERS AFFORDING COVERAGE NAIC p Raleigh, NC 27615 INSURER A : Twin City Fire Insurance Company 29459 INSURED INSURER B : Hartford Fire Insurance Company 19682 HazmatlQ by Federal Resources INSURER C : Indian Harbor Insurance Company 36940 235-G Log Canoe Circle INSURER D INSURER E : Stevensville MD 21666 INSURER F : COVERAGES CERTIFICATE NUMBER: 8628204 REVISION NUMBER: See below 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. ILTR TYPE OF INSURANCE INSD SUWVD ER POLICY NUMBER MM/DDY EFF MM DDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY A 22CESOF4755 02/16/2014 02/16/2015 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR DAMAGE T RENTED 300,000 PREMISES Ea occurrence $ MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 X POLICY ❑ JECT PRO F-] LOC PRODUCTS -COMP/OP AGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY 22UUNRB6466 02/16/2014 02/16/2015 EO aBIINdEeD1SINGLE LIMIT $ 1,000,000 X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-0WNED PROPERTY DAMAGE $ AUTOS Per accident Comp.& Coll.ded. $500 $ A X UMBRELLA LIAB X OCCUR 22HUSS3916 02/16/2014 02/16/2015 EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED X RETENTION $ 10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? NIA E.L. EACH ACCIDENT $ (Mandatory In NH) E.L. DISEASE - EA EMPLOYE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ C Professional Liability MTP0041276 02/16/2014 02/16/2015 $1,ooo,ooo DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) The City of Ashland, Oregon is included as additional insured for General Liability, Automobile Liability, and Professional Liability as their interest may appear as required by written contract. Coverage is primary and non-contributory. CERTIFICATE HOLDER CANCELLATION The City of Ashford, Oregon SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 20 East Main Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE The ACORD name and logo are registered marks of ACORD © 1988-2014 ACORDD CORPORATION. All rights reserved. ACORD 25 (2014/01) (TNS,-,film, replaces difi ate# 0628193 isseed m 111312015) Page 1 / 1 CITY OF ASHLAND DATE. ' PO NUMBER 20 E MAIN ST. 1/21/2015 12690 ASHLAND, OR 97520 F (541) 488-5300 VENDOR: 019216 SHIP To: Ashland Fire Department HAZMATIQ (541) 482-2770 235 G LOG CANOE CIRCLE 455 SISKIYOU BLVD STEVENSVILLE, MD 21666 ASHLAND, OR 97520 FOB Point: Req. No.: Terms: Net Dept.: Req. Del. Date: Contact: Kimberley Summers Special Inst: Confirming? No Quantity Unit Description Unit Price Ext. Price HazMatlQ First Responder Offensive 17,850.00 Traininq, Per attached quotation. Quote No. 022414-1-1, dated 02/24/2014 (3) Traininq Days Dates of class: February 23, 24, 26, 2015 1 Day - $6,450.00 1 Day - $5,950.00 1 Day - $5,450.00 Contract for Personal Services Beqinninq date: February 23, 2015 Completion date: February 27, 2015 SUBTOTAL 17 850.00 BILL TO: Account Payable TAX 0.00 20 EAST MAIN ST FREIGHT 0.00 541-552-2010 TOTAL 17, 850.00 ASHLAND, OR 97520 Account Number . Project Number Amount Account Number Project Number Amount E 110.07.12.00.60640 E 000462.700 5,003.22 E 110.07.12.00.60640 E 000462.999 12,846.78 ~v` Authorized-Signaturd VENDOR COPY FORM #3 CITY OF w ~LSH LAN D REQUISITION Date of request: 01-07-2015 Required date for delivery: Vendor Name Haz Mat In Address, City, State, Zip 377 Loa Canoe Circle Stevensville. MD 21666 800-518-9895 Fax 540-665-4440 Contact Name & Telephone Number Fax Number SOURCING METHOD z;l ❑ Exempt from Competitive Bidding ❑ E ergencv ❑ Reason for exemption: ❑ Inv lion to Bid (Copies on file) ❑ Form #13, Written findings an Authorization ❑ AMC 2.50 Dat pproved by Council: ❑ Written quote or proposal attached ❑ Written quote or proposal attached ❑ Small Procurement Cooperative Procurement Less than $5,000 ❑ Reauest for Proposal (Copies on file) ❑ State of Oregon ❑ Direct Award Date approved by Council: Contract # ❑ Verbal/Written quote(s) or proposal ❑ 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 ,a_ olieitatie ed ❑ Form #4, Personal Services $5K to $75K Contract # NACSERVICE - Intergovernmental A reement _PlEftSO Special Procurement g 5 000 to $75,000 Worm #9, Request for Approval ❑ Agency Less than $35,000, by direct appointment Written quote or proposal attached Date original contract approved by Council: ritten-proposa ~ Date approved by Council: (Date) ❑ Form #4, Personal Services $5K to $75K Valid until: Date Description of SERVICES Total Cost $5,003.22 $5,003.22 Match grant funds $175.00 $175.00 will be aid to church Item # Quantity Unit Description of MATERIALS Unit Price Total Cost 1 1 Day Haz Mat IQ First Responder Offensive training 6450.00 6450.00 2 1 Day Haz Mat IQ First Responder Offensive training 5950.00 5950.00 3 1 Day Haz Mat IQ First Responder Offensive Training 5450.00 5450.00 TOTAL COST 0 Per attached quotelproposal _ $17,850.00 Project Number 000462 .22 Project Number 000462. 99 17,850.00 Grant Reimbursed Account Number 110.07.12.00.606400 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 rty's public contracting requirements have been satisfied. Employee: K' . ~L ,f Department Head: (Equal to or greater than $5,000) Department ManagedSupervisor: City Administrator: (Equal to or greater than $25,000) Funds appropriated for current fiscal year: YES / NO Finance Director- (Equal to orgreaterthan $5,000) Date Comments: Form #3 - Requisition