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HomeMy WebLinkAbout2015-049 Contract - Cut n Break Construction Contract for GOODS AND SERVICES Small Procurement Less than $5,000 CITY OF INDEPENDENT CONTRACTOR: Cut'N Break Construction Inc. -AS H LAND CONTACT: John Lawton, President 20 East Main Street ADDRESS: P.O. Box 1455 Ashland, Oregon 97520 Telephone: 541/488-6002 Medford, OR 97501 Fax: 5411488-5311 TELEPHONE: (541) 779-1482 FAX: (541) 772-1913 BEGINNING DATE: February 17, 2015 COMPLETION DATE: February 27, 2015 COMPENSATION: Not to Exceed $1,450.00 see attached GOODS AND SERVICES TO BE PROVIDED: In the event of conflicts or discrepancies among Contract Documents, this standard form of the City of Ashland Contract 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 this standard form City of Ashland Contract. 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. Ownership of Production: All documents, materials or items produced by Contractor pursuant to this contract shall be the property of City. 4. Statutory Requirements: ORS 2798.220, 2798.225, 2798.230, 279B.235, ORS Chapter 244 and ORS 670.600 are made part of this contract. 5. Indemnification: Contractor agrees to defend, indemnify and save City, its officers, employees and agents harmless from those tosses, expenses, or other damages resulting from injury to any person or damage to property arising out of or incident to the negligent performance of this contract by Contractor its employees, or agents. Contractor shall not be held responsible for any losses, expenses, or other damages, directly, solely, and proximately caused by the negligence of City. 6. Termination: City's Convenience. This contract may be terminated at any time by the City. 7. 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. 8. 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. 9. Asbestos Abatement License: If required under ORS 468A.710, Contractor or Subcontractor shall possess an asbestos abatement license. 10. Assignment and Subcontracts: Contractor shall not assign this contract or subcontract any portion of the work. 11. 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. 12. Default. The Contractor shall be In default of this agreement !(Contractor commits any material breach or default of any covenant, warranty, certification, or obligation it owes under the Contract 13. Insurance. Contractor shall at its own expense provide the following insurance: a. a. Workees Compensation insurance in compliance with ORS 656.017, which requires subject employers to provide Oregon workers' compensation coverage for all their subject workers. Worker's compensation insurance is required if work is performed by employees, subcontractors, or volunteers. BY INITIALING THIS SENTENCE, CONTRACTOR CERTIFIES UNDER PENALTY OF LAW THAT THE WORK REQUIRED BY THIS CONTRACT SHALL BE PERFORMED SOLELY BY THE UNDERSIGNED: b. General Liability insurance with a combined single limit, or the equivalent, of not less than $1.000,000 for each occurrence for Bodily Injury and Property Damage. It shall include contractual liability coverage for the indemnity provided under this contract. C. Automobile Liability insurance with a combined single limit, or the equivalent, of not less than $1,000.000 for each accident for Bodily Injury and Property Damage, including coverage for owned, hired or non-owned vehicles, as applicable. 14. Governing Law; Jurisdiction; Venue: This contract shall be governed and construed in accordance with the laws of the State of Oregon 15. 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. Certification. Contractor shall n t certification attached hereto as Exhibit A and herein incorporated by reference. Contra r: City of Ashland: rE By 1 T---- BY 7 Signature Department Head Print Name Print Nam Title Date W-9 One copy of a W-9 is to be submitted with the signed contract. Purchase Order No. A~ 0 ~®RM Revised 10-28-14 Page 1 of 2 t, Ci . tt®meJy D a t a. .4,7Z 2-`3 EXHIBIT A CERTIFICATIONWREPRESENTATIONS: 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. i. (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 th )2bor or services to be provided. ContractoY (Date) Revised 10-28.14 Page 2 of 2 CUT `N BREAK CONSTRUCTION INC. am ~ loll- P.0, Box 1455 Medford, OR 9750 1-0 1 08 CCS License #72046 541-779--1482/FAX 541-772-1913 John Lawton, President February 17, 2015 Karl Johnson, E.I.T 541-4$5-5347 johnsonk ,ashland.onus Job Site: corner of E Main and Pioneer St This proposal is to grade and pour concrete as discussed. • fine grade • Install mono footing for block wall • Install fornis • Install 3500 psi concrete • Place and broom finish • Install control joints 2' squares EQUIPMENT, MATERIAL, AND LABOR: $1,050.00 Note: I . It will be S 1,050.00 if poured at same time with OSF 2. It will be S1,450.00 if poured separate When saw cutting, Cut `N Break Constriction, Inc. is not responsible for any damage to anything in or below the concrete. This includes water lines, electrical line, sprinkler systems, etc. Your signature indicates that your have read this notice and fully understand the limits of Cut 'N Break Construction, Inc. responsibility. Billing and Payment Procedures: Invoices are presented on completion of work. Invoices are due and payable upon receipt. Delinquent invoices are subject to 1 112% monthly on unpaid balance. We accept Visa and MasterCard for your convenience. Should you have any questions or need any additional information regarding the above proposal please do not hesitate to contact this office. THIS ESTIMATE IS GOOD FOR 30 DAYS! Signing one copy of this letter and returning it in the enclosed envelope indicates acceptance of this proposal Travis Lawton 1:37-08' tL7G ~OCtf~~~LTfI Die: 2y signed by:2Kad Johnson ACCEPTED By: Date: 20155.02.02.1 .1715:2137-08'00 Date: THIS ESTIMATE IS GOOD FOR 30 DAYS! DATE (MM/DDNYYY) AcC'RL> CERTIFICATE OF LIABILITY INSURANCE - 2/17/2015 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 Brown & Brown Northwest NAME: CONTACT Susan Wilson _ 3256 Hillcrest Park Drive PAHCO"N E}.t. 541 494-2658 A/c N541-494-2758 Medford, OR 97504 E-MAIL ADDRESS: swllson bbnw.com _ INSURE R(S) AFFORDING COVERAGE _ j N_AIC # www.bbnw.com INSURER A : American Hallmark Insurance Com an of Texas 43494 INSURED INSURER B : SAIF Corporation _524.12_ Cut N Break Construction Inc - - PO Box 1455 INSURER C : Western Sure Company 13133 Medford OR 97501-0108 INSURER D : INSURER E : _ INSURER F : COVERAGES CERTIFICATE NUMBER: 23470933 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. INSRADDL SUBR; POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DDIYYW A COMMERCIAL GENERAL LIABILITY / 44CL44930207 4/13/2014 4/13/2015 EACH OCCURRENCE $ _ 1,0_00,000 DAMAGE TO RENTED 100,000 CLAIMS-MADE [VI OCCUR PREMISES Ea occurrence)' $ - MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS-COMP/OPAGG $ 2,000,000 POLICY L~l I JECO_ LOC OTHER: AUTOMOBILE LIABILITY 44CL44930207 4/13/2014 4/13/2015 COMBINED SINGLE LIMIT $ 1,000,000 A (Ea accident)_ ✓ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ _ AUTOS AUTOS - NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident) _ $ A ✓ UMBRELLA LIAB / OCCUR 44CUl 11421 7/1/2014 4/13/2015 EACH OCCURRENCE $ 1 000,000 EXCESS LAB CLAIMS-MADE AGGREGATE$ 1,000,000 DED ✓ RETENTION $10,000 $ B WORKERS COMPENSATION 1489003 10/1/2014 10/1/2015 ✓ 1 PER STATUTE OERH AND EMPLOYERS' LIABILITY - ANY PROPRIETOR/PARTNER/EXECUTIVE Y/ N E.L. EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 C ',BOLI Bond (Statutory) 70106243 6/5/2014 6/5/2015 Limit: $30,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Job Site - Corner of E Main and Pioneer Street. Grade and Pour Concrete. General Liability includes Additional Insured Coverage, including Primary/Non-Contributory, Waiver of Subrogation and Per Project Aggregate when required by written contract. Subject to policy terms, limits, conditions and exclusions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Karl Johnson, E.I.T. ACCORDANCE WITH THE POLICY PROVISIONS. 20 East Main Street Ashland OR 97520 AUTHORIZED REPRESENTATIVE ` Susan Wilson ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/011 The ACORD name and logo are registered marks of ACORD CERT NO.: 23470933 Susar Wilson 2/17/2015 4;04;40 PM ;PST) Page 1 of 6 ARTISANS ADVANTAGE ENHANCED COVERAGE ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUILDING AND PERSONAL PROPERTY COVERAGE FORM CAUSES OF LOSS - SPECIAL FORM COMMERCIAL PROPERTY CONDITIONS COMMERCIAL GENERAL LIABILITY COVERAGE FORM When this endorsement is attached to the policy, insurance under the Building and Personal Property Coverage Form, the Causes of Loss - Special Form, the Commercial Property Conditions and the Commercial General Liability Coverage Form is enhanced to provide the coverages described in this endorsement. All other conditions of the policy continue to apply. This coverage is subject to the provisions applicable to the Building and Personal Property Coverage Form, Causes of Loss - Special Form, the Commercial Property Conditions and the General Liability Coverage Form. SCHEDULE Coverage Enhancements Limits of Insurance Each Location Property Coverage Premises Boundary 1,000 feet Property Coverage Extensions Newly Acquired or Constructed Property Buildings $500,000. at Each Building Business Personal Property $250,000. at Each Building Personal Effects and Property of Others $ 25,000. at Replacement Cost Valuable Papers and Records (Other than Electronic Data) $ 25,000. Property Off-Premises (Including Laptops and Other Electronic Equipment) $ 15,000. Outdoor Property (Named Perils) $ 1,000. per tree/shrub, max. limit $25,000. Non-Owned Detached Trailers $ 10,000. Accounts Receivable $ 50,000. Property in Transit (Including Laptops and Other Electronic Equipment) $ 15,000. Fine Arts $ 25,000. Property Additional Coverages Debris Removal $ 25,000. Fire Department Service Charge $ 5,000. Pollutant Clean-up and Removal $ 15,000. Electronic Data $ 25,000. Interruption of Computer Operations $ 15,000. Arson Reward $ 5,000. Water Back-Up and Sump Overflow $ 25,000. Brands and Labels $ 25,000. Employee Theft $ 10,000. Business Income Including Extra Expense $ 25,000. Business Income from Dependent Properties $ 10,000. Claims Expenses $ 10,000. Inventory or Appraisal Cost $ 5,000. Money and Securities Inside $ 10,000. Outside $ 5,000. Off Premises Power Failure - Direct Damage $ 10,000. Ordinance or Law Coverage Coverage A Included within Building Limit. Coverages B and C Combined 25% of Bldg. Limit, $150,000. maximum Outdoor Signs $ 10,000. Recharging of Fire Extinguishers $ 5,000. Unauthorized Business Card Use $ 5,000. Forgery or Alteration $ 10,000. Salespersons Samples $ 2,500. MP 97 67 10 10 Includes copyrighted material of Insurance Services Office, Inc. and Page 1 of 25 American Association of Insurance Services, Inc., with their permission CERT NO.: 23470933 Susac Wilson 2/17/2015 4:04:40 PM (PST) Page 2 o`_ 6 Inland Marine Coverages Installation Coverage $ 10,000. Contractors Equipment Coverages: Small Tools $ 5,000. (Maximum limit per item $1,000) Employee Small Tools $ 1,000. (Maximum limit per item $250) Leased and Rented Equipment $ 5,000. Rental Reimbursement $ 1,000. General Liability Additional Coverages Blanket Additional Insured (Including Primary Non-Contributing Coverage) Included in Each Occurrence Limit Mobile Equipment Broadened Coverage Included in Each Occurrence Limit Aggregate Limit Per Project Included in Each Occurrence Limit Blanket Waiver Included in Each Occurrence Limit Voluntary Property Damage Coverage $ 2,500. The following applies to coverages under this endorsement only. Property Coverage The phrase'within 100 feet of the described premises' used in Paragraphs a.(5)(b), b. and c.(2) under A.1. Covered Property of the BUILDING AND PERSONAL PROPERTY COVERAGE FORM and Paragraph 2.c.(1) under C. Limitations of the CAUSES OF LOSS - SPECIAL FORM is replaced by the phrase 'within 1,000 feet of the described premises'. Property Coverage Extensions Paragraph A.5. Coverage Extensions of the BUILDING AND PERSONAL PROPERTY COVERAGE FORM is deleted in its entirety and replaced by the following: 5. Coverage Extensions Except as otherwise provided, the following Extensions apply to property located in or on the building described in the Declarations or in the open (or in a vehicle) within 1,000 feet of the described premises. If a Coinsurance percentage of 80% or more or, a Value Reporting period symbol, is shown in the Declarations, you may extend the insurance provided by this Coverage Part as follows: a. Newly Acquired Or Constructed Property (1) Buildings If this policy covers Building, you may extend that insurance to apply to: (a) Your new buildings while being built on the described premises; and (b) Buildings you acquire at locations, other than the described premises, intended for: (i) Similar use as the building described in the Declarations; or (ii) Use as a warehouse. The most we will pay for loss or damage under this Extension is $500,000 at each building. (2) Your Business Personal Property (a) If this policy covers Your Business Personal Property, you may extend that insurance to apply to: (i) Business personal property, including such property that you newly acquire, at any location you acquire, at any location you acquire other than at fairs, trade shows or exhibitions; (ii) Business personal property, including such property that you newly acquire, located at your newly constructed or acquired buildings at the location described in the Declarations; or (iii) Business personal property that you newly acquire, located at the described premises. The most we will pay for loss or damage under this Extension is $250,000 at each building. (b) This Extension does not apply to: Page 2 of 25 Includes copyrighted material of Insurance Services Office, Inc. and MP 97 57 10 10 American Association of Insurance Services, Inc., with their permission CERT NO. 23470933 Susan Wilson 2/17/2015 4:04:40 PM ;PST) Page 3 of 6 (5) Vandalism and malicious mischief; or (6) Theft. c. The following is added to A.2. Property Not Covered of the BUILDING AND PERSONAL PROPERTY COVERAGE FORM: r. Property while stored or operated underground in connection with any mining operations. d. The following is added to Paragraph 2. of B. Exclusions of the CAUSES OF LOSS - SPECIAL FORM: n. We will not pay for loss or damage caused by puncture, blowout and road damage to tires and tubes mounted on vehicles. However, we do pay for puncture, blowout or road damage caused by a specified peril. o. We will not pay for loss caused by humidity, dampness, dryness or changes in or extremes of temperature. p. We will not pay for loss caused by the weight of a load which, under the operating conditions at the time of a loss, exceeds the registered lifting capacity of any equipment or machine. q. We will not pay for loss due to theft or mysterious disappearance from any vehicle or attached container. We will pay for loss due to burglary when there are signs of forcible entry to a locked vehicle or container. e. E.7. Valuation of the BUILDING AND PERSONAL PROPERTY COVERAGE FORM is deleted and replaced by the following: 7. Valuation We will determine the value of covered property in the event of loss or damage as follows: a. At actual cash value at the time of the loss (with a deduction for depreciation) except as provided in Paragraphs b. and c. following. b. Pair or Set. The value of a lost or damaged article which is part of a pair or set is based on a reasonable proportion of the value of the entire pair or set. The loss is not considered a total loss of the pair or set. c. Loss to Parts. The value of a lost or damaged part of an item that consists of several parts when it is complete is based on the value of only the lost or damaged part or the cost to repair or replace it. 2. Rental Reimbursement In the event of loss by a covered peril to covered contractors' equipment that you own, we will reimburse you for your expense to rent similar equipment while your equipment is inoperable. The most we will reimburse you for rental reimbursement expenses is $1,000. We will continue to reimburse you for the rental of equipment after the expiration date of this coverage provided the loss occurred before the expiration date. We will not reimburse you: a. If you can continue or resume your operations with similar equipment that is available to you at no additional expense to you; or b. For the rental expense of any equipment unless you make every reasonable effort to repair, replace or rebuild the inoperable equipment after the covered loss occurs. 3. With respect to this Additional Coverage, Contractors Equipment Coverage, Section D. Deductible of the BUILDING AND PERSONAL PROPERTY COVERAGE FORM is deleted and replaced by the following: D. Deductible We will not pay for loss or damage in any one occurrence until the amount of loss or damage exceeds $500. We will then pay the amount of loss or damage in excess of $500 up to the applicable limit of insurance. We will not reimburse you for the rental of equipment until after 72 hours have passed since the covered property was rendered inoperable. After 72 hours have passed, we will only reimburse you for the rental expense that you actually incur. The deductible of $500 does not apply to rental reimbursement expenses. General Liability Additional Coverages The following Additional Coverages are added to the COMMERCIAL GENERAL LIABILITY COVERAGE FORM. A. Blanket Additional Insured Coverage 1. SECTION II -WHO IS AN INSURED of the COMMERCIAL GENERAL LIABILITY COVERAGE FORM is amended to include as an insured any person or organization (referred to as Additional Insured) whom you are required to add as an Additional Insured on this policy under: a. A written contract or agreement; and b. Where a certificate of insurance showing that person or organization as an additional insured has been issued; and Page 20 of 25 Includes copyrighted material of Insurance Services Office, Inc. and MP 97 67 10 10 American Association of Insurance Services, Inc., with their permission CERT NO.: 23470933 5-1 Nilson 2/17/2C15 4:04:40 PM (PST) Page 4 0- 6 c. When the written contract or agreement and certificate of insurance are currently in effect or becoming in effect during the term of the policy and executed prior to the "bodily injury," "property damage," or "personal and advertising injury." 2. The insurance provided to the Additional Insured is limited as follows: a. The Additional Insured is only an additional insured for: (1) "Bodily injury," "property damage," or "personal and advertising injury" caused in whole or in part by negligent acts or omissions of the Named Insured or anyone directly or indirectly employed by the Named Insured or for whose acts a Named Insured may be liable. (2) Liability arising out of your ongoing operations for the Additional Insured by or for you. A person's or organization's status as an insured under this coverage ends when your operations for that insured are completed. b. The Limits of Insurance applicable to the Additional Insured are those specified in the written contractor agreement but not more than the Limits of Insurance specified in the Declarations for this policy. The Limits of Insurance applicable to the Additional Insured are inclusive of and not in addition to the Limits of Insurance shown in the Declarations for the Named Insured. 3. In addition to the other exclusions applicable to Section I, Coverages A., B. and C. of the COMMERCIAL GENERAL LIABILITY COVERAGE FORM, the insurance provided to the Additional Insured does not apply to: a. "Property damage" to: (1) Property owned, used, occupied by, loaned or rented to the Additional Insured; (2) Property in the care, custody or control of the Additional Insured or over which the Additional Insured are for any purpose exercising physical control; or (3) "Your work" performed for the Additional Insured. b. "Bodily injury," "property damage," or "personal and advertising injury" arising out of an architect's, engineer's or surveyor's rendering or failure to render any professional services for you, for the Additional Insured or for others, including, but not limited to: (1) The preparing, approving or failure to prepare or approve maps, drawings, opinions, reports, surveys, change orders, designs or specifications; or (2) Supervisory, inspection or engineering services. c. "Bodily injury" or "property damage" occurring after: (1) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured at the site of the covered operations has been completed; or (2) That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. 4. SECTION IV- COMMERCIAL GENERAL LIABILITY CONDITIONS, Paragraph 4. Other Insurance, is amended to add the following subparagraph: d. Additional Insured's Other Insurance As Excess Insurance To the extent required by an "insured contract," this insurance is primary on behalf of the Additional Insured; and any other insurance maintained by the Additional Insured is excess and not contributory with this insurance. If the "insured contract" does not require this provision, then Paragraph a. above will apply. B. Mobile Equipment Broadened Coverage V.121(1) of the COMMERCIAL GENERAL LIABILITY COVERAGE FORM is replaced by the following: (1) Equipment designed primarily for: (a) Snow Removal; (b) Road maintenance, but not construction or resurfacing; or (c) Street cleaning. Except the above provisions do not apply to self-propelled vehicles of less than 1,000 pounds gross vehicle weight which are not intended for use on a highway. C. Aggregate Limit Per Project The General Aggregate Limit under SECTION III - LIMITS OF INSURANCE of the COMMERCIAL GENERAL LIABILITY COVERAGE FORM applies separately to each of your projects away from premises owned by or rented to you. MP 97 67 10 10 Includes copyrighted material of Insurance Services Office, Inc. and Page 21 of 25 American Association of Insurance Services, Inc., with their permission CERT NO.: 23470933 Susan Wilson 2!17/2C15 4:04:40 PM (PST) Page 5 of 6 D. Blanket Waiver Of Transfer Of Rights Of Recovery Against Others To Us The Transfer Of Rights Of Recovery Against Others To Us Condition (SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of the following: We waive any right of recovery we may have against any person or organization to whom you by written contract or written agreement have waived your own right or recovery for loss caused by that person or organization because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a written contract or written agreement with that person or organization and included in the "products-completed operations hazard." This provision does not apply unless the written contract or written agreement has been executed prior to the "occurrence" or offense giving rise to the "bodily injury" or "property damage." E. Voluntary Property Damage Coverage 1. We will, at your request, pay but not defend any claim for "property damage" to the property of others otherwise excluded under A.2.j.(4), (5) and (6) of the COMMERCIAL GENERAL LIABILITY COVERAGE FORM provided that.. a. Such "property damage" takes place while such property is in your care, custody or control, or is property of others over which you, for any purpose, are exercising or have exercised physical control; and b. Such "property damage" takes place away from any premises you own, rent or lease; and c. Such "property damage" takes place within the "coverage territory" and during the policy term; and d. Such "property damage" takes place only during your operations that are known to us, are scheduled on the policy and for which a premium has been charged. 2. The insurance under this additional coverage does not apply to "property damage" to property: a. Held by you for servicing, repair, storage or sale at premises owned by, rented or leased to you; b. While being transported by or caused by the ownership, maintenance, operation, use, "loading or unloading" of any "auto," watercraft or aircraft; or c. Owned or occupied by or rented to you. 3. Deductible This additional coverage will apply only to that amount of any loss in each "occurrence" that exceeds $500. The terms of the policy with respect to your duties in the event of "occurrence," claim or "suit" and the Company's right to investigate, negotiate and settle any claim or "suit" apply irrespective of the application of the deductible amount of $500. We may pay any part or all of the deductible amount of $500 to effect settlement of any claim or "suit." Upon notification of the action taken, you must promptly reimburse us for such part of the deductible amount as has been paid by us. 4. Limits of Liability The Limit of Liability for this additional coverage shall not exceed $2,500 for each "occurrence" and is the limit of the Company's liability for all damages on account of each claim or "suit" covered herein. The annual aggregate Limit of Liability is $2,500 and is, subject to the above provisions respecting each claim, the total limit of the Company's liability for all damages. 5. Settlement In the event of loss covered by this additional coverage, you shall, if requested by us, replace the property or furnish the labor and materials necessary for repairs thereto at actual cost to you, excluding prospective profit or overhead charges of any nature. Any property so paid for or replaced shall, at our option, become the property of the Company. Payment hereunder shall not constitute an admission of liability of you or, except as stated herein, of the Company. Additional Conditions A. Insurance Under Two Or More Coverages The following is added to Paragraph C. Insurance under Two or More Coverages of the COMMERCIAL PROPERTY CONDITIONS: If a Coverage Form is attached to this policy that provides a limit for any coverage provided by this endorsement; the limit shown in the SCHEDULE and the coverage provided by this endorsement are deleted and replaced by the limit and coverage provided by the Coverage Form. B. Limits Of Insurance Regardless of the number of buildings at a location covered by this endorsement, the most we will pay under this Coverage Enhancement endorsement in any one occurrence is the applicable Limits of Insurance shown in the SCHEDULE on page 1 of this endorsement. Page 22 of 25 Includes copyrighted material of Insurance Services Office, Inc. and MP 97 67 10 10 American Association of Insurance Services, Inc., with their permission CERT NO.: 23470933 Susac Wilson 2/17/2C15 4:04:40 PM iPST) Page 6 6 a Page 1 / 1 CITY OF P. ASHLAND DATE FPO NUMBER 20 E MAIN ST. 2/26/2015 12741 ASHLAND, OR 97520 (541) 488-5300 VENDOR: 004823 SHIP To: Ashland Public Works CUT N BREAK CONSTRUCTION INC (541) 488-5587 PO BOX 1455 51 WINBURN WAY MEDFORD, OR 97501 ASHLAND, OR 97520 FOB Point: Ashland, Oreqon Req. No.: Terms: Net Dept.: Req. Del. Date: contact: Karl Johnson Special Inst: Confirming? No Quantity Unit Description Unit Price Ext. Price Provide concrete construction work for 1,450.00 Pioneer Square Remodel Project Contract for Goods and Services Small Procurement Less than $5,000 Beqinninq date: February 17, 2015 Completion date: February 27, 2015 SUBTOTAL 1450.00 BILL To: Account Payable TAX 0.00 20 EAST MAIN ST FREIGHT 0.00 541-552-2010 TOTAL 1,450.00 ASHLAND, OR 97520 Account Number Project Number Amount Account Number Project Number Amount E 410.08.24.00.60240 E 201502.120 1,450.00 horized Signature VENDOR COPY FORM #3~ CITY OF ASHLAND REQUISITION Date of request: 02/18/15 Required date for delivery: ASAP Vendor Name Cut `N Break Construction. Inc. Address, City, State, Zip P.O. Box 1455. Medford. OR 97501 Contact Name & Telephone Number John Lawton. President, (541) 779-1482 Fax Number (541) 772-1913 SOURCING METHOD ❑ Exempt from Competitive Bidding ❑ Emergency ❑ Reason for exemption: ❑ Invitation to Bid (Copies on file) ❑ Form #13, Written findings and Authorization ❑ AMC 2.50 Date approved by Council: ❑ Written quote or proposal attached ❑ Written quote or proposal attached ❑ Small Procurement Cooperative Procurement Less than $5.000 ❑ Request for Proposal (Copies on file) ❑ State of Oregon ® Direct Award Date approved by Council: Contract # ® VerbalMritten quote(s) or proposal(s) ❑ State of Washington Intermediate Procurement ❑ Sole Source Contract # GOODS & SERVICES ❑ Applicable Form (#5,6, 7 or 8) ❑ Other government agency contract $5,000 to $100.000 ❑ Written quote or proposal attached Agency ❑ (3) Written quotes and solicitation attached ❑ Form #4, Personal Services $5K 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 Date original contract approved by Council: ❑ (3) Written proposals/written solicitation Date approved by Council: (Date) ❑ Form #4, Personal Services $5K to $75K Valid until: Date Description of SERVICES Total Cost Provide concrete construction work for Pioneer Square Remodel Project. $1,450.00 Item # Quantity Unit Description of MATERIALS Unit Price Total Cost TOTAL COST ❑ Per attached quotelproposal $ Project Number 201502.120 Account Number 410.08.24.00.602400 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 requis' 'norm that th City's public contracting requirements have been satisfied. Employee: / Department Head: (Equal to or greater than $5,000) Department Manager/91. pervis 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