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HomeMy WebLinkAbout2015-141 Contract - Welburn Electric Inc Contract for GOODS AND SERVICES Less than $25,000 C I T Y Of CONTRACTOR: Welburn Electric, Inc. -ASHLAND CONTACT: Alan Welburn 20 East Main Street Ashland, Oregon 97520 ADDRESS: P.O. Box 329, Phoenix, OR 97535 Telephone: 541/488-6002 Fax: 541/488-5311 TELEPHONE: (541) 535-3727 DATE AGREEMENT PREPARED: FAX: (541) 535-3572 BEGINNING DATE: May 18, 2015 COMPLETION DATE: June 30, 2016 COMPENSATION: Not to Exceed $4999.00 GOODS AND SERVICES TO BE PROVIDED: Flexible electrical goods and services to include time and materials as needed per attached Exhibit C ADDITIONAL TERMS: In the event of conflicts or discrepancies among the contract documents, the City of Ashland Contract for Goods and 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 primary 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. Completion Date: Contractor shall provide all goods in accordance with the standards and specifications, no later than the date indicated above and start performing the work under this contract by the beginning date indicated above and complete the work by the completion date indicated above. 4. Compensation: City shall pay Contractor for the specified goods and for any work performed, including costs and expenses, the sum specified above. Payments shall be made within 30 days of the date of the invoice. Should the contract be prematurely terminated, payments will be made for work completed and accepted to date of termination. Compensation under this contract, including all costs and expenses of Contractor, is limited to $25,000.00, unless a separate written contract is entered into by the City. 5. Ownership of Documents: All documents prepared by Contractor pursuant to this contract shall be the property of City. 6. Statutory Requirements: ORS 2796.220, 27913.225, 27913.230, 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 $20,142.20 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 art, effective upon delivery of Contract for Goods and Services Less than $25,000, Revised 07/08/2014, Page 1 of 5 written notice to Contractor, or at such later date as may be established by City under any of the following conditions: i. If City funding from federal, state, county or other sources is not obtained and continued at levels sufficient to allow for the purchase of the indicated quantity of services; ii. If federal or state regulations or guidelines are modified, changed, or interpreted in such a way that the services are no longer allowable or appropriate for purchase under this contract or are no longer eligible for the funding proposed for payments authorized by this contract; or iii. If any license or certificate required by law or regulation to be held by Contractor to provide the services required by this contract is for any reason denied, revoked, suspended, or not renewed. d. For Default or Breach. i. Either City or Contractor may terminate this contract in the event of a breach of the contract by the other. Prior to such termination the party seeking termination shall give to the other party written notice of the breach and intent to terminate. If the party committing the breach has not entirely cured the breach within 15 days of the date of the notice, or within such other period as the party giving the notice may authorize or require, then the contract may be terminated at any time thereafter by a written notice of termination by the party giving notice. ii. Time is of the essence for Contractor's performance of each and every obligation and duty under this contract. City by written notice to Contractor of default or breach, may at any time terminate the whole or any part of this contract if Contractor fails to provide services called for by this contract within the time specified herein or in any extension thereof. iii. The rights and remedies of City provided in this subsection (d) are not exclusive and are in addition to any other rights and remedies provided by law or under this contract. e. Obligation/Liability of Parties. Termination or modification of this contract pursuant to subsections a, b, or c above shall be without prejudice to any obligations or liabilities of either party already accrued prior to such termination or modification. However, upon receiving a notice of termination (regardless whether such notice is given pursuant to subsections a, b, c or d of this section, Contractor shall immediately cease all activities under this contract, unless expressly directed otherwise by City in the notice of termination. Further, upon termination, Contractor shall deliver to City all contract documents, information, works-in-progress and other property that are or would be deliverables had the contract been completed. City shall pay Contractor for work performed prior to the termination date if such work was performed in accordance with the Contract. 10. Independent Contractor Status: Contractor is an independent Contractor and not an employee of the City. Contractor shall have the complete responsibility for the performance of this contract. 11. Non-discrimination Certification: The undersigned certifies that the undersigned Contractor has not discriminated against minority, women or emerging small businesses enterprises in obtaining any required subcontracts. Contractor further certifies that it shall not discriminate in the award of such subcontracts, if any. The Contractor understands and acknowledges that it may be disqualified from bidding on this contract, including but not limited to City discovery of a misrepresentation or sham regarding a subcontract or that the Bidder has violated any requirement of ORS 279A.110 or the administrative rules implementing the Statute. 12. Asbestos Abatement License: If required under ORS 468A.710, Contractor or Subcontractor shall possess an asbestos abatement license. 13. Assignment and Subcontracts: Contractor shall not assign this contract or subcontract any portion of the work without the written consent of City. Any attempted assignment or subcontract without written consent of City shall be void. Contractor shall be fully responsible for the acts or omissions of any assigns or subcontractors and of all persons employed by them, and the approval by City of any assignment or subcontract shall not create any contractual relation between the assignee or subcontractor and City. 14. Use of Recyclable Products: Contractor shall use recyclable products to the maximum extent economically feasible in the performance of the contract work set forth in this document. 15. Default. The Contractor shall be in default of this agreement if Contractor: commits any material breach or default of any covenant, warranty, certification, or obligation it owes under the Contract; if it loses its QRF status pursuant to the QRF Rules or loses any license, certificate or certification that is required to perform the work or to qualify as a QRF if Contractor has qualified as a QRF for this agreement; institutes an action for relief in bankruptcy or has instituted against it an action for insolvency; makes a general assignment for the benefit of creditors; or ceases doing business on a regular basis of the type identified in its obligations under the Contract; or attempts to assign rights in, or delegate duties under, the Contract. 16. Insurance. Contractor shall at its own expense provide the following insurance: a. Worker's Compensation insurance in compliance with ORS 656.017, which requires subject employers to provide Oregon workers' compensation coverage for all their subject workers b. General Liability insurance with a combined single limit, or the equivalent, of not less than Enter one: $200,000, $500,000, $1,000,000, $2,000,000 or Not Applicable for each occurrence for Bodily Injury and Property Damage. C. Automobile Liability insurance with a combined single limit, or the equivalent, of not less than Enter one: $200,000, $500,000, $1,000,000, or Not Applicable for each accident for Bodily Injury and Property e, Contract for Goods and Services Less than $25,000, Revised 07/08/2014, Page 2 of 5 including coverage for owned, hired or non-owned vehicles, as applicable. d. Notice of cancellation or change. There shall be no cancellation, material change, reduction of limits or intent not to renew the insurance coverage(s) without 30 days' written notice from the Contractor or its insurer(s) to the City. e. Additional Insured/Certificates of Insurance. Contractor shall name The City of Ashland, Oregon, and its elected officials, officers and employees as Additional Insureds on any insurance policies required herein but only with respect to Contractor's services to be provided under this Contract. As evidence of the insurance coverages required by this Contract, the Contractor shall furnish acceptable insurance certificates prior to commencing work under this contract. The contractor's insurance is primary and non-contributory. The certificate will specify all of the parties who are Additional Insureds. Insuring companies or entities are subject to the City's acceptance. If requested, complete copies of insurance policies, trust agreements, etc. shall be provided to the City. The Contractor shall be financially responsible for all pertinent deductibles, self-insured retentions and/or self- insurance. 17. Governing Law; Jurisdiction; Venue: This contract shall be governed and construed in accordance with the laws of the State of Oregon without resort to any jurisdiction's conflict of laws, rules or doctrines. Any claim, action, suit or proceeding (collectively, "the claim") between the City (and/or any other or department of the State of Oregon) and the Contractor that arises from or relates to this contract shall be brought and conducted solely and exclusively within the Circuit Court of Jackson County for the State of Oregon. If, however, the claim must be brought in a federal forum, then it shall be brought and conducted solely and exclusively within the United States District Court for the District of Oregon filed in Jackson County, Oregon. Contractor, by the signature herein of its authorized representative, hereby consents to the in personam jurisdiction of said courts. In no event shall this section be construed as a waiver by City of any form of defense or immunity, based on the Eleventh Amendment to the United States Constitution, or otherwise, from any claim or from the jurisdiction. 18. THIS CONTRACT AND ATTACHED EXHIBITS CONSTITUTE THE ENTIRE AGREEMENT BETWEEN THE PARTIES. NO WAIVER, CONSENT, MODIFICATION OR CHANGE OF TERMS OF THIS CONTRACT SHALL BIND EITHER PARTY UNLESS IN WRITING AND SIGNED BY BOTH PARTIES. SUCH WAIVER, CONSENT, MODIFICATION OR CHANGE, IF MADE, SHALL BE EFFECTIVE ONLY IN THE SPECIFIC INSTANCE AND FOR THE SPECIFIC PURPOSE GIVEN. THERE ARE NO UNDERSTANDINGS, AGREEMENTS, OR REPRESENTATIONS, ORAL OR WRITTEN, NOT SPECIFIED HEREIN REGARDING THIS CONTRACT. CONTRACTOR, BY SIGNATURE OF ITS AUTHORIZED REPRESENTATIVE, HEREBY ACKNOWLEDGES THAT HE/SHE HAS READ THIS CONTRACT, UNDERSTANDS IT, AND AGREES TO BE BOUND BY ITS TERMS AND CONDITIONS. 19. Nonappropriations Clause. Funds Available and Authorized: City has sufficient funds currently available and authorized for expenditure to finance the costs of this contract within the City's fiscal year budget. Contractor understands and agrees that City's payment of amounts under this contract attributable to work performed after the last day of the current fiscal year is contingent on City appropriations, or other expenditure authority sufficient to allow City in the exercise of its reasonable administrative discretion, to continue to make payments under this contract. In the event City has insufficient appropriations, limitations or other expenditure authority, City may terminate this contract without penalty or liability to City, effective upon the delivery of written notice to Contractor, with no further liability to Contractor. 20. Prior Approval Required Provision. Approval by the City of Ashland Council or the Public Contracting Officer is required before any work may begin under this contract. 21. Certification. Contractor shall sign the certification attached hereto as Exhibit A and herein incorporated by reference. Contractor: City of Ashland By By ck Signature Department ead a4xv WCiauftu YV1`~~t3-> t 1Z r-y P nt Name 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 Goods and Services Less than $25,000, 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. (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. Contractor (Date) Contract for Goods and Services Less than $25,000, Revised 07/08/2014, Page 4 of 5 CITY • ASHLAND, OREGON EXHIBIT B City of Ashland LIVING WAC;E •1 1 ~ 1 • 1 1 per hour effective June 30, 2014 (Increases annually every June 30 by the 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. ➢ from the City of service contract between their business 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 ➢ For all hours worked in a month if the employee spends and Recreation Department. details on applicability of this policy, please 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, For additional information: 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 Goods and Services Less than $25,000, Revised 07/08/2014, Page 5 of 5 Bid Proposal 4529 S. Pacific Highway fflj~ ~ Phone (541) 535-3727 P.O. Box 329 Fax (541) 535-3572 Phoenix, Oregon 97535 symum Oregon Lie. # 15-189C C.C.B. Lie. # 78794 ELECTRIC, INC. California Lic. # 777522 PROPOSAL RECIPIENT; City of Ashland PHONE: 541-552-2413 FAX: DATE: 5/12/15 STREET. 20 N. Main St. JOB NAN[E. Water System Improvements CITY, STATE, ZIP: Ashland, OR. 97520 JOB LOCATION: 528 Terrace St. Pump Station CONTACT: Pieter Smeenk DATE Or PLANS: ARCHITECT: HEREBY SUBMIT SPECIFICATIONS AND ESTIMATES FOR. Please use the following T&M service rates for work at the TID/C.O.A pump station. Journeyman Electrician $80.00/hr. Apprentice Electrician $65.00/hr. Parts Delivery -------------------------------$42.00/hr. Material supplied by W.E.I. will be sold at cost plus 15%. We propose hereby to furnish material and labor - complete in accordance with above specifications, for the sum of. Please see details above $ PAYMENT TO BE MADE AS FOLLOWS: { For all new customers payment to be 50% down due upon acceptance of proposal, balance paid C.O.D For existing customers Payment due 15 days from receipt of invoice 0igidlW ilwxd tea IVA Alan Welburn -Authorized Signature Note: This proposal may be withdrawn by us if not accepted within 15 days. ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work specified. ACCEPTED: Company Date Signature o astip,l tcits boLIi c ifvmt a ~i, tarnv..c cops 3±fitli pr- - 1 ?.:C' III th; a ells the nn < . vc set slut, and if Ip s1IIS1 pr- e. c . '1 be m"I'de for ~ fi k ai the sh III be llwlec 1 r =1 r.: art rbPe slifoslr , * IeEs 1t1 tI L, a _ l I i,'3 n annu t(r _ tc iEi t ~}iar ed oII n asi dua a 4:It€n t i 1 J riflEill 3E} tz~ s oY Contact Alan Welburn with any questions regarding this proposal. Alan @welbumelectric.corn www.saif.com Oregon Workers' Compensation salf Certificate of Insurance ~ ,corporation Mail to: Certificate holder: WELBURN ELECTRIC INC CITY OF ASHLAND PO BOX 329 20 E. MAIN STREET PHOENIX, OR 97535-0329 ASHLAND, OR 97520 The policy of insurance listed below has been issued to the insured named below for the policy period indicated. The insurance afforded by this policy is subject to all the terms, exclusions and conditions of such policy; this policy is subject to change or cancellation at any time. Insured Producer/contact Welburn Electric Inc SAIF Corporation PO Box 329 Phil L Swinford Phoenix, Or 97535-0329 541.672.4422 phiswi@saif.com Issued 05/14/2015 Limits of liability Policy 488390 Bodily Injury by Accident $500,000 each accident Period 10/01/2014 to 10/01/2015 Bodily Injury by Disease $500,000 each employee Body Injury by Disease $500,000 policy limit Description of operations/locations/special items ELECTRICAL WORK AS REQUESTED AT VARIOUS SITES Important This certificate is issued as a matter of information only and confers no rights to the certificate holder. This certificate does not amend, extend or alter the coverage afforded by the policies above. This certificate does not constitute a contract between the issuing insurer, authorized representative or producer and the certificate holder. CANCELLATION: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED TO THE POLICYHOLDER AND CERTIFICATE HOLDER IN ACCORDANCE WITH THE POLICY PROVISIONS AND OREGON LAW. SAIF WILL ENDEAVOR TO PROVIDE WRITTEN NOTICE WITHIN 30 DAYS WHENEVER POSSIBLE. Authorized representative 7 I John D. Gilkey Interim President and CEO 400 High Street SE Salem, OR 97312 P: 800.285.8525 F: 503.584.9812 Pol i cy_O LCA_Ce rtificate Of I n s u ran ce ® DATE (M MIDD/YYYY) ACORO CERTIFICATE OF LIABILITY INSURANCE F511412015 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 endorsements . PRODUCER NAMEA T_Kendatl__YeaW. - Protectors Insurance, LLC PHONE 41 42-2 Talc Noe(5411772-1906 P.O. Box 4669 E-MAIL Medford OR 97504 ADDREss:kendally@prQtectorsii3s.com _ INSURER(S) AFFORDING COVERAGE _ NAIC # INSURERA ••The Gincinnatl InSUranse Co .Z-. INSURED WELBU-1 -INSURER B: Welburn Electric Inc INSURER C". PO Box 329 INSURER D : Phoenix OR 97535 INSURER E : INSURER F COVERAGES CERTIFICATE NUMBER: 9$697420$ 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', 'ADDL(SUR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE I IN R WVD'. POLICY NUMBER MM/DD/YYYY MM/DDIYYYY LIMITS A GENERALLIABILITY EPP0295267 12/23/2014 2/23/2015 EACH OCCURRENCE $1,000,000 X DAMAGE TO RENTED _ COMMERCIAL GENERAL LIABILITY PR EMISES (Ea_occurrence $1,000,000_ CLAIMS-MADE OCCUR MED EXP (Any one person) $10,000 LPERSONAL & ADV INJURY $1,000,000 _ GENERAL AGGREGATE ,$2,000,000 ~RODUCTS -COMP/OP AGG $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER $ POLICY X PRO- LOC A AUTOMOBILE LIABILITY EBA0295267 12123/2014 2/23/2015 CO accident $1,00 000 LY INJURY (Per person) $ X ANY AUTO I - - ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ - AUTOS AUTOS - - - - NON-OWNED PROPERTY DAMAGE y Per accidenJ~. _ ' HIRED AUTOS AUTOS A X UMBRELLA LIAB X _ OCCUR EPP0295267 12/23/2014 2/23/2015 EACH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE _ $5,000,000. DED RETENTION $ $ STATU- 02;_ WORKERS COMPENSATION WCRY LIMIT$ YIN ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E L. EACH ACCIDENT $ AND EMPLOYERS' LIABILITY E.L. DISEASE -IDNT _ '!i (Manda ory OFFICER/MEMBER EXCLUDED? NIA (Mandatory in in NH) EMPLOYEE $ If yes, describe under E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS below I I DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) As additional insured per policy endorsement GA233. 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 E Main St Ashland OR 97520 AUTHORIZED REPRESENTATIVE x/ ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD Coverage Summary CGL Contractors' Broadened Endorsement Contractors' Commercial General Liability Broadened Endorsement GA233 Liability Coverages Limits Employee benefit liability ($1,000 deductible) $1,000,000 each employee/ $3,000,000 aggregate Expands damage to premises rented to insured to include lightning, At the lesser of $500,000 or the smoke, soot or water CGL each occurrence limit Waiver of subrogation if required in a written contract Included Unintentional failure to disclose existing hazards provision Included Broadened notice of occurrence Included Property damage to borrowed equipment when not in use $10,000 each occurrence ($250 deductible) Newly formed or newly acquired organizations for up to 180 days Included Automatic additional insured coverage where required in a written contract or oral agreement (where a certificate of insurance showing that person or organization as an additional insured has been issued) Included for: lessors of premises, lessors of equipment, vendors, state or political subdivision's permits relating to premises, state or political subdivision's permits relating to contractor operations Automatic additional insured coverage where required in a written contract or oral agreement (where a certificate of insurance showing that person or organization as an additional insured has been issued) from Included the named insured's work performed for that person or organization. Varying degrees of coverage apply based upon the additional insured requirements included in written and oral contracts (except AZ) Supplementary payments • Bail bonds $1,000 • Loss of earnings $350 per day Employees as insureds for specified healthcare services (nurses, EMTs Included and paramedics) Medical payments $10,000 any one person Voluntary property damage ($250 deductible) $1,000 each occurrence Care, custody or control ($250 deductible) $5,000 each occurrence Broadened contractual liability for work within 50 feet of railroad property Included This is not a policy. For a complete statement of the coverages and exclusions, please see the policy contract. For information, coverage availability in your state, quotes or policy service, please contact your local independent agent recommending coverage. "The Cincinnati Insurance Companies" and "Cincinnati" refer to member companies of the insurer group providing property and casualty coverages through ❑ The Cincinnati Insurance Company or one of its wholly owned subsidiaries - o The Cincinnati Indemnity Company, o The Cincinnati Casualty Company or n The Cincinnati Specialty Underwriters Insurance Company - and life and disability income insurance and annuities through o The Cincinnati Life Insurance Company. Each Insurer has sole financial responsibility for its own products. Not all subsidiaries operate in all states. 6200 S. Gilmore Road. Fairfield. OH 45014-5141. wvra.cinfin.com j~ Copyright (n 2012 The Cincinnati Insurance Company. All rights reserved. Do not post online, in whole or in part, CI t V C 1 N NATI without written permission. ? % INSURANCE COMPANIFS Adv. 694 (7/12) Ed.2 Page 1 / 1 CITY OF DATE NUMBER ASHLAND ,AM 20 E MAIN ST. 6/2/2015 12900 ASHLAND, OR 97520 (541) 488-5300 VENDOR: 007846 SHIP TO: Ashland Public Works WELBURN ELECTRIC INC (541) 488-5587 PO BOX 329 51 WINBURN WAY PHOENIX, OR 97535 ASHLAND, OR 97520 FOB Point: Ashland, Oreqon Req. No.: Terms: Net Dept.: Req. Del. Date: Contact: Pieter Smeenk Special Inst: Confirming? NO Quantity Unit Description Unit Price Ext. Price Time and materials NTE for services 4,999.00 related to worker safety and repairinq control valve, per attached contract and fee schedule, NTE $4,999.00 Contract for Goods and Services Beqinninq date: Mav 18, 2015 Completion date: June 30, 2016 SUBTOTAL 4,999.00 BILL TO: Account Payable TAX 0.00 20 EAST MAIN ST FREIGHT 0.00 541-552-2010 TOTAL 4,999.00 ASHLAND, OR 97520 Account Number Project Number Amount Account Number Project Number Amount E 670.08.15.00.70420 E 201201.999 4,999.00 A n-'a Ii✓ ` Authorized Signature VENDOR COPY V T®RM#3 CITY OF 11 t_ ASHLAND rrc ,1 +vh3:14 U -'J C, PaIrcUIIase~ REQUISITION Date of request: Required date for delivery: 6 g Ili~,r+dl1) Vendor Name Address, City, State, Zi Ll r C t,l~ ~.r a L~ 1! P ft'v"~ l ;f Contact Name & Telephone Number T vgell h !-ter; l 5-11 S~7 S:; Fax Number j 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 # ❑ VerbalMditen 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 Intergovemmental Agreement $5,000 to $75,000 ❑ Agency ❑ Form #9 Request for Approval ❑ 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 ~ jn~ ~ 1 01 der iv as- A - Y L ..~r I I n E,' S' I ! l A 1 ! ~'S ! Q 161 1~~ 1 , ~ o l P~ L _ '~P - Item # Quantity U . i Desc4iion of MATERIALS Unit Price Total Cost TOTAL COST Per attached quote/proposal $ ; Project Number _~b 62_- L Account Number Account Number -L5- - LD4 Account Number_-- - o "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 l No By signing this requisition form, l certify that the City's public contracting requirements have. been satisfied. Employee: i7= Department Head: /i S (Equalto o greater than $5,000) !partment Manager/Supervi ( I City Administrator: v (Equal to orgreaterthan $25,000) Funds appropriated for current fiscal year ESi 0 V /14 d ~k- !ry' t✓ ~i ~ -1 Fib ance Director- (Equal to or greater than $5,000) Date Form #3 - Requisition