HomeMy WebLinkAbout2015-226 Contract - Mountain View Paving
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Contract for GOODS AND SERVICES Small Procurement Less than $5,000
J, 11;
INDEPENDENT CONTRACTOR' Mountain View Paving
CONTACT: Paul Meyer
ADDRESS: 530 W. Valley View Road, Talent, OR 97540
City of Ashland Parks and Recreation
340 S. Pioneer Street TELEPHONE: 541-210.3735 FAX: 541-535-3805
Ashland, Oregon 97520
Telephone: 541/488-5340 Fax' 5411488-5314
BEGINNING DATE: July-1,6,2015 COMPLETION DATE: October 30, 2015
COMPENSATION: 53.85 per square foot for laid In place asphalt (4-)1$4.10 per square for laid in pfaCO asphalt (4°) plus prepwork -for a total of 300
square feet of asphalt.
GOODS AND SERVICES TO BE PROVIDED: 300 feet of asphalt patching and re work.
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 oiherwise apecifiea, furnish ail labor, equipment and materials required for the proper performance of such work.
2. Qualified Work: Contractor has represented, and by entering into tills 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 279B.220, 2798.225, 279B.230, 2796,235, 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 losses, 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: QiLy'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 Cily. Contractor shall have the complete
responsibility for the performance of this contract,
8_ Non-dlscrImInation 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 tills Contract or subcontract any portion of the work.
11. Use of Recyclable Products: Contractor shall use recyclable products to the maximum extent econa>11Cally feasible in the performance of the
contract work set forth in this document.
12_ Default. The Contractor shalt 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.
13. Insurance- Contractor shall at Its own expense provide the following insurance:
a. 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. Worker's compensation insurance is required if work Is performed by employees,
subcontractors, or volunteers.
BY INiTIALINC THIS SENTENCE, CONTRACTOR CERTIFIES UNDER Pi?NALT'1' OE LAW THAT rHE vVORK REQUIRED b'y 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.
e. 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 LdW, Juri6dlcti011; Venue: This contract shall ba governod 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. Conlrarrtor shall sign the certifcatlon attached hereto as Exhibit A and herein incorporated by reference,
Contractor: City of Ashland:
Y ( -
Siygnature n
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Print Name Print,Nanie
Its. i et c%. S, o~36Y~ .n ROVE
Title -Date D AS T FOR
W-9 One copy of a W-9 is to be submitted with file signed Contract, Purchase Or-del-'No. No.
Ashland
Revised 7-14-15 Page 1 Of 2 0~
Dot C~
i. 24, 2 15 12.JJF~IVI A '17!1~:1 fi1•~k & f\Ci- IVIOyI ~r NI i, 4,J! f 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 (1) 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 obllgatlon 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, professlonally 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 desl~nated above and authorized to do business In Oregon or is an independent Contractor as defined in the
carftract 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.
f~ (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) I 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)
Rcvhcd 7-14-1$ Page 2 of 2
07/15/2015 09:21 FAX 0001/0001
5. ~0, 15 RN Ashio.nd r'urks r,.,. ;VG :n iti ce 2,2I
Jul.
4AL
Request for Quote - REVISED (vs. 2)
DATE: July 15, 2015
TO: Mountain View Paving - Paul Meyer Fax: 541-535-3865
Pacific Paving - Bonnie Verstegan Fax: 541-772-0080
LTM Tnc., dba Knife River -Nick Kapphahn Fax: 541-664-4567
FROM:: Bruce Dickens, Parks Superintendent
RC: RFQ - Asphalt Patching Services
Please provide firm prices for the following asphalt patching services:
PRICE PER SQUARE TOOT for 500 SQUARE FEET CURRENTLY NEEDED
Prices due Tuesday, July 21, 2015. Prices will valid #'i-om July 15, 2015, to October 30, 2015
Laid in place (4") $ '3a
Laid in place (4"), plus prepwork
A.ddition.al Information:
"Z"
Company Name:
Contact Name: 17Au.t_ (5 1) Z t o - 3 3
Date of Quote: -Z-
Once bids are received and a contract awarded, a signed contract will need to be submitted by the
cozltractor. The City of Ashland Parks and Recreation requires certificates of insurance in the contractor's
name (general liability and automobile), with the City of Ashland listed as additional insured. No
subcontracting will be permitted without proof of Worker's Compensation insurance coverage. if you
have any questions or need additional information, please call me directly at 541-488-5340.
Thank you. lV 1 Vie j ./n C
Bruce Dickens, Parks Superintendent 3'S-z o
Ashland Parks and Recreation
340 S. Pioneer Street
Ashland, OR 97520
Tel: 541-488-5340 * as: 541-488-5314 j Email: bruce.dickensnashland.or.us
JUL-31-2015 09:06 Ward Insurance 541 342 8280 P.002/010
DATE (MM/DD YVYY)
A
tft~ CERTIFICATE OF LIABILITY INSURANCE 7/31/2015
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 Kim Schnetzk
y
NAME:
Ward Insurance Agency PHONE E,I_ (541) 687-1117 WC No: (541)342-8280
PO Box 10167 EMAIL ,kim@wardinsurance.net
INSURE S AFFORDING COVERAGE NAIC #
Eugene OR 97440 INSURER ADepositors Ins Company 2587
INSURED
INSURER 8
Mountain View Paving, Inc- INSURER C:
PO BOX '5508 INSURER D:
INSURER E :
Talent OR 97540 INSURER F:
COVERAGES CERTIFICATE NUMBER:14/15 GL/AL/UNB 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 VATH 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 INSURANCE ADDL UBR POLICY EFF POLICY EXP LIMITS
LTR TYPE POLICY NUMBER MM/OWYYYY MM/DO/YYYV
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
DAMAGE RENTED
300,000
X COMMERCIAL GENERAL LIABILI-Y PREM15ES Ea a:currence $
A CLAIMS-MADE Fx] OCCUR X Y CP751630$292 9/25/2014 9/25/2015 M ED EXP(Any ate person) $ 10,000
PERSONAL B ADV IN URY $ 11000,000
GENERA- AGGREGATE $ 2,000,000
GEN'LAGORECATELIMIT APPLIES PER PRODUCTS - COMPIOPAGO $ 2,000,000
POLICY X PRO LOG $
-IFfT F7 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
Eaaccidenfl 1,000,000
A Ix ANY AUTO BODILY INJURY (Per person) $
ALL OWNED SCHEDULED CP7516305292 9/25/2014 9/25/2015 BOD ILY INJURY(Pei aCodent) $
AUTOS AUTOS
HIRED AUTOS X AUOTOS~M ED PR~Op~RI2lrDAMACE $
$
X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 11000,000
A EXCESS LIAR CLAIMS-MADE AGGREGATE $ 1,000,000
DEO RE[ENIION& CP7516305292 9/25/2014 9/25/2016 $
WORKERS COMPENSATION Il STATU- OTH-
'R' I ANO EMPLOYERS' LIABILITY j
YIN
ANY PROPRIETORIPAR-INER/EXECUTIVE E.'- EACH ACCIDENT $
OFFIGErL'MEr,ibER EXCLUDEL'? F7 NIA
(Mandatory in NH) E'_. DISEASE - EA EMPLOYE $
If yes, dwcnbe under
DESCRIPTION OF OPERATIONS helcw E.'- DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required)
City of Ashland is named as additional insured on a primary and non-contributory basis including waiver
of subrogation per the attached CG7323. Completed operations apply per the attached CG7246. All when
required by written contract. Subject to policy limits, terms, conditions and exclusions.
CERTIFICATE HOLDER CANCELLATION
(541)488-5314 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.
Parks & Recreation Department
340 S Pioneer Street AUTHORIZED REPRESENTATIVE
Ashland, OR 97520
Darrin Godfrey/TRACES
ACORD 26 (2010/06) (D 1988-2010 ACORD CORPORATION. All rights reserved.
INS025onion5t ftt The annpn nnma nnrl Innn nra mnlatararl mnr4e of Ar'OPn
vwm.saif.com
Oregon Workers' Compensation
sa iF
Certificate of Insurance ,corporation
Mail to: Certificate holder:
MOUNTAIN VIEW PAVING INC CITY OF ASHLAND, PARKS AND RECREATION
PO BOX 508 DEPARTMENT
TALENT, OR 97540-0508 340 S. PIONEER STREET
ASHLAND, OR 97520
The policy of insurance listed below has been issued to the insured named below for the policy period
indicated. The insurance afforded by 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
Mountain View Paving Inc Ward Insurance Agency Inc
PO Box 508 Chris Christensen
Talent, Or 97540-0508 541.687.1117 chris@wardinsurance.net
Issued 07/31/2015 Limits of liability
Policy 496578 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
Attn: All operations preformed by the named insured for the certificate holder in accordance with the policy terms and
conditions.
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
/ P
Kerry Barnett
President and CEO
400 High Street SE
Salem, OR 97312
P: 800.285.8525
F: 503.584.9812
Policy_C LCA_Ce rtificate0fl ns u ra n ce
JUL-31-2015 09:07 Ward Insurance 541 342 8280 P.003i010
COMMERCIAL GENERAL LIABILITY
CG 73 23 11 11
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CONTRACTORS ENHANCEMENT PLUS ENDORSEMENT
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
LOST KEY COVERAGE "Loss" means unintentional damage or
SECTION I - COVERAGES, COVERAGE A destruction but does not include disappearance,
BODILY INJURY AND PROPERTY DAMAGE theft, or loss of use.
LIABILITY, coverage is extended to include the NON-OWNED WATERCRAFT
following: SECTION I - COVERAGES, COVERAGE A
If a customer's master or grand key, excluding BODILY INJURY AND PROPERTY DAMAGE
electronic key card, is lost while in your care, LIABILITY, 2. Exclusions is amended as follows:
custody or control we will pay the cost of g, Aircraft, Auto Or Watercraft (2) (a) is
replacing the keys, including the master lock and replaced with:
all keys used in the same lock, the cost of
adjusting locks to accept the new keys, or the (a) Less than ~1 feet long; and
cost to replace the locks, whichever is less. EXPANDED PROPERTY DAMAGE COV-
Limit of Insurance - The most we will pay for ERAGE
"loss" arising out of any one "occurrence" is For the purposes of this endorsement only:
$5,000. SECTION I - COVERAGES, COVERAGE A
SECTION V DEFINITIONS is amended as BODILY INJURY AND PROPERTY DAMAGE
follows: LIABILITY, 2. Exclusions is amended as follows:
The following definition applies to Lost Key a. Exclusions j.(3), j.(5), and j.(6) are
Coverage: deleted in their entirety.
"Loss" means unintentional physical damage or b, Exclusion j.(4) is deleted in its entirety
destruction to tangible property, including theft or and replaced by the following:
disappearance. Tangible property does not Personal property in the care custody or
include money or securities. control of the insured:
VOLUNTARY PROPERTY DAMAGE 1, for storage or sale at premises you
SECTION I - COVERAGES, COVERAGE A own, rent or occupy; or
BODILY INJURY AND PROPERTY DAMAGE 2, while being transported by any
LIABILITY, coverage is extended to include the aircraft, "auto" or watercraft owned
following: or operated by or rented to or loaned
At your request, we will pay for "properly damage" to to any insured.
property of others caused by you and while in your c. The following exclusions are added:
possession, arising out of your business operations
and occurring during the policy period. 1, The coverage provided by this
Limit of Insurance - The most we will for endorsement does not apply t
pay property damage" arising out of the
e
"loss" arising out of any one "occurrence" is disappearance or loss of use of
$500. personal property.
SECTION V - DEFINITIONS is amended as 2. The coverage provided by this
follows: endorsement does not apply to
The following definition applies to Voluntary "property damage" included in the
Property Damage coverage: "products-completed operations
hazard".
CG 73 23 11 11 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 6
with its permission.
JUL-31-2015 09:08 Ward Insurance 541 342 8280 P.004i010
CG 73231111
Limit of Insurance - The most we will pay b. Up to $2,500 for cost of bail bonds
for "property damage" provided by this required because of accidents or traffic
coverage in any one "occurrence" is $5,000. law violations arising out of the use of
Deductible - Our obligation to pay for a any vehicle to which the Bodily Injury
covered loss applies only to the amount of Liability Coverage applies. We do not
loss in excess of $250. have to furnish these bonds.
This insurance is excess over any other valid 2. 1. d. replaced with:
and collectible insurance. d. All reasonable expenses incurred by the
DAMAGE TO PREMISES RENTED TO YOU insured at our request to assist us in the
SECTION I - COVERAGES, COVERAGE A investigation or defense of the claim or
BODILY INJURY AND PROPERTY DAMAGE "suit", including actual loss of earnings
LIABILITY, the last paragraph of 2. Exclusions up to $500 a day because of time off
of is replaced by the following: from work.
If Damage to Premises Rented to You is NEWLY FORMED AND ACQUIRED
not otherwise excluded, exclusions c. ORGANIZATIONS
through n. do not apply to damage by fire, SECTION II - WHO IS AN INSURED is
lightning, explosion, smoke or sprinkler amended as follows:
leakage to premises while rented to you or 1. 3. a. is replaced with:
temporarily occupied by you with permission a. Coverage under this provision is
of the owner. A separate limit of insurance afforded only until the 180`h day after you
applies to this coverage as described in acquire or form the organization or the
Section III-Limits of Insurance. end of the policy period, whichever is
SECTION III - LIMITS OF INSURANCE, earlier,
paragraph 6 is replaced with: ADDITIONAL INSURED - WHEN REQUIRED
6. Subject to 5. above, the Damage To IN AN AGREEMENT OR CONTRACT WITH
Premises Rented To You Limit is the most YOU PRIMARY AND NON-CONTRIBUTORY
we will pay under Coverage A for damages The following is added to SECTION II - WHO IS
because of "property damage" to any one AN INSURED
premises, while rented to you, or in the case 4. Any person(s) or organization(s) with whom
of damage by fire, lightning, explosion, you have agreed in a valid written contract or
smoke or sprinkler leakage, while rented to written agreement that such person or
you or temporarily occupied by you with organization be added as an additional
permission of the owner. The limit is insured on your policy during the policy
increased to $300,000. period shown in the Declarations. Such
SECTION IV - COMMERCIAL GENERAL person or organization is an additional
LIABILITY CONDITIONS, 4. Other Insurance, insured only with respect to liability for
b. Excess Insurance (1) (a) (ii) is replaced "bodily injury", "property damage" or
with: "personal and advertising injury".
(ii) That is Fire, Lightning, Explosion, The person or organization added as an
Smoke or Sprinkler leakage insurance insured by this endorsement is an insured
for premises rented to you or temporarily only to the extent you are held liable due to:
occupied by you with permission of the a. Lessors of Leased Equipment
owner. Maintenance, operation or use of
SUPPLEMENTARY PAYMENTS equipment leased to you by such person
SECTION I - COVERAGES, SUPPLEMEN- or organization. This insurance does not
TARY PAYMENTS - COVERAGES A AND B is apply to any "occurrence" which takes
amended as follows: place after the equipment lease expires.
1. 1. b. replaced with: However; their status as additional
insured under this policy ends when their
lease, contract or agreement with you
for such leased equipment expires.
Page 2 of 6 Includes copyrighted material of Insurance Services Office, Inc., CG 73 23 11 11
with its permission.
JUL-31-2015 09:10 Ward Insurance 541 342 8280 P.005i010
CG 73 23 11 11
b. Managers or Lessors of Premises The insurance does not apply to:
The ownership, maintenance or use of (1) "bodily injury", "property damage", or
that part of the premises you own, rent, "personal and advertising injury" arising
lease or occupy. out of the rendering of or the failure to
This insurance does not apply to: render any professional architectural,
(1) Any "occurrence" which takes place engineering or survey services,
including:
after you cease to be a tenant in that
premises. (a). The preparing, approving, or failing
(2) Structural alterations, new con- to prepare or approve maps, shop
struction or demolition operations drawings, opinions, reports, survey,
performed by or on behalf of the field orders, change orders or
person or organization. drawings and specifications: or
However, their status as additional (b) Supervisory, inspection, architec-
insured under this policy ends when you tural or engineering activities.
cease to be a tenant of such premises. (2) "Bodily injury" or "property damage"
c. State or Political Subdivision - occurring after:
Permits (a) All work, including materials, parts
or equipment furnished in
Operations performed by you or on your connection with such work, on the
behalf for which the state or political project (other than service,
subdivision has issued a permit. maintenance or repairs) to be
This insurance does not apply to: performed by or on behalf of the
(1) "Bodily injury" or "property damage" additional insured(s) at the location
or "personal or advertising injury" of the covered operations has been
arising out of operations performed completed; or
for the state or municipality; or (b) That portion of "your work" out of
which the
(2) "Bodily injury" or "property damage" injury or damage arises
included within the "products- has been put to its intended use by
p any person or organization other
completed operations hazard". than another contractor or
However, such state or political subcontractor engaged in
subdivision's status as additional insured performing operations for a principal
under this policy ends when the permit as a part of the same project.
ends. However, a person or organization's
d. Owners, Lessees, or Contractors status as additional insured under this
"Bodily injury", "property damage" or policy ends when your operations for
"personal and advertising injury" caused, in that additional insured are completed.
whole or in part, by: With respect to paragraph 4 of SECTION II
(1) Your acts or omissions; or WHO IS AN INSURED, Condition 4. Other
Insurance of Section IV - Commercial
(2) The acts or omissions of those acting on General Liability Conditions is replaced by the
your behalf; following:
in the performance of your ongoing 4. Other Insurance
operations performed for that additional If other valid and collectible insurance is
insured, whether the work is performed by available to the insured for a loss we cover
you or on your behalf. under Coverages A or B of this Coverage
Part, our obligations are limited as follows:
a. Primary Insurance
This insurance is primary if you have
agreed in a written contract or written
agreement:
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with its permission.
JUL-31-2015 09:11 Ward Insurance 541 342 8280 P.006i010
CG 73 23 11 11
(1) That this insurance be primary. If
other insurance is also primary, we (2) When this insurance is excess, we
will share with all that other will have no duty under Coverages A
insurance as described in c. below; or B to defend the additional insured
or against any "suit" if any other insurer
(2) The coverage afforded by this has a duty to defend the additional
insurance is primary and non- insured against that "suit". If no
contributory with the additional other insurer defends, we will
insured's own insurance. undertake to do so, but we will be
Paragraphs (1) and (2) do not apply entitled to the additional insured's
to other insurance to which the rights against all those other
additional insured has been added insurers.
as an additional insured or to other (3) When this insurance is excess over
insurance described in paragraph b. other insurance, we will pay only our
below. share of the amount of the loss, if
b. Excess Insurance any, that exceeds the sum of:
This insurance is excess over: (a) The total amount that all such
other insurance would pay for
(1) Any of the other insurance, whether the loss in the absence of this
primary, excess, contingent or on insurance: and
any other basis:
Fire, Extended (b) The total of all deductible and
(a) That is self-insured amounts under all
Coverage, Builder's Risk, that other insurance.
Installation Risk or similar (4) We will share the remaining loss, if
coverage for "your work"; any, with any other insurance that is
(b) That is fire, lightning, or not described in this Excess
explosion insurance for Insurance provision and was not
premises rented to you or bought specifically to apply in
temporarily occupied by you with excess of the Limits of Insurance
permission of the owner; shown in the Declarations of this
(c) That is insurance purchased by Coverage Part.
you to cover your liability as a c. Method Of Sharing
tenant for "property damage" to If all of the other insurance available to
premises rented to you or the additional insured permits
temporarily occupied by you with contribution by equal shares, we will
permission of the owner; or follow this method also. Under this
(d) If the loss arises out of the approach each insurer contributes equal
maintenance or use of aircraft, amounts until it has paid its applicable
"autos" or watercraft to the limit of insurance or none of the loss
extent not subject to Exclusion remains, whichever comes first.
g. of Section I - Coverage A - If any of the other insurance available to
Bodily Injury And Property the additional insured does not permit
Damage Liability. contribution by equal shares, we will
(e) That is any other insurance contribute by limits. Under this method,
available to an additional each insurer's share is based on the
insured under this endorsement ratio of its applicable limit of insurance to
covering liability arising out of the total applicable limits of insurance of
the premises or operations, or all insurers.
products completed operations,
for which the additional insured
has been added as an additional
insured by that other insurance.
Page 4 of 6 Includes copyrighted material of Insurance Services Office, Inc., CG 7323 11 11
with its permission.
JUL-31-2015 09:12 Ward Insurance 541 342 8280 P.007i010
CG 73 23 11 11
EMPLOYEE BODILY INJURY TO ANOTHER MEDICAL PAYMENTS
EMPLOYEE SECTION III - LIMITS OF INSURANCE,
SECTION II - WHO IS AN INSURED The Paragraph 7. is replaced:
following Paragraph is added to 2.a.(1) 7. Subject to 5. above, the higher of:
Paragraphs 2.a.(1)(a), (b) and (c) do not a. $10,000; or
apply to "bodily injury" to a co-"employee" in b. The amount shown in the Declarations
the course of the co-"employee's" for Medical Expense Limit is the most
employment by you, or to "bodily injury" to a we will pay under Coverage C for all
co-"volunteer worker" while performing
duties related to the conduct of your medical expenses because of "bodily
business. injury" sustained by one person.
BROAD FORM NAMED INSURED This coverage does not apply if Coverage C -
SECTION II - WHO IS AN INSURED The Medical Payments is excluded either by the
following Paragraph is added to 2. provisions of any coverage forms attached to the
policy or by endorsement.
e. Any business entity incorporated or KNOWLEDGE OF AN OCCURRENCE
organized under the laws of the United State
of America (including any State thereof), its SECTION IV - COMMERCIAL GENERAL
territories or possessions or Canada LIABILITY CONDITIONS, The following is added
(including any Province thereof) in which the to 2. Duties In The Event Of Occurrence,
Named Insured shown in the Declarations Offense, Claim Or Suit condition:
owns, during the policy period, an interest of e. Knowledge of an occurrence, offense, claim
more than fifty percent. If other valid or suit by an agent or employee of any
collectible insurance is available to any insured shall not in itself constitute
business entity covered by this solely by knowledge of the insured unless you, a
reason of ownership by the Named Insured partner, if you are a partnership; or an
shown in the Declarations in excess of fifty executive officer or insurance manager, if
percent, this insurance is excess over the you are a corporation receives such notice of
other insurance, whether primary, excess, an occurrence, offense, claim or suit from
contingent, or on any other basis, the agent or employee.
AGGREGATE LIMIT PER LOCATION f. The requirements in Section IV -
SECTION III - LIMITS OF INSURANCE The Conditions Paragraph 2.b. will not be
following paragraph is added to paragraph 2: considered breached unless there is
The General Aggregate Limit under Section knowledge of occurrence as outlined in
III Limits of Insurance applies separately to paragraph e. above.
each of your locations owned by or rented to UNINTENTIONAL FAILURE TO DISCLOSE
you or temporarily occupied by you with the HAZARD
permission of the owner. For the purposes of SECTION IV - COMMERCIAL GENERAL
this provision, location means premises LIABILITY CONDITIONS, 6. Representations is
involving the same or connecting lots, or amended to include:
premises whose connection is interrupted d. Your failure to disclose all hazards or prior
only by a public street, roadway, waterway or "occurrences' or offenses existing as of the
railroad right-of-way, inception date of the policy shall not
AGGREGATE LIMIT PER PROJECT prejudice the coverage afforded by this
SECTION III - LIMITS OF INSURANCE The policy provided such failure to disclose all
following paragraph is added to paragraph 2: hazards or prior "occurrences" or offenses is
The General Aggregate Limit under Section not intentional. This provision does not
III Limits of Insurance applies separately to affect our right to collect additional premium
each of your construction projects away from or exercise out right of cancellation or non-
premises owned by or rented to you. renewal.
CG 73 23 11 11 Includes copyrighted material of Insurance Services Office, Inc., Page 5 of 6
with its permission.
JUL-31-2015 09:13 Ward Insurance 541 342 8280 P.008i010
CG 73 23 11 11
WAIVER OF SUBROGATION BROADENED BODILY INJURY DEFINITION
SECTION IV - COMMERCIAL GENERAL (MENTAL ANGUISH)
LIABILITY CONDITIONS, 8. Transfer of Rights SECTION V - DEFINITIONS is amended as
of Recovery Against Others to Us is amended follows:
to include: 1. 3. "Bodily injury" is deleted and replaced with
If required by a written contract executed the following:
prior to loss, we waive any right of "Bodily injury" means physical injury,
subrogation we may have against the sickness or disease to a person and, if
contracting person or organization because arising out of the foregoing, mental anguish,
of payments we make for injury or damage mental injury, shock or humiliation, including
arising out of your ongoing operations or death at any time resulting therefrom.
"your work" done under a contract with that
person or organization and included in the
'products-completed operations hazards".
LIBERALIZATION
SECTION IV - COMMERCIAL GENERA'
LIABILITY CONDITIONS, 10. Liberalization is
added as follows:
If we revise this coverage form to provide more
coverage without additional premium charge,
your policy will automatically provide the
additional coverage as of the day the revision is
effective in your state.
All terms and conditions of this policy apply unless modified by this endorsement.
Page 6 of 6 Includes copyrighted material of Insurance Services Office, Inc., CG 73 23 11 11
with its permission.
JUL-31-2015 09:14 Ward Insurance 541 342 8280 P.009i010
COMMERCIAL GENERAL LIABILITY
CG 72 46 09 08
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
BLANKET ADDITIONAL INSURED ENDORSEMENT
COMMERCIAL CONTRACTORS COVERAGE
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
A. WHO IS AN INSURED (Section II) is amended c. Any continuation, progression, change
to include as an insured any person or or resumption of bodily injury",
organization whom you are required to add as "property damage", or "personal and
an additional insured on this policy under a advertising injury" will be deemed to be
written contract or written agreement. The one occurrence;
written contract or written agreement must be: d. Our limit of liability will not exceed the
1. Valid and legally enforceable; Limits of Insurance for one annual policy
2. Currently in effect or becoming effective period.
during the term of this policy, and 4. The coverage provided to the additional
3. Executed prior to an "occurrence" resulting insured by this endorsement and paragraph
in "bodily injury", "property damage,' or f. of the definition of "insured contract" under
"personal and advertising injury." DEFINITIONS (SECTION V) do not apply to
B. The insurance provided to the additional insured "bodily injury" or "property damage" arising
is further limited as follows: out of the products-completed operations
hazard" unless required by the written
1. That person or organization is an additional contract or written agreement. When
insured solely for liability due to your coverage does apply to "bodily injury" or
negligence specifically resulting from "your "property damage" arising out of the
work" for the additional insured which is the "products-completed operations hazard"
subject of the written contract or written such coverage will not apply beyond the
agreement. No coverage applies for any lesser of:
liability due to negligence attributable to any a. The period of time required by the
person or entity other than the Named written contract or written agreement, or
Insured.
2. The Limits of Insurance applicable to the b. Five years from the completion of "your
additional insured are those specified in the work" on the project which is the subject
written contract or written agreement or in of the written contract or written
the Declarations of this policy, whichever is agreement,
less. These Limits of Insurance are 5. The insurance provided to the additional
inclusive of, and not in addition, to the Limits insured does not apply to:
of Insurance shown in the Declarations. "Bodily injury', "property damage", or
3. If we insured the Named Insured for more "personal and advertising injury" arising out
than one annual policy period: of the rendering of, or failure to render, any
a. Only the policy in effect at the time the professional architectural, engineering or
"bodily injury"," property damage", or surveying services, including:
"personal and advertising injury" first a. The preparing, approving, or failure to
occurs will apply; prepare or approve maps, shop
b. "Bodily injury", "property damage", or drawings, opinions, reports, surreys,
"personal and advertising injury", first field orders, change orders or drawings
occurs when it is initially discovered by and specifications, and
any person;
CG 72 46 09 08 Includes copyrighted material of Insurance Services Office Inc., with its permission. Page 1 of 2
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Kari Olson
From: Kari Olson [kari.olson@ashland. or.us]
Sent: Thursday, August 13, 2015 1:58 PM
To: susan.dyssegard@ashland. or. us
Cc: 'Karl Olson'
Subject: Mtn View Paving
Contract is for a "total of 300 square feet"
Quote and requisition are for "500 square feet"
Kariann Olson
Purchasing Representative
City of Ashland
90 N. Mountain Avenue
Ashland, OR 97520
Tel: 541.488.5354
Fax: 541.488.5320
TTY: 800.735.2900
kari.olson@ashland.or.us
Visit the City's web site at: www.ashland.or.us
This email transmission is official business of the City of Ashland, and it is subject to Oregon Public Records law for
disclosure and retention. If you have received this message in error, please contact me at (541) 488-5354. Thank you.
1
Page 1 / 1
ASHLAND PARK COMMISSION
?
20 E MAIN ST. DATE PO NUMBER
- -
ASHLAND, OR 97520 8/13/2015 00478
(541) 488-5300
VENDOR: 000559 SHIP TO:
MOUNTAIN VIEW PAVING, INC
PO BOX 508
TALENT, OR 97540
FOB Point: Ashland, Oreqon Req. No.:
Terms: net Dept.:
Req. Del. Date: Contact: Bruce Dickens
Special Inst: Confirming? No
Quantity Unit Description Unit Price Ext. Price
Asphalt patchinq - 500 square feet 2,050.00
throuqhout the Parks system
Laid in place (4") - $3.85
Laid in place, plus prepwork (4") -
$4.10
Contract for Goods and Services Small
Procurement less than $5,000
Beqinninq date: July 15, 2015
Completion date: October 30, 2015
SUBTOTAL 2,050.00
BILL TO: TAX 0.00
FREIGHT 0.00
TOTAL 2,050.00
Account Number Project Number Amount Account Number Project Number Amount
E 211.12.02.06.60414 2,050.00
~i711j,
Authorize ignature VENDOR COPY
FORM #3
O
for a Purchase, ord.-Z~
REQUISITION Date of request: 8/6/15
Required date for delivery: 9/30/15
Vendor Name Mountain View Paving, Inc
Address, City, State, Zip Paul Meyer PO Box 508 Talent, OR 97540 541-210-3735
Contact Name & Tel 1 Fax Number
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 #
❑ Verbal/Written quote(s) or proposal(s) ❑ State of Washington
Intermediate Procurement ❑ Sole Source Contract #
GOODS & SERVICES ❑ Applicable Form (#5,6, 7 or 8) ❑ Other 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 Aqreement
$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
Asphalt patching - 500 square feet throughout the Parks system.
Laid in place (4") = $3.85 $2,050.00
Laid in place (4"), plus prepwork = $4.10
Item # Quantity Unit Description of MATERIALS Unit Price Total Cost
® Per attached quote/proposal TOTAL COST
$ 2,050.00
Project Number Account Numbers: 211.12.02.06.604140
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 re uisition form, l certify that the City's public contracting requirements have been satisfied.
Employee: 1)" Department Head:
(Equal to or greater than $5,000)
Department Manager/Supervisor: 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
Form #3 - Requisition